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Health Department Expenditure Review and Service Delivery Challenges

Review of Health Department's 3rd quarter expenditure, challenges in service delivery areas like waste management and information systems. Response to recommendations. Implications of slow spending on service providers.

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Health Department Expenditure Review and Service Delivery Challenges

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  1. BRIEFING FOR THE STANDING COMMITTEE ON APPROPRIATIONS ON THE THIRD QUARTER EXPENDITURE FOR THE 2015/16 FINANCIAL YEAR NATIONAL DEPARTMENT OF HEALTH 3 MAY 2016 1

  2. OUTLINE OF THE PRESENTATION • Spending Performance on all conditional grants as the end of the 3rd quarter. • 2. Service delivery implications from the slow spending areas and implications for the targets in the National Development Plan. • 3. Challenges and Remedial actions in the service delivery areas of health care waste management. • 4. Challenges and Remedial actions in the service delivery areas of health care information systems. • 5. Response to the Standing Committee on Appropriations observations and recommendations made in the Report on the 2015 Adjustments Appropriation Bill and the Report on the 2014/15 Third Quarter Expenditure Patterns. 2

  3. CONDITIONAL GRANT EXPENDITURE 3RD QUARTER 2015/16 • Spending Performance on all conditional grants as the end of the 3rd quarter: • Schedule 4 and 5 • Total CG spent sits at 73.6% or R23.5bn against the original budget of R31.9bn as compared to 70.0% or R21.0bn spent in the same period last financial year; • Low spending grants are NHI at 53.8% and NTSG at 72.0%, however, as compared to the 3rd quarter for 2014/15FY the grants has shown improvement; • Grants spent within the norm are HPTDG at 72.5%, HIV/AIDS 74.0% and HFRG 76.9%. • Schedule 6 (Indirect Grant) • Spent 44.6% or R629.8mil against the original budget of R1.4bn, the grant has shown improvement year on year; • Preliminary expenditure has improved to 96,8% on the back of a reduction in budget. 3

  4. Overall Expenditure Per Grant (Schedule 4 and 5 grants) 4

  5. National Health Grant (Schedule 6 – Indirect Grant) 5

  6. SERVICE DELIVERY IMPLICATIONS OF SLOW SPENDING • Service delivery implications from the slow spending areas and implications for the targets in the National Development Plan: • Late payment of service providers by Provinces cause financial and service delivery problems especially at project level; • HFRG funds to be ring-fenced on transfer to PDoH’s to prevent cash flow constraints experienced by Provinces impacting on projects; • To streamline and shorten payment processes to avoid late payments in Provinces; • Health Technology (equipment) planning and expenditure needs improvement. NDoH will provide a lead and guidance in budget preparations and ensure integration between Infrastructure planning and Health Technology • Inability to recruit and retain health professionals for rural tertiary hospitals, thus impact on spending and service delivery. 6

  7. HEALTH CARE WASTE MANAGEMENT CHALLENGES • Challenges and Remedial actions in the service delivery areas of health care waste management : • Challenges • Lack of resources (equipment for In-house transportation and containers, vehicles and human resource i.e. HCW officers); • Late payment of HCW service providers, which results to suspensions of services; • Lack of central and temporary storage facilities / areas; • Poor segregation of waste material. • Remedial Actions • Budget reprioritisation to be considered to allocate funds for the procurement of resources and hiring of HCW officers; • HCW service providers to be prioritised and to report monthly on progress on payments – to be tracked as a non negotiable item; • Structure procured for development and waste cages in line with SANS 10248 will be provided; • Policy and procedures approved and training to be conducted in different facilities. 7

  8. REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE THIRD QUARTER EXPENDITURE PATTERNS FOR THE 2014/15 FINANCIAL YEAR, DATED 3 JUNE 2015 • Recommendation 5.2.1 of this document states that the Minister of Health should ensure: • that the Department in partnership with National Treasury with Department of Monitoring and Evaluation, Financial and Fiscal Commission consider a review and enhancement of the efficacy and effectiveness of the conditional grant frameworks of the health sector in ensuring accelerated delivery of quality health services to all • NDOH Response: • The efficacy and effectiveness was reconsidered in consultation with National Treasury and changes will be made to requirements; • The NHI grant will come to an end in 2017/18 financial year and be consilidated as part of the NHI Indirect Grant; • Grant frameworks are reassessed annually with all Grant Managers and Provincial representatives before it is presented to National Treasury 8

  9. REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE THIRD QUARTER EXPENDITURE PATTERNS FOR THE 2014/15 FINANCIAL YEAR, DATED 3 JUNE 2015 • Recommendation 5.2.2 of this document states that The Minister of Health • should work with DPME and State Information Technology Agency to develop and enhance systems that monitors and systematically tracks all aspects of performance in each facility in the country • NDOH Response: Reflected on slides 10 and 11, and includes challenges and remedial action in the service delivery area of health care information systems 9

  10. CHALLENGES AND REMEDIAL ACTIONS IN THE SERVICE DELIVERY AREAS OF HEALTH CARE INFORMATION SYSTEMS. • The Department is implementing the ePHC Project which comprises of a patient administration and web-based patient information system in order to deal with challenges of quality, timely access and availability of health information for use and decision-making • The ePHC Project consist of the Health Patient Registration System (HPRS) development which commenced in July 2013, through a partnership between National Department of Health, Department of Science and Technology and Council for Scientific and Industrial Research. HPRS has been developed to provide a Patient Registry and Master Patient Index using the South African Identification Number and other legal personal identification systems such as passports. • The implementation of HPRS has been completed in 657 of the targeted 700 facilities in the NHI Pilot districts (i.e. they were HPRS functional by the end of March 2016). This project is being expanded to cover all PHC facilities within the next three years; • The Rationalisation of Registers (ROR) in Primary Health Care facilities was implemented as from April 2015 in order to reduce the number of PHC registers used at facilities. The ROR was implemented all PHC facilities in the provinces, except Western Cape; • A standardised PHC Patient Filing System and a Patient File has been piloted in 10 NHI facilities. The results of this pilot will be used to inform further implementation; 10

  11. CHALLENGES AND REMEDIAL ACTIONS IN THE SERVICE DELIVERY AREAS OF HEALTH CARE INFORMATION SYSTEMS • NDoH is also conducting a rapid assessment in partnership with CSIR, in order to identify gaps in existing information systems and rationalise hospital information systems and data collection tools; • NDoH is providing monthly feedback to provinces on data quality which is also discussed at NHISSA quartely meetings. • The SA Demographic Health Survey has shown significant progress: NDoH has received more funding from development partners (i.e. R20million from EU and 7.9 from Global Fund). The Survey commenced in November 2015, the pilot has taken place, tools amended and finalised, and data collection for the DHS will commence in Mat 2016; • NDoH will develop acceleration mechanisms for targets that were not met in 2015/16 for fast-tracking purposes. For example, the Medical Male Circumcision service delivery sites are being expanded to traditional sites through contracted GPs and other mechanisms. 11

  12. REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE THIRD QUARTER EXPENDITURE PATTERNS FOR THE 2014/15 FINANCIAL YEAR, DATED 3 JUNE 2015 • Recommendation 5.2.3 of this document states that the Minister of Health should ensure: • that the Department in partnership with the Department of Performance Monitoring and Evaluation explore, evaluate and implement mechanism in which the responsibility of maintaining hospitals and other health infrastructure can been devolved to the Department of Health and other capable state agencies • NDOH Response: • Focus in the HFRG Business Plans by Provinces should be on maintenance; • Current Grant Frameworks do provide for a split of budget i.e. 50% New Infrastructure, 25% Maintenance and 25% Refurbishments; • NDoH will review and approve business plans only if this split is adhered to and if business plans have a bias towards maintenancee rather than to new Infrastructure. 12

  13. REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE ADJUSTMENTS APPROPRIATION BILL [B28 – 2015] [NATIONAL ASSEMBLY (SECTION 77)], DATED 25 NOVEMBER 2015 • Minister of Health should ensure that: • 5.4.1: the Department align and enhance its budget planning and strategic planning function in order to ensure improvement on the spending performance of especially on its health infrastructure grant. • NDOH Response: • Overall spending of HFRG has improved as compared to 2014/15FY same period from 64.0% to 76.9% and is showing a preliminary expenditure at year end of 102%; • The improvement is through interventions on projects acceleration and performance of contractors by means of monitoring and evaluation thru the IUSS programme 13

  14. REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE ADJUSTMENTS APPROPRIATION BILL [B28 – 2015] [NATIONAL ASSEMBLY (SECTION 77)], DATED 25 NOVEMBER 2015 • Minister of Health should ensure that: • 5.4.2: the Department ensure that all vacant posts are filled timeously • NDOH Response: • NDoH constantly engage and liaise with PDoH’s to fast-track the appointment of all DORA posts within vacancy turn-around time as indicated on the APP and per DPSA guidelines / framework; • The NDOH has introduced a 4 month turn around time in the filling of vacancies, within its APP, as opposed to the 6 month window allowed by DPSA. 14

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