GAUTENG DEPARTMENT OF HEALTH PERFORMANCE PRESENTATION HEALTH PORTFOLIO

GAUTENG DEPARTMENT OF HEALTH PERFORMANCE PRESENTATION HEALTH PORTFOLIO 21 MAY 2015 By MEC Q. D MAHLANGU

Contents q Outline q References q Vision and Mission q Departmental Values q Alignment of NDP Goals/Priorities with MTSF q SONA q SOPA q MEC’s Performance Agreement q Accelerated Social Transformation q Alignment of Strategic Goals with MTSF q GPG 2020 Strategic planning process and outcomes q 2015/16 -18 Annual Performance Plan q Unaudited Expenditure as at 31 March 2015 q 2015/16 Budget Allocation q Analysis of Improved audit Outcomes over Past 5 years q 2015/16 Budget Allocation q Root Causes for current qualifications and mitigating actions q Human Resources 2

Vision and Mission Vision Daily we provide high-quality, efficient and accessible healthcare to transform people’s lives Mission Create an effective public health system in Gauteng by ensuring we have the right people, skills, systems and equipment to provide the care our patients need to live healthy, quality lives 3

Departmental Values Patient focused Ensure patients benefit on everything we do Accountability Taking ownership of our responsibilities and go above and beyond and expect our colleagues to do the same to achieve the best outcome for our patients Transparency Making decisions based on facts and we are willing to explain them to those affected by our decisions Efficiency Working efficiently to optimise the scarce resources to achieve more with less q q Provincial Values q q Patriotism Integrity Purposefulness Passionate Accountability Activism 4

Outline 2015/16 -2020 Strategic Plan q Alignment of National, Provincial and Departmental Priorities q Key Provincial Priorities ( MEC’s PA) q State of Nation Address (SONA) q State of the Province Address (SOPA) q Strategic Overview q Vision, Mission and Values q Strategic Goals and Objectives 2015/16 -18 Annual Performance Plan q Budget Programme priorities and Performance indicators and targets q Programme 1: Administration q Programme 2: District Health Services q Programme 3: Emergency Medical and Planned Patient Transport Services q Provincial Hospital Services q Central Hospital Services q Health Sciences and Training q Health Care Support Services q Health facilities Management 5

References Election Manifesto May 2014 National NDP 2030 NSDA 201419 SONA 2015 Provincial GPG 2020 TMR EXCO Lekgotla GPG 5 year POA MTSF 2014 -19 NDOH 2014 -19 Strategic Plan SOP 2015 Gauteng Department of Health Long Term Plan Health 2030 2015/16 -2020 Strategic Plan Annual Performance Plan 2015 -16 / 2017 -18 Programme of Action 2015/16 MEC Performance Agreement 6

Alignment of NDP Goals/Priorities with MTSF NDP GOALS 2030 NDP PRIORITIES 2030 SUB-OUTCOMES 2014 -2019 (MTSF) Average male and female life expectancy at § Address the social determinants that affect health birth increased to 70 years and diseases § Prevent and reduce the disease burden and promote Tuberculosis (TB) prevention and cure § HIV & AIDS and Tuberculosis prevented and health progressively improved; successfully Managed Prevalence of Non-Communicable Diseases reduced by 28% Injury, accidents and violence reduced by 50% from 2010 levels § Maternal, infant and child mortality reduced Health systems reforms completed § Strengthen the health system § Improved health facility planning and infrastructure delivery § Health care costs reduced § Improve health information systems § Improve quality by using evidence Primary health care teams deployed to provide care to families and communities Universal health coverage achieved § Efficient Health Management Information System for improved decision making § Improved quality of health care § Re-engineering of Primary Health Care § Financing universal healthcare coverage § Universal Health coverage achieved through implementation of National Health Insurance Posts filled with skilled, committed and § Improve human resources in the health sector competent individuals § Review management positions and appointments and § Improved human resources for health strengthen accountability mechanisms § Improved health management and leadership 7

SONA NATIONAL MANADATES ACTIONS War room est. Eskom stabilization § § § Government department to save on electricity Government owned buildings to be energy efficient Switch from electricity to gas for cooking First phase of broadband roll-out § Telkom lead agency for the roll-out Conservation of water § Training of Artisans/Plumbers to fix leaking taps Operation Phakisa Ideal Clinics Initiatives § Promoting efficiency, effectiveness and professionalism in clinics Launch massive programme to turn tide against TB § § Special Focus Prisons Mine workers Mining towns State Company Ketlaphela est. for ART supply § Involvement on ART procurement by MSD Public Admin & Management Act – signed Law § Prohibits Public Servants from doing business with government Continue to promote healthy lifestyles § Urge citizens to refrain from smoking and abuse of alcohol and drugs (10 th May – Move for Health Day celebrations)

SOPA PROVINCIAL MANADATE ACTIONS Revitalisation of Kliptown and Alexandra § § Possibility of New Clinic replacement at Kliptown Taking over CHC in Alexandra Changing Human Settlements patterns § New Housing Projects in various areas (Interaction with Housing Department) Infrastructure Development and ICT § § ICT and Broadband Project ICT Infrastructure Energy Security § § § Install Roof-Top Solar panels in government building Continue to replace boilers with natural gas Trigeneration programme in 6 hospitals Waste Energy to Bio-gas Replace lights with LED lights Water and Conservation § § Rain water harvesting in our facilities Maintenance of taps/pumps to prevent leakages 9

MEC’s Performance Agreement q Implement green agenda though Tri-generation, retrofitting gas boilers (cleaner energy technology), roof-top solar panels and green building design of all health facilities New clinic and hospital construction and revitalisation q Strengthening health system and NHI Roll-out Appointment of skilled infrastructure professionals q Infrastructure q Support effective maintenance system q Provincial Health Operation Centre /EMS Communications Centre q Revitalization and building new EMS Bases q Activation of Step Down Beds to replace Selby q q Gauteng Health Imaging Centre (GHIC) for MRI, CT, Mammogram scanners etc. To ensure that the Provincial Laundries: Improvement of Systems Efficiencies Introduce UPA (Emergency medical Services) in 50 poorest wards in the province as per the Brazilian Model Establish Maternal Home 10

MEC’s Performance Agreement q q NHI Strengthening health system and NHI Roll-out q q Roll out of NHI in all 5 Districts Prepare facilities for certification by the national Office of Health Standards Compliance for NHI implementation Expand increase the number of clinics the meet the ideal clinic criteria Improved performance against national core standards including waiting times, five key priorities Improved availability of vital and essential medicines All stable patients enrolled on centralised chronic medicine dispensing and distribution programme 11

MEC’s Performance Agreement q Implementation of Workplace Indicators of approved Staffing Needs (WISN) in all PHC facilities Approved organisational structure All Hospitals and Clinics implementing Lean Management Improved EMS response times EMS service is integrated with hospital emergency departments Implement Bed Beaure Management q Service providers paid within 30 days q Revenue collected q Accruals not cleared against the goods and services budget q Modernised Supply chain management and procurement q Strengthening health system and NHI Roll-out Strengthening Systems q q q Tertiary and central hospitals implementing activity based costing in all departments Unqualified Audit 12

MEC’s Performance Agreement Prevention & reduction of burden of disease Burden of Disease q q q Primary Health Care § Improve the quality, efficiency and effectiveness of Primary Health Care services § Ward Based Teams in all 508 wards § Ensure functional District Clinical Specialist Teams established § Expand increase school health services Promote and activate communities to practice a healthy lifestyle Fight against HIV and AIDS and TB (90/90/90 UNAIDS) § Number of men and women tested for HIV 90% § 90% of patients registered on ART § 90% of patients to have their viral load suppressed § 90% of patients screened for TB § Reduce new infections by 50% Maternal, infant and child mortality § Maternal Homes § Provision of Post natal care for mother and baby § Implement Kangaroo mother care in hospitals § Establish fully functional breast milk banks Address social determinants of health 13

MEC’s Performance Agreement Transform the Economy Township Economy q Partnering with DED, this centre will maintain and repair health emergency vehicles, especially Ambulances and GPG Vehicles q All linen contracts awarded to women cooperatives q Procuring/buying vegetables from local farmers q Procuring/buying dairy products from local farmers q Procuring/buying bread from small medium scale Bakeries q Wheelchair Repairs: Youth, women and people with disabilities to benefit as cooperatives 14

MEC’s Performance Agreement Unified Health Information System Modernisation § § § § Monitor Broadband connectivity to all health facilities by GDF Document and implement ITC Road Map Scanning of all patient records and Implement a electronic patient records management system Roll out of V-block infrastructure Develop and implement Ehealth and Mhealth solutions Upgrade health information system ensuring a complete e. Health patient record is created Roll out of PACS to all Hospitals and interface with HIS Implementation of a Bed Beaure Management System linking EMS and all Hospitals Expansion of the PASOP app Explanation of the application for the capture of data by Community Health Care Workers Re-engineer and procurement of computer aided call taking and dispatch system Procure Modernized Histology Equipment Procure toxicology processing equipment 15

The process being followed is a key component to ensuring success of the overall project. GPG 2020 Strategic planning process and outcomes OUTPUTS Alignment? Strategic Objectives 5/20 year review Key Driving Forces Alignment? What factors are driving change in our environment? GDo. H 2020 Strategic plan Desired outcomes GDo. H APP Strategic goals What are game changers What are factors affecting service delivery Institutional strategic plans District Health Plans Vision 20202 Institutional/Directorate operational / Municipal Plans PROCESS Emphasis on broad Stakeholders consultation and participation Stakeholder engagement 2015 -2020 process driven by Department with support of Strategic Plan Steering Committee Stakeholder engagement High-level workshops with senior management and experts Internal stakeholder interviews Expert engagement priority programmes (HAST, MCWH) Workshops with external stakeholders 16 Workshops, round tables & interaction with programme managers for eight Budget Programmes 16

Accelerated Social Transformation KEY POINTS ACTIONS ICT (Modernisation) § § § § Monitor Broadband connectivity to all health facilities by GDF Document and implement ITC Road Map Scanning of all patient records and Implement a electronic patient records management system Roll out of V-block infrastructure Develop and implement Ehealth and Mhealth solutions Upgrade health information system ensuring a complete e. Health patient record is created Roll out of PACS to all Hospitals and interface with HIS Implementation of a Bed Beaure Management System linking EMS and all Hospitals Expansion of the PASOP app Explanation of the application for the capture of data by Community Health Care Workers Re-engineer and procurement of computer aided call taking and dispatch system Procure Modernized Histology Equipment Procure toxicology processing equipment 17

Accelerated Social Transformation PROVINCIAL MANDATES PHC care is the backbone of our Health System ACTIONS § By 2019, all health facilities will complying with norms and § § § standards of Quality Assurance core priorities WBOT’s in all 508 wards Life expectancy to increase to 70 years in line with the NDP Increase TB cure rate to 95% Implementation of the 90, 90 strategy Upscaling of the PASOP Campaign NHI Rollout to all districts § Roll out of NHI in all 5 districts National Core Standards Compliance § Compliance with the National Core Standards for health facilities TAS (Section 18 PFMA) § § Ensure lifting of administration by end of May 2015 Stabilise finances especially payment of suppliers within 30 days, reduce accruals and improved revenue management Renaming of 3 hospitals (process to launch new names) § § § Zola-Jabulani to Bheki Mlangeni NNH to Thelle Mogoerane Far East Rand to Ms Ruth First 18

Accelerated Social Transformation PROVINCIAL MANDATES ACTIONS Improving Health Infrastructure Building of new hospitals §Soshanguve §Lillian Ngoyi Revitalisation hospitals §Jubilee §Kalafong §Sebokeng §Dr Yusuf Dadoo EPWP’s and Tshepo 500 000 § § CHW’s Data Captures CHW’s or EPWP’s who have completed grade 12 Maths, Science or Biology to be trained as Pharmacy assistants or nurses EPWP workers who are working as cleaners at facilities to be absorbed into permanent posts where ever posts are available 19

Accelerated Social Transformation PROVINCIAL MANDATES ACTIONS Comprehensive Response to Drug Abuse § Development of Prototype Treatment Centre – 1 stop integrated comprehensive treatment of substance abuse Eradication of Gender Based Violence § Medico-legal forensic clinics (victim support) War Room § Walk-in-centre established and staffed (awaiting branding) § Team leaders and CHCW’s allocated to 50 priority wards § Health war room team established § Training of teams § Case resolution management Disclosures (SMS) § § § Research and Development Capacity 100% by SMS No business with government by SMS Functional PHRC unit/committee MOA with universities Partnership with GCRO, health questions with in the 2015 Quality of Life Survey and analysis of data from the WBOT’s 20

Alignment of Strategic Goals with MTSF • Maternal, infant and child mortality reduced Improved health and well-being of all citizens, with an emphasis on children and women • Improved health facility planning and infrastructuredelivery • Health care costs reduced • Efficient Health Management Information System for improved decision making • Improved human resources for health • Improved health management and leadership Goals • HIV & AIDS and Tuberculosis prevented and successfully managed Reduced rate of new infections and burden of HIV & AIDS and TB I Excellence in our nonclinical functions Increased equal and timely access to efficient and quality health care services, thereby preparing for rollout of NHI • Improved quality of health care • Re-engineering of Primary Health Care • Universal Health coverage achieved through implementation of National Health Insurance 21

2015/16 – 2020 Strategic Plan 22

Strategic Goal Improved health and well-being of all citizens, with an emphasis on children and women Strategic Goals and Objectives Strategic Objectives q MCWH q q Reduce maternal morbidity and mortality due to pregnancy and childbirth Reduce perinatal and neonatal morbidity and mortality Expand integrated school health services 23

Strategic Goal Improved health and well-being of all citizens, with an emphasis on children and women Strategic Goals and Objectives Strategic Objectives q q MCWH q Reduce mother to child transmission Reduce the levels of unwanted pregnancies in all women of reproductive age Reduce the incidence and prevalence of cervical cancer 24

Strategic Goals and Objectives Strategic Objectives Reduced rate of new infections and burden of HIV & AIDS and TB q q HIV and AIDS & TB q q Reduce incidents of new HIV infections & STIs Improve care and life expectancy for HIV positive people Increase opportunities for testing and screening for TB Reduce new TB infections Reduce mortality for people with TB Combat MDRTB 25

Strategic Goal Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goals and Objectives Strategic Objectives q q q Expand Primary Health Care q q Increase NHI coverage in the province Expand ward-based PHC outreach teams Improve functionality of district clinical specialist teams Increase quality and access of PHC facilities Prevent non-natural deaths caused by injury, accidents and violence Reduce prevalence of targeted non -communicable diseases Improve quality of patient services 26

Strategic Goal Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goals and Objectives Strategic Objectives q Efficient Hospital Services q q Quality Assurance within PHC and hospital services q Improve access and efficiency of regional and specialised care Improve quality of clinical care Improve access and efficiency of central and tertiary care Increase quality of patient services 27

Strategic Goal Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goals and Objectives Strategic Objectives Expand Primary Health Care q q q EMS Increase availability of pharmaceuticals Improve access and usage of pharmaceuticals Improve quality and access to EMS services 28

Strategic Goals and Objectives Strategic Objectives Excellence in our non-clinical functions q Financial Management q q Improve financial management skills and out-comes for the health sector Improve revenue collection Establish accurate cost base for health department budget 29

Strategic Goal Excellence in our non-clinical functions Strategic Goals and Objectives Strategic Objectives q Human Resource Development q q Human Resource Management q q Develop a competent and accountable health workforce that matches demand Increase employee satisfaction Create an effective organisation Increase recruitment and retention of qualified health care workers Ensure equitable and diverse workforce 30

Strategic Goal Excellence in our non-clinical functions Strategic Goals and Objectives Strategic Objectives Governance Structures q q ICT q SCM Improve functionality of Governance Structures Improve quality of and access to information systems in health care facilities Promote procurement from local communities and modernisation of SCM technology 31

Strategic Goals and Objectives Strategic Objectives q Excellence in our non-clinical functions q Improving Infrastructure dev & Maintenance q Deliver infrastructure Improve governance and contract management Maintain CHC facilities and (nonmedical) equipment within CHC facilities 32

2015/16 -18 Annual Performance Plan Programme 1: Administration

2015/16 -18 Annual Performance Plan: Administration 2015/16 -18 Annual Performance Plan: q Improving Quality of Health Care Strategic Goal Increased equal and timely access to efficient and quality health care services, thereby preparing for rollout of NHI § § § Implement the Lean Management project and electronic queuing systems in all hospitals and district to reduce waiting times Conduct gap assessment and develop quality improvement plans in all hospitals to improve quality of care Increase performance of all facilities against the national core standards & compliance through certification by Office of Health Standards Compliance Conduct patient satisfaction survey at all health institutions Better management of serious adverse events 34

2015/16 -18 Annual Performance Plan: Administration 2015/16 -18 Annual Performance Plan: Excellence in our non-clinical functions Strategic Goal q Implementation of Turnaround Strategy § Engage service providers and resolve outstanding accruals, and improve procurement systems with electronic procurement implemented, exit from Section 18 § Improve financial management skills and outcomes for the Department § Ensure Department obtain an unqualified audit opinion § Activity-based costing completed and resource requirements of health services determined 35

2015/16 -18 Annual Performance Plan: Administration 2015/16 -18 Annual Performance Plan: Excellence in our non-clinical functions Strategic Goal q Effective management of information system § Develop and implement efficient integrated patient based management Information System to improve decision making § Improved records management including scanning of all existing records in central, tertiary and regional hospitals § Upgrade ICT infrastructure and ensure connectivity in all health facilities § Upgrade health information system, roll out PACS and interface with HIS and NHLS, develop and implement e-health and m-health solutions § Build multi-skilled health information personnel 36

2015/16 -18 Annual Performance Plan: Administration 2015/16 -18 Annual Performance Plan: Excellence in our non-clinical functions Strategic Goal q Improve Human Resource for Health § Implementation of WISN Staffing Needs in all PHC facilities § Develop, cost and publish human resource for Health plan for implementation in the Department § Strengthen Labour Relation Processes and Systems to achieve legislated turnaround times § Implement, manage and enforce the general and Commuted Overtime policies to reduce and eliminate abuse and over expenditure on Co. E, including RWOPS § Ensure compliance with performance management system § Recruitment of women at SMS levels § Recruitment of people with disabilities § Improve access for people with disabilities 37

Administration: Strategic Objectives, Indicators and Targets Strategic objective Performance Indicator Strategic Plan 2015/16 Target Q 1 (2019/20) Improve quality of patient services Number of hospitals implementing Lean Management project Improve quality of and access to information systems in health care facilities Number of mhealth applications developed N/A Number of hospitals with PACS Number of hospitals with scanned medical records 36 2015/16 Quarterly Targets Q 2 Q 3 Q 4 98 99 99 25% 25% 36 36 98 100% 36 and 375 Clinics 19 Hospitals and 375 Clinics 9 11 10 6 25% of clinics 50% of Clinics 36 50% of 100% of Hospitals Percentage of Hospitals with Broadband access 50% (18) 100% 25% 25% Percentage of fixed PHC facilities with broadband access 1% (2) 100% 25% 25% 38

Administration: Strategic Objectives, Indicators and Targets Strategic objective Performance indicators Strategic plan Target 2015/16 Target (2019/20) Improve financial Audit opinion from Auditor management skills General Unqualified and out-comes for the health sector Improve revenue collection Rand value of revenue collected R 522 m Establish accurate Percentage of actual spend cost base for against forecast Gauteng health <2% department budget Ensure Equitable and Diverse Workforce Percentage of women in senior management posts (106) senior managers) Percentage of people with disabilities employed by the Gauteng Department 2015/16 Quarterly Targets Q 1 Unqualified Q 2 NA Q 3 NA Q 4 NA Unqualified 700, 000 175, 000, 000 <2% NA NA NA <2% 50% 43% 37% 39% 41% 43% 2% 2% 0. 5% 1% 1. 5% 2%

2015/16 -18 Annual Performance Plan Pw. C 40

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of National Health Insurance (NHI) Strategic Goal 2015/16 -18 Annual Performance Plan: DHS q Universal coverage through implementation of National Health Insurance (NHI) § Expansion of NHI implementation beyond the Tshwane Health District § Increase doctor support at CHCs and clinics levels § Roll-out of Ideal Clinic Project to all the health districts in the Province 41

2015/16 -18 Annual Performance Plan: DHS Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal q Strengthen Re-engineering of Primary Health Care § Accelerate the implementation of Primary Health care (PHC) services through PHC reengineering’s three streams v Expansion of Ward Based Outreach Teams (WBOTs) based on Brazilian and Cuban models v Implementation of District Clinical Specialist Teams (DCST) contributing to reduction of maternal, infant and child mortality 42

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal 2015/16 -18 Annual Performance Plan: DHS § Implementation of District Mental Health Specialist teams will improve access and quality of mental health service delivery § Strengthen integration of all district based programmes such as Mental Health Services, Oral Health Services and Rehabilitation and Radiography into PHC services § The Department will also expand the Integrated Chronic Disease Management (ICDM) programme to more than 100 000 patients. This will ensure that patients receive medicine through the direct delivery programme and decongest PHC facilities § Ensure appropriate service delivery at all levels of care that prevent disability and restore integration of people with disability, mental health disorders and those that require psychosocial rehabilitation in hospitals and in the community § Strengthen partnerships with civil society and other external stakeholders and interdepartmental collaboration and communication 43

DHS: Strategic objectives, Indicators and Targets Strategic objective Performance indicators Increase quality Number CHCs providing and access in PHC 24 hour services facilities Expand wardbased PHC outreach teams Number of fully-fledged, functional Ward Based Outreach Teams Increased quality Number of assistive and access in PHC devices issued facilities Percentage of PHC facilities with integrated mental health services Number of Fissure Sealants placed Strategic Plan Target (2019/20) 2015/16 Target 2015/16 Quarterly Targets Q 1 Q 2 Q 3 Q 4 35 35 10 10 10 5 508 372 93 93 N/A 36 000 9 000 18 000 27 000 36 000 100% 85% 78% 81% 85% N/A 53 500 13 375 133 75 44

2015/16 -18 Annual Performance Plan: DHS Strategic Objective Programme Performance Indicator Strategic Plan Target (2019/20) 2015/16 Target Increase NHI coverage in Number of Districts piloting NHI 5 the province interventions NHI Consultation Fora established 1 No Increase quality and access in PHC services 50% Percentage of fixed PHC facilities 5. 3% scoring above 80% on the ideal clinic dashboard Number of District Mental Health N/A Teams established Expand ward-based PHC OHH registration visit coverage outreach teams (annualised) Improve functionality of district clinical specialist teams Improve quality of patient services N/A 5 1 2015/16 Quarterly Targets Q 4 Q 1 Q 2 Q 3 5 5 N/A 12. 5% N/A 5 No 12. 5% N/A 12. 5% 1 70% 65% 68% 70% 5 5 5 Number of Districts with District Clinical Specialist Teams (DCSTs) 5 Patient Experience of Care Survey rate N/A 100% 100% Patient Experience of care rate N/A 90% 90% 90% PHC Utilisation rate N/A 3 3 3 100% 100% 100% Complaints resolution rate Respond to complaints within 24 hours N/A 45

2015/16 -18 Annual Performance Plan: DHS Strategic Objective Improve quality of patient services Programme Performance Indicator Strategic plan target (2019/20) 2015/16 Target 100% 2015/16 Quarterly Targets Q 1 Q 2 Q 3 Q 4 100% 100% 100% 90% 100% 100% Patient experience of care Survey Rate N/A 100% 100% Patient experience of care rate 85% 90% 90% Complaints resolution rate Respond to complaints within 24 hours N/A 100% 100% 100% Average Length of Stay N/A 4 4 4 Inpatient Bed Utilisation Rate N/A 80% 80% 80% Expenditure per PDE N/A R 2500 R 2500 National Core Standards selfassessment rate Quality improvement plan after selfassessment rate Percentage of hospitals compliant with all extreme and vital measures of the national core standards 46

2015/16 -18 Annual Performance Plan Programme 3: HIV and AIDS, STI and TB 47

2015/16 -18 Annual Performance Plan : HIV and AIDS, STI and TB q Intensify HIV and AIDS Programme Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal § § Reduce new HIV infections: reducing mother to child transmission of HIV, expansion of medical male circumcision programme and strengthening the multisectoral response; HCT expansion, targeting vulnerable and high risk groups Strengthen management of patient with HIV and TB co-infection Expand ART programme and roll-out fixed dose combination Provide training of TB staff on NIMART and NIMDR to increase uptake of ART and TB 48

2015/16 -18 Annual Performance Plan : HIV and AIDS, STI and TB Reduced rate of new infections and burden of HIV & AIDS and TB Strategic Goal q Tuberculosis (TB) prevention and management § Further improve TB cure rate and defaulter rate § Improve linkage to care following MDR diagnosis § Standardise contact tracing and hold staff accountable for conducting contact tracing § Integrate TB/HIV for DR-TB patients § Improve social support for DR-TB patients and their families § Ensure adequate TB infection control at all levels 49

2015/16 -18 Annual Performance Plan : HIV and AIDS, STI and TB Strategic Objective Programme Performance Indicator Strategic 2015/16 Plan Target (2019/20) Reduce incidents of new HIV infections & STI Reduction of new HIV infections young men and women aged 15 -49 Reduce mother to child transmission Transmission rate from mother to child Improve care and life expectancy for HIV positive people Total patients remaining on ART 90% Patients tested for HIV (incl ANC)1 Reduce incidents of new HIV infections & STI 2015/16 quarterly Targets Q 1 Q 2 Q 3 Q 4 N/A N/A 50% 15% 2% <1. 5% 1. 5 Million 375, 000 4 m 4 Million 1 million Male condom distribution Rate (Annualised) 309 m 191 782 721 47 945 680 Female condom distribution Rate (Annualised) 5 m 4. 4 Million 1. 4 Million 1 314 246 300, 000 75, 000 Medical male circumcision performed - Total 15% 50

2015/16 -18 Annual Performance Plan : HIV and AIDS, STI and TB Strategic Objective Programme Performance Indicator Strategic Plan Target (2019/20) Increase opportunities for TB symptom 5 yrs and testing and screening older screened rate for TB 2015/16 quarterly Targets Q 1 Q 2 Q 3 Q 4 5 m 30% 24% 26% 28% 30% <87% 90% 90% 90% <4% 3% 3% 3% <5% 2. 00% N/A N/A 2. 00% TB MDR confirmed treatment start rate 80% 70% 70% 80% TB MDR treatment success rate 65% 90% 90% 90% TB patient treatment success rate Reduce mortality for people with TB TB patient lost to follow up rate TB patient death Rate Combat MDR TB 2015/16 Target 51

2015/16 -18 Annual Performance Plan Programme 4: Maternal Child and Women’s Health and Nutrition (MCWHN) 52

Decreasing maternal, infant and child mortality Strategic Goal 2015/16 -18 Annual Performance Plan: MCWHN q Implementation of the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa (CARMMA) q Reduce Maternal Mortality through implementation of early initiation of antenatal care, provision of obstetric ambulances at all MOUs and District Hospitals, We will improve use of partogram and post-caesarean section monitoring q Provide support for ESMOE training for training doctors, nurses and paramedics at institutions perform fire drill according to protocol q Hospitals accredited as mother and baby friendly and Kangaroo Mother Care q Improve family planning & quality of contraceptives through rollout of long acting reversible contraceptives to all facilities q The Integrated School Health Services will be expanded and implemented for grade R, 1 and 8 pupils 53

2015/16 -18 Annual Performance Plan: MCWHN Strategic Objective Programme Performance Indicators Strategic plan target 2015/16 Target Q 1 (2019/20) Reduce maternal morbidity and mortality due to pregnancy and childbirth Maternal mortality in facility ratio (annualised) 2015/16 Quarterly Targets Q 2 Q 3 Q 4 50/100000 90% 90% 90% Mother postnatal visit within 6 days rate) 90% 90% 90% Antenatal patient initiated on ART rate 98% 90% 90% 90% Infant 1 st PCR test positive around 6 weeks rate 0. 80% <1. 5% Antenatal 1 st visit before 20 weeks rate Reduce mother to child transmission <1. 5% 54

2015/16 -18 Annual Performance Plan: MCWHN Strategic Objective Programme Performance Indicator Strategic plan target (2019/20) Vitamin A dose 12 - 59 months coverage (annualised) 2015/16 Quarterly Targets Q 1 Q 2 Q 3 Q 4 10 N/A N/A 10 95% 95% 95% <10% <10% 2% 2% 2. 5% 6. 10% 5% 5% 5% N/A 95% 95% Reduce perinatal and Inpatient early neonatal death rate <10/1000 neonatal morbidity Immunisation coverage under 1 year and mortality 95% (annualised) Measles 2 nd dose coverage 95% (annualised) DTa. P-IPV/Hib 3 - Measles 1 st dose <2% drop-out rate Child under 5 years diarrhoea case <2% fatality rate Child under 5 years pneumonia case N/A fatality rate Child under 5 years severe acute malnutrition case fatality rate 2015/16 Target 55

2015/16 -18 Annual Performance Plan: MCWHN Strategic Objective Expand integrated school health services Programme Performance Indicators Strategic plan 2015/16 target Target (2019/20) 2015/16 Quarterly Targets Q 1 Q 2 Q 3 Q 4 School Grade R screening coverage (annualised) N/A 100% 25% 25% School Grade 1 screening coverage (annualised) 40% 100% 25% 25% School Grade 8 screening coverage (annualised) 25% 100% 25% 25% 80% 70% 17% 18% 70% 80% 20% 20% 90% 90% 90% Reduce the levels of unwanted pregnancies in all women of reproductive age Reduce the incidence and prevalence of cervical cancer Couple year protection rate (annualised) Human Papilloma Virus Vaccine 1 st dose coverage Cervical cancer screening Coverage (Annualised) 56

2015/16 -18 Annual Performance Plan Programme 5: Disease Control and Prevention 57

Improved health and well-being of all citizens, with an emphasis on children and women Strategic Goal 2015/16 -18 Annual Performance Plan : Disease Control and Prevention q Develop and implement a Social Behaviour Change Communication Strategy; ensuring healthy lifestyle campaigns take priority q Roll out Integrated Chronic Disease Management Model in all 5 districts q Develop and implement Communicable disease control monitoring and evaluation plan q Increase performance of cataract surgery in all hospitals q Recruit and sustain optometrists and health promoters q Implementation of the malaria elimination strategy 58

2015/16 -18 Annual Performance Plan : Disease Control and Prevention Strategic Objective Reduce prevalence of non -communicable diseases Prevent non-natural deaths caused by injury, accidents and violence Performance Indicator Number of noncommunicable diseases educational campaigns/ programmes (cumulative) Patient screened for hypertension - 25 years and older Patients screened for diabetes - 5 years and older Cataract surgery rate annualised Patients screened for mental disorder Patients treated for mental disorders Malaria case fatality rate Strategic Plan Target (2019/20) 2015/16 Target N/A 100% of Schools and clinics 25% 25% 550 00 100% 100% 280 00 100% 100% N/A 1300/mil 1300/ml 1300/mil N/A 50% 50% 50% N/A 100% 100% N/A <0. 3% 2015/16 Quarterly Targets Q 1 Q 2 Q 3 Q 4 59

2015/16 -18 Annual Performance Plan Pw. C 60 60

Effective and efficient emergency medical care and non-emergency medical services Strategic Goal 2015/16 -18 Annual Performance Plan: EMS and Planned Patient Transport q Integrated computer aided call taking and dispatch system implemented q Integrated Disaster Management Centre & EMS efficiency q To provide comprehensive EMS service, staffed by fully qualified paramedics with necessary equipment , integrated with Hospital Emergency Departments q Support the Department of Economic Development (DED) with specifications and design of purpose built ambulances, to pursue investment to establish plants to manufacture Ambulances. (DED to lead the process) q Engage with Engineering faculties, technical colleges/technicians, to establish automotive ambulance repair centres through the government approved contractor 61

EMS &PPT: Strategic Objectives, Indicator and Targets Strategic Objective Performance Indicator Improve quality and access to EMS services EMS P 1 urban response under 15 minutes rate 90% 99% EMS P 1 rural response under 60 minutes rate 100% EMS inter - facility transfer rate 15% Number of Districts Health Council with provincialised EMS N/A Coordinate processes to complete provincialisation of EMS Integration of disaster management with EMS Bed Beaure management to be impended in all hospitals co-ordinated by the EMS operations centre Strategic Plan Target (2019/20) N/A 2015/16 Quarterly Targets Target Q 1 Q 3 Q 4 99% 99% 100% 12% 10. 5% 11. 5% 12% 2 2 2 Activation 1 1 36 Q 2 Costing and Procurement Planning George Steve Biko Charlotte Chris Hani Mukhari Cluster Maxeke Cluster Bara Cluster 62

2015/16 -18 Annual Performance Plan Pw. C 63

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal 2015/16 -18 Annual Performance Plan: Hospital Services q Implement national policies on conditional grants and revitalisation of hospital services; and q Compliance to the National Health Act q Implementation of Hospitals Turnaround Plan (Accord), which include Improvement of medicine’s supply through Direct Delivery from Suppliers, Ward-Based management, equipment procurement and maintenance q Strengthen the bi-directional referral systems through hospital clusters headed by each Central hospital q Implement cost containment measures functional business unit and ward based management in all hospitals 64

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal 2015/16 -18 Annual Performance Plan: Hospital Services q Improve systems for logistics and stock management, and equipment procurement and maintenance. q Compliance with National Core Standards; and, Implementation of Lean Management Project to reduce waiting times; q Increase the number of both neonatal and adult ICU beds; q Strengthen implementation of Mental Health Care Act (MHCA) at all levels of care q Strengthen TB management at Sizwe Hospital 65

Regional Hospitals : Strategic objectives, Indicators and Targets Strategic Objective Strategic Plan 2015/16 Target (2019/20) 2015/16 Quarterly Targets Q 1 Q 2 100% 100% Quality Improvement plan after 100% self-assessment rate 100% 100% Percentage of Hospitals compliant with all extreme and vital measures of the national 100% core standards 90% 90% Patient experience of care Survey rate 100% 100% 80% 90% 90% 90% Performance Indicator Increase quality of patient services National Core Standard selfassessment rate Patient experience of care rate Q 3 Q 4 66

Regional Hospitals: Strategic objectives, Indicators and Targets Strategic Objective Performance Indicator Strategic Plan Target (2019/20) 2015/16 Target 2015/16 Quarterly Targets Q 1 Increase quality of patient services Complaints resolution rate Q 2 Q 3 Q 4 100% 100% >95% 100% 100% 4. 7 Days Respond to complaints within 24 hours N/A 4. 8 4. 8 80% Improve access and efficiency of regional and specialised care Average Length of Stay Inpatient Bed Utilisation Rate 78% 80% 80% Expenditure per patient day equivalent (PDE) N/A R 2250 R 2250 67

Strategic Objectives, Indicators and Targets: Specialised Hospitals Strategic Objective Performance Indicator Strategic Plan Target (2019/20) 2015/16 Target 2015/16 Quarterly Targets Q 2 Q 1 Improve access and efficiency of regional and specialised care Q 3 Q 4 Inpatient Bed Utilisation Rate 85% 75% 75% 75% Respond to complaints within 24 hours >95% 100% 100% Patient Experience of care Rate N/A 90% 90% 90% 68

2015/16 -18 Annual Performance Plan Pw. C 69

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal SUB-PROGRAMME: Tertiary Hospitals q Implementation of Hospitals Turnaround Plan (Accord), which include Improvement of medicine’s supply through Direct Delivery from Suppliers, Ward-Based management, equipment procurement and maintenance q Strengthen the referral system through hospital clusters headed by each Central hospital; and q Agree and implement service level agreements with universities q Modernise tertiary services q Implement Activity Based Costing, Implement Functional Business Unit q Implementation of Electronic Record Management System q Compliance with National Core Standards and implement Lean Management to reduce waiting times 70

SUB-PROGRAMME: Tertiary Hospitals Strategic Objective Performance Indicator Improve quality of clinical care Improve access and efficiency of central and tertiary care National Core Standards selfassessment rate Quality Improvement Plan after self-assessment rate Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaint Resolution rate Respond to complaints within 24 hours Average Length of Stay Inpatient Bed Utilisation Rate Expenditure per patient day equivalent (PDE) Strategic 2015/16 Plan Target (2019/20) Q 1 2015/16 Targets Q 2 Q 3 Q 4 N/A 100% 100% 100% 100% N/A 100% 100% 80% <95% 90% 100% 100% 90% 100% N/A 5. 4 5. 4 82% R 2625 80% R 2625 82% R 2625 71

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal SUB-PROGRAMME: Central Hospitals q Transfer of Central hospitals to National Department of Health completed and seamless co-ordination between provincial and national services q Implement national policies on conditional grants and revitalisation of hospital services; q Implement the Accord between WITS and the Department, which includes Direct Delivery from Suppliers, Implement Ward-Based Management Approach, and equipment procurement and maintenance q Implementation of Electronic Record Management System q Compliance with National Core Standards including implementing Lean Management to reduce waiting times q Implement functional business unit and ward based management in all hospitals, improved bi-directional referral systems and Improved systems for logistics and stock management q Implement service level agreements with universities 72

Central Hospitals: Strategic Objectives, Indicators and Targets Strategic Objective Performance Indicator Improve quality of patient services Improve access and efficiency of central and tertiary care Strategic Plan Target (2019/20) 2015/16 Targets Q 1 Q 2 Q 3 Q 4 100% 100% 100% 100% 100% 80% N/A >90% 100% 90% 100% 100% Average Length of Stay Inpatient Bed Utilisation Rate N/A 6 80% 6 80% Expenditure per patient day equivalent (PDE) N/A 3000 3000 National Core Standards selfassessment rate Quality Improvement Plan after self-assessment rate Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaints resolution rate Respond to complaints within 24 hours N/A 100% N/A 73

SUB-Programme: Steve Biko Academic Hospital Strategic Objective Performance Indicator Improve quality of National Core Standards selfpatient services assessment rate Quality Improvement Plan after self assessment rate Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaints resolution rate Respond to complaints within 24 hours Improve access and Average Length of Stay efficiency of central Inpatient Bed Utilisation Rate and tertiary care Expenditure per patient day equivalent (PDE) Strategic Plan 2015/16 Target (2019/20) N/A 100% 2015/16 Targets Q 1 100% Q 2 100% Q 3 Q 4 100% 100% N/A 100% 100% 80% N/A 90% 100% 90% 100% >95% 100% 100% N/A 6 80% 6 80% N/A R 4 000 R 4 000 74

SUB-PROGRAMME: Dr George Mukhari Academic Hospital Strategic 2015/16 Targets Strategic Objective Performance Indicator Plan Target Improve quality of patient services National Core Standards selfassessment rate Quality Improvement Plan after self-assessment rate Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaints resolution rate Respond to complaints within 24 hours Average Length of Stay Improve access and efficiency of Inpatient Bed Utilisation Rate central and tertiary Expenditure per patient day care equivalent (PDE) Target (2019/20) N/A Q 1 Q 2 Q 3 Q 4 78% 72% 74% 76% 78% 100% 100% 100% 100% 80% N/A 90% 100% 90% 100% >95% 100% 100% N/A 6. 8 6. 8 N/A 76% 76% 76% N/A R 3500 R 3500 N/A 100% N/A 75

SUB-Programme: Charlotte Maxeke Johannesburg Academic Hospital Strategic Objective Performance Indicator Improve quality of patient services Strategic 2015/16 Plan Target (2019/20) National Core Standards selfassessment rate N/A Quality Improvement Plan after self-assessment rate N/A Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaints resolution rate Respond to complaints within 24 hours Improve access Average Length of Stay and efficiency of Inpatient Bed Utilisation Rate central and tertiary Expenditure per patient day care equivalent (PDE) 100% N/A Q 1 2015/16 Targets Q 2 Q 3 Q 4 100% 100% 100% 100% 100% 80% N/A 90% 100% 90% 100% >95% 100% 100% N/A 6. 2 85% 6. 2 85% N/A R 3 000 R 3 000 76

SUB-PROGRAMME: Chris Hani Baragwanath Academic Hospital Strategic Objective Improve quality of patient services Improve access and efficiency of central and tertiary care Performance Indicator Strategic Plan Target National Core Standards selfassessment rate N/A Quality Improvement Plan after self -assessment rate N/A Percentage of Hospitals compliant with all extreme and vital measures of the national core standards Patient Experience of care Survey Rate Patient Experience of care Rate Complaints resolution rate Respond to complaints within 24 hours Average Length of Stay Inpatient Bed Utilisation Rate Expenditure per patient day equivalent (PDE) 2015/16 Targets Target Q 1 Q 2 Q 3 Q 4 100% 100% 100% 100% 100% 80% N/A 90% 100% 90% 100% >95% 100% 100% N/A 5. 8 79% N/A R 3101 R 3101 100% N/A 77

2015/16 -18 Annual Performance Plan Pw. C 78

Excellence in our non-clinical functions Strategic Goal 2015/16 -18 Annual Performance Plan Health Sciences and Training q Implement the Skills Development Act in compliance to the key imperatives for job creation through Internships, Learnerships, related graduate entry and the Expanded Public Works Programmes q The implementation of the HRD Strategy, policy and strategic plan to give effect to the key legislative, statutory and policy frameworks of government generally and the health sector specifically q Review the expanded teaching and learning platform in line with the Service Transformation Plan and a Department’s HRH plan, consistent with the Memorandum of Agreement with the Institutions of higher learning q Participate in the South African/Cuban Medical training program as per the Bilateral Cooperation Agreement between South Africa and Cuba 79

Excellence in our non-clinical functions Strategic Goal 2015/16 -18 Annual Performance Plan Health Sciences and Training q. Develop collaborative strategic alliances and partnerships with universities, private sector, NGOs and key stakeholders through MOUs and SLAs q. Participate in the literacy and numeracy strategy of Government through the Gauteng Department of Health Adult Basic Education and Training (ABET) Programme and promote career progression q. Improve access to an Integrated Employee Wellness Service for all Department employees generally and establish sustainable Wellness Centres in Gauteng Department of Health institutions q. Revitalisation of the Nursing profession: Development of Provincial Nursing and Midwifery (Applied) Ethics Committee in each district 80

2015/16 -18 Annual Performance Plan Health Sciences and Training Strategic Objective Performance Indicator Strategic 2015/16 Targets Plan Target (2019/20) Develop a competent and accountable health workforce that matches demand Q 1 Q 2 Q 3 Q 4 Basic nurse students graduating N/A 1000 N/A 1 000 Intake of Medicine Students annually N/A 650 N/A N/A 660 10 80 N/A N/A 80 Number of clinical engineers on training 50 100 25 25 Number of Bursaries awarded for first year medicine students N/A 650 N/A N/A 650 Number of Bursaries awarded for first year nursing students Increase employees satisfaction Number of new medical students enrolled annually on the RSA-Cuban medical N/A 1 500 N/A 1500 1 500 Percentage of health facilities conducting employee satisfaction surveys 90% 100% 100% 81

2015/16 -18 Annual Performance Plan Pw. C 82 82

Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI Strategic Goal 2015/16 -18 Annual Performance Plan: Health Care Support Services q Strengthening of supply chain management systems focusing on organisational design; contract management, Procure to Pay System within the Health Processing Centre q Ensure full availability of the Essential Drug List (EDL) at all facilities, in order to achieve quality and effective patient care and to improve core service efficiency q strengthening systems to prevent drug stock outs at facility level q Implement Direct Deliveries from Suppliers q Ensure successful implementation of the new computerised ORACLE system 83

2015/16 -18 Annual Performance Plan: Health Care Support Services Excellence in our non-clinical functions Strategic Goal q Transforming the health economy § Coordinate establishment of plants to manufacture Ambulance, Pharmaceuticals and other consumables in conjunction with DED, the Department will bring new investors § Coordinate establishment automotive repair centre for all vehicles related to health services in partnership with Engineering faculties, technical colleges/Technicians § The Department will support Cooperatives, SMMEs and economic empowerment targeted to women through provision of linen and other hospital related need localisation of production and procurement § Support local farmers who are producing protein, vegetables and dairy products to supply fresh produce to our health facilities; and § Support small to medium scale Bakeries through supply bread to health facilities 84

2015/16 -18 Annual Performance Plan: Health Care Support Services Strategic Objective Performance Indicator Increase availability of pharmaceuticals Strategic 2015/16 Plan Target (2019/20) 2015/16 Targets Q 1 Q 2 Q 3 Q 4 Percentage of vital medicine availability at health facilities 98% 99% 99% 99% Percentage of essential medicine availability at health facilities 95% 99% 99% 99% Percentage of essential medicines delivered directly to health facilities 70% 60% 70% 70% 150000 100% 25% 25% 300000 100% 25% 25% 200000 50000 125000 37500 50000 90% 90% 90% Number of patients registered in the Tshwane CCMDD programme Number of patients enrolled on centralized chronic medicine dispensing and distribution programme Number of patients registered with remote automated dispensing unit Percentage of genexpert results available within 48 hours 85

2015/16 -18 Annual Performance Plan: Health Care Support Services Strategic Objective Performance Indicator Strategic Plan Target (2019/20) Modernised Supply chain management and procurement 2015/16 Targets Q 1 Q 2 Q 3 Q 4 100% 100% Percentage of hospital procuring/buying vegetables from local farmers 100% 40% 40% 40% Percentage of hospital procuring/buying dairy products from local farmers >80% 40% 40% 20% Percentage of hospital procuring/buying bread from small medium scale Bakeries Increase access and efficiency in hospitals Percentage of linen contracts awarded to women cooperatives >70% 20% 20% 20% 100% 100% Percentage health institutions with

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Excellence in our non-clinical functions Strategic goal 2015/16 -18 Annual Performance Plan: Health Facilities Management q Improved health infrastructure design, delivery & maintenance q Building new clinics and hospitals to address population growth incl. Diepsloot, Tembisa/ Rabie Ridge; Soshanguve q Improve maintenance through adequate budget allocation and average completion for minor maintenance within 48 hours q Deal with under-spending on infrastructure budget through appointment of professionals to monitor projects q Adhere to norms and standards and align with national norms and standards through construction of proto -type clinic in all districts q Development & maintenance, implement green agenda though Tri-generation, retro-fitting gas boilers, roof-top solar panels and green building design 88

2015/16 -18 Annual Performance Plan: Health Facilities Management Strategic Objective Deliver infrastructure Performance Indicator Proportion of P 8 budget spent on maintenance (preventative and scheduled) Number of additional clinics and community health centres constructed Number of health facilities that have undergone major and minor refurbishment Improve governance and contract management Percentage of capital work projects finished on time Number of Provincial Departments of Health that have established Service Level Agreements (SLAs) with Departments of Public Works Strategic 2015/16 Plan Target (2019/20) 100% 55% 11 2015/16 Targets Q 1 25% Q 2 50% Q 3 75% Q 4 100% 1 Under 1 10 Under Constructi Completed constructio on n n 19 43 100% 100% 1 1 89

2015 MTEF INFRASTRUCTURE BUDGET q The budget for new infrastructure assets increases to provide funding for revitalisation of 5 hospitals, small works at various facilities as well as planning and design for new hospitals and clinics. Over the 2015 MTEF, R 1 billion is allocated towards existing infrastructure in 2015/16, increasing to 1. 1 R 1 billion in 2016/17 and reducing again to R 1 billion in 2017/18. 90

2015 MTEF HOSPITAL REVITALISATION GRANT BUDGET 91

Unaudited Expenditure as at 31 st March 2015 92

Unaudited expenditure per Programme - 2014/2015 93

Unaudited expenditure per Economic Classification 94

2015/16 Budget Allocation 95

2015 MTEF Overall Allocation Ø 2015 MTEF Baseline adds R 190, 0 m in year 1; R 882, 8 m in year 2 and R 1, 5 bill in year three, sufficient to meet inflationary rise on costs but not to introduce major and new programmes 96

2015 MTEF Allocation by Programme ØDistrict Health Services has the highest percentage share of the departmental allocation and it increases lightly over the MTEF. Over the MTEF, its nominal growth is also the highest at 9. 4%. ØCentral Hospital Services programme which includes the three tertiary hospitals shares 34% of the allocation. 97

2015 MTEF Allocation by Economic Classification ØCompensation of employees has the highest share of the budget with a nominal growth of 6. 4% over the MTEF ØGoods and Services nominal growth is at 8. 3% over the MTEF 98

2015 MTEF Conditional Grants Allocation Ø 2015 MTEF Baseline adds R 190, 0 m in year 1; R 882, 8 m in year 2 and R 1, 5 bill in year three, sufficient to meet inflationary rise on costs but not to introduce major and new programmes 99

2015 MTEF Budget Share per Programme ØDistrict Health Services has the second highest percentage share of the departmental allocation and it increases lightly over the MTEF. Over the MTEF, its nominal growth is the highest at 9. 4%. ØCentral Hospital Services programme which includes the three tertiary hospitals shares 34% of the allocation. 100

2015 MTEF Budget Share per Economic Classification ØCompensation of employees has the highest share of the budget with a nominal growth of 6. 4% over the MTEF ØGoods and Services nominal growth is at 8. 3% over the MTEF 101

Own Revenue Collection Projections 102

Improvements of own revenue collection • The Department has appointed since 1 November 2014 three service providers to assist in increasing the revenue collection: • Trans Union ITC Credit Bureau: for verification of patients detail which will assist in billing of accounts, Revenue Consulting: which will assist in collection of outstanding patient debt from self-paying patients and EOH Abantu: which will assist in the collection of revenue from Compensation Fund. • The Department is continuously engaging with the State Departments on the settlement of outstanding claims for patients referred to the Gauteng Hospitals. 103

Improvements of own revenue collection • The department has a service provider that specializes on RAF recoveries that is assisting the collection from RAF. • The department has the service provider for submission of electronic claims to medical schemes 104

2015 MTEF ALLOCATION-Health Profession Training Grant 105

2015 MTEF ALLOCATION-HIV and AIDS 106

2015 MTEF ALLOCATION-National Health Insurance 107

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2014/15 30 Days Payment Month Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Totals No of invoices processed 21798 20390 19742 16364 11383 13496 10195 13964 15809 9140 10601 9694 No within 30 days 19028 15980 18640 13465 8188 9586 8558 10711 11363 7101 8037 6948 % within 30 days 87% 78% 94% 82% 71% 84% 77% 72% 78% 76% 72% 172576 137605 80% April 2015 stats for 30 day payment 74% achievement on scan date by Gauteng Department of Finance (GDF) 98% achievement on posting date by Gauteng Department of Health (GDo. H Pw. C 109

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• Analysis of improved audit outcomes over past 5 years • Root causes for current qualification and mitigating actions • HR matters 111

Analysis of improved audit outcomes over past 5 years Financial Year Audit outcome Number of areas affecting audit outcome Number of areas of non Compliance 2008/2009 Disclaimer 7 10 2009/2010 Disclaimer 8 8 2010/2011 Qualified 3 36 2011/2012 Qualified 4 29 2012/2013 Qualified 4 15 2013/2014 Qualified 1 10 112

Analysis of improved audit outcomes over past 5 years • • • The Department started focusing on improving the audit outcome in the 2011 and detailed action plans were designed to address the audit findings The Department further had to go back to 2008/2009 and 2009/2010 financial years to clear the disclaimer of those financial years. The action plans were monitored consistently over the past few years to track progress on implementation of action plans and to ensure that corrective measures is taken. The improved audit outcome were further due is the consistent improvement of the internal control environment in the department to ensure accurate and complete financial reporting. Over and above the improvement with regards to the financial reporting of the Department there were also significant improvements with regards to compliance to laws and regulations reducing areas of non compliance from 36 in 2010/2011 to 10 in the 2013/2014 financial year The Department is currently in the process of addressing the remaining qualification item of the completeness of Accrued Departmental Revenue 113

Root Causes for current qualification and mitigating actions 114

Root Causes for current qualification and mitigating actions Root Cause Mitigating actions Inadequate systems in place for the recording of downtime • Down time registers were developed and implemented to record all down time. • A detailed project plan was developed to ensure that all down time transaction is identified, recorded and billed on the billing system. • Tracking tool was implemented and monitored to ensure all transactions is recorded • Resources were allocated to ensure all transaction identified is captured. The Department is current 98% completed with this project. Inadequate ICT infrastructure and outdated Patient administration • The Department is currently in the process of upgrading all ICT infrastructure to enable the Department to implement an improved ICT environment and to prevent system down times and improve the accuracy of information. • The Department is further in the process of upgrading the current patient administration. • This is a long term project that will be implemented over more than 1 financial year Patient files not provided for audit purposes or insufficient supporting documents found on some patient files • • The Department has embarked on a process of digitalising patient records to ensure that patients records is readily available and don’t get lost. The Department is further providing on-going training on records management to ensure that 115

Root Causes for current qualification and mitigating actions Root Cause Mitigating actions Significant patient debtor balances outstanding at year end that are older than 90 days • The service provider for debt collection has commenced in the four central hospitals assisting in the collection of outstanding debt from self paying patients. • Patient Detail verification system has been implemented from 01/November 2014. 116

Human Resources 117

STATUS OF SMS POSITIONS IN THE DEPARTMENT POST STATUS HH HJSNSHSH HOD: HEALTH The post has been advertised and interviews conducted. CFO: HEALTH Mr. G Mahlangu has been transferred to the position with effect from 01 /03/2015 DDG: Clinical Services Dr TE Selebano has been appointed in the position with effect from 01/08/2014 CD: EMS Mr A Malotana has been appointed in the position with effect from 01/08/2014 CD: Infrastructure Ms T Ramanyini has been transferred in the position with effect from CD: Supply Chain Management and Asset Management Mr KM Mashiloane has been appointed in the position with effect from 01/05/2015 CD: Legal Services Mr T Mlambo has been transferred in the position with effect from 01/03/2015

STATUS OF SMS POSITIONS IN THE DEPARTMENT POST STATUS Chief Nursing Officer The post has been advertised. CD: HRD The post has been advertised CD: Budget Management Interviews conducted. Appointment process underway. Mr T Matsebula is Acting in the position. CEO: Betha Gxowa hospital Dr NN Mtshali is Acting in the position with effect from 01/04/2015 CEO: South Rand hospital Dr M Maleka is Acting in the position with effect from 23/03/2015 CEO: Dr George Mukhari Academic hospital The post has been advertised. Dr Kgongwana is Acting in the position with effect from 01/08/2014 CEO: Sterkfontein hospital Mr J Mapunya has been appointed in the position with effect from 15/03/205 CEO: Pretoria West hospital Dr HP Mosoane has been appointed in the position with effect from 01/04/2015 119

STATUS OF SMS POSITIONS IN THE DEPARTMENT POST STATUS CEO: Carletonville hospital Dr JC Ganda has been appointed in the position with effect from 01/03/2015 CEO: Pholosong hospital Dr Lingham is Acting in the position with effect from 01/12/2014 Director: HAS Interviews conducted. Mr TX Mhlubulwana will resume duty on 01/06/2015 Director: EMS Interviews conducted. Appointment process underway. Director: Accounts Payable Ms M Lebese been appointed in the position with effect from 10/11/2014 Director: DHS Ms F Kgatoke is Acting in the position with effect from 01/02/2015 Director: Information, Records & Knowledge Management The post has been advertised. Ms N Makhubele is Acting in the position with effect from 01/04/2015 Director: Budget Management Mr M Botsane has been appointed in the position with effect from 01/05/2015 120

STATUS OF SMS POSITIONS IN THE DEPARTMENT POST STATUS Director: Nursing Compliance & Research Ms NP Dlamini has been appointed in the position with effect from 01/04/2015 Director: Nursing Practice & Services Dr SJ Marais has been appointed in the position with effect from 01/04/2015. Director: Nursing Education & Training Ms Y Skosana has been appointed in the position with effect from 01/04/2015 Director: Revenue Management Ms SD Masemola has been appointed to the position with effect from 01/02/2015 Director: Legal Services Mr J Tsoka has been appointed in the position with effect from 01/06/2014 121

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