click to edit master subtitle style 9/8/11 select committee on apropriations hearing on conditional...

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9/8/11

SELECT COMMITTEE ON APROPRIATIONS

HEARING ON CONDITIONAL GRANTS

EXPENDITURE

Tuesday 6 September 2011

11

9/8/11

1. DATA ON TRENDS IN ALLOCATION, TRANSFERS AND ACTUAL EXPENDITURE OF THE CONDITIONAL GRANTS OF

THE DEPARTMENT

The 1st Quarter 2011/12:

The three month period ended 30 June 2011 conditional grants expenditure figures show that the Department has spent R341.44 million (66%) of its June 2011 YTD Section 40 projection of R519.11 million, as summarized in the tables hereunder. Net under spending of R177.66 million occurred mostly in compensation of employees of R24.70, goods & services of R88.76 million, transfers of R32.64 million and payments for capital assets of R31.54 million, summarized as follows:

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BY CONDITIONAL GRANT

1ST QUARTER 2011/12 ANALYSIS

2011/12 Allocations

Actual Exp for Quarter

% of Budget Allocn

Exp Target for Quarter

Variance % of Target for QuarterYTD

Commitments

R'000

Comprehensive HIV/AIDS Grant 864,173 99,867 12% 190,302 90,435 52% 160,104

Forensic Pathology Grant 73,506 17,923 24% 21,956 4,033 82% 7,338

National Tertiary Services Grant 609,327 104,522 17% 131,765 27,243 79% 125,668

Health Professionals and Development Grant 170,071 14,213 8% 42,517 28,304 33% 20,465

Hospital Revitalisation Grant 382,048 45,976 12% 72,110 26,134 64% 313,001

EPWP Incentive- Social Cluster Grant 16,579 2,864 17% 4,132 1,268 69% 1,286

Infrastructure Grant to Provinces 299,754 56,078 19% 56,324 246 100% 101,056

Total 2,415,458 341,443 14% 519,106 177,663 66% 728,918

BY ECONOMIC CLASSIFICATION

Current Expenditure 1,546,397 232,684 15% 346,173 113,489 67% 289,177

Compensation of employees 377,823 71,086 19% 95,789 24,703 74% 0

Goods and services 1,168,574 161,598 14% 250,384 88,786 65% 289,177

Total transfers and subsidies 171,705 0 0% 32,635 32,635 0% 5,652

Departmental Agencies 41,322 0 0% 0 0 n/a 5,652

Universities & technikons 130,383 0 0% 32,635 32,635 0% 0

Payments for capital assets 697,356 108,759 16% 140,298 31,539 78% 434,089

Buildings & Fix Structures 578,605 79,792 14% 107,899 28,107 74% 405,345

Machinery and equipment 118,751 28,967 24% 32,399 3,432 89% 28,744

Total 2,415,458 341,443 14% 519,106 177,663 66% 728,91833

9/8/11

BY CONDITIONAL GRANTS

1ST QUARTER 2010/11 COMPARATIVE

2010/11 AllocationsActual Exp for

Quarter% of Budget

AllocnExp Target for

QuarterVariance

% of Target for Quarter

R'000

Comprehensive HIV/AIDS Grant 690,940 127,383 18% 142,491 15,108 89%

Forensic Pathology Grant 69,345 12,439 18% 19,550 7,111 64%

National Tertiary Services Grant 557,137 173,914 31% 137,609 -36,305 126%

Health Professionals and Development Grant 160,444 14,402 9% 40,110 25,708 36%

Hospital Revitalisation Grant 360,660 50,921 14% 66,350 15,429 77%

EPWP Incentive- Social Cluster Grant 33,659 938 3% 9,808 8,870 10%

Infrastructure Grant to Provinces 331,782 148,319 45% 123,102 -25,217 120%

Total 2,203,967 528,316 24% 539,020 10,704 98%

BY ECONOMIC CLASSIFICATION

Current Expenditure 1,279,619 324,674 25% 285,801 -38,873 114%

Compensation of employees 316,396 54,091 17% 72,929 18,838 74%

Goods and services 963,223 270,583 28% 212,872 -57,711 127%

Total transfers and subsidies 152,386 1,181 1% 44,242 43,061 3%

Departmental Agencies 44,095 1,022 2% 15,012 13,990 7%

Universities & technikons 108,291 0 0% 29,230 29,230 0%

Payments for capital assets 771,962 202,461 26% 208,977 6,516 97%

Buildings & Fix Structures 647,442 191,923 30% 178,568 -13,355 107%

Machinery and equipment 124,520 10,538 8% 30,409 19,871 35%

Total 2,203,967 528,316 24% 539,020 10,704 98%

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Extracts from 2010/11 Audited Annual Financial Statements:

The department has applied for the Conditional Grants funds totaling R489.7 million appropriated but not spent in the 2010/11 financial year to be rolled over to the 2011 / 2012 financial year. The request for roll over is supported by commitments where goods and services had been delivered or rendered and therefore funds were committed and the department is either awaiting submission of invoices by suppliers or invoices had been received but will be paid in the next financial year.

55

NAME OF GRANT

2010/11 GRANT ALLOCATION SPENT 2009/10

Division ofRevenue Act/ ProvincialGrants

RollOvers

Other Adjustments

TotalAvailable

Amountreceived

bydepartment

Amount spent bydepartmen

t

% of available funds

spent bydepartment

Divisionof

RevenueAct

Amount spent bydepartment

R’000 R’000 R'000 R’000 R'000 R'000 % R’000 R’000

National Tertiary Services Grant 557,137 75,094 - 632,231 594,454 594,454 100% 603,329 528,235

Health Professionals and Development Grant

160,444 46,754 - 207,198 182,320 182,320 100% 171,106 124,352

Hospital Revitalisation Grant 360,660 78,875 - 439,535 168,610 168,610 100% 282,987 204,048

Comprehensive HIV/AIDS 690,940 67,187 1,000 759,127 700,216 700,216 100% 493,702 425,817

Forensic Pathology 69,345 7,237 - 76,582 63,070 63,070 100% 61,214 53,882

Infrastructure grant to provinces 331,782 24,383 - 356,165 256,165 278,691 109% 279,483 255,100

2010 World Cup Health Preparation Strategy Grant

- - - - - - - 4,345 -

EPWP Incentive- Social Cluster 6,012 - - 6,012 6,012 6,012 100% 1,175 -

EPWP-Incentive 27,647 - - 27,647 - 26,187 100% - -

TOTAL 2,203,967 299,530 1,000 2,504,497 1,970,847 2,019,560 100% 1,897,341 1,591,434

9/8/11

2. ASSESSMENT OF MONITORING CAPACITY THUS FAR FOR THE FINANCIAL YEAR 2011/12. INDICATING UNDER / OVER SPENDING AND WHAT THE CAPACITY CONSTRAINTS ARE THAT IMPACTED ON THESE

OUTCOMES

The Department has strengthened its monitoring capacity thus far for the financial year 2011/12 by requiring Programme and Grant Managers to address the MEC and SG at monthly In - Year - Monitoring meetings and account for the performance of the respective Grants. The following capacity constraints have adversely impacted on the outcomes:

Compensation of Employees – the department has had challenges with problematic Conditional Grant persal link codes, which situation has recently been remedied. Goods and Services – the Department has not always been able to pay various key accounts timeously adversely impacting on the expenditure disclosed. This situation is currently being remedied through the Finance Cluster turnaround plans for accounts payable. In addition, Medsas interfaces with BAS in the month of June 2011 were not up to date, which has been rectified in July. Transfers and Subsidies - The primary reasons that transfer payments have not been moving is that there have been extensive challenges with the respective institutions in complying with the Public Finance Management Act requirements of Section 38(1)(j) (written assurance from the entity that that entity implements effective, efficient and transparent financial management and internal control systems; as well as Treasury Regulation 8.4.2 (…withholding transfers and subsidies to an entity where conditions attached to the transfer and subsidy have not been complied with)

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3. THE RECEIPT OF MONTHLY REPORTS FROM RECEIVING ENTITIES - Refer discussion in (2) above

4. DEPARTMENT’S SPENDING PLANS. BUSINESS PLANS ON THE

SAID CONDITIONAL GRANTS - These are discussed in Annexures 1, 2 and 3 respectively

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ANNEXURE 1COMPREHENSIVE HIV AND AIDS GRANT

1. Introduction

This is the first quarter of the 2011/12 financial year Conditional Grant Expenditure

Report to the Select Committee on Appropriations

2.1 Purpose, Objectives of the Conditional Grant and Expected Outcomes

To enable the health sector to develop an effective response to HIV and Aids; To support the implementation of the National Operational Plan for

comprehensive HIV and Aids treatment and care To subsidise in–part funding for the antiretroviral treatment programme.

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PROJECT BUDGET

R'000

OUTPUT/OUTCOME

Anti Retroviral Treatment 637 664 Number of facilities competent to provide ART Total number of patients (children and adults) on ART Number of Health care workers trained on nurse initiated management of ART (NIMART

HIV Counseling and Testing 63 229 HCT testing rate Number of PHC facilities offering HCT services

Prevention of Mother To Child Transmission

20 783 Number of PHC facilities offering PMTCT services % of HIV positive ante-natal clients on PMTCT Programme Antenatal client initiated on HAART % of babies born to HIV positive mothers done Polymerase Chain Reactive (PCR) testing at

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

(%)

Home Based Care 35 000 Number of clients accessing HBC services Number of NGOs/CBOs funded

Step Down Care 7 434 Number of facilities offering the SDC services Number of clients accessing SDC services

Condoms 28 000 Number of female and male condoms procured and distributed

2.2 Project List

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High Transmission Area 5 875 Number of functional High Transmission Areas (HTA) facilities

Post Exposure Prophylaxis 654 Number of facilities offering the PEP services Number of clients accessing PEP services

Programme Management 23 148 Transfer of training funds to AIDS Training Information and Counseling Centre

Medical Male Circumcision 14 301 Number of facilities offering the MMC services Number of clients accessing MMC services

Regional Training Centre 18 210 Number of Health Care Professional trained on ART, PEP, TB/HIV, HCT/PMTCT, STI

TB/HIV 9 875 Percentage of smear positive PTB cases detected Number of new PTB cases detected Percentage of HIV+ patients started on Isoniazid (INH) Prophylaxis % of TB/HIV co-infected patients started on Cotrimoxazole % of TB cases tested for HIV % of TB/HIV co-infected patients with CD4 count <350 started on ARVs

TOTAL 864 173

1010

2.2 Project List cont.

9/8/11

OBJECTIVE PERFORMANCE

INDICATOR

MEASUREMENT UNIT

ANNUAL TARGET QUARTERLY TARGETS

ACTUAL PERFORMANCE( QU

ARTER UNDER REVIEW)

EXPLANATION OF VARIANCE BETWEEN PLANNED AND ACTUAL OUTPUT

HIV & AIDS , STIs and TBTo increase the number of HIV patients started on ART to 350,000 by 2014/15

Number of facilities competent to provide ART

Assessment forms

668 2010/11

Comparative: 410

602 (22 new) 2010/11 Comparative:

114

2010/11 Comparative: 147

114 PHC facilities were assessed to provide ART services. All these facilities were found to be competent. The target was exceeded because of the involvement of the sub district coordinators in identification of potential facilities and pre-assessment preparations. These included identification of available space and training of nurses on NIMART by sub district managers and clinic supervisors.

Total number of patients (children and adults) on ART

ART Registers 215 000 (65 000 new) 2010/11 Comparative: 150 000

166 250 (16 250 new) 2010/11 Comparative: 120 000

175 878 (25 878 new clients were

added to the programme during

quarter 1)


101

The number of clients on ART has increased because • There has been a significant increase in number of health facilities

assessed and competent to provide ART. These have increased from a total of 580 by end of March 2011 to 693 by end of June 2011.

• The increase in the number of sites competent to provide ART is due to a number of professional nurses that were trained on Nurse Initiated Management of Ante-Retroviral Therapy (NIMART). 195 Professional nurses were trained on NIMART during quarter 1 of the financial year whilst a total of 852 nurses were trained in the previous year.

• Financial implications: Anti-Retro Viral drug prices have decreased by 53% so there won’t be any shortfall on budget. This decrease was not provided for in the initial business plan so it will make up for the exponential increase of patients receiving ART. There is also a rollover of R51M which has been approved should there be a shortfall it will cover the cost of medicines.

2.3 Service Delivery PerformanceTable 1 : Performance Indicators and Targets

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To increase the number of HIV patients started on ART to 350,000 by 2014/15

Number of Health care workers trained on nurse initiated management of ART (NIMART)

Attendance registers

1512 (747 new) 2010/11 Comparative: 5 527


195 nurses were trained on NIMART

2010/11

Comparative: 3 269

There are more sites providing ART and more demand for training of NIMART. There are roving teams in sub districts which initiate patient in facilities where there are no NIMART trained nurses. These are competent teams led by sub district co ordinator and The ECRTC. The target has been exceeded due to demand for training by facilities. The ECRTC and NGO supporting the programme find themselves training more nurses as sent by facilities.

1212

2.3 Service Delivery Performance cont.Table 1 : Performance Indicators and Targets

To reduce HIV incidence

Number of female condoms distributed

Condoms data input form and bin cards

2m 2010/11 Comparative: 2m

500 000 2010/11 Comparative: 500 000

75,958


456

Female condoms are procured by the national DOH for all the nine provinces from the one company that is manufacturing these. Lately there is a huge shortage of female condoms due to this service provider who is no longer producing these female condoms. The National department of health has requested approval from Treasury to procure out of RT 4 tender; the NDOH is still awaiting response

Number of male condoms distributed

Condoms data input form/bin cards

28 556 102

2010/11 Comparative: 70m

7 139 026 2010/11 Comparative: 17 500

7,487,758

2010/11 Comparative:

6 746 957

The observed increase in number of male condoms distributed is due to monitoring and addition of statistics from social marketing of condoms which during the previous years was excluded with only those distributed from the public sector were monitored and reported. As a result, thus far the observed increase in numbers will not have any budgetary implications with regards to over expenditure as would be anticipated The Society for Family Health (SFH) has contributed to the increase in condom distribution. They are distributing to non-medical sites including petrol stations and farm areas.

Male condom distribution rate

12%

2010/11 Comparative: 12%

12%


12%

14.10%


12.9%

The inclusion of the social marketing condom distribution data from the Society for Family Health has contributed to the increased distribution of condoms in non-medical sites such as farms and petrol stations.

9/8/11

To reduce HIV incidence

Number of functional High Transmission Areas (HTA) facilities

Accreditation forms 49 (6 new) 2010/11 Comparative: 50


0


44

There were no new sites established during quarter one because, the programme was still busy with the recruitment process and training of peer educators before a site can be established. The challenge is high turnover of peer educators as their stipend is very minimal. However, discussions of opening two new HTA sites are underway with St Albans and North End Prison in Port Elizabeth.

HCT testing rate 2010/11 Comparative: Number of clients tested for HIV

HCT Register 90%

2010/11 Comparative: 1 600

000

90%


000

85.60%

2010/11 Comparative :

205 166

HCT programme is voluntary and therefore clients have an option to refuse to test after being counseled. The programme has initiated implementation of Provider Initiated Counseling and Testing (PICT) which is expected to improve acceptance of the actual testing for HIV. A target of 10 patients per Professional nurse was set and is being monitored to facilitate removal of bottlenecks.Lay counselors are trained to do HIV Rapid testing. A target of 6 patients per day is set and supervised by Retired nurses(2 per sub district) they also test during Community Outreach events

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To facilitate expansion of PMTCT programme

% of PHC facilities offering PMTCT services (N=796)

List of facilities 97%


97%


99.6% (793/796) facilities


2m

793 PHC facilities in the Eastern Cape province provide PMTCT services; three PHC including Bisho Parliament, Tyamzashe and Efata clinics are not providing PMTCT since they do not provide ANC service. However, as part of National PMTCT Action Framework to screen all women of child bearing age at all entry points and to promote ART initiation for all eligible patients at all entry points

% of HIV positive ante-natal clients on PMTCT Programme

Registers 85%


000

85%


68.20%


904

Under performance reflected here is due primarily to under reporting. Some facilities had not reported at the time of report writing due to unavailability of faxes and data capturers. The HIV and AIDS Directorate and Information Directorate are ensuring that facilities have at least one data capturers. Data capturers from DOH Partners are being mapped and roped in to strengthen DOH reporting.

Antenatal client initiated on HAART

Registers 100%


000

100%


88.50%


601

ANC clients are delayed by the referral systems since not all facilities are initiating HAART. Currently there are 525 sites initiating ARVs, to address this the programme is embarking on the process of training nurses on NIMART so that all sites can be able to initiate. ANC cannot be attended only at the ART initiating sites as it will be difficult for the pregnant mothers to travel to those sites and that will contribute to late presentation for ANC.

1414


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To reduce HIV transmission rate in children born to HIV positive mothers to less than 5%

% of babies born to HIV positive mothers done Polymerase Chain Reactive (PCR) testing at 6 weeks

Registers

90%


90%


79.70%


Target not met due to high numbers of babies lost to follow up. The contributing factor to loss to follow up is relocation where mothers move from one place to another. Amathole and O.R Tambo are leading in lost to follow up. There are NGO partners that are supporting the programme in tracing those babies viz PATH and Khethimpilo. Secondly the Community care workers are also used to trace those babies and support group for mothers on PMTCT programme called “mothers to mothers to be”, with all these strategies the programme is hoping to win this battle.

Baby tested PCR positive six weeks after birth as a proportion of babies tested at six weeks (%)

Registers 5%


5%


4.50%


One of the success stories of the PMTCT programme in the province. The success of this programme is attributable to the integration with the MCWH and immunizations which are due at 6weeks. In addition, Mothers to Mothers to be programme also influences these outcomes positively.There are patient advocates provided by the NGOs which also assist in supporting and tracing these mothers within this period. On discharge, mothers are given nevirapine for six days then six weeks dose; this motivates them to come back and to comply. The PCR testing is coupled with peuperal sepsis check-up which is done at 6 weeks and the mothers are compelled to come for check-up, secondly during this period most of the mothers are still on martenity leave and as such able to breastfeed their babies exclusively1515


9/8/11

To facilitate expansion of PMTCT programme

% of PHC facilities offering PMTCT services (N=796)

List of facilities 97%


2m

97%


2m

99.6% (793/796) facilities


2m

793 PHC facilities in the Eastern Cape province provide PMTCT services; three PHC including Bisho Parliament, Tyamzashe and Efata clinics are not providing PMTCT since they do not provide ANC service. However, as part of National PMTCT Action Framework to screen all women of child bearing age at all entry points and to promote ART initiation for all eligible patients at all entry points

% of HIV positive ante-natal clients on PMTCT Programme

Registers 85%


28 000

85%


000

68.20%


52 904

Under performance reflected here is due primarily to under reporting. Some facilities had not reported at the time of report writing due to unavailability of faxes and data capturers. The HIV and AIDS Directorate and Information Directorate are ensuring that facilities have at least one data capturers. Data capturers from DOH Partners are being mapped and roped in to strengthen DOH reporting.

Antenatal client initiated on HAART

Registers 100%


28 000

100%


000

88.50%


601

ANC clients are delayed by the referral systems since not all facilities are initiating HAART. Currently there are 525 sites initiating ARVs, to address this the programme is embarking on the process of training nurses on NIMART so that all sites can be able to initiate. ANC cannot be attended only at the ART initiating sites as it will be difficult for the pregnant mothers to travel to those sites and that will contribute to late presentation for ANC.

1616


9/8/11

To reduce HIV transmission rate in children born to HIV positive mothers to less than 5%

% of babies born to HIV positive mothers done Polymerase Chain Reactive (PCR) testing at 6 weeks

Registers

90%


90%


79.70%


Target not met due to high numbers of babies lost to follow up. The contributing factor to loss to follow up is relocation where mothers move from one place to another. Amathole and O.R Tambo are leading in lost to follow up. There are NGO partners that are supporting the programme in tracing those babies viz PATH and Khethimpilo. Secondly the Community care workers are also used to trace those babies and support group for mothers on PMTCT programme called “mothers to mothers to be”, with all these strategies the programme is hoping to win this battle.

Baby tested PCR positive six weeks after birth as a proportion of babies tested at six weeks (%)

Registers 5%


5%


4.50%


One of the success stories of the PMTCT programme in the province. The success of this programme is attributable to the integration with the MCWH and immunizations which are due at 6weeks. In addition, Mothers to Mothers to be programme also influences these outcomes positively.There are patient advocates provided by the NGOs which also assist in supporting and tracing these mothers within this period. On discharge, mothers are given nevirapine for six days then six weeks dose; this motivates them to come back and to comply. The PCR testing is coupled with peuperal sepsis check-up which is done at 6 weeks and the mothers are compelled to come for check-up, secondly during this period most of the mothers are still on martenity leave and as such able to breastfeed their babies exclusively1717


9/8/11

2.4. Quarterly Expenditure2.4.1. Total Conditional Grant Expenditure

1ST QUARTER 2011/12

HIV& AIDS

2011/12 Allocations


% of Budget Allocn


Variance % of Target for Quarter

YTD Commitments

R'000

Current Expenditure 809,173 99,810 12% 186,843 87,033 53% 159,793


Goods and services 645,598 74,330 12% 147,291 72,961 50% 159,793

Total transfers and Subsidies

55,000 0 0% 3,459 3,459 0% 0

Departmental Agencies 41,322 0 0% 0 0 n/a

Universities & technikon 13,678 0 0% 3,459 3,459 0%

Payments for Capital assets 0 57 -57 311

Machinery & Equipment 57 0 -57 311

Total 864,173 99,867 12% 190,302 90,435 52% 160,104

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HIV& AIDS 2010/11 Allocations Actual Exp for Quarter

% of Budget Allocn



R'000

Current Expenditure 633,155 126,227 20% 122,144 -4,083 103%


Goods and services 516,904 108,398 21% 96,221 -12,177 113%

Total transfers and Subsidies 56,803 1,022 2% 20,347 19,325 5%

Departmental Agencies 44,095 1,022 2% 15,012 13,990 7%

Universities & technikon 12,708 0 0% 5,335 5,335 0%

Payments for Capital assets 982 134 14% 0 -134

Machinery & Equipment 982 134 14% 0 -134

Total 690,940 127,383 18% 142,491 15,108 89%

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OBJECTIVES ORIGINAL BUDGET

EXPENDITURE COMMITMENTS

%SPENT COMM

% SPENT EXCL COMM

AVAIL BUDGET INC COMM

AVAIL BUDGT EXCL COM

COND GRANT: TB HIV 4,303,000 0 645,992 15 0 3,657,008 4,303,000

COND GRANT: CONDOMS 28,000,000 0 0 0 0 28,000,000 28,000,000

COND GRANT: MMC - (HIV AIDS) 13,501,520 32,314 212,009 2 0 13,257,197 13,469,206

COND GRANT HCT 63,229,000 161,799 521,820 1 0 62,545,381 63,067,201

RTC 13,678,000 0 0 0 0 13,678,000 13,678,000

2.4.2. Total Conditional Grant Project Expenditure

2020

9/8/11

COND GRANT HIGH TRANSM AREAS 7,332,000 53,243 5,015 0 1 7,273,743 7,278,757

COND GRANT PROGRAMME MANGT 30,612,000 69,469 57,697 0 0 30,484,833 30,542,531

COND GRANT PMTCT 15,783,000 392,321 784,969 5 2 14,605,709 15,390,679

POST EXPOSURE PROPHYLAXIS 654,000 0 246,069 38 0 407,931 654,000

COND GRANT HOME BASED CARE 35,000,000 693,036 463,778 1 2 33,843,186 34,306,964

COND GRANT STEP DOWN 7,445,666 275,808 244,532 3 4 6,925,326 7,169,858

COND GRANT ARV 644,646,480 98,188,153 157,237,650 24 15 389,220,677 546,458,327

TOTAL 864,184,666 99,866,143 160,419,532 19 12603,898,991 764,318,523

2121



%SPENT COMM

% SPENT EXCL COMM



9/8/11

ECONOMIC CLASSIFICATION

COE 163,575,000 25,479,683 0 0 16 138,095,317 138,095,317

GOODS AND SERVICES 645,609,666 74,329,385 160,108,312 25 12 411,171,969 571,280,281

DEPARTMENTAL AGENCIES 41,322,000 0 0 0 0 41,322,000 41,322,000

MACHINERY & EQUIP 0 57,075 311,220 -368,295 -57,075

UNIVERSITIES AND TECH 13,678,000 0 0 0 0 13,678,000 13,678,000

TOTAL 864,184,666 99,866,143 160,419,532 19 12 603,898,991 764,318,523

2222



%SPENT COMM

% SPENT EXCL COMM



9/8/11

2.5. Challenges and Remedial Steps

NHLS - The expenditure on Goods & Services as at end June 2011 is R74,330m as against cash flow projections R147, 291m. Under expenditure (variance) is at 72,961mReason: Invoices for the period Feb, March and April 2011 were not paid as decentralized NHLS funds to be paid by facilities first undergoes verification of invoices. SANBS - Reason: R37,0m allocated for blood and blood products was under spent as facilities who do not transfuse could not spend even though allocations to them were made.Facilities also prioritize spending Equitable Share allocation before closure rather than Conditional Grant allocation which has a longer life. Remedial action: The situation for both of the above – named has been remedied in subsequent months.CONDOMSReason: Allocation of 28m was not spent due to new arrangements by National regarding payments of delivered condoms procured by provinces. Remedial action: National suppliers are being registered into EC database to enable invoicing by National including requests for other compliance requirements i.e. SBD 4, SBD 9 and Tax clearance. HIV Directorate / Procurement / Treasury will finalize this process to allow procurement of condoms.ARVsReason: Allocations were overestimated as ARV prices were reduced by 53% whilst EC only reduced by 25%.Remedial action: An amendment will be made to shift funds to another economic classification

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9/8/11 2424

2.5. Challenges and Remedial Steps cont.

Home Based CareReason: Allocations of 17m for training of home based carers plus purchasing of home based kits was decentralized to districts whose spending is delayed by the district tender process and district supply chains Remedial action: Provincial Programme managers will facilitate expenditure through District tender processes.TBHIVReason: Expenditure for activities (conferences and printing) done in April, May and June remains unpaidRemedial action: Provincial Programme managers to facilitate timely payment of commitmentPMTCTReason: Allocations were not spent in April, May and June due to tenders not awarded yet (e.g. printing of registers for PMTCT). Remedial action: Remedial Provincial 5 day tender to speed up the tender process HTAReason: Allocation for purchase for HTA programme was not done as HTA Programme manager’s post is vacant post departure of the manager in AprilRemedial Action: EU Monitoring and Evaluation manager has been transferred to HIV Directorate to start by 1 August. Meanwhile procurement for HTA programme has been delegated and will be facilitated by Provincial Programme managersPEPReason: Allocations to purchase PEP comfort packs was not done as selected Supplier 1 WITHDREW.Remedial Action: Procurement to be done through Supplier no2

9/8/11

Annexure 2FORENSIC PATHOLOGY SERVICES GRANT

1. Introduction

Quarterly Conditional Grant Expenditure Report to the Select Committee on

Appropriations

2.1 Purpose, Objectives of the Conditional Grant and Expected Outcomes

To continue the development and provision of adequate mortuary services in all

provinces

2.2 Programme or Project List

Refer 2.4.2 hereunder

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Objective Performance indicator Annual Target 2011/12

QUARTERLY TARGETS

ACTUAL PERFORMANCE( QUARTER UNDER REVIEW)

Explanation of variance between planned and actual output

To strengthen the capacity and functionality of Forensic Pathology Institutions within the Province

Number of forensic pathology institutions implementing the National Core Standards (6 Priority Areas)

21

(Not measured in the previous years)

5 5 Target achieved as more equipment, protective clothing through an awarded provincial tender

To ensure that post mortem services are conducted within 48 hours and post mortem forensic reports are accepted by the courts

% of postmortems performed within 72hrs

2010/11Comparative: was within 48 hrs – not in line with National guidelines of 72 hours

90%

2010/11Comparative: 90%

90%


90%


This has been made possible by the involvement of the principal specialists appointed in the Port Elizabeth and Mthatha Regions; these specialists are tasked to closely monitor the clinical component of the service.

% of submitted postmortems accepted by the court

95%


95%


95%


The involvement of the principal specialists and their close monitoring has improved the quality of reporting by the Medical Officers hence a larger percentage of post mortems are now accepted by the court.

2.3 Service Delivery Performance

Table 1: Performance Indicators and Targets

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9/8/11

To ensure that post mortem services are conducted within 48 hours and post mortem forensic reports are accepted by the courts

% of cold case collected within 1 hour (Urban)

50%


50% 40% The target was not achieved due to staff shortages. Recruitment process for vacant posts in the Port Elizabeth and East London region will only be finalized at the end of August 2011.

In addition, a request has been made to the Organizational Development directorate (OD) to create additional posts to the organogram of this Unit

% of cold case collected within 3 hours (Rural)

50%


50% 40% The target was not achieved due to staff shortages. Recruitment process for vacant posts in the Port Elizabeth and East London region will only be finalized at the end of August 2011.

In addition, a request has been made to the Organizational Development directorate (OD) for creation of additional posts.

To facilitate access to clinical forensic medical services

% of sexual assault victims examined within an hour of reporting at facility

45%


45%


45%


The service delivery in sexual assault centres has improved considerable lately due to the upgrading of these centres to fully fledged Thuthuzela Centres.

Number of sexual assault centres upgraded (face-lift)

2

2010/2011

Comparative

4 additional

centres

-

2010/2011 Comparative

1

1

2010/2011 Comparative

0

The upgrade of the Butterworth hospital sexual assault centre was made possible by the funding received from the UNICEF. The funds were used to procure a park home which is now installed and from where the service is provided to sexual assault victims.

2727

Objective Performance indicator Annual Target 2011/12

QUARTERLY TARGETS

ACTUAL PERFORMANCE( QUARTER UNDER REVIEW)

Explanation of variance between planned and actual output

9/8/11

1ST QUARTER 2011/12

Forensic Pathology

2011/12 Allocations


% of Budget Allocn



YTD Commitments

R'000



Goods and services 11,986 2,208 18% 2,926 718 75% 2,043

Payments for Capital assets 14,000 4,864 35% 2,967 -1,897 164% 5,295

Buildings & Fix Structures 14,000 3,010 22% 2,967 -43 101% 2,958

Machinery & Equipment 1,854 0 -1,854 2,337

Total 73,506 17,923 24% 21,956 4,033 82% 7,338

2.4 Quarterly Expenditure2.4.1 Total Conditional Grant Expenditure

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9/8/11


Forensic Pathology

2010/11 Allocations Actual Exp for Quarter

% of Budget Allocn



R'000

Current Expenditure 56,345 12,439 22% 13,750 1,311 90%


Goods and services 11,345 3,101 27% 3,100 -1 100%

Payments for Capital assets 13,000 0 0% 5,800 5,800 0%

Buildings & Fix Structures 8,000 0 0% 5,000 5,000 0%

Machinery & Equipment 5,000 0 0% 800 800 0%

Total 69,345 12,439 18% 19,550 7,111 64%

2929

9/8/11

ANNEXURE 3HOSPITAL REVITALISATION GRANT

1. Purpose, Objectives of the Conditional Grant and Expected Outcomes To provide funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, monitoring and evaluation of hospitals; and to transform hospital management and improve quality of care in line with national policy objectives. 2.1. Project List and Service Delivery PerformanceOf the R382 million budget, the bulk (R317 million is for buildings) is allocated to major projects as follows:

a. Cecelia Makiwane R 137 million b. St Elizabeth’s Hospital R114 million c. St. Patricks R 53.5 million d. Frontier R 43.2 million

3030

9/8/11

PROJECT BUDGET ALLOCATED 2011-12

PROJECTED EXPENDITURE APR-JUNE

EXPENDITURE APR -

JUNE

VARIANCE STATUS OF EACH PROJECT PROPOSED INTERVENTIONS

BLDGS & FIX STRUCTURES

1 Cecilia Makiwane Hospital - Phase 4 Main Hospital Complex

137,700,000 16,000,000 7,129,316 8,870,684 The site was handed over on 01 June 2011. The contractor has started with the enabling works.The existing site office has been refurbished, it is to accommodate site representatives for the Contracting stakeholders. Construction of the batch plant (site concrete mixing unit) has commenced and the first crane tower is set to be erected as soon as construction is set to go at full speed. The labour agreement has been signed to guide the labour rates that will be used by the contractor and to avoid work interruptions due to labour payment rates disagreements. Demolition have started at the old service building to prepare for construction of the main hospital. The contractor has started with construction of the batch plant.

The expenditure to date has improve and is todate R 19,842,715.29 with R 25,379,713 certificates that are currently in aprocess of payment.

3131

9/8/11

2 Dr Mpehle/St. Lucys Hospital - Replacement Hospital

3,723,000 0 0 0 Construction is completed and the building was occupied on November 2009. The main contractor is still busy rectifying defects before the final account willo be paid before the end of Second quarter.

A process of fastracking finalisation of all outstanding issues and submition of the final account certificate for payment is underway. Expenditure is expected before the end of the second quarter.

3 Dr Mpehle/St Lucys Hospital Gateway Clinic

3,650,000 273,000 35,048 237,952 The building is completed and occupied and utilised by the end users. The Principal Agent is busy finalising the final account for submission and this will be submitted by the 30 September 2011.

A process of fastracking finalisation of all outstanding issues and submition of the final account certificate for payment is underway. Expenditure is expected before the end of the second quarter.

4 Dr Mpehle/St Lucys Hospital - New EMS

3,127,000 3,127,000 1,795,211 1,331,789 Construction of the building has been completed the contractor is busy attending to the snaglist, a practical completion will be achieved by 31 September.

A certificate was received in the last week of August 2011 and will be processed in April 2011.

3232



EXPENDITURE APR -

JUNE


9/8/11

5 Frontier Hospital - Phase 3 (Theatre and ICU, Male surgical Ward, X- Ray and Pharmacy, Substation, Female Medical Ward and Female Surgical Ward)

3,198,000 3,198,000 0 3,198,000 The Principal Agent has not yet finalised the final account and this is expected to be resolved during the second quarter.

Final Account to be processed before the end of the second quarter.

6 Frontier Hospital - Eye Unit

250,000 200,000 0 200,000 An amount of R 195,132 has been paid towards the final Account.

The Infrastructure Manager will follow up with the Implementing Agent.

7 Frontier Hospital - New Ward Blocks and Mortuary

18,000,000

4,106,958 0 4,106,958 The termination of the contractor was approved by the DRPW and the the project was re-advertised and awarded in June. The contractor is currently busy with internal finishings and has started with excavationg for the mortaury delivery area.

Expenditure will take place as planned and payment of invoices will improve.

8 Frontier Hospital - CAS/OPD

13,941,000

250,000 0 250,000 The project was re-advertised on the 24th of June 2011 and closed on the 21st of July 2011. The compulsory site inspection was done on the 04th of July 2011. It is planned that thewill be on site on the second week of September 2011.

Project need to proceed as planned and invoices settled on time.

3333



EXPENDITURE APR -

JUNE


9/8/11

9 Frontier Hospital - New Paeds Ward

7,059,000 0 0 0 Tender for this project was advertised on the 4th of March of 2011 with site inspection meeting on the 11th of March 2011 and closed on the 25th of March 2011 but waiting for award that is now delayed due to the CAS/OPD contractor not yet appointed because of the phased approach of the construction.

The CAS/OPD contractor needs to be awarded to ensure that this project is not delayed and contractor establishes site before 31 December 2012.

10 Madwaleni Hospital Upgrade

6,795,331 1,500,000 1,033,071 466,929 The project is still at designing and planning stage. Business Case was approved by the National Department of Health. Construction is expected to start in the last quarter of the financial year.

Construction will take as planned and that the outstanding professional fees will be paid before the end of the third quarter.

11 Madzikane ka Zulu Hospital - Professional accommodation accomodation

204,669 0 157,824 157,824 The final account has been paid.

12 St. Elizabeths Hospital - Extensions to Admin Block, Paediatrics

9,000,000 0 0 0 The project has been merged in the OPD contract.

The budget will be reviewd and shifted to thge main OPD/CAS contract.

3434



EXPENDITURE APR -

JUNE


9/8/11

13 St Elizabeth's Hospital - General Ward Block

2,600,000 0 0 0 The allocated budget was for repairs of the burnt ward and a tender in this regard will be re-advertised in the month of September 2011.

A tender to be re-advertised as planned as construction to resume as soon as possible.

14 St. Elizabeths Hospital - Kitchen

0 5,000,000 935,529 4,064,471 The final account has been paid. This project was not budgeted for it was due to be paid by end March 2010.

Project was paid.

15 St. Elizabeths Hospital - Mortuary and Labour Theatre

10,000,000 4,000,000 1,919,291 2,080,709 The mortuary has been completed and occupied. The extention to include labour theatre to the exsiting maternity ward has been completed the contractor is busy with internal finishings. The budget on this project includes the fixed equipment which will only be paid towards the end of the project.

16 St Elizabeths Hospital - Professional Staff Accommodation.

6,000,000 1,500,000 0 1,500,000 Construction is complete and final snags are in progress. Landscaping is complete and the maintenance period has commenced. The contractor is testing the functionality of the electrical installations. The contractor is busy attending the snag list. The practical handing is expected before the end of September 2011.

3535



EXPENDITURE APR -

JUNE


9/8/11

17 St Elizabeths Hospital - Resource Centre

8,000,000 5,000,000 3,388,567 1,611,433 The Resource centre was re-advertised in June 20111 and the tender closed on the 28 July 2011.

The tender needs to be awarded and the contractor appointed and start with the construction as soon as possible.

18 St Elizabeths Hospital - New Trauma / CAS/OPD

28,400,000 6,000,000 4,509,999 1,490,001 The civil contract was awarded on the 22nd of June 2011 and the contractor is busy doing services connections for site establishment.

19 St. Patricks Hospital - Professional Accommodation

9,400,000 0 495,375 495,375 The administration offices and staff accommodation are completed and occupied. (9 single units, 8 family blocks, 64 dormitotries and midwives block)

21 St Patricks Hospital - Upgrading CAS/OPD, Maternity, etc.

42,600,000 4,000,000 0 4,000,000 The site handing over was on 01 June 2011. The contractor is busy with demolitions and enabling works for the Rehabilitation unit and the temporary martenity.

22 St. Patricks Hospital - Upgrade Phase 1 (General wards, Peads, Theatre/CSSD, Mortuary, Workshop, kitchen and Laundry)

4,000,000 0 0 The final account has been submitted and is at registry for payment.

SUBTOTAL 317,648,000 54,154,958 21,399,232 32,755,726

3636



EXPENDITURE APR -

JUNE


9/8/11

MACHINERY & EQUIPMENT

23 Dr. Mpehle Hospital - Equipment

8,500,000 1,700,000 661,900 1,038,100 Medical equipment tenders have been awarded in the latter part of the month of August 2011 to successful service providers.

Suppliers are expected to submit invoices on time and payment of these is done accordingly.

24 St Elizabeths Hospital: Equipment

8,000,000 2,500,000 606,131 1,893,869 Medical equipment tenders have been awarded in the latter part of the month of August 2011 to successful service providers.


25 St Patricks Hospital: Equipment

6,700,000 1,000,000 0 1,000,000 Medical equipment tenders have been awarded in the latter part of the month of August 2011 to successful service providers.


26 Frontier Equipment 12,000,000 8,700,000 19,457,099 10,757,099 Medical equipment tenders have been awarded in the latter part of the month of August 2011 to successful service providers.


SUBTOTAL 35,200,000 13,900,000 20,725,131 6,825,131

3737



EXPENDITURE APR -

JUNE


9/8/11

GOODS & SERVICES

27 Quality of Care 21,420,000 4,708,023 2,685,262 2,022,761 The underspending is due to: The Patient administration system contract has only been renewed on 14 June 2011 and this was budgeted to be paid from April 2011.

The payment for the Patient Administration System is in the process of being effected.

SUBTOTAL 21,420,000 4,708,023 3,072,572 1,635,451

COMPENSATION OF EMPLOYEES

0

28 Compensation of Employees HRP

4,180,000 819,527 1,058,464 238,937 Not all proposed personnel have been appointed.

Vavant post to be advertised before the end of the second quarter.

29 Compensation of Employees HRP at institutions

3,600,000 370,473 160,817 209,656 The underspending is due to the funds allocated and projected to be spent at DMMMH (R2,000,000) as per Project Implementation Plan for appointments. Furthermore, a pharmacist for St Patrick's Hospital that was appointed and due to start on 01 April 2011 has declined the offer. Recruitment process has been re-initiated.

The recruitment process should be strengthened within the instiutions and the district offices to ensure smooth runiing of the process

SUBTOTAL 7,780,000 1,190,000 1,613,217 423,217

GRAND TOTAL 382,048,000 73,952,981 46,810,152 27,142,829

3838

PROJECT BUDGET ALLOCATED

2011-12


EXPENDITURE APR -

JUNE


9/8/11

1ST QUARTER 2011/12

Hospital Revitalization

2011/12 Allocations


% of Budget Allocn



YTD Commitments

R'000


Compensation of employees 7,780 1,219 16% 1,190 -29 102%

Goods and services 21,420 2,632 12% 4,708 2,076 56% 4,681

Payments for capital assets 352,848 42,125 12% 66,212 24,087 64% 308,320

Buildings & Fix Structures 317,648 21,399 7% 52,312 30,913 41% 305,427

Machinery and equipment 35,200 20,726 59% 13,900 -6,826 149% 2,893

Total 382,048 45,976 12% 72,110 26,134 64% 313,001

3939

2.2 Quarterly Expenditure

2.2.1 Total Conditional Grant Expenditure

Expenditure in the first quarter of this year stood at R46 million compared to R51 million in the same period last year. This reflects a reduction in expenditure amounting to R4 million, albeit the programme budget increased from R360 million to R382 million. The bulk of this under expenditure is accounted for by Buildings The reason for this relates to late (in June 2011) commissioning of major Building Works

9/8/11


Hospital Revitalization

2010/11 Allocations Actual Exp for Quarter

% of Budget Allocn



R'000

Current Expenditure 15,500 4,564

29% 4,316

-248 106%

Compensation of employees 5,500 1,572

29%1,551

-21 101%

Goods and services 10,000 2,992

30%2,765

-227 108%

Payments for capital assets345,160 46,357

13%62,034

15,677 75%

Buildings & Fix Structures315,660 43,759

14%52,173

8,414 84%

Machinery and equipment29,500 2,598

9%9,861

7,263 26%

Total 360,660 50,921

14% 66,350

15,429 77%

2.2.2 Total Conditional Grant Programme / Project Expenditure As per table below

4040

9/8/11

0.00

5 000 000.00

10 000 000.00

15 000 000.00

20 000 000.00

25 000 000.00

30 000 000.00

35 000 000.00

40 000 000.00

45 000 000.00

APR MAY JUN JUL AUG SEPT OCT NOV DEC JAN FEB MAR

RAND

S

PROJECTED EXPENDITURE BY YEAR END 2011/12

BUDGET

EXPENDITURE

2.3 Challenges and Remedial Steps

4141

9/8/11

• Note that the Infrastructure Unit together with the Budget Office and the departmental Project Implemementation Agency have put a process in place in order to improve settling of outstanding invoices

• Note that since the end of June expenditure for this grant has improved and stood at R95 million

by the end of August 2011

4242

In terms of the graph above, expenditure is projected to pick up from the second quarter on wards

While an expenditure of R73 million was planned for the first quarter, the second and third quarter

expenditure are anticipated to reach R98 million and R109 million, respectively

This positive expenditure growth is based on the bulk of the work of the afore-mentioned projects taking place

during this period.

Notwithstanding un under spending of R27 million in the first quarter, a revite budget amounting to R382

million will be spent by year as it is committed to live projects (bulk of which is buildings)

2.3 Challenges and Remedial Steps

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