nhi spending progress report standing committee on appropriations 22 february 2013

NHI Spending Progress Report

Standing Committee on Appropriations

22 February 2013

NHI Grant Framework Overview

• R 150 million for 2012/13 financial year– Each pilot district allocated R11.5 million – Each of the 7 selected central hospitals received R5 million

• Focus:– To provide strategic resources for supporting the pilot

districts in implementing selected health service delivery interventions

– To undertake health system strengthening initiatives in identified districts

– To test innovations that are necessary for the implementation of NHI

– Strengthen revenue collection and revenue management systems at selected Central Hospitals

2

NHI Allocation per Province, 2012/13

Province Budget Allocation%

Eastern Cape 11,500,000 8%

Free State 16,500,000 11%

Gauteng 31,500,000 21%

KwaZulu Natal 33,000,000 22%

Limpopo 11,500,000 8%

Mpumalanga 11,500,000 8%

Northern Cape 11,500,000 8%

North West 11,500,000 8%

Western Cape 11,500,000 8%

TOTAL 150,000,000 100%

3

Provide Strategic Resources for Supporting the Pilot Districts

• Provided unemployed graduates to hospitals for revenue collection

• Mobilised support from the World Bank • Technical assistance from DfID and EU • Financial support from EU• Sent Health Facility Improvement Teams from

National to NHI pilots • Appointment of Provincial NHI Coordinators

4

Undertake Health System Strengthening1. Health service delivery – PHC re-engineering 2. Health workforce – determining the staffing norms and

needs using the WISN tool 3. Health information – first phase roll-out of the business

intelligence system i.e. NHIRD 4. Medical products, vaccines and technologies – pilot

sites purchased equipment for PHC facilities; introduction of non-negotiables framework

5. Health system financing – costing work on a service package based on services rendered in NHI pilot districts

6. Leadership and governance – district managers from 8 NHI pilot districts on leadership in health, health policy transformation, and health policy reform

5

Test Innovations that are necessary for the implementation of NHI

• Different contracting models for GPs specifically for PHC services–Introduce active purchasing of services

• Roll out of the PHC streams, specifically the community specialists approach

• Mobile Units for School Health

6

School Health Services

7

Strengthen Revenue Management Systems at selected Central Hospitals

• Joint project with World Bank in Gauteng – Appointment of interns

• Purchase of equipment i.e. Computers, servers• Improved systems of revenue collection• Improvement of patient filing systems in 3

central hospitals• Improved claim processes to medical schemes• Positive impact on actual revenue collection

8

NHI Grant Framework Outputs

• Improved management of district health offices and facilities within selected pilot districts

• Strengthening the districts health system and establishment of a functional district health authority (DHA) model that integrates health service provision and management functions and institutional and administrative implications for such arrangements is developed for scaling up

• Enhancement of managerial autonomy, delegation of functions and accountability in districts and health facilities implemented for selected pilot districts

9

NHI Grant Framework Outputs • Innovative models for contracting private providers that

include innovative arrangements for harnessing private sector resources a primary health care level

• A rational referral system based on a re-engineered primary health care platform with a particular focus in rural and previously disadvantaged areas of the selected pilot districts

• Revenue collection and management model for the 7 selected central hospitals

10

NHI EXPENDITURE YTD (JANUARY 2013)Province Budget Expenditure Funds Available

Eastern Cape 11,500,000 1,241,000 10,259,000

Free State 16,500,000 5,692,000 10,808,000

Gauteng 31,500,000 4,370,000 27,130,000

KwaZulu Natal 33,000,000 1,174,000 31,826,000

Limpopo 11,500,000 491,000 11,009,000

Mpumalanga 11,500,000 2,320,000 9,180,000

Northern Cape 11,500,000 509,000 10,991,000

North West 11,500,000 1,662,000 9,838,000

Western Cape 11,500,000 3,441,000 8,059,000

TOTAL 150,000,000 20,900,000 129,100,000

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NHI Committed funds by Province per District(January 2012/13)

12

Provinces Budget ExpenditureCommitments for the district

VariancesTotal

including commitments

%

Eastern Cape 11 500 000 1 241 000 10 259 000 - 11 500 000 100.00

Free State 16 500 000 5 692 000 9 283 806 (1 524 194) 14 975 806 90.76

Gauteng 31 500 000 4 370 000 11 057 891 (16 072 109) 15 427 891 48.98

KwaZulu Natal 33 000 000 1 174 000 20 159 926 (11 666 074) 21 333 926 64.65

Limpopo 11 500 000 491 000 11 009 000 - 11 500 000 100.00

Mpumalanga 11 500 000 2 320 000 9 153 000 (27 000) 11 473 000 99.77

Northern Cape 11 500 000 509 000 10 064 658 (926 342) 10 573 658 91.94

North West 11 500 000 1 662 000 9 838 000 - 11 500 000 100.00

Western Cape 11 500 000 3 441 000 7 863 608 (195 392) 11 304 608 98.30

Total 150 000 000 20 900 000 98 688 889 (30 411 111) 119 588 889 79.73

NHI Commitments in FS: Thabo Mofutsanyana CategoryCategory CommitmentCommitment Amount SpentAmount Spent Variance Explanation Variance Explanation

Strengthening the District Referral Systems including linkages to PHC streams R800,000 R316,178

Delays in appointment of suppliers; lack of appropriately

skilled service provider

Supply Chain Management interventions e.g. Training, employment of temporal staff; etc

R1,440,000 R633,000 Delays in appointment of Chief User Clerks

Integrated procurement of basic equipment at health facilities, such as charts to conduct basic eye tests; Blood Pressure Monitoring machines; and Scales.

R5,086,110 R1,260,250 Delays in issuing orders; Delays in delivery of ordered equipment

Maintenance of identified PHC facilities focusing mainly on infection control R526,196 R316,118

District will achieve 100% spend – no variance anticipated at end of

year

Strengthening of the District Health Management Teams through procurement of computer and related equipment for improved performance of health districts

R600,000 None Yet Delays in delivery of ordered equipment

Capacity building for managers & PHC supervisors on HR, Finance and SCM R831,500 R470,126 Delays in service providers

submitted invoices for work done

Total Spend To-dateTotal Spend To-date R9,283,806R9,283,806 R2,995,672R2,995,67213

NHI Commitments in GP: TshwaneCategoryCategory CommitmentCommitment Amount SpentAmount Spent Variance Explanation Variance Explanation

Innovative models for contracting private practitioners that include arrangements for harnessing private sector resources at the primary health care level (Three months GP contracts for 12 GPs)

R960,000

R272, 920.90No variance is anticipated – district will spend all the allocated money by end of

the year

Strengthening the PHC teams (Three months contracts for 49 CHW for ward based outreach teams)

R332,661

Procurement of basic equipment at PHC facilities, such as charts to conduct basic eye tests; Blood Pressure Monitoring machines; and Scales.

R10,075,770 R37, 620.00

District encountered challenges in placing and processing orders; suppliers

not willing to deliver due to non-payment on previous invoices;

Total Spend To-dateTotal Spend To-date R11,368,431R11,368,431 R310 ,4090R310 ,4090

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NHI Commitments in KZN: Umzinyathi

Category Commitment Amount Spent

Variance Explanation


R7,885,964 -The processes for obtaining approvals are tedious; district faces huge delays in getting requests processed through SCM; limited delegations that hinder activities to be undertaken; delays in submission of invoices by suppliers (especially for training)

Strengthening the PHC streams through provision of furniture and clinical equipment for the school health teams, Family health teams and District Clinical Specialist Teams

R309,820 -

Strengthening of the District Health Management Team through procurement of computer and related equipment for improved performance of health districts

R638,380 -

Strengthening District patient referral information systems R398,980 -

Capacity building for managers & PHC supervisors on HR, Finance and SCM R1,133,428 -

Total Spend To-dateTotal Spend To-date R10,366,572R10,366,572 00

15

NHI Commitments in KZN: Umgungundlovu

CategoryCategory CommitmentCommitment Amount Amount SpentSpent Variance ExplanationVariance Explanation


R6,143,354

None (awaiting SCM processes at

Provincial Office)

Delays in getting requests processed through SCM


R635,000 - Equipment and furniture have

been ordered, awaiting delivery and capturing


R555,000 - Delays in getting requests processed through SCM

Strengthening District patient referral information systems R460,000 - Delays in appointing suitable

service provider

Testing models for contracting GPs at the primary health care level

R2,000,000 R932,000 No variance is anticipated – district will spend all the allocated

money by end of the year

Total Spend To-dateTotal Spend To-date R9,793,354R9,793,354 R932,000 R932,000 16

NHI Commitments in LP: Vhembe

CategoryCategory CommitmentCommitment Amount SpentAmount Spent Variance ExplanationVariance Explanation


R1,811,396 R301,596Orders have been generated and the district awaits delivery of the items.


R 9,030,604 R158,404Orders have been generated and the district awaits delivery of the items.


R658,000 R31,000District is struggling to attract the correct calibre of staff to take up PHC posts

Total Spend To-dateTotal Spend To-date R11,500,000R11,500,000 R491,000 R491,000

17

NHI Commitments in MP: Gert SibandeCategoryCategory CommitmentCommitment Amount SpentAmount Spent Variance ExplanationVariance Explanation

Enhanced managerial autonomy, delegation of functions and accountability in districts and health facilities including improved Supply Chain Management capacity to support development of frameworks

R2,700,000 R1,684,240


R2,152,000 NilIt is expected that there will be no variance on

this item.


R4,385,300 NilThe district has placed orders and is awaiting delivery of the equipment; delays in delivery

from suppliers


R2,262,700 R877,342 No variance is anticipated

Total Spend To-dateTotal Spend To-date R11,473,000R11,473,000

R2,561,582 R2,561,582

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NHI Commitments in NC: Pixley Ka Seme

CategoryCategory CommitmentCommitment Amount SpentAmount Spent Reasons for VarianceReasons for Variance


R10,064,657.54 None

The district is awaiting the receipt of equipment and processing of payments, prior to the payment of invoices


R509,000 R509,000 None


R246,217 R246,217 None

Total Spend To-dateTotal Spend To-date R10,819,874R10,819,874 R755,217 R755,217

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NHI Commitments in NW: Dr K KaundaCategoryCategory CommitmentCommitment Amount SpentAmount Spent Reasons for varianceReasons for variance


R480,000 R230,100Difficulty to attract the correct calibre of staff, and specifically GPs


R2,582,927 R1,300,599Orders have been placed and the districts awaits delivery and invoicing prior to payment


R6,740,706 None Awaiting deliveries and capturing on BAS

Capacity building for managers & PHC supervisors on HR, Finance and SCM R1,696,367

Training will be done in full by PALAMA and invoice will be provided in March 2013.


20

NHI Commitments in WC: Eden (1)

ProjectProject Committed Committed to dateto date Spent to dateSpent to date Explanation of Explanation of

VarianceVariance

Development of an appropriate model for strengthening the District Health System

R841 000 0

Contractor has been appointed and the

work must be completed.

Work is being fast-tracked

Work is underway and payment will be done

when the work is completed

Service providers have been appointed and payment done when the work is

completedWork is underway and

the

Revision of contract management R100 000 R4 796

Situational analysis of the patient referral system at George Hospital

R108 000 0

Primary Health Care patient folder management review and improvement

R1 050 000 682 617

Community Health Worker training: Chronic Disease Management

R665 000 0

Develop an Eye-Care model for the Eden District

R157 000 0

Policy review and development of Home and Community Based Care (HCBC &ID)

R1 842 600 R460 650

21

NHI Commitments in WC: Eden (2) Project Spent to date Committed to

dateExplanation for

Variance

Review and improvement of consumables management R167 541 R480 900

Service providers have been

appointed and the work is being done. Payment

will be done when the work is

completed satisfactorily.

Appointment of Project Co-ordinator – DHMT strengthening R214 821 R444 000

Appointment of Project Administrator – DHMT strengthening R89 000 R122 000

Purchasing of Medical Equipment R109 812 R768 290

School Health Programme R1 095 662 R1 524 000

Purchasing of computer and related equipment (support health information systems)

R660 803 R660 803

Audit and appraisal of private health care providers 0 R498 515

Testing models for contracting by appointment of GPs at PHC facilities on sessional basis

R1 015 522 R2 042 500No variance anticipated.

TOTALTOTAL R4 501 224R4 501 224 R11 304 608R11 304 608 22

NHI Commitments in EC: OR Tambo

CategoryCategory CommitmentCommitment Amount SpentAmount Spent Explanation for Variance Explanation for Variance

Strengthening of PHC streams (School health teams, ward-based community workers, etc)

R3,700,000

R1,241,000R1,241,000

Shortage of key HR in essential categories, particularly GPs in specified sub-districts;Supply chain hurdles; Delays in getting approvals

Strengthening of the District Health Management Teams through procurement of computer and related equipment for improved performance of health districts

R1,300,000


R6,500,000


23

Intervention Plan: NHC resolution• Business plans for the financial year 2012/13 for the NHI-CG

amended to, inter alia, provide for the following output / outcome areas:

1. Procurement of basic equipment at health facilities, such as:a) Charts to conduct basic eye tests;

b) Blood Pressure Monitoring machines;

c) Scales;

2. Strengthening the School Health Programme;

3. Procurement of computer equipment for health Districts;

• Furthermore, the NHC noted the presentation on the NHI Grant outputs and agreed that although a number of the interventions will take a period of up to five (5) years to implement, the outputs should be revised to ensure that they take into account all the aspects of Primary Health Care Teams and how these will be integrated into the NHI service delivery platform

24

Intervention Plan: NHC resolution

• Contractual employment of General Practitioners to do session duties at public health facilities should be commenced with immediately and NHI conditional grant funding should be used to defray the costs related to sessional duties performed by GPs

• Project managers to control and manage the NHI Conditional Grant should be appointed for each District as a matter of extreme urgency

25

Future Plan for the NHI Grant• Create a National Health Grant

– Perennial under-expenditure and underperformance by provinces

– Gives NDOH stronger and more direct control – Develop and implement systems to overcome numerous

challenges encountered by pilot sites– Integrates Infrastructure and NHI activities

• High-level engagements to revise DORB to adjust the purpose, focus activities and funding allocations to Provinces– Impact on programme of work to be undertaken solely at

pilot site level;– Influences ultimate allocations across sites i.e. resource

reprioritisation– Flexibility to reallocate between grants and between

Provinces 26

nhi spending progress report standing committee on appropriations 22 february 2013

Documents

health facilities

districts health system

health service provision

school health services

health policy reform

health policy transformation

nhi pilot districts

wisn tool health information