FREE STATE DEPARTMENT OF HEALTH

GENERAL COMMENTS
1. General
The department has jumped the milestone in the past six years by creating the necessary infrastructure and policy frameworks for health delivery. The department has made enormous strides during the first year of its second term. Lots of achievements have been made of which one is the revision of the posts and functions of management that were reviewed by the MEC and re-deployed according to the needs of the Department. The Department of Health also saw a need to popularise its service plan through roadshows held in the different sectors of the Department. The challenge is to provide quality health care to the people of this province within the allocated budget.

The objectives of the Department of Health as set out in the Service and Business plans, are the following:

•To maintain a culture of accountability through the implementation of appropriate capacity building programs;
•To improve the quality of care of all levels of health service and ensure that primary EDL drugs are available in all facilities;
•To address the most prevalent health needs within each district according to its burden of disease;
•To develop programmes to provide care to HIV/AIDS orphans and people living with HIV/AIDS;
•To maximise revenue generation;
•To maintain an effective Medium Term Expenditure framework and ensure effective cash flow management;
•To allocate health resources more equitably between the health districts;

The aim of the Vote is to render health and related services in terms of the Legislation and is divided into eight programmes:

•Programme 1: Health Administration,
•Programme 2: District Health Services,
•Programme 3: Regional and Specialised Hospitals,
•Programme 4: Central Hospital Services,
•Programme 5: Health Sciences,
•Programme 6: Health Care Support Services,
•Programme 7: Health Facilities and Capital Stock,
• Programme 8: Supernumerary Staff
The budget allocation for 2000/2001 was made on the principle that personnel expenditure should firstly be provided for before funds could be made available for the funding of other services.

1.2. Ring-fenced amounts
The following priorities have been identified and the allocations
Ring-fenced for the 2000/2001 financial year:

1.3. Budget allocation 2000/2001

The table gives an indication of the budget allocation for 2000/2001 in comparison with 1999/2000.

* % Increase on the Budget allocation for 1998/1999 - R 1,566 billion.

Programmes 1, 2, 3 and 5 received increased funding.

2. DISCUSSIONS ON PROGRAMMES:
2.1. PROGRAMME 1: HEALTH ADMINISTRATION
Scope of the programme: To conduct the overall management and administration of the Department of Health within the directorates MEC, Top Management, Human Resources, Finance, District Management, Provincial Health, Admin Support Services, Management Support, Strategic Management and Corporate Communication.

The following important shifts in emphasis will be implemented in Programme 1 during the 2000/2001 financial year.

2.1.1. A new Directorate of Financial Management and Internal Audit has
been established to support financial management in this
Department. A Chief Financial Officer was appointed;
2.1.2. The Chief Director Support Services has been appointed;
2.1.3. The R11 million for training will assist in the empowerment and
development of personnel and relevant stakeholders;

No substantial changes have occurred in policy and activities. The increases
in estimated amounts are attributable to the escalation of continuation costs.

2.2. PROGRAMME 2: DISTRICT HEALTH SERVICES
Scope of the Programme: To provide primary health care services that includes Environmental Health, Nutrition, Rehabilitation, Radiography, Pharmaceutical, Oral Health, Health Promotion, Maternal Woman and Child, Communicable Diseases & Mental Health, District Hospitals and Emergency Medical Services.

The only shifts in service rendering in Programme 2, are the Provincialisation of Emergency Medical Services, the treatment and hospitalisation of patients with tuberculosis at private hospitals (shifted from Programme 3 to Programme 2), as well as the orthotic and prosthetic workshops that were shifted from Programme 6. The rest of Programme 2 remains unchanged.

2.2.1. Expenditure control to remain within budget remains a challenge;
2.2.2. Management of Local Authority transfer payments remains
complicated and problematic;
2.2.3. Provision for three mobile dental clinics and personnel for community
service dentists will amounts to R 1,5 million;
2.2.4. The HIV/AIDS programs are funded under programme 2.

2.3. PROGRAMME 3: REGIONAL AND SPECIALISED HOSPITALS
Scope of the Programme: To render level II and specialised hospital services through the Regional Hospitals – Pelonomi Hospital, Bethlehem Hospitals, Manapo Hospital, Goldfields Hospital, Boitumelo Hospital, Psychiatric Complex.

The major concerns of programme 3 are limited funds for the procurement of pharmaceuticals and the maintenance and the replacement of equipment.

The challenges facing Programme 3 are as follows:
2.3.1. Improve the quality of care at all regional and specialised hospitals
within the allocated budget;
2.3.2. Establish a sub - campus of the Faculty of Health Sciences at the
Goldfields Regional Hospital;
2.3.3. Expenditure control to remain within budget in Programme 3;
2.3.4. Improving the management capacity of the regional hospital;
2.3.5. Regional Hospitals could not replace essential medical equipment
over the past two years and it is critical to develop strategies to replace and maintain equipment to ensure quality of care.

2.4. PROGRAMME 4: CENTRAL HOSPITAL SERVICES
Scope of the programme: Rendering of central medical health care service (level III and IV) and providing a platform for the training of health workers at Universitas Hospital and the Faculty for Health Sciences.
2.4.1. The Academic Health Services are rendering a total service on Level III and IV for the Free State Province as well as the Northern Cape Provinces;
2.4.2. The allocation of R351 400 000 to Programme 4 will enable the
Programme to continue with the services that were rendered
previously. Certain services including pediatric, oncology, high risk
maternity and neonatology will be transferred to Universitas Hospital
with effect from 1^st April 2000. These additional services will increase
the burden on the budget of Universitas Hospital;
2.4.3. Universitas Hospital faces a major challenge to control its expenditure
with respect to medical consumables. Major price increases in medical
consumables and the effect of inflation on medical consumables will
have a major impact on the cost of services where medical
consumables are utilized;
2.4.4. The service contracts of equipment also result in a significant financial
burden because of the high levels of technology that are required;
2.4.5. The capital equipment allocation of R800 000 is insufficient for the
replacement and maintenance of equipment and other strategies will
have to be developed in this regard.

2.5. PROGRAMME 5: HEALTH SCIENCES
Scope of the Programme: The training of nursing and ambulance personnel and promoting research and development of health systems through the Training Colleges and the Ambulance Training
2.5.1. Programme 5 has experienced policy changes through the
implementation of the Free State Nursing Education Act No 15, of
1998, which led to the rationalization of Colleges and the formation of
the Free State School of Nursing;
2.5.2. The restructuring of the Ambulance Training College led to the
decentralisation of basic courses and the inception of decentralised
refresher courses.

2.6. PROGRAMME 6: HEALTH CARE SUPPORT SERVICES
Scope of the Programme: To render Non-Clinical Services, the provisioning for Provincial Transport and the Capital Augmentation of the MEDPAS Trading Account.

No substantial changes have occurred in programme 6, other than the shifting of the Orthotic and Prosthetic Workshops to Programme 2. Provincial Motor Transport make provision for the purchase of departmental vehicles.

2.7. PROGRAMME 7: HEALTH FACILITIES AND CAPITAL STOCK
Scope of the Programme: The provision of new facilities through the construction and building of related structures, the maintenance of existing buildings and structures as well as the refurbishing of all existing buildings and structures to keep them at par with the latest health related needs of the community.

The programme is to ensure the success of technical projects (development and rehabilitation) by managing collaboration between the role-players in the Department of Health, Public Works and the Private sector. The allocation of R35 million from the Department of Public Works (R 4 million) and the Hospital Rehabilitation Programme (R 31 million) will be spent on the upgrading of health facilities. This amount will still not provide in the existing needs because various institutions are in direct need of upgrading of either the buildings or engineering services.

2.8. PROGRAMME 8: SUPERNUMERARY STAFF
Scope of the Programme: Placement strategy for the appropriate absorption of staff additional to the establishment.

Supernumerary staff creates additional pressures on the budget. To avoid this added burden on the budget, training programmes for personnel in this programme has been developed (i.e. Nursing, Pharmacy Assistants, etc.) to utilize the supernumerary staff efficiently. Where possible supernumerary personnel will be placed in vacant posts.


B.1. Budget Information: Budget and expenditure by programme and sub-programme for the 1996/1997, 1997/1998, 1998/1999 and 1999/2000
B.1.2 (a) Total revenue raised from private patients using public hospitals for the years 1995/1996, 1996/1997, 1997/1998, 1998/1999 and 1999/2000.

1995/1996: R 35 812 966
1996/1997: R 32 557 242
1997/1998: R 20 758 839
1998/1999: R 19 334 985
1999/2000: R 14 541 94
B.1.3 (a) Key problems experienced in relation to the budgeting
process

The request for Virement shift approvals is not attended to timeously which resulted in programme managers being unable to perform their duties.
B.1.3 (b) Ability to realize national policy objectives generally
See Departmental Business and Service Plan.
B.1.3 (c) Implementation of revenue retention policy
According to the Provincial Treasury no revenue retention
policy has been decided on as yet.
B.1.3 (d) Medium Term Expenditure Framework - Comments
Effective medium-term expenditure planning is taking place in the Free State Department of Health. The MTEF budget process within the Department of Health is characterized by close working relationship between the MEC Health, the Head of the Department, Programme Managers as well as lower level responsibility and objective managers.

The MTEF input preparations for the period 2001 to 2003 were done by conducting regular MTEF review meetings with the above mentioned managers. Key issues were identified and resolutions taken that serve as guidelines for service rendering in the Department. The positive results achieved at these meetings were also related to the Provincial Treasury during bilateral discussions.

The MTEF was compiled according to the service and business plans of the Department. With the identification, prioritization and scheduling of activities, managers made provision for high priority services, taking into consideration the costs for services between the different levels of health care. The programme managers thus had to ensure that all aspects have been budgeted for in accordance with the collective agreements between the respective programmes. Emphasis was placed on personnel expenditure estimates and the importance of the implementation of the Human Resource Plan for the period 2001 up to 2003. Positive results have been achieved as the accuracy of personnel expenditure was improved by using a standardized personnel template.

B.2.2. Specific Policy Areas
Donor Funding

KEY PROBLEMS EXPERIENCED IN RELATION TO THE BUDGETING PROCESS
The requests for Virement shift approvals are not attended to timeously which resulted in programme managers being unable to perform their duties.

THE REALISATION OF NATIONAL POLICY OBJECTIVES
Service and Business Plans

IMPLEMENTATION OF A REVENUE RETENTION POLICY
According to the Provincial Treasury no revenue retention policy has been decided on as yet

B.1.3 (c) Implementation of revenue retention policy

According to the provincial Treasury no revenue retention policy has been decided on as yet.