Presentation to the Select Committee on Social Services Annual Performance Plan 2018/19 – 2020/21 Presentation to the Select Committee on Social Services 15 May 2018

VISION MISSION Outcome 2: Long and healthy life for all South Africans To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

Sustainable Development Goal 3 2018/19 – 2020/21 MTEF PRIORITIES The priorities for the MTEF commencing 2018/19 year are derived from: Sustainable Development Goal 3

Legislation and Prescripts that regulate Health Sector planning National Health Act, 2003 Section 21(4) - “the national health plans must comply with national health policy. Section 21(5) - “The Director-General must integrate the health plans of the national department and provincial departments annually and submit the integrated health plans to the National Health Council”. Section 33(1) - “Each district and metropolitan health manager must within the national budget cycle develop … a district health plan drawn up in accordance with national guidelines issued by the Director-General…” Section 23(2) - “The National Health Council may determine the time frames, guidelines and the format for the preparation of national and provincial health plans. Public Finance Management Act, 1999 Treasury Regulations – Chapter 5 of 2007 Framework for Strategic Plans and Annual Performance Plans, 2010

Impact Indicator Baseline (2009) Outcome 2 : A long and Healthy lives for all South Africans Impact Indicators: Targets Impact Indicator Baseline (2009) Current Performance1 Targets (2019) (2030) Life expectancy at birth: Total 56.5 years 63.8 years 64.2 years 70 years (NDP) Life expectancy at birth: Male 54.0 years 60.8 years 61.5 years Life expectancy at birth: Female 59.0 years   66.9 years 67 years Under-5 Mortality Rate 56 Under 5 deaths per 1,000 live-births 34 Under 5 deaths per 1,000 live-births 33 Under 5 deaths per 1,000 live-births 30 Under 5 deaths per 1,000 live-births (NDP) Neonatal Mortality Rate 14 neonatal deaths per 1000 live births 12 neonatal deaths per 1000 live births 8 neonate deaths per 1000 live births Infant Mortality Rate (IMR) 39 per 1,000 live-births 25 infant deaths per 1,000 live-births 23 infant deaths per 1000 live births (15% decrease) 20 infant deaths per thousand live births (NDP) Maternal Mortality Ratio 304 per 100,000 live-births 152 /100 000 live births (2015) <100 maternal deaths per 100,000live-births Rapid Mortality Surveillance (RMS) Report 2016, (Published by MRC during March 2018)

PROGRAMME 1 - ADMINISTRATION The purpose of the Administration Programme is to provide support services to the National Department of Health. These include: Human Resources Development and Management, Labour Relations Services, Information Communication Technology Services, Property Management Services, Security Services, Legal Services, Supply Chain Management and Financial Management Services

Performance Indicator Estimated performance Programme 1 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Ensure effective financial management and accountability by improving audit outcomes Audit opinion from Auditor General Unqualified audit opinion with no significant matters for 2016/17 Clean Audit opinion for the NDOH for 2017/18 Clean Audit Opinion for the NDOH for 2018/19 Clean Audit Opinion for the NDOH for 2019/20 Number of Provincial DoH that demonstrate improvements in Audit Outcomes or Opinions 4 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2016/17 5 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2017/18 5 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2018/19 6 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2019/20

Programme 1: Administration Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 197,170 6 209,195 Goods and Services 308,819 328,136 Transfers 2,252 9 2,455 Capital 4,597 139 11,006 TOTAL 512,838 7 550,792 8

DISCRIPTION: EARMARKED Programme 1: Administration SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EAR-MARKED GRANTS Ministry   31,840 31,217 Management 19,646 25,666 Corporate Services 232,421 239,998 Medico-legal Committees - 5,000 Office Accommodation 165,179 174,912 Financial Management 63,752 65,999 SAICA programme 8,000 Total Programme 1 512,838 537,792 13,000 Total per financial year 550,792 9

PROGRAMME 2 - NATIONAL HEALTH INSURANCE, HEALTH PLANNING AND SYSTEMS ENABLEMENT The purpose of National Health Insurance, Health Planning And Systems Enablement Programme is to improve access to quality health services through the development and implementation of policies to achieve universal health coverage, health financing reform, integrated health systems planning, monitoring and evaluation, and research.

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Achieve Universal Health Coverage through the phased implementation of National Health Insurance Legislation for NHI Draft NHI Bill gazetted for public comments Draft NHI Bill published for comments NHI Bill approved by the National Assembly and National Council of Provinces. NHI Bill assented to by the President Private Health providers contracted to expand coverage of care New Indicator Private health providers contracted to provide health services on behalf of population Additional Private health providers contracted to provide health services on behalf of population Implement eHealth Strategy of South Africa through the development of patient information systems eHealth Strategy 2019-2023 published eHealth Strategy 2012-2016 implementation reviewed eHealth Strategy 2019 – 2023 implantation commenced, and monitored eHealth Strategy 2019 – 2023 implementation monitored

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Develop and implement a system for the creation of a NHI Beneficiary Registry Number of health facilities implementing health patient registration system (HPRS) 3000 PHC Facilities implementing the health patient registration system (HPRS) 3000 PHC Facilities maintained; Additional 470 PHC facilities and 22 Hospitals implementing the health patient registration system (HPRS) 3470 PHC facilities and 22 Hospitals maintained; Additional 38 hospitals implementing the health patient registration system (HPRS) 3470 PHC facilities and 60 Hospitals maintained; Additional 260 hospitals implementing the health patient registration system (HPRS) Number of individuals from the population registered on the NHI Patient Beneficiary Registry 15 million 35 million 50 million 57 million

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Establish a national stock management surveillance centre to improve medicine availability Total number of health facilities reporting stock availability at national surveillance centre 3450 of health facilities reporting stock availability at national surveillance centre (cumulative) 3625 of health facilities reporting stock availability at national surveillance centre (cumulative) 3800 of health facilities reporting stock availability at national surveillance centre (cumulative) 3942 health facilities reporting stock availability at national surveillance centre (cumulative) Improve contracting and supply of medicines through innovative service delivery models Number of patients enrolled for receiving medicines through the centralised chronic medicine dispensing & distribution (CCMDD) programme 1,900,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 2,500, 000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 2,800,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 3,000,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative)

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve the use of antibiotics in South Africa by implementing the Antimicrobial Resistance Strategy Surveillance system implemented for monitoring resistance Surveillance system for monitoring resistance developed. Surveillance system for monitoring resistance accessible to 3 provincial DoH Surveillance system for monitoring resistance accessible to 6 provincial DoH Surveillance system for monitoring resistance accessible to 9 provincial DoH Regulate Traditional Health Practitioners in South Africa Traditional Health Practitioners Amendment Bill drafted and published for comment Traditional Health Practitioners Amendment Bill drafted Traditional Health Practitioners Amendment Bill published for comment Amendment Bill promulgated NA

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Regulation of the price on medicines through the transparent pricing system Single Exit Price Adjustments Published and Implemented Annually 2017/18 Annual Price Adjustments gazetted and published 2018/19 Annual Price Adjustments gazetted and implemented 2019/20 Annual Price Adjustments gazetted and implemented 2020/21 Annual Price Adjustments gazetted and implemented Improve the acceptability, quality and safety of health services by increasing user and community feedback and involvement Number of PHC health facilities conducting Patient Experience of Care Survey 9 Provincial Health Departments trained on use of PEC Guideline 1500 PHC facilities conducting Patient Experience of care surveys annually 2000 PHC facilities conducting Patient Experience of care surveys 3000 PHC facilities conducting Patient Experience of care surveys

Performance Indicator Estimated performance Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy NHI Phase 1 Evaluation Conducted NHI Phase 1 evaluation conducted NHI Phase 1 evaluation report published NHI Phase 1 evaluation report disseminated and used to inform further planning for NHI Comprehensive NHI indicator list developed

Programme 2: National Health Insurance, Health Planning and System Enablement Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 114,740 2 116,693 Goods and Services 585,328 130 1,347,334 Transfers 28,401 6 30,048 Capital 6,618 2,582 177,478 TOTAL 735,087 127 1,671,553 17

DISCRIPTION: EARMARKED SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Chief Operating Officer   3,752 4,649 Technical Policy & Planning 21,961 21,377 PHC Integrated Patient Information System In-kind grant - 76,000 Health Information Management, Monitoring & Evaluation . 39,132 32,000 Health System Trust 15,019 15,890 Health Information System Programme 13,382 14,158 Sector-wide Procurement 39,445 36,279 Electronic Medicine Stock Management System 10,000 National Medicine Stock Surveillance System In-kind grant 90,000 18

DISCRIPTION: EARMARKED SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Health Financing & National Health Insurance . 11,497   24,693 Health Professionals Contracting In-kind grant - 318,053 DRG Project 17,159 NHI in-kind: Non-personal services 700,000 NHI in-kind: Personal services 712,500 NHI Interim Fund Management & Administration 5,000 NHI Ministerial advisory committees 2,000 Health Technology Assessment 7,000 International Health & Development 79,687 86,007 Total Programme 2 195,474 55,560 484,053 205,005 47,048 1,419,500 Total per financial year 735,087 1,671,553 19

Programme 2- Growth 17/18 to 18/19 Additional R700 million for the NHI. NHI allocations were restructured, by centralizing the budgets previously allocated under Responsibilities (such as Technical Policy and Planning and Sector-Wide Procurement) under Health Financing and NHI; NHI in-kind grant is allocated to both Goods and Services as well as Capital; Conversion of DRG allocation under Goods and Services and Capital to a Conditional Grant for Western Cape under Transfers and Subsidies; Programmes allocated Capital Budgets were reduced to allocate funds to Information Communication Technology to maintain current systems; Compensation of Employees budget was realigned in accordance with the filling of priority posts. 20

PROGRAMME 3 - HIV / AIDS, TB AND MATERNAL AND CHILD HEALTH The purpose of HIV / AIDS, TB and Maternal And Child Health Programme is to develop and monitor implementation of national policies, guidelines, norms and standards, and targets for the national responses needed to decrease the burden of disease associated with burden of HIV and TB epidemics; to minimise maternal and child mortality and morbidity; and to optimise good health for children, adolescents and women; and monitor and evaluate the outcomes and impact of these.

Performance Indicator Estimated performance Programme 3 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 To implement combination of prevention and treatment interventions to reduce burden of HIV, STI and TB infections Total number of clients remaining on ART (TROA) 4 200 000 5 000 000 5 800 000 6 100 000 Number of people reached in the National Health Screening and Testing campaign annually New Indicator 14 000 000 Medical Male Circumcisions performed 500 000 600 000 550 000 Number of undiagnosed TB infected persons (new cases) found 80 000 110 000 120 000

Performance Indicator Estimated performance Programme 3 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 To reduce under 5 mortality rate to less than 33 per 1 000 live births EPI coverage survey conducted EPI coverage survey protocol developed. Survey protocol developed and field work completed Survey report completed and used to strengthen EPI programme Targeted Interventions identified and implemented to strengthen EPI Programme EPI surveillance and coverage external review recommendations implemented New Indicator Implementation plans developed in partnership with Provincial DoH; and Three (3) pro-vincial trainings conducted Six (6) provincial trainings conducted Implementation plans monitored

Programme 3: HIV and AIDS, TB, Maternal and Child Health Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 79,420 6 84,413 Goods and Services 454,561 (27) 332,742 Transfers 17,728,096 15 20,301,535 Capital 16,267 (98) 367 TOTAL 18,278,344 13 20,719,057 24

DISCRIPTION: EARMARKED SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Office of DDG: Programme 3   6,458 5,409 HIV & AIDS 276,481 333,626 Condoms 94,116 119,099 Communication campaign 50,000 Higher Education & Training AIDS 8,500 - Comprehensive HIV, AIDS & TB conditional grant 17,557,903 18,645,071 Comprehensive HIV, AIDS, TB & community health worker conditional grant 1,276,626 SANAC 17,547 17,108 Tuberculosis Management 26,498 27,240 Women's, Maternal & Reproductive Health . 18,390 19,907 Child, Youth & School Health 22,451 24,971 Human Papilloma Virus Vaccines in-kind grant 200,000 Human Papilloma Virus Vaccines conditional Grant Total Programme 3 73,797 446,644 17,757,903 77,527 719,833 19,921,697 Total per financial year 18,278,344 20,719,057 25

Programme 3 - Growth 17/18 to 18/19 Transfer budget for Public Universities of South Africa was shifted to Department of Higher Education; Conversion of Human Papilloma Virus Vaccination In-Kind grant under Goods and Services and Capital a Direct Conditional grant under Transfers and Subsidies; Inclusion of Community Heath Workers into Comprehensive HIV and AIDS and TB Conditional Grant (ringfenced); Programmes allocated Capital Budgets were reduced to allocate funds to Information Communication Technology to maintain current systems; 26

PROGRAMME 4 - PRIMARY HEALTH CARE SERVICES (PHC) The purpose of Primary Health Care Service Programme is to develop and oversee the implementation of legislation, policies, systems, and norms and standards for a uniform well functioning district health system, environmental health services, communicable disease control, non-communicable disease control as well as health promotion and nutrition programmes.

Performance Indicator Estimated performance Programme 4 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Eliminate Malaria in South Africa The National Malaria elimination Strategic Plan for South Africa Published New Indicator Malaria Elimination Strategic Plan for South Africa published M&E report produced on the key indicators for Malaria Elimination Implement the International Health Regulations Joint External Evaluation recommendations Joint External Evaluation (JEE) Recommendations implemented Joint External Evaluation on International Health Regulations conducted Work plan for JEE recommendations developed JEE recommendation implemented All JEE recommendation implemented

Performance Indicator Estimated performance Programme 4 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Strengthen district governance and improve management and leadership of the district health system Number of Districts compliant with the minimum requirements of the District Health Management Office structure guidelines National Guidelines for District Health Management Structures approved Plans developed for 10 districts structures to meet the minimum requirements of the guidelines Plans developed for 30 districts structures to meet the minimum requirements of the guidelines Plans developed for 52 districts structures to meet the minimum requirements of the guidelines Number of PHC facility committees assessed to determine functionality 3400 PHC facility committees assessed to determine its functionality 3400 PHC facility committees assessed to determine its functionality; Report on findings with recommendations completed

Performance Indicator Estimated performance Programme 4 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve quality of services at primary health care facilities through the Ideal Clinic Initiative Number of primary health Care facilities in the 52 districts that qualify as Ideal Clinics 1000 primary health Care facilities in the 52 districts qualify as Ideal Clinics 1400 primary health Care facilities in the 52 districts qualify as Ideal Clinics 1800 primary health care facilities in the 52 districts qualify as Ideal Clinics 2500 primary health care facilities in the 52 districts qualify as Ideal Clinics Improve accessibility of Primary Health Services to people with disabilities Proportion of PHC facilities accessible to people with disabilities 34% of PHC facilities accessible to people with disabilities 40% of 3400 PHC facilities accessible to people with disabilities 50% of 3400 of PHC facilities accessible to people with disabilities 60% of 3400 of PHC facilities accessible to people with disabilities

Performance Indicator Estimated performance Programme 4 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve quality of services at District Hospitals through the Ideal District Hospitals Programme Ideal District Hospital Framework implemented Ideal District hospital framework drafted and presented to NDHSC Status of all district hospitals determined against the Ideal District hospital framework version 1 80% of district hospitals score at least 60% against the Ideal District hospital framework 80% of district hospitals score at least 70% against the Ideal District hospital framework Improve environmental health services in all 52 districts and metropolitan municipalities in the country Number of public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards 50 public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals that generate more than 25kg per day) assessed for adherence to HCRW Norms and Standards

Performance Indicator Estimated performance Programme 4 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve environmental health services in all 52 districts and metropolitan municipalities in the country Number of municipalities that are randomly selected and audited against environmental health norms and standards in executing their environmental health functions 20 municipalities are randomly selected and audited against environmental health norms and standards in executing their environmental health functions 21 municipalities randomly selected and audited against environmental health norms and standards Municipalities that achieved less than 65% compliance during 2018/19 audited against environmental health norms and standards Municipalities that achieved less than 65% compliance during 2020/21 audited against environmental health norms and standards Strengthen district mental health services Number of Districts with Mental Health Teams established 10 District mental health teams established 15 District mental health teams established 20 District mental health teams established 25 District mental health teams established Expand provision of rehabilitation services, and accessibility of Primary Health Services to people with physical disabilities Number of multi-disciplinary rehabilitation teams (physiotherapist, optometrist, audiologist, occupational therapist) established Survey conducted to determine the number of Districts with an multi-disciplinary rehabilitation team 2 multi-disciplinary rehabilitation teams established 5 multi-disciplinary rehabilitation teams established 9 multi-disciplinary rehabilitation teams established

Programme 4: Primary Health Care Services Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 185,583 13 209,054 Goods and Services 70,501 27 89,332 Transfers 2,960 6 3,131 Capital 5,255 (96) 219 TOTAL 264,299 14 301,736 33

DISCRIPTION: EARMARKED 11/30/2018 SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Office of DDG: Programme 4   3,136 3,976 District Health Services 16,266 10,606 Ideal Clinic in-kind grant 30,000 - Communicable Diseases 21,923 22,727 Non-Communicable Diseases 22,491 24,183 NDC Prevention and health promotion 50,000 Health Promotion & Nutrition 26,456 24,682 Environmental Health & Port Health Services . 144,027 165,562 Total programme 4 234,299 251,736 Total per financial year 264,299 301,736 34

Programme 4 - Growth 17/18 to 18/19 Additional allocations for Chronic Disease Prevention and Health Promotion; Programmes allocated Capital Budgets were reduced to allocate funds to Information Communication Technology to maintain current systems; 35

PROGRAMME 5:HOSPITAL, TERTIARY HEALTH SERVICES AND HUMAN RESOURCE DEVELOPMENT The purpose of the programme is to develop policies, delivery models and clinical protocols for hospitals and emergency medical services. It is also to ensure alignment of academic medical centres with health workforce programmes, training of health professionals and to ensure the planning of health infrastructure meet the health needs of the country. This programme will also assist the government to achieve the population health goals of the country through nursing and midwifery, by the provision of expert policy and technical advice and recommendations on the role of nurses in attainment of desired health outputs.

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Strengthen local decision making and accountability of central hospitals to facilitate semi-autonomy Number of central hospital organisational structures aligned with Guidelines on Organisational Structures for Central Hospitals Draft Guidelines on Organisational Structures for Central Hospitals Developed Guidelines on Organisational Structures for Central Hospitals approved by TechNHC Costed implementation plans for improvement of 10 Central hospitals organisational structures completed Implementation plans monitored Ensure quality health Care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Number of Hospitals that achieved an overall performance 75% (or more) compliance with the National Core Standards assessed 43 Hospitals (8 Central, 15 Tertiary, 20Regional Hospitals) 10 Central Hospitals achieved an overall performance 75% (or more) compliance with the National Core Standards assessed 50% of Hospitals assessed, and achieved an overall performance of 75% (or more) compliance with NCS 70% of Hospitals assessed, and achieved an overall performance of 75% (or more) compliance with NCS Oncology services improvement plan developed New Indicator Oncology service improvement plan developed for public hospitals Implementation monitored

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Ensure quality health Care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Obstetric services improvement plans developed New Indicator Obstetric service improvement plan developed for public hospitals Implementation monitored Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS)Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS) Number of provinces that are monitored for compliance with the EMS regulations Compliance checklist finalised and presented to Tech NHC for approval. 9 Provincial DoH baseline assessments conducted and reports produced to determine compliance levels 9 provincial department of health monitored for compliance with the EMS regulations using the approved checklist 9 x EMS Improvement plans developed 9 provincial DoH monitored for compliance with the EMS regulations using the approved checklist annually and 9 x EMS Improvement plans revised accordingly 9 provincial DoH monitored for compliance with the EMS regulations using the approved checklist 9 x EMS Improvement plans revised accordingly

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21  To build new and improve quality of existing health infrastructure in South Africa Number of facilities that comply with gazetted infrastructure Norms & Standards. Specifications of 50 facilities compliant with Infrastructure norms and standards 400 facilities compliant with Infrastructure norms and standards 800 facilities compliant with Infrastructure norms and standards 1500 facilities compliant with Infrastructure norms and standards Number of clinics and Community Health Centres constructed or revitalised 20 clinics and Community Health Centres constructed or revitalised Number of hospitals constructed or revitalised 1 hospitals constructed or revitalised 2 hospitals constructed or revitalised Number of facilities maintained, repaired and/or refurbished in NHI Districts 150 facilities, repaired and/or refurbished in NHI Districts 125 facilities maintained, repaired and/or refurbished in NHI Districts 120 facilities maintained, repaired and/or refurbished in NHI Districts Not Applicable1 1. By the end of 2019/20, all health facilities in national health insurance pilot districts will have been maintained, repaired and/or refurbished)

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21   Improve management of PERSAL data to track implementation of staffing norms and facilitate HRH planning Number of facilities maintained, repaired and/or refurbished outside NHI Districts 100 facilities maintained, repaired and/or refurbished outside NHI pilot Districts 100 facilities maintained, repaired and/or refurbished outside NHI pilot Districts HR Regulations developed and promulgated to ensure WISN based HRH planning in PHC facilities New Indicator Draft HR Regulations submitted to NHC for consideration Draft HR Regulations for WISN implementation promulgated Monitor implementation and compliance with HR Regulations for WISN implementation

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve the Human resource planning by strengthening the placement process for medical interns and community service personel Percentage South African Medical Interns and Community service personel allocated in health facilities that studied at South African universities 98% (1510/1529) Medical Interns Placed and 91% (6878/7527) Community service personnel placed 100 % of South African Medical Interns and Community service personnel who studied at SA Universities allocated for placement by October for annual and April for asynchronous allocations respectively

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Develop and support implementation of health workforce staffing norms and standards National Human Resources for Health (HRH) Strategy 2019-2024 drafted A review of the HRH strategic plan 2012/2013-2016/2017 conducted HRH Strategic plan 2019- 2024 drafted HRH Strategic plan 2019- 2024 published and implementation commenced HRH Strategic plan 2019- 2024 monitored Increase production of Human Resources for Health to strengthen capacity in the health system through the implementation of the Nelson Mandela Fidel Castro Medical Programme Number of medical students returning to South Africa from the expanded Nelson Mandela Fidel Castro Medical Programme placed in local medical schools Expanded academic integration programme finalized for final year training in South Africa All students returning from Cuba during 2018/19 placed for final clinical training in the local medical schools All students returning from Cuba placed for final clinical training in the local medical schools All students returning from Cuba placed for final clinical training in the local medical schools

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Improve management of health facilities at all levels of are through the Health Leadership and Management Academy Number of managers accessing the knowledge hub information system for coaching and mentoring 100 Hospital Managers and 300 PHC Managers accessing the knowledge hub information system for coaching and mentoring 150 Hospital and 900 PHC Managers accessing the knowledge hub information system for coaching and mentoring 250 Hospital and 1800 PHC Managers accessing the knowledge hub information system for coaching and mentoring All hospital and PHC managers accessing the knowledge hub information system for coaching and mentoring

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. New basic Nursing qualification programmes and draft curricula developed New basic nursing qualification programmes finalised  8 colleges with customised draft curricula 9/17 remaining colleges have customised curricula for the new 3yr Diploma in General Nursing New courses commenced in 2019 academic year New basic nursing qualification programmes implemented and monitored at all 17 public nursing colleges Progress reports produced on the implementation of the new basic nursing qualification programmes at all 17 public nursing colleges  Norms and standards for clinical training platform developed Norms and standards for clinical training platform drafted and consultations held Norms and standards for clinical training platform approved Provinces supported in the development of implementation plans of the Norms and Standards for Clinical Training Platforms Provinces supported in the development of improvement plans of the norms and standards for clinical training platforms

Performance Indicator Estimated performance Programme 5 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Eliminate the backlog of blood alcohol tests by 2018/19 and toxicology tests by 2020/21 Percentage backlog eliminated for blood alcohol tests Backlog of blood alcohol tests eliminated (0% backlog) in Durban, Cape Town, and Pretoria Laboratories 100% backlog eliminated for blood alcohol tests in Johannesburg laboratory Not applicable Percentage backlog eliminated for toxicology tests 40% backlog eliminated for toxicology tests (cumulative target) 60% backlog eliminated for toxicology tests 70%backlog eliminated for toxicology tests 95% backlog eliminated for toxicology tests 

Programme 5: Hospitals, Tertiary Health Services and HR Development Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 130,750 11 145,181 Goods and Services 189,878 (29) 134,161 Transfers 19,962,489 6 21,100,893 Capital 830,177 2 843,947 TOTAL 21,113,294 5 22,224,182 46

DISCRIPTION: EARMARKED SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Office of DDG: Programme 5   3,692 3,271 Health Facilities Infrastructure Management . IUSS, infrastructure management 20,191 33,532 Health Facility Revitalization In-kind grant 948,984 891,359 Health Facility Revitalization conditional grant - 5,654,495 5,815,694 Tertiary Health Care Planning & Policy 4,618 4,384 Nelson Mandela Children's Memorial Hospital 150,000 200,000 National Tertiary Services conditional grant 11,526,145 12,194,661 National Tertiary Services: DRG Western Cape conditional grant 6,042 Hospital Management 5,155 6,498 Human Resources for Health 21,939 20,867 Health Professions Training & Development conditional grant 2,631,849 2,784,496 Nursing services 6,562 9,077 Forensic Chemistry Laboratories 127,405 145,804 Violence, Trauma & EMS 7,149 8,497 Total Programme 5 49,115 147,596 20,911,473 52,594 179,336 21,892,252 Total per financial year 21,108,184 22,124,182 47

Programme 5 - Growth 17/18 to 18/19 Increase in Capital Asset and Goods and Services budgets for Forensic Chemistry Laboratories to address backlogs and improve turnaround times; Programmes allocated Capital Budgets were reduced to allocate funds to Information Communication Technology to maintain current systems; 48

PROGRAMME 6 - HEALTH REGULATION AND COMPLIANCE MANAGEMENT The purpose of this programme is to regulate the sale of food and to ensure accountability and compliance by public entities and statutory health professional councils in accordance with applicable legislative prescripts. .

Performance Indicator Estimated performance Programme 6 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 To establish the National Public Health Institutes of South Africa (NAPHISA) for coordinated and integrated disease and injury surveillance. Legal framework to establish National Public Health Institutes of South Africa (NAPHISA) NAPHISA Bill tabled for consideration to the Parliamentary Portfolio Committee of Health NAPHISA Act Promulgated into law. NAPHISA established as a public entity, and NAPHISA board appointed NAPHISA fully operational and functional Improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools. Governance monitoring system implemented to strengthen oversight and corporate governance Bi-annual governance progress reports produced of all health entities and councils Biannual governance progress reports produced of all health entities and councils

Performance Indicator Estimated performance Programme 6 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2017/18 2018/19 2019/20 2020/21 Ensure integrated and coordinated governance and management oversight of public entities and statutory professional councils Handbook for Board members serving on public health entities and statutory professional councils developed. New Indicator Handbook for departmental representatives serving on Entities Boards developed. Handbook for departmental representatives serving on Entities Boards implemented Handbook for departmental representatives serving on Entities Boards evaluated and reviewed

Programme 6: Health Regulation and Compliance Management Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 52,369 23 64,278 Goods and Services 36,795 (19) 29,866 Transfers 1,629,998 3 1,678,961 Capital 2,699 (10) 2,441 TOTAL 1,721,861 1,775,546 52

DISCRIPTION: EARMARKED 11/30/2018 SUBPROGRAMME DISCRIPTION: EARMARKED 2017/18 2018/19 R'000 VOTED EARMARKED GRANTS Office of DDG; Programme 6   4,532 6,021 Food Control 11,728 10,571 Radiation Control 18,956 14,218 Public Entities Management 9,298 9,617 NHLS 746,464 789,759 MRC 614,961 624,829 SAHPRA 133,648 125,189 OHSC 125,711 129,678 CCOD & Occupational Health 57,955 61,828 Compensation Fund 3,718 3,836 Total Programme 6 44,514 1,682,457 - 40,427 1,735,119 Total per financial year 1,726,971 1,775,546 Total for NDoH 1,110,037 2,332,257 39,183,429 1,165,081 2,744,336 43,233,449 Total FOR NDoH per financial year 42,625,723 47,142,866 53

Programme 6 - Growth 17/18 to 18/19 Most of the general allocations to Departmental Agencies, namely Council for Medical Schemes, Office of Health Standards Compliance, South African Health Product Regulatory Authority and Compensation Commissioner were reduced; Programmes allocated Capital Budgets were reduced to allocate funds to Information Communication Technology to maintain current systems; 54

TRANSFERS TO PUBLIC ENTITIES, TRADING ACCOUNTS AND TRUSTS 11/30/2018 TRANSFERS TO PUBLIC ENTITIES, TRADING ACCOUNTS AND TRUSTS Type Name 2017/18 R’000 2018/19 Public Entities NHLS 746 464 789 759 MRC 614 961 624 829 SAHPRA 133 648 125 189 OHSC 125 711 129 678 CMS 5 496 5 670 Trading Accounts Compensation Fund (CCOD) 3 718 3 836 Trusts South African National AIDS Council 17 547 17 108 55

NDOH BUDGET ALLOCATION

Summary per Programme 11/30/2018 57

Economic Classification Summary per Economic Classification 11/30/2018 Subprogramme 2017/18 % Growth from 2017/18 to 2018/19 2018/19 R'000 % Compensation of Employees 760,032 9 828,814 Goods and Services 1,645,882 37 2,261,571 Transfers 39,354,196 10 43,117,023 Capital 865,613 20 1,035,458 TOTAL 42,625,723 11 47,242,866 58

NDOH - Growth 17/18 to 18/19 Establishment of Medico-legal Committees and expansion of SAICA financial management support programmes in Provinces; Additional Goods and Services funds of R700 million for the NHI, and the centralizing of the NHI In-Kind Grants under one Programme; Additional allocations for Chronic Disease Prevention and Health Promotion, Health Technology Assessment, the Management and Administration of the interim NHI, and the NHI Ministerial Advisory Committees; Increase in budget for Forensic Chemistry Laboratories to acquire specialized laboratory equipment to address backlogs and improve turnaround times; Inclusion of Community Health Workers transfer of R 1,27 billion into Comprehensive HIV and AIDS and TB Conditional Grant; Allocation to upgrade Civitas Building security systems. 59

Conditional Grants Direct Allocations 11/30/2018 Conditional Grants Direct Allocations 60

Conditional Grants Indirect Allocations 11/30/2018 Conditional Grants Indirect Allocations 61

CONCLUSION National DoH Annual Performance Plan 2018/19-2020/21 is founded on government’s 2030 vision outlined in the National Development Plan 2030. The Department will continue to work towards improving equity, quality and access to healthcare through the implementation of the National Health Insurance policy of South Africa, which commences during 2018/19 financial year.