STANDING COMMITTEE ON APPROPRIATIONS AND PORTFOLIO COMMITTEE ON HEALTH PARLIAMENT 23 March 2017

Transcription

1 WHEN THE SUN RISES WE WORK HARD TO DELIVER STANDING COMMITTEE ON APPROPRIATIONS AND PORTFOLIO COMMITTEE ON HEALTH PARLIAMENT 23 March

2 PRESENTATION OUTLINE 1. Purpose 2. Alignment between national budget and provincial budget processes 3. MTEF budget summary 4. Alignment in health information systems 5. Critical functions appropriately devolved to designated level for service delivery efficiencies and better performance 6. Effective management of personnel expenditure 7. Alignment of national and provincial health infrastructure priorities and improving infrastructure budget expenditure 8. Other matters to ensure improved alignment and coordination in the health sector 9. Recommendations 2

3 PURPOSE To brief the Standing Committee on Appropriations and Portfolio Committee on Health on the effective co-ordination and alignment of national and provincial government in the delivery of health services so as to ensure value for money, effective planning and resources. 3

4 LEGISLATIVE MANDATE Legislative Mandates The legislative mandate of the Department is derived from the Constitution and legislation passed by Parliament. CONSTITUTIONAL MANDATES In terms of the Constitution of the Republic of South Africa (Act No. 108 of 1996), the Department is guided by the following sections and schedules: Section 27 (1): Everyone has the right to have access to (a) health care services, including reproductive health care; (3) No one may be refused emergency medical treatment: Section 28 (1): Every child has the right to basic health care services Schedule 4, which lists health services as a concurrent national and provincial legislative competence. LEGAL MANDATES National Health Act (Act No. 61 of 2003) Provides a framework for a structured uniform health system within the Republic, taking into account the obligations imposed by the constitution and other laws on the national, provincial and local governments with regard to health services and to provide for matters connected therewith. 4

5 ALIGNMENT BETWEEN NATIONAL BUDGET AND PROVINCIAL BUDGET PROCESSES 5

6 ALIGNMENT BETWEEN NATIONAL BUDGET AND PROVINCIAL BUDGET PROCESSES BUDGET PROCESS CHALLENGES REMEDIAL ACTIONS Lack of aligned planning and MTEF budgeting processes (APP preparation, DHER and MTEF budget- National Treasury budget process). Delays in finalization of provincial budget budgets. Grants frameworks are finalized after first budget submission (done for compliance). The process does not provide for post final budget allocation benchmark. Develop an integrated APP, DHER and MTEF budget processes. National Treasury should assist in the development of budget processes for Provincial Treasuries. Grants frameworks must be finalized prior first submission of the MTEF budgets. The budget process must include final budget allocation benchmark exercise. 6

7 MTEF BUDGET SUMMARY 7

8 PROGRAMMES: MTEF BUDGET SUMMARY VOTE 10: MPU HEALTH Outcome Main Adjusted appropriatio appropriatio n n Revised estimate Medium-term estimates Medium-term estimates Increase R thousand 2015/ / / / / / / /20 1. Administration % -7% 15% 2. District Health Services % 7% 7% 3. Emergency Medical Services % 1% 6% 4. Provincial Hospital Services % 6% 6% 5. Tertiary Hospital Services % 5% 6% 6. Health Sciences and Training % 9% 6% 7. Health Care Support Services % 22% 6% 8. Health Facilities Management % 0% 6% TOTAL % 6% 7% 8

9 ECONOMIC CLASSIFICATION : MTEF BUDGET SUMMARY MPU HEALTH- ECONOMIC CLASSIFICATION Outcome Main appropriati on Adjusted appropriatio n Revised estimate Medium-term estimates Medium-term estimates R thousand 2015/ / / / / / / /20 Current payments % 6% 7% Compensation of employees % 7% 6% Goods and services % 4% 10% Interest and rent on land Transfers and subsidies % -10% 6% Provinces and municipalities % 12% 6% Departmental agencies and accounts % 8% 6% Non-profit institutions % -12% 6% Households % -5% 6% Payments for capital assets % 4% 8% Buildings and other fixed structures % 3% 6% Machinery and equipment % 20% 28% Payments for financial assets Total economic classification % 6% 7% 9

10 PROGRAMME SHARE- MTEF ALLOCATIONS 2017/ / /20 100% 90% 80% 70% 2% 59% 3% 11% 9% 4% 1% 11% 60% 50% 40% 30% 2% 58% 3% 11% 9% 4% 2% 11% 20% 10% 0% 3% 58% 3% 11% 9% 4% 1% 12% 10

11 MTEF ALLOCATION PER CLASSIFICATION Compensation of employees Goods and services Transfers and subsidies Payments for capital assets 11% 3% 25% 11% 2% 25% 11% 2% 25% 61% 62% 61% 2017/ / /20 11

12 2017 MTEF BUDGET FOR NON-NEGOTIABLES 25% 20% 2017/18 FY Increase 15% 10% 2018/19 FY Increase 5% 0% 2019/20 FY Increase -5% -10% -15% -20% 12

13 ALIGNMENT IN HEALTH INFORMATION SYSTEMS 13

14 ALIGNMENT IN HEALTH INFORMATION SYSTEMS KEY AREA Coordination Health information Systems COORDINATION MECHANISMS The coordination is done through National Health Information Systems of South Africa (NHISSA) established by National Department of Health. The NHISSA determine normative standards for all information systems implemented by all provinces to ensure interoperability. All provinces are represented in the committee for easier coordination of National Health Information System. Meetings are done quarterly. However, this forum does not adequately address IT issues as it focuses more on information Management issues rather than ICT. The establishment of Health Chief Information Officer (CIO) Forum is recommended for coordination of ICT issues and reports to the DG. 14

15 ALIGNMENT IN HEALTH INFORMATION SYSTEMS CONT KEY AREA Patient Administration and Revenue & Billing Systems COORDINATION MECHANISMS There is no standardized system for patient administration, revenue and billing across all Provinces. Therefore patient historic information shared among provinces. This results in costly repeat test due unavailability of patient history when patients cress boundaries. Mpumalanga Department of Health uses a Patient Electronic Information System (PEIS) for both Patient administration, Revenue and Billing. It is recommended that Government enhances PEIS to become a National Health Information System for patient administration, revenue, billing and clinical purposes. 15

16 ALIGNMENT IN HEALTH INFORMATION SYSTEMS CONT KEY AREA Pharmaceutical Systems COORDINATION MECHANISMS Mpumalanga is using the RX solution which is supported by National Department (12 Hospitals). Stock Visibility System (SVS) has been implemented to all Primary Health Care facilities to monitor drug availability. There is no standardised system for managing the medical inventory at the Medical Depots. A comprehensive integrated solution is recommended for inventory management from suppliers, depot, Hospitals up to clinics including dispensing to patients. 16

17 ALIGNMENT IN HEALTH INFORMATION SYSTEMS CONT KEY AREA Network Infrastructure CO-ORDINATION MECHANISMS There is no co-ordination of Network Infrastructure from National Department of Health. Establishment of Health Chief Information Officers (CIO) forum is recommended to focus on Development of Health ICT master plan to guide coordinated ICT infrastructure. There is co-ordination in deploying systems like HPRS and e-tick. These are done under the NHI programme. Mpumalanga is rolling out Health Patient Registration System (HPRS), web-dhis and e- tick to Clinics. 281/286 (98%) Facilities are implementing HPRS which are 74/76 (99%) at Gert Sibande, 121/121 (100%) at Ehlanzeni and 84/89 (94%) at Nkangala. Other Systems Gert Sibande district is implementing e-tick, while other two districts are planned for roll-out in 2017/18. Web-DHIS is being implemented from sub-district level and all data will be captured on the web from April Establishment of Health CIO forum is recommended. 17

18 CRITICAL FUNCTIONS APPROPRIATELY DEVOLVED TO DESIGNATED LEVEL FOR SERVICE DELIVERY EFFICIENCIES AND BETTER PERFORMANCE 18

19 DEVOLUTION OF CRITICAL FUNCTIONS TO DESIGNATED LEVEL FOR SERVICE DELIVERY The Department has three District Offices Delegated procurement authority up to R Financial Management Unit which consists of budgeting and reporting, expenditure, supply chain management to support hospitals and clinics. District Finance Committee appointed. The Department has 33 hospitals Delegated procurement authority up to R Cost Centre Management appointed as responsibility managers. Financial Management Unit which consists of budgeting and reporting, expenditure, supply chain management. Hospital Finance Committees (HFC s) appointed. 19

20 EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITURE 20

21 EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITURE The Department has a total number of officials employed on the approved organizational structure distributed as follows: Programme Total number of staff Budget 2017/18 Administration District Health Services Emergency Medical Services Provincial Hospital Services Tertiary Hospital Services Health Science and Training Health Care Support Services Health Facilities Management Grand Total

22 EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITURE CONT 62% of the total Departmental budget is spent on Compensation of Employees of which 88% is spent on Health Professionals and Health Support Personnel. The following measures are in place to ensure that there is effective management of personnel expenditure: The Department has an approved organogram and currently in the process of reviewing it Payroll Management system introduced to ensure that signed pay sheets are returned to Salaries for verification purposes on a monthly basis. Staff verification exercise was conducted in conjunction with Treasury. The Department is currently reviewing the organogram aligning it to service delivery imperatives and for the clinics to the WISN model. The intention is to transfer staff from over provisioned facilities to under provisioned facilities. Monthly Cost per Head Analysis is done. 22

23 ALIGNMENT OF NATIONAL AND PROVINCIAL HEALTH INFRASTRUCTURE PRIORITIES AND IMPROVING INFRASTRUCTURE BUDGET EXPENDITURE 23

24 HEALTH FACILITIES MANAGEMENT SUMMARY ALLOCATION FOR 2017/18 ES HFRG EPWP TOTAL % R'000 % R'000 % R'000 R'000 Programme A: New 41.3% % % Programme B: Upgrade and additions 50.6% % % Programme C: Repairs; Rehabilitation & 0.5% % % 0 Refurbishment Programme D: Maintenance 6.6% % 0 0.0% Sub-total infrastructure 99.0% % % Operational costs 1.0% % % Sub-total operational 1.0% % % Grand total 100.0% % % The Department has a total allocation of R1, 437 Billion; made up of R1, 109 Billion of Equitable Share, R325 Million of Health Facilities Revitalisation Grant and R2 Million of Expanded Public Works Programme. A total budget of R1, 377 Billion is for Infrastructure i.e projects and maintenance 24

25 Health Facilities Management Summary Allocation for 2017/18 Funding Source 2017/18 Commitment New R'000 R'000 R'000 Equitable Share Expanded Public Works Programme Health Facilities Revitalisation Grant Total Equitable Share has an allocated budget of R1, 098 Billion for Infrastructure; within the allocation there is R579 Million of Contractual commitments i.e for;- current running projects and portion of R98 Million will pay for final accounts, accruals of R98 Million. The Balance of R518 Million will be for new projects commencing in the 2017/18 financial year. Grants have an allocated budget of R279 Million for Infrastructure; within the allocation there is R55 Million of Contractual commitments and R224 Million for new projects 25

26 ALLOCATIONS PER FUNDING SOURCE AND FACILITY TYPE Health Facilities Revitalisation Grant 2017/18 Allocation Nature of investment R'000 Hospital CHC Clinic Other Total R'000 R'000 R'000 R'000 R'000 Programme A: New Programme B: Upgrade and additions Programme C: Repairs; Rehabilitation & Refurbishment Programme D: Maintenance Total Infrastructure Equitable Share 2017/18 Allocation Nature of investment R'000 Hospital CHC Clinic Other Total R'000 R'000 R'000 R'000 R'000 Programme A: New Programme B: Upgrade and additions Programme C: Repairs; Rehabilitation & Refurbishment Programme D: Maintenance Total Infrastructure

27 ALLOCATIONS PER FUNDING SOURCE AND FACILITY TYPE Expanded Public Works 2017/18 Allocation Nature of investment R'000 Hospital CHC Clinic Other Total R'000 R'000 R'000 R'000 R'000 Programme A: New Programme B: Upgrade and additions Programme C: Repairs; Rehabilitation & Refurbishment Programme D: Maintenance Total Infrastructure

28 ALIGNMENT OF NATIONAL AND PROVINCIAL HEALTH INFRASTRUCTURE PRIORITIES AND IMPROVING INFRASTRUCTURE BUDGET EXPENDITURE Strategic objective statement Improved health facility planning and accelerate infrastructure delivery Indicator 1. Improve access to healthcare by increasing number of PHC facilities maintained 2. Number of PHC facilities constructed (new/replacement) Indicator Type Target No 30 (Cumulative 270/284) 8 (cumulative 14) Ehlanzeni: 2 Gert Sibande: 5 Nkangala: 1 Budget R , , Number of Hospitals under maintenance 31 34, Enhance patient care & safety and improving medical care by constructing Modern hi-tech hospitals 5. Improve maintenance of health facilities by appointing cooperatives 28 No 6 (Construction) Ehlanzeni: 2 Gert Sibande: 1 Nkangala: 3 16 Cooperatives appointed (cumulative 26) 1,009,504 Ehlanzeni (136,000) Gert Sibande (368,784) Nkangala (504,720) 19,042 Included under project costs RRR

29 Alignment of National and Provincial Health Infrastructure Priorities and Improving Infrastructure Budget Expenditure Strategic objective statement Indicator Indicator Type Target No Budget R 000 Improved health facility planning and accelerate infrastructure delivery 7. Number of health facilities that have undergone major and minor refurbishment in NHI Pilot District 25 PHC* (cumulative 40) Number of health facilities that have undergone major and minor refurbishment outside NHI pilot District (excluding facilities in NHI Pilot District) No 4 Hospitals 22 PHC 75, Hospitals (11,190) 22 PHC (64,650) 29

30 CATALYTIC PROJECTS No Project Name On-going Upgrading and Additions at Bethal Hospital (Phase 1) Construction Commencement of New Middelburg District Hospital Completion of Phase 1 for the New Mapulaneng Regional Hospital (Bulk Services, access road as well as Boundary Fencing Construction Commencement of Phase 2 for the New Mapulaneng Regional Hospital (Main Buildings and specilised mechanical installation Completion of the on going upgrading and additions at Mammethlake Hospital (Phase 1) Progress to date Completio n Date Allocated Budget (2017/18) R % 10 Sep Procurement Stage 29 Mar % 15 Sep Planning and Design 27 Sep % 30 Nov

31 CATALYTIC PROJECTS No. Project Name Progress to date Completio n Date Allocated Budget (2017/18) R % planning and design completion as well as construction commencement for the New Pankop Clinic Planning and Design 14 April % planning and design completion as well as construction commencement for the New Oakley Clinic Planning and Design 14 April % planning and design completion as well as construction commencement for the New Ka Nyamazane CHC Planning and Design 14 April % planning and design completion as well as construction commencement of a New Psychiatric ward at KwaMhlanga Hospital Planning and Design 15 Mar

32 INFRASTRUCTURE CAPACITY Directors: Health Technology; Infrastructure Planning, Programme Delivery and Engineering Deputy Directors: Finance OHS Maintenance x 2 Monitoring and Evaluation Property Management Health Technology x 4 Assistant Director: Finance Chief Engineer Chief Works Inspector Works Inspector x 2 Total 19/45 Artisans (day to day Maintenance) Name of trade No Carpenter 18 Electrician 19 Plumber 24 Builder 12 Painter 4 Plaster 1 Boiler 1 Mechanician 1 Total 80 32

33 IDEAL CLINIC INFRASTRUCTURE SUPPORT 56 backup generators installed in Primary Health Care facilities in the province Rollout of air-conditioners in the pharmacy and thermal controlled areas in facilities Gradual rollout of maintenance in district maintenance hubs by internal artisans, MRTT student artisans and cooperatives Frequent servicing of underground infrastructure e.g. septic tanks and pipes by contracted service providers Construction of guardhouses, waste storage areas, septic tanks, provision of jojo tanks and drilling of boreholes in various facilities 33

34 COMMON CHALLENGES FACING PROJECT DELIVERY The following are common problems that have affected infrastructure rollout:- Slow contractor performance; Re-works emanating from poor quality of works; Social protests resulting to disruption of works; Changes on scope of work; Delays in approval and connection of services such as electricity and water; Appointment of a new contractor after termination of poor performing contractor; Lack of capacity within DPWRT. Interventions Poor performing contractor s appointment terminated; Penalties applied on projects running behind schedule; Extension of time approved where necessary; Re-working of poor works at contractors own cost Coordination meetings at senior level for monitoring and evaluation. 34

35 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR 35

36 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR Legislative Framework Political Oversight NDOH Support A Long and Healthy Life for All South Africans Partnerships Provincial District 36

37 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR- CLINICAL HEALTH SERVICES: PROGRAMME BASED APPROACH Programme Priorities Programme 2 Main Focus Areas Strengthening of Primary Health Care Successes Challenges Remedial Budget allocation more biased towards District Health Services (59% of Departmental budget) Performance on Health Outcomes still not satisfactory in line with budget allocation Developed improvement Strategies that are implemented and monitored eg. Maternal and Neonatal Strategy 37

38 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR- CLINICAL HEALTH SERVICES: PROGRAMME BASED APPROACH Programme Priorities Programme 3 Main Focus Areas Successes Challenges Remedial Improve effectiveness of Emergency Medical Services Increased number of advanced life support staff from 3 to Station managers appointed. 143 EMS personnel appointed. 6 Obstetric ambulances procured EMS College started to provide refresher training for communication and operational staff Opening of five ambulance satellite bases in Morgenzon, Greenside, Daggakraal, Dwarsloop and Breyten. Response time still not within the expected norm Procure the Computer Aided Dispatch (CAD) System to monitor functionality of the EMS 38

39 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR- CLINICAL HEALTH SERVICES: PROGRAMME BASED APPROACH Programme Priorities Main Focus Areas Successes Challenges Remedial Programme 4 Provide a full package of regional services The Department has secured the services of the foreign qualified specialists majority of which are Cuban to improve the provision of the package of level 2 services. To date Ermelo hospital provides all eight core domain and Mapulaneng five domains and Themba Hospital six domains. Shortage of specialists Signed level agreement with Africa Health Placement to assist in recruiting scarce skills personnel. 39

40 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR- CLINICAL HEALTH SERVICES: PROGRAMME BASED APPROACH Programme Priorities Main Focus Areas Successes Challenges Remedial Programme 5 Provide a full package of Tertiary Health Services Establishment of the registrar programme, currently there are 28 registrars on the programme. Difficult to recruit and retain specialists because of the limited number. Train Registrars and Participation on National programme that recruit foreign work force. Programme 7 Pharmaceutical Services Implementation of CCMDD project, to date there are patients enrolled in the programme. Lack of IT control systems like RX solution at the main Depot and PHC facilities. Engage National Department of Health to assist with the installation of systems. 40

41 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR Sector Wide Approach Operates at the level of an entire health sector ensuring a strong focus on bringing together governments, donors and other stakeholders within any sector. The approach should involve: Government leadership. Developing a single sector policy (ideally a policy that addresses private and public sector issues) and a common realistic expenditure programme (budget framework) - this will ensure the success of implementation of NHI. Have a formalized process for donor co-ordination at National, Provincial and District levels with clearly defined donor procedures for reporting, budgeting, financial management and procurement. Improve efforts to increase the use of local systems for programme design and implementation, financial management, monitoring and evaluation. Skills transfer by Development Partners. 41

42 OTHER MATTERS TO ENSURE IMPROVED ALIGNMENT AND COORDINATION IN THE HEALTH SECTOR CONT Sector Wide Approach cont Establish fewer, more focused, better managed meetings. Implement new approaches of sharing basic information. Cluster health programmes. Health services to be delivered by teams (inter professional teams). Health services at the local level geographic area to be coordinated in one centre. Integrated patients file. Intersectoral collaboration- participating in IDP at all levels national, provincial and local. 42

43 RECOMMENDATIONS That the Standing Committee on Appropriations and Portfolio Committee on Health note the Mpumalanga Department of Health presentation on the effective co-ordination and alignment of national and provincial government in the delivery of health services so as to ensure value for money, efficient planning and resource allocation. 43

44 Thank you 44