1. PRESENTATION TO NCOP SELECT COMMITTEE ON FINANCE
SECOND QUARTER ENDING 30 SEPTEMBER 2005

2. PURPOSE
To provide information to the NCOP on performance of all conditional grants managed by the Department, and the details on achievements, challenges and remedial actions for the Quarter ending 30th September 2005.

3. OVERVIEW 6 CONDITIONAL GRANTS MANAGED BY DOH NW.
CONSTITUTES 14% OF TOTAL BUDGET.
NEEDS TO IMPROVE QUALITY OF BUSINESS PLANS FOR CONDITIONAL GRANTS.
STRENGTHENING OF PROJECT MANAGEMENT IN RELATION TO CONDITIONAL GRANTS.
IMPROVE CAPACITY FOR MONITORING AND EVALUATION.
INFRASTRUCTURE DELIVERY MODEL AND POSSIBLE IMPACT.
INTERVENTIONS IN RELATION TO THE ABOVE ARE BEEN PUT IN PLACE.

4. HIV and AIDS GRANT PURPOSE:
To enable the health sector to develop an effective response to HIV and AIDS as well as supporting the implementation of the National Operational Plan for Comprehensive HIV and AIDS Treatment and Care.

5. COPREHENSIVE HIV/AIDS
EXPENDITURE
Sub-Programmes
Budget
R’000
Expenditure for Sep. 05
Expenditure: 1st Quarter
Expenditure:
2nd Quarter
Budget Balance.
PERCENTAGE
Prevention (AB4)
25 944
3755
3 813
7278
14 853
 42.75
Care & Support (H89)
26 166
306 17
7 799
18 350
29.87
Programme Mx. (H90)
1 815
161
336
256
1 223
 32.61
ARV (H51; H65 - H68)
46 996
8299
4 990
19 171
22 835
51.41
TOTAL
9 155
34 504
57 262
43.26 

6. COMPREHENSIVE HIV/AIDS (CONT)
Expenditure grown by 40% from last month.
Actual expenditure is at 43.26% as at 30 September.

7. COMPREHENSIVE HIV/AIDS (CONT)
Progress:
The adjustment for the budget of the Comprehensive Plan (ARV) sites has been done by the Budget section.
The funds to the tune of R6, 815m from National Treasury were transferred and the cash flow made available was spent.
There is availability of pharmaceuticals (ARV) and a growing number of professionals trained in CCMT.
We have in the Province accredited six additional sites for provision of the comprehensive plan.

8. COMPREHENSIVE HIV/AIDS (CONT)
Challenges:
The cash flow constraints especially with the payment of NGOs where we have to effect the quarterly payment but we only getting monthly cash.
Cash flow constraints also makes it difficult for the Department of fast rack certain activities which could be done earlier than the planned. This matter will be resolved with National.

9. COMPREHENSIVE HIV/AIDS (CONT)
Remedial Action:
Interaction between Province and NDoH to review the transfer schedule for HIV/AIDS Grants (Possible DORA implications).

10. HOSPITAL MANAGEMENT & QUALITY IMPROVEMENT.
PURPOSE :
To transform hospital management and improve quality of care in line with national policy.

11. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT
EXPENDITURE
Sub-Programmes
Budget R’000
Expenditure for Sep. 05
R’000
Expenditure: 1st Quarter
Expenditure:
2nd Quarter
Budget Balance.
PERCENTAGE
Hospital Development (AE1)
14 683
3237
978
4670
9035
 38.47
Klerksdorp (J80)
1 974 46 2
142
1 830
 7.31
Mafikeng (J81)
836 -
Rustenburg (J82)
810
266
544
32.84
AE3
171 60
-231
TOTAL
18 303
3283
1 151
5138
12 013
34.36

12. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)
Expenditure has grown by 109 % from last month(August).
Actual expenditure is % of the budget as at 30 September.

13. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)
Progress:
Staff has been appointed and maintained in Swartruggens hospital, in line with the business plan.
Upgrading of Patient Administration And Billing System (PAAB) is going well.
Governance structures (hospital boards etc) have been relaunched and are now been trained, (service provider has been appointed).
A partnership with Cohsasa on Quality Improvement and hospital accreditation is ongoing. Two hospitals have already been accredited.
There have been two training sessions in the implementation of the Clinic Supervision Manual.
The final draft of the Hospital supervision manual is ready for submission for adoption by the Management Committee.

14. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)
Challenges:
The training of governance structures is continuing and expenditure will reflect in the next quarter.
Initial problems experienced in relation to a contract for the PAAB system with one of the service providers, now resolved.
Strengthen Quality Assurance unit in terms human resource.
Expenditure for Swartruggens hospital (Revitalisation site) benefiting from this grant is currently incurred under Equitable Share.
The Cost Centre Accounting project plan is being revised for faster implementation.

15. HOSPITAL MANAGEMENT AND QUALITY IMPROVEMENT (cont)
Remedial Action:
The Business Plan is being amended to sufficiently cover for activities which have been under allocated or delayed.
A team of three appointed to support areas that are showing poor spending.
Journals are being passed to correct expenditure.

16. HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT.
PURPOSE :
Support services to fund costs associated with training of health professionals and the development and recruitment of medical specialists in under-served provinces.
To support and strengthen under & postgraduate teaching and training processes in health facilities, and to enable shifting of teaching activities from central hospitals to regional and district hospitals.

17. HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT
EXPENDITURE
Sub-Programmes
BudgetR’000
Expenditure for ep. 05R’000
Expenditure: 1st Quarter
R’000
Expenditure:
2nd Quarte 
Budget Balance.
Percentage
MMACON (AA0)
23 945
3193
6 176
9225
8 544
 64.32
EXCELSIUS (AB8)
26 154
3005
5 665
8251
12 238
 53.21
Klerksdorp (J90)
5 065
329 67
1197
3 801
 24.96
Mafikeng (J91)
4 900
130
176
361
4 363
10.97
Rustenburg (J92)
2 500 -
100
Prof. Training (J69)
156
-156
TOTAL
62 654
6657
12 240
21 534
28 789
53.98

18. HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont)
53.98% has been spent to date.
This grant is on target in terms of planned activities and ideal expenditure.

19. HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont)
Progress:
The fund has been used to increase the intake of nursing trainees from 100 to 180.
Community based education and problem based learning is unfolding well under this grant.
Nurses, Doctors, Community Service Personnel, Interns and Healalth Support Staff have been trained in Emergency Courses, e.g. Advanced Trauma Life Support, Paediatric Advanced Life Support and Advanced Cardiac Life Support, Advanced Medical Life Support, and Advanced Orthopaedic and Basis Surgical Skills Courses.

20. HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT (cont)
Challenges:
The grant is on target .

21. INTEGRATED NUTRION PROGRAMME GRANT
To implement integrated nutrition activities aimed at improving the nutritional status of South Africans, based on disease-specific nutrition support, treatment and counselling focus areas, which are dependant on information, human resources and financial and administrative systems.

22. INTEGRATED NUTRITION PROGRAMME
EXPENDITURE
Sub-Programmes
Budget
R’000
Expenditure for Sep. 05
Expenditure: 1st Quarter
Expenditure:
2nd Quarter
Budget Balance.
PERCENTAGE
INP (HX7)
10 981
838
852
2 467
7662
30.22
TOTAL

23. INTEGRATED NUTRITION PROGRAMME (cont)
Expenditure has increased by 34 % from August.
Performance is at 30.22% as at 30 September.

24. INTEGRATED NUTRITION PROGRAMME (cont)
Progress:
There is adequate supply of road to health charts.
The inputs for the budget adjustment have been finalised to re-align the budget to the Programme needs.
One extra hospital declared baby friendly.

25. INTEGRATED NUTRITION PROGRAMME (cont)
Challenges:
The funds for the second quarter from the National Treasury were only received on the 22nd August instead of 18th July.

26. INTEGRATED NUTRITION PROGRAMME (cont)
Remedial Action:
The programme is showing potential to spend its entire budget. There is R2 M already that is being processed this week which will take expenditure to 45.3 % to compared to a half year target of 50%.
Transfer schedule needs to be reviewed in consultation with National Department of Health.

27. HOSPITAL REVITILIZATION GRANT.
To provide funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, organizational management & development and monitoring and evaluation of hospitals in line with national policy objectives.

28. HOSPITAL REVITALIZATION
EXPENDITURE
Sub-Programmes
Budget 
R’000
Expenditure for Sep. 05
Expenditure: 1st Quarter
Expenditure:
2nd Quarter
Budget Balance.
PERCENTAGE
New Facilities (H3E)
8 469
927
137
1 728
6 604
22.02
Upgrading (H3F)
47 000
867
1 101
6 577
39 322
16.34
Other Facilities (H3G)
32 056
1 048
7 167
5 383
19 506
39.15
Rehabilitation (AA1)
10 531 -  0
TOTAL
98 056
2 842
8 405
13 688
75 963
22.53

29. HOSPITAL REVITALIZATION (cont)
Expenditure has grown by 15%. Although there’s a 15% growth, actual expenditure as a percentage of the budget is still at 22.53%.

30. HOSPITAL REVITALIZATION (cont)
Challenges :
Human Resource capacity both within and with implementing agents.
Inadequate response by experienced contractors and empowered joint ventures.
Incapacity of some consultants and small emerging contractors to handle projects with the required competencies.
Tendering and procurement processes both internally and externally takes longer than expected.
Infrastructure delivery model require review.

31. HOSPITAL REVITALIZATION (cont)
Remedial Action:
Intervene on Tshwaragano business case (cross border municipality).
Complete business cases for the entire province.
Commence planning for priority areas.
Review the implementing strategy and process thoroughly. e.g. MEC for Education is convinced a task team between Health, Education and Public Works.
Discussion are underway with the Provincial Treasury for the amount to only be transferred to the Department during 2006/07 financial year.
Review of the bottom structure to address human resource challenges.

32. NATIONAL TERTIARY SERVICES.
To compensate provinces for the supra-provincial nature of tertiary services provision and spill over effects as well as providing strategic funding to enable provinces to plan, modernise, rationalise and transform the tertiary hospital service delivery platform in line with national policy objectives including improving access and equity.

33. National Tertiary Services
EXPENDITURE
Sub-Programmes
Budget
R’000
Expenditure for Sep. 05
Expenditure: 1st Quarter
Expenditure:
2nd Quarter
Budget Balance.
PERCENTAGE
Mafikeng (H61)
18 966
1112
382
3317
15 267
19.51
Klerksdorp (H62)
36 493
3 884
2 725
11 861
21 907
39.97
Rustenburg (H63)
15 823
590
1 639
2 214
11 970
24.35
TOTAL
71 282
5586
4 747
17 392
49 143
31.06

34. National Tertiary Services (cont)
Expenditure on this grant has grown by 34% from end of August.
It stands 31.06% of the budget.

35. National Tertiary Services (cont)
Progress:
The Programme has shown an improvement in its expenditure compared to the previous months, however this still needs more attention.
Previously, only Klerksdorp hospital complex provided a wider range of tertiary services; now Rustenburg and Mafikeng are expanding services.

36. National Tertiary Services (cont)
Challenges:
Concluding the procurement process and receiving tertiary equipments for all the tertiary hospitals.
Amending the specifications for CT Scans due to market demands led to the delay. Price of 16 Slice CT scans came down, and we responded accordingly. NB: For this year CT scans accounts for more than 29% of the NTSG budget.

37. National Tertiary Services (cont)
Remedial Action:
Follow up on the finalisation of the contract of procuring hospital medical equipments expected to be concluded during October 2005.
Once delivery of this equipment takes place, this will bring the expenditure to the expected level.

38. Malaria & Cholera Prevention Grant
PURPOSE :
For the sustenance of the programmes related with pushing back the frontiers of poverty and hunger among women, Aids victims and especially to provide equipment for the food gardens and in some instances provide stipend to volunteer garden workers.

39. Malaria & Cholera Prevention Grant
Progress :
A business plan has been developed and approved for the utilisation of the rollover amounting to R1,111,460. The funds are currently under the provincial contingency reserve fund. Treasury will be transferring the money to the Department the 10th October

40. Malaria & Cholera Prevention Grant
Challenges:
This is a once off conditional grant resulting from the drought of 2004.
The Programme has to ensure that the roll-out of the activities is expedited to ensure spending of funds only in relation to time affected largely by a rural Bophirima district.

41. Malaria & Cholera Prevention Grant
Remedial Action :
All line expenditure items to benefit from this grant have been identified e.g. pharmaceuticals, water tanks for clinics, food gardens and fencing for food gardens.

42. Medico Legal Mortuaries
PURPOSE:
To facilitate the transfer of forensic pathology services from the South African Police Services (SAPS) to the Department of Health and provinces.

43. Medico Legal Mortuaries
Progress:
The Programme has the costed operational plan for the year and the necessary staff structure has been finalised.
All facilities have been audited and are in the process of being upgraded.

44. Medico Legal Mortuaries
Challenges:
The funds from the conditional grant of the Programme are not available yet.
The programme is presently having at its disposal its equitable share which is being used for the programme.

45. Medico Legal Mortuaries
Remedial Action:
Funds will be transferred with effect from the 1st October However, the actual transfer will be with effect from April 2006 into provincial coffers.

46. Expenditure on Equitable Share in relation to pressures points
Personnel – we are at 51%, and project over expenditure of R69m.( being addressed with provincial Treasury).
Administration (Indicates pool vehicles transport costs including ambulances) – we are at 65%. ( will review funding during Adjustment Estimates process).

47. Current Pressure Points (Economic Classifications)
Professional services (expected to be a pressure point as service expand waste management).
Equipment (Expected to be a pressure point as we implement health technology audit recommendations).
Uniform for nurses ( based on new agreement ).

48. Thank you for listening
Closure
Thank you for listening