FREE STATE DEPARTMENT OF HEALTH

Presentation on the Status of Conditional Grants

Public Hearings on Conditional Grants

03 May 2006

1. Overview of Presentation

Introduction Background Monitoring Mechanisms Implemented Current Status on Business Plans 2005/2006 Actual Expenditure on Conditional Grants Projected Expenditure on Conditional Grants Capacity constraints and measures to overcome it Approved Business Plans Conclusion

The Free State Department of Health represented by Mr Sakhiwo Belot, the MEC for Health, supported

by the following members:

Dr RD Chapman: Acting Head: HealthDr AJ Schoonwinkel: Chief Financial OfficerMrs M Khokho: Acting Executive Manager: Clinical

Health Services

2. Free State Department of Health Team

3. Introduction The Free State Department of Health has been invited to Public Hearings on Conditional Grants and Capital Expenditure and to address the Parliamentary Committee on the following:

a) Data on trends in allocations, transfers & actual expenditure of conditional grants and capital expenditure of the department;

b) Brief assessment on the department’s monitoring capacity thus far, for 2005/06 by indicating the following:

under/over expenditure,

capacity constraints that impacted on these events &

approved Business Plans

The FSDoH implemented the following mechanisms

to monitor Conditional Grants: Expenditure on Conditional Grants, were based on approved Business Plans.

(Business Plans have been approved)

Allocation of Programme Manager to manage each Conditional Grant with the support of a Managerial Accountant to support the monitoring of spending trends. (Programme Managers have been appointed in writing per conditional grant)

Monthly progress report to MEC for Health, by Executive Management. (Regular reports submitted to MEC. MEC health has also facilitated two joint

formal meetings with MEC : PWR&T)

Monthly Provincial Steering Committee meetings to monitor implementation, especially on Capital Projects. (Monthly meetings held)

Presentation of full report at Quarterly Review Meetings. Done

Close collaboration with National Department of Health and DPWR&T. Done

4. Monitoring Mechanisms

5. Conditional Grants & Capital expenditure administered by FSDoH

The following conditional grants are being administered by the Free State Department of Health:

5.1 National Tertiary Services5.2 Comprehensive HIV and Aids (Health)5.3 Hospital Revitalisation5.4 Integrated Nutrition Programme5.5 Hospital Management & Quality Improvement5.6 Health Professions Training & Development5.7 Infrastructure Grant

6. Expenditure Trends over past 2 years

GRANT % EXPENDITURE 2003/2004

% EXPENDITURE 2004/2005

Health Professional Training & Development Grant 100% 100%Comprehensive HIV and AIDS Grant 100% 99%Hospital Management & Quality Improvement Grant 100% 100%Hospital Revitilisation 100% 91%Integrated Nutrition Programme 100% 94%National Tertiary Services 100% 100%Infrastructure 100% 62%Infrastructure - Flood Relief 100% 100%

7. Actual Expenditure on Conditional Grants – 31 March 2006

Conditional Grant Budget Actual Expenditure

% Spent – 31 March

2006National Tertiary Services 432,018,000 432,018, 000 100%

Comprehensive HIV and AIDS (Health) 100,874,000 100,479,069 99%

Hospital Revitalisation 106,082,000 87,415,125 82%

Integrated Nutrition Programme 7,296,001 7,296,001 100%Hospital Management & Quality Improvement

13,393,000 13,393,000 100%

Health Prof Training & Development 92,517,001 92,517,001 100%Forensic & Pathology Services 2,366,000 317,374 13%Infrastructure Grant 46,817,068 40,641,896 87%Total 801,363,070 774,077,466 97%

8. Projected Expenditure on Conditional Grants – Oct 2005 to March 2006

Conditional Grant Actual Expenditure

31 March 2006

Budget 2005/2006

Actual (over)/under

spending

National Tertiary Services 432,018,000 432,018, 000 -Comprehensive HIV and AIDS (Health) 100,479,069 100,874,000 R394,391Hospital Revitalisation 87,415,125 106,082,000 R18,666,875Integrated Nutrition Programme 7,296,001 7,296,001 -Hospital Management & Quality Improvement

13,393,000 13,393,000 -

Health Prof Training & Development 92,517,001 92,517,001 -Forensic & Pathology Services 317,374 2,366,000 R2,048,626Infrastructure Grant 40,641,896 46,817,068 R6,175,172Total 437,042,097 783,920,81

1R27,285,064

9. Current Status on Conditional Grants

9.1National Tertiary ServicesPurpose To fund national tertiary services delivered in hospitals as identified

by the Free State Department of Health, in order to ensure equitable access to basic tertiary health services by all South Africans.

Funds appointments of Chief, Principal and Specialists; Equipment; Goods and Services

Current Status according to Business Plan Expenditure to date on this grant, is 100%. The expenditure was according to the service level agreement as

signed with National Department of Health.

9.2 Comprehensive HIV and AIDS (Health)

PurposeTo enable the health sector to develop an effective response to the HIV and

Aids epidemic, by supporting the following: approved interventions including voluntary counselling and testing,

prevention of mother to child transmission programmes, strengthening of provincial management, establishment of Regional Training Centres, post exposure prophylaxis, home based care and step down care to provide a comprehensive treatment package, and

the implementation of the National Operational Plan for HIV and Aids treatment and care.

Current Status according to Business Plan Expenditure to date on this grant, is at 99%. The service is also being

rendered as part of an integrated service at district level.

Capacity Constraints Created cost centres at district level, to ensure expenditure from the

beginning of the financial year.

9.3 Hospital Revitalization Grant

Purpose To transform and modernise infrastructure and equipment in hospitals in line

with national policy and to achieve a sustainable infrastructure from which modern equitable and sustainable services can be delivered.

Current Status according to Business Plan The expenditure to date on this grant, is 82%. See attached Excel document for details on project status.

Capacity Constraints Development of a Working Agreement with Public Works, Roads &

Transport to reach consensus on agreed-upon targets. Lack of funding to complete existing projects in the new financial year.

9.4 Integrated Nutrition Grant

Purpose To implement integrated nutrition activities aimed at improving the

nutritional status of all South Africans.

Current Status according to Business Plan The expenditure to date on this grant, is 100%. The expenditure was in line with the Business Plan.

9.5 Hospital Management & Quality Improvement

Purpose To transform hospital management and improve quality care in line with

national policy.

Current Status according to Business Plan The expenditure to date on this grant, is 100%. Expenditure was in line with the Business Plan.

9.6 Health Professional Training & Development Grant

Purpose To support the Free State Department of Health to fund service costs

associated with training of health professionals; To enable shifting of teaching activities from central hospitals to

regional- and district facilities; To develop and recruit medical specialists in under-served provinces; To expand specialists and teaching infrastructure in the province.

Current Status according to Business Plan Expenditure to date on the grant, is 100%. Expenditure was in line with the Business Plan. The allocation on this grant is far less than the true provincial needs

and allocations for training & development of professionals.

9.7 Infrastructure Grant

Purpose To transform and modernise infrastructure and equipment in hospitals

in line with national policy and to achieve a sustainable infrastructure from which modern equitable and sustainable services can be delivered.

Current Status according to Business Plan See attached Excel Document.

Capacity Constraints Development of a Service Level Agreement with Public Works, Roads

and Transport and to reach consensus on agreed-upon targets. Lack of funding to complete existing projects.

10. Capacity Constraints

The ability to monitor projects and to have an experienced project manager on site.

The joint planning and monitoring of projects with DPR&T in order to have same targets for delivery.

Determining the size of the projects so that smaller projects can be given to Health to project manage as minor works.

12. Approved Business Plans

Business Plan Date Approved

Facilities Planning Infrastructure Plan 05/09/2005

Hospital Management & Quality Improvement Grant 28/04/2006

Health Professional Training & Development Grant 21/04/2006

Comprehensive HIV and AIDS Integrated Business Plan 19/04/2006

Revitalisation Grant 28/04/2006

The following Business Plans have been approved:

12. Conclusion

The corrective measures that have been put in place, have been effective and will assist to ensure spending of the conditional grant budget according to the Business Plans.

Thank YouRe a Leboha

Contact Dr RD Chapman

Free State Department of Health P O Box 227

BloemfonteinEmail – Chapmard@fshealth.gov.za

Tel: 051 408 1107