1. PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S ANNUAL REPORT FOR 2005/06 PORTFOLIO COMMITTEE ON HEALTH CAPE TOWN 29 MAY 2007

2. 2 1. FLOW OF PRESENTATION VISION & MISSION LEGISLATIVE MANDATES KEY PRIORITIES OF THE NATIONAL HEALTH SYSTEM (NHS) FOR 2004-2009 SUMMARY OF ACHIEVEMENTS & CHALLENGES PER BUDGET PROGRAMME, COMPARING PROGRESS BETWEEN 2004/05 AND 2005/06 BUDGET AND EXPENDITURE REPORT KEY PRIORITIES AS REFLECTED IN THE NDOH STRATEGIC PLANS FOR 2006/07-2008/09 AND 2007/08-2009/10 CONCLUSIONS

3. 3 2. VISION & MISSION VISION AN ACCESSIBLE, CARING AND HIGH QUALITY HEALTH SYSTEM MISSION TO IMPROVE HEALTH STATUS THROUGH PREVENTION OF ILLNESS & DISEASE AND THROUGH THE PROMOTION OF HEALTHY LIFESTYLES AND TO CONSISTENTLY IMPROVE THE HEALTH CARE DELIVERY SYSTEM BY FOCUSING ON ACCESS, EQUITY, EFFICIENCY, QUALITY AND SUSTAINABILITY

4. 4 3. LEGISLATIVE MANDATES 51 ACTS MENTIONED IN THE NDOH ANNUAL REPORT 2005/06 INCLUDING: THE CONSTITUTION OF THE REPUBLIC NATIONAL HEALTH ACT OF 2003 PUBLIC FINANCE MANAGEMENT ACT OF 1999 NURSING ACT OF 2005 MEDICINES & RELATED SUBSTANCES ACT MEDICAL SCHEMES ACT OF 1998 TOBACCO PRODUCTS CONTROL AMENDMENT ACT OF 1999

5. 5 4. BUDGET PROGRAMME STRUCTURE OF THE NDOH IN 2005/06 PROGRAMME 1: ADMINISTRATION PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES PROGRAMME 3: HEALTH SERVICE DELIVERY PROGRAMME 4: HUMAN RESOURCES NB. BUDGET PROGRAMME STRUCTURE CHANGED BETWEEN 2004/05 AND 2005/06, WITH PROGRAMMES SUCH AS DISTRICTS AND DEVELOPMENT AND HIER MOVING FROM PROGRAMME 2 TO PROGRAMME 3

6. 6 5. KEY NHS PRIORITIES FOR 2004-2009 1. IMPROVE GOVERNANCE & MANAGEMENT OF THE NHS 2. PROMOTE HEALTHY LIFESTYLES 3. CONTRIBUTE TOWARDS HUMAN DIGNITY BY IMPROVING QUALITY OF CARE 4. IMPROVE MANAGEMENT OF COMMUNICABLE & NON-COMMUNICABLE DISEASES 5. STRENGTHEN PHC, EMS AND HOSPITAL SERVICE DELIVERY SYSTEMS 6. STRENGTHEN SUPPORT SERVICES 7. HUMAN RESOURCE PLANNING, MANAGEMENT AND DEVELOPMENT 8. PLANNING, BUDGETING AND MONITORING & EVALUATION 9. PREPARATION AND IMPLEMENTATION OF LEGISLATION 10. STRENGTHEN INTERNATIONAL RELATIONS

7. 7 6. SUMMARY OF ACHIEVEMENTS 6.1. PROGRAMME 1: ADMINISTRATION NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 DEVELOPMENT OF HEALTH LEGISLATION 8 BILLS PROCESSED DURING 2004/05. NATIONAL HEALTH ACT OF 2003 ALSO SIGNED INTO LAW 5 BILLS PROCESSED DURING 2005/06 STRENGTHENING COMMUNICATION WITH PROVINCIAL & NATIONAL STAKEHOLDERS NATIONAL CONSULTATIVE HEALTH FORUM (NCHF) HOSTED IN DECEMBER 2005 RANGE OF PUBLICATIONS PRODUCED NCHF HOSTED IN MAY 2006 18 MINISTERIAL IZIMBIZO HELD RANGE OF PUBLICATIONS PRODUCED

8. 8 6. SUMMARY OF ACHIEVEMENTS 6.1. PROGRAMME 1: ADMINISTRATION NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 STRENGTHENING HEALTH SECTOR PLANNING PROVINCIAL ANNUAL PERFORMANCE PLANS (APPs) FOR 2005/06 REVIEWED ANNUAL REPORTS FOR 2004/05 REVIEWED DISTRICT HEALTH PLANNING (DHP) GUIDELINES REVISED BY MARCH 2005 APPs FOR 2006/07 AND ANNUAL REPORTS FOR 2005/06 REVIEWED 8/9 PROVINCES PRODUCED SERVICE TRANSFORMATION PLANS (STPs) FOR 2007/08 DHP GUIDELINES PUBLISHED BY JULY 2005 AND USED BY 53 DISTRICTS TO DEVELOP DISTRICT PLANS FOR 2006/07. DESPITE GOOD PROGRESS, QUALITY OF MOST DHPs NEEDS FURTHER STRENGTHENING.

9. 9 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 EXPANSION OF THE IMPLEMENTATION OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) STRATEGY ALL 53 DISTRICTS IMPLEMENTING IMCI IMCI CASCADED TO 136 OF 284 LOCAL MUNICIPALITIES (EXPANDED TO SUB- DISTRICTS) TRAINING OF HEALTH WORKERS IN THE IMCI STRATEGY 64% OF HEALTH WORKERS PROVIDING SERVICES TO CHILDREN TRAINED IN IMCI 60% OF THOSE WHO PROVIDE SERVICES TO CHILDREN TRAINED IN IMCI IMPROVING IMMUNISATION COVERAGE NATIONAL IMMUNISATION COVERAGE OF 82% ATTAINED IMPROVING IMMUNISATION COVERAGE AT DISTRICT LEVEL 37/53 DISTRICTS (69%) OF DISTRICTS HAVE MORE THAN 80% IMMUNISATION COVERAGE 12/53 DISTRICTS (23%) OF DISTRICTS HAVE MORE THAN 90% IMMUNISATION COVERAGE

10. 10 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH ACHIEVEMENTS JECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 EXPANSION OF SCHOOL HEALTH SERVICES 30% OF PROVINCES WITH 100% OF DISTRICTS PROVIDING PHASE 1 OF SCHOOL SERVICES 72% OF DISTRICTS PROVIDE PHASE 1 OF SCHOOL HEALTH SERVICES IMPROVING WOMEN’S ACCESS TO CHOICE ON TERMINATION OF PREGNANCY (CTOP) SERVICES 55% OF APPROVED FACILITIES PROVIDED CTOP 60% OF APPROVED FACILITIES PROVIDED CTOP

11. 11 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 STRENGTHENING PREVENTION OF HIV AND STIs 347 MILLION MALE CONDOMS AND OVER 1 MILLION FEMALE CONDOMS DISTRIBUTED 413 MILLION MALE CONDOMS & OVER 2 MILLION FEMALE CONDOMS DISTRIBUTED EXPANSION OF VOLUNTARY COUNSELLING AND TESTING (VCT) AND PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) SERVICES 80% OF PUBLIC HEALTH FACILITIES OFFERED VCT 60% OFFERED PMTCT 88% OF FACILITIES OFFERED VCT 87% OFFERED PMTCT EXPANDING THE COMPREHENSIVE PLAN FOR HIV &AIDS CARE, TREATMENT AND MANAGEMENT (CCMT) 139 CCMT SITES ESTABLISHED 210 CCMT SITES ESTABLISHED 65% OF PEOPLE LIVING WITH HIV&AIDS, TB AND OTHER CONDITIONS PROVIDED WITH NUTRITIONAL SUPPORT

12. 12 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 STRENGTHENING TB CONTROL 50/53 HEALTH DISTRICTS IMPLEMENTING DOTS STRATEGY 53/53 HEALTH DISTRICTS IMPLEMENTING DOTS STRATEGY TB SMEAR CONVERSION RATE OF 61% ATTAINED (TARGET 70%) TB SMEAR CONVERSION RATE OF 62.8% ATTAINED (TARGET 70%) 10.3% OF TB PATIENTS DEFAULTING PATIENTS 9.9% OF TB PATIENTS DEFAULTING PATIENTS TB CURE RATE OF 50.8% ATTAINED (TARGET = 65%) TB CURE RATE OF 56.2% ATTAINED (TARGET = 65%)

13. 13 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 ENHANCING COLLABORATION WITH NGOs IN CURBING HIV AND AIDS 74 NGOs FUNDED WITH CLOSE MONITORING ABOUT 70 NGOs FUNDED WITH CLOSE MONITORING EXPANDING INTERNATIONAL HEALTH RELATIONS DIVERSE BILATERAL AND TRILATERAL AGREEMENTS WERE SIGNED INCLUDING THOSE WITH IRAN, RWANDA, MALI, INDIA AND BRAZIL DIVERSE BILATERAL AND TRILATERAL AGREEMENTS WERE SIGNED INCLUDING: PROGRAMME OF ACTION WITH DRC AND NIGERIA ON TRADITIONAL MEDICINE; 24 CONTRACTS FOR RECRUITMENT OF IRANIAN DOCTORS; THROUGH DFID, UK GOVERNMENT PROVIDED R90 MILLION FOR THE COMPREHENSIVE PLAN FOR HIV AND AIDS; SA-CHINA MOU; ETC.

14. 14 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 IMPROVING ACCESS TO SAFE AND AFFORDABLE MEDICINES 100% OF NEW PHARMACIES LICENSED IN LINE WITH THE NEW PHARMACY ACT 70% OF PHARMACY LICENCES ISSUED AGAINST APPLICATIONS RECEIVED APPROPRIATE DISPENSING FEE PUBLISHED BUT UNDER CHALLENGE MEDICINE PRICING REGULATIONS REVIEWED

15. 15 6. SUMMARY OF ACHIEVEMENTS 6.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 STRENGTHENING MALARIA CONTROL 9 PROVINCES WITH EPIDEMIC PREPAREDNESS AND INTEGRATED RESPONSE FUNCTIONS 9 PROVINCES WITH EPIDEMIC PREPAREDNESS AND INTEGRATED RESPONSE (EPR) FUNCTIONS EPR GUIDELINES FINALISED AND USED BY PROVINCES ALL 3 MALARIA AFFECTED PROVINCES (KWAZULU-NATAL, LIMPOPO & MPUMALANGA) IMPLEMENTED RECOMMENDATIONS FROM THE ROLL BACK MALARIA STRATEGY

16. 16 6. SUMMARY OF ACHIEVEMENTS 6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 INCREASING ACCESS TO AND UTILISATION OF PHC SERVICES PHC UTILISATION RATE OF 2.1. VISITS PHC UTILISATION RATE OF 2.2 VISITS 35/53 DISTRICTS PROVIDE A FULL BASKET OF PHC SERVICES 48/53 DISTRICTS PROVIDE A FULL BASKET OF PHC SERVICES PHC HEADCOUNT OF 97, 993, 394 ATTAINED IN 2004/05 PHC HEADCOUNT OF 101,758,377 ATTAINED IN 2005/6 PHC SUPERVISION RATE OF 60% ATTAINED

17. 17 6. SUMMARY OF ACHIEVEMENTS 6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 EXPANSION OF THE HOSPITAL REVITALISATION PROGRAMME 3 HOSPITALS COMPLETED NAMELY: (CALVINIA & COLESBURG IN THE NORTHERN CAPE; PIET RETIEF IN MPUMALANGA) 5 HOSPITALS COMPLETED NAMELY: (LEBOWAKGOMO & JANE FURSE IN LIMPOPO; MARY THERESA IN THE EASTERN CAPE; GEORGE HOSPITAL IN WESTERN CAPE & SWARTRUGGENS IN THE NORTH WEST) 11% OF HOSPITALS ARE PART OF THE HOSPITAL REVITALISATION PROGRAMME 12% OF HOSPITALS ARE PART OF THE HOSPITAL REVITALISATION PROGRAMME (I.E. 46 HOSPITALS) DELEGATION OF AUTHORITY TO HOSPITAL MANAGERS ALL 9 PROVINCES DELEGATED AUTHORITY TO HOSPITAL CEOs

18. 18 6. SUMMARY OF ACHIEVEMENTS 6.3. PROGRAMME 3: HEALTH SERVICE DELIVERY NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 EXPANDING ACCESS TO TELEMEDICINE 12% OF HOSPITALS HAVE TELEMEDICINE FACILITIES ADDITIONAL TELEMEDICINE SITES ESTABLISHED IN EC & MP TRANSFER OF FORENSIC LABS AND MORTUARIES TO PROVINCIAL DOHs 8 PROVINCIAL BUSINESS PLANS DEVELOPED FOR THE TRANSFER OF FORENSIC LABS AND MORTUARIES FROM SAPS TO DOHs TRANSFER OF FORENSIC LABS AND MORTUARIES TO DOHs COMPLETED EXPANSION OF THE CATARACT SURGERY PROJECT CATARACT SURGERY RATE OF 1039 OPERATIONS PER MILLION PEOPLE ATTAINED (TARGET 950 PER MILLION) CATARACT SURGERY RATE OF 1030 OPERATIONS PER MILLION PEOPLE ATTAINED (TARGET 1000 PER MILLION) NATIONAL HEALTH REPORTS PUBLISHED ANTENATAL SURVEY; SADHS; CONFIDENTIAL INQUIRIES INTO MATERNAL DEATHS UNGASS REPORT COMPLETED;

19. 19 6. SUMMARY OF ACHIEVEMENTS 6.4. PROGRAMME 4: HUMAN RESOURCES MANAGEMENT NATIONAL DOH OBJECTIVES AND INTERVENTIONS ACHIEVEMENTS 2004/052005/06 DEVELOPMENT OF A NATIONAL HUMAN RESOURCES (HR) FOR HEALTH PLAN DRAFT HR PLAN DEVELOPED AND CONSULTATION PROCESS COMPLETED HR PLAN LAUNCHED IN APRIL 2006 TRAINING OF HEALTH WORKERS TO IMPLEMENT THE COMPREHENSIVE PLAN FOR HIV &AIDS CARE, TREATMENT AND MANAGEMENT (CCMT) MORE THAN 9 000 HEALTH WORKERS TRAINED TO IMPLEMENT THE CCMT 11 958 HEALTH WORKERS TRAINED IN THE IMPLEMENTATION OF CCMT (TARGET WAS 6 233) EXPAND HEALTH SECTOR’S CONTRIBUTION TO THE EPWP PROGRAMME CO-ORDINATION OF POLICY ON COMMUNITY CARE GIVERS WITH SOCIAL DEVELOPMENT COMPLETED DRAFT REGULATIONS FOR CHWs DEVELOPED; NATIONAL COMMUNITY HEALTH WORKER POLICY FRAMEWORK DEVELOPED

20. 20 7. CHALLENGES POVERTY, UNEMPLOYMENT, LOW EDUCATION LEVELS, POOR TRANSPORT INFRASTRUCTURE, SOCIAL COHESION ISSUES TRIPLE BURDEN OF DISEASE (COMMUNICABLE, NON- COMMUNICABLE, INJURIES AND TRAUMA) LACK OF SUFFICIENT & SKILLED HUMAN RESOURCES FOR HEALTH (CLINICAL & MANAGEMENT LEVEL) POOR HEALTH INFRASTRUCTURE COMMUNITY MOBILISATION, PATIENT ADHERENCE ISSUES

21. 8. BUDGET, EXPENDITURE AND AUDIT OUTCOMES FOR 2005/06 MR. F.G. MULLER (CFO )

22. 22 8.1. NATIONAL DEPARTMENT OF HEALTH

23. 23 8.1. NATIONAL DEPARTMENT OF HEALTH

24. 24 8.2. NATIONAL DEPARTMENT OF HEALTH

25. 25 8.3. NATIONAL DEPARTMENT OF HEALTH

26. 26 8.4. NATIONAL DEPARTMENT OF HEALTH AUDIT OUTCOMES 1. Qualification – DORA Reasons: Payments made prior to approval of Business plans Difference between total amounts of Business Plans and DORA applications Late and non submission of monthly financial reports

27. 27. 8.4. NATIONAL DEPARTMENT OF HEALTH 1. Qualification – DORA (cont.) Late and non submission of quarterly reports Quarterly visits to provinces not always conducted Appointment of monitoring staff happened late in the financial year.

28. 28 8.5. NATIONAL DEPARTMENT OF HEALTH 2. Matters of Emphasis Audit Committee – non functional Internal Audit – ineffective National Environmental Management Act – non compliance, report not done Supply Chain Management Unit – not fully operational.

29. 29 9. KEY NHS PRIORITIES FOR 2006/07 & 2007/089 9.1. DEVELOP PROVINCIAL SERVICE TRANSFORMATION PLANS; 9.2. STRENGTHEN HUMAN RESOURCES; 9.3. IMPROVE QUALITY OF CARE; 9.4.STRENGTHEN INFRASTRUCTURE; 9.5. STRENGTHEN PRIORITY HEALTH PROGRAMMES (HEALTHY LIFESTYLES, HIV PREVENTION, TB CRISIS MANAGEMENT, MCWH&N)

30. 30 10. CONCLUSION DESPITE MANY CHALLENGES THE DOH HAS SEEN PROGRESS IN HEALTH SERVICE DELIVERY IN 2005/06 (AND IN 2006/07) WITH GUIDANCE FROM THE MINISTER AND DEPUTY MINISTER NDOH WILL WORK HARD TO ENSURE ACHIEVEMENT OF 2007/08 TARGETS HOWEVER, CHANGES IN THE SOCIAL CONTEXTS IN WHICH OUR PEOPLE LIVE AND ADEQUATE RESOURCE AVAILABILITY FOR THE HEALTH SYSTEM (HUMAN RESOURCES & FINANCES) ARE KEY TO THE SUCCESSFUL IMPLEMENTATION OF THIS PLAN; INTERSECTORAL COLLABORATION ACROSS GOVERNMENT AND WITH KEY STAKEHOLDERS ARE CRUCIAL; ONCE THE MINISTER HAS TABLED THE ANNUAL REPORT FOR 2006/07 IN PARLIAMENT IN SEPTEMBER 2007, THE NATIONAL DOH WILL RETURN TO PRESENT IT TO THE PORTFOLIO COMMITTEE.