ATC120419: Report on Budget Vote 16 & the Strategic Plan of the department for 2012/13 - 2014/15, dated 19 April 2012
Health
REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON BUDGET VOTE 16 AND THE STRATEGIC PLAN OF THE DEPARTMENT FOR 2012/13 - 2014/15, DATED 19 APRIL 2012
REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON BUDGET VOTE 16 AND THE STRATEGIC PLAN OF THE DEPARTMENT FOR 2012/13 - 2014/15, DATED 19 APRIL 2012
1. INTRODUCTION
The briefing on Budget Vote 16 took place on the 18 April 2012.
The Director General, Ms MP Matsoso led the delegation. The delegation included the Deputy Director-General, Corporate Services, Ms T Rennie ; Chief Financial Officer, Mr I Van der Merwe ; Director: Strategic Planning, Ms M Wolmarans and the Parliamentary Liaison Officer in the Office of the Minister, Mr Joe Kgatla .
OVERVIEW OF THE DEPARTMENT OF HEALTH (DOH) KEY PRIORITY STRATEGIC FOCUS AREAS
The Department of Health aimed to provide leadership and coordination of health services to promote a long and healthy life for all South Africans. The Strategic Plan of the department was drawn mainly from the State of the Nation Address (SONA), the Budget Speech by the Minister of Finance and the lessons drawn from the Departments programme performance over the last couple of years.
The structure of the Department of Healths budget changed considerably in the previous financial year, with some programmes being either combined, shifted to other programmes or discontinued. The Department also introduced new sub- programmes , and changed the titles of the programmes accordingly.
Government adopted an outcome-based approach to service delivery and the health sector was responsible for the achievement of Outcome 2: Long and healthy life for all South Africans. The following were the four identified outputs:
Output 1: Increasing Life Expectancy
Output 2: Decreasing Maternal and Child mortality
Output 3: Combating HIV and AIDS and decreasing the burden of disease from
Tuberculosis
Output 4: Strengthening Health System Effectiveness
In Strengthening the Health System Effectiveness, the Department would focus on the following inputs:
Primary Health Care Orientated Service Delivery,
Improved quality of services,
Improved Human Resources for Health,
Improved access to Health facilities,
Improved financial management,
National Health insurance,
Health information, and
Inter- sectoral action for social determinants of Health.
The expected outcomes were:
Reduced Maternal and Child Mortality rates,
Reduced burden from HIV&AIDS and TB (Mortality and Morbidity),
Reduced burden from non-communicable diseases, and
Reduced burden from violence and injury.
3. THE IMPLEMENTAION OF THE HEALTH SECTORS RESPONSE DURING 2012/13 2014/15 ARE AS FOLLOWS:
3.1 PREPARATION FOR THE IMPLEMENTATION OF NHI
Progress on Phase 1 Deliverables of Green Paper on the National Health Insurance was as follows:
Preparation of the legal framework for the establishment of the NHI fund.
The Green Paper was released for public consultation on 12 August 2011.
Public consultations ended on the 30 December 2011.
The Department was currently evaluating and reviewing written inputs.
Regulations on designations of hospitals and policy on management of hospitals were released for public comments on 12 August 2011.
Posts for Hospital CEO were advertised in February 2012.
The establishment of the Office of Health Standard Compliance Bill was tabled in Parliament in December 2011.
Initiated NHI pilots in 10 selected Districts during 2012/13.
3.2 SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS
The key strategic interventions during 2012/13 to 2014/15 would include:
Increasing the number of Medical Male Circumcision to 600 000 during 2012/13, 800 000 during 2012/12 and 1 000 000 during 2014/15.
Increasing the HIV Counseling and Testing (HCT) uptake rate and the number of HIV tests done annually which would be 18 million in the current financial year, 20 million during 2013/14 and 22 million during 2014/15.
Number of new patients initiated on Antiretroviral Therapy (ART) was targeted at between 500 000 to 550 000 annually during 2012/13 and 2014/15.
Increasing the proportion of Primary Health Care (PCC) facilities implementing nutritional intervention for people living with HIV and AIDS and TB from 80% in 2011/12 to 100% in 2014/15.
3.3 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY
Key strategic interventions during 2012/13 to 2014/15 would include:
Maintaining the percentage of children under 1-year of age fully immunized at 90% throughout the MTEF period.
Maintaining the measles immunization coverage rate of 90% throughout the MTEF period.
Increasing the Vitamin Supplementation coverage among children 12 to 59 months from 40% in 2011/12 to 55% in 2014/15.
Providing integrated school health services at 80% of quintile 1 schools during 2012/13, 90% in 2013/14 and 95% in 2014/15.
Assessing grade 1 learners in quintile 1 and 2 schools targeting 680 000 learners in 2012/13, and this would be increased to 807 500 learners during 2014/15.
Assessing grade 8 learners in quintile 1 schools targeting 65100 learners in 2012/13, and that would increase to 156 240 learners in 2014/14
3.4 REDUCE MATERNAL MORTALITY
Key strategic interventions during 2012/13 to 2014/15 would include:
Maintaining ante-natal coverage rate of 100% throughout the MTEF period.
Increasing the antenatal coverage before 20 weeks from 37% in 2010/11 to 65% in 2014/15.
Increasing the proportion of deliveries taking place in health facilities under the supervision of trained personnel from 86.5% in 2010/11 to 96% in 2014/15.
Increasing the percentage of mothers and babies who received post-natal care within 6 days of delivery from 30% in 2010/11 to 82% in 2014/15.
3.5 IMPROVED ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH
Key strategic interventions during 2012/13 to 2014/15 would include
Increasing the cervical cancer screening coverage from 52% in 2010/11 to 58% by 2014/15.
Increasing the couple year protection rate from 32% in 2010/11 to 37% by 2014/15.
Providing contraceptive services in 80% of health facilities in 2012/13, 85% in 2013/14 and 90% in 2014/15.
EXPAND PREVENTION OF MOTHER TO CHILD TRANSMISSION PMTCT )COVERAGE TO PREGNANT WOMEN
Key strategic interventions during 2012/13 to 2014/15 would include:
Ninety eight percent (98%) of pregnant women tested for HIV. The target was to reduce to 0% the number of children who were born HIV+ in South Africa .
Increasing the antenatal clients initiated on HAART rate from 79.4% in 2010/11 to 95% in 2014/15.
Decreasing the percentage of babies testing PCR positive six weeks after birth from 3.5% in 2010 to 2% in 2014/15.
REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS
Key strategic interventions during 2012/13 to 2014/15 would include:
Increasing the TB cure rate from 72% to 90% by 2014/15.
Reducing the TB treatment defaulter rate from 7% in 2010/11 to less than 5% in 2014/15
COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN
Key strategic interventions during 2012/13 to 2014/15 would include:
Increasing the percentage of HIV positive patients screened for TB from 71% in 2010/11 to 90% in 2014/15.
Increasing the percentage of TB patients tested for HIV from 68% in 2010/11 to 90% in 2014/15.
Increasing the percentage of TB and HIV co-infected patients receiving Cotrimoxazole Prophylaxis Therapy from 71% in 2010/11 to 100% in 2014/15.
Increasing the number of HIV positive patients receiving Isoniazid Preventative Therapy (IPT) from 210 396 in 2010/11 to 500 000 in 2014/15.
RE-ENGINEERING OF PRIMARY HEALTH CARE
Key strategic interventions during 2012/13 to 2014/15 would include the:
Implementation of community based services in each district by establishing Family Health Teams, 500 in 2012/13, 1000 in 2013/14 and 2000 in 2014/15.
Improvement of access to primary health care services, with an increased utilization rate of 3.2 visits by 2014/15.
Implementation of the Districts Specialists teams, 10 districts in 2012/13, an additional 20 districts in 2013/14 with a total of 50 districts in 2014/15.
Improvement of the percentage of Primary Health Care facilities that receive a monthly supervisory visit from 68.4% in 2010/11 to 90% in 2014/15.
FUNCTIONAL DISTRICT HEALTH SYSTEM
The key strategic interventions during 2012/13 to 2014/15 would include the:
Revision of the District Health System Policy.
Development of an inter- sectoral framework for addressing the Social Determinants of Health.
Support of the development of 52 Districts Health plans aligned to the Health Sector priorities.
3.11 REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON-COMMUNICABLE DISEASES
The key strategic interventions during 2012/13 to 2014/15 would include:
Decreasing the incidence of malaria from 0.62 per 1000 people at risk in 2010/11 to 0.34 per 1000 people at risk in 2014/15.
Chronic care, whether from communicable or non-communicable causes would be aligned and a single chronic care model would be rolled out to 10 districts by 2014/15.
Introducing legislation on alcohol advertising and enacting regulations on salt content in food products.
Strengthening the quality of Environmental Health Services, Norms and Standards would be developed and implemented by 2014/15.
ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE
The key strategic interventions during 2012/13 to 2014/15 would include the:
Development and implementation of a national infrastructure plan in conjunction with provincial infrastructure units and updated on an annual basis.
Maintenance of existing prioritized nursing colleges and schools, and the development and implementation of an infrastructure master plan for nursing colleges and schools.
Acceleration of the delivery of health infrastructure through Public Private Partnerships ( PPPs ).
Completion of feasibility studies by all five tertiary hospitals and issued the request for proposals by March 2013. These tertiary hospitals are:
Nelson Mandela Academic ( Eastern Cape )
Chris Hani Baragwanath ( Gauteng )
Dr. George Mukhari ( Gauteng )
Limpopo Academic ( Limpopo )
King Edward V111 (KwaZulu-Natal)
3.13 EFFICIENT MANAGEMENT OF HEALTH CARE TECHNOLOGY
The key strategic interventions during 2012/13 to 2014/15 would include the:
Commencement of the implementation of the Health Technology Strategy.
Revision of the Essential Equipment lists for all levels of care.
Finalisation of the standards for the use and maintenance of Health Care Technology.
IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT
The key strategic interventions during 2012/13 to 2014/15 would include:
Norms and Standards for Health Workforce for Primary and Secondary Health Care developed and gap analysis conducted.
Standardized training programme for Community Health Workers in partnership with FET and HWSETA.
IMPROVE THE QUALITY OF HEALTH SERVICES
The key strategic interventions during 2012/13 to 2014/15 would include the following:
During 2012/13, the Office of Health Standards Compliance would be established.
Patient satisfaction will be monitored and a patient satisfaction surveys would be conducted in 90% of the 400 public hospitals during 2012/13 and 100% during 2013/14 and 2014/15.
Seventy five percent (75%) of public complaints would be resolved within 25 days during 2012/13, increased to 80% during 2013/14 and 2014/15.
Twenty percent (20%) meaning that 800 of the 4, 333 public health facilities would be assessed for compliance with the six priorities of the core standards. That figure grows to 40% in 2013/14 and to 60% by 2014/15.
BUDGET SUMMARY
The Department of Health received R27.6 billion, which is 5% of the total appropriation in the 2012/13 financial year. The total budget had increased in nominal terms by 6.12% and increased slightly in real terms by 0.21%. The bulk of the budget (R26.2 billion or 95.3%) would be transferred to provinces and municipalities for HIV and AIDS, TB and maternal, child and womens health and the hospitals, tertiary services and workforce development programmes.
4.1 PROGRAMME ALLOCATIONS FOR 2012/13-2014/15
Programme 1: Administration
The Programme budget had decreased by 2.2% in nominal terms (7.7%) from R366 million in 2011/12 to R357.09 million in 2012/13.
Programme 2: National Health Insurance, Health Planning and Systems Enablement
The Programme budget had increased by 94% from the 2011/12 financial year due to the budget increase of the NHI sub-programme. The NHI received the largest portion of the budget at 58% (R182.1 million) to develop and implement policies, legislation and frameworks for expansion of health insurance to the broader population, amongst other things. This represented an increase of more that 300.08%. The conditional grant for the pilot NHI projects would amount to R150 million, R350 million and R500 million over the medium term expenditure framework. This grant would serve as an interim funding mechanism until a more permanent funding source was established.
Programme 3: HIV and AIDS, TB and Maternal, Child and Womens Health
This programme received the second largest allocation which amounted to R9.3 billion or 33.7% of the total budget. R9.2 billion of this budget is allocated to the HIV and AIDS sub programme. The maternal and child health sub-programme declined by 40% from R51.07 million to R32.09 million. About 96.3% was transferred to provinces.
Programme 4: Primary Health Care Services
The Non-Communicable Diseases sub-programme received R27.2 million representing 31.2% of the programmes budget allocation.
Programme 5: Hospitals, Tertiary Services and Workforce Development
This programme received 61.4% of the total health budget which was R16.9 billion. Most of the budget was transferred to provinces.
Programme 6: Health Regulation and Compliance Management
This programme budget had increased by 2.3% from 531.04 million to R575.08 million. Most of the funds in this programme were allocated to Public Entities Management.
4.2 EXPENDITURE TRENDS
The Departments expenditure grew from R16, 4 billion in 2008/09 to R25, 9 billion in 2011/12 at an average annual rate of 16, 5%. Over the Medium Term period, expenditure was expected to grow to R33, 9 billion, at an average annual rate of 9, 25%. The increase in both periods was driven largely by transfers to provinces for the conditional grants, with the main increase being on the HIV and AIDS and the introduction of NHI grant and Nursing Colleges grant.
4.3 MEDIUM TERM ALLOCATIONS FOR 2012/13 2014/15
The budget included new allocations of R97.6 million for 2012/13, R618.4 million for 2013/14 and R1.9 billion for 2014/15. The allocations were divided as follows:
Ten million per annum for the forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs.
Twenty million per annum for higher accommodation costs of renovated head-office of the Department.
Costs associated with annual wage increases (3 million per annum for the Medical Research Council and 10 million per annum for the Department of Health).
R100 million, R150 million and R200 million to nursing colleges to plan and coordinate the upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit.
Eight hundred and thirty four million for the HIV and AIDS conditional grant for the rapidly growing treatment programme (lower threshold Cd4 count of 350) and to strengthen prevention programmes.
One hundred and twenty eight million on Hospital Revitalisation grant to start making provision for the first of five large hospital PPP projects.
One hundred and fifty million, R350 million and R500 million to cover the cost of NHI pilots.
One hundred and eighty nine million, R231 million and R216 million increases for effects of wage increases in National Treasury Services Grant (NTSG).
4.4 FUNDS EARMARKED FOR POLICY PRIORITIES
Funds earmarked for policy priorities would be allocated as follows:
R67 million, R70 million and 73.2 million for the forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs.
R48.5 million, R40.1 million and R42.5 million to establish the Office of Standards Compliance and support its inspectorate, certificate of compliance and ombudsman functions.
R135 million in 2012/13, R140 million in 2012/13 and R148.4 million in 2013/14 to increase the distribution of condoms.
R27 million, R23 million and R24.4 million for infrastructure management to build up capacity in the department to oversee the hospital revitalisation projects and to support planning and transaction advisor costs for large private public partnership projects.
R7 million, R9 million, and R9.6 million for health technology to support provincial upgrading for engineering workshops and equipment audits and to develop equipment packages and systems for health technology.
R10 million to develop improve hospital tariff schedules linked to case mix for use by provinces and the Road Accident Fund, including improved uniform patient fee structure and developing diagnosis related groups (DRG) system.
R5 million per annum to plan and coordinate the second phase of upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit.
R10 million per annum for district health information systems, improving data quality analysis and reporting.
R8.3 million, R10,2 million and R10,8 million for the Health Systems Trust to support health systems research activities including the annual health review and district health barometer.
R2 million per year to publish standardised annual health statistics in the new annual health statistics publication to facilitate performance auditing and better inform the public and health service providers.
R19 million, R21.4 million and R22.6 million for the Compensation Commissioner for Occupational Diseases to address backlogs in compensation, improve systems and address problems identified in audit reports.
R9 million, R10.3 million and R11 million to establish a unit to monitor and support provincial finances and improve audit outcomes.
R31.6 million, R33.4 million and R35. 4 million to establish SA Health Products regulatory authority and IT system.
4.5 INFRASTRUCTURE SPENDING
This section reflects how the infrastructure spending would look like:
Three conditional grants for health infrastructure: Hospital Revitalisation, Health Infrastructure and Nursing College grants.
Hospital Revitalisation Grant allocation over the MTEF was R4.1 billion, R4.2 billion and R4.6 billion.
Health Infrastructure Grant allocations over the MTEF of R1.6 billion, R1.7 billion and R1.8 billion and would focus on maintenance of institutions and smaller upgrading projects in primary care institutions and hospitals.
Nursing colleges grant was a new grant to upgrade nursing colleges. Allocation over the MTEF was R100 million, R150 million and R200 million.
COMMITTEES CONCERNS
The committee expressed the following concerns:
Primary Health Care was not getting the necessary attention it deserves from the Department. This was also demonstrated by the cut in budget allocation for PHC.
The Department did not have sufficient plans to deal with communicable disease.
6. CONCLUSION
Having considered the budget and the strategic plan and responses to questions by the department, the Committee accepted the budget and would continue to do its oversight role on the spending trends of the Department of Health.
Report to be considered.
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