FREE STATE PROVINCIAL GOVERNMENT DEPARTMENT OF HEALTH

1. FREE STATE PROVINCIAL GOVERNMENTDEPARTMENT OF HEALTH PORTFOLIO COMMITTEE ON HEALTH BUDGET HEARINGS APRIL 2001

2. VISION STATEMENT • A healthy and self reliant Free State community • MISSION STATEMENT The Free State Department of Health • provides a quality comprehensive health care services to the Free State community • optimally utilises health care resources to provide a caring and compassionate service • endeavours to empower and develop all personnel to the best of their potential

3. STRATEGIC THEMES • THEME 1: PROMOTING THE WELL BEING OF ALL THE PEOPLE • THEME 2: MEETING COMMUNITY DEMANDS • THEME 3: RENDER QUALITY COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES AT ALL LEVELS OF CARE • THEME 4: EMPOWERING AND DEVELOPING ALL PERSONNEL AND THE RELEVANT STAKEHOLDERS • THEME 5: TRANSFORMING HEALTH SERVICES TOWARDS PRIMARY HEALTH CARE FOUNDED ON DISTRICT HEALTH SYSTEM • THEME 6: IMPROVING THE MANAGEMENT OF HEALTH SERVICES

4. KEY STRATEGIC OBJECTIVES FROM THE STRATEGIC PLAN STRATEGIC THEME 1 PROMOTING THE WELL BEING OF ALL THE PEOPLE • Implement an integrated health promotion strategy through an inter-sectoral approach • Increased interventions in HIV/AIDS • Voluntary Counseling and Testing • Mother to child transmission • Home-based care • Ensure improved management of Tuberculosis • Implement and maintain a system for improved rural health • Ensure the development and rendering of Environmental Health Services • Ensure the implementation of an Integrated Nutrition Programme • Ensure services are accessible to people with disabilities • Ensure services are accessible to personnel

5. STRATEGIC THEME 2 MEETING COMMUNITY DEMANDS • Cultivate an Organisational Culture that is characterised by staff that are: • Proud of being health workers • Enjoy working for the department • Caring for colleagues and the clients • Improve Customer Satisfaction at all levels of service

6. STRATEGIC THEME 3 RENDER QUALITY COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES AT ALL LEVELS OF CARE • Render comprehensive health care services at the most appropriate level • Improve quality and efficiency of services rendered • Render affordable and equitable services

7. STRATEGIC THEME 4 EMPOWERING AND DEVELOPING ALL PERSONNEL AND THE RELEVANT STAKEHOLDERS • Training in line with service needs • Implement Interactive Distance Education and Learning • Implement ,review, maintain and monitor the induction programme • Ensure availability of health professionals • Develop and implement intervention strategies to address the impact of HIV/AIDS on health personnel • Empower the community (Hospital Boards and College Councils)

8. STRATEGIC THEME 5TRANSFORMING HEALTH SERVICES TOWARDS PRIMARY HEALTH CARE FOUNDED ON DISTRICT HEALTH SYSTEM • Implement District Health Authorities in line with the Provincial Health Act (Act 8 of 1999) • Implement District Health System in line with District Health Plan per district • Ensure an extended access to 24 hour health services in all districts • Ensure and render comprehensive maternal services to rural communities • Restructure and re-organise integrated psychiatric and mental health services according to the Mental Health Bill

9. STRATEGIC THEME 6IMPROVING THE MANAGEMENT OF HEALTH SERVICES • Access to and use of management information • Effective Financial Management • Develop and maintain Human Resource Plan • Public Private Partnership • Strategic Planning • Ensure sensitivity for gender issues • International co-operation • Implementation of the PFMA • Service Level Agreements (Municipalities) • Loss of cohesion in Top Management • Rationalisation of services

10. FINANCIAL RESULTS • 1997/1998 - R 141 MILLION OVER EXP - 9.28% (BUDGET R 1,518 BILLION) • 1998/1999 - R 98 MILLION OVER EXP - 5.95% (BUDGET R 1,646 BILLION) • 1999/2000 - R 135 MILLION UNDER EXP - 7.83% (BUDGET R 1,724 BILLION) • 2000/2001 - R 60,3 MILLION UNDER EXP - 3.28% BUDGET R 1,833 BILLION

11. BUDGET AND MTEF BUDGET 2001/2002 - R 1,880 BILLION MTEF 2002/2003 - R 1,985 BILLION MTEF 2003/2004 - R2,099 BILLION

12. REVENUE

13. HOSPITAL AND OTHER CLINICAL SERVICES • Policy decisions that will be implemented this year • Implementation of EDL • Strategic Physical Facilities Plan • Policy decisions intended for the MTEF period • Performance Agreements with Hospitals • Implement District Health System together with local government in line with management plan and legislation • Significant problems and constraints faced in achieving key objectives • Improve staff morale and attitudes • Lack of specific skills - Bio-Engineering • The impact and usefulness of conditional grants • Support Outreach Programme • Issues relevant from National policy perspective • Quality Assurance and Accreditation for all hospitals using COHSASA Programme • Recommendations • Improved equity and access

14. PRIMARY HEALTH CARE PROGRAMMES • Policy decisions that will be implemented this year • High dose of Vit. A to woman after delivery • Feeding of learners at identified schools • Policy decisions intended for the MTEF period • Develop and implement provincial guidelines, capacity building strategies,monitoring tools and Health Promotion Programs for all Primary Health Care programs • Significant problems and constraints faced in achieving key objectives • The burden of HIV/AIDS and TB epidemics divert funds and other resources needed for transformation • The impact and usefulness of conditional grants • Grants for Integrated Nutrition Program utilised appropriately • Squezze of Central Hospital Grant. • Issues relevant from National policy perspective • Develop and implement Primary Health Care packages for clinics • Estimated HIV/AIDS impact • Prevalence of HIV remained the same as 1999 survey - plateau phase has been reached • Recommendations • Funding need to reflect the impact of the twin epidemics of HIV/AIDS and TB

15. TEACHING AND TRAINING Policy decisions that will be implemented this year • Strategic areas of training • Adult Basic Education and Training programmes • Pharmaceutical services: Assistant Pharmacists • Radiographic services:Supplementary Radiographers • Nursing services: Assistant nurses on supernumerary to be trained as professional nurses • Bursaries • Education and training of all health professional • Award bursaries to meet the needs of the Department • Training in line with Skills Development Act • Development of skills according to the needs of the Department

16. PSYCHIATRIC AND MENTAL HEALTH SERVICES • Policy decisions that will be implemented this year • District Psychiatric services • bed capacity at specific levels of care • Policy decisions intended for the MTEF period • Restructure District Psychiatric Services • Significant problems and constraints faced in achieving key objectives • To appoint and retain Psychiatrists at Regional complexes • Recommendations • Restructure psychiatric services

17. TB SERVICES • Policy decisions that will be implemented this year • Improve management of TB statistics • Improve DOTS to decrease defaulter rate • Policy decisions intended for the MTEF period • Training of community doctors to manage TB • Hospitalisation of TB patients in district hospitals • Significant problems and constraints faced in achieving key objectives • Financial and personnel constraints where additional beds need to be established • Issues relevant from National policy perspective • Coordination with HIV/AIDS program to decrease the impact on the TB program

18. EMERGENCY MEDICAL SERVICE • Policy decisions that will be implemented this year • Maintain a quality Provincial Emergency Medical Service • Establish a Provincial Commuter Service (patient transport) • Policy decisions intended for the MTEF period • All patient transport to be accommodated within EMS sub-directorate • Training of 20% of staff to an advanced level • Significant problems and constraints faced in achieving key objectives • Severe staff shortage if Conditions of Employment Act is implemented and the total staff establishment is not filled • Issues relevant from National policy perspective • Provincialisation of Emergency Medical Service (EMS) • Recommendations • Guidelines for EMS regarding personnel, equipment and vehicles to be developed and implemented

19. SUPPORT SERVICES • Policy decisions that will be implemented this year • Implement Antifraud and Corruption system • Implement Monitoring and Evaluation system • Policy decisions intended for the MTEF period • Implement Transport and Fleet management policy • Unlocking resources within private sector for public sector delivery • Issues relevant from National policy perspective • Implement Antifraud and Corruption system • Implement PFMA • Implement Administrative Justice and Promotion of Access to Information legislation as well as Employment Equity Plan • Ensure Batho Pele culture and attitude change

20. PERSONNEL • Shortage of key staff • All health and related professions and specialists • Development and implementation of staffing norms consistent with a strategic plan • Provincial Human Resource Plan • Critical problem areas involving Human Resource issues requiring urgent attention from government as a whole • Implement Departmental Performance Management System • Current rewards and incentives system is still protected by collective agreements. • Training staff in new performance management system

21. KEY HEALTH PROBLEMS • Trends • HIV/ AIDS is stabilising • Health service interventions • Establishment of Health Promotion strategies • Promotion of advanced midwifery training • Establishment of Disease Outbreak Response Teams in every district • Implementation of Step-down facilities and Home-based care • Establishment of Victim support Centres and training • Implementation of Cervical Screening Programs in collaboration with CANSA • Building capacity to manage HIV/AIDS patients at Primary Health Care level • Dissemination of information to the community using the media