INFORMATION SERVICES: RESEARCH
1st Floor, 90 Plein Street, Cape Town, 8000
Berenice Makani-Mansomi
Telephone: (021) 403 8205 Fax
403-8118
e-mail address: [email protected]
30
October 2004
OVERVIEW AND ANALYSIS OF THE DEPARTMENT
OF HEALTH (VOTE 16) ANNUAL REPORT 2005/06
1. Introduction
1.1 Background
Through its vision, the Department of
Health seeks to provide “an accessible, caring and high quality health
system.”
The Department’s mission is, therefore,
aimed at “improving health status through prevention and promotion of
healthy lifestyles and to consistently improve the health care delivery system
by focussing on access, equity, efficiency, quality and sustainability.”
While the Department of Health derives
its legislative mandate from several pieces of legislation, including the
Constitution (No. 108 of 1996), the National Health Act (No. of 2003) provides
the overarching framework for governance of the health sector in South Africa.
During 2005/06, the Department made some
changes to its programme structure by introducing a new programme, Programme
4: Human Resources. The establishment of this new programme reflects an
increased focus on human resources planning for the health sector. It should
also be regarded as a response to some of the commitments made by the President
in his 2005 State of the Nation Address.
1.2 Strategic imperatives
The 2005 State
of the Nation address outlined the following key issues for the health sector
during 2005/06:
- As part of the
Expanded Public Works Programme, starting April 2005, the number of
Community Health Workers will be increased.
- Campaigns to
reduce non-communicable and communicable diseases, as well as non-natural
causes of death will continue, through the promotion of healthy life
styles, and increased focus on Tuberculosis (TB), AIDS, malaria, cholera
and other water-borne diseases.
- The
Comprehensive Plan for the Treatment and Care of HIV and AIDS will be
implemented with greater vigour.
- Government
will continue to ensure that all citizens have access to affordable
medicines.
- The programme
to refurbish hospitals and provide more professionals, especially in rural
areas will be intensified.
2. Technical issues
For the most
part, the Department’s annual report is drafted in a user-friendly format,
which makes it a very useful oversight tool. With a few exceptions, the report
outlines clearly defined measurable objectives per sub-programme, linked to an
indicator and target for the financial year. For easy comparison, and to track
progress, a column, reporting on actual performance for the financial year, is
provided. Furthermore, the measurable objectives and targets reported on in
the annual report correspond with those listed in the Department’s strategic
plan and Estimates of National Expenditure (ENE).
A review of
annual reports often exposes how Departments change the formats of indicators,
and especially targets, between ENE reports, strategic plans and annual
reports. This often results in significant challenges when reviewing progress,
since it is difficult to assess performance when indictors change from,
example, a percentage in the strategic plan, to an actual number in the annual
report. Unless the reader is familiar with the actual number of services
already provided, it almost impossible to re-calculate the figure to a
percentage, in order to measure actual progress, as indicated in the strategic
plan. This also becomes a very useful way to mask the lack of progress or
inability to meet targets outlined in a strategic plan. However, with a few
exceptions, the Department in its 2005/06 annual report steers clear from
changing formats for reporting, thereby making it much easier to assess its
performance during the year under review.
There are, however, areas where the
reporting can be strengthened to assist Parliament in its oversight function.
For example, the Department would indicate an actual date as the target, but in
the corresponding column where it reports on actual performance, it would only
report that the task has been completed (and not indicate the date it was
completed). Whenever a date is used as a target to measure performance, in
reporting progress the Department should clearly indicate whether it was
achieved on the date it set as a target for itself. The following examples
apply:
|
Sub-programme
|
Measurable objectives for 2005-2008
|
Indicator
|
Target (05/06
|
Actual performance (05/06)
|
|
Strategic Planning
|
Implement an
integrated strategic planning framework
|
Provincial Annual Reports analysed and trends
compiled
|
Report on
Provincial Annual Reports compiled in November 2005.
|
All
provincial Annual Reports for 2004/05 were analysed and feedback provided.
|
|
Monitor
implementation pf National and Provincial Strategic Plans (linked to the
10-point plan on NHS).
|
Quarterly Reports
|
Quarterly
Reports produced in July and November 2005 and in January and April 2006.
|
4 Quarterly
reports on the performance of the NDoH on its strategic plan were produced
during 2005/06.
|
|
Health
Technology Policy
|
Ensure safety
of medical devices
|
Quality
assurance Programme for medical devices developed
|
November
2005
|
Completed
|
In terms of Treasury Regulation 1.3.13,
the Department’s annual report must include a report by the audit committee,
which should comment on the effectiveness of internal control, the quality of
in-year management and monthly/ quarterly reports, and its evaluation of the
annual financial statements. However, the Department is not in compliance with
Treasury Regulations since the audit committee report is not included in the
annual report.
3. Brief
overview of performance in terms of strategic goals and objectives
3.1 Programme 1: Administration
Achievements
·
Attempting to revive
the Provincial Communicators Forum, the Department held a series of four
meetings during the financial year, as planned.
Challenges
In terms of Social Health Insurance
(SHI), there is some discrepancy between the 2005/06 – 2007/08 Strategic Plan
and what is reported in the Annual Report. In the Strategic Plan, the Department
indicated as the measurable objective that it would ‘implement SHI
policy’, whereas in the Annual Report it becomes, ‘Obtain Cabinet approval for
SHI’. Similarly, the target in the Strategic Plan indicated that ‘SHI
legislation passed and Statutory authority approved’, in the Annual Report it
becomes ‘Obtain Cabinet approval of policy on Risk Equalisation Fund (REF). The
changes suggest that the Department might have realised that it was over
ambitious in its Strategic Plan and, therefore, amended the strategic
objective. However, the Department provides no explanation in its Annual
Report. In addition, the Department does not report on its intention to
develop alternative reimbursement mechanisms. In this regard, the Department
indicated in its Strategic Plan that by March 2006 the pilot prepayment
mechanisms would be implemented. It should also be noted that in the 2006/07 –
2008/09 Strategic Plan, the Department did not report on measurable objectives,
targets or indictors for SHI for the next three years, which would compromise
Parliament’s ability to measure progress.
Strategic
Planning subprogramme did well in achieving outputs with regard to provinces.
For example, all provincial Annual Performance Plans were analysed and feedback
provided, as planned. However, the Department did not meet the deadlines set
for April and July 2005, but instead finalised the process in November.
Similarly, the subprogramme managed to analyse all provincial Annual Report and
provide feedback to provincial Heads of Department as planned, but did not
indicate whether this was achieved during the target date of November 2005.
3.2
Programme 2: Strategic Health Programmes
Achievements
During the
reporting period, Programme 2: Strategic Health Programmes was able to
achieve, and in some instances even exceed, the targets set for the financial
year. For example:
·
The Department expanded the Integrated
Management of Childhood Illnesses (IMCI) strategy to health sub-districts,
having attained 100% saturation at district level during the previous year.
·
The Department achieved its target of 20% of
community health centres that are authorised to provide termination of
pregnancy services.
·
In addition, 72% of health districts provided
Phase 1 of school health services, exceeding the 30% target set for the
financial year.
·
The 30% target set for primary health care
facilities with services providers trained on pap smear was exceeded. During
2005/06, 100% of primary health care facilities were reached.
·
The percentage of eligible people living with
HIV and other debilitating illnesses who receive nutrition supplements
increased to 65%, which exceeded the anticipated figure of 50%.
- The Department
made progress towards ensuring the availability of safe and affordable
medicines during the year under review. An important achievement was that
pharmacies managed to keep the percentage of stock outs of medicines on
the Essential Drug List (EDL) at 0% during 2005/06. In addition, there
were no stock outs of antiretroviral medicines at accredited Comprehensive
HIV and AIDS Management and Treatment Plan sites.
Challenges
Despite these
achievements, Programme 2 faced several challenges around maternal and
child health during 2005/06. It should be taken into account that some of the
key strategies to achieve the health-related Millennium Development Goals
(MDGs), such as the reduction of maternal mortality, infant mortality and
under-five mortality, are the focus of activities of one of the sub-programmes
under Programme 2. Some of the challenges experienced during 2005/06 include,
but are not limited to the following:
- While the
target for health districts with 90% full immunisation coverage was set at
70% for 2005/06, the actual performance was 23% of health districts.
- A target was
set for 70% of institutions to implement recommendations from Saving
Mothers Saving Babies reports, but instead only 48% of institutions managed
to do so.
- South Africa did not attain polio-free certification as planned and is
unlikely to achieve this status until polio is eradicated in the region as
a whole.
- Cervical
cancer screening coverage was below the 10% target set for 2005/06, i.e.
only 1,3% achieved.
- The Department
failed to meet its target of 100% of public health facilities providing
voluntary counselling and testing (VCT) services. The actual performance
indicates 88% public health facilities providing VCT in 2005/06.
- The Department
of Health also failed to publish several policy guidelines in 2005/06 as
anticipated, including Guidelines for Infant and Young Child Feeding,
Guidelines on Maternal Nutrition in the context of HIV and AIDS and
Food-Based Dietary Guidelines. This was mainly due to delays in getting
feedback from provinces.
Key Issues
- Although 100% of primary
health care facilities had health providers trained to conduct pap smeers,
cervical cancer screening was reported as 1,3%. What was the reason for
the low rate of cervical cancer screenings? What remedial action will be
taken by the Department in 2006/07 to increase the cervical
cancer-screening rate?
- The Department’s failure
to eradicate polio and measles in South Africa during 2005/06 relates to
the low immunisation coverage in some districts and sub-districts. Which
districts experienced low immunisation coverage during 2005/06, and what
were the reasons for this situation?
- The Department planned
to distribute 3,5 million female condoms by the end of 2005/06, but only
managed to distribute 2,0 million. Since the Department was also not able
to distribute the number of female condoms as planned during the two
previous financial years, can it be assumed that the Department is
experiencing a capacity problem in this regard?
- Why were health
districts unable to meet the 48 hours turn around time for TB specimens,
resulting in the Department not meeting its 80% target in this regard?
- The Department aimed at
having 100% of health districts with high quality DOTS programmes by the
end of 2005/06, but instead achieved only 94,3%. What was the reason for
not meeting this objective? Which districts were unable to achieve high
quality DOTS programmes, and how will the Department support them in
future to remedy the situation?
- The Department did not
meet its objective of establishing palliative care centres in 20% of the
health districts by the end of the financial year. What was the reason for
not meeting the target?
- During the 2005/06
financial year, the Department was supposed to host two advocacy workshops
on the monitoring and evaluation of EDP survey implementation, but none
took place. What was the reason for failure to host the workshops?
- The Department seem to
experience a number of challenges in meeting targets set with regard to
the Health Technology Policy. Why was the Department not able to endorse
the National Health Technology Management Committee? What was the reason
for not publishing the Health Technology regulations?
- The Department indicated
that it completed the development of a Quality Assurance Programme for
medical devices, but not whether it has actually met the targeted deadline
of November 2005. Please indicate whether the Department met this target
date, as indicated in the Strategic Plan.
- The Department indicated
that it completed the development and implemented the Risk Management and
Infection Control strategies, but not whether it has actually met the
targeted deadline of December 2005. Please indicate whether the Department
met this target date, as indicated in the Strategic Plan.
- The Department was
supposed to have developed a Comprehensive Policy document on food control
by December 2005, but only managed to establish a Task Team by February
2006. What was the reason for the delay in finalising the Policy document?
When does the Department anticipate it will be able to finalise the
document?
- The Department’s failure
to achieve the target of 50% public health institutions in each province
providing occupational health services is due to the lack of trained
personnel. What measures will be put in place to ensure the availability
of an adequate number of occupational practitioners?
- The Department indicated
that the findings and recommendations from the Roll Back Malaria survey
was shared with all malaria affected provinces, but not implemented, as
anticipated in the Strategic Plan. What was the reason for lack of
implementation by the end of 2005/06?
3.3 Programme 3: Health Service Delivery
Achievements
- During the
year under review, the Department made considerable progress towards
strengthening the health care support services. In this regard, the South
African National Blood Transfusion Services (SANBTS) developed a
non-discriminatory risk model and started implementing it during October
2005, after interventions from the Department. In addition, a billing
system for laboratory services, which allows for differentiation, was
completed and implemented.
- In 60% of
health districts, mental health and substance abuse services were
integrated into the primary health care services (PHC), which exceeds to
40% target set for 2005/06.
- The Department
did very well in terms of meeting the targets set with regard to Hospital
Services. For example, in all nine provinces, authority was delegated to
hospital managers. Furthermore, in keeping with the target set of 2005/06,
an additional 12% of hospitals in the country were included in the
Hospital Revitalisation Programme.
- While the
Department generally appeared to be doing less well in meeting targets set
with regard to Emergency Medical Services (EMS), it did achieve the target
of all nine provinces in which the national EMS Information System has
been integrated into the National Health Information System.
- The Department
also appears to experiencing a number of challenges in meeting targets
relating to Health Monitoring and Evaluation, but did report
meeting its 60% target for functional telemedicine sites. In addition, the
Department was able to meet its target of 27 hospitals in the
Revitalisation programme that are conducting at least one clinical audit,
as required by the Division of Revenue Act (DoRA).
- The Department
exceeded its target for 2005/06 of having 50% of health sub-districts
providing school health services. In addition, it exceeded (and in fact
doubled) the target of 10% of schools in the country implementing the
healthy lifestyles programme.
- In terms of
PHC, the Department met the target of achieving a 60% supervisory rate in
PHC facilities. Furthermore, the Department achieved a R220 per capita
expenditure for PHC, compared to the R200 target set for the 2005/06
financial year.
Challenges
- As stated
previously, the Department did not perform very well in meeting targets
set for EMS. In particular, the Department, despite it having set a target
of nine provinces for 2005/06, did not approve a single provincial
business case for the national EMS strategic framework. In addition, none
the provincial business plans for ambulance service improvement have been
approved or implemented.
- The Department
planned on having all nine provinces adopting and implementing a
nationally agreed disaster management policy by the end 2005/06, but this
did not take place since the policy is only partially completed
- It is evident
that Department did not do well in meeting targets relating to Health
Economics, and few of the deadlines set for 2005/06 were actually
achieved. For example, in order to conduct provincial health expenditure
reviews, the Department planned to have analysed financial expenditure data
by November 2005, but by the end of the 2005/06 financial year, this
process was not finalised. Similarly, by May 2005, the Department was
supposed to have finalised the process of linking health inflation with
Geographic Information System (GIS) mapping of health facilities, but
failed to meet the target even by the end March 2006. This is also the
case for conducting hospital costing studies and producing reports by May
2005, and conducting a National Health Accounts by December 2005.
- The Department
was supposed to implement an Electronic Integrated Diseases Surveillance
System and achieve its interface with other surveillance systems by March
2006, but instead developed an interim solution during the year under
review.
- By March 2006,
revised birth and death forms were supposed to be available in order to
improve the accuracy of data, but this target has not been achieved. No
explanation is provided on the Department’s failure meet this target.
- The Department
seem to experience a number of challenges in publishing regulations in
line with target dates set. By the end the 2005/06 financial year,
regulations relating to the following were not published, as anticipated
in the 2005/06 Strategic Plan: regulations in order to establish a
National Health Research Committee, regulations on notifiable medical
conditions, and regulations on the National Health Research Ethics Council
(NHREC).
- In addition to
challenges relating to publishing of regulations, Programme three also
faces several challenges in finalising policies and strategies in line
with targets set in the Strategic Plan. For example, a national strategy
for monitoring effectiveness of the referral system was not finalised by
March 2006, the Rural Health Policy was not ratified by August 2005 and
the Environmental Health Policy was not adopted by March 2006.
Key issues
- The Department indicated
that by the end of 2005/06, business plans for ambulance service
improvement would have been approved and implemented in all nine
provinces, but unfortunately this did not take place. Similarly, in
2004/05, the Department indicated that business cases for the national EMS
Strategic Framework would be approved for all nine provinces, but also
failed to meet this target. Why has the Department not been able to meet
its targets aimed at improving the effectiveness of EMS over the last two
financial years? Were the challenges experienced in 2005/06 similar to
those encountered during 2004/05?
- The Department planned
to have all nine provinces adopting and implementing a national disaster
management plan, but this did not happen as result of the policy only
being partially completed. What is the reason for the delay in finalising
the policy?
- In addition, it is
evident that Programme three was unable to finalise a number of other
policies in line with its Strategic Plan, such as the Rural Health Policy
and the Environmental Health Policy. Is the Department over-committing
themselves or experiencing a capacity problem in this regard?
- Despite committing
itself to focussing on the preparation and implementation of legislation
in its five-year strategic plan, the Department appears to be struggling
with the actual publication of regulations, which is essential for
ensuring legislation is implemented. What were the reasons for failure to
the publish regulations in order to establish a National Health Research
Committee, regulations relating to notifiable medical conditions, and
regulations on the National Health Research Ethics Council (NHREC)?
- By the end of the
financial year, each province was supposed to have at least one
psychiatric hospital in the hospital revitalisation programme, but in
reality this is only the case for four of the nine provinces. The issue
becomes particularly important given recent media coverage of the poor
state of psychiatric hospitals in South Africa. What was the reason for
the five other provinces not including a psychiatric hospital in the
revitalisation programme?
- Only five of the nine
provinces were able to establish at least one child and adolescent
psychiatric service during the year under review. Give an indication of
the provinces were unable to comply, and the reason for each.
- Why did the Department
decide to developed an interim solution, instead of implementing an
Electronic Integrated Diseases Surveillance System able to interface with
other surveillance systems by March 2006, as outlined in the Strategic
Plan? Did the Department anticipate significant problems in this regard,
and what is the anticipated date of completion?
- The Department planned
to support provinces to implement the Health Care Waste Strategy (HCW) in
all provincial health facilities, but reported that for the year under
review health facilities manage HCW using their own provincial strategies.
In this regard, was the intention for the provinces to use a national HCW
strategy? If yes, why are provinces not changing from their provincial
strategies? Has the national strategy been finalised? When does the
Department anticipate the shift from provincial HCW strategies to the
national one will take place?
- During the year under
review, 40% of the Department’s health clusters were supposed to implement
Environmental Management Plans (EMPs) in their programmes, as required by
the National Environmental Management Act (No. 8 of 2004)(NEMA). By the
end 2005/06, only 20% of the health clusters developed legislation and
programmes. What was the reason for the non-compliance with NEMA?
- In terms of
strengthening the PHC programme, it was planned that 60% of health
facilities should have a minimum of one documented clinic committee
meeting per month, but the actual performance was 30%. What was the reason
for the poor performance?
2.4 Programme 4: Human Resources
- A significant
achievement during the year under review was the production of the
National Human Resource Plan.
- The Department
exceeded it target of establishing at least one national training
programme for senior management, and by the end of the financial year, a
Hospital Management Training Programme has commenced in two universities.
- The Department
planned on training 6 233 health workers to implement the Comprehensive
Plan for HIV and AIDS, by managed to train a total of 11 958 health
workers by the end of the financial year.
- In terms of
International Health Liaison, a number of achievements include, amongst
others: A programme of action was finalised with the Democratic Republic
of the Congo (DRC) and Nigeria, focussing on traditional medicines. In
addition, 24 contracts were finalised for recruitment of Iranian doctors,
while Japan funded projects for the improvement of health facilities and
provision of equipment in the Eastern Cape and Limpopo. Belgium is
currently providing funding for the expansion of the Tuberculosis (TB),
HIV and Sexually Transmitted Infections (STI) Prevention, Care and Support
Programmes.
Key issues
A major challenge in evaluating the performance
of Programme 4: Human Resources is the fact that there are a number of
performance indicators listed in the Strategic Plan, but not reported in the
current Annual Report. These include, amongst others:
- A community service for
nurses to be implemented by June 2005.
- By the end of the
financial year, 75% of training institutions having to implement the need
and employment equity quotas set nationally.
- Regulations for
Traditional Practitioners to be developed by March 2006.
- Traditional Health
Practitioners Council to be established by June 2005.
Furthermore, in terms of International Health
Relations, targets are often not given in terms of time or quantity, which
makes comparison with actual performance difficult.
4. Human Resource Management issues
·
By
the end of the 2006/07 financial year, the Department employed a total of 1 204
persons. Compensation of employees represents an average of 2% of total
expenditure.
- In term of
employment equity, the Department appears to be doing relatively well with
black women dominating the following occupational bands: top management
(50%), senior management (47,6%), and professionally qualified and
experienced specialist and middle-management (41,8%).
- During
2005/06, the Department made 123 new appointments, but also received 100
terminations. This resulted in an overall staff turnover rate of 8,5%,
with the highest turnover experienced among the permanent critical
occupations: appraisers-valuers and related professionals (50%), other
occupations (72,7%), medical specialists (42,9%), medical
technicians/technologists (33,3%), and logistical support personnel
(33,3%).
- The average
vacancy rate is 22%, with the highest number of vacancies experienced
among the following permanently occupations: administrative-related
occupations (75 vacant posts), health sciences-related (31 vacancies),
other administrative and related clerks and organisers (28 vacant posts),
other administrative policy and related officers (21 vacant posts), and
secretaries and other keyboard operating clerks (20 vacant posts), and
senior managers (23 vacant posts).
- During the
year under review, 12% of the Department’s posts were evaluated, and
subsequently a total of 39 posts were upgraded and 1 post downgraded.
5. Financial issues
5.1 Financial overview for 2005/06
- The
Department’s initial appropriation for 2005/06 was R9,825 billion, but was
adjusted upward to R9,952 billion, of which the Department managed to
spent 99% by the end of the financial year. While an under spending of 1%
may not appear to be significant, taking into account the Department’s
considerable budget allocation, this resulted in R102, 8 million not being
spent by the end of the financial year.
- During the
year under review, Department conducted a number of virements, with
additional funds notably being taken from current payments (which includes
compensation of employees and goods and services), and allocated to
transfers and subsidies. The programmes benefiting from such virements
are: Programme 2: Strategic Health Programmes and Programme 3:
Health Service Delivery. In the case of Programme 2, R23,075 million was
added and Programme 3, R31,896 million. This raises questions about
overspending on some conditional grants to provinces.
- While
expenditure on current payments, as well as transfers and subsidies
appears to be reasonably well, expenditure for capital assets across all
four programmes appears to be more challenging. In this regard, Programme
1 and Programme 2 managed to spend 85,6% and 89,9% respectively, while
Programme 3 spent 60,1% of its capital budget, and Programme 4: Human
Resources spent 87,2%.
5.2 Qualified Financial Audit by the Auditor-General (AG)
The AG has given a qualified audit
opinion of the Department of Health, and raised a number of concerns with
regard to financial management. As was the case during the two previous
financial years, the AG raised concerns with regard to the transfer of funds to
provinces for conditional grants:
(a) The Framework for the Division
of Revenue Act (No. 1 of 2005) (DoRA) indicates that the business plans for a
specific grant be approved prior to any transfers being made. However:
- Payments of
R1,3 billion were made to provinces before the approval of business plans.
- Amounts
transferred as per the DoRA schedules were R110 million more than the
amounts approved in the individual business plans.
(b) The Framework for DoRA required quarterly
performance reports, monthly financial reports and quarterly provincial liaison
and quarterly visits to the provinces, as part of the monitoring mechanisms to
be implemented by the Department. Despite the Department’s efforts to monitor
these conditional grants, the following shortcomings were noted:
·
Late or non-submission of monthly financial
reports by provinces resulting in the Department not being able to properly
monitor expenditure in the provinces.
·
Late or non-submission of quarterly performance
reports by provinces, resulting in the Department not being able to properly
monitor performance in the provinces.
·
Quarterly visits to provinces were not always
conducted.
It should be
noted that the National Treasury earmarked funds to the amount of R8 million to
appoint managers to monitor conditional grants, but appointments were made
after the end of the year.
c) An audit of the HIV and AIDS and Hospital Revitalisation Grant
reviewed the following:
In terms of the DoRA Framework, provinces need to
submit quarterly performance reports to the Department, but the majority of
reports were not submitted during the year under review. This failure on the
part of provinces compromised the effectiveness of review by the Department.
5.3 Emphasis of matter
5.3.1 Audit Committee
As was the case with the previous financial year, the AG
raised a concern about how the audit committee operates, noting the that the
minimum number of meetings were not held, as defined by section 77 of the
Public Finance Management Act (No. 1 of 1999) (PMFA). Furthermore, for one
meeting held, no quorum was present. The AG raised similar concerns in 2004/05.
5.3.2 Internal audit
During the year under review, the
internal audit function was ineffective, and did not carry out functions as planned:
- The majority of audits planned
were not performed, but instead postponed till the next financial year.
- The internal audit function is
also responsible for the operation of a fraud hotline. During 2005/06,
only 8% (i.e. 15 cases) of the 192 cases reported were investigated.
- In terms of section 30(1)(a) of
DoRA, the transferring national officer is supposed to determine a minimum
set of risks that must be taken into account and mitigated by the
receiving province. However, the internal audit unit of the Department did
not determine and communicate the minimum risks to the provinces.
5.3.3 Non-compliance with the
National Environmental Management Act (NEMA)
NEMA requires certain
departments, including the Department of Health, to provide environmental
implementation or management plans, and to report their compliance against the
plans to the Committee for Environmental Coordination.
Due to a lack of
management framework for monitoring the NEMA requirements, the Department did
not comply with this requirement for 2005/06. (See key issue raised under
Programme 3 above).
5.3.4 Supply
Chain Management
Although a
supply chain management unit has been established by the Department, as
required by Treasury Regulation 16A, the unit is still not fully operational.
During the year under review, delays were experienced in achieving the
milestones in line with the Department’s implementation plans. Policies and
procedures have been drawn up, but have not been approved by the accounting
officer.
5.3.5 Lack of performance
information
The Department
was unable to provide performance information, as required by the National
Treasury.
Key
issues
·
In terms of Treasury Regulation 1.3.13, the
Department’s annual report must include a report by the audit committee, which
should comment on the effectiveness of internal control, the quality of in-year
management and monthly /quarterly reports, and its evaluation of the annual
financial statements. However, the audit committee report is not included in
the Department’s 2005/06 annual report. What is the reason for non-compliance
with Treasury Regulations?
·
As was the case during the two previous
financial years, the AG expressed concern about that the Audit Committee not
functioning effectively, despite the appointment of suitably qualified staff.
Has the Department implemented any mechanisms to address the issue since it was
first raised in 2003/04? If yes, why is the Committee still unable to hold the
minimum number of meetings or hold meetings where no quorum is present?
·
In his briefing to Committee Chairpersons on 16
October 2006, the AG indicated that Director-Generals are supposed to be a
member of their departmental audit committee. Is this the case for the
Department? Who are the rest of the members of the audit committee, and please
indicate how many members are part of the senior management (chief director
upwards).
·
During the year under review, a virement was
done, adding R11 million to compensation of employees under Programme 2. What
was the reason for the virement? Why were there not sufficient funds available
for the compensation of employees under Programme 2?
·
A virement was done to add R30 million for
transfers and subsidies under the sub-programme Health Information, Research
and Evaluation. What was the reason for the virement?
·
During the year under review, a virement was
done, removing R14,5 million from compensation to employees. Where was this
money shifted? Was Treasury approval obtained prior to the shifting of funds
taking place?
·
Despite establishing a supply chain management
unit, it was still not functional by the end of the financial year. In
particular, policies and procedures were drawn up, but not approved by the
accounting officer. Why has approval been delayed? When does the Department
anticipate the unit will be fully functional?
·
The AG indicated that the Department did not
furnish the relevant performance information, as prescribed by the National
Treasury. Please provide an overview of the type of information required, as
well as the reason for failing to comply.
·
Why was only 8% of the total number of cases
reported to the fraud hotline during 2005/06 investigated?
·
During the year under review, which provinces
failed to submit quarterly reports on their hospital revitalisation grants to
the Department? What was the reason for provinces not complying with the
Division of Revenue Act (DoRA) Framework? What mechanisms has the Department
put in place to ensure greater compliance from provinces during 2006/07?
·
What was the reason for transferring R1,3
billion to provinces, prior to the approval of business plans, in
contradiction with the DoRA Framework?
·
Why were R110 million more transferred to
provinces, than what amounts to in individual business plans? Was this money
budgeted for?
·
As part of the monitoring mechanism to be
implemented by the Department for conditional grants, quarterly visits to
provinces are supposed to take place, as prescribed by the DoRA Framework. What
was the reason for the Department failing to comply with DoRA? How will this
issue be addressed in future?
6. Conclusion
In terms of the technical aspects of
reporting, the Department’s 2005/06 Annual Report can generally regarded as a
significant improvement on the previous financial year. To a large extent, the
Annual Report corresponds with the reporting format used in the 2005/06 –
2007/08 Strategic Plan, which makes for easy comparison and monitoring of
progress. However, there are still instances where the Department does not
indicate whether the target for a specific measurable objective has been
achieved on the planned date, as indicated in the Strategic Plan. Another
concern is the absence of a report by the Audit Committee, which contravenes
the PMFA and National Treasury Regulations.
The management of communicable and
non-communicable diseases was identified as a key priority in the Department’s
five–year strategic framework, as well as the 2005 State of the Nation Address
(SONA). It is evident that the Department performed well in some instances in
meeting its targets, and in others even exceeded it own targets. However, the
eradication of polio and measles, as well as meeting some of the targets
relating to TB remains a challenge. Progress with regard to some of the targets
relating to HIV and AIDS remains mixed. In some instances the Department is
meeting, and even exceeding its own targets, while others are failing to meet
targets.
Human resources was identified a
priority for the next five years, while the State of the Nation Address also
indicated the need to increase the numbers of Community Health Workers (CHWs).
The launching of the National Human Resource Plan during the year under review
can, therefore, be considered a milestone for the Department. In addition, the
Department adopted a Skills Development Policy. The Department also managed to
exceed the numbers of CHW it planned on training to implement the Comprehensive
HIV and AIDS Plan, and the Department appears to be on track with regard to its
other targets relating to CHWs. A concern, however, is the fact that the Health
and Welfare Sector Education and Training Authority (HWSETA) did not expand its
learnership programme due to limited funding. In terms of the Department’s
Strategic Plan, SETA learnerships were supposed to be developed for, amongst
other, nursing, pharmacy, occupational therapy, physiotherapy, and radiography.
EMS appears to be a serious challenge
for the Department, and as was the case in 2004/05, the Department is
struggling to meet some of the targets. The situation clearly needs to be
monitored by Parliament, since strengthening EMS, together with PHC and the
hospital service delivery system, remains a key five-year strategic priority.
The hospital revitalisation programme, as identified in the SONA, continued during
the year under review, and the Department managed to meet most of its targets,
although it does not relate to actual spending on conditional grants.
The 2005/06 Annual Report marks the 3rd
consecutive year that the Department of Health received a qualified report by
the AG. This relates mainly to non-compliance with the DoRA framework for
conditional grants. While the internal audit function is not an item for
qualification, the AG for the 3rd year in a row pointed to problems
in how the committee functions, which has important implications for the
internal control function.
Sources
Department of
Health. 2006. Annual Report 2005/06. Pretoria: Department of Health.
Department of
Health. 2005. Strategic Plan 2005/06 – 2007/08. Pretoria: Department of
Health.
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Report, Dept Health 2006 final.doc