WHEN THE SUN RISES
WE WORK HARD TO DELIVER
REVIEW OF PROGRESS
RE: IMPLEMENTATION OF TURNAROUND STRATEGY
May 2015
KEY PILLARS OF THE CHANGE PROGRAMME
REDUCE MORTALITY AND INCREASE LIFE EXPECTANCY
Communication and Social
Mobilisation
Health Care Infrastructure
Sound HR and Financial
Management
Good Governance and
Environmental Controls
Strategic Leadership and
Good Organisational Culture
MPUMALANGA DEPARTMENT OF HEALTH
STRATEGIC LEADERSHIP
KEY FINDING
Ineffective editing
committee
ACTIONS TO BE TAKEN
•
•
•
Poor management of
policies, guidelines
and procedure manuals
•
•
•
•
Re-establish the editing committee. •
The editing committee to go through
the Strategic Plan and Annual
Performance Plan before submission
to relevant authorities
Implement the checklist to assess
SP and APP
•
Develop and implement the
framework for the development of
policies
Assign a responsible Unit / official to
keep policies and procedures
•
centrally and to ensure regular
review of such
Create a database of policies
Assign coordinators of policies from
various programmes
PROGRESS
Editing Committee was
established and
appointment letters
furnished.
CHALLENGES
None
All Programs requested to Awaiting response.
forward updated approved
policies.
8 Programmes complied.
STRATEGIC LEADERSHIP
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
Lack of performance
assessment and
monitoring tool
•
Develop and implement the
performance assessment and
monitoring tool
•
Lack of a standardised
Procedure Manual for
collation of data from
institutions
•
Customise and implement a
Standardised Procedure Manual for
Health Information that will crossreference District Health Information
System (DHIS) and all paper based
means of verification (MOV)
Consult on the Procedure Manual
and obtain inputs from all
responsible officials
•
•
TAS Balanced Score
Cards and Weekly
hospital performance
indicators developed and
being implemented.
Collecting of data
according to SOP,
National Standards
policies and procedures
for DHMIS
CHALLENGES
None
None
STRATEGIC LEADERSHIP
KEY FINDING
Ineffective governance
structures
ACTIONS TO BE TAKEN
•
•
•
•
•
•
Develop and circulate an annual
schedule of all management and
executive management meetings
Develop and implement Terms of
Reference (TOR’s) for all
management structures
PROGRESS
CHALLENGES
•
Schedule circulated.
None.
•
TOR in process (HRD)
None.
Appoint the Chairperson of the Risk •
Management Committee
Risk management to be a standing
item in all meetings
•
Risk management to be key
performance area for all staff in the
department
•
Appoint the Audit Committee
members and consult with the
Executive Authority on appointments
Risk management
None
committee was appointed.
In process of finalising
additional members..
Audit Committee members
recommended approval
awaited.
None
STRATEGIC LEADERSHIP
KEY FINDING
Non-alignment of the
District Health
Expenditure Review
(DHER) to the
Department’s budget
and expenditure
outcomes
ACTIONS TO BE TAKEN
•
•
Improve the consolidation of districts •
budget and expenditure outcomes
Integrated Health Planning, District
Health Services and Management
Accounting to conduct joint sessions
at the end of each quarter
PROGRESS
CHALLENGES
Meetings and Reviews
Budgetary constraints.
were held at all Districts to
address this issue.
HOSPITAL MANAGEMENT
KEY FINDING
Non-compliance to
Norms and Standards
Inadequate provisioning
of non- negotiables
ACTIONS TO BE TAKEN
•
•
•
•
•
•
•
Strengthen management of
resources (human, financial and
assets) in hospitals/districts.
Strengthen leadership and
accountability
Strengthen financial management
structures
Facility upgrades, repairs and
maintenance
Ensure availability of basic functional
equipment with maintenance plan
Assist institutions with appointments
of critical staff
Assist Hospital/District managers
with basic tools to enable them to
improve on quality service delivery
PROGRESS
•
•
•
•
•
Processes in place to fill
critical posts.
CHALLENGES
Interdisciplinary
collaboration at incipient
level.
Monthly reporting on non - None
negotiables. Monitoring
taking place.
Infrastructure plans and
refurbishment/
maintenance
implemented.
HR delegations given to
CEO’s/ DM.
Maintenance plans
developed for buildings
and equipment.
HOSPITAL MANAGEMENT
PHARMACEUTICAL DEPOT
KEY FINDING
The warehouse does not
comply with the Medicine
and Related Substances
Control Act, No 101 of
1965
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
•
The Department to apply for a license for
the depot to operate as a wholesale by
The National Department of Health
(NDoH)
•
Department applied Depending on NDoH.
for license. Awaiting
license from NDoH.
•
License by the MCC and Certificate of
recording of both the premises and the
owner by the South African pharmacy
Council (SAPC)
•
Dependent on
approval from
NDoH.
Awaits approval (as
above)
•
The Department to appoint a Responsible •
Pharmacist and a Deputy Responsible
Pharmacist
Responsible
pharmacist
appointed.
Finalised.
HOSPITAL MANAGEMENT
PHARMACEUTICAL DEPOT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
There is no contract
indicating the different
responsibilities of
departmental officials’
and those of the
contractor with clear lines
of reporting
•
•
The Department to enter into a contract
with the service provider to ensure that all
activities of ordering, receiving,
warehousing and dispatching of items are
allocated to responsible persons / officials
Pharmaceutical
tender to be
advertised in Feb
2015 and SLA with
awarded entity will
correct the matter.
None
The items packaged by
the service provider are
not checked for
correctness of the
medication before
distribution to the
institutions
•
The Department to capacitate the depot
to ensure that quality control takes place
throughout the supply process
•
Will be addressed
by the SLA above.
None
HEALTH FACILITY
WASTE MANAGEMENT
KEY FINDING
Poor Management of
Health Care Risk Waste
ACTIONS TO BE TAKEN
•
•
•
•
•
Finalise tender process for
waste management
Once service provider has been
appointed ,the tender to be
decentralised to strengthen
accountability
Update the ‘Health Care Waste
Guideline’ for approval
Capacity districts on contract
management
Orientate waste officers on
technical requirements
PROGRESS
•
•
•
Specifications for
•
the waste
management tender
are done,
•
Tender was
advertised, and
withdrawn due to
•
administrative error
Tender must be re
advertised
CHALLENGES
Service providers are
appointed on contact basis
to render the service.
No specific unit solely
responsible to monitor the
tender
Critical post for a waste
manager not yet advertised
HOSPITAL MANAGEMENT LAUNDRY SERVICES
KEY FINDING
•
Ineffective
management of
laundry services
ACTIONS TO BE TAKEN
•
•
Specifications for procurement of linen
already drawn
Process of procuring laundry services at
initial stages
PROGRESS
•
RFP received and
adjudication in
progress.
CHALLENGES
None
MEDICO-LEGAL SERVICES & LITIGATIONS
•
•
KEY FINDING
High litigation costs
ACTIONS TO BE TAKEN
PROGRESS
•
•
Reduce rates of adverse events and
medical negligence, especially in
Obstetrics and Gynaecology, Surgery,
Emergency Units and Orthopaedics
•
Reduce contingent liabilities from litigation •
costs
•
Reduce work environment related risksource constraints (e.g. breakdowns of
equipment, unavailability of commodities
or equipment)
•
•
Address human resource issues such as
high patient / health professional ratios,
health professionals burnout and low
morale, health professionals ignorance of
patients ‘rights and the seriousness of
patients’ medical conditions;
•
•
CHALLENGES
Weekly reports and None
remedial actions
from hospitals.
Improve on record
management and
clinical outcomes.
Preventative
maintenance plans
put into place.
Filling of senior Health
professionals posts.
Improved facility
management
component.
Strengthen usage
of PHC facilities.
High workload and
vacancy rates.
None
MEDICO-LEGAL SERVICES & LITIGATIONS
KEY FINDING
High litigation costs
ACTIONS TO BE TAKEN
•
Reduce disease burden, and utilization of
junior staff (Interns and community
Service doctors) with poor Supervision
and Support, to do difficult and
complicated procedures
PROGRESS
•
•
•
•
Ensure Public Works performs routine
testing of all generators on a regular basis
and warrants their functionality
•
Improve relations with the Office of the
State Attorney.
•
Headhunting of
specialists has
commenced.
Collaboration with
Pretoria University
and Dept. Health
KZN started.
CHALLENGES
None
Weekly monitoring None
tool in place and an
audit of all
generators to be
implemented.
Continuous
None
engagement.
HEALTH INFORMATION MANAGEMENT AND SYSTEM
KEY FINDING
Irregular update of
Health information
systems
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
•
Update technology equipment and LAN,
and provide support and maintenance on
equipment.
•
•
Ongoing
150 sites updated
None
•
Enhance connectivity in all facilities to
improve efficiency.
•
All facilities
connected.
None
•
Streamline systems for unified Health
Information System.
•
None
•
Mainstream Information Management and •
accountability
Information
systems RFP’s to
be adjudicated.
Information
systems RFP’s to
be adjudicated.
•
Improve efficiency of Pharmaceutical
Services throughout the system.
Awaiting tender
advert.
System
requirement
included.
None
•
•
None
CORPORATE SERVICES
DOCUMENT & INFORMATION MANAGEMENT
KEY FINDING
Inadequate document and
information management
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
•
Develop and implement the file plan for
the department
•
Work in progress
Shortage of clerical staff
•
Present the file plan to Operational and
Top Management
•
Not yet approved
by DCSR
Shortage of clerical staff
•
Circulate the file plan to all key staff in the •
Department e.g., Secretaries.
Work in progress
Lack of records clerks
•
Train the secretaries and Admin. Officers
on the implementation of the file plan
•
Not done yet.
Shortage of staff
•
Reference all documents and files and
move all documents to the registry
•
Not done yet.
Shortage of staff
•
Obtain space for the creation of a registry •
Not done yet.
Shortage of staff
•
Monitor the use of the file through visiting
districts and sub-districts
•
Not done yet.
Shortage of staff
COMMUNICATION AND SOCIAL MOBILISATION
KEY FINDING
Lack of a cohesive and
coordinated Advocacy
and Communications
strategy
Absence of a regular
publication of
Implementation
Successes and Risks
Absence of a Social
compact with the Public
Lack of a user friendly
suite of multi-lingual and
multi-modality documents
(pamphlets, posters,
brochures, guidelines)
ACTIONS TO BE TAKEN
•
•
•
•
•
PROGRESS
•
Develop a clearly articulated
communication strategy
Mainstreaming of communication
management throughout the organization. •
Access to credible and reliable
information to reduce the risk of
miscommunication.
Streamline responses to complaints from
•
the public for positive media publicity.
Communication
Strategy
Developed.
Departmental
Newsletter
“Maphelo”
published.
Processes
commenced
To be developed.
Not done yet.
•
CHALLENGES
None
HUMAN RESOURCES MANAGEMENT
KEY FINDING
Ineffective Recruitment
and Selection processes
ACTIONS TO BE TAKEN
•
•
•
•
•
Obsolete HR policies
•
•
•
•
•
PROGRESS
CHALLENGES
Update recruitment plan
Ensure all shortlisting and interview
panels are appointed in writing
Finalise shortlisting
Finalise interviews
Finalise appointments
•
Ongoing. Not
completed yet.
HR capacity.
Review all HRM&D policies
Distribute for inputs from all stakeholders
Obtain approval from management
Implement and communicate reviewed
policies
Ensure and monitor implementation
•
Policies reviewed
and approved.
None.
HUMAN RESOURCES MANAGEMENT
KEY FINDING
Inadequate HR Plan
ACTIONS TO BE TAKEN
•
•
•
•
•
•
Non Standardisation of
HR forms
•
•
•
•
Develop HR plan that is linked to the APP •
and budget
Develop HRD long term plan
Distribute for inputs from all stakeholders
Obtain approval from management
Implement and distribute HR plan
Ensure and monitor implementation
•
Review all matters that must be
standardised (eg. submissions, claim
forms, etc.)
Develop standardised formats
Distribute formats
Ensure and monitor implementation
PROGRESS
CHALLENGES
HR Plan developed None
Process started
Lack of capacity.
HUMAN RESOURCES MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
Non adherence to
Conditions of service
allowance
•
Out of adjustment
appointment-Organogram
•
•
•
•
•
•
•
Identify conditions of service allowances •
and plan for the next financial year
Ensure funds are available
Submit list and memorandum for approval
Capture payments
Capacitate responsible unit
•
Capture organogram on PERSAL
Review the captured organogram on a
regular basis
Capacitate the responsible unit
PROGRESS
CHALLENGES
Process started.
HR capacity.
Process started.
HR capacity.
FINANCIAL MANAGEMENT
COST DRIVERS
KEY FINDING
Items not on contract
ACTIONS TO BE TAKEN
•
•
•
•
•
•
•
Review all major cost drivers in
terms of whether those are
contracted or not
Compile specifications for those
items that are not on contract
Issue specifications
Evaluate tenders
Adjudicate tenders
Appoint service providers
Enter into Service Level
Agreements
PROGRESS
Major cost drivers identified as
follows:
Contracted out services
• Medicine
• NHLS
• Blood services
• Management of health waste
• Food / Meals
In-house / Non-contracted out
services
• Laundry services
• Fuel and Oil
CHALLENGES
None
SERVICE LEVEL AGREEMENT
KEY FINDING
Obtain all SLA’s
ACTIONS TO BE TAKEN
•
•
•
•
Develop a process flow
document on SLA management.
Check which SLA are currently
available.
Liaise with programme
managers.
Capacitate the unit in terms of
human resources.
PROGRESS
•
•
•
•
Director: SCM - Recruitment
and selection in progress
Other positions being
attended to - SCM structure
currently being reviewed in
consultation with OTP
Process flow on SLA
management compiled and
awaiting approval
Stock being taken of all
current and available SLA’s
CHALLENGES
None
SUPPLY CHAIN MANAGEMENT
KEY FINDING
Develop a capacity
building plan
ACTIONS TO BE TAKEN
Prioritise training on SCM.
PROGRESS
•
•
Demand plans
Develop demand plans for goods
and services
• Above R500 000
• Below R500 000
Appropriated Budget
•
•
Prioritise commitments and
accruals carried forward from
the previous financial year
Reprioritise business and
demands plans in line with the
approved budget
•
•
•
CHALLENGES
Undertaken skills assessment None
of current SCM officials
Ongoing process eg. AFS
training
Demand Plans developed for None
both categories.
Ongoing process.
Registers implemented.
None
SUPPLY CHAIN MANAGEMENT
KEY FINDING
Capacity
ACTIONS TO BE TAKEN
•
•
Insufficient capacity in
Supply Chain Management
•
Segregation of tasks and
rotation of officials
•
•
•
PROGRESS
Appoint Director: SCM
•
Restructure the Organogram in
line with the five elements of
SCM and fund posts and fill them
Minimise the same elements in to
KPA’s at District and Hospital
level and fund
Segregate tasks on Performance
agreement and as per KPA.
Ensure annually rotation as per
PT instructions
Capacity building via skills audit
and training
 Motivation for extra staff was
submitted.
Post advertised.
CHALLENGES
None
Lack of HR capacity.
 Rotation according instruction
planned for 1 April 2015.
•
Segregation of tasks
implemented.
•
Annual rotation planned for 1
April 2015.
None
SUPPLY CHAIN MANAGEMENT
KEY FINDING
Compliance Committees
ACTIONS TO BE TAKEN
•
•
Bid Committees
•
•
•
•
All institutions will nominate
officials other than the bid
committees to be in the
compliance committees;
Sustain FMC committees
beyond intervention
PROGRESS
CHALLENGES
•
Finalised
None
Bid Committee members for all •
Committees will be appointed
Training to be provided to all Bid
Committee members
Internal Control Unit must
monitor evaluate and report
Security clearance
Finalised
None
SUPPLY CHAIN MANAGEMENT
KEY FINDING
Deviations
ACTIONS TO BE TAKEN



Risks and performance
management

Appointment of
consultants

Deviations from SCM
•
processes to be reviewed by
the Bid Adjudication Committee
and recommended
Proposals to the HOD regarding
reviews on deviations
Submission of deviations to the
Provincial Treasury and the
Auditor-General
Enhance relationship between •
Internal control, Internal Audit
unit and Risk management
Compliance to the SCM
•
guidelines and the Practice
notes around appointment of
consultant’s;
PROGRESS
CHALLENGES
Deviations reviewed by Bid
Adjudication Committee.
None
Ongoing engagement.
None
Ongoing.
INVOICES RECEIVED
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
Determine central point
for receipt of all invoices
•
Appointment letter through the
Accounting Officer
•
Officials appointed to receive
invoices.
None
Implement invoice receipt
register
•
•
Use of the recommended
template by Provincial Treasury.
Registers implemented at all
institutions and PO.
None
Notify all service
providers of the central
point to submit invoices
•
Through Circulars and follow-up •
phone calls for all service
providers on the suppliers’
database and as and when new
contractors are sourced.
Ongoing.
None.
INVOICES RECEIVED
KEY FINDING
There are no officials
responsible for
coordination of invoices
ACTIONS TO BE TAKEN
•
•
•
•
•
•
PROGRESS
CHALLENGES
•
Officials appointed
None
Appoint responsible officials to •
reconcile invoices received
Appointment letters to be issued
through the HOD’s office
Training of appointed officials to •
reconcile invoices received
Officials appointed
None
Officials trained during
February 2015.
None
Appoint a responsible official(s)
to populate the register,
distribute the invoices to the
relevant programme managers
and follow-up on outstanding
invoices from programme
managers
Draft appointment letters and
distribute to appointees
Appointment letter through the
Accounting Officer
PAYMENT OF INVOICES
KEY FINDING
There are no officials
responsible for
coordination of invoices
ACTIONS TO BE TAKEN
PROGRESS
•
•
Develop and implement a
checklist to be attached to
invoices to ensure payment
documents are complete
•
Major accounts will be allocated •
to specific officials for monthly
reconciliation e.g. blood, NHLS,
•
Medicine, Telephone, rentals
and contracts)
Reports to be submitted
•
monthly on reconciliation to
CFO and Provincial Treasury
Develop a training manual/
presentation
Schedule joint training
Conduct training
•
•
•
•
CHALLENGES
Officials are appointed and
informed
None
Major accounts are allocated
to specific officials.
None
Monthly reports are
submitted.
Training manual in process.
PAYMENT OF INVOICES
KEY FINDING
There are no officials
responsible for
coordination of invoices
ACTIONS TO BE TAKEN
•
•
•
•
•
•
•
Follow-up with service providers •
•
where balances are brought
forward from previous months
Prepare reconciliation reports
Identify unpaid invoices
Liaise with chief users to
facilitate payment of invoices
The 0-9 file will also be included
with monitoring and follow up on
outstanding orders
Review and reconcile invoice
receipt register monthly
Reconciliation of receipt register
will be approved by the CFO
monthly
PROGRESS
Procedural issues.
On-going implementation
is monitored.
CHALLENGES
None
DEBTORS
KEY FINDING
Poor management of
debtors
ACTIONS TO BE TAKEN
•
•
•
•
•
•
PROGRESS
CHALLENGES
Review / Develop the policy on
debt management
Develop procedure manual to
implement the policy
Management of appointed
Departmental collector contract
•
Debt policy reviewed
None
Review debt register for
correctness and identify debts
that are uneconomical to collect
for writing-off
Writing-off of bad debts
provided funds are available
Instatement of
PERSAL/pension deduction
•
Ongoing Reviewed daily.
None
•
Procedure implemented.
DEBTORS
KEY FINDING
Poor management of
debtors
ACTIONS TO BE TAKEN
•
Develop a strategy on
outstanding debts
PROGRESS
•
Internal debtors:
• PERSAL deductions
•
• Pension deductions
•
• External debtors:
• Recovery letters to debtors
• Human Resource Management
capacity building (training)
• Review targets for debt collector
with actual collections.
• Monitor RAF claims and the
write- off of stale debts
CHALLENGES
Strategy part of policy
None
Debtors managed.
Strategy part of policy.
None
OPERATING LEASES
KEY FINDING
Deficient management of
operating leases
ACTIONS TO BE TAKEN
•
•
•
•
•
Review current operating leases •
Improve capacity of the Contract
Management Unit through
training of current official and
•
through internship program
To keep register of readings for
the usage of photocopiers to
ensure that on a monthly these
registers serve as supporting
documents for invoices to be
paid
Contracts for labour saving
devices to insert the clauses on
submission of invoices within a
specific time frame (new SLA’s)
Written requests to service
providers to submit invoices
within specific period
PROGRESS
CHALLENGES
Contract register for Labour None
Saving devices implemented,
monitored and evaluated.
Processes on-going.
ASSET MANAGEMENT
KEY FINDING
Deficient management of
assets
ACTIONS TO BE TAKEN
•
•
•
•
•
Develop and implement an Asset
Management Purchase plan
Identification of need and description
of asset
Budget available balance
Update Purchase plan with available
budget
Develop a standardised asset
catalogue (naming of assets is a
major challenge and standardise
catalogue will eliminate that)
PROGRESS
•
•
CHALLENGES
Asset management
None
policy developed and
implemented.
Purchase plan
developed and updated.
ASSET MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
Deficient management of
assets
Procurement
• Monitoring procurement in line with
Purchase plan
• Conditional Grants must be
distributed to institutions for
procurement purposes (limitation of
procurement at head office level and
distribution without updating asset
register at institutions)
•
Conditional Grants
distributed according to
DORA Act.
Barcode and update of asset register
• Procure pre printed barcodes (
eliminate duplicate barcodes and
possibility of replacement of wrong
barcode)
• Develop procedure to replace
barcodes if lost
•
Barcode implementation None
project in progress.
None
ASSET MANAGEMENT
KEY FINDING
Deficient management of
assets
ACTIONS TO BE TAKEN
•
Barcode and update of asset
register……….
• Warehouse to receive assets and call
•
end user to identify asset correctly
delivered.
• Asset Management to barcode
assets before distribution to end user
• Warehouse to capture serial number
and barcode on system before
invoice is processed and given to
expenditure
• Ensure correct value of asset on
system. If conversion cost or other
include on asset.
• Provide report and copies of all
purchases to District office on
monthly basis.
PROGRESS
Barcode project in
process.
Approved Asset
management plan is in
process of
implementation
CHALLENGES
None
ASSET MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
Deficient management of
assets
Barcode and update of asset
register……….
• District to provide report to Provincial
Office on quarterly basis.
•
Reports submitted.
HR capacity.
Distribution
• Asset Management ensure that end
user receive asset and verify that
asset register is updated
• End user to sign new updated
inventory list to accept asset
•
Approved Asset
management plan in
process of being
implemented
None
ASSET MANAGEMENT
KEY FINDING
Deficient management of
assets
ACTIONS TO BE TAKEN
•
Verification
•Verification plan to be developed (Asset
verification teams per hospital must be
appointed.)
•Verification report template to be
develop (Items on floor and not on
register, asset on register and not on
floor, assets verified, new assets,
disposals, repairs and movements)
•First verification done by institutions own
asset management team and report on
verification given to Districts for
consolidation and investigations if
needed.
PROGRESS
Approved Asset
management plan in
process of being
implemented
CHALLENGES
None
ASSET MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
Deficient management of
assets
Verification………….
•Second verification must be rotations of
teams to next door institution to ensure
accountability and accuracy.
•Total reconciliation of verification by
Provincial Office to ensure identification
of duplications and movement of assets
between institutions.
•Investigations of assets not found on
floor.
•Develop process to replace barcodes if
lost with new pre-printed barcode.
•Verification report quarterly to CFO and
Second quarter and last quarter to
Provincial Treasury
PROGRESS
•
Ongoing processes
implemented.
CHALLENGES
None
ASSET MANAGEMENT
KEY FINDING
Deficient management of
assets
ACTIONS TO BE TAKEN
•
Movements and Repairs
• Develop registers to transfer assets
between institutions.
• Budget for tracker barcode system on
major expensive movable assets and
plan implementation there off.
• Develop repair register and monitor
monthly and report to CFO quarterly.
•
Disposal
• Identify disposable asset (keep
records of each asset, barcode serial
number and institution with end user)
• Identify warehouses or safe keeping
areas in each institution and one per
district.
• Identify disposable assets with
verification process
PROGRESS
Ongoing
CHALLENGES
None
Approved asset
None
management plan in
process of being
implemented. Will be
finalised by end of
March 2015.
ASSET MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
Deficient management of
assets
Disposal…………
• Appoint disposal committees in each
institution
• Submit Disposal list to Districts for
approval
• Report to Provincial office on
approved disposals per district for
arrangement of auction
• Develop auction processes
• Write-off disposed assets
•
Ongoing
None
Lost and Stolen
• Develop procedure to report lost and
stolen assets
• Report Monthly to District on lost and
stolen items
• Report quarterly to Provincial Office
and to Provincial Treasury
•
Procedures developed.
Districts report monthly.
None
ASSET MANAGEMENT
KEY FINDING
Deficient management of
assets
ACTIONS TO BE TAKEN
•
Training and Development
•Draft training plan on asset
management
•Introduction for new employees must be
provided
•Train end users on asset policy and
procedure manual
•
•Appoint asset champions in each
section and train them on procurement,
movement and lost and stolen
procedures and reporting requirements
•
Restructuring on monitoring and
reporting of Clinics and CHC’s
•CHC’s and Clinics assets must be
managed by Hospitals - to be able to do
this all purchases must also be done at
Hospital level.
PROGRESS
Training plan drafted
CHALLENGES
None
Asset champions
appointed..
Hospitals assist with
assets at CHC’s and
Clinics.
None
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
PROGRESS
Finalise the Development of the
automated Budget Model
The module must include:
•Contractual obligations must be
automated captured
•Intranet availability
•Responsibility Managers linked
•
Budget structure and planning
•Appointment of programme managers
in writing to manage budgets
•Development of time table for
programme managers to review budget
and preparation of MTEF budgets.
•
•
CHALLENGES
Present Budget model
according to Treasury
prescripts.
In progress.
None
Budget structure
according to Treasury
regulations.
None
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
Budget structure and planning
• If online submissions consolidating
will be automated and reduce risk of
budgets from finance without inputs
of program managers.
• Contractual obligations must be
projected
• Assets and additional budget must
be provided as additional need
PROGRESS
•
•
Budget committee
• HOD to enforce budget meetings
with management to review budget
inputs and needs
• Establish District budget committees
• Quarterly reports of budget meeting
to Provincial Treasury
Process to be
implemented.
CHALLENGES
None
Financial and budgeting None
meetings were held in all
the districts
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
•
Compensation of Employees
•HR to take full responsibility of vacant
post needs and align post with available
budget over MTEF
•HR to ensure replacement of
employees if it was a vacant funded post
within three months after vacation.
•Review HR plan and implement plan
with training to all programme managers
•HR plan must include translation in
rank, intake of community service as
well as new nursing students in line with
vacant post on structure (there is
currently no alignment with structure and
intake of the above)
PROGRESS
In progress.
CHALLENGES
None
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
•
Compensation of Employees………
•Roll out of Compensation module to
programme managers. Training must be
provided
•Monitor appointments in line with HR
plan monthly and submission of report to
Provincial Treasury quarterly or when
needed.
•
Development of commitment
registers
•To reduce accruals and over
expenditure the budget office must
include commitment registers link to the
approved budget for the financial year.
PROGRESS
CHALLENGES
In progress
None
Manual commitment
register developed.
None
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
Development of commitment
registers ………..
•Appointed responsibility managers for
budget must reconcile actual
expenditure report and commitment
register to ensure accuracy and enforce
budget monitoring and spending as well
as management of accruals
•Review orders print to suppliers
(include limitation of time valid on order
e.g. three months then the order expire
and must be de-committed. Only CFO
will then be in position to extend order
for a longer period depending on reason
from supplier) this however will not
include standing orders for day to day
operations.
PROGRESS
•
Commitment registers
analysed monthly.
CHALLENGES
None
BUDGET AND ACCRUAL MANAGEMENT
KEY FINDING
Deficient budget and
accrual management
ACTIONS TO BE TAKEN
Accruals
• Limit purchasing of equipment if
contractual obligations are not fully
budgeted for.
• Districts to review contractual
obligations and provide proof and
consolidated report to Provincial
Office.
• Review cash flow need monthly in
line with commitments and accruals
as well as cash in bank and
received.
• Split cash flow between conditional
grant and voted funds and report
monthly to Provincial Treasury
PROGRESS
CHALLENGES
•
Accruals and
None
commitment meetings
held monthly in Districts.
•
Cash flow reviewed daily
REVENUE MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
Records management
•
•
Enforce management of patients flies •
Develop and implement operational
plan on Records Management
None
ICT system
•
To benchmark ICT system with
Charlotte Maxeke and Steve Biko
hospitals. The ICT system to
accommodate:
Initial entrance, to the exit
(discharge) including the medicine
and even blood tests ( thus medical
holistically) billing and linking with
BAS to clear the patient debt and
close the account . GRAP and
GAAP orientated
None
•
•
CHALLENGES
REVENUE MANAGEMENT
KEY FINDING
Capacity
Road Accident Fund
ACTIONS TO BE TAKEN
Need analysis for appointments and
upgrading/ posts of the organogram and
the resources of such for:
• The admissions
• (day and night) and
• Discharge’s officials
• ward clerks
• case managers
• records management and revenue
(billing) and debt (follow up and
tracing)
• Skills tests as the two main functions
that is dealt with here is patient
affairs and revenue at the end of the
day (thus financial aspects)
• Appoint a RAF agent to facilitate
improvement of revenue in the Big
five hospitals.
PROGRESS
•
•
•
•
CHALLENGES
Inputs received from
None.
hospitals.
Forwarded to HR to form
part of HR plan.
Benchmarking took place
in Gauteng.
To follown SCM process
in new Financial year
REVENUE MANAGEMENT
KEY FINDING
ACTIONS TO BE TAKEN
PROGRESS
CHALLENGES
ICT
•
To link the accounts directly to the
•
external stakeholders e.g Medical aid
schemes and RAF;
None
New Contract will
include EDI capability.
Reclassifications of
patients
•
Pre-approval before reclassification
and daily monitoring of
reclassification
•
Ongoing
None
Reconciliation
•
Monthly Reconciliation between BAS •
and PAAB
Ongoing
None
ICD 10 Code training
•
All holistically involved in the cycle to •
be trained on ICD codes
None
Patient files not captured
•
Develop and implement a plan to
capture the files and start the billing
processes
Ongoing
Training needs
registered with HRD.
Directives issued to
hospital.
•
HEALTH INFRASTRUCTURE MANAGEMENT & DEVELOPMENT
KEY FINDING
Deficient management of
infrastructure upgrading
& renovations
ACTIONS TO BE TAKEN
•
•
•
•
•
Re-alignment of budget according to •
project requirements
Contractors put on terms
Revise scope of projects and finalise
approval
Close monitoring of progress in line
with programme plan
Close-out all projects due for
completion
PROGRESS
Budgets and project
scope were re aligned
according to projects.
CHALLENGES
None
HEALTH INFRASTRUCTURE MANAGEMENT & DEVELOPMENT
KEY FINDING
Poor infrastructure
planning
ACTIONS TO BE TAKEN
•
•
•
Poor infrastructure
maintenance
•
•
•
To develop a provincial infrastructure •
master plan for 5 - 10 years
Develop a provincial prioritisation
model for projects
To capacitate the unit with more
relevant skilled Built Environment
personnel
•
To develop a comprehensive
provincial maintenance policy
Revise dates and implementation of
maintenance plan for the department
Close monitoring of progress in line
with programme plan
PROGRESS
CHALLENGES
In progress
None
In progress
None
MANAGEMENT OF CONDITIONAL GRANTS
KEY FINDING
Low spending on and
inadequate management
of Conditional grants
ACTIONS TO BE TAKEN
PROGRESS
•
Improve spending on grants
•
•
•
SLA’s signed with NGO’s / NPO’s
•
•
Tender for medical equipment
advertised
•
•
Bursaries awarded
•
•
Infrastructure spending accelerated
•
Grants monitored.
NHI, Revitalisation,
Infrastructure. low
spending
SLA’s signed with 224
entities.
Tender advertised
awaiting adjudication
Bursaries awarded by
Department of Education
Projects awaiting
finalisation.
CHALLENGES
None
None
None
None
None
Summary of progress April 2015:
77.8%
55
Summary per Cluster
774
900
654.5
800
493
558
700
600
500
400
300
Sum of 2015 April 29 Achieved
0
56
13.5
27
1
3
23
23
32
38
47
Sum of Objective
3
19
0
0
1
0
1
26
100
108
153
80
200
Objectives per Chief Directorate
Objectives per Chief Directorate
Row Labels
Sum of 2015 April 29 Achieved
CD: Corporate Services
Sum of Objective
0
27
81
132
127
133
3
22
CD: Infrastructure Management
32
39
CD: Integrated Health Planning
4.5
9
CD: Nkangala District
92
101
752
874
18
25
130.5
184
1
2
80
154
Dir.: Internal Audit
1
2
Dir.: Legal Services
23
23
Dir.: PA
1
1
Dir.: Security Management and Aux Serv
1
3
1347
1731
CD: Ehlanzeni District
CD: Gert Sibande District
CD: Human Resource Management
CD: Primary Health Care
CD: Tertiary and Secondary Hosp
Chief Financial Officer
Dir.: Communication
Dir.: ICT
Grand Total
58
Thank you