PRESENTATION TO THE PORTFOLIO COMMITTEE ON HEALTH

1. PRESENTATION TO THE PORTFOLIO COMMITTEE ON HEALTH 2014/2015 Annual Report of the National Department of Health 15 October 2015

3. Purpose of the Presentation • To reflect on achievements and highlights in the Annual Report of the National Department of Health (DoH) for 2014/15.

4. Structure of the Presentation • Vision and Mission • National Development Plan • National Health Sector Priorities • Programme Performance • Human Resource Management • Financial Management • Conclusion

5. Vision and Mission Vision A long and healthy life for all South Africans. Mission To improve the health status through the prevention of illnesses and the promotion of healthy lifestyles and consistently to improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability. 5

6. National Development Plan Vision 2030 The Health Sector derives its vision and mandate from NDP 2030. By 2030, South Africa should have: Raised the life expectancy of South Africans to at least 70 years. Progressively improve TB prevention and cure. Reduced maternal, infant and child mortality. Significantly reduced prevalence of non-communicable diseases. Reduced injury, accidents and violence by 50 percent from 2010 levels. Completed health system reforms. Established primary healthcare teams to provide care to families and communities. Implement universal health coverage. Fill posts with skilled, committed and competent individuals. 6

7. Medium Term Strategic Framework (MTSF) 2014-2019 The Annual Performance Plan 2014/15 was designed to deliver on the MTSF commitments, namely: Sub-outcome 1: Universal Health coverage progressively achieved through implementation of National Health Insurance Sub-outcome 2: Improved quality of health care Sub-outcome 3. Implement the re-engineering of Primary Health Care Sub-outcome 4: Reduced health care costs Sub-outcome 5: Improved human resources for health Sub-outcome 6: Improved health management and leadership Sub-outcome 7: Improved health facility planning and infrastructure delivery Sub-outcome 8: HIV & AIDS and Tuberculosis prevented and successfully managed Sub-outcome 9: Maternal, infant and child mortality reduced Sub-outcome 10 : Efficient Health Management Information System developed and implemented for improved decision making 7

8. Strategic Goals 2014-2019 of the Department The National DoH Strategic Goals are: • Prevent disease and reduce its burden, and promote health; • Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of health facilities for its implementation; • Re-engineer primary healthcare by: increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams; and expanding school health services; • Improve health facility planning by implementing norms and standards; • Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms; • Develop an efficient health management information system for improved decision making; • Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; and • Improve human resources for health by ensuring adequate training and accountability measures.

9. Programme 1 Administration 9

10. Programme 1 • The vacancy rate was 6.6%; this performance remained below the DPSA’s target of 10%. • Turn-around Time for recruitment process was within 5 months. This performance is within the 6 months DPSA benchmark. • The National Department of Health (NDoH) has for the last 4 consecutive years obtained an “unqualified audit opinion” from the Auditor-General (SA), including for the 2014/15 financial year. • 3 out of 9 provincial DoHs obtained unqualified audit opinions for the 2014/15 financial year compared to two provincial DoHs for 2013/14.

11. Programme 1: Administration 11

12. Programme 1: Administration 12

13. Programme 1: Administration 13

14. Programme 2 National Health Insurance, Health Planning and Systems Enablement 14

15. Programme 2 National Health Insurance (NHI) • The health sector continued to implement key strategies linked to the NHI pilot sites. The country is still within the first phase (Year 3) of implementation of NHI which is planned to take five years. • The results of an appraisal conducted in 2014/15 show that all NHI districts reported full integration, co-ordination and alignment between District Health planning and implementation with that of NHI pilot activities • This is a significant improvement over the previous financial year, when only six out of 10 districts reported integration of NHI pilot activities into routine district management planning and implementation. • All pilot districts have appointed, or have proxy for, NHI co-ordinators, at both the provincial and the district level • A process of developing and testing Diagnosis-related Groups (DRG) as an alternative reimbursement tool for hospitals is in place. Phase 1 of this process involves developing a base DRG tool for the 10 central hospitals across the country. Good progress was made.

16. Programme 2: National Health Insurance, Health Planning and Systems Enablement 16

17. Programme 2 Sector-wide Procurement • The Department is implementing the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, covering chronic prescriptions for 183 989 patients. • Electronic stock management systems were implemented in 39 hospitals in order to strengthen demand planning and governance. • Access to medicines was enhanced with the approval of 306 pharmacy licences and 2 391 dispensing licences. 17

18. Programme 2: National Health Insurance, Health Planning and Systems Enablement 18

19. Programme 2: National Health Insurance, Health Planning and Systems Enablement 19

20. Programme 2: National Health Insurance, Health Planning and Systems Enablement 20

21. Programme 2 Implementation of Patient-based Health Information Systems at PHC Facilities • The National Health Normative Standards Framework for Interoperability in eHealth in South Africa was gazetted in April 2014. • The Council for Scientific and Industrial Research (CSIR) was commissioned to assess the level of Primary Health Care Patient Information Systems (PHC-PIS) implemented in South Africa against the published National Health Normative Standards Framework. The report is available. • The enterprise architecture for a PHC Integrated Patient Based Information System was developed. • A project for the reference implementation of the Interoperability Normative Standards Framework for eHealth in the 700 primary health care facilities is being implemented . • Distribution of the required hardware which included 3 370 computers to 698 facilities,

22. Programme 2 Research • Under the auspices of the National Health Research Committee, National Health Research Database, was launched in October 2014 and is being implemented in all provinces. This is the first building block for the establishment of the National Health Observatory , for which the business plan has been finalised • Continued implementation of the National Health Research Scholars Programme with funding support from both the Department and the Public Health Enhancement Funds • 18 new candidates were enrolled in 2014/15 • a total of 55 candidates have been enrolled since the NHSP in 2013 • Under the auspices of the National Health Research Ethics Council : • National Health Ethics Guidelines were revised and released ; • Regulations on Human Subjects were published ; and • 2006 National Good Clinical Guidelines for Clinical Trials were reviewed. 22

23. Programme 2: National Health Insurance, Health Planning and Systems Enablement 23

24. Programme 2: National Health Insurance, Health Planning and Systems Enablement 24

25. Programme 2: National Health Insurance, Health Planning and Systems Enablement 25

26. Programme 3 HIV and AIDS, TB and Maternal and Child Health

27. Programme 3Increasing Life Expectancy 27

28. Programme 3 • The Ward-based Primary Health Care Outreach Teams are following-up new mothers within six days of giving birth. At the end of 2014/15, 74.3% of mothers received a postnatal visit. • The Integrated School Health Programme (ISHP) had a 23.2% coverage rate for 2014/15 in Quintile 1 and 2 schools, and 463 School Health Teams screened a total of 709 396 learners. • The Human Papilloma Virus (HPV) immunisation campaign was largely successful, with 91.8% of the targeted number of girls reached for the 1st dose HPV immunisation. 28

29. Programme 3: HIV / AIDS, TB and Maternal and Child Health 29

30. Programme 3 • Prevention is the mainstay of efforts to combat HIV and AIDS. Since the HIV Counselling and Testing (HCT) campaign was introduced in 2010, over 35 million people have been tested. • For the 2014/15 financial year, 9 566 097 people between the ages of 15 and 49 years were tested. 30

31. Programme 3 • At the end of March 2015, there were 3 103 902 clients remaining on antiretroviral therapy (ART) (total clients remaining on ART – TROA) • The Department revised the HIV guidelines to align them with the World Health Organization (WHO) HIV Guidelines • Programme data are also showing that fewer infants are infected with HIV, with a polymerase chain reaction (PCR) positivity rate of 1.5% of all babies born to HIV-positive women around six weeks 31

32. Programme 3: HIV / AIDS, TB and Maternal and Child Health 32

33. Programme 3: HIV / AIDS, TB and Maternal and Child Health 33

34. Programme 3: HIV / AIDS, TB and Maternal and Child Health 34

35. Programme 3: HIV / AIDS, TB and Maternal and Child Health 35

36. Programme 4 Primary Health Care

37. Programme 4 • The Ideal Clinic(IC) initiative was launched in July 2013, and culminated in the Operation Phakisa Ideal Clinic laboratory , from 12 October to 21 November 2014 • In line with the National Health Amendment Act (12 of 2013) Port Health Services were transferred to NDOH in March 2015. • 44 Points of Entry (POE) were supported to improve their operations and are now compliant with International Health Regulations • In addressing the management of the Ebola Disease outbreak in Northern Africa, an Emergency Operations Centre (EOC) with a 24-hour, seven days per week medical hotline was established at the National Institute for Communicable Disease( NICD). Laboratory surveillance for Ebola Virus Disease(EVD) was also intensified through the NICD that was designated as a centre of excellence for testing samples and training on EVD in the SADC region 37

38. Programme 4 • The restructuring of Primary Health Care(PHC) and overhauling of the health system are intended to improve the quality of care and prepare the health system for National Health Insurance (NHI) • In the 2014/15 financial year, 1 748 PHC WBOTs reported their activities in the District Health Information System. This is an improvement from 2013/14, where 1 063 teams reported. • A total of 800 community healthcare workers have been allocated mobile phones and have been trained on the use of this technology for data capturing and reporting. This initiative supports a faster turnaround time for care of individuals and families in the community. • Since inception of GP contracting, a total of 300 GPs have been recruited and placed at PHC facilities at the end of March 2015 38

39. Programme 4 • A draft Policy Framework and Strategy for persons with disability was developed • Cataract surgeries were performed for 43 742 older persons. • The Minister of Health convened a summit for kidney care in January 2015. The outcome was a Declaration which forms the basis for improving future kidney care from primary to tertiary health levels • To improve oral health in children department provided fissure sealants, toothbrushes and toothpaste to 12 000 children in Quintile 1 and 2 primary schools. • The Oral Health programme has received fully equipped Mobile Dental Units in all NHI pilot districts for oral health services at schools. 39

40. Programme 4: Primary Health Care (PHC) Services 40

41. Programme 4: Primary Health Care (PHC) Services 41

42. Programme 4: Primary Health Care (PHC) Services 42

43. Programme 4: Primary Health Care (PHC) Services 43

44. Programme 4: Primary Health Care (PHC) Services 44

45. Programme 5 Hospital, Tertiary Health Services and Human Resource Development

46. Programme 5 Human Resources for Health • An audit of the profile and capacity of nurse educators to offer service-oriented nursing education and training programmes within a re-engineered primary health care approach was determined • A process was started to assist public nursing colleges to be ready to offer NQF-aligned nursing qualifications. An assessment of the state of readiness of selected nursing colleges to offer NQF-aligned nursing qualifications (one per province) has been completed

47. Programme 5 Health Infrastructure • At the end of 2014/15, there was a total of 1761 infrastructure projects at 888 facilities • The Health Infrastructure Norms and Standards Guidelines were published in Government Gazette No. 37790 R512, 30 June 2014 Forensic Chemistry Laboratory • A National Forensic Pathology Committee was appointed to ensure that forensic pathology services in the country are upholding acceptable standards. • In 2014/15, the norms and standards for the management of disasters were developed. These assisted in successful repatriation of the remains of all South Africans who perished in the collapse of a building in Lagos, Nigeria, including the facilitation of tissues for DNA analysis through authorisation of the required import and export permits in terms of Chapter 8 of the National Health Act (61 of 2003).

48. Programme 5: Hospital, Tertiary Health Services and Human Resource Development 48

49. Programme 5: Hospital, Tertiary Health Services and Human Resource Development 49

50. Programme 6 Health Regulation and Compliance Management