DEPARTMENT OF HEALTH & WELFARE

1. DEPARTMENT OF HEALTH & WELFARE Portfolio Committee on Health 16 April 2003

2. INTRODUCTION • Vision, mission and core functions • Health Progress report per program 2002/3 • Health priorities 2003/4 • Health budget pressures 2003/4 and service implications • Concluding remarks

3. VISION AND MISSION VISION A caring and developmental health and welfare system which promotes well-being, self-reliance and humane society in which all people in the Northern Province have access to affordable and good quality services. MISSION Through providing comprehensive, integrated and equitable Health and Welfare services which are sustainable, cost effective and focus on the development of human potential in partnership with relevant stakeholders.”

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

5. MORTALITY INDICATORS 2000 Source: SAHRS 2000

6. MAJOR CAUSES OF DEATH Source: MRC 2001

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

8. PROGRAMME 1Health Administration

9. POLICIES ACHIEVEMENTS:11 Policies and guidelines on the following areas have been developed • Procedures for recruitment and appointment of employees • Employee suspension; Subsidized motor transport • Departmental cellular phone; Procurement Policy • Minimum sanctions and misconduct; • Managing discipline • Remuneration outside Public Service • Employee compensation and over time • Transfer of employee; Work Environment CONSTRAINTS: Policy development inherently a lengthy process

10. STAFF ESTABLISHMENT ACHIEVEMENTS: Reviewed, finalized and approved the following establishments: • Head Office with savings of R9.521m; Polokwane/ Mankweng Tertiary hospital complex; Polokwane Place of Safety; Thohoyandou children’s home; Sekutupu old age home. • The following management structures were reviewed: district offices, district hospitals, regional hospitals and level 13 district hospitals, specialized hospitals including 4 revitalization project hospitals finalized.

11. HRM: STAFFING ACHIEVEMENTS: 1110 vacant posts have been filled, this number also includes doctors and nurses. • Rank and leg promotions for 4400 employees arrear payment have been finalized as planned for 2002/03 • A total number of 390 employees arrear payments are still outstanding • Performance management and development system implementation plan has been initiated. • Advertised 3 posts of General Manager, 1 CEO, 1 Senior Manager and reasonable number of managers posts. • A further R181m is required to fully implement 2nd and 3rd notch promotions in terms of DPSA circular which extends beyond once off payment stipulated in the Provincial circular. • There is vacancy rate of 41,2%, and 6,03% staff turnover

12. HRM: STAFFING cont’d • TRANSFORMATION AND RESTRUCTURING IN TERMS OF RESOLUTION 7 OF 2002: List of excess personnel has been compiled and employees have started with the process of placement into vacant posts. • CONSTRAINTS: Employees turnover rate=6,03%; Vacancy rate 41,2% • Staff retention strategy • Total staff establishment loss of 1085 .This included 407 that have left the Department through resignation and transfer. • A number of outstanding promotion arrear payments • Payment of outstanding 2nd and 3rd notches not finalized • Staff establishments for institutions and district offices are not finalized yet to enable restructuring and redeployment process to run smoothly

13. LABOUR RELATIONS AND LEGAL SERVICES ACHIEVEMENTS: District and institutions have been delegated management and handling of disciplinary cases • 186 misconduct cases were reported and 144 cases finalized of which 13 cases were dismissals, only 42 cases still pending • 15 Disputes (Conciliation and Arbitration) cases were reported and 11 cases finalized, only 4 still pending • 8 Appeals reported, 1 finalized and 7 still outstanding • 42 grievances have been reported, 28 were finalized, 14 are still being investigated. CONSTRAINTS: Capacity building of line managers

14. FLEET MANAGEMENT ACHIEVEMENTS: Fleet audit is finalized • Vehicle replacement plan developed • A total of 93 new vehicles have been ordered, broken down as follows :40 Ambulances, 8 response vehicles, 25 pool cars for hospital administration and 20 for mobile services. • 10 Ambulances, 23 patients transport and 1LDV have been delivered.

15. FLEET MANAGEMENT cont. CONSTRAINTS: -Vehicles take a long time to be delivered -355 vehicles have traveled more than 200 000-400 000kms. -Almost 50% of vehicles (including EMS) are always in Garages for repairs

16. EMPLOYMENT EQUITY ACHIEVEMENTS: Complied with the Department of Labour with regard to submission of Equity progress reports • The Department has achieved 70/30 targets, however with regard to Provincial Demographics ratio of 56:44, the equity status is as follows:- CONSTRAINTS: No disabled persons in management

17. BATHO PELE PRINCIPLES & SERVICE DELIVERY PLAN ACHIEVEMENTS:12 consultative workshops on standards development and service delivery plan conducted • Workshops conducted monthly in all districts to review, develop and implement domain specific standards • Manual on Promotion of Access to Information Act, 2000 compiled and approved • Departmental annual Merit Award Ceremony was held to recognize good performance of employees • Suggestion boxes have been installed in 95 % of the institutions, client satisfaction surveys done in all hospitals

18. Financial Planning and Budgeting ACHIEVEMENTS: Achievability exercise, MTEC hearings, quarterly reports & IGFR all assisted to provide a credible adjustment budget that dealt with personnel under funding and inflationary pressures. • The new Chart of Accounts for 2003/04 based on the nationally agreed programme structure and Departmental restructuring has been finalised. • Strategic plans in new format have been developed. CONSTRAINTS:Lack of staff due to resolution 7.

19. Donor Funds ACHIEVEMENTS: R1m was donated to Shiluvana Health Centre by Flemish government for the eye centre. • R504 000 has been commited so far. • Business plan for EU’s PDPHC in place. CONSTRAINTS: Systems for administering donor funds are new and therefore there is a learning curve involved.

20. Revenue Generation ACHIEVEMENTS:The revised fees schedule was implemented as from 1st October 2002 with a potential 10% decrease in income. • Some private wards have been established to entice private patients. • R43.2m of revised target of R56.99m(98.8% of tgt) CONSTRAINTS: Incorrect personal data provided by patients. • 92% of patients not on medical aid.

21. PROGRAMME 2District Health Services

22. PREVENTION AND CONTROL OF HIV/AIDS • 80% communities reached on community awareness • +/-10 million male condoms distributed • 21 sites for female condom distribution established and +/-400 000 female condoms distributed • All 8 Regional offer PMTCT services and 33 District Hospitals offer Nevirapine • 233 VCT sites established and functional • PEP treatment is being provided at all hospitals

23. HIV/AIDS/STDI’S/TB cont. ACHIEVEMENTS :ICHB CARE PROGRAMME • 20 Community Based Organisations offering ICHBC services 25,666 (inclusive of all chronic conditions) clients were attended to. • 636 Care-givers trained and offering ICHBC services • 3641 orphans (of which 2157 HIV/AIDS orphans) are benefiting from ICHBC services • 2 Step-down facilities approved and started operating . (Kgapane & St Ritas) Constraints: • Community Home base care kits not always available to all clients.

24. NATIONAL VS. LIMPOPO HIV TRENDS 2001

25. 2000 vs. 2001 HIV PREVALENCE BY AGE GROUP

26. TB CASE FINDING 2000-2002

27. TB CONTROL & MANAGEMENT Achievements • TB Case detection increased from 6468 in 2000 to 7793 in 2001) • DOT Support work • Community awareness • Overall TB cure rate improved from 52,8 in 2000 to 53,2% 2001 • MDR/TB Clinic established at Polokwane Hospital • Business plan for establishment of MDR/TB Unit F. H. Odendaal Hospital submitted. • Establishment of mobile laboratories services Challenges • Sputum Turn- around time of 7- 14 days which is higher than expected National recommendation of 4 days • Collapse of mobile services in some districts affecting the transportation of specimen

28. Integrated Mother ,Child and Women health services ACHIEVEMENTS: • Approximately 80% PHC facilities provide IMCI which resulted in reduction of incidences diarrheal from 16.2 in 2001 to 13.5 in 2002, and upper respiratory infections from 25.1 in 2001 to 23.4 in 2002 • 5 clinics per districts offer PAP services and the rest on demand. • 3715 women access PAP services. • Family planning services are offered in all clinics and mobiles • 29 hospitals offer TOP.

29. TERMINATION OF PREGNANCY 1997-2002

30. TOP BY AGE GROUP– 2000-2002

31. TOP BY GESTATIONAL AGE– 2000-2002

32. Prevention and Control of Communicable Diseases ACHIEVEMENTS: • 75% of targeted household for February 2003 are already sprayed • 80 temporary spraying operators are appointed. • Cases fatality for Malaria reduced from 86/100 000 population in 2001 to 51/ 100 000 population for 2002 CHALLENGES • Emerging and re-emerging infectious diseases such as Anthrax, Severe Acute Respiratory Syndrome

33. IMMUNIZATION COVERAGE (%) UNDER 1 YEAR BY DISTRICT 2000-2002

34. AFP SURVEILLANCE 1997-2003

35. UNDER 5 MORBIDITIES 2000-2002 Source: DHIS

36. 5 TOP NOTIFIABLE MEDICAL CONDITIONS 2000 -2002

37. Environmental Health Related Conditions ACHIEVEMENTS: • 38 178 males enrolled for initiation. Of which 648 were admitted to hospitals and one died. • 465 cholera cases were reported with fatality rate of 0.4% • Of the 813 villages with access to water supply, 200 of them were monitored and found to have safe water supply (quality & quantity). CONSTRAINTS: • Poor water supply and sanitation

38. INTEGRATED NUTRITION PROGRAMME NUTRITION PROGRAMME: • 68 of the 105 projects are sustainable. • 2747 schools are participating. • A total number of children qualifying for PSNP 1,173 million and only 1,131 million benefiting from the programme. • 7 additional hospitals obtained BFHI status. A total of 21 hospitals obtain BFHI status. • Stunting decreased from 34.2%in 1994 to123.1% in 2001 • Wasting increased from 3.8% in 1994 to 7.5% 2001 • Underweight increased from 10.4% in 1994 to 15% in 2001 CONSTRAINTS: Logistical problems and management problem

39. Occupational Health Related Conditions • ACHIEVEMENTS: • 50% of hospitals have trained Occupational Health Officers. • CONSTRAINTS: • Lack of training in the implementation of the Occupational Health and Safety Act in the Workplace.

40. PHC SERVICESAccessibility & Availability of PHC Services ACHIEVEMENTS: • 24 hour services have increased from 183 to 233 • 10 clinics increased hours of services from 8 hours to 12 hours • 142 care groups activated and 18 new care groups established. • PHC service delivery at social security paypoint has been started in Vhembe and Mopani district. • PHC service delivery started in Prisons in the Vhembe districts. • Antenatal coverage is 77.5% and antenatal visits per client is 3.7 CONSTRAINTS: budget for security at clinics not available.

41. PHC UTILIZATION RATE BY DISTRICTS 2000 - 2002

42. ANTENATAL VISITS PER ANTENATAL CLIENT BY DISTRICTS 2000-2002 Source: DHIS

43. DHS Development & Devolution Support Achievements; Devolution of PHC Services: • Newly Demarcated District Re-alignment • A Multi-Sectoral Task Team was established in July 2002 to develop a Devolution Strategy for Limpopo Province • Draft 1 of the Strategy is under consideration by Department of Health & Welfare, Local Government & Housing and other key stakeholders. • Plan A of the strategy deals with the transfer of EHS to district Municipalities while Plan B contain measures to address delegations of PHC services to district council municipalities. • Draft services level agreements have been developed for signing with each municipality that will receive ‘devolved’ service functions. • Heads of Health district have been appointed and given delegated powers and functions

44. EMERGENCY MEDICAL SERVICES Achievements: • 3 New stations were opened • Hospital Based staff have been taken over by EMS • 118 posts have been filled at various stations and the 4 shift system is being implemented at stations with sufficient staff. Constraints: • Community misunderstandings of EMS Restructuring Programme vs Community Expectations

45. PROGRAMME 3Regional and Specialised Hospital Services

46. Equitable access to Health Care Services • Polokwane /Mankweng complex has reduced referrals to Ga- Rankuwa by 25%. • Referrals into PMHC • 3271 • Referrals out of PMHC • 418

47. HOSPITAL PERFORMANCE INDICATORS PER DISTRICT

48. HOSPITAL PERFORMANCE INDICATORS BY LEVELS OF HOSPITALS

49. PROGRAMME 4Health Sciences

50. HEALTH SCIENCES Achievements NURSING • Level 1 training material for outcome based and community based education developed. • Total enrolment stand at 690. Constraints • Absence of Selection Criteria for Rural Schools Recruitment