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EASTERN CAPE DEPARTMENT OF HEALTH. Parliamentary Budget Hearings Tuesday, 08 June 2004. INDEX. Page 1.Overview3 2.Organisational Establishment4 3.Revised Service Delivery Model5-6 4.Where do we want to be7-9

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EASTERN CAPE DEPARTMENT OF HEALTH

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Eastern cape department of health

EASTERN CAPE DEPARTMENT OF HEALTH

Parliamentary Budget Hearings

Tuesday, 08 June 2004


Index

INDEX

Page

1.Overview3

2.Organisational Establishment4

3.Revised Service Delivery Model5-6

4.Where do we want to be7-9

5.Achievements according to Ten Point Plan10 – 20

6.Major challenges21-23

7.Alignment of goals with National and Provincial imperative24-29

8.Priorities30-34

9.Finance Information

10Conclusion


Overview where do we come from

OVERVIEW- (WHERE DO WE COME FROM?)


Eastern cape department of health

2. ORGANISATIONAL ESTABLISHMENT

MEC: HEALTH

SUPERINTENDENT GENERAL

DDG: Clinical

Services

DDG: Corporate

Services

CD:

DHS

CD:

PHC

CD

HSM

CD:

QA

CD:

FIN

MNG

CD:

PROC

CD:

STRAT

PLAN

CD:

FAC &

ASSTS

Acronyms:

CD-Chief Director; DHS – District Hospital Services;

PHC-Primary Health Care; HSM – Hospital Services Management;

QA-Quality Assurance; FINMNG- Financial Management;

PROC-Procurement; STRAT-Strategic & FAC-Facilities


3 revised service delivery model

3. Revised Service Delivery Model

Head Office

7 District Managers

5 CEOs of

Hospital

Complexes

and Regional

Hospitals

18 District

Hospital

Cluster

Managers

25 Sub District

Offices

District Hospital

Managers

713 clinics

28 Community

Health centres


Service delivery model

SERVICE DELIVERY MODEL

The role of Head Office will be focused on programs coordination, integration and policy formulation, monitoring and evaluation.

Our PHC services are provided through 713 clinics and 28 Community Health Centres, and these are managed by 27 Local Service Area (LSA) managers. Patients that need high level of care will be referred to Level 1 hospitals

18 Clusters of 47 district hospitals as well as 18 provincial aided and 4 privately run hospitals provide level 1 services. Clustering will allow for sharing of resources including professional staff.

The three complexes and two regional hospitals provide levels 2 and 3 services.

The 7 district managers have responsibility over 18 CEOs in the clusters and 25 LSA managers. They report to head office.

The 2 regional and 3 complex CEOs report directly to head office.


Where do we want to be

WHERE DO WE WANT TO BE?

4.1 VISION

  • A health service to the people in the Eastern Cape Province promoting a better quality of life for all.


4 2 mission

4.2 MISSION

To provide and ensure accessible comprehensive integrated services in the Eastern Cape emphasizing the primary health care approach utilizing and developing all resources to enable all its present and future generation to enjoy health and quality of life.


4 3 values

4.3 VALUES

Human Rights, customer satisfaction, service excellence and value for money are ensured through adherence to the following values:-

  • Equity of both distribution and quality of services

  • Service excellence including customer satisfaction

  • Fair labour practices

  • Good work ethic and a high degree of accountability

  • Transparency demonstrated through consultations with all stakeholders in the health industry/field


Eastern cape department of health

5. ACHIEVEMENTS ACCORDING TO THE TEN POINT PLAN

(WHERE ARE WE NOW?)


5 1 reorganisation of certain support services

CORPORATE SERVICES CENTRES

The department and the Interim Management Team (IMT) established 11 Corporate Service Centres

3 Complexes

7 Districts

Head Office

to provide shared support services

HR,

Finance,

Procurement,

Administration &

IT

5.1. REORGANISATION OF CERTAIN SUPPORT SERVICES


5 2 legislative reform

Education and Training of Nurses and Midwives Act no. 4 of 2003

Medicines Act 90 of 1997 and Pharmacy Act 88 of 1997 they will be applicable in July 2005 to the State

Mental Health Act of 2002

5.2. LEGISLATIVE REFORM


5 3 improving quality of care

Health service awards launched in East London and Umtata aimed at maintaining high standards in institutions

A 24 hr call centre has been established with a toll free number of 0800032364 providing opportunity for grievances and suggestions

In line with the prevention of blindness (Global vision 2020) we are improving our cataract performance yearly.

5.3. IMPROVING QUALITY OF CARE


5 4 revitalization of hospital services

PE Complex is our flagship in Rationalisation of Services

Provincial secondary and tertiary service delivery plans have been developed and these are linked to national modernisation of tertiary services

Outreach program focussing on mother and child health as well as anaesthetic training

Rationalisation of psychiatric services establishing psychiatric beds in the eastern side of the province

Nelson Mandela Academic Hospital functional and awaiting official opening

21 hospital construction projects completed,14 under construction, equipment procured for 50 hospitals and maintenance done to 88 hospitals

5.4. REVITALIZATION OF HOSPITAL SERVICES


5 5 speeding of delivery of an essential package of service through the district health system

Institutionalisation of the 18 hospital clusters including appointment of management teams for these clusters

Clustering will allow sharing of resources

5.5. SPEEDING OF DELIVERY OF AN ESSENTIAL PACKAGE OF SERVICE THROUGH THE DISTRICT HEALTH SYSTEM


5 6 decreasing morbidity and mortality rates through strategic interventions

5.6. DECREASING MORBIDITY AND MORTALITY RATES THROUGH STRATEGIC INTERVENTIONS

  • Following implementation of standards in Traditional Circumcision Act (Act no. 6 of 2001) there has been marked decrease in morbidity and mortality resulting from circumcision (statistics)

  • Placement of staff to oversee the ARV treatment plan has been completed;

  • 270 nurses, doctors, pharmacists, dieticians and workers have been trained in the various aspects of disease management


5 7 improving resource mobilization and utilisation

5.7. IMPROVING RESOURCE MOBILIZATION AND UTILISATION

  • For the first time Eastern Cape had an unqualified report

  • PPP – Kouga Partnership Hospital at Humansdorp being the first co-location PPP in the Province


5 8 improving communication and consultation within the health system and with communities we serve

5.8. IMPROVING COMMUNICATION AND CONSULTATION WITHIN THE HEALTH SYSTEM AND WITH COMMUNITIES WE SERVE

  • Communication unit established at head office and director appointed

  • Hospital boards clinic committees established

  • Three mental health review boards established

  • Weekly slot in local radio station talking about health issues


5 9 improving human resource development and management

5.9. IMPROVING HUMAN RESOURCE DEVELOPMENT AND MANAGEMENT

  • Increased number of community service professionals

  • Induction of community service professionals aimed at presenting our recruitment and retention strategy

  • Learnerships & internships introduced

  • Delegations – human resources and finance

    have been finalised

  • Implementation of scarce skills and rural allowances

  • Implementation of skills development plan

  • Gradual implementation of the Employment Equity


5 10 strengthening co operation with our partners internationally

5.10.STRENGTHENING CO-OPERATION WITH OUR PARTNERS INTERNATIONALLY

  • Fred Hollows Foundation training programme to assist in improving prevention of blindness

  • Luxemburg-Aid in infrastructure development (Mnquma – former Transkei

  • Communicable Disease Centre, British Columbia, PEPFAR supporting the implementation of the Comprehensive Treatment Plan

  • Training of rehabilitation technicians in Tanzania


6 major challenges in the department

6. MAJOR CHALLENGES IN THE DEPARTMENT


6 1 health challenges

6.1 HEALTH CHALLENGES

  • Management and reduction of communicable disease, Cholera HIV/AIDS, TB and STIs including the Comprehensive Treatment Plan which includes ARV roll-out.

  • Staff recruitment, retention and composition

  • Management of childhood disease including low immunization coverage

  • Cross boundaries movement of people

  • Legislative reforms influenced by cultural factors e.g. circumcision, and recognition of alternative medicine including traditional healing

  • Drug supply

  • Backlog in health infrastructure development


6 2 other challenges

6.2 OTHER CHALLENGES

  • Escalating crime calling for more security for staff working in primary health care facilities, establishment of Crisis Centres and counseling facilities for victims of abuse as well as calling for more collaborative endeavors with other sectors

  • The impact of increased motor vehicle accidents on emergency medical services and other services


7 alignment of goals with national and provincial imperatives

7. ALIGNMENT OF GOALS WITH NATIONAL AND PROVINCIAL IMPERATIVES


Alignment of goals

Alignment of Goals


Alignment of goals continued

Alignment of Goals Continued


Alignment of goals continued1

Alignment of GoalsContinued


Alignment of goals continued2

Alignment of GoalsContinued


Alignment of goals end

Alignment of GoalsEnd


8 priorities for department of health in next 3 years

8. PRIORITIES FOR DEPARTMENT OF HEALTH IN NEXT 3 YEARS


8 1 clinical services phc

8.1 CLINICAL SERVICES (PHC)

  • Roll out Comprehensive Plan to target 147 200 cumulative clients by 2008 including 2700 in 2004/05. Accreditation of Ukhahlamba and Alfred Nzo phase 1 sites will be finalized by end July 2004

  • Collaborative project with DWAF and Municipalities on water and sanitation

  • Expanded Programme of Immunisation campaign in July 2004

  • R1 million set aside for food gardens to benefit 4000 clients

  • Commenced a programme on training professionals on maternity and child health services

  • Finalise transfer of 174 Environmental Health Professionals to municipalities


8 2 clinical services hospital

8.2 CLINICAL SERVICES (HOSPITAL)

  • 80 New EMS vehicles were purchased between November 2003 and March 2004 for deployment. An Air Ambulance service has been implemented

  • Finalise recruitment of management in the District Hospital Clusters and implementation of clinical programmes

  • Aligning our service delivery plans with MTS

  • NMAH commissioned and awaiting official opening in 2004/05


8 3 clinical services quality of care

8.3 CLINICAL SERVICES (QUALITY OF CARE)

  • Implementation of fully-fledged call centre to be able to monitor and provide feedback in all our customer complaints

  • Will establish clinical audit on target clinical programmes to ensure on-going monitoring and quality

  • Will implement accreditation programme targeting 40 hospitals over the next 3 years (and targeting 5 accredited hospitals)


8 4 support services

8.4 SUPPORT SERVICES

  • Infrastructure

    -Roll-out revitalisation programme with 4 Hospitals at different phases of development (St Elizabeth, Frontier, Mary Terese and Rietvlei)

    -Building of 46 clinics (including 13 in 2004/05) over the next 3 years

    -Replacing 47 clinic over next 3 years

  • Roll-out Corporate Service Centres to all districts (functional by March 2005)

  • Implementation of good finance governance and management principles

    • Audit committee

    • Internal Audit

    • Risk assessment and management

    • Decentralized pre-audit function


Support services continued

Support Services continued

  • Enhance HRM in the department

    • Robust recruitment and retention strategy

    • Roll-out PMDS to all levels

    • Learnership and internship programmes and targeting 1000 school leavers training as Nursing assistants and /or Community Health Workers

  • Mobilization of resources

    • Finalization of Drug PPP

    • Implementation Humansdorp PPP

    • Development of Port Alfred and Settlers PPP’s


Total health allocation in 2003 04

TOTAL HEALTH ALLOCATION IN 2003/04


6 budget

6. BUDGET


Percentage real increase between 2003 04 and 2004 05

PERCENTAGE REAL INCREASE BETWEEN 2003/04 AND 2004/05


Expenditure on personnel

EXPENDITURE ON PERSONNEL


Transfers

TRANSFERS


Conditional grants 2004 05 1

CONDITIONAL GRANTS 2004/051


Hiv aids budget 2004 05

HIV/Aids Budget 2004/05


2003 04 expenditure analysis

2003/04 Expenditure analysis


2003 04 variance analysis by programme

2003/04 Variance analysis by programme


Programme distribution 2004 05

Programme Distribution 2004/05


Expenditure amount per capita

EXPENDITURE AMOUNT PER CAPITA

In terms of the Inter Governmental Fiscal Review (IGFR) 2003 this province at R769.00 received the third lowest per capita allocation in South Africa.

(1) Census data 2001


Programme analysis

Programme Analysis

  • The proportion of the budget transferred to Local Government

    • 2.8 % was transferred.

  • The total amount for donor funding was

    • Approx. R26 million in kind where the USAID sponsored the Equity Project who rendered technical support and training.


Programme analysis cont r 000

Programme Analysis (cont) R’000

  • Proportion of the Budget spent on District Health Services:

    • R 2,684,102 or 49.6 %

  • Proportion of the Budget spent on Community Health Services and Primary Health Services

    • R 1,200,057 or 22.18 % which is 45% of District Health Services budget


Cost pressures

Cost Pressures

  • Transport management R37m short

  • Laboratory services R44m short

  • Land and buildings especially maintenance R43m short

  • Nutrition budget of R23m not enough to cover patients with HIV and TB


7 conclusion

7. CONCLUSION

  • Various restructuring programs have been put in place, and now we are in a process to deepen implementation.

  • We have started the roll-out of the Plan and we will increase the pace and capacity to absorb the demand

  • We are continuously seized with the challenge to increase the access and thereby drastically reducing the morbidity and mortality, and any other curable diseases

  • Even though significant improvements have been made on PPTV it remains a challenge

  • Demand for services continues to outweigh our resources

  • We remain committed to strengthen our links with partners in civil society


Eastern cape department of health

WE ARE READY TO DELIVER

ENKOSI!!!


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