NATIONAL DEPARTMENT OF HEALTH: STRATEGIC PLAN 2008/09-2010/11

1. NATIONAL DEPARTMENT OF HEALTH:STRATEGIC PLAN 2008/09-2010/11 PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES 3 JUNE 2008

2. STRUCTURE OF PRESENTATION 1. VISION AND MISSION; 2. LEGISLATIVE MANDATES; 3. KEY PRIORITIES OF THE NATIONAL HEALTH SYSTEM (NHS) 2004-2009 4. NHS PRIORITIES 2007/08; 5. SUMMARY OF ACHIEVEMENTS DURING 2007/08; 6. CHALLENGES 7. REVISED ORGANISATIONAL STRUCTURE OF THE NATIONAL DOH; 8. NATIONAL HEALTH SYSTEMS (NHS) PRIORITIES FOR 2008/09 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 10. NDOH BUDGET FOR 2008/09-2010/11; 11. CONCLUSION

3. 1. VISION AND MISSION VISION An accessible, caring and high quality health system. MISSION To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

4. 2. LEGISLATIVE MANDATES • 49 pieces of legislation reflected in the Strategic Plan 2008/09-2010/11, including: • Constitution of the Republic of South Africa • National Health Act of 2003; • Public Finance Management Act of 1999; • Nursing Act of 2005; • Medical Schemes Act of 1998; • Tobacco Products Control Amendment Act

5. 3. KEY NHS PRIORITIES FOR 2004-2009 • Improve governance and management of the NHS; • Promote healthy lifestyles; • Contribute towards human dignity by improving quality of care; • Improve management of communicable diseases and non-communicable illnesses; • Strengthen primary health care, EMS and hospital service delivery systems • Strengthen support services • Human resource planning, development and management • Planning, budgeting and monitoring and evaluation • Prepare & implement legislation • Strengthen international relations

6. 4. NHS PRIORITIES FOR 2007/08 • Development of Provincial Service Transformation Plans (STPs); • Strengthening Human Resources; • Improving Quality of Care; • Strengthening the provision of infrastructure; • Strengthening Priority Health Programmes

7. 5. SUMMARY OF ACHIEVEMENTS IN 2007/08(BY BUDGET PROGRAMME) 5.1. ADMINISTRATION (PROGRAMME 1) • 6 pieces of health legislation signed into law by the President during 2007/08; • Review of progress towards health-related Millennium Development Goals (MDGs) published in July 2007, which indicated progress in key areas; • Provincial Service Transformation Plans (STPs) developed by Provinces; • Annual National Health Plan 2007/08 was printed and disseminated; • Multimedia campaigns focusing on a diversity of health topics were conducted, on SABC African Language Radio Stations; Community Radio Stations and Commercial Radio Stations; • Health awareness articles were also published in professional and stakeholder publications. • Ministerial Izimbizo held in different districts across the country.

8. 5. SUMMARY OF ACHIEVEMENTS IN 2007/08 5.2. STRATEGIC HEALTH PROGRAMMES (PROGRAMME 2) • 85% of health facilities implemented 10 recommendations of the Confidential Enquiries into Maternal Deaths (CEMD); • Routine immunization coverage of 84% was achieved in 2007, increasing from 82% in 2006/07, and 78% in 2002; • Mid-term review of June 2007 reflects that severe malnutrition amongst children under-5 decreased from 88 971 cases in 2001 to 30 082 in 2005; • Vitamin A supplementation provided to post-partum women and children who use public health sector facilities (61% of post-partum women; 100% of children aged 6-11 months and 26% of children aged 12-59 months); • South Africa’s Annual Update Report on Polio-free Certification submitted to the Africa Regional Certification Committee;

9. 5. SUMMARY OF ACHIEVEMENTS IN 2007/08 5.2. STRATEGIC HEALTH PROGRAMMES (PROG. 2) (CONT.) • Healthy lifestyles programme implemented. 15 Food Garden Project and 20 Physical Activity projects were established in EC, KZN and WC. Health messages on a range of topics disseminated through SABC Radio; 10 Regional Radio Stations and 46 Community Radio Stations • 1800 Schools identified and implementing the Health Promoting Schools Initiative; • 2006 HIV Antenatal Survey reflected a significant decrease in HIV prevalence, from 30.2% in 2005, to 29.1 in 2006; • VCT and PMTCT provided in over 90% of public health facilities; • Comprehensive Care, Management & Treatment Plan (CCMT) Plan service points established in all 284 local municipalities; • Cumulatively, over 437 844 patients placed on Antiretroviral Treatment by January 2008. Nutrition supplements provided to 480 000 eligible people; • National Strategic Plan (NSP) for HIV and AIDS developed and launched; • National Strategic Plan for TB developed and disseminated

10. 5. SUMMARY OF ACHIEVEMENTS IN 2007/08 5.3. HEALTH SERVICE DELIVERY (PROGRAMME 3) • Access to PHC services, as measured by PHC Headcounts, continued to increase, with more than 72 million visits recorded in the first 3 quarters of 2007/08; • PHC utilization rate of 2.5 visits per person attained, ranging from 2.0 visits per person in Eastern Cape, to 3.0 visits per person in Western Cape. This marks an increase from the utilization rate of 2.11 visits reported in 2006/07; • PHC supervision rate of 68% achieved, an improvement from the 48% achieved in 2006/07; • National Conference to celebrate 30 Years of Primary Health Care (PHC), since the signing of the Alma Ata Declaration in 1978, hosted in April 2008; • 20% reduction achieved in medicine prices through medicine pricing regulations, despite the fact that these were faced with legal challenges; • 33 Hospitals were under construction and 11 in the planning phase, as part of the Hospital Revitalisation Project; • National Infection Control Policy published and disseminated.

11. 5. SUMMARY OF ACHIEVEMENTS IN 2007/08 5.4. HUMAN RESOURCES (PROGRAMME 4) • Occupation Specific Dispensation (OSD) for all categories of nurses was agreed to with National DoH, DPSA, Treasury and signed into a collective agreement in 2007; • OSD is applicable to 100 000 nurses in the public sector; • Community service for nurses implemented as from January 2008; • Treaty permits were extended for 115 Cuban doctors & 32 Iranian doctors; • 22 Tunisian doctors started working in South African Hospitals • A further 312 Tunisian doctors were assessed by the HPCSA, and 258 were selected to be deployed.

12. 6. CHALLENGES • Public sector strike in the first quarter of 2007/08; • Progress towards Millennium Development Goals (MDGs) slower than anticipated; • Increased contribution of Non-Communicable Diseases (NCDs) to the country’s Burden of Diseases; • Inadequate intersectoral action to address social determinants of health. • Inadequate availability of health workers; • Impact of the 2-year Medical Internship programme; • Safety in Hospitals.

13. 7. REVISED ORGANISATIONAL STRUCTURE OF THE NATIONAL DOH • To enhance its capacity to accelerate implementation, the National DoH has revised its organisational structure from 4 to 6 Budget Programmes, namely: (i) Administration (incorporating Corporate Services); (ii) Strategic Health Programmes; (iii) Health Planning and Monitoring; (iv) Human Resources Development and Management; (v) Special Programmes and Health Entities Management; (vi) International Relations; Health Trade and Health Product Regulation.

14. 8. NATIONAL HEALTH SYSTEMS PRIORITIES FOR 2008/09 (i) Strengthening Management and Communication (ii) Implement programmes to combat both Communicable and Non- Communicable Diseases; (iii) Public Health Facility improvement through development and implementation of a Health Facilities Improvement Plan; (iv) Implementation of an integrated National Health Information System; (v) Health Financing, including the design of the National Health Insurance System and reducing the rate of tariff increases in the private health care sector; (vi) Further reduction in the prices of Pharmaceutical Products; (vii) Strengthen provision of Human Resources for Health; and (viii) Strengthen International Health Relations;

15. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.1. PROGRAMME 1: ADMINISTRATION During 2008/09, the National DoH will: • Strengthen planning within the National Health System at all levels, and improve monitoring and reporting; • Implement a Turn-Around-Strategy for improving Audit Outcomes and responses to queries from the Auditor-General (A-G); • Obtain Unqualified Audit Opinions from the A-G during this planning cycle; • Improve efficiency and effectiveness of the procurement of Goods and Services; • Strengthen implementation of the Performance Management and Development System (PMDS); • Develop and implement a policy for fast-tracking filling of vacant posts in the National DoH;

16. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES The National DoH will: • Ensure that 40/52 districts (77%) have full immunization coverage of 80% and above, for children under the age of 1 year; • Update the Polio Preparedness Plans and conduct campaigns; • Train 3600 health professionals in TB management and control; • Reduce the TB defaulter rate from 10% to 7%; • Achieve a 10% reduction in malaria deaths annually during the planning cycle.

17. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES • Accelerate the implementation of the NSP for HIV&AIDS 2007-2011; • Implement the TB Strategic Plan 2007-2011; • Expand provision of Vitamin A supplementation to eligible women and children using the Public Health Sector, from the 2007/08 baselines; • Provide 500 000 eligible people living with debilitating conditions with nutritional supplements; • Finalise Policy and produce draft Legislation on African Traditional Medicine; • Increase cataract surgery rate from 1146/million population in 2006/07, to 1600/million population in 2008/09.

18. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.3. PROGRAMME 3: HEALTH PLANNING AND MONITORING The National DoH will: • Implement the Health Facility Improvement Plan in 32 health facilities (28 hospitals and 4 Community Health Centres); • Appoint and train1110 data capturers to improve the quality of health information in the Public Health Sector; • Conduct the 2008 South African Demographic and Health Survey; • Conduct the 2007 National HIV and Syphilis Survey; • Finalise National Health Insurance (NHI) proposals and draft legislation; • Produce the final report on the National Burden of Diseases (BoD) Study, which will help generate a comprehensive picture of diseases patterns in South Africa; • Achieve further reduction in medicine prices through benchmarking with other countries; • Accelerate the process of restructuring the Medicines Control Council (MCC).

19. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.4. PROGRAMME 4: HUMAN RESOURCES MANAGEMENT AND DEVELOPMENT The National DoH will: • Extend the OSD to medical doctors, dentists, Emergency Medical Servces (EMS) personnel and pharmacists; • Implement the National Human Resources Information System (NHRIS); • Implement the Clinical Associates Programme together with the Universities of Pretoria; Witwatersrand and Walter Sisulu; • Support all 9 Province to produce or strengthen Provincial Human Resources Plans; • Appoint Members of Statutory Councils for the new terms of office [Health Professions Council of South Africa (HPCSA); SA Nursing Council (SANC); SA Dental Technicians Council].

20. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME 9.5.PROGRAMME 5:SPECIAL PROGRAMMES AND HEALTHENTITIES MANAGEMENT The National DoH will: • Complete 3 new hospitals (Dilokong & Nkhensani in Limpopo and Barkley West in Northern Cape Province in 2008/09; • Accept an additional 9 Hospitals into the Hospital Revitalisation Programme; • Ensure the appointment of Health Information Officers in 286 hospitals; • Complete the Audit of PHC Services and Infrastructure; • Further improve the supervision of PHC facilities;

21. 9. KEY INTERVENTIONS BY BUDGET PROGRAMME9.6. PROGRAMME 6: INTERNATIONAL RELATIONS; HEALTH TRADE AND HEALTHPRODUCT REGULATION The National DoH will: • Facilitate various multilateral activities and for a taking place in South Africa, such as CODEX, Red Cross, COPT); • Provide support to the post-conflict reconstruction processes in countries such as the DRC, Burundi and Sudan; • Enhance programmes to implement key priority areas of the Africa Health Strategy (e.g. malaria elimination, combating childhood illnesses and promoting safe motherhood); • Complete guidelines and systems for the registration of Traditional Medicines; • Develop and implement an electronic system for the registration of clinical trials

22. 10. BUDGET OF THE NATIONAL DEPARTMENT OF HEALTH 2008/09-2011

23. 10. NDOH BUDGET 2008/9-2010/11 • Conditional grant funding increases in 2008/09 budget; • The Hospital Revitalization Grant (R600m, R500m, R900m) to address recent cost escalations in the first year and allow additional projects in the outer years;

24. 10. NDOH BUDGET 2008/9-2010/11 • The Comprehensive HIV and AIDS Conditional Grant (R350m, R600m, R1.2b) to expand coverage of the comprehensive plan and strengthen prevention programmes;

25. 10. NDOH BUDGET 2008/9-2010/11 • The National Tertiary Services Grant(R193m, R248m, R640m) to strengthen tertiary services and central hospitals;

26. 10. NDOH BUDGET 2008/9-2010/11 • R 10 million has been earmarked to formulate detailed plans to recapitalize the nursing colleges • These plans need to be drawn for Colleges and must also include refurbishment of the colleges.

27. 10. NDOH BUDGET 2008/9-2010/11 New Organogram • Previously 4 programmes; from 2008/09 onwards 6 programmes; • Reduce span of management; • Better monitoring and control; • Enhance capacity to accelerate implementation

28. 10. NDOH BUDGET 2008/9-2010/11

29. 10. NDOH BUDGET 2008/9-2010/11

30. 10. NDOH BUDGET 2008/9-2010/11

31. 10. NDOH BUDGET 2008/9-2010/11

32. 10. NDOH BUDGET 2008/9-2010/11

33. 10. NDOH BUDGET 2008/9-2010/11

34. 10. NDOH BUDGET 2008/9-2010/11

35. 11. CONCLUSION • Linked to the President’s State of the Nation Address, 2008/09 will be a period of Business Unusual for the National DoH; • The Department will work very hard to implement the identified national priorities; • In 2007/08, significant progress was made in several key areas; • Critical challenges remain, which will be addressed during 2008/09.