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Presentation to the Portfolio Committee on Health 16 October 2013

Presentation to the Portfolio Committee on Health 16 October 2013. Purpose of the Presentation. To reflect on key issues (highlights) from the Annual Report of the National Department of Health (DoH) for 2012/13.

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Presentation to the Portfolio Committee on Health 16 October 2013

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  1. Presentation to the Portfolio Committee on Health 16 October 2013

  2. Purpose of the Presentation • To reflect on key issues (highlights) from the Annual Report of the National Department of Health (DoH) for 2012/13. • To reflect on strategies for addressing constraints experienced – which are also outlined in the National DoH’s Annual Performance Plan for 2013/14.

  3. Structure of the Presentation • Vision and Mission • National Health Sector Priorities • Review of Programme Performance • Human Resource Management • Budget and Expenditure Per Economical Classification • Explanations of Material Variances • Audit Outcomes • Conditional Grant Expenditure • Conclusions

  4. 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. National Health Sector Priorities The major strategic framework for the work of the National Department of Health (NDoH) during 2012/13 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 2012/13.

  6. Programme 1: Administration and Corporate Services Fiscal Environment • National DoH obtained an unqualified audit opinion in 3 years. • Significant improved financial management both within the Department and the health sector. Even though 5 provinces were unqualified there has been some improvements as a result of an intervention from National. 2 provinces moved from a disclaimer to qualified and one from qualified to unqualified • Appointment of 371 unemployed financial, ICT and Human Resources graduates to support the financial management plans and improve audit

  7. Programme 1: Administration and Corporate Services Using Donor Funding 371 Unemployed Graduates worked over 12 months in the Intern Programme: • Financial Management 125 • Information Communication Technology 137 • Human Resources management 109 Revenue Management Model: • Interns were instrumental in the implementation of a project for improvement of revenue management which was implemented in Charlotte Maxeke Hospital. • The objectives of the Project were to reduce Medicom backlog in the hospital, due to system down time, and to increase data quality by correcting errors in patient contact details. • The entire Medicom backlog of patient admissions dating back to April 2012 was cleared and 400 downtime patients were registered daily and 400 patient files were checked daily to ensure accurate data is captured on the system. • The Road Accident Fund and Medical Scheme receipt allocations were earmarked for correction. Through the project, a total of R36.5 million receipts were reconciled to their invoices, i.e R14million (RAF) and R21.5 million (Medical Schemes). • The billing backlog to April 2012 for support services was cleared. • This model is now rolled out to 6 additional provinces.

  8. Programme 2: NHI, Health Planning and Systems Enablement Norms and Standards • Four norms and Standards were developed in key areas, namely: • Information Technology (IT) • Human Resources • Quality • Infrastructure

  9. Programme 2: NHI, Health Planning and Systems Enablement Norms and Standards • Four norms and Standards for Information Technology (IT) • The IT work is premised on the eHealth Strategy for South Africa was adopted in July 2012. • The Council for Scientific and Industrial Research commenced with the development of National Health Normative Standards for Interoperability.

  10. Programme 2: NHI, Health Planning & Systems Enablement National Health Insurance • Health service innovations and preparation for NHI in 10 selected districts were rolled-out: • The Ministerial road-shows in each of the NHI districts involved a wide range of stakeholders; • NHI management structures established by Provinces; • Workload Indicator of Staffing Norms (WISN) were introduced; • Ward based Primary Health Care outreach teams were constituted; • District clinical specialist teams were launched; • Health Facility Improvement Teams were established; and • Independent assessment of 12 month implementation were undertaken in the NHI pilot districts. • Draft White Paper on NHI was prepared. • Consultations are underway in line with Cabinet guidelines.

  11. Mindset Health Channel

  12. Mindset Health Channel Educating the public and users of health services • Over 84% of the population utilises the public health system • The Mindset patient/public broadcast channel is both an educational and a compelling viewing experience incorporating: • drama • public service announcements • documentaries • interviews and discussions • The Channel covers health education and promotion on HIV and AIDS, tuberculosis, child health, chronic conditions and underlying factors such as gender violence in multiple languages. • Available every week day from 07h30 – 17h30 • Broadcasts into 600 public health facilities in RSA (June 2012) • Some content is sourced (for free) from media partners: Soul City, USAID/JHHESA, CMT, Khomanani, Izwi Multimedia, etc 6

  13. Reach of the Mindset Health Channel in NHI Districts

  14. Mindset Health Channel: Satellite Receiving Equipment Mindset Health TV Channel Computer based HCP training

  15. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health HIV and AIDS • Prevention is the mainstay of efforts to combat HIV and AIDS • During 2012/13 a total of 422 262 medical male circumcisions were conducted, which was 70.4% of the 600 000 target set for 2012/13; and • A total of 8 978 177 people accepted HIV Counselling and Testing during 2012/13. After the HCT campaign of 2010/11 the programme was integrated into the routine health services and this resulted in a decrease of South Africans participating which is expected with any campaign. The HCT Campaign will again be implemented during 2013/14. • A total of 612 118 new patients were put on Antiretroviral Treatment, which exceeded the 2012/13 target of 500 000 patients.

  16. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health • 85.3% of TB patients were tested for HIV. Though this was an improvement from the 82.9% achieved in 2011/12, • 74.1% of eligible TB/HIV co-infected patients received Cotrimaxozole Prophylaxis Therapy (CTP) to prevent opportunistic infections. • A TB cure rate of 73.8% (for 2011) was achieved, against a target of 80%. • A total of 360 168 HIV positive patients received Isoniazid Preventive Therapy (IPT) - to prevent latent TB from progressing to clinically apparent disease - compared to the target of 400 000 patients.

  17. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health Maternal and Woman's Health • For Couple year protection rate the Department has exceeded the 2012/13 target of 35 %, and a performance of of 37% was achieved. • All public health facilities provided contraceptive services. • 55.4% of women were screened for cervical cancer, this was 1.4% above the 2012/13 target of 54%. This improvement is linked to improved training of healthcare providers to take cervical swabs. • 44% of pregnant women presented to the health services before 20 weeks of pregnancy, which was 6% lower than the 2012/13 target of 50%. • 65.2% of Mothers and 66.2% of Babies received postnatal care within 6 days after delivery, against a target of 75%.

  18. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health Maternal and Woman's Health cont... • 98.2% of pregnant women were tested for HIV, which was consistent with the 2012/13 target of 98%. • 81.6% antenatal clients were initiated on HAART, compared to the target of 85%, because initiation of HAART could only be done after CD4 counts were done and some women struggled to come back for the results and initiation. • 2.5% of babies tested Polymerase Chain Reaction (PCR) positive 6 weeks after birth (out of all babies tested) against the 2012/13 target of 3%. The outcomes of this programme continued to show a downward trend. This implies that a much lower proportion of babies contracted HIV from their mothers at birth.

  19. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health Child Health • National immunisation coverage of 94% was achieved, which exceeded the 2012/13 target of 90%. • A total of 10354 Quintile 1 and 2 schools were visited by school health teams to provide Integrated School Health Programme (ISHP). The 2012/13 target was to visit 6454 Quintile 1 schools. • A total of 84 281 Grade 8 learners assessed using the ISHP learner assessment, compared to the target of 65 100 learners.

  20. School Health Services • Bilateral between the Department of Education and Department of health • Focus on quintile 1 and 2 schools (poorest schools) • Developed an integrated school health programme • A High-level launch took place on 11 October 2012

  21. School Health Services

  22. School Health Services EU Supported Project 1st Phase – Purchased 30 Mobiles – EU Branded 2nd Phase – Purchase 30 more mobiles for delivery in January 2013 Provincial Departments will be responsible for : • Staff • Maintenance • Overheads Intersectoral Collaboration is a critical success factor. Sectors include among others • Department of Rural Development • Presidency- War on Poverty • Department of Transport • Local Government – Water and Sanitation • Social Development

  23. Programme 4: Primary Health Care Services Re-engineering of PHC and District Health System • A total of 945 ward-based PHC outreach teams were established as part of the PHC re-engineering strategy, and exceeded the target of 500. • 34 districts had at least 3 members of the District Clinical Specialist Teams appointed compared to the target of 10 districts. • The draft District Health Systems policy was developed. • The draft Framework for addressing the social determinants of health was developed. • A PHC utilisation rate of 2.5 visits per person was achieved in 2012/13, against a target of 2.8 visits per person. • 76% of fixed PHC facilities had monthly supervisory visits, against the target of 80%. Supervision of PHC facilities was affected by a lack of dedicated supervisors caused by shortages of staff. • 51 District Health Plans (DHPs) were analysed and feedback provided against the target of 52 DHPs – except one district in the Western Cape.

  24. Programme 4: Primary Health Care Services Nutrition and Health Promotion • 51% (278) of health facilities in which deliveries are done were accredited as Mother Baby Friendly Initiative, against the target of 55% (300). • Vitamin A supplementation coverage rate among children aged 12-59 months was 42.8%, which was marginally above the target of 42%. • The Integrated Health Promotion Strategy was not implemented as certain components of the Strategy required consultation with stakeholders.

  25. Programme 4: Primary Health Care Services Environmental Health • Norms and standards for Environmental Health Services were developed and finalised as per the planned target. • In compliance with the requirements of Chapter 3 of the National Environmental Management Act (NEMA), the Department’s Annual NEMA compliance Report was prepared and submitted. • A total of 27 ports of entry were assessed and found to be ready for designation. Draft regulations were developed to effect designation. Malaria • The cumulative incidence for malaria cases of local origin was 0.18 per 1000 population at risk , compared to the target of 0.4 per 1000 population at risk. The cumulative incidence was 0.28 for the aggregate of local cases and cases of unknown origin, compared to the target of 0.58 per 1000 population at risk.

  26. Programme 4: Primary Health Care Services Re-engineering of PHC and District Health System • There are three workstreams: • Municipal Ward-Based PHC Outreach Teams (6 members per team) • District Specialist teams • School Health teams

  27. Programme 4: Primary Health Care Services Municipal Ward-Based PHC Outreach Teams • Teams established • 945 at end March 2013 • 1114 at end September 2013 • 9896 CHWs have been trained on Phase 1 • Module 2 training is starting in November 2013 • Phase 1: Health Promotion, Nutrition, maternal, child health, HIV, TB • Phase 2 NCDs, Mental health, Youth, older persons, substance abuse, violence

  28. Programme 4: Primary Health Care Services

  29. Progress on DCST appointments by specialty per province

  30. Districts with a Minimum of 3 DCST Members

  31. Programme 5: Hospital, Tertiary Services and Workforce Development • Feasibility studies for 4 out of 7 Flagships Projects have been completed. Costing work is underway • Embarked on a process of development 46 norms and standards, guidelines and benchmarks on infrastructure • As at end March 2013, 69% were completed • As at end of September 2013, 80% were completed • A National Infrastructure Plan based on health facility Planning have been developed • A project monitoring information system has been developed and is being cascaded to provincial departments of health for purposes of reporting on progress on infrastructure projects

  32. Programme 6: Health Regulation and Compliance Management Management and Governance of Public Entities • Bi-annual Public Health Entities governance and management framework reports produced. • Quarterly Public Health Entities compliance reports produced. • Forum for Statutory Health Professional Council established and bi-annual reports submitted.

  33. Programme 6: Health Regulation and Compliance Management Medicines Control Council • During 2012/13, a total of 706 generic medicines were registered. 224 were from the backlog. The remaining 482 were registered within an average period of 34 months. The target for 2012/13 was 15 months. • A total of 21 Human New Chemical Entities were registered with an average period of 36 months. The target for 2012/13 was 28 months. • Addressing backlog in medicines registration is affected by: • The non-availability of evaluators, both in-house and external; • The evaluators that were appointed were undergoing training; • Difficulty to attract specialist evaluators at rates paid; and • Delays by applicants in responding to MCC recommendations. • Draft amendments to legislation to enable transition of the MCC to South African Health Products Regulatory Authority was submitted to Cabinet.

  34. Programme 6: Health Regulation and Compliance Management Office of Health Standards Compliance (OHSC) • National Health Amendment Bill on establishment on the Office of Health Standards Compliance was processed by Parliament. This was enacted on 2 September 2013. • Number of inspectors appointed to assess compliance of public health facilities with core standards of care increased towards the end of the financial year • 87.5% of the 64 randomly selected public sector hospitals conducted patient satisfaction surveys at least once per year. The target was 90% of the 400 public sector hospitals. • 57% of the complaints were resolved within 25 days against the target of 75%. • 6.2% (235) of facilities were fully assessed for compliance with six core standards of care, against the target of 20% (800 facilities).

  35. Human Resources Management • For the year under review, Human Resources oversight and control mechanisms have improved in the areas of developing check lists for recruitment processes, as well as implementation of exit processes, to determine causes of staff turnover. • One of the achievements in this area relates to the development of the Human Resource Plan and the reduction of the vacancy rate. • These control measures responded to the prior year's audit findings.

  36. Human Resources Management • The implementation of the new organisational structure began on 1 April 2012. • The first phase of matching and placing employees on the three-tiers of the structure (Director-General, Deputy Directors-General and Chief Directors levels) has been completed. • The second phase of the matching process (Director and below) is in progress, which will allow for a greater alignment of functions.

  37. Human Resources Management • The Department has created a dedicated Performance Management and Development System (PMDS) Unit at a Directorate level to provide advisory and administrative support in ensuring linkages between individual and organisational performance. • An electronic PMDS system has been implemented to minimise the administrative burden of the process.

  38. Human Resources Priorities for 2012 to 2014- NDOH • Priority 1: To manage the re-engineering of business processes and systems in the Department. • Priority 2:To strengthen the organisational structure and evaluation of staff utilisation in the Department. • Priority 3: To strengthen the capacity of employees in the Department through HR development initiatives. • Priority 4: To enhance employee health and wellness in the workplace. • Priority 5: To enforce the implementation and compliance of Performance Management Development System in the Department. • Priority 6: To implement Human Resources Strategic Planning and Reporting.

  39. BUDGET AND EXPENDITURE PER PROGRAMME

  40. BUDGET AND EXPENDITURE PER PROGRAMMEContinue

  41. BUDGET AND EXPENDITURE PER PROGRAMMEContinue

  42. EXPLANATIONS OF MATERIAL VARIANCES

  43. EXPLANATIONS OF MATERIAL VARIANCES Continue

  44. AUDIT OUTCOME • U Unqualified Audit Opinion for 2012/13. Matters to be attended to: • Due to internal controls not being fully implemented the department did not have and maintain an effective and efficient system of internal control regarding performance management; • Quarterly performance reports on Conditional Grants were not submitted within 45 days after the end of each quarter to the National Treasury; • Business plans for utilisation of the HIV and AIDS grant allocation made to all provincial departments of health were not approved prior to the start of the financial year. • Employees of the department performed remunerative work outside their employment in the department without written permission. • Annual leave taken by employees were not recorded in a timely manner thereby ensuring that all leave is accounted for accurately and in full.

  45. AUDIT OUTCOME • Audit plans to address this have been developed both for Performance Information as well as Financial Regularity; • In addition the Department has identified a number of additional audit risks and plans have been developed to address these; • The protocol with the AG remains in place and a number of close out and engagement meetings have been held.

  46. CONDITIONAL GRANT EXPENDITURE

  47. CONDITIONAL GRANT EXPENDITURENTSG

  48. CONDITIONAL GRANT EXPENDITURENTSG VARIANCE Eastern Cape • Delays in the procurement process of the three MRI machines Limpopo • Delays in the tendering processes of the CAT scan and GAMMAR camera for nuclear medicines North West • Delays in the procurement process one MRI machine for Tshepong Hospital in Klerksdorp

  49. CONDITIONAL GRANT EXPENDITUREHIV/AIDS

  50. CONDITIONAL GRANT EXPENDITUREHIV/AIDS VARIANCE Limpopo • There were savings accrued due activities not carried out which are: • Delays in recruitment of key personnel, Training through RTC, Condoms & Computers • A rollover request of R50,724 for NHLS has been made Northern Cape • There were commitments not paid in time for the financial year end which amounted to R18, 132 million in the following: • ARVs,Computers for TIER.net, NHLS , IEC Materials, Nutrition, Stipends , NGO Conference, Condom Warehousing, Training and Condoms, Test Kits & MMC consumables

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