MEC DR GWEN RAMOKGOPA PRESENTATION TO STANDING COMMITTEE ON APPROPRIATIONS AND PORTFOLIO COMMITTEE ON HEALTH Purpose Alignment in Planning budget and implementation Current status of projects in terms of performance and alignment coordination of the following areas ID: 740416
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REVIEW OF THE EFFECTIVENESS OF COORDINATION AND ALIGNMENT OF NATIONAL AND PROVINCIAL SPHERES OF GOVERNMENT IN THE DELIVERY OF HEALTH SERVICES
MEC: DR GWEN RAMOKGOPA
PRESENTATION TO STANDING COMMITTEE ON APPROPRIATIONS AND PORTFOLIO COMMITTEE ON HEALTHSlide2
Purpose
Alignment
in
Planning, budget and implementation Current status of projects in terms of performance and alignment /coordination of the following areas: Health Information systems Infrastructure projects Human Resource Expenditure Management and Devolution of Functions
Challenges
OUTLINE
2
2Slide3
OBJECTIVE
To brief the Standing Committee on Appropriations and Portfolio Committee on Health on the effective co-ordination and alignment of national and provincial government in the delivery of health services .
3PURPOSE Slide4
PLANNING AND BUDGET
4Slide5
GDOH LINKAGE WITH MTSF
STRATEGIC GOAL
LINKAGE WITH MTSF 2014 - 2019Improved health and well-being of all citizens, with an emphasis on children and women
Maternal, infant and child mortality reduced Maternal, infant and child mortality reduced Reduced rate of new infections and burden of HIV & AIDS and TBHIV & AIDS and Tuberculosis prevented and successfully managed
Increased equal and timely access to efficient and quality health care services, thereby preparing for roll-out of NHI
Re-engineering of Primary Health Care
Excellence in clinical and non-clinical functions Improved human resources for health Improved health management and leadership
Health care costs reducedEfficient Health Management Information System for improved decision making
Improved health facility planning and infrastructure delivery
5Slide6
STRATEGIC APPROACH REFLECTING ALIGNMENT
THE NDOH STRATEGIC GOALS
Prevent disease and reduce its burden, and promote health. Make progress towards universal coverage through the development of the NHI scheme, and improve the readiness of health facilities for its implementation. Re - engineer Primary Health Care (PHC) by: increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams and expanding school health services. Improve health facility planning by implementing norms and standards. Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms. Develop an efficient health information management system for improved decision making.
Improve the quality of care by setting and monitoring national norms, improving system user feedback, increasing safety in health care, and by improving clinical governance. Improve human resources for health by ensuring adequate training and accountability measures. The Gauteng Provincial Government [GPG] Strategic Approach Strengthening Health Systems and NHI rollout focusing on:Universal coverage through implementation of NHI;Expansion of primary health care including Re-engineering of PHC (Cuban Model)Improved hospital management;Improved quality of health care through compliance with National Core Standards (six key priority areas);Improved human resource development and management and finance and financial management;Improved Health infrastructure development and management; andImproved medico-legal services and reduced litigation.Prevention and reduction of the burden of disease, which include:
Improving maternal, infant and child health; intensify the fight against HIV and AIDS, TB;
Address Social Determinants of Health; Promotion of preventive health and healthy life styles; andStrengthen provision of mental health, substance abuse and detoxification services.
Transforming the health economy through localised production and procurement of goods and services.Modernisation of public service with focus on development and implementation of E-health programme.6Slide7
HOW GDOH BUDGET ALIGNS TO NATIONAL PRIORITIES
The Strategic Plan and APP of GDOH is aligned to National Health priorities
Budget is allocated in terms of priorities aligned to National Priorities, demonstration as follows:-Primary Health Care re- engineering - The primary health care is allocated a total of R6 billion in 2017/18
, which increases to R6.7 billion in 2019/20 to enhance service delivery outcomes for community health clinics and centres as well as other community-based servicesHIV/ AIDS- In the quest to intensify fight against HIV/AIDS and Tuberculosis (TB), the province will continue to implement the Anti-Retroviral (ARV) programme with the increased awareness programme of the test and treat, TB screening and treatment and will continue increase of male circumcisions and condom distribution. The budget allocated towards these priorities amounts to R3.7 billion in 2017/18, R4.2 billion in 2018/19 and R4.6 billion in the 2019/20 financial yearHealth infrastructure - The total budget made available for investment in infrastructure amounts to R1.6 billion in 2017/18, R865 million in 2018/19 and R3.3 billion over the MTEF
In finalization of the budget, there are national processes undertaken to ensure that there is alignment of priorities and funding across the sector, e.g. 10 x 10, National Health Council, Budget Bilaterals, etc.
National Health standardised Non- Negotiables to ensure that key priorities are funded and alignment to national priorities.
7Slide8
ALLIGNMENT IN REPORTING
ITEMSTATUS
RECEPIENTTreasury Instruction No.02 and 03 Cost Containment MeasuresImplemented and reported with effect from 30 November 2016 – requested Treasury to schedule a training workshop
Provincial and National TreasuryPFMA - section 40 (Cash Flow)Compiled yearly during March Provincial and National TreasuryIn-Year Monitoring reportA new template introduced by Treasury from 1 April 2016 and reporting is submitted on the 15th monthly Provincial and National Treasury
Non-negotiable report
Submitted monthly on the 15th monthly
National Health and Provincial TreasuryConditional Grants Expenditure and Variance reportsSubmitted monthly on the 15th monthly National Health and Provincial Treasury8Slide9
BUDGET ALLOCATION ALIGNED TO POLICY PRIORITIES – EQUITABLE SHARE
Goods and ServicesAdditional funding of R1.8 billion over the 2017 MTEF has been made available mainly to alleviate excess spending pressures on items - Medicine, Medical Supplies, Consumable Supplies and Fuel, Oil and Gas within Central Hospitals
Compensation of Employees Funding made available to comply with the 2015 PSCBC Resolution No.4 to Health Professionals qualifying for Danger AllowanceFurther allocation was made to recruit nurses to alleviate spending and reduce reliance on nursing agencies R642 million over the 2017 MTEF was also made available to improve conditions of services for health professionals in service delivery programmes 9Slide10
BUDGET ALLOCATION ALIGNED TO POLICY PRIORITIES –
GRANTS
The overall 2017 MTEF budget nominal growth is 6.5%Comprehensive HIV AIDS TB grant grows nominally from 16/17 to 19/20 by 12.7% to address the following:90/90/90 project (Know, Test and Treat)Universal Test and Treat (UTT)Pre exposure prophylaxisNational Adherence (Central Chronic Medicine Dispensing and Distribution, Central Dispensing Unit) National Tertiary Services The Nelson Mandela Children’s hospital is funded through this grant and receives R150, R200 and R291 millions over 2017 MTEFHuman Papillomavirus VaccineThe grant and its programme is introduced in 2018/19 and is aimed at reducing cervical cancer to girls aged 9 to 10 years
10Slide11
DEVOLUTION OF FUNCTIONS AND HR RESOURCE EXPENDITURE
11Slide12
EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITUREFactors putting pressure on personnel expenditure
Head Count Growth – Due to expansion of services, building of new facilities, categorisation of hospitals, etc.
Rising Medical staff salariesDeclassification of Principal & Chief Specialists (Clinical Heads of Unit & Department) from the Senior Management Services (SMS) Cadre . They receive same % increase as MMS and other low category employee having major impact for provinces such as Gauteng with high numbers of such employees.Delayed
payments of pay and grade progressionsPayment of leave gratuities (capped leave days)Turn around times for ill-health retirement applications Employee(s) not at workThree (3) months termination noticeLong service awardsOvertime in lieu of additional hours workedTranslation of Nurses that upgraded qualificationsIntroduction of new services that require additional staff
12Slide13
MEASURES BEING IMPLEMENTED TO ENSURE EFFECTIVE MANAGEMENT OF PERSONNEL EXPENDITURE
Strengthening of Controls regarding filling of postsRegular verification of employees
PERSAL clean upEnforcement of Accountability for filling of unfunded positionsFunded Posts to be set aside for absorption of staff including Community Services Health Professionals and Nursing staff by all hospitals OR Alternative the department should consider releasing them from contracts for themRegular monitoring and reconciliation of personnel numbersDevelopment of approved post list by the department and each CEO and programme managers to be provided with a list of approved posts for their branches and hospitals
13Slide14
The department has 5 health districts, 34 Hospitals, with appointed District Managers and CEO’s respectively.
New delegations in HR, Finance ,Clinical, Infrastructure and Quality management, will be devolved to District and institutional managers from 1
st
April 2017, for authority and accountability.Delegations above Heads will remain e.g. tenders above R500 000 will remain at Head Office.GDOH aligned HR delegations with the public service regulations 2016 and is under consideration by the Executive for approval The delegations will be done within the framework of relevant Acts and Regulations i.e. PFMA, Public Service Act, Procurement Regulations etc.The Head Office has initiated a process of personnel rationalisation in order to strengthen institutions and district offices where direct patient care takes place
DELEGATIONS AND DEVOLUTION OF FUNCTIONS
14
14Slide15
Ensuring alignment
in
health information systems
15Slide16
Alignment with National E-Health Strategic Priorities
10 National E-Health Strategic Priorities
GDoH ICT Branch Initiatives to support E-Health Priorities and Gauteng AlignmentStrategy and LeadershipImplementation of the Corporate Governance of ICT (Business ICT Steering Committee, ICT Charter, ICT Strategic Plan, ICT Structures, ICT Initiatives including Modernisation, E-Health and M-Health).
Stakeholder Engagement Compliance with the Normative standards and Interoperability Standards developed by the CSIRImproved stakeholder satisfaction rate through enhanced ICT Corporate Governance and complianceStandards and Interoperability
Provide integration, interfacing and verification of all GDoH ICT systems to achieve a single view of patient record through compliance to change processes.
Governance and Regulation
Provision of adequate Health Information System for management of patients and revenue
collection in preparation for NHI implementation. Enhance ICT Security through ICT Security plans to ensure protection of departmental information systems, manage ICT risk, minimization of litigation and ensuring adherence with regulatory and legislative frameworks.16Slide17
Alignment with National E-Health Strategic Priorities
10 National E-Health Strategic Priorities
Gauteng AlignmentInvestment, Affordability and SustainabilityInvested in ICT Infrastructure, connectivity and moving towards open source solutions to reduce the prohibitive costs of licensing.
Sustainable ICT Funding. Performance Measurement. Implement business continuity plans.Benefits RealisationMaximizing use of existing resourcesCapacity and Workforce
Improve support for institutions through building ICT capacity in all health facilities to ensure better management and support of ICT systems environment. Improve communication and knowledge management across health facilities. Permanent filling of ICT posts.
eHealth Foundations
A solid infrastructure, connectivity, registration of patients, has been laid and projects are geared to building a the full electronic record that is interoperable with the national electronic health record.
Increase the broadband network access in the department such that 100% of PHC facilities and hospitals have broadband network access and 100% of total staff has email access by 2019/20
Decrease health cost and increase availability and quality of care by developing and implementing eHealth and mHealth and solutions where they will optimise efficiency and improve quality of care of patients
17Slide18
10 E-Health Strategic Priorities
10 National E-Health Strategic Priorities
Gauteng AlignmentApplications and Tools to support Healthcare DeliveryAIATA Health; PASOP App; Response; Hear Screen; Antenatal Ultrasound; Stock Visibility;
Monitoring and Evaluation of the eHealth StrategyMPAT; engagements with National Health TeamAlignment with business through ICT Steering Committee, and the implementation of Corporate Governance of ICT, monthly and quarterly progress reporting to Risk and Audit Committee. To be achieved through the following; Maximize on return on investment, Increase Agility, Manage and Mitigate Risk and improve performance.18Slide19
Alignment in Health Information SystemsThe province uses MEDICOM system and the PAAB system for patient registration and billing. UPFS tariffs are loaded into the systems.GDOH utilises the DHIS to track and record patient load and activities.GDOH uses MEDSAS system for ordering and dispatching of medicines between all health facilities and provincial medical
depot. 19Slide20
OBJECTIVE
All business cases and Clinical Briefs for new Facilities are submitted for review by the National Department of Health Peer Review committeeProvincial Infrastructure Strategic in the form of User Asset Management Act (UAMP) submitted annually to NDOH
All Annual Implementation Plans (AIP) are submitted to NDOH Quarterly Review Meetings held for both Health Facilities Revitalisation Grant(HFRG) and In-kind Grant funded projectsImplementation Protocols Agreements is signed for the In-Kind Grant projectsCapacitation of the Provincial Infrastructure Unit a priority towards at the improving the alignment
95% of the 2016/17 Infrastructure Budget spent to dateThe finalisation of the National Health Infrastructure 10 year plan will improve the coordination.The adoption and implementation of the National Health Infrastructure Maintenance strategy will assist in the improvement of the alignment 20ALIGNMENT OF INFRASTRUCTURE PROJECT Slide21
2017/18 ALLOCATIONThe projection on maintenance only for continuations and statutory maintenance
HFRG include R69 000 00 for Incentive GrantProposal to use to pay for Medical Equipment's that could not be paid on time in 2016/17 financial year or
NB: ES-Equitable share; HFRG-Health Facilities Revitalisation Grant; EPWP-Expended Public Works Program21Sources
2017/18HFRG R 890 665 ES R 709 112 EPWP R 2 000 TOTAL
R 1 601 777 Slide22
2017/18 ALLOCATION2017/18 ALLOCATION
Sources
2017/18HFRG R 890 665
ES R 709 112 EPWP R 2 000 TOTAL R 1 601 777 2017/18 Breakdown 22Slide23
Funding Source23Slide24
2017/19 -2020 MTEF ALLOCATION
Sources
2016/17
2017/182018/19
2019/20
HFRG
R 777 818
R 890 665
R 845 975
R 893 350
ES
R 1 221 550
R 709 112
R 19 800
R 20 988
EPWP
R 2 000
R 2 000
R -
R -
TOTAL
R 2 001 368
R 1 601 777
R 865 775
R 914 338
24Slide25
2017/18 BUDGET ALLOCATION PER PROJECT STATUS25
PROJECT STATUS
HFRGESTOTAL
CancelledR 0R 0R 0IdentificationR 82 700R 407 607R 490 307Feasibility
R 132 000
R 9 700
R 141 700DesignR 206 628R 48 950R 255 578TenderR 114 200
R 156 245R 270 445
Construction
R 355 137
R 88 610
R 443 747
Retention
R 0
R 0
R 0
TOTAL
R 890 665
R 711 112
R 1 601 777Slide26
PROCESS FOLLOWED WHEN ALLOCATING
Priority on allocation
Commitment for construction, can not be cancelled without incurring fruitless and wasteful expenditure
Can be cancelled but will have to pay consultants up to tender stageCan be cancelled but will pay consultants up to Design stageImplications f or cancellationCan be cancelled with minimal costs
Can
be reviewed with no cost
26Slide27
HFRG City of Tshwane 2017/18
Project / Programme NameType of InfrastructureMunicipalitySource of FundingProject Status
Nature of Investment
Bronkhorstspruit FPS Mortuary - Construction of new Bronkhorstspruit FPS mortuary
FPS MortuaryCity of TshwaneHealth Facility Revitalisation GrantDesignNew infrastructure assetsGa-Rankuwa Nursing College - Upgrading and Renovations
Nursing CollegeCity of Tshwane
Health Facility Revitalisation Grant
Construction 51% - 75%
Upgrades and Additions
New Kekana Gardens Clinic-Construction new Clinic-ID
PHC - CLINIC
City of Tshwane
Health Facility Revitalisation Grant
Construction 51% - 75%
New infrastructure assets
27Slide28
HFRG City of Johannesburg 2017/18
Project / Programme NameType of InfrastructureMunicipalitySource of FundingProject Status
Nature of Investment
Charlotte Maxeke Nurses and Doctors Residence Block A,D &E-Upgrade of Nurses and doctors residence
AccommodationCity of JohannesburgHealth Facility Revitalisation GrantConstruction 76% - 99%Upgrades and AdditionsDiscoverers District Hospital
District HospitalCity of Johannesburg
Health Facility Revitalisation Grant
Design
Upgrades and additions
Finetown Clinic -Construction of new Finetown Clinic-ID
PHC - CLINIC
City of Johannesburg
Health Facility Revitalisation Grant
Construction 1% - 25%
New infrastructure assets
Hillbrow District Hospital- new district hospital
District Hospital
City of Johannesburg
Health Facility Revitalisation Grant
Design
Refurbishment and rehabilitation
Johannesburg FPS Mortuary- Demolition of old building and construction of new Johannesburg FPS mortu
FPS Mortuary
City of Johannesburg
Health Facility Revitalisation Grant
Construction 1% - 25%
New infrastructure assets
Lillian Ngoyi - Construction of new District Hospital
District Hospital
City of Johannesburg
Health Facility Revitalisation Grant
Design
New infrastructure assets
28Slide29
HFRG Ekurhuleni 2017/18
Project / Programme NameType of InfrastructureMunicipalitySource of FundingProject StatusNature of Investment
Bertha Gxowa Hospital - Medical
Equipment
District HospitalEkurhuleniHealth Facility Revitalisation GrantIdentifiedNew infrastructure assetsEkurhuleni District Health - Medical EquipmentCHC/ Clinic
EkurhuleniHealth Facility Revitalisation Grant
Identified
New infrastructure assets
Khayalami Hospital
– Revitalization
District Hospital
Ekurhuleni
Health Facility Revitalisation Grant
Feasibility
New infrastructure assets
Tambo Memorial Hospital - Complete revitalisation of entire Tambo Memorial Hospital
Regional Hospital
Ekurhuleni
Health Facility Revitalisation Grant
Identified
New infrastructure assets
Thelle
Mogwerane
Hospital (
Natalspruit
Hospital) - Staff residences
Accommodation
Ekurhuleni
Health Facility Revitalisation Grant
Construction 76% - 99%
New infrastructure assets
29Slide30
HFRG Sedibeng 2017/18
Project / Programme NameType of InfrastructureMunicipalitySource of FundingProject Status
Nature of Investment
Sebokeng
Hospital - Completion of worksRegional HospitalSedibengHealth Facility Revitalisation GrantConstruction 76% - 99%Upgrades and AdditionsRandgate Clinic Construction of new clinic
PHC - CLINICWest Rand
Health Facility Revitalisation Grant
Construction 76% - 99%
New Infrastructure Asset
30Slide31
PARTICIPATION IN NATIONAL GOVERNANCE STRUCTURES The following are just a few structures GDOH participates on:
National Health Councils and the NHC Technical Advisory Committee (NHC TAC)
Provincial Health CouncilNational Health Quarterly HAST National Review for finance and Non financial performanceGauteng Health Portfolio Committee
National District Health Services Committee CFO forum 31Slide32
CHALLENGES IMPACTING ON ALIGNMENT AND PROVISION OF EFFECTIVE HEALTH CAREUnderfunding of the Health Sector
– Leading to increase in AccrualsRapid MigrationPayment of Medico Legal claims
Increase in number of Patients from other provinces – Lead to increase in payment of medicines, NHLS Test, Blood, etc. Once the neighbouring provinces experience cash flow challenges patients are referred to Gauteng hospitals. These patients were not budgeted for thus leads to over commitment.Increase in number of foreign patientsMedical inflationExpansion of services and reclassification of hospitals post finalisation of budget (result in additional personnel being appointed & procurement of goods)
Unfunded mandates – A regulation/policy/decision/ mandate that requires GDOH to implement certain action with no funding provided (e.g. Universal Test & Treat, Provincialisation, Absorbtion of staff from closed facilities, etc.)Unplanned and Unforeseen services/activities critical to service delivery (Not budgeted for) – e.g. Catering for healing session – Life Esidimedi, Patient records digitisation project to reduce litigations, Lean Project in support of Deliverology, etc.32Slide33
Thank You
THANK YOU