Brief to the Standing Committee on Appropriations Human Sciences Research Council

1. Brief to the Standing Committee on AppropriationsHuman Sciences Research Council Date: 19 April 2011

2. Presentation Outline • Education • Health • Food Security • Local Government • Human Settlements • Public Service

3. Education

4. Education: School and post school Budget for Basic Education: 2011 / 12

5. Education: School and post school • Outcome 1: Improved quality of Basic Education • Output 1: improve the quality of teaching and learning • Output 2: Undertake regular assessments to track progress • Output 3: Improve Early Childhood Development • Output 4: Ensure credible outcomes focused planning and accountability system

6. Education: School and post school • Teacher Development • Many interventions are undertaken to upgrade teachers knowledge competences. These need to be evaluated. • FunzaLushaka bursary scheme a success and high quality applicants being attracted to teaching. • Teachers have to be in classroom and reduce leave taking. (HSRC: Research)

7. Education: School and post school • Workbook Provisions • DBE has embarked on an ambitious plan to provide high quality workbooks to grade 1 learners. • Initiative fairly successful and there are problems of overambitious delivery targets – would get better the next round • Challenge is usage of books in classrooms

8. Education: School and post school • System of standardised assessments • The first ambitious ANA were administered in February 2011. • There are teething problems, but with time the mechanics and logistics for undertaking such a huge exercise will be routinised. • National Department drives the process, and embarks on a cascading model. But capacity in districts is weak and that is the critical leverage point that needs to be strengthened to better support schools

9. Education: School and post school • Lessons from participation in International Assessments • DBE committed to SACMEQ, TIMSS (math and science); PIRLS (literacy). • This will provide externally benchmarked scores and an objective measure of the health of the education system. • HSRC is co-ordinating TIMSS, with data collection in Aug/ Sept 2011.

10. Education: School and post school • Universal access to Grade R • The access question is easier to deal with. Quality is more elusive. • Need to include and demand the quality inputs in Grade R and early years. • Performance in early grades predict later performance. If we do not get it right in this early phase, especially in numeracy, math and thus analytical skills, it is very difficult to play catch up.

11. Education: School and post school • Strengthen capacity of district office • This is a key challenge for the education system – as one moves from national to provincial to district the skills, expertise and experience levels decreases. • Also expectations and workloads of district level staff is diffuse and they are unable to provide the support to schools.

12. Education: School and post school • Outcome 5: Skilled and Capable Workforce • Output 1: Establish a credible institutional mechanism for skills planning which includes the provision of information with regard to supply and demand of skills • Output 2: Increased access to programmes leading to intermediate and high level learning • Output 3: Increase access to occupationally directed programmes in needed areas. • Output 4: Increased access to high level occupationally directed programmes • Increase research, development and innovation in human capital for growing the knowledge economy.

13. Education: School and post school • Budget for Higher Education and Training

14. Education: School and post school • Credible institutional mechanism for skills planning • DHET in discussion with HSRC about co-ordinating this research function so that there could be effective skills forecasting and an analysis of supply and demand and therefore the appropriate Sector Skills Plans developed. • Skills forecasting will form the core of the skills development plans and work of SETAs

15. Education: School and post school • Programmes of intermediate and high level learning • Key institution for delivery are the FET colleges & learnerships. • FET colleges are designed for 1.2 million students, but the present enrollment is around 460 000. Sector needs to attract more students and offer appropriate curricula to students. • Currently for every 4 HE students there is 1 FET – need to change this ratio.

16. Education: School and post school • General comments • DHET has serious capacity issues and therefore have been unable deliver on all their programmes. • DHET dealing with governance issues in SETAs and and funding for post-school students is affected by NSFAS governance issues and suspension of CEO.

17. Health

18. A long and healthy life for all South Africans • Update on HIV/AIDS epidemic in South Africa • To date there have been some notable successes as follows: • The significant reduction of new infections especially among female youth (Rehle et al., 2011; UNAIDS, 2010) • The groundbreaking HCT campaign has also tested 6.2 million of out a target of 15 million set to end in June 2011. • Scaling up ARV treatment to over 1.3 million PLWHA initiating treatment (UNAIDS, 2010). • Unfortunately, there are three people still getting infected for every two individuals who are initiated on treatment. • Tuberculosis cure rates are improving across the country, while treatment defaulter rates are decreasing.

19. A long and healthy life for all South Africans • HIV incidence (/100 pyar), 15-24 age group South Africa 2002-2005 and 2005-2008

20. A long and healthy life for all South Africans • Condom use by age group and sex, South Africa 2002, 2005 and 2008

21. A long and healthy life for all South Africans • 2011-2012 Appropriations to Social Development • The HIV and AIDS programme develops, supports and monitors the implementation of policies, programmes and guidelines to prevent and mitigate the impact of HIV and AIDS, in line with the 2007-2011 national strategic plan. • R43.6 million (64 per cent of the total budget) has been made available for non-profit organisations (NPOs) in 2011/12. • This allocation is considered grossly inadequate as few NPOs receive adequate funding these days. It is there recommended that additional funds be made available to support the excellent work done by the NGOs in the HIV/AIDS sector

22. A long and healthy life for all South Africans • Recommendations for further appropriations • As was alluded to at the beginning of the presentation, prevention remains the cornerstone of HIV and AIDS interventions. To be able to do this, there is need for an effectively functioning and well resourced SANAC. • Therefore adequate funding needs to be provided for SANAC to implement the final 8 months of the current NSP as well as start implementing the new NSP currently being written up from January next year until the end of 2016. • There is also a clear need for support to scale up evidence-based interventions such as PMTCT, ARV treatment, Male circumcision and HCT to identify PLWHA as combination prevention especially in hot spots or high transmission areas in KZN, MP and EC..

23. A long and healthy life for all South Africans • Recommendations for further appropriations • In addition, there is also a need to support on-going research on biomedical prevention technologies such as vaccines, microbicides and PrEP as well and structural/social and behavioural interventions for which South African researchers are well known for across the world. • Interventions such as tenofovir treatment (ARV) vaginal microbicide which have been tested successfully in South Africa should receive more support. • The same is true for social and behavioural interventions such as Stepping Stones, Intervention with Microfinance for AIDS & Gender Equity, and Phaphama, among others, which have been shown to be efficacious in local studies.

24. Primary Health Care Services • Strategic Focus • Over the 2011/12–2013/14 planning cycle • Implementing interventions to achieve the four outputs entailed in the minister’s performance agreement, and elaborated on in the negotiated service delivery agreement for 2010–2014. • These are: • increasing life expectancy • reducing maternal and child mortality rates • combating HIV and AIDS and decreasing the burden of diseases from tuberculosis • strengthening health system effectiveness.

25. Primary Health Care Services • Implementation Plan • It is planned that 50 primary health care outreach teams, consisting of professional nurses, enrolled nurses and community health workers, will be deployed in different wards across the country, each serving about 1 500 families (estimated 6 000 people). • District support teams will be established with medical specialists.

26. Primary Health Care Services • Community Health Workers • Greater efficiency and effective use of the Department of Health’s funds to provide a better service, it is important to strengthen a core element of the delivery of primary health care, namely Community Health Workers (CHWs). • Family health teams are expected to be made up of nurses, doctors and CHWs. • If task-shifting as a model of implementation is envisaged, then there needs to be a specific costing model that ensures that CHWs will receive proper training and support to become the backbone of service delivery in the public sector. An envisaged 5.7% increase in the health professions training and development budget makes no mention of what proportion of the training costs will be allocated to this important cadre of workers.

27. Indicators: Targets 27

28. Consolidated Health Budget by Function • R102.5 billion- 2010/11 and • R112.6 billion in 2011/12 • 7.5% increase

29. Capacity in infrastructure development • Health infrastructure grant has been established, • new facilities are being built and existing ones upgraded • --under-spending in provinces remains a problem • 5 hospitals being built and likely to be completed in 2013 • Limpopo Academic hospital • Nelson Mandela Hospital ( Eastern Cape) • Chris Han Baragwanath hospital • Dr. George Mukhari Hospital • King Edward the VIIIth Hospital

30. Solution Human resource challenge Gap by 2025 40 000 uniformly well trained community health workers 19 516 nurses will have to be trained medical schools will have to produce 12 600 more doctors by 2025. Train community health workers Increase intake Strength academic support to increase throughput of medical students Open nursing colleges Task shifting

31. Challenges in Quality of Health Care • South Africa’s health care system is impaired by: • A lack of management skills; • A lack of induction and in-service training; • Failure to act on identified deficiencies; • Delayed response to quality improvement requirements; • Unsatisfactory maintenance and repair services; • Poor technology management; • Ineffective supply chain management systems; • Inability of individuals to take responsibility for their actions • Accreditation: Quality improvement will be phased in over 14 years

32. National Health Insurance Implementation Preparation • The 2011 Budget takes the first steps in establishing national health but only budget for the following: • A family health approach to primary health care is being launched (R1.2 billion) • The quality of care in hospitals is being improved (R2.7 billion) • The Office of Standards and Compliance is being established as an independent authority, which will include an inspectorate and an ombudsman (R117 million). • Budget leaves out essential funds for preparation of implementation:

33. NHI: allocation for preparation is inadequate

34. Food Security

35. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Output 1: Sustainable agrarian reform, • Output 2: Improved access to affordable and diverse food • Output 3: Rural services and sustainable livelihoods • Output 4: Rural job creation linked to skills training and promoting economic livelihoods • Output 5: Enabling institutional environment for sustainable and inclusive growth

36. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Almost R13 bn allocated to DAFF and DRDLR in 2011/12 and this is set to reach R14 bn in 2013/14. However, as a share of overall budget spending, this amounts to less than 2% of R890 bn and inadequate to address one of top 5 priorities.

37. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • The adoption of CASP in 2004 resulted in higher spending on farmer support and development- reaching more than 70% of total agricultural allocation in 2008.

38. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • However, rising CASP spending per capita is probably reaching a smaller number of ‘emerging farmers’ and this is not aligned to achieving outcome 7 and NGP targets.

39. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Allocation of DAFF spending towards ‘Food Security and Agrarian Reform”- 2009/2010

40. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • The composition of DAFF “Food Security and Agrarian Reform” is shifting towards agricultural extension support.

41. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • 80-90% of DRDLR budget is allocated towards land reform, restitution and rural development- priority spending areas in the CRDP.

42. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Low-income households experienced difficulties to afford food as a result of South Africa’s food price inflation and economic downturn.

43. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Job shedding in the agricultural sector persists

44. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Following the food price crisis and economic downturn interventions to support food insecure households must be fast-tracked • Available information points to worsening household food insecurity following the food price crisis and downturn: • Old GHS (2007) found that 12% of children and 10% of adults sometimes or always went hungry in that year; • GHS for 2008 reports increased household hunger in the order of 15% • New GHS (2009…) shows that 20% ofhouseholds ran out of money to buy food; nearly 35% in Free State • And 18% of household skipped meals during the past year because there was not enough food in the house= 18%

45. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Following the food price crisis and economic downturn interventions to support food insecure households must be fast-tracked • Rural households spend 9% to 15% more than urban ones for the same basic food basket • Nutrition in the context of unemployment • 51% of all severely hungry households qualify for grants but do not receive them • Policy implication: • Urgent that grants be more fully rolled out, especially to young children • Recent approval to raise the eligibility age of CSG should help • Expansion of household food production to widen food groups consumed

46. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Food security • Combination of policies – impact not sufficient • Policy complements include: nutrition programmes (fortification, school feeding , etc • Currently not possible to extract a ‘food security budget’ that can be monitored • Most funding targeted at nutrition allocated through provinces, with great uncertainty about whether spent as intended by national policy. • Policy implication: • Urgent attention to complement of policies to improve nutrition status and food security • Affordable nutritious food must be made available on a regular basis – this will involve attending to food price levels and stability, as well as strengthening nutrient supplementation and food fortification • Budgets aimed at improving food security should be ring-fenced and monitored • Reliable, nationally representative and regular monitoring and evaluation systems of household food security nationally are urgent and essential

47. VIBRANT, EQUITABLE AND SUSTAINABLE RURAL COMMUNITIES AND FOOD SECURITY FOR ALL • Rural Development and Land Reform • Policy & capacity issues which include: • The development of a White Paper on Agrarian Transformation, Rural Development & Land Reform • The Green Paper is to be tabled in cabinet in May 2011 • Rural Development Agency (RDA) to co-ordinate implementation • Overhaul land policy framework & consolidate all land-related laws • A revised tenure security law for farm workers • Fix collapsing land reform projects through the land reform recap intervention- combined with CASP critical to sustain rural livelihoods