NATIONAL DEPARTMENT OF HEALTH PRESENTATION TO THE STANDING

NATIONAL DEPARTMENT OF HEALTH PRESENTATION TO THE STANDING COMMITTEE ON APPROPRIATIONS 2015/16: QUARTER ONE PERFORMANCE Director General 02 SEPTEMBER 2015

Purpose Present Progress Report on the Annual Performance Plan 2014/15. The report is presented by the following programmes: 1. 2. 3. 4. 5. Programme 1 : Administration Programme 2: Health Planning and Systems Enablement Programme 3: HIV & AIDS, TB and MCWH Programme 4: PHC Services Programme 5: Hospitals, Tertiary Services and Workforce Development 6. Programme 6: Health Regulation and Compliance Management 2

Medium Term Strategic Framework (MTSF) 2014 -2019 The Department Annual Performance Plan is designed to deliver on the MTSF commitments, namely: Sub-outcome 1: Universal Health coverage progressively achieved through implementation of National Health Insurance Sub-outcome 2: Improved quality of health care Sub-outcome 3. Implement the re-engineering of Primary Health Care Sub-outcome 4: Reduced health care costs Sub-outcome 5: Improved human resources for health Sub-outcome 6: Improved health management and leadership Sub-outcome 7: Improved health facility planning and infrastructure delivery Sub-outcome 8: HIV & AIDS and Tuberculosis prevented and successfully managed Sub-outcome 9: Maternal, infant and child mortality reduced Sub-outcome 10 : Efficient Health Management Information System developed and implemented for improved decision making 3

Total Targets in the Annual Performance Plan of 2015/16 Programmes Quarterly Targets 6 monthly Targets Programme 1 5 2 Programme 2 Annual Targets Total targets 5 12 16 15 31 Programme 3 28 17 45 Programme 4 1 25 26 Programme 5 3 24 27 Programme 6 15 1 16 Total 69 86 157 2 4

Progress Report PROGRAMME 1 : ADMINISTRATION 6

Programme 1: Administration Strategic Objective Ensure effective financial management and accountability by improving audit outcomes Indicator Audit opinion from Auditor-General Annual Target: Unqualified Audit Opinion Audit opinion from Annual target: 3 Auditor-General for Unqualified audit Provincial opinions Departments of Health Number of Annual target: 9 provinces that submit reports against defined set of non-negotiable items on a monthly basis Actual performance Performance Rating NDo. H obtained unqualified Audit Achieved 3 Unqualified audit Achieved opinions for 2014/15 for Western Cape, Limpopo and North West Partially achieved 7 (out of 9) provinces submitted signed off reports. 7

Programme 1: Administration Strategic Objective Ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes Indicator Target Actual performance Performance Rating Average Turnaround times for recruitment processes Bi-annual Target: Average recruitment process turnaround time will be 4 months This is a biannual target. Figures will be consolidated end of 2 nd and 4 th quarters NDo. H vacancy rate Bi-Annual target: 5% 2% (2/98) were filled within four months as per FOSAD target 7% (7/98)of the vacant posts were filled within six months as Public Service Regulation of 2001 and 5% Percentage of Senior Managers that have entered into Performance Agreements with their supervisors Annual target: 98% 95% Achieved. 8 Achieved. Same above

Programme 1: Administration Strategic Objective Indicator Quarter Target Actual performance Ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes Develop and Implement Employee wellness programme that comply with Public Service Regulations (PSR) and Employee Health and Wellness Strategic Framework(EHWSF) Quarter target: EHW induction programme to Port Health employees Induction Schedule drawn to resume in July 2015 and meeting held with Environmental Health Partially Achieved Fully implement the Departmental Information Communication Technology (ICT) Service Continuity Plan by the 31 st of March 2018 Establish ability to access domain services outside the NDo. H premises Quarter target: Enter into a BCM agreement with SITA for transversal systems. Quarter target: Ascertain the implications of duplicating all the existing domain in a DR site. Quarter target: Procure hardware for Domain services DR site. BCM agreement with SITA for transversal systems approved and signed Achieved The requirements to duplicate the domain services were established Achieved First draft of the integrated communication strategiy and implementation plan, which includes a draft tool kit has been Partially Achieved 9 Performance Rating

Programme 1: Administration Strategic Objective Indicator Target Provide support for effective communication by developing an integrated communication strategy and implementation plan Develop an integrated communication strategy and implementation plan Annual Target: Communicatio n Toolkit developed to integrate messages A National Health Litigation Strategy development and implemented Develop National Health Litigation Strategy Quarter Target: The matter tabled for discussion in the National Legal Forum Actual performance Performance Rating 1. A guide on writing a Partially achieved: communication strategy for Annual target public health campaigns developed. 2. A guide to writing the Ministry's Persuasive Speeches 3. Communication strategy/plan guide (events specific) 4. MBOD and CCOD Communication strategy/plan and fact sheet for Project Ku. Riha There is a declaration Partially achieved emanating from the medico legal summit held on the 09 -10 March 2015. 10

Progress Report PROGRAMME 2 : HEALTH PLANNING AND SYSTEMS ENABLEMENT 11

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Achieve Universal Health Coverage through the phased implementation of the National Health Insurance(NHI implementation of the National Health Insurance (NHI). Indicator Target Actual performance White Paper on NHI Annual Target: Finalise and publish White Paper on NHI Partially achieved Legislation for NHI Annual Target: Publication of the White Paper Quarter target: Funding Modality for the National Health Insurance Fund including budget reallocation for the district primary health care (PHC) Annual target: Review of the 2015/16 dispensing fee in determining the 2016/17 maximum dispensing fee Draft White Paper has been prepared and is available for use in consultation purposes with National Treasury. The draft NHI Bill has been prepared. The draft concept document on the NHI Fund is available. Partially achieved The Draft dispensing fee for Pharmacists was published on 15 June 2015. Partially achieved Establishment of the National Health Insurance Fund Review Annual dispensing fee 12 Partially achieved

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Strengthen revenue collection by incentivizing hospitals to maximise revenue generation Indicator Target Actual performance Performance Rating Publish & implement Single Exit Price Adjustments Annually. Develop and implement a Revenue Retention Model (RRM) at central hospitals Annual Target: SEPA adjustment for 2015 Draft SEPA developed for publication in gazette in Q 2. Partially achieved Quarter Target Conduct a comparative analysis of the WC and FS Revenue Retention Model Annual Target: UPFS regulations gazetted and implemented Comparative analysis of Revenue Retention Models concluded. Achieved Draft regulations developed Partially Achieved Quarter Target: Consultation with Council for Medical Schemes (CMS) Consulted with the CMS regarding the draft specifications and data required. Achieved Develop regulations pertaining to Uniform Patient Fee Schedule Develop a Central Repository for the funded and unfunded patients 13

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Target Actual performance Improve Management and control of pharmaceutic al services Percentage of the review process of PHC Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Percentage of the review process of Hospital Level Paediatric Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Percentage of the review process of Hospital Level Adult Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Number of medicines review for the Tertiary & Quaternary EML Annual Target: 20% 5% Partially achieved : annual target Annual Target: 50% 28% Partially achieved : annual target Annual Target: 100% 46% Partially achieved annual target Quarter Target : 3 reviews Achieved 14

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Target Actual performance Performance Rating Establish a national stock management surveillance centre to improve medicine availability Implement an Electronic system for the early detection of stock outs of medicines at hospitals Quarter target : Site assessment completed in 10 central hospitals Site assessment completed in 6 central hospitals. The remaining four suite assessments done in quarter two Partially achieved : Implement an Electronic system for the early detection of stock outs of medicines at PHC facilities Quarter target : Electronic stock management system functional in 750 PHC facilities Achieved Establish a national surveillance centre to monitor medicine availability Quarter target : Business Plan for National surveillance centre developed and approved (quarter target) Draft Business Plan for National surveillance centre developed. Partially achieved 15

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Target Actual performance Improve contractin g and supply of medicines Establish Provincial Control Towers for the management of direct delivery of medicines Quarter Target: Project plan of the rollout of control tower developed for Eastern Cape and Free State Established Quarter Target: 275, 000 patients Achieved Project plan developed to implement FS and EC control towers. Quarter Target: 100% of contract expiring in Q 1 have been renewed at least 8 weeks prior to expiration. Nil contract expired in the Quarter 1. Quarter Target: Review of the Criteria for the approval of Pharmacy licences Achieved Criteria for the approval of Pharmacy licences reviewed Number of patients receiving medicines through the centralised chronic medicine dispensing & distribution system Contracts are available at least 8 weeks prior to expiration of outgoing tender Review Criteria for the approval of Pharmacy Licences Performance Rating Partially Achieved 210, 840 patients 16

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Target Actual performance Performance Rating Implement the Strategy to address antimicrobial resistance (AMR) Implement the National AMR strategy Quarter Target: Development of Terms of Reference developed. Achieved Regulate African Traditional Practitioners Establish Council for Traditional Practitioners Quarter Target: Advert placed for appointment of Council for Traditional Practitioners and Registrar Approval for advert finalised Partially Achieved 17

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Implement e. Health Strategy of South Africa through the development of the system design of patient information systems and implementati on Develop a complete System design for a National Integrated Patient based information system Target Quarter targets: Shared infrastructure to host Health Information Exchange established Number of PHC Quarter targets: health facilities with 350 PHC Facilities required IT receiving new IT Hardware for the Hardware reference implementation e. Health project Number of health Quarter targets: facilities 175 Facilities implementing improved patient administration and web based information systems information system Actual performance Performance Rating Shared Infrastructure established for hosting Health Information Exchange Developed and tested integration between HPRS and Tier. net. Achieved NDo. H has received quotations for seeking funding approval from National Treasury for the procurement of equipment from the Infrastructure grant. 50 PHC Facilities implemented the patient administration systems due to unavailability of required network connectivity in facilities Not Achieved 18

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Annual Target Actual performance Develop and implement a national research strategic plan National health research plan developed and implemented Annual target: National Health Research strategic plan approved Partially Achieved: Annual target Develop and implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy Integrated monitoring and evaluation plan implemented. Annual target: Fully defined comprehensive list of indicators and data elements approved At least one national evaluation conducted Draft 2 of the National Research Strategy document was produced after consultation with international reviewers. Lists of international and other indicators have been identified Branches engaged on identification of evaluations to be conducted The Department reviewed provincial APPs in second and third quarters of 2015/16 financial year Partially Achieved: Annual target The survey tool for outpatients/primary health care facilities has been fieldtested. National survey will be conducted once database and protocol has been finalised and provincial training in this regard has taken place. Partially Achieved: Annual target Number of Provincial Annual Performance Plans (APPs) aligned to the National Health System Priorities Implement Patient Quality of care survey tool. Conduct a National Survey to measure Patient Quality of care Annual target: 9 Provincial APPs reviewed and feedback provided to ensure health sector plans are aligned to the National Health System (NHS) Priorities Annual target: Patient Quality of care survey tool tested & piloted Annual target A national survey conducted to measure patient quality of care at all PHC facilities 19 Performance Rating Partially Achieved: Annual target

Programme 2: National Health Insurance, Health Planning and Systems Enablement Strategic Objective Indicator Annual Target Actual performance Domestication of international treaties and Implementation of multilateral cooperation on areas of mutual and measurable benefit Number of International treaties and multilateral frameworks implemented Annual Target: 3 international treaties and multilateral frameworks implemented Implementation of bilateral cooperation on areas of mutual and measurable benefit. Number of Bilateral projects implemented. Annual Target: 5 strategic bilateral projects implemented The Memorandum of Understanding between South Africa Partially Achieved: and African Union on contributing resources to support Annual EBOLA Outbreak in West Africa was signed on the 15 th target June 2015. South Africa is currently implementing one (1) cross border project of Phase two (II) of the SADC HIV and AIDS Trust Fund. The project is: Strengthening and consolidating the engagement of Religious leaders living with HIV to promote positive health, Dignity and Prevention. Facilitated the SADC HIV and AIDS Trust fund payment of R 3 792 802. 18 for 2015/16. Partially During 31 March to 3 April 2015, a delegation from the Ministry of Health of Zanzibar visited South Africa to share Achieved: Annual experiences on port health services. The visit resulted in target the development of Programme of Action (Po. A) on port health services as well as work plan to implement the Po. A. During 4 to 15 May 2015, Coordinated visit to South Africa by the delegation from Ministry of Health and Social Welfare of Tanzania visited South Africa to share information and experiences on how new emerging issues in Antiretroviral Therapy (ART) are implemented at community level. The visit resulted in sharing of information and best practices on new emerging issues in ART. 20

Mechanisms to fast-track performance A total of 50 facilities had internet connectivityagainst the first quarter one target of 175 PHC facilities. ØIn order to address the challenge is unavailability of broad band connectivity in PHC facilities that will enable implemented the webbased patient administration systems; NDo. H is actively working with Department of Telecommunications and Postal Services (DTPS) to address this challenge broadband internet connectivity in primary health care facilities of the NHI Pilot districts, as announced by the Minister of DTPS in his budget speech. 21

Progress Report PROGRAMME 3 : HIV AND AIDS, TUBERCULOSIS , MATERNAL, CHILD AND WOMEN’S HEALTH 22

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator To scale up combination of prevention interventions to reduce new infections Number of HIV test client 15 -49 years Number of Medical Male circumcisions performed Quarter Target: 2. 5 million Quarter Target: 250 000 Male Condoms Distributed Quarter Target: 175 million Quarter Target: 4. 125 million Quarter target: 3. 2 million Increase the numbers of HIV positive people on ARVs Female Condoms Distributed Total clients remaining on ART (TROA) at the end of the month Develop and implement the HIV Counselling and Testing (HCT) policy Monitor implementation of the HIV and AIDS Programme Target Annual target: HCT policy finalised and approved Quarter target: Quarterly report developed Actual performance Performance Rating 2, 600, 316 Achieved 137 640 (including MMCs performance by doctors in traditional settings and in the private sector). 181, 252, 919 Partially achieved 5, 211, 220 Achieved 3, 053, 294 Achieved The draft policy document has been prepared Achieved: Achieved Partially Final quarter one report available end of July 2015. achieved Annual report 2014/16 available 23

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator Target Actual performance Develop and implement HIV prevention strategy Annual Target: Strategy Developed and Approved and produce 9 provincial reports on its implementation Annual target: Guidelines developed and approved and produce 9 provincial reports on its implementation Annual Target: 52 district distribution plans for male and female condoms developed and implemented with 9 provincial progress reports Quarter Target: Quarterly HIV conditional grant reports produced Latest draft of the HIV prevention strategy has been prepared Develop and implement adherence guidelines for health programmes Facilitate development of district plans to support NDo. H male and female condom distribution strategy Monitor the implementation of the HIV and AIDS Conditional grant Annual Target : Annual HIV Conditional Grant Report produced Performance Rating Partially achieved: annual target It will be implemented from quarter two A draft plan is available for Gert Sibande. The plan is being finalised. Partially achieved: annual target Final quarter one report Partially Achieved was available for quarter one data. It was consolidated and submitted as per DORA timelines. Achieved Annual Evaluation report for 2014/15 produced 24

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator Annual Target Actual performance Undertake a massive TB screening campaign TB client 5 years and older screened at health facilities for TB symptoms rate Percentage of inmates screened for TB annually Annual Target: 50% 28. 5% Partially achieved: Annual target Annual Target: 75% 72. 7% Achieved: Annual targets Percentage of mines providing routine TB screening Annual Target: 60% 83. 2% achieved: Annual target 329, 448 Partially achieved: Annual target Number of Annual Target: 462 community members 000 in 6 Peri mining districts screened for TB Performance Rating 25

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator Annual Target Actual performance Improve Access to treatment TB client 5 years and older initiated on treatment rate TB Rifampicin Resistant clients treatment initiation rate TB new client treatment success rate Annual target: 85% 80% 94. 6% achieved: Annual targets 76. 6% Partially achieved: Annual targets Annual target: 83% 79. 9% Partially achieved: Annual target TB client loss to follow up rate Annual target: 5% 5. 9% Partially achieved: Annual target TB client death Rate Annual target: 6% 6. 4% Partially achieved: Annual target TB/HIV co-infected client on ART rate Annual target: 75% 74. 4% achieved: Annual target Strengthen patient retention in treatment and care TB/HIV Co-infection Performance Rating 26

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator Annual Target Actual performance Strengthen patient retention in treatment and care TB MDR client loss to follow up rate TB MDR client death Rate Annual Target: 16% Annual Target: 15% 18. 4% Partially achieved: Annual target 22. 8% Annual Target TB MDR treatment success rate Annual Target: 55% 43. 4% Partially achieved: Annual target 27

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective To reduce the maternal mortality ratio to under 100 per 100 000 live births. Indicator Performance Rating Actual performance Antenatal 1 st visit before 20 Quarter target: weeks rate 55% 54. 3% Achieved Mother postnatal visit within 6 days rate 70. 9% Partially Achieved 115. 6 per 100 000 live births Achieved Maternal mortality in facility ratio (annualised) To reduce the neonatal mortality rate to under 6 per 1000 live births. Quarter Target Inpatient Neonatal death rate (annualized) Monitor implementation of Maternal, Neonatal and Woman’s health programmes using the standardised dashboard reports Quarter target: 80% Quarter target: 123 per 100000 live births Quarter target: 11. 5 per 1000 Live Births Quarter target: Quarterly report produced with feedback provided to each provincial Do. H 13. 5 per 1000 live Not achieved: births. Mortality tends to be higher in the first quarter compared to other quarters Quarterly Dashboard Achieved report for 2014/15 shared with provinces on 9 July 2015 28

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Performance Rating Strategic Objective Indicator Target Actual performance Expand the PMTCT coverage to pregnant women by ensuring all HIV positive Antenatal clients are placed on ARVs and reducing the positivity rate to below 1% Antenatal client initiated on ART rate Infant 1 st PCR test positive around six week rate Develop provincial reports to track progress on the eliminations of mother-tochild transmission of HIV Annual target: 88% 91. 6% Achieved Quarter Target : 1. 8% 1. 6% Achieved Quarter Target: Conduct stocktaking workshops in all 3 provinces to monitor and evaluate progress towards elimination Quarter Target: 60% Stocktaking workshops will be conducted in quarter tw 44. 7% Not achieved Quarter Target: 55% 51. 8% Quarter Target: Draft CFP training manual Final draft 0 was piloted during master training in June 2015 Pharmacovigil ance form distributed to province in January 2015 Consultative Achieved meeting was held. To improve access to sexual and reproductive health services by expanding the availability of contraceptives. Couple year protection rate Cervical cancer screening coverage Develop Training manual for the implantation of Contraception and Fertility Planning (CFP) Policy Develop Pharmacovigilance system for adverse events for contraceptive implants Quarter Target: Pharmacovigilance information system implementation plan drafted Develop cervical cancer control Policy Quarter Target: Consultative process with relevant stake holders intitiated 29 Partially Achieved

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective To reduce underfive mortality rate to less than 23 per 1, 000 live births by promoting early childhood development Indicator Target Develop breast cancer Policy Quarter Target: Consultative process with relevant Stakeholders completed, and situational analysis completed Child under 5 years diarrhoea case fatality rate Child under 5 years pneumonia case fatality rate Child under 5 years severe acute malnutrition case fatality rate Confirmed measles case incidence per million total population Immunisation coverage under 1 year (annualised) Quarter Target: 3. 25% Actual performance Consultative Partially achieved meeting was held with technical group participants on 10 July 2015, and the report was finalised in July 2015 Achieved 2. 7% Quarter Target: 3% 1. 9% Achieved Quarter Target: 10% 10. 9% Partially Achieved Annual Target: <3/1, 000 0. 171/1, 000 population Achieved : Annual Target Quarter Target: ≥ 90% 90. 7% Achieved 30

Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective Indicator Annual Target Actual performance Contribute to health and wellbeing of learners by screening for health barriers to learning School Grade 1 screening coverage (annualised) School Grade 8 screening coverage (annualised) Annual Target 25% Annual Target 10% 42% To protect girl learners against cervical cancer HPV 1 st dose coverage Annual target: 80% HPV 2 nd dose coverage Annual target: 80% Achieved: Annual target 16% Vaccinations to be administered in the second and fourth quarters 31

Mechanisms to fast-track performance • NDo. H will strengthen data management systems for collection of data on medical male circumcisions conducted outside public health facilities to ensure that all MMCs conducted are reported on • The stocktaking workshops on PMTCT were postponed in Q 1 to implement birth PCR testing; all 9 provincial stocktaking workshops will be completed in Q 2 and Q 3 • To address the high neonatal death rate in Q 1, data inaccuracies will be addressed urgently (hospitals reported deaths but no deliveries); training of master trainers in management of sick and small babies has commenced – training to be cascaded in all provinces; NDOH to monitor implementation of provincial newborn care plans • To address the high TB MDR client death rate the NDOH is developing a mhealth based tracing system which links the lab diagnosis to patient tracers to close the gap between diagnosis and initiation on treatment; expansion of access to new TB medication (bedaquiline and lineozoid) should improve treatment outcomes

Progress Report PROGRAMME 4 : PRIMARY HEALTH CARE SERVICES 33

Programme 4: Primary Health Care Services 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 Indicator Annual Target Actual performance Performance Rating Number of districts with uniform management structures for primary health care facilities. Number of primary health care facilities with functional clinic committees/ district hospital boards. Number of functional WBPHCOTs Annual target: 15 Districts with uniform management structures. Annual target: 1000 health care facilities with functional clinic committees. Currently evaluating to determine existing management structures Partially achieved : Annual target 1209 Clinics with functional clinic committees Partially achieved : Annual target; 2000 functional WBPHCOTs 1740 functional WBPHCOTs Partially achieved : Annual target Number of primary health care clinics in the 52 districts that qualify as Ideal Clinics Annual target; 500 primary health care facilities in the 52 districts qualify as Ideal Clinics Preparatory work underway in facilities; 1234 clinics assessed during first quarter 1 PHC clinic qualified as ideal clinic out of Partially achieved : Annual target 34

Programme 4: Primary Health Care Services Strategic Objective Improve environmental health services in all 52 districts and metropolitan municipalities in the country. Performance Rating Indicator Annual Target Actual performance Number of municipalities that meet environmental health norms and standards in executing their environmental health functions. Annual target: 20 Municipalities meet environmental health norms and standards in executing their environmental health functions Annual target: A national hand hygiene strategy developed Annual target: Health care risk waste regulations finalised and tools for audit implementation developed Annual target: Operating framework for National Health Commission developed Audits of the Partially municipalities have been achieved : completed. In process of Annual target analyzing data to determine compliance Hand hygiene campaign rolled out in all nine (9) provinces Ensure compliance with Health Waste management regulations Establish an Establish National Health intersectoral Commission forum that will plan and oversee the implementation of interventions across all sectors. First draft completed. It is in circulation for comment Health care risk waste regulations approved by the Minister. In process of developing audit tool Partially achieved : Annual target Draft framework is ready. Partially Will present this to achieved : executive management Annual target in the second quarter 35

Programme 4: Primary Health Care Services Strategic Objective Indicator Annual and Quarter Target Actual performance Reduce risk factors and improve management for Non. Communicable Diseases (NCDS) by implementing the Strategic Plan for NCDs 2012 -2017 Number of National government Departments oriented on the National guide for healthy meal provision in the workplace Regulations relating to Labelling and packaging of tobacco products and smoking indoor and outdoor public places developed Annual target: 20 National Departments Awareness on risk factors relating to excessive salt intake, excessive sugar intake, physical inactivity and , alcohol related harm created Random Monitoring of salt content in foodstuffs conducted Annual target: Content of campaign finalised and ready for implementation The draft National guide for healthy meal provision in the workplace has been developed and circulated for comment. First draft submitted to Legal Services for onward submission to State Legal Advisors. Meeting held to review State Law advisors inputs on 22 May 15 In process of awarding a tender for the content development in cooperation with programme 3 managers Annual target: Tobacco Act amended Annual Target : Random samples from each of 13 regulated food category tested, reported on and corrective action taken Performance Rating Partially achieved : Annual target Obtained agreement from Not achieved laboratories on how testing will be done and a budget drawn up. 36

Programme 4: Primary Health Care Services Strategic Objective Improve access to and quality of mental health services in South Africa Indicator Annual Target Actual performance Number of people screened for high blood pressure as part of comprehensive health screening Annual target: 8 million people screened for high blood pressure Annual target: 8 million people screened for raised blood glucose levels Annual target; 28 % of 16. 5% (prevalence) people screened for mental disorders Annual target: 16% of mental health inpatient units attached to designated district and regional hospitals 2 468 177 Achieved : Annual target 1 4113 541 Partially achieved : Annual target 290690 out of 664000 annual target Partially achieved : Annual target 16 504 out of 66400 annual target Partially achieved : Annual target Percentage people screened for mental disorders Percentage of people treated for mental disorders Percentage of mental health inpatient units attached to designated district and regional hospitals 38/274 (14%) of mental health inpatient units attached to general hospitals are under planning and construction 37 Performance Rating Partially achieved : Annual target

Programme 4: Primary Health Care Services Strategic Objective Improve access to disability and rehabilitation services through the implementation of the framework and model for rehabilitation and disability services Indicator Annual Target Mental health teams established in each district Annual target: Strategy for establishment of specialist mental health teams approved by the TAC NHC Annual target: Resources allocated for the approved Framework and Model Number of Districts implementing the framework and model for rehabilitation services Actual performance Performance Rating Draft Strategy is Partially achieved : being circulated for Annual target comment Framework has been approved by NHC. Costing is in progress 38 Partially achieved : Annual target

Programme 4: Primary Health Care Services Strategic Objective Indicator Annual and Quarter Target Prevent avoidable blindness Cataract Surgery Rate Annual target: 1 500 operations per million uninsured population Eliminate Malaria by 2018, so that there is zero local cases of malaria in South Africa Malaria incidence per 1000 population at risk Quarter Target: 0. 2 malaria cases per 1000 population at risk (quarter) Annual target: 5 malaria targeted districts reporting malaria cases within 24 hours of diagnosis Number of districts targeted for malaria elimination reporting malaria cases within 24 hours of diagnosis Actual performance 217 per million uninsured population 0. 055 (533 confirmed local cases) Partially achieved : Annual target Achieved Partially achieved : 10% of malaria cases in 1 district Annual target reported within 24 hours 39

Programme 4: Primary Health Care Services Strategic Objective Indicator Annual and Quarter Target Actual performance 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 Teams capacitated to respond to zoonotic, infectious and foodborne disease outbreaks Number of high risk population covered by the seasonal influenza vaccination Held a workshop planning meeting on 8 May. Submission for training approved. Partially achieved : Annual target 513718 vaccines administered to high risk individuals Partially achieved : Annual target Establish a coordinated disease surveillance system for Notifiable Medical conditions (NMC) A strategy and plan for the integration of disease surveillance systems for NMC Develop and implemented Conduct Annual National HIV Antenatal Prevalence Survey conducted Annual target: 9 Provincial Outbreak Teams capacitated to respond to zoonotic, infectious and foodborne disease outbreaks Annual target: 800 000 high risk individuals covered with seasonal influenza vaccination Annual target: Strategy for the integration of disease surveillance systems for NMC approved and implementation plans developed Annual target: 2015 National HIV prevalence report produced Partially A list of stakeholders achieved : to be consulted in the drafting of the strategy Annual target compiled and meeting arranged Submission prepared for the 2015 survey to be conducted in the third quarter of 2015 41 Partially achieved : Annual target

Progress Report PROGRAMME 5 : HOSPITALS, TERTIARY SERVICES AND WORKFORCE DEVELOPMENT 41

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Target Actual performance Increase capacity of central hospitals to strengthen local decision making and accountability to facilitate semi-autonomy of 10 central hospitals Ensure quality health care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Number of central hospital with full delegated authority Annual target: 10 central hospitals with full delegated authority Task team on delegation Partially achieved : framework for central hospitals established and Annual target two meetings held to prepare hospitals Number of Hospitals that comply fully with the National Core Standards 3 Central hospitals (Steve Partially achieved : Biko, Groote Schuur and Tygerberg Hospitals) Annual target fully complied with the National Core Standard in 2014/15 Ensure equitable access to tertiary service through implementation of the National Tertiary services plan Number of gazetted hospitals providing the full package of Tertiary 1 Services Annual target: Full compliance with the National Core Standards in 8 Central hospitals and 5 Tertiary Hospitals Annual target additional tertiary hospitals (Pietersburg, Frere, Kimberley and Ngwelezana) providing the full package of Tertiary 1 services Public Health Registrar appointed to finalise tertiary services plan Plan of action developed by the National Hospital Coordinating Committee 42 Performance Rating Partially achieved : Annual target

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Annual Target Actual performance Performance Rating Improve quality of health infrastructur e in South Africa Number of facilities maintained, repaired and/or refurbished in NHI Districts Annual target: 198 facilities Partially achieved : Annual target Number of facilities maintained, repaired and/or refurbished outside NHI pilot Districts Annual target: 310 facilities Refurbishment in process of 23 Clinics in the Eastern Cape. In tendering process of appointment of contractors & Professional Services Providers for maintenance. 188 facilities in Renovations, Rehabilitation or Refurbishments phase. Number of clinics and Community Health Centres constructed or revitalised Number of hospitals constructed or revitalised Annual target: 35 9 Clinics & 3 CHC's in handover phase Partially achieved : Annual target: 2 8 Hospitals in handover phase Partially achieved : Annual target Number of new facilities that comply with gazetted infrastructure Norms & Standards Develop a Infrastructure Monitoring System Annual target: 37 new facilities 8 new facilities under construction with the Inkind Grant Partially achieved : Annual target: Infrastructure Monitoring System fully developed and tabled at NHC Monitoring systems has been developed Partially achieved : Annual target 43 Partially achieved : Annual target

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Develop and implement health workforce staffing norms and standards Develop guidelines for HRH norms and standards using the WISN methodology Number of facilities benchmarked against PHC staffing normative guidelines Number of RTC's established Target Actual performance Performance Rating Annual target; Guidelines for HRH Norms for District and specialised hospitals developed. Unpacking of activities leading to production of staffing norms for district and specialised hospitals Partially achieved : Annual target; 1000 About 508 facilities have started with the process of benchmarking against PHC staffing normative guides based on the implementation Guideline in 6 out of 9 provinces Orientation workshops held with provincial representatives Achieved : Annual target 5 RTCs established Achieved: Annual Target Annual target: Tertiary, Regional and Central Hospital managers oriented on WISN tool and methodology Annual target: 5 RTCs established 44 Partially achieved

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Target Actual performance Performance Rating Professiona lise Nursing training and Practice implementa tion of the objectives of the Nursing Strategy Public nursing colleges offering new nursing programmes (in line with National Qualifications Framework) Quarter Target: A national policy for nursing education developed in the context of bedside training Quarter Target: A Nursing and midwifery educators’ training and development programme developed Quarter target: Provincial Nursing structures to give authority over nursing and midwifery services tabled at NHC Components of the national nursing education policy have been defined Partially achieved Audit of capacity of nurse educators completed Achieved Recommended structures for authority for nursing at provincial levels identified and reviewed Partially achieved Develop a Nursing and Midwifery educators' training and development programme Develop a standardised Nursing leadership structure for Provincial Do. H 45

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Annual Target Actual performance Performance Rating Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS). Number of provinces that are compliant with the EMS regulations. Annual target: EMS Regulations and compliance checklist gazetted for implementation. Annual target: Policy on education and training of EMS Personnel published. Circulation of the Gazetted Regulations. Partially achieved: Annual target The draft policy was presented and approved at the NHC TAC. The migration plan to operationalise the policy was drafted Draft regulations completed Partially achieved: Annual target Final draft document prepared Partially achieved: Annual target Publish Policy on education and training of EMS Personnel published for implementation Develop regulations for Emergency Care Centres Publish Regulations for EMS in Mass Gatherings Annual target: Regulations on Emergency Care Centres Drafted Annual target: EMS regulations in mass gatherings published for public comment and implementation 46 Partially achieved: Annual target

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Annual Target Actual performance To eliminate the backlog of blood alcohol and toxicology tests by 2016 Number of Blood Alcohol reports produced Annual target: 120 000 28, 656 Partially achieved: Annual target Number of Toxicology reports produced Annual target: 4500 583 Partially achieved: Annual target To provide food analysis services Number of food tests performed. Annual target: 4000 3417 Partially achieved: Annual target Develop a monitoring system to effectively measure turnaround time of tests conducted at Forensic Chemistry Laboratories Annual target: A standardised workflow and monitoring system developed for all 3 tests and implemented at 4 forensic chemistry laboratories A draft standardised workflow and monitoring system has been prepared Partially achieved: Annual target 47

Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective Indicator Target Actual performance Regulations for the Rendering of Forensic Pathology Services promulgated Annual Target: Regulations on for the Rendering of Forensic Pathology Services reviewed and Published for public comments Annual target: Review and Finalise the Scope of Practice Guidelines for the rendering of Forensic Pathology Services and Publish for Implementation NFPSC meeting held on 25 March 2015 agreed to review the regulations under priority 1 item Partially achieved: Annual target NFPSC meeting held on 25 March 2015 agreed to review the scope of practice under priority 1 item. Questionnaire developed for provinces to gather information on what scope of practice is done by the FPO's Mpumalanga province identified 4 new designated facilities. Western Cape province identified 7 new designated facilities Partially achieved: Annual target Publish Scope of Practice Guidelines for the rendering of Forensic Pathology Services Number of Health Facilities that are designated to render services for the management of sexual and related offences Annual target: 60 additional facilities designated 48 Partially achieved: Annual target

Progress Report PROGRAMME 6 : HEALTH REGULATION AND COMPLIANCE MANAGEMENT 49

Programme 6: Health regulations and Compliance Management Strategic Objective Indicator Annual and Quarter Target Actual performance Establish the South African Health Product Regulation Authority (SAHPRA) Establish SAHPRA as a public entity Establish Institute of Regulatory Science (IRS) providing training Regulate Medical devices, IVDs, cosmetics and expand on regulation of Complementary and Alternative Medicines (CAMS) Annual target: SAHPRA Act (Bill 6 of 2014) Promulgated , and transitional plan from MCC to SAHPRA developed Quarter target: Project team appointed Finalized corrections to the Bill as per directive of Portfolio Committee of Health Project team appointed Quarter Target: Evaluate stakeholder comments on Medical Devices and IVDs and CAMs Regulations in-house • Cosmetics: None Quarter Target: 15 % of priority medicines registered NCE = 36 month; Generics = 28 month Evaluated Achieved stakeholders comments and prepared new set of Medical Device and IVD Regulations Improve registration turnaround times of ARV’s, TB, oncology and vaccines to treat and prevent high burden of diseases 13% (88 human medicines registered of which 7 were priority medicines) 50 Performance Rating Partially Achieved Partially achieved

Programme 6: Health regulations and Compliance Management Strategic Objective Indicator Quarter Target Actual performance Establish a MOU with Department of Agriculture, Fisheries and Forestry’s (DAFF)` Quarter Target: Identify tests to be carried out by internal and external laboratories Quarter Target: Prepare draft Cosmetic regulations Quarter Target: Report on occupational health policy framework Quarter Target: Document on structure, organogram and activities of the occupational health cluster Tests identified to be carried out on foodstuffs for internal and external laboratories Achieved Cosmetic Regulations prepared Achieved Policy document drafted. Achieved No structure and organogram document developed until NAPHISA structure finalised Not achieved Develop Regulations for Cosmetic products To develop the policy and legislative framework for occupational health and compensation To establish an occupational health cluster Review occupational health legislative framework Occupational health cluster established and functional 51 Performance Rating

Programme 6: Health regulations and Compliance Management Strategic Objective Indicator Target Actual performance To provide occupational health and compensation services through the development of One Stop Service centres in provinces To establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance Number of provinces with One Stop Service Centres to deliver occupational health and compensation services Quarter target : 1 preparatory meeting with stakeholders and role-players in Northern Cape 3 preparatory meetings have been hosted in Northern Cape and 1 in Limpopo Develop legal framework to establish National Public Health Institutes of South Africa (NAPHISA) Number of applications certified at MBOD as compensable disease claims Quarter target: Finalise legislative framework for NAPHISA Quarter target: 1500 Legislative framework being reviewed with legal section and includes amendments to NHLS Act 1137 Partially achieved Number of compensable disease claims paid by CCOD other than pensioners Quarter target: 500 447 partially achieved 52 Achieved Partially achieved

Programme 6: Health regulations and Compliance Management Strategic Objective Indicator Target Actual performance Improve oversight and Corporate Governance practices by reviewing the Governance Framework and Implementati on Plan biennially. Number of Health entities’ and Statutory Health professional Councils with fully functional and compliant to good Governance practices (structures, Finance, HR , Supply Chain Management policies) and also respond to health sector priorities Develop and implement a performance management system for board members Quarter target: Checklists for measuring functionality of health entities and professional councils developed and consulted Quarter target: Standardised performance management system for board members drafted and circulated for consultation Quarter target: None Draft Checklist for Entities to include specific internal control system circulated for input. Number of newly appointed boards inducted and trained Partially Achieved Draft performance assessment system for board members developed. Partially Achieved Call for nominations for candidates for the new term of Office of the Professional Boards of the HPCSA published. The panel to consider and make recommendations for appointment has been appointed by the Minister. Partially Achieved 53

Programme 6: Health regulations and Compliance Management Strategic Objective Indicator Quarter Target Actual performance Performance Rating Develop and implement Dashboard to monitor entities performance and compliance to legislative prescripts Quarter target: 3 Dashboards developed and piloted (1 per entity or statutory council) Quarter target: Standardised reporting template drafted and circulated for consultation Dashboard developed for NHLS, SAMRC and CMS finalized Achieved Reporting template developed, presented and circulated to Departmental representatives serving on Boards/Councils Achieved Develop a reporting template to enable feedback to the executive authority 54

Mechanisms to fast-track performance ØDocument on structure, organogram and activities of the occupational health cluster have not been finalised until the structure of NAPHISA is finalised. ØRegistration turnaround times of ARV’s, TB, oncology and vaccines to be improvoed through training of additional evaluators, propose prioritisation of existing applications based on public health needs. 55

Summary of Quarter One 2015/16 APP Performance Programmes Quarterly Targets Total Achieved Total Partially Achieved Total Not Achieved Programme 1 5 2 3 0 Programme 2 16 7 8 1 Programme 3 28 15 11 2 Programme 4 1 1 Programme 5 4 1 2 Programme 6 15 8 6 1 Total 70 32 31 6 56

FIRST QUARTER EXPENDITURE 2015/16 57

Background Quarterly performance briefings for the Committee. The Department of Health recorded an expenditure of R 8. 70 billion or 23. 9% of an allocation of R 36. 47 billion at the end of the first quarter of the 2015/16 financial year. The table below explains the financial performance for each programme. 58

Financial Performance per programme 59

Reasons for variances Note 1 – Programme 1 - Administration §The outstanding invoices for office accommodation for the 2014/15 financial year were processed during the first quarter of 2015/16; §The renewal of the IT-related licences is due in the fourth quarter of the year; §The maintenance of Civitas' security equipment amounting to R 4 million is scheduled to take place during November 2015; §Electronic boards, digital recording equipment and other capital assets were ordered but not yet received and paid. 60

Reasons for variances Note 2 – Programme 2 – National Health Insurance, Health Planning and Systems Enablement NHI Direct Grant spending low due to: • As per operational plans the SCM processes were planned to be finalised by end of Quarter 1 – Improvements have been in recorded in quarter 2 with spending at 16%; – Procurement plans have been delayed in many pilot districts; – Capacity constraints continue to plague some of the pilot districts; – Some districts have low levels of financial delegations; – Delays by appointed suppliers to deliver key equipment/kits for the MWBOTs for which contracts have already been awarded. 60

Reasons for variances - Continue Note 2 – Programme 2 – National Health Insurance, Health Planning and Systems Enablement §The tender for the printing and publication of the Essential Medicines List will be paid in the second quarter of the year; §The planned publication of the STG of PHC could not be finalized during the 1 st quarter due to a delay in the contracting of a printing service provider; §The appointment of Health Practitioners at the NHI pilot sites is complete and it is expected that the expenditure increase accordingly; §Contract for mid-level workers not finalized during the 1 st quarter.

Reasons for variances - Continue Note 3 – Programme 3 – HIV and Aids, TB, Maternal and Child Health §The National TB Meeting was postponed from May until September 2015 as the provinces were developing district improvements plans to implement the 90, 90 targets for HIV and TB; §There were delays in printing the Saving Mothers Report (softcopies of the report have been distributed); §Payment for the printing of the TB Patient Treatment Cards has not been effected as less than half the order has been delivered. Payment will be made once the full order has been delivered. 63

Reasons for variances - Continue Note 4 – Programme 4 – Primary Health Care Services §The project on Regulatory Impact Assessment on the Control of Marketing Alcohol Beverages Bill is not finalized yet; §The printing of the Road-to-Health booklets is not finalized; §The development of clinical guidelines on Management of Co-morbidity Psychiatric and Substance Abuse is taking longer than expected; §Developing procurement processes and guidelines in line with PFMA requirements to be finalised. 64

Reasons for variances - Continue Note 5 – Programme 5 – Hospital, Tertiary Services and Human Resource Development §Liquid chromatography systems, nitrogen analyser and LIMS server are not yet delivered. Delivery expected in 2 nd quarter; §Construction of new clinics and relocatable doctor consulting rooms ongoing. See progress on PICC expectations. 64

Reasons for variances - Continue Note 6 – Programme 6 – Health Regulation and Compliance Management §File servers and steel shelving was ordered for MCC but not delivered during the 1 st quarter. 65

Reasons for variances - Continue Note 7 – Goods and Services expenditure is R 219, 9 million or 13, 9% of the budget of R 1, 5 billion. §Spending on the Human Papilloma Virus vaccines did not occur in Q 1 because the vaccine is administered in two years each calendar year - the first dose is administered in February/March and the second dose in August/September. §The South African Demographic Health Survey is running over three financial years. The first payments to this project are anticipated to flow in the latter half of the year; 67

Reasons for variances - Continue Note 7 – Goods and Services §The printing of the Tuberculosis Pamphlets in Braille has been delayed because of the poor quality of the format and layout (not approved by the Society for the Blind), the procurement will be done through the Society to ensure compliance with quality standards. §WHO membership fees will be paid in the 4 th quarter. 68

Reasons for variances - Continue Note 8 – Payment of Capital Assets The renewal of the IT-related licences is due in the fourth quarter of the year; §File servers and steel shelving was ordered for MCC but not delivered during the 1 st quarter; §The maintenance of Civitas' security equipment amounting to R 4 million is scheduled to take place during November 2015; §Electronic boards, digital recording equipment and other assets were ordered but not yet received and paid; §Liquid chromatography systems, nitrogen analyser and LIMS server are not yet delivered. Delivery expected in 2 nd quarter; §Construction of new clinics and relocatable doctor consulting rooms ongoing (PICC progress). 69

CONDITIONAL GRANTS Conditional Grants expenditure as at 30 June 2015: ØTotal CG spending is at 22. 6 % or R 7. 2 bn against total original budget of R 31. 8 bn. Ø The overall spending of the Provinces is not on par with the current norm of 25%. Ø The major contributors to under spending are: • National Health Insurance Grant (6. 5%) • Health Facility Revitalisation Grant (19%) Ø HPTDG, NTSG & CHIV/AIDS spent within the acceptable norm at 26. 1%, 24. 0% and 22. 5% respectively. 70

Expenditure Summary Per Grant (Schedule 4 and 5 grants) 71

Health Professions Training Grant 72

Health Professions Training Grant § Overall spending has improved this financial year from 18. 9% (2013/14) and 24. 4% (2014/15) to 26. 1% and is within the norm. § All provinces spent within the acceptable norm with the exception of EC and FS that spent 18. 4% and 19. 1% respectively. § The under spending for the two provinces is attributed to: ü Delays in recruitment process for Registrars ü Dual registrar intake (January and July intake) 73

National Tertiary Services Grant 74

National Tertiary Services Grant § Overall spending has improved this financial year from 20. 2% (2013/14) and 23. 9% (2014/15) to 24. 0% and is within the acceptable norm. § All provinces spent within the acceptable norm with the exception of LP, MP and KZN that spent 22. 0% and 17. 9% and 19. 8% respectively. § The under spending for the three provinces is attributed to: ü PERSAL linkages ü Expenditure for salary adjustment not yet effected. ü Delays in supply chain management processes (changing from quotation to contract for pharmaceuticals) ü Delays on supplier delivery. 75

Comprehensive HIV/AIDS Grant 76

Comprehensive HIV/AIDS Grant § Overall spending has improved this financial year from 20. 7% (2013/14) and 20. 2% (2014/15) to 22. 5% and is within the acceptable norm. § All provinces spent below the norm with the exception of EC and KZN that spent 25. 2% and 26. 6% respectively. § The under spending is attributed to: ü Centralized delegations at Provincial Treasury. ü Delays in recruitment processes and supplier delivery lead time (condoms). ü Late submission of invoices by suppliers. ü Moratorium on filling of posts ü Outstanding accruals for key accounts (NHLS, condoms and drugs). 77

Health Facility Revitalisation Grant 78

Health Facility Revitalisation Grant § Overall spending has improved this financial year from 14. 2% (2013/14) & 17% (2014/15) to 19. 0% and is below the norm. § All provinces spent below the norm with the exception of GP and LP that spent 28. 9% and 37. 3% respectively. § The under spending is attributed to: ü Slow SCM processes (tender processes). ü Centralised delegations at provincial treasury. ü Poor performance of contractors. ü Inability to attract scarce skills – some projects not initiated. ü Cancellation of contracts and sourcing of new contractor. 79

National Health Insurance Grant 80

National Health Insurance Grant NHI Direct Grant spending low due to: • As per operational plans the SCM processes were planned to be finalised by end of Quarter 1 – Improvements have been in recorded in quarter 2 with spending sitting at 16% – Procurement plans have been delayed in many pilot districts – Capacity constraints continue to plague some of the pilot districts – Some districts have low levels of financial delegations – Delays by appointed suppliers to deliver key equipment/kits for the MWBOTs for which contracts have already been awarded 80

National Health Grant (Schedule 6 – Indirect Grant) 82

INTRODUCTION TO PROGRESS (PICC SUMMARIZED REPORT) AND CASH FLOW ANALYSIS –IN KIND GRANT 2015/16 F/Y-Q 1 § In-Kind budget = R 913 m, 146 multi and single Projects § Delays due to new approach to Ideal Clinics § Delays due to magnitude of procurement process § Several innovative initiatives § Contract for mid-level workers not finalized during the 1 st quarter. 83

Progress on In Kind Grant projects (PICC summarized report) Q 1 84

Progress on In Kind Grant projects (PICC summarized report) Q 1 85

Progress on In Kind Grant projects(PICC summarized report) Q 1 86

Progress on In Kind Grant Projects (PICC summarized report) Q 1 87

DOCTOR’S CONSULTING ROOMS Cumulative Cash flow, (R 000) 160, 000 140, 000 120, 000 100, 000 80, 000 60, 000 40, 000 20, 000 0 1 03 20 1 6/ /0 02 6/ /0 1 1 20 1 01 20 1 6/ /0 12 5/ /0 1 1 20 1 11 5/ /0 20 1 10 5/ /0 1 1 20 1 5/ 09 /0 1 20 1 08 20 1 5/ /0 07 5/ /0 1 1 /0 20 1 06 20 1 5/ /0 05 5/ 20 1 5/ 04 /0 1 1 2015/04/0 2015/05/0 2015/06/0 2015/07/0 2015/08/0 2015/09/0 2015/10/0 2015/11/0 2015/12/0 2016/01/0 2016/02/0 2016/03/0 1 1 1 Doctor's Consulting Room General 0 3, 408 5, 680 42, 507 79, 748 117, 741 123, 189 128, 287 137, 244 141, 579

IDEAL CLINIC 160, 000 140, 000 Cumulative planned cash flow (R 000) 120, 000 100, 000 80, 000 60, 000 40, 000 20, 000 0 Ideal Clinic Apr-15 4, 756 May-15 8, 095 Jun-15 14, 490 Jul-15 20, 084 Aug-15 29, 369 Sep-15 44, 116 Oct-15 59, 545 Nov-15 75, 045 Dec-15 90, 545 Jan-16 106, 045 Feb-16 121, 945 Mar-16 137, 845

COMMUNITY HEALTHCARE CENTRES 6, 000 Cumulative planned cash flow (R 000) 5, 000 4, 000 3, 000 2, 000 1, 000 0 Ideal CHC Apr-15 0 May-15 0 Jun-15 0 Jul-15 0 Aug-15 170 Sep-15 170 Oct-15 170 Nov-15 170 Dec-15 1, 420 Jan-16 2, 670 Feb-16 3, 920 Mar-16 5, 170

HOSPITAL BUILDING PROGRAMME 700, 000 Cumulative planned cash flow (R 000) 600, 000 500, 000 400, 000 300, 000 200, 000 100, 000 0 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 May-15 Hospital building (General) 5, 455 13, 758 27, 254 37, 254 52, 093 76, 856 90, 068 Hospital building (Sakhiwo) 0 0 0 44, 000 79, 000 Hospital building (Flagship) 0 0 0 0 Dec-15 Nov-15 106, 254 135, 000 20, 000 Jan-16 Feb-16 Mar-16 Dec-15 121, 446 136, 291 148, 765 157, 815 176, 000 233, 000 248, 000 60, 000 100, 000 140, 000 180, 000

NURSING EDUCATION INSTITUTION (COLLEGES) 70, 000 Cumulative planned cash flow (R 000) 60, 000 50, 000 40, 000 30, 000 20, 000 10, 000 0 Nursing Education Institution Apr-15 384 May-15 3, 061 Jun-15 4, 782 Jul-15 9, 540 Aug-15 15, 070 Sep-15 20, 630 Oct-15 26, 230 Nov-15 31, 830 Dec-15 38, 430 Jan-16 45, 030 Feb-16 51, 630 Mar-16 59, 230

MAINTENANCE 350, 000 Cumulative planned cash flow (R 000) 300, 000 250, 000 200, 000 150, 000 100, 000 50, 000 0 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 May-15 Maintenance (General) 0 0 4, 858 17, 101 29, 344 30, 344 54, 344 83, 844 112, 344 Maintenance (KZNl) 0 0 0 0 0 15, 000 30, 000 45, 000 Maintenance (Generator) 0 0 0 0 0 5, 000 10, 000 15, 000 Maintenance (Ideal Clinic) 0 2, 462 6, 393 25, 327 40, 327 55, 327 70, 327 85, 327 100, 327 115, 327 130, 327 145, 327

PROFESSIONAL AND TECHNICAL SUPPORT 120, 000 Cumulative planned cash flow (R 000) 100, 000 80, 000 60, 000 40, 000 20, 000 0 Professional & Technical Support Apr-15 5, 448 May-15 10, 040 Jun-15 21, 269 Jul-15 32, 130 Aug-15 40, 830 Sep-15 49, 530 Oct-15 58, 230 Nov-15 66, 930 Dec-15 75, 630 Jan-16 84, 330 Feb-16 Mar-16 92, 930 101, 530

IN-KIND TOTAL • Low road: Expenditure amounts to R 860 m (potential under spending of R 53 m) • High road: Expenditure amounts to R 1 348 m (potential over spending of R 435 m)

SUPPLIER PAYMENT PERIOD 1. Monthly statistics on late payments relating to the 2014/2016 financial year are as follows: Month Number of invoices paid late Value of invoices paid late April 2015 1 R 24, 307. 08 May 2015 1 R 129, 418. 00 0 0 July 2015 0 0 Total 2 R 153, 725. 08 June 2015 96

SUPPLIER PAYMENT PERIOD 2. The results can be attributed to the following actions; § A circular under signature of the DG was distributed to all NDOH staff to raise the awareness of invoices being paid within 30 days; § Monthly letters are being issued for signature of the DG to units responsible for late payments; § Orders are not being placed if bank details of service providers are not active on the system; § Funding are being confirmed before placing orders. 97

SUPPLIER PAYMENT PERIOD 3. The department is currently in process of procuring an invoice tracking system after funding was secured which will further contribute in an reduction in late payments. The invoice tracking system will be used as an early warning system to flag all invoices reaching a preset number of days (e. g. 14 days). 4. It is trusted that the abovementioned input will suffice. 98

The End 99