DEPARTMENT OF HEALTH (VOTE 7) ANNUAL REPORT 2012/13

Transcription

1 (VOTE 7) ANNUAL REPORT 2012/ /13 Annual Report 1

2 PART A: GENERAL INFORMATION DEPARTMENT GENERAL INFORMATION LIST OF ABBREVIATIONS/ACRONYMS STRATEGIC OVERVIEW Vision Mission Values Strategic outcome orientated goals LEGISLATIVE AND OTHER MANDATES ORGANISATIONAL STRUCTURE ENTITIES REPORTING TO THE MINISTER/MEC FOREWORD BY THE MINISTER/MEC OVERVIEW OF THE ACCOUNTING OFFICER PART B: PERFORMANCE INFORMATION STATEMENT OF RESPONSIBILITY FOR PERFORMANCE INFORMATION AUDITOR GENERAL S REPORT: PREDETERMINED OBJECTIVES OVERVIEW OF DEPARTMENTAL PERFORMANCE Service Delivery Environment Service Delivery Improvement Plan Organisational environment Key policy developments and legislative changes STRATEGIC OUTCOME ORIENTED GOALS PERFORMANCE INFORMATION BY PROGRAMME Programme 1: Administration Programme 2: District Health Services Programme 3: Emergency Medical Services Programme 4: Provincial Hospitals Programme 5: Central and Tertiary Hospitals /13 Annual Report

3 5.6. Programme 6: Health Sciences and Training Programme 7: Health Care Support Services Programme 8: Health Facilities Management SUMMARY OF FINANCIAL INFORMATION Departmental receipts Programme Expenditure Transfer payments, excluding public entities Public Entities Conditional grants and earmarked funds paid Conditional grants and earmarked funds received Donor Funds Capital investment, maintenance and asset management plan PART C: GOVERNANCE INTRODUCTION RISK MANAGEMENT FRAUD AND CORRUPTION MINIMISING CONFLICT OF INTEREST CODE OF CONDUCT HEALTH SAFETY AND ENVIRONMENTAL ISSUES INTERNAL CONTROL UNIT AUDIT COMMITTEE REPORT PART D: HUMAN RESOURCE MANAGEMENT LEGISLATURE THAT GOVERN HR MANAGEMENT INTRODUCTION HUMAN RESOURCE OVERSIGHT STATISTICS Personnel related expenditure Employment and Vacancies Job Evaluation Employment Changes /13 Annual Report 3

4 3.5. Employment Equity Performance Rewards Foreign Workers Leave utilisation HIV/AIDS & Health Promotion Programmes Labour Relations Skills development Injury on duty Utilisation of Consultants PART E: FINANCIAL INFORMATION REPORT OF THE ACCOUNTING OFFICER ACCOUNTING OFFICER S STATEMENT OF RESPONSIBILITY REPORT OF THE AUDITOR GENERAL ANNUAL FINANCIAL STATEMENTS ANNEXURE /13 Annual Report

5 PART A: GENERAL INFORMATION 2012/13 Annual Report 5

6 1. DEPARTMENT GENERAL INFORMATION PHYSICAL ADDRESS: 18 College Street Polokwane 0699 POSTAL ADDRESS: Private Bag X 9302 Polokwane 0700 TELEPHONE NUMBER/S: FAX NUMBER: ADDRESS: WEBSITE ADDRESS : sipho.kabane2@dhsd.limpopo.gov.za /13 Annual Report

7 2. LIST OF ABBREVIATIONS/ACRONYMS Acronym AGSA AIDS ALOS ANC ART ARV AZT BBBEE CEO CFO DHIS DORA DOT DST ECP EMS ESMOE EU FIT HAART HAST HCT HCRW HDI Definition AUDITOR GENERAL OF SOUTH AFRICA ACQUIRED IMMUNO DEFICIENCY SYNDROME AVERAGE LENGTH OF STAY ANTENATAL CARE ANTI-RETROVIRAL THERAPY ANTI-RETROVIRAL ZIDOVUDINE BROAD BASED BLACK ECONOMIC EMPOWERMENT CHIEF EXECUTIVE OFFICER CHIEF FINANCIAL OFFICER DISTRICT HEALTH INFORMATION SYSTEM DIVISION OF REVENUE ACT DIRECTLY OBSERVED TREATMENT DISTRICT SPECIALIST TEAMS EMERGENCY CARE PRACTITIONERS EMERGENCY MEDICAL SERVICES ESSENTIAL STEPS TO MANAGE OBSTETRIC EMERGENCIES EUROPEAN UNION FACILITY IMPROVEMENT TEAMS HIGHLY ACTIVE ANTI-RETROVIRA THERAPY HIV AND AIDS, STI AND TB HIV COUNSELLING AND TESTING HEALTH CARE RISK WASTE HISTORICALLY DISADVANTAGED INDIVIDUAL 2012/13 Annual Report 7

8 Acronym HIV HOD HPR IMCI MEC MEDUNSA MHCU MCWH MDR MTEF NHI NHLS NIMART NPO NVP OPD PDE PFMA PHC PHIS PMTCT PPP PVC RV SASQAF SCM Definition HUMAN IMMUNO VIRUS HEAD OF DEPARTMENT HOSPITAL REVITILISATION PLAN INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES MEMBER OF EXECUTIVE COUNCIL MEDICAL UNIVERSITY OF SOUTH AFRICA MENTAL HEALTH CARE USER MOTHER AND CHILD AND WOMEN S HEALTH MULTIDRUG-RESISTANT MEDIUM TERM EXPENDITURE FRAMEWORK NATIONAL HEALTH INSURANCE NATIONAL HEALTH LABORATORY SERVICE NURSE INITIATED MANAGED ANTI-RETROVIRAL NON PROFIT ORGANISATION NEVIRAPINE OUT PATIENT DEPARTMENT PATIENT DAY EQUIVALENT PUBLIC FINANCE MANAGEMENT ACT PRIMARY HEALTH CARE PROVINCIAL HEALTH INFORMATION SYSTEM PREVENTION OF MOTHER TO CHILD TRANSMISSION PUBLIC PRIVATE PARTNERSHIPS PNEUMOCOCCAL CONJUGATE VACCINE ROTA VIRUS SOUTH AFRICAN QUALITY ASSURANCE FRAMEWORK SUPPLY CHAIN MANAGEMENT /13 Annual Report

9 Acronym SMS STI TB TR UBUR VCT XDR Definition SENIOR MANAGEMENT SERVICE SEXUALLY TRANSMITTED INFECTIONS TUBERCULOSIS TREASURY REGULATIONS USABLE BED UTILIZATION RATE VOLUNTARY COUNSELLING AND TESTING EXTREME DRUG RESISTANT 2012/13 Annual Report 9

10 3. STRATEGIC OVERVIEW 3.1. Vision An optimal and sustainable health care service in Limpopo 3.2. Mission The provision and promotion of a comprehensive, accessible and affordable quality health care service to improve the life expectancy of the people Values The Department adheres to the following values and ethics that uphold the Constitution of the Republic of South Africa: Caring and professionalism; Honesty and integrity; Fairness and equity; Respect and dignity; Efficiency and effectiveness; Teamwork and partnership; Patriotism; Transparency; and Innovation and quality Strategic outcome orientated goals The strategic goals of the Department as reflected in the five year strategic plan are indicated below: Strategic goal Goal statement Rationale Expected outcomes 1. Effective corporate governance provided Ensure an effective corporate governance system by 2014 Support the implementation of the Departmental plans and programs to improve service delivery Improved quality of health services by Appropriate human resources management and development provided Ensure appropriate HRM and development services by 2014 A need to optimize the realization of the strategic objectives of the Department through human resource management and development services Improved realization of the Department s objectives 3. Sound financial Ensure efficient and A need to ensure fiscal Improved /13 Annual Report

11 Strategic goal Goal statement Rationale Expected outcomes management practice promoted 4. Implementation of comprehensive care and management of HIV and AIDS,TB, STIs and other communicable and non communicable diseases accelerated 5. Strengthen District health and hospital services 6. Improve quality of health care 7. Improve Emergency Medical Services 8. Tertiary services developed 9. Improve infrastructure development and maintenance effective financial and supply chain management by 2014 Develop and implement plans for the provincial priority programs by 2014 Implement 80% of DHS components in all districts and sustainable outreach programme at all levels of care by 2014 Implement quality improvement plans in the districts and hospitals by 2014 Ensure that 90% of EMS calls are responded to within national norm of 15 minutes in urban areas and 40 minutes in rural areas by 2014 Tertiary/academic services increased from 22 to 37 in line with the Modernisation of Tertiary Services Document Implement a reviewed 5 year infrastructure development and maintenance plan by discipline and optimisation of resource allocation A need to reduce morbidity and mortality related to the burden of diseases A need to ensure equitable access to health care services Improve client satisfaction and clinical outcomes A need to respond to calls within the norm in order to save lives Improved and increased access to tertiary services in the province Developed teaching platform in the province Reduced referrals to other provinces Health service delivery needs for additional infrastructure expansion accountability on financial resources resulting in well funded and managed health services Reduced morbidity and mortality Improved access to health services Reduced morbidity and mortality in the province Improved client satisfaction and patient safety Reduce morbidity and mortality Increased access to tertiary services Improved access and quality of health services 2012/13 Annual Report 11

12 Strategic goal Goal statement Rationale Expected outcomes 2014 Health services provided in accessible, safe and maintained buildings 4. LEGISLATIVE AND OTHER MANDATES The following national legislation and policy documents form the legal and policy framework being implemented within the Department. National Health Act 61 of 2003 Provides for a transformed National Health System for the entire Republic. Mental Health Care Act, Act 17 of 2002 Provides a legal framework for mental health services in the Republic. Medicines and Related Substance Act, 101 of 1965 Provides for the registration of medicines and other medical products to ensure their safety and efficacy. Medical Schemes Act, 131 of 1998 Provides for the regulations of the medical schemes industry to ensure consonance with National Health objectives. Council for Medical Schemes Levy Act, 58 of 2000 Provides for legal framework for the council to charge medical schemes certain fees. Choice on Termination of Pregnancy Act 92 of 1996 Provides a legal framework for choice on termination of pregnancy. Sterilisation Act, 44 of 1998 Provides a legal framework for sterilizations, also for persons with mental health challenges. Tobacco Products Control Act 12 of 1999 Provides for the control of tobacco products, prohibition of smoking in public places advertisements of tobacco products as well as sponsoring of events by the tobacco industry. National Health Laboratory Services Act 37 of 2000 Provides for statutory body that provides laboratory services to the public health sector. Pharmacy Act 53 of 1974 as amended by no 1 of 2000 Provides for the regulation of pharmacy profession, including community service pharmacists. Nursing Act, of 2005 Provides for the regulation of nursing profession /13 Annual Report

13 Health Professions Act, 56 of 1974 Provides for the regulation of health profession, in particular, medical practitioner, dentists, psychologists and other related health professions, including community services by these professionals. Allied Health Professions Act, 63 of 1982 Provides for the regulations of health practitioners like chiropractors, homeopaths, etc. and for the establishment of a council to regulate this professions. Hazardous Substances Act 15 of 1973 Provides for the control of hazardous substances, in particular those emitting radiation. Foodstuffs, Cosmetics and Disinfectants Act 54 of 1972 Provides for the regulation of foodstuffs, cosmetics and disinfections, in particular, safety and quality standards that must be complied with. Occupational Diseases in Mine and Works Act 78 of 1973 Provides for medical examinations on persons suspected of having contracted occupational diseases. Occupational Health and Safety Act 85 of 1983 Provides for the requirements that employers must comply with in order to create a safe working environment for employees in workplaces. Academic Health Centres Act 86 of 1993 Provides for the establishment, management and operation of academic health centres. Older Persons Act no.13 of Provides a framework for the empowerment and protection of older persons. Children s Amendment Act 38 of 2005 Provides the framework for the care and protection of children. Non-profit Organisation Act,1997 Provides framework for the regulations of non-profit organizations. Health Professions Councils Act of South Africa Provides a regulatory framework for the practice of health professionals. South African Nursing Act 33 of 2005 Regulates the nursing profession. Traditional Health Practitioners Act, 2004 Provides for regulatory framework to ensure the efficacy, safety and quality of traditional health care services /13 Annual Report 13

14 5. ORGANISATIONAL STRUCTURE Figure 1: Organisational Structure Ms. MS Dipou Letsatsi Letsatsi-Duba Member of Executing Authority (MEC): Department of Health and Social Development Dr. S. Kabane The Accounting Officer for the Department of Health responsible for: - Health Services - Financial Management - Corporate Services - Strategic Planning, Policy and Monitoring - Academic and Tertiary Development - Communication and Media Liaison - Risk Management Head of Department L16 MEC Management support The unit responsible for the overall support and management of the MEC s office Dr M Nkadimeng Ms ND Nyathikazi Mr P.J Ramawa Mr FP Mushwana Mrs J Molapelo Branch: Health Services This component is responsible for the provision of: - Health care support - Health special programmes - Hospital services - District management services Senior General Manager L15 Branch: Academic & Tertiary Development The component deals with matters related to the: - development of academic health and medical school - support of telemedicine Senior General Manager L15 Branch: Strategic Planning, Policy and Monitoring The component is responsible for: - Policy, strategy and planning services - Transformation and transversal services - Monitoring and evaluation General Manager L14 Branch: Financial Management The component is responsible for: - Financial budgeting and revenue - Financial accounting - Supply chain management - Physical facilities management and maintenance Chief Financial Officer L15 Branch: Corporate Services Corporate Services deals with functions such as: - Human resources management & development - Human resources planning & research - Government information management and technology - Legal services - Security management Senior General Manager L /13 Annual Report

15 6. ENTITIES REPORTING TO THE MEC The Office of the MEC has put in place structures of governance to assist the Department to effectively deal with the transformation agenda and other policy matters. These structures inter-alia includes the following entities which reports to the MEC for the Department of Health and Social Development: The table below indicates the entities that report to the MEC. Hospital boards Name of Entity Mental Health Review boards Legislative Mandate National Health Act,61 of 2003,section 41 Mental Health Care Act 17 of 2002 Financial Relationship Hospitals pay members travel and subsistence at the rate applicable to public services Members are paid by Districts as follows: Chairperson: R 380 per hour per sitting Nature of Operations To provide oversight regarding provision of patient care Make decisions with regard to assisted or involuntary mental health care, treatment and rehabilitation services Mental health practitioners R 330 per hour per sitting District Health Councils Clinic and community health centre committees National Health Act,61 of 2003,section 31 National Health Act,61 of 2003,section 42 Community representative: R 280 per hour per sitting No payments made to the council No payment made to the committees A District Health Council : (a) Promote co-operative governance; (b) Ensure co-ordination of planning, budgeting, provisioning and monitoring of all health services that affect residents of the health district for which the council was established; and (c) Advise the relevant members of the Executive Council, through the Provincial Health Councils, and the municipal council of the relevant metropolitan or district municipality, on any matter regarding health or health services in the health district for which the council was established. To provide oversight regarding provision of patient care 2012/13 Annual Report 15

16 FOREWORD BY THE MEC It is my pleasure to present the 2012/13 annual report of the Department of Health, Limpopo, for the period 01 April 2012 to 31 March 2013, in compliance with Section 40 of the Public Finance Management Act, 1999 (Act No. 1 of 1999). The Constitution of the Republic of South Africa imposes on us the responsibility to provide quality and accessible healthcare services. This requires of us to design and execute programmes geared towards ensuring universal access to quality and uninterrupted healthcare services by all our citizens regardless of their socio-economic conditions. This report provides progress on the 2012/13 annual performance plan as well as the overall departmental performance against the set targets for the financial year. It therefore gives a reflection on what has and what has not been achieved, and some of the underlying constraints to guide future planning. The Department will continue to prioritize interventions aimed at achieving the outputs defined in the Negotiated Service Delivery Agreement (NSDA) for Outcome 2: A long and health life for all South Africans, namely, increasing life expectancy, decreasing maternal and child mortality, combating HIV and AIDS and decreasing the burden of disease from Tuberculosis and Strengthening Health System effectiveness (output 4). During the financial year under review the Department made significant strides to achieve a number of outputs and outcomes, including the following: o Worked with key stakeholders to market and promote awareness about the NHI, and launched Facility Improvement Teams (FITs) to assess the status of health infrastructure and make proposals for the necessary improvements. o Accelerated access and provision of quality Primary Health Care services by increasing the number of healthcare facilities rendering 24 hours services, improving the PHC facilities supervisory rate and increasing the resident doctor rate. o Intensified Maternal, Child and Women s Health (MCWH) and Nutrition services by continuing to roll out the Integrated School Health Programme and increasing the immunisation coverage of children under 1 year. o Increased Cervical Cancer screening coverage and intensified prevention and disease control through anti-malaria indoor residual spraying o Intensified the combating of HIV and AIDS and decreasing the burden of disease from Tuberculosis by testing more pregnant women for HIV, initiating patients on Lifelong ART, recording improvement on HIV testing rate and TB treatment success rate. o Provided more accommodation units for health professionals and appointed suitably qualified CEOs for hospitals in the province /13 Annual Report

17 2012/13 Annual Report Vote 7: Limpopo Department of Health The year under review will also be remembered for many challenges with which we were hamstrung in our quest to deliver quality and uninterrupted healthcare services, some of which are: o General under-funding of the Department. o Shortage of some medicines due to funding constraints, especially during the last three months or quarter of 2012/13 financial year. o Inadequate funding of compensation of employees. o Fast deteriorating infrastructure in some facilities which create conditions not conducive to providing effective and efficient healthcare services. The Department is committed to refocusing priorities to interventions aimed at making positive progress towards achieving its five-year strategic goals. In this respect, the following outcomes are targeted for the financial year 2013/14: o Improved quality of and access to healthcare services o Improved realisation of the Department s objectives o Improved accountability on financial resources, which should result in well-funded and managed healthcare services o Reduced Morbidity and Mortality as well as improved patient care The Department recognises the contribution of all health sector stakeholders, including civil society, in the achievement of the progress reported in this annual performance report. Performance improvements were also made possible by the multitude of all categories of health workers in the sector, sometimes working under challenging conditions, especially in the rural and hard-to-reach parts of the Province. I commend the dedicated and productive health workers and also implore those health workers whose work ethics, behaviour and conduct hold back sector progress, and appeal to them to improve. Notwithstanding all that we have planned to implement and achieve in 2013/14, it has to be borne in mind that there are variables that are and will always remain beyond the control of the Department due to the nature of resources, capacity and other challenges confronting our healthcare system. However, I remain confident that through sound managerial and leadership practices, the support of all sector stakeholders, and building on the lessons drawn from previous financial years performance, we will achieve our set targets. Ms Dipou Letsatsi-Duba Date Member of the Executive Council (MEC) Department of Health /13 Annual Report 17

18 7. OVERVIEW OF THE ACCOUNTING OFFICER The Public Finance Management Act and other related pieces of legislation bestows on me as the accounting officer, the responsibility to account on annual basis on both the progress made and the challenges encountered in the process of executing our service delivery plans articulated in our Annual Performance Plan. In line with this responsibility and through this Annual Report, I hereby present the progress made by the Department in the Financial Year 2012/13 and the challenges encountered in the execution of this responsibility. We entered the financial Year 2012/13 with the clear mandate to carry forward the commitment we have made in previous financial years for the attainment of optimal and sustainable health care service to the people of Limpopo. This we have done with the support of the National Department of Health, which intervened through the section 100 (1)(b) of the Constitution of the Republic of South Africa, Act 108 of The support of the intervention team in the key focus areas of Learning and Organisational Realignment; Human Resources Management; Governance and Financial Management; Pharmaceutical Supplies Management; and Infrastructure Management was instrumental in the achievements reported in this report. The Annual Performance Plan was geared towards attaining the outcomes and objectives of both Social Cluster Programme of Action and the Negotiated Service Delivery Agreement (NSDA) of the Health Sector. In this regard we made a remarkable progress to achieve the following outcomes: Increasing Life Expectancy; Decreasing Maternal and Child mortality; Combating HIV and AIDS and decreasing the burden of diseases from Tuberculosis; and Strengthening Health System Effectiveness In order to strengthen health system effectiveness the Department engaged in Primary Health Care re-engineering process and valuable progress has been recorded in this regard. The District Specialist Teams (DSTs) have been appointed in the financial year 2012/13 as part of the re-engineering process. We have also ensured appointment of Chief Executive Officers (CEOs) in most of the hospitals so as to ensure strategic institutional leadership. We strongly hold that this will go a long way in addressing the challenge of lack of strategic leadership has negatively affected our facilities in the previous financial year. The department has worked hard to combat HIV and AIDS and decrease the burden of disease from Tuberculosis by among others:- Number of male medical circumcisions performed has been increased /13 Annual Report

19 Ensuring that all ARV sites are fully functional Improving our DOT support programme Using the GenExpert machines to improve detection and early diagnosis of TB patients Although more work has been done to ensure achievement of targets set in the Annual Performance Plan, the financial year 2012/13 was not immune from challenges. These challenges included:- Shortage of staff and particularly health professionals Budgetary constraints Infrastructural challenges Shortage of drugs and surgical sundries We have no doubt that the interventions we have sought in trying to resolve some of these noted challenges will go a long way to impact positively in the next financial year and beyond. The noted progress will serve as a necessary foundation upon which future planning will be based. The progress recorded could not have been possible without the efforts, dedication and support of the staff in the Department. I commend the commitment of the Executive Management, the entire staff and the Administration Intervention Team to providing a better health care service to the people of our Province. Dr S. Kabane HEAD OF DEPARTMENT OF HEALTH Date /13 Annual Report 19

20 PART B: PERFORMANCE INFORMATION /13 Annual Report

21 1. STATEMENT OF RESPONSIBILITY FOR PERFORMANCE INFORMATION Statement of Responsibility for Performance Information for the year ended 31 March 2013 The Accounting Officer is responsible for the preparation of the department s performance information and for the judgements made in this information. The Accounting Officer is responsible for establishing, and implementing a system of internal control designed to provide reasonable assurance as to the integrity and reliability of performance information. In my opinion, the performance information fairly reflects the performance information of the department for the financial year ended 31 March Dr Ms S. D Kabane Mafubelu Accounting Officer : Limpopo Department of Health Date: /13 Annual Report 21

22 2. AUDITOR GENERAL S REPORT: PREDETERMINED OBJECTIVES The AGSA currently performs the necessary audit procedures on the performance information to provide reasonable assurance in the form of an audit conclusion. The audit conclusion on the performance against predetermined objectives is included in the report to management, with material findings being reported under the Predetermined Objectives heading in the Report on other legal and regulatory requirements section of the auditor s report. Refer to page XXXX 209 of the Report of the Auditor General, published as Part E: Financial Information. 3. OVERVIEW OF DEPARTMENTAL PERFORMANCE 3.1. Service Delivery Environment The Department s overall performance; that is its key outputs, particularly relating to services rendered directly to the public, including how facilities were utilised by the public is discussed hereunder: Department s key outputs and services rendered to the public during 2012/13 financial year Strengthening Health Care System effectiveness In strengthening health care system effectiveness, the following were achieved: Using the National Health Insurance (NHI) funding, the Department procured diagnostic and basic medical equipment for eight (8) community health centres and fifty six (56) PHC clinics in Vhembe District 196 patient chairs were purchased to ensure that 70 PHC facilities have wellfurnished consultation rooms. Conducted National Core Standards assessment on the six (6) ministerial priorities in 297 (105 in 2011/12) health facilities in 2012/13 Comprehensive primary health care services In accelerating access and provision of quality primary health care services the following were achieved: 272 of 443 Primary health care facilities provided 24 hours on call system 65 of 443 Primary health care facilities provided 24 hours services 93% of Fixed PHC facilities had monthly supervisory visit 32.5% of CHCs/CDCs had a residential doctor rate /13 Annual Report

23 Maternal, Child and Women s Health (MCWH) And Nutrition Programme In intensifying Maternal, Child and Women s Health (MCWH) and Nutrition services the following were achieved: Immunisation coverage under 1 year was targeted at 90% and the actual achievement is reported as 93.8% Diarrhoea incident under 5(five) reduced from 164.1/1000 to 160.4/1000 Ante natal care coverage increased from 41% to 42% Delivery of women below 18 years reduced from 8.1% to 7.8% 35 PHC facilities implementing youth friendly services 32 hospitals accredited as mother and baby friendly Cervical cancer screening coverage has been reported at 61.7% in the 2012/13 financial year as compared to the 60.2% reported in the 2011/12 financial year. Health Care Professionals Trained on ESMOE increased from 0 in 2011/12 financial year to 212 in the 2012/13 financial year. Prevention and Disease Control Programme Cholera outbreak was contained in one district (Vhembe) where one patient was confirmed positive Appointment and functionality of outbreak response team in the 5 districts and the Provincial head office Comprehensive HIV and AIDS, STI and TB Programme In combating HIV and AIDS and decreasing the burden of disease from Tuberculosis: Maternal HIV vertical transmission was reduced from 4.9% to 2.4% patients initiated on lifelong ART. Patients remaining in care on ART improved from to HIV testing rate among TB patients improved from 89.3% in the 2011/12 financial year to 90.1% in the 2012/13 financial year TB treatment success rate has improved from 77.8% in 2011/12 financial year to 78.6% in the 2012/13 financial year Medical Male Circumcisions improved from to /13 Annual Report 23

24 3.1.2 Problems encountered by the department when providing the relevant services The following are challenges which the Department had in rendering of Health services: Programme 1 High vacancy rate Asset management Underfunded vote Programme 2 Insufficient number of health professionals and Support staff Patients by-passing Primary Health Care facilities to Hospitals and Private doctors Inadequate Pharmaceutical supplies (inability of contracted suppliers to deliver) Inadequate and inappropriate health infrastructure Inadequate Medical Equipment and Office Equipment Programme 3 Shortage of Emergency Medical Services vehicles Radio communication network not functioning well Shortage of Emergency Equipment Shortage of Emergency Care Practitioners Programme 4 and 5 Insufficient number of Specialists Infrastructural challenges Inadequate Medical Equipment Inappropriate referral pattern Programme 6 Shortage of Nurse Educators Programme 7 Shortage of medicines and Pharmaceutical sundries. Infrastructural challenges Shortage of equipment Programme 8 Inadequate maintenance budget Inadequate grants for Revitalisation of Health Facilities Delays in completion of projects by Department of Public Works /13 Annual Report

25 3.1.3 Corrective steps to be taken in dealing with challenges encountered in providing services in 2012/13 financial year Motivate for additional funding for the recruitment, appointment and retention of staff(including health professionals) Continue with Physical asset verification for the remaining institutions Continue with monthly reconciliation of asset register with expenditure report Motivate for funding of upgrading and building of facilities Improve Pharmaceutical supplies to health facilities Conduct community awareness on health services Intensify counseling and HIV awareness programmes Procurement of equipment should be prioritized Procure additional EMS vehicles in 2013/14 financial year Appoint additional EMS staff in 2013/2014 financial year. Implement Recruitment and Retention strategy To implement the direct delivery of Pharmaceutical supplies to facilities Appointment of sponsored nurse educators Significant developments, external to the department, that impacted on the demand for the department s services and the department s ability to deliver those services There was no significant activities that occurred outside the department that impacted negatively on the provision of services by the Department 3.2. Service Delivery Improvement Plan The department has completed a service delivery improvement plan. The tables below highlights the service delivery plan and the achievements to date. Main services provided and standards Main services Actual customers Potential customers Standard of service Antenatal care Communities Communities 100% of public health facilities achieving a target of 62% for women attending Ante natal care clinic before 20weeks Family planning Communities Communities All facilities to make available all methods of contraception to women and men in the child bearing age and reduce unplanned pregnancies target 45%( f ) Actual achievement against standards Facilities achieved 41.9%( of ) Unplanned pregnancy reduced to 41.5%( of ) Maternal health Pregnant women Public health facilities of Limpopo providing Maternal Mortality reduced to 159.9/ live births Mortality rate 198.8/ /13 Annual Report 25

26 Main services Women s health Actual customers Teenagers Women Potential customers maternal health services Teenagers Women Standard of service 6.5 Reduced teenage pregnancy( of Reduce mortality due to invasive cancer of the cervix by 65 % Primary health care Communities Communities Public health facilities in Limpopo providing child health services( 60% IMCI saturation (400 out of 464 )) Child health Communities Communities 300 School children Pregnant women Children months Children under 5 year Children under 5 year School children New born Facilities in Limpopo Children under 5 year Children under 5 year Public health facilities in Limpopo providing child health services with Community Component of IMCMI Provide routine Integrated School Health Programme to Grade 1,4,8 and 10 learners in quintile 1 & 2 schools as per health services package to 3931 Reduce still birth rate through providing quality maternal health services at all level of care ( 2%) Provide vitamin A supplementation to all children in the target age(12-59month ) group to improve quality of life and health status55% of ) Provide Rota Virus vaccination and implement IMCI in all public health facilities. Engage community health workers to encourage breast feeding( diarrhoea incidence to 175/1000 Provide Pneumococcal Vaccine and implement IMCI in all public health facilities to reduce mortality due to pneumonia in children under 5years of age(48/1000) Actual achievement against standards Reduced by.5 %(9 649 of ) 6% coverage( of ) 407 out of 464 facilities 301 facilities implementing community component of IMCI Provide routine Integrated School Health Programme provided to 2959 Birth rate reduced to 2.3% Coverage was 36.6%( of ) Achievements:165.7 /1000 Mortality reduced to 4.6/ /13 Annual Report

27 Main services Actual customers Potential customers Standard of service in all public health facilities to reduce mortality due to pneumonia in children under 5years of age(48/1000) Actual achievement against standards Nurse training Learners that have passed Matric with entry requirement into Bachelor Degree Learners that have passed Matric with entry requirement into Bachelor Degree 250 professional nurses with Matric and entry requirement into Bachelor Degree, from all health facilities in Limpopo, are trained for a period of four years, by beginning of 2012/2013 financial year Only 152 trained HIV and AIDS counselling and testing Registered nurses with Matric Communities/ HIV and AIDS patients Communities/H IV and AIDS patients 120 post basic nurse professionals from all health facilities with matric are trained for 44 weeks by the end of June 2013 Provide HIV and AIDS counselling and testing 206 trained patients initiated on lifelong ART patients (Children and Adults) on ART 97.6% HIV Testing rate Pharmaceutical and Laboratory services Communities Communities Render health care support services to the entire Health Care Services Availability of medicine :92%-95% Percentage availability of Essential Medicines is 59.01% at the Depot, 79.68% at Hospitals and 72.75% at clinics 2012/13 Annual Report 27

28 Type of arrangement Consultation arrangements with customers Actual Customers Potential Customers Actual achievements Door to door campaign Public Public Held in March 2013 in Vhembe TB campaigns Public Public 182 campaigns conducted in all the districts TB DAY Public Public Held in March 2013 Wold Aids Day Public Public World AIDS day conducted in Waterberg District in December 2012 STI Condom week Public Public Conducted in institutions of high learning March 2013 Service delivery access strategy Access Strategy Annual performance Plans PHC 24 hours services PHC on call system Actual achievements 2012/13 produced, published and available on the Departmental website under documents 65 of 443 Primary health care facilities rendered 24 hours services 272 Primary health care facilities rendered 24 hours services on call system Service information tool Types of information tool Departmental annual reports Pamphlets Health Awareness days Published service standards Departmental website Citizens reports Actual achievements Annually prepared and submitted to provincial legislature and also available to the public Distributed to the public Are conducted as per the health calendar Available at health facilities and departmental webside under documents tab Information is available Presented during health summits in all five Districts /13 Annual Report

29 Complaints mechanism Complaints Mechanism Complaint/Suggestion Boxes Provincial Complaints Database Provincial Complaints Policy Guideline Complaint Register(s) Provincial Complaint Toll-Free number Provincial Complaint Procedure Manual Provincial Complaint Flow chart Actual achievements All Hospitals(40), five Districts Health Offices and Clinic /Health Centres have Suggestion Boxes Provincial Complaints Data-base in all Facilities available Provincial Complaints policy guideline There are Complaints registers in all the Hospitals, District Office and PHC facilities Provincial Toll-Free number available Provincial Complaint Procedure Manual Developed Provincial Complaint Flow chart available 3.3. ORGANISATIONAL ENVIRONMENT FOR 2012/13 FINANCIAL YEAR a) Successes Governance structures District Health Councils have been appointed during the 2012/13 financial year whose function is the co-ordination of planning, budgeting, provisioning and monitoring of all health services that affect residents of the health district for which the council was established. However inauguration of the councils is still pending Chief Executive Officers have been appointed in most of the Hospitals in order to strengthen the leadership and improve institutional/hospital leadership Acting Chief Financial Officer was seconded from National Department of Health in order to improve financial management in the Department b) Challenges During the 2012/13 financial year, the Department has encountered the following challenges: c) Mitigating factors Budget shortfall had impacted negatively to the Departmental objectives particularly: Procurement of key equipment Procurement of Pharmaceuticals and medical sundries Appointment of Health professionals and key support staff Training of health Professionals Provisioning and improvement of Health Facilities The mitigating factors include: Cost containment measures Motivation for additional funding to cover the health services 2012/13 Annual Report 29

30 3.4. KEY POLICY DEVELOPMENTS AND LEGISLATIVE CHANGES The Department has developed adverse events guideline which was in the process of approval at 31 March 2013 Risk Management Policy is still in the process of review and approval 4. STRATEGIC OUTCOME ORIENTED GOALS The strategic outcome oriented goals of the Department as reflected in the five year strategic plan are indicated below per programme: Programme 1: Administration The purpose of the programme is to provide strategic management and overall administration of the department including rendering of advisory, secretarial and office support services through the sub programmes of Administration and Office of the MEC. a) Effective corporate governance provided The Department has achieved the following with regard to this goal: 300 Institutions conducted risk assessments in the 2012/13 financial year Conducted National Core Standards assessment on the six (6) ministerial priorities in 297 health (105 in 2011/12) facilities in 2012/13 b) Appropriate human resources management and development provided The Department has achieved the following with regard to this goal: Financial constraints have negatively affected the recruitment and retention of personnel which resulted in the vacancy rate for the Department being at 43.1%. 206 post basic nurse professionals trained in the 2012/13 financial year c) Sound financial management practice promoted The Department has achieved the following with regard to this goal: The Department collected revenue of R million in the 2012/13 financial year The Department had during the 2012/13 financial year reviewed its Supply Chain Management Policies and Procedures Special projects were undertaken by the Department for the improvement of the assets management with the aim of having a credible asset register Programme 2: District Health Services The purpose is to render Primary Health Care Services and District Hospital. d) Implementation of comprehensive care and management of HIV and AIDS,TB, STIs and other communicable and non-communicable diseases accelerated The Department has achieved the following with regard to this goal: /13 Annual Report

31 Maternal HIV vertical transmission reduced from 4.9% to 2.4% patients initiated on lifelong ART. Patients remaining in care improved from to HIV testing rate among TB patients improved from 89.3% in the 2011/12 financial year to 90.1% in the 2012/13 financial year TB treatment success rate has improved from 77.8% in 2011/12 financial year to 78.6% in the 2012/13 financial year Medical Male Circumcisions improved from to Cholera outbreak was contained in Vhembe where only one patient was confirmed positive Appointment and functionality of outbreak response team in the 5 districts and the Provincial head office e) Strengthen District health and hospital services The Department has achieved the following with regard to this goal: All five (5) District Health Councils have been established during the 2012/13 financial year to assist in the planning, budgeting, provisioning and monitoring of all health services f) Improve quality of health care The Department has achieved the following with regard to this goal: Using the National Health Insurance (NHI) funding, the Department procured diagnostic and basic medical equipment for eight (8) community health centres and fifty six (56) PHC clinics in Vhembe District 196 patient chairs were purchased to ensure that 70 PHC facilities have wellfurnished consultation rooms and waiting areas in the Vhembe district utilising the NHI funding Programme 3: Emergency Medical Services The aim of the program is to render pre-hospital Emergency Medical Services including Inter-hospital transfers and Planned Patient Transport. g) Improve Emergency Medical Services Programme 5: Central and Tertiary Hospitals The purpose of the programme is to provide tertiary health services and create a platform for training of health professionals and research h) Tertiary services developed The Department has achieved the following with regard to this goal: Retention of medical specialists Appointment of two Chief Executive officers for Polokwane/Mankweng Complex 2012/13 Annual Report 31

32 Programme 8: Health Facility Management The purpose of the programme is to plan provide and equip new facilities/assets and upgrade rehabilitate and maintain hospitals clinics and other facilities. i) Improve infrastructure development and maintenance The Department has achieved the following with regard to this goal: Fifteen (15) new and upgraded PHC facilities Thirty (30) health institutions provided with own source of water Thirty (30) health institutions provided with pollution free sanitation units Two (2) health institutions with upgraded electrical supply Construction of two (2) EMS facilities Construction of fifty (50) single units for staff accommodation Repair of 38 boilers in nineteen(19) hospitals /13 Annual Report

33 5. PERFORMANCE INFORMATION BY PROGRAMME 5.1 PROGRAMME 1: ADMINISTRATION PROGRAMME PURPOSE The purpose of the programme is to provide strategic management and overall administration of the department including rendering of advisory, secretarial and office support services through the sub programmes of Administration and Office of the MEC Sub-programmes Corporate Services Financial Management MEC s Office HoD s Office Strategic Objectives effective corporate governance provided; appropriate human resource management and development provided and Sound financial management practice promoted 2012/13 Annual Report 33

34 TABLE 2: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: ADMINISTRATION Performance indicator Type Actual Achieve ment 2011/20 12 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1.Medical officers per 100,000 people 2.Professional nurses per 100,000 people No No baseline 17 No No baseline None None 3.Pharmacists per 100,000 people No No baseline None 4.Vacancy rate for professional nurses % 40% (5 324/13 473) 5.Vacancy rate for doctors % 62.7% (1816/2892 ) 44% (6414 of 14478) 65% (1904 of 2931) 42,3% (6125 of 14478) 61% (1786 of 2931) 1.7% None 4% None 6.Vacancy rate for medical specialists % 80% (325/404) 79% (333 of 419) 77,8% (326 of 419) 1.2% None 7.Vacancy rate for pharmacists % 19% (107/559) 37% ( 211 of 573) 32% ( 183 of 573) 5% None /13 Annual Report

35 TABLE 2: 2012/2013 ANNUAL PERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: ADMINISTRATION Performance indicator Type Actual Achieve ment 2011/20 12 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1.Medical officers per 100,000 people 2.Professional nurses per 100,000 people No No baseline 17 No No baseline None None 3.Pharmacists per 100,000 people No No baseline None 4.Vacancy rate for professional nurses % 40% (5 324/13 473) 5.Vacancy rate for doctors % 62.7% (1816/2892 ) 44% (6414 of 14478) 65% (1904 of 2931) 42,3% (6125 of 14478) 61% (1786 of 2931) 1.7% None 4% None 6.Vacancy rate for medical specialists % 80% (325/404) 79% (333 of 419) 77,8% (326 of 419) 1.2% None 7.Vacancy rate for pharmacists % 19% (107/559) 37% ( 211 of 573) 32% ( 183 of 573) 5% None 2012/13 Annual Report 35

36 Reasons for All Deviations for Programme 1: Administration Financial Constraints Duplicate asset numbers in the assets registers Misclassification of assets Asset register not agree with Annual Financial Statements Inability to recruit and retain health professionals Strategy to overcome areas of under performance Despite the challenges faced by the Department, the following strategies have been put in place to improve the quality of health service and meet targets: Continue with Physical asset verifications in the remaining institutions Continue with monthly reconciliations of asset register with expenditure report Encourage the public to pay for the services they received, through campaigns and community engagement programmes Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature /13 Annual Report

37 Linking performance with budgets Sub-programme expenditure: Administration 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expendi ture (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 MEC MANAGE MENT 335 TOTAL /13 Annual Report 37

38 5.2 PROGRAMME 2: DISTRICT HEALTH SERVICES PROGRAMME PURPOSE The purpose is to render Primary Health Care Services and District Hospital Sub-programmes Primary Health Care Services ( District management Community Health Centres Clinics Community Based Services Other community services) District hospitals; HIV and AIDS Sexually Transmitted Infections (STI) and Tuberculosis (TB) Control Programmes; Mother and Child and Women s Health and nutrition (MCWHN) ; and Disease Prevention and Control Strategic objectives Strengthening district health and hospital services; improving quality of health care; implementation of comprehensive care and management of HIV and AIDS TB STIs and other communicable and non-communicable diseases; Accelerated disease prevention and control /13 Annual Report

39 SUB-PROGRAMME 2.1: DISTRICT MANAGEMENT COMMUNITY HEALTH CENTRES CLINICS COMMUNITY BASED SERVICES AND OTHER COMMUNITY SERVICES TABLE 4: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: DISTRICT MANAGEMENT COMMUNITY HEALTH CENTRES CLINICS COMMUNITY BASED AND OTHER COMMUNITY BASED SERVICES Strategic objective Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Strengthen PHC service delivery systems Number of Districts with functional District Management Teams Number of districts implementing the District Health Plan Number of PHC facilities providing 24 hours service Number of PHC facilities on call systems 5 of None 5 of None 53 of of of Shortage of staff 296 of of of Shortage of staff Dilapidating infrastructure 2012/13 Annual Report 39

40 TABLE 5: 2012/2013 ANNUAL PERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME DISTRICT MANAGEMENT COMMUNITY HEALTH CENTRES CLINICS COMMUNITY BASED AND OTHER COMMUNITY BASED SERVICES Indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievem ent 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Provincial PHC expenditure per uninsured person R R R464 R750 R 286 Low headcount due to patients by-passing PHC to higher levels of care and other service providers 2. PHC total headcount No m Low headcount due to patients by-passing PHC to higher levels of care and other service providers 3. PHC total headcount under 5 years No R Low headcount due to patients by-passing PHC to higher levels of care and other service providers 4. Utilisation rate PHC % 2.8% 3% 2.7% 0.36% Low headcount due to patients by-passing PHC to higher levels of care and other service providers 5. Utilisation rate under 5 years- PHC % 6.3% 7% 6% 1% Low headcount due to patients by-passing PHC to higher levels of care and other service providers 6. Fixed PHC facilities with a monthly supervisory visit rate % 85.9% 65% 92.3% 28% Strengthened supervisory visits to the facilities /13 Annual Report

41 Indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievem ent 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 7. Expenditure per PHC headcount R R R167 R256 R 89 Low headcount due to patients by-passing PHC to higher levels of care and other service providers 8. Percentage of complaints of users of PHC services resolved within 25 days % 61.7% 70% 54.9% 15.10% Complexity of complaints 9. CHCs/CDCs with resident doctor rate % No Baseline 7.4 % (2 of 27) 18.5% 5/27 11% 3 more doctors were appointed in Mopani District 10. Number of PHC facilities assessed for compliance against the 6 priorities core standards No Increased capacity at District level 2012/13 Annual Report 41

42 SUB-PROGRAMME 2.2: DISTRICT HOSPITALS TABLE 6: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: DISTRICT HOSPITALS Indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievemen t 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Caesarean section rate 17% 15% 18.1% 3.1% Within performance range 2. Separations Total None 3. Patient Day Equivalents Total None 4. OPD Headcounts Total None 5. Average length of stay 4.5 days 4 days 4.3 days 0.64days None 6. Bed utilisation rate 71.7% 65% 72.2% 7% None 7. Expenditure per patient day equivalent ( PDE) R R1 814 R2 050 R Escalating costs of key accounts for example NHLS security Increased theatre utilization 8. Percentage of complaints of users of District Hospital Services resolved within 25 days 70% 100% 75.2% 2016/ % 666/2682 Complexity of complaints /13 Annual Report

43 Indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievemen t 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 9. Percentage of District Hospitals with monthly Mortality and Morbidity Meetings 68% 100% (30 of 30) 92% 28/30 8% 2/30 Shortage of doctors 10. District Hospital Patient Satisfaction rate 11. Number of district hospitals assessed for compliance with six priorities of the core standards No baseline 75% 62.5% 12.5% Non-compliance with Ministerial priorities Increased capacity at District level 2012/13 Annual Report 43

44 SUB-PROGRAMME 2.3: HIV & AIDS STI & TB CONTROL (HAST) TABLE 7: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL INDICATORS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: FOR HIV & AIDS STI AND TB CONTROL Strategic objectives Performance indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Increase access to comprehensive HIV and AIDS, STIs, Care, treatment, management and support Percentage of HIV positive infants initiated on lifelong ART Percentage of HIV exposed babies testing positive at 18 Months Percentage of pregnant women who are tested for HIV Number of patients initiated on lifelong ART 49.5 % (331 of 669) 70% No baseline 15% 100.1% ( of ) 100% (51 317) % (338 0f 723) 5.3% (209 of 3 972) 101.7% ( of ) 23.3% Limited number of trained nurses on NIMART 9.7% Transmission of the virus is decreasing due to: Dual prophylactic treatment and lifelong ART while breastfeeding. 1.7% Some women who have refused testing during the first visit do agree to be tested during the sub sequent visit Improved confidence on ARV treatment /13 Annual Report

45 Strategic objectives Performance indicators Number of female condoms distributed Number of Medical Male Circumcisions Conducted Number of newly diagnosed eligible HIV positive patients starting INH Prophylactic Treatment [IPT] Percentage of TB patients with a DOT supporter (DOT Coverage) Treatment Success Rate (Cure Rate plus Completion Rate) HIV testing rate among TB patients Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations ( ) Improved female condoms procurement in the province (41 657) Improved relations (39 170) between the Department and stakeholders Fear of creation of drug resistance by health professionals 86.7% ( of ) 89% 89.9% 0.1% None (7921/8812) 77.8% (6 931 of 8 904) 77% 78.6% (6178/7866) 1.6% Introduction of tracer teams 89.3% ( of ) 100% 90.1% (17676/19620) 9.9% Some patients refuse testing 2012/13 Annual Report 45

46 Strategic objectives Performance indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Percentage of eligible MDR-TB patients started on ARVs Percentage of eligible XDR-TB patients started on ARVs Percentage of TB patients with MDR-TB 90.4% (75 of 83) 100% (4 of 4) 0.6% (130 of ) 100% 94.5% (69/73) 100% 100% (4/4) 1% 1.5% (121/1775) 5.5% Very ill patient need to be stabilised 0% None 0.5% Improvement in diagnostic technology (GeneXpert ). TB incidence rate 300.9/ / / Improve intensified case finding and linkage to treatment /13 Annual Report

47 TABLE 8: 2012/2013 ANNUAL PERFORMANCE AGAINST NATIONAL INDICATORS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: FOR HIV & AIDS STI AND TB CONTROL Performance indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Total number of patients (Children and Adults) on ART 2. Male condom distribution rate 3. New smear positive PTB defaulter rate 4. PTB two month smear conversion rate No Rate % 5.7% (505 of 8904) % 70.5% (6 023 of 8 546) 6.5 (465 of 7 158) 67 (5 203 of 7 767) Improved on-going counseling 21 4 Improved procurement and distribution of male condoms 4.7% (369/7866) 68.3% (4679/6853) 1.8% Introduction tracer teams Improvement in diagnostic technology (GeneXpert ). 1.3% Improved DOT coverage 5. Percentage of HIV-TB Co-infected patients placed on ART % 80.7% (6005 of 7438) % (6159/11769) 47.7% Change of policy on ART initiation affected the denominator 6. HIV Testing rate % 95% ( of ) % ( of ) 2.6 Improved Counseling Capacity 7. New smear positive PTB cure rate % 75.7% (6 742 of 8 904) 75 (5 368 of 7 158) 76.4% (6007/7866) 1.4% Introduction of tracer teams 2012/13 Annual Report 47

48 SUB-PROGRAMME 2.4: MATERNAL CHILD AND WOMEN S HEALTH AND NUTRITION TABLE 9: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: MATERNAL CHILD AND WOMEN S HEALTH AND NUTRITION Strategic objectives Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Strengthen programme s on maternal, child, woman, youth and adolescent health Number of facilities conducting fire drills in the management of obstetric emergencies Number of PHC facilities with 60% IMCI saturation Number of PHC facilities implementing Community Component of IMCI No baseline 10 of of 61 6 ESMOE training conducted 354 of of of Strengthened Collaboration between HAST and MCWH&N 247 of of of None Number of quintile 1 and 2 schools receiving Integrated School Health Programme No baseline No dedicated teams and transport /13 Annual Report

49 Strategic objectives Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Delivery rate in facility No baseline 100% 113.9% 13.9% Migration of pregnant women from neighbouring countries and Province Stillbirth rate reduced No baseline 2 % 2.2% 0.2% Poor skills in the management of women during labour 2012/13 Annual Report 49

50 TABLE 10: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME MATERNAL CHILD AND WOMEN S HEALTH AND NUTRITION Performance indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Immunisation coverage under 1 year % 96.6% ( of ) 90% ( of ) 93.8 ( of ) 3.8 (3 978 of ) Catch up campaigns conducted 2. Vitamin A coverage months % 46.8% ( of ) 55 ( of ) 40.2 ( of ) 14.8 ( of ) Drug stock out on vitamin A 3. Measles 1 st dose coverage under 1 year % 109.6% ( of ) 90 ( of ) ( of ) 17.7 ( of ) Catch up campaigns conducted 4. Pneumococcal Vaccine (PCV) 3 rd Dose Coverage % 105.7% ( of ( of ) 106 ( of ) 16 ( of ) /13 Annual Report

51 Performance indicator Type Actual Achievement 2011/ Rota Virus (RV) 2 nd Dose Coverage % 109.5% ( of ) 6. Diarrhoea incidence under 5years No per /1000 population ( of ) 7. Pneumonia incidence under 5 years No per /1000 population ( of ) 8. Cervical cancer screening coverage % 60.2% ( of ) 9. Ante natal visit before 20 weeks rate % 41% ( of ) Planned Target 2012/2013 Actual Achievement 2012/13 90 ( of ) ( of ) 175/ /1000 ( Of ) 48/ /1000 ( Of ) 65 ( of ) 56.5 ( of ) 62 42% ( of ) Deviation from planned target to Actual Achievement for 2012/ ( of ) 14.6/ 1000 ( Of ) 3.2 /1000 (1 730 Of ) 8.5 ( of ) 20% ( of ) Comment on deviations Improved Rotavirus vaccine coverage Strengthened Community IMCI and Improved PCV Immunisation Coverage Some patients reluctant to accept screening. Patients bypassing public facilities 2012/13 Annual Report 51

52 Performance indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 10. Baby tested PCR Positive six weeks after birth as a proportion of babies tested at six weeks 11. Couple year protection rate % 4.02% 503 of % 36.1 ( of ) <3 2.4% (536 of ) 45 ( of ) 37.3% ( of ) None None 3.5% ( of ) Usage of alternative health facilities 12. Public Health Facility Maternal mortality rate No per / / / / Shortage of skilled health professionals Negative impact of burden of diseases (HIV&AIDS) 13. Delivery rate for women under 18 years % 8.1 ( of ) ( of ) 1.3 (1 673 of ) Poor family planning uptake 14. Public health facility infant mortality rate(under 1) No per / / / /1000 Straightened ESMOE Training /13 Annual Report

53 Performance indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 15. Public health facility child mortality (under 5) rate No per / / /1000 1/1000 Burden of diseases Lack of basic life saving skills SUB-PROGRAMME 2.5: DISEASE PREVENTION AND CONTROL TABLE 11: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: DISEASE PREVENTION AND CONTROL Strategic objective Performance indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achieveme nt 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Reduce Malaria Incidence Number of dwellings sprayed Additional temporary staffing from EPWP. 2012/13 Annual Report 53

54 TABLE 12: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: DISEASE PREVENTION AND CONTROL Performance indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Malaria fatality rate No baseline % (1386 cases & 20 deaths) 0.8% Delays in seeking treatment Poor Clinical Management 2. Cholera fatality rate None None 3. Cataract surgery rate No baseline >1000 per million Shortage of appropriately skilled staff and consumables REASONS FOR ALL DEVIATIONS FOR PROGRAMME 2: DISTRICT HEALTH SERVICES Dilapidating Health Infrastructure Shortage of health professionals and Support staff Patients by-passing clinics to higher levels of care Inability of contracted suppliers to deliver medicines and surgical sundries Inadequate and inappropriate health infrastructure Some patients refuse to be tested after counselling for HIV Some patients refuse TB treatment No dedicated teams and transport for school health programmes /13 Annual Report

55 Strategy to overcome areas of under performance Despite the challenges faced by the Department, the following strategies have been put in place to improve the quality of health service and meet targets: Motivate for additional funding for the recruitment, appointment and retention of staff (Including health professionals) Motivate for funding for upgrading and building of facilities Improve Pharmaceutical supplies to health facilities Intensify counseling and HIV awareness programmes Continue follow ups with Pharmaceutical Depot Implement the direct delivery of Pharmaceutical supplies to hospitals Establish dedicated school health teams Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature. 2012/13 Annual Report 55

56 Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 District Management 539, ,459 18, , , ,989 Community Health 1,564,500 1,802,150 (237,650) 1,442,549 1,607,304 (164,755) Clinics Community Health 317, ,928 (7,715) 236, ,928 (48,377) Centre Community Based 130, ,315 19, , ,042 7,347 Services Other Community 213, ,455 38, , , ,466 Services HIV/AIDS 769, ,764 77, , ,758 47,151 Nutrition 10,692 7,130 3,562 26,087 16,638 9,449 District Hospitals 3,536,344 3,556,315 (19,,971) 3,032,938 3,171,783 (138,845) TOTAL 7,081,718 7,189,516 (107,798) 6,451,446 6,423,021 28, /13 Annual Report

57 5.3 Programme 3: Emergency Medical Services PROGRAMME PURPOSE The aim of the program is to render pre-hospital Emergency Medical Services including Inter-hospital transfers and Planned Patient Transport SUB-PROGRAMMES Emergency transport and planned patient transport STRATEGIC OBJECTIVES The programme is provided through the strategic goal of improving emergency medical services and supported by the strategic objective of improving emergency medical services. 2012/13 Annual Report 57

58 TABLE 14: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: EMERGENCY MEDICAL SERVICES AND PATIENT TRANSPORT Strategic objective Performance Indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Improve Emergency Medical Services Ratio of Ambulance per population Number of Planned Patients Transported 1: : : :1000 No new vehicles purchased due to financial constraints Improvement in the capacity of lower level facilities /13 Annual Report

59 TABLE 15: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: EMERGENCY MEDICAL SERVICES AND PATIENT TRANSPORT Performance indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Rostered Ambulances 2. P1 (red calls) calls with a response time of <15 minutes in an urban areas 3. P1 (red calls) calls with a response time of <40 minutes in a rural area 4. All calls with a response time within 60 minutes per populati on 0.66% No new vehicles purchased Shortage of staff % 57% 60% 47.94% (163 of 340) % 56% 60% 76.49% (1015 of 1327) % 65% 70% 80.85% ( of ) 12.06% No new vehicles purchased Shortage of appropriately skilled staff Shortage of equipment 16.49% Reduction in the number of recorded P1 calls 10.6% Reduced number calls received 2012/13 Annual Report 59

60 Provide reasons for all deviations Shortage of Emergency Medical Services vehicles Shortage of EMS staff EMS vehicles withdrawn from service due to age and uneconomical repairs Financial Constraints Shortage of equipment Strategy to overcome areas of under performance Procure additional EMS vehicles in 2013/14 financial year Motivate for additional funding to appoint EMS staff in the next financial years Procurement of EMS equipment Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature /13 Annual Report

61 Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 Emergency Transport 490, , , ,282 13,271 TOTAL 490, , , ,282 13, /13 Annual Report 61

62 5.4 Programme 4: Provincial Hospitals PROGRAMME PURPOSE The purpose is delivery of hospital services which are accessible appropriate and effective and provide general specialist services including a specialized rehabilitation service as well as a platform for training health professionals and research SUB-PROGRAMMES general (regional) hospitals and specialized hospitals STRATEGIC OBJECTIVES strengthening district health and hospital services and improving quality of health care /13 Annual Report

63 5.4.3 SUB-PROGRAMME 4.1 GENERAL (REGIONAL) HOSPITALS TABLE 17: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: GENERAL (REGIONAL) HOSPITALS Quarterly Indicators Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achieveme nt 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Caesarean section rate % % None 2. Separations - Total No None Patient Day Equivalents Total No None OPD Headcounts Total No None Average length of stay Days days 5 days 0 None 6. Bed utilisation rate % 65.85% % 7.9% Shortage of Specialists 7. Expenditure per patient day equivalent (PDE) R R R2 400 R2 541 R141 Escalating costs of key accounts for example NHLS security 8. Percentage of complaints of users of Regional Hospital Services Increased theatre utilization % 74% % 37.8% Complexity of complaints 2012/13 Annual Report 63

64 Quarterly Indicators Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achieveme nt 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations resolved within 25 days 605/ / Percentage of Regional Hospitals with monthly Morbidity and Mortality Meetings 10. Percentage of users of regional hospital services satisfied with the services received (Regional hospitals patient satisfaction rate) 11. Number of Regional Hospitals assessed for compliance with the 6 priorities of the core standards % 86% 100 (5 of 5) 70 (4 of 5) 30% Shortage of Specialists Clinical Management abdication of duties % No baseline 75% 72.7% 2.3% Shortage of staff No of 5 1 hospital Mokopane hospital not assessed /13 Annual Report

65 5.4.4 SUB-PROGRAMME 4.2: SPECIALISED HOSPITALS TABLE 18: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR SUB-PROGRAMME (SPECIALISED) HOSPITALS Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Average length of stay (acute) 20.1 days 30 days 506 days (DHIS) 476 days High turnover of patients at Evuxakeni due to small capacity of Acute ward Usable bed utilisation rate 82.55% 80% 86.6% 6.6% Availability of Psychiatric wards at Regional hospitals in addition to Specialized hospitals Number of specialised hospitals assessed for compliance with the 6 priorities of the core standards Assessment tool not customised for Specialized hospitals 2012/13 Annual Report 65

66 REASONS FOR ALL DEVIATIONS FOR PROGRAMME 4: PROVINCIAL HOSPITALS (REGIONAL AND SPECIALISED) Backlog of Orthopaedic operations Shortage of health specialists Shortage of Pharmaceutical items High turnover of patients at Evuxakeni due to small capacity of Acute ward STRATEGY TO OVERCOME AREAS OF UNDER PERFORMANCE Despite the challenges faced by the Department, the following strategies have been put in place to improve the quality of health service and meet targets: Implement Recruitment and Retention Continue follow ups with Depot on shortage of medicines Motivate for additional funding for the recruitment and retention of health specialists To have nearby hospitals starting with the 72 hours psychiatric patients observation Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature /13 Annual Report

67 Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 General (Regional (1 080) Hospital) Psychiatric/Mental Hospital Total /13 Annual Report 67

68 5.5 Programme 5: Central and Tertiary Hospitals PROGRAMME PURPOSE The purpose of the programme is to provide tertiary health services and create a platform for training of health professionals and research STRATEGIC OBJECTIVES Strengthening tertiary/academic services /13 Annual Report

69 TABLE 20: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: TERTIARY HOSPITALS Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Number of disciplines using telemedicine None None 2012/13 Annual Report 69

70 TABLE 21: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: TERTIARY HOSPITALS Quarterly Indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievem ent 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1. Caesarean section rate % Normal range of performance 2. Separations - Total No None 3. Patient Day Equivalents Total No None 4. OPD -Headcounts Total No Shortage of specialists. 5. Average length of stay Days days Shortage of specialists. 6. Bed utilisation rate % % Specialist clinics not operating on holidays 7. Expenditure per patient day equivalent (PDE) 8. Percentage of complaints of users of the hospital s services resolved within 25 days 9. Percentage of tertiary hospitals with monthly mortality and morbidity meetings R R R R R162 Non functionality of some theatres % 50.2% 100 % / /1419 % % None Complexity of complaints /13 Annual Report

71 Quarterly Indicator Type Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievem ent 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 10. Percentage of users of Tertiary Hospital Services satisfied with the services received (Tertiary hospitals patient satisfaction rate) % No baseline 70% Non-compliance with 6 priorities 11. Number of Tertiary Hospitals assessed for compliance with the 6 priorities of core standards No None 2012/13 Annual Report 71

72 REASONS FOR ALL DEVIATIONS FOR PROGRAMME 5: CENTRAL & TERTIARY HOSPITALS Specialist clinics not operating on holidays Increased length of stay of some patients Backlog of operations due to lack of pharmaceutical supplies Patients bypass clinics STRATEGY TO OVERCOME AREAS OF UNDER PERFORMANCE Strengthening of PHC services To strengthen down referral To implement the direct delivery of pharmaceutical supplies Conduct community awareness CHANGES TO PLANNED TARGETS There were no changes made to the targets. The reported targets are as per the approved Annual Performance plan as approved by Provincial Legislature /13 Annual Report

73 Linking performance with budgets Sub-programme expenditure Sub- Programme Name Final Appropriation 2012/ /2012 Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 Provincial Tertiary 1,118,092 1,117, ,034,880 1,029,210 5,670 Hospital Services Total 1,118,092 1,117, ,034,880 1,029,210 5, /13 Annual Report 73

74 5.6 Programme 6: Health Science and Training PROGRAMME PURPOSE The purpose of the programme is to render training and development opportunities for actual and potential employees of the Department through sub programmes human resource development (bursaries PHC training and other training); nurse and EMS training colleges SUB PROGRAMMES Human resource development Nurse training colleges Ems training college STRATEGIC OBJECTIVES Provide human resource training and development Train and develop nurse professionals Train and Develop Emergency Care technicians (ECTs) /13 Annual Report

75 SUB PROGRAMME 6.1: HUMAN RESOURCE DEVELOPMENT TABLE 23: 2012/2013 ANNUAL PERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR SUB PROGRAMME: HUMAN RESOURCE DEVELOPMENT Strategic objectives Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Provide human resource training and development Number of new bursaries awarded None SUB-PROGRAMME 6.2: NURSE TRAINING COLLEGES TABLE 24: 2012/2013 ANNUAL PERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR SUB-PROGRAMME: NURSE TRAINING COLLEGES Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achieveme nt 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Number of post basic nurse professionals trained re-wrote the examinations 2012/13 Annual Report 75

76 Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achieveme nt 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Number of professional nurses trained (comprehensive programme) Number of professional nurses trained (bridging programmes) Reduction of student intake due to negative staff turnover Poor academic progress by students No baseline /13 Annual Report

77 SUB-PROGRAMME 6.3: EMS TRAINING COLLEGE TABLE 25: 2012/2013 ANNUALPERFORMANCE AGAINST NATIONAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR SUB-PROGRAMME: EMS TRAINING COLLEGE Annual indicators Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations 1 Intake of nurse students No baseline Reduction of student intake due to negative staff turnover 2 Students with bursaries from the province No baseline None 3 Basic nurse students graduating No baseline re-wrote the examinations Provide reasons for all deviations Reduction of student intake due to negative staff turnover Poor academic progress by students Strategy to overcome areas of under performance Appoint staff in the next financial years 2012/13 Annual Report 77

78 Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature. Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 Nursing Training Colleges 136, ,586 (47,297) 150, ,104 (15,818) EMS Training Colleges 3,169 5,377 (2,208) 4,596 4, Bursaries 96,671 96,811 (140) 83,591 74,533 9,058 Primary Health Care 6, ,477 4,718 1,039 3,679 Training Other Training 176, ,966 70, , ,715 17,763 TOTAL 418, ,905 27, , ,647 15, /13 Annual Report

79 5.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES PROGRAMME PURPOSE The purpose of the programme is to render support services as required by the Department to realise its objectives of incorporating all aspects of rehabilitation SUB-PROGRAMMES Medicine trading account (Pharmaceutical Services); Orthotic and Prosthetic ( Allied Health Care Support Services); Oral health services; and Forensic Pathology Services SUB-PROGRAMMES Provide all essential medicines Provide healthcare support services 2012/13 Annual Report 79

80 TABLE 27: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: HEALTH CARE SUPPORT SERVICES Performance indicator Actual Achievement 2011/2012 Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations Percentage availability of essential medicines in Depot 76.5% 95% 59.01% 35.99% Inadequate budget Shortage of staff at depot Large number of items not on tender Suppliers on national tender are unable to supply National tenders are awarded late Restructuring of pharmaceutical depot from private management to departmental management. Challenges with communication systems at depot Out-dated stock control system Delay in appointment of staff Hospitals 87% 95% 79.68% 15.32% Unavailability of stock at depot Out-dated stock control system Number of hospitals with full complement of clinical health support services Clinics 84.5% 92% 72.75% 19.25% Manual stock control system Shortage of pharmacy assistants at PHC level 34/40 36 of of 40 0 None /13 Annual Report

81 Reasons for All Deviations for Programme 7: Health Care Support Services Inadequate pharmaceutical budget Shortage of staff at pharmaceutical depot Large number of items not on tender Suppliers on national tender are unable to supply National tenders are awarded late Restructuring of pharmaceutical depot from private management to departmental management. Challenges with communication systems at depot Out-dated stock control system Delay in appointment of staff Unavailability of stock at depot Out-dated stock control system Shortage of pharmacy assistants at PHC level Strategy to overcome areas of under performance Motivate for additional funding Recruited and appointed staff at the depot Put items on tender basis Liase with National Department of Health regarding suppliers not abiding turnaround times Capacitate depot management Improve depot communication system Improve stock control system Motivate for funding and recruit and retain pharmacy assistants at PHC level 2012/13 Annual Report 81

82 Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature. Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 Forensic Services 33,675 32, ,779 37,822 1,957 Orthotic and Prosthetic 9,000 7,723 1,277 12,097 11, Services Medical Training 587, ,724 (22,422) 488, ,081 3,777 Account TOTAL 629, ,244 (20,267) 540, ,902 5, /13 Annual Report

83 5.8 Programme 8: Health Facility Management PROGRAMME PURPOSE The purpose of the programme is to plan provide and equip new facilities/assets and upgrade rehabilitate and maintain hospitals clinics and other facilities STRATEGIC OBJECTIVES Develop, upgrade and maintain health facilities 2012/13 Annual Report 83

84 TABLE 29: 2012/2013 ANNUALPERFORMANCE AGAINST PROVINCIAL TARGETS FROM 2012/13 ANNUAL PERFORMANCE PLAN FOR PROGRAMME: HEALTH FACILITIES MANAGEMENT Annual Indicator Type Actual Achieve ment 2011/ Equitable share capital programme as % of total health expenditure 2.Number of hospitals currently unfunded on revitalisation programme 3.Expenditure on facility maintenance as % of total health expenditure 4.Average backlog of service platform in fixed PHC facilities Planned Target 2012/2013 Actual Achievement 2012/13 Deviation from planned target to Actual Achievement for 2012/2013 Comment on deviations % % 40% Purchasing of the staff accommodation in Polokwane No None None % Deviation due to budget adjustment to refurbish boilers R None None 5.Level 1 beds per 1000 No None None uninsured population 1 6.Level 2 beds per 1000 No None None uninsured population /13 Annual Report

85 Reasons for All Deviations for Programme 8: Health Care Support Services Budget adjustment to refurbishment of boilers Purchasing of new doctor s staff accommodation STRATEGY TO OVERCOME AREAS OF UNDER PERFORMANCE Proper financial management Timely Monitoring of expenditure Changes to planned targets There have not been any changes to the targets. The reported targets are as per the approved Annual Performance plan as approved by the Provincial Legislature. 2012/13 Annual Report 85

86 Linking performance with budgets Sub-programme expenditure 2012/ /2012 Sub- Programme Name Final Appropriation Actual Expenditure (Over)/Under Expenditure Final Appropriation Actual Expenditure (Over)/Under Expenditure R 000 R 000 R 000 R 000 R 000 R 000 Community Health 346, ,215 77, , ,105 (10,047) Facilities District Hospital 407, ,395 5, , , ,877 Services Provincial Hospital 42,103 13,239 28,864 15,226 14, Services Tertiary Hospitals 11,838 8,552 3,286 16,533 9,353 7,180 Other Facilities 379, ,238 26, , ,583 51,364 TOTAL 1,187,034 1,045, ,395 1,018, , , /13 Annual Report

87 6 SUMMARY OF FINANCIAL INFORMATION 6.1. Departmental receipts Departmental receipts Estimate Actual Amount Collected 2012/ /2012 (Over)/Under Estimate Collection Actual Amount Collected (Over)/Under Collection R 000 R 000 R 000 R 000 R 000 R 000 Tax Receipts Casino taxes Horse racing taxes Liquor licences Motor vehicle licences Sale of goods and services other than capital assets , , , , , 314 (6, 639) Transfers received 0 47 (47) Fines, penalties and forfeits Interest, dividends and rent on land 0 84 (84) (84) Sale of capital assets 3, 383 8, 209 (4, 826) 5, 500 4, 283 1, 217 Financial transactions in assets and liabilities 8, , 993 (19, 666) 8, , 407 (3, 101) Total 116, , 618 (13, 867) 107, , 684 (8, 607) Summary of revenue collection The department collected R130.6 million against the adjusted budget of R116.8 million. This indicates an over collection of R13.9 million or 12%. The previous year collection was R115.7 million against the adjusted budget of R107.1 million Tariff policy/determination The Department uses the National Uniform Patient Fee Schedule (UPFS) as a basis for charges to all patients visiting the hospitals in the Province. The non-patient related items are departmentally determined in consultation with the Provincial Treasury and other stake holders. The department also uses global tariffs that are determined by the Provincial Treasury. The latest review of all the charges in the Department was in 1 June 2012 and the next review will be in the new financial year (2013/14). 2012/13 Annual Report 87

88 6.1.3 Free Services The Department provides free health care services at all Limpopo primary health care facilities and are in line with the National and Provincial policies. In addition, these free services are also provided in all our hospitals to patients who are not members of registered medical schemes - Primary Health Care Services including free health services rendered to children under 6 years, pregnant women, social pensioners, persons receiving social grants and unemployed and those not having any income; - Mental Health Services; - Free health care for people with disability; - Tuberculosis (TB) services; - Voluntary Counselling and Testing for HIV; - Prevention of Mother to Child Transmission of HIV and AIDS; - Termination of pregnancy; - Medico Legal service for survivors of sexual assault who falls within the criminal Procedure Act; - Victims of rape, assault and those who falls within the criminal Procedure Act; and - Employee Assistance programme. - Medical Male Circumcision for prevention of infection from HIV and Aids and other sexually transmitted diseases Free services introduced this financial year: No free services were introduced Reasons for over collection The over collection was due to the improvement in efficiencies in the collection, namely enforcing salary deductions on tenants residing in Department owned properties and highly professional auctions for sales of motor vehicles that were uneconomical to run. The other source of the over collection was refunds by Non-Profit Organisation Programme Expenditure Programme Name Final Appropriation 2012/ /2012 Actual Actual Expenditure Expenditure (Over)/Und er Expenditur e Final Appropriatio n (Over)/Un der Expendit ure R 000 R 000 R 000 R 000 R 000 R 000 Administration 241, ,987 1, , ,091 10,495 District Health 7,081,718 7,189,516 (107,798) 6,451,446 6,423,021 28,425 Services Emergency Medical 490, , , ,282 13,271 Services Provincial Hospital 1,640,966 1,639,771 1,195 1,446,677 1,439,089 7,588 Services Central Hospital 1,118,092 1,117, ,034,880 1,029,210 5,670 Services Health Sciences and 418, ,905 27, , ,647 15, /13 Annual Report

89 Programme Name Final Appropriation 2012/ /2012 Actual Actual Expenditure Expenditure (Over)/Und er Expenditur e Final Appropriatio n (Over)/Un der Expendit ure Training Health Care Support 629, ,244 (20,267) 540, ,902 5,832 Services Health Facilities 1,187,034 1,111,023 76,011 1,018, , ,040 Management TOTAL 12,808,523 12,829,996 (21,473) 11,670,119 11,364, ,343 Explanation of material variances per programme Programme 1: Administration The savings of R1.8m was due to the delays in the payments process and implementation of austerity measures Programme 2 : District Health Services The negative variance was due to over expenditure in compensation of employees that could not be fully funded in the beginning of the year. This was unavoidable expenditure and there were no other funds to be shifted to increase the compensation of employees. R2.7m under transfers and subsidies was due to payments of leave gratuities which are always unpredictable due to unexpected death Programme 3: Emergency Medical Services The savings of R0.9m was due to delays in the payment process and implementation of austerity measures Programme 4: Provincial Hospital Services The savings of R1.1m was due to the delays in the payment benefits to Health Professionals in Provincial Hospitals Programme 5: Central Hospital The savings of R0.4m was due to the delays in the payments of committed machinery and equipment for NTSG conditional grant Programme 6: Health Science and Training The under expenditure of R27.0m was due to savings in Nursing College grant and Health Professional Training Conditional Grants due to delays in training of Health Professionals and austerity measures Programme 7: Health Care Support The over expenditure in the inventory medicine was caused by shortfall that emanates from medicine shortage in the beginning of the financial year resulting in more stock required to meet the required target stock level. R121 million accruals from 2011/12 financial year were also paid from the current budget resulting in the shortfall. The medicine problem was well communicated with Provincial Treasury before the 2012/13 Annual Report 89

90 adjustment, and Provincial Treasury made available R42 million for spending but was later withdrawn as second adjustment could not be passed Health Facilities Management The savings of R65.1million was due to earmarked funding for boiler repairs that was not fully utilised and the project is still underway hence a request for the rollover of funds was made. The remaining R10.9million savings was due under spending in Health Infrastructure Grant and Hospital Revitalisation Grant as a result of payment system challenges in the last days of payment processing Summary of Departmental variation analyses The Department over spent in compensation of employees due to carried over of R140m accruals for 2011/12 financial year to 2012/13 financial year. The effort for implementing of cost containment was made by the Department where all retired, transferred and resigned staff members on support services were not replaced. The pay progression and performance bonuses for 2011/12 financial year were not paid, which will put pressure to the 2013/14 financial year budget. The Department showed this compensation pressure from June 2012/13 financial year when submitting the IYM to Provincial Treasury. These were unavoidable expenditure after all effort by Department as other services were stopped after adjustments in order to increase compensation of employees. The savings in goods and services was due to earmarked funding for boilers and repairs that was not fully utilised, and the projects are still underway hence the for the rollover was requested. The overspending in transfers was mostly due to payments of leave gratuities under households which are unpredictable. The savings in capital payments was due to under spending in Provincial grant and Hospital Revitalisation conditional grants as a result of payment system challenges Transfer payments, excluding public entities The table below reflects the transfer payments made for the period 1 April 2012 to 31 March 2013 Name of transferee Vhembe district Municipality Capricorn District Municipality Purpose for which the funds were used Devolution of Environmental Health services Devolution of Environmental Health services Compliance with s 38 (1) (j) of the PFMA Amount transferred (R 000) Amount spent by the entity Reasons for the funds unspent by the entity Yes 2,184 2,184 N/A Yes 3,554 3,554 N/A TOTAL 5,738 5,738 N/A /13 Annual Report

91 The table below reflects the transfer payments which were budgeted for in the period 1 April 2012 to 31 March 2013, but no transfer payments were made. Name of transferee Purpose for which the funds were to be used Amount budgeted for (R 000) Amount transferred (R 000) Reasons why funds were not transferred Not applicable. All the funds budgeted were transferred 6.4. Public Entities The Department does not have any private entities and there were no transfer payments made to public entities during the year under review 6.5. Conditional grants and earmarked funds paid The Department did not pay any grant to any organisation Conditional grants and earmarked funds received Conditional Grant : Comprehensive HIV and Aids Grant Department who transferred the grant Purpose of the grant Health To enable the health sector to develop an effective response to HIV and Aids including universal access to HIV Counselling and Testing ( HCT) To support the implementation of the National Operational Plan for comprehensive HIV and Aids treatment and care To subsidise in-part funding for the antiretroviral programme Expected outputs of the grant Number of fixed public health facilities offering ART services Number of new patients that started on ART Total number of patients on ART remaining in care Number of beneficiaries served by home-based caregivers Number of active home based carers receiving stipends Number of male and female condoms distributed Number of High Transmission Areas ( HTA) intervention sites Number of Antenatal Care (ANC) clients initiated on life-long ART Number of babies Polymerase Chain Reaction ( PCR) tested at 6 weeks Number of HIV positive clients screened for TB Number of HIV positive patients that started on IPT 2012/13 Annual Report 91

92 Department who transferred the grant Health Number of active lay counsellors on stipends Number of clients pre-test counselled on HIV testing ( including antenatal) Number of client tested for HIV ( including antenatal) Number of Health facilities offering MMC services Medical Male Circumcision performed Sexually assault cases offered ARV prophylaxis Step Down Care ( SDC) facilities /units Doctors and professional nurses trained on HIV/AIDS, STIs, TB and chronic diseases Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity 767,597, ,597, None 690, Non delivery of condoms Slow response time of BAS system delays some of the payments Delayed training programme Monitoring mechanism by the receiving department Comprehensive turnaround strategy on these grant has been developed and being implemented An approval has been obtained from National Department of Health to partly fund the shortfall on medicine of R50million and laboratory service of R100million. Conditional Grant : Health Professions Training and Development Grant Department who transferred the grant Purpose of the grant Health Support provinces to fund services costs associated with training of health science trainees on the public service platform Co- funding of the National Human Resource Plan for Health in expanding undergraduate medical education for 2012 and beyond (2025) /13 Annual Report

93 Expected outputs of the grant All provinces must measure performance against the National Human Resources Plan for Health by monitoring the following categories of trainees on the health platform by their category, province and training institution: undergraduate health science trainees, postgraduate health sciences trainees ( excluding registrars), registrars, community services health professionals and other health science trainees supervised on the public health service platform as per statutory requirements Provinces receiving a developmental portion ( Northern Cape, North West, Limpopo, Mpumalanga and Eastern Cape ) must also indicate the specific clinical teaching and clinical number of health professionals recruited and retained for this function Clinical teaching and training capacity established as required on the public service platform in earmarked provinces ( Northern Cape, North West, Limpopo, Mpumalanga, Eastern Cape) Actual outputs achieved Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Monitoring mechanism by the receiving department The utilisation of the grant has helped the Department to produce 341 Undergraduate Students (MBCHB, EMS, B.Physiotherapy, B.Radiology, Pharmacy, Dentistry, B.Occupational therapy, B. Dental therapy), 60 Postgraduate student (Emergency Medicine, Community Health, Anaesthesiology, Obstetrics and Gynaecology, Paediatrics, Diagnostic Radiology, Radiation Oncology) 57 registrars and 101 Specialists. 103,913, ,913, None 92,578, Delayed training of health professionals Some of health professionals paid from equitable share Monthly financial reports are submitted to the Provincial and National Treasury. Quarterly reports and Annual reports are submitted to the Provincial and National Treasury. 2012/13 Annual Report 93

94 Conditional Grant : National Tertiary Services Department who transferred the grant Purpose of the grant Health Ensure provision of tertiary health services for all South African citizen s To compensate tertiary facilities for the costs associated with provision of these services including cross border patients Expected outputs of the grant Actual outputs achieved Provision of designated central and national tertiary services ( T1, T2 and T3) in 22 hospital/complexes as agreed between the province and the national Department of Health (DoH) NTSG has enabled the province to develop and provide more tertiary services, thus improve access Significant decrease in referrals to tertiary institutions in Gauteng Province 32 NTSG services are provided by the complex Additional specialists for clinical, nursing and allied health were recruited Spinal management, Rheumatology and Gastroenterology services are now provided Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Monitoring mechanism by the receiving department 288,427, ,427, None 276,123, Delay in deliveries of ordered medical equipment and appointment of theatre cleaners -Monthly and quarterly and annual reports -annual internal and external audits /13 Annual Report

95 Conditional Grant : Hospital Revitalisation Department who transferred the grant Purpose of the grant Health To provide funding to enable provinces to plan, manage, modernise, rationalise, and transform the health infrastructure, health technology, monitoring and evaluation of the health facilities in line with national policy objectives To supplement expenditure and health infrastructure delivered through public-private partnerships Expected outputs of the grant Actual outputs achieved Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Number of hospitals upgraded, rebuilt and fully commissioned 6 Hospitals in construction R R None R Delayed delivery of procured equipment by service provider resulted in under expenditure. Appointment of professionals was delayed due to lack of suitable candidates. Monitoring mechanism by the receiving department Site/technical inspection meetings held monthly. Conducting progress review meetings with Implementing Agents monthly. Infrastructure Reporting Model (IRM) updated and submitted to Provincial Treasury and National Department of Health monthly Conditional Grant :Health infrastructure grant Department who transferred the grant Purpose of the grant Expected outputs of the grant Health To supplement provincial funding of health infrastructure to address backlogs, accelerate the provision of health facilities and ensure proper life cycle maintenance of provincial health infrastructure Number of health facilities, planned, designed, constructed, maintained and operationalized Number of work opportunities created Actual outputs achieved Fifteen (15) new and upgraded PHC facilities completed 2012/13 Annual Report 95

96 Thirty (30) health institutions provided with own source of water Thirty (30) health institutions provided with pollution free sanitation units Two (2) health institutions with upgraded electrical supply Two (2) EMS facilities completed Fifty (50) single units for staff accommodation completed Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Monitoring mechanism by the receiving department 267, 888, , 888, None 258,120, Network problem (BAS) delayed the processing of invoices which led to under expenditure Site/technical inspection meetings held monthly. Conducting progress review meetings with Implementing Agents monthly. Infrastructure Reporting Model (IRM) updated and submitted to Provincial Treasury and National Department of Health monthly. Conditional Grant : EPWP Incentive grant Department who transferred the grant Purpose of the grant Health To incentivise provincial departments to expand work creation efforts through the use of labour intensive delivery methods in the following identified focus areas, in compliance with the EPWP guidelines: - Road maintenance and the maintenance of buildings - Low traffic volume roads and rural roads - other economic and social infrastructure - sustainable land based livelihoods - Tourism and cultural industries Expected outputs of the grant Increased number of people employed and receiving income through the EPWP Increased average duration of the work opportunities created Actual outputs achieved 686 work opportunities created /13 Annual Report

97 Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Monitoring mechanism by the receiving department 1000, , None 1000, None Monthly reports generated by institutions and submitted to Department of Public Works. Site inspections conducted to confirm progress. Conditional Grant : Expanded Public Work Programme Department who transferred the grant Purpose of the grant Expected outputs of the grant Health To incentivise provincial social sector departments identified in the 2012 Social Sector EPWP long-frame to increase job creation by focusing on the strengthening and expansion of social service programmes that have employment potential Increased number of people employed and receiving income through the EPWP Increase duration of the work opportunities created Increase number of households and beneficiaries to which services are provided Increased number people with augmented wages Increased number of people who receive training Increased number of people who receive training Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Monitoring mechanism by the receiving department 29,197, ,197, None 28,616, Within the spending norm None 2012/13 Annual Report 97

98 Conditional Grant : Nursing Training Colleges Department who transferred the grant Purpose of the grant Expected outputs of the grant Actual outputs achieved Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Health To supplement provincial funding of health infrastructure to accelerate the provision of health facilities including office furniture and related equipment and to ensure proper maintenance of provincial health infrastructure for nursing colleges and schools Number of nursing colleges and schools, planned, designed, constructed, operationalized Five (5) water projects and two (2) sanitation projects completed at nursing college campuses 12,400, ,400, None 11,777, Spending is within the norm, with the slight under spending Monitoring mechanism by the receiving department Quarterly and monthly reports are submitted Conditional Grant : National Health Insurance Department who transferred the grant Purpose of the grant Health Test innovations necessary for implementing National Health Insurance To undertake health system strengthening initiatives and support selected pilot districts in implementing identified service delivery interventions To strengthened the resources management of selected central hospitals Expected outputs of the grant A framework that: Enhances managerial autonomy, delegation of functions and accountability in districts and health facilities Provides for scalable model, including the required institutional arrangements, for a district health authority ( DHA) as the contracting agency Test the linkage between health service management and administration and how it relates to the functions and /13 Annual Report

99 Department who transferred the grant Health responsibilities of DHAs Provide for a rational referral system based on re-engineered primary health care platform with a particular focus in rural and previously disadvantaged areas Provides a model for revenue collection and management model for identified central hospitals Actual outputs achieved Amount per amended DORA Amount received (R 000) Reasons if amount as per DORA was not received Amount spent by the department (R 000) Reasons for the funds unspent by the entity Procurement of diagnostic and basis medical equipment for eight (8) community health centres and fifty six (56) PHC clinics 196 patient chairs were purchased to ensure that 70 PHC facilities have well-furnished consultation rooms and waiting areas 11, , None 4,118, i) R1m was earmarked for contracting private General Practitioners (GPs). Funds were not used due delays at national DoH to finalize a uniform GPs Contracting Framework. The framework has been concluded and contracting of GPs is scheduled to start in May ii) iii) R was earmarked for the training of Pharmacy Assistants to support District based Clinical Specialists Teams at the DHS/PHC settings. Funds could not be utilized as the final revised Business Plan was only approved late in December 2012 and this did not provide adequate time to process approval and implement the training course for pharmacy assistants. The balance of the unspent funds were earmarked to be utilized towards paying for goods & services as well as medical equipment that were ordered but the procurement processes did not reach delivery stages due to delays by suppliers. The procurement process did not give suppliers adequate time to source their supplies from local and international vendors. Monitoring mechanism by the receiving department Business plan approved, grant manager appointed and district specialist appointed in the pilot district (Vhembe) To fast-track the procurement and payment of the required services as per revised business plans 2012/13 Annual Report 99

100 Department who transferred the grant Health Available contracts to be used to procure services thereby reducing the long procurement process Rollover to be requested to cover accruals and commitments 6.7. Donor Funds Donor Fund : European Union donor fund Name of donor Full amount of the funding Period of the commitment Purpose of the funding Expected outputs European donor 1,016, /13 These funds are used for strengthening primary health care delivery, formalise partnership with Non- profit organisations in the PHC delivery system and capacity building for health stakeholders. Contracting of NPO s providing Home Community Based Care services to our communities Improve compliance and service delivery by NPO management through capacity building Actual outputs achieved 434 NPO s rendering community based care were contracted Conducted capacity building workshop to all contracted NPO on Governance, financial management, planning and data collection and analysis as part of compliance with section 38(1)j of the PFMA Amount received in current period (R 000) Amount spent by the department (R 000) Reasons for the funds unspent Monitoring mechanism by the donor R 0.00 R Late activation of the donor funding in the system Reports are sent to the donor monthly and quarterly /13 Annual Report

101 Donor Fund: Global funding Name of donor Full amount of the funding Period of the commitment Purpose of the funding Expected outputs Actual outputs achieved Amount received in current period (R 000) Amount spent by the department (R 000) Reasons for the funds unspent Monitoring mechanism by the donor Global funding 2,171, /13 This project assist in rendering TB/MDR services in the province especially the building of TB hospital in Waterberg District Extent the TB/MDR clinic The extension of TB/MDR Hospital was completed R 0.00 R Late activation of the donor funding in the system Reports are sent to the donor Donor Fund : Irish funding Name of donor Full amount of the funding Period of the commitment Purpose of the funding Expected outputs Actual outputs achieved Irish funding R 3,018, /13 The funds assist in the control and prevention of HIV and AIDS and gender mainstreaming To strengthen the capacity of Provincial AIDS Council (LPAC),District AIDS Councils (DACs) and Local AIDS Councils in coordinating and monitoring the implementation of the Provincial HIV and TB strategic plan. 1) A study on situational analysis on the status of AIDS Councils in the province was conducted. 2)Benchmarking visit to a province in the country (KZN) and other country (Zambia) 3) The AIDS Council policy framework was developed aligned to the KZN model. 4) Supported the development of the HIV and TB Strategic Plan ( ) and the development of District plans aligned to the provincial plan. 5) Induction and orientation of the AIDS Council members on the AIDS Councils policy framework. 2012/13 Annual Report 101

102 Name of donor Irish funding Amount received in current period (R 000) R 0.00 Amount spent by the department (R 000) 6)Capacity building of AIDS council members at the provincial, District and Local level on governance, Basic HIV and TB,The Provincial strategic Plan( ) and M&E. 7)Translation of the Provincial strategic plan into Braille R Reasons for the funds unspent Monitoring mechanism by the donor The austerity measures in the department. Postponement of trainings due to commitments by political leaders. Delay in establishment of AIDS councils by municipalities. Reports, Project Steering Committee meetings, monitoring visits /13 Annual Report

103 6.8. Capital investment, maintenance and asset management plan Progress made on implementing the capital, investment and asset management plan: In implementing the Capital and investment plan, the following was achieved: Fifteen (15) new and upgraded PHC facilities completed Thirty (30) health institutions provided with own source of water Thirty (30) health institutions provided with pollution free sanitation units Two (2) health institutions with upgraded electrical supply Two (2 ) EMS facilities completed One (1) District Hospital (OPD, Admin, Staff Accommodation) completed One (1) Tertiary Hospital Upgrade (Ward A, Dentistry, Audiology and Cardiothoracic unit) completed Two (2) Public Private Partnership Projects in planning phase One hundred and twelve (112) doctors accommodation units purchased and fifty (50) single units for staff accommodation completed One (1) TB-MDR facility completed Five (5) water projects and two (2) sanitation projects completed at nursing college campuses Ten (10) IDMS capacitation posts filled In implementing the asset management plan, the Department has achieved the following: A circular on the acquisition of assets was issued out to insure that misallocations are minimised as far as possible Institutions that did not dispose assets for the past two or more years were engaged through a memorandum to insure that they disposed the assets before 31 March 2013 The total physical asset verification was performed during August to December 2012 to insure that all assets are captured into the Departmental Register. Infrastructure projects which have been completed in the current year and the progress in comparison to what was planned at the beginning of the year. Provide reasons for material variances (2% variance) Fifteen (15) new and upgraded PHC facilities Thirty (30) health institutions to be provided with own source of water Thirty (30) health institutions to be provided with pollution free sanitation units Two (2) health institutions with upgraded electrical supply Two (2) EMS facilities Six (6) hospitals on revitalization under construction Two (2) Public Private Partnership Projects in planning phase Hundred (100) family units and fifty (50) single units for staff accommodation One (1) TB-MDR facility completed Five (5) water projects and two (2) sanitation projects completed at nursing college campuses 2012/13 Annual Report 103

104 Ten (10) IDMS capacitation posts filled There was no material variance between what was planned for and what was achieved. Infrastructure projects that are currently in progress (list projects) and when are they expected to be completed, Projects to be completed in 2013/14 Financial Year No Facility Name Project Desciption 1 Letaba Hospital Gynaecology Ward, Demolish nurses resid & new Nurs Resid. new Nurses college, prostatic centre, office & workshop, staff houses upgrade 2 Thabamoopo Hospital Transport Control 3 Thabazimbi Hospital OPD, Cazualty, X-ray, Pharmacy and ARV Clinic and administration block 4 Thabazimbi Hospital Ward Blocks, Theatre, Maternity, OPD, Admin, Staff Acc (20 Batcheler flats) 5 Mokopane Hospital Theatre Complex - Enabling Works Program 6 WF Knobel Hospital Hospital Staff Accomm. (10 single rooms) 7 Kgapane Hospital Hospital Staff Accomm. (10 single rooms) 8 Nkhensani Hospital Hospital Staff Accomm. (10 single rooms) 9 Dilokong Hospital Hospital Staff Accomm. (10 single rooms) 10 Jane Furse Hospital Hospital Staff Accomm. (10 single rooms) 11 Philadelphia Hospital Hospital Staff Accomm. (10 single rooms) 12 Malamulele Hospital Hospital Staff Accomm. (10 single rooms) 13 Louis Trichardt Hospital Hospital Staff Accomm. (10 single rooms) 14 Siloam EMS New Emergency Medical Service Station 15 EMS Head Office Head Office EMS 16 Loloka Clinic New Clinic 17 Shotong Clinic Clinic upgrade to standard 18 Shigalo Clinic Clinic upgrade on New Site 19 Rooiberg Clinic Clinic upgrade on New Site 20 Muyexe Clinic Clinic upgrade on New Site 21 Tzaneen Malaria Head Office Malaria Control Head Office Tzaneen & Insectory 22 Waterpoort Malaria Unit New Malaria Camp 23 Waterberg Malaria Unit New Malaria Camp /13 Annual Report

105 Projects to be completed in 2014/15 Financial Year No Facility Name Project Desciption 1 Letaba Hospital Maternity ward, Walkways, Victim Empowerment Centre 2 Thabazimbi Hospital Ward Blocks, Theatre, Maternity, OPD, Admin, Staff Acc (20 Batcheler flats) 3 Letaba Hospital Hospital Staff Accommodation (10 single rooms) 4 Donald Fraser Hospital Hospital Staff Accommodation (10 single rooms) 5 George Masebe Hospital Hospital Staff Accommodation (10 single rooms) 6 WF Knobel Hospital Theatre Complex - Enabling Works Program 7 Dr CN Phatudi Hospital OPD, X-ray and Pharmacy - Enabling Works Program 8 Philadelphia Hospital OPD, X-Ray, Casualty - Enabling Works Program 9 George Masebe Hospital Maternity &Theatre - Enabling Works Program 10 Voortrekker Hospital OPD, X-Ray, Casualty & Pharmacy - Enabling Works Program 11 WF Knobel Hospital Hospital Staff Accommodation (10 single rooms) 12 Sekororo Hospital Hospital Staff Accommodation (20 single rooms) 13 Leboeng EMS New Emergency Medical Service Station 14 Soetfontein Clinic Clinic upgrade on New Site 15 Phalaborwa (Busstop) Clinic New Clinic 16 Mamone Clinic Clinic upgrade to standard 17 Vlaakplaas Clinic New Clinic 18 Marulaneng Clinic Clinic upgrade to standard 19 Smashersblok Clinic New Clinic 20 Botlokwa Hospital Upgrade of Sewer Ponds 21 Elim Hospital (Boiler) Boilers Upgrade Plans to close down or down-grade any current facilities No facilities were closed down or down-graded during the 2012/13 financial year. Progress made on the major maintenance of infrastructure Upgrade of water reticulation and sanitation at Nkhensani Nursing College. Upgrade of sanitation at Thohoyandou Nursing College. Upgrade of electricity at Groblersdal and Mankweng Hospitals. Upgrade of stand-by generators at Messina and Mecklenburg Hospital. Twenty (20) existing boilers upgraded 2012/13 Annual Report 105

106 Developments relating to the above that are expected to impact on the department s current expenditure The following actions have been taken: Devolved the management and budgets for maintenance to the facilities. Twenty five (25) term contracts are in place. Implementation of comprehensive maintenance strategy. Details as to how asset holdings have changed in the 2012/13 financial year: The Department s asset holding had during the 2012/13 financial year changed as follows: Total additions for the year is R There was only one Laptop reported lost during the year with a value of R Disposals have taken place in 33 Institutions throughout the year with a value of R Measures taken to ensure that the department s asset register remained up-to-date during 2012/13 financial year include: signing off of all Inventory Lists by asset holders Monthly identifying misallocations and correct them in time Conducted asset verifications during the year Reconciliations between asset register and accounting systems The current state of the department s capital assets, for example what percentage is in good, fair or bad condition The total capital stock of immovable assets is R9.5 billion. Included in the value is R 5.0 billion for hospitals, R4.5 billion for PHC and R1 billion for Malaria facilities, Nursing college and residence. The overall average condition is fair. Major maintenance projects that have been undertaken during the period under review Upgrade of water reticulation and sanitation at Nkhensani Nursing College. Upgrade of sanitation at Thohoyandou Nursing College. Upgrade of electricity at Groblersdal and Mankweng Hospitals. Upgrade of stand-by generators at Messina and Mecklenburg Hospital. Twenty (20) existing boilers upgraded Progress made in addressing the maintenance backlog during the period under review During the year under review, the budget was R 74m (adjusted to R171m) for both primary health care facilities and hospitals. The amount of R93m was spent /13 Annual Report

107 The Department needs a budget of R670m per annum to maintain facilities at acceptable standards. Infrastructur e projects New and replacement assets Existing infrastructure assets - Upgrades and additions - Rehabilitation, renovations and refurbishment s - Maintenance and repairs Final Appropriatio n R / /2012 Actual (Over)/Unde Final Actual Expenditu r Appropriation Expenditur re Expenditure R 000 e R 000 R 000 R ,632 45, , , (Over)/Under Expenditure R , , ,022-69, , ,793-78, ,209 Infrastructure transfer - Current ,793-78, ,209 - Capital ,043,654-24, ,978 Total ,136, , , /13 Annual Report 107

108 PART C: GOVERNANCE /13 Annual Report