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Presentation to the Portfolio Committee on Health

This presentation to the Portfolio Committee on Health outlines the vision, mission, and priorities of the National Health Sector in South Africa. It covers the National Development Plan 2030 goals, key interventions, programme performance, human resource and financial management, and strategic priorities. The focus is on improving healthcare access, equity, efficiency, quality, and sustainability to achieve a long and healthy life for all South Africans.

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Presentation to the Portfolio Committee on Health

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  1. Presentation to the Portfolio Committee on Health 15 October 2014

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

  3. 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. 3

  4. National Development Plan 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.

  5. National Development Plan 2030 The NDP also identifies a set of nine (9) priorities that highlight the key interventions required to achieve a more effective health system, which will contribute to the achievement of the desired outcomes. The priorities are as follows: • Address the social determinants that affect health and diseases. • Strengthen the health system. • Improve health information systems. • Prevent and reduce the disease burden and promote health. • Finance universal healthcare coverage. • Improve human resources in the health sector. • Review management positions and appointments and strengthen accountability mechanisms. • Improve quality by using evidence. • Development meaningful public-private partnerships.

  6. National Health Sector Priorities The major strategic framework for the work of the National Department of Health (NDoH) during 2013/14 was the Negotiated Service Delivery Agreement (NSDA) 2010 to 2014, which provides key strategies for accelerating progress towards the vision of “A Long and Healthy Life for all South Africans”. The four outputs required from the health sector in terms of the NSDA are: (a) Increased life expectancy; (b) Reduction in maternal and child mortality rates; (c) Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis; and (d) Strengthening health system effectiveness. These outputs are interlinked. An effective and well-functioning health system is essential for the attainment of the desired improved health outcomes. The NSDA 2010 to 2014 informed the development, implementation and monitoring of the Annual Performance Plan (APP) of the NDoH for 2013/14. 6

  7. Programme Performance • Programme 1: Administration • Programme 2: National Health Insurance, Health Planning and Systems Enablement • Programme 3: HIV and AIDS, TB and Maternal and Child Health • Programme 4: Primary Health Care • Programme 5: Hospital, Tertiary Health Services and Human Resource Development • Programme 6: Health Regulation and Compliance Management

  8. Programme 1 Administration

  9. Programme 1 • Performance management systems have been reviewed and aligned to Department’s strategic direction. • Vacancy rate was reduced to 4.34% which is below DPSA’s target of 10%. • 103 out of 109 senior managers signed and timeously filed performance agreements with DPSA. • The National Department of Health (NDoH) has for the last 3 consecutive years obtained an “unqualified audit opinion” on external audit of the financial information by the Auditor-General (SA), including 2013/14 financial year. • 7 out of 9 provinces had qualified audits. All provinces have developed financial improvement plans.

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

  11. Programme 2 Implementation of Patient-based Health Information Systems at PHC Facilities • The Department partnered with Council for Scientific and Industrial Research (CSIR) to develop Health Patient Registration System (HPRS) to establish a patient registry. • There are 5 components of the system are People, Processes, Hardware, Software and Telecommunications • The Department procured IT equipment (computers, printers and basic network equipment) for 700 clinics in NHI Pilot Districts during the 2013/14 financial year. • The Department has supplied and installed equipment at 590 clinics in NHI Pilot Districts thus far.

  12. HARDWARE AND NETWORK INSTALLATION SOFTWARE INSTALLATION AND TRAINING

  13. Programme 2 Broadband Connectivity is essential to implement the HPRS: • All Clinics in both KZN NHI Pilot Districts were connected during the financial year. • The Department is working with Department of Telecommunications and Postal Services (DTPS) to scale up connectivity to all clinics in NHI Districts through the SA Connect project. The Department is also currently expanding the roll out of web-based District Health Information System (DHIS) daily data capture (DDC) where connectivity exist. Both HPRS and DHIS DDC will be scaled up to 700 clinics in NHI Pilot Districts. Implementation of Patient-based Health Information Systems at PHC Facilities (continue...)

  14. Programme 2 Information Systems, Monitoring & Evaluation • The Normative Standards Framework for eHealth for the public health sector was developed and approved. The eHealth Strategy seeks to ensure an Integrated National Patient-Based Information System. • Electronic Register (TIER. Net) was implemented in 2754 health facilities. • Rapid Mortality Surveillance was conducted by MRC and UCT School of Actuary Sciences to provide estimates for life expectancy, maternal and child mortality rates.

  15. Programme 2 Research • The Council for Scientific and Industrial Research (CSIR) undertook an assessment of Patient Information Systems used in Primary Health Care settings to make recommendations for effective patient information system. • Under the auspices of the National Health Research Council a National Health Research Database is being established. • The National Health Research Scholars Programme which seeks to produce 1 000 PhD graduates in all fields of Health Sciences over the next 10 years, was expanded in 2013/14. 13 PhD candidates were enrolled in 2012/13; and 26 candidates enrolled in 2013/14.

  16. Programme 2 Sector-wide Procurement • An early warning system has been implemented to prevent stock-outs at facility level. • A toll free line is also available to report low stock levels. • In an effort to improve access and to decongest public facilities, work has started in NHI pilot districts whereby stable patients on chronic medicines are offered the opportunity to collect their chronic medicines at a point close to their homes or workplaces. • To monitor the overall performance of the Provincial Pharmaceutical Services, a dashboard of key pharmaceutical indicators has been developed.

  17. Programme 2 Procurement Reforms: Total Impact 1-6

  18. Programme 2 Procurement Reforms Impact • Availability of drugs has improved from 58% to 73% • Out of contract procurement decreased from 36% to 12% • Buy-outs decreased by 26% • Warehouse productivity has improved by 26% reducing the requirement for overtime as well additional hiring of staff • Order processing time has been improved from pre project levels of 32 days on average to current levels of 11 days • Cost of distribution has decreased by 27% • Non Essential Medicine List orders reduced from 50% to 40% • Backorders have reduced by 30% Financial savings of over R150,000,000 have been achieved through the improved governance around procurement and contract management.

  19. Programme 2 National Health Insurance (NHI) • The Department continued to implement the new re-engineered Primary Health Care (PHC) model for South Africa which consist of District Clinical Specialist Teams; Ward Based Primary Health Care Outreach Teams, the Integrated School Health Programme and the Contracting of General Practitioners to work in Primary Health Care Facilities. •  District Clinical Specialist Teams with at least three specialists were established in 46 of the 52 health districts. •  A total of 1 063 Municipal Ward Based Primary Health Care Outreach Teams (WBPHCOT) were established. • 119 GPs were contracted for NHI. • The various interventions implemented in the pilot districts focused on developing capacity in the area of monitoring and evaluation, supply chain management, and planning and strengthening the referral system.

  20. Programme 2 • In order to strengthen the school health programme launched in October 2012, the National Department of Health has purchased 60 mobiles which have been deployed and are being used in the NHI pilot districts • A further 28 mobiles are currently on order for delivering in this financial year Integrated School Health Programme

  21. 33 1668 medical male circumcision were performed • 6 688950 people aged 15-49 were tested for HIV • 662312 new clients were put on ARVs • Immunization coverage under 1 year reached 91.8% • 77. 5% of Antenatal clients initiated on ART • 89% of pregnant women delivered at facilities • TB cure rate at 75.9% • 88.7% of TB clients were tested for HIV

  22. Programme 2 1st AU International Maternal, Newborn & Child Health Conference • Co-hosted with the AU and held in August 2013 • Attended by Ministers and deputy Ministers from as well as officials from more than 30 countries • The objective was to review progress in the implementation of the Campaign on the accelerated reduction of maternal and child mortality (CARMMA) • Recommendations from the conference were adopted by the joint AU/AFRO Health Ministers meeting held on 16-17 April 2014

  23. Programme 2 Strategies to Improve: National Health Insurance (APP 2014/15) • Installation of consulting rooms • GPs programme for NHI • Contracting • Accurate documentation • GP induction programme • Expand from GP contracting to other health professionals

  24. Programme 2 Strategies to Improve: Performance Data Quality • Implement web based District Health Information System to improve data quality and timeliness of routine health information. • Strengthen the implementation of the District Health Management Information System (DHMIS) Policy • Improve the quality of data collection tools at PHC Facilities • Conclude the review of the National Indicator Data Set (NIDS) 2015-2017 • Develop and implement standardised guidelines for review of Provincial Indicator Data Set 2015-2017 • Rationalisation of PHC Registers Project • Integrate TB (ETR.net) and HIV (Tier.net) Health Information Systems • Accelerate the implementation of the eHealth strategy

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

  26. Programme 3District -based Clinical Specialist Teams per Province

  27. Programme 3Increasing Life Expectancy

  28. Programme 3 Declining Number of Deaths Source: Statistics South Africa, 2014

  29. Programme 3Death Trends • The total number of deaths registered by Home Affairs was 480 476, which was a decline of 6,2% from the 512 310 deaths that occurred in 2011. • The median age at death (age at which deaths occurred, indicating early or late mortality in the population) is increasing. • From 2008 – 2011, the highest proportion of deaths occurred amongst young adults. However, the 2012 data show that the age profile of deaths in South Africa is starting to normalise, with the older age groups having a higher proportion of deaths than young adults.

  30. Programme 3Key mortality data (MRC &UCT)

  31. Programme 4 Primary Health Care

  32. Programme 4 • PHC utilization rate is of 2.4 visits per person per annum was achieved • A total of 1063 Municipal Ward Based Primary Health Care Outreach teams established. • “Ideal Clinic” initiative is being implemented in primary health care facility to improve quality. • National Environmental Health Policy was approved and published in the Government Gazette for implementation. • Malaria incidence reduced from 0.60 to 0.17 per 1000 . • Infant & Young Child Feeding Policy was approved and published. • A diagnostic & implementation of evaluation of Government Nutrition Programme for under five years of age was undertaken.

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

  34. Programme 5 • 2 638 students were registered for the first year of the medical degree in South Africa (1756) and Cuba (882). • A total of 88 doctors from Cuba were distributed to provinces • 260 Hospital CEOs have undergone training to enhance the management capacity of the public health sector •  A Public Health Enhancement Fund was created, jointly with the private sector. R20 million from this fund was used to support training of 100 medical students from disadvantaged backgrounds.

  35. Programme 5 9 898 Community Health Workers (CHWs) were trained on Phase One Foundation Training. They have been placed in the Municipal Ward Based Outreach Teams to support the PHC re-engineering process.

  36. Programme 5 Human Resources for Health • During 2013/14, the Workload Indicators for Staffing Need (WISN) model from WHO was used to determine health workforce staffing requirements. Staffing norms for clinics and community health centres were developed and adopted as guidelines for implementation by National Health Council. • A total of 75 521 health professionals and non-professional were trained in programmes dealing with HIV and AIDS, STIs, TB and chronic disease management. • The National Department of Health enrolled 70 Forensic Interns out of a pool of qualified but unemployed applicants.

  37. Programme 5 Health Infrastructure • In 2013/14: • 842 projects at various stages of construction • 587 at planning stages • 39 handed over • Infrastructure norms & standards being finalised with CSIR • Manual monitoring system converted into a web-based system • 14 hospitals revitalised through Health Facility Revitalisation Grant • 105 clinics being refurbished in NHI districts from the National Health grant through DBSA FET college student initiative • 12 nursing education institutions upgrading process initiated

  38. Physical Progress in the MP Province Ermelo Clinic (Gert Sibande) Lebohang Clinic (Gert Sibande)

  39. FS province Mahaig Clinic (Thabo Mofutsanyane) Tshirela Clinic (Thabo Mofutsanyane)

  40. Physical progress in the FS province Bohlokong Clinic (Thabo Mofutsanyane) Bluegumbosch Clinic (Thabo Mofutsanyane)

  41. Portchefstroom clinic close to completion

  42. Portchefstroom clinic furniture and medical equipment

  43. Human Resource Management

  44. Human Resource Management Employment and Vacancies

  45. Human Resource Management Employment Equity

  46. Programme 6 Health Regulation and Compliance Management

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