ANNUAL REPORT
JANUARY - DECEMBER 2012
South Africa
UNDP Support to the
Limpopo Health Sector
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Contents
Executive summary ................................................................................................................................. 3
1.
Background & Context..................................................................................................................... 6
2.
Overall progress overview ............................................................................................................... 8
2.1
Sub-programme: Health Professionals Volunteerism and Capacity Development ................ 8
2.1.1 Recruitment and placement of volunteers ................................................................................ 8
2.1.2 Pharmacists and Nurses registration.......................................................................................... 8
2.1.3 Volunteer living conditions and well-being ................................................................................ 8
2.1.4 Knowledge enhancement of the volunteers ......................................................................... 10
2.1.5 Contribution of the volunteer programme to the health sector .......................................... 10
Figure 6: Number of Repatriated Doctors in 2012 ........................................................................ 13
4.
5.
6.
2.2
Sub- programme Two: Health Planning Support................................................................... 14
2.3
Sub-programme Three: Knowledge Management and Leadership Development ............... 14
2.4
Sub-Programme four: MDGs, Monitoring and Evaluation System ....................................... 14
3.
General Administration and Management .......................................................................... 15
Implementation Strategy Review .................................................................................................. 15
4.1
Participatory/Consultative processes .................................................................................... 15
4.2
Quality of Partnerships .......................................................................................................... 15
Management Effectiveness Review .............................................................................................. 16
5.1
Quality of Monitoring ............................................................................................................ 16
5.2
Timely delivery of outputs ..................................................................................................... 16
5.3
Resource allocation ............................................................................................................... 16
5.4
Project Risks and Actions ....................................................................................................... 19
Implementation challenges ........................................................................................................... 21
6.1
Programme funding ............................................................................................................... 21
6.2
Recruitment of Nurses and Pharmacists ............................................................................... 21
Annexure1: Phase III Alignment to Provincial and National Priorities .................................................. 22
2
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Executive summary
During 2012 financial year, the programme was implemented under severe financial constraints
which resulted in the suspension of all activities of the three supporting sub-programmes (Health
planning support, Knowledge Management and Leadership Development, and MDGs, Monitoring and
Evaluation System). The recruitment of new UNV doctors as well as replacement those who were
repatriated was also put on hold. By the end of the financial year, the programme had retained 28
doctors, a reduction from 41 doctors since September 2012.
Limitations and delays in the registration of nurses and pharmacists have made it difficult to initiate
their recruitment into the programme. The requirements of the Pharmacy and Nursing Councils
include a series of processes, firstly, the verification of foreign qualifications with the South African
Qualifications Authority. Secondly, the applicants have to pass the board examinations before they
can be considered for registration and thereafter, considered for recruitment into the programme.
During this reporting period, there was no focal point person in the Department to facilitate
registration processes.
The programme had an opening balance of US$ 270,187 in January 2012. An income of R17,500,000
(US$ 2,071,006) was received in two tranches during the course of the year. The total programme
expenditure for 2012, as depicted below, was R16,756,713 (US$ 2,041,452),with a balance of
R1,130,290 (US$ 133,762). The Department has committed a total of R15.4 million for the 2013/14
financial year within which the programme has to run. Allocation of funds for the programme is
currently determined at the level of the province. However, the department hopes to engage the
National Treasury about existing opportunities for support and future funding of the programme.
The current programme cycle will be ending in August, 2014. UNDP and the Department will be
working together on a strategy to evaluate and close the current phase of the programme. The
programme remains a key partner and contributor to the Department’s goal of meeting the health
service delivery of the population; and the UNV doctors remain a priority for the Department. The
new programme is envisaged to focus on recruitment of other categories of health professionals.
There is a need to strengthen the full representation and effectiveness of the Programme Steering
Committee. The Department has appointed a new Focal Point person to take full responsibility of
representing the Executive Management of the Department and provide feedback for decision
making on programme matters.
Programme contribution to the provincial and national strategic goals
The recruitment and placement of a total of 46 UNV volunteers contributed to the quality of health
care service delivery in Limpopo by providing service in 15 hospitals distributed across the five
districts of the province. In the various areas of specialization, a positive impact on the
implementation of programmes for combating HIV and AIDS, STI, TB and other communicable
3
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
diseases has been enhanced in the largely rural areas of the province. More specifically, the service
of volunteers have contributed towards the following three MDGs,
(i)
(ii)
(iii)
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria and other diseases
The specialist services enhanced norms and standards of health care services by improving the
doctor-to-patient ratio in the regional and district hospital facilities.
4
Programme contribution to provincial and national strategies
UNDP Support
DoHSD Strategic Goals 2010/11
National Department of Health
Ten Point Plan
National Government
Outcome No. 2
Immediate Outcomes
Intermediate Outcomes
Final Outcomes
Strategic Impact
 Increased culture of
volunteerism

Effective corporate governance is
provided

Strategic leadership and creation
of a social compact for better
health outcomes;
 Improved hospital
performance vis-ὰ-vis
organizational management
and development

Appropriate human resource
management and development is
provided

National Health Insurance (NHI)
implemented;

Sound financial management
practice is promoted

Improved quality of health
services;

Comprehensive HIV and AIDS, TB,
STI and other communicable
diseases programmes are
implemented

Overhauled healthcare system

Improved human resources,
planning, development and
management;

Revitalized infrastructure

Accelerated implementation of
programmes for HIV and AIDS,
STIs, TB and associated diseases;

Mass mobilization for better
health for the population;

Reviewed Drug Policy; and

Strengthened research and
development
 Improved Doctor-patient
ratio
 Improved knowledge and
access to health related
information
 Diversification and increase in
the number of health
professionals

Districts Health Services and
Primary health Care services are
strengthened

Quality of health care is improved

Emergency medical services are
improved

Tertiary services are developed

Infrastructure development and
maintenance is improved
A long and healthy life for
all South Africans”.
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
1. Background & Context
UNDP Support to the Health Sector programme is a partnership with the Department of Health in
Limpopo, with the objective to support the Department in its effort to improve health care service
delivery in the province. Since the inception of the partnership in 2002, UNDP has assisted the
Government of Limpopo in addressing the shortage of health personnel caused by brain-drain; and
building capacity of local health professionals to improve service delivery and management of health
care in the province. During the first 2 phases of programme implementation, the programme
focused on the recruitment and placement of doctors. In the current phase (Phase III), which began
in 2009 October, in addition to the recruitment and placement of volunteers, the scope of the
programme expanded to include 3 additional complementary sub-programmes:
 Health Planning Support Programme (Health economics)
 Knowledge management and leadership development; and
 Monitoring and evaluation, which includes the domestication of MDGs.
The programme made a contribution in addressing the 4 key challenges as identified in the Annual
Performance Plan, Vote 7, 2010 /11- 2013/14. These challenges are:




Mismatch between health service demands and available resources;
Shortage of skilled health professionals;
Inadequate evidence-based decision making, planning, and resource allocation; and
Inadequate management skills at some key level of the department.
The province is largely rural with an estimated population of 5, 404, 868 people which constitutes
10.4 % of the South African total population. Being a rural province, the resultant brain drain creates
a huge shortage of health professionals in the province as health professionals leave the province for
better opportunities locally and internationally. The province currently has 40 hospitals, 22 health
centres and 416 clinics.
The programme aimed to address the department’s challenges through the implementation of the
following activities:
Activity 1: Recruitment and placement of health professionals
In partnership with UNDP South Africa, United Nations Volunteer Programme sources and recruits
health professionals. The long term benefit of their service is to accelerate transfer of skills and
development of local practitioners in order to improve the delivery of health services to the people
of Limpopo.
Activity 2: Health planning support programme
UNDP provided technical assistance to develop the capacity of personnel at policy and planning
levels within the healthcare sector through the deployment of a Health Economist(s) to improve
health service delivery planning through hands-on technical support, guidelines and framework for
effective planning for improved health service delivery.
6
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Activity 3: Knowledge Management and Leadership Development
The purpose of this activity was threefold. Firstly, UNDP provided technical assistance in creating
platforms for the exchange of information and knowledge, and facilitated collaboration between
health professionals. These platforms will encourage and stimulate transfer of tools and skills to
enhance the development of individual and organizational capacity for improved health service
delivery in Limpopo.
Secondly, technical assistance is provided for the establishment of a resource centre which will
systematically generate, collect, store and utilize information to inform strategic planning processes.
The Centre will also be responsible for facilitating health related seminars to improve knowledge
sharing and exchange.
Thirdly, UNDP will facilitate the development of a strategy, and support the implementation of, a
leadership and capacity development programme for Senior Managers to improve on the holistic
performance of the Department of health in Limpopo.
Activity 4: MDGs, Monitoring and Evaluation System
UNDP provides technical support in the development and institutionalization of a Results Based
Monitoring and Evaluation system. The monitoring and evaluation is intended to improve reporting
within the Department of health, improve performance, transparency and accountability, and
localize the MDGs within the Department of Health.
The intended key results for the programme are:








Improved health care service delivery in Limpopo Province;
Institutionalized local volunteerism programme and increased/growing culture of local
volunteerism and improved health service delivery through local volunteerism;
Improved Doctor-patient ratio, diversification and increase in the number of allied services
professionals;
Integrated health economics in health service delivery planning;
Increased knowledge base on contemporary health related subjects;
Improved knowledge and access to health related information;
Improved capacity to manage the health system; and
Improved performance, accountability, and informed strategic planning content; and
Institutionalized MDGs reporting process
7
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
2. Overall progress overview
2.1 Sub-programme:
Development
Health
Professionals
Volunteerism
and
Capacity
This sub-programme was instituted to support the Department of Health in the Limpopo Province to
reduce the impact of the shortage of health professionals. The exodus of medical professionals to
metropolitan areas in the country and abroad places a strain in the effective provision of medical
services in the province. Within this sub-programme medical practitioners are recruited as United
Nations Volunteers to serve a minimum of 12 months, which is renewable for a maximum of 6 years.
2.1.1 Recruitment and placement of volunteers
The programme retained a total of 41 doctors into 2012. Although 19 candidates were identified to
commence their assignments, due to financial challenges, 5 new medical volunteer doctors were
recruited during the first and second quarters of the year, which added to a total of 46 for 2012
In the course of 2012, 18 doctors were repatriated. Of the 18 repatriated doctors, 5 had completed
the maximum permissible 6 years to serve as volunteers within the UN system.
2.1.2 Pharmacists and Nurses registration
Whilst the programme is expected to recruit other medical practitioners like bioengineers, nurses
and pharmacists, a number of recruitment challenges have not been resolved. No progress has been
made in creating volunteer categories with exemption processes similar to those of the doctors, in
order to expedite their recruitment in 2012.
The recruitment of volunteer nurses experienced some challenges. There is currently no provision for
volunteer registration for duration of 12 months. The council currently has a provision for up to 4
months. A meeting was held with the council and they expressed their willingness to support the
programme. There are however some requirements which cannot be waived, such as sitting for the
board exam. Consequently, the recruitment of nurses as well as that of pharmacists has been
referred to the department for further guidance.
2.1.3 Volunteer living conditions and well-being
Continued support is fundamental to the productivity adaptation and retention of volunteers. UNDP
programme staff and UNV Field Unit conducted regular visits to the doctors placed in 14 of the 40
hospitals around the province. Through the visits, settling in of newly recruited volunteers and the
general welfare and security of all the volunteers is duly monitored. Consultations with the relevant
supervisors are held to discuss performance matters that also ensure professional support of the
volunteers as well as understanding of UN Volunteers guidelines and conditions of service for
hospital staff.
8
UNDP Support to the Health Sector in Limpopo
(i)
Annual Report (January –December 2012)
Living conditions
The hospitals recognize the need for the volunteers to have suitable accommodation
within their premises or at convenient proximity. Whilst the concerns were raised about
maintenance of the properties in these areas, it can be stated that living conditions of
the volunteers are generally acceptable.
(ii)
Treatment of volunteers by local health professionals
A number of volunteers reported that they were often seen to have insufficient technical
skills, training and professional experience to work in their new environment and that
their abilities and experience were often questioned by their local counterparts at their
duty stations. This is usually expressed when the local doctors find the need to review
and alter some of the diagnostic processes as well as treatment protocols the UNVs may
have prescribed. Quite often, these occurrences were seen as undervaluing and were
especially disturbing for volunteers. Whilst some of these instances have reduced due to
the intervention of Clinical Managers, the perceptions have an impact in the adaptation
and retentions of UNVs in these institutions. More interventions need to be explored to
properly position and distinguish the UNV doctors at their duty stations in order for their
input to be adequately recognized throughout the province.
(iii)
Workload and compensatory time-off (CTO)
Workload remains a huge challenge for the volunteers as the Department of Health
battles to attract doctors to the province. As the shortage of health professionals
persists, the volunteers continue to invest long hours, from which the hours themselves
can be recovered through compensation of extra time worked (CTO).
Figure 1: Average number of hours and cases attended
1200
1000
800
600
400
200
0
Jan
Feb
Mar April May June
Jul
Aug
Sep
Oct
Nov
Dec
Cases attended 427
626
800
247
109
314
239
335
221
371
509
329
Hours worked
231
267
118
128
131
126
237
187
172
423
149
212
9
UNDP Support to the Health Sector in Limpopo
(iv)
Annual Report (January –December 2012)
Reporting
The reporting tool developed in 2011 has assisted in monitoring the extent and nature of
work of UNV doctors at their respective duty stations. The information captured in the
reports has allowed UNDP to measure and qualify the contribution of the programme to
health service delivery in the province. Figure 1 reflects the volume of work performed
by the volunteers throughout the year.
2.1.4
Knowledge enhancement of the volunteers
The programme recognizes that conferences and courses are one of the best mechanisms for
volunteers to keep abreast with recent developments in medicine. Over the years, the PMU has
facilitated their participation in these forums to ensure exposure with the latest treatments and
technologies. However, due to financial constraints, the UNV doctors could not attend conferences
during the 2012 financial year. Volunteers have continued to share their experience and knowledge
to support community service doctors and interns within their respective area of specialization.
2.1.5
Contribution of the volunteer programme to the health sector
The recruitment and placement UNV volunteers contributed to the quality of health care service
delivery in Limpopo by providing services in 15 hospitals across the five districts of the province.
Through the outreach programmes to local clinics and with the assistance of technology solutions in
some hospitals, the rate of transfer of patients to the regional and tertiary hospital has been
reduced. Most significantly, the doctor-to-patient ratio facilitated the timeous and appropriate care
to patients and reduced costs.
The implementation of programmes for combating HIV and AIDS, STI, TB and other communicable
diseases has been supported through the allocation of doctors to manage the respective centres, in
particular to Dilokong hospital.
Figure 2: Volunteers per Area of Specialization
14
7
7
4
4
3
2
2
1
1
1
10
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Figure 3: Number of Volunteers per Hospital
10
7
5
4
4
3
3
2
2
1
1
1
1
1
1
Figure 4: Number of Hospitals with Volunteers per District
16
14
14
12
12
10
10
9
8
6
4
2
1
0
Capricon
Vhembe
Mopani
Sekhukhune
Waterberg
11
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Table 1: List of volunteers in the programme in 2012
Name and Surname
Area of Specialization
Hosting Hospital
Status of UNV
1. Bautista, Jose
Family Medicine
Mecklenburg
Still serving
2. Eunice Kajala
Family Medicine
Mecklenburg
3. Thomas Kaung
Family Medicine
Mecklenburg
4. Blando, Rommel
Pediatrics
St. Ritas
Repatriated
5. Jacqueline Ontoy
Anesthesiology
St Ritas
Repatriated
6. Tawheed Emam
Surgery
St Ritas
7. Azmi Ahmed
Internal Medicine
St. Ritas
8. Ebrima Jarra
Family Medicine
Botlokwa/Elim
9. Soe Myint
Anesthesiology
Mokopane
10. Karchenko Andriy
Anesthesiology
Philadelphia
Processing Repatriation (6yrs)
11. Sharonova Tatiana
Pediatrics
Lebowakgomo
Still serving
12. Theo Brugman
Surgery
Lebowakgomo
13. Nuzhat Sultana Ahmed
Family Medicine
Zebediela
Still serving
14. Pyai Win Gaung
Pediatrics
Letaba
Processing Repatriation
15. Serguei Nikiforov
Surgery
Letaba
Still serving
16. Lioudimila Nikiforova
Obstetrics and Gynecology
Letaba
Still serving
17. Projo Djhoanna
Obstetrics and Gynecology
Letaba
18. Zhyrnyi Sergii
Surgery
Letaba
19. Rayos Jason
Family Medicine
Tshilidzini
20. Guiang Stefanie
Dermatology
Tshilidzini
21. Ladion Marjorie
Anesthesiology
Tshilidzini
Repatriated
22. Raymundo Renato Claudio
Surgery
Tshilidzini
Repatriated
23. Dmitriev Nikolay
Surgery
Tshilidzini
Repatriated
24. Allan Cortes
Surgery
Tshilidzini
Repatriated
25. Shawgi Taha
Anesthesiology
Tshilidzini
Repatriated
26. Ryabchiy Borys
Anesthesiology
Elim
27. Torralba Benicio
Ophthalmology
Elim
Processing Repatriation (6yrs)
28. Iryna Danylenko
Internal Medicine
Elim
Still serving
29. Akeem Adedolapo
Family Medicine
Elim
Still serving
30. Misra Asha
Obstetrics & Gynaecology
Polokwane/Mankweng
31. Misra Rajeev
Cardiology
Polokwane/Mankweng
32. Nahendra Kumar Sharma
Ophthalmology
Polokwane/Mankweng
33. Kapoor Pardeep Kumar
Cardiology
Polokwane/Mankweng
Still serving
34. Sergiy Bocharov
Anesthesiology
Polokwane/Mankweng
Still serving
35. Ivantchenko Nikolaevitch
Neurology
Polokwne/Mankweng
Still serving
36. Jerome Hubahib
Internal medicine
Polokwane/Mankweng
Still serving
37. Delinikaytis Sergey
Orthopedic Surgery
Polokwane/Mankweng
Still serving
38. Nadia Rozumyk
Internal Medicine
Polokwane/Mankweng
Repatriated
39. Joy Naiga
Family Medicine
Polokwane/Mankweng
Repatriated
Repatriated
Still serving
Still serving
Repatriated (2013)
Processing Repatriation
Repatriated
Deceased
Repatriated (6yrs)
Still serving
Repatriated (6yrs)
Still serving
Repatriated (6yrs)
Repatriated (6yrs)
Still serving
Repatriated (8yrs, 2013)
12
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
40. Shahid Mehmood
Family Medicine
Siloam
Still serving
41. Patrick Mulindwa
Obstetrics & Gynaecology
Sekororo
Still serving
42. Khan Inamullah
Family Medicine
Sekororo
Still serving
43. Abu Minah
Family Medicine
Sekororo
Still serving
44. Godwin Attamah
Family Medicine
Dilokong
Still serving
45. Win Htay
Family Medicine
Maphutha-Malatji
Repatriated
46. Dieudonne Takam
Family Medicine
Maphutha-Malatji
Repatriated (2013)
Figure 5: Number of Years in Service per Volunteer in 2012
5
6
2
5
0
4
no of volunteers
1
3
years of service
0
2
11
1
0
2
4
6
8
10
12
Figure 6: Number of Repatriated Doctors in 2012
10
9
8
7
6
5
4
3
2
1
0
9
5
4
1
Q1
Q2
Q3
Q4
13
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
2.2 Sub- programme Two: Health Planning Support
The programme was developed to support the activities of the Department towards the
improvement of health service delivery challenges through improved planning processes and
systems. Due to financial challenges, no activities were implemented in 2012.
2.3 Sub-programme
Development
Three:
Knowledge
Management
and
Leadership
The planned activities of this sub-programme included amongst other things, the creation of an
information base for planning purposes, design for the knowledge management systems, the drafting
of the leadership development programme, and the process plan for the establishment of the
resource centre. These activities were not realized due to funding challenges in 2012.
However, at a programme management level, a series of exit interviews conducted with the UNV
doctors who were repatriated in 2012 have served to document their invaluable experiences of
volunteering in South Africa. A number of these experiences have been shared with other volunteers
in the rest of the world through the United Nations Volunteers website and other media.
Additionally, the information will be integrated towards the improvement of coordination and
management of volunteers within the programme. Discussions were held with the UNDP CO website
focal point to revamp the UNV webpage so that these experiences can be made accessible to the
public, particular to potential UNV Volunteers. Also under discussion was to include a page where
profiles of past and current UNVs would be showcased and presentation of their worked displayed.
These would also have linkages to the Programme's Teamwork space that was created in 2011.
Additionally, more lessons learnt will assist in the improvement of recruitment processes of the
volunteers themselves.
Under the supervision of the Knowledge management Programme Officer, a brochure detailing a
description of the overall programme and the relevance of UNV volunteer presence in the province
was developed by a volunteer student. The brochure was targeted particularly at the newly recruited
volunteers as well as hospital management. A picture poster showing all UNVs with a short biography
was also produced and it would be updated from time to time. The purpose of these products is to
ensure the visibility of the Programme to all stakeholders and to demonstrate the value that the
UNVs are bringing to the people of the Province.
2.4 Sub-Programme four: MDGs, Monitoring and Evaluation System
Lack of effective Monitoring and Evaluation framework within the Department of Health and Social
Development hampers access to quantitative and qualitative data. Under this sub-programme a
comprehensive M & E system will be established to improve on service delivery, accountability and
strategic planning. The sub-programme also assists with the domestication of MDGs relevant to
health within the Limpopo Department of Health and Social Development. Due to financial
constraint, the programme was not implemented in 2012.
14
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
3. General Administration and Management
In January 2012, the Programme Management Unit (PMU) maintained its complement of the
programme manager, Knowledge management and leadership programme officer, Programme and
administration coordinator, and driver. Due to challenges regarding funding, all sub-programmes
were suspended, which later resulted in the exit of the Knowledge Management Officer as well as
the Programme Manager in October and November 2012 respectively. The programme oversight
function is still held with the M&E unit within UNDP.
4. Implementation Strategy Review
The Programme Management Unit (PMU)is responsible for the overall implementation and
management function of the programme. The Steering Committee, co-chaired and represented by
UNDP and the Department, plays a policy and advisory role on strategic issues and to oversee the
implementation of programme activities.
4.1
Participatory/Consultative processes
The Steering Committee played a role in the facilitation of strategic participation of key stakeholders
to inform the implementation of programme activities. Regular meetings were held to mainly discuss
challenges relating to funding and sustenance of volunteer assignments and other operational issues.
4.2
Quality of Partnerships
The quality of the partnership enabled the successful achievement of tangible results that the
programme had envisaged. The partnership has been very effective since it continued to receive high
level supervisory support from both parties. The programme also assembled a team of highly
dedicated staff personnel with adequate capacity and skills for programme implementation and
management.
Strategies to operationalize national ownership of the programme have been informed by the
funding model and decision making processes of the programme. The overall funding for the
activities of the programme is provided for by the Department. As the beneficiary of the
programme, the Department is actively involved in the planning, implementation and monitoring of
activities, through its full representation and participation in the Steering Committee activities.
15
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
5. Management Effectiveness Review
5.1 Quality of Monitoring
During the course of 2012 quarterly progress reports provided updates on the progress, challenges,
resource utilization, risks and other issues in the implementation of the programme. However,
sittings of the Steering Committee were irregular and thus were viewed as ineffective in resolving
crucial problems facing the programme. One of the factors was the representation of the
department in relation to follow-up mechanisms on undertakings agreed upon in meetings.
Additionally, members could not quorate, resulting in the postponement of the meetings.
5.2 Timely delivery of outputs
Under the circumstances which prevailed in 2012, the programme was able to maintain 46
volunteers, which is inclusive of doctors retained in 2011 and those recruited in 2012. However, by
the end of the year, the number reduced to 28 as indicated above. This figure is less than what was
planned for the year because insufficient funding made it difficult to achieve the set targets.
5.3 Resource allocation
The programme had an opening balance of US$ 270,187 in January 2012. An income of R17,500.000
(US$ 2,071,006) was received in two tranches during the course of the year. The total expenditure
for 2012, as depicted below, is R16,756,713 (US$ 2,041,452) with a balance of R1,130,290 (US$
133,762).
16
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Table 2: Financial expenditure report per sub-programme: January - December 2012
USD
ZAR
-270,187
-2,071,006
-17,500,000
2,041,452
16,756,713
Activity
Opening balance
Income
Expenditure
1. Health Professionals volunteerism and capacity Development
Volunteer living allowances (VLA)
1,448,582
11,874,065
Settling in Grants
35,418
2. Health planning support
0
0
3. Knowledge Management and Leadership Development
0
0
4. MDGs, Monitoring and Evaluation System
0
0
290,286
5. General Management and Administration
PMU salaries
215,338
Vehicle maintenance
Travel
7,379
34,281
60,691
307,252
Office costs (rent and maintenance)
68,188
555,369
Audits
10,168
85,632
UNDP Administrative Charge
222,098
Total expenditure
Closing cash balance
2,041,452
-133,762
1,762,885
1,820,533
16,756,713
-1,130,290
17
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Table 3: Total expenditure per quarter: January - December 2012
QUARTER 1
QUARTER 2
QUARTER 3
QUARTER 4
TOTAL EXPENDITURE
USD
ZAR
USD
ZAR
USD
ZAR
USD
ZAR
USD
ZAR
636,624
5,093,000
473,591
3,788,730
547,226
4,596,700
384,011
3,278,283
2,041,452
16,756,713
Figure 7: Total expenditure per quarter: January - December 2012
6000000
5093000
5000000
4596700
3788730
4000000
3278283
3000000
2000000
1000000
0
Q1
Q2
Q3
Q4
18
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
5.4 Project Risks and Actions
RISK TYPE
DESCRIPTION
IMPACT
SUGGESTED MANAGEMENT RESPONSE
RESPONSIBLE PARTY
Organizational
Non-provision of UNDP or UNV inputs to
ensure efficient/effective programme
deliverables is detrimental to the project
Ineffective strategy could mean that the
provision of UNVs may only be a short term
service and not have real impact on the long
term retention of medical personnel in the
Province
Project Steering Committee for project
oversight
UNV PO / PMU
UNV as the executing agency has limited
capacity
Financial
Over or under expenditure and/or
misappropriation of project financial
resources Project
Unclear commitment to continue
timeframes and funding for the
programme
Partners may not honour cost sharing
commitment
Lack in :
(1) the provision of accommodation for UNVs
at duty stations,
Project Evaluation
Ongoing PMU Staff training and training
entitlements for UNVs
Regular interaction and appropriate
segregation of responsibilities between
the PMU and the UNV PO.
UNDP/ DOH
Ensure that there is, sufficient
resources available for each UNV until
the completion of their assignments.
PMU/ UNDP/ DOH
(2) provision of furniture and utilities, and
Provide continuous expenditure
updates, forecasts and reports
(3) funding for UNV VLA’s and SIG, could
result in the collapse of the Project
Ensure that project expenditure is
aligned to the Annual Workplan
PMU
19
UNDP Support to the Health Sector in Limpopo
RISK TYPE
DESCRIPTION
Operational
Annual Report (January –December 2012)
IMPACT
SUGGESTED MANAGEMENT RESPONSE
RESPONSIBLE PARTY
Loss or damage to the PMU assets (example,
office equipment, injury to staff etc.)
Ensure payment of all insurances
PMU / UNDP
Political
Change in political/ administrative
leadership could adversely affect DOH
resource allocation
The absence of a focal point or political
champion for the Project, could mean that
Project resources may be diverted to other
similar Projects and/or Project funding
discontinued
Ensure long-term commitment by DOH
through the PSC and/or the written
commitment to the Phase 3 of the
Project
UNDP / DOH / PSC
Regulatory
Non-provision of HPCSA registration and
work permits has occupational risks and
could render the work and stay of UNVs
illegal
Non-issuance of and/or invalid HPCSA
registration put UNVs at occupational risks.
Ensure that each UNV has a valid
HPCSA registration certificate.
PMU
Security
Ineffective monitoring and
security/safety measures for UNVs at
their duty stations can result in loss
and/or injury
Lack of valid work permits, Diplomatic ID Cards
and/or UNV ID cards could render the work
and stay of UNV illegal
Injury and/or loss to UNVs as a result of
ineffective security/safety measures would be
detrimental to the Project
PMU/ UNV PO
Ensure that the contract extension,
work permits /VISA’s of all UNVs are
valid and/or up to date
Encourage regular security visits of
UNDP Security team to UNV duty
station and the sharing of all security
alerts and information with UNVs
Ensure that travel authorizations are
signed for all UNV travel
UNDP/ PMU
PMU
20
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
6. Implementation challenges
6.1 Programme funding
The programme experienced serious challenges related to financial resources. Out of the
R27,533,600 budgeted to meet the target of 30 and other medical professionals, recruited and
placed, as well sustaining the existing volunteers, R17,500,000 was received. Activities planned for
2012 could not all be fulfilled as the overall budget could only support the existing team of
volunteers and other operational costs of the programme. Only five doctors were recruited in
2012.During the third and the last quarter, the contracts of the Programme Manager and Knowledge
Management Officer could no longer be sustained. Additionally, the late receipt of funds had
negative implications on the operational matters of the programme.
6.2 Recruitment of Nurses and Pharmacists
The strict adherence to the requirements set by the Nursing and Pharmacist Councils on the
programme made it impossible to recruit candidates during this reporting period. An intervention by
the Department is crucial in order for any recruitment of these professionals to succeed.
21
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Annexure1: Phase III Alignment to Provincial and National Priorities
Relevant National Outcome
 A long and healthy life for all South Africans
 Objective: To increase the life expectancy of our citizens and ensure that all people have
access to health care.
Relevant National Activities (RSA)
 Ensure a well-coordinated roll-out of antiretrovirals (ARVs) with a specific emphasis on
effective roll-out of the preventative mother to child treatments;
 Integrate HIV and tuberculosis (TB) services;
 Strengthen maternal health services;
 Develop a national strategy for chronic diseases;
 Conduct hospital audit process in 2010, with the view to improving hospitals.
Relevant National outputs
 Reduce the mortality rate;
 Reduce the impact and prevalence of HIV and AIDS and Tuberculosis, and
 Ensure an effective healthcare system.
Medium Term Strategic Framework (Relevant to Health)
 Transform the public health system so as to reduce inequalities (National Health Insurance)
in the health system, improve quality of care and public facilities, boost human resources
and step up the fight against HIV and AIDS, TB and other communicable diseases as well as
lifestyle and other causes of ill-health and mortality.
Department of health and Social Development (Limpopo province)
Vision: A health promoting and developmental to the people of Limpopo
Mission: The department is committed to provide sustainable Health and Developmental services
through a comprehensive and integrated system
Department Health and Social Development Strategic goals
 Implement comprehensive HIV and AIDS care, treatment and management, Tuberculosis
(TB), Sexual Transmitted Infections (STIs) and other communicable diseases programmes
 Strengthen Districts Health Services and Primary health Care services
 Human Resources management issues
Relevant Millennium Development Goals (MDGs)
 Reduce child mortality
 Improve maternal health
 Combat HIV/AIDS, Malaria and other diseases
Relevant UNDAF Outcome
 Democracy, good governance and administration
22
UNDP Support to the Health Sector in Limpopo
Annual Report (January –December 2012)
Envisaged Programme Outcomes
 Improved healthcare service delivery in Limpopo Province
 Increased culture of volunteerism
 Improved hospital performance vis-ὰ-vis organizational management and development
 Integration of health economics in health service planning
 Improved knowledge and access to health related information
 Improved monitoring and evaluation capacity
Expected Programme Outputs
 Recruitment of PMU staff: 1 Programme Manager; 2 Programme Officers; 1 Programme
Assistant and 1 Programme Driver
 Recruit and place 75 UNV medical doctors, 8 UNV Clinical Engineers, 30 UNV Pharmacists,
and 15 UNV special Nurses
 Develop a framework for a mentorship programme strategy
 Develop and implement a leadership development seminar series programme targeting
senior management of health facilities and health managers
 Develop guidelines and frameworks for effective health services planning
 Develop a concept document for the establishment of a health knowledge management
centre in Limpopo province
 Develop and implement monitoring and evaluation system
23