1 Hospital Revitalization Grant Performance Report: Free State

2 Free State Health Hospital Revitalization Program The program started in 2003/04 financial year with Pelonomi and Boitumelo Hospitals as approved projects, Five additional business cases( Ladybrand, Trompsburg, Mangaung, FSPC and Dihlabeng) completed and approved in 2006/07 financial year Ladybrand and Trompsburg completed phase 1 of their construction and the award for Phase 2 contracts were done in August and October 2010 respectively For Free State Psychiatric we are completing technical documentation and Bill of Quantities. Process to be completed by end November 2010, 2 Hospitals at initial planning stage, Mangaung District and Dihlabeng Regional Hospitals,

3 Expenditure- to Date Funding SourceBudget for 2010/11Expenditure on budget 2010/11 Percentage spent of the budget 2010/11 Projected Over/under Expenditure Hospital Revitalization 378,426,00062,819,21419%105,908,293

4 Boitumelo Hospital expenditure 2 nd Quarter 2010/11 ComponentsBudget 2010/11Expenditure% spentProjected Over / under InfrastructureR 65,000,000R 16,625, ,303,489 Health Tech.R 15,000,000R 4,647,367314,246,315 IT InfrastructureR10,000, TOTALR 90,000,000R 21,272, ,549,804 Procurement for IT infrastructure will be spent this financial year and equipment is in the process of being bought for finished phases of the hospital

5 Pelonomi Hospital expenditure 2 nd Quarter 2010/11 ComponentAdjusted Budget 2010/11 Expenditure% spentProjected Over / under InfrastructureR 86,000,0008,693, ,801,309 HTR 15,000,00013,811, IT Infrastructure R 10,000, TotalR 111,000,00022,505, ,801,309 Procurement for IT infrastructure will be spent this financial year

6 HRP - Grant Management 2 nd Quarter 2010/11 ComponentBudget 2010/11Expenditure% spentProjected Over / under Grant ManagementR 4,426,0001,259, ,201 TotalR 4,426,0001,259, ,201 Vacant site project manager’s posts are in the recruitment phase and will be filled this month

7 Overall Grants Performance

8 Performance per grant as at BAS 28/09/2010 Grant Original Budget 2010/11 Budget after fund shifts Expenditure% spentProjections Over / Under HRP - Boitumelo90,000,00090,000, ,272, ,450,19521,549,804 HRP - Pelonomi86,000,000111,000,00022,505, ,198,69021,801,309 Lady brand hospital 44,000, ,942143,639,999360,000 Trompsburg hospital 44,000,000 0,00019,658,07124,341,929 FS Psychiatric 55,000,00030,000,00013,812, ,181,8437,818,156 FS Mangaung hospital 30,000,000 0,0008,415,51321,584,487 Dihlabeng hospital 10,000,000 0,0002,040,5957,959,405 HRP - Grant Management4,246,000 4,426, ,259, ,932,798493,201 Programme 4(QA&OD) 15,000,000 3,332, ,000,0000 HRP Total 378,426,000378,246,000 62,,819, ,517,706105,908,293

9 Revitalization Grant Boitumelo Regional Hospital Projects Performance

10 Project name Progress to date Comments Allocated Budget 2010/11 Expenditure 2010/11 Projected Over/under Expenditure Contract 10- Casualties11% Contract Terminated however the contractor has declared a dispute. The new contractor is in the process of being appointed despite the dispute lodged by the previous contractor 30,000,0004,352,730 3,474,849 Contract 11- Hall, Lecture 91 % Construction Progressing well with good quality of work. Lecture Halls completed and occupied. Completion end November ,500,0007,046, BOITUMELO HOSPITAL HOSPITAL REVITE GRANT

11 Project name Progress to date Comments Allocated Budget 2010/11 Expenditure 2010/11 Projected Over/under Expenditure Contract 12 H Block95% Planning Planning progressing well. Architects attended to required changes on sketch plans, the bill of quantities to be completed by end November ,600,0001,511,583 11,902,420 Contract 13 EMS, Workshop 98% Construction EMS is occupying the building, additional notice and pin boards to be provided. There is still additional equipment to be installed 6,000,0002,907,898 1,785,220 Total Boitumelo hospital65,000,00015,687,45621,549,804 BOITUMELO HOSPITAL HOSPITAL REVITE GRANT (Continues)

12 Specific Issues Poor performance by contract 10 (casualties) contractor, as a result the contract is terminated, the new contractor in a process of being advertised while the legal processes are continuing with the previous contractor, Procurement of Health Technology equipments is being fast tracked

13 Revitalization Grant Pelonomi Regional Hospital Projects Performance

14 Project name Progress to date comments Allocated Budget 2010/11 Expenditure 2010/11 Projected Under/over Expenditure I.C.U. (Pelonomi) 2,5% The contractor is on site and demolition work complete but progress slow. Major component of contract is equipment 45,000,000 4,673,879 8,196,842 Upgrade Radiology (pelonomi) 82% Construction Progressing well and reception area almost Complete and completion date is January ,500,0004,019,889 3,060,689 Speclialised ClinicsPlanning Accommodation schedule still to be finalized. 2,500, ,768 Pelonomi CasualtyPlanning Inputs have been consolidated from all stake holders and Sketch plans are at an advance stage. Project scope also include community health centre 15,000,0000 5,551,342 Upgrade main entrance and perimeter fence Planning Tender documents complete and awaiting tender advertisement. 10,000,0000 4,308,668 Total Pelonomi86,000,000 8,693,768 21,801,309 PELONOMI HOSPITAL HOSPITAL REVITE GRANT

15 Issues and Challenges The ICU contractor appointed and the site handed over to the contractor on the 4 th June 2010, the progress is slow. Equipment in the process of being ordered Delays in planning due to un-finalised service package for Pelonomi hospital in relation to other health facilities in Mangaung, Delays due to decanting resulting in claims for extension of time,

16 Revitalization Grant Various Institutions Projects Performance

17 Project name Progress to date comments Allocated Budget 2010/11 Expenditure 2010/11 Projected Over/under expenditure DihlabengPlanningConsultants still to be appointed10,000,0000 7,959,405 Mangaung Hospital Planning Site identified, the Brief finalized and the draft concept design 30,000, ,584,487 BFN Psychiatric Hospital98% Planning Finalizing Technical Documentation and Bill of Quantities 30,000,00013,811,841 7,818,156 Trompsburg Hospital(Phase 2)On tender Contractor appointed and site to be handed over 44,000, ,341,929 Ladybrand Hospital (phase 2)Construction Contractor on site and started with pilling and ground levelling 44,000, ,000 Total for Other Institutions under Revitalisation 158,000,00013,811,841 62,063,977 OTHER INSTITUTIONS HOSPITAL REVITE GRANT

18 Issues Dihlabeng Regional Hospital for planning of the new hospital – waiting for appointment of Professional Team. Mangaung District Hospital- The Brief is finalised, the land secured, awaiting the appointment of the land surveyor, concept design planned for presentation to the Peer Review Committee end November 2010, Trompsburg and Ladybrand Hospitals- Delays in appointment of a contractor contributes to under expenditure, FS Psychiatric Hospital - Finalizing Technical Documentation and Bill of Quantities,

19 Performance and Monitoring of HRP Monthly Site Meetings with the contractors, implementing agent and the professional team, Quarterly Review meetings with the professional team, contractors and implementing agent, the reviews are coordinated by the Department of Health – the sessions are a platform used to monitor physical and financial progress of each project, In between there are coordination meetings on specific issues which may be on a critical path for progress, Monthly Bi-lateral meetings with the DPW&RD to monitor the progress and identify challenges, High level bi-monthly meetings of both Health and the implementing agent HOD’s,

Immediate Recovery Plan Accelerate projects and prevent R105m under expenditure Renegotiate with newly appointed contractors to accelerate project and work through holiday Negotiate with National Health and Treasury to utilise funds for 2011 priorities and release back to the HRG in new year Target Capital items EMS, Mobiles, Equipment linked to infrastructure

Key Challenges Lack of internal capacity: Poor planning (project implementation cycle, budget cycle, cash flow estimates) Delays in bid evaluation and adjudication Poor contract management Delayed decision making Decanting challenges

Key Interventions Appointment of Chief Engineer Appointment of Managerial Accountant Review of structure and current personnel functions Joint Planning with PW & RD Synchronization of project cycle, cash flows and budgets Support from National Health expertise

23 THANK YOU