Presentation to the Select Committee on Finance

1. Presentation to the Select Committee on Finance Dr. Ayanda Ntsaluba Director-General: Health

2. Health oversees the following grants: NTSG HPTD Hospital Revitalisation Hospital management and quality improvement HIV/AIDS INP Hospital Construction – Pretoria Academic Medico-legal??? Conditional Grants

3. Purpose Fund national tertiary services as identified and costed by the NDoH Allocation Mechanism A cost model is used that standardises the unit cost of each of the designated tertiary services. The level/quantity of tertiary services that each province provides is determined On the basis of the cost and quantity, the allocations for each province is determined NTSG

4. NTSG – trends

5. Conditions: Key condition is the provision of Tertiary Services in return for Funding Monitoring mechanisms Quarterly submission of NTSG monitoring data via District Hospital Information System (DHIS) Measurable objectives/outputs Improvement in management information in the befitting hospitals Number of admissions, outpatients and day cases per specialised service unit Number of treated patients managed from outside each province NTSG

6. Purpose Compensate provinces for service costs associated with training Allocation Mechanism HPT Number of final year medical students 4 provinces receive equal share of 10% of Grant Development component Specialist and registrar population ratios for provinces without medical schools (except KZN and Eastern Cape) HPTD

7. HPTD – trends

8. Conditions Timely submission of monitoring information as agreed with national DOH. Monitoring mechanisms Quarterly and annual reporting by provinces on number of students enrolled by discipline Quarterly and annual reporting by targeted provinces on achievement of planned expansion of specialist and teaching infrastructure Measurable objectives/ outputs Increase number and improve composition of health sciences students by province and institution Shift in the location of practical training placements by discipline to regional and district facilities\ Expanded specialist and teaching infrastructure in target provinces HPTD

9. Purpose to transform and modernise hospitals in line with national policy and to achieve a sustainable infrastructure from which modern, equitable and sustainable services can be delivered Allocation Allocations are based on projects comprised of at least one hospital per province Hospital Revitalisation

10. Hospital Revitalisation – Trends

11. Conditions Compliance with Integrated Health Planning Framework (IHPF) and monitoring and reporting requirements Compliance with provincial priorities for sustainable service delivery as identified in the provinces’ Strategic Position Statements (SPS) Monitoring mechanisms Prescribed format and indicators in hospital and provincial monitoring modules Monthly reporting on project implementation progress and expenditure to the national department Measurable objectives/output Number of hospitals revitalised Hospital Revitalisation

12. Purpose to strengthen management in hospitals including the development of management systems and structures Allocation The grant accommodates funding, on a limited scale, of the existing activities/projects started in the 2001/2 financial year Allocations are based on the number of revitalisation projects Hospital Mx

13. Hospital Mx – trends

14. Conditions Business plans approved by HOD’s to be submitted before the first payment. Monitoring mechanisms Monthly and quarterly financial reports to be submitted in the prescribed Treasury format. Quarterly reports on progress against approved business plans Measurable objectives/ outputs Demonstrable progress with the decentralisation and improvement in msnagement capacity Hospital Mx

15. Purpose to enable the health sector to develop an effective response to HIV/Aids epidemic Allocation based on a few data sources and methodology, as the interventions cannot all fit within one approach. The following data sources inform the allocation resources. 2001 Antenatal HIV Prevalence Survey, Estimated share of HIV+ births, Share of reported rapes, Estimated share of Aids cases HIV/AIDS

16. HIV/AIDS – trends

17. Conditions The flow of first installments is subject to approval of business plans Quarterly monitoring returns to be submitted Monitoring mechanisms Quarterly reporting of output in terms of the monitoring framework established by national DOH HIV/AIDS

18. Measurable objectives/ outputs Increased access to voluntary counseling and testing by 12,5 per cent of adult population aged between 15-49 years within three years, with specific targets for the youth and rural communities Number of health districts which have voluntary counseling and testing facilities Number of mothers receiving VCT and number of mother/baby pairs receiving PMTCT prophylaxis Number of home based care teams in operation, caseload and number of patient contacts Number of step-down facilities in operation, number of admissions and bed days Number of adults and children receiving PEP after sexual assault Number of projects targeting commercial sex workers and number of sex workers reached HIV/AIDS

19. Purpose Improve the nutrition status of South African children; Specifically to enhance active learning capacity and improve school attendance in schools Improve nutritional knowledge, perceptions, attitudes and behavior amongst school learners, their parents and teachers Allocation The INP conditional grant is distributed in total to the provincial departments of health according to an Index of poverty INP

20. INP – trends

21. Conditions Access of funding through business plans Use of funds only for approved purposes Grant must be kept on separate responsibility and objective codes Feeding in poor primary schools Compliance with minimum norms and standards as determined by policy and implementation guidelines Monitoring mechanisms Provinces must report quarterly in terms of progress indicators Provinces must report monthly in terms of financial indicators Monitoring visits Formal assessments INP

22. Measurable objectives/ outputs Improve coverage of targeted primary school feeding from 86 per cent to 100 per cent Improve coverage of planned feeding days from 85 per cent to 100 per cent Improve compliance with nutritional criteria for school feeding from 0 per cent to 100 per cent Decrease underweight, stunting and wasting in children from 10.3 per cent to 10 percent, 21.6 per cent to 20 per cent and 3.7 per cent to 2 per cent respectively Increase provision of Road to Health Chart from 74.6 per cent to 85 per cent Eliminate micronutrient deficiencies Increase exclusive breastfeeding from 5 per cent to 10 per cent and breastfeeding from 67.9 per cent to 70 per cent Increase baby-friendly health facilities from 40 to 72 out of 480 INP

23. Main areas of non-compliance, problems include: Late submission of reports and business plans Non-submission of reports – sometimes Incorrect figures (when the next report is submitted the previous months figures are amended). Reports not signed by Financial Officer or Head of Health No explanation for deviations on spending patterns etc. Compliance with Grant and Problems

24. Significant investment in systems and people Able to better track progress Improved national and provincial communication Improved Monitoring Capacity