Annual Performance Plan 2019/ /21

Annual Performance Plan 2019/20-2020/21
Presentation to the Select Committee on Health and Social Services Director-General: Health 9 July 2019

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

NDP: Vision 2030 The priorities for the MTEF commencing 2019/20 year are derived from:

Sustainable Development Goals
Health system must deliver Goal 3, however, improved health is also a target in many other goals. Health is a target in SDG 1, 2, 5, 6, 13, 16. SDGs are advocating that response is required by whole government to improve health of all its citizens. Strong partnerships between sectors will be imperative to prevent disease, and improve the quality of life, thereby increasing life expectancy to achieve both NDP and SDG goals

Legislation and Prescripts that regulate Health Sector planning
National Health Act, 2003 Section 21(4) - “the national health plans must comply with national health policy. Section 21(5) - “The Director-General must integrate the health plans of the national department and provincial departments annually and submit the integrated health plans to the National Health Council”. Section 33(1) - “Each district and metropolitan health manager must within the national budget cycle develop … a district health plan drawn up in accordance with national guidelines issued by the Director-General…” Section 23(2) - “The National Health Council may determine the time frames, guidelines and the format for the preparation of national and provincial health plans. Public Finance Management Act, 1999 Treasury Regulations – Chapter 5 of 2007 Framework for Strategic Plans and Annual Performance Plans(FSAPP), 2010 Integrated Planning Framework Bill, 2018 (soon to be tabled in parliament by the Presidency) FSAPP also currently being revised, DPME has circulated the final draft to all government Departments

Proposed Targets (TBC)
Outcome 2 : A long and Healthy lives for all South Africans MTSF : Impact Indicators, Targets, and Achievements to date Impact Indicator Trends 2019 MTSF targets Achievement Proposed Targets (TBC) 2009 2014 2024 2030 Life Expectancy LE at birth: Total 56.5 years 62.9 years 64.2 years 64.2 years 1 67.2 years 70 years LE at birth: Male 54.0 years 60.0 years 61.5 years 61.1 years years 3 67 years LE at birth: Female 59.0 years 65.8 years 67.3 years years3 70.2 years 73 years Mothers and Children Maternal Mortality Ratio 304 per 100,000 live-births 269 per 100,000 live-births <100 per 100,000 live-births 134 per live births4 <100 per 100 000 live births <70 per live births Neonatal (<28 days) Mortality Rate (NMR) - 14 per 1000 live births 8 per 1000 live births 12 per live births3 <10 per 1,000 live births <7 per 1,000 live births Infant (<1 year) Mortality Rate (IMR) 39 per 1,000 live-births 28 per 1,000 live-births 23 per 1000 live births 23 per 1000 live births 3 <20 per 1000 live births <15 per 1,000 live birth Child (<5 years) Mortality Rate (U5MR) 56 per 1,000 live-births 39 per 1,000 live-births 33 per 1,000 live-births 32 per 1,000 live Births3 <25 per 1,000 live births <20 per 1,000 live births TB/ HIV Number of AIDS related deaths N/A 68 302 21 436 Number of TB Deaths 39 695 29 513 (2016) 8 510 3 404 Total clients remaining on ART 2.3m patients 5 million 4.7 million5 6m (by 2020) Mother to Child Transmission 10.3% 1.6% 0.8%5 Eliminated 1. Mid-year Population Estimates(MYPE) 2018, StatsSA 2018 and Rapid Mortality Surveillance (RMS) 2017, MRC 2019 2. MYPE 2018, 3. Rapid Mortality Surveillance 2017, MRC 2019 (published 2019) 4. NCCEMD, 2018 5. DHIS, 2018

Organizational Structure linkages with Budget Programme Structure
Director-General: Health DG: Ms MP Matsoso Programme 1: Administration - Corporate Services DDG: Ms V Rennie Programme 1: Administration CFO: Mr I van der Merwe Programme 2: National Health Insurance DDG: Dr A Pillay Programme 3: Communicable and Non-Communicable Diseases DDG: Dr Y PIllay Programme 4 and 5: Primary Health Care and Hospital Systems DDG: Ms J Hunter Programme 6: Health System Governance and HRH DDG: Dr G Andrews Organizational Structure linkages with Budget Programme Structure The current functional organisational structure, and budget programme structure (as depicted above) will be reviewed during 2019/20 financial year to align with the institutional arrangements that will be necessitated by the implementation of the NHI.

NDoH Budgets 2019/20 – 2021/22 includes: Conditional Grants, Transfer Payments to Entities, and NGOs, and ear marked funds Programme 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % ADMINISTRATION 661,277 6 703,249 746,186 NATIONAL HEALTH INSURANCE 2,111,663 32 2,793,388 8 3,023,700 COMMUNICABLE & NON- COMMUNICABLE DISEASES 23,007,269 11 25,529,107 14 28,985,876 PRIMARY HEALTH CARE SERVICES 221,751 7 238,012 255,695 HOSPITAL SYSTEMS 20,381,141 22,082,763 23,325,146 HEALTH SYSTEM GOVERNANCE & HUMAN RESOURCES 5,077,589 5 5,339,732 5,603,317 TOTAL 51,460,690 10 56,686,251 9 61,939,920 Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 880,543 7 946,523 1,008,210 Goods and Services 2,409,279 15 2,769,560 9 3,022,531 Transfers 46,986,594 51,303,953 10 56,258,528 Capital 1,184,274 41 1,666,215 (1) 1,650,651 TOTAL 51,460,690 56,686,251 61,939,920

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

Programme 1 - Administration
Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Ensure effective financial management and accountability by improving audit outcomes Audit opinion from Auditor General Unqualified Audit opinion for the NDOH for 2017/18 Unqualified Audit Opinion for the NDOH for 2018/19 Clean Audit Opinion for the NDOH for 2019/20 Clean Audit Opinion for the NDOH for 2020/21 Number of Provincial DoH that demonstrate improvements in Audit Outcomes or Opinions 5 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2017/18 5 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2018/19 6 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2019/20 7 Provincial DoH that demonstrate improvements in Audit with no significant matters for 2020/21 Improve management of medico-legal claims and contain costs Claim management system implemented to contain costs and streamline its management New Indicator Claim management system implemented to manage medico-legal claims in all Provincial DoH Medico-legal claim contingent liability reduced by 30% Medico-legal claim contingent liability reduced by 50%

Programme 1 - Administration
Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 247,144 7 265,021 284,399 Goods and Services 403,220 6 426,243 5 449,113 Transfers 2,683 2,884 3,072 Capital 8,230 11 9,101 9,602 TOTAL 661,277 703,249 746,186 Ear Marked Funds, and Conditional Grants Sub Programme Item 2019/20 R'000 Corporate Services Medico-legal Committees 7, 500 Financial Management SAICA programme 12,000 TOTAL 19,500

PROGRAMME 2 - NATIONAL HEALTH INSURANCE
The purpose of National Health Insurance Programme is to improve access to quality health services through the development and implementation of policies to achieve universal health coverage and health financing reform National Department of Health, will provide leadership to implement National Health Insurance, and ensure quality health care: National DoH will be restructured to optimize functions in support of service delivery, and release much needed resources for implementing NHI. National Health Insurance Bill will be tabled in Parliament, and enacted into law, where after an NHI Fund will be established.

Performance Indicator Estimated performance
Programme 2 Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Achieve Universal Health Coverage through the phased implementation of National Health Insurance (NHI) Legislation for NHI Draft NHI Bill published for public comments Proclamation of NHI Act NHI Fund established Not Applicable NHI Office Established New Indicator NHI Office Established, and key positions filled NHI Office purchasing comprehensive package of services from public and private health providers in selected districts using the NHI Fund NHI Office purchasing comprehensive package of services from Regional and Tertiary Hospitals using the NHI Fund

Programme 2: National Health Insurance
Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Achieve Universal Health Coverage through the phased implementation of National Health Insurance (NHI) Comprehensive Package of District Health Services designed New Indicator Comprehensive Package of District Health Services implemented; and Comprehensive package of services for Regional and Tertiary Services developed Number of District health contracting teams trained for accelerated implementation of NHI 52 District health contracting team trained for accelerated implementation of NHI Performance of 52 District health contracting teams evaluated Not Applicable

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Develop and implement a system for the creation of a NHI Beneficiary Registry Number of health facilities implementing health patient registration system (HPRS) 3000 PHC Facilities maintained; Additional 470 PHC facilities and 22 Hospitals implementing the health patient registration system (HPRS) 3220 PHC facilities and 22 Hospitals maintained; Additional 30 hospitals implementing the health patient registration system (HPRS) 3470 PHC facilities and 52 Hospitals maintained; Additional 60 hospitals implementing the health patient registration system (HPRS) 3470 PHC facilities and 112 Hospitals maintained; Additional 120 hospitals implementing the health patient registration system (HPRS) Number of individuals from the population registered on the NHI Patient Beneficiary Registry 35 million 40 million (cumulative) 45 million 50 million *Pharmaceutical Depots, Pharmacy dispensing units, contracted GPs, and CCMDD suppliers

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Eliminate stock outs of essential medicines Total number of health facilities reporting stock availability at national surveillance centre 3625 of health facilities reporting stock availability at national surveillance centre (cumulative) 3725 of health facilities reporting stock availability at national surveillance centre: 3290 Clinics/CHC/CDC 385 Hospitals 50 Other medicine storage sites* 3775 of health facilities reporting stock availability at national surveillance centre (cumulative) Clinics/CHC/CDC 395 Hospitals 70 Other medicine storage sites* 3850 of health facilities reporting stock availability at national surveillance centre (cumulative) Clinics/CHC/CDC 405 Hospitals 75 Other medicine storage sites* *Pharmaceutical Depots, Pharmacy dispensing units, contracted GPs, and CCMDD suppliers

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Eliminate stock outs of essential medicines Early Warning system for medicine stock outs implemented in partnership with users of services and patient groups New Indicator Early Warning system for medicine stock outs implemented Not Applicable Number of facilities with automated ePrescription and eDispensing system implemented 25 facilities with automated ePrescription and eDispensing system implemented 300 facilities with automated ePrescription and eDispensing system implemented 500 facilities with automated ePrescription and eDispensing system implemented Electronic medicine catalogue implemented Electronic medicine catalogue Electronic medicine catalogue monitored for implementation and maintained

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve contracting and supply of medicines through innovative service delivery models Number of patients enrolled for receiving medicines through the centralised chronic medicine dispensing & distribution (CCMDD) programme 2,300, 000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 3,000,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 3,500,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) 3,800,000 patients enrolled for receiving medicines through the CCMDD programme (cumulative) Improve the use of antibiotics in South Africa by implementing the Antimicrobial Resistance Strategy Surveillance system implemented for monitoring resistance Surveillance system for monitoring resistance accessible to 3 provincial DoH Surveillance system for monitoring resistance accessible to 6 provincial DoH Surveillance system for monitoring resistance accessible to 9 provincial DoH Not Applicable

Budgets : Programme 2: National Health Insurance
Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 52,019 6 55,156 7 59,121 Goods and Services 1,367,624 15 1,568,212 9 1,710,835 Transfers 605,696 76 1,063,083 1,127,227 Capital 86,324 24 106,937 18 126,517 TOTAL 2,111,663 32 2,793,388 8 3,023,700 19

Budgets: Programme 2: National Health Insurance
Ear Marked Funds, and Conditional Grants Sub Programme Item 2019/20 (R ‘000) Ear marked CG Affordable Medicine Eletronic Medicine Stock Management System 10,560 Health Financing, NHI, Revenue Related Services & Technical Advisor NHI Indirect Grant: Non-personal services component 758,000 NHI Indirect Grant: Personal services component 639,288 NHI Interim Fund Management & Administration 10,000 NHI Ministerial advisory committees 2,000 Health technology assessment Human Resources Capacitation Conditional grant 605,696 TOTAL

Programme 3 - Communicable and Non-Communicable Diseases
The programme develops and supports the implementation of national policies, guidelines, norms and standards, and achievement of targets for the national response needed to decrease morbidity and mortality associated with communicable diseases (HIV, Tuberculosis, Malaria, Influenza and others) and non-communicable diseases (mental health; cancer, hypertension, diabetes and others). It is also responsible to develop strategies and implement programmes that reduces Maternal and Child Mortality.

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 To implement combination of prevention and treatment interventions to reduce burden of HIV, STI and TB infections Medical Male Circumcisions performed 600,000 700,000 Number of undiagnosed TB infected persons (new cases) found 80 000 40 000 To prevent disease and promote health Total number of tests for HIV conducted during National Health Screening & Testing Campaign

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 To reduce under 5 mortality rate to less than 33 per live births EPI coverage survey conducted Survey protocol developed and field work completed Survey report published and targeted interventions identified to strengthen EPI programme Targeted Interventions implemented to strengthen EPI Programme Not Applicable EPI surveillance external review recommendations implemented Implementation plans developed in partnership with Provincial DoH; and Three (3) provincial trainings conducted Six (6) provincial trainings conducted to implement the external review recommendations Implementation plans monitored

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Eliminate Malaria in South Africa by 2023 Provincial Malaria Elimination Implementation Plans developed Malaria Elimination Strategic Plan for South Africa published 5 Provincial (3 Endemic and 2 Non Endemic) Elimination Implementation Plans developed 4 Provincial (Non Endemic) Elimination Implementation Plans developed; M&E Reports of 5 Provincial DoH Produced to monitor implementation 9 Provincial M&E reports produced on the key indicators for Malaria Elimination Implement the International Health Regulations Joint External Evaluation recommendations Percentage of National Action Plan activities from the JEE recommendations for IHR implemented National Action Plan (NAP) finalized 50% of NAP activities implemented 100% of NAP activities implemented (cumulative) Conduct Vulnerability and Risk Assessment and Mapping for Public Health Events Strengthen district mental health services Number of Districts with Mental Health Teams established 15 District mental health teams established (cumulative) 20 (5 additional) Districts with mental health teams established 25 (5 additional) Districts with mental health teams established 30 (5 additional) Districts mental health teams established

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 To expand the access to mental health services through the strategic purchasing of services from private healthcare providers Number of patients with mental health problems consulted by contracted psychiatrists or psychologists 5 000 patients with mental health problems consulted by contracted psychiatrists or psychologists patients with mental health problems consulted by contracted psychiatrists or psychologists patients with mental health problems consulted by contracted psychiatrists or psychologists patients with mental health problems consulted by contracted psychiatrists or psychologists To reduce the forensic mental health backlog through the strategic purchasing of services from private healthcare providers Number of forensic mental health observations conducted 500 forensic mental health observations conducted 1000 forensic mental health observations conducted 1200 forensic mental health observations conducted Expand provision of rehabilitation services, and accessibility of Primary Health Services to people with physical disabilities Number of Districts with multi-disciplinary rehabilitation teams (physiotherapist, optometrist, audiologist, occupational therapist and speech therapist) established 2 districts with multi-disciplinary rehabilitation teams established 5 districts with multi-disciplinary rehabilitation teams established (cumulative) 9 districts multi-disciplinary rehabilitation teams established 12 districts multi-disciplinary rehabilitation teams established

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Reduce the radiation oncology backlogs through the strategic purchasing of services from private healthcare providers Number of patients receiving radiation oncology 5000 patients receiving radiation oncology 7 000 patients receiving radiation oncology 9 000 patients receiving radiation oncology patients receiving radiation oncology To reduce mortality among the maternal mortality ratio to under 100 per 100,000 live births, and neonatal mortality rate to under 8 per 1,000 live births by 2020 Number of regional hospitals implementing the quality Improvement Programme for pregnant women and neonates New Indicator 11 regional hospitals implementing the quality Improvement Programme for pregnant women and neonates 18 regional hospitals implementing the quality Improvement Programme for pregnant women and neonates (cumulative) 21 regional hospitals implementing the quality Improvement Programme for pregnant women and neonates

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve access to community based PHC services Number of CHWs re-trained in the revised scope of work New Indicator 20 000 Number of clients traced by CHWs Improve management of community based PHC services Number of Districts where CHWs use a mobile health application to register households that received care 27 Districts 52 Districts

Budgets: Programme 3 - Communicable and Non-Communicable Diseases
Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 167,903 6 178,142 7 190,986 Goods and Services 395,661 30 515,511 14 588,133 Transfers 22,443,341 11 24,835,057 28,206,329 Capital 364 9 397 8 428 TOTAL 23,007,269 25,529,107 28,985,876 28

Ear Marked Funds, and Conditional Grants Sub Programme Item 2019/20 (R ‘000) Ear marked CG HIV & AIDS and Sexually Transmitted infections HIV & AIDS and Sexually Transmitted infections 220,778 HIV Conditional Grant: HIV & AIDS 19,963,270 HIV Conditional Grant: TB 485,300 HIV Conditional Grant: Community Outreach Services 1,500,000 HIV Conditional Grant: Malaria Elimination 90,425 Lifeline 24,579 Lovelife 68,376 Soulcity 21,336 Condoms 122,796 Communication Campaign - SANAC 18,066 HIV & AIDS NGO's 57,482 Child, Youth & School Health Human Papilloma Virus Vaccines Conditional grant 211,200 Non-Communicable Deseases Chronic Desease Prevention and Health Promotion 40,000 TOTAL 573,413 22,250,195 29

Programme 4: Primary Health Care
To develop and oversee the implementation of legislation, policies, systems, and norms and standards for a uniform well-functioning District Health System, including Emergency and Environmental Health Services.

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Strengthen district governance and improve management and leadership of the district health system Number of Districts supported to be compliant with the minimum requirements of the District Health Management Office (DHMO) structure guidelines Plans developed for 10 districts structures to meet the minimum requirements of the guidelines Plans developed for 30 districts structures to meet the minimum requirements of the DHMO guidelines Plans developed for 52 districts structures to meet the minimum requirements of the DHMO guidelines Not Applicable National Health Act reviewed to define the functions of the District Health Management Office New Indicator National Health Amendment Bill drafted to incorporate the functions of the District Health Management Office National Health Amendment Act published for public comments National Health Amendment Bill enacted into Law

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Strengthen district governance and improve management and leadership of the district health system Number of PHC facility committees trained 3400 PHC facility committees assessed and report on findings with recommendations completed 970 PHC facility committees trained to implement the Handbook for governance structures 1500 PHC facility committees trained to implement the Handbook for governance structures 995 PHC facility committees trained to implement the Handbook for governance structures Number of District Hospital Boards trained New Indicator 80 District Hospital Boards trained to implement the Handbook for governance structures 100 District Hospital Boards trained to implement the Handbook for governance structures

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve the acceptability, quality and safety of health services by increasing user and community feedback and involvement National Guideline on conducting Patient Experience of Care Survey 1500 PHC facilities conducting Patient Experience of care survey annually National Guideline on conducting Patient Experience of Care Survey reviewed 50% of patients that participated in the survey satisfied with health services received at PHC facilities 55% of patients that participated in the survey satisfied with health services received at PHC facilities Improve the quality of health care by increasing user feedback Number of Chronic patients providing feedback on the quality of care through an electronic platform New Indicator 1 000 000 chronic patients providing feedback 3 000 000 chronic patients providing feedback 6 000 000 chronic patients providing feedback Regulate Traditional Health Practitioners in South Africa Traditional Health Practitioners Amendment Bill submitted to parliament Traditional Health Practitioners Amendment Bill published for comment Traditional Health Practitioners Amendment Bill submitted to Parliament to commence Parliamentary Process Traditional Health Practitioners Amendment Bill enacted into Law, and implementation commenced Traditional Health Practitioners Act monitored for implementation

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve quality of services at primary health care facilities through the Ideal Clinic Initiative Number of primary health Care facilities in the districts that qualify as Ideal Clinics 1400 primary health Care facilities in the districts qualify as Ideal Clinics 1800 primary health care facilities in the districts qualify as Ideal Clinics 1950 primary health care facilities in the districts qualify as Ideal Clinics 2100 primary health care facilities in the districts qualify as Ideal Clinics Improve quality of services at Hospitals through the Ideal Hospitals Programme Number of District Hospitals assessed using the Ideal Hospital Framework Ideal Hospital Framework completed, and 9 provincial workshops conducted to implement the framework 254 District Hospitals baseline self-assessments conducted using the Ideal Hospital Framework 15 District Hospitals achieving the Ideal Hospital Status 30 District Hospitals achieving the Ideal Hospital Status Improve accessibility of Primary Health Services to people with disabilities Proportion of PHC facilities accessible to people with disabilities 40% (of 3400) PHC facilities accessible to people with disabilities 45% (of 3400) PHC facilities accessible to people with disabilities 50% (of 3400) PHC facilities accessible to people with disabilities 55% (of 3400) PHC facilities accessible to people with disabilities

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve environmental health services in all 52 districts and metropolitan municipalities in the country Improve environmental health services in the country Improve Environmental Health Services in the country Number of public health facilities assessed for adherence to Health Care Risk Waste (HCRW) Norms and Standards 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals that generate more than 25kg per day) assessed for adherence to HCRW Norms and Standards 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals and CHCs that generate more than 20kg per day) assessed for adherence to HCRW Norms and Standards 78 Major Health Care Risk Waste (HCRW) generating public health facilities (hospitals and CHCs that generate more than 20kg per day) assessed for adherence to HCRW Norms and Standards Number of municipalities that are selected and audited against environmental health norms and standards in executing their environmental health functions 21 municipalities randomly selected and audited against environmental health norms and standards 31 of 52 Municipalities (that were not audited during 2018/19 audited against EH norms and standards) Metropolitan and district municipalities that achieve less than 65% compliance in 2019/20 audited against environmental health norms and standards Metropolitan and district municipalities that achieve less than 65% compliance in 2020/21 audited against environmental health norms and standards

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve environmental health services in all 52 districts and metropolitan municipalities in the country Improve environmental health services in the country Improve Environmental Health Services in the country Number of Points of Entry compliant with IHR,2005 core capacity requirements New Indicator 20 Points of Entry (11 airports and 9 high risk land borders) compliant with IHR, 2005 core capacity requirements 25 Points of Entry (5 medium risk land borders) compliant with IHR, 2005 core capacity requirements 30 (5 harbours) Points of Entry compliant with IHR, 2005 core capacity requirements Environmental health legislation reviewed Environmental Health Sections of the of the National Health Act and Environmental Health Bill drafted Environmental Health Bill published for comments Environmental Health Bill enacted into Law

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Ensure access to and efficient effective delivery of quality Emergency Medical Services (EMS) Number of provinces that are monitored for compliance with the EMS regulations 9 provincial department of health monitored for compliance with the EMS regulations using the approved checklist 9 x EMS Improvement plans revised accordingly 9 provincial DoH monitored for compliance with the EMS regulations using the approved checklist annually and 9 x EMS Improvement plans revised accordingly 9 provincial DoH monitored for compliance with the EMS regulations using the approved checklist 9 x EMS Improvement plans revised accordingly Ideal EMS framework developed New Indicator Ideal EMS Framework developed to improve service delivery and compliance to EMS regulations EMS services in all Provincial DoH assessed using the Ideal EMS Framework

Budgets: Programme 4: Primary Health Care Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 195,109 7 209,272 224,777 Goods and Services 26,403 8 28,468 30,631 Transfers Capital 239 14 272 6 287 TOTAL 221,751 238,012 255,695 38

PROGRAMME 5: HOSPITAL SYSTEMS
Develops national policy on hospital services and responsibilities by level of care; providing clear guidelines for referral and improved communication; developing detailed hospital plans; and facilitating quality improvement for hospitals. The programme is further responsible for the management of the national tertiary services grant and ensures that planning of health infrastructure meets the health needs of the country.

Programme 5 – Hospital Systems
Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Improve quality of services at Hospitals through the Ideal Hospitals Programme Number of regional and tertiary hospitals assessed using the Ideal Hospital Framework Ideal Hospital Framework completed, and 9 provincial workshops conducted to implement the framework Baseline assessment of 61 hospitals (17 Tertiary and 44 Regional) conducted using the Ideal Hospital Framework 10 Regional, and 17 Tertiary hospitals achieving 75% improvement against the Ideal hospital framework 25 Regional, and 17 Tertiary hospitals achieving 75% improvement against the Ideal hospital framework Strengthen local decision making and accountability of central hospitals to facilitate semi-autonomy Number of central hospital organisational structures compliant with Guidelines on Organisational Structures for Central Hospitals Guidelines on Organisational Structures for Central Hospitals approved by TechNHC Costed implementation plans for improvement of 10 Central hospitals organisational structures completed Implementation plans monitored 10 central hospital organisational structures compliant with Guidelines on Organisational Structures for Central Hospitals

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 To build new and improve quality of existing health infrastructure in South Africa Number of facilities that comply with infrastructure Norms & Standards. 400 facilities compliant with Infrastructure norms and standards 37 facilities compliant with Infrastructure Norms and Standards 30 facilities compliant with Infrastructure Norms and Standards Number of clinics and Community Health Centres constructed or revitalised 20 clinics and Community Health Centres constructed or revitalised 60 Clinics and CHCs Constructed or Revitalised (23 constructed and 37 revitalised) 54 Clinics and CHCs Constructed or Revitalised (6 constructed and 48 revitalised) 40 Clinics and CHCs Constructed or Revitalised (5 constructed and 35 revitalised)

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Accelerate the implementation of the 10 year infrastructure plan Number of hospitals constructed 2 hospitals 1 hospital constructed 2 hospitals constructed Number of hospitals revitalised New Indicator 36 hospitals revitalised 23 hospitals revitalised 26 hospitals revitalised Number of facilities maintained, repaired and/or refurbished through In Kind Grant in Districts 125 facilities maintained, repaired and/or refurbished 45 facilities maintained, repaired and/or refurbished 50 facilities maintained, repaired and/or refurbished 70 facilities maintained, repaired and/or refurbished Number of facilities maintained, repaired and/or refurbished through Equitable Share and HFRG in Districts 100 facilities maintained, repaired and/or refurbished 100 facilities maintained, repaired and/or refurbished through Equitable Share and HFRG in Districts 120 facilities maintained, repaired and/or refurbished through Equitable Share and HFRG in Districts

Budgets: Programme 5 – Hospital Systems
Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 29,805 7 31,968 34,222 Goods and Services 95,637 9 104,242 6 110,117 Transfers 19,192,501 20,428,420 21,700,674 Capital 1,063,198 43 1,518,133 (3) 1,480,133 TOTAL 20,381,141 8 22,082,763 23,325,146

Budgets: Programme 5 – Hospital Systems
Ear Marked Funds, and Conditional Grants Sub Programme Item 2019/20 (R ‘000) Ear marked CG Health Facilities Infrastructure Management, and Health Technology Health Facility Management 29,541 NHI Indirect Grant: Health Facilities Revitalization 889,411 NHI Indirect Grant: HFR: Limpopo Academic Hospital 247,000 Health Facility Revitalization Conditional Grant 6,006,973 Hospital Systems National Tertiary Services Conditional grant 13,185,528 TOTAL 20,328,912

PROGRAMME 6 – HEALTH SYSTEM GOVERNANCE AND HUMAN RESOURCES
The purpose of the programme is threefold: to achieve integrated health systems planning, monitoring and evaluation, and research. Develops and monitors the implementation of health workforce policies and ensures effective health workforce planning, development and management in the national health system, as well as alignment of academic medical centres with health workforce programmes and training of health professionals. It assists the government to achieve the population health goals of the country through nursing and midwifery, through the provision of expert policy and technical advice and recommendations on the role of nurses in attainment of desired health outputs. Lastly, the programme also has the responsibility for oversight over public entities and statutory health professional councils, and ensuring compliance by with applicable legislative prescripts. .

Programme 6 - Health System Governance And Human Resources
Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 To establish the National Public Health Institute of South Africa (NAPHISA) for coordinated and integrated disease and injury surveillance Legal framework to establish National Public Health Institute of South Africa (NAPHISA) NAPHISA Act Promulgated into law. NAPHISA established as a public entity, and NAPHISA board appointed NAPHISA fully operational and functional Not Applicable Improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools. Governance monitoring system implemented to strengthen oversight and corporate governance Biannual governance progress reports produced of all health entities and councils Biannual governance progress reports of all 5 health Entities and 6 statutory health professional councils produced

Programme 6 - Health System Governance and Human Resources
Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Ensure integrated and coordinated governance and management oversight of public entities and statutory professional councils Handbook for departmental representatives serving on public health entities boards and statutory professional councils implemented Handbook for departmental representatives serving on public health entities boards and statutory professional councils produced. Handbook for departmental representatives serving on public health entities boards and statutory professional councils implemented. Public health entities boards and statutory professional councils’ governance functionality and effectiveness assessed. Public health entities boards and statutory professional councils’ governance functionality and effectiveness monitored Implement eHealth Strategy of South Africa through the development of patient information systems eHealth Strategy 2020 – 2025 published eHealth Strategy 2020 – 2025 developed eHealth Strategy 2020 – 2025 implementation monitored Implement an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the Health Sector Strategy NHI Phase 1 Evaluation Conducted NHI Phase 1 evaluation report published NHI Phase 1 evaluation results disseminated NHI M&E Framework developed NHI Implementation monitored

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Plan, develop and manage Human Resources for Health (HRH) in South Africa National Human Resources for Health (HRH) Strategy published HRH Strategic plan drafted HRH Strategic plan published HRH Strategic plan monitored HRH Strategic plan reviewed Number of PHC facilities having revised organisational structures as per normative guides New Indicator All PHC facilities with revised organizational structures as per normative guides 10% of PHC facilities fully staffed as per the approved organizational structures 35% of PHC facilities fully staffed as per the approved organizational structures HR Regulations for Section 52 of the National Health Act of 2003 developed and implemented HR Regulations for section 52 of the National Health Act of 2003 drafted HR Regulations under section 52 of the National Health Act of 2003 published for public comments HR Regulations for section 52 of the National Health Act promulgated and implementation commenced

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Plan, develop and manage Human Resources for Health (HRH) in South Africa Policy for community service reviewed New Indicator Policy for community service approved and Implemented for 2021 intake Policy impact measured and policy reviewed User manual developed containing standardised PERSAL data definitions PERSAL data structures implemented to facilitate data clean up completed by 9 provincial DoH Not Applicable

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Increase production of Human Resources for Health to strengthen capacity in the health system through the implementation of the expanded clinical training platform that is Primary Health Care oriented Number of Cuban trained medical students placed for their final year training at South African universities All students returning from Cuba during 2018/19 placed for final clinical training in the local medical schools 650 Cuban trained medical students placed for their final year training at South African universities 720 Cuban trained medical students placed for their final year training at South African universities 370 Cuban trained medical students placed for their final year training at South African universities Improve the Human resource planning by strengthening the placement process for medical interns and community service personnel Percentage Medical Interns and Community service personnel who studied at South African universities allocated in health facilities 100 % of South African Medical Interns and Community service personnel who studied at SA Universities allocated for placement by October for annual and April for asynchronous allocations respectively 100 % of South African Medical Interns and Community service personnel who studied at SA Universities allocated for placement by October

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. Number of nursing colleges accredited to offer the new qualification programmes 9/17 remaining colleges have customised curricula for the new 3yr Diploma in General Nursing New courses commenced in 2019 academic year All 10 nursing colleges accredited to offer the new nursing curriculum for the three year Diploma in General Nursing from 2020 academic year Progress reports of 10 nursing collages reviewed to ensure quality of the implementation of the new nursing qualification programmes (3 year diploma in general nursing; and Midwifery)

Strategic Objective Performance Indicator Estimated performance Medium-term targets 2018/19 2019/20 2020/21 2021/22 Strengthen Nursing Education Training and Practice Nursing Strategy approved New Indicator Nursing Strategy implementation monitored Not Applicable Eliminate the backlog of blood alcohol tests by 2019/20 Percentage backlog for blood alcohol tests eliminated 100% backlog for blood alcohol tests eliminated Eliminate the backlog of toxicology tests by 2019/20 Percentage backlog for toxicology tests eliminated 60% backlog for toxicology tests eliminated 70% backlog for toxicology tests eliminated 95% backlog for toxicology tests eliminated 100% backlog for toxicology tests eliminated

Programme 6: Health System Governance and Human Resources
Economic classification 2019/20 % Growth (from 2019/20 to 2020/21) 2020/21 % Growth (from 2020/21 to 2021/22) 2021/22 R'000 % Compensation of Employees 188,563 10 206,964 4 214,705 Goods and Services 120,734 5 126,884 133,702 Transfers 4,742,373 4,974,509 5,221,226 Capital 25,919 21 31,375 7 33,684 TOTAL 5,077,589 5,339,732 5,603,317 53

Programme 6: Health System Governance and Human Resources
9/21/2019 Ear Marked Funds, and Conditional Grants Sub Programme Item 2019/20 (R ‘000) Ear marked CG Health Information, Research, Monitoring and Evaluation Health Information Systems Programme 14,951 Health Systems Trust 16,780 Human Resources for Health Health Professionals Training and Development Cond Grant 2,940,428 Public Entities Management and Laboratories Office of Health Standards Compliance 136,471 National Health Laboratory Services 785,497 SA Medical Research Council 686,666 SA Health Products Regulatory Authority 183,274 Traditional Medicines 5,000 Council for Medical Schemes 5,987 Forensic Chemistry Laboratories 158,835 Compensation Commissioner for Occupational Diseases 68,694 TOTAL 2,062,155 54

SUMMARY OF DIRECT AND INDIRECT CONDITIONAL GRANT ALLOCATIONS

Conditional Grants Direct Allocations
9/21/2019 Conditional Grants Direct Allocations Direct Grants 2019 MTEF Allocations 2019/20 2020/21 R'000 Health Prof Training and Dev Grant 2,940,428 3,102,152 3,272,770 National Tertiary Services Grant 13,185,528 14,068,863 14,842,650 Comprehensive HIV and AIDS, TB & COS 22,038,995 24,408,471 27,752,587 HIV/AIDS Component 19,963,270 22,195,284 24,518,748 TB Component 485,300 511,989 540,151 Community Outreached Services Component 1,500,000 1,584,000 2,582,500 Malaria Component 90,425 117,198 111,188 Health Facility Revitalisation Grant 6,006,973 6,359,557 6,858,024 Human Papillomavirus (HPV) 211,200 222,816 235,071 Human Resources Capacitation Grant 605,696 1,063,083 1,127,227 TOTAL 44,988,820 49,224,942 54,088,329 56

Conditional Grants Indirect Allocations
9/21/2019 Conditional Grants Indirect Allocations Indirect Grant 2019 MTEF Allocations 2019/20 2020/21 2021/22 R'000 NHI Components 1) Health Facility Revite Component 1,136,411 1,595,816 1,562,088 2) Non-Personal Services Component 758,000 832,000 858,860 CCMDD 420,000 476,000 483,280 Ideal Clinic Component 23,000 26,000 27,430 Information Systems 315,000 330,000 348,150 Medicine Stock Surveillance System 143,000 150,000 158,250 Health Patient Registration System 172,000 180,000 189,900 3) Personal Services Component 639,288 783,000 915,068 HP Contracting Current Model (contr - In) 289,288 305,198 321,053 GP Contracting - Capitation 200,000 211,000 Mental Health Services 100,000 125,000 Other priority services (Oncology) 152,802 233,015 Total NHI Indirect Grant 2,533,699 3,210,816 3,336,016 57

CONCLUSION National DoH Annual Performance Plan 2019/ /22 is founded on government’s 2030 vision outlined in the National Development Plan 2030. The Department will continue to work towards improving equity, quality and access to healthcare through the implementation of the National Health Insurance policy of South Africa commencing 2019/20 financial year.

Annual Performance Plan 2019/ /21

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Annual Performance Plan 2019/ /21

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