hospital revitalisation program
DESCRIPTION
Hospital Revitalisation Program. Portfolio Committee 24 August 2005 Dr Thabo Sibeko Chief Director: Hospital Services Gert Steyn Director: Hospital Revitalisation. Agenda. Vision Purpose of Hospital Revitalisation Grant Process Brief overview of HRP Grant Methodology of Allocations - PowerPoint PPT PresentationTRANSCRIPT
Hospital Revitalisation Program
Portfolio Committee24 August 2005Dr Thabo SibekoChief Director: Hospital ServicesGert SteynDirector: Hospital Revitalisation
Agenda
Vision Purpose of Hospital Revitalisation Grant Process Brief overview of HRP Grant Methodology of Allocations Challenges Achievements Progress/Expenditure on Grant DoRA Conditions Project Management Unit Delay of Transfers Current and New Projects Photos
Vision of Revitalised Hospital
Good fully operational physical condition Deliver appropriate services:
– to suit the population’s needs – levels of care provided
Appropriate management system operating with appropriate delegations.
Community structures to hold the hospitals accountable Appropriately equipped and resourced. Implementing and monitoring quality improvement programmes Equitable budget based on the population served and services
delivered.
Vision of Revitalised Hospital
Improve cost efficiency and effectiveness of hospitals
Have in place sustainable Planned Preventative Maintenance and replacement programmes supported by:
– appropriately qualified and trained staff – technical resources.
Implement all National policies. All health facilities will be part of a national health
service and will operate within a rationalised referral system network.
Project405 hospitals
Revitalise Hospitals
Quality
Province
NationalREVITALISATION OF PUBLIC
HOSPITALS
EMS
Project M anagem ent S tructure
Resource Group
Project (Com m issioning) Team
Local Steering Com m ittee
Provincial Steering Com m ittee
National Project Coordination Team
National Steering Com m ittee
Programme Management
Provide Technical Support
Overall provincial projects coordination and managementRegional/ Local Facilitation of Project Implementation process
Day to day management of project implementation activities
Political & Technical Guidance
Purpose of HRP Grant
Purpose– “To provide strategic funding to enable provinces
to plan, manage, modernise, rationalise and transform the infrastructure, health technology, organizational management and development and monitoring and evaluation of hospitals in line with national policy objectives”: DoRA Act 1 of 2005 Framework
Process
Provincial Responsibility– Do prioritisation of hospitals to be revitalised in Province.
Decisions to be made at provincial level– Submit business cases according to required format– Submit Project Implementation Plans according to required
format– Submit monthly financial and quarterly non-financial reports– Implement all components of the HRP
Process
National Health Responsibility– Prioritisation framework supplied, BUT province ultimately
responsible for prioritisation outcome. National provides guidance on using system.
– Provide framework (PIM) for business cases, Project Implementation Plans (PIP)
– Appraise and formally approve business cases and PIP’s– Collect and analyse monthly and quarterly reports, combine
into single report– Monitor and evaluate performance on site for all projects– Support provincial implementation
Business Cases
Provinces must submit business case to have project included in HRP
Business case consists of 2 areas1. Strategic Context containing:
Strategic plan of province on health service delivery in hospitals
Prioritisation of hospitals to be included based on:– Service delivery issues (Access to services, political risk, risk of
delays, and other areas the province identifies)– Financial issues (cost to correct, backlog of maintenance,
condition)
Business Cases
2. Priority Hospital Details with regard to site Size of hospital (beds by level of care) Specific details such as area per bed, cost per bed, admission rate, average
length of stay) Cost Period of Construction Operational cost Staffing plan Health technology plan Quality Assurance plan
Appraisal– National Department of Health appraises all business cases to ensure
strategic plan of province is adhered to and size, location, cost, sustainability and level of service adheres to National Guidelines
Brief Overview
MTEF AllocationProvince 2005/2006 2006/2007 2007/2008
Eastern Cape 157732 71666 102552
Free State 113082 128853 104360
Gauteng 17955 148664 133093
KwaZulu-Natal 128977 60940 81090
Limpopo 212918 123698 160690
Mpumalanga 57018 101032 117071
Northern Cape 69651 217464 234960
North West 98056 125493 106495
Western Cape 172038 202474 198987
TOTAL 1 027 427 1 180 284 1 239 298
Methodology of Allocation
Project/Needs based allocation Information utilised:
– Approved business cases– Expected cash flows per year (received from
provinces)– Number of active projects (currently minimum 4
due to funding constraints)
Methodology of Allocation
Process to obtain available funds figure:– 2004/2005 DORA allocation amount– ADD expected roll-over from 2003/2004– SUBTRACT Expected expenditure for 2004/2005– Result = Expected Roll-over into 2005/2006 +
DoRA allocation
Methodology of Allocation
Provinces supplied expected expenditure over MTEF period (information from business cases and Project Implementation Plans)
Expected Need calculated as follows:– Amount required for projects in provinces– The allocation puts provinces in a favourable
position where they will be able to spend the full allocation without having to cut on budget.
Methodology of Allocation
Allocation– Need LESS 2004/2005 roll-over indicates
2005/2006 allocation– Process is repeated into outer years to determine
allocation Allocation HEAVILY dependent on quality of
information and prioritisation received from provinces.
Challenges
Delays in appointing contractors on site (public works related issues) – ALL provinces reported various problems with public works
Public Works – Specific Examples:– Lebowakgomo, Jane Furse (LP) – Tenders closed in Aug 2004, contract
not yet awarded.– Contracts awarded to inefficient contractors – contractor awarded tender at
Jane Furse after contractor went 80% over contract at other site. (LP)– Contractor on 14 month contract at King George V was 6 months into
contract, but already 3 months behind. Appeal followed, appellant received contract. (KZN) – delayed by about 10 months
– Design/Architect/Engineers do not give input in design phase. Nothing from contractors questioned – “Everything goes” (NC)
– Large contracts awarded to small contractors – insufficient capacity, no capital to fund project, delays are inevitable. All provinces are troubled by this.
– Procurement: Extremely slow: 10 months to appoint completion contract at Frontier Hospital (EC)
– Lack of personnel to do quality checks on construction at regular intervals
Challenges
Provincial Capacity in Revitalisation– Appointing Revitalisation Managers is slow process– Most managers schooled in infrastructure – very little
capacity exists in Health Technology, Organisational Development and Quality Assurance.
Reporting/Communication to and from provinces are ineffective and unreliable. Recommendation will be made shortly to increase accuracy, compliance and reliability at limited cost. Web page reporting model to be designed that will result in a more accurate, efficient data and compliance of HRP
Achievements on Grant
Progress– 3 Hospitals finished:
Calvinia (NC) – 35 Beds, District, R35m Colesberg (NC) – 35 Beds, District, R35m Swartruggens (NW) – 28 Beds, District, R39m Piet Retief (MP) – 140 beds, District, R140m
– Hospitals to be completed in 2005/2006 George (WC) 276 Beds, Regional, R78m Eben Donges (WC) 315 Beds, Regional, R213m Lebowakgomo (LP) – 255 Beds, District, R105m Jane Furse (LP) – 252 Beds, District, R110m
– Hospitals to be completed in 2006/2007 Dilokong (LP) – 244 Beds, District, R134m Nkenshani (LP) – 290 Beds, District, R127m Vredenburg (WC) – 80 Beds, District, R58m Barkley West (NC) – 40 Beds, District, R40m
Expenditure on Grant
In 2004/2005– HRP spent 84% if KZN is excluded
*KZN requested to return the allocation due to extensive problems with Public Works
Division of Revenue Act (No. 7 of 2003)
Total expenditure to date
Roll Overs"000 "000 "000
EC 116,354 98,376 85% 17,978 FS 52,370 40,092 77% 12,278 GP 155,126 62,317 40% 92,809 KZN 178,054 LP 106,463 98,939 93% 7,524 MP 68,292 52,357 77% 15,935 NC 57,135 58,246 102% (1,111) NW 92,845 81,929 88% 10,916 WC 85,217 124,114 146% (38,897) Total (excluding KZN) 733,802 616,370 84%
911,856
Expenditure in %
Allocation
Province
DoRA Conditions
All new projects commencing in 2005/06 must have business cases and project implementation plans approved before funds can be released for such projects
Provincial strategic plans must include comprehensive hospital plans, which provide a framework in which business cases are subsequently developed
Adhere to the process of approval of business plans for the 2006 MTEF
DoRA Conditions
Adherence to monitoring requirements National Department to strengthen grant
management and capacity and business planning and reporting processes
Provincial departmental strategic plans for 2005/06 and over the MTEF to clearly indicate measurable objectives and performance targets as agreed with national department
Project Management Unit
Program Manager
Monitoring & EvaluationDeputy Director
Secretary
Organisational Development and Quality Improvement
Deputy Director
InfrastructureDeputy Director
Health TechnologyDeputy Director
Senior admin OfficerAdmin / Logistics
Administration Officer
FinanceAssistant DirectorTechnical Specialists – New Posts to
be filled
Reason of Delaying Transfer
Prov
2005/06 Business
Case2005 PIP (Due 15
March 05)Revised PIP (after appraisal by 18/04)
EC yes received (26/04) 28-AprFS no received (04/04) 25-AprGP yes received (11/04) 5-AprKZN yes received (12/04)LP yes received (01/04) 28-AprMP no received (05/04)NC yes received (07/04) 29-AprNW no received (12/04)
WC yes
received (31/03 Vredenburg, 01/04 George, 12/04 Eben Donges)
George 19/04, Vredenburg 25/04
Current and New projects
PROV Project name 2005/06 New Projects1. Frontier 5. St. Lucy's2. St. Elizabeth's3. Mary Theresa4. Rietvlei1. Boitumelo 3. National Hospital2. Pelonomi 4.Bethlehem (Dhilabaneng)1. Mamelodi 2. Zola
3. Natalspruit4 Chris Hani Bara level1
1. King George V 3. Dr. Pixley Seme2. Ngwelezane / Lower Umfolozi 4. Dr. John Dube
5. Hlabisa1. Lebowakgomo2. Jane Furse3. Dilokong4. Nkhensani
HOSPITAL REVITALIZATION PROGRAMME
LP
EC
FS
GP
KZN
Current and New projects
PROV Project name 2005/06 New Projects1. Piet Retief 5. New Nelspruit2. Themba3. Rob Ferreira4. Ermelo1. Colesburg 4. Upington (Gordonia)2. Calvinia 5. New Kimberly (start 3. Psychiatric (West End)6. Barkely West
7. De Aar2. Swartruggens 4. Tshwaragano1. Moreteletsi / George Stegmann5. Brits3. Vryburg1. Vredenburg 4. Paarl 2. George 5. Khayelitsha 3. Eben Donges
NW
WC
HOSPITAL REVITALIZATION PROGRAMME
MP
NC
Photos: Jane Furse (LP)
Old Revitalised
[PMG note: Graphics not included]
Photos: Dilokong (LP)
Old Revitalised
[PMG note: Graphics not included]
Photos: Swartruggens (NW) [PMG note: Graphics not included]
Photos: Colesberg (NC)
[PMG note: Graphics not included]
Making a movie is like trying to grill a steak by having a succession of people coming into a room and breathing on it.
Douglas Adams
Should progress in Revitalisation be as slow??
Thank You