Annual Performance Plan 201819 202021 Presentation to the

Annual Performance Plan 2018/19 – 2020/21 Presentation to the Portfolio Committee on Health 19 April 2018

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.

2018/19 – 2020/21 MTEF PRIORITIES The priorities for the MTEF commencing 2018/19 year are derived from: Sustainable Development Goal 3

Legislation and Prescripts that regulate Health Sector planning 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 Pubic Finance Management Act, annually and submit the integrated health 1999 plans to the National Health Council”. – Treasury Regulations – – Section 33(1) - “Each district and Chapter 5 of 2007 metropolitan health manager must within the national budget cycle develop … a – Framework for Strategic Plans district health plan drawn up in accordance and Annual Performance with national guidelines issued by the Plans, 2010 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.

Alignment between National <-> Provincial <-> District Annual 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 to date a) An increase in overall life expectancy from 57. 1 years in 2009 to 63. 8 years in 2016. b) A decrease in the Under-5 mortality rate (U 5 MR) from 56 deaths per 1 000 live births in 2009, to 34 deaths per 1 000 live births in 2016. c) A decrease in the Infant Mortality Rate (IMR) from 39 deaths per 1 000 live births in 2009, to 25 deaths per 1 000 live births in 2016. d) A decrease in mother-to-child transmission (MTCT) of HIV from 8. 5% in 2008, to 3. 5% in 2010 and to 1% in 2017. 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 25. 03% (2017). g) TB Treatment Success Rate increased from 74% in 2009 to 86% in 2016.

Outcome 2 : A long and Healthy lives for all South Africans Impact Indicators: Targets Impact Indicator Baseline (2009) Current Performance 1 Targets (2019) Life expectancy at birth: Total Life expectancy at birth: Male Life expectancy at birth: Female 56. 5 years 63. 8 years 64. 2 years 54. 0 years 60. 8 years 61. 5 years 59. 0 years 66. 9 years 67 years Under-5 Mortality Rate 56 Under 5 deaths per 1, 000 live-births 34 Under 5 deaths per 1, 000 live-births 33 Under 5 deaths per 1, 000 live-births Neonatal Mortality Rate 14 neonatal deaths per 1000 live births 12 neonatal deaths per 1000 live births 8 neonate deaths per 1000 live births Infant Mortality Rate (IMR) 39 per 1, 000 live-births 25 infant deaths per 1, 000 live-births 23 infant deaths per 1000 live births (15% decrease) Maternal Mortality Ratio 304 per 100, 000 livebirths 152 /100 000 live births (2015) <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 2016, (Published by MRC during March 2018)

President’s SONA 2018 1. “This year, we will take the next critical steps to eliminate HIV from our midst. By scaling up our testing and treating campaign, we will initiate an additional two million people on antiretroviral treatment by December 2020. ” 2. “We will also need to confront lifestyles diseases such as high blood pressure, diabetes, cancers and cardiovascular diseases. ” 3. “In the next three months we will launch a huge cancer campaign similar to the HIV counselling and testing campaign” 4. “The time has now arrived to finally implement universal health coverage through the National Health Insurance. The NHI Bill is now ready to be processed through government and will be submitted to Parliament in the next few weeks”. 5. “Certain NHI projects targeting the most vulnerable people in society will commence in April this year”. President Cyril Ramaphosa, SONA, 16 Feb 2018

Synopsis of NHI Reforms to implement NHI Policy (2017)

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

Programme 1 Strategic Objective Ensure effective financial management and accountability by improving audit outcomes Performance Indicator Audit opinion from Auditor General Number of Provincial Do. H that demonstrate improvements in Audit Outcomes or Opinions Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Unqualified audit opinion with no significant matters for 2016/17 Clean Audit opinion for the NDOH for 2017/18 4 Provincial Do. H that demonstrate improvements in Audit with no significant matters for 2016/17 5 Provincial Do. H that demonstrate improvements in Audit with no significant matters for 2017/18 Clean Audit Opinion for the NDOH for 2018/19 5 Provincial Do. H that demonstrate improvements in Audit with no significant matters for 2018/19 2020/21 Clean Audit Opinion for the NDOH for 2019/20 6 Provincial Do. H that demonstrate improvements in Audit with no significant matters for 2019/20

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.

Programme 2 Strategic Objective Achieve Universal Health Coverage through the phased implementation of National Health Insurance Performance Indicator Legislation for NHI Private Health providers contracted to expand coverage of care Implement e. Health Strategy of South Africa through the e. Health Strategy 2019 development of 2023 published patient information systems Estimated performance 2017/18 Draft NHI Bill gazetted for public comments New Indicator e. Health Strategy 2012 -2016 implementation reviewed 2018/19 Medium-term targets 2019/20 2020/21 Draft NHI Bill published for comments NHI Bill approved by the National Assembly and National Council of Provinces. NHI Bill assented to by the President Private health providers contracted to purchase health services on behalf of population Additional Private health providers contracted to purchase health services on behalf of population e. Health Strategy 2019 -2023 published e. Health Strategy 2019 – 2023 implantation commenced, and monitored e. Health Strategy 2019 – 2023 implementation monitored

Programme 2 Strategic Objective Develop and implement a system for the creation of a NHI Beneficiary Registry Performance Indicator Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Number of health facilities implementing health patient registration system (HPRS) 3000 PHC Facilities implementing the health patient registration system (HPRS) 3470 PHC 3000 PHC Facilities facilities and 22 maintained; Hospitals maintained; Additional 470 PHC facilities and 22 Additional 38 Hospitals hospitals implementing the implementing health patient the health registration system patient (HPRS) registration system (HPRS) Number of individuals from the population registered on the NHI Patient Beneficiary Registry 15 million 35 million 50 million 2020/21 3470 PHC facilities and 60 Hospitals maintained; Additional 260 hospitals implementing the health patient registration system (HPRS) 57 million

Programme 2 Strategic Objective Performance Indicator Establish a national stock management surveillance centre to improve medicine availability Total number of health facilities reporting stock availability at national surveillance centre Improve contracting and supply of medicines through innovative service delivery models Number of patients enrolled for receiving medicines through the centralised chronic medicine dispensing & distribution (CCMDD) programme Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 3800 of health facilities 3625 of health 3450 of health facilities reporting stock availability at stock availability at national surveillance centre (cumulative) 2, 800, 000 2, 500, 000 patients enrolled 1, 900, 000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 2020/21 3942 health facilities reporting stock availability at national surveillance centre (cumulative) 3, 000 patients enrolled for receiving medicines through the CCMDD programme (cumulative)

Programme 2 Strategic Objective Performance Indicator Improve the use of antibiotics in South Surveillance system Africa by implemented for implementing the Antimicrobial monitoring resistance Resistance Strategy Regulate Traditional Health Practitioners in South Africa Traditional Health Practitioners Amendment Bill drafted and published for comment Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Surveillance system for monitoring Surveillance system resistance for monitoring accessible to 3 resistance developed. provincial Do. H Traditional Health Practitioners Amendment Bill drafted Traditional Health Practitioners Amendment Bill published for comment Surveillance system for monitoring resistance accessible to 6 provincial Do. H Amendment Bill promulgated 2020/21 Surveillance system for monitoring resistance accessible to 9 provincial Do. H NA

Programme 2 Strategic Objective Regulation of the price on medicines through the transparent pricing system Improve the acceptability, quality and safety of health services by increasing user and community feedback and involvement Performance Indicator Single Exit Price Adjustments Published and Implemented Annually Number of PHC health facilities conducting Patient Experience of Care Survey Estimated performance 2017/18 Annual Price Adjustments gazetted and published 9 Provincial Health Departments trained on use of PEC Guideline 2018/19 Medium-term targets 2019/20 2020/21 2018/19 Annual Price Adjustments gazetted and implemented 2019/20 Annual Price Adjustments gazetted and implemented 2020/21 Annual Price Adjustments gazetted and implemented 1500 PHC facilities conducting Patient Experience of care surveys annually 2000 PHC facilities conducting Patient Experience of care surveys 3000 PHC facilities conducting Patient Experience of care surveys

Programme 2 Strategic Objective Implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy Performance Indicator NHI Phase 1 Evaluation Conducted Estimated performance 2017/18 2018/19 NHI Phase 1 evaluation report evaluation conducted published Medium-term targets 2019/20 2020/21 NHI Phase 1 evaluation report Comprehensive disseminated NHI indicator list and used to developed inform further planning for NHI

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.

Programme 3 Strategic Objective To implement combination of prevention and treatment interventions to reduce burden of HIV, STI and TB infections Performance Indicator Total number of clients remaining on ART (TROA) Number of people reached in the National Health Screening and Testing campaign annually Medical Male Circumcisions performed Number of undiagnosed TB infected persons (new cases) found Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 2020/21 4 200 000 5 800 000 6 100 000 New Indicator 14 000 000 14 000 500 000 600 000 550 000 500 000 New Indicator 80 000 110 000 120 000

Programme 3 Strategic Objective To reduce under 5 mortality rate to less than 33 per 1 000 live births Performance Indicator EPI coverage survey conducted EPI surveillance and coverage external review recommendations implemented Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 2020/21 Targeted Interventions identified and implemented to strengthen EPI Programme EPI coverage survey protocol developed. Survey protocol developed and field work completed Survey report completed and used to strengthen EPI programme New Indicator Implementation plans developed in partnership with Provincial Do. H; and Three (3) provincial trainings conducted Six (6) provincial Implementation trainings plans monitored conducted

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, non-communicable disease control as well as health promotion and nutrition programmes.

Programme 4 Strategic Objective Performance Indicator Eliminate Malaria in South Africa The National Malaria elimination Strategic Plan for South Africa Published Implement the International Health Regulations Joint External Evaluation recommendations Joint External Evaluation (JEE) Recommendations implemented Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 2020/21 New Indicator Malaria Elimination Strategic Plan for South Africa published M&E report produced on the key indicators for Malaria Elimination Joint External Evaluation on International Health Regulations conducted Work plan for JEE recommendations developed JEE All JEE recommendation implemented M&E report produced on the key indicators for Malaria Elimination

Programme 4 Strategic Objective Strengthen district governance and improve management and leadership of the district health system Performance Indicator Number of Districts compliant with the minimum requirements of the District Health Management Office structure guidelines Number of PHC facility committees assessed to determine functionality Estimated performance 2017/18 National Guidelines for District Health Management Structures approved 3400 PHC facility committees assessed to determine its functionality 2018/19 Medium-term targets 2019/20 Plans developed for 10 districts structures to meet the minimum requirements of the guidelines 3400 PHC facility committees assessed to determine its functionality; Report on findings with recommendations completed Plans developed for 30 districts structures to meet the minimum requirements of the guidelines 3400 PHC facility committees assessed to determine its functionality; Report on findings with recommendatio ns completed 2020/21 Plans developed for 52 districts structures to meet the minimum requirements of the guidelines 3400 PHC facility committees assessed to determine its functionality; Report on findings with recommendations completed

Programme 4 Strategic Objective Improve quality of services at primary health care facilities through the Ideal Clinic Initiative Improve accessibility of Primary Health Services to people with disabilities Performance Indicator Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Number of primary health Care facilities in the 52 districts that qualify as Ideal Clinics 1800 primary 1000 primary health 1400 primary health care Care facilities in the 52 districts qualify as 52 districts qualify 52 districts Ideal Clinics as Ideal Clinics qualify as Ideal Clinics Proportion of PHC facilities accessible to people with disabilities 40% of 3400 PHC 34% of PHC facilities accessible to people with disabilities 50% of 3400 of PHC facilities accessible to people with disabilities 2020/21 2500 primary health care facilities in the 52 districts qualify as Ideal Clinics 60% of 3400 of PHC facilities accessible to people with disabilities

Programme 4 Strategic Objective 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 Performance Indicator Ideal District Hospital Framework implemented Number of public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards Estimated performance 2017/18 Ideal District hospital framework drafted and presented to NDHSC 50 public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards 2018/19 Medium-term targets 2019/20 Status of all district hospitals determined against the Ideal District hospital framework version 1 80% of district hospitals score at least 60% against the Ideal District hospital framework 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals facilities that generate more (hospitals that than 25 kg per day) generate more assessed for than 25 kg per adherence to day) assessed HCRW Norms and for adherence to Standards HCRW Norms and Standards 2020/21 80% of district hospitals score at least 70% against the Ideal District hospital framework 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals that generate more than 25 kg per day) assessed for adherence to HCRW Norms and Standards

Programme 4 Strategic Objective Performance Indicator Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Improve environmental health services in all 52 districts and metropolitan municipalities in the country Number of municipalities that 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 in executing their environmental health functions 21 municipalities randomly selected and audited against environmental health norms and standards Strengthen district mental health services Number of Districts with Mental Health Teams established 10 District mental health teams established 15 District mental health teams established Expand provision of rehabilitation services, and accessibility of Primary Health Services to people with physical disabilities Number of multidisciplinary rehabilitation teams (physiotherapist, optometrist, audiologist, occupational therapist) established Survey conducted to determine the number of Districts with an multidisciplinary rehabilitation team 2 multi-disciplinary rehabilitation teams established Municipalities that achieved less than 65% compliance during 2018/19 audited against environmental health norms and standards 20 District mental health teams established 5 multidisciplinary rehabilitation teams established 2020/21 Municipalities that achieved less than 65% compliance during 2020/21 audited against environmental health norms and standards 25 District mental health teams established 9 multi-disciplinary rehabilitation teams established

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.

Programme 5 Strategic Objective Strengthen local decision making and accountability of central hospitals to facilitate semiautonomy Ensure quality health Care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Performance Indicator Number of central hospital organisational structures aligned with Guidelines on Organisational Structures for Central Hospitals Number of Hospitals that achieved an overall performance 75% (or more) compliance with the National Core Standards assessed Oncology services improvement plan developed Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 Draft Guidelines on Organisational Structures for Central Hospitals Developed Guidelines on Organisational Structures for Central Hospitals approved by Tech. NHC 43 Hospitals (8 Central, 15 Tertiary, 20 Regional Hospitals) 10 Central Hospitals achieved an overall performance 75% (or more) compliance with the National Core Standards assessed New Indicator Oncology service improvement plan developed for public hospitals Costed implementation plans for improvement of 10 Central hospitals organisational structures completed 50% of Hospitals assessed, and achieved an overall performance of 75% (or more) compliance with NCS Implementation monitored 2020/21 Implementation plans monitored 70% of Hospitals assessed, and achieved an overall performance of 75% (or more) compliance with NCS Implementation monitored

Programme 5 Strategic Objective Performance Indicator Ensure quality health Care by improving Obstetric services compliance with National improvement plans Core Standards at all developed Central, Tertiary, Regional and Specialised Hospitals 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 Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 2020/21 New Indicator Obstetric service Implementation improvement plan developed for public monitored hospitals Implementation monitored Compliance checklist finalised and presented to Tech NHC for approval. 9 Provincial Do. H baseline assessments conducted and reports produced to determine compliance levels 9 provincial Do. H monitored for 9 provincial compliance with department of the EMS health monitored for regulations compliance with the using the EMS regulations approved using the approved checklist annually and 9 x EMS Improvement plans Improvement developed plans revised accordingly 9 provincial Do. H monitored for compliance with the EMS regulations using the approved checklist 9 x EMS Improvement plans revised accordingly

Programme 5 Strategic Objective Performance Indicator Number of facilities that comply with gazetted infrastructure Norms & Standards. To build new and improve quality of existing health infrastructure in South Africa Number of clinics and Community Health Centres constructed or revitalised Number of hospitals constructed or revitalised Number of facilities maintained, repaired and/or refurbished in NHI Districts Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 400 facilities Specifications of 50 compliant with facilities compliant Infrastructure with Infrastructure norms and standards 20 clinics and Community Health Centres constructed or or revitalised 1 hospitals 2 hospitals constructed or revitalised 125 facilities 150 facilities, maintained, repaired and/or refurbished in NHI Districts 800 facilities compliant with Infrastructure norms and standards 20 clinics and Community Health Centres constructed or revitalised 2 hospitals constructed or revitalised 120 facilities maintained, repaired and/or refurbished in NHI Districts 2020/21 1500 facilities compliant with Infrastructure norms and standards 20 clinics and Community Health Centres constructed or revitalised 2 hospitals constructed or revitalised Not Applicable 1 1. By the end of 2019/20, all health facilities in national health insurance pilot districts will have been maintained, repaired and/or refurbished)

Programme 5 Strategic Objective Improve management of PERSAL data to track implementation of staffing norms and facilitate HRH planning Performance Indicator Number of facilities maintained, repaired and/or refurbished outside NHI Districts HR Regulations developed and promulgated to ensure WISN based HRH planning in PHC facilities Estimated performance 2017/18 2018/19 100 facilities maintained, repaired and/or refurbished outside NHI pilot Districts New Indicator Medium-term targets 2019/20 Draft HR Regulations submitted to NHC for consideration 2020/21 100 facilities maintained, repaired and/or refurbished outside NHI pilot Districts Draft HR Regulations for WISN implementation promulgated Monitor implementation and compliance with HR Regulations for WISN implementation

Programme 5 Strategic Objective Improve the Human resource planning by strengthening the placement process for medical interns and community service personel Performance Indicator Percentage South African Medical Interns and Community service personel allocated in health facilities that studied at South African universities Estimated performance 2017/18 98% (1510/1529) Medical Interns Placed and 91% (6878/7527) Community service personnel placed 2018/19 Medium-term targets 2019/20 100 % of South African Medical Interns and Community service personnel who studied at SA Universities allocated for placement by October for annual and April for asynchronous allocations respectively 2020/21 100 % of South African Medical Interns and Community service personnel who studied at SA Universities allocated for placement by October for annual and April for asynchronous allocations respectively

Programme 5 Strategic Objective Develop and support implementation of health workforce staffing norms and standards 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 Performance Indicator National Human Resources for Health (HRH) Strategy 20192024 drafted Number of medical students returning to South Africa from the expanded Nelson Mandela Fidel Castro Medical Programme placed in local medical schools Estimated performance 2017/18 2018/19 Medium-term targets 2019/20 2020/21 A review of the HRH strategic plan 2012/20132016/2017 conducted HRH Strategic plan 2019 - 2024 HRH Strategic plan published and 2019 - 2024 drafted implementation commenced HRH Strategic plan 2019 - 2024 monitored Expanded academic integration programme finalized for final year training in South Africa All students returning from Cuba during 2018/19 placed for final clinical training in the local medical schools All students returning from Cuba placed for final clinical training in the local medical schools

Programme 5 Strategic Objective Improve management of health facilities at all levels of are through the Health Leadership and Management Academy Performance Indicator Number of managers accessing the knowledge hub information system for coaching and mentoring Estimated performance 2017/18 100 Hospital Managers and 300 PHC Managers accessing the knowledge hub information system for coaching and mentoring 2018/19 Medium-term targets 2019/20 150 Hospital and 900 PHC Managers accessing the knowledge hub information system for coaching and mentoring 250 Hospital and 1800 PHC Managers accessing the knowledge hub information system for coaching and mentoring 2020/21 All hospital and PHC managers accessing the knowledge hub information system for coaching and mentoring

Programme 5 Strategic Objective Strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. Performance Indicator New basic Nursing qualification programmes and draft curricula developed Norms and standards for clinical training platform developed Estimated performance 2017/18 New basic nursing qualification programmes finalised 8 colleges with customised draft curricula Norms and standards for clinical training platform drafted and consultations held 2018/19 Medium-term targets 2019/20 2020/21 9/17 remaining colleges have customised curricula for the new 3 yr Diploma in General Nursing New courses commenced in 2019 academic year New basic nursing qualification programmes implemented and monitored at all 17 public nursing colleges Progress reports produced on the implementation of the new basic nursing qualification programmes at all 17 public nursing colleges Norms and standards for clinical training platform approved Provinces supported in the development of implementation plans of the Norms and Standards for Clinical Training Platforms Provinces supported in the development of improvement plans of the norms and standards for clinical training platforms

Programme 5 Strategic Objective Eliminate the backlog of blood alcohol tests by 2018/19 and toxicology tests by 2020/21 Performance Indicator Percentage backlog eliminated for blood alcohol tests Estimated performance 2017/18 Backlog of blood alcohol tests eliminated (0% backlog) in Durban, Cape Town, and Pretoria Laboratories 40% backlog Percentage backlog eliminated for toxicology tests (cumulative target) 2018/19 Medium-term targets 2019/20 2020/21 100% backlog eliminated for blood alcohol tests in Johannesburg laboratory Not applicable 60% backlog eliminated for toxicology tests 70%backlog eliminated for toxicology tests 95% backlog eliminated for toxicology tests

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. .

Programme 6 Strategic Objective To establish the National Public Health Institutes of South Africa (NAPHISA) for coordinated and integrated disease and injury surveillance. Improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools. Performance Indicator Estimated performance 2017/18 NAPHISA Bill Legal framework to tabled for establish National Public consideration Health Institutes of to the Parliamentary South Africa (NAPHISA) Portfolio Committee of Health Governance monitoring system implemented to strengthen oversight and corporate governance Bi-annual governance progress reports produced of all health entities and councils 2018/19 Medium-term targets 2019/20 2020/21 NAPHISA Act Promulgated into law. NAPHISA established as a public entity, and NAPHISA board appointed NAPHISA fully operational and functional Biannual governance progress reports produced of all health entities and councils

Programme 6 Strategic Objective Ensure integrated and coordinated governance and management oversight of public entities and statutory professional councils Performance Indicator Handbook for Board members serving on public health entities and statutory professional councils developed. Estimated performance 2017/18 New Indicator 2018/19 Medium-term targets 2019/20 Handbook for departmental representatives serving on Entities Boards developed. Handbook for departmental representatives serving on Entities Boards implemented 2020/21 Handbook for departmental representatives serving on Entities Boards evaluated and reviewed

BUDGET GROWTH

Summary per Programme 42

Summary per Economic Classification Subprogramme Compensation of Employees 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 760, 032 9 828, 814 1, 645, 882 37 2, 261, 571 39, 354, 196 10 43, 117, 023 Capital 865, 613 20 1, 035, 458 TOTAL 42, 625, 723 11 47, 242, 866 Goods and Services Transfers 43

Programme 1: Administration SUBPROGRAMME DISCRIPTION: EARMARKED Ministry Management Corporate Services Medico-legal Committees Office Accommodation Financial Management SAICA programme Total Programme 1 Total per financial year 2017/18 2018/19 R'000 R'000 EAREARVOTED GRANTS MARKED 31, 8 31, 40 217 19, 6 25, 46 666 232, 4 239, 21 998 5, 000 165, 1 174, 79 912 63, 7 65, 52 999 8, 000 512, 8 537, 13, 38 792 000 512, 838 550, 792

Programme 1 - Growth 17/18 to 18/19 1. Establishment of Medico-legal Committees and expansion of SAICA financial management support programmes in provinces. 2. Additional Goods & Services funds of R 700 million for the NHI, and the centralizing of the NHI in-kind grants from the applicable Responsibilities. 3. Additional allocations for Chronic disease prevention and health promotion, health technology assessment, the management and administration of the interim NHI, and the NHI Ministerial advisory committees. 4. Increase in budget for Forensic Chemistry Laboratories to acquire specialized laboratory equipment to address backlogs and improve turnaround times. 5. Conversion of DRG allocation under Goods & Services and Capital budget to conditional grant for Western Cape under Transfers & Subsidies. 6. Inclusion of community health workers transfer of R 1, 3 billion into Comprehensive HIV & AIDS and TB Conditional Grant. 7. Allocation to upgrade Civitas Building security systems.

Programme 1: Administration Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 Compensation of Employees 197, 170 6 209, 195 Goods and Services 308, 819 6 328, 136 Transfers 2, 252 9 2, 455 Capital 4, 597 139 11, 006 TOTAL 512, 838 7 550, 792 46

Programme 1 - Growth 17/18 to 18/19 1. Capital allocation to upgrade Civitas Building security systems. 2. Capital allocation of funds to Information Communication Technology to maintain current systems. 3. Establishment of expert Medical Committees to support provinces to effectively and efficiently deal with medico-legal matters. 4. Expansion of SAICA financial management support programmes in provinces. 5. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 6. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Programme 2: National Health Insurance, Health Planning and System Enablement Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 Compensation of Employees 114, 740 2 116, 693 Goods and Services 585, 328 130 1, 347, 334 28, 401 6 30, 048 Capital 6, 618 2, 582 177, 478 TOTAL 735, 087 127 1, 671, 553 Transfers

SUBPROGRAMME DISCRIPTION: EARMARKED Chief Operating Officer Technical Policy & Planning 2017/18 R'000 EARMARKED R'000 VOTED R'000 GRANTS R'000 VOTED 3, 752 4, 649 21, 961 1, 377 2018/19 R'000 EARMARKED R'000 GRANTS 2 PHC Integrated Patient Information System Inkind grant Health Information Management, Monitoring & Evaluation. - 76, 000 3 39, 132 2, 000 1 Health System Trust 1 5, 019 5, 890 1 Health Information System Programme Sector-wide Procurement 1 3, 382 4, 158 3 39, 445 6, 279 1 Electronic Medicine Stock Management System National Medicine Stock Surveillance System Inkind grant - - 0, 000 1 0, 000 90, 000 - -

SUBPROGRAMME DISCRIPTION: EARMARKED Health Financing & National Health Insurance. International Health & Development Total Programme 2 Total per financial year 2017/18 R'000 EARMARKED R'000 VOTED R'000 GRANTS R'000 VOTED 2018/19 R'000 EARMARKED R'000 GRANTS 2 11, 497 4, 693 Health Professionals Contracting In-kind grant - 318, 053 1 DRG Project - NHI in-kind: Non-personal services - 700, 000 NHI in-kind: Personal services - 712, 500 NHI Interim Fund Management & Administration - 5, 000 NHI Ministerial advisory committees - 2, 000 Health Technology Assessment - 7, 159 7, 000 8 79, 687 195, 474 - 6, 007 5 5, 560 484, 053 735, 087 5, 005 20 4 7, 048 419, 500 1, 671, 553

Programme 2 - Growth 17/18 to 18/19 1. Additional funds of R 700 million for the NHI and the NHI was restructured, by centralizing the budgets previously allocated under Responsibilities (such as Technical Policy & Planning and Sector-wide Procurement) under Health Financing & NHI. 2. NHI in-kind grant is allocated to both Goods & Services as well as Capital Assets, while it was previously only allocated under G&S. 3. Conversion of DRG allocation under Goods & Services and Capital budget to conditional grant for Western Cape under Transfers & Subsidies on Programme 5. 4. Units’ allocated capital budgets were reduced to allocate funds to Information Communication Technology to maintain current systems. 5. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 6. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Programme 3: HIV and AIDS, TB, Maternal and Child Health Subprogramme Compensation of Employees 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 79, 420 6 84, 413 454, 561 (27) 332, 742 17, 728, 096 15 20, 301, 535 Capital 16, 267 (98) 367 TOTAL 18, 278, 344 13 20, 719, 057 Goods and Services Transfers

SUBPROGRAMME DISCRIPTION: EARMARKED R'000 2017/18 R'000 VOTED EARMARKED GRANTS VOTED 6, 4 Office of DDG: Programme 3 R'000 EARMARKED GRANTS 5, 58 409 276, 48 1 94, 11 6 50, 00 0 8, 50 0 17, 557, 90 3 HIV & AIDS Condoms Communication campaign Higher Education & Training AIDS Comprehensive HIV, AIDS & TB conditional grant Comprehensive HIV, AIDS, TB & community health worker conditional grant 2018/19 R'000 - - 333, 62 6 119, 09 9 50, 00 0 - 18, 645 071 1, 27 626 17, 10 17, 54 SANAC 7 8 26, 49 Tuberculosis Management Women's, Maternal & Reproductive Health 27, 8 240 18, 39 . 19, 0 907 22, 45 Child, Youth & School Health Human Papilloma Virus Vaccines in-kind grant Human Papilloma Virus Vaccines conditional Grant 971 200, 0 00 73, 79 Total Programme 3 Total per financial year 24, 1 7 278, 344 446, 64 17, 757, 9 4 03 77, 527 18, 20, 719, 057 200, 00 0 719, 8319, 921 3 697

Programme 3 - Growth 17/18 to 18/19 1. Transfer budget for Public Universities of South Africa was shifted to Department of Higher Education. 2. Conversion of Human Papilloma Virus Vaccination in-kind grant under Goods & Services and Capital budget to conditional grant under Transfers & Subsidies. 3. Inclusion of community heath workers into Comprehensive HIV & AIDS and TB Conditional Grant. 4. The allocations to Departmental Agencies, such as SANAC, were cut. 5. Reduction of condom allocation. 6. Units’ allocated capital budgets were reduced to allocate funds to Information Communication Technology to maintain current systems. 7. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 8. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Programme 4: Primary Health Care Services Subprogramme Compensation of Employees 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 185, 583 13 209, 054 70, 501 27 89, 332 Transfers 2, 960 6 3, 131 Capital 5, 255 (96) 219 TOTAL 264, 299 14 301, 736 Goods and Services

SUBPROGRAMME DISCRIPTION: EARMARKED Office of DDG: Programme 4 R'000 VOTED 2017/18 R'000 EARMARKED GRANTS 3, 136 R'000 VOTED 3, 976 16, District Health Services 2018/19 R'000 EARMARKED GRANTS 10, 266 606 3 Ideal Clinic in-kind grant 0, 000 - 21, Communicable Diseases 22, 923 727 22, Non-Communicable Diseases 24, 491 183 NDC Prevention and health promotion 50, 00 0 26, Health Promotion & Nutrition 456 Environmental Health & Port Health Services. 027 Total programme 4 299 24, 682 144, 165, 562 234, Total per financial year - 264, 299 0, 000 3 251, 736 301, 736 50, 00 0 -

Programme 4 - Growth 17/18 to 18/19 1. Additional allocations for Chronic disease prevention and health promotion. 2. Additional funds of R 700 million for the NHI and the NHI was restructured, by centralizing the budgets previously allocated under Responsibilities (such as District Health Services) under Health Financing & NHI. 3. Units’ allocated capital budgets were reduced to allocate funds to Information Communication Technology to maintain current systems. 4. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 5. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Programme 5: Hospitals, Tertiary Health Services and HR Development Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 Compensation of Employees 130, 750 11 145, 181 Goods and Services 189, 878 (29) 134, 161 19, 962, 489 6 21, 100, 893 Capital 830, 177 2 843, 947 TOTAL 21, 113, 294 5 22, 224, 182 Transfers

SUBPROGRAMME Office of DDG: Programme 5 Health Facilities Infrastructure Management DISCRIPTION: EARMARKED R'000 2017/18 R'000 VOTED EARMARKED GRANTS VOTED 3, 692 2018/19 R'000 EARMARKED 3, 271 . 20, 1 IUSS, infrastructure management Health Facility Revitalization conditional grant. Nelson Mandela Children's Memorial Hospital National Tertiary Services conditional grant National Tertiary Services: DRG Western Cape conditional grant Hospital Management Human Resources for Health 2 - 5, 654, 495 4, 618 Total Programme 5 Total per financial year 5, 815, 694 4, 384 - 200 0 150, 000 11, 526, 145 12, 194, 661 - 2 - 6, 498 20, 867 - 2, 631, 849 6, 562 2, 784, 496 9, 077 127, 4 05 Forensic Chemistry Laboratories Violence, Trauma & EMS 891 9 948, 984 5, 155 21, 939 Health Professions Training & Development conditional grant Nursing services 33, 53 91 Health Facility Revitalization In-kind grant Tertiary Health Care Planning & Policy GRANTS 7, 149 145, 80 4 8, 497 147, 5 96 20, 911, 473 49, 115 8, 184 179, 33 21, 892, 25 6 2 52, 594 21, 10 4, 182

Programme 5 - Growth 17/18 to 18/19 1. Increase in Capital Asset and Goods & Services budgets for Forensic Chemistry Laboratories to address backlogs and improve turnaround times. 2. Both the in-kind grant as well as the conditional grant of the Health Facility Revitalization were cut. 3. Conversion of DRG allocation under Goods & Services and Capital budget under Programme 2 to conditional grant for Western Cape under Transfers & Subsidies. 4. Units’ allocated capital budgets were reduced to allocate funds to Information Communication Technology to maintain current systems. 5. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 6. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Programme 6: Health Regulation and Compliance Management Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 R'000 % R'000 Compensation of Employees 52, 369 23 64, 278 Goods and Services 36, 795 (19) 29, 866 1, 629, 998 3 1, 678, 961 Capital 2, 699 (10) 2, 441 TOTAL 1, 721, 861 3 1, 775, 546 Transfers

SUBPROGRAMME DISCRIPTION: EARMARKED R'000 2017/18 R'000 VOTED EARMARKED GRANTS VOTED 2018/19 R'000 4, Office of DDG; Programme 6 021 11, 7 10, 5 28 71 18, 9 Radiation Control 14, 2 56 18 9, Public Entities Management 9, 298 617 746, NHLS 789, 464 759 614, MRC 624, 961 829 133, SAHPRA 648 OHSC 711 125, 189 125, 129, 678 57, CCOD & Occupational Health GRANTS 6, 532 Food Control R'000 EARMARKED 61, 955 828 3, Compensation Fund Total Programme 6 Total per financial year Total for NDo. H Total FOR NDo. H per financial year 14 3, 718 44, 5 1, 682, 457 1, 726, 971 1, 110, 0 2, 332, 37 257 42, 625, 723 - 39, 183, 429 27 836 40, 4 1, 735, 119 1, 775, 546 1, 165, 0 2, 744, 81 336 47, 142, 866 - 43, 233 449

Programme 6 - Growth 17/18 to 18/19 1. The allocations to Departmental Agencies, namely Council for Medical Schemes, Office of Health Standards Compliance, South African Health Product Regulatory Authority and Compensation Commissioner, were cut. 2. Units’ allocated capital budgets were reduced to allocate funds to Information Communication Technology to maintain current systems. 3. Compensation of Employees budget was realigned in accordance with the filling of priority posts. 4. Budget cuts on Goods & Services across the Department results in lower G&S budgets.

Conditional Grants Direct Allocations 64

Conditional Grants Indirect Allocations 65

CONCLUSION q National Do. H Annual Performance Plan 2018/19 -2020/21 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 implementation of the National Health Insurance policy of South Africa, which commences during 2018/19 financial year.