1 national department of health: strategic plan 2008/09-2010/11 presentation to the select committee...

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NATIONAL DEPARTMENT OF HEALTH:

STRATEGIC PLAN 2008/09-2010/11

PRESENTATION TO THE SELECT COMMITTEE ON

SOCIAL SERVICES

3 JUNE 2008

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STRUCTURE OF PRESENTATION

1. VISION AND MISSION;

2. LEGISLATIVE MANDATES;

3. KEY PRIORITIES OF THE NATIONAL HEALTH SYSTEM (NHS) 2004-2009

4. NHS PRIORITIES 2007/08;

5. SUMMARY OF ACHIEVEMENTS DURING 2007/08;

6. CHALLENGES

7. REVISED ORGANISATIONAL STRUCTURE OF THE NATIONAL DOH;

8. NATIONAL HEALTH SYSTEMS (NHS) PRIORITIES FOR 2008/09

9. KEY INTERVENTIONS BY BUDGET PROGRAMME

10. NDOH BUDGET FOR 2008/09-2010/11;

11. CONCLUSION

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1. VISION AND MISSION

VISION

An accessible, caring and high quality health system.

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.

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2. LEGISLATIVE MANDATES

49 pieces of legislation reflected in the Strategic Plan 2008/09-2010/11, including:

Constitution of the Republic of South Africa

National Health Act of 2003;

Public Finance Management Act of 1999;

Nursing Act of 2005;

Medical Schemes Act of 1998;

Tobacco Products Control Amendment Act

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3. KEY NHS PRIORITIES FOR 2004-2009

Improve governance and management of the NHS;

Promote healthy lifestyles;

Contribute towards human dignity by improving quality of care;

Improve management of communicable diseases and non-communicable illnesses;

Strengthen primary health care, EMS and hospital service delivery systems

Strengthen support services

Human resource planning, development and management

Planning, budgeting and monitoring and evaluation

Prepare & implement legislation

Strengthen international relations

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4. NHS PRIORITIES FOR 2007/08

Development of Provincial Service Transformation Plans (STPs);

Strengthening Human Resources;

Improving Quality of Care;

Strengthening the provision of infrastructure;

Strengthening Priority Health Programmes

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5. SUMMARY OF ACHIEVEMENTS IN 2007/08 (BY BUDGET PROGRAMME)

5.1. ADMINISTRATION (PROGRAMME 1)

6 pieces of health legislation signed into law by the President during 2007/08;

Review of progress towards health-related Millennium Development Goals (MDGs) published in July 2007, which indicated progress in key areas;

Provincial Service Transformation Plans (STPs) developed by Provinces;

Annual National Health Plan 2007/08 was printed and disseminated;

Multimedia campaigns focusing on a diversity of health topics were conducted, on SABC African Language Radio Stations; Community Radio Stations and Commercial Radio Stations;

Health awareness articles were also published in professional and stakeholder publications.

Ministerial Izimbizo held in different districts across the country.

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5. SUMMARY OF ACHIEVEMENTS IN 2007/08

5.2. STRATEGIC HEALTH PROGRAMMES (PROGRAMME 2)

85% of health facilities implemented 10 recommendations of the Confidential Enquiries into Maternal Deaths (CEMD);

Routine immunization coverage of 84% was achieved in 2007, increasing from 82% in 2006/07, and 78% in 2002;

Mid-term review of June 2007 reflects that severe malnutrition amongst children under-5 decreased from 88 971 cases in 2001 to 30 082 in 2005;

Vitamin A supplementation provided to post-partum women and children who use public health sector facilities (61% of post-partum women; 100% of children aged 6-11 months and 26% of children aged 12-59 months);

South Africa’s Annual Update Report on Polio-free Certification submitted to the Africa Regional Certification Committee;

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5.2. STRATEGIC HEALTH PROGRAMMES (PROG. 2) (CONT.)

Healthy lifestyles programme implemented. 15 Food Garden Project and 20 Physical Activity projects were established in EC, KZN and WC. Health messages on a range of topics disseminated through SABC Radio; 10 Regional Radio Stations and 46 Community Radio Stations

1800 Schools identified and implementing the Health Promoting Schools Initiative;

2006 HIV Antenatal Survey reflected a significant decrease in HIV prevalence, from 30.2% in 2005, to 29.1 in 2006;

VCT and PMTCT provided in over 90% of public health facilities;

Comprehensive Care, Management & Treatment Plan (CCMT) Plan service points established in all 284 local municipalities;

Cumulatively, over 437 844 patients placed on Antiretroviral Treatment by January 2008. Nutrition supplements provided to 480 000 eligible people;

National Strategic Plan (NSP) for HIV and AIDS developed and launched;

National Strategic Plan for TB developed and disseminated

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5.3. HEALTH SERVICE DELIVERY (PROGRAMME 3)

Access to PHC services, as measured by PHC Headcounts, continued to increase, with more than 72 million visits recorded in the first 3 quarters of 2007/08;

PHC utilization rate of 2.5 visits per person attained, ranging from 2.0 visits per person in Eastern Cape, to 3.0 visits per person in Western Cape. This marks an increase from the utilization rate of 2.11 visits reported in 2006/07;

PHC supervision rate of 68% achieved, an improvement from the 48% achieved in 2006/07;

National Conference to celebrate 30 Years of Primary Health Care (PHC), since the signing of the Alma Ata Declaration in 1978, hosted in April 2008;

20% reduction achieved in medicine prices through medicine pricing regulations, despite the fact that these were faced with legal challenges;

33 Hospitals were under construction and 11 in the planning phase, as part of the Hospital Revitalisation Project;

National Infection Control Policy published and disseminated.

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5.4. HUMAN RESOURCES (PROGRAMME 4)

Occupation Specific Dispensation (OSD) for all categories of nurses was agreed to with National DoH, DPSA, Treasury and signed into a collective agreement in 2007;

OSD is applicable to 100 000 nurses in the public sector;

Community service for nurses implemented as from January 2008;

Treaty permits were extended for 115 Cuban doctors & 32 Iranian doctors;

22 Tunisian doctors started working in South African Hospitals

A further 312 Tunisian doctors were assessed by the HPCSA, and 258 were selected to be deployed.

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6. CHALLENGES

Public sector strike in the first quarter of 2007/08;

Progress towards Millennium Development Goals (MDGs) slower than anticipated;

Increased contribution of Non-Communicable Diseases (NCDs) to the country’s Burden of Diseases;

Inadequate intersectoral action to address social determinants of health.

Inadequate availability of health workers;

Impact of the 2-year Medical Internship programme;

Safety in Hospitals.

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7. REVISED ORGANISATIONAL STRUCTURE OF THE NATIONAL DOH

To enhance its capacity to accelerate implementation, the National DoH has revised its organisational structure from 4 to 6 Budget Programmes, namely:

(i) Administration (incorporating Corporate Services);

(ii) Strategic Health Programmes;

(iii) Health Planning and Monitoring;

(iv) Human Resources Development and Management;

(v) Special Programmes and Health Entities Management;

(vi) International Relations; Health Trade and Health Product Regulation.

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8. NATIONAL HEALTH SYSTEMS PRIORITIES FOR 2008/09

(i) Strengthening Management and Communication

(ii) Implement programmes to combat both Communicable and Non-Communicable Diseases;

(iii) Public Health Facility improvement through development and implementation of a Health Facilities Improvement Plan;

(iv) Implementation of an integrated National Health Information System;

(v) Health Financing, including the design of the National Health Insurance System and reducing the rate of tariff increases in the private health care sector;

(vi) Further reduction in the prices of Pharmaceutical Products;

(vii) Strengthen provision of Human Resources for Health; and

(viii) Strengthen International Health Relations;

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9.1. PROGRAMME 1: ADMINISTRATION

During 2008/09, the National DoH will:

Strengthen planning within the National Health System at all levels, and improve monitoring and reporting;

Implement a Turn-Around-Strategy for improving Audit Outcomes and responses to queries from the Auditor-General (A-G);

Obtain Unqualified Audit Opinions from the A-G during this planning cycle;

Improve efficiency and effectiveness of the procurement of Goods and Services;

Strengthen implementation of the Performance Management and Development System (PMDS);

Develop and implement a policy for fast-tracking filling of vacant posts in the National DoH;

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9.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

The National DoH will:

Ensure that 40/52 districts (77%) have full immunization coverage of 80% and above, for children under the age of 1 year;

Update the Polio Preparedness Plans and conduct campaigns;

Train 3600 health professionals in TB management and control;

Reduce the TB defaulter rate from 10% to 7%;

Achieve a 10% reduction in malaria deaths annually during the planning cycle.

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9.2. PROGRAMME 2: STRATEGIC HEALTH PROGRAMMES

Accelerate the implementation of the NSP for HIV&AIDS 2007-2011;

Implement the TB Strategic Plan 2007-2011;

Expand provision of Vitamin A supplementation to eligible women and children using the Public Health Sector, from the 2007/08 baselines;

Provide 500 000 eligible people living with debilitating conditions with nutritional supplements;

Finalise Policy and produce draft Legislation on African Traditional Medicine;

Increase cataract surgery rate from 1146/million population in 2006/07, to 1600/million population in 2008/09.

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9.3. PROGRAMME 3: HEALTH PLANNING AND MONITORING


Implement the Health Facility Improvement Plan in 32 health facilities (28 hospitals and 4 Community Health Centres);

Appoint and train1110 data capturers to improve the quality of health information in the Public Health Sector;

Conduct the 2008 South African Demographic and Health Survey;

Conduct the 2007 National HIV and Syphilis Survey;

Finalise National Health Insurance (NHI) proposals and draft legislation;

Produce the final report on the National Burden of Diseases (BoD) Study, which will help generate a comprehensive picture of diseases patterns in South Africa;

Achieve further reduction in medicine prices through benchmarking with other countries;

Accelerate the process of restructuring the Medicines Control Council (MCC).

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9.4. PROGRAMME 4: HUMAN RESOURCES MANAGEMENT AND DEVELOPMENT


Extend the OSD to medical doctors, dentists, Emergency Medical Servces (EMS) personnel and pharmacists;

Implement the National Human Resources Information System (NHRIS);

Implement the Clinical Associates Programme together with the Universities of Pretoria; Witwatersrand and Walter Sisulu;

Support all 9 Province to produce or strengthen Provincial Human Resources Plans;

Appoint Members of Statutory Councils for the new terms of office [Health Professions Council of South Africa (HPCSA); SA Nursing Council (SANC); SA Dental Technicians Council].

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9.5. PROGRAMME 5: SPECIAL PROGRAMMES AND HEALTH ENTITIES MANAGEMENT


Complete 3 new hospitals (Dilokong & Nkhensani in Limpopo and Barkley West in Northern Cape Province in 2008/09;

Accept an additional 9 Hospitals into the Hospital Revitalisation Programme;

Ensure the appointment of Health Information Officers in 286 hospitals;

Complete the Audit of PHC Services and Infrastructure;

Further improve the supervision of PHC facilities;

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9.6. PROGRAMME 6: INTERNATIONAL RELATIONS; HEALTH TRADE AND HEALTH PRODUCT REGULATION


Facilitate various multilateral activities and for a taking place in South Africa, such as CODEX, Red Cross, COPT);

Provide support to the post-conflict reconstruction processes in countries such as the DRC, Burundi and Sudan;

Enhance programmes to implement key priority areas of the Africa Health Strategy (e.g. malaria elimination, combating childhood illnesses and promoting safe motherhood);

Complete guidelines and systems for the registration of Traditional Medicines;

Develop and implement an electronic system for the registration of clinical trials

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10. BUDGET OF THE NATIONAL DEPARTMENT OF HEALTH

2008/09-2011

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10. NDOH BUDGET 2008/9-2010/11

Conditional grant funding increases in 2008/09 budget;

The Hospital Revitalization Grant (R600m, R500m, R900m) to address recent cost escalations in the first year and allow additional projects in the outer years;

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10. NDOH BUDGET 2008/9-2010/11

The Comprehensive HIV and AIDS Conditional Grant (R350m, R600m, R1.2b) to expand coverage of the comprehensive plan and strengthen prevention programmes;

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10. NDOH BUDGET 2008/9-2010/11

The National Tertiary Services Grant (R193m, R248m, R640m) to strengthen tertiary services and central hospitals;

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10. NDOH BUDGET 2008/9-2010/11

R 10 million has been earmarked to formulate detailed plans to recapitalize the nursing colleges

These plans need to be drawn for Colleges and must also include refurbishment of the colleges.

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10. NDOH BUDGET 2008/9-2010/11

New Organogram

Previously 4 programmes; from 2008/09 onwards 6 programmes;

Reduce span of management;

Better monitoring and control;

Enhance capacity to accelerate implementation

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10. NDOH BUDGET 2008/9-2010/11

2008 EnEActual Actual Actual Budget Budget Estimated Estimated

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Ave GrowthProgrm 1: Administration 04/05-10/11Minister 791 837 885 951 1,008 1,059 1,112 5.84%Deputy Minister 593 680 719 703 820 861 904 7.28%Management 10,425 14,449 16,381 21,769 27,247 29,592 31,761 20.40%Corporate Services 106,183 115,083 123,759 153,456 145,006 149,642 159,328 7.00%Property Management 29,736 32,124 33,848 38,164 41,566 46,466 51,561 9.61%Total 147,728 163,173 175,592 215,043 215,647 227,620 244,666 8.77%

8.77%

RECORD OF ACTUAL, BUDGET AND ESTIMATED EXPENDITURE

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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Ave Growth

Progrm 2: Strategic Health Programmes 04/05-10/11Maternal Child ecta 16,445 16,397 19,305 24,024 24,505 25,541 27,091 8.68%HIV and Aids 1,107,303 1,511,802 1,953,312 2,473,597 3,078,038 3,795,913 4,531,588 26.47%Communicable Disease 12,486 4,636 5,806 7,599 8,449 8,737 9,234 -4.90%TB Cont & Man 6,753 8,901 11,155 11,754 12,869 12,851 14,097 13.05%Non-Communicable Disease 256,393 373,520 669,198 804,358 589,224 620,150 693,317 18.03%Total 1,399,380 1,915,256 2,658,776 3,321,332 3,713,085 4,463,192 5,275,327 24.75%

24.75%


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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated Ave GrowthProgrm 3: Health Planning & Monitoring 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 04/05-10/11Health Information 189,885 210,833 233,360 250,507 258,065 271,850 288,166 7.20%Health Economics 11,528 12,684 27,586 22,192 24,646 25,435 26,933 15.19%Pharmaceutical Policy & Planning 12,181 12,387 11,923 14,116 16,145 16,842 18,053 6.78%Office of Standards Compliance 16,098 23,948 28,427 27,069 27,671 29,213 31,108 11.60%Total 229,692 259,852 301,296 313,884 326,527 343,340 364,260 7.99%

7.99%


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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated Ave GrowthProgrm 4: Human Resources Management & Development 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 04/05-10/11Human Resources Policy & Planning 26 4,468 3,341 5,804 9,328 7,927 8,361 161.75%Labour Relations 923 878 1,935 4,159 4,355 4,580 4,889 32.03%H R Development & Management 1,442,052 1,525,805 1,570,703 1,608,118 1,700,521 1,773,967 1,881,818 4.54%Total 1,443,001 1,531,151 1,575,979 1,618,081 1,714,204 1,786,474 1,895,068 4.65%

4.65%


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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated Ave GrowthProgrm 5: Special Programmes & Health Entities 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 04/05-10/11District Health Services 7,080 7,991 9,036 22,085 18,395 20,849 23,541 22.17%Environmental Health 11,926 15,049 18,190 17,746 19,832 20,785 21,875 10.64%Occupational Health 22,895 26,159 20,292 30,189 29,630 31,047 33,111 6.34%Hospital Services 5,136,822 5,975,493 6,519,157 7,482,534 8,984,600 9,643,408 10,969,058 13.48%Total 5,178,723 6,024,692 6,566,675 7,552,554 9,052,457 9,716,089 11,047,585 13.46%

13.46%


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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated Ave Growth

Progrm 6:International relations, Health Trade & Health Product Regulation 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 04/05-10/11Multilateral Relations North-South 26,747 18,834 31,419 44,116 44,554 46,028 48,854 10.56%Food control and Non Medical Prod. Reg. 4,745 3,737 3,514 5,300 6,002 6,323 6,707 5.94%Pharmaceutical Regulations 24,845 20,389 24,796 20,826 28,369 29,901 32,098 4.36%Total 56,337 42,960 59,729 70,242 78,925 82,252 87,659 7.65%

7.65%Ave Growth04/05-10/11

Total Department 8,454,861 9,937,084 11,338,047 13,091,136 15,100,845 16,618,967 18,914,565 14.36%14.36% 15.69% 11.92%


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10. NDOH BUDGET 2008/9-2010/11

Actual Actual Actual Budget Budget Estimated Estimated Ave GrowthConditional Grants 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 04/05-10/11National Tertiary Services Grant 4,273,005 4,709,386 4,981,149 5,321,206 6,075,634 6,533,931 7,303,077 9.34%Hosp Man & Quality Impr. 122,200 150,342 0 0 0 0 0Hospt Revialization 733,802 1,105,427 1,527,323 2,140,640 2,882,663 3,081,796 3,636,704 30.57%

Health Professions Training & Development 1,434,132 1,520,180 1,520,180 1,596,189 1,675,999 1,759,799 1,865,387 4.48%Hiv And Aids 735,381 1,150,108 1,616,214 2,006,223 2,585,423 3,276,186 3,986,757 32.54%Forensic Pathology Services 145,024 271,903 561,676 672,420 466,878 491,662 556,962 25.14%Total 7,443,544 8,907,346 10,206,542 11,736,678 13,686,597 15,143,374 17,348,887 15.15%

Hiv and Aids Excl Con Grnt 371,922 361,694 337,098 467,374 492,615 519,727 544,831 6.57%HR excl HPT&DG 8,869 10,971 55,799 21,892 38,205 26,675 29,681 22.30%Total Transfers 7,795,292 9,307,632 10,610,188 12,186,334 13,810,554 15,495,290 17,818,805 14.77%


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11. CONCLUSION

Linked to the President’s State of the Nation Address, 2008/09 will be a period of Business Unusual for the National DoH;

The Department will work very hard to implement the identified national priorities;

In 2007/08, significant progress was made in several key areas;

Critical challenges remain, which will be addressed during 2008/09.

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