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Presentation to the Ad Hoc Committee on Health on the 2004 / 2005 Budget

Presentation to the Ad Hoc Committee on Health on the 2004 / 2005 Budget. Presented by the Department of Health and Welfare Limpopo for Vote 7 : Health 8 June 2004 in Cape Town. Vision.

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Presentation to the Ad Hoc Committee on Health on the 2004 / 2005 Budget

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  1. Presentation to theAd Hoc Committee on Health on the 2004 / 2005 Budget Presented by the Department of Health and Welfare Limpopo for Vote 7 : Health 8 June 2004 in Cape Town Health - Limpopo

  2. Vision A caring and developmental Health and Welfare system which promotes well-being, self-reliance and a humane society in which all people in LIMPOPO have access to affordable and good quality services !” The above vision statement emphasises the ultimate goal ofthe Department, i.e. a society consisting of contented individuals, who take charge of their own destinies. The dignity of society and their quality of life is promoted by their employment of good quality services. Health - Limpopo

  3. Mission The Department is committed to providing comprehensive, integrated and equitable Health and Welfare services which are sustainable, cost effective and focus on the development of human potential in partnership with relevant stakeholders. Health - Limpopo

  4. Provincial Overview DEMOGRAPHICS for Limpopo • The Population grew from 4.9m in ’96 to 5.2m in 2001 and is estimated at 5.6 m at present. • This constitutes a 7% growth for both periods • 54 % of the population are Women • Literacy rate for 20 rye's & older people was 63.1 % In 1996 • 89% of the population live in rural areas • Unemployment rate was at 36.1% in 2001 • The Province is divided in 6 Districts Health - Limpopo

  5. Population of South Africa by Province(Source: STATSSA-Census 2001) Health - Limpopo

  6. Source: StatsSA-Census 2001 Health - Limpopo

  7. Source: Labour Force Survey 2001 Health - Limpopo

  8. Top Ten (10) Causes of DeathSource : STATSSA; Advance Release of Recorded Deaths 1997 - 2001 Health - Limpopo

  9. HEALTH CORE FUNCTIONS • Formulate and implement provincial health policies, norms, standards and legislation    • Provide regional and specialised hospital services as well as academic Health Services, where relevant. • Render and co-ordinate Medical Emergency Services (including ambulance service) • Render Medico-legal services. • Render health services to those detained, arrested or charged. • Screen applications for licensing and inspection of private facilities. Health - Limpopo

  10. HEALTH CORE FUNCTIONS • Inter-provincial and intersectoral co-ordination and collaboration. • Co-ordinate the funding and financial management (budgetary process) of the district health services. • Provide technical and logistical support to health districts. • Render specific provincial services programmes, e.g. TB programme. • Provide non-personal health services. • Quality control of all health services and facilities. Health - Limpopo

  11. HEALTH CORE FUNCTIONS Cont. • Provide and maintain equipment, vehicles and health care services. • Effective consultation on health matters at the community level. • Provide occupational health services. • Research on, and planning, co-ordination, monitoring and evaluation of health services rendered in the Province. • Ensure that functions delegated by the National level are carried out. Health - Limpopo

  12. Ten Point Plan for Health • Re-organization of Certain Support Services and Legislative reform • Attainment of equity in resource allocation • Improving Quality of Care • Revitalisation of Hospital Services • Speeding up delivery of PHC Services through District Health System • Decreasing Morbidity and Mortality Rates through Strategic Interventions • Improving Resource Mobilization and Resource Management • Improving Human Resource Development and Management • Improving Communication and Consultation between the Health System and Communities. • Strategic Co-operation with our Partners Internationally. Health - Limpopo

  13. Re-organization of Certain Support Services and Legislative reform • Laboratory services via NHLS • 7 New EMS stations to total 18 • 95 New ambulances purchased (2002 – 2004) • New ( Rescue 11 & 13 Response ) vehicles in place • Drug availability in the depot increased from 70% to 93% and in the hospitals from 85% to 90% • Rreferral Hospitals increased from 2 to 7 • Purchased 126 patient transport vehicles in 2003 • Review of the Provincial Health Act to align with National Health - Limpopo

  14. Attainment of equity in resource allocationUnder funding of Limpopo Health Under funding of the Limpopo Health Vote has led to the department over spending against the budget. The following un-authorised expenditure resulted that equates to a bank overdraft for as long as the over expenditure is not funded. R 410 593. • 2000 / 2001 R 114 914m • 2001 / 2002 R 53 261m • 2002 / 2003 R 48 209m • 2003 / 2004 R 194 209m The under funding results from the deviations of budget allocations as opposed to the Equitable Share Formula Health - Limpopo

  15. Limpopo Provincial Equitable Share Allocations Health - Limpopo

  16. Over / ( Short ) Funding on the Equitable Share Formula Health - Limpopo

  17. Short Funding on the Equitable Share Formula cont. • Health Vote 7 is under funded as per the Equitable Share Formula as contained in the IGFR and DORA. • Should the budget allocation be correct as per the formula which is based on the Census results of the population distribution within the provinces, then Vote 7 Health would have received R 566m more for the current year and R 651m more for the next year. • The funding of the additional allocation to Health, Education and the other departments would have to come from Vote 12 Welfare. • The Welfare vote is currently also under funded. Health - Limpopo

  18. Improving Quality of Care • Centres of Excellence @ Letaba & Maphuta Malatji • The number of transfers to Gauteng hospitals was reduced by 25% • Establishment of the latest technology Oncology unit • 33 Hospitals offer CTOP • 400 Active care groups established • Provincial policy on HIV & AIDS / TB / STDI • 40 Hospitals and 350 PHC Facilities offer PMTCT • Utilization of community service health professionals, such as pharmacy and medical interns has improved access to services Health - Limpopo

  19. Revitalisation of Hospital Services • Clinic building and upgrading • 109 New clinics built for a total of 474 • 68 Clinics upgraded • 5 Health centres built • 5 New mobile visiting points • 63 Mobile visiting sites upgraded • 40 hospitals have health information systems core module (admission / discharges / transfers & revenue) • One MDR TB Clinic established at Pietersburg • Construction of an MDR Unit for Limpopo has started • 3 Hospitals in 3rd and 4th phases of revitalisation Health - Limpopo

  20. Speeding up delivery of PHC Services through District Health System • Free service to all pregnant woman and children below 6 years • 129 aditional clinics offer 24 hour service to total 292 Clinics to date • 15 Hospitals have a PHC Gateway • Post Exposure Prophylaxis (PEP) Treatment is being provided at all hospitals • 7 Sub acute facilities are operational • 414 VCT sites established Health - Limpopo

  21. Decreasing Morbidity and Mortality Rates through Strategic Interventions • TB new smear positive cure rate increased from 42 to 68 % • TB Interruption rate decreased from 19 % to 9 % • 8 Sites have been designated to provide Antiretroviral Therapy and other supportive care services • Routine immunization coverage for under 1 year increased from 64 % to 82 %. • Increased number of households sprayed for Malaria Health - Limpopo

  22. Improving Resource Mobilization and Resource Management • All hospitals have business plans in line with Provincial Strategic Plan • The UPFS is implemented to improve revenue collection and medical claims submissions. • Nurses increased from 10 520 to 11 432 • Professional nurses increased from 104.6 to110.5 per 100 000 • 3039 Enrolled nurses translated into Professional N Health - Limpopo

  23. COMMUNITY SERVICE HEALTH PROFESSIONALS Health - Limpopo

  24. VACANCY RATES Health - Limpopo

  25. Number of Medical/Dental Officers Health - Limpopo

  26. POSTS FILLED BY RACE & GENDER IN 2003 Health - Limpopo

  27. Professionals Trained Via Bursary Scheme Health - Limpopo

  28. Improving Communication and Consultation between the Health System and Communities. • Both the intranet and the websites are live. • All district offices are on e-mail • IS/IT policy development is co-ordinated with SITA • Reviving of the Hospital Boards & Clinic Committees • Established AIDS Councils and PHW Authorities • Continued and expanded NGO funding Health - Limpopo

  29. Strategic Co-operation with our Partners Internationally • Collaboration with MEDUNSA led to the recognition of a 2 Years Post – Graduate training in major Clinical Disciplines. • Twining agreements around issues of PHC with • France • The UK • Mozambique Health - Limpopo

  30. Expenditure Trends: 1997/98 – 2003/04 & MTEF Health - Limpopo

  31. Expenditure Trends: 1997/98 – 2003/04 & MTEF • The departmental budget increased by 46.2 % between 2001/02 to 2004/05. • The Personnel budget for the same period increased by only 43 %. • More funds were thus allocated to Pharmaceuticals, and Non – Personnel costs together with a growth in Conditional Grants. • Personnel Costs reduced from 63.9 % to 62.5 % of the budget for the same period. • An over expenditure of R 150m in 1998/99 was due to the budget allocation being reduced by 9 % over the previous year. • The department could not implement 2nd and 3rd Notches as from 1997/98 due to budget constraints. • Additional budget was allocated in the 2003/04 year ( R 82.5m) to begin to bring the staff to the correct Notches and begin to address the backlogs. Health - Limpopo

  32. Expenditure Trends: 1997/98 – 2003/04 & MTEF • The 2003 / 04 year also saw the introduction of the Scarce Skills and Rural Allowance that was introduced as from July 2003, with an amount of R 31.8m allocated for this. • As part of Resolution 7, the department had 680 officials transferred from Dept of Agric together with a budget of R 30m, as fro April 2004 onwards. • The Personnel budget thus grew with 0.8 % as a result of the funding received for these three programmes. • The over expenditure of R 127.7m for the past year is attributed to the payment of most of the arrears for 2nd and 3rd Notches. • The actual over expenditure on the Equitable Share amounted to R 194m after taking the Conditional Grants into account. Health - Limpopo

  33. Departmental Revenue Collection2001/02 - 2003/04 & MTEF Budget Health - Limpopo

  34. Personnel v/s Non-Personnel Expenditure trends Health - Limpopo

  35. Summary of Expenditure & Estimates 2001/02 - 2005/06 Health - Limpopo

  36. Current estimates and the MTEF to 2006/07 Health - Limpopo

  37. Current estimates and the MTEF • The Conditional Grants have increased by R 38.8m but the transfer of INP to DoE results in the reduction. • Pharmaceuticals have been ring fenced to show the steady increase over the MTEF. • The concern is the decrease in the Non PE budget for the current year and outer year with the 2005/06 showing only a marginal increase. • The previous years Non- PE included once off costs of R 93.4m that has been utilised to fund critical areas in the current year. • The current year only includes once off costs of R34m that can be rerouted in the next financial year • Service delivery over the next three years is being stifled due to the lack of growth in the Non – PE budget. Health - Limpopo

  38. Challenges for the MTEF Health - Limpopo

  39. Challenges for the MTEF Infrastructure service implications • Infrastructure development cannot be fast tracked. It is well known that there are a large number of clinics with no water, no electricity, insufficient equipment and inadequate facilities. • The development of the tertiary facilities will also be delayed. Maintenance of medical equipment will still be inadequate. • The Hospital Revitalisation Grant and Provincial Infrastructure Grant remain the main source of Capital for the department. • The lack of growth in the Non PE budget entails that Equitable Share cannot be allocated to Infrastructure Health - Limpopo

  40. Challenges for the MTEF • The health institutions (hospitals, clinics and Health centres) have not had any increase in Budget for the past two financial years in respect of Non- PE costs. • With Patients as the major cost driver the provision of rations, clothing and linen could not keep track due to the limited resources. • Other major cost relating to patients is the supply of blood and blood products as well as the Laboratory tests. • The increase in cost of communication, water and electricity, repairs and maintenance, security as well as transport costs has made it impossible to expand health services, and extremely difficult to maintain standards of health care. Health - Limpopo

  41. Health - Limpopo

  42. HEALTH PRIORITIES – M T E F HIV/AIDS/TB/STI CONTROL & MANAGEMENT: Reduction of HIV/AIDS infection • Caring of the infected and affected by HIV and AIDS • Decreasing number of patients infected • Decrease Multi Drug Resistance (MDR) • COMMUNICABLE DISEASE CONTROL: • Polio Eeradication • Expanded Programme on Immunisation • Malaria Control Health - Limpopo

  43. HEALTH PRIORITIES - M T E F PHC SERVICES & DHS DEVELOPMENT: • Devolution of Municipal Health services • Provide 24 Hour Services at Clinics • Provide comprehensive PHC package • Referral System EMERGENCY MEDICAL SERVICES: • Increasing access to EMS & Patients transport for rural settings LOGISTICAL SUPPORT SERVICES: • Adequate Medicines at Facilities. • Improve Management of Health Technologies & Assistive Devices • Functioning health information systems • Striving for adequate budget allocation Health - Limpopo

  44. HEALTH PRIORITIES - M T E F INFRASTRUCTURE DEVELOPMENT: • Revitalization of hospitals • Uupgrading and building of clinics • Improve water, sanitation & electricity at clinics HUMAN RESOURCE DEVELOPMENT: • Development of a Departmental HR Plan • Nursing and EMS Training Colleges • Skills Development • Development of mid-level health worker cadre core HUMAN RESOURCE MANAGEMENT: • Recruitment and retention of scarce and skilled workers Health - Limpopo

  45. HEALTH PRIORITIES - M T E F COMMUNICATION, COLLABORATION AND PARTICIPATION: • Engage in PPP for Phalaborwa hospital, Duiwelskloof hospital, Laundry, Accommodation and Renal Dialysis unit. • Conduct feasibility studies for possible Expansion of PPP Initiatives. • Quality Improvement & Management • Corporate Communication & Media Liaison • Transformation & Inter-governmental Relations & Gender Issues • Health Promotion TERTIARY SERVICES: • Fully modernized tertiary services REVENUE GENERATION: • Fully implemented designated provider network Health - Limpopo

  46. HEALTH PRIORITIES – M T E F INFORMATION MANAGEMENT AND TECHNOLOGY: • Improve themanagement of records • Improve the quality of data within departmental information systems • Streamline IT service provision in line with the SITA act RISK MANAGEMENT: • Instill a culture of Risk Management within the Department • Effective management of security and fraud related risks. Health - Limpopo

  47. Strategic Plan to achieve the Health priorities Pr 1. Health Administration = R230 m • Develop and review departmental policies • Develop norms and standards • Develop an Info and Technology strategy • Expand MIS to all clinics and hospitals • Ensure effective revenue management • Provide and maintain EEE and transparent • Financial Management • Procurement and provisioning systems • Contract Management system Health - Limpopo

  48. Strategic Plan to achieve the Health priorities Pr 1. Health Administration cont. • Implement EEE, PPP’s as required • Provide labour relations services • Provide communication services • Promote community participation and partnerships • Develop an integrated HR plan • Co-ordinate training & develop HR Health - Limpopo

  49. Strategic Plan to achieve the Health priorities Pr 1. Health Administration • Personnel Performance Management • Implement Telemedicine / Telehealth at all levels of care by 2010 • To improve the management of Risk • To strengthen the vital registration of births and deaths. Health - Limpopo

  50. Strategic Plan to achieve the Health priorities Pr 2 . District Health = R 2 054m • Develop DHS devolution strategy • Strengthen DHS via partnerships • Provide a comprehensive PHC package • Improve efficiencies at PHC facilities • Improve access to drugs • Promote community participation at district level • Improve access to PHS services • Improvement of the PHC infrastructure • Improve the quality of care Health - Limpopo

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