INTRODUCTION
ACHIEVEMENTS 1999/2000

• Hospital service norms
• Appointment of Hospital Boards
• Increased focus on HIV/AIDS
• Improved financial management
• Alignment of expenditure to budget
• Khanyisa Service Excellence Awards
• Revenue Incentive Scheme
• Appointment of CEOs
• IPHA
• ENVISAGED ACHIEVEMENTS 2000/2001
• Strengthening management at institutions
• Improved revenue generation
• Private Financing Initiatives
• Health Rights Revival and improved quality services
• Focus on legislation
• Step down and homebased care

• Budget more realistic, but constraints on meeting needs
• Media focus on issue of care in hospitals
• Constraints on filling of posts, addressing facilities and equipment backlogs
• Low morale of staff
• Re-defining service structures

• Improve financial and management systems
• Strengthen decentralisation and performance management system
• Implementation of service norms and standards
• Alternative financing mechanisms to address facilities and equipment backlogs

• HIV/AIDS
• Payment of notches for PPMS
• BCEA
• Increased costs of local authority services
• Natural disasters
• Equipment and facilities backlog

• Virtually all institutions have access to FMS
• Routinely tracking expenditure in all institutions and responding to anomalies
• Distributing FMS downloads in easy-to-use format
• Billing system in all institutions
• Cabling of institutions improved performance
• In 2000/2001 the following will be achieved:
• Focus on financial management capacity
• R25 million per year for next three years allocated
• Focus on filling of key posts and setting up systems
• Systems for pharmacy management, stock control and asset security
• Improved revenue generation and retention
• Improved cost efficiency in laundries and non-core services

[Table not included]

• IPHA established, MEC meets regularly with councillors
• DHS White Paper gazetted, Act to be tabled this year
• Budget constraints undermining expansion; adequacy of staffing
• Major loss of nurses from services
• Questions regarding extent to which DHS takes load off hospitals

• Evidence that GHD has "turned the corner" , with most hospitals coming within budget for the first time
• Revenue retention beginning to bear fruit
• Some efficiency gains realised
• Real impact on services and staffing in order to make budget
• Weak management in many institutions
• CEOs a major step forward
• Refocusing of decentralisation project to meet broader departmental needs
• Service plan to achieve regional equity and application of budget-driven service norms - widespread consultation underway with all stakeholders
• Limited private practice ended January 2000; new RWOPS system to facilitate management and controls
• budgets will show a small but real shift to regional hospitals
• concrete plans re shift of patients and staff to DHS

• Safe motherhood - given concrete expression through maternal death reporting and response
• major focus on Adolescent sexual and reproductive health - Youth Friendly Services
• campaign to reduce of all forms of violence against women
• Empowerment of communities and service providers

• Staff resistance still a factor; made worse by general budget restrictions
• Midwife training set to improve capacity and access at primary level
• Second trimester service a major bottleneck
• Large cross-boundary flow for these services still apparent

• Data on deaths and their causes is a major step forward
• Used to guide protocols, training, service re-organisation
• Staffing norms used to monitor adequacy of staffing
• Peer review process strengthened (M&M meetings)

• hard work is beginning to show results as cure rates rise
• district based data is used for quarterly reviews with coordinators
• focus on reducing interruption rate through community DOTS supporters
• impact of HIV/AIDS seen on numbers, deaths, hospital admissions
• better coordination with hospitals and on MDR management

• strong political leadership and support as seen in budget allocation, Premier’s Committee, AIDS Council
• Inter-departmental coordination and planning now extended to Local Government level
• target largely met (measured in April for financial year)
• communication and media strategy prioritises radio, drama and a limited number of campaigns
• several projects are starting to yield both data and results (peer education, HBC)
• impact on service loads and mortality rates now apparent
• long term projections of load and costs are significant
• strategies and costs for HBC being reviewed