1. PRESENTATION OF THE NATIONAL DEPARTMENT OF HEALTH’S ANNUAL REPORT 2004/05 AND THE STRATEGIC PLAN & BUDGET 2006/07-2008/09 NATIONAL COUNCIL OF PROVINCES 09 MAY 2006

2. 2 FLOW OF PRESENTATION VISION & MISSION LEGISLATIVE MANDATES KEY PRIORITIES, 2004-2009 (THE 10 POINT PLAN OF THE NHS) SUMMARY OF ACHIEVEMENTS AND KEY CHALLENGES AS REFLECTED IN THE NDOH ANNUAL REPORT 2004/05

3. 3 FLOW OF PRESENTATION PRIORITIES FOR 2006/07 AS REFLECTED IN THE NDOH STRATEGIC PLAN FOR 2006/07- 2008/09 NDOH BUDGET FOR 2006/07-2008/09 CONCLUSIONS

4. 4 VISION & MISSION VISION AN ASSESSIBLE, CARING AND HIGH QUALITY HEALTH SYSTEM MISSION TO IMPROVE HEALTH STATUS THROUGH PREVENTION OF ILLNESS & DISEASE AND THROUGH THE PROMOTION OF HEALTHY LIFESTYLES AND TO CONSISTENTLY IMPROVE THE HEALTH CARE DELIVERY SYSTEM BY FOCUSING ON ACCESS, EQUITY, EFFICIENCY, QUALITY AND SUSTAINABILITY

5. 5 LEGISLATIVE MANDATES 49 ACTS MENTIONED IN THE ANNUAL REPORT, INCLUDING: THE CONSTITUTION OF THE REPUBLIC NATIONAL HEALTH ACT MENTAL HEALTH CARE ACT PUBLIC FINANCE MANAGEMENT ACT MEDICINES & RELATED SUBSTANCES ACT MEDICAL SCHEMES ACT

6. 6 KEY PRIORITIES, 2004-2009 IMPROVE GOVERNANCE & MANAGEMENT OF THE NHS PROMOTE HEALTHY LIFESTYLES CONTRIBUTE TOWARDS HUMAN DIGNITY BY IMPROVING QUALITY OF CARE IMPROVE MANAGEMENT OF COMMUNICABLE & NON- COMMUNICABLE DISEASES STRENGTHEN PHC, EMS AND HOSPITAL SERVICE DELIVERY SYSTEMS

7. 7 KEY PRIORITIES, 2004-2009 (CONTD) STRENGTHEN SUPPORT SERVICES HUMAN RESOURCE PLANNING, MANAGEMENT AND DEVELOPMENT PLANNING, BUDGETING AND MONITORING & EVALUATION PREPARATION AND IMPLEMENTATION OF LEGISLATION STRENGTHEN INTERNATIONAL RELATIONS

8. 8 BUDGET PROGRAMME STRUCTURE OF THE NDOH IN 2004/05 PROGRAMME 1: ADMINISTRATION (OFFICE OF MINISTER. DEPUTY MINISTER,LEGAL, PLANNING, COMMUNICATION) PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES (DISTRICTS; HEALTH PROGRAMMES; IHL; M/E) PROGRAMME 3: HEALTH SERVICE DELIVERY (HOSPITALS; COMMUNICABLE & NCDs; HR)

9. 9 KEY ACHIEVEMENTS 2004/05: PROGRAMME 1 AS REFLECTED ON P22 A NUMBER OF BILLS WERE TABLED DURING THE 04/05 FINANCIAL YEAR NATIONAL HEALTH ACT SIGNED INTO LAW COURTS UPHELD RIGHT OF DOH TO SET POLICY RE: LICENSING OF DESPENSERS & SINGLE EXIT PRICING RANGE OF PUBLICATIONS, RADIO AND TV INTERVIEWS TO ENHANCE COMMUNICATION (PP24-25)

10. 10 KEY ACHIEVEMENTS 2004/05: PROGRAMME 1 (CONT) IMPROVED INTEGRATED PLANNING WITH PROVINCES & DISTRICTS REVIEW OF ANNUAL REPORTS OF PROVINCES PACKAGES OF CARE (PHC, DISTRICT HOSPITALS AND TERTIARY CARE) HAVE BEEN COSTED INTER-PROVINCIAL EQUITY ANALYSED

11. 11 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 66% OF HEALTH DISTRICTS PROVIDE FULL BASKET OF PHC SERVICES WITH INCREASING PHC UTILISATION (P 29) PROVINCES ARE MOVING TOWARDS FUNCTIONAL INTEGRATION USING A NATIONAL CHECKLIST ALL DISTRICTS HAVE STARTED TO USE THE NATIONAL DISTRICT HEALTH PLANNING GUIDELINES

12. 12 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 A NUMBER OF BI AND TRILATERAL AGREEMENTS HAVE BEEN SIGNED INCLUDING THOSE WITH IRAN, RWANDA, MALI, INDIA AND BRAZIL TO NAME A FEW (P 31) ADDITIONAL RESOURCES FROM DONORS HAVE BEEN MOBILISED E.G., R80M FROM THE ITALIAN GOVERNMENT

13. 13 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 30% OF HEALTH INSTITUTIONS HAVE A FUNCTIONAL HEALTH INFORMATION SYSTEM & MORE THAN 17% RECEIVE HEALTH BROADCASTS 12% OF HOSPITALS HAVE TELEMEDICINE FACILITIES SIGNIFICANTLY MORE BIRTHS AND DEATHS ARE BEING REGISTERED

14. 14 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 A NUMBER OF HEALTH REPORTS HAVE BEEN PUBLISHED (E.G., QUARTERLY REPORTS ON THE COMPREHENSIVE PLAN, ANTENATAL SURVEY, SADHS, CONFIDENTIAL INQUIRIES INTO MATERNAL DEATHS)

15. 15 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES STRATEGY EXPANDED TO ALL 53 HEALTH DISTRICTS 8 000 HEALTH PROVIDERS TRAINED (64% OF THOSE WHO PROVIDE SERVICES TO CHILDREN) 70% OF DISTRICTS REACHED IMMUNISATION COVERAGE OF 80% SCHOOL HEALTH SERVICES EXTENDED - 30% OF PROVINCES PROVIDE 100% OF PHASE 1 SERVICES

16. 16 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 80% OF PUBLIC HEALTH FACILITIES OFFER VCT & 60% OFFER PMTCT MORE THAN 347m MALE & OVER 1m FEMALE CONDOMS DISTRIBUTED BUSINESS CASES APPROVED BEFORE FUNDING FROM CONDITIONAL GRANT FOR HIV AND AIDS ARE DISBURSED TO PROVINCES – 97% OF FUNDS WERE USED

17. 17 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 NUMBER OF ACCREDITED SITES – 139 (AGAINST TARGET OF 113) 74 NGOs FUNDED WITH CLOSE MONITORING

18. 18 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 57% OF NEW SMEAR-POSTIVE CASES OF TB CURED AT THE FIRST ATTEMPT (TARGET IS 65%) 12% OF TB PATIENTS DEFAULT (TARGET IS 10%) 42% OF TB PATIENTS OFFERED VCT & 59% OF THESE ACCEPT

19. 19 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 USER-FRIENDLY SERVICE NORMS FOR PHC LAUNCHED PROCESS PUT IN PLACE TO STRENGTHEN THE NATIONAL COMPLAINTS CENTRE PRIORITY AREAS FOR QA TRAINING DEVELOPED

20. 20 KEY ACHIEVEMENTS 2004/05: PROGRAMME 2 ALL NEW PHARMACIES HAVE BEEN LICENSED WORK ON REVIEW OF HOSPITAL EDL BOOKS LARGELY COMPLETED 75% COMPLIANCE REACHED ON COMPLETION OF EXPEDITED APPLICATIONS FOR DRUG REGISTRATION WITHIN 9 MONTHS

21. 21 KEY ACHIEVEMENTS 2004/05: PROGRAMME 3 COVERAGE OF INDOOR RESIDUAL SPRAYING INCREASED TO 83% OF TARGETED HOUSES GOOD COLLABORATION WITH NEIGHBOURING STATES ACHIEVED 10 407 WHEELCHAIRS AND 4 547 HEARING AIDS DISTRIBUTED – BACKLOG ELIMINATED NO OF CATARACT SURGERIES EXCEEDED TARGET (1 039/M DONE)

22. 22 KEY ACHIEVEMENTS 2004/05: PROGRAMME 3 11% OF HOSPITALS ARE PART OF THE HOSPITAL REVITALISATION PROGRAMME CONDITIONAL GRANT FOR REVITALISATION OF HOSPITALS EFFECTIVELY MANAGED (BUSINESS CASES, REPORTS ETC) 60% OF HOSPITALS ADOPTED GUIDELINES TO IMPROVE MANAGEMENT

23. 23 KEY ACHIEVEMENTS 2004/05: PROGRAMME 3 DRAFT HR PLAN COMPLETED AND CONSULTATION PROCESS UNDERWAY WORK ON MID LEVEL WORKERS ADVANCED EG. MEDICAL ASSISTANTS CO-ORDINATION OF POLICY ON COMMUNITY CARE GIVERS WITH SOCIAL DEVELOPMENT COMPLETED ON MORE THAN 9 000 HEALTH WORKERS TRAINED TO IMPLEMENT THE COMPREHENSIVE PLAN

24. 24 KEY ACHIEVEMENTS 2004/05: PROGRAMME 3 IMPROVING EMPLOYEE RELATIONS WITHIN THE NDOH: 55% OF GRIEVANCES RESOLVED INTERNALLY 83% OF DISCIPLINARY HEARINGS FINALISED WITHIN 6 MONTHS

25. 25 CHALLENGES 2004/05 IMPLEMENTATION OF POLICIES WITHIN RESOURCE CONSTRAINTS RECRUITMENT & RETENTION OF HUMAN RESOURCES TB CONTROL REMAINS A CHALLENGE –- CURE RATE IS 56.7%

26. 26 CHALLENGES 2004/05 IMPROVEMENT OF EMERGENCY MEDICAL SERVICES REQUIRED FURTHER STEPS NEEDED TO IMPROVE SERVICES IN PUBLIC HOSPITALS

27. 27 BUDGET AND EXPENDITURE FOR 2004/05

28. 28 NATIONAL DEPARTMENT OF HEALTH: 2004/05 Appropriation per programme Programme 1: Administration - 94% Programme 2: Strategic Health Programme - 91% Condoms ordered but not delivered HIV/Aids Conditional Grant transferees withheld Programme 3: Health Services Delivery - 96% Laboratory equipment ordered but not delivered Conditional Grant transfers withheld

29. 29 KEY PRIORITIES FOR 2006/07 – 2006/07 STRAT PLAN DEVELOPMENT & IMPLEMENTATION OF SERVICE TRANSFORMATION PLANS IMPLEMENTATION OF THE NATIONAL HUMAN RESOURCES FOR HEALTH PLAN STRENGTHENING PHYSICAL INFRASTRUCTURE (PHC, HOSPITALS) IMPROVING QUALITY OF CARE PRIORITY HEALTH PROGRAMMES (HEALTHY LIFESTYLES, TB CRISIS MANAGEMENT PLAN, ACCELERATED HIV PREVENTION STRATEGY)

30. 30 DEVELOPMENT & IMPLEMENTATION OF SERVICE TRANSFORMATION PLANS ALL PROVINCIAL DOHs TO FINALISE SERVICE TRANSFORMATION PLANS BY MAY 2006 THESE WILL BE ANALYSED AND COLLATED INTO AN ANNUAL NATIONAL HEALTH PLAN FOR 2007/08 (IN TERMS OF SECTION 21(5) OF THE NHA OF 2003) EMS BEING STRENGTHENED TO REDUCE RESPONSE TIMES

31. 31 IMPLEMENTATION OF THE NATIONAL HUMAN RESOURCES FOR HEALTH PLAN WHO DECLARED 2006 AS HUMAN RESOURCES FOR HEALTH YEAR NATIONAL HR PLAN COMPLETED & LAUNCHED ON 7 APRIL (WORLD HEALTH DAY) SCOPES OF PRACTICE OF MID LEVEL WORKERS FINALISED

32. 32 HR PLAN PREPARATIONS FINALISED FOR INITIATION OF CLINICAL ASSOCIATE PROGRAMME IN 2007 POLICY ON COMMUNITY CARE GIVERS FINALISED DISCUSSIONS WITH TREASURY AND DPSA ABOUT REMUNERATION LEVELS AND CONDITIONS OF SERVICE INITIATED

33. 33 STRENGTHENING PHYSICAL INFRASTRUCTURE (HOSPITALS & PHC) HOSPITAL REVITALISATION IS IN ITS 4 TH YEAR 4 HOSPITALS COMPLETED IN 2004/05 (MP, NW AND 2 IN NC) 45 HOSPITALS TO BE ENROLLED INTO THE PROGRAMME OVER THE NEXT 3 YEARS HOSPITAL IMPROVEMENT PLANS TO BE DEVELOPED BY EACH HOSPITAL IN 2006/07

34. 34 STRENGTHENING PHYSICAL INFRASTRUCTURE (HOSPITALS & PHC) PLAN FOR IMPLEMENTING MODERNISATION OF TERTIARY SERVICES TO COMMENCE IN 2006 BY SEPTEMBER 2006 ALL HOSPITAL CEOs WILL HAVE APPROPRIATE DELEGATIONS TRAINING PROGRAMME FOR CEOS COMMENCED PHC FACILITIES AUDIT TO BE CONDUCTED PER PROVINCE IN 2006, INCLUDING IDENTIFICATION OF FACILITIES REQUIRING ACCOMMODATION FOR STAFF REQUIRED PROFILE AND DISTRIBUTION OF CHC’S BY PROVINCE WILL BE COMPILED AND COSTED

35. 35 CLINICAL AUDITS WILL BE ROUTINELY MONITORED IN ALL TERTIARY HOSPITALS AND 25% OF LEVEL 2 HOSPITALS; COMPLAINTS MECHANISMS WILL BE ROUTINELY MANAGED IN ALL TERTIARY HOSPITALS AND 25% OF LEVEL 2 HOSPITALS; INFECTION CONTROL MANAGEMENT WILL BE EFFECTED IN ALL LEVEL 1 HOSPITALS AND CHCS AND ALL CLINICS; PLANNED PATIENT TRANSPORT DEPLOYED FLEET WILL INCREASE BY 10% IMPROVING QUALITY OF CARE

36. 36 STRENGTHENING PRIORITY HEALTH PROGRAMMES IN KEEPING WITH WHO-AFRO RESOLUTIONS AN ACCELERATED HIV PREVENTION PLAN WILL BE DEVELOPED TB CRISIS MANAGEMENT PLAN WILL BE IMPLEMENTED TO OBTAIN IMPROVEMENT OF 10% IN SMEAR CONVERSION RATES AND TB CURE RATES IN THE NELSON MANDELA METRO, AMATOLE DISTRICT, ETHEKWINI METRO AND CITY OF JOHANNESBURG ALL PROVINCES WILL DEVELOP DETAILED, CONTEXT SPECIFIC IMPLEMENTATION PLANS FOR THE HEALTH LIFESTYLES CA\MPAIGN INCLUDING, COMMUNITY-BASED HEALTH PROGRAMMES WILL BE IMPLEMENTED IN ALL 53 DISTRICTS & THE NUMBER OF HEALTH PROMOTING SCHOOLS WILL BE ESCALATED AND 60% OF SCHOOLS WILL IMPLEMENT THE SCHOOL HEALTH POLICY.

37. 37 RESOURCE ALLOCATION TO THE HEALTH SECTOR 2006/07-2008/09: NATIONAL DOH (INCLUDING PROVINCIAL CONDITIONAL GRANTS) PROGRAMMEADJUSTED APPROPRIATION MEDIUM-TERM EXPENDITURE ESTIMATES R’ 0002005/062006/072007/082008/09 ADMINISTRA TION 166 771188 067 195 467 205 914 STRATEGIC HEALTH PROGRAMMES 1 689 1762 105 2112 217 9762 330 915 HEALTH SERVICE DELIVERY 8 124 9178 907 5589 526 66910 083 100 HUMAN RESOURCES 57 535 69 160 75 020 82 834 TOTAL10 039 39911 269 99612 015 13212 702 763

38. 38 NATIONAL DEPARTMENT OF HEALTH

39. 39 NATIONAL DEPARTMENT OF HEALTH

40. 40 NATIONAL DEPARTMENT OF HEALTH

41. 41 NATIONAL DEPARTMENT OF HEALTH

42. 42 NATIONAL DEPARTMENT OF HEALTH

43. 43 NATIONAL DEPARTMENT OF HEALTH

44. 44 NATIONAL DEPARTMENT OF HEALTH

45. 45 RESOURCE ALLOCATION TO THE HEALTH SECTOR 2006/07-2008/09: PROVINCIAL DOHs (INCLUDE GRANTS) BUDG PROG ALLOCATION FOR THE 2006/07 FINANCIAL YEAR R’ 000ECFSGPKZNLPMPNCNWWC Admini- stration 256, 792188,551282,190211,139314,407192,01960,014146,656199,354 DHS 3, 052 765 1,308,2752,543,5625,437,8792,362,8971,491,165493,0641,825,7371,914,072 EMS 397, 098145, 070325, 100453,380270,830118,41672,863110,864278,999 Provincial Hospitals 2,169,097840,8532,785,0003,086,580601,924435,347294,491751,0711,336,078 Central Hospitals -556,0493,225, 1371,173,060493,397403,98233,67069,3802,086,517 Health Science 397,43191, 658241, 000448,856225,76591,2937,29095,988106,047 Support Services 32, 25560,313120,0019,560437,79238,766329,042113,08477,480 Health Facility Maintenan ce 587,26384,849871,861916,307339,921141,254815314,824324,946 TOTAL 6, 892,7013,249,61310,404,35111,736,7615,447,9332,912,2421,291,2493,427,6046,323,493

46. 46

47. 47

48. 48 RESOURCE ALLOCATION TO THE HEALTH SECTOR 2006/07-2008/09: NATIONAL AND PROVINCIAL DOHs (INCLUDING GRANTS) PROVINCIAL DOH (INCLUDING COND. GRANTS) ALLOCATION (R’ 000) EC 6 892 701 FS 3 249 613 GP10 404 351 KZN11 736 761 LP 5 447 933 MP 2 912 242 NC 1 291 249 WC 6 323 493 SUB-TOTAL51 685 947 NDOH (EXCLUDING COND. GRANTS) 1 100 000 TOTAL52 785 947

49. 49 CONCLUSION DESPITE MANY CHALLENGES THE DOH HAS SEEN PROGRESS IN HEALTH SERVICE DELIVERY IN 2004/05 (AND IN 2005/06) NDOH ORGANOGRAM TO BE EXPANDED IN 2006/07 TO INCLUDE A FURTHER 3 BRANCHES (WAS EXPANDED IN 2004/05 TO INCLUDE AN HR BRANCH) WITH GUIDANCE FROM THE MINISTER AND DEPUTY MINISTER NDOH WILL WORK HARD TO ENSURE ACHIEVEMENT OF 2006/07 TARGETS