Annual Performance Plan 201718 201920 Presentation to the

Annual Performance Plan 2017/18 – 2019/20 Presentation to the Select Committee on Social Services 30 May 2017

VISION Outcome 2: Long and healthy life for all South Africans MISSION To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability. 2

2017/18 – 2019/20 MTEF PRIORITIES The priorities for the MTEF commencing 2017/18 year are derived from: Sustainable Development Goals 3

Legislation and Prescripts that regulate Health Sector planning Pubic Finance Management Act, 1999 – Treasury Regulations – Chapter 5 of 2007 – Framework for Strategic Plans and Annual Performance Plans, 2010 National Health Act, 2003 – Section 21(4) - “the national health plans must comply with national health policy. – Section 21(5) - “The Director-General must integrate the health plans of the national department and provincial departments annually and submit the integrated health plans to the National Health Council”. – Section 33(1) - “Each district and metropolitan health manager must within the national budget cycle develop … a district health plan drawn up in accordance with national guidelines issued by the Director-General…” – Section 23(2) - “The National Health Council may determine the time frames, guidelines and the format for the preparation of national and provincial health plans. 4

Alignment between National <-> Provincial <-> District Plans National Health Act 2003, Section 23(2) - The National Health Council may determine the time frames, guidelines and the format for the preparation of national and provincial health plans National Health Act 2003, Section 33(1) - “Each district and metropolitan health manager must within the national budget cycle develop … a district health plan drawn up in accordance with national guidelines issued by the Director-General…” 5

Outcome 2 : A long and Healthy lives for all South Africans Gains 2009 -2014 a) An increase in overall life expectancy from 57. 1 years in 2009 to 63. 3 years in 2015. b) A decrease in the Under-5 mortality rate (U 5 MR) from 56 deaths per 1 000 live births in 2009, to 37 deaths per 1 000 live births in 2015. c) A decrease in the Infant Mortality Rate (IMR) from 39 deaths per 1 000 live births in 2009, to 27 deaths per 1 000 live births in 2015. d) A decrease in mother-to-child transmission (MTCT) of HIV from 8. 5% in 2008, to 3. 5% in 2010 and to 1. 5% in 2015. e) An increase in the number of people initiated on antiretroviral therapy (ART) has increased nearly threefold (1. 4 m in 2011 to 3. 7 m in 2016) in the past 5 years f) A decrease in the total number of people dying from AIDS. Percentage of AIDS deaths reduced from 41. 9% (2009) to 27. 9% (2016). g) TB Treatment Success Rate increased from 74% in 2009 to 84% in 2015. 6

Outcome 2 : A long and Healthy lives for all South Africans Impact Indicators: Baselines and Impact Baseline Targets. Current 1 Targets Indicator (2009) Performance (2019) Life expectancy at birth: Total Life expectancy at birth: Male Life expectancy at birth: Female 56. 5 years 63. 3 years 65 years 54. 0 years 60. 0 years 61. 5 years 59. 0 years 65. 8 years 67 years Under-5 Mortality Rate 56 Under 5 deaths per 37 Under 5 deaths 1, 000 live-births per 1, 000 live-births 33 Under 5 deaths per 1, 000 live-births Neonatal Mortality Rate 14 neonatal deaths per 1000 live births 11 neonatal deaths per 1000 live births 8 neonate deaths per 1000 live births Infant Mortality Rate (IMR) 39 per 1, 000 live-births 27 infant deaths per 1, 000 live-births 23 infant deaths per 1000 live births (15% decrease) Maternal Mortality Ratio 304 per 100, 000 livebirths 154 /100 000 live births (2014) <100 maternal deaths per 100, 000 live-births Targets (2030) 70 years (NDP) 30 Under 5 deaths per 1, 000 live-births (NDP) 20 infant deaths per thousand live births (NDP) 1. Rapid Mortality Surveillance (RMS) Report 2015, (Published by MRC during December 2016)

PROGRAMME 1 - ADMINISTRATION The purpose of the Administration Programme is to provide support services to the National Department of Health. These include: Human Resources Development and Management, Labour Relations Services, Information Communication Technology Services, Property Management Services, Security Services, Legal Services, Supply Chain Management and Financial Management Services 8

Programme 1 Strategic Objective Performance Indicator Ensure effective financial management and accountability by improving audit outcomes Audit opinion from Auditor General Ensure efficient and responsive Human Resource Services to the National Department of Health Percentage of Employees accessing the Health and wellness programmes Number of Provincial Do. H that demonstrate improvements in Audit Outcomes or Opinions Estimated performance 2016/17 Unqualified Audit opinion 2017/18 Medium-term targets 2018/19 Unqualified audit opinion with no significant matters for 2016/17 4 Provincial Do. H that 5 Provincial Do. H demonstrate that demonstrate improvements in Audit 30% of NDo. H employees Clean Audit opinion for the NDOH for 2017/18 7 Provincial Do. H that demonstrate improvements in Audit 35% (of 1504 NDo. H 40% (of 1520 employees) NDo. H employees) 2019/20 Clean Audit Opinion for the NDOH for 2018/19 9 Provincial Do. H that demonstrate improvements in Audit 45% of National Do. H employees 9

Programme 1 Strategic Objective Coordinate the development and implementation of the Departmental Business Continuity Plan by the 31 st of March 2020 Provide support for effective communication by developing an integrated communication strategy and implementation plan Performance Indicator Departmental Business Continuity Plan (BCP) developed. Number of communication interventions implemented Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Phase 1 of the BCP developed and disseminated Self-assessment as per ISO 22300 conducted, and short term corrective action plan implemented 52 Communication interventions implemented 56 Communication interventions implemented Pre-certification assessment as per ISO 22300 conducted, and medium term corrective actions implemented 60 Communication interventions implemented 2019/20 Certified and compliant with ISO 22300 62 Communication interventions implemented 10

Programme 1 Programme Performance Indicator NDo. H vacancy rate Estimated performance 2016/17 <10 % Percentage of Senior 98% Managers that have entered into Performance agreements with their supervisors 2017/18 Medium-term targets 2018/19 10 % 10% 100% 2019/20 11

PROGRAMME 2 - NATIONAL HEALTH INSURANCE, HEALTH PLANNING AND SYSTEMS ENABLEMENT The purpose of National Health Insurance, Health Planning And Systems Enablement Programme is to improve access to quality health services through the development and implementation of policies to achieve universal health coverage, health financing reform, integrated health systems planning, monitoring and evaluation, and research. 12

Programme 2 Strategic Objective Achieve Universal Health Coverage through the phased implementation of the National Health Insurance(NHI) Establish a national stock management surveillance centre to improve medicine availability Performance Indicator Estimated performance 2016/17 White Paper on NHI Review public comments and revise and publish final White Paper on NHI Legislation for NHI Bill conceptualised Establishment of the National Health Insurance Funding Modality for the National Health Insurance Fund including budget reallocation for the primary health care updated 3200 of health facilities reporting stock availability at national surveillance centre Total number of health facilities reporting stock availability at national surveillance centre 2017/18 Medium-term targets 2018/19 2019/20 Final White Paper on NHI finalised and gazetted as a policy document. Draft NHI Bill gazetted for public comments Not Applicable Revised NHI Bill submitted to Parliament NHI Bill approved by the National Assembly and National Council of Provinces. Funding Modality for the budget allocation to the primary health care (PHC) facilities developed Service providers accreditation and contracting mechanisms developed 3300 of health facilities reporting stock availability at national surveillance centre 3400 of health facilities reporting stock availability at national surveillance centre Functional NHI fund – purchasing services on behalf of the population from accredited and contracted providers 3450 of health facilities reporting stock availability at national surveillance centre 13

Programme 2 Strategic Objective Improve contracting and supply of medicines Implement the Strategy to address antimicrobial resistance (AMR) Performance Indicator Number of Provincial Medicine Procurement Unit (PMPU) for the management of direct delivery of medicines established Number of patients enrolled for receiving medicines through the centralised chronic medicine dispensing & distribution (CCMDD) system National antimicrobial resistance(AMR) strategy Implemented Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 2 PMPUs 2 x PMPUs established (Northestablished West and KZN Do. H). (Mpumalanga and Northern Cape Do. H) All PMPUs monitored Control towers have been implemented in 8 Provincial Do. H 1, 100, 000 patients enrolled for receiving medicines through the CCMDD system 1, 500, 000 patients enrolled for receiving medicines through the CCMDD system 1, 700, 000 patients enrolled for receiving medicines through the CCMDD system 2, 000 patients enrolled for receiving medicines through the CCMDD system Antimicrobial stewardship guideline as identified in the antimicrobial resistance strategy developed Surveillance system for monitoring resistance developed Surveillance system monitoring resistance developed and piloted for implementation Surveillance system monitoring resistance implemented 14

Programme 2 Strategic Objective Performance Indicator Estimated performance 2016/17 Regulate Traditional Health Practice in South Africa Traditional Health Practitioners (THP) Act New Indicator Strengthen Revenue collection by incentivising hospitals to maximise revenue generation. Implement e. Health Strategy of South Africa through the development of the system design of patient information systems A Revenue Retention Model (RRM) developed and implemented A discussion paper on revenue retention models developed and approved A complete System design for a National Integrated Patient based information system Health Normative Standards Framework (HNSF) Implementation protocol developed for Basic Health Information Exchange (HIE) for piloting integration with sub national systems 1 450 PHC Facilities implementing the web based health Patient Registration System Number of PHC health facilities implementing improved patient administration and web based information systems Medium-term targets 2017/18 2018/19 Amendment Bill of the Traditional Health Practitioners (THP) Act drafted Discussion paper on revenue retention models presented at the Health sector’s 10 x 10 with Treasury Integrated System architecture for a National Integrated Patient Based Information System developed 2 450 PHC Facilities implementing the web based health Patient Registration System 2019/20 Traditional Health Practitioners Act gazetted for public comments All 9 Provinces implementing the Revenue Retention Model Traditional Health Practitioners Act Promulgated and Implemented Revenue retention model evaluated for effectiveness Phase 1 of System Technology, and Data architectures integrated for a National Integrated Patient Based Information System implemented 3000 PHC Facilities implementing the web based health Patient Registration System Architecture fully developed and patient registry implemented through the development of Health Information Exchange, 3656 PHC Facilities implementing the web based health Patient Registration System 15

Programme 2 Strategic Objective Develop and Implement a national research strategic plan Develop and implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy Performance Indicator Estimated performance 2016/17 2017/18 National health research plan implemented Costed National Health Research implementation plan approved; Priority Health Research study trends monitored and report produced South African Demographic and Health Survey (SADHS) 2016 conducted 2016 SADHS data collection completed SADHS 2016 key indicator report published Integrated Monitoring and Evaluation plan developed Draft Monitoring framework for NHI developed NHI Phase 1 evaluation conducted Medium-term targets 2018/19 Priority Health Research knowledge generated to inform future research and interventions 2016 SADHS detailed report published and disseminated to inform planning and interventions Evidence available to inform expansion in NHI implementation 2019/20 National Health Research priorities funded None Integrated monitoring and evaluation system providing evidence for planning and performance management. 16

Programme 2 Strategic Objective Domestication of international Treaties and Implementation of multilateral cooperation on areas of mutual and measurable benefit Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 Number of International Treaties and Conventions implemented Three International Treaties implemented An audit on the progress of ratification of a treaty completed Three International Treaties and Conventions implemented Number of multilateral Frameworks and Strategies implemented Three Multilateral Frameworks implemented and reviewed Three Multilateral Frameworks and Strategies implemented Six strategic bilateral frameworks and projects implemented Review of all signed bilateral agreements completed and progress reports produced Six strategic bilateral frameworks and projects implemented Six strategic bilateral projects implemented Implementation of Number of Bilateral bilateral cooperation on frameworks and projects areas of mutual and implemented measurable benefit Three International Treaties and Conventions implemented And an audit on the progress of ratification of a treaty completed by 2016/17 Three Multilateral Frameworks and strategies implemented 17

Programme 2 Programme Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Single Exit Price Adjustments Published and Implemented Annually Central Repository for the funded and unfunded patients 2016/17 Annual Price Adjustments gazetted and published A repository containing information related to medical scheme members developed. 2017/18 Annual Price Adjustments gazetted and published Electronic interface piloted at 3 central hospitals to facilitate exchange of records 2018/19 Annual Price Adjustments gazetted and published Electronic Data Interchange (EDI) Switch operational A national electronic system to monitor supplier performance developed Performance reports of all contracted pharmaceutical suppliers produced on a quarterly basis 4 x Quarterly Performance reports of all contracted pharmaceutical suppliers produced A forum to promote transparency and multi-stakeholder engagement regarding medicine availability Forum established; Terms of Reference developed; Forum members appointed; One quarterly stakeholder meeting convened 4 x Quarterly meetings of the forum held 2019/20 Annual Price Adjustments gazetted and published A functional central Repository containing personal and demographic information of medical scheme members 4 x Quarterly Performance reports of all contracted pharmaceutical suppliers produced on a quarterly basis Quarterly meetings of the stakeholders held 18

Programme 2 Programme Performance Indicator Number of Provincial Annual Performance Plans (APPs) aligned to the National Health System Priorities Integrated Planning Framework for National Health System Estimated performance 2016/17 9 Provincial APPs reviewed and aligned to the National Health System Priorities Integrated Planning Framework for National Health System developed and presented to NHC 2017/18 Medium-term targets 2018/19 9 Provincial APPs reviewed and aligned to the National Health System Priorities Integrated Planning Framework approved by Tech NHC and piloted in 1 provincial Do. H to compile 2018/19 Plans 9 Provincial APPs reviewed aligned to the National Health System Priorities Integrated Planning Framework for National Health System implemented in all 9 Provincial Do. H 2019/20 9 Provincial APPs reviewed aligned to the National Health System Priorities Integrated Planning Framework for National Health System revised and implemented 19

Programme 2 Programme Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Patient Experience of care survey guidelines developed 9 Provincial Health Department trained on PEC Guideline National Survey to measure Patient Experience of Care A national survey to measure patient experience of care commenced National PEC Survey completed and report produced National Guideline to manage Complaints, Compliments and Suggestions for the Public Health Sector of South Africa Guideline to manage Complaints, Compliments and Suggestions for the Public Health Sector of developed and approved 9 Provincial Health Departments trained on Guideline to manage Complaints, Compliments and Suggestions National Guideline to manage Patient Safety Incidents in the Public Health Sector of South Africa developed and approved 9 Provincial Health Department trained on Guideline to manage Patient Safety Incidents 6 Provincial Health Departments implementing the PEC guideline Implementation of recommendations from patient experience of care survey report monitored 6 Provincial Health Departments implementing the Guideline to manage Complaints, Compliments and Suggestions 6 Provincial Health Departments implementing the Guideline to manage Patient Safety Incidents 2019/20 All 9 Provincial Health Departments implementing the PEC guideline Not Applicable All 9 Provincial Health Departments implementing the Guideline to manage Complaints, Compliments and Suggestions All 9 Provincial Health Departments implementing the Guideline to manage Patient Safety Incidents 20

PROGRAMME 3 - HIV / AIDS, TB AND MATERNAL AND CHILD HEALTH The purpose of HIV / AIDS, TB and Maternal And Child Health Programme is to develop and monitor implementation of national policies, guidelines, norms and standards, and targets for the national responses needed to decrease the burden of disease associated with burden of HIV and TB epidemics; to minimise maternal and child mortality and morbidity; and to optimise good health for children, adolescents and women; and monitor and evaluate the outcomes and impact of these. 21

Programme 3 Strategic Objective Performance Indicator To reduce maternal Maternal, Neonatal and neonatal morbidity Woman’s health programmes and mortality monitored using the standardised dashboard reports Eliminate Mother To Remedial Elimination of Child Transmission Mother To Child (EMTCT) in South Transmission (EMTCT) Africa plans developed and monitored of selected Districts To improve access to Cervical Cancer control Cervical and Breast Policy Cancer treatment in South Africa Breast Cancer Policy Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 4 x National Quarterly reports produced with recommendations Remedial plans developed with all Districts that have MTCT rates > 2% Remedial plans developed and monitored of all Districts that have MTCT rates > 1. 5% Remedial plans developed and monitored of Districts that have MTCT rates > 1% Cervical Cancer control Policy developed Guidelines for the Cervical Cancer Policy produced and 9 Provincial Do. H supported to develop Implementations plans Breast cancer policy developed Guidelines for Breast Cancer Policy produced and 9 Provincial Do. H supported to develop Implementations plans Remedial plans developed and monitored of Districts that have MTCT rates > 1. 25% 9 provincial DOH monitored against provincial plans and National Reports produced with recommendations Cervical Cancer control Policy reviewed Breast Cancer Policy and Guidelines reviewed 22

Programme 3 Strategic Objective Reduce under 5 mortality rate Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Monitor implementation of child health programmes using the standardised dashboard reports 4 x National Quarterly Monitoring dashboard reports produced with recommendations Number of Provincial Do. H with Remedial plans to reduce severe acute malnutrition. Maternal, Newborn, Child, Adolescent , Women’s Health (MNCAWH) and Nutrition Strategy 2017/182021/22 Road to Health Booklet (RTHB) revised Two (Mpumalanga Do. H and Free State Do. H) Two (Eastern Cape and North West Do. H) New Indicator MNCAWH and Nutrition Strategy 2017/18 -2021/22 approved New Indicator RTHB revised and Distributed to 52 District Offices and head offices of 9 Provincial Do. H for implementation 2019/20 4 x National Quarterly Monitoring dashboard reports produced with recommendations All Nine Provincial Do. H 4 x National Quarterly Monitoring dashboard reports produced with recommendations Monitor implementation of the MNCAWH and Nutrition Strategy 2017/18 -2012/22 RTHB Implemented at all Public health facilities; Midterm review of the MNCAWH and Nutrition Strategy 2017/18 -2021/22 conducted RTHB reviewed Nine Provincial Do. H remedial plans reviewed 23

Programme 3 Strategic Objective Reduce under 5 mortality rate Performance Indicator Estimated performance 2016/17 Surveillance system for Polio, Measles and Neonatal Tetanus reviewed New Indicator EPI Coverage Survey conducted New Indicator 2017/18 Medium-term targets 2018/19 Situational analysis conducted on the implementation of the current surveillance system in 9 provinces and Provincial Reports produced Revised surveillance system drafted and presented to Tech. NHC for approval EPI Coverage Survey conducted in 9 Provinces 9 Provincial implementation plans developed for implementing the approved surveillance system, and Provincial Do. H monitored against the implementation plans. EPI Coverage Survey report produced and Published 2019/20 Evaluation conducted of the revised surveillance system. Not Applicable 24

Programme 3 Strategic Objective Performance Indicator Estimated performance 2016/17 To improve access to adolescent and youth health services in South Africa Adolescent and Youth Health Policy (AYHP) New Indicator To implement combination of prevention and treatment interventions to reduce burden of HIV, STI and TB infections Number of Districts Implementation plans developed with support from NDo. H to reach 9090 -90 targets for TB and HIV Number of Districts Implementation plans for 2017/18 monitored to reach 90 -90 -90 targets for TB and HIV 52 DIPs developed with health districts for 2017/18 52 Districts Implementation Plans (DIPs) monitored and reports produced Medium-term targets 2017/18 2018/19 2019/20 Guidelines for AYHP produced and 9 Provincial Do. H supported to develop Implementation Plans. 52 DIPs for developed with health districts for 2018/19 9 Provincial Implementation Plans monitored Review of the Adolescent and Youth Health Policy Conducted 52 DIPs for developed with health districts for 2019/20 A national report produced to review progress towards 90 -90 -90 targets for HIV and TB 52 Districts Implementation Plans (DIPs) for 2017/18 monitored and feedback reports with recommendations produced 52 Districts Implementation Plans (DIPs) for 2018/19 monitored and feedback reports with recommendations produced 52 Districts Implementation Plans (DIPs) for 2019/20 monitored and feedback reports with recommendations produced 25

Programme 3 Strategic Objective To implement combination of prevention and treatment interventions to reduce burden of HIV, STI and TB infections Performance Indicator Estimated performance 2016/17 Medium-term targets 2017/18 2018/19 Dashboard reports for Monitoring implementation of the HIV and AIDS and STI Programmes 4 x National Quarterly monitoring dashboard reports produced with recommendations HIV and AIDS Conditional grant Reports 3 x Quarterly HIV and AIDS Conditional grant reports produced Annual HIV Conditional Grant Report for 2015/16 year produced 3 x Quarterly HIV and AIDS Conditional grant reports produced Annual HIV Conditional Grant Report for 2016/17 year produced HIV Strategic Plan Developed and monitored NSP for HIV/AIDS and HIV Strategic Plan TB 2017 -2022 outlining key actions published by SANAC and strategies for public health system developed and presented to Tech NHC for approval 4 x National Quarterly monitoring dashboard reports produced with recommendations 3 x Quarterly HIV and AIDS Conditional grant reports produced Annual HIV Conditional Grant Report for 2017/18 year produced HIV Strategic Plan monitored and feedback reports to 9 Provincial Do. H produced 2019/20 4 x National Quarterly monitoring dashboard reports produced with recommendations 3 x Quarterly HIV and AIDS Conditional grant reports produced Annual HIV Conditional Grant Report for 2017/18 year produced HIV Strategic Plan monitored and feedback reports to 9 Provincial Do. H produced 26

Programme 3 Strategic Objective Strengthen patient retention in treatment and care for TB Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 Number of MDR-TB treatment initiation facilities with clinical audits conducted New indicator 18 MDR-TB treatment initiation facilities Number of provinces with IPT/3 HP sentinel sites New indicator 3 provinces with IPT/3 HP sentinel sites 6 provinces with IPT/3 HP sentinel sites 9 provinces with IPT/3 HP sentinel sites Number of hospitals implementing FAST New indicator 15 hospitals implementing FAST 30 hospitals implementing FAST 50 hospitals implementing FAST Dashboard reports for Monitoring implementation of the TB Programmes 4 x National Quarterly monitoring dashboard reports produced with recommendations Number of facilities reviewed during provincial supervisory and support visits to track implementation of the TB Quality Improvement Programme New indicator 24 facilities reviewed during provincial supervisory and support visits 4 x National Quarterly monitoring dashboard reports produced with recommendations 24 facilities reviewed during provincial supervisory and support visits 27

PROGRAMME 4 - PRIMARY HEALTH CARE SERVICES (PHC) The purpose of Primary Health Care Service Programme is to develop and oversee the implementation of legislation, policies, systems, and norms and standards for a uniform well functioning district health system, environmental health services, communicable disease control, noncommunicable disease control as well as health promotion and nutrition programmes. 28

Programme 4 Strategic Objective Improve district governance and strengthen management and leadership of the district health system Improve access to community based PHC services Improve quality of services at primary health Care facilities Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Uniform structure for District Health Management approved. National Guidelines for District Health Management Structures approved 52 Districts audited against the approved guidelines, Number of PHC facility committees assessed to determine functionality 1200 PHC facility committees assessed to determine its functionality 2000 PHC facility committees assessed to determine its functionality Number of functional WBPHCOTs 2000 functional WBPHCOTs 2500 PHC facility committees assessed to determine its functionality 2000 functional WBPHCOTs Number of primary health Care facilities in the 52 districts that qualify as Ideal Clinics 811 primary health Care facilities in the 52 districts qualify as Ideal Clinics 1000 primary health Care facilities in the 52 districts qualify as Ideal Clinics Number of Districts with management structures in line with the National Guidelines 1500 primary health Care facilities in the 52 districts qualify as Ideal Clinics 2019/20 Implementation plan in place to arrive at 52 Districts with District Health Management structures in line with the National Guidelines 3400 PHC facility committees assessed to determine its functionality 2000 functional WBPHCOTs 2823 primary health care facilities in the 52 districts qualify as Ideal Clinics 29

Strategic Objective Performance Indicator Estimated performance 2016/17 Programme 4 Medium-term targets 2017/18 2018/19 2019/20 Improve accessibility of Primary Health Services to people with physical disabilities Proportion of PHC facilities accessible to people with physical disabilities 25% of PHC health facilities 35% (of 2823) of PHC facilities accessible to people with physical disabilities 50% (of 2823) of PHC facilities accessible to people with physical disabilities 70% (of 2823) of PHC facilities accessible to people with physical disabilities Improve quality of services at District Hospitals through the Ideal District Hospitals Programme Improve environmental health services in all 52 districts and metropolitan municipalities in the country Ideal District Hospital Framework New Indicator Ideal District hospital framework drafted and presented to NDHSC Ideal District hospital framework approved by Tech NHC Number of municipalities that are randomly selected and audited against environmental health norms and standards in executing their environmental health functions 35 municipalities are randomly selected and audited against environmental health norms and standards in executing their environmental health functions 20 municipalities are randomly selected and audited against environmental health norms and standards Ideal District hospital framework Implemented at 25% of District Hospitals 20 municipalities are randomly selected and audited against environmental health norms and standards 50 public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards Number of public health 9 Provincial facilities assessed for Implementation adherence to Health Plans developed Care Risk Waste (HCRW) Norms and Standards 50 public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards 30

Programme 4 Strategic Objective Ensure provision of IHR compliant port health services at all 44 commercial points of entry in South Africa Reduce risk factors and improve management for Non. Communicable Diseases (NCDs) by implementing the Strategic Plan for NCDs 2012 -2017 Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 Number of points of entry that provide IHR compliant port health services All 44 points of entry audited, and report produced 10 commercial points of entry compliant with IHR 2005 core capacity requirements 15 commercial points of entry compliant with IHR 2005 core capacity requirements 20 commercial points of entry compliant with IHR 2005 core capacity requirements Number of media campaigns creating awareness of risk factors that contribute to NCDs New Indicator 3 media campaigns creating awareness of risk factors that contribute to NCDs Number of government Departments oriented on the National guide for healthy meal provision in the workplace 35 (15 additional) National Departments oriented on the National guide for healthy meal provision in the workplace Guidelines on Nutrition for Early Childhood consulted widely and approved Implementation of the National guide for healthy meal provision in the workplace assessed in 50% of the oriented government departments Implementation plan monitored Implementation of the National guide for healthy meal provision in the workplace assessed in 100% of the oriented government Departments Guidelines on Nutrition for Early Childhood 3 Government Departments (Education, Social Development and Health) in 9 provinces oriented on the National guide for healthy meal provision in the workplace Implementation plan developed in collaboration with Department of Social Development Implementation Evaluation conducted at ECD Centres and report produced 31

Programme 4 Strategic Objective Reduce risk factors and improve management for Non. Communicable Diseases (NCDs) by implementing the Strategic Plan for NCDs 2012 -2017 Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 Regulations relating to labelling and packaging of tobacco products and smoking in indoor and outdoor public places developed Draft Tobacco Product Consultations led by Bill submitted to Cabinet supported and comments incorporated Random Monitoring of salt content in foodstuffs Random samples from each of 13 regulated food categories tested, reported on and corrective action taken Establish a National Health Commission to address the social determinants of health National Health Commission established Framework for National Health Commission developed Improve access to and quality of mental health services in South Africa Number of Districts with Mental Health Teams established 5 District mental health teams established Tobacco Product Bill enacted Random samples from each of 13 regulated food categories tested, reported on and corrective action taken Framework for National Framework for Health Commission National Health presented to Cabinet for Commission approval approved 10 districts with mental health teams established 15 district mental health teams established 2019/20 Regulations relating to labelling and packaging of tobacco products gazetted; and Regulations relating to smoking in indoor and outdoor public places gazetted Random samples from each of 13 regulated food categories tested, reported on and corrective action taken National Health Commission established 20 districts with mental health teams established 32

Programme 4 Strategic Objective Performance Indicator Expand provision of rehabilitation services in South Africa Number of Districts with an inter-disciplinary rehabilitation team including physiotherapist, optometrist, speech and hearing/audiologist, occupational therapist, medical orthotist/prosthetist Malaria Incidence per 1000 population at risk New Indicator Survey conducted to determine the number of Districts with an interdisciplinary rehabilitation team 5% increase on baseline 10% increase on baseline 0. 2 malaria cases per 1000 population at risk 0. 1 malaria cases per 1000 population at risk Malaria Eliminated, so that there is zero local cases of malaria in South Africa Number of targeted districts reporting malaria cases within 24 hours of diagnosis 7 of 9 malaria targeted districts reporting malaria cases within 24 hours of diagnosis 9 districts targeted for malaria elimination reporting malaria cases within 24 hours of diagnosis Eliminate Malaria so that there is zero local cases of malaria in South Africa by 2020 Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 33

Programme 4 Strategic Objective Performance Indicator Estimated performance 2016/17 Strengthen preparedness and core response capacities for public health emergencies in line with International Health Regulations Improve South Africa’s response with regard to Influenza prevention and control Number of Provincial Outbreak Response Teams trained to respond to zoonotic, infectious and food -borne diseases outbreaks 9 Provincial Outbreak Response Teams trained on food borne disease outbreak response 9 Provincial Outbreak Response Teams trained on Infectious disease surveillance and response Number of high risk population covered by the seasonal influenza vaccination 800 000 high risk individuals covered with seasonal influenza vaccination 630 000 high risk individuals covered with seasonal influenza vaccination 2017/18 Medium-term targets 2018/19 Evaluation Report commenced on the capacity of all 9 provinces to respond to zoonotic, infectious and foodborne diseases 630 000 high risk individuals covered with seasonal influenza vaccination 2019/20 Evaluation report on the capacity of all 9 provinces to respond to zoonotic, infectious and food-borne diseases 630 000 high risk individuals covered with seasonal influenza vaccination annually 34

Programme 4 Programme Performance Indicator Regulations on organ transplantation developed Estimated performance 2016/17 Regulations for organ transplantation drafted Regulations on dialysis developed Regulations for dialysis drafted National Policy Framework and Strategy on Eye Health developed Draft National Policy Framework and Strategy on Eye Health developed Oral health Policy and strategy New indicator 2017/18 Regulations for organ transplantation published for public comment Regulations for dialysis published for public comment Medium-term targets 2018/19 Regulations for organ transplantation promulgated Regulations for dialysis promulgated Policy framework developed and presented to Implemented and NHC Provincial Do. H supported to develop Implementation Plans Oral health policy and strategy drafted strategy costed and approved 2019/20 National report compiled to review implementation of organ transplantation National report compiled to review implementation of dialysis 9 Provincial Do. H monitored for implementation Implementation of Oral health policy and strategy monitored and reported on 35

PROGRAMME 5: HOSPITAL, TERTIARY HEALTH SERVICES AND HUMAN RESOURCE DEVELOPMENT The purpose of the programme is to develop policies, delivery models and clinical protocols for hospitals and emergency medical services. It is also to ensure alignment of academic medical centres with health workforce programmes, training of health professionals and to ensure the planning of health infrastructure meet the health needs of the country. This programme will also assist the government to achieve the population health goals of the country through nursing and midwifery, by the provision of expert policy and technical advice and recommendations on the role of nurses in attainment of desired health outputs. 36

Programme 5 Strategic Objective Performance Indicator Estimated performance 2016/17 Ensure quality health Care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Increase capacity of central hospitals to strengthen local decision making and accountability to facilitate semiautonomy of 10 central hospitals Develop and Implement health workforce staffing norms and standards. Number of Hospitals that achieved an overall performance 75% (or more) compliance with the National Core Standards assessment. 26 Hospitals (5 Central 10 Tertiary, 11 Regional) 43 Hospitals (8 Central, 15 Tertiary, 20 Regional Hospitals) 72 Hospitals (10 Central, 17 Tertiary, 30 Regional Hospitals and 15 Specialised Hospitals) All Hospitals assessed, and achieved an overall performance of 75% (or more) compliance with NC Number of central hospitals benchmarked against standardised organisational structures Organisational structure for Central Hospitals approved by NHC 3 Central hospitals benchmarked against approved Organisational structure 6 Central hospitals benchmarked against approved Organisational structure All 10 Central hospitals benchmarked and implementing approved Organisational structure Guidelines for Human Resources for Health (HRH) norms and standards using the WISN methodology HRH Norms for District and specialised hospitals developed using WISN methodology HRH standards for Regional, Tertiary and Central Hospitals presented at Tech. NHC Guidelines for HR Norms and standards published for all levels of care. Number of health facilities benchmarked against staffing normative guides 3500 PHC Facilities benchmarked 30 District Hospitals benchmarked HRH Normative guidelines for Regional, Tertiary and Central Hospitals completed and presented to Tech. NHC 50 Regional and Specialised hospitals benchmarked Medium-term targets 2017/18 2018/19 2019/20 All PHC facilities, District Hospitals, Regional and Specialised Hospitals benchmarked 37 37

Programme 5 Strategic Objective Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 Develop and Implement health workforce staffing norms and standards. National Human Resources for Health (HRH) Strategy New indicator A review of the current HRH strategy Revised national HRH strategy developed and tabled at Tech. NHC 6 provincial HRH plans updated in line with the revised national strategy 8 provincial HRH plans updated in line with the revised national strategy Increase production of Human Resources for Health to strengthen capacity in the health system through the implementation of the Nelson Mandela Fidel Castro Medical Programme Strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. Expanded Academic Integration Programme developed and implemented for medical students returning to South African from the expanded Nelson Mandela Fidel Castro Medical Programme Consultation with key stakeholders and provinces on planning for the returning South African medical students. Ministerial Task team established and Expanded Academic Integration Programme finalised for their final year training in South Africa First cohort students placed on the expanded academic programme second cohort students placed on the expanded academic programme New basic nursing qualification programmes finalised 8 colleges with customised draft curricula New basic nursing qualification programmes accredited 9 additional colleges with customised curricula New basic nursing qualification programmes and curricula developed and offered at all 17 public Nursing colleges New basic Nursing New basic nursing qualification programmes and qualification programmes draft curricula developed and draft curricula developed in line with the national nursing education and training policy 38

Programme 5 Strategic Objective Strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. To improve quality of health infrastructure in South Africa Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 National Policy for the management of nursing placement agencies developed New Indicator National Policy for the management of nursing placement agencies drafted and consulted. National Policy for the management of nursing placement agencies finalised, consulted and tabled at Tech NHC for approval National Policy for the management of nursing placement agencies implemented and monitored Norms and standards for decentralised clinical training platforms developed New Indicator Norms and standards for decentralised clinical training platform drafted and consulted. Norms and Standards for decentralised Clinical Training Platforms at all levels of care implemented and monitored. Number of facilities maintained, repaired and/or refurbished in NHI Districts 178 facilities maintained, repaired and/or refurbished in NHI Districts 197 facilities maintained, repaired and/or refurbished in NHI Districts Norms and standards for decentralised clinical training platform consulted, finzalised, and tabled at Tech. NHC for approval 125 facilities maintained, repaired and/or refurbished in NHI Districts 120 facilities maintained, repaired and/or refurbished in NHI Districts 39

Programme 5 Strategic Objective To improve quality of health infrastructure in South Africa Performance Indicator Estimated performance 2016/17 2017/18 Number of facilities maintained, repaired and/or refurbished outside NHI pilot Districts 307 facilities maintained, repaired and/or refurbished outside NHI pilot Districts 321 facilities maintained, repaired and/or refurbished outside NHI pilot Districts Number of clinics and Community Health Centres constructed or revitalised 44 clinics and Community Health Centres constructed or revitalised Number of hospitals constructed or revitalised 8 hospitals constructed or revitalised Number of new facilities that comply with gazetted infrastructure Norms & Standards. 52 new facilities Medium-term targets 2018/19 2019/20 297 facilities maintained, repaired and/or refurbished outside NHI pilot Districts 42 clinics and 40 clinics and Community Health Community Centres constructed Health Centres or revitalised constructed or revitalised 8 hospitals constructed or revitalised 290 facilities maintained, repaired and/or refurbished outside NHI pilot Districts Specifications of 50 new facilities compliant with Infrastructure norms and standards Specifications of 46 new facilities compliant with Infrastructure norms and standards Specifications of 48 new facilities compliant with Infrastructure norms and standards 40 clinics and Community Health Centres constructed or revitalised 6 hospitals constructed or revitalised 40

Programme 5 Strategic Objective Performance Indicator Estimated performance 2016/17 Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS) Number of provinces that are monitored for compliance with the EMS regulations EMS Regulations revised, and a compliance checklist drafted and presented to National Committee Emergency Medical services (NCEMS To eliminate the backlog of blood alcohol tests by 2017/18 and toxicology tests by 2019/20 Percentage backlog eliminated for blood alcohol tests 90% Backlog of blood alcohol tests eliminated Percentage backlog Review of all the eliminated for toxicology tests samples with CAS number completed to determine the extent of backlog 2017/18 Medium-term targets 2018/19 Compliance checklist finalised and presented to Tech NHC for approval. 9 Provincial Do. H baseline assessments conducted and reports produced to determine compliance levels Backlog of blood alcohol tests eliminated (0% backlog) in all 4 laboratories 40% backlog eliminated for toxicology tests 2019/20 9 provincial department of health monitored using the approved checklist and 9 x EMS Improvement plans developed 9 provincial Do. H monitored using the approved checklist annually Not applicable 60% backlog eliminated for toxicology tests 85% backlog eliminated for toxicology tests 41

Programme 5 Strategic Objective Performance Indicator Estimated performance 2016/17 Contribute to a comprehensive and inter sectoral response by government to prevent deaths due to violence and injury, Roadside testing programme implemented to monitor driving under the influence of alcohol New Indicator To provide food analysis services Percentage of food tests completed within normative turnaround time (30 days – perishable, and 60 days nonperishable) Number of managers accessing the coaching and mentoring Programme 100% of food tests completed within normative turnaround time Number of managers using the knowledge hub information system 200 Hospital CEOs and 700 PHC Facility managers. Improve management of health facilities at all levels of Care through the Health Leadership and Management Academy. 40 Hospital CEOs and 200 PHC Facility Managers 2017/18 Medium-term targets 2018/19 2019/20 Memorandum of Understanding signed between the NDo. H and Department of Transport to implement the roadside testing programme 100% of food tests completed within normative turnaround time Mobile laboratory established and piloted in one Province Mobile laboratory established and implemented in three Provinces 100% of food tests completed within normative turnaround time 80 Hospital Managers and 800 Managers responsible for PHC accessing the online Programme 350 Hospital CEOs and 2100 PHC Facility managers accessing the online Programme 100 of Hospital Managers, and 1200 Managers responsible for PHC Mentoring and training Programme accessible to all Hospital Managers and PHC Managers All Hospital CEOs and All PHC Facility managers Knowledge hub fully developed and accessible to all Hospital CEOs and PHC Managers 42

Programme 5 Strategic Objective Performance Indicator Estimated performance 2016/17 Ensure equitable access to specialised health care by increasing the training platform for medical specialists Medium-term targets 2017/18 2018/19 2019/20 Number of Tertiary Hospitals with approved National Tertiary Service Grant (NTSG) Business Plans New Indicator 17 Tertiary Hospitals with approved National Tertiary Service Grant (NTSG) Business Plans Number of Tertiary Hospitals with approved service specifications New Indicator 17 Tertiary Hospitals with approved service specifications 43

Programme 5 Programme Performance Indicator Policy on education and training of EMS Personnel monitored Regulations for Emergency Care Centres at Hospitals Regulations for EMS in Mass Gatherings Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 A checklist for EMS education and training accreditation criteria in line with the Policy developed and approved by NCEMS. One Monitoring report produced to monitor compliance with Policy on education and training by training providers Regulations for Emergency Care Centres consulted with OHSC 4 quarterly monitoring reports produced to determine compliance with Policy on education and training by training providers Regulations for Emergency Care Centres published for public comment Regulations implemented by 9 Provinces Regulations for EMS in mass gatherings published for implementation A monitoring system developed and consulted with Tech. NHC to measure compliance with Regulation for EMS in Mass Gatherings Regulations on Emergency Care Centres reviewed and published for implementation Monitor compliance of Regulations for EMS in Mass Gatherings 44

Programme 5 Programme Performance Indicator Estimated performance 2016/17 Regulations for the Rendering of Forensic Pathology Services Regulation on for the rendering of Forensic Pathology Services published for implementation Scope of Practice for the rendering of Forensic Pathology Services published for Implementation Health Facilities that are designated to render services for the management of sexual and related offences monitored Monitoring system developed and Implemented to monitor facilities which render services for the management of sexual and related offences 2017/18 Medium-term targets 2018/19 A monitoring system developed to measure compliance with Regulations for the Rendering of Forensic Pathology Services A monitoring system developed and implemented to measure compliance with Forensic Pathology Services scope of practice Biannual monitoring reports produced on facilities which render services for the management of sexual and related offences 2019/20 Monitor compliance of Regulations for the Rendering of Forensic Pathology Services Monitor compliance of Forensic Pathology Services scope of practice National report produced to review Biannual monitoring reports produced to monitor facilities which render services for the management of sexual and related offences 45

PROGRAMME 6 - HEALTH REGULATION AND COMPLIANCE MANAGEMENT The purpose of this programme is to regulate the sale of food and to ensure accountability and compliance by public entities and statutory health professional councils in accordance with applicable legislative prescripts. . 46

Programme 6 Strategic Objective Establish the South African Health Product Regulatory Authority (SAHPRA) Performance Indicator South African Health Product Regulatory Authority (SAHPRA) established as a public entity Estimated performance 2016/17 South African Health Product Regulatory Authority Listed as a public entity 2017/18 Medium-term targets 2018/19 Memorandum of Understanding between the Department and South African Health Product Regulatory Authority (SAHPRA) finalised and Implemented 2019/20 South African Health Product Regulatory Authority fully functional South African Health Product Regulatory Authority established by 2016/17 and fully operational and functional by 2019/20 National Health Laboratory Service Amendment Act Promulgated into law National Health Laboratory Service Amendment Act implemented and CEO, Executive Management, and committees appointed Provide diagnostic health laboratory services with greater efficiency by reforming the NHLS business model National Health Laboratory Service Amendment Act developed New Indicator National Health Laboratory Service Amendment Bill tabled for consideration to the Parliamentary Portfolio Committee of Health 47

Programme 6 Strategic Objective Performance Indicator Estimated performance 2016/17 2017/18 Medium-term targets 2018/19 2019/20 To establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance Legal framework to establish National Public Health Institutes of South Africa (NAPHISA) Comments on draft NAPHISA legislation considered and revised NAPHISA bill submitted to cabinet. NAPHISA Bill tabled for consideration to the Parliamentary Portfolio Committee of Health NAPHISA Act promulgated into law. NAPHISA established and operational as a public entity Improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools Governance monitoring system implemented to strengthen oversight and corporate governance 4 health Entities’ and 6 statutory health professional councils Governance reports of 4 health Entities’ and 6 statutory health professional councils produced 48

Programme 6 Programme Performance Indicator Estimated performance 2016/17 Number of newly appointed boards inducted and trained 3 new boards appointed, inducted and trained (South African Medical Research Council; Office of Health Standards Compliance and Allied Health Professions Council of SA) Medium-term targets 2017/18 2018/19 2019/20 2 new boards appointed. (South African Health Product Regulatory Authority, Council for Medical Schemes) 4 New boards appointed. South African Dental Technician Council, South African Nursing Council, South African Pharmacy Council an National Health Laboratory Service 2 new boards appointed. (South African Medical Research Council; Office of Health Standards Compliance) 49

EXPENDITURE AND BUDGETS FOR 2017/182019/20 50

Summary per Programme Subprogramme % Growth from 2016 ENE 2016/17 allocation to 2017/18 R'000 % ADMINISTRATION 463, 46 4 5 NATIONAL HEALTH INSURANCE, HEALTH PLANNING & SYSTEM ENABLEMENT 559, 76 2 2 HIV & AIDS, TB, MATERNAL & CHILD HEALTH PRIMARY HEALTH CARE SERVICES HOSPITALS, TERTIARY HEALTH SERVICES & HUMAN RESOURCE DEVELOPMENT HEALTH REGULATION & COMPLIANCE MANAGEMENT TOTAL 16, 018, 56 8 257, 83 9 19, 573, 49 8 1, 690, 18 6 38, 563, 31 7 2017/18 R'000 % 10. 6 512, 83 8 31. 3 1 1 4 8 3 % Growth from 2017/18 to 2018/19 735, 08 7 14. 1 18, 278, 34 4 2. 5 264, 29 9 21, 108, 18 7. 8 4 2. 1 1, 726, 97 1 10. 5 42, 625, 72 3 5 2018/19 R'000 % 6. 7 547, 47 0 35. 0 6 0 9 5 7 8 % Growth from 2018/19 to 2019/20 992, 82 2 13. 5 20, 745, 59 5 10. 8 293, 08 9 22, 301, 13 5. 6 0 3. 4 1, 786, 86 6 46, 666, 97 9. 4 2 2019/20 9 R'000 6. 3 582, 47 5 9 5. 4 1, 047, 35 1 3 0 1 6 7 10. 4 22, 909, 43 1 7. 5 315, 07 1 23, 640, 75 6. 0 6 5. 7 1, 889, 86 3 50, 384, 94 7. 9 7 51

Growth over MTEF • The department’s compensation of employees budget has been reduced by R 9. 7 million for 2017/18, R 10. 7 million for 2018/19 and R 11. 3 m for 2019/20 respectively. • The goods & services budget has been reduced with R 60. 5 million over the MTEF (R 17. 8 m; R 19. 0 m and R 23. 7 m). • The payment for capital assets were reduced with R 22. 0 million over the MTEF period. • A new component has been added to the national health insurance indirect grant for an integrated patient based information system and an electronic stock management system which include an early warning system for stockouts of medicine in primary health care facilities. R 166 million, R 390 million and R 411. 8 million is allocated over the MTEF period. • R 600 million has been reprioritised for the operationalization of the Nelson Mandela Children’s Hospital (R 100 million, R 200 million and R 300 million) 52

Programme 1: Administration Subprogramme MINISTRY MANAGEMENT CORPORATE SERVICES OFFICE ACCOMMODATION FINANCIAL MANAGEMENT TOTAL % % % Growth from 2016/17 2017/18 2018/19 2019/20 2017/18 2018/19 ENE allocation to to to 2018/19 2019/20 2017/18 R'000 % R'000 31, 5 0. 31, 8 7. 34, 2 6. 36, 3 34 97 40 61 64 17 77 20, 0 19, 6 11. 21, 9 6. 23, 2 69 -2. 11 46 50 05 23 70 206, 7 12. 232, 4 6. 246, 8 6. 263, 1 33 43 21 21 54 61 71 143, 6 14. 165, 1 5. 174, 9 6. 185, 9 95 95 79 89 12 34 95 61, 4 3. 63, 7 9. 69, 5 5. 73, 6 33 77 52 07 35 94 62 463, 4 10. 512, 8 6. 547, 4 6. 582, 4 64 65 38 75 70 39 75 53

Programme 2: National Health Insurance, Health Planning and System Enablement Subprogramme % Growth from 2016 ENE 2016/17 allocation to 2017/18 R'000 OFFICE OF THE DDG % 2017/18 % Growth from 2017/18 to 2018/19 R'000 % 2018/19 % Growth from 2018/19 to 2019/20 R'000 % R'000 3, 184 17. 84 3, 752 14. 42 4, 293 -8. 22 3, 940 TECHNICAL POLICY & PLANNING 22, 011 345. 05 97, 961 128. 16 223, 504 5. 71 236, 263 HEALTH INFORMATION MANAGEMENT, MONITORING & EVALUATION 55, 491 21. 70 67, 533 0. 41 67, 810 6. 03 71, 897 SECTOR-WIDE PROCUREMENT HEALTH FINANCING & NATIONAL HEALTH INSURANCE INTERNATIONAL HEALTH & DEVELOPMENT 39, 550 252. 58 139, 445 73. 77 242, 316 5. 01 254, 453 373, 528 -7. 18 346, 709 4. 52 362, 370 6. 01 384, 153 65, 998 20. 74 79, 687 16. 12 92, 529 4. 45 96, 645 TOTAL 559, 762 31. 32 735, 087 35. 06 992, 822 5. 49 1, 047, 351 54

Programme 3: HIV and AIDS, TB, Maternal and Child Health Subprogramme % Growth from 2016 ENE 2016/17 allocation to 2017/18 R'000 OFFICE OF THE DDG HIV & AIDS 4, 736 15, 744, 874 % 36. 36 2017/18 % Growth from 2017/18 to 2018/19 R'000 % 6, 458 0. 81 2018/19 % Growth from 2018/19 to 2019/20 R'000 % R'000 6, 510 14. 35 18, 004, 547 13. 66 20, 463, 809 -1. 97 6, 382 10. 49 22, 611, 465 TUBERCULOSIS 27, 370 -3. 19 26, 498 12. 60 29, 837 6. 55 31, 790 WOMEN'S MATERNAL & REPODUCTIVE HEALTH 18, 924 -2. 82 18, 390 16. 01 21, 334 6. 85 22, 796 222, 664 -0. 10 222, 451 0. 74 224, 105 5. 75 236, 998 CHILD, YOUTH & SCHOOL HEALTH TOTAL 16, 018, 568 14. 11 18, 278, 344 13. 50 20, 745, 595 10. 43 22, 909, 431 55

Programme 4: Primary Health Care Services Subprogramme 2016 ENE R'000 OFFICE OF THE DDG % 2, 994 4 26, DISTRICT HEALTH SERVICES ENVIRONMENTAL AND PORT HEALTH SERVICES COMMUNICABLE DISEASES NON-COMMUNICABLE DISEASES HEALTH PROMOTION & NUTRITION TOTAL 047 % % Growth from 2018/19 2019/20 2017/18 2018/19 to to 2018/19 2019/20 R'000 % R'000 4. 7 3, 1 12. 3, 5 36 56 30 3. 88 93 77. 6 46, 2 45. 67, 4 6. 71 66 81 62 01 19 144, 0 4. 150, 8 8. 163, 8 27 73 39 65 91 1. 6 21, 9 4. 22, 8 6. 24 23 31 67 92 50 4. 1 22, 4 4. 23, 5 7. 25 91 87 87 08 56 16. 4 26, 4 24, 8 7. 26 56 -6. 24 04 09 62 2. 5 264, 2 10. 293, 0 7. 315, 0 99 89 89 50 71 % Growth from 2016/17 2017/18 allocation to 2017/18 3 162, 916 11. 59 21, 561 8 21, 598 3 22, 723 3 257, 839 1 56

Programme 5: Hospitals, Tertiary Health Services and HR Development % Growth from 2016 ENE 2016/17 Subprogramme allocation to 2017/18 R'000 % 3, 71 OFFICE OF THE DDG 3 -0. 57 HEALTH FACILITIES 6, 078, 82 INFRASTRUCTURE MANAGEMENT 1 9 TERTIARY HEALTH CARE PLANNING 10, 851, 43 & POLICY 8 8 5, 15 HOSPITAL MANAGEMENT 9 -0. 08 2, 500, 06 HUMAN RESOURCES FOR HEALTH 9 5 6, 62 NURSING SERVICES 7 -0. 98 FORENSIC CHEMISTRY 120, 53 LABORATORIES 3 0 7, 13 VIOLENCE, TRAUMA & EMS 8 5 19, 573, 49 TOTAL 8 4 2017/18 R'000 % Growth from 2017/18 to 2018/19 % 3, 69 2 9. 7 6, 673, 67 0 11, 630, 76 7. 1 3 5, 15 5 6. 1 2, 653, 78 8 6, 56 2 5. 7 127, 40 5 0. 1 7, 14 9 21, 108, 18 7. 8 4 2018/19 R'000 7. 5 6 1 1 5 0 3 5 % Growth from 2018/19 to 2019/20 % 3, 97 1 3. 9 6, 934, 64 2 12, 399, 64 6. 6 2 7. 4 5, 53 9 5. 8 2, 807, 79 2 7. 8 7, 07 6 5. 8 134, 79 5 7. 3 7, 67 3 22, 301, 13 5. 6 0 2019/20 R'000 7. 2 3 0 2 8 2 1 5 4 1 4, 25 8 5. 6 7, 323, 26 0 13, 182, 90 6. 3 3 7. 0 5, 93 1 5. 6 2, 965, 50 0 7. 4 7, 60 0 6. 1 143, 09 1 7. 0 8, 21 3 23, 640, 75 6. 0 6 57

Programme 6: Health Regulation and Compliance Management Subprogramme % Growth from 2016 ENE 2016/17 allocation to 2017/18 R'000 OFFICE OF THE DDG FOOD CONTROL RADIATION CONTROL AND HEALTH TECHNOLOGY PUBLIC ENTITIES MANAGEMENT COMPENSATION COMMISSIONER FOR OCCUPATIONAL DISEASES & OCCUPATIONAL HEALTH TOTAL % 4, 06 2 11. 57 9, 97 2 17. 61 139, 57 2 86. 42 1, 474, 93 7 10. 52 61, 64 3 1, 690, 18 6 2017/18 R'000 % Growth from 2017/18 to 2018/19 % 4, 532 7. 37 11, 728 -1. 92 18, 956 3. 43 1, 630, 082 3. 38 0. 05 61, 673 6. 63 2. 18 1, 726, 971 3. 47 % Growth from 2018/19 to 2019/20 R'000 % 4, 8 66 7. 13 11, 5 03 7. 24 19, 6 06 8. 63 1, 685, 1 29 5. 60 65, 7 62 5. 69 1, 786, 8 66 5. 76 2019/20 R'000 5 3 12, 3 6 1 23, 2 8 1, 779, 55 4 69, 5 2 1, 889, 86 3 58

SPENDING TRENDS AUDITED OUTCOME PROGRAMME PRELIMINARY 2013/14 2014/15 2015/16 2016/17 R'000 R’ 000 ADMINISTRATION 347 342 386 476 438 501 442 876 NATIONAL HEALTH INSURANCE, HEALTH PLANNING & SYSTEM ENABLEMENT 222 556 338 199 553 053 679 170 HIV & AIDS, TB, MATERNAL & CHILD HEALTH PRIMARY HEALTH CARE SERVICES HOSPITALS, TERTIARY HEALTH SERVICES & HUMAN RESOURCE DEVELOPMENT HEALTH REGULATION & COMPLIANCE MANAGEMENT 10 763 504 12 818 696 14 179 001 15 965 743 183 488 206 322 212 571 225 731 17 493 249 18 448 578 19 002 315 19 468 716 1 214 381 1 340 701 1 599 420 1 714 510 TOTAL 30 224 520 33 538 972 35 984 861 38 496 746 97. 7% 97. 8% 99. 4% 99. 7% % OF BUDGET EXPENDED 59

SPENDING TRENDS – CONDITIONAL GRANTS Audited outcome CONDITIONAL GRANTS National Tertiary Services Preliminary 2013/14 2014/15 2015/16 2016/17 R'000 9 620 357 10 168 235 10 381 174 10 846 778 10 533 886 12 311 322 13 670 730 15 290 603 Health Facility Revitalisation 3 751 933 5 501 981 5 417 045 5 272 680 Professional Training and Development 2 190 366 2 321 788 2 374 722 2 476 724 50 953 76 956 61 077 94 227 - 189 489 158 719 189 992 182 692 292 345 `612 623 686 496 8 458 82 261 279 760 371 372 75 975 - - - 4 561 - - - Comprehensive HIV and AIDS National Health Insurance HPV Vaccine (Indirect) Health Infrastructure (Indirect) Health Professionals Contracting (Indirect) Nursing College and School (Indirect) CHAN 2013 (Indirect) 60

Conditional Grant - Budgets Covers comparative budget for 2017/18 and 2016/17 Ø Total budget is R 37. 5 bn which is 11% increase compared to last financial year budget of R 33. 8 bn. Ø The major contributors to 11% increase is ü inflation of 5. 5% ü 5. 8% or R 2 bn increase in HIV/AIDS as a result of scale up on key prevention interventions on v Male Medical Circumcision(MMC) v Universal Test & Treat (UTT) ü 0. 5% or R 150 m for Nelson Mandela Childrens Hospital allocation

Proportionate Allocation - 2017/18 v It is evident from the chart that HIV/AIDSreceives almost 50% of the total grant allocation which is in line with the priorities of the department. v The other 50% is allocated to other three grants with NTSG receiving significant portion (31%).

Overview - Grants

Health Professions Training Grant (01)

Health Professions Training Grant (02) q The grant has 6% increase which represents an inflation increase. q The purpose of the grant is to support provinces to fund service costs associated with clinical training and supervision of health science trainees on the public service platform q Allocation to provinces is based on historical allocation and spending patterns.

National Tertiary Services Grant (01)

National Tertiary Services Grant (02) q An increase of 8% is as a result of Nelson Mandela Children’s Hospital and general inflationary increase. q Key priorities of the grant is to ensure v provision of tertiary health services for all South African citizens (including documented foreign nationals) v To compensate tertiary facilities for the additional costs associated with provision of these services q Grant allocation is based on historical allocation and spending patterns.

Comprehensive HIV/AIDS & TB (01)

Comprehensive HIV/AIDS & TB (02) q An increase of 15% is as result of inflation and scale up of key prevention interventions – MMC & UTT. q The grant will focus on improving quality of HIV and AIDS and TB services including access to: v HIV Counseling and Testing (HCT) v TB case finding, screening and diagnosis v Antiretroviral Treatment (ART) v treatment for TB, including drug-resistant TB v adherence monitoring and support v prevention of TB v prevention of mother-to-child-transmission (PMTCT) v medical male circumcision (MMC) q Allocations are based on antenatal HIV prevalence, estimated share of AIDS cases, populations post-demarcation

Health Facility Revitalisation Grant (01)

Health Facility Revitalisation Grant (02) q Increase of 7% is an inflation increase (5. 5%) and accelleration of infrastructure in preparation for NHI (1. 5%). q The grant will focus on v accelerating construction, maintenance, upgrading and rehabilitation of new and existing infrastructure in health including, health technology, organisational development systems and quality assurance v To enhance capacity to deliver health infrastructure v More than 50% of the grant will be dedicated on maintenance. q Allocation to provinces is project and performance based.

National Health Grant (Schedule 6 – Indirect Grant ) – (01)

National Health Indirect Grant (Schedule 6 – Indirect Grant ) – (02) q CCMDD was previously focusing on NHI pilot sites however the programme has extended outside the NHI pilots (since there is no piloting). This is also due to successes of the programme hence an increase of 150%. q Ideal Clinic component increased by 200% to accelerate the ideal clinic programme. q Indirect grants are not allocated to provinces as programmes are implemented and managed at national level.

Overview - Provinces

CONCLUSION q National Do. H Annual Performance Plan 2017/18 -2019/20 is founded on government’s 2030 vision outlined in the National Development Plan 2030. q It reflects interventions to improve the health system and health outcomes for all South Africans. q The Department will continue to work towards improving equity, quality and access to healthcare through the introduction of the National Health Insurance, and other Health Sector reforms through various initiatives. 75

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