ATC121025: The Budgetary Review and Recommendations Report of the Portfolio Committee on Health on the performance of the Department of Health for the 2011/12 financial year, dated 24 October 2012

Health

The Budgetary Review and Recommendations Report of the Portfolio Committee on Health on the performance of the Department of Health for the 2011/12 financial year, dated 24 October 2012

The Budgetary Review and Recommendations Report of the Portfolio Committee on Health on the performance of the Department of Health for the 2011/12 financial year, d ated 24 October 2012

1. Introduction

Section 77 (3) of the Constitution of South Africa provides for an Act of Parliament which will provide for a procedure to amend the Money Bills before it. The Money Bills Amendment Procedure and Related Matters Act, 2009 (Act 9 of 2009) thus enables Parliament to amend aspects related to tabled Money Bills. The objectives of this Bill are twofold:

  • To establish a procedure to amend Money Bills before Parliament within the context of oversight findings and the adoption of the fiscal framework; and
  • To establish a Parliamentary Budget Office to provide research support to Parliament and its Committees pursuant to maintaining oversight of the budget process and the possible amendment to Money Bills.

1.1. The role of the Committee

Parliament conducts its constitutional obligations through the work of Committees. Committees of Parliament facilitate the passing of legislation, approve annual departmental budgets and conduct oversight over departments falling within their perimeters.

Section 5 (1) of the Money Bills Amendment Procedure and Related Matters Bill provides for the National Assembly (NA), through its committees, to annually assess the performance of each national department, with reference to the following:

  • Medium Term estimates of expenditure, its strategic priorities and measurable objectives;
  • Prevailing strategic plans;
  • Expenditure report relating to such department published by National Treasury in terms of Section 32 of the Public Finance Management Act;
  • Financial statements and annual report of such departments;
  • Reports of the Committee on Public Accounts relating to the department; and
  • Any other information requested by or presented to a House or Parliament.

Section 5 (2) makes provision for the annual submission of the Budgetary Review and Recommendations Report (BRRR) for tabling in the National Assembly for each department. It is expected of the BRRR to report on the following:

  • Assessment of the department’s service delivery performance given the available resources;
  • Assessment on the effectiveness and efficiency of the department’s use and forward allocation of available resources; and
  • May include recommendations on the forward use of resources.

In order to enable the Committee to take an informed decision on the performance of the Department of Health for the financial year 2011/12, the Committee consulted the following reports and/or documents:

  • The State-of-the-Nation Address (SONA);
  • Reports of the Auditor-General;
  • Reports of fact-finding visits (or oversight);
  • Prior BRR reports; and
  • Reports emanating from Committee meetings (Briefings).

1.2. The Department of Health (The Department)

The Department of Health derives its mandate from the Constitution. Section 27(1)(a) of the Constitution states that “Everyone has the right to have access to health care services, including reproductive health care”. Section 27(3) further notes that “no one may be refused emergency medical treatment.” Section 28(1)(c) further gives every child the right to “basic nutrition, shelter, basic health care services and social services”. Finally, schedule 4 of the Constitution makes health care services both a national and provincial legislative competence and/or imperative.

In line with its constitutional obligations, the vision of the Department is ‘a long and healthy life for all South Africans’. Its mission is to improve health status through prevention of illness and disease, through the promotion of healthy lifestyles, and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

Government adopted an outcome-based approach to service delivery and the health sector is responsible for the achievement of outcome two which is a long and healthy life for all South Africans. The Department has therefore identified four outputs as follows:

  • Output 1: Increasing life expectancy;
  • Output 2: Decreasing maternal and child mortality;
  • Output 3: Combating HIV and AIDS and decreasing the burden of

Diseases from tuberculosis; and

  • Output 4: Strengthening Health System Effectiveness

In Strengthening the Health System Effectiveness, the Department focuses on the following inputs:

  1. Primary Health Care Orientated Service Delivery
  2. Improved quality of services
  3. Improved Human Resources for Health
  4. Improved access to Health facilities
  5. Improved financial management
  6. National Health insurance
  7. Health information

8. Inter-sectoral action for social determinants of Health

2. Department’s Strategic Priorities and Measurable Objectives

2.1. Strategic Plan of the Department - Ten Point Plan

The Health sector’s 10 Point Plan for 2009-2014 serves as an important overarching and macro framework for overhauling the health system, to enhance its capacity to improve health outcomes, and to harness focused interventions towards the Millennium Development Goals.

The priorities comprising the 10 Point Plan are as follows:

· Provision of strategic leadership and creation of social compact for better health outcomes;

· Implementation of the National Health Insurance (NHI);

· Improving the quality of health services;

· Overhauling the healthcare system and improving its management;

· Improved human resources planning development and management;

· Revitalization of infrastructure;

· Accelerated implementation of HIV and AIDS, STI and TB strategic plan;

· Mass mobilization for better health for the population;

· Review the Drug Policy; and

· Strengthening Research and Development.

2.2. Measurable Objectives of the Department

The measurable objectives and outcomes of the Department are outlined in accordance with its six programmes. They summarise what the Department intends to achieve in each programme in order to achieve its overall health care service delivery mandate. These programmes are as follows:

2.2.1. Programme 1: Administration

The aim of this programme is the overall management of the Department and centralised support services. In the 2011/12 financial year, the Department’s main goal was to ensure that it obtains an unqualified audit opinion. Consequently, the Department of Health received an unqualified audit opinion from the Auditor-General of South Africa at the end of 2011/12.

Measurable Objectives

  • To ensure effective financial management and accountability
  • To ensure that Information Communication Technology (ICT) supports the business objectives of the Department.

2.2.2. Programme 2: Health Planning and Systems Enablement

The objective of this programme is to improve access and quality of health services through planning, integration of health systems, reporting, monitoring, evaluation and research. The allocated budget for the Health Planning and Systems Enablement programme is R161 million for 2011/2012.

Measurable Objectives

  • Facilitate and coordinate evidence based planning for all levels of the health care system, aligned to the health sector’s 10 point plan and negotiated service delivery agreement.
  • Develop and implement an integrated monitoring and evaluation system aligned to outcomes contained in the negotiated service delivery agreement.
  • Monitor HIV and syphilis prevalence by conducting the annual national HIV survey.
  • Strengthen research and development .
  • Prepare for the implementation of the National Health Insurance (NHI)
  • Provide stewardship and leadership for improving health outcomes through working with international development partners, SADC and AU.
  • Revise guidelines for planning developed and implemented.

· Analyse and provide feedback on nine Provincial Annual Performance Plans.

2.2.3. Programme 3: HIV & AIDS, TB and Maternal, Child and Women’s Health

The objective of this programme is to coordinate, manage and fund HIV and AIDS, Tuberculosis (TB) and maternal, child and women’s health programmes. Develop and oversee implementation of policies, systems and norms and standards. The allocated budget for the HIV & AIDS, TB and Maternal, Child and Women’s Health programme was R8, 027 million for 2011/2012.

Measurable Objectives

  • To scale up combination of prevention interventions to reduce new infections
  • To improve the quality of life of people living with HIV and AIDS by providing an appropriate package of care, treatment and support services to at least 80%of people living with HIV and AIDS.
  • To reduce infant, child and youth morbidity and mortality.
  • To reduce maternal mortality.
  • To improve access to reproductive health.
  • Expand the Prevention of Mother to Child Transmission coverage to pregnant women.
  • To reduce the burden of Tuberculosis.
  • To combat TB and HIV by reducing the co-infection burden.

2.2.4. Programme 4: Primary Health Care Services (PHC)

The objective of this programme is to develop and implement a uniform District Heath System. The programme also develops a policy for district health services (PHC and district hospitals), identifies and promotes centres of excellence and supports planning, delivers and monitors these services. The allocated budget for this programme was R730 million for 2011/2012.

Measurable Objectives

  • To eliminate Malaria by reducing the local transmission of malaria cases to 0% population at risk, through the implementation of the malaria elimination strategy by 2018.
  • Prevent and manage non-communicable diseases by implementing the chronic care model and strengthen the implementation of the long term care model for diabetes over the MTEF period.
  • Strengthen the implementation of Health Promotion Initiatives.
  • Strengthen the quality of Environmental Health Services.
  • Reduce morbidity and mortality from injuries and violence.
  • Improve community participation, in supporting the delivery of PHC services by establishing governance structures in line with National Health Act (2003) by 2011/2012.
  • Conduct a comprehensive primary health care audit including district hospitals by March 2012.
  • Improve access to primary health care services.
  • Improve the management of District Hospital .
  • Improve health outcomes through ensuring the 52 district health plans are used for planning, monitoring and reporting and programme implementation by providing direct and indirect support to the District Management Teams during the process of developing District Health Plans.

2.2.5. Programme 5: Hospitals, Tertiary Services and Workforce Development

The purpose of this programme is to develop policies, delivery models and clinical protocols for hospital and emergency medical services. The programme also ensures that Academic Medical Centres (AMCs) and health workforce development programmes are aligned. The allocated budget for the Hospital Tertiary Services and Workforce Development programme was R15, 963 million for 2011/2012.

Measurable Objectives

  • Accelerate the delivery of health infrastructure.
  • Ensure appropriate health technology is available and efficiently managed.

· Improve Health Workforce planning, management and development.

2.2.6. Programme 6: Health Regulation and Compliance Management

The purpose of this programme is to regulate procurement of medicines and pharmaceutical supplies, including trade in health products and to promote accountability and compliance by regulatory bodies for effective governance and quality of health care. The allocated budget for Regulations and Compliance Management programme was R525 million for 2011/2012.

Measurable Objectives

  • Improve the registration of medicines and reduce the time to market through reducing the backlog on medicine registrations by building in house capacity, recruit and train evaluators, manage clinical trials and perform inspections on an on-going basis.
  • Improve oversight over the registration of Pharmaceutical and related products.
  • Improve the quality of health services.
  • Improve access to occupational health services through expanding comprehensive occupational health units in district hospitals.
  • Strengthen food control and risk management measures related to development/publication/implementation of relevant national legislation based on international standards adopted by the FAO/WHO Codex Alimentarius, where applicable.
  • Strengthen and facilitate good corporate and management governance of public entities and statutory health professional councils.
  • Monitor compliance and implementation of policies and legislative prescripts relevant to public entities.
  • Establish a forum of statutory health professional council in terms of Section 50 of the National Health Act, 2003.

3. Analysis of the Department’s Prevailing Strategic and Operational Plan

3.1. Introduction

The aim of the Department of Health is to provide leadership and coordination of health services to promote the health of all people in South Africa through an accessible, caring and high quality health system based on the primary health care approach. The structure of the Department’s budget changed considerably from the 2010/11 financial year, with some programmes either combined, shifted to another programmes or discontinued. The Department also introduced new sub-programmes, and changed the titles of the programmes accordingly. While the Department remains within the ambit of broader policy priorities identified in the 2009-2014 Medium Term Strategic Framework (MTSF), as well as its 2010/11-2012/13 strategic plan, focus areas were altered significantly due to its programme and budget restructuring.

The Department is in the process of restructuring in order to align itself to the Minister of Health’s 10-Point Plan for improving health outcomes in South Africa. This change is evident in the restructuring of the Department’s entire budget as new programmes are created and other programmes reprioritised. The six programmes in the new structure are: administration; health planning and system enablement; HIV and AIDS, TB and maternal, child and women’s health; primary health care services; hospitals, tertiary services and workforce development. It is important to note that the changes in the Department’s programmes will impact on the Committee’s ability to track progress on expenditure on last year’s budget and service delivery performance.

There are some important changes to be aware of within the health budget during this financial year (2011/12). These include: the introduction of a family health approach to primary health care and the establishment of the Office of Standards Compliance in the 2011/12 financial year.

3.2. Policy Priorities for 2011/12

The health sector was specifically highlighted in the 2011 SONA as one of the five main priority areas of government, which include creating decent work, education, health, rural development and agrarian reform and fighting crime. In line with the President’s directive that all government departments align their programmes with the job creation initiative and ensure improved access to Human Resources for Health, one of the most important focus areas for the Department was the appointment of appropriate and qualified personnel to the right positions.

The 2011 SONA further emphasised the training of doctors and nurses, as well as the revitalisation of 105 nursing colleges and refurbishment and renovations of hospitals and clinics. This is important in order to achieve the Department’s priority of improving patient care and satisfaction and improve the quality of health facilities.

These and other national priorities such as women’s health (including programmes related to reproductive health rights and services related to contraception, sexually transmitted infections (STI), teenage pregnancy and provision of sanitary towels (for the indigent), and Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) programmes should also be prioritised by the Department and reflected in the budget.

Below are the priorities that are in line with the strategic objectives of the Department, which are:

· HIV and AIDS and Tuberculosis (TB), with emphasis on prevention.

· Improved Primary Health Care and Public Health Facilities – the re-engineered primary health care system aims to improve health outcomes and to assist in achieving the National Health Insurance (NHI), which is an important priority of the department.

· A more efficient health sector with respect to financial management, ICT solutions, improving the health sector’s monitoring and evaluation capacity, and improving the quality and integrity of data on health indicators.

· Ensuring that the Department adopts an outcomes-based approach for service delivery and performance management.

Furthermore, the 2011 budget also emphasised the need to ensure that the Department’s priorities are aligned to the Millennium Development Goals (MDGs).

3.3. Performance and Service Delivery Information

Ten of the twelve selected performance indicators differ from the indicators that were reported on in the previous financial year (2010/11). Therefore, only two performance indicators can be assessed, which are Tuberculosis Cure Rate and Tuberculosis treatment defaulter rate.

3.4. Budget Analysis


The Department received R25.7 billion, which is 5 per cent of the total appropriation to all budget votes in the 2011/12 financial year. The Department, therefore, received a higher percentage of the national budget than the previous financial year, when it received 4.65 percent of the budget. The total budget has also increased in both nominal (11.24 per cent) and real (6.14 per cent) terms. The bulk of the budget, about 93 per cent, was transferred to provinces and municipalities for HIV and AIDS, TB and Maternal, Child and Women’s Health and the Hospitals, Tertiary Services and Workforce Development Programmes.

Current payments constituted a total value of R1.2 billion, which represented 4.7 per cent of the total budget allocation. Most of the expenditure was allocated to Goods and Services, taking up 64.9 per cent of the total current payments. Expenditure items that received the largest share of the goods and services budget were Medical supplies at R150.8 million, consultants and professional services at R116.2 million and Travel and Subsistence at R114.4 million.

All capital payments amounting to R32.9 million were allocated to Machinery and Equipment in the 2011/12 financial year.

The following additional allocations had been made in the 2011/12 financial year:

· R60 million for the HIV and AIDS conditional grant for the rapidly growing treatment programme and to strengthen prevention programmes, including R60 million per year for male circumcision.

· R250 million for the national tertiary services conditional grant to support public hospitals to achieve norms and standards (partly in preparation for the NHI) and to implement standards and guidelines of the Office of Standards Compliance and Quality Assurance, as well as to address differential costs of occupation specific dispensation for doctors.

· R10 million to forensic chemistry laboratories to purchase equipment and provide capacity to address backlogs.

· A once-off payment of R10 million to the South African Health Products and Regulatory Authority to establish itself and to deal with the medicine registration backlogs.

· R10 million to the Office of Standards Compliance and Quality Assurance to establish itself and to support its inspectorate, certificate of compliance and ombudsman functions.

· R30 million to progressively increase the distribution of condoms.

· R21 million for infrastructure management and private public partnerships to build capacity in the Department to oversee the hospital revitalisation projects, and to support planning and transaction advisor costs for large private public partnership projects.

· R5 million for health technology to support provincial upgrading of engineering workshops and equipment audits and to develop equipment packages and systems for health technology.

· R5 million for the NHI to support development work and projects, including the Ministerial Advisory Committee.

· R4 million to develop improved hospital tariff schedules for use by provinces and the Road Accident Fund, including an improved uniform patient fee structure, Road Accident Fund reimbursements and tariff structure, and developing a diagnosis related groups system.

· R9 million to nursing colleges to plan and coordinate the second phase of upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit.

· R5 million for health information systems to support national workgroup investigations of new patient based IT systems and to propose next steps in IT infrastructure to support the district health information system.

· R3 million for the Health Systems Trust to support health systems research activities, including the annual health review and district health barometer.

· R2 million 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.

· R5 million for the Compensation Commissioner for Occupational Diseases (CCOD) to address backlogs in compensation, improve systems and address problems identified in audit reports.

· R2 million to monitor and support provinces to stabilise provincial finances and improve audit outcomes.

· R1.7 billion towards a new infrastructure grant to provinces.

· R4.1 billion for the Hospital Revitalisation Grant. The Department had started with the planning and design phase of five flagship private public partnership (PPPs): Chris Hani Baragwanath, Garankuwa, King Edward VII, Polokwane and Eastern Cape academic complex.

4. Programme Analysis

4.1. Programme 1: Administration

In the period under review, the budget for this programme had increased by 15.6 per cent in nominal terms and 8.32 per cent in real terms due to the significant increases in the Management and Financial Management sub-programmes. These sub-programmes increased by 41.05 per cent and 48.16 per cent in real terms respectively in the financial year under review. The Corporate Services sub-programme receives 47.9 per cent of the programme budget and was the only programme that decreased slightly in real terms by 1.16 per cent, while Office Accommodation received 16.9 per cent of the Programme budget. A new sub-programme was the Financial Management sub-programme, which received the third highest portion of the budget at 13.9 per cent.

In terms economic classification, 97.5 per cent of the budget was allocated to current payments. The highest expenditure items under current payments were Compensation of Employees at 37.1 per cent; lease payments at 17.3 per cent; 7.6 per cent on external audit costs and 7.5 per cent on Travel and Subsistence.

4.2. Programme 2: Health Planning and Systems Enablement

The budget for this programme increased by 13.25 per cent in real terms from the 2010/11 financial year, mainly due to the budget increase of the NHI sub-programme. The NHI, however, still received the lowest portion of the budget at 4.9 per cent to develop and implement policies, legislation and frameworks for expansion of health insurance to the broader population, amongst other things. The highest portion of this programme’s budget was allocated to the International Relations sub-programme, which was responsible for developing and implementing bilateral and multilateral agreements to strengthen the health systems. The Financial Planning and Health Economics sub-programme’s budget was reduced by 41.74 per cent in real terms from the 2010/11 financial year.

This Programme included the following six sub-programmes:

  • Technical Policy and Planning – contained some functions that were carried out within the Health Human Resources Management and Development Programme (Programme 4) in 2010/11.
  • Health Information Management, Monitoring and Evaluation - was shifted from the Health Planning and Monitoring Programme (Programme 3) in 2010/11.
  • Sector Procurement and Policy – was a new sub-programme, which seemed to be a combination of activities from different sub-programmes in the last financial year.
  • Financial Planning and Health Economics – was shifted from the Health Planning and Monitoring Programme (Programme 3) in 2010/11.
  • International Relations sub-programme was shifted from the prior International Relations, Health Trade and Health Product Regulation programme (Programme 6).
  • NHI was a new programme within the vote.

4.3. Programme 3: HIV and AIDS, TB and Maternal, Child and Women’s Health

The budget for the programme also aimed to develop and oversee the implementation of policies, systems, norms and standards. This programme contained two sub-programmes from the programme that was previously named Strategic Health Programmes (Programme 2) in 2010/11, and still received the second largest allocation (that is R8.0 billion or 31.2 per cent) of the budget vote. Of the R8 billion, a total of R7.97 billion (or 99.4 per cent) of that budget was allocated to the HIV and AIDS and TB sub programme; and the remaining allocation went to the Maternal, Child and Women’s Health sub-programme (R51.7 million). In terms of economic classification, most of the allocation, about 98 per cent, was transferred to provinces.

In 2010/11 voluntary counselling and testing (VCT), and the prevention of mother to child transmission of HIV (PMTCT) services were provided in more than 95 per cent of health facilities at a cost of R 122.6 million.

Payments were allocated a total of R357.6 million. The highest expenditure items of current payments were compensation of employees at 15.9 per cent, advertising costs at 17.3 per cent and Inventory: Medical Supplies at 41.9 per cent.

4.4. Programme 4: Primary Health Care Services

The programme was comprised of four sub-programmes, two of which were part of Programme 2 (Strategic Health Programmes) and two from Programme 5 (Health Services) in 2010/11. The bulk of the programme budget, which was 91.7 per cent or R 669.5 million, went to the Non-communicable Diseases sub-programme. That sub-programme, amongst others, assisted provinces in implementing and monitoring chronic diseases, disability, elderly people oral health, mental health and substance abuse.

In terms of economic classification, 80.82 per cent of the budget was transferred to provinces and municipalities. The highest expenditure items of the expenditure were compensation of employees at 47.3 per cent, consultants and professional services at 10.6 per cent, and Travel and Subsistence at 11 per cent.

Although the programme budget increased by 2.5 per cent in nominal terms, that translated into a decrease of 2.15 per cent in real terms. That was due to the large decreases in the budgets of the Districts Health Services (51.57 per cent real decrease) and Communicable Diseases (18.50 per cent real decrease) sub-programmes.

4.5. Programme 5: Hospitals, Tertiary Services and Workforce Development

The programme received 62 per cent of the total health budget (R15 962.7 million), most of which was transferred to provinces and municipalities through the National Tertiary Services Management and Health Facilities Infrastructure Management sub programmes which received 50.4 per cent and 36.8 per cent respectively. Transfer payments consumed 99.4 per cent of the total budget. In terms of current expenditure, the highest allocations were made to compensation of employees at 37.5 per cent; consultants and professional services at 34.0 per cent, property payment at 11.2 per cent and outsourced services at 6.5 per cent.

All the sub-programmes within the programme increased in both nominal and real terms, resulting in a nominal increase of 7.7 per cent and real increase of 2.72 per cent in the programme budget. The Hospital Management sub-programme, which dealt with national policy on hospital and emergency medical services, reflected the highest increase of 28.96 per cent in real terms from the 2010/11 financial year.

4.6. Programme 6: Health Regulation and Compliance Management

The budget for the programme budget had increased by 1 per cent in real terms, as the budget allocations of four of the six sub-programmes had increased both in nominal and real terms. Most of the funds in the programme were allocated to the Public Entities Management sub-programme, which received 69.5 per cent of the budget. 69.7 per cent of the budget would be transferred to departmental agencies and accounts and non-profit institutions. The highest spending items under current payments were compensation of employees at 52.4 per cent, consultants and professional services at 20.6 per cent; and Travel and Subsistence at 8.6 per cent.

The programme consisted of six sub-programmes, three of which were in the Human Resources Management and Development Programme in the 2010/11 financial year. Those were the Human Resources Policy Research and Planning; Sector Relations and Planning; and Health Human Resources and Workforce Management, and Development Programmes. The Hospital Management, Health Facilities Infrastructure Management and National Tertiary Services Management sub-programmes were previously located in the Health Management Programme (Programme 5) in 2010/11. The Health Facilities Infrastructure Management and National Tertiary Services Management sub-programmes still consumed the largest portion of the department’s budget at 54.1 per cent.

5. Analysis of Section 32 Expenditure Report

5.1. Introduction

In 2011/12 financial year, the Department was allocated R25 967 971 billion. Of the amount, the Department spent R25 712 842 billion, which was 99.25% of the available budget. That amounted to an under-expenditure of R255 129 million, which was 0.75%. The under-expenditure was a significant decrease compared to the previous financial year. The under-expenditure was largely attributed to under-expenditure in all the programmes of the Department.

Programme 1: Administration

The programme showed expenditure of 95.3%, with under-expenditure of R15 958 million (4.7%) against a budget of R342 941 million. The under-expenditure on goods and services was related to the allocated funds for health statistics publications, the provincial support unit and the hospital tariffs system review, which could not be fully used. The 4.7% under-spending on capital could be ascribed to the suppliers not being able to deliver the ordered Information Technology (IT) equipment before year end.

Programme 2: Health Planning and System Enablement

The programme showed expenditure amounting to 91.3% with under-expenditure of R15 359 million (2%) against a budget of R177 313 million. The under-expenditure was attributed to slow spending on the NHI funding received, as the legislative processes delayed the consultation processes. The Technical Policy and Planning Unit were inactive, as the panel of technical experts was only finalised towards the end of the financial year.

Programme 3: HIV and AIDS, TB and Maternal, Child, and Women’s Health

From a total allocation of R8 014 742 billion, the programme had spent 98.9% of its allocated funds, amounting to R7 927 131 billion, with under-expenditure of R87 611 million. The under-expenditure could be ascribed to the late finalisation of the national condom tender awarded by National Treasury and failure to appoint a communication consultant for HIV and AIDS.

Programme 4: Primary Health Care Services

The total allocation for the programme amounted to R761 703 million. The programme showed an expenditure outcome of R741 483 million, which was 97.3%, with under-expenditure of R20 220 million. The under-expenditure was related to the late delivery of influenza vaccines.

Programme 5: Hospital, Tertiary Services and Workforce Development

The programme had spent 99.4% of its R16 149 471 billion allocated funds, amounting to R16 057 420 billion, resulted in under-expenditure of R92 051 million. The under-expenditure was mainly attributed to the Infrastructure Unit Support System not being invoiced by the supplier before year end and the slow start of the nursing college’s project.

Programme 6: Health Regulation and Compliance Management

The programme had spent 95.4% of its R521 801 million allocated funds, amounting to R497 871 million, with under-expenditure of R23 930 million. The under-spending could be attributed to delays in the implementation of planned activities in the Office of Standards Compliance.

6. Analysis of the Annual Report and Financial Statements of the Department

This section of the report focuses on the analysis of the annual report and financial statements of the Department in the 2011/12 financial year.

6.1. Department’s Key Strategic Objectives

The South African government adopted an outcome-based approach to service delivery. The health sector is responsible for the achievement of outcome 2, which is a “Long and Healthy Life for all South Africans” .

In order for the health sector to contribute towards achieving a long and healthy life for all South Africans, the Minister Dr. Aaron Motsoaledi, has committed to the following Negotiated Service Delivery Agreement (NSDA) 2010-2014 outputs:

(a) Increased life expectancy;

(b) Reduction in maternal and child mortality rates;

(c) Combating Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and decreasing the burden of disease from Tuberculosis (TB); and

(d) Strengthening health system effectiveness.

The above mentioned four outputs are aligned to the priorities outlined in the Department’s 10 point plan, as well as the health-related Millennium Development Goals (MDGs).

6.2. Programme Performance by Budget Programme

During the period under review, the Department received R25 967 971 billion, of which the Department spent R25 712 842 billion, which was 99.25% of the available budget. The Department under-spent a total amount of R255 129 million, resulting in under-expenditure of 0.75%. That showed an improvement compared to 3.4% under-expenditure during 2010/11 financial year.

The activities of the Department were organised in six programmes. Those were as follows:

6.2.1. Programme 1: Administration

This programme shows expenditure of 95.3%, with under-expenditure of R15 958 million (4.7%) against a budget of R342 941 million. The under-expenditure on goods and services is related to the allocated funds for health statistics publications, the provincial support unit and the hospital tariffs system review, which could not be fully used. The 4.7% under-spending on capital can be ascribed to the suppliers not being able to deliver the ordered Information Technology (IT) equipment before year end.

The programme consisted of the following five sub-programmes:

· Ministry;

· Management;

· Financial Management;

· Corporate services; and

· Office administration.

In 2010/11 financial year, the Department of Health received a qualified audit opinion from Auditor-General of South Africa (AGSA) which was an indication of financial mismanagement. However, the Department of Health received an unqualified audit opinion from the AGSA for the 2011/12 financial year. Therefore, the Department managed to achieve its set target for “ensuring effective financial management and accountability” for 2011/12. That was attributed to the establishment of an asset management plan during the period under review. Furthermore, the Department reported that it implemented an asset management plan in three provincial departments; Eastern Cape, KwaZulu-Natal and Mpumalanga. It also reported that it funded the Northern Cape to implement its own asset management project.

However, out of the nine provincial health departments, six provinces received qualified audit opinions for 2011/12 financial year and two received disclaimers (Limpopo and Northern Cape). Only one province received an unqualified audit opinion (Western Cape) during 2011/12. In 2010/11 financial year, 7 out of 9 provincial departments received qualified audit opinions (Free State, Mpumalanga, Gauteng, Northern Cape, KZN, EC and Limpopo), whereas only two received unqualified audit opinion (Western Cape and North West). According to AGSA report, the reasons for unqualified audit opinion were based mainly on asset register, irregular expenditure, accruals, revenue management and contingent liabilities.

6.2.2. Programme 2: Health Planning and System Enablement

The programme showed expenditure amounting to 91.3% with under-expenditure of R15 359 million (2%) against a budget of R177 313 million. The under-expenditure was attributed to slow spending on the NHI funding received, as the legislative processes delayed the consultation processes. The Technical Policy and Planning Unit were inactive, as the panel of technical experts was only finalised towards the end of the financial year.

6.2.2.1. Technical Policy and Planning

In terms of Annual Performance Plans (APPs), 7 out of the set target of 9 provincial APPs were analysed and feedback was provided to provinces (Eastern Cape, Free State, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape and Northern Cape). The Department reported that due to capacity constraints two APPs of Gauteng and Western Cape were not analysed.

6.2.2.2. Health Information Management, Monitoring and Evaluation

In terms of the monitoring and evaluation, a monitoring and evaluation plan for NSDA was produced in March 2011 and that was done with technical support from an external service provider. Thus, the plan was accepted by the Health Data Advisory and Co-ordination Committee (HDACC) of the Department of Health. The department established a new sub-committee of HDACC, which would focus on the performance and effectiveness of the health system.

Other related monitoring and evaluation achievement were made in the following areas:

· A monitoring and evaluation framework for the National Strategic Plan for HIV and AIDS and TB 2012-2016 was produced;

· Targets for the outcome and impact indicators of the Global Fund Rounds were revised in alignment with NSP 2012-2016.

· Progress made with the implementation of a three-tiered monitoring and evaluation subsystem for Antiretroviral (ART). By the end of 2011/12 there were 582

6.2.2.3. National Health Insurance

The aim of this sub-programme is to ensure that all South Africans citizens and residents, irrespective of their socio-economic status, have access to good quality health services provided by both the public and private sectors. The ultimate goal for the NHI is to eradicate financial barriers limiting access to health care.

Some of the achievements made during that period under review included the following:

· The Department released the Green Paper on NHI in 12 August 2012 for public comment;

· The Department evaluated and reviewed written inputs;

· Ten pilot district selected in February 2012 (OR Tambo (EC), Thabo Mofutsanyane (FS), City of Tshwane (GP), UMgungundlovu (KZN), UMzinyathi (KZN), Vhembe (Limpopo), Gert Sibande (Mpumalanga) Dr. KK Kaunda (NW), Pixley Ka Seme (NC), and Eden (WC);

· The NHI Conditional Grant of R1 billion over the MTEF period 2011/12-2012/13/14 was established.

6.2.2.4. International Relations

The aim of this sub-programme is to provide stewardship and leadership for improving health outcomes through working with international development partners, Southern African Development Community (SADC) and African Union (AU).

The set target for 2011/12 was to facilitate three cross-border initiatives. According to the Department, that target was exceeded, as numerous initiatives were implemented. These include:

· The SADC HIV and AIDS Cross-Border Initiative in Zeerust, Ladybrand, Ficksburg and Oshoek border areas;

· The Lubombo Spatial Development Initiative (LSDI) for a malaria control cross-border project in selected sites in South Africa, Mozambique and Swaziland and MOZIZA cross-border malaria initiative;

· Facilitated a technical working group meeting on TB in mines to discuss background information on issues relevant to TB in mines, with specific focus on migrants and development of road map on 12 December 2011 and 5 to 8 March 2012. Those meetings resulted in the Development of the draft SADC Declaration on TB in the Mines and the draft SADC Code on TB in the Mines.

In addition to the above, during 2011/12 financial year, the Department also participated in several forums in the SADC region, continent and globally, with the view to enhancing international collaboration to improve South African health outcome. Those could be found on page 49 of the Department’s Annual Report for 2011/12.

6.2.3. Programme 3: HIV and AIDS, TB and Maternal, Child, and Women’s Health

The aim of this programme is to coordinate, manage and fund HIV and AIDS, TB and maternal, child and women’s health programmes.

From a total allocation of R8 014 742 billion, the programme had spent 98.9% of its allocated funds, amounting to R7 927 131 billion, with under-expenditure of R87 611 million. The under-expenditure could be ascribed to the late finalisation of the national condom tender awarded by National Treasury and failure to appoint a communication consultant for HIV and AIDS.

The programme consisted of three sub-programmes that relate directly to MDGs 4, 5 and 6. These sub-programmes included the following:

6.2.3.1. HIV and AIDS and STIs

In terms of HIV prevention initiatives for 2011/12, the Department recorded the following achievements:

· The HIV Counselling and Testing (HCT) campaign was transformed from the campaign mode and incorporated into the routine services provided in the public sector. As at end March 2012 an HCT uptake of 91% had been achieved. By the end of March 2012, a total of 9 602 553 million people had undergone counselling. Of these people mentioned, 8 772 423 people accepted HIV testing, which translate to 91% testing rate. This exceeded the targeted 85% in 2011/12 financial year.

· In total, 6 353 000 female condoms were distributed in 2011/12. That exceeded the annual target of 6 million. It also exceeded the recorded figure of 4 989 100 female condoms distributed in 2010/11 financial year.

In terms of access to antiretroviral treatment, the Department recorded the following achievements:

· A total of 617 147 people were initiated on ART during 2011/12, which translate to 99% of the annual target of 625 000. That figure was higher than the recorded 418 677 patients initiated on ART in the previous financial year, 2010/11.

Even though the Department made significant progress in programme 3, there were challenges that the Department encountered in the 2011/12 financial year.

6.2.3.2. Maternal, Child and Women’s Health

The aim of this sub-programme was to reduce infant, child and youth morbidity and mortality. The Department implemented strategic interventions to improve maternal, child and women’s health and to enhance progress towards the health-related MDGs 4 and 5. The targeted interventions to improve maternal and child health care during 2011/12 included:

· Increasing nutritional support to children under the age of five years;

· Increasing health-seeking behaviour by encouraging woman to make use of the health services early ;

· Increasing the proportion of deliveries in formal health establishments; and

· Increasing access to ART for HIV-positive pregnant women.

6.2.3.3. Improving Maternal Health

According to a recent Biomed Central (BMC) Health Services Research, South Africa's maternal mortality rate (625 deaths/100,000 live births) was high for a middle-income country, although over 90% of pregnant women utilised maternal health services. In its efforts in improving maternal health, the Department reported that an average rate of 100.4% was recorded nationally during 2011/12 financial year, which was consistent with the annual target of 100% for 2011/12.

Some of the achievements in improving maternal health during 2011/12 financial year include the following:

· A total of 89.3% of deliveries took place in health facilities, which was consistent with the set national target of 90% for 2011/12;

· A total of 56.9% out of targeted 60% for 2011/12 of mothers received post-natal care within six days after delivery. That was an improvement compared to 40% for 2010/11 financial year;

· A total of 98.8% out of the targeted 100% of pregnant women were tested for HIV in the 2011/12 financial year. Five (5) provinces recorded 100% coverage for the indicator, i.e. KwaZulu Natal 114.2%, Mpumalanga 110.9%, North West 106.2%, Limpopo 101.6% and Western Cape 100.4%. However, the following provinces recorded figures below the set target for 2011/12; Northern Cape 74.7%, Eastern Cape 94.3%, Free State 97.5% and Gauteng 85.1%.

6.2.3.4. Improving Child Health

According to a report by the South African Medical Journal, the South Africa’s child health statistics had deteriorated, with under-5 mortality rising from 56 per 1 000 live births in 1990, to 67 in 2008 and just over half of all under-5 deaths occurring outside health facilities.

However, in its response to improving child health, the South African Department of Health during the 2011/12 financial year implemented a number of interventions. The achievements that the Department recorded in the 2011/12 financial year included:

· In 2011/12, the coverage rate for vitamin A supplementation among children aged 12-59 months was 43% which exceeded the set target of 40% for 2011/12 financial year;

· In improving support for exclusive breastfeeding, 24 facilities against a set target of 25 for 2011/12 were accredited as providing baby-friendly health services;

· In 2011/12, the full immunisation coverage rate for children under the age of one (1 year) was 95.2% against the set target of 95%. That exceeded the set target. For this indicator there were variations that occurred in provinces, i.e. Eastern Cape, Free State, Gauteng, KwaZulu Natal, Limpopo and Northern Cape exceeded the national target. Whereas, Western Cape, North West and Mpumalanga reported figures below the national target;

· The Department had joined with the Department of Basic Education and Social Development to revise the Schools Health Policy. The national Integrated School Health Programme (ISHP) would be implemented for a period of five years beginning in 2012/13 financial year. That would target all education phases (including Early Childhood Development, Primary and Secondary Schools). Each province had developed and submitted their district-specific ISHP plan, which outlined how the provinces would ensure that all targeted learners were reached during 2012/13.

6.2.3.5. TB Control and Management

The aim of this sub-programme is to combat TB and HIV by reducing co-infection burden. Some of the achievements made during 2011/12 financial year in this sub-programme include:

· The Department reported that the TB defaulter rate continued to decrease, and now it stood at 6.8%, compared to a target of 6% in 2010/11 financial year;

· In terms of TB cure rate, a total of 73.1% was achieved against a set target of 75% for 2011/12 financial year. That was an improvement compared to the 71.1% achieved in 2010/11 financial year;

· A total of 94.1% of HIV patients were screened for TB against a set target of 85% in the 2011/12 financial year. That exceeded the set target by 9.1%.

· With regard to the GeneXpert, South Africa led the way globally. South Africa had procured more than 50% of the global supply of GeneXpert tests. From March 2011 to February 2012, South Africa conducted almost 300 000 (of the global total of 592 000) GeneXpert tests. Of these, 17% of people suspected of having TB infection were found to have TB. That was a significantly higher yield than the usual yield of between 4% and 9% using old technology.

6.2.4. Programme 4: Primary Health Care Services

The purpose of this programme is to develop and implement a uniform district health system. It also develops a policy on for district health services (PHC and district hospitals). It further identifies and promotes centres of excellence and supports planning, delivery and monitoring of these services.

The total allocation for the programme amounted to R761 703 million. The programme showed an expenditure outcome of R741 483 million, which was 97.3%, with under-expenditure of R20 220 million. The under-expenditure was related to the late delivery of influenza vaccines.

The programme consisted of four sub-programmes:

6.2.4.1. Communicable Disease Control

This sub-programme aimed to eliminate malaria by 2018 by reducing the local transmission of malaria cases to 0 per 1000 of the population at risk, through the implementation of the malaria elimination strategy.

The Department had implemented measures to track confirmed malaria cases of local origin, malaria of unknown origin, as well as the total burden of disease from all malaria cases from both sources of origin. According to the Department, malaria was endemic (widespread) in three provinces; KwaZulu Natal, Limpopo and Mpumalanga, and was more prevalent (common) in specific districts than others.

According to the Department, the following were achieved in malaria cases:

· Total confirmed cases of local origin: 2 443 (translated to 0,43). That was inconsistent with the set target of 0.43 per 1000 of the population at risk confirmed local cases for 2011/12

· Aggregate of cases (local and unknown): 3 715 (translated to 0,73). That was higher than the set target of 0,62 per 1000 of the population at risk.

· It should be noted that the local transmission was higher in April 2011 and January 2012. The Department argued that it could be due to higher importation of malaria cases and population movement. It further stated that evidence suggested that between 70% and 90% of imported cases came from Mozambique. And the cessation of the LSDI could be a contributory factor.

6.2.4.2. Non-Communicable Diseases

The aim of this sub-programme is to prevent and manage the chronic care model and strengthening the implementation of the long-term care model for diabetes over the Medium Term Expenditure Framework (MTEF) period.

In the 2011/12 financial year, the Department implemented the following:

· Three districts were identified to implement the chronic care model;

· The Department targeted 48 districts to implement the long-term model for diabetes and hypertension. However, a total of 46 districts managed to implement the long-term model. Two districts in Northern Cape could not implement the long-term plan due to resource constraints, according to the Department;

· In 2011/12 financial year, the Department produced a Strategic Framework for the Prevention of Injury in South Africa, which incorporates a plan for response violence.

6.2.4.3. District Health Services

The delivery of Primary Health Care (PHC) services through the District Health Services (DHS) was a key priority for the Department and was reflected in the health sector’s NSDA for 2010-2014.

In 2011/12 financial year, the Department achieved the following:

· A PHC utilisation rate of 2.5 visits per person was achieved, which fell below a set target of 2.6 visits per person per annum. Two provinces (Northern Cape and Western Cape) recorded the highest PHC utilisation rates of 3.0 and 2.9 visits per person per annum respectively. On the other hand, Gauteng recorded the lowest PHC utilisation rate of 2.1 visits per person;

· A total of 337 PHC outreach teams were established across provinces, which exceeded the set target of establishing 54 teams. As a result, around 5000 Community Health Workers (CHWs) were re-trained by December 2011.

6.2.5. Programme 5: Hospitals, Tertiary Services and Workforce Development

This programme deals with development of policies, delivery models and clinical protocols for hospital and emergency medical services. It also ensures that Academic Medical Centres (AMCs) and health workforce.

The programme had spent 99.4% of its R16 149 471 billion allocated funds, amounting to R16 057 420 billion, resulted in under-expenditure of R92 051 million. The under-expenditure was mainly attributed to the Infrastructure Unit Support System not being invoiced by the supplier before year end and the slow start of the nursing college’s project.

Under this programme, the Department achieved the following during the 2011/12 financial year:

· By the end of 2011/12 financial year, all 9 Provincial Department of Health submitted the revised draft of their User Asset Management Plans (USMPs), that was intended for 2012/13 MTEF period;

· By the end of 2011/12 financial year, the Department had made progress in the construction of five tertiary hospitals through Public Private Partnership (PPP), these include; Limpopo Academic Hospital, Chris Hani Baragwanath Academic Hospital, Dr. George Mukhari Hospital, Nelson Mandela Academic and King Edward VIII Hospital;

· The Department completed and launched the five-year HRH Strategy for 2012-2016. This strategy would assist the health sector to improve health workforce planning, development and management.

6.2.6. Programme 6: Health Regulation and Compliance Management

The aim of this programme is to regulate procurement of medicines and pharmaceutical supplies, including trade in health products, promotes accountability and compliance by regulatory bodies for effective governance and quality of health care. This programme consists of six sub-programmes, namely; Food Control and Regulations, Public Entities Management, Office Standard of Compliance, Compensation Commissioner for Occupation Diseases, Occupational Health Management, and Pharmaceutical Trade and Product Regulation.

The programme had spent 95.4% of its R521 801 million allocated funds, amounting to R497 871 million, with under-expenditure of R23 930 million. The under-spending could be attributed to delays in the implementation of planned activities in the Office of Standards Compliance.

Some of the achievements made by the Department in 2011/12 financial year include the following:

· In terms of improving its oversight over the registration of pharmaceutical and related products, the Department established a new pharmaceutical and related product regulation and management authority in 2011/12 financial year;

· In total, 386 generics were registered in an average period of 34 months. The target for 2011/12 was 18 months. Thirty-four (34) human NCEs were registered within an average period of 37 months. The target for 2011/12 was 30 months;

· A comprehensive baseline audit of quality (together with other key aspects, including infrastructure and human resources), covering 90% (3 780) of public health facilities by the end of March 2012, using tools developed by the cluster to assess compliance with six priority core standards, had been a huge step forward for the Department;

· During 2011/12 the Department developed the legislative framework required for the establishment of an OHSC as a national quality certification body, which would enforce compliance with norms and standards for quality and investigate complaints relating to a breach of norms and standards;

· The Department participated in twelve Codex activities, and included Codex standards in four sets of regulations. Nine sets of regulations were also drafted, published for comment and/or final were regulations published. The target for 2011/12 was exceeded by the publication of four more sets of regulations.

6.3. Human Resources

During 2011/12 financial year, the Department had a total of 1 293 posts filled out of 1 819 posts available on its staff establishment. That translated to an average vacancy rate 28.9% by the end of the financial year. A total of 160 filled were additional to the establishment. The Department reported that it was in the process of abolishing all the unfunded posts on the establishment as part of the Persal clean-up.

The highest vacancy rate were experienced in the Senior Management (level 13-16) permanent at a vacancy rate of 37.3%, followed by Highly Skilled supervision (level 9-12) permanent at a vacancy rate of 35.3%, lower Skilled (level 1-2) at 28.4%, Skilled (level 3-5) at 26.6%, and Highly Skilled Production (level 6-8) at 23.9%.

7. Consideration of Reports of Committee on Public Accounts

The Department did not appear before the Committee on Public Accounts for the period under review.

8. Consideration of other Sources

8.1. The State of the Nation Address

The health sector was specifically highlighted in the 2011 State of the Nation Address as one of the five main priority areas of government. In line with the President’s directive that all government departments should align their programmes with the job creation initiative and to ensure improved access to Human Resources for Health, one of the most important focus areas for the Department of Health would be the appointment of appropriate and qualified personnel to the right positions.

The State of the Nation Address further emphasized the training of doctors and nurses, as well as the revitalization of 105 nursing colleges and refurbishment and renovations of hospitals and clinics. That was important in order to achieve the Department’s priority of improving patient care and satisfaction and improve the quality of health facilities. Also, it was critical for the initial phase of the implementation of NHI.

8.2. Report of the Auditor-General of South Africa

8.2.1. The findings of the Auditor-General (AG)

According to the Auditor-General South Africa’s (AG) opinion, the financial statements presented fairly, in all material aspects, the financial position of the National Department of Health at 31 March 2012, and its financial performance and cash flows for the year then ended in accordance with the Departmental Financial Reporting Framework prescribed by the National Treasury and the requirements of the Public Finance Management Act (PFMA). Consequently, the Department of Health received an unqualified opinion with no findings by the AG. However, there are matters raised in the AG’s report.

8.2.2. Report on other legal and regulatory requirements

8.2.2.1. Predetermined Objectives

8.2.2.2. Usefulness of information

· There were no material findings on the annual performance report concerning the usefulness of the information.

8.2.2.3. Reliability of information

· In respect of nine indicators selected for programme 3, tested at 20 facilities at provincial level, the manual registers supporting the totals recorded in the information systems of the Department did not agree to amounts reported. That was due to inadequate control processes implemented at provincial facilities to ensure that data was properly recorded.

· In addition, because of the inadequate design of internal controls, there were no procedures that the AG could perform to satisfy itself that all information was completely recorded. As a result, the AG was unable to satisfy itself that actual reported performance is valid, accurate and complete.

· For two indicators selected relating to programme 3, the AG was unable to obtain sufficient, appropriate audit evidence to satisfy itself that actual reported performance was valid, accurate and complete. That was primarily due to the lack of a properly documented management system.

8.2.2.4. Compliance with laws and regulations

· Strategic Planning and Performance Management

The Department did not have and/or maintained an effective and efficient system of internal control regarding performance management, which described and represented how the Department’s processes of performance monitoring, measurement, review and reporting were conducted, organised and managed, as required by section 38(1) (a) (i) and (b) of the PFMA. Policies had been developed and approved for performance information. The standard operating procedures had been drafted but had not yet been approved.

· Human Resource Management and Compensation

(a) Employees were appointed without following a proper process to verify the claims made in their applications, in contravention of Public Service Regulation 1/VII/D.8.

(b) Not all senior managers signed performance agreements as required by Public Service Regulation 4/ III/B.1.

(c) A human resource plan was not in place as required by Public Service Regulation 1/III/B.2 (d).

8.2.2.5. Transfer of funds to Non-Profit Institutions and Conditional Grants

· The Accounting Officer did not maintain appropriate monitoring and review measures to ensure that transfers to non-profit institutions were applied for their intended purposes, as required by Treasury Regulation 8.4.1.

· The expenditure and non-financial information was not adequately monitored for the programmes funded by the Health Infrastructure Grant, the Health Professions Training and Development Grant and the National Tertiary Services Grant in accordance with the framework for the allocation, as required by section 9(1) (b) of the Division of Revenue Act.

· The requirements and responsibilities for the Health Infrastructure Grant were not adhered to, in contravention of section 9(1) (c) of the Division of Revenue Act.

· Transfer payments for the Comprehensive HIV and Aids Grant were not made in accordance with the payment schedule approved by the National Treasury, as required by sections 10(1)(c) of the Division of Revenue Act.

· The arrangements and requirements for the Hospital Revitalisation Grant, Forensic Pathology Grant and the Comprehensive HIV and Aids Grant, as defined in the framework for the allocation, were not adequately adhered to, in contravention of section 10(1)(e) of the Division of Revenue Act.

· Business plans for the utilisation of the Forensic Pathology Grant and the Comprehensive HIV and Aids Grant allocations made to all provinces were not approved prior to the start of the financial year, as required by section 10(1)(a)(iii) of the Division of Revenue Act.

8.2.2.6. Internal Controls

· Leadership

The accounting officer had developed and approved policies for reporting performance information. Standard operating procedures had been drafted but had not yet been approved and formally implemented.

· Financial and Performance Management

Management did not adequately implement internal controls designed to monitor compliance with laws and regulations relating to human resource management, transfer payments and conditional grants.

· Donor Funding

(a) An audit was performed on the donor funds received by the Department in respect of the Global Funds Grant: Strengthening National and Provincial Capacity for Prevention, Treatment, Care and Support Related to HIV and Tuberculosis for the year ended 31 March 2011. The audit was in the process of being finalised.

(b) An audit was performed on the donor funds received by the Department in respect of the Global Funds Grant: Expanding Services and Strengthening Systems for the Implementation of the Comprehensive Plan for HIV and Aids in South Africa for the year ended 31 March 2011. The audit was in the process of being finalised.

8.2.2.7. Investigations

The Department and National Treasury were currently investigating the awarding of tenders for HIV testing kits which did not comply with the standards set by the World Health Organisation (WHO). The investigation commenced in July 2012. The National Treasury was in the process of investigating fraudulent payments that were made on the Basic Accounting System during the 2009-10 financial years.

8.3. Fact-finding visit and meetings held with provincial departments

The following findings were drawn from most of the health institutions the Committee visited and on meetings the committee held with provincial departments:

  • Most institutions continued to be faced with the challenge of human resources shortage and the prolonged process to fill vacancies.
  • Health institutions did not have maintenance budget.
  • Hospital revitalization programme was not going very well in most provinces which resulted in projects talking longer than they were planned for. That also resulted in huge cost overruns.
  • Not all provinces had a dedicated engineer to assist with the hospital revitalization programme.
  • In most health institutions ambulance services were very old and irreparable.
  • Most provinces complained that due budget constraints, they would not be able to meet the prescribed norms and standards.

9. Report on Entities

9.1. National Laboratory Services

9.1.1. Introduction

The National Health Laboratory Service (NHLS) provided laboratory and diagnostic services to public health facilities in South Africa. Created by the National Health Laboratory Act (No. 37 of 2000), the NHLS also provided health science training and education and supported health research. As the largest provider of diagnostic pathology services in South Africa, the NHLS services over 80 per cent of the population through its 265 laboratories countrywide.

9.1.2. Highlights and Challenges

Cash flow remained a significant challenge for the National Health Laboratory Service, as it was in the previous financial year. The Gauteng and KwaZulu-Natal Provincial Departments of Health remained significantly in debt to the NHLS. The KZN Department of Health continued paying a flat fee of R45 million per month (against a consumption of R90 million) and the NHLS was awaiting a decision of an arbitrator, appointed by the Minister of Health to resolve the dispute.

The NHLS increased overall test costs by 0.1 per cent; priority tests prices were reduced by 5 per cent and for all other tests there was an increase of 3 per cent.

Turnaround times (TAT) continue to be met; except for cytology as there was a shortage of cytotechnologists. There was growth in test volumes of 11 per cent, processing over 80 million tests. The increase was due mainly to several gate-keeping initiatives implemented in pilot hospitals in all provinces.

The surplus was R614 million. However, cash flow remained a significant challenge.


Research output equalled 448 peer publications for the year. 218 pathologists, 201 medical scientists, 1388 technologists and 639 technicians are in training.

9.1.3. Key Performance Indicators

The NHLS reported Key Performance Indicators in terms of four perspectives (comparable to programmes), namely:

· Customer Perspective (previously Customer Value);

· Financial Perspective (previously Financial Efficiency and Sustainability);

· Employee Perspective (previously People Value); and

· Internal Perspective (previously Operational Efficiency).

9.1.3.1. Perspective 1: Customer Perspective

The performance of the Perspective was as follows:

In terms of C1 which is to Improve Customer Satisfaction:

A total of 70% of Customer satisfaction index – Service was achieved against a set target of 69%. The percentage exceeded the set target. A total of 94.4% of turnaround time for TB Microscopy was achieved against a set target of 90%. That also exceeded the set target. A total of 84.8% for TAT CD4 was achieved against a set target of 80%. That exceeded the set target of 80%. However, it should be noted that in the previous financial year 86% was achieved against a target of 95%).

In terms of C2 which was to improve total TAT:

A total of 57% for TAT Target for cervical smear was achieved against a set target of 60%. The NHLS did not achieve its set target.

In terms of C3 which was to improve quality of tests:

The two indicators reported on appear identical (Proficiency testing – Excluding Parasitological + Mycology), yet the targets (90 % and 70 % respectively) and actual performance (93,3% and 87,5%) differ.

9.1.3.2. Financial Perspective

Only 3 out of the 6 targets were met. These included:

· Turnover (Rm): R3 947 (target R3 460)

· Spend overheads as per budget: R2 503 (target R2 519)

· Spend materials as per budget: 25.6% (target 26.6%)

The targets not achieved related to late or non-payment by debtors included:

· Minimum cash collection (Rm): R3 547 (target R4 536)

· Improve payment to creditors: 108 days (target 30)

· Improve collections from debtors: 160 days (target 45)

9.1.3.3. Employee Perspective

The NHLS reports had achieved all set targets, except an employee satisfaction survey which it said was not done due to cash constraints. Those measures achieved included:

· Maintain low staff turnover: 9.8% (target 10%)

· Maintain low vacancy rate: 6.8% (target 10%)

· Maintain high registrar pass rate: 94% (target 64%)

· Improve BEE procurement: 56% (target 42%)

9.1.3.4. Internal Perspective

Performance measures (except Regional labs’ SANAS accreditation) were largely achieved:

· Achieve lab accreditation:

o SANAS accreditation – Academic institutions: 83% (target 70%)

o SANAS accreditation – Regional laboratories: 24% (target 30%) not achieved

· Improve translation of research:

o Research report submitted to influence policy: 23 (target 2)

o Research report translated into service: 35 (target 2)

9.1.4. Financial Information

The 2011/12 year was described as “ annus horribilis” , which in English means “horrible year.” That was due to the cash flow crisis which “threatened the viability and continued sustainability of the entity”. The cash flow crisis was caused largely by poor payment patterns by certain Provincial Departments of Health. Two Provincial Departments of Health, in particular, were highlighted, namely Gauteng and KwaZulu-Natal (KZN) as these departments’ collective debts accounted for 80 per cent of the total debt, amounting to R1.69 billion of the R2.1 billion debt. As a result of this, services were reduced, capital projects put on hold and key critical vacancies were not filled.

9.1.4.1. Report of the Independent Auditors to Parliament on the NHLS

· The independent auditor gave the NHLS an unqualified audit opinion with additional matters.

9.1.4.2. Material Inconsistencies in other Information Included in the Annual Report

· The auditor reported that at the date of writing, the annual report had not been made available for audit inspection.

9.1.4.3. Report on Other Legal and Regulatory Requirements

· There were no material findings on the usefulness and reliability of the information presented.

· Achievement of targets: only 19 of the 25 targets were achieved, meaning 24% (6) of the targets were not achieved. This was largely attributed to cash flow problems.

· Compliance with laws and regulations: 6 properties were still not in the name of the NHLS.

· Investigations: 3 employees were dismissed following disciplinary proceedings regarding travel, subsistence and procurement non-compliance.

9.2. Council for Medical Schemes

9.2.1. Introduction

The Council for Medical Schemes (CMS), under the Medical Schemes Act (No. 131 of 1998), oversees the medical schemes industry in South Africa. The report looked at some of the performance indicators, and financial issues raised in the Annual Report as well as highlight key issues for consideration.

9.2.2. Key Performance Indicators

The CMS reported Key Performance Indicators for the ten programmes it administered, namely:

1. Administration

2. Accreditation

3. Research and Monitoring

4. Stakeholder

5. Compliance

6. Complaints Adjudication

7. Benefit Management

8. Legal Services

9. Strategic Projects

10. Financial Supervision

9.2.2.1. Administration

Three of the nine performance indicators were not achieved. Those related to revenue, procurement, and asset management. Some of the key successes and challenges included:

· Accurate Financial statements: 1 out of 1(target 1)

· Number of tenders adjudicated on: 2 out of 1(target 1) exceeded the set target

· Number of Audit and Risk Committee meetings held: 4 out of 4 (target 4)

· Number of Helpdesk incidents handled per year: 744 out of 800 (target) less than set target

· Number of major network-related incidents per year: 3 out of 4(target 4) less than set target

· Number of software “bugs” reported per year: 173 out of 600 (target 600) exceeds the target.

· Number of days of interrupted access per year: 1 out of 4 (target 4) exceed the target.

· Staff turnover rate: 1.1% out of 8% (target 8%) less than set target

· Percentage of budgeted income collected: 99.9% out of 100% (target 100%) less than set target

· Number of staff trained per year: 31 out of 50 (target 50) less than set target

· Accurate asset register maintained : 98% out of 100% (target 100%) less than set target

9.2.2.2. Accreditation

Whilst the number of applications had increased across all categories, the percentage of actual accreditations appeared to be low. That could indicate, amongst other things, a lack of adequate application preparations or ineffective communication on the requirements.

· Number of new individual broker applications: 918 out of 617 (target) exceeded the set target

· Number of new individual brokers accredited: 326 out of 415 (target 415) less than set target

· Number of individual broker renewals applications: 4 298 out of 3 372 (target 3 372) exceeded the set target

· Number of individual broker renewals accredited: 3 722 out of 2 920 (target 2 920) exceeded the set target

· Number of new broker organisation applications: 145 out of 122 (target 122) exceeded the set target

· Number of new broker organisations accredited: 83 out of 90 (target 90) exceeded the set target

· Number of Managed Care Organisation (MCO) applications: 26 out of 21 (target 21) exceeded the set target

· Number of MCOs accredited: 15 out of 20 (target 20) less than the target. target

9.2.2.3. Research and Monitoring

· Number of clinical support cases completed: 827 out of 750 (target 750) exceeded the set target

· Number of research projects finalised: 5 out of 4 (target 4) exceeded the set target

· Number of support projects completed: 3 out of 4 (target 4) less than set target

· Number of medical schemes complying with ICD-10: 359 out of 380 (target 380) less than set target

9.2.2.4. Stakeholder

Three out of the five targets for the Education and training sub-programme were not met. A planned trustee training session for KwaZulu –Natal (KZN) was not held due to low participation. One of three planned annual return workshops was also cancelled due to low attendance. Over 40 000 beneficiaries attended consumer education training (target 30 000). In the communication

9.2.2.5. Compliance

Five of the eight targets were not met. Inspection of regulated entities performed poorly achieving none of the set targets. A high number of directives were issued due to non-compliance by medical schemes. Exemption applications did poorly in communicating Council decisions after receiving them.

· Number of directives issued : 23 out of 20 (target 20) exceeded the set target

· Number of schemes requiring inspection actually inspected: 10 out of 12 (target 12) less than set target

· Number of completed individual inspections: 9 out of 12 (target 12) less than set target

· Number of units utilising inspection reports: 3 out of 20 (target 20) less than set target

· Number of days it takes to communicate Council’s decisions: 29 out of 8 (target not met)

9.2.2.6. Complaints Adjudication

Four of the six targets were met. However, 5 of the measures deal with the time taken to resolve complaints and it appears that most complaints take longer than 60 days to be resolved.

· Number of complaints received: 6 138 out of 5 645 (target 5 645) less than set target

· Number of complaints resolved within 30 days: 1 490 out of 1 649 (target 1 649) less than set target

· Number of complaints resolved within 60 days: 1 505 out of 2 258 (target 2 258) less than set target

· Number of complaints resolved within 90 days: 1 278 out of 1 016 (target 1 016) exceeded the set target

· Number of complaints resolved 120+ days: 1 075 out of 169 (target 169) exceeded the set target

9.2.2.7. Benefit Management

All the targets appear to have been achieved.

· Number of schemes’ marketing material reviewed per year: 45 out of 45 (target 45)

· Number of amalgamations: 1 out of 2 (target 2) less than set target

9.2.2.8. Legal Services

A number of legal opinions (61) were provided and there were 20 court cases where court papers were filed.

9.2.2.9. Strategic Projects

One of the strategic projects was to provide recommendations to the Department of Health on amendments to the prescribed minimum benefits (PMB)

9.2.2.10. Financial Supervision

The sub-programme dealt with, amongst other things, improving statutory returns as well as medical schemes’ reporting, and providing financial oversight of medical schemes.

9.2.3. Financial Information

9.2.3.1. Auditor General’s Report on the CMS

· The Auditor General of South Africa (AGSA) gave the CMS an unqualified audit opinion with additional matters. That was the CMS’ 12 th unqualified audit in a row.

9.2.3.2. Material adjustments to the annual performance information report

· The AGSA reported that “material misstatements in the annual performance report were identified during the audit, all of which were corrected by management.”

10. Report on Millennium Development Goal

10.1. Background

In September 2000, South Africa with other world leaders made commitments to the Millennium Declaration. The leaders committed themselves to a series of eight time-bound goals with a target date of 2015 that respond to the world’s main development challenges. According to a recent assessment of achievements made by various countries, human rights had not yet played a significant role in supporting and influencing MDG-related activities. The content of the MDGs partly resembled some aspect of human rights, but systematic human rights based approach to understanding and achieving the MDGs remained an unmet challenge.

However, three of the MDGs related directly to health care, thus underlying the importance of the status of the health of a nation on the path to development. A number of laudable development targets for health had been agreed to at the Millennium Summit and in other UN conferences and international forums. These included reducing mortality rate for children under five by two-thirds, and reducing the maternal mortality rate (MMR) by three-quarters by 2015; by 2010, reducing HIV prevalence in all young people (aged 15-24 years) by 25%, and the proportion of infants infected with HIV by 50%; as well as reducing TB related deaths and prevalence, and the burden of disease associated with malaria by 50%, also by 2010. South Africa has pledged to meet the eight MDG goals by 2015.

According to a report of the Medical Research Council (MRC), the South African government had made much better progress in improving life expectancy and reducing deaths among young children than it had expected. It was argued that that was largely due to the rapid expansion of the Department of Health’s HIV-treatment programme. The report further stated that by 2011, life expectancy had risen to 60 and the childhood mortality rate had fallen to 42 per 1000 live births. There had also been marked improvement in the infant mortality rate, which was 30 per 1000 per live births in 2011, that was well ahead of the 2014 set target of 36 per 1000 live births.

However, it should be noted that the maternal mortality ratio (goal 5) had worsened to an estimated level of 333 per 100 000 live births in 2009 and the neonatal (babies under-1 month of age) mortality rate had shown no signs of improvement by 2009.

10.2. Goal 4: Reduce Child Mortality

The improvement of child health remained one of the Department of Health’s key performance areas. In that regard, the Department strived to “reduce infant, child and youth morbidity and mortality. The target for MDG 4 was to reduce by two thirds the mortality rate among children under five. The indicators for goal 4 included the following:

4.1. Under-five mortality rate (U5MR);

4.2. Infant-mortality rate (IMR); and

4.3. Proportion of one-year old children immunised against measles.

10.2.1. Progress to Date

10.2.1.1. Strategic Interventions

The Department of Health’s key strategic interventions identified for the 2011/12-2013/14 period include the following:

· Maintaining a set target of 95% rate of full immunisation for children under the age of 1 year;

· Maintaining a set target of 95% measles immunisation coverage rate;

· Increasing the number of sub-districts implementing school health services from 100 to 150 in 2011/12, 200 in 2012/13 and 232 by 2013/14

10.2.1.2. Achievements

During 2011/12, the Department of Health hade made the following achievements in reducing child mortality:

· A national immunisation coverage rate (under 1 year) of 95,2% was achieved, against a target of 95%.

· A total of 4% of babies tested PCR positive 6 weeks after birth (out of all babies tested), which reflected very good performance when compared to the target of 7,5%. The Medical Research Council Prevention of Mother-to-Child Transmission survey reflected a transmission rate of 3,5%.

· A total of 56,9% of Mothers and 57,8% Babies received post natal care within 6 days after delivery, against a target of 60%.

· The mortality rate of children under 5 years of age fell from 73 per 1000 live births to 42 per 1000 live births.

10.3. Goal 5: Improve Maternal Mortality

Maternal health remained a core strategic focus for the Department of Health. In that regard, the Department strived to reduce by three quarters the maternal mortality ratio. Goal 5 has two set targets, namely; Target 5 (a) Reduce by three quarters the maternal mortality ratio and 5 (b) achieve, by 2015, universal access to reproductive health. The indicators for goal 5 (a) and 5 (b) included the following:

· Maternal mortality ratio;

· Proportion of births attended by a skilled health personnel;

· Contraceptive prevalence rate;

· Adolescent birth rate;

· Antenatal care coverage (at least one visit and at least four visits); and

· Unmet need for family planning.

10.3.1. Strategic Interventions and Achievements

10.3.1.1. Strategic Interventions

The Department’s key strategic interventions for 2011/12 aimed at reducing maternal mortality included the following:

· Maintaining ante-natal coverage at 100%;

· Increasing the proportion of deliveries in health facilities;

· Increasing the proportion of designated health facilities providing Choice on Termination of Pregnancy (CTOP), thereby reducing the demand for back-street abortions;

· Increasing the percentage of mothers and babies receiving post-natal care from 40% to 80%;

· Implementing programmes in secondary schools to address youth risk behaviour with a focus on life skill based HIV and AIDS education in 60 Sub-Districts during 2011/12 and 100 Sub-Districts during 2012/13;

· Increasing cervical cancer screening and extending screening to include breast cancer;

· Testing 100% of pregnant woman for HIV;

· Increasing the rate of antenatal clients initiated on Highly Active Antiretroviral Therapy (HAART) from 87% in 2011/12 to 100% in 2013/14;

· Decreasing the proportion of babies testing polymerase chain reaction (PCR) positive 6 weeks after birth from 10% in 2011/12 to 6.5% in 2013/14; and

· Increasing the uptake rate of HIV positive antenatal clients on AZT for any period before labour from 86% in 2011/12 to 100% in 2013/14.

10.3.1.2. Achievements

During 2011/12, the Department of Health reported that it had made the following achievements in reducing maternal mortality:

· An antenatal care coverage (ANC) rate of 100.4% was recorded, consistent with the target of 100%. Denominator issues were being discussed with StatsSA.

· 40,2% of pregnant women presented to the health services before 20 weeks of pregnancy, which exceeded the 2011/12 target of 40%.

· 100,7% of pregnant women were tested for HIV, which was consistent with the set target.

· 89,3% of deliveries took place in health facilities, under the supervision of qualified health personnel. The target for 2011/12 was 90%.

· A cervical cancer screening coverage rate of 55% was achieved, which exceeded the target of 52%

10.4. Goal 6: Combat HIV and AIDS, Malaria and Other Diseases

Combating HIV and AIDS remained one of the core Department’s key performance areas. In that regard, the Department strived to combat HIV and AIDS, Malaria and other Diseases. Goals 6 had three set targets, namely; 6 (a) Halted and began to reverse the spread of HIV and AIDS, 6 (b) achieved by 2010, universal access to treatment for HIV and AIDS for all those who need it, and 6 (c) Halted and began to reverse the incidence of malaria and other major diseases. The indicators for goal 6 included the following:

  • HIV prevalence among population aged 15-24 years.
  • Condom use at last high-risk sex.
  • Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV and AIDS.
  • Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years.
  • Proportion of population with advanced HIV infection with access to antiretroviral drugs.
  • Incidence and death rates associated with malaria.
  • Proportion of children under 5 sleeping under insecticide- treated bednets.
  • Proportion of children under 5 with fever who are treated with appropriate anti- malarial drugs.
  • Incidence, prevalence and death rates associated with tuberculosis.
  • Proportion of tuberculosis cases detected and cured under directly observed treatment short course.

10.4.1. Progress to Date

10.4.1.1. Strategic Interventions

The Department’s key strategic interventions for 2011/12 aimed at reducing new HIV infections included the following:

· 1 billion male condoms to be distributed in 2011/12;

· 6 million female condoms to be distributed in 2011/12;

· Perform 500 000 Medical Male Circumcisions in 2011/12;

· To achieve a total of 85% HCT (HIV and AIDS counselling and treatment) uptake in 2011/12;

· Initiate 625 000 new patients on ART in 2011/12;

· Achieve a total of 100% pregnant women tested for HIV;

· Achieve a total of 100% antenatal clients initiated on HAART;

· Achieve a total of 100% HIV positive antenatal clients on AZT for any period before labour;

· Increasing the number of new patients initiated on anti-retroviral therapy (ART) to between 625 000 and 675 000 annually;

· Increasing the number of primary health care facilities (PHC); and

· Implementing nutritional intervention for people with HIV and AIDS and TB from 77% to 88%.

10.4.1.2. Achievements

· A total of 617,147 new patients were put on Antiretroviral Treatment in 2011/12, compared to 418,677 in 2010/11;

· A total of 9,6 million South Africans accepted HIV Testing in 2011/12;

· A cumulative total of 20,2 million people had undergone HIV Testing since the launch of the HCT campaign by the President of RSA in April 2010;

· A total of 6,353,000 female condoms were distributed, which exceeded the target of 6 million;

· A TB cure rate of 73,1% (for 2010) was achieved, against a set target of 75%. That reflected an improving trend compared to the 71,1% cure rate recorded in 2010/11 (for 2009); and

· The TB defaulter rate had decreased from 7% in 2010/11 to 6, 8% in 2011/12.

The Department of Health made progress in improving the health status of the South African citizens. The life expectancy started to increase from a low of 54 in 2005 to 60 in 2011. That showed that there had been sustained improvements in mortality of young adults and child mortality. It was argued that that was largely due to the roll-out of ART treatment and prevention of mother-to-child transmission of HIV. However, as mentioned earlier neonatal mortality rate had not improved, and by the year 2009, maternal mortality was said to be increasing.

11. Recommendations made by the Committee and not implemented by the Department

Programme 1

  • Corruption and fraud had been raised again by the AG as a serious concern. That was also raised in previous years. The Committee recommended that the Department should deal with the matter immediately and appropriately (through crime investigation units) and people involved should be dealt with accordingly and money recovered.

Programme 2

  • The Department must focus more on Maternal, Child and Women’s Health especially depression as that was the area that had been not received much attention.
  • The Department needed to encourage all hospitals and clinics to review the cleanliness of health facilities and also included good hygiene measures to enhance infection control. The Department must have updated its national infection control policy and reported back to the Portfolio Committee on Health within six months on how the infection policy was implemented and monitored.

Programme 3

  • A patient satisfaction survey should be done every four months to assess the functioning of institutions in terms of service delivery plans and corrective measures should be undertaken.
  • The Provincial Departments of Health needed to do proper stock control measures to ensure that medication was available at all times especially those that were in the non-negotiable list. They should also play their supportive role and provide administrative support in ensuring that medical suppliers were paid on time as per agreement.
  • Most of the money allocated for HIV and AIDS went to treatment instead of prevention. The Department should have concentrated more on prevention than cure.

Programme 4

  • The Department needed to prioritise Human Resources Management and infrastructural revitalization of hospitals and assistance must have been provided to those provinces that were still struggling with their hospital revitalisation programmes.
  • Provincial Departments of Health should have developed the recruitment and retention strategies. That would assist provinces in addressing the issue of human resources shortage. .

Programme 5

  • The Department should have made primary healthcare a priority as that would assist in reducing the burden in hospitals.
  • The Revitalisation grant should have be monitored by the National Department of Health on quarterly basis and a report should have been submitted to the Portfolio Committee on Health.
  • Hospitals should be given budget for maintenance.

12. Committee’s Observations

  • The Cancer Register which was not up to date was a concern for the Committee.
  • Litigations for the Department of Health due to wrong procedures was a serious challenge and the Committee was concerned about whether the Health Professions Council of South Africa was doing a proper job in making sure that the country got the best doctors.
  • Hospital Revitalisation programme took too long as institutions should be aligned with the National Health Insurance.

13. Committee’s observations on Programme by Programme

Programme 1

  • The National Department of Health and the Western Cape Provincial Department of Health received unqualified audit opinions from the Auditor – General. Six provinces received qualified audit opinions (Eastern Cape, Free State, Gauteng, KwaZulu Natal, Mpumalanga and North West). Two provinces got a disclaimer (Limpopo and Northern Cape). That was against a target for 2010/11 of having unqualified audit in at least four provinces.
  • The issue of corruption was also raised as a serious concern which was evident in the Auditor-General’s report which found that tenders were awarded to state officials and their close family members.
  • Implementation of the Provincial Financial Improvement Plans was constrained by inadequate human resource capacity and limited resources

Programme 2

  • The reliability of data for nine indicators for programme three which was tested in 20 public health facilities and in eight provinces was raised as a serious concern.

Programme 3

  • The Department of Health did not meet its target on medical male circumcision (MMC). A total of 347, 973 MMCs were conducted in 2011/12, against the target of 500, 000.
  • A total of 397, 106,000 male condoms were distributed, against a target of 1 billion male condoms.
  • The Department did not meet its target of 95% on the second dose on measles immunization coverage and only achieved 85,3%.

Programme 4

· The Department continues to concentrate more on hospitals (curative intervention) rather than preventative or Primary Health Care. This is illustrated by the greater proportion of the budget which went to hospitals rather than programme dealing with Primary Health Care and clinics.

· Primary Health Care supervision rate of 66,6% was recorded, against the target of 70%.

Programme 6

  • During 2011/12, a total of 386 generics were registered within an average for 34 months and the target was 18 months.
  • Thirty New Chemical Entities (NCEs) were registered in an average period of 37 months against the target of 18 months.
  • The Department does not have internal evaluators and uses external ones which are full time employed elsewhere; this contributes to delays in registering of medicines.

13. Recommendations

The Minister of Health should ensure that:

· Traditional leaders and communities are better educated about the importance of medical male circumcision and continuously ensure that sterile equipment and consumables are made available.

· The Department increases its focus on the Primary Health Care programme by increasing funding and human resources in order to reduce hospital overcrowding and move away from hospital centralism.

· The Department of Health prioritises rural health and ensures that rural health institutions are supported with the necessary resources.

· The Department allocates additional funds for hospital revitalization and monitor spending, in preparation for the Office of Health Standard Compliance. This will assist health institutions when they are assessed on the prescribed norms and standards.

· The Department of Health regulates the functioning of the private healthcare industry, including collecting health data, and also play an oversight role.

· The National Department of Health provides support to the Eastern Cape and Limpopo Provincial Departments of Health especially with regards to upgrading of infrastructure and improvement and strengthening of health services.

· People who manage hospitals or health institutions are skilled professionals with medical backgrounds.

· Academic and tertiary hospitals are run by the National Department of Health. This will alleviate budget constraints provinces are faced with.

· The cancer registry is updated.

· Consideration is given to amending the National Health Laboratory Services Act so as to ensure that the entity is able to deliver on its mandate.

· The Department of Health increases its budget allocation to the Medical Research Council (MRC) to enable it to do more research in assisting the country in the fight against the high burden of diseases.

14. Conclusion

The report provided an assessment of the performance of the Department of Health on its programme, budget and administration. The overall assessment and production of this report enables the committee to fulfil its obligations in relation to the amendment of Money Bills by Parliament in relation to the Department of Health.

During 2011/12, The Department of health received an unqualified audit opinion from the Auditor-General of South Africa. However, the Department experienced financially driven challenges during this period of reporting.

Key milestones were achieved during the reporting period. The highlight of this is the improvement of financial management and the unqualified audit opinion.

The Department of Health is committed to fulfilling its constitutional obligations to deliver socio-economic rights within the context of Millennium Development Goals (MDGs) 4, 5 and 6.

Report to be considered.

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