1. Department of Health Presentation to the Portfolio Committee on Health Annual Performance Plan and Budget 2012/13-2014/15 18 April 2012

2. HEALTH SECTOR PLAN Government adopted an outcome-based approach to service delivery The Health sector is responsible for the achievement of Outcome 2 : A long and healthy life for all South Africans Four Identified outputs: –Output 1 : Increasing Life Expectancy –Output 2 : Decreasing Maternal and Child mortality –Output 3 : Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis –Output 4 : Strengthening Health System Effectiveness

3. INCREASED LIFE EXPECTANCY STRENGTHENING HEALTH SYSTEM EFFECTIVENESS IMPROVED ACCESS TO HUMAN RESOURCES FOR HEALTH INTER- SECTORAL ACTION FOR SOCIAL DETERMI- NANTS OF HEALTH IMPROVED QUALITY OF SERVICES NATIONAL HEALTH INSURANCE IMPACT OUTCOMES OUTPUT IMPROVED FINANCIAL MANAGE MENT INPUTS PRIMARY HEALTH CARE ORIENTED SERVICE DELIVERY HEALTH INFORMA- TION IMPROVED ACCESSS TO HEALTH FACILITIES HEALTH SECTOR NSDA 2010 - 2014 Reduced Maternal and Child mortality rates Reduced burden from HIV&AIDS and TB (Mortality and Morbidity) Reduced burden from non- communicable diseases Reduced burden from violence and injury Primary Health Care Oriented Service Delivery Quality of services Human Resources for Health Health Infrastruc ture and Health Care Technolo gy Financial manage- ment National Health Insurance Health Informa - tion Inter - sectoral action for social de - terminants of Health

4. 4 VISION AND MISSION VISION Long and healthy life for all South Africans MISSION 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.

5. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 – 2014/15 PREPARATION FOR THE IMPLEMENTATION OF NHI KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE:  Preparation of the legal framework for the establishment of the NHI fund 2012/13 Draft NHI legislation for public consultation 2013/14 NHI Bill tables to parliament 2014/15 Relevant regulations developed  Phased implementation of NHI – initiating NHI pilots in 10 selected Districts during 2012/13

6. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 201/15 SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE:  Increase the number of Medical Male Circumcisions to 600 000 during 2012/13 and 800 000 during 2012/13 and 1 000 000 during 2014/15  Increase the HCT uptake rate and increase the number of HIV tests done annually – 18 million 2012/13, 20 million during 2013/14 and 22 million during 2014/15

7. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 SCALE UP THE COMBINATION OF TREATMENT INTERVENTIONS TO REDUCE NEW HIV INFECTIONS SCALE UP THE COMBINATION OF TREATMENT INTERVENTIONS TO REDUCE NEW HIV INFECTIONS KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Number of new patients initiated on Antiretroviral Therapy (ART) are targeted at between 500 000 to 550 000 annually during 2012/13 and 2014/15 Increasing the proportion of PHC facilities implementing nutritional intervention for People living with HIV and AIDS and TB from 80% in 2011/12 to 100 % in 2014/15

8. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Maintain the percentage of children under 1-year of age fully immunised at 90% throughout the MTEF period Maintain the measles immunisation coverage rate of 90 % throughout the MTEF period Increasing the Vitamin Supplementation coverage among children 12 to 59 Months from 40% in 2011/12 to 55% in 2014/15

9. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE:  School Health services with a focus on : Providing integrated school health services at 80% of quintile 1 schools during 2012/13, 90% in 2013/14 and 95% in 2014/15 Assessing grade 1 learners in quintile 1 and 2 schools targeting 680 000 learners in 2012/13 and this will be increased to 807 500 learners during 2014/15 Assessing grade 8 learners in quintile 1 schools targeting 65100 learners in 2012/13 and this will be increased to 156 240 learners in 2014/15

10. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 TO REDUCE MATERNAL MORTALITY KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Maintain ante – natal coverage rate of 100 % throughout the MTEF period Increasing the antenatal coverage before 20 weeks from 37% in 2010/11 to 65% in 2014/15 Increasing the proportion of deliveries taking place in health facilities under the supervision of trained personnel from 86.5% in 2010/11 to 96% in 2014/15 Increasing the percentage of mothers and babies who receive post-natal care within 6 days of delivery from 30% in 2010/11 to 82% in 2014/15

11. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 IMPROVED ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH IMPROVED ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Increasing the cervical cancer screening coverage from 52% in 2010/11 to 58% by 2014/15 Increasing the couple year protection rate from 32% in 2010/11 to 37 % by 2014/15 Contraceptive services provided in 80% of health facilities in 2012/13, 85% in 2013/14 and 90% in 2014/15

12. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 EXPAND PMTCT COVERAGE TO PREGNANT WOMEN KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: 98% of pregnant woman to be tested for HIV Increasing the antenatal clients initiated on HAART rate from 79.4% in 2010/11 to 95% in 2014/15 Decreasing the percentage of babies testing PCR positive 6 weeks after birth from 3.5% in 2010/11 to 2% in 2014/15

13. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 TO REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Increasing the TB cure rate from 72 % in 2010 to 90% in 2014/15. Reducing the TB treatment defaulter rate from 7% in 2010/11 to less than 5% in 2014/15

14. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Increasing the percentage of HIV positive patients screened for TB from 71% in 2010/11 to 90% in 2014/15 Increasing the percentage of TB patients tested for HIV from 68% in 2010/11 to 90% in 2014/15 Increasing the percentage of TB/HIV co-infected patients receiving Cotrimoxazole Prophylaxis Therapy from 71% in 2010/11 to 100% in 2014/15 Increasing the number of HIV positive patients receiving Isoniazid Preventative Therapy (IPT) from 210 396 2010/11 to 500 000 in 2014/15

15. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 RE- ENGINEERING OF PRIMARY HEALTH CARE KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Implementation of community based services in each district by establishing Family Health Teams ; 500 in 2012/13, 1000 in 2013/14 and 2000 in 2014/15 Improve access to primary health care services, with an increased utilisation rate of 3.2 visits by 2014/15 Implementation of the Districts Specialist teams ; 10 Districts in 2012/13, additional 20 Districts in 2013/14 with a total of 50 Districts in 2014/15 Improve the percentage of Primary Health Care Facilities that receive a monthly supervisory visit, from 68.4% in 2010/11 to 90% in 2014/15

16. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 FUNCTIONAL DISTRICT HEALTH SYSTEM KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Revision of the District Health System Policy Development of a Intersectoral Framework for addressing the Social Determinants of Health Support the development of 52 Districts Health plans aligned to the Health Sector priorities.

17. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Decreasing the incidence of malaria from 0,62 per 1000 population at risk in 2010/11 to 0.34 per 1000 population at risk in 2014/15; Chronic care whether from communicable or non-communicable causes will be aligned and a single chronic care model will be rolled out to 10 districts by 2014/15 Introduce legislation on alcohol advertising and enacted regulations on salt content in food products To strengthen the quality of Environmental Health Services, norms and Standards will be developed and implemented by 2014/15

18. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Develop and implement a national infrastructure plan in conjunction with provincial infrastructure units – updated on an annual basis Maintenance of existing prioritised nursing colleges and schools and the development and implementation of an infrastructure master plan for nursing colleges and schools. Implementation, configuration and maintenance of the Health Infrastructure Project Management Information System

19. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) All five tertiary hospitals should completed the feasibility study and issued the Request for proposals by March 2013. These are: Nelson Mandela Academic (Eastern Cape); Chris Hani Baragwanath (Gauteng); Dr. George Mukhari (Gauteng); Limpopo Academic (Limpopo); King Edward VIII (KwaZulu-Natal);

20. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 EFFICIENT MANAGEMENT OF HEALTH CARE TECHNOLOGY KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Commence with the implementation of the Health Technology Strategy Revision of the Essential Equipment lists for all levels of care Finalisation of the standards for the use and maintenance of Health Care Technology

21. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: Norms and Standards for Health Workforce for Primary and Secondary Health Care developed and gap analysis conducted Standardized training program for Community Health Workers in partnership with FET and HWSETA

22. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2012/13 to 2014/15 IMPROVE THE QUALITY OF HEALTH SERVICES KEY STRATEGIC INTERVENTIONS DURING 2012/13 to 2014/15 WILL INCLUDE: During 2012/13 the Office of Health Standards compliance will be established Patient satisfaction will be monitored and a patient satisfaction surveys will be conducted in 90% of the 400 public hospitals during 2012/13 and 100% during 2013/14 and 2014/15 75% of Public complaints will be resolved within 25 days during 2012/13, increasing it to 80 % during 2013/14 and 2014/15 20% (800) of the 4,333 public health facilities will be assessed for compliance with the 6 priorities of the core standards. This figure grows to 40% in 2013/14 and to 60% by 2014/15;

23. RESOURCE ENVELOPE FOR IMPLEMENTING OF THE NATIONAL DOH PLANS FOR 2012/13 to 2014/15

24. PROGRAMME ALLOCATIONS FOR 2012/13 - 2014/15 Programmes R’ million 11/1212/1313/1414/15 Administration326358382398 National Health Insurance, health Planning and System Enablement 161316526670 HIV/AIDS, TB, Maternal and Child Health 8,0279,29311,08112,816 Primary Health Care Services730879397 Hospital, Tertiary Health Services and Human Resource Development 15,96316,92818,01719,232 Health Regulation and Compliance Management 525575614645 Total Budget Allocation25,73227,55730,71333,858

25. ECONOMIC CLASSIFICATIONS ALLOCATIONS FOR 2013/14 TO 2014/15 Economic Classification11/1212/1313/1414/15 Compensation of Employees 424479507528 Goods and Services785788816865 Total Transfers & Subsidies 24,48926,26229,36032,435 Payment of Capital Assets 332930 Total25,73227,55830,71333,858

26. EXPENDITURE TRENDS The Department’s expenditure grew from R16,4 billion in 2008/09 to R25,9 billion in 2011/12 at an average annual rate of 16,5 percent. Over the Medium Term period, expenditure is expected to grow to R33,9 billion, at an average annual rate of 9,25 percent. The increase in both periods is driven largely by transfers to provinces for the conditional grants, with the main increase being on the HIV and AIDS and the introduction of NHI grant and Nursing Colleges grant.

27. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 The Budget includes new allocations of R97,6 million for 2012/13, R618,4 million for 2013/14 and R1,9 billion for 2014/15.

28. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 10 million per annum for the forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs. 20 million per annum for higher accommodation costs of the renovated head-office of the Department. Costs associated with annual wage increases (3 million per annum for the Medical Research Council and 10 million per annum for the Department). R100 million, R150 million and R200 million to nursing colleges to plan and coordinate the upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit.

29. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 R834 million for the HIV and AIDS conditional grant for the rapidly growing treatment programme (lower threshold cd4 350) and to strengthen prevention programmes. R128 million on Hospital Revitalisation grant to start making provision for first of five large hospital PPP projects. R150 million, R350 million and R500 million to cover the cost of NHI pilots. R189 million, R231 million and R216 million increases for effects of wage increases in National Tertiary Services Grant (NTSG).

30. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 Funds earmarked for policy priorities R67 million, R70 million and 73.2 million for the forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs. R48.5 million, R40.1 million and R42.5 million to establish the Office of Standards Compliance and support its inspectorate, certificate of compliance and ombudsman functions. R135 million in 2012/13, R140 million in 2012/13 and R148.4 million in 2013/14 to increase the distribution of condoms. R27 million, R23 million and R24.4 million for infrastructure management to build up capacity in the department to oversee the hospital revitalisation projects and to support planning and transaction advisor costs for large private public partnership projects.

31. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 Funds earmarked for policy priorities continue R7 million, R9 million, and R9.6 million for health technology to support provincial upgrading of engineering workshops and equipment audits and to develop equipment packages and systems for health technology. R10 million to develop improve hospital tariff schedules linked to case mix for use by provinces and the Road Accident Fund, including improved uniform patient fee structure and developing diagnosis related groups (DRG) system. R5 million per annum to plan and coordinate the second phase of upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit R10 million per annum for district health information systems, improving data quality analysis and reporting

32. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 Funds earmarked for policy priorities continue R8.3 million, R10,2 million and R10,8 million for the Health Systems Trust to support health systems research activities including the annual health review and district health barometer. R2 million per year to publish standardised annual health statistics in the new annual health statistics publication to facilitate performance auditing and better inform the public and health service providers. R19 million, R21.4 million and R22.6 million for the Compensation Commissioner for Occupational Diseases to address backlogs in compensation, improve systems and address problems identified in audit reports.

33. MEDIUM TERM ALLOCATION FOR 2012/13 – 2014/15 Funds earmarked for policy priorities continue R9 million, R10.3 million and R11 million to establish a unit to monitor and support provincial finances and improve audit outcomes. R31.6 million, R33.4 million and 35.4 million to establish SA Health Products regulatory authority and IT system.

34. INFRASTRUCTURE SPENDING Three conditional grants for health infrastructure: Hospital Revitalisation, Health Infrastructure and Nursing College grants. Hospital Revitalisation Grant allocation over the MTEF is R4.1 billion, R4.2 billion and R4.6 billion. Health Infrastructure Grant allocations over the MTEF of R1.6 billion, R1.7 billion and R1.8 billion and will focus on maintenance of institutions and smaller upgrading projects in primary care institutions and hospitals. Nursing Colleges grant is a new grant to upgrade nursing colleges. Allocation over the MTEF is R100 million, R150 million and R200 million.

35. CONDITIONAL GRANTS ALLOCATIONS 2012/13 - 2014/15 GrantSchedul e 2012/13 R’000 2013/14 R’000 2014/15 R’000 Health Infrastructure Grant 41 620 9811 721 1341 836 402 Health Professions and Development Grant 42 076 1762 190 3662 321 788 National Tertiary Services48 878 0109 620 35710 168 235 Comprehensive HIV and AIDS 58 762 84810 533 886 12 211 322 Hospital Revitalization Grant 54 103 5954 183 9334 556 297 National Health Insurance5150 000350 000500 000 Nursing Colleges5100 000150 000200 000 Total25 691 610 28 749 676 31 794 044

36. CONDITIONAL GRANTS ALLOCATIONS 2012/13 - 2014/15 Schedule 4 grants: specifying allocations to provinces to supplement the funding of programmes or functions funded from provincial budgets; Transfer payments cannot be withheld based on non performance or compliance, however, the new Division of Revenue Grant allows a 5% withholding while interventions are put in place. Grants included are: - National Tertiary Services, - Health Professions Training and Development, - Health Infrastructure Grant.

37. CONDITIONAL GRANTS ALLOCATIONS 2012/13 - 2014/15 Schedule 5 : specifying specific-purpose allocations to provinces. Grants included are: - HIV and AIDS grant – Hospital Revitalization Grant. - National Health Insurance Grant. - Nursing Colleges Grant. Schedule 5 grants may be withheld for non performance and or compliance. Interventions must also be put in place for compliance.

38. CONCLUSION National DoH Annual Performance Plan 2012/13-2014/15 reflects interventions to improve the health system and health outcomes for all South Africans. A sector wide plan will be produced by end of May 2012, which will reflect the contribution of the entire sector - National and 9 Provincial DoH - to the achievement of the Health Sector NSDA outcomes