Revitalisation of hospital services Ensure an appropriate inter facility referral system supported by an adequate and appropriate transport system Empowerment and support of hospital management

Speeding up delivery of an essential package of services through the district health system Gradually increasing the budget to primary health care facilities as cost centres for human and material resources to improve service delivery Enforcing the implementation of Primary Health Care package at all the clinics and mobile services

Commissioning 24 hour facilities to function as intended Speeding up delivery of an essential package of services through the district health system Commissioning 24 hour facilities to function as intended Increase number of PHC facilities by 2% per annum Ensure outreach service by medical officers to all PHC facilities at least once a week by 2007

Speeding up delivery of an essential package of services through the district health system Comprehensively trained PHC nurses available in 50% of the total PHC facilities by 2007 Establishing a Provincial training school for PHC nursing by April 2005

Emergency Medical Services Decreasing morbidity and mortality rates through strategic interventions Emergency Medical Services Ensure the improvement of EMS resources (vehicles, human resources and equipment) from a current level of 30% of national norms to 80% over the next 3 years Establish a fully accredited provincial EMS College providing basic, intermediate, advanced life support and rescue courses

Continue Acute Flaccid Paralysis (AFP) surveillance Decreasing morbidity and mortality rates through strategic interventions Continue Acute Flaccid Paralysis (AFP) surveillance 90% immunisation coverage for children under one year Sustain and increase IMCI implementation to all Health facilities Strengthen the cervical cancer screening programme

Develop a Provincial Specialised Rehabilitation Centre by 2006 Decreasing morbidity and mortality rates through strategic interventions Develop a Provincial Specialised Rehabilitation Centre by 2006 80% of hospitals rendering rehabilitation services in line with National norms and standards by 2007 Outreach rehabilitation services available at all CHC’s by 2007

Decreasing morbidity and mortality rates through strategic interventions To implement integrated malnutrition intervention in 50% of the PHC facilities by March 2007

Establish three Mental Health Review Boards by March 2005 Decreasing morbidity and mortality rates through strategic interventions Ensure fully functional Psychiatric units in the three districts by December 2005 Establish three Mental Health Review Boards by March 2005 To ensure that 80% of PHC facilities are rendering integrated Mental Health services by December 2006

To ensure a Malaria case fatality rate less than 0,5% Decreasing morbidity and mortality rates through strategic interventions To ensure a Malaria case fatality rate less than 0,5% To reduce the Malaria case incidence to less than 1,5% by December 2007 To achieve a spray coverage of 80% in the Malaria high risk area

Decreasing morbidity and mortality rates through strategic interventions To strengthen capacity for health promotion in 17 health promotion units to effect community outreach programmes in respect of preventive and promotive aspects in diseases of lifestyle by March 2007 To improve the health status of the child by launching 30 health promoting schools by March 2007

Decreasing morbidity and mortality rates through strategic interventions To implement the community component of the IMCI in 13 sites by March 2007 To implement clinical guidelines for the management of Diabetes and Hypertension in all health facilities in the province by March 2007

Decreasing morbidity and mortality rates through strategic interventions To put monitoring mechanisms in place to identify index Cholera cases towards the early prevention of Cholera outbreaks by October 2004 To strengthen and maintain a fully functional Epidemic Preparedness and Response(EPR) system by March 2007

Decreasing morbidity and mortality rates through strategic interventions Increase awareness on the benefits of Voluntary Counseling and Testing (VCT) To continuously strengthen social mobilization using the Abstain, Be faithful and Condomise strategy Increase awareness on the Prevention of Mother To Child Transmission programme

Implementation of a HIV and AIDS workplace policy by October 2004 Decreasing morbidity and mortality rates through strategic interventions Implementation of a HIV and AIDS workplace policy by October 2004 Increase the utilization of community based health workers including Home Based Care workers to extend community outreach programmes Reduce the incidence of STI’s using the syndromic approach for management of all STI cases

Decreasing morbidity and mortality rates through strategic interventions Implementation of the Comprehensive, management and treatment of HIV and AIDS patients at all hospitals and some PHC facilities by March 2007 Reduce the Multiple Drug Resistance (MDR) to TB drugs to less than 1% by March 2007 Expand the Directly Observed Treatment Programme to all districts by March 2007

Optimally utilise information to equitably allocate resources Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation Establish assessment teams to evaluate Certificate of Need applications in conjunction with National Department of Health Optimally utilise information to equitably allocate resources

Improve revenue generation at all hospitals Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation Improve revenue generation at all hospitals Finalise and implement PPP framework Develop and implement Donor funding policy using National guidelines

Improving human resource development and management Strengthen and expand the tele-tuition project in the province Train 30 additional PHC qualified nurses per annum Train 100 Pharmacist assistants per annum Empower health managers in Labour Relations management

Improving human resource development and management Strengthen cooperation for training of various health workers by the University of Pretoria, Limpopo, Free State and MEDUNSA Strengthen the implementation of the Personnel Management and Development System (PMDS)

Improving human resource development and management Improve personnel and administrative filing system as well as developing an electronic filing system Continuous update of the PERSAL information

Improving communication and consultation within the health system and between the health system and communities we serve Enhance community interaction through IZIMBIZO’s Produce internal newsletter for the department Increase the effectiveness of the Departmental Website Schedule stakeholders meetings/summits with Medical Practitioners, Allied Health Professionals, Traditional Healers and NGO’s

Strengthening co-operation with our partners internationally Implement plans of action with the Maputo Province in Mozambique Jointly manage Health Information System development and GIS plotting projects with the Italian Corporation Strengthen the Lebombo Spatial Development Initiative towards eradication of Malaria in the region

Brief description of the Budget with Trends 2000/01 – 2006/07

Department of Health Expenditure R’000 Medium Term Estimates Sources of revenue 2000/2001 2001/ 2002 2002/2003 2003/2004 2004/ 2005 2005/ 2006 2006/ 2007 Equitable share 990 469 1 285 511 1 489 433 1 821 474 2 032 743 2 208 705 2 432 932 Conditional Grants 126 899 174 050 198 713 320 352 262 637 310 900 356 665 Own Revenue 10 370 10 540 46 000 Total Revenue 1 117 368 1 456 561 1 688 146 2 152 196 2 305 920 2 519 605 2 835 597

Expenditure as % allocation Department of Health Budget 2003/2004 R’000 Expenditure Savings (Excess) Expenditure as % allocation Equitable share 1 831 844 1 762 214 66 753 96% Conditional Grants 320 352 244 289 78 940 75% Total 2 152 196 2 006 503 145 693 93%

Department of Health Expenditure R’000 Medium Term Estimates Programmes 2000/2001 2001/ 2002 2002/2003 2003/2004 2004/ 2005 2005/ 2006 2006/ 2007 1. Administration 97 152 111 015 120 729 176 035 210 681 184 112 197 278 2. District Health Services 886 338 1 076 260 1 247 955 1 407 961 1 469 502 1 597 910 1 737 165 3. Emergency Medical Services 70 031 84 549 95 908 107 182 4. Provincial Hospital Services 91 339 160 221 183 037 303 393 310 553 367 843 414 385 6. Health Sciences and Training 25 816 32 638 39 328 48 225 55 619 58 937 62 473 7. Health care Support services 9 847 12 664 24 696 27 793 31 501 34 629 36 707 8. Health Facilities Management 6 876 63 763 72 401 117 758 143 515 180 266 280 407 Total Revenue 1 117 368 1 456 561 1 688 146 2 152 196 2 305 920 2 519 605 2 835 597

Department of Health Expenditure R’000 Medium Term Estimates Conditional Grant 2002/2003 2003/2004 2004/ 2005 2005/ 2006 2006/ 2007 Health Financial Management Grant 2 844 Provincial Infrastructure Grant 16 655 29 171 35 724 39 975 44 323 Flood Infrastructure Grant 10 000 11 016 National Tertiary Services Grant 39 044 41 796 41 427 42 224 44 757 Health Professional Training and Development Grant 31 147 46 575 41 808 54 363 Hospital Revitalisation Grant 48 000 65 944 68 292 71 025 92 662 Hospital Management and Quality Improvement Grant 8 333 20 273 12 833 12 340 13 081 Integrated Nutrition Programme Grant 39 728 67 183 8 713 9 581 HIV and AIDS Grant 20 867 34 550 53 840 81 392 107 479 Medico Legal Services 1 000 Total 213 774 320 352 262 637 310 900 356 665

Department of Health Budget 2003/2004 R’000 Expenditure 2003/2004 Savings(Excess) Health Financial Management Grant 2 844 836 2 008 Provincial Infrastructure Grant 29 171 24 342 4 829 Flood Infrastructure Grant 11 016 4 339 6 677 National Tertiary Services Grant 41 796 34 696 7 100 Health Professional Training and Development Grant 46 575 Hospital Revitalisation Grant 65 944 45 813 20 131 Hospital Management and Quality Improvement Grant 20 273 4 116 16 157 Integrated Nutrition Programme Grant 67 183 60 843 6 340 HIV and AIDS Grant 34 550 22 729 11 821 Medico Legal Services 1 000 Total 320 352 244 289 76 063

Budgetary Trends The Mpumalanga Province had a budget of R1,456 billion for the 2001/2 financial year. For 2002/3 the budget was R1,688 billion and for 2003/4 the budget was R2,152 billion The department provides in addition to the population of the province, health care services to patients from neighboring countries of Swaziland and Mozambique

Budgetary Trends Mpumalanga Province, is the third lowest in terms of per capita spending at R770 The Head count per capita for the visits to PHC facilities (2001/2) indicates an average of 1,5 visits as opposed to the 3-3,5 national norm Expenditure has increased by 19% in 2003/4