Province of KwaZulu-Natal Department of Health

1. Province of KwaZulu-Natal Department of Health Presentation to Health Portfolio Committee Cape Town 6 April 2005 Presented on behalf of the MEC for Health by Prof R W Green Thompson: Head of Department and Mr. H A W Conradie: Chief Financial Officer

2. Sequence of Presentation • Guiding Principles For Strategic Focus • Strategic Focus for KZN Health • Outlook for the coming financial year – 2005/06 • Challenges for Department 2005/06 • Performance 2004/05 • Financial Performance 2004/05 • Budget Information 2005/06 • Questions

3. Guiding Principles For Strategic Focus People’s Contract WHO Health Sector Strategies in Poverty Alleviation Millennium Development Goals NEPAD Health Targets State of the Nation Address 11 February 2005 State of the Province Address 28 February 2005 National Health Act, 2003 Provincial Health Act, 2000 Provincial Priorities/PGDS National Department of Health Strategic Priorities

4. Salient Points of the Guiding Principles • Poverty reduction and protection of vulnerable groups • Address the major causes of illness among the poor • Health promotion approaches, such as safe water, sanitation and health behaviour • Reverse the spread of HIV and AIDS • Improved Health Service Delivery • Strengthen Women and Youth Programmes • Creating employment

5. Outlook for the coming financial year – 2005/06 The requirement of the Department of Health to immediately provide a high standard of health services excluding the full roll-out of anti-retroviral therapy, is R12,293 billion. The estimated cost of a full implementation of a comprehensive HIV and AIDS management programme will increase this requirement by a further R4,8 bil. The amount of R10,379 billion, to be appropriated for the 2005/06 financial year, still falls short of the ideal funding requirement. The moderate increase in real terms will, however, enable the Department, in line with the provincial priorities, to improve its services in all areas. The per capita spending in KZN is still much lower than those of comparable Provinces especially on Tertiary services.

6. Challenges for Department 2005/06 • The comprehensive management of TB, HIV & AIDS and other diseases • Expansion and upgrading the Emergency Medical and Rescue Services – Province-wide • Addressing the shortage of professional and skilled personnel • Addressing the increasing burden of poverty related diseases through health promotion and food security

7. Challenges for Department 2005/06 • Integration of the Primary Heath Care Services provided by the Municipalities outside the Metro, with the provincial services • The development of an acceptable level of Central and Tertiary Health Services to improve access and to be on par with certain other provinces. • Redistribution and development of Regional Hospital Services to ensure service availability in the Presidential rural nodes • Redress the backlog in Infrastructure Upgrading and to overcome the impasse presently experienced.

8. Performance 2004/05 Programme 1 Administration • Restructuring of the Health Services delivery cluster has been completed and resulted in the strengthening of the District Health System. • The Supply Chain Management system in the Department has been adapted to comply with the new Treasury guidelines with effect from 1 June 2005. • In Consultation with Provincial Treasury a computerised Assets Management system is being rolled out in the Department • A Feasibility Study into a possible PPP for the outsourcing of the soft facilities management at institutions has received Treasury One approval.

9. Performance 2004/05 Programme 2 District Health Services • Workloads, in general, has increased in all the services rendered under this programme. Details in Annexure A. • The ART rollout commenced in this Financial Year. The service is presently available at designated institutions in all Districts and by the end of 2005/06, at all hospitals. • The PMTCT programme is progressing well and is available at all Institutions throughout the Province. • Over600VCT sites are available throughout the Province. • The cure rate for TB is unacceptably low at 35% at present. The Department has set a target to increase this by at least 10 percentage points per annum.

10. Performance 2004/05 Programme 2 District Health Services Excl District Hospitals • Communities in remote rural areas are being reached by the Health services through Mobile services and in one case by helicopter. • The Department has 160 Mobile Clinic teams visiting some 2000 points at least twice a month. • Five Community Health Centres are providing full 24 hour services, two an extended 12 hour service and one an eight hour service. All these facilities will shortly provide a full 24-hour service. • Sixteen clinics are providing or are in the process of providing a full 24-hour service. Twenty-six are providing an on-call system. More clinics will provide 24-hour on-call services depending on the availability of staff and accommodation.

13. Performance 2004/05 Programme 3 Emergency Medical & Rescue Services • Major improvement in the emergency services was achieved due to the policy of expanding the service to cover the whole of the Province • More than 570 cases were dealt with in 2004/05 compared to 340 in 2002/03 and 481 in 2003/04. • Although response times have decreased by some 20% there is is still room for improvement • The Planned Patient Transport service will start in the new year as the buses arrived late in 2004/05

14. Performance 2004/05 Programmes 2(part), 4 & 5 Hospitals Services • The load on all hospitals remains high mainly as a result of poverty driven diseases and the incidence of HIV and AIDS • In-patient admissions have increased from 670,043 to 690 805 and the out patient headcount from 4,9 million to 5,2 million between 2003/04 and 2004/05 • Because of the shortage of staff and the increased workload the quality of services are below the standards envisaged by the Department • The Scarce skills and rural allowances, although welcome, did not improve the recruitment situation. • Surgical interventions increased from 144,809to 191,200.

15. Performance 2004/05 Programme 6 Health sciences and Training • Some 4650 Student nurses were in training in 2004/05, some 800 more than in 2003/04. • Bursaries were granted to 780 students compared to the 650 granted in 2003/04. The Additional bursaries are granted with the emphasis on the demographics of the Province and preference to applicants from the lower income levels. • Various skills development training programmes were undertaken and 6,550 staff participated compared to the 4,252 in the previous year • Some 2,500 staff attended various other courses/conferences offered by the Department and other institutions.

16. Performance 2004/05 Programme 8 Facilities Management • The performance in the revitalisation of facilities was well below expectations due to problem experienced with tenders and the non-performance of the Works Department • The state of facilities in the Province remains one of the major challenges and will require substantial Investment. • Various interventions to remedy the unsatisfactory situation has been under taken and major progress is expected in the new financial year. • The Department has revived the Clinic Upgrading and Building Programme to address the backlog of some 200 clinics. • With the assistance of the Provincial Treasury the Department is engaging the assistance of other service providers in place of Works to speed-up the delivery process.

17. Financial Performance 2004/05

21. Global Fund Funds transferred to Treasury R86 mil Feb 2004 Funds transferred to Health R53 mil Feb 2004 Funds spent Jan to Mar 2004 R 4,56 mil R4,56 mil Funds spent Apr to Jun 2004 R 1,55 mil R6,11 mil Funds spent Jul to Sept 2004 R11,43 mil R17,54 mil Funds spent Oct to Dec 2004 R23,70 mil R41,24 mil Funds spent Jan to Mar 2005 (Est) R25,32 mil R66,56 mil

22. Financial Outlook 2005/06

26. Discussion and Questions