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NATIONAL DEPARTMENT OF HEALTH National Health Insurance Grant

NATIONAL DEPARTMENT OF HEALTH National Health Insurance Grant. Select Committee on Appropriations Hearing on 3 rd and 4 th Quarter Expenditure 4 th June 2013. Index. Background Provincial Expenditure Summaries (IYM) Q3 and Q4 figures (incl. Province specific challenges)

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NATIONAL DEPARTMENT OF HEALTH National Health Insurance Grant

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  1. NATIONAL DEPARTMENT OF HEALTHNational Health Insurance Grant Select Committee on Appropriations Hearing on 3rd and 4th Quarter Expenditure 4th June 2013

  2. Index • Background • Provincial Expenditure Summaries (IYM) • Q3 and Q4 figures (incl. Province specific challenges) • Total Grant Expenditure • Summary of challenges impacting on Expenditure • Monitoring and Evaluation matters • Way Forward Select Committee on Appropriations_4 June 2013

  3. Background • R150 million allocated for 2012/13 FY • Each pilot District received R11.5 million • Focus: • To test innovations that are necessary for the implementation of NHI • To undertake health system strengthening initiatives in identified Districts • To provide strategic resources for supporting the pilot Districts in implementing selected health service delivery interventions Select Committee on Appropriations_4 June 2013

  4. Eastern CapeQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  5. Eastern Cape: Challenges • Provincial office delayed notification of the availability of funds to the District • District capacity constraints • Lack of key HR in essential categories; • Inadequate technical support • Supply Chain hurdles • Delays in getting approvals Select Committee on Appropriations_4 June 2013

  6. Free StateQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  7. Free State: Challenges • Reprioritisation of funds allocated to activities • SCM hurdles Select Committee on Appropriations_4 June 2013

  8. GautengQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  9. Gauteng: Challenges • No support/guidance from relevant officials at Provincial Office • Significant hurdles in procurement processes • Delays in getting information on budget codes • Staff shortages in key areas • Lack of ability to employ staff on long term basis using NHI-CG funding e.g. clinical staff, sessional doctors, etc. Select Committee on Appropriations_4 June 2013

  10. KZNQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  11. KZN: Challenges • Structural administrative process • Bureaucratic processes that hamper innovation • The process for obtaining signatures needs to be streamlined • Huge delays at Provincial office • Limited delegations to allow for activities to be undertaken • District level delegations very limited • Significant Supply Chain hurdles • Lack of clarity regarding long delays in getting necessary approvals Select Committee on Appropriations_4 June 2013

  12. LimpopoQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  13. Limpopo: Challenges • Challenges around budget matters • Inappropriate / incorrect budget coding • SCM hurdles • Significant delays in getting approvals • Challenges in identifying relevant providers to undertake some activities due to limited database • Technical and administrative support from Province inadequate Select Committee on Appropriations_4 June 2013

  14. MpumalangaQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  15. Mpumalanga: Challenges • Majority of the DHMT not appointed • Too many vacancies to undertake activities • Non-existent / limited delegations to allow for activities to be undertaken • District level delegations very limited • SCM hurdles impacting on key activities Select Committee on Appropriations_4 June 2013

  16. Northern CapeQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  17. Northern Cape: Challenges • Delays in Provincial Treasury providing information regarding availability of funds • SCM hurdles • Significant delays in getting necessary approvals and lack of technical support in key areas • Challenges in identifying relevant providers to undertake some activities due to limited database • Contextual factors also impact on programme: • Majority of key staff complement based in Kimberley • DHMT has limited delegations Select Committee on Appropriations_4 June 2013

  18. North WestQ3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  19. North West: Challenges • Incorrect capturing of budget at Provincial level • District submitted an incorrect business plan to Provincial Treasury • Poor prioritisation of allocated funding • Need to reprioritise to other activities • Lack of technical support in key areas • Need Provincial NHI Coordinator • Challenges in identifying relevant providers to undertake some activities due to limited database • Inability to spend on Infrastructure i.e. clinics, motor vehicles, etc Select Committee on Appropriations_4 June 2013

  20. Western Cape Q3 and Q4 Expenditure (R’000) Select Committee on Appropriations_4 June 2013

  21. Western Cape: Challenges • Delays in finalising business plan impacted on progress • Approval only granted in August 2012 • Encountered some challenges in undertaking work around Governance arrangements at Community level i.e. CHCs • Delays in getting a supporting legal opinion on the exact roles, responsibilities and functioning of Clinic Committees Select Committee on Appropriations_4 June 2013

  22. Summary of Quarter 3 Expenditure(R’000) Select Committee on Appropriations_4 June 2013

  23. Summary of Quarter 4 Expenditure(R’000) Select Committee on Appropriations_4 June 2013

  24. DORA: Implementation Select Committee on Appropriations_4 June 2013

  25. Total Expenditure by Province (%) (April 2012 – 31 March 2013) Select Committee on Appropriations_4 June 2013

  26. NHI-CG Provincial Commitments/Roll-Overs2012/13 Financial Year

  27. Summary Challenges • Weak HR capacity in some Districts • Weak Provincial technical support • Delays in budgets being communicated to some pilot sites • Incorrect budget capturing • Significant Supply Chain management challenges in many Districts • Lack of necessary delegations to perform outlined activities Select Committee on Appropriations_4 June 2013

  28. Monitoring and Evaluation Matters • Monitoring and Evaluation undertaken by Grant Management Unit and Directorate: NHI • Financial, Health Economics and Monitoring and Evaluation skills appointed • All Provinces have submitted Month on Month financial data • Used to compile IYM data • Quarterly reports and meetings with all sites • Mutually identified shortfalls and challenges; • Mutually identified “quick win” activities and interventions; • Expedited Expenditure on commitments in approved Business Plans • Assessed progress on operational plans • Prioritisation process • Focus on quality spending • Evidence gathering Select Committee on Appropriations_4 June 2013

  29. Way Forward (1) • Inherent underperformance in early part of the 2012/13 cycle: • NHC Intervention resulted in improvement in Q3 and Q4 • DORA framework to adjust the purpose, focus activities and funding allocations to Provinces: • Allows NDOH a stronger and more interventionist approach: • Influences the scope of work to be undertaken at National and pilot site levels: • Changes in allocations across Districts Select Committee on Appropriations_4 June 2013

  30. Way Forward (2) • For 2013/14, the grant has been split into 2 components: • Direct: District piloting (Schedule 5) • In-kind: GP contracting and Central Hospitals work (Schedule 6A) • New focus areas: • Strengthening SCM; • Supporting the roll-out of PHC streams and their role within the District referral system; • Strengthening District level Monitoring and Evaluation capacity • Mobilised funding for appointment of Provincial NHI Coordinators: • Majority appointed to post; • Assist in coordination, project management and Monitoring and Evaluation functions Select Committee on Appropriations_4 June 2013

  31. THANK YOU Select Committee on Appropriations_4 June 2013

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