REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON BUDGET VOTE 15 AND THE STRATEGIC PLAN FOR 2011/12-2013/14, DATED 25 MAY 2011

 

1. INTRODUCTION

 

1.1 The briefing on Budget Vote 16 took place on the 16 March 2011.

 

1.2   The Director General, Ms MP Matsoso led the delegation. The delegation included the Acting Chief Financial Officer – Ms Tiny Rennie, Director – Strategic Planning; Ms M Wolmarans and the Parliamentary Liaison Officer in the Office of the Minister – Mr Joe Kgatla.

 

 

2.       OVERVIEW OF THE DEPARTMENT OF HEALTH (DOH) KEY PRIORITY STRATEGIC FOCUS AREAS

 

2.1 Health is one of the five key priorities of government for 2011-2014.  The Strategic Plan of the department is drawn mainly from the State of the Nation Address (SONA), the Budget Speech by the Minister of Finance and the lessons drawn from the Department’s programme performance over the last couple of years.

 

2.2   The Department of Health’s mission is to improve the health status of the people of South Africa through:

 

  • Prevention of illness and the promotion of healthy lifestyles, and   
  • Consistent improvement of the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

 

3. HEALTH SECTOR RESPONSE

 

  • 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.  The following are the 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

 

In Strengthening the Health System Effectiveness, the Department will focus on the following inputs:

 

  1. Primary Health Care Orientated Service Delivery
  2. Improved quality of services
  3. Improved Human Resources for Health
  4. Improved access to Health facilities
  5. Improved financial management
  6. National Health insurance
  7. Health information
  8. Inter-sectoral action for social determinants of Health

 

4. SCALE UP THE COMBINATION OF PREVENTION INTERVENTIONS TO REDUCE NEW HIV INFECTIONS

 

4.1 THE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

 

  • Increasing condom distribution, with 1 billion male condoms distributed annually during 2011/12-2013/14, and 6 million female condoms distributed annually during 2013/14.
  • Increasing the number of Medical Male Circumcisions to 500 000 during 2011/12 and 600 000 annuallly during 2012/13 and 2013/14.
  • Increasing the HIV Counselling and Testing (HCT) uptake rate from 80% to 90% in 2013/14.  The Campaign will also look at encouraging those negative to stay negative and those who tested positive to be on treatment.

 

5. IMPROVE THE QUALITY OF LIFE FOR PEOPLE LIVING WITH HIV AND AIDS BY PROVIDING AN APPROPRIATE PACKAGE OF CARE, TREATMENT AND SUPPORT

 

5.1 THE KEY STRATEGIC INTERVENTIONS DURING 2011/12-2012/14 WILL INCLUDE:

 

  • Increasing the number of new patients initiated on Antiretroviral Therapy (ART) between 625 000 to 675 000 annually during 2011/12-2013/14.
  • Increasing the proportion of Primary Health Care facilities implementing nutritional interventions for People living with HIV and AIDS and TB from 77% in 2010/11 to 88% in 2013/14.

 

6. REDUCE INFANT, CHILD AND YOUTH MORBIDITY AND MORTALITY

 

6.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

  • Maintaining the number of children under 1 year of age fully immunized at 95% throughout the MTEF period.
  • Maintaining the measles immunization coverage rate of 95% throughout the MTEF period.
  • Increasing the number of sub-districts implementing school health services from 100-150 in 2011/12, 200 in 2012/13 and 232 in 2013/14.  Early childhood development is significant for school health services.
  • Implementing programmes in secondary schools to address youth risk behavior 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.

 

7. TO REDUCE MATERNAL MORTALITY

 

7.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

  • Maintaining 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.  Those who are not attending will be advised to attend.
  • 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 six days of delivery from 40% in 2010/11 to 80% in 2013/14.

 

  1. IMPROVED ACCESS TO REPRODUCTIVE HEALTH

 

9.1    KEY STRATEGIC INTEREVENTIONS 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.

 

  1. EXPAND THE PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT)

COVERAGE TO PREGNANT WOMEN

 

10.1 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 Highly Active Antiretroviral Therapy (HAART) rate from 87% in 2011/12 to 100% in 2013/14.

·         Decreasing the percentage of babies testing polymerase chain reaction (PCR) positive 6 weeks after birth from 10% in 2011/12 to 6.5% in 2013/14.

·         Increasing the uptake rate of HIV positive antenatal clients on AZT for any period before labour from 86% in 2011/12 to 100% in 2013/14.

 

  1. TO REDUCE THE BURDEN OF DISEASE OF TUBERCULOSIS

 

11.1 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. 

 

 

  1. COMBATING TB AND HIV BY REDUCING THE CO-INFECTION BURDEN

 

12.1 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. Where there are high TB cases, interventions will be increased.

·         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.

 

 

  1. REDUCE THE BURDEN OF DISEASE FROM COMMUNICABLE AND NON-COMMUNICABLE DISEASE

 

13.1 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 2012/14.

·         Chronic care whether from communicable or non-communicable causes will be aligned and a single chronic care model will be rolled out of 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 finalized during 2011/12.

·         To strengthen the quality of Environmental Health Services, norms and Standards will be developed during 2011/12.  The department will also look at increasing the number of inspections at ground level.

 

  1. RE-ENGINEERING OF PRIMARY HEALTH CARE

 

14.1 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.

·         Completing the comprehensive audit of Primary Level Services inclusive of District Hospitals by March 2011/12.

·         Improving community participation to strengthen the governance of the District Health System.

·         Improving access to primary health care services, with an increased utilization rate of three visits by 2013/14.

·         Improving 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.

 

  1. ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE

 

15.1KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 INCLUDE:

 

·         Improving health planning. The Department will look at how long it takes for people to get to facilities and see if services are relevant.

·         Developing and implementing a national infrastructure plan in conjunction with provincial infrastructure units.

·         Developing a set of Health infrastructure norms and standards for levels of care.

·         Establishing an infrastructure project management information system.

·         Finalisation of the essential equipment lists for primary health care in 2011/12 and for secondary and tertiary health care in 2012/13.

·         Ensuring tertiary hospitals are functional.

·         Ensuring all facilities have the relevant equipment.

·         Setting up equipment committees.

 

 

 

  1. ACCELERATE THE DELIVERY OF HEALTH INFRASTRUCTURE

 

16.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

·         All five tertiary hospitals completing the feasibility study by March 2012

These are:

 

ü       Nelson Mandela Academic (Eastern Cape);

ü       Chris Hani Baragwanath (Gauteng);

ü       Dr George Mukhari (Gauteng);

ü       Limpopo Academic (Limpopo);

ü       King Edward V111 (KwaZulu-Natal)

 

·         Providing funding to hospitals through the hospital revitalization grant:

 

ü       41 Hospitals will be under construction

ü       25 Hospitals will be in the planning phase

 

  1. IMPROVED HEALTH WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT

 

 

 

 

 

17.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

·         Finalising the revised Health Workforce Plan responsive to service delivery platforms by 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.

·         Integration of the Community Health Workers into the formal health sector.

 

  1. IMPROVED HEALTH CARE FINANCING

 

18.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

·         Work in preparation for the implementation of the National Health Insurance (NHI) will continue.  Specific outputs for 2011/12 include:

 

ü       Finalisation of the NHI policy and legislative framework

ü       NHI pilot sites established

ü       Funding model developed

 

  1. IMPROVE QUALITY OF HEALTH SERVICES

 

19.1 KEY STRATEGIC INTERVENTIONS DURING 2011/12-2013/14 WILL INCLUDE:

 

·         In 2011/2012 new policies related to the legislative amendment governing the establishment and functioning of the Office of Health Standard Compliance and relevant regulation will be finalized.

·         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 survey will be conducted in an independent manner 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 six priorities of the core standards. This figure grows to 40% in 2012/13 and to 70% by 2013/14.

 

 

  1. BUDGET SUMMARY

 

·         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 for the provincial health departments for earmarked funds additional to the equitable share baseline.

 

 

20.1 EXPENDITURE TRENDS

 

  • The Department’s expenditure grew from R13.6 billion in 2007/2008 to R23.1 billion in 2010/2011 at an average annual rate of 19.4%.
  • Over the Medium Term period, expenditure is expected to grow to R30.1 billion, at an average annual rate of 9.2%.
  • The increase in 2007 and 2008 periods is driven largely by transfers to provinces for the conditional grants, with the main increase being on the HIV and AIDS and the Revitalisation 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 2012/2013 financial year and has therefore been included in the provincial equitable share allocations.
  • The budget includes new allocations of R442 million for 2011/2012, R692 million for 2012/2013 and R2.2 billion for 2013/14.

 

20.2 Administration

 

The administration programme has been allocated R282 million for 2010/2012 and R326 million for 2011/2012.

 

 Health Planning and Systems Enablement

 

The Health Planning and Systems Enablement programme has been allocated R125 million for 2010/2011 and R161 million for 2011/2012.

 

HIV & AIDS, TB and Maternal, Child and Women’s Health

 

The HIV & AIDS, TB and Maternal, Child and Women’s Health programme has been allocated R6, 669 million for 2010/2012 and R8,027 for 2011/2012.

 

Primary Health Care Services

 

The Primary Health care services have been allocated R700 million for 2010/2012 and R730 million for 2011/2012.

 

Hospital Tertiary Services and Workforce Development

 

The allocated budget for the Hospital Tertiary Services and Workforce Development for 2010/2012 is R13, 947 million and R15, 963 million for 2011/2012.

 

Regulations and Compliance Management

 

The allocated budget for Regulations and Compliance Management is R496 million for 2010/2012 and R525 million for 2011/2012.  

 

The total allocated budget for the National Department of Health for 2011/2012 is R25, 732 billion.

 

 

 

20.3 CONDITIONAL GRANTS ALLOCATIONS FOR 2011/2012-2013/2014

 

  • Schedule 4 grants: are specifically 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 and Forensic Pathology Services.
  • Schedule 5 grants are specifying specific- purpose allocations to provinces.  Grants included are HIV and AIDS grant and the Revitalisation of Hospital Grant.
  • Schedule 5 grants may be withheld for non performance and or non compliance.  Interventions must also be put in place for compliance.

 

21.         COMMITTEE’S CONCERNS

 

The committee expressed the following concerns:

 

  • The backlog in forensic chemistry, and were of the opinion that it was not receiving the attention it deserves.
  • Religious leaders and traditional healers who claim that they can cure AIDS are misleading people. This claim is also undermining the work done by the Department of Health.
  • The discrepancy in the distribution of male and female condoms. More male condoms are distributed and this is considered as disempowering to women.
  • The current TB statistics do not reflect the incidences of people working on the mines.
  • With regards to revitalisation of health facilities, the Committee felt government builds a hospital but lacks sufficient staff and essential equipment to provide quality medical care.
  • Lack or poor security in health facilities was raised as a serious concern.
  • The Department of Health’s budget prioritises tertiary care as opposed to primary health care (PHC) which is the current government priority.

 

22. RECOMMENDATIONS

 

The Committee recommends the following:

 

  • The department should address the backlog in forensic chemistry as a matter of urgency.
  • The department should increase its outreach programme on empowering and educating communities on HIV/AIDS
  • The department should increase the distribution and availability of female condoms drastically.
  • The department should work closely with doctors in the mines to reduce TB in the mining industry.
  • The health facilities revitalisation programme should always go hand in hand with all resources.
  • The department should strengthen security in health facilities.
  • The Committee proposed that PHC should be a priority and the department’s budget should reflect this.
  • Tertiary hospitals should account to the National Department of Health.

 

23. CONCLUSION

 

Having considered the budget and the strategic plan and responses to questions by the department, the Committee accepts the budget and will continue to do its oversight role on the spending trends of the department. The Committee appreciates the Department’s responses and commends the Director General.

 

Report to be considered