Presentation to Standing Committee on Appropriation on 1

Presentation to Standing Committee on Appropriation on 1 st Quarter Expenditure for 2014/15 FY 10 September 2014 1

Table of Content • Departmental expenditure • Conditional Grants expenditure • Plans for improving expenditure performance in Infrastructure Programmes • Plans for improving expenditure performance in the National Health Insurance pilot programme • Report on implementation of cost containment measures 2

Departmental Expenditure for 1 st Quarter Expenditure for 2014/15 FY 3

Departmental Summary Expenditure 4

Departmental Summary Expenditure • All Programmes Compensation of Employees are showing a degree of pressure mainly due to the implementation of the grading of Assistant and Deputy Directors. This matter has been raised with National Treasury and will most likely be addressed during the Adjustment Budget 5

Programme 1: Administration 6

Programme 1: Administration • Invoices for property payments (water, electricity, and rent) for the last quarter of 2013/14 were processed during 2014/15 after it was received from Public Works. 7

Programme 2: National Health Insurance, Health Planning and System Enablement 8

Programme 2: Reasons for Variances • The budget for compensation of employees is exceeded due to the appointment of a Health Attaché in Cuba • Slow spending on the indirect National Health Insurance grant. To this end a service provider was appointed in July 2014 to assist with the recruitment of GPs and test the Purchaser Provider split • WHO membership fees will be processed during third quarter of the financial year. • The SA Demographic Health Survey has started and still awaiting invoices from Stats. SA and MRC 9

Programme 3: HIV and AIDS, Tuberculosis, Maternal and Child Health 10

Programme 3: HIV and AIDS, Tuberculosis, Maternal and Child Health • The vaccinations for the Human Papilloma Virus is scheduled for September - October 2014 and February – March 2015. For this reason no expenditure is reflecting yet on the budget of R 200 million. • The printing of the general TB pamphlets in Braille was delayed at the Government Printing Works. 11

Programme 4: Primary Health Care Services: 12

Programme 4: Primary Health Care Services: • The transfers to the NGO’s are scheduled for the third quarter of the financial year. • Invoices are awaited from the GCIS for the No Tobacco Campaign. • Expenditure on Environmental Health Services is expected to increase with the transfer of Port Health Services to the National Department 13

Programme 5: Hospital, Tertiary Services and Human Resource Development 14

Programme 5: Hospital, Tertiary Services and Human Resource Development • Payments amounting to R 11, 5 million or 1. 1% of the budget of R 807 million for the indirect grant for Health Facilities Infrastructure were processed. Invoices are awaited from the DBSA in this regard. Indications are DBSA will claim R 83 million for work done to date. • The Forensic Chemistry Laboratories advertised in the first quarter several tenders for the procurement of specialized laboratory equipment. Expenditure is expected during the 2 nd and 3 rd quarter 15

Programme 6: Health Regulation and Compliance Management 16

Programme 6: Health Regulation and Compliance Management • The transfer payment to the Compensation Fund is scheduled to be paid in the latter half of the year. • No invoices were received from the Auditor-General to be paid yet. • The Board for the Office of Health Standards Compliance was established on 4 June 2014. The recruitment of staff as well as the expected lease of a building should increase expenditure. The office will function independent and occupy premises outside of the NDOH. This is expected to be finalised in October 2014. 17

Conditional Grants Expenditure for 1 st Quarter Expenditure for 2014/15 FY 18

Conditional Grants Ø Overall provincial CG spending was 21. 2% or R 6. 4 billion against total budget of R 30. 1 billion Ø Major contributors to under spending are: o Comprehensive HIV/AIDS Grant- spent 20. 2% o Health Facility Revitalization Grant – spent 17. 0% o National Health Insurance – spent 12. 6% Ø Health Professions and Training Grant at 24. 4% and National Tertiary Services Grant at 23. 9% spent within the acceptable norm 19

Summary Expenditure Per Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL PROVINCIAL EXPENDITURE TRANSFERS Actual Transfers Expenditure % Transfers % of Transfers per % of Spent Received Transfer Payment of s Schedule Budget Receive d R'000 % 2, 321, 583, 788 243 100. 0% 10, 168, 2 2, 542, 35 062 100. 0% 12, 311, 3 3, 008, 22 904 100. 0% 5, 239, 1, 310, 981 001 100. 0% 70, 7, 000 100. 0% 30, 111, 3 7, 451, 26 210 100. 0% R'000 % 566, 844 24. 4% 2, 428, 525 23. 9% 2, 491, 939 20. 2% 892, 553 17. 0% R'000 % 541, 718 92. 9% 2, 207, 645 86. 8% 2, 601, 154 86. 4% 937, 261 71. 5% 8, 806 12. 6% 6, 388, 667 21. 2% 20 9, 865 140. 9% 6, 297, 643 84. 5%

Summary Expenditure Per Province Grant Name Eastern Cape Free State Gauteng Kwazulu-Natal Limpopo Mpumalanga Northern Cape North Western Cape TOTAL NATIONAL EXPENDITURE BUDGET TRANSFERS Original Actual Transfers Expenditure % Spent Budget Transfers per % of of Budget Payment Schedule R'000 % 3, 041, 748, 506, 349 426 100. 0% 528 16. 7% 2, 343, 588, 518, 498 151 100. 0% 493 22. 1% 7, 615, 1, 918, 1, 695, 616 428 100. 0% 171 22. 3% 6, 223, 1, 511, 1, 369, 725 204 100. 0% 666 22. 0% 1, 891, 483, 280, 938 669 100. 0% 955 14. 9% 1, 361, 343, 291, 749 144 100. 0% 832 21. 4% 1, 146, 282, 277, 641 154 100. 0% 775 24. 2% 1, 771, 441, 387, 909 947 100. 0% 687 21. 9% 4, 714, 1, 134, 1, 060, 901 087 100. 0% 560 22. 5% 30, 111, 7, 451, 6, 388, 326 210 100. 0% 667 21. 2% 21 PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 528 194 171 502 414 173 154 947 560 643 % 506, 67. 7% 457, 77. 7% 1, 695, 88. 4% 1, 386, 91. 7% 147, 30. 5% 320, 93. 3% 282, 100. 0% 441, 100. 0% 1, 060, 93. 5% 6, 297, 84. 5%

Eastern Cape Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL PROVINCIAL EXPENDITURE TRANSFERS Actual Transfers Expenditure % Spent Transfers % of Transfers per % of of Received Transfers Payment Budget Received Schedule R'000 % 199, 874 49, 959 100. 0% 35, 025 17. 5% 35, 025 70. 1% 786, 007 196, 503 100. 0% 151, 450 19. 3% 151, 450 77. 1% 1, 449, 237 351, 456 100. 0% 254, 374 17. 6% 254, 374 72. 4% 599, 231 149, 808 100. 0% 64, 582 10. 8% 64, 582 43. 1% 7, 000 3, 041, 349 700 748, 426 100. 0% 1, 097 506, 528 15. 7% 16. 7% 1, 097 506, 528 156. 7% 67. 7% 22

Eastern Cape Variance Explanations

Free State Expenditure Grant Name BUDGET Original Budget R'000 NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE PROVINCIAL TRANSFERS Expenditure % Spent of Budget Transfers Received % of Transfers Received R'000 % Health Professions Training and Development Grant 146, 419 39, 931 100. 0% 35, 731 24. 4% 26, 308 65. 9% National Tertiary Services Grant 898, 091 224, 523 100. 0% 262, 658 29. 2% 224, 523 100. 0% Comprehensive HIV and AIDS Grant 843, 026 210, 756 100. 0% 118, 254 14. 0% 103, 891 49. 3% Health Facility Revitalisation Grant 448, 962 112, 241 100. 0% 101, 848 22. 7% 101, 772 90. 7% 7, 000 700 100. 0% 2, 343, 498 588, 151 100. 0% 22. 1% 457, 194 77. 7% National Health Insurance Grant TOTAL 2 518, 493 24

Free State Variance Explanations

Gauteng Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE PROVINCIAL TRANSFERS Expenditure % Spent of Budget Transfers Received % of Transfers Received R'000 % 811, 114 202, 779 100. 0% 223, 558 27. 6% 223, 558 110. 2% National Tertiary Services Grant 3, 493, 891 873, 474 100. 0% 755, 732 21. 6% 755, 732 86. 5% Comprehensive HIV and AIDS Grant 2, 632, 578 673, 716 100. 0% 654, 926 24. 9% 654, 926 97. 2% 671, 033 167, 759 100. 0% 57, 781 8. 6% 57, 781 34. 4% 7, 000 7, 615, 616 700 1, 918, 428 100. 0% 3, 174 1, 695, 171 45. 3% 22. 3% 3, 174 1, 695, 171 453. 4% 88. 4% Health Facility Revitalisation Grant National Health Insurance Grant TOTAL 26

Gauteng Variance Explanations

Kwa. Zulu Natal Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % 292, 837 73, 209 100. 0% 73, 209 25. 0% 73, 209 100. 0% 1, 496, 427 374, 106 100. 0% 394, 573 26. 4% 249, 404 66. 7% 3, 257, 992 771, 870 100. 0% 668, 277 20. 5% 771, 870 100. 0% 1, 162, 469 290, 619 100. 0% 233, 015 20. 0% 290, 619 100. 0% 14, 000 6, 223, 725 1, 400 1, 511, 204 100. 0% 592 1, 369, 666 4. 2% 22. 0% 1, 400 1, 386, 502 100. 0% 91. 7% 28

Kwazulu-Natal Variance Explanations

Limpopo Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % 116, 206 29, 052 100. 0% 14, 907 12. 8% 9, 305 32. 0% 323, 158 80, 790 100. 0% 70, 010 21. 7% 38, 189 47. 3% 978, 132 256, 266 100. 0% 126, 387 12. 9% 94, 584 36. 9% 467, 442 116, 861 100. 0% 69, 202 14. 8% 5, 242 4. 5% 7, 000 1, 891, 938 700 483, 669 100. 0% 449 280, 955 6. 4% 14. 9% 94 147, 414 13. 4% 30. 5% 30

Limpopo Variance Explanations (1)

Limpopo Variance Explanations (2)

Mpumalanga Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % 95, 288 21, 000 100. 0% 16, 097 16. 9% 7, 000 33. 3% 97, 116 24, 279 100. 0% 22, 888 23. 6% 16, 186 66. 7% 818, 836 211, 287 100. 0% 216, 808 26. 5% 211, 287 100. 0% 343, 509 85, 878 100. 0% 34, 926 10. 2% 85, 000 99. 0% 7, 000 1, 361, 749 700 343, 144 100. 0% 1, 113 291, 832 15. 9% 21. 4% 700 320, 173 100. 0% 93. 3% 33

Mpumalanga Variance Explanations

Northern Cape Expenditure Grant Name BUDGET Original Budget R'000 NATIONAL TRANSFERS Actual Transfers s per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % Health Professions Training and Development Grant 76, 697 21, 474 100. 0% 21, 128 27. 5% 21, 474 100. 0% National Tertiary Services Grant 298, 727 74, 682 100. 0% 88, 304 29. 6% 74, 682 100. 0% Comprehensive HIV and AIDS Grant 342, 789 79, 941 100. 0% 83, 339 24. 3% 79, 941 100. 0% Health Facility Revitalisation Grant 421, 428 105, 357 100. 0% 84, 306 20. 0% 105, 357 100. 0% 7, 000 700 100. 0% 698 10. 0% 700 100. 0% 1, 146, 641 282, 154 100. 0% 277, 775 24. 2% 282, 154 100. 0% National Health Insurance Grant TOTAL 35

Northern Cape Variance Explanations

North West Expenditure Grant Name BUDGET Original Budget R'000 Health Professions Training and Development Grant National Tertiary Services Grant Comprehensive HIV and AIDS Grant Health Facility Revitalisation Grant National Health Insurance Grant TOTAL NATIONAL TRANSFERS Actual Transfers s per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % 104, 586 26, 148 100. 0% 27, 498 26. 3% 26, 148 100. 0% 237, 264 59, 316 100. 0% 44, 747 18. 9% 59, 316 100. 0% 936, 938 234, 252 100. 0% 173, 545 18. 5% 234, 252 100. 0% 486, 121, 531 100. 0% 141, 516 29. 1% 121, 531 100. 0% 7, 000 1, 771, 909 700 441, 947 100. 0% 381 387, 687 5. 4% 21. 9% 700 441, 947 100. 0% 37

North West Variance Explanations

Western Cape Expenditure Grant Name BUDGET Original Budget R'000 NATIONAL TRANSFERS Actual Transfers per % of Payment Schedule R'000 % EXPENDITURE Expenditure % Spent of Budget R'000 % PROVINCIAL TRANSFERS Transfers % of Received Transfers Received R'000 % Health Professions Training and Development Grant 478, 767 119, 691 100. 0% 119, 691 25. 0% 119, 691 100. 0% National Tertiary Services Grant 2, 537, 554 634, 389 100. 0% 638, 163 25. 1% 638, 163 100. 6% Comprehensive HIV and AIDS Grant 1, 051, 794 219, 360 100. 0% 196, 029 18. 6% 196, 029 89. 4% 639, 786 159, 947 100. 0% 105, 377 16. 5% 105, 377 65. 9% 7, 000 4, 714, 901 700 1, 134, 087 100. 0% 1, 300 1, 060, 560 18. 6% 22. 5% 1, 300 1, 060, 560 185. 7% 93. 5% Health Facility Revitalisation Grant National Health Insurance Grant TOTAL 39

Western Cape Variance Explanations (1)

Western Cape Variance Explanations (2)

Schedule 6 (Indirect Grants) SCHEDULE 6 A GRANT PERFORMANCE REPORT AS AT 30 JUNE 2014 • . Grants Original Budget (R'000) 2014/15 Total Budget % Spent Quarter 1 Commitments Available of Expenditure (R'000) Budget Health Facility Revitalisation Grant - In Direct 979, 862 11, 470 26, 423 968, 392 1% Human Papillomavirus 200, 000 0 0 200, 000 0% National Health Insurance - In Direct 395, 000 5, 983 13, 070 389, 017 2% 1, 574, 862 17, 453 39, 493 1, 557, 409 1% Total National Health Grant 42

HFRG Indirect- Variance Explanations • Delay by the Implementing Agent in awarding the contracts on time resulting in the projects starting later than anticipated. Interventions by the NDOH have resumed and the matter was taken up with the National Health Council • Industrial strike action by the staff members, particularly in the Eastern Cape and Northern Cape Provinces 43

HPV – Variance Explanations • Only two doses are planned for the 2014/15 financial year. The first dose will take place during October month (2 nd quarter). The expenditure will therefore reflect during 2 nd and 3 rd quarter reporting • Orders are in the process of being issued for vaccines worth R 47 m , transportation and medical supplies • Anticipate to spend entire budget allocation by end financial year 44

NHI Indirect – Variance Explanations • Under spending caused by challenges in attracting GPs • Appointment of a Service Provider was finalised in July 2014 to assist with the recruitment and to test the Purchaser Provider split 45

Plans for improving expenditure performance in Infrastructure Programmes 46

Infrastructure • Situation analysis done on the Health Infrastructure service delivery in 2010, introduction of IUSS and achievement on improvising of infrastructure expenditure • Expenditure in the first quarter of 2014 -15 F/Y and magnitude of the task ahead and focus area of infrastructure maintenance. • Capacitation Program at national and provincial levels for alignment with Infrastructure Delivery Management System (IDMS) • State of Readiness of provinces in relation to implementation of IDMS capacitation program • Restructuring of the Infrastructure Unit of the NDo. H and establishment of Infrastructure Program Office. 47

Infrastructure Delivery Management System [IDMS] § The IDMS has been developed through the Infrastructure Delivery Improvement Programme. § It is the Government Management System for planning, budgeting, procurement, delivery, maintenance, operations, monitoring and evaluation of infrastructure. § It comprises a set of interrelating or interacting service delivery processes which transform inputs into outputs. § IDMS focuses on infrastructure planning, decision making points through the gateway system, construction procurement, portfolio management, project management, maintenance and operations. 48

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IDMS Capacitating Strategy § National Treasury and National Department of Health have embarked upon implementation of the “Capacitation Framework for the Infrastructure Development Management System” in all nine Provincial Health Departments as well as in the NDo. H. § All Nine Provincial EXCOs agreed on how the IDMS will be implemented in their respective provinces with clarity on the roles of Health Departments and the roles of Public Works Departments. It also clarified the Governance Principles and Service Delivery Principles applicable for Infrastructure Delivery in each Province. 50

IDMS Capacitating Strategy § This “Framework” included the alignment of the organisational structures to the core business roles of the Infrastructure Units in each Provincial Department of Health and the Provincial Department of Public Works and the creation & appointment of personnel that matches the competency profiles to be responsible for the planning, management and maintenance of infrastructure and health technology at all Health Facilities. § The framework was adopted by the government and for Health Departments funding is provided for the appointment of public servants in these units under DORA funding. There is no funding for Public Works. 51

Agreed Provincial Head Office Structure for Health Main Purpose: Develop –U-AMPs, Norms, Standards, Business Cases, Designs, Condition Assessments, Post Project/Occupation Evaluations Main Purpose: Finalise procurement strategy, budget, IPMP, sign off on IPIP, oversee procurement, oversee implementation, manage funding, reporting, monitoring and evaluation Main Purpose : Plan, budget, procure and implement ongoing maintenance of all buildings [including laundries] implement OHS Main Purpose : Plan, budget, procure, commission and maintain medical equipment 52

DORA Funded Posts: Provincial Health Offices : Minimum Staffing Norms 44 posts – R 29 million – Average salary scales. Chief Director IDMS Strategic and Technical Advisor [contract] Planning Delivery Health Technology Engineering & Technical Support Director Chief Architect [2] Deputy Director Projects [2] Chief Engineer [2] Health Facility Planner Chief Quantity Surveyor [2] Deputy Director Maintenance Electrical Engineer Architect Chief Engineer Deputy Director Policy and Systems Mechanical Engineer Chief Civil Structural Engineer Architect [2] Deputy Director OHS Mechanical Engineer Quantity Surveyor [2] Control Engineering Technician Deputy Director M &E Engineering Technician [2] Electrical Engineer Deputy Director Institutional Improvement Chief Works Inspector Quantity Surveyor Deputy Director Finance Works Inspector [2] Assistant Director Finance Deputy Director Maintenance Operations Deputy Director Contracts 53

Dealing with issues at Portfolio level Dealing with issues at Program level Dealing with issues at project level 54 Program Manageme nt Office (PMO) Dealing with contractual Institutional arrangemen ts Dealing with issues at admin and coordinatio n level 54

Plans for improving expenditure performance in the National Health Insurance pilot programme 55

Interventions – NHI (Districts) • Assist the NHI pilot districts in improving their SCM systems and processes • Engage the PDo. Hs on improving delegations for managers i. e. District Managers • Ensure that all PDo. Hs have formally appointed Provincial NHI Coordinator – Streamline role of Prov. NHI Coordinators – Strengthen district performance and oversight – Improve expenditure levels through strengthening M&E • Ensure that all existing and future commitments are processed and captured as expenditure 56

NHI Indirect Grant: National GP Contracting • From 2014/15 financial onward NDo. H will pilot the purchaser-provider split with regard to contracting for additional health services starting with GPs: • Tender for contracting with service provider to recruit, contract, orient and manage GPs service to clinics • NDo. H (purchaser) about to enter into an agreement with service provider (provider) • New way already proving more effective since about 70 additional GPs have are lined up to sign on • Existing contracts will be transferred to the service provider

NA TIO NA L 151 Number of Contracted GPs per District TSHWANE 57 THABO MOFUTSANYANA 13 VHEMBE 8 GERT SIBANDE 13 UMGUNGUNDLOVU 18 UMZINYATHI 11 DR KENNETH KAUNDA 8 PIXLEY KA SEME 9 EDEN 14 OR Tambo still to start

Programme Support Activities • GP/HP Contracting National Technical Task Team (NTTT), meets quarterly • Roll out of the PHC-HP Support Programme • Induction sessions (2 national and 10 district sessions, 1 left) • Objectives • Sensitise team to the most recent clinical guidelines & protocols • Familiarise new team members with District specific administrative, referral and other procedures • Clarify contractual and administrative issues, Identify training needs and areas of support • District specific training programme • Orientation to integration with clinic personnel, DCST, School Health, WBOTs • GP/HP special interest sessions • Mentoring and support • Establishing GP/HP Research Forum • Developed the Information Pamphlet on GP/HP Contracting • Developed the Query Process Flows to assist GPs with problems encountered by them

Spending Projections 2014/15 Item 151 current Nationally contracted GPs Estimates/ month Months remaining Total R 4 530 000 7 R 31 710 000 R 42 591 276 6 R 255 547 653 Courier / logistics R 50 000 7 R 350 000 Recruitment fees R 2 000 6 R 12 000 Payroll administrator (2. 5%) R 1 172 480 7 R 8 207 362 Contract and performance management fees (10%) R 5 471 574 6 R 32 829 446 Training & workshops, NTTT coordination 7 R 12 000 Communications and marketing 7 R 7 000 635 additional GPs for sessions Total projection Sept 14 to March 15 Total spent Apr to Aug 2014 Total 2014/15 R 359 644 460 R 15 355 539 R 375 000

Report on implementation of cost containment measures 61

Implementation of cost containment measures q Cost containment measures were initially implemented on 23 October 2013 after the Medium Term Budget Policy Statement ( MTBPS) on the following: ØDowngrading of all staff members from using business class to economy class when using air traveling with exception of Minister, Deputy Minister and Director- General ØHiring of luxury cars was limited to Minister, Deputy MINISTER and Director General and the rest of officials use B class vehicles only ØAccommodation expenditure was limited to R 1 300. 00 including bed and breakfast irrespective of the grading of accommodation ØTransport optimization measures were also introduced by encouraging officials to consolidate their trips q Subsequent to this National Treasury issued Instruction Note 01 of 2013 on 19 December 2013 indicating mandatory cost containment measures to be implemented by departments. The mentioned circular was implemented in National Department of Health on 28 February 2014 after the circular being thoroughly analyzed.

Impact of implementation of cost containment measures 63