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Gauteng Provincial Government | Health | Annual Report 2012/2013

Annual Report 2012/13In terms of the Public Finance Management Act Rule 9.4 (1) of the Gauteng Legislature

Standing Rules August 2009

PR 222/2013

ISBN: 978-0-621-42072-2

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Part A:

GENERAL INFORMATION

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1. DEPARTMENT GENERAL INFORMATION

Physical address: 37 Sauer Street

Johannesburg

2001

Postal address: Private Bag X085

Marshalltown

2107

South Africa

Telephone number: 011 355 3503

Twitter: @GautengHealth

Facebook Gauteng Provincial Health

Department

Website address: http://www.health.gpg.gov.za


TABLE OF CONTENTSPART A: GENERAL INFORMATION 21. DEPARTMENT GENERAL INFORMATION 32. LIST OF ABBREVIATIONS/ACRONYMS 6 3. STRATEGIC OVERVIEW 83.1. Vision 83.2. Mission 83.3. Values 83.4. Strategic outcome orientated goals 8 4. LEGISLATIVE AND OTHER MANDATES 8 5. ORGANISATIONAL STRUCTURE 96. ENTITIES REPORTING TO THE MEC 10FOREWORD BY THE MEC FOR HEALTH 11OVERVIEW OF THE ACCOUNTING OFFICER 12PART B: PERFORMANCE INFORMATION 161. STATEMENT OF RESPONSIBILITY FOR PERFORMANCE INFORMATION 172. AUDITOR GENERAL’S REPORT: PREDETERMINED OBJECTIVES 183. OVERVIEW OF DEPARTMENTAL PERFORMANCE 193.1 Service delivery environment for 2012/2013 193.2 Service Delivery Improvement Plan 213.3 Organisational environment 233.4 Key policy developments and legislative changes 244. STRATEGIC OUTCOME ORIENTED GOALS 245 PERFORMANCE INFORMATION BY PROGRAMME 255.1 PROGRAMME 1: ADMINISTRATION 25 PHARMACEUTICAL SERVICES 25 EMPLOYMENT EQUITY 27 QUALITY ASSURANCE 27 INFORMATION AND COMMUNICATION TECHNOLOGY 305.2 PROGRAMME 2: DISTRICT HEALTH SERVICES 38SUB-PROGRAMME 2.1: DISTRICT HEALTH MANAGEMENT AND PHC SERVICES 38SUB-PROGRAMME 2.2: DISTRICT HOSPITALS 40SUB-PROGRAMME 2.3: HIV AND AIDS, STIs AND TB 40SUB-PROGRAMME 2.4: MATERNAL, CHILD AND WOMEN’S HEALTH AND NUTRITION 44SUB-PROGRAMME 2.5: DISEASE PREVENTION AND CONTROL 47SUB-PROGRAMME 2.6: FORENSIC PATHOLOGY SERVICES 495.3 PROGRAMME 3: EMERGENCY MEDICAL SERVICES 745.4 PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES 77 TUBERCULOSIS HOSPITALS 77 PSYCHIATRIC HOSPITALS 77 ORAL AND DENTAL HEALTH CENTRES 785.5 PROGRAMME 5: CENTRAL HOSPITAL SERVICES 84 STEVE BIKO ACADEMIC HOSPITAL 88 DR GEORGE MUKHARI HOSPITAL 92 CHARLOTTE MAXEKE JOHANNESBURG ACADEMIC HOSPITAL 93 CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL 955.6 PROGRAMME 6: HEALTH SCIENCES AND TRAINING 97

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5.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES 1085.8 PROGRAMME 8: HEALTH FACILITIES MANAGEMENT 1126 SUMMARY OF FINANCIAL INFORMATION 1186.1. Departmental receipts 1186.2. Programme Expenditure 1206.3. Transfer payments, excluding public entities 1216.4. Transfer payments to Public Entities 1236.5. Conditional grants and earmarked funds received 1246.6. Donor Funds 1366.7 Capital Investment, maintenance and asset management plan 1456.8 Disposal of assets 1486.9 Reconciliations 1506.10 Achievements in asset management 151PART C: GOVERNANCE 1521. INTRODUCTION 1542. RISK MANAGEMENT 1543. FRAUD AND CORRUPTION 1544. MINIMISING CONFLICT OF INTEREST 1555. CODE OF CONDUCT 1556. HEALTH SAFETY AND ENVIRONMENTAL ISSUES 1557. INTERNAL CONTROL UNIT 156REPORT OF THE AUDIT COMMITTEE 157PART D: HUMAN RESOURCE MANAGEMENT 1601. LEGISLATION THAT GOVERNS HR MANAGEMENT 1622. INTRODUCTION 1623. HUMAN RESOURCE OVERSIGHT STATISTICS 1643.1. Personnel related expenditure 1643.2. Employment and Vacancies 1693.3. Job Evaluation 1713.4. Employment changes 1733.5 Employment Equity 1763.6. Performance Rewards 1823.7. Foreign Workers 1843.8. Leave utilisation 1853.9. HIV and AIDS & Health Promotion Programmes 1873.10. Labour Relations 1903.11. Skills Development 1923.12. Injury on duty 1943.13. Utilisation of consultants 194PART E: FINANCIAL INFORMATION 1961. REPORT OF THE ACCOUNTING OFFICER 1982. ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITY 2223. REPORT OF THE AUDITOR GENERAL 2234. ANNUAL FINANCIAL STATEMENTS 230MEDICAL SUPPLIES DEPOT 329 ANNEXURES 384 LEGISLATION 384 GOALS AND STRATEGIC OBJECTIVES 2009-14 389

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2. ABBREVIATIONS AND ACRONYMSAG Auditor-General

A&E Accident and emergency

AIDS Acquired immune defi ciency

syndrome

ALOS Average length of stay

ANC Antenatal care

ART Antiretroviral treatment

BAS Basic Accounting System

BBBEE Broad-based black economic

empowerment

BFHI Baby Friendly Hospital Initiative

BLS Basic life support

BUR Bed utilisation rate

CARMMA Campaign for Accelerated

Reduction of Maternal

Mortality in Africa

CBO Community-based organisation

CEO Chief executive offi cer

CFO Chief fi nancial offi cer

CHC Community health centre

CHW Community health worker

CMR Child mortality rate

CPD Continuing professional

development

DAC Departmental Acquisition Council

DHIS District Health Information System

DHS District Health System

DID Department of Infrastructure

Development

DOH Department of Health (national)

DPSA Department of Public Service and

Administration

EAP Employee assistance programme

EE Employment equity

EML Essential Medicines List

EMS Emergency medical services

EPI Expanded Programme on

Immunisation

EPWP Expanded Public Works

Programme

ESMOE Essential Steps in Managing

Obstetric Emergencies

EXCO Executive committee or council

FBO Faith-based organisation

FDC Fixed-dose combination (ARV pill)

FY Financial year

GAS Gauteng Audit Services

GIS Geographic information system

GPG Gauteng Provincial Government

GSSC Gauteng Shared Services Centre

HAART Highly active antiretroviral

treatment

HAST HIV, AIDS, STIs and TB

HCT HIV counselling and testing

HFM Health Facilities Management

HIV Human immunodefi ciency virus

HOD Head of department

HR Human resources

HWSETA Health and Welfare Sector

Education and Training

Authority

ICT Information and communication

technology

ICU Intensive care unit

IEC Information, education and

communication

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ILS Intermediate life support

IMCI Integrated Management of

Childhood Illnesses

IMR Infant mortality rate

IPT Isoniazid prophylaxis

IT Information technology

M&E Monitoring and evaluation

MDGs Millennium Development Goals

MDR-TB Multi-drug resistant tuberculosis

MEC Member of Executive Council

MIS Management information system

MMC Medical male circumcision

MMR Maternal mortality rate

MOU Memorandum of understanding

MSD Medical Supplies Depot

MSM Men who have sex with men

MTEF Medium-Term Expenditure

Framework

NCDs Non-communicable diseases

NGO Non-governmental organisation

NHI National Health Insurance

NHLS National Health Laboratory Services

NIMART Nurse-initiated management of ART

NPO Non-profi t organisation

NSP National Strategic Plan on HIV, TB

and STI

OPD Outpatient department

OSD Occupation-specifi c dispensation

OVC Orphans and vulnerable children

PDE Patient-day equivalent

PEP Post-exposure prophylaxis

PFMA Public Finance Management Act

PHC Primary health care

PLHIV People living with HIV

PMTCT Prevention of mother-to-child

transmission

POA Programme of action

PPP Public-private partnership

PTC Pharmacy Therapeutic Committee

PSETA Public Service Education and

Training Authority

PWD People with disabilities

RAF Road Accident Fund

RWOPS Remunerative work outside public

service

QA Quality assurance

SADC Southern African Development

Community

SANBS South African National Blood

Service

SAPS South African Police Service

SLA Service-level agreement

TB Tuberculosis

TOR Terms of reference

XDR-TB Extensively drug resistant

tuberculosis

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3. STRATEGIC OVERVIEW

3.1. Vision

To be the best provider of quality health services to

the people in Gauteng.

3.2. Mission

To provide excellent, integrated health services in

partnership with stakeholders and to contribute

towards the reduced burden of disease in all

communities in Gauteng.

3.3. Values

• Batho Pele principles.

• Excellence.

• Integrity.

• Humility.

• Selflessness.

• Respect.

• Social justice.

I care, I serve, I belong.

3.4. Strategic outcome-orientated goals

The strategic goals of the Gauteng Department of

Health (GDoH) are:

• Improved health and wellbeing with an

emphasis on vulnerable groups.

• Reduction in the rate of new HIV infections

by 50% in youth, adults and babies, and

reduction in the number of deaths from TB

and AIDS by 20%.

• Increased effi ciency of service implemen-

tation.

• Human capital management and develop-

ment for better health outcomes.

• Organisational excellence.

4. LEGISLATIVE AND OTHER MANDATES

The GDoH derives its mandate from the South

African Constitution, the National Health Act, and

other legislation promulgated by Parliament.

The core mandate of the department is to:

• Improve the health status of the population.

• Improve health services.

• Secure better value for money.

• Ensure effective organisation.

• Provide integrated services and pro-

grammes that promote and protect healthy,

quality and sustainable livelihoods of poor,

vulnerable and marginalised groups in

society

In fulfi lling its mandate, the GDoH is guided by

legislation listed in the annexure at the end of this

report. 8


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6. ENTITIES REPORTING TO THE MEC

The only public entity that falls under the control of the MEC for Health is the Medical Supplies Depot (MSD)

which is a trading entity. The performance of the MSD in respect of the performance of pharmaceutical

services forms part of this report. The table below provides details of the MSD.

Name of Entity Legislative mandate Financial relationship Nature of operations

Medical Supplies Depot

(MSD)

Registered as “The Central

Medical Trading Account”

since 1 April 1992 under

the Exchequer Act No 1

of 1976.

The MSD charges a levy

of 5% on stock supplied

to the provincial

healthcare facilities.

The MSD is responsible

for the supply of

essential medicines

and disposable sundry

items to provincial

healthcare facilities in

Gauteng.

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Foreword by the MEC for HealthGauteng MEC for Health, Mr AHM Papo’s Foreword to the 2012/13 Annual ReportDuring the year under review, the delivery of health services was guided by the Turnaround Strategy which was extensively consulted on, adopted by the Gauteng Executive Council and subsequently launched for implementation in July 2012.

The interventions contained in the Turnaround Strategy included strengthening fi nancial management, Supply Chain Management, and human resource management at central offi ce, district offi ces and facility level.

The Turnaround Strategy will continue to be implemented until the end of the current term of offi ce. In order to strengthen fi nancial management at all levels, budget allocations are informed by service packages. The Department also linked these allocations to health priorities and main outcomes.

These interventions, among others, will ensure organisational stability and an institutionalised culture of fi scal discipline. We will also continue to manage irregular expenditure in order to fi nally eliminate accruals.

Notable progress has been made regarding transforming Supply Chain Management in the department and the containment of accruals. While the Department was faced with challenges as alluded to above, service delivery was not compromised as indicated by many of the service and health outcomes contained in this Annual Report.

In the year under review, four of our hospitals were reclassifi ed as Central hospitals and three as Tertiary hospitals. This change has required aligning service packages provided at these hospitals with new mandates. Within the general approach of the Turnaround Strategy, the fi lling of key vacancies in Health Districts and Central Offi ce contributed towards organisational stability.

This has put the Department on a sound footing to consolidate the Turnaround Strategy into concrete programmes that will guide the Department as we approache the end of the term. We have prioritised delivery of quality health services and continue to direct resources in pursuit of this objective.

We have continued to focus on the social determinants of health in order to deal with some of the causes of diseases currently over burdening the health system. We have also put various measures to strengthen Primary Health Care.

Mr A.H.M Papo

MEC for Gauteng Department of Health

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Overview of the Accounting Offi cerThe year under review saw an acceleration of

efforts to improve health system effi ciency within

the Gauteng Department of Health (GDoH).

The department intensifi ed efforts to foster an

organisational culture of fi scal discipline and fi nd

innovative ways to improve the patient experience

of healthcare services. We continued to implement

the Turnaround Strategy, the ultimate goal of which

is to bring about stability and improve service

delivery.

Major strides have been made in the implementation

of fi nancial reforms and, as a result, budget

allocations are being made according to health

priorities. A cost analysis of service packages was

nearing completion at the end of the year and it will

inform future budget processes. The department is

fi nalising the establishment of a Health Processing

Centre to ensure compliance with the injunction

to pay suppliers within 30 days. Thanks to the

commitment of our staff as a whole and our

stakeholders, we are confi dent that the department

is moving in the right direction.

In the light of our commitment to providing quality

healthcare services to the people of Gauteng, we

have made concerted efforts to shift resources

progressively towards primary healthcare (PHC). We

have also brought services closer to communities

through the expansion of ward-based outreach

teams which are now functioning in 49 municipal

wards alongside school health teams and district

health specialist teams. In the period under review,

the number of visits to healthcare institutions grew

substantially. PHC facilities saw more than two

million more patients than in the previous year,

while outpatient departments at the province’s

regional hospitals treated 1.8 million more patients

than in 2011/12 and outpatient visits at central

hospitals increased by two million.

The Ministry of Health is preparing to introduce

National Health Insurance (NHI) as a way to

improve access to healthcare for all who require

it thus achieving universal coverage. The changes

that this will involve are being tested and fi ne-tuned

through NHI pilot districts. In Gauteng, Tshwane is

the designated NHI pilot district and it will provide

valuable information about the requirements of NHI

in the rest of the province. While the Tshwane pilot

project got off to a slow start and spent only part of

its allocated funding, it gained momentum over the

course of the year.

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Improving life expectancy and reducing mortality

and morbidity through prevention and management

of communicable and non-communicable diseases

has remained uppermost in our minds. Evidence

of this can be found in the investments made in

the past year in capital infrastructure and service

delivery. In order to improve diagnosis of TB,

including drug-resistant forms of TB, we have

expanded the availability of GeneXpert machines

to an additional seven institutions. Along with

improved diagnosis of TB we have seen sustained

progress in TB treatment outcomes.

Gauteng has been a strong contributor to South

Africa’s HIV success story. In 2011/12, residents

of Gauteng continued to flock in their millions for

HIV testing. Although the antiretroviral treatment

(ART) programme continued to grow, the rate of

expansion was slower than planned. By the end of

the year 693 136 adults and 41 172 children were

receiving ART.

High rates of maternal mortality have been a

serious concern for South Africa as a whole, and

Gauteng is no exception. Throughout 2012/13, the

department sustained a concerted effort to reduce

maternal mortality through training of health

workers and following internationally recognised

approaches to managing obstetric emergencies.

The results of this effort will only be known when

the Independent Committee of Enquiry on Maternal

Mortality publishes its three-yearly Saving Mothers

report in 2014/15.

The department has also made headway in

the prevention childhood diseases. There was

improved coverage by immunisation programmes.

Notable achievements included further progress in

preventing HIV transmission from mother to child.

We continue to explore various social platforms

for communicating healthcare messages aimed at

preventing ill-health and promoting appropriate use

of health services. We are also engaged in exploring

the use of technology to improve healthcare

delivery.

The department is sensitive to the concerns of

our communities about the quality of service they

receive at our institutions. We continue to conduct

client satisfaction surveys to measure the quality

of care from the patient’s perspective and we have

created platforms for communities to provide

feedback without fear of being prejudiced. In

addition to this, teams of inspectors from the GDoH

and National Department of Health have begun to

assess our institutions against national standards

and provide an objective report on the strengths

and weaknesses of service provision.

An area of serious concern to both patients and

health professionals in recent years has been

inadequate availability of medicines in many

hospitals and clinics. Problems encountered were

partly due to the Department's delay in processing

payments and at times inability of suppliers

to meet demands. The department has been

working relentlessly to ensure optimal availability

of medicines at all times. We strive to achieve a

100% availability of all medicines on the Essential

Medicines list in the Medical Supplies Depot (MSD)

We believe that 2012/13 was a critical turning point

in respect of this element of care. In the previous

year, the availability of essential medicines dropped

to an average of 64% but by the end of 2012/13

this fi gure had improved to 76%. This improvement

was due to re-engineering of business processes at

the Medical Supplies Depot and stronger fi nancial

management under the Turnaround Strategy. The

department accepts that further improvement in

this area remains critical to good care.

We continue to partner with various stakeholders

to improve provision of healthcare services and we

strive continually to strengthen the professional

expertise and skills of our staff through a range of

training programmes and bursaries. Our growing

investment in human resources development

attests to our commitment to improving the quality

of healthcare.

While the demand for services continues to grow,

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the department’s resources are not infi nite. The

need to ensure that available resources are used

effi ciently and in a manner calculated to improve

health outcomes, cannot be overemphasised.

The department acknowledges that adequate

provision of health services to all who need it is

a huge responsibility – we thus require the full

cooperation and participation of our partners in the

sector and the people to whom we provide services.

We appreciate community members who use health

facilities appropriately and access health services

at the correct level of care We value the continued

contribution of community health workers and

civil society organisations that participate in the

delivery of healthcare. We are cognisant of the

contribution of countless healthcare workers, of

their often heroic efforts to save lives and of the

ground-breaking work done in our own institutions.

This continues to inspire us to strive to be the best

provider of quality healthcare services.

Ndoda Biyela

(ACTING) ACCOUNTING OFFICER

GAUTENG DEPARTMENT OF HEALTH

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15

16

Part B:

PERFORMANCE INFORMATION

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1. STATEMENT OF RESPONSIBILITY FOR PERFORMANCE INFORMATION

In my opinion, the performance information contained in this report fairly reflects the performance

information of the department for the fi nancial year ended 31 March 2013.

Ndoda Biyela



31 May 2013


2. AUDITOR-GENERAL'S REPORT PREDETERMINED OBJECTIVES

See Part E of this report (Financial Information) for

the full Report of the Auditor-General. No assurance

were provided on predetemined objectives.

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3. OVERVIEW OF DEPARTMENTAL PERFORMANCE

3.1 Service delivery environment for 2012/13

The GDoH remains committed to the National goal

of a long and healthy life for all South Africans. It

continues to implement a number of interventions

aimed at increasing life expectancy, with an

emphasis on reducing infant, child and maternal

mortality rates, reducing new HIV infections and

managing the impact of AIDS, reducing the burden

of disease from TB and improving health system

effectiveness.

The Departmental Turnaround Strategy is designed

to address major challenges and areas of concern.

It covers eight focal areas, namely: fi nancial

management, human resources, district health

services, hospital management, medico-legal

services, health information, communication and

social mobilisation, and health infrastructure. This

strategy guided numerous interventions during the

course of 2012/13.

Gains from implementation of the Turnaround

Strategy are beginning to emerge. Budget reforms

have been implemented and the Department has

been able to keep expenditure within budget. For

the fi rst time in many years, expenditure on the

compensation of employees has been within budget.

Long-standing issues in relation to Remunerated

Work Outside the Public Service (RWOPS) and

overtime are being addressed through a range of

initiatives. A new procure-to-pay process has been

established to minimise incidents of fraudulent

transactions and possible collusion by offi cials with

suppliers. A supply chain management charter has

also been developed. The Department had verifi ed

77% of targeted employees by the end of January

2013.

Key achievements and challenges in relation to

health service delivery are outlined below.

Health system effectiveness

The demand for primary healthcare (PHC) services

grew substantially during the year under review. The

total number of visits to PHC facilities exceeded

the projected fi gure by more than two million and

amounted to more than 23 million visits. In addition,

1 853 400 patients attended out-patient Departments

(OPDs) at regional hospitals and 2 597 531 were seen

at OPDs at central hospitals.

The Department remains focused on strengthening

primary prevention of diseases through health

promotion and by encouraging communities to

attend PHC facilities for preventive care.

In order to improve the working and patient care

environment, various infrastructure projects have

been undertaken. Equipment such as generators,

chillers, boilers and autoclaves has been replaced.

This should not only improve the patient experience

but also contribute to better infection control and

patient safety. Where possible, the Department

utilised the services of small and medium

enterprises for infrastructure contracts.

Health services are provided through a combination

of community-based outreach programmes and

facility-based care involving hospitals, Community

Health Centres (CHCs), and fi xed and mobile clinics.

There is a continuous effort to improve access

to care by increasing the number of healthcare

facilities, extending hours of service and attending

to soft issues which may discourage people from

using health services.

The Department provides comprehensive PHC care

services in all its CHCs. It offers 24-hour services

at 26 of the 32 CHCs. Ward-based community

health outreach teams are active in 49 municipal

wards. They ensure that households are visited

and services are offered to frail people in their

homes. PHC care has been further enhanced by

19


ensuring that each CHC has a resident doctor and a

specialist family physician. Every health district has

a core specialist team, comprising obstetricians

and paediatricians, to provide guidance to staff at

CHCs and clinics within the district.

The Department provides extensive training to

existing personnel and offers bursaries to members

of the public wishing to study for occupations in

which there are critical staff shortages. A total of

4 397 students were awarded bursaries in targeted

areas of need during 2012/13.

Reducing maternal and child mortality

The provision of maternal and child health

interventions remains a key priority. The Department

provides 24-hour maternity services in all CHCs

and hospitals. During 2012/13, a total of 211 144

deliveries took place in our facilities, an increase of

7 279 on the previous year. Staff received training

in approaches designed to reduce maternal and

infant mortality, such as Essential Steps in the

Management of Obstetric Emergencies (ESMOE).

Signifi cant progress has been made in relation

to screening for cervical cancer among women

aged 30 years and older. Presently about 44% of

eligible women are being screened in accordance

with guidelines. The target is to increase screening

coverage to 70% by 2019/20 fi nancial year.

The Department took a number of measures aimed

at improving child survival rates. It achieved Mother

and Baby Friendly accreditation for an additional

fi ve institutions, bringing the total to 48 facilities.

These facilities assist mothers to breast feed

(which contributes to good nutrition and infant

survival) and educate them about the advantages

of breastfeeding. All fi xed PHC facilities implement

Integrated Management of Childhood Illnesses,

an approach advocated by the World Health

Organisation (WHO) for the early detection and

effective treatment of common health problems

among pre-school children.

Immunisation services are provided daily by

all clinics and some hospitals in Gauteng. The

immunisation coverage rate for various vaccine-

preventable infections has consistently been

maintained above 90%. In addition, there is constant

surveillance in respect of various diseases, including

polio. All cases of acute flaccid paralysis (AFP),

which might be due to polio, have been investigated

to rule out polio.

An additional preventive intervention is the

provision of vitamin A supplements to children

aged 6-11months and Gauteng managed to cover

more than 90% of eligible children.

Dedicated health services for teenagers and young

adults were strengthened and the number of youth

friendly services was increased to 121 facilities.

The oral health programme provided several

thousand children with fi ssure sealants to conserve

their teeth and involved 151 000 children in its

tooth-brushing projects. Other health promotion

programmes for children included education in

correct hand-washing technique – which benefi ted

104 103 learners from 138 schools – and healthy

living programmes which reached 706 schools. A

total of 111 schools in Gauteng have now been WHO-

accredited as health promoting schools. More than

700 child minders and 150 community members

received training on how they could contribute to

the management of childhood diseases.

The Department provided a total of 43 251 assistive

devices – such as wheelchairs and hearing aids –

to persons with disabilities, including children. In so

doing, the Department exceeded its target by 10 251

devices.

Combating HIV and AIDS

There has been a further notable reduction in HIV

transmission from mother to child. During the year

under review, 2.4% of babies tested HIV-positive

when tested at six weeks of age, compared to

3.6% in 2011/12. All babies born to women with

20


HIV should receive the antiretroviral drug (ARV),

nevirapine, within 72 hours of birth and 95.5% of

babies actually received nevirapine.

During the course of the year, the Department

expanded its accredited services for antiretroviral

treatment (ART) from 359 to 364 sites. A total

of 693 136 adults and 41 172 children were on

treatment by the end of the financial year.

The number of facilities providing Medical Male

circumcision (MMC) increased substantially, from 43

to 60 sites. Other measures to reduce the incidence

of HIV included the work done in the community and

individual homes by non-profi t organisations with

support from the Department. Community-based

programmes benefi ted 933 059 individuals in high

risk groups and ward-based education initiatives

reached over six million residents.

Reducing the burden of disease from TB

During the reporting year, a total of 50 461 TB

cases were diagnosed in Gauteng and the affected

individuals commenced treatment. Evidence from

sputum smears that tested positive for TB over

two months was 83.4%, providing an indication that

patients were responding well to treatment. There

has been sustained progress in TB outcomes, and

the cure rate for pulmonary TB reached 82.4% in the

reporting year. The Department treated 794 cases

of multidrug-resistant TB (MDR-TB), constituting

1.6% of all TB cases. Seven additional hospitals

acquired GeneXpert diagnostic equipment, which

delivers TB test results – including the diagnosis

of drug-resistance – within a matter of hours. The

Department also provides the drug isoniazid to HIV-

positive patients to prevent them acquiring TB. This

intervention benefi ted 96 800 people living with HIV

in 2012/13.

External factors impacting on GDoH provision of healthcare

Service delivery in Gauteng is affected by various

environmental factors, including cross-border

utilisation of services and high rates of migration

into the province. Both of these factors increase

the size of the population served and impact on

expenditure on the health care system in Gauteng.

The fact that a fair proportion of the population

is transient and unstable present healthcare

challenges. For example, it is diffi cult to follow up

patients on TB treatment and ART.

There is still a tendency for service users to

bypass PHC facilities because of perceptions that

they receive better care in hospitals which offer

specialist services. Furthermore, cultural and

socio-economic factors still play a role in utilisation

of services. For example, such factors appear to

deter women from making their fi rst antenatal

care visits early (before 20 weeks) and mothers

from bringing children to clinics for HIV testing

and vitamin A supplementation. The attitudes of

administrative and professional staff also influence

patients’ decisions to avoid health services entirely

or choose some over others.

3.2 Service Delivery Improvement Plan

The Department has completed a service delivery

improvement plan. The tables below summarise

key components of the plan and achievements to

date.

21


Table 1: Main services provided and standards

Main services Actual customers Potential

customers

Standard of

service

Actual

achievement

Complaints

response system.

Dissatisfi ed or

aggrieved patients

and members of

the public.

Public, patients,

patients’ relatives

and other

interested bodies.

95% of complaints

received to be

resolved within 25

working days.

95.4% resolution

rate within

specifi ed time

limit.

Table 2: Consultation arrangements with customers

Type of arrangement Actual customers Potential customers Actual achievements

Annual open days at

hospitals and clinics

in order to consult

with and inform

communities about the

Patients’ Rights Charter,

Batho Pele Principles

and the departmental

toll-free hotline for

complaints about poor

service.

Patients, healthcare

users, members

of the public, other

stakeholders and

interested parties.

Patients and other

healthcare service

users.

Open days held.

Awareness raised as

shown by the increased

number of complaints

received and managed.

Table 3: Service delivery access strategy

Access strategy Actual achievements

Establish toll-free complaints line operating

24 hours a day, seven days a week. Appoint

complaints offi cials at various institutions and

display contact details on posters in frontline

service areas. Conduct client satisfaction surveys

annually to measure patients’ perceptions of care

they receive.

Strategy implemented successfully with high

utilisation of the complaints system.

Client satisfaction survey showed that 67,4%

hospital users were satisfi ed with the care they

received.

Conduct awareness campaigns through

community radio stations to promote the toll-

free hotline and inform the public about the

departmental complaints response system.

Strategy achieved high utilisation of the system

and a high proportion of complaints were resolved

to the user’s satisfaction.

Table 4: Service information tool

Types of information tool Actual achievements

Information tools comprise posters on complaints

procedure, leaflets with the complaints number

and booklets guiding patients on procedure to be

used when a complaint is lodged.

Information tools are displayed in service areas at

all healthcare facilities. The attention of patients

and members of the public is drawn to these

information items.

22


Types of information tool Actual achievements

Posters on the Batho Pele Principles and the

Patients’ Rights Charter and “know your services

rights” are placed at all institutions.

The number of complaints received from patients

and the public increased from 3 100 in 2011/12 to

6 750 in 2012/13.

Table 5: Complaints mechanism

Complaints mechanism Actual achievements

There is a toll-free complaints hotline.

Quality assurance/customer care units exist at

the central and district offi ces and at all health

facilities.

Complaints management guidelines are available

to staff to guide them on how to deal with

complaints and utilise redress mechanisms.

Attended to more than 350 complaints per month.

More than 95% are investigated and fi nalised

within 25 working days to satisfaction of most

patients.

Complaints are dealt with effectively at all levels

of care.

A user-friendly complaints form has been

developed. A procedure for walk-in complaints is

in place. There is a dedicated e-mail address for

complaints.

Implemented and functional.

3.3 Organisational environment

In December 2011, a Memorandum of Agreement

(MOA) between the Premier, the Minister of Health

and Treasury was signed. The obligations of the

province, in terms of this agreement, included

strengthening budget planning and implementation,

recovering debts owed to the province and

developing a comprehensive Turnaround Strategy.

The Health Turnaround Strategy 2012-14

was developed with the involvement of staff,

management, the National Department of Health

(NDOH), National Treasury, Provincial Treasury,

stakeholders, and the Gauteng Executive Council.

It was approved by the Gauteng Executive Council

on 4 July 2012. The strategy addresses eight

areas: fi nance and fi nancial management; human

resources; the district health system and PHC;

hospital management; the health information

system and health information management;

medico-legal services, communication and

infrastructure.

In December 2012, the Executive Council resolved

that the GDoH would be placed under administrative

curatorship in terms of section 18 of the Public

Finance Management Act (PFMA). In terms of this

section, the Gauteng Provincial Treasury would

intervene to assist the Department to put in place

systems and build capacity for effi cient, effective

and transparent fi nancial management.

A new MEC for Health, Mr Hope Papo, was appointed

in July 2012 and a permanent Chief Financial

Offi cer assumed duty in September 2012. The

Head of Department, Dr Nomonde Xundu, resigned

in October 2012. The CFO, Mr Ndoda Biyela, acted

as HOD for the remainder of the fi nancial year.

23


3.4 Key policy developments and legislative changes

During the year under review, there were no major

changes in legislation and policies affecting

the operations of the Department. However, the

following developments were noteworthy:

• In March 2012, the DOH identifi ed Tshwane

district as one of the 10 National Health

Insurance (NHI) pilot sites. As a consequence

the Tshwane district received an NHI conditional

grant for the fi nancial year under review, as did

the four central hospitals in Gauteng.

• An amendment to the National Health Act

during 2012/13 changed the categorisation of

hospitals. Three of Gauteng’s regional hospitals

– Helen Joseph, Tembisa and Kalafong – were

redefi ned as tertiary hospitals.

• In addition, two policy decisions taken during

2012/13 will affect the Department going

forward:

• Central hospitals are to become a national

responsibility.

• Fixed dose combination ARVs will be introduced.

The decision to place all central hospitals under

the authority of the NDOH will affect four hospitals

in Gauteng. Preparations for this will continue

throughout 2013/14 as there will be implications

for planning, budgeting and ensuring seamless

service delivery from clinic to central hospital level.

At the end of 2012/13, the NDOH announced that

the fi xed dose combination (FDC) ARV would be

introduced from 1 April 2013. The once-a-day, single

ARV tablet contains a combination of three ARVs:

tenofovir, efavirenz and emtricitabine. Initially, it will

be given to newly diagnosed HIV-positive persons,

TB/HIV co-infected and all HIV positive pregnant

women and breast-feeding mothers regardless of

their CD4 count. It is expected that the FDC will

improve and strengthen adherence to treatment by

reducing the pill burden.

4. STRATEGIC OUTCOME ORIENTED GOALS

Strategic goals of the Department

• Improved health and wellbeing with an empha-

sis on vulnerable groups.

• Reduction in the rate of new HIV infections by

50% in youth, adults and babies in Gauteng, and

reduction in deaths from TB and AIDS by 20%.

• Increased effi ciency of service implementation.

• Human capital management and development

for better health outcomes.

• Organisational excellence.

Goals of the National Negotiated Service Delivery Agreement of the DOH

• Increase life expectancy.

• Decrease maternal and child mortality.

• Combat HIV and AIDS and decrease the burden

of disease from TB.

• Improve health system effectiveness.24


5. PERFORMANCE INFORMATION BY PROGRAMME

5.1 Programme 1: Administration

Purpose of the programme

The purpose of this programme is to provide

strategic direction and leadership, to guide and

support the development of policy frameworks

and guidelines for priority programmes, to develop

policies and legislation on healthcare provision, and

to ensure that norms and standards are followed in

the course of implementation.

List of sub-programmes

• Pharmaceutical Services.

• Human Resource Management.

• Quality Assurance.

• Information and Communication Technology.

• Risk Management.

Strategic objectives

The following strategic objectives are relevant for

Programme 1:

• Improve client satisfaction rate.

• Improve achievement of national norms in

terms of the ratio of health professionals to

population.

• Improve employment equity and strengthen di-

versity management.

Pharmaceutical Services Sub-programme

The Pharmaceutical Services Sub-programme

strives to ensure the provision and rational use of

essential medicines by suitably qualifi ed personnel

from pharmacies that are compliant with pharmacy

legislation and good pharmacy practice.

In order to monitor adherence to the National

Standard Treatment Guidelines, the unit facilitated

the strengthening of Pharmacy and Therapeutics

Committees (PTCs) at all institutions and in all

districts. The Provincial PTC was revived with four

sub-committees each focusing on a specifi ed area:

the formulary, rational medicine use, procurement

and safety and quality.

The Provincial PTC developed a new formulary and

removed from the formulary most non-contract

medicines and those that are not on the Essential

Medicines List (EML). This will reduce the high

costs related to the use of non-contract items and

facilitate uniform and rational use of medicines by

prescribers and dispensers. The committee also

created a mechanism to report adverse medicine

reactions.

The unit trained 38 pharmacy interns and 71

community service pharmacists completed their

service in our pharmacies. In order to train more

pharmacists’ assistants in preparation for PHC re-

engineering, the unit obtained authorisation from

the South African Pharmacy Council to change

the tutor: learner ratio from 1:3 to 1:5. This allowed

the Department to train 248 pharmacist assistants

who should be ready in two years to be deployed to

PHC facilities.

The provincial Medical Supplies Depot will be

empowered to submit accurate estimates of

medicine requirements to the DOH for purposes of

preparing national medicine tenders.

Pharmacy managers and drug controllers from

the central and tertiary hospitals received training

on fi nancial management, the Division of Revenue

Act (DORA) and the use of the National Tertiary

Services Grant (NTSG). Medicines constitute one

of the largest items in the goods and services

budget and it is therefore important for pharmacy

managers to be skilled in budget management.

Training was also provided on the new TB guidelines

and the roll out of the ARV FDC pill.

25


To improve adherence to good pharmacy practice

and relevant legislation, all standard operating

procedures for pharmaceutical services were

reviewed and circulated to facilities. In response

to the National Core Standards for Health

Establishments, a protocol for safe administration

of medication to patients was developed and

approved. This protocol is specifi cally designed

to minimise prescribing, dispensing and

administration errors.

The re-engineering of business processes at

the Medical Supplies Depot (MSD) resulted in

an improvement in the percentage of essential

medicines available at facilities and the depot from

an average of 64% in March 2012 to 76% by the end

of the fi nancial year.

Laboratory and Blood Services Sub-programme

The following initiatives were taken during 2012/13

to promote the rational utilisation of laboratory

services.

Electronic gate-keeping

Electronic gate-keeping is an automated system

for requesting and approving diagnostic tests.

It has in-built features for ensuring the rational

use of tests. Following the successful piloting

of electronic gate-keeping (EGK) at Chris Hani

Baragwanath Academic Hospital, the system was

extended to an additional 19 hospitals from April

2012. These hospitals are listed below.

Table 5.1: List of hospitals implementing electronic gate-keeping

Chris Hani Baragwanath Academic Hospital Far East Rand Hospital

Charlotte Maxeke Academic Hospital Pholosong Hospital

Steve Biko Academic Hospital Tambo Memorial Hospital

Dr George Mukhari Hospital Tembisa Hospital

Kalafong Hospital Leratong Hospital

Mamelodi Hospital Natalspruit Hospital

Jubilee Hospital Kopanong Hospital

Helen Joseph Hospital Bertha Gxowa Hospital

Edenvale Hospital South Rand Hospital

Rahima Moosa Hospital Sebokeng Hospital

Improved control of accounts for laboratory services

All newly commissioned health facilities must

process applications for accounts with the National

Health Laboratory Service (NHLS) through the

Clinical Support Services unit to ensure that all

facilities are verifi ed by the Health Information

Directorate.

Service Level Agreements with SA National Blood Services (SANBS) and NHLS

There was a thorough review of the service level

agreement between the Department and NHLS.

The terms and conditions of the current agreement

were extended until 30 June 2013. Copies of

the agreement that governs the department’s

relationship with SANBS were distributed to

departmental facilities.

26


Human Resource Management Sub-programme

Employment Equity

The Department undertook a road show to all

institutions to communicate employment equity

targets and raise awareness of the signifi cance

of the Employment Equity Act. Human resource

policies are regularly analysed to identify barriers

to implementation of the Act. The department’s

Skills Development Plan was developed in such a

way that it addresses skills gaps and ensures that

designated groups (in terms of Employment Equity

Act. 55 of 1998) are prioritised at all levels. The

plan also seeks to ensure continuous learning and

development.

For the fi nancial year 2012/13, the GDoH set a

target of 47% for female appointments at senior

management level and achieved 35.8% by the end

of March 2013. Three women were appointed to

senior management posts despite the moratorium

on recruitment that applied for a portion of the

fi nancial year. There is a high demand in the market

for senior female managers and resignations tend

to counterbalance appointments as senior women

in the Department move on to new opportunities.

Gender and disability mainstreaming

The Department continues to mainstream

provisions on gender, opportunities for people

with disabilities and opportunities for youth in

programme planning and implementation.

There has been a steady growth in the recruitment

of people with disabilities and the total number

stood at 458 at the end of the fi nancial year. The

moratorium on appointments also affected the

recruitment of people with disabilities. In addition,

most appointments in the Department comprise

health professionals and there are few people with

disabilities who have qualifi cations in medicine and

nursing.

The Department continues to source curricula vitae

of people with disabilities and include them in a

database. Heads of institutions are encouraged

to consider this database when recruiting staff for

relevant positions.

The Department continues to improve infrastructure

to accommodate people with disabilities and there

are workshops to sensitise staff to the needs of

their colleagues with disabilities and assist them to

provide support in a respectful manner.

Quality Assurance Sub-programme

The Department is committed to providing the

best quality of care to patients and users of its

health services and to meeting their service

expectations and needs. The Quality Assurance

Directorate coordinates quality assurance activities

in the province, promotes patient-centred care and

monitors the compliance of public health facilities

with norms and standards for service delivery.

Patients complaints management system

The Department complaints system responds to

complaints from patients and other members of

the public received at healthcare facilities and the

central offi ce as well as through the departmental

complaints hotline. Complaints are also channelled

through the call centres run by the Offi ce of the

Premier and the Presidency.

A total of 6 874 complaints were received by the

hotline and call centres during 2012/13 and 6 560

were resolved. Of these, 95, 4% were resolved within

25 working days. The Department ensures that

complainants are informed about the outcome of

their complaints.

The swift resolution of a high proportion of

complaints was assisted by the appointment of

dedicated complaints managers to respond to

complaints referred from the Premier’s Offi ce

and Presidential call centre. The Department has

also held workshops to strengthen the capacity

27


of complaints managers in facilities to respond

effectively to complaints. Various communication

methods were used to create public awareness

of complaints mechanisms, including community

radio stations and posters in frontline service areas

at all institutions.

Special attention has been paid to the swift

investigation of serious adverse events. These

are unforeseen and untoward accidents involving

patients (and occasionally other members of the

public) in our health facilities that may lead to

serious injury, permanent damage or even death.

The Department has appointed a multidisciplinary

Serious Adverse Events Management Committee

at central offi ce. This committee ensures the

investigation of all serious adverse events and has

conducted workshops throughout the province to

make certain that facilities use a new reporting tool

for serious adverse events.

A total of 518 serious adverse events were reported

in 2012/13 and 390 were resolved, with affected

patients and/or families receiving redress where

appropriate. The 75,3 % resolution rate was about

30% better than in the previous fi nancial year. The

unresolved cases comprise those that have major

legal implications and those that can be dealt

with more appropriately by the Health Professions

Council of South Africa, to which they are referred.

Serious adverse events can be mitigated through

the practice of clinical audits. This involves the

comparison of current practice with models of

good practice and continual improvement in the

quality of clinical care. A total of 17 hospitals out

of 32 have implemented the clinical audit system

and this has assisted in the development of quality

improvement plans.

There are still challenges in relation to good

complaints management, including:

• Under-reporting by health facilities of cases in-

volving serious breaches of norms and stand-

ards.

• Prank calls by members of the public to the

complaints hotline.

Assessments reveal that there has been a gradual

improvement in terms of compliance with the

National Core Standards for Health Establishments.

Highlights from the assessments are provided

below. In all cases the results of self-assessments

undertaken by facilities in 2011/12 are compared

with the post-baseline assessments (performed by

provincial and national inspectors) in 2012/13.

• The four central hospitals – Steve Biko, Char-

lotte Maxeke, Dr George Mukhari and Chris Hani

Baragwanath academic hospitals – achieved an

overall average compliance score of 47.5 % in

the 2011/12 self-assessment and overall scores

ranging from 70% to 80 % in 2012/13.

• Regional and tertiary hospitals improved from

an overall average of 67% in 2011/12 to 72% in

2012/13.

• District hospitals increased compliance from an

overall average of 62.3% in 2011/12 to 73.5 %

in 2012/13.

The progress in district hospitals may be attributable

to the establishment of the facility improvement

team model in these hospitals and their use of the

national quality improvement plan. In Sedibeng,

hospitals followed the strategy of identifying and

addressing problem areas where “quick wins” were

possible.

More generally, inspectors from the Quality

Assurance Directorate discuss gaps identifi ed

during assessments with institutions. They

encourage the formulation of quality improvement

plans and monitor the implementation of these

plans.

28


Achievements in relation to the six priority areas

Within the National Core Standards for Health

Establishments, six national priority areas have

been identifi ed for urgent improvement. These

areas are:

• Improving values and attitudes of staff of healthcare establishments.

• Cleanliness of hospitals and clinics.• Reducing waiting times and queues.• Keeping patients safe and providing reliable

care.• Preventing the transmission of infections within

hospitals and clinics.• Making sure medicines, supplies and equipment

are available.

In Gauteng, quality improvement teams have been established in all districts to focus on achieving progress in these priority areas. Details of progress in some areas are provided below.

Infection prevention and control

The Department has introduced specifi c measures to improve infection control in public hospitals and there has been a measurable reduction in certain hospital-acquired infections.

The Department has a provincial Infection Prevention and Control (IPC) manager who works with a team of retired nurses to conduct inspections in neonatal and maternity wards. They compile weekly dashboard reports that serve as an early warning system of potential outbreaks of hospital-acquired infections.

The rollout of the Best Care Always (BCA) project reduced certain hospital-acquired infections substantially. BCA is a joint venture of the national DOH and the private health sector and it has been implemented in 28 provincial hospitals. The project focuses on ventilator-associated pneumonia, infection at surgical sites and bloodstream infections associated with catheter use. The following reductions in infection have been

observed between February 2010 and March 2013:

• Ventilator-associated infections have dropped

from affecting 30% of hospitals to 20%.

• Surgical site infections are down dramatically.

At the start of the project they were experienced

at 27% of hospitals and by March 2013 the

fi gure was down to 5%.

• Catheter-associated bloodstream infections

have been reduced from occurring at 30% of

hospitals to 25%.

The number of outbreaks of disease within

provincial hospitals has been reduced from 63%

of hospitals in 2010 to 18.8% in March 2013. Strict

adherence to simple infection-control measures,

such as health professionals using the Betasan

hand disinfectant gel, makes a critical difference.

Improved cleanliness in the health institutions

There is an improvement in compliance with the

cleanliness standards specifi ed in the National Core

Standards. The province-wide score has improve:

in 2011/12 the average score of institutions on

cleanliness indicators was 50% and it increased

to 65 % in 2012/13. However, this still represents a

high level of non-compliance.

The following measures were taken to improve the

cleanliness of health facilities:

• A group of 152 cleaners from hospitals, district

health services and central offi ce, received

training on the cleanliness requirements of the

National Core Standards to ensure that they

understood what was expected of them.

• Special processes have been adopted to resolve

bottlenecks in the procurement system thus

improving the availability of cleaning equipment

and supplies.

• The Department formed a partnership with

private companies to sponsor training for

cleaners. This resulted in more than 300

cleaners receiving training that followed a

corporate cleaning model.

29


Waiting times at health facilities

The Quality Assurance Directorate has developed

provincial benchmarks for waiting times in

out-patient departments (OPDs), accident and

emergency service areas, and pharmacies. Training

of queue marshals has been strengthened.

Continuous monitoring and evaluation of waiting

times has been implemented in all facilities.

There have been some improvements against

benchmarks:

• 75% – 80% of CHCs achieved the prescribed

provincial benchmark of 160 minutes from en-

try to exit of facility.

• 70% to 75% of hospitals achieved the prescribed

provincial benchmarks for waiting times at

out-patients departments, casualty, X-ray ser-

vices and pharmacies.

However, the results have been uneven. There has

been a marked reduction in waiting times at all

district hospitals and some clinics. However, two of

the central hospitals and all tertiary hospitals have

been unable to improve waiting times.

Strategies to address areas of underperformance

Proper queue management has been introduced

through appointment and training of queue

marshals. Fast queues have been established for

particular categories of patients. Signage is being

improved to direct patients to relevant service areas

and to fast queues.

There is training at all facilities to address staff

attitudes and to improve communication between

staff and end-users and their relatives. Private

partners are involved in this type of training. The

client satisfaction survey conducted annually

by the Department showed that clients saw an

improvement in staff attitudes especially at hospital

level. Overall 70% of healthcare users were satisfi ed

with the manner in which staff interacted with them.

This means that three out of every 10 patients is

still dissatisfi ed, indicating that challenges remain.

The Department identifi ed a leadership gap

in nursing management and established the

Provincial Nurse Leaders’ Forum. Members include

senior nurse managers from public and private

sector health institutions, nursing colleges and

universities. The focus is on understanding how to

inspire and execute best practice among nursing

staff at institutions.

Information and Communication Technology Sub-programme

The Department has an urgent need to upgrade

ailing ICT infrastructure which was mostly installed

more than 10 years ago. The ICT Directorate

developed an ICT strategy which is aligned with the

departmental business plan and also developed

individual implementation plans for different

functions, such as information management,

institutional arrangements and information

systems.

Data management

The DHIS Notifi able Medical Conditions (NMC)

Patient Module was designed and put into effect.

The Department completed a pilot project to

capture active surveillance data and interface

it with the intranet GIS. In a second phase of the

pilot project, MDR-TB cases were mapped as they

were confi rmed. Information offi cers were trained

to capture geo-coordinate data of MDR-TB cases at

Sizwe Hospital.

Records management

In 2012/13 the Department established 11 record

centres at central offi ce. A records management

policy is being developed together with a fi le

plan that will be sent to the National Archives for

approval. Other signifi cant achievements included:

• The design and implementation of a records dis-

posal programme.

• The drafting and approval of guidelines on the

preservation of patient records.

• The disposal of non-archival records.

30


• The establishment of an active and effective

Health Records and Archives Forum.

• The introduction by all hospitals of a tool to

monitor the recording, sorting and fi ling of pa-

tient fi les.

ICT enterprise management

In terms of ICT security, the Department has rolled

out Symantec End Point Protection to 90% of its

sites. This provides protection against malicious

codes with the potential to crash systems. Other

important interventions included the roll-out of the

patch management system, adoption of security

procedures and policies, and raising awareness

among end-users of acceptable computer use.

Help desk services were also provided to all internal

clients.

ICT infrastructure

The backbone or foundation of ICT is the

infrastructure through which systems are

implemented. A project to transform ICT in the

GDoH started with the upgrade of infrastructure

at the central offi ce and Pretoria West Hospital

and included the upgrade of data lines in some

central hospitals and central offi ce. The ageing

infrastructure at the central offi ce was replaced in

the course of 2012/13 and the server was upgraded

to an appropriate standard for the volume and type

of business it is required to support.

Risk Management Sub-programme

A detailed report on risk management appears in

Part C: Governance.

31


Performance indicators: Programme 1 - Administration

Strategic objectives:

• Improved client satisfaction rates.

• Improved achievement against national norms for health professionals.

• Employment equity and diversity management.

Programme1: Administration

Strategic objective

Actual achievement

2011/12

Planned target2012/13

Actual achievement

2012/13

Deviation from planned target

for 2012/13

Comment on deviation

Improved client satisfaction rate

Client

satisfaction

rate

69% 70% 67.5% (2.5%) Sustained

efforts are

required

from CEOs

of hospitals

to ensure

that results

from client

satisfaction

surveys are

utilised to

improve

service

provision.

Improved achievement of national norms

Medical

offi cers (22.6)

per 100 000

people

26.3 22 23.9 1.9 The target

of 22 was

exceeded. This

is due to an

accelerated

recruitment

drive. Salary

packages

of medical

offi cers have

improved.

32


Programme1: Administration

Strategic objective

Actual achievement

2011/12


Actual achievement

2012/13


for 2012/13


Professional

nurses (87)

per 100 000

people

109 105 103.8 (1.2) Appointments

were

constrained

by available

budgets.

Pharmacists

(3) per 100 000

people

4.2 8 7.1 (0.9) There was

signifi cant

improvement.

Employment equity and diversity management

Percentage

of women

in senior

management

41% 47% 35.8% (11.2%) Posts at senior

management

level are

currently

fi lled. When

vacancies

occur, female

candidates will

be prioritised.

Percentage of

people with

disabilities

0.5% 1.5% 0.8% (0.7%) Only critical

clinical posts

were being

fi lled and few

people with

disabilities

work in these

occupations.

33


Programme 1: Administration

Performance indicator

Actual achievement

2011/12


Actual achievement

2012/13


for 2012/13

Comment on deviations

Client

satisfaction

rate

69% 70% 67.5% (2.5%) Sustained

efforts are

required

from CEOs

of hospitals

to ensure

that results

from client

satisfaction

surveys are

utilised to

improve

service

provision.

Number of

CHCs with

waiting times

below agreed

benchmark

(35)

25 26 26 0 Trained

120 queue

marshals and

this improved

queue

management.

Number of

hospitals with

waiting times

below agreed

benchmark for

OPD (26)

18.5 18 19 1 Queue

marshals have

been trained to

improve queue

management.

Number of

hospitals with

waiting times

below agreed

benchmark for

casualty (26)

19.5 18 20 2 Exceeded

target. Work

will continue to

build capacity

of all staff

members to

contribute to

reduction of

waiting times.

34




Actual achievement

2011/12


Actual achievement

2012/13


for 2012/13


Number of

hospitals, with

waiting times

below agreed

benchmark for

pharmacy (26)

18 18 20 2 Exceeded

target. More

effort has

been devoted

to training

of queue

marshals.

Number of

hospitals

assessed

against the

National Core

Standards

# 25 25 0 There were

joint audits

conducted by

province and

national offi ce.

Capacity of

inspectors to

conduct audits

has improved.

Number of

CHCs assessed

against the

National Core

Standards

# 28 31 3 Target

achieved due

to improved

capacity of

inspectors.

Number

of clinics

assessed

against the

National Core

Standards

# 251 251 0 Achieved due

to improved

capacity of

inspectors.

Percentage

of women

in senior

management

(349)

41% 47% 35.8% (11.2%) Posts at senior

management

level are

currently

fi lled. When

vacancies

occur, female

candidates will

be prioritised.

# Indicator did not have baseline

35




Actual achievement

2011/12


Actual achievement

2012/13


for 2012/13


Percentage of

people with

disabilities

0.5% 1.5% 0.8% (0.7%) Only critical

clinical

posts were

advertised and

fi lled and there

are few people

with disabilities

in these

occupations.

Percentage

increase

in revenue

collection

3.4% 10% 12% 2% Revenue target

exceeded

because of

improved

processes and

liaison with

funders of

medical care.

Medical

offi cers per

100 000 people

26.3 22 23.9 1.9 The target

of 22 was

exceeded. This

is due to an

accelerated

recruitment

drive. Salary

packages

of medical

offi cers have

improved.

Professional

nurses per

100 000

109.0 105 103.8 (1.2) Appointments

were

constrained

by available

budgets.

Pharmacists

per 100 000

people

4.2 8 7.1 (0.9) There was a

signifi cant

improvement.

36




Actual achievement

2011/12


Actual achievement

2012/13


for 2012/13


Vacancy rate

for professional

nurses

8% 6% 8.7% (2.7) Appointments

were

constrained

by available

budgets.

Vacancy rate

for doctors

14% <20% 17.33% 2.67% Vacancy rate

was kept low

because of the

recruitment

drive for

clinicians.

Vacancy rate

for medical

specialists

9% <20% 11.03% 8.97% Vacancy rate

was kept low

because of the

recruitment

drive for

clinicians.

Vacancy

rate for

pharmacists

14% 20% 16.6% 3.4 Retention of

pharmacists

meant the

vacancies for

pharmacists

were reduced.

Expenditure: Programme 1 – Administration

2012/2013 2011/2012

Budget sub-

programme

Final

appropriation

Actual

expenditure

(Over)/Under

expenditure

Final

appropriation

Actual

expenditure

(Over)/Under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Offi ce of the

MEC 16 482 11 519 4 963 13 518 11 033 2 485

Management:

Health 666 965 489 843 177 122 494 076 432 200 61 876

Management:

Social

Development - - - 165 525 156 871 8 654

District

management - - - 169 475 152 301 17 174

Total 683 447 501 362 182 085 842 594 752 405 90 189

37


5.2 Programme 2: District Health Services


The purpose of the programme is to provide

comprehensive primary healthcare (PHC) services,

district hospital services, and comprehensive

HIV and AIDS care and to deliver priority health

programmes, including the nutrition programme.

The District Health System is the vehicle for the

delivery of PHC which encompasses a range

of basic health services and includes health

promotion, disease prevention, curative care, and

rehabilitation. PHC coupled with equitable access

to decent housing, clean water, sanitation, nutrition

and education has been shown to have a signifi cant

impact on health and health outcomes.


• District health management and PHC services.

• District hospitals.

• Maternal, child and women’s health and nutri-

tion

• HIV, AIDS, STIs and TB.

• Disease prevention and control.


• Reduce preventable causes of maternal deaths.

• Reduce infant mortality.

• Reduce child mortality.

• Reduce malnutrition in children.

• Reduce referrals for specialised psychiatric

care.

• Increase mobility among people with disabili-

ties.

• Reduce new HIV infections in youth and adults

through increased safe sex behaviours.

• Reduce new HIV infections in babies.

• Increase male circumcision among youth.

• Reduce deaths from TB through effective treat-

ment.

• Reduce death from AIDS through appropriate

treatment, care and support for 80% of people

living with HIV (PLHIV).

• Facilitate normal psychosocial development of

orphans and vulnerable children (OVC), includ-

ing children affected by AIDS.

• Increase partnerships on HIV and AIDS.


• Increase level of effi ciency in PHC facilities.

Sub-programme 2.1 District Health Management and PHC Services

Improving quality and effi ciency of PHC services

The GDoH comprises fi ve health districts: three

correspond to the metropolitan areas of Ekurhuleni,

Johannesburg and Tshwane and two to the district

councils of Sedibeng and West Rand. Each health

district is further organised into sub-districts, in

line with the administrative demarcations of the

municipalities. The number of sub-districts in each

health district is indicated below:

• Ekurhuleni: three sub-districts.

• Johannesburg: seven sub-districts.

• Tshwane: seven sub-districts.

• Sedibeng: three sub-districts.

• West Rand: four sub-districts.

Facilities offering PHC services within a health sub-

district include community health centres (CHCs),

community day centres, fi xed clinics, satellite clinics

and mobile clinics. In addition, district hospitals

provide the fi rst level of in-patient care. Some PHC

services extend beyond the walls of health facilities

into the community – for example, the ward-based

PHC outreach services and school health services.

At most PHC facilities, specially trained professional

nurses provide the bulk of curative health services

with the support of a medical offi cer to whom they

refer appropriate cases. Support services such as

investigative radiology and pathology are available

at district hospitals and some CHCs.

38


Re-engineering of PHC through three service

streams

PHC re-engineering was designed to strengthen PHC

services and help improve performance in terms of

the Millennium Development Goals. The strategy

consists of three streams which are calculated to

show rapid results in terms of promoting health,

preventing disease and reducing mortality. These

streams are: district clinical specialist teams, ward-

based PHC outreach teams, and the integrated

school health programme.

District clinical specialist teams

Each district clinical specialist team consists of an

obstetrician, a family physician, an anaesthetist,

a paediatrician, who is supported by a paediatric

medical offi cer, and nurses with specialist PHC,

advanced midwifery and paediatric expertise.

Specialist teams exist in all Gauteng health districts

although some districts do not yet have the full

complement of team members.

The GDoH appointed additional specialists in three

districts:

• A medical offi cer in obstetrics and gynaecology

was added in Johannesburg.

• A specialist and a medical offi cer in obstetrics

and gynaecology and a paediatrics specialist

were added in the West Rand.

• A specialist family physician and medical offi cer

were included in the Sedibeng team.

Training was undertaken to provide additional

advanced midwives, PHC nurses and paediatric

nurses to assist specialist teams.

Ward-based PHC outreach teams

Each ward-based PHC outreach team comprises

a team leader (who is a professional nurse), an

enrolled nurse, and six to eight community health

workers (CHWs). These teams are linked to the PHC

facilities serving the municipal wards in which they

operate. A total of 49 teams had been established

by the end of 2012/13. Sedibeng with 15 teams,

has the largest number. Ekurhuleni, Tshwane

and the West Rand each have nine teams while

Johannesburg has seven.

A total of 2 058 CHWs have been trained to deliver

the services envisaged in the PHC re-engineering

strategy and 29 professional nurses have been

trained as team leaders. Funding for this preparation

was provided by development partners. There are

plans to train an additional 27 professional nurses

as team leaders.

Integrated school health services

The Department has partnered with provincial

departments of education and social development

to provide integrated school health services.

Each school health team consists of a professional

nurse, an auxiliary nurse and a health promoter, and

is supported by an optometrist, an oral hygienist

and a dental assistant. There were 50 school health

teams in place at the end of 2012/13. There is a

need for 59 additional teams to reach all schools

serving residents in the two lowest income quintiles.

The target date for achieving this level of resourcing

is the end of 2013/14.

During the year, 225 877 learners were screened

for various conditions. Of these, 14 212 fell into

schools serving the poorest 40% of the population.

Improving access to PHC services

The overall headcount of patients at PHC facilities

in Gauteng increased from 22 711 585 in 2011/12 to

23 063 294 in 2012/13. The increase in visits can be

attributed to the ward-based outreach teams who

encourage community members to seek healthcare

where necessary.

Extended hours of operation at PHC facilities also

contributed to increased utilisation of services. In

the year under review, 26 out of 32 CHCs provided

24-hour services and 112 out of 317 clinics had

extended hours of operation. These clinics remained

open until 18h00 during the week and functioned

between 7h30 and 13h00 during weekends.

39


Rehabilitation and therapeutic services

The purpose of the rehabilitation and therapeutic

services is to ensure appropriate services to prevent

disability and restore the integration of people with

disability in the community. Such services are

offered in collaboration with other government

departments and disability organisations.

The Department provided 43 251 assistive devices,

such as wheelchairs and hearing aids, to assist the

reintegration of people with disabilities into their

communities. This exceeded the target of 33 000

assistive devices for the year.

The Vocational Rehabilitation Project prepares

adult patients, who have suffered an injury or illness

that resulted in a permanent disability, to regain full

employment within the open labour market. During

the year under review the vocational rehabilitation

team developed and promoted a screening tool to

facilitate referral of potential rehabilitation clients

to the central hospitals for full assessment.

The interdepartmental Early Childhood Intervention

Project aims to ensure that vulnerable children

have access to rehabilitation services as early as

possible. A parental information brochure about

children between the ages of 0 – 3 months was

developed with the aim of educating parents on

the expected milestones. The Offi ce of the Premier

is the custodian of the project. During 2012/13, a

total of 13 hospitals and two districts participated

actively in the project.

Sub-programme 2.2 District Hospitals

District hospitals saw a higher number of patients

at their outpatient departments than in the

previous fi nancial year. Outpatient visits and patient

admissions amounted to slightly more patient-day

equivalents than projected. The average length of

stay for inpatients was within the acceptable range.

Use of district hospital beds needs to increase in

order to achieve effi cient use of resources.

Sub-programme 2.3 HIV, AIDS, STIs and TB

HIV counselling and testing

There is a sustained commitment to increasing HIV

counselling and testing and in 2012/13 a total of

3 863 419 people were offered counselling for HIV

testing and 3 697 292 people underwent testing.

The fact that 93% of people counselled opted

to test is testimony to the improved standard of

counselling among lay counsellors.

Prevention of mother-to-child transmission

The HIV transmission rate from mothers living

with HIV to their babies reduced once more. Only

2.4% of babies tested at the age of six weeks were

HIV positive, compared to 3.6% in 2011/12. This

is partly due to a 3% increase in pregnant women

receiving long-term antiretroviral therapy (ART) and

a higher proportion of babies receiving nevirapine

within 72 hours of birth.

Antiretroviral therapy

The provision of ART to eligible individuals is one

of the most critical interventions for achieving the

department’s objective of reducing deaths from

AIDS. At the end of the year under review, there were

693 136 adults and 41 172 children receiving ART

in Gauteng.

40


The Department increased the number of facilities

providing ART from 359 to 364. This means ART is

now available at 90.3% of all public health facilities.

The capacity of facilities to expand the ART

programme was underpinned by the training of an

additional 5 582 nurses to initiate and manage ART.

During the year, a special information management

system, known as 3 TIER (TIER.NET), was extended

to all districts in order to improve the quality of data

available on the ART programme.

Medical male circumcision

Medical Male Circumcision (MMC) is a component of

reproductive health services and the HIV prevention

programme. The Department increased the number of MMC sites substantially in 2012/13, from 43 to 60. Although the desired target for MMC was not met there was a large increase in the number of procedures performed, from 51 205 in 2011/12 to 94 059 in 2012/13. The support of development partners was crucial to this achievement. Output on MMC was affected by limited space at health facilities and a shortage of staff.

Home and community-based care

The department funded 234 Non-Profi t Organisations (NPOs) to provide home and community-based care services. These organisations included 27 hospices that provide palliative care. In all, 80 577 people received care through these CHBC services during 2012/13. The programme is delivered by 7 081 active home-based carers, 6 555 of whom receive stipends. The number of home visits conducted by home-based carers in 2012/13 was 164 243, exceeding the target of 100 000 visits.

High transmission areas

A total of 63 locations have been identified as high transmission areas for HIV and these areas form a focus for peer education and condom distribution. A total of 131 972 200 male condoms and 2 368 915 female condoms were distributed across the province in 2012/13, from health

facilities and other distribution points.

Strategies for addressing underperformance

The district health information system (DHIS) does

not capture data from external partners, such as

business organisations and NGOs, and therefore

reporting on the number of individuals tested for

HIV in the province is not complete. Arrangements

will be made to add external partners as DHIS

reporting units.

Despite the increase in the number of individuals on

ART, this aspect of the programme has experienced

challenges. Limited support from some local

authorities, coupled with shortage of space in some

clinics, affected expansion of the ART programme.

While the department aimed to provide ART at 403

facilities in 2012/13, this was possible at only 364

facilities. Plans are underway to bring all health

services under the provincial authority and this will

speed up processes to ensure that all facilities offer

ART services.

Data collection and reporting remain a challenge,

as data submission from facilities is often delayed

and this results in under-reporting. The introduction

of the 3TIER system in all clinics will improve data

quality going forward and the employment of

additional data capturers should improve the flow

of information.

A matter of considerable concern is the high

number of clients lost to follow-up after ART is

initiated. The task of tracing these patients is made

more diffi cult when incorrect residential addresses

have been provided by patients. The involvement of

home-based caregivers in the follow-up of patients

may improve our success rate.

There were problems with condom availability at

health facilities during the year. This was because

suppliers who were awarded the national tender to

provide condoms had limited stocks of condoms

available and national DoH had a limited supply of

female condoms.

41


The Gauteng AIDS Council adopted the Gauteng

Strategic and Implementation Plans for HIV, TB and

STIs for 2012 to 2016. This includes a campaign

strategy and a draft fi ve-year plan. The plan is multi-

sectoral, involving all departments of government

and key sectors of civil society plus service NGOs.

Community education programmes met or

exceeded very large targets for 2012/13:

• Ward educators reached six million people

through door-to-door education.

• Community organisations communicated with

seven million people.

• Peer educators reached 933 059 people in high

risk settings.

Behavioural outcomes of HIV prevention

campaigns

The National Communication Survey (NCS) involves

a large representative sample of young people

and adults from across South Africa. It measures

patterns of belief and behaviour related to HIV

prevention. Provincial results of the survey are

available and the 2012 survey showed the following

outcomes for Gauteng province:

• Levels of knowledge of HIV prevention and

treatment for HIV and TB are high. There is very

high access to media in Gauteng and mass

media interventions on HIV reach 98% of youth.

• The highest use of condoms the last time they

had sex was reported by teenagers (80%).

Condom use declines with age.

• The practice of multiple sex partners continues

and is highest amongst young males of 20 to

25 years. One in four survey participants in this

group reported having more than one partner.

Females have fewer sex partners. Many men

with more than one sex partner still do not use

condoms.

• Since the mass HIV testing campaign started in

2010, 66% of adults have tested for HIV.

• Half of all men are already circumcised.

There are slightly more men who have been

medically circumcised than those undergoing

the traditional method. Men are willing to

circumcise and there is high demand for the

medical service.

• Young women aged 15 to 29 years have the

highest risk of new HIV infections. The NCS

points to the need for prevention programmes

to increase regular condom use among young

single women and their male partners.

• About half of young women have sex partners

who are fi ve or more years older than they

are. Older men tend to have younger partners.

Women in unequal relationships are less likely

to be able to insist on regular condom use. Sex

is often associated with partners who provide

benefi ts, including status, gifts or favours.

• Community programmes are quite extensive

but not visible enough to the public. Media

interventions need to be focused on all youth,

including educated and middle class youth.

Better use of social media is a priority.

Tuberculosis and HIV

Before the HIV pandemic, the incidence of TB

was declining. However, over the last 10 years TB

incidence has increased by 400%. TB is the number

one killer among HIV-positive populations. The high

prevalence of HIV is fuelling the TB epidemic and

more than 70% of TB patients are also living with

HIV.

Certain populations are at higher risk of TB

infection. These high-risk groups include healthcare

workers, mine workers, prisoners, prison offi cers

and household contacts of confi rmed TB cases.

In addition, certain groups have a greater chance

of progressing from TB infection to TB disease.

These include children, people living with HIV,

diabetics, smokers, people with silicosis, alcohol

and substance abusers and people who are

malnourished.

The department has adopted the new strategy

outlined in the Strategic Plan for HIV, TB and STI

2012-2016. Objectives of the plan are to:

• Reduce the TB case notifi cation rate by 50% by

2016.

42


• Reduce the TB mortality rate by 50% by 2016.

• Reduce the psychosocial impact of HIV and

AIDS and TB on individuals, families and

communities.

• Reduce stigma and discrimination.

• Increase the TB treatment success rate to 90%

by 2016.

Overview and performance of TB programme

During the year under review, a total of 367 086

people attending PHC facilities and outpatient

departments of hospitals (including patients known

to be HIV-positive) were screened for TB. Laboratory

tests confi rmed that 50 461 of these had active TB

and treatment was initiated. The number of new TB

patients is lower than in the previous year and this may

be due to the successful implementation of Isoniazid

prophylaxis, which reduces new TB infections among

PLHIV and children under the age of fi ve years who

are household contacts of TB patients. Isoniazid

prophylaxis was provided to 98 801 PLHIV, exceeding

the target of 80 000.

At the end of six months of treatment, 18 492 out

of 22 669 smear positive patients (82.4%) were

cured. This cure rate exceeded the target of 82%.

There was also a reduction in the rate of patients

defaulting on treatment before completion. This

contributed to the increased cure rate and also

reduced the risk of drug-resistant TB developing.

Only 1 092 patients defaulted on their treatment.

This translates to a defaulter rate of 4.8%, which is

below the target of 5%.

Multidrug-resistant TB continues to be a problem.

It is imperative that patients have their sputum

collected at the end of two months of treatment to

ensure that they are responding to the drugs and

have converted to smear negative. During 2012/13

the two-month smear conversion rate was 83.4%,

slightly exceeding the target of 82%.

Where TB patients are living with HIV it is important

to manage the two conditions in an integrated way.

More than 88% of TB patients were counselled and

tested for HIV in the year under review and 71%

tested HIV positive. More than half of these (54%)

were initiated on ART.

MDR-TB often develops in patients who fail to

complete their initial TB treatment. In total, 794

new cases of MDR-TB were confi rmed in 2012/13.

This number translated to 1.57% of all TB patients,

which is within the national limit of 2.5%.

The GeneXpert technology, which diagnoses TB

(including drug-resistant TB) within hours, has been

expanded from fi ve to 12 hospitals. The advantage

is that patients know their results within 48 hours

and treatment can then be initiated, unlike in the

past where patients were lost to the system whilst

waiting weeks for test results.

Patients who become resistant to the drugs used to

treat MDR-TB have developed XDR-TB. The number

of newly diagnosed patients with XDR-TB was 19, a

signifi cant decrease from 37 in 2011/12. Treatment

support and adherence contributed to this reduction

as did the decentralised management of MDR-TB.

The department has initiated talks with the Hospice

Palliative Care Association, which will assist with

treating drug-resistant patients in their homes. The

department has also commenced with creating

isolation wards for the treatment of MDR-TB in

district hospitals. This will allow patients to undergo

treatment close to home and will overcome the

problem of patients absconding while being treated

at Sizwe Hospital. The current default rate at Sizwe

Hospital stands at 21%.

With the help of the University Research Corporation

(URC), the TB programme expanded its capacity

to respond to TB by providing appropriate training

to various categories of internal and external

stakeholders, including 466 nurses, 60 traditional

healers, fi ve laboratory technicians, 72 doctors, and

74 other individuals in diverse occupations.

43


Intersectoral collaboration

The department has commenced meetings with

mining companies as the extremely high incidence

of TB on the mines. Effective management of TB

in the mining industry would go a long way to

reducing new infections and TB-related deaths in

the province.

The Aurum Health Institute opened a new clinical

trial facility at Tembisa Hospital. This centre will

conduct research on the prevention and treatment

of HIV and TB.

International relations

The department received delegates from the

Chinese government and the Democratic Republic

of Congo to learn from our best practices. The

NHLS was one of the places they visited.

Strategies to address underperformance

The turnaround time for sputum test results was

unsatisfactory: only 71% of results were delivered

within the specifi ed time and this was far below

the target of 90%. The underperformance was

attributed to instability within the NHLS. To address

this problem, more facilities will be equipped with

GeneXpert machines which produce results within

a few hours.

Sub-programme 2.4: Maternal, Child and Women’s Health and Nutrition

Maternal and newborn health

The achievment of targets relating to antenatal care

attendance before 20 weeks’ gestation remains a

major challenge. Only 37.8% of pregnant women

“book” (make their fi rst antenatal visit) during this

crucial stage for effective prenatal care.

The number of deliveries in facilities increased

slightly from 203 865 last year to 211 144 in

2012/13. This might reflect normal population

growth or indicate that more individuals perceive

the benefi ts of delivering babies in a health facility

with the attention of a skilled health worker.

Initiatives to reduce maternal mortality included

training of clinicians on Essential Steps in the

Management of Obstetric Emergencies (ESMOE). A

total of 188 doctors and 203 nurses were trained on

the management of obstetric emergencies during

2012/13. In addition, nurses were trained to use

early warning charts and implement the “Five Hs”

(a key component of Saving Mothers report and

the Campaign for the Accelerated Reduction of

Maternal Mortality in South Africa).

There was an observable improvement in coverage

of postnatal care for mother and baby within six

weeks of birth. Coverage for mothers increased

from 60% to 85% and for babies from 60% to 86.6%

during the reporting year.

Vitamin A supplementation for babies aged 6-11

months remained above target.

Child health

The programme on Integrated Management of

Childhood Illnesses is followed in 100% of facilities

that provide child health services.

During the National School Health Week 22

schools were visited. A total of 1 318 learners were

screened and 498 referred to appropriate services

for assistance with learning problems, poor vision,

hearing diffi culties, oral health problems and other

conditions.

Adolescent and youth health

The number of Youth-Friendly Services increased

from 117 to 121 in 2012/13 with the addition of four

facilities in the Sedibeng and Johannesburg health

districts. The percentage of babies born in health

facilities to mothers under 18 years dropped from

5.6% to 4.8% during the year. This fi gure is used as

a proxy for the teenage pregnancy rate.

44


Expanded Programme on Immunisation

The coverage rate for routine immunisation against

various vaccine-preventable conditions was

maintained above 90% of children in the relevant

age group during the fi nancial year. For instance:

coverage for full immunisation of babies under

one year was 107.9%; coverage for the fi rst dose

of measles vaccine was 111.6%; coverage for the

pneumococcal vaccine third dose was 109.3%;

and rotavirus vaccine second dose coverage was

112.4%. Coverage can exceed 100% when the

actual number of children immunised exceeds the

estimated number in that age group in the province.

Cross-border flows of patients and migration into

the province may be the reasons behind this.

The national health department conducted training

on effective vaccine management during the third

quarter of the year and this training was cascaded

to all districts.

Disease surveillance was carried out throughout

the year, with 89% of weekly surveillance reports

submitted during 2012. The department will

continue to strive for 100% reporting.

Surveillance for acute flaccid paralysis – which

must be investigated to rule out polio – was above

target. Traditional healers are being trained and

the participation of relevant community groups is

being sought to ensure that proper stool samples

are obtained for testing.

Women’s health, including reproductive health

The number of hospitals providing mammograms

for breast cancer screening has increased slightly

from six to seven. Collectively they performed

14 753 mammograms during 2012/13.

The number of screening procedures performed for

cervical cancer was 116 100, representing 44.1% of

the target group comprising women 30 years and

older.

In terms of contraceptive use, the woman-year

protection rate was 26.9% and the couple-year

protection rate was 28.3%. In order to support the

goals of universal access to contraceptives and

choice in terms of method of contraception, 49

master trainers were trained in the insertion of the

intrauterine contraceptive device.

Nutrition and hospital food services

Mother Baby Friendly health facilities play an

important role in infant nutrition because of the

support they provide for breastfeeding. The number

of GDoH facilities accredited as Mother Baby

Friendly increased from 38 to 44 during 2012/13.

This means that 73% of maternity facilities in the

province are now accredited and the aim for the

coming year is to accredit another six facilities.

Orientation and capacity building on nutrition

assessment, care and support was conducted with

the assistance of the Programme for Advancing

Technology on Health (PATH). Participants

comprised 73 district and facility managers and

members of the paediatric clinical specialist teams

in the districts.

Training of professional healthcare professionals

in the area of nutrition has yielded positive results:

correct classifi cation of severe malnutrition has

contributed to a lower number of cases in children

under the age of fi ve years.

Food service audits were conducted in 20 health

facilities.

The department increased the number of early

childhood centres funded from 831 to 929 with

a corresponding increase in the number of

benefi ciaries from 37 342 to 44 160.

Healthy lifestyles

A total of 296 health promoters and CHWs received

training on subjects ranging from childhood cancer

and the Integrated Management of Childhood

Illnesses to malaria and tobacco control legislation.

45


During the year, 557 health promotion events and campaigns took place. Usually they combined educational activities with screening for hypertension, diabetes and HIV.

The department established 271 walking clubs in 2012/13. Members of existing support groups for non-communicable diseases and older persons played a leading role in stimulating community interest in walking clubs. Additional healthy lifestyle activities took place at 1 293 venues – work places, service centres, luncheon clubs and youth clubs. A total of 95 health promoters were trained to assist with the organisation of Golden Games, an initiative of the Department of Social Development which aims to keep older people physically active.

Other health promotion activities during included a door-to-door awareness drive on paraffi n safety which focused on informal settlements and hostel residents in the West Rand district, and a TB and STI awareness event conducted for students at Monash University.

Health promotion in schools

Learners from 706 schools received education on various aspects of healthy lifestyles, including the dangers of smoking, drugs and substance abuse, prevention of pregnancy, medical male circumcision, healthy eating and physical activity.

In partnership with Awuzwe Communications, demonstrations were conducted on correct hand washing techniques. These reached about 104 103 learners from 138 schools in the province and 5 492 hand washing bags were distributed to participating schools. Similar campaigns were conducted for children in crèches and informal food vendors.

In collaboration with the Gauteng Department of Education (GDE), a number of health promoting schools (HPS) activities were conducted. These included advocacy sessions on HPSs in 582 schools and 197 assessments for accreditation of schools as HPS. A total of 111 schools met the WHO criteria

and were awarded HPS certifi cates.

Health promotion in clinics

Health education activities, mostly focused on

health lifestyles, were conducted in 775 clinics. A

Move for Health campaign was run and included

talks on the benefi ts of exercise and a fun walk

in which more than 5 000 community members

participated. A special effort was made to include

pregnant women in the campaign. A school holiday

programme benefi ted 320 learners. Exhibitions on

nutrition, TB and healthy lifestyles were displayed

in clinics.

Health promotion at crèches and early learning

centres

Activities on healthy lifestyles were conducted at

597 crèches. A total of 95 facilities participated in

the Healthy Baby & Growth Monitoring Initiative, in

partnership with Johnson & Johnson. More than

705 child minders and 156 community members

received training on the community component of

the Integrated Management of Childhood Illnesses.

Health promotion on maternal and women’s health

Awareness campaigns on breast cancer and

cervical cancer were conducted in Ekurhuleni

and the West Rand and benefi ted 1 324 women,

including some older women. A door-to-door

initiative to promote early booking for antenatal

care reached a total of 566 men and women in

Magagula Heights, Ekurhuleni.

Strategies for addressing areas of underperformance

There is a continued loss of health promoters as

they opt for careers in nursing. This turnover affects

performance and the department is offering health

promoters avenues for improving their career

prospects within the fi eld of health promotion.

Gauteng was responsible for an initiative to produce

an induction manual in health promotion and

introductory training for health promoters. Funding

was sought from the Japanese International

Cooperation Agency (JICA) and at this point the national health department became involved.

46


The intention is to expand the project so that the training will eventually culminate in an NQF level 4 qualifi cation for health promoters.

Some schools were reluctant to give health promoters time to conduct healthy lifestyles activities but discussions have resulted in a number of these schools agreeing to accommodate health promotion after 13h00.

Health promotion programmes were sometimes constrained by a shortage of vehicles. This issue is being addressed through the departmental Turnaround Strategy.

There are areas of advocacy where health promotion has had a minimal response. These include the promotion of vitamin A supplementation, early attendance of antenatal clinics and follow-up HIV testing of babies born to mothers living with HIV. The plan is to seek the collaboration of faith-based organisations in these advocacy initiatives.

Sub-programme 2.5: Disease Prevention and Control

Non-communicable diseases, geriatric care and eye care

The West Rand district is participating in a pilot project on the Integrated Chronic Diseases Care Model, which is an initiative of the national health department. Fifteen facilities are involved in the pilot which aims to improve chronic diseases management. The Bertha Gxowa District Hospital is participating in a National Cancer Registry pilot project. All cancer cases are systematically entered into the cancer register which will help track incidence and types of cancer and this information will inform programme planning.

Inspections took place at 32 old age homes and health reports were issued for re-registration of

these homes.

A total of 323 doctors and nurses participated

in training on national protocols and guidelines

for a variety of chronic conditions: rheumatic

fever, rheumatic heart disease, chronic kidney

disease, chronic renal dialysis, cancer detection at

community level and obstructive sleep apnoea.

A public-private partnership resulted in a

successful World Sight Day event held in Dhlamini

Multi-purpose Hall in the Johannesburg region.

A total of 361 people were screened, 187 pairs

of spectacles were issued and 130 people were

referred for further management. There were 26

district-level awareness campaigns and events

in Eye Care Awareness Month during which 2 814

people were screened for eye problems, 187 pairs

of spectacles were issued and 944 people were

referred for further management. In addition,

eye care outreach services benefited 30 old age

homes and 200 pairs of spectacles were provided to residents of these homes.

The department employed three optometry bursary holders at district facilities.

Partnerships were forged with the Brian Holden Vision Institute for the purpose of improving eye care services in the Johannesburg District and with African Vision in order to increase capacity for cataract surgery.

A total of 35 new chronic disease support groups were established in various districts: 11 for people with diabetes, 14 for people with epilepsy, nine focusing on hypertension and one dealing with cancer. Campaigns were held in the districts to mark World Diabetes Day, World Older Persons Abuse Day, World Sight Day, World Glaucoma Day and World Kidney Day.

In terms of primary prevention of diseases, a total of 19 997 men over the age of 45 were screened for the prostate-specifi c antigen, a predictor of prostate cancer. Of those screened, 2 543 were found to have raised levels of the antigen and were

referred to appropriate management.

47



The department has allocated a specifi c budget

for cataract surgery and has accelerated the fi lling

of posts for ophthalmologists. The department

continues to provide bursaries to students in the

fi eld of optometry.

Oral health services

A dental examination card is now being attached to

the Road to Health Chart that is opened for every

young child attending PHC facilities. This system

ensures that children who present themselves for

immunisation also receive a dental examination.

Oral health promotion is integrated into school

health programmes and is generously supported by

private sector donors. As a result, 151 000 learners

were involved in tooth-brushing initiatives.

Mental health and substance abuse services

PHC facilities serve as the entry point for mental

healthcare. In order to improve capacity in these

facilities for assessing, diagnosing and treating

common mental health disorders, 138 nurses and

74 medical doctors received relevant training. In the

year under review, 74% of PHC facilities were able to

provide mental health services.

At 107 CHCs and clinics there are multidisciplinary

teams for the provision of out-patient mental

healthcare to adults and children referred to these

facilities. Some of these clinics and CHCs facilitate

support groups for individuals with mental health

and substance abuse problems.

Non-governmental organisations (NGOs) are

licensed by the department to provide day care

and residential care to individuals with severe

psychiatric disability and profound intellectual

disability. A total of 4 681 persons were assisted

in this way by NGOs, some of which also received

funding from the department. These services are

an alternative to inpatient hospital care.

Services to prevent and reduce the harm of

illicit drugs are provided at district level, while

general hospitals provide emergency and acute

detoxifi cation services for substance abuse. The

use of drugs often causes or compounds mental

illness and PHC services provide community

management for persons with the dual diagnosis

of mental illness and substance abuse.

Communicable Diseases Control and Surveillance

All communicable disease outbreaks were reported

and responded to within 24 hours. The province

had only one case of imported cholera during the

year and there was no transmission beyond this

patient. This containment of cholera is mainly due

to consistent monitoring of water by Environmental

Health Services.

The Provincial Surveillance Task Team meets

regularly to ensure maintenance of systems for

tracking specifi ed communicable diseases and

containing their spread. A successful campaign to

prevent influenza saw the immunisation of more

than 30 580 pregnant women and 26 000 children

under the age of fi ve years. The department utilised

more than 99% of vaccines available.

Malaria deaths continued to be a matter of concern.

Since Gauteng is not a malaria-endemic area, levels

of public awareness are not suffi ciently high. All

reported malaria deaths in Gauteng were audited.

Provincial surveillance guidelines have been

implemented and are in the process of being

revised. These assist communicable disease

control coordinators and surveillance offi cers in

the early detection and containment of outbreaks.

Progress was made on developing a module on

notifi able medical conditions for the DHIS and it will

be put into effect in 2013/14.

Strategies to address areas of under-performance

Audits of malaria deaths have revealed that late

treatment is a major contributor to the high malaria

fatality rate. In order to address this, malaria alert

48


posters and malaria treatment guidelines were

distributed to all facilities in the province to create

awareness and improve disease management.

There is also ongoing training of doctors and

nurses.

Social mobilisation campaigns were conducted

targeting travellers returning from malaria-endemic

areas and focusing on areas in Gauteng where

malaria deaths had previously occurred. Messages

focused on early recognition of malaria symptoms

and encouraging people with these symptoms to

seek early treatment. The intention is to collaborate

with taxi associations servicing relevant routes.

Environmental and Port Health Services

In 2012/13, environmental health offi cers inspected

172 public health facilities to establish whether

they had safe potable water and 223 facilities to

establish whether they met sanitation standards.

Municipal environmental health offi cers collected

2 235 samples which were analysed by the NHLS

to establish whether they complied with food

safety requirements. Only 36 food samples failed

to comply: they were contaminated with toxins

produced by strains of staphylococcus aureus.

A total of 41 dealers in hazardous substances were

inspected and those complying with the Hazardous

Substances Act were granted licences for a period

of one year.

More than 18 396 aircraft from malaria-endemic

countries that landed at OR Tambo and Lanseria

international airports were disinsected according

to the International Health Regulations of 2005. A

total of 7 662 aircraft from yellow fever-endemic

countries were also disinfected. During 2012/13

permission was granted for 783 air ambulance

flights to transport sick passengers into the country.

All these flights complied with International Health

Regulations.

The department received an award from the

National Institute of Communicable Diseases for

the successful Viral Watch Programme at the OR

Tambo International Airport Clinic. This programme

tracks trends in various agents that cause upper

respiratory tract infections.

Consistent application of the national yellow

fever guidelines in respect of visiting heads of

state, government ministers and diplomats is a

matter that continues to require attention. The

national Department of Health is managing these

challenges in collaboration with the Department of

International Relations and Cooperation.

Sub-programme 2.6 Forensic Pathology Services

The Forensic Pathology Service undertook

infrastructural upgrading projects at seven of

the province’s 11 forensic mortuaries. This not

only improved the working environment but also

ensured compliance with occupational health and

safety requirements.

Working with the Development Bank of Southern

Africa and the Department of Infrastructure

Development, the department fi nalised projects

briefs related to the building of three new forensic

mortuaries in Johannesburg, Daveyton and

Bronkhorstspruit.

Stakeholder meetings were held at regional level

with the South African Police Service (SAPS),

hospitals and undertakers to address operational

challenges.

During the 2012 16 Days of Activism against

Violence against Women and Children the

department opened a dedicated clinic for survivors

of violence at the main PHC facility in Daveyton,

Ekurhuleni. Permission has been granted to

establish three similar structures for the treatment

of survivors of violence in Sedibeng, Johannesburg

and West Rand District.

49


In an effort to strengthen clinical forensic services

a meeting was held with the Nursing Council and

national DoH about the recognition of a specialty in

forensic nursing. Subsequently, Gauteng province

hosted a Forensic Nurses Forum with a view to

launching the Forensic Nurses Association.


The budget does not fully support the approved

staff establishment for clinical forensic services

and the resulting vacancies mean that the required

24-hour service is not always available. This will be

discussed with senior management.

Gauteng has the highest number of unnatural

deaths in South Africa. The department has

prioritised implementation of the National Strategic

Framework for Prevention of Non-natural Deaths. It

remains the only province reporting on preventive

activities in this regard. Implementation of the

strategy demands a multi-sectoral approach and

the department has secured the collaboration

of the departments of Community Safety, Social

Development, Education, Local Government and

SAPS, as well as certain community structures.

50


Performance indicators: Programme 2 – District Health Services

Strategic objectives:

• Reduce preventable causes of maternal deaths.

• Reduce infant mortality.

• Reduce child mortality.

• Reduce malnutrition in children.

• Reduce referrals for specialised psychiatric

care.

• Increase mobility among people with disabili-

ties.

• Reduce new HIV infections in youth and adults

through increased safe sex behaviours.

• Reduce new HIV infections in babies.

• Increase male circumcision among youth.

• Reduce deaths from TB through effective treat-

ment.

• Reduce death from AIDS through appropriate

treatment, care and support for 80% of people

living with HIV (PLHIV).

• Facilitate normal psychosocial development of

orphans and vulnerable children (OVC), includ-

ing children affected by AIDS.

• Increase partnerships on HIV and AIDS.


• Increase level of effi ciency in PHC facilities.

Sub-programme: District Health Management and PHC Services

District Health Management and PHC Services


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Improved health and wellbeing with an emphasis on vulnerable groups

Maternal

mortality rate

(MMR)

145/100 000

live births

160/100 000

live births

117.3/100 000

live births

42.7/100 000

live births

The fi gure for actual

achievement is an

estimate from DHIS

as the applicable

Saving Mothers

report with offi cial

data will only be

available in 2014/15.

Infant mortality

rate (IMR:34 per

1 000)

6.4/1000 live

births

30/1000 live

births

5/1000

live births

(25)/1000

live births

These are estimates

from DHIS. Data

integrity needs to be

addressed.

Mortality rate

(CMR: 43 per

1 000)

2.4/1000 live

births

25/1000 live

births

3.7/1000

live births

(21.3)/1000

live births

These are estimates

from DHIS. Data

integrity needs to be

addressed.

51




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Severe

malnutrition:

under 5 years

incidence

(0.27)

2.8 % 3.5% 2.5% (1%) Target exceeded

due to ongoing

training of health

professionals,

community

mobilisation and

surveillance.

Incidence of

hypertension

0.5% No target 0.3% n/a Health promotion

will be intensifi ed

to encourage

self-monitoring by

members of the

public.

Incidence of

type 2 diabetes

(2.7%)

0.3% 2.7% 0.2% 2.5% Rate of type 2

diabetes was

lower than

target but social

mobilisation needs

to be strengthened

to encourage

screening, promote

healthy lifestyles

and strengthen

treatment

adherence.

Reduce deaths

from TB and

AIDS by 20%

5.7% 6% 5.4% (0.6) Timely provision of

TB treatment and

ART.

70% of people

who require

ART are on

treatment

600 284 992 000

(70%)

734 308 (257 692) The failure to initiate

the targeted number

on ART points to a

need to strengthen

the continuum of

care.

52




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Medical Male

circumcision

among Gauteng

youth

51 205 138 841 94 059 (44 782) Challenges

in relation to

infrastructure and

appointment of staff

limited capacity to

perform MMC in

clinics.

Reduce deaths from TB through effective TB treatment

Cure rate 61% 82% 82.4% 0.4% Effective DOTS

support by CHWs

working with PHC

outreach teams,

availability of drugs

and well-functioning

laboratory system

contributed to the

achievement.

Reduce new HIV infections in babies

Transmission

rate

3.6% <5% 2.4% (2.6%) Result is based on

test conducted at six

weeks of age. More

pregnant women are

on ART and most

babies are receiving

nevirapine within 72

hours of birth.

Reduce death from AIDS through appropriate treatment, care and support for 80% of people living

with HIV (by 2016)

Total number

of adults and

children on ART

(cumulative)

600 284 992 000 734 308 (257 692) The failure to initiate

the targeted number

on ART points to a

need to strengthen

the continuum of

care.

53




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Improved client satisfaction rate

Client

satisfaction

rate for district

hospitals

65% 85% 66% (19%) Not achieved.

Challenges existed

in meeting National

Core Standards,

especially in relation

to cleanliness,

waiting times and

staff attitudes.

Increased level of effi ciency in PHC facilities

Total patient

headcount

(19.6 million)

22 711 585 21 000 000 23 063 294 2 063 294 Annual target of 21

million exceeded. A

contributory factor

may be the number

of patients seen in

their homes by ward-

based outreach

teams.

Utilisation rate:

PHC

(1.8 million)

2.0 2.5 2.0 (0.5) Many PHC patients

are still being treated

at higher levels of

care and renewed

efforts are needed

to redirect patients

to the appropriate

facility.

Utilisation rate:

PHC under 5

years

(4 million)

2 2.5 4.2 (0.5) Many PHC patients

are still being treated

at higher levels of

care and renewed

efforts are needed

to redirect patients

to the appropriate

facility.

Supervision rate

80%

86.5% 95% 90.7% (4.3%) Transport challenges

have obstructed

scheduled monthly

supervisory visits to

some facilities.

54




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Provincial PHC

expenditure per

head

(R 265.35)

R110 R225 R132.36 (R92.64) An increase in

patients, beyond the

targeted fi gure, led

to lower expenditure

per patient seen.

% complaints

resolved within

25 days

(100%)

100% 100% 94% (6%) The fi gure for

actual performance

is based on joint

audits conducted

by provincial and

national department

Increased level of effi ciency in district hospitals

Average length

of stay

( 3.5days)

3.5 days 3.0 days 3.2 days 0.2 days The condition of

each patient is

assessed at regular

intervals. Most

health conditions

treated at level 1

hospitals do not

require prolonged

treatment.

Caesarean

section rate

(16%)

22% <15% 21.2% (6.2%) Obstetrical

complications due

to late presentation

and HIV epidemic

increase caesarean

sections.

Bed utilisation

rate

(75%)

64% 75% 66.3% (8.7%) Level 1 cases are

still treated at

hospitals offering

higher levels of care

and not referred

back to district

hospitals.

55




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Expenditure

per patient-day

equivalent

(1 600)

R1 811 R1 250 R2 031.98 R781.98 Expenditure

substantially above

target may be due

to an increase in

surgery performed

at district hospitals.

Some district

hospitals are

assisting tertiary

hospitals with

caesarean sections

and this increases

costs.

Patient-day

equivalents -

Total

(825 000)

870 728 813 200 885 094 71 894 PDEs were

slightly higher

than projected.

Secondary and

tertiary hospitals

should continue

re-directing patients

to district hospitals

where appropriate.

OPD headcount

- Total

(870 950)

696 782 833 971 739 783 (94 188) The number

of outpatients

seen at district

hospitals was below

projection. However,

the PHC headcount

was higher than

projected and

regional hospital

OPDs also had more

visits than expected.

Patients may be

selecting these

facilities.

56




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Improved health and wellbeing with an emphasis on vulnerable groups

Number of

assistive

devices

provided

(31 092)

45 635 33 000 43251 10 251 A dedicated central

budget for assistive

devices augmented

facility budgets.

Number of

CHCs with 24-

hour access

as a percentage

of total number

of CHCs

25 32 26 (6) Financial constraints

have impeded

expansion of 24-

hour services. Only

one CHC was added

to those already

offering 24-hour

access.

Number of

fully trained

community

health workers

(cumulative)

0 3 000 2 058 (942) Insuffi cient funding

resulted in training

shortfall.

Number of

ward-based

outreach teams

established

(cumulative)

22 32 49 17 The target was

substantially

exceeded. The

intervention is

supported by the

Extended Public

Works Programme.

Professional

nurse clinical

workload (PHC)

31.7

consultations/

day

40

consultations/

day

32.9

consultations/

day

(7.1)

consultations/

day

PHC re-engineering

should improve

health system

effi ciency and

achieve a more

strongly nurse-driven

model.

57




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Doctor clinical

workload (PHC)

35.7

consultations/

day

30

consultations/

day

36.6

consultations/

day

6.6

consultations/

day

Workload of doctors

has increased as

a result of doctors

conducting outreach

to smaller clinics

that do not have a

permanent doctor

on site.

Provincial PHC

expenditure

per uninsured

person

R294 R400 R366 R34 There has been

an increase in

spending on PHC

per uninsured

resident which

reflects stronger

prioritisation of PHC.

PHC total

headcount

22 711 585 21 000 000 23 063 294 2 063 294 The number of

patient visits to PHC

facilities exceeded

the projection by

more than two

million.

PHC total

headcount

under 5 years

4 202 126 4 300 000 4 145 897 (154 103) Some patients may

still be choosing

hospital OPDs rather

than CHCs and

clinics. Ward-based

outreach teams

may be attending to

some problems in

the community.

Utilisation rate

- PHC

2.0 visits/

uninsured

resident

2.5 visits/

uninsured

resident

2.0 visits/

uninsured

resident

(0.5) visits/

uninsured

resident

On average, patients

visit facilities twice

a year which was

slightly less often

than expected.

Utilisation rate:

PHC under 5

years

4.2 visits/child 5.0 visits/

child

4.2 visits/child (0.8) visits/

child

Average number of

visits for children

under the age of fi ve

was slightly lower

than expected.

58




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Percentage

of fi xed PHC

facilities with

a monthly

supervisory visit

86.5% 95% 90.7% (4.3%) Cost containment

measures impacted

on availability

of transport for

supervisory visits.

This concern has

been addressed

and sub-district

management teams

will be strengthened

in 2013/14.

Expenditure per

PHC headcount

R110 R225 R 132.36 (R92.64) The increase in total

number of visits

contributed to low

expenditure per visit.

Finite resources

were stretched

to attend to more

patients.

Percentage

of complaints

of users of

PHC services

resolved within

60 days

100% 100% 94% (6%) The number of

complaints received

from patients and

public increased

from 3 100 in

2011/12 to 6 750 in

2012/13.

CHCs with a

resident doctor

rate

100% 100% 100% 0 All CHCs have a

resident medical

offi cer and a family

physician.

Number of

PHC facilities

assessed for

compliance

against the

National Core

Standards

72 72 282 210 There were joint

audits conducted

by provincial and

national health

departments.

59


Sub-programme: District Hospitals

District Hospitals


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Caesarean

section rate

22% 15% 21.2% 6.2% Some district

hospitals perform

caesarean sections

on behalf of

neighbouring

central and regional

hospitals.

Separations -

total

166 388 180 078 179 871 (207) Within projected

range.

Patient-day

equivalents -

total

870 728 813 200 885 094 71 894 Slightly higher PDEs

than the projected.

OPD

headcounts -

total

696 782 833 971 739783 (94 188) The number of

outpatients seen at

district hospitals was

below projection.

However, the PHC

headcount was

higher than projected

and regional hospital

OPDs also had more

visits than expected.

Patients may be

selecting these

facilities.

Average length

of stay

3.5 days 3.0 days 3.2 days 0.2 days Patients are assessed

at regular intervals

and discharged when

appropriate. The type

of conditions treated

at level 1 hospitals

do not usually require

prolonged treatment.

Bed utilisation rate

64% 75% 66.3% (8.7) Level 1 cases are still treated at hospitals offering higher levels of care and not referred back to district hospitals.

60


District Hospitals


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Expenditure per patient-day equivalent (PDE)

R1 811 R1 250 R2 031.98 R781.98 Expenditure per patient-day exceeded projections. This could be due to the low bed utilisation and/or the increase in surgery (including caesarian sections) performed at district hospitals.

Percentage of complaints of users of district hospital services resolved within 25 days

100% 100% 87.4% (12.6%) Some complex complaints require more than 25 working days to resolve.

Percentage of District hospitals with Mortality and Morbidity meetings every month

10/10 10/10 10/10 0 The holding of mortality and morbidity meetings is encouraged and supported through meetings and workshops with clinical managers. The district clinical specialist teams have contributed to the practice of regular mortality and morbidity meetings.

District hospitals Patient Satisfaction rate

65% 85% 66% (19%) Hospitals experience challenges in meeting National Core Standards on cleanliness, waiting times and staff attitudes.

61


District Hospitals


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Number

of district

hospitals

assessed for

compliance

against the 6

priorities of the

National Core

Standards

10 5 9 4 Improved capacity of inspectors enabled them to undertake more audits. There was joint auditing by provincial and national inspectors.

62


Sub-programme: Oral Health and Rehabilitation Services

Oral Health and Rehabilitation Services


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13

Deviation from planned

target 2012/2013


Number of

assistive

devices issued

45 635 33 000 43 251 10 251 There was a

dedicated central

budget for assistive

devices that

supplemented facility

budgets.

Number of

fi ssure sealants

placed

54 242 52 500 52 769 269 Performance was

within range of target.

Number of

dentures

delivered to

pensioners

5 690 5 500 6 906 1 406 The availability of

students in oral

health centres and

improvement in

pensioners’ grants

contributed to better

access to this service.

Number

of schools

learners on

tooth brushing

programmes

134 391 130 000 151 000 21 000 Target achieved

due to generous

donations of tooth

brushes and pastes

by private companies.

63


Sub-programme: HIV, AIDS, STIs and TB

HIV, AIDS, STIs and TB


Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target 2012/13


Number of people in high risk groups reached with peer education

555 479 700 000 933 059 233 059 Target achieved due to high output from peer educators.

Number of people reached with ward-based education

2 765 487 6 000 000 6 090 898 90 898 Target achieved due to increased implementation of ward-based outreach teams.

Number of CBO members reached with education and support

4 193 563 5 000 000 8 891825 3 891 825 Target substantially exceeded due to increased partnerships with community organisations that provided implementation capacity.

Numbers reached with media

6 438 000 6 000 000 7 281 848 1 281 848 Target achieved due to increased visibility of AIDS campaigns.

Number of civil society leaders trained on multi-sectoral AIDS programme

7 340 10 000 9 268 (732) Service contract delays impacted on the ability to achieve the target.

Number of government (GPG and municipal) managers trained on multi-sectoral programme

0 600 294 (306) Service contract delays impacted on the ability to achieve the target. Training will be completed during Q1 of 2013/14.

Number of people acccesing HCT

# 3 000 000 3 863 419 863 419 All health facilities offer HCT

64




Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target 2012/13


Percentage of clients tested for HIV to those counselled (excl antenatal)

95.8% 95% 95.7% 0.7% Good quality pre-test counselling resulted in high uptake of testing.

Number of male condoms distributed

77 383 000 214 000 000 131 972 200 (82 027 800) The data includes data from DHIS (44 747 556) and data other sources (87 224 644). Limited stocks of condoms from suppliers impacted on the achievement of the target.

Number of female condoms distributed

600 834 2 782 000 2 368 915 (413 085) Limited national supply of female condoms.

Number of males circumcised

51 205 138 841 94 059 (44 782) The number of male circumcisions improved compared to the previous year.

Transmission rate from mother to child

3.6% <5% 2.4% 2.6% Improved PMTCT implementation.

Number of ART sites accredited

359 403 364 (39) Expansion was limited by infrastructural factors.

ARV drug Stock out rate

3.3% 0 6.1% (6.1%)Suppliers of drugs did not meet the demand.

Total number of adults on ART

564 520 942 000 693 136 (248 864) The failure to initiate targeted number on ART points to need to strengthen continuum of care.


65




Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target 2012/13


Total number of children on ART

35 764 50 000 41 172 (828) The department is performing relatively well in identifying children requiring ART.

Male condom distribution rate

7.9 12 10.3 (1.7) Low stock from suppliers had an impact on distribution rate.

New smear-positive defaulter rate

5.7% 5.0% 4.80 0.2% Intensifi ed defaulter tracing led to fewer TB patients defaulting on treatment.

HCT testing rate

93% 95% 93.1% (1.9%) Good quality of pre-test counselling secured high uptake of testing.

PTB two-month smear conversion rate

82% 80% 83.4% 3.4% High sputum testing rate due to good monitoring of patients and education on importance of sputum assessments at two months.

Percentage of HIV-TB co-infected patients placed on ART

75% 45% 54.80% 9.8% More ART sites opened. Trained staff, availability of drugs, and TB patients knowing their HIV status contributed to achievement of target.

New smear-positive PTB cure rate

81.3% 82% 83.10% 1.1% Effective directly observed treatment support by CHW helped improve cure rate.

66




Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target 2012/13


Smear result turn-around time under 48 hours

80% 82% 71% (11%) High staff turnover at some of the laboratories resulted in longer turn-around times.

Sub-programme: Maternal, Child and Women’s Health and Nutrition

Maternal, Child and Women’s Health and Nutrition


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Number of facilities with maternity services newly certifi ed as BFHI

9 5 6 1 Target achieved due to commitment by management, training of healthcare providers and community participation.

Percentage of fi xed PHC facilities implementing IMCI

98.8% 98% 100% 2% Target achieved due to commitment by management and training of healthcare providers.

Vitamin A coverage 6-11 months

109.5% 90% 100.7% 10.7% Community mobilisation was sustained and there was good attendance at well-baby clinics.

Vitamin A coverage new (post partum mothers)

100.4% 90% 87.5% (2.5%) There was a minimal decline in postnatal coverage.

Antenatal clients initiated on AZT during antenatal care

78.7% 100% 78% (22%) Women with low haemoglobin are not given AZT.

67




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Antenatal clients Nevirapine uptake

54.6% 80% 52.3% (27.7%) Women on ART do not require single dose nevirapine.

Baby nevirapine uptake

98.4% 100% 95.5% (4.5%) The gap between target and performance is partly due to babies dying before receiving nevirapine.

Antenatal clients initiated on HAART rate

80.5% 80% 83% 3% Nurses have been trained to initiate ART and treatment can commence on site.

Severe malnutrition under 5 years incidence

2.8% <3.5% 2.5% (1%) Target exceeded due to ongoing training, community mobilisation and surveillance.

Number (rate) of deliveries in health facility

203 865 220 000 211 144 (8 856) Deliveries increased by 7 279 compared to the previous fi nancial year.

Immunisation coverage under 1 year

114.6% 90% 107.9% 17.9% Training on effective vaccine management occurred in all districts. Coverage can exceed 100% of the estimated number of children when there is rapid migration or use of services by residents of other provinces.

68




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Vitamin A coverage 12-59 months

47.7% 50% 46.32% (3.68%) Children in this age group are not regular clinic attendees unless sick. Coverage can be improved by training early childhood development centre managers.

Measles 1st dose under 1 year coverage

113.9% 90% 111.6% 21.6% All surveillance reporting units were visited twice this year. Under-performing units were visited more frequently. Coverage can exceed 100% of the estimated number of children when there is rapid migration or use of services by residents of other provinces.

Pneumococcal PCV 3rd dose coverage

102.8% 90% 109. 3% 19.3% Adequate vaccine stocks were available throughout the year. Coverage can exceed 100% of the estimated number of children when there is rapid migration or use of services by residents of other provinces.

69




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Rotavirus (RV) 2nd dose coverage

111.8% 90% 112.4% 22.4% Personnel have been made aware of need to adhere strictly to the immunisation schedule for this vaccine. Coverage can exceed 100% of the estimated number of children when there is rapid migration or use of services by residents of other provinces.

Diarrhoea incidences under 5 years

5% <1.3% 4.1% 2.8% Hand washing practices still not adequate. An interdepartmental committee will be set up to consider socio-economic determinants of health. Awareness on the use of zinc will be promoted.

Pneumonia incidence under 5 years

4.7% <5% 3.7% 1.3% Target achieved.

Cervical cancer screening coverage

45% 56% 44.1% (11.9%) Target not achieved. The GDoH is three years into a 10-year cycle which should conclude with 70% of eligible women receiving screening.

Antenatal visits before 20 weeks’ rate

34.6% 40% 37.8% (2.2%) The target was not achieved in spite of social mobilisation activities.

70




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Baby tested PCR positive six weeks after birth as a propotion of babies tested at six weeks

4.1% <5% 2.4% 2.6% There is a sustained reduction in mother-to-child transmission of HIV.

Couple-year protection rate

26.1% 45% 28.3% (16.7%) Data will be interrogated and if necessary programme adjustments will be made to achieve higher coverage.

Public Health Facilities Maternal mortality rate

145/100 000 live births

160/100 000 live births

117.3/100 000 live births

42.7/100 000 live births

The actual performance fi gure is an estimate derived from DHIS data. The offi cial fi gure will only become available when the next Saving Mothers report is published in 2014/15.

Delivery rate for women under 18 years

5.6% 6.5% 4.8% 1.7% Health promotion activities have contributed to the reduction in young mothers. There is a strong partnership between the departments of Health, Education and Social Development and support from development partners.

Public Health Facilities Infant mortality (under 1) rate

30/1000 live births

5.0/1000 live births

(25)/1000 live births

These are estimates from the DHIS. Data integrity needs to be addressed.

71




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Public Health Facilities Child mortality (under 5) rate

25/1000 live births

3.7/1000 live births

(21.3)/1000 live births

These are estimates from the DHIS. Data integrity needs to be addressed.

Malaria case fatality rate

1.3% <0.4% 1.1% 0.7% Cases imported from malaria- endemic areas present late at facilities and this often results in complications and deaths.

Cholera fatality rate

0% <1% 0.0 0 There is regular testing of tap and river water.

Cataract surgery rate

1 268/million 13 430/million

11 4 33/million (1 997) Target not achieved due to lack of dedicated cataract surgery budget in hospitals. Ring-fenced budget introduced in 2013/14.

72


Expenditure: Programme 2 – District Health Services

2012/2013 2011/2012

Final

appropriation

Actual

expenditure

(Over)/

under

expenditure

Final

appropriation

Actual

expenditure

(Over)/

under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

District

management 529 506 512 335 17 171 318 577 434 769 (116 192)

Community

health clinics 1 970 362 1 884 133 86 229 1 477 412 1 439 244 38 168

Community

health centres 1 103 078 1 184 942 (81 864) 1 049 815 1 065 918 (16 103)

Community-

based services 978 352 919 224 59 128 748 767 823 889 (75 122)

HIV and AIDS 2 262 327 2 134 361 127 966 1 912 390 1 727 578 184 812

Nutrition 50 342 49 411 931 41 948 32 192 9 756

Coroner

services 147 971 126 423 21 548 144 905 129 981 14 924

District

hospitals 1 740 546 1 745 127 (4 581) 1 546 458 1 585 610 (39 152)

Total 8 782 484 8 555 956 226 528 7 240 272 7 239 181 1 091

73


5.3 Programme 3: Emergency Medical Services


The purpose of the Emergency Medical Services

Programme (EMS) is to ensure rapid and effective

emergency medical care and transport as well as

effi cient planned patient transport, in accordance

with provincial norms and standards.

Developments during 2012/13

During 2012/13 EMS increased the vehicle fleet by

28 ambulances and six vehicles for planned patient

transport.

Response times remained a challenge in 2012/13.

However, the recapitalisation plan currently

being rolled out will address some of the existing

defi ciencies. The plan is briefly described below

under strategies to address underperformance.

Five ambulance bases in the province were

renovated and upgraded: two in Tshwane, two in

Johannesburg and one on the West Rand. This has

gone a long way to improving the accommodation

of EMS staff in the province.

EMS was at the forefront of service provision at the

2013 Africa Cup of Nations Soccer Tournament in

January and February 2013. Emergency services

were provided with a modest grant of R3 million from

the national health department. The tournament

was incident-free and declared successful.

The department has completed the process of

resuming direct management of Sedibeng EMS.


In terms of the recapitalisation plan, the department

will be procuring an additional 120 ambulances, 20

which will be dedicated to obstetric emergencies.

This will boost the total of number of dedicated

obstetric ambulances to 36 and strengthen efforts

to reduce maternal and neonatal deaths.

Other improvements that will be prioritised are:

reducing turn-around times for vehicle repairs and

maintenance; improving systems in the emergency

control centre; training more emergency care

practitioners; reducing time spent by ambulances

at hospitals; and operating across municipal

boundaries. Effective tracking devices will be

installed to monitor the fleet.

The department will foster relationships with

municipalities and ensure better reporting,

monitoring and evaluation in terms of the service

level agreement between the province and various

municipalities. 74


Performance indicators: Programme 3 – Emergency Medical Services

Emergency Medical Services


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target2012/13


Rostered

ambulances per

10 000 people

0.02 0.05 0.023/1000

population

(0.027) The department

will procure 120

ambulances,

including 20 for

obstetric care, as

part of the EMS

recapitalisation

project. Other issues

impacting on systems

effectiveness will be

addressed.

Priority 1 calls

with a response

time <15

minutes in an

urban area

33% 70% 52% (18%) Shortages of

ambulances and staff

continue to impact

negatively on the

achievement of the

target. Incomplete

data remains a

challenge.

Priority 1 calls

with a response

time of <40

minutes in rural

areas

100% 100% 95% (5%) The indicator reflects

the situation in

Metsweding, the only

rural sub-district.

Progress has been

made on raising

performance above

95%.

All calls with

a response

time within 60

minutes

93% 85% 77% (8%) Shortage of

ambulances and

staff members have

impacted on the

achievement of the

target.

75


Expenditure: Programme 3 – Emergency Medical Services

2012/2013 2011/2012

Final appropriation

Actualexpenditure

(Over)/under

expenditure

Final appropriation

Actualexpenditure

(Over)/under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Emergency

transport

859 869 916 241 (56 372) 692 104 557 465 134 639

Planned

patient

transport

199 415 230 990 (31 575) 95 566 139 079 43 513

Total 1 059 284 1 147 231 (87 947) 787 670 696 544 91 126

76


5.4 Programme 4: Provincial Hospital Services

Programme purpose

To provide general and specialised hospital services

by general specialists through regional hospitals,

TB hospitals, psychiatric/mental hospitals, dental

training hospitals and other specialised hospitals.


• General (Regional) Hospitals.

• Tuberculosis Hospitals.

• Psychiatric hospitals.

Increased effi ciency in hospitals

Effi ciency gains by regional hospitals may be

attributed to hospitals rationalising some services.

These hospitals function as complexes within

the referral clusters and frequent support visits

are provided to them by central offi ce managers.

Out-patient headcounts have declined and this

appears to be due to down-referral of patients with

chronic conditions to clinics for repeat medication.

The lower headcounts have been associated with

reduced out-patient waiting times.

In 2012/13 there was an improvement in the general

cleanliness of hospitals in accordance with quality

of care priorities identifi ed by the Minister of Health.

Cluster meetings, headed by central hospitals, are

held at least once every two months to ensure that

services across levels of care are seamless. All

hospitals have effi cient complaints management

systems in place. Tembisa Hospital in Ekurhuleni

and Edenvale Hospital in Johannesburg received

awards from the national health department for

excellent waste management.

Some hospitals still experience high numbers of

inpatients in medical wards. The average cost per

patient-day equivalent remains high across regional

hospitals. This may be due to price increases for

medication, laboratory and blood services, surgical

consumables and food.

Reduction in maternal and child mortality

All hospitals are required to have maternal

mobidity and mortality committee meetings These

committees meet regularly to discuss matters

related to maternal and child mortality, including

ways to improve the quality of maternal and child

health care. Infection control measures have been

strengthened at all hospitals.


Overcrowding continues to occur at regional

hospitals in Johannesburg, West Rand and

Ekurhuleni. The completion of the Jabulani/Zola

Hospital and commissioning of Natalspruit Hospital

will relieve this situation to some extend. In addition,

there are plans to activate beds at Discoverers and

Lenasia South CHCs as they are converted into

district hospitals. There is also a long-term plan

to revitalise other hospitals to ensure that they

function optimally.

Tuberculosis Hospitals

Sizwe Hospital is designated as the only specialized

hospital in Gauteng for treatment of MDR-TB

and XDR-TB. It serves as the province’s central

refaral centre for outpatients requiring drugs for

the treatment of drug-resistant forms of TB. The

province is moving towards a more decentralised

model of managing drug-resistant TB.

Psychiatric Hospitals

This programme provides specialised inpatient and

outpatient services for adults and children with

mental illness or profound intellectual disability.

These services are provided at psychiatric units

in general hospitals and in specialised psychiatric

hospitals. The department provides forensic

psychiatric services to adults and adolescents

referred through the Criminal Procedures Act.

The department also has a contract with Life

Esidimeni to provide services for older persons with

chronic psychiatric disability or severe intellectual

disability who cannot be managed at home or by

77


NGOs. A total of 2 260 beds in fi ve facilities are

made available through this arrangement, which

helps to improve bed utilisation at the department’s

specialised psychiatric hospitals.

Oral and Dental Health Centres

Training of oral health professionals and service

delivery at the University of Pretoria Oral Health

Centre was strengthened by additional upgrading

of facilities and equipment and good management.

At Medunsa Oral Health Centre the second

phase of the digitisation of the maxillofacial and

oral radiology unit got underway. Cabling was

completed and some screens had been installed in

clinical areas by the end of the fi nancial year.

At Wits Oral Health Centre heads of department

were appointed for orthodontics and the

clinical units, oral medicine and periodontology,

maxillofacial and oral surgery. The HPCSA

accredited a postgraduate specialist programme

in oral medicine and periodontology. The Wits Oral

Health School hosted the International Association

of Dental Research 2012 conference and Prof

Veerasamy Yengopalwas inaugurated president of

IADR South African division.

A total of 970 patients, mainly children and people

with special needs, received treatment under general

anaesthesia. There were outreach services to more

than 30 schools and more than 2 500 patients

were seen for oral health promotion, preventive and

corrective care.

78


Performance indicators: Programme 4 - Provincial Hospitals

Sub-programme: General (Regional) Hospitals

Strategic objectives: Increased level of effi ciency in hospitals


Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target2012/13


Caesarean

section rate

30% 18% 32% 14% Denominator does

not account for

normal vertex

deliveries. Regional

hospitals serve as

referral centres

for complicated

caesarean section

cases.

Separations-

Total

443 854 546 016 453 399 (92 617) Law seperations

could be attributed

to improved level

of care, down

referral and effective

clustering

Patient-day

equivalents

(PDEs)-Total

2 650 397 3 383 058 2 609 924 (773 134) PDEs slightly lower

than previous

fi nancial year.

Out-patient

headcount-Total

2 022 677 1 700 000 1 853 400 153 400 Slightly above target

because some

patients continue

to bypass district

hospitals and present

at regional hospitals.

Anecdotal evidence

shows that patients

prefer to be seen and

treated by specialists

Average length

of stay

4.8 days 4.8 days 4.1 days (0.7) days Within range.

Improvement

attributed to better

case management.

Bed utilisation

rate

79% 86% 80% (6%) Minimal deviation.

Indicator also

points to good case

management of level

2 bates

79





Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target2012/13


Expenditure

per patient day

equivalent (PDE)

R1 748 R1 128 R1 964 R836 Expenditure

is affected by

price increases

in medication,

laboratory and blood

services, surgical

consumables,

salaries and food.

Percentage

of complaints

of users of

the hospitals

services

resolved within

25 days

98.7% 95% 90% 5% There are complex

cases that take longer

than 25 working

days to resolve.

Many of these are

serious complaints

sometimes involving

adverse events.

Percentage

of regional

hospitals

with Monthly

Mortality and

Morbidity

meetings

100% 100% 100% 0% Target achieved.

Workshops were

conducted with

CEOs on mandatory

reporting on mortality

and morbidity. Quality

improvement plans

based on discussions

at these meetings are

instituted.

Regional

Hospitals

Patient

satisfaction rate

(percentage

of users of

services at

the hospital

satisfi ed with

the services

received)

69.7% 85% 67% 18% Training to address

staff attitudes and

improve patient

experiences is being

planned together with

private partners.

80





Actual achievement

2011/12

Planned target

2012/2013

Actual achievement

2012/13


target2012/13


Number

of regional

hospitals

assessed for

compliance with

the six priorities

of the National

Core Standards

11 6 9 3 Target exceeded

due to improved

capacity of inspectors

conducting audits

and joint auditing

by provincial and

national inspectors.

Sub-programme: Specialised Hospitals (Tuberculosis)



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Average length

of stay in Sizwe

Infectious

Disease

Hospital

120 days 120 days 104.0 days (16) days The nature of

treatment for drug-

resistant TB requires

protracted hospital

admission.

Bed occupancy

rate (BOR)

in Sizwe

Infectious

Disease

Hospital

75% 60% 55% (5%) More patients are

now treated for

drug-resistant TB

while residing in the

community, in line

with the national

policy. Optimal

utilisation of surplus

beds to be explored.

Expenditure

per patient-

day equivalent

(PDE) in Sizwe

Infectious

Disease

Hospital

R1 700 R1 750 R2 177 (R 427) Expenditure is

affected by price

rises for items such

as medication,

laboratory

services, surgical

consumables and

food.

81


Sub-programme: Specialised Hospitals (Psychiatric)

Performance Indicator

Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/2013


Number of

dedicated acute

beds for adults

at designated

psychiatric

units in general

hospitals

419 480 419 (61) The annual target

was not achieved

mainly due to delays

in infrastructure

projects.

Number of

contracted

(life Esidimeni)

beds utilised for

chronic users

(Alos >1 year

as a % of total

beds)

79% 60% 80% (20%) The annual target

was not achieved.

The number of

chronic patients

requiring full-time

care is increasing.

There are few NGOs

that provide such

services. Families

experience diffi culties

managing patients at

home.

82


Expenditure: Programme 4 – Provincial Hospitals

2012/2013 2011/2012

Final appropriation

Actualexpenditure

(Over)/under

expenditure

Final appropriation

Actualexpenditure

(Over)/under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

General hospitals 4 826 251 5 150 556 (324 305) 3 885 242 4 666 316 (781 074)

Tuberculosis

hospital 350 003 156 715 193 288 300 468 136 029 164 439

Psychiatric/

mental

healthcare

hospitals 956 038 893 466 62 572 723 777 785 378 (61 601)

Dental training

hospitals 355 284 329 030 26 254 305 108 293 615 11 493

Other specialised

hospitals 59 320 52 673 6 647 45 350 46 761 (1 411)

Total 6 546 896 6 582 440 (35 544) 5 259 945 5 928 099 (668 154)

83


5.5 Programme 5: Central Hospital Services

Programme purpose

To provide highly specialised healthcare services,

platforms for the training of health workers, sites

for research, and to serve as specialist referral

centres for regional, tertiary hospitals as well as

neighbouring provinces and SADC .

There are four central hospitals in Gauteng: Steve

Biko Academic Hospital, Dr George Mukhari

Hospital, Charlotte Maxeke Johannesburg

Academic Hospital and Chris Hani Baragwanath

Academic Hospital.

Strengthening health system effectiveness

For the 2012/13 fi nancial year, hospital effi ciency

indicators such as bed occupancy rate and average

length of stay for central hospitals were within

set targets, except at Dr George Mukhari Hospital

where bed occupancy remained low throughout the

year. Caesarean section rates remained high at all

central hospitals. This may be attributed to the fact

that central hospitals deal with complicated cases

that have been refared.

By structuring the relationship between referring

institutions the department has ensured that

patients benefi t from a well-functioning referral

system. Dr George Mukhari Hospital received a

donation from Royal Bafokeng Holdings to build a

burns unit. The project was in the planning phase

in 2012/13 and the process was progressing well.

Reducing maternal and child mortality

The four central hospitals hold regular maternal

morbidity and mortality meetings to reduce deaths

related to pregnancy and childbirth. Infection

control is well managed in these hospitals.

The high burden of disease and trauma remains a

challenge for central hospitals. There is always a

demand for acute surgery and this results in longer

waiting times for elective surgery. The department

is constantly exploring ways to reduce the elective

surgery backlog. Central hospitals resources

continue to be severely stretched since they treat

large numbers of patients from Gauteng and

beyond while serving as teaching platforms. Cost

containment measures are in place at all central

hospitals.

Strategies to overcome areas of under

performance

The challenges experienced by hospitals are

systems related. The Turnaround Strategy of the

department prioritises hospitals as an area of

intervention. Support systems for infrastructure

maintenance and capital projects have been

introduced at various hospitals and these also serve

to improve the functionality of electromechanical

equipment. Quality improvement programmes to

enhance patient experiences have been developed

and processes have been introduced to address

medico-legal issues arising in hospitals.

84


Performance indicators: Programme 5 – Central Hospital Services

Central Hospital Services



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Average length

of stay

5.4 days 6.4 days 5.3 days 1.1 days The shorter length

of stay can be

attributed to

improved case

management in

hospitals.

Caesarean

section rate

42% 40% 41% 1% Caesarean sections

are within range of

target.

Bed utilisation

rate

74% 80.5% 77% (3.5%) Bed utilisation has

increased in the

last year. It was still

slightly below target

due to careful case

management.

Expenditure

per patient

day equivalent

(PDE)

R1 748 R1 744 R2 950 R1 206 Expenditure is

affected by price

rises for items such

as medication,

laboratory and blood

services, surgical

consumables,

salaries and food.

Patient-day

equivalents

2 561 461 2 497 823 2 615 032 117 209 Actual numbers

exceeded the target

and last year’s fi gure.

Central hospitals

in Gauteng receive

referrals from

within the country

and across the SA

borders.

85


Central Hospital Services



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


OPD

headcount-

total

2 603 663 2 813 215 2 597 531 (215 684) Actual performance

was lower than

projected and

lower than previous

year. This is due

to improved down

refferals to lower

levels of care.

Separations

total

306 966 277 917 318 805 40 888 Number of

separations is

consistent with

the high number of

patients referred to

level 3 hospitals from

within SA and SADC.

Programme: Central Hospital Services



Actual achievement 2011/2012

Planned target

2012/2013

Actual achievement2012/2013


target 2012/2013


Client

satisfaction rate

(Percentage of

users of service

at the hospital

satisfi ed with

the services

received)

80% 85% 67% (18%) Central hospitals

are not complying

with aspects of

the National Core

Standards such

as cleanliness,

waiting times and

staff attitudes.

Hospital governance

structures will be

involved when

assessments on

core standards are

conducted.

86


Programme: Central Hospital Services



Actual achievement 2011/2012

Planned target

2012/2013

Actual achievement2012/2013


target 2012/2013


Percentage

of complaints

of users of

the hospital

services

resolved within

25 days

95.7% 95% 87.7% (7.3%) Target not achieved.

However, workshops

conducted at the

CEOs’ Forum dealt

with mandatory

reporting on

complaints

and addressing

complaints

mechanisms in

quality improvement

plans.

Monthly

mortality and

morbidity

meetings

100% 100% 100% 0% Target achieved.

Workshops

during the CEOs’

Forum dealt with

mandatory reporting

on morbidity and

mortality and

incorporation

of this in quality

improvement

initiatives.

Hospitals

assessed for

compliance

against the six

priorities of the

National Core

Standards

Yes Yes Yes None There were joint

audits at all central

hospitals conducted

by provincial

and national

inspectors. Capacity

of inspectors to

undertake audits has

improved.

87


Expenditure: Programme 5 – Central Hospital Services

2012/2013 2011/2012

Final

appropriation

Actual

expenditure

(Over)/

under

expenditure

Final

appropriation

Actual

expenditure

(Over)/

under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Central

hospital

services 7 599 859 7 799 913 (233 054) 6 778 355 7 131 562 (353 207)Total 7 566 859 7 799 913 (233 054) 6 778 355 7 131 562 (353 207)

Performance indicators: Steve Biko Academic Hospital

Steve Biko Academic Hospital



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Caesarean

section rate

59% 40% 62% 22% Caesarean section

rate exceeded limit

substantially. This

was due to the high

rate of obstetric

emergencies. Better

risk identifi cation

is needed during

antenatal care.

Hospital provides

obstetric services

only for complicated

maternity cases.

Normal deliveries are

handled in the nearby

Tshwane district

hospital, Mamelodi

and in Stanza Bopape

CHC

Separations-

total

41 897 60 000 42 270 (17 730) Separations are

slightly higher than in

the previous year.

88





Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Patient day

equivalent-

total

428 318 39 000 387 293 348 293 The target was hugely

exceeded. The target

clearly needs to be

revised.

OPD headcount-

total

601 403 710 000 478 075 (231 925) Even though the

active reffering

of patients is

implemented, still

having inapropriate

(level of care and

catchment area)

patients coming to

hospital

Average length

of stay

5.3 days 6 days 5.5 days (0.5) days Management and

processing of

patients improved,

resulting in quicker

discharges. Limited

theatre time due to

nursing shortages

extends length of stay

for some patients.

Bed utilisation

rate

76% 85% 77% (8%) The sharp drop in bed

occupancy over the

festive season affects

the average for the

year.

Expenditure

per patient day

equivalent (PDE)

R3 300 R3 200 R3 899 (R 699) Cost per PDE is

affected by high cost

of healthcare due to

medical inflation and

salaries of health

professionals on

occupation-specifi c

dispensation.

89





Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Percentage

of complaints

of users of

the hospital

services

resolved within

25 days

96.2% 95% 97% 2% Target achieved due

to adequate numbers

of fully trained and

dedicated complaints

personnel.

Monthly

Mortality and

Morbidity

meetings

Yes Yes Yes 0% Target achieved

due to continuous

support meetings

and individualised

workshops with all

clinical managers.

Percentage of

users of service

at the hospital

satisfi ed with

the services

received

(Hospital patient

satisfaction

rate)

# 85% 67% (18%) Not achieved due

to challenges in

compliance with

National Core

Standards in areas of

cleanliness, waiting

times and staff

attitudes.

Hospitals

assessed for

compliance

against the six

priorities of the

National Core

Standards

# Yes Yes None There were joint

audits conducted

by provincial and

national inspectors.

Capacity of

inspectors to perform

audits has improved.


90


Performance indicators: Dr George Mukhari Hospita Dr George Mukhari Hospital



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Caesarean

section rate

42% 41% 35% 6% High rate of normal

vaginal deliveries

due to large number

of “walk-in” (non-

referred) patients.

Separations-

total

50 163 51 882 55 512 3 630 Hospital is located

in an area where

there are no regional

hospitals. It therefore

sees a high number

of patients and a

mixture of level 2 and

3 patients.

Patient day

equivalent-

total

492 163 586 987 534 716 (52 571) Underperformance

in terms of

projection was due

to insuffi cient ICU

beds and shortages

of equipment and

consumables.

OPD headcount-

total

288 153 358 754 348 646 10 108 Target achieved and

utilisation of OPD is

increasing. Systems

are to be in place to

maintain this.

Average length

of stay

7.8 days 5.5 days 7.3 days (1.8 days) Patients are staying

longer than expected

because of long

waiting times for

surgical procedures

due to shortages of

consumables and

insuffi cient ICU beds.

91


Dr George Mukhari Hospital



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Bed utilisation

rate

68% 74% 72% (2%) Insuffi cient ICU

beds and shortage

of equipment and

consumables.

Expenditure

per patient- day

equivalent (PDE)

R2 518 R1 877 R2 456 R579 Cost per PDE is

higher than target

due to payments of

accrued debts and an

unrealistic target.

Percentage

of complaints

of users of

the hospital

services

resolved within

25 days

96% 95% 97% 2% Target achieved due

to adequate skilled,

trained and dedicated

complaints personnel.

Monthly

Mortality and

Morbidity

meetings

Yes Yes Yes 0 Target achieved

due to continuous

support meetings and

workshops with all

clinical managers.

Percentage of

users of service

at the hospital

satisfi ed with

the services

received

(Hospital patient

satisfaction

rate)


to challenges in

complying with

National Core

Standards in respect

of cleanliness, waiting

times and staff

attitudes.

Hospitals

assessed for

compliance

against the six

priorities of the

National Core

Standards

# Yes Yes 0 Target achieved

due to effi ciency of

inspectors and joint

audits by provincial

and national

inspectors.


92


Performance indicators: Charlotte Maxeke Johannesburg Academic Hospital

Charlotte Maxeke Johannesburg Academic Hospital



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Caesarean

section rate

50% 46% 51% 4.9% The caesarean

section rate is higher

than the target as the

hospital treats a high

number of unbooked

cases.

Separations-

total

72 457 50 724 92 517 41 793 Separations were

higher than in the

previous fi nancial

year and well over

projection.

Patient day

equivalent-

total

779 068 781 774 781 843 (4 112) Target achieved.

OPD headcount-

total

1 218 727 1 265 897 1 225 775 (40 122) Actual fi gure within

acceptable range of

target. Hospital will

strive to maintain

these volumes of

patients at OPD.

Average length

of stay (ALOS)

5.0 days 7 days 3.9 days 3.1 days A revised formula

has been adopted for

calculation of ALOS

and this is the main

reason for deviation

from the target.

Bed utilisation

rate

83% 87% 83% (4.2%) Rate is only slightly

lower than target

due to increase in

refferals from cluster

hospitals and inter-

provincial hospital

transfer

93





Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Expenditure

per patient day

equivalent (PDE)

R2 565 R2 172 R2 640 R 468 Deviation due to

need to clear billings

accrued from

previous fi nanciajl

year.

Percentage

of complaints

of users of

the hospital

services

resolved within

25 days

95.7% 95% 97% 2% Target exceeded

due to skilled, fully


complaints personnel

and an increase

in complaints

managers. Also

assisted by a

workshop for CEOs

on compliance

with complaints

standards.

Monthly

Mortality and

Morbidity

meetings

Yes Yes Yes 0 Target achieved due

to continuous support

and workshops

with all institutional

clinical managers.

Percentage of

users of service

at the hospital

satisfi ed with

the services

received

(Hospital patient

satisfaction

rate)


to challenges in

meeting National

Core Standards

particularly in relation

to cleanliness, waiting

times and staff

attitudes.

Hospitals

assessed for

compliance

against the six

priorities of the

National Core

Standards

# Yes Yes 0 Target achieved

as inspectors now

conduct audits

effi ciently and there

have been joint audits

by national and

provincial inspectors.


94


Performance indicators: Chris Hani Baragwanath Academic Hospital

Chris Hani Baragwanath Academic Hospital



Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target2012/13


Caesarean

section rate

36% 33% 36% 3% The fi gures reflect

the high proportion of

complex cases dealt

with and attendance

to unbooked

emergencies.

Separations-

total

142 449 115 311 128 506 13 195 Separations slightly

lower than previous

year but still above

projection.

Patient day

equivalent-

total

861 911 739 062 911 180 172 118 There were more

than 100 000 more

admissions in

2012/13 than in the

previous year.

OPD headcount-

total

495 380 478 564 545 035 66 471 Hospital still attends

to level 1 and 2

patients who have

bypassed facilities

offering lower levels

of care.

Average length

of stay (ALOS)

4.8 days 5.8 days 5.5 days 0.3 days Observed ALOS

is slightly shorter

than target and

can be attributed

to improved case

management.

Bed utilisation

rate

72% 78.7% 77% (1.7) Slightly below target

due to improved case

management.

Expenditure

per patient day

equivalent (PDE)

R 2 822 R1 917 R3 101 (R1 184) Expenditure was

higher than the target

throughout the year.

This suggests a need

to review expenditure

target.

95





Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target2012/13


Percentage

of complaints

of users of

the hospital

services

resolved within

25 days

96% 95% 97% (2%) Target achieved due

to adequate skilled,


complaints personnel.

Monthly

Mortality and

Morbidity

meetings

Yes Yes Yes 0 Target achieved

due to continuous

support meetings and

workshops with all

clinical managers.

Percentage of

users of service

at the hospital

satisfi ed with

the services

received

(Hospital patient

satisfaction

rate)

# 85% 67% 18% Not achieved due

to challenges in

meeting National

Core Standards

particularly in respect

of cleanliness, waiting

times and staff

attitudes.

Hospitals

assessed for

compliance

against the six

priorities of the

National Core

Standards

# yes Yes 0 Target achieved as

both national and

provincial inspectors

participated in such

audits and achieved

effi ciency in their

operations.


96


5.6 Programme 6: Health Sciences and Training

Purpose

The Health Sciences and Training Programme

is strategically positioned to plan, produce and

manage the education, training and development

needs of the department. It is designed to comply

with relevant legislative and policy imperatives at

national, provincial and local level and to respond

to service transformation imperatives. Priorities

include support for the Service Transformation

Plan, Re-engineering of PHC, expansion of the HIV,

AIDS, STI and TB programmes and the development

of NHI.


• Professional Development.

• Leadership Management and Skills Develop-

ment.

• Employee Health and Wellness Programme.


• Improve achievement of national norms for sup-

ply of health professionals.

• Improve compliance with legislative framework.

Professional Development Sub-programme

Nursing education

The department trains various categories of nurses

in accordance with the legislative framework

of the South African Nursing Council and the

National Human Resources for Health Strategy.

The department provides mandatory community

service placements for graduates with four-year

diplomas and degrees which cover general nursing,

psychiatric and community nursing and midwifery.

The intake of nurses annually is informed by the

targets in the performance plan. Appropriate

numbers are accepted in various categories of

nursing (including the category of mid-level enrolled

nurses) for the range of services offered in the

province.

The sub-programme supports and co-ordinates the

activities of six nursing colleges and ensures that

they meet the requirements of the South African

Nursing Council. Hospitals and clinics in the

province provide a platform for experiential learning

for nursing students from all these colleges.

During the year under review, the number of nursing

students in training in all courses and at all levels of

training was 6 327. The total intake during 2012/13

was 1 341.

A total of 2 327 nurses graduated in various

categories. These graduates comprised:

• Basic training graduates: 1 729.

• Post-basic training graduates: 598.

A total of 696 professional nurses were placed in

health institutions for community service.

The composition of basic nursing training graduates

in 2012/13 appears in the table below.

Table 7: Composition of 2012/13 basic nursing

graduates

Category Number

Professional nurses: four-year degree 114

Professional nurses: four-year diploma 651

Professional nurses: bridging course 169

Enrolled nurses: two-year course 617

Enrolled nurses: exiting from four-year

course 78

Enrolled nursing auxiliaries: exiting

from four-year course 100

TOTAL 1 729

The training of specialist nurses is informed by

the strategic priorities and needs analysis of the

province. Output increased slightly from 588 in

2011 to 598 in 2012. In response to the need for

advanced midwives, the number of graduates for

this programme was 79 in 2012 and the number of

critical care nursing graduates was 72.

97


The nature of post-basic clinical training provided to

professional nurses is indicated in the table below.

Table 8: Fields of study of post-basic nursing

graduates in 2012/13

Field of study Number

Primary healthcare 137

Psychiatric nursing 17

Child nursing 52

Ophthalmic nursing 17

Advanced midwifery and neonatology 79

Midwifery 120

Orthopaedic nursing 21

Critical care nursing 72

Trauma and emergency nursing 23

Nephrology nursing 14

Operating theatre nursing 38

Oncology nursing 8

TOTAL 598

While the provincial nursing colleges produce the

largest number of nurses in the province, there are

quite a number of private sector nursing schools

in Gauteng. Thirteen private nursing schools have

entered into agreements with the department and

place their students in various Gauteng hospitals

for clinical experiential learning. The benefi t to the

department has been that some graduates from

these schools seek employment in provincial health

establishments.

Nursing as a career of choice was marketed through

career exhibitions, open days and visits to schools

throughout the year. By providing prospective

candidates with information about the selection

criteria they are able to make an informed decision

about applying for training.

The Minister of Health launched the National

Strategy for Nursing Education and Practice in

March 2013. Nursing colleges are developing a

provincial implementation plan for the nursing

education component.

Professional development

Professional development entails education,

training and development of all health

professionals, allied health professionals and mid-

level workers for hospitals, district health facilities

and health programmes. The directorate also

attends to job creation and career progression

through the management of clinical learnerships

and internships. Substantial formal employment

is created each year through the placement of

medical interns, community service professionals

and bursary benefi ciaries in the province’s health

facilities.

Bursaries

Through its bursary section the department

aims to produce, recruit and retain skilled staff

in occupations for which it has a high need.

Bursaries are awarded to full-time students not in

the employ of the department (“external” students)

and part-time students already working for the

department. Where possible the department

seeks to assist young people with good academic

performance from disadvantaged environments

gain qualifi cations in the health sciences.

The bursary fund complies with the PFMA and

Treasury Regulations and supports the national

Human Resources for Health Strategy. Bursary

funding is determined by service priorities. Bursary

benefi ciaries are contractually bound to serve the

department for a period equivalent to the period of

funded study.

During 2012/13 a total of 390 new bursaries were

provided, 242 for full-time courses and 148 for part-

time studies. The following are areas of scarce

skills that were identifi ed by the department for full-

time study: medicine, podiatry, pharmacy, dietetics,

physiotherapy, clinical engineering, speech and

hearing therapy, occupational therapy, medical

physics, oral hygiene, clinical technology, diagnostic

radiography and clinical associates.

98


The following part-time courses were funded

through the bursary fund: post graduate nursing

(BCur, honours and master’s degrees, nursing

education, nursing management, midwifery and

psychiatric nursing), master’s in public health,

post-graduate diploma in HIV and AIDS and the

diploma in occupational health. In the areas of

management and administrative support the

following were funded: graduate and post graduate

degrees in information technology, human resource

management, public administration, labour law and

BCom.

With 4 161 bursaries being maintained from earlier

years, the intake for 2012/13 brought the number of

bursary benefi ciaries to 4 397.

Cuban medical programme

Through the 1996 bilateral cooperation agreement

between South Africa and Cuba, the department

has participated in programmes to train medical

students in Cuba. In 2011 and 2012 a group of

20 students from Gauteng were among the 80

receiving scholarships for Cuban study. A larger

group of 90 from Gauteng was recruited at the

end of 2012, bringing the total number awarded

scholarships from this province to 110. However,

four students have returned from Cuba due to

illness or pregnancy.

Professional services support

Community service is a statutory requirement for

health professionals. During 2012 the department

placed 220 medical doctors and 448 allied health

professionals in community service positions.

In compliance with the HPCSA regulations, 417

medical interns were placed in 13 accredited

health institutions in Gauteng for the fi rst year

of medical internship and 398 medical interns

completed their second year of internship. All these

health professionals are formally employed in the

services and contribute to the job creation agenda

of government.

Continuing professional development

Short clinical courses conducted for health

professionals are informed by strategic service

priorities and an analysis of training needs. These

courses are accredited for continuing professional

development (CPD) points which enable health

professionals to maintain registration. A total of

1 306 health professionals, including doctors,

participated in clinical short courses.

Eleven clinical technologists and two medical

orthotics and prosthetics interns completed a

one-year internship in central hospitals and at

the Orthopaedic Workshop in Tambo Memorial

Hospital.

Mid-level workers

The production of the mid-level workers is informed

by the national human resource strategy, the need

to address critical shortages of skills in the services

and the human resources component of the

department’s Turnaround Strategy.

Clinical associates:

A total of 49 clinical associates in all years of

study received bursaries during 2012/13. Of these,

13 graduated at the end of 2012. These clinical

associates were placed in various district hospitals

under the supervision of family physicians. They

play a signifi cant role in relieving the pressures on

services arising from a shortage of doctors. Their

scope of practice is determined by the HPCSA.

Pharmacist assistants:

In 2012/13, a total of 616 learners were in training

or recruited for training as pharmacist assistants.

Of these, 220 were employees from hospitals within

the department. A group of 45 learners completed

their courses during the year, 34 at basic level and

11 at post-basic level. The number of learners

actually undergoing training in 2012/13 was 416,

while a further 155 were waiting to commence

training pending the registration of pharmacist

tutors by the Pharmacy Council.

99


The training of pharmacist assistants is an integral

part of the Turnaround Strategy. It is also an

important aspect of the re-engineering of PHC and

the expansion of the HIV and AIDS programme

Enrolled nurses working in maternity settings:

In-service training of the enrolled nurses working in

maternity settings commenced at the end of July

and 19 enrolled nurses completed the training in

January 2013. Two new groups were to commence

training before the end of April 2013. It is envisaged

that this training will improve the quality of services

in midwifery units and contribute to the reduction in

maternal and neonatal deaths.

Health Professions Training and Development Grant

The Health Professions Training and Development

Grant (HPTDG) is an allocation from the National

Treasury that supplements the provincial health

budget in all academic hospitals and faculties of

health sciences. It is aimed at sustaining a quality

teaching platform for health professionals.

The HPTDG’s purpose and overall policy direction in

2012/13 was to:

• Assist provinces to fund service costs associat-

ed with training of health science trainees.

• Establish clinical teaching and training capacity

in provinces that lack this capacity.

• Co-fund the expansion of undergraduate medi-

cal education in 2012 and in subsequent years

until 2025.

The HPDTG is essentially a top-up grant for service

costs related to training. It also benefi ts district

hospitals and PHC services in instances where

teaching and learning are shifted from tertiary

institutions to these services.

In 2012/13 the grant amounted to R725 310 000.

It is governed by the Division of Revenue Act which

requires monthly and quarterly reporting on its

utilisation. The entire amount allocated to Gauteng

was used in 2012/13.

In the year under review, a total of 22 438 students

in medicine, nursing and allied health professions

were enrolled in Gauteng’s institutions of higher

learning. These comprised 17 426 undergraduates

and 5 012 post-graduates. An estimated 15 000 of

these students used the department’s experiential

learning platform which is supported partially by

the HPTDG.

Gauteng institutions of higher learning produced

4 180 graduates in the health sciences in 2012/13.

Of these, 2 579 completed under-graduate degrees

while 1 601 earned post-graduate qualifi cations.

Table 9: Breakdown of health sciences graduates

from Gauteng institutions 2012/13

Field of study Number

Medicine (including specialists) 948

Nursing 2 060

Allied health professions 601

Other 534

Doctoral degrees 37

TOTAL 4 180

While graduates in medicine and allied health

professions are allocated to various provinces

for internships and community service, nearly all

nursing graduates have attended provincial nursing

colleges and take up employment in GDoH facilities.

Regional training centres

Training in the regional training centres is informed

by the National Strategic Plan for HIV, STI and

TB 2012-2016, the National 10-Point Plan, the

Negotiated Service Delivery Agreement (NSDA),

and the Provincial HIV/AIDS Strategy and related

operational plan.

The regional training centres have been created in

terms of a nationally driven project to expand the

learning and development platform by utilising

internal knowledge and expertise while drawing

on best practice approaches both nationally and

internationally. The project’s core strategic function

100


is to strengthen the HIV and AIDS programme but

the centres also serve as broader training and development platforms for hospitals, districts and priority health programmes. The centres are funded by the national conditional grant for HIV and AIDS.

In the year under review, 10 546 health professionals, mid-level workers and community health workers participated in skills-building courses to equip them for service priorities in the prevention and management of HIV, STIs, and TB. These included 1 195 professional nurses who were trained to initiate antiretroviral treatment. Their training underpinned the further expansion of the ART programme. In addition, 9 351 doctors, nurses, pharmacists, social workers and pharmacist assistants as well as lay counsellors (including traditional healers) received training in other aspects of treatment and care of people with HIV, STIs and TB, as well as prevention of these infections.

Lebone College of Emergency Care

The college provided experiential learning for 22 critical care assistants, 20 of whom successfully completed their training. In addition, 11 emergency care technician (ECT) students were found to be competent and were registered with HPCSA.

A total of 90 students were enrolled in their fi rst year of study at the college, bringing the total number of ECT students to 108. By the end of 2012/13 there were 66 graduates awaiting employment in public sector emergency medical services in Gauteng

The year also saw the enrolment of 24 students in the ambulance emergency assistance (AEA) course. Continuing professional development (CPD) in the form of training in basic life support was offered to 62 nursing and EMS personnel. Monthly continuing medical education sessions were conducted at the college and decentralised training centres for 702 doctors, nurses, allied health professionals and emergency service personnel.

Refresher courses were run for 67 basic ambulance

assistants and six ambulance emergency

assistants.

A total of 831 health professionals successfully

completed continuing medical and professional

education in emergency medical care.

Leadership, Management and Skills Development Sub-programme

The directorate delivering this sub-programme

focuses on the imperatives of ensuring health

system effectiveness and job-creation. It complies

with the key provisions of the Skills Development

Act, the National Skills Development Strategy III,

and the Skills Development Levies Act, working

closely with relevant sector education and training

authorities.

In order to strengthen compliance with the

Promotion of Access to Information Act (PAIA),

the Directorate is currently building capacity for

knowledge management in the department.

The directorate provides education, training and

skills development to all levels of management and

builds capacity among various categories of staff

through skills programmes. This includes the ABET

programme for less skilled categories of employees

and youth development programmes organised in

collaboration with various strategic partners.

The directorate accessed donor funding from

strategic partners for selected skills programmes,

including youth development programmes. Youth

development programmes included learnerships,

internships, career expos and initiatives like the

annual “take a girl child to work” event.

A total of 875 managers participated in various

management and leadership development

programmes including executive coaching in 2012.

An executive coaching programme was completed

by the CEOs and executive teams of nine hospitals.

A variety of other skills development initiatives

benefi ted 6 067 staff members who attended

various skills programmes.

101


In accordance with provisions of the Turnaround

Strategy, 2 416 employees in relevant positions

attended code of conduct training. The ABET

programme admitted 963 employees.

Learnership programmes accommodated

297 young people while 1 690 participated in

internships. The department is not in a position to

guarantee employment to all learners and interns

who are trained. At least 2 137 school-goers were

reached through career expos aimed at providing

information and marketing health sciences.

Employee Health and Wellness Programme

The Employee Health and Wellness Programme

(EHWP) is informed by the Constitution of South

Africa of 1996, the Labour Relations Act, the

Occupational Health and Safety Act, and the

Compensation of Occupational Injuries and

Disease Act. It is also guided by National Strategic

Plan for HIV, STI and TB 2012-2016, policies of the

Department of Public Service and Administration

and strategic service delivery objectives of the

department.

The core business of the programme is to provide

an integrated health and wellness service to more

than 63 000 employees across the province. In

2012/13 the number of employees who accessed

EHWP services was 12 712. The nature of EHWP

services is described below.

Occupational health services

In 2012/13, occupational health services were

utilised by 4 198 employees. There were 31 reported

cases of occupational TB. Three of these resulted

in death while all other cases were successfully

treated. The total number of occupational injuries

and diseases reported to the Compensation

Commissioner was 583. Occupational health

services include medical surveillance, vaccination

programmes, case management and prophylaxis

for biological exposure. The department has

17 employee wellness centres which offer

family planning, PHC services, chronic disease

management and occupational health services.

A medical surveillance policy was developed

in 2012/13 as well as an occupational health

handbook for managers.

HIV, STIs and TB

Workplace services for HIV and AIDS, STIs and TB

were accessed by 5 862 employees, of these 663

employees requested HCT and 10 tested positive

and were referred for further management.

Employee Assistance Programme

The Employee Assistance Programme (EAP)

responded to requests from 2 652 employees

requiring counselling and trauma debriefi ng. Most

of these (1 677) accessed these services through

an external service provider while 975 utilised

internal services through trained EAP coordinators.

Financial wellness programmes reduced garnishee

orders applicable to departmental staff from 39 000

to 36 000. The pre-retirement counselling service

benefi ts employees preparing for retirement.

A substance abuse protocol was put into effect.

However, only fi ve employees were referred for

rehabilitation through the department’s EAP

programme.

Capacity-building in EHWP

In the year under review, 11 289 employees were

trained in HIV and TB management. This included 6 727

trained in reduction of stigma, mainstreaming of HIV

and AIDS, basic counselling skills, peer education

and management of disclosure. In addition, 4

562 staff members participated in prevention

programmes on health awareness days. HCT drives

and campaigns continued at provincial, regional and

district level. EHWP coordinators and peer educators

actively involved themselves in educating their peers.

Posters and pamphlets were developed, produced

and distributed to institutions.

102


As part of the Turnaround Strategy, an action plan

was developed for improving staff morale as well

as a programme for rewarding employees who are

star performers.

A total of 4 419 employees were trained in prevention

of violence in the workplace, resilience building,

fi nancial wellness, pre-retirement preparation

and substance abuse management. In the area

of occupational health, 571 employees received

training in the management of occupational injuries

and diseases

Strategies for addressing areas of under

performance

The National Qualifi cations Framework Act, the

amended Higher Education Act and the Nursing

Act require that nursing education, which is mainly

a function of provincial health departments, be

transferred to jurisdiction of the Department of

Higher Education and Training. A collaborative

approach will be required to manage this change.

Capacity and resources need to be supplemented

in order to achieve increased production of health

professionals. The department has explored various

ways to maximise resources – collaboration with

other departments, training of mid-level workers

and expansion of experiential platforms by including

regional hospitals and district health services.

However, there are still insuffi cient experiential

learning sites for certain categories of students,

such as nurses and pharmacist assistants. This

limitation affects the numbers accepted for

training. It is possible that better use could be made

of existing experiential learning facilities by training

over weekends, public holidays and on a 24-hour

basis. However, there still would be signifi cant cost

implications.

A long standing challenge is that of placement of

nursing graduates. In 2012/13 the department

absorbed enrolled nurses who completed their

training in various institutions in order to facilitate

better service delivery. A plan is being devised to

place enrolled nurses who are due to complete

training in August and December 2013.

The department’s bursary funds assists some

4 500 individuals but its ability to employ and

retain benefi ciaries is limited, even though many

possess scarce skills which the department needs.

This compromises the return on investment in

bursaries. The HRH strategy and plan must be

more closely aligned with the projected demand

for health professionals. In 2012/13 nearly 70

emergency care technicians could not be absorbed

upon completion of their studies. They are likely to

be lost to the private sector.

Yet, when measured against service demands –

rather than budgeted posts – the number of health

professionals being produced is inadequate. The

amount allocated in the HPTDG must be reviewed

and policy decisions taken on recruitment and

retention, particularly in respect of some disciplines.

The relatively high staff turnover in the department

results in training backlogs. A policy is being

developed to address this.

The Employee Health and Wellness Programme

has been constrained by a lack of dedicated posts

for programme coordinators at institution level and

by fi nancial allocations. Training in occupational

health and safety will be prioritised in the new

fi nancial year.

103


Performance indicators: Programme 6 – Health Sciences and Training

Health Sciences and Training


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Number of

basic medical

graduates

550 600 517 (83) The number is

dependent on

university enrolment.

Number of fi rst

year medical

interns placed in

the services

403 400 422 22 Target exceeded

because Pholosong

Hospital was

accredited and

accepted nine

medical Interns in

January 2013 and

Sebokeng Hospital

had both budget and

an urgent need of

medical interns.

Number of

community

service doctors

placed in the

services

206 200 205 5 Target exceeded.

Number of

community

service dentists

placed

11 20 4 (16) Target not achieved

due to the retention

of community service

dentists from the

previous year and

need to prioritise

bursary holders in

post-fi lling.

Number

of medical

specialist

graduates


Number of allied

community

service

professionals

placed for in the

services


104




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Number of

pharmacy

interns placed

35 30 6 (24) Target not met due to

diffi culty in attracting

pharmacists. The

department will work

with the Pharmacy

Council to devise

ways to attract more

pharmacists to the

public sector.

Number of

community

service

pharmacists

placed

49 60 52 (8) Diffi culty in attracting

pharmacists as they

are in high demand

and competitive with

private sector

Number

of nursing

community

service placed

in the service

644 1 231 696 (535) Target not met.

Although the intake

for four-year courses

in 2009 was 1 311,

poor academic

performance of

students led to

low output of

graduates. Colleges

are addressing the

problem through

academic support

programmes.

Number of mid-

level workers

produced

(clinical

associates,

enrolled nurses,

emergency care

technicians,

pharmacist

assistant

graduates)

1 140 855 819 (36) Target not achieved

as there are limited

tutors for pharmacist

assistant training.

105




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


2012/13


Number

of youth

completing

internships

1 926 1 000 1 690 690 Additional

sponsorship was

received from

strategic partners.

Number

of youth

completing

learnerships

652 500 297 (203) Insuffi cient funding

was received from the

Health and Welfare

Sector Education and

Training Authority

(HWSETA).

Intake of

nursing

students

1 676 2 280 1 341 939 Target revised

downward due to

fi nancial constraints.

Plans are underway

to ensure nurses are

trained and absorbed.

Students with

bursaries from

the province

4 166 4 341 4 397 56 Target exceeded. The

bursaries were widely

advertised at career

expos and through

community radio

stations.

Basic nursing

students

graduating

1 785 1 712 1 729 17 Target exceeded.

106


Expenditure: Programme 6 – Health Sciences and Training

2012/13 2011/12

Final

appropriati on

Actual

expenditure

(Over)/under

expenditure

Final

appropriati on

Actual

expenditure

(Over)/under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Nurse

training

colleges 691 617 689 133 2 484 666 168 648 885 17 283EMS

training

colleges 38 141 24 371 13 770 26 913 20 074 6 839Bursaries 50 815 43 575 7 240 30 000 32 138 (2 138)Other

training 61 351 49 983 11 368 42 941 24 992 17 949Total 841 924 807 070 34 854 766 022 726 089 39 933

107


5.7 Programme 7: Healthcare Support Services

Purpose

The purpose of this programme is to provide non-

clinical services, including laundry, food services

and medical supplies, to support hospitals and

clinics in an effective and effi cient manner.

Strategic objective

The central objective is to increase the effi cacy of

the supply chain management system.

Summary of signifi cant achievements

The achievements of this programme focus on

improvements in supply chain management,

including implementation of the broad-based black

economic empowerment (BBBEE) strategy.

The Preferential Procurement Policy Framework

Act (PPPFA) requires that government departments

award contracts to BBBEE companies. During the

year under review, 56% of the total value of items

procured was channelled to BEE companies,

against a target of 70%.

The PPPFA also requires that government

departments procure goods and services from

enterprises owned by women. In 2012/13, 24%

of the total value of the department’s contracts

was awarded to businesses owned by women,

exceeding the target of 15%.

The department continues to acquire linen from 12

cooperatives owned by women and it encouraged

all health institutions to procure linen from these

cooperatives. In 2012/13 19 out of 31 institutions

were conducting business with the cooperatives.

Strategies to address areas of underperformance

Challenges during the year included suppliers

not delivering critical items, such as medication

and food, due to non-payment resulting from the

adverse cash flow situation. Financial assistance

was provided by the Offi ce of the Premier, Provincial

Treasury, national Department of Health and

National Treasury.

Supply of clean linen was under pressure due to the

poor condition of laundry machinery at Masakhane

and Dunswart laundries. Tenders were awarded for

replacing laundry machinery at four major laundries.

The completion date was the end of March 2013.

108


Performance indicators: Programme 7 – Healthcare Support Services

Healthcare Support Services


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target2012/13


BBBEE spend

as a % of total

procurement

budget

70% 70% 56% (14%) Not all vendors are

submitting their

BBBEE certifi cates for

verifi cation and they

are not complying

with the requirement

of the BBBEE score

card.

Number of

hospitals

procuring

goods through

cooperatives


Additional

hospitals began to

procure linen from

cooperatives.

Percentage of

procurement

awarded to

women-owned

enterprises

30% 15% 24% 9% Target achieved

by ensuring that

suppliers have

signifi cant female

participation if not

owned outright by

women.

109


Healthcare Support Services


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target2012/13


Percentage of

EDL available at

facilities

64% 98% 76% (22%) The target has not

been achieved.

Reasons include

operational and

fi nancial issues,

poor supplier

performance and

inadequate contract

management.

However, the situation

in 2012/13 showed

an improvement on

the previous year.

The re-engineering

of processes at the

Medical Supplies

Depot is continuing to

improve effi ciencies

and to highlight areas

of concern on the part

of institutions.

110


Expenditure: Programme 7 – Healthcare Support Services

2012/2013 2011/2012

Final

appropriation

Actual

expenditure

(Over)/under

expenditure

Final

appropriation

Actual

expenditure

(Over)/under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Laundries 161 853 152 113 9 746 139 460 141 187 (1 727)

Food supply

services 37 967 44 280 (6 313) 29 765 32 351 (2 586)

Medicine

trading

account 1 150 (149) 1 145 (144)

Total 199 821 196 544 3 277 169 226 173 687 (4 461)

111


5.8 Programme 8: Health Facilities Management

Purpose

The purpose of this programme is to plan, provide and equip new facilities; to upgrade and rehabilitate community health centres, clinics, and district, provincial, specialised and academic hospitals, and other health-related facilities; and to undertake life-cycle management of immovable assets through maintenance.


• Capital Programme.• Maintenance Programme.• Special Projects.


• To increase effi ciency of service implementa-tion.

• To increase effi ciency in PHC facilities and hos-pitals.

• Signifi cant developments during 2012/13 in-cluded the following:

• The department delegated the power to ap-prove contracts up to the value of R1 million to the CEOs of central hospitals in order facilitate proper maintenance at these hospitals.

• A joint collaboration committee was established to expedite the NHI pilot project in Tshwane Dis-trict. This committee comprises a representa-tive from this programme and one each from Gauteng DID, Tshwane District and the national DOH.

Additional areas of progress are presented below.

Capital projects completed

The new Bertha Gxowa Hospital was offi cially opened on the 29 November 2012 with the OPD, admissions and pharmacy departments functional. Functionality was limited until after August when the fi re-stopping was completed and a certifi cate of occupation could be issued. The hospital

subsequently became fully functional.

Another infrastructural improvement was the

widening of the access road to the new Natalspruit

Hospital.

Upgrading and renovations

A number of projects for refurbishing hospitals and

nurses homes have been completed, including:

• Renovation and refurbishment of TB wards.

• Upgrading and renovation of the nurses’ resi-

dence at South Rand Hospital.

In addition, refurbishment of nurses’ residences

reached works completion at Chris Hani

Baragwanath Academic Hospital, Helen Joseph

Hospital, Sebokeng Hospital and Bonalesedi

Nursing College.

Electrical reticulation was completed at 10

institutions, the upgrade of autoclaves at 26

institutions, the upgrade of chillers at 15 institutions,

the upgrade of generators at 17 institutions and

steam reticulation at three institutions.

The main air-conditioning plant for the theatres

at Leratong Hospital was installed as were air-

conditioners in the Folateng wards at Sebokeng

Hospital.

Renovations of the bulk storage and dispensary

buildings at Hillbrow Pharmacy were accomplished

along with the construction of a pre-pack cold room

at the West Rand Pharmacy.

Additional oxygen and vacuum points were installed

at Edenvale Hospital, Dr George Mukhari Hospital

and Rahima Moosa Hospital.

In order to improve hygiene and safety for

employees and patients, healthcare waste storage

facilities were constructed at various institutions.

112


Projects in construction

Among projects still under construction are the new

Natalspruit Hospital and Zola/Jabulani Hospital

which were projected to reach works completion in

quarter 1 and quarter 2 of 2013/14 respectively.

The fi rst quarter of 2013/14 was also expected to

see completion of works at residences at Charlotte

Maxeke Hospital, Leratong Hospital, Tembisa

Hospital, Natalspruit Hospital and Lebone College.

Other projects that commenced during the year

under review included:

• Construction of additional oxygen and vacuum

points at seven hospitals.

• The upgrade of chiller plants at Pretoria West

Hospital, Kalafong Hospital and Bonalesedi

Nursing College.

• Renovation and refurbishment of the TB ward at

Tshwane District Hospital.

• Renovation and refurbishment at Ann Latsky

Nursing College.

• Renovation and refurbishment of the psychiat-

ric ward at Tambo Memorial Hospital.

• Refurbishment of theatres at Helen Joseph

Hospital.

In addition electrical reticulation was in progress

at three institutions. Boilers were being installed

at seven institutions and were under manufacture

for another 14 institutions. The installation of lifts

at seven institutions was in progress, while 15

institutions were awaiting delivery of new lifts.

Generators were being installed at four institutions

and another two hospitals were awaiting the

delivery of new generators.

Projects in planning

Planning of the new Randgate Clinic was completed

and contractors were to be appointed early in

2013/14.

The Development Bank of Southern Africa (DBSA)

was appointed as the implementing agent for the

emergency repair and refurbishment at Chris Hani

Baragwanath Academic Hospital, the development

of new forensic pathology facilities in Johannesburg

and Bronkhorstspruit, and the revitalisation and re-

opening of Khayalami Hospital in Kempton Park. In

addition, DBSA was tasked with the conversion of

Discoverers CHC and Lenasia South CHC to district

hospitals. The project briefs for these conversions

were approved and tenders were advertised in

March 2013.

Strategy to overcome areas of under performance

Various steps will be taken to ensure effi cient

and effective management of projects. The

department will ensure that project management

personnel have appropriate technical knowledge

and will augment the staff complement. Lengthy

approval processes and slow payment to service

providers has long been a bone of contention. The

department has sought to address these through

delegation of authority to facility level, in some

instances, and introduction of shorter processes

within the provincial departments of health, fi nance

and infrastructure development.

In addition the department will enter into a service

level agreement with Gauteng DID to facilitate

accountability.

113


Performance indicators: Programme 8 – Health Facilities Management

Health Facilities Management


Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Percentage

completed

(Completion and

commissioning

of Zola/Jabulani

Hospital)

80% 100% 98% 2% Delays in the payment

of contractors

impacted on the

project. Practical

completion was

expected during

quarter 1 of 2013/14,

with fi nal completion

in quarter 2.

Percentage

completed

(Completion of

new Natalspruit

Hospital)

80% 100% 97% 3% Construction of the

new Natalspruit

Hospital reached

practical completion

on 28 February 2013.

Works completion

is anticipated on 31

May 2013 with fi nal

completion on 30

June 2013.

Percentage

completed

(Equipment for

new Natalspruit

Hospital)

10% 100% 28% 72% As the hospital was

not completed to

schedule, equipment

could not be delivered

to an incomplete

facility for security

reasons.

Percentage

completed

(Planning for

construction of

Randgate Clinic)

0% 100% 100% 0% Planning was

completed.

Construction will

commence in

2013/14.

114




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Percentage

completed

(Equipment for

Zola/Jabulani

Hospital and

gateway clinic)

10% 100% 35% 65% As the hospital was

not completed to

schedule, equipment

could not be delivered

to an incomplete

facility for security

reasons.

Percentage

completed

(Planning for

revitalisation

of Jubilee

Hospital)

0% 100% 0% 100% Planning depended

on approval of

business case by

DOH. Preliminary

approval was given

in January 2013,

but was withdrawn

in February 2013.

Further advice

from the national

department is

awaited.

Percentage

completed

(Planning for

revitalisation of

Dr Yusuf Dadoo

Hospital)


on approval of

business case by

DOH. Preliminary

approval was given

in January 2013,

but was withdrawn

in February 2013.

Further advice

from the national

department is

awaited.

115




Actual achievement

2011/12

Planned target

2012/13

Actual achievement

2012/13


target 2012/13


Percentage

completed

(Planning for

revitalisation

of Tambo

Memorial

Hospital)


on approval of

business case by

DOH. Preliminary

approval was given

in January 2013,

but was withdrawn

in February 2013.

Further advice

from the national

department is

awaited.

Percentage

completed

(Planning for

revitalisation

of Sebokeng

Hospital)


on approval of

business case by

DOH. Preliminary

approval was given

in January 2013,

but was withdrawn

in February 2013.

Further advice

from the national

department is

awaited.

Percentage

completed

(Planning for

revitalisation

of Kalafong

Hospital)


on approval of

business case by

DOH. Preliminary

approval was given

in January 2013,

but was withdrawn

in February 2013.

Further advice

from the national

department is

awaited.

116


Expenditure: Programme 8 – Health Facilities Management

2012/2013 2011/2012

Final

appropriation

Actual

expenditure

(Over)/under

expenditure

Final

appropriation

Actual

expenditure

(Over)/

under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Community

health

facilities 106 325 101 168 5 157 56 842 100 989 (44 147)

Emergency

medical

rescue

services 939 19 344 (18 405) 34 020 2 870 31 150

District

hospital

services 368 159 271 852 96 307 623 136 529 011 94 125

Provincial

hospital

services 636 813 505 784 131 029 726 635 349 398 377 237

Central

hospital

services 257 904 212 039 45 865 311 090 225 152 85 938

Other

facilities 140 739 134 482 6 257 126 026 110 846 15 180

Total 1 510 879 1 243 831 267 048 1 877 749 1 318 266 559 483

117


6. SUMMARY OF FINANCIAL INFORMATION

6.1. Departmental receipts

The table below reflects the department’s revenue collection for 2011/12 and the year under review. There was an increase of R53 million or 12% in revenue collected in 2012/13 compared to the previous year. Revenue collection also exceeded

the 2012/13 target of R472 million by R35 million. The generation of more than half a billion rand in own revenue is a considerable achievement which benefi ts both the province and the department.

The main source of revenue is patient fees which constituted 80% of total revenue.

The department has a working relationship with Gauteng Provincial Treasury on revenue-related matters. Agency fees on outsourced services are funded by the Provincial Treasury. This is an incentive to the department to increase revenue

collection.

Table 10: GDoH revenue collection 2012/13 and 2011/12

2012/13 2011/12

Departmental

receipts

Estimate Actual

amount

collected

(Over)/

under

collection

Estimate Actual

amount

collected

(Over)/

under

collection

R’000 R’000 R’000 R’000 R’000 R’000

Sale of goods and

services other than

capital assets 423 269 474 153 (50 884) 452 112 398 072 54 040

Transfers received 37 0 37 275 55l6 (281)

Fines, penalties

and forfeits 40 2 38 24 13 (11)

Interest, dividends

and rent on land 975 1 257 (282) 595 487 108

Sale of capital

assets 0 0 0 0 0 0

Financial

transactions

in assets and

liabilities 47 230 31 529 15 701 36 508 54 933 (18 425)

Total 471 551 506 941 (35 390) 489 514 454 061 35 453

The increase in revenue collection has been

achieved despite serious challenges relating to

patient administration systems. Effective liaison

with healthcare funders has contributed to better

revenue collection. Major success factors have

been the outsourcing of the submission of claims

to the Road Accident Fund (RAF) and the electronic

submission of claims to external funders.

Currently the claims process involves extracting

data from patient administration systems and

having this converted by MediKredit into an

acceptable electronic format before submitting

it to medical schemes. A live interface would be

ideal as it would be more effi cient and eliminate

rejections. Patients classifi ed as paying patients

are charged according to the Uniform Patient

118


Fees Schedule which is revised annually at the

beginning of the fi nancial hear. For 2012/13 patient

tariffs were adjusted upward by 5.5%. For other

sources of revenue – parking fees and payment

for accommodation – the amounts payable are

determined outside the department by relevant

government structures.

The following healthcare services are free to

patients who are not members of medical schemes

or whose treatment is not paid for by the employer:

• Health services for pregnant women and chil-

dren under the age of six years (Notice 657 of

1 July 1994).

• Primary healthcare services (Notice 1514 of 17

October 1996).

• Termination of pregnancy (Choice on Termina-

tion of Pregnancy Act 92 of 1996).

• Services to social pensioners. (Aged Persons

Act 81 of 1967 as amended by Act 100 of 1998).

• Medico-legal services for survivors of rape and

assault and post mortem examinations (Crimi-

nal Procedures Act 51 of 1977).

• Organ and tissue donors (Human Tissue Act 63

of 1965).

• Children who are committed to a children’s

home, industrial school or foster parents (Child

Care Act 74 of 1983).

• Persons with mental disorders (Mental Health

Act 18 of 1973).

• Individuals with infectious, formidable and/or

notifi able diseases (National Health Act 61 of

2003).

• Services to those formally recognised as un-

employed (Unemployment Insurance Act 63 of

2001).

An estimated 80% of patients receive services free

of charge while only 20% pay a full or subsidised

fee. The actual cost of providing free services is not

available as the health information system is not

geared to producing this data.

The department has entered into an agreement

with nine medical schemes to participate in

their designated service provider networks for

the provision of prescribed minimum benefi ts

(PMBs) to their members. The Medical Schemes

Act requires medical schemes to cover PMBs

even when the members’ benefi ts in terms of the

rules of the scheme have been exhausted. Good

working relationships with medical schemes serve

to facilitate the settlement of claims. Payments

from medical schemes amounted to R94 million in

2012/13.

The appointment of Alexander Forbes to provide

supporting documents on RAF claims resulted in

increased payments from the RAF. The total amount

of revenue from RAF claims was R 155 million in

2012/13. Management of these claims requires

some legal knowledge as well as a thorough

understanding of the Road Accident Fund Act. The

volume of RAF claims is driven by the sheer number

of road accidents and the fact that most of injured

people are admitted to public facilities.

The service level agreement with Alexander Forbes

was managed closely until it expired in July 2012.

Part of the service provider’s role was to provide

training to hospital employees on the requirements

of the RAF.

During 2012/13 amounts owed by patients that

were not collectable were written off after attempts

had been made to recover them. The total value of

these irrecoverable debts was R 198 million.

Better business processes in health facilities

contributed to improved revenue collection. Training

combined with utilisation of Patient Classifi cation

Guidelines and the standard operating procedure

manual contributed signifi cantly to the success.

Guidelines have also been drafted on the

management of foreign patients visiting public

hospitals for medical treatment. These will be

implemented during 2013/14.

The department purchased new servers for

seven hospitals for the operation of the patient

119


management system, Medicom. Installation will

take place in 2013/14 and this will reduce down time

and loss of data on patients because of IT system

failure. The most up to date version of Medicom

will be installed and this will facilitate storage of

comprehensive and accurate patient information

required for billing purposes.

The department plans to outsource some services

where in-facility skills and capacity are still not

adequate. This will apply to case managers for the

four central and three tertiary hospitals within the

department.

6.2 Programme expenditure

Table 11: GDoH expenditure by budget programme 2012/13 and 2011/12

2012/13 2011/12

Programme nameFinal

appropriation

Actual

expenditure

(Over)/under

expenditure

Final

appropriat-ion

Actual

expenditure

(Over)/under

expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Administration 683 447 501 362 182 085 842 594 752 405 90 189

District Health

Services 8 782 484 8 555 956 226 528 7 240 272 7 239 181 1 091

Emergency

Medical Services 1 059 284 1 147 231 (87 947) 787 670 696 544 91 126

Provincial

Hospital Services 6 546 896 6 582 440 (35 544) 5 259 945 5 928 099 (668 154)

Central Hospital

Services 7 566 859 7 799 913 (233 054) 6 778 355 7 131 562 (353 207)

Health Sciences

and Training 841 924 807 070 34 854 766 022 726 089 39 933

Healthcare

Support Services 199 821 196 544 3 277 169 226 173 687 (4 461)

Health Facilities

Management 1 510 879 243 831 267 048 1 877 749 1 318 266 559 483

Social Welfare

Services - - - 1 888 430 1 834 046 54 384

Development &

Research - - - 209 651 190 285 19 366

TOTAL 27 191 594 26 834 347 357 247 25 819 914 25 990 164 (170 250)

120


6.3. Transfer payments excluding public entities

The table below reflects the transfer payments made for the period 1 April 2012 to 31 March 2013.

Table 12: Transfer payments 2012/13

Name of transferee

Purpose for

which the

funds were

used

Compliance

with s 38

(1) (j) of the

PFMA

Amount

transferred

(R’000)

Amount

spent by the

entity

Reasons for the funds

unspent by the entity

City of Johannesburg Metro Primary

healthcare

No contract 184 032 184 032 Transferred funds

were fully spent

City of Tshwane Metro Primary

healthcare

No contract 49 348 49 348

Ekurhuleni Metro Primary

healthcare

No contract 190 627 190 627

West Rand District Council Primary

healthcare

No contract 0 0

Sedibeng District Council Primary

healthcare

No contract 0 0

City of Johannesburg Metro Emergency

medical

services

Contract 192 867 192 867

City of Tshwane Metro Emergency

Medical

Services

Contract 61 504 61 504 13 010 under-spent as

the municipal fi nancial

year ends at the end

of June. A request

for roll-over was

submitted to Treasury

Ekurhuleni Metro Emergency

Medical

Services

- 229 534 229 534 Transferred funds

were fully spent

West Rand District Emergency

Medical

Services

Contract 48 887 48 887 Transferred funds

were fully spent

Sedibeng District Emergency

Medical

Services

- 44 235 44 235 R19 082 under-spent

due to provincial-

isation of EMS as from

1 September 2012

City of Johannesburg Metro HIV and AIDS Contract 14 582 14 582 Transferred funds

were fully spentCity of Tshwane Metro HIV and AIDS Contract 28 254 28 254

Ekurhuleni Metro HIV and AIDS Contract 20 868 20 868

West Rand District Council HIV and AIDS Contract 8 813 8 813

Sedibeng District Council HIV and AIDS Contract 9 974 9 974

121


The table below reflects the transfer payments which were budgeted for in the period 1 April 2012 to 31

March 2013, but no transfer payments were made.

Table 13: Budgeted transfer payments that were not paid 2012/13

Name of transferee Purpose for which

the funds were to

be used

Amount budgeted

for

(R’000)

Amount

transferred

(R’000)

Reasons why

funds were not

transferred

Ekurhuleni Metro HIV and AIDS 9 988 0 Payments made

under wrong

allocations. A

Transfer Unit has

been established to

monitor payments

from 2013/14

West Rand District HIV and AIDS 5 783 0 Payments made

under wrong

allocations. A

Transfer Unit has

been established to

monitor payments

from 2013/14

Sedibeng District

Council

HIV and AIDS 6 069 0 Payments made

under wrong

allocations. A

Transfer Unit has

been established to

monitor payments

from 2013/14

University of

Johannesburg

540 0 Payments made

under wrong

allocations. A

Transfer Unit has

been established to

monitor payments

from 2013/14

University of

Limpopo

181 0 Payments made

under wrong

allocations. A

Transfer Unit has

been established to

monitor payments

from 2013/14

122


6.4. Transfer payments to public entities

Table 14: Transfer payments made to public entities 2012/13

Name of public

entity

Services rendered

by the public entity

Amount

transferred to the

public entity

Amount spent by

the public entity

Achievements of

the public entity

Health and Welfare

SETA

Implementation of

Skills Development

Act, utilising

employers’

contributions for

skills development

and work-based

training

28 238 28 238 297 learnerships

implemented

123


6.5 Conditional grants and earmarked funds received

The tables below describe the conditional grants and earmarked funds received by the department

Table 15: Health Professions Training and Development Grant

Department that transferred grant: National Department of Health

Purpose of the grant Assist provinces to cover costs associated with

providing a public service training platform for

students in the health sciences.

Establish new clinical teaching and training

capacity for public service platform in earmarked

provinces (Northern Cape, North West, Limpopo,

Mpumalanga, Eastern Cape).

Co-fund implementation of the National Human

Resources for Health Strategy in relation to the

expansion of undergraduate medical education

from 2012-2025.

Expected outputs of the grant All provinces will measure performance against the

National Human Resources for Health Strategy by

monitoring:

• Number of undergraduate health sciences

trainees utilising the public health service

platform, by category, training institution

and province.

• Number of postgraduate health sciences

trainees (excluding registrars) utilising the

public health service platform, by category,

training institution and province.

• Number of registrars trained on the public

health service platform, per discipline and

per training institution in province.

• Number of community service health

professionals utilising the public service

training platform.

• Number of other health science trainees

supervised during training on the public

health service platform as per statuary

requirements (for example, interns).

124


Department that transferred grant: National Department of Health

Actual outputs achieved • 22 438 students in all health sciences

disciplines enrolled in Gauteng’s institutions

of higher learning:

- 17 426 undergraduates are utilising

public sector platform.

- 5 012 post-graduate students are using

this platform.

• 739 fi rst and second year medical interns.

• 1 350 community service health

professionals.

• 1 193 registrars in training on the service

platform.

• 1 085 fi eld posts for registrars.

• 1 029 fi eld post for specialists.

Amount per amended DORA R725 310

Amount received (R’000) R725 310

Reasons if amount as per DORA was not received Amount received per DORA

Amount spent by the department (R’000) R725 310

Reasons for the funds unspent by the entity Funds entirely spent

Monitoring mechanism by the receiving

department

Monitor expenditure trends using BAS monthly

reports.

Produce fi nancial and non-fi nancial performance

evaluation reports which are shared with Treasury.

Undertake two national monitoring support visits.

Follow up and implementation of corrective

measures for underperforming institutions.

Table 16: National Tertiary Services Grant

Department that transferred the grant: National Department of Health

Purpose of the grant Ensure provision of tertiary health services for all

South African citizens.

Compensate tertiary facilities for the costs

associated with providing these services to

patients including those from across boundaries/

borders.

Expected outputs of the grant Provision of designated central and national

tertiary services in 22 hospitals/complexes as

agreed between the province and the national DOH.

125



Actual outputs achieved Total number of inpatient days: 1 348 346.

Number of inpatient days at individual hospitals:

Charlotte Maxeke Johannesburg Academic

Hospital: 240 068.

Chris Hani Baragwanath Academic Hospital:

340 007.

Dr George Mukhari Hospital: 336 659.

Steve Biko Academic Hospital: 233 333.

Helen Joseph Hospital: 62 443.

Kalafong Hospital: 135 836.

Amount per amended DORA R3 044 567

Amount received (R’000) R3 044 567


Amount spent by the department (R’000) R3 044 526

Reasons for the funds unspent by the entity Full amount spent


department

Information offi cers at facilities collect information

monthly’ as per SLA and “YES” list, and collate

it quarterly. Discrepancies are identifi ed and

corrected.

Collated information from the individual facility

is then forwarded to the provincial information

offi cer who compiles a provincial report which is

sent to the Programme Manager: Hopsital Services

for coordination of signatures of relevant chief

directors, the CFO and HOD. The fi nal copy is then

sent to national health department and other

relevant stake holders.

126


Table 17: Nati onal Health Insurance Grant


Purpose of the grant Test innovations necessary for implementing

National Health Insurance.

Undertake health system strengthening initiatives

and support selected pilot districts in implementing

identifi ed service delivery interventions.

Strengthen resource management of selected

central hospitals.

Expected outputs of the grant A framework that:

Enhances managerial autonomy, delegation of

functions and accountability in districts and health

facilities.

Provides for a scalable model, including the

required institutional arrangements, for a district

health authority (DHA) as the NHI contracting

agency.

Tests how health service management and

administration and relate to the functions and

responsibilities of DHAs.

Provides models for contracting private providers

that include innovative arrangements for

harnessing private sector resources at PHC level.

Provides for a rational referral system based on a

re-engineered PHC platform with a particular focus

on rural and previously disadvantaged areas.

Provides a model for revenue collection and a

management model for identifi ed central hospitals.

Actual outputs achieved • Procurement of medical equipment for

CHCs and clinics.

• Contracting of 11 general practitioners

where the need was identifi ed.

• Contracting of 49 CHWs to support ward-

based outreach teams.

• Full district specialist team appointed.





127



Reasons for the funds unspent by the entity An amount of R23 435 could not be spent by the

department due late approval of the business plan

which resulted in:

Non-fi lling of case managers’ posts.

Delays in procurement of medical equipment.

Delays in contracting of NGOs which caused late

processing of CHWs’ payments.

The department applied for a rollover of

R12 026 which had not been approved by

Provincial Treasury at the time of compiling this

report. Equipment was purchased but not yet

delivered.


department

Steering committee that meets on a weekly basis.

Performance reviews are conducted.

M&E reports are compiled.

Table 18: Comprehensive HIV and AIDS Grant


Purpose of the grant Enable the health sector to develop an effective

response to HIV and AIDS, including universal

access to HCT.

Support the implementation of the National

Operational Plan for comprehensive HIV and AIDS

treatment and care.

Subsidise funding for antiretroviral treatment

programme.

128



Expected outputs of the grant • Renovation/expansion of health facilities

offering ART services.

• New patients started on ART.

• Total number of patients on ART remaining

in care.

• Benefi ciaries served by home-based carers.

• Active home-based carers receiving

stipends.

• Male condoms distributed.

• Female condoms distributed.

• High transmission area intervention sites

• ANC clients initiated on life-long ART.

• Babies tested for HIV at six weeks.

• HIV-positive clients screened for TB.

• HIV-positive patients started on isoniazid

prophylaxis.

• Active lay counsellors on stipends.

• Clients receiving pre-test counselling on

HCT (including ANC).

• Clients tested for HIV (including ANC).

• Health facilities offering MMC services.

• MMC procedures performed.

• Sexual assault cases offered ARV

prophylaxis.

• Step Down Care (SDC) facilities/units

• Doctors and professional nurses trained

in management of HIV, AIDS, STIs, TB and

chronic diseases.

129



Actual outputs achieved • 364 fi xed public health facilities offering

ART services.

• 133 983 new patients started on ART.

• 714 308 patients in total remaining on ART.

• 80 577 benefi ciaries served by home-based

carers.

• 6 555 active home-based carers receiving

stipends.

• 131 972 200 male condoms distributed.

• 2 368 915 female condoms distributed.

• 14 736 ANC clients initiated on life-long

ART.

• 52 728 babies tested for HIV at six weeks.

• 244 784 HIV-positive clients screened for

TB.

• 1 644 active lay counsellors on stipends.

• 3 863 419 clients received pre-test counsel-

ling (including ANC).

• 3 697 292 clients tested for HIV (including

ANC).

• 60 health facilities offering MMC services.

• 94 159 medical male circumcisions per-

formed.

• 4 817 sexual assault cases offered ARV

prophylaxis.

• 18 SDC facilities/units.

• 5 991 doctors and professional nurses

trained on HIV, AIDS, STIs, TB and chronic

diseases.

Amount per amended DORA R1 901 293

Amount received (R’000) R1 901 293


Amount spent by the department (R’000) R1 901 293

Reasons for the funds unspent by the entity Full amount spent

130




department

Data is collected as per the reporting format of the

DORA: monthly fi nancial reports and quarterly non-

fi nancial reports. Data is collected at facilities, sent

to sub-district offi ces, then to district offi ce and

fi nally to the central offi ce. There it is verifi ed by

the HIS Directorate before forwarding to the HAST

Directorate.

Indicators per sub-programme are compared

against targets in the business plan to identify

deviations. If targets are not achieved, reasons are

sought and corrective action is taken.

Table 19: Nursing Colleges Grant


Purpose of the grant Supplement provincial funding of health

infrastructure (including provision of equipment

and furniture) to accelerate provision.

Ensure proper maintenance of infrastructure for

nursing colleges and schools.

Expected outputs of the grant Number of nursing colleges and schools planned,

designed, constructed, operationalized and

maintained.

Number of work opportunities created.

Actual outputs achieved One nursing college at 92% construction.

One nursing college at 80% planning.







Reasons for the funds unspent by the entity Delays in appointment of contractors led to late

payment of service providers.

Poor performance by service providers.

Lengthy process for approval of documents.


department

Monitoring mechanisms during planning are:

project plans, submissions, monthly design reviews

and fi nalisations and meetings.

Monitoring mechanisms during construction are:

monthly progress review reports and meetings.

131


Table 20: Health Infrastructure Grant


Purpose of the grant Supplement provincial funding of health

infrastructure to address backlogs and accelerate

provision of health facilities.

Ensure proper life cycle maintenance of provincial

healthcare infrastructure.

Expected outputs of the grant Number of health facilities, planned, designed,

constructed, operationalised and maintained.

Number of work opportunities created.

Actual outputs achieved Number of facilities designed and planned: 34.

Number of facilities in construction: 18.

Number of facilities operationalised: 57.

Number of facilities maintained: 2.





Reasons for the funds unspent by the entity Delays in appointment of contractors led to late





department






132


Table 21: Hospital Revitalisation Grant


Purpose of the grant Provide funding to enable provinces to plan,

manage, modernise, rationalise and transform

health infrastructure, health technology, and

monitoring and evaluation of the health facilities in

line with national policy objectives.

Supplement expenditure on health infrastructure

delivered through public-private partnerships.

Expected outputs of the grant Number of hospitals upgraded, rebuilt and fully

commissioned.

Actual outputs achieved New Natalspruit Hospital reached 97% completion.

New Zola/Jabulani Hospital reached 98%

completion.

Access road for new Natalspruit Hospital was

completed.

Electro-mechanical replacement programme was

implemented.

Nine facilities were maintained.



Reasons if amount as per DORA was not received Amount received as per DORA.


Reasons for the funds unspent by the entity The department could not fully utilise the amount

appropriated due to poor designs and project

management which lead to changes in scope,

variation orders and extension of time.

Delays in appointment of contractors led to late





department






133


Table 22: EPWP Integrated Grant

Department that transferred the grant: National Department of Public Works

Purpose of the grant Provide an incentive to provincial departments to

expand work creation efforts through the use of

labour-intensive delivery methods in the following

focus areas:

- Road maintenance and the maintenance of

buildings.

- Low traffi c volume roads and rural roads.

- Other economic and social infrastructure.

- Tourism and cultural industries.

- Sustainable land-based livelihoods.

Expected outputs of the grant Increase in number of people employed and

receiving income through the EPWP.

Increase in average duration of the work

opportunities created.

Increase in income per EPWP benefi ciary.

Actual outputs achieved None



Reasons if amount as per DORA was not received Amount received as per DORA

Amount spent by the department (R’000) 0

Reasons for the funds unspent by the entity The projects earmarked for implementation did not

progress and were moved to the next fi nancial year.


department

None

Table 23: EPWP Incentive Grant for the Social Sector


Purpose of the grant Provide an incentive to provincial social sector

departments identifi ed in the 2012 Social Sector

EPWP Log-frame to increase job creation by

focusing on strengthening and expanding

programmes that have employment potential.

134



Expected outputs of the grant Increase in number of people employed and

receiving income through the EPWP.

Increase in duration of the work opportunities

created.

Increase in number of households and

benefi ciaries to which services are provided.

Increase in income per EPWP benefi ciary.

Actual outputs achieved 1 540 jobs were created.

1 540 contracts were extended by 230 days.

1 019 148 households benefi ted.

855 005 clients were seen.

Income increased from R63.18 per day (R1 264 per

month) to R66.34 per day (R1 326 per month).



Reasons if amount as per DORA was not received Amount received as per DORA


Reasons for the funds unspent by the entity Under-spent by 2% due to disqualifi cation of NGO

identifi ed for the grant because of mismanagement

of funds and two NGOs submitting their claim

forms late for the fourth quarter.


department

Monthly reports of expenditure against budgeted

allocation are submitted through HOD to

Department of Public Works.

Table 24: African Cup of Nations Grant


Purpose of the grant Provide health and medical services for the African

cup of Nations.

Expected outputs of the grant EMS at venues used in African Cup of Nations.

Actual outputs achieved Number of doctors: 0.

Number of nurses: 0.

Number of paramedics: 97.

Number of emergency care practitioners: 502.

Number of ambulances: 14.

Number of response vehicles: 6.

Number of disaster buses: 4.

Number of golf carts or equivalent: 2.

Number of port health practitioners: 0.

Number of forensic pathology services: 0.

Command and control function: 8 per day.

135





Reasons if amount as per DORA was not received Amount received as per DORA.

Amount spent by the department (R’000) None

Reasons for the funds unspent by the entity R3 000


department

These were based on the operational and

implementation plan

6.6. Donor funds

Donor assistance includes both cash and in-kind contributions. There is a need for substantial

improvement in reporting on donor assistance as institutions have provided insuffi cient information. All

fi gures for donor funding must correspond with the amounts disclosed in the annual fi nancial statement

and the following information must be provided:

• The name of the donor.

• The amount received in the current reporting period.

• The purpose of donor funding.

• Outputs achieved.

• Specifi cation whether the donation was in cash or kind.

• Amount spent from donor funds.

• Monitoring/reporting to the donor.

• Reasons for any unspent funds and an indication whether surplus funds will be returned to the

donor.

Table 25: Donor funds made in cash 2012/13

Name of donor: Various donors

Full amount of the funding R202 740.00

Period of the commitment Indefi nite

Purpose of the funding Provide and ensure necessary equipment/ furniture

at institution

Expected outputs Excellence in providing required services

Actual outputs achieved Indefi ned

Amount received in current period (R’000) Equipment (various) was donated

Amount spent by department (R’000) No cash received

Reasons for the funds unspent N/A

Monitoring mechanism by the donor Equipment becomes the department's

responsibility after acceptance of donation

136


Tables 26 (a – w): Donor funds made In-kind/assets 2012/13

a) Name of donor: Bracing Air Trading Project



Purpose of the funding To promote effi cient healthcare services in the

West Rand Region

Expected outputs Determine early detection of the haemoglobin

levels in the blood of patients

Actual outputs achieved Undefi ned

Amount received in current period (R’000) N/A

Amount spent by the department (R’000) Equipment (various) was donated

Reasons for the funds unspent No cash received



b) Name of donor: DDP Valuers and Airports Company South Africa



Purpose of the funding Ensure institution is equipped with the necessary

equipment for patients

Expected outputs Ensure patients are consulted with equipment in

good working condition

Actual outputs achieved Equipment becomes the department's



Amount spent by the department (R’000) Equipment (various) was donated




c) Name of donor: National Department of Health


Period of the commitment N/A

Purpose of the funding To support and roll out the implementation of HIV

register

Expected outputs N/A



Amount spent by the department (R’000) Computer equipment was received


137


c) Name of donor: National Department of Health



d) Name of donor: Ms Ephonia Sophie Nkosi



Purpose of the funding Provide education resources to institution

Expected outputs Ensure institution is equipped with required

resources



Amount spent by the department (R’000) Television was donated




e) Name of donor: Abbott Laboratories



Purpose of the funding Ensure correct ergonomics for staff and patients

Expected outputs Ensure institution is equipped with furniture

required



Amount spent by the department (R’000) Chairs were donated




f) Name of donor: Aspen Pharmacies, Wendy Braun, Natal Lowes, Dr Naicker & Ellen



Purpose of the funding Ensure accurate and correct results for relevant

medical tests of patients

Expected outputs Obtain the necessary test results for patient

diagnosis



Amount spent by the department (R’000) Medical equipment donated

138


f) Name of donor: Aspen Pharmacies, Wendy Braun, Natal Lowes, Dr Naicker & Ellen




g) Name of donor: Ms Simone Samuels & Dolly Marcus

Full amount of the funding R599.94


Purpose of the funding Provide warmth in wards

Expected outputs Ensure that wards are at correct temperatures for

patients



Amount spent by the department (R’000) Equipment (heaters) were donated




h) Name of donor: Welchallyn, Logan Medical & Surgical and Tal



Purpose of the funding Ensure effi cient and professional service provided

by the institution

Expected outputs Ensure working tools for staff at institution



Amount spent by the department (R’000) Equipment / furniture was donated




i) Name of donor: University of Pretoria



Purpose of the funding Repair of 30 chairs

Expected outputs Ensure comfortable ergonomics for patients and

staff



Amount spent by the department (R’000) Repair service was donated


139


i) Name of donor: University of Pretoria



j) Name of donor: Makro and Globir Medical Supplier



Purpose of the funding Used for the relaxation of muscles

Expected outputs Ensure use of high-frequency electromagnetic

currents as a form of physical or occupational

therapy and in surgical procedures.


Amount received in current period (R’000) Diathermy equipment was donated

Amount spent by the department (R’000) N/A




k) Name of donor: Carefusion



Purpose of the funding Ensure effi cient and professional service provided

by the institution

Expected outputs Ensure working tools for staff at institution



Amount spent by the department (R’000) Equipment/ Furniture (various) was donated




l) Name of donor: Techblitz Communication



Purpose of the funding Ensure working audio visual equipment at

institution

Expected outputs Provide institution with the necessary audio visual

equipment needed for staff, patients


140


l) Name of donor: Techblitz Communication

Amount received in current period (R’000) Equipment was donated





m) Name of donor: Professional Orthopaedics and Isigidi Trading



Purpose of the funding Used for the relaxation of muscles

Expected outputs Ensure use of high-frequency electromagnetic

currents as a form of physical or occupational

therapy and in surgical procedures


Amount received in current period (R’000) Diathermy equipment was donated





n) Name of donor: Game Stores



Purpose of the funding Used to store medicine with minimum

temperature requirements

Expected outputs Ensure longer life for medicines required to be

stored at below room temperature


Amount received in current period (R’000) Refrigerators were donated, not funds





o) Name of donor: University of North West and Drager



Purpose of the funding Used to care for premature babies in a neonatal

intensive care unit

141


o) Name of donor: University of North West and Drager

Expected outputs Ensure maximum care and monitor growth of

premature babies


Amount received in current period (R’000) Incubators were donated





p) Name of donor: PSA



Purpose of the funding Ensure working computer equipment for

institution to perform required daily tasks

Expected outputs Obtain and provide accurate and relevant

information to Central Offi ce


Amount received in current period (R’000) Equipment was donated





q) Name of donor: Vitalaire

Full amount of the funding R 1 708.86


Purpose of the funding To assist in faxing scripts for patients

Expected outputs Ensure correct and accurate information for

patients


Amount received in current period (R’000) Fax machines / Printers were donated





r) Name of donor: Randfontein District Municipality



Purpose of the funding Weighing of patients

142


r) Name of donor: Randfontein District Municipality

Expected outputs Ensure correct weight for patients requiring

treatment


Amount received in current period (R’000) Bathroom scales were donated





s) Name of donor: Aurum Institute for Health Research and TB Free



Purpose of the funding Health research and TB Free road shows

Expected outputs Ensure communities are educated in the

prevention / treatment of TB


Amount received in current period (R’000) Two cars were donated





t) Name of donor: Welch Allyn, GEO Cloud, Samsung, Makro and Furniture City



Purpose of the funding Ensure institution is equipped with the necessary

tools

Expected outputs Ensure availability of relevant equipment and

furniture for job requirements


Amount received in current period (R’000) Equipment / furniture was donated





u) Name of donor: National Department of Health



Purpose of the funding Improve healthcare waste management

Expected outputs Ensure appropriate storage for placentas and other

anatomical HCW in certain facilities


143


u) Name of donor: National Department of Health

Amount received in current period (R’000) Equipment (Freezers) were donated





v) Name of donor: Hifi Corporation



Purpose of the funding Improve healthcare waste management

Expected outputs Ensure institution is equipped with resources


Amount received in current period (R’000) Audio visual equipment was donated





w) Name of donor: Old Mutual

Full amount of the funding R620.00


Purpose of the funding Ensure institution is equipped with utensils

Expected outputs Ensure patients receive warm food


Amount received in current period (R’000) Microwave Oven was donated





144


6.7 Capital investment, maintenance and asset management plan

Through the implementation of various capital and maintenance infrastructure projects, Programme 8

(Health Facilities Management) spent 82% of its allocated budget.

Table 27: Infrastructure projects completed 2012/13

Project name Planned date for completion

Actual date of completion

Reasons for variance

Bertha Gxowa Hospital New 300-bed district hospital

1 July 2011 31 August 2012 On 29 November 2011, the Bertha

Gxowa Hospital was offi cially opened.

Only the outpatients department,

admissions and pharmacy were

functional because the certifi cate

of occupation could not be issued

before completion of fi re-stopping.

Fire-stopping was completed in

August 2012 and the certifi cate was

issued, enabling the hospital to be fully

functional.

Leratong Hospital

Replacement of the main air-conditioning

8 July 2010 5 March 2013 Insuffi cient budget in early years of the

project. Shutting down all theatres for a

period of eight weeks was challenging

as services had to continue.

South Rand Hospital Upgrading and renovations to nurses’ residence

31 August 2012 31 August 2012 The project was completed on time.

Replacement of generators: Helen Joseph Hospital, Sterkfontein Hospital, Tambo Memorial Hospital, Carletonville Hospital, Chris Hani Baragwanath Academic Hospital, South Rand Hospital, Tshwane District Hospital, Lenasia South CHC, Zola CHC, Chiawelo CHC, Lillian Ngoyi CHC, Mofolo CHC

22 December 2011 26 October 2012 Procurement of service providers took

longer than expected.

145


Project name Planned date for completion

Actual date of completion

Reasons for variance

Johannesburg

Laundry

Replacement of

laundry equipment

18 November 2011 20 June 2012 Procurement of service providers took

longer than expected.

Table 28: Infrastructure projects that are currently in progress

Institution Description Planned completion date

Natalspruit Hospital New 760-bed regional hospital 30 June 2013

Zola Hospital (in Jabulani) New 300-bed district hospital and gateway clinic in Jabulani

16 August 2013

Jubilee Hospital Planning of construction: revitalisation of regional hospital

31 March 2014

Dr Yusuf Dadoo Hospital Planning of construction: revitalisation of regional hospital

31 March 2014

Tambo Memorial Hospital Planning of construction: revitalisation of regional hospital

31 March 2014

Kalafong Hospital Planning of construction: revitalisation of regional hospital

31 March 2014

Sebokeng Hospital Planning of construction: revitalisation of regional hospital

31 March 2014


Emergency repairs and refurbishment

31 July 2016

Khayalami Hospital Complete refurbishment of the unused hospital for use as a district hospital

30 November 2017

Helen Joseph Hospital Renovations to psychiatric ward and observation units

30 November 2013

Pretoria West Hospital Upgrading of main air-conditioning chiller plant

30 September 2013


Upgrading and renovation of the psychiatric unit

30 November 2014

Kopanong Hospital Renovation of wards 1 and 2 and psychiatric ward

31 March 2014

Randgate Clinic New clinic 30 September 2014

Tembisa Hospital Renovations and refurbishments to psychiatric wards

30 June 2014

Tambo Memorial Hospital Renovations and refurbishments to psychiatric wards

30 September 2013

146


Institution Description Planned completion date


Renovations and refurbishments to psychiatric wards and observation units

30 June 2014

Helen Joseph Hospital Upgrading and renovation of four nurses’ and doctors’ residences

30 November 2013


Renovations of doctors’ quarters and staff residences

31 June 2016

Phase 1Charlotte Maxeke , Sebokeng, Leratong, Tembisa and Natalspruit hospitals and Lebone and Bonalesedi colleges

Rapid refurbishment of nurses’ residences

15 May 2013

Phase 2Chris Hani Baragwanath Academic and Dr George Mukari hospitals

Rapid refurbishment of nurses’ residences

30 November 2013

S G Lourens Nursing College Refurbishment of nursing college 27 March 2015

Bonalesedi Nursing College Renovations and additions to nursing college

30 March 2014

Ga-Rankuwa Nursing College Upgrading and renovations to nursing college

27 March 2015

Ann Latsky Nursing College Completion of Phase 2A: upgrading and renovations to nursing college

30 November 2013

Discoverers CHC Convert CHC into district hospital

15 August 2016

Lenasia South CHC Convert CHC into district hospital

31 October 2016

Sterkfontein Hospital Upgrading of psychiatric ward 31 January 2014

Boikutsong CHC Planning for building of new clinic

30 April 2014

Johannesburg FPS Mortuary Either upgrading of existing mortuary or building of new mortuary (depending on site selection)

31 May 2016

Bronkhorstspruit FPS Mortuary Building of new mortuary (possibly together with new EMS facility)

31 May 2016

Finetown Clinic New build 31 May 2015

Project 274 Various institutions Replacement of lifts and boilers 31 March 2014

147


The old Germiston Hospital will be demolished.

CEOs of central hospitals were delegated the

authority to approve maintenance projects up to

the value of R1 million. Projects at institutional

level that were valued at less than R500 000

were implemented on the basis of obtaining

three quotations. In accordance with Treasury

Regulations, projects valued at more than R500 000

followed the normal tendering process.

General maintenance of facilities in GDoH has been

mostly unsatisfactory due to capacity challenges.

However, through the Infrastructure Development

Improvement Plan (IDIP), GDID embarked on a

process of appointing new staff with much needed

technical expertise. As GDoH has also instituted a

process to capacitate district offi ces and facility

management units in hospitals, it is envisaged that

maintenance of facilities will improve in the longer

term.

As part of the Turnaround Strategy, the following

tertiary and central hospitals were prioritised:

• Steve Biko Academic Hospital.

• Dr George Mukhari Hospital.

• Charlotte Maxeke Johannesburg Academic

Hospital.

• Chris Hani Baragwanath Academic Hospital.

• Kalafong Hospital.

• Tembisa Hospital.

• Helen Joseph Hospital.

From October 2012 the Infrastructure Directorate

implemented a short term project to improve

maintenance at institutional level. Each prioritised

hospital was allocated a project manager who

visited the hospital weekly and monitored

maintenance and work in progress. Challenges

identifi ed during these visits were discussed at

provincial level and escalated for HOD intervention.

The substantial maintenance backlog continues

to result in the deterioration of the value of assets

and functionality of facilities. Addressing the

maintenance backlog will require an increased

budget.

6.8 Disposal of assets

The asset disposal plan defi nes the assets that can

be considered unsuitable or in excess of service

delivery needs and takes into account the options

of transferring these assets for alternative use or

making them available for rental or sale. All assets

identifi ed in the disposal plan should be disposed of.

An explanation must be given for any such assets

not disposed of. The method, frequency and timing

of disposal , as set out in the disposal plan, must

be followed. Disposal of movable assets should be

done on a quarterly basis and when the need arises.

Transaction

All asset disposals require approval by the

Accounting Offi cer unless the function has been

delegated to CEOs of institutions.

Movable assets will be disposed each fi nancial year

under the following circumstances:

• The asset is obsolete.

• The cost of repairing or maintaining the asset

exceeds the replacement cost.

• Performance of the asset fails to meet opera-

tional requirements.

• The asset has been damaged beyond repair.

Regulations require that disposal of movable

assets must be at market-related value or by tender

or auction, whichever is most advantageous to

the state, unless determined otherwise by the

relevant treasury. They also require that any sale

of immovable state property be at market-related

value, unless the relevant treasury approves

otherwise.

All institutions must ensure that they have (or

have access to) a disposal committee to deal with

disposal of assets.

Where computer equipment is to be disposed of,

148


the relevant department of education should be

approached to make arrangements for free transfer

of such assets to educational institutions. Before

disposal of computer hardware, the hard disks have

to be formatted and forensically sanitised to ensure

data cannot be extracted.

All equipment is disposed of in accordance with

sound environmental practice.

All assets disposed of should be recorded in the

disposals register.

• The cash received must be recorded

• The disposal register should record a clear refer-

ence to source documentation.

Non-traceable assets should be written off after

investigation and removed from the asset register.

Proper approval for the write-off must be obtained.

Any losses or discrepancies which appear to result

from criminal action must be reported to the SAPS.

Table 29: Value of assets disposed of 2012/13

Output 2012/2013

Intangible assets 0

Transport assets 3 516 615.80

Other machinery and

equipment 8 573 857.89

Computer equipment 926 180.57

Offi ce furniture and

equipment 369 251.77

Total R13 385 906.09

Because of the department has well-formulated

guidelines for asset disposal, it is able to provide

correct and accurate information and fi nancials.

Measures were taken during the year under review

to ensure that the department’s asset register

remained up to date. All assets must be recorded

in the asset register and asset management

system in accordance with the specifi cations in

Treasury guidelines. The information captured

must include non-fi nancial data on acquisition,

identity, accountability, performance and disposal,

in addition to detailed fi nancial data.

Classifi cation of assets should be directly linked

and conform to the classifi cations within the Annual

Financial Statement disclosure notes.

All assets must be recorded in the asset register,

regardless of the funding source, whether they are

cash or non-cash (found, donated, transferred). Any

and all costs incurred in the process of deploying

an asset within the Department in a working

state, such as confi guration, delivery, installation,

commissioning or other similar costs, must be

included in the overall cost of the asset.

The asset register and asset management system

must allow asset data to be;

• Updated as transactions and events occur.

• Regularly reconciled with acquisition, disposal

and transfer data and the general ledger.

• Readily available to asset managers, preferably

online, for review.

All the information in the asset register must be

safeguarded. No unauthorised changes must be

allowed. Reconciliations between the asset register

and the accounting records (general ledger) must

be done on a monthly basis.

149


6.9 Reconciliations

Reconciliation involves a physical asset count

as well as reconciling the asset register and

accounting system. Assets that are procured and

received must be bar-coded and reported to central

offi ce on a weekly basis. A fi le for reconciliation

must be submitted to central offi ce no later than

the tenth day of each month.

Table 30: Breakdown of departmental assets by type and condition

Asset

category

Conditions description

Very

good

% Good % Fair % Poor % Very

poor

% Total %

Intangible assets - - - - - - - - - - - -

Transport assets 63 0.2 469 0.3 1122 0.2 6 0.1 110 0.5 1770 0.2

Other machinery and equipment 15 844 56.9 50 457 30.7 221 178 35.0 2 068 28.7 9 517 42.1 299 064 35.1

Computer equipment 2 877 10.3 15 489 9.4 29 659 4.7 678 9.4 3 485 15.4 52 188 6.1

Offi ce furniture and equipment 9 077 32.6 97 897 59.6 379 549 60.1 4 462 61.9 9 475 41.9 500 460 58.6

Total 27 861 100 164 312 100 631 508 100 7 214 100 22 587 100 853 482 100

None of the department’s immovable assets were

disposed of, scrapped or lost due to theft during

2012/13..

The User Asset Management Plan (UAMP) for

2012/13, rated the condition of 43% of immovable

assets occupied by the GDoH as good to excellent

and 57% as fair. These fi gures do not take into

account electrical and plumbing systems that are

in a poor to very poor state in many health facilities.

This situation is being addressed through the

Electro-Mechanical Replacement Programme and

the following projects were completed in 2012/13:

• Electrical reticulation at 10 institutions.

• Steam reticulation at three institutions.

• Upgrade of autoclaves at 26 institutions.

• Upgrade of chillers at 15 institutions.

The maintenance backlog has increased due to

limited supplier expertise and availability of material

and/or equipment. Supplier diversifi cation is being

considered as remedy.

150


Table 31: Expenditure on infrastructure projects 2012/13

2012/2013 2011/2012

Infrastructure

projects

Final

appropriation

R’000

Actual

expenditure

R’000

(Over)/under

expenditure

R’000

Final

appropriation

R’000

Actual

expenditure

R’000

(Over)/under

expenditure

R’000

New and

replacement

assets 738 320 508 359 229 961 1 248 068 596 395 651 673

Existing infra-

structure assets 743 102 672 981 70 121 682 481 538 516 143 965

Upgrades and

additions 96 564 32 357 64 207 213 759 69 044 144 715

Rehabilitation,

renovation and

refurbishment 160 042 34 048 125 994 46 507 - 46 507

Maintenance and

repairs 468 496 606 576 (138 080) 422 215 469 472 (47 257)

Infrastructure

transfer 1 481 422 1 181 340 300 082 1 930 559 1 134 911 795 638

Current 486 496 606 576 (120 080) 422 215 469 472 (47 257)

Capital 994 926 574 764 420 162 1 508 334 665 439 842 895

Total 1 481 422 1 181 340 300 082 1 930 549 1 134 911 795 638

6.10 Achievements in asset management

Monthly reconciliations of the asset register and the

Basic Accounting System (BAS) were submitted to

Treasury before the required deadline. The amounts

involved in reconciliation are indicated in Table 32.

The Asset Management Directorate has achieved

an unqualifi ed audit for two consecutive years

and was approached by the health departments of

Mpumalanga and KwaZulu-Natal for guidance on

achieving similar results. It also received requests

from Treasury to assist another department and

to use the GDoH Asset Management Policy and

Procedure Manual for benchmarking purposes.

Table 32: Reconciliations between BAS and asset register 2012/13

Capital items (R’millions) Minor items (R’millions)

Additions R414 623 R33 477

Disposals R13 385 -

Transfers (GDoH to Social

Development) R92 517 R69 108

Donations R29 616 R7 416

151

152

Part C

GOVERNANCE

153

Governance


1. Introduction

Commitment to maintaining the highest standards

of governance is fundamental to the management

of public fi nances and resources. Tax payers and the

broader public want assurance that the department

has good governance structures in place to utilise

state resources effectively and economically.

2. Risk management

Effective risk management is necessary for the

department to ensure competent strategic decision

making and to conduct of effi cient, effective and

robust business processes. It is essential for

the realisation of the department’s strategic and

operational objectives. Sound management of risk

enables the department to anticipate and respond

to changes in the health environment, and make

informed decisions under conditions of uncertainty.

These decisions impact on the quality of service

delivery.

Strategy development

The department developed a risk management

strategy during the year under review. This focused

on understanding the risks that the department

faces, identifying the causes and developing

control measures. The strategy also acknowledged

the important of creating an environment of

honesty and openness where adverse incidents

are identifi ed quickly and dealt with in a positive

and responsive way. Other aspects of the strategy

dealt with reducing risks to employees and

stakeholders, managing them or transferring them,

as appropriate.

The strategy focus on mitigating risks relating to

the following areas:

• The National Health Council’s top 10 prior-

ities.

• The Gauteng Health Turnaround Strategy.

• Cash flow management.

• Human resources.

• Information and communication technol-

ogy.

• Infrastructure.

• Financial management.

• Risks related to internal and external audit

queries and areas of non-compliance.

Progress in addressing risks

The department’s cash flow position has improved

during the year under review. The department has

considerably decreased its overspending as well

as unauthorised expenditure. Targets in this regard

were developed as part of the Turnaround Strategy

and they were monitored regularly. The fi ve

pillars of the turnaround strategy were: strategic

leadership and a desirable organisational culture;

environmental controls for good governance;

communication and social mobilisation; human

resource management and development; health

infrastructure development and rehabilitation.

Mandate committees were established for high

risk areas. Compensation of employees remained

within the allocated budget and measures were

put into place to reduce expenditure on overtime.

Critical positions were fi lled. Risk assessments

were conducted for infrastructure management

and information and communication technology

and progress was monitored.

3. Fraud and corruption

The following activities were undertaken during

2012/13 with a view to eliminating fraud and

corruption:

• The department developed and implemented a

gift policy to address the common practice of

companies offering gifts as a courtesy to cli-

ents.

• Four offi cials attended the DPSA‘s anti-corrup-

tion training programme.

• Offi cials who attend the induction programme,

154


tha tis offered on a monthly basis, are intro-

duced to the culture and ethos of the depart-

ment.

• There are awareness-raising activities on fraud

prevention and whistle blowing.

• The department conducted 17 training sessions

on ethics and fraud prevention.

Posters promoting the reporting of fraud and

corruption to the Public Service Commission’s

hotline were displayed in all institutions and

on the department’s intranet. Offi cials are also

encouraged to report fraud and corruption to the

risk management unit. Cases reported are referred

by the offi ce of the Public Service Commission

for investigation which is undertaken by Gauteng

Forensic Services.

4. Minimising conflict of interest

The Department has put a process in place whereby

all offi cials are requested to complete a declaration

of interest form on a yearly basis to minimize

conflict of interest. Awareness around conflict

of interest is raised at orientation and induction

sessions as well as training session on the code of

conduct.

Where conflict of interest has been identifi ed,

disciplinary action is taken.

Financial Disclosures were submitted by 90 SMS

members and these were submitted to the Public

Service Commission (PSC).

There were only three (3) SMS members who didn’t

submit as they were on suspension at the time and

have since been dismissed.

Staff on salary levels 1 to 12, including Supply

Chain employees and staff who were translated to

Occupational Specifi c Dispensations (OSDs) are all

required to submit annual Declarations of Interest,

declaring where the employees or their spouses

have business interest with the Department or

any other Department within the Public Service, or

where the employee is performing Remunerative

Work Outside the Public Service (RWOPS).The

system was introduced in the 2012/ 2013 fi nancial

year with varying degrees of compliance. The

monitoring and control measures have been

strengthened to ensure 100% compliance in the

coming fi nancial year.

A vetting plan has been approved and agreed with

the State Security Agency for implementation in the

2013/2014 fi nancial period

5. Code of conduct

The department conducted two training sessions

per institution on the code of conduct during the

fi nancial year. Awareness is also raised during

induction sessions.

Disciplinary procedures are followed where the

code of conduct is breached

6. Health, safety and environmental issues

Occupational health safety structures within

the department were established to address

occupational, health and environmental health

challenges as well as statutory requirements

applicable to these programmes. Occupational

health safety matters are managed within the

context of occupational health safety act. Internal

audits and risk assessments are done and where

occupational health and safety risks are identifi ed,

mitigation plans are put in place to address these.

In addition, the employee health and wellness

challenges is catered for through a range of

programmes as provided for in the DPSA policy for

155

intergrated policy for employee health and wellness.

All employee challenges and needs are addressed

through various committees and referral systems

within the department. Whilst environmental

health and related matters aim is to facilitate

legal compliance to environmental requirements

such as environmental pollution control within the

department.

7. Internal Control Unit

The Internal Control Unit assisted management to

improve the internal control environment through

the following activities:

• The development and implementation of a

monthly key control monitoring tool for all insti-

tutions. This is used to evaluate the effective-

ness of key controls and provide feedback to

management on areas requiring improvement

• Quarterly assessment of overall compliance

with internal controls to provide feedback to

management of weaknesses in the control en-

vironment.

• The establishment and coordination of an Audit

Action Plan Progress Review Committee that

meets on a monthly basis with all relevant of-

fi cials to evaluate progress made on the audit

action plan and to make recommendations for

improvement of audit outcomes.

• Coordination of internal and external audit pro-

cesses and quality assurance of all audit related

submissions.

• Regular training and awareness sessions with

regard to internal control and audit processes to

ensure improvement in the internal control envi-

ronment and the audit outcome.


156

Department of Health Vote 4


REPORT OF THE AUDIT COMMITTEE – CLUSTER 03for the year ended 31 March 2013.

Gauteng Department of Health

We are pleased to present our report for the fi nancial

year ended 31 March 2013

The Audit Committee consists of the external

members listed hereunder and is required to meet

a minimum of at least two times per annum as per

provisions of the Public Finance Management Act

(PFMA). In terms of the approved Terms of Reference

(GPG Audit Committee Charter), fi ve meetings were

held during the current year, i.e. three meetings for

Quarterly Performance Reporting (fi nancial and

non-fi nancial) and two meetings to review and

discuss the Annual Financial Statements and the

Auditor General Report.

Composition of the Audit Committee and Attendance:



a minimum of at least three times per annum as

per provisions of the Public Finance Management

Act (PFMA). In terms of the approved Terms of

Reference (GPG Audit Committee Charter), fi ve

meetings were held during the current year, i.e.3

meetings for Quarterly Performance Reporting

(fi nancial and non-fi nancial) and two meetings to

review and discuss the Annual Financial Statements

and the Auditor-General Report.

Non-Executive Members:

Name of Member Number of Meetings Attended

Lungelwa Sonqishe

(Chairperson)

05

Mandla Ncube

(Member)

05

Nkateko Mabaso

(Member)

05

Executive Members:

In terms of the GPG Audit Committee Charter, the

Offi cials listed hereunder are obliged to attend the

meetings of the Audit Committee:

Compulsory Attendees Number of Meetings

Attended

N Biyela (Acting Head of

Department)

04

Abey Marokoane (Acting

Chief Financial Offi cer)

05

Johann Strauss (Acting

Chief Risk Offi cer)

05

The Audit Committee noted that the Acting Head of

Department did not attend one meeting. However

a letter of apology was tendered with a duly

authorised representative attending on his behalf.

Therefore, the Audit Committee is satisfi ed that the

Department adhered to the provisions of the GPG

Audit Committee Charter.

The Members of the Audit Committee met with the

Senior Management of the Department and Internal

Audit, collectively to address risks and challenges

facing the Departments. A number of in-committee

meetings were held to address control weaknesses

and conflicts with the Department.

Audit Committee Responsibility

The Audit Committee reports that it has complied

with its responsibilities arising from section 38 (1)

(a) of the PFMA and Treasury Regulation 3.1.13. The

Audit Committee also reports that it has adopted

appropriate formal terms of reference as its Audit

Committee Charter, has regulated its affairs in

compliance with this Charter and has discharged

all its responsibilities as contained therein.

The effectiveness of internal control

The Audit Committee has observed that the overall

control environment has continued to improve

during the year under review. However, there

are still some concerns with the level of internal

controls within the Department where evidence of

157




lapses of effective monitoring and enforcement by

Management were observed.

During the year under review, several defi ciencies in

the system of internal control and deviations were

reported by the Auditor-General South Africa. In

certain instances, the matters reported previously

have not been fully and satisfactorily addressed.

The quality of in year management and monthly / quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

The Audit Committee is satisfi ed with the content

and quality of monthly and quarterly reports

prepared and issued by the Accounting Offi cer of

the Department during the year under review, in

compliance with the statutory reporting framework.

The managing of performance information needs

to be improved upon.

Evaluation of Financial Statements

The Audit Committee has:

• reviewed and discussed the audited Annual Fi-

nancial Statements to be included in the An-

nual Report, with the Auditor-General and the

Accounting Offi cer;

• reviewed the Auditor-General’s management re-

port and Management’s response thereto;

• reviewed the Department’s compliance with le-

gal and regulatory provisions; and

• reviewed signifi cant adjustments resulting from

the audit.

The Audit Committee concurs with and accepts

the Auditor-General’s conclusions on the Annual

Financial Statements, and is of the opinion that the

audited Annual Financial Statements be accepted

and read together with the report of the Auditor-

General.

Internal Audit

The Audit Committee is satisfi ed that the Internal

Audit plans addresses a clear alignment with

the major risks, adequate information systems

coverage, a good balance between different

categories of audits, i.e. risk-based, mandatory,

performance and follow-up audits and involvement

and support by Management of the plans.

The Audit Committee has noted considerable

improvement in the communication between the

Executive Management, the Auditor General and

the Internal Audit Function, which has strengthened

the Corporate Governance initiatives.

The Audit Committee wishes to stress that in order

for the Internal Audit Function to operate at optimal

level as expected by the Audit Committee, it requires

more capacity and skills. This is being addressed

and corrective action is being implemented.

Risk Management

Progress on Departmental risk management was

reported to the Audit Committee on a quarterly

basis. The Audit Committee is not satisfi ed that the

actual management of risk is receiving attention

and the implementation of the Risk Management

process requires a lot more commitment from

Management.

Forensic Investigations

The Audit Committee is not satisfi ed that the

forensic investigations are properly reported with

age-analysis of all reported issues indicated. Details

of results in respect of investigations conducted as

a result of calls through the fraud hotline were not

provided to the Committee.

158




One-on-One Meetings with the Accounting Offi cer

The Audit Committee has met with the Accounting

Offi cer for the Department to address unresolved

issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive

Authority for the Department to appraise him on the

performance of the Department.

Auditor-General South Africa

The Audit Committee has met with the Offi ce of the

Auditor-General South Africa to ensure that there

are no unresolved issues.

Lungelwa Sonqishe

CHAIRPERSON OF THE AUDIT COMMITTEE

159

160

Part D:

HUMAN RESOURCE

161

Human Resource


1. Legislation governing HR management The following legislation guides human

resources management in the department:

• The Constitution of the Republic of

South Africa 108 of 1996

• Public Service Regulation of 2001

as amended

• Employment Equity Act. 55 of 1998

• Treasury Regulations of 2001

• Public Service Act 103. Of 1994 as

Amended

• Skills Development Act. 97 Of 1998

• Basic Conditions of Employment Act.

75 of 1997

• Labour Relations Act. 66 of 1995

• All Collective Bargaining Resolutions

agreed upon at the Public Service Co

ordinating Bargaining Council and

Public Health and Social Develop-

ment Sector Bargaining Council

Other key strategic and policy documents

that inform the management of HR in the

health sector are:

• The National Ten Point Plan.

• 12 National Outcomes.

• NHI Green Paper.

• National Human Resources for

Health Strategic Plan.

• DPSA Manual on Organisational De-

sign.

• Negotiated Service Delivery Agree-

ment: Four Health Outcomes.

• Re-engineering of Primary Health-

Care.

• Modernization of Tertiary Services.

• Directive specifying which changes

to organisational structure must be

consulted with the Minister for Pub-

lic Service and Administration prior

to approval by executive authority.

• Policy approved by the Minister of

Public Service and Administration on

national co-ordination of entire occu-

pational categories or certain post

levels, including occupation-specifi c

dispensations.

2. IntroductionThe vision of the Human Resources

Management and Organisational

Development Division is to provide effi cient,

effective and responsive human resources

for the public health sector in Gauteng.

At end of 2012/13, the total number of

employees in the department was 63 659.

This fi gure includes 40 628 health

professionals. The breakdown of

professional employees was as follows:

• Doctors – 5 404

• Dentists – 453

• Nurses – 30 252

• Allied health professionals – 4 042

• Pharmacists – 477

The department prioritised the recruitment of clinical and clinical support staff over administrative and general support Staff. This approach ensured a constant supply of critical clinical staff. However, it also impacted negatively on the supply of general support staff. At the end of the fi nancial year, the total number of health administrative and general support staff was 22 741. This number excludes senior and middle management. In 2013/14 there should be a balance in appointments in order to ensure adequate support for the clinical professional staff.

The department introduced new systems and

improved existing processes for managing

the budget allocated to compensation of

employees. Ineffi ciencies were identifi ed

(for example, the management of overtime

and commuted overtime, and utilisation of

162


provisions on remunerative work outside the

public sector [RWOPS]) and existing policies,

guidelines, operating procedures and control

systems were analysed and reviewed. The

changes resulting from these reviews were

at different stages of development as the

year ended.

The Human Resources Plan for 2012/13

was reviewed and amended in line with the

Turnaround Strategy’s cost containment

measures.

Between July and March the post fi lling

process was expedited and the following

senior management positions were fi lled:

• Chief Financial Offi cer.

• Chief Director: ICT.

• Chief Director: Health Economics.

• Chief Director: Infrastructure

Management.

• Chief Director: District Health

Services.

• Chief executive offi cers for the four

central hospitals.

The departmental HR plan is informed by

the National Human Resources for Health

Plan (HRH) that seeks to strengthen the

entire health system in South Africa. The

GDoH is a labour intensive organisation and

the shortage of skilled health professionals

is a matter of concern. The HR strategy is

developed in the context of preparing the

public health system for the introduction

of National Health Insurance. In the light of

these priorities and in accordance with the

GDoH Turnaround Strategy, the main focus

during 2012/13 was:

• Rationalisation of the staff establish-

ment to manage expenditure on em-

ployees while sustaining good quality

health services.

• Accelerate the fi lling of vacant fund-

ed posts in key health professions

(for example, professional nurses,

doctors, pharmacists, and pharma-

cist assistants).

• Increase productivity and accounta-

bility through effective performance

management.

• Tightening management of overtime

and RWOPS in order to secure best

value for the department.

• Aligning human resource plans with

the strategic direction of the depart-

ment.

The development of a clear human resource

plan assists the department’s managers

to approach HR more strategically, in

alignment with health targets such as the

achievement of the Millennium Development

Goals and the strengthening of the district

health system. The departmental plan is

also informed by the Integrated Health

Planning Framework (IHPF) and the Service

Transformation Plan (STP).

Improved access to human resources has been identifi ed in the national Performance Plan 2012/13 – 2013/14 as a key factor in improving health system effectiveness. This plan identifi es the following as key policy issues that give shape to HR planning:

• Re-engineered model of PHC. • Population-oriented service delivery.• Multi-disciplinary district PHC and

specialist teams.• Ensure expert clinical support for

frontline of healthcare provision: placing doctors at district level.

• Improving maternal and child health-care and TB and HIV services at all levels of the health system.

• Strengthening health facility man-agement for all levels of care.

• Improving working conditions of the health workforce.

• Revitalising infrastructure at all lev-els of care.

163


The following policies were amended to

comply with resolutions and directives from

the DPSA:

• Recruitment and Selection Policy.

• Special Leave Policy.

• Management of Study Leave Policy.

The most signifi cant achievement of the

year was averting over-expenditure on

compensation of employees by means of

stringent monitoring of all appointments

– despite the challenges related to the

budget allocation and the shortage of health

professionals.

Challenges faced by the department

The demerger between the department

of Health and Social Development and

the migration of the functions back to

the department from the Department of

Finance were some of the major challenges

faced during the year. Another was the

rationalisation of the system of placing

personnel closer to the point of service.

There were a number of fi nancial challenges

arising from items that were not fully covered

by the budget. These included the increase

in the compensation of employees and the

retention of consultants to deal with HR

matters arising from ill-health of employees

and disciplinary matters.

Goals and future HR plans

The department needs to address the slow

appointment of employees with clinical

support skills in the new fi nancial year.

There is also a need to appoint key support

staff in human resources, infrastructure

management, fi nance and ICT. There needs

to be an intensifi ed focus on strengthening

PHC through community outreach teams

that have access to appropriate clinical

support.

3. Human resource oversight statisticsUnless stated otherwise, the human

resource oversight statistics tables contain

data from the PERSAL system as at the end

of March 2013.

3.1 Personnel-related expenditure

The following four tables summarise the

fi nal audited personnel-related expenditure

by programme and by salary band. In

particular, they provide an indication of the

following:

• The amount spent on personnel.

• The amounts spent on salaries, over-

time, home-owner’s allowances and

medical aid.

164


Table 3.1.1: Personnel expenditure by programme 2012/213

ProgrammeTotal

expenditure (R’000)

Personnel expenditure

(R’000)

Training expenditure

(R’000)

Professional & special services (R’000)

Personnel cost as

% of total expenditure

Average personnel cost per

employee (R’000)

Employment

1.Administration 501 362 241 566 13 293 48 896 48% 92 306 2 617

2.District Health

Services 8 555 956 4 243 315 5 095 7 751 50% 252 608 16 798

3.Emergency

Medical

Services 1 147 231 262 330 32 0 23% 179 310 1 463

4.Provincial

Hospital

Services 6 582 440 4 584 209 532 12 932 70% 250 846 18 275

5.Central

Hospital

Services 7 799 913 5 096 361 584 8 397 65% 277 293 18 379

6.Health

Sciences and

Training 807 070 686 496 5 336 1 85% 134 029 5 122

7.Healthcare

Support

Services 196 544 120 031 0 0 61% 124 643 963

8.Health

Facilities

Management 1 243 831 10 234 3 529 407 1% 243 667 42

HWSETA

Accounts 106 0 3 103 0 0% 0 0

Total 26 834 339 15 244 542 31 504 78 384 56.81% 239 472 63 659

Notes:

a. Financial data extracted from Basic Accounting System (BAS).b. Personnel numbers extracted from the PERSAL system.c. Employment: employees as at 31 March 2013 on the PERSAL System.

165


Table 3.1.2 Personnel costs by salary band 2012/13

Salary BandPersonnel

Expenditure (R’000)

% of total personnel

cost

no of employees

Average personnel cost per employee

(R’000)

Lower skilled (Levels 1-2) 940,691 6.2 6 744 139,485.6

Skilled (Level 3-5) 3,540,460 23.2 27 293 129,720.4

Highly skilled production (Levels 6-8) 2,687,674 17.6 11 980 224,346.7

Highly skilled supervision (Levels 9-12) 5,121,372 33.6 12 068 424,376.2

Senior and Top management (levels 13-16) 1,201,004 7.9 81 14,827,209.9

Contract (Levels 1-2) 2,106 0.0 31 67,935.5

Contract (Level 3-5) 37,636 0.2 243 154,880.7

Contract (Levels 6-8) 169,692 1.1 796 213,180.9

Contract (Levels 9-12) 1,336,840 8.8 2 366 565,021.1

Contract (levels 13-16) 59,771 0.4 10 5,977,100.0

Periodical Remuneration 111,225 0.7 891 124,831.6

Abnormal Appointment 36,069 0.2 1 599 22,557.2

Total 15,244,540 100 64 102 237,816.9

Notes:a) Data extracted from Vulindlela.

b) Number of employees refers to a head count of current employees on PERSAL.

166


Table 3.1.3 Salaries, overtime pay, home-owner’s allowance and medical aid costs by programme

2012/13

Prog

ram

me

Sala

ries

(R’0

00)

Sala

riesa

s %

of p

erso

n-el

co

st

Ove

rtim

e (R

’000

)

Ove

rtim

e as

% o

f pe

rson

nel c

ost

HO

A (R

’000

)

HO

A as

% o

f pe

rson

nel c

ost

Med

ical

aid

. (R

’000

)

Med

ical

aid

as

% o

f pe

rson

nel c

ost

Tota

l per

sonn

el

cost

(R’0

00)

Administration 226 204 94% 3 139 1% 4 276 2% 7 947 3% 241 566

District Health

Services 3 678 369 87% 224 160 5% 144 898 3% 195 886 5% 4 243 315

Emergency

Medical Services 220 602 84% 4 859 2% 14 111 5% 22 757 9% 262 330

Provincial Hospital

Services 3 812 703 83% 434 259 9% 152 259 3% 184 698 4% 4 584 209

Central Hospitals

Services 4 232 128 83% 550 412 11% 147 970 3% 165 851 3% 5 096 361

Health Sciences

and Training 599 263 87% 660 0% 45 510 7% 41 062 6% 686 496

Healthcare

Support Services 90 205 75% 11 324 9% 9 278 8% 9 223 8% 120 031

Health Facilities

Management 9 698 95% 0 0% 172 2% 364 4% 10 234

Total 12 869 172 84% 1 228 813 8% 518 474 3% 627 788 4% 15 244 542

Notes:a) Data extracted from Basic Accounting System (BAS).b) Total personnel cost differs from Table 3.4.3 as the data sources differ (BAS and Vulindlela).c) Salaries include all compensation of employees except overtime, housing allowance, and employer’s contribution to medical

aid.

167


Table 3.1.4: Salaries, overtime pay, home-owner’s allowance and medical aid by salary band: 2012/13

Salary BandsSalaries Overtime

Home Owners Allowance Medical Aid

Amount (R’000)

Salaries as a % of personnel

costs

Amount (R’000)

Overtime as a % of personnel

costs

Amount (R’000)

HOA as a % of

personnel costs

Amount (R’000)

Medical aid as a % of

personnel costs

Lower skilled (Levels 1-2) 640 174 67.7 15402 1.6 86 263 9.1% 61 654 6.5%

Skilled (Level 3-5) 2 444 106 67.7 72 177 2.0 246 332 6.8% 266 846 7.4%

Highly skilled production (Levels 6-8) 2 108 560 73.1 63 080 2.2 107 285 3.7% 151 829 5.3%

Highly skilled supervision (Levels 9-12) 3 904 563 59.9 80 0675 12.3 73 882 1.1% 136 133 2.1%

Senior and Top Management (levels 13-16) 831 539 65.5 277 478 21.9 4 712 0.4% 11 287 0.9%

Total 9 928 942 65.2 1 228 812 8% 518 474 3.4% 627 749 4.1%Notes:a. Data extracted from Vulindlela.b. All totals on this table differ from Table 3.1.3 as the data sources differ. BAS vs Vulindlela).BAS does not cater for salary bands.c. Senior and top management who are not health professionals do not qualify for overtime. However, 21.9% of this salary band

comprise medical SMS and heads of clinical departments and units.168


3.2 Employment and vacancies

The tables in this section summarise the

position with regard to employment and

vacancies - covering the number of posts on

the establishment, the number of employees,

the vacancy rate, and whether there are any

staff members who are additional to the

establishment.

This information is presented in terms of

three key variables:• Programme.

• Salary band.

• Critical occupations.

The department has identifi ed critical

occupations that need to be monitored. In

terms of current regulations, it is possible to

create a post on the establishment that can

be occupied by more than one employee.

Therefore, the vacancy rate reflects the

percentage of posts that are not fi lled.

Unfunded vacant posts

In order to manage and correctly monitor

the budget for compensation of employees,

specifi c measures were put in place to

prevent over-expenditure.. The process

involved the clean-up of the Personnel and

Salaries (PERSAL) system by abolishing

unfunded posts and freezing vacant funded

posts. The latter will only be fi lled only when

there are funds available.

Although the department was compelled

to take drastic cost containment measures

on the fi lling of vacant funded posts, steps

were also taken to ensure continuation of

critical and essential services. Post-fi lling

was focused on the appointment of staff in

critical health professional categories and

critical support categories.

Tables below (3.2.1 – 3.2.3) also reflect

posts that are additional to the staff

establishment. These additional posts are

made of:

• Health professionals performing

community service: doctors, nurses

and allied professionals.

• Contract personnel in administra-

tion, nursing (retired nurses) and

support categories.

• Interns in medical and allied profes-

sions.

Table 3.2.1: Employment and vacancies by programme 2012/13

Programme Number of posts on approved

establishment

Number of posts

fi lled

Vacancy rate

Number of posts fi lled additional

to the establishment

Administration 1 261 890 24.3% 64

District Health Services 17 898 15 591 9.0% 696

Emergency Medical Services 1 528 1 457 4.6% 1

Provincial Hospital Services 19 277 16 874 7.6% 941

Central Hospital Services 19 764 17 090 8.6% 967

Health Sciences and Training 5 605 4 874 9.9% 176

Healthcare Support Services 1 029 956 6.6% 5

Health Facilities Management 39 34 12.8% -

Total 66 401 57 766 8.7% 2 850

Notes:a. Data was extracted from PERSAL (Establishment Report) as at end March 2013.

b. The vacant posts include 14 frozen posts and nine posts that were approved in principle.

169


Table 3.2.2: Employment and vacancies by salary band 2012/13

Salary Band Number of posts on approved

establishment

Number of posts

fi lled

Vacancy rate

Number of employees

additional to the establishment

Lower skilled (Level 1 - 2) 7 908 7 436 5.8% 14

Skilled (Level 3 - 5) 27 278 25 233 6.6% 252

Highly skilled production (Level 6 - 8) 15 757 12 546 10.5% 1 557

Highly skilled supervision (Level 9 - 12) 15 328 12 459 12.0% 1 025

Senior management (Level 13 - 16) 130 92 27.7% 2

Total 66 401 57 766 8.7% 2 850Notes:

a. Data was extracted from PERSAL (Establishment Report) as at end March 2013.

Table 3.2.3: Employment and vacancies by critical occupations 2012/13

Critical occupation Number of posts on approved

establishment

Number of posts fi lled

Vacancy rate Number of employees additional

to the establishment

Dental practitioner 224 187 12.1% 10

Dental specialist 135 112 14.1% 4

Medical practitioner 2 264 1 565 21.9% 203

Medical practitioner (intern) 953 227 12.6% 606

Medical specialist 2 459 2 078 14.4% 26

Emergency care practitioner 1 432 1 360 5.0% 0

Pharmacist 479 351 17.5% 44

Pharmacist (intern) 79 9 27.8% 48

Professional nurse 14 411 11 612 9.6% 1 417

Staff nurse 5 972 5 689 4.3% 26

Nursing assistant 7 186 6 904 3.9% 5

Professional nurse (student) 4 742 4 188 11.5% 10

Total 40 336 34 282 7.0% 2 399Notes:a. Data was extracted from PERSAL (Establishment Report) as at end March 2013.b. This report reflects the number of critical posts as they appear on the establishment.

170


3.3 Job evaluation

Within a nationally determined framework,

executing authorities may evaluate or re-

evaluate any job in their organisations. In

terms of the regulations, all vacancies on

salary levels 9 and higher must be evaluated

before they are fi lled. Many posts have

been evaluated through the process of

national co-ordination and the results are

communicated to departments through the

ministerial directives. The following tables

summarise the number of jobs that were

evaluated during the year under review

and indicates the number of posts that

were upgraded or downgraded. As Table

3.3.1 indicates, there was only one network

controller post that was evaluated for the

department.in 2012/13.

Table 3.3.1: Job evaluation by salary band 2012/13

Salary band Posts onestablish-

ment

Number of jobs

evaluated

% of jobs evaluated

Posts upgraded Posts downgraded

Number % of posts

evaluated

Number % of posts

evaluated

Lower skilled (L 1-2) 7 902 0 0.0% 0 0.0% 0 0.0%

Skilled (L 3-5) 27 182 0 0.0% 0 0.0% 0 0.0%

Highly skilled production (L 6-8) 15 134 1 0.0% 0 0.0% 0 0.0%

Highly skilled supervision (L9-12) 12 871 0 0.0% 0 0.0% 0 0.0%

Senior management Band A 84 0 0.0% 0 0.0% 0 0.0%

Senior management Band B 22 0 0.0% 0 0.0% 0 0.0%

Senior management Band C 8 0 0.0% 0 0.0% 0 0.0%

Senior management Band D 2 0 0.0% 0 0.0% 0 0.0%

Contract (L 1-2) 6 0 0.0% 0 0.0% 0 0.0%

Contract (L 3-5) 96 0 0.0% 0 0.0% 0 0.0%

Contract (L 6-8) 623 0 0.0% 0 0.0% 0 0.0%

Contract (L 9-12) 2 457 0 0.0% 0 0.0% 0 0.0%

Contract Band A 4 0 0.0% 0 0.0% 0 0.0%

Contract Band B 7 0 0.0% 0 0.0% 0 0.0%

Contract Band C 3 0 0.0% 0 0.0% 0 0.0%

Contract Band D 0 0 0.0% 0 0.0% 0 0.0%

Total 66 401 1 0.0% 0 0.0% 0 0.0%Notes:

a. Number of posts is based on the establishment report as at the end of March 2013.b. The above mentioned post has been evaluated and confi rmed to be in the correct level. It was not upgraded.c Due to national coordination most of the jobs are evaluated nationally by DPSA.

d. All OSD post cannot be evaluated.

171


Table 3.3.2 provides a summary of the number of employees whose positions were upgraded due

to their post being upgraded. The number of employees benefi ting might differ from the number of

posts upgraded since not all employees are automatically absorbed into the new posts and some of

the upgraded posts could be vacant.

Table 3.3.2: Profi le of employees whose positions were upgraded due to their posts being upgraded

2012/13

Benefi ciary African Asian Coloured White Total

Female 0 0 0 0 0

Male 0 0 0 0 0

Total 0 0 0 0 0

Employees with a disability 0 0 0 0 0Notes:

a. There were no upgraded or downgraded posts.

The following table summarises the number of cases where remuneration bands exceeded the grade

determined by job evaluation. Reasons for the deviation are provided in each case.

Table 3.3.3: Employees with salary levels higher than those determined by job evaluation of occupation

2012/13

Occupation Number of employees

Job evaluation

level

Remuneration level

Reasons for deviation

None 0 0 0 0

Percentage of total employed N/A

Table 3.3.4 summarises the benefi ciaries of the above in terms of race, gender, and disability.

Benefi ciary African Asian Coloured White Total

Female 0 0 0 0 0

Male 0 0 0 0 0

Total 0 0 0 0 0

Employees with a disability 0 0 0 0 0

Total number of employees whose

remuneration exceeded the grade determined

by job evaluation in 2012/2013

NONE

172


3.4 Employment changes

This section provides information on changes in employment over the fi nancial year. Turnover rates

provide an indication of trends in the employment profi le of the department. The following tables provide a

summary of turnover rates by salary band and critical occupations.

Table 3.4.1: Annual turnover rates by salary band 2012/13

Salary Band

Number of employees April 2012

Appointments and transfers

into the department

Terminations and transfers

out of the department

Turnover rate (%)

Lower skilled (Level 1 - 2) 6 744 336 251 0.04

Skilled (Level 3 - 5) 27 293 1 258 857 0.03

Highly skilled production (Level 6 - 8) 11 980 738 878 0.07

Highly skilled supervision (Level

9 - 12) 14 558 1 410 1 421 0.10

Senior management service (Band

A) 60 3 3 0.05


B) 19 2 10 0.53


C) 1 0 6 6.00


D) 1 0 3 3.00

Contracts 3 446 2 624 1 656 0.48

Total 64 102 6 371 5 085 7.9Notes:a. Data extracted from PERSAL.b. Number of employees - as on 1 April 2012.c. Appointments and transfers into the department between 1 April 2012 and 31 March 2013.

d. Terminations and transfers out of the department between 1 April 2012 and 31 March 2013.

173


Table 3.4.2: Annual turnover rates by critical occupation 2012/13

Critical occupation Number of employees at the beginning

of period - April 2012

Appointments and Transfers

into the Department

Terminations and

transfers out of the

Department

Turnover rate

Dental Practitioner 284 50 43 15.1%

Dental Specialist 169 27 19 11.2%

Medical Practitioner 2 139 951 498 23.3%

Medical Practitioner (Intern) 845 492 258 30.5%

Medical Specialist 2 420 356 288 12.9%

Emergency care practitioner 1 340 202 35 2.6%

Pharmacists 430 125 116 27.0%

Pharmacists (Intern) 47 224 56 119.1%

Professional Nurse 12 363 918 1 106 8.9%

Staff Nurse 5 705 74 166 2.9%

Nursing Assistant 6 871 267 207 3.0%

Professional Nurse (Student) 5 313 737 106 2.0%

Total 37 926 4 423 2 898 7.6%Notesa. Data extracted from PERSAL.b. This table only represents critical occupations.c. Number of employees as on the 1 April 2012d. Appointments and transfers into the department between 1 April 2012 and 31 March 2013.e. Terminations and transfers out of the department between 1 April 2012 and 31 March 2013.

The table 3.4.3 provides reasons for staff leaving

the department.

The function of terminating employment is

being transferred from the GDF to institutions is

underway. This also decentralises the processing

of pensions and improves the turnaround time on

receipt of pension benefi ts. Improvements have

already been evident with the waiting period for

retirement benefi ts reduced from more than 90

days to less than 30 days.

174


Table 3.4.3: Reasons for staff leaving the department 2012/13

Termination type (a) Number% of total

resignations

Death 272 5.3%Resignation 1 985 39.0%Expiry of contract 1 880 37.0%Dismissal - operational changes 0 0.0%Dismissal – misconduct 109 2.1%Dismissal – ineffi ciency 0 0.0%Discharged due to ill-health 38 0.7%Retirement 789 15.5%Transfer to another public service department 12 0.2%Other 0 0.0%Total 5 085 100.0%

Total number of employees who left as a % of total employment 7.9%

Notes:a. Data extracted from PERSAL.

b. Terminations between 1 April 2012 and 31 March 2013.

Table 3.4.4: Promotions by critical occupation

Occupational Class (b) Employees as at 01 April

2012

Promotionsto anothersalary level

Salary level promotions

as a % of Employees by

occupation

Progression to

another notch within a salary level

Notch progression

as a % of

Employees by occupation

Dental Practitioner 284 0 0.00% 1 0.35%

Dental Specialist 169 0 0.00% 0 0.00%

Medical Practitioner 2139 0 0.00% 22 1.03%

Medical Practitioner

(Intern) 845 0 0.00% 0 0.00%

Medical Specialist 2 420 8 0.36% 5 0.22%

Emergency care

practitioner 1 340 0 0.00% 0 0.00%

Pharmacists 430 0 0.00% 1 0.23%

Pharmacists (Intern) 47 0 0.00% 0 0.00%

Professional Nurse 12 363 6 0.05% 2 0.02%

Staff Nurse 5 705 1 0.02% 1 0.02%

Nursing Assistant 6 871 0 0.00% 0 0.00%

Professional Nurse

(Student) 5 313 0 0.00% 0 0.00%

Total 37 926 15 0.04% 32 0.08%Notes:a. Data extracted from PERSAL.b. Promotions between 1 April 2012 and 31 March 2013.c. Number of employees as on 1 April 2012.

175


Table 3.4.5 Promotions by salary band: 2012/2013

Salary band Employees

1 April 2012

Promotionsto anothersalary level

Salary band promotions

as a % of employees in salary level

Progression to another

notch within a salary level

Notch progression

as a % of employees in salary bands

Lower skilled (Level 1 - 2) 6 775 7 0.1% 0 0.0%

Skilled (Level 3 - 5) 27 536 47 0.2% 1 0.0%

Highly skilled production

(Level 6 - 8) 12 776 19 0.1% 1 0.0%

Highly skilled supervision

(Level 9 - 12) 16 924 20 0.1% 31 0.2%

Senior management

(Level 13 - 16) 91 2 2.2% 0 0.0%

Total 64 102 95 0.1% 33 0.05%Notes:a. Data extracted from PERSAL.b. Number of employees as on 1 April 2012.

c. Promotions between 1 April 2012 and 31 March 2013.

3.5 Employment Equity

Table 3.5.1: Total number of employees (including employees with disabilities) as at 31 March 2013 by

occupational category

Occupational category Male Female

TotalA C I W A C I W

Legislators, senior offi cials

and managers 106 8 4 8 80 6 7 13 232

Professionals 1 625 41 432 875 1449 67 441 913 5 843

Technicians and associate

professionals 2 572 40 51 1 83 16 910 557 342 1 392 22 047

Clerks 2 287 55 17 91 5 143 103 16 426 8 138

Service workers and shop

and market sales workers 2336 25 16 74 12 865 184 22 226 15 748

Craft and related trades

workers 1 0 0 0 1 0 0 2 4

Plant and machine

operators and assemblers 366 9 2 11 37 0 0 0 425

Elementary occupations 3 520 51 7 93 7 267 166 6 112 11 222

Grand Total 12 813 229 529 1 335 43 752 1 083 834 3 084 63 659

Employees with

disabilities 27 1 0 12 26 4 1 6 77

Notes:a. Data extracted from PERSAL as at end March 2013b. Total number of employees is as at the end of the reporting period (31 March 2013).This table counts current employees and

not fi lled posts.

c. Abbreviations: A=African, C=coloured, I=Indian, W=white.

176


Table 3.5.2 Total number of employees (including employees with disabilities) as at 31 March 2013 by

occupational band

Occupational band Male Female Total

A C I W A C I W

Top management 4 1 5

Senior management 43 1 3 7 20 3 3 4 84

Professionally qualifi ed,

experienced specialists

and mid-management 2 930 75 475 1 019 9 708 325 637 1 641 16 810

Skilled technical and

academically qualifi ed

workers, junior

management, and

supervisors 2 215 52 31 163 9 558 370 151 1 061 13 601

Semi-skilled and

discretionary decision-

making 5 427 70 19 107 20 403 300 40 354 26 720

Unskilled and defi ned

decision-making 2 194 31 1 39 4 062 85 3 24 6 439

Total 12 813 229 529 1 335 43 752 1 083 834 3 084 63 659

Employees with

disabilities 27 1 12 26 4 1 6 77The existing fi gure were wrong so I added up again – think its fi neNotes:a. This table counts current employees and not fi lled posts.b. Abbreviations: A=African, C=coloured, I=Indian, W=white.c. Classifi cation legend: Top management: Deputy director-general and upwards, but excludes the MEC. Senior management: Chief director and director. Professionally qualifi ed, mid-management: Level 9 to 12 and professionals level 0, 13 and 14. Skilled technical, junior management and supervisory: Levels 6 to 8. Semi-skilled, discretionary decisions: Levels 3 to 5. Unskilled, defi ned decisions: Levels 1 to 2.

177


Table 3.5.3: Recruitment 2012/13

Occupational band

Male Female

TotalA C I W A C I W

Top management 1 1

Senior management 3 5 8

Professionally

qualifi ed, experienced

specialists and mid-

management 590 16 97 230 996 37 181 357 2 504

Skilled technical

and academically

qualifi ed workers,

junior management,

and supervisors 187 5 4 22 702 48 50 286 1 304

Semi-skilled and

discretionary

decision-making 326 5 6 12 1 094 21 15 40 1 519

Unskilled and defi ned

decision-making 135 1 1 2 244 383

Total 1 242 27 108 266 3 041 106 246 683 5 719

Employees with

disabilities 1 Notes:a. Data extracted from PERSAL for period from1 April 2012 to 31 March 2013.b. This table counts only the number of appointments and excludes transfers into the department.c. Abbreviations: A=African, C=coloured, I=Indian, W=white.d. Classifi cation legend: Top management: Deputy director-general and upwards, but excludes the MEC. Senior management: Chief director and director. Professionally qualifi ed, mid-management: Level 9 to 12 and professionals level 0, 13 and 14. Skilled technical, junior management and supervisory: Levels 6 to 8. Semi-skilled, discretionary decisions: Levels 3 to 5.

Unskilled, defi ned decisions: Levels 1 to 2.

178


Table 3.5.4: Promotions: 2012/13


A C I W A C I W

Top management 1 1

Senior management 1 1

Professionally qualifi ed and experienced specialists and mid-management

15 4 6 13 1 7 5 51

Skilled technical and academically qualifi ed workers, junior management, supervisors

5 15 20

Semi -skilled and discretionary decision-making 18 30 48

Unskilled and defi ned decision-making 2 5 7

Total 42 0 4 6 63 1 7 5 128

Employees with disabilities 0

Notes:a. Data extracted from PERSAL for the period 1 April 2012 to 31 March 2013.b. Table includes both level and notch promotions. Level promotion = promotion from one salary level to another (For example,

Professional Nurse Grade 1 [Level 6] to Professional Nurse Grade 2 [Level 7]). Notch promotion = promotion or pay progression from one notch to another within the same salary level.

c. Classifi cation legend: Top management: Deputy director-general and upwards, but excludes the MEC. Senior management: Chief director and director. Professionally qualifi ed, mid-management: Level 9 to 12 and professionals level 0, 13 and 14. Skilled technical, junior management and supervisory: Levels 6 to 8. Semi-skilled, discretionary decisions: Levels 3 to 5. Unskilled, defi ned decisions: Levels 1 to 2.

d. Abbreviations: A=African, C=coloured, I=Indian, W=white.

179


Table 3.5.5: Terminations: 2012/13


A C I W A C I W

Top management 3 1 5 1 10

Senior management 3 2 1 6

Professionally qualifi ed, experienced specialists and mid-management 481 13 85 182 1 063 36 119 277 2 256

Skilled technical and academically qualifi ed workers, junior management, and supervisors 195 8 12 22 738 39 43 330 1 387

Semi-skilled and discretionary decision-making 282 8 1 10 795 26 5 31 1 158

Unskilled and defi ned decision-making 91 1 1 9 156 5 1 4 268

Total 1 055 30 100 228 2 754 106 169 643 5 085

Employees with disabilities 3 2 1 1 7

Notes:

a. Data extracted from PERSAL.

b. Abbreviations: A=African, C=coloured, I=Indian, W=white.

c. Classifi cation legend:

Top management: Deputy director-general and upwards, but excludes the MEC.

Senior management: Chief director and director.

Professionally qualifi ed, mid-management: Level 9 to 12 and professionals level 0, 13 and 14.

Skilled technical, junior management and supervisory: Levels 6 to 8.

Semi-skilled, discretionary decisions: Levels 3 to 5.

Unskilled, defi ned decisions: Levels 1 to 2.

Management of discipline has improved immensely

due to training. Most disciplinary cases in 2012/13

2012/13 were fi nalised on time. Disciplinary cases

related mainly to absenteeism and theft. High

profi le cases involving senior management were

appropriately managed

The department managed to fi nalise all grievances

lodged through the Public Service Commission.

Most of employees’ grievances related to

recruitment and selection processes and the

majority were resolved. Most of employee disputes

concerned unfair dismissal, promotions and unfair

disciplinary action.

Table 3.5.6: Number of employees involved in disciplinary actions 2012/13

Male Female Total

A C I Total

black

W A C I Total

black

W

342 10 4 356 7 445 10 2 457 28 848Notes:

a. Data extracted from PERSAL.

180


Table 3.5.7: Skills development: 2012/2013

Occupational category

Male Female Total

A C I Totalblack

W A C I Totalblack

W

Legislators, senior offi cials & managers 61 1 0 62 0 111 4 1 116 0 178

Professionals 61 9 13 83 10 88 17 5 110 4 207

Technicians & associate professionals 1 006 57 99 1 162 336 3 862 102 97 4 061 618 6 177

Clerks 2 005 191 35 2 231 89 4 867 228 199 5 294 991 8 605

Service workers, shop & market sales workers 411 58 51 520 7 901 68 37 1 006 115 1 648

Craft and related trades workers 0 0 0 0 0 0 0 0 0 0 0

Plant and machine operators and assemblers 67 3 9 79 16 2 1 6 9 1 105

Elementary occupations 71 0 11 82 5 161 21 17 199 26 312

Total 3 682 319 218 4 219 463 9 992 441 362 10 795 1 755 17 232

Employees with disabilities 0 0 0 0 0 1 0 1 2 0 2

Notes:a. Abbreviations: A=African, C=coloured, I=Indian, W=white.b. Classifi cation legend: Legislators, senior offi cials and managers: Offi cials responsible for determining and formulating policy and strategy, planning,

directing and coordinating policies and activities of organisation. Professionals: Include offi cials whose main tasks require a high level of professional knowledge. Technicians and associate professionals: This group includes employees whose main tasks require technical knowledge and

experience. Clerks: This group includes occupations whose tasks require the knowledge and experience necessary to organise, store,

compute and retrieve information. Service workers, shop and market sales workers: This group includes employees whose main tasks require knowledge and

experience necessary to provide personal and protective services. Craft and related trades workers: This comprises employees whose main tasks require knowledge and experience of skilled

trades and handicrafts. Plant and machine operators and assemblers: The main tasks of these employees involve the use of automated industrial

machinery and equipment. Elementary occupations: This group covers occupations which require relatively low levels of knowledge and experience

required to perform mostly simple and routine tasks, involving use of hand held tools and in some cases considerable physical

effort. With few exceptions, their work requires limited personal initiative and judgment.

181


3.6 Performance rewards

To encourage good performance, the department granted performance rewards to selected employees, as

indicated in the following four tables. The information is presented in terms of race, gender, and disability,

salary bands and critical occupations

Table 3.6.1: Performance rewards by race, gender and disability 2012/13

Race and gender

Benefi ciary profi le Cost

Number of

benefi ciaries

Number of

employees

% of total within

group Cost (R’000)

Average cost

per employee

African male 78 42 036 0.2% 455 5 833

Indian male 11 11 893 0.1% 67 6 091

Coloured male 1 802 0.1% 6 6 000

White male 1 482 0.2% 6 6 000

African female 2 1 031 0.2% 11 5 500

Indian female 0 212 0.0% 0 0

Coloured female 3 2 967 0.1% 17 5 667

White female 0 1 146 0.0% 0 0

Total 96 60 569 0.2% 562 5 854Notes:

a. Data extracted from Vulindlela as at 31 March 2013.

Table 3.6.2: Performance rewards by salary band for personnel below senior management service

2012/13

Salary band


Number of benefi ciaries

Number of employees

% of total within salary bands

Total cost (R’000)

Average cost per

employee

Cost as a % of total personnel

expenditure

Unskilled (Levels

1-2) 9 8 738 0.1 51 5 667 0.0%

Skilled (Levels

3-5) 37 25 196 0.1 209 5 649 0.1%

Highly skilled

production

(Levels 6-8) 22 12 520 0.2 123 5 591 0.1%

Highly skilled

supervision

(Levels 9-12) 26 12 958 0.2 162 6 231 0.1%

Periodical

remuneration 0 908 0 0 0 0.0%

Abnormal

appointment 0 1 741 0 0 0 0.0%

Total 94 62 061 0.2 545 5 798 0.4%Notes:a. Data extracted from Vulindlelaas at 31 March 2013.

182


Table 3.6.3: Performance rewards by critical occupation 2012/13

Critical Occupation

Benefi ciaries Cost


Number of employees

% of total within

occupation


Average cost per employee

Dental practitioner 0 230 0 0 0

Dental specialist 0 99 0 0 0

EMS practitioner 1 1 360 0.1 0 6 000

Medical practitioners 2 2 956 0.1 12 6 000

Medical specialist 1 1 801 0.1 6 6 000

Nursing assistant 5 6 522 0.1 28 5 600

Pharmacist 3 987 0.3 17 5 667

Professional nurse 25 11 610 0.2 150 6 000

Staff nurse 14 5 779 0.2 79 5 643

Total 51 31 344 0.2 292 5 725Notes:

a. Data extracted from Vulindlela as at 31 March 2013.

Table 3.6.4: Performance related rewards by salary band for senior management service: 2012/13

Salary Band



Number of employees

% of total within salary bands


Average cost per

employee

Total cost as % of total

personnel expenditure

Band A 0 66 0 0 0 0

Band B 0 25 0 0 0 0

Band C 0 3 0 0 0 0

Band D 0 0 0 0 0 0

Total 0 94 0 0 0 0

183


3.7 Foreign workers

The tables below summarise the employment of foreign nationals in the department in terms of salary

band and major occupation.

Table 3.7.1 Foreign workers by salary band : 2012/2013

Salary Band 1 April 2012 31 March 2013 Change

Number

% of

total Number

% of

total Number

%

Change

Lower skilled 15 2.2% 17 2.4% 2 8.7%

Highly skilled (Level 6-8) 67 9.7% 73 10.2% 6 26.1%

Highly skilled supervision (Level 9-12) 309 44.7% 307 43.0% -2 -8.7%

Contract (Level 9-12) 300 43.4% 317 44.4% 17 73.9%

Contract (Level 13-16) 0 0.0% 0 0.0% 0 0.0%

Total 691 100.0% 714 100.0% 23 100.0%Notes:

Data extracted from Vulindlela – 31st March 2013

Table 3.7.2 Foreign workers by major occupation: 2012/2013

Major occupation 1 April 2012 31 March 2013 Change

Number % of

total

Number % of total Number % Change

Administrative offi ce workers 16 2.1% 12 1.6% (4) 30.8%

Elementary occupations 15 2.0% 6 0.8% (9) 69.2%

Information technology personnel 2 0.3% 2 0.3% 0 0.0%

Professionals and managers 708 94.7% 553 75.2% (155) 1192.3%

Social natural technical and medical

sciences+supp 1 0.1% 1 0.1% 0 0.0%

Technicians and associated

professionals 6 0.8% 161 21.9% 155 (1192.3%)

Total 748 100.0% 735 100.0% (13) 100.0%

Notes:

a. Data extracted from Persal

184


3.8 Leave utilisation

The Public Service Commission has identifi ed a need for careful monitoring of sick leave within the public

service. The following tables provide an indication of the use of sick leave and disability leave. In both

cases, the estimated cost of the leave is also provided.

Table 3.8.1: Sick leave 2012

Salary Band Total days % days with

medical certifi cate

Number of employees using sick

leave

% of total employees using sick

leave

Average days per

employee for year

Estimated cost

(R’000)

Unskilled (Levels 1-2) 37 566 92.7% 5 466 12.3% 7 9 516

Skilled (Levels 3-5) 124 489 90.2% 18 837 42.5% 7 43 062


(Levels 6-8) 71 810 85.9% 10 799 24.4% 7 41 766

Highly skilled & supervisory

(Levels 9-12) 55 997 85.1% 8 684 19.6% 6 68 640

Senior management (Levels

13-16) 3 290 77.0% 541 1.2% 6 10 339

Total 293 151 88.34% 44 327 100.0% 7 173 323Notes:a. Data extracted from Vulindlela.b. Data is available for calendar year and not fi nancial year.

Table 3.8.2: Disability leave (temporary and permanent) 2012

Salary band Totaldays

% Days with

medical certifi cate

Number of employees

using disability

leave

% of total employees

using disability

leave

Average days per

employee per year

Estimated cost

(R’000)

Lower skilled (Levels 1-2) 376 100.0% 38 15.8 10 93

Skilled (Levels 3-5) 1 639 100.0% 92 38.3 18 592


(Levels 6-8) 836 100.0% 69 28.8 12 475

Highly skilled and

supervisory (Levels 9-12) 742 100.0% 37 15.4 20 900

Senior management (Levels

13-16) 15 100.0% 4 1.7 4 53

Total 3 608 100.0% 240 100.0 15 2 113Notes:a. Data extracted from Vulindlela.b. Data is presented for calendar year and not fi nancial year.

185


The table below summarises the utilisation of annual leave. The wage agreement concluded with trade

unions in the Public Sector Collective Bargaining Chamber in 2000 requires management of annual leave

to prevent high levels of accrued leave being paid at the time of termination of service.

Table 3.8.3: Annual leave 2012

Salary Band Total days taken

Number of employees

using annual leave

Average days per employee

per year

Lower skilled (Levels 1-2) 157 402 7 851 20

Skilled (Levels 3-5) 552 798 26 337 21

Highly skilled production (Levels 6-8) 281 612 14 314 20

Highly skilled and supervisory (Levels 9-12) 272 513 13 325 20

Senior management (Levels 13-16) 27 112 1 298 21

Total 1 291 436 63 125 20Notes:a. Data extracted from Vulindlela.

b. Data is presented for the calendar and not fi nancial year.

Table 3.8.4 Capped leave 2012

Salary band Total days of capped leave

taken

Number of employees

using capped leave

Average number of days taken

per employee

Average capped leave per employee

as at 31 December

2012

Lower skilled (Levels 1-2) 187 46 4 46

Skilled (Levels 3-5) 1 315 320 4 320

Highly skilled production (Levels 6-8) 1 231 260 5 260

Highly skilled and supervisory (Levels

9-12) 1 531 318 5 318

Senior management (Levels 13-16) 197 33 6 33

Total 4 461 977 5 977

Notes:a. Data extracted from Vulindlela.b. Data is presented by calendar year and not fi nancial year.

c. Number of employees refers to those with capped leave between 1 January 2012 and 31 December 2012.

186


The following table summarises payments made to employees as a result of leave that was not taken.

Table 3.8.5 Leave pay-outs: 2012

Reason Total amount

(R’000)

Number of

employees

Average

payment

per employee

(R’000)

Leave payout for 2011/12 due to non-utilisation of leave

for the previous cycle - - -

Capped leave payouts on termination of service for

2012/13 39 766 53 40 7 447

Current leave payout on termination of service for

2012/13 146 945 154

Total 39 912 6 285 6 350Notes:a. Data extracted from Vulindlela.b. Data is presented by calendar year and not fi nancial year.

c. Number of employees refers to those with capped leave between 1 January 2012 and 31 December 2012.

3.9 HIV and AIDS and Health Promotion Programmes

Table 3.9.1: Steps taken to reduce the risk of occupational exposure 2012/13

Categories of employees considered at high risk of contracting HIV and related diseases

Key steps taken to reduce the risk

Doctors Policy approved and implemented for prophylaxis for accidental exposure to blood-borne pathogens.

Nurses Guidelines in place for prophylaxis for accidental exposure to blood borne pathogens.

Laboratory workers Protective clothing provided.

Cleaners working in clinical areas Survey undertaken to assess risk.

Laundry workers Training provided for offi cers.

Mortuary workers A Directorate of Health Care Waste & Occupational Hygiene Management has been created.

Healthcare waste offi cers

187


Table 3.9.2: Details of Health Promotion and HIV/AIDS Programmes 2012/13

Question Yes No Details, if yes

1. Has the department designated a

member of the SMS to implement the

provisions contained in Part VI E of Chapter

1 of the Public Service Regulations, 2001? If

so, provide her/his name and position.

X

2. Does the department have a dedicated

unit or designated staff members to

promote health and wellbeing of your

employees? If so, indicate the number of

employees who are involved in this task and

the annual budget that is available for this

purpose.

X

The relevant unit is the EHWP Directorate

consisting of the following units: HIV &

AIDS and TB Management (4 posts); EAP (4

posts); and Occupational Health (7 posts).

The budget allocated from the equitable

share was R6.4 million for 2011/12 and

R5.3 million for 2013/2014. There was

no allocation from the HIV and AIDS

Conditional Grant.

3. Has the department introduced an

employee assistance or health promotion

programme for its employees? If so,

indicate the key elements/services of the

programme.

X

The department has developed an

integrated workplace health and wellness

programme for employees. It comprises

HIV and AIDS and TB management, EAP

and occupational health. The EAP provides

psychosocial support to employees,

including: individual and group counselling,

fi nancial and debt management, trauma

counselling, conflict management,

resilience training and pre-retirement

courses.

4. Has the department established a

committee as contemplated in Part VI

E.5 (e) of Chapter 1 of the Public Service

Regulations, 2001? If so, please provide the

names of the members of the committee

and the stakeholder(s) that they represent.

X

There are provincial, regional and

institutional committees in place. These are

under the leadership of the Acting Director:

Wellness Programme. The provincial

committee comprises:

Departmental representatives: Ms D

Mopedi, Ms G Gemell, Ms N Mdumbe,

Ms P Koetsi, Ms Ms B Mathebula, Ms K

Tembani, Ms E Molefe, Ms N . Ngxabi.

Union representatives are: Mr R Lawrence,

Mr S Motlhabane, Mr. J Mashala and

additional representatives of all recognised

trade unions (PSA, NEHAWU, HOSPERSA,

NUPSAW & DENOSA).

188



5. Has the department reviewed its

employment policies and practices

to ensure that these do not unfairly

discriminate against employees on the

basis of their HIV status? If so, list the

employment policies/practices so reviewed.

X

The HIV and AIDS Workplace policy and

the Recruitment and Selection policy

have been ratifi ed and implemented. The

Employment Equity statement is clear on

no discrimination.

6. Has the department introduced measures

to protect HIV-positive employees or

those perceived to be HIV-positive from

discrimination? If so, list the key elements of

these measures.

X

HIV and AIDS prevention and awareness

programmes have been implemented.

Treatment, care and support is available

in the department. Social mobilisation

programmes are also undertaken.

7. Does the department encourage its

employees to undergo voluntary counselling

and testing? If so, list the results that you

have achieved.

X

As part of the HCT programme the

department encourages employees

undergoing voluntary testing. Due to the

confi dential nature of the process, it is

diffi cult to measure achievements. However

staff members have presented themselves

in large numbers for testing in recent

years. During the 2013 Condom Week,

398 personnel members underwent HCT,

eye testing, and glucose and hypertension

testing.

8. Has the department developed measures/

indicators to monitor & evaluate the impact

of your health promotion programme? If so,

list these measures/indicators.

X

Indicators have been developed and are

monitored quarterly. They include the

number of institutions engaging in healthy

lifestyle, nutrition, food gardening and

physical activity programmes, the number

of personnel who disclosed their HIV status,

and the number of personnel on ARVs.

Quarterly reports are also available from the

Directorate Integrated EHWP. Indicators for

measuring the impact of EHWP services are

as follows: number of employees accessing

EHWP services, number of employee

wellness centres established, number of

employees undergoing training on EHWP

and reduction of occupational injuries and

disease.

189



Number of employees undergoing training

on HIV and AIDS issues conducted by HIV

and AIDS workplace programmes.

Number trained on:

Management of disclosure.

Reduction of stigma and discrimination.

HIV and TB co-infection.

Peer education.

Training of the trainer.

Empowerment of people with disabilities.

Mainstreaming of HIV and AIDS and TB

management.

X

The total number of employees who

attended training in the year under review

was 4 076.

The detailed breakdown of attendance on

different topics:

Management of disclosure:

Reduction of stigma and discrimination:

HIV and TB co – infection:

Peer education:

Training of the trainer:

Empowerment of people with disabilities:

Mainstreaming of HIV and AIDS and TB

management:

Capacity building on PMTCT:

3.10 Labour Relations

Table 3.10.1: Collective agreements 2012/13

Subject matter Date

PSCBC Resolution 1 of 2012 (Wage agreement) 31/07/2012

PSCBC Resolution 3 of 2012 (Closing of pension redress project) 03/19/2012

PHSDSBC Resolution 1 of 2012 (OSD for engineers etc) 29/11/2012

PHSDSBC Resolution 2 of 2012 (Offi ce space) 29/11/2012

Table 3.10.2: Misconduct and disciplinary hearings fi nalised 2012/13

Outcomes of disciplinary hearings Number % of total

Correctional counselling 25 3.1%

Verbal warning 93 11.5%

Written warning 263 32.5%

Final written warning 380 47.0%

Suspended without pay 0 0.0%

Fine 0 0.0%

Demotion 0 0.0%

Dismissal 28 3.5%

Not guilty 7 0.9%

Case withdrawn 12 1.5%

Total 808 100.0%

190


Table 3.10.3: Types of misconduct addressed at disciplinary hearings 2012/13

Type of misconduct (based on annexure A) Number % of total

HR and procurement irregularities 14 1.7%

Absenteeism 258 30.4%

Negligence 34 4.0%

Insubordination 74 8.7%

Fraud and corruption 26 3.1%

Dishonesty and misrepresentation 9 1.1%

Theft 138 16.3%

Dereliction of duty 85 10.0%

Other 188 22.2%

Intimidation and incitement 22 2.6%

Total 848 100.0%Notes:

a. The 188 cases under “Other” include: 1. Misuse of state vehicles and damage of state property (22). 2. Assault (16). 3. Abscondment (5) 4. Unauthorised RWOPS (22). 4. Late coming (74). 5. Poor performance (49).b. The above total of 848 includes 40 cases pending at the end of the fi nancial year.

Table 3.10.4: Grievances lodged 2012/13

Number % of total

Number of grievances resolved 430 97.7%

Number of grievances not resolved 10 2.3%

Total number of grievances lodged 440 100.0%

Table 3.10.5: Disputes lodged 2012/13

Number % of total

Number of disputes upheld 94 59.1%

Number of disputes pending 65 40.9%

Total number of disputes lodged 159 100.0%Notes:

a. The pending cases include those:

1. Awaiting arbitration awards.

2. Arbitration which are in progress.

3. Awaiting dates for arbitration.

191


Table 3.10.6: Strike actions 2012/13

Total number of person working days lost 57

Total cost of working days lost (R’000) 23 157

Amount recovered as a result of no work no pay (R’000) 23 157

Table 3.10.7: Precautionary suspensions 2012/13

Number of people suspended 12

Number of people whose suspension exceeded 30 days 12

Average number of days suspended 185

Cost of suspensions (R’000) 3 231

3.11 Skills development

Table 3.11.1 Training needs identifi ed 2012/13

Occupational category Gender

Number of employees

as at 1 April 2012

Learnerships

Training needs at the start of the reporting period

Skills programmes & other short

courses

Other forms of training

Total

Legislators, Senior Offi cials

and Managers

Female 112 0 100 0 100

Male 116 0 80 0 80

Professionals Female 2 813 0 785 0 785

Male 3 043 0 474 0 474

Technicians and associate

professionals

Female 18 893 350 5 229 0 5 229

Male 2 701 150 796 0 796

Clerks Female 5 905 0 2 305 0 2 305

Male 2 548 0 1 260 0 1 260

Service workers and shop

and market sales workers

Female 13 541 0 1 805 0 1 805

Male 2 394 0 1 405 0 1 405

Craft and related trades

workers

Female 3 0 2 0 2

Male 1 0 1 0 1

Plant and machine

operators and assemblers

Female 38 0 20 0 20

Male 412 0 200 0 200

Elementary occupations Female 7 801 0 605 0 605

Male 3 781 0 220 0 220

Total 64 102 500 15 287 0 15 287Notes:a. Number of employees is as at the beginning of the reporting period (i.e. April 2012) as required by the reporting guideline.b. Learnerships, Skills Programmes and other forms of training are trainining needs identifi ed as per Workplace Skills Plan of

2012/ 2013c. Classifi cation legend: Legislators, senior offi cials and managers: Offi cials responsible for determining and formulating policy and strategy, planning,


experience.

192


Clerks: This group includes occupations whose tasks require the knowledge and experience necessary to organise, store, compute and retrieve information.

Service workers, shop and market sales workers: This group includes employees whose main tasks require knowledge and experience necessary to provide personal and protective services.

Craft and related trades workers: This comprises employees whose main tasks require knowledge and experience of skilled trades and handicrafts.

Plant and machine operators and assemblers: The main tasks of these employees involve the use of automated industrial machinery and equipment.

Elementary occupations: This group covers occupations which require relatively low levels of knowledge and experience required to perform mostly simple and routine tasks, involving use of hand held tools and in some cases considerable physical effort. With few exceptions, their work requires limited personal initiative and judgment.

Table 3.11.2: Training provided for the period 2012/13

Occupational category Gender

Number of employees

as at 1 April 2012

Learner-ships

Training provided within the reporting period

Skills programmes & other short

courses

Other forms of training

Total

Legislators, senior offi cials and managers

Female 112 0 116 0 100

Male116 0 62 0 80

Professionals Female 2 813 0 114 0 785

Male 3 043 0 93 0 474

Technicians and associate Ppofessionals

Female 18 893 191 4 679 0 5 229

Male 2 701 106 1 498 0 796

Clerks Female 5 905 0 6 285 0 2 305

Male 2 548 0 2 320 0 1 260

Service workers and shop and market sales workers

Female 13 541 0 1 121 0 1 805

Male 2 394 0 527 0 1 405

Craft and related trades workers

Female 3 0 0 0 2

Male 1 0 0 0 1

Plant and machine operators and assemblers

Female 38 0 10 0 20

Male 412 0 95 0 200

Elementary occupations

Female 7 801 0 225 0 605

Male3 781 0 87 0 220

Total 64 102 297 17 232 0 15 287Notes:a. Number of employees is extracted from PERSAL as at the beginning of the reporting period (April 2012) as required by the

reporting guideline.b. Learnerships, skills programmes and other forms of trainingare per narrative section of Annual Training Report of 2012/13.c. Classifi cation legend: Legislators, senior offi cials and managers: Offi cials responsible for determining and formulating policy and strategy, planning,


experience. Clerks: This group includes occupations whose tasks require the knowledge and experience necessary to organise, store,

compute and retrieve information. Service workers, shop and market sales workers: This group includes employees whose main tasks require knowledge and

experience necessary to provide personal and protective services. Craft and related trades workers: This comprises employees whose main tasks require knowledge and experience of skilled

trades and handicrafts. Plant and machine operators and assemblers: The main tasks of these employees involve the use of automated industrial

machinery and equipment. Elementary occupations: This group covers occupations which require relatively low levels of knowledge and experience

required to perform mostly simple and routine tasks, involving use of hand held tools and in some cases considerable physical

effort. With few exceptions, their work requires limited personal initiative and judgment.

193


3.12 Injury on duty

Table 3.12.1: Injury on duty 2012/13

Nature of injury on duty Number % of total

Required basic medical attention only 500 99.60%

Temporary total disablement 2 0.40%

Permanent disablement 0 0.00%

Fatal 0 0.00%

Total 502 100.00%

3.13 Utilisation of consultants

Table 3.13.1: Report on consultant appointments using appropriated funds 2012/13

Project title Total number of

consultants that worked

on the project

Duration work days

Contract value

(Rands)

Renewal of the Oracle licence for the support and

maintenance of patient information systems databases

(Medicom, ECIS, SMS and HER)

1 (Oracle) 12 months R3 419 208.73

Notes:

a. All projects approved during the reporting period.

Table 3.13.2: Analysis of consultant appointments using appropriated funds, in terms of historically

disadvantaged individuals 2012/13

Project Title Percentage ownership by HDI groups

Percentage management

by HDI groups

Number of consultants

from HDI groups that work on the

project

Renewal of the Oracle licence for the support and

maintenance of patient information systems databases

(Medicom, ECIS, SMS and HER)

1% 1% 1

Notes:b. 55% of appropriated funds for goods and services were spent on BEE companies.

194


195

196

Part E:

FINANCIAL INFORMATION

197

Financial Information

TABLE OF CONTENTS

REPORT OF THE ACCOUNTING OFFICER 198ACCOUNTING OFFICER'S STATEMENT OF RESPONSIBILITY 222REPORT OF THE AUDITOR GENERAL 223APPROPRIATION STATEMENT 230NOTES TO THE APPROPRIATION STATEMENT 263STATEMENT OF FINANCIAL PERFORMANCE 265STATEMENT OF FINANCIAL POSITION 266STATEMENT OF CHANGES IN NET ASSETS 267CASH FLOW STATEMENT 268ACCOUNTING POLICIES 269NOTES TO THE ANNUAL FINANCIAL STATEMENTS 278DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENTS 294ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS 308



REPORT OF THE ACCOUNTING OFFICERfor the year ended 31 March 2013.

1. General review of the state of fi nancial affairs

1.1 Vision To be the best provider of quality health

services to the people in Gauteng.

1.2 MissionTo provide excellent, integrated health

services in partnership with stakeholders

and to contribute towards the reduced

burden of disease in all communities in

Gauteng.

1.3 Important policy decisions affecting the departmentThe following signifi cant policy

developments during 2012/13 will affect the

work of the department in future years:

Memorandum of Agreement (MOA) with

National Government and Turnaround

Strategy

In December 2011, a Memorandum of

Agreement (MOA) between the Premier and

the National Ministers of Health and Finance

was signed.

The obligations of the province included

strengthening budget planning and

implementation, recovering debts owed

to the province and the development of a

comprehensive Turnaround Strategy. The

MOA remained in effect for the duration of

2012/13, and implementation was monitored

through weekly and monthly meetings of the

Technical Task Team, consisting of GDoH,

Gauteng Treasury, Gauteng Department of

Infrastructure Development, the Offi ce of

the Premier, the national DOH and National

Treasury.

The Turnaround Strategy 2012-14 was

developed with the involvement of staff,

management, the National Department

of Health, National Treasury, Provincial

Treasury, stakeholders, and the Gauteng

Executive Council, and was approved by the

Executive Council on 4 July 2012.

The Turnaround Strategy seeks to address

the following eight key areas:

1. Financial management.

2. Human resource management.

3. District health services.

4. Hospital management.

5. Communication and social

mobilisation.

6. Infrastructure and maintenance.

7. Information management.

8. Litigation management.

The Turnaround Strategy will continue to be

implemented for the remainder of the period

of the 2013 Medium Term Expenditure

Framework (MTEF).

As part of the Turnaround Strategy, the

department is implementing fi nancial

management interventions that will ensure

organisational stability and an institutional

culture of fi scal discipline. The department

continue to manage irregular expenditure in

order to eliminate accruals. Commitment

by all categories of staff to ensuing that

the Turnaround Strategy permeates all our

programmes will ensure that the department

delivers on its mandate.

Good progress is being made with stabilising

the department and implementing far-

reaching changes, particularly with regard

to fi nancial management, supply chain

management, the Medical Supplies Depot

198



REPORT OF THE ACCOUNTING OFFICERfor the year ended 31 March 2013.

and human resources. However, the scale

of the problems faced by the department

in previous years means that the process

of restoring service levels, improving

effi ciencies and building improved systems

for quality service delivery will continue into

2013/14.

The department will continue to face severe

budget constraints in 2013/14. However, in

spite of these constraints, we are committed

to delivering quality health services and

achieving the health outcomes in the

Negotiated Service Delivery Agreement and

the Gauteng Programme of Action. We will

achieve this by doing things more effi ciently,

working smarter, and implementing cost

containment measures to ensure that

resources are focused on core service

delivery.

As a result, the majority of targets in the

Annual Performance Plan continue to

increase in line with the MTEF targets.

In addition, certain “targets”’ (projections

of demand for services), such as PHC

headcounts and the number of outpatients

at hospitals, continue to increase over the

MTEF because the reality is that demand for

services in Gauteng continues to increase,

in spite of a restricted resource envelope.

Our challenge is to continue to ensure

quality services even as the demand for

services increases. We are confi dent that

the Turnaround Strategy maps out a way to

do this, and the dedication and energy of our

health workers is the engine that will drive

implementation of the strategy.

Administrative curatorship (Section 18)

In December 2012, the Executive Council

of the Gauteng Provincial Government

resolved that the Department of Health

would be placed under administrative curatorship as per Section 18 of the Public Finance Management Act (PFMA). Invoking Section 18 of the PFMA will assist the department to achieve its mandate and to comply with the PFMA. In terms of this section, the Gauteng Provincial Treasury has appointed a consortium, consisting of Price Waterhouse Coopers, EOH and Ngubane and Co, that will assist the Department to put in place systems and build capacity for effi cient, effective and transparent fi nancial management. Specifi c areas that require the consortium’s assistance have been identifi ed.

• Finance: Financial mismanagement, defi cits and inadequate systems all point to a poor control environment, a general lack of adequate super-vision and fi scal discipline, which unfortunately severely impairs the department’s ability to deliver servic-es as expected. Problems in supply chain management are also sympto-matic of a poor control environment, ill-discipline, inadequate systems and poorly skilled human resources.

• Accenture has also been deployed as per National Treasury’s advice to assist the department with budget reforms. The team is in the process of developing a budget monitoring tool which will be useful for man-agement to review budgeting and spending trends.

• Hospital services: Overall manage-ment, accountability and structures that allow for interventions to be measured, monitored and improved upon are needed throughout the end-to-end management of health-care facilities where the service

delivery is the key objective.

199

Department of Health Vote 4REPORT OF THE ACCOUNTING OFFICERfor the year ended 31 March 2013.


• Leadership and culture: Weaknesses

in this area have left the department

disoriented in the strategic sense,

and service delivery staff experience

lack of certainty and a weakened

sense of direction as a result.

• Human resources: While it is true

that properly skilled and effectively

managed human resources are the

most important investment for good

service delivery, organisational per-

formance (or effectiveness) is also

critically allied to strategy execution,

which can be enhanced by effective

programme management.

Fixed-dose combination (FDC) ARVs

At the end of 2012/13, the national

Department of Health announced that, with

effect from 1 April 2013, implementation

of the Fixed Dose Combination (FDC) ARV

would be rolled out for treatment of AIDS.

The once-a-day, single ARV tablet contains

a combination of three ARVs – tenofovir,

efavirenz and emtricitabine. Initially, it is

being given to newly diagnosed HIV positive

persons with CD4 counts lower than 350

and to all HIV positive pregnant women

and breast-feeding mothers regardless of

their CD 4 count. It is expected that FDC

will improve and strengthen adherence to

treatment by reducing the pill burden.

1.4 Important strategic issues facing the department A new MEC for Health was appointed in

July 2012, and a permanent Chief Financial

Offi cer (CFO) assumed duty in October 2012.

The Head of Department left the department

in October 2012, and the Chief Financial

Offi cer acted as Head of Department for the

remainder of the fi nancial year.

The department continued with the cost-

saving measures introduced in 2011/12.

Despite cost-saving measures having been

achieved to some extent, the department

continued to experience some resource

constraints. However, these resource

constraints were less severe in the reporting

period compared with previous fi nancial

years. During 2012/13, the department

settled accruals to the value of R4.2 billion

while ensuring that current year payments

were also made.

The department also settled accruals

relating to the Gauteng Medical Supplies

Depot in the fi rst quarter of the fi nancial

year which made possible the restoration

of pharmaceutical services at the depot.

The department made consistent payments

to the Medical Supplies Depot throughout

the 2012/13 fi nancial year. Some medicine

shortages were still experienced at the

Medical Supplies Depot during the year but

these could mainly be attributed to lead

times of suppliers between production of

drugs and deliveries.

The merger between the GDoH and the

Department of Social Development was

reversed with effect from 1 April 2012.

The GDoH therefore became a standalone

department with effect from the same

date. During the process of separating

the departments a formal agreement was

reached that accruals to the value of R63

million would be paid by the GDoH on behalf

of the Department of Social Development

during 2012/13. This amount was duly paid.

A process to convert debt balances and

other relevant asset and liability accounts of

the two departments was undertaken. There

were certain assets that were procured

while the departments were merged and a

200



process to transfer assets took place with

appropriate recording in both asset registers.

In terms of reporting on prior year balances,

GDoH disclosed all prior year balances on

behalf of both departments while Social

Development disclosed zero prior year

balances.

The department continued to work with the

Provincial Treasury in making cash available

to pay suppliers. There has been acceleration

in paying suppliers as a result of which the

department is disclosing lower accruals for

the fi nancial year 2012/13 in comparison to

previous fi nancial years.

To ensure that only valid invoices of the

previous fi nancial years are paid, the

department has implemented a prepayment

audit process where each invoice relating

to previous fi nancial years is validated for

authenticity and only released for payment

once validated as correct.

Three senior managers were charged with

fraud and corruption. The disciplinary cases

were fi nalised in February 2013 with a

dismissal sanction for all three. Two of the

senior managers have declared a dispute

at the Bargaining Council, alleging unfair

dismissal. These cases are in progress.

The Identifi cation Verifi cation Solution (IVS)

Project, which involves verifying employees

against the population register and the pay-

roll, was launched on 13 February 2013. The

project is driven by Gauteng Department of

Finance (GDF) in partnership with the GDoH.

Central offi ce was the fi rst institution to be

verifi ed on the 25 and 26 February 2013

followed by the four central hospitals. As the

fi nancial year closed, the department was

busy with verifying personnel from central

offi ce and the four central hospitals who had

been on vacation or sick leave. The roll out to

the tertiary, regional, district and specialised

hospitals was due to follow in the new

fi nancial year. The whole department,

including the district health services,

nursing colleges and the laundries, is to be

completed within the 2013/14 fi nancial year.

The ICT and Revenue sections are in the

process of upgrading Medicom to the

latest version, EM 12.x. The upgrade will

be implemented at all institutions which

were previously running on MEDICOM. The

maintenance and support of EM 12.x will

form part of the upgrade and will extend

for a period of three years. A submission

has been made to BAC for approval of the

project. It should be noted that the two new

hospitals (Zola and Natalspruit) will form

part of the EM 12.x implementation.

1.5 Priorities of the department The programme and service priorities of

the GDoH are guided by the international,

national and provincial policies and

strategies listed below.

The Millennium Development Goals and

improving health outcomes

Goal 1: Eradicate extreme poverty and

hunger.

Goal 3: Promote gender equality and

empower women.

Goal 4: Reduce child mortality.

Goal 5: Improve maternal health.

Goal 6: Combat HIV and AIDS, malaria and

other diseases.

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The outcomes in the Negotiated Service

Delivery Agreement between the President

and the Minister of Health

1. Increased life expectancy.

2. Decreased maternal, infant and child

mortality.

3. Combating HIV and AIDS and

decreasing the burden of disease

from tuberculosis.

4. Improving health systems

effectiveness.

The 10-Point Plan of the national

Department of Health

• Provision of strategic leadership and

creation of social compact for better

health outcomes.

• Implementation of National Health

Insurance (NHI) as a pilot project.

• Improving the quality of health ser-

vices.

• Overhauling the healthcare system

and improving its management.

• Improved human resources planning

development and management.

• Revitalisation of infrastructure.

• Accelerated implementation of the

HIV and AIDS strategic plan and the

increased focus on TB and other

communicable diseases.

• Mass mobilisation for the better

health for the population.

• Review of drug policy.

• Strengthening research and develop-

ment.

Gauteng provincial strategic priorities

2009-14

• Quality basic education.

• Long and healthy life for all.

• All people are and feel safe.

• Decent employment.

• Sustainable human settlements.

• Effective local government system.

• Fair and inclusive citizenship.

Objectives of the Turnaround Strategy for

Health 2012-14

• More effective utilisation of available

resources by the department.

• The clearing of debt and accruals.

• Delivery within allocated budgets.

• Improvement of health outcomes.

• Entrenchment of the desired

organisational culture and enhanced

internal discipline. throughout the

organization.

• Improved public and partner

confi dence.

National health priorities, including NHI

pilot initiative and the non-negotiable

priorities

The African Cup of Nations

From 19 January to 12 February 2013 South

Africa hosted the Orange African Cup of

Nations. The tournament was played in fi ve

cities, with Gauteng hosting the opening

and closing ceremonies. In terms of the

mandate, the national Department of Health

and the South African Local Organising

Committee (SALOC) made commitments to

provide health and medical services for the

games. The GDoH was obliged to provide

certain health and medical services in terms

of guarantees provided by the Minister of

Health.

The department, together with the host

city, provided comprehensive medical

services for the CAF delegation, VIPs, teams’

delegates, match offi cials and spectators.

The department was also responsible

for the provision of health and medical

202



services to foreign and local spectators,

media, sponsors, offi cials, administrators

and the small business sector servicing

the spectators at the respective venues.

As a result, EMS personnel, vehicles and

equipment were deployed in the following

areas during the duration of the tournament.

• Competition areas at stadiums.

• VIP medical centres at stadiums.

• Training grounds.

• Team base camps.

• Airports.

The games were a success and the

department played a role in this through the

following:

• Hospitals were placed on standby for

treatment of government VIPs and

spectators and for mass casualty

situations should they have arisen.

• Environmental health offi cers

provided appropriate accreditation

of all appropriate Orange Cup of

Nations venues.

• A provincial communicable disease

outbreak response team was

established and placed on standby

during the tournament.

• Health promotion was provided at

identifi ed hot spots.

• Port health services were provided at

all international airports on a 24-hour

basis.

• Forensic pathology services were

placed on standby as part of the

precautions for disaster management

(in case of mass deaths and victim

identifi cation requirements).

203



1.6 Spending trends and general review of fi nancial affairsTable A: Departmental expenditure by budget programme

Programme

Final appropriation

2012/13R’000

Expenditure 31March

2013R’000

PercentageSpent

VarianceR’000

Administration 683 447 501 362 73% 182 085

District Health Services 8 782 484 8 555 956 97% 226 528

Emergency Medical Services 1 059 284 1 147 231 108% (87 947)

Provincial Hospital Services 6 546 896 6 582 440 101% (35 544)

Central Hospitals 7 566 859 7 799 913 103% (233 054)

Health Sciences and Training 841 924 807 070 96% 34 854

Health Care Support Services 199 821 196 544 98% 3 277

Health Facilities Management 1 510 879 1 243 831 82% 267 048

Total 27 191 594 26 834 347 99% 357 247

The table above summarises the budget

versus actual amount spent as at 31 March

2013. The department spent 99% of the

budget which implies that the department

is within budget. However, the department

reported over-spending on two programmes:

• Emergency Medical Services: over-

spent by 8%. The over-expenditure

is due to the payment of accruals for

goods and services and transfers to

municipalities. The provincialisation

of Sedibeng District with effect from

1 September 2012 also contributed

to overspending on compensation of

employees.

• Central Hospitals: overspent by 3%.

The main contributors to over-ex-

penditure on this programme are

goods and services as a result of the

payment of accruals and payments

to households arising from injury and

deaths on duty and unplanned resig-

nations.

204



Table B: Expenditure by economic classifi cation

Economic classifi cation

Final appropriation

2012/13R’000

Expenditure 31 March

2013R’000

Percentagespent

VarianceR’000

Compensation of employees 15 278 812 15 244 542 100% 34 270

Goods and services 8 380 580 8 625 127 103% (244 547)

Interest and rent on land 0 981 0% (981)

Provinces and municipalities 964 285 1 083 525 112% (119 240)

Departmental agencies and accounts 28 286 28 267 100% 19

Universities and technikons 1 500 500 33% 1 000

Non-profi t institutions 916 785 817 505 89% 99 280

Households 83 731 86 713 104% (2 982)

Buildings and other fi xed structure 848 689 528 282 62% 320 407

Machinery and equipment 688 926 413 182 60% 275 744

Payment of fi nancial assets 0 5 723 0% (5 723)

Total 27 191 594 26 834 347 99% 357 247

From the table above it is evident that the

categories Goods and services, Transfers

to provinces and municipalities and

Households exceeded the allocated budget.

The main reason for the overspending was

payment of the previous year’s accruals in

2012/13. Over-expenditure in relation to

Households was attributable to the payment

for injury and deaths on duty and unplanned

resignations.

The under-spending on items may be

explained as follows: Under-spending on

Universities and technikons was due to

actual student intake which was less than

what was projected by the department. In

respect of NPOs, the under-spending was as

a result of late submission of claims by the

municipalities.

The overall under-spending on buildings

and other fi xed structures was due to slow

performance on infrastructure grants

– delays in appointment of contractors

by the implementing agent resulted in

projects not being completed as planned

and late processing of invoices. The delays

in completion of infrastructure projects

resulted in unavailability of storage space for

medical equipment and therefore spending

against budget was only 60%.

205



Table C: Department’s spending trends over the past fi ve years

Year

Annual

appropriation

R’000

Actual

R’000

Over/under

expenditure

R’000

2008/9 16 649 946 17 421 818 (771 872)

2009/10 19 144 154 20 272 357 (1 128 203)

2010/11 22 568 438 22 380 182 188 256

2011/12 25 819 914 25 990 164 (170 250)

2012/13 27 191 594 26 834 347 357 257

The table above depicts the growth in the department’s spending by R11 billion from 2008/9 to 2012/13.

This is the result of an increase in the price of medical commodities as well as cost of living adjustments.

Table D: Non-negotiable items

Actual

expenditure

R’000

Infection control and cleaning 287 065

Medical supplies including dry dispensary 1 131 245

Medicines 1 122 517

Medical waste 101 896

Laboratory services: National Health Laboratory Services (NHLS) 1 239 164

Blood supply and services 535 230

Food services 195 358

Security services 278 186

Laundry services 30 071

Essential equipment and maintenance of equipment 296 790

Infrastructure maintenance 711 348

Children’s vaccines 53 283

HIV & AIDS programme 878 309

Total 6 859 462

The table above provides the spending

on non-negotiable items. The top cost

drivers among the non-negotiable items

are medicines, laboratory services, medical

supplies, the HIV and AIDS programme and

infrastructure maintenance.

Virement

An application for virement was made to

the Provincial Treasury to alleviate excess

expenditure on standard items within

programmes and sub-programmes. The

application was guided by Section 43 of the

PFMA and Treasury Regulation 6.3.

206



Virement was made only in relation to the

compensation of employees and goods

and services economic classifi cations. The

following main divisions were affected:

• Administration.

• District Health Services.

• Provincial Hospital Services.

• Central Hospital Services.

• Health Sciences and Training.

• Healthcare Support Services.

The Acting Chief Financial Offi cer of the

department recommended the application

which was subsequently approved by the

Provincial Treasury.

The main reasons for unauthorised

expenditure incurred by the department

related to payment of accruals from the

previous fi nancial years which included

transfers to municipalities. The department

will continue to implement cost-saving

measures which started in 2012/13 during

the 2013/14 fi nancial year.

2. Services rendered by the department

• Strategic management and support

services are provided at all levels of

the department, that is, provincial, re-

gional and district levels.

• Primary healthcare services are de-

livered through the district health

system. A network of provincial clin-

ics and community health centres

provide ambulatory care adminis-

tered by doctors, nurses and other

professionals. In some areas local

authorities are subsidised to render

care at clinics.

• Emergency medical services and

planned patient transport are provid-

ed throughout the province.

• Secondary healthcare services are

provided through regional hospitals

that offer outpatient and inpatient

care at general specialist level and

tertiary care at three tertiary hospi-

tals.

• Specialised healthcare services pro-

vide inpatient care for psychiatric and

infectious diseases. Some tuberculo-

sis and chronic psychiatric services

are provided on an outsourced basis.

• Inpatient and outpatient academ-

ic healthcare services are provided

through four central hospitals and

three dental hospitals, with teaching

also taking place at other service lev-

els.

• Health sciences faculties and nurs-

ing colleges provide training for fu-

ture healthcare professionals.

These services are supported through

human resource development, management

and health support systems such as

laundries, facilities management, food

services and medicine supply services.

3. Tariff policy

The department applies the Uniform Patient

Fee Structure (UPFS) as its tariff policy.

The UPFS manual is reviewed annually as

per provision of Treasury Regulation 7. In

addition the department charges fees for

other revenue items and reviews the fees

schedule annually in consultation with

the Provincial Treasury as per Treasury

Regulation 7.

207



4. Free services

H1 patients do not pay for services rendered

by the department as per government policy.

A full schedule of services provided free of

charge to specifi c categories of people in

accordance with legislation appears on page

119 of this report.

5. Inventories

• Inventory management has become

the function of supply chain manage-

ment (SCM) and falls under the Re-

porting: Sub-directorate. A policy on

inventory management was adopted

and rolled out to all health institu-

tions .

• A road show on inventory manage-

ment was undertaken for the districts

in February 2013 to inform SCM offi -

cials of the annual stocktake and the

need to include counting stock at

wards, clinics and open pharmacies.

SCM offi cials were notifi ed that the

counting of stock at wards must be

done by the sister in charge and a TPH 42 form must be used only for reporting on the description of the item and the quantity on hand as at the last day of March. The weighted average cost was done by stores.

• A meeting took place between EMS and Internal Control and Risk Man-agement in respect of inventory management pertaining to the stock in the ambulances and the method that was agreed to be used during stock-take.

• Stock-take certifi cates are consoli-dated at central offi ce and reported to Provincial Treasury for the depart-ment.

6. Capacity constraints

The department is currently engaged in a restructuring process to strengthen the management of hospitals and health districts in line with the national Human Resources for Health Strategy, the Re-engineering Primary Healthcare Services and the departmental Turnaround Strategy. Organisational structures are being aligned with national Department of Health structures.

There has been consultation with relevant parties on the rationalisation of the staff establishment, in accordance with the principle of decentralisation. Human Resource Management was compelled to take serious cost containment measures on the fi lling of vacant posts and has demonstrated commitment in the implementation of these measures. Statutory posts for community service and internships for graduating health professionals remain a challenge.

The challenges experienced by the department in retaining health professionals are being addressed as a priority. Good progress has been made in the appointment of medical specialists and practitioners. There has been accelerated fi lling of health professional posts through regular institutional post-fi lling planning meetings based on costed human resource plans, which are monitored by dedicated HR practitioners. All vacant unfunded posts were frozen.

The department is implementing the national DOH process of developing staffi ng norms for all categories of staff. This is being piloted in the Tshwane Health District as part of the preparation for implementation of NHI.

208



There has been tighter management of remunerative work outside the public service (RWOPS) and overtime to align with service delivery needs and budget allocation. Overtime in excess of 30% must be motivated to the Head of Department.

There is close monitoring of attendance, leave and absenteeism. Disciplinary action is being taken where there are transgressions.

Most of senior positions vacant for a period of time, such as Chief Financial Offi cer, Head of Infrastructure, Health Economist, Chief Director for District Health and the Chief Director for Information and Communication Technology, have been fi lled. The appointment of chief executive offi cers (CEOs) for the four central hospitals and the pending appointment of CEOs for other levels of hospitals will strengthen the management of systems.

These appointments are accompanied by delegation of authority and performance management agreements (PMA) aligned with the National Service Delivery Agreement (NDSA). The fi lling of these posts is having a positive impact on service delivery and

planned programmes.

7. Utilisation of donor funding

The department receives donations from diverse donors for utilisation on various activities which might have not been provided for in the budget and to supplement the available resources. Donations are received in cash and kind and are used for purposes as specifi ed by the donor. Donations are managed in accordance with Treasury Regulations and the PFMA. Donations received in cash during 2012/13 amounted to R203 000. Donations in kind included medical supplies, computer equipment, vehicles and other machinery.

8. Trading entities and public entities

The Medical Supplies Depot is a trading entity of the department which is responsible for the supply of essential medicines and disposable sundry items to provincial healthcare facilities. The depot charges a levy of fi ve percent (5%) on stock issued to provincial facilities. The Annual Financial Statements of the Medical Supplies Depot along with the Accounting Offi cer’s Report, Audit Committee Report and the Report of the Auditor-General, is contained elsewhere in this annual report. These reports provide comparative information, describe new developments at the depot and include

information on losses and guarantees.

209



9. Organisations to which transfer payments have been made Table E: Transfers to municipalities for delivery of PHC services

Municipality BudgetR’000

Total expenditure R’000

Ekurhuleni 168 117 190 627

City of Johannesburg 142 960 184 032

City of Tshwane 67 546 49 348

Total 378 623 424 007

Table F: Transfers to municipalities for delivery of emergency medical services

Municipality Budget

R’000

Total expenditure R’000

Sedibeng District Municipality 63 317 44235

West Rand District Municipality 49 675 48887

Ekurhuleni 178 830 229 534

City of Johannesburg 127 264 192 867

City of Tshwane 74 514 61504

Total 493 600 577 027

Table G: Transfers to departmental agencies and accounts

Agency Budget

R’000

Actual transfer

R’000

Health & Welfare SETA 28 238 28 238

SABC 0 29

Total 28 238 28 267

Table H: Transfer to universities and technikons

Institution Budget

R’000

Actual transfer

R’000

University of Johannesburg 540 0

University of Witwatersrand 434 302

University of Pretoria 345 198

University of Limpopo 181 0

Total 1 500 500

210



Table J: Transfers to non-governmental and community-based organisations

Institution Budget R’000 Total expenditure R’000

Psychiatric/mental health 285 519 241 843

Community-based services 266 498 221 924

HIV and AIDS 196 153 199 388

Nutrition 49 379 48 856

Witkoppen Clinic 8 125 5 063

Alexander Health Centre 45 580 39 655

Phillip Moyo 24 110 17 907

District management 41 421 27 360

Management 0 15 121

Total 916 785 817 504

10. Public-private partnerships

Public-private partnership (PPP)

infrastructure projects for the GDoH are

implemented through a agreement, signed

on the 5 May 2010, which is referred to as

the Joint Implementation Agreement (JIA).

The agreement involves the following role

players:

• Development Bank of Southern

Africa (DBSA).

• Department of National Treasury

(PPP Unit).

• National Department of Health

(DOH).

• Gauteng Department of Health

(GDOH).

The following are Ministerial Flagship

projects in Gauteng:

• Chris Hani Baragwanath Academic

Hospital.

• Dr George Mukhari Academic

Hospital.

These projects are governed by the Joint

Implementation Committee (JIC) with

shared responsibilities between DBSA,

National Treasury – PPP Unit, national DOH

and GDOH.

Previously GDoH was mandated to lead the

PPP projects. This function has now been

taken over by the Infrastructure Unit of the

national health department. Currently, there

is no funding or budget for these projects

from the GDoH.

See disclosure note on PPPs for details in

this regard.

11. Corporate governance arrangements

The Audit Committee continued to provide

valuable and effective support and oversight

to the department in relation to performance

management, fi nancial management, risk

management and accountability during the

2012/13 fi nancial year.

The Audit Committee was established

in 2001 and was fully functional during

2012/13. Quarterly reviews of fi nancial and

non-fi nancial performance were held as

well as meetings to review the department’s

Annual Financial Statements, management

letter and audit report. The department

is incorporated in Cluster 3 of the Audit

Committee.

211



The Gauteng Audit Services (GAS) of

the Gauteng Department of Finance

provide internal audit services for the

department. Internal audit plans, based on

the departmental risk assessment, were

developed by GAS to ensure compliance

with the PFMA and Treasury Regulations.

These plans were approved by the Audit

Committee, which exercises oversight of the

activities of GAS. All internal audits planned

for the year under review were completed

and all audit fi ndings and recommendations

and management action plans were

regularly monitored for implementation

with the assistance of the departmental risk

management unit.

The departmental Bid Adjudication

Committee (BAC) fulfi ls its role very

adequately in enabling the accounting offi cer

to ensure that procurement is fair, equitable,

transparent, competitive and cost effective.

It meets on average once a week and

deals with all cases involving procurement

in excess of delegated limits, including

requests for information (RFI), requests for

proposals (RFP), and cases where it is in the

best interests of the department to deviate,

within prescribed limits, from normal

procurement procedures.

The Audit Action Plan Progress Review

Committee (AAPPRC) was established for

the purpose of monitoring progress on the

implementation of action plans relating to

audit qualifi cations and other audit report

and management letter outcomes for the

2011/12 audit. It further focused on key

areas of non-compliance and performance

information. The AAPPRC consist of offi cials

from the GDoH, Gauteng Department of

Finance, Internal Audit, Gauteng Treasury

and the Offi ce of the Auditor-General. The

review of audit action plans through the

AAPPRC was expanded at institutional level

during 2012/13.

A Risk Management Committee was

established to provide oversight of all

aspects of the risk management process

within the department in accordance with

the Gauteng Provincial Government Risk

Management Framework.

Chapter III of the Hospitals Ordinance, 1956

(Ord.14 of 1958) (Which year was it?), as

amended, provides for the establishment

of hospital boards by the MEC for Health,

and prescribes the rights, powers, duties

and functions of the boards. Nursing

colleges under control of the department

were established in terms of Chapter IIA

of the abovementioned ordinance. Each

college is governed by a council which has

defi ned duties and powers of oversight and

control, particularly in relation to the funds

and accounts administered in the name

of the college council. Other governance

structures are described elsewhere in this

annual report.

12. Code of conduct and management of conflicts of interest

The Code of Conduct for Public Servants, as

contained in the Public Service Regulations,

and the Batho Pele Principles are well communicated to staff. Specifi c codes of conduct also exist, for example, for members of the BAC. Members of the BAC and bid evaluation committees sign a declaration of interest before each meeting. The Code of Conduct for Supply Chain Managers was also communicated to staff.

212



Interests are declared annually by members of senior management, as required by law. All staff members, including supply chain management staff, are aware of the need to declare interests and potential conflict of interest whenever they become aware of these, as required by Regulation 16A8.3(a) of the Treasury Regulations. The department now requires all staff members to complete a form to declare their interests on an annual basis in order to strengthen controls in this area.

The department has clear policies with regard to remunerative work outside of the public service (RWOPS). This is communicated during induction of new employees as well

as through circulars.

The department has started vetting key

offi cials in the department and a vetting plan

has been approved by the State Security

Agency for full implementation in the

2013/14 fi nancial year.

13. Safety, health and environmental Issues

The department has continued to create

a healthy working environment for its

employees by ensuring good work ethics

and discipline through progressive human

resource development and management

practices.

While numerous challenges still confront

institutions regarding compliance with some

aspects of environmental and occupational

health and safety management, the

department has succeeded in establishing

active occupational health and safety

committees in most Institutions. The

development of an Environmental

Management Plan has been initiated and is

nearing completion. This will be rolled out to

Institutions on approval.

The department has, on its staff

establishment, environmental health

offi cers to ensure delivery of environmental

programmes as defi ned in the new National

Health Act as well as to coordinate the

activities of local and metro governments to

ensure compliance with legislated functions.

The environmental health programme also

focuses on environmental health conditions

at all health facilities, ensuring safe food

supply to staff and patients.

14. Discontinued activities/activities to be discontinued

A number of infrastructure projects

were halted in 2012/13 and certain

local government clinics in the City of

Johannesburg stopped providing extended

services. Apart from these projects,

described below, no major activities were

discontinued or will be discontinued.

However, there will be normal shifts of focus

within programmes and adjustments due to

budget changes.

Construction of new Boitumelo Clinic,

Bophelong Clinic, Magagula Heights Clinic,

Braamfi scherville Clinic, Randfontein Clinic

and Heidelberg Clinic

These clinics were identifi ed for construction

and GDID was requested to appoint

professional service providers to develop

designs. GDID subsequently appointed Tau

Pride. Tau Pride prepared the designs, which

were halted as Tau Pride initiated a legal

dispute with GDID. Until the legal matter is

resolved, GDID cannot appoint other service

213



providers and the projects cannot progress.

It was decided to put the projects on hold

until GDID and Tau Pride resolve the legal

dispute. In 2012/13 a total of R13 264 000

was allocated for these projects, but in view

of the lack of progress the 2012/13 Adjusted

Budget was reduced to zero. Although the

current clinics are functional, the buildings

are dilapidated and new facilities will greatly

improve service delivery to the communities.

Renovation and refurbishment of wards to

accommodate TB beds at Dr Yusuf Dadoo

Hospital

In 2009 six hospitals were identifi ed for possible revitalisation and professional service providers were appointed to do a complete assessment of the institutions. Business cases were prepared, presenting three possible options for revitalisation of each institution. These business cases await approval from DOH. As these projects have major fi nancial implications, implementation will have to be prioritised. The six identifi ed hospitals were:

• Dr Yusuf Dadoo Hospital.• Sebokeng Hospital.• Tambo Memorial Hospital.• Dr George Mukhari Hospital.• Jubilee Hospital.• Kalafong Hospital.

Renovation and refurbishment of wards to

accommodate TB beds at old Germiston

Hospital

On 29 November 2011, the new Bertha Gxowa Hospital was opened. The new hospital was intended to replace the old Germiston Hospital but not all the services could be accommodated in the new facility and the TB wards had to remain in the old hospital. The estimated cost of renovating

and refurbishing the TB wards in the Germiston Hospital was R138 million. As it was uncertain whether the old facility should be renovated or demolished completely, the project was put on hold, awaiting a decision on the hospital’s future. An amount of R30 261 000 was allocated in the 2013/14 budget for the possible demolition. TB services are continuing, but patient care would improve if better infrastructure could

be provided.

The Zola/Jabulani and Natalspruit hospitals

are still work in progress.

Conversion of SAPS Building for Kagiso

CHC

In June 2012 GDOH requested GDID to

appoint professional service providers for

the conversion of part of the SAPS building

in Kagiso into a CHC. The SAPS building is

centrally located in the community which

makes it an ideal site for a CHC. Service

providers developed a design according to

the scope provided by GDoH, but the design

could not fi t on the available site. The project

was put on hold pending a decision on

whether to reduce the scope of the design or

request SAPS to vacate the building, making

it completely available for construction

of a CHC. In 2012/13 a total of R750 000

was allocated to this project, but this was

increased to R900 000 in the 2012/13

Adjusted Budget. As there is currently only

a clinic in Kagiso, services will be greatly

enhanced by the construction of a new CHC.

Extended hours

Due to fi nancial constraints, the department

experienced challenges in paying staff

the overtime required to render extended

services. Twenty-six local government

214



clinics in the City of Johannesburg stopped

operating for extended hours in 2012/13.

This is likely to have affected access to

services for some patients. An additional

10 provincial clinics began to offer extended

hours during the course of the year which

has helped to mitigate the impact of

curtailing services at the local government

clinics.

15. New/proposed activities

Fixed-dose combination ARVs

From 1 April 2013, the department will

implement the revised approach to ART

featuring fi xed-dose combination (FDC)

ARVs, in line with the national DOH ARV

tender. This is not a “new” activity, but a

revised approach to ART that will improve

and strengthen adherence to treatment. The

costs will be covered by the HIV and AIDS

conditional grant.

New maternal and obstetric unit

The department opened a new maternal

and obstetric unit at Ethafeni in Ekurhuleni

during 2012/13. This will help to reduce the

load at Tembisa Hospital. When the MOU is

fully functional, Tembisa will be able to focus

on the more complicated deliveries while

routine cases can be dealt with at Ethafeni.

16. Asset management

The Asset Management Directorate has

maintained its momentum and continues

to achieve favourable results from all

stakeholders.

The directorate is currently leasing the Asset

Ware Management system from TAT I-Chain

which assists in monitoring and maintaining

the asset register which is updated and kept

correct and accurate by the directorate’s

staff.

Areas such as existence, completeness,

valuation, cut off, classifi cation, rights and

ownership of tangible assets were taken

into account by the asset management

staff. Assets bought in 2012/13 were

updated daily on the register and submitted

to Treasury. Quality checks were done by

the data capturing supervisor on an ongoing

basis.

The Asset Management Policy and

Procedure Manual, which includes

numerous guidelines, was reviewed, updated

and implemented across the department.

All parties are monitored and are strictly

adhering to the following:

• Compliance in respect of

reconciliations.

• Compliance in respect of journals.

• Compliance in respect of theft and

losses of departmental assets.

The above functions have been centralised

at central offi ce and are monitored

and managed strictly in order to

maintain consistency when dealing with

misallocations. Journals are submitted

to the necessary data capturing teams in

order to maintain a correct and accurate

asset register for the department. Staff

members who are well trained in the areas

of reconciliation and journal processing

ensure correctness and accuracy.

A theft/ loss control offi cer monitors

departmental assets and ensures that lost

and stolen assets are reported to SAPS as

well as all relevant parties. Investigations are

carried out and reported to the Accounting

215



Offi cer in order to obtain permission to establish liability before writing off or removing the assets from the asset register.

Experienced teams from central offi ce assist institutions with the physical verifi cation and reporting of assets.

17. Events after the reporting date

An amount of R286 million was owing to the Medical Supplies Depot at 31 March 2013. This was settled during the fi rst quarter of the 2013/14 fi nancial year.

18. Information on predetermined objectives

Data collection and reporting on performance are governed by the District Health Information Management Policy, the data flow policy and a number of standard operating procedures which guide reporting and data validation. Data informing progress made with the predetermined objectives is largely collected at facility level and fed into the District Health Information System (DHIS).

Data is fi rst captured at facility level using paper-based registers and summarised using the PHC summary sheets before DHIS capturing can commence. The DHIS is the largest provider of performance data. Other performance data, in particular information on TB management, is from the ETR.net information system. Each level of reporting – health facilities, sub-districts and districts – is provided with sign-off sheets to ensure verifi cation of the correctness of the data that is sent to the next reporting level.

Programme performance data, once captured on the DHIS, is uploaded at the

provincial offi ce where another level of verifi cation takes place. The inbuilt validation checks in the DHIS help in improving the data received from districts. The department has also introduced physical data validation tools which are implemented on-site to assess the level of completeness and accuracy of the reported data. These self-assessments are conducted on a quarterly or six-monthly basis by district teams. A data validation assessment reporting tool has been developed to track progress on validation exercises and will be utilised in the new fi nancial year. However, there are still challenges in terms of capacity for verifi cation of data.

The department has produced a guide on performance reviews which provides information on the schedule and the scope of performance reviews. In accordance with this guide, the department held three performance review sessions where detailed discussions on areas of non-performance took place and plans to address these were compiled. The department will strengthen the monitoring of implementation of these plans in the new fi nancial year.

As part of the medium to long-term solution to data challenges, the department has developed a proposal for a comprehensive electronic health information management system which will address record keeping and provide detailed information that can be used for planning and informing management and oversight bodies on the department’s performance.

19. SCOPA resolutions

The department did not receive any SCOPA resolutions for the fi nancial year under review.

216



20. Prior modifi cations to audit reports

Nature of qualifi cation, disclaimer, adverse opinion and matters of non-compliance

Financial year in

which it fi rst arose

Progress made in clearing/resolving the matter

I was unable to obtain suffi cient appropriate

audit evidence for departmental revenue

amounting to R453 505 000 (2010-11:

R438 979 000) as disclosed in note 1 to

the fi nancial statements due to inadequate

record keeping, ineffective computerised

information systems and failure to update

patient fee tariffs. I was unable to confi rm

the departmental revenue by alternative

means. Consequently, I was unable to

obtain suffi cient appropriate audit evidence

to satisfy myself as to the completeness,

classifi cation, accuracy, measurement,

occurrence and cut-off of departmental

revenue.

2009/10 • The classifi cation policy was re-

vised to cater for patients who

present themselves at public

facilities without required doc-

uments.

• The department conducted

training and improved on pro-

cesses to comply with the re-

quired portfolio of evidence re-

quired in patient classifi cation

of self-paying patients.

• The system problem remains,

but there is a plan to address in-

formation technology and infor-

mation systems in the province

in 2013/14. The issue of differ-

ent fi gures was resolved and

the Basic Accounting System

now balances with the stan-

dalone Patient Administration

System. Monitoring is under-

taken monthly and involves rec-

onciling the two systems. Insti-

tutions are submitting reports

monthly as a control measure.

• The issue of Uniform Patient

Fee Schedule of tariffs was re-

solved and updates are done at

the beginning of each fi nancial

year. Tariffs for 2012/13 and

2013/14 were up to date.

217




Financial year in



I was unable to obtain suffi cient

appropriate audit evidence for receivables

for departmental revenue and provision for

bad debts amounting to R2 025 279 000

(2010-11: R1 535 700 000) and

R932 951 000 (2010-11: R648 353 000),

respectively as disclosed in notes 27 and

27.1 to the fi nancial statements. I was

unable to confi rm the receivables from

departmental revenue and provision for bad

debts by alternative means. Consequently, I

was unable to obtain suffi cient appropriate

audit evidence to satisfy myself as to the

existence, completeness, valuation, cut-off,

classifi cation and rights and ownership of

receivables for departmental revenue and

the provision for bad debts.

2009/10 • The department has devel-

oped a manual document to

cater for patients who present

themselves at Gauteng public

facilities without the required

identifi cation information for

classifi cation. The GPF is used

in cases where a patient cannot

furnish required information.

This information is then pre-

sented by patients in subse-

quent visits to the hospital.

• Ongoing training is provided

to hospital admission offi cials

to assist them to comply with

departmental policies. The ap-

pointment of case managers in

certain hospitals has improved

the quality of mandates and re-

ferral documents by funders.

• Further rollout of the case man-

agement system to other hos-

pitals will provide the required

skills and capacity.

218




Financial year in



I was unable to obtain suffi cient appropriate

audit evidence for leave entitlement and

capped leave commitments amounting to

R1 032 722 000 (2010-11: R1 049 987 000)

as disclosed in note 25 to the fi nancial

statements due to inadequate system of

internal controls over all leave records on

which I could rely for the purpose of my

audit. I was unable to confi rm the leave

entitlement and capped leave commitments

by alternative means. Consequently, I was

unable to obtain suffi cient appropriate

audit evidence to satisfy myself as to the

completeness, valuation, existence, cut-off,

classifi cation and rights and obligations

of leave entitlement and capped leave

commitments.

2008/09 • The department implemented

several measures to strength-

en leave management, ensure

that this fi nding was properly

addressed and that the leave

entitlement was properly dis-

closed. This has had satisfacto-

ry results as reflected in the fact

that this fi nding does not repeat

in the 2012/13 audit.

The department did not have an adequate

system of internal controls in place for the

identifi cation and recognition of irregular

expenditure. There were no satisfactory

audit procedures that I could perform

to obtain reasonable assurance that

all irregular expenditure was recorded.

Consequently, I was unable to obtain

suffi cient appropriate audit evidence to

satisfy myself as to the completeness of

irregular expenditure of R1 115 884 000

as disclosed in note 28 to the fi nancial

statements.

2011/12 • The department implemented

several measures to strength-

en the reporting and identifi -

cation of irregular expenditure

to ensure that this fi nding was

properly addressed and that the

irregular expenditure was prop-

erly disclosed. These measures

have had satisfactory results

as reflected in the fact that this

fi nding does not repeat in the

2012/13 audit.

219



21. Exemptions and deviations received from the National Treasury

There were no exemptions and deviations

received from National Treasury during the

year under review.

22. Quarterly fi nancial statements

In terms of the Offi ce of the Accountant-

General Instruction Note 1 of 2012/2013,

issued by the National Treasury, departments

were required to compile and submit interim

fi nancial statements (IFS) within 30 days

of the periods ending 30 June 2012, 30

September 2012, 31 December 2012 and 31

March 2013.

The Financial Accounting Unit of the

Provincial Accounting Services Branch in

Provincial Treasury conducts reviews of the

quarterly fi nancial statements in order to

identify issues of concern to be addressed

before the year-end fi nancial statements.

The primary purposes of the review by

Provincial Treasury are to:

• Improve the fi nancial reporting pro-

cess by constructing recommenda-

tions based on an analytical review

of the data.

• Ensure that the correct template has

been used as issued by Treasury.

• Identify any recognition, measure-

ment and disclosure errors in the fi -

nancial statements template.

• Ascertain whether the department

is ready for the purpose of fi nal AFS

preparation.

• Ensure compliance with National

Treasury preparation guidelines.

• Ensure correct classifi cation,

accuracy and reliability of information

presented.

For the fi nancial year 2012/13, the

department complied with the requirements

for submission of interim fi nancial

statements for each of the prescribed

quarters.

The analysis of the quarterly fi nancial

statements by Provincial Treasury suggested

that the department has an effi cient system

of internal control in place and is able to

report on all transactions. Matters that were

emphasised by the Provincial Treasury after

review of the IFS are addressed internally in

the department.

After the fi nancial statements for the period

ending 30 September 2012, the Auditor-

General also conducted an interim audit and

fi ndings presented to the department noted

shortcomings in the following areas:

• Understatement of commitments.

• Accruals and payments exceeding

the 30-day payment term required by

legislation.

• Operating and fi nance lease commit-

ments.

• Receivables for departmental reve-

nue.

• Irregular expenditure.

• Impairments/provision for doubtful

accounts.

• Movable tangible capital assets.

• Minor assets.

• Inventory.

These matters were responded to by

the department and addressed during

the compilation of the Annual Financial

Statements of the department.

220



23. Other matters

Unauthorised expenditure

An amount of R4.5 billion has been condoned

by the Gauteng Provincial Legislature for

unauthorised expenditure incurred during

the fi nancial years 2007/8, 2008/9, 2009/10

and 2010/11. Unauthorised expenditure

amounting to R261 million was not approved

by the Gauteng Provincial Legislature for

the fi nancial years 2008/9, 2009/10 and

2010/11.

24. Approval

The Annual Financial Statements set out on

pages 230 to 328 have been approved by the

Accounting Offi cer.

Ndoda Biyela



31 MAY 2013

221



Statement of Responsibility for the Annual

Financial Statements for the year ended 31

March 2013

The Accounting Offi cer is responsible for the

preparation of the department’s annual fi nancial

statements and for the judgements made in this

information.

The Accounting Offi cer is responsible for

establishing, and implementing a system of internal

control designed to provide reasonable assurance

as to the integrity and reliability of the annual

fi nancial statements

In my opinion, the fi nancial statements fairly

reflects the operations of the department for the

fi nancial year ended 31 March 2013

The external auditors are engaged to express an

independent opinion on the AFS of the department.

The Department of Health AFS for the year ended

31 March 2013 have been examined by the external

auditors and their report is presented on page 230.

The Annual Financial Statements of the Department

set out on page 230 to page 328 have been approved

Ndoda Biyela



31 MAY 2013

ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITYfor the year ended 31 March 2013.

222



REPORT OF THE AUDITOR-GENERAL.


REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

Introduction1. I have audited the fi nancial statements of

the Gauteng Department of Health, set out

on pages 230 to 328, which comprise the

appropriation statement, the statement

of fi nancial position as at 31 March 2013,

the statement of fi nancial performance,

statement of changes in net assets and

the cash flow statement for the year

then ended, and the notes, comprising a

summary of signifi cant accounting policies

and other explanatory information.

Accounting offi cer’s responsibility for the fi nancial statements2. The accounting offi cer is responsible

for the preparation of these fi nancial

statements in accordance with the

Departmental Financial Reporting

Framework prescribed by National Treasury

and the requirements of the Public Finance

Management Act, 1999 (Act No.1 of 1999)

(PFMA), and for such internal control as the

accounting offi cer determines necessary

to enable the preparation of fi nancial

statements that are free from material

misstatement, whether due to fraud or

error.

Auditor-General’s responsibility3. My responsibility is to express an opinion

on these fi nancial statements based on my

audit. I conducted my audit in accordance

with the Public Audit Act of South Africa,

2004 Act No. 25 of 2004) (PAA), the

General Notice issued in terms thereof and

International Standards on Auditing.

Those standards require that I comply with

ethical requirements and plan and perform

the audit to obtain reasonable assurance

about whether the fi nancial statements are

free from material misstatement.

4. An audit involves performing procedures

to obtain audit evidence about the

amounts and disclosures in the fi nancial

statements. The procedures selected

depend on the auditor’s judgement,

including the assessment of the risks of

material misstatement of the fi nancial

statements, whether due to fraud or error.

In making those risk assessments, the

auditor considers internal control relevant

to the department’s preparation and fair

presentation of the fi nancial statements in

order to design audit procedures that are

appropriate in the circumstances, but not

for the purpose of expressing an opinion

on the effectiveness of the entity’s internal

control. An audit also includes evaluating

the appropriateness of accounting policies

used and the reasonableness of accounting

estimates made by management, as well

as evaluating the overall presentation of the

fi nancial statements.

5. I believe that the audit evidence I have

obtained is suffi cient and appropriate to

provide a basis for my audit opinion.

Basis for qualifi ed opinion

Departmental revenue 6. I was unable to obtain suffi cient

appropriate audit evidence for departmental

revenue amounting to R506 939 000

(2011-12: R453 505 000) as disclosed in

note 2 to the fi nancial statements due to

inadequate record keeping and ineffective

computerised information systems.

223



REPORT OF THE AUDITOR-GENERAL

6. Departmental revenue (continued) I was unable to confi rm the departmental

revenue by alternative means.

Consequently, I was unable to determine

whether any adjustment to the fi nancial

statements was necessary.

Receivables for departmental revenue7. I was unable to obtain suffi cient

appropriate audit evidence for

receivables for departmental revenue

amounting R 2 438 694 000 (2011-12:

R2 025 279 000), as disclosed in note

27.1 to the financial statements due

to material weaknesses identified in

the receivables management system,

inadequate record keeping and

ineffective computerised information

systems. I was unable to confirm the

receivables from departmental revenue

by alternative means. Consequently, I

was unable to determine whether any

adjustment to the financial statements

was necessary.

Contingent liabilities 8. I was unable to obtain suffi cient

appropriate audit evidence for claims

against the department amounting to

R 2 725 656 000 (2011-12: R1 636 427 000)

as disclosed in note 22.1 to the fi nancial

statements, as the department had an

inadequate system of internal controls in

place for the identifi cation and recognition

of contingent liabilities in accordance with

Chapter 8 of the Departmental Financial

Reporting Framework prescribed by

National Treasury. I was unable to confi rm

the contingent liabilities by alternative

means. Consequently, I was unable to

determine whether any adjustment to the

fi nancial statements was necessary.

Provisions 9. The department did not recognise legal

claims as provisions where the outcome

of the claim is probable in accordance with

Chapter 8 of the Departmental Financial

Reporting Framework prescribed by

National Treasury. The department had a

number of claims instituted against them which should have been accounted for as provisions. I was unable to confi rm the provisions by alternative means. Consequently, I was unable to determine whether any adjustment to the fi nancial statements was necessary.

Qualifi ed opinion10. In my opinion, except for the possible

effects of the matters described in the Basis for qualified opinion paragraphs, the financial statements present fairly, in all material respects, the financial position of the Gauteng Department of Health as at 31 March 2013 and its financial performance and cash flows for the year then ended, in accordance with the Departmental Financial Reporting Framework prescribed by National Treasury and the requirements of the PFMA.

Emphasis of matters11. I draw attention to the matters below. My

opinion is not modifi ed in respect of these

matters.

Restatement of corresponding fi gures 12. As disclosed in note 25 to the fi nancial

statements, the corresponding fi gures for

31 March 2012 have been restated as a

result of an error discovered during the year

ended 31 March 2013.

224




Material impairment13. As disclosed in note 34 to the fi nancial

statements, potential irrecoverrable debts

relating to staff and patient debtors to the

amount of R1 133 353 000

(2011-12: R 994 176 000) were provided for

as a result of poor debt collection.

Material losses14. As disclosed in note 27.2 to the fi nancial

statements, material losses to the amount

of R198 434 000 (2011-12: R127 592 000)

were incurred as a result of a write-off of

irrecoverable patient debtors.

Material under spending of the budget15. As disclosed in the appropriation statement

and accounting offi cer’s report, the

department has materially underspent

the budget on Programme 1: Health

Administration - R182 085 000, Programme

2: District Health Services

– R226 528 000, Programme 6: Health

Sciences and Training - R34 854 000,

Programme 7: Health Care Support

Services – R3 277 000 and Programme 8:

Health Facilities Management –

R267 048 000. The total underspending of

these programmes amounted to

R713 792 000. As a consequence, the

department did not achieve its objectives of

the above mentioned programmes.

Additional matters I draw attention to the matters below. My

opinion is not modifi ed in respect of these

matters:

Financial reporting framework16. The fi nancial reporting framework

prescribed by the National Treasury and

applied by the department is a compliance

framework. The wording of my opinion

on a compliance framework should

reflect that the fi nancial statements have

been prepared in accordance with this

framework and not that they “present

fairly”. Section 20(2)(a) of the PAA, however,

requires me to express an opinion on

the fair presentation of the fi nancial

statements. The wording of my opinion

therefore reflects this requirement.

Signifi cant transactions17. As disclosed in the accounting offi cer’s

report, the Executive Council of the

Gauteng Provicial Government resolved

that the department will be placed under

Administrative Curatorship as per section

18 of the PFMA.

18. The Gauteng Department of Health and Social Development demerged

1 April 2012 and the two departments operated separately as Gauteng Department of Health and Gauteng Department of Social Development from

1 April 2012.

19. As disclosed in note 22.1 contingent liabilities, note 23 commitments, note 24 accruals and note 34.2 provision for liabilities to the fi nancial statements, the department is exposed to liabilities and potential liabilities of R 8 143 242 000. This represents 29% of the annual appropriation for 2013-14.

225




Unaudited supplementary schedules20. The supplementary information set out on

pages 308 to 328 does not form part of the

fi nancial statements and is presented as

additional information. I have not audited

these schedules and, accordingly, I do not

express an opinion thereon.

REPORT ON OTHER LEGAL AND REGULATORY REQUIREMENTS

21. In accordance with the PAA and the General

Notice issued in terms thereof, I report the

following fi ndings relevant to performance

against predetermined objectives,

compliance with laws and regulations and

internal control, but not for the purpose of

expressing an opinion.

Predetermined objectives22. I performed procedures to obtain evidence

about the usefulness and reliability of the

information in the annual performance

report as set out on pages 16 to 151 of the

annual report.

23. The reported performance against

predetermined objectives was evaluated

against the overall criteria of usefulness

and reliability. The usefulness of


report relates to whether it is presented

in accordance with the National Treasury

annual reporting principles and whether the

reported performance is consistent with

the planned objectives. The usefulness

of information further relates to whether

indicators and targets are measurable (i.e.

well defi ned, verifi able, specifi c, measurable

and time bound) and relevant as required

by the National Treasury Framework

for managing programme performance

information (FMPPI).

The reliability of the information in respect

of the selected programmes is assessed

to determine whether it adequately reflects

the facts (i.e. whether it is valid, accurate

and complete).

24. The material fi ndings are as follows:

Reliability of informationValidity, accuracy and completeness

25. The National Treasury FMPPI requires

that institutions should have appropriate

systems to collect, collate, verify and

store performance information to ensure

valid, accurate and complete reporting

of actual achievements against planned

objectives, indicators and targets.

Signifi cantly important targets with respect

to programme 2 District Health service

are materially misstated. This was due

to the lack of frequent review of validity

of reported achievements against source

documentation.

26. The National Treasury FMPPI requires

that it must be possible to validate the

processes and systems that produce the

indicator. A total of 24% of the indicators

were not verifi able in that valid processes

that produce the information on actual

performance did not exist. This was due

to the lack of key controls in the relevant

systems of collection, collation, verifi cation,

and storage of actual performance

information.

Additional matterI draw attention to the following matter below.

This matter does not have an impact on the

predetermined objective audit fi ndings reported

above.

226




Achievement of planned targets27. Of the total number of 203 targets planned

for the year, 107 of targets were not achieved during the year under review. This represents 53% of total planned targets that were not achieved during the year under review. This was mainly due to underspending of the budget.

Compliance with laws and regulations28. I performed procedures to obtain evidence

that the department has complied with applicable laws and regulations regarding fi nancial matters, fi nancial management and other related matters. My fi ndings on material non-compliance with specifi c matters in key applicable laws and regulations as set out in the General Notice issued in terms of the PAA are as follows:

Annual fi nancial statements29. The fi nancial statements submitted for

auditing were prepared in accordance with the Departmental Financial Reporting Framework prescribed by National Treasury, however material misstatements were identifi ed by the auditors in the submitted fi nancial statements and were subsequently corrected which is in contravention of section 40(1) (a) of the PFMA. The uncorrected material misstatements and supporting records that could not be provided resulted in the fi nancial statements receiving a qualifi cation of audit opinion.

Expenditure management30. The accounting offi cer did not take

effective steps to prevent unauthorised expenditure (note 11.1: R6 095 207 000), irregular expenditure (note 28.1: R5 748 235 000) and fruitless and wasteful expenditure (note 29.1: R408 050 000), as required by section 38(1)(c)(ii) of the PFMA and Treasury regulation(TR)9.1.1.

31. Contractual obligations and money owed by the department were not settled within 30 days or an agreed period, as required by section 38(1)(f) of the PFMA and TR8.2.3.

Revenue management32. The accounting offi cer did not ensure that

appropriate processes were developed and implemented to provide for the identifi cation , collection, recording, reconciliation and safeguarding of information about revenue, as required by TR7.2.1.

33. The accounting offi cer did not take effective and appropriate steps to recover all debts due prior to the debts being written off as required by section 38(1)(c)(i) of the PFMA and TR11.2.1, TR15.10.1.2(a), TR15.10.1.2(e) and TR11.4.1.

34. Bad debtors were written off that did not comply with the requirements of the department’s write-off policy, as required by TR11.4.2.

Budgets35. The accounting offi cer did not ensure that

all expenditure was made in accordance with the purpose of the department’s budget, as required by section 39(1)(a) of the PFMA.

Procurement and contract management36. Goods and services with a transaction

value below R500 000 were procured without obtaining the required price quotations, as required by TR16A6.1.

37. Goods and services of a transaction value above R500 000 were procured without inviting competitive bids, as required by TR16A6.1. Deviations were approved by the accounting offi cer even though it was not impractical to invite competitive bids, in contravention of TR16A6.4.

227




38. Contracts were extended or modifi ed without the approval of a properly delegated offi cial as required by TR8.2.

Human resource management and compensation39. Job descriptions were not specifi c for all

posts in which appointments were made in the current year, as required by Public Service Regulation (PSR) 1/III/I.1.

40. Employees were appointed without following a proper process to verify the claims made in their applications in contravention of PSR 1/VII/D.8.

41. Persons in charge at pay points did not always certify that the employees receiving payment were entitled thereto as required by TR8.3.4.

42. An organisational structure was not in place that is based on the department’s strategic plan as required by PSR 1/III/B.2(a).

Internal control43. I considered internal control relevant to

my audit of the fi nancial statements, the annual performance report and compliance with laws and regulations. The matters reported below under the fundamentals of internal control are limited to the signifi cant defi ciencies that resulted in the basis for qualifi ed opinion, the fi ndings on the annual performance report and the fi ndings on compliance with laws and regulations included in this report.

Leadership44. There was no formal code of ethics in

the department and many instances of management override and numerous cases of fraud and theft are being investigated as indicated under the “other reports” section of this report.

45. The accounting offi cer did not adequately implement documented policies and procedures to guide the effectiveness of the operations of the department and as a result instances of non compliance with the applicable laws and regulations were identifi ed as detailed under the reporting on compliance with laws and regulations section of this report.

46. An action plan was developed to address internal and external audit fi ndings and adherence to the plan was monitored on a monthly basis by the appropriate level of management, however the action plan was not implemented timorously and key prior year fi ndings there for re-occurred during the current year audit.

47. The accounting offi cer did not approve an Information Technology (IT) governance framework that supports and enables the business, delivers value and improves performance.

Financial and performance management48. The fi nancial statements were subject

to material amendments resulting from the audit as a result of inadequate review for completeness and accuracy prior to submission for audit.

49. The accounting offi cer did not always implement proper record keeping in a timely manner to ensure that complete, relevant and accurate information was accessible and available to support fi nancial and performance reporting.

50. The accounting offi cer did not implement controls over daily and monthly processing and reconciling of transactions.

51. The accounting offi cer did not always review and monitor compliance with applicable laws and regulations.

228




52. The accounting offi cer did not design and implement formal controls over IT systems to ensure the reliability of the systems and the availability, accuracy and protection of information.

Governance53. The accounting offi cer did not implement

appropriate risk management activities to ensure that adequate risk assessments, including consideration of IT risks that impacts departmental revenue and fraud prevention, are conducted and that a risk strategy to address the risks was adequately developed and monitored.

OTHER REPORTSInvestigations54. There are investigations in progress relating

to procurement irregularities, fraud, theft, negligence and the investigations were ongoing at reporting date.

55. Investigations were conducted by independent consulting fi rms on request by the accounting offi cer. The investigations were initiated based on allegations of possible corruption and mismanagement at the department. The investigations were concluded and irregularities were reported to the accounting offi cer.

Performance auditsUse of Consultants56. A performance audit on the Use of

Consultants was conducted. The audit focused on the economic, effi cient and effective use of consultants at the provincial department. The management report was issued during this year.

Performance audit on the readiness of government to report on its performance57. A performance audit was conducted on the

Readiness of Government to report on its performance. The focus of the audit is on how government institutions are guided and assisted to report on their performance, as

well as the systems and processes that they

have put in place. The management report

was issued during this year.

Johannesburg

31 July 2013

229

Department of Health Vote 4APPROPRIATION STATEMENTfor the year ended 31 March 2013.


Appr

opria

tion

per p

rogr

amm

e

2012

/201

320

11/1

2

APPR

OPR

IATI

ON

ST

ATEM

ENT

Ad

just

ed

Appr

opria

tion

Shift

ing

of

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sVi

rem

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Fina

lAp

prop

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tual

Expe

nditu

reVa

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pend

iture

as %

of

fi nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

re

R’0

00R

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R’0

00R

’000

R’0

00R

’000

%R

’000

R’0

00

1. A

dmin

istr

atio

n

Curr

ent p

aym

ent

723,

842

-(5

9,00

0)66

4,84

247

1,73

119

3,11

171

%80

8,96

5 71

7,82

3

Tran

sfer

s an

d su

bsid

ies

2,10

0-

-2,

100

16,1

36(1

4,03

6)76

8.4%

7,1

36

6,04

3

Paym

ent f

or c

apita

l ass

ets

16,5

05-

-16

,505

12,7

613,

744

77.3

%26

,493

2

8,49

3

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-

734

(734

)-

- 4

6

742,

447

-(5

9,00

0)68

3,44

750

1,36

218

2,08

5-

842,

594

752

,405

2. D

istr

ict H

ealth

Ser

vice

s

Curr

ent p

aym

ent

7,59

8,10

8-

(44,

000)

7,55

4,10

87,

415,

385

138,

723

98.2

%6,

317,

185

6,68

8,29

2

Tran

sfer

s an

d su

bsid

ies

1,11

4,43

0-

-1,

114,

430

1,08

0,39

434

,036

96.9

%76

2,31

9

473

,202

Paym

ent f

or c

apita

l ass

ets

113,

946

--

113,

946

58,9

9054

,956

51.8

%16

0,76

8

77

,194

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-1,

187

(1,1

87)

- -

4

93

8,82

6,48

4-

(44,

000)

8,78

2,48

48,

555,

956

226,

528

-7,

240,

272

7,23

9,18

1

3. E

mer

genc

y M

edic

al

Serv

ices

Curr

ent p

aym

ent

535,

810

--

535,

810

556,

692

(20,

882)

103.

9% 3

72,7

44

39

7,64

9

Tran

sfer

s an

d su

bsid

ies

494,

074

--

494,

074

577,

474

(83,

400)

116.

9%

3

72,1

70

283

,101

Paym

ent f

or c

apita

l ass

ets

29,4

00-

-29

,400

13,0

6316

,337

44.4

%42

,756

15,

784

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-2

(2)

- -

1

0

1,05

9,28

4-

-1,

059,

284

1,14

7,23

1(8

7,94

7)-

7

87,6

70

696

,544

230



Appr

opria

tion

per p

rogr

amm

e

2012

/201

320

11/1

2

APPR

OPR

IATI

ON

ST

ATEM

ENT

Ad

just

ed

Appr

opria

tion

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Fina

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nditu

re

R’0

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R’0

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4. P

rovi

ncia

l Hos

pita

l

Serv

ices

Curr

ent p

aym

ent

5,95

3,23

9-

152,

369

6,10

5,60

86,

248,

011

(142

,403

)10

2.3%

4,9

21,5

805,

674,

147

Tran

sfer

s an

d su

bsid

ies

298,

198

--

298,

198

255,

714

42,4

8485

.8%

1

99,8

40

1

83,9

84

Paym

ent f

or c

apita

l ass

ets

143,

090

--

143,

090

76,9

4466

,146

53.8

%

138

,525

69,

177

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-1,

771

(1,7

71)

-

-

791

6,39

4,52

7-

152,

369

6,54

6,89

66,

582,

440

(35,

544)

-5,

259,

945

5,92

8,09

9

5. C

entr

al H

ospi

tal S

ervi

ces

Curr

ent p

aym

ent

7,26

0,45

4-

-7.

260,

454

7,61

3,64

4(3

53,1

90)

104,

9%

6

,652

,455

7,

018,

157

Tran

sfer

s an

d su

bsid

ies

18,8

29-

-18

,829

21,0

08(2

,179

)11

1,6%

6,9

00

15,3

33

Paym

ent f

or c

apita

l ass

ets

287,

576

--

287,

576

163,

639

(123

,937

)56

,9%

1

19,0

00

96,3

39

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-.1,

622

(1,6

22)

-

-

1,

733

7,56

6,85

9-

-7,

566,

859

7,79

9,91

3(2

33,0

54)

-6,

778,

355

7,1

31,5

62

6. H

ealth

Sci

ence

s an

d

Trai

ning

Curr

ent p

aym

ent

816,

682

-(4

9,36

9)76

7,31

373

2,86

134

,452

95,5

%

720

,626

.6

91,8

54

231



Appr

opria

tion

per p

rogr

amm

e

2012

/201

320

11/1

2

APPR

OPR

IATI

ON

ST

ATEM

ENT

Ad

just

ed

Appr

opria

tion

Shift

ing

of

Fund

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rem

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Fina

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nditu

reVa

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pend

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as %

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fi nal

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nditu

re

R’0

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Tran

sfer

s an

d su

bsid

ies

66,6

82-

-66

,682

65,2

961,

386

97,9

%

34

,997

27,

552

Paym

ent f

or c

apita

l ass

ets

7,92

9-

-7,

929

8,54

9(6

20)

107,

8%

10

,399

6

,566

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-36

4(3

64)

-

-

117

891,

293

-(4

9,36

9)84

1,92

480

7,07

034

,854

- 7

66,0

22

726,

089

7. H

ealth

Car

e Su

ppor

t

Serv

ices

Curr

ent p

aym

ent

195,

864

--

195,

864

194,

173

1,69

199

,1%

1

65,3

65

16

9,97

9

Tran

sfer

s an

d su

bsid

ies

274

--

274

276

(2)

100,

7%

261

333

Paym

ent f

or c

apita

l ass

ets

3,68

3-

-3,

683

2,05

21,

631

55,7

%

3

,600

3

,344

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-43

(43)

-

-

31

199,

821

--

199,

821

196,

544

3,27

7-

169

,226

17

3,68

7

8.H

ealth

Fac

ilitie

s

Man

agem

ent

Curr

ent p

aym

ent

575,

393

--

575,

393

638,

152

(62,

759)

110,

9%

736

,907

5

66,3

82

Tran

sfer

s an

d su

bsid

ies

--

--

211

(211

)-

-

21

Paym

ent f

or c

apita

l ass

ets

935,

486

--

935,

486

605,

468

330,

018

64.7

%

1,1

40,8

42

7

51,8

63

1,51

0,87

9-

-1,

510,

879

1,24

3,83

126

7,04

81,

877,

749

1,31

8,26

6

232



Appr

opria

tion

per p

rogr

amm

e

2012

/201

320

11/1

2

APPR

OPR

IATI

ON

ST

ATEM

ENT

Ad

just

ed

Appr

opria

tion

Shift

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of

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rem

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Fina

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nditu

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of

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nditu

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9. S

ocia

l Wel

fare

Ser

vice

s

Curr

ent p

aym

ent

--

--

--

-

6

35,9

36

636

,707

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

1,17

2,18

9

1

,118

,752

Paym

ent f

or c

apita

l ass

ets

--

--

--

- 8

0,30

5 78

,539

Paym

ent f

or fi

nanc

ial a

sset

s-

--

--

--

-

48

--

--

--

-1,

888,

430

1

,834

,046

10.D

evel

opm

ent &

Res

earc

h

Curr

ent p

aym

ent

--

--

--

-13

7,93

4 12

4,37

9

Tran

sfer

s an

d su

bsid

ies

--

--

--

-71

,645

65

,804

Paym

ent f

or c

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l ass

ets

--

--

--

- 7

2 65

Paym

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anci

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sset

s-

--

--

--

- 3

7

--

--

--

-20

9,65

1 1

90,2

85

Subt

otal

27,1

91,5

94-

-27

,191

,594

26,8

34,3

4735

7,24

798

.7%

25,8

19,9

1425

,990

,164

TOTA

L27

,191

,594

--

27,1

91,5

9426

,834

,347

357,

247

98.7

%25

,819

,914

25,9

90,1

64

233



Rec

onci

liatio

n w

ith s

tate

men

t of fi

nan

cial

per

form

ance

Dep

artm

enta

l rec

eipt

s 50

6,93

9-

--

453,

505

-

Aid

assi

stan

ce

- -

--

676

-

Actu

al a

mou

nts

per s

tate

men

t of fi

nan

cial

per

form

ance

(tot

al re

venu

e)27

,698

,533

--

-26

,274

,095

-

Actu

al a

mou

nts

per s

tate

men

t of fi

nan

cial

per

form

ance

(tot

al e

xpen

ditu

re)

-26

,834

,347

--

25,9

90,1

6425

,990

,164

234



Appr

opria

tion

per e

cono

mic

cla

ssifi

catio

n

2012

/201

320

11/1

2

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

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prop

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% o

f fi n

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appr

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nditu

re

R’0

00R

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00R

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%R

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R’0

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Curr

ent p

aym

ents

Com

pens

atio

n of

em

ploy

ees

15,2

78,8

12-

-15

,278

,812

15,2

44,5

4234

,270

99.8

%

14,1

37,4

27

14,

882,

194

Goo

ds a

nd s

ervi

ces

8,38

0,58

0-

-8,

380,

580

8,62

5,12

7(2

44,5

47)

102.

9%

7

,330

,238

7

,798

,991

Inte

rest

and

rent

on

land

--

--

981

(981

)-

-

4,1

84

Tran

sfer

s &

sub

sidi

es

Pro

vinc

es &

mun

icip

aliti

es

964,

285

--

964,

285

1,08

3,52

5(1

19,2

40)

112.

4% 6

63,0

60

404

,090

Dep

artm

enta

l age

ncie

s &

acc

ount

s 28

,286

--

28,2

8628

,267

1999

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13

,182

2

Uni

vers

ities

& T

echn

ikon

s 1,

500

--

1,50

050

01,

000

33,3

%

1

,162

910

Non

-pro

fi t In

stitu

tions

916,

785

--

916,

785

817,

505

99,2

8089

.2%

1,90

1,33

21,

697,

856

Hou

seho

lds

83,7

31-

-83

,731

86,7

13(2

.982

)10

3.6%

48,

880

71,2

69

Paym

ents

for c

apita

l ass

ets

Build

ings

& o

ther

fi xe

d

stru

ctur

es

848,

689

--

848,

689

528,

282

320,

407

62.2

% 8

86,5

88

674

,354

Mac

hine

ry &

equ

ipm

ent

688,

926

--

688,

926

413,

182

275,

744

60.0

% 8

37,9

76

452

,887

Soft

war

e an

d ot

her

inta

ngib

le a

sset

s -

--

--

--

69

122

Paym

ent f

or fi

nanc

ial a

sset

s-

--

-5,

723

(5,7

23)

--

3,30

5

TOTA

L27

,191

,594

--

27,1

91,5

9426

,834

,347

357,

247

98.7

%25

,819

,914

25,9

90,1

64

235



Deta

il Per

Pro

gram

me

1 –

Adm

inis

tratio

n

For t

he y

ear e

nded

31

Mar

ch 2

013

2012

/201

320

11/1

2

Deta

il pe

r sub

-pro

gram

me

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% o

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f the

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Curr

ent p

aym

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16,2

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-16

,232

11,0

815,

151

68.3

%

13

,273

10

,566

Paym

ent f

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l ass

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250

--

250

438

(188

)17

5.2%

2

45

4

67

1.2.

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ent (

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Curr

ent p

aym

ent

707,

610

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0,65

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7,96

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.0%

4

76,3

21

4

15,7

29

Tran

sfer

s an

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ies

2,10

0-

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100

16,1

36(1

4,03

6)76

8.4%

2,0

00

777

Paym

ent f

or c

apita

l ass

ets

16,2

55-

-16

,255

12,3

233,

932

75.8

%

15

,755

1

5,66

1

Paym

ent f

or fi

nanc

ial a

sset

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--

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34)

-

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33

Tota

l

1.3.

Man

agem

ent (

Soci

al

Deve

lopm

ent)

Curr

ent p

aym

ent

--

--

--

-15

6,71

614

8,02

3

Tran

sfer

s an

d su

bsid

ies

--

--

--

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041

5,01

2

Paym

ent f

or c

apita

l ass

ets

--

--

--

-3,

768

3,83

6

1.4.

Dist

rict m

anag

emen

t

Curr

ent p

aym

ent

--

--

--

-

162

,655

143

,505

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

95

254

Paym

ent f

or c

apita

l ass

ets

--

--

--

-

6

,725

8

,529

Paym

ent f

or fi

nanc

ial a

sset

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--

--

--

-

13

Tota

l 74

2,44

7-

(59,

000)

683,

447

501,

362

182,

085

73.4

%

842

,594

752

,405

236



Deta

il per

Pro

gram

me

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Adm

inis

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n

For t

he y

ear e

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31

Mar

ch 2

013

2012

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320

11/1

2

Prog

ram

me

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r Eco

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Curr

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Com

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Paym

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Paym

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Deta

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Deta

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,759

)13

1%

-

1

24

8.2.

Emer

genc

y M

edic

al

Res

cue

Serv

ices

Curr

ent p

aym

ent

217

--

217

13,3

37(1

3,12

0)61

46.1

%

34

,020

2

,870

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

-

-

Paym

ent f

or c

apita

l ass

ets

722

--

722

5,16

9(4

,447

)71

6%-

-

8.3.

Dist

rict H

ospi

tal

Serv

ices

Curr

ent p

aym

ent

86,0

66-

-86

,066

85,1

41(9

25)

99%

63,9

72

1

11,3

12

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

-

-

Paym

ent f

or c

apita

l ass

ets

282,

093

--

282,

093

186,

711

95,3

8266

%

559

,164

417

,699

Paym

ent f

or fi

nanc

ial a

sset

s -

--

--

--

-

-

8.4.

Prov

inci

al H

ospi

tal

Serv

ices

Curr

ent p

aym

ent

150,

198

--

150,

198

192,

896

(42,

698)

128%

3

08,6

12

1

18,1

45

253



2012

/13

2011

/12

Deta

il pe

r sub

-pro

gram

me

Adju

sted

Ap

prop

riatio

nSh

iftin

g of

Fu

nds

Vire

men

tFi

nal

Appr

opria

tion

Actu

alEx

pend

iture

Varia

nce

Expe

nditu

reas

% o

f fi n

al

appr

opria

tion

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

R’0

00R

’000

R’0

00R

’000

R’0

00R

’000

%R

’000

R’0

00

Paym

ent f

or c

apita

l ass

ets

486,

615

--

486,

615

312,

888

173,

727

64%

4

18,0

23

2

31,2

53

8.5.

Cent

ral H

ospi

tal

Serv

ices

Curr

ent p

aym

ent

127,

002

--

127,

002

157,

717

(30,

715)

124%

147,

935

131,

275

Paym

ent f

or c

apita

l ass

ets

130,

902

--

130,

902

54,3

2276

,580

42%

163,

155

93,8

77

8.6

Oth

er F

acili

ties

Curr

ent p

aym

ent

120,

852

--

120,

852

107,

919

12,9

3389

%12

5,52

610

1,91

5

Tran

sfer

s an

d su

bsid

ies

--

--

211

(211

)-

-21

Paym

ent f

or c

apita

l ass

ets

19,8

87-

-19

,887

26,3

52(6

,465

)13

3%50

08,

910

Tota

l1,

510,

879

--

1,51

0,87

91,

243,

831

267,

048

82%

1,87

7,74

91,

318,

266

254



Deta

il Per

Pro

gram

me

8 –

Hea

lth F

acilit

y M

anag

emen

t

For t

he y

ear e

nded

31

Mar

ch 2

013

2012

/13

2011

/12

Prog

ram

me

8 pe

r Eco

nom

ic

clas

sifi c

atio

nAd

just

edAp

prop

riatio

nSh

iftin

g of

Fu

nds

Vire

men

tFi

nal

Appr

opria

tion

Actu

alEx

pend

iture

Varia

nce

Expe

nditu

reas

% o

f fi n

al

appr

opria

tion

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

R’0

00R

’000

R’0

00R

’000

R’0

00R

’000

%R

’000

R’0

00

Curr

ent p

aym

ents

Com

pens

atio

n of

em

plo y

ees

13,6

31-

-13

,631

10,2

343,

397

75%

12,2

7711

,166

Goo

ds a

nd s

ervi

ces

561,

762

--

561,

762

627,

919

(66,

157)

112%

724,

630

555,

205

Inte

rest

and

Ren

t on

land

--

--

--

--

10

Tran

sfer

s an

d su

bsid

ies

to:

Hou

seho

lds

--

--

91(9

1)-

-21

Non

-Pro

fi t In

stitu

tions

--

--

113

(113

)-

--

Dep

artm

enta

l Age

ncie

s an

d Ac

coun

ts

--

--

7(7

)-

--

Paym

ent

for c

apita

l ass

ets

Build

ings

and

oth

er fi

xed

stru

ctur

es77

8,49

9-

-77

8,49

952

6,77

225

1,72

760

.2%

722,

144

590,

617

Mac

hine

ry a

nd e

quip

men

t15

6,98

7-

-15

6,98

778

,695

78,2

9253

.6%

418,

698

161,

247

Tota

l1,

510,

879

--

1,51

0,87

91,

243,

831

267,

048

82%

1,87

7,74

91,

318,

266

255



Deta

il Per

Pro

gram

me

9 –

Soc

ial W

elfa

re S

ervi

ces

For t

he y

ear e

nded

31

Mar

ch 2

013

2012

/13

2011

/12

Deta

il pe

r sub

-pro

gram

me

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

reVa

rianc

eEx

pend

iture

as %

of fi

nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

R’0

00R

’000

R’0

00R

’000

R’0

00R

’000

%R

’000

R’0

00

9.1

Prof

essi

onal

and

Ad

min

istr

ativ

e Su

ppor

t

Curr

ent p

aym

ent

--

--

--

-

6

,008

5

,127

Paym

ent f

or c

apita

l ass

ets

--

--

--

-

30

92

Paym

ent f

or fi

nanc

ial a

sset

s-

--

--

--

-

1

9.2

Subs

tanc

e Ab

use,

Pr

even

tion

& R

ehab

ilita

tion

Curr

ent p

aym

ent

--

--

--

-

37

,932

33

,253

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

44

,439

39

,931

Paym

ent f

or c

apita

l ass

ets

--

--

--

-

18

4

172

Paym

ent f

or fi

nanc

ial a

sset

s -

--

--

--

-16

9.3

Care

& S

ervi

ce to

old

er

pers

ons

Curr

ent p

aym

ent

--

--

--

-

43

,444

45

,543

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

155

,392

151

,081

Paym

ent f

or c

apita

l ass

ets

--

--

--

-

51

,823

58

,178

9.4

Crim

e, P

reve

ntio

n &

Supp

ort

Curr

ent p

aym

ent

--

--

--

-

64

,948

56

,998

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

72

,994

64

,800

Paym

ent f

or c

apita

l ass

ets

--

--

--

-

15

,000

1

,155

256



2012

/13

2011

/12

Deta

il pe

r sub

-pro

gram

me

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

reVa

rianc

eEx

pend

iture

as %

of fi

nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

R’0

00R

’000

R’0

00R

’000

R’0

00R

’000

%R

’000

R’0

00

9.5

Serv

ice

To P

erso

ns W

ith

Disa

bilit

y

Curr

ent p

aym

ent

--

--

--

- 2

7,90

4 19

,922

Tran

sfer

s an

d su

bsid

ies

--

--

--

- 7

8,52

9 8

6,14

5

Paym

ent f

or c

apita

l ass

ets

--

--

--

- 6

69

6

99

9.6

Child

Car

e &

Pro

tect

ion

Serv

Curr

ent p

aym

ent

--

--

--

- 4

40,9

47

467,

649

Tran

sfer

s an

d su

bsid

ies

--

--

--

-45

0,51

7 41

4,95

5

Paym

ent f

or c

apita

l ass

ets

--

--

--

- 1

2,58

4 1

8,22

5

Paym

ent f

or fi

nanc

ial a

sset

s-

--

--

--

-

31

9.7

Vi

ctim

Em

pow

erm

ent

Curr

ent p

aym

ent

--

--

--

-8,

511

5

,962

Tran

sfer

s an

d su

bsid

ies

--

--

--

- 3

7,06

8 3

4,49

4

Paym

ent f

or c

apita

l ass

ets

--

--

--

- -

3

9.8

HIV

and

AID

S

Curr

ent p

aym

ent

--

--

--

- 6

,242

2

,253

Tran

sfer

s an

d su

bsid

ies

--

--

--

-23

5,19

8 2

30,3

57

Paym

ent f

or c

apita

l ass

ets

--

--

--

- 1

5 15

9.9

Care

and

Sup

port

Se

rvic

es

to F

amili

es

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

98

,052

96

,989

Tot

al

--

--

--

-1,

888,

430

1,83

4,04

6

257



Prog

ram

me

9 p

er E

cono

mic

cl

assi

fi cat

ion

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

reVa

rianc

eEx

pend

iture

as %

of fi

nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

Curr

ent p

aym

ents

Com

pens

atio

n of

em

plo y

ees

--

--

--

-42

7,52

0 46

2,92

7

Goo

ds a

nd s

ervi

ces

--

--

--

-20

9,41

6 1

73,7

12

Inte

rest

and

rent

on

land

-

--

--

--

- 6

6

Tran

sfer

s &

sub

sidi

es

Non

-pro

fi t in

stitu

tions

-

--

--

--

1,17

0,34

41,

117,

278

Hou

seho

lds

--

--

--

-1,

845

1,4

75

Paym

ent f

or c

apita

l ass

ets

Build

ings

& o

ther

fi xe

d st

ruct

ures

-

--

--

--

77,

200

74,

700

Mac

hine

ry &

equ

ipm

ent

--

--

--

-

3,1

05

3,8

39

Soft

war

e &

othe

r int

angi

ble

asse

ts

--

--

--

-

-

-

Paym

ent f

or fi

nanc

ial a

sset

s-

--

--

--

- 49

Tota

l-

--

--

--

1,88

8,43

01,

834,

046

258



Deta

il pe

r sub

-pro

gram

me

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

reVa

rianc

eEx

pend

iture

as %

of fi

nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

Deta

ils p

er s

ub –

prog

ram

me

10.1

Pro

fess

iona

l and

Ad

min

istr

ativ

e Su

ppor

t

Curr

ent p

aym

ent

--

--

--

- 2

,920

3,

187

Tran

sfer

s an

d su

bsid

ies

--

--

--

- -

53

Paym

ent f

or c

apita

l ass

ets

--

--

--

-66

6

5

Paym

ent f

or F

inan

cial

Ass

ets

--

--

--

--

30

10.2

You

th D

evel

opm

ent

Curr

ent p

aym

ent

--

--

--

-7,

961

1,4

78

Tran

sfer

s an

d su

bsid

ies

--

--

--

- 6

,389

6,

625

10.3

.Sus

tain

able

Liv

elih

ood

Curr

ent p

aym

ent

--

--

--

-22

,643

19

,399

Tran

sfer

s an

d su

bsid

ies

--

--

--

-65

,256

59

,067

10.4

Inst

itutio

nal C

apac

ity

Build

ing

& S

uppo

rt

Curr

ent p

aym

ent

--

--

--

- 9

8,61

0 9

6,83

5

Tran

sfer

s an

d su

bsid

ies

--

--

--

-

- 59

Paym

ent f

or c

apita

l ass

ets

--

--

--

- 6

-

10.5

Res

earc

h an

d De

mog

raph

y

Curr

ent p

aym

ent

--

--

--

- 2

,891

2,

262

Tran

sfer

s an

d su

bsid

ies

--

--

--

- -

-

Tota

l-

--

--

--

209,

651

190,

284

259



Deta

il pe

r sub

-pro

gram

me

Adju

sted

Appr

opria

tion

Shift

ing

of

Fund

sVi

rem

ent

Fina

lAp

prop

riatio

nAc

tual

Expe

nditu

reVa

rianc

eEx

pend

iture

as %

of fi

nal

ap

prop

riatio

n

Fina

lAp

prop

riatio

nAc

tual

expe

nditu

re

10.6

Pop

ulat

ion

Capa

city

De

velo

pmen

t & A

dvoc

acy

Curr

ent p

aym

ent

--

--

--

- 2

,909

1,

218

Tran

sfer

s an

d su

bsid

ies

--

--

--

- -

-

Tota

l-

--

--

--

209,

651

190,

285

Prog

ram

me

10 P

er E

cono

mic

cl

assi

fi cat

ion

Curr

ent p

aym

ents

Com

pens

atio

n of

em

ploy

ees

--

--

--

- 1

28,2

54

116,

194

Goo

ds a

nd s

ervi

ces

--

--

--

-9,

680

8,1

86

Inte

rest

and

rent

on

land

--

--

--

--

-

Tran

sfer

s &

sub

sidi

es

Non

-pro

fi t in

stitu

tions

--

--

--

-71

,619

65,6

66

Hou

seho

lds

--

--

--

-26

137

Paym

ent f

or c

apita

l ass

ets

Mac

hine

ry &

equ

ipm

ent

--

--

--

-72

65

Paym

ents

for F

inan

cial

As

sets

--

--

--

--

37

Tota

l-

--

--

--

209,

651

190,

285

260



NOTES TO THE APPROPRIATION STATEMENTfor the year ended 31 March 2013.

1. Detail of transfers and subsidies as per Appropriation Act (after Virement):

Detail of these transactions can be viewed in the note on Transfers and subsidies, disclosure notes

and Annexure 1 (A-G) to the Annual Financial Statements.

2. Detail of specifi cally and exclusively appropriated amounts voted (after Virement):

Detail of these transactions can be viewed in note 1 (Annual Appropriation) to the Annual Financial

Statements.

3. Detail on payments for fi nancial assets

Detail of these transactions per programme can be viewed in the note on Payments for fi nancial

assets to the Annual Financial Statements.

4. Explanations of material variances from Amounts Voted (after Virement):

4.1 Per ProgrammeFinal

Appropriation

Actual

ExpenditureVariance

Variance as

a % of Final

Appropriation

Programme Name R’000 R’000 R’000

Administration 683,447 501,362 182,085 27

District Health Services 8,782,484 8,555,956 226,528 3

Emergency Medical Services 1,059,284 1,147,231 (87,947) (8)

Provincial Hospital Services 6,546,896 6,582,440 (35,544) (1)

Central Hospital Services 7,566,859 7,799,913 (233,054) (3)

Health Sciences and Training 841,924 807,070 34,854 4

Health Care Support Services 199,821 196,544 3,277 2

Health Facilities Management 1,510,879 1,243,831 267,048 18

TOTAL 27,191,594 26,834,347 357,247 1

The table above summarises the budget versus actual amount spent as at 31 March 2013. The

department spent 99% of the budget which implies that the department is within budget. However,

the department is reporting over-spending on three programmes which are:

• Emergency Medical Services at 8%

• Provincial Hospital Services at 1%

• Central Hospital Services at 3%

261





The under-expenditure is attributed to the non-fi lling of funded posts due to a moratorium on

administrative posts, restructuring and reallocation of personnel to District Health Services with the

aim of re-engineering of Primary Health Care. In addition the NHI funding allocated to strengthening

revenue collection could not be utilized fully due to delays in the approval of the business plan.

Programme 2: District Health Services

The under- spending on District Health Services is as a result of delays in the procurement of park-

homes for the HIV and AIDS programme. Furthermore, the funding which was set aside during

the adjustment budget for the new Zola hospital which could not be utilised due to delays in the

appointment of support staff.

Programme 3: Emergency Medical Services

The over-expenditure is due to payment of accruals for goods & services and transfers to

municipalities. The Provincilisation of Sedibeng district with effect from 1st September 2012 also

contributed to overspending on compensation of employees.

Programme 4: Provincial Hospital Services

The programme is within the allocated budget.

Programme 5: Central Hospital Services

The main contributors to the over-expenditure on this programme are goods & services as a result

of the payment of previous year’s accruals and households which emanated from injury on duty,

unplanned resignation and deaths.

Programme 6: Health Sciences and Training

The under-spending on this programme is attributed to the non- payment of invoices for training.

During the adjustment budget the department received an additional allocation of R8 million for

bursaries. This funding could not be fully utilised as this was appropriated at the beginning of the

academic year. Another contributing factor to the under-spending is the actual university student

intake (1 341) was less than what was projected (2 280) by the department.

Programme 7: Health Care Support Services

The programme is within the allocated budget.

262




Programme 8: Health Facilities Management

The under-spending is attributed to conditional grant funding not fully utilised due to poor design

and project management which resulted in scope changes, variation orders, cost escalations

and extension of time. Furthermore the factors mentioned led to delays in the appointment of

contractors by the implementing agent. Delays in the completion of projects which resulted in

the unavailability of storage space for medical equipment, hence the deferment of procurement

processes for machinery and equipment.

4.2. Per Economic classifi cation Final Appropriation

Actual Expenditure

Variance Variance as a % of Final

Appropriation

R’000 R’000 R’000 R’000

Current Payments 23,659,392 23,870,650 (211,258) (1)

Compensation of employees 15,278,812 15,244,542 34,270 0

Goods and services 8,380,580 8,625,127 (244,547) (3)

Interest and rent on land - 981 (981) (100)

Transfers & subsidies 1,994,587 2,016,510 (21,923) (1)

Provinces and municipalities 964,285 1,083,525 (119,240) (12)

Departmental agencies and

accounts 28,286 28,267 19 0

Universities and technikons 1,500 500 1,000 67

Non profi t organisation 916,785 817,504 99,281 11

Households 83,731 86,713 (2,982) (4)

Payments for capital assets 1,537,615 941,464 596,151 39

Building and other fi xed structures 848,689 528,282 320,407 38

Machinery and equipment 688,926 413,182 275,744 40

Payments for fi nancial assets - 5,723 (5,723) (100)

TOTAL 27,191,594 26,834,347 357,247 1

From the table above it is evident that the Goods & Services, Transfers to Provinces & Municipalities

and Households exceeded the allocated budget. The main reason for the overspending is due to

the payment of previous year’s accruals in 2012/2013. Over-expenditure in households is attributed

to the payment of injury on duty, unplanned resignations and deaths. The under-spending items

may be explained as follows: Universities and Technikons are due to actual student intake which

was less than what was projected by the department. NPIs: the under spending is as a result of

late submission of claims by the Municipalities The overall under-spending on buildings and other

fi xed structures is due to slow performance on Infrastructure Grants - delays in appointment of

contractors by the implementing agent resulted in projects not completed as planned and the

late processing of invoices. The delays in completion of infrastructure projects resulted in an

unavailability of storage space for medical equipment, hence, the spending is at 60%.

263




4.3 Per conditional grant Final Appropriation

Actual Expenditure

Variance Variance as a % of Final

Appropriation

R’000 R’000 R’000 R’000

National Tertiary Services Grant 3,044,567 3,044,526 41 0

Comprehensive HIV and AIDS

Grant 1,901,293 1,901,293 - 0

Hospital Revitalisation Grant 795,439 572,080 223,359 28

Health Professions Training

&Development Grant 725,310 725,310 - 0

Health Infrastructure Grant 110,361 98,513 11,848 11

Nat Health Insurance Grant 31,500 8,062 23,438 74

Nursing Colleges & Schools 12,480 7,701 4,779 38

EPWP Incentive Grant for the

Social Sector (Health) 29,072 28,727 345 1

AFCON Grant 3,000 3,000 - 0

EPWP Public Works Integrated

Grnt 1,000 0 1,000 0

TOTAL 6,654,022 6,389,212 264,810 4

264



STATEMENT OF FINANCIAL PERFORMANCEfor the year ended 31 March 2013.

Note 2012/13 2011/12

R’000 R’000

REVENUE

Annual appropriation 1 27,191,594 25,819,914

Departmental revenue 2 506,939 453,505

Aid assistance 3 - 676

TOTAL REVENUE 27,698,533 26,274,095

EXPENDITURE

Current expenditure

Compensation of employees 4 15,244,542 14,882,194

Goods and services 5 8,625,127 7,798,991

Interest and rent on land 6 981 4,184

Total current expenditure 23,870,650 22, 685,369

Transfers and subsidies

Transfers and subsidies 9 2,016,510 2,174,127

Total transfers and subsidies 2,016,510 2,174,127

Expenditure for capital assets

Tangible capital assets 10 941,464 1,127,242

Software and other intangible assets 10 - 121

Total expenditure for capital assets 941,464 1,127,363

Payments for fi nancial assets 7 5,723 3,305

TOTAL EXPENDITURE 26,834,347 25,990,164

SURPLUS FOR THE YEAR 864,186 283,931

Reconciliation of Surplus for the year

Voted funds 357,247 (170,250)

Annual appropriation 92,437 (170,250)

Conditional grants 264,810 -

Departmental revenue 2 506,939 453,505

Aid assistance 3 - 676

SURPLUS FOR THE YEAR 864,186 283,931

265



STATEMENT OF FINANCIAL POSITIONas at 31 March 2013.

POSITION Note 2012/13 2011/12

R’000 R’000ASSETS

Current assets 6,184,943 5,839,760

Unauthorised expenditure 11 6,095,207 5,770,734

Cash and cash equivalents 12 25,410 1,129

Prepayments and advances 13 109 221

Receivables 14 64,217 67,676

Non-current assets 54,000 54,000

Investments 15 54,000 54,000

TOTAL ASSETS 6,238,943 5,893,760

LIABILITIES

Current liabilities 6,184,943 5,839,760

Voted funds to be surrendered to the Revenue Fund 16 2,113,891 2,092,553

Departmental revenue and NRF Receipts to be

surrendered to the Revenue Fund

17 76,770 74,700

Bank overdraft 18 3,777,932 2,660,499

Payables 19 216,350 1,011,332

Aid assistance unutilised 3 - 676

TOTAL LIABILITIES 6,184,943 5,839,760

NET ASSETS 54,000 54,000

Represented by:

Capitalisation reserve 54,000 54,000

TOTAL 54,000 54,000

266



STATEMENT OF CHANGES IN NET ASSETSfor the year ended 31 March 2013.

NET ASSETS Note 2012/13 2011/12

R’000 R’000

Capitalisation Reserves

Opening balance 54,000 54,000

Closing balance 54,000 54,000

TOTAL 54,000 54,000

267


Department of Health Vote 4CASHFLOW STATEMENTfor the year ended 31 March 2013.

CASH FLOW Note 2012/13 2011/12

R’000 R’000

CASH FLOWS FROM OPERATING ACTIVITIES

Receipts 27,698,533 26,274,095

Annual appropriated funds received 1.1 27,191,594 25,819,914

Departmental revenue received 2 506,939 453,505

Aid assistance received 3 - 676

Net increase in working capital (1,115,984) (711,316)

Surrendered to Revenue Fund (1,165,928) (637,250)

Current payments (23,546,176) (21,659,583)

Payments for fi nancial assets (5,723) (3,305)

Transfers and subsidies paid (2,016,510) (2,174,127)

Net cash fl ow available from operating activities 20 (151,688) 1,088,514

CASH FLOWS FROM INVESTING ACTIVITIES

Payments for capital assets 10 (941,464) (1,127,363)

Net cash fl ows from investing activities (941,464) (1,127,363)

Net increase/(decrease) in cash and cash equivalents (1,093,152) (38,849)

Cash and cash equivalents at beginning of period (2,659,370) (2,620,521)

Cash and cash equivalents at end of period 21 (3,752,522) (2,659,370)

268

Department of Health Vote 4ACCOUNTING POLICIESfor the year ended 31 March 2013.


The Financial Statements have been prepared in accordance with the following policies, which

have been applied consistently in all material aspects, unless otherwise indicated. However, where

appropriate and meaningful, additional information has been disclosed to enhance the usefulness

of the Financial Statements and to comply with the statutory requirements of the Public Finance

Management Act, Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations

issued in terms of the Act and the Division of Revenue Act, Act 1 of 2010.

1. Presentation of the Financial Statements1.1 Basis of preparation

The fi nancial statements have been prepared on a modifi ed cash basis of accounting.

Under this basis, the effects of transactions and other events are recognised in the fi nancial records

when the resulting cash is received or paid. The “modifi cation” results from the recognition of certain

near-cash balances in the fi nancial statements as well as the revaluation of foreign investments and

loans and the recognition of resulting revaluation gains and losses.

In addition supplementary information is provided in the disclosure notes to the fi nancial statements

where it is deemed to be useful to the users of the fi nancial statements.

1.2 Presentation currency

All amounts have been presented in the currency of the South African Rand (R) which is also the

functional currency of the department.

1.3 Rounding

Unless otherwise stated all fi nancial fi gures have been rounded to the nearest one thousand Rand

(R’000).

1.4 Comparative fi gures

Prior period comparative information has been presented in the current year’s fi nancial statements.

Where necessary fi gures included in the prior period fi nancial statements have been reclassifi ed to

ensure that the format in which the information is presented is consistent with the format of the

current year’s fi nancial statements.

1.5 Comparative fi gures - Appropriation Statement

A comparison between actual amounts and fi nal appropriation per major classifi cation of expenditure

is included in the Appropriation Statement.

2. Revenue2.1 Appropriated funds

Appropriated funds comprises of departmental allocations as well as direct charges against revenue

fund.

269



Appropriated funds are recognised in the fi nancial records on the date the appropriation becomes

effective. Adjustments made in terms of the adjustments budget process are recognised in the

fi nancial records on the date the adjustments become effective.

Unexpended appropriated funds are surrendered to the Provincial Revenue Fund. Any amounts

owing to the Provincial Revenue Fund at the end of the fi nancial year are recognised as payable in

the statement of fi nancial position.

Any amount due from the Provincial Revenue Fund at the end of the fi nancial year is recognised as

a receivable in the statement of fi nancial position.

2.2 Departmental revenue

All departmental revenue is recognised in the statement of fi nancial performance when received

and is subsequently paid into the Provincial Revenue Fund, unless stated otherwise.

Any amount owing to the Provincial Revenue Fund at the end if the fi nancial year is recognised as a

payable in the statement of fi nancial position.

No accrual is made for amounts receivable from the last receipt date to the end of the reporting

period. These amounts are however disclosed in the disclosure notes to the annual fi nancial

statements.

2.3 Direct Exchequer receipts

All direct exchequer receipts are recognised in the statement of fi nancial performance when the

cash is received and is subsequently paid into the Provincial Revenue Fund, unless stated otherwise.

Any amount owing to the Provincial Revenue Funds at the end of the fi nancial year is recognised as

a payable in the statement of fi nancial position.

2.4 Direct Exchequer payments

All direct exchequer payments are recognised in the statement of fi nancial performance when fi nal

authorisation for payment is effected on the system (by no later than 31 March of each year).

2.5 Aid assistance

Aids assistance is recognised as revenue when received

All in-kind aid assistance is disclosed at fair value on the date of receipt in the annexures to the

Annual Financial Statements

The cash payments made during the year relating to aid assistance projects are recognised as

expenditure in the statement of fi nancial performance when fi nal authorisation for payments is

effected on the system (by no later than 31 March of each year)

270



The value of the assistance expensed prior to the receipt of funds is recognised as a receivable in

the statement of fi nancial position.

Inappropriately expensed amounts using aid assistance and any unutilised amounts are recognised as payables in the statement of fi nancial position.

3. Expenditure3.1 Compensation of employees

3.1.1 Salaries and wages

Salaries and wages are expensed in the statement of fi nancial performance when the fi nal authorisation for payment is effected on the system (by no later than 31 March of each year).

Other employee benefi ts that give rise to a present legal or constructive obligation are disclosed in the disclosure notes to the fi nancial statements at its face value and are not recognised in the statement of fi nancial performance or position.

Employee costs are capitalised to the cost of a capital project when an employee spends more than 50% of his/her time on the project. These payments form part of expenditure for capital assets in the statement of fi nancial performance.

3.1.2 Social contributions

Employer contributions to post employment benefi t plans in respect of current employees are expensed in the statement of fi nancial performance when the fi nal authorisation for payment is effected on the system (by no later than 31 March of each year).

No provision is made for retirement benefi ts in the fi nancial statements of the department. Any potential liabilities are disclosed in the fi nancial statements of the National Revenue Fund and not in the fi nancial statements of the employer department.

Employer contributions made by the department for certain of its ex-employees (such as medical benefi ts) are classifi ed as transfers to households in the statement of fi nancial performance.

3.2 Goods and services

Payments made during the year for goods and/or services are recognised as an expense in the statement of fi nancial performance when the fi nal authorisation for payment is effected on the system (by no later than 31 March of each year).

The expense is classifi ed as capital if the goods and/or services were acquired for a capital project or if the total purchase price exceeds the capitalisation threshold (currently R5, 000). All other expenditures are classifi ed as current.

Rental paid for the use of buildings or other fi xed structures is classifi ed as goods and services

and not as rent on land.

271



3.3 Interest and rent on land

Interest and rental payments are recognised as an expense in the statement of fi nancial performance

when the fi nal authorisation for payment is effected on the system (by no later than 31 March of

each year). This item excludes rental for the use of buildings or other fi xed structures. If it is not

possible to distinguish between payment for the use of land and the fi xed structures on it, the whole

amount should be recorded under goods and services.

3.4 Payments for fi nancial assets

Debts are written off when identifi ed as irrecoverable. Debts written-off are limited to the amount

of savings and/or underspending of appropriated funds. The write off occurs at year-end or when

funds are available. No provision is made for irrecoverable amounts but an estimate is included in

the disclosure notes to the fi nancial statements.

All other losses are recognised when authorisation has been granted for the recognition thereof.

3.5 Transfers and subsidies

Transfers and subsidies are recognised as an expense when the fi nal authorisation for payment is

effected on the system (by no later than 31 March of each year).

3.6 Unauthorised expenditure

When confi rmed unauthorised expenditure is recognised as an asset in the statement of fi nancial

position until such time as the expenditure is either approved by the relevant authority, recovered

from the responsible person or written off as irrecoverable in the statement of fi nancial performance.

Unauthorised expenditure approved with funding is derecognised from the statement of fi nancial

position when the unauthorised expenditure is approved and the related funds are received.

Where the amount is approved without funding it is recognised as expenditure in the statement of

fi nancial performance on the date stipulated in the Act.

3.7 Fruitless and wasteful expenditure

Fruitless and wasteful expenditure is recognised as expenditure in the statement of fi nancial

performance according to the nature of the payment and not as a separate line item on the face of

the statement. If the expenditure is recoverable it is treated as an asset until it is recovered from the

responsible person or written off as irrecoverable in the statement of fi nancial performance.

3.8 Irregular expenditure

Irregular expenditure is recognised as expenditure in the statement of fi nancial performance. If the

expenditure is not condoned by the relevant authority it is treated as an asset until it is recovered or

written off as irrecoverable.

272



4. Assets4.1 Cash and cash equivalents

Cash and cash equivalents are carried in the statement of fi nancial position at cost.

Bank overdrafts are shown separately on the face of the statement of fi nancial position.

For the purposes of the cash flow statement, cash and cash equivalents comprise cash on hand,

deposits held, other short-term highly liquid investments and bank overdrafts.

4.2 Other fi nancial assets

Other fi nancial assets are carried in the statement of fi nancial position at cost.

4.3 Prepayments and advances

Amounts prepaid or advanced are recognised in the statement of fi nancial position when the

payments are made and are derecognised as and when the goods/services are received or the

funds are utilised.

Prepayments and advances outstanding at the end of the year are carried in the statement of

fi nancial position at cost.

4.4 Receivables

Receivables included in the statement of fi nancial position arise from cash payments made that

are recoverable from another party (including departmental employees) and are derecognised upon

recovery or write-off.

Receivables outstanding at year-end are carried in the statement of fi nancial position at cost plus

any accrued interest. Amounts that are potentially irrecoverable are included in the disclosure notes.

4.5 Investments

Capitalised investments are shown at cost in the statement of fi nancial position.

Investments are tested for an impairment loss whenever events or changes in circumstances

indicate that the investment may be impaired. Any impairment loss is included in the disclosure

notes.

4.6 Loans

Loans are recognised in the statement of fi nancial position when the cash is paid to the benefi ciary.

Loans that are outstanding at year-end are carried in the statement of fi nancial position at cost plus

accrued interest.

Amounts that are potentially irrecoverable are included in the disclosure notes.

273



4.7 Inventory

Inventories that qualify for recognition must be initially reflected at cost. Where inventories are

acquired at no cost, or for nominal consideration, their cost shall be their fair value at the date of

acquisition.

All inventory items at year-end are reflected using the weighted average cost.

4.8 Capital assets

4.8.1 Movable assets

Initial recognition

A capital asset is recorded in the asset register on receipt of the item at cost. Cost of an asset

is defi ned as the total cost of acquisition. Where the cost cannot be determined accurately, the

movable capital asset is stated at fair value. Where fair value cannot be determined, the capital

asset is included in the asset register at R1.

All assets acquired prior to 1 April 2002 are included in the register R1.

Subsequent recognition

Subsequent expenditure of a capital nature is recorded in the statement of fi nancial performance

as “expenditure for capital assets” and is capitalised in the asset register of the department on

completion of the project.

Repairs and maintenance is expensed as current “goods and services” in the statement of fi nancial

performance.

4.8.2 Immovable assets

Initial recognition

A capital asset is recorded on receipt of the item at cost. Cost of an asset is defi ned as the total

cost of acquisition. Where the cost cannot be determined accurately, the immovable capital asset

is stated at R1 unless the fair value for the asset has been reliably estimated.

Subsequent recognition

Work-in-progress of a capital nature is recorded in the statement of fi nancial performance as

“expenditure for capital assets”. On completion, the total cost of the project is included in the asset

register of the department that is accountable for the asset.

Repairs and maintenance is expensed as current “goods and services” in the statement of fi nancial

performance.

274



4.8.3 Intangible assets

Initial recognition

An intangible asset is recorded in the asset register on receipt of the item at cost. Cost of an

intangible asset is defi ned as the total cost of acquisition. Where the cost cannot be determined

accurately, the intangible asset is stated at fair value. Where fair value cannot be determined, the

intangible asset is included in the asset register at R1.

Subsequent expenditure

Subsequent expenditure of a capital nature is recorded in the statement of fi nancial performance as

“expenditure for capital asset” and is capitalised in the asset register of the department.

Maintenance is expensed as current “goods and services” in the statement of fi nancial performance.

5. Liabilities5.1 Payables

Recognised payables mainly comprise of amounts owing to other governmental entities. These

payables are carried at cost in the statement of fi nancial position.

5.2 Contingent liabilities

Contingent liabilities are included in the disclosure notes to the fi nancial statements when it is

possible that economic benefi ts will flow from the department, or when an outflow of economic

benefi ts or service potential is probable but cannot be measured reliably.

5.3 Contingent assets

Contingent assets are included in the disclosure notes to the fi nancial statements when it is probable

that an inflow of economic benefi ts will flow to the entity.

5.4 Commitments

Commitments are not recognised in the statement of fi nancial position as a liability or as expenditure

in the statement of fi nancial performance but are included in the disclosure notes.

5.5 Accruals

Accruals are not recognised in the statement of fi nancial position as a liability or as expenditure in

the statement of fi nancial performance but are included in the disclosure notes.

5.6 Employee benefi ts

Short-term employee benefi ts that give rise to a present legal or constructive obligation are

disclosed in the disclosure notes to the fi nancial statements. These amounts are not recognised in

the statement of fi nancial performance or the statement of fi nancial position.

275



5.7 Lease commitments

Finance lease

Finance leases are not recognised as assets and liabilities in the statement of fi nancial position.

Finance lease payments are recognised as a capital expense in the statement of fi nancial

performance and are not apportioned between the capital and the interest portions. The total

fi nance lease payment is disclosed in the disclosure notes to the fi nancial statements.

Operating lease

Operating lease payments are recognised as an expense in the statement of fi nancial performance.

The operating lease commitments are disclosed in the disclosure notes to the fi nancial statements.

5.8 Impairment

The department tests for impairment where there is an indication that a receivable, loan or investment

may be impaired. An assessment of whether there is an indication of possible impairment is done

at each reporting date. An estimate is made for doubtful loans and receivables based on a review

of all outstanding amounts at year-end. Impairments on investments are calculated as being the

difference between the carrying amount and the present value of the expected future cash flows /

service potential flowing from the instrument.

5.9 Provisions

Provisions are disclosed when there is a present legal or constructive obligation to forfeit economic

benefi ts as a result of events in the past and it is probable that an outflow of resources embodying

economic benefi ts will be required to settle the obligation and a reliable estimate of the obligation

can be made.

6. Receivables for departmental revenue

Receivables for departmental revenue are disclosed in the disclosure notes to the annual fi nancial

statements. These receivables are written off when identifi ed as irrecoverable and are disclosed

separately.

7. Net Assets7.1 Capitalisation reserve

The capitalisation reserve comprises of fi nancial assets and/or liabilities originating in a prior

reporting period but which are recognised in the statement of fi nancial position for the fi rst time in

the current reporting period. Amounts are recognised in the capitalisation reserves when identifi ed

in the current period and are transferred to the Provincial Revenue Fund when the underlying asset

is disposed and the related funds are received.

276



7.2 Recoverable revenue

Amounts are recognised as recoverable revenue when a payment made in a previous fi nancial year

becomes recoverable from a debtor in the current fi nancial year. Amounts are either transferred

to the Provincial Revenue Fund when recovered or are transferred to the statement of fi nancial

performance when written-off.

8. Related party transactions

Specifi c information with regards to related party transactions is included in the disclosure notes.

9. Key management personnel

Compensation paid to key management personnel including their family members where relevant,

is included in the disclosure notes.

10. Public Private Partnerships

A description of the PPP arrangement, the contract fees and current and capital expenditure relating

to the PPP arrangement is included in the disclosure notes.

277

Department of Health Vote 4NOTES TO THE ANNUAL FINANCIAL STATEMENTSfor the year ended 31 March 2013.


1. An nual Appropriation 1.1 Appropriation

ProgrammeFinal

Appropriation

Actual Funds Received 2012/13

Funds not received/not

requested

Appropriation Received

2011/2012

R’000 R’000 R’000 R’000

Administration 683,447 683,447 - 842,594

District Health Services 8,782,484 8,782,484 - 7,240,272

Emergency Medical Services 1,059,284 1,059,284 - 787,670

Provincial Hospital Services 6,546,896 6,546,896 - 5,259,945

Central Hospitals 7,566,859 7,566,859 - 6,778,355

Health Sciences and Training 841,924 841,924 - 766,022

Health Care Support Service 199,821 199,821 - 169,226

Health Facilities Management 1,510,879 1,510,879 - 1,877,749

Social Welfare Services - - - 1,888,430

Development and Research - - - 209,651

Total 27,191,594 27,191,594 - 25,819,914

1.2 Conditional grants

2012/13 2011/12

Note R’000 R’000

Total grants received 39 6,654,022 6,199,217

Provincial grants included in Total Grants received - 142,694

Total 6,654,022 6,341,911

The department did not receive any provincial grants during the 2012/2013 fi nancial year

2. Departmental revenue

Sales of goods and services other than capital assets 2.1 474,156 398,072

Fines, penalties and forfeits 2.2 3 13

Interest, dividends and rent on land 2.3 1,255 487

Transactions in fi nancial assets and liabilities 2.4 31,525 54,933

Total revenue collected 506,939 453,505

Departmental revenue collected 506,939 453,505

2.1 Sales of goods and services other than capital assets

Sales of goods and services produced by the department 472,533 396,264

Sales by market establishment 13,080 392,642

Administrative fees 2,966 3,622

Other Sales 456,487 -

278



Note 2012/13 2011/12

R’000 R’000

Sales of scrap, waste and other used current goods 1,623 1,808

Total 474,156 398,072

The comparative of the revenue item in Note 2.1 Other Sales is included under Sales by Market

Establishment. The reclassifi cation is as a result of SCOA changes.

2.2 Fines, penalties and forfeits

Fines 3 13

Total 3 13

2.3 Interest, dividends and rent on land

Interest 1,255 487

Total 1,255 487

2.4 Transactions in fi nancial assets and liabilities

Loans and advances 6 1

Receivables 22,001 31,256

Stale cheques written back 421 515

Other Receipts including Recoverable Revenue 9,097 23,161

Total 31,525 54,933

3. Aid assistance 3.1 Aid assistance received in cash from other sources

Local

Opening Balance 676 -

Surrendered (676) 676

Closing Balance 0 676

279



4. Compensation of employees4.1 Salaries and Wages

Note 2012/13 2011/12

R’000 R’000

Basic salary 9,928,941 9,592,928

Performance award 636 198,849

Service Based 766,271 719,310

Compensative/circumstantial 1,293,297 908,166

Periodic payments 108,823 104,410

Other non-pensionable allowances 1,313,285 1,564,421Total 13,411,253 13,088,084

4.2 Social contributions

Employer contributions

Pension 1,203,417 1,168,966

Medical 627,789 622,820

UIF 172 289

Bargaining council 1,851 1,906

Insurance 60 129

Total 1,833,289 1,794,110

Total compensation of employees 15,244,542 14,882,194

Average number of employees 63,360 65,546

The average number of employees disclosed during 2011/2012 included employees of the

Department of Social Development. The Department of Health is a stand-alone department

with effect from 1 April 2012.

280



5. Goods and services

Note 2012/13 2011/12

R’000 R’000

Administrative fees 3,178 4,469

Advertising 13,672 13,047

Assets less then R5,000 5.1 25,791 40,589

Bursaries (employees) 9,503 8,404

Catering 3,354 8,963

Communication 79,537 109,962

Computer services 5.2 75,807 99,629

Consultants, contractors and agency/outsourced services 5.3 1,993,616 1,853,124

Entertainment 242 66

Audit cost – external 5.4 28,583 19,952

Fleet services 95,535 11

Inventory 5.5 4,473,726 4,166,459

Housing 11 -

Operating leases 81,277 76,891

Property payments 5.6 1,312,556 1,149,199

Rental and hiring 1,537 -

Transport provided as part of the departmental activities 157,191 89,477

Travel and subsistence 5.7 194,475 69,757

Venues and facilities 5,146 15,402

Training and staff development 28,484 28,273

Other operating expenditure 5.8 41,906 45,317

Total 8,625,127 7,798,991

Other operating expenditure includes an amount of R35 million in respect of learnerships.

281



5.1 A ssets less than R5,000

Note 2012/13 2011/12

R’000 R’000

Tangible assets 5 25,791 40,589

Machinery and equipment 25,791 40,589

Total 25,791 40,589

5.2 Computer services

SITA computer services 46 -

External computer service providers 75,761 99,629

Total 75,807 99,629

5.3 Consultants, contractors and agency/outsourced services

Business and advisory services 50,701 74,349

Infrastructure and planning 132,828 -

Laboratory services 1,249,751 1,210,037

Legal costs 144,460 68,472

Contractors 189,182 187,706

Agency and support/outsourced services 226,694 312,560

Total 1,993,616 1,853,124

The amount of R189 million disclosed under contractors represents payments made in respect

of blood and blood products. The amount of R185 706 as disclosed in the 2011/2012 Annual

Report of the department for contractors is incorrectly disclosed as a result of a printing error.

The correct amount is R187 706 million.

5.4 Audit cost – External

Regularity audits 17,499 19,750

Performance audits - 1

Investigations 11,084 -

Other audits - 201

Total 28,583 19,952

282



5.5 I nventory

Note 2012/13 2011/12

R’000 R’000

Learning and teaching support material 5 1,330 748

Food and food supplies 184,748 215,979

Fuel, oil and gas 85,450 157,044

Other consumables 340,309 314,644

Materials and supplies 20,506 155

Stationery and printing 82,001 66,405

Medical supplies 1,766,582 2,066,011

Medicine 1,992,800 1,345,473

Total 4,473,726 4,166,459

5.6 Property payments

Municipal services 499,009 304,515

Property maintenance and repairs 578,279 602,281

Other 235,268 242,403

Total 1,312,556 1,149,199

Other represents laundry services, cleaning services safeguarding and security amongst other

items.

5.7 Travel and subsistence

Local 193,656 69,332

Foreign 819 425

Total 194,475 69,757

Included in the amount of R194 million is an amount of R174 million in respect of G Fleet

Services.

283



5.8 O ther operating expenditure

Note 2012/13 2011/12

R’000 R’000

Learnerships 5 35,368 25,803

Professional bodies, membership and subscription fees 171 150

Resettlement costs 1,148 5,338

Gifts - 1

Other 5,219 14,025

Total 41,906 45,317

The amount of R5.2 million disclosed as Other represents courier and delivery services.

6. Interest and rent on land

Interest paid 6 981 4,184

Total 981 4,184

7. Payments for fi nancial assets

Debts written off 7 5,723 3,305

Total 5,723 3,305

8. Debts written off

Nature of debts written off

Bad debts written off in respect of staff debt 5,723 3,305

Total debt written off 5,723 3,305

284



9. T ransfers and subsidies

Note 2012/13 2011/12

R’000 R’000

Provinces and municipalities 39, 40, Annex

1A, Annex 1B 1,083,525 404,090

Departmental agencies and accounts Annex 1C 28,267 2

Universities and technikons Annex 1D 500 909

Non-profi t institutions Annex 1G 817,504 1,697,856

Households Annex 1H 86,714 71,270Total 2,016,510 2,174,127

Included in the amount of R1, 083 billion representing transfers to Provinces and Municipalities

is an amount of R535 million relating to previous fi nancial years but paid in 2012/2013.

10. Expenditure for capital assets

Tangible assets 941,464 1,127,242

Buildings and other fi xed structures 37 528,282 674,355

Machinery and equipment 35 413,182 452,887

Software and other intangible assets - 121

Computer software 36 - 121

Total 941,464 1,127,363

10.1 Analysis of funds utilised to acquire capital assets – 2012/13

Voted Funds Aid

Assistance

Total

Tangible assets 941,464 - 941,464

Buildings and other fi xed structures 528,282 - 528,282

Machinery and equipment 413,182 - 413,182

Total 941,464 - 941,464

10.2 Analysis of funds utilised to acquire capital assets – 2011/12

Voted Funds Aid

Assistance

Total

Tangible assets 1,127,242 - 1,127,242

Buildings and other fi xed structures 674,355 - 674,355

Machinery and equipment 452,887 - 452,887

Software and other intangible assets 121 - 121

Computer software 121 - 121

Total 1,127,363 - 1,127,363

285



11. Unauthorised expenditure11.1 Reconciliation of unauthorised expenditure

Note 2012/13 2011/12

R’000 R’000

Opening balance 5,770,734 4,744,948

Unauthorised expenditure – discovered in current year 324,474 1,025,786

Less: Amounts approved by Parliament/Legislature with

funding (1) -

Unauthorised expenditure awaiting authorisation /

written off 6,095,207 5,770,734

Total 6,095,207 5,770,734

286



11.2 Analysis of unauthorised expenditure awaiting authorisation per economic classifi cation

Note 2012/13 2011/12

R’000 R’000

Capital - -

Current 6,095,207 5,770,734

Total 6,095,207 5,770,734

11.3 Analysis of unauthorised expenditure awaiting authorisation per type

Unauthorised expenditure relating to overspending of the

vote or a main division within a vote 6,095,207 5,770,734

Total 6,095,207 5,770,734

11.4 Details of unauthorised expenditure – current year

Incident Disciplinary steps taken/criminal proceedings

2012/13

R’000

Overspending of the main divisions

within the vote None 324,474

Total 324,474

An amount of R4.5 billion relating to unauthorized expenditure for the fi nancial years

2007/2008, 2008/2009, 2009/2010 and 2010/2011 was condoned by the Gauteng Provincial

Legislature on the 15th of May 2013 as per the Second Unauthorized Expenditure Act No. 2 of

2013. By the 31st of March 2013, the amount condoned in respect of unauthorized expenditure

was not effected in the bank account of the Department of Health. An amount of R261 million

was not approved by the Gauteng Provincial Legislature relating to 2008/2009, 2009/2010 and

2010/2011 fi nancial years.

287



12. Cash and cash equivalents

Note 2012/13 2011/12

R’000 R’000

Consolidated Paymaster General Account 24,361 -

Cash receipts 20 92

Disbursements 3 -

Cash on hand 1,026 1,037

Total 25,410 1,129

13. Prepayments and advances

Travel and subsistence 56 168

Advances paid to other entities (Provincial) 53 53

Total 109 221

14. Receivables

2012/13 2011/12

Note R’000 R’000 R’000 R’000

Less than one year

One to three years

Older than three years

Total Total

Claims recoverable 14.1 6,671 - - 6,671 9,146

Recoverable

expenditure

14.2

11,211 - - 11,211 12,592

Staff debt 14.3 13,613 (4,214) 29,109 38,508 40,248

Other debtors 14.4 7,827 7,827 5,690

Total 39,322 (4,214) 29,109 64,217 67,676

14.1 C laims recoverable

Note 2012/13 2011/12

R’000 R’000

Provincial Departments 6,671 9,146

Total 6,671 9,146

Included in other debtors is an amount of R370 000 for debts with credit balances. The Provincial

Departments indicated above relates to Provincial Departments in Gauteng.

288



14.2 Recoverable expenditure (disallowance accounts)

Note 2012/13 2011/12

R’000 R’000

Disallowance Damages and Losses 1,223 3,633

Disallowance Miscellaneous 9,883 8,860

Disallowance Payment Fraud: CA 105 99

Total 11,211 12,592

14.3 Staff debt

Breach of Contract 7,191 6,319

Employee 5,037 5,177

Ex Employee 51,146 52,272

Supplier 3,935 4,960

State Guarantee 138 107

GG Accident - 31

Fraud 44 50

Travel and Subsistence - (4)

Other (28,983) (28,664)

Total 38,508 40,248

The amount of (R28 983 million) includes Receivable Interest, Receivable Income and debts

with credit balances for an amount of R370 000.

14.4 Other debtors

Private Telephone - 40

Salary Disallowance Account 1 -

Salary Deduction Disallowance 204 101

Sal: Recoverable 687 1,766

Salary: Tax Debt 62 -

Salary Bargaining Council 2 -

Salary Reversal Control Account 6,769 3,760

Sal: Medical Aid - 22

Telephone Erroneous Interface Account 93 -

Sal: Fin Other Institutions 7 -

Sal: Deduction Parking 1 1

Sal: Offi cial Unions 1 -

Total 7,827 5,690

289



15. Investments

Note 2012/13 2011/12

R’000 R’000

Non-Current

Shares and other equity

Investment in Medical Supplies Depot 54,000 54,000

Total 54,000 54,000

Total non-current 54,000 54,000

Analysis of non current investments



The difference of R50, 377 million between the capital amount as disclosed by the Medical

Supplies Depot and the Department of Health as refl ected in the fi nancial statements is as

a result of a cash injection to increase stock holdings. The transaction was funded from the

depot’s own proceeds. The investment of R54 million is the initial capital outlay to the depot,

no additional funds were transferred by the department.

16. Voted funds to be surrendered to the Revenue Fund


Transfer from statement of fi nancial performance 357,247 (170,250)

Add: Unauthorised expenditure for current year 324,474 1,025,786

Paid during the year (660,383) (181,229)

Closing balance 2,113,891 2,092,553

The unauthorised amount disclosed is as per the main division of the Vote. The amount of R661

million disclosed as paid during the year represents surrender of unspent funds for 2011/2012

paid during the 2012/2013 fi nancial year.

290



17. Departmental revenue to be surrendered to the Revenue Fund

Note 2012/13 2011/12

R’000 R’000


Transfer from Statement of Financial Performance 506,939 453,505

Paid during the year (504,869) (456,021)


The amount of (R504 869 million) comprises of an amount of (R429 612) million for current

year’s revenue paid over and an amount of (R75 257) for the month of March 2012 which was

paid over in the fi nancial year 2012/2013.

18. Bank Overdraft

Consolidated Paymaster General Account 3,777,932 2,660,499

Total 3,777,932 2,660,499

19. Payables – current

Amounts owing to other entities

202,649 996,064

Clearing accounts 19.1 - 10,731

Other payables 19.2 13,701 4,537

Total 216,350 1,011,332

The amount of R203 million disclosed as amounts owing to other entities is the amount that

was still payable to the Medical Supplies Depot as at 31 March 2013. This amount was settled

to the Medical Supplies Depot during the fi rst quarter of the fi nancial year 2013/2014. An

amount of R70 million relating to the fi nancial year 2012/2013 only interfaced in April 2013.

291



19.1 Clearing accounts

Note 2012/13 2011/12

21 R’000 R’000

Description

Telephone Control Account - 10,731

Total - 10,731

19.2 Other payables

Description

Salary ACB Recalls 3,482 1,627

Private Telephone 77 -

Salary: Garnishee Orders 13 -

Salary: Income Tax 1,426 1,669

Salary: Pension Fund 7 249

Housing Loan Guarantees 551 436

Salary Disallowance - 3

Other Payables 8,145 553

Total 13,701 4,537

• Other Payables includes the following:

• Sal: Bargaining Councils: CL

• Housing Key Deposits: CL

• Sal: Insurance Deductions: CL

• Sal: Offi cial Unions

292



20. N et cash flow available from operating activities

Note 2012/13 2011/12

R’000 R’000

Net surplus/(defi cit) as per Statement of Financial

Performance 864,186 283,931

Add back non cash/cash movements not deemed

operating activities (1,015,874) 804,583

decrease in receivables – current 3,459 (6,539)

decrease in prepayments and advances 112 1,315

decrease in other current assets 1 -

(decrease) in payables – current (794,982) 319,694

Expenditure on Capital Assets 941,464 1,127,363

Surrenders to Revenue Fund (1,165,928) (637,250)

Net cash fl ow generated by operating activities (151,688) 1,088,514

21. Reconciliation of cash and cash equivalents for cash flow purposes

Consolidated Paymaster General account (3,753,571) (2,660,499)

Cash receipts 20 92

Disbursements 3 -

Cash on hand 1,026 1,037

Total (3,752,522) (2,659,370)

293

Department of Health Vote 4DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENTSfor the year ended 31 March 2013.


These amounts are not recognised in the Annual Financial Statements and are disclosed to

enhance the usefulness of the Annual Financial Statements.

22. Contingent liabilities and contingent assets22.1 Contingent liabilities

Note 2012/13 2011/12

25 R’000 R’000

Liable to Nature

Housing loan guarantees Employees Annex 3A 1,857 4,645

Claims against the department Annex 3B 2,725,656 1,636,427

Other departments (interdepartmental unconfi rmed

balances)

Annex 5

94 4,009

Total 2,727,607 1,645,081

Claims against the department represent mainly Medico Legal claims. The amount disclosed

under.

22.2 Contingent assets

Nature of contingent asset

Claims against suppliers - 396,028

Claim against employees (Negative Leave Credits) 24,652 5

Total 24,652 396,033

The amount of R24.6 million represents leave over grant to employees.

23. Commitments

Current expenditure

Approved and contracted 103,526 1,217,020

103,526 1,217,020

Capital expenditure

Approved and contracted 1,603,575 1,259,961

Approved but not yet contracted 210,278 -

1,813,853 1,259,961

Total Commitments 1,917,379 2,476,981

A total of R1 882 billion relating to commitments was older than a year.

294



24. Accruals

Listed by economic classifi cation 2012/13 2011/12

R’000 R’000

30 Days 30+ Days Total Total

Goods and services 357,767 1,175,655 1,533,422 2,844,601

Transfers and subsidies - 9,764 9,764 503,319

Capital assets - 20,317 20,317 10,347

Other 13,661 - 13,661 -

Total 371,428 1,205,736 1,577,164 3,358,267

Listed by programme level

1. Administration 238,672 206,943

2. District Health Services 282,888 806,909

3. Emergency Medical Services 63,669 133,158

4. Provincial Hospitals 387,017 1,023,869

5. Central Hospital Services 564,362 928,034

6. Health Sciences and Training 28,668 28,530

7. Health Care Support Services 4,207 7,369

8. Health Facilities Management 7,681 135,354

9 + 10 Social Development - 88,101

Total 1,577,164 3,358,267

Confi rmed balances with other departments 117,897 151,082

Confi rmed balances with other government

entities 285,762 854,474

Total 403,659 1,005,556

The amount of R118 million disclosed as confi rmed balances with other departments

represents amounts owing to the Gauteng Department of Finance, Department of Infrastructure

Development and G Fleet. The amount of R203 million disclosed as amounts owing to other

entities is the amount that was still payable to the Medical Supplies Depot as at 31 March

2013. This amount was settled to the Medical Supplies Depot during the fi rst quarter of the

fi nancial year 2013/2014. The accruals of 2011/2012 have been restated from R2.8 billion to

R3.3 billion after a review by the department.

295



25. Employee benefi ts

Note 2012/13 2011/12

R’000 R’000

Leave entitlement 596,908 448,825

Service bonus (Thirteenth cheque) 391,925 384,738

Performance awards 229,182 211,994

Capped leave commitments 458,451 486,144

Total 1,676,466 1,531,701

The leave entitlement has been reduced by an amount of R11.0 million relating to leave taken

during the fi nancial year 2012/2013 but not captured on Persal as at 31 March 2013.

26. Lease commitments26.1 Operating leases expenditure

2012/13

Buildings and other fi xed

structures Total

Not later than 1 year 23,588 23,588

Later than 1 year and not later

than 5 years 33,200 33,200

Later than fi ve years - -

Total lease commitments 56,788 56,788

2011/12

Buildings and other fi xed

structures Total



than 5 years 16,884 16,884


296



26.2 Finance leases expenditure**

2012/13 Machinery and equipment Total



than 5 years 22,479 22,479

Later than fi ve years - -


2011/12 Machinery and equipment Total



than 5 years 10,782 10,782

Later than fi ve years 113 113


LESS: fi nance costs 3,154 3,154

Total present value of lease

liabilities 47,688 47,688

This note excludes leases relating to public private partnership as they are separately disclosed

to note no.39.

Finance costs relating to fi nance leases are included in the capital cost of fi nance leases. This

is as a result of a policy change by National Treasury.

27. Receivables for departmental revenue

Note 2012/13 2011/12

R’000 R’000

Sales of goods and services other than capital assets 1,334,450 1,200,952

Total 1,334,450 1,200,952

The amount of R1.3 billion represents Patient Fees.

297



27.1 Analysis of receivables for departmental revenue

Note 2012/13 2011/12

R’000 R’000


Less: amounts received 324,173 332,884

Add: amounts recognised 936,022 950,055

Less: amounts written-off/reversed as irrecoverable 198,434 127,592

Closing balance 2,438,694 2,025,279

Provision for bad debts 1,104,244 933,951

An amount of R1, 104 billion has been provided for in respect of patient debt older than 3

months.

27.2 Receivables for department revenue written off

Patient Fees written off on the standalone systems 198,434 127,592

Total 198,434 127,592

Patient Fees written off represents patient debt older than 90 days.

28. Irregular expenditure28.1 Reconciliation of irregular expenditure


Add: Irregular expenditure – relating to prior year 372,633 -

Add: Irregular expenditure – relating to current year 1,141,557 1,115,884

Less: Amounts condoned (239,212) (60,274)

Less: Amounts recoverable (not condoned) - -

Less: Amounts not recoverable (not condoned) - -

Irregular expenditure awaiting condonation 5,748,235 4,473,257

Analysis of awaiting condonation per age classifi cation

Current year 902,345 1,115,884

Prior years 4,845,890 3,417,647

Total 5,748,235 4,533,531

298



28.2 Details of irregular expenditure – current year

Incident Disciplinary steps taken/criminal proceedings

2012/13R’000

BAC approvals (condonement) of request for

ex post facto approvals

None

58,877

BAC approvals of deviation from normal

tender and procurement procedures

Pending investigations

99,697

Extensions of the period term contracts Pending investigations 80,638

Security Services Pending investigations 199,908

Request for Quotations Pending investigations 10,558

Unsolicited Bids 2012/2013 Pending investigations 476,675

Overtime claims exceeding 30% Pending investigations 9,991

Unsolicited Bids 2011/2012 None 348,380

Nursing Services outsourced from agencies

on an ad hoc basis

Disciplinary actions in progress

19,087

Irregular contracts extended on a month to

month basis

None

66,317

Infrastructure irregularities None 119,809

Irregular Expenditure Note reported to BAC in

209/10, 2010/11 and 2011/12

None

24,253

Total 1,514,190

28.3 Details of irregular expenditure condoned

Incident Condoned by (condoning authority)

2012/13R’000

Condonement of ex post facto approvals BAC (58,877)

Approvals of deviations from normal tender

and procurement procedures BAC (99,697)

Extensions of the period terms contracts BAC (80,638)

Total (239,212)

For all amounts disclosed as condoned, the condoning authority was the Departmental Bid

Adjudication Committee (DBAC).

299



29. Fruitless and wasteful expenditure29.1 Reconciliation of fruitless and wasteful expenditure

Note 2012/13 2011/12

R’000 R’000


Fruitless and wasteful expenditure – relating to prior year 41,345 -

Fruitless and wasteful expenditure – relating to current

year 145,967 155,422

Less: Amounts resolved (166,555) -

Fruitless and wasteful expenditure awaiting resolution 408,050 387,293

30. Analysis of awaiting resolution per economic classifi cation

Current 408,050 30,586

Capital - 218,815

Total 408,050 249,401

31. Analysis of Current year’s fruitless and wasteful expenditure

Incident Disciplinary steps taken/criminal

proceedings

2012/13

R’000

Expired medication None 8,394

Interest on late payments None 7,630

Disposal of other inventory None 504

Legal Claims against the Department None 125,212

Other None 201

Rent None 134

Penalties/interest relating to

infrastructure(DID)

None

3,892

Total 145,967

32. Related party transactions

Note 2012/13 2011/12

R’000 R’000

Payments made

Goods and services 3,493,235 2,377,382

Total 3,493,235 2,377,382

Year end balances arising from revenue/payments

Payables to related parties 202,649 946,119

Total 202,649 946,119

300



The related party transactions relates to the Medical Supplies Depot, a trading entity of the

department. Included in the amount of R3.4 billion paid to the Medical Supplies Depot during the

2012/2013 fi nancial year is an amount of R946 million relating to the previous fi nancial year.

Other related parties include the following Gauteng Departments:

• Offi ce of the Premier

• Legislature

• Economic Development and Trading Entities

• Education

• Social Development

• Local Government and Housing

• Roads and Transport

• Community Safety

• Agriculture and Rural Development

• Sports, Arts, Culture and Recreation

• Finance

• Provincial Treasury

• Infrastructure Development

33. Key Management Personnel

No. Of

Individuals

2012/13 2011/12

R’000 R’000

Political offi ce bearers (provide detail below) 2 1,737 1,560

Offi cials:

Level 15 to 16 5 3,906 8,552

Level 14 (incl. CFO if at a lower level) 21 17,730 19,185

Family members of key management personnel 8 1,579 3,345

Total 36 24,952 32,642

Any guarantees issued to Senior Management by the department are disclosed in Note 29.

Included under political offi ce bearers is the salary of the previous MEC. The current MEC

assumed duty in July 2012. The post of Head of Department has been vacant since November

2012. The Chief Financial Offi cer assumed duty in October 2012. The Chief Financial Offi cer

acted as Head of Department from November 2012 to March 2013.

301



34. Provisions

Note 2012/13 2011/12

R’000 R’000

34.1 Provisions for Receivables

Staff Debtors 29,109 61,225

Other Debtors 1,104,244 932,951

Total 1,133,353 994,176

34.2 Provisions for Liabilities

Premature termination of Contracts 1,508,092 1,508,092

Performance Bonuses (2008/9/,2009/10 and 2010/11) 413,000 306,038

Total 1,921,092 1,814,130

An amount of R29,109 million has been provided for in respect of staff debt older than 3 years

and an amount of R1,104 billion has been provided for in respect of patient debt older than 3

months.

35. Movable Tangible Capital Assets

MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR

ENDED 31 MARCH 2013

Opening balance

Curr Year Adjust-

ments to prior year balances

Additions Disposals Closing Balance

R’000 R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 3,236,671 (267,793) 382,295 105,903 3,245,270

Transport assets 267,186 (7,439) 12,525 4,394 267,878

Computer equipment 177,120 (12,824) 35,442 56,806 142,932

Furniture and offi ce equipment 365,071 (260,270) 6,223 17,483 93,541

Other machinery and equipment 2,427,294 12,740 328,106 27,220 2,740,920

TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 3,236,671 (267,793) 382,295 105,903 3,245,270

302



35.1 Additions

ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR

ENDED 31 MARCH 2013

Cash Non-cash (Capital Work in Progress current costs and fi nance lease payments)

Received current, not paid

(Paid current year, received prior year)

Total

R’000 R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 414,623 29,616 (61,211) (733) 382,295

Transport assets 41,325 9,366 (31,524) (6,642) 12,525

Computer equipment 32,956 1,995 - 491 35,442

Furniture and offi ce equipment 6,028 466 - (271) 6,223

Other machinery and equipment 334,314 17,790 (29,687) 5,689 328,106

TOTAL ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS 414,623 29,616 (61,211) (733) 382,295

35.2 Disposals

DISPOSALS OF MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR

ENDED 31 MARCH 2013

Transfer out

or destroyed

or scrapped

Total

disposals

R’000 R’000

MACHINERY AND EQUIPMENT 105,903 105,903

Transport assets 4,394 4,394

Computer equipment 56,806 56,806

Furniture and offi ce equipment 17,483 17,483

Other machinery and equipment 27,220 27,220

TOTAL DISPOSAL OF MOVABLE TANGIBLE CAPITAL ASSETS 105,903 105,903

303



35.3 Movement for 2011/12

MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR

ENDED 31 MARCH 2012

Opening balance

Additions Disposals Closing balance

R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 2,852,217 426,139 41,685 3,236,671Transport assets 245,029 22,665 508 267,186

Computer equipment 166,936 16,153 5,969 177,120

Furniture and offi ce equipment 353,637 13,539 2,105 365,071

Other machinery and equipment 2,086,615 373,782 33,103 2,427,294

TOTAL MOVABLE TANGIBLE

ASSETS 2,852,217 426,139 41,685 3,236,671

35.4 Minor assets

MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31

MARCH 2013

Intangible assets

Machinery and

equipment

Total

R’000 R’000 R’000

Opening balance 4 448,530 448,534

Curr Year Adjustments to Prior Year balances - 189,027 189,027

Additions - 33,477 33,477

Disposals - 75,253 75,253

TOTAL MINOR ASSETS 4 595,781 595,785

Number of R1 minor assets - 12,471 12,471

Number of minor assets at cost - 430,066 430,066

TOTAL NUMBER OF MINOR ASSETS - 442,537 442,537

304



MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31

MARCH 2012

Intangible assets

Machinery and

equipment

Total

R’000 R’000 R’000

Opening balance 4 416,412 416,416

Additions - 40,587 40,587

Disposals - 8,469 8,469

TOTAL MINOR ASSETS 4 448,530 448,534

35.5 Movable assets written off

MOVABLE ASSETS WRITTEN OFF FOR THE YEAR ENDED AS AT 31 MARCH 2013

Specialised military assets

Intangible assets

Heritage assets

Machinery and

equipment

Biological assets

Total

R’000 R’000 R’000 R’000 R’000 R’000

Assets written off - - - 325 - 325

TOTAL MOVABLE ASSETS WRITTEN OFF - - - 325 - 325

36. Intangible Capital Assets

Opening balance

AdditionsClosing Balance

R’000 R’000 R’000

COMPUTER SOFTWARE 236,475 162 236,637

TOTAL INTANGIBLE CAPITAL ASSETS 236,475 162 236,637

36.1 Disposals

Transfer out

or destroyed

or scrapped

Total

disposals

R’000 R’000

COMPUTER SOFTWARE 28,916 28,916

TOTAL DISPOSALS OF INTANGIBLE CAPITAL ASSETS 28,916 28,916

305



36.2 Movement for 2011/12

Opening

balance

Disposal Closing

balance

R’000 R’000 R’000

COMPUTER SOFTWARE 236,637 28,916 207,721

TOTAL INTANGIBLE CAPITAL ASSETS 236,637 28,916 207,721

37. Immovable Tangible Capital Assets (Movement for 2012/2013)

Movement in immovable tangible capital assets per asset register for the year ended 31 March

2013

Opening

balance

Closing

Balance

R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES 4,006,508 4,006,508

Non-residential buildings 1,851,011 1,851,011

Other fi xed structures 2,155,497 2,155,497

TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 4,006,508 4,006,508

38. Additions to immovable tangible capital assets per asset register for the year ended 31 March 2013

Cash (Capital Work in Progress

current costs and

fi nance lease payments)

Total

R’000 R’000 R’000

BUILDING AND OTHER FIXED STRUCTURES 457,386 (457,386) -

Other fi xed structures 457,386 (457,386) -

TOTAL ADDITIONS TO IMMOVABLE TANGIBLE

CAPITAL ASSETS 457,386 (457,386) -

306



38.1 Movement in immovable tangible capital assets per asset register for the year ended 31 March 2012 (Movement for 2011/2012)

Cash Additions Total

R’000 R’000 R’000

BUILDING AND OTHER FIXED STRUCTURES 3,971,762 34,746 4,006,508

Non-residential buildings 1,851,011 - 1,851,011

Other fi xed structures 2,120,751 34,746 2,155,497

TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 3,971,762 34,746 4,006,508

Immovable assets valued at R1

Immovable assets valued at R1 in the asset register as at 31 march 2013

Buildings and other fi xed structures

Heritage Assets Total

R 1 Immovable assets 0.33 - 0.33

TOTAL 0.33 - 0.33

The department has disclosed 330 items (immovable assets) valued at R1 (R330).

307

Department of Health Vote 4ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTSfor the year ended 31 March 2013.


39.

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308

Department of Health Vote 4ANNEXURESTO THE ANNUAL FINANCIAL STATEMENTSfor the year ended 31 March 2013.


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40.

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311



41. TRANSFER OF FUNCTIONS41.1 Statement of Financial Position

Note

Bal per dept 2011/12

AFS before transfer

Functions per dept

2011/12 Bal after transfer

(transferred)

2011/12 2011/12 2011/12

R’000 R’000 R’000

ASSETS

Current Assets 5,840,436 (11,630) 5,828,806

Unauthorised expenditure 11 5,770,734 - 5,770,734

Cash and cash equivalents 12 1,129 (77) 1,052

Prepayments and advances 13 221 (37) 184

Receivables 14 67,676 (11,516) 56,160

Aid assistance receivable 3 676 - 676

Non-Current Assets 5,400 - 5,400

Investments 5,400 - 5,400

TOTAL ASSETS 5,845,836 (11,630) 5,834,206

LIABILITIES

Current Liabilities 15,839,760 - 15,839,760

Voted funds to be surrendered to the Revenue Fund 16 2,092,553 - 2,092,553

Departmental revenue and NRF Receipts to be surrendered to the Revenue Fund 17 74,700 - 74,700

Bank overdraft 18 2,660,499 - 2,660,499

Payables 19 11,011,332 11,011,332

Aid assistance repayable 3 - - -

Aid assistance unutilised 676 - 676

TOTAL LIABILITIES 15,839,760 - 15,839,760

NET ASSETS (9,993,924) (11,630) (10,005,554)

312



41.2 Disclosure Notes

Bal per dept 2011/12

AFS before transfer

Functions per dept

(transferred) 2011/12 Bal after transfer

2011/12 2011/12 2011/12

R’000 R’000 R’000

Contingent liabilities 22.1 3,459,211 (2,522) 3,456,689

Contingent assets 22.2 396,033 (396,033) -

Commitments 23 2,476,981 (121,192) 2,355,789

Accurals 24 2,827,177 - 2,827,177

Employee benefi ts 25 1,629,454 (83,761) 1,545,693

Lease commitments - operating lease 26.1 29,324 - 29,324

Lease commitments - fi nance lease 26.2 47,688 (6,437) 41,251

Receivables for departmental revenue 27 1,200,952 - 1,200,952

Irregular expenditure 28 4,533,531 - 4,533,531

Fruitless and wasteful expenditure 29 387,293 - 387,293

Impairment and other provisions 34 994,176 (24,749) 969,427

Movable tangible capital assets 35 3,236,671 (105,903) 3,130,768

Immovable tangible capital assets 37 406,508 - 406,508

Intangible capital assets 36 236,637 - 236,637 313



ANN

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ANN

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OF

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2012

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203

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319



ANN

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GST

ATEM

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OF

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are

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12

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L67

6-

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0

320



ANN

EXU

RE 3

AST

ATEM

ENT

OF

FIN

ANCI

AL G

UARA

NTE

ES IS

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AS

AT 3

1 M

ARCH

201

2 –

LO

CAL

Gua

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or in

stitu

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Gua

rant

ee in

re

spec

t of

Orig

inal

gu

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teed

ca

pita

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ount

Ope

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ba

lanc

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April

201

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Gua

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draw

dow

ns

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g th

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repa

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d/

redu

ced/

re

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durin

g th

e ye

ar

Rev

alua

tions

Clos

ing

bala

nce

31 M

arch

20

13

Gua

rant

eed

inte

rest

for

year

end

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31 M

arch

20

13

Rea

lised

loss

es n

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reco

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i.e. c

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175

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-(7

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(74)

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L-

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645

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02)

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-1,

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ANN

EXU

RE 3

BST

ATEM

ENT

OF

CON

TIN

GEN

T LI

ABIL

ITIE

S AS

AT

31 M

ARCH

201

2

Nat

ure

of L

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lity

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ning

Ba

lanc

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April

20

12

Liab

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curr

ed d

urin

g th

e ye

ar

Liab

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d/re

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the

year

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31

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9,07

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192

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900

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1,31

2,04

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2,72

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6

322



ANN

EXU

RE 4

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MS

RECO

VERA

BLE

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rm

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alan

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outs

tand

ing

Unc

onfi r

med

bal

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outs

tand

ing

Tot

al

Gov

ernm

ent e

ntity

31

/03/

2013

31

/03/

2012

3

1/03

/201

3 3

1/03

/201

2 3

1/03

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3 3

1/03

/201

2

R

’000

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’000

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Mpu

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: D

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tmen

t of H

ealth

(C5

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-

171

9

1

71

9

East

ern

Cape

: Dep

artm

ent o

f Hea

lth (D

2) -

-

11

-

11

-

Nor

th W

est:

Hea

lth (3

Y) -

-

75

-

75

-

Gau

teng

: Dep

artm

ent o

f Edu

catio

n (K

5) -

18

-

-

18

Lim

popo

Dep

artm

ent o

f Hea

lth a

nd S

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l Dev

elop

men

t (P4

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-

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94

97

94

97

Wes

tern

Cap

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Hea

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3)

-

16

5

-

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16

5

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Sta

te: D

epar

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t of H

ealth

(V5)

-

-

- 3

- 3

Gau

teng

: Agr

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ture

and

Rur

al D

evel

opm

ent (

G4)

1

3

-

- -

13

-

Dep

artm

ent o

f Wat

er A

ffai

rs(T

radi

ng A

ccou

nt) W

7

-

-

-

10

-

10

Lim

popo

: Soc

ial D

evel

opm

ent(

Q7)

-

-

- 51

- 51

Nor

th W

est:

Educ

atio

n (8

Y)

-

-

-

4

8 -

48

Gau

teng

: Dep

artm

ent o

f Fin

ance

(I1)

-

-

-

9

- 9

Nat

iona

l Dep

artm

ent o

f Hom

e Af

fairs

(18)

-

-

-

29

-

29

Nat

iona

l Dep

artm

ent o

f Hea

lth(2

0)

-

-

-

3

5 -

35

Nat

iona

l Dep

artm

ent o

f Cor

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iona

l Ser

vice

s(95

)

-

-

34

2

5 34

2

5

Sout

h Af

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Pol

ice

Serv

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-

-

-

103

- 1

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Nat

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l: D

epar

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t of J

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Nat

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Aff

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For

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-

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Nat

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18

Gov

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-

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11

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Nor

th W

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Dep

artm

ent o

f Hea

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ocia

l Dev

elop

men

t (67

)

-

-

-

92

7 -

927

323



Confi

rm

ed b

alan

ce

outs

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Unc

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outs

tand

ing

Tot

al

Gov

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ntity

31

/03/

2013

31

/03/

2012

3

1/03

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3 3

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L9)

-

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-

147

-

147

Mpu

mal

anga

: Dep

artm

ent o

f Hea

lth &

Soc

ial S

ervi

ces(

Patie

nt fe

es)

-

-

4

4,98

6

20,

113

44,9

86

20,1

13

Dep

artm

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s (P

atie

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-

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3

4,66

7

33,

758

34,

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-

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4 26

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ent o

f Hea

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t (Pa

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Nat

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Nat

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KZN

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ther

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3

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40

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7

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324



ANN

EXU

RE 5

INTE

R-G

OVER

NM

ENT

PAYA

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C

onfi r

med

bal

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outs

tand

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Unc

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outs

tand

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Tot

al

GO

VER

NM

ENT

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TY

31/0

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13

31/0

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DEPA

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Curr

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Dep

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f Fin

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(GSS

C) (L

8) 6

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7,

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- -

6,80

5

7,

625

Wes

tern

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t of H

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8

--

-8

-

East

ern

Cape

Dep

artm

ent o

f Hea

lth (D

2)

-

6

0

-

118

-

178

Free

Sta

te: D

epar

tmen

t of H

ealth

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7

5

8

-

1

87

7

5

1

95

Free

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-

12

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-

12

Sout

h Af

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Pol

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Serv

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(Hea

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90)

-

35

-

62

-

97

Sout

h Af

rican

Pol

ice

Serv

ices

(Soc

ial)

(90)

-

23

6

42

6

65

Nor

th W

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t of H

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& S

ocia

l Dev

elop

men

t (67

)

-

768

-

-

-

768

Gau

teng

Dep

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ent o

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Wes

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Cap

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148

104

-

7

7

1

48

181

Sout

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Def

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For

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-

-

-

680

-

680

Nat

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l Dep

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ent o

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tion

-

13

-

-

-

13

Gau

teng

Dep

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ent o

f Soc

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ent

213

-

-

- 21

3

-

Lim

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Dep

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7)63

1

5

83

-

-

631

583

Lim

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Dep

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f Soc

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opm

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-

81

-

-

-

81

Dep

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s21

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21

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Gau

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over

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-

1

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-

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-

1

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-

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Nat

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l Dep

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12

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-

5

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2,81

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2,87

0

325



C

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GO

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NM

ENT

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31/0

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13

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12

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R

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Nat

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For

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)17

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8

7,61

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0

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Nat

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-

12

-

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12

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-

28

-

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28

Mpu

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500

- 88

-

1,58

8

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-

3

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-

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3

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Nat

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183

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-

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3

9

94

Stat

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-

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1

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94

4,00

9

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91

155

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MEN

T EN

TITY

Curr

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Med

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Sup

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(K7)

285

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8

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74

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,474

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-

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2

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326



ANN

EXU

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INVE

NTO

RY

201

2/13

201

1/12

Not

eQ

uant

ity R

’000

Qua

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R’0

00

Inve

ntor

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Ope

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bal

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- 56

4,12

6 -

638,

231

Add:

Add

ition

s/Pu

rcha

ses

- Cas

h-

4,47

3,72

6 -

4,16

6,33

3

(Les

s): D

ispo

sals

-

(8

,394

) -

(1,2

84)

(Les

s): I

ssue

s

- (4

,523

,156

)-

(4,2

39,1

54)

Clos

ing

bala

nce

-

50

6,30

2 -

564

,126

327



ANNEXURE 7MOVEMENT IN CAPITAL WORK IN PROGRESS

Opening

balance

Current Year

Capital WIP

Closing

balance

R’000 R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES 639,609 457,386 1,096,995

Other fi xed structures 639,609 457,386 1,096,995

TOTAL 639,609 457,386 1,096,995

328



MEDICAL SUPPLIES DEPOT 329


TABLE OF CONTENTS

REPORT OF THE AUDIT COMMITTEE 331REPORT OF THE ACCOUNTING OFFICER 334REPORT OF THE AUDITOR-GENERAL 347STATEMENT OF FINANCIAL POSITION 351STATEMENT OF COMPREHENSIVE INCOME 352STATEMENT OF CHANGES IN EQUITY 353STATEMENT OF CASH FLOW 354NOTES TO THE ANNUAL FINANCIAL STATEMENTS 355

MSD Financial Information

330



GAUTENG MEDICAL SUPPLIES DEPOT AUDIT COMMITTEE REPORTfor the year ended 31 March 2013.Medical Supplies Depot

We are pleased to present our report for the fi nancial

year ended 31 March 2013

Composition of the Audit Committee and Attendance:



a minimum of at least three times per annum as

per provisions of the Public Finance Management

Act (PFMA). In terms of the approved Terms of

Reference (GPG Audit Committee Charter), fi ve

meetings were held during the current year, i.e.3

meetings for Quarterly Performance Reporting

(fi nancial and non-fi nancial) and two meetings to

review and discuss the Annual Financial Statements

and the Auditor-General Report.

Non-Executive Members:

Name of Member Number of Meetings

Attended

Lungelwa Sonqishe

(Chairperson)

5

Mandla Ncube

(Member)

5

Nkateko Mabaso

(Member)

5

Executive Members:

In terms of the GPG Audit Committee Charter, the

Offi cials listed hereunder are obliged to attend the

meetings of the Audit Committee:

Compulsory Attendees Number of Meetings

Attended

Nocawe Thipa (Acting

Chief Executive Offi cer)

3

Kobie Smidt (Acting

Chief Financial Offi cer)

3

Mohamed Kasumba

(Chief Risk Offi cer)

5

The Audit Committee noted that the CEO did not

attend two meetings. The CEO is expected to

prioritise and attend future meetings. This will be

monitored going forward.

The Members of the Audit Committee met with the

Senior Management of the entity and Internal Audit,

collectively to address risks and challenges facing

the entity. A number of in-committee meetings were

held to address control weaknesses and conflicts

with the entity.

Audit Committee Responsibility

The Audit Committee reports that it has complied

with its responsibilities arising from section 38 (1)

(a) of the PFMA and Treasury Regulation 3.1.13. The

Audit Committee also reports that it has adopted

appropriate formal terms of reference as its Audit

Committee Charter, has regulated its affairs in

compliance with this Charter and has discharged

all its responsibilities as contained therein.

331



GAUTENG MEDICAL SUPPLIES DEPOT AUDIT COMMITTEE REPORTfor the year ended 31 March 2013.

The effectiveness of internal control

The Audit Committee has observed that the overall

control environment has continued to improve

during the year under review. However, there

are still some concerns with the level of internal

controls within the entity where evidence of

lapses of effective monitoring and enforcement by

Management were observed.

During the year under review, several defi ciencies

in the system of internal control and of deviations

were reported by the Auditor-General South Africa.

In certain instances, the matters reported previously

have not been fully and satisfactorily addressed.

The quality of in year management and monthly / quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

The Audit Committee is satisfi ed with the content

and quality of monthly and quarterly reports

prepared and issued by the Accounting Offi cer

of the entity during the year under review were in

compliance with the statutory reporting framework.

Evaluation of Financial Statements

The Audit Committee has:

• reviewed and discussed the audited Annual

Financial Statements to be included in the

Annual Report, with the Auditor-General and the

Accounting Offi cer;

• reviewed the Auditor-General’s management

report and Management’s response thereto;

• reviewed the Auditor-General’s audit report

• reviewed the Department’s compliance with

legal and regulatory provisions; and

• reviewed signifi cant adjustments resulting from

the audit.

The Audit Committee concurs with and accepts

the Auditor-General’s conclusions on the Annual

Financial Statements, and is of the opinion that the

audited Annual Financial Statements be accepted

and read together with the report of the Auditor-

General.

Internal Audit

The Audit Committee is satisfi ed that the Internal

Audit plans addresses a clear alignment with

the major risks, adequate information systems

coverage, a good balance between different

categories of audits, i.e. risk-based, mandatory,

performance and follow-up audits.

The Audit Committee has noted considerable

improvement in the communication between the

Executive Management, the Auditor-General and

the Internal Audit Function, which has strengthened

the Corporate Governance initiatives.

The Audit Committee wishes to stress that in order

for the Internal Audit Function to operate at optimal

level as expected by the Audit Committee, it requires

more capacity and skills. This is being addressed

and corrective action is being implemented.

Risk Management

Progress on entity's risk management was reported

to the Audit Committee on a quarterly basis. The

Audit Committee is not entirely satisfi ed that the

actual management of risk is receiving attention

as there areas that still require improvement.

Management should take full responsibility for the

entire Enterprise Risk Management process and

support the Chief Risk Offi cer.

332



GAUTENG MEDICAL SUPPLIES DEPOT AUDIT COMMITTEE REPORTfor the year ended 31 March 2013.Forensic Investigations

The Audit Committee is not satisfi ed that the

forensic investigations are properly reported with

age-analysis of all reported issues indicated. Details

of results in respect of investigations conducted as

a result of calls through the fraud hotline were not

provided to the Committee.

One-on-One Meetings with the Accounting Offi cer

The Audit Committee has met with the Accounting

Offi cer for the entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive

Authority for the entity to apprise him on the

performance of the entity.

Auditor-General South Africa

The Audit Committee has met with the Offi ce of the

Auditor-General of South Africa to ensure that there

are no unresolved issues

Lungelwa Sonqishe

CHAIRPERSON OF THE AUDIT COMMITTEE

333

GAUTENG MEDICAL SUPPLIES DEPOTREPORT OF THE ACCOUNTING OFFICERfor the year ended 31 March 2013.



The Accounting Offi cer of the Gauteng Department

of Health hereby submits the annual report for the

Gauteng Medical Supplies Depot, to the Executive

Authority of the Gauteng Department of Health, and

the Gauteng Provincial Legislature of the Republic

of South Africa.

1. General review of the state of affairs

The Medical Supplies Depot is responsible

for the supply of essential medicines and

medically related items to Provincial Health

Care Facilities in Gauteng. The Depot

operates as a trading entity and charges a

levy of 5% on stock issued to the Provincial

Health Care Facilities.

The Depot procures essential medicines

and medically related items on contract or

quotations and either store these items at

the Depot or orders are placed with suppliers

on behalf of institutions for direct delivery to

the various institutions. Accurate usage of

items, as well as money spent by hospitals,

can be obtained from the Medical Stock

Administration System (MEDSAS). The

Economic Order Quantity (EOQ) together

with the First-Entry-Expiry-First-Out, (FEEFO)

system is applied to ensure that correct

stock levels are maintained.

The Depot prepares fi nancial statements

for each fi nancial year in accordance with

the prescribed practice that can be found

in chapter 18.4 of the Treasury Regulations,

where it is stated that annual fi nancial

statements for trading entities must

conform to Statements of South African

Generally Accepted Accounting Practice

(Statements of SA GAAP). The fi nancial

statements are therefor prepared and

reported on accordingly.

The Medical Supplies Depot has a re-packing

function, where bulk medicine is repacked

into patient ready packs. The re-packing

expenses are recovered from the normal

levy charged. Managers for each cost centre

were identifi ed and procedures to ensure

the completeness of stock requisitioning

and receiving were designed. Cost centre

implementation was further enhanced for

the fi nancial year ending 31 March 2013

where various implementation concerns

were addressed and are frequently reviewed.

It is possible to reconcile the relevant cost

centres with the records of the fi nance

section. This will further enhance the

monitoring of some expense items through

a budget process.

The Acting Chief Director: Pharmaceutical

Services of Gauteng Department of Health

was appointed as the Acting Chief Executive

Offi cer of the Depot. The Chief Executive

Offi cer’s duties are time-apportioned in an

equal split (50:50) between the Depot and

the Department. The Gauteng Department of

Health carries the compensation expenses

of the Acting Chief Executive Offi cer.

1.1 Signifi cant events that have taken place during the year

Implementation of the New Gauteng Department of Health Turnaround Strategy

Turnaround Strategy

The Department is pleased to inform the

public that in order to bring about the

much needed improved health services in

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the province, a Turnaround Strategy with

the primary objective of transforming the

Department towards effective service

delivery and achieving a clean audit in 2014

was developed for implementation from

April 2012. The Medical Supplies Depot as its

trading entity was also affected by changes

in the turnaround strategy for alignment

purposes.

New Key Management Personnel

The implementation of the Turnaround

Strategy required that some form of

restructuring took place not only at

Departmental level but also at the Medical

Supplies Depot. These new changes

culminated in, for instance, the appointment

of Mrs Nocawe Thipa as the Depot’s Acting

Chief Executive Offi cer (CEO) effective

from 15 March 2012. This being a key

management position, the Department is

prioritizing, among other things, the fi lling of

this position with a more permanent offi ce

bearer.

Re-engineering the Depot’s Processes

In line with the Turnaround Strategy, the

Depot’s people, systems and processes

in the procurement and warehousing

functional areas have been assessed by

the re-engineering team of consultants

from Supply Chain Management Services

(SCMS) funded by the USAID. Phase one:

situation analysis and phase 2: solution

development were completedduring the year

whilst phase 3: implementation of solutions

is 99% complete and phase 4: Handover is

expected to be completed in October 2013.

A key position already identifi ed by re-

engineering team is that of quality assurance

manager who will ensure that processes and

procedures are monitored. Management is

pleased to report that this critical post was

fi lled and the manager reported for duty on

1 May 2013.

Revival of the Provincial Pharmacy and Therapeutics Committee (PPTC)

The Provincial Pharmacy and Therapeutics

Committee has been revived. Through

its subcommittees (Formulary, Rationale

medicine use, Safety & quality and

Procurement advisory subcommittees), it

will assist in:

• the standardisation of medicines

used in accordance with the Essen-

tial Drugs Programme

• the rationale utilisation of medicines

aligned to evidence-based medicine

principles.

• Improved medicine procurement

through the tender system and de-

termination of pack sizes to be re-

packed or purchased

• Refi ning the provincial medicine for-

mulary such that non-EDL medicines

allowed for use are not greater than

20% of the total medicines used

• Monitoring of expenditure on medi-

cines using the ABC analysis where

A medicines are those that consume

80% of the budget, B medicines 15%

of the budget and C medicines 5%

of the budget. On a quarterly basis,

medicine utilisation review is done

focussing primarily on the A medi-

cines.

It is therefore expected that the cost of

medicines used will be reduced.

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Capitalisation of G-Fleet motor vehicles

The Depot had a total of 5 G-Fleet motor vehicles during the year under review of which 4 met the criteria for fi nance lease and 1 motor vehicle continued to be treated as an operating lease. The capitalisation of these vehicles result in fi nance charges amounting to R237 417 (2012: R269 153), refer to note 12 to the fi nancial statements.

Spending Trends

A summary of major spending trends indicates that medicines price increased at a rate higher than the consumer price index (CPI). This has the effect that revenue increases at a higher rate and has

a favourable influence on the net profi t of the Depot. Cost containment measures were implemented which further improved the net profi t, unfortunately non-delivery by suppliers due to non-payment still occurred but frequent timely payment occurred from November 2012. This also had an impact on the priority objective of the Depot in ensuring the availability of essential medicines and medically related items. Items not on the Essential Medicines List that used to be procured through the Gauteng Department of Finance (GDF) are procured via the Depot’s buy-out function since July 2009

and has dramatically increased the turnover

of the Depot.

Major accounts

Description 2013 Amount R

Variance from Prior

year

2012 Amount R Variance from Prior

year

2011 Amount R

Variance from

Prior year

2010 Amount R

Revenue 2 928 979 725 22.09% 2 399 029 813 (10.03)% 2 666 262 368 17.91% 2 261 431 896Expenditure: Personnel

48 684 146 4.07% 46 778 513 5.86% 44 188 916 44.25% 30 635 305

Expenditure: General

37 560 706 10.00% 34 094 761 (18.03)% 41 590 596 (61.99)% 109 401 037

Net profi t / (loss)

35 205 211 >100% (65 738 035) (246.87)% 44 761 981 >100% (9 553 798)

Personnel expenses increased as more

scarce skills posts on the staff establishment

were fi lled. A general moratorium on the

fi lling of posts were in place for other posts.

The Depot management has identifi ed areas

where career development constraints

exist and where risks identifi ed need to be

addressed. The proposed organisational

structure that was forwarded to our Head

Offi ce has been reviewed, amended and

approved. The vacancies were not fi lled due

to space limitations and other restrictions.

This exercise will continue after the re-

engineering processes project has been

completed.

2. Services rendered

The Medical Supplies Depot is responsible

for the effective and effi cient procurement,

quality testing, storage and distribution of

essential medicines and medically related

items to all the Provincial Health Care

Facilities in Gauteng. The Depot ensures that

Essential Medicines List (EML) medicines

336




and medically related items are available

to our clients at all times. This involves the

evaluation of medicine and surgical sundry

items for tender purposes, participation in

tender adjudication meetings, procurement

and distribution of these items, as well as

quality control of medicines distributed to

our institutions.

Quality control is carried out in a fully

equipped laboratory, where samples are

tested from each batch of medicines

received. The Depot’s laboratory is the

only laboratory in South-Africa where the

fi ndings on quality tests performed are also

communicated to other provinces.

Tariff policy

The tariff policy for the trading account

was approved on 1 April 1992 as per the

Exchequer Act, Act No. 66 of 1975. Approval

was granted for a fi ve percent levy on the

average carrying value of stock issued to

customer hospitals.

Free Service

The Depot does not provide any free

service. The quality control of the medicines

performed by the laboratory on site is part

of the administrative expenses of the Depot,

which are recovered as part of the fi ve

percent levy charge.

3. Capacity constraints

The Medical Supplies Depot delivers a vital

service to all the Health Care Institutions in

Gauteng.

Currently the Medical Supplies Depot

has 336 posts on the approved staff

establishment, with 117 vacant. The high

vacancy rate is as a result of compliance

with cost saving measures implemented in

the Department. Measures have been taken

to strengthen the operations of the Depot

and its management.

The average percentage of orders fulfi lled

on fi rst request improved from 73.25% for

the prior year to 76%. The service level was

also measured based on availability of stock

at institutional level which ranged between

80% – 85% for the same period.

In 2010/11, systems for measuring the

indicator "% of orders supplied to institutions

on fi rst requests" were strengthened, and

the actual performance is calculated

according to the following defi nition: "If an

order / request (which could consist of multiple

different items) is fulfi lled 100% within 24 hours,

then that order counts towards the achieving of

the target. If even one item is not captured as

part of the request within 24 hours, the order

does not count as being fulfi lled". This is an

extremely high standard to fulfi l, but it is

specifi c, measurable and time-bound. Also,

it holds the Depot to higher standards as

meeting orders within 24 hours could have a

life-saving impact at the level of institutions.

However, the more rigorous monitoring

system makes it appear that performance is

lower than planned.

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A constraint to ensure effective, economical

and effi cient reporting exists in that

information from various systems needs

to be manually collated. Information from

the following systems is used and involves

time-consuming reconciliation procedures

to enable compliance with Statements of SA

GAAP for disclosure purposes:• Basic Accounting System (BAS)

• Personnel and Salary Administration

System (PERSAL)

• Medical Stock Administration Sys-

tem (MEDSAS)

• Asset Management System (ASSET-

WARE)

• Manual systems to perform reconcil-

iation procedures and accrual based

accounting

4. Utilisation of donor funds

The Depot receives a donation of Nevirapine

Solution and Tablets from Boehringer

Ingelheim for the Prevention of Mother-to-

Child Transmission of HIV, and a further

donation of Fluconazole from Pfi zer

Laboratories for use by AIDS patients with

Oesophageal Candidiasis and Cryptococcal

Meningitis. This type of donor funding is

received on a continuous basis.

ITEM DESCRIPTION

Supplied by/

Arranged by

QUANTITY ISSUED

Current Market Value

per Unit (Single Exit

Price – (SEP)

Total SEP Value

Fluconazole Powder for oral suspension

50mg/5ml 35mlNDoH 600 R 168.94 R 101 364.00

Fluconazole Injection 2mg/ml, 100ml NDoH 9 000 R 163.93 R 1 475 370.00

Fluconazole tablets 200mg 28’s NDoH 26 017 R1 954.43 R 50 848 405.31

Nevirapine Tablets 200mg 60,s NDoH 20 R 193.61 R 3 872.20

Total R 52 429 011.51

The quantity of medicine, received and

issued, and the approximate value of the

donations for the fi nancial year under review

are as follows:

The current market value of the donation

issued is approximately R52 429 011.51 for

the tablets and powder suspension. This

medicine was issued and charged at a value

of one-hundredth of one cent (R0.0001) to

all clients of the Depot. The total charge to

health institutions for donations received

amounted to R3.62.

Please note that the Depot does not account

for the economic benefi t received in the

Statement of Comprehensive Income, as

the Depot is considered to be only a conduit

for hospitals and to control the receipt of

donations for the Department.

US-Aid Funding for re-engineering the

Depot’s Processes

The re-engineering of the Depot processes

was funded by US-Aid (Implementation

partner of Presidents Emergency Plan For

Aids Relief - PEPFAR). In April 2012 SCMS

completed a 4 week survey of the Auckland

338




Park Medical Supplies Depot (MSD).

Procurement was identifi ed as an area of

weakness within the GDoH supply chain,

and the SCMS Survey Report indicated that

Contract Compliance could conservatively

achieve R30 million savings for GDoH with

regard to improved contract compliance.

(The total Project target for all improvements

was set at R116 Million in the SCMS Survey

Report)

Subsequently, the SCMS project was given

the green light and the projects’ phase

2 started in August 2012. The project

procurement stream was established with

senior managers at MSD and facilitated

by SCMS Technical advisors. This project

became known as “Kenako Kitima”. Please

note that the cost of the project is unknown.

One of the key benefi ts from the project

was the fact that a contract database was

developed to assist in ensuring compliance

national and provincial contracts. The

contract compliance database developed by

SCMS and implemented with MSD support

to improve contract compliance for National

(HP) contracts has resulted in undiscounted

savings amounting to R95million in the

fi nancial year. Back orders was reduced.

Warehouse management practices were

improved with the introduction of trolley

consolidations, streamlining of schedules

for supervisors that assists in effective staff

utilisation. Quality assurance processes

were improved with a complete overhaul of

the standard operating procedures coupled

with it. Internal audits were done and a

process to allow for interim contracts are

under way which will save management

time. Training was provided to both Depot

personnel and to procurement managers of

health institutions on stock management to

enhance sustainability of the implemented

processes.

5. Trading entities

The Medical Supplies Depot operates as a

trading entity, also known as “The Central

Medical Trading Account” since 1 April 1992.

The trading entity acts as a shared supply

chain for the procurement and provisioning

of pharmaceutical and surgical sundry items

to the Department’s Health Care Institutions

in Gauteng.

Comparative information

A four year comparative analysis of major

accounts is disclosed under paragraph 1

above.

6. Organisation to whom transfer payments have been made

No transfer payments have been made by

the Depot in this fi nancial year.

7. Public/Private Partnership (PPP)

No Public Private Partnership has been

entered into by the Depot in this fi nancial

year.

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The following non-core services have

been outsourced to the private sector of

which consist mostly of Black Economic

Empowerment companies:

• Maintenance and support of the

MEDSAS computer system.

• Distribution of stock to health care

institutions.

• Security of the property and vehicle

access control.

• Maintenance, pest control and minor

landscaping of the garden at the De-

pot.

• General maintenance contracts,

such as lifts, air conditioners, stand-

by generator, fi re equipment and ac-

cess control mechanisms.

Refer to note 21 of the fi nancial statements

for operating lease and commitments detail.

8. Corporate governance arrangements

Management, with the objective of

safeguarding the assets of the Depot and

ensuring a high quality of service delivery,

performs an annual risk assessment. The

following fi nancial risks were prioritised:

• A system was developed to reconcile

creditors and to ensure recovery and

payment of over- or under- payments

made.

• Debtors control was introduced to

ensure that revenue is collected

timeously and outstanding orders

are cleared.

• A reconciliation procedure was im-

plemented whereby hospitals recon-

cile stock received, with charges on

their accounting system (BAS) and

MEDSAS (Budget Expenditure Re-

port).

• The asset management system (AS-

SETWARE) was implemented and all

assets are recorded and capitalized.

• The Depot’s controls and operations

are evaluated together with the Au-

dit Committee of the Department of

Health and Social Development.

• The Depot utilises and follows the

Fraud Prevention Plan of the Depart-

ment of Health and Social Develop-

ment.

Management uses risk assessments and

reports of both internal and external audit on

a monthly basis in order to identify areas for

improvement of the operations of the Depot.

Updated reports made available are being

used to strengthen the implementation

of risk management and fraud prevention

plans at the Medical Supplies Depot. An

updated risk assessment for all operations

at the Depot was completed in March 2012.

9. Discontinued activities

No activities were discontinued during the year under review.

10. New / proposed activities

The re-engineering of the Medical Supplies

Depot project underway referred to in

paragraph 1.1 above which is nearing

completion is expected to recommend

a more effective inventory management

system, among other things.

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11. InventoriesThe valuation method used by the Medical Supplies Depot is the moving weighted average method

as per the MEDSAS:

Medicine and medically related items

2013

R

2012

R

2011

R

2010

R

Closing stock 164 252 270 104 130 374 147 332 339 155 419 885

Medicine and medically related items

2013

R

2012

R

2011

R

2010

R

Breakages 27 584 24 753 114 107 103 195

Expired stock 2 648 327 2 332 284 3 290 151 3 713 103

The value of breakages and expired stock

combined for the fi nancial years ended

31 March 2013 and 2012 represents

0.09% and 0.10% of a percent of turnover

respectively. The main reason for expired

stock relates to the fact that the Medical

Supplies Depot receives late communication

regarding regimen changes, for instance,

for TB treatment resulting in doctors not

prescribing the already stocked medicines.

Control measures in place

Whilst the long term solutions for ensuring

effi cient and effective stock management

at the depot require an appropriate infra-

structure (new warehouse), an integrated

information system and adequate workforce

in terms of numbers and skills, the following

short term controls have been instituted:

• Shelf marshals have been appointed

to monitor expiry dates and identify-

ing items expiring in 6 months.

• Stock on hand is fi rst issued before

replacement items are issued when

regimens (treatment protocols) are

changed.

• Reviewing the list of items to be kept

at the Depot.

• Discuss regimen changes with Na-

tional Department of Health to align

with current stock levels

12. Events after the reporting date

12.1 Forensic investigation

A forensic investigation was requested by

the Head of Department: Health and Social

Development with regards to irregularities

at the medical Supplies Depot and the

investigation commenced on Monday, 7 May

2012. This investigation was completed in

the 2012/2013 fi nancial year and the report

was provided to the relevant authorities who

are taking the necessary steps as per the

outcomes of the report which led to three

senior managers and one manager being

suspended with pay on 4 June 2013.

341




The Department has promised a speedy

fi nalization of due processes.

13. Information on predetermined objectives

The Gauteng Department of Health's

Strategic Plan, 2009 to 2014 was used as a

basis for developing the Depot’s Operational

Plan. This approach ensured that the

Depot’s predetermined objectives are clearly

aligned to those of the Department as far as

the Depot’s relevance to the Department is

concerned.

For the year under review, the Depot had a

total of seven (7) predetermined objectives

which were reported on quarterly. Each

of the seven objectives had at least one

indicator whose measurement variable

inputs were collected either through the

current IT Systems in use such as MEDSAS

whilst other input information was collected

manually or a combination of IT and manual

systems.

The key performance indicators per the

operational plan based on measurable

objectives and our actual achievement are

reflected in the table below:

No.Key Performance

Indicator

Target for the fi nancial year

ended 31 March 2013

Percentage achieved at

fi nancial year ended 31 March

2013

Details on achievement of Target

1 Percentage of Essential Medicines List (EML) items available at the depot.

90% 74% The performance is far below the 90% target. This is mainly due to non-payment of suppliers by the entity during 2011/12 and part of 2012/13 as a result of cash flow challenges in the Department which negatively affected the supply of medicines and therefore stock levels at the Depot.

2 % of EML orders supplied to institutions on fi rst request.

90% 76% The service level and how fast the MSD provides EML items to institutions is also in many ways dependent on the EML availability hence linked to indicator No 1 above.

342




No.Key Performance

Indicator

Target for the fi nancial year

ended 31 March 2013

Percentage achieved at

fi nancial year ended 31 March

2013

Details on achievement of Target

3 Number of staff trained per annum on: MEDSAS (Drug Supply Management System) and Supply Chain Management (SCM)

10 18 Training is generally offered by Central Offi ce (Head Offi ce) with the Medical Supplies Depot (MSD) having little or no control over the type and frequency of training to be offered. The demand for training in the department is huge and therefore not enough depot staff are trained to management’s satisfaction.

Number of staff trained per annum on: Risk management, fi nancial management and performance management

10 15 Training is generally offered by Central Offi ce (Head Offi ce) with the Medical Supplies Depot (MSD) having little or no control over the type and frequency of training to be offered. The demand for training in the department is huge and therefore not enough depot staff are trained to management’s satisfaction.

4 % expired stock on average stock holding

< 2.00% 0.44% Performance target met

5 Laboratory Testing Turnaround time not to exceed 48 hours of working days

95% 99.0% Performance target met

6 Number of Pre-packed stock units

4 000 000 units 3 941 392 units Performance target not met (short by 58 608)

7 % completion of timely

reports of and review

of identifi ed Key Control

Accounts . (Refer to

Monitoring Tool for

Performance Info:

Objective No 7)

>70 % 80% Performance target met

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Given the performance results above, the

Depot achieved 4 out of the 7 objectives.

Management is however not satisfi ed with

the annual average performance level

of 74% relating to the availability of EML

items as this measurement relates to the

core purpose of the Depot. This objective

outweighs the supporting objectives in

the value chain of the Depot. It is however

encouraging that the continued payment

of suppliers which is one of the key factors

in achieving good results is taking place.

Coupled with the re-engineering process

as mentioned in paragraph 1.1 above,

management is confi dent that the service

level will continue to improve.

14. SCOPA Resolutions

There were no adopted resolutions for the

Medical Supplies Depot (MEDSAS) for the

year ended 31 March 2012.

15. Prior modifi cations to audit report

The turnaround strategy referred to in

paragraph 1 above is intended to address,

among other things, risks identifi ed by the

Auditor-General as well as the Internal Audit

and improve future audit outcomes.

The following are issues emanating from the

previous audit report:

Nature of qualifi cation (Extracted from Auditor-General report)

Financial year in which

the matter fi rst arose

Progress made in resolving the matter

Material stock losses (Asset management)

As disclosed in note 3 to the fi nancial

statements, material stock losses to the

amount of R3 404 258 (2009-10: R3 816

298) was incurred as a result of stock

breakages and expired stock.

2009/10 • The Depot’s Operational Plan for

2011/12 was revised to include

the objective “Ensure minimum

levels of expired stock” as a con-

tinuous monitoring tool for this

(risk) stock losses in the form of

expiry and breakages. Although

this objective is reported on

quarterly with the other Pre-de-

termined objectives, management

has actually gone further to

report monthly on this particular

objective as an additional control

measure. (Refer to paragraph 11

for control measures in place)

344








Financial and Performance management -

(Internal Control defi ciencies)

Management did not implement controls

over daily and monthly processing and

reconciling of transactions.

2010/11 • The depot’s operational Plan for

2011/12 was revised to include

Key Pre-determined Performance

Objectives which are “SMART”. In

particular, objective No 7 “Im-

proved Financial management

and internal control system”

with performance indicator “ %

completion of timely reports and

review of Key Control Accounts”

is earmarked for improving these

areas as the name suggests.

• A checklist/ monitoring tool has

been developed which identifi es

all Key Control Accounts and their

reporting timeframes. On-going

supervision and review is key to

this process.

Payments not made within 30 days

Payments due to creditors amounting

to Rx at year end were not settled within

30 days from receipt of an invoice as per

the requirements of section 38(1) (f) of

the PFMA as well as TR 8.2.3. Further

non compliance amounting to Rx was

identifi ed for audit procedures performed on

payments made during the year which was

not settled within 30 days from receipt of an

invoice as per the above requirements.

2010/11

&

2011/12

• Normality is being restored in

compliance with Section 38.f of

the Public Finance Management

Act, (Act 1 of 1999). Conse-

quently, the Depot has reported

an amount due to suppliers of

R262 787 394 in comparison

with that of 2012: amounting

to R900 657 700 (refer to note

9 to the fi nancial statements).

The current year fi gure relates to

current invoices only.

345








Surrender of funds at year end An

accounting offi cer of a department

operating a trading entity must, at the end

of each fi nancial year and after books of

account have been closed, declare any

surplus to the relevant treasury. The relevant

treasury may apply such surplus to reduce

any proposed allocation to the trading

entity, or require that all or part of it be re-

deposited in the Exchequer bank account.

The accounting offi cer did not at the end of

the fi nancial year declare the net surplus for

the 31 March 2011 fi nancial year end to the

Provincial Treasury as required by section

30(2)(g) and 31(2)(g) of the PFMA and TR

6.4.

2009/10 • The challenge for the 2009/10

fi nancial year was the fact that

the depot obtained a disclaimer

audit opinion hence it was not

possible to determine the extent

of the prior period error until such

a time that the Auditor-General

had concluded the 2010/11 audit.

• After the Auditor-General issued

an Unqualifi ed audit opinion in

respect of the 2010/11, it was

possible to determine the exact

profi t. We are pleased to report

that a submission was made to

the Provincial Treasury during Au-

gust 2011 declaring and therefore

surrendering outstanding profi ts.

This matter has therefore been

resolved.

16. Exemptions and deviations received from the Treasury

The Depot has no record of any new

exemptions and deviations either from the

Gauteng Provincial Treasury or the National

Treasury.

17. Other

The Depot was still incurring a cost relating

to price increases not recovered from

demanders. This is mostly attributable to

the back dated approval of contract price

increases by the Gauteng Department of

Finance.

18. Approval

The annual fi nancial statements set out on

pages 351 to 382 have been approved by

the Accounting Offi cer.

Ndoda Biyela

Acting Head of Department

31 May 2013

346



REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON THE GAUTENG MEDICAL SUPPLIES DEPOT

Introduction

1. I have audited the fi nancial statements of the Gauteng Medical Supplies Depot (MSD), set out on pages 351 to 382, which comprise the statement of fi nancial position as at 31 March 2013, the statement of comprehensive income, statement of changes in equity and statement of cash flows for the year then ended, and the notes, comprising a summary of signifi cant accounting policies and other explanatory information.

Accounting offi cer’s responsibility for the fi nancial statements

2. The accounting offi cer is responsible for the preparation of these fi nancial statements in accordance with South African Statements of Generally Accepted Accounting Practice ( SA Statements of GAAP) and the requirements of the Public Finance Management Act, 1999 (Act No.1 of 1999) (PFMA), and for such internal control as the accounting offi cer determines necessary to enable the preparation of fi nancial statements that are free from material misstatement, whether due to fraud or error.

Auditor-General’s responsibility

3. My responsibility is to express an opinion on these fi nancial statements based on my audit. I conducted my audit in accordance with the Public Audit Act of South Africa, 2004 (Act No. 25 of 2004) (PAA), the General Notice issued in terms thereof and International Standards on Auditing. Those standards require that I comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the fi nancial statements are free

from material misstatement.

4. An audit involves performing procedures

to obtain audit evidence about the

amounts and disclosures in the fi nancial

statements. The procedures selected

depend on the auditor’s judgement,

including the assessment of the risks of

material misstatement of the fi nancial

statements, whether due to fraud or error.

In making those risk assessments, the

auditor considers internal control relevant

to the trading entity’s preparation and fair

presentation of the fi nancial statements in

order to design audit procedures that are

appropriate in the circumstances, but not

for the purpose of expressing an opinion

on the effectiveness of the entity’s internal

control. An audit also includes evaluating

the appropriateness of accounting policies

used and the reasonableness of accounting

estimates made by management, as well

as evaluating the overall presentation of the

fi nancial statements.

5. I believe that the audit evidence I have

obtained is suffi cient and appropriate to

provide a basis for my audit opinion.

Opinion

6. In my opinion, the fi nancial statements

present fairly, in all material respects,

the fi nancial position of the MSD as

at 31 March 2013, and its fi nancial

performance and cash flows for the

year then ended in accordance with SA

Statements of GAAP and the requirements

of the PFMA.

347




REPORT ON OTHER LEGAL AND REGULATORY REQUIREMENTS

7. In accordance with the PAA and the General

Notice issued in terms thereof, I report the

following fi ndings relevant to performance

against predetermined objectives,

compliance with laws and regulations and

internal control, but not for the purpose of

expressing an opinion.

Predetermined objectives

8. I performed procedures to obtain evidence

about the usefulness and reliability of the


matrix as set out on pages 342 to 343 of

the annual report.

9. The reported performance against

predetermined objectives was evaluated

against the overall criteria of usefulness

and reliability. The usefulness of


report relates to whether it is presented in

accordance with the National Treasury’s

annual reporting principles and whether the

reported performance is consistent with

the planned objectives. The usefulness

of information further relates to whether

indicators and targets are measurable

(i.e. well defi ned, verifi able, specifi c,

measurable and time bound) and relevant

as required by the National Treasury

Framework for managing programme

performance information. The reliability of

the information in respect of the selected

objectives is assessed to determine

whether it adequately reflects the facts (i.e.

whether it is valid, accurate and complete).

10. There were no material fi ndings on the

annual performance report concerning the

usefulness and reliability of the information.

Compliance with laws and regulations

11. I performed procedures to obtain evidence

that the entity has complied with applicable

laws and regulations regarding fi nancial

matters, fi nancial management and other

related matters. My fi ndings on material

non-compliance with specifi c matters in

key applicable laws and regulations as set

out in the General Notice issued in terms of

the PAA are as follows:

Annual fi nancial statements

12. The fi nancial statements submitted for

auditing were not prepared in accordance

with the prescribed fi nancial reporting

framework as required by section 55(1)

(a) and) (b) of the PFMA. Material

misstatements identifi ed during the audit

were subsequently corrected. Material

misstatements identifi ed during the audit

were subsequently corrected, resulting

in the fi nancial statements receiving an

unqualifi ed audit opinion.

Asset management

13. Proper control systems to safeguard and

maintain inventory were not implemented,

as required by section 38(1)(d) of the PFMA

and Treasury Regulation (TR)10.1.1(a).

Expenditure management

14. The accounting offi cer did not take effective

steps to prevent and detect irregular and

fruitless and wasteful expenditure as

required by section 38(1)(c)(ii) and 39(1) (b)

of the PFMA.

348




15. Contractual obligations and money owed

by the trading entity were not settled within

30 days or an agreed period, as required by

section 38(1)(f) of the PFMA and TR8.2.3.

Procurement and contract management

16. Goods and services with a transaction value below R500 000 were procured without obtaining the required price quotations, as required by TR16A6.1.

17. Goods and services of a transaction value above R500 000 were procured without inviting competitive bids, as required by TR16A6.1. Deviations were approved by the accounting offi cer even though it was not impractical to invite competitive bids, in contravention of TR16A6.4.

18. Quotations were awarded to suppliers whose tax matters had not been declared by the South African Revenue Services to be in order as required by TR16A9.1 (d) and Practice Note 8 of 2007-08.

Internal control

19. I considered internal control relevant to my audit of the fi nancial statements, the annual performance report and compliance with laws and regulations. The matters reported below under the fundamentals of internal control are limited to the signifi cant defi ciencies that resulted in the basis for an unqualifi ed opinion, the fi ndings on the annual performance report and the fi ndings on compliance with laws and regulations included in this report.

Leadership

20. There was no formal code of ethics at the entity and many instances of management override and cases of fraud and theft are being investigated as indicated under the

“other reports” section of this report.

21. Inadequate oversight and monitoring

responsibility over certain documented

policies and procedures, resulting in certain

instances of non compliance with the

PFMA.

22. An action plan was developed to address

internal and external audit fi ndings and

adherence to the plan was monitored on a

monthly basis by the appropriate level of

management, however the action plan was

not implemented timorously and key prior

year fi ndings there for re-occurred during

the current year audit.

Financial and performance management

23. The fi nancial statements submitted for

audit were subject to material amendments

due to inadequate and untimely review

for completeness and accuracy prior to

submission for audit.

24. Management did not comply with certain

laws and regulations.

25. Management did not always implement

proper record keeping in a timely manner

to ensure that complete, relevant and

accurate information was accessible and

available to support fi nancial reporting.

26. Management did not implement controls

over daily and monthly processing and

reconciling of transactions.

349


Department of Health Vote 4REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON THE GAUTENG MEDICAL SUPPLIES DEPOT

OTHER REPORTS

Investigations

An investigation was conducted by an independent

consulting fi rm on request of the accounting

offi cer. The investigation was initiated based on

concerns surrounding the procurement process.

The investigation has resulted in four suspensions

and other disciplinary proceedings. Certain

individuals have resigned from the employment

of MSD due to number of transgressions revealed

from the investigation.

Johannesburg

31 July 2013

350



GAUTENG MEDICAL SUPPLIES DEPOTSTATEMENT OF FINANCIAL POSITIONas at 31 March 2013.

2013 2012

Note R R

ASSETS

Non-current assets 8 319 318 9 585 040

Property, plant and equipment 2 8 319 318 9 585 040

Current assets 470 421 319 1 056 238 980

Inventories 3 164 252 270 104 130 374

Trade and other receivables 4 305 118 256 944 218 177

Cash and cash equivalents 5 1 050 793 7 890 429

Total assets 478 740 637 1 065 824 020

EQUITY AND LIABILITIES

Equity

Capital and reserves 193 828 513 158 623 302

Medsas capital account 6 104 376 790 104 376 790

Retained earnings 89 451 723 54 246 512

Non-current liabilities 728 291 744 461

Finance lease obligation 7 728 291 744 461

Current liabilities 284 183 833 906 456 257

Leave accruals 8 2 966 266 2 607 150

Trade and other payables 9 280 777 721 903 188 014

Finance lease obligation 7 439 846 661 093

Total equity and liabilities 478 740 637 1 065 824 020

351



GAUTENG MEDICAL SUPPLIES DEPOTSTATEMENT OF COMPREHENSIVE INCOMEfor the year ended 31 March 2013.

Revenue 10 2 928 979 725 2 399 029 813

Cost of sales 24 (2 803 521 784) (2 381 948 004)

Gross profi t 125 457 941 17 081 809

Other income 10 66 781 73 385

Operating expenditure 11 ( 86 244 852) ( 80 873 274)

Distribution cost ( 11 876 523) ( 11 308 665)

Administrative expenses ( 66 246 334) ( 64 812 172)

Other expenses ( 8 121 995) ( 4 752 437)

Operating profi t/ (loss) 39 279 870 ( 63 718 080)

Finance income ( 79 080 816) 2 014 207

Finance cost 12 75 006 157 ( 4 034 162)

Profi t\ (loss) before taxation 35 205 211 ( 65 738 035)

Taxation 13 - -

Profi t/ (loss) for the year 35 205 211 ( 65 738 035)

Other comprehensive income, net of tax: - -

Total comprehensive income/ (loss) attributable to:

Gauteng Department of Health 35 205 211 ( 65 738 035)352



GAUTENG MEDICAL SUPPLIES DEPOTSTATEMENT OF CHANGES IN EQUITYfor the year ended 31 March 2013.

MEDSAS capital account

Retained earnings

Total

Note R R R

Balance at 31 March 2011 6 104 376 790 119 984 547 224 361 337

Loss for the year - ( 65 738 035) ( 65 738 035)

Balance at 31 March 2012 104 376 790 54 246 512 158 623 302

Profi t for the year - 35 205 211 35 205 211

Balance at 31 March 2013 104 376 790 89 451 723 193 828 513

353


Department of Health Vote 4GAUTENG MEDICAL SUPPLIES DEPOTSTATEMENT OF CASH FLOWSfor the year ended 31 March 2013.

2013 2012

Note R R

Cash fl ows from operating activities

Cash generated by operations 14 (5 006 123) 5 604 662

Interest income - 2 014 207

Finance costs 12 - (4 034 162)

Net cash generated by operating activities (5 006 123) 3 584 707

Cash fl ows from investing activities

Purchase of property, plant and equipment 2 (1 088 042) (2 822 206)

Proceeds on disposal of property, plant and equipment 18 963 494 363

Net cash utilized by investing activities (1 069 079) (2 327 843)

Cash fl ows from fi nancing activities

Finance lease obligation ( 764 434) 946 416

Net cash (utilized)/ generated by fi nancing activities ( 764 434) 946 416

Net (decrease)/ increase in cash and cash equivalents (6 839 636) 2 203 280

Cash and cash equivalents at the beginning of the year 5 7 890 429 5 687 149

Cash and cash equivalents at the end of the year 5 1 050 793 7 890 429

354

GAUTENG MEDICAL SUPPLIES DEPOTNOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2013.



1. ACCOUNTING POLICIES

The annual fi nancial statements were prepared in accordance with Statements of South African

Generally Accepted Accounting Practice (Statements of SA GAAP) and the Public Finance

Management Act, 1999 (Act No. 1 of 1999) as amended by the Public Finance Management

Amendment Act (Act No. 29 of 1999).

The following are the principal accounting policies of the Depot which are, in all material respects,

consistent with those applied in the previous year, except as otherwise indicated:

1.1 Basis of preparation

The fi nancial statements were prepared on the historical cost basis and incorporate the principal

accounting policies set out below.

1.2 Revenue recognition

Revenue is recognised when it is probable that future economic benefi ts will flow to the Depot and

these benefi ts can be measured reliably. Revenue is measured at the fair value of the consideration

received or receivable.

Revenue from the sale of goods is recognised when signifi cant risks and rewards of ownership of

the goods have been transferred to the buyer.

1.3 Irregular and fruitless and wasteful expenditure

Irregular expenditure means expenditure incurred in contravention of, or not in accordance with, a

requirement of any applicable legislation, including:

• The PFMA, or

• Any provincial legislation providing for procurement procedures in that provincial govern-

ment.

Fruitless and wasteful expenditure means expenditure that was made in vain and would have been

avoided had reasonable care been exercised.

All irregular and fruitless and wasteful expenditure is charged against income in the period in which

they are incurred.

355




1.4 Employee costs

1.4.1 Short-term employee benefi ts

The cost of short-term employee benefi ts is expensed in the Statement of Comprehensive Income

in the reporting period when the payment is made. Short-term employee benefi ts, that give rise

to a present legal or constructive obligation, are deferred until they can be reliably measured and

then expensed. Details of these benefi ts and the potential liabilities are disclosed as a disclosure

note to the fi nancial statements where applicable and are not recognised in the Statement of

Comprehensive Income.

1.4.2 Termination benefi ts

Termination benefi ts are recognised and expensed only when the payment is made.

1.4.3 Retirement benefi t cost s

The Depot provides retirement benefi ts for its employees through a defi ned benefi t plan for

government employees. These benefi ts are funded by both employer and employee contributions.

Employer contributions to the fund are expensed when money is paid to the fund. No provision or

benefi t accounting is disclosed for retirement benefi ts in the fi nancial statements as the obligation

and plan assets is the responsibility of the multi-employer Government Employee Pension Fund

resorting under the control of National Treasury.

1.4.4 Medical benefi ts

The Depot provides medical benefi ts for its employees. These benefi ts are funded by employer and

employee contributions. Employer contributions to the fund are expensed when money is paid to the

fund. No provision is made for medical benefi ts in the fi nancial statements.

1.5 Property, plant and equipment

Property, plant and equipment are stated at cost less accumulated depreciation and any impairment

in value. Costs include costs incurred initially to acquire or construct an item of property, plant and

equipment and costs incurred subsequently to add to, replace part of, or service it.

If a replacement cost is recognised in the carrying amount of an item of property, plant and

equipment, the carrying amount of the replaced part is derecognised.

ACCOUNTING POLICIES (continued)

356




Depreciation is provided on all property, plant and equipment to write down the cost, less residual

value, on a straight line basis over their estimated useful lives as follows:

Classifi cation of assets Depreciation rates (Straight line method)

Fixtures and fi ttings

System alarm 20%

Building 2%

Irrigation systems 20%

Lifts and escalators 10%

Property and buildings 0% - 2%

Motor vehicles

Cars, minibuses, trucks 20%

Plant and Equipment

Air-conditioning 15%

Instruments 0%

Laundry equipment 15%

Medical equipment 15%

Vehicles 20%

Parking equipment 15%

Radio equipment 15%

Telephone system 15%

Workshop and tools 15%

Computer equipment

Computer equipment 33.3%

Offi ce furniture

Bed 15%

Crockery and cutlery 0%

Furniture and fi ttings 15%

Kitchen equipment 15%

Linen, curtains and mattresses 0%

Offi ce equipment 20%


357




Depreciation commences when the asset is available for use. Each part of an item of property,

plant and equipment with a cost that is signifi cant in relation to the total cost of the item shall be

depreciated separately. The depreciation charge for each period is recognised in profi t or loss unless

it is included in the carrying amount of another asset.

The carrying values of property, plant and equipment are reviewed for impairment when events

or circumstances indicate that the carrying value may not be recoverable. Impairment losses are

recognised in the Statement of Comprehensive Income.

The item of property, plant and equipment is derecognised upon disposal or when no future

economic benefi ts are expected from its use or disposal.

Valuations to property, plant and equipment are performed frequently enough to ensure that the fair

value of a revalued asset does not differ materially from its carrying amount.

1.6 Impairment

At each balance sheet date, the Depot reviews the carrying amounts of its tangible assets to

determine whether there is any indication that those assets may be impaired. For the year under

review no impairments were done. Assets that may not be effi ciently utilised for their intended use

were disposed of. If any such indication exists, the recoverable amount of the asset is estimated in

order to determine the extent of the impairment loss (if any). Where it is not possible to estimate

the recoverable amount for an individual asset, the recoverable amount is determined for the cash-

generating unit to which the asset belongs.

If the recoverable amount of an asset (cash-generating unit) is estimated to be less than its carrying

amount, the carrying amount of the asset (cash-generating unit) is reduced to its recoverable

amount. Impairment losses are immediately recognised as an expense, unless the relevant asset is

carried at a revalued amount under another standard, in which case the impairment loss is treated

as a revaluation decrease under the standard.

Where an impairment loss subsequently reverses, the carrying amount of the asset (cash-generating

unit) is increased to the revised estimate of its recoverable amount, but so that the increased

carrying amount does not exceed the carrying amount that would have been determined had no

impairment loss been recognised for the asset (cash-generating unit) in prior years.

A reversal of an impairment loss is recognised as income immediately, unless the relevant asset is

carried at a revalued amount under another standard, in which case the reversal of the impairment

loss is treated as a revaluation increase under that other standard.


358




1.7 Leasing/Operating contracts

1.7.1 Operating leases as the lessee

Leases of assets under which all the risks and rewards of ownership are effectively retained by the

lessor are classifi ed as operating leases. Payments made under operating leases are charged to the

Statement of Comprehensive Income on a straight-line basis over the period of the relevant lease.

1.7.2 Finance leases as the lessee

Leases of assets are classifi ed as fi nance leases whenever the terms of the lease transfer

substantially all the risks and rewards of ownership to the lessee. All other leases are classifi ed as

operating leases.

Assets held under fi nance leases are recognised as assets at their fair value at the inception of the

lease or, if lower, at the present value of the minimum lease payments. The corresponding liability

to the lessor is included in the Statement of Financial Position as a fi nance lease obligation. Lease

payments are apportioned between fi nance charges and reduction of the lease obligation so as to

achieve a constant rate of interest on the remaining balance of the liability. Finance charges are

charged to surplus or defi cit.

Leases of assets under which all the risks and rewards of ownership are effectively retained by the

lessor are classifi ed as operating leases.

Maintenance contracts as arranged by the Department of Transport, Roads and Public Works are

recognized as commitments, but not as payables. Refer to note 21.

1.8 Inventories

Inventory is measured at the lower of cost price and net realisable value (NRV). Net realisable value

is the estimated selling price in the ordinary course of business less the estimated costs of the

completion and the estimated costs necessary to make the sale. The cost of inventories comprises

of all costs of purchase, costs of conversion and other costs incurred in bringing the inventories to

their present location and condition. Inventories are stated at the weighted average moving basis.

The same cost formula is used for all inventories having a similar nature and use to the Depot. When

inventories are sold, the carrying amounts of those inventories are recognised as an expense in the

period in which the related revenue is recognised. The amount of any write-down, the period the

write-down or loss occurs. The amount of any reversal of any write-down of inventories, arising from

an increase in the net realisable value, are recognised as a reduction in the amount of inventories

recognised as an expense in the period in which the reversal occurs.


359




1.9 Financial instruments

Initial recognitio n

The Depot classifi es fi nancial instruments, or their component parts, on initial recognition as a

fi nancial asset, a fi nancial liability or an equity instrument in accordance with the substance of the

contractual arrangement.

Financial assets and fi nancial liabilities are recognised on the Depot’s Statement of Financial

Position when the Depot becomes party to contractual provisions of the instrument.

Financial instruments recognised on the Statement of Financial Position include trade and other

receivables, cash and cash equivalents and trade and other payables.

Trade and other receivable s

Trade and other receivables are measured at initial recognition at fair value, and are subsequently

measured at amortised cost using the effective interest rate method less any impairment.

Impairment is determined on a specifi c basis, whereby each asset is individually assessed for

impairment indicators. Appropriate allowances for estimated irrecoverable amounts are recognised

in profi t or loss when there is objective evidence that the asset is impaired.

Trade and other payable s

Trade and other payables are initially measured at fair value, and are subsequently measured at

amortised cost, using the effective interest rate method.

Cash and cash equivalents

Cash and cash equivalents comprise cash on hand and demand deposits and other short term

highly liquid investments that are readily convertible to a known amount of cash and are subject to

an insignifi cant risk of changes in value. These are initially and subsequently recorded at amortised

cost. Due to the short nature of cash, the amortised cost would equal the cash balance.

Gains and losses

A gain or loss from a change in a fi nancial asset or fi nancial liability is recognised as follows:

• Gains and losses on trade and other receivables and cash and cash equivalents are recog-

nised in income when receivables are derecognised or impaired.

• Gains and losses on trade and other payables are recognised in profi t and loss when liabili-

ties are derecognised.


360




Derecognition

Financial assets

Financial assets (or part thereof) are derecognised when the entity realises the rights to benefi ts

specifi ed in the contract, the right expires, or the company surrenders or otherwise loses control of

the contractual rights that comprise the fi nancial asset.

The rights to receive cash flows from the asset have expired; the entity retains the right to receive

cash flows from the asset, but has assumed an obligation to pay them in full without any material

delay to a third party under a ‘pass-through’ arrangement; or, the entity has transferred its rights to

receive cash flows from the asset and either has transferred substantially all the risks and rewards

of the asset; or has neither transferred nor retained substantially all the risks and rewards of the

asset but has transferred control of the asset.

Financial liabilities

Financial liabilities (or part thereof) are derecognised when the obligation specifi ed in the contract

is discharged, cancelled or expired.

Impairment of fi nancial instruments

The entity assesses on each balance sheet date whether a fi nancial asset of the entity is impaired.

Impairments are made when there is objective evidence that cash flows from specifi c fi nancial

assets would not materialise. Cash flow values estimated not to materialise are impaired. The

amount of the impairment is measured as the difference between the fi nancial asset’s carrying

amount and the present value of estimated future cash flows discounted at the effective interest

rate computed at initial recognition. The amount of the impairment is recognised in the Statement

of Comprehensive Income.

Off-setting of fi nancial instruments

Financial assets and fi nancial liabilities are offset, if a legally enforceable right exists to set off

fi nancial assets against fi nancial liabilities and the fi nancial instrument relate to the same entity.

1.10 Provisions

A provision is a liability of uncertain timing or amount. Provisions are recognised when the entity has

a present obligation, legal or constructive, as a result of a past event, it is probable that an outflow

of resources embodying economic benefi ts will be required to settle the obligation and a reliable

estimate can be made of the obligation.

The amount of a provision is the present value of the expenditure expected to be required to settle

the obligation. Contingent assets and contingent liabilities are not recognised as provisions as they

do not comply with the recognition criteria.


361




The Depot is not exposed to environmental liabilities relating to its operations.

1.11 Comparative fi gures

Where necessary, comparative fi gures have been adjusted to conform to changes in presentation

in the current year, limited to audited fi gures. Reasonably, calculated, comparative fi gures are

disclosed in the notes to the annual fi nancial statements for better understanding of changes that

have occurred in presentation.

1.12 Taxation

In terms of section 10.1 of the Income Tax Act, Act Number 59 of 1962, the Depot, as a government

institution, is not liable for any income taxation. Employees’ tax is paid over to SARS by the Gauteng

Department of Finance at the time when the employee expenses are programmatically recognised.

1.13 Presentation of fi nancial statements

The fi nancial statements are presented in South African Rand and amounts presented are rounded

to the nearest Rand.

1.14 Related parties

The Depot operates in an economic environment currently dominated by entities directly or indirectly

owned by the South African government. Other related party transactions are also disclosed in

terms of the requirements of the accounting standards.

1.15 Signifi cant judgements, estimates and assumptions

The preparation of annual fi nancial statements in conformity with Statements of SA GAAP requires

the use of certain critical accounting estimates. It also requires management to exercise its

judgment in the process of applying the company’s accounting policies in areas that involve a higher

degree of judgment or complexity, or areas where assumptions and estimates are signifi cant to the

fi nancial statements. Although these estimates are based on management’s best knowledge of

current events and actions they may undertake in the future, actual results may differ from these

estimates.

The key assumptions concerning the future and other key sources of estimation uncertainty at the

balance sheet date, that have a signifi cant risk of causing a material adjustment to the carrying

amount of the assets and liabilities in the next fi nancial year are listed below:

Estimates

Provisions

Provisions were raised and management determined an estimate based on the information available.


362




Property, plant and equipment

Management has made certain estimates with regards to the determination of estimated useful

lives and residual values of items of property, plant and equipment.

Judgments

Leases

Management has applied judgment to classify all lease agreements that the Depot is party to as

operating leases if the leases do not transfer substantially all risks and rewards of ownership to the

entity, or the other recognition criteria is met in terms of IAS 17 to classify leases as fi nance leases.

Impairment of trade receivables

Management has applied judgment in estimating the extent of any impairment deemed necessary

on the gross carrying value of trade receivables and have impaired all accounts in arrears for a

period longer than normal expected trading terms.

1.16 Cash and cash equivalents

Cash and cash equivalents are carried at face value. Cash and cash equivalents comprise cash on

hand and cash held in current accounts with registered and approved banks.

1.17 Borrowing costs

Borrowing costs that are directly attributable to the acquisition, construction or production of a

qualifying asset are capitalized as part of the cost of that asset. All other borrowing costs are

recognized as an expense in the period in which it occurs.

1.18 New standards and interpretations issued but not yet effective

The following new or revised fi nancial reporting standards, amendments and interpretations of

those standards which are applicable to the Depot are not yet effective for the year ended 31 March

2012 and were not applied in preparing these fi nancial statements.

On review of these amendments and interpretations, the impact (if any) has not yet been estimated,

or is not expected to have a material impact on the Depot’s fi nancial statements:


363




Standard or interpretation Title Effective date

IAS 1 (amendment) Presentation of

Financial Statements

• Annual periods beginning on or after 01

January 2011.

• Clarifi cation of statement of changes in

equity 01 January 2011.

• New requirements to group together

items within OCI that may be reclassifi ed

to the profi t or loss section of the income

statement in order to facilitate the as-

sessment of their impact on the overall

performance of an entity. 01 July 2012

IAS 19 Employee Benefi ts • Amendments to the accounting for cur-

rent and future obligations resulting from

the provision of defi ned benefi t plans 01

January 2013

IAS 24 (revised) Related Party

Disclosures


January 2011

IAS 32 Financial Instruments:

Presentation

• Amendments require entities to disclose

gross amounts subject to rights of set-

off, amounts set off in accordance with

the accounting standards followed, and

the related net credit exposure. This in-

formation will help investors understand

the extent to which an entity has set off

in its balance sheet and the effects of

rights of set-off on the entity’s rights and

obligations 01 January 2013

IAS 34 (amendment) Interim Financial

Reporting


January 2011.

IFRS 1

(amendment)

First-time Adoption of

IFRS


January 2011 and 01 July 2011

IFRS 7 (amendment) Financial Instruments:

Disclosures


January 2011.

IFRS 9

(new)

Financial Instruments • Annual periods beginning on or after 01

January 2013.

• New standard that forms the fi rst part

of a three-part project to replace IAS 39

Financial Instruments: Recognition and

Measurement 01 January 2015

364




Standard or interpretation Title Effective date

IFRS 13

(new)

Fair Value Measurement • Annual periods beginning on or after 01

January 2013.

1.19 Accounting for Black Economic Empowerment (BEE) transactions

The South African interpretation (AC 503) effective for annual periods beginning on or after 1 May

2006 is not applicable for the Depot. No share-based transactions are allowed for the Depot.

365




2. PROPERTY, PLANT AND EQUIPMENT

2013 2012

Cost/ valuation

Accumulated Depreciation

Carrying value at the end of the

year

Cost/Valuation

Accumulated Depreciation

Carrying value at

the end of the year

R R R R R R

Owned equipmentComputer equipment 5 833 665 (5 347 108) 486 557 5 679 749 (4 740 099) 939 650

Fixtures and fi ttings 5 161 247 (3 750 962) 1 410 285 5 136 395 (3 662 845) 1 473 550

Offi ce furniture 5 654 214 (3 761 551) 1 892 663 5 656 276 (3 050 084) 2 606 192 Plant and equipment 7 188 140 (3 438 676) 3 749 464 6 330 058 (2 550 728) 3 779 330

23 837 266 (16 298 297) 7 538 969 22 802 478 (14 003 756) 8 798 722

Leased assetsMotor vehicles- G-Fleet 946 416 ( 585 913) 360 503 946 416 ( 265 545) 680 871

Offi ce equipment 720 178 ( 469 037) 251 141 313 449 ( 244 292) 69 157

Cell phones 378 256 ( 209 550) 168 706 158 896 ( 122 606) 36 290

2 044 850 (1 264 500) 780 350 1 418 761 ( 632 443) 786 318

25 882 116 (17 562 797) 8 319 318 24 221 239 (14 636 199) 9 585 040

2013

Carrying value at the beginning of

the year

Additions Disposals/Impairment

Accumulative depreciation on disposal / impairment

Depreciation current year value at the end of the

year

Carryingvalue at

the end of the year

R R R R R R

Owned equipmentComputer equipment 939 650 154 450 ( 534) 204 ( 607 213) 486 557 Fixtures and fi ttings 1 473 550 24 852 - - ( 88 117) 1 410 285

Offi ce furniture 2 606 192 24 766 ( 26 828) 16 049 ( 727 516) 1 892 663 Plant and equipment 3 779 330 883 974 ( 25 892) 14 501 ( 902 449) 3 749 464

8 798 722 1 088 042 ( 53 254) 30 754 (2 325 295) 7 538 969

Leased assets

Motor vehicles – gFleet 680 871 - - - ( 320 369) 360 502

Offi ce equipment 69 157 406 729 - - ( 224 745) 251 141

Cell phones 36 290 219 360 - - ( 86 943) 168 707

786 318 626 089 - - ( 632 057) 780 350

9 585 040 1 714 131 ( 53 254) 30 754 (2 957 352) 8 319 319

366




2. PROPERTY, PLANT AND EQUIPMENT (Continued) 2012

Carrying value at the beginning of

the year

Additions Disposals/ Impairment

Accumulative depreciation on disposal / impairment

Depreciation current year

Carryingvalue at the end of the

yearR R R R R R

Owned equipmentComputer equipment 1 106 234 631 591 ( 174 920) 166 535 ( 789 790) 939 650 Fixtures and fi ttings 1 407 584 160 790 - - ( 94 824) 1 473 550 Offi ce furniture 3 371 535 226 810 ( 228 636) 111 801 ( 875 318) 2 606 192 Plant and equipment 3 852 145 775 476 ( 108 886) 78 285 ( 817 690) 3 779 330

9 737 498 1 794 667 ( 512 442) 356 621 (2 577 622) 8 798 722 Leased assetsMotor vehicles - 946 416 - - ( 265 545) 680 871 Offi ce equipment 283 383 78 076 ( 195 353) - ( 96 949) 69 157 Cell phones 102 217 3 047 ( 51 299) - ( 17 675) 36 290

385 600 1 027 539 ( 246 652) - ( 380 169) 786 318 10 123 098 2 822 206 ( 759 094) 356 621 (2 957 791) 9 585 040

3. INVENTORIES2013 2012

R R

Trading stock - Main warehouse 115 142 050 80 224 099

Trading stock - Pre-pack store 6 411 962 5 592 246

Trading stock - ARV store 42 109 286 17 799 247

Operational stock 588 972 514 782

164 252 270 104 130 374

The valuation method used by the Depot was the weighted average moving basis based on cost price. There were no impairment of inventory raised at 31 March 2013 (2012: Nil). Management has assessed impairment at year end individually and based on this assessment no impairment of inventory has been raised.

2013 2012

R R

Breakages 27 584 24 753

Expired stock 2 648 327 2 332 284

2 675 911 2 357 037

Stock shortage of R2 283 151 (2012: R1 306 894) were recognised during the year. Damaged

and obsolete stock is excluded from the total inventory value shown above. No write down of

inventory to net realisable value was required at fi nancial year end (2012: Nil).

367




4. TRADE AND OTHER RECEIVABLES

2013 2012

R R

Trade receivables 302 782 324 943 141 098

Other receivables 2 335 932 1 077 079

(Refer to note 15 for fair values) 305 118 256 944 218 177

Trade receivables are non-interest bearing and are generally repayable between 30 and 90 days.

Although there were amounts older than 90 days as at year end, management has assessed trade

receivables individually and collectively and has come to the conclusion that there is no reason to

believe that these amounts will not be recovered within 90 days after year end hence no impairment

of trade receivables carried out (2012: R Nil). These accounts have however been discounted due

to the fact that normal trading terms had been violated during the year under review and were in

excess of 90 days.

As at 31 March 2013, the age analysis of trade receivables that were due but not impaired is as

follows:

Total < 30 days > 30 days

R R R

2013 302 782 324 302 782 324 -

2012 943 141 098 267 730 572 675 410 526

5. CASH AND CASH EQUIVALENTS2013 2012

R R

Bank balance 1 049 293 7 889 112

Petty cash 1 500 1 317


Cash and cash equivalents earn interest at

floating rates based on daily bank deposit

rates.

368




6. MEDSAS CAPITAL ACCOUNT2013 2012

R R

MEDSAS capital account 104 376 790 104 376 790

Capital is used for the operating expenses of the Depot and for the purchasing of inventory. The

Gauteng Department of Health provided the initial capital of R54 000 000 after Treasury approval

was obtained. The capital was increased by R26 000 000 in 2007, after obtaining Treasury

approval, by transferring from the retained earnings and an additional transfer of R 24 376 790 in

2009.

7. FINANCE LEASE OBLIGATIONSPresent value

of minimum

lease payments

Future fi nance

charges

Minimum lease

payments

2013 R R R

Amount payable under fi nance

lease:

Within one year 439 846 76 144 363 702

In the second to fi fth year inclusive 728 291 117 831 610 460

After fi ve years - - -

1 168 137 193 975 974 162

Less: Amount due for settlement

within 12 months

( 439 846)

728 291

2012 R R R

Amount payable under fi nance lease:

Within one year 661 093 295 453 365 640

In the second to fi fth year inclusive 744 461 464 504 279 957

After fi ve years - - -

1 405 554 759 957 645 597

Less: Amount due for settlement

within 12 months

( 661 093)

744 461

Obligations under fi nance leases are secured by the lessor’s title to the leased asset. Finance

leases bear interest at an average rate of 9%.

369




8. LEAVE ACCRUALS 2013 2012

R R

Balance at beginning of the year 2 607 150 2 537 629

Additional accruals made during the year 359 116 69 521

Amount used during the year - -

Balance at end of the year 2 966 266 2 607 150

A leave accrual is recognised for leave due to employees at year end. The accrual for leave is

calculated by multiplying the number of leave days due to each employee by a daily rate based on

the total cost to the company. The accrual is expected to realise within the following year when the

employees request leave or is paid out.

9. TRADE AND OTHER PAYABLES 2013 2012

R R

Trade payables 275 900 473 900 657 700

Sundry creditors 4 877 248 2 530 314


Trade payables are non-interest bearing and are generally repayable within 30 days. Although

there were amounts older than 30 days as at year end, management has assessed trade payables

individually and collectively and has come to the conclusion that there is no reason to believe that

these amounts will not be paid within 90 days after year end and thereafter all payments to be

paid within 30 days hence no impairment of trade receivables carried out for the year (2012: R Nil).

These accounts have however been discounted due to the fact that normal trading terms had been

violated during the year under review and were in excess of 90 days.

As at 31 March 2013, the age analysis of trade payables that were due but not impaired is as

follows:

Total < 30 days > 30 days

R R R

2013 275 900 473 275 900 473 -

2012 900 657 700 294 320 785 606 336 915

370




10. REVENUE AND OTHER INCOME 2013 2012

R R

Turnover - sales of medical supplies 2 928 979 725 2 399 029 813

Other 66 781 73 385

2 929 046 506 2 399 103 198

There were no discontinued operations for the period under review.

371




11. OPERATING EXPENDITURE 2013 2012

R R

Distribution cost: 11 876 523 11 308 665

Fees for distribution costs 11 787 925 11 251 806

Rental of vehicles 88 598 56 859

Administrative expenses 66 246 334 64 812 172

Staff Costs 44 628 080 46 778 513

Contribution to defi ned benefi t plan 4 056 066 -

Communication 661 591 471 014

Maintenance and repairs 2 465 879 4 812 136

Stationery and printing 916 069 1 073 502

Other administrative expenses 6 926 880 2 450 146

Fees for services:

Lease rentals of equipment 388 445 118 733

Audit fees 1 107 819 2 122 271

Technical 356 499 2 029 805

Security 4 739 006 4 956 052

Other expenses: 8 121 995 4 752 437

Depreciation owned assets 2 325 295 2 577 622

Depreciation leased assets 632 058 380 169

External training 205 580 175 387

Staff entertainment - 312 365

Stock price adjustments not recovered 2 283 151 -

Stock expiry 2 675 911 1 306 894

Total operating expenditure 86 244 852 80 873 274

372




12. FINANCE COST AND FINANCE INCOME 2013 2012

R R

Finance cost:

Interest expense - fi nance lease 237 417 269 153

Interest on discounting of trade payables (75 243 574) 3 765 009

(75 006 157) 4 034 162

Interest expense consists of interest paid on fi nance

leases and discounting of trade payables

Finance income:

Interest on discounting of trade receivables 79 080 816 2 014 207

Interest on trade receivables consists of discounting of

trade receivables

13. TAXATION

No provision has been made for taxation as the Depot is exempt from income taxation in terms of

section 10 (1).

373




14. RECONCILIATION OF PROFIT/ (LOSS) BEFORE TAXATION TO CASH GENERATED BY OPERATIONS

2013 2012

R R

Profi t/ (loss) before taxation 35 205 211 (65 738 035)

Adjusted for:

Depreciation on property, plant and equipment 2 957 352 2 957 791

Leave pay accrual 359 116 69 521

Profi t on the disposal of property, plant and equipment ( 18 963) ( 512 442)

Stock expiry 2 675 911 -

Discounting journals (6 827 141) -

Finance income 79 080 816 (2 014 207)

Finance costs (75 006 157) 4 034 162

Operating profi t/ (loss) before changes in working capital 38 426 145 (61 203 210)

Movement in working capital

(Increase)/ decrease in inventories (60 121 896) 43 201 965

Decrease/ (increase) in trade and other receivables 639 099 921 (42 699 422)

(Decrease)/ increase in trade and other payables (622 410 293) 66 305 329

(43 432 268) 66 807 872

(5 006 123) 5 604 662

374




15. RISK MANAGEMENT

General

The main risks faced by the trading entity are interest rate risk, credit risks, liquidity risks and currency

risk. The Depot has developed a comprehensive risk strategy in terms of Treasury Regulation 28.1

in order to monitor and control these risks. The risk management process relating to each of these

risks is discussed under the headings below.

Interest rate risk

The entity is not exposed to signifi cant interest rate risk as there is no internal funding other than

cash and fi nance leases. The following table set out the carrying amount, by maturity, of the entity’s

fi nancial instruments exposed to interest rate risk:

2013 Within 1 year 1 - 5 years Total

R R R

Cash and cash equivalents 1 050 793 - 1 050 793

Finance lease obligations 439 846 728 291 1 168 137

Trade receivables 305 118 256 - 305 118 256

Trade payables 280 777 721 - 280 777 721

2012 Within 1 year 1 - 5 years Total

R R R

Cash and cash equivalents 7 890 429 - 7 890 429

Finance lease obligations 661 093 744 461 1 405 554

Trade receivables 944 218 177 - 944 218 177

Trade payables 903 188 014 - 903 188 014

The entity’s fi nancial instruments are linked to the South African prime rate.

375




15. RISK MANAGEMENT (Continued)

Increase in interest rate

Effects on profi t before

taxation

2013

Cash and cash equivalents 1% 10 508

Finance lease obligations 1% 11 681

Trade receivables 1% 3 027 823

Trade payables 1% 2 750 900

2012

Cash and cash equivalents 1% 78 904

Finance lease obligations 1% 14 056

Trade receivables 1% 9 433 466

Trade payables 1% 9 006 577

Credit riskFinancial assets, which potentially subject the Depot to the risk of non-performance by counter parties, consist mainly of cash and accounts receivable, consisting trade receivables and staff debtors. Trade accounts receivable consist of a small consumer base. The Depot limits its treasury counter-party exposure by only dealing with well-established fi nancial institutions approved by National Treasury. Trade debtors – The Gauteng Department of Health is effectively the only client of the Depot, although deliveries occur to various health institutions.

Credit risk with regards to receivables is managed as follows:Trade debtors – A monthly claim is compiled of all issues from the Depot to health institutions and of payments affected to suppliers for direct deliveries. This claim is normally paid within a week by Central Offi ce as the Depot follows-up strongly on outstanding monies to ensure that there is money available to release a weekly run of payments to suppliers.

Staff debtors – Section 17, 30 and 38 of the Public Service Act indicate that any overpayment or wrongly granted remuneration to staff irrespective of whose fault it is may be recovered from the employee. There are built-in control measures in Persal to limit overpayments and adjustments have a three-tier approval process. The employee applies or provides approved documents, a practitioner records the transaction on Persal, a senior reviews the transaction on Persal and a third person is required to approve the transaction. With death, retirement or resignation there is a prescribed debt form that needs to be completed and is forwarded with the pension withdrawal form (Z102) to the National Department of Finance (Pension Offi ce) where the staff debt is recovered before payment to the employee or employee benefi ciaries occur. Where the debt recovered is inadequate

the Gauteng Shared Service Center’s debt recovery section recovers outstanding monies.

376




15. RISK MANAGEMENT (Continued)

Financial assets and liabilities exposed to credit risk at the reporting date were as follows:

2 013 2 012

R R

Trade and other receivables ( less than 3 months) 305 118 256 944 218 177

Cash and cash equivalents (less than 3 months) 1 050 793 7 890 429

Finance lease obligation - long term (2 to 5 years) 728 291 744 461

Finance lease obligation - short term ( less than 1 year) 439 846 661 093

Trade and other payables ( Less than 3 months) 280 777 721 903 188 014

Liquidity risk

The Depot maintains a large amount of inventory, the maximum turnover period for the inventory

kept however is twelve weeks or three months.

Liquidity risk is managed as follows

Proper stock management processes are in place where stock is ordered based on economic order

quantities. The maximum turnover period of stock kept at the Depot is three months. On-going

cyclic stock counts are conducted to identify slow moving items and a memo is issued to health

institutions every six months with an inventory list of the items as a reminder that the stock is

available.

Currency risk

The Depot does not transact with any supplier or customer outside the South African borders

and this risk is therefore not directly applicable. However, this risk arises as suppliers purchase

raw material from international suppliers which is subject to foreign exchange rate fluctuations.

Suppliers therefore request, through an application to either National Treasury (State Tender Board)

or the GDF/GSSC, for a price adjustment based on the fluctuation of foreign exchange rates.

Fair values

At 31 March 2013, the carrying values of cash and cash equivalents, trade and other receivables and

trade and other payables approximate the fair values due to short term maturities of these assets

and liabilities as disclosed below:-

377




15. RISK MANAGEMENT (Continued)Carrying Amount Fair Value

2013 2012 2013 2012

R R R R

Financial assets:

Cash and cash equivalents 1 050 793 7 890 429 1 050 793 7 890 429

Trade and other receivables 305 118 256 947 196 080 305 118 256 944 218 177

Financial liabilities:

Trade and other payables 280 777 721 902 340 608 280 777 721 903 188 014

Finance lease obligations 1 168 137 1 405 554 1 168 137 1 405 554

Capital Management

The primary objective of the entity’s capital management is to ensure that it maintains a strong

credit rating and healthy ratio’s in order to support its business and maximise value.

2013 2012

R R

Trade and other payables 280 777 721 903 188 014

Finance obligations 1 168 137 1 405 554

Less: cash and cash equivalents (1 050 793) (7 890 429)

Net debt 280 895 065 896 703 139

Equity/capital 193 828 513 158 623 302

Capital and net debt 87 066 552 738 079 837

Gearing ratio 31.00% 82.31%

16 CONTINGENT LIABILITIES

The total housing guarantees outstanding as at 31 March 2013 amounted to R Nil (2012: R Nil).

There were no other contingent liabilities.

378




17. FRUITLESS AND WASTEFUL EXPENDITURE2013 2012

R R

Opening Balance - -

Prior year expenditure identifi ed in current year 18 377 661 -

Current year wasteful expenditure 2 675 911 -

Closing Balance 21 053 572 -

18. IRREGULAR EXPENDITURE2013 2012

R R

Opening Balance 129 960 -

Irregular from prior year identifi ed in current year 367 811 127 -

Current year Irregular 758 596 866 129 960

Closing Balance 1 126 537 953 129 960

The above irregular expenditure relates to non-compliance with supply chain management

policies for a number of national, provincial and Departmental Bid Adjudication Committee (BAC)

contracts.

19. GOING CONCERN

The annual fi nancial statements have been prepared on the basis of accounting policies applicable

to a going concern. This basis presumes that funds will be available to fi nance future operations and

that the realisation of assets and settlement of liabilities, contingent obligations and commitments

will occur in the ordinary course of business.

20. EVENTS AFTER THE BALANCE SHEET DATE

There were no signifi cant events between the fi nancial year end and the date of this report that

warranted adjustment to or disclosure in the annual fi nancial statements.

379




21. KEY MANAGEMENT PERSONNEL EMOLUMENTS

The key performance areas of the post of a Depot manager was reviewed when the Medicines

and Related Substances Control Act came into effect on 1 July 2005. In an attempt to strengthen

pharmaceutical services in the province and the key performance areas of the Depot manager, a

decision was made to use the post of Chief Director: Clinical Support Services on a pro-rata basis

with the post of the Depot manager. This split is a time basis of 50:50. The expense related to the

compensation of this post is not part of the Depot but funded in full by the Gauteng Department of

Health. No loans, profi t sharing or similar schemes are available to key personnel and all personnel

of the Depot are considered as offi ce holders as defi ned in the Public Service Act.

2013

Salary Bonuses and performance

payments

Expense allowance

Pension contributions

Total

R R R R R

Director Administration: Mr. J M Smidt

431 589 35 981 163 272 32 376 663 218

Director: Pharmaceutical Services: Mr. M S Choma

431 589 35 981 163 272 32 376 663 218

863 178 71 962 326 544 64 752 1 326 436

2012

Salary Bonuses and performance

payments

Expense allowance

Pension contributions

Total

R R R R R

Chief Executive Offi cer:

Dr. D C Mondzanga

251 019 20 763 234 735 37 653 544 170

(50:50 split)

Director Administration:

Mr. J M Smidt

380 923 31 743 187 071 61 909 661 646

Director: Pharmaceutical

Services: Mr. M S. Choma

412 662 34 260 187 071 61 909 695 902

1 044 604 86 766 608 877 161 471 1 901 718

380




22. OPERATING LEASE/ CONTRACT ARRANGEMENTS

At the balance sheet date the Depot had outstanding commitments under non-cancellable operating

leases and/or contracts, which fall due as follows:

2013 2012

Operating leases - maintenance contracts R R

Up to 1 year 76 144 174 895

1 to 5 years 117 831 58 736

193 975 233 631

The lease agreements are not renewable at the end of the lease term and the Depot does not have

the option to acquire the equipment. The lease agreements do not impose any restrictions. The

lease agreements’ escalation rate is 0%.

381


23. RELATED PARTY TRANSACTIONS

Name of Related Party Relationship

Gauteng Department of Health Controlling entity

Gauteng Department of Roads & Transport Fellow Department

The Medical Supplies Depot is a trading entity under the control of the Gauteng Department

ofHealth. All transactions with the Department of Health are considered to be related party

transactions and are at arm’s length.

Related party balances at year end

2013 2012

R R

Gauteng Department of Health – Receivables 284 854 703 946 119 002

Sales to related parties

Gauteng Department of Health 2 832 878 596 2 404 021 925

The above amounts exclude the discounting effect

Other related party transactions

The building currently occupied by the Depot is owned by the Department of Infrastructure

Development (DID). Market related rentals for the buildings occupied amounts to R9 300 000 per

year.

24. COST OF SALESDuring the fi nancial year the following corrections were made to cost of sales. Due to the corrections

made, the gross profi t margin of the entity is not 5 % as the adjustments are not related to normal

terms of trade.

2013 2012

R R

Actual cost of sales prior to adjustments 2 803 521 784 2 384 892 608

Price adjustments - 2 944 604

Total 2 803 521 784 2 381 948 004

382

OTHER INFORMATION 383


ANNEXURE: LEGISLATION

Merchandise Marks Act, 17 of 1941

Provides for the covering and marking of merchandise, and incidental matters.

State Liability Act, 20 of 1957

Provides for the circumstances under which the state attracts legal liability.

Conventional Penalties Act, 15 of 1962

Provides for the enforceability of penal provisions in contracts

Medicines and Related Substances Act, 101 of 1965 (as amended in 1997)

Provides for the registration of medicines and other medicinal products to ensure their safety. The Act also

provides for transparency in the pricing of medicines.

Foodstuffs, Cosmetics and Disinfectants Act, 54 of 1972

Provides for the regulation of foodstuffs, cosmetics and disinfectants, in relation to safety and quality

standards that must be complied with by manufacturers, importers and persons selling the products

concerned.

Occupational Diseases in Mines and Works Act, 78 of 1973

Provides for medical examinations on persons suspected of having contracted occupational diseases in

the mining industry for compensation in respect of those diseases.

Hazardous Substances Act, 15 of 1973

Provides for the control of hazardous substances, in particular those emitting radiation.

International Health Regulations Act, 28 of 1974

Provides for the adoption of resolutions adopted at the World Health Assembly.

Pharmacy Act, 53 of 1974

Provides for the regulation of the pharmacy profession, including community service by pharmacists.

Health Professions Act, 56 of 1974

Provides for the regulation of health professions, in particular, medical practitioners, dentists, psychologists

and other related health professions, including community service by these professionals.

Nursing Act, 33 of 2005

Provides for the regulation of the nursing profession.

384


Patents Act, 57 of 1978

Provides for the protection of inventions including gadgets and chemical processes.

Dental Technicians Act, 19 of 1979

Provides for the regulation of dental technicians and for the establishment of a council to regulate the profession.

Allied Health Professions Act, 63 of 1982

Provides for the regulation of health practitioners, like chiropractors and homeopaths, and for the establishment of a council to regulate these professions.

Child Care Act, 74 of 1983

Provides for the protection of the rights and wellbeing of children.

Control of Access to Public Premises and Vehicles Act, 53 of 1985

Provides for the regulation of individuals entering government premises, and incidental matters.

SA Medical Research Council Act, 58 of 1991

Provides for the establishment of the SA Medical Research Council and its role in relation to research, in particular, health research.

Occupational Health and Safety Act, 85 of 1993

Provides requirements that employers must comply with in order to create a safe working environment for employees in the workplace.

Trade Marks Act, 194 of 1993

Provides for the registration, certifi cation and a collective of trademarks and matters incidental thereto.

Designs Act, 195 of 1993

Provides for the registration of designs and matters incidental thereto.

Public Service Act, Proclamation 103 of 1994

Provides for the administration of the public service in its national and provincial spheres, and empowers the Minister to appoint and dismiss offi cials.

Choice on Termination of Pregnancy Act, 92 of 1996

Provides a legal framework for termination of pregnancies based on choice under certain circumstances.

Public Service Commission Act, 46 of 1997

Provides for the amplifi cation of the constitutional principle of accountable governance, and incidental

matters

385


Basic Conditions of Employment Act, 75 of 1997

Provides for the minimum conditions of employment that employers must comply with in their workplaces.

Intergovernmental Fiscal Relations Act, 97 of 1997

Provides for the harmonization of fi nancial relations between the various spheres of government, and

incidental matters

State Information Technology Act, 88 of 1998

Provides for the creation and administration of an institution responsible for the state’s information

technology system.

Competition Act, 89 of 1998

Provides for the regulation of permissible competitive behaviour, regulation of mergers of companies and

matters related thereto.

Copyright Act, 98 of 1998

Provides for the protection of intellectual property of a literary, artistic or musical nature that is reduced to

writing.

Sterilisation Act, 44 of 1998

Provides for the right to sterilization; to determine the circumstances under which sterilization may be

performed and, in particular, the circumstances under which sterilization may be performed on persons

incapable of consenting or incompetent to consent due to mental disability.

Employment Equity Act, 55 of 1998

Provides for the measures that must be put into operation in the workplace in order to eliminate

discrimination and promote affi rmative action.

Skills Development Act, 97 of 1998

Provides for the measures that employers are required to take to improve the levels of skill of employees

in workplaces.

Medical Schemes Act, 131 of 1998

Provides for the regulation of the medical schemes industry to ensure consonance with national health

objectives.

Public Finance Management Act, 1 of 1999

Provides for the administration of state funds by functionaries, their responsibilities and incidental matters.

386


Tobacco Products Control Amendment Act, 12 of 1999Provides for the control of tobacco products, prohibi on of smoking in public places and regula on of adver sements of tobacco products as well as sponsoring of events by the tobacco industry.

Promotion of Access to Information Act, 2 of 2000

Amplifi es the constitutional provision pertaining to accessing information under the control of various

bodies.

Promotion of Administrative Justice Act, 3 of 2000

Amplifi es the constitutional provisions pertaining to administrative law by codifying it.

Promotion of Equality and the Prevention of Unfair Discrimination Act, 4 of 2000

Provides for the further amplifi cation of the constitutional principles of equality and elimination of unfair

discrimination.

Preferential Procurement Policy Framework Act, 5 of 2000

Provides for the implementation of the policy on preferential procurement pertaining to historically

disadvantaged entrepreneurs.

Protected Disclosures Act, 26 of 2000

Provides for the protection of whistle-blowers in the fi ght against corruption.

National Health Laboratory Service Act, 37 of 2000

Provides for a statutory body that provides laboratory services to the public health sector.

Council for Medical Schemes Levy Act, 58 of 2000

Provides for a legal framework for the council to charge medical schemes certain fees.

Mental Health Care Act, 17 of 2002

Provides a legal framework for mental health and in particular the admission and discharge of patients in

mental health institutions with emphasis on the human rights of mental patients.

Unemployment Insurance Contributions Act, 4 of 2002

Provides for the statutory deductions that employers are required to make on the salaries of employees.

The Division of Revenue Act, 7 of 2003

Provides for the manner in which revenue generated may be disbursed.

Broad Based Black Economic Empowerment Act, 53 of 2003

Provides for the promotion of black economic empowerment in the manner that the state awards contracts

for services to be rendered, and incidental matters.

387


The National Health Act, 61 of 2003

Provides for regulation of national health and promotes uniformity in respect of health services across the

nation.

Intergovernmental Relations Framework Act, 13 of 2005

Provides for formalization of relations between (and within) the three spheres of government through

facilitating coordination in the implementation of policy and the establishment of intergovernmental

structures.

Specifi c provincial health legislation

National legislation and policy are further supported by the following provincial legislation:

• The Hospital Ordinance Act, 1958 (as amended in 1999).

• The Gauteng District Health Services Act, 2000.

• The Gauteng Ambulance Services Act, 2002.

Other policy imperatives guiding the work of the Department include the following:

• Strategic priorities for the National Health System.

• Provincial government’s fi ve-year strategic programme of action.

• Gauteng fi ve-year strategic plan for health.

• The Provincial Growth and Development Strategy.

• The Gauteng Global City Region Strategy.

388


GOALS AND STRATEGIC OBJECTIVES 2009-14

Goals

Strategic goal 1Improved health and wellbeing with an emphasis on vulnerable groups

Goal statement

Health (physical and mental) and wellbeing (psychosocial and

empowerment of vulnerable groups) improved from average to good

by 2014 (See defi nition of ‘average’ and ‘good’ below.)

Rationale

This is the core business of the Department.

The Department’s mandate is to achieve the Millennium

Development Goals, implement the GPG priority 3:‘Better health

care’, 7: Building cohesive, sustainable communities, and the

NDOH’s 10-point plan (priority 8: mass mobilisation for health

outcomes).

Baseline

Average is:

MMR: 167,6 per 100 000

CMR: 45 per 1000

IMR: 36.3 per 1000

Malnutrition rate: 0,27%

Hypertension rate: 17,9 % in female and 12,5% in males

Rate of type 2 diabetes: 2,7%

Percentage of PHC facilities providing psychiatric care: 40%

Number of assistive devices received by PWD: 31 092

Expected outcomes

Good is achievement of at least 6 of the 8 indicators below:

MMR: 100 per 100 000

CMR: 30 per 1000

IMR: 25 per 1000

Malnutrition rate: 0,24%

Hypertension rate: 15% females and 10% males

Rate of type 2 diabetes:2,2%

Percentage of PHC facilities providing psychiatric care: 60%

Number of assistive devices received by PWD: 34 000

Strategic goal 2Reduce the rate of new HIV infections by 50% in youth, adults and babies in GautengReduce deaths from TB and AIDS by 20%

Goal statement 2.1

Reduce new HIV infections by 50% through mass education to

increase safe sex behaviours, and prevention of mother to child

transmission of HIV (PMTCT).

389


Strategic goal 2Reduce the rate of new HIV infections by 50% in youth, adults and babies in GautengReduce deaths from TB and AIDS by 20%

Goal statement 2.2Reduce deaths from TB and AIDS through increased results of

treatment (TB and ARV).

Rationale

National Strategic Plan on HIV and AIDS 2007 - 2011

Achievement of the MDGs

ANC Election Manifesto 2009

GDHSD Re-Prioritisation Document

National DOH 10-Point Plan

Baseline

1 36% HIV incidence in 2010

70% of people who require ART are on treatment

TB death rate: 9%

Expected outcomes

0,47% HIV incidence in 2016

80% of people who require ART are on treatment

TB death rate: 6%

Strategic goal 3 Increased effi ciency of service implementation

Goal statement

Increased effi ciency of implementation of service delivery at

community level, district level, institutions and support services,

from average to good by 2014.

(‘Average’ and ‘good’ are defi ned in the indicator protocol reference

sheet.)

Rationale

NDOH 10 Point Plan: Priority 3: Improving quality; 4: Overhaul the

health system, and 6: Revitalisation of infrastructure

GPG priority 3: Better health care for all and 7: Strengthening the

developmental state and good governance

Baseline

Average

3.1 Client satisfaction rate of 67%

3.2 Adequate effi ciency of PHC facilities

3.3 Adequate effi ciency of hospitals

3.4 57% of P1 calls responded to within 15 minutes

Expected outcomes

Good: at least 3 of the 4

3.1 Client satisfaction rate of 70%

3.2 Good effi ciency of PHC facilities

3.3 Good effi ciency of hospitals

3.4 70% of P1 calls responded to within 15 minutes

390


Strategic goal 4Human capital management and development for better health outcomes

Goal statement

Human capital management and development improved from

adequate to good by 2014

(‘Adequate’ and ‘good’ are defi ned in the indicator protocol reference

sheet.)

Rationale

NDOH 10 Point Plan Priority 4: Overhaul the health care system and

improve its management, and 5: Improvement of Human Resources.

GPG priority 3: Better health care for all and 7: Strengthening the

developmental state and good governance.

Baseline

Adequate is:

4.1 Partial compliance to national norms (health professionals per

100,000 people)

4.2 60% employee satisfaction rate

4.3 Adequate employee equity

4.4 50% labour cases resolved

Expected outcomes

Good is achievement of at least 3 of the following 4 indicators:

4.1 Full compliance to national norms (health professionals per

100,000 people)

4.2 75% employee satisfaction rate

4.3 Good employee equity

4.4 70% labour cases resolved

Strategic goal 5 Organisational excellence

Goal statementOrganisational excellence improved from inadequate to good by

2014 (‘Inadequate’ and ‘good’ defi ned below.)

Rationale

NDOH 10 Point Plan Priority 1: Provision of Strategic leadership

and creation of Social compact for better health outcomes, and 10:

Research and Development.

GPG Priority 3: Better health care for all and 7: Strengthening the

developmental state and good governance.

Social compact.

Baseline

Inadequate means:

5.1 Stakeholder satisfaction rate of 60%

5.2 Disclaimer

5.3 Over expenditure of 5%

5.4 Adequate effi cacy of supply chain management system

5.5 Nascent M&E system

5.6 Average compliance rate to legislative framework

391


Strategic goal 5 Organisational excellence

Expected outcomes

Good means achieving at least 4 of the following 6 indicators:

5.1 Stakeholder satisfaction rate of 75%

5.2 Unqualifi ed audit

5.3 Over- / under-expenditure <2%

5.4 Good effi cacy of supply chain management system

5.5 Mature M&E system

5.6 Good compliance rate to legislative framework


Please note: Some of these strategic objectives will need to be reformulated/adjusted if budget is not

available to conduct baseline and follow up surveys.

STRATEGIC GOAL 1IMPROVED HEALTH AND WELLBEING WITH AN EMPHASIS ON VULNERABLE GROUPS

Strategic Objective 1.1 Reduce preventable causes of maternal deaths

Objective statement

Maternal mortality reduced from 167 to 100 by 2014

Note: This is classifi ed as an impact measure and as such should

be a ‘goal’ but is included here as a strategic objective (usually

corresponding to outcomes)

RationaleMDGs

10 Point Plan

Baseline MMR: 167

Expected outcome MMR: 100

Strategic Objective 1.2 Reduce infant mortality

Objective statement

Infant mortality reduced from 34 per 1000 to 25 per 1000 by 2014




Rationale

MDGs

10 Point Plan

Improve the health and wellbeing of children under six years and

those at risk due to poverty

Baseline IMR: 34 per 1000

Expected outcome IMR: 25 per 1000

392


Strategic Objective 1.3 Reduce child mortality

Objective statement

Child mortality reduced from 43 per 1000 to 30 per 1000 by 2014




Rationale

MDGs

10 Point Plan

Improve the health and wellbeing of children under six years and

those at risk due to poverty

Baseline CMR: 43 per 1000

Expected outcome CMR: 30 per 1000

Strategic Objective 1.4 Reduce malnutrition in children

Objective statementIncidence rate of severe malnutrition of children under 5 years

reduced from 0.27% to 0.24% by 2014

Rationale

MDGs

10 Point Plan

Improve the nutritional status of vulnerable groups, with special

emphasis on people with chronic and debilitating conditions

Baseline Rate of severe malnutrition: 0.27%

Expected outcome Rate of severe malnutrition: 0.24%

Strategic Objective 1.5 Reduce rate of hypertension

Objective statementIncidence of hypertension reduced from 17.9% (females) and 12.5%

(males) to 15% (females) and 10% (males) by 2014

Rationale10 Point Plan

Healthy Lifestyles

Baseline17.9% (f)

12.5% (m)

Expected outcome15% (f)

10% (m)

Strategic Objective 1.6 Reduce rate of type 2 diabetes

Objective statement Incidence of diabetes reduced from 2.7% (2003) to 2.2% by 2014


Healthy Lifestyles

Baseline 2.7%

393


Strategic Objective 1.6 Reduce rate of type 2 diabetes

Expected outcome 2.2%

Strategic Objective 1.7 Reduce referrals for specialised psychiatric care

Objective statementNumber of patients admitted into specialised psychiatric care

reduced by 2014

Rationale

10 Point Plan

Reduction in the number of referrals for specialised psychiatric

care suggests fewer relapses, better management of psychiatric

patients, improved outpatient and community care, improved

capacity.

Strategic Objective 1.8 Increased mobility amongst people with disabilities

Objective statementIncrease the number of people with disabilities that have received

assistive devises by 2014 from 31092 to 34000.

Rationale Provide rehabilitation and support to people with disabilities

Baseline 31092

Expected outcome 34000

STRATEGIC GOAL 2REDUCE THE RATE OF NEW HIV INFECTIONS BY 50% IN YOUTH, ADULTS AND BABIES IN GAUTENGREDUCE DEATHS FROM TB AND AIDS BY 20%

Strategic Objective 2.1Reduced new infections in youth and adults through increased

safe sex behaviours

Objective statementIncreased safe sex behaviours from low to high among youth and

adults by 20151

Rationale

MDGs

UNGASS (United Nations General Assembly on HIV and AIDS)

National Strategic Plan 2007 - 2011

GDHSD Re-Prioritisation Document

National DOH 10-Point Plan

Baseline

Very high safe sex behaviours in youth in schools, 15 – 19 years

Low safe sex behaviours in youth out of school, 20 – 24 years

Safe sex behaviours in adults needs to be improved

Expected outcomeIncreased safe sex behaviours for (BSS standards) among youth

and adults in Gauteng

394


Strategic Objective 2.2 Reduce new HIV infections in babies

Objective statementReduced % of babies born to HIV positive mothers who test positive

to HIV, from 10% to 4% by 2014

Rationale

MDG target to reduce infant mortality by 50% in 2015

National Strategic Plan

Saving Babies Report

Baseline 10% of babies born to HIV positive mothers are HIV positive

Expected outcome Reduced % of infants infected with HIV from 10% to <5%

Strategic Objective 2.3 Increased Male circumcision among Gauteng youth

Objective statementIncreased % of men aged 15 – 45 years who are circumcised from

35% to 50% by 2015 (tbc)

Rationale

National Strategic Plan for HIV and AIDS 2007 – 2011

SANAC/NDOH Male circumcision guidelines

UNAIDS recommendation

Baseline 35% of males in tertiary institution (2008)

Expected outcome

Reduction in female to male transmission of HIV

Effective combination prevention strategy

Increased safe circumcision in the traditional sector

Strategic Objective 2.4 Reduce deaths from TB through effective TB treatment

Objective statementReduce deaths from TB by increasing TB cure rates from 78% to

85% by 2015

Rationale

National Strategic Plan for TB

NSP 2007 – 2011

NDOH 10 Point Plan

Baseline 78% cure rate

Expected outcome Increase in TB cure rate to 85% by 2014

Strategic Objective 2.5Reduce death from AIDS through appropriate treatment, care and

support for 80% of people living with HIV (PLHIV)

Objective statement

Reduce AIDS morbidity and mortality as well as its socioeconomic

impacts by providing appropriate packages of treatment, care and

support to 80% of HIV positive people by 2011.

Rationale

NSP 2007 – 2011

ANC manifesto 2009

GDHSD Re-prioritisation

NDOH 10 Point Plan

Baseline 185,126 on ART (cumulative) 2008/09

395


Strategic Objective 2.5Reduce death from AIDS through appropriate treatment, care and

support for 80% of people living with HIV (PLHIV)

Expected outcomePrimary health care for people living with HIV (PLHIV)

Viral suppression on ART

STRATEGIC GOAL 3 INCREASED EFFICIENCY OF SERVICE IMPLEMENTATION

Strategic Objective 3.1 Improved client satisfaction rate

Objective statement Improved client satisfaction rate from 67% to 70% by 2014

Rationale

10 Point Plan

GPG priority 3: Better health care for all

Batho Pele

Baseline

PHC: Not yet measured

District hospitals:

Regional hospitals:

Central hospitals:

Indicator Client satisfaction rate

Expected outcome

PHC:

District hospitals:

Regional hospitals:

Central hospitals:

Strategic Objective 3.2 Increased level of effi ciency in PHC facilities

Objective statementLevel of effi ciency in PHC facilities increased from adequate to good

by 2014 (see defi nition of ‘adequate’ and ‘good’ below)

Rationale

10 Point Plan


Batho Pele

Baseline

‘Adequate’ was understood to be ‘reasonable’ – not good, but not

terrible.

Adequate in 2010 =

Total headcount: 19,6 million

Utilisation rate : 1,8 million

Utilisation rate - under 5: 4 million

Supervision rate: 80%

Provincial PHC expenditure per head count: R265.35

% complaints resolved within 25 days: 100%

396


Strategic Objective 3.2 Increased level of effi ciency in PHC facilities

Expected outcome

‘Good’ = achieving at least 4 of the following 6:

Total headcount: 24 million

Utilisation rate: 2,7 million

Utilisation rate - under 5: 5 million

Supervision rate: 100%

Provincial PHC expenditure per head count: R425

% complaints resolved within 25 days: 100%

Strategic Objective 3.3 Increased level of effi ciency in hospitals

Objective statement

Level of effi ciency in hospitals (district, regional and central)

increased from adequate to good by 2014

(see defi nition of ‘adequate’ and ‘good’ below)

Rationale

10 Point Plan


Batho Pele

Baseline

‘Adequate’ was understood to be ‘reasonable’ – not good, but not terrible. Adequate in 2010 =District hospitals:• Average length of stay: 3,5 days• Caesarean section rate: 16% • Bed utilisation rate: 75% • Expenditure per patient day equivalent: R1 600• Patient Day Equivalents: 825 000• OPD total headcount: 870 950

Regional hospitals:• Average length of stay: 4,3 days• Caesarean section rate: 20%• Bed utilisation rate: 81%• Expenditure per patient day equivalent: R1309• Patient Day Equivalents: 2646102• OPD total headcount: 2435938

Central hospitals:• Average length of stay: 5,7 days• Caesarean section rate: 37,5%• Bed utilisation rate: 77%• Expenditure per patient day equivalent: R2304• Patient Day Equivalents: 2421612• OPD total headcount: 2139909

397


Strategic Objective 3.3 Increased level of effi ciency in hospitals

Expected outcome

‘Good’ = achieving at least 4 of the following 6 for each category of

hospital:

District hospitals:

• Average length of stay: 3 days

• Caesarean section rate: 17%

• Bed utilisation rate: 67%

• Expenditure per patient day equivalent:R1 044

• Patient Day Equivalents:789140

• OPD total headcount:875887

Regional hospitals:

• Average length of stay:4,8 days

• Caesarean section rate: 18%

• Bed utilisation rate:80%

• Expenditure per patient day equivalent: R1857

• Patient Day Equivalents: 3 million

• OPD total headcount: 2,5million

Central hospitals:

• Average length of stay: 5.3 days

• Caesarean section rate: 46,2%

• Bed utilisation rate: 80,5%

• Expenditure per patient day equivalent: R2496

• Patient Day Equivalents: 2624902

• OPD total headcount: 2758103

Strategic Objective 3.4 Increase the number of P1 calls responded to within 15 minutes

Objective statementIncrease the number of P1 calls responded to within 15 minutes

from 57% to 70% by 2014

Rationale

10 Point Plan


Batho Pele

Baseline 57%

Expected outcome 70%

Note: Infrastructure (new construc on, maintenance, revite), equipment, security contribute towards effi ciency of PHC and hospitals; as do most support services – blood, NHLS, DHIS.

398


STRATEGIC GOAL 4HUMAN CAPITAL MANAGEMENT AND DEVELOPMENT FOR BETTER HEALTH OUTCOMES

Strategic Objective 4.1 Improve achievement of national norms

Objective statement

Improve achievement of national norms (health professionals per

100,000 population) by 2014 from partial to full compliance

(see defi nition of ‘partial’ and ‘full’ below)



Baseline

Partial compliance to norms in 2010 =

Medical offi cers: 22,6 per 100,000

Medical specialists: 9,3 per 100,000

Professional nurses: 87 per 100,000

Pharmacists: 3 per 100,000

Expected outcome

Full compliance to norms in 2014 =

Medical offi cers: 25 per 100,000

Medical specialists: 20 per 100,000

Professional nurses: 111 per 100,000

Pharmacists: 7,50 per 100,000

Strategic Objective 4.2 Employee satisfaction

Objective statementIncrease employee satisfaction from an 60% (estimate) to 75% by

2014 (SURVEY REQUIRED).

Rationale

10 Point Plan


Batho Pele

Baseline 60% (estimate)

Expected outcome 75%

Strategic Objective 4.3 Employment equity and diversity management

Objective statement

Level of implementation of employment equity improved from

adequate to good by 2014


399


Strategic Objective 4.3 Employment equity and diversity management

Rationale

10 Point Plan


GPG priority 7: Strengthening the developmental state and good

governance

Baseline

‘Adequate’ in 2010 =

• PWD: 0,68%

• Women in SMS: 38%

Indicator Success rate of the employment equity act

Expected outcome

‘Good’ =

PWD: 2%

• Women in SMS: 50D: xte’ ate)ted 60% to 75%

• ceollowing 8: Social Development programmes.%

Strategic Objective 4.4 Labour peace (Industrial relations )

Objective statementIncreased grievance and disputes amicably resolved within specifi ed

timeframes from 50% to 70% by 2014

Rationale

10 Point Plan



governance

BaselineX number of cases out of y number of cases solved within x months

(50%)

Expected outcomeX number of cases out of y number of cases solved within x months

(70%)

STRATEGIC GOAL 5 ORGANISATIONAL EXCELLENCE

Strategic Objective 5.1Improved stakeholder satisfaction rate through enhanced

corporate governance

Objective statementStakeholder satisfaction improved from 60% (estimate) to 75% by

2014 (SURVEY REQUIRED).

Rationale

Batho Pele

10 Point Plan


governance

Baseline60% (estimate) – opinion of the department by hospital boards,

clinic committees, and other oversight bodies

400


Strategic Objective 5.1Improved stakeholder satisfaction rate through enhanced

corporate governance

Expected outcome75% (survey required of hospital boards, clinic committees, other

oversight bodies)

Strategic Objective 5.2 Unqualifi ed audit opinion

Objective statementNature of audit opinion improved from disclaimer to unqualifi ed by

2014

Rationale

Batho Pele

10 Point Plan


governance

Baseline Disclaimer

Expected outcome Unqualifi ed audit

Strategic Objective 5.3 Reduce over- and/or under-expenditure against budget

Objective statement Reduce over-expenditure from 5% to <2% by 2014

Rationale

Batho Pele

10 Point Plan


governance

Baseline Over-expenditure of 5%

Expected outcome Over or under expenditure within 2% as permitted by the PFMA

Strategic Objective 5.4 Increased level of effi cacy of supply chain management system

Objective statement

Increased level of effi cacy of supply chain management system

from adequate to good by 2014


Rationale

Batho Pele

10 Point Plan


governance

Ensure implementation and management of an effi cient and cost

effective supply chain management system

401


Strategic Objective 5.4 Increased level of effi cacy of supply chain management system

Baseline

‘Adequate’ in 2010 was understood to be ‘reasonable’, i.e.

• Departmental Acquisition Committee exists but no TORs

• No asset management plan

• No demand plans

• BBBEE spend as a % of total procurement budget: 56%

• Percentage of procurement awarded to women owned enter-

prises: 15%

Expected outcome

Good (at least 4 of the 5)

• Departmental Acquisition Committee exists with TORs

• Approved asset management plan

• Each hospital has a demand plan

• BBBEE spend as a % of total procurement budget: 70%

• Percentage of procurement awarded to women owned enter-

prises: 15%

Strategic Objective 5.5 Increased level of implementation of the M&E system

Objective statement

Increased level of implementation of the M&E system from nascent

to mature by 2014

(see defi nition of ‘nascent’ and ‘mature’ below)

Rationale

Batho Pele

10 Point Plan


governance

Baseline

Nascent

• No approved M&E framework

• AG AOPO opinion: Disclaimer

• No Provincial Health Research Committee

• No approved list of provincial research priorities

Expected outcome

Mature (at least 3 of the 4)

• Approved M&E framework

• AG AOPO opinion: unqualifi ed

• Provincial Health Research Committee established, 2 meet-

ings per year

• Approved list of provincial research priorities

402


Strategic Objective 5.5 Compliance rate to the legislative framework

Objective statement

Improve compliance rate to the legislative framework from average

to good by 2014.

(see defi nition of ‘average’ and ‘good’ below)

Rationale

Batho Pele

10 Point Plan


governance

Baseline

Average

• IYMs, Quarterly reports, Annual Report, APP submitted on

time

• 0 quarterly reviews held

• 0 SMS declaration of interests

Expected outcome

Good (at least 3 of the 4)

• IYM, Quarterly reports, Annual Report, APP submitted on

time

• 4 quarterly reviews held

• 100% SMS declaration of interests

• 100% Level 1-12 declaration of interests

1 Defi nitions of low and high safe sex behaviours, youth and adults will be provided

403


Notes

404

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