ATC100412: Report Budget Vote 15 & Strategic Plan for 2010/11-2012/13
REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON BUDGET VOTE 15 AND THE STRATEGIC PLAN FOR 2010/11-2012/13, DATED 12 APRIL 2010
1.1 The briefing on Budget Vote 15 took place on the 24 March 2010
1.2 The Minister of Health, Dr Aaron Motsoaledi, led the delegation. The delegation included the Acting Director General – Dr Yogan Pillay, Deputy Director General – Ms MK Matsau, Acting Deputy Director General – Mr James Cornwall, Special Advisor to the Minister – Dr Komfi Moloko, Acting Chief Financial Officer – Ms Tiny Rennie, Chief Director – Dr Carol Marshall, Registrar of MCC – Ms Mandisa Hela, Chief Director –Strategic Planning; Thulani Masilela, Chief of Staff- Ms Shireen Pandesa, Acting Deputy Director - Human Resources and Management Development - James T Cornwall, Chief Director- District Health, Mr Ramphelane Morewane, Chief Director –Office of the DG –Ms Qhakazile Gambu, Acting Chief Director- Andre Venter, Deputy Director – Mr Clive Magagula, Media Liason- Mr Fidel Hadebe, Parliamentary Liaison Officer in the Office of the Deputy Minister – Ms Monica A Sempe and the Parliamentary Officer in the Office of the Minister – Mr Joe Kgatla.
2. OVERVIEW OF THE DOH KEY PRIORITY STRATEGIC FOCUS AREAS BY THE MINISTER OF HEALTH
2.1 Health is one of the 5 key priorities of government for 2009-2014. The Strategic Plan of the department is drawn mainly from the Cabinet Lekgotla resolutions, the State of the Nation Address (SONA), the Budget Speech by the Minister of Finance, the announcement made by the President on December 1, the World AIDS day and the lessons drawn from the Department’s programme performance over the last couple of years.
2.2 The Department of Health’s mission is to improve the health status of the people of South Africa through:
- Prevention of illness and the promotion of healthy lifestyles;
- Consistent improvement of health care delivery system by focusing on access, equity, efficiency, quality and sustainability.
The 10 point plan of the Health Sector for 2009-2014
- Provision of Strategic leadership and creation of a social compact for better health outcomes;
- Implementation of the National Health Insurance (NHI);
- Improving the Quality of Health Services;
- Overhauling the health care system by:
- Refocusing on Primary Health Care (PHC)
- Improving the functionality and management of the Health system
- Improving Human Resources, Planning, Development and Management;
- Revitalization of infrastructure with a focus on :
- Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) which were also mentioned by the Minister of Finance.
- Accelerating the delivery of Health Technology and Information Communication Technology (ICT) infrastructure;
- Accelerated implementation of HIV and AIDS and Sexually Transmitted Infections and reduction of mortality due to TB and associated disease;
- Mass mobilization for better health for the population ;
- Review of the Drug policy including logistic supply;
- Strengthening Research and Development.
In 2010, government adopted a new outcome-based approach to attaining the objectives outlined in the MTSF 2009- 2014. In relation to health, South Africa is faced with a quadruple burden of disease consisting of the following:
- HIV & AIDS and TB;
- High maternal and child mortality,
- Non-Communicable Diseases, and
- Violence and injuries.
In addressing these four areas, the health sector has produced 20 deliverables for the next five years which are as follows:
- Increased life expectancy at birth;
- Reduced Child mortality;
- Reducing Maternal Mortality ratio;
- Managing HIV prevalence;
- Reducing the rate of HIV infections;
- Expanded Prevention of Mother to Child Transmission programme (PMTCT);
- Improved TB case finding;
- Improved TB outcomes;
- Improved access to Antiretroviral Treatment for HIV-TB co-infected patients;
- Decreased prevalence of MDR-TB;
- Revitalisation of primary health care
- Improved physical infrastructure for healthcare delivery;
- Improved patient care and satisfaction;
- Accreditation of health facilities for quality;
- Enhanced operational management of health facilities;
- Improved access to human resources for health;
- Improved health care financing;
- Strengthened health information system (HIS);
- Improved health services for the youth; and
- Expanded access to Home Based Care and Community Health workers.
The following section discusses the above-mentioned deliverables in efforts to deal with the quadruple burden of disease in South Africa.
- Increasing life expectancy
HIV & Aids: The key strategic interventions during 2010/11-2012/13 will include initiating and administering antiretroviral treatment to all people living with HIV & AIDS and tuberculosis. With regards to HIV, all persons with a CD 4 count of 350 or less will have access to anti-retroviral treatment as from 1 April 2010. This is in line with the announcements made by the President on 1 December 2009, the World Aids day. The number of new patients initiated for antiretroviral therapy will also increase between 400, 000 and 550,000 annually during 2010/11-2012/13.
Malaria: South Africa has been successful in the fight against malaria but there is a need to do more to decrease the incidence of malaria.
- Reducing Child mortality
South Africa is one of the 10 countries that are unable to reduce child mortality. The key strategic interventions in decreasing the high child mortality will among others include increasing the number of new child patients initiated on Antiretroviral Therapy (ART) from 38,000 in 2009/10 to 40,000-45,000 in 2012/13. Children under the age of 1 year will be immunized with two new vaccines called the Pneumoccocal and Rotavirus vaccines. The drive would effectively increase the percentage of immunised children less than 1 year of age from 40% in 2009 to more than 80 % in 2012/13.
The department will also ensure that School Health Services are provided in the 18 priority districts by 2010/11 and in all schools by the end of 2012/13. The Minister of Health is engaged in discussions with the Minister of Education to launch the School Health Services by June 2010. The School Health Services will encourage learners to walk 30 minutes for 5 days and this will assist in reducing the burden of diseases.
- Reducing Maternal Mortality
The key interventions in addressing maternal mortality during 2010/11- 2012/13 will include increasing the proportion of health facilities providing Basic Antenatal Care (BANC) from 42% in 2010/11 to 95% in 2012/13. The department will also ensure that 70% of primary level health workers are trained in Emergency Obsteric Care and Comprehensive Emergency Obsteric Care.
The minister was also concerned that due to the increased knowledge on the choice of termination of pregnancy among women, more women uses less or no contraceptives thereby using the termination of pregnancy as a form of contraception. The department will increase the designated health facilities providing termination of pregnancy services from 30% in 2009/10 to 70% in 2012/13.
- Managing HIV prevalence
The Department of Health will run a massive campaign on HIV counseling and testing from the 15th April 2010 to end of June 2011. During the HIV counseling and testing campaign, the number of condoms distributed will increase by 1.5 billion which will be provided to 15 million people who will undergo counseling and testing. The number of pregnant women tested through health care provider-initiated counselling and testing will increase to 100% by 2010/11. Patients with HIV starting on Isoniazid Preventive Therapy will increase from 10% in 2009/10 to 80% in 2012/13.
The condom distribution will be scaled up with 1 billion male additional condoms distributed annually during 2010/11 – 2012/13. Six million female condoms will be distributed in 2010/11 which will increase to 9 million by 2012/13. The Department of Health will implement an Information, Education and Communication (IEC) campaign/programme targeting the high risk groups.
- Expanding of Prevention of Mother To Child Transmission Programme (PMTCT)
The Department will focus on the integration of Antenatal Care and PMTCT services during 2010/11- 2012/13 financial years. HIV exposed infants will be tested and diagnosed early. However, the Minister expressed concern with regard to infants and children who are dumped in hospitals which would delay their testing.
- Improving TB case finding
The implementation of the Directly Observed Treatment (DOTS) strategy in all districts will be strengthened. The number of community health workers trained as DOT supporters will increase from 1,905 in 2009/10 to 2,200 annually during 2010/11; 2011/12 and 2012/13. The TB and HIV services will be fully integrated by March 2011. The number of community health workers trained as DOTS supporters will be gradually increased from 1 905 in 2010/11 to 2 200 by 2012/13.
- Improving TB outcomes
The department will train at least 3,500 health professionals in TB management annually from 2010/11 through to 2012/13. The department will also ensure that all 52 districts and 232 sub-districts have appointed TB coordinators. The TB defaulter rate will be reduced from 7.9% in 2009/10 to 5% or less in 2012/13 and the TB cure rate will be increased from 64% in 2007 to 80% in 2012/13.
- Improving access to antiretroviral treatment for HIV –TB co-infected patients.
The key strategic interventions during 2010/11-2012/13 will include initiating on ART for all eligible people presenting with HIV & AIDS and tuberculosis co-morbility. However, patients presenting with HIV must have a CD4 count of 350 or less to access treatment as from 1 April 2010. The integration of TB and HIV services will also be strengthened.
- Decreasing Prevalence of drug Resistant TB
The Department will ensure that all 20 drug resistant TB facilities appropriately implement Drug Resistant TB guidelines by 2012/13. The diagnosis of Drug Resistant TB must be accurate and place patients on appropriate TB regime.
- Revitalisation of Primary Health Care
The Minister was concerned that South Africa has shifted from primary health care and that has caused increased burden on secondary and tertiary services. The Primary Health Care teams will be strengthened in all 9 provinces to improve access to health care by 2011/12. The audit of Primary Level Services and infrastructure will be completed by 2012/13.
- Improving infrastructure for healthcare delivery
The department will place dedicated focus on three areas of infrastructure revitalization, which are:
(i) Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs), especially for the construction and refurbishment of 5 tertiary hospitals namely:
1. Nelson Mandela Academic (Eastern Cape),
2. Chris Hani Baragwanath (Gauteng),
3. Dr George Mukhari (Gauteng),
4. Limpopo Academic (Limpopo),
5. King Edward VII (KwaZulu – Natal).
(ii) Revitalizing primary level facilities.
(iii) Accelerating the delivery of Health Technology and Information Communication Technology (ICT) infrastructure.
- Improved patient care and satisfaction
The key strategic interventions during 2010/11- 2012/13 will include fast tracking improvements in six priority areas of quality of care namely:
· Positive and caring values and attitudes,
· Reduced waiting times,
· Improved cleanliness,
· Improved patient safety,
· Infection prevention and control, and
· Availability of medicines and supplies.
Complaints from users of public health services will be monitored and at least 75% of those complaints should be resolved within 25 days.
- Accreditation of health facilities for quality
A quality Management and Accreditation Body will be established. The body will be independent but will report to the Minister of Health. Twenty percent (20%) of public health facilities will be audited to assess if they meet core standards. This figure will grow to 40% in 2011/12 and to 70% by 2012/13.
- Enhanced operational management of health facilities
The Department will assess the functionality, efficiency and appropriateness of the organizational structure of a particular hospital; and the appropriateness of the delegations for the hospital in partnership with the Development Bank of Southern Africa by March 2011. The department will report hospital by hospital instead of generalizing.
The Department will work towards obtaining accreditation for the Management and Leadership Academy for Health Managers from the Council for Higher Education and South African Qualifications Authority by March 2012. It envisages that the academy will accept the first group of students by February 2013. If a person has not attended the above-mentioned institutions, his/her application will not even be considered.
- Improved Access to Human Resources for Health
The Department will revise and produce its human resources health plan by the end of 2010/11. The strategies for increasing the production of key PHC workers such as environmental health practitioners, infection control workers will be outlined and the diverse categories of mid level workers. Walter Sisulu University in Mthatha is the only university that trains mid-level workers.
- Improved Health Care financing
The strategic interventions during 2010/11- 2012/13 will include improving financial management and establishing a dedicated Provincial Finance and Budget Support Unit in the National Department of Health.
A draft National Health Insurance legislation will be produced and submitted to cabinet and will be in Parliament by 2011.
- Strengthening Health information Systems
Interventions during 2010/11 -2012/13 will include developing and implementing an ICT strategy, establishing a Health Agency by 2010/11, establishing a Disease Control Hub by 2010/11, and implementing the Primary Health care information system in 36 districts by 2012/13.
- Improved Health Services for the Youth
The Youth Health Strategy will be finalized by March 2011 and the provision of life skills education to youth will be strengthened. The implementation of the Mini Drug Master Plan to reduce the usage of illicit substances, especially by the youth will be finalized by 2010/11.
- Expanded Access to Home Based Care and Community Health Workers
During 2010/11-2012/13 the department will include finalizing the policy on Community Health Workers in conjunction with the Departments of Social Development and Local Government and Traditional Affairs.
Strategy for expanding access to Home and Community-based Care will be developed. The department is also looking at employing the community based care givers so that it can establish teams so that when one visits a home the others are aware of his/her visit.
3. MAJOR FORTHCOMING HEALTH CAMPAIGNS
- The kick TB 2010 campaign will start on 26th March 2010 and it will end in March 2011. The launch will be in Thokoza.
- The H1N1 campaign will start on 5 April 2010 and it will end on the 31st May 2010. All medicines have passed, and the immunisation will commence on the said date.
- The measles and Polio Vaccination campaign will start on 12 April 2010 and it will end on 23 April 2010.
- HIV counselling and Testing (HCT) will start on 15 April 2010 and end in June 2011.
- The second round of Polio Vaccination Campaign will run from 24 to 28 May 2010.
The Minister urged the committee to cooperate in these campaigns in assisting the department in sending the message to the public.
4. NEW ALLOCATIONS FOR 2010/11-2012/13 PRIORITY AREAS ARE AS FOLLOWS:
- R1.883 billion is for 2010/11, R2.845 billion is for 2011/12 and R3.944 billion for 2012/13.
- The comprehensive HIV and AIDS conditional grant will also be rolled over a period of 3 years. R1.7 billion for 2010/11, R2.8 billion for 2011/12 and R3.9 billion for 2012/13 in order to expand treatment and to commence treatment for all patients of sub-groups including women and newborn babies with CD4 count of 350 or less. This will improve access to treatment and in line with the announcements made by the President on December 1, the World AIDS day.
- On hospital Revitalisation Conditional Grant, R140 million will be allocated for Mitchell’s Plain Hospital. The Office of Standard Compliance (OSC) will get an additional R2 million for 2010/11 and R8 million for 2011/12. In 2012/13 the Quality Assurance Programme will receive R18 million. This will assist with continued build up of all aspects around the functioning of the OSC and increase the number of audited hospitals.
- R2 million will be allocated for the establishment of a Provincial Finance and Budget Support Unit for 2010/11, R4 million for 2011/12 and R6 million for 2012/13 to build up internal capacity to monitor support to provinces.
- The personnel shortfall will receive R22 million for 2010/11, R24 million for 2011/12 and R30 million for 2012/13 for compensation of employees to stabilise personnel expenditure.
- The Forensic Chemistry Laboratories will receive R2 million for 2010/11, R3 million for 2011/12 and R5 million for 2012/13 to address backlogs in these laboratories.
- R1 million per financial year over the MTEF period to develop the hospital re-imbursement tool.
- The measles and Polio Vaccination campaign will receive R30 million for 2010/11 and R20 million for 2011/12. Emergency Medical Services (EMS) will receive R13 million once off funding which is linked to the 2010 FIFA World Cup.
5. BUDGET SUMMARY
The Department of Health received a budget of R21.5 billion for 2010/11 financial year as compared to R18. 4 billion received in 2009/10. The department carries its mandate through six programmes, namely Administration, Strategic Health Programmes, Health Planning and Monitoring, Health Human Resources Management and Development, Health Services and International Relations, Health Trade and Health Product Regulation. Following is the discussion of the purpose and budget allocation for each programme.
Programme 1: Administration
The purpose of the Administration Programme is overall management of the department and providing centralised support services. This programme is allocated R264.8 million for 2010/11 which is 1.23% of the department’s budget. Most of the budget is allocated to the Corporate Services Sub-programme, which receives R181.million of the programmes budget.
The bulk of the allocation for this programme is consumed as current expenditure (97.3%) which includes Goods and Services, which amount to 55.1% of the programme budget, Compensation of Employment at 42.18% of the programme budget and Lease payments which take up to 17.78% of the programme budget. 2.6% of the allocation will be spent as capital expenditure on Machinery and equipment.
Programme 2: Strategic Health Programmes
The purpose of this programme is to coordinate, manage and fund strategic national health programmes, including developing policies, systems, norms and standards. The programme received an increase of 26% which is the largest increase in all the programmes of the Health Department. This programme is also the second largest and is allocated R7.3 billion of the department’s overall budget. Overall expenditure in this programme is dominated by transfers and subsidies which include:
- Comprehensive HIV and AIDS grant to provinces which is R6.0 billion
- Forensic Pathology Services grant to provinces which is R557.0 million
- National Health Laboratory Services which receives R77.7 million
- MEDUNSA received R1 million
- Council for the Blind which received R600.00
- HIIV and AIDS NGO’s which received R65.1 million
- Lifeline which received R12.2 million
- Lovelife which received R77.4 million
- Soul City which received R17 million
- South African AIDS Vaccine Initiative which is R11.7 million
- Tuberculosis NGO’s which received R3.9 million
- Maternal, Child and Women’s Health NGO’s received R1.1 million.
The Non-Communicable Diseases sub-programme increased from R636 million in 2009/10 to R665.4 million in 2010/11. The forensic pathology which is also part of this programme received an allocation of R557 million for 2010/11.
Programme 3: Health Planning Monitoring
The purpose of this programme is to plan and monitor health services and coordinate health research programme. This programme is allocated R406.9 million for 2010/11 as compared to R396.4 million for 2009/10. This programme is divided into four sub - programmes namely, the health information research and evaluation, the financial planning and health economics, the pharmaceutical policy and planning and the office of the standards compliance.
The Health information research and evaluation sub-programme received 74.71% of the programme allocation. This sub-programme aims at maintaining health information systems, conduct research and training on disease surveillance and outbreaks. The allocation for this sub-programme for 2010/11 is R304 million as compared to R278.1 million for 2009/10. The Medical Research Council is also funded through this sub-programme.
The Financial Planning and Health Economics sub-programme is responsible for conducting health economic research, developing policy for medical schemes, social health insurance and public private partnerships. This sub- programme also oversees funds for the funds for Medical schemes. This sub-programme has seen a decrease in 2010/11 as compared to 2009/10. The allocation for 2010/11 is R36.4 million as compared to R62.4 million for 2009/10. This decrease in budget is because the 2009/10 budget contained R30 million which was used by provinces in preparation for the 2010 FIFA World Cup, mainly to procure medical equipment for stadiums and Emergency Medical Services.
The Pharmaceutical Policy and Planning sub-programme aims to monitor the procurement and supply of drugs, and ensure that there are no stock-outs of all essential drugs especially paediatrics, TB and antiretroviral drugs. This sub-programme received a nominal increase of 4.3%, which represents a real decrease of 2.51%.
The Office of Standard Compliance sub-programme aims to deal with quality assurance in all public hospitals. The budget for the office of the standard compliance is R51.0 million for 2010/11 financial year as compared to R41.1 million for 2009/10.
Programme 4: Health Human Resources Management and Development
The purpose of this programme is to plan and coordinate human resources for the Department of Health. It aims to plan for the medium to long term human resources needs in the national health system. This programme receives R1.9 billion in 2010/11 of which 98, 3% will be spent througt transfers and subsidies.
The Human Resources Policy, Research and Planning sub-programme aims at planning for the medium and long term of human resources needs in the national health system. It has received an allocation of R8.9 million for 2010/11. The subprogramme received a large increase in expenditure in order to conduct and audit of nursing colleges.
Programme 5: Health Services
The purpose of this programme is to support health services in the provinces including hospitals, emergency medical services and occupational health. This programme received the largest share of the National Department of Health budget. The largest portion of this programme’s budget goes to the hospital and health facilities management sub-programme. This sub-programme is responsible for national policy in hospitals and emergency medical services. It is also responsible for the funding of the Hospital Revitalisation Grant which takes up to R4 billion within this programme. The Tertiary Services takes up to R7.4 billion of the programme’s transfer budget. The budget allocation for 2010/11 is R11528. 8 million compared to R10.086 million for 2009/10.
Programme 6: International Relations, Health Trade and Health Product Regulation Programme
The purpose of this programme is to coordinate bilateral and multilateral health relations, including donor support, regulate procurement of medicines and pharmaceutical supplies, and regulations and oversight of trade in health products. The budget allocation for this programme increased from R90.2 million in 2009/10 to R104.5 million in 2010/11. The major budget of the multilateral sub- programme goes to paying membership fees to the international agencies such as the World Health Organisation and for activities of health attaches. This sub-programme receives R50.7 million for 2010/11 as compared to R45.1 million in 2009/10.
The Food Control and Non-medical Health Product Regulation is also a sub-programme in programme 6. This sub-programme aims at ensuring food safety by developing and implementing food control policies, norms and standards and regulations. This sub-programme receives a budget allocation of R7.2 million for 2010/11 as compared to R6.5 million in 2009/10.
The Pharmaceutical and Related Product Regulation and Management is a sub-programme in programme 6. The aim of this sub-programme is to regulate the trade in medicines and pharmaceutical products through the Medicine Control Council. This sub-programme increased by R7.9 million from the 2009/10 allocation to R46.6 million in 2010/11. The expenditure on this sub-programme will increase by an average of 10.2% over the MTEF period to support the new Medicines Regulatory Agency, develop information Technology systems and reduce backlogs in certification of medicines.
6. COMMITTEE’S CONCERNS
Most of the concerns raised by the Committee were responded to satisfactorily by the Minister and the departmental officials.
- The Committee recommends that the department must sort out the issue of OSD especially in the provinces and finalise the planning of paying out.
- The committee also recommends that the Medicines Control Council must speed up the approval of drugs.
- Looking at the challenges facing the department with regards to Human Resources, the Committee recommends that the department should to address the challenges as soon as possible.
Having considered the budget vote and the strategic plan of the department, the committee recommends that the House passes the budget.
The Committee would like to thank the Minister of Health for his commitment in improving health services in the country and highlights that he is very passionate on what he is doing. The Committee also noted that the attitudes of the Departmental officials have changed from what it was during previous meetings and now officials were keen to answer concerns raised by the Committee.
Report to be considered.
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