1. Province of the Eastern Cape Department of Health Select Committee on Finance 2 nd Quarter Spending on Conditional Grants and CAPEX 13 November 2007

2. The Department received an adverse opinion from the Auditor – General The areas of concern revolved around Financial and Human Resource management / control In response to that, the Department is implementing an “Audit Intervention Process”, driven by Finance and Human Resource Turnaround Project Plans approved by Provincial Treasury

3. CONDITIONAL GRANTS Grant 03/0404/0505/0606/0707/08 R'000 NTSG 195,504 272,036 353,022 374,203 428,912 HPTD 79,873 97,464 127,566 133,392 133,944 Comprehensive HIV&AIDS 38,934 98,970 159,005 232,021 233,204 Forensic Pathology Services 1,000 - 8,866 91,867 68,135 Hosp Revitalization 90,751 116,354 147,732 125,071 246,750 Prov Infra Grant 150,000 TOTAL 406,062 584,824 796,191 956,554 1,260,945 Percentage growth44.02%36.14%20.14%31.82* * The department received for the first time, a portion of the Provincial Infra Grant

4. 2007/08 Conditional Grants Appropriated Budget Total Expenditure up to 30 Sept 2007% Spent R'000 % Comprehensive HIV & AIDS233,20496,36141.3 Forensic Pathology Services68,13548,91071.8 Health Professions Training & Development133,94449,33336.8 Hospital Revitalization246,75093,06937.7 National Tertiary Services428,913165,22938.5 Provincial Infrastructure Grant 150,00075,160 50.1 TOTAL1,260,945528,06241.7

5. 2 : EXPENDITURE ANALYSIS: CONDITIONAL GRANTS HIV & AIDS grant was under-spent by 8.3%. Forensic Pathology Grant was over-spent by 21.8% HPTD Grant was under-spent by 13.2% Hospital Revitalization Grant was under-spent by 12.3% National Tertiary Services Grant was under-spent by 11.5% Provincial Infrastructure Grant was on track at 50.1%

6. The HIV & AIDS Conditional Grant was under-spent by 8.7% as at 30 September 2007. The major reason for the under-expenditure was as follows: –Due to various reasons, the business plan was only approved at the end of June 2007. This meant that the implementation of planned activities could only commence in earnest in the 2 nd Quarter –The main challenges relate to provision of tests through NHLS and supply of ARV drugs for infected people. Activities were planned for 40 000 patients/ recipients. However, to date the headcount is 35 376. Projecting forward, one can see that there will be a gross shortage of funding to carry out this critical activity.

7. As at 30 September 2007, the grant was over-spent by 21.8%. The reasons for the over-expenditure were the following: -Due to the contractual obligation to the project manager (Coega Development Corporation) for the 2006/07 financial year, the Department had to transfer R 31 Million to the company in the current financial year. -A roll-over request for 2006/07 unspent funds (R 51,853 Million) has been lodged with the National Department of Health and Provincial Treasury. Achievements thus far are: –All personnel have been appointed –Vehicles have been leased from Fleet Africa with another 22 expected by January 2008. –11 mortuaries are already under construction with a further 3 due to start construction in November.

8. On a benchmark of 50%, the Health Professionals Training & Development (HPTD) grant under-spent by 13.2% due to the following reason: –Transfer of funds to Walter Sisulu University for the 2nd quarter were withheld due to non-submission of progress reports –Service Level Agreement with Rhodes University for Doctorate in Pharmacy Programme was only finalised in October. Achievements thus far include: –R7 Million worth of capital equipment procured for eHealth –7 students are on the Doctorate in Pharmacy Programme

9. The grant was under-spent by 11.5% from benchmark of 50%. The main contributor is capital spending under MTS for Oncology Services. This is driven by National Department of Health. Achievements thus far are: –The launch of a Drug down-referral programme in East London to strengthen access to drugs –The launch of a Clinicians’ Forum to strengthen involvement of Clinicians in Tertiary Services Planning, and to improve quality of care –Port Elizabeth Hospital Complex has received Theatre and Radiotherapy equipment. –East London Hospital has received the Cobalt Source necessary for the treatment of cancer patients –Tertiary cases managed exceeded the set targets for OPD headcounts, Inpatient days and Inpatient separations The main challenge is to secure funding in order to extend Oncology Services to Nelson Mandela Academic Hospital

10. The Revitalization Grant under spent by 12.3%. The main reasons are: –The Gateway Clinic in St Patrick’s Hospital could not take off due to the Municipality not approving the issue of land timeously. –Tenders for the building of Doctors’ houses at Madzikane KaZulu Memorial Hospital could not be sold because of the industrial action. This delayed the commencement of construction Construction in the following hospitals is underway and on schedule: Frontier, St Lucy’s, Madzikane KaZulu, St Patrick’s and St Elizabeth. The main challenge is business cases which have not yet been approved. The impact is that revitalisation of Port Elizabeth Provincial, Dora Nginza, Livingstone, Cecilia Makiwane, Frere and Mthatha General Hospitals will not take place. This is of great concern as these hospitals are a provincial priority with respect to the readiness of the Department for the 2010 World Cup

11. INFRASTRUCTURE (Equitable Share and Conditional Grants) 03/0404/0505/0606/0707/08 R'000 Buildings and other fixed structures 361,858 343,887 433,242 469,909 632,247 Machinery and equipment 163,808 26,782 21,265 115,425 274,617 TOTAL 525,666370,669 454,507 585,334 906,864 Percentage growth-29,49%36.14%28.78%54.93* * The department received for the first time, a portion of the Provincial Infrastructure Grant

12. 2007/08 Infrastructure Appropriated Budget Expenditure as at 30 Sept 2007% Spent Total Expenditure906,864 362,481 40.0

13. I Capital expenditure at 40% is 10% below the benchmark of 50%. This is due to Revitalisation under-expenditure (dealt with under Revitalisation) Expenditure for Infrastructure as at 31 October has risen to 65% Works orders to the value of R30m have been issued and contractors are on site for the following projects; Alfred Nzo; Mthatha; Chris Hani; East London and Humansdorp. Achievements 11 new clinics built with a further 49 being upgraded 60 clinics have been provided with essential equipment

14. A formal Monitoring & Evaluation (M & E) system is functional and being improved upon where deemed necessary. M & E practitioners have been recruited to populate the M & E structures at Head Office. A roll out plan for the Districts and Complexes is currently being carried out. Monthly reporting on service delivery and programme implementation as well as site visits are done. Budget & expenditure review meetings take place fortnightly

15. Conclusion The department is confident that all allocated funding will be spent by the end of the financial year Close monitoring of expenditure is a priority