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North West Province Department of Health. Budget Hearing presentation Portfolio Committee Parliament 13 May 2001. Presenters. Mrs R Hlabatau – Chief Financial Officer Dr T G K Oosthuizen – Acting Chief Director Health Service Delivery and Strategic Health Programs - PowerPoint PPT Presentation
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North West Province Department of Health
Budget Hearing presentation Portfolio Committee Parliament
13 May 2001
Presenters
• Mrs R Hlabatau – Chief Financial
Officer• Dr T G K Oosthuizen – Acting Chief
Director Health Service Delivery
and Strategic Health Programs• Mr P Netshipale – Director Primary
Health Care Programs and
Communicable Diseases
STRATEGY
• The Department reviewed its strategic plan during October 2001
• New focused strategic goals, objectives and high level activities were developed as discussed in attached strategic plan
The Vision
Optimum health for all individuals and communities in the North West Province.
The Mission
To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through
Value statement
• Community involvement and partnerships
• Batho Pele Principles and the Patients’ Rights Charter
• Innovation and performance driven,
• And by valuing our people and their diversity.
Strategic Goals
1. Providing quality health services2. Providing accessible, equitable and affordable comprehensive primary health services3. Well functioning and competitive hospital services4. Improving the health status of communities through implementation of integrated health programs5. Well managed and effective district health system
Strategic Goals
6. Competent, empowered and
performance focused employees
7. Appropriate and effective
organisational systems
8. Effective management of the department’s finance and assets
ACHIEVEMENTS
(DISCUSSED AS PART OF VARIOUS HEADINGS)
EXPENDITURE PATTERNS
STD ITEM BUDGET EXP. VAR.
PERSONNEL 1 133 612 1 159 342 -25 730
ADMIN 48 822 52 455 -3 633
STORES 238 392 231 232 6 161
EQUIPMENT 47 634 46 634 1 000
LAND & BUIL. 5 477 6 440 963
PROF. SERV. 195 156 161 955 33 201
TRANSFERS 54 894 40 278 14 616
MISC. 10 830 1 669 9 161
TOTALS 1 734 817 1 700 005 34 812
EXPENDITURE PATTERNS
Budget vs Expenditure
-500,000
-
500,000
1,000,000
1,500,000
2,000,000
A.
PE
RS
ON
NE
L
C.
ST
OR
ES
E.
LAN
D &
BU
LDIN
GS
G.
TR
AN
SF
ER
S
TO
TA
L
Std Items
Ran
ds
BUDGET R'000 EXP. R'000VARIENCE R'000
Expenditure patterns
• Personnel budget comprises 65% of the total budget
• This is consistent with prior years• The national average personnel
budget is 68%• The personnel budget was
overspend by 2% due to the insufficient budget of ICS, backlog in rank and leg promotions
Expenditure patterns
• Transfers were under spent by 26% as a result of delays by institutions in complying with the PFMA e.g.
• Non submission of invoices by local Authorities
• Non submission of Audited Financial Statements
• Under expenditure in professional services relates to capital projects
• Over 98% of the budget was utilized
MECHANISMS TO IMPROVE
CAPACITY
The Department uses various mechanisms to improve its Human Resource, Financial, Procurement and Service Delivery Capacity
Human Resource
• General Managers appointments with Heads of Admin, Clinical, and Nursing
• Job descriptions for staff with Personal Performance Management Agreements levels 13 and higher
• Key performance areas and key performance indicators built in, into job descriptions of all levels of staff in one Complex as a pilot for all other health facilities
Human Resource
Organisational Performance Management Frameworks implemented for the biggest Complex with a roll out empowerment process started to other two regional Hospital Complex’s
Human Resource• During the year under review, the department
developed its first Work Place Skills Plan, and will build on this during the current year and in years to come.
• In an effort to improve our ability to deliver quality PHC services to our communities, the department has prioritized the training of primary health care nurses. In the year under review, 118 were trained as PHC practitioners.
• The issue of proper deployment of these nurses will continue to receive attention in the current year.
Human Resource• The post basic training of nurses in the
following fields also continued to be a priority: IMCI (10), psychiatry (10), and midwifery (45).
• The department sees discipline of employees as being central to capacity to deliver services.
• Therefore, the training of managers and employees as investigating officers and presiding officers. A total of 40 were trained as investigating and presiding officers.
Financial
• Establishment of a functional Internal Control Unit, filling 97% of vacant posts
• Improved co-ordination and co-operation of Finance Committees
• UPFS implemented at all hospitals• Developed the transaction flow
process• Trained 70% of HO finance staff on the
following courses:
Financial
• Project Management• Cash Flow Management• Policy making and Budgeting• Provisioning and
Administration System• Computer Training and
Writing skills
Procurement
• Took charge of our own maintenance of own buildings and patients transport due to poor performance experienced from Department of Transport, Roads and Public Works
• Provincialisation of Emergency medical services
• Outsourcing of procurement of pharmaceuticals with efforts to decentralise the process started via Vuna Health Care logistics
Procurement
• Rolling out of a computerised asset management system
• Outsourcing initiatives for garden services, catering- and security services
Service Delivery CapacityPPP’s:• Coordinator for the Provincial Council on Aids
plus 18 Coordinators for the Local Aids Councils were appointed
• Lichtenburg health district (Environmental Health Officers) in partnership with Agriculture improved the quality of their dairy products to the extent that it is now adhering to the criteria set by the EU and permission for export was granted
• Joint appointments with Universities • Alpha cement/licthenburg DHS initiatives
Service Delivery CapacityThrough empowerment:• Primary school nutrition program was decentralised
with empowerment of local women groups, etc• 90 Primary Health care nurses underwent training in
sign language• 240 donated wheelchairs were distributed and 1130
bought out of own funds were distributed• Five multi purpose youth centres established to
enhance the reproductive health of the youth, to protect themselves against HIV and teenage pregnancy was a joint effort between DFID and PPASA now fully funded by the Department
Service Delivery Capacity
Through empowerment:
• 141 VCT sites
• 33 funded NGO as part of the system
Service Delivery Capacity
Optimising resource utilisation:• 100 patients were de-institutionalised• EMS – Provincialisation 1 December 2001• Forensic Medical Services – Started the
process of taking over from the SAPS – Vryburg region will be first
• Quality Assurance – Tender document out to get COHSASSA accreditation for all Institutions with capacity development management to sustain quality assurance program
Service Delivery Capacity
Networking and linking with tertiary institutions:
• Attracting and retaining specialised personnel – A process started looking mainly at linking Regional Complex’s with tertiary institutions like MEDUNSA / WITS and UP to enable registrar training at and rotation of specialists through regional hospitals
Service Delivery Capacity
Through stakeholder involvement:• Farm worker summit held with a
definite project plan to implement the outputs received from the summit which included new mobile services to be established
• Governance summit held with outputs taken forward
COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND
ANY SHORTCOMINGS
PROVINCIAL PROCESS:• Each department submits inputs to Treasury• The provincial Budget Lekgotla is held
where trade offs between departments are considered to try and stay within the provincial allocation
• Process of avoiding duplications by cluster approach
• CFO’s meet to discuss approaches to minimise administrative expenditures
COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND
ANY SHORTCOMINGS
PROVINCIAL PROCESS:• 85% National target to be spent on
Social Cluster not reached due to:– North West Star– NWDC– Agric– SABC – Public Works– Ring fencing of National Allocations could
assist
COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND
ANY SHORTCOMINGSDEPARTMENTAL PROCESS
• MTEF PROCESS & SHORTCOMINGS:• Individual cost center managers prepare
and submit their inputs through regional structures, hospital CEOs, College principals and program managers.
• These are consolidated, compared to previous allocations, expenditure and priority program plans for the department and forwarded to the Equity/Budget Committee for further attention.
MTEF PROCESS cont.
• The Equity/Budget committee analyses the inputs and aligns them to current and new priorities and or objectives for the next MTEF cycle and makes recommendations to the Departmental Management Committee(DMC) for discussion, verification and further recommendations to the Departmental Executive Committee.
MTEF PROCESS cont.
• The DEC makes decisions based on the strategic priorities of the department as well as the provincial budget memorandum and strategies, and directs further adjustment where necessary.
• Consultation is then done with relevant stake holders for further attention, buy-in and finalization of proposed allocations.
SHORTCOMMINGS-MTEF• The time frames are not realistic in terms of
adequate involvement of all stake holders.• Due to limited availability of resources, it is
sometimes difficult to address Equity issues.
• Allocation of funds for personnel is based on previous expenditure patterns.
• The financial impact of Strategic challenges is higher than the budget growth
CONDITIONAL GRANTS
The Department received the following conditional Grants:
• Redistribution of Specialised Hospital Services conditional Grant
• Training of Health Professionals Grant• Hospital Revitalisation and
Rehabilitation Grant• Primary School Nutrition Grant• HIV / AIDS
Redistribution of Specialised Hospital Services Conditional Grant
38,65538,655RECEIVED
EXPENDITURE
Training of Health Professionals Grant
24,37724,377
RECEIVED
EXPENDITURE
Hospital Revitalisation and Rehabilitation Grant
56,000
44,707 RECEIVED
EXPENDITURE
Primary School Nutrition Grant
39,391
28,314 RECEI VED
EXPENDITURE
HIV/AIDS
4,641
2,254RECEI VED
EXPENDITURE
OUTCOMES REDISTRIBTION SPECIALISED HOSPITAL SERVICES CONDITIONAL
GRANT
Provincial Referral Hospital Allocations & Expenditure Redistribution of Specialisted Services Condiditional Grant
BUDGET APPROVED
17%
10%
17%2%19%
13%
6%
16%RENAL UNIT
ONCOLOGY UNIT
MDR TB UNIT
EMS/ICU AMBULANCE
BURNS UNIT
JOINT SURGERY
IN PATIENT ONCOLOGY
PSYCHIATRIC UNIT
Provincial Referral Hospital Allocations & Expenditure redistibution of Specialist Services Conditional Grant TOTAL EXPENDITURE FO THE YEAR
18%
14%
16%1%
21%
12%
5%
13% RENAL UNIT
ONCOLOGY UNIT
MDR TB UNIT
EMS/ICU AMBULANCE
BURNS UNIT
JOINT SURGERY
IN PATIENT ONCOLOGY
PSYCHIATRIC UNIT
Total patients treated for the yearRenal Unit 4852
Oncology Unit 1989
MDR Unit : Out : In
638258
EMS/ICU AMBULANCE 231
BURNS UNIT 117
JOINT SURGERY 58
IN PATIENT ONCOLOGY 747
PSYCHIATRIC UNIT 307
SUCCESS IN ACHIEVING EQUITY
• The Equity committee has made attempts to address gaps related to resource allocation per district and region (health districts).
• The difficulty of shifting of funds from one area to another is still a challenge due to 65% of expenditure being allocated to personnel
SUCCESS IN ACHIEVING EQUITY
• Progress made to date relates to a decentralized system, which reflects fully fledged District Management structures, independent Hospital managers for level 1, and CEOs for level 2 hospitals.
• Financial, Human Resource and Procurement delegations are in place to enable managers to make appropriate decisions and manage their allocated resources.
COMMENTS REGARDING EQUITY ON INTERPROVINCIAL
ALLOCATIONS-SHORTCOMINGS Facilitation of the devolution of primary
health care to Local Authorities by creation of equal conditions of service between Provincial Health Authority staff and those appointed by Local Authorities with the end result of “One Public Service” with equal conditions of service / pay packages / progression irrespective of what tier of Governance
COMMENTS REGARDING EQUITY ON INTERPROVINCIAL
ALLOCATIONS
The Department experience difficulty in attracting various categories of Health Care workers to rural areas. Rural allowance exists for Doctors only. Assistance regarding possible incentives to attract other categories of Health workers to rural areas equally across the country will help
COMMENTS REGARDING EQUITY ON INTERPROVINCIAL
ALLOCATIONS Equity regarding budget allocations
between various Provincial Departments of Health is still not achieved due to the fact that money allocated by the National Department of Health is not ring fenced and within Provincial Treasuries Departments then start to compete for funding which lead to National Department of Health funding ending up being used for other Departments, i.e. Education, etc
PUBLIC PRIVATE PARTNERSHIPS
The Department is actively involved in both public – public and public private partnerships. Some examples:
• Outsourcing of various services• Private specialists responsible for a
major part of specialist services in the Province
• Lichtenburg District and Department of Agriculture joint venture
• University links
HIV / AIDS
HIV ACHIEVEMENTS AND PLAN FOR 2002/3
OBJECTIVES ACHIEVEMENTS
Functionalise PCA
Assist in funding all LAC
Expand VCT sites in the Province
Establish PMTCT pilot sites
Expand female condoms distribution
Reduce incidence of STI by 30%
Provide effective HBC in all 18 districts
PCA act in place, all staff appointed in all 18 DistrictsAll 18 LAC funded
141 sites established & 970 Nurses trained in counseling with 8909 clients tested(2392 positive,26.8%)Two sites established July 2001
Expanded female condoms sites from 4 to 18 and distributed 200 000 female & 23 million male condomsReduced Syphilis form 17% to 3,6%New form implemented in the Province
Funded 33 NGO for R1,06M in the Province and 14 National funded for R1,5M
HIV/AIDS ACHIEVEMENTSOBJEC TIVES ACHIEVEMENTS
HBC (cont..)
To involve Tertiary institutions in HIV/AIDS management in the Province
Intergovernmental committee on HIV/AIDS Conduct Door to door campaign in the Province
To celebrate all HIV/AIDS calendar days
101 HBC district trainers trained 467 Caregivers trained including LAC’s
Develop a framework for participation of Tertiary Institutions in the HIV/AIDS programmes e.g. Research & Training
Health Act as secretariat for IDC in the ProvinceFacilitate all operations of the Interdepartmental Committee on HIV/AIDS
All 18 Districts conducted door to door campaigns during December 2001with 1 950 houses visited and 24 387 persons reached and 991 350 Condoms distributed in one week(5days)All HIV/AIDS calendar days celebrated
HIV/AIDS ACHIEVEMENTSOBJEC TIVES ACHIEVEMENTS
Conduct a survey for the Health promotion in the Province
Organize a workshop for all Private practitioners
To organize workshops for Traditional healers
To coordinate with DEPT of Education on life skills education at school
Health promotion survey conducted on the availability of Health promoters in all districts to establish health promotion activities in the Province
Workshop organized through ROCHE in the Province with good attendances from All GP( Private Medical Officers)to standardize syndromic management of STI’sOrganized traditional healers workshop took place to address HIV/AIDS
Close collaboration with education established
NO OF VCT SITES IN THE PROVINCE
District Number of sites Number operational
Mafikeng 18 14
Zeerust 21 21
Lichtenburg 13 9
Delareyville 10 4
Klerksdorp 12 12
Potchefstroom 11 10
Ventersdorp 11 11
Wolmaranstad 5 4
Vryburg 6 4
Ganyesa 5 5
Taung 6 5
Schweizer-Reneke 1 1
Kudumane 3 3
Odi 8 8
Moretele 7 7
Brits 5 3
Mogwase 9 7
Rustenburg 21 13
TOTALS 172 141
0
100
200
300
400
500
600
700
800
900
1000
NO OF NURSES TRAINED IN COUNSELLING 2001/2
BOJANALA
KLERKSDORP
MAFIKENG
VRYBURG
TOTALS
BOJANALA 108 133 75 27 343
KLERKSDORP 47 94 43 51 235
MAFIKENG 68 0 101 32 219
VRYBURG 66 18 36 20 140
TOTALS 289 245 255 130 937
QTR1 QTR2 QTR3 QRT 4. Provincial
0
500
1000
1500
2000
2500
3000
VCT SITE PERFORMANCE 2001/2
Bojanala
Klerksdorp
Mafikeng
vryburg
Totals
Bojanala 321 366 464 717 96 134 124 321
Klerksdorp 41 69 98 434 8 26 18 107
Mafikeng 683 826 1099 652 361 219 309 208
vryburg 162 1143 1042 792 66 70 68 257
Totals 1207 2404 2703 2595 531 449 519 893
QTR1 QTR2 QTR3 QRT 4. QTR1 QTR2 QTR3 QRT 4.
NO OF TESTS NO.OF POSITIVES
PMTCT SITES SRVICES• Thlabane (U): Jul-
March 2001/2• ANC - 2797• VC - 204 = 7%
• Tested - 204 =
7%• HIV+ - 90 =44%• NVP - 38• Babies - 38• EBF - 9 =23%• EFF - 29=77%
• Lehurutshe (R): Jul-March 2001/2
• ANC - 1998• VC - 851 = 42%• Tested- 727 = 37%• HIV+ - 183 = 25%• NVP - 65• Babies- 65• EBF - 1= 2%• EFF - 64 =
98%
DISTRICT ORGANISATION VISITS CLIENTS
MORETELE SUNRISE 780 193
ZEERUST GIVE A HAND & HOPE 386 81
KLERKSDORP NW HOSPICE 726 141
KLERKSDORP KOSH 147 141
DELARYVILLE TSHWARAGANANG 716 104DELAREYVILLE BRIGHT FUTURE 698 112
ODI GARANKUWA SUNSHINE 140 32
ODI MERCY AIDS PROJECT 382 105
BRITS MABOLOKA AIDS PROJECT 475 78
KUDUMANE RETLATHUSA 89 23
RUSTENBURG VISION FOR NATION 357 70
MAFIKENG LEMOGANG 102 42
NAPWA 626 210
OPERATION BLANKET 410 185
OPERATION H8UNGER 80 38
HELPING HAND 863 490POTCHEFSTROOM TSHEPONG 258 47
TOTAL 7238 Home visits 1999 clients
LEGISLATION
• We the process of passing the Provincial Council on Aids Act during the 2001/2 financial year
• Drafted the Provincial Health Bill
THANK YOU