limpopo unv annual report 2010 · web viewannual report january - december 2010 undp support to the...

South Africa

ANNUAL REPORTJANUARY - DECEMBER 2010

UNDP Support to theLimpopo Health Sector

UNDP Support to the Health Sector in Limpopo Annual Report (January –December 2010)

Contents

Executive summary................................................................................................31. Context............................................................................................................52. Overall progress overview................................................................................6

2.1 Sub- programme one: Health Professionals Volunteerism and Capacity Development.......................................................................................................6

2.1.1 Recruitment and placement of volunteers..........................................62.1.2 PMU monitoring visits..........................................................................62.1.3 Distribution of Volunteers in Limpopo hospitals..................................72.1.4 Capacity building and skills transfers................................................112.1.5 Development of a mentorship programme........................................11

2.2 Sub- programme Two: Health Planning Support......................................112.3 Sub-programme Three: Knowledge Management and Leadership Development.....................................................................................................11

2.3.1 Mapping.............................................................................................112.3.2 Consultations and planning information............................................122.3.3 Development of tools and process plans...........................................12

2.4 Sub-Programme four: MDGs, Monitoring and Evaluation System............122.5 General management and administration of the programme..................13

3. Implementation strategy review....................................................................133.1 Participatory/Consultative processes.......................................................133.3 Quality of Partnerships............................................................................133.3 National ownership..................................................................................14

4. Management Effectiveness Review................................................................144.1 Quality of Monitoring...............................................................................144.2 Timely delivery of outputs.......................................................................144.3 Resource allocation.................................................................................144.4 Project Risks and Actions.........................................................................18

5. Implementation challenges............................................................................205.1 Volunteer Workload and Compensatory-Time-Off (CTO) Management....205.2 Recruitment of Nurses and Pharmacists..................................................205.3 Authorization processes...........................................................................20

Annexure: Phase III Alignment to Provincial and National Priorities.....................21

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Executive summary

UNDP’s support to the Health Sector in Limpopo is the partnership between UNDP and the Department of Health and Social Development. This partnership comes as the result of efforts by the department to address some of the challenges currently faced as recorded in the Annual Performance Plan Vote 7, 2010/11- 2013/14. Some of the challenges currently affecting the department which this programme seeks to address are:

The increase of demands for health services without matching funding; Shortage of skilled professionals; Inadequate integrated planning; and Inadequate management skills at district level.

It is envisaged that through the implementation of the following programme these challenges could be addressed:

Health Professional Volunteerism and capacity development, Health planning support programme, Knowledge management and leadership development programme, and MDGs, Monitoring and evaluation system.

Programme Management

2010 began with the recruitment process of the programme management unit as per the project document. In June and July 2010, the Programme Manager, Programme Officer for Knowledge Management, Programme and Administration Coordinator, and the Programme Driver were appointed. However, the appointment of the Programme Officer for the Volunteerism sub-programme is yet to be filled as UNV Bonn recommended that it be filled by a UNV Volunteer. UNDP is awaiting an authorisation from the department in this regard.

Health Professional Volunteerism and Capacity Development

The programme began the year with18 UNV medical doctors placed at 10 hospitals in the province. 5 doctors were recruited and placed bringing the total to 23 doctors. 4 doctors were repatriated. At the end of 2010 the programme had retained 19 doctors. With the appointment of the PMU staff and the finalization of the Terms of Reference (ToRs) of volunteer health professionals, a massive recruitment drive was entered into.

Health planning support

A consultant to implement the health economics sub-programme was identified in 2010. A contractual agreement will be finalized in the first quarter of 2011 upon the endorsement of the scope of work.

Knowledge Management and Leadership Development

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The Programme Officer was appointed in July, and the period between July and December 2010 was dedicated to laying the foundation for the establishment of knowledge management systems and leadership development mechanisms. The activities included amongst other things, the creation of an information base for planning purposes, design for the knowledge management systems, the drafting of the leadership development programme, and the process plan for the establishment of the resource centre.

MDGs, Monitoring and Evaluation Support

This sub-programme is UNDP funded and will be implemented through consultancy. Due to a number of technicalities the recruitment of the consultant could not be finalized. All the necessary procedures to conclude the engagement of the consultant will be finalized in the first quarter of 2011.

Resource utilization

The programme had an opening balance of R3, 038,802 (US$ 434,114.6) in January 2010. The programme received a cash injection of R 7,115,124.00 (US$976,011.52) in September 2010, which increased the programme income for 2010 to R10, 193,926 (US$1,410,126.10). The total programme expenditure for 2010 is R7, 754,296.2 (US$1,107,756.64). The balance is R2, 121,257 (US$ 302,369.48) which will be an opening balance in 2011.

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1. Context

The overall objective of the programme is to support the department to improve health care service delivery in the Limpopo province. The province is largely a rural province with an estimated population of about 5.23 million. Due to the remoteness and perceived unattractiveness of rural hospitals, many health professionals opt to work in urban areas and abroad. This created chronic shortages of health professionals in the 40 hospitals, 22 health centres, and 416 clinics of the province.

This programme is designed to respond to some of the key challenges as recorded in the Annual Performance Plan, Vote 7, 2010 /11- 2013/14, viz:

The increase of demands for health services without matching funding; Shortage of skilled professionals; Inadequate integrated planning; and Inadequate management skills at district level.

This programme attempts to address these challenges by implementing the following four sub- programmes:

Health Professional Volunteerism and capacity development: Under this sub- programme, experienced foreign health professionals are recruited and placed at hospitals in Limpopo;

Health planning support programme: introduces health economics to address the capacity development of health care personnel at policy and planning levels so as to improve health support management;

Knowledge management and leadership development programme: This sub- programme addresses capacity development and skills transfer challenges; and

MDGs, Monitoring and evaluation system: Development of a provincial DoHSD monitoring and evaluation system to improve on service delivery, accountability and strategic planning.

Through this intervention it is envisaged that the programme will achieve the following outcomes:

Improved health care service delivery; Improved hospital performance; Increase culture of volunteerism; Improved health service planning; Improved knowledge and access to health related information; and Improved monitoring and evaluation capacity.

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The programme also seeks to support the provincial department of health achieve the Millennium Development Goals relevant to health, which are, reduction of child mortality; improvement of maternal health; and combating of HIV and AIDS, malaria and other diseases.

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2. Overall progress overview

2.1 Sub- programme one: Health Professionals Volunteerism and Capacity Development

The Department of Health and Social Development in Limpopo is currently facing a huge shortage of health professionals to meet the health services demands. Under this sub-programme, experienced health professionals (UNV Volunteers) are recruited and placed in hospitals in the province. The appointment of the Programme Officer for the Volunteerism sub-programme is yet to be filled as UNV Bonn recommended that it be filled by a UNV Volunteer. UNDP is awaiting an authorisation from the department in this regard.

2.1.1 Recruitment and placement of volunteers

The programme began the year with 18 UNV medical doctors placed at 10 hospitals in the province. 5 doctors were recruited and placed bringing the total to 23 doctors. 4 doctors were repatriated. At the end of 2010 the programme had retained 19 doctors. The target for the year was to recruit and place 60 UNV medical doctors, 4 UNV Clinical Engineers, 15 UNV Pharmacists and 5 UNV Special Nurses.

The difficulty in reaching the target is attributed to the delay in the recruitment of Programme Management Unit staff. Since the beginning of 2010, the project only had 1 staff member instead of 6. It was only in June and July where a Programme Manager and a Programme Officer for Knowledge Management were recruited respectively.

Recruitment of pharmacists and Nurses could not be done as there is no provision for volunteer status with the respective registration councils. The recruitment for these professions requires foreign candidates to sit for a board examination. Upon successful completion of the board examination, candidates will then be eligible for recruited into the programme. The recruitment of Clinical engineers as well was not successful as these professionals are in high demand globally.

A massive recruitment process was entered into and the programme received 50 fact sheets from UNV Bonn by the end of December 2010. All suitable candidates will join the programme in 2011. The shortfall of 2010 will be combined with the targets of 2011, and it is planned that by the end of 2011 the programme will have 90 volunteers recruited and placed.

2.1.2 PMU monitoring visits

Monitoring visits to UNV Volunteers hosting hospitals provided an opportunity for UNDP to regularly observe and record activities in the programme. It also provided a platform to meet with the volunteers in the field and also interact with hosting hospitals and discuss issues of importance to the programme and the

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well-being of the volunteers. All thirteen hospitals currently benefiting from the programme were visited in the last.

Arising from the discussions held with the volunteers and the Clinical Managers, the following challenges were identified:

(i) Accessibility of the UNV Volunteer profiles: The Clinical Managers indicated the usefulness of acquiring profiles of volunteers upon their presentation to the hospitals. They pointed out the difficulty in managing a volunteer in the absence of profiles. It was agreed that the PMU will create a file for each UNV Volunteer and deliver it to each hosting hospital. Henceforth, upon presentation to hospitals, all recruits will be accompanied by a file.

(ii) UNV Conditions of Service (CoS): The Clinical Managers indicated that they are not conversant with the UNV Conditions of Service and they relying on information received from the volunteer. It was agreed that the PMU deliver UNV CoS to all hosting hospitals.

(iii)Compensatory Time-Off (CTO): This issue has been a concern for many years without clear solution. Some Clinical Managers raised concerns that some volunteers are away for more than 2 months due to CTO. With the involvement of volunteers, it was resolved that all extra hours worked must be taken immediately or in the following month. Volunteers will agree with their immediate supervisors on how extra hours worked can be recovered through CTO. This will alleviate a situation where CTO is accumulated so as to be taken for an extended home leave.

(iv) Delays in contract renewals: Volunteers were concerned that their contracts are not renewed on time and this affect their stay in the country as their diplomatic identification cards expire with their contracts. They are therefore unable to travel out of the country or do banking activities. The PMU should improve the monitoring of UNV contracts and ensure that the renewal process starts at least three months before the contract expires.

2.1.3 Distribution of Volunteers in Limpopo hospitals

In 2010, 13 hospitals benefited from the programme as shown in the map. The table below also shows the distribution of UNV Volunteers per district. In 2010, all districts benefited from the programme but the distribution is not equal with Waterberg and Mopani least benefiting. Getting into the district themselves, most hospitals benefitting from the programme are located on the main line of economic activity in the province which runs along the N1 route. Hospitals which are further away from this region, such as Elisras, Thabazimbi and Maphutha L. Malatjie hospitals are not benefitting.

With planning information being generated through the knowledge management sub- programme, the programme will assist or make placement recommendations based on spatial analyses and the criteria used by the Department. Factors that would be important to consider would include amongst

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others, the spatial distribution of disease, demographics, the socio-economic situation of the hospital catchment area, the physical environment, as well as other factors such as crime. The distance between the health facilities and the distance between specific types of health facilities would play a role in the distribution of resources.

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Distribution of volunteers per district

District Name Population

No of Hospitals (Excluding special hospitals)

No of hospitals with UNVs

Total No. of UNVs per district

Vhembe 1, 237,324 7 4 6

Capricorn 1,240,569 8 4 9

Waterberg 594,991 8 1 1

Mopane 1,066,324 7 1 2

Sekhukhune 1,087,992 7 3 5

Total 5,227,200 37 13 23

Population stat Source: 2010/11-2014/15 DoHSD strategic plan

New volunteers recruited in 2010

Name and Surname Area of Specialization Hosting hospitals1. Soek Jin Ahn Internal Medicine Polokwane2. Nahendra Kumar Sharma Ophthalmologist Polokwane3. Antonio Dematteis Internal Medicine Polokwane4. Kapoor Pardeep Kumar Cardiologist Polokwane5. Shahid Mehmood General Practitioner Siloam

Repatriated volunteers in 2010

Name and Surname Area of Specialization Hosting hospital1. Zhyrnyi Sergii Surgeon Philadelphia2. Subba Palla Dilmaya Anaesthesia St Ritas3. Rozumyk Nadia Internal Medicine Polokwane4. Avilov Vladimir Anaesthesia Tshilidzini

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The distribution of Volunteers and the location of health facilities in Limpopo

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List of volunteers in the programme in 2010

Name and SurnameArea of Specialization

Hosting Hospital

1. Bautista, Jose General Practitioner Mecklenburg2. Blando, Rommel Peadiatrician St Ritas3. Bondareva, Galina Endoscopy Mokopane

4. Guiang, StefanieObstetrics &Gynaecology

Tshilidzini

5. Karchenko, Andriy Anaesthesia Philadelphia6. Kebede, Abner Anaesthesia Lebowakgomo

7. Misra, AshaObstetrics and Gynaecology

Polokwane/Mankweng

8. Misra, Rajeev Cardiologist Polokwane/Mankweng9. Nuzhat, Sultana Ahmed General Practitioner Zebediala10. Prabodh, Pradkhan Anaesthesia Letaba

11. Projo, DjhoannaObstetrics and Gynaecology

Letaba

12. Rayos, Jason Family Medicine Tshilidzini13. Ryabchiy, Borys Anaesthesia Elim14. Torralba, Benicio Ophthalmology Elim and Donald Fraser15. Soek Jin Ahn Internal Medicine Polokwane/ Mankweng16. Nahendra Kumar Sharma Ophthamology Polokwane/Mankweng17. Antonio Dematteis Internal Medicine Polokwane/Mankweng18. Kapoor Pardeep Kumar Cardiologist Polokwane/Mankweng19. Shahid Mehmood General Practitioner Siloam20. Zhyrnyi Sergii Surgeaon Philadelphia21. Subba Palla Dilmaya Anaesthesia St Ritas22. Rozumyk Nadia Internal Medicine Polokwane23. Avilov Vladimir Anaesthesia Tshilidzini

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2.1.4 Capacity building and skills transfers

Skills transfer and knowledge sharing from experienced volunteers was reported to have gone well during 2010. This was achieved through formal presentations and mentorship sessions conducted by volunteers and the beneficiaries being local doctors, community service doctors and interns. Volunteers themselves were also given an opportunity to attend conferences, seminars and hospital based capacity development activities related to their areas of specialization. This was done to ensure that volunteers are up to date with the developments in their field of specialization.

2.1.5 Development of a mentorship programme

The development of a framework for a mentorship programme and its implementation was planned in 2010.The successful implementation of this activity depended largely on the appointment of a Programme Officer. The Programme Officer is yet to be appointed and as a result this activity was not implemented.

2.2 Sub- programme Two: Health Planning Support

The delivery of quality health services requires capacity to develop a comprehensive and integrated health service delivery. The health planning support sub-programme seeks to address health service delivery challenges through improved planning process and systems. This requires competencies in health economics and as a result a health economist consultant has been identified and is expected to commence in the first quarter of 2011.

2.3 Sub-programme Three: Knowledge Management and Leadership Development

The Programme Officer was appointed in July, and the period between July and December 2010 was dedicated to laying the foundation for the establishment of knowledge management systems and leadership development mechanisms. The activities included amongst other things, the creation of an information base for planning purposes, design for the knowledge management systems, the drafting of the leadership development programme, and the process plan for the establishment of the resource centre.

2.3.1 Mapping

The dynamics of the health sector in Limpopo had to be well-understood in the mission of implementing a knowledge management and leadership development programme. The planning for the establishment of a health resource centre, for instance, had to be weighed against the spatial distribution of the health facilities

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in the province, as well as the departmental head office and its district offices. The mapping of these facilities, spatial analysis and the production of maps in a Geographic Information System hence became inevitable. The products of these activities were presented to the department’s Head of Department together with the process plan for the roll out of the sub-programme.

2.3.2 Consultations and planning information

A series of consultations were held with knowledge generating agencies of government, notably the Statistic South Africa (StatsSA), the Demarcation Board and the Human Sciences Research Council (HSRC). StatsSA provided data from the census of 1996 and 2001 while the Demarcation Board provided the geo-referenced data on the distribution of human settlement and the current political boundaries which included ward boundaries, local and district municipalities. The Office of the Premier’s GIS Unit provided invaluable data on the province, including some health specific information such as cholera and Malaria prone areas. Consultation with The Population, Health, Health Systems and Information (PHHSI) directorate of the HSRC led to their proposing the development of a Spatial Enterprise Information Resources System (SEIRS) for Limpopo. Discussions continue around this proposal and the institutionalization of partnerships with the agency.

The planning information collected ranged from socio-economic statistics to spatially referenced infrastructure, environmental, human settlement and, of course, health data. Contacts were established with provincial and national custodians of information, with the national departments providing the most in terms of geo-referenced data.

2.3.3 Development of tools and process plans

The deliverables on knowledge management products for the sub-programme for 2010 required the undertaking of a situation analysis. A tool was developed and made available to the department for their input. Desktop study was done in preparation of the situation analysis and process plans for the seminar series and the needs assessment tool for a health resource centre(s) were also developed. The activity plan as scheduled in the sub-programme work plan for the year was unfortunately severely delayed as a result of the late transfer of funding to the Programme. The situation analysis also required official introduction of the Programme Management Unit to the relevant senior officials of the department and hospital CEOs. This introduction only became possible in December.

2.4 Sub-Programme four: MDGs, Monitoring and Evaluation System

Lack of effective Monitoring and Evaluation framework with the Department of Health and Social Development hampers access to quantitative and qualitative data. Under this sub-programme a comprehensive M & E system will be established to improve on service delivery, accountability and strategic planning.

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The sub-programme also assists with the domestication of MDGs relevant to health within the Limpopo Department of Health and Social Development.

This sub-programme is UNDP funded and will be implemented through consultancy. Due to a number of technicalities the recruitment of the consultant could not be finalized. All the necessary procedures to conclude the engagement of the consultant will be finalized in the first quarter of 2011.

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2.5 General management and administration of the programme

2010 began with the recruitment process of the programme management unit as per the project document. In June and July 2010, the Programme Manager, Programme Officer for Knowledge Management, Programme and Administration Coordinator, and the Programme Driver were appointed. However, the appointment of the Programme Officer for the Volunteerism sub-programme is yet to be filled as UNV Bonn recommended that it be filled by a UNV Volunteer. UNDP is awaiting an authorisation from the department in this regard.

The main task on management and administration was to operationalize Phase III as per the project document. This involved finalization of financial audits and reports, development of annual work plans and budgeting for 2010 and 2011. The PMU office relocated from Pro Limpopo building in Bendor, to 26 Jorissen Street, Adam Tas Forum building in the City Centre of Polokwane. The relocation was necessitated by the anticipated growth of the PMU team, where a bigger office space would be required.

3. Implementation strategy reviewThis programme is implemented in partnership with the Department of Health and Social Development in Limpopo and United Nations Volunteers- Bonn. The Programme Management Unit (PMU) is there to oversee the day-to-day activities of the programme. The Programme has a steering committee which is co-chaired by UNDP and the department. Its main task is to guide the PMU and oversee programme implementation.

3.1 Participatory/Consultative processes

Thorough consultations between the department, UNDP and UNV Bonn were conducted on the concept and design of Phase III. All three stakeholders play different roles in the implementation of the programme. Programme activities are implemented through a coordinated approach which ensures timely and quality attainment of expected outcomes.

3.3 Quality of Partnerships

The programme made some progress in the area of partnerships. In the last quarter of 2010 the programme engaged in discussions with the Population, Health, Health Systems and Innovation (PHHSI) of the Human Science Research Council (HSRC). The partnership discussed was about the development of a pilot Health Resource Information System for Limpopo. The motivation for

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establishing the partnership with HSRC is based on overlapping interest between both parties which are:

Human capacity development; Institutional capacity development; Policy review and development; and Technical support and high-end technical advice.

3.3 National ownership

Funding for this programme is provided by the department, which demonstrates that the country is in full support of the programme. The department as the main beneficiary participates in the planning, implementation and monitoring of activities.

4. Management Effectiveness Review

4.1 Quality of Monitoring

During the course of 2010 quarterly progress reports were submitted to the Department of Health and Social Development. The reports provided update on implementation progress, challenges, resource utilization, risks and recommendations. Programme steering committee meetings were held to address issues any issues affecting the performance of the project and achievements of its objectives. Security checks by UNDSS were also conducted to ascertain the safety of the volunteers at their different duty stations. The PMU reviewed the annual work plan, and developed quarterly work plans which were based on the available resources. A 2009 annual and financial audit reports were produced and submitted to the Department of Health and Social Development. It must also be pointed out that the project received a clean audit.

4.2 Timely delivery of outputs

There was a delay in the appointment of staff and consultants which affected the delivery of outputs as planned in the project document. However, some stability to the programme was established in the second half of the year as a Programme Manager and Programme Officer were appointed in June and July respectively. The better part of the second half of the year was spent finalizing the workplans and completing outstanding reports. Despite these challenges the programme was able to maintain 19 volunteers and recruited 5 new volunteers. Some databases were also developed to start the knowledge management sub-programme.

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4.3 Resource allocation

The programme had an opening balance of R2,755,758.70 (US$ 434,114.6) in January 2010. The programme received a cash injection of R 7,115,124.00 (US$976,011.52) in September 2010, which increased the programme income for 2010 to R9,870,882.70 (US$1,410,126.10). The total programme expenditure for 2010 is R7,754,296.2 (US$1,107,756.64). The balance is R2,121,257 (US$ 302,369.48) which will be an opening balance in 2011.

Financial expenditure report per sub-programme: January - December 2010

Activity USD ZAR

Opening balance 1,410,126.1 9,870,882.7

Operating expenses 1,107,756.64

7,754,296.2

1. Health Professionals volunteerism and capacity Development

714,501.08 5,001,507.6

Volunteer recruitment and allowances 162,839.12 1,139,873.84Accommodation for volunteers during induction 11,906.88 83,348.16Volunteer living allowances 471,601.21 3,301,208.47UNV Bonn charges to the project 27,686.36 193,804.52Volunteers Conference expenses 40,467.51 283,272.57

2. Health planning supportConsultant travel expenses 585.33 4,097.31

3. Knowledge Management and Leadership Development

5,496.80 38,477.6

Knowledge Management equipment 1,562.33 10,936.31

4. MDGs, Monitoring and Evaluation System

5. General Management and Administration 385,611.10 2,699,277.7Salaries 228,608.46 1,600,259.2Travel and accommodation 11,699.4 81,895.8Vehicle Maintenance 6,259.65 43,817.55IT Equipment and LAN infrastructure 27,414.26 191,899.82(GMS) UNDP charges 68,320.81 478,245.67Communication 6,327.89 44,295.23Office rental 33,709.61 235,967.27

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Miscellaneous 3,271.02 22,897.14

Total expenditure 1,107,756.64

7,754,296.2

Closing cash balance 302,369.48 2,121,257

64%

0%0%

0%

35%

Total expenditure per activity(ZAR)

Health Professionals Volunteerism & Capacity DevelopmentHealth planning supportKnowledge Management and Leadership DevelopmentMDGs, Monitoring and Evaluation SystemGeneral Management and Admin-istration

Total expenditure per activity (USD)

Health Professionals Volunteerism & Capacity DevelopmentHealth planning supportKnowledge Management and Leadership DevelopmentMDGs, Monitoring and Evaluation SystemGeneral Management and Admin-istration

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Total expenditure per quarter: January - December 2010

QUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4 TOTAL EXPENDITURE

USD ZAR USD ZAR USD ZAR USD ZAR USD ZAR

202,163.25 1,415,141 312,981.10 2,190,867.7 208,902.19 1,462,315.33 383,710.10 2,685,970.7 1,107,756.64 7,754,296.48

USD ZAR USD ZAR USD ZAR USD ZARQUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4

0

500000

1000000

1500000

2000000

2500000

3000000

Quarterly expenditure: January-December 2010

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4.4 Project Risks and Actions

RISK TYPE DESCRIPTION IMPACT SUGGESTED MANAGEMENT RESPONSE

RESPONSIBLE PARTY

Organizational Non-provision of UNDP or UNV inputs to ensure efficient/effective programme deliverables is detrimental to the project

UNV as the executing agency has limited capacity

Ineffective strategy could mean that the provision of UNVs may only be a short term service and not have real impact on the long term retention of medical personnel in the Province

Project Steering Committee for project oversight

Project Evaluation

Ongoing PMU Staff training and training entitlements for UNVs

Regular interaction and appropriate segregation of responsibilities between the PMU and the UNV PO.

UNV PO / PMU

UNDP/ DOH

Financial Over or under expenditure and/or misappropriation of project financial resources Project

Unclear commitment to continue timeframes and funding for the programmePartners may not honour cost sharing commitment

Lack in :

(1) the provision of accommodation for UNVs at duty stations,

(2) provision of furniture and utilities, and

(3) funding for UNV VLA’s and SIG, could result in the collapse of the Project

Ensure that there is, sufficient resources available for each UNV until the completion of their assignments.

Provide continuous expenditure updates, forecasts and reports

Ensure that project expenditure is aligned to the Annual Workplan

PMU/ UNDP/ DOH

PMU

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RESPONSIBLE PARTY

Operational Loss or damage to the PMU assets (example, office equipment, injury to staff etc.)

Ensure payment of all insurances

PMU / UNDP

Political Change in political/ administrative leadership could adversely affect DOH resource allocation

The absence of a focal point or political champion for the Project, could mean that Project resources may be diverted to other similar Projects and/or Project funding discontinued

Ensure long-term commitment by DOH through the PSC and/or the written commitment to the Phase 3 of the Project

UNDP / DOH / PSC

Regulatory Non-provision of HPCSA registration and work permits has occupational risks and could render the work and stay of UNVs illegal

Non-issuance of and/or invalid HPCSA registration put UNVs at occupational risks.

Lack of valid work permits, Diplomatic ID Cards and/or UNV ID cards could render the work and stay of UNV illegal

Ensure that each UNV has a valid HPCSA registration certificate.

Ensure that the contract extension, work permits /VISA’s of all UNVs are valid and/or up to date

PMU

PMU/ UNV PO

Security Ineffective monitoring and security/safety measures for UNVs at their duty stations can result in loss and/or injury

Injury and/or loss to UNVs as a result of ineffective security/safety measures would be detrimental to the Project

Encourage regular security visits of UNDP Security team to UNV duty station and the sharing of all security alerts and information with UNVs

Ensure that travel authorizations

UNDP/ PMU

PMU

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RESPONSIBLE PARTY

are signed for all UNV travel

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5. Implementation challenges

5.1 Volunteer Workload and Compensatory-Time-Off (CTO) Management

Some volunteers are the only specialists in their duty stations and as a result they are requested to work long hours. In the process of working long-hours they accumulate compensatory time-off. The challenge is that the Volunteers do not take it immediately, but they wait for it to accumulate and take it as home leave. This creates problems for hospitals because in some instances a Volunteer will be away for more than 2 months. This adds to the problem which this programme aims to eradicate. To resolve this problem the PMU has started discussions with the Volunteers and the Clinical Managers. The PMU is also developing a monitoring tool which will monitor the work of the Volunteers and their working hours.

5.2 Recruitment of Nurses and Pharmacists

Recruitment of pharmacists and nurses could not be achieved. The challenge is that there is no provision for volunteer status with the respective registration councils. The programme has sought the department’s intervention and in the meantime, current national recruitment processes will be observed.

5.3 Authorization processes

PMU submissions are sometimes not timeously responded to by UNDP and the department. This affects the implementation of activities. Regular follow-ups will be made depending on the nature of the submission if a response has not been received.

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Annexure: Phase III Alignment to Provincial and National Priorities

Relevant National Outcome A long and healthy life for all South Africans Objective: To increase the life expectancy of our citizens and ensure that all people

have access to health care.

Relevant National Activities (RSA) Ensure a well-coordinated roll-out of antiretrovirals (ARVs) with a specific emphasis

on effective roll-out of the preventative mother to child treatments; Integrate HIV and tuberculosis (TB) services; Strengthen maternal health services; Develop a national strategy for chronic diseases; Conduct hospital audit process in 2010, with the view to improving hospitals.

Relevant National outputs Reduce the mortality rate; Reduce the impact and prevalence of HIV and AIDS and Tuberculosis, and Ensure an effective healthcare system.

Medium Term Strategic Framework (Relevant to Health) Transform the public health system so as to reduce inequalities (National Health

Insurance) in the health system, improve quality of care and public facilities, boost human resources and step up the fight against HIV and AIDS, TB and other communicable diseases as well as lifestyle and other causes of ill-health and mortality.

Department of health and Social Development (Limpopo province)

Vision: A health promoting and developmental to the people of Limpopo

Mission: The department is committed to provide sustainable Health and Developmental services through a comprehensive and integrated system

Department Health and Social Development Strategic goals (Relevant to Health) Implement comprehensive HIV and AIDS care, treatment and management,

Tuberculosis (TB), Sexual Transmitted Infections (STIs) and other communicable diseases programmes

Strengthen Districts Health Services and Primary health Care services Human Resources management issues

Relevant Millennium Development Goals (MDGs) Reduce child mortality Improve maternal health Combat HIV/AIDS, Malaria and other diseases

Relevant UNDAF Outcome Democracy, good governance and administration

Envisaged Programme Outcomes Improved healthcare service delivery in Limpopo Province Increased culture of volunteerism Improved hospital performance vis-ὰ-vis organizational management and

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development Integration of health economics in health service planning Improved knowledge and access to health related information Improved monitoring and evaluation capacity

Expected Programme Outputs Recruitment of PMU staff: 1 Programme Manager; 2 Programme Officers; 1

Programme Assistant and 1 Programme Driver Recruit and place 75 UNV medical doctors, 8 UNV Clinical Engineers, 30 UNV

Pharmacists, and 15 UNV special Nurses Develop a framework for a mentorship programme strategy Develop and implement a leadership development seminar series programme

targeting senior management of health facilities and health managers Develop guidelines and frameworks for effective health services planning Develop a concept document for the establishment of a health knowledge

management centre in Limpopo province Develop and implement monitoring and evaluation system

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