NATIONAL DEPARTMENT OF HEALTH
PRESENTATION TO THE PORTFOLIO
COMMITTEE ON HEALTH
STRATEGIC PLAN AND BUDGET
2010/11-2012/13
24 MARCH 2010
1
STRUCTURE OF PRESENTATION
1.
VISION AND MISSION
2.
CONTEXT OF HEALTH SERVICE DELIVERY
3.
HEALTH SECTOR RESPONSE
4.
IMPLEMENTING THE HEALTH SECTOR’S RESPONSE DURING
2010/11-2012/13
5.
MAJOR HEALTH CAMPAIGNS FORTHCOMING
6.
RESOURCE ENVELOPE FOR IMPLEMENTING THE NATIONAL
DOH PLANS FOR 2010/11-2012/13
7.
MTEF ALLOCATIONS FOR 2010/11-2012/13
2
STRUCTURE OF PRESENTATION
8. OVERALL BUDGET ALLOCATION PER PROGRAMME (INCLUDING
CONDITIONAL GRANTS)
9. OBSERVATIONS FROM THE MEDIUM TERM EXPENDITURE
FRAMEWORK (MTEF) ALLOCATIONS FOR CONDITIONAL GRANTS
10. OVERALL BUDGET ALLOCATION PER PROGRAMME
(EXCLUDING CONDITIONAL GRANTS)
11. MTEF ALLOCATIONS FOR CONDITIONAL GRANTS
12. NEW ALLOCATIONS FOR 2010/11-2012/13: PRIORITY AREAS
13.
CONCLUSION
3
1. VISION AND MISSION
VISION
An accessible, caring and high quality health system.
MISSION
To improve health status through the prevention of illnesses and the
promotion of healthy lifestyles and to consistently improve the health
care delivery system by focusing on access, equity, efficiency, quality
and sustainability.
4
2. CONTEXT OF HEALTH SERVICE DELIVERY
National DoH Strategic Plan for 2010/11-2012/13 evolves in a context
of several key issues facing the health sector namely:
Health is one of the 5 key priorities of government for 2009-2014;
South Africa faces a quadruple Burden of Disease (BoD) consisting
of:




HIV & AIDS and TB;
High Maternal and Child Mortality;
Non-Communicable Diseases and;
Violence and Injuries;
In 2007, South Africa had only 0.7% of the world’s population, but
accounted for 17% (about 5.5 million people) of the global burden
of HIV infections (The Lancet, August 2009);
5
2. CONTEXT OF HEALTH SERVICE DELIVERY
Despite spending 8.7% of its GDP on health, and spending more on health
than any other African country, South Africa is one of only 12 countries in
which mortality rates for children younger than 5 years have increased since
1990 (The Lancet, August 2009);
Life expectancy in South Africa has declined:
For the period 1985-1994, StatsSA estimated life expectancy at birth at about
54,12 years for males and 64,38 years for females.
For 1996, the estimates were 52,11 years for males and 61,6 years for
females.
The first set of figures provided a pre-AIDS baseline, whilst the second set
reflected a period when HIV/AIDS was emerging as a key health issue.
In 2009, StatsSA estimated life expectancy at 53.5 years for males and 57.2
years for females (StatsSSA, 2009)
Urgent need exists to accelerate progress towards health-related Millennium
Development Goals (MDGs);
South Africa has a predominantly curative health system; which places less
emphasis on disease prevention and health promotion;
Urgent need exists to enhance Health Systems Effectiveness at all levels.
6
2. CONTEXT OF HEALTH SERVICE DELIVERY
INDICATOR
BASELINE 2009
Life Expectancy at Birth


53.5 years for males (StatsSSA, 2009)
57.2 year for females (StatsSSA,
2009)
Child Mortality

69 per 1,000 live births
Maternal Mortality Ratio

400-625 per 100,000 live births
HIV Prevalence
(amongst 15-24 year old pregnant women)

21,7%
Mother to child transmission rate of HIV

10%
Percentage of eligible HIV positive women
initiated on ART

37%
TB Cure Rate

64%
Percentage of HIV-TB co-infected patients who
are on ART

30%
DATA SOURCES: STATSSA: STATISTICAL RELEASES P0302, MID YEAR POPULAITON ESTIMATES 2009;
PRESIDENCY (2010): IMPROVING GOVERNMENT’S PERFORMANCE, DEVELOPING THE MTSF INTO A SET OF
KEY OUTCOMES WITH MEASURABLE OUTPUTS AND AGREED INTERVENTIONS; STATISTICS SOUTH AFRICA,
7
3. HEALTH SECTOR RESPONSE
3.1. THE 10 POINT PLAN OF THE HEALTH SECTOR 2009-2014
(i)
Provision of Strategic leadership and creation of a social compact for better
health outcomes;
(ii)
Implementation of National Health Insurance (NHI);
(iii)
Improving the Quality of Health Services;
(iv) Overhauling the health care system by:
(a) Refocusing on Primary Health Care (PHC);
(b) Improving the functionality and management of the Health System
(v) Improving Human Resources, Planning, Development and Management;
8
3. HEALTH SECTOR RESPONSE
3.1. THE 10 POINT PLAN OF THE HEALTH SECTOR 2009-2014
(vi) Revitalisation of infrastructure, with a focus on:
(a) Accelerating the delivery of health infrastructure through Public Private
Partnerships (PPPs);
(b) Revitalising Primary Level Facilities;
(c) Accelerating the delivery of Health Technology and Information
Communication Technology (ICT) infrastructure
(vii) Accelerated implementation of HIV and AIDS and Sexually Transmitted
Infections National Strategic Plan, 2007-2011 and reduction of mortality due
to TB and associated diseases;
(viii) Mass mobilisation for better health for the population;
(ix) Review of the Drug Policy; and
(x)
Strengthening Research and Development
9
3. HEALTH SECTOR RESPONSE
3.2. THE OUTCOME-BASED MTSF 2010-2014
(i)
Increased Life Expectancy at Birth
(ii) Reduced Child Mortality
(iii) Decreased Maternal Mortality Ratio
(iv) Managing HIV Prevalence
(v)
Reduced the rate of HIV Infections
(vi) Expanded PMTCT Programme
(vii) Improved TB Case Finding
(viii) Improved TB outcomes
(ix) Improved access to Antiretroviral Treatment for HIV-TB co-infected patients
(x) Decreased prevalence of MDR-TB
10
3. HEALTH SECTOR RESPONSE
3.2. THE OUTCOME-BASED MTSF 2010-2014
(xi)
Revitalisation of Primary Health Care
(xii)
Improved Physical Infra-structure for Healthcare Delivery
(xiii)
Improved Patient Care and Satisfaction
(xiv)
Accreditation of health facilities for quality
(xv)
Enhanced Operational Management of Health Facilities
(xvi)
Improved access to Human Resources for Health
(xvii)
Improved Health Care Financing
(xviii)
Strengthened Health Information Systems (HIS)
(xix)
Improved health services for the Youth
(xx)
Expanded access to Home Based Care and Community
Health Workers
11
3. HEALTH SECTOR RESPONSE
3.3. REQUIRED IMPROVEMENTS IN HEALTH OUTCOMES
INDICATOR
BASELINE 2009
Life Expectancy at Birth

TARGET 2014/15

58-60 years

53.5 years for males
57.2 year for females
Child Mortality

69 per 1,000 live births

30-45 per 1,000 live births
Maternal Mortality Ratio

400-625 per 100,000 live births

100 per 100,000 live births
HIV Prevalence (amongst 15-24
year old pregnant women)

21,7%

Improved quality of life of
people living with HIV and
AIDS
Mother to child transmission rate
of HIV

10%

0% - <5%
Percentage of eligible HIV
positive women initiated on ART

37%

All eligible pregnant women
to be initiated on ART at a
CD4 count of <350 or WHO
stage iii or IV
TB Cure Rate

64%

85%
Percentage of HIV-TB coinfected patients who are on ART

30%

100%
12
4. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.1.
INCREASING LIFE EXPECTANCY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Initiating on Antiretroviral Treatment (ART) all eligible people presenting with HIV and
AIDS and Tuberculosis (TB) co-morbidity at a CD 4 count of 350 or less as from 01
April 2010. This is in keeping with the President’s Announcements on World AIDS
Day, 01 December 2009;

Increasing the number of new patients initiated on Antiretroviral Therapy (ART) to
between 400,000-550,000 annually during 2010/11-2012/13;

Increasing the national average TB cure rate from 64% in 2006 to 80% by 2012/13;

Decreasing the incidence of malaria from 0,71 per 1000 population at risk in 2009/10
to 0.56 per 1000 population at risk in 2012/13;
13
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.2.
REDUCING CHILD MORTALITY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Increasing the number of new child patients initiated on Antiretroviral Therapy (ART) from
38,000 in 2009/10 to between 40,000-45,000 annually during 2010/11-2012/13;

Increasing the proportion of HIV positive children initiated on Cotrimoxazole prophylaxis from
6 weeks of birth from 50% in 2009/10 to 80% in 2012/13;

Increasing the percentage of mothers and babies who receive post-natal care within 6 days
of delivery from 20% in 2009/10 to 80% in 2012/13;

Conducting Measles and Polio Campaigns in all Provinces by May 2010;

Increasing the percentage of children under 1-year of age fully immunised from 88% in
2009/10 to more than 95% in 2012/13.

Increasing the percentage of children under 1-year of age immunised with two new vaccines
(Pneumoccocal and Rotavirus vaccines) from 40% in 2009/10 to more than 80% in 2012/13.

Ensuring that School Health Services are provided in the 18 priority districts by 2010/11, and
in all schools by the end of 2012/13.
14
4. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.3. REDUCING MATERNAL MORTALITY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Increasing the proportion of health facilities providing Basic Antenatal Care (BANC) from
42% in 2009/10 to 95% in 2012/13;

Ensuring that 70% of primary level health facilities have health workers trained in
Emergency Obstetric Care and Comprehensive Emergency Obstetric Care;

Increasing the percentage of mothers and babies who receive post-natal care within 6
days of delivery from 20% in 2009/10 to 80% in 2012/13;

Increasing the percentage of eligible HIV positive pregnant women placed on Highly Active
Antiretroviral Therapy (HAART) from 37% in 2009/10 to 100% in 2012/13;

Increasing the proportion of desginated health facilities providing Choice on Termination of
Pregnancy (CTOP) from 30% in 2009/10 to 70% in 2012/13;

Increasing the percentage of maternity care facilities which review maternal and perinatal
deaths and address identified deficiencies from 53% in 2009/10 to 100% in 2012/13;
15
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.4.
MANAGING HIV PREVALENCE
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
Implementing Health care provider-initiated Counselling and Testing in 100% of
health facilities by June 2010;
Increasing the proportion of pregnant women tested through Health care providerinitiated Counselling and Testing to 100% by 2010/11;
Increasing the proportion of HIV patients started on Cotrimoxazole Prophylaxis
from 71% in 2009/10 to 95% by 2012/13;
Increasing the proportion of HIV patients started on Isoniazid Preventive Therapy
(IPT) from 10% in 2009/10 to 80% in 2012/13.
16
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.5.
REDUCING THE RATE OF HIV INFECTIONS
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
Scaling up condom distribution, with 1 billion male condoms distributed
annually during 2010/11-2012/13, and 6 million female condoms distributed
in 2010/11, which will increase to 9 million by 2012/13;



NB. During the HIV Counseling and Testing (HCT) campaign, this number
will increase by 1,5 billion condoms, which will be provided to the 15 million
people who will undergo counselling and testing;
Implementation of Youth Friendly Services (YFS), with the proportion of
primary level facilities providing YFS increasing from 41% in 2009/10 to
70% in 2012/13;
17
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.5.
REDUCING THE RATE OF HIV INFECTIONS
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL
INCLUDE:

Increase proportion of pregnant women tested through Health care
provider-initiated Counselling and Testing to 100% by 2010/11;

Implementation of Information, Education and Communication (IEC)
targeting high risk groups;

Implementation of behaviour-change programmes, with external
partners.
18
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.6. EXPANDED PMTCT PROGRAMME
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Integrating Antenatal Care and PMTCT services;

Providing PMTCT prophylaxis to pregnant women not on HAART at 14 weeks of
pregnancy;

Implementing Health care provider-initiated Counselling and Testing in 100% of
health facilities;

Improving early diagnosis of HIV-exposed infants, by increasing the proportion of
HIV-exposed infants diagnosed using Dry Blood Spot-Polymerase Chain
Reaction (DBS-PCR) from 70% in 2009/10 to 80% in 2012/13
19
4. IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.7. IMPROVING NOTIFICATION OF TB CASES
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
Strengthening the implementation of the DOTS Strategy in all Districts;
Increasing the number of Community Health Workers trained as DOT
Supporters from 1,905 in 2009/10 to 2,500 annually during 2010/11; 2011/12
and 2012/13;
Decreasing TB cases reported from 405,512 in 2010/11 to 205, 256 in 2011/12
and to 175,000 in 2012/13. Number of new TB cases reported will initially
increase due to vigorous contact tracing, and then start dropping later through
improved infection control and decreasing the number of patients who are
infectious, through early detection and successful treatment;
Fully integrating TB and HIV services by March 2011.
20
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.8.
IMPROVED TB OUTCOMES
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
Training at least 3,500 health professionals in TB management annually during
2010/11; 2011/12 and 2012/13
Ensuring that all 52 Districts and 232 Sub-districts have appointed TB
Coordinators;
Reducing the TB defaulter rate from 7,9% in 2009/10 to 5% (or less) in 2012/13;
Increasing the proportion of TB patients who successfully complete their treatment
from 75% in 2009/10 to 90% in 2012/13;
Increasing the TB cure rate from 64% in 2007 to >80% in 2012/13.
21
4. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.9. IMPROVED ACCESS TO ANTIRETROVIRAL TREATMENT FOR HIV-TB
CO-INFECTED PATIENTS
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Initiating on ART all eligible people presenting with HIV and AIDS and Tuberculosis
(TB) co-morbidity at a CD4 count of 350 or less, as from 01 April 2010;

Training at least 3,500 health professionals in TB management annually during
2010/11; 2011/12 and 2012/13;
Increasing the proportion of HIV positive patients started on Isoniazid Preventive
Therapy (IPT) from 10% in 2009/10 to 80% in 2012/13;
Strengthening the integration of TB and HIV services (including provision of ART)
22
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.10.
DECREASING PREVALENCE OF DRUG RESISTANT TB
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL
INCLUDE:

Ensuring that by 2011/12, all 20 Drug Resistant TB Facilities appropriately
implement Drug Resistant TB Guidelines (i.e. diagnose Drug Resistant TB
accurately and place patients on appropriate TB regimen);

Initiating on ART all eligible people presenting with HIV and AIDS and
Tuberculosis (TB) co-morbidity at a CD4 count of 350 or less, as from 01 April
2010;
23
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.11.
REVITALIZATION OF PRIMARY HEALTH CARE
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
•
Review and strengthen the model for the delivery of health services in South Africa
based on the Primary Health Care (PHC) approach by March 2011;
•
Strengthen PHC Teams in all 9 Provinces (and 52 Districts) to improve access to
health care by 2011/12;
•
Complete the audit of Primary Level Services and Infrastructure by 2012/13
•
Improve the governance of the District Health System, and increase number of
District Health Councils established from 43 in 2009/10 to 52 in 20102/13;
•
Ensure that all 52 Districts have District Management Teams, with formal and
written delegations by 2010/11.
24
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.12.
IMPROVED INFRASTRUCTURE FOR HEALTHCARE
DELIVERY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
Placing dedicated focus on three areas of infrastructure revitalization namely:
(i)
Accelerating the delivery of health infrastructure through Public Private
Partnerships (PPPs) especially for the construction (and refurbishment)
of 5 Tertiary Hospitals namely:
Nelson Mandela Academic (Eastern Cape);
Chris Hani Baragwanath (Gauteng);
Dr. George Mukhari (Gauteng);
Limpopo Academic (Limpopo);
King Edward VIII (KwaZulu-Natal);
25
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.12.
IMPROVED INFRASTRUCTURE FOR HEALTHCARE
DELIVERY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:
(ii)
(iii)
Revitalizing primary level facilities;
Accelerating the delivery of Health Technology and Information
Communication Technology (ICT) infrastructure.
The National Health Technology (HT) Strategy and HT Standards will be finalised
in 2011/12;
The e-Health Agency will be established in 2010/11 to steer the development of
the ICT Strategy;
ICT Standards will be finalised and implemented in all 9 Provinces during 2011/12
and 2012/13.
26
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.13.
IMPROVED PATIENT CARE AND SATISFACTION
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:


Ensuring that 30% of the 400 public sector hospitals to conduct at least one
Patient Satisfaction Survey per annum by 2010/11. This will figure grow to 60%
in 2011/12 and to 90% of public sector hospitals in 2012/13.
Fast-tracking improvements in six priority areas of quality of care namely:

Positive and caring values and attitudes;

Reduced waiting times;

Improved Cleanliness;

Improved patient safety;

Infection prevention and control; and

Availability of medicines and supplies.
27
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.13.
IMPROVED PATIENT CARE AND SATISFACTION
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

In 2010/11, 50% of health facilities will produce and implement Quality
Improvement Plans. Quality Improvement Plans will be produced by 60% of
public health facilities in 2011/12; and by 70% of these facilities by 2012/13.

Monitoring complaints from users of public health services, and ensuring that
at least 75% of complaints from users of services are resolved within 25 days
by 2012/13.
28
4. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE
DURING 2010/11-2012/13
4.14. ACCREDITATION OF HEALTH FACILITIES FOR QUALITY
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Establishing a “Quality Management and Accreditation Body” to function
independently of National, Provincial Departments, but accountable to the
Ministry;

Amending the National Health Act of 2003 to facilitate this process, through
required Cabinet and Parliamentary processes;

Auditing 20% of the 4,333 public health facilities in 2010/11, to assess if they
meet core standards. This figure grows to 40% in 2011/12 and to 70% by
2012/13;

Accrediting 10% of health establishments (public and private) in 2010/11; 30%
in 2011/12 and 65% by 2012/13.
29
4. IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.15.
ENHANCED OPERATIONAL MANAGEMENT OF HEALTH
FACILITIES
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Assessing the functionality, efficiency and appropriateness of the organisational
structure of a particular hospital, and the appropriateness of the delegations for the
hospital, in partnership with the Development Bank of Southern Africa (DBSA) by
March 2011;

Conducting a feasibility study for the establishment of a Management and
Leadership Academy for Health Managers;

Producing and costing a Business Plan for the development of the Management and
Leadership Academy for Health Managers; by March 2011;

Obtaining accreditation for the Management and Leadership Academy for
Health Managers from the Council for Higher Education (CHE) and South
African Qualifications Authority (SAQA) by March 2012, and accepting the first
group of students by February 2013.
30
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.16.
IMPROVED ACCESS TO HUMAN RESOURCES FOR HEALTH
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Producing a revised Human Resources for Health Plan by the end of 2010/11, which will:





Quantify the country’s needs for health care workers, and specify training targets for the
next 5 years;
Outline strategies for increasing the production of key PHC workers such as
Environmental Health Practitioners (EHPs), Infection Control Workers and diverse
categories of Mid-level workers;
Reflect comprehensive strategies for the recruitment and retention of health professionals;
including urgent collaboration with countries that have excess of these professionals, as
well as strategies to strengthening the training platform;
Reflect an appropriate balance between health professionals and administrative
personnel.
Supporting Provincial DoHs to produce their own Human Resources for Health Plans;
31
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.17. IMPROVED HEALTH CARE FINANCING
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL
INCLUDE:

Improving financial management by establishing a dedicated
Provincial Finance and Budget Support Unit in the National DoH;

Producing draft NHI legislation for submission to Cabinet and
Parliament by March 2011.
32
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.18. STRENGTHENING HEALTH INFORMATION
SYSTEMS (HIS)
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL
INCLUDE:

Developing and implementing an ICT Strategy;

Developing ICT Standards and ensuring implementation in all 9 Provinces during
2011/12 and 2012/13;

Establishing an eHealth Agency by 2010/11

Establishing a Disease Control Hub by 2010/11;

Implementing the Primary Health Care Information System in 36 Districts by
2012/13.
33
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.19.
IMPROVED HEALTH SERVICES FOR THE YOUTH
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Finalising the Youth Health Strategy by March 2011, and strengthening
the provision of life skills education to youth;

Strengthening the implementation of Youth Friendly Services (YFS),
with the proportion of primary level facilities providing YFS increasing
from 41% in 2009/10 to 70% in 2012/13;

Finalising and implementing the Mini Drug Master Plan by 2010/11, to
reduce the usage of illicit substances, especially by the youth;
34
4.
IMPLEMENTATION OF THE HEALTH SECTOR’S
RESPONSE DURING 2010/11-2012/13
4.20.
EXPANDED ACCESS TO HOME BASED CARE AND
COMMUNITY HEALTH WORKERS
KEY STRATEGIC INTERVENTIONS DURING 2010/11-2012/13 WILL INCLUDE:

Finalising the policy on Community Health Workers in conjunction with the
Departments of Social Development and Local Government and Traditional
Affairs;

Developing a strategy for expanding access to Home and Community-based
Care (HCBC);

Standardising the training curriculum and conditions of service of Community
Health Workers.
35
5. MAJOR HEALTH CAMPAIGNS FORTHCOMING

Kick TB 2010 – starts on 26 March 2010, and ends in March 2011;

H1N1 Campaign - starts on 05 April 2010, and ends on 31 May
2010;

Measles and Polio Vaccination Campaign - starts on 12 April 2010
and ends on 23 April 2010;


HIV Counseling and Testing (HCT) – starts on 15 April 2010, and
ends in June 2011;
Second round of Polio Vaccination Campaign runs from 24 to 28
May 2010.
36
6.

RESOURCE ENVELOPE FOR IMPLEMENTING THE
NATIONAL DOH PLANS FOR 2010/11-2012/13
In line with National Treasury’s request to all government
Departments, cost saving measures were identified across the
Department to improve cost efficiency on the utilization of funds
for the delivery of services;

Focus areas were on expenditure related to catering and
entertainment, traveling costs both air and road (local and
international), conferencing, printing and stationery, venues and
facilities as well as the utilization of consultants;

Discounted efficiency savings of R47.8 million in 2010/11, R51
million in 2011/12 and R54.5 million were identified in selected goods
and services items as indicated above.
37
7. MTEF ALLOCATION FOR 2010/11-2012/13
Original MTEF Allocation
MTEF Allocations
2010/11
2011/12
2012/13
R' 000
R' 000
R' 000
19,614,027
20,862,795
21,900,415
1,601,254
1,690,973
1,770,001
18,012,773
19,171,822
20,130,414
National Tertiary Services Grant
7,398,000
7,798,878
8,188,822
Comprehensive HIV and AIDS Grant
4,311,757
4,632,962
4,864,610
Hospital Revitalization Grant
3,880,667
4,172,292
4,380,907
556,962
590,380
619,899
1,865,387
1,977,310
2,076,176
90,723
96,102
98,791
-47,765
-50,967
-54,474
1,840,000
2,800,000
3,900,000
21,496,985
23,707,930
25,844,732
Departmental baseline
Conditional Grants to Provincial Government
Forensic Pathology Services Grant
Health Professions Training and Development Grant
Additional Funds Allocated to Baseline
Adjustments to Baseline
Additional Funds Allocated to Conditional Grants
TOTAL MTEF ALLOCATIONS
38
8. OVERALL BUDGET ALLOCATION PER PROGRAMME
(INCLUDING CONDITIONAL GRANTS)
2009/10 R'000
2010/11
R'000
2011/12
R'000
2012/13
R'000
%
Increas
e from
2009/10
2010/11
260,437
264,834
299,880
330,921
2%
13%
8,774,402
10,147,611
28%
20%
426,123
454,171
3%
5%
Programme
1. Administration
2. Strategic Health Programmes
3. Health Planning and Monitoring
4. Health Human Resources
Management and Development
5. Health Services
6. International
Trade
and
Regulation
Total
5,688,253
393,449
7,294,902
406,933
%
Increas
e from
2010/112012/13
1,798,974
1,897,051
2,011,691
2,111,830
5%
6%
9,794,099
11,528,757
12,083,474
12,681,711
18%
5%.
104,508
112,360
118,488
16%
8%
21,496,985
23,707,930
25,844,732
19%
10%
Relations, Health
Health
Product
90,247
18,025,459
39
9. OBSERVATIONS FROM MTEF ALLOCATIONS





The Department’s overall budget has increased by 19% from 2009/10 to
2010/11.
The increase for subsequent MTEF outer years 2010/11– 2012/2013 is
10%.
It should be noted that despite these increases, for the National DoH
there is a 6% decrease between 2009/10 and 2010/11 below the
inflation rate.
The increase indicated is largely for conditional grants, especially for the
HIV and AIDS Grant. Other grants received an inflationary increase.
Health conditional grants account for +/- 95% of total National
Department of Health budget.
40
10. OVERALL BUDGET ALLOCATION PER PROGRAMME
(EXCLUDING CONDITIONAL GRANTS)
2009/10
R'000
260,437
Strategic Health
Programmes
863,198
Health Planning and
Monitoring
396,449
Health Human
Resources Management
and Development
Health Services
International
Relations,
Health Trade and Health
Product Regulation
Total
39,175
96,697
90,247
1,746,203
%
Increase
from
2010/112012/13
2010/11
R'000
2011/12
R'000
2012/13
R'000
264,834
299,880
330,921
2%
20%
726,183
751,060
763,102
-16%
5%
406,933
426,123
454,171
3%
10%
31,664
34,381
35,654
-19%
11%
110,090
112,304
111,982
14%
2%
104,508
112,360
118,488
16%
12%
1,644,212
1,736,108
1,814,318
-6%
9%
Programme
Administration
%
Increase
from
2009/102010/11
10.
OVERALL BUDGET ALLOCATION PER
PROGRAMME (EXCLUDING CONDITIONAL
GRANTS) (CONT.)

The negative growth under programme two – Strategic
Health Programmes is due to once off allocation of
R160m for the H1N1 outbreak.

The negative growth under programme four – Human
Resources and Management Development, is due to
once off allocation of R10m for the audit of Nursing
Colleges project.
10.
OVERALL BUDGET ALLOCATION PER
PROGRAMME (EXCLUDING CONDITIONAL
GRANTS) (CONT.)

The increase in the Health Services programme is
largely for the two Provincial conditional grants, i.e
National Tertiary Services Grant (NTSG) and the
Hospital Revitalization Grant.

The increase in the International Relations, Health Trade
and Health Product Regulation programme is largely to
support the establishment of the new medicines
regulatory agency, develop IT systems and reduce
backlogs.
43
11.
MTEF ALLOCATIONS FOR CONDITIONAL
GRANTS
Conditional Grants
2009/10
R’000
2010/11
R'000
2011/12
R'000
Comprehensive HIV
and AIDS Grant
4,376,186
6,011,757
Forensic
Pathology
Services Grant
501,869
556,962
Health
Professions
Training
and
Development Grant
1,759,799
1,865,387
1,977,310
2,076,176
Hospital Revitalization
Grant
3,370,203
4,020,667
4,172,292
4,380,907
National Tertiary
Services Grant
6,614,442
7,398,000
7,798,878
8,188,822
Total
16,622,499 19,852,773
7,432,962
590,380
2012/13
R'000
8,764,610
619,899
21,971,822 24,030,414
44
12. NEW ALLOCATIONS FOR 2010/11-2012/13: PRIORITY
AREAS

New allocation of R8,672 billion over three years of which:

R1.883 billion is for 2010/11;

R2.845 billion for 2011/12 and

R3.944 billion for 2012/13,

New allocations are for spending on the following policy priorities,
including transfers to public entities:
1.
Comprehensive HIV and AIDS Conditional Grant :



R1.7 billion for 2010/11
R2.8 billion for 2011/12 and
R3.9 billion for 2012/13, in order to expand treatment and to
commence treatment for all patients of sub-groups ( HIV/TB; Antenatal
Women and Newborn babies) at CD4 level of 350 or less.
45
12. NEW ALLOCATIONS FOR 2010/11-2012/13: PRIORITY
AREAS
2. Hospital Revitalization Conditional Grant:

R140 million for Mitchell’s Plain Hospital.
3. Office of Standards Compliance (OSC):



An additional amount of R2 million for 2010/11;
R8 million for 2011/12;and
R18 million for 2012/13, for the Quality Assurance Programme. This is to
continue to build up all aspects of the functioning of the OSC and increase
the number of hospitals audited.
46
12. NEW ALLOCATIONS FOR 2010/11-2012/13: PRIORITY AREAS
4. Establishment of a Provincial Finance and Budget Support Unit:



R2 million for 2010/11;
R4 million for 2011/12; and
R6 million for 2012/13, to build up internal capacity to monitor and support
provinces.
5. Personnel shortfall:



R22 million for 2010/11;
R24 million for 2011/12; and
R30 million for 2012/13, for Compensation of Employees to stabilize
personnel expenditure.
47
12.
NEW ALLOCATIONS FOR 2010/11-2012/13:
PRIORITY AREAS
6. Stabilize the Forensic Chemistry Laboratories:



R2 million for 2010/11
R3 million for 2011/12;
and R5 million for 2012/13, to address backlogs in these laboratories.
7. Development of new hospital reimbursement mechanism linked with case
mix:
 R1 million per financial year over the MTEF period, to develop a hospital
re-imbursement tool.
48
12.
9.
NEW ALLOCATIONS FOR 2010/11-2012/13:
PRIORITY AREAS
Measles and Polio Vaccination Campaign:


R30m for 2010/11 and
R20m for 2011/12
10. Emergency Medical Services (EMS) 2010:

R13m for 2010/11
49
13. CONCLUSION

National DoH Strategic Plan 2010/11-2012/13 reflects interventions to improve health
service delivery and improve health outcomes for all South Africans.

National DoH Strategic Plan 2010/11-2012/13 reflects ambitious targets - Health is one
of 5 key priorities of Government for 2009-2014.

A sector wide plan will be produced by end of May 2010, which will reflect the
contribution of the entire sector - National and 9 Provincial DoHs - to the
achievement of the 20 deliverables outlined in the foregoing sections.
Despite the growth in the resource allocation for conditional grants (especially for HIV
and AIDS), the overall allocation for the National Department for Operational costs
declines by 6%.
This means we must do more with less, without compromising quality;
Where possible, donor funding will have to be mobilised, managed appropriately,
and strategies developed to ensure sustainability of donor funded projects.
50