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PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES

PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES ANNUAL PERFORMANCE PLAN AND BUDGET 2011/12-2013/14. 1. VISION AND MISSION. VISION Long and healthy life for all South Africans MISSION

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PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES

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  1. PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES ANNUAL PERFORMANCE PLAN AND BUDGET 2011/12-2013/14

  2. 1. VISION AND MISSION VISION Long and healthy life for all South Africans MISSION To improve health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

  3. HEALTH SECTORS PLAN 2011/12 TO 2013/14 • Government adopted an outcome-based approach to service delivery • The Health sector is responsible for the achievement of Outcome 2 : A long and healthy life for all South Africans • Four Identified outputs: • Output 1 : Increasing Life Expectancy • Output 2 : Decreasing Maternal and Child mortality • Output 3 : Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis • Output 4 : Strengthening Health System Effectiveness

  4. Interrelationship across the Health Sector Negotiated Service Delivery Agreement, the 10 Point Plan and the National Health Insurance Health Sector 10 point Plan NSDA A LONG & HEALTHY LIFE FOR ALL SOUTH AFRICANS NHI Defined Targets Defined Timeframes & critical milestones Secret

  5. HEALTH SECTOR NSDA 2010 - 2014 IMPACT INCREASED LIFE EXPECTANCY OUTCOMES OUTPUT STRENGTHENING HEALTH SYSTEM EFFECTIVENESS INTER - PRIMARY IMPROVED SECTORAL IMPROVED HEALTH ACCESSS IMPROVED ACTION IMPROVED ACCESS TO NATIONAL HEALTH INPUTS CARE TO FINANCIAL FOR QUALITY HUMAN HEALTH INFORMA - ORIENTED HEALTH MANAGE SOCIAL OF RESOURCES INSURANCE TION SERVICE FACILITIES MENT DETERMI - SERVICES FOR DELIVERY NANTS OF HEALTH HEALTH Reduce burden from HIV&AIDS and TB (Mortality and Morbidity) Reduce burden from non-communicable diseases Reduced Maternal and Child mortality rates Reduce burden from violence and injury Primary Health Care Oriented Service Delivery Improved quality of services Improved Human Resources for Health Improved access to Health Facilities Improved financial manage-ment National Health Insurance Health Informa - tion Inter -sectoral action for social de -terminants of Health

  6. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Scaling up condom distribution, with 1 billion male condoms distributed annually during 2011/12-2013/14, and 6 million female condoms distributed annually during 2013/14 • Increase the number of Medical Male Circumcisions to 500 000 during 2011/12 and 600 000 annually during 2012/13 and 2013/14 • Increase the HCT uptake rate from 80% to 90% in 2013/14

  7. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVE THE QUALITY OF LIFE OF PEOPLE LIVING WITH HIV &AIDS BY PROVIDING AN APPROPRIATE PACKAGE OF CARE, TREATMENTS AND SUPPORT • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Increasing the number of new patients initiated on Antiretroviral Therapy (ART) to between 625 000 to 675 000 annually during 2011/12-2013/14 • Increasing the proportion of PHC facilities implementing nutritional intervention for People living with HIV and AIDS and TB from 77% in 2010/11 to 88% in 2013/14

  8. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Maintain the percentage of children under 1-year of age fully immunised at 95% throughout the MTEF period • Maintain the measles immunisation coverage rate of 95 % throughout the MTEF period • Increasing the number of sub-districts implementing school health services from 100 to 150 in 2011/12 , 200 in 2012/13 and 232 in 2013/14 • 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 the Vitamin Supplementation coverage among children 12 to 59 Months from 38% in 2010/11 to 45% in 2013/14

  9. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 TO REDUCE MATERNAL MORTALITY • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Maintain ante – natal coverage rate of 100 % throughout the MTEF period • Increasing the antenatal coverage before 20 weeks from 37% in 2010/11 to 60% in 2013/14 • Increasing the proportion of deliveries taking place in health facilities under the supervision of trained personnel from 88% in 2010/11 to 95% in 2013/14 • Increasing the proportion of designated health facilities providing Choice on Termination of Pregnancy (CTOP) from 40% in 2010/11 to 55% in 2013/14; • Increasing the percentage of mothers and babies who receive post-natal care within 6 days of delivery from 40% in 2010/11 to 80% in 2013/14;

  10. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED ACCESS TO REPRODUCTIVE HEALTH • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Increasing the cervical cancer screening coverage from 50% in 2010/11 to 56% by 2013/14 • Increasing the couple year protection rate from 32% in 2010/11 to 37 % by 2013/14

  11. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 EXPAND PMTCT COVERAGE TO PREGNANT WOMEN • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • 100% of pregnant woman to be tested for HIV • Increasing the antenatal clients initiated on HAART rate from 87% in 2011/12 to 100% in 2013/14 • Decreasing the percentage of babies testing PCR positive 6 weeks after birth from 10% in 2011/12 to 6.5% in 2013/14 • Increasing the uptake rate for HIV Positive antenatal clients on AZT for any period before labour from 86% in 2011/12 to 100% in 2013/14

  12. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 TO REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS • KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Increasing the TB cure rate from 70 % in 2009 to 85% in 2013/14. • Reducing the TB treatment defaulter rate from 7% in 2010/11 to 5% (or less) in 2013/14

  13. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Increasing the percentage of HIV positive patients screened for TB from 70% in 2011/12 to 100% in 2013/14 • Increasing the percentage of TB patients tested for HIV from 80% in 2011/12 to 100% in 2013/14 • Increasing the percentage of TB/HIV co-infected patients receiving Cotrimoxazole Prophylaxis Therapy from 90% in 2011/12 to 100% in 2013/14 • Increasing the number of HIV positive patients receiving Isoniazid Preventative Therapy (IPT) from 45 000 in 2011/12 to 80 000 in 2013/14

  14. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON – COMMUNICABLE DISEASES KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Decreasing the incidence of malaria from 0,62 per 1000 population at risk in 2010/11 to 0.54 per 1000 population at risk in 2013/14; • Chronic care whether from communicable or non-communicable causes will be aligned and a single chronic care model will be rolled out to 3 districts in 2011/12 • The number of districts implementing the long term care model for diabetes and hypertension will be increased to 52 by 2013/14 • The integrated Health Promotion Policy and Strategy with an implementation plan will be finalised during 2011/12 • To strengthen the quality of Environmental Health Services , norms and Standards will be developed during 2011/12

  15. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 RE- ENGINEERING OF PRIMARY HEALTH CARE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Implementation of community based services in each district by establishing Family Health Teams ; 54 in 2011/12, 100 in 2012/13 and 250 in 2013/14 • Complete the comprehensive audit of Primary Level Services inclusive of District Hospitals by March 2011/12 • Improve community participation to strengthen the governance of the District Health System, • Increase number of District Health Councils established from 43 in 2010/11 to 52 in 2012/13 • Increase the percentage of functional committees established for PHC facilities to 60 % in 2013/14 • Improve access to primary health care services, with an increased utilisation rate of 3 visits by 2013/14 • Improve health outcomes through ensuring that 52 Districts Health Plans are used for planning, budgeting, monitoring ,reporting and improved programme implementation by providing more direct support to the District Management Teams

  16. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Develop and implement a national infrastructure plan in conjunction with provincial infrastructure units • Develop a set of Health Infrastructure norms and standards for all levels of care • Establish an Infrastructure Project Management information system • Finalisation of the Health Care Technology strategy • Finalisation of the essential equipment lists for primary health care in 2011/12 and for secondary and tertiary health care in 2012/13

  17. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) • All five tertiary hospitals should complete the feasibility study by March 2012. These are: • Nelson Mandela Academic (Eastern Cape); • Chris Hani Baragwanath (Gauteng); • Dr. George Mukhari (Gauteng); • Limpopo Academic (Limpopo); • King Edward VIII (KwaZulu-Natal); • Funding will be provided to hospitals through the hospital revitalization grant : • 41 Hospitals will be under construction • 25 Hospitals will be in the planning phase

  18. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPEMNT KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Finalising the revised Health Workforce Plan responsive to service delivery platforms by the end of 2011/12 • Strategy for Rural Health workforce developed by the end of 2011/12 • Norms and Standards for Health Workforce for Primary and Secondary Health Care developed • Integrate Community Health Workers into the formal Health System

  19. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVED HEALTH CARE FINANCING KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • Work in preparation for the implementation of NHI will continue. Specific outputs for 2011/12 include: • Finalization of the NHI policy and legislative framework • NHI Pilot Sites established • Funding model developed

  20. IMPLEMENTATION OF THE HEALTH SECTOR’S RESPONSE DURING 2011/12 – 2013/14 IMPROVE THE QUALITY OF HEALTH SERVICES KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE: • In 2011/12 new policies related to the legislative amendment governing the establishment and functioning of the Office of Health Standards Compliance and relevant regulation will be finalised • The Office of Health Standards Compliance as a national certification body will be established by March 2012 • Patient satisfaction will be monitored and a patient satisfaction surveys will be conducted in 60 % of public hospitals during 2011/12 , in 90% during 2012/13 and 100% during 2013/14 • 20% (800) of the 4,333 public health facilities will be assessed for compliance with the 6 priorities of the core standards. This figure grows to 40% in 2012/13 and to 70% by 2013/14;

  21. RESOURCE ENVELOPE FOR IMPLEMENTING OF THE NATIONAL DOH PLANS FOR 2010/11-2012/13

  22. INTRODUCTION • During the Medium Term Framework ( MTEF) budget process, the Health Department requested additional funding for both National and Provincial departments for the amount of R19,9 billion for the three year MTEF period. • Cabinet and National Treasury approved an amount of R18,1 billion made up of R3,4billion for National Health and R14,6 billion for the provincial health departments for earmarked funds additional to the equitable share baseline.

  23. EXPENDITURE TRENDS • The Department’s expenditure grew from R13.6 billion in 2007/08 to R23.1 billion in 2010/11 at an average annual rate of 19.4 percent. • Over the Medium Term period, expenditure is expected to grow to R30.1 billion, at an average annual rate of 9.2 percent. • The increase in both periods is driven largely by transfers to provinces for the conditional grants, with the main increase being on the HIV and AIDS and the Revitalization of Hospitals grants, while the National Tertiary Services grant (NTSG) increased significantly in the MTEF period. • The Forensic Pathology Services grant will be phased out in the 2012/13 financial year and has therefore been included in the provincial equitable share allocations.

  24. MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 • The Budget includes new allocations of R442 million for 2011/12, R692 million for 2012/13 and R2.2 billion for 2013/14.

  25. MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 • R3 million, R5 million and R7 million for the Health Systems Trust to support health systems research activities including the annual health review and district health barometer • R2 million per year to publish standardised annual health statistics in the new annual health statistics publication to facilitate performance auditing and better inform the public and health service providers • R5 million, R6 million and R7 million for the Compensation Commissioner for Occupational Diseases to address backlogs in compensation, improve systems and address problems identified in audit reports • R60 million in 2011/12 and 2012/13, R60 million and R1.4 billion for the HIV and AIDS conditional grant for the rapidly growing treatment programme and to strengthen prevention programmes including R60 million per annum for male circumcision

  26. MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 • R10 million per year to forensic chemistry laboratories to purchase equipment and appoint staff to address backlogs R10 million to the South Africa Health Products and Regulatory Authority to establish itself and to deal with the medicine registration backlogs. This is a once off payment, based on the understanding that SAHPRA will generate and retain its own revenue going forward. • R30 million in 2011/12, and R30 million in 2012/13 and 2013/14 to progressively increase the distribution of condoms • R9 million, R5 million and R5 million to nursing colleges to plan and coordinate the second phase of upgrading, recapitalising and maintaining nursing colleges following the infrastructure audit

  27. MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 • The expenditure below is towards preparatory work for NHI. • R10 million, R20 million and R10 million to Office of Standards Compliance and Quality Assurance to establish itself and to support its inspectorate, certificate of compliance and ombudsman functions • R21 million, R17 million and R13 million for infrastructure management and private public partnerships to build up capacity in the department to oversee the hospital revitalisation projects and to support planning and transaction advisor cost for large private public partnership projects • R5 million, R7 million, and R9 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 per year for National Health Insurance to support development work and projects including the ministerial advisory committee

  28. MEDIUM TERM ALLOCATION FOR 2011/12 – 2013/14 • Expenditure towards preparatory work for NHI continue ..... • R4 million in 2011/12 and 2012/13 and R5 million in 2013/14 to develop improved hospital tariff schedules for use by provinces and the Road Accident Fund, including improved uniform patient fee structure, Road Accident Fund reimbursement and tariff structure, and developing diagnosis related groups system. • R5 million per year for health information systems to support national workgroup investigations of new patient based IT system and to propose next steps in IT infrastructure to support the district health information system • R2 million, R3 million and R4 million to monitor and support provinces in order to stabilise provincial finances and improve audit outcomes • R250 million, R500 million and R750 million for the national tertiary services conditional grant to support public hospitals to achieve norms and standards partly in preparation for the National Health Insurance and to implement standards and guidelines of the Office of Standards Compliance and Quality Assurance, as well as to address differential costs of doctor occupation specific dispensation

  29. ADDITIONAL FUNDS ALLOCATED TO THE BASELINE FOR THE NATIONAL DEPARTMENT

  30. ADDITIONAL FUNDS ALLOCATED TO BASELINE

  31. PROGRAMME ALLOCATIONS FOR 2011/12-2013/14

  32. ECONOMIC CLASSIFICATIONS ALLOCATIONS FOR 2012/13 TO 2013/14

  33. CONDITIONAL GRANTS ALLOCATIONS 2011/12-2013/14

  34. CONDITIONAL GRANTS ALLOCATIONS 2011/12-2013/14 • Schedule 4 grants: specifying allocations to provinces to supplement the funding of programmes or functions funded from provincial budgets; • Transfer payments cannot be withheld based on non performance or compliance, however, the new Division of Revenue Grant allows a 5% withholding while interventions are put in place. • Grants included are: • - National Tertiary Services, • - Health Professions Training and Development • - Forensic Pathology Services.

  35. CONDITIONAL GRANTS ALLOCATIONS 2011/12 - 2013/14 • Schedule 5 : specifying specific-purpose allocations to provinces. • Grants included are: • - HIV and AIDS grant and the Revitalization of • Hospital grant. • Schedule 5 grants may be withheld for non performance and or compliance. Interventions must also be put in place for compliance.

  36. ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) SUMMARY PROV. ALLOCATED.

  37. CONDITIONAL GRANTSCOMPREHENSIVE HIV & AIDS

  38. CONDITIONAL GRANTSFORENSIC PATHOLOGY SERVICES

  39. CONDITIONAL GRANTS HEALTH PROFESSIONS TRAINING AND DEVELOPMENT

  40. CONDITIONAL GRANTS HOSPITAL REVITALIZATION

  41. CONDITIONAL GRANTS NATIONAL TERTIARY SERVICES

  42. CONDITIONAL GRANTS HEALTH INFRASTRUCTURE GRANT

  43. ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) ALLOCATED DIRECTLY TO PROVINCES.

  44. ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) ALLOCATED DIRECTLY TO PROVINCES.

  45. COMMENTS ON ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) • EC: Allocated only for: • Allocated funds for OSD for doctors and health therapeutics and medical registrars in obstetrics and pediatrics. • Recapitalizing nursing college; etc. • Improvements in Conditions of Service • FS: Allocated only for: • All priorities have combine amount which is R20,6m ,R53,4m and R73,5 for three years • R 86,2 m, R87,7 & R89,4 m for Improvement in condition of service (ICS) • GP: Allocated only for: • all OSD and recapitalization of nursing colleges • Improvements in Conditions of Service for Housing allowance carry through costs • Policy adjustment: includes family health teams and PHC re-engineering and public hospital norms and standards.

  46. COMMENTS ON ADDITIONAL PRIORITY FOCUS AREAS (EARMARKED FUNDS) • KZN, MP, NC, NW and WC :Allocated funding for all priorities identified • Total Allocated Funds Earmarked are R3,2 billion, R5,9 billion,& R7 billion for 2011/12,2012/13 &2013/14 respectively. Provinces allocated R2,6 billion, R4,1 billion & R2,3 billion. • Not ALL the earmarked funds have been allocated to the Health Departments. An amount of R4,7 billion remains unallocated. It is assumed that National Treasury allocated the funds to the provincial Treasuries.

  47. CONCLUSION • National DoH Annual Performance Plan 2011/12-2013/14 reflects interventions to improve health service delivery and improve health outcomes for all South Africans. • A sector wide plan will be produced by end of May 2011, which will reflect the contribution of the entire sector - National and 9 Provincial DoHs - to the achievement of the Health Sector NSDA outcomes

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