North West Province Department of Health

Budget Hearing presentation Portfolio Committee Parliament

13 May 2001

Presenters

• Mrs R Hlabatau – Chief Financial

Officer• Dr T G K Oosthuizen – Acting Chief

Director Health Service Delivery

and Strategic Health Programs• Mr P Netshipale – Director Primary

Health Care Programs and

Communicable Diseases

STRATEGY

• The Department reviewed its strategic plan during October 2001

• New focused strategic goals, objectives and high level activities were developed as discussed in attached strategic plan

The Vision

Optimum health for all individuals and communities in the North West Province.

The Mission

  To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through       

Value statement

•  Community involvement and partnerships

• Batho Pele Principles and the Patients’ Rights Charter

• Innovation and performance driven,

• And by valuing our people and their diversity.

Strategic Goals

1. Providing quality health services2.  Providing accessible, equitable and affordable comprehensive primary health services3.  Well functioning and competitive hospital services4.  Improving the health status of communities through implementation of integrated health programs5.  Well managed and effective district health system

Strategic Goals

6. Competent, empowered and

performance focused employees

7. Appropriate and effective

organisational systems

8. Effective management of the department’s finance and assets

ACHIEVEMENTS

(DISCUSSED AS PART OF VARIOUS HEADINGS)

EXPENDITURE PATTERNS

STD ITEM BUDGET EXP. VAR.

PERSONNEL 1 133 612 1 159 342 -25 730

ADMIN 48 822 52 455 -3 633

STORES 238 392 231 232 6 161

EQUIPMENT 47 634 46 634 1 000

LAND & BUIL. 5 477 6 440 963

PROF. SERV. 195 156 161 955 33 201

TRANSFERS 54 894 40 278 14 616

MISC. 10 830 1 669 9 161

TOTALS 1 734 817 1 700 005 34 812

EXPENDITURE PATTERNS

Budget vs Expenditure

-500,000

-

500,000

1,000,000

1,500,000

2,000,000

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Std Items

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BUDGET R'000 EXP. R'000VARIENCE R'000

Expenditure patterns

• Personnel budget comprises 65% of the total budget

• This is consistent with prior years• The national average personnel

budget is 68%• The personnel budget was

overspend by 2% due to the insufficient budget of ICS, backlog in rank and leg promotions

Expenditure patterns

• Transfers were under spent by 26% as a result of delays by institutions in complying with the PFMA e.g.

• Non submission of invoices by local Authorities

• Non submission of Audited Financial Statements

• Under expenditure in professional services relates to capital projects

• Over 98% of the budget was utilized

MECHANISMS TO IMPROVE

CAPACITY

The Department uses various mechanisms to improve its Human Resource, Financial, Procurement and Service Delivery Capacity

Human Resource

• General Managers appointments with Heads of Admin, Clinical, and Nursing

• Job descriptions for staff with Personal Performance Management Agreements levels 13 and higher

• Key performance areas and key performance indicators built in, into job descriptions of all levels of staff in one Complex as a pilot for all other health facilities

Human Resource

Organisational Performance Management Frameworks implemented for the biggest Complex with a roll out empowerment process started to other two regional Hospital Complex’s

Human Resource• During the year under review, the department

developed its first Work Place Skills Plan, and will build on this during the current year and in years to come.

• In an effort to improve our ability to deliver quality PHC services to our communities, the department has prioritized the training of primary health care nurses. In the year under review, 118 were trained as PHC practitioners.

• The issue of proper deployment of these nurses will continue to receive attention in the current year.

Human Resource• The post basic training of nurses in the

following fields also continued to be a priority: IMCI (10), psychiatry (10), and midwifery (45).

• The department sees discipline of employees as being central to capacity to deliver services.

• Therefore, the training of managers and employees as investigating officers and presiding officers. A total of 40 were trained as investigating and presiding officers.

Financial

• Establishment of a functional Internal Control Unit, filling 97% of vacant posts

• Improved co-ordination and co-operation of Finance Committees

• UPFS implemented at all hospitals• Developed the transaction flow

process• Trained 70% of HO finance staff on the

following courses:

Financial

• Project Management• Cash Flow Management• Policy making and Budgeting• Provisioning and

Administration System• Computer Training and

Writing skills

Procurement

• Took charge of our own maintenance of own buildings and patients transport due to poor performance experienced from Department of Transport, Roads and Public Works

• Provincialisation of Emergency medical services

• Outsourcing of procurement of pharmaceuticals with efforts to decentralise the process started via Vuna Health Care logistics

Procurement

• Rolling out of a computerised asset management system

• Outsourcing initiatives for garden services, catering- and security services

Service Delivery CapacityPPP’s:• Coordinator for the Provincial Council on Aids

plus 18 Coordinators for the Local Aids Councils were appointed

• Lichtenburg health district (Environmental Health Officers) in partnership with Agriculture improved the quality of their dairy products to the extent that it is now adhering to the criteria set by the EU and permission for export was granted

• Joint appointments with Universities • Alpha cement/licthenburg DHS initiatives

Service Delivery CapacityThrough empowerment:• Primary school nutrition program was decentralised

with empowerment of local women groups, etc• 90 Primary Health care nurses underwent training in

sign language• 240 donated wheelchairs were distributed and 1130

bought out of own funds were distributed• Five multi purpose youth centres established to

enhance the reproductive health of the youth, to protect themselves against HIV and teenage pregnancy was a joint effort between DFID and PPASA now fully funded by the Department

Service Delivery Capacity

Through empowerment:

• 141 VCT sites

• 33 funded NGO as part of the system

Service Delivery Capacity

Optimising resource utilisation:• 100 patients were de-institutionalised• EMS – Provincialisation 1 December 2001• Forensic Medical Services – Started the

process of taking over from the SAPS – Vryburg region will be first

• Quality Assurance – Tender document out to get COHSASSA accreditation for all Institutions with capacity development management to sustain quality assurance program

Service Delivery Capacity

Networking and linking with tertiary institutions:

• Attracting and retaining specialised personnel – A process started looking mainly at linking Regional Complex’s with tertiary institutions like MEDUNSA / WITS and UP to enable registrar training at and rotation of specialists through regional hospitals

Service Delivery Capacity

Through stakeholder involvement:• Farm worker summit held with a

definite project plan to implement the outputs received from the summit which included new mobile services to be established

• Governance summit held with outputs taken forward

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND

ANY SHORTCOMINGS

PROVINCIAL PROCESS:• Each department submits inputs to Treasury• The provincial Budget Lekgotla is held

where trade offs between departments are considered to try and stay within the provincial allocation

• Process of avoiding duplications by cluster approach

• CFO’s meet to discuss approaches to minimise administrative expenditures

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND

ANY SHORTCOMINGS

PROVINCIAL PROCESS:• 85% National target to be spent on

Social Cluster not reached due to:– North West Star– NWDC– Agric– SABC – Public Works– Ring fencing of National Allocations could

assist

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND

ANY SHORTCOMINGSDEPARTMENTAL PROCESS

• MTEF PROCESS & SHORTCOMINGS:• Individual cost center managers prepare

and submit their inputs through regional structures, hospital CEOs, College principals and program managers.

• These are consolidated, compared to previous allocations, expenditure and priority program plans for the department and forwarded to the Equity/Budget Committee for further attention.

MTEF PROCESS cont.

• The Equity/Budget committee analyses the inputs and aligns them to current and new priorities and or objectives for the next MTEF cycle and makes recommendations to the Departmental Management Committee(DMC) for discussion, verification and further recommendations to the Departmental Executive Committee.

MTEF PROCESS cont.

• The DEC makes decisions based on the strategic priorities of the department as well as the provincial budget memorandum and strategies, and directs further adjustment where necessary.

• Consultation is then done with relevant stake holders for further attention, buy-in and finalization of proposed allocations.

SHORTCOMMINGS-MTEF• The time frames are not realistic in terms of

adequate involvement of all stake holders.• Due to limited availability of resources, it is

sometimes difficult to address Equity issues.

• Allocation of funds for personnel is based on previous expenditure patterns.

• The financial impact of Strategic challenges is higher than the budget growth

CONDITIONAL GRANTS

The Department received the following conditional Grants:

• Redistribution of Specialised Hospital Services conditional Grant

• Training of Health Professionals Grant• Hospital Revitalisation and

Rehabilitation Grant• Primary School Nutrition Grant• HIV / AIDS

Redistribution of Specialised Hospital Services Conditional Grant

38,65538,655RECEIVED

EXPENDITURE

Training of Health Professionals Grant

24,37724,377

RECEIVED

EXPENDITURE

Hospital Revitalisation and Rehabilitation Grant

56,000

44,707 RECEIVED

EXPENDITURE

Primary School Nutrition Grant

39,391

28,314 RECEI VED

EXPENDITURE

HIV/AIDS

4,641

2,254RECEI VED

EXPENDITURE

OUTCOMES REDISTRIBTION SPECIALISED HOSPITAL SERVICES CONDITIONAL

GRANT

Provincial Referral Hospital Allocations & Expenditure Redistribution of Specialisted Services Condiditional Grant

BUDGET APPROVED

17%

10%

17%2%19%

13%

6%

16%RENAL UNIT

ONCOLOGY UNIT

MDR TB UNIT

EMS/ICU AMBULANCE

BURNS UNIT

JOINT SURGERY

IN PATIENT ONCOLOGY

PSYCHIATRIC UNIT

Provincial Referral Hospital Allocations & Expenditure redistibution of Specialist Services Conditional Grant TOTAL EXPENDITURE FO THE YEAR

18%

14%

16%1%

21%

12%

5%

13% RENAL UNIT

ONCOLOGY UNIT

MDR TB UNIT

EMS/ICU AMBULANCE

BURNS UNIT

JOINT SURGERY

IN PATIENT ONCOLOGY

PSYCHIATRIC UNIT

Total patients treated for the yearRenal Unit 4852

Oncology Unit 1989

MDR Unit : Out : In

638258

EMS/ICU AMBULANCE 231

BURNS UNIT 117

JOINT SURGERY 58

IN PATIENT ONCOLOGY 747

PSYCHIATRIC UNIT 307

SUCCESS IN ACHIEVING EQUITY

• The Equity committee has made attempts to address gaps related to resource allocation per district and region (health districts).

• The difficulty of shifting of funds from one area to another is still a challenge due to 65% of expenditure being allocated to personnel

SUCCESS IN ACHIEVING EQUITY

• Progress made to date relates to a decentralized system, which reflects fully fledged District Management structures, independent Hospital managers for level 1, and CEOs for level 2 hospitals.

• Financial, Human Resource and Procurement delegations are in place to enable managers to make appropriate decisions and manage their allocated resources.

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL

ALLOCATIONS-SHORTCOMINGS Facilitation of the devolution of primary

health care to Local Authorities by creation of equal conditions of service between Provincial Health Authority staff and those appointed by Local Authorities with the end result of “One Public Service” with equal conditions of service / pay packages / progression irrespective of what tier of Governance

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL

ALLOCATIONS 

The Department experience difficulty in attracting various categories of Health Care workers to rural areas. Rural allowance exists for Doctors only. Assistance regarding possible incentives to attract other categories of Health workers to rural areas equally across the country will help

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL

ALLOCATIONS Equity regarding budget allocations

between various Provincial Departments of Health is still not achieved due to the fact that money allocated by the National Department of Health is not ring fenced and within Provincial Treasuries Departments then start to compete for funding which lead to National Department of Health funding ending up being used for other Departments, i.e. Education, etc

PUBLIC PRIVATE PARTNERSHIPS

The Department is actively involved in both public – public and public private partnerships. Some examples:

• Outsourcing of various services• Private specialists responsible for a

major part of specialist services in the Province

• Lichtenburg District and Department of Agriculture joint venture

• University links

HIV / AIDS

HIV ACHIEVEMENTS AND PLAN FOR 2002/3

OBJECTIVES ACHIEVEMENTS

Functionalise PCA

Assist in funding all LAC

Expand VCT sites in the Province

Establish PMTCT pilot sites

Expand female condoms distribution

Reduce incidence of STI by 30%

Provide effective HBC in all 18 districts

PCA act in place, all staff appointed in all 18 DistrictsAll 18 LAC funded

141 sites established & 970 Nurses trained in counseling with 8909 clients tested(2392 positive,26.8%)Two sites established July 2001

Expanded female condoms sites from 4 to 18 and distributed 200 000 female & 23 million male condomsReduced Syphilis form 17% to 3,6%New form implemented in the Province

Funded 33 NGO for R1,06M in the Province and 14 National funded for R1,5M

HIV/AIDS ACHIEVEMENTSOBJEC TIVES ACHIEVEMENTS

HBC (cont..)

To involve Tertiary institutions in HIV/AIDS management in the Province

Intergovernmental committee on HIV/AIDS Conduct Door to door campaign in the Province

To celebrate all HIV/AIDS calendar days

101 HBC district trainers trained 467 Caregivers trained including LAC’s

Develop a framework for participation of Tertiary Institutions in the HIV/AIDS programmes e.g. Research & Training

Health Act as secretariat for IDC in the ProvinceFacilitate all operations of the Interdepartmental Committee on HIV/AIDS

All 18 Districts conducted door to door campaigns during December 2001with 1 950 houses visited and 24 387 persons reached and 991 350 Condoms distributed in one week(5days)All HIV/AIDS calendar days celebrated

HIV/AIDS ACHIEVEMENTSOBJEC TIVES ACHIEVEMENTS

Conduct a survey for the Health promotion in the Province

Organize a workshop for all Private practitioners

To organize workshops for Traditional healers

To coordinate with DEPT of Education on life skills education at school

Health promotion survey conducted on the availability of Health promoters in all districts to establish health promotion activities in the Province

Workshop organized through ROCHE in the Province with good attendances from All GP( Private Medical Officers)to standardize syndromic management of STI’sOrganized traditional healers workshop took place to address HIV/AIDS

Close collaboration with education established

NO OF VCT SITES IN THE PROVINCE

District Number of sites Number operational

Mafikeng 18 14

Zeerust 21 21

Lichtenburg 13 9

Delareyville 10 4

Klerksdorp 12 12

Potchefstroom 11 10

Ventersdorp 11 11

Wolmaranstad 5 4

Vryburg 6 4

Ganyesa 5 5

Taung 6 5

Schweizer-Reneke 1 1

Kudumane 3 3

Odi 8 8

Moretele 7 7

Brits 5 3

Mogwase 9 7

Rustenburg 21 13

TOTALS 172 141

0

100

200

300

400

500

600

700

800

900

1000

NO OF NURSES TRAINED IN COUNSELLING 2001/2

BOJANALA

KLERKSDORP

MAFIKENG

VRYBURG

TOTALS

BOJANALA 108 133 75 27 343

KLERKSDORP 47 94 43 51 235

MAFIKENG 68 0 101 32 219

VRYBURG 66 18 36 20 140

TOTALS 289 245 255 130 937

QTR1 QTR2 QTR3 QRT 4. Provincial

0

500

1000

1500

2000

2500

3000

VCT SITE PERFORMANCE 2001/2

Bojanala

Klerksdorp

Mafikeng

vryburg

Totals

Bojanala 321 366 464 717 96 134 124 321

Klerksdorp 41 69 98 434 8 26 18 107

Mafikeng 683 826 1099 652 361 219 309 208

vryburg 162 1143 1042 792 66 70 68 257

Totals 1207 2404 2703 2595 531 449 519 893

QTR1 QTR2 QTR3 QRT 4. QTR1 QTR2 QTR3 QRT 4.

NO OF TESTS NO.OF POSITIVES

PMTCT SITES SRVICES• Thlabane (U): Jul-

March 2001/2• ANC - 2797• VC - 204 = 7%

• Tested - 204 =

7%• HIV+ - 90 =44%• NVP - 38• Babies - 38• EBF - 9 =23%• EFF - 29=77%

• Lehurutshe (R): Jul-March 2001/2

• ANC - 1998• VC - 851 = 42%• Tested- 727 = 37%• HIV+ - 183 = 25%• NVP - 65• Babies- 65• EBF - 1= 2%• EFF - 64 =

98%

DISTRICT ORGANISATION VISITS CLIENTS       

MORETELE SUNRISE 780 193

ZEERUST GIVE A HAND & HOPE 386 81

KLERKSDORP NW HOSPICE 726 141

KLERKSDORP KOSH 147 141

DELARYVILLE TSHWARAGANANG 716 104DELAREYVILLE BRIGHT FUTURE 698 112

ODI GARANKUWA SUNSHINE 140 32

ODI MERCY AIDS PROJECT 382 105

BRITS MABOLOKA AIDS PROJECT 475 78

KUDUMANE RETLATHUSA 89 23

RUSTENBURG VISION FOR NATION 357 70

MAFIKENG LEMOGANG 102 42

  NAPWA 626 210

  OPERATION BLANKET 410 185

  OPERATION H8UNGER 80 38

  HELPING HAND 863 490POTCHEFSTROOM TSHEPONG 258 47

TOTAL   7238 Home visits 1999 clients

LEGISLATION

• We the process of passing the Provincial Council on Aids Act during the 2001/2 financial year

• Drafted the Provincial Health Bill

THANK YOU