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EASTERN CAPE DEPARTMENT OF HEALTH

EASTERN CAPE DEPARTMENT OF HEALTH. STRATEGIC PLAN 2003/4 15 April 2003. OVERVIEW. The Department’s Strategic Plan: Aims to improve the health status of the Eastern Cape population through 8 programs with specific objectives, targets and indicators Is informed by the:

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EASTERN CAPE DEPARTMENT OF HEALTH

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  1. EASTERN CAPE DEPARTMENT OF HEALTH STRATEGIC PLAN 2003/4 15 April 2003

  2. OVERVIEW The Department’s Strategic Plan: • Aims to improve the health status of the Eastern Cape population through 8 programs with specific objectives, targets and indicators • Is informed by the: • Epidemiological profile of the EC population • Demand & utilisation of health services • Existing backlogs in service delivery • Is aligned with the Ten Point Plan, Batho Pele, EC Provincial Growth and Development Strategic Plan and the Strategic Position Statement of the province

  3. VISION • A health service to the people in the Eastern Cape Province promoting a better quality of life for all.

  4. MISION To provide and ensure accessible comprehensive integrated services in the Eastern Cape emphasizing the primary health care approach utilizing and developing all resources to enable all its present and future generation to enjoy health and quality of life.

  5. VALUES The Department formulated a policy to ensure that all its residents have access to essential health services. The policy encapsulated the following VALUES: • Equity of both distribution and quality of services • Service excellence including customer satisfaction • Fair labour practices • Good work ethic and a high degree of accountability • Transparency demonstrated through consultations with all stakeholders in the health industry/field

  6. Strategic goals and objectives of theDepartment of Health • Strategic Goal 1: Ensuring equitable access by all communities to essential package of services through DHS. • Strategic Goal 2: Health services in the province meet quality standards. • Strategic Goal 3: Communities throughout the province become active, responsible partners in health issues which affect them. • Strategic Goal 4: Build capacity in the Department to support improved implementation of its goals. • Strategic Goal 5: Effective utilization of the Department’s finance and assets to achieve effective service delivery.

  7. SECTORAL SITUATION ANALYSIS • Size of the province 169,580 sq kms and is 13,9% of the country’s land surface Table A-1: Land area distribution by Province in SA Source: Pop census 1996

  8. SECTORAL SITUATION ANALYSIS Urban /Rural distribution Table A-4: % Urban/Non-urban population distribution by province (1996 census) Source: Pop census 1996

  9. SECTORAL SITUATION ANALYSIS District Health Services facilities by health district

  10. POPULATION PYRAMID COMPARING WESTERN AND EASTERN REGIONS OF THE EC

  11. Population by health district Source: Stats SA Mid-Year Population Estimates 2002

  12. EPIDEMIOLOGY CHILD HEALTH MORBIDITY AND MORTALITY The IMR of 61.2 per 1000 live births is the highest in the country with the National figure of 45.2(SADHS 1998). The following conditions accounted for the high morbidity and mortality rates • Diarrhoea • HIV/AIDS • Communicable diseases • Malnutrition • Tuberculosis • Injuries and burns

  13. WOMEN’S AND MATERNAL HEALTH (epidemiology cont) • The provincial hospital maternal death rate was calculated at 133 maternal deaths per 100 000 hospital deliveries. • In 2000 108 deaths were reported and 53% of these were from the Eastern regions. These occurred in the public hospitals only. • 32% of reported maternal deaths were primigravidas. • The recent review of maternal deaths identified AIDS as the most common cause of maternal deaths at all levels of care in SA.

  14. EPIDEMIOLOGY CONT MEDICAL CONDITIONS 1. TB Prevalence in the Eastern Cape • There has been a dramatic rise in TB cases from mid-1980s and this rise is directly associated with HIV and improved case-finding. TB cases reported 2000 2001 28428 30010 • TB patients accounted for 10.2% of all medical admissions • This can be attributes to improved case finding

  15. ACHIEVEMENTS • Significant improvement in the hospital revitalization and rehabilitation programme From 1994 to date the following health facilities have been constructed: Completion of Nelson Mandela and its readiness to admit patients by the 1st of September 2003. Clinics 130 Community Health Centres 5 Hospital OPDs 16 Academic Health Resource Centres 3

  16. ACHIEVEMENTS CONT • An increase in the utilization of primary health care services of 2,287,069 between 1998 an1999. this is increasing yearly. • Management and Administration of the Department has been significantly improved through filling of critical posts, recruitment and appointment of suitable qualified personnel in all fields. • Leave gratuities 90% of backlog cleared.

  17. ACHIEVEMENTS CONT • Ante-natal care (ANC) has been offered five days a week in 80% of clinics in 1999, a remarkable increase from the baseline survey when only half of all clinics were providing the service for the five working days. • The utilization of the 9 HIV/AIDS National Policy Guidelines

  18. ACHIEVEMENTS CONT • Appointment of CEOs in all the Provincial/Regional Hospitals • Formation of a Provincial Hospitals Coordinating Committee • Implementation of the deinstitutionalization programme in mental health. • PFMA Implementation with ECDOH moving to the third position in the Province in terms of the PFMA compliance matrix applied by Provincial Treasury

  19. ACHIEVEMENTS CONT • Budget Review Process Quarterly budget reviews with all institutions are held by the ECDOH. This has improved the monitoring process. • Policy for nursing education (Nursing Education Bill) to assist with the rationalization of nursing education has been formulated and submitted to the legislature. • Continuous research is taking place with yearly conferences to share results • Nursing Education Bill with the Legislature

  20. BUDGET

  21. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS • Please indicate the total health allocation in 2002/03

  22. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 2. What was the percentage real increase between 02/03 and 03/04?

  23. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 3. What was the total overspending, if any, specify reasons. No over-expenditure was incurred. 4. What was the total underspending, if any, specify reasons. Please note that the above figures are provisional as the books were not closed at the time the figures were prepared however, it is likely that there will no under-expenditure.

  24. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 5.Provide variance by programme between budgeted allocation and actual expenditure for 2002/03

  25. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 6. Which health programme has received the highest budget increase within 02/03? Provide the reason for this. Programme 1 Health Administration received the highest budget increase in the 2002/03 financial year. The reason : the Personnel Budget for Critical posts was managed under this programme; Management contract to be outsourced and managed in this programme [Increase R46,137m or 23.69%] 7. Which programme has received the least increase, please indicate why? Programme 6 Health Care Support Services: received the least budget increase in the 2002/03 financial year: The reason: [Increase R70,000 or 0.75%] is insufficient budget.

  26. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 8.Indicate the proportion of the budget that is spent on personnel.

  27. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 9.What proportion of your 02/03 budget was transferred to Local Government 3.06 % or R143m - proportion of the 2002/03 budget was transferred to Local Government 10. What was the total amount received in Donor funding, and provide a breakdown of how the money was disbursed and spent and the criteria used for making the allocations. This department did not receive any direct or Cash donor funding for the 2002/03 financial year, however the Equity Project, which is funded by USAID, has provided technical support, training, equipment and donated 22 vehicles with a total value of R24m

  28. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 11. Give proportion of budget spending on personnel The proportion of personnel spending is R2,537,368 or 54.74% of the adjusted budget for 2002/3 12. Give proportion of budget spent on district health services The proportion of the budget spent on district health services is R2,391,815or 52.44% of the adjusted budget for 2002/3 13. Give proportion spent on Community Health Services and primary health services The proportion of the budget spent on community health services and primary health services is R1,053,338m or 44,56% of the adjusted budget for 2002/3.

  29. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 14. How does the budget accommodate the provision of free care to the Disabled as announced by the President on 14 February 2003 The Department is currently assessing the budgetary implications of the policy 15. What proportion of the Provincial Budget does health account for? The Eastern Cape Department of Health Budget was 17.49% for the 2002/03 and 18.32% for the 2003/04 financial year of the Eastern Cape Provincial Budget

  30. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 16. Based on the 2003/04 budget allocation what is your per capita budget allocation In terms of the Inter Governmental Fiscal Review (IGFR) 2003 this province at R769.00 received the third lowest per capita allocation in South Africa. 1 Source: STATS SA Mid Year Population Estimates 2002

  31. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS CONDITIONAL GRANTS 17.Give the overall HIV/Aids budget allocations for 2003/04 and the percentage increase from 2002/03 The overall HIV/AIDS budget for 2003/04 is R71,934m which is a 17.46 % increase from 2002/03

  32. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 18. Provide variance for 2002/03 between allocated budget and actual expenditure

  33. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 19. The Eastern Cape Province breakdown of HIV budget is: (R’000) • The Health HIV/AIDS grant is for the following programmatic interventions: • VCT • HBC • PMTCT • Step-down care • Provincial Management • Non-occupational post-exposure prophylaxis • Commercial sex workers • Centre of Excellence • The Education Grant is for life skills education and the Social Development Grant for HBC

  34. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS • 20. The following initiatives from the National Department of Health will assist with provincial implementation and improve the capacity to spend: • Appointment of coordinators and administrative staff in the key programmes VCT, HBC and PMTCT. • Training of master trainers for VCT, Home Based care to fast track training • Appropriate VCT guidelines were developed and distributed. • Decentralization of funds to Districts and Hospitals

  35. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS • 21. Areas that have experienced under spending in the last financial year and the reasons therefore • Infrastructure: Procurement of equipment • Maintenance and intervention funds and roll-overs were only received in August 2002. Lack of trained artisans in institutions. • Personnel: An additional amount of R41,288 for critical post was not able to attract external applicants • Grants: the under spending occurred mainly on the Integrated Nutrition Programme grant owing to changes in the implementation structure and a roll over amount of R36m from the previous financial year.

  36. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 22. An allocation was made for the provision of step-down facilities, please provide a progress report also indication how much of the allocation was spent The Eastern Cape Department of Health spent R1,314,077 on the provision of step-down facilities.

  37. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 29. Inter provincial inequity remains a major area of concern- how is the Department addressing this The department address this by interacting with the NDoH who engages the National Treasury; and through the Provincial Budget Committee this is being addressed 30. Intra- provincial inequity still persist how is the Department working to ensure a more equitable distribution of funds especially at district and sub-district level. The allocation of budget is based on the HTP (that took equity into consideration)

  38. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 31. Areas of the budget and the budget process, where the Department might require assistance / advocacy of the Committee in facilitating the necessary changes. It may be necessary in addressing the inequity in per capita allocation especially because of the historical circumstances and geographic nature (mostly rural with poor infrastructure). 32. Provide the number of district management posts and how many are filled – provide reasons for vacancies There are 25 District Management posts of which 20 are filled. The reason for the vacancies is that the department restructured the number of districts from 21 to 25 and had to change and load the new structure.

  39. RESPONSES TO QUESTIONS POSED BY THE NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL QUESTIONS 33. What guides your district and sub-district budget allocation e.g. formula etc. The allocation for district and sub-district is based on the results of the Hospital Transformation Project recommended establishments (based on equity considerations). 34. What steps have been put in place to facilitate implementation of the rural incentive scheme? The department has identified the areas and commenced with payments to the nursing staff only.

  40. MAJOR HEALTH CHALLENGES • Escalating HIV/AIDS • Escalating TB prevalence • Brain drain of health professionals especially doctors and nurses to countries like UK and Saudi Arabia. Presently the doctor patient ratio is 1 per 3000. • Low immunization coverage • Legislative reforms influenced by cultural factors e.g. circumcision, and recognition of alternative medicine including traditional healing

  41. MAJOR HEALTH CHALLENGES CONT • Escalating crime calling for more security for staff working in primary health care facilities, establishment of crisis centers and counseling facilities for victims of abuse as well as calling for more collaborative endeavors with other sectors • The impact of increased motor vehicle accidents on Emergency Medical services and other services • Backlog in health facilities development • High Infant and Maternal mortality

  42. PRIORITIES FOR 2003/4 • To manage and improve health outcomes for HIV/AIDS, STDs and TB • To reduce infant and child mortality • To control communicable diseases • To develop the district health system and the delivery of the PHC Package • To improve emergency and patient transport • To improve logistical and other support • To implement the hospital revitalization programme • To improve capacity and access to regional and tertiary services in the province • To develop human resources for quality management and service delivery

  43. SERVICE DELIVERY PROGRAMMES • The core services of the department is driven through PROGRAMMES 2 DISTRICT HEALTH and 4 PROVINCIAL HOSPITAL SERVICES with the remainder of the departments programmes offering the necessary support. • There is an overlap between programmes in the provision of services which means that some interventions willnot have specific budgets as they cut across the board

  44. SERVICE DELIVERY PROGRAMMES CONT • 1. PROGRAMME 2 AIM: TO DEVELOP AND SUPPORT DISTRICT HEALTH SERVICES BUDGET (000) 2003/4 2004/5 2005/6 R2,252,759 R2,523,756 R2,725,766 • SUBPROGRAMMES District management Community Health Clinic Services Community Health Centers Community Based services Other Community Services HIV/AIDS Nutrition District Hospitals

  45. SERVICE DELIVERY PROGRAMMES CONT • 2.PROGRAMME 4 AIM : To provide cost effective, good quality, high level specialized services to the people of the Eastern Cape in collaboration with the Health Sciences Faculties BUDGET (000) 2003/4 2004/5 2005/6 R1,736,779 R2,053,528 R2,306,945 • SUBPROGRAMMES General Hospitals: T.B. Hospitals: Psychiatric/Mental Hospitals

  46. HIV/AIDS • BUDGET (000) 2003/4 2004/5 2005/6 R70,947 R92,988 114,111 • IMPROVED MANAGEMENT OF HIV/AIDS EPIDEMIC • IMPROVE ACCESS TO VCT BY INCREASING NUMBER OF TESTING SITES BY 30% • IMPLEMENT POST EXPOSURE PROPHYLAXIS FOR RAPE SURVIVORS • EXPAND PMTCT PROGRAMME • IMPROVE CARE AND SUPPORT FOR PEOPLE INFECTED WITH AND AFFECTED BY AIDS/HIV

  47. HIV/AIDSCONT • COMMUNITY INVOLVEMENT IN HIV & AIDS MANAGEMENT THROUGH AIDS COUNCILS • PROVIDE SERVICES TO VULNERABLE GROUPS(CSW) • PROVIDE CONTINUUM OF QUALITY CARE THROUGH PROVISION OF STEP DOWN CARE IN DESIGNATED HOSPITALS • SET UP CENTRE OF EXCELLENCE IN PARTNERSHIP WITH A MEDICAL SCHOOL TO PROVIDE MODELS OF PREVENTION TREATMENT AND RESEARCH

  48. TB PROGRAMME • REDUCE THE MORTALITY AND MORBIDITY OF TB • INCREASE TB CURE RATE BY • IMPROVING AND MONITORING DRUG SUPPLY • INCREASE CASE DETECTION BY SMEAR MICROSCOPY AMONG ALL TB SUSPECTS TO 80% • IMPROVE MDR PROGRAMME • DECREASE TREATMENT INTERRUPTION • EXPAND DIRECT OBSERVED TREATMENT SHORT COURSE • FINALIZE TB ADVOCACY PLAN FOR EASTERN CAPE

  49. REDUCE INFANT MORTALITY DECREASE IMR FROM 61,5 TO 40 PER 1000 LIVE BIRTHS IN 2006 INTERVENTIONS PLANNED • IMPROVE IMMUNISATION COVERAGE TO 85% IN 2005/6 • IMPROVE ACCESS TO PRIMARY HEALTH CARE FACILITIES • PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS • MANAGEMENT AND FOLLOW UP OF CHILDREN WITH HIV/AIDS • IMPLEMENTATION OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES

  50. INTEGRATED NUTRITION PROGRAM BUDGET(000) 2003/4 2004/5 2005/6 R172,465 R202,698 R222,133 • DECREASE MORBIDITY AND MORTALITY THROUGH STRATEGIC INTERVENTIONS TO PREVENT AND MANAGE MALNUTRITION. INTERVENTIONS • INTENSIFY IMPLEMENTATION OF INP AS GUIDED BY THE UNICEF CONCEPTUAL FRAMEWORK AND THE TRIPLE A APPROACH. • PROMOTE COMMUNITY BASED GROWTH MONITORING. • STRENGTHEN NUTRITION INTERVENTIONS AT HEALTH FACILITY AND COMMUNITY LEVELS, AND REHABILITATE MALNOURISHED CHILDREN. • TO WORK WITH OTHER SECTORS IN TACKLING THE ROOT CAUSES OF MALNUTRITION AND POVERTY. • FACILITATE TRANSFER OF PSNP TO THE DEPARTMENT OF EDUCATION

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