EASTERN CAPE DEPARTMENT OF HEALTH

1. EASTERN CAPE DEPARTMENT OF HEALTH Parliamentary Budget Hearings Tuesday, 08 June 2004

2. INDEX Page 1. Overview 3 2. Organisational Establishment 4 3. Revised Service Delivery Model 5-6 4. Where do we want to be 7-9 5. Achievements according to Ten Point Plan 10 – 20 6. Major challenges 21-23 7. Alignment of goals with National and Provincial imperative 24-29 8. Priorities 30-34 9. Finance Information 10 Conclusion

3. OVERVIEW- (WHERE DO WE COME FROM?)

4. 2. ORGANISATIONAL ESTABLISHMENT MEC: HEALTH SUPERINTENDENT GENERAL DDG: Clinical Services DDG: Corporate Services CD: DHS CD: PHC CD HSM CD: QA CD: FIN MNG CD: PROC CD: STRAT PLAN CD: FAC & ASSTS Acronyms: CD-Chief Director; DHS – District Hospital Services; PHC-Primary Health Care; HSM – Hospital Services Management; QA-Quality Assurance; FINMNG- Financial Management; PROC-Procurement; STRAT-Strategic & FAC-Facilities

5. 3. Revised Service Delivery Model Head Office 7 District Managers 5 CEOs of Hospital Complexes and Regional Hospitals 18 District Hospital Cluster Managers 25 Sub District Offices District Hospital Managers 713 clinics 28 Community Health centres

6. SERVICE DELIVERY MODEL The role of Head Office will be focused on programs coordination, integration and policy formulation, monitoring and evaluation. Our PHC services are provided through 713 clinics and 28 Community Health Centres, and these are managed by 27 Local Service Area (LSA) managers. Patients that need high level of care will be referred to Level 1 hospitals 18 Clusters of 47 district hospitals as well as 18 provincial aided and 4 privately run hospitals provide level 1 services. Clustering will allow for sharing of resources including professional staff. The three complexes and two regional hospitals provide levels 2 and 3 services. The 7 district managers have responsibility over 18 CEOs in the clusters and 25 LSA managers. They report to head office. The 2 regional and 3 complex CEOs report directly to head office.

7. WHERE DO WE WANT TO BE? 4.1 VISION • A health service to the people in the Eastern Cape Province promoting a better quality of life for all.

8. 4.2 MISSION To provide and ensure accessible comprehensive integrated services in the Eastern Cape emphasizing the primary health care approach utilizing and developing all resources to enable all its present and future generation to enjoy health and quality of life.

9. 4.3 VALUES Human Rights, customer satisfaction, service excellence and value for money are ensured through adherence to the following values:- • Equity of both distribution and quality of services • Service excellence including customer satisfaction • Fair labour practices • Good work ethic and a high degree of accountability • Transparency demonstrated through consultations with all stakeholders in the health industry/field

10. 5. ACHIEVEMENTS ACCORDING TO THE TEN POINT PLAN (WHERE ARE WE NOW?)

11. CORPORATE SERVICES CENTRES The department and the Interim Management Team (IMT) established 11 Corporate Service Centres 3 Complexes 7 Districts Head Office to provide shared support services HR, Finance, Procurement, Administration & IT 5.1. REORGANISATION OF CERTAIN SUPPORT SERVICES

12. Education and Training of Nurses and Midwives Act no. 4 of 2003 Medicines Act 90 of 1997 and Pharmacy Act 88 of 1997 they will be applicable in July 2005 to the State Mental Health Act of 2002 5.2. LEGISLATIVE REFORM

13. Health service awards launched in East London and Umtata aimed at maintaining high standards in institutions A 24 hr call centre has been established with a toll free number of 0800032364 providing opportunity for grievances and suggestions In line with the prevention of blindness (Global vision 2020) we are improving our cataract performance yearly. 5.3. IMPROVING QUALITY OF CARE

14. PE Complex is our flagship in Rationalisation of Services Provincial secondary and tertiary service delivery plans have been developed and these are linked to national modernisation of tertiary services Outreach program focussing on mother and child health as well as anaesthetic training Rationalisation of psychiatric services establishing psychiatric beds in the eastern side of the province Nelson Mandela Academic Hospital functional and awaiting official opening 21 hospital construction projects completed,14 under construction, equipment procured for 50 hospitals and maintenance done to 88 hospitals 5.4. REVITALIZATION OF HOSPITAL SERVICES

15. Institutionalisation of the 18 hospital clusters including appointment of management teams for these clusters Clustering will allow sharing of resources 5.5. SPEEDING OF DELIVERY OF AN ESSENTIAL PACKAGE OF SERVICE THROUGH THE DISTRICT HEALTH SYSTEM

16. 5.6. DECREASING MORBIDITY AND MORTALITY RATES THROUGH STRATEGIC INTERVENTIONS • Following implementation of standards in Traditional Circumcision Act (Act no. 6 of 2001) there has been marked decrease in morbidity and mortality resulting from circumcision (statistics) • Placement of staff to oversee the ARV treatment plan has been completed; • 270 nurses, doctors, pharmacists, dieticians and workers have been trained in the various aspects of disease management

17. 5.7. IMPROVING RESOURCE MOBILIZATION AND UTILISATION • For the first time Eastern Cape had an unqualified report • PPP – Kouga Partnership Hospital at Humansdorp being the first co-location PPP in the Province

18. 5.8. IMPROVING COMMUNICATION AND CONSULTATION WITHIN THE HEALTH SYSTEM AND WITH COMMUNITIES WE SERVE • Communication unit established at head office and director appointed • Hospital boards clinic committees established • Three mental health review boards established • Weekly slot in local radio station talking about health issues

19. 5.9. IMPROVING HUMAN RESOURCE DEVELOPMENT AND MANAGEMENT • Increased number of community service professionals • Induction of community service professionals aimed at presenting our recruitment and retention strategy • Learnerships & internships introduced • Delegations – human resources and finance have been finalised • Implementation of scarce skills and rural allowances • Implementation of skills development plan • Gradual implementation of the Employment Equity

20. 5.10. STRENGTHENING CO-OPERATION WITH OUR PARTNERS INTERNATIONALLY • Fred Hollows Foundation training programme to assist in improving prevention of blindness • Luxemburg-Aid in infrastructure development (Mnquma – former Transkei • Communicable Disease Centre, British Columbia, PEPFAR supporting the implementation of the Comprehensive Treatment Plan • Training of rehabilitation technicians in Tanzania

21. 6. MAJOR CHALLENGES IN THE DEPARTMENT

22. 6.1 HEALTH CHALLENGES • Management and reduction of communicable disease, Cholera HIV/AIDS, TB and STIs including the Comprehensive Treatment Plan which includes ARV roll-out. • Staff recruitment, retention and composition • Management of childhood disease including low immunization coverage • Cross boundaries movement of people • Legislative reforms influenced by cultural factors e.g. circumcision, and recognition of alternative medicine including traditional healing • Drug supply • Backlog in health infrastructure development

23. 6.2 OTHER CHALLENGES • Escalating crime calling for more security for staff working in primary health care facilities, establishment of Crisis Centres and counseling facilities for victims of abuse as well as calling for more collaborative endeavors with other sectors • The impact of increased motor vehicle accidents on emergency medical services and other services

24. 7. ALIGNMENT OF GOALS WITH NATIONAL AND PROVINCIAL IMPERATIVES

25. Alignment of Goals

26. Alignment of Goals Continued

27. Alignment of GoalsContinued

28. Alignment of GoalsContinued

29. Alignment of GoalsEnd

30. 8. PRIORITIES FOR DEPARTMENT OF HEALTH IN NEXT 3 YEARS

31. 8.1 CLINICAL SERVICES (PHC) • Roll out Comprehensive Plan to target 147 200 cumulative clients by 2008 including 2700 in 2004/05. Accreditation of Ukhahlamba and Alfred Nzo phase 1 sites will be finalized by end July 2004 • Collaborative project with DWAF and Municipalities on water and sanitation • Expanded Programme of Immunisation campaign in July 2004 • R1 million set aside for food gardens to benefit 4000 clients • Commenced a programme on training professionals on maternity and child health services • Finalise transfer of 174 Environmental Health Professionals to municipalities

32. 8.2 CLINICAL SERVICES (HOSPITAL) • 80 New EMS vehicles were purchased between November 2003 and March 2004 for deployment. An Air Ambulance service has been implemented • Finalise recruitment of management in the District Hospital Clusters and implementation of clinical programmes • Aligning our service delivery plans with MTS • NMAH commissioned and awaiting official opening in 2004/05

33. 8.3 CLINICAL SERVICES (QUALITY OF CARE) • Implementation of fully-fledged call centre to be able to monitor and provide feedback in all our customer complaints • Will establish clinical audit on target clinical programmes to ensure on-going monitoring and quality • Will implement accreditation programme targeting 40 hospitals over the next 3 years (and targeting 5 accredited hospitals)

34. 8.4 SUPPORT SERVICES • Infrastructure -Roll-out revitalisation programme with 4 Hospitals at different phases of development (St Elizabeth, Frontier, Mary Terese and Rietvlei) -Building of 46 clinics (including 13 in 2004/05) over the next 3 years -Replacing 47 clinic over next 3 years • Roll-out Corporate Service Centres to all districts (functional by March 2005) • Implementation of good finance governance and management principles • Audit committee • Internal Audit • Risk assessment and management • Decentralized pre-audit function

35. Support Services continued • Enhance HRM in the department • Robust recruitment and retention strategy • Roll-out PMDS to all levels • Learnership and internship programmes and targeting 1000 school leavers training as Nursing assistants and /or Community Health Workers • Mobilization of resources • Finalization of Drug PPP • Implementation Humansdorp PPP • Development of Port Alfred and Settlers PPP’s

36. TOTAL HEALTH ALLOCATION IN 2003/04

37. 6. BUDGET

38. PERCENTAGE REAL INCREASE BETWEEN 2003/04 AND 2004/05

39. EXPENDITURE ON PERSONNEL

40. TRANSFERS

41. CONDITIONAL GRANTS 2004/051

42. HIV/Aids Budget 2004/05

43. 2003/04 Expenditure analysis

44. 2003/04 Variance analysis by programme

45. Programme Distribution 2004/05

46. EXPENDITURE AMOUNT PER CAPITA In terms of the Inter Governmental Fiscal Review (IGFR) 2003 this province at R769.00 received the third lowest per capita allocation in South Africa. (1) Census data 2001

47. Programme Analysis • The proportion of the budget transferred to Local Government • 2.8 % was transferred. • The total amount for donor funding was • Approx. R26 million in kind where the USAID sponsored the Equity Project who rendered technical support and training.

48. Programme Analysis (cont) R’000 • Proportion of the Budget spent on District Health Services: • R 2,684,102 or 49.6 % • Proportion of the Budget spent on Community Health Services and Primary Health Services • R 1,200,057 or 22.18 % which is 45% of District Health Services budget

49. Cost Pressures • Transport management R37m short • Laboratory services R44m short • Land and buildings especially maintenance R43m short • Nutrition budget of R23m not enough to cover patients with HIV and TB

50. 7. CONCLUSION • Various restructuring programs have been put in place, and now we are in a process to deepen implementation. • We have started the roll-out of the Plan and we will increase the pace and capacity to absorb the demand • We are continuously seized with the challenge to increase the access and thereby drastically reducing the morbidity and mortality, and any other curable diseases • Even though significant improvements have been made on PPTV it remains a challenge • Demand for services continues to outweigh our resources • We remain committed to strengthen our links with partners in civil society