programme & sub - programme plans - western cape · other functions include legal advisory...

Annual PerformancePlan 2010/11

Programme & Sub - Programme Plans

PART B

PART B: PROGRAMME 1: ADMINISTRATION

ANNUAL PERFORMANCE PLAN: 2010/11 29

PROGRAMME 1: ADMINISTRATION

1. PROGRAMME PURPOSE

To conduct the strategic management and overall administration of the Department of Health.

2. PROGRAMME STRUCTURE

2.1 SUB-PROGRAMME 1.1: OFFICE OF THE MEC

Rendering of advisory, secretarial and office support services.

2.2 SUB-PROGRAMME 1.2: MANAGEMENT

Policy formulation, overall management and administration support of the Department and the respective regions and institutions within the Department.

2.2.1 Sub-programme 1.2.1: Central management

Policy formulation by the Provincial Minister and other members of management, implementing policy and organising the Health Department, managing personnel and financial administration, determining working methods and procedures and exercising central control.

2.2.2 Sub-programme 1.2.2: Decentralised management

Implementing policy and organising health regions, managing personnel and financial administration, determining work methods and procedures and exercising regional control.

2.2.3 Programme Overview

The Department of Health is managed by a combination of a central management component situated in the head office in Cape Town, with decentralised district offices in Beaufort West, George, Worcester, Caledon, Malmesbury and sub-structure offices in the Metro District. Each sub-structure office of the Metro district manages two sub-districts, in Khayelitsha, Athlone, Mitchell’s Plain and Retreat as well as institutional management at the respective facilities.

The strategy and operation of the Department is influenced by various international, national and provincial programmes and mandates, which include the Millennium Development Goals, the National Medium Term Strategic Framework, the National Department Ten Point Plan and the Provincial Cabinet Programmes and Priorities.

The Department is responsible for the provision and management of the provincial health services, which provides for predominantly the health care needs of the uninsured population of the Western Cape.

The first phase of the Burden of Disease Report has been tabled and the findings accepted by the Department and the Provincial Cabinet. This forms the basis for provincial interventions to reduce the disease burden.



The Comprehensive Service Plan provides the strategic direction for the provision of health services in the Western Cape.

The infrastructure plan of the Department supports the Comprehensive Service Plan and is being implemented using all available funding for infrastructure either from the national conditional grants or provincial funding. The Department faces a significant challenge to fund the necessary upgrading and construction of Primary Health Care facilities from the available budget.

The Human Resources Plan supports the implementation of the Comprehensive Service Plan and the Annual Performance Plan. Human resource planning is an ongoing process in the Department.

The Provincial Minister determines provincial policy and the central head office management gives effect to provincial and national policies ensuring that the Western Cape provincial health service is aligned with national, provincial and departmental strategy, policy and directives.

This programme consists of the central management of the department, including the central functions of Finance, Human Resources, the Central Pharmaceutical Store, the Chronic Dispensing Unit, Information Management, Infrastructure Management, Strategic Planning and Health Support, Communication and certain central clinical management functions, such as the development of pharmaceutical protocols.

The programme has both a controlling and a supporting function. Examples of controlling functions are:

• The control over which posts may be filled,

• Norms and standards as per the departmental policies,

• Allocation of budgets and setting of revenue targets,

• Determination of the grading of posts and staffing requirements for specific functions,

• Adherence to employment equity norms,

• Development and maintenance of the Accounting Officer System (norms and standards for Supply Chain Management),

• Monitoring of BAS posting inconsistencies and errors,

• Monitoring adherence to strategic and performance plans.

Support functions include:

• The analysis and comparison of inputs and outputs of the various institutions,

• Support to institutions with the filling of posts,

• Monitoring of IT response times and interaction with the Centre for e-Innovation in this regard,

• Risk Management,

• Support of the implementation of national decisions with respect to salary levels, (such as the recent Occupational Specific Dispensations)

• Training and staff development,

• Facilitation of the development of the strategic and performance plans, which plan service delivery on the basis of the evolving service needs.



The management of the Department of Health is highly decentralised. Administrative functions such as IT, finance and HR are mostly performed at institutional levels. The high level of decentralisation has the benefit of increased responsiveness to institutional needs, but raises challenges with respect to consistency, adherence to prescripts and supervision of administrative staff. An important function of Programme 1 is to develop and implement mechanisms to achieve these objectives.

Other functions include legal advisory services, laboratory services, licensing and private facility inspections and management of medico legal claims.

Programme 1 plays an important role in driving cost containment and efficiencies. This is addressed at various management meetings such as monthly top management, financial, monitoring and evaluation meetings, where projections and saving measures are reviewed. In addition, focused project teams identify and formulate best practices, which are made available to managers for major cost items such as blood products, pharmaceuticals and medical supplies.

Programme 1 serves mostly institutions within the Department of Health but the programme is also the conduit for interactions with Provincial Treasury and various provincial and national departments.

The Modernisation Programme of the Department of the Premier, which is in an advanced stage, proposes the shift of the Human Resources (excluding the Departments of Health and Education), Internal Audit and Enterprise Risk Management functions to a shared Corporate Services within the Department of the Premier from 1 April 2010. Therefore the strategic objectives and performance indicators relating to these functions are only reflected in the Strategic and Annual Performance Plans of the Department of the Premier. The financial implications of the function shift will be finalised during the 2010/11 Adjusted Estimates process once all of the HR and other related issues have been finalised.

Table 1.1: Public health personnel in 2008/09 [ADMIN 1]

Categories Number employed

% of total employed

Number per 1 000

people

Number per 1 000

uninsured people

Vacancy Rate

% of total personnel

budget

Annual cost per staff member

Medical Officers 1 852 6.76% 0.3359 0.42 15.78% 14.81% 386 573

Medical Specialists 471 1.72% 0.0854 0.11 18.51% 6.66% 683 166

Dental Specialists 6 0.02% 0.0011 0.00 82.35% 0.12% 963 407

Dentists 69 0.25% 0.0125 0.02 28.87% 0.63% 438 496

Professional Nurse 5 098 18.60% 0.9247 1.16 24.75% 26.08% 247 297

Enrolled Nurses 2 141 7.81% 0.3884 0.49 17.69% 6.28% 141 853

Enrolled Nursing Auxiliaries 3 934 14.36% 0.7136 0.89 16.03% 9.37% 115 132

Student Nurses 12 0.04% 0.0022 0.00 42.86% 0.01% 59 687

Pharmacists 343 1.25% 0.0622 0.08 27.79% 1.63% 229 772

Physiotherapists 121 0.44% 0.0219 0.03 37.95% 0.46% 183 785

Occupational Therapists 118 0.43% 0.0214 0.03 34.08% 0.43% 175 993

Clinical Psychologists 71 0.26% 0.0129 0.02 43.20% 0.33% 224 439

Radiographers 407 1.49% 0.0738 0.09 13.40% 1.69% 200 879

Emergency Medical Staff 1 509 5.51% 0.2737 0.34 37.39% 4.81% 154 199

Dieticians 81 0.30% 0.0147 0.02 38.17% 0.30% 180 758

Other allied health professionals & technicians

1 118 4.08% 0.2028 0.25 33.89% 3.87% 167 216

Managers, Administrators & all other staff 10 051 36.68% 1.8231 2.29 27.84% 22.50% 108 214

Grand Total 27 402 100.00% 4.9704 6.23 25.12% 100.00% 176 384

Notes: 1. These vacancy rates are expressed as a percentage vacancy determined by the existing approved staff establishment.

This is materially different from the envisaged staff establishment that will be derived from the Comprehensive Service Plan. 2. Professional nurses on salary levels 9-12 are included as managers.



3. SITUATION ANALYSIS AND PROJECTED PERFORMANCE FOR HUMAN RESOURCES

Table 1.2: Situational analysis and projected performance for Human Resources [ADMIN 3]

Strategic goal: Strategic objective Measurable objective Performance Measure/Indicator Type 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1. Ensure and maintain organisational strategic management capacity and synergy

1.1 To have an effective and efficient and skilled workforce.

1.1.1 To provide sufficient staff with appropriate skills per occupational group.

1) Number of medical officers per 100 000 people No 37 37 33.59 32.87 32.18 31.51 30.88

2) Number of medical officers per 100 000 people in rural districts No 13 13 16.17 17.12 16.80 16.50 16.21

3) Number of professional nurses per 100 000 people No 95 100 92.47 90.48 88.57 86.75 84.99

4) Number of professional nurses per 100 000 people in rural districts

No 60 70 84.15 84.03 82.48 80.99 79.55

5) Number of pharmacists per 100 000 people No 8 10 6.22 6.09 5.96 5.84 5.72

6) Number of pharmacists per 100 000 people in rural districts No 6 8 5.87 6.02 5.91 5.80 5.70

7) Vacancy rate for professional nurses % 28% 28% 25% 23% 23% 23% 23%

8) Vacancy rate for medical officers % 13% 17% 16% 13% 13% 13% 13%

9) Vacancy rate for medical specialists % 24% 22% 22% 19% 19% 19% 19%

10) Vacancy rate for pharmacists % 33% 43% 28% 24% 24% 24% 24%

11) Attrition rate for professional nurses % 11% 7% 6% 6% 6% 6% 6%

12) Absenteeism for professional nurses % 3% 3% 3% 3% 3% 3% 3%

Note: The number of employees per category of staff for 2008/09 is shown in Table 1.5. The same staffing level is maintained for the MTEF period due to the increasing pressure on the personnel budget as a result of the implementation of the OSD.



4. PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR ADMINISTRATION

Table 1.3: Provincial strategic objectives, indicators and annual targets for Administration [ADMIN 2]

Strategic goal Strategic objective: Title Strategic objective Performance indicator Type Baseline

target 2014

Audited/actual performance Estimate Medium term target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1. Ensure a sustainable income to provide the required health service.

1.1 Promote efficient financial resource use.

1.1.1 The development and maintenance of a financial efficiency programme to ensure under/over spending is within 1% of the annual allocated budget throughout the reporting periods.

Strategic objective [SO] SO baseline measure 1) Percentage under/over

spending of the annual allocated budget

% 1% 1% 6. 419 bn/

6. 476 bn

1% 7.383 bn/ 7.427 bn

2% 8.655 bn/ 8.870 bn

1% 10.556 bn/ 10.463 bn

1% 11.843 bn/ 11.962 bn

1% 12.662 bn/ 12.790 bn

1% 13.424 bn/ 13 559 bn

2. Develop and maintain a capacitated workforce.

2.1 Develop and maintain a comprehensive human resources plan for the department.

2.1.1 To determine the educational qualifications and experience of 98% of the current staff by conducting a skills analysis by 2014/15

SO baseline measure 2) Percentage of

occupational skills analysis completed for staff

% 98% 28 082/ 28 656

0 0 0 31% 8 883/

28 656

62% 17 766/ 28 656

80% 22 924/ 28 656

98% 28 082/28 656

2.2 Ensure optimal staffing levels within the finance components at Head Office.

2.2.1 Ensure a 97% filled post rate within the finance components at Head Office throughout the reporting period.

SO baseline measure 3) Percentage of filled finance

posts at head office.

97% 185/190

0 0 0 88% 157/178

95 % 169/178

95% 176/185

97% 185/190

3. Ensure organisational strategic management capacity and synergy.

3.1 Implement and maintain the organisational and post structures of the Comprehensive Service Plan (CSP)

3.1.1 Ensure the implementation and maintenance of 147 organisational and post structures aligned to the CSP by 2014.

SO Baseline measure 4) Number of organisational

and post structures, aligned with the CSP, implemented by 2014/15.

No 147 0 0 0 65 85 119 147

5) Number of implemented organisational and post structures of Head Office

No 37 0 0 0 2 11 25 37

6) Number of implemented organisational and post structures of Central and Dental Hospitals

No 4 0 0 0 0 1 3 4

7) Number of implemented organisational and post structures of the office of the Chief Director: Regional Hospitals, Mental Health & EMS

No 15 0 0 0 0 3 11 15

8) Number of implemented organisational and post structures of metro hospitals of the Chief Directorate: Regional Hospitals, Mental Health & EMS

No 7 0 0 0 0 1 5 7




target 2014


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

9) Number of implemented organisational and post structures of TB and infectious diseases hospitals

No 4 0 0 0 2 2 3 4

10) Number of implemented organisational and post structures of Associated Psychiatric Hospitals

No 4 0 0 0 2 2 3 4

11) Number of implemented organisational and post structures of Emergency Medical Services

No 11 0 0 0 9 11 11 11

12) Number of implemented organisational and post structures of Metro District Health Services (9 District Hospitals & 4 PHC Sub-structures

No 13 0 0 0 0 4 8 13

13) Number of implemented and maintained organisational and post structures of Rural District Health Services (25 District Hospitals & 5 Districts)

No 50 0 0 0 50 50 50 50

3.2 An effective and viable departmental website to serve as the primary source of communication for internal stakeholders

3.2.1 Revitalisation and maintenance of the official website to increase optimal usage of site by 2014/15.

SO Baseline measure 14) Number of Chief

Directorates’ policies and practices posted and maintained on the department’s official website

No 8 0 0 0 Website under re-construction

8 8 8

3.3. Provide an effective financial compliance reporting tool.

3.3.1. Ensure that 63 institutions report monthly on the financial compliance to the departmental predetermined list which addresses the shortcomings identified by the Auditor-General.

SO Baseline measure 15) Number of institutions

submitting monthly finance compliance reports.

No 63 0 0 0 40 63 63 63

3.4. Ensure optimum pharmaceutical stock levels

3.4.1. Maintain a 93% stock availability rate at Cape Medical Depot [CMD] during each reporting period

SO Baseline measure 16) Percentage of

pharmaceutical stock availability at the CMD

% 93% 685/ 735

93% 685/ 735

92% 676 /735

90% 661 /735

93% 685 /735

93% 685 /735

93% 685 /735

93% 685 /735




target 2014


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

3.5. Raise Supply Chain Management to a level 3 compliance.

3.5.1. Ensure the policy maintenance of the Accounting Officers System (AOS) by end April of each reporting period.

SO Baseline measure 17) Provision of the

Accounting Officers System policy.

No 1 0 1 0 1 1 1 1

3.5.2. Development and maintenance of a Procurement Plan for minor and major assets by end April of each reporting period.

SO Baseline measure 18) Provision of a Procurement

Plan.

No 1 1 (Major assets)

1 (Major assets))

1 (Major assets)

1 (Major assets)

1 1 1

3.5.3. Ensure that the 59 sites registered on the LOGIS or SYSPRO system account for all assets by compiling monthly reconciliation reports throughout the reporting periods.

SO Baseline measure 19) Number of registered sites

compiling asset reconciliation reports.

No 59 0 0 0 0 59 59 59

3.6. Co-ordinate, integrate and provide health information to the department.

3.6.1. Improve the integrity of performance data by ensuring a 99% submission rate of prioritised data by 2014/15

SO Baseline measure 20) Data submission rate of

prioritised data sets

% 99% 13 698/ 13 836

0 0 0 85% 11 760/ 13 836

92% 12 729/13 836

97% 13 421/ 13 836

99% 13 698/ 13 836

4. Ensure the provision of infrastructure that meets the needs of current and future development

4.1. Provide Infrastructure to support workforce development

4.1.1. Ensure a 98% implementation of the Health Information System (HIS) at all contracted hospitals by 2014/15.

SO Baseline measure 21) Percentage of hospitals

where the HIS has been implemented

% 98% 40/41

34% 14/41

47% 19/41

58% 24/41

68% 28/41

78% 32/41

88% 36/41

98% 40/41

5. To improve the quality of health services

5.1. The institutionalisation and integration of Quality Improvement (QI) at all levels of care in line with National and Provincial Departmental objectives and initiatives.

5.1.1. The institutionalisation and integration of QI across all levels of care reflected by the timeous submission of composite reports on consumer and technical quality.

SO Baseline measure 22) Number or organizational

structures (APH; Central Hospitals; Districts; CD: Regional hospitals and EMS) submitting composite QI Reports.

No 12 0 0 0 6 8 9 12



5. QUARTERLY TARGETS FOR 2010/11

Table 1.4: Quarterly targets for 2010/11 [ADMIN 4]

Strategic goal Strategic objective: Title Smart objective: Statement Programme performance indicator Reporting period

Annual target

2010/11

Quarterly targets

Q1 Q2 Q3 Q4

1. Ensure a sustainable income to provide the required health service.

1.1. Promote efficient financial resource use.

1.1.1. The development and maintenance of a financial efficiency programme to ensure under/over spending is within 1% of the annual allocated budget throughout the reporting periods.

Strategic objective [SO] SO baseline measure 1) Percentage under/over spending of the annual

allocated budget

Quarterly 1%

11.843 bn/ 11.962 bn

1%

11.843 bn/ 11.962 bn

1%

11.843 bn/ 11.962 bn

1%

11.843 bn/ 11.962 bn

1%

11.843 bn/ 11.962 bn


2.1. Develop and maintain a comprehensive human resources plan for the department

2.1.1. To determine the educational qualifications and experience of 98% of the current staff by conducting a skills analysis by 2014/15

2) Percentage of occupational skills analysis completed for all staff

Quarterly 62% 17 766/ 28 656

31% 8 769/ 28 656

31% 8 769/ 28 656

31% 8 769/ 28 656

62% 17 692/ 28 656

2.2. Ensure optimal staffing levels within the finance components at Head Office.

2.2.1 Ensure a 97% filled post rate within the finance components at Head Office throughout the reporting period.

SO baseline measure 3) Percentage of filled finance posts at head office.

Quarterly 95% 88% 88% 88% 95%

3. Ensure organisational strategic management capacity and synergy.

3.1. To implement and maintain the organisational and post structures of the Comprehensive Service Plan (CSP)

3.1.1. Ensure the implementation and maintenance of 147 organisational and post structures aligned to the CSP by 2014.

4) Number of organisational and post structures, aligned with the CSP, implemented by 2014/15.

Quarterly 85 56 68 76 85

5) Number of implemented organisational and post structures of Head Office

Quarterly 11 2 5 8 11

6) Number of implemented organisational and post structures of Central and Dental Hospitals

Quarterly 1 0 1 1 1

7) Number of implemented organisational and post structures of the office of the Chief Director Regional Hospitals, Mental Health & EMS

Quarterly 3 1 2 3 3

8) Number of implemented organisational and post structures of metro hospitals of the Chief Directorate: Regional Hospitals, Mental Health & EMS

Quarterly 1 0 1 1 1

9) Number of implemented organisational and post structures of TB and infectious diseases hospitals

Quarterly 2 0 1 1 2

10) Number of implemented organisational and post

structures of Associated Psychiatric Hospitals Quarterly 2 0 1 1 2




Annual target

2010/11

Quarterly targets

Q1 Q2 Q3 Q4

11) Number of implemented organisational and post

structures of Emergency Medical Services Quarterly 11 2 5 8 11

12) Number of implemented organisational and post structures of Metro District Health Services (9 District Hospitals & 4 PHC Sub-structures

Quarterly 4 1 2 3 4

13) Number of implemented and maintained organisational and post structures of Rural District Health Services (25 District Hospitals & 5 Districts)

Quarterly 50 50 50 50 50

3.2. An effective and viable departmental website

3.2.1. Revitalisation and maintenance of the official website to increase optimal usage of site by 2014/15.

SO Baseline measure 14) Number of Chief Directorates’ policies and

practices posted on the department’s official website

Quarterly 8 2 4 6 8

3.3. Provide an effective financial compliance reporting tool.

3.3.1. Ensure that 63 institutions report monthly on the financial compliance to the departmental predetermined list which addresses the shortcomings identified by the Auditor-General.

SO Baseline measure 15) Number of institutions submitting monthly finance

compliance reports.

Quarterly 63 63 63 63 63

3.4. Ensure optimum pharmaceutical stock levels

3.4.1. Maintain a 93% stock availability rate at Cape Medical Depot [CMD] during each reporting period.

16) Percentage of pharmaceutical stock availability at the CMD.

Quarterly 93% 685/ 735

93% 685/ 735

93% 685/ 735

93% 685/ 735

93% 685/ 735

3.5. Raise Supply Chain Management to a level 3 compliance.

3.5.1. Ensure the policy maintenance of the Accounting Officers System (AOS) by end April of each reporting period.

SO Baseline measure 17) Provision of the Accounting Officers System

policy.

Annually 1 1 0 0 0

3.5.2. Development and maintenance of a Procurement Plan for minor and major assets by end April of each reporting period.

SO Baseline measure 18) Provision of a Procurement Plan.

Annually 1 1 0 0 0

3.5.3. Ensure that the 59 sites registered on the LOGIS or SYSPRO system account for all assets by compiling monthly reconciliation reports throughout the reporting periods.

SO Baseline measure 19) Number of registered sites compiling asset

reconciliation reports.

Quarterly 59 59 59 59 59

3.6. Co-ordinate, integrate and provide health information to the department.

3.6.1. Improve the integrity of performance data by ensuring a 99% submission rate of prioritised data by 2014/15

20) Data submission rate of prioritised data sets Quarterly 92% 12 728/ 13 836

92% 3 182/ 3 459

92% 3 182/ 3 459

92% 3 182/ 3 459

92% 3182/ 3 459




Annual target

2010/11

Quarterly targets

Q1 Q2 Q3 Q4

4. Ensure the provision of infrastructure that meets the needs of current and future development

4.1. Provide Infrastructure to support workforce development

4.1.1. Ensure a 98% implementation of the Health Information System (HIS) at all contracted hospitals by 2014/15.

21) Percentage of hospitals where the HIS has been implemented

Quarterly 78% 32/41

71% 29/41

73% 30/41

76% 31/41

78% 32/41

5. To improve the quality of health services

5.2. The institutionalisation and integration of Quality Improvement (QI) at all levels of care in line with National and Provincial Departmental objectives and initiatives.

5.1.1. The institutionalisation and integration of Quality Improvement (QI) across all levels of care reflected by the timeous submission of composite reports on consumer and technical quality

22) Number or organizational structures (APH; Central Hospitals; Districts; CD: Regional hospitals and EMS) submitting composite QI Reports.

Quarterly 8 8 8 8 8



6. RECONCILING PERFORMANCE TARGETS WITH THE BUDGET AND THE MTEF

6.1 RELATING EXPENDITURE TRENDS TO STRATEGIC GOALS

The determination of the Programme 1 budget is based on staffing requirements and the latest expenditure trends. The programme budget includes the expenditure of the Chronic Dispensing Unit (a high volume, low cost dispensing process which alleviates workload at institutions), the cost of medico legal claims and other central costs such as audit fees, recruitment and advertising fees.

The Cape Medical Depot is a central pharmaceutical depot which carries stock to the value of R100 million, which although under the managerial responsibility of Finance centrally, in Programme 1, the working capital of the trading account is reflected in Sub-programme 7.5.

Programme 1 is allocated 3.32 per cent of the vote in 2010/11 in comparison to the 2.90 per cent allocated in the revised estimate of 2009/10. This amounts to a nominal increase of R91.689 million or 29.98 per cent from the revised estimate.

Note that the funding for Sub-programme 1.2.2 has been shifted to Sub-programme 4.1 from 2010/11.

Table 1.5: Trends in provincial public health expenditure for Administration [ADMIN 6]

Expenditure Audited/ actual Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 162 125 000 205 333 000 249 104 000 305 833 000 397 522 000 404 265 000 430 865 000

Total per person 30.71 38.08 45.18 54.28 69.07 68.79 71.83

Total per uninsured person 39.37 48.80 57.91 69.57 88.52 88.17 92.07

Constant 2008/09 prices

Total 184 370 496 221 964 973 249 104 000 284 834 752 345 290 789 330 430 092 332 098 075

Total per person 34.93 41.17 45.18 50.55 59.99 56.23 55.37


Table 1.6: Expenditure estimates: Administration [ADMIN 5]

Audited Audited Audited

% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Office of the Provincial Minister a

3 738 3 840 5 855 5 531 5 505 5 328 5 386 1.09 5 779 6 116

Management 158 387 201 493 243 249 308 282 301 429 300 505 392 136 30.49 398 486 424 749 Central Management 149 100 191 379 233 528 297 150 289 986 288 675 392 136 35.84 398 486 424 749 Decentralised Management 9 287 10 114 9 721 11 132 11 443 11 830 (100.00)

162 125 205 333 249 104 313 813 306 934 305 833 397 522 29.98 404 265 430 865

Revised estimate

Medium-term estimate

Sub-programmeR'000

Outcome

Main appro-priation

Adjusted appro-

priation

1.

2.

Total payments and estimates

a MEC total remuneration package: R1 420 489 with effect from 1 April 2009.

Note: Sub-programme 1.2.2 allocations from 2010/11 was shifted to sub-programme 4.1.



Table 1.7: Summary of provincial expenditure estimates by economic classification for Administration


% Change from Revised

estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Current payments 148 832 190 418 228 741 280 101 279 120 277 048 361 901 30.63 366 898 391 369 Compensation of employees 69 853 81 317 96 213 115 822 118 406 114 662 150 070 30.88 160 497 168 140

Salaries and wages 61 082 71 259 84 683 100 043 102 433 102 049 133 562 30.88 142 842 149 647 Social contributions 8 771 10 058 11 530 15 779 15 973 12 613 16 508 30.88 17 655 18 493

Goods and services 78 979 109 101 132 528 164 279 160 714 162 386 211 831 30.45 206 401 223 229 of which

969 604 639 662 733 794 902 13.60 975 1 043 14 189 8 923 20 747 17 544 16 056 16 025 14 642 (8.63) 15 813 16 923 1 573 2 818 1 128 1 073 1 688 1 389 1 444 3.96 1 559 1 666 5 600 7 422 11 344 11 657 19 527 21 595 23 735 9.91 25 634 27 428 268 321 384 421 510 426 445 4.46 478 513

5 246 5 495 4 803 5 964 6 538 5 290 5 893 11.40 6 367 6 812 13 610 34 579 35 637 46 164 49 907 49 781 55 247 10.98 59 665 63 842 16 120 23 710 34 765 46 885 40 212 42 935 50 627 17.92 54 676 58 504

5 26 6

2 322 4 562 3 982 4 262 5 010 5 244 6 023 14.86 6 505 6 960 118 8 259 5 150 10 751 2 173 3 702 36 881 896.25 17 491 21 063

7 692 1 833 739 1 477 1 958 1 147 1 228 7.06 1 329 1 419

93 99 76 182 171 75 78 4.00 83 93 8 2 2 3 3 4 4

3 1 5 6 1 10 2 181 27 28 3.70 30 31

34 1 3 4 4 3 3 3 3 18 35 22 54 32 78 59 (24.36) 66 70

1 952 2 572 2 822 3 228 3 155 2 820 2 914 3.33 3 143 3 364 801 711 757 1 069 1 020 913 892 (2.30) 963 1 030 335 184 411 239 371 352 120 (65.91) 127 138

1

5 701 5 429 6 546 8 556 8 119 7 268 7 853 8.05 8 451 9 076 571 354 1 088 2 513 1 532 1 254 1 345 7.26 1 452 1 551

1 191 230 277 338 363 118 137 16.10 148 158 557 933 1 186 1 233 1 447 1 147 1 332 16.13 1 439 1 538

Transfers and subsidies to 8 922 7 921 9 028 22 150 16 150 16 150 23 148 43.33 24 283 25 667 Provinces and municipalities 39

Municipalities 39 Municipalities 39

39 Households 8 883 7 921 9 028 22 150 16 150 16 150 23 148 43.33 24 283 25 667

Social benefits 229 94 4 966 145 4 659 4 657 4 922 5.69 5 164 5 457 Other transfers to households 8 654 7 827 4 062 22 005 11 491 11 493 18 226 58.58 19 119 20 210

Payments for capital assets 4 366 6 908 11 192 11 562 11 664 12 635 12 473 (1.28) 13 084 13 829 Machinery and equipment 4 358 6 901 11 138 11 562 11 664 12 635 12 473 (1.28) 13 084 13 829

Transport equipment 96 1 941 112 112 386 240 (37.82) 252 266 Other machinery and equipment 4 262 4 960 11 138 11 450 11 552 12 249 12 233 (0.13) 12 832 13 563

8 7 54

Payments for financial assets 5 86 143

Total economic classification 162 125 205 333 249 104 313 813 306 934 305 833 397 522 29.98 404 265 430 865

Software and other intangibleassets

Venues and facilities

Adjusted appro-priation

of whichRegional services council levies

Inventory: Other consumables Inventory: Stationery and printing

Revised estimate


Communication

Inventory: Food and food supplies

Economic classificationR'000

Outcome

Main appro-priation

Cons/prof: Legal costContractors

Travel and subsistenceTraining and staff development

Inventory: Medical supplies

Lease payments

Operating expenditure

Owned and leasehold property expenditureTransport provided departmental activity

Administrative feesAdvertisingAssets <R5 000Audit cost: External

Agency and support/outsourced services

Catering: Departmental activities

Computer servicesCons/prof: Business and advisory servicesCons/prof: Infrastructure & Cons/prof: Laboratory services

Inventory: Fuel, oil and gas

Entertainment

Inventory: Raw materials

PART B: PROGRAMME 2: DISTRICT HEALTH SERVICES


PROGRAMME 2: DISTRICT HEALTH SERVICES


The purpose of the Division of District Health Services and Health Programmes (Programme 2) is to render facility-based district health services (at clinics, community health centres and district hospitals) and community-based district health services (CBS) to the population of the Western Cape Province.


2.1 SUB-PROGRAMME 2.1: DISTRICT MANAGEMENT

Management of District Health Services (including Facility and Community Based Services), Corporate Governance (including financial, human resource management and professional support services e.g. infrastructure and technology planning) and Quality Assurance (including Clinical Governance).

2.2 SUB-PROGRAMME 2.2: COMMUNITY HEALTH CLINICS

Rendering a nurse driven primary health care service at clinic level including visiting points and mobile clinics.

2.3 SUB-PROGRAMME 2.3: COMMUNITY HEALTH CENTRES

Rendering a primary health care service with full-time medical officers in respect of mother and child, health promotion, geriatrics, occupational therapy, physiotherapy, psychiatry, speech therapy, communicable diseases, mental health, etc.

2.4 SUB-PROGRAMME 2.4: COMMUNITY BASED SERVICES

Rendering a community based health service at non–health facilities in respect of home based care, mental- and chronic care, school health, etc.

2.5 SUB-PROGRAMME 2.5: OTHER COMMUNITY SERVICES

Rendering environmental and port health services.

2.6 SUB-PROGRAMME 2.6: HIV AND AIDS

Rendering a primary health care service in respect of HIV and AIDS.



2.7 SUB-PROGRAMME 2.7: NUTRITION

Rendering a nutrition service aimed at specific target groups and combines direct and indirect nutrition interventions to address malnutrition.

2.8 SUB-PROGRAMME 2.8: CORONER SERVICES

Rendering forensic and medico-legal services in order to establish the circumstances and causes surrounding unnatural death.

These services are reported in Sub-programme 7.4: Forensic Pathology Services.

2.9 SUB-PROGRAMME 2.9: DISTRICT HOSPITALS

Rendering of a district hospital service at sub-district level.

2.10 SUB-PROGRAMME 2.10: GLOBAL FUND

Strengthen and expand the HIV and AIDS care, prevention and treatment programmes:

• TB hospitals are funded from Programme 4.2 but are managed as part of the District Health System and are the responsibility of the District Directors. The narrative and tables for TB hospitals is in Programme 4.2.

• Forensic services are reported in Sub-programme 7.4: Forensic Pathology Services.

3. PROGRAMME OVERVIEW: SPECIFIC INFORMATION FOR DISTRICT HEALTH SERVICES

The Table 2.1 illustrates the inequity in PHC access across the Province. In the more densely populated areas in the City of Cape Town District, access is constrained due to rapid population growth. Relief will be brought in areas such as Du Noon, Delft Symphony, Asanda Village, and Weltevreden Valley when new facilities are constructed. In the rural districts reasonably good access is provided as evidenced by the utilization rates.



Table 2.1: District Health Service facilities [DHS1]

Health district Facility type No. Population (Uninsured) 2008/09

Uninsured Population per

fixed PHC facility Utilisation per

capita (Uninsured)

WEST COAST Non fixed clinics 43

Fixed Clinics 27

CHCs 0 253 677 9 395 4.1

CDCs 0

Sub-total clinics + CHCs 70

District hospitals 7

CAPE WINELANDS Non fixed clinics 28

Fixed Clinics 46

CHCs 0 568 007 12 348 3.7

CDCs 5



OVERBERG Non fixed clinics 25

Fixed Clinics 22

CHCs 0 188 969 8 589 4.0

CDCs 1



EDEN Non fixed clinics 35

Fixed Clinics 36 459 797 12 772 4.3

CHCs 0

CDCs 4



CENTRAL KAROO Non fixed clinics 11

(Rural development node) Fixed Clinics 8 51 268 6 408 5.2

CHCs 0

CDCs 1



METROPOLE Non fixed clinics 30

Fixed Clinics 93

CHCs (including MOU’s) 33 2 780 164 29 894 3.2

CDCs 20


District hospitals (including Victoria Khayelitsha & Mitchells Plain DH hubs)

9

PROVINCE Non fixed clinics 172

Fixed Clinics 232

CHCs (including MOU’s) 33

CDCs 31

Sub-total clinics + CHCs 468 4 301 882 18 543 3.5

District hospitals (including Victoria Khayelitsha & Mitchells Plain DH hubs)

34

Note: Non-fixed clinics include satellite and mobile clinics.



Table 2.2: Personnel in district health services by health district [DHS2]

Health district Personnel category Posts filled Posts approved Vacancy rate (%)

Total Personnel (including LG)

Number of post per 1000

uninsured people

West Coast PHC facilities

Medical officers 1 2 50.00% 1 0.004

Professional nurses 87 94 7.45% 87 0.343

Pharmacists 4 5 20.00% 4 0.016

Community health workers

Not on establishment





District hospitals



Pharmacists 5 7 28.57% 5 0.020

Cape Winelands

PHC facilities



Pharmacists 13 15 13.33% 13 0.023







District hospitals



Pharmacists 3 4 25.00% 3 0.005

Overberg PHC facilities



Pharmacists 5 5 0.00% 5 0.026







District hospitals



Pharmacists 3 3 0.00% 3 0.016

Eden PHC facilities



Pharmacists 19 14 -35.71% 19 0.041







District hospitals



Pharmacists 8 10 20.00% 8 0.017

Central Karoo PHC facilities



Pharmacists 1 2 50.00% 1 0.020







District hospitals

Medical officers 6 5 -20.00% 6 0.117



Health district Personnel category Posts filled Posts approved Vacancy rate (%)

Total Personnel (including LG)

Number of post per 1000

uninsured people

Professional nurses 36 35 -2.86% 36 0.702

Pharmacists 3 2 -50.00% 3 0.059

Metropole (Local government numbers)*

PHC facilities

Medical officers 134 (LG: 32) 143 (LG: 32) 6.29% (0%) 166 0.060

Professional nurses 573(LG: 465) 592 (LG: 465) 3.21% (0%) 1038 0.373

Pharmacists 68(LG: 12) 79(LG: 12) 16.18% (0%) 80 0.029







District hospitals



Pharmacists 22 25 12.00% 22 0.008

Province PHC facilities



Pharmacists* 122 132 7.58% 122 0.028







District hospitals



Pharmacists 44 51 13.73% 44 0.010

*Note: Personal primary health care services are also provided by the local government (City of Cape Town) in the Cape Metropole.

Table 2.2 illustrates that more than 90% of posts, in most staff categories, are filled. However, current staff establishment is not at the target CSP level and therefore does not match the actual service needs.



3.1 THE SIX KEY STRATEGIC GOALS WHICH WILL BE PURSUED DURING THIS MTEF ARE:

1) Manage the burden of disease.

2) Ensure a sustainable income to provide the required health services according to the needs.

3) Develop and maintain a capacitated workforce to deliver the required health services.

4) Ensure and maintain organizational strategic management capacity and synergy.

5) Provide and maintain appropriate health technology and infrastructure.

6) Improve the quality of health services.

Providing access to emergency/acute services is a constitutional mandate which the Department is striving to honour by significantly improving the provision of high quality acute and emergency services. The latter will be strengthened by increasing the numbers of trained emergency centre personnel, the creation of additional emergency centres, at existing facilities (Eerste River, Swartland, Hermanus, Stellenbosch, Swellendam and Karl Bremer), and the construction of Mitchell’s plain and Khayelitsha Hospitals.

A recurrent complaint from users of the Department’s services relate to quality of care. These complaints relate not only to the quality of the clinical inputs but also the physical appearance of facilities and to staff attitudes. To address these matters the Department is committed to implementing a number of quality improvement initiatives.



4. DISTRICT HEALTH SERVICES

4.1 SITUATION ANALYSIS FOR DISTRICT HEALTH SERVICES (DHS)

Table 2.3: Situation analysis indicators for district health services [DHS3]

Strategic Goal Strategic Objective: Title

Strategic Objective: Statement Measure/Indicator Type

Province wide value

2008/09 Metro Cape

WinelandsCentral Karoo Eden Overberg West Coast

National Average 2008/09

1. Manage the burden of disease

1.1 Increase access to PHC services in the DHS in the Western Cape.

1.1.1 Achieve a PHC utilisation rate of 3.84 visits per person per annum by 2014/15.

1) Utilisation rate – PHC (total population) No 2.8 (15 051 210/5 299 999)

2.5(8 892 301/3 511 285)

2.9 (2 107 262/

715 303)

4.8 (268 229/

56 457)

3.9 (1 995 655/

515 391)

3.5(753 624/

213 650

3.6(1 034 139/

287 913)

2.44

2) PHC total headcount No 15 051 21 8 892 30 2 107 26 268 22 1 995 65 753 62 1 034 13 117 674 357

3) Utilisation rate – PHC under 5 years No 4.9 (2 436 479/

495 993)

4.2(1 397 301/

332 369)

5.7 (366 995/

64 737)

7.6(45 524/

5 969)

7 (323 104/

46 355)

6.4(130 014/

20 454)

6.6 (173 541/

26 109)

4.52

4) PHC total headcount - under 5 years 2 436 479 1 397 301 366 995 45 524 323 104 130 014 173,541 22 882 694

5) Supervision rate % 70.30% (3 140 / 4 464)

63.50% (1 258/1 980)

73.20% (527/720)

81.30% (725/612)

118.50% (725/612)

83.30% (340/408)

28.80% (173/600)

6) Percentage of community health centres and community day centres (CDCs) with a resident doctor.

% Not reported

before

Not reported

before

Not reported

before

Not reported

before

Not reported

before

Not reported

before

Not reported

before

7) Percentage of fixed clinics supported by a doctor at least once a week.

% Not reported

before

Not reported

before

Not reported

before

Not reported

before

Not reported

before

Notreported

before

Not reported

before

8) Professional Nurse clinical workload (PHC)

No 52.4 (15 051 10/

287 505)

53.6 (8 892 301/

165 871)

43.4(2 107 262/

48 533)

55.1 (268 229/

4 869)

61.3 (1 995 655/

32 564)

42.3 (753 624/

17 802)

57.9 (1 034 139/

17 866)

9) Doctor clinical workload (PHC) No 31.1 32.1 25.1 28.6 37.2 25.6 33 23.6

10) Total number of NPO appointed home carers.

No 2 455 1 495 146 70 291 197 256

11) Total CBS headcounts No 2 024 061 857 892 251 300 85 503 213 418 207 412 408 536

12) Number of palliative / sub acute and chronic care beds

No 763 637 60 0 50 4 12

13) Number of prescriptions dispensed through the CDU

No 1 919 172 1 063 784 204 060 64 638 396 113 88 894 101 683




Strategic Objective: Statement Measure/Indicator Type

Province wide value

2008/09 Metro Cape

WinelandsCentral Karoo Eden Overberg West Coast


2. Ensure a sustainable income to provide the required health services according to the needs.

2.1 Allocate sufficient funds to ensure access to and the sustained delivery of the full package of quality PHC Services by 2014.

2.1.1 Achieve a primary health care (PHC) expenditure of R950 per uninsured person by 2015 (in 2009 rands).

14) Provincial expenditure per PHC headcount.

R R219 [R2008/09

rands]

R 122 R 60 R 141 R 88 R 123 R 202

15) Provincial PHC expenditure per uninsured person

R R767 [R2008/09

rands

R 381 R 213 R 710 R 395 R 510 R 822 268.49

3. Improve the quality of health services.

3.1 Improve clinical governance in all six districts by employing Family Medicine Specialists and Family Medicine Registrars.

3.1.1 Employ 37 Family Medicine Specialists and 80 Family Medicine Registrars to work within the district health system.

16) The number of Family Physicians appointed in the District Health System

No 13 11 1 0 0 0 1

17) The number of Family Medicine registrars employed in the District Health System

No 30 16 6 0 5 0 3



• A total PHC headcount of 15 051 210 was recorded in 2008/09. This represents an increase of 13.4% from the 2007/08 financial year.

• The PHC supervision rate increased from 43.8% in2007/08 to 70.3% in 2008/09. The target of 100% indicates zero tolerance for no supervision being done. Even though that has not been achieved mainly due to the delay in appointing PHC managers across the province, this is a significant improvement and thus a rate of 100% is achievable over the MTEF period.

• The number of non-profit organisations (NPO) appointed home carers will not be expanded over the MTEF period, in light of the financial challenge of exiting from the European Union funding and the MTEF Expanded Public Works Programme budget envelope.

• The number of Family Medicine registrars in the District Health System (DHS) has increased from 18 in 2007/08 to 31 in 2008/09 and the employed Family Physicians in the DHS has increased from 9 in 2007/08 to 13 in 2008/09. The number of registrars is projected to be 50 and the number of Family Physicians is projected to be 16 by the end of the 2009/10 financial year.

• The number of prescriptions dispensed through the CDU has increased by 26% from 2007/08 to 2008/09. The service outputs will increase on average by 9.5% per annum in the outer two years of the MTEF period.



4.2 STRATEGIC OBJECTIVES, INDICATORS AND ANNUAL TARGETS FOR DISTRICT HEALTH SERVICES

Table 2.4: Strategic objectives, indicators and annual targets for District Health Services [DHS 4 & 5]

Strategic goal Strategic Objective: Title

Strategic Objective Statement Measure / Indicator Type

Baseline target Audited/ Actual performance Estimate MTEF Projection National

Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Increase access to PHC services in the DHS in the Western Cape

1.1.1 Achieve a PHC utilisation rate of 3.84 visits per annum by 2014/15.

Strategic objective baseline measure 1) Utilisation rate – PHC

No 3.84 2.3 2.4 2.8 2.96 (15 612 220/

5 321 416)

3.1 (17 466 401/

5 634 323)

3.2 (18 417 942/

5 755 607))

3.3 (19 393 727/

5 876 887)

3.5

2) PHC total headcount No 12 180 933 13 029 007 15 051 210 15 612 220 17 466 401 18 417 942 19 393 727

3) Utilisation rate – PHC under 5 years

No 4.8 4.9 4.9 5.06 (2 519 860/

497,996)

5.0 (2 636 075/

527 215)

5.0 (2 692 620/

538 524)

5.0 (2 749 160/

549 832)

5.5

4) PHC total headcount - under 5 years

No Not required to report

Not required to report

2 436 479 2 519 860 2 636 075 2 692 620 2 749 160

5) Supervision rate % 72% 44% 70% 86% (254/296)

100% (296/296)

100% (296/296)

100% (296/296)

100%

6) Percentage of community health centres with a resident doctor.

% Not required to report


100% 100% [53/53]

100% [53/53]

100% [53/53]

100% [53/53]

100%






70% [162/232]

80% [186/232]

90% [209/232]

8) Professional Nurse clinical workload (PHC)

No Not required to report

52.4 (15 051 210

/287 505)

51.4 (17 466 401

/ 318 553)

55 (17 466 401

/317 571)

55 (18 417 942

/334 872)

55 (19 393 727

/ 352 613)

40

9) Doctor clinical workload (PHC)

No 31 27 24 25 27 30 30

10) Number of NPO appointed home carers.

No 1 100 1 343 2 455 2 245 2 245 2 245 2 245

11) Total CBS headcount No Not required to report


2 024 061 3 135 789 3 300 000 3 500 000 3 710 000


No 792 807 780 782 872 872 872


No 700 000 1 420 500 1 919 172 1 928 710 1 938 354 2 122 498 2 324 135




Strategic Objective Statement Measure / Indicator Type

Baseline target Audited/ Actual performance Estimate MTEF Projection National

Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15




14) Provincial expenditure per PHC headcount in 2008/09 prices

R R246 R188 R232 R219 R239 R234 R231 R220

SO Baseline measure: 15) Provincial PHC expenditure

per uninsured person in 2008/09 prices

R R541 R556 R717 R767 R850 R909 R930 R910

3. Improve the quality of health services



SO Baseline measure: 16) Number of Family

Physicians appointed in the District Health System

No 37 Not required to report

9 13 16 20 24 28

SO Baseline measure: 17) Number of Family Medicine

registrars employed in the District Health System

No 80 Not required to report

18 30 50 70 80 80

Note:

Indicators 9 and 10 have been explained in the narrative below.



4.3 QUARTERLY TARGETS FOR DISTRICT HEALTH SERVICES

Table 2.5: Quarterly targets for District Health Services for 2010/11 [DHS6]

Strategic goal Strategic Objective Title Strategic Objective Statement Measure / Indicator Reporting period 2010/11

Quarterly targets (2010/2011)

Q1 Q2 Q3 Q4




1) Utilisation rate – PHC Quarterly 3.1 3.1 (4 366 600/ 1 408 581)

3.1 (4 366 600/ 1 408 581)

3.1 (4 366 600/ 1 408 581)

3.1 (4 366

600/ 1 408 581)

2) PHC total headcount Quarterly 15 612 220 3 903 055 3 903 055 3 903 055 3 903 055

3) Utilisation rate – PHC under 5 years Quarterly 5.0 5.0 (659 019/ 131 804)

5.0 (659 019/ 131 804)

5.0 (659 019/ 131 804)

5.0 (659 019/ 131 804)

4) PHC total headcount - under 5 years Quarterly 2 636 075 659 019 659 019 659 019 659 019

5) Supervision rate Quarterly 100%. 100% (296/296)

100% (296/296)

100% (296/296)

100% (296/296)

6) Percentage of community health centres and community day centres (CDCs) with a resident doctor.

Quarterly 100% [53/53]

100% [53/53]

100% [53/53]

100% [53/53]

100% [53/53])


Quarterly 70% (162/232).

70% (162/232)

70% (162/232).

70% (162/232).

70% (162/232).

8) Professional Nurse clinical workload (PHC) Quarterly 55 (17 466 401

/317 571)

55 (4 366 600/

79 392)

55 (4 366 600/

79 392)

55 (4 366 600/

79 392)

55 (4 366 600/

79 392)

9) Doctor clinical workload (PHC) Quarterly 25 25 25 25 25

10) Total number of NPO appointed home carers. Quarterly 2 245 2 245 2 245 2 245 2 245

11) Total CBS headcounts Quarterly 3 300 000 825 000 825 000 825 000 825 000


Quarterly 872 872 872 872 872


Quarterly 1 938 354 484 588 484 588 484 588 484 588



Strategic goal Strategic Objective Title Strategic Objective Statement Measure / Indicator Reporting period 2010/11

Quarterly targets (2010/2011)

Q1 Q2 Q3 Q4




14) Provincial expenditure per PHC headcount in 2008/09 prices

Quarterly R234 R234 R234 R234 R234

15) Provincial PHC expenditure per uninsured person in 2008/09 prices


3. Improve the quality of health services



16) The number of Family Physicians appointed in the District Health System

Annual 20 20 20 20 20

17) The number of Family Medicine registrars employed in the District Health System

Annual 70 50 50 50 70



• The Division anticipates the continued growth in patient numbers, as has been the trend over the last decade, as a result of increased disease burden and improved access to health services.

• In response to the above the Department has instituted a number of interventions. A primary aim is to ensure the ongoing strengthening of nurse and medical officer cadres at primary health care facilities, as is appropriate. Furthermore, regular monitoring, evaluation and support visits by supervisors continue to be emphasised. To this end the Division has committed itself to a 100% PHC supervision rate.

• The Community Based programme will be strengthened in the coming year with a continued increase in the enrolment of home based care (HBC) clients. In addition, HBC workers will be deployed to support prevention and promotion activities and to strengthen community-based interventions such as the Diarrhoeal Season Campaign.

• The expansion of the Chronic Dispensing Unit (CDU) is regarded as a key factor for improving patient care by reducing patient visits to Primary Health Care facilities for medication. In the coming year the aim is to introduce home deliveries and postal deliveries in some areas, in an attempt to further reduce the burden on staff in the PHC facilities.

• Improvements in clinical governance through ensuring that junior staff members receive ongoing clinical support aims to improve the quality of care delivered to patients as well as the efficiency of referrals. In this regard the role of the Family Physicians and Family Medicine Registrars is pivotal.


Table 2.6: Trends in provincial public health expenditure for District Health Services Sub-programme 2.1 – 2.5 [DHS12]

Expenditure Audited/actual Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total excluding capital 1 149 888 000 1 389 473 000 1 625 985 000 1 937 580 000 2 165 562 000 2 391 005 000 2 525 493 000

Total Capital 31 249 000 28 400 000 28 026 000 36 657 000 86 760 000 94 384 000 112 953 000

Grand Total 1 181 137 000 1 417 873 000 1 654 011 000 1 974 237 000 2 252 322 000 2 485 389 000 2 638 446 000

Total per person 223.76 262.97 300.02 350.39 391.33 422.91 439.88




Total Capital 35 536 738 30 700 400 28 026 000 59 490 368 75 360 430 77 145 718 87 060 852

Grand Total 1 343 203 170 1 532 720 713 1 654 011 000 1 816 413 376 1 956 384 908 2 031 457 871 2 033 636 608

Total per person 254.46 284.27 300.02 322.38 339.91 345.67 339.04


District Health Services [Sub-programmes 2.1 – 2.5] is allocated a nominal increase of R227.982 million or 11.77 per cent in 2010/11 in comparison to the revised estimate of 2009/10.



5. DISTRICT HOSPITAL SERVICES

5.1 SITUATION ANALYSIS INDICATORS FOR DISTRICT HOSPITALS

Table 2.7: Situation analysis indicators for district hospitals [DHS7]

Strategic goal Strategic Objective Strategic objective Statement Measure / Indicator Type

Province wide value

20008/09Metro

Cape Wine-lands

Central Karoo Eden Over-

berg West Coast



1.1 Increase access to acute services/district hospital services in the DHS in the Western Cape

1.1.1 Establish 2 673 acute district hospital beds in the DHS by 2014/15

1) Number of District Hospital beds No 2 312 951 266 120 418 193 354

2) Caesarean section rate for district hospitals

% 20.60% (6 093/ 2 964 )

27.80% (2 778/

10 000)

19.30% (902/

4 663)

20.00% (239/

1 196)

16.00% (974/

6 079)

21.60% (5 58/

2 585)

12.50% (642/

5 125)

16.2%

3) Total separations in District Hospitals No 221 365 91 755 25 608 11 521 39 087 16 328 37 066 1 716 911

4) Patient Day Equivalents in District Hospitals

No 963 020 446 037 108 860 45 972 165 669 66 158 130 325 10 740 610

5) OPD Total Headcounts in District Hospitals

No 840 179 409 610 84 777 28 597 143 953 54 942 118 300 7 486 845

6) Average length of stay in district hospitals

Days 3.1 days 3.4 days 3.1 days 3.2 days 3 days 2.9 days 2.5 days 4.3

7) Bed utilisation rate (based on usable beds) in district hospitals

% 80.90% 89.20% 83.00% 83.20% 77.10% 67.90% 70.30% 73.2

8) District hospitals with mortality and morbidity meetings every month

% 62.50% (20/32)

100.00% (7/7)

75.00% (3/4)

25.00% (1/4)

66.70% (4/6)

0.00% (0/0)

57.10% (4/7)

9) Percentage of district hospitals with clinical audit meetings every month.

% 75.5% 67.3% 90.2% 42.9% 73.7% 87.3% 60.5%


2.1 Allocate sufficient funds to ensure access to the full package of quality District Hospital Services by 2014

2.1.1 Achieve a provincial district hospital expenditure of R365 per uninsured person by 2015 (in 2009 rands).

10) Provincial district hospital expenditure per uninsured person

R R270[2008/09

rands]

R657 R69 R556 R301 R603 R195

11) Expenditure per patient day equivalent (PDE) in district hospitals

R R1 070[2008/ 09

rands]

R1 185 R 456 R 683 R 832 R 971 R1 332

• The caesarean section rate has remained at 20.6% in 2008/09. • The total separations increased from 203 932 in 2007/08 to 221 365 in 2008/09 and the total PDEs increased from 956 181 in 2007/08 to 963 020 in 2008/09. • The average length of stay decreased from 3.3 in 2007/08 to 3.1 days in 2008/09. • The total number of district hospital beds has increase to 2 452 in 2009/10, due to the shift of Victoria Hospital to the DHS from Sub-programme 4.1.



5.2 STRATEGIC OBJECTIVES, INDICATORS AND ANNUAL TARGETS FOR DISTRICT HOSPITALS [DHS 7 & 8]

Table 2.8: Strategic objectives, indicators and annual targets for district hospitals [DHS 7 & 8]

Strategic goal Strategic objective Title Strategic objective statement Measure / Indicator Type

Baseline target Audited/Actual performance Estimate Medium-term targets National

target

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15



1.1.1 Establish 2 673 acute district hospital beds in the DHS by 2014/15

Strategic objective [SO]: Baseline measure 1) Number of District

Hospital beds

No 2 673 1 570 2 292 2 312 2,452 2 452 2 554 2 664

2) Caesarean section rate for district hospitals

% 14.30% 20.6 20.6% 21.3% (6 508/

30 780)

20% 20% 20% 15%

3) Total separations in District Hospitals

No 144 373 203 932 221365 228 568 239 996 251 996 264 596

4) Patient Day Equivalents in District Hospitals

No 661 655 956 181 963 020 1 016 966 1 067 814 1 121 205 1 177 265

5) OPD Total Headcounts in District Hospitals

436 643 515 501 840 179 552 900 580 545 609 572 640 050

6) Average length of stay in district hospitals

Days 2.8 days 3.3 days 3.1 days 3.1 days 3.1 days 3.0 days 2.9 days 3.5 days


% 71.70% 79.30% 80.90% 78.5% 82% 84% 85% 75%


% 21.40% 71.4 62.50% 61.8% (21/34)

75% (26/34)

75% (26/34)

75% (26/34)




75.50% 76% (26/34)

80% (28/34)

80% (28/34)

80% (28/34)



2.1.1 Achieve a provincial district hospital expenditure of R365 per uninsured person by 2015 (in 2008/09 rands

SO Baseline measure 10) Provincial district hospital

expenditure per uninsured person.

Rand R365 R142 R234 R271 R323 R359 R367 R350

11) Expenditure per patient day equivalent (PDE) in district hospitals [Constant 2008/09 rands]

Rand R1 941 R785 R966 R1 070 R1 211 R1 196 R1 150 R1 089



5.3 QUARTERLY TARGETS FOR DISTRICT HOSPITALS

Table 2.9: Quarterly targets for district hospitals for 2010/11 [DHS9]

Strategic goal Strategic Objective SMART Objective Statement Measure/Indicator Reporting period

Annual target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4



1.1.1 Establish 2 273 acute district hospital beds in the DHS by 2014/15.

1) Number of district hospital beds Quarterly 2 452 2 452 2 452 2 452 2 452

2) Caesarean section rate for district hospitals Quarterly 20% 20% 20% 20% 20%

3) Total separations in district hospital Quarterly 239 996 59 999 59 999 59 999 59 999

4) Patient Day Equivalents in district hospital Quarterly 1 067 814 266 954 266 954 266 954 266 954

5) OPD Total Headcounts in district hospital Quarterly 580 545 145 136 145 136 145 136 145 136

6) Average length of stay in district hospitals Quarterly 3.1 3.1 3.1 3.1 3.1


Quarterly 82% 82% 82% 82% 82%


Quarterly 75% 75% (26/34) 75% (26/34) 75% (26/34) 75% (26/34)


Quarterly 80% 80% (27/34) 80% (27/34) 80% (27/34) 80% (27/34)



2.1.1 Achieve a provincial district hospital expenditure of R365 per uninsured person by 2015 (in 2008/2009 rands).

10) Provincial district hospital expenditure per uninsured person


11) Expenditure per patient day equivalent (PDE) in district hospitals [Constant 2008/09 rands]

Quarterly R1 196 R1 196 R1 196 R1 196 R1 196


ANNUAL PERFORMANCE PLAN: 2010/11

58

• It is projected that the caesarean section rate will increase to 21.3% in 2009/10, and to stabilize at 20% for the outer two years in the MTEF period. This reflects an increasing capacity at district hospital level through the introduction of the Family Physicians. It also represents a significant saving for the Department as fewer patients are inappropriately referred to secondary and tertiary levels.

• The expenditure per patient day equivalent (PDE) increased from R966 in 2007/08 to R1 070 in 2008/09.


District hospitals are allocated an additional R142.703 million in nominal terms or 10.75% in 2010/11 in comparison to the revised estimate of 2010/11.

Table 2.10: Trends in provincial public health expenditure for district hospitals [DHS12]

Expenditure Audited/actual outcome Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total excluding capital 456 673 000 854 454 000 1 030 902 000 1 327 240 000 1 469 943 000 1 577 262 000 1 663 742 000

Total Capital 58 649 000 55 281 000 132 460 000 202 073 000 388 071 000 480 449 000 459 434 000

Grand Total 515 322 000 909 735 000 1 163 362 000 1 529 313 000 1 858 014 000 2 057 711 000 2 123 176 000

Total per person 97.62 168.73 211.02 271.43 322.82 350.14 353.97




Total Capital 66 696 347 59 758 761 132 460 000 229 314 368 337 081 575 392 699 856 354 118 220

Grand Total 586 030 362 983 423 535 1 163 362 000 1 444 530 368 1 613 885 825 1 681 890 926 1 636 481 641

Total per person 111.02 182.39 211.02 256.38 280.40 286.19 272.83




6. HIV AND AIDS, STI’S AND TB CONTROL (HAST)

6.1 SITUATION ANALYSIS INDICATORS FOR HAST

Table 2.11: Situation analysis indicators for HIV and AIDS, STI's and TB control [HIV 1]


Strategic Objective: Statement Indicator Type

Province wide value

2008/09 Metro Cape

Winelands Central Karoo Eden Overber

g West Coast


1. Manage the burden of disease.

1.1 MDG Goal 6: Have halted and begun to reverse the spread of HIV and AIDS and TB by 2015

1.1.1 Implement an effective HIV prevention strategy to decrease the HIV prevalence in the age group 15-24 years to 8% in 2015.

Baseline measure: 1) HIV Prevalence in women aged 15 - 24

years*

% 10.9 Not measured at district

level.

Not measured at district level.

Not measured at district

level.


level.


level.


level.

2) Total registered patients receiving Antiretroviral Therapy (ART patients)

No 54 703 41 225 5 703 1 372 4 751 428 1 224

3) Number of new ART patients No 8 321 15 191 2 334 155 2 026 634 500

4) Fixed facilities with any ARV drug stock out

No 0.80% 0.20% 0.00% 0.00% 1.10% 0.00% 4.10%

5) Male condom distribution rate from public sector health facilities.

No 33.6 42.3 11.9 33.5 16.1 18 22.7 12.4

6) STI partner treatment rate % 19.90% (30 925/

155 841)

19.80% (11 815/ 59 571)

17.90% (2 348/

13 094)

17.20% (203/

1 178)

21.10% (2 297

/10 882)

23.70% (1 212 / 5 109)

19.20% (1 235/ 6 436)

7) Percentage of clients tested for HIV to those counselled (excluding antenatal)

% 95.1% (553 478/581 894)

94.3%(199 519/211 588)

97.3% (46 066/ 47 352)

94.7% (4 692/ 4 956)

98.1% (47 832/ 48 768)

97.9% (22 591/ 23 076)

96.2% (3 259/

34 566)

8) TB treatment interruption rate % 9.20% (2 404/

25 819)

9.50% (870/

9 116)

9.00% (254/

2 811)

11.40% (31/ 272)

7.60% (171/

2 262)

7.80% (64/817)

10.10% (144/

1 425)

9) TB sputa results received in less than 48 hours

% 53.90% (431 864

/813 306)

51.60% (142 538/ 276 472)

29.80% (27 429/ 91 901)

47.30% (3 298/ 6 976)

68.30% (55 368/ 81 058)

52.10% (17 313/ 33 255)

92.00% (43 380/ 47172)

10) New smear positive PTB ure rate % 77.80% (19 974/ 25 819)

76.60% (6 984/ 9 116)

77.40% (2 177/ 2 811)

78.30% (213/ 272)

80.20% (1 814/ 2 262)

85.40% (698/ 817)

77.50% (1 104/ 1 425)

11) Smear conversion rate at 2 months for new smear positive PTB cases

% 70.50% (17 845/ 25 291)

70.50% (6 329/ 8 974)

68% (1 823/ 2 662)

63% (156 /249)

70% (1 658/

2 374)

87% (630/ 738)

69% (911/

1 320)



60



Province wide value

2008/09 Metro Cape

Winelands Central Karoo Eden Overber

g West Coast


MDG goal 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

Reduce the mortality in children under the age of 5 years to 30 per 1000 live births by 2015.

12) Newborn baby NVP uptake % 98.6 (22 176/ 22 499)

98.5 (9 458/ 9 605)

98.5 (1 340/ 1 361)

100 (58/58)

99.8 (1 058/ 1 060)

99.5 (416/ 418)

99.0 (388/ 392)

73.6%

13) Newborn baby AZT uptake % 98.6 (22 176/ 22 499)

98.5 (9 458/ 9 605)

98.5 (1 340/ 1 361)

100 (58/58))

99.8 (1 058/ 1 060)

99.5 (416 /418)

99.0 (388 /392)

14) Antenatal client initiated on AZT during antenatal care



Not required to

report





15) Antenatal client Nevirapine uptake % Not required to report


Not required to

report





75.7%

16) PMTCT transmission rate % 5% (863/

18 949)

5% (376/

8 152)

4% (43/ 968)

15% (6/40)

4% (38 /944)

4% (15/ 396)

3% (9/ 297)

* At district level the numbers are too small to give a percentage for the age group 15-24 years. Data are reported from the national component of the antenatal survey.

• Based on the number of accredited sites, the number of patients already on ART and taking the Actuarial Society of South Africa modelling into account (namely, the number of HIV+ persons expected to enter stage 4 and therefore in need of ART), the number of patients expected to be in care by the end of a financial year is projected as the target for the year. Consideration is given to the funding available, but invariably the monthly enrolment targets are exceeded and additional funding is sought during the year to cover projected shortfalls. Additional funding is sought from National Treasury through the adjustment budget and through donor funding.

• The TB cure rate has also maintained its upward trajectory with the Overberg District achieving a cure rate in excess of the WHO benchmark.



6.2 STRATEGIC OBJECTIVES, INDICATORS AND ANNUAL TARGETS FOR HIV AND AIDS

Table 2.12: Strategic objectives, indicators and annual targets for HIV and AIDS, STI and TB control [HIV 2 and 3]

Strategic goal Strategic objective Title

Strategic objective statement Indicator Type

Baseline target Audited/actual performance Estimate MTEF projection National

Target

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15




Baseline measure 1. HIV Prevalence in women

aged 15 - 24 years *

% 8% 11.9 11.0 10.9 10.8 10 9.5 8.5 8

2. Total registered patients receiving Antiretroviral Therapy (ART patients)

No 26 111 37 435 54 703 68 236 90 968 11 2748 13 6607

3. Number of new ART patients No 12 529 13 928 8 321 22 270 26 976 30 681 36 342

4. Fixed facilities with any ARV drug stock out

% 0% 0% 0.80% 0% (0/296)

0% (0/296)

0% (0/296)

0% (0/296)

5. Male condom distribution rate from public sector health facilities

No 34.9 41.1 33.6 39.2 (17 440 929/

1 909 053)

52 (104 000 000/

2 000 000)

69 (200 000 000/

2 898 552)

75 (217 000 000/

2 893 333)

15

6. STI partner treatment rate % 19.75% 18.90% 19.90% 19.23% (4 024/

20 928)

21% (19 320/ 91 000)

22% (20 120/ 91 500)

23% (20 930/ 91 000)

7. Percentage of clients tested for HIV to those counselled (excluding antenatal)

% 97.2% 95.1% 95.1% 94.4% (400 796/ 424 400)

91% (503 858/ 554 244)

91% (572 566/ 629 /823)

91% ( 600 000/ 660 000)

8. TB treatment interruption rate % 11.10% 9.60% 9.20% 9.10% (1 616/

17 740)

9% (1 446/

16 076)

8% (1 273/

15 915)

7% (1 102/

15 755)

5%

9. TB sputa results received in less than 48 hours

% 67% 65% 53.90% 52.4% (310 904/ 593 116)

52% (37 134/ 71 412)

53% (39 840/ 75 171)

54% (43 934/ 81 360)

80%

10. New smear positive PTB cure rate

% 71.90% 77.50% 77.80% 78.2% (13 864/ 17 740)

79% (12 700/ 16 076)

80% (12 732/ 15 915)

80% (12 604/ 15 755)

11. Smear conversion rate at 2 months for new smear positive PTB cases

% 72.20% 71.20% 70.60% 73.6% (9 480/

12 884)

74% (11 896/ 16 076)

75% (11 936/ 15 915)

76% 11 973/ 15 755)

75%



62

Strategic goal Strategic objective Title

Strategic objective statement Indicator Type


Target

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15

1.2 MDG goal 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

1.2.1 Reduce the mortality in children under the age of 5 years to 30 per 1000 live births by 2015.

12. Newborn baby NVP uptake % 67 73 90 90 (10 322/ 11 469)

95 (13 300/ 14 000)

95 (13 680/ 14 400)

95 (14 060/ 14 800)

95%

13. Newborn baby AZT uptake % 67 73 90 90 (10 322/ 11 469)

95 (13 300/ 14 000)

95 (13 680/ 14 400)

95 (14 060/ 14 800)

95%

14. Antenatal client initiated on AZT during antenatal care

% Not required

to report.

Not required

to report.

Not required

to report.

Not required

to report.

90% 95% 95% 100%

15. Antenatal client nevirapine uptake

% Not required

to report.

Not required

to report.

Not required

to report.

Not required

to report.

90% 95% 95% 95%

16. PMTCT transmission rate % 5.50% 5.20% 4.50% 4.00% (495/

12 372)

3.00% 3.00% 3.00%

• Data are reported from the national component of the antenatal survey. Numerators and denominators cannot be provided as the estimates are determined by a survey.



6.3 QUARTERLY TARGETS FOR HAST

Table 2.13: Quarterly targets for HIV and AIDS, STI and TB control [HIV4]

Strategic goal Strategic Objective SMART Objective Statement Performance indicator/ Measure Reporting period

Annual Target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4




1) HIV Prevalence in women aged 15 - 24 years * Annually 10 - - - -

2) Total registered patients receiving Antiretroviral Therapy (ART patients)

Quarterly 90, 968 78 083 82 942 87 003 90 968

3) Number of new ART patients Quarterly 26976 6744 6744 6744 6744

4) Fixed facilities with any ARV drug stock out. Quarterly 0 (0/296)

0 (0/296)

0 (0/296)

0 (0/296)

0 (0/296)

5) Male condom distribution rate from public sector health

Quarterly 52 (104 000 000/

2 000 000)

52 (26 000 000/

500 000)

52 (26 000,000/

500 000)

52 (26 000 000/

500 000)

52 (26 000 000/

500 000)

6) STI partner treatment rate Quarterly 21%(19 320/ 91 000)

21% (4 830/22 750)

21% (4 830/

22 750)

21% (4 830/

22 750)

21% (4 830/

22 750)

7) Percentage of clients tested for HIV to those counselled (excluding antenatal)

Quarterly 91% (503 858/ 554 244)

91% (125 965/ 138 561)

91% (125 965/ 138 561)

91% (125 965/ 138 561)

91% (125 965/ 138 561)

8) TB treatment interruption rate Quarterly 9%(1 446/

16 076)

9% (362/ 4 019)

9% (362/ 4 019)

9% (362/ 4 019)

9% (362/ 4 019)

9) TB sputa results received in less than 48 hours Quarterly 52% (37 134/ 71 412)

52% (9 284/

17 853)

52% (9 284/

17 853)

52% (9 284/17,853)

52% (9 284/

17 853)

10) New smear positive PTB cure rate Quarterly 79%(12 700/16 076)

79% (3 175/ 4 019)

79%(3 175/ 4 019)

79%(3 175/ 4 019)

79% (3 175/ 4 019)

11) Smear conversion rate at 2 months for new smear positive PTB cases

Quarterly 74%(11,896/ 16,076)

74% (2 974/ 4 019)

74% (2 974/ 4 019)

74% (2 974/ 4 019)

74% (2 974/ 4 019)

1.2 MDG goal 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate..


12) Newborn baby NVP uptake Quarterly 95%(13 300/ 14,000)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

13) Newborn baby AZT uptake Quarterly 95% (13 300/ 14 000)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

95% (3 325/ 3 500)

14) Antenatal client initiated on AZT during antenatal care

Quarterly 90% 90% 90% 90% 90%

15) Antenatal client nevirapine uptake Quarterly 90% 90% 90% 90% 90%

16) PMTCT transmission rate Quarterly 3% 3% 3% 3% 3%

* Data are reported from the national component of the antenatal survey. Numerators and denominators cannot be provided as the estimates are determined by a survey.



64


• Current funding from the National HIV Conditional Grant, the Global Fund and Pepfar allows for the attainment of all the performance targets in the HIV programme, including the Antiretroviral Treatment (ART) sub-programme.

• The Department is in the process of submitting a proposal to the Global Fund for continued funding for the HIV programme. If successful, funding for an additional six years will be secured. PEPFAR funded agencies have also undertaken to continue providing donations in kind to alleviate pressures in the ART sub-programme.

• TB services are funded mainly through the Equitable Share and certain aspects of the programme are funded through a National Global Fund grant. Performance targets are met with the available budget but additional funding would allow expansion of the Enhanced Response and improve the organization of in-patient TB services in the province. It is the Department’s aim to reach an 80% cure rate for the Province by the end of the MTEF period.

Table 2.14: Trends in provincial public health expenditure for HIV and AIDS Conditional Grant

[HIV5]

Expenditure Audited/ actual outcome Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 168 579 000 239 899 000 268 931 000 383 538 000 554 054 000 648 314 000 738 098 000

Total per person 31.94 44.49 48.78 68.07 96.26 110.32 123.05



Total 191 710 062 259 330 819 268 931 000 355 923 264 481 255 737 529 906 014 568 904 239

Total per person 36.32 48.10 48.78 63.17 83.62 90.17 94.85


Table 2.15: Trends in provincial public health expenditure on HIV and AIDS and Global Fund

Sub-programmes 2.6 and 2.10

Expenditure Audited/ actual outcome Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 249 129 000 324 575 000 382 307 000 491 966 000 564 767 000 648 314 000 738 098 000

Total per person 47.20 60.20 69.35 87.32 98.12 110.32 123.05



Total 283 312 488 350 865 575 382 307 000 456 544 448 490 561 134 529 906 014 568 904 239

Total per person 53.67 65.07 69.35 81.03 85.23 90.17 94.85




7. MATERNAL, CHILD AND WOMEN’S HEALTH AND NUTRITION [MCWH & N]

7.1 SITUATION ANALYSIS INDICATORS FOR MCWH & N

Table 2.16: Situation analysis indicators for MCWH & N [MCWH1]



Province wide value

2008/09 Metro

Cape Wine-lands


berg West Coast





1) Under-5 mortality rate Rate 38.6 Not required to report






2) Immunisation coverage under 1 year

% 96.5% (94 540/ 98 008)

93.9% (62 244/ 66 313)

95.7% (11 975/ 12 519)

112.0% (1 276/ 1 139)

113.0% (10 091/

8 933)

94.8% (3 865/ 4 065)

101.2% (5 089/ 5 029)

89.5%

3) Vitamin A coverage under 1 year

% 99.7% (97 726/ 98 008)

97.0% (64 292/ 66 313)

98.4% (12 320/ 12 519)

118.0% (1 344/ 1 139)

118.5%(10 589/

8 933)

96.3% (3 924/ 4 075)

104.5% (5 257/ 5 029)

98.7%

4) Vitamin A coverage - new mothers








78.4%

1.2 MDG goal 5: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.

1.2.1 Reduce the maternal mortality ratio to 90 per 100 000 live births by 2015.

5) Measles coverage under 1 year % 88.8% (87 001/ 98 008)

84.8% (56 244/ 66, 13)

91.4% (11 442/ 12 519)

113.6% (1 294/ 1 139)

106.0% (9 466/ 8 933)

86.5% (3, 26/ 4 075)

100.2% (5 039/ 5 029)

91.7%

6) Pneumococcal 1st dose coverage under 1 years








7) Rotavirus 1st dose coverage under 1 year








8) Maternal mortality rate Rate Not required to report







9) Institutional maternal mortality rate

No per 100 000










66



Province wide value

2008/09 Metro

Cape Wine-lands


berg West Coast


10) Cervical cancer screening coverage

% 5.2% (63 127/

1 213 224)

4.3% (34 669/

802 012)

6.6% (10 381/

158 415)

9.0% (1 114/

12, 334)

7.2% (8 747/

121 466)

5.5% (2 866/

51 891)

8.0% (5 350/

67 106)

43.9%

11) Total deliveries in facilities No 94 139 63 269 12 242 1 196 9 280 3 027 5 125 945 223

12) Delivery rate for women under 18 years

% 7.9% (7 412/

94,139)

7.1% (4 520/

63 269)

9.8% (1 194/

12 424)

9.0% (108/

1 196)

8.9% (826/

9 280)

7.7% (232/

3027)

10.4% (532/ 5 25)

8.8%

13) Antenatal visits before 20 weeks rate

No 42% (45 787/

108 243)

33% (22 339/ 67 084)

52% (8 532/

16 285)

62% (862/

1 397)

59% (7 234/

12 289)

58% (2 690/ 4 626)

63% (4 130/ 6 562)

32.5%

• The Department has consistently reported immunization coverage in excess of 90% over the past MTEF period. The current detection of measles cases challenges the efficacy of the departmental Expanded Programme of Immunisation. This is a source for concern and requires more in-depth assessment to ascertain the actual immunization coverage levels.

• Cervical cancer screenings targets remain unmet. This puts large numbers of women at risk and remains a constant challenge for the Department.

• Similarly, the percentage of women attending antenatal facilities before the 20th week of their pregnancies remains unacceptably low in certain Districts.



7.2 STRATEGIC OBJECTIVES, INDICATORS AND ANNUAL TARGETS FOR MCWH & N

Table 2.17: Strategic objectives, indicators and annual targets for MCWH & N [MCWH & N 2 AND 3]

Strategic goal Strategic Objective: Title Strategic Objective: Statement Performance Indicator Type

Baseline target Audited/ Actual performance Estimate MTEF projection National

target

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 MDG goal 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.


Strategic objective: Baseline measure 1) Under-5 mortality rate*

Rate 30 38.8 38.6 38.6 37 35 33

2) Immunisation coverage under 1 year

% 92.90% 100.5% 96.5% 99.3% (97 756/ 98 404)

95% (98 966/1

04 175)

95% (101 092/ 106,413)

95% (103,218/ 108,651)

90%

3) Vitamin A coverage under 1 year

% 68.60% 91.60% 99.7% 91.2% (89 696/ 98 404)

93% (96 883/

104 175)

93% (98,964/

106 413)

93% (101 045/ 108 651)

90%

4) Vitamin A coverage - new mothers





85% 90% 90% 90%



5) Pneumococcal 1st dose coverage under 1 years

Rate Not required to report




93% (96 883/

104 175)

93% (98 964/

106 413)

93% (101 045/108 651)

90%

6) Rotavirus 1st dose coverage under 1 year





93% (96 883/ 104 175)

93% (98 964/

106 413)

93% (101 045/108 651)

90%

7) Measles coverage under 1 year

% 93.70% 102.80% 100% 101.1% (24 864/ 24 601)

95% (98 966/

104 175)

95% (101 092/106 413)

95% (103 218/

10 651)

90%

8) Maternal mortality rate* Rate 90 98.8 98 97 95 93

9) Institutional maternal mortality rate




57.3 (57/ (97 773

x 100 000)

52.3 47.3 42.3

10) Cervical cancer screening coverage

% 6.30% 5.10% 5.2% 6.2% (75 460/

1 218 12)

10% (128, 998/

1 289 981)

11% (144 957/

1 317 791)

12% (161 472/

1 345 600)

40%

11) Total deliveries in facilities

No 95 289 97 404 94 139 92 000 92 500 93 000 93 500 75%

12) Delivery rate for women under 18 years

Rate 10.10% 7.50% 7.90% 7.80% (7 640

97 868)

7.50% 7.50% 7.50% 10

13) Antenatal visits before 20 weeks

% 37% 39% 44.20% 48.8% (11 921/ 24 439)

65% 70% 70% 70%

* Numerators and denominators cannot be provided as the estimates are determined using routine health statistics.



68

7.3 QUARTERLY TARGETS FOR MCWH&N

Table 2.18: Quarterly targets for MCWH&N for 2010/11 [MCWH4]

Strategic goal Strategic Objective: Title SMART Objective

Statement Indicator Reporting

period

MTEF projection

2010/11

QUARTERLY TARGETS

Q1 Q2 Q3 Q4




1) Under-5 mortality rate Annual 37

2) Immunisation coverage under 1 year Quarterly 95%(98 966/

104 175)

95% (24 742/ 26 044)

95% (24 742/2

6 044)

95% (24 742/2

6 044)

95% (24 742/2

6 044)

3) Vitamin A coverage under 1 year Quarterly 93%(96 883/

104 175)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

4) Vitamin A coverage - new mothers Quarterly 85 85 85 85 85



5) Measles coverage under 1 year Quarterly 95%(98 966/

104 175)

95% (24 742/ 26 044)

95% (24 742/ 26 044)

95% (24 742/ 26 044)

95% (24 742/ 26 044)

6) Pneumococcal 1st dose coverage under 1 years Quarterly 93%(96 883/

104 175)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

7) Rotavirus 1st dose coverage under 1 year Quarterly 93%(96 883/

104 175)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

93% (24 221/ 26 044)

8) Maternal mortality rate Annual 97 - - - -

9) Institutional maternal mortality rate Annual 52.3

10) Cervical cancer screening coverage Quarterly 10% (128 998/

1 289 981)

10% (322 250/322 495)

10% (322 250/322 495)

10% (322 250/322 495)

10% (322 250/322 495)

11) Total deliveries in facilities Quarterly 92 500 23 125 23 125 23 125 23 125

12) Delivery rate for women under 18 years Quarterly 7.50% 7.50% 7.50%) 7.50% 7.50%

13) Antenatal visits before 20 weeks rate Quarterly 65% 65% 65% 65% 65%



• The Department is currently piloting an intervention which attempts to heighten activity across the service delivery platform to address the challenges of cervical cancer. Following an audit of the existing services, the intention is to strengthen the capacity of PHC facilities to perform screening test for cervical cancer (Papanicolaou (pap) smears). This will be done mainly through outreach and support from Level 1 and Level 2 Hospitals. The Department aims to reach a 12% screening rate by the end of the MTEF period.

• The Department is committed to aggressively implement the recommendations of the Saving Mothers and Saving Babies Reports. In this regard the key interventions will be the strengthening of nurse cadres working at Midwife Obstetric Unit level (both quantitatively and qualitatively), increasing access to antenatal care through the implementation of Basic Antenatal Care, enhancing antenatal ultrasonographic capabilities, and through the expansion of the number of Kangaroo Mother Care beds, as well as through improved Family Planning Services.


7.4.1 Maternal, child and women’s health

Funds allocated by the National Treasury for the Pneumococcal and Rotavirus vaccines are as follows:

Table 2.19: Funds allocated by National treasury for MTEF period

Adjustment budget 2008 2009/2010 20/10/2011 2011/2012

R4 449 000 R35 926 000 R54 595 000 R73 734 000

Table 2.20: Allocation of fund

District Population 2010

90% of population

2010 Population

2011

90% of population

2011 Allocation

2009/10 Allocation

2010/11 Allocation

2011/12

Cape Town 66 849 60 164 67 117 60 405 R 24 338 000 R 36 174 647 R 48 856 148

Cape Winelands

12 620 11 358 12 671 11 404 R 4 550 000 R 6 911 727 R 9 334 724

Central Karoo 1 148 1 033 1 153 1 038 R 418 000 R 633 302 R 855 314

Eden 9 005 8 105 9 041 8 137 R 3 279 000 R 4 984 524 R 6 731 914

Overberg 4 108 3 697 4 125 3 713 R 1 495 000 R 2 271 152 R 3 067 334

West Coast 5 069 4 562 5 089 4 580 R 1 846 000 R 3 619 649 R 4 888 564

Grand Total 98 799 88 919 99 196 89 276 R 35 926 000 R 54 595 000 R 73 734 000

The EPI was enhanced during 2009 by the addition of two new vaccines to this schedule:

1) Pneumococcal vaccine (PCV) was implemented on the 1st July 2009. Each child requires three doses, which are administered at 6 weeks, 14 weeks and 9 months. The cost per dose is R253.

2) Rotavirus vaccine was implemented on the 1st November 2009. Each child requires two doses, administered at 6 and 14 weeks. The cost of the vaccine per dose is currently R84.



70

7.4.2 Nutrition

An additional amount of R2.797 million or 14.03 per cent, in nominal terms, has been allocated to Nutrition.

Table 2.21: Trends in provincial public health expenditure on INP

Expenditure Audited/actual outcome Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 15 136 000 16 810 000 17 068 000 19 933 000 22 730 000 24 327 000 25 847 000

Total per person 2.87 3.12 3.10 3.54 3.95 4.14 4.31



Total 17 212 841 18 171 610 17 068 000 17 195 840 19 743 460 19 883 920 19 922 108

Total per person 3.26 3.37 3.10 3.05 3.43 3.38 3.32


Three key priorities identified for 2010/11 in the nutrition programme;

• Adequate and optimal feeding for children especially for the 0–2 year age group

• Prevention and treatment of nutrition-related diseases

• Improvement of nutritional status through targeted micronutrient supplementation



8. DISEASE PREVENTION AND CONTROL

8.1 SITUATION ANALYSIS INDICATORS FOR DISEASE PREVENTION AND CONTROL

Table 2.22: Situation analysis indicators for disease prevention and control {DCP1]


SMART Objective: Statement Indicator Type

Province wide value

2008/09 Metro

Cape Wine-lands

Central Karoo Eden Over-berg West

Coast




1.1.1 Achieve a PHC utilisation rate of 3.85 visits per person per annum by 2014/15

1) Outbreaks responded to within 24 hours

% 100% 100% 100% 100% 100% 100% 100% 1.13

2) Malaria fatality rate (annual) % 0 0 0 0 0 0 0 1.06

3) Cholera fatality rate (annual) 0 0 0 0 0 0 0

4) Percentage of bacteriological water samples taken from water services authorities conforming to standards

% 92% Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

5) Percentage of households with access to potable water within 200m

% Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

Not required to

report previously

6) Cataract surgery rate (annual) No /million population

1070 1 070



72

8.2 STRATEGIC OBJECTIVES, INDICATORS AND TARGETS FOR DISEASE PREVENTION AND CONTROL [DCP2]

Table 2.23: Strategic objectives, indicators and annual targets for disease prevention and control [DCP 3]


Strategic Objective Statement Indicator Type


target

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2008/09




1) Outbreaks responded to within 24 hours

% 100% 100% 100% 100% 100% 100% 100% 100% 1.13

2) Malaria fatality rate (annual) % 0 0 0 0 0 0 0 1.06

3) Cholera fatality rate (annual) 0 0 0 0 0 0 0


% New indicator

New indicator

92% 94.50% (8 444/ 8 932)

93% 94% 94.50%

5) Percentage of households with access to potable water within 200m

% New indicator

New indicator

New indicator

74.9% (3 540 308/ 4 728 006)

80% 80% 81%

6) Cataract surgery rate (annual) No/million population

1 287 1 033 1,070 1 800 2 000 2 050 2100 1.059 per million

population

8.3 QUARTERLY TARGETS FOR DISEASE PREVENTION AND CONTROL

Table 2.24: Quarterly targets for disease prevention and control for 2010/11 [DCP4]

Strategic goal Strategic Objective Strategic Objective Statement Indicator Reporting

period MTEF

projection 2010/11

Quarterly Targets

Q1 Q2 Q3 Q4




1) Outbreaks responded to within 24 hours Quarterly 100% 100% 100% 100% 100%

2) Malaria fatality rate (annual) Annual 0 0 0 0 0

3) Cholera fatality rate (annual) Annual 0 0 0 0 0


Quarterly 93% 93% 93% 93% 93%

5) Percentage of households with access to potable water within 200m as in table 2.23

Quarterly 80% 80% 80% 80% 80%

6) Cataract surgery rate (annual) Annual 2 000 2 000 2 000 2 000 2 000

.



• It is anticipated that the current measles outbreak will present a great challenge to the Programme in the upcoming year. The Department’s ability to contain this will be determined by the availability of sufficient vaccines and the capacity to deliver them rapidly.

• Funding for the provision of vaccines for H1N1 Influenza will have to be made available. A concerted media campaign will also be required to mitigate the impact of H1N1.

9. RECONCILING PERFORMANCE TARGETS WITH EXPENDITURE TRENDS

Programme 2 is allocated 35.30 per cent of the total vote in 2010/11, in comparison to the 35.78 per cent that was allocated in the revised estimate for 2009/10. This translates to a nominal increase of R 446.283 million or 11.82%.

Table 2.25: Trends in provincial public health expenditure District Health Services [Programme 2]

Expenditure Audited /actual Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital 89 898 000 83 681 000 160 486 000 238 730 000 474 831 000 574 833 000 572 387 000

Grand Total 2 012 690 000 2 791 259 000 3 300 286 000 4 015 450 000 4 697 834 000 5 215 742 000 5 525 568 000

Total per person 381.29 517.69 598.63 712.68 816.22 887.50 921.21




Total Capital 102 233 084 90 459 161 160 486 000 288 804 736 412 442 005 469 845 574 441 179 072

Grand Total 2 288 855 220 3 017 350 979 3 300 286 000 3 734 684 960 4 080 576 195 4 263 139 549 4 258 945 367

Total per person 433.61 559.62 598.63 662.85 708.97 725.41 710.04




74

Table 2.26: District health services [DHS11]



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

District Management 94 151 103 010 164 641 187 565 207 443 222 350 242 509 9.07 314 090 330 530

Community Health Clinics a 372 910 430 608 649 969 750 561 757 050 766 444 871 457 13.70 947 369 1 001 441

Community Health Centres a 552 220 677 703 705 342 800 149 807 629 826 934 922 077 11.51 992 975 1 049 281

Community Based Services a 98 295 125 738 106 033 117 802 121 113 121 851 129 518 6.29 136 570 144 240 Other Community Services 32 312 52 414 1 1 1 1 1 1

HIV and Aids b 168 579 239 899 268 931 309 913 383 538 383 538 554 054 44.46 648 314 738 098 Nutrition 15 136 16 810 17 068 18 452 18 530 19 933 22 730 14.03 24 327 25 847 Coroner Services 51 966 122 266 83 538 1 1 1 1 1 1

District Hospitals a 456 673 854 454 1 030 902 1 245 566 1 309 500 1 327 240 1 469 943 10.75 1 577 262 1 663 742 Global Fund 80 550 84 676 113 376 73 620 108 428 108 428 10 713 (90.12)

1 922 792 2 707 578 3 139 800 3 503 630 3 713 233 3 776 720 4 223 003 11.82 4 640 909 4 953 181

b Conditional grant: Comprehensive HIV and Aids: R554 054 000 (Compensation of employees R156 449 000; Goods and services R255 058 000,Transfers and subsidies R138 577 000 and Payments for capital assets R3 970 000).

Note: A contributing factor to the increase of funding in this programme is the allocation of Victoria Hospital from sub-programme 4.1 to sub-programme 2.9with effect of 1 April 2009.

6.

2010/11: Conditional grant: Health Professions Training and Development: R97 163 000 (Compensation of employees R77 730 000; Goods andservices R19 433 000).


a

Note: Contributing factors to the increase of funding in this programme in 2007/08 are the creation of the District Health Service structures in sub-programme2.1 and the allocation of GF Jooste, Helderberg and Karl Bremer Hospitals from sub-programme 4.1 to sub-programme 2.9 and Nelspoort Hospital from sub-programme 4 4 to sub programme 2 4Note: A contributing factor to the decrease of funding in sub-programme 2.5 in 2008/09 is the shift of allocations to more appropriate sub-programmes withinprogramme 2 (mostly to sub-programme 2.2).

9.

Note: The Forensic Services previously in sub-programme 2.8 has been transferred to sub-programme 7.3 with effect of 1 April 2009.

Revised estimate


Main appro-priation


Outcome

5.

2.

3.

7.

8.

Sub-programmeR'000

10.

4.

1.



Table 2.27: Payments and estimates by economic classification: District Health Services [DS11]



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Current payments 1 615 253 2 299 185 2 730 836 3 071 360 3 211 440 3 264 704 3 726 849 14.16 4 122 993 4 402 322 Compensation of employees 940 896 1 399 729 1 699 818 1 884 033 1 994 863 2 015 927 2 280 741 13.14 2 457 667 2 585 509

Salaries and wages 830 633 1 234 751 1 501 085 1 620 024 1 725 728 1 794 175 2 023 503 12.78 2 178 933 2 292 591 Social contributions 110 263 164 978 198 733 264 009 269 135 221 752 257 238 16.00 278 734 292 918

Goods and services 674 357 899 456 1 030 729 1 187 327 1 216 577 1 248 777 1 446 108 15.80 1 665 326 1 816 813 of which

35 8 1 6 1 (100.00) 1 746 3 001 783 3 937 1 899 1 799 5 064 181.49 5 423 5 849

10 752 16 335 12 580 17 039 14 360 11 571 12 902 11.50 13 931 14 906 284 572 561 677 657 (100.00) 6

738 1 239 1 786 1 692 1 909 1 250 1 425 14.00 1 552 1 663 15 030 19 485 20 577 23 938 22 708 19 293 22 298 15.58 24 084 25 770 6 967 7 050 4 513 4 184 4 380 3 860 4 238 9.79 4 584 4 903 3 643 5 101 4 522 3 945 4 420 4 339 2 614 (39.76) 913 981

8 646 85 402 117 715 145 907 154 862 178 598 180 002 210 057 16.70 232 695 254 609

38 11 2 19 9 8 8 8 10 18 292 21 212 19 396 23 871 21 951 23 377 25 022 7.04 28 557 30 558 57 154 90 016 109 097 94 500 126 718 123 585 119 927 (2.96) 129 512 138 574

51 23 36 133 95 40 50 25.00 55 60 15 445 22 563 26 436 25 032 31 260 39 462 45 750 15.93 57 176 64 420 5 293 9 207 8 828 13 496 12 298 11 017 12 267 11.35 13 250 14 178 3 102 2 419 4 898 5 732 5 393 3 866 4 223 9.23 4 556 4 884

332 816 428 854 484 911 610 327 590 536 639 989 765 216 19.57 914 130 1 002 552 13 841 18 585 21 952 23 982 31 849 30 318 34 484 13.74 37 344 39 955 12 740 14 714 18 968 20 688 21 974 17 631 20 863 18.33 22 520 24 108 4 065 8 719 9 157 16 265 7 773 5 062 5 515 8.95 5 962 6 375

43 822 57 467 73 898 69 417 76 244 81 522 92 913 13.97 100 347 107 374

804 490 862 680 1 052 908 976 7.49 1 053 1 127

23 682 34 340 40 596 46 726 41 455 35 533 42 542 19.73 46 072 49 959 8 698 8 543 8 439 13 414 12 447 9 047 12 106 33.81 15 032 16 143 9 148 10 092 9 869 9 962 3 429 2 715 2 748 1.22 2 960 3 168 761 1 049 2 155 3 479 3 137 1 925 2 900 50.65 3 610 4 687 Interest and rent on land 289

Interest 289

Transfers and subsidies to 279 899 307 597 323 408 352 550 405 345 406 636 434 195 6.78 456 989 486 449 Provinces and municipalities 139 797 150 924 165 186 191 557 229 551 229 551 240 191 4.64 253 141 268 952

Municipalities 139 797 150 924 165 186 191 557 229 551 229 551 240 191 4.64 253 141 268 952 Municipalities 139 797 150 924 165 186 191 557 229 551 229 551 240 191 4.64 253 141 268 952

564 Non-profit institutions 137 859 154 685 155 029 157 767 172 568 172 568 190 573 10.43 200 250 213 690

Households 2 243 1 988 3 193 3 226 3 226 4 517 3 431 (24.04) 3 598 3 807 Social benefits 2 003 1 988 3 193 3 226 3 226 4 377 3 281 (25.04) 3 441 3 641 Other transfers to households 240 140 150 7.14 157 166

Payments for capital assets 27 433 99 998 85 069 79 720 96 448 105 189 61 959 (41.10) 60 927 64 410 Buildings and other fixed structures 4 904 49 609 48 754 27 050 42 816 42 837 (100.00)

Buildings 4 904 49 609 48 754 27 050 42 816 42 837 (100.00) Machinery and equipment 22 517 50 352 36 307 52 670 53 632 62 263 61 959 (0.49) 60 927 64 410

Transport equipment 4 636 9 024 3 917 5 433 6 381 7 967 4 905 (38.43) 5 146 5 438 Other machinery and equipment 17 881 41 328 32 390 47 237 47 251 54 296 57 054 5.08 55 781 58 972

12 37 8 89 (100.00)

48 558 27 050 43 016 43 037 4 967 (88.46) 5 213 5 512

Payments for financial assets 207 798 487 191 (100.00)

Total economic classification 1 922 792 2 707 578 3 139 800 3 503 630 3 713 233 3 776 720 4 223 003 11.82 4 640 909 4 953 181

Revised estimate


Communication



Outcome

Main appro-priation

Adjusted appro-

priation

Computer services


Cons/prof: Business and advisory servicesCons/prof: Infrastructure & Cons/prof: Laboratory servicesCons/prof: Legal costContractors

Administrative feesAdvertisingAssets <R5 000Audit cost: ExternalBursaries (employees)Catering: Departmental activities

Agency and support/outsourced servicesEntertainment

Inventory: Raw materialsInventory: Medical supplies


Inventory: Other consumables Inventory: Stationery and printingLease paymentsOwned and leasehold property expenditureTransport provided departmental activityTravel and subsistenceTraining and staff developmentOperating expenditureVenues and facilities


Of which: "Capitalised Goods and services" included in Payments for capital assets

PART B: PROGRAMME 3: EMERGENCY MEDICAL SERVICES


PROGRAMME 3: EMERGENCY MEDICAL AND RESCUE SERVICES


The rendering of pre-hospital Emergency Medical Services including inter-hospital transfers, and Planned Patient Transport.

The clinical governance and co-ordination of Emergency Medicine within the Provincial Health Department.

The co-ordination for the Department of Health of preparation for the FIFA 2010 World Cup Soccer Tournament.

1.1 EMERGENCY MEDICAL SERVICES’ VISION FOR 2009-2014

“To be the leading Emergency Medical Service through quality patient care”

1.2 EMERGENCY MEDICAL SERVICES MISSION STATEMENT FOR 2009 - 2014

“Our Mission is to respond to the Constitutional imperative of the universal individual right of:

• Access to emergency care, through the delivery of a comprehensive well co-ordinated EMS system consisting of:

o Communication Services

o Ambulance Services

o Rescue Services

o Aeromedical Services

o Patient Transport Services and

o Emergency Centers

• Staffed by passionate, performance focused, proficient personnel using cutting edge technology solutions in a culture of:

o Compassion

o Diligence

o Integrity

o Honesty

o Accountability

o Respect And Dignity

• With the best possible patient outcomes.




2.1 SUB-PROGRAMME 3.1: EMERGENCY MEDICAL SERVICES

Rendering Emergency Medical Services including ambulance services, special operations, communications and air ambulance services.

Emergency Medicine and the FIFA 2010 World Cup are reflected as two separate objectives within Sub-programme 3.1: Emergency Medical Services

2.2 SUB-PROGRAMME 3.2: PLANNED PATIENT TRANSPORT (PPT) - HEALTHNET

Rendering planned patient transport including local outpatient transport (within the boundaries of a given town or local area) and inter-city/town outpatient transport (into referral centres).

3. SITUATION ANALYSIS INDICATORS FOR EMS

Table 3.1: Situation analysis indicators for EMS and patient transport [EMS1]

Strategic objective

SMART objective statement

Indicator Type Province wide value

2008/09

Cape Town

District2008/09

West Coast

District2008/09

Cape Winelands

District 2008/09

Overberg District 2008/9

Eden District 2008/9

Central Karoo District2008/9

National Average2007/08

Provide roadside to bedside definitive emergency care with defined emergency time frames within and across geographic and clinical service platforms.

To meet the response time performance for urban and rural clients and ensure the shortest time to definitive care by integrated management of pre-hospital and hospital emergency care resources by 2014.

1. Rostered ambulances per 1000 people

No 0.05 0.03 0.03 0.04 0.11 0.06 0.24 0.08

2. P1 calls with a response of time <15 minutes in an urban area

% 42% 37% 54% 58% 66% 75% 71% 54.11

3. P1 calls with a response time of <40 minutes in a rural area

% 70% 75 70 80 78 82 63 53.08

4. All calls with a response time within 60 minutes

% 69% 94 92 96 97 99 96 67.97

5. Percentage of operational rostered ambulances with single person crews

% 0 0 0 0 0 0 0 7.17

6. Percentage green code patients transported by ambulance

% 29% 19% 39% 45% 42% 42% 47% 54.41

7. Total number of EMS emergency cases

No 418 578 157 402 35 078 35 929 28 468 63 692 16 304



4. STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR EMS

Table 3.2: Performance indicators for EMS and patient transport [EMS 2 &3]

Strategic goal Strategic objective: Title Strategic objective Statement Performance indicator Type

Baseline Target

Audited/Actual Performance Estimate MTEF Projection National

Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Integration of quality assurance into all levels of care

1.1.1. To improve quality and decrease adverse patient incidents to 10 per annum by the institution of staff surveys, patient surveys, adverse incident reporting and a quality management structure by 2014.

Strategic objective [SO] baseline measure

1) Number of adverse incidents per annum

No 10 New Indicator

New Indicator

New Indicator

20 20 15 10

2) Percentage of staff surveyed per annum

% 10% New Indicator

New Indicator

New Indicator

5% 10% 10% 10%

3) Percentage of patients surveyed per annum

% 10% New Indicator

New Indicator

New Indicator

5% 10% 10% 10%

1.2 Fully implement the CSP model by 2014.

1.1.2. To complete the implementation of the Comprehensive Service Plan by operationalizing the EMS resources (542 vehicles, 54 bases and 2366 personnel) necessary to the specified service levels of 156 rostered ambulances per hour in the CSP by 2014.

SO Baseline measure:

4) Number of rostered ambulances

No 156 126 130 126 126

5) Rostered ambulances per 1 000 people

No 0.039 0.042 0.05 0.05 0.05 0.05 0.05

6) Percentage of operational rostered ambulances with single person crews

% 0% 0% 0% 0% 0% 0% 0% 0%

7) Percentage of CSP bases/ stations established

% 100% 94.4% 94.4% 94.4% 94.4% 94.4% 96.2% 98.1% 100%

1.3 Manage all patients at the appropriate level of care within the appropriate packages of care

1.1.3. To meet the patient response, transport and inter hospital referral needs of the Department in line with the 90:10 CSP Model by realigning the configuration (proportion of emergency vs. non emergency resources) of the EMS Service by 2014.


8) Percentage of ambulance patients transferred between facilities

% 10% 21% 34% 20% 15% 10%

9) Percentage of green triaged patients transferred by an ambulance.

% 10% 36.5% 30% 20% 10%

10) Percentage of ambulance trips used for inter-hospital transfers.

% 34.8% 34.8% 29% 30% 30% 30% 30%

11) Total number of EMS emergency cases.

No 392 395 387 438 418 578 420 000 420 000 420 000 420 000




Baseline Target


Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15

1.4 Efficiently and effectively manage chronic diseases.

1.1.4. To meet the APPROPRIATE outpatient transfer needs of the Department through the intra-district and trans-district HealthNET Transport System ensuring that patients are managed at the appropriate level of care by 2014.


12) Number of patients transferred to tertiary level hospitals per annum

No 10 000 New Indicator

New Indicator

New Indicator

36 000 30 000 20 000 10 000

1.5 Provide roadside to bedside definitive emergency care within defined emergency time frames within and across geographic and clinical service platforms.

1.1.5. To meet the response time performance for urban (90% P1 within 15 Min) and rural (90% P1 within 40 min) clients and ensure the shortest time to definitive care by integrated management of pre-hospital and hospital emergency care resources by 2014.


13) Percentage of urban Priority 1 responses within 15 minutes

% 90% 37.6% 50% 43.6% 45% 60% 65% 70% 80%


14) Percentage of rural Priority 1 responses within 40 minutes

% 90% 64.4% 69% 75.4% 80% 85% 90% 95% 80%

15) All calls with a response time within 60 minutes.

% 75% 69% 65% 65% 65% 65% 100%

1.6 Institute Trauma and Violence Prevention Programs

1.1.6. To initiate a trauma and violence prevention program in Cape Town and each of the five rural districts by 2014.


16) Number of prevention programs initiated.

No 6 New Indicator

New Indicator

New Indicator

0 2 4 6

2. Ensure and maintain organizational strategic management capacity and synergy

2.1 Develop integrated support and management structures to render effective clinical service.

1.1.7. To ensure the integrated management of emergency clients through competent EMS and support managers and the institution of 5 geographic cooperative emergency care management structures by 2014.


17) The number of Emergency Medicine Specialist led cooperative geographic structures operational out of 5 geographic areas

No 5 New Indicator

New Indicator

New Indicator

2 4 5 5

1.1.8. To achieve a qualification of Certificate in Management for 100 shift and station managers by 2014.


18) Number of supervisors with a certificate in management.

No 100 New Indicator

New Indicator

New Indicator

0 25 50 100

1.1.9. To achieve an HRM Clerk, Finance Clerk, Reception Clerk, Information Clerk and Admin clerk in each of 9 district/divisional structures by 2014.


19) Number of support clerks appointed out of 36.

No 36 New Indicator

New Indicator

New Indicator

18 23 32 36




Baseline Target


Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15

2.3 Ensure efficient and cost effective procurement

1.1.10. To complete the institution of EMS Supply Chain Management structures and systems (LOGIS, personnel, administration, training) necessary to the continuous supply and maintenance of EMS equipment by 2014.


20) Number of districts that can electronically requisition goods and services.

No 6 New Indicator

New Indicator

New Indicator

0 3 6 6

21) The percentage of SCM personnel of the establishment appointed

% 100% New Indicator

New Indicator

New Indicator

100%

22) The percentage of ambulances with a full suite of ambulance equipment


New Indicator

New Indicator

50% 75% 95% 100%

3. Develop and maintain a capacitated workforce to deliver the required health services.

3.1 Implement the Human Resource Plan

3.1.1. To recruit, train and deploy all 2366 staff necessary to achieving service levels in the CSP by 2014.


23) Percentage of CSP personnel out of 2 366 appointed


New Indicator

New Indicator

72.8% 72.8% 72.8% 72.8% 100%

3.2 Become the employer of choice in the health sector by creating an environment for a satisfied workforce.

3.2.1. To develop a positive attitude and motivation in 80% of operational staff by instituting the good quality facilities, squad system, providing squad leadership, quality uniforms, training and development, quality equipment and vehicles, acknowledgement and rewards by 2014.


24) Percentage of personnel surveyed with a positive attitude and motivation.

% 80% New Indicator

New Indicator

New Indicator

40% 50% 60% 80%

3.2.2. To imbed an Occupational Health and Safety Structure in EMS with a dedicated OHS Officer in each of the 9 Districts/Divisions by 2014.


25) Number of OHS officers appointed

No 9 New Indicator

New Indicator

New Indicator

0 2 5 9




Baseline Target


Target

2014 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15

4. Provide and maintain appropriate health technology and infrastructure.

4.1 To provide responsive and appropriate information technology for the Department

4.1.1. To institute a comprehensive Information Communication Technology Solution for EMS in Cape Town and the five rural districts integrated with Hospital Emergency Centers to provide reliable, real time and accurate data in order to meet target emergency care outcomes (response times) by 2014.


26) Number of districts out of six with fully solution.

No 6 New Indicator

New Indicator

New Indicator

0 1 3 6

5. Ensure a sustainable income to provide the required health services according to the needs

5.1 Augment the funding streams for health services

5.1.1. To institute 6 sponsorship, branding and business relationships that provide additional funding streams for EMS in order to achieve quality service levels by 2014.


27) Number of projects delivering sponsorship

No 6 New Indicator

New Indicator

New Indicator

0 1 3 6



5. QUARTERLY TARGETS FOR EMERGENCY MEDICAL SERVICES

Table 3.3: Quarterly targets for EMS and patient transport for 2010/11 [EMS4]

Strategic Goal Strategic Objective Title Strategic Objective Statement Performance Indicator Reporting period

MTEF Projection Quarterly targets

2010/11 Q1 Q2 Q3 Q4

1. Manage the Burden of Disease


1.1.1 To improve quality and decrease adverse patient incidents to 10 per annum by the institution of staff surveys, patient surveys, adverse incident reporting and a quality management structure by 2014.

SO Baseline measure 1) Number of adverse incidents

per annum

Quarterly 20 5 10 15 20

2) Percentage of staff surveyed per annum

Quarterly 10% 2.5% 5% 7.5% 10%

3) Percentage of patients surveyed per annum

Quarterly 10% 2.5% 5% 7.5% 10%

1.2 Fully implement the Comprehensive Service Plan model by 2014.

1.2.1 To complete the implementation of the Comprehensive Service Plan by operationalizing the EMS resources (542 vehicles, 54 bases and 2366 personnel) necessary to the specified service levels of 156 rostered ambulances per hour in the CSP by 2014.

SO Baseline measure: 4) Number of rostered

ambulances

Quarterly 130 126 128 129 130

5) Rostered ambulances per 1000 people

Quarterly 0.05[250/5 364]

0.05[250/5 364]

0.05[250/5 364]

0.05[250/5 364]

0.05 [250/5 364]

6) Percentage of operational rostered ambulances with single person crews

Quarterly 0% 0% 0% 0% 0%

7) Percentage of CSP bases/ stations established

Quarterly 94.4% 94.4% 94.4% 94.4% 94.4%

1.3 Manage all patients at the appropriate level of care within the appropriate packages of care

1.3.1 To meet the patient response, transport and inter hospital referral needs of the Department in line with the 90:10 CSP Model by realigning the configuration (proportion of emergency vs non emergency resources) of the EMS Service by 2014.

SO Baseline measure: 8) Percentage of ambulance

patients transferred between facilities

Quarterly 20% 20% 20% 20% 20%

9) Percentage of green triaged patients transferred by an ambulance.

Quarterly 30% 30% 30% 30% 30%

10) Percentage of ambulance trips used for inter-hospital transfers.

Quarterly 30% 30% 30% 30% 30%

11) Total number of EMS emergency cases.

Quarterly 420 000 105 000 105 000 105 000 105 000

1.4 Efficiently and effectively manage chronic diseases.

1.4.1 To meet the APPROPRIATE outpatient transfer needs of the Department through the intra-district and trans-district HealthNET Transport System ensuring that patients are managed at the appropriate level of care by 2014.

SO Baseline measure: 12) Number of patients transferred

to tertiary level hospitals per annum

Quarterly 30 000 7 000 15 000 25 000 30 000





2010/11 Q1 Q2 Q3 Q4

1.5 Provide roadside to bedside definitive emergency care within defined emergency time frames within and across geographic and clinical service platforms.

1.5.1 To meet the response time performance for urban (90% P1 Within 15 Min) and rural (90% P1 within 40 min) clients and ensure the shortest time to definitive care by integrated management of pre-hospital and hospital emergency care resources by 2014.

SO Baseline measure: 13) Percentage of urban Priority 1

responses within 15 minutes

Quarterly 50% 30% 40% 45% 50%

SO Baseline measure: 14) Percentage of rural Priority 1

responses within 40 minutes

Quarterly 85% 75% 78% 80% 85%

15) All calls with a response time within 60 minutes.

Quarterly 65% 50% 55% 60% 65%

1.6 Institute Trauma and Violence Prevention Programs

1.6.1 To initiate a trauma and violence prevention program in Cape Town and each of the five rural Districts by 2014.

SO Baseline measure: 16) The number of prevention

programs Initiated.

Quarterly 2 0 1 2 2


2.1 Develop integrated support and management structures to render effective clinical service.

2.1.1 To ensure the integrated management of emergency clients through competent EMS and Support Managers and the institution of 5 geographic cooperative emergency care management structures by 2014.

SO Baseline measure: 17) The number of Emergency

Medicine Specialist led cooperative geographic structures operational out of 5 geographic areas

Quarterly 4 2 2 3 4

2.1.2 To achieve a qualification of Certificate in Management for 100 shift and station managers by 2014.

SO Baseline measure: 18) The number of supervisors

with a certificate in management.

Annual 25 0 0 0 25

2.1.3 To achieve an HRM Clerk, Finance Clerk, Reception Clerk, Information Clerk and Admin clerk in each of 9 District/Divisional structures by 2014.

SO Baseline measure: 19) The number of support clerks

appointed out of 36.

Quarterly 23 18 20 22 23

2.2 Ensure efficient and cost effective procurement

3.1.1 To complete the institution of EMS Supply Chain Management structures and systems (LOGIS, personnel, administration, training) necessary to the continuous supply and maintenance of EMS equipment by 2014.

SO Baseline measure: 20) The number of districts that

can electronically requisition goods and services.

Quarterly 3 0 1 2 3

21) The percentage of SCM personnel of the establishment appointed

Quarterly 100% 70% 80% 90% 100%

22) The percentage of ambulances with a full suite of ambulance equipment

Quarterly 75% 50% 60% 70% 75%





2010/11 Q1 Q2 Q3 Q4



3.1.1 To recruit, train and deploy all 2366 staff necessary to achieving service levels in the CSP by 2014.

SO Baseline measure: 23) The percentage of CSP

personnel out of 2 366 appointed

Quarterly 72.8% 72.8% 72.8% 72.8% 72.8%


3.2.1 To develop a positive attitude and motivation in 80% of operational staff by instituting the good quality facilities, squad system, providing squad leadership, quality uniforms, training and development, quality equipment and vehicles, acknowledgement and rewards by 2014.

SO Baseline measure: 24) The percentage of personnel

surveyed with a positive attitude and motivation.

Quarterly 50% 30% 40% 50% 50%

3.2.2 To imbed an Occupational Health and Safety Structure in EMS with a dedicated OHS Officer in each of the 9 Districts/Divisions by 2014.

SO Baseline measure: 25) The number of OHS officers

appointed

Quarterly 2 0 1 2 2

4. Provide and maintain appropriate health technology and infrastructure

4.1 To provide responsive and appropriate information technology for the Department

4.1.1 To institute a comprehensive Information Communication Technology Solution for EMS in Cape Town and the Five Rural Districts integrated with Hospital Emergency Centers to provide reliable, real time and accurate data in order to meet target emergency care outcomes (response times) by 2014.

SO Baseline measure: 26) The number of districts out of

six with fully functional ICT solution.

Annually 1 0 0 0 1


5.1 Augment the funding streams for health services

5.1.1 To institute 6 sponsorships, branding and business relationships that provide additional funding streams for EMS in order to achieve quality service levels by 2014.

SO Baseline measure: 27) The number of projects

delivering a revenue stream.

Annually 1 0 0 0 1





Emergency Medical Services in the Western Cape received additional allocations in 2008/09 and 2009/10 in order to fund expansion of the personnel establishment towards achieving service levels in the Comprehensive Service Plan and in creating greater capacity for the FIFA World Cup.

The result is that both service performance in Cape Town and rural districts has improved. The strategy to provide air transport for acutely ill patients from rural areas has also retained ambulances in rural towns and improved their availability and performance. The performance of the Cape Town service lags that of rural services however (40% of target) because parallel investment in Information Communication Technology and personnel is required.

Emergency Medical Services is resource dependent particularly in respect of the vehicles it operates (aircraft and road vehicles) and inflation in these environments exceeds the levels of inflation budgeted for thereby nominally decreasing the available budget for expenditure on these items and necessitating the reprioritization of expenditure (e.g. decreased capital vehicle purchases) which may have longer term consequences.

Emergency Medical Services has not yet achieved the 2010 service levels of the CSP and remains R173 million (2009) short of funding levels required by the CSP.

It would assist EMS if MTEF funding was consistent and incremental towards achieving CSP targets and if actual inflation in nominal terms was funded.

6.2 ALLOCATED FUNDING

In 2010/11 Emergency Medical Services is allocated 4.69 per cent of the Vote in comparison to the 4.98 per cent that was allocated in the revised estimate of 2009/10. This amounts to a nominal increase of R34.673 million or 6.59 per cent.

The following minimum amounts are earmarked for Emergency Medical Services: R563.651 million in 2010/11; R588.479 million in 2011/12 and R617.903 in 2012/13. The sum of the budgets allocated to Programme 3 and Sub-programme 6.2: Emergency Medical Services Training Colleges should as a minimum correspond with the earmarked amounts to EMS budget.

Included in the 2010/11 earmarked funding is an amount of R17.350 million which has been shifted from Vote 1 for the 2010 FIFA World Cup.

The objectives of the funding remain to:

• Ensure the provision of sufficient resources for the rendering of an effective and efficient emergency and patient transport service.

• Train appropriate numbers of Emergency Medical Care Personnel to meet the quantitative and qualitative needs of the Emergency Medical Services

• Maintain and improve the standards of emergency medical service through the continuous clinical development of Emergency Medical Care.



Table 3.4: Trends in provincial public health expenditure for EMS and Planned Patient Transport [EMS6]

Expenditure Audited / actual Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total excluding capital 277 844 000 341 877 000 403 118 000 525 905 000 560 578 000 580 791 000 614 550 000

Total Capital 9 093 000 18 706 000 7 892 000 13 188 000 24 785 000 22 402 000 7 816 000

Grand Total 286 937 000 360 583 000 411 010 000 539 093 000 585 363 000 603 193 000 622 366 000

Total per person 54.36 66.88 74.55 95.68 101.70 102.64 103.76




Total Capital 10 340 669 20 221 186 7 892 000 22 926 240 21 528 449 18 310 502 6 024 343

Grand Total 326 308 200 389 790 223 411 010 000 518 754 784 508 450 985 493 025 908 479 701 416

Total per person 61.82 72.29 74.55 92.07 88.34 83.89 79.97


Table 3.5: Expenditure estimates: Emergency Medical Services [EMS5]


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Emergency Transport 268 597 321 120 378 469 459 713 497 020 487 966 520 386 6.64 537 795 568 454 Planned Patient Transport 9 247 20 757 24 649 28 423 37 278 37 939 40 192 5.94 42 996 46 096

277 844 341 877 403 118 488 136 534 298 525 905 560 578 6.59 580 791 614 550 Total payments and estimates

1.

Sub-programmeR'000

Outcome

2.

Revised estimate


Main appro-priation

Adjusted appro-

priation

Earmarked allocations:

Included in sub-programme 3.1: Emergency Transport is an earmarked allocation amounting to R514 342 000 (2010/11), R535 709 000 (2011/12) and R561 470 000 (2012/13), for the purpose of Emergency Medical Services.

Included in sub-programme 3.2: Planned Patient Transport is an earmarked allocation amounting to R40 192 000(2010/11), R42 996 000 (2011/12) and R46 096 000(2012/13) for the purpose of Emergency Medical Services.



Table 3.6: Payments and estimates by economic classification for Emergency Medical Services



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13




41 159 41 2 152 4 485 2 446 3 860 3 434 3 176 3 696 16.37 3 991 4 271

43 112 112 337 105 198 104 (47.47) 112 120 3 752 4 293 4 312 4 447 9 001 9 024 10 177 12.78 9 991 10 690 355 306 415 450 678 609 682 11.99 737 788 560 345 329 108 208 294 293 (0.34) 316 338

21 2 2 2 2 2

851 1 111 1 029 965 2 364 2 670 2 806 5.09 3 351 3 585 48 121 174 104 454 576 236 (59.03) 255 273

1 5 5 5 4 (20.00) 5 5 6 1 1

856 1 463 2 161 1 765 2 513 2 846 3 175 11.56 2 929 3 134 698 558 434 758 906 905 1 118 23.54 1 207 1 292

3 844 4 695 4 667 4 958 7 456 8 483 10 120 19.30 9 929 10 625 366 3 243 329 632 5 958 5 833 6 706 14.97 6 742 7 215 810 1 286 1 389 1 094 2 210 2 425 2 716 12.00 2 933 3 138

5 386 6 129 8 254 7 506 4 042 1 975 1 561 (20.96) 1 686 1 804 2 579 1 706 2 353 1 745 2 303 2 754 3 217 16.81 3 473 3 718

54 182 65 755 81 775 125 633 118 231 114 637 134 038 16.92 138 434 149 545 457 662 718 8.46 776 830

2 770 54 1 779 4 967 230 390 263 (32.56) 284 304 17 183 369 226 20 10 8 (20.00) 9 9 Interest and rent on land 29

Interest 29




Households 17 57 66 66 66 84 70 (16.67) 74 78 Social benefits 17 57 66 66 66 84 70 (16.67) 74 78


Transport equipment 10 264 11 545 2 697 5 232 8 403 8 403 4 941 (41.20) 5 183 5 478 Other machinery and equipment 4 340 10 045 6 782 8 513 18 675 18 399 13 672 (25.69) 12 343 13 020

12 7

2 000 4 127 3 922 (4.97) 4 115 4 349

Payments for financial assets 321 1 013 818 1 736 (100.00)




Regional services council levies


Inventory: Medical supplies


Revised estimate


Communication



Outcome

Main appro-priation


Computer services

Inventory: Stationery and printingLease payments

Cons/prof: Infrastructure &

Operating expenditureVenues and facilities

Owned and leasehold property expenditure

Inventory: Other consumables

Entertainment


AdvertisingAssets <R5 000

Cons/prof: Business and advisory services

Catering: Departmental activities

Cons/prof: Legal costContractorsAgency and support/outsourced services

PART B: PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES


PROGRAMME 4: PROVINCIAL HOSPITALS


Delivery of hospital services, which are accessible, appropriate, and effective and provide general specialist services, including a specialized rehabilitation service, as well as a platform for training health professionals and research.


2.1 SUB-PROGRAMME 4.1: GENERAL (REGIONAL) HOSPITALS

Rendering of hospital services at a general specialist level and providing a platform for training of health workers and research.

2.2 SUB-PROGRAMME 4.2: TUBERCULOSIS HOSPITALS

To provide for the hospitalization of acutely ill and complex TB patients (including MDR and XDR TB.)

2.3 SUB-PROGRAMME 4.3: PSYCHIATRIC HOSPITALS

Rendering a specialist psychiatric hospital service for people with mental illness and intellectual disability and providing a platform for the training of health workers and research.

2.4 SUB-PROGRAMME 4.4: REHABILITATION SERVICES

Rendering of specialized rehabilitation services for persons with physical disabilities including the provision of orthotic and prosthetic services.

2.5 SUB-PROGRAMME 4.5: DENTAL TRAINING HOSPITALS

Rendering an affordable and comprehensive oral health service for complicated dental patients and provide a platform for training and research.



3. STRATEGIC DIRECTION OF THE PROGRAMME

Programme 4 remains focused on developing and maintaining a high quality, efficient and equitable specialist health service that is accessible to the population of the Western Cape.

Access to services and service delivery excellence are the key components of the broader goal of the Department to ensure quality health for all.

This programme is committed to reducing and addressing the impact of the burden of disease and disability.

The relationship between the key performance areas and the strategic goals are as follows:

Table 4.1: Relationship between key performance areas and departmental strategic goals

Key Performance Area Departmental Strategic Goal National Health System Priorities applicable to this Program

Service delivery • Manage the burden of disease • Provision of strategic leadership and creation of a social compact for better health outcomes

• Improve the quality of health services

• Overhauling the health care system and improve its management

• Improve human resources

• Revitalization of infrastructure

• Accelerated implementation of the HIV and AIDS strategic plan and the increased focus on TB and other communicable diseases

• Mass mobilization for the better health of the population

• Review of drug policy

• Research and development

Clinical governance and Quality Assurance • Manage burden of disease

• Ensure and maintain organizational strategic management capacity and synergy.

Corporate governance • Ensure and maintain organizational strategic management capacity and synergy.

• Develop and maintain a capacitated workforce to deliver the required health services.

• Provide and maintain appropriate health technology and Infrastructure.

• Ensure a sustainable income to provide the required health services according to the needs.

3.1 STRATEGIC GOALS AND OBJECTIVES FOR SERVICE DELIVERY

The priorities for the next five years are addressed in an integrated approach to service delivery across the health platform. The Programme 4 strategies are categorized in terms of the strategic goals of the Department:

3.1.1 Goal: Manage the burden of disease

3.1.1.1 Strategic Objectives:

1) Ensure access to general specialist hospital services

2) Reduce maternal mortality

3) Provide roadside to bedside definitive emergency care

4) Improve quality of care at all levels of care



3.1.2 Goal: Ensure and maintain organizational strategic management capacity and synergy.


1) Ensure that management provides sustained support and strategic direction in the delivery of health services:

• By the development of annual performance plans that align and integrates the Departmental objectives

• With well defined efficiency targets

• Create structures across levels of care to ensure organizational synergy.

3.1.3 Goal: Develop and maintain a capacitated workforce to deliver the required health services.


1) Become the employer of choice in the health sector by creating an environment for a satisfied workforce

3.1.4 Goal: Provide and maintain appropriate health technology and infrastructure.

3.1.4.1 Strategic Objective:

1) Ensure the provision of infrastructure that meets the needs of current and future development.

3.1.5 Goal: Ensure a sustainable income to provide the required health services according to the needs.


1. Allocate sufficient funds to ensure the sustained delivery of quality general specialist hospital services



4. SUB-PROGRAMME 4.1: GENERAL (REGIONAL) HOSPITALS

The strategic goals and strategic objectives in general (regional) hospitals are outlined as follows:

4.1 STRATEGIC GOAL 1: MANAGE THE BURDEN OF DISEASE:

4.1.1 Strategic objectives

4.1.1.1 Ensure access to general specialist hospital services:

• The health services in the Metro are demarcated into Metro West and Metro East. Metro West includes Western, Southern, Klipfontein and Mitchells Plain sub structures. Metro East includes Khayelitsha, Eastern, Northern and Tygerberg substructures.

• The rural regional hospital services are clustered around Paarl, George and Worcester.

• There will therefore be five regional service areas (RSA): Metro West, Metro East, Paarl, George and Worcester.

4.1.1.2 Ensure access to the package of regional hospital services by providing 2 384 regional Hospital beds by 2014:

The following are some transversal issues to be addressed in the acute hospital services:

• Fully functional level two heads of disciplines within Metro West and Metro East.

• Strengthen outreach and support.

• Improve the functionality of designated level one and two beds in regional and central hospitals.

• Increase level two beds in central hospitals.

• Ensure access to the package of regional hospital services.

• Strengthen clinical governance within each of the five regional service areas.

• Ensure the efficient transfer of sub acute patients from acute beds into sub acute facilities.

• Strengthen the general specialist cadre within regional hospitals.

• Phased implementation of service shifts as per the Comprehensive Service Plan (CSP).

4.1.1.3 Provide roadside to bedside definitive emergency care

• The key objective is to improve access to emergency services and improving the quality of care and the interface between the emergency services and the admitting hospital.

• Compliance with the Acute Emergency Case Load Management Policy (AECLM) with specific focus on patient flow, improving the throughput in the emergency centres to definitive care.

• Integrate emergency centres.

• Child friendly emergency centres.

• Strengthen the capacity of emergency centres (staffing, equipment, and infrastructure) as per recommended norms.



4.1.1.4 Improve quality of care at all levels of care:

• The central intention is to inculcate continuous quality improvement into the work life of each staff member. The key strategies in terms of clinical governance and quality assurance are:

o The implementations of formal outreach and support agreements between hospitals.

o Co-ordinate and integrate quality assurance within the management of the institution.

o Incremental development of a minimum set of quality assurance norms and standards.

o Improved infection control and preventative measures.

o Surgical site infection surveillance.

o Ensure regular morbidity and mortality meetings and clinical audit takes place.

o Annual patient and staff satisfaction surveys and actions to address issues emanating from the surveys.

o Specific campaign to have clean facilities with a specific focus on clean toilets.

4.1.1.5 Reduce maternal mortality

• Perform appropriate clinically indicated caesarian sections in regional hospitals (deliveries) to ensure improved outcomes and safety for mothers and babies.

• Strengthen outreach and support to District Health Services.

4.2 STRATEGIC GOAL 2: ENSURE AND MAINTAIN ORGANIZATIONAL STRATEGIC MANAGEMENT CAPACITY AND SYNERGY:


4.2.1.1 Strategic and operational structures to co-ordinate service delivery at provincial and local levels:

• Number of hospitals with fully functional business units.

• Fully functional strategic and operational management teams at provincial and regional level.

4.3 STRATEGIC GOAL 3: DEVELOP AND MAINTAIN A CAPACITATED WORKFORCE TO DELIVER THE REQUIRED HEALTH SERVICES


4.3.1.1 Become the employer of choice in the health sector by creating an environment for a satisfied workforce:

• Implementation of the ODI recommendations will be done in a phased approach with matching and placing of current staff as the first step and then filling all the vacant posts on the new establishments in line with the service plan and available funding

• Ensure that 97.5% of affordable staff establishment remains filled.

• Strengthen training of staff through formal and informal means.



• Build workforce capacity to provide the planned services as reflected in the package of care in a phased manner.

• Perform annual staff satisfaction surveys and implement recommendations to improve the working environment and satisfaction of personnel.

• Increased visibility of management and better communication with staff.

• Create a climate to enable and encourage innovation within the health services.

4.4 STRATEGIC GOAL 4: PROVIDE AND MAINTAIN APPROPRIATE HEALTH TECHNOLOGY AND INFRASTRUCTURE:


4.4.1.1 Ensure the provision of infrastructure that meets the needs of current and future development

• Develop a five-year infrastructure plan for all facilities.

• All hospitals to have a functional infrastructure planning system with a planning and commissioning unit.

• Hospitals to allocate adequate funding for infrastructure and maintenance.

• All hospitals to have a prioritized equipment list and procure equipment accordingly within the budget allocation

• Improve data quality and information management at institutional and regional level.

• Optimal provision of hardware and software to support the provision of integrated information systems for the functional business units.

4.5 STRATEGIC GOAL 5: ENSURE A SUSTAINABLE INCOME TO PROVIDE THE REQUIRED HEALTH SERVICES ACCORDING TO THE NEEDS:


4.5.1.1 Ensure the sustainable generation of financial resources to ensure funding for the provision of health services

• Ensure ICD10 coding correctly administered to affect billing.

• Ensure collection of Road Accident Fund revenue.

• Ensure Department of Justice payment for forensic psychiatric observation services.

• Encourage funding initiatives by the hospital boards.



4.6 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR GENERAL (REGIONAL) HOSPITALS

Table 4.2: Strategic objectives, performance indicators and annual for general (regional) hospitals [PHS1 & 2]

Strategic Goal Strategic objective: Title Strategic objective statements Performance Indicator Type

Baseline target

2014/15

Actual/Audited performance Estimate MTEF projection National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Ensure access to general specialist hospital services

1.1.1 Ensure access to the full package of regional hospital services by providing 2 384 regional hospital beds by 2014.

Strategic objective [SO] Baseline measure: 1) Number of regional hospital

beds

No 2 384 (CSP

numbers)

1 943 1 379 2 490 2 362 (Includes

20 L1 beds at

Mowbray Maternity)

2 367 2 379 2 362 (20 L1

beds shift to

Mitchells Plain)

2) Total separations in regional hospitals

No 197 751 196 904 130 205 196 668 190 744 191 878 193 816 195 773

3) Patient day equivalents [PDE] in regional hospitals

No 1 065 457 942 460 636 992 1 122 369 1 029 412 1 033 812 1 044 255 1 054 803

4) OPD total headcounts in regional hospitals

No 737 500 807 344 362 960 718 131 742 536 741 500 740 500 739 500

1.2 Provide roadside to bedside definite emergency care

1.2.1 Improve access to emergency services and improving the quality of care and the interface between the emergency services and the admitting hospital

SO Baseline measure: 5) Casualty/ Emergency and

trauma headcount in regional hospitals

No 300 000 182 462 201 009 308 188 296 718 297 500 298 000 298 500

1.3 Reduce maternal mortality

1.3.1 Perform appropriate clinically indicated caesarean sections in regional hospitals to ensure improved outcomes and safety for mothers and babies at a target of 35% in 2014/15.

SO Baseline measure: 6) Caesarean section rate for

regional hospitals

% 35% 33% 33% 33% 35% 35% 35% 35% 25%

1.4 Improve quality of care at all levels of care

1.4.1 Perform and analyze one standardized patient satisfaction survey per year to measure patient satisfaction in regional hospitals

SO Baseline measure: 7) Percentage of regional

hospitals with patient satisfaction survey using DOH template (8/8)

% 100% 100% 100% 100% 100% 100% 100% 100%

1.5.1 Implement and maintain quality assurance measures in regional hospitals to minimise patient risk by performing monthly mortality and morbidity meetings


hospitals with mortality and morbidity meetings every month. (8/8)

% 100% 100% 100% 100% 100% 100% 100% 100%

1.6.1 Implement and maintain quality assurance measures in general hospitals to minimise patient risk

SO Baseline measure: 9) Case fatality rate for

regional hospitals for surgery separations

% 3.5% 1.7% 1.7% 3.6% 3.9% 3.9% 3.8% 3.7%



Strategic Goal Strategic objective: Title Strategic objective statements Performance Indicator Type

Baseline target

2014/15

Actual/Audited performance Estimate MTEF projection National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


2.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality general specialist hospital services.

2.1.1 Allocate sufficient funds to ensure the effective and efficient delivery of the full package of regional hospital services at a rate of R2 629. per PDE. [Constant 2008/09 rand]

SO Baseline measure 10) Expenditure per patient day

equivalent (PDE) in regional hospitals

R R2 629 R1 098 R1 219 R1 397 R1 556 R1 663 R1 661 R1 636

3. Develop and maintain a capacitated workforce to deliver the required health services


3.1.1 Perform and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in the regional hospitals.


hospitals with annual staff satisfaction survey completed.

% 100% Not reported

Not reported

Not reported

100% 100% 100%

100%

3.1.2 Ensure optimum staffing levels for all facilities by ensuring that 97.5% of affordable staff establishment remains filled

12) 97.5% of affordable staff establishment filled for regional hospitals

% 97.5% Not reported

Not reported

Not reported

Not reported

97.5% 97.5% 97.5%


4.1 Ensure that management provides sustained support and strategic direction in the delivery of health services.

4.1.1 Efficiently manage the allocated resources of regional hospitals to achieve a target bed utilisation rate of 85% and an average length of stay of 4 days.

SO Baseline measure 13) Bed utilisation rate (based

on usable beds) in regional hospitals

% 99% 91% 89% 88% 87% 86% 85% 75%

14) Average length of stay in regional hospitals.

Days 4 days 3 days 3 day 4 days 4 days 4 days 4 days 4days 4.8days

4.1.2 Establish functional business units within provincial hospitals as a key supportive structure in ensuring that resources are adequately utilised within cost centres.

15) Number of hospitals with fully Functional Business Units.

8 Not reported

Not reported

Not reported

Not reported

5 6 7


5.1 Ensure the provision of infrastructure that meets the needs of current and future development

5.1.1 Ensure the establishment of PCU’s at all institutions

16) Percentage of hospitals with PCU’s (8/8)

100% [8/8]

Not reported

Not reported

Not reported

Not reported

70% 80%

90%

5.1.2 Ensure 5 year plan per institution

17) Percentage of hospitals with 5 year infrastructure plan (8/8)

100% [8/8]

Not reported

Not reported

Not reported

Not reported

70% 80%

90%

Note: 1. During the 2006/07 financial year Sub-programme 4.1 included: Somerset, Mowbray Maternity, Paarl, and Worcester, George, GF Jooste, Helderberg, Victoria and Karl Bremer Hospitals. 2. The level two services within central hospitals are included in this sub-programme as from 1 April 2008 3. Victoria Hospital shifted to Programme 2 from 1 April 2009 4. Indicator 9: Average case fatality rate in level 2 services central hospitals are 6% and the average for regional hospitals vary between 1.7% and 2%



4.7 QUARTERLY TARGETS FOR GENERAL (REGIONAL) HOSPITALS

Table 4.3: Quarterly targets for general (regional) hospitals for 2010/11 [PHS3]

Strategic Goal Strategic objective: Title Strategic objective statements Performance Indicator Reporting period

Annual target Quarterly targets

2010/11 Q1 Q2 Q3 Q4


1.1 Ensure access to general specialist hospital services

1.1.1 Ensure access to the full package of regional hospital services by providing 2 384 regional hospital beds by 2014.

SO Baseline measure: 1) Number of regional hospital beds

Quarterly 2 367 2 367 2 367 2 367 2 367

2) Total separations in regional hospitals Quarterly 191 878 47 969 47 969 47 970 47 970

3) Patient day equivalents [PDE] in regional hospitals

Quarterly 1 033 812 258 453 258 453 258 453 258 453

4) OPD total headcounts in regional hospitals

Quarterly 741 500 185 375 185 375 185 375 185 375

1.2 Provide roadside to bedside definite emergency care

1.2.1 Improve access to emergency services and improving the quality of care and the interface between the emergency services and the admitting hospital.

SO Baseline measure: 5) Casualty/ Emergency and trauma

headcount in regional hospitals

Quarterly 297 500 74 375 74 375 74 375 74 375

1.3 Reduce maternal mortality 1.3.1 Perform appropriate clinically indicated caesarean sections in regional hospitals to ensure improved outcomes and safety for mothers and babies at a target of 35% in 2014/15.

SO Baseline measure: 6) Caesarean section rate for regional

hospitals

Quarterly 35% 35% 35% 35% 35%



SO Baseline measure: 7) Percentage of regional hospitals with

patient satisfaction survey using DOH template (8/8)

Quarterly 100%[8/8]

0 0 0 100% [8/8]

1.4.2 Implement and maintain quality assurance measures in regional hospitals to minimise patient risk by performing monthly mortality and morbidity meetings

SO Baseline measure: 8) Percentage regional hospitals with

mortality and morbidity meetings every month.(8/8)

Quarterly 100%[8/8]

100%[8/8]

100%[8/8]

100% [8/8]

100% [8/8]

1.4.3 Implement and maintain quality assurance measures in general hospitals to minimise patient risk

SO Baseline measure: 9) Case fatality rate for regional hospitals

for surgery separations [aligned with SP]

3.9% 3.9% 3.9% 3.9% 3.9%


2.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality general specialist hospital services.

2.1.1 Allocate sufficient funds to ensure the effective and efficient delivery of the full package of regional hospital services at a rate of R2 629 per PDE. [Constant 2008/09 rand]

SO Baseline measure: 10) Expenditure per patient day equivalent

(PDE) in regional hospitals

Quarterly R1 663 R1 663 R1 663 R1 663 R1 663



Strategic Goal Strategic objective: Title Strategic objective statements Performance Indicator Reporting period


2010/11 Q1 Q2 Q3 Q4

3 Develop and maintain a capacitated workforce to deliver the required health services


3.1.1 Perform and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in the regional hospitals

SO Baseline measure: 11) Percentage of regional hospitals with

annual staff satisfaction survey completed (8/8)

Quarterly 100%[8/8]

0 0 0 100% [8/8]

3.2 Ensure optimum staffing levels for all facilities by ensuring that 97.5% of affordable staff establishment remains filled


12) 97.5% of affordable staff establishment filled for regional hospitals

Quarterly 97.5% 97.5% 97.5% 97.5% 97.5%


4.1 Ensure that management provides sustained support and strategic direction in the delivery of health services

4.1.1 Efficiently manage the allocated resources of regional hospitals to achieve a target bed utilisation rate of 85% and an average length of stay of 4 days.

SO Baseline measure: 13) Bed utilisation rate (based on usable

beds) in regional hospitals

Quarterly 85% 85% 85% 85% 85%

4.1.2 Ensure that management provides sustained support and strategic direction in the delivery of health services: -

14) Average length of stay in regional hospitals.

Quarterly 4 days 4 days 4 days 4 days 4 days

4.1.3 Create structures across levels of care 15) Number of hospitals with fully Functional Business Units.

Quarterly 5 2 3 4 5



5.1.1 Ensure the establishment of PCU’s at all institutions 16) Establish PCU’s per institution Quarterly 70% 70% 70% 70% 70%

5.1.2 Ensure 5 year plan per institution 17) Percentage of hospitals with 5 year infrastructure plan

Quarterly 70% 70% 70% 70% 70%

Note: 1. Victoria Hospital shifted to Programme 2 from 1 April 2009. 2. Indicator 8: constant 2008/09 prices.



4.8 RECONCILING PERFORMANCE TARGETS WITH THE BUDGET AND THE MTEF

Sub-programme 4.1 is allocated 68.8 per cent of the Programme 4 budget in 2010/11 in comparison to the 67.84 per cent allocated in the revised estimate of the 2009/10 budget. This amounts to a nominal increase of R252.361 million or 14.62 per cent.

Funding was shifted during the adjustments estimates to Programme 2 for the management of sub-acute facilities. The budget for Level 2 services is included in sub-programme 4.1.

4.8.1 Personnel

Personnel expenditure has increased significantly. The impact of OSD for nurses, clinicians and other categories of staff is evident by the budget shortfall. However, it is envisaged that the impact of OSD will ensure staff retention and a reduction on agency dependency.

Each institution has an approved post list, which is managed through the Establishment Control Committee of the Chief Directorate within the Programme.

4.8.2 Goods and Services

One of the main challenges is that the funding levels of the budget allocation do not match inflation over time, which is evident in the severe price increases for medical and surgical items.

Agency expenditure remains high and all efforts are made to appoint staff permanently. There is a serious commitment to reduce and stop the use of agencies in certain staff categories. While full time employees may not be cheaper in all cases, it would lead to a stable workforce and improved quality of care.

Table 4.4: Trends in public health expenditure for general (regional) hospitals [PHS5]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital 191 900 000 201 568 000 176 875 000 272 322 000 262 822 000 105 276 000 146 993 000

Grand Total 1 101 534 000 919 758 000 1 744 619 000 1 998 748 000 2 241 609 000 2 227 305 000 2 386 349 000

Total per person 208.68 170.59 316.45 354.75 389.47 378.99 397.85



Total excluding capital 1 034 446 700 776 363 390 1 567 744 000 1 580 703 232 1 718 790 218 1 734 461 895 1 726 029 769

Total Capital 218 230 983 217 895 008 176 875 000 267 171 200 228 289 292 86 048 405 113 297 883

Grand Total 1 252 677 683 994 258 398 1 744 619 000 1 847 874 432 1 947 079 510 1 820 510 300 1 839 327 652

Total per person 237.31 184.40 316.45 327.97 338.29 309.77 306.65




5. SUB-PROGRAMME 4.2 TB HOSPITALS

5.1 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR TB HOSPITALS

Table 4.5: Strategic objectives, performance indicators and annual targets for TB hospitals [PHS 1 & 2]

Strategic Goal: Strategic objective SMART objective statement Indicator Type Baseline

target 2014

Audited/actual performance Estimate MTEF Projection National target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Ensure access to TB hospital services.

1.1.1 Ensure access to the full package of TB hospital services by providing 1 284 TB hospital beds by 2014.

Strategic objective [SO] Baseline measure

1) Number of TB hospital beds.

No 1 284 1 008 1 008 1 040 1 020 1 040 1 040 1 040

2) Total separations in TB Hospitals

No 3 742 4 006 3 759 3 725 3 316 3 481 3 618 3 668

3) Patient Day Equivalents in TB Hospitals

No 376 732 306 287 300 307 304 302 289 108 289 411 313 651 340 921

4) OPD Total Headcounts in TB Hospitals

No 2 202 3 839 2 942 1 818 1 704 1 740 1 888 1 987


1.2.1 Perform and analyze one standardized patient satisfaction survey per year to measure patient satisfaction in TB Hospitals

SO Baseline measure: 5) Percentage of TB

hospitals with patient satisfaction survey using DOH template.

% 100% [[6/6]

100% [6/6]

100% [6/6]

100% [6/6]

100% [6/6]

100% [6/6]

100% [6/6]

100% [6/6]

1.2.2 Implement quality assurance measures to minimize patient risk in TB hospitals by conducting monthly morbidity and mortality meetings

SO Baseline measure 6) TB Hospitals with

mortality and morbidity meetings every month(6/6)

% 100% [6/6]

100% [6/6]

50% [3/6]

67% [4/6]

76%

100% [6/6]

100% [6/6]

100% [6/6]


2.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality general specialist hospital services by 2014.

2.1.1 Allocate sufficient funds to ensure the delivery of the full package of TB hospital services at a rate of R750 by 2014. [Constant 2008/09 rand]

SO Baseline measure 7) Expenditure per patient

day equivalent (PDE) in TB Hospitals

R R750 R284 R366 R446 R520 R535 R499 R457



Strategic Goal: Strategic objective SMART objective statement Indicator Type Baseline

target 2014

Audited/actual performance Estimate MTEF Projection National target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


3.1 Become the employer of choice in the health sector by creating an environment for a satisfied workforce

3.1.1 Perform and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in the, TB hospitals

SO Baseline measure 8) Percentage of TB

hospitals with annual staff satisfaction survey completed. (6/6)

% 100% [6/6]

100% [6/6]

100% [6/6]

100% [6/6]

3.1.2 Ensure optimum staffing levels for all facilities by ensuring that 97.5% of affordable staff establishment remains filled.

9) 97.5% of affordable staff establishment filled for TB hospitals

% 100% [6/6]

Not reported

Not reported

Not reported

Not reported

100% 100% 100%



4.1.1 Effectively manage the allocated resources of TB hospitals to achieve a bed utilisation rate of 90% and an average length of stay of 85 days.

SO Baseline measure 10) Average length of stay in

TB hospitals.

Days 85 days 76 days 80 days 82 days 87 days 90 days 92 days 94 days

11) Bed utilisation rate in TB hospitals.

% 90% 83% 83% 82% 76% 78 % 82% 85%

Note: Indicator 6: Constant 2008/09 prices.



5.2 QUARTERLY TARGETS FOR TB HOSPITALS

Table 4.6: Quarterly targets for TB hospitals for 2010/11 [PHS3]

Strategic Goal: Strategic objective SMART objective statement Indicator Reporting period

Annual Target Quarterly targets

2010/11 Q1 Q2 Q3 Q4


1.1 Ensure access to general specialist hospital services.

1.1.1 Ensure access to the full package of TB hospital services by providing 1 284 TB hospital beds by 2014.

SO Baseline measure 1) Number of TB hospital beds.

Quarterly 1 040 1 040 1 040 1 040 1 040

2) Total separations in TB Hospitals Quarterly 3,481 829 829 829 829

3) Patient Day Equivalents in TB Hospitals Quarterly 289 411 72 277 72 277 72 277 72 277

4) OPD Total Headcounts in TB Hospitals Quarterly 1 740 435 435 435 435


1.1.2 Perform and analyze one standardized patient satisfaction survey per year to measure patient satisfaction in TB Hospitals

SO Baseline measure: 5) Percentage of TB hospitals with patient

satisfaction survey using DOH template. (6/6)

Annually 100% 0 0 0 100%

1.1.3 Implement quality assurance measures to minimize patient risk in TB hospitals by conducting monthly morbidity and mortality meetings

SO Baseline measure 6) Percentage of TB Hospitals with mortality

and morbidity meetings every month(6/6)

Quarterly 100% 100% 100% 100% 100%


2.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality general specialist hospital services by 2014.

2.1.1 Allocate sufficient funds to ensure the delivery of the full package of TB hospital services at a rate of R750 by 2014. [Constant 2008/09 rand]

SO Baseline measure 7) Expenditure per patient day equivalent

(PDE) in TB Hospitals



3.1 Become the employer of choice in the health sector by creating an environment for a satisfied workforce

3.1.1 Perform and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in the TB hospitals

SO Baseline measure 8) Percentage of TB hospitals with annual

staff satisfaction survey completed. (6/6)

Annually 100% 100% 100% 100% 100%


9) 97.5% of affordable staff establishment filled for TB hospitals.

Quarterly 100% 100% 100% 100% 100%



4.1.1 Effectively manage the allocated resources of TB hospitals to achieve a bed utilisation rate of 90% and an average length of stay of 85 days by 2014.

SO Baseline measure 10) Average length of stay in TB hospitals.


11) Bed utilisation rate in TB hospitals. Quarterly 78% 78% 78% 78% 78%



5.3 RECONCILING PERFORMANCE TARGETS WITH THE BUDGET AND MTEF

5.3.1 Performance and expenditure trends

Sub-programme 4.2 is allocated 6.2 per cent of the Programme 4 budget in 2010/11 in comparison to the 6.36 per cent of the budget that was allocated in the revised estimate of 2009/10. This amounts to an increase of R16.392 million or 10.12 per cent.

Table 4.7: Trends in public health expenditure for Tuberculosis (TB) hospitals [PHS2]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital

Grand Total 76 379 000 101 671 000 135 635 000 161 978 000 178 370 000 191 353 000 202 025 000

Total per person 14.47 18.86 24.60 28.75 30.99 32.56 33.68




Total Capital

Grand Total 86 859 115 109 906 351 135 635 000 148 848 416 154 933 609 156 404 313 155 714 931

Total per person 16.45 20.38 24.60 26.42 26.92 26.61 25.96




6. SUB-PROGRAMME 4.3 PSYCHIATRIC HOSPITALS

The strategic goals and strategic objectives in psychiatric hospitals are outlined below.

6.1 STRATEGIC GOAL 1: MANAGE THE BURDEN OF DISEASE


Integration of mental health services into general care settings in accordance with the Mental Health Care Act 17 of 2002 and ensure access to the full package of psychiatric hospital services.

6.1.1.1 Improve quality of care at all levels of care

6.1.1.2 Ensure access to the full package of psychiatric hospital services by providing 1 568

psychiatric hospital beds by 2014.

Acute, sub-acute and chronic in-patient beds to be reviewed across all levels of care

1) Sub-Acute Services

• Strengthen and stabilise the sub acute services at William Slater and New Beginnings

• Explore the possibility of transferring William Slater to an NPO during this period.

2) Acute services

• Strengthen the outreach and support from the psychiatric hospitals to the acute regional and district hospitals.

• Create structures across the platform in the metro to improve the management and coordination of the acute service load.

• Strengthen ambulatory services across all levels of care.

o Strengthen the ACTeams within the Psychiatric hospitals.

o Strengthen Specialised Ambulatory Treatment Service at Stikland Hospital and establish similar services at Lentegeur and Valkenberg Hospitals.

6.2 STRATEGIC GOAL 2: ENSURE AND MAINTAIN ORGANIZATIONAL STRATEGIC MANAGEMENT CAPACITY AND SYNERGY


6.2.1.1 Develop integrated support and management structures to render effective clinical services

• Staff recruitment and retention strategies to be enhanced to support systems in areas such as finance, human resources, maintenance and information management.

• Improve efficiencies in supply chain management, filling of posts and working across divisions.

6.2.1.2 Strengthen monitoring and evaluation capability and capacity

• Align reporting requirements.

• Undertake a discipline specific review of mental health in the province.



6.3 STRATEGIC GOAL 3: DEVELOP AND MAINTAIN A CAPACITATED WORKFORCE TO DELIVER THE REQUIRED HEALTH SERVICES


6.3.1.1 Become the employer of choice in the health sector by creating an environment for a satisfied workforce

• Maintain filled posts at 97.5 % of the approved and funded staff establishment for each hospital

• Strengthen continuing professional development.

6.4 STRATEGIC GOAL 4: PROVIDE AND MAINTAIN APPROPRIATE HEALTH TECHNOLOGY AND INFRASTRUCTURE


6.4.1.1 Ensure the provision of infrastructure that meets the needs of current and future development

• Infrastructure to be completed according to planned maintenance schedule at all four hospitals.

• Ensure all hospitals have a five year infrastructure plan

• Ensure functional planning and commissioning units [PCU’s] per hospital and continue to have executive platform PCU meetings to monitor and evaluate progress and prioritise platform requirements in accordance with service plan.



6.5 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR PSYCHIATRIC HOSPITALS

Table 4.8: Strategic objectives, performance indicators and annual targets for psychiatric hospitals [PHS1 & 2]

Strategic goal Strategic objective title Strategic objective statement Performance indicator Type

Baseline target

2014/15

Audited/actual performance Estimate MTEF projections National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Ensure access to psychiatric hospital services

1.1.1 Provide a total of 1 568 beds in specialist psychiatric hospitals by 2014

Strategic objective [SO] Baseline measure: 1) Number of beds in

Psychiatric hospitals

No 1 568 2 015 1 924 1 934 1 745 1 696 1 640 1 584

2) Total separations in psychiatric hospitals

No 4 907 4 560 5 051 5 052 4 951 4 852 4 755

3) Patient day equivalents in psychiatric hospitals

No 647 315 641 220 616 296 605 200 593 200 581 400 569 800

4) OPD total headcounts in psychiatric hospitals

No 20 573 21 403 23 955 24 516 24 763 25 013 25 266

1.1.2 Provide a total of 72 step-down beds and maintain a bed occupancy rate of 85% in sub-acute facilities by 2014.

5) Number of step down beds No New indicator

New indicator

New indicator

127 72 32 32

6) Bed utilisation rate in step down beds

% New indicator

New indicator

New indicator

85% 85% 85% 85%

7) Total number of patient days in step down beds

No New indicator

New indicator

New indicator

38 871 28 543 31 025 37 230


1.2.1 Implement and maintain quality assurance measures in psychiatric hospitals to minimise patient risk by performing monthly mortality and morbidity meetings to monitor the quality of hospital services.

SO Baseline measure: 8) Psychiatric hospitals with

mortality and morbidity meetings every month

% 100% [4/4]

100 [4/4]

100 [4/4]

100 [4/4]

100 [4/4]

100 [4/4]

100 [4/4]


SO Baseline measure: 9) Percentage of psychiatric

hospitals with patient satisfaction survey using DOH template (4/4)

100% [4/4]

0 0 0 100% [4/4]

100% [4/4]

100% [4/4]

100% [4/4]

1.2.3 Implement and maintain quality assurance measures in psychiatric hospitals to minimise patient risk

10) Psychiatric hospitals monitor adverse and safety and security incidents monthly and have a system for using the information to improve safety and reduce risks

100% [4/4]

100%

[4/4] 100%

[4/4] 100%

[4/4] 100%

[4/4] 100%

[4/4] 100%

[4/4] 100%

[4/4]



Strategic goal Strategic objective title Strategic objective statement Performance indicator Type

Baseline target

2014/15

Audited/actual performance Estimate MTEF projections National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15



2.1.1 Appropriate management of bed utilisation within specialist psychiatric hospitals to achieve an average length of stay of 90 days and bed occupancy rate of 85% by 2014

11) Average length of stay in Psychiatric Hospitals

Days 130 days

139 days

118 days

115 days

100 days

100 days

95 days

12) Bed utilisation rate (based on usable beds in Psychiatric Hospitals

% 86% 90% 87% 86% 86% 85% 85%


3.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality psychiatric hospital services

3.1.1 Ensure the cost effective management of psychiatric hospitals at a target expenditure of R977 per PDE by 2014. [Constant 2008/09 rand]

S0 Baseline measure: 13) Expenditure per patient day

equivalent (PDE) in Psychiatric Hospitals

R R977 R528 R612 R673 R749 R778 R800 R810




14) 97.5% of affordable staff establishment filled for psychiatric hospitals

% Not reported

Not reported

Not reported

Not reported

100% 100% 100%

4.1.2 Perform and analyze one l standardized staff satisfaction surveys to measure workforce satisfaction in the, Psychiatric hospitals every two years.

SO Baseline measure 15) Percentage of psychiatric

hospitals with staff satisfaction surveys conducted using DoH template (4/4)

% 100% [4/4]

100% [4/4]

100% [4/4]

100% [4/4]





% 100% [4/4]

Not reported

Not reported

Not reported

Not reported

100% [4/4]

100% [4/4]

100% [4/4]

5.1.2 Ensure 5 year plan per institution

17) Percentage of hospitals with 5 year infrastructure plan (4/4)

% 100% [4/4]

Not reported

Not reported

Not reported

100% [4/4]

75% [3/4]

100% [4/4]

100% [4/4]

Note: 1. ALOS for acute patients is 45 days and the current overall average for all psychiatric services is 111 days 2. Indicator 7: 2008/09 constant prices 3. Indicator 5: 40 Beds at William Slater and 15 Forensic beds at Lentegeur hospital will be transferred to a NGO in 2010/11 and 40 beds at New Beginning will be transferred in 2011/12.



6.6 QUARTERLY TARGETS FOR PSYCHIATRIC HOSPITALS

Table 4.9: Quarterly targets for psychiatric hospitals for 2010/11 [PHS3]

Strategic goal Strategic objective title Strategic objective statement Performance indicator Reporting period

Annual Target 2010/11

Q1 Q2 Q3 Q4


1.1 Ensure access to psychiatric hospital services

1.1.1 Provide a total of 1 568 beds in specialist psychiatric hospitals by 2014

Strategic objective [SO] Baseline measure: 1) Number of beds in Psychiatric

hospitals

Quarterly 1 696 1 696 1 696 1 696 1 696

2) Total separations in psychiatric hospitals

Quarterly 4 951 1 238 1 238 1 238 1 237

3) Patient day equivalents in psychiatric hospitals

Quarterly 593 200 148 300 148 300 148 300 148 300

4) OPD total headcounts in psychiatric hospitals

Quarterly 24 763 6 012 6 071 6 280 6 400

1.1.2 Provide a total of 72 step-down beds and maintain a bed occupancy rate of 85% in sub-acute facilities by 2014.

5) Number of step down beds Quarterly 72 72 72 72 72

6) Bed utilisation rate in step down beds Quarterly 85% 85% 85% 85% 85%

7) Total number of patient days in step down beds

Quarterly 28 543 28 543 28 543 28 543 28 543


1.2.1 Implement and maintain quality assurance measures in psychiatric hospitals to minimise patient risk by performing monthly mortality and morbidity meetings to monitor the quality of hospital services.

SO Baseline measure: 8) Psychiatric hospitals with mortality and

morbidity meetings every month

Quarterly 100 [4/4]

100% [4/4]

100% [4/4]

100% [4/4]

100% [4/4]


SO Baseline measure: 9) Percentage of psychiatric hospitals

with patient satisfaction survey using DOH template (4/4)

Annually? 100% [4/4]

0%

0% 0%

100% [4/4]

1.2.3 Implement and maintain quality assurance measures in psychiatric hospitals to minimise patient risk

10) Psychiatric hospitals monitor adverse and safety and security incidents monthly and have a system for using the information to improve safety and reduce risks


100% [4/4]

100% [4/4]

100% [4/4]

100% [4/4]



Strategic goal Strategic objective title Strategic objective statement Performance indicator Reporting period


Q1 Q2 Q3 Q4



2.1.2 Appropriate management of bed utilisation within specialist psychiatric hospitals to achieve an average length of stay of 90 days and bed occupancy rate of 85% by 2014

11) Average length of stay in Psychiatric Hospitals


12) Bed utilisation rate (based on usable beds in Psychiatric Hospitals

Quarterly 86% 85% 85% 85% 85%


3.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality psychiatric hospital services

3.1.2 Ensure the cost effective management of psychiatric hospitals at a target expenditure of R977 per PDE by 2014. [Constant 2008/09 rand]

S0 Baseline measure: 13) Expenditure per patient day equivalent

(PDE) in Psychiatric Hospitals





14) 97.5% of affordable staff establishment filled for psychiatric hospitals

Quarterly 100% 100% 100% 100% 100%

4.1.3 Perform and analyze one l standardized staff satisfaction surveys to measure workforce satisfaction in the, Psychiatric hospitals every two years using the DOH template.

SO Baseline measure 15) Percentage of psychiatric hospitals

with staff satisfaction surveys conducted using DoH template (4/4)

Annually 100% [4/4]

0%

0% 0%

100% [4/4]






100% [4/4]

100% [4/4]

100% [4/4]

100% [4/4]

5.1.3 Ensure 5 year plan per institution 17) Percentage of hospitals with 5 year infrastructure plan (4/4)

Quarterly 75% [3/4]

75% [3/4]

75% [3/4]

75% [3/4]

75% [3/4]

Note: Indicator 7: 2008/09 constant prices Indicator 11: ALOS for acute patients are 45 days and the overall average for all psychiatric services is 115 days





Sub-programme 4.3 is allocated 17.47 per cent of the Programme 4 budget in 2010/11 in comparison to the 18.17 per cent that was allocated in the 2009/10 budget. This amounts to a nominal increase of R40.101 million or 8.67 per cent.

Table 4.10: Trends in public health expenditure for psychiatric hospitals [PHS5]

Expenditure Actual/audited Estimate MTEF projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital

Grand Total 300 496 000 344 390 000 391 902 000 462 519 000 502 620 000 538 408 000 566 163 000

Total per person 56.93 63.87 71.09 82.09 87.33 91.61 94.39




Total Capital

Grand Total 341 727 657 372 285 590 391 902 000 414 691 648 436 579 753 440 073 232 436 381 796

Total per person 64.74 69.05 71.09 73.60 75.85 74.88 72.75




7. SUB-PROGRAMME 4.4: SPECIALISED REHABILITATION SERVICES

The key priorities in line with the strategic goals within specialized rehabilitation services are:


7.1.1 Strategic objective: Ensure access to the full package of rehabilitation services by providing 156 rehabilitation beds by 2014

• Deliver inter-disciplinary outcome based rehabilitation services in line with the Rehabilitation and Disability Management Service Plan in the Comprehensive Service Plan.

• Facilitate the implementation of appropriate service solutions for the prevention of secondary complications in persons with disabilities, particularly in high risk groups such as the spinal cord injured.

• Provide a training and research platform to the tertiary education institutions in the Western Cape.

• Promote the sustainability of the Western Cape Rehabilitation Centre as a centre of excellence for rehabilitation services.

• Provide support to District Health Services to facilitate the development of quality rehabilitation services for persons with physical disabilities.

• Facilitate the development of a DPO (Disabled Persons Organization)-/ NGO- mediated peer supporter network throughout the Western Cape, who will educate, train and support people with disabilities in their communities.

• Provide sufficient capacity to render comprehensive, individualised rehabilitation programmes to disabled clients.

• Support the project to investigate and make recommendations on the modernization of audiology services for the Western Cape.

• Provide an oversight and co-ordinating structure for the Provincial Mobility and Communication Assistive Devices Committees.

• Enhance the functionality of persons with disabilities through the provision of an efficient and effective Orthotic and Prosthetic Services:

• Render on-site, off-site and outreach orthotic and prosthetic services to all regions in the Western Cape.

• Render outsourced orthotic and prosthetic services to the Southern Cape Karoo region.

• Facilitate the development and implementation of a modernized and quality orthotic and prosthetic service.

• Develop and implement a strategic service plan for orthotic and prosthetic services and monitor and evaluate progress.

7.1.2 Strategic objective: Improve quality of care at all levels of care

• Co-ordinate and integrate quality assurance within the management of the institution.

• Ongoing quarterly review and audit of the rehabilitation- specific standards previously developed.



• Improved infection and prevention control measures, particularly in high risk areas in the facility in respect of TB transmission.

• Ensure regular morbidity and mortality meetings and clinical audit takes place.

• Annual patient and staff satisfaction surveys and actions to address issues emanating from the surveys

7.2 STRATEGIC GOAL: ENSURE AND MAINTAIN ORGANISATIONAL STRATEGIC MANAGEMENT CAPACITY AND SYNERGY

• Develop integrated support and management structures to render effective rehabilitation services.

• Render services through a configuration of four interdisciplinary teams as functional business units.

7.3 STRATEGIC GOAL: DEVELOP AND MAINTAIN A CAPACITATED WORKFORCE TO DELIVER THE REQUIRED HEALTH SERVICES

• Organisational development investigation for WCRC to be completed and report submitted.

• Maintain filled posts at 97.5 % of the approved and funded staff establishment.

• 250 CBR peer supporters trained.

• Continue with the nurse training bridging programmes at WCRC.

7.3.1 Strategic objective: Become the employer of choice in the health sector by creating an environment for a satisfied workforce

• Ensure workforce capacity to render required rehabilitation services, whilst at the same time maintain a balance between service- and training / capacity-development demands.

• Perform annual staff satisfaction surveys and implement recommendations to improve the working environment and satisfaction of personnel.

• Further development of the skills development strategy for OPC staff in line with the technological upgrade of equipment.

7.4 STRATEGIC GOAL: PROVIDE AND MAINTAIN APPROPRIATE HEALTH TECHNOLOGY AND INFRASTRUCTURE

7.4.1 Strategic objective: Ensure the provision of infrastructure that meets the needs of current and future development.

• Infrastructure is maintained through the public private partnership [PPP] contract and effective contract management by the project manager and support team ensures that contractual obligations are met.

• Assess current and future infrastructure needs for the orthotic and prosthetic service for the Western Cape.



7.5 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR REHABILITATION HOSPITALS

Table 4.11: Strategic objectives and annual targets for rehabilitation hospitals [PHS1 & 2]

Strategic goal Strategic objective: Title Strategic objective statement Indicator Type Baseline

target 2014/15

Audited/ actual performance Estimate MTEF projection National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


1.1 Ensure access to specialized rehabilitation services

1.1.1 Provide a total of 156 beds in specialist rehabilitation hospitals by 2014.


rehabilitation hospitals

No 156 156 156 156 156 156 156 156 Not provided by NDOH

2) Total number of patient days in rehabilitation hospitals

No 51 270 45 395 48 743 49 176 49 250 49 747 50 249 50 757

3) Total separations in rehabilitation hospitals

No 1 045 1 049 958 944 1 004 1 014 1 024 1 034

4) Patient day equivalents in rehabilitation hospitals

No 57 661 47 130 50 654 54 940 55 389 55 948 56 513 57 084

5) OPD total headcounts in rehabilitation hospitals

No 25 846 5 206 5 856 16 227 24 828 25 078 25 332 25 587


1.1.2 Implement and maintain quality assurance measures in rehabilitation hospitals to minimize patient risk by performing monthly mortality and morbidity meetings to monitor the quality of hospital services as reflected in the acuity of diseases, adverse events and proportion of deaths for the reporting period.

SO Baseline measure: 6) Rehabilitation

hospitals with mortality and morbidity meetings every month (1/1)

% 100% 100% 100% 100% 100% 100% 100% 100%


2.1 Ensure that management provides sustained and strategic direction in the delivery of health services with well defined efficiency targets towards improving quality of care

2.1.1 Efficiently manage the allocated resources of rehabilitation services to achieve a target bed utilization rate of 85% and an average length of stay of 50 days.

SO Baseline measure: 7) Average length of

stay in rehabilitation hospitals

Days 50 days 43 days 52 days 56 days 52 days 52 days

52 days

50 days

SO Baseline measure: 8) Bed utilization rate

(based on usable beds) in rehabilitation hospitals

% 85% 80% 87% 86% 85% 85% 85% 85%



Strategic goal Strategic objective: Title Strategic objective statement Indicator Type Baseline

target 2014/15

Audited/ actual performance Estimate MTEF projection National Target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2014/15


3.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality rehabilitation hospital services by 2014

3.1.1 Ensure the cost effective management of rehabilitation hospitals at a target expenditure of R1 667 per PDE by 2014. [Constant R2008/09 rands]

SO Baseline measure: 9) Expenditure per

patient day equivalent (PDE) in rehabilitation hospitals

R R1 667 R1 332 R1 308 R1 387 R1 445 R1 455 R1 459 R1 442




10) 97.5% of affordable staff establishment filled for rehabilitation hospitals (1/1)

% 100% Not reported

Not reported

Not reported

Not reported

100% 100% 100%


5.1 Ensure access to specialized orthotic and prosthetic services

5.1.1 Appropriately manage the in-house and outsourced orthotic and prosthetic services

11) Number of orthotic and prosthetic devices manufactured

No 5 798 4 467 5 250 5 462 5 570 5 626 5 683 5 740

5.1.2 Reduce the waiting list for orthotic and prosthetic services by increasing productivity and outsourcing of services where more cost effective

12) Number of patients on waiting list for orthotic and prosthetic service for over 6 months

No 340 758 441 295 420 400 380 360



6.1.1 Ensure the establishment of PCU’s at all institutions.

13) Establish PCU’s per institution (1/1)

100% Not reported

Not reported

Not reported

100% 100% 100% 100%

6.1.2 Ensure 5 year plan per institution. 14) Percentage of hospitals with 5 year infrastructure plan (1/1)

100% Not reported

Not reported

Not reported

100% 100% 100% 100%

Note: Indicator 1: Throughput remains constant Indicator 3: WCRC went on Clinicom in 20008/2009 and all the service groups at OPD’s are now included in the headcount as per the definitions Indicator 7: 2008/09 constant prices. Indicator 10: Increases are based on the current staff establishment which is filled below optimal level. Indicator 11: Projected decrease in the waiting list is based on the current staff establishment which is filled below optimal level and the waiting list shorter than 6 months has been increasing



7.6 QUARTERLY TARGETS FOR REHABILITATION HOSPITALS

Table 4.12: Quarterly targets for rehabilitation hospitals for 2010/11 [PHS3]

Strategic goal Strategic objective: Title Strategic objective statement Indicator Reporting period

Annual target

2010/11

Quarterly target

Q1 Q2 Q3 Q4


1.1 Ensure access to specialized rehabilitation services

1.1.1 Provide a total of 156 beds in specialist rehabilitation hospitals by 2014.



Quarterly 156 156 156 156 156

2) Total number of patient days in rehabilitation hospitals

Quarterly 49 747

3) Total separations in rehabilitation hospitals

Quarterly 1 014 253 253 254 254

4) Patient day equivalents in rehabilitation hospitals

Quarterly 55 948 13 987 13 987 13 987 13 987

5) OPD total headcounts in rehabilitation hospitals

Quarterly 25 078 6 269 6 269 6 270 6 270


1.2.1 Implement and maintain quality assurance measures in rehabilitation hospitals to minimize patient risk by performing monthly mortality and morbidity meetings to monitor the quality of hospital services as reflected in the acuity of diseases, adverse events and proportion of deaths for the reporting period.

SO Baseline measure: 6) Rehabilitation hospitals

with mortality and morbidity meetings every month (1/1)

Quarterly 100% 100% 100% 100% 100%


2.1 Ensure that management provides sustained and strategic direction in the delivery of health services with well defined efficiency targets towards improving quality of care

2.1.1 Efficiently manage the allocated resources of rehabilitation services to achieve a target bed utilization rate of 85% and an average length of stay of 50 days.

SO Baseline measure: 7) Average length of stay in



SO Baseline measure: 8) Bed utilization rate (based

on usable beds) in rehabilitation hospitals

Quarterly 85% 85% 85% 85% 85%


3.1 Allocate sufficient funds to ensure the sustained delivery of the full package of quality rehabilitation hospital services by 2014

3.1.1 Ensure the cost effective management of rehabilitation hospitals at a target expenditure of R1 667 per PDE by 2014. [Constant R2008/09 rands]

SO Baseline measure: 9) Expenditure per patient

day equivalent (PDE) in rehabilitation hospitals

Quarterly R1 455 R1 455 R1 455 R1 455 R1 455




10) 97.5% of affordable staff establishment filled for rehabilitation hospitals (1/1)

Quarterly 100% 100% 100% 100% 100%



Strategic goal Strategic objective: Title Strategic objective statement Indicator Reporting period

Annual target

2010/11

Quarterly target

Q1 Q2 Q3 Q4


5.1 Ensure access to specialized orthotic and prosthetic services

5.1.1 Appropriately manage the in-house and outsourced orthotic and prosthetic services

11) Number of orthotic and prosthetic devices manufactured

Quarterly 5 626 1 406 1 406 1 406 1 408

5.1.2 Reduce the waiting list for orthotic and prosthetic services by increasing productivity and outsourcing of services where more cost effective

12) Number of patients on waiting list for orthotic and prosthetic service for over 6 months

Quarterly 400 420 415 410 400



6.1.1 Ensure the establishment of PCU’s at all institutions.

13) Establish PCU’s per institution (1/1)

Annually 100% 100% 100% 100% 100%

6.1.2 Ensure 5 year plan per institution. 14) Percentage of hospitals with 5 year infrastructure plan (1/1)

Annually 100% 100% 100% 100% 100%

Note: Indicator 7: 2008/09 constant prices.





Sub-programme 4.4 is allocated 4.25 per cent of the Programme 4 budget in 2010/11 in comparison to the 4.42 per cent that was allocated in 2009/10. This amounts to a nominal increase of R9.785 million or 8.71 per cent.

Table 4.13: Trends in public health expenditure for rehabilitation hospitals [PHS5]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital

Grand Total 55 202 000 79 888 000 99 317 000 112 383 000 122 168 000 131 463 000 139 227 000

Total per person 10.46 14.82 18.01 19.95 21.23 22.37 23.21




Total Capital

Grand Total 62 776 377 86 358 928 99 317 000 106 035 136 106 116 102 107 452 615 107 312 078

Total per person 11.89 16.02 18.01 18.82 18.44 18.28 17.89


8. SUB-PROGRAMME 4.5: DENTAL TRAINING HOSPITALS

8.1 STRATEGIC GOAL: MANAGE THE BURDEN OF DISEASE.

Strategic objectives

Ensure access to an integrated oral health service and training platform by providing for 185 454 patient visits per annum by 2014.



Table 4.14: Strategic objectives and annual targets for dental training hospitals [PHS2]

Strategic goal Strategic objective: Title Strategic Objective: Statement Indicator Type

Baseline target

2014/15

Audited/ actual Estimate MTEF Projection National target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1 Manage the burden of disease

1.1 Ensure access to dental training hospitals

1.1.1 Ensure dental patients attending clinics are seen by a specialist, a general dentist, an allied health professional or students with a target of 185 454 by 2014

Strategic objective Baseline measure: 1) Number of patient visits

per annum

No 195 203 176 991 199 021 179 120 180 000 181 800 183 618 Not determined

1.1.2 Performing maxillofacial surgery procedures during which one or more incisions are made to the Head and Neck area and is performed in a registered operating theatre that is equipped for anaesthesia and able to provide sterile conditions for surgical procedures with a target of 1700 by 2014

2) Number of theatre cases per annum

No 1 500 1 016 1 523 1 604 1 616 1 640 1 664

1.1.3 Provide quality removable prosthetic devices to patients with a target of 4 108 by 2014

3) Number of removable prosthetic devices manufactured (Dentures)

No Not reported

Not reported

Not reported

Not reported

3 988 4 028 4 068

1.1.4 Provide a quality Orthodontic service to Dental patients with a target of 297 by 2014

4) Number of new patients banded for orthodontic treatment (braces)

No Not reported

Not reported

Not reported

Not reported

288 290 294

Table 4.15: Quarterly targets for dental training hospitals for 2010/11 [PHS3]

Strategic goal Strategic objective: Title Strategic Objective: Statement Indicator Reporting

period Annual target Quarterly targets

2010/11 Q1 Q2 Q3 Q4

1 Manage the burden of disease

1.1 Ensure access to dental training hospitals

1.1.1 Ensure dental patients attending clinics are seen by a specialist, a general dentist, an allied health professional or students with a target of 185 454 by 2014

Strategic objective Baseline measure: 1) Number of patient visits per annum

Quarterly 180 000 48 600 52 200 36 000 43 200

1.1.2 Performing maxillofacial surgery procedures during which one or more incisions are made to the Head and Neck area and is performed in a registered operating theatre that is equipped for anaesthesia and able to provide sterile conditions for surgical procedures with a target of 1700 by 2014

2) Number of theatre cases per annum Quarterly 1 616 388 388 404 436

1.1.3 Provide quality removable prosthetic devices to patients with a target of 4 108 by 2014

3) Number of removable prosthetic devices manufactured (Dentures)

Quarterly 3 988 1 196 1 515 798 479

1.1.4 Provide a quality Orthodontic service to Dental patients with a target of 297 by 2014

4) Number of new patients banded for orthodontic treatment (Braces)

Quarterly 288 29 141 72 46





Sub-programme 4.5 is allocated 3.28 per cent of the Programme 4 budget for 2010/11 in comparison to the 3.21 per cent that was allocated in 2009/10. This is a nominal increase of R12.680 million or 15.54 per cent.

Table 4.16: Trends in public health expenditure in dental training hospitals [PHS5]

Expenditure Audited/ actual Estimate MTEF Projection

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital

Grand Total 55 924 000 61 888 000 66 052 000 81 606 000 94 286 000 101 033 000 106 878 000

Total per person 10.59 11.48 11.98 14.48 16.38 17.19 17.82




Total Capital

Grand Total 63 597 444 66 900 928 66 052 000 76 198 080 81 897 574 82 580 346 82 378 420

Total per person 12.05 12.41 11.98 13.52 14.23 14.05 13.73


9. RECONCILING PERFORMANCE TARGETS WITH EXPENDITURE TRENDS IN PROGRAMME 4


The funding for Programme 4 increased significantly in 2008/09 as the funding for level two services provided in central hospitals was transferred from Programme 5 to Sub-programme 4.1.

The funding for GF Jooste, Helderberg, Karl Bremer and Nelspoort Hospitals was transferred from Programme 4 to Programme 2 during 2007/08.

The management and funding for the Orthotic and Prosthetic Centre was transferred from Programme 7 to Sub-programme 4.4 from 2008/09.

R3 million was vired during the adjustments estimates from sub-programme 4.3 to Programme 2 for funding sub-acute facilities.

Programme 4 is allocated 24.04 per cent of the vote during 2010/11 in comparison to the 24.11 per cent that was allocated in the 2009/10 revised estimate. This amounts to a nominal increase of R331.319 million or 13.02 per cent.



Table 4.17: Expenditure estimates: Provincial Hospital Services [PHS4]


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

General Hospitals a 909 634 718 190 1 567 744 1 845 237 1 703 344 1 726 426 1 978 787 14.62 2 122 029 2 239 356

Tuberculosis Hospitals a 76 379 101 671 135 635 155 621 160 397 161 978 178 370 10.12 191 353 202 025

Psychiatric/Mental Hospitals a 300 496 344 390 391 902 430 171 446 866 462 519 502 620 8.67 538 408 566 163

Chronic Medical Hospitals a 55 202 79 888 99 317 111 600 114 262 112 383 122 168 8.71 131 463 139 227

Dental Training Hospitals a 55 924 61 888 66 052 78 682 82 110 81 606 94 286 15.54 101 033 106 878

1 397 635 1 306 027 2 260 650 2 621 311 2 506 979 2 544 912 2 876 231 13.02 3 084 286 3 253 649

Note: Sub-programme 1.2.2 allocations from 2010/11 was shifted to sub-programme 4.1

Note: Contributing factors to the decrease of funding in this programme in 2007/08 are the allocation of GF Jooste, Hottentots Holland and Karl BremerHospitals from sub-programme 4.1 to sub-programme 2.9 and Nelspoort Hospital from sub-programme 4.4 to sub-programme 2.4.

Note: The increase in 2008/09 is due to the shift of the equitable share funding for level 2 beds in the central hospitals that is allocated to sub-programme 4.1 from sub-programme 5.1 and Orthotic and Prosthetic Services previously in sub-programme 7.4 been transferred to sub-programme 4.4.

Note: A contributing factor to the decrease of funding in this programme in 2009/10 is the allocation of Victoria Hospital from sub-programme 4.1 to sub-programme 2.9.


a 2010/11: Conditional grant: Health professions training and development: R87 548 000 (Compensation of employees R70 038 000; Goods and servicesR17 510 000).

5.

Outcome

2.

3.

Revised estimate


Main appro-priation

Adjusted appro-

priation

1.

4.

Sub-programmeR'000



Table 4.18: Payments and estimates by economic classification: Provincial Health Services



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Current payments 1 370 657 1 292 089 2 243 275 2 587 418 2 473 688 2 509 976 2 838 714 13.10 3 044 937 3 212 057 Compensation of employees 880 442 877 609 1 553 809 1 735 946 1 668 183 1 677 039 1 952 746 16.44 2 085 849 2 185 747

Salaries and wages 777 854 775 403 1 381 181 1 492 914 1 461 710 1 492 564 1 737 945 16.44 1 856 404 1 945 314 Social contributions 102 588 102 206 172 628 243 032 206 473 184 475 214 801 16.44 229 445 240 433

Goods and services 490 215 414 480 689 388 851 472 805 505 832 937 885 968 6.37 959 088 1 026 310 of which

3 1 14 7 (50.00) 7 7 166 996 37 1 980 475 88 98 11.36 105 114

7 827 5 175 7 483 9 839 8 859 7 625 8 366 9.72 9 038 9 670 14 19 377 300 76 272 686 958 593 344 364 5.81 390 418

10 397 9 729 12 005 12 749 12 552 16 508 17 689 7.15 19 104 20 442 1 176 1 206 1 279 1 487 1 312 1 921 2 051 6.77 2 214 2 373 4 068 36 556 39 261 41 173 42 671 44 931 46 932 4.45 50 684 54 236

111 506 61 459 42 889 91 809 95 452 94 551 104 586 109 981 5.16 118 779 127 091

16 3 27 3 2 2 2 2 17 319 13 638 22 268 25 481 31 608 32 891 36 793 11.86 42 055 44 995

110 667 64 541 103 917 98 668 105 741 124 233 84 883 (31.67) 91 676 98 093

2 2 1 30 31 3 3 4 4 16 555 16 477 29 898 26 831 33 846 34 349 35 766 4.13 38 628 41 330

2 306 3 039 4 969 5 678 6 488 4 949 5 594 13.03 6 038 6 465 3 797 3 286 7 281 7 645 11 031 11 277 11 910 5.61 12 862 13 762

155 585 132 200 231 329 386 826 294 199 297 378 353 768 18.96 382 071 408 815 15 534 12 133 17 887 20 072 30 666 27 666 28 698 3.73 30 999 33 167

8 107 6 131 8 127 9 101 9 632 10 561 11 120 5.29 12 011 12 851 3 830 4 638 5 475 7 231 5 738 4 194 4 595 9.56 4 962 5 309

54 619 46 379 84 320 75 913 97 498 91 927 108 816 18.37 117 523 125 751

2 551 1 059 1 095 1 239 716 716 696 (2.79) 751 803

5 934 6 238 8 778 8 858 9 803 9 803 10 675 8.90 11 451 12 338 3 201 2 788 4 202 6 909 6 154 5 627 5 798 3.04 6 261 6 701 4 858 4 565 6 828 7 039 866 1 254 1 288 2.71 1 390 1 486

37 15 76 285 172 90 75 (16.67) 83 87 Interest and rent on land 78

Interest 78

Transfers and subsidies to 9 531 2 686 4 863 4 174 4 174 4 174 4 132 (1.01) 4 335 4 581 Provinces and municipalities 648


648 Non-profit institutions 6 018 1 021 1 226

Households 2 865 1 665 3 637 4 174 4 174 4 174 4 132 (1.01) 4 335 4 581 Social benefits 2 865 1 665 3 637 4 174 4 174 4 174 4 132 (1.01) 4 335 4 581

Payments for capital assets 16 955 10 965 12 337 29 719 29 117 30 648 33 385 8.93 35 014 37 011 Buildings and other fixed structures 11 588 45 (100.00)

Buildings 11 588 45 (100.00) Machinery and equipment 16 853 10 948 11 738 29 719 29 117 30 597 33 385 9.11 35 014 37 011

Transport equipment 11 686 756 965 760 (21.24) 796 841 Other machinery and equipment 16 853 10 948 11 727 29 033 28 361 29 632 32 625 10.10 34 218 36 170

Software and other intangible�assets 102 6 11 6 (100.00)

222 329 48.20 344 363





Inventory: Stationery and printingLease paymentsOwned and leasehold property expenditureTransport provided departmental activity

Revised estimate


Communication



Outcome

Main appro-priation

Adjusted appro-

priation

Cons/prof: Infrastructure & Cons/prof: Laboratory services

Administrative feesAdvertisingAssets <R5 000Audit cost: ExternalCatering: Departmental activities

Computer servicesCons/prof: Business and advisory services


Cons/prof: Legal costContractorsAgency and support/outsourced servicesEntertainment


Inventory: Medical suppliesInventory: Other consumables

Travel and subsistenceTraining and staff developmentOperating expenditureVenues and facilities

PART B: PROGRAMME 5: CENTRAL HOSPITAL SERVICES


PROGRAMME 5: CENTRAL HOSPITAL SERVICES (HIGHLY SPECIALIZED)


To provide tertiary and quaternary health services and create a platform for the training of health workers, and research.


2.1 SUB-PROGRAMME 5.1 CENTRAL HOSPITAL SERVICES

Rendering of highly specialized tertiary and quaternary services on a national basis, and a platform for the training of health workers, and research.

2.2 PROGRAMME OVERVIEW

The three central hospitals, Tygerberg Hospital, Groote Schuur Hospital and Red Cross War Memorial Children’s Hospital, provide highly specialized health services to the people of the Western Cape, as well as patients from beyond provincial boundaries.

The highly specialized services across these three hospitals form the Unitary/Integrated Western Cape Tertiary Service (UWCTS), providing services in 1 460 beds, and related outpatient clinics.

The UWCTS interacts with the level two platform of services, and through outreach, support and participation in clinical governance structures, the service plays an important role in the comprehensive service delivery of the Western Cape Province.

The UWCTS identified three key performance areas in its endeavour to achieve the strategic goals of the Department. The key performance areas for 2010/2011 are as follows:

• Service delivery.

• Clinical governance and quality assurance.

• Corporate governance.



3. STRATEGIC GOALS, OBJECTIVES AND INDICATORS

The relationship between the key performance areas and the strategic goals are as follows:

Table 5.1: Relationship between the key performance areas and the strategic goals

Key Performance Area Departmental Strategic Goal National Health System Priorities applicable to this Program

Service delivery • Manage the burden of disease • Provision of strategic leadership and creation of a social compact for better health outcomes

• Improve the quality of health services

• Overhauling the health care system and improve its management

• Improve human resources

• Revitalization of infrastructure

• Mass mobilization for the better health of the population

• Review of drug policy

• Research and development

Clinical governance and quality assurance

• Manage the burden of disease

• Ensure and maintain organizational strategic management capacity and synergy

Corporate governance • Ensure and maintain organizational strategic management capacity and synergy

• Develop and maintain a capacitated workforce to deliver the required health services

• Provide and maintain appropriate health technology and Infrastructure

• Ensure a sustainable income to provide the required health services according to the needs.

The following section captures high level notes to tables 5.1 and 5.2 tables.

A. KEY PERFORMANCE AREA: SERVICE DELIVERY


Strategies include the following:

• Fully implement the Acute Emergency case Load Management Policy priorities by March 2011.

• Provide access to 22 critical care beds at Red Cross War Memorial Children’s Hospital.

B. KEY PERFORMANCE AREA: CLINICAL GOVERNANCE


3.2.1 Strategic objective: Integration of quality assurance into all levels of care


• Implement quality assurance measures to minimise patient risk in the Central Hospitals by performing monthly morbidity and mortality meetings to monitor the quality of hospital services.

• Perform and analyze one annual survey to measure patient satisfaction in the Central Hospitals.



C. KEY PERFORMANCE AREA: CORPORATE GOVERNANCE

3.3 STRATEGIC GOAL 2: ENSURE AND MAINTAIN ORGANISATIONAL STRATEGIC MANAGEMENT CAPACITY AND SYNERGY


• Embed Functional Business Units1 (FBUs) for decentralised decision making, management and accountability.

4. RELATING FUNDING TRENDS TO STRATEGIC GOALS

Table 5.2 below indicates the allocation of funding to Programme 5.1. in the central hospitals

Table 5.2: Allocation of funding to Programme 5.1 in the central hospitals.

Audited 2006/07

Audited 2007/08

Audited 2008/09

Revised Estimate 2009/10

2010/11 2011/12 2012/13

Groote Schuur Hospital

910 200 996 524 978 601 1 112 081 1 254 755 1 352 484 1 427 120

Red Cross War Memorial Children’s Hospital

265 999 312 876 294 903 382 048 400 084 429 560 453 155

Tygerberg HOspitla 940 299 1 032 487 686 147 860 512 894 435 967 910 1 020 933

Maitland Cottage 4 595 4 825 5 812 7 547 7 695 8 072 8 532

Office DDG 1 907 3 172 5 223 7 361 5 290 5 674 6 023

MTS 33 712 35 734 37 521

Total: Programme 5 2 123 000 2 349 884 1 970 686 2 369 550 2 595 971 2 799 434 2 953 284

Note: Office of DDG: MTS funds are provided in the office of the DDG and finally allocated to central hospitals in the adjustment estimate.

4.1 FUNDING TRENDS:

Programme 5.1 is primarily funded from Conditional Grants namely the National Tertiary Service Grant (NTSG) and the Health Professional Training and Development Grant (HPTDG). It must be noted that due to funding deficit in rendering the required services Programme 5.1 is supplemented with the equitable share funding.

1 FBUs are aggregated cost centres in a logical arrangement, supported with information on human and financial resources,

expenditure trends, quality and patient activities.



4.2 CONDITIONAL GRANTS

4.2.1 National Tertiary Service Grant (NTSG)

The NTSG aims to compensate provinces for the supra-provincial nature of tertiary services provision and spill over effects to enable provinces to plan, modernize, rationalize and render tertiary services in line with national policy objectives.

Challenges: • The NTSG is R811 million short for the services that the province renders in terms of the NTSG

service level agreement.

• There is a lack of a comprehensive National Tertiary Health Plan, which would determine relative service distribution and access across the country.

The Western Cape Department of Health has made submissions to the NDOH, highlighting challenges and requesting augmented funding, in this regard.

4.2.2 Health Professional Training and Development Grant (HPTDG)

The purpose of the Health Professional Training and Development Grant is to support the funding of service costs associated with the training of health professionals in the services platform towards the national aim of expanding the number of health professionals. This platform accommodates students from four institutes of Higher Education (University of Stellenbosch, University of Cape Town, University of Western Cape, Cape Peninsula University of Technology).

Challenge:

• The funding levels of the grant have not matched inflation over time, or OSD implications. A

costing study concluded in 2007 reiterated the grant under funding for that year amounting to be

R468.4 million required to provide a service platform for teaching and training for students. This

situation makes it difficult to continue to have the same number of students training on the

service platform.

The Western Cape Department of Health has repeatedly motivated for the correction of deficits in the funding levels of this particular grant.

The Western Cape should continue to train health professionals to form part of a provincial and national pool of clinicians delivering health services to the citizens of South Africa. The Grant must therefore extend beyond the MTEF.



5. STRATEGIC OBJECTIVES PERFORMANCE INDICATORS AND TARGETS FOR CENTRAL HOSPITALS Table 5.3: Performance indicators for Central Hospitals [CHS 4 & 5]

Strategic goal Strategic objective Strategic objective statement Performance Indicator Type

Baseline target Audited/ actual Estimate Medium term targets

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


1.1 Reduce maternal mortality as a result of complications during delivery

1.1.1 Perform appropriate 44% clinically indicated caesarean sections to ensure improved outcomes and safety for mothers and babies by 2014/15.

Strategic Objective [SO] Baseline measure: 1) Caesarean section rate for

central hospitals

% 44%(6 055/

13 690)

35.0% 36.6% 40.6%(4 915/

12 123)

44%(5 058/

11 527)

44%(5 235/

11 930)

44% 5 462/

12 348

44% 5 653/

12 780

1.2 Ensure the delivery of tertiary services to manage the burden of disease at the appropriate level of care.

1.1.1 Ensure access to tertiary services by providing 1 460 tertiary beds for the reporting period

SO Baseline measure: 2) Number of designated

tertiary beds in central hospitals.

No 1 460 2 472 2 417 1 460 1 460 1 460 1 460 1 460

3) Total separations in central hospitals

No 75 871 127 671 123 495 70 000 69 659 70 610 71 390 71 103

4) OPD total headcounts in central hospitals

No 496 025 964 193 957 339 543 461 535 523 539 279 536 958 531 629

5) Patient day equivalents in central hospitals

No 620 567 1 117 316 1 090 957 603 475 629 202 635 859 636 138 631 000

1.3 Ensure optimal access to highly specialised services to manage the burden of disease.

1.3.1 Manage bed utilisation to achieve bed occupancy rate of 85% in central hospitals by 2014/2015.

Baseline measure 6) Bed utilisation rate (based

on usable beds) in central hospitals

% 85% 83% 81% 79% 84% 84% 84%

84%

1.4 Integration of quality assurance into all levels of care.

1.4.1 Implement quality assurance measures to minimise patient risk in the 3 Central Hospitals by performing monthly morbidity and mortality meetings to monitor the quality of hospital services by 2014/15.

Baseline measure 7) Number of central hospitals

conducting monthly morbidity and mortality reviews

No 3 3 3 3 3 3 3 3

1.4.2 Perform and analyse one annual survey to measure patient satisfaction in each of the Central Hospitals by 2014/15.

SO Baseline measure: 8) Number of central hospitals

that performed a annual patient satisfaction survey

No 3 3 3 3 3 3 3 3

1.4.3 Implement quality assurance measures to minimise patients risk in the central hospitals by monthly monitoring of the surgical deaths (mortality) for the reporting period and maintaining a mortality rate of less than 4.0% for tertiary surgical services by 2014/15.

SO Baseline measure: 9) Case fatality rate in central

hospitals for surgery separations

% 4.0% 3.0% 3.8% 2.4% 3.8% 4.2% 4.2%

4.2%


2.1 Allocate, manage and generate sufficient funds to ensure sustained delivery of the full package of quality, highly specialised services.

2.1.1 Increase the ICD coding of inpatient activities to 80% by 2014/15

SO Baseline measure: 10) ICD 10 coding rate of 80%

for inpatient activities in central hospitals by 2014/2015

% 80%

Not reported

Not reported

Not reported

Not reported

75% 75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent 2014/15. [Constant R2008/09 rand]


equivalent in central hospitals

R R5 534 R2 161 R2 328 R3 266 R3 392 R3 546 R3 597 R3 607





2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


3.1 Have a human resource development plan in place to deliver the required package of care and manage its resources.

3.1.1 Ensure each central hospital has a skills development plan to develop and maintain key skills to render effective and quality health services and manage its resources by 2014/15.


with an approved skills development plan.

No 3 Notreported

Not reported

Not reported

3 3 3 3


3.2.1 Perform, analyse and respond to the findings of one annual standardised staff satisfaction survey to measure workforce satisfaction in the each of the central hospitals by 2014/15.

13) Number of central hospitals that performed a staff satisfaction survey.

No 3 3 3 3 3 3 3 3

4. Ensure organisational strategic management capacity and synergy

4.1 Establish a Drug and Therapeutic committee to ensure compliance with Provincial Drug policies and participate in the review of drug policy

4.1.1 Ensure that a drug and therapeutic committee is established at each central hospital by 2014/15.


with an appointed Drug and Therapeutic committee.

No 3 Not reported

Not reported

Not reported

3 3 3 3

4.2 Establish a health facility board as a key supportive governance structure.

4.2.1 An appointed, functional health facility board serves as a key interface with the community at each central hospital by 2014/15.


with an appointed health facility board

No 3 Not reported

Not reported

Not reported

3 3 3 3

4.3 Management provides sustained strategic direction in the delivery of sustained health services with well defined efficiency targets for tertiary services

4.3.1 Effectively mange allocated resources to achieve the Comprehensive Service Plan target average length of stay of 6 days for central hospitals


central hospitals

Days 6 days

5.4 days 5.8 days 6.8 days[422 267/

62 555]

6.6 days[450 000/ 69 000]

6.4 days[447 528/

69 659]

6.4 days

6.4 days



5.1.1 Ensure that a functional planning and commissioning unit is appointed at each central hospital to perform key planning and monitoring activities to ensure that current and future infrastructure needs are met by 2014/15.


with an appointed and functioning planning and commissioning unit.

No 3 Not reported

Not reported

Not reported

3 3 3 3

Notes: Indicator 1): The ceasarian section rate indicated is for the central hospital services.

The ceasarian section rate would change once the Comprehensive service plan service shifts and differentiation between level 2 and level 3 services in terms of ceasarian sections has been completed.



Table 5.4: Quarterly targets for central hospitals for 2010/11 [CHS6]

Strategic goal Strategic objective Strategic objective statement Performance Indicator Reporting period


2010/11 Q1 Q2 Q3 Q4




Strategic Objective [SO] Baseline measure: 1) Caesarean section rate for central

hospitals

Quarterly 44%

44%

44%

44%

44%



SO Baseline measure: 2) Number of designated tertiary beds

in central hospitals.

Quarterly 1 460 1 460 1 460 1 460 1 460

3) Total separations in central hospitals Quarterly 70 610 17 652 17 652 17 652 17 652

4) OPD total headcounts in central hospitals Quarterly 539 279 134 819 134 819 134 819 134 819

5) Patient day equivalents in central hospitals Quarterly 635 859 158 965 158 965 158 965 158 965



Baseline measure 6) Bed utilisation rate (based on usable

beds) in central hospitals

Quarterly 84%

84%

84%

84%

84%



Baseline measure 7) Number of central hospitals

conducting monthly morbidity and mortality reviews

Quarterly 3 3 3 3 3


SO Baseline measure: 8) Number of central hospitals that

performed a annual patient satisfaction survey

Quarterly 3 - - - 3


SO Baseline measure: 9) Case fatality rate in central hospitals

for surgery separations

Annually 4.2%

4.2%

4.2%

4.2%

4.2%




SO Baseline measure: 10) ICD 10 coding rate of 80% for

inpatient activities in central hospitals by 2014/2015

Quarterly 75%

75%

75%

75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R 5 535 per patient day equivalent 2014/15. [Constant R2008/09 rand].


equivalent in central hospitals

Quarterly R3 546 R3 546 R3 546 R3 546 R3 546





2010/11 Q1 Q2 Q3 Q4




SO Baseline measure: 12) Number of central hospitals with an

approved skills development plan. Annually

3 0 0 0 3



13) Number of central hospitals that performed a staff satisfaction survey. Annually

3 0 0 0 3





appointed Drug and Therapeutic committee.

Quarterly

3 3 3 3 3




appointed health facility board

Quarterly 3 3 3 3 3



SO Baseline measure: 16) Average length of stay in central

hospitals

Quarterly 6.4 days

(447 525/69 659)

6.4 days (111 881/

17 415)

6.4 days (111 881/

17 415)

6.4 days (111 881/

17 415)

6.4 days (111 881/

17 415)





appointed and functioning planning and commissioning unit.

Quarterly 3 3 3 3 3

Notes: Indicator 1: The ceasarian section rate indicated is for the central hospital services.

The ceasarian section rate will change once the Comprehensive Service Plan service shifts and differentiation between Level 2 and Level 3 services in terms of ceasarian sections has been completed



Table 5.5: Performance indicators for Groote Schuur Hospital [CHS 4 & 5]



2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13






% 55%

43% 47% 51.1%

54%

54%

55%

55%



SO Baseline measure: 2) Provide 607 tertiary beds in

Groote Schuur Hospital.

No 607 919 867 695 617 617 607 607

3) Total separations in Groote Schuur Hospital.

No 31 500 45 089 42 977 33 785 33 965 30 474 29 655 29 655

4) OPD total headcounts in Groote Schuur Hospital.

No 209 000 417 801 418 466 259 361 277 159 256 440 252 700 247 000

5) Patient day equivalents in Groote Schuur Hospital.

No 258 677 436 967 424 173 302 817 312 201 304 072 304 072 302 000




on usable beds) in Groote Schuur Hospital.

% 87%

82% 82% 85.5%

92%

88%

87%

87%



Baseline measure 7) Groote Schuur Hospital

conducts monthly morbidity and mortality reviews

No 1 1 1 1 1 1 1 1


SO Baseline measure: 8) Groote Schuur Hospital


No 1 1 1 1 1 1 1 1


SO Baseline measure: 9) Case fatality rate in Groote

Schuur Hospital for surgery separations

% 3.4% 4.1% 4.4% 3.0% 2,8% 3.5% 3.5%

3.5%





2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13





for inpatient activities in Groote Schuur Hospital by 2014/2015

% 80% Not reported

on

Not reported

on

Not reported

on

Not reported

on

75% 75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent 2014/15 [Constant 2008/09 rands].


equivalent in Groote Schuur Hospital.

R R5 534 R2 369 R2 540 R3 232 R3 306 R3 584 R3 636 R3 642




SO Baseline measure: 12) Groote Schuur Hospital with

an approved skills development plan.

No 1 Not reported

on

Not reported

on

Not reported

on

1 1 1 1



13) Groote Schuur Hospital performed a staff satisfaction survey.

No 1 1 1 1 1 1 1 1




SO Baseline measure: 14) Groote Schuur Hospital has

appointed a Drug and Therapeutic committee.

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1




appointed a health facility board

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1





Days 6 days 6.1 days 6.26 days 6.4 days 6.2 days 6.5 days 6.5 days

6.5 days





an appointed and functioning planning and commissioning unit.

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1

Notes: Indicator 1: The ceasarian section rate indicated is for the central hospital services. The ceasarian section rate would change once the Comprehensive service plan service shifts and differentiation between

Level 2 and level 3 services in terms of ceasarian sections has been completed.



Table 5.6: Quarterly targets for Groote Schuur Hospital for 2010/11 [CHS6]



2010/11 Q1 Q2 Q3 Q4




Strategic Objective [SO] Baseline measure: 1) Caesarean section rate for Groote

Schuur Hospital

Quarterly 54%

54%

54%

54%

54%



SO Baseline measure: 2) Provide 607 tertiary beds in Groote

Schuur Hospital.

Quarterly 617 617 617 617 617

3) Total separations in Groote Schuur Hospital.

Quarterly 30 474 7 619 7 619 7 619 7 619

4) OPD total headcounts in Groote Schuur Hospital.

Quarterly 256 440 73 220 73 220 55 000 55 000

1.3 1.4 5) Patient day equivalents in Groote Schuur Hospital.

Quarterly 304 072 76 018 76 018 76 018 76 018




beds) in Groote Schuur Hospital.

Quarterly 87%

87%

87%

87%

87%



Baseline measure 7) Groote Schuur Hospital conducts

monthly morbidity and mortality reviews

Quarterly 1 1 1 1 1


SO Baseline measure: 8) Groote Schuur Hospital performed a

annual patient satisfaction survey

Annually 1 1 0 0 0


SO Baseline measure: 9) Case fatality rate in Groote Schuur

Hospital for surgery separations

Quarterly 3.5%

3.5%

3.5%

3.5%

3.5%





inpatient activities in Groote Schuur Hospital by 2014/2015

Quarterly 75%

75%

75%

75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent 2014/15. [Constant 2008/09 rands]

SO Baseline measure 11) Expenditure per patient day equivalent

in Groote Schuur Hospital.

Quarterly R3 584 R3 584 R3 584 R3 584 R3 584





2010/11 Q1 Q2 Q3 Q4




SO Baseline measure: 12) Groote Schuur Hospital with an

approved skills development plan.

Annually 1 0 0 0 1



13) Groote Schuur Hospital performed a staff satisfaction survey.

Annually 1 1 0 0 0




SO Baseline measure: 14) Groote Schuur Hospital has appointed

a Drug and Therapeutic committee.

Quarterly 1 1 1 1 1



SO Baseline measure: 15) Groote Schuur Hospital has appointed

a health facility board

Quarterly 1 1 1 1 1



SO Baseline measure: 16) Average length of stay in Groote

Schuur Hospital

Quarterly 6.5 days (198 084/

30 474)

6.5 days (49 521/

7 619)

6.5 days (49 521/

7 619)

6.5 days (49 521/

7 619)

6.5 days (49 521/

7 619)




SO Baseline measure: 17) Groote Schuur Hospital has an


Quarterly 1 1 1 1 1

Notes: Indicator 1: The ceasarian section rate indicated is for the central hospital services. The ceasarian section rate would change once the Comprehensive service plan service shifts and differentiation between level 2 and level 3 services in terms of ceasarian sections has been completed



Table 5.7: Performance indicators for Tygerberg Hospital [CHS4 and 5]



2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13





Tygerberg Hospital

% 35%

28% 30% 33.2% (2 328/ 7 029)

35% (2 130/ 6 127)

35% (2 205/ 6 341)

35%

35%




Tygerberg Hospital.

No 598 1 238 1 262 538 608 608 608 608

3) Total separations in Tygerberg Hospital.

No 30 922 60 751 59 237 18 548 23 211 27 200 28 337

4) OPD total headcounts in Tygerberg Hospital.

No 200 000 395 928 370 123 203 643 194 239 202 391 202 613 202 000

5) Patient day equivalents in Tygerberg Hospital.

No 252 196 536 918 518 130 205 995 234 361 233 066 233 066 231 000




on usable beds) in Tygerberg Hospital.

% 85% 81% 80% 70.3%

76% 80%) 83%

84%



Baseline measure 7) Tygerberg Hospital

conducts monthly morbidity and mortality reviews

No 1 1 1 1 1 1 1 1


SO Baseline measure: 8) Tygerberg Hospital


No 1 1 1 1 1 1 1 1


SO Baseline measure: 9) Case fatality rate in

Tygerberg Hospital for surgery separations

% 5.2%

4.50% 4.90% 2.8% 5.0% 5.4 % 5.3%

5.3% )





2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13





for inpatient activities in Tygerberg Hospital by 2014/2015

% 80% Not reported

on

Not reported

on

Not reported

on

Not reported

on

75% 75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of

R5 534 per patient day equivalent 2014/15.[Constant R2008/09 rands].


equivalent in Tygerberg Hospital.

R R5 534 R1 992 R2 154 R3 331 R3 407 R3 333 R3 394 R3 407




SO Baseline measure: 12) Tygerberg Hospital with an


No 1 Not reported

on

Not reported

on

Not reported

on

1 1 1 1



13) Tygerberg Hospital performed a staff satisfaction survey.

No 1 1 1 1 1 1 1 1




SO Baseline measure: 14) Tygerberg Hospital has

appointed a Drug and Therapeutic committee.

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1



SO Baseline measure: 15) Tygerberg Hospital has

appointed a health facility board

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1


5. Effectively mange allocated resources to achieve the Comprehensive Service Plan target average length of stay of 6 days for central hospitals


Tygerberg Hospital

Days 6 days

6.25 days 6.2 days 7.5 days 6.2 days

6.5 days 6.5 days

6.4 days




SO Baseline measure: 17) Tygerberg Hospital has an


No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1

Notes: Indicator 1: The ceasarian section rate indicated is for the central hospital services. The ceasarian section rate would change once the Comprehensive service plan service shifts and differentiation

between level 2 and level 3 services in terms of ceasarian sections has been completed



Table 5.8: Quarterly targets for Tygerberg Hospital for 2010/11 [CHS6]


Annual Target Quarterly target

2010/11 Q1 Q2 Q3 Q4




Strategic Objective [SO] Baseline measure: 1) Caesarean section rate for Tygerberg

Hospital

Quarterly 35%

35% 35% 35% 35%




Tygerberg Hospital.

Quarterly 608 608 608 608 608

3) Total separations in Tygerberg Hospital.

Quarterly 27 200 6 800 6 800 6 800 6 800`

4) OPD total headcounts in Tygerberg Hospital.

Quarterly 202 391 50 598 50 598 50 598 50 598

5) Patient day equivalents in Tygerberg Hospital.

Quarterly 245 000 61 250 61 250 61 250 61 250




beds) in Tygerberg Hospital.

Quarterly 80% 80% 80% 80%

80%



Baseline measure 7) Tygerberg Hospital conducts monthly

morbidity and mortality reviews

Quarterly 1 1 1 1 1


SO Baseline measure: 8) Tygerberg Hospital performed a


Annually 1 0 0 0 1


SO Baseline measure: 9) Case fatality rate in Tygerberg

Hospital for surgery separations

Quarterly 5.4 % 5.4% 5.4% 5.4% 5.4%





inpatient activities in Tygerberg Hospital by 2014/2015

Quarterly 75% 75% 75% 75% 75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent 2014/15 [Constant 2008/09 rands].


equivalent in Tygerberg Hospital.

Quarterly R3 333 R3 333 R3 333 R3 333 R3 333




Annual Target Quarterly target

2010/11 Q1 Q2 Q3 Q4




SO Baseline measure: 12) Tygerberg Hospital with an approved

skills development plan.

Quarterly 1 1 1 1 1



13) Tygerberg Hospital performed a staff satisfaction survey.

Annually 1 0 0 0 1




SO Baseline measure: 14) Tygerberg Hospital has appointed a

Drug and Therapeutic committee.

Quarterly 1 1 1 1 1



SO Baseline measure: 15) Tygerberg Hospital has appointed a

health facility board

Quarterly 1 1 1 1 1



SO Baseline measure: 16) Average length of stay in Tygerberg

Hospital

Quarterly 6.5 days 6.5 days 6.5 days 6.5 days 6.5 days




SO Baseline measure: 17) Tygerberg Hospital has an appointed

and functioning planning and commissioning unit.

Quarterly 1 1 1 1 1

Notes: Indicator 1: The ceasarian section rate indicated is for the central hospital services. The ceasarian section rate would change once the Comprehensive service plan service shifts and differentiation

between level 2 and level 3 services in terms of ceasarian sections has been completed



Table 5.9: Performance indicators for Red Cross War Memorial Children's Hospital [CHS4 & 5]



2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13





Red Cross War Memorial Children’s Hospital [RCWMCH]

% Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable




RCWMCH.

No 255 277 288 227 235 235 235 245

3) Total separations in RCWMCH.

No 13 449 21 831 21 281 10 222 12 587 11 984 12 618 12 770

4) OPD total headcounts in RCWMCH.

No 87 025 150 464 145 639 80 457 86 272 80 448 81 645 82 629

5) Patient day equivalents in RCWMCH.

No 109,704 143,431 148,654 94,664 102,491 98,721 99 000 98 000




on usable beds) in RCWMCH.

% 85%

84% 82% 81.9% 86% 83%) 83% 84%



Baseline measure 7) RCWMCH conducts

monthly morbidity and mortality reviews

No 1 1 1 1 1 1 1 1


SO Baseline measure: 8) RCWMCH performed a


No 1 1 1 1 1 1 1 1


SO Baseline measure: 9) Case fatality rate in

RCWMCH for surgery separations

% 0.5%

0.4% 0.3% 0.2% 0.5% 0.5% 0.5%

0.5%





2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13





for inpatient activities in RCWMCH by 2014/2015

% 80%

Not reported

on

Not reported

on

Not reported

on

Not reported

on

75% 75%

75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent by 2014/15 [Constant 2008/09 rands]


equivalent in RCWMCH

R R5 534 R2 109 R2 275 R3 115 R3 459 R3 520 R3 547 R3 564




SO Baseline measure: 12) RCWMCH with an


No 1 Not reported

on

Not reported

on

Not reported

on

1 1 1 1



13) RCWMCH performed a staff satisfaction survey.

No 1 1 1 1 1 1 1 1




SO Baseline measure: 14) RCWMCH has appointed a

Drug and Therapeutic committee.

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1



SO Baseline measure: 15) RCWMCH has appointed a

health facility board

No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1




RCWMCH

Days 6 days 3.9 4 6.6 days 5,9days 6 days 6 days 6 days




SO Baseline measure: 17) RCWMCH has an


No 1 Not reported

on

Not reported

on

Not reported

on

Not reported

on

1 1 1



Table 5.10: Quarterly targets for Red Cross War Memorial Children’s Hospital for 2010/11 [CHS6]



2010/11 Q1 Q2 Q3 Q4




Strategic Objective [SO] Baseline measure: 1) Caesarean section rate for Red Cross War

Memorial Children’s Hospital [RCWMCH]

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable



SO Baseline measure: 2) Provide 255 tertiary beds in RCWMCH.

Quarterly 235 235 235 235 235

3) Total separations in RCWMCH. Quarterly 11 984 2 996 2 996 2 996 2 996

4) OPD total headcounts in RCWMCH. Quarterly 80 448 20 112 20 112 20 112 20 112

5) Patient day equivalents in RCWMCH. Quarterly 98 721 24 680 24 680 24 680 24 680




beds) in RCWMCH.

Quarterly 83% 83% 83% 83% 83%



Baseline measure 7) RCWMCH conducts monthly morbidity

and mortality reviews

Quarterly 1 1 1 1 1


SO Baseline measure: 8) RCWMCH performed a annual patient

satisfaction survey

Annually 1 0 0 0 1


SO Baseline measure: 9) Case fatality rate in RCWMCH for surgery

separations

Quarterly 0.5% 0.0% 0.0% 0.0% 0.05%




SO Baseline measure: 10) ICD 10 coding rate of 80% for inpatient

activities in RCWMCH by 2014/2015

Quarterly 75% 75% 75% 75% 75%

2.1.2 Ensure the cost effective management of central hospitals at a target cost of R5 534 per patient day equivalent 2014/15 [Constant 2008/09 rands]

SO Baseline measure 11) Expenditure per patient day equivalent in

RCWMCH

Quarterly R3 520 R3 520 R3 520 R3 520 R3 520





2010/11 Q1 Q2 Q3 Q4




SO Baseline measure: 12) RCWMCH with an approved skills

development plan.

Quarterly 1 1 1 1 1



13) RCWMCH performed a staff satisfaction survey.

Annually 1 1 1 1 1




SO Baseline measure: 14) RCWMCH has appointed a Drug and

Therapeutic committee.

Quarterly 1 1 1 1 1



SO Baseline measure: 15) RCWMCH has appointed a health facility

board

Quarterly 1 1 1 1 1



SO Baseline measure: 16) Average length of stay in RCWMCH





SO Baseline measure: 17) RCWMCH has an appointed and

functioning planning and commissioning unit.

Quarterly 1 1 1 1 1





Programme 5 receives 21.70 per cent of the Vote in 2010/11 in comparison to the 22.45 per cent of the revised estimate of 2009/10. This amounts to a nominal increase of R226.421 million or 9.56 per cent.

In real terms, given improved conditions of service (ICS), Occupational Specific Dispensation (OSD) and medical inflation, the Programme can not plan expansion of services. The focus will therefore be on increasing efficiencies, value for money, quality of care transformation, and management systems.

Tables 5.11 to 5.13 provide more detail on expenditure trends, further explained by the brief notes below.

6.1.1 Personnel

Personnel expenditure has increased over the MTEF period with the main cost drivers ICS and OSD for nurses, doctors, pharmacists, social workers, and engineers.

6.1.2 Goods and services

The expenditure in goods and services remains a challenge for the central hospitals as medical inflation exceeds general inflation. The same basket of goods and services cost up to 18% more in 2009/10 compared to 2008/09. Tertiary services also represent the end of the referral chain and depend heavily on advanced health technology. Control measures for the purchasing of goods and services are in place to ensure decisions based on the best value for money is made.

Table 5.11: Trends in provincial public health expenditure for central hospitals [CHS 8]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices


Total Capital 41 092 000 52 320 000 41 775 000 101 503 000 88 281 000 95 150 000 112 193 000

Grand Total 2 164 092 000 2 402 204 000 2 012 461 000 2 471 053 000 2 684 252 000 2 894 584 000 3 065 477 000

Total per person 409.97 445.53 365.04 438.57 466.37 492.54 511.07




Total Capital 46 730 316 56 557 920 41 775 000 94 194 784 76 681 583 77 771 816 86 475 066

Grand Total 2 461 031 392 2 596 782 524 2 012 461 000 2 293 137 184 2 331 562 761 2 365 917 549 2 362 779 549

Total per person 466.23 481.62 365.04 406.99 405.09 402.58 393.92


Note: The expenditure per person and uninsured person does not take into consideration the cross boundary flow of patients, funded by the National Tertiary Services Grant.



Table 5.12: Summary of payments and estimates: Central Hospital Services [CHS7]


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Central Hospital Services a,b 2 123 000 2 349 884 1 970 686 1 911 422 2 270 500 2 369 550 2 595 971 9.56 2 799 434 2 953 284

2 123 000 2 349 884 1 970 686 1 911 422 2 270 500 2 369 550 2 595 971 9.56 2 799 434 2 953 284


a

2010/11: Conditional grant: Health professions training and development: R200 000 000 (Compensation of employees R160 000 000; Goods and services R40 000 000).

Revised estimate


Main appro-priation

Adjusted appro-

priation

1.

Sub-programmeR'000

Outcome

Note: Contributing factors to the decrease in funding in 2008/09 is the shift of the equitable share funding for level 2 beds in the central hospitals that isallocated to sub-programme 4.1.

2010/11: Conditional grant: National tertiary services: R1 763 234 000 (Compensation of employees R1 057 940 000; Goods and services R687 661 000 and Machinery and Equipment R17 633 000).

b

The variance in the budgets for programmes 4 and 5 is due to the reclassification of the services of the central hospitals between levels 2 (programme 4) and3 (programme 5). These variances do not mean that the budgets of the central hospitals decline.



Table 5.13: Payments and estimates by economic classification: Central Hospital Services [CHS7]



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Current payments 2 034 168 2 274 635 1 906 294 1 827 940 2 190 005 2 286 468 2 512 513 9.89 2 711 221 2 859 920 Compensation of employees 1 293 684 1 500 187 1 186 494 1 184 831 1 494 207 1 558 351 1 716 705 10.16 1 838 710 1 926 930

Salaries and wages 1 158 616 1 345 672 1 067 606 1 018 955 1 284 202 1 386 932 1 527 643 10.15 1 636 204 1 714 695 Social contributions 135 068 154 515 118 888 165 876 210 005 171 419 189 062 10.29 202 506 212 235


1 319 2 442 21 2 196 296 23 27 17.39 30 32

8 484 3 861 6 015 5 040 8 654 4 448 5 505 23.76 5 785 6 050 19 103 173 50 251 103 154 49.51 166 178

6 293 7 413 5 074 5 887 6 068 7 004 7 868 12.34 8 496 9 091 138 172 120 132 174 458 517 12.88 559 598 549 2 013 1 920 1 697 1 713 715 766 7.13 820 871

118 121 122 115 111 337 106 340 102 753 125 183 136 509 9.05 147 430 157 750 52 37 3 21 1

33 265 33 605 41 773 34 032 36 903 35 598 29 391 (17.44) 45 244 48 201 91 616 76 265 57 564 63 669 54 866 51 876 32 649 (37.06) 35 259 37 728

24 9 8 76 72 3 3 3 3 14 381 17 721 11 776 14 781 13 276 18 261 21 126 15.69 22 815 24 412

5 061 5 771 3 411 3 712 4 135 4 070 4 673 14.82 5 046 5 399 5 283 5 550 9 695 8 857 9 592 8 331 9 236 10.86 9 935 10 596

365 187 396 018 380 370 299 248 357 126 373 257 430 476 15.33 464 916 497 456 19 314 18 129 17 564 18 996 29 205 23 056 26 640 15.54 28 771 30 786

5 673 6 544 7 830 5 547 7 416 7 711 8 176 6.03 8 829 9 445 2 713 5 301 6 043 4 300 5 972 1 527 1 755 14.93 1 896 2 028

52 633 58 914 49 552 55 916 50 669 60 716 73 858 21.65 79 526 84 883

818 363 153 245 221 122 148 21.31 160 171

2 523 3 106 2 019 3 452 2 753 2 787 2 857 2.51 3 071 3 298 1 813 2 003 1 641 2 914 2 874 2 158 2 644 22.52 2 857 3 055 6 205 6 848 5 649 5 560 403 440 534 21.36 577 617

145 88 441 405 270 296 9.63 320 342




Households 3 108 3 730 3 999 3 201 3 201 3 201 3 750 17.15 3 933 4 157 Social benefits 3 008 3 730 3 999 3 201 3 201 3 201 3 750 17.15 3 933 4 157 Other transfers to households 100


Transport equipment 100 105 111 Other machinery and equipment 80 121 65 819 54 318 73 049 69 835 72 128 71 913 (0.30) 76 103 80 564

227 385 (100.00)

17 18 19





Inventory: Other consumables Inventory: Stationery and printingLease paymentsOwned and leasehold property expenditureTransport provided departmental activity

Revised estimate


Communication



Outcome

Main appro-priation

Adjusted appro-

priation

Administrative feesAdvertisingAssets <R5 000Catering: Departmental activities

Computer servicesCons/prof: Business and advisory servicesCons/prof: Laboratory servicesCons/prof: Legal costContractorsAgency and support/outsourced servicesEntertainment



Operating expenditureVenues and facilities



PART B: PROGRAMME 6: HEALTH SCIENCES AND TRAINING


PROGRAMME 6: HEALTH SCIENCES AND TRAINING


Rendering of training and development opportunities for actual and potential employees of the Department of Health.


2.1 SUB-PROGRAMME 6.1: NURSE TRAINING COLLEGE

Training of nurses at undergraduate and post-graduate level. Target group includes actual and potential employees.

2.2 SUB-PROGRAMME 6.2: EMERGENCY MEDICAL SERVICES (EMS) TRAINING COLLEGE

Training of rescue and ambulance personnel. Target group includes actual and potential employees.

2.3 SUB-PROGRAMME 6.3: BURSARIES

Provision of bursaries for health science training programmes at undergraduate and post graduate levels. Target group includes actual and potential employees.

2.4 SUB-PROGRAMME 6.4: PRIMARY HEALTH CARE (PHC) TRAINING

Provision of PHC related training for personnel, provided by the regions.

2.5 SUB-PROGRAMME 6.5: TRAINING (OTHER)

Provision of skills development interventions for all occupational categories in the Department. Target group includes actual and potential employees.

3. OVERVIEW

The appropriate numbers of personnel with the appropriate competencies to address current and future needs need to be attracted, trained and retained. This is based on the packages of care at the primary, secondary and tertiary levels as reflected in the Comprehensive Service Plan (CSP).

Programme 6 resources provide education; training and development opportunities for serving and prospective employees and for community members engaged in governance of or service delivery for the Department of Health.



Interventions to address the scarce and critical skills and the evaluation to examine the impact and effectiveness thereof on health indicators are required to drive the following interdivisional key performance areas for 2010/ 2011

• Acute Services

• Ambulatory Care

• Infectious Diseases

• De - hospitalised Care

• Emergency Health Care

• Child and Women’s health

• Chronic disease management

A comprehensive Human Resource Development Strategy (HRDS) and an annual implementation plan will flow from the Human Resource Plan (HRP).

A competency profile assessment of 14 targeted occupational categories is set for completion May 2010. This will support the HRD strategy and HR Plan.

In addition a skills audit on SMS and facilities management will be conducted from November 2009 to September 2010 to ensure managers are fit for purpose.

To increase the numbers of competent nurses the Department invests substantially in nursing education, training and development, marketing, recruitment and retention strategies.

The Expanded Public Works Programme (EPWP) is a short to medium term government initiative aimed at the provision of work opportunities coupled with training, with particular focus on communities with high levels of unemployment. The EPWP strengthens the sustainability of community-based services at primary care level through the training of Home Community Based Carers toward formal qualifications in ancillary health care and community health work. It contributes to creating employment opportunities and alleviating poverty through stipended work opportunities and training of relief workers who are recruited from the community.

Learnership programmes for unemployed persons within Nursing and the Pharmaceutical services are also provided. Internship opportunities are offered through the EPWP funded 3535 Data Capturer programme and the Assistant to Artisan (ATA) programme will be implemented in 2010.

As an exit strategy the learners and interns may be absorbed by the Department on completion of their learning and internship programmes.

Ongoing analysis of education, training and development requirements for specific priority occupational groups will be informed by the annual Workplace Skills Plan and the HWSETA and the PSETA Sector Skills Plans. These analyses are done in collaboration with relevant service personnel and higher education institutions. Information will be supplemented by the outcomes of the competency profile assessment.



Education, training and development needs of health and support professionals in the Department are indicated through the continued engagement with all the appropriate Higher Education Institutions (HEIs) in South Africa.

Current relationships with professional bodies in relation to the following require strengthening:

• Formal training of professionals (health and support)

• Exit strategies for community-based workers

• Mid-level categories within professions.

The improvement and maintenance of competencies (iMOCOMP) of health professionals in the district health services strives to strengthen effective and efficient service delivery to the public through the continual improved capacity of healthcare professionals of evidence-based interventions.

The iMOCOMP project is based on an internal partnership with District Health Services and an external partnership between the Department and all four Western Cape HEIs.

The Provincial Government of the Western Cape (PGWC) College of Emergency Care was re-established in 2008. It received accreditation from HPCSA to restart short course training for EMS personnel from January 2009. The college currently train Emergency Care Practitioners through short course certificate programmes. They also provide Rescue and Communication modular training.

Short course training is being phased out by HPCSA and as from 2010/11 the PGWC College of Emergency Care will apply for and run the Emergency Care Technician Certificate which is a 2 year programme.

Emergency Medical Services (EMS) will address the shortfall of Emergency Care Personnel being trained in order to meet current and future EMS patient care requirements, promote formal career pathing to previously informal categories of personnel within the Emergency Medical Services by:

• Formalising emergency communications training

• Formalising medical rescue training

• Building management/leadership capacity in support services crucial to the provision of Emergency Medical Care within the Western Cape.

• Continual Medical Education of EMC staff



4. STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND TARGETS FOR HEALTH SCIENCES AND TRAINING

Table 6.1: Performance indicators for health sciences and training [HST1 & 2]

Strategic goal Strategic objective: Title Strategic objective: statement Indicator Type

Baseline target

2014/15

Audited/actual Estimate MTEF Projection National target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


1.1 Develop, implement, monitor and evaluate a comprehensive Training Plan guided by the HRP (BP: 1) for health & support professionals (BP 2, 3, 4 & 5) in line with the packages of care within the Comprehensive Service Plan (CSP).

1.1.1 Increase the availability of health science students to address scarce skills.

Strategic objective: Baseline measure

1) Total number of health science students graduating

No 900 378 527 547 542 643 543 770

2) Intake of nurse students [HEIs and nursing colleges]

No 3 160 871 992 1 192 1 236 2 213 2 495 2 820

3) Students with bursaries from the province

No 4 540 2 332 2 117 2 848 3 055 3 340 3 674 3 980

4) Basic nurse students graduating

No 600 133 285 304 299 400 400 500

5) Medical registrars graduating No 60 47 43 44 44 44 44 50

6) Advanced nurse students graduating

No 240 198 199 199 199 199 199 220

7) Average training cost per basic nursing graduate

R R20 000 R10 450 R11 500 R12 650 R14 000 R15 300 R16 800 R18 500

8) Development component of HPTD grant spent

% 0% 0% 1 0% 1 0% 1 0% 1 0% 1 0% 1 0% 1

1.1.2 Ensure optimum competency levels of health and support professionals through education, training and development to render optimum accessible packages of care in line with CSP by 2014.


9) Total number of health and support professionals trained and developed through formal and informal training.

No 2 970 566 664 1 018 2 520 2 338 2 387 2 521

10) Number of EMC staff intake on HPCSA accredited Programmes (one of these courses is a 2 year course )

No 150 250 207 132 132

11) Number of EMC staff accessing CME activities

No 860 350 448 708 790 800 800 800




Baseline target

2014/15


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

12) Number of EMC staff in training in Rescue Qualifications

50 40 36 36 36

13) Number of EMC students in training in the Contact Centre (Communications) Qualifications

No 50 0 2 0 2 0 2 30 35 35 35

14) Number of employees attending the Massified Induction Programme (MIP)

No 1200 0 2 0 2 0 2 780 860 944 1,038

15) Number of learnerships for employed personnel

No 340 115 124 190 230 250 270 290

16) Number of learnerships for unemployed personnel

No 320 101 92 120 130 150 170 190

2. Ensure and organisational strategic management capacity and synergy.

2.1 Develop, maintain and implement a training plan for managers based on the result of a skills audit of senior management and facilities management.

2.1.1 Ensure senior management and facilities’ management have the required management competencies to deliver quality health services


17) Number of bursaries awarded to managers for formal Leadership & Management training

No 86 0 2 0 2 0 2 48 53 58 64

18) Number of personnel attending Leadership & Management training programmes

No 1 200 1 559 1 500 1 600 812 893 983 1,081


3.1 Develop and implement an iMOCOMP training plan in alignment with the Clinical Governance Framework (CGF) to support quality assurance through the provision of training.

3.1.1 Ensure optimum improvement and maintenance of competencies (iMOCOMP) of health and support professionals to address integrated health care including DHS burden of disease priorities.


19) Number of health and support professionals receiving clinical training at the various levels of care on interdivisional burden of disease priorities

No 2 400 0 2 0 2 300 2 200 1 600 1 800 2 000

3.1.2 Ensure the integration of quality assurance into all levels of care


20) Number of front line personnel on salary level 1 - 6 trained on Batho Pele principles.

No 998 0 2 0 2 0 2 600 600 726 798




Baseline target

2014/15


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


4.1 Efficiently and effectively manage the dehospitalisation of patients and health promotion and prevention in the home and community.

4.1.1 Expand community-based care services through the optimum training and development of Home based Carers as part of Expanded Public Works Programme (EPWP).


21) Number of Home Community Based Carers (HCBCs)

No 2 800 1 009 1 805 1 840 2 000 2 200 2 600 2,800

22) Number of data capturers interns

No 0 0 2 0 2 172 108 192 0 3 0 3

Notes: 1. Indicator 8: No development component is received by the Province for the HPTDG. 2. Indicator 20: Data reflected is only for support personnel with bursaries. 3. Indicator 25: New indicator: not data exists for the preceding financial years.

Increase in iMOCOMP training (indicator 12) in 2009/ 10 is due to the procurement of a service provider to deliver training. Thereafter more realistic targets have been set as a result of training provider not being able to meet targets.

4. Indicator 28: The data capturers programme is only funded for three financial years.



Table 6.2: Quarterly targets for Health Sciences and Training for 2010/11 [HST3]

Strategic goal Strategic objective: Title Strategic objective: statement Indicator Reporting period


2010/11 Q1 Q2 Q3 Q4


1.1 Develop, implement, monitor and evaluate a comprehensive Training Plan guided by the HRP (BP: 1) for health & support professionals (BP 2, 3, 4 & 5) in line with the packages of care within the Comprehensive Service Plan (CSP).

1.1.2 Increase the availability of health science students to address scarce skills.

Strategic objective: Baseline measure 1) Total number of health

science students graduating

643 0 0 0 643

2) Intake of nurse students [HEIs and nursing colleges]

2 213 2 213 0 0 0

3) Students with bursaries from the province

3 340 3 340 0 0 0

4) Basic nurse students graduating

400 0 0 0 400

5) Medical registrars graduating 44 0 0 0 44

6) Advanced nurse students graduating

199 0 0 0 199

7) Average training cost per basic nursing graduate

R15 300 0 0 0 R15 300

8) Development component of HPTD grant spent

0% 0% 0% 0% 0%

1.2.2 Ensure optimum competency levels of health and support professionals through education, training and development to render optimum accessible packages of care in line with CSP by 2014.

SO Baseline measure: 9) Total number of health and

support professionals trained and developed through formal and informal training.

2 338 493 525 491 869

10) Number of EMC staff intake on HPCSA accredited Programmes (one of these courses is a 2 year course )

207 66 63 24 54

11) Number of EMC staff accessing CME activities

800 200 200 200 200

12) Number of EMC staff in training in Rescue Qualifications

36 12 12 12 0



Strategic goal Strategic objective: Title Strategic objective: statement Indicator Reporting period


2010/11 Q1 Q2 Q3 Q4

13) Number of EMC students in training in the Contact Centre (Communications) Qualifications

35 0 35 0 0

14) Number of employees attending the Massified Induction Programme (MIP)

860 215 215 215 215

15) Number of learnerships for employed personnel

250 0 0 0 250

16) Number of learnerships for unemployed personnel

150 0 0 0 150

2. Ensure and organisational strategic management capacity and synergy.

2.1 Develop, maintain and implement a training plan for managers based on the result of a skills audit of senior management and facilities management.

2.1.1 Ensure senior management and facilities’ management have the required management competencies to deliver quality health services

SO Baseline measure: 17) Number of bursaries awarded

to managers for formal Leadership & Management training

53 53 0 0 0

18) Number of personnel attending Leadership & Management training programmes

893 225 240 230 198


3.1 Develop and implement an iMOCOMP training plan in alignment with the Clinical Governance Framework (CGF) to support quality assurance through the provision of training.

3.1.1 Ensure optimum improvement and maintenance of competencies (iMOCOMP) of health and support professionals to address integrated health care including DHS burden of disease priorities.

SO Baseline measure: 19) Number of health and support

professionals receiving clinical training at the various levels of care on interdivisional burden of disease priorities.

1 600 400 500 400 300

3.1.2 Ensure the integration of quality assurance into all levels of care

SO Baseline measure: 20) Number of front line personnel

on salary level 1 - 6 trained on Batho Pele principles.

600 150 150 150 150


4.1 Efficiently and effectively manage the dehospitalisation of patients and health promotion and prevention in the home and community.

4.1.1 Expand community-based care services through the optimum training and development of Home based Carers as part of Expanded Public Works Programme (EPWP).

SO Baseline measure: 21) Number of Home Community

Based Carers (HCBCs)

2 200 1 200 0 1 000 0

22) Number of data capturers interns

192 0 0 192 0





Programme 6 is allocated 1.81 per cent of the vote in 2010/11 in comparison to the 1.83 per cent allocated in the revised estimate of 2009/10. This amounts to a nominal increase of R23.495 million or 12.14 per cent.

The Department receives an additional R1.188 million as a conditional grant in the form of the Expanded Public Works Programme grant for the Social Sector. This grant Is not an incentive grant but a wage subsidy that the Province receives as an upfront payment to be paid out to qualifying non-profit organizations, i.e. to subsidise non-profit organizations currently working in the Home Community Based Care sector for salaries to volunteers.

Programme 6 is allocated a 3.56 increase in bursaries to serving employees in 2010/11, R5.8 million in comparison to the R5.6m allocated in the adjusted appropriation of 2009/10. Training and staff development is allocated a marginal increase of 0.5% while payments to universities and technikons, the HWSETA and non-profit institutions increase in the range of 9.4%. The trend will imply the pressure on increasing training baseline targets, rather a conservative sustaining and maintenance of targets as per the 2009/10 financial year than any expansion of training targets will follow.

Table 6.3: Trends in public health expenditure for Health Sciences and Training [HST5]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 98 858 000 133 706 000 136 629 000 193 471 000 216 966 000 230 715 000 244 508 000

Total per person 18.73 24.80 24.78 34.34 37.70 39.26 40.76



Total 112 422 504 144 536 186 136 629 000 178 435 840 188 458 403 188 577 242 188 459 578

Total per person 21.30 26.81 24.78 31.67 32.74 32.09 31.42


Table 4: Expenditure estimates: Health Sciences and Training [HST 4]


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Nursing Training College 26 746 32 117 35 767 40 397 41 088 42 396 49 464 16.67 52 977 55 817 Emergency Medical Services Training Colleges

3 705 6 152 7 156 7 475 7 730 7 665 9 117 18.94 9 774 10 337

Bursaries 50 397 52 178 31 249 61 198 61 198 61 094 66 306 8.53 69 779 73 858 Primary Health CareTraining

1 1 1 1 1 1

Training Other a 18 010 43 259 62 457 82 263 82 263 82 315 92 078 11.86 98 184 104 495

98 858 133 706 136 629 191 334 192 280 193 471 216 966 12.14 230 715 244 508


Main appro-priation

Adjusted appro-

priationRevised estimate

Sub-programmeR'000

5.

Outcome

2.

3.

1.

4.

a 2010/11: Conditional grant: Expanded Public Works Programme Grant for Social Sector: R1 188 000 (Transfers and Subsidies R1 188 000).




Table 6.5: Summary of provincial expenditure estimates by economic classification for Health Sciences and Training



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13Current payments 47 304 69 224 77 980 99 813 98 359 99 367 115 959 16.70 124 758 132 510 Compensation of employees 20 605 25 243 30 917 35 932 36 878 37 813 44 354 17.30 47 434 49 764



140 5 32 218 1 36 34 (5.56) 36 39

343 406 761 539 751 310 433 39.68 468 501 2 567 3 850 4 581 4 381 5 614 5 813 7 218 24.17 7 796 8 341 899 1 925 1 980 11 2 513 2 199 2 742 24.69 2 961 3 168 785 684 734 719 691 611 701 14.73 757 810

7 29 145 62 155 43 32 (25.58) 34 37 3 012 5 178 1 850 3 866 3 500 3 701 3 640 (1.65) 3 931 4 207

102 1 25 2 261 12 9 (25.00) 10 11

398 703 625 576 700 870 24.29 940 1 005

2 1 1 2 2 683 841 1 248 1 008 1 339 1 659 1 974 18.99 2 132 2 281 701 786 1 016 1 078 1 318 800 1 032 29.00 1 114 1 192 772 584 449 336 450 300 327 9.00 353 377 14 6 18 13 11 46 59 28.26 64 69

222 177 268 263 313 400 458 14.50 494 529 627 329 663 659 1 497 600 1 140 90.00 1 232 1 318 268 391 534 460 373 618 737 19.26 796 852

1 291 4 345 4 029 3 815 4 270 4 700 6 129 30.40 6 617 7 082

3 030 3 395 7 137 5 585 7 317 8 500 8 097 (4.74) 8 738 9 357 11 110 20 004 20 215 39 653 30 211 29 985 35 420 18.13 38 253 40 931

141 66 95 95 54 6 6 7 7 84 454 602 232 525 515 547 6.21 591 632



14

Departmental agencies and accounts 2 045 2 169 2 795 2 997 2 997 2 997 3 189 6.41 3 345 3 536 2 045 2 169 2 795 2 997 2 997 2 997 3 189 6.41 3 345 3 536

2 045 2 169 2 795 2 997 2 997 2 997 3 189 6.41 3 345 3 536 Universities and technikons 1 275 1 400 1 708 1 708 1 708 1 817 6.38 1 906 2 015

Non-profit institutions 12 000 28 482 30 000 33 000 33 000 36 188 9.66 37 961 40 125 Households 47 876 48 177 26 473 56 232 55 632 55 632 59 192 6.40 62 093 65 633

Social benefits 46 3 43 98 98 104 110 116 Other transfers to households 47 830 48 174 26 430 56 134 55 534 55 632 59 088 6.21 61 983 65 517

Payments for capital assets 318 723 695 584 584 584 621 6.34 652 689 Machinery and equipment 318 723 695 584 584 584 621 6.34 652 689

Other machinery and equipment 318 723 695 584 584 584 621 6.34 652 689 Payments for financial assets 26 13 204 183 (100.00)


SETA

Owned and leasehold property expenditureTravel and subsistenceTraining and staff developmentOperating expenditureVenues and facilities

Inventory: Medical suppliesInventory: Other consumables Inventory: Stationery and printingLease payments

Entertainment

Inventory: Raw materialsInventory: Fuel, oil and gas

Cons/prof: Business and advisory servicesCons/prof: Infrastructure & ContractorsAgency and support/outsourced services

AdvertisingAssets <R5 000Bursaries (employees)Catering: Departmental activities

Computer services


Provide list of entities receiving transfers

Revised estimate


Communication



Outcome

Main appro-priation

Adjusted appro-

priation

Administrative fees

PART B: PROGRAMME 7: HEALTH CARE SUPPORT SE


PROGRAMME 7: HEALTH CARE SUPPORT SERVICES


To render support services required by the Department to realise its aims.


2.1 PROGRAMME 7.1: LAUNDRY SERVICES

Rendering a laundry service to hospitals, care and rehabilitation centres and certain local authorities.

2.2 PROGRAMME 7.2: ENGINEERING SERVICES

Rendering a maintenance service to equipment and engineering installations, and minor maintenance to buildings.

2.3 PROGRAMME 7.3: FORENSIC SERVICES

Rendering specialised forensic and medico-legal services in order to establish the circumstances and causes surrounding unnatural death.

This service is now transferred from programme 2.

2.4 PROGRAMME 7.4 ORTHOTIC AND PROSTHETIC SERVICES

Rendering specialised orthotic and prosthetic services.

This service is transferred to Sub-programme 4.4.

2.5 PROGRAMME 7.5 MEDICINE TRADING ACCOUNT

Managing the supply of pharmaceuticals and medical sundries to hospitals, Community Health Centres and local authorities.

PART B: PROGRAMME 7: HEALTH CARE SUPPORT SEVICES


3. SUB-PROGRAMME 7.1: LAUNDRY SERVICES

3.1 ALIGNMENT WITH THE STRATEGIC GOALS OF THE DEPARTMENT

Programme 7.1 supports the Strategic Goals of the Department by providing a reliable supply of clean disinfected linen:

• An uninterrupted supply of linen is essential for the provision of healthcare to manage the burden of disease

• The cost effective delivery of laundry services reduces the drain on financial resources and promotes the sustainability of the service delivery platform.

• Promotes quality of healthcare by ensuring that patients have clean disinfected linen at all times.

3.2 FOCUS AREAS

The focus is increasing operational efficiency by:

• Training of personnel – particularly Laundry Managers.

• Achieving the optimum balance between in-house and outsourced work.

• Replacing older inefficient equipment with new equipment designed to reduce the consumption of water, electricity and chemicals.



3.3 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR LAUNDRY SERVICES

Table 7.1: Provincial strategic objectives, performance indicators and annual targets for laundry services [SUP1]


target 2014 Audited/actual performance Estimate Medium term target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


1.1 Provide an effective and efficient laundry service to all hospitals

1.1.1 Provide all health facilities with the quantity of clean disinfected linen required to deliver quality healthcare

SO baseline measure: 1) Total number of pieces

laundered: Number

20.5m 20m 20.06m 20m 20.05m 20.5m 20.5m 20.5m

1.1.2 Provide a laundry service using in-house laundries


laundered: in-house Number

15m 14m 14.8m 14.5m 15m 15m 15m 15m

1.1.3 Provide a laundry service using outsourced laundries in the private sector


laundered: outsourced Number

5.5m 6m 5.26m 5m 5.5m 5.5m 5.5m 5.5m

1.1.4 Provide cost effective in-house laundry service

SO baseline measure: 4) Average cost per item

laundered: in-house Number

R4.90 R1.74 R1.91 R2.10 R1.90 R3.20 R3.60 R4.10

1.1.5 Provide cost effective outsourced laundry service

SO baseline measure: 5) Average cost per item

laundered: outsourced Number

R5,20 R1.47 R1.61 R1.75 R1.70 R3.30 R3.90 R4.60

1.1.6 Ensure effective and efficient utilisation of the linen stock: In-house laundries

SO baseline measure: 6) Turnaround time for laundered

linen: in-house Number

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

1.1.7 Ensure effective and efficient utilisation of the linen stock: outsourced laundries

SO baseline measure: 7) Turnaround time for laundered

linen: outsourced Number

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend

24 hour weekday

72 hour weekend



3.4 QUARTERLY TARGETS FOR LAUNDRY SERVICES

Table 7.2: Quarterly targets for Laundry Services for 2010/11 [SUP2]

Strategic goal Strategic objective: Title Strategic objective Performance indicator Reporting period

Annual target Quarterly Targets

2010/11 Q1 Q2 Q3 Q4


1.1 Provide an effective and efficient laundry service to all hospitals

1.1.1 Provide all health facilities with the quantity of clean disinfected linen required to deliver quality healthcare

1) Total number of pieces laundered: Quarterly 20.5m 4.75m 4.7m 5.55m 5.50m

1.1.2 Provide a laundry service using in-house laundries

2) Total number of pieces laundered: In-house

Quarterly 15m 3.30m 3.10m 4.30m 4.30m

1.1.3 Provide a laundry service using outsourced laundries in the private sector

3) Total number of pieces laundered: Outsourced

Quarterly 5.5m 1.45m 1.60m 1.25m 1.20m

1.1.4 Provide cost effective in-house laundry service

4) Average cost per item laundered: In-house

Quarterly R3.20 R3.20 R3.20 R3.20 R3.20

1.1.5 Provide cost effective outsourced laundry service

5) Average cost per item laundered: Outsourced

Quarterly R3.30 R3.30 R3.30 R3.30 R3.30

1.1.6 Ensure effective and efficient utilisation of the linen stock: In-house laundries

6) Turnaround time for laundered linen: In-house

Quarterly 24 hour weekday 72 hour

weekend

24 hour weekday 72 hour

weekend


weekend


weekend


weekend

1.1.7 Ensure effective and efficient utilisation of the linen stock: outsourced laundries

7) Turnaround time for laundered linen: outsourced

Quarterly 24 hour weekday 72 hour

weekend


weekend


weekend


weekend


weekend



4. SUB-PROGRAMME 7.2 ENGINEERING SERVICES


Programme 7.2 supports the Strategic Goals of the Department by providing well maintained infrastructure and equipment in order to facilitate:

• The management of the burden of disease

• The maintenance of appropriate healthcare technology and infrastructure.

• Improving the quality of health services.

4.2 FOCUS AREAS

A successful maintenance programme requires the following six key interlinking needs which are:

• A clear, unambiguous and structured approach – including policies and procedures – to maintenance and immovable asset management;

• A management information system to enable effective maintenance planning, budgeting and decision making;

• Current, quality information on existing assets;

• Sufficient funding;

• Sufficient capacity at all levels, and

• Clearly defined processes and allocated responsibilities for maintenance related functions.



4.3 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR ENGINEERING SERVICES

Table 7.3: Strategic objectives, performance indicators and annual targets for Engineering Services [SUP1]


target 2014 Audited/ actual performance Estimate Medium term target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


1.1 Provide an effective and efficient maintenance service to all health facilities

1.1.1 Provide effective maintenance on facilities, plant and equipment

SO baseline measure: 1) Number of maintenance jobs

completed

Number 13 500 13 011 11 234 11 817 13 000 13 100 13 200 13 200

1.1.2 Provide preventative maintenance to critical equipment

SO baseline measure: 2) Number of preventative

maintenance jobs completed

Number 2 100 1 723 1640 1755 2000 2 100 2 100 2 100

1.1.3 Provide repairs and renovation to DoH infrastructure

SO baseline measure: 3) Number of repairs completed

Number 10 800 11 102 9 416 9 872 10 800 10 750 10 800 10 800

1.1.4 Provide a service to deal with all infrastructure emergencies at institutions

SO baseline measure: 4) Number of emergencies handled

Number 300 186 178 190 200 250 300 300

1.1.5 Provide efficient engineering installations

SO baseline measure: 5) Average cost of utilities per bed

Number R10 800 R6 112 R6 912 R8 120 R7 300 R9 200 R9 900 R10 300

1.1.6 Ensuring compliance with OHS Act

SO baseline measure: 6) Number of reportable incidents

Number 95 300 183 113 160 90 95 95



4.4 QUARTERLY TARGETS FOR ENGINEERING SERVICES

Table 7.4: Quarterly targets for Engineering Services for 2010/11 [SUP2]

Strategic goal Strategic objective: Title Strategic objective Performance indicator Reporting period


2010/11 Q1 Q2 Q3 Q4


1.1 Provide an effective and efficient maintenance service to all health facilities

1.1.1 Provide effective maintenance on facilities, plant and equipment

1) Number of maintenance jobs completed

Quarterly 13 100 2 475 3 975 4 175 3 375

1.1.2 Provide preventative maintenance to critical equipment

2) Number of preventative maintenance jobs completed

Quarterly 2 100 525 525 525 525

1.1.3 Provide repairs and renovation to DoH infrastructure

3) Number of repairs completed Quarterly 10 750 2 688 2 687 2 688 2 637

1.1.4 Provide a service to deal with all infrastructure emergencies at institutions

4) Number of emergencies handled Quarterly 250 75 50 75 50

1.1.5 Provide efficient engineering installations

5) Average cost of utilities per bed Quarterly R9 200 R9 200 R9 200 R9 200 R9 200

1.1.6 Ensuring compliance with OHS Act

6) Number of reportable incidents Quarterly 90 23 23 22 22



5. SUB-PROGRAMME 7.3 FORENSIC PATHOLOGY SERVICES


Programme 7.3 supports the Strategic Goals of the Department by providing a Forensic Pathology Service in order to facilitate:

• The management of the burden of disease by ensuring access to a forensic pathology service and improving the quality of the forensic pathology service to ensure integration of quality assurance into all levels of care.

• Ensuring and maintaining organisational strategic management capacity and synergy by developing integrated support and management structures to render an effective clinical service.

• Developing and maintaining a capacitated workforce to deliver the required health services by implementing the human resource plan and becoming the employer of choice in the health sector by creating an environment for a satisfied workforce.

5.2 FOCUS AREAS

A successful maintenance programme requires the following six key interlinking needs which are:

The focus areas for the for the five-year period are:

• Maintaining response times;

• Maintaining turn around times;

• Improving the turn around time from admission to release;

• Implementing and maintaining standard operating procedures;

• Improving the management of unknowns by reducing the number of unknowns;

• Maintaining a high level of filled posts;

• Pilot, implement and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in all FPS facilities.



5.3 STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR FORENSIC PATHOLOGY SERVICES

Table 7.5: Strategic objectives, performance indicators and annual targets for Forensic Pathology Services [SUP1]

Strategic goal Strategic objective: Title Strategic objective: Statement Performance indicator

Baseline target 2014

Audited/ actual performance Estimate Medium term target

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1. Manage the consequences of the burden of disease

1.1 Ensure access to a Forensic Pathology service

1.1.1 Provide an efficient Forensic Pathology Service through maintenance of average response times ≤ 40 minutes

SO baseline measure: 1) Average response time from

dispatch to arrival of FPS on scene

≤ 40 minutes

≤ 40 minutes

≤ 40 minutes

39 minutes

39 minutes

≤ 40 minutes

≤ 40 minutes

≤ 40 minutes

1.1.2 Provide an efficient Forensic Pathology Service through maintenance of turnaround time from admission to examination done ≤ 3,5 days

SO baseline measure: 2) Average turnaround time from

admission to examination done

≤ 3.5 days

Not measured

Not measured

3,26 days New

indicator

3,49 days New

indicator

≤ 3,5 days

≤ 3,5 days

≤ 3,5 days

1.1.3 Manage the turnaround time from admission to release of deceased (excluding unidentified persons) to below 5,5 days.

SO baseline measure: 3) Average turnaround time from

admission to release of deceased (Excluding unidentified persons)

≤ 5,5 days

Not measured

5,04 days

11,28 days

*Average Include Un-identified persons

5,52 days

≤ 5,5 days

≤ 5,5 days

≤ 5,5 days


1.1.4 Implement and maintain standard operating procedures across 20 Forensic Pathology Facilities

SO baseline measure: 4) The percentage of Standard

operating procedures implemented across all facilities

100% New indicator

New indicator

New indicator

New indicator

70% 90% 100%

2. Ensure and maintain organisational strategic management capacity and synergy.

2.1 Develop integrated support and management structures to render effective FPS service

2.1.1 Improve the management of unknowns by reducing the number of unknowns

SO baseline measure: 5) Number of unknown persons

exceeding 90 days.

125 Not measured

120 New

indicator

197 New

indicator

150 New

indicator

125 125 125



3.1.1 Maintain the percentage of filled posts at 97,5% of the funded establishment by 2012/13.

SO baseline measure: 6) Percentage of funded posts filled

97,5% 98% (166/ 170)

92% (213/ 231)

81% (222/ 275)

85% (227/ 267)

97,5% (260/ 267)

97,5% (298/ 306)

95% (298/ 306)

3.2 Become the employer of choice in the health sector by creating and environment for a satisfied workforce.

3.1.2 Pilot, implement and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in all FPS facilities by 2014

SO baseline measure: 7) Annual staff satisfaction survey

completed

1 New indicator

New indicator

New indicator

New indicator

Pilot 1 1



5.4 QUARTERLY TARGETS FOR FORENSIC PATHOLOGY SERVICES

Table 7.6: Quarterly targets for Forensic Pathology Services for 2010/11 [SUP2]

Strategic goal Strategic objective: Title Strategic objective: Statement Performance indicator Reporting period


2010/11 Q1 Q2 Q3 Q4

1. Manage the consequences of the burden of disease

1.1 Ensure access to a Forensic Pathology Service

1.1.1 Provide an efficient Forensic Pathology Service through maintenance of average response times ≤ 40 minutes.

SO baseline measure 1) Average response time from

dispatch to FPS arrival on scene

Quarterly ≤ 40 minutes

40 40 40 40

1.1.2 Provide an efficient Forensic Pathology Service through maintenance of turnaround time from admission to examination done ≤ 3,5 days .

SO baseline measure 2) Average turnaround time from

admission to examination done

Quarterly ≤ 3,5 days

3,5 days 3,5 days 3,5 days 3,5 days

1.1.3 Manage the turnaround time from admission to release of deceased (excluding unidentified persons) to below 5.5 days.

SO baseline measure 3) Average turnaround time from

admission to release of deceased (Excluding unidentified persons).

Quarterly ≤ 5,5 days

≤ 5,5 days

≤ 5,5 days

≤ 5,5 days

≤ 5,5 days


1.1.4 Implement and maintain standard operating procedures across 20 Forensic Pathology Facilities

SO baseline measure 4) The percentage of standard

operating procedures implemented across all facilities

Quarterly 70% 50% 60% 70% 70%

2. Ensure and maintain organisational strategic management capacity and synergy.

2.1 Develop integrated support and management structures to render effective FPS service

2.1.1 Improve the management of unknowns by reducing the number of unknowns.

SO baseline measure 5) Reduce the number of unknowns

exceeding 90 days

Quarterly ≤125 ≤125 ≤125 ≤125 ≤125


3.1 Implement the Human Resource Plan.

3.1.1 Maintain the percentage of filled posts at 97,5% of the funded establishment by 2012/13.

SO baseline measure 6) Percentage of funded posts filled

Quarterly 97,5% (260/267)

90% 240/267

92% 246/267

93% 248/267

97,5% 260/267

3.2 Become the employer of choice in the health sector by creating and environment for a satisfied workforce

3.2.1 Pilot, implement and analyze one annual standardized staff satisfaction surveys to measure workforce satisfaction in all FPS facilities by 2014.

SO baseline measure 7) Annual staff satisfaction survey

completed.

Annual Pilot concluded and action plan available



167

6. SUB-PROGRAMME 7.4 ORTHOTIC AND PROSTHETIC SERVICES

Funding and managerial responsibility for Orthotic and Prosthetic Services has been transferred to Sub-programme 4.4.

7. SUB-PROGRAMME 7.5 MEDICINE TRADING ACCOUNT


Programme 7.5 supports the Strategic Goals of the Department by providing pharmaceuticals and medical sundries in order to facilitate:

• Reduce and effectively manage the burden of disease.

• Improve the quality of health services.

7.2 FOCUS AREAS

The focus areas for programme 7.5:

• Augmenting the working capital in the medicine trading account.

• Relocating the Cape Medical Depot to a purpose built premises.



7.2 STRATEGIC OBJECTIVE, PERFORMANCE INDICATOR AND ANNUAL TARGET FOR THE MEDICINE TRADING ACCOUNT

Table 7.7: Strategic objective, performance indicator and annual target for Medicine trading account [SUP1]

Strategic goal Strategic objective SMART objective statement Indicator Type

Baseline target Audited/actual Estimate MTEF Projection

2014/15 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1. 1.1 Develop integrated support and management structures to render effective clinical service.

1.1.1 Sufficient working capital to support adequate stock-holding

1) Working capital in the medicine trading account

Rand R84m R43.8.m R50.0 R46.8m R58.3m R62.9m R68.0m R76m

7.3 QUARTELRY TARGETS FOR FORENSIC PATHOLOGY SERVICES

Table 7.8: Quarterly targets for the Medicine Trading Account [SUP2]

Strategic goal Strategic objective SMART objective statement Indicator Reporting period


Quarterly targets

Q1 Q2 Q3 Q4

1. 1.1 Develop integrated support and management structures to render effective clinical service.

1.1.1 Sufficient working capital to support adequate stock-holding

1) Working capital in the medicine trading account

Annual R62.9m R62.9m R62.9m R62.9m R62.9m



169



Programme 7 is allocated 1.81 per cent of the Vote in 2010/11 in comparison to the 1.90 per cent allocated in the 20091/0 revised allocation. This amounts to a nominal increase of 7.61 per cent or R15.276 million.

Included in sub-programme 7.2: Engineering is an earmarked allocation amounting to R67 575 000 (2010/11), R72 614 000 (2011/12) and R77 564 000 (2012/13), for the purpose of Maintenance.

Orthotic and Prosthetic Services, previously in Sub-programme 7.4 were transferred to Sub-programme 4.4 with effect from 1 April 2008.

Forensic Pathology Services previously reported in Sub-programme 2.8 transferred to Sub-programme 7.3 with effect from 1 April 2009.

8.1.1 Sub-programme 7.1, Laundry Services, supports the strategic goals of the Department by providing a reliable supply of clean disinfected linen. An uninterrupted supply of linen is essential for the provision of healthcare to manage the burden of disease. The increase of the budget over the MTEF period indicates an increase linked to the anticipated general inflation. The anticipated increase in the cost of utilities, particularly electricity and water, is expected to be well above general inflation. For this reason considerable attention will be paid to the continued procurement of modern efficient equipment and the effective management of laundry operations.

8.1.2 Sub-programme 7.2, Engineering Services, supports the strategic goals of the Department by providing well maintained infrastructure and equipment. The management of the burden of disease is dependent on well maintained and appropriate healthcare technology and infrastructure. The increase of the budget over the MTEF period indicates an increase linked to the anticipated general inflation. Apart from the obvious efficient utilisation of the maintenance budget, attention will be paid to ensuring that new technology and infrastructure has a low maintenance requirement.

8.1.3 Sub-programme 7.3, Forensic Pathology Services, supports the strategic goals of the Department by ensuring access, integrating quality, integrating support and management structures and improving Human Resource Management to become employer of choice. The increase from R69 million in 2009/10 to R82 million in 2010/11 is to address the under-funding of goods and services and to provide additional funding for the commissioning of the new facilities at Worcester, Paarl and Malmesbury. The additional R16 million allocated in 2009/10 for capital expenditure is not reflected in Table 7.3.



Table 7.9: Trends in provincial public health expenditure for Support Services [SUP4]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 92 906 000 81 785 000 96 150 000 200 668 000 215 944 000 230 912 000 244 330 000

Total per person 17.60 15.17 17.44 35.62 37.52 39.29 40.73



Total 105 653 818 88 409 585 96 150 000 185 036 704 187 570 686 188 738 262 188 322 381

Total per person 20.02 16.40 17.44 32.84 32.59 32.12 31.40


Table 7.10: Summary of payments and estimates: Health Care Support Services [SUP 3]


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Laundry Services 46 547 34 696 45 134 48 998 49 294 52 533 58 743 11.82 63 098 66 837 Engineering Services 33 615 35 732 49 443 58 088 59 181 57 217 69 994 22.33 75 196 80 258

Forensic Services a 69 176 89 202 89 202 85 381 (4.28) 90 703 95 211 Orthotic and Prosthetic Services

8 700 9 946 1 1 1 1 1 1

Medicine Trading Account 4 044 1 411 1 573 1 715 1 715 1 715 1 825 6.41 1 914 2 023

92 906 81 785 96 150 177 978 199 393 200 668 215 944 7.61 230 912 244 330

a

Revised estimate


Main appro-priation

Adjusted appro-

priation

Sub-programmeR'000

Outcome

2.

3.

5.

1.

4.


2010/11: Conditional grant: Forensic pathology services: R66 251 000 (Compensation of employees R44 980 000; Goods and services R19 049 000 and

Payments for capital assets R2 222 000). Note: The Orthotic and Prosthetic Services previously in Sub-programme 7.4 has been transferred to Sub-programme 4.4 with effect of 1 April 2008.Note: The Forensic Services previously in Sub-programme 2.8 has been transferred to Sub-programme 7.3 with effect of 1 April 2009.



171

Table 7.11: Payments and estimates by economic classification: Health Care Support Services



estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13




214 422 56 7 (100.00) 347 275 262 791 2 904 656 886 35.06 947 1 005 1 2 38 101 120 18.81 127 134

428 461 433 710 1 985 1 906 2 129 11.70 2 269 2 396 20 1 028 1 810 2 084 15.14 2 210 2 321 2

501 777 821 5.66 885 946 9 098 9 989 2 463 4 415 5 856 5 812 6 241 7.38 6 722 7 173

50 2 332 4 014 2 947 5 012 6 451 7 303 13.21 7 885 8 434

4 3 2 6 5 9 9 9 9 181 98 117 184 144 150 163 8.67 176 187 532 596 870 903 1 056 832 876 5.29 946 1 013

6 472 5 328 6 420 10 214 8 653 9 681 10 478 8.23 11 313 12 103 2 688 4 461 2 3 500 199 738 821 11.25 872 916 5 711 3 070 8 984 12 629 10 259 11 239 12 359 9.97 13 320 14 228 455 487 551 2 000 936 1 399 1 556 11.22 1 667 1 772 122 229 130 282 865 909 977 7.48 1 041 1 097

4 050 3 816 20 816 21 662 20 481 23 363 25 905 10.88 27 942 29 860

3 829 4 122 4 354 7 969 12 511 12 394 12 820 3.44 13 650 14 505 241 351 202 490 521 455 531 16.70 572 608 231 24 16 900 64 119 1 071 800.00 140 147

2 36 64 16 109 10 (90.83) 11 12

Transfers and subsidies to 4 067 1 554 1 657 2 085 2 085 2 682 2 219 (17.26) 2 327 2 460 Provinces and municipalities 23


23

Departmental agencies and accounts 4 044 1 411 1 573 1 715 1 715 1 715 1 825 6.41 1 914 2 023 4 044 1 411 1 573 1 715 1 715 1 715 1 825 6.41 1 914 2 023 4 044 1 411 1 573 1 715 1 715 1 715 1 825 6.41 1 914 2 023

Households 143 84 370 370 967 394 (59.26) 413 437 Social benefits 143 84 370 370 967 394 (59.26) 413 437

Payments for capital assets 14 825 399 1 203 1 122 17 181 15 112 3 561 (76.44) 6 876 7 233 Buildings and other fixed structures 385 11 577 10 515 (100.00)

Buildings 385 11 577 10 515 (100.00) Machinery and equipment 14 825 399 818 1 122 5 604 4 597 3 561 (22.54) 6 876 7 233

Transport equipment 500 495 890 79.80 935 988 Other machinery and equipment 14 825 399 818 1 122 5 104 4 102 2 671 (34.89) 5 941 6 245

1 300 1 300 20 (98.46) 20 23




CMD Capital Augmentation


Entities receiving transfers

Inventory: Other consumables Inventory: Stationery and printingLease paymentsOwned and leasehold property expenditureTravel and subsistenceTraining and staff developmentOperating expenditure

Revised estimate


Communication



Outcome

Main appro-priation

Adjusted appro-

priation

AdvertisingAssets <R5 000Catering: Departmental activities

Computer servicesCons/prof: Infrastructure & planningCons/prof: Laboratory servicesContractorsAgency and support/outsourced servicesEntertainment



Venues and facilities

PROGRAMME 8: HEALTH FACILITIES MANAGEMENT

ANNUAL PERFORMANCE PLAN – 2010/11

173


1. PROGRAMME PURPOSE:

To provide for new health facilities, upgrading and maintenance of existing facilities, including the Hospital Revitalisation Programme and the Provincial Infrastructure Grant.


2.1 SUB-PROGRAMME 8.1: COMMUNITY HEALTH FACILITIES

Construction of new community health facilities and the upgrading and maintenance of existing facilities.

2.2 SUB-PROGRAMME 8.2: EMERGENCY MEDICAL SERVICE

Construction of new emergency medical service facilities and the upgrading and maintenance of existing facilities.

2.3 SUB-PROGRAMME 8.3: DISTRICT HOSPITAL SERVICES

Construction of new district hospitals and the upgrading and maintenance of existing hospitals.

2.4 SUB-PROGRAMME 8.4: PROVINCIAL HOSPITAL SERVICES

Construction of new provincial hospitals and the upgrading and maintenance of existing hospitals.

2.5 SUB-PROGRAMME 8.5: CENTRAL HOSPITAL SERVICES

Construction of new central hospitals and the upgrading and maintenance of existing hospitals.

2.6 SUB-PROGRAMME 8.6: OTHER FACILITIES

Construction of other new health facilities and the upgrading and maintenance of existing facilities.

3. ALIGNMENT WITH THE STRATEGIC GOALS OF THE DEPARTMENT

Programme 8 directly supports the Strategic Goals of the Department by providing infrastructure that is:

• Located as indicated in the Comprehensive Service Plan (CSP) to ensure accessibility of healthcare.

• Planned to facilitate the level and quantum of healthcare defined in the CSP.

• Designed to ensure the efficient and effective utilisation of resources – both human and material.

• Constructed for ease of maintenance to promote long-term sustainability.



The long-term vision of the Department, Healthcare 2010, requires an incremental approach to the restructuring of health services to align with the CSP. Programme 8 will ensure infrastructure alignment with the implementation of the CSP by providing infrastructure in synchronisation with the re-alignment of health services in the Province.

3.1 FOCUS AREAS

A major infrastructure initiative is to strengthen the rural regional hospitals. The rural regional hospitals at George, Worcester and Paarl are part of to the national Hospital Revitalisation Programme. The final phases of these three projects will be completed during the MTEF period.

The need for clinics and community health centres (CHC’s) in under-serviced areas is an ongoing focus area for infrastructure delivery. During the MTEF period new CHC’s are planned for Malmesbury, Plettenberg Bay, Delft and Knysna and a clinic is planned for Grassy Park.

The upgrading and extending of district hospitals in growth areas and the improvement of district hospitals in other towns is an on-going focus area. The upgrading of the Caledon and Riversdale Hospitals is nearing completion. The upgrading and extension of the Hermanus and Karl Bremer Hospitals will commence in the MTEF period. The final phase of the revitalisation project at Vredenburg Hospital will also commence in the MTEF period.

The increasing of level one beds in the Metropole has long been a priority. The construction of the new Khayelitsha and Mitchell’s Plain District Hospitals has commenced. These two hospitals will greatly alleviate the level one bed shortage in the Cape Metropole, once completed and commissioned.

The upgrading of the Red Cross War Memorial Children’s Hospital, in co-operation with the Children’s Hospital Trust, is ongoing. In the past three years the Trust has undertaken a number of major projects including the construction of a new operating theatre complex and the upgrading of wards. The ward upgrades will continue in the MTEF period.

The construction of appropriate facilities for the Emergency Medical Services and the upgrading of casualty units at hospitals is a focus area. During the MTEF period new ambulance stations are planned for Khayelitsha, Kwanokuthula, Ceres, Vredendal, Leeu Gamka and Malmesbury. Upgraded casualty units are planned for Knysna, Hermanus, Ceres, Eerste River and Tygerberg Hospitals.

The campaign to prevent the spread of TB and to provide adequate treatment for those infected requires a major improvement of the physical infrastructure. A major concern is infection control to prevent cross infection between patients and to protect the hospital personnel. Interim measures are being applied using maintenance funding. An additional earmarked sum of R10 million was provided in 2008/09 and 2009/10, and a similar amount will be provided in 2010/11. There is an urgent need for new purpose-built facilities. Brooklyn Chest Hospital has been accepted into the Hospital Revitalisation Programme but funding has as yet to be approved.



175

4. STRATEGIC OBJECTIVES, PERFORMANCE INDICATORS AND ANNUAL TARGETS FOR HEALTH FACILITIES MANGEMENT

Table 8.1: Strategic objectives, performance indicators and annual targets for health facilities management [HFM1 and 2]

Strategic goal Strategic objective: Title Strategic objective Performance indicator Type



2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13


1.1 Construct and commission new health care facilities and upgrade facilities to ensure access to the integrated comprehensive health care platform.

1.1.1. Allocate sufficient capital funding to ensure the infrastructure backlog is significantly reduced in the MTEF period.

Strategic Objective [SO] Baseline measure: 1) Programme 8 capital funding as a

percentage of total health expenditure

% 6%

R800m/

R13,200m

3.6% 6.0% 6.3% 5.4% 5.4%

2) Hospitals funded from the revitalisation programme

% 23% 12% 12% 12% 13% 14% 15% 23%

3) Equitable share capital programme as percentage of total health expenditure

% 0.27% 0.52% 0.21% 0.32% 0.58% 0.26% 0.25% 0.25%

4) Expenditure on facility maintenance as % of total health expenditure

% 1.23% 1.12% 1.12% 1.03% 1.08% 1.15% 1.13% 1.11%

5) Fixed PHC facilities with access to piped water

% 100% 100% 100% 100% 100% 100% 100% 100%

6) Fixed PHC facilities with access to mains electricity

% 100% 100% 100% 100% 100% 100% 100% 100%

7) Fixed PHC facilities with access to fixed line telephone

% 100% 100% 100% 100% 100% 100% 100% 100%

8) Average backlog of service platform in fixed PHC facilities

R million R240 R265 R300 R255 R240 R240 R240 R240

9) Average backlog of service platform in district hospitals

R million R2,000 R1,285 R2,000 R2,000 R2,000 R2,000 R2,000 R2,000

10) Average backlog of service platform in regional hospitals


11) Average backlog of service platform in specialised hospitals (including TB & psychiatric hospitals)


12) Average backlog of service platform in tertiary and central hospitals


13) Average backlog of service platform in provincially aided hospitals







2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

14) District hospital beds per 1000 uninsured population

Number 0.59 0,53 0,53 0,55 0.59 0.59 0.59 0.59

15) Regional Hospital beds per 1000 uninsured population

Number 0.63 0,61 0,61 0,61 0.63 0.63 0.63 0.63

1.1.2 Complete the 10 PHC projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

[SO] Baseline measure 16) Number of capital projects completed

in PHC facilities that are funded by the Programme 8 capital budget. [Sub-programme 8.1]

Number 10 New indicator

New indicator

New indicator

New indicator

1 3 2

17) Number of primary health care facility capital projects in inception, funded by the Programme 8 capital budget.

Number Refer to Note 1 below

New indicator

New indicator

New indicator

New indicator

1 1 1

18) Number of primary health care facility capital projects in planning funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

10 7 4

19) Number of primary health care facility capital projects in construction funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

3 3 4

1.1.3 Complete the 9 ambulance station projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

[SO] Baseline measure 20) Number of ambulance stations

projects completed funded by the Programme 8 capital budget. [Sub-programme 8.2]


New indicator

New indicator

New indicator

2 4 3

21) Number of capital ambulance station infrastructure projects in inception funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

4 2 1

22) Number of ambulance station capital infrastructure projects in planning funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

3 3 3

23) Number of capital ambulance stations projects in construction funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

4 2 0

1.1.4 Complete the 14 district hospital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.


in district hospitals funded by the Programme 8 capital budget. [Sub-programme 8.3]


New indicator

New indicator

New indicator

3 5 3



177




2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

25) Number of capital projects in district hospitals in inception funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

6 6 1

26) Number of capital projects in district hospitals in planning funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

3 1 6

27) Number of capital projects in district hospitals in construction, funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

7 4 1

1.1.5 Complete the 9 provincial hospital capital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15


in provincial hospitals funded by the Programme 8 capital budget. [Sub-programme 8.4]


New indicator

New indicator

New indicator

6 1 0

29) Number of capital projects in provincial hospitals in inception funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

3 2 0

30) Number of capital projects in provincial hospitals in planning funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

2 2 3

31) Number of capital projects in provincial hospitals in construction, funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

2 1 2

1.1.6 Complete the 8 central hospital capital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15

[SO] Baseline measure 32) Number of Capital projects

completed in central hospitals funded by the Programme 8 capital budget. [Sub-programme 8.5]


New indicator

New indicator

New indicator

3 3 2

33) Number of capital projects in central hospitals in inception funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

3 2 0

34) Number of capital projects in central hospitals in planning funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

1 1 3

35) Number of capital projects in central hospitals in construction, funded by the Programme 8 capital budget.

Refer to Note 1 below

New indicator

New indicator

New indicator

New indicator

0 0 0






2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

1.1.7 Complete the 6 forensic mortuary and other projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

[SO] Baseline measure 36) Number of projects completed in

forensic mortuaries and other projects funded by the Programme 8 capital budget. [Sub-programme 8.6]

3 New indicator

New indicator

New indicator

New indicator

1 1 0

37) Number of capital projects in inception in forensic mortuaries and other projects funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

0 0 0

38) Number of capital projects in planning in forensic mortuaries and other projects funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

2 2 2

39) Number of capital projects in construction in forensic mortuaries and other projects funded by the Programme 8 capital budget.


New indicator

New indicator

New indicator

New indicator

1 0 0

Note 1: The performance indicator predicts the number of projects in a specific phase at the end of the financial year. A baseline target, other than for completed projects is thus meaningless. The purpose of including project phases is to facilitate the

monitoring of progress on a quarterly basis during a current financial year for monitoring and evaluation purposes – see table 8.2 below.



179

5. QUARTERLY TARGETS FOR HEALTH FACILITIES MANAGMENT

Table 8.2: Quarterly targets for Health Facilities Management [HFM3]

Strategic al goal Strategic objective: Title Strategic objective Performance indicator Type Reporting period

Annual target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4


1.1 Construct and commission new health care facilities and upgrade facilities to ensure access to the integrated comprehensive health care platform.

1.1.1 Allocate sufficient capital funding to ensure the infrastructure backlog is significantly reduced in the MTEF period.

SO Baseline measure: 1) Programme 8 capital funding as a percentage of

total health expenditure

% Annual 6.3% 6.3%

2) Hospitals funded from the revitalisation programme

% Annual 14% 14%

3) Equitable share capital programme as percentage of total health expenditure

% Annual 0.26% 0.26%

4) Expenditure on facility maintenance as % of total health expenditure

% Annual 1.15% 1.15%

5) Fixed PHC facilities with access to piped water % Annual 100% 100%

6) Fixed PHC facilities with access to mains electricity

% Annual 100% 100%

7) Fixed PHC facilities with access to fixed line telephone

R million Annual 100% 100%

8) Average backlog of service platform in fixed PHC facilities

R million Annual R240 R240

9) Average backlog of service platform in district hospitals

R million Annual R2,000 R2,000

10) Average backlog of service platform in regional hospitals

R million Annual R100 R100

11) Average backlog of service platform in specialised hospitals (including TB & psychiatric hospitals)


12) Average backlog of service platform in tertiary and central hospitals


13) Average backlog of service platform in provincially aided hospitals

Number Annual R13 R13

14) District hospital beds per 1000 uninsured population

Number Annual 0.59 0.59




Annual target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4

15) Regional Hospital beds per 1000 uninsured population

Number Annual 0.63 0.63

1.1.2 Complete the target number of PHC projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

Baseline measure 16) Number of capital projects completed in PHC

facilities that are funded by the Programme 8 capital budget. [Sub-programme 8.1]

Number Quarterly 1 0 0 0 1

17) Number of primary health care facility capital projects in inception, funded by the Programme 8 capital budget.

Number Quarterly Refer to Note 1 below

1 1 1 1

18) Number of primary health care facility capital projects in planning funded by the Programme 8 capital budget.


10 10 10 10

19) Number of primary health care facility capital projects in construction funded by the Programme 8 capital budget.


5 5 5 4

1.1.3 Complete the target number of ambulance station projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

Baseline measure 20) Number of ambulance stations projects

completed funded by the Programme 8 capital budget. [Sub-programme 8.2]


21) Number of capital ambulance station infrastructure projects in inception funded by the Programme 8 capital budget.


4 4 4 4

22) Number of ambulance station capital infrastructure projects in planning funded by the Programme 8 capital budget.


4 4 4 4

. 23) Number of capital ambulance stations projects in construction funded by the Programme 8 capital budget.


5 5 4 4



181


Annual target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4

1.1.4 Complete the target number of district hospital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15

Baseline measure 24) Number of capital projects completed in district

hospitals funded by the Programme 8 capital budget. [Sub-programme 8.3]


25) Number of capital projects in district hospitals in inception funded by the Programme 8 capital budget..


6 6 6 6

26) Number of capital projects in district hospitals in planning funded by the Programme 8 capital budget..


9 8 3 3

27) Number of capital projects in district hospitals in construction, funded by the Programme 8 capital budget..


5 6 8 8

1.1.5 Complete the target number of provincial hospital capital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15

Baseline measure 28) Number of capital projects completed in

provincial hospitals funded by the Programme 8 capital budget. [Sub-programme 8.4]


29) Number of capital projects in provincial hospitals in inception funded by the Programme 8 capital budget.


0 3 0 3

30) Number of capital projects in provincial hospitals in planning funded by the Programme 8 capital budget.


2 2 2 2

31) Number of capital projects in provincial hospitals in construction, funded by the Programme 8 capital budget.


8 6 6 3

1.1.6 Complete the target number of central hospital capital projects funded from the Programme 8 capital budget between 2010/11 and 2014/15

Baseline measure 32) Number of Capital projects completed in central

hospitals funded by the Programme 8 capital budget. [Sub-programme 8.5]


33) Number of capital projects in central hospitals in inception funded by the Programme 8 capital budget.


4 4 4 4




Annual target

2010/11

Quarterly Targets

Q1 Q2 Q3 Q4

34) Number of capital projects in central hospitals in planning funded by the Programme 8 capital budget.


4 2 2 1

35) Number of capital projects in central hospitals in construction, funded by the Programme 8 capital budget.


6 6 5 6

1.1.7 Complete the target number of forensic mortuary projects and other projects funded from the Programme 8 capital budget between 2010/11 and 2014/15.

Baseline measure 36) Number of projects completed in forensic

mortuaries funded by the Programme 8 capital budget. [Sub -programme 8.6]


37) Number of capital projects in inception in forensic mortuaries and other projects funded by the Programme 8 capital budget.


0 0 0 0

38) Number of capital projects in planning in forensic mortuaries and other projects funded by the Programme 8 capital budget.


4 3 2 2

39) Number of capital projects in construction in forensic mortuaries and other projects funded by the Programme 8 capital budget.


0 1 2 1

Note 1: The performance indicator predicts the number of projects in a specific phase at the end of the each quarter. An annual target, other than for completed projects, is thus meaningless. The purpose of including project phases is to facilitate the

monitoring of progress on a quarterly basis for monitoring and evaluation purposes.



6. RECONCILING PERFORMANCE TARGETS WITH THE BUDGET AND MTEF

6.1 RELATING EXPENDITURE TRENDS TO STRATEGIC GOALS:

6.1.1 Programme 8 is allocated 7.33 per cent of the Vote in 2010/11 in comparison to the 6.05 per cent that was allocated in the revised estimate. This reflects a nominal increase of R237.605 million or 37.18 per cent.

6.1.2 Earmarked allocation:

6.1.2.1 Included in sub-programme 8.1: Community Health Facilities is an earmarked allocation amounting to R14 651 000 (2010/11), R15 426 000 (2011/12) and R16 053 000 (2012/13) for the purpose of Maintenance.

6.1.2.2 Included in sub-programme 8.3: District hospital services is an earmarked allocation amounting to R18 158 000 (2010/11), R19 118 000 (2011/12) and R19 896 000 (2012/13), for the purpose of Maintenance.

6.1.2.3 Included in sub-programme 8.4: Provincial hospital services is an earmarked allocation amounting to R34 075 000 (2010/11), R35 876 000 (2011/12) and R37 336 000 (2012/13) for the purpose of Maintenance.

6.1.2.4 Included in sub-programme 8.5: Central hospital services is an earmarked allocation amounting to R58 602 000 (2010/11), R61 700 000 (2011/12) and R64 211 000 (2012/13) for the purpose of Maintenance.

6.1.2.5 Included in sub-programme 8.6: Other facilities is an earmarked allocation amounting to R9 079 000 (2010/11), R9 559 000 (2011/12) and R9 948 000 (2012/13) for the purpose of Maintenance.

6.1.3 A once-off special allocation of R40 million was made to the Major Capital (Health) budget in 2009/10 to facilitate the upgrading of the Somerset Hospital in preparation for the Soccer World Cup. Work is in progress and is scheduled to be completed before the World Cup commences in June 2010.

6.1.4 The Major Capital (HRP) budget has been increased in the MTEF period to accommodate the construction of the new Khayelitsha and Mitchell’s Plain District Hospitals. The commissioning of these two hospitals is an essential part of the implementation of the Comprehensive Service Plan.

6.1.5 The Major Capital (IGP) budget has been increased in the MTEF period to assist in addressing the infrastructure backlog.

6.1.6 The Maintenance and Minor Capital budget has been increased in the MTEF period to assist in addressing the maintenance backlog.

6.1.7 Programme 8 is allocated 7.33 per cent of the vote in 2010/11 in comparison to the 6.05 per cent that was allocated in the 2009/10 revised estimate. This translates into a nominal increase of R237.605 million or 37.18 per cent.



184

Table 8.3: Trends in public health expenditure for Health Facilities Management [HFM 5]


2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Current prices

Total 344 355 000 371 678 000 399 708 000 639 043 000 876 648 000 818 720 000 865 346 000

Total per person 65.24 68.93 72.50 113.42 152.31 139.31 144.27



Total 391 604 638 401 783 918 399 708 000 686 811 872 761 463 466 669 189 084 666 983 256

Total per person 74.19 74.52 72.50 121.90 132.30 113.87 111.20


Table 8.4: Historic and planned capital expenditure by type

R’000s 2005/06 Actual

2006/07 Actual

2007/08 Actual

2008/09 Actual

2009/10 Estimate

2010/11 MTEF

projection

2011/12 MTEF

projection

2012/13 MTEF

projection

Major capital (Health) 18 000 33 486 16 434 21 000 68 000 30 000 31 000 33 000

Major capital (HRP) 103 445 174 337 192 159 238 992 388 845 580 554 485 501 506 363

Major capital (IPG) 55 229 64 056 79 429 94 643 114 924 131 529 160 540 178 539

Major capital (Other) 43 456 34 291 27 050 - - -

Major capital (Donor RCCH) 16 000 0 25 000 25 000 - - - -

Maintenance and minor capital 48 538 72 478 84 155 85 197 113 405 134 565 141 679 147 444

Total capital 241 212 344 357 440 633 499 123 712 224 876 648 818 720 865 346

Notes on table HFM 1 1. “Maintenance and minor capital” is the “maintenance” expenditure by Public Works. 2. “Major Capital (Other)” refers to the upgrade of the forensic and pathology service



Table 8.5: Summary of payments and estimates: Health Facilities Management


% Change from

Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13

Community Health Facilities a,b 31 249 28 400 28 026 46 550 64 106 36 657 86 760 136.68 94 384 112 953 Emergency Medical Rescue Services a,b

9 093 18 706 7 892 27 120 24 705 13 188 24 785 87.94 22 402 7 816

District Hospital Services a,b 58 649 55 281 132 460 294 619 247 106 202 073 388 071 92.04 480 449 459 434

Provincial Hospital Services a,b 191 900 201 568 176 875 203 210 287 900 272 322 262 822 (3.49) 105 276 146 993

Central Hospital Services b 41 092 52 320 41 775 100 375 102 982 101 503 88 281 (13.03) 95 150 112 193

Other Facilities a 12 372 15 403 12 680 13 300 13 300 13 300 25 929 94.95 21 059 25 957

344 355 371 678 399 708 685 174 740 099 639 043 876 648 37.18 818 720 865 346

Sub-programmeR'000

Outcome

2.

3.

Revised estimate


Main appro-priation

Adjusted appro-

priation

5. 6.

1.

4.


a 2009/10: Conditional grant: Hospital revitalisation: R580 554 000 (Compensation of employees R16 826 000; Goods and services R12 045 000; Machinery and Equipment R46 310 000 and Buildings and other fixed structures R505 373 000).

b

2009/10: Conditional grant: Infrastructure grant to province: R131 529 000 (Compensation of employees R2 150 000, Buildings and other fixedstructures R129 379 000).



186

Table 8.6: Payments and estimates by economic classification: Health Facilities Management [HFM4]


% Change from Revised estimate

2006/07 2007/08 2008/09 2009/10 2009/10 2009/10 2010/11 2009/10 2011/12 2012/13


Salaries and wages 6 496 6 111 5 875 10 329 10 429 10 733 17 449 62.57 15 554 13 697 Social contributions 239 179 146 1 681 1 631 1 327 1 527 15.07 1 282 1 129


12 40 5 23 11 4 3 4

271 752 5 915 12 244 5 094 4 064 4 693 15.48 3 894 4 675 38 18 119 17 96 92 128 39.13 106 128 5 25 4 79 32 21 48 128.57 40 48

24 30 5 10 57 (100.00) 2 996 2 768 3 076 4 987 3 507 2 002 5 356 167.53 4 440 5 335

4 425 7 9 668 9 084 719 1 079 3 246 7 953 1 298 62 212 614 (100.00)

20 2 7 5 2 5 150.00 4 5 12 3 2 3 2 3 5 383 1 355 1 735 (100.00)

44 101 4 67 (100.00) 26 544 143 9 699 9 (98.71) 7 9

137 71 66 208 122 158 105 (33.54) 87 105 3 450 500 617 (100.00)

63 517 74 754 79 676 113 405 127 437 127 167 134 733 5.95 141 818 147 611

348 291 343 449 369 612 320 (47.71) 266 319 1 627 241 773 818 1 692 888 856 (3.60) 711 853

52 10 1 4 (100.00) 263 46 43 80 300 106 350 230.19 291 349

Transfers and subsidies to 2 7 000 8 000 9 952 Provinces and municipalities 2


2

Payments for capital assets 255 304 267 822 295 218 539 705 589 134 488 078 704 062 44.25 642 215 681 124

Buildings and other fixed structures 229 685 247 850 278 392 482 269 552 698 451 642 657 752 45.64 597 116 576 451 Buildings 229 685 247 850 278 392 482 269 552 698 451 642 657 752 45.64 597 116 576 451

Machinery and equipment 25 520 19 972 16 809 57 436 36 436 36 436 46 310 27.10 45 099 104 673 Other machinery and equipment 25 520 19 972 16 809 57 436 36 436 36 436 46 310 27.10 45 099 104 673

99 17

278 393 482 269 552 698 451 642 657 752 45.64 597 116 576 451


Owned and leasehold property expenditureTravel and subsistenceTraining and staff developmentOperating expenditureVenues and facilities

Inventory: Medical suppliesInventory: Other consumables Inventory: Stationery and printingLease payments

Entertainment


Cons/prof: Business and advisory servicesCons/prof: Infrastructure & ContractorsAgency and support/outsourced services

AdvertisingAssets <R5 000Catering: Departmental activities

Computer services


Revised estimate


Communication



Outcome

Main appro-priation


Administrative fees





7. CAPITAL INFRASTRUCTURE PROGRAMME

7.1 DELIVERABLES

The tables that follow indicate the deliverables in the capital infrastructure programme.

7.2 DEFINITIONS

Inception: Health is detailing the need and is drafting a brief for Public Works

Planning: Public Works have received the brief from Health and are proceeding with the design.

Tender: Public Works have completed the documentation to tender readiness.

Construction: Project is under construction.

Start date: Date of letter of acceptance of tender

Completion date: Date of practical completion

Duration: Time from Start to Completion.



188

Schedule 1 Capital Projects Funding

No Sub Prog. Facility Type of Infrastructure

Current Project Stage

Project Duration Months

Start Target Date

Complete Target Date

Estimated Total cost

2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000

1 8.1 Bonnievale New clinic Clinic Inception 12 2013 2014 9 600 100 500 5 200 4 000

2 8.2 De Doorns ambulance station

Ambulance station Inception 6 2012 2013 5 000 200 4 700 100

3 8.2 Heidelberg ambulance station

Ambulance station Inception 12 2015 2016 4 000 100 584 1 416 4 100

4 8.2 Piketberg Ambulance Station

Ambulance station Inception 12 2011 2012 8 700 100 6 484 2 116

5 8.5 Red Cross Hospital Radiology & Paediatric. ward

Inception 12 2013 2014 23 500 7 000 16 500

6 8.2 Robertson Hospital Ambulance station Inception 12 2013 2014 8 000 400 6 300 1 500

7 8.2 Tulbach Ambulance Station

Ambulance station Inception 12 2013 2014 5 184 100 4 184 900

8 8.2 Leeu Gamka Ambulance Station

Ambulance station Planning 15 2010 2011 10 400 120 364 6 600 3 316

9 8.5 Red Cross Hospital Ward upgrades 12 7 000 7 000 8 000 10 000

10 8.1 Simondium New CHC Complete 16 2006 2007 11 000 720

11 8.2 Swellendam Ambulance station

Property to be acquired

6 2010 2010 800 800

12 8.5 Tygerberg Kitchen 7 500 5 100 2 400

13 8.2 Vredendal Hospital Ambulance station Tender 12 2009 2010 10 000 500 997

14 8.1 Wellington New CHC Complete 22 2006 2008 21 500 10 249 1 998

TOTALS 11 079 19 800 21 000 23 000 23 000 23 000

BUDGET 11 000 18 000 19 800 21 000 23 000 23 000 23 000



Schedule 1 Capital Projects Funding (Earmarked TB allocation)




Start Target Date



2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000

1 8.4 Bewelskloof TB Hospital Fire Escape Complete 3 2008 2008 450 450

2 8.4 Brooklyn Chest TB hospital Repair & renovations Complete 10 2009 2009 5 800 350 5 935

3 8.4 Brooklyn Chest TB hospital New MDR & XDR wards

Inception 48 2011 2015 2 000 8 000 10 000 10 000 10 000

4 8.4 George Harry Comay TB Hospital

Repair & renovations Complete 8 2008 2009 1 600 650 868

5 8.4 Malmesbury TB Hospital Repair & renovations Complete 12 2008 2009 3 700 400 3 185

6 8.4 Paarl Sonstraal TB hospital Repair & renovations Complete 9 2009 2009 6 600 900 5 700

7 8.4 Paarl Sonstraal TB hospital Inception 12 2010 2011 4 000 2 000

8 8.4 Paarl Sonstraal TB hospital UV lights & extraction Inception 12 2010 2011 4 000

TOTAL 2 750 15 688 10 000 10 000 10 000 10 000 10 000

BUDGET 10 000 10 000 10 000 10 000 10 000 10 000 10 000



190

Schedule 2 Provincial Infrastructure Grant




Start Target Date



2007/08 R’000

2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000

1 8.1 Asanda Clinic New clinic Inception 12 2013 2015 24 000 800 10000 13 200

2 8.1 Beaufort West New clinic Inception 12 2014 2015 15 000 1 500 10 000

3 8.1 Delft Symphony Way New CHC Inception 18 2011 2013 35 000 1 940 21 060 12 000

4 8.1 District 6 New CHC Inception 18 2013 2015 35 000 911 100 8 000 24 000 1 989

5 8.1 Du Noon CHC New CHC Inception 24 2011 2014 80 000 2 000 18 000 45 000 15 000

6 8.1 Hermanus New CHC Inception 18 2013 2015 35 000 800 21 925 10 000

7 8.1 Rawsonville New clinic Inception 12 2013 2014 8 300 300 8 000

8 8.1 Weltevedren Valley New CHC Inception 14 2013 2015 36 000 500 1 000 12 000

9 8.2 Malmesbury EMS Ambulance station Inception 12 2011 2012 10 000 1 200 8 000 800

10 8.2 Pinelands EMS New Ambulance Station Inception 18 2014 2016 20 000 5 314 7 914

11 8.3 Karl Bremer Hosp Emergence Centre Inception 20 2012 2104 50 000 1 200 10 000 25 000 12 800 1 000

12 8.3 Knysna Hospital Emergence Centre Inception 18 2013 2015 25 000 2000 100 100 20 000 2 800

13 8.3 Robertson Hospital EC and new wards Inception 24 2014 2016 60 000 1 000 20 000 23 436

14 8.3 Robertson Hospital Maternity ward Inception 9 2011 2012 3 000 500 2 500

15 8.3 Swellendam Hospital EC and offices Inception 12 2016 2018 12 500 700

16 8.5 Groote Schuur Hospital

Interim improvements Inception 36 425 500 15 925 20 000


Master Plan Inception 24 2010 2011 1 500 500 1 000

18 8.5 Tygerberg Hospital Interim improvements Inception 35 500 3 000 13 500 19 000

19 8.6 Dept of Health CD:IM offices Inception 10 2010 2011 3 000 3 000

20 8.6 Riversdale Hospital Forensic mortuary Inception 12 2013 2014 8 200 1 000 5 000 2 500

21 8.6 Salt River Forensic mortuary Inception 24 2014 2016 120 000 1 420 6 509 9 912 60 000

22 8.1 Knysna - Witlokasie New CHC Planning 18 2011 2013 35 000 200 2000 11 800 21 000

23 8.3 Caledon Hospital Upgrade - phase 2 Planning 12 2010 2011 8 000 660 6 000 1 340

24 8.3 Ceres Hospital Emergence Centre Planning 12 2010 2012 8 000 90 5 910 2 000

25 8.3 Hermanus Hospital EC and new wards Planning 30 2010 2013 68 000 2 000 16 000 27 926 24 412 2 588

26 8.3 Malmesbury Hospital Casualty extension Planning 12 2010 2011 3 000 3 000

27 8.3 Riversdale Hospital Phase 3 upgrade Planning 9 2010 2011 7 500 6 000 1 500

28 8.4 Somerset Hospital Lift Upgrade Planning 15 2010 2011 6 000 348 920 4 500






Start Target Date



2007/08 R’000

2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000


Alt TB patient areas Planning 8 2010 2010 900 150 750


NMB fire detection ph 2 Planning 12 2010 2011 3 500 1 500 1 950

31 8.5 Tygerberg Hospital EC Upgrade Planning 12 2010 2011 13 200 500 3 000 7 700 2 000

32 8.6 4 Dorp Street 15th and 16th floor Planning 4 2009 2010 150 250

33 8.6 Beaufort West Hospital

Forensic mortuary Planning 12 2011 2013 8 000 6 000 2 000

34 8.6 Central Karoo Office accomodation Planning 5 2009 2010 1 800 200 1 600

35 8.1 Grassy Park New clinic Tender 14 2010 2011 18 100 34 859 16 643 523

36 8.1 Malmesbury - Wesbank

New CHC Tender 18 2010 2011 33 000 238 1 337 12 000 19 039 100

37 8.2 Lamberts Bay Ambulance station Tender 4 2010 2010 1 622 5 659 847

38 8.2 Vredendal Hospital Ambulance Station Tender 10 000 7 285 1 550


Relocation of Engineering Workshop

Tender 8 2010 2011 8 400 1 616 6 000 1 200


Upgrade pharmacy Tender 15 2010 2011 16 500 12 1878 7 295 4 000 3 193

41 8.1 Bonnievale/Happy Valley Clinic

Extend clinic Construction

6 2009 2010 1 500 840 500

42 8.1 Kwanokuthula New CDC Construction

18 2010 2011 30 000 2 200 24 000 6 000

43 8.1 Mitchell's Plain CHC EC & Pharmacy Construction

12 2009 2010 33 700 10 200

44 8.2 Ceres Ambulance Station Construction

12 2010 2011 10 500 148 1 018 8 000 1 352

45 8.2 Kwanokuthula New ambulance station Construction

12 2010 2011 9 000 110 495 7 000 1 400

46 8.3 Eerste River Hospital New casualty Construction

16 2008 2010 30 139 438 7 400 17 828 3 115

47 8.3 Riversdale Hospital Phase 2 upgrade. Construction

22 2008 2010 17 000 8 450 7 214 1 271



192




Start Target Date



2007/08 R’000

2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000

48 8.3 Vredendal Hospital New Chiller Construction

2 2009 2010 150 150

49 8.4 Somerset Hospital 2010 Enabling Work Construction

10 2009 2010 32 131 2 000


Security upgrade Ph 1 Construction

8 2009 2010 12 500 373 7 226 1 727

51 8.5 Tygerberg Hospital Electric fence Construction

9 2009 2010 2 400 2 979 100

52 8.5 Tygerberg Hospital Lift upgrading Construction

14 2008 2010 7 956 200 7 656 100

53 8.4 Somerset Hospital Shipley building renovation

Complete 2009 2009 500


Fire detection Ph 1 Complete 36 2006 2009 14 000 8 100 3 300 1 930 570


Lift upgrading Complete 11 2007 2007 2 264 1 926 277 61


Pharmacy store a/c Complete 2 2009 2009 146 146


Topographical survey Complete 4 2009 2009 534 534


Ugrade D23 department anaesthesia

Complete 5 2009 2009 2 150 193 2 142 87

59 8.5 Tygerberg Hospital Helipad Complete 4 2009 2009 1 470 1 242

60 8.5 Tygerberg Hospital Security fence - East Side Complete 4 2009 2009 6 100 745 4 919 55

61 8.1 Mitchell's Plain CHC Site acquistion In progress 2010 2010 2 500 2 500

62 8.3 Beaufort West Hospital

New store Complete 7 2008 2009 3 852 1 752 2 267

63 8.3 Bredasdorp Hospital Upgrade entrance & store Complete 3 2008 2008 827 801 26

64 8.3 Caledon hospital Upgrading of electrical supply

Complete 5 2008 2008 1 822 1 447 544

65 8.3 Caledon Hospital New wards & EMS Complete 8 2007 2009 26 500 8 200 12 500 3 522

66 8.3 Eerste River Hospital Pre-Fab Complete 6 2009 2009 4 500 4 000 500

67 8.3 Helderberg Hospital New OPD & wards Complete 14 2007 2008 18 400 2 630 12 800 1 058

68 8.3 Riversdale Hospital Phase 1 Complete 12 2007 2008 5 000 155

69 8.3 Riversdale Hospital Resurface roads Complete 6 2009 2009 2 018 33 1 925 60

70 8.3 Vredendal Hospital CSSD and X-Ray Complete 30 2006 2008 9 000 4 485 1250 1164

71 8.4 Western Cape Rehab Road maintenance 1 000






Start Target Date



2007/08 R’000

2008/09 R’000

2009/10 R’000

2010/11 R’000

2011/12 R’000

2012/13 R’000

2013/14 R’000

2014/15 R’000


Survey for place utilisation

In progress 12 2008 2009 2 972 2 972

73 8.5 Tygerberg Hospital Fire door upgrade phase 2

Retention 15 2008 2009 4 433 1 263 2 703 194

74 8.6 4 Dorp Street video conference 200

75 8.6 Dept of Health Technical capacity In progress 1 000 1 000 3 000 4 000 4 000 4 000 4 000

76 8.6 George Harry Comay Office accomodation 3 000

TOTAL Expenditure 25 779 57 331 91 363 185 800 160 540 178 539 178 539 178 539

BUDGET 80 262 94 643 114 924 131 529 160 540 178 539 178 539 178 539

Roll over 30 710 54 271

Adjust Budget

145 634 185 800 160 540 178 539 178 539 178 539

Under/over exp

54 271



194

Schedule 3: Hospital Revitalisation

No. Sub Prog Project name Project Description/

Type of Infrastructure

Project duration Total project cost Estimated

expenditure to date from

previous years

Professional Fees Budget

Construction/Maintenance

Budget

Total available

MTEF Forward Estimates

Date: Start

Date: Finish At start At

completion MTEF 2009/10 MTEF

2010/11 MTEF

2011/12 MTEF

2012/13 MTEF

2013/14 MTEF

2014/15

R'000 R'000 R'000 R'000 R'000 R'000 R'000 R'000 R'000

1 8.1 Paarl TC Newman CHC

Community health center upgrade (co-funded GF)

15-May-09 14-May-11 10 000 10 000 16 000

2 8.2 Worcester DMC & ambulance station

New DMC and ambulance station

14-Nov-06 9-Apr-09 10 900 16,400 11 500 759 7 962 8 721

3 8.3 Helderberg Replacement Hospital 1-Apr-14 31-Mar-17 300 000 350 000 3 500 40 000 80 000

4 8.3 Khayelitsha hospital Infrastructure Installation

8-Aug-08 23-Mar-09 14 000 15 020 9 700 400 5 397 5 797

5 8.3 Khayelitsha hospital New hospital and ambulance station

5-Jan-09 4-Jan-12 480 000 540 000 52 000 11 000 104 594 115 594 196 021 115 600 7 962

6 8.3 Mitchell's Plain hospital

New hospital 22-Sep-09 21-Oct-12 480 000 520 000 32 000 5 319 6 391 11 710 120 500 238 000 142 300

7 8.3 Mitchell's Plain hospital

Regional laundry upgrade

1-Apr-13 31-Mar-13 30 000 40 000 2 501 35 000

8 8.3 Mossel Bay New hospital 1-Oct-13 31-Mar-16 300 000 350 000 2 000 25 500 80 500

9 8.3 Victoria Replacement Hospital 1-Oct-14 31-Mar-17 540,000 600,000 2 000 5 058 25 862

10 8.3 Vredenburg hospital Upgrading phase 1B- Varous internal work

29-Oct-08 31-Mar-09 3,700 5,600 1 800 356 2 964 3 320 20

11 8.3 Vredenburg hospital Upgrading phase 2A 28-Jan-09 29-Jul-10 30,000 35,000 1 200 2 045 14 641 16 686 11 000

12 8.3 Vredenburg hospital Upgrading phase 2B 1-Oct-10 30-Sep-12 90,000 138,000 3 000 2 257 2 257 8 000 47 000 70 000 2 804

13 8.4 Brooklyn Chest Extensions & Upgrades 1-Apr-13 31-Mar-13 350,000 400,000 2 000 80 000 134 500

14 8.4 George hospital Hospital upgrade phase 3

1-Apr-09 31-Mar-11 56 000 59 000 2 500 5 160 14 249 19 409 28 750 5 000

15 8.4 Paarl hospital Hospital upgrade 10-Apr-06 1-Dec-10 332 000 430 000 228 861 9 278 105 569 114 847 90 000 6 100

16 8.4 Paarl Hospital New Administration Block

1-Apr-13 31-Mar-14 18 000 25 000 2 000 23 000

17 8.4 Valkenberg hospital Emergency repairs to admin building

17-Apr-09 31-Mar-10 5,000 7,800 1 750 1 109 4 801 5 910 1 500



No. Sub Prog Project name Project Description/

Type of Infrastructure

Project duration Total project cost Estimated

expenditure to date from

previous years

Professional Fees Budget

Construction/Maintenance

Budget Total

available MTEF

Forward Estimates

Date: Start

Date: Finish At start At

completion MTEF 2009/10 MTEF

2010/11 MTEF

2011/12 MTEF

2012/13 MTEF

2013/14 MTEF

2014/15

R'000 R'000 R'000 R'000 R'000 R'000 R'000 R'000 R'000

18 8.4 Valkenberg hospital Hospital upgrading 1-Apr-12 31-Mar-17 600 000 700 000 1 200 240 240 2 285 2 076 90 601 185 000 80 000

19 8.4 Worcester hospital phase 3

Hospital upgrade phase 3

26-Jun-03 31-Dec-08 170 000 260 540 255 000 2 626 3 053 5 679

20 8.4 Worcester hospital phase 4


2-Nov-09 1-Nov-10 20 000 45 000 3 991 3 621 7 612 30 000 1 300

21 8.4 Worcester Hospital phase 5


1-Apr-12 30-Jun-13 30 000 32 000 2 500 25 000 4 500

22 8.5 Tygerberg Replacement Hospital 2 000 7 200 29 000 25 000 25 000

Infrastructure 317 782 506 076 424 776 378 864 425 862 425 862

OD and QA 89 500 86 041 67 925 127 499 80 501 80 501

TOTAL 407 282 592 117 492 701 506 363 506 363 506 363

Roll-over 30 000 11 563

BUDGET 388 845 580 554 492 701 506 363 506 363 506 363

Adjustment Budget 418 845 592 117 492 701 506 363 506 363

Surplus / (Shortfall) 11 563



196

Schedule 5: Recurrent Maintenance

Name of the project/Programme Type of infrastructure Brief need/ proposed outcome

2008/09 R'000

2009/10 R'000

2010/11 R'000

2011/12 R'000

2012/13 R'000

2013/14 R'000

2014/15 R'000

Vote 6 : Health Community Health facilities Maintain Serviceability 9,678 9,678 14,651 15,426 16,053 16,053 16,053

District Hospitals Maintain Serviceability 11,000 12,000 18,158 19,118 19,896 19,896 19,896

Provincial Hospitals Maintain Serviceability 21,725 22,533 34,075 35,876 37,336 37,336 37,336

Central Hospitals Maintain Serviceability 37,794 38,716 58,602 61,700 64,211 64,211 64,211

Other Facilities Maintain Serviceability 5,000 6,000 9,079 9,559 9,948 9,948 9,948

TOTAL 85,197 88,927 134,565 141,679 147,444 147,444 147,444

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