North West Province Department of Health Budget Hearing

North West Province Department of Health Budget Hearing presentation Portfolio Committee Parliament 13 May 2001

Presenters • Mrs R Hlabatau – Chief Financial Officer • Dr T G K Oosthuizen – Acting Chief Director Health Service Delivery and Strategic Health Programs • Mr P Netshipale – Director Primary Health Care Programs and Communicable Diseases

STRATEGY • The Department reviewed its strategic plan during October 2001 • New focused strategic goals, objectives and high level activities were developed as discussed in attached strategic plan

The Vision Optimum health for all individuals and communities in the North West Province.

The Mission To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through

Value statement • Community involvement and partnerships • Batho Pele Principles and the Patients’ Rights Charter • Innovation and performance driven, • And by valuing our people and their diversity.

Strategic Goals 1. Providing quality health services 2. Providing accessible, equitable and affordable comprehensive primary health services 3. Well functioning and competitive hospital services 4. Improving the health status of communities through implementation of integrated health programs 5. Well managed and effective district health system

Strategic Goals 6. Competent, empowered and performance focused employees 7. Appropriate and effective organisational systems 8. Effective management of the department’s finance and assets

ACHIEVEMENTS (DISCUSSED AS PART OF VARIOUS HEADINGS)

EXPENDITURE PATTERNS

STD ITEM BUDGET EXP. VAR. PERSONNEL 1 133 612 1 159 342 -25 730 ADMIN 48 822 52 455 -3 633 STORES 238 392 231 232 6 161 EQUIPMENT 47 634 46 634 1 000 LAND & BUIL. 5 477 6 440 963 PROF. SERV. 195 156 161 955 33 201 TRANSFERS 54 894 40 278 14 616 MISC. 10 830 1 669 9 161 TOTALS 1 734 817 1 700 005 34 812

EXPENDITURE PATTERNS

Expenditure patterns • Personnel budget comprises 65% of the total budget • This is consistent with prior years • The national average personnel budget is 68% • The personnel budget was overspend by 2% due to the insufficient budget of ICS, backlog in rank and leg promotions

Expenditure patterns • Transfers were under spent by 26% as a result of delays by institutions in complying with the PFMA e. g. • Non submission of invoices by local Authorities • Non submission of Audited Financial Statements • Under expenditure in professional services relates to capital projects • Over 98% of the budget was utilized

MECHANISMS TO IMPROVE CAPACITY The Department uses various mechanisms to improve its Human Resource, Financial, Procurement and Service Delivery Capacity

Human Resource • General Managers appointments with Heads of Admin, Clinical, and Nursing • Job descriptions for staff with Personal Performance Management Agreements levels 13 and higher • Key performance areas and key performance indicators built in, into job descriptions of all levels of staff in one Complex as a pilot for all other health facilities

Human Resource Organisational Performance Management Frameworks implemented for the biggest Complex with a roll out empowerment process started to other two regional Hospital Complex’s

Human Resource • During the year under review, the department developed its first Work Place Skills Plan, and will build on this during the current year and in years to come. • In an effort to improve our ability to deliver quality PHC services to our communities, the department has prioritized the training of primary health care nurses. In the year under review, 118 were trained as PHC practitioners. • The issue of proper deployment of these nurses will continue to receive attention in the current year.

Human Resource • The post basic training of nurses in the following fields also continued to be a priority: IMCI (10), psychiatry (10), and midwifery (45). • The department sees discipline of employees as being central to capacity to deliver services. • Therefore, the training of managers and employees as investigating officers and presiding officers. A total of 40 were trained as investigating and presiding officers.

Financial • Establishment of a functional Internal Control Unit, filling 97% of vacant posts • Improved co-ordination and co-operation of Finance Committees • UPFS implemented at all hospitals • Developed the transaction flow process • Trained 70% of HO finance staff on the following courses:

Financial • • Project Management Cash Flow Management Policy making and Budgeting Provisioning and Administration System • Computer Training and Writing skills

Procurement • Took charge of our own maintenance of own buildings and patients transport due to poor performance experienced from Department of Transport, Roads and Public Works • Provincialisation of Emergency medical services • Outsourcing of procurement of pharmaceuticals with efforts to decentralise the process started via Vuna Health Care logistics

Procurement • Rolling out of a computerised asset management system • Outsourcing initiatives for garden services, catering- and security services

Service Delivery Capacity PPP’s: • Coordinator for the Provincial Council on Aids plus 18 Coordinators for the Local Aids Councils were appointed • Lichtenburg health district (Environmental Health Officers) in partnership with Agriculture improved the quality of their dairy products to the extent that it is now adhering to the criteria set by the EU and permission for export was granted • Joint appointments with Universities • Alpha cement/licthenburg DHS initiatives

Service Delivery Capacity Through empowerment: • Primary school nutrition program was decentralised with empowerment of local women groups, etc • 90 Primary Health care nurses underwent training in sign language • 240 donated wheelchairs were distributed and 1130 bought out of own funds were distributed • Five multi purpose youth centres established to enhance the reproductive health of the youth, to protect themselves against HIV and teenage pregnancy was a joint effort between DFID and PPASA now fully funded by the Department

Service Delivery Capacity Through empowerment: • 141 VCT sites • 33 funded NGO as part of the system

Service Delivery Capacity Optimising resource utilisation: • 100 patients were de-institutionalised • EMS – Provincialisation 1 December 2001 • Forensic Medical Services – Started the process of taking over from the SAPS – Vryburg region will be first • Quality Assurance – Tender document out to get COHSASSA accreditation for all Institutions with capacity development management to sustain quality assurance program

Service Delivery Capacity Networking and linking with tertiary institutions: • Attracting and retaining specialised personnel – A process started looking mainly at linking Regional Complex’s with tertiary institutions like MEDUNSA / WITS and UP to enable registrar training at and rotation of specialists through regional hospitals

Service Delivery Capacity Through stakeholder involvement: • Farm worker summit held with a definite project plan to implement the outputs received from the summit which included new mobile services to be established • Governance summit held with outputs taken forward

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS PROVINCIAL PROCESS: • Each department submits inputs to Treasury • The provincial Budget Lekgotla is held where trade offs between departments are considered to try and stay within the provincial allocation • Process of avoiding duplications by cluster approach • CFO’s meet to discuss approaches to minimise administrative expenditures

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS PROVINCIAL PROCESS: • 85% National target to be spent on Social Cluster not reached due to: – – – North West Star NWDC Agric SABC Public Works Ring fencing of National Allocations could assist

COMMENTS BUDGETARY ALLOCATIONS, MTEF PROCESS AND ANY SHORTCOMINGS DEPARTMENTAL PROCESS • MTEF PROCESS & SHORTCOMINGS: • Individual cost center managers prepare and submit their inputs through regional structures, hospital CEOs, College principals and program managers. • These are consolidated, compared to previous allocations, expenditure and priority program plans for the department and forwarded to the Equity/Budget Committee for further attention.

MTEF PROCESS cont. • The Equity/Budget committee analyses the inputs and aligns them to current and new priorities and or objectives for the next MTEF cycle and makes recommendations to the Departmental Management Committee(DMC) for discussion, verification and further recommendations to the Departmental Executive Committee.

MTEF PROCESS cont. • The DEC makes decisions based on the strategic priorities of the department as well as the provincial budget memorandum and strategies, and directs further adjustment where necessary. • Consultation is then done with relevant stake holders for further attention, buy-in and finalization of proposed allocations.

SHORTCOMMINGS-MTEF • The time frames are not realistic in terms of adequate involvement of all stake holders. • Due to limited availability of resources, it is sometimes difficult to address Equity issues. • Allocation of funds for personnel is based on previous expenditure patterns. • The financial impact of Strategic challenges is higher than the budget growth

CONDITIONAL GRANTS The Department received the following conditional Grants: • Redistribution of Specialised Hospital Services conditional Grant • Training of Health Professionals Grant • Hospital Revitalisation and Rehabilitation Grant • Primary School Nutrition Grant • HIV / AIDS

OUTCOMES REDISTRIBTION SPECIALISED HOSPITAL SERVICES CONDITIONAL GRANT

Total patients treated for the year Renal Unit 4852 Oncology Unit 1989 MDR Unit : Out : In 638 258 EMS/ICU AMBULANCE 231 BURNS UNIT 117 JOINT SURGERY 58 IN PATIENT ONCOLOGY 747 PSYCHIATRIC UNIT 307

SUCCESS IN ACHIEVING EQUITY • The Equity committee has made attempts to address gaps related to resource allocation per district and region (health districts). • The difficulty of shifting of funds from one area to another is still a challenge due to 65% of expenditure being allocated to personnel

SUCCESS IN ACHIEVING EQUITY • Progress made to date relates to a decentralized system, which reflects fully fledged District Management structures, independent Hospital managers for level 1, and CEOs for level 2 hospitals. • Financial, Human Resource and Procurement delegations are in place to enable managers to make appropriate decisions and manage their allocated resources.

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS-SHORTCOMINGS Facilitation of the devolution of primary health care to Local Authorities by creation of equal conditions of service between Provincial Health Authority staff and those appointed by Local Authorities with the end result of “One Public Service” with equal conditions of service / pay packages / progression irrespective of what tier of Governance

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS The Department experience difficulty in attracting various categories of Health Care workers to rural areas. Rural allowance exists for Doctors only. Assistance regarding possible incentives to attract other categories of Health workers to rural areas equally across the country will help

COMMENTS REGARDING EQUITY ON INTERPROVINCIAL ALLOCATIONS Equity regarding budget allocations between various Provincial Departments of Health is still not achieved due to the fact that money allocated by the National Department of Health is not ring fenced and within Provincial Treasuries Departments then start to compete for funding which lead to National Department of Health funding ending up being used for other Departments, i. e. Education, etc

PUBLIC PRIVATE PARTNERSHIPS The Department is actively involved in both public – public and public private partnerships. Some examples: • Outsourcing of various services • Private specialists responsible for a major part of specialist services in the Province • Lichtenburg District and Department of Agriculture joint venture • University links

HIV / AIDS

HIV ACHIEVEMENTS AND PLAN FOR 2002/3 OBJECTIVES ACHIEVEMENTS Functionalise PCA act in place, all staff appointed in all 18 Districts All 18 LAC funded Assist in funding all LAC Expand VCT sites in the Province Establish PMTCT pilot sites Expand female condoms distribution Reduce incidence of STI by 30% 141 sites established & 970 Nurses trained in counseling with 8909 clients tested(2392 positive, 26. 8%) Two sites established July 2001 Expanded female condoms sites from 4 to 18 and distributed 200 000 female & 23 million male condoms Reduced Syphilis form 17% to 3, 6% New form implemented in the Province Provide effective HBC in all 18 districts Funded 33 NGO for R 1, 06 M in the Province and 14 National funded for R 1, 5 M

HIV/AIDS ACHIEVEMENTS OBJEC TIVES ACHIEVEMENTS HBC (cont. . ) 101 HBC district trainers trained 467 Caregivers trained including LAC’s To involve Tertiary institutions in HIV/AIDS Develop a framework for participation of management in the Province Tertiary Institutions in the HIV/AIDS programmes e. g. Research & Training Intergovernmental committee on HIV/AIDS Conduct Door to door campaign in the Province Health Act as secretariat for IDC in the Province Facilitate all operations of the Interdepartmental Committee on HIV/AIDS To celebrate all HIV/AIDS calendar days All 18 Districts conducted door to door campaigns during December 2001 with 1 950 houses visited and 24 387 persons reached and 991 350 Condoms distributed in one week(5 days) All HIV/AIDS calendar days celebrated

HIV/AIDS ACHIEVEMENTS OBJEC TIVES ACHIEVEMENTS Conduct a survey for the Health promotion in the Province Health promotion survey conducted on the availability of Health promoters in all districts to establish health promotion activities in the Province Organize a workshop for all Private practitioners To organize workshops for Traditional healers Workshop organized through ROCHE in the Province with good attendances from All GP( Private Medical Officers)to standardize syndromic management of STI’s Organized traditional healers workshop took place to address HIV/AIDS To coordinate with DEPT of Education on life skills education at school Close collaboration with education established

NO OF VCT SITES IN THE PROVINCE District Number of sites Number operational Mafikeng 18 14 Zeerust 21 21 Lichtenburg 13 9 Delareyville 10 4 Klerksdorp 12 12 Potchefstroom 11 10 Ventersdorp 11 11 Wolmaranstad 5 4 Vryburg 6 4 Ganyesa 5 5 Taung 6 5 Schweizer-Reneke 1 1 Kudumane 3 3 Odi 8 8 Moretele 7 7 Brits 5 3 Mogwase 9 7 21 13 172 141 Rustenburg TOTALS

PMTCT SITES SRVICES • Thlabane (U): Jul. March 2001/2 • ANC - 2797 • VC - 204 = 7% • Tested - 204 = 7% • HIV+ - 90 =44% • NVP - 38 • Babies - 38 • EBF - 9 =23% • EFF - 29=77% • Lehurutshe (R): Jul. March 2001/2 • ANC - 1998 • VC - 851 = 42% • Tested - 727 = 37% • HIV+ - 183 = 25% • NVP - 65 • Babies - 65 • EBF - 1= 2% • EFF - 64 = 98%

DISTRICT ORGANISATION VISITS CLIENTS SUNRISE 780 193 ZEERUST GIVE A HAND & HOPE 386 81 KLERKSDORP NW HOSPICE 726 141 KLERKSDORP KOSH 147 141 DELARYVILLE TSHWARAGANANG 716 104 DELAREYVILLE BRIGHT FUTURE 698 112 ODI GARANKUWA SUNSHINE 140 32 ODI MERCY AIDS PROJECT 382 105 BRITS MABOLOKA AIDS PROJECT 475 78 KUDUMANE RETLATHUSA 89 23 RUSTENBURG VISION FOR NATION 357 70 MAFIKENG LEMOGANG 102 42 NAPWA 626 210 OPERATION BLANKET 410 185 OPERATION H 8 UNGER 80 38 HELPING HAND 863 490 TSHEPONG 258 47 7238 Home visits 1999 clients MORETELE POTCHEFSTROOM TOTAL

LEGISLATION • We the process of passing the Provincial Council on Aids Act during the 2001/2 financial year • Drafted the Provincial Health Bill

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