1. 2015/16 QUARTER FOUR 14 SEPTEMBER 2016 STANDING COMMITTEE ON APPROPRIATIONS 2015/16 ANNUAL PERFORMANCE PLAN

2. Purpose Present Quarter Four Performance Report on the Annual Performance Plan 2015/16. The report is presented by the following programmes: 1.Programme 1: Administration 2.Programme 2: Health Planning and Systems Enablement 3.Programme 3: HIV & AIDS, TB and MCWH 4.Programme 4: PHC Services 5.Programme 5: Hospitals, Tertiary Services and Workforce Development 6.Programme 6: Health Regulation and Compliance Management Q4 performance is also presented in the background of 2015/16 performance 2

3. The Department Annual Performance Plan is designed to deliver on the MTSF commitments, namely: Sub-outcome 1: Universal Health coverage progressively achieved through implementation of National Health Insurance Sub-outcome 2: Improved quality of health care Sub-outcome 3. Implement the re-engineering of Primary Health Care Sub-outcome 4: Reduced health care costs Sub-outcome 5: Improved human resources for health Sub-outcome 6: Improved health management and leadership Sub-outcome 7: Improved health facility planning and infrastructure delivery Sub-outcome 8: HIV & AIDS and Tuberculosis prevented and successfully managed Sub-outcome 9: Maternal, infant and child mortality reduced Sub-outcome 10 : Efficient Health Management Information System developed and implemented for improved decision making Medium Term Strategic Framework (MTSF) 2014-2019 3

4. 4 Progress Report PROGRAMME 1 : ADMINISTRATION

5. Programme 1: Administration Strategic Objective IndicatorTargetQ4 performanceAnnual Report Ensure effective financial management and accountability by improving audit outcomes Audit opinion from Auditor-General Annual: Unqualified Audit Opinion Audit Action Plan Progress reports verified and updated by Internal Audi Unqualified Audit Opinion Audit opinion from Auditor for Provincial Departments of Health Annual: 3 Unqualified audit opinions 9 provinces have submitted financial improvement plans with timelines to address qualification matters towards unqualified 3 Unqualified Audit Opinions Number of provinces that submit reports against defined set of non-negotiable items on a monthly basis Annual: 9 All nine provinces submitted their reports for January and February, and six reports were received for the month of March All nine provinces submitted reports against defined set of non-negotiable items on a monthly basis 5

6. Programme 1: Administration Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes Average Turnaround times for recruitment processes Bi-annual& Annual: Average recruitment process turnaround time will be 4 months for all advertised posts 52% (33/61) of vacant posts were filled within the target of 6 months as per Public Service Regulations, 2001, as amended. 41% (25/61) of vacancies were filled within the target of 4 months as per FOSAD target Average recruitment process turnaround time was within 5 months NDoH vacancy rate Bi-annual & Annual: 5% 3.3% 3.5% Percentage of Senior Managers that have entered into Performance Agreements with their supervisors Annual: 98% of SMS members timeously concluded their PA and half yearly performance reviews in terms of prescribed DPSA timeline 95% 6

7. Programme 1: Administration Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes Develop and Implement Employee wellness programme that comply with Public Service Regulations (PSR) and Employee Health and Wellness Strategic Framework(EHWSF) Annual: EHW induction programme to Port Health employees 17 and 22 Port Health personnel at OR Tambo and Lanseria Airports respectively received audio-visual tests EHW induction workshops held for Port Health employees in the provinces of Gauteng, KwaZulu-Natal, Free State, Mpumalanga and North West. Fully implement the Departmental Information Communication Technology (ICT) Service Continuity Plan by the 31st of March 2018 Establish ability to access domain services outside the NDoH premises Q4: Test access to domain services Annual: Domain services at DR sites established and implemented Tested accessibility for Domain Services from the DR site. Three servers have been set up for domain services Ability to access domain services outside the NDoH premises tested at DR site 7

8. Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Provide support for effective communication by developing an integrated communication strategy and implementation plan Develop an integrated communication strategy and implementation plan Annual: Communication Toolkit developed to integrate messages The following communication Toolkits were developed and implemented: 1. Online Internship and community service applications: draft communications strategy/plans 2. 2016 SADHS Media and Stakeholder launch plan, SADHS Stakeholder and advocacy plan, SADHS Online publicity plan, SADHS Internal communication plan, 3. Reproductive Health Month communication plan, 4. Public communication campaigns toolkit, 5. The SADHS Toolkits; the World TB Day 2016 Toolkit; the Reproductive Health Month 2016 toolkits; and the World Cancer Day toolkits developed, implemented and distributed through GCIS, printed material and social At least 15 toolkits were developed and implemented A National Health Litigation Strategy developed and implemented Develop National Health Litigation Strategy Q4:The draft document referred to the TECH NHC for recommendation to NHC Annual: National Litigation strategy approved A national litigation strategy developed. The Summit Declaration has been signed off. The National Health Litigation Strategy was adopted from the Medico Litigation Summit Declaration Programme 1: Administration 10 8

9. 9 Programme 1 Performance Improvement Strategies Turn-around time on staff recruitment processes: The Department measured itself against a stringent 4-months target; however the DPSA target in Public Service is 6 months. For this reporting period, NDoH met the 6 months target, even though there were challenges in meeting the 4 months target. NDoH has engaged the institutions responsible for the prerequisite verification of qualifications of selected candidates in order to improve the processes. In the 2016/17 financial year, the Departmental target will be aligned with the DPSA target of six months.

10. Progress Report PROGRAMME 2 : HEALTH PLANNING AND SYSTEMS ENABLEMENT 10

11. Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Achieve Universal Health Coverage through the phased implementation of National Health Insurance(NHI) White Paper on NHI Annual: Finalise and publish White Paper on NHI White Paper on NHI published for public comments on 11 December 2015 Legislation for NHI Annual: Publication of the White Paper Draft legislation will be prepared once the White Paper is finalised Draft Bill has been developed however this cannot be finalised until the White has been approved. Establishment of the National Health Insurance Fund Q4: Funding modality for the National Health Insurance Fund including budget reallocation for a defined set of personal health services developed Annual: Funding modality for the National Health Insurance Fund including budget reallocation for district primary health care White Paper on NHI outlines the alternative funding options for NHI. Work on the final funding modality is underway in Workstream 2 White Paper on NHI outlines the alternative funding options Review Annual dispensing fee Annual: Review of the 2015/16 dispensing fee in determining the 2016/17 maximum dispensing fee The final gazette was published on 5 February 2016 for the implementation of the dispensing fee for pharmacists 2015/16 dispensing fee for pharmacists was reviewed and the current fee was published on 5 February 2016 Programme 2: National Health Insurance, Health Planning and Systems Enablement 11

12. Programme 2: National Health Insurance, Health Planning and Systems Enablement 12 Strategic Objective IndicatorTargetQ4 performanceAnnual Report Establish a national stock management surveillance centre to improve medicine availability Implement an Electronic system for the early detection of stock outs of medicines at hospitals Q4: Electronic stock management system implemented and functional at 25 Regional hospitals. Annual: Electronic stock management system implemented and functional at 10 cntral hospitals & 25 Regional hospitals ESMS implemented at 10 central hospitals,17 tertiary hospitals and 25 regional hospitals Implement an Electronic system for the early detection of stock outs of medicines at PHC facilities Q4 & Annual: Electronic stock management system functional in 1 200 PHC facilities Electronic stock management system functional in 1849 PHC facilities Establish a national surveillance centre to monitor medicine availability Annual: National surveillance centre functional and tracking stock availability at 10 central hospitals & 1 200 PHC facilities National surveillance centre functional and reporting stock availability at 10 central hospitals and 1 200 PHC facilities

13. Strategic Objective IndicatorTargetQ4 performanceAnnual Report Improve contracting and supply of medicines Establish Provincial Control Towers for the management of direct delivery of medicines Q4: Control towers in Free State and Eastern Cape DoH established and fully functional Annual: Control towers implemented in FS & EC Control Towers in EC and FS established Number of patients receiving medicines through the centralised chronic medicine dispensing & distribution system Q4 & Annual: 500 000 patients396 567 396 567 patients Contracts are available at least 8 weeks prior to expiration of outgoing tender Q4: 100% of contract expiring in Q1 have been renewed at least 8 weeks prior to expiration. Annual: 100% pharmaceutical tenders awarded at least 8 weeks prior to expiration of outgoing tender Two tenders were awarded before January 2016 prior to the date of expiry All pharmaceutical contracts were in place 8 weeks prior to expiration of the outgoing contract Review Criteria for the approval of Pharmacy Licences Q4 & Annual: Criteria for the approval of Pharmacy licences are finalised and published for implementation Criteria Comments consolidated. Task team for the review of the comments established Comments from stakeholders on draft Criteria received and consolidated Programme 2: National Health Insurance, Health Planning and Systems Enablement 13

14. Strategic Objective IndicatorTargetQ4 performanceAnnual Report Implement the Strategy to address antimicrobial resistance (AMR) Implement the National AMR strategy Q4: Quarterly meeting of the MAC Annual: Appointment of the MAC Implementation plan for AMR strategy developed MAC appointed. AMR Strategy developed Call for application was disseminated in January 2016. Minister has approved appointment of Committee MAC appointed. AMR Strategy developed Regulate African Traditional Practitioners Establish Council for Traditional Practitioners Q4: Quarterly meeting Annual: Council for Traditional Practitioners and Registrar appointed Meeting of the Interim Traditional Healer Practitioners Council held on 01 March 2016 Term of Office of the Interim Traditional Healer Practitioners Council and process for recruitment of the Register in progress Programme 2: National Health Insurance, Health Planning and Systems Enablement 14

15. Strategic Objective IndicatorTargetQ4 Preliminary performance Annual Report Improve Management and control of pharmaceutical services Percentage of the review process of PHC Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Annual: 20%20% Percentage of the review process of Hospital Level Paediatric Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Annual: 50%50% Percentage of the review process of Hospital Level Adult Essential Medicines List (EML) and Standard treatment Guidelines (STGs) completed Annual: 100%100% Number of medicines review for the Tertiary & Quaternary EML Q4: 3 reviews Annual :12 reviews 3 reviews 12 reviews Programme 2: National Health Insurance, Health Planning and Systems Enablement 15

16. Strategic Objective IndicatorTargetQ4 performanceAnnual Report Publish & implement Single Exit Price Adjustments Annually. Q4: Recommendation of the SEP adjustment to Minister and publication of approved SEP Adjustment. Annual: Implementation n of the gazette 2015/16 Annual Price Adjustment The 2016 SEPA gazette was published on 13 January 2016. Implementation of the 4.8% quantum, contained in the gazette commenced on 13 January 2016. 13 March 2016 was the last date of receiving first time submissions from manufacturers. The last date of receiving re-submissions is 28 April 2016. The SEPA gazette was published for implementation of 4.8% increase on 13 January 2016. Strengthen revenue collection by incentivizing hospitals to maximise revenue generation Develop and implement a Revenue Retention Model (RRM) at central hospitals Q4: The discussion paper presented to NHC for approval. Annual: A discussion paper developed and presented to NHC and FFC. Principles of the Hybrid Revenue retention model were presented to the TECH NHC. The discussion paper has been approved by NHC A discussion paper on RRM models was developed presented to NHC and FFC Develop regulations pertaining to Uniform Patient Fee Schedule Annual: UPFS regulations gazetted and implemented The UPFS proposed tariffs were presented to the NHC -Tech and the National Health Council; The NHC approved the tariffs to be regulated. Approval has been granted to gazette tariffs for Foreign nationals. Develop a Central Repository for the funded and unfunded patients Q4: A repository containing funded patients functional. Annual: A repository containing funded patients functional Discussions between NDOH, CSIR and CMS to discuss Normative Health Standards Framework for Interoperability applicable to the repository specifications. Specifications for establishment of the repository were developed in collaboration with CMS Programme 2: National Health Insurance, Health Planning and Systems Enablement 16

17. 17 Strategic Objective IndicatorTargetQ4 performance Annual Report Implement eHealth Strategy of South Africa through the development of the system design of patient information systems and implementatio n Develop a complete System design for a National Integrated Patient based information system Q4: Basic Health Information Exchange implemented. Annual: Basic Health Information Exchange developed to conduct a reference implementation of eHealth interoperability norms and standards Continued testing of the Basic Health Information Exchange The Basic Health Information Exchange has been developed. PIX and PDQ services for third party applications were developed. A reference implementation of interoperability was conducted on the Health Patient Registration System and TIER.Net Number of PHC health facilities with required IT Hardware for the reference implementation on eHealth project Q4: 350 PHC Facilities receiving new IT Hardware Annual: Additional 1400 PHC Facilities received required IT Hardware for the reference implementation of the eHealth Programme New IT Hardware purchased for 1200 PHC facilities cumulative IT Hardware equipment were purchased for an additional 1200 facilities.This include the purchasing of 6232 computers and 1196 printers. Number of health facilities implementing improved patient administration and web based information systems Q4:175 Facilities implementing improved patient administration and web based information system. Annual: Additional 700 Facilities implementing improved patient administration and web based information systems 657 PHC facilities are implementing the web based Health Patient Registration System Programme 2: National Health Insurance, Health Planning and Systems Enablement

18. Strategic Objective IndicatorTargetQ4 performanceAnnual Performance Develop and implement a national research strategic plan National health research plan developed and implemented Annual: National health research plan developed and implemented A meeting between NHRC, NHREC, the PHRC’s, provinces and key partners like HST was held on 9 February 2016 to review and provide final inputs into the draft Integrated National Health Research Strategy Draft Integrated National Research Strategy developed Develop and implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy Integrated monitoring and evaluation plan implemented. Annual: Fully defined comprehensive list of indicators and data elements approved Comprehensive List, including NIDS 2016 was ready for consultative meeting in January 2016 Fully defined comprehensive list of indicators and data elements was drafted Annual: At least one national evaluation conducted Recommendations finalised for TIER.Net evaluation. A national study designed to determine the status of disability and rehabilitation services within the KwaZulu-Natal public health sector and the province’s preparedness for the implementation of the South African Framework and Strategy on Disability and Rehabilitation Two evaluations are being conducted Number of Provincial Annual Performance Plans (APPs) aligned to the National Health System Priorities Annual : 9 Provincial APPs reviewed and feedback provided to ensure health sector plans are aligned to the National Health System (NHS) Priorities 9 Provincial APPs reviewed and feedback provided during meetings with provinces 9 Provincial APPs were reviewed and feedback provided to all 9 provincial DoHs. Programme 2: National Health Insurance, Health Planning and Systems Enablement 18

19. Strategic ObjectiveIndicatorAnnual TargetQ4 Preliminary performanceAnnual Report Domestication of international treaties and Implementation of multilateral cooperation on areas of mutual and measurable benefit Annual: Number of International treaties and multilateral frameworks implemented Annual: 3 international treaties and multilateral frameworks implemented Three International treaties and multilateral frameworks were implemented Three International treaties and multilateral frameworks were implemented Implementation of bilateral cooperation on areas of mutual and measurable benefit. Annual: Number of Bilateral projects implemented. Annual: 5 strategic bilateral projects implemented Five strategic bilateral projects were implemented. Five strategic bilateral projects were implemented. Implement Patient Quality of care survey tool. Annual: Patient Quality of care survey tool tested & piloted Annual: Operational plan for roll-out in provinces available Patient Quality of Care survey tool was tested and piloted. Revisions were made to the draft guideline and an online database was developed. An operational plan for roll-out in provinces was prepared. Conduct a National Survey to measure Patient Quality of care National survey conducted to measure patient quality of care at all PHC facilities None Study planned and protocol developed. Programme 2: National Health Insurance, Health Planning and Systems Enablement 19

20. 20 Programme 2 Performance Improvement Strategies  To improve numbers of patients receiving medications through the CCMDD programme, additional patients have been identified for enrolment into the programme in eThekwini, Alexandra Clinic, RK Khan Hospital, Potchefstroom Hospital and patients who participate in adherence clubs.  The Financial and Fiscal Commission will be further engaged on the revenue retention model. The Department and the Council for Medical Schemes are working with the Council for Industrial and Scientific Research to ensure that the repository of patients will comply with the National Health Normative Standards for Interoperability.  In order to fast-track the implementation of improved patient administration and web based information systems at health facilities, the NDoH engaged and supplied the Department of Telecommunications and Postal Services with a list of health facilities in the NHI pilot districts for broadband connectivity. The purchase order of new IT hardware for the remaining 200 facilities had been issued in the last quarter of 2015/16 financial year. The process to roll out the implementation of the Health Patient Register System will continue during the 2016/17 financial year once the infrastructure and systemic challenges have been resolved.

21. Progress Report PROGRAMME 3 : HIV AND AIDS, TUBERCULOSIS, MATERNAL, CHILD AND WOMEN’S HEALTH 21

22. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic ObjectiveIndicatorTargetQ4 performance Annual Report To reduce the maternal mortality ratio to under 100 per 100 000 live births. Antenatal 1 st visit before 20 weeks rate Annual & Q4: 60% 62.2%61.2% Mother postnatal visit within 6 days rate Annual & Q4:85% 68.5%68.5% Maternal mortality in facility ratio Annual & Q4 & Annul: 120 per 100000 live births 117 per 100 000 live births 119.1 per 100 000 live births To reduce the neonatal mortality rate to under 6 per 1000 live births. Inpatient Neonatal death rate (annualized) Annual & Q4: 10 per 1000 Live Births 10.8 per 1000 live births 10.5 per 1000 live births 22

23. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Expand the PMTCT coverage to pregnant women by ensuring all HIV positive Antenatal clients are placed on ARVs and reducing the positivity rate to below 1% Antenatal client initiated on ART rateAnnual: 88%92.5%93% Infant 1 st PCR test positive around six week rate Annual & Q4: 1.5%1.5% To improve access to sexual and reproductive health services by expanding the availability of contraceptives. Couple year protection rate Annual &Q4 :60%60.9% 66.8% Cervical cancer screening coverage Annual &Q4 :60% 54.6%56.6% Develop Training manual for the implementation of Contraception and Fertility Planning (CFP) Policy Q4: Dissemination of the CFP training manual and training commenced Annual: CFP policy training manual finalised, disseminated and training commenced KZN conducted trainings in three regions (2, 3, and 4) using the updated CFP training manual, Process of printing manual underway but the electronic copy is available for provincial master trainers CFP policy training manual was finalised, disseminated electronically and training commenced with training in KwaZulu-Natal Develop Pharmacovigilance system for adverse events for contraceptive implants Q4: Pharmacovigilance system piloted in all 9 provinces Annual:Pharmacovigilance information system for adverse events developed and implemented in All Provincial DoH Provinces are using the pharmacovigilance form for reporting. 358 pharmacovigilance forms were received from all provinces A Pharmacovigilance system including a customized reporting tool was developed for adverse events for contraceptive implants Develop cervical cancer control PolicyQ4: Policy guidelines approved and distributed to all facilities Annual: Cervical cancer policy guidelines finalised and disseminated to facilities Final Draft Policy was tabled for discussion at the Tech NHC Final draft policy was tabled for discussion at Tech NHC 23

24. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective IndicatorTargetQ4 performanceAnnual Report Develop breast cancer Policy Q4: Draft Breast Cancer policy guidelines finalised and approved Annual:Breast cancer policy guidelines developed and disseminated to facilities Final Draft Policy was tabled for discussion at the Tech NHC Final draft policy was developed and presented to Tech NHC To reduce under- five mortality rate to less than 23 per 1,000 live births by promoting early childhood development Child under 5 years diarrhoea case fatality rate Annual & Q4: 3.2%1.9% 2.2% Child under 5 years pneumonia case fatality rate Annual & Q4: 3% 2.4% 2.3% Child under 5 years severe acute malnutrition case fatality rate Annual & Q4: 10%7.7% 8.9% Confirmed measles case incidence per million total population Annual: <3/1,000,000 (Annual target) 0.22/ 1000 000 Immunisation coverage under 1 year (annualised) Annual & Q4: ≥90% 86.7%89.2% 24

25. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective IndicatorTargetQ4 performanceAnnual Report Infant exclusively breastfed at HepB 3rd dose rate Annual &Q4: ≥50%29.9% 33.6% DTaP-IPV/Hib 3-Measles 1st dose drop- out rate Annual & Q4: ≤6%-31.4% -11.8% Measles 2nd dose coverageAnnual & Q4: ≥83%90.8% 84.8% Develop and Distribute EPI Disease Surveillance Manual Q4: Disseminate the Surveillance Manual, 9 province progress reports produced Annual:EPI Disease Surveillance Manual developed, printed distributed and implemented with 9 provincial progress reports produced Manuals were distributed to five provinces Manual was developed, printed and distributed Develop and Distribute EPI Cold Chain Manual Q4: Disseminate the cold chain manual Annual:EPI Cold Chain Manual developed, printed and distributed to 9 Provincial DoH with 9 province progress reports produced Copies of the manual were disseminated to all provinces EPI Cold Chain Manual developed, printed and distributed to 9 Provincial DoH 25

26. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective IndicatorTargetQ4 performanceAnnual Report Contribute to health and wellbeing of learners by screening for health barriers to learning School Grade 1 screening coverage (annualised) Annual: 25%11.4%29.2% School Grade 8 screening coverage (annualised) Annual: 10%7.7%12.8% To protect girl learners against cervical cancer HPV 1st dose coverageAnnual: 80%85.3% HPV 2nd dose coverageAnnual: 80%63.8% 26

27. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective IndicatorTargetQ4 performanceAnnual Report Convene quarterly meetings of Minister’s Polio Committees Q4: One meeting and Annual Report Annual: One Ministerial Polio committee meeting convened per quarter, And Annual Report produced One meeting held All quarterly Ministerial committee meetings were convened Develop and distribute guidelines for the management of common childhood illness in district hospitals printed and disseminated Q4: Implementation in least three provinces Annual:Guidelines printed and disseminated to all district hospitals Guideline Dissemination workshop conducted in March to Professional Nurses, Doctors, Provincial mangers and DCST's in 3 provinces Guidelines printed and dissemination workshop held. Convene Morbidity and Mortality in Children under 5 years (COMMiC) Committee quarterly meetings Q4: Quarterly Dashboard report produced Annual: 4 Quarterly CoMMIC meetings convened One COMMiC meeting 4 Quarterly CoMMIC meetings were convened Develop Adolescent and Youth health policy and implementation guidelines Q4: Provincial dissemination workshops Annual:Adolescent and Youth health policy and guidelines finalised, printed and distributed Adolescent and Youth health policy and guidelines presented to Tech NHC Adolescent and Youth health policy and guidelines presented to Tech NHC 27

28. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Undertake a massive TB screening campaign TB client 5 years and older screened at health facilities for TB symptoms rate Annual: 50% 49.2% 36.1% Percentage of inmates screened for TB annually Annual: 75% 215.4% (348,946/161,982 215.4% (348,946/161,982) Percentage of mines providing routine TB screening Annual: 60%97.3% (215/221) Number of community members in 6 Peri mining districts screened for TB Annual: 462 000183 631 28

29. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic ObjectiveIndicatorTargetQ4 performance Annual Report Improve Access to treatment TB client 5 years and older initiated on treatment rate Annual & Q4: 85%92.4% TB Rifampicin Resistant clients treatment initiation rate Annual & Q4 : 80% 93% 71.0% Strengthen patient retention in treatment and care TB new client treatment success rate Annual & Q4 :83%83.3% TB client loss to follow up rate Annual & Q4 :5%4.5% 6.1% TB client death RateAnnual & Q4: 6%4.4% TB/HIV Co-infection TB/HIV co-infected client on ART rate Annual & Q4: 75%79.6% 87.5% Strengthen patient retention in treatment and care TB MDR client loss to follow up rate Annual & Q4: 16%22.3% TB MDR client death RateAnnual & Q4: 15%20.7% 22.3% TB MDR treatment success rate Annual & Q4: 55%47% 47.2% 29

30. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic ObjectiveIndicator TargetQ4 performanceAnnual Report To scale up combination of prevention interventions to reduce new infections Number of HIV test client 15-49 years Q4: 2 500 000 Annual : 10 000 000 2 059 341 11 898 308 Number of Medical Male circumcisions performed Q4: 450 000 Annual: 1 600 000 63321 464 731 (excluding 53 399 from private sector, PEPFAR and Shembe Church; and 51 393 Traditional medical circumcisions in the Eastern Cape ) Male Condoms Distributed Q4: 175 000 000 Annual: 600 000 000 127 021 788 839 874 751 Female Condoms Distributed Q4: 4 125 000 Annual: 15 200 000 4 287 715 27 005 805 Increase the numbers of HIV positive people on ARVs Total clients remaining on ART (TROA) at the end of the month Q4 & Annual : 3 800 000 3 332 685 3 407 336 Develop and implement the HIV Counselling and Testing (HCT) policy Annual: HCT policy finalised and approved HCT policy finalized and adopted by NHC Monitor implementation of the HIV and AIDS Programme Q4: Quarterly report developed Annual: 4 quarterly reports produced Draft Quarter 4 report developed 3 quarterly reports produced 30

31. Programme 3: HIV and AIDS, TB and Maternal Child and Women’s Health Strategic Objective IndicatorTargetQ4 Preliminary performance Annual Performance Develop and implement HIV prevention strategy Annual: Strategy Developed and Approved and produce 9 provincial reports on its implementation HIV prevention strategy adopted by NHC Develop and implement adherence guidelines for health programmes Annual: Guidelines developed and approved and produce 9 provincial reports on its implementation Final Adherence Guidelines presented to Tech NHC Facilitate development of district plans to support NDoH male and female condom distribution strategy Annual: 52 district distribution plans for male and female condoms developed and implemented with 9 provincial progress reports 44 district plans from EC, FS, KZN, MP, GP, LP, NC and NW 44 district plans developed Monitor the implementation of the HIV and AIDS Conditional grant Q4: Quarterly HIV conditional grant reports produced Annual HIV Conditional Grant Report produced. Annual: 4 x Quarterly HIV conditional grant reports within the required timeframe produced Annual HIV Conditional Grant Report produced Quarter 3 HIV conditional grant report produced and submitted Annual 2014/15 HIV and AIDS conditional grant report produced 4 Quarter HIV conditional grant report produced and submitted 31

32. 32 Programme 3 Performance Improvement Strategies  Implementation of the adherence strategy will aim to assist in retention of patients on TB treatment  Based on the 2015/16 performance on medical male circumcision, the target for the 2016/17 financial year has been realistically determined  The country operational plan and district-level micro-plans include a demand creation strategy to address social mobilisation at local level by employing social mobilisation teams

33. Progress Report PROGRAMME 4 : PRIMARY HEALTH CARE SERVICES 33

34. Programme 4: Primary Health Care Services Strategic Objective IndicatorTargetQ4 performanceAnnual Report Improve district governance and strengthen management and leadership of the district health system. Number of districts with uniform management structures for primary health care facilities. Annual: 15 Districts with uniform management structures. The District Health Management Office structure and job profiles were finalised The District Health Management Office structure and job profiles were finalised. Number of primary health care facilities with functional clinic committees/ district hospital boards. Annual: 1000 health care facilities with functional clinic committees. 1588 Clinics with functional clinic committees Improve access to community based PHC services Number of functional WBPHCOTs Annual: 2000 functional WBPHCOTs 2 590 functional WBPHCOTs Improve quality of services at primary health care facilities Number of primary health care clinics in the 52 districts that qualify as Ideal Clinics Annual: 500 primary health care facilities in the 52 districts qualify as Ideal Clinics 322 facilities qualifying as Ideal clinics 34

35. Programme 4: Primary Health Care Services Strategic Objective IndicatorTargetQ4 performanceAnnual Report Improve environmental health services in all 52 districts and metropolitan municipalities in the country. Number of municipalities that meet environmental health norms and standards in executing their environmental health functions. Annual: 20 Municipalities meet environmental health norms and standards in executing their environmental health functions 20 Municipalities met environmental health norms and standards in executing their environmental health functions Hand hygiene campaign rolled out in all nine (9) provinces Annual: A national hand hygiene strategy developed National hand hygiene behaviour change strategy developed and finalised Ensure compliance with Health Waste management regulations Annual: Health care risk waste regulations finalised and tools for audit implementation developed Audit tools for Health Care Waste Management Regulations developed Health care risk waste regulations finalised and tools for audit implementation developed Establish an intersectoral forum that will plan and oversee the implementation of interventions across all sectors. Establish National Health Commission Annual: Operating framework for National Health Commission developed Operating framework developed 35

36. Strategic Objective IndicatorTargetQ4 PerformanceAnnual Report Reduce risk factors and improve management for Non- Communicable Diseases (NCDS) by implementing the Strategic Plan for NCDs 2012- 2017 Number of National government Departments oriented on the National guide for healthy meal provision in the workplace Annual: 20 National Departments 28 National Departments orientated on the National guide for healthy meal provision in the workplace and 2 additional parastatals Regulations relating to Labelling and packaging of tobacco products and smoking indoor and outdoor public places developed Annual: Tobacco Act amended Memorandum of Objects for New Tobacco Products Bill prepared and submitted to State Law Advisors Awareness on risk factors relating to excessive salt intake, excessive sugar intake, physical inactivity and, alcohol related harm created Annual: Content of campaign finalised and prepared for implementation Content for healthy lifestyle practices was developed and implemented Random Monitoring of salt content in foodstuffs conducted Annual: Random samples from each of 13 regulated food category tested, reported on and corrective action taken Chemicals purchased and laboratory ready for testing Programme 4: Primary Health Care Services 36

37. Strategic Objective IndicatorAnnual TargetPreliminary performanceAnnual report Number of people screened for high blood pressure as part of comprehensive health screening Annual: 8 million people screened for high blood pressure 19 749 960 Annual: 8 million people screened for raised blood glucose levels 12 268 202 Improve access to and quality of mental health services in South Africa Percentage people screened for mental disorders Annual target; 28 % of 16.5% (prevalence) people screened for mental disorders 57% of 16.5% of uninsured population (4 085 578) screened for mental disorder Percentage of people treated for mental disorders Annual: 28 % of 16.5% (prevalence) people screened for mental disorders 31% of 16.5% of uninsured population (2 226 768) treated for mental disorders Percentage of mental health inpatient units attached to designated district and regional hospitals Annual:16% (246) of mental health inpatient units attached to designated district and regional hospitals 16% Programme 4: Primary Health Care Services 37

38. Programme 4: Primary Health Care Services Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Mental health teams established in each district Annual: Strategy for establishment of specialist mental health teams approved Strategy for establishment of specialist mental health teams was approved by Tech NHC Strategy for establishment of specialist mental health teams was approved by Tech NHC Improve access to disability and rehabilitation services through the implementation of the framework and model for rehabilitation and disability services Number of Districts implementing the framework and model for rehabilitation services Annual: Resources allocated for the approved Framework and Model A study commissioned to determine the readiness of districts (including financial readiness) to implement the framework and model A study commissioned to determine the readiness of districts (including financial readiness) to implement the framework and model. 38

39. Programme 4: Primary Health Care Services Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Prevent avoidable blindness Cataract Surgery Rate Annual: 1 500 operations per million un-insured population 1064 operations per million population (45 112 operations) conducted Eliminate Malaria by 2018, so that there is zero local cases of malaria in South Africa Malaria incidence per 1000 population at risk Q4 & Annual: 0.2 malaria cases per 1000 population at risk (quarter) Q4: 0.036 (345 confirmed local cases) 0.15 malaria cases per 1000 population at risk Number of districts targeted for malaria elimination reporting malaria cases within 24 hours of diagnosis Annual: 5 malaria targeted districts reporting malaria cases within 24 hours of diagnosis 5 Districts Reporting Malaria Cases within 24 hours of diagnosis 5 districts reporting malaria cases within 24 hours of diagnosis 39

40. Programme 4: Primary Health Care Services Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Strengthen preparedness and core response capacities for public health emergencies in line with International Health Regulations Number of Provincial Outbreak Teams capacitated to respond to zoonotic, infectious and food-borne disease outbreaks Annual:9 Provincial Outbreak Teams capacitated to respond to zoonotic, infectious and food-borne disease outbreaks 9 Provincial Outbreak Teams trained 9 provincial outbreak response teams capacitated to respond to zoonotic disease outbreaks Improve South Africa’s response with regard to Influenza prevention and control Number of high risk population covered by the seasonal influenza vaccination Annual: n800 000 high risk individuals covered with seasonal influenza vaccination 820 390 individuals vaccinated 820 390 individuals vaccinated Establish a coordinated disease surveillance system for Notifiable Medical conditions (NMC) Develop and implement a strategy and plan for the integration of disease surveillance systems for NMC Annual: Strategy for the integration of disease surveillance systems for NMC approved and implementation plans developed Strategy for the integration of disease surveillance systems for NMC developed and implemented Conduct Annual National HIV Antenatal Prevalence Survey Annual National HIV Antenatal Prevalence Survey conducted Annual: 2014 National HIV prevalence report produced Draft 2014 National Antenatal HIV prevalence Report produced Draft 2014 National Antenatal HIV prevalence Report produced 40

41. 41 Programme 4 Performance Improvement Strategies  In order to fast track the Ideal Clinics Initiative implementation as a flagship programme for improving quality in the public sector, NDOH provides support and assistance to provinces, districts and facilities to improve quality by facilitating assessments and the procurement of essential equipment for individual facilities  The implementation of the Policy Framework and Strategy for Rehabilitation and Disability requires detailed analysis of the readiness of districts to implement it and a full costing prior to the allocation of resources, and therefore a change in approach was adopted. This change was required to avoid disorganised expenditure and service delivery  The testing of salt content in foods will be done in the 2016/17 financial year.

42. Progress Report PROGRAMME 5 : HOSPITALS, TERTIARY SERVICES AND WORKFORCE DEVELOPMENT 42

43. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic ObjectiveIndicator TargetQ4 performanceAnnual report Increase capacity of central hospitals to strengthen local decision making and accountability to facilitate semi-autonomy of 10 central hospitals Number of central hospital with full delegated authority Annual:10 central hospitals with full delegated authority A draft organisation structure for Central hospital discussed at the NHC An assessment on the current capacity of the central hospital was conducted. Draft organisational structure for central hospitals was presented at NHC for approval Ensure quality health care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals Number of Hospitals that comply fully with the National Core Standards Annual: Full compliance with the National Core Standards in 8 Central hospitals and 5 Tertiary Hospitals 2 hospitals obtained overall scores of 91% and 80% but did not meet 100% compliance on extreme measures and more than 90% compliance on vital measures. 10 hospitals obtained overall scores in the range of 47% to 76% 2 hospitals obtained of overall scores of 91% and 80% but did not meet 100% compliance on extreme measures and more than 90% compliance on vital measures] Ensure equitable access to tertiary service through implementation of the National Tertiary services plan Number of gazetted hospitals providing the full package of Tertiary1 Services Annual: 4 additional tertiary hospitals (Pietersburg, Frere, Kimberley and Ngwelezana) providing the full package of Tertiary 1 services 0 hospital implemented the full package of T1 services [Pietersburg provided about 69.4%, Frere provided about 67%, Kimberley provided about 94% and Ngwelezana Hospital provided about 41.6 % of the full package Tertiary 1 services 43

44. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective IndicatorTargetQ4 performanceAnnual Report Develop and implement health workforce staffing norms and standards Develop guidelines for HRH norms and standards using the WISN methodology Annual: Guidelines for HRH Norms for District and specialised hospitals developed. Annual: Auditing of services and activities of various cadres(health professionals) /per functional area was completed in the sampled hospitals, and thereafter the process to build consensus on standards for guidelines commenced. Auditing of services and activities of various cadres(health professionals) /per functional area was completed in the sampled hospitals, and thereafter the process to build consensus on standards for guidelines commenced. Annual: Tertiary, Regional and Central Hospital managers oriented on WISN tool and methodology Annual: Tertiary, Regional and Central Hospital managers were oriented on WISN tool & methodology Tertiary, Regional and Central Hospital managers were oriented on WISN tool & methodology Number of facilities benchmarked against PHC staffing normative guidelines Annual: 1000 1000 Number of RTC's established Annual: 5RTCs established 5 RTCs established 44

45. Programme 5: Hospitals, Tertiary Services and Workforce Development IndicatorTargetQ4 performanceAnnual Report Improve management of health facilities at all levels of care through the Health Leadership and Management Academy Establish a coaching mentoring and training programme for health managers Annual: Coaching mentoring and training programme developed and piloted Coaching mentoring and training programme has been developed and preparations for implementation done Develop a knowledge hub which includes a web based interactive information system Annual: Framework for knowledge hub developed and approved Framework for knowledge hub developed and approved Professionalise Nursing training and Practice implementation of the objectives of the Nursing Strategy Public nursing colleges offering new nursing programmes (in line with National Qualifications Framework) Annual: A national policy for nursing education approved The draft national policy for nursing education approved by the National Health Council with certain conditions A National Policy for Nursing Education and Training was developed and presented to National Health Council. Develop a Nursing and Midwifery educators' training and development programme Annual: Curriculum for capacity development for nurse educators approved Programme/ curriculum for capacity development for nursing and midwifery educators developed and approved A Programme/ curriculum for capacity development for nursing and midwifery educators was developed Develop a standardised Nursing leadership structure for Provincial DoH None Draft provincial Nursing Structures document to give authority over nursing and midwifery services presented to the National Human Resources Committee. Draft provincial Nursing Structures document to give authority over nursing and midwifery services presented to the National Human Resources Committee 45

46. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective IndicatorTargetQ4 performanceAnnual Report Improve quality of health infrastructure in South Africa Number of facilities maintained, repaired and/or refurbished in NHI Districts Annual: 198 facilities 109 facilities maintained, repaired and/or refurbished.81 facilities upgraded as part of maintenance programme. 190 facilities completed 198 facilities (117 facilities maintained, repaired and/ or refurbished; and 81 facilities upgraded as part of maintenance programme). Number of facilities maintained, repaired and/or refurbished outside NHI pilot Districts Annual: 310 facilities 266 facilities 217 facilities maintained, repaired and/or refurbished. Number of clinics and Community Health Centres constructed or revitalised Annual: 35 65 clinics and community health centres 49 clinics and CHC’s constructed and revitalised Number of hospitals constructed or revitalised Annual: 21 hospital completed Number of new facilities that comply with gazetted infrastructure Norms & Standards Annual: 37 20 Clinic & CHC's in process that comply with gazetted infrastructure Norms & Standards. 78 Doctor Consulting Rooms constructed & comply. 78 doctor consulting rooms constructed and comply. Develop a Infrastructure Monitoring System Annual: Infrastructure Monitoring System fully developed and tabled at NHC Developed Infrastructure Monitoring System An Infrastructure Monitoring System was developed 46

47. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective IndicatorTargetQ4 performanceAnnual Report Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS). Number of provinces that are compliant with the EMS regulations. Annual: EMS Regulations and compliance checklist gazetted for implementation EMS Regulations were published on 9 May 2015. The regulations were revised to incorporate all the stakeholder inputs and the missing Annexures. EMS Regulations were published on 9 May 2015. The regulations were revised to incorporate all the stakeholder inputs and the missing Annexures. Publish Policy on education and training of EMS Personnel published for implementation Annual: Policy on education and training of EMS Personnel published. Policy approved by NHC Tech. Final draft Policy submitted to NHC for approval Develop regulations for Emergency Care Centres Annual: Regulations on Emergency Care Centres Drafted Regulations on Emergency Centres drafted Regulations on Emergency Centres drafted Publish Regulations for EMS in Mass Gatherings Annual: EMS regulations in mass gatherings published for public comment and implementation EMS in mass gatherings published for public comment and implementation EMS in mass gatherings published for public comment and implementation 47

48. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective IndicatorTargetQ4 performanceAnnual Report To eliminate the backlog of blood alcohol and toxicology tests by 2016 Number of Blood Alcohol reports produced 120 00098 250 Number of Toxicology reports produced 4 500 3 3 362 To provide food analysis services Number of food tests performed. 400016 140 Develop a monitoring system to effectively measure turnaround time of tests conducted at Forensic Chemistry Laboratories A standardised workflow and monitoring system developed for all 3 tests and implemented at 4 forensic chemistry laboratories Monitoring system developed and implemented at 4 forensic chemistry laboratories 48

49. Programme 5: Hospitals, Tertiary Services and Workforce Development Strategic Objective IndicatorTargetQ4 performanceAnnual Report Regulations for the Rendering of Forensic Pathology Services promulgated Regulations on the Rendering of Forensic Pathology Services reviewed and Published for public comments Regulations reviewed and circulated for final perusal to members of the National Forensic Pathology Services Committee Publish Scope of Practice Guidelines for the rendering of Forensic Pathology Services Review and Finalise the Scope of Practice Guidelines for the rendering of Forensic Pathology Services and Publish for Implementation Scope of Practice Guidelines reviewed and circulated for final input by the all NFPSC members Number of Health Facilities that are designated to render services for the management of sexual and related offences 60 additional facilities designated Total 38 facilities achieved for designation 49

50. 50 Programme 5: Performance Improve Strategies The activities to increase the capacity of central hospitals are to: strengthen local decision making and accountability; facilitate semi-autonomy of 10 central hospitals; ensure quality health care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals, as well as equitable access to tertiary service through implementation of the National Tertiary services plan are vital, particularly within the context of progressive NHI implementation.  In order to improve performance of the above areas, NDoH is: benchmarking the strategies and tools to assist the development of hospitals to achieve the required status for semi-autonomy, including a “tool-kit” for the development and training of hospital boards. Engaging provincial departments of health who have a responsibility for implementation engaging National Treasury on funding of key interventions such as the appointment of specialists in tertiary hospitals  Regarding toxicology, equipment failures (now fixed) at Pretoria Lab contributed to non-achievement of target. The Pretoria Lab will move to new facility in 2016/17, and capacity at Jhb lab is being expanded, which will address backlogs.  In addition to facilitating the development of staffing norms and standards for the district and specialised hospitals, the sub-programme will mobilise resources from partner organisations to support the work at both national and provincial level

51. Progress Report PROGRAMME 6 : HEALTH REGULATION AND COMPLIANCE MANAGEMENT 51

52. Programme 6: Health regulations and Compliance Management Strategic Objective IndicatorTargetQ4 performanceAnnual Report Establish the South African Health Product Regulation Authority (SAHPRA) Establish SAHPRA as a public entity Annual: SAHPRA Act (Bill 6 of 2014) Promulgated and transitional plan from MCC to SAHPRA developed President assented to Medicines and Related Substances Amendment Act, No. 14 of 2015. Awaiting its proclamation SAHPRA approved by parliament, and assented to by the State President on 24 December 2015 and published and gazette on the 7 January 2016. Transitional plan from MCC to SAHPRA developed. Establish Institute of Regulatory Science (IRS) Institute of Regulatory Science (IRS) providing training Annual: Establishment of IRS as a virtual university within MCC/SAHPRA(quarter target) Basic course for National Regulatory Authority (NRA) staff outlined IRS project team was appointed with Business Plan finalised. Regulate Medical devices, IVDs, cosmetics and expand on regulation of Complementary and Alternative Medicines (CAMS) Annual: Finalise and promulgate Regulations for Medical Devices and IVDs and call up high risk Medical Devices and IVDs Proposed Regulations returned for corrections from the office of the State Law Advisors Proposed regulations for Medical Devices and IVDs and call up high risk Medical Devices and IVDs were finalised. Improve registration turnaround times of ARV’s, TB, oncology and vaccines to treat and prevent high burden of diseases Annual: 55 % of priority medicines registered NCE = 36 month; Q4: Generics = 28 month NCEs - 7 out of 7 registered within 36 months = 100 % registered within 36 months. Generics (priority) - 3 out of 8 registered within 28 months = 37,5% registered within 28 months. 56% of priority medicines registered 52

53. Programme 6: Health regulations and Compliance Management Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report Establish a MOU with of Agriculture, Fisheries and Forestry’s (DAFF)` Q4 & Annual: MOU signedDraft MoU submitted to DAFF for inputs. * Consolidated list of Tests/Analysis finalised (DAFF/DOH) Draft MoU submitted to DAFF for inputs. * Consolidated list of Tests/Analysis finalised (DAFF/DOH) Develop Regulations for Cosmetic products Q4 & Annual: Cosmetic regulations published for comments Regulations finalised and submitted to with Legal Services for gazzeting To develop the policy and legislative framework for occupational health and compensation Review occupational health legislative framework One consultative meeting on amendments to the Occupational Diseases in Mines and Works Act, 1973 and the occupational health framework Occupational Health Framework reviewed. Draft amendments are being developed in line with policy on integration of compensation systems. Policy framework developed towards integration of compensation systems with steering committee and task teams in place. To establish an occupational health cluster Occupational health cluster established and functional Approved structure, organogram and activities of the occupational health cluster Draft Occupational Health Cluster organogram developed Policy inputs on integration of MBOD, CCOD and National Institute for Occupational Health (NIOH) in place and draft structure and organogram in place 53

54. Programme 6: Health regulations and Compliance Management Strategic ObjectiveIndicatorTargetQ4 performanceAnnual Report To provide occupational health and compensation services through the development of One Stop Service centres in provinces Number of provinces with One Stop Service Centres to deliver occupational health and compensation services Annual: Establishment of One Stop Service Centre in Limpopo Funding raised for One Stop Service Centres in Kuruman, Northern Cape and Burgersfort, Limpopo; local organizing committees set up in the two districts to support the process of setting up the One Stop Service Centres Number of applications certified at MBOD as compensable disease claims Q4: 2000 Annual: 8000 27647 295 Number of compensable disease claims paid by CCOD other than pensioners Q4: 500 Annual: 3000 5211774 To establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance Develop legal framework to establish National Public Health Institutes of South Africa (NAPHISA) Annual: Gazetted legislation on NAPHISA Legislation was gazetted on NAPHISA 54

55. Programme 6: Health regulations and Compliance Management Strategic Objective IndicatorTargetQ4 performanceAnnual Report Improve oversight and Corporate Governance practices by reviewing the Governance Framework and Implementatio n Plan biennially. Number of Health entities’ and Statutory Health professional Councils with fully functional and compliant to good Governance practices (structures, Finance, HR, Supply Chain Management policies) and also respond to health sector priorities Q4: Compile a functionality report based on 10 checklists received from health entities and professional councils Annual:4 health Entities’ and 6 statutory health professional councils A functionality report was compiled based on 10 checklists received from health entities and professional councils 4 health Entities’ and 6 statutory health professional council’s functionality reports compiled to review compliance to good corporate governance practices. Develop and implement a performance management system for board members Q4: Standardised performance management system for board members approved and circulated for implementation Annual:A standardised performance management system for board members developed and piloted Standardised performance management system for board members approved and circulated for implementation Standardised performance management system for board members was developed and implemented Number of newly appointed boards inducted and trained Q4: 2 new boards appointed, inducted and trained ( National Laboratory Service and the interim Traditional Health Practitioners Council of South Africa) Annual: 3 new boards appointed, inducted and trained 2 new boards appointed, inducted and trained (Health Professions Council of South Africa; National Health Laboratory Service) 3 new boards appointed, inducted and trained 55

56. Programme 6: Health regulations and Compliance Management Strategic Objective IndicatorTargetQ4 Preliminary performance Annual Report Develop and implement Dashboard to monitor entities performance and compliance to legislative prescripts Q4: 2 Dashboards developed and piloted (1 per entity or statutory council) Annual: 10 dashboards developed and piloted 1 dashboard developed and piloted (HPCSA). The 9 dashboards previously developed were also piloted (1 per entity or statutory council). In total 10 dashboards were developed and piloted during the year under review. 10 Dashboards to monitor entities and statutory health professional council’s performance and compliance to legislative prescripts were developed. Develop a reporting template to enable feedback to the executive authority Q4 & annual: Standardised reporting template approved Standardised reporting template approved and implemented. Standardised reporting template was developed and implemented 56

57. 57 Programme 6 Performance Improvement Strategies  The Institute of Regulatory Science (IRS) will be implemented as part of the MM/SAHPRA  The MoU with DAFF will be finalised during 2016/17 once the two parties have agreed to the content thereof  The Minister approved 24 additional medical doctors as members of the Certification Committee who began working in December 2016  A track-and-trace project is in place at the CCOD to find claimants and update documents, and change management support interventions were introduced at the CCOD.

58. Fourth Quarter Expenditure 2015/16 58

59. Summary per Programme As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 ADMINISTRATION 456,578 443,416 438,501 4,91598.89% NATIONAL HEALTH INSURANCE, HEALTH PLANNING & SYSTEM ENABLEMENT 596,646 611,213 553,053 58,16090.48% HIV & AIDS, TB, MATERNAL & CHILD HEALTH 14,378,878 14,324,860 14,179,001 145,85998.98% PRIMARY HEALTH CARE SERVICES 224,917 215,239 212,571 2,66898.76% HOSPITALS, TERTIARY HEALTH SERVICES & HUMAN RESOURCE DEVELOPMENT 18,993,031 19,057,465 19,056,279 1,18699.99% HEALTH REGULATION & COMPLIANCE MANAGEMENT 1,603,875 1,601,732 1,599,420 2,31299.86% TOTAL 36,253,925 36,038,825 215,10099.41% 59

60. Summary per Economical Classification As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 774,278 750,097 -100.00% Goods and Services 1,495,819 1,377,821 1,183,893 193,92885.93% Transfers 33,519,141 33,553,890 33,536,117 17,77399.95% Capital 464,687 571,217 567,817 3,40099.40% Losses - 900 -100.00% TOTAL 36,253,925 36,038,825 215,10099.41% 60

61. Programme 1: Administration As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 MINISTRY 31,417 29,952 -100.00% MANAGEMENT 19,496 19,846 -100.00% CORPORATE SERVICES 213,612 199,996 199,693 30399.85% OFFICE ACCOMMODATION 125,810 147,624 -100.00% FINANCIAL MANAGEMENT 66,243 45,998 41,386 4,61289.97% TOTAL 456,578 443,416 438,501 4,91598.89% 61

62. Programme 1: Administration As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 177,115 177,730 177,729 1100.00% Goods and Services 266,878 253,782 249,207 4,57598.20% Transfers 2,742 3,716 3,413 30391.85% Capital 9,843 7,978 7,942 3699.55% Losses - 210 -100.00% TOTAL 456,578 443,416 438,501 4,91598.89% 62

63. REASONS FOR DEVIATIONS PROGRAMME 1 Goods & services: The Provincial Support Unit did not travel extensively to the provinces as compared to previous year. Due to the fact that these funds are earmarked, the amount of R4.575 million couldn't be reallocated. 63

64. Programme 2: National Health Insurance, Health Planning and System Enablement As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 OFFICE OF THE DDG 3,020 597 -100.00% TECHNICAL POLICY & PLANNING 19,869 14,246 14,028 21898.47% HEALTH INFORMATION MANAGEMENT, MONITORING & EVALUATION 85,042 89,237 57,421 31,81664.35% SECTOR-WIDE PROCUREMENT 29,429 26,282 -100.00% HEALTH FINANCING & NATIONAL HEALTH INSURANCE 395,765 393,789 367,663 26,12693.37% INTERNATIONAL HEALTH & DEVELOPMENT 63,521 87,062 -100.00% TOTAL 596,646 611,213 553,053 58,16090.48% 64

65. Programme 2: National Health Insurance, Health Planning and System Enablement As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 95,534 98,433 -100.00% Goods and Services 412,427 425,673 369,063 56,61086.70% Transfers 86,097 86,217 84,667 1,55098.20% Capital 2,588 828 -100.00% Losses - 62 -100.00% TOTAL 596,646 611,213 553,053 58,16090.48% 65

66. REASONS FOR DEVIATIONS PROGRAMME 2 Goods & Services: DRG Project started in July 2015 after the service level agreement was signed. Cash did not flow mainly due to the SA Health & Demographic Survey project running over multiple years. ICD-10 and other training and workshops were rescheduled for the 2016/17 financial year. Transfers & Subsidies: Request for approval to change beneficiary (Wits Health Consortium to SA Medical Research Council) to keep the Clinical Trials Register on behalf of the Department, was done late in the financial year, thus approval was received after year-end and will be concluded in the current financial year. 66

67. Programme 3: HIV and AIDS, TB, Maternal and Child Health As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 OFFICE OF THE DDG 3,652 5,388 -100.00% HIV & AIDS 14,106,361 14,064,158 13,962,474 101,68499.28% TUBERCULOSIS 27,571 22,989 20,094 2,89587.41% WOMEN'S MATERNAL & REPODUCTIVE HEALTH 18,578 13,717 -100.00% CHILD, YOUTH & SCHOOL HEALTH 222,716 218,608 177,328 41,28081.12% TOTAL 14,378,878 14,324,860 14,179,001 145,85998.98% 67

68. Programme 3: HIV and AIDS, TB, Maternal and Child Health As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 72,303 71,345 -100.00% Goods and Services 470,956 417,297 287,150 130,14768.81% Transfers 13,833,817 13,834,527 13,819,482 15,04599.89% Capital 1,802 1,466 799 66754.50% Losses - 225 -100.00% TOTAL 14,378,878 14,324,860 14,179,001 145,85998.98% 68

69. REASONS FOR DEVIATIONS PROGRAMME 3 Goods & Services: Printing of TB Recording and Reporting tool was not finalized before year-end, for which roll-over of funds was applied for. Some Multi-Pronged Mass Media Communications Campaign on HIV & AIDS projects were postponed and will commence in the new financial year. Approval for the donation of Genexpert Machines and cartridges to the Democratic Republic of Congo is still awaited. Expenditure for the Human Papilloma Virus Vaccines campaign was lower than anticipated. Male condoms were not delivered due to price adjustments, specifications of coloured and scented condoms. Female condoms were ordered in 4th quarter. Transfers and subsidies: Transfers to universities for pharmacovigilance services did not flow due to a delay in signing the service level agreements. The Department contracted fewer Non-profit Institutions as a results of budget pressure and reprioritizing for arrears such as medical students intake, SANAC as well as contribution to International AIDS Society. Capital Furniture and equipment is procured on the need basis. 69

70. Programme 4: Primary Health Care Services As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 OFFICE OF THE DDG 3,095 3,245 -100.00% DISTRICT SERVICES 24,481 10,864 9,784 1,08090.06% COMMUNICABLE DISEASES 18,088 21,133 -100.00% NON-COMMUNICABLE DISEASES 23,533 22,150 20,562 1,58892.83% HEALTH PROMOTION & NUTRITION 25,625 22,107 -100.00% ENVIRONMENTAL AND PORT HEALTH SERVICES 130,095 135,740 -100.00% TOTAL 224,917 215,239 212,571 2,66898.76% 70

71. Programme 4: Primary Health Care Services As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 175,878 167,726 -100.00% Goods and Services 43,813 41,917 39,298 2,61993.75% Transfers 2,901 3,467 3,417 5098.56% Capital 2,325 2,098 -100.00% Losses - 31 32 (1)103.23% TOTAL 224,917 215,239 212,571 2,66898.76% 71

72. REASONS FOR DEVIATIONS PROGRAMME 4 Goods and services: The Awareness and education of the public on mental health project is conducted in six phases and invoices are received after a phase is completed. The project runs into the next financial year. Procurement of uniforms for Port Health Services Officers took longer than expected, due to the re-advertisement of the tender. The laboratory chemicals for testing sodium contents in foodstuff were not yet delivered by the end of March 2016. Procurement of IEC material was delayed. Promotional items for oral health were not delivered before year-end. 72

73. Programme 5: Hospitals, Tertiary Health Services and HR Development As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 OFFICE OF THE DDG 3,619 3,738 -100.00% HEALTH FACILITIES INFRA- STRUCTURE MANAGEMENT 6,052,635 6,093,069 6,092,904 165100.00% TERTIARY HEALTH CARE PLANNING & POLICY 10,384,206 10,384,335 -100.00% HOSPITAL MANAGEMENT 4,962 4,771 -100.00% HUMAN RESOURCES FOR HEALTH 2,421,285 2,449,047 2,448,222 82599.97% NURSING SERVICES 4,741 4,230 4,229 199.98% FORENSIC CHEMISTRY LABORATORIES 114,450 112,959 112,764 19599.83% VIOLENCE TRAUMA AND EMS 7,133 5,316 -100.00% TOTAL 18,993,031 19,057,465 19,056,279 1,18699.99% 73

74. Programme 5: Hospitals, Tertiary Health Services and HR Development As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 116,037 110,874 -100.00% Goods and Services 243,977 173,174 173,196 (22)100.00% Transfers 18,195,941 18,228,113 18,227,287 826100.00% Capital 437,076 545,165 544,783 38299.93% Losses - 139 -100.00% TOTAL 18,993,031 19,057,465 19,056,279 1,18699.99% 74

75. REASONS FOR DEVIATIONS PROGRAMME 5 Transfers & subsidies: Not all funds transferred, due to disputes with two universities on amount per student payable by NDoH. 75

76. Programme 6: Health Regulation and Compliance Management As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 OFFICE OF THE DDG 3,670 3,502 -100.00% FOOD CONTROL 9,798 8,346 8,347 (1)100.01% PHARMACEUTICAL TRADE & PRODUCT REGULATION 131,772 139,545 138,303 1,24299.11% PUBLIC ENTITIES MANAGEMENT 1,399,991 1,399,104 -100.00% COMPENSATION COMMISSIONER FOR OCCUPATIONAL DISEASES & OCCUPATIONAL HEALTH 58,644 51,235 50,164 1,07197.91% TOTAL 1,603,875 1,601,732 1,599,420 2,31299.86% 76

77. Programme 6: Health Regulation and Compliance Management As at 31 March 2016 Expenditure target: 100% Subprogramme Actual Expenditure as on 31 March 2016 Funds Available % Spent Adjusted Budget Final Allocation R'000 Compensation of Employees 137,411 123,989 123,990 (1)100.00% Goods and Services 57,768 65,978 65,980 (2)100.00% Transfers 1,397,643 1,397,850 -100.00% Capital 11,053 13,682 11,368 2,31483.09% Losses - 233 232 199.57% TOTAL 1,603,875 1,601,732 1,599,420 2,31299.86% 77

78. REASONS FOR DEVIATIONS PROGRAMME 6 Capital Expenditure: The renovation of CCOD and MBOD building and laboratory is in progress. 78

79. Conditional Grants Expenditure 31 March 2016 – Fourth Quarter Expenditure 79

80. Spending Performance on all conditional grants as at end of 31 March 2016:  Schedule 4 and 5 (Direct Grants) Total CG spending sits at 99.1% or R31.9 bn against revised budget of R32.2 bn. HPTDG spent 100% of the budget whilst NTSG and HIV/AIDS spent 99.6% and 99.9% respectively. HFRG and NHI spent 96.4% and 90.2% respectively the norm.  Schedule 6 (Indirect Grant) Spending for 4 th quarter is at 95.3%. Introduction 80

81. Grants Overview (Direct) 81

82. Health Professions Training Grant 82

83. Health Professions Training Grant (02 )  All provinces spent 100% of the budget with the exception of Limpopo that spent 96.8% due to outstanding invoices for medical equipment and rollover has been requested.  Northern Cape is overspending due to accruals. Expenditure will be journalised to equitable share to keep expenditure within the norm. 83

84. National Tertiary Services Grant 84

85. National Tertiary Service Grant (02)  All provinces spent 100% of the budget with the exception of EC, LP, MP & NW.  The major reason for under spending is due to: lack of contracts for medical equipment. delays in delivery of medical equipment  However a rollover has been requested by all provinces under spending for unpaid invoices and awaited delivery 85

86. Comprehensive HIV/AIDS 86

87. Comprehensive HIV/AIDS (02)  All provinces spent 100% of the budget with the exception of LP and NW  The reason for under spending is due to outstanding invoices for Medicines and consumables.  However a rollover has been requested by both provinces 87

88. Health Facility Revitalisation Grant 88

89. Health Facility Revitalisation Grant (02)  All provinces under spent with the exception of EC, GP, KZN & LP that spent 100%.  The main reason for under spending is due to: Delays in appointment of staff in FS under Organisational Development. Challenges with Implementing Agent in WC Outstanding invoices of which rollover has been requested.  Rollover has been requested by all provinces under spending. 89

90. National Health Insurance Grant 90

91. National Health Insurance (02)  All provinces under spent with the exception of EC, FS, MP.  The main reason for under spending is due to: Supply chain Management inefficiencies Delays in delivery of WBOT uniforms and other equipment. Inability to contract Health Professionals (HP) in WC as indirect funding was converted to direct for HP contracting.  However, a rollover has been requested by all provinces under spending. 91

92. Provincial Overview (Direct) 92

93. Eastern Cape 93

94. Eastern Cape (02)  All grants spent 100% with the exception NTSG and NHI.  The main reason for under spending of NTSG is due to: challenges with specifications for equipment, equipment was only procured towards the end of the financial year.  NHI over spent due to application of S22 of DoRA – unspent funds and not surrendered from previous year are charged against current allocation. 94

95. Free State 95

96. Free State (02)  All grants spent 100% with the exception HFRG.  The main reason for under spending of HFRG is due to: Non filling of posts under Organisational Development component of the grant. Funds were only made available to the province during Adjustment budget.  However, a rollover has been requested. 96

97. Gauteng 97

98. Gauteng (02)  All grants spent100% with the exception of NHI.  The main reason for under spending of NHI is due to: Outstanding invoices for WBOT uniforms.  However, a rollover has been requested by the provinces. 98

99. KwaZulu Natal 99

100. KwaZulu Natal (02)  All grants spent 100% with the exception of NHI.  The main reason for under spending of NHI is due to: IT project not completed and will be paid during 1 st quarter of 2016/17  However, a rollover has been requested by all provinces under spending. 100

101. Limpopo 101

102. Limpopo (02)  All grants spent below the norm with the exception of HFRG.  The main reason for under spending is due to: Supply chain Management inefficiencies Outstanding delivery for medical equipment (Full body Scanner machine) Outstanding invoices for Condoms ordered in Q3. Examination equipment for patients not yet delivered.  However, a rollover has been requested by all grant under spending. 102

103. Mpumalanga 103

104. Mpumalanga (02)  All grants spent 100% with the exception of NTSG & HFRG.  The main reason for under spending is due to: Equipment procured during the 3 rd quarter and not yet delivered for NTSG. Health Technology equipment not yet delivered  Mpumalanga affected with implementation of S22 of DoRA resulting on overspending of NHI.  A rollover has been requested by the province for under spending grants. 104

105. Northern Cape 105

106. Northern Cape (02)  NTSG and HIV and AIDS spent the entire allocations at 100.7% and 100.4% respectively, however, HFRG and NHI under spent at 95.1% and 54.5%.  The main reasons for under spending are due to: Supply chain Management inefficiencies Delays in delivery of WBOT uniforms and other equipment. Outstanding invoices for health technology.  However, a rollover has been requested by the province for under spending grants. 106

107. North West 107

108. North West (02)  All grants under spent with the exception of HPTDG.  The main reason for under spending is due to: Outstanding invoices for infrastructure projects, NTSG equipment for hospitals and WBOT equipments..  However, a rollover has been requested by all provinces under spending. 108

109. Western Cape 109

110. Western Cape (02)  All grants spent 100% with the exception of HFRG & NHI.  The main reason for under spending is due to: Challenges with implementing Agent. Currently province is using one implementing agent (Public Works) Delays in implementation of projects Inability to contract Health Professionals (HP) in WC as indirect funding was converted to direct for HP contracting. Funds for conversion were only allocated during adjustment budget.  A rollover for infrastructure has been requested by the provinces. 110

111. Indirect Grant – Schedule 6 111

112. Indirect Grant – Schedule 6 (02)  The main reason for under spending is due to: HPV – delays in submission of claims by provinces, outstanding invoices of which rollover has been requested.. NHI – Contracting of Health Professionals including Pharmacy Assistants have improved 112

113. Conclusion  NHI framework has been reviewed to include the Ideal Clinic. Most activities relates to Ideal Clinic which will accelerate expenditure in 2016/17.  Strengthening of monitoring and evaluation for infrastructure projects to ensure spending efficacy. 113

114. The End 114