DEPARTMENT OF
HEALTH &
WELFARE
Portfolio Committee
on Health
16 April 2003
1
INTRODUCTION




Vision, mission and core functions
Health Progress report per program 2002/3
Health priorities 2003/4
Health budget pressures 2003/4 and service
implications
 Concluding remarks
2
VISION AND MISSION
VISION
A caring and developmental health and welfare system
which promotes well-being, self-reliance and humane
society in which all people in the Northern Province
have access to affordable and good quality services.
MISSION
Through providing comprehensive, integrated and
equitable Health and Welfare services which are
sustainable, cost effective and focus on the
development of human potential in partnership with
relevant stakeholders.”
3
DEMOGRAPHY

POPULATION DISTRIBUTION
TOTAL POPULATION = 5.8 Million
(DWAF, CWSS Study, 2000)
EC
15.5%

LP
12.1%
89% OF THE POPULATION LIVE IN
RURAL AREAS.
WC
9.7%

54.3% 0F THE POPULATION ARE
WOMEN
GP
18.1%
NC
8.3%

36.9% 0F THE POPULATION AGED

LITERACY RATE FOR 20 YRS &
MP
6.9%
KZN
20.7%
FS
NC 6.5%
2.1%
OLDER PEOPLE WAS 63.1 % IN 1996

46% UNEMPLOYMENT RATE

GDP CONTRIBUTION = 4.2 % IN 1996

6 DISTRICTS

44 HOSPITALS & 477 CLINICS
4
MORTALITY INDICATORS
2000
Indicator
Limpopo
National
1994
2000
2000
Infant mortality
rate/1000 live births
57
37.2
45
Under 5 mortality
rate/1000 live births
83
52.3
61.0
Maternal mortality
ratio /100 000 live
births
53
30
150
5
Source: SAHRS 2000
MAJOR CAUSES OF DEATH
Cause
Percentage
Ill define (All natural)
23.5
Undetermined injuries
9.1
Cardiovascular disease
7.4
Stroke
5.9
Tuberculosis
5.6
Lower Respiratory Infections
4.8
Diarrhoeal Diseases
3.9
Diabetic Mellitus
3.1
Ischaemic Heart Disease
3.0
Road Accidents
1.8
Source: MRC 2001
6
Core Functions
· Provide Regional and Specialised hospital services & Academic Health
Services
· Render and co-ordinate Medical Emergency Services
· Render Medico-legal services.
· Quality control of all health services and facilities.
· Formulate and implement provincial health policies, norms, standards and
legislation.
· Develop & Manage District Health Services
· Provide technical and logistical support to health districts.
· Render specific provincial services programmes, e.g. TB programme.
· Provide non-personal health services.
· Provide and maintain Health Care Technologies.
•
Research on, monitor and evaluate health services/programmes.
7
PROGRAMME 1
Health Administration
8
POLICIES
ACHIEVEMENTS: 11 Policies and guidelines on the
following areas have been developed
 Procedures for recruitment and appointment of employees
 Employee suspension; Subsidized motor transport
 Departmental cellular phone; Procurement Policy
 Minimum sanctions and misconduct;
 Managing discipline
 Remuneration outside Public Service
 Employee compensation and over time
 Transfer of employee; Work Environment
CONSTRAINTS: Policy development inherently a lengthy
process
9
STAFF ESTABLISHMENT
ACHIEVEMENTS: Reviewed, finalized and
approved the following establishments:
 Head Office with savings of R9.521m; Polokwane/
Mankweng Tertiary hospital complex; Polokwane Place
of Safety; Thohoyandou children’s home; Sekutupu old
age home.
 The following management structures were reviewed:
district offices, district hospitals, regional hospitals and
level 13 district hospitals, specialized hospitals
including 4 revitalization project hospitals finalized.
10
HRM: STAFFING
ACHIEVEMENTS: 1110 vacant posts have been filled, this number
also includes doctors and nurses.
 Rank and leg promotions for 4400 employees arrear payment have
been finalized as planned for 2002/03
 A total number of 390 employees arrear payments are still
outstanding
 Performance management and development system implementation
plan has been initiated.
 Advertised 3 posts of General Manager, 1 CEO, 1 Senior Manager
and reasonable number of managers posts.
 A further R181m is required to fully implement 2nd and 3rd notch
promotions in terms of DPSA circular which extends beyond once off
payment stipulated in the Provincial circular.
 There is vacancy rate of 41,2%, and 6,03% staff turnover
11
HRM: STAFFING cont’d







TRANSFORMATION AND RESTRUCTURING IN TERMS
OF RESOLUTION 7 OF 2002: List of excess personnel has been
compiled and employees have started with the process of
placement into vacant posts.
CONSTRAINTS: Employees turnover rate=6,03%; Vacancy
rate 41,2%
Staff retention strategy
Total staff establishment loss of 1085 .This included 407 that
have left the Department through resignation and transfer.
A number of outstanding promotion arrear payments
Payment of outstanding 2nd and 3rd notches not finalized
Staff establishments for institutions and district offices are not
finalized yet to enable restructuring and redeployment process to
run smoothly
12
LABOUR RELATIONS AND
LEGAL SERVICES
ACHIEVEMENTS: District and institutions have been
delegated management and handling of disciplinary cases
 186 misconduct cases were reported and 144 cases
finalized of which 13 cases were dismissals, only 42
cases still pending
 15 Disputes (Conciliation and Arbitration) cases were
reported and 11 cases finalized, only 4 still pending
 8 Appeals reported, 1 finalized and 7 still outstanding
 42 grievances have been reported, 28 were finalized, 14
are still being investigated.
CONSTRAINTS: Capacity building of line managers
13
FLEET MANAGEMENT
ACHIEVEMENTS: Fleet audit is finalized
 Vehicle replacement plan developed
 A total of 93 new vehicles have been ordered,
broken down as follows :40 Ambulances, 8
response vehicles, 25 pool cars for hospital
administration and 20 for mobile services.
 10 Ambulances, 23 patients transport and 1LDV
have been delivered.
14
FLEET MANAGEMENT cont.
CONSTRAINTS:
-Vehicles take a long time to be delivered
-355 vehicles have traveled more than
200 000-400 000kms.
-Almost 50% of vehicles (including EMS)
are always in Garages for repairs
15
EMPLOYMENT EQUITY
ACHIEVEMENTS: Complied with the Department of
Labour with regard to submission of Equity progress
reports
 The Department has achieved 70/30 targets, however
with regard to Provincial Demographics ratio of 56:44,
the equity status is as follows:Senior management
Middle management
Supervisory level
Lower level
Disabled persons
Health
60/40
47/53
23/77
42/58
Welfare
47/55
55/45
31/69
32/68
0,5%
CONSTRAINTS: No disabled persons in management
16
BATHO PELE PRINCIPLES &
SERVICE DELIVERY PLAN
ACHIEVEMENTS: 12 consultative workshops on standards
development and service delivery plan conducted
 Workshops conducted monthly in all districts to review,
develop and implement domain specific standards
 Manual on Promotion of Access to Information Act, 2000
compiled and approved
 Departmental annual Merit Award Ceremony was held to
recognize good performance of employees
 Suggestion boxes have been installed in 95 % of the
institutions, client satisfaction surveys done in all hospitals
17
Financial Planning and
Budgeting
ACHIEVEMENTS: Achievability exercise, MTEC hearings,
quarterly reports & IGFR all assisted to provide a credible
adjustment budget that dealt with personnel under
funding and inflationary pressures.
 The new Chart of Accounts for 2003/04 based on the
nationally agreed programme structure and Departmental
restructuring has been finalised.
 Strategic plans in new format have been developed.
CONSTRAINTS: Lack of staff due to resolution 7.
18
Donor Funds
ACHIEVEMENTS: R1m was donated to Shiluvana
Health Centre by Flemish government for the eye centre.
 R504 000 has been commited so far.
 Business plan for EU’s PDPHC in place.
CONSTRAINTS: Systems for administering donor funds
are new and therefore there is a learning curve involved.
19
Revenue Generation
ACHIEVEMENTS: The revised fees schedule
was implemented as from 1st October 2002 with
a potential 10% decrease in income.
 Some private wards have been established to
entice private patients.
 R43.2m of revised target of R56.99m(98.8% of
tgt)
CONSTRAINTS: Incorrect personal data
provided by patients.
 92% of patients not on medical aid.
20
PROGRAMME 2
District Health Services
21
PREVENTION AND
CONTROL OF HIV/AIDS
• 80% communities reached on community awareness
 +/-10 million male condoms distributed
 21 sites for female condom distribution established and
+/-400 000 female condoms distributed
 All 8 Regional offer PMTCT services and 33 District
Hospitals offer Nevirapine
 233 VCT sites established and functional
 PEP treatment is being provided at all hospitals
22
HIV/AIDS/STDI’S/TB cont.
ACHIEVEMENTS :ICHB CARE PROGRAMME
– 20 Community Based Organisations offering ICHBC
services 25,666 (inclusive of all chronic conditions)
clients were attended to.
– 636 Care-givers trained and offering ICHBC services
– 3641 orphans (of which 2157 HIV/AIDS orphans) are
benefiting from ICHBC services
– 2 Step-down facilities approved and started operating .
(Kgapane & St Ritas)
Constraints:
– Community Home base care kits not always available
to all clients.
23
NATIONAL VS. LIMPOPO HIV
TRENDS 2001
30
25
24.5
22.8
24.8
22.4
20
16.01
15
14.17
11.4
10.44
10
4.25
5
13.2
2.42
7.96
7.57
14.5
11.43
8.2
4.89
4.1
3.04
1.35
2.56
0.53 0.55
1990
1991
1992
1993
1994
1995
0.76
0
Limpopo
1996
1997
1998
1999
2000
2001
National
24
2000 vs. 2001 HIV PREVALENCE BY AGE
GROUP
25
20.1
20
17.6
16.6
18.4
15.4
15
10.5
10
7.7 9.3
8.9
7.2 7.8
5.5
5
0
14-19
20-24
25-29
30-34
2000
35-39
40+
2001
25
Percentage (%)
TB CASE FINDING 2000-2002
92
90
88
86
84
82
80
78
76
74
72
70
90.7
90.7
88.5
82.7
80.2
77.7
Bacteriological Coverage
2000
Bacteriological Positivity
2001
2002
26
TB CONTROL & MANAGEMENT
Achievements
– TB Case detection increased from 6468 in 2000 to 7793 in 2001)
• DOT Support work
• Community awareness
– Overall TB cure rate improved from 52,8 in 2000 to 53,2% 2001
– MDR/TB Clinic established at Polokwane Hospital
– Business plan for establishment of MDR/TB Unit F. H. Odendaal
Hospital submitted.
– Establishment of mobile laboratories services
Challenges
– Sputum Turn- around time of 7- 14 days which is higher than expected
National recommendation of 4 days
– Collapse of mobile services in some districts affecting the
transportation of specimen
27
Integrated Mother ,Child and
Women health services
ACHIEVEMENTS:
– Approximately 80% PHC facilities provide IMCI
–
–
–
–
which resulted in reduction of incidences diarrheal
from 16.2 in 2001 to 13.5 in 2002, and upper
respiratory infections from 25.1 in 2001 to 23.4 in
2002
5 clinics per districts offer PAP services and the rest
on demand.
3715 women access PAP services.
Family planning services are offered in all clinics and
mobiles
29 hospitals offer TOP.
28
Number of terminations
TERMINATION OF PREGNANCY 1997-2002
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
4700
4429
2133
1924
929
419
1997
1998
1999
2000
2001
2002
29
TOP BY AGE GROUP– 2000-2002
89.2
90
88.1
80
70
60
50.4
49.1
50
40
30
10.2
20
11.4
0.5
10
0.5
0.6
0
2000
Under 18yrs
2001
Above 18yrs
2002
unknown
30
TOP BY GESTATIONAL AGE– 2000-2002
84.6
79.3
90
80
70
56.9
60
50
42.1
40
30
19.7
14.4
20
1.0
10
1.0
1.0
0
2000
Under 12wks
2001
Above 12wks
2002
unknown
31
Prevention and Control of
Communicable Diseases
ACHIEVEMENTS:
– 75% of targeted household for February 2003 are
already sprayed
– 80 temporary spraying operators are appointed.
– Cases fatality for Malaria reduced from 86/100 000
population in 2001 to 51/ 100 000 population for 2002
CHALLENGES
– Emerging and re-emerging infectious diseases such as
Anthrax, Severe Acute Respiratory Syndrome
32
IMMUNIZATION COVERAGE (%) UNDER 1
YEAR BY DISTRICT 2000-2002
90
81.8 81 79.8
80
75.9
70
64.9
64.2
61.8
60
76.9
71.5 72.7
74.6
58
53.9
50.3
50
52.549.4
45
40
30
28.7
20
10
0
Bohlabela
Capricorn
Mopani
2000
Sekhukhune
2001
Vhembe
Waterberg
2002
33
AFP SURVEILLANCE 1997-2003
Detected
Detection
Rate
1998
1999
19
19
20
11
14
14
0.6
0.7
0.8
0
2
3
0
14
19
2000
2001
2002
21
24
25
29
18
28
1.4
0.8
1.1
12
9
25
41
50
89
2003
25
15
0.54
14
YEAR
1997
Target
No.
Adequate
Stool
Stool
Adequacy
rate (%)
34
UNDER 5 MORBIDITIES 2000-2002
Limpopo
National
Average
INDICATOR
Incidence
severe malnutrition
under 5 years
Diarrhoeal
incidence
Lower Respiratory
Infections
2000
2001
2002
2001
0.84 per 1K
0.61 per 1K
0.56 per 1K
15.41
per 1K
16.20
per 1K
13.12
per 1K.
13.2 per 1K
3.87per 1K.
25.10
per 1K.
21.86
per 1K
7.1 per 1K
Source: DHIS
35
5 TOP NOTIFIABLE MEDICAL
CONDITIONS 2000 -2002
250
Cases per 100 000 population
213
200
141
150
100
90.6
100.6
86.2
65
50
5.6
3.1 1.9
2.7 1.6 1.1
1.7 3.8 1.65
Viral Hepatitis
Typhiod
0
TB
Malaria
2000
Measles
2001
2002
36
Environmental Health Related
Conditions
ACHIEVEMENTS:
 38 178 males enrolled for initiation. Of which 648 were
admitted to hospitals and one died.
 465 cholera cases were reported with fatality rate of 0.4%
 Of the 813 villages with access to water supply, 200 of
them were monitored and found to have safe water supply
(quality & quantity).
CONSTRAINTS:
 Poor water supply and sanitation
37
INTEGRATED NUTRITION
PROGRAMME
NUTRITION PROGRAMME:
– 68 of the 105 projects are sustainable.
– 2747 schools are participating.
– A total number of children qualifying for PSNP 1,173 million and
–
–
–
–
only 1,131 million benefiting from the programme.
7 additional hospitals obtained BFHI status. A total of 21
hospitals obtain BFHI status.
Stunting decreased from 34.2%in 1994 to123.1% in 2001
Wasting increased from 3.8% in 1994 to 7.5% 2001
Underweight increased from 10.4% in 1994 to 15% in 2001
CONSTRAINTS: Logistical problems and management
problem
38
Occupational Health Related
Conditions
 ACHIEVEMENTS:
– 50% of hospitals have trained Occupational Health
Officers.
 CONSTRAINTS:
– Lack of training in the implementation of the
Occupational Health and Safety Act in the Workplace.
39
PHC SERVICES
Accessibility & Availability of PHC Services
ACHIEVEMENTS:
– 24 hour services have increased from 183 to 233
– 10 clinics increased hours of services from 8 hours to 12 hours
– 142 care groups activated and 18 new care groups established.
– PHC service delivery at social security paypoint has been started
in Vhembe and Mopani district.
– PHC service delivery started in Prisons in the Vhembe districts.
– Antenatal coverage is 77.5% and antenatal visits per client is 3.7
CONSTRAINTS: budget for security at clinics not
available.
40
PHC UTILIZATION RATE BY DISTRICTS
2000 - 2002
Number of visits per person per year
3.5
3.29
3
2.76
2.5
2.27
1.9
2
1.71
1.531.67
1.43
1.5
1
2.82
2.61
2.77
1.52
1.28
1.67
1.13 1.161.12
0.68
0.5
0
Bohlabela
Capricorn
2000
Mopani
S ekhukhune
2001
Vhembe
Waterberg
2002
41
ANTENATAL VISITS PER ANTENATAL
CLIENT BY DISTRICTS 2000-2002
4.4 4.4
4.5
4
4.2
3.9
4
3.9
3.7 3.6
3.8
3.8
3.6
3.5
3.5 3.5
3.4
3
3
3
3.2
2.7
2.5
2
1.5
1
0.5
0
Bohlabela
Capricorn
2000
Source: DHIS
Mopani
2001
Sekhukhune
Vhembe
Waterberg
2002
42
DHS Development &
Devolution Support
Achievements; Devolution of PHC Services:
 Newly Demarcated District Re-alignment
 A Multi-Sectoral Task Team was established in July 2002 to develop a
Devolution Strategy for Limpopo Province
 Draft 1 of the Strategy is under consideration by Department of Health
& Welfare, Local Government & Housing and other key stakeholders.
 Plan A of the strategy deals with the transfer of EHS to district
Municipalities while Plan B contain measures to address delegations of
PHC services to district council municipalities.
 Draft services level agreements have been developed for signing with
each municipality that will receive ‘devolved’ service functions.
 Heads of Health district have been appointed and given delegated powers and
functions
43
EMERGENCY MEDICAL SERVICES
Achievements:
 3 New stations were opened
 Hospital Based staff have been taken over by EMS
 118 posts have been filled at various stations and the 4
shift system is being implemented at stations with
sufficient staff.
Constraints:
 Community misunderstandings of EMS Restructuring
Programme vs Community Expectations
44
PROGRAMME 3
Regional and
Specialised Hospital
Services
45
Equitable access to Health Care
Services
 Polokwane /Mankweng complex has
reduced referrals to Ga- Rankuwa by 25%.
 Referrals into PMHC
– 3271
 Referrals out of PMHC
– 418
46
HOSPITAL PERFORMANCE
INDICATORS PER DISTRICT
DISTRICTS
NO.
BEDS
BOR
ALOS
NORMAL
DEIVERY
RATE
LIVE
BIRTH
RATE
STILL BIRTH
RATE
C/S
RATE
Bohlabela
1061
65.9
6.6
89.4
79.6
2.3
9.8
Capricorn
2181
71.7
11.0
78.4
79.4
2.5
11.8
Mopani
1525
73.3
7.6
84.4
79.7
1.9
13.8
Sekhukhune
1171
54.5
5.7
78.7
96.8
3.1
11
Vhembe
1945
66.2
5.2
76
94.3
2.2
21.4
Waterberg
791
60.8
5.0
68.7
79.8
2.1
12.34
47
HOSPITAL PERFORMANCE INDICATORS BY
LEVELS OF HOSPITALS
LEVELS
NO.
BEDS
BOR
ALOS
NORMAL
DEIVERY
RATE
LIVE
BIRTH
RATE
STILL
BIRTH
RATE
C/S RATE
DISTRICT
HOSPITALS
5136
60.8
5.5
86.7
79.4
2.5
12
REGIONAL
HOSPITALS
1221
68.6
5.5
82.3
94.4
2
16.3
TERTIARY
HOSPITALS
698
72.1
7.9
74.5
97.2
2.8
24.4
TOTAL
7055
66.6
6.9
85
96.8
2.4
13.7
48
PROGRAMME 4
Health Sciences
49
HEALTH SCIENCES
Achievements
NURSING
 Level 1 training material for outcome based and
community based education developed.
 Total enrolment stand at 690.
Constraints
 Absence of Selection Criteria for Rural Schools
Recruitment
50
COLLEGE OF
EMERGENCY CARE
Achievements:
 60 of the 72 enrolled EMS Practitioners have completed
the course.
 65 completed rescue technique course.
51
HR DEVELOPMENT AND
PLANNING
ACHIEVEMENTS:
 A total of 515 new bursaries were awarded to
students in various health and medical related
fields..
52
PROGRAMME 5
Health Care Support
Services
53
Improved access to medicine
at all Health Facilities
Achievements:




90% of medicines is available at depot
85% of medicines available at Hospitals
75% medicines available at clinics
8 Hospitals have Therapeutic committees
54
PROGRAMME 6
Health Facilities Dev.
And Maint.
55
PHYSICAL RESOURCES
ACHIEVEMENTS: 35 projects to the value of R139
million were completed at 20 hospitals and R2m spent on
clinic water supply.
 5 revitalisation hospitals: completed initial phase;
Lebowakgomo 2nd phase almost completed.
 Institutions have completed and already implementing
their annual maintenance plans
CONSTRAINTS: Most physical facilities projects were
put on hold due to budget cuts
 Tendering process take too long resulting in projects not
being completed in time
 Clinic electrification has stopped since April 2002 due to
lack of funds
56
Provisional expenditure
and revenue 2002/03
57
Expenditure 2002/03 per
program
PROGRAMME
HEALTH ADMINISTRATION
DISTRICT HEALTH SERVICES
REG & SPECIALISED HOSP SERV.
HEALTH SCIENCES SERVICES
HEALTH CARE SUP. SERVICES
HEALTH FACIL. DEV.& MAINT.
TOTAL
BUDGET
EXPEND
BALANCE
R'000
R'000
R'000
187,098
182,808
4,290
1,680,421
1,710,523
-30,102
705,680
697,806
7,874
126,606
97,744
28,862
220,376
222,872
-2,496
225,593
242,765
-17,172
3,145,774
3,154,518
-8,744
 It should be noted that all figures for 2002/03 as
presented in this section should be considered provisional
as the Department has had financial systems problems
since the last week of March 2003.
58
CONDITIONAL GRANTS
DISCRIPTIONS
1
EXPENDITURE
BUDGET EXPENDITURE VARIANCES
FOR
FOR
FOR
2002/03
2002/03
2002/03
5
R'000
3
R'000
1. Intergrated Nutrition Prog
129,919
129,814
2. Nat'l Tertiary Serv. Grant
76,256
76,256
3. Training and Research
45,101
4. Hospital Rehabilitation Grant 126,821
4
R'000
BUDGET
FOR
2004/05
BUDGET
FOR
2005/06
6
R'000
7
R'000
8
R'000
146,433
172,102
188,603
-
46,297
46,878
46,973
25,973
19,128
40,414
51,805
72,411
126,821
-
96,239
106,463
110,722
23,905
23,905
-
28,962
42,479
55,996
6. Improv. Financial Management10,451
6,145
4,306
13,337
15,388
17,457
38,993
38,993
-
58,888
72,735
77,320
451,446
427,907
23,539
430,570
507,850
569,482
5. HIV/AIDS
7. Infrastructure
TOTAL EXPENDITURE
105
BUDGET
FOR
2003/04
Note: The expenditure figures fof 02/03 are provisional as there have been financial systems problems
since the last week of March 2003.
59
Revenue collected 2002/03 &
MTEF budget
DISCRIPTIONS
1
EXPENDITURE
BUDGET COLLECTED VARIANCES BUDGET
FOR
FOR
FOR
FOR
2002/03
2002/03
2002/03
2003/04
provisional
2
3
4
6
R'000
R'000
R'000
R'000
BUDGET
FOR
2004/05
BUDGET
FOR
2005/06
7
R'000
8
R'000
1. HOSPITAL FEES
45,334
45,472
138
48,054
50,937
53,993
2. OTHER SOURCES
11,656
11,963
307
13,215
14,037
14,683
TOTAL REVENUE
56,990
57,435
445
61,269
64,974
68,676
60
Financials for MTEF
61
Equitable Share & Conditional
Grants
R' 000
Equitable share
Conditional grants
Other
Total revenue
2000/01
Actual
2001/02
Actual
2002/03
Est.Actual
2003/04
Voted
2004/05
MTEF
2005/06
MTEF
2,255,678
294,386
2,430,365
288,536
2,694,328
451,446
2,982,002
430,570
3,276,814
507,850
3,530,876
569,482
2,550,064
2,718,901
3,145,774
3,412,572
3,784,664
4,100,358
62
REVENUE ESTIMATES
DISCRIPTIONS
BUDGET
FOR
2001/02
BUDGET
FOR
2002/03
BUDGET
FOR
2003/04
BUDGET
FOR
2004/05
BUDGET
FOR
2005/06
1
EXPENDITURE
2
R'000
5
R'000
6
R'000
7
R'000
8
R'000
1. HOSPITAL FEES
42,209
45,334
48,054
50,937
53,993
2. OTHER SOURCES
15,000
11,656
13,215
14,037
14,683
TOTAL REVENUE
57,209
56,990
61,269
64,974
68,676
63
Summary of Expenditure &
Estimates 2000/01 - 2005/06
R' 000
Health Administration
District Health Services
Emergency Medical Services
Provincial Hospital Services
Central Hospital Services
Health Sciences and Training
Health Care Support Services
Health Facilities Management
Statutory Payments
Total
2000/01
Actual
163,902
1,348,946
36,568
351,214
248,995
73,617
158,925
141,240
571
2,523,978
2001/02
Actual
151,672
1,412,655
47,833
365,022
239,890
77,063
176,237
192,681
477
2,663,530
2002/03
Est.Actual
186,587
1,643,634
36,787
435,492
270,188
126,606
220,376
225,593
511
3,145,774
2003/04
Voted
214,670
1,826,524
91,631
442,526
308,242
126,383
254,585
200,500
511
3,465,572
2004/05
MTEF
223,017
2,038,227
103,507
476,198
314,844
143,945
309,459
234,956
511
3,844,664
2005/06
MTEF
241,189
2,210,002
111,818
506,654
340,393
173,076
328,878
254,837
511
4,167,358
64
Summary of Expenditure & Estimates
by Std Items 2000/01 – 2005/06
STD Items
R' 000
2000/01
Actual
2001/02
Actual
2002/03
Est.Actual
1,594,931
Personnel
80,944
Administrative Expenditure
285,972
Stores and Livestock
27,132
Equipment Current
85,204
Equipment Capital
0
Land and Buildings: Current
0
Land and Buildings: Capital
Prof and Special Serv: Current 198,116
Prof and Special Serv: Capital 140,891
99,994
Transfer Payment Current
0
Transfer Payment Capital
10,794
Miscellaneous
1,737,624
95,704
273,607
17,927
40,271
4,466
0
215,834
184,603
92,578
0
916
1,945,218
144,907
354,232
26,420
73,794
9,991
0
237,928
217,574
134,232
0
1,478
2,297,883
226,095
2,438,656
224,874
2,854,406
291,368
2,523,978 2,663,530
TOTAL STANDARD ITEM CLASSIFICATION
3,145,774
Total Current
Total Capital
2003/04
Voted
2,086,508
167,161
415,603
48,879
89,017
8,640
0
309,648
190,210
148,433
0
1,473
0
3,186,345
279,227
0
3,465,572
2004/05
MTEF
2,270,434
205,482
484,573
60,478
77,484
8,975
0
338,938
224,668
172,102
0
1,531
0
3,542,513
302,152
0
3,844,665
2005/06
MTEF
2,442,695
237,938
526,088
67,157
85,240
9,705
0
364,454
243,823
188,603
0
1,655
0
3,838,295
329,063
0
4,167,358
65
CONDITIONAL GRANTS
DISCRIPTIONS
BUDGET
FOR
2001/02
BUDGET
FOR
2002/03
BUDGET
FOR
2003/04
BUDGET
FOR
2004/05
BUDGET
FOR
2005/06
1
EXPENDITURE
2
R'000
3
R'000
4
R'000
5
R'000
6
R'000
1. Intergrated Nutrition Prog
124,331
129,919
146,433
172,102
188,603
2. Nat'l Tertiary Serv. Grant
79,008
76,256
46,297
46,878
46,973
3. Training and Research
33,551
45,101
40,414
51,805
72,411
4. Hospital Rehabilitation Grant
88,000
126,821
96,239
106,463
110,722
7,458
23,905
28,962
42,479
55,996
6. Improv. Financial Management 4,000
10,451
13,337
15,388
17,457
7. Infrastructure
38,993
58,888
72,735
77,320
451,446
430,570
507,850
569,482
5. HIV/AIDS
TOTAL EXPENDITURE
336,348
Note: The expenditure figures fof 02/03 are provisional as there have been financial systems problems
since the last week of March 2003.
66
Expend analysis 00/01 to 05/06
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
R' 000
Actual
Actual
Est.Actual
Voted
MTEF
MTEF
Pers. Exp.
1,626,285 1,737,624
1,945,218 2,086,508 2,270,434 2,442,696
% of budget:
64.43%
65.24%
61.84%
60.21%
59.05%
58.61%
growth rate
6.85%
11.95%
7.26%
8.82%
7.59%
Non-PE
897,693
925,906
1,200,556 1,379,064 1,574,230 1,724,662
% of budget:
35.57%
34.76%
38.16%
39.79%
40.95%
41.39%
growth rate
3.14%
29.66%
14.87%
14.15%
9.56%
Cond. Grants
294,386
288,536
451,446
430,570
507,850
569,482
11.66%
10.83%
14.35%
12.42%
13.21%
13.67%
Total
2,523,978 2,663,530
3,145,774 3,465,572 3,844,664 4,167,358
growth rate
5.53%
18.11%
10.17%
10.94%
8.39%
 The personnel expenditure as a % of the budget
has been declining since 2000 (64.43% to
61.84% in 2002/3). The personnel numbers have
declined over this period from 23,607 to 23,569.
67
Fiscal Equity Issues
The Budget for DHS: increased from 49.2 % in 1996/97
to 52.3 % in 2002/03 (excl pharmac. & capex). With
pharmac. & capex included this figure moves to 63.0%.
Population served by Public Sector:
• By 1999, LP had 92.4 % people without Medical Aid Cover.
Per capita Health Expenditure:
•
•
•
LP is the lowest. In 2002/03 LP spent R586 per uninsured person, which
was 27% below the national average and about 1/3 of Gauteng’s R1580.
(IGFR 2003)
Using constant 2002 prices the LP showed a decline from 1997/98
(R611/uninsured) to 2002/03(R586/uninsured) of 4.1%.
By 1997, LP was spending R24/person on medicines compared to the
National average of R42/person & currently LP spends
R37.14/person which = 3 times less than that of Gauteng.
68
Fiscal Equity Issues
Percentage Growth of the Health Budget:
• Has been consistently lower than national and provincial norm.
• In 02/03 the growth was 18.11% compared to the Provincial budget
growth of 22.26%.
• The comparative figures for 03/04 budget growth are 10.17% for Health
and 11.66% for the Province.
• The national average growth in Health budgets is 10.87% for 2003/04
• The department got 16,43 % of the provincial budget compared to
Education’s 41,55 % in 02/03. In 03/04 the comparative figures are
16,21% vs 39,83%. The national averages for % of education budget
are 36,7% (02/03) and 35,6% (03/04).
•
16.21% is less than the 19% national guideline and less than the national
average of 22.3% (03/04) and 16.43% is less than the national average of
22.9% (02/03).
• Equity within the LP still needs to improve as demonstrated by the
above Tables & notes.
69
HEALTH PRIORITIES
2003/04
70
HEALTH PRIORITIES 2003/04
HIV/AIDS/STI CONTROL & MANAGEMENT:
Introduction of VCT sites in private sectors
 Rollout of the PMTCT services in all remaining 319 clinics in the
province by end of 2003
 To reach and train more of commercial sex workers.
 To establish Youth Information, Education and Counselling in all
border gates.
 Health Promotion Strategies
TB CONTROL & MANAGEMENT: Decreasing number
of patients infected with both TB and HIV.




Consider Stipends for DOTS supporters
Accessibility of Laboratory services
Capacity for Management MDR TB
Strengthening & Consolidation of Care Groups
71
HEALTH PRIORITIES 2003/04
COMMUNICABLE DISEASE CONTROL: Polio
Eradication by 2004 Strategy
 Expanded Programme on Immunisation
 Laboratory Services & Malaria Control
PHC SERVICES & DHS DEVELOPMENT: Devolution
of Environmental Health & other PHC Services to
District Municipalities







Improve 24 Hour Services at Clinics
Security at Clinics and Total Risk Management
Capacity for Disaster Management
Integrated Nutrition Programme
Integrated Management of Childhood Illnesses (IMCI)
Referral System
Non- personal Health Programmes
72
HEALTH PRIORITIES 2003/04
EMERGENCY MEDICAL SERVICES: Decentralisation
of EMS & Patients transport to rural settings
LOGISTICAL SUPPORT SERVICES: Adequate
Medicines at Facilities.








Better Mx. of Health Technologies & Assistive Devices
Roll out Cost Centres
Capacity for Strategic Planning & Policy Analysis
Capacity for Financial & General Management
Consolidation of Procurement policies
Capacity for in-house Fleet Management
Labour Relations, Litigations & Legislative Reforms
Implementation of the remaining Health information system
modules
73
HEALTH PRIORITIES 2003/04
INFRASTRUCTURE DEVELOPMENT: Focus on 5
revitalization hospitals
 Upgrading of 21 clinics
 Improve water, sanitation & electricity at clinics
74
FINANCIALS 2003/04
WITH SERVICE
IMPLICATIONS
75
HEALTH PRIORITIES 2003/04
HUMAN RESOURCE DEVELOPMENT:
Consolidate Health Districts
Organograms




Consolidate a Departmental HR Plan
Management of Bursaries
Nursing and EMS Training Colleges
PHC Nurse Training & Community Rehabilitation Workers
Training
 Professional Training & Development
HUMAN RESOURCE MANAGEMENT: Filling of
Critical Posts & Retention of Staff
 Rural Staff Incentives Strategy
 Conditions of Service for Staff (2nd & 3rd Notch, etc.)
76
HEALTH PRIORITIES 2003/04
COMMUNICATION, COLLABORATION AND
PARTICIPATION: The following PPP projects are
envisaged - Phalaborwa hospital, Duiwelskloof hospital,
Laundry & Boiler services and Renal Dialysis unit.
 To conduct feasibility studies for possible Expansion of PPP
Initiatives.
 Quality Improvement & Management
 Corporate Communication & Media Liaison
 Transformation & Inter-governmental Relations & Gender Issues
 Health Promotion
TERTIARY SERVICES:
REVENUE GENERATION:
77
PRIORITY BUDGET
HIV/AIDS/TB/STI & other communicable diseases
 HIV/AIDS and TB
 Communicable diseases
District Health Services – Primary Health Care
Emergency Medical Services
Logistical support services (including pharmaceuticals,
ambulances, Hospital Information Systems (HIS)
 Pharmaceuticals
 Ambulance
 HIS
Infrastructure development (including hospital revitalisation, clinic
upgrading and maintenance)
 Hospital Rehabilitation
 Clinics
 New Head Office and other
 Maintenance
Human Resources Management issues
Human Resources Development
 Training
 Nursing Training Colleges
 Ambulance Training Colleges
 Bursaries
 Professional Training and Research
Communication, Collaboration and participation
Tertiary Service Development
Revenue generation
2002/03
R’ 000
37,783
34,783
3,000
1,638,741
41,680
264,765
2003/04
R’ 000
43,095
40,095
3,000
1,852,524
41,631
264,848
220,376
15,000
29,389
228,593
220,459
15,000
29,389
195,912
126,821
42,000
21,000
38,772
3,957
138,426
11,820
47,072
5,328
29,105
45,101
1,814
309,229
56,990
96,140
40,000
21,000
38,772
3,957
130,928
11,820
46,828
2,771
29,105
40,404
1,814
353,339
60,409
78
BUDGET ANALYSIS FOR
2003/04 - VOTE 7: HEALTH
Table 1: SUMMARY OF EXPENDITURE AND ESTIMATES
1. Health Administration
2. District Health services
3. Emergency Medical Services
4. Provincial Hospital Services
5. Central Hospital Services
6.Health Sciences and Training
7. Health Care Support Services
8.Health Facilities Management
1999/00
Actual
R'000
127,810
1,220,434
29,029
309,021
205,131
58,896
141,273
-
2000/01
Actual
R'000
164,473
1,348,946
36,568
351,214
248,995
73,617
158,925
141,240
2001/02
Actual
R'000
152,149
1,412,655
47,833
365,022
239,890
77,063
176,237
192,681
2002/03
Est. Actual
R'000
187,098
1,643,634
36,787
435,492
270,188
126,606
220,376
225,593
TOTAL
2,091,594
2,523,978
2,663,530
3,145,774
Programme
2003/04
DEVIATION DEVIATION
Voted
02/03 vs 03/04 NOMINAL
R'000
R'000
%
215,181
28,083
15.01%
1,826,524
182,890
11.13%
91,631
54,844
149.08%
442,526
7,034
1.62%
308,242
38,054
14.08%
126,383
-223
-0.18%
254,585
34,209
15.52%
200,500
-25,093
-11.12%
3,465,572
319,798
10.17%
79
BUDGET ANALYSIS FOR 2003/04 - VOTE
7: HEALTH
Table 2: SUMMARY OF ECONOMIC CLASSIFICATION
1999/00
2000/01
2001/02
2002/03
2003/04
DEVIATION DEVIATION
Actual
Actual
Actual
Est. Actual
Voted
02/03 vs 03/04 NOMINAL
R'000
R'000
R'000
R'000
R'000
R'000
%
Current
Personnel
1,505,003 1,626,285 1,737,624 1,845,779 2,086,508
240,729
13.04%
Transfers
54,294
91,549
92,578
134,232
148,433
14,201
10.58%
Other Current Expenditure
521,607
580,049
608,454
874,395
951,404
77,009
8.81%
Sub-total: Current
2,080,904 2,297,883 2,438,656 2,854,406 3,186,345
331,939
11.63%
Capital
Acquisition of capital assets
138,426
226,095
224,874
291,368
279,227
-12,141
-4.17%
Transfers Payments
1,208
0
Other Capital
0
Sub-total: Capital
139,634
226,095
224,874
291,368
279,227
-12,141
0
Total : Economic Classification
2,091,594 2,523,978 2,663,530 3,145,774 3,465,572
319,798
10.17%
80
OVERVIEW OF BUDGET 2003/04
 As can be seen the nominal increase between 2002/03 adjusted
estimates and 2003/04 is R319,8m. This equates to a 10% increase
in the budget. The inflation for 2002 was also 10%. (CPIX figure
provided by Statistics SA) There is therefore no growth in Health’s
budget.
 Besides the problem of no growth it should be remembered that
health inflation(pharmaceuticals, surgical supplies, medical
equipment, etc.) is always more than general inflation, resulting in
less services to the community. The main reason why health inflation
is so high is due to the fact that most of these items are imported.
 The per capita expenditure on Health in this Province is the lowest in
the country (IGFR 2001). With a no growth budget this situation is
unlikely to change. The implications of this are that the people of this
Province will not be able to have the standard of Health care that they
should have. The budget pressures section will expound on this
issue.
81
Table 3: EVOLUTION OF EXPENDITURE OF
BUDGET IN CONSTANT 2002/03 PRICES (R MILLION)
Expenditure
Total
% growth
Total per person
Total per uninsured
person
1995/96
(actual)
1997/98
(actual)
2,841
in rands
in rands
564.14
610.54
1998/99
(actual)
1999/00
(actual)
2000/01
(actual)
2001/02
2002/03
(actual) (estimate)
2,827
-0.49%
544.90
589.72
2,578
-8.80%
482.42
528.39
2,939
13.98%
533.80
584.67
2,931
-0.25%
516.85
566.11
3,145
7.29%
538.29
589.59
Average
annual
change
61
2.05%
-5.17
-4.19
2003/04
(budget
estimate)
3,251
3.38%
540.19
591.67
As can be seen from the table there has been a slight real growth
of 2% over the years. This has been due to the above inflation
increase of personnel expenditure. This is less than the
population growth. As a result the provincial per capita health
expenditure has decreased annually by about R5. This again is
an indicator that despite the province being the lowest funded
per capita in the country the situation is unlikely to improve
unless the funding situation improves.
82
BUDGET PRESSURES FOR
2003/04
 The indicative budget for 2003/04 according to GFS 2002/03
was R3,109,083,000. The final budget allocated for 2003/04 is
R3,465,572,000. The increase is R356,489,000.
 The following table shows the allocation of this additional
money.
 Following the table there will be some more detailed
explanations of the service implications of the lack of sufficient
budget.
83
Table 4: ALLOCATION OF FUNDS
FOR BUDGET PRESSURES 2003/04
REQUESTALLOCATEDEVIATION
2003/04
2003/04
2003/04
R'000
R'000
R'000
HR MANAGEMENT
PERSONNEL
285,038
146,921
-138,117
& ALL PRIORITIES
Leg & rank ;
48,000
19,000
-29,000
(PR 1-7)
2nd & 3rd notches
33,306
-33,306
Rural incentives /critical pos ts
10,000
12,000
2,000
Critical Pos ts
98,000
20,189
-77,811
ICS 02/03 carry through
57,443
57,443
0
Under budgeting(inflation adjus tm ent)
38,289
38,289
0
NONPERSONNEL
286,000
209,568
-76,432
DHS (PR 2)
Security s erv. at clinics
69,000
32,000
-37,000
DHS/RHS (PR 2, 4)
Equipm ent
15,000
10,000
-5,000
DHS/RHS ( PR 2, 4)
Maintenance & repair
5,000
4,568
-432
LOG SUPPORT (PR 7)
Pharm aceuticals
66,000
82,000
16,000
R41m carry through
41,000
41,000
0
Increas e per capita by R5 each year
25,000
41,000
16,000
DHS/TERTIARY (PR 1-8)
Inflationary pres s ures (R22m carry through)
22,000
22,000
0
EMS (PR 3)
Vehicles -am bulances (full m aintenance leas e) 35,000
35,000
0
EMS (PR 3)
EMS
10,000
4,000
-6,000
New m etro
4,000
4,000
0
EMS equipm ent
6,000
-6,000
INFRASTRUCTURE (PR 8) Capex clinics
40,000
20,000
-20,000
INFRASTRUCTURE (PR 8) Capex hos pitals (tertiary hos pital)
24,000
-24,000
GRAND TOTAL:
571,038
356,489
-214,549
PRIORITY
Note: DHS=Dis trict Health Services ; RHS=Regional Hos pital Services ; EMS=Em ergency Medical Services
84
BUDGET PRESSURES FOR
2003/04 (continued)

Human resource service implications (shortage of R138m)
Health is a human resource intensive service. Due to the budget
shortage there is inadequate money for filling most of the vacant
critical posts. This will make it difficult to improve service delivery at
the clinics. As a result the best scenario will be the maintenance of
existing services.

Security service implications at clinics (shortage of R37m)
Security at the clinics can not be improved everywhere. Clinics with
no adequate security will not be able to provide 24 hour services. The
lack of security will also have a detrimental effect on retention and
recruitment of staff.
85
BUDGET PRESSURES FOR
2003/04 (continued)

EMS service implications (shortage of R6m & HR portion)
Emergency Medical Services can not be expanded. The response time
to very rural areas will therefore not be able to be improved. This will
most likely result in some unnecessary deaths due to the fact that there
is a golden hour in which to get emergency patients to a hospital for
them to have a good prognosis.

Infrastructure service implications (shortage of R44m)
Infrastructure development cannot be fast tracked. It is well known that
there are a large number of clinics with no water, no electricity,
insufficient equipment and inadequate facilities. The development of
the tertiary facilities will also be delayed. Maintenance of medical
equipment will still be inadequate though better than 02/03.
86
Thank You
87