1. Gauteng Department of Health
Presentation to the National Portfolio Committee on Health
14 April 2003

2. Outline of presentation
Background and context
Vision and Mission
Strategic Goals
Highlight Strategic Priorities for MTEF
Performance Highlights
Key Priorities
Key outputs (Budget statement 2)
Key Challenges
Financial Management (budget and expenditure)
Responses to questions
Budget Highlights 2003/04
Budget Allocation
Budget Issues
Budget Process
Equity
Other Issues

3. Health for a better life
Our vision
Health for a better life

4. Our Mission The Gauteng Department of Health aims to
promote and protect the health of our people,
especially those most vulnerable to illness and
injury.

5. Our Mission Cont..
Through innovative leadership, we provide quality health services and strive to:
Ensure a caring climate for service users;
Create a positive work environment;
Obtain the greatest benefit from public monies;
Forge partnerships with others;
Provide excellent training for health workers.
Our work is reflected in the enhanced well-being of our staff and clients, the social and economic development of our province and a more just society.

6. Strategic Goals Improve health status (Outcome goal)
Improve health services
Ensure value for money and effective organisation

7. Alignment of Ten Point Plan with Departmental Strategic Goals
Improving health status of the population of Gauteng
Decreasing morbidity and mortality rates through strategic interventions
Improving health services
2. Speeding up the delivery of an essential package of services through the district health system
Improved quality of care
Revitalising hospital services

8. Alignment of Ten Point Plan with Departmental Strategic Goals
Ensure value for money and effective organisation
Improving resource mobilisation and the management of resources without neglecting the attainment of equity in resource allocation
Improving human resource development and management
Re-organising certain support services
Legislative reform
Improving communication and consultation within the health system and between the health system and communities we serve
Strengthening co-operation with our partners internationally

9. High level policy decisions 2003/4 budget
Budget linked to the strategic plan
Focus on strengthening PHC and district level services
Focus on disease burden and interventions resulting in improved health outcomes e.g.
HIV/AIDS TB
Expanded programme on immunisation (EPI)

10. High level policy decisions 2003/4 budget
Increase for academic health services in line with national conditional grant allocation
Above inflation increase for all other programmes
Infrastructure Maintenance budget: between 3% and 5%

11. Issues considered regarding budget allocation
Conditional Grants: We have to stay within the conditions of the grant: These are itemised below
National Tertiary Services Grant: Only to central hospitals
Research and Training Grant: For health professional training
Nutrition: Various components specified
HIV/AIDS: Greater flexibility introduced during 2002
CAPEX
Infrastructure
Equipment
FINCAP: National grant only for central hospitals

12. Issues continued Equitable share Personnel: Specified
Use of Goods and Services: Inflationary pressures
Property Expenses
Transfer Payments
Local Authorities
PHCs
EMS
Private Institutions
SANTA
NGOs
Universities

13. Issues - continued Hospital budgets:
Strengthen regional and district hospitals
Program Budgets (e.g. HIV; nutrition):
Ensure that pressures and challenges addressed
Human Resource Management
Skills Levy
Bursaries (both continuation and small amount for new bursaries)
HIS
Software licences: This is a statutory obligation

14. Issues continued
Assistive devices: An amount of R 3 million was made available (100% increase - exclude hospital budget)
PHC Budgets: Determined effort to move towards equity
Local Authority Budgets: Inflation related increase
EMS – Transfer payments: In line with proposed norms
NGO – Transfer payments
Laundries and Linen: Fund the gap of about R 8 million

15. Issues continued
Mental Health Review Boards and implementation of the Act: R 3.5 million set aside
Backlog of surgical procedures: R 20 million top slice

16. Response to Questions

17. Financials

18. Expenditure 2002/03 Highlights

19. 5 Biggest Expense Items 2002 -2003
Projected Expenditure
N H L S and Lab Services
SOLID DOSAGE FORMS (tablets)
BLOOD and BLOOD SERVICES
ELECTRICITY & WATER
ANTIBIOTICS

20. Personnel Expenditure
Financial Year
Amount Spent
‘R000
% increase
6.8%
1.63%
6.6%
(Proj)
7.1%
(Budget)
8.7%

21. Expenditure 2002-2003 Budget 2002-2003 Proj. Expenditure 2002-03
Variance
Prog 1: Administration
13 815
Prog 2: District Health Services
(8 366)
Prog 3: Provincial Hospital Services
35 683
Prog 4: Academic Health Services
( )
Prog 5: Health Training and Sciences
7 486
Prog 6: Health Care Support Services
84 851
72 524
12 327
Prog 7: Health Facilities Management
13 893
Special Functions
6 981
(6 981)
Internal Charges
(48 672)
(23 726)
(24 946)
( )

22. Over-expenditure
The financial year has not finally closed and certain transactions like the expenditure by Works is not yet captured in our books.
The projected over-expenditure is R 138 million for
Over-expenditure is projected in the Programmes
District Health Services
Academic Health Services

23. Reasons for over-spending
Inflationary pressures in health sector
Goods and services
Inappropriate utilization of central hospitals
Increase in PDE’s

24. Mechanisms to overcome over-expenditure: Short term
Individual accountability through performance management
Balanced approach not to impact on Services
Special attention on main cost drivers
Reduced Stock Levels
Measures to maximise cost effectiveness with regards to Laboratory tests
Tight Management of Appointments
Intense focus on human resource management
Strengthening of Management Controls and capacity

25. Mechanisms to overcome over-expenditure (medium term)
Service improvement plan
Strengthening district level services
Strengthening regional hospitals
Smaller and more cost effective central hospitals
Referral networks
Affordable staff establishment

26. District Health Services - Expenditure
Expenditure
Percentage increase
23.9%
16.5%

27. Budget 2003/04 Highlights

28. Revenue Projected increase from R158 million to R164 million
R 5 million increase in patient fees projected
Ongoing tariff revisions
UPFS
Other
Revision of UPFS tariffs
Implementation of UPFS for subsidised patients 1 April 2003
Disabled patients exempted from any fees
Shared debt management centre
Training has started at selected venues
Proposed implementation third quarter of 2003/2004
Folateng initiative
Helen Joseph, Pretoria West to open in first quarter of 2003/2004
New Revenue Retention Agreement with Treasury
No Donor Funding was received by the Department

29. Revenue from

30. Budget Allocation The Budget and the MTEF (R‘000)
2003/2004 R8,111, ,47%(Orig) 8,62%(Adj)
2004/2005 R8,680, ,01%
2005/2006 R9,120, ,07%

31. Allocation Conditional Grants Discretionary allocation
National – R
Provincial – R
Total CG R
Discretionary allocation
Amount - R
Total R

32. National Treasury Assumptions
Inflation
2003 – %
2004 – %
2005 – %
Improvements of Conditions of Service (ICS)
2003 – %
2004 – %
2005 – %
ICS includes general salary increase as well as all other adjustments like PMS, merits, promotions.

33. Budget allocation
The Health budget equals 30% of the total Gauteng budget. The biggest allocation goes to Education with 33% while Social Services and Population Development is third with 20%.
The per capita allocation for Health in Gauteng is R945.
R360 million budgeted for Local Authorities

34. Budget distribution Prog 1: Administration
Budget Statement 2
% Variance from
% of total budget
Prog 1: Administration
-1.6%
2.9%
Prog 2: District Health Services
23.3%
22.1%
Prog 3: Emergency Medical Services
16.7%
3.2%
Prog 4: Provincial Hospital Services
12.3%
28.9%
Prog 5: Central Hospital Services
5.6%
33.0%
Prog 6: Health Training and Sciences
29.6%
2.0%
Prog 7: Health Care Support Services
93 761
13.1%
1.2%
Prog 8: Health Facilities Management
17.4%
6.6%
12.5%
100.0%

35. Allocation – cont See last page for enlargement

36. Programme 1
Quality programmes: R 6 million (excluding compensation of employees)
Khanyisa awards and additional awards for individual health professionals
Accreditation committee activities
Customer service initiatives
Communication and marketing: R9,1 million in total

37. Programme 1: (continued)
Management issues and financial capacity building:
Provincial - R20 million (health budget)
National – R23 million
Monitoring and evaluation
Pharmaceuticals and controls
Supply chain management
Cost centres
PFMA implementation
HR planner and resolution 7 implementation

38. Programme 2 Strengthening of PHC: 10% increase
Strengthen district hospitals
Address off the street access to PHC services at central hospitals
Extended hours in each sub-district
Funded through the equity formula and management systems strengthening

39. Programme 3 Fund EMS support according to MTEF norms
Purchase of new ambulances
Inter-institutional transport

40. Programme 4
Strengthen the large regional hospitals in the Historically disadvantaged areas
Address the equipment backlog at Leratong and Sebokeng

41. Programme 5 Efficiency measures
Appropriate use of services at academic institutions and rationalisation
Alignment to national increases

42. Programme 6 Bursary budget : R13 million
New bursaries to achieve strategic goals,
Carry through costs of existing bursaries
Appointment of nurses at nursing colleges

43. Programme 7 Funding gaps for linen (complete in 2003/4)
Continue laundry revitalisation, including equipment and infrastructure
Food supply services (Cookfreeze)

44. Programme 8 R 90 million for the new Pretoria Academic Hospital
Funding of equipment PPP for Leratong and Sebokeng hospitals
Folateng expansion
Keep maintenance budget at least 3% of budget
Focused revitalisation money for
Chris Hani Bara (PFI and casualty)
Mamelodi hospital
New Natalspruit hospital (planning)
Clinics - total of R10 million

45. Issues continued Revitalisation of Services: Within Capex budget
Family Medicine – Level 1 Beds as well as protection and appropriate use of services-particularly at central hospitals

46. Equipment
R300 million budgeted
DAC to look at local purchases and leases
Johannesburg Radiation Oncology unit

47. Efficiency of Budget Allocations
Process of Participation
Senior Management (SM) Lekgotla
Briefing Meetings
Budget Workshops
Institutional submissions and budget “Hearings”
Process not an once-off event
Budget linked to outputs
Micro-prioritisation process

48. Capital Expenditure SLA with Works to provide service
GFS Classification (Maintenance)
Day to Day Maintenance funds allocated to institutions

49. Capital Budget

50. Maintenance Budget

51. HIV/AIDS Budget Source 2002/03 2003/04 National Conditional Grant
32 249
55 275
Provincial Grant
75 000
Total
87 249
78% increase between and

52. HIV/AIDS budget Communication 16 000 Prevention Programmes 30 550
Workplace
6 600
Services
36 759
Care
58 636
Local HIV/AIDS programmes
9 000
Provincial HIV/AIDS Programme Management including monitoring and evaluation (IDU)
10 060
NB: Include transfers to 10 provincial Departments

53. HIV / AIDS Measures to improve spending
Personnel with specialised skills in the form of specialists, medical advisors, and finance have been employed to jointly drive and align the programme with the budget.
In the latter half of the financial year, the budget that concerned the operations and/or activities at the decentralised areas, was devolved to the regions and facilities.
Contrary to the former general allocation of AIDS, the budget was streamlined according to areas of focus as informed by the operational plans. For example prevention and care which were further cascaded into sub-programmes like VCT, CBC, MTCT. This has improved and made workable the process of reporting

54. HIV/AIDS – Step Down Facilities
Hospitals were piloted for step-down facilities, namely Kopanong, South Rand, Pholosong, Germiston, and Pretoria West. R5,748m was allocated and fully utilised by the end of October 2002.
A shortfall of R2,0m to carry the facilities through to March 31, 2003 could not be met by the Department's finance resources, and further analyses were still being undertaken on the appropriate costing system of the beds.

55. Conditional Grants

56. Conditional grants
Conditional grants (32.04% of budget)

57. Conditional grants Purpose
To enable the social sector to develop an effective integrated response to HIV/Aids epidemic, focusing on children infected and affected by HIV/Aids. The responsibility for health include:
 Expanding access to voluntary HIV counseling and testing (VCT)
Funding pilot sites of mother to child prevention programme per province and roll-out of programme once DOH is satisfied with performance in pilot sites
Strengthening of provincial programme management terms
Implementation of home-based care as management option
Implementation of step –down care as a management option
HIV/AIDS (R )
(Includes Provincial Share)

58. Conditional grants
Hospital Management and Quality Improvement Grant (R )
Purpose
Improving management in hospitals including development of cost centres, accounting systems, improved PFMA implementation and strengthen financial skills and capacity
To support quality of care interventions to substantially improve quality of hospital services

59. Conditional grants Health Professional training and Development Grant
Purpose
Support the training of health professional
Support province to fund service costs associated with undergraduate and post-graduate remedial students training
Development and recruitment of medical specialists in under-served provinces
Enable shifting of some teaching activities from central hospitals to regional and district facilities

60. Conditional grants Hospital Rehabilitation (HR&R) (R 87 939 000)
Purpose
To transform and modernise hospital in line with the national planning framework and to achieve sustainability

61. Conditional grants
Construction/Pretoria Academic Hospital (R )
Purpose
To contribute toward the funding of new construction for Pretoria Academic Hospital in Gauteng

62. Conditional grants Integrated Nutrition Programme (R 74 723 000)
Purpose
To improve the nutritional status of South African children; specifically to enhance active learning capacity and improve school attendance of primary school learners from poor households

63. Conditional grants National Tertiary Services Grant (R1 679 760 000)
Purpose
To fund national tertiary services, as identified and costed by the Department of Health (DOH)
To ensure equitable access by all South African to basic level of Tertiary Health care
To ensure national national coordinated planning for tertiary services

64. Equity Issues

65. Budget process Process of Participation Improved
Senior Management (SM) Lekgotla
Briefing Meetings
Budget Workshops
Institutional submissions and budget “Hearings”
Public Hearings
Process not an once-off event
Budget linked to outputs
Strengthening of Primary and Secondary Health Services
Funds shifted to point of service (Linen, Day to Day Maintenance)

66. Inter - Provincial Budget Allocation
Equity one of our core values
Extent of equitable access to Tertiary services for neighboring priorities as funded by national conditional grant
Committed to ensuring access
Urgent need of better data on patient origin
Phasing

67. Equity
Shifting services and resources to previously under-served areas and programmes
Strengthen allocation of budgets for previously disadvantaged institutions and regions
additional allocations
District Health Services
Region B and district council areas
Sedibeng
Metsweding
West Rand

68. Equity - Continued Equity among regions for PHC services:
National norm for package=R173 per capita (2001 prices)
For 2003/4 will fund 80% of package norms for all regions at least at R 140, and take 4 years to fund 100% of package

69. Other issues

70. Measures to improve capacity to spend the HIV/AIDS conditional grants
Appointment oh HIV/AIDS programme manager
Appointment of Deputy Director financial management
Creation of 40 professional nurses posts for PMTCT
Decentralisation of operational functions to the regions with funding
Monitoring system implemented
For 2003/04, specific HIV/AIDS grant for each hospital and region

71. Strengthening Primary Health Care (PHC)
Community service
Providing health services in most disadvantaged areas
Strengthening District Health system and PHC services
Providing on the job exposure and learning experience through placement of community service Doctors, Pharmacists, Dentists and allied professionals in hospitals and CHCs and clinics as indicated in the next table

72. Strengthening Primary Health Care (PHC)
Community service professionals
Number
Placement
2002/2003
Doctors
Pharmacists
Dentists
145
135 24
Hospitals
Hospitals and regional offices
Hospitals, CHCs and Dental clinics
2003/2004
164 82
Average of 18

73. Strengthening Primary Health Care (PHC)
Community service professionals
Number
Placement
2003/04
Environmental officers
Clinical Psychologists
Radiographers
Dieticians
Occupational therapists
Speech and Audio
Physiotherapists 6 21 51 18 45 31 62
Central and regional offices
Hospitals, CHCs and clinics
Total Allied community service professionals
234

74. District Management posts
Categories
Approved posts
Number Filled
% Filled
Reasons for vacancies
Directors 9 7
78%
Implementation of
resolution 7
- Migration of skilled staff due to promotions, jobs in Local Government etc.
Deputy Directors 12
58%
Assistant Directors 26 16
62%
Total 47 30
64%

75. Steps in implementation of rural incentives Scheme
Gauteng is predominately an urban province with 97% of the population urbanised
Not regarded as rural by national health Department
Therefore does not qualify for rural allowance
However, issue of incentives for under-served areas are concern to Province

76. Thank You
Questions and Comment?