PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S ANNUAL REPORT FOR 2010/11

PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S

ANNUAL REPORT FOR 2010/11

Select Committee on Social Services

25 OCTOBER 2011

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1. Purpose of the Presentation

1. To reflect on key issues from the Annual Report of the National Department of Health (DoH) for 2010/11.

2. To reflect both achievements and problem areas.

3. To reflect strategies for addressing constraints experienced – which are also outlined in the National DoH’s Annual Performance Plan for 2011/12.

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2. Structure of the presentation (1)

Vision and Mission

National Health Systems Priorities: the 10 Point Plan for 2009-2014

Government priorities for 2010-2014: the Outcome-based Approach

The Negotiated Service Delivery Agreement (NSDA) 2010-2014

Highlights of Performance on the Departmental Strategic Plan 2010/11-2012/13 (for each of the six Budget Programmes that existed in 2010/11)

Key issues from the National DoH Budget and Expenditure

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3. Vision & Mission

Vision

“A long and healthy life for all South Africans”

Mission

“To improve health status through prevention of illness and disease and through the promotion of healthy lifestyles, and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability”.

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4. National Health Systems Priorities: the 10 Point Plan 2009-2014

1. Provision of Strategic Leadership and creation of Social Compact for better Health Outcomes

2. Implementation of National Health Insurance (NHI)

3. Improving the Quality of Health Services

4. Overhauling the Health Care System and Improving its Management

5. Improved Human Resources Planning Development and Management

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4. National Health Systems Priorities:

the 10 Point Plan 2009-2014

6. Revitalization of Infrastructure

7. Accelerated implementation of the HIV and AIDS Strategic Plan and the increased focus on TB and other Communicable Diseases

8. Mass Mobilisation for Better Health for the Population

9. Review of Drug Policy

10. Strengthening Research and Development.

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5. Government priorities for 2010-2014: The Outcome-based Approach

Twelve key outcomes of government for 2010-2014 as outlined in the revised Medium Term Strategic Framework (MTSF) are:

1.Improved quality of basic education

2. “A long and healthy life for all South Africans”

3.All people in South Africa are and feel safe

4. Decent employment through inclusive economic growth

5. A skilled and capable workforce to support an inclusive growth path

6. An efficient, competitive and responsive economic infrastructure network

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5. Government priorities for 2010-2014: The Outcome-based Approach

7. Vibrant, equitable and sustainable rural communities with food security for all.

8. Sustainable human settlements and improved quality of household life

9. A responsive, accountable, effective and efficient local government system.

10. Environmental assets and natural resources that are well protected and continually enhanced.

11. Create a better South Africa and contribute to a better and safer Africa and World.

12. An efficient, effective and development oriented public service and an empowered, fair and inclusive citizenship.

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6. The Negotiated Service Delivery Agreement (NSDA) 2010-2014

Health sector is a lead department in the country’s efforts towards Outcome 2. “A long and healthy life for all South Africans”

Health Sector NSDA was signed in October 2010

Four (4) major outputs must be achieved namely:

Increasing Life Expectancy;Decreasing Maternal and Child Mortality RatesCombating HIV and AIDS and decreasing the burden of diseases from TuberculosisStrengthening Health System Effectiveness

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7. LINKAGES BETWEEN NATIONAL AND INTERNATIONAL HEALTH PRIORITIES

10 POINT PLAN 2009-2014 NSDA 2010-2014OUTPUTS

HEALTH RELATED MDGs 2000-2015

1. Provision of Strategic leadership and creation of a social compact for better health outcomes;

2. Implementation of National Health Insurance (NHI);

3. Improving the Quality of Health Services;

4. Overhauling the health care system

5. Improving Human Resources, Planning, Development and Management;

6. Revitalisation of infrastructure

7. Accelerated implementation of HIV and AIDS and Sexually Transmitted Infections National Strategic Plan, 2007-2011 and reduction of mortality due to TB and associated diseases;

8. Mass mobilisation for better health for the population;

9. Review of Drug Policy; and

10. Strengthening Research and Development

1. Increasing life expectancy;

2. Decreasing child and maternal mortality rates

3. Combating HIV and AIDS and STIs and decreasing the burden of disease from Tuberculosis

4. Enhancing health systems effectiveness

MDG Goal 4 MDG Goal 5

MDG Goal 6

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8. Highlights of Performance on the Departmental Strategic Plan 2010/11-2012/13

8.1. Programme 1: Administration

The Administration Programme consists of the Offices of the Minister, Deputy Minister and the Director-General, and provides leadership and overall management to the National DoH.

The work of this programme is consistent with Priority No 1 in the 10 Point Plan 2009-2014 & Output 4 of the NSDA 2010-2014.

8.1.1. Achievements

In keeping with the 2010/11 target, a revised National DoH organisational structure aligned to the NSDA 2010-2014 was produced, approved by the Minister and submitted to the Department for Public Service and Administration (DPSA) for concurrence.

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8.1.1. Achievements

The National Consultative Health Forum (NCHF) was convened in accordance with the National Health Act of 2003.

The AID Effectiveness Framework was produced and launched with major support from international development partners. This is a policy framework for harmonising and coordinating support from diverse development partners.

The Provincial Financial Management Turn-around Plans developed jointly with the Technical Assistance Unit at the National Treasury in 2009/10, were implemented.

7 Provinces were supported to implement these plans with the exception of KwaZulu-Natal and Western Cape – which were already in the process of developing their own plans.

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8.1.1. Achievements

Reviews of financial management in the 7 Provinces were conducted, and support visits conducted.

Reports with recommendations for improving financial management were produced, which were adopted by the National Health Council.

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8.1. Programme 1: Administration

8.1.2. Problem Areas

A massive public sector strike took place in 2010/11, and affected health service delivery.

The National DoH received a qualified Audit Opinion for the Auditor-General of South Africa (AGSA). The major reason for this is the Asset Register, with regard to the valuation of assets.

Only 2 Provinces – North West and Western Cape – received an Unqualified Audit Opinion from the AGSA. The target for 2010/11 was that 4 Provinces (at the least) would obtain an Unqualified Audit Opinion.

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8.2. Programme 2: Strategic Health Programmes

Programme 2 co-ordinates a range of strategic national health programmes by developing policies and systems and manages and funds key health programmes.

The work of this programme is consistent with MDGs 4,6 and 6; Priorities 7&8 of the 10 Point Plan 2009-2014 and Output 3 of the NSDA 2010-2014.

8.2.1. Achievements 72% of PHC facilities implemented the Basic Antenatal Care (BANC) programme, which exceeded the 2010/11 target of 60%. This also exceeded twofold performance during 2009/10, where only 30% of PHC facilities provided BANC.

The BANC programme play a pivotal role in enhancing the quality of antenatal care, and requires availability of advanced midwives or experienced medical officers, to impart skills and knowledge to frontline health workers.

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8.2.1. Achievements

Improving Maternal and Women’s Health

A total of 96,9% of pregnant women agreed to be tested for HIV and underwent testing during the reporting period. The 2010/11 target was 100%.

79,4% of HIV-positive pregnant women were placed on highly active antiretroviral therapy (HAART), which exceeded the 2010/11 target of 70%. It also exceeded the figure of 76,6% which was recorded in 2009/10.

Choice on Termination of Pregnancy (CToP) services were provided in 46% of designated facilities and was higher than the target of 40% for 2010/11.

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8.2.1. Achievements

Improving Child Health

• Empirical evidence points to the fact the range of child health programmes implemented by the public health sector, under the stewardship of the National DoH, have begun to yield the desired results.

• An independent study conducted by the Medical Research Council during the reporting period reflects that the Prevention of Mother to Child Transmission (PMTCT) of HIV programme reflected improved outcomes, including improved coverage and sustained declines in transmission rates. Transmission rates decreased on average from 8,5% to 3,5%, with KwaZulu-Natal Province achieving the largest gains

• Also, a study conducted by the Human Sciences Research Council (HSRC) in 2010 found that about 25% of infants 0-6 months were exclusively breastfed. This exceeded the target of 10% for 2010/11.

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8.2.1. Achievements

Improving Child Health

Major gains were made in immunising South African children against vaccine preventable conditions.

89,4% of South African children under the age of 1 were fully immunised during 2010/11. The target was 90%.

72.8% of targeted children were immunised with pneumococcal conjugate vaccine, and 72.2% with the Rotavirus vaccine to reduce their susceptibility to pneumonia and diarrhoea respectively.

This exceeded the 2010/11 target of 60%, as well actual performance during 2009/10, whereby only 34,6% of eligible infants received the rotavirus vaccine, while 22,8% were immunized with the pneumococcal conjugate vaccine.

69.1% of HIV exposed infants were initiated on Cotrimoxazole Prophylaxis Therapy (CPT) to reduce opportunistic infections. This exceeded the set target of 60% for 2010/11.

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8.2.1. Achievements

Combating HIV and AIDS and Tuberculosis

HIV Prevention (1)

In April 2010, the President of RSA launched the largest HIV Counselling and Testing (HCT) Campaign globally. By the end of March 2011, 11,4 million South Africans had responded to the HCT Campaign, and 9,7million people had agreed to be tested.

The set target was to test 15 million South Africans by June 2011. At the end of June 2011, 14,7 million people had accepted HIV counselling, and 13 million had agreed to undergo HIV testing.

A total of 492,156,000 male condoms were distributed during 2010/11, which was lower than the target set in the HCT Campaign of distributing 1 billion male condoms.

However, performance during 2010/11 reflects an improvement from the 445,156,000 male condoms distributed in 2009/10.

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8.2.1. Achievements

Combating HIV and AIDS and Tuberculosis

HIV Prevention (2)

A total of 4,989,000 female condoms were distributed during 2010/11, which was lower than 2010/11 target of 6 million.

However, this performance reflects an improvement from the 3,6 million female condoms distributed in 2009/10.

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8.2.1 Achievements

Combating HIV and AIDS

Treatment

418,677 people living with HIV were initiated on treatment in 2010/11, of which 318,612 were adults and 37,065 were children.

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8.2.1. Achievements


Care and Support

A total of 42,756 Community Care-Givers (CCGs) supporting people living with HIV&AIDS and other debilitating conditions received stipends during 2010/11. This exceeded the 2010/11 target of providing stipends to 36,106 CCGs.

Performance during 2010/11 also reflects an improvement from 2009/10 where stipends were provided to 25,278 CCGs.

97 step-down facilities were established, against a target of 98. One step-down facility was not established in Mpumalanga Province, due to an ongoing hospital revitalisation project.

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8.2.1. Achievements

Combating Tuberculosis

In terms of WHO reporting guidelines, TB treatment outcomes are recorded with a one-year time lag.

7,9% of TB patients defaulted treatment, against a target of 7%.

A TB cure rate of 71,1% was achieved during the reporting period, which exceeded set target of 70%. It also reflects an improvement from the 63,4% achieved in the 2009/10 reporting cycle.

As part of the HCT campaign, TB screening was also offered and 8m people were screened for TB and more than 1 m were referred for further investigation

In Feb 2011 intensified TB case finding to reach 200 000 homes by March 2012 of index patients was initiated

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8.2.1. Achievements


19 Drug Resistant Tuberculosis Facilities diagnosed and placed drug-resistant TB patients on the appropriate treatment regimen. This exceeded the set target of 15 facilities.

A total of 11,378 health care providers were trained in TB management during the reporting period, which exceeded threefold the set target of 3,500 for 2010/11.

A total of 7,128 non-professionals (CHWs) were also trained, which exceeded twofold the set target of 2,500 for 2010/11.

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8.2.1. Achievements

Combating Non-Communicable Diseases

The health sector set a target of developing a drug master plan known as “mini drug master plan”.

In keeping with the target for 2010/11, the Health Sector Mini Drug Master Plan was adopted by the National Health Council in March 2011.

Effective implementation of this plan across the country will contribute significantly to curbing drug abuse.

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Improving Maternal and Child Health

29,9% of mothers and 27% of babies were reviewed within six post-partum days, which was lower than the 2010/11 target of 40%. This was also lower than the 30% achieved in 2009/10.

81% of maternity facilities conducted perinatal review meetings, against a target of 100%. Personnel shortages and inadequate clinical facilitation skills contributed to this.

61% of Primary care facilities had providers trained in the Integrated Management of Childhood Illnesses (IMCI), which was lower than the set target of 75%, as well as the actual performance of 74% during 2009/10. This was due to health worker migration due to OSD, and migration towards provide paediatric ART services.

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Improving Maternal and Women’s Health

The re-engineered Primary Health Care (PHC) model approved by the NHC in 2011 will assist in addressing these challenges – with its three streams of ward based PHC outreach Teams; Clinical Specialists Teams and strengthening of School Health Services.

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Delays in procurement processes resulted affected the distribution of both male and female condoms in 2010/11.

Although access to ART was expanded to 418,677 people living with HIV&AIDS in 2010/11 (318,612 adults and 37,065 children), these figures were lower than the set targets of placing 400,000 new adult patients and 40,000 new child patients on ART.

The public sector strike of 2010 impacted initiating patients on ART – every effort however was made to ensure that those already was treatment experienced no interruption of treatment.

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A total of 74% of TB patients completed their treatment during the reporting period. The 2010/11 target was 80%. Due to migration, some patients were lost to follow-up.

55,8% of health facilities had a turn-around time of not more than 48 hours for laboratory specimen. The introduction of the new technology, the Gene-Xpert machines, will improve the turn-around times.

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A total of 69% of HIV positive MDR patients were initiated on ART, against a 2010/11 target of 100%. Although this was lower than the set target, it reflected improvement from the 55% recorded in 2009/10.

A total of 84% of HIV positive XDR patients were initiated on ART, against a 2010/11 target of 100%.

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Combating Non-Communicable Diseases

To monitor the quality of treatment of diabetes a new register was piloted in 2010/11 - the Chronic Diseases Management Register (CDMR). However an audit of its implementation reflected challenges such as poor use, analysis and follow-up.

A Cataract Surgery Rate (CSR) of 1,061 operations per 1 million population was achieved, against a 2010/11 target of 1,500 operations per 1 million population.

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Forensic Laboratory Services

The National DoH manages Chemistry Laboratories (FCL) located in Pretoria, Johannesburg and Cape Town, which are divided into three primary sections – toxicology section to provide analytical support to forensic pathologists and other clients in cases involving toxic substances, blood alcohol section to provide scientific evidence in support of drunken driving prosecutions and to establish cause of death and food section to analyse food samples to control compliance with legislation.

Decreasing the turn-around times for Blood Alcohol, Toxicology and Food Specimen proved to be a key challenge during the reporting period.

Turn around times were inconsistent with the set targets for 2010/11 in the three laboratories.

The challenges resulted from factors such as lack of staff and the refurbishment of the Johannesburg lab. 32

8.3. Programme 3: Health Planning and Monitoring

Programme 3 conducts health systems planning, and monitors health service delivery and coordinates health research programmes.

The work of this programme is consistent with Priorities 3&4 in the 10 Point Plan for 2009-2014 & Output 4 in the NSDA 2010-2014.

8.3.1. Achievements

Enhancing Health Information; Epidemiology and Surveillance

As required, the South Africa’s 2008-2010 Report was compiled and submitted to the United Nations General Assembly Special Session on HIV and AIDS.

The Annual Antenatal (ANC) HIV and Syphilis Sentinel Survey for 2009 was launched in November 2010. Data collection for the ANC HIV and Syphilis Sentinel Survey for 2010 was also completed during 2010/11. 33


8.3.1. Achievements

Enhancing Health Information; Epidemiology and Surveillance

A web-based disease notification surveillance system was developed and used during the FIFA 2010 World Cup held in RSA. The system served as a back-up for early warning systems at all FIFA dedicated hospitals, private hospital groups; airports; harbours; public viewing areas and 10 stadia.

Improving Quality of Care

The National Health Amendment Bill, was gazetted in January 2011 for public comment.

The Bill aims to improve the quality of healthcare through compliance with national mandatory standards and the independent investigation of complaints.

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8.3.1. Achievements

Introduction of National Health Insurance

The draft NHI policy (issued as a Green Paper) was tabled before Cabinet during the reporting period.Cabinet approved both the draft NHI policy and the establishment of the NHI fund.

Reliable Supply of Safe and Affordable Medicines

A 2,6% stock-out of the total number of Antiretroviral medicines on tender (45) measured in 9 provinces (405 items) was reported, which was consistent with the set target of <5%.

A 5% stock-outs out of the total number of TB medicines on tender (35) measured in 9 provinces (315), which was which was consistent with the set target of <5%.

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The following key activities did not place during place during the reporting period:

Accreditation of facilities;

External audits of health facilities

Establishment of the Ombuds Office

These will take place once the legislative framework has been completed.

NHI fund was not established during the reporting period – approval was however, obtained from Cabinet for this.

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8.4. Programme 4: Human Resource Development and Management

Programme 4 plans and coordinates Human Resources for the Health sector.

The work of this programme is consistent with Priority 5 in the 10 Point Plan for 2009-2014 & Output 4 in the NSDA 2010-2014.

8.4.1. Achievements

In keeping with the 2010/11 target, a draft Workforce Strategy was compiled and presented to the Technical Advisory Committee of the National Health Council (and to the NHC).

A total of 183 clinical associates were enrolled within the degree programme, which exceeded the 2010/11 target of 125. Two Universities increased their annual intake of students for 2010 resulting in the increase of 58 students in the programme.

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8.4.1. Achievements

Two OSD agreements were signed during 2010/11 namely:

PHSDSBC Resolution 1 of 2010: Agreement on the Addendum to PHSDSBC Resolution 3 of 2009: Implementation of an OSD for Doctors, Medical Specialists, Dentists, Dental Specialists, Pharmacists, Pharmacologists and Emergency Care Personnel;

PHSDSBC Resolution 2 of 2010: Agreement on the OSD for Therapeutic, Diagnostic and Allied Health Professionals.

This was consistent with the 2010/11 target.

National Implementation workshops were held with Provincial DoHs and the trade unions in the PHSDSBC in preparation for implementation of the agreements.

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A total of 143/400 hospital managers were enrolled for a hospital management, training programme. The intake of students was reduced by both the Universities of KwaZulu-Natal and WITS to address the research backlog and throughput.

No progress was made with the Management and Leadership Feasibility Study for the Management and Leadership Academy, which was planned to be completed by March 2011.

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8.5. Programme 5: Health Service Delivery

Programme 5 supports the delivery of health services in provinces including primary health care, hospitals, emergency medical services and occupational health.

The work of this programme is consistent with Priorities 3,4,7&8 in the 10 Point Plan for 2009-2014 & Output 4 in the NSDA 2010-2014.

8.5.1. Achievements

A revised and updated Primary Health Care (PHC) package was produced, with technical support from the University of the Witwatersrand, to guide service delivery at primary care level.

A re-engineered PHC model was also produced and approved by the NHC. The new PHC model places greater emphasis on both the individual and the family, and focuses on promotion and prevention, rehabilitative and referral services, rather than exclusively on curative services.

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8.5.1. Achievements

Construction of 4 hospitals commenced during the reporting period namely:

Cecilia Makiwane (EC);Ladybrand (FS);Trompsburg (FS) and De Aar (NC).

Feasibility studies were undertaken for 2/5 Flagship Tertiary Hospitals, Chris Hani Baragwanath (GP) and Limpopo Academic Hospital (LP).

Appointment process of transactional advisors was finalised for 3/5 Flagship Tertiary Hospitals namely: Nelson Mandela Academic (EC); Dr. G. Mukhari (GP) and King Edward VIII (KZN).

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8.5.1. Achievements

All nine provinces appointed Technical Assistants through the Integrated Delivery of Infrastructure Programme (IDIP) of National Treasury.

The National DoH and 3/9 Provinces (EC;KZN & WC) appointed engineers to strengthen internal capacity, with the aim of improving the delivery of integrated health infrastructure. Amongst others, this will assist in:

ensuring cost-effectiveness in awarding contracts for the construction of health facilities; fast-tracking the completion of health facilities; improving the quality of health facilities completed

Health technology regulations were drafted

A draft Health Technology Assessment Strategy was also produced.

Health Technology Committees were created to guide Health Technology Planning at sub-national levels.

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With respect to the functioning of the District Health System (DHS) not all targets were completely reached.

District Management Teams (DMTs) were established in 40/52 districts across Provinces.

Of the 40 DMTs established, 32 had written HR delegations; 11 had financial management delegations; and 7 had Supply Chain Management delegations. The target for 2010/11 was 52 districts.

District Health Councils (DHCs) were established in 32/52 districts.

PHC facility committees were established in 43/52 districts.

A PHC facility supervision rate of 68,4% was recorded, against a target of 80%.

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For various reasons, delays occurred in the approval of business cases for the following hospitals:

Dr. P. ka Seme and Edendale Hospitals (KZN);

Musina Hospital (LP);

Bophelong Psychiatric Hospital (NW);

Valkenburg Psychiatric Hospital (WC);

Tygerberg Tertiary Hospital (WC)

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8.6. Programme 6: International Relations; Health Trade and Health Product Regulation

Programme 6 coordinates bilateral and multilateral international health relations including donor support. It also regulates the procurement of medicines and pharmaceutical supplies and provides oversight of trade in health products.

The work of this programme is consistent with Priority 1 in the 10 Point Plan for 2009-2014 & Output 4 in the NSDA 2010-2014.

8.6.1. Achievements

During 2010/11, the Department continued to contribute towards post conflict reconstruction & development of health systems in Rwanda and Sierra Leone.

32 Cuban health care workers were recruited and started working in Rwanda.

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8.6.1. Achievements

In keeping with the set target, 80 South African students were recruited and retained in the SA-Cuba programme.

6 cross-border initiatives were implemented to manage communicable diseases along border areas. These focused mostly on malaria and HIV&AIDS, and included the Lubombo Spatial Development Initiative (LSDI) and the Mozambique-Zimbabwe-SA (MOZIZA) cross-border malaria initiative. This exceeded the 2010/11 target of 2 initiatives.

7 agreements were signed with international development partners to mobilise resources (technical and financial assistance) to RSA. This was consistent with the set target for 2010/11.

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No health care workers were recruited to work in Sierra Leone. Delays occurred in the finalization of the MOU between Cuba and Sierra Leone on recruitment of Cuban doctors, as well as in the signing off for the transfer of funds to Sierra Leone for the implementation of the Trilateral Project.

With regard to the registration of medicines, the National DoH set itself targets of 24 months for Non-Chemical Entities (NCE) and 18 months for generics. The Department also aimed to eliminate the backlog of safety updates. However, during the reporting period, the average time for the registration of medicines was 32 months for NCEs and 30 months for Generics.

This resulted from: (i) delays by the applicants in responding to the resolutions of the Medicines Control Council; and (ii) shortage of evaluators.

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9. BACKGROUND TO THE NATIONAL DOH BUDGET AND EXPENDITURE

The final appropriation for the National Department of Health for the year 2010/11 was R21,6 billion. The budget increased by R3,2 billion from 2009/10.The Conditional Grant allocation is 92% of the total allocation for Vote 14. This is an increase of 1% from 2009/10 which was at R18,4 billion.Of the R21,6 billion appropriated, an amount of R19,892 billion was for the provision for five Conditional Grants, of which R19,440 billion was transferred to Provinces and R18,867 billion spent, as per disclosure note 31 of the Annual Financial Statements.Actual total expenditure for 2010/11 amounted to R20,9 billion which is 96.6% of the appropriated amount.Under expenditure amounted to R743 million which is 3.4% of the total appropriated. This is the same percentage of under expenditure for the previous financial year.The Conditional Grants under expenditure makes up 84% of the total under expenditure.

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A SUMMARY OF THE ECONOMIC CLASSIFICATION VARIANCE ON THE BUDGET AND EXPENDITURE

The Under Expenditure on Compensation of Employees (COE) was influenced mainly by a long recruitment process which commenced in September 2010 after the lifting of the moratorium on filling of posts. The amount involved is R30,7 million.

Some of the Goods and Services which were committed late during the financial year could not be delivered before year end. There was a delay with the procurement of condoms, through a tender managed by National Treasury. The under spending was R181,418 million while an amount of R213 million was committed over a period of more than twelve months.

Under expenditure for Transfer Payments included an amount of R452,5 million for the Revitalization grant which had to be withheld due to non spending by Provinces.

Capital expenditure under expenditure amounting to R27 million was due to delays in the procurement processes.

Facilities audit: completion rate as at end September 2011

Prov Hosp CHC Clinic Prov Total Tot Fac % Comp.EC 29 10 242 281 880 47%FS 16 6 136 158 312 72%GP 16 17 132 165 453 47%KZN 23 2 247 272 662 57%LP 14 7 166 187 504 51%MP 16 20 104 140 338 55%NW 11 28 140 179 387 61%NC 23 35 157 215 235 99%WC 13 6 59 78 439 22%

Total 161 131 1383 1675 4210 53%

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Facilities audit: completion datesProvince and Start date

Provincial Total

Completed Sept 2011

Estimate Completion date

EC 13/6 880 412 April 2012

FS 13/6 316 226 Nov 2011

GP 20/6 453 215 Dec 2011

KZN 20/6 662 380 Feb 2012

LP 27/6 504 259 Dec 2011

MP 27/6 38 185 Dec 2011

NC 3/5 235 215 Sept 2011

NW 20/6 387 236 Nov 2011

WC 20/7 435 96 April 2012Page 51

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NATIONAL DOH APPROPRIATION INCLUDING CONDITIONAL GRANTS

ProgNumber Programmes

Final AppropriationR’000

Actual Expenditure by 31 March 2011 R’000

Variance R’000

Actual Expenditure as %

1 Administration 282,134

260,272

21,862 92.3%

2Strategic Health Programmes

7,393,626 7,232,905

160,721 97.8%

3 Health Planning & Monitoring 422,636

391,347

31,289 92.6%

4

Human Resource Management & Development

1,897,551 1,883,283

14,268 99.2%

5 Health Services 11,557,057 11,072,393

484,664 95.8%

6

International Relations, Health Trade & Production Regulation

108,508 78,379

30,129 72,2%

Total 21,661,512 20,918,579

742,933 96.6%

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SUMMARISED REASONS PER PROGRAMME FOR UNDERSPENDING INCLUDING CONDITIONAL GRANTS

PROGRAM 1: ADMINISTRATION

The programme shows an under expenditure of R21,8 million (7.7%) against a budget of R282 million. The under expenditure has increased by 6% from 2009/10.

The under spending is related to vacancies as well as late commitment of roll over funds for Capital expenditure for IT equipment.

Recruitment processes are underway to ensure full utilization of funds and the delivery of IT equipment has been done and continuing.

SUMMARISED REASONS PER PROGRAMME FORUNDERSPENDING INCLUDING CONDITIONAL

GRANTS

PROGRAM 2: STRATEGIC HEALTH PROGRAMMES

The programme shows an under expenditure of R 160,7 million (2,2%) against a budget of R7,4 billion. The funding for the programme increased by R1,6 billion from 2009/10 and the under expenditure increased by 2% from 2009/10.The under spending can mainly be ascribed to the delayed finalization of the condom tender by National Treasury as well as delayed transfers to some NGOs due to non compliance with the PFMA and alignment with the new Departmental priorities.Late commitment for capital expenditure for Forensic Chemistry Laboratories equipment resulted in under expenditure.

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SUMMARISED REASONS PER PROGRAMME FOR UNDERSPENDING INCLUDING CONDITIONAL

GRANTS

PROGRAM 3: HEALTH PLANNING AND MONITORING

The programme shows an under spend of R 31,2 million (7.4%) against a budget of R422,6 million. This is an increase from 5% for 2009/10.

The under spending was attributed to vacancies. The recruitment processes could not be concluded before year end.

Commitments made for Goods and Services as well as Capital Expenditure will be paid in the new financial year.

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GRANTS

PROGRAM 4: HUMAN RESOURCES AND MANAGEMENT DEVELOPMENT

The programme reflects an under spending of R14,2 million (0.8%) against a budget of R1,897 billion. The funding for the programme increased by R97 million. The under expenditure for 2009/10 was 0.04%The under spending is ascribed to the high vacancy rate within the programme, which resulted in low expenditure for Compensation of Employees and the related goods and services.

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GRANTS

PROGRAM 5: HEALTH SERVICES

The programme has spent 95.6% of its allocated funds amounting to R11 billion which resulted in an under expenditure of 4% amounting to R484,6 million.The under expenditure was due to delays in commencing the national facilities audit. The project has started and expenditure is being incurred in 2011/12.Also contributing is the withholding of Hospital Revitalization Conditional Grants for some Provinces due to delays with construction processes of approved projects and inadequate monitoring of projects at provincial and construction level.The expenditure pattern for the grant has remained constant in terms of percentage, however, in monetary terms have increased by R1 billion.

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GRANTS

PROGRAM 6: INTERNATIONAL RELATIONS, HEALTH TRADE AND HEALTH PRODUCTS REGULATION.

The programme has spent 72.2% of its allocated funds amounting to R78 million with an under spending of R30 million (7,8%).Under spending was due to vacancy rate which resulted in under expenditure for Compensation of Employees as well as related Goods and Services. Also, the Department of International Corporations and Relations did not submit the relevant claims for expenditure incurred by health officials for international travel before year end.

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PROVINCIAL CONDITIONAL GRANTS EXPENDITURE AS AT 31 MARCH 2011

Prog GrantsBudget

R'000

Funds Withheld R'000

Total available R'000

Amount Spent R'000

(Over)

R'000

Under

R'000

% (Over)/Under

of Tot Available

2 HIV and Aids

6,051,757

-

6,051,757

5,981,418

-

70,339 99%

2

Forensic Pathology Services

557,462

-

557,462

494,561

-

62,901 89%

4

Health Professional Training & Development

1,865,387

-

1,865,387

1,864,482

-

905 100%

5

National Tertiary Services

7,398,000

7,398,000

7,388,570

-

9,430 100%

5Hospital Revitalization

4,020,667

452,864

3,567,803

3,138,682

-

881,985 88%

Total 19,893,273

452,864 19,440,409

18,867,713 1,025,560 97%

60

CONDITIONAL GRANT: COMPREHENSIVE: HIV AND AIDS (PROGRAMME 2)

Provinces Total available

R'000

Amount Spent R'000

(Over) R'000

Under R'000

% (Over)/Under of

Total Available

Eastern Cape 691,940 691,940 - - 100%

Free State 437,583 388,329 - 49,254 89%

Gauteng 1,281,683 1,281,683 - - 100%

KwaZulu-Natal 1,518,811 1,500,926 - 17,885 99%

Limpopo 515,896 515,592 - 304 100%

Mpumalanga 387,646 387,646 - - 100%

Northern Cape 186,306 183,493 - 2,813 98%

North West 476,838 476,838 - - 100%

Western Cape 555,054 554,971 - 83 100%

TOTAL 6,051,757 5,981,418 70,339 99%

61

CONDITIONAL GRANT : FORENSIC PATHOLOGY SERVICES (PROGRAMME 2)


R'000

Amount Spent R'000

(Over) R'000

Under R'000

% (Over)/Under

of Total

Available

Eastern Cape 69,345 63,070 - 6,275 91%

Free State 37,218 30,738 - 6,480 83%

Gauteng 92,921 50,772 - 42,149 55%

KwaZulu-Natal 152,406 152,406 - - 100%

Limpopo 39,913 38,744 - 1,169 97%

Mpumalanga 50,107 46,016 - 4,091 92%

Northern Cape 22,868 20,131 - 2,737 88%

North West 26,433 26,433 - - 100%

Western Cape 66,251 66,251 - - 100%

TOTAL 557,462 494,561 62,901 89%

62

CONDITIONAL GRANT : HEALTH PROFESSIONS AND DEVELOPMENT (PROGRAMME 4)


R'000

Amount Spent R'000

(Over)

R'000

Under

R'000

% (Over)/Under of Total Available

Eastern Cape 160,444 160,444 - - 100%

Free State 117,400 117,400 - - 100%

Gauteng 651,701 651,701 - - 100%

KwaZulu-Natal 235,771 235,771 - - 100%

Limpopo 94,085 93,180 - 905 99%

Mpumalanga 76,149 76,149 - - 100%

Northern Cape 61,802 61,802 - - 100%

North West 83,324 83,324 - - 100%

Western Cape 384,711 384,711 - - 100%

TOTAL 1,865,387 1,864,482 905 100%

63

CONDITIONAL GRANT : HOSPITAL REVITALIZATION (PROGRAMME 5)

Provinces Budget

R'000

Funds Withheld

R'000

Total available

R'000

Amount Spent R'000

(Over)

R'000

Under

R'000

(Over)/Under of Total Available

Eastern Cape 360,660

48,669

311,991 168,610

-

192,050 54%

Free State 378,426

45,893

332,533 244,634

-

133,792 74%

Gauteng 798,609

72,600

726,009 726,009

-

72,600 100%

KwaZulu-Natal 500,815

111,250

389,565 297,570

-

203,245 76%

Limpopo 323,425

49,469

273,956 234,309

-

89,116 86%

Mpumalanga 331,657

-

331,657 298,753

-

32,904 90%

Northern Cape 420,218

124,983

295,235 261,940

-

158,278 89%

North West 326,303

-

326,303 326,303

-

- 100%

Western Cape 580,554

-

580,554 580,554

-

- 100%

TOTAL 4,020,667

452,864

3,567,803 3,138,682

-

881,985 78%

64

CONDITIONAL GRANT : NATIONAL TERTIARY SERVICES (PROGRAMME 5)


R'000

Amount Spent R'000

(Over)

R'000

Under

R'000

% (Over)/Under of

Total Available

Eastern Cape 557,137 557,137

- - 100%

Free State 659,469 659,469

- - 100%

Gauteng 2,561,154 2,561,009

- 145 100%

KwaZulu-Natal 1,102,585 1,102,517

- 68 100%

Limpopo 257,314 255,565

- 1,749 99%

Mpumalanga 91,879 90,769

- 1,110 99%

Northern Cape 225,948 219,651

- 6,297 97%

North West 179,280 179,219

- 61 100%

Western Cape 1,763,234 1,763,234

- - 100%

TOTAL 7,398,000 7,388,570

- 9,430 100%

65

TRADING ENTITIES AND PUBLIC ENTITIES

Medical Research Council :

The Medical Research Council (MRC) undertakes scientific research on clinical and health systems issues.

Funding from the Department’s vote amounts to R 276,5 million in 2010/11.

There is close co-operation with the Department of Health in setting research priorities.

66


National Health Laboratory ServicesThe National Health Laboratory Service Act, Act No 37 of 2000 came into operation in May 2001.

The National Health Laboratory Service’s major source of funding will be the sale of analytical laboratory services to users such as Provincial Departments of Health, but it continues to receive a transfer from the National Department, which amounted to R124,91 million in 2010/11.

The adjusted amount of R47,2 million was for the funding of the GeneXpert TB medical equipment project.

67


Medical Schemes Council

The Medical Schemes Council regulates the Private medical scheme industry in terms of the Medical Schemes Act (131 of 1998), and is funded mainly through levies on the industry in terms of the Council for Medical Schemes Levies Act (58 of 2000).

During 2010/11 the Department transferred R3,993 million to the Council.

68


South African National Aids Council Trust (SANACT)

During the period under review the SANAT was dormant. SANAC itself operated as planned with its activities funded by the HIV and AIDS Cluster within the National Department of Health.

69


Mines and Works Compensation Fund

The Compensation Commissioner for Occupational Diseases is responsible for the payment of benefits to miners and ex-miners who have been certified to be suffering from lung-related diseases because of working conditions.

The Mines and Works Compensation Fund derives funding from levies (Mine Account, Works Account, Research Account, State Account) collected from controlled mines and works, as well as appropriations from Parliament.

Payments to beneficiaries are made in terms of the Occupational Diseases in Mines and Works Act (78 of 1973). The value of the fund for the CCOD amounts to R1,1 billion while the Department’s transfer payment amounting to R2,620 million for the year under review.

The entire financial system of the Compensation Commissioner for Occupational Diseases is being re-engineered.

ANNUAL FINANCIAL STATEMENTS

The Department received a Qualified Audit opinion.The main reason for the opinion is related to the Asset Register with regard to the valuation of assets.Matters of Emphasis on the following:– Restatement of comparative figures for the operating lease

expenditure for Buildings and other structures.– Irregular expenditure of R43 million, of which R30 million was

for the supply chain process undertaken for the Expenditure incurred for local and overseas travel, conferencing, accommodation

Predetermined objectives:– Reliability of reported performance information

70

71

ANNUAL FINANCIAL STATEMENTS: REMEDIAL ACTION

The Asset Management project is currently 95% complete to correct the Asset Register findings and will be completed by December 2011 and ready for an interim audit by AGSA in January 2012. The Irregular Expenditure is being addressed. The matter related to the process followed for the travel, conferencing and accommodation has already been referred to National Treasury for consideration of condonment.The issues related to the Predetermined objectives will be addressed in a planned workshop with all critical parties (AGSA, OAG, Health)

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10. Conclusion

Major progress was made in certain key priority areas of the Strategic Plan of the National DoH for 2010/11-2012/12

There were also problem areas that were experienced during the reporting period that affected some areas of service delivery

The DoH will address the challenges encountered during the 2011/12 planning and implementation cycle, and beyond.

Focus of the Department will also be on accelerating progress towards the three sets of mandates:

Health related MDGs10 Point Plan for 2009-2014NSDA 2010-2014.

Documents

PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S ANNUAL REPORT FOR 2010/11