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NORTHERN PROVINCE

NORTHERN PROVINCE. PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE ON HEALTH. 14 May 2002 9:00 – 10:00. Contents:. Introduction Expenditure Trends: 1999/00 – 2004/05 Expenditure Trends: 2001/02 – 2004/05 Achievements on Strategic Service Areas Priorities for the 2002/03 Financial Year.

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NORTHERN PROVINCE

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  1. NORTHERN PROVINCE PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE ON HEALTH 14 May 2002 9:00 – 10:00

  2. Contents: • Introduction • Expenditure Trends: 1999/00 – 2004/05 • Expenditure Trends: 2001/02 – 2004/05 • Achievements on Strategic Service Areas • Priorities for the 2002/03 Financial Year

  3. DEMOGRAPHY • TOTAL POPULATION = 5.8 Million (DWAF, CWSS Study, 2000) • 89% OF THE POPULATION LIVE IN RURAL AREAS. • 54.3% 0F THE POPULATION ARE WOMEN • 36.9% 0F THE POPULATION AGED • LITERACY RATE FOR 20 YRS & OLDER PEOPLE WAS 63.1 % IN 1996 • 46% UNEMPLOYMENT RATE • GDP CONTRIBUTION = 4.2 % IN 1996 • 6 DISTRICTS • 44 HOSPITALS & 477 CLINICS POPULATION DISTRIBUTION

  4. HEALTH STATUS INDICATORS MORTALITY RATES • INFANT MORTALITY RATE DECREASED FROM 57 IN 1994 TO 37.2 PER 1 000 LIVE BIRTHS IN 2001 • UNDER FIVE MORTALITY RATE DECREASED FROM 83 IN 1994 TO 53 PER 1 000 LIVE BIRTHS IN 2001 • MATERNAL MORTALITY RATE = DROPPED FROM 53 TO 30 PER 100 000 LIVE BIRTHS IN SAME PERIOD • HIV PREVALENCE RATE INCREASED FROM 3.04 % IN 1994 TO 13.2 % IN 2001 MORBIDITY RATES • REPORTED CASES OF TB = 40 PER 100 000 POPULATION • REPORTED CASES OF MALARIA=65 PER 100 000 POPULATION • REPORTED CASES OF TYPHOID = 1.7 PER 100 000 POPULATION • REPORTED CASES OF MEASLES= 5.6 PER 100 000 POPULATION • REPORTED CASES OF VIRAL HEPATITIS= 2.7 PER 100 000 POPULATION NUTRITIONAL STATUS • WASTING = CHANGED FROM 3.8 IN 1994 TO 7.5 IN 2001 • STUNTING = CHANGED FROM 34.2 IN 1994 TO 23.1 % IN 2001 • UNDER WEIGHT INCREASED FROM 10.4 TO 15.0 IN THE SAME PERIOD • IMMUNISATIN COVERAGE INCRESED FROM 50 % IN 1994 TO 60 % IN 2001.

  5. VISION “A CARING AND DEVELOPMENTAL HEALTH AND WELFARE SYSTEM WHICH PROMOTES WELL BEING, SELF RELIANCE AND A HUMAN SOCIETY IN WHICH ALL PEOPLE IN THE NORTHERN PROVINCE HAVE ACCESS TO AFFORDABLE AND GOOD QUALITY SERVICES!”

  6. MISSION STATEMENT ‘THE DEPARTMENT IS COMMITTED TO PROVIDING COMPREHENSIVE, INTEGRATED AND EQUITABLE HEALTH AND WELFARE SERVICES WHICH ARE SUSTAINABLE, COST EFFECTIVE AND FOCUS ON THE DEVELOPMENT OF HUMAN POTENTIAL IN PARTNERSHIP WITH RELEVANT STAKEHOLDERS’

  7. Core Functions ·   Provide Regional and Specialised hospital services &Academic Health Services ·  Render and co-ordinate Medical Emergency Services ·  Render Medico-legal services. ·  Quality control of all health services and facilities. ·  Formulate and implement provincial health policies, norms, standards and legislation. ·  Develop & Manage District Health Services ·  Provide technical and logistical support to health districts. ·  Render specific provincial services programmes, e.g. TB programme. ·  Provide non-personal health services. ·  Provide and maintain Health Care Technologies. • Research on, monitor and evaluate health services/programmes.

  8. Strategic Priorities • TB/STD/HIV/AIDS & other Ccommunicable diseases • Maternal, Child, Women, Youth & Adolescence Health • Integrated Poverty Alleviation • Health Promotion • District Health Development & Primary Health Care • Hospital Revitalisation • Health Planning, Logistics & Support Services • Quality of Care • Mental, Chronic, Disabilities & Geriatric Health • Communication, Collaboration & Community Participation. • Development of a Medical School

  9. Summary of Expenditure & Estimates 1999 - 2004/05

  10. Summary of Expenditure & Estimates by Std Items 1999 – 2004/05

  11. Equitable Share & Conditional Grants

  12. Departmental Revenue Collection 1999 – 2004/05

  13. Personnel v/s Non-Personnel Expenditure Trends • Non-Personnel Expenditure for service delivery items has been declining in real terms whilst nominal increase has been below inflation rate. • Nominal growth of Non-PE between 2000/01 and 2001/02 was 3.70 % • Nominal growth of Non – PE between 2001/02 and 2002/03 was 1.62 % • Nominal growth of Non – PE between 2002/03 and 2003/04 is 1.95 %

  14. Fiscal Equity Issues The Budget for PHC: increased from 49.2 % in 1996/97 to 54.3 % in 2001/02 Population served by Public Sector: • By 1999, NP had 92.4 % people without Medical Aids Cover. Per capita Health Expenditure: • NP showed an average decline of – 15.7% from 1996 – 1999/00 • NP is the second lowest.. By 1999, NP had R483/person, which was about half of Gauteng’s R913/person (SA Health Review, 2000) • By 1997, NP was spending R24/person on medicines compared to the National average of R42/person & currently NP spends R35.60/person which = 3 times less than that of Gauteng.

  15. Fiscal Equity Issues Percentage Growth of the Health Budget: • Has been consistently lower than National norm • The department gets 16 % of the Social Cluster Budget compared to Education’s 44 % • 16% is inflated as it includes Capital Works & is less than 19% national average • The Budget shows nominal increases while in real terms it is declining as the bulk goes to Personnel Expenditure which increased from 53.59 % in 1995/96 to 64.62 in 2001/02 while actual staff Numbers are declining (from 24085 in 1998/99 to 23 310 in 2001/02) • The Actual growth is experienced in Conditional Grants. • Equity within NP and between Provinces still need to improve as demonstrated by the above Tables & notes.

  16. SUMMARY OF BUDGET AND EXPENDITURE PER PROGRAMME FOR 2001/02 TO 2004/05

  17. SUMMARY OF BUDGET AND EXPENDITURE PER STANDARD ITEM FOR 2001/02 TO 2004/05

  18. REVENUE ESTIMATES

  19. CONDITIONAL GRANTS

  20. Expenditure Variances Analysis for 2001/02 Programme 1: Health Admin • Savings of R19,534m accrued from Austerity Measures placed on Non-Personnel & a moratorium on Appointment of Staff aimed at bailing out projected over-expenditure in Personnel Expenditure. Programme 2: District Health & PHC • Saving of R20,314m is due to late transfer of rollovers of Cond. Grants (CGs) & unspent Cond. Grants resulting from failure to get Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY).

  21. Expenditure Variances Analysis for 2001/02 Programme 3: Regional & Specialised Hospitals: • Saving of R16,181m is due to late transfer of rollovers of Cond. Grants (CGs) & unspent budgets resulting from failure to get Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY). Programme 4: Health Sciences Services • Saving of R18,433m is due to late transfer of rollovers of Prof. Training & research Grant & unspent budgets resulting from failure to get Tenders out in time for delivery of goods & payment before the end of the Financial Year (FY).

  22. Expenditure Variances Analysis for 2001/02 Programme 5: Health Care Support Services • Savings of R7,191m accrued due to the Tender Board failing to approve Specifications for the EMS Vehicles. The Tender will now be re-advertised. Programme 6: Health Facilities Development & Maintenance • An over-expenditure of R27,281m occurred as a result of a process whereby the Provincial Treasury suspended an allocation of R27,404m from the budget earmarked for Professional Services under this progreamme in order to ‘bail out’ budget pressures elsewhere in the province.

  23. Expenditure Variances Analysis for 2001/02 Revenue Collection: • There is an under-collection (variance) of R422m in Patient Fees compared to a set target of R42,209m. The under-collection is related to late payment by Health Funders for private Patients & MVA Claims as the private patients are the main pool of UPFS (New Hospital Tariffs). Other fees showed a variance of R1,235m as they are from sources which the department is able to control. Conditional Grants: Saving accrued in all CGs are mainly due to: • Late arrival and delayed access to Conditional Grants. • Delays in Tender Processes especially Public Works Department & Tender Board delays in approving Specifications and Contracts. • Delays lead to purchase orders being released late thus delaying delivery & payments of goods and services received before the end of FY in March.

  24. Service Implications for the 2002/03 Budget • HR Mx: there is a R117m shortfall & this will limit the filling of critical Posts • DHS: has a R190m short fall; limiting improvement of security at clinics • EMS: has a R61m shortfall; limiting purchase of EMS Vehicles & Expnasion of New Stations to Rural Districts. • Hospital Revitalisation & Clinic Upgrading: Almost no Funds for New Projects • Pharmaceuticals: possibility of over-spending due to Opportunistic Infections related to HIV/AIDS & hiking prices of medicines • Revenue Collection: need to strengthen PPP to attract Private Patients & effective management of Debtors Book.

  25. Achievements on Strategic Service Areas Programme 1: Health Administration • Draft HR, Master Fraud Prevention & Vehicle Replacement Plans are in place. • Cost Centre Responsibility Managers have HR & Financial Delegations • Policies are being finalised for 8 identified areas • Compliance with EEA: have achieved ratios of male/female of 70/30 at Sen. Mx.; 58/42 at Mid. Mx.; 23/77 at Supervisory and 42/58 at lower levels. Constraints/challenges: Need more funding for: • R120m for Filling critical Posts- Clinics & Hospitals(approved posts = 37 906 & 61 % filed) • R20m for Rank & Leg Promotions • Creation of incentives for retaining Staff in Limpopo. • Training & retention of PHC Nurses, Doctors & Allied Health Professionals.

  26. Achievements on Strategic Service Areas Programme 2: District Health Services & PHC • Devolution: Consultation taking place with LG, DoH & other stakeholders. • 6 Health District have aligned their boundaries with those of the District Councils. • The Budget for PHC: increased from 49.2 % in 1996/97 to 54.3 % in 2001/02 • Number of clinics has increased from 302 to 477; 160 clinics have been upgraded & 183 clinics offer 24 hour service while the rest offer 8 – 12 hours. • Clinics are being designated as Cost Centres to improve efficiency in care • TB Cure Rates have increased from 33 % in ‘94 to 57 % in 2001 • TB Treatment Failure Rate has decreased from 5 % in ’94 to 1.1 % in 2001 • Routine Immunisation Coverage increased from 50 % in ’94 to 60 % in 2001 • Immunisation Campaigns: Polio = 91% ; Measles = 100% in 2001 • 28 Institutions are doing TOP & 4 447 TOPs were done from 1997 – 2001 • 127 Clinics are implementing IMCI & 510 Nurses trained in IMCI Policy

  27. Achievements on Strategic Service Areas • HIV/AIDS: a Full Directorate has been established. • A Provincial AIDS Council has been formed; Districts arefinalising theirs. • Lessons are being learnt from the 2 PMTCT Pilot Sites for future planning • A Draft PMTCT Expansion Plan is under consideration by Management • Have hosted the Ministerial Meeting to brief NP about recent Cabinet Decision on HIV/AIDS. Superintendents , Matrons & District Managers benefited from these inputs • About 8 million Condoms were distributed in 2001/02 • Funding is discussed under Budget trends and Statistics are shown at the back

  28. PMTCT Data from August 2001 to March 2002 For both Mankweng & Siloam Pilot Sites: • Of the 7 047 Women who attended PMTCT Clinics, 3 273 (46 %) consented to Volnt. Counselling & 1 489 (45 %) did Voluntary Testing • 290 (19%) tested positive; 1 196 (80 %) tested negative • 1 196 had post – counselling; 72 Mothers received Nevirapine; • Number of Live Births was 432 ; 75 babies were given Nevirapine • 42 mothers excluded breastfeeding and 45 excluded Formula Feeding.

  29. Achievements on Strategic Service Areas Impact of Nutrition Conditional Grant: • PSNP is accessed by 2 649 Schools & 1.17 million children are benefiting from feeding schemes. • 121 Poverty Alleviation Projects have been established Challenges/Constraints: • Critical posts for Clinics to be filled & Devolution of services • R89m needed to improve Security Services at Clinics. • Transport for PHC Services

  30. Achievements on Strategic Service Areas Programme 3: Regional & Specialised Hospitals: • A Hospital Revitalisation Plan is being implemented to: decentralise hospital management & improve quality of care • Hospital CEOs are being appointed. Community Service Health Professionals are improving access to services • HIS: 38 Hospital have live Unicare Hosp. Information System • PPP: 6 Regional Hospital & few district hospital are ready to admit Private Patients RECONSTRUCTION AND REHABILITATION GRANT • 424 projects to the value of R70,4m have been completed.

  31. Achievements on Strategic Service Areas Training & Research Grant: • Skills of Health Professionals are being developed • Research Projects are being initiated on various health issues Redistribution of Specialised Services Grant: • Development of Tertiary Services is going well • HPCSA has accredited the Tertiary Complex for training of some specialities • Referrals of patients to Gauteng has decreased by 50 %. Constraints/Challenges: • R42.2m needed to address Capital Works Backlogs • Need to focus on improving Quality of Services & Health Technology Management

  32. Achievements on Strategic Service Areas Programme 4: Health Science Services • A full Nursing Directorate has been established to oversee quality of services • Former homelands Nursing Colleges have been rationalised into one. • A NP College of EMS has been established for training Emergency Care Staff • 60 more new Ambulances, 11 Rescue Vehicles and 6 Response Cars have been purchased in 2001/02. Constraints/Challenges: • Decentralisation of PHC Traininf from HSDU to other Districts • Decentralisation of EMS Stations to Rural Sub-districts • Find a solution to poor management of EMS Fleet.

  33. Achievements on Strategic Service Areas Programme 5: Health Care Support Services • Procurement & distribution of medicines has been out-sourced. • Distribution by a central Depot ensures 95 % medicines availability at hospitals. • Presence of Community Service Professionals improve access to services. Constraints/Challenges: • Low Per Capita spending on Medicines. • Increased utilisation of medicines for HIV Opportunistic Infections. • Recruitment & retention of Allied Health Professionals • Slow process for Rationalisatipn of Laboratory Services into the National Laboratory Organogram.

  34. Achievements on Strategic Service Areas Programme 6: Health Facilities Development • 424 Hospital projects have been completed. • 160 Clinics have been upgraded Constraints/Challenges: • A backlog of 132 Clinics that need upgrading at 20 Clinics costing about R42m per year. • Completion of Phase II of Hospital Capital Projects

  35. HIV PREVALENCE FROM 1990-2000

  36. ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTS

  37. ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTS

  38. ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTS

  39. ANNUAL ANTENATAL HIV SEROPREVALENCE SURVEY RESULTS

  40. TERMINATION OF PREGNANCY SERVICES

  41. TOP 5 PREVALENT DISEASES

  42. Priorities for 2002/03: Program. 1

  43. Priorities for 2002/03: Program. 2

  44. Priorities for 2002/03: Program. 3

  45. Priorities for 2002/03: Program. 4

  46. Priorities for 2002/03: Program. 5

  47. Priorities for 2002/03: Program. 6

  48. Requested v/s Actual Allocated Budget For 2002/03 Financial Year

  49. THE END I Thank You

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