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DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH

ACHIEVEMENTS AND BUDGET PRIORITIES Presentation to Portfolio Committee April 2002 Mid Term Review of ACHIEVEMENTS AND BUDGET PRIORITIES Presentation to Portfolio Committee April 2002 Mid Term Review of Achievements Priorities for 2002/03

Our VISION is a caring and humane society in which all South Africans have Our VISION is a caring and humane society in which all South Africans have access to affordable, good quality health care

Our MISSION is to consolidate and build on the achievements of the past five Our MISSION is to consolidate and build on the achievements of the past five years in improving access to health care for all and reducing inequity, and to focus on working in partnership with other stakeholders to improve the quality of care of all levels of the health system, especially preventative and promotive health, and to improve the overall efficiency of the health care delivery system

ACHIEVEMENTS Presentation covers achievements for the Mid-Term, as well as achievements for the past ACHIEVEMENTS Presentation covers achievements for the Mid-Term, as well as achievements for the past financial year

Decreasing morbidity and mortality Maternal, Child and Womens Health – Reduction of incidence and Decreasing morbidity and mortality Maternal, Child and Womens Health – Reduction of incidence and prevalence of childhood infectious diseases – Decrease in measles, NNT and AFP – Hi. B introduced into EPI – Intradermal BCG – 3 provincial EPI Reviews – Implementation of IMCI in all provinces

Decreasing morbidity and mortality cont Maternal, Child and Womens Health cont – 40 Baby Decreasing morbidity and mortality cont Maternal, Child and Womens Health cont – 40 Baby Friendly Facilities: 8% of 480 facilities – Guidelines for Maternity Care – Confidential Enquiry in all Provinces – 309 TOP facilities (255 public, 54 private) – 131 TOP facilities functional (83 public, 48 private) – Contraceptive Policy guidelines

Decreasing morbidity and mortality Nutrition cont – Initiatives: PSNP, INP, food fortification, food consumption Decreasing morbidity and mortality Nutrition cont – Initiatives: PSNP, INP, food fortification, food consumption survey – PSNP: 4. 8 million children, 14, 500 schools – Aflatoxin: strategies in place – Food fortification of staple foods – Nutrition guidelines for HIV/AIDs and other chronic diseases – Vitamin A supplementation for Children. – Policy guidelines for youth and adolescent health

Decreasing morbidity and mortality cont HIV/AIDS and STIs – National: Surveillance and research – Decreasing morbidity and mortality cont HIV/AIDS and STIs – National: Surveillance and research – Diflucan distribution – HIV/AIDS antenatal survey – SANAC and provincial AIDS councils: 28 District AID Councils – Numerous guidelines distributed – Improvement in surveillance

Decreasing morbidity and mortality cont HIV/AIDS and STIs – – – – 250 million Decreasing morbidity and mortality cont HIV/AIDS and STIs – – – – 250 million male condoms (190 sites) 700, 000 female condoms (127 sites) 260 sites providing PMTCT services Partnership with Love. Life Traditional Leaders HIV/AIDS Forum established Home based Care 359 VCT sites operational, with 1800 HIV/AIDS counsellors trained

Decreasing morbidity and mortality cont TB – Steady increase in number of DTDs – Decreasing morbidity and mortality cont TB – Steady increase in number of DTDs – More districts meeting target cure rates of 85% – Decision taken to assume responsibility for SANTA hospitals – Challenges: • • Need to improve sputum turnaround time Availability of drugs Increasing compliance Strengthening management of TB hospitals

Decreasing morbidity and mortality cont Cholera – 106, 000 people. 230 deaths – CFR: Decreasing morbidity and mortality cont Cholera – 106, 000 people. 230 deaths – CFR: 0. 2% Malaria – Dramatic decrease: 62, 000 to 36, 000 – WHO-AFRO award for best malaria control programme

Decreasing morbidity and mortality cont Chronic Diseases – Number of guidelines – Cataract projects Decreasing morbidity and mortality cont Chronic Diseases – Number of guidelines – Cataract projects – Range of initiatives Disability – Rehabilitation policy launched – Assistive devices – Partnerships to reduce backlogs

Decreasing morbidity and mortality cont Mental Health Care Bill High secure facility Victim empowerment Decreasing morbidity and mortality cont Mental Health Care Bill High secure facility Victim empowerment programmes Prevention of abuse programmes Life skills programmes Policy guidelines for children and adolescents mental health service developed Policy on psycho-social rehabilitation developed.

Decreasing morbidity and mortality cont Issues for Consideration Improving access to TOP services Improving Decreasing morbidity and mortality cont Issues for Consideration Improving access to TOP services Improving coverage of immunisation Strategies to improve effective immunisation Strategies to reduce teenage pregnancy Integration of various initiatives eg mental health and substance abuse Strategies for cervical cancer

Improving Quality of Care Policy framework on quality of care Introduction of Patients Charter Improving Quality of Care Policy framework on quality of care Introduction of Patients Charter and Batho Pele PHC package completed Minimum data set for PHC Number of awards to reward good performance

Improving Quality of Care Issues for Consideration Challenges – Staff morale – Caring ethos Improving Quality of Care Issues for Consideration Challenges – Staff morale – Caring ethos – Batho Pele – Patients Rights Charter Strategies to improve medical equipment Establishment of quality of care units

Speeding up delivery of PHC through the DHS Audit of PHC services being rendered Speeding up delivery of PHC through the DHS Audit of PHC services being rendered Identifying the service delivery gap, including the gap analysis Development of a methodology for resource allocation and district health expenditure reviews

Speeding up delivery of PHC through the DHS Availability of antenatal care improved substantially Speeding up delivery of PHC through the DHS Availability of antenatal care improved substantially DOTS implemented widely Referral system efficient Turn-around times of various tests improved. Study on “referral patterns” Pro forma service level agreements

Speeding up delivery of PHC through the DHS District Health Information System Step by Speeding up delivery of PHC through the DHS District Health Information System Step by step guide to facilitate the transfer of staff from province to local government Quantification of the size and financial implications as well as the requirements as dictated by the human resource legislative framework has been developed. Annual DHS Best Practice Awards (DHS Competition)

Speeding up delivery of PHC through the DHS Issues for Consideration Need for uniform Speeding up delivery of PHC through the DHS Issues for Consideration Need for uniform indicators and reporting Improvement of community participation Structured assessment of users views Engagement of other departments re infrastructure development Evaluation of personnel mix Evaluating impact of different organisational approaches re districts and regions Gateway clinic concept Reporting on partnerships with NGOs and different delivery approaches

Revitalisation of Hospital Services ± R 423 -million spent on hospital rehabilitation ± R Revitalisation of Hospital Services ± R 423 -million spent on hospital rehabilitation ± R 442 -million spent on construction of major new hospitals. Three large Academic Complexes nearing completion. 242 hospitals will benefit from this programme (3331 individual building projects completed at 86 hospitals)

Revitalisation of Hospital Services Implement cost centres. 210 managers trained in cost center accounting Revitalisation of Hospital Services Implement cost centres. 210 managers trained in cost center accounting Cost Centre Manual developed Standard nation-wide data set implemented

Revitalisation of Hospital Services Issues for Consideration Different interpretations of what needs to be Revitalisation of Hospital Services Issues for Consideration Different interpretations of what needs to be done Too many small projects: not often strategic Problems with Public Works and alternative approaches to delivery Levels of CEO posts and people attracted

Improving resource mobilisation and the management of resources Review of the three major conditionals Improving resource mobilisation and the management of resources Review of the three major conditionals grants and Highly Specialised Services (HSS) was undertaken An enhanced response to HIV/AIDS and Tuberculosis in the Public Health Sector Implementation of UPFS Introduction of PAAB Number of public private partnerships National Health Accounts

Improving resource mobilisation and the management of resources Health Technology Policy Framework published Template Improving resource mobilisation and the management of resources Health Technology Policy Framework published Template for the Essential Health Technology Audits produced Health technology (HT) audit guidelines produced. A pilot HT audit has been completed in the Eastern Cape

Improving human resource development and management Provincial bargaining chambers established HWSETA established. Sector Skills Improving human resource development and management Provincial bargaining chambers established HWSETA established. Sector Skills Plan. National Strategy for Human Resources for Health finalized Mid level workers and scopes of practice DHS Management Competency profile Roll out of community service Number of training courses

Improving human resource development and management Issues for Consideration Distribution of health professionals between Improving human resource development and management Issues for Consideration Distribution of health professionals between provinces and between rural and urban areas Representativeness in the senior management service Training of district and other managers Representativeness in the intake of undergraduate and post-graduate health

Improving human resource development and management Brain drain of doctors and highly specialised nurses Improving human resource development and management Brain drain of doctors and highly specialised nurses to the private sector and developed countries Lack of skills, such as epidemiology, health economics, public health and medical scientists; Programme to deal with the impact of the HIV/AIDS epidemic on health workers Attitudes of health workers Transformation within statutory councils Disciplinary measures by statutory councils Productivity of personnel

Reorganisation of certain support services South African Telemedicine System implemented on an incremental basis Reorganisation of certain support services South African Telemedicine System implemented on an incremental basis 28 sites are implemented and operating in the six provinces National health care management information system (NHC/MIS) implemented District Health Information System (DHIS) implemented Common national data dictionary established New Birth and Death notification forms

Reorganisation of certain support services Systems to strengthen the ability to support the Medicine Reorganisation of certain support services Systems to strengthen the ability to support the Medicine Control Council: – Development and implementation of a file and document tracking system – System to enforce laws and identify bodies whose licensing fees are outstanding – System to control the issues of licenses for medication.

Reorganisation of certain support services National Health Laboratory Service (NHLS) – South African National Reorganisation of certain support services National Health Laboratory Service (NHLS) – South African National Blood Service (SANBS) established

Legislative Reform Legislation tabled The Mental health Care Bill Medical Schemes Amendment Bill National Legislative Reform Legislation tabled The Mental health Care Bill Medical Schemes Amendment Bill National Health Laboratory Service Amendment Bill Other legislation due to be tabled

Improving communication Communication within the Department Communication and interaction with stakeholders occur at various Improving communication Communication within the Department Communication and interaction with stakeholders occur at various levels and platforms. Health Summit Health month Various for a to improve consultation

Strengthening co-operation with our partners internationally WHO: Draft work plan for the WHO 2002 Strengthening co-operation with our partners internationally WHO: Draft work plan for the WHO 2002 -2003 Biennium on Legislative Reform submitted Agreement with WHO to address problem of supervision and decentralization of PHC to local government Child and adolescent health and development; women’s health; health promotion; surveillance of non communicable diseases and protection of human environment

Strengthening co-operation with our partners internationally Japan: Building of the Zamani clinic in Gauteng Strengthening co-operation with our partners internationally Japan: Building of the Zamani clinic in Gauteng Purchase and maintenance of clinic and hospital equipment in 3 provinces UNFPA: Support for development of training materials and the development of policies for maternal, child and women’s health

Strengthening co-operation with our partners internationally FAO: Improvement of street foods and the strengthening Strengthening co-operation with our partners internationally FAO: Improvement of street foods and the strengthening of the Codex committee USAID: Assist communities with responses to HIV/AIDS related needs and care and research into potential high transmissions areas for HIV/AIDS in the Eastern Cape CDC: Assist the Department in the area of HIV/AIDS and infectious diseases

AREAS TO BE COVERED Non Personal Health Services – Environmental Health – Occupational Health AREAS TO BE COVERED Non Personal Health Services – Environmental Health – Occupational Health – Health Promotion Disease Prevention and Control Hospital Services Human Resource Development Legal Services Communication

PRIORITIES FOR 2002/2003 KEY PRIORITIES OF THE DEPARTMENT ACCORDING TO TEN POINT PLAN PRIORITIES FOR 2002/2003 KEY PRIORITIES OF THE DEPARTMENT ACCORDING TO TEN POINT PLAN

AREAS TO BE COVERED HIV/AIDS & TB Pharmaceutical Services Maternal, Child & Women’s Health AREAS TO BE COVERED HIV/AIDS & TB Pharmaceutical Services Maternal, Child & Women’s Health and Nutrition Mental Health Districts and Development Health Monitoring and Evaluation Financial Management Gender

TEN POINT PLAN FOR 1999 - 2004 1. Decreasing morbidity and mortality rates through TEN POINT PLAN FOR 1999 - 2004 1. Decreasing morbidity and mortality rates through strategic interventions 2. Improving quality of care 3. Speeding up delivery of an essential package of services through the district health system 4. Revitalisation of hospital services 5. Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation

TEN POINT PLAN FOR 1999 – 2004 (cont) 6. Improving human resource development and TEN POINT PLAN FOR 1999 – 2004 (cont) 6. Improving human resource development and management 7. Reorganisation of certain support services 8. Legislative reform 9. Improving communication and consultation within the health system and the communities we serve 10. Strengthening co-operation with our partners

Decreasing morbidity and mortality through strategic interventions Improve the effectiveness of Emergency Medical Services Decreasing morbidity and mortality through strategic interventions Improve the effectiveness of Emergency Medical Services Provincial business plans for EMS development, including HR and training Pre-hospital EMS regulations finalised Part of in-hospital EMS draft regulations finalised Planning and provision of health, medical and disaster management and fire services for Earth Summit 2003 finalised and implemented.

Decreasing morbidity and mortality through strategic interventions Non Personal Health Services Develop a National Decreasing morbidity and mortality through strategic interventions Non Personal Health Services Develop a National Department of Health Occupational Health Strategy document Minimum package of Occupational Health Service determined Strengthening management and control of payments of compensation for mining related Occupational Lung Diseases Finalisation of proposed regulations for the control of environmental conditions constituting a danger to

Decreasing morbidity and mortality through strategic interventions Rationalization of occupational health and compensation competencies Decreasing morbidity and mortality through strategic interventions Rationalization of occupational health and compensation competencies Monitoring protocols for water quality to be developed and implemented Business plans for health and hygiene education on sanitation programme

Decreasing morbidity and mortality through strategic interventions Health Promotion Strengthen Health Promoting Schools (HPS) Decreasing morbidity and mortality through strategic interventions Health Promotion Strengthen Health Promoting Schools (HPS) initiatives in all provinces in collaboration with the Departments of Education, Social Developments, the teachers unions and NGOs Education Facilitate implementation and monitoring of Tobacco Legislation Finalise HP Policy Develop guidelines for HP at district level

Decreasing morbidity and mortality through strategic interventions Chronic Diseases and Disability Distribution of health Decreasing morbidity and mortality through strategic interventions Chronic Diseases and Disability Distribution of health promotion/information material on breast and prostate cancer Finalise guidelines for the management of asthma in children Finalise strategy for management of chronic diseases in children Develop disability and rehabilitation norms and standards Finalise disability prevention booklets Distribution and implementation of prevention of blindness programme guidelines

Decreasing morbidity and mortality through strategic interventions Communicable disease control Update and implement 5 Decreasing morbidity and mortality through strategic interventions Communicable disease control Update and implement 5 year plan and the annual plans for national and provincial malaria control programmes Collaboration on the SDI project with Mozambique and Swaziland to improve malaria control in South Africa and the Lubombo and Maputo Corridors Contain and prevent the outbreak of cholera in the provinces

Decreasing morbidity and mortality through strategic interventions Finalise and distribute general guidelines on outbreak Decreasing morbidity and mortality through strategic interventions Finalise and distribute general guidelines on outbreak response and epidemic preparedness Develop and distribute guidelines on diarrhoeal diseases, haemorrhagic fevers and central nervous system diseases Enhance strategies to respond to outbreaks related to bio-terrorism

Decreasing morbidity and mortality through strategic interventions Programmes in the Chief Directorate: HIV/AIDS & Decreasing morbidity and mortality through strategic interventions Programmes in the Chief Directorate: HIV/AIDS & TB STIs AND BARRIER METHODS YOUTH PROGRAMME PARTNERSHIP SUPPORT CARE, COUNSELLING AND SUPPORT GAAP NGO FUNDING INTERDEPARTMENTAL SUPPORT TB

Decreasing morbidity and mortality through strategic interventions Decrease the risk of HIV transmission through Decreasing morbidity and mortality through strategic interventions Decrease the risk of HIV transmission through appropriate treatment of Sexually Transmitted Infections as well as the piloting and implementation of an effective PMTCT programme Decrease AIDS related morbidity through the implementation of effective guidelines for nutrition among HIV persons as well as prophylaxis for tuberculosis

Decreasing morbidity and mortality through strategic interventions Decrease AIDS related morbidity through strengthening of Decreasing morbidity and mortality through strategic interventions Decrease AIDS related morbidity through strengthening of TB/HIV care and treatment of opportunistic infections Decrease Maternal Morbidity due to AIDS through the implementation of guidelines for the clinical management of HIV positive pregnant women Sustain the momentum of the Diflucan initiative (as PPI) for the treatment of Cryplococcal meningitis and oral/candidiasis

Decreasing morbidity and mortality through strategic interventions Improve the quality of treatment of STI Decreasing morbidity and mortality through strategic interventions Improve the quality of treatment of STI in the private sector Support the execution of Quality control assessment of HIV rapid and standard testing. Ensure the appropriate implementation of guidelines for VCT, HBC as well the PMTCT protocol Review and update guidelines for STI treatment Strengthening traditional healers programme Youth programme Campaigns Life Skills Programme with the Department of Education

Decreasing morbidity and mortality through strategic interventions Broaden the base on prevention activities through Decreasing morbidity and mortality through strategic interventions Broaden the base on prevention activities through intersectoral collaboration in order to achieve equity in access to prevention messages as these relate to the following groups: Transport Sector (RFA), Shebeens, taverns, Hospitality industry, Women’s sector, Traditional leaders Finalisation of condom policy Partner notification project Expansion of PMTCT services Support research on PEP for sexual assault

Decreasing morbidity and mortality through strategic interventions Policies: Develop VCT policy Develop care and Decreasing morbidity and mortality through strategic interventions Policies: Develop VCT policy Develop care and treatment policy Develop policy on lay workers and volunteers Finalise policy on children Finalise policy on support for health workers

Decreasing morbidity and mortality through strategic interventions Guidelines: Couples counselling Group counselling Counselling for Decreasing morbidity and mortality through strategic interventions Guidelines: Couples counselling Group counselling Counselling for children Palliative care Protocols for quality control (rapid tests) Review and expansion of VCT services

Decreasing morbidity and mortality through strategic interventions TB: Revision of the MDR-TB treatment guidelines Decreasing morbidity and mortality through strategic interventions TB: Revision of the MDR-TB treatment guidelines Prevention of transmission of TB in health care facilities Expansion of electronic district-based reporting and recording systems to five Provinces Training of home based caregivers and TB treatment supporters in TB/HIV/AIDS training districts Expansion of DTDs in Kwa. Zulu-Natal, Northern Province, Mpumalanga and Northern Cape

Decreasing morbidity and mortality through strategic interventions Strengthen 30 districts that are performing poorly Decreasing morbidity and mortality through strategic interventions Strengthen 30 districts that are performing poorly (DTDs) Develop a TB/HIV advocacy document Develop a District Managers Training Manual Develop and pilot a link system between the laboratory data and district-based reporting system for TB Establish one TB/HIV training district in each province Training of health care workers in an integrated TB/HIV approach National review of the tuberculosis situation and control

Decreasing morbidity and mortality through strategic interventions Pharmaceutical Services: LEGISLATION Food fortification regulations Nutritional Decreasing morbidity and mortality through strategic interventions Pharmaceutical Services: LEGISLATION Food fortification regulations Nutritional supplements regulations Alcoholic beverages, labeling and advertising regulations Amendments to the microbiological standards Codex obligations to Regulations

Decreasing morbidity and mortality through strategic interventions LEGISLATION Finalize “Ownership of Pharmacies” regulations, Act Decreasing morbidity and mortality through strategic interventions LEGISLATION Finalize “Ownership of Pharmacies” regulations, Act No. 88 of 1997 Amendments to Act No. 90 of 1997. Finalize regulations, Act No. 90 of 1997 POLICY Framework for ‘New National Food Control System’ Review of the National Drug Policy, 1996

Decreasing morbidity and mortality through strategic interventions NORMS AND STANDARDS ( DSM ) Best Decreasing morbidity and mortality through strategic interventions NORMS AND STANDARDS ( DSM ) Best practice : procurement, warehousing, distribution of drug products. Best practice : stock management at all health facilities. Review EDL Impact Study Explore and develop model for local manufacture Establish pricing committee

Decreasing morbidity and mortality through strategic interventions Maternal, Child and Women’s Health & Nutrition Decreasing morbidity and mortality through strategic interventions Maternal, Child and Women’s Health & Nutrition Implementation of steps to improve school feeding Baby-friendly Hospital Initiative Assessments Phasing in implementation of National Nutrition Surveillance System through 3 pilot sites per province Expansion of vitamin A supplementation to all provinces Nutrition campaign Finalisation of Food-based Dietary Guidelines and related IEC material

Decreasing morbidity and mortality through strategic interventions Publication of final regulations on food fortification Decreasing morbidity and mortality through strategic interventions Publication of final regulations on food fortification Launch of food fortification programme Development of draft regulations on the marketing of designated products (Breast-milk substitutes) Provincial meetings to assist in the implementation of human genetics policy guidelines Development of a training package for primary health care workers Development of policy guidelines for chronic diseases of childhood

Decreasing morbidity and mortality through strategic interventions Developing parent friendly Management Guidelines Genetic Curriculum Decreasing morbidity and mortality through strategic interventions Developing parent friendly Management Guidelines Genetic Curriculum Development Printing of IEC material on priority conditions Development of new IEC material (NTD, Teratogens) National training on birth defects monitoring Report on the confidential enquires into maternal deaths to assess preventable causes and identify strategies to reduce maternal deaths

Decreasing morbidity and mortality through strategic interventions Monitor and evaluate progress made with the Decreasing morbidity and mortality through strategic interventions Monitor and evaluate progress made with the implementation of the ten recommendations from 1998 Saving Mothers Report Develop booklet, news letter and / or radio messages on Hypertensive conditions in pregnancy, Anaemia and for women living with HIV and as well as management of reduced fetal movements Printing and distribution IEC Materials for safe motherhood Facilitate development of safer motherhood

Decreasing morbidity and mortality through strategic interventions Launch of Contraception Service Delivery Guidelines Facilitate Decreasing morbidity and mortality through strategic interventions Launch of Contraception Service Delivery Guidelines Facilitate and monitor the implementing of National Guidelines on cervical cancer screening programme. Increase access to CTOP services Develop guidelines on the management of rape/sexual abuse Implementation of all three components of Integrated Management of Childhood Illness (IMCI) at provincial and district level.

Decreasing morbidity and mortality through strategic interventions Develop revised school health guidelines and facilitate Decreasing morbidity and mortality through strategic interventions Develop revised school health guidelines and facilitate implementation of school health services Develop appropriate basic health care information guidelines for all children in especially difficult circumstances. Finalisation and dissemination of the popular version of youth and adolescent health policy guidelines Dissemination of Youth and Adolescent Health policy guidelines

Decreasing morbidity and mortality through strategic interventions Audit appropriate Information Education Communication materials on Decreasing morbidity and mortality through strategic interventions Audit appropriate Information Education Communication materials on , teenage pregnancy, STIs and HIV/AIDS. Finalise national strategy on prevention of teenage pregnancy Develop appropriate guidelines for health workers on health priority areas to address the needs of young people. Meet the criteria set for surveillance of 4 EPI priority diseases

Decreasing morbidity and mortality through strategic interventions Mental Health & Substance Abuse Set up Decreasing morbidity and mortality through strategic interventions Mental Health & Substance Abuse Set up a task team and conduct consultation on alcohol/ counter advertising Print and distribute child and youth mental health policy Development of psycho-social rehabilitation policy Draft women's mental health policy Develop substance abuse prevention & treatment policy Accept and adapt ILO guidelines for substance

Decreasing morbidity and mortality through strategic interventions Assist provinces with integrated mental health care Decreasing morbidity and mortality through strategic interventions Assist provinces with integrated mental health care and deinstitutionalisation Train PHC workers in mental health, substance abuse and victim empowerment Continue with implementation and evaluation of violence prevention in schools Continue with implementation and evaluation of parent/child bonding programme Develop and test manual for suicide prevention

Decreasing morbidity and mortality through strategic interventions Establish extent of HIV infection in psychiatric Decreasing morbidity and mortality through strategic interventions Establish extent of HIV infection in psychiatric hospitals HIV/AIDS education in psychiatric hospitals evaluated in pilot sites Finalise and print guidelines in HIV infection and mental health Develop norms for community mental health care Assess quality of care in 15 psychiatric hospitals in order to set national quality standards Train practitioners in use of Mental Health Care Act

Improving quality of care National Council for Health Care Quality established. Introduce certain means Improving quality of care National Council for Health Care Quality established. Introduce certain means to improve quality of care as proposed in National Policy on Quality: Clinical Audit, National Adverse Event Reporting System, and Supervision. Finalise and implement District Hospital Package with accompanying norms and standards Complete preparation and costing of a Regional Hospital Package

Improving quality of care Set up national help desk to inter alia manage complaints Improving quality of care Set up national help desk to inter alia manage complaints Design and introduce a Quality Improvement Training Programme for health workers Design and adjust National Health Information System to measure quality Strengthen awareness on health rights QI training tool & prog. for especially mid-level health workers

Speeding up delivery of an essential package of services through the district health system Speeding up delivery of an essential package of services through the district health system Provide leadership (DHS, rural development, urban renewal) Promote inter-sectoral development through ISRDP & URP Build institutional support for delivery of PHC services Implementation strategy for PHC package Framework for decentralized management Monitor & manage donor funded projects Communication strategy on district health services

Revitalisation of Hospital Services Integrated Health Planning Framework finalised Hospital revitalisation project implemented Policy Revitalisation of Hospital Services Integrated Health Planning Framework finalised Hospital revitalisation project implemented Policy framework for the decentralisation process including good practice guidelines for implementation at provincial level finalised. Re-alignment of tertiary services review completed Organ Donor Policy completed

Revitalisation of Hospital Services Regulations and guidelines on hospital boards finalised. Step down facilities Revitalisation of Hospital Services Regulations and guidelines on hospital boards finalised. Step down facilities included in the regulations for the National health Act Provincial planning and commissioning capacity strengthened (5 provinces) Implementation of cost centres in fifteen of the hospital management grant pilots.

Improving resource mobilisation and the management of resources Financial Management Services Compilation of the Improving resource mobilisation and the management of resources Financial Management Services Compilation of the public sector National Health Account (NHA) for SA Consolidation of the National PPP framework, including a compilation of a monitoring and evaluation framework for developing PPPs. Development of a well functioning PPI forum Development of a monitoring and evaluation system after the restructuring of the Conditional Grants

Improving resource mobilisation and the management of resources Develop a long-term plan for the Improving resource mobilisation and the management of resources Develop a long-term plan for the modernisation of tertiary services (MTS) after the restructuring of the Conditional Grants for National Tertiary services Costing Studies – Completion of the costing of the district hospitals package – Costing of the package will be undertaken upon completion of the first draft of the regional hospitals package Policy proposal on the retention of revenue by provincial

Improving resource mobilisation and the management of resources A review of Patient utilisation and Improving resource mobilisation and the management of resources A review of Patient utilisation and appropriateness of hospitalisation will be undertaken as it relates to the increased burden of HIV/AIDS on the Health sector. Evaluation of the UPFS to consolidate uniform implementation Incidence of Financing and Benefits Analysis Develop proposals on restructuring the tax subsidy

Improving resource mobilisation and the management of resources Develop public finance options for ensuring Improving resource mobilisation and the management of resources Develop public finance options for ensuring additionality of SHI revenue Develop alternative proposals for achieving universal cover for civil servants Risk equalisation research Details development of the state sponsored scheme, ((package, cost, admin. , etc. )

Improving resource mobilisation and the management of resources Building capacity in terms of project Improving resource mobilisation and the management of resources Building capacity in terms of project management skills & tools. Build Project Management Knowledge and Lessons learned (e. g. planning and re-planning by managers) Further roll out of the PFMA. Improve on the quality of financial data. More specialised financial training. Improve system of asset management. Review current financial policies and delegations.

Improving resource mobilisation and the management of resources Implementation of Basic Accounting System (BAS). Improving resource mobilisation and the management of resources Implementation of Basic Accounting System (BAS). Implementation of Procurement Policy with special focus on BEE Develop a Service Level Agreement with the Department. Stabilise Networks.

Improving resource mobilisation and the management of resources Health Technology Scoping Study Completed HT Improving resource mobilisation and the management of resources Health Technology Scoping Study Completed HT Audit Guidelines for roll-out to other provinces Health technology packages for maternal and child health at district level Health technology management policy (first draft) Interim National Health Technology Forum in place Staffing Norms for Clinical Engineering Technicians Completed Japanese Grant-Aided project in Kwa. Zulu. Natal

Improving Human Resource Development and Management Transformation of Education and training health professionals Recruitment Improving Human Resource Development and Management Transformation of Education and training health professionals Recruitment and retention strategy for DOH including rural strategy and migration Transformation of statutory councils Capacity building re: Cholera, Batho Pele Facilitate the equitable intern allocation and community service

Human Resources Collective agreements with unions – Essential services – Full-time shop stewards – Human Resources Collective agreements with unions – Essential services – Full-time shop stewards – Picketing agreement – Danger allowance – Upgrading of pharmacists Strengthen HWSETA

Human Resources Strengthen functioning of HWBC with focus on employee benefits – BCEA determination Human Resources Strengthen functioning of HWBC with focus on employee benefits – BCEA determination for H&W sector – Pay progression model – Restructuring of the Public Service Participation in task teams to assist PSCBC agreements – Public Servants medical aid restructuring – Retention of skills Workplace Skills Plan

Human Resources Health management training Human Resource planning Scopes of practice for mid level Human Resources Health management training Human Resource planning Scopes of practice for mid level workers Schools of Public Health Finalise skills competency profile for Senior Managers Review the training and development policy Training and Development within Skills development Act and SETA requirements

Human Resources Develop, finalize and monitor implementation of communication strategy on employment equity, employment Human Resources Develop, finalize and monitor implementation of communication strategy on employment equity, employment equity plan and succession plans, diversity management programme and coaching and mentorship programme. Monitor by participating in all transformation related committees Collate and develop reports on Employment Equity Assess and evaluate EE Plan and Policies

Human Resources Gender Focal Point Finalise policy guidelines on gender Gender Analysis Research Training Human Resources Gender Focal Point Finalise policy guidelines on gender Gender Analysis Research Training of senior managers in gender analysis Training of provincial Gender Focal Points in policy guidelines and gender and health related issues targeting Gender Focal Points in the all the provinces

Human Resources Conducting awareness raising activities for staff re: policy guidelines and various gender Human Resources Conducting awareness raising activities for staff re: policy guidelines and various gender issues. Workplace gender forum Health sector coordinating committee Organise and coordinate the Gender and Health Summit Develop the Public Health Sector Gender and Health Action Plan

Human Resources Finalise the situational analysis into medicolegal services Develop a forensic nursing training Human Resources Finalise the situational analysis into medicolegal services Develop a forensic nursing training plan and curriculum Facilitate training in forensic nursing Advocacy (Violence Against Women) IDMT: develop an Anti-rape strategy, an intersectoral collaboration 16 days of no violence against women campaign.

Reorganisation of certain support services Incorporation of Western Province Blood Transfusion Service (WPBTS) into Reorganisation of certain support services Incorporation of Western Province Blood Transfusion Service (WPBTS) into South African National Blood Service (SANBS) Facilitate transfer of medicolegal mortuaries from SAPS to provincial departments of health. Support efficient functioning of National health laboratory service

Reorganisation of certain support services Set-up information network for epidemiological and disease outbreak control Reorganisation of certain support services Set-up information network for epidemiological and disease outbreak control Developing a primary health care package for laboratory test repertoire for district laboratory services Facilitate construction of a BLS 4 laboratory Administering the Human Tissue Act Establishment of a joint venture vaccine production facility

Reorganisation of certain support services Telemedicine instituted in 8 medical schools & distance learning Reorganisation of certain support services Telemedicine instituted in 8 medical schools & distance learning reviewed NHC/MIS - consolidate PAAB & expand to more hospitals Vital registration - increase coverage (HA & SD) Finalise ethics guidelines

Reorganisation of certain support services Publish educational brochure on guidelines for clinical trials for Reorganisation of certain support services Publish educational brochure on guidelines for clinical trials for communities Publish Health Research policy Finalise Implementation Strategy for Health Research Policy Constitute a National Health Research Ethics Council Conduct second SADHS Complete Impact of HIV/AIDS in the health sector

Legal Reform Tabling of National Health Bill Medicines Control Act amendments and regulations re Legal Reform Tabling of National Health Bill Medicines Control Act amendments and regulations re parallel importation, generic substitution, dispensing by health professionals. Pharmacy Act regulations on financial management of the Pharmacy Council and ownership regulations

Legal Reform Tobacco Products Control Act Amendment Bill and regulations on smoking of tobacco Legal Reform Tobacco Products Control Act Amendment Bill and regulations on smoking of tobacco products Dental Technicians Amendment Bill Foodstuffs, Cosmetics and Disinfectants AB Traditional Healers Bill Health Laws Repeal Bill Nursing Amendment Bill

Communication within Do. H Communication with provinces/districts Communication with sector stakeholders General public information Communication within Do. H Communication with provinces/districts Communication with sector stakeholders General public information Support to HP: media production

Communication Facilitate production of annual report Implement strategy, especially roadshows targeting managers Effective Media Communication Facilitate production of annual report Implement strategy, especially roadshows targeting managers Effective Media Liaison for Department Plan media interventions re major developments Plan and organise key public relations events, including Health Month in April

Strengthening co-operation with our partners internationally Submit proposals on the restructuring of IHL Ensure Strengthening co-operation with our partners internationally Submit proposals on the restructuring of IHL Ensure a smooth transition of work from SADC HSCU to IHL Review current bilateral agreements Prioritise countries and programmes to support SA's human resource development Initiate Programme of cooperation in the Manufacture of Pharmaceuticals, including identification of countries to collaborate with Monitor implementation of bilateral agreements

Strengthening co-operation with our partners internationally Develop programme for placement of South Africans in Strengthening co-operation with our partners internationally Develop programme for placement of South Africans in key international agencies/bodies Ensure South African participation in international fora Facilitate the utilization of funds from partners, including the Global Health Fund for HIV/AIDS, TB and Malaria in SA, SADC and NEPAD Ensure better cooperation between DOH and donor countries and agencies (Bilateral and Multi lateral) Strategic Framework for Official Development Aid

CONDITIONAL GRANTS (HOSPITAL GRANTS) CONDITIONAL GRANTS (HOSPITAL GRANTS)

LIST OF OLD & NEW GRANTS Old Central hospitals and Redistribution of 3 o LIST OF OLD & NEW GRANTS Old Central hospitals and Redistribution of 3 o Services Health professional training & research Pretoria Academic Hospital reconstruction & rehabilitation New National tertiary services Health professional training & development Pretoria Academic Hospital Revitalization Hospital Mx & Quality improvement

Notes Service Agreements for NTSG and HPTD prepared Business plans for other grants are Notes Service Agreements for NTSG and HPTD prepared Business plans for other grants are developed and approved Expenditure according to business plan Progress against action plan List of indicators pertaining to expenditure vs cash flow RDP and INP indicators

Notes (Cont…) Provincial heads of health submit monthly and quarterly financial reports Certificates signed Notes (Cont…) Provincial heads of health submit monthly and quarterly financial reports Certificates signed by Provincial Accounting Officer at the end of the financial year. Provincial liaison and technical support visits Regular meetings per financial year between national and provinces

Payment Schedule National Tertiary Services and HPT &Dmonthly transfers Hospital revitalization , Pretoria Academic- Payment Schedule National Tertiary Services and HPT &Dmonthly transfers Hospital revitalization , Pretoria Academic- quarterly advances and Hosp Mx & Quality Improvement- 3 advance installments

National Tertiary Services PURPOSE To fund national tertiary services To ensure equitable access by National Tertiary Services PURPOSE To fund national tertiary services To ensure equitable access by all South Africans to basic tertiary health care To ensure nationally coord. Ainated planning for tertiary services

Monitoring mechanisms NTS Grant Signing of service agreement standards for tertiary services. Monthly and Monitoring mechanisms NTS Grant Signing of service agreement standards for tertiary services. Monthly and quarterly reporting on transfers and expenditure. Quarterly reporting on tertiary service level

MONITORING MECHANISMS CONT…… HPT&D GRANT Quarterly and annual reporting on number of students enrolled MONITORING MECHANISMS CONT…… HPT&D GRANT Quarterly and annual reporting on number of students enrolled by discipline, level and institution. Quarterly and annual reporting on number and duration of practical placements by health sciences students by type of health facility. Quarterly and annual reporting by targeted provinces on achievement of planned expansion of specialist and

MONITORING MECHANISMS CONT…… HOSPITAL REVITALIZATION GRANT Monthly reporting on project implementation progress and financial MONITORING MECHANISMS CONT…… HOSPITAL REVITALIZATION GRANT Monthly reporting on project implementation progress and financial flows to the national Do. H CONSTRUCTION GRANT PRETORIA ACADEMIC HOSPITAL Regular reports on status of the project. Site visits in every 2 -3 months for progress assessment.

MONITORING MECHANISMS CONT…… Hospital Management & Quality Improvement Quarterly progress reports on the implementation MONITORING MECHANISMS CONT…… Hospital Management & Quality Improvement Quarterly progress reports on the implementation of hospital improvement projects to NDo. H. Quarterly and monthly financial reporting on transfers and expenditure.

NTSG Conditions Demonstrate progress towards creation of separate cost & mx centre for each NTSG Conditions Demonstrate progress towards creation of separate cost & mx centre for each hospital Demonstrate progress towards appointment of CEO for each hospital Delegation of mx, accounting officer procurement, hiring, disciplining and dismissal powers to CEO Provision of designated national tertiary services Provision of services at activity levels as agreed between Province and the NDo. H

NTSG Criteria for division Cost of designated national tertiary services standardized between provinces to NTSG Criteria for division Cost of designated national tertiary services standardized between provinces to ensure “like for like”funding Non-personnel costs based on service delivery levels

Health Professional Training & Development PURPOSE Support training of health professional Develop & recruit Health Professional Training & Development PURPOSE Support training of health professional Develop & recruit medical specialists Fund costs associated with undergraduate and post-graduate remedial students Enable shifting of some teaching activities from central hospitals to regional and district facilities.

HPT & D Conditions Provinces to supply information on the training of medical personnel HPT & D Conditions Provinces to supply information on the training of medical personnel by institution Deployment of additional registrars and specialists to gaining provinces and institutions in terms of the plan agreed to by provinces and NDo. H Provinces to create and budget for additional posts related to registrars and specialists as agreed with NDo. H and the deans of medical

HPT & D Conditions (cont…) Timely submission of monitoring information as agreed with NDo. HPT & D Conditions (cont…) Timely submission of monitoring information as agreed with NDo. H.

HPT & D Criteria for division – HPT Component 5 provinces with medical schools HPT & D Criteria for division – HPT Component 5 provinces with medical schools get proportionate to medical undergraduates. 10% is divided between 4 provinces without medical schools Criteria for division – Development Component Based on specialists and registrars needed for the expansion of Level II services to reach national per capita average for the distribution of registrars and specialists

Hospital Revitalization PURPOSE Transform and modernize public hospitals in line with the national planning Hospital Revitalization PURPOSE Transform and modernize public hospitals in line with the national planning framework and to achieve sustainability.

Hospital Revitalization Conditions Compliance with the IHPF and reporting requirements Compliance with the provincial Hospital Revitalization Conditions Compliance with the IHPF and reporting requirements Compliance with the provincial priorities identified in the SPS All additional projects must include broader revitalization issues Implement pilot projects as identified in project business cases 2003/4 business plans to be submitted by 30

Hospital Revitalization Criteria for division 1995 CSIR hospital facilities audit provided a base for Hospital Revitalization Criteria for division 1995 CSIR hospital facilities audit provided a base for determining a backlog index. This index forms the base for the division of funds. Projects of national priority are funded from this grant.

Hospital Construction Pretoria Academic PURPOSE To fund the construction of Pretoria Academic Hospital Hospital Construction Pretoria Academic PURPOSE To fund the construction of Pretoria Academic Hospital

Hospital Construction Conditions GP to fund future operational costs of the hospital Hospital Construction Conditions GP to fund future operational costs of the hospital

Hospital Management & Quality Improvement PURPOSE Improving hospitals management including development of cost center Hospital Management & Quality Improvement PURPOSE Improving hospitals management including development of cost center accounting systems Improved PFMA implementation and strengthened financial skills and capacity Support quality of care interventions to substantially improve quality of hospital services

Hospital Management & Quality Improvement Conditions Demonstrate significant progress towards decentralization of mx before Hospital Management & Quality Improvement Conditions Demonstrate significant progress towards decentralization of mx before 2 nd payment Implementation plan for cost centers before 3 rd payment All hospitals funded to implement quality improvements specified in national policy on quality of care Funds can be used in hospitals in association with Hospital Revitalization projects

Hospital Management & Quality Improvement Criteria for division Grant initially focuses on big budget Hospital Management & Quality Improvement Criteria for division Grant initially focuses on big budget hospitals, particularly tertiary hospitals which are identified as pilots Allocations in the initial years of programme are based towards provinces with major tertiary hospitals.

Hospital grants-MTEF Table 1 Summary of hospital grants 2001/02 2002/03 2003/04 2004/05 R thousand Hospital grants-MTEF Table 1 Summary of hospital grants 2001/02 2002/03 2003/04 2004/05 R thousand Budget Medium Term Estimates National Tertiary Services 3, 453, 080 3, 666, 842 3, 892, 849 4, 151, 542 Professionals training and Development 1, 234, 090 1, 279, 248 1, 299, 475 1, 393, 366 Hospital rehabilitation programme Durban and Umtata hospitals Pretoria Academic Hospital Total 500, 000 520, 000 543, 400 576, 004 103, 800 - - - 50, 000 70, 000 90, 000 - 5, 340, 970 5, 536, 090 5, 825, 724 6, 120, 912

NTSG NTSG

Hospital Mx & Quality Improvement Hospital Mx & Quality Improvement

HPT & D HPT & D

Hospital Revitalization Hospital Revitalization

FISCAL FEDERALISM AND INTER-PROVINCIAL INEQUITY IN HEALTH SPENDING FISCAL FEDERALISM AND INTER-PROVINCIAL INEQUITY IN HEALTH SPENDING

Progress towards Equity Little or no role for the NDo. H Provincial discretion on Progress towards Equity Little or no role for the NDo. H Provincial discretion on allocation of funds between sectors Conditional grants – Only mechanism available – Used this to reform the funding of Tertiary Services All provinces are moving upwards in their spending patterns – Although there is evidence that in some provinces we are moving away from equity

Provincial Allocations to Health Provincial Allocations to Health

% Change Year-on-Year % Change Year-on-Year

Per Capita Spending Per Capita Spending

Over-Under National Average Over-Under National Average