Health Portfolio Committee. NHLS Budget. John Robertson CEO

Transcription

1 Health Portfolio Committee NHLS Budget John Robertson CEO

2 Budget

3 Budget Assumptions 2007/8 Headline CPI 6.2% Service delivery incl. CCMT 17% CPIX 5.5% Salaries 5% PPI 5.9% Headcount 11% R/$ 7.50 Training 35% Research Trust 0% Capital Expenditure 26% Profit (31%) Tariff increase 2.2%

4 NHLS Group NATIONAL HEALTH LABORATORY SERVICE /2007 Change 2007/2008 Forecast R % Base Inflation Budget REVENUE 1,866, ,394 24% 2,310, % 2,358,893 NHLS Group BUDGET F2008 ANALYSIS Test Revenue 1,776, ,603 25% 2,212, % 2,260, Test Revenue 1,258, ,877 17% 1,466, % 1,502, Test Revenue - Referrals 314,594 60,297 19% 374, % 384, Test Revenue - Surcharge - - 0% - 2.5% Media Sales - External % % Venom & Vaccine Sales - External 8, % 9, % 9, Flat Rate 132, , % 290, % 290, NIOH Revenue 650 1, % 2, % 2, Internal Referral Revenue (20%) 61,234 8,297 14% 69, % 71,269 Other Income 90,778 6,791 7% 97, % 98,156 Interest Received 16,516 1,384 8% 17, % 17,900 Teaching Income 6,027 (27) 0% 6, % 6,000 Discounts Received 2, % 2, % 2,535 Bad Debt Recovery 23 (12) -52% % 11 Miscellaneous Sales 6,440 1,827 28% 8, % 8,722 Internal Recoveries - - 0% - 2.5% - Sundry income 6,396 2,207 35% 8, % 8,603 Recovery - NICD 29,512 (565) -2% 28, % 28,947 Recovery - NIOH 23,744 1,695 7% 25, % 25,439 EXPENDITURE 1,682, ,861 25% 2,106, % 2,218,179 Production Expenses 1,006, ,174 27% 1,281, % 1,352,040 Direct Materials 379, ,262 32% 503, % 534,072 Direct Labour 503, ,828 21% 609, % 640,480 Training Labour 83,437 35,968 43% 119, % 125,375 Other Direct Expenses 40,105 9,116 23% 49, % 52,113 Operating Expenses 669, ,688 22% 818, % 859,139 Indirect Labour 280,421 43,966 16% 324, % 340,606 Depreciation 23,959 46, % 70, % 70,234 Other Operating Expenses 364,976 58,447 16% 423, % 448,298 Other Expenses 7, % 7, % 7,000 Possible retrenchments & retraining - - 0% - 0.0% - Research Trust 7,000 (0) 0% 7, % 7,000 Profit/(Loss) 184,016 19,533 11% 203, % 140,715 Investment in capital expenditure (95,624) (135,836) (135,836) Add: Depreciation 23,959 70,234 70,234 Less: Capex 119, , ,070 Surplus/(Deficit) 88,392 67, % 4,879 Investment in working capital (21,152) (64,438) (69,025) Accounts receivable (70,849) (72,767) (80,778) Accounts payable 61,776 23,526 30,776 Inventory (12,079) (15,197) (19,023) Net surplus/(deficit) after investment in working capital and capital expenditure 67,239 3, % (64,147)

5 SAVP NATIONAL HEALTH LABORATORY SERVICE SAVP 1000 BUDGET F2008 ANALYSIS 2006/2007 Change 2007/2008 Forecast R % Base Inflation Budget REVENUE 8, % 9, % 9,669 Test Revenue 8, % 9, % 9, Test Revenue - - 0% - 2.5% Test Revenue - Referrals - - 0% - 2.5% Test Revenue - Surcharge - - 0% - 2.5% Media Sales - External - - 0% - 2.5% Venom & Vaccine Sales - External 8, % 9, % 9, Flat Rate - - 0% - 0.0% NIOH Revenue - - 0% - 2.5% Internal Referral Revenue (20%) - - 0% - 2.5% - Other Income 2 (2) -100% % - Interest Received - - 0% - 0.0% - Teaching Income - - 0% - 0.0% - Discounts Received 2 (2) -100% - 5.5% - Bad Debt Recovery - - 0% - 0.0% - Miscellaneous Sales 0 (0) -100% - 5.5% - Internal Recoveries - - 0% - 2.5% - Sundry income (0) 0-100% - 0.0% - Recovery - NICD - - 0% - 0.0% - Recovery - NIOH - - 0% - 0.0% - EXPENDITURE 8, % 9, % 9,543 Production Expenses 5, % 5, % 6,186 Direct Materials % 1, % 1,265 Direct Labour 3, % 3, % 3,803 Training Labour - - 0% - 5.0% - Other Direct Expenses % 1, % 1,118 Operating Expenses 3, % 3, % 3,357 Indirect Labour 1, % 1, % 1,895 Depreciation % % 206 Other Operating Expenses 1, % 1, % 1,255 Other Expenses - - 0% % - Possible retrenchments & retraining - - 0% - 0.0% - Research Trust - - 0% - 0.0% - Profit/(Loss) % % Add: Depreciation Less: Capex 3,417 3,417 Surplus/(Deficit) (2,844) 8.5% (3,085)

6 NATIONAL HEALTH LABORATORY SERVICE NHLS ENTITY /2007 Change 2007/2008 Forecast R % Base Infl Budget REVENUE 1,858, ,698 24% 2,300, % 2,349,225 NHLS Entity BUDGET F2008 ANALYSIS Test Revenue 1,767, ,905 25% 2,203, % 2,251, Test Revenue 1,258, ,877 17% 1,466, % 1,502, Test Revenue - Referrals 314,594 60,297 19% 374, % 384, Test Revenue - Surcharge - - 0% - 2.5% Media Sales - External % % Venom & Vaccine Sales - External - - 0% - 2.5% Flat Rate 132, , % 290, % 290, NIOH Revenue 650 1, % 2, % 2, Internal Referral Revenue (20%) 61,234 8,297 14% 69, % 71,269 Other Income 90,776 6,793 7% 97, % 98,156 Interest Received 16,516 1,384 8% 17, % 17,900 Teaching Income 6,027 (27) 0% 6, % 6,000 Discounts Received 2, % 2, % 2,535 Bad Debt Recovery 23 (12) -52% % 11 Miscellaneous Sales 6,440 1,827 28% 8, % 8,722 Internal Recoveries - - 0% - 2.5% - Sundry income 6,396 2,207 35% 8, % 8,603 Recovery - NICD 29,512 (565) -2% 28, % 28,947 Recovery - NIOH 23,744 1,695 7% 25, % 25,439 EXPENDITURE 1,674, ,057 25% 2,097, % 2,208,636 Production Expenses 1,001, ,532 27% 1,275, % 1,345,854 Direct Materials 378, ,027 32% 501, % 532,807 Direct Labour 499, ,572 21% 606, % 636,677 Training Labour 83,437 35,968 43% 119, % 125,375 Other Direct Expenses 39,200 8,965 23% 48, % 50,995 Operating Expenses 666, ,526 22% 814, % 855,782 Indirect Labour 278,716 43,866 16% 322, % 338,711 Depreciation 23,780 46, % 70, % 70,028 Other Operating Expenses 363,826 58,411 16% 422, % 447,043 Other Expenses 7,000 (0) 0% 7, % 7,000 Possible retrenchments & retraining - - 0% - 0.0% - Research Trust 7,000 (0) 0% 7, % 7,000 Profit/(Loss) 183, ,640 11% 203, % 140, Add: Depreciation 70,028 70,028 Less: Capex 202, ,654 Surplus/(Deficit) 70, % 7,963

7 NATIONAL HEALTH LABORATORY SERVICE KZN REGION /2007 Change 2007/2008 Forecast R % Base Inflation Budget REVENUE 138, , % 300, % 300,626 KZN Region BUDGET F2008 ANALYSIS Test Revenue 133, , % 293, % 293, Test Revenue 1,489 1, % 3, % 3, Test Revenue - Referrals - - 0% - 2.5% Test Revenue - Surcharge - - 0% - 2.5% Media Sales - External - - 0% - 2.5% Venom & Vaccine Sales - External - - 0% - 2.5% Flat Rate 132, , % 290, % 290, NIOH Revenue - - 0% - 2.5% Internal Referral Revenue (20%) - - 0% - 2.5% - Other Income 4,847 2,705 56% 7, % 7,551 Interest Received - - 0% - 0.0% - Teaching Income - - 0% - 0.0% - Discounts Received - - 0% - 5.5% - Bad Debt Recovery - - 0% - 0.0% - Miscellaneous Sales - - 0% - 5.5% - Internal Recoveries - - 0% - 2.5% - Sundry income 4,847 2,705 56% 7, % 7,551 Recovery - NICD - - 0% - 0.0% - Recovery - NIOH - - 0% - 0.0% - EXPENDITURE 176, ,685 98% 300, % 316,787 Production Expenses 115, , % 251, % 264,984 Direct Materials 32,999 57, % 90, % 95,552 Direct Labour 69,532 66,468 96% 136, % 142,800 Training Labour 6,001 8, % 14, % 15,621 Other Direct Expenses 7,400 3,000 41% 10, % 11,011 Operating Expenses 60,935 (11,661) -19% 49, % 51,803 Indirect Labour 8,100 5,700 70% 13, % 14,490 Depreciation - 4,174 0% 4, % 4,174 Other Operating Expenses 52,835 (21,535) -41% 31, % 33,139 Other Expenses - - 0% - 0.0% - Possible retrenchments & retraining - - 0% - 0.0% - Research Trust - - 0% - 0.0% - Profit/(Loss) -38, , % % -16,16 1 Add: Depreciation 4,174 4,174 Less: Capex 52,582 52,582 Surplus/(Deficit) (48,408) 33.4% (64,569

8 NATIONAL HEALTH LABORATORY SERVICE NHLS excl KZN NHLS 1000 excl. KZN BUDGET F2008 ANALYSIS 2006/2007 Change 2007/2008 Forecast R % Base Inflation Budget REVENUE 1,719, ,618 16% 2,000, % 2,048,598 Test Revenue 1,633, ,531 17% 1,910, % 1,957, Test Revenue 1,256, ,366 16% 1,463, % 1,499, Test Revenue - Referrals 314,594 60,297 19% 374, % 384, Test Revenue - Surcharge - - 0% - 2.5% Media Sales - External % % Venom & Vaccine Sales - Exter - - 0% - 2.5% Flat Rate - - 0% NIOH Revenue 650 1, % 2, % 2, Internal Referral Revenue (20% 61,234 8,297 14% 69, % 71,269 Other Income 85,932 4,086 5% 90, % 90,605 Interest Received 16,516 1,384 8% 17,900 17,900 Teaching Income 6,027 (27) 0% 6,000 6,000 Discounts Received 2, % 2, % 2,535 Bad Debt Recovery 23 (12) -52% Miscellaneous Sales 6,440 1,827 28% 8, % 8,722 Internal Recoveries - - 0% - 2.5% - Sundry income 1,549 (498) -32% 1,051 1,051 Recovery - NICD 29,512 (565) -2% 28,947 28,947 Recovery - NIOH 23,744 1,695 7% 25,439 25,439 EXPENDITURE 1,497, ,372 20% 1,797, % 1,891,849 Production Expenses 885, ,186 16% 1,024, % 1,080,870 Direct Materials 345,823 66,026 19% 411, % 437,255 Direct Labour 430,256 40,104 9% 470, % 493,877 Training Labour 77,436 27,092 35% 104, % 109,754 Other Direct Expenses 31,800 5,965 19% 37, % 39,984 Operating Expenses 605, ,186 26% 765, % 803,979 Indirect Labour 270,616 38,166 14% 308, % 324,221 Depreciation 23,780 42, % 65, % 65,854 Other Operating Expenses 310,991 79,946 26% 390, % 413,904 Other Expenses 7,000 (0) 0% 7, % 7,000 Possible retrenchments & retraining - - 0% - - Research Trust 7,000 (0) 0% 7,000 7,000 Profit/(Loss) 221, ,755-8% 203, % 156, Add: Depreciation 65,854 65,854 Less: Capex 150, ,071 Surplus/(Deficit) 118, % 72,532

9 Tariff Development NHLS Change in Price 05/06 06/07 07/08 Ave Price Revenue Volm (06/7) Ave Price Revenue Price Ave Change Price ** Revenue Price Change ** Anatomical ,188,176 1,380, ,648, % ,752, % Chemical ,843,866 21,425, ,678, % ,267, % Genetics ,535,579 45, ,185, % ,480, % Haemotology ,583,061 8,925, ,521, % ,950, % Microbiology ,368,445 11,188, ,412, % ,161, % Total ,762,519,127 42,964, ,826,446, % ,866,613, % State NHLS Change in Price CMS 06/07 07/08 CMS v Volm (06/7) Ave Price Revenue STATE Ave Price Revenue CMS v STATE Anatomical 1,380, ,823, % ,185, % Chemical 21,425, ,712, % ,005,479, % Genetics 45, ,090, % ,173, % Haemotology 8,925, ,184, % ,439, % Microbiology 11,188, ,828, % ,337, % Total 42,964, ,591,639, % ,718,615, %

10 Budget 2007/8 Entity NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS Actual Outlook Budget NHLS ENTITY Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 1,164, % 1,419, % 1,858, % 2,349,225 Test Revenue 1,055, % 1,319, % 1,767, % 2,251,068 Other Income 109, % 100, % 90, % 98,156 EXPENDITURE 1,064, % 1,247, % 1,674, % 2,208,636 Production Expenses 644, % 749, % 1,001, % 1,345,854 Operating Expenses 414, % 490, % 666, % 855,782 Other Expenses 6, % 7, % 7, % 7,000 Operating profit/(loss) 99, % 172, % 183, % 140,589 Add: Non-cash items 19,250 14,512 23,780 70,028 Less: Capex 56,564 84, , ,654 Net cash surplus/(deficit) 62, % 102, % 70, % 7,963

11 Budget 2007/8 Central Region Central NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 503, % 612, % 676, % 799,461 Test Revenue 483, % 596, % 668, % 791,847 Other Income 20, % 16, % 7, % 7,614 EXPENDITURE 398, % 471, % 490, % 585,999 Production Expenses 281, % 318, % 341, % 407,513 Operating Expenses 116, % 153, % 149, % 178,486 Other Expenses % - - Profit/(Loss) 105, % 140, % 185, % 213,462

12 Budget 2007/8 Coastal Region Coastal NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 341, % 406, % 508, % 615,500 Test Revenue 337, % 404, % 508, % 615,090 Other Income 4, % 1, % % 410 EXPENDITURE 254, % 306, % 394, % 481,262 Production Expenses 177, % 210, % 259, % 317,263 Operating Expenses 76, % 96, % 135, % 163,999 Other Expenses Profit/(Loss) 87, % 100, % 114, % 134,239

13 Budget 2007/8 Northern Region NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS Northern Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 233, % 317, % 455, % 547,845 Test Revenue 232, % 316, % 455, % 547,623 Other Income % 1, % % 222 EXPENDITURE 202, % 237, % 342, % 411,765 Production Expenses 144, % 166, % 230, % 277,267 Operating Expenses 57, % 70, % 111, % 134,497 Other Expenses Profit/(Loss) 31, % 79, % 112, % 136,080

14 Budget 2007/8 KZN Region NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS KZN Rollout Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE , % 300,626 Test Revenue , % 293,075 Other Income - - 4, % 7,551 EXPENDITURE , % 316,787 Production Expenses , % 264,984 Operating Expenses , % 51,803 Other Expenses Profit/(Loss) % -38, % -16,160

15 Budget 2007/8 NICD NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS NICD Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 33, % 46, % 34, % 36,555 Test Revenue 2, % 1, % 1, % 1,415 Other Income 31, % 45, % 33, % 35,140 EXPENDITURE 50, % 76, % 74, % 101,153 Production Expenses 23, % 37, % 35, % 51,948 Operating Expenses 26, % 38, % 39, % 49,204 Other Expenses % - - Profit/(Loss) -16, % -29, % -39, % -64,598

16 Budget 2007/8 NIOH NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS NIOH Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 24, % 22, % 24, % 27,710 Test Revenue % % % 2,271 Other Income 24, % 21, % 23, % 25,439 EXPENDITURE 24, % 23, % 30, % 40,144 Production Expenses 15, % 15, % 17, % 25,621 Operating Expenses 9, % 8, % 12, % 14,523 Other Expenses Profit/(Loss) % % -5, % -12,434

17 Budget 2007/8 Corporate NATIONAL HEALTH LABORATORY SERVICE BUDGET F2008 ANALYSIS Corporate Actual Outlook Budget Var% Var% 2004/5 Var % 2005/6 2006/7 2007/8 REVENUE 26, % 13, % 20, % 21,527 Test Revenue (1,086) % - (247) 2.5% (253) Other Income 27, % 13, % 20, % 21,780 EXPENDITURE 135, % 131, % 165, % 271,526 Production Expenses 1, % 1, % % 1,257 Operating Expenses 128, % 123, % 157, % 263,270 Other Expenses 6, % 7, % 7, % 7,000 Profit/(Loss) -108, % -117, % -144, % -249,999

18 Laboratory Services Laboratory Expenditure by Province 2006/7 GP WC FS MP NW NC EC KZN LP RSA 067 Budget R 10,404 R 6,323 R 3,250 R 2,912 R 3,428 R 1,291 R 6,893 R 11,737 R 5,448 51, Conditional grant R 1,610 R 979 R 503 R 451 R 531 R 200 R 1,067 R 1,817 R 843 8, Billing [incl VAT] R 670 R 329 R 155 R 131 R 144 R 49 R 231 R 300 R 120 2,128 Population [Mid-year estimate 2005] 9,018 4,646 2,953 3,220 3, ,039 9,651 5,635 46,888 # of NHLS laboratories Population per laboratory Health expenditure per capita 1,332 1,572 1,271 1,044 1,035 1,653 1,131 1,404 1,116 1,273 Lab expenditure per capita Lab expenditure % Budget 5.6% 4.5% 4.1% 3.9% 3.6% 3.3% 2.9% 2.2% 1.9% 3.6%

19 Health Portfolio Committee Strategic Plan John Robertson CEO

20 Purpose Provide cost-effective health laboratory services Provide training for health science education Support health research Surveillance

21 Head Office

22 Head Office & NICD

23 NHLS Sites

24 Structure NHLS Board CEO John Robertson Operations Corporate Surveillance Central Region Stan Harvey Finance & Administration Suliman Minty NICD Barry Schoub Coastal Region Sipho Mahlati Human Resources Elsje Greyling NIOH Mary Ross Northern region Joyce Mogale Information Technology Stelios Michas National Cancer Registry Nokuzola Mqoqi Kwazulu Natal Quality Assurance & Academic Affairs Martin Hale

25 NHLS Services Primary Healthcare Clinics District Hospitals Regional Hospitals Tertiary Hospitals National Institute for Communicable Diseases National Institute for Occupational Health

26 NHLS Service Model Fee for Service Preferred Provider Training Research

27 Facilities Laboratories 265 laboratories across nine provinces Personnel 5473 Total personnel 1878 Technologists and Technicians 180 Scientists 150 Pathologists 200 Registrars

28 Human Resources Headcount: March 2003: March 2004: March 2005: March 2006: 3990 March 2006: 5473

29 Training Affiliated to 9 Medical Universities Affiliated to 15 Universities of Technology 50 HoD s Under & Post Graduate Training Graduate 35 Pathologists annually Graduate 150 Technologists annually

30 Research 6 MRC units 1 NRF Centre of Excellence Cancer Registry 183 Scientists 400 Research publications annually

31 Diagnostic Services

32 Extension of service to all the communities in the country Transport logistics deployed to service the Primary Health Care (PHC) facilities Extend consultation and outreach programmesp to rural provinces

33 Provision of Quality Service Programme Quality Assessment conducted in all laboratories Turn-around around-times of laboratory results measured Training programs conducted for HCW s Regular communication meetings with clients Client satisfaction surveys conducted and remedial action taken on areas of poor performance

34 Provincial Programs Support both national and provincial health programs Information resource to provincial coordinators. Focussed TB, CD4 and Viral load management

35 CCMT

36 Monitoring CD4 counts and percentages Viral load assays Resistance assays Drug levels Biochemistry Liver enzymes, U&E, lactate, lipids Haematology

37 PCR DNA PCR Mainly used for infant diagnosis Sometimes used for seroconversion period DBS

38 Proposed CD4 lab expansion 2007/2008: At least one laboratory per health district as far as is feasible.

39 Gauteng: Province GP Region Region A Region A Region B Region B Region C Region C District Johannesburg Metro JHB (5) West Rand DM Ekurhuleni Metro Sedibeng DM Metsweding DM Laboratory (number of machines) HJH (2) CHB (3) Leratong (1) Proposed laboratory Carletonville Tambo (1) Natalspruit Sebokeng (1) NO LAB Tshwane Metro DGM (3) Tshwane academic (3) Kalafong (1) FER Tembisa

40 Free state: Province Region District Laboratory Proposed laboratory FS Lejweleputswa DM Lejweleputswa DM Welkom Motheo DM Motheo DM Universitas Pelonomi T Mofutsanyane DM T Mofutsanyane DM Manapo Xhariep DM Xhariep DM NO LAB Fezile Dabi DM Fezile Dabi DM Kroonstad

41 Northern Cape: Provinc e Region District Laboratory Proposed laboratory NCP Frances Baard DM Frances Baard DM Kimberley Karoo DM Karoo DM De Aar Kgalagadi DM Kgalagadi DM Tshwaragano (kuruman) Namakwa DM Namakwa DM Springbok Siyanda DM Siyanda DM Upington

42 Western Cape: Provinc e Region District Laboratory Proposed laboratory WC Boland Boland Worcester Cape Town Cape Town Groote Schuur Tygerberg Greenpoint Central Karoo Central Karoo Beaufort West Eden DM G Route/K Karoo George Overberg Overberg NO LABS Hermanus West Coast West Coast Vredendal

43 Eastern Cape: Province Region District Laboratory Proposed laboratory EC A Nzo DM A Nzo DM Mary Theresa Amatole DM Amatole DM East London Butterworth C Hani DM C Hani DM Cecilia Makiwane Queenstown Cacadu DM Cacadu DM Grahamstown N Mandela Metro N Mandela Metro Port Elizabeth O Tambo DM O Tambo DM St Elizabeth Umtata Ukhahlamba DM Ukhahlamba DM Empilisweni

44 KZN: Province Region District Laboratory Proposed laboratory KZN Amajuba DM Amajuba DM Madadeni ethekwini Metro ethekwini Metro IALCH PMMH MGMH ilembe DM ilembe DM Stanger Sisonke DM Sisonke DM CTK Ugu DM Ugu DM Port Shepstone umgungundlovu DM umgungundlovu DM Edendale Greys Montobello Umkhanyakude DM Umkhanyakude DM Bethesda Umzinyathi DM Umzinyathi DM CJM COSH Uthukela DM Uthukela DM Ladysmith Uthungulu DM Uthungulu DM Eshowe Ngwelezane Zululand DM Zululand DM Benedictine

45 Limpopo: Provin ce Region District Laboratory Proposed laboratory LP Bohlabela DM Bohlabela DM Tintswalo Capricorn DM Capricorn DM Polokwane Mopani DM Mopani DM Letaba Sekhukhune DM Sekhukhune DM St Ritas Vhembe DM Vhembe DM Tshilidzini Waterberg DM Waterberg DM Mokopane

46 Mpumalanga: Province Region District Laboratory Proposed laboratory MP Eastvaal DM Eastvaal DM Ermelo Ehlanzeni DM Ehlanzeni DM Nelspruit Shongwe Nkangala DM Nkangala DM Witbank

47 North West: Province Region District Laboratory Proposed laboratory NWP Bojanala Platinum DM Bojanala Platinum DM Rustenburg Bophirima DM Bophirima DM Taung Central DM Central DM Mafikeng Southern DM Southern DM Tshepong

48 Proposed Viral load lab expansion 2007/2008: At least one viral load laboratory per province as far as feasible.

49 Current laboratories (13 Labs, 5 provinces) Johannesburg Helen Joseph Chris Hani Baragwanath Tshwane Dr George Mukhari Bloemfontein IALCH Ngwelezane Groote Schuur Tygerberg Umtata Port Elizabeth NICD

50 New laboratories (18-20 labs, 9 provinces) Nelspruit Tshepong Kimberley Mankweng East London Possibly Rustenburg Possibly Greys

51 Proposed PCR lab expansion 2007/2008: At least one PCR lab per province as far as feasible.

52 Current PCR labs (8 labs, 5 provinces): Johannesburg Tshwane Dr George Mukhari Bloemfontein IALCH Umtata Groote Schuur (Tygerberg)

53 Proposed new labs (14 labs, 9 provinces) : Kimberley Tshepong Nelspruit Mankweng East London Chris Hani Baragwanath

54 Data

55 CD4 tests: CD4 tests: Number of CD4 tests by month Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Month Number of tests

56 Category of CD4 tests: Category of CD4 tests: Percentage of CD4 results in each category per month <=200 >201 Not resulted Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May- Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Percentage of CD4 tests Month

57 Number of VL tests: Number of VL tests: Viral load tests Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Number of tests Sep-06 Oct-06 Nov-06 Dec-06 Month

58 Category of VL tests: Category of VL tests: Percentage of viral load results by category May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Percentage of tests Month <=50 or > not resulted

59 Number of PCR tests: Number of PCR tests: Number of HIV PCR tests per month Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-05 Feb-05 M ar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 M ar-06 Apr-06 Num ber of tests May-06 Month

60 Category of PCR tests: Category of PCR tests: Percentage of HIV PCR tests by category Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Percentage of tests Month Positive Negative NRES

61 Laboratory capacity

62 Laboratory capacity: Laboratory capacity Test Number of labs Number of systems Monthly capacity Monthly usage CD (65%) VL (67%) PCR (43%)

63 TB

64 Total Numbers of TB Microscopy 700, , , , , , ,000 0 GP WC EC NWP FS LP MP NC , , , , , , ,814 93, , , , , , , , , , , , , , , , ,397

65 TB Total Microscopy Tests per Population 18,000 16,000 14,000 12,000 10,000 8,000 6, ,000 2,000 0 NC WC FS GP MP NWP EC LP RSA (Excl. KZN)

66 Total of TB Cultures 200, , ,000 50, WC GP EC NC FS NW MP LP ,3480,80635,86620,48119,31614,80713,071 5, ,65124,1845,17725,36220,72818,91013,213 6, ,22158,6469,98332,69430,18725,78415,308 9,510

67 TB Cultures per 100,000 population Rate 6,000 4,000 2, NC WC GP FS EC NWP MP LP RSA (Excl ,489 2, ,083 3,1751, , ,974 3,7181,795 1,115 1, ,442

68 What are we doing about MDR-TB and XDR-TB

69 DRS MDR-TB INH + Rif XDR-TB All M. tuberculosis MDR-TB T FQ INJT XDR-TB

70 MDR Tuberculosis Resistance to INH + Rifampicin Due to selective pressure with non-adherence Person to person transmission possible Treating with second line drugs Treatment extended to ~24 months Less effective than first line Toxicity increase ++ Expensive (>100x)

71

72

73

74 Number of MDR-TB cases identified Number WC GP EC FS NWP NC MP LP 2004 Total Total Total Total 2005 Total 2006 Total

75 Number of XDR-TB cases identified Number EC GP WC NWP NC FS LP MP 2004 Total Total Total Total 2005 Total 2006 Total

76 DNA STRIP Technology DNA STRIP STRIP Technology HAIN LIFESCIENCE

77 Rifampicin resistance region of the rpob- and katg-gene

78 FASTPlaque Plaque -Response FASTPlaque- Response assay procedure Sputum collection Specimen processing (NALC-NaOH) o/n incubation ± rifampicin Interpretation of results

79 Gauteng: proposed flowchart for PCR diagnosis Suspect Suspect Positive smears 20 Negative smears 80 PCR 1 week Resistant Sensitivie Still symptoms 45 low Index of Suspicion 35 culture 1MDR positive 30 negative Sizwe PCR Resistant 2 Sensitive 13 Culture + DST Sizwe Culture + DST Treat: Individual Treat: standard Treat: Individual Treat: standard discharge

80 Challenges Human Resources Medical Technologists Medical Technicians Medical scientists Pathologists Logistics Easy part has been done DW and interfaces

81 Skills

82 Strategic Plan

83 Balanced Scorecard

84 END