Hospital Revitalisation Program

1. Hospital Revitalisation Program Portfolio Committee 24 August 2005 Dr Thabo Sibeko Chief Director: Hospital Services Gert Steyn Director: Hospital Revitalisation

2. Agenda • Vision • Purpose of Hospital Revitalisation Grant • Process • Brief overview of HRP Grant • Methodology of Allocations • Challenges • Achievements • Progress/Expenditure on Grant • DoRA Conditions • Project Management Unit • Delay of Transfers • Current and New Projects • Photos

3. Vision of Revitalised Hospital • Good fully operational physical condition • Deliver appropriate services: • to suit the population’s needs • levels of care provided • Appropriate management system operating with appropriate delegations. • Community structures to hold the hospitals accountable • Appropriately equipped and resourced. • Implementing and monitoring quality improvement programmes • Equitable budget based on the population served and services delivered.

4. Vision of Revitalised Hospital • Improve cost efficiency and effectiveness of hospitals • Have in place sustainable Planned Preventative Maintenance and replacement programmes supported by: • appropriately qualified and trained staff • technical resources. • Implement all National policies. • All health facilities will be part of a national health service and will operate within a rationalised referral system network.

5. 9 405 hospitals Project Revitalise Hospitals 21

6. National Province Quality EMS REVITALISATION OF PUBLIC HOSPITALS

7. Political & Technical Guidance Programme Management Provide Technical Support Overall provincial projects coordination and management Regional/ Local Facilitation of Project Implementation process Day to day management of project implementation activities

8. Purpose of HRP Grant • Purpose • “To provide strategic funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, organizational management and development and monitoring and evaluation of hospitals in line with national policy objectives”: DoRA Act 1 of 2005 Framework

9. Process • Provincial Responsibility • Do prioritisation of hospitals to be revitalised in Province. Decisions to be made at provincial level • Submit business cases according to required format • Submit Project Implementation Plans according to required format • Submit monthly financial and quarterly non-financial reports • Implement all components of the HRP

10. Process • National Health Responsibility • Prioritisation framework supplied, BUT province ultimately responsible for prioritisation outcome. National provides guidance on using system. • Provide framework (PIM) for business cases, Project Implementation Plans (PIP) • Appraise and formally approve business cases and PIP’s • Collect and analyse monthly and quarterly reports, combine into single report • Monitor and evaluate performance on site for all projects • Support provincial implementation

11. Business Cases • Provinces must submit business case to have project included in HRP • Business case consists of 2 areas • Strategic Context containing: • Strategic plan of province on health service delivery in hospitals • Prioritisation of hospitals to be included based on: • Service delivery issues (Access to services, political risk, risk of delays, and other areas the province identifies) • Financial issues (cost to correct, backlog of maintenance, condition)

12. Business Cases 2. Priority Hospital • Details with regard to site • Size of hospital (beds by level of care) • Specific details such as area per bed, cost per bed, admission rate, average length of stay) • Cost • Period of Construction • Operational cost • Staffing plan • Health technology plan • Quality Assurance plan • Appraisal • National Department of Health appraises all business cases to ensure strategic plan of province is adhered to and size, location, cost, sustainability and level of service adheres to National Guidelines

13. Brief Overview • MTEF Allocation

14. Methodology of Allocation • Project/Needs based allocation • Information utilised: • Approved business cases • Expected cash flows per year (received from provinces) • Number of active projects (currently minimum 4 due to funding constraints)

15. Methodology of Allocation • Process to obtain available funds figure: • 2004/2005 DORA allocation amount • ADD expected roll-over from 2003/2004 • SUBTRACT Expected expenditure for 2004/2005 • Result = Expected Roll-over into 2005/2006 + DoRA allocation

16. Methodology of Allocation • Provinces supplied expected expenditure over MTEF period (information from business cases and Project Implementation Plans) • Expected Need calculated as follows: • Amount required for projects in provinces • The allocation puts provinces in a favourable position where they will be able to spend the full allocation without having to cut on budget.

17. Methodology of Allocation • Allocation • Need LESS 2004/2005 roll-over indicates 2005/2006 allocation • Process is repeated into outer years to determine allocation • Allocation HEAVILY dependent on quality of information and prioritisation received from provinces.

18. Challenges • Delays in appointing contractors on site (public works related issues) – ALL provinces reported various problems with public works • Public Works – Specific Examples: • Lebowakgomo, Jane Furse (LP) – Tenders closed in Aug 2004, contract not yet awarded. • Contracts awarded to inefficient contractors – contractor awarded tender at Jane Furse after contractor went 80% over contract at other site. (LP) • Contractor on 14 month contract at King George V was 6 months into contract, but already 3 months behind. Appeal followed, appellant received contract. (KZN) – delayed by about 10 months • Design/Architect/Engineers do not give input in design phase. Nothing from contractors questioned – “Everything goes” (NC) • Large contracts awarded to small contractors – insufficient capacity, no capital to fund project, delays are inevitable. All provinces are troubled by this. • Procurement: Extremely slow: 10 months to appoint completion contract at Frontier Hospital (EC) • Lack of personnel to do quality checks on construction at regular intervals

19. Challenges • Provincial Capacity in Revitalisation • Appointing Revitalisation Managers is slow process • Most managers schooled in infrastructure – very little capacity exists in Health Technology, Organisational Development and Quality Assurance. • Reporting/Communication to and from provinces are ineffective and unreliable. Recommendation will be made shortly to increase accuracy, compliance and reliability at limited cost. Web page reporting model to be designed that will result in a more accurate, efficient data and compliance of HRP

20. Achievements on Grant • Progress • 3 Hospitals finished: • Calvinia (NC) – 35 Beds, District, R35m • Colesberg (NC) – 35 Beds, District, R35m • Swartruggens (NW) – 28 Beds, District, R39m • Piet Retief (MP) – 140 beds, District, R140m • Hospitals to be completed in 2005/2006 • George (WC) 276 Beds, Regional, R78m • Eben Donges (WC) 315 Beds, Regional, R213m • Lebowakgomo (LP) – 255 Beds, District, R105m • Jane Furse (LP) – 252 Beds, District, R110m • Hospitals to be completed in 2006/2007 • Dilokong (LP) – 244 Beds, District, R134m • Nkenshani (LP) – 290 Beds, District, R127m • Vredenburg (WC) – 80 Beds, District, R58m • Barkley West (NC) – 40 Beds, District, R40m

21. Expenditure on Grant • In 2004/2005– HRP spent 84% if KZN is excluded *KZN requested to return the allocation due to extensive problems with Public Works

22. DoRA Conditions • All new projects commencing in 2005/06 must have business cases and project implementation plans approved before funds can be released for such projects • Provincial strategic plans must include comprehensive hospital plans, which provide a framework in which business cases are subsequently developed • Adhere to the process of approval of business plans for the 2006 MTEF

23. DoRA Conditions • Adherence to monitoring requirements • National Department to strengthen grant management and capacity and business planning and reporting processes • Provincial departmental strategic plans for 2005/06 and over the MTEF to clearly indicate measurable objectives and performance targets as agreed with national department

24. Project Management Unit

25. Reason of Delaying Transfer

26. Current and New projects

27. Current and New projects

28. Photos: Jane Furse (LP) Old Revitalised [PMG note: Graphics not included]

29. Photos: Dilokong (LP) Old Revitalised [PMG note: Graphics not included]

30. Photos: Swartruggens (NW)[PMG note: Graphics not included]

31. Photos: Colesberg (NC)[PMG note: Graphics not included]

32. Making a movie is like trying to grill a steak by having a succession of people coming into a room and breathing on it. Douglas Adams Should progress in Revitalisation be as slow??

33. Thank You Together towards Revitalisation