NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Honourable Mr N.M. Jack MPL Executive Authority
I have the honour of submitting the Annual Report of the Northern Cape Department of Health, for the period 1st April 2014 to 31st March 2015.
Ms. G.E. Matlaopane Head of Department Date: 28 August 2015
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1 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1. TABLE OF CONTENTS 2. Part A: General Information
2.1. Department’s General Information 4
2.2. List of Abbreviations / Acronyms 5
2.2.1. Official sign-off of the annual performance report 7
2.3. Foreword by MEC of the Department 8
2.4. Overview of the Accounting Officer 9 -18
2.5. Statement of Responsibility and Confirmation of the Accuracy of the Annual Report 19
2.6. Strategic Overview 20
2.7. Legislative and Other Mandates 20 - 21
2.8. Organisational Structure 22
2.9. Entities reporting to the MEC 22
3. Part B: Performance Information
3.1. Auditor General’s Report: Predetermined Objectives 23
3.2. Overview of Departmental Performance 23 - 26
3.3. Strategic Outcome Oriented Goals 26 - 27
3.4. Performance Information by Programme 28 - 83
3.5. Transfer of Payments 84 - 86
3.6. Conditional Grants 87 - 89
3.7. Donor Funds 90
3.8. Capital Investments 90 - 91
4. Part C: Governance
4.1. Introduction 92
4.2. Risk Management 92
4.3. Fraud and Corruption 92
4.4. Minimising Conflict of Interest 92 - 93
4.5. Code of Conduct 93
4.6. Health Safety and Environmental Issues 93 -94
4.7. Portfolio Committees 94 - 97
4.8. SCOPA Resolutions 97 - 98
4.9. Prior modifications to audit Committees 98 - 99
4.10 Internal Control Unit 100
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4.11 Internal and Audit Committees 100 - 101
4.12. Audit Committee Report 101 - 102
5. Part D: Human Resource Management
5.1. Introduction 103 - 104
5.2. Human Resources Oversight Statistics 104 - 137
6. Part E: Financial Information
6.1. Report of the Auditor General 138 - 144
6.2. Annual Financial Statements 145 - 243
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2. Part A: General Information 2.1 Department’s General Information
Northern Cape Department of Health Du Toit Span Road, James Exum Building Private Bag X 5049 Kimberley 8300 Tel: 053 830 2148 Fax: 053 833 4394 [email protected]
4 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1. ABBREVIATIONS
AFS Annual Financial Statement AGSA Auditor- General South Africa AIDS Acquired Immune Deficiency Syndrome ALOS Average Length of Stay ANC Ante Natal Care ART Anti-Retroviral Treatment ARV Anti-Retro Viral BANC Basic Antenatal Care BHF Board of Health Funders BUR Bed Utilisation Rate CaSIPO Care and Support for Improved Patient Outcome CCDU Central Chronic Dispensing Unit CCMDD Central Chronic Management Dispensing and Distribution CDC Communicable Disease Control CDU Chronic Dispensing Unit CEO Chief Executive Officer CFO Chief Financial Officer CHC Community Health Centre CHW Community Health Workers CPD Continuous Professional Development CSS Client Satisfaction survey CT Computed Tomography DBSA Development Bank of South Africa DCST District Clinical Specialist Teams DHIS District Health Information System DHMIS District Health Management Information System DORA Division of Revenue Act DPSA Department of Public Service and Administration DPTC District Pharmaceutical Therapeutic Committee EDI Electronic Data Interchange EMC Executive Management Committee EMS Emergency Medical Services EPMDS Employment Performance Management Development System ESMOE Essential Step in the Management of Obstetric Emergency ETR Electronic TB Register FDC Fixed Dose Combination FET Further Education and Training HAART Highly Active Anti -Retroviral Therapy HAM Health Area Manager HBC Home Based Care HCT HIV Counselling and Testing HIV Human Immunodeficiency Virus HOD Head of Department HPTDG Health Professional Training and Development Grant HPV Human Papilloma Virus HRD Human Resource Development HSNC Henrietta Stockdale Nursing College IACT Integrated Access to Care and Treatment ICF Intensified Case Finding ICT Information, Communication and Technology ICU Intensive Care Unit IMCI Integrated Management of Childhood Illnesses IPIP Infrastructure Programme Implementation Plan IPMP Infrastructure Programme Management Plan IPT Isoniazid Preventive Therapy ISHP Integrated School Health Programme JHPIEGO John Hopkins Program for Interventions Education in Gynaecology and Obstetrics KH Kimberley Hospital MCWH Mother, Child and Women’s Health MDG Millennium Development Goal MDR Multi-Drug Resistant 5 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
MEC Member of the Executive Council MMC Medical Male Circumcision MMR Maternal Mortality Ratio MPAT Management Performance Assessment Tool MTEF Medium Term Expenditure Framework MTSF Medium Term Strategic Framework NDOH National Department of Health NGO Non-Governmental Organisations NHI National Health Insurance NHLS National Health Laboratory Services NIMART Nurse Initiated Management of Antiretroviral Treatment NPA National Prosecuting Authority NSDA Negotiated Service Delivery Agreement NTSG National Tertiary Services Grant OHSC Office of Health Standard Compliance OPD Out Patients Department PCV Pneumococcal Vaccine PDE Patient Day Equivalents PEP Post Exposure Prophylaxis PFMA Public Finance Management Act PHC Primary Health Care PICT Provider Initiated HIV Counselling and Testing PILIR Policy on Incapacity Leave and Ill-Health Retirement PMDS Performance Management Development System PMTEC Provincial Medium Term Expenditure Committee PMTCT Prevention of Mother to Child Transmission PORT Provincial Outbreak Response Team PPIP Peri-natal Problem Identification Programme PSS Patient Satisfaction Survey RAF Road Accident Fund RPM Rapid Prototyping Manufacturing SANCB South African National Council for the Blind SAPC South African Pharmacy Council SAPS South African Police Service SAQA South African Qualifications Authority SDIP Service Delivery Improvement Plan SCOPA Standing Committee on Public Accounts SLA Service Level Agreements STG Standard Treatment Guidelines TB Tuberculosis TIER Three Integrated Electronic Registers TROA Total Client Remaining on ART UAMP User Asset Management Plan UFS University of the Free State WBOT Ward Based Outreach Teams WBPHCOTs Ward Based Primary Health Care Outreach Teams WHO World Health Organisation WISN Workload Indicators of Staffing Needs XDR Extreme Drug Resistant ZF MGCAWU Zwelentlanga Fatman Mgcawu
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NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.2.1. OFFICIAL SIGN-OFF OF THE ANNUAL PERFORMANCE REPORT
It is hereby certified that this Annual Performance Report:
• Was developed by the Provincial Department of Health in the Northern Cape Province • Was prepared in line with the current Annual Performance Plan of the Department of the Health of the Northern Cape Province under the guidance of Honourable Mac Jack, MEC for Health
• Accurately reflects the performance of the Department of Health in the Northern Cape Province for 2014/15
Mr. Mxolisi Mlatha Director: Policy & Planning Date: 28 August 2015
Mr. Dan Gaborone Acting Chief Financial Officer Date: 28 August 2015
Ms. Gugulethu E. Matlaopane Head of Department Date: 28 August 2015
APPROVED BY:
Mr. N.M Jack Executive Authority
Date: 28 August 2015
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2.3. Foreword by the Member of Executive Council for Health
It gives me great pleasure to present the 2014/15 Annual report for the Northern Cape Department of Health. In the development and implementation of programmes and strategies, the Department was guided by key policies and plans for the medium term, including the National Development Plan-vision 2030.
Therefore, this report highlights achievements attained and challenges encountered in relation to policy directives and strategic outcome related goals for the financial year.
Financial Management:
Significant progress and interventions has been made in reviving staff morale in the Department and I believe that the current team of staff will work in synergy towards the realisation of ‘A long and healthy life for all South Africans’ as outlined in the National Development Plan vision 2030.
It was simply through robust internal sessions held to effect change in the Department, especially in critical areas such as; Human Resource, Supply Chain Management and Finance to enable us to manage accruals through the introduction and implementation of Cost Containment Plan.
Financial management will continue to receive priority attention this coming financial year, as we will ensure that budget allocations are based on our provincial priorities. This is one strategy which will enable us to spend wisely and within our budget, so as to avoid over-expenditure that led to us receiving a qualified Audit outcome report. I now have the greatest confidence that as a collective, we will rise to the occasion.
Burden of Diseases:
Although, a lot still needs to be done in swiftly dealing with the burden of diseases ravaging communities, evidence attest to the fact that our province is beginning to yield positive results following concerted efforts made in rolling-out the HIV, Testing and Counselling revitalisation campaign aimed at encouraging our people to know their status as well as kicking TB and STI out of our communities.
The role of partnership and a multi-sectoral approach in the realisation of the Provincial Strategic Plan on HIV/AIDS, STI and TB cannot be over-emphasised. It is only through combining resources, skills and experience of all sectors that our goals and objectives can be achieved.
National Health Insurance:
The universal health coverage is a means to achieving better health outcomes for all our people. Its aim is to ensure that people use preventive, curative, rehabilitative and palliative health services that are of sufficient quality, while at the same time ensuring that the use of such services does not cause financial hardship to consumers.
Our medical health care practitioners are instrumental and key drivers of ensuring that NHI blueprint becomes a reality towards achieving our mandate.
We once again, acknowledge the unwavering support and contribution made by our Honourable Premier, Mme Sylvia Lucas, the entire Executive Committee (EXCO) members (MEC’s) and stakeholders in ensuring that we deliver in our mandate of providing quality health care services to our communities.
I remain steadfast in providing leadership and support to the staff and management of the Department, as we strive for Health Excellence in Service Delivery to all communities across our province.
I thank you
MR N.M JACK
MEC FOR HEALTH Date: 28 August 2015
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6 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.4. Report of the Accounting Officer
2.4.1 Overview of the operations of the department
There were key policy developments that we continued to undertake which are strengthening the health system through Primary Health Care Re-engineering to buttress and support District Health Systems. Furthermore there was the ongoing piloting the National Health Insurance and implementation of the Ideal Clinic Initiative.
Progress has been made on NHI which includes; (a). School Health Programmes that has revived in some districts to ensure that health care services are accessible, (b) with regard to Community Health Ward Based Out Reach Services, in Pixley Ka Seme there are thirty eight (38) trained community ward based out-reach teams led by a Professional Nurse (c)in strengthening the Districts Health Systems, District Clinical Specialist Teams (DCST) were also introduced in order to improve the health care services in districts.
In 2014, Operation Phakisa was announced by Honourable President, Mr. Jacob Zuma which requires that all 3507 Primary Health Care facilities in the country must be classified as Ideal Clinic. There have been significant progress made on the implementation of Ideal Clinic in relation to improvement of infrastructure (renovation of Loxton, Carnavon CHC, De Aar Hospital amongst others); satellite connectivity in (six) 6 facilities in the Pixkey Ka Seme district, establishment of Perfect Permanent Teams for Realization of Ideal Clinic Management (PPTICRM) coordinating structures to provide support in facilities. Despite progress highlighted on the ideal Clinic, there is still a challenge on finances, as the project was handed over without a designated budget.
In 2014/15 financial year the Department of Health together with stakeholders conducted a cross-sectional study on “Maternal and child Health Programme Effectiveness Evaluation” in John Taolo Gaetsewe district. The aim of the study was to identify the root causes of challenges in achieving low maternal mortality ratios despite the efforts exerted by government in implementing priority maternal and child health programme interventions. The Department is in the process of developing improvement plans on the implementation of the recommendations of the maternal evaluation.
The Department currently has recurring number of 129 students in the Cuban-Doctor Programme. This number ranges from first-year students right through to sixth-year students. In the financial year under review, seven (7) Cuban doctors wer enrolled. Twenty (20) internship opportunities for graduates appointed throughout the Province.
Important strategic issues facing the department
• Service delivery: Achieving the Millennium Development Goals and other service delivery commitments within the context of limited resources and under-funded health sector; • Quality: Improving clients’ experience and the quality of service delivery including decreasing waiting times, improving clinical outcomes, staffing levels, supplies of medication and response times to emergencies; • Management and compliance: The need to strengthen management systems including monitoring, reporting, accountability and addressing the Auditor-General’s findings; • Financial austerity: Addressing over expenditure, accruals and restricted cash flow; • Human resources: Addressing the shortage of skilled doctors, nurses, pharmacists, other allied personnel, emergency services, appropriate skills in finance and human resource management units; • Infrastructure: The health sector faces the problem of facilities that require significant upgrading in terms of maintenance, medical equipment, Information Technology infrastructure and management information systems.
Significant events that have taken place during the year
At the beginning of the year, the department welcomed seven (7) Medical student doctors from Cuba, these students enrolled with various universities for their final year of studies. They will be deployed to various facilities to improve the quality of care for our patients upon completion of their studies. We continue with the Castro-Mandela agreement by sending young matriculants to Cuba to study medicine that will also alleviate the shortage of doctors at our hospitals in the long term. As the late former President of South Africa, Mr Nelson Mandela once said “Education is the most powerful weapon which you can use to change the world.”
It is important to report significant progress made with the National Health Insurance (NHI) pilot project in Pixley Ka Seme district. This has been realised by appointing all the ward based outreach teams. It is envisaged that these teams will deal with health issues at community level and thus reduces the number of patients flocking to hospitals.
The appointment of six (6) doctors at Prof Z K Matthews Hospital at Dikgatlong Municipality in Barkley West, indicates our commitment to improve the quality of health services. Prof Z K Matthews Hospital service package has been increased to reduce referrals to Kimberley Hospital and the hospital completed the revenue generating project to ensure that patients are billed accordingly. 9 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
More good news is that Kimberley Hospital has been reclassified as a level 3 hospital. Two patients underwent titanium mandible transplants at Kimberley Hospital, this procedure was the first in the country. The installation of a Computed Tomography (CT) machine at the Kimberley Hospital radiology department has shown progress in delivering quality health services to our communities. It will also save costs and traveling time as patients will no longer need to be transported to Bloemfontein in the Free State Province to access such services. The newly installed mammogram unit at the facility is making an immense difference in the lives of women in this province especially those who do not have medical aid. I am sure you will agree with me that breast cancer can be beaten if women undergo regular mammogram examinations especially those above 45 years.
President Jacob Zuma opening the Dr Harry Surtie Hospital in Upington was another highlight for the year as it has continued to assist in minimising unnecessary referrals to Kimberley Hospital. It will also save costs as more health services are now available to the patients located on the western side of the province. The staff accommodation at Williston Community Health Centre has been completed which is good news for the recruitment of health personnel in the area. Upgrades at Fraserburg and Sutherland facilities as well as the newly built Postmasburg clinic were completed recently. The outstanding issue is adequate staffing of all the facilities especially the newly built ones to ensure that services are delivered optimally. The procurement of emergency vehicles will shorten the waiting period for patients who make calls for emergency services as such requests demand prompt action.
Dr Harry Surtie and Bill Pickard Hospitals were accredited as Mother and Baby Friendly facilities. Dr Harry Surtie Hospital also established a milk bank to assist mothers who cannot breastfeed their new born babies.
The monitoring of Mom Connect project at John Taolo Gaetsewe and Pixley Ka Seme districts will assist in identifying challenges and resolve them as they arise. The department also trained Community Health Workers on the revised eligibility criteria for Antiretroviral Treatment (ART) initiation of clients to avoid delays on the initiation process.
We are also proud of increasing the roll-out of Fixed Dose Combination (FDC) by 93% in the province which clearly shows that the performance will improve to 100%. We have also trained about two hundred and sixty one (261) health professionals on Prevention of Mother To Child Transmission (PMTCT) guidelines and more health professionals will undergo training to ensure that these guidelines are implemented at all facilities. The implementation of these guidelines will minimise the mother to child transmission of HIV and working hard towards HIV free generation as envisioned in the National Development Plan.
The departmental officials who attended the Lung Health Conference in Spain will implement all the innovative ideas that were presented at the conference. Continuous training and refresher courses for personnel is critical in ensuring that we are on par with the latest developments in the health sector as it is a dynamic environment.
The robust and constructive debate at the Health Portfolio Committee presentations is clear indication that our department is working hard in delivering health care services in our communities. The finalisation of the Strategic Plan 2015/16-2019/20 and Annual Performance Plan 2015/16 documents show that the department is on the right direction towards achieving its objectives. The slow progress regarding provincialisation of Frances Baard health facilities that are part of the municipality is a worrying factor as it is negatively affecting the quality of health services. We should not be distracted by challenges but to continue to strive for excellence.
The cataract marathon was held successfully by the Ophthalmology unit at Kimberley Hospital in collaboration with the South African National Council for the Blind (SANCB) during October 2014, as a result of which seventy nine (79) cataract operations were conducted on patients residing in our province.
The following progress has been made on infrastructure projects during 2014/15 financial year in respect of construction and refurbishment of hospitals: • De Aar main hospital project is at 66.5 per cent and is planned to be completed during 2015/16 financial year. • Fraserburg and Sutherland Community Health Centre`s were successfully completed • The Mammography unit at Kimberly Hospital was completed and will be operational in February 2015
2.5 Overview of the financial results of the department:
The management of accruals remains a challenge and this poses a risk to the financial sustainability of the department. The cost containment measures circular was introduced to ensure that departmental spending patterns focus on the core services in line with the Ministerial Non-negotiable items and National Core Standards.
Provincial Treasury continues to support the department in dealing with factors affecting financial management including supply chain management as well as management of accruals. The department has strengthened internal controls, started to investigate irregular expenditure through compliance unit and implementing the integrated planning through regular finance
10 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15 and supply chain management forums.
2.4.2.1 Departmental receipts
The department derives 90% of its revenue from patient fees and these are based on determined tariffs set by the Minister of Health. Tariffs in the current financial year were increased by 5% and so was the revenue target. Revenue collection target was not achieved as planned resulting in collection of R42.937 million which is 1% below in comparison to that of the previous financial year.
Below is the financial performance on revenue generation: Departmental receipts 2014/2015 2013/2014
Estimate Actual Over)/Under Estimate Actual (Over)/Under Amount Collection Amount Collection Collected Collected R’000 R’000 R’000 R’000 R’000 R’000 Sale of goods and services 51,781 41,236 10,545 49,281 39,673 9,608 (other than capital assets) Interest, dividends and rent - 288 (288) - - - on land Sale of capital assets 2,000 - 2,000 1,314 1,775 (461) Financial transactions in - 1,413 (1,413) - 1,715 (1,715) assets and liabilities Total 53,781 42,937 10,844 50,595 43,163 7,432
Plans for collecting departmental revenue
The department rolled out Electronic Data Interchange (EDI) which enables viewing whether the patient has sufficient funds on the medical aid scheme before admission to the health facility. This was successfully completed by the end of September 2014.
However, three facilities are still remaining, namely, • Kakamas Hospital due to connectivity, the interim measure is that they will download information and process the Road Accident Fund and Medical aid claims on EDI at Dr Harry Surtie Regional Hospital; • Postmasburg Hospital due to connectivity, the interim measure is that they will download information and process the Road Accident Fund (RAF) and Medical aid claims on Electronic Data Interchange at Tshwaragano District Hospital; • West End Specialised Hospital is a new site in which infrastructure and human capacity is still to be strengthened. The Information Technology connectivity and infrastructure was planned to be completed by the end of March 2015, however Information Technology equipment was not delivered on time.
Kimberley Hospital has now been properly registered with the Board of Health Funders (BHF) in line with the tertiary services package and West End Specialised Hospital was also registered to charge equitable tariff to patients from clients such as the Department of Correctional Services, South African Police Service and Department of Justice.
Future plans for collecting of revenue The future plans include the department developing a patient debt collection strategy and further plan to build capacity through on-going training for revenue personnel. The review of personnel capacity at facility level was performed and vacancies were identified. The posts will be reprioritized within the available budget. The review of patient classification and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) will receive preference.
Revenue tariff policy The tariffs charged by the department on patient fees are based on the national tariffs as approved by the Minister. These tariffs are uniform throughout the country and are compiled by the national task team, representative of all the provinces. Tariffs charged to the public patients are determined according to their scale of income. Tariffs with regard to other sources of income, such as parking are determined by using guidelines issued by relevant national departments from time to time.
Free services There are circumstances in which patients will receive services free of charge independently of their classification as full paying or subsidized patients. Such circumstances include infectious, formidable diseases, pregnant women and children. Also patients classified under H0 (null hypothesis) category receive free services. 11 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Reasons for under collection of revenue The under collection resulted from lack of dedicated personnel in revenue management at specific health facilities, lack of computer system connectivity in most health facilities and internal control deficiency to classify patients properly in order to maximise revenue. These result in the lost opportunity to collect revenue from private paying patients.
2.4.2.2 Programme Expenditure
During the year under review, the department was allocated an adjusted budget of R3.757 billion, which included an adjustment to the conditional grants, roll-overs and other adjustments. At the end of the financial year the department had spent R3.713 billion resulting in an under-expenditure of R44.008 million. A request to rollover unspent funds was submitted to the Provincial Treasury on both the conditional grants and equitable share budget.
The table below shows budget and expenditure by programmes for the financial years 2013/14 and 2014/15. Detailed performance by economic classification and fund is shown in the Appropriation Statement in the Annual Financial Statements.
Programme Name 2014/2015 2013/2014 Final Actual (Over)/ Final Actual (Over)/ Appropriation Expenditure Under Appropriation Expenditure Under Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Administration 173,694 192,331 (18,637) 167,616 171,647 (4,031) District Health Services 1,618,498 1 633,011 (14,513) 1,486,556 1,465,611 20,945 Emergency Medical 259,262 242,847 16,415 231,955 199,910 32,045 Services Provincial Hospital 265,715 292,594 (26,879) 214,569 201,082 13,487 Services Central Hospital Services 788,826 767,519 21,307 719,640 739,655 (20,015) Health Sciences 108,698 104,251 4,447 88,845 86,012 2,833 Health Care Support 85,258 85,263 (5) 85,898 84,524 1,374 Services Health Facilities 458,037 396,164 61,873 481,909 453,360 28,549 Management Total 3,757,988 3,713,980 44,008 3,476,988 3,401,801 75,187
Administration – (R18.367 million)
The programme overspending was due to claims against the department, interest on overdue accounts and outstanding payments from prior year that are processed centrally such as computer services, security services, consulting fees and audit fees. The spending is being reprioritised in line with the approved Cost containment measures and Provincial Treasury was consulted to assist with the impact of accruals.
District Health Services – (R14.513 million)
The programme overspends mainly on the goods and services budget. These goods and services were overspend due to accruals specifically on security services, municipal services, consumable supplies, medical waste and interest onoverdue accounts, machinery & equipment, outsourced professional staff, operating leases and telephone costs. The spending is being reprioritised in line with the approved Cost containment measures and Provincial Treasury was consulted to assist with the impact of accruals
Emergency Medical Services – (R16.415 million)
The department had reprioritised the budget by implementing the strategy of replacing vehicles with mileage exceeding 250 000 kilometres, in order to improve emergency response time and cut down on repairs and maintenance costs.
However, there were procurement delays by the department. This delay was further affected by cash flow constraints affecting the payment of suppliers in which case the suppliers wanted payments before conversion of vehicles takes place.
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The department had committed R16.954 million towards the procurement of emergency mobiles, in order to make the vehicle ready for service delivery, the department has issued another tender for the conversion of vehicles into ambulance including the supply and installation of equipment to be mounted as outlined above. The vehicles have been delivered to relevant service providers for conversion and mounting the required equipment. A roll over has been requested to mitigate this effect.
Provincial Hospital Services (R26.879 million)
This programme overspends its budget due to the impact of accruals that could not be paid during 2013/14 financial year. The programme overspend on goods and services, machinery, equipment specifically on outsourced medical services, operating leases, security services and municipal services. The operationalisation of Dr Harry Surtie Regional Hospital is funded over three year periods, however full operationalisation of certain clinical units such as pharmacy were accelerated due to service delivery demands.
The spending is being reprioritised in line with the approved Cost containment measures and Provincial Treasury was consulted to assist with the impact of accruals.
Central Hospital Services – (R21.307 million)
The department experienced delays of deliveries by suppliers, this was partly due to cash flow constraints affecting the payment of suppliers. The department had committed R2.176 million towards the procurement of medical equipment and office automation devices. A further amount of R17.489 million was committed towards the procurement of goods and services, which was mainly the laboratory services and blood supplies that have a direct impact on the patient care. The committed funds have been requested as a roll over.
Health Sciences and Training (R4.447 million)
The compensation underspends due to delays on the recruitment of two hundred (200) auxillary nurses. However, the programme overspends on transfers to the Cuban Programme in the form of bursaries. The strategy has been sought for recruitment of two hundred (200) auxillary nurses. The budget bid to fund the Cuban Programme was presented to National Department of Health and the Provincial Treasury for consideration.
Health Care Support Services (R5 000)
The programme almost breaks even, despite the budget pressures affecting infrastructure needs of the forensic medical services and provincial medical depot.
Health Facilities Management – (R61.873 million)
The programme underspends due to delays in appointing contractor for Port Nolloth Community Health centre, termination of contractor for Kagung Clinic and slow progress on Mental Health project. The acceleration plan has been developed and the implementing agents are constantly monitored for adherence to the service level agreements (SLA). The department could not spend all funds allocated. A roll over has been requested for the funds that were already committed.
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Virements/roll overs
Description Virements Reason for the virement R’000 1. ADMINISTRATION 12 882
Goods & Services 6 432 This programme over spent on its goods and services budget as a result of accounts paid centrally such as telephone costs, specific operating leases, legal fees and audit fees. The virement is to mitigate this situation was done from programme 3 and 7.
Machinery & equipment 5 223 The budget pressure on leasing of medical equipment and replacing old computer equipment led this programme to over spend on machinery and equipment. The virement is to mitigate this situation was done from programme 3.
Buildings & other fixed structures 813 This programme overspent on its buildings and other fixed structures budget as a result of upgrading office space. The virement is to mitigate this situation was done from programme 8.
Provinces and municipalities 17 This programme overspent on its households as a result of increases municipal services. The virement is to mitigate this situation was done from programme 2. 2. DISTRICT HEALTH SERVICES 13 596
Provinces and municipalities (689) This programme underspends on its transfers to municipalities as a result of replacing the posts that become vacant at municipal clinics. This under spend amount was moved to programme 1, 4 and 5.
Buildings & other fixed structures 648 This programme overspent on its buildings and other fixed structures budget as a result of upgrading and rehabilitation of existing health facilities. The virement to mitigate this situation was done from programme 8.
Machinery & equipment 13 248 The budget pressure on leasing of medical equipment and replacing old computer equipment at several health facilities led this programme to over spend on machinery and equipment. The virement is to mitigate this situation and was done from programme 7 and 8.
Software and other intangible assets 389 This programme overspent on its allocation for software and other intangible assets due to the replacement of operating system software for Frances Baard district office. The virement to mitigate this situation was done from programme 8. 3. EMERGENCY MEDICAL SERVICES (13 827)
Goods & Services (9 198) This programme underspent on its machinery and equipment as a result of lack of cash flow in the last quarter of the financial year and payments were restricted to Conditional Grants only. The underspend amount was moved to programme 1 and 4.
Provinces and municipalities (121) This programme underspent on its transfers to municipalities for vehicle licences as a result of delays in the delivery of procured emergency vehicles, which will only be delivered in the next financial year. This under spend amount was moved to programme 5 and 7.
Machinery & equipment (4 508) This programme under spent its machinery & equipment as a result of lack of cash flow in the last quarter of the year and payments were restricted to Conditional Grants only. This under spend amount was moved to programme 1. 4. PROVINCIAL HOSPITAL SERVICES 9 880
Compensation of Employees 2 615 The budget pressure on compensation of employees resulted from early recruitment of personnel for the full operationalisation of the pharmacy. The funding is only available in the next financial year. The funding for the full operationalisation is done on a three-year multi funding model that expires in 2016/17 financial year. The virement to mitigate this situation was done from programmes 5.
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Description Virements Reason for the virement R’000 Goods & Services 3 749 The budget pressure on goods and services, particularly in medical supplies, pharmaceuticals, blood products, patient catering and laboratory services, led this programme to over spend its goods and services allocation. The virement is to mitigate this situation was done from programmes 3.
Provinces and municipalities 365 The budget pressure on payments to municipalities, particularly for municipal rates and taxes led this programme to overspend its allocation. The virement is to mitigate this situation was done from programme 2.
Buildings & other fixed structures 2 422 This programme overspent its buildings and other fixed structures budget as a result of unforeseen upgrading and rehabilitation of West End Specialised Hospital, for the operationalisation of additional thirty six (36) bed facility in response to service delivery demands. The virement is to mitigate this situation was done from programme 8.
Machinery & equipment 685 The budget pressure on procurement of new medical equipment and procurement of new computer equipment at West End Specialised Hospital, for the operationalisation of additional thirty six (36) bed facility. Led this programme to over spend on machinery and equipment. The virement to mitigate this situation was done from programme 7.
Software and other intangible assets 44 This programme overspent on its allocation for software licence due to unforeseen procurement of new computer equipment at West End Specialised Hospital. The virement to mitigate this situation was done from programme 5. 5. CENTRAL HOSPITAL SERVICES (2 346)
Compensation of Employees (2 615) This programme underspent on its compensation of employees as a result of delays in the processing of the intake of replacement allied community service workers. This under spend amount was moved to programme 4.
Non-Profit Institutions 421 This programme overspent on its allocation towards transfers to non-profit institution, as a result of accruals that could not be paid from the prior financial year. The virement is to mitigate this situation was done from programme 2 and 3.
Buildings & other fixed structures (152) This programme underspent on its budget on buildings and other fixed structures, due to savings on the upgrading of high care unit. This under spend amount was moved to programme 4. 6. HEALTH SCIENCES & TRAINING (685)
Machinery & equipment (685) This programme underspent on its machinery and equipment due to delays in the procurement of a bus for transportation of students at the nursing college. This under spend amount was moved to programme 4. 7. HEALTH CARE SUPPORT SERVICES (4 417)
Goods & Services (983) This programme underspent on its machinery and equipment as a result of lack of cash flow in the last quarter of the year and payments were restricted to Conditional Grants only. This under spend amount was moved to programme 1.
Provinces and municipalities 7 This programme underspent on its allocation for transfers to municipalities for vehicles licences, since the delivery of procured forensic vehicles was planned for 2013/14 financial, while the actual delivery only took place in the current year. The virement is to mitigate this situation was done from programme 3.
Machinery & equipment (3 441) This programme underspent on its machinery and equipment since reprioritised the budget for procurement of vehicles for the operations of the forensic services and medical depot. This under spend amount was moved to programme 2.
15 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Description Virements Reason for the virement R’000 8. HEALTH FACILITIES MANAGEMENT (15 083)
Buildings & other fixed structures (14 305) This programme underspent on its buildings and other fixed structures due to delays in finalising tender processes. This underspent amount was moved to programme 1, 2 and 4.
Machinery & equipment (778) This programme underspent on its machinery and equipment due to reprioritisation of infrastructure projects. This underspent amount was moved to programme 1 and 2.
2.5.2 Unauthorised Expenditure
The department has for the year under review incurred unauthorised expenditure of R91.636 million, 2.43% of the final appropriation. This is mainly as a result of over expenditure on the budget vote. Unauthorised expenditure as disclosed in the disclosure notes to the financial statements amounts to R91.636 million compared to R26.506 million from the previous financial year. The unauthorised expenditure has increased to R236.856 million from R145.220 million.
The overspending by different main divisions of the vote in the current financial year is attributed to unexpected and unavoidable expenditures on medical-legal claims, breach of contract and interest on overdue accounts amounting to R6.380 million. An amount of R61.048 million resulted from accruals of 2013/14, which has escalated on the cash flow resources. A further amount of R1.413 million overspending on payments for capital assets is attributable to unplanned rehabilitation and upgrading of health facilities.
And the remaining R16.741 million overspending on transfers to universities results from over-commitment on the intake for Cuban Programme. The department carries this expenditure without dedicated funds, while the National Department of Health (NDoH) gave instruction to phase out its financial impact from the Health Professions Training & Development Grant (HPTDG). The department has submitted the business plan which was valid and acceptable for 2015/16.
A budget bid was submitted to Provincial Treasury during the Provincial Medium Term Expenditure Committee (PMTEC) Budget bilateral for funding but could not be considered due to economic outlook affecting budget allocations. A further bid was submitted to NDoH for consideration. A Departmental Budget Committee has been established and is chaired by the Accounting Officer. Programme managers have been appointed in writing and play a pivotal role in controlling expenditure within their programmes. Expenditure trends are discussed and variances between budget and expenditure are explained by programme managers.
2.5.3 Fruitless and wasteful Expenditure Fruitless and wasteful expenditure as at the end of the financial year is R6.380 million and mainly as a result of medical-legal claims against the department amounting to R3.829 million resulting from adverse events and interest charged on overdue amounts to R2.344 million to several suppliers, mainly resulting from cash flow constraints.
The department assigned officials to monitor the processing of payments to avoid late payments. The department developed monitoring tools for the processing of payments which clearly outlines the ageing of payments. All finance personnel were trained on how to use the monitoring recording and reporting tool. The department appointed additional people in the Supply Chain Management unit and has advertised the vacant positions; this will address the delay in the processing of payments.
The department further re-engineered the Adverse Events Committee to investigate possible negligence on medico-legal cases and recommend disciplinary measures.
2.5.4 Irregular Expenditure Irregular expenditure amounting to R556.339 million was incurred during the current year, compared to R747.048 million. This was mainly due to infrastructure contracts that were awarded through implementing agents and contracts that have expired but running on the month to month basis. The smaller portion of irregular expenditure results from not following proper procurement processes. Cumulatively, irregular expenditure amounts to R4.185 billion; the reason for the increase is that the department had not condoned the irregular expenditure over a number of financial years.
An official from the department has been assigned to form part of joint bid committee for contracts awarded by implementing agent, where the department will be a user of the facility to be constructed. A number of contracts that expired were prioritised to be regularised. The department had provided training workshops on Supply Chain Management Policy and Standard Operating Procedures during the year under review. The department will further initiate disciplinary processes against officials who caused irregular expenditure in terms of the law and as recommended by Standing Committee on Public Accounts (SCOPA). 16 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.5.5 Future plans of the department
The department is committed in ensuring that the provision of health services is sustainable and the focus moving forward recognizes that improving health outcomes depend on several determinants: • Improve corporate governance • Building of human capital for financial management and critically funded clinical posts • The implementation of the infrastructure generic organisation structure to ensure that the preventative maintenance takes place other than building new infrastructure • Improving the quality of primary health care • Streamlining of training platforms especially for enrolled nurses and Emergency Medical Services practitioners • The operationalization of the De Aar District Hospital and Kimberly Mental Health Hospital • The improvement on the district hospitals referral patterns to the provincial hospital • The fully operationalization of Dr Harry Surtie Hospital will improve patient satisfactory rate for the regional hospital services • Improved financial and District Health Information Systems (DHIS) • Improvement on the implementation of the vaccination of the school girls for Human Papilloma Virus and HIV and Aids awareness, prevention and treatment activities • Improve tertiary services • Improve on the operational ambulance coverage
Primary Health Care
The department will implement cost containment measures to deal with inefficiencies and focus spending on its core mandate, promoting fiscal discipline and ensuring financial sustainability on the Ministerial Non-negotiable items, which include aspects such as: • Infection control services • Medicines and medical supplies, including drug dispensary • Essential equipment and maintenance of equipment • Laboratory services • Non-communicable diseases • Child health services • Maternal and reproductive health services • HIV/AIDS and TB • Infrastructure
2.5.6 Public Private Partnerships (PPP)
The department does not have PPP’s neither has it entered in new PPP’s in the year under review.
2.5.7 Discontinued activities / activities to be discontinued
There were no discontinued activities or activities planned to be discontinued.
2.5.8 New or proposed activities
There were no new or proposed activities during the year under review.
2.5.9 Supply chain management
With respect to the period under review, there were no unsolicited bid proposals dealt with through Supply Chain Management bidding processes.
Measures and mechanisms that the Department has initiated and accordingly instituted as an effort to prevent irregular expenditure is:-
• Supply Chain Management Forum: which is a formal structure constituted of both Finance and Supply Chain Management officials from the Districts and Provincial Office who meets on quarterly basis and deal with matters considered critical and have a bearing on creation of irregular expenditure. • Transactions check listing: Proactively through the office of the Chief Financial Officer at Provincial Office level, a checklist to assess compliance on transactions processed through quotations. • Pre-bid award compliance evaluation: Upon receipt of Tenders / Bids through advertisement placed, Supply Chain Management in consultation to the End User conducts pre evaluation / bid award compliance evaluation to ascertain whether responses received as bids adhere to National Treasury set requirements as well as to Preferential Procurement Policy Framework Act 5 of 2000 as promulgated. 17 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
• Financial Accounting: Maintains a register of transactions considered through their assessment as not fully complaint. In relation to the above, as recommended by Provincial Treasury Internal Audit, the register must be a matter where Supply Chain Management and Financial Accounting consistently address through collaboration so that causes of irregularity are addressed properly.
As far as challenges are concerned, the following are mechanisms put in place to coherently address the same:
• Control measures: Supply Chain Management Policy as well as Procedure Manuals has been reviewed to ensure that Supply Chain Management policy covers all operational and administrative environments in line with National Treasury policy updates and Practice Notes accordingly. • Potential conflict of interest: As an inherent risk to any transaction, all Supply Chain Management staff has been made aware of the business ownership that any official employed at Supply Chain Management might have. • Alignment of Supply Chain Management Structures to functional areas: Given limited staff complement as a risk due to lack of segregation of functions. Posts were advertised for the appointment of staff, recruitment processes have been expedited for finalization. • Adherence to procedural requirements: This is an area where huge challenges are experienced. Service requisitioning by End User does not fully regard that Supply Chain Management needs to filter such requisitions through procedural parameters so that substantive outcome is sustainable. Example is where some End Users would want to dictate to Supply Chain Management which service provider to interact with for acquisition of services.
2.5.10. Gifts and Donations received in kind from non-related parties
No donations in kind were received by the Department from non-related parties during the year under review.
Exemptions and deviations received from the National Treasury There was no exemptions or deviations received from National Treasury for the current and/or previous financial years
2.5.12. Events after the reporting date
No reportable events after the reporting date were identified. 2.5.13. Acknowledgement/s or Appreciation
Let me take this opportunity to express my sincere gratitude for the leadership provided by our honourable MEC: NM Jack and Executive Management Committee. Let me further, extend this appreciation to the support of senior management and all staff of the department in ensuring that the service delivery is not compromised while the department experience dire financial constraints.
The department would not be able to sustain its services without the immense support from the oversight by Portfolio Committee on Health, Audit Committee and the Provincial Treasury. I therefore acknowledge their immeasurable support.
2.5.13. Approval and sign off
Ms Gugulethu Matlaopane Accounting Officer Northern Cape Department of Health Date: 28 August 2015
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NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.5. Statement of responsibility and Confirmation of the Accuracy of the Annual Report
I have the honour of submitting and confirming responsibility for the performance information of the Northern Cape Department of Health, for the period 1st April 2014 to 31st March 2015.
Ms G.E. Matlaopane Head of department Date:
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19 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.6. Strategic Overview
Vision
Health Service Excellence for all.
Mission
‘Working together we are committed to provide quality health care services’. We will promote a healthy society in which we care for one another and take responsibility for our health. Our caring, multi- skilled professionals will integrate comprehensive services using evidence-based care strategies and partnerships to maximise efficiencies for the benefit of all.
Values
• Respect (towards colleagues and clients, rule of law and cultural diversity) • Integrity (Honesty, Discipline and Ethics) • Excellence through effectiveness, efficiency and quality health care. • Ubuntu (Caring Institution, Facility and Community)
2.7. Legislation and Other Mandates
Constitutional Mandates
Section 27 of the Constitution of the Republic of South Africa, Act 108 of 1996, provides for right of access to health care services, including reproductive health care.
The Department provides access to health care services, including reproductive health care by making sure that hospitals and clinics are built closer to communities and emergency vehicle are provided, promotion of primary health care, etc.
Legal Mandates
The legislative mandates are derived from the National Health Act, 61 of 2003.
Chapter 4
Section 25 provides for Provincial health services and general functions of provincial departments; Section 26 provides for Establishment and composition of Provincial Health Council; Section 27 provides for Functions of Provincial Health Council and Section 28 provides for Provincial consultative bodies.
Chapter 5
Section 29 provides for the Establishment of District Health System; Section 30 provides for division of health districts into sub-districts; Section 31 provides for establishment of district health councils; Section 32 provides for health services to be provided by municipalities and Section 33 provides for preparation of district health plans. • Basic Conditions of Employment (Act 75 0f 1975) • Choice on Termination of Pregnancy (Act 92 of 1996) • Constitution of the Republic of South Africa (Act 106 of 1996) • Division of Revenue (Act 7 of 2007) • Employment Equity (Act 55 of 1998) • Foodstuffs, Cosmetics and Disinfectants (Act 54 of 1972)
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• Health Act, (Chapter 10) • Health Professions ( Act 56 of 1974) • Higher Education (Act 101 of 1997) • Labour Relations (Act 66 of 1995) • Maternal Death (Act 63 of 1977) • Medicine and Related Substance Control (Act 101 of 1965) • Mental Health Care (Act17 of 2002) • National Building Regulations and Building Standards (Act 103 of 1997) • National Health Insurance • National Development Plan (Chapter 10 of MTSF) • Nursing (Act 50 of 1978 and Related Regulations) • Nursing (Act 33 of 2005) • Occupational Health and Safety (Act 85 of 1993) • Pharmacy (Act 53 of 1974 as amended) • Public Finance Management (Act 1 of 1999 and Treasury Regulations) Policy Mandates • Reclassification of Health facilities • White Paper on Transformation of Health Service • National Development Plan (Chapter 10 of NDP) • National Health Insurance
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2.8. Organisational Structure
2.9. Entities Reporting to the MEC
• There are no entities reporting to the MEC
22 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3. PART B: PERFORMANCE INFORMATION 3.1. Auditor General’s Report: Predetermined Objectives
Refer to Auditor General’s (AGSA) Report (Reporting on other legal and Regulatory requirements) published as Part E (Annual Financial Statement’s) of the department’s annual report.
3.2. Overview of Departmental Performance
This synopsis of Departmental Performance highlights key activities that were planned and achieved in 2014/15 financial year towards the realisation of the Medium Term Strategic Framework. The improvement of the Health sector aimed at creating a well-functioning health system which is capable of producing improved population health outcomes. The Department of Health adopted a new outcome-based approach to accelerate attainment of set objectives.
The Department stayed focused on these commitments which were formalised in a Negotiated Service Delivery Agreement (NSDA) that was signed in by the Minister of Health. The NSDA is a charter that reflects the commitment of the Department and key partners to achieving the goals of the Government’s vision of “A Long and Healthy Life for All South Africans.” To this end, the Government has identified four outputs for the health sector. These outputs include:
1: Increasing Life Expectancy. 2: Decreasing Maternal and Child mortality. 3. Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis. 4: Strengthening Health System Effectiveness.
To achieve these desired health outcomes of Government’s Programme of Action, for the health sector. The Provincial Department of Health set the “health services excellence for all” vision to improve the health status of the entire population in the Province. In keeping with this aim, more emphasis and resources were devoted to these four key areas. The quarterly and annual performance reports of different programme units showed that the Department’s efforts have improved on outputs and outcomes in the above mentioned key output areas. However, this could not have been achieved without the steady political support, leadership, staff and stakeholders committed support to the Department.
For instance, during the year under review the Department has made significant improvements in a number of health outcomes contained in this report. However, we acknowledge that a lot still needs to be done. The achievements include, but not limited to:
• The appointment of Health Facility Managers and District Health System managers contributed to improved leadership and oversight capacity at facilities; • The introduction of the unit costing approach in prioritization of activities and resources allocation for efficient and effective use of resources; • The review of human resources organisational structure was finalised and approval is awaited from the Department of Public Service and Administration; • The completion of Dr Harry Surtie Hospital and health facilities to render quality and integrated referral systems; and • The quarterly and annual reviews are conducted to strengthen monitoring and evaluation systems in the department.
3.2.1. Service delivery environment
The Department has a comprehensive Service Delivery Improvement Plan (SDIP) which is derived from the Negotiated Service Delivery Agreement. To achieve Government’s ultimate goal of ‘’a long and healthy life for all’’, the Department uses government’s principles of “Batho Pele”, which include exercising courtesy in our dealings with the public, setting service standards, increasing access, consultation, openness and transparency, access to information, redress, and proving value for money in public resources.
3.2.2. Service Delivery Improvement Plan
The Northern Cape Department of developed the Service Delivery Improvement Plan (SDIP) in line with the legislative requirements in 2012. Two key services we identified for improvement being;
• Provision of Primary Health Care Services • Provision of Non- Communicable Health Care Services
23 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Provision of Primary Health Care Services
In order to move forward towards the implementation of the comprehensive package in the department, district health systems had to be strengthened and systemic interventions had to be developed to respond to the basic issues that had to be in place like establishing the three streams which are: Ward Based Outreach Teams, School Health Programme and District Based Specialist Teams
Provision of Non- Communicable Health Care Services
In a quest to reduce the impact of non-communicable diseases such as diabetes, heart disease and hypertension, the department had to monitor the implementation of chronic protocols. Furthermore health promotions through Community Health Workers and Ward Based Outreach Teams and ensuring sufficient supply of medication at facilities are some of the interventions to reach the objective of reducing non-communicable diseases.
Main services and standards Main services Beneficiaries Current/ actual standard Desired standard of Actual achievement of service service Provision of Primary The broader • One hundred and thir- • 100% provision of • 100% rendering of com- Health Care Services Public ty two (132) facilities comprehensive prehensive PHC pack- (clinics) are rendering PHC package age a comprehensive PHC package Provision of non- People diag- • Seven thousand nine • Reduce and man- • Reduction in new cases communicable nosed with hundred and ninety age current reg- three thousand five health care services chronic disease one (7991) people di- istered cases and hundred and twenty Prospective agnosed with Diabe- provide health two (3522) cases and chronic sufferers tes/Hypertension education to all the rest remain on the management programme
Batho pele arrangements with beneficiaries (Consultation access etc.)
Current/ actual arrangements Desired arrangements Actual achievements Political Imbizo’s • As per National and Provincial • Political imbizos were conducted to all districts political engagement as per the Executive Authority schedule Health calendar programs - • All health calendar programmes were implemented Day – to-day consultation Establishment of Clinic committees All clinic committees fully established and through health education during and having quarterly forums functional clinic visits Forty three (43) Clinics to have es- Establish Ward Based Outreach Teams: Mainly tablished support groups using community health workers Quarterly support group meetings Established District Clinical Specialist Teams (DCST’s): These teams will focus on improving the health of mothers, new born and children towards the attainment of the Millennium Development Goals (MDG’s) Contracting of Medical Practitioners to Public health facilities (clinics) Radio slots on health programmes conducted on an on-going basis.
24 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Service delivery information tool
Current/ actual information tools Desired information tools Actual achievements General Health Education provided • Prepare pamphlets in line with • Distribute pamphlets during health calen- during consultation the departmental language dar months events to shops, taxi ranks and policy. door to door campaigns.
Ministerial Health Campaigns • On-going Ministerial campaigns • Conduct monthly clinic committee meet- for all five districts. ings and submit reports. Public Service Week information • Implement the Outreach teams • All districts have Ward Base Outreach stalls system. Teams (WBOT’s), located in the wards. Door to door campaigns • Form partnership with other • Ward Base Outreach Teams (WBOT’s) in all stakeholder in joint service deliv- districts doing door-to-door on a daily basis. ery.
Complaints mechanism
Current/ actual complaints Desired complaints mechanism Actual achievements mechanism Complaints boxes in all facilities • Established complaints commit- • Policy on managing complaints for health tees. service users in place. • Complaints are managed at facility level. • Full adherence of complaints policy monitored through the six core standards assessment.
3.2.3. Organizational environment, key policy developments, legislative changes and strategy to overcome areas of underperformance
The absence of an approved final organogram impacts on the strategic management and capacity of the institution as a whole to execute its mandate. The necessary sagacity to manage a complex organization such as a department of health requires that the requisite fundamentals be in place. It had already been envisaged that the departmental structure would have been elevated with a Superintendent General at the helm, in line with the generic structure for the country. The failure to finalize the organogram because of both external and internal factors served as a hindrance and bottleneck for this transition.
The Department of Health derives its mandate from Section 27 of the Constitution of the Republic of South Africa, Act 108 of 1996 and the National Health Act, Act 61 of 2003, to inter alia provide for the right of access to health care services, including reproductive health care. Over the past years the department has been appointing new Chief Financial Officers and Accounting Officers. This situation and other policy shifts for example the introduction of Ideal Clinic initiative has necessitated some alterations in the department resulting in the instability in the organisation.
For instance, new policies and regulations under the general umbrella of Primary Heath Care Re-engineering (PHC) are overwhelming. The policy includes dynamic and highly-impactful health delivery mechanism reform, which include:
• The National Health Insurance (NHI) policy. An innovative system of healthcare financing with far reaching consequences on the health of South Africans. The NHI will ensure that everyone has access to appropriate, efficient and quality health services. Since 2011 the Department has placed the National Health Insurance policy and strategies in one of its districts to generate innovative lessons to other districts in the province as well. • The ideal clinics: This work entails transforming the existing clinics and Community Health Centres into ideal clinics, which will be proudly utilised by all South Africans due to the enhanced quality of services they will provide. • The establishment of the Office of Health Standards Compliance. This office is responsible to monitor and set standards for the health sector where public and private facilities comply with. Although currently the regulations are in draft form the department has been implementing the service improvement plans. • New Mental Health Policy. The Mental Health Policy framework and strategic plan have just been developed.
Despite policy efforts, the successful implementation and obtaining the strategic and operational plans targets have been influenced by the availability of human resources for health. In the reporting period the resignation of the key officials such as the provincial National Health Insurance Coordinator, Provincial Medical Director, Chief Financial Officer and Human Resources Management Director were impactful challenges for the department. These officials are critical and have strategic imperatives to the success of the department.
Instability in senior management can result in leadership gaps that can impact negatively on the effective delivery of health care services though failure to meet key regulatory and guiding principles, and the loss of experienced resources. To address this 25 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15 core challenge, acting officials have been appointed while the recruitment process is underway. However, there are still more challenges specific to the delivery of health care service in the province, which includes: Inadequate budget: With so many policy mandates to improve the delivery of health care, the department struggle to secure adequate funding to fully implement its strategic and operational plans. As a result, important activities do not have adequate budget, including human resources, and which negatively can impact the delivery of health services. Inadequate human resources for health: As health care’s policy changes, so do the skills required to successfully implement the policy mandates as well as to deliver good quality of health services to meet client’s demand. Without the necessary skills, experiences, and expertise, the delivery of good quality health care for all is a challenge.
Poor integration with heath support services: Effectively managing stakeholders including government sectors is critical to the success of health policy. Without strong collaboration with other sectors, health challenges of the population may not be resolved efficiently.
Some of the challenges are internal and others external. To turn-around the challenges, the following are necessary: 1. Addressing the financial and human resources constraint. 2. Health delivery priority setting. 3. Close collaboration and work in partnership with stakeholders 4. Conduct research, and 5. Strong monitoring and evaluation.
3.3. Strategic Outcome oriented goals
Strategic Goals Goal Statement Rationale Expected Outcomes 1. Provision of Strategic Ensure that the health Health system effectiveness is Efficient and effective Leadership and creation of system functions optimally central in ensuring that sector planning and the execution a social compact for effec- within the ambit of the sec- priorities and the vision of the of the priorities of govern- tive health service delivery. tor priorities of government. Department is accomplished. ment across the sector; The Department must provide leadership and direction to stakeholders. 2. Improved quality manage- Create an environment Quality management is at the Reduce the risk of litigations ment and patient care within which the system heart of running any health against the Department; across the system through responds to the need for facility and system. Everything Reduce and manage inter alia developing the patient safety and our hu- that the Department do, infections in our facilities; Department’s human re- man resources are opti- should primarily take into ac- Ensure that patients in sources. mally geared to deal with count the life of the patient. Department’s care are the attended challenges. treated in the safest environments. 3. Improved health outcomes The Department will man- Creation of a healthy soci- Create a healthy society in managing both commu- age current and emerging ety which is able to optimally and reduce morbidity and nicable and non-communi- diseases and ensure that galvanise its human resources, mortality in terms of the cable diseases. we create healthy com- and eliminate all the condi- Millennium Development munities. tions and catalysts increasing Goal’s. the burden of diseases. 4. Attainment of a positive Ensure that the Depart- A clean audit outcome for A clean audit for both audit outcome for both ment comply with the both financial and non-finan- financial and non-financial financial and non-financial PFMA, related legislation cial information is important in data; management. and treasury prescripts. creating trust and a positive Comply with the regulations image about the Department and policies of the in the public eye. department; The Department should have all the requisite policies in place. 5. Improved and accelerated Reduce the infrastructure People must receive health Well maintained health infrastructure development backlog and ensure that services in an environment facilities; programme. all our facilities meet the that secures their dignity, Accelerate the construction minimum standards of privacy and helps health pro- of new facilities; the sector for the delivery fessionals to function without Have an optimal health of optimal and dignified infrastructure related limita- service delivery platform for health care to our people. tions. the people of the Northern Cape.
26 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.3.1. Performance Information
The Department conducts District and Provincial Reviews on a quarterly basis in order to monitor progress that has been achieved in implementation of the Strategic Plan and Annual Performance Plan. These sessions assist the department in identifying early warning signs on poor performance; furthermore, programmes developed action plans on indicators that have not been achieved. Minutes and resolutions taken during proceedings are implemented and reported to different forums by programmes.
The Department submits performance reports on a quarterly basis to the National Department of Health, Provincial Legislature and Provincial Treasury, through the Quarterly Reporting System (QRS). The system utilizes national customized performance indicators that have been identified from different budget programmes. These indicators are published by National Treasury on a quarterly basis on its website. The Department further uses an internal monitoring tool, which is the Quarterly Performance Report, (QPR) to monitor the other performance indicators. Performance information sessions are conducted with all budget programmes at the end of each quarter to review performance as per the annual performance plan. At the end of the financial year an annual report is consolidated to account how the budget was implemented and the state of the Department’s financial management systems.
Analyses of performance reports are consolidated in each quarter and shared with all relevant managers on strategies to overcome areas of underperformance. The outcome of analyses requires programmes to develop risk improvement plans on how to mitigate risks of non-achieving planned targets. Programmes are also accountable to provide means of evidence for performance achieved.
27 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.4. PERFORMANCE INFORMATION BY PROGRAMME PROGRAMME 1: ADMINISTRATION
Policy and Planning
Priorities • Alignment of Departmental Plans • Monitor the implementation of the Departments’ integrated planning framework • Improve communication of policies
Strategic Goal 1: Provision of Strategic Leadership and creation of a social compact for effective health service delivery
Situation analysis
The Policy and Planning directorate continues to conduct Performance Information Monitoring Sessions with all programmes to monitor performance and develop improvement plans for indicators not achieved. The directorate provided support to the districts in their reviews, so as to guide and improve on performance management.
The Strategic Plan for 2015/16-2019/20 and Annual Performance Plan 2015/16 were completed on time and tabled to the Portfolio Committee in the Provincial Legislature. A Strategic Planning Session was held with National Department of Health on the implementation of the Ideal clinic initiative. The District Health Plans have been finalised and submitted to the National Department of Health. A workshop on Management Performance Assessment Tool was provided for senior managers, on their roles and responsibilities. The Department of Planning, Monitoring and Evaluation and Office of the Premier gave feedback on the plans that were submitted and recommendations were made by the department.
District Health Services and Tertiary Hospitals have been identified as the two programmes that will be audited for the 2014/15 financial year on performance information. The directorate is working tirelessly to ensure that areas that were highlighted by Auditor General in the previous audit are rectified and implemented in order to improve performance management. The unit participated fully in ensuring that the Programme of Action inputs are finalised and submitted to the Office of the Premier as the oversight body.
Achievements
• Tabled Strategic Plan 2015/16-2019/20 and Annual Performance Plan 2015/16 to the Provincial Legislature • Submitted Programme of Action (POA) progress report to Office of the Premier • Submitted four (4) Quarterly Reporting System (QRS) 2014/15 to Provincial Treasury and National Department of Health • Submitted four (4) Quarterly Performance Report and presentations to Health Portfolio Committee at Provincial Legislature • Conducted performance information monitoring sessions with all budget programmes on a quarterly basis to review performance information • Conducted three (3) departmental performance review sessions • Submitted Performance Information Annual Report to the Auditor General on the 30 May 2014 • Held departmental annual review session on the 20-21 May 2014 • Developed Performance Information Audit Rectification Plan 2013/14 as per audit findings • Submitted Management Performance Assessment Tool (MPAT) 1.4 and Improvement Plan progress report to the Office of the Premier (department improved from MPAT 1.3 at 41% to 50% for MPAT 1.4) • Tabled Annual Report 2013/14 to Health Portfolio Committee and SCOPA at the Provincial Legislature
The following policies have been approved:
• Bereavement policy • Job Description Policy • EPMDS Policy • Learnership and Internship • Disposal of Medicine and Scheduled Substances (Pharmaceutical Wastes)
28 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
• HIV & AIDS, STI and TB in the Workplace • Policy on Handling Schedule 1 to 4 Medicines • Policy on Handling Schedule 5, Specified Schedule 5 and Schedule 6 Medicines • Job Evaluation Policy • Health and Productivity policy
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action
• Non-adherence to reporting timelines on perfor- • Ensure the adherence to performance management mance managment framework.
• Slow progress in development of institutional policies • Key policies and controls have been identified for special intervention, some of these tabulated in audit rectification plan.
29 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 1: Annual targets for Policy and Planning
Strategic Objectives Performance Actual Target Actual Deviation Comments on deviations Indicator 2013/14 2014/15 2014/15 To finalise and implement Provincial Develop Provincial - Develop Provincial - - • The department is in the Health Plans aligned with National Long Term Health Long Term Health Plan process of developing long Development Plan, Negotiated Plan term health plan based on Service Delivery Agreement, National the service transformation Health Services (NHS) and Medium plan Term Strategic Framework (MTSF) Table 5 year - Tabled 5 year Tabled 5 year Strategic - - priorities for 2010-2014 Strategic Plan strategic Plan Plan 2015/16-2019/20 to the Provincial Legislature Table 2015/16- Tabled Annual Tabled Annual Tabled Annual - - 2016/17 Annual Performance Plan Performance Plan d Performance Plan Performance Plan (APP) 2014/15 to draft APP (APP) 2015/16 to the (APP) Provincial Legislature Legislature Published 2013/14 Annual Report Published Annual Tabled Annual Report - - Annual Report produced Report 2013/14
Developed a - Approved Policies are circulated - • Fast-track the finalization of strategy on communication to all employees upon communication strategy on communication of strategy of policies approval through the policies policies GroupWise • Monitor approved and reviewed policies for their implementation
30 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Research and Epidemiology
Priorities: Strengthen research and development
Strategic Goal: Provision of Strategic leadership and creation of a social compact for effective health service delivery
Situation analysis
Health research is an important investment for health and offers many benefits, such as improvement in public health programme effectiveness, generating best clinical practices, cost-effective ways of allocation of scarce resources, and reduction of public health threats. Hence, the unit plays a key role in improving the delivery of good quality health services in the Province.
Several basic issues negatively impacted on the performances of Research and Development unit. These include the shortage of human resources, inadequate financial and lack of departmental website. It is important that the department should develop its website so that our data base (PDF files) should be linked to it and released to potential users, and adequate resources allocation to the unit.
Achievements
• The study on the Maternal Child Health Programme Effectiveness Evaluation in John Taolo Gaetsewe District was completed. The study used both the World Health Organization (WHO) health system building blocks and the Logic Model for generating evidence on different services utilization indictors. The output of the study provides evidences and insights that can be used as leverage to influence future maternal and child health programme plan in the Province. A major finding of the study is a lack of adequate human resources for health, particularly in rural health facilities impede the delivery of good quality services in the district. The recommendation indicates that multi-sectoral action is needed to benefit more mothers and children from maternal and child health programme in the district.
• To develop the research database, the unit needs to employee human resource responsible for this activity as well as departmental website. A request to employ a person for the task has been made. Currently the unit relies on the national dashboard (data base) system to upload research proposals that sought permission to be conducted in our province.
• In addition to this, research to scale-up HIV/AIDS intervention programme for Men who have Sex with Men (MSM) is going according to its plan. Two research articles submitted to journals for publication. Two (2) staff capacity development trainings on research methodology and statistical analysis were conducted and health research priorities for the Province identified.
Table 2: Annual targets Research and Epidemiology
Strategic Performance Actual Target Actual Deviation Comments on Deviations Objectives Indicator 2013/14 2014/15 2014/15 Strengthen Conduct - 1 1 - • The study on Maternal research and Programme Child Health Programme development performance Effectiveness Evaluation in evaluation John Taolo Gaetsewe District was completed as planned Research - Developed 75% -25% • The Department of Health database Research is using National Health created database Research dashboard as a database • Lack of departmental website to publish research material
31 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Information, Communication & Technology (ICT)
Priorities: Improve ICT infrastructure in all facilities
Strategic Goal 2: Improve Quality Management and Patient Care across the System
Situation analysis
Provincial Information, Communication and Technology Directorate is well established with a Deputy Manager heading the operations. The post of a Director: ICT remains vacant whilst the Department is in the process of headhunting.
Information Communication Technology support remains a challenge at Districts and facilities province-wide. The only facilities with appointed ICT support personnel are Kimberley Hospital and Dr Harry Surtie Hospital. All the other facilities in the province are being serviced by our current service provider Mind Matter for ICT technical support and maintenance. Most of our facilities in the province especially clinics and Community Health Centres do not have connectivity and this negatively affects administrative operations, correspondence and reporting.
Achievements
• Microsoft Enterprise Agreement finalized and costing completed, awaiting approval of Purchase Order. • ICT helpdesk fully operational with more than 90% faults resolution within a day. • 90% System availability and accessibility restored within forty eight (48) hours.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • The process of developing Departmental ICT • Fast-track recruitment of a Senior Manager for Information governance and other strategic documents is a Communication & Technology. challenge • Lack of ICT support personnel at districts and facilities • With the involvement of District Health Service Office, facilitate recruitment of IT technicians for districts and facilities, using phased approach. (e.g. 1st phase - recruit for placement at each district office then 2nd phase – placement at all hospitals) • Insufficient bandwidth size at most facilities negatively • To upgrade data lines for higher bandwidth (512kb affecting all applications (e.g. Nootroclin, emails, etc.) Community Health Centre’s, 1MB for all hospitals and District Offices). • Majority of computers throughout the Province does • Implement and roll out the Window Server Update Services not get required regular updates of Operating System at all facilities in the Province. and MicroSoft
Table 3: Annual targets for Information, Communication & Technology
Strategic Objective Performance Actual Target Actual Deviation Comments on Indicator 2013/14 2014/15 2014/15 Deviations To overhaul the Proportion of - 11 District 11 District -27 Community • Bid for funding health information health facilities Hospitals & Hospitals Health for the Virtual system in order to connected to the 33 CHC’s Connected Centre’s not Private Network improve integration internet & 6 CHC connected rollout in the and data usage for connected. new financial planning and service year (2015/16) delivery
32 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Human Resource Management
Priorities
• Review and align the Provincial Human Resource Plan with the service delivery platform • Improve Performance Management and Development systems and process
Strategic Goal 1: Improved Quality Management and Patient Care across the system through inter alia developing the Department’s resources
Situation analysis
Providing efficient and effective human resource systems is one of the critical areas raised by the department over the years. In addressing the matter, a staff session was held with the executive of the department both politically and administratively with the intention of addressing improvement of human resource within the department.
The structure of the Human Resource unit still needs to be presented to the Chief Director, Corporate Services. However, the movement of staff with human resource skills and qualifications internally has been initiated. All contract posts from salary level three (3) to eight (8) were advertised to ensure continuity in the Department as well as compliance to legislation.
Payment spread sheet was sent to all South African Universities requesting student’s invoices for the 2014 academic year. There is a notable improvement on submissions of invoices and payment thereof. Circular 1 of 2014 on the Employee Performance Management Development System implementation plan in relation to the EPMDS policy was forwarded to all employees for its implementation.
Achievements
• Appointed a Persal Controller to ensure allocations of functions in the districts and improve productivity. • Seven (7) Cuban doctors were appointed; • Developed a database for bursary holders, as well as their respective placement as of 2009 to end of 2014/15 financial year; • A Health Professional Training and Development Grant (HPTDG) annual evaluation report submitted to National Department of Health on the 30 May 2014; • Twenty (20) internship opportunities for graduates were provided throughout the province; • One hundred and fifty eight (158) application for pensions were finalized.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Over expenditure on the Health Professions Training and • A Business Plan in line with Division of Revenue Act Development Grant (HPTDG) due to incremental spending in (DoRA) has been developed for 2015/16. awarding of bursaries. • Submit budget bidding to Provincial Treasury for application of new funding for bursaries. • Non-adherence to the Leave Management Policy • Train all line managers on leave management and implementation of leave management • Vacancies not filled within four (4) months • Recruitment plan in line with the submissions of the directorates to ensure shortened recruitment turnaround through block advertisements. • Interpretation of the Employee Performance Management • Continuously conduct information on the and Development System (EPMDS) Policy. interpretation of the policy.
33 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 4: Annual targets for Human Resource Management
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on Deviation 2013/14 2014/15 2014/15 Promote effective and efficient Vacancy rate for professional 15.1% 16% 25% -9% • The Department experienced huge exit of recruitment and retention within the nurses. professional nurses due to their fears with Department regard to the new pension reforms. These nurses are being recruited back into the system Vacancy rate for doctors 19% 25% 28% -3% • The number of patients that the hospitals are servicing have increased tremendously over the number of years though the number of doctors in the hospitals remained the same. • This has led to the department having to create more posts in these hospitals to ensure quality health services. Vacancy rate for medical 13.7% 18% 32% -14% • A number of specialists have left the Province specialists. to open private practices locally and in other provinces • Several adverts were placed in the newspapers for the categories but no applications received. Vacancy rate for pharmacists. 45% 23% 28% -5% • A high number of pharmacists have been appointed however there are still challenges in other districts. Reduced vacancy rate 21.1% 10% 24% -14% • The Department terminated contract vacancies at the end of March 2015. This led to the increased vacancy rate. Proportion of Local Government - 26 0 -26 • The Department is faced with challenges Health Personnel which are in dealing with the transfer of Pensions and transferred to Provincial Medical Aid issues as some of the employees Department of Health are nearer to pension age. Develop Provincial Human - 1 Human 0 Human • A new HR Plan for 2015/16–2017/18 is in the Resources for Health Plan Resources Resource process of being developed. Health Plan Plan was not developed developed (HRP) Measure performance in line with Total number of Performance 31 (out of 35 35 - • All managers have signed performance departmental objectives Agreements signed for SMS of- 38 Senior agreement ficials Managers) Total number of Performance 3333 (out of 6 533 4 204 -2329 • Managers have been trained on how to man- Agreements signed for levels 6509 in the age the PMDS process and disciplinary action 1-12 officials establishment) to be instituted to those who do not comply. 34 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Finance & Supply Chain Management
Priorities
• Attain an unqualified audit report
Strategic Goal 4: Attainment of a positive audit outcome for both financial and non-financial data
Situation Analysis:
The office of the Chief Financial Officer focussed on the implementation of Audit Rectification Plan nine (9) projects which related to the 2013/14 Regularity Audit Outcome.
The Audit outcome highlighted major concerns in Supply Chain Management, Financial Accounting as well as the Assets Management Unit. The management of accruals remain the challenge for the department, of which poses the risk to the budget over the Medium Term Expenditure Framework. The major challenges were incorporated in the Audit Rectification plan and had been monitored on a monthly basis.
The Provincial Treasury supported the department to deal with factors affecting financial management including supply chain management as well as management of accruals. The department has strengthened internal controls, investigated irregular expenditure through compliance unit and implementing the integrated planning through regular finance and supply chain management forums.
The units mentioned above have been experiencing a major shortage of skilled human resources. The office of the Chief Financial Officer is in the process of advertising and filling funded posts. Revenue management operations of the department could not reach the desired target due to inadequate processes in the generation and collection of revenue by health facilities.
The Departmental cash flow constraints remain a major source of concern. The customised cost containment measures circular was introduced in November 2014 to ensure that departmental spending focus on the core services in line with the Ministerial Non-negotiable items and National Core Standards.
Achievements
• The remaining Immovable Assets transferred to the Department of Roads and Public Works. • The interim financial statements were submitted to Provincial Treasury
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Shortage of staff in the office of the Chief Financial Officer. • The department has advertised posts and will be filled in the new financial year • Lack of an effective patient verification system in all revenue • Most facilities were provided with tools of trade such generating facilities to ensure that paying patients are classi- as photocopying machines, scanners etc. The depart- fied as such. ment is in a process of appointing a service provider • Filing and safe keeping of patient’s information is a great that will provide services to verify financial status of concern at the moment due to unavailability of space. the patient. • Motor vehicle claims processed by an agent without pro- • Facilities are looking at processes of archiving old and viding any proper reconciliation reports to the department unused files and exploring a process of procuring an poses a risk of not knowing whether the amount paid by electronic data management system to ensure safe Road Accident fund is reconciling to claims submitted or not. keeping of information. • The department will employ sufficient staff per facility that will deal with all revenue generation and collec- tion in those facilities including motor vehicle accident claims. • The Department continues to experience cash flow con- • The Departments has implemented cost containment straints as a result of the high rate of spending on the Equita- measures. It further implemented the centralisation of ble Share and slow spending of the conditional grants. payments, procurement orders and recruitment pro- cesses with the support of Provincial Treasury.
35 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 5: Annual targets for Finance and Supply Chain Management
Strategic Performance Actual Target Actual Deviation Comments on deviations Objective Indicator 2013/14 2014/15 2014/15 To ensure Achieve an Qualified Unqualified Qualified -Unqualified • Department of health effective unqualified Audit Audit Audit Report Audit opinion Audit Report was unable to obtain financial Opinion from opinion an unqualified audit management Auditor General opinion due to the processes in of South Africa lack of a sound line with PFMA (AGSA) controls environment Section 39, 43 & and the lack of key chapter 6 of the personnel. 2005 Treasury Approved Asset Asset Approved Asset Reg- -Asset • The asset register Regulation Register Register was Asset ister will be Register not was completed in audited Register approved approved September 2014 during the after quality and referred to financial assurance Internal Audit for an year from Internal independent opinion. Audit unit. • The 2014/15 additions have been reconciled until the end of November 2014, it is planned that the final register with additions will be ready by 31 May 2015. To ensure Collection of pro- 85% 85% 80% -5% • The target could not effective and jected revenue collection of collection of be attained due to efficient revenue projected projected disposal of assets management revenue revenue amounting to R2 million that was not performed during the anticipated period. • 1% of this under collection is due to motor vehicle claims that were not paid by Road Accident fund on time.
36 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Security & Risk Management
Priorities
• Compliance with Risk Management Strategy
Strategic Goal: Provision of Strategic leadership and creation of social compact for effective health service delivery
Situation analysis
The Provincial Risk Management Unit was re-enforced to co-ordinate the risk management processes across the department. Risk assessment was successfully conducted for the year 2013/2014 and the risk register populated. A consolidated prioritized list has been compiled. It should also be mentioned that all relevant regulatory documents have been drafted and others approved so that this strategy can be implemented. The Department is in a continuous endeavour to improve the situation. Risk Management is currently managed by only three officials.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action Non-existence of the formal risk management structure in • The establishment and extension of a formal risk manage- the districts. ment structure and function in the districts. The risk identification & assessment process is not linked to • Assessments to be conducted before the new financial the flow of the financial year. year commences. No continuous monitoring of risks by risk owners and action • Quarterly review and monitoring of the risk register by the owners. Risk Owners and Action owners.
Table 6: Annual targets for Security & Risk Management
Strategic Objective Performance Indica- Actual Target Actual Deviation Comments on Deviation tor 2013/14 2014/15 2014/15 Comprehensive Number of facilities - 163 7 -156 • Department compiled implementation with updated Risk draft risk register from of the Risk Register risk identified in all audit Management reports with facilities, Strategy programmes on the completeness and accuracy thereof. • A new comprehensive and relevant risk register will be in place for the department and submitted to the Risk Management Committee for approval.
37 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 2: DISTRICT HEALTH SERVICES
Sub-Programme: District Health
Priorities
• Roll-out of 194 Ward Based Outreach Teams (wall-to wall provincial coverage) by the end of 2018/19 Financial Year • Operationalize the integrated School Health Programme (ISHP) • Establish functional District Clinical Specialist Teams in all districts • Ensure accessibility to health care services and the full implementation of the Primary Health Care and District Hospital packages
Priorities: Quality Assurance
• Improve the rate of patient complaints resolution within the province • Improve the percentage of facilities that have conducted self-assessments
Strategic Goal 1: Provision of Strategic Leadership and creation of a social compact for effective health service delivery
Strategic Goal 2: Improved quality management and patient care across the system
Situation analysis District Health Services continue to deliver a full package of Primary Health Care (PHC) services, where the majority of community health centres and district hospitals are unable to match up to the level of their counterparts in many provinces as they deliver a small package of services. While upward referrals are almost the norm, this is not necessarily a solution to the problem as road transportation is expensive, while it is invariably more expensive to provide a low-level service at a higher level in the pyramid. In a continued effort to address this challenge, the Chief Directorate presented a bid at the Departmental Budget Lekgotla held in November 2014, as well as its plans for a staggered intervention of operationalizing some of these facilities over the next 3 years.
The plan of District Health is to operationalize six (6) Community Health Centres for a 24 hour service and four (4) District Hospital theatres in the new financial year, while continuing with cost-containment measures in an effort to stay within budget.
Supervision is an essential part of ensuring quality of care and there has been an improvement from 42.1% in 2013/14, to 61.3% in 2014/15. The utilisation rate of our facilities is 2.8 visits for 2014/15, which indicates decrease of 0.1 visits from previous financial year. This might be as a result of new strategy for central chronic drug dispensing and distribution is working, whereby stable chronic patients receive a supply of three to six months’ drugs supply in order to not necessarily have to frequent the clinic merely to collect their treatment. This strategy is being rolled out with good results in the National Health Insurance (NHI) Pilot district, Pixley Ka Seme.
Achievements
• Appointment of six (6) doctors for Prof ZK Matthews Hospital in Frances Baard has made it possible for this hospital to operationalize its theatre; • The appointment and coverage of District Clinical Specialist Teams members in the districts has increased to 57.1%; • Electronic Patient File system piloted and implemented in Britstown has contributed to the enhancement of the PHC Re-engineering strategy; • Two (2) Professional Nurses and one (1) Dentist have been appointed for Integrated School Health Programme (ISHP) in Pixley Ka Seme, whilst one (1) Professional Nurse has been appointed for the Zwelentlanga Fatman Mgcawu district; • Postmasburg Clinic was constructed with medical and office equipment handed over by the KUMBA Iron Ore Mine in ZF Mgcawu district; • Partnership with AURUM Institute led to the appointment of forty nine (49) Nurses on contract, paid by AURUM in two (2) districts. This alleviated the gross shortage of Professional Nurses and District Health Services has subsequently begun with the process of the absorption of these nurses; • Frances Baard district is at an advanced stage in preparation for the introduction of flexi hours for Betty Gaetsewe PHC in an attempt to make healthcare services accessible in line with the recommendations of Operation Phakisa; • Namakwa district appointed a Monitoring and Evaluation manager resulted in the improvement in information management; • Pixley ka Seme, Frances Baard and Z.F Mgcawu districts managed to roll out the Workload Indicators of Staffing Need (WISN) tool for their facilities thus managing to provide a Human Resource profile for the districts.
38 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Challenges and measures planned to overcome them
Challenges and concerns Proposed corrective action • No-adherence to the District Health Management • Enforce adherence to District Health Management Information System Policy Information System (DHMIS) Policy and Standard Operating Procedures through mentoring and coaching of managers including health area managers. • Delays in the payment of suppliers as a result of poor • Creditor’s reconciliation should be done on a monthly basis reconciliation of invoices leading to accruals. and pay suppliers according to age analysis. • Poor maintenance of infrastructure in facilities. • Allocation of dedicated facility maintenance budget and strengthening of oversight for technical support by infrastructure unit. • Inability to recruit skilled personnel into the districts • Rationalised and reprioritized planning and budgeting for for a myriad of reasons including rural nature of the vacant and critical posts and enhance recruitment to retain province. and attract professionals • Slow establishment of the Ward Based Primary • Strengthening of Regional Training Centre and utilization of Health Care Outreach Teams in the districts due available National funds for outsourcing Community Health to the inadequate capacity of Regional Training Workers training through the Further Education and Training Centre colleges.
39 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 7: Annual targets for District Health
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Ensure accessible PHC Utilisation rate 2.9 visits 3.5 visits 2.8 visits -0.7 visit • The operational hours of clinics and Community Health and efficient PHC Centres limit the utilisation in that the clinic operational hours services are until 16h00. • CHCs instead of a 24 hour service they are rendering or are limited to 8- 12 hours due staff shortages. The department is currently looking at introducing the flexi hours for clinics. OHH registration visit rate - 60% 31.3% -28.7% • Most Ward Based Outreach Teams (WBOT) in districts are not functional due to the absence of Outreach Team Leaders which are supposed to be Professional Nurses. PHC supervisor visit rate (fixed 42.1% 80% 61.3% -18.7% • Health Area Managers take dual responsibilities in instances clinic/ CHC/CDC) where there are no coordinators; a budget is set aside to appoint programme coordinators. Complaints Resolution within 25 53.3% 60% 100% +40% • Exceeded our target due to the fact that the Quality working days rate (363/681) Assurance coordinators have been appointed in all districts. Expenditure per PHC visit. R185.84 R136.56 R197.87 -R61.31 • The budget has been overspent due to the accruals, accounting systems to be strengthened to monitor budget and expenditure on monthly basis. Improve quality of Compliance rate of PHC of - 21% 15% -6% • Involvement of all stakeholders in all the districts. Health services National Core Standards (35/163) Provincial PHC expenditure per R650 R565.60 R646.63 -R81.03 • The budget has been overspent due to the accruals, but uninsured person. accounting systems to be strengthened to monitor budget and expenditure on monthly basis. Number of fully-fledge District - 1 5 teams + 4 teams • Teams have been established in all districts, however, they are Clinical specialist Teams 20/35 not complete. appointed (57.1%)
Number of fully-fledged - 30 (93) -63 • Community Health Workers still need to be trained on phases 2 Ward Based Outreach Teams and 3 for them to be appointed on PERSAL. appointed Percentage of fixed facilities - 100% 97.2% -2.8% • Some facilities were closed due to renovations (Olifantshoek) that have conducted gap and the others were facilities managed by one Professional assessments for compliance Nurse, who was off sick and one on retirement. against the National Core • Continue to strengthen assessments in the facilities. Standards Percentage of PHC facilities - 100% 47% -53% • Facilities doing the survey but not reporting. conducting patient satisfaction • Strengthen the number of facilities reporting by improving surveys (PSS) monitoring and introduce an electronic tool. PHC Patient - 80% 79% -1% • The performance is within range. satisfaction rate
40 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 8: Annual targets for District Hospitals
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Improve quality of Average length of stay. 3.2 days 3.5 days 3.5 days - - Health Services Inpatient Bed utilisation rate. 64% 70% 62% -8% • Three out of eleven (3/11) hospitals’ theatres are not functional due to shortage of doctors and skilled professionals Expenditure per patient day R 2 553 R1 630.60 R2 054.17 -R423.57 • The budget has been overspent due to equivalent (PDE). the accruals, but accounting systems to be strengthened to monitor budget and expenditure on monthly basis. Complaints Resolution resolved 63% 60% 93.% +33% • The system for complaints management has within 25 days rate been revised, and the protocol finalised. Mental Health admission - 0.5% 0.7% -0.2% • This reflects that there are more mental health patients admitted at district hospitals. Percentage of Hospitals that have - 100% 100% - • Continue to strengthen assessments in the conducted gap-assessments for (11 District facilities compliance against the National Hospitals) Core Standards Proportion of hospitals assessed as - 9% (1/11) 9% (1/11) - • Prieska Hospital is the only one that is compliant compliant with the Extreme Measures but the biggest challenge is the infrastructure. of National Core Standards Patient Satisfaction rate 80.3% 80% 78% -2% • Continue to strengthen assessments in the hospitals
41 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: HIV/AIDS, STI and TB (HAST)
Priorities • Address social and structural barriers to HIV, STI and TB prevention, care and impact • Prevent new HIV, STI and TB infections • Sustain health and wellness • Increase protection of human rights and improve access to justice
Strategic Goal 3: Improved health outcomes in managing both communicable and non-communicable diseases
Situation analysis
Prevention Programme
The National uptake of HIV Counselling and Testing (HCT) has dropped as compared to the past years performances and based on this low achievement, the Northern Cape Department of Health undertook a decision to re- launch the HCT revitalisation campaign. One of the key strategies was to have a political buy-in and as a result the Premier together with the members of the Legislature took a political lead to encourage the communities to know their HIV status by re-launching the HCT revitalisation campaign in Frances Baard in November 2014 and subsequent to the launch, other districts conducted successful HCT campaigns.
This has yielded a positive impact in the improvement of HCT uptake. The campaigns on HCT resulted in one hundred and ninety thousand seven hundred and seventy four (190 774) people knowing their HIV statuses in the 2014/15 financial year. The campaigns did not only form part of build-up activities to the commemoration of World Aids day on the 1st December 2014, but also continued until the end of the financial year in order to improve current poor HCT performance across the province.
ART, Care and Support
Implementation of the revised eligibility criteria for HIV Positive people including pregnant women The Minister of Health, Dr Aaron Motsoaledi announced during the Health Budget vote speech on the 23 July 2014 that as from the 1st January 2015, eligibility criteria for ART initiation will unfold as follow:
• All children >5years old, adolescents and adults with CD4 count of 500mm3 or less • All HIV positive pregnant and breastfeeding women irrespective of CD4 cell count (Option B+)
The new criteria will significantly reduce mortality, morbidity and incidence of opportunistic diseases, prevent new infections including mother to child transmission, resulting in better clinical outcomes for patients on treatment and health outcomes. A significant improvement has been observed in the ART uptake since the implementation of the revised guidelines. Two hundred and forty one (241) health care practitioners were trained and eight (8) radio slots for marketing of the revised eligibility criteria were conducted. Intensive support visits were conducted in Frances Baard and John Taolo Gaetsewe districts.
The interventions resulted in target for ART uptake being exceeded. A total of nine thousand six hundred and twenty eight (9 628) eligible HIV positive clients were started on ART with Frances Baard and John Taolo Gaetsewe districts attributing to the increase. Antiretroviral Initiation of Antenatal Care (ANC) clients increased from 89.9% in 2013/14 to 92.9% in 2014/15 with Namakwa district contributing 100% while John Taolo Gaetsewe is at 89%. This increase in ART uptake amongst pregnant women resulted in the reduction of mother to child transmission.
The programme implemented retention in care strategies such as Integrated Access to Care and Treatment (IACT) support groups, Chronic Dispensing of ARVs for stable patients, active tracing of patients who miss appointments and patient appointment system. A total of one thousand nine hundred and fifty (1950) people living with HIV were put on the Integrated Access to Care and Treatment (IACT) support groups. The programme is however, experiencing attrition of patients due to socio economic factors such as lack of income, lack of sustainable food, nutrition and housing. The programme managed to retain forty one thousand two hundred and thirty six (41 236) HIV positive clients on ART despite the abovementioned challenges.
Non-Governmental Organisations (NGO) were contracted to render TB and HIV services increased from five (5) in the last financial year to thirty (30). This expansion of services resulted in more NGOs being funded for community health services. A total of one thousand eight hundred and ninety (1890) Community Health workers are on stipend, leading to four hundred and fifty three thousand four hundred and twenty six (453 426) individuals benefitted from Home Based Community services. The increase in number of NGOs, Ward based Outreach services and intensified social mobilisation resulted in the target for Community Home based care services being exceeded.
42 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Finance
Centre for Economic Governance and AIDS in Africa (CEGAA) has been contracted through the Innovations Research on AIDS (INROADS) project, funded by USAID, to support the Department in Conditional Grant management. The first project assigned to them was to assist in modifying the current Business Plan template to become user friendly. Programme Managers were trained on the 3rd December 2015 on the revised Conditional Grant Business plan ensuring that the final 2015/’16 financial year Business Plan is compiled using the newly modified template.
Conferences
The International AIDS Conference was held in Melbourne, Australia on the 20th -25th July 2014 and eight (8) officials and one (1) civil society member of the Provincial AIDS Council attended. The Melbourne conference highlighted best practices around the world, the issue of task shifting (Nurses conducting the actual circumcision) for the programme was important to the programme performance throughout the country. Secondly, the contracting of private General Practitioners was noted as another strategy towards improving the performance.
The HIV Clinician Society Conference was held on the 24-28 September 2014 in Cape Town with nine (9) officials from the Province, Districts and Kimberley Hospital Complex attended. The highlights of the conference were Retention in Care/Adherence Strategies, Adolescent ART clinics, Paediatric ART Care, Prevention of Mother to Child Transmission (PMTCT) B Plus. The lessons learned from this conference resulted in change in the ART access programme for HIV positive pregnant women and all HIV positive patients with CD4 500 and less. An Adolescent and Youth Friendly clinic was also subsequently established at Galeshewe Day Hospital in the Frances Baard district. Adherence strategies were developed and implemented in all facilities which resulted in more than 90% of patients on ART retained in care.
In 2014, Hospice Palliative Care Association (HPCA) Conference was held aimed at affording different key stakeholders with an opportunity to show case or share best practices and innovative ways, networking with partners and funders. The message was to receive encouragement and inspirations from local and international colleagues. This Annual Conference was based on the conscientizing theme “Who Cares? Improve patient outcome”. The conference draws from wide key objectives of Care and Support to Improved Patient Outcomes (CaSIPO) project that include Policies, Capacity building, Improved retention and referral systems and Tuberculosis. Four (4) delegates from the Province attended the 45th Union World Conference on Lung Health that was held from 28th October to 01st November 2014 in Barcelona, Spain. The Minister of Health Dr Aaron Motsoaledi announced the UNAIDS 2020 90-90-90 targets for HIV and Tuberculosis. Best practices in terms of TB and diabetes, TB and Pregnancy and TB and Mental Health were highlighted. The highlight of the conference was the introduction of Bedqualine as part of the XDR TB treatment. The conference once again highlighted the need for Youth Friendly facilities at clinics.
Awareness Campaigns
Sexually Transmitted Infection and Condom Awareness Campaign
The Sexual and Reproductive Health, STI and Condom awareness month is observed on an annual basis and the activities are culminated by the event whereby the MEC for Health addresses the communities on the importance of using protection, reducing number of STIs, Pregnancies and the promotion of Circumcision among the sexually active populations. The Provincial STI Condom awareness event was held under the theme: “My responsibility, My choice, Our future…..I choose dual protection” in March 2015, at Hopetown.
An estimated five thousand (5000) people attended the event with different key stakeholders, partners were invited to render health care services on site. There were various health services such as dental health service, HIV testing, Condom distribution, Family planning, TB screening, Eye care and people were referred to the facilities where necessary.
A successful Provincial World AIDS Day 2014 was celebrated at Batlharos Stadium, in the John Taolo Gaetsewe District and provided an opportunity to raise awareness of the global AIDS epidemic, to empower and support the millions that are living with HIV and AIDS and to remember those whose who have died. The 2014 theme focused on “Zero Stigma and Discrimination”, without losing sight of the other ‘zeroes’: zero new HIV infections and zero AIDS related deaths.
Five (5) community awareness campaigns were conducted in John Taolo Gaetsewe and ZF Mgcawu districts (dialogues for school going kids and three (3) for Frances Baard, dialogue for school going kids, youth during youth month and tertiary students for Kimberley Further Education Training and Sol Plaatje University. An estimate of nine thousand (9000) youth was reached through these dialogues.
43 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Provincial STI Seminar
A Provincial HIV & AIDS and STI Prevention Seminar was held on the 30-31st March 2015 in Kimberley with the aim of strengthening prevention and management strategies against HIV & AIDS and sexually transmitted infections in the Northern Cape. The seminar was driven under the theme “Working Together Towards Understanding and Addressing STIs”. The Objectives were:
• To understand the national and provincial burden of STIs; • To identify ways of improving STI surveillance in the public health sector; • Mapping and strategies for key populations; • Human papilloma virus and Cancer of the cervix, • Preparing for the emergence of Multi-Drug Resistant (MDR) and Extreme Drug Resistant (XDR) gonorrhoea in South Africa, identify areas on interaction and implement action plans and other matters relating to prevention strategies.
Attendees included academic institutions, programme managers (province and district), 3rd year nursing students, Doctors and nurses, Non-Government Organisation, NDOH, and the National Institute for Communicable Diseases (NICD). This was successfully held in partnership with Anova Health, Centre for Communication Impact in South Africa (CCISA), Itech SA and the University of the Free State. The expectation of the seminar will yield positive results in terms of the improved Sexual Transmitted Infections Management and Treatment outcomes, improvement in the implementation of STI Syndromic Management and finally the attainment of high STIs cure rates.
Achievement
• Developed and implemented Standard Operating Procedures for Retention in Care of patients on ART, in addition pillboxes procured and distributed to districts to improve treatment adherence. The implementation of the strategies resulted in more than forty thousand (40 000) patients on ART being put on treatment. Central Chronic Medicine Dispensing and Distribution programme is implemented at all health facilities in the province. The aim is to reduce long waiting times for ART and chronic medicine, increase access to ART and chronic treatment and reduce congestion at health facilities. There are currently six hundred and seventy two (672) patients on ART and one thousand one hundred and twenty six (1126) chronic patients on the Centralised Chronic Medicine Distribution and Dispensing programme. • Clinical equipment and fridges for cold chain for vaccines procured and distributed to facilities in the districts. • Sixteen (16) PIMA CD4 testing Point of Care machines procured for CD4 testing on site to accelerate ART uptake. The Chief Directorate continued with integrated support visits to health facilities in Frances Baard, Namakwa and John Taolo Gaetsewe districts. Health systems related challenges were noted throughout the districts. Detailed quality improvement plans were developed and are being monitored. • Infrastructure improvement for the provision of HIV Counselling and Testing in facilities through SA/German Collaboration Project. The second phase of the project will result in HIV Counselling and Testing services being extended to the private health sector starting in the new financial year. • Appointed a Provincial HCT Coordinator and four (4) District Prevention Strategies Clinical Programme Coordinators: HIV, STI, Medical Male Circumcision and Condom Coordinators. • Development of MMC plans for all districts and increased demand and supply for the Programme. • Vehicles to the amount of R2, 2 million have been procured from the Conditional Grant budget for pharmaceutical services as one of the strategies to address drug shortages at facilities. • HIV Counselling and Testing have been achieved by 86% due to the implementation of the HCT acceleration plan. • The Department of Health in partnership with I-Tech SA implemented the Condom Mapping Pilot Project in John Taolo Gaetsewe district in March 2015. • The Northern Cape Department of Health is the only province that managed to complete the National High Transmission Area mapping project. • A successful STI seminar was held in the Province on the 30-31 March 2015 with about one hundred and thirty (130) participants. • Technical Vocational Education and Training (TVET) Wellness days held with Institutions of Higher Education.
44 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Low Fixed Dose Combination (FDC) uptake and • Fast-track appointment of Clinical Mentors. switching of patients due to lack of clinical mentor- ship • Defaulting of patients already on ART treatment in- • Strengthen adherence counselling through training and cluding paediatric patients support groups. • Strengthen linkage to care for children on ART and improve recording and reporting of children referred or transferred. • Integrate paediatric ART to Integrated Management of Childhood Illnesses programme. • Implement Adolescent and Youth friendly services at designated facilities. • Mixed feeding amongst mothers who are on Preven- • Intensify awareness to community to about importance of tion of Mother to Child Transmission programme still exclusive breastfeeding. remains a challenge and contributes towards mother to child transmission • Lost to follow up of babies at 18 months for HIV re- • Encourage mothers to bring babies at 18 months for testing testing and align with Expanded Programme on Immunisation and Integrated Management of Childhood Illnesses program. • Low HIV Counselling Testing uptake in the province • Revive finger pricking training and refresher course for Lay Counsellors. • Conduct HCT revitalisation campaigns in all settings including partnering with mines and private general practitioners • Strengthen and mobilise HCT messages to the communities including Key populations. • Phase 2 of Developmental Bank of South Africa (DBSA) project initiated through HST (Health Systems Trust) to promote HCT in the private sector and private practitioners. • Lack of Counselling Space in facilities • Phase 1 of Developmental Bank of South Africa (DBSA) project initiated in 2014 for the refurbishment of facilities. A total of thirty (30) facilities have been prioritised. • Lack of “victim friendly” areas in public health facili- • Hospital Managers to dedicate consultation and ties for sexual assault cases counselling areas within their facilities in order to be “victim- friendly”. • Reporting of adverse drug events from facilities • NDOH to conduct training on the revised reporting tools and assist province to form pharmacovigilance clusters in districts. • STI Clinical sentinel surveillance sites not reporting on • Conduct in-service training to facility managers from STI the STI Sentinel data as required resulting in under sentinel sites, their data capturers, district coordinators and estimation of STI prevalence in the Province M&E officers. • Provincial Aids Council (PAC) to establish nerve cen- • Establish a forum for key population. tre to collate data from non-medical sites and private • Approach Provincial Council to establish central nerve institutions centre, provincial and at districts.
45 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 9: Annual targets for HIV & AIDS, STI
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Prevent new HIV,STI Total clients remaining on 39158 44 959 43022 - 1937 • Poor implementation of adherence strategies at facilities (e.g. poor and TB infections ART (TROA) at the end of the tracing of defaulters due to lack of tracer teams in some districts month and inadequate coordination by NGOs) leading to loss to follow- up of patients. • Strengthen Adherence strategies through training and technical support from CaSIPO. • Implement KIDZ ALIVE Programme to improve retention in Care for Children. • Embark on benchmark visit to Western Cape for best practices on Retention in Care. • Improve reporting rate of health facilities. • Strengthen Collaboration with external stakeholders to address socio economic conditions that hampers treatment adherence e.g. Departments of Social Development, Agriculture, Labour and Education. Number of medical male - 32 615 9 944 - 22 671 • Shortages of doctors impacting on institutionalization of MMC circumcision performed services into public hospitals. This is also coupled by uptake of MMC amongst certain community groups due to lack of awareness programs. • Increase the pool of private General Practitioners to assist with MMC in all districts. • Developing an MMC Model that will assist in the uptake of the programme. • Seek assistance from Clinton Health Access Initiative (CHAI) for appointment of contract personnel at the district. Sustain health, HIV testing coverage (15-49 20.3% 49.5% 25.8% -23.7% • Poor implementation of HCT revitalization campaigns in districts wellness and years) due to lack of district prevention coordinators. productive life • Strengthen HIV/AIDS Counselling and Testing acceleration plan. • Improve behaviour by changing communication strategies. • Fast track recruitment process for Prevention Strategies Coordinators for Namakwa and Zwelentlanga Fatman Mgcawu districts. • Partnership with other stakeholders e.g. Mines, Department of Correctional Services, private doctors, etc. Proportion of eligible sexual 90% 95% 86.5% -8.5% • Under-performance due to patients presenting late (after 72 hours) assault cases receiving PEP at health facilities. Reporting of Post Exposure Prophylaxis (PEP) within 72 hours indicators not implemented fully at facility level resulting. • Conduct awareness campaigns and health educations on Post Exposure Prophylaxis services. • Strengthen reporting of PEP data into District Health Information System by providing training on the completion of the National Indicator Data Set in order to ensure that the proportion of eligible sexual assault patients is equal to the number of new cases reported. 46 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Sustain health, well- Proportion of HIV tested peo- 7.3% 8% 6.5% -1.5% • Positive deviation as less people targeted were diagnosed with HIV ness and productive ple who are HIV positive due to existing preventative strategies. life • Continue to sustain advocacy plans to encourage clients to test regularly for HIV • Strengthen couple counselling and behaviour change strategies Percentage of HIV positive 91.9% 85% 90.2% +5.2% • Positive deviation as more HIV positive pregnant women were ANC clients initiated on ART initiated on ART due to effective implementation of PMTCT program and change in guidelines which requires all antenatal HIV positive clients to be initiated on treatment irrespective of CD4 count. • Continuous training on revised Prevention of Mother to Child Transmission guideline and data elements HIV Entry Point: Incidence of 8.8% 13% 12.8% -0.2% • Positive deviation which indicates a slight decline of TB amongst TB among HIV positive clients HIV patients • Strengthen TB screening through training and recording and reporting in order to sustain this positive outputs HIV Entry Point: Percentage 91.9% 80% 76.8% -3.2% • Strengthen Isoniazid Preventative Therapy (IPT) initiation through of HIV positive clients on IPT training and intensify support to underperforming facilities. Training on revised guidelines to be conducted in new financial year STI incidence rate (%). 2.3 1.6 2.1 -0.5 • Under – performance due to inadequate prevention programmes for key populations e.g. sex workers, Men having sex with men (MSM), etc. • Strengthen STI control and Condom distribution plans • Intensify STI screening campaigns among key populations in the province • Facilitate trainings of clinicians on the new STI guidelines • Strengthen implementation of Prevention Strategy particularly amongst key population Sustain health and Number of adults and chil- 9469 8 772 9854 +1082 • Positive deviation/achievement due to implementation of ART at wellness dren started on ART-new CD4500 and less. • Improve performance through aggressive marketing of eligibility criteria trough media, radio, posters, pamphlets and billboards. Active tracing of HIV positive clients who are eligible for ART treatment • Fast track Human Resource processes for appointment of clinical mentors, HIV Clinical coordinators in Namakwa and ZF Mgcawu district.
47 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: Tuberculosis (TB)
Priorities:
• Address social and structural barriers to HIV, STI and TB prevention, care and impact • Prevention of new HIV,STI’s and TB infections • Sustain Health and Wellness • Increase protection of human rights and improve access to justice
Situation analysis
TB Infection Control
Infection Control is an important aspect within the Control and Management of TB as it seeks to reduce the risk of transmitting the disease even amongst Health Care Workers. Infection Control in inpatient care settings is a challenge, as the clinical management of TB patients requires that strict infection control precautions be adhered to in order to minimise the risk of transmission. Technical support was sought from the Council for Scientific Industrial Research (CSIR) to assist with Infection Control Risk Assessment at the Kimberley Hospital Complex as a starting point with intention to be rolled out to other District hospitals.
TB Case finding
Intensified Case Finding (ICF) campaigns is one of the key strategies in improving TB Case Detection in realising targets as set out in the joint TB/HIV strategic plan (2012-2016) to fight the scourge of TB/HIV and create community awareness.
Table 1: Total TB cases and new smear positive diagnosed 2012 –2014
Northern Cape 2012 2013 2014 All TB cases New sm+ve All TB New sme+ve All TB New sm+ve cases cases cases cases cases Frances Baard 2510 1001 2223 1286 2268 520 ZF Mgcawu 2199 723 2173 588 2099 485 Pixley Ka Seme 1871 713 1327 981 1988 1003 John Taolo Gaetsewe 1539 854 1275 764 1488 740 Namakwa 632 333 670 496 677 263 Northern Cape 8751 3624 (41%) 7668 4115 (53.7%) 8520 3111(37.6%)
In the last three years the total number of people diagnosed with TB remained stable throughout all districts. Even so with the marked stabilisation of TB cases across districts, new infections also seem to be stabilising as evident in the table above at 37.6% of total TB cases (2014). While a marked reduction in TB cases is observed, poor socio economic conditions e.g. overcrowding, unemployment continue to pose infection control risks as the poor living conditions predisposes these families to the disease.
The 4th South African TB Conference took place in Durban, South Africa from the 10th -13th June 2014. Thirty (30) participants from the Northern Cape Department of Health attended. The purpose of the 4th National TB Conference was to create a platform where the world of TB and HIV with its accompanying threats and opportunities can be debated and resolved as well as the tabling of progress reports to ensure better outcomes as per strategic frameworks provided in the global fight against TB and HIV.
The conference aimed to address the following areas:
• Track progress achieved in South Africa on reaching the Millennium Development Goals 1990-2015 • Management of Tuberculosis post 2015 in new era of health development • Review the progress National TB Control Programme made in reaching the National Strategic Plan 2012-16 target on Tuberculosis • Share experiences on the improvement of retention in care among Drug Resistant TB patients • New TB diagnostics and treatment advances available in testing • Role of Civil Society in the fight against TB
48 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
World TB Day Commemoration
Tuberculosis epidemic within the Northern Cape contributes to the third TB highest incidence in South Africa. The multi- sectoral approach is one of the key strategies in the Northern Cape Provincial Strategic Plan (PSP) for HIV and AIDS, STI’s and TB (2012- 2016). This plan represents a framework of strategic actions that must be undertaken by the province in order to address the growing HIV and AIDS, STI’s and TB epidemic. One of the goals of the Provincial Strategic Plan is to reduce new infections of HIV and TB by 50% by 2016.
The 2015 World TB Day commemoration was held at De Aar in the Pixley ka Seme district. Key note address was delivered by MEC for Health Mr M Jack and distributed food parcels to one hundred and fifty (150) identified TB patients. Intensified Case Finding (ICF) Campaign was one of the activities in addressing contact tracing for newly diagnosed TB cases (Index Cases) and fast-track for treatment in an effort to reduce the spread of TB and create TB awareness in the community.
Partnership with the Mines
The strategy to intensify TB case finding and management partnership with the Mines is being strengthened for the provision of TB, HIV and STI services. The partnership has grown to include a total of nine (9) Mines of which six (6) already have signed Memoranda of Understanding. The process is underway for the remaining Mines to sign the Memorandum of Understanding. To date two mines viz Khumani and Afrisam have already started rendering TB, HIV and STI services. A cumulative total of one thousand seven hundred (1700) miners have benefitted from the partnership. Monthly meetings are conducted to assess progress and support mines in this initiative. Preparations are underway to get Blackrock and Beeskoek Mines to start service rendition on the 1st June 2015.
TB Control Program Management and Performance Review
The TB Control Programme utilises Electronic TB Register (ETR) system for Monitoring and Evaluation, was successfully migrated to ETR version 2 which is more efficient for Monitoring and Evaluation purposes. This system was successfully implemented in all five districts. All the districts conducted data review sessions which aim to assess and monitor program performance, and finally develop implementable performance improvement plans.
Drug Resistant TB Drugs
Two Drug Resistant TB Drugs viz: Bedaquiline and Linezolid have been registered for utilisation in the country for eligible patients. Procurement processes have been concluded by the provincial pharmaceutical depot. This will have a positive impact on case management and improving the outcomes due to the documented efficacy of these drugs. To date a total of six (6) patients have been commenced on these drugs post registration. The patients are on strict clinical monitoring, the provincial plan is to scale up the use of these drugs and have projected to start a total of one hundred and twenty six (126) patients in the financial year 2015/2016.
Achievements
• Positive improvements have been made in the management of Drug Resistant TB, Two Drug Resistant TB Drugs viz: Bedaquiline and Linezolid have been registered for utilisation in the country on eligible patients, procurement processes have been concluded by the provincial pharmaceutical depot. • Appointment of Programme Manager for TB Control • An Assistant Director was assigned to coordinate and manage the Drug Resistant TB program and two doctors to support patient care at the two districts namely Pixley ka Seme and John Taolo Gaetsewe districts by initiating Drug Resistant TB treatment and conducting Outpatient services for follow up patients. • The Service Delivery Improvement Plan (SDIP) for 2015-2018 was drafted and submitted to the MEC for approval. • The province hosted the TB/HIV directorates from National Department of Health and conducted joint support visit in January 2015 in the John Taolo Gaetsewe district. The visit included all provincial partners operational in different districts. The aim of the visit was to support the district as it was identified as the worst performing district in the province based on the data analysis. • Strengthened stakeholder involvement through Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO) in supporting provinces by appointing trained Nurse Practitioners to support and mentor professional nurses at Primary health care to initiate Drug Resistant TB treatment.
49 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Vacancies impedes on adequate supervisory support to the district which is key to identify and • Fast track appointment of staff both in the district and provincial office in the challenges and plan interventions to overcome those. new financial year 2015/2016. • Absence of TB focal persons leads to the poor performance of the TB program in hospitals and • Plans to appoint focal people in the 2015/2016 financial year in a phased in some PHC facilities. approach. • Difficulty in tracing defaulters. • Intensify health promotion to track defaulters and strengthen intergation of tracer team into PHC.
Table 10: Annual targets for Tuberculosis (TB) Strategic Objective Performance Actual Target Actual Deviation Comments on deviations Indicator 2013/14 2014/15 2014/15 To achieve an 85% TB TB (new pulmonary) 7% 5% 8% -3% • Lack of TB defaulter tracing teams cure rate defaulter rate • Poor socio- economic conditions (e.g. excessive alcohol intake, unemployment, etc.) having a negative impact on treatment adherence • Fast tracking the recruitment of retired nurses for appointments at districts • Integration of TB into HIV’s I-ACT support group to strengthen adherence by enrolling TB patients to minimise defaulting • Patient education and continuous counselling to be scaled up in facilities to ensure that patients take responsibility for their health and treatment. TB new client treatment 80% 90% 76.7% -13.3% • Low treatment success rate as a result of high defaulter rate and poor success rate treatment adherence amongst patients • Strengthen adherence counselling and patient education upon treatment initiation and continuously throughout the duration of treatment. • Health Area Managers to support the program implementation at facility level. TB AFB sputum result turn- 57.4% 68% 60% -8% • Challenges still experienced with National Health Laboratory Services around time under 48 sputum collection and SMS printers in some areas/facilities hours rate • Facilities to be supported in developing a system to manage labora- tory results. • Improve the communication with National Health Laboratory Services and have regular meetings with laboratory to address issues as they arise
50 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Actual Target Actual Deviation Comments on deviations Indicator 2013/14 2014/15 2014/15 To achieve an 85% TB PTB two-month smear 74.4% 85% 62.8% -22.2% • TB Diary system to record the date of next sputa collection is poorly cure rate conversion rate utilised, • In service training to be conducted by district and provincial coordinators on the poor recording of the next sputa date to both facility managers (for enforcing) and data capturers (to assist in tracking patients due for follow up sputa TB (new pulmonary) cure 70% 80% 67.9% -12.1% • Lack of TB defaulter tracing teams. rate • Poor socio – economic conditions (e.g. excessive alcohol intake, unemployment, etc.) having a negative impact on treatment adherence. • High default rate and poor treatment adherence. • Strengthen provincial support visits to the districts to ensure adequate supervisory support to facilities. • Strengthen adherence counselling and patient education upon treatment initiation. • Fast track appointment of tracer team in the districts and strengthen the existing teams. • District Health Services to strengthen integration of the tracer teams to the Primary Health Care Re - engineering teams to improve on outcomes. Treatment success rate 80% 90% 76.7% -13.3% • Strengthen adherence counselling and patient education upon treatment initiation and throughout the treatment duration. • Conduct in service training on recording and reporting for all facility staff prioritising data capturers and facility managers. To achieve a 5% XDR- Proportion of XDR-TB 100% 100% 90% -10% • Patient lost to follow-up prior to treatment initiation. Lack of TB cure rate by 2019 patients started on treat- dedicated doctors for multi-drug TB programme, resulting in delayed ment treatment initiation. • Strengthen the support to Drug Resistant TB sites. • Appoint Doctors at John Taolo Gaetsewe and Pixley ka Seme districts in the 2015/2016 financial year. • Scale up training of nurses in the treatment initiation of Drug Resistant TB. Proportion of HIV+XDR TB 100% 100% 100% - • Sustain current interventions that yield positive outputs, e.g. patients started on ART (a). Strengthen the linkage established between Drug Resistant TB manager and the sites for continuous program monitoring and management (b). Monthly support visit to the Drug Resistant TB sites to be strengthened. • Drug Resistant TB doctors to validate report prior to submission to ensure that all patients managed can be accounted for.
51 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Actual Target Actual Deviation Comments on deviations Indicator 2013/14 2014/15 2014/15 To achieve a 30% Proportion of HIV+ MDR- 94% 100% 91% -9% • Some eligible patients were not initiated due to ART Guidelines MDR-TB cure rate by TB patients started on requirements that patients with low CD4 count require more than two 2019 ART weeks of MDR - TB treatment before ART can be initiated. • Lack of dedicated doctors for multi-drug TB programme • Patient lost to follow-up prior to ART treatment initiation. • Strengthen the linkage established between Drug Resistant TB manager and the sites for continuous programme monitoring. • Monthly support visit to the Drug Resistant TB sites to be strengthened. • Drug Resistant TB doctors to validate report prior to submission to ensure that all patients managed can be accounted. TB MDR confirmed treat- - 100% 92.8% -7.2% • Patient lost to follow up before treatment was commenced. ment initiation rate • Active surveillance to be conducted by provincial TB M&E unit by following up with the DR TB sites using National Health Laboratory Services reports for all diagnosed Drug Resistant TB patients.
52 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: Mother to Child Woman’s Health & Nutrition (MCWH&N)
Priorities:
• Reduce maternal, infant and child mortality and morbidity • Strengthen access to comprehensive sexual and reproductive health services • Promote early ANC attendance i.e. before 13 weeks and regular follow up visits • Promote exclusive breast feeding for at least 6 months and children to be breastfeed for 2 years • Promote Kangaroo mother care for low birth weight babies • Improve access to HIV treatment for both mothers and children • Train health care workers on the Essential Steps in the Management of Obstetric Emergencies (ESMOE) and Help Babies Breath (HBB) • Implement Integrated School Health Programme in Quintile 1 and Quintile 2 schools
Strategic Goal 3: Improved Health Outcomes in Managing both Communicable and Non-Communicable Diseases
Situation analysis
The maternal mortality ratio has reduced from 127/100 000 in 2013/14 to 126/100 000 in 2014/15. The following highlights maternal deaths and live births in the facilities.
• Total number of maternal deaths for 2014/15 in public facilities: 30 • Total number of live births for 2014/15 in public facilities: 23 784
This is attributed to provincial support visits in the districts, Essential Steps in Management of Obstetric Emergencies (ESMOE) training of Health Care Practitioners, monitoring and mentoring by District Clinical Specialist Teams (DCSTs), and regular peri-natal mortality meetings.
The Ante Natal coverage before 20 weeks has increased from 54% to 57.6% at the end of the financial year, even though the target of 60% could not be reached. The Couple Year Protection Rate target has been reached with a noted increase from 32.7% in 2013/14 to 45.2% in 2014/15. Training of Health Care Practitioners on the insertion of the sub-dermal implants and the intrauterine device has been supported by John Hopkins Program for International Health, Education in Gynaecology and Obstetrics (JHPIEGO SA).
There is a need to intensify the integration of Cervical Cancer screening into Primary Health Care package. The Prevention of Mother to Child Transmission (PMTCT) programme has shown a noted decline in the Mother to Child Transmission rate from 3% in 2013/14 to 2.1% in 2014/15, this is ascribed to the revised guidelines implemented in January 2015 with continuous training and supervision. The Under 18 year delivery rate has decreased from 10.8% to 9.6%. Even though the target of 8.5% was not achieved, an effort to intensify the Adolescent and Youth Friendly Strategies through training personnel and accreditation of facilities will be embarked on.
There is an increase in Infant and child under 5 year’s mortality rates compared to the previous years. Malnutrition and diarrhoea still remain a major causes of morbidity and mortality amongst this age group. The underweight for age under 2 years are much higher than the target although this is not a true reflection of the indicator. The target is currently expressed as percentage although the District Health Information System (DHIS) expresses it as a rate per 1000 polpulation. The coverage of Vitamin A and deworming has increased due to outreach visits to Early Childhood Development (ECD) centres to screen children and the provision of nutritional education to practitioners in order to prevent and treat malnutrition timeously.
The Immunization coverage has decreased due to shortage of mobile services and facilities not doing outreach programmes. An effort to fully involve Ward Based Outreach Teams (WBOT) will be utilised to trace defaulters and to audit the Road to Health booklets. A Measles Outbreak in ZF Mgcawu district with thirty one (31) confirmed cases was reported from September 2014 to January 2015. A Measles catch-up drive was conducted to combat the outbreak. No mortalities were encountered during the outbreak. The Under-five (5) pneumonia case fatality rate target has been achieved with the diarrhoea case fatality rate also decreasing, although the target has not been reached. This can be attributed to the continuous training of health care workers and optimal management of children at facility level.
The Integrated School Health program is only being implemented in three (3) out of the five (5) districts namely; Frances Baard, Pixley ka Seme and John Taolo Gaetsewe. The target could not be reached due to insufficient Integrated School Health Programme teams allocated in the implementing districts, with two non-implementing districts having no Integrated School Health Programme teams appointed.
53 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
The Human Papilloma Virus vaccine campaign launched in 2014 is protecting women against cervical cancer and all Grade 4 girls aged between 9 and 12 years old, will receive two sets of vaccines in 6 months apart to protect them against this virus.
1st round • Schools coverage i.e. Percentage of schools visited: 97% • Grade 4 girls coverage i.e. percentage of girls immunized: 88% 2nd round • Schools coverage i.e. percentage of schools visited: 86% • Grade 4 girls coverage i.e. percentage of girls immunized: 87%
Achievements
• Human Milk Bank was established in Dr. Harry Surtie Hospital: ◦ Mother Baby Friendly Initiative facilities that were accredited: Bill Pickard (Prieska) and Dr. Harry Surtie Hospital (Upington) • Awareness campaigns during Pregnancy Awareness week in the Pixley ka Seme district: ◦ Six (6) Community dialogues ◦ One hundred and fifty (150) house door to door campaigns ◦ Nine (9) Radio slots • Four (4) Provincial MCYWH & N unit quarterly reviews were conducted, with the districts to monitor program implementation • Mother Postnatal visit within six days rate above the target. • Mother Child Youth Woman’s Health & Nutrition conducted training for health care workers in all disciplines.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action Lack of adherence to Mother Child Youth Woman Health & • Continuous onsite training on guidelines and Nutrition guidelines and protocols protocols. • Generic protocols to be distributed to all facilities. • Support, monitoring and continuous in-service training to be conducted in all districts. Inaccurate reporting of data • Conduct in-service training for all health care workers on Mother Child Youth Woman’s Health & Nutrition indicators and data elements at facility level.
Shortage of personnel and prolonged recruitment processes • Expedite recruitment and appointment processes.
Poor access to delivery facilities and insufficient emergency • Provide 24 hour services at all Community Health transport for pregnant women Centre and improve inter-facility transport. • Establish maternity waiting homes.
54 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 11: Annual targets for MCWH&N
Strategic Objective Performance Indicator Actual Target Actual Deviations Comments on deviations 2013/14 2014/15 2014/15 Improve nutritional status of Immunisation coverage under 97% 98% 85.3% -12.7% • Follow-ups on missed opportunities are not children and mothers 1 year. conducted consistently by facilities. • Insufficient immunization catch-ups campaigns conducted at districts. • Ward Based Outreach Teams to be trained on Road to Health Cards for tracing purposes. • Lack of defaulter tracing system in place for missed opportunities. Vitamin A coverage 12 – 59 41% 40% 45.3% +5.3% • Positive deviation due to a change in guidelines with months. (OR 1-4 years) capsule being administered on a six month basis. Measles 1st dose under 1 year 92% 98% 86.4% -11.6% • Follow-ups on missed opportunities are not done coverage. consistently by facilities. • No immunization catch–ups campaigns conducted at districts. • Ward Based Outreach Teams to be trained on Road to Health Cards for tracing purposes. • Lack of defaulter tracing system in place for missed opportunities. Pneumococcal Vaccine 90% 95% 87.6% -7.4% • Follow-ups on missed opportunities are not done (PCV) 3rd Dose Coverage. consistently by facilities. • No immunization catch-ups campaigns conducted at districts. • Ward Based Outreach Teams to be trained on Road to Health Cards for tracing purposes. • Lack of defaulter tracing system in place for missed opportunities. Rota Virus (RV) 2nd Dose 96% 95% 91.5% -3.5% • Ward Based Outreach Teams to be trained on Road Coverage. to Health Cards for tracing purposes. • Lack of defaulter tracing system in place for missed opportunities. Cervical cancer screening 34% 50% 30% -20% • Cervical Cancer screening coverage is not well coverage. integrated into Primary Health Care package. • Training of health care workers on cervical cancer screening techniques at PHC level. • Conduct awareness campaigns to address low uptake rate amongst targeted women. Infant 1st PCR test positive 3% 2.5% 2.1% +0.4% • Positive deviation due to revised guidelines. around six weeks rate Deworming 12-59 months - 30% 39.3% +9.3% • The syrup was administered by Dieticians at Early coverage Childhood Centres.
55 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Indicator Actual Target Actual Deviations Comments on deviations 2013/14 2014/15 2014/15 Improve nutritional status of Child under 2 years under- - 10% 50.7/1000 -40.7/1000 • DHIS Calculates the indicator as a rate per 1000 whilst children and mothers weight for age incidence in the APP the indicator is measured as a percentage hence the difficulty to measure the performance. The calculation to be rectified in the 2015/16 Annual Performance Plan. Child under 5 years severe - 5% 10.7% -5.7% • High severe acute malnutrition case fatality rate was acute malnutrition case fatal- influenced by poor socio-economic conditions in ity rate communities e.g. high unemployment rate, poor food security • Escalate socio-economic factors affecting health outcomes by integrating with other departments (i.e. social development), civil society Scale up coverage and im- Antenatal 1st visits before 20 54% 60% 57.6% -2.4% • Implement fully integrated health services in all facili- prove the quality of PMTCT, and weeks rate. ties to address linkages of services reduce MTCT to less than 5% • Pregnant women presenting late at facilities due to lack of education. • Conduct awareness campaigns at community level Fixed PHC facilities offering - 100% 100% - • All facilities are offering prevention of Mother to Child PMTCT Transmission Antenatal client HIV 1st test. 90% 100% 97.6% -2.4% • Some pregnant women were already on ART treat- ment and others HIV positive but not yet on ART treat- ment when present for antenatal services thus cannot be tested. • The indicator definition can be amended to exclude those who are already HIV positive so that they are not included during calculation HPV 1st dose coverage - 80% 87% +7% • Target exceeded due to good marketing strate- gies and awareness campaigns in communities and schools Infant given NVP within 72 - 95% 99.6% -4.6% • Positive deviation due to continuous training on indi- hours after birth uptake cators and data elements rate Reduce maternal mortality Facility Maternal Mortality 127/100 145/100 000 124/100 000 +21/100 000 • Positive deviation – Essential Steps in Obstetric by 2/3 (inclusive of Private ratio 000 Emergencies (ESMOE) training provided assisted in the Facilities) reduction of maternal mortality Delivery in facility under 18 10.3% 8.5% 9.6% -1.1% • Poor implementation of Adolescent and Youth years rate Friendly strategies including awareness campaigns in reproductive health • Training for health care practitioners on the Adoles- cent and Youth Friendly strategies. • Establish youth friendly centres in selected facilities Couple year protection rate 32.7% 40% 45.2% +5.2% • Positive deviation – long term contraceptive methods contributed in the increase in uptake 56 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Indicator Actual Target Actual Deviations Comments on deviations 2013/14 2014/15 2014/15 Reduce child and youth Child under 1 year mortality in 8.1/1000 7.5/1000 2.5/1000 (553) -5/1000 • Positive deviation with few children dying as a result morbidity and mortality facility rate deaths of a combination of interventions e.g. reduction in HIV transmission rate, training of health care workers, etc. Inpatient death under 5 years 5.8/1000 3.5/1000 7.5/1000 4/1000 • High HIV infections at 18 months due to poor follow- rate up of children at 18 months for HIV testing in some areas. • Strengthen care and support of babies born to HIV positive women. • Train Health Care Practitioners in Child Healthcare Problem Identification Programme and capturing. Child under 5 years diarrhoea - 2/1000 3.4/1000 -1.4/1000 • Integrated Management of Childhood Illnesses (IMCI) case fatality rate poorly implemented in facilities to address childhood illness/conditions. • Refresher course on IMCI and training of C-IMCI at community level. • Strengthen poor disease surveillance systems by advocating for community surveillance Child under 5 years pneumo- - 4.3/1000 2.9/1000 -1.4/1000 • Positive deviation due to support visits that were nia case fatality rate conducted. AFP detection rate 100% 7/100 000 17/100 000 -10/100000 • Positive deviation due to sensitization on detection and investigation of cases in facilities. School ISHP coverage - 30% 13.3% -16.7% • Only three districts have dedicated School Health personnel. Namakwa and ZF Mgcawu still to appoint personnel. Schools Grade 1 screening - 25% 7.3% -17.7% • Only three districts have dedicated School Health coverage personnel. Namakwa and ZF Mgcawu still to appoint personnel for school health programme. Schools Grade 4 screening - 20% 11.5% -8.5% • Only three districts have dedicated School Health coverage personnel. Namakwa and ZF Mgcawu still to appoint personnel. Schools Grade 8 screening - 20% 8.1% -11.9% • Only three districts have dedicated School Health coverage personnel. Namakwa and ZF Mgcawu still to appoint personnel. AFP stool adequacy - 100% 100% - Target achieved due to: • Improved training of health care workers • Sensitization on detection and investigation of cases in facilities
57 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: Non-Communicable Disease (Disease Prevention and Control)
Priorities
• Improve the Public Health and Private Health Sector’s awareness and understanding of emerging and re-emerging infectious diseases • Support stakeholder’s involvement in the implementation of the International Health Regulation (2005) for the control and prevention of international spread of infectious diseases • Strengthen partnerships and collaborate across sectors with government and non-government agencies to influence public health outcomes
Strategic Goal: Improve Health Outcomes in Managing both Communicable & Non-Communicable Diseases
Situation analysis Chronic diseases are the major causes of morbidity and mortality in developed and undeveloped countries. Chronic diseases such as heart disease, cancer, stroke, diabetes, and respiratory diseases share major risk factors beyond genetics and social inequalities including tobacco use, unhealthy diet, physical inactivity, and lack of access to preventive care. The Sub-Directorate is responsible for other programmes like Mental Health; Eye Care Services; Environmental Health and Communicable Diseases Control (CDC).
The Chronic Disease unit is part of the Central Chronic Management Dispensing and Distribution project which was launched in Pixley ka Seme district. The rectification of the challenges in the project will be a solution for continuous medication to chronic patients and adherence to take medication.
A conference was held in 2014 with South African Non Communicable Disease Alliance to provide training on health promotions and assist with Information, Education and Communication material. A need was identified to establish a register for cancer patients together with Provincial Health Information System to have a database on type cancers treated in the Northern Cape. Eye care service should establish relationships with local mines to assist in cataract surgery, the John Taolo Gaetsewe Development Trust assisted financially with cataract surgery.
Achievements
• A partnership with Mapalane Trust re-Rehabilitation Services for disabled people has been established • Influenza vaccination 98% was achieved against the 90% target • Diabetic incidence rate achieved 1.4/1000 against the 2.9/1000 target • All five (5) districts implement 72 hour mental health assessments
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action A decline in dental school health and an increase in ex- • Train more Oral Hygienists to assist in Oral Health. tractions. • Improve Health Promotion at schools. • Mounting and purchasing of water bottles • Need also complete Dental surgeries for Oral Health services. • More fissure sealants need to be done: need for consumables and Oral Hygienists. Inadequate budget and shortage of personnel. • Lobby for more funds from the Budget Committee for recruitment of personnel. Low cataract surgery output. • Identify one more facility conducting cataract surgery regularly. • To kick start Kumba project at John Taolo Gaetsewe district. • Initiate pilot cataract outreach programme (employing province based personnel). Professional nurses not trained on primary eye care. • Implement training package on primary eye care. Few partners are involved in eye care programme. • Train two professional nurses per facility. • Sustain existing partnership by honouring agreements to perpetuate lasting relationships. • Advocate new partnership to increase coverage on eye care service.
58 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 12: Annual targets for Disease Prevention and Control
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 To organise oral health preventative Dental utilisation coverage - 50/1000 58/1000 +8/1000 • Positive deviation due to awareness programme at PHC level programmes on access to dental services prevention in community and health talks offered by dental therapists in facilities. Dental extraction to restoration - 30/1000 13/1000 -17/1000 • Non-functional dental equipment ratio (especially chairs) specific to perform dental restoration. • Replacement of equipment • Complete Oral Health surgeries for Dentists to perform procedures. Expose schools to organised oral health Percentage of schools exposed - 80% 52.4% -27.6% • Appoint Oral Hygienists at district level preventative programme to school preventative oral • Provide transport for Dental Therapists to health programme schools and/or integrate dental services into Integrated School Health Programmes Coordinate control of hazardous Percentage of premises - 100% 106% +6% • Positive deviation as more facilities substances and premises complying with legislation and requested to be licenced license To improve Mental Health Care services Mental Health case load - 2% 1.9% -0.6% • Positive deviation with less mental cases due to improved Mental Health Services at Primary Health Care and awareness Decrease the proportion of people Hypertension incidence rate 18.5/1000 17/1 000 17.1/1000 0.1/1000 • Improved Chronic disease management with uncontrollable diabetes and hypertension Diabetes incidence rate 3.7/1000 2.9/1 000 3.8/1000 -0.9/1000 • Target exceeded due to awareness campaigns at community level and improved Chronic disease management resulting in more people presenting at facilities for screening and care • This may also be due to change in lifestyles e.g. poor nutrition Prevent blindness through increased Cataract Surgery Rates 1351/1000 1 200/1000 1029/1000 000 -171/1000 • There was a delay in the signing of the cataract surgery 000 (1346 000 000 contract with service provider South cataracts African National Council for the Blind) for conducted) strengthening the eye care service in the Province
59 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Strengthen disease surveillance system Malaria case fatality rates 0% 0% 11% -11% • Malaria is imported and patients delay (2 deaths seeking medical care and present to clinics reported) when they are critical • Strengthen disease surveillance systems at port of entry and improve case management at facilities Proportion of seasonal influenza 80.65% 90% 98% +8% • Positive deviation due to improved aware- vaccines administered to ness and uptake amongst targeted risk designated risk group groups
Facilitate compliance with the Mental Number of Districts providing a 5 2 5 +3 • Facilitate compliance with the Mental Health Care Act 17 of 2002 72 hour psychiatric service Health Care Act 17 of 2002
60 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 3: EMERGENCY MEDICAL SERVICES (EMS)
Priorities • Improve on response times • Gradual employment of more staff
Strategic Goal 2: Improved quality management and patient care across the system
Situation analysis
The programme is currently experiencing a downfall with ambulance coverage due to breakdowns and motor vehicle accidents. The response time has been adversely affected due to the reduced number of operational vehicles. The programme is still experiencing a constant increase in the number of patients transferred within the province and outside the province. This increase is caused by lack of specialist services at the districts. There is still a serious challenge with regards to institutionalised training of EMS personnel due to loss of accreditation which in turn was constituted by lack of premises.
Achievements
• Completion of new Control Centre building in Kimberley; • Eight hundred and fifty four (854) Emergency Care Officers participated in the Continuous Professional Development program (CPD); • New sixty (60) Emergency Medical Services vehicles released into operations on the 23rd September 2014; • Five (5) employees were capacitated on Fleet Management and finance for non-financial managers courses; • One (1) manager successfully completed the Management Development Programme (MDP) with University of Free State; • One (1) Advanced Life Support bursary student was appointed in Colesburg; • Forty five (45) employees were trained on Light Motor Vehicle Rescue (LMVR) and thirteen (13) employees trained on Aviation Health Care Provider (AHCP) courses; • Two (2) candidates passed the two (2) year Emergency Care Technician course; • Ten (10) Patient Transport Vehicles drivers were trained on first Aid level 1; • Three (3) Emergency Care Practitioners (ECP) were translated to Sub-district managers and one official translated to Station Manager in Namakwa district; • One hundred (100) Emergency Care Practitioners and ten (10) Patient Transport Vehicle drivers were appointed through funding from Provincial Treasury • Two (2) station managers and two supervisors were appointed in John Taolo Gaetsewe district; • Forty six (46) decommissioned vehicles were auctioned and a revenue of R1, 100 000.00 was generated
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Shortage of operational staff which constitutes one • Approval of the organogram and appointment of person crew situation in the programme as well as personnel. personnel shortage in the admin section. • Source additional funding .
• Lack of proper control centres. • Electronic infrastructure must be installed at Kimberley and Upington Control Centres.
• Inaccurate reporting of data • Informal training of data capturers is on-going.
61 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 13: Annual targets Emergency Medical Services
Strategic Performance Indica- Actual Target Actual Devia- Comments on Deviations Objective tor 2013/14 2014/15 2014/15 tion
Render an EMS Operational 0.8 0.5 0.84 +0.34 • Shortage of ambulances, effective and Ambulance coverage Vehicle breakdowns and efficient EMS vastness of the Province.
EMS P1 urban under 15 63% 60% 57% -3% • Increase the number of minutes rate operational ambulances and appointment of more staff.
EMS P1 rural under 40 47% 40% 56% +16% • Review target setting minutes rate going forward and source funding for appointment of staff.
EMS P1 call response 55% 60% 62% +2% • Source funding for under 60 minutes rate appointment of staff.
Number of patients 122 745 80 000 113 075 +33 075 • Review the referral transferred pathways at the districts. • Appointment of doctors at clinics and specialist will alleviate the burden.
Implement two 100% two crew system 63% 60% 53% -7% • Shortage of operational crew system staff.
62 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 4: PROVINCIAL HOSPITAL (DR HARRY SURTIE)
Priorities
• Render multiple discipline evidence based Regional health services • Theatre output management • Achieve 85% TB cure rate
Strategic Goal 3: Improved health outcomes in managing both communicable and non-communicable diseases
Situation analysis
The Dr Harry Surtie Regional Hospital is still experiencing staff shortages in critical areas such as Labour Relations, Quality Assurance, Infection Control, Risk management and Health Wellness. Major strides have been made with the operationalisation of certain wards in delivering services to the people of the Northern Cape.
The facility is experiencing challenges on retention of staff, as it is competing with private sector for the limited resources. Thirty (30) out of sixty five (65) beds are operational in the MDR/XDR TB hospital wards. The susceptible unit could not be opened due to shortage of nursing and cleaning staff. The 72 hour Psychiatric admission unit has a challenge on the absence of this service at local facilities. Dr Harry Surtie Regional Hospital is the only facility providing a 72 hour mental observation service in this district. This hospital is the only referral hospital in the southern part of the province and there is a high bed utilization rate of 104%, as not all beds are operationalised.
Achievements
• Dr Harry Surtie Hospital Ophthalmology Unit in collaboration with National Bureau for the Blind and A- vision successfully conducted nine (9) Cataract tours where three hundred and twenty nine (329) cataract cases were conducted, with the help of Kumba Mining and Lions Club sponsored accommodation and the travelling costs of the medical personnel; • The hospital has officially regained its status as Mother Baby Friendly Hospital initiative which is a National requirement; • A fully functional Milk Bank has been opened, operated by the Nutritional team with the help of the Neonatal staff to provide milk for the premature babies; • Establishment of a help desk at the Information Technology department, managing all Information Technology; • Viral Haemorrhagic Fever response team was established after the high incidents of Ebola virus as our town is situated near the two Namibian boarders. • Specialized services e.g. Computerised Tomography (CT) and Fluoroscopy that were not previously rendered or available in Upington and lower Northern Cape areas (remote areas) are now rendered at Dr Harry Surtie Hospital; • Employment of Locum Orthopaedic Surgeon, two hundred and fifty (250) operations of Orthopaedic patients were performed; • Ten (10) bed day-ward has been opened at Casualty to reduce the number of admissions and overflow in ward; • Opening of the Endoscopy theatre to do non-invasive procedures to diagnose and treat patients faster; • Community service doctor assigned to Ophthalmology and Oncology clinic, which has reduced the burden from the Professional nurses; • Sixty seven (67) Professional Nurses were trained on Cardio Pulmonary Resuscitation so as to improve the management of patients in cases of emergency for quality nursing care.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Recruitment of Doctors and Professional Nurses (scares skills), • Recruit and appoint personnel as per currently making use of locum doctors which is costly as we organogram also in line with recruitment and need to adhere to minimum staff complement of at least 40 retention strategy medical officers per day • Accommodation for staff due to very high rental rates. • Building of affordable houses for public servants by relevant stake holders • Centralisation of Human Resource Management systems • Decentralisation of Human Resource systems remains a major problem as it is delaying appointment processes • Long average length stay of Mental Health Care users in the 72 Increase capacity at Mental Health facility hour unit due to inadequate beds at West- End Hospital
63 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 14: Annual targets for Regional Hospitals
Strategic Objective Performance Indicator Actual Target Actual Deviations Comments on deviations 2013/14 2014/15 2014/15 Improve access to regional health Number of Paediatric patients 4219 6000 Medical 2698 +198 • Improved by employment of Locum services receiving interventional treatment cases-2500 doctors. 1971 Surgical cases 192 -808 • Most patients referred to Kimberley - 1000 Hospital. • Transport challenges results to patients not adhering to appointments. - ART cases - 1620 +120 - 1500 - TB cases - 1000 63 937 • Patients diagnosed with TB are mostly inpatients and they are directly down referred to PHC, only complicated cases come back. • Down referral of patients. Number of surgical cases done. 1971 1164 (15%) 2274 -1110 • There was a backlog of Orthopaedics Increase per cases conducted. year • Opening of the endoscopy theatre improve cases. Total Accident & Emergency 32 530 35 000 33770 -1230 • Few emergency cases were reported. head count. Progressively- improve hospital Average length of stay. 4 days 4.8 days 4.1 days -0.7 days - efficiencies Inpatient Bed Utilisation Rate 81% 72% 104% -32% • Out of 364 gazetted beds only 211 beds are utilized and not all units are opened due to inadequate staff. Expenditure per patient day R1705 R1 985.80 R3 316.69 +R1 330.89 • Outstanding accruals from the previous equivalent financial year. • The measles outbreak hence the increase in expenditure. • Increased caesarean cases mostly emergency cases. • Increased service package such as: • - Orthopaedic - Endoscopy - Mental Health - Ophthalmology Complaints Resolution within 25 - 60% 25% -35% • Complaints resolved were not responded working days rate within the 25 days due to incorrect phone numbers and addresses provided.
64 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objective Performance Indicator Actual Target Actual Deviations Comments on deviations 2013/14 2014/15 2014/15 Improve quality of Regional Hospital Mental Health Admission rate - 1% 1.2% +0.2% • Dr Harry Surtie Regional Hospital has been services declared the only designated 72 hour mental health unit for the ZF Mgcawu district. Percentage of hospitals that have - 100% 100% - - conducted gap assessments for (1 Regional compliance against the National Hospital) Core Standards Proportion of hospitals assessed - 100% 100% - - as compliant with the Extreme Measures of National Core Standards Patient Satisfaction rate - 80% 96% +5% • Remedial actions are implemented to improve the quality of the service rendered to the clients. To achieve a 30% MDR-TB cure rate by Proportion of MDR-TB patients 94% 100% 95% -5% • One hundred and twenty nine out of one 2014 started on treatment hundred and thirty six (129/136) -patients started on treatment. Seven (7) patients died before treatment started. MDR-TB smear conversion rate at 66% 35% 59% +24% • Q3/13, Q4/13, Q1/14, Q2/14 - 49/83 6 months patients converted (-) at 6 months of treatment. Proportion of HIV+MDR-TB patients 76% 100% 78% -22% • Q2/14 till Q1/15- 52/67-patients tested qualifying and started on ART (+) for HIV. Nine (9) patients died during preparation of ART, one (1) initial defaulter, one (1) transfer out to another district. Four (4) patients on preparation of ART. Proportion of new MDR-TB cases 21% 18% 27% +9% • Q2/12, Q3/12, Q4/12, Q1/13 - 8/30-patients cured at first attempt cured at 1st attempt. To achieve a 5% XDR-TB cure rate by Proportion of XDR-TB patients 88% 100% 92% -8% • Twelve out of thirteen (12/13) patients 2014 started on treatment started treatment. One (1) patient died before treatment started. XDR-TB smear conversion rate at 75% 23% 54% +31% • Q3/13, Q4/13, Q1/14, Q2/14 – 7/13 6 months patients converted (-) at 6 months of treatment. Proportion of HIV+XDR-TB patients 50% 100% 100% - • Four (4) patients tested (+) and four (4) qualifying and started on ART started on ART. Proportion of new XDR-TB cases 0% 1% 0% 1% • Q2/12,Q3/12,Q4/12,Q1/13 cured at first attempt • 0/1 patient cured at 1st attempt.
65 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: SPECIALISED HOSPITAL SERVICES (WEST END HOSPITAL)
Priorities
• Achieve 85% TB cure rate by 2019 • Improved specialised hospital services • Improve accessibility to mental health service in the specialised hospital
Strategic Goal 3: Improved health outcomes in managing both communicable and non-communicable diseases
Situation analysis
West End Specialized Hospital is taking care of Mental Health Care Users in one hundred and six (106) beds and Drug Resistant TB patient’s forty (40) beds. Both areas are servicing the Northern Cape Province including the Districts. The following Committees were established for improving service delivery:
• Audit and Risk Sub-Committee • Budget and Resource Management Committee • Hospital Management Committee • Clinical Governance Committee
An audit was carried out by Quality Improvement Team and pointed out areas that needed attention for quality improvement and compliance and adherence to quality standards. The hand washing basins were installed at Drug Resistant TB wards both inside and outside the building. The hospital is experiencing an exodus of staff members due to various reasons and replacement is underway to have a full staff compliment in order to render quality care to all patients.
There is a challenge of space for patient’s e.g. involuntary users at 72 hours facilities and state patients who are still accommodated at the department of Correctional Services facilities throughout the Province. In order to address this challenge a thirty six (36) bed facility is under construction and is envisaged to reach completion end of May 2015. Admission of underage user’s poses a challenge which requires more space to have an appropriate ward. Observantees for 30 days will also be accommodated on the premises and revenue will be generated from this service. Extra office space has been refurbishing to accommodate Social Workers and Doctors.
Kimberley Hospital Complex donated nine (9) beds to alleviate the pressure of shortage of beds at the acute ward. The Pharmacy has been registered with the South African Pharmacy Council (SAPC). This action will enable the facility to receive all the pharmaceuticals that are needed. Medication has been ordered in bulk and stored safely according to prescribed regulations.
Achievements
• Twelve (12) Desk top computers received and prepped for billing system; • Levofloxacin and Biperiden medication back in stock; • Thirty six (36) Bed wards refurbishment underway; • Registration of Pharmacy with the South African Pharmacy Council (SAPC); • Entered into contract with MHR personnel recruitment agency in March 2015, to implement moonlighting for nursing staff from 01st April 2015.
Challenges and measures planned to overcome them Challenges and Concerns Proposed corrective action • Exodus of five (5) professional nurses, Eight (8) Auxillary • Continue with external and internal moonlighting for nurses assistants and one (1) Auxillary Nurse. nurses as remedial intervention. • Urgent recruitment of staff as per the block adverts • Medical equipment still outstanding • Continuous intervention with provincial Supply Chain Management to expedite process. • Extreme slow server network compromising service • Liaison with provincial Information Technology Unit to • delivery. assess the magnitude of the problem and recommend intervention.
66 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 15: Annual targets for Specialised TB Hospital
Strategic Objectives Performance Indicator Actual Target 2014/15 Actual Deviation Comments for Deviations 2013/14 2014/15 To achieve a 30% MDR-TB cure rate Proportion of MDR TB patients started 91% 100% 95% -5% • One (1) patient died and two (2) by 2014 on treatment patients on treatment. Proportion of HIV positive MDR TB 60% 100% 110% +10% • Six (6) patients died before patients qualifying for ART and started treatment. on ART • Two (2) patients are being prepared to start on ART and twelve (12) patients are on ART. To achieve a 5% XDR-TB cure rate Proportion of XDR-TB patients started 97% 100% 100% - - by 2014 on treatment Proportion of HIV positive XDR-TB 94% 100% 100% - - patients qualifying for and started on ART To provide sufficient capacity to Inpatient Bed utilisation Rate (MDR TB) - 90% 84% -6% - render comprehensive specialist mental health care services Expenditure per patient day - R1820 R1081 -R783.00 • Programme to review target equivalent (PDE) (MDR TB) setting. Complaints resolved within 25 days - 60% 0% -60% • No complaints registered for the rate (MDR TB) MDR TB unit. Patient satisfaction Rate (MDR TB) - 80% 0% -80% • Questionnaires circulated, however not analysed. Inpatient Bed utilisation Rate - 100% 99% -1% • State patients put on leave of (Psychiatric) absence. Expenditure per patient day - R4078 R1502 -R2576 • State patients counted within equivalent (PDE) (Psychiatric) actual bed utilization rate. Complaints resolved within 25 days 60% 25% -35% • Encourage and instil a culture rate (Psychiatric) of reporting and recording of complaints. Mental Health Admission Rate - 100% 96% -4% • Post 72 hours observation discharge at Kimberley Hospital Complex effective management of clients in the community. Number of clinical audit meetings 9 12 3 -9 • Formalise reporting structures, as held meetings were not recorded. Patient satisfaction Rate (MDR TB) - 80% 0% -80% • Questionnaires circulated to patients, but not analysed.
67 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategic Objectives Performance Indicator Actual Target 2014/15 Actual Deviation Comments for Deviations 2013/14 2014/15 To provide sufficient capacity to Percentage of Hospital that have - 100% 100% - - render comprehensive specialist conducted gap assessments for com- mental health care services pliance against the National Core Standards Proportion of hospitals assessed as - 100% 0% -100% • The facility did not achieve all compliant with the Extreme Measures elements of core standards of National Core Standards to be compliant with extreme measures. Patient satisfaction Rate (Psychiatric) - 80% 0% -80% • Questionnaires circulated to patients, but not analysed. Ensure access to the full package Number of psychiatric hospital beds 143 143 106 -37 • Lack of infrastructure. A 36 bed of psychiatric hospital services by ward refurbishment underway. providing 143 hospital beds by 2014
68 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 5: TERTIARY HOSPITAL (KIMBERLEY HOSPITAL)
Strategic Goal 3: Improve Health Outcome in Managing both Communicable and Non-Communicable Diseases
Priorities:
• Compliance with the service platform for tertiary health services in the Republic of South Africa • Improve the quality of maternal, child, and emergency health service • Comply with the national core standards for effective health service delivery
Situation analysis
The hospital continued with its goal of improving access to Secondary and Tertiary services despite the gross under staffing especially in Human Resource Management. The mass exodus of nursing management and nurse professionals had a tremendous strain on the functionality of the Hospital towards achieving its desired goals with the major impact felt in the theatre. A total of fifty one (51) Professional Nurses and nine (9) Nursing managers resigned during the year and this number continues to rise. Reasons cited for the resignations related to finances and the current Government Pension Scheme.
The non-availability of Primary Essential Medicines List (EML) medicines at facility level has once again resulted in patients streaming to Kimberley Hospital for repeat medicines. Overcrowding is still experienced in the Accident and Emergency unit due to the lack of health services after 16:00 hours in the Sol Plaatje Municipality where we end up with a mixture of Primary, District and Tertiary patients. A follow up meeting was held with the Frances Baard Pharmaceutical Services to address the issue of non-availability of medicines in the clinics. A plan has been put in place and this will be monitored on a monthly basis.
The 72 hour Psychiatric admissions remain a constant challenge exacerbated by the absence of medication at the local clinics resulting in the admission of the same client over and over again. Total number of patients admitted for 72 hour Psychiatric observations for the year is five hundred and eighty eight (588).
Orthopaedic admissions continue to increase with no available capacity in the wards and the theatre to handle the load. The utilisation of Curomed for Orthopaedics and Ophthalmology will open up much needed infrastructural space on the premises of Kimberley Hospital Complex and can alleviate severe service delivery pressures that will impact positively on the whole province.
Maternal and Peri-Natal mortality remains a priority for us with all efforts made to ensure improved outcomes for the mother and child. Peri-Natal mortality is 28.22/1000 and thirteen (13) maternal deaths were reported for the year, mostly due to haemorrhage. Thirteen (13) cases were referred from Kuruman, Barkly West, Hartswater and Kimberley. The continued demand for high risk ante natal care puts a tremendous pressure on the available staff and bed capacity with a bed occupancy rate of 79%. There is a need to seriously look at the capabilities of Primary Health Care in delivering effective quality Ante Natal Care to reduce the high incidence of high risk pregnancies and adverse labour outcomes. The Caesarean section rate remains constantly above the norm at 56%.
The Medical Department continues to experience a high mortality and morbidity rate due to the burden of disease especially TB, HIV and AIDS, and this impact heavily on the limited staff available with thirteen (13) staff members infected with TB. Risk assessments were conducted on staff members with regard to TB prevention by Council for Scientific and Industrial Research (CSIR) team and early identification of illnesses that could affect performance of employees.
The Internal Medicine High Care six beds & Isolation unit project is presently at 90% and will be operationalised during the 2015/16 financial year. This will reduce the occupancy rate in the Adult ICU as well as improve the quality of patient care Hospital cleanliness have been prioritised through centralisation of cleaning services under facilities management so as to improve on cleaning standards, ensure the effective and efficient utilisation of cleaning personnel.
Achievements:
Quality improvement
• A first titanium mandible transplant in South Africa was done at Kimberley Hospital in July 2014.This is a ground-breaking work in 3-D printing in the medical field. Two (2) patients received titanium mandible implants after having lost parts of their faces due to cancer and other related diseases. This extraordinary breakthrough was made possible in partnership with the Central University of Technology (CUT) Centre for Rapid Prototyping and Manufacturing. • Hip and Knee replacement surgery target outdone with fifty four (54) cases above the expected of forty (40) Kimberley Hospital Complex (KHC) Ophthalmology unit in collaboration with the South African National Council for the Blind (SANCB) from Black Mountain Mining and Alcon PTY LTD held two successful cataract marathons during the Eye Care Awareness Week from the 6-10 October 2014 and on the 24th-25th January 2015. One hundred and thirty four (134) cataract operations were conducted on patients that reside all over the Northern Cape 69 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
• A relationship has been established with “Operation Smile” a non - governmental organisation responsible for the repair of Hare Lip and Cleft Palate deformities. Through this partnership thirty five (35) nurses were trained for free in Basic Life Support which is a vital competence for health workers in saving lives. • An Internal assessment on the National core standards was conducted from Monday, 17-21 November 2014; significant progress was made in addressing the elements of the Core Standards around Infection Prevention and Control, Improving patient and staff safety, addressing waiting times, hospital cleanliness, availability of drugs and positive staff attitude through constant monitoring of compliance and training. • The Electronic Gate Keeping (EGK) for laboratory specimens has been implemented and continuous monitoring is in place. This will assist in the prevention of duplicate blood tests as well as unnecessary blood test requested by junior or inexperienced doctors. This initiative will lead to cost savings on the National Health Laboratory Services account. • Agreement with MHR Agency completed and process commenced to place nurse professionals when the need arises especially in the critical areas of ICU, Theatre and Maternity • The restructuring cleaners have been successfully completed with a centralised model in place and constant supervision applied. This model is aimed at ensuring a clean hospital environment and reducing the risk of infections and thus addressing the national core standards for Hospitals; • The Hospital was officially awarded the plague for the Mother and Baby Friendly Hospital initiative which is aNational requirement; • Plastic Surgery Outreach to Calvinia was introduced as a new service; • A Burns awareness campaign was conducted on the 16th May 2014 in educating the public on measures to prevent and manage burns as the Hospital usually experiences an influx of burn patients during the winter.
Status of Infrastructural projects
• The new 64 slice Computerised Tomography (CT) machine was successfully installed in the Radiology department and the first images were made available at the end of September 2014. Seven hundred and seventy seven (777) examinations were performed for the current financial year. • The refurbishment to house the Mammography machine commenced in June 2014. The number of patients who have benefitted from this service since operationalisation in January 2015 is three hundred and ninety three (393). • The Internal Medicine High Care (Six beds) & Isolation unit project is presently at 90% and will be operationalised during the 2015/16 financial year. This will reduce the occupancy rate in the Adult ICU as well as improve the quality of patient care • The upgrading in the Accident and Emergency unit is well in advance which once complete will assist in the efficient management of patient flow. • The refurbishment of Ward M2 is complete; this will address the elements of the core standards around Infection Prevention and Control. • The lecture hall project to an amount of R2 million for under graduate students has been completed. • The Health Professions Council of South Africa will visit Kimberley Hospital in May 2015 to assess the hospital for accreditation to train undergraduate medical students to expand the training platform of the University of the Free State. It is anticipated that ten (10) students will start in January 2016 at the Kimberley satellite campus if the accreditation is approved.
Clinical equipment
• Improving standard of care and quality of working life through the procurement of Clinical and support equipment. This will enable efficient and effective services to patient care. Including among others:
◦ Four (4) Anaesthesia machines procured on a lease agreement, ◦ Otoacoustic Emissions (OAE) screener, ◦ Two (2) Saturation monitors for resuscitation.
Continuous staff Development
• Continued Professional Development and Capacitation of Medical, Nursing and Support Staff on key health outcomes with emphasis on Clinical Governance, Medical Negligence, Basic Life Support, Infection Prevention and Control, Financial Management, Core and Job description, Management Development Programme (MDP), Human Resource Strategic Planning and Records Management. These targeted trainings will greatly assist in reducing medico legal negligence and litigations.
70 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appointments: The following categories of staff commenced duty during the year under review: Category Number Professional Nurse 61 Occupational Therapist 1 Nursing Assistant 34 Medical Officer 22 Medical Specialist 3 Radiographer 4 Nursing Manager 3 General assistants 29 Admin Support 13
N/B: Some of the posts filled for the 2014/15 financial year were vacant as from the previous financial year and thus only filled in the year under review. These posts were still funded.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Continued demand for additional theatre time and • Utilisation of the Curomed theatre capacity. This will open ICU beds. The over load weighs heavily on the limited up much needed infrastructural space and can alleviate number of staff available as well as the increased severe service delivery pressures that will impact positively possibility of adverse incidents occurring. on the whole province. • Allocation of adequate budget for upgrading. • Speed up the completion of the 6 bed High Care unit and appointment of appropriate staff. • Fast track the implementation of the district Specialist teams programme, PHC and the School Health programme. • Strengthen outreach programme to districts. • Inadequate infrastructure amidst a fast growing service • Utilisation of the Curomed theatre capacity and package e.g. limited functional space in the Renal unit, appointment of additional Theatre personnel. • Over- crowding of mental health users in the 72 Hour • Increase capacity at the specialised mental health facility. unit due to inadequate beds at West End Hospital as • Facility that have been identify to render 72 hour well as patients relapsing due to absence of drugs at observation must start implementing the service. PHC facilities. • Influx of patients for Orthopaedic services due to lack • Strengthen the Outreach programme for Orthopaedic of these services in the Districts leading to Patients over- services. crowded in the Emergency unit waiting for beds and • Extent outreach services to include orthopaedics at De Aar Patients waiting longer for surgery with possible clinical and Prieska. complications • Motivate for the appointment of Orthopaedic surgeons and capacitation of District Hospitals. • Delays in the processing of applications for Incapacity • Provincial Office to fast track all submitted applications for Leave and Ill Health Retirement (PILLIR). Staff on PILLIR PILLIR. process for more than three years on full pay • Major challenges are currently being experienced with • Meetings are constantly being held with National Health the Laboratory Services. Due to absence of reagents Laboratory Services (NHLS) to improve the situation. A critical tests are not being processed timeously, request has also been made to National Health Laboratory resulting in a delay to diagnose patients. Services to refer specimens to the private sector at their • The microbiologist from National Health Laboratory cost. Services resigned at the end of December 2014 and this has hampered microbiology services especially the “daily alert” list of microorganisms which was sent to all clinical units.
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Challenges and Concerns Proposed corrective action • Inadequate safety and security for staff, patients and • Request approval for in sourcing of security services. Plan property. High incidence of theft reported. drafted and costed. • Strengthen mechanical security systems. • Continued mass exodus of nursing staff with slow • Approval requested for the immediate replacement of response in recruitment leading to an increase in the funded nursing and support staff as posts are vacated. number of complaints of poor standard of nursing and • Requests strict adherence to set turnaround times for sub- postponement of theatre cases. The Province produc- missions by all signatories. tion of nurses cannot meet the demand • Utilisation of Nursing Agency.
Transfer outs, Resignations & Retirements during the year under review: • Professional Nurse X 51 • Nursing Manager X 9 • Nursing Assistant X 36 • Head Clinical X1 • Medical Officer X 25 • Medical Specialty X 1 • Radiographer X 5 • Occupational Therapist X 4 • General assistants X 15 • Admin Support X 10 • Inadequate equitable share budget to address critical • Motivate for an increase in budget allocation that will sus- service delivery demands tain the services required. • Lack of Human Resource delegations • Request approval for limited Human Resource delegations to the Hospital management to shorten the lengthy submis- sion process.
72 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 16: Annual targets for Tertiary Hospital
Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Improve secondary and Number of patients 157 Cardiac surgery 88 -62 • Reduction in the availability of Cardiology services at tertiary health services receiving interventional 150 Universitas hospital hence fewer referrals were accepted treatment form the Northern Cape. Improvement Plan: • Establish a Catheterization Laboratory (Cath Lab) - Long term solution. • Explore the possibility of collaborating with another province to deliver the service as an interim solution. 115 Thoracic surgery 95 -55 • Reduced theatre list due to staffing constraints. 150 Improvement Plan: • Improve staffing capacity. • Correct the backlog created and achieve set target. 48 Hip & knee 54 +4 • Increase in the total number of surgery performed. replacement Improvement Plan: Surgery 50 • Efficiencies in the surgery interventions to be maintained. Improve the quality of Number of clinical audit 12 12 11 -1 • Limited available staff during the festive season to maternal, child and family meetings held. convene a meeting – no quorum formed . health Improvement Plan: • Adhere to scheduled monthly meetings. • Schedule Meeting before the committee members goes on leave. Improve quality of Hospital Mental health admission - 2.3% 1.7% -0.6% • Improved availability of admission beds at West End services rate Specialised Hospital resulted in a decrease in admissions at the facility. Number of patients seen 4782 5 079 6 135 +1 056 • Increase in the number of health care practitioners at Tertiary Specialist out- performing outreach services. reach services Average length of stay. 6.5 days 5.5 days 6.8 days +1.3 days • Increased burden of disease effect gave rise to an increase in the average length of stay.
Inpatient Bed utilisation 71% 74% 73% -1% • Reduction in number of elective operations. rate. Expenditure per patient R3 487 R3 663 R3 446 -R217 • Increase in the Patient Day Equivalent (PDE) cost of day equivalent (PDE). medical inflation. Improvement Plan: • Services to operate normally.
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Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on deviations 2013/14 2014/15 2014/15 Improve quality of Hospital Percentage of Hospitals - 100% 100% - - services that have conducted (1 Tertiary Hospi- (1 Tertiary gap assessments for tal) Hospital) compliance against the National Core Standards Proportion of hospitals - 100% 0% -100% The institution did not comply to all extreme measures of the assessed as compliance national core standards with the Extreme Measures of National Core Standards Complaints resolution 66% 60% 86% +26% Nature and the low volume of complaints received influenced within 25 working days the performance of the indicator. rate Improvement Plan: Awareness campaign around the complaints procedure Patient Satisfaction rate 76% 80% 84% +4% Generally, patients prove to be more satisfied with services offered
74 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 6: HEALTH SCIENCES AND TRAINING
Strategic Goal: Improve Quality Management and Patient Care across the System
Priorities:
• Training of undergraduate nurses • To identify and address scarce and critical skills in the public Health Sector through the Bursary Programme • Training of EMS Personnel • Promoting a conducive learning and working environment within the workplace
Situation analysis
The geographical size of the province, special divide of communities, population’s numbers and shortage of critical specialties, limited resources and healthcare facilities are some of the constant daily challenges encountered by the EMS College. EMS personnel are all obligated to register with the Health Profession council of South Africa (HPCSA). To ensure quality services, the council expects all practitioners to participate in Continuity Profession Development related events. The council has suspended personnel from their registers due to non-compliance to Continuity Profession Development. It is impossible for all EMS staff to participate in Continuity Profession Development events in the province due to operational demand and access to training.
EMS College is the only accredited training facility in both the private and public sector in the Northern Cape. Majority of the Emergency Medical Services personnel possess a basic qualification which is not a South African Qualifications Authority (SAQA) recognized qualification. Historically, this qualification was designed to address the immediate service delivery needs with little focus to quality of services/ treatment.
Further, there is a national focus towards the provision of quality of Emergency Medical Services. Provision of SAQA recognized training of the existent and new emergency management personnel is a national focus to professionalize the profession. This alignment of training is accompanied by secondary schooling prerequisites which majority of the current emergency management personnel lack.
The Henrietta Stockdale Nursing College had two hundred and thirty one (231) students as at the end of the financial year. The College had an intake of sixty (60) four year course students which sums up the total of two hundred and fifty one (251)
Achievements
• The EMS College trained nine (9) staff in Level 1 First Aid; • Three (3) Light Motor Vehicle Rescue (LMVR) training conducted in the new EMS facility (Upington); • EMS College appointed the following personnel i.e. Registrar, Principal Personnel Officer for Conditions of Service and Personnel Officer for student affairs; • Human Resource Development Implementation plan was submitted to the Office of the Premier; • Nine (9) new Health Sciences bursaries awarded.
Forty three (43) Health & Science Bursary Holders completed their studies
Category of study Number Pharmacy 4 Dentistry 2 Nursing 20 Optometry 1 Clinical Psychology 1 MBcHB – 9 Physiotherapy 2 Audiology 2 Paramedic 1 Social Work 1 Total 43
75 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Challenges and measures planned to overcome them Challenges and Concerns Proposed corrective action • Loss of accreditation of EMS College by Health Professions Council of South Af- • Delivery date of Structure, Accreditation visit by Health Profession council of South Africa rica (HPCSA). (HPCSA). • Inadequate transport for students and staff for Henrietta Stockdale Nursing • Budget for additional transport. College. • Equipment and insufficient budget. • Identify source of funding for the college (phasing out of the Health Professional Training and development Grant). • Students not receiving books and uniform on time. • Students to get books and uniforms on recommended/ scheduled time. • Skills levy not protected against cost containment irrespective of spending • The determination on the skills levy should be translated into conditions of expenditure. patterns.
Table 17: Annual Targets for Health Sciences and Training Strategic Objective Performance Indicator Actual Target Actual Deviation Comments on Deviations 2013/14 2014/15 2014/15 To expand and sustain the Number of Registrars in training 9 15 16 -1 • To adhere to business plan outcomes performance Registrar training programme indicators. Number of Registrars retained after 1 7 0 -7 • Registrars are still in training. qualifying
To implement a Training Strategy Number of PHC nurses graduating 20 20 0 -20 • Post basic programme targets should be set per aligned to the core function of programme of study as compared to a general the Department target. Number of paediatric Nurses graduating 2 5 0 -5 • Districts should set targets in line with their staff complements. Number of Advanced Midwives 4 5 0 -5 • Budget to be allocated in the new financial year. graduating
Number of Managers accessing the 20 20 20 -20 • Supply chain process to adhere to End-user Management Skills Programmes deadlines and understand skills development prescripts. Train learners to qualify as Basic nurse students graduating 45 45 94 = +49 • Midwifery and Bridging group’s results were not yet Professional nurse 23 R425 received on time from the South African Nursing 26 R254 Council. All groups were kept for graduation of 20 45 R683 March 2015 Proportion of bursary - 15% 14% -1% • Appointments to be coordinated provincially holders permanently appointed
Ensure optimum competency Number of employees enrolled for - 36 12 -24 • Health Professions Council of South Africa (HPCSA) level of EMS staff training on Intermediate Life Support to accredit the new EMS College for training
Strengthening the Human Provide bursaries for administrative staff - 20 20 - - Resource Capacity
76 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 7: HEALTH CARE SUPPORT SERVICES
Sub-Programme: Forensic Medical Services Priorities: • Reduced turnaround on completion of autopsies • Upgrade two (Kimberley and Kuruman) forensic pathology service mortuaries (Reference Programme 8) • Improve turnaround time of submission of autopsy reports to stakeholders (South African Police Services and National Prosecuting Authority) • Development of health care practitioners Strategic Goal: Improved Quality Management and Patient Care across the System Situation analysis The focal point around the programmes indicators has been to reduce the turnaround time to completion of autopsies, with a coverage target of 70% cases done in four days, to track the turnaround time to service delivery. An annual average of 93% was achieved in 2014/15 FY on this target resulting in a positive deviation of +23%, compared to previous financial years where the targets were not met.
A new indicator was also set in the 2015/16 financial year to track the turnaround time of autopsy reports availability in 14 days with a set target of 80% from performance of autopsy. The target was achieved in 2014/15 FY with an annual average of 84% resulting in a positive deviation of +4%.
The continuous service delivery hinges on availability of doctors and specialists including the technical support personnel (forensic pathology officers). Forensic Pathologists (Specialists) are scarce skills in the country. To date 2 forensic specialists and 5 medical officers are within the employ of the department, the appointments resulted somehow in the stability that was much needed. However, we are pursuing for it to be sustainable and the continuous headhunting and recruitment of medical officers for all mortuaries across the province.
Statistics which includes holding facilities April 2014-March 2015
Types of Post Mortems Kimberley Upington De Aar Calvinia Springbok Kuruman Murder 133 79 74 21 20 91 Accident 74 88 24 4 21 30 Motor Vehicle Accident 167 59 72 13 42 106 Suicide 91 36 12 9 18 40 Undetermined 4 16 8 0 0 5 Natural 89 192 51 20 33 15 Anaesthetic 9 0 1 0 0 1 Fetus 4 0 3 0 0 3 Decomposed 11 0 0 0 0 0 Bones 1 0 0 0 0 0 Other 6 2 2 1 0 2 Total 589 472 247 68 134 293
Total Post Mortems performed 1803
*There are high number of suicide cases reported from Hartswater area (including Pampierstad, Warrenton and Jan Kempdorp), the department is looking into role and intervention needed by stakeholders with the plight of addressing the matter urgently.
**investigating the high figures with the plight to reduce the numbers, so that clinical protocols can guide doctors on mechanisms of diagnosing a natural case on clinical data, which will reduce the use of resources currently attached to it and also reducing costs. Special In-service training will be conducted for doctors and support personnel on collection of clinical data, to diagnose the natural cases without autopsy.
77 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Figure 1: Graphical View of Pathological Statistics – April 2014 -March 2015
NB: 6 % of cases is referred to Kimberley, bringing the caseload of Kimberley close to 40% as the main centre in the province.
NB: There is a steady rise in the motor vehicle accident including murder cases in Kuruman since economic boom.
Figure 2: Clinical Medical Services Statistical view of cases from 1st April 2014- 31st March 2015
Districts Reporting Frances Baard Pixley ka ZF Mgcawu Namakwa John Taolo Seme Gaetsewe Sexual Assault/New 191 54 106 47 58 HIV Counselling & testing 151 30 104 47 54 HIV Positive clients 25 19 2 12 19 Clients on ARV (PEP) 98 32 92 38 40 DNA testing perpetrators 98 21 56 18 4 Domestic violence 28 93 21 129 17 Common assault 252 234 1262 491 366 Drunken driving 9 11 25 14 1 Total 852 494 1668 796 559 TOTAL 4369
Figure 3: Graphical Forensic Statics April 2014 -March 2015
78 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Figure 4: Graphical Forensic Services April 2014-March 2015
Graphical presentation of reported cases and services per district NB: Notable is the high numbers of common assault cases reported in ZFM, Namakwa and JTG
Challenges and measures planned to overcome them Challenges and Concerns Proposed corrective action • Shortage of practising forensic nurses at Kuruman , De Aar, • District Health Services to budget, train and appoint Kakamas Thuthuzela Centres and throughout health facilities forensic nurses and doctors in the province • Refer patients to the nearest health facilities • Shortage of forensic pathology doctors/specialists and • Request approval and additional budget to build support staff (data captures) capacity • Lack of proper Employee Awareness Programme (EAP) • Engage principals to relook recruitment strategies to services for forensic employees including doctors allow us to compete with other provinces • Inadequate budget allocation and worsening state of affairs • Bid for additional funding to address budget issues • Improve efficiency to safe costs and shift funds to addresses particular pressures • Incomplete mortuary upgrades and worsening state of • Continually engage the Executive Management affairs. Committee to lobby for funds to complete the mortuaries. • Develop a business case for appropriate facilities to be built (Kimberley & Springbok) especially Kimberley for training purposes.
Table 18: Annual targets for Forensic Medical Services Strategic Performance Actual Target Actual Deviation Comments on deviations Objective Indicator 2013/14 2014/15 2014/15
Improved Forensic Percentage 54% autopsies 70% 93% +23% • Improved turn-around time in Medical Services of autopsies completed in completion of autopsies due completed two (2) days to the appointment of addi- within 4 tional Specialist working days Percentage - 80% 84% +4% • Continuous in-service training of autopsy for doctors and management reports of reports submissions. submitted • Engage the courts for in 14 days to management process of stakeholders subpoenas which impacts (SAPS, NPA) heavily on doctor’s availability for autopsies. Increase the 0 40 0 -40 • Reviewing of training due to pool of trained budget cuts and pressures. healthcare • Reprioritising of basic training practitioners due to better prospects of in sexual forensic diploma course with assault case University of the Free State management which require funding. • Lack of human resource capacity
79 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Sub-Programme: PHARMACEUTICALS
Priorities:
• Improve availability and accessibility of medicine • Improve quality of service including clinical governance and patient safety • Improved and efficient medicine stock management
Strategic Goal 2: Improved Quality Management and Patient Care across the System
Situation analysis
All pharmaceutical stock was adequately accounted for through the annual stock processes that was concluded at all those facilities that manage medication. The stock take information will be forwarded to the Depot for consolidation and submission to the office of the Chief Financial Officer for inclusion in the Annual Financial Statements for the financial year ended 2014/15.
The Department was also involved in conducting the Human Papilloma Virus (HPV) campaigns. To this end Pharmaceutical Services in all districts ensured vaccines were available to immunize school-going girls at the age of nine (9) (mainly) against this scourge. The left over stock were collected and stored for the next campaign. These were also accounted for carefully as the reconciliation thereof is paramount and needs to be reported to the National Department of Health.
The Pharmaceutical Services Directorate conducted a successful strategic session over a period of two days (2) involving all the District Pharmacist and Senior Pharmacists from the Depot and hospitals. At the end of the two days (2) an action plan (to be converted into a strategic document) was compiled which clearly highlighted the objectives that the Directorate has set for itself. This plan also alluded to the shortcomings and attempted to highlight the mitigating steps to address and overcome such challenges.
The roll-out and implementation of the Rx Solution stock management system was discussed and a decision takn was that Dr Harry Surtie Hospital in Upington would serve as a pilot before it is rolled out to the Pixley ka Seme district. This pilot has now been concluded and only monitoring and evaluation will take place whilst plans have been set in motion in the year under review to implement and roll out the system to the NHI district.
All Community Service Pharmacists (CSP) have started in their designated facilities and districts, improving quality of care in their immediate surroundings. All District and Hospital Pharmacists were involved in compiling the budget requirements for the ensuing financial year. These requirements were submitted to the relevant District Managers and the Director, Pharmaceutical Services for further engagement and deliberations.
Achievements:
• A Strategic Planning Session was held involving all Districts, Hospital Pharmacists and Senior Pharmacists from the Provincial Medical Depot. The Action Plan compiled highlights the objectives of the Pharmaceutical Services Directorate and alluded to challenges and mitigating factors to combat or overcome it; • Dr. Harry Surtie Hospital in Upington was identified as a pilot for the roll-out and implementation of the Rx Solution Stock Management System. Monitoring and evaluation is currently taking place at the Hospital whilst the Rx Solution Stock Management System team paves the way forward for the roll-out and implementation of the system in the NHI district (Pixley ka Seme District); • Connie Vorster Hospital Pharmacy has been registered and a Pharmacy Manager appointed; • Partnerships and Memorandum of Agreement formed between Mines in the John Taolo Gaetsewe, Frances Baard District and ZF Mgcawu Districts and the Northern Cape Department of Health. The primary objective is to treat mining employees at their respective places of work; • The ZF Mgcawu district Chronic Dispensing Unit (an alternative dispensing and distribution model) is in the completion stage and will be finalised in the new financial year.
80 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Shortage of qualified pharmaceutical staff at all facilities • Registration of tutors that can supervise and mentor staff in completion of studies. • An organogram in conjunction with the Workload Indicators Staffing Needs programme will be compiled and submitted. • Management of surgical and dressings • Processes are underway to render an alternative model with regard to the management of surgical and dressings. • Medicine out-of-stock challenges • Introduce an electronic stock management system at facility level. • Infrastructure challenges resulting in non-conformance • Infrastructure Directorate and Pharmaceutical Services to the South African Pharmacy Council training site Directorate to visit sites and provide plans to address requirements shortcomings. • Down referral of patients to Primary Health Care facilities • Prescribers should be advised to utilise the Provincial Formulary, Standard Treatment Guidelines and Essential Medicine Lists when prescribing.
Table 19: Annual targets for Pharmaceuticals
Strategic Performance Indicator Actual Target Actual Deviation Comments on Objective 2013/14 2014/15 2014/15 deviations
Improve • Percentage 96% 100% 97% -3% • Challenges with medicine availability of supplier. availability and tracer medication • New tenders were rational use of (Essential Medicine awarded. medicine List (EML) and • Poor stock Standard Treatment management at Guideline ( STG) in facility level. the health facilities and institutions
• Percentage of - ≤1 % ≤1% - - medication written off vs. medication on hand
Reduce Patient • Number of districts - 3 1 -2 • Non-payment of waiting times implementing suppliers resulting an alternative in incomplete dispensing and infrastructure to distribution system roll-out alternative for chronic dispensing and medicines distribution system for chronic patients.
• Average out-patient ≤21 minutes ≤30min- ≤15minutes ≤15minutes • Improved waiting waiting time at utes times at our hospital pharmacies facilities.
81 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
PROGRAMME 8: HEALTH FACILITIES MANAGEMENT
Priorities:
• Implementation of Hospital Revitalization Programme • Implementation of Infrastructure Grants for Provinces • Implementation of Capital Infrastructure Maintenance Programme • Implementation of Clinical Engineering Maintenance Programme
Strategic Goal: Improved and Accelerated Infrastructure Development Programme
Situation analysis:
The Health Facilities Management programme has implemented projects funded through Conditional Grants and Equitable Share Engineering. The Conditional Grant budget services 90% of the projects in a form of new constructions and upgrading. The maintenance projects are mainly funded through the equitable share engineering budget. This budget remains insufficient taking into account the maintenance backlog experienced with the health facilities and lack of day to day maintenance budget in the majority of health facilities. Further, the Health Facilities Management Programme experienced slow delivery on new construction projects i.e. Mental Hospital, Port Nolloth CHC and Ka Gung Clinic.
Despite the challenges, the Health Facilities Management programme with the support of programmes in the Provincial Office, District Offices and the Health Facilities managed to achieve delivery of infrastructure projects.
Achievements
In 2014/15 financial year the Health Facilities Management Programme has managed to complete the following projects:
• Upgrading at Frazerburg and Sutherland Community Health Centres; • Completion of Williston CHC staff accommodation; • Supply of 5 standby generators in all districts; • Refurbishments at Kuruman Hospital; • Conversion of old Gordonia Hospital into ZF Mgcawu Health District office; • Erection of fence and guard house at Connie Vaster and Galeshewe Day Hospitals
Progress has been made in the delivery of the following facilities: - • Construction of De Aar Hospital (Phase 3). • Construction of Mental Hospital.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Slow delivery by Implementing agents • Project performance monitoring by means of site visits, monthly meetings and interim communications. • Slow delivery of Mental Health contractor • Regular meetings with the Implementing agent to speed up progress. • Existing contractor/company being taken over by new Group – amendment of contract to expedite works. In-loco monitor appointed to monitor and advice. • No procurement of service providers for renovation • Tenders closed in January 2015. Follow-up meetings with of Nababeep CHC Supply Chain Management to resolve bottleneck in bid evaluation and adjudication.
82 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 20: Annual targets for Health Facilities Management
Strategic Performance Actual Target Actual Deviations Comments on deviations Objective Indicator 2013/14 2014/15 2014/15 Implementation New replacement 38% 100% completion of New 65% -35% • Slow delivery by the of Hospital Revitalization hospitals Mental Health Hospital; contractor Programme 100% TB Unit 80% Completion of De Aar 100% completion - - 65% Main Hospital Hospital; of TB Unit. 75% completion of the main hospital. Business case Planning Kuruman Hospital Business plan - - prepared preparation in progress. Implementation of infrastructure New clinics & 60% Kagung clinic 30% completed. 30% • Contractor was terminated Grants for Province community health due to slow delivery and bad centre. quality work. 5% Heuningsvlei clinic Project planning - - processes completed. 95% Williston Clinic 100% completed. - - - Port Nolloth CHC Project at foundation • Corrections to platform stage. caused a delay on the building works. Implementation Upgraded & refur- - Sutherland Upgradings - - of capital bished facilities; completed. Infrastructure - Fraserburg Upgradings - - Maintenance completed. Programme - Galeshewe Hospital Fencing and guard - - house completed. - Clinic, Hospital and CHC Facilities prioritised - - upgrades for upgrading completed Implementation Proportion of - 18% 18% - - of Clinical Engineering Programme 8 budget Cumulative Maintenance Programme spent on maintenance (preventative and schedule) Number of districts - 5 districts All districts. - - spending more than (100%) 90% of maintenance budget
83 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Strategy to overcome areas of under performance
• Budget Committee to oversee the utilisation of the departmental budget; • Review job description of employees to include risk and performance management; • Programme managers to account by means of evidence, verify, quality assure documents submitted and take responsibility of their programmes; • The department should take timely action where deviations indicating underperformance has been identified with regard to managing performance information; • The department should evaluate the correlation between the planned vs actual performance and its budget vs actual expenditure; • The department’s budget should be aligned to its measurable objectives and performance targets; • The department’s performance targets should be selected with due regard to the result of relevant research and programme evaluations; • Programmes must develop risk improvement plans on how to mitigate risks of not achieving planned targets. • Strengthen departmental Monitoring and Evaluation Forum
Changes to planned targets • There were no indicators changed in the Annual Performance Plan during the reporting period
Linking performance with budgets
2014/2015 2013/2014 Programme Name Final Actual (Over)/Under Final Actual (Over)/ Appropria- Expenditure Expenditure Appropria- Expenditure Under tion tion Expenditure R’000 R’000 R’000 R’000 R’000 R’000 1. Administration 173,694 192,331 (18,637) 167,616 171,647 (4,031) 2. District Health Services 1,618,498 1 633,011 (14,513) 1,486,556 1,465,611 20,945 3. Emergency Medical 259,262 242,847 16,415 231,955 199,910 32,045 Services 4. Provincial Hospital 265,715 292,594 (26,879) 214,569 201,082 13,487 Services 5. Central Hospital Services 788,826 767,519 21,307 719,640 739,655 (20,015) 6. Health Sciences & 108,698 104,251 4,447 88,845 86,012 2,833 Training 7. Health Care Support 85,258 85,263 (5) 85,898 84,524 1,374 Services 8. Health Facilities 458,037 396,164 61,873 481,909 453,360 28,549 Management Total 3,757,988 3,713,980 44,008 3,476,988 3,401,801 75,187
2.4.5 Transfer Payments Table 1: Transfer payments to public entities
Name of transferee Type of organi- Purpose for Did the Amount Amount Reasons for sation which the department transferred spent by the funds un- funds were comply (R’000) the entity spent by the used with s 38 entity (1) (j) of the PFMA //Khara Hais Municipal- Local Municipality Primary Health Yes 984 984 Not Applicable ity Care Sol Plaatjie Municipality Local Municipality Primary Health Yes 624 624 Not Applicable Care
84 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table2: Transfer payments to all organisations other than public entities
Name of Type of Purpose for Did the Amount Amount Reasons for the transferee organisation which the department transferred spent by funds unspent funds were comply (R’000) the entity by the entity used with s 38 (1) (j) of the PFMA Legatus NGO Non-profit Institution Home Based Yes 10,215 10,215 Not Applicable Care Northern Cape Non-profit Institution Home Based Yes 6,392 6,392 Not Applicable Aids Forum Care Nightingale Non-profit Institution Home Based Yes 2,950 2,950 Not Applicable Hospice Care Modder Non-profit Institution Home Based Yes 3,791 3,791 Not Applicable Theresa Care Hospice Helen Bishop Non-profit Institution Home Based Yes 2,110 2,110 Not Applicable Orthopaedic Care After-Care Home Aganang Aids Non-profit Institution Home Based Yes 4,302 4,302 Not Applicable Services Care Organisation Boikobo Health Non-profit Institution Home Based Yes 6,703 6,703 Not Applicable Care Care Boitumelo NPO Non-profit Institution Home Based Yes 1,863 1,863 Not Applicable Care Bophelong Care Non-profit Institution Home Based Yes 635 635 Not Applicable Centre Care Cecilia Non-profit Institution Home Based Yes 808 808 Not Applicable Makiwane Care Hospice Dingleton Non-profit Institution Home Based Yes 1,693 1,693 Not Applicable Community Care Health Workers Diocese Aids Non-profit Institution Home Based Yes 2,231 2,231 Not Applicable Ministry NPO Care Diocese Non-profit Institution Home Based Yes 446 446 Not Applicable Keimoes Care Upington Drydo Home Non-profit Institution Home Based Yes 4,591 4,591 Not Applicable Based Care Care Ebenezer Youth Non-profit Institution Home Based Yes 663 663 Not Applicable Group Care Education Non-profit Institution Home Based Yes 2,346 2,346 Not Applicable Support Care Services Trust Grassroot Non-profit Institution Home Based Yes 353 353 Not Applicable Soccer SA Care Hope Christian Non-profit Institution Home Based Yes 1,887 1,887 Not Applicable Home Based Care Care Hopetown Non-profit Institution Home Based Yes 955 955 Not Applicable Home Based Care Care Hospice Hospice Health Non-profit Institution Home Based Yes 1,137 1,137 Not Applicable Care Institute for Non-profit Institution Home Based Yes 1,001 1,001 Not Applicable Disability Care Innovation
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Name of Type of Purpose for Did the Amount Amount Reasons for the transferee organisation which the department transferred spent by funds unspent funds were comply (R’000) the entity by the entity used with s 38 (1) (j) of the PFMA Kgatelopele Non-profit Institution Home Based Yes 1,593 1,593 Not Applicable NPO Care Maggie Non-profit Institution Home Based Yes 2,138 2,138 Not Applicable Samboer Care Hospice Maruping Non-profit Institution Home Based Yes 5,332 5,332 Not Applicable Health Care Care Masiphele NGO Non-profit Institution Home Based Yes 3,097 3,097 Not Applicable Care Mobile HIV Non-profit Institution Home Based Yes 629 629 Not Applicable Counselling and Care Testing Napwa Non-profit Institution Home Based Yes 599 599 Not Applicable Northern Cape Care NGO Phutaditshaba Non-profit Institution Home Based Yes 1,341 1,341 Not Applicable Home Based Care Care Re-Action Non-profit Institution Home Based Yes 862 862 Not Applicable Consulting Care (PTY) LTD Renosterberg Non-profit Institution Home Based Yes 1,318 1,318 Not Applicable Gemeenskaap Care Projek The Little Big Non-profit Institution Home Based Yes 1,004 1,004 Not Applicable Soup Kitchen Care NGO Thusanang Non-profit Institution Home Based Yes 4,192 4,192 Not Applicable Home Based Care Care Williston Drop Non-profit Institution Home Based Yes 1,329 1,329 Not Applicable in Centre Care
The table below reflects the transfer payments which were budgeted for in the period 1 April 2014 to 31 March 2015, but no transfer payments were made.
Name of transferee Type of Purpose for Amount Amount Reasons why funds were organization which the funds budgeted transferred not transferred were used for (R’000) (R’000) Emthanjeni Municipality Local Municipality Primary Health 1,114 - PHC functions provincialised Care Nama Khoi Municipality Local Municipality Primary Health 100 - PHC functions provincialised Care Pixley Ka Seme District District Municipality Primary Health 100 - PHC functions provincialised Municipality Care Frances Baard District District Municipality Primary Health 100 - PHC functions provincialised Municipality Care Gamagara Municipality Local Municipality Primary Health 100 - PHC functions provincialised Care Ubuntu Municipality Local Municipality Primary Health 149 - PHC functions provincialised Care
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2.4.6 Conditional Grants
Conditional grants and earmarked funds paid
The table/s below details the conditional grants and ear marked funds paid during for the period 01 April 2014 to 31 March 2015 Department / Municipality to whom the grant has Not Applicable been transferred Purpose of the grant - Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) - Amount transferred (R’000) - Reasons if amount as per DORA not transferred - Amount spent by the Department/ municipality (R’000) - Reasons for the funds unspent by the entity - Monitoring mechanism by the transferring department -
Conditional grants and earmarked funds received The table/s below details the conditional grants and ear marked funds received during the period 1 April 2014 to 31 March 2015 Department who transferred the grant National Department of Health Purpose of the grant • To enable the health sector to develop an effective response to HIV and AIDS including universal access to HIV counselling and testing (HCT) • To support the implementation of the National Operational Plan for comprehensive HIV treatment and care • To subsidise in part, funding for the anti-retroviral treatment programme Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 355,972 Amount received (R’000) 355,972 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 354,004 Reasons for the funds unspent by the entity • The grant underspends with minimal amount of R1.968 million which results from delays of delivery by suppliers. Reasons for deviations on performance • Due to delays of delivery by suppliers. Measures taken to improve performance • Funds had been committed and a roll-over has been requested on this grant. Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Health Purpose of the grant • Support provinces to fund service costs associated with training of health science trainees on the public service platform Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 76,697 Amount received (R’000) 76,697 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 76,697 Reasons for the funds unspent by the entity 100% spent Reasons for deviations on performance - Measures taken to improve performance -
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Department who transferred the grant National Department of Health Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Health Purpose of the grant • Ensure provision of tertiary services for all South African citizens To compensate tertiary facilities for the additional costs associated with provision of these services Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 298,727 Amount received (R’000) 298,727 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 291,526 Reasons for the funds unspent by the entity • Delays in supplier delivery Reasons for deviations on performance • Delays in supplier delivery Measures taken to improve performance • The department assigned as officials to do order chasing. Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Health Purpose of the grant • Test innovations in health services delivery and provision for implementing NHI, allowing for each district to interpret and design innovations relevant to its specific context, in line with the vision for realising universal health coverage for all • To undertake health system strengthening activities in identified focus areas • To assess the effectiveness of interventions/activities undertaken in the districts funded through this grant Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 7,000 Amount received (R’000) 7,000 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 3,975 Reasons for the funds unspent by the entity • Delays in the implementation of business plan and vacancy on the position of NHI Project Manager.
Reasons for deviations on performance • Delays in the implementation of business plan and vacancy on the position of NHI Project Manager. Measures taken to improve performance • An official was appointed in November 2014 to act in the position of NHI Coordinator which was already late, considering other challenges. However, interviews were held in January 2015, which will only assist to accelerate grant performance in the new financial year. Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Public Works Purpose of the grant • To incentivise provincial departments to expand work creation efforts through the use of labour intensive delivery methods in the following focus areas, in compliance with the Expanded Public Works Programme guidelines: • Road maintenance and the maintenance of buildings • Low traffic volume roads and rural roads • Other economic and social infrastructure • Tourism and cultural industries • Sustainable land based livelihoods • Waste management Expected outputs of the grant -
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Department who transferred the grant National Department of Public Works Actual outputs achieved - Amount per amended DORA (R’000) 2,115 Amount received (R’000) 2,115 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 2,115 Reasons for the funds unspent by the entity 100% spent
Reasons for deviations on performance - Measures taken to improve performance - Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Public Works Purpose of the grant • To incentivise provincial social sector departments identified in the 2013 Social Sector Expanded Public Works Programme log-frame to increase job creation by focusing on the strengthening and expansion of social sector programmes that have employment potential. Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 7,337 Amount received (R’000) 7,337 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 7,337 Reasons for the funds unspent by the entity 100% spent
Reasons for deviations on performance - Measures taken to improve performance - Monitoring mechanism by the receiving department • Monthly and quarterly performance review
Department who transferred the grant National Department of Public Works Purpose of the grant • To help accelerate construction, maintenance, upgrading and rehabilitation of new and existing infrastructure in health including: health technology, organisational design (OD) systems and quality assurance (QA) • Supplement expenditure on health infrastructure delivered through public-private partnerships • To enhance capacity to deliver health infrastructure Expected outputs of the grant - Actual outputs achieved - Amount per amended DORA (R’000) 464,910 Amount received (R’000) 464,910 Reasons if amount as per DORA was not received 100% received Amount spent by the department (R’000) 395,519 Reasons for the funds unspent by the entity • Due to delays in appointing contractor of Port Nolloth, termination of contractor for Kagung Clinic and slow progress on Mental Health project. Reasons for deviations on performance • Due to delays in appointing contractor of Port Nolloth, termination of contractor for Kagung Clinic and slow progress on Mental Health project. Measures taken to improve performance • The acceleration plan has been developed and the implementing agents are constantly monitored for adherence to the service level agreements (SLA). A roll over has been requested for the funds that were already committed. Monitoring mechanism by the receiving department • Monthly and quarterly performance review.
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2.4.7 Donor Funds Donor Funds Received
Name of donor Not Applicable Full amount of the funding
Period of the commitment
Purpose of the funding
Expected outputs
Actual outputs achieved
Amount received (R’000)
Amount spent by the department (R’000)
Reasons for the funds unspent
Monitoring mechanism by the donor
2.4.8 Capital Investment
The department implemented capital investment, maintenance and asset management plan during the current financial year, the financial implications were as follows:
Infrastructure 2014/2015 2013/2014 projects
Final Actual (Over)/ Final Actual (Over)/ Appropria- Expenditure Under Appro- Expenditure Under tion R’000 Expenditure priation R’000 Expenditure R’000 R’000 R’000 R’000 New and replacement assets 446,000 335,827 110,173 357,795 416,257 58,462
Existing infrastructure assets 27,206 67,988 (40,782) 85,429 122,012 (36,583)
Upgrades and additions 11,186 40,117 (28,931) 24,500 15,598 8,902
Rehabilitation, renovations and 11,020 547 10,473 27,800 15,552 12,248 refurbishments
Maintenance and repairs 5,000 27,324 (22,324) 33,129 90,862 (57,733)
Infrastructure transfer ------
Capital 462,020 363,698 98,322 468,557 388,945 79,612
Current 11,186 40,117 (28,931) 33,129 90,862 (57,733)
Total 473,206 403,815 69,391 501,686 479,807 21,879
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Below are the comments for each of the areas of concern:
Item Progress Progress made on implementing the capital, in- 2014/15 Capital Projects were planned and implemented in vestment and asset management plan accordance with the User Asset Management Plan (U-AMP). The Health Facilities Management Programme has managed to complete the following projects: - • Upgrading at Frazerburg and Sutherland Hospitals. • Completion of Williston CHC staff accommodation. • Supply of 5 standby generators • Refurbishments at Kuruman Hospital. • Conversion of Gordonia Hospital into ZF Mgcawu Health District Office. • Erection of fence and guard house at Connie Voster and Galeshewe Day Hospital. There were progress on the - • Construction of De Aar Hospital (Phase 3). • Construction of Mental Hospital. Infrastructure projects which have been complet- • All upgrading projects have been completed. Deviations from ed in the current year and the progress in compari- the plan were experienced on the implementation of new capital son to what was planned at the beginning of the projects due to slow delivery by the Contractors. year. Provide reasons for material variances (2% • The Independent Development Trust (IDT) Implementing Agent variance) had to make correction proposals to the platform of the new Port Nolloth CHC. • Further industrial actions also had a detrimental effect on the delivery of both Port Nolloth CHC and De Aar Hospital. Infrastructure projects that are currently in progress • Port Nolloth CHC: 2017 (list projects) and when they are expected to be • Kagung Clinic: 2016 completed • Mental Health Hospital: 2016 • De Aar Hospital: 2016 Plans to close down or down-grade any current Not Applicable facilities Progress made on the maintenance of infrastruc- • Continuous capacitation of all staff at health facilities on ture maintenance requirements. • Continuous servicing of fire-fighting equipment. Repairs to buildings and roof structures in accordance with the Conditions Assessment. Developments relating to the above that are • Continuous engagement of all Health District Offices to create expected to impact on the departments current awareness on budget allocation for day-to-day maintenance. expenditure • This budget forms part of the current budget. Details as to how asset holdings have changed • Asset ownership has changed a lot with the buying of new furniture over the period under review, including informa- and the movement of the old furniture to other offices. tion on disposals, scrapping and loss due to theft • The department has identified assets for disposal, part of which has been evaluated by a service provider for either disposal through auctioning or donation. • A Theft and Losses register is being maintained. Measures taken to ensure that the departments as- • There has been no change in the main asset register in the last set register remained up to date during the period financial year. The additions register has been updated with the under review new assets bought in the year under review. The current state of the departments capital as- • 40% of the assets are in excellent condition, 20% in good condition, sets, for example what percentage is in good, fair 20% in fair condition and 20% in bad condition or bad condition Major maintenance projects that have been un- • Galeshewe Day Hospital, dertaken during the period under review • Kuruman Hospital, • Sutherland CHC and Fraserburg CHC and Dr Harry Surtie Hospital Progress made in addressing the maintenance • Continuous capacitation of all staff at health facilities on backlog during the period under review, for exam- maintenance requirements. ple, has the backlog grown or become smaller? Is • Improvements are being experienced at facilities that have the rate of progress according to plan? If not why undergone maintenance. not, and what measures were taken to keep on • The challenge that is facing the health facilities management track programme is insufficient budget allocation for the day-to-day maintenance by the health facility managers. • Despite the fact that maintenance takes place according to the plan the pace of addressing the backlog remains inadequate.
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2.5. PART C: GOVERNACE
2.5.1. Introduction
Good governance in public service is one of the indicators that show how well public funds are spent by officials. This further indicates the processes and structures that exist within government institutions geared towards ensuring compliance with all relevant legislative requirements that govern public service in general and the expenditure of funds thereof.
Our department has put in place processes, from recruitment of employees, to procurement of goods and services, right through to the disbursements and expenditure of public funds. These measures seek to ensure complete compliance with statutory requirements and the continuous provision of health services to the public.
In this instance the department has developed and is at the stage of completion of its organisational structure (organogram) which will address the human resource needs and performance efficiencies in the department, ensuring that health facilities are better staffed and equipped to effectively deliver services in an equitable and efficient manner. We have adopted and approved SCM policy to procure goods and services within the prescripts of the law. We have created structures to manage risks within the department, and to ensure that fraud and corruption is eliminated.
The department has established committees that are tasked to monitor good governance within. These include Audit Committee, Risk Management Committee, Policy Committee, and SCM Bid Committees.
We are in the processes of reviewing our performance in order to ensure that good governance is always improved to avoid any form of irregularity happening in the department.
2.5.2. Risk Management
The Department has an approved Risk Management Policy and Strategy and these have been implemented within the operations of the department. The Risk Management unit is in the process of ensuring risk management becomes and remains a high priority within the department.
The Department will be conducting regular risk assessments to review the risk registers of directorates, districts and facilities. These assessments help the department to better manage risks, and to come up with effective strategies to reduce those risks. These assessments also help in the identification of new emerging risks.
The Risk Management Committee was established and advises management on the issues of Risk Management. The Risk Management Committee also reviews the risk register for the whole department and it decides on the top ten risks of the Department.
There has been some progress made with Risk Management in the department and this has to an extent resulted in the improvement in some areas. There is room for improvement hence our endeavours to continue and strive for better performance. The Risk Management unit is continuously interacting with all relevant stakeholders to ensure that quality improvements are realised.
2.5.3. Fraud and Corruption
The Department has a Fraud Prevention Plan that was approved, together with the Whistle Blowing Policy. These documents have created an environment within the Department that seeks to ensure that ordinary employees are able to report cases of fraud and corruption without fear of reprisals.
The Security and Risk Management unit is in the process of conducting awareness campaigns with regards to the two above mentioned policy documents. These campaigns are geared towards ensuring that the incidents of fraud and corruption within the Department are minimized and eliminated.
Generally employees are aware of the procedure and processes followed when wanting to report fraud and corruption, and these are now documented in the policy documents.
2.5.4. Minimising Conflict of Interest
In all procurement thresholds as detailed in the National Treasury Practice Note 2 of 2005 reviewed in 2008 /2009, are areas of transactions that potential conflict of interest can occur. In this context, the Department has therefore instructed the following measures:
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a. As requested in terms of National Treasury Practice notes, all transactions between R10 000.00 until R30 000.00 the service providers bidding through quotation are expected to submit declaration, herein referred to as “SBD forms” to confirm whether owners of the companies are government employees. b. In light of the Department’s approved policy on Supply Chain Management, in terms of clause 20 of the same policy all SCM officials sign a code of conduct received from National Treasury requiring declaration of interest as well as disclosing any gifts received. c. With respect to bids / tenders, both committees at Evaluation and Adjudication level, all members sign a declaration of interest to attest to the best knowledge of their conscience as individuals in that they do not have conflict of interest with respect to the bids serving before them. d. As a further measure to address conflict of interest, transaction that were conducted in light of threshold values below R500 000.00, the following measure has been instituted:- d. (i). Transaction assessment and profiling to assess full compliance in terms of the following National Treasury Practice notes:
COMPLIANCE REQUIREMENTS RELATIVE TO THIS TRANSACTION THRESHOLD VALUE- * Compliance requirements to be adhered to: 1. National Treasury Practice Note 8 of 2007/2008 – Applicable sections in terms of this authority: 1a). -:- Section: 2.1, 3.3.1, 3.3.2 as well as 3.3.3 (about quotations). 2a). -:- Section: 6.1 (about Tax Clearance requirements). 2. National Treasury Practice Note 3 of 2006 – Applicable section in terms of this authority:- 1b). -:- Section: 1 (about Tax Clearance requirements). 3. National Treasury Practice Note 4 of 2006 – Applicable section in terms of this authority:- 1c) -:- Section: 3 (about submission of SBD 8 form) 4. National Treasury Practice Note 7 of 2009/2010 –Applicable section in terms of this authority:- 1d) -:- Section: 2.3 (about submission of SBD 4 form). 5. National Treasury Practice Note of 21 July 2010 – Applicable sections in terms of this authority:- 1e) -:- Section: 3.1.2 (about submission of SBD 9 form).
Through the above indicated Practice Notes from National Treasury, the specific sections indicated per each Practice Note are a requirement that SCM operationally and practically considers to address potential conflict of interests as well as necessary compliance to be adhered to in each transaction requisitioned by varying end users in the department to further and give effect to their operational requirements accordingly
2.5.5. Code of Conduct
The Department is using the national code of conduct as published by the Department of Public Administration in line with Batho Pele principles. Employees are taken through an induction programme that indicates, what is expected of each employee and what is the role of the Department in assisting each employee. (Refer to Explanatory manual on the code of conduct for the public service)
2.5.6. Health Safety and Environment Issues
Health, Safety and Environment (as understood under the common term “Occupational Health & Safety”) is not a competency of the various health departments, but resorts directly under the Department of Labour. The safety of our employees within their workplace is vitally important and the Department is committed to establishing and implementing relevant Policies and Protocols which promotes this.
The biggest gap in the Department presently is that there are no trained Safety Officers and therefore no fully functioning Health and Safety Committees. Health and Safety activities are also executed in an adhoc way, for example a district might have safety officers but they have not been trained, where there is Wellness staffs, initial medical surveillances are completed but no exit surveillances are completed. In order to rectify this, the Department has advertised the Safety Health Environment Risk and Quality (SHERQ) Manager’s post in order to establish a more co-ordinated and streamlined Safety Programme with the Department.
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The Department is also in the process of addressing the gaps with regard to approved policies. Some strides have been made in this area as the Department has approved SHERQ and Occupational Injuries and Disease in the Workplace policies. The HIV and AIDS, STIs and TB in the Workplace and Protective Clothing policies are in the consultative process.
The local authorities, mostly the district municipalities, are responsible for the rendering of Municipal Health Services (MHS) at government premises and also at all public health facilities in the Northern Cape Province. The role of Environmental Health Practitioners is to monitor the Health Care Risk Waste Management service rendered by the contracted service provider, Tshenolo Resources.
The safety of employees within the Department of Health is of paramount importance and therefore the lack of compliance in this area has been a concern. In order to improve this situation a SHERQ manager has been appointed to address the issues of non-compliance.
Letters of Delegation (Section 16.2) have been signed by the Head of Department and given to the following six (6) senior managers:
Senior Manager Area of Responsibility Ms V. Solo Provincial Office Mrs Selemela Henrietta Stockdale Nursing College Mr Links West End Specialised Hospital Ms Mazibuko District Health Services Ms Beukes Dr Harry Surtie Hospital Mr Moncho Kimberley Hospital Complex
One hundred and forty eight (148) Safety Representatives have been nominated.
2.5.7. Portfolio Committees
The dates of the Portfolio Committee meetings are as follows: Date of meeting Purpose of meeting Number of attendees
08 July 2014 Budget presentation 2014/2015 28 03 September 2014 1st Quarterly Presentation[April - June] 16 06 November 2014 Annual Report presentation 2013/2014 24 12 February 2015 2nd Quarterly presentation [July - September] 22 18 March 2015 3rd Quarterly presentation [October-December] 15
Matters raised by the Portfolio Committee and how has the department addressed these matters.
COMMITTEE OBSERVATIONS
• Planned targets are not clearly stated in the Annual Performance Plan. • Inability of the Department to retain Doctors and medical professionals. • The slow progress of transferring clinics from the local authorities to the Department. • Many patients still prefer treatment at hospitals instead of Primary Health Care facilities in especially rural areas.
RECOMMENDATIONS
The Department must:
• Always set SMART compliant targets in the Annual Performance plans. • Review its retention strategy and also improve incentives with a view of ensuring the high turnover rate of doctors and medical professionals is reduced. • Expedite the process of transferring all clinics from local authorities to the Department.
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• With the help of home based care givers and other stakeholders, continuously educate the public about the quality health services offered at Primary Health Care facilities.
REPORTS TO THE COMMITTEE The Department should forward the following report to the Committee within 30 days of tabling of this report: List of all clinical and hospital boards and their membership
1st Quarterly Report
COMMITTEE OBSERVATIONS
• The recruitment of health professionals especially in rural areas. • The over -expenditure on almost all the programmes of the Department. • Ineffective community dialogues in terms of communicable diseases in all districts. • The recruitment of the correct personnel in the supply chain management unit.
RECOMMENDATIONS
The Department must:
• Make a concerted effort to recruit health professionals in especially rural areas. • Set targets that are Specific, Measurable, Achievable, Realistic and Time bound and in line with the regulation on expenditure. • Intensify community dialogues with relevant stakeholders in all districts in respect of communicable diseases. • Ensure that vacant positions are filled in the supply chain management as per the prescripts of treasury.
REPORTS TO THE COMMITTEE
The Department must forward the following reports to the Committee within 30 days of tabling of this report:
• A report on the construction of the Port Nolloth Community Health Centre. • A report on the communication strategy on communicable diseases; • A report on the financial breakdown on the expenditure of the Opening of Dr Harry Surtie Hospital. • A list on the distribution of new ambulances to the districts for 2014/2015. • The Department submitted all requested Reports to the Committee on 29 September 2014.
Annual Report presentation The Committee made the following observations • Lack of proper financial management, thus compromising service delivery; • Performance targets that are unrealistic and repeatedly not achieved. • Lack of capacity in the Human Resources and Supply Chain Management units. • Inability to implement a proper record keeping systems within the Department. • Prolonged inability to collect revenue from private paying patients. • The appointment of personnel in unfunded positions that does not meet the criteria of the job. • The high level of absence of medical practitioners in the Province especially in rural areas. • Slow progress of contractors appointed by implementing agencies in terms of construction or refurbishments of facilities. • Nursing students not completing the nursing course.
RECOMMENDATIONS
The Department must:
Ensure proper financial management in all programmes of the department; • Review their annual performance plan and set performance targets that are Specific, Measurable, Achievable, Realistic and Time bound; • Speedily employ skilled and competent personnel in the Human Resources, and Supply Chain Management units.
95 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
• Vigorously implement the records management system within the department. • Implement the electronic data interface system as a matter of urgency to maximise revenue collection; • Ensure that critical funded positions are filled by employees that meet the necessary criteria for vacant positions; • Explore all avenues to ensure that medical practitioners are attracted and retained especially in rural areas. • Regularly monitor progress on tender processes and performance of the implementing agencies as it relates to the upgrading and construction of facilities; • Develop and implement an appropriate screening test to ensure that only dedicated candidates are enrolled as nursing students.
ACKNOWLEDGEMENT
The Committee acknowledges the efforts and the commitments made by the Department. However, the Committee remains concerned about the performance and financial management of the department. The Department needs to do more in order to migrate towards an unqualified audit report without matters of emphasis.
Reports to the Committee The Department should forward the following reports to the Committee within 30 days of tabling of this report:
• A report that highlights the remedial action in the 2014/2015 Annual Performance Plan. • Detailed report on the construction of the Port Nolloth hospital; • Report on the eights (8) irregular contracts and the value of each.
2nd Quarterly Report
COMMITTEE OBSERVATIONS • The improper financial control, leading to over–expenditure in Programme 1 – Administration and Programme 6 – Health Sciences and Training. • Lack of monitoring the implementation of quarterly set targets, as it relates to Internet connectivity in Community Health Centres and Infrastructure projects. • Inefficient monitoring of implementing agencies that is responsible for upgrading and infrastructure projects ofthe department.
RECOMMENDATIONS
The Department must:
• Strengthen capacity to ensure proper financial management in Programme 1-Administration and Programme 6 – Health Sciences and Training, to curb over-expenditure. • Set targets that are SMART, with the assurance that: Management oversees the implementation of set targets and; • Speedily roll-out the Internet connectivity in all Community health centres. • Regularly monitor progress on performance of the implementing agencies as it relates to upgrading and infrastructure projects.
REPORTS TO THE COMMITTEE The Department must forward the following reports to the Committee within 30 days after tabling of this report:
• The report on the Bid for the Emergency medical services training college. • Progress report on the Province’s readiness of the Ebola unit. • Report on the operational status of the West End hospital. • Progress report on the upgrading of the Henrietta Stockdale nursing college. • Comprehensive report on the forensic - pathology services in the province.
3rd Quarterly Report COMMITTEE OBSERVATIONS
• Poor financial planning that leads to continuous over expenditure. • Improper financial management in supply chain management unit, resulting in late payment of service providers and prolonged accruals.
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• Slow progress in implementing the integrated school health programme. • Slow progress on the provincialisation of clinics in the province.
RECOMMENDATIONS
The Department must • Properly plan and put financial control measures in place to prevent over expenditure. • Urgently employ financial experts in the supply chain management unit, to ensure that payments are done in line with the prescripts of the law and to curb accruals. • Strengthen its recruitment strategy to attract health professionals to areas where the School integrated health programme is not operational. • Expedite the provincialisation of clinics in the province.
REPORTS TO THE COMMITTEE
The Department must forward the following reports to the Committee within 30 days after tabling of this report:
• A report on the human papilloma virus campaign that was held in the province. • A report on the critical funded vacant positions that was filled in the 2nd 2014/15, and 3rd quarter of 2014/2015. • A Report on the primary health centres that were earmarked to operate for 24hours in the province.
2.5.8. SCOPA Resolutions
Resolution Subject Details Response by the department Resolved No. (Yes/No) 1. Prevention of The department must • The department initiated an Audit No Irregular, fruitless and take effective steps Project Management Plan, the purpose wasteful expenditure to prevent irregular, of which is to develop and implement wasteful and fruitless a rectification plan designed to address expenditure as the audit qualifications. prescribed by law and • This plan covers all the qualification regulations paragraphs in the Audit Report which are then converted into projects. • Irregular, Fruitless and wasteful expenditure are projects 4 and 5 respectively on the Audit Project Management Plan. • This plan was approved by the Accounting Officer.
2. Disciplinary steps The Accounting Officer • One of the responsibility of the project No against officials must take effective champion is to develop standard responsible for non- disciplinary steps against operating procedures that will spell out compliance officials responsible the following amongst others; for non- compliance • The processes and procedures to with the provision of be put in place to prevent non- the PFMA, Treasury compliance Regulations and any • The methodology of determining other applicable non-compliance, and corrective legislation measures to be implemented once non-compliance is confirmed.
3. Proper planning to The department • The planning and budgeting process of No avoid under must ensure proper the Department will be linked expenditure planning to avoid • SCM processes of the department will under expenditure. be improved as part of the Audit Project This must be included Management Plan. in the performance • Corrective actions will be outlined at agreements of all the end of every performance quarterly managers responsible review. • Financial management will be included in all managers performance agreements.
97 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Resolution Subject Details Response by the department Resolved No. (Yes/No) 4. Contract The Department must • The contract management unit within No management ensure that its contract the SCM unit will be strengthened to management system adequately monitor contracts. is effective and that • End users will be held accountable for there are adequate the management and monitoring of controls, supervision and contracts in their area of responsibility. monitoring to ensure accuracy and credibility
5. Asset management The Accounting Officer • Asset management is project number No must ensure that all 1, 2 and 3 on the Audit Project assets of the department Management Plan. are accounted for • The asset management unit will be and an asset register strengthened at provincial, districts and is regularly updated to institutions monitor asset movement • Addition register will be reconciled on in the department monthly basis • Asset controllers will be trained and account regularly on the state of assets in their area of responsibility • Full Asset count will be performed at least once a year • Disposals will be done on a quarterly basis
6. Capacity in Supply Officials in the supply • This process will be undertaken as No Chain unit chain management unit part of projects 4 and 5 of the Audit must be re-trained and Project Management plan that deals re-capacitated with, Irregular, Fruitless and wasteful expenditure
7. Audit Rectification The department must • An Audit Rectification Plan for both Yes Plan reflect in their 2014/15 finance and performance were annual performance developed and presented to the plan the Audit legislature Rectification Plan
2.5.9. Prior modification to audit reports
Nature of qualification, disclaimer, adverse Financial year in Progress made in clearing/resolving the mat- opinion and matters of non-compliance which it first arose ter Immovable tangible capital assets: 2012 • The immovable asset register was maintained The auditor was unable to obtain sufficient for the year under review and completed appropriate audit evidence for immovable assets were transferred to the Department of assets due to the department not providing Public Works. supporting documentation for audit purposes. • The department developed an Audit Project Management Plan with all qualification paragraphs converted into projects led by a project champion. Immovable tangible capital assets are project number 1 on the plan. Movable tangible capital assets: 2012 • A service provider has been appointment • This item was overstated in the annual to assist the department with the process of financial statements due to obsolete disposal. movable capital assets not written off by the • Addition register is updated on a monthly department. basis • Movable capital assets were not accounted • The department developed an Audit Project for in accordance with the Modified Cash Management Plan with all qualification Standard prescribed by the National paragraphs converted into projects led by a Treasury. project champion. Movable tangible capital • The auditors were unable to obtain sufficient assets are project number 2 on the plan. appropriate audit evidence for the amount disclosed due to the department providing an inaccurate asset register for audit purposes.
98 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Nature of qualification, disclaimer, adverse Financial year in Progress made in clearing/resolving the mat- opinion and matters of non-compliance which it first arose ter Intangible capital assets: 2012 • Addition register is updated on a monthly • Intangible capital assets were understated basis because they were no recorded in the • All intangible assets are procured through the intangible asset register. departmental IT unit • Intangible capital assets were not • The department developed an Audit Project accounted for in accordance with the Management Plan with all qualification Modified Cash Standard prescribed by the paragraphs converted into projects led by a National Treasury. project champion. Intangible capital assets • The auditors were unable to obtain sufficient are project number 3 on the plan. appropriate audit evidence for the amount disclosed due to the department providing an inaccurate asset register for audit purposes. Commitments: 2014 • A bursary commitment register will be • Commitments were understated due to developed commitments not disclosed in accordance • Monthly reporting of commitments will be with the Modified Cash Standard prescribed enforced by the National Treasury • The department developed an Audit Project • The auditors were unable to obtain sufficient Management Plan with all qualification appropriate audit evidence for bursary paragraphs converted into projects led by a commitments project champion. Commitments are project number 9 on the plan. Accruals: 2012 • Monthly reporting of accruals will be enforced Accruals were understated due to accruals not • The department developed an Audit Project disclosed in accordance with the Modified Cash Management Plan with all qualification Standard prescribed by the National Treasury paragraphs converted into projects led by a project champion. Accruals are project number 8 on the plan. Irregular expenditure: 2011 • Management of irregular expenditure registers • Irregular expenditure was understated due will be enforced to payments made in contravention of • Monthly reporting of irregular expenditure will numerous laws and regulations also be enforced • The approved delegations were included in • The department developed an Audit Project the irregular expenditure as required by the Management Plan with all qualification Modified Cash Standard prescribed by the paragraphs converted into projects led by National Treasury a project champion. Irregular expenditure is project number 4 on the plan Fruitless and wasteful expenditure: 2012 • Management of fruitless and wasteful • The department did not have an adequate expenditure registers will be enforced system to identify and record fruitless and • Monthly reporting of fruitless and wasteful wasteful expenditure as required by the expenditure will also be enforced Modified Cash Standard prescribed by the • The department developed an Audit Project National Treasury Management Plan with all qualification paragraphs converted into projects led by a project champion. Fruitless and wasteful expenditure is project number 5 on the plan Accrued departmental revenue: • The department developed an Audit Project • Accrued departmental revenue was Management Plan with all qualification understated paragraphs converted into projects led by a • Weaknesses in the system prevented the project champion. Accrued departmental auditors from determining the extent of the revenue is project number 6 on the plan error. Employee-related cost: 2011 • The department developed an Audit Project • The employee related costs were misstated Management Plan with all qualification due to the department not having paragraphs converted into projects led by a adequate controls over employee costs. project champion. Employee related cost is • The auditors were unable to obtain sufficient project number 7 on the plan appropriate audit evidence for overtime.
99 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.5.10. Internal Control Unit
The Audit and Internal Control unit’s primary objective is to facilitate in the process of achieving and improvement in the department’s audit outcome. The unit facilitated communication between the department and the Auditor General in order to provide a central point of contact for information requests and communications. The unit is also responsible to review all submissions to the auditors to ensure quality and consistency.
The unit also facilitated communication in the same manner as with the external auditors, between the department and the Shared Internal Audit for all internal audits conducted during the year. Once the unit’s capacity is expanded, it will be able to expand its activities into regular reviews of systems and procedures (both financial and performance related) within the department.
2.5.11 Internal Audit and Audit Committees
Key activities and objectives of the internal audit: The Executive Council of the Northern Cape Provincial Government has established an Internal Audit Unit (IAU) to provide internal audit services to all twelve (12) departments within the province. The shared Provincial Internal Audit Unit is divided into four (4) clusters, Department of Health being serviced by the Internal Audit Unit - Health Cluster. The IAU is an independent, objective assurance and consulting activity designed to add value and improve the client’s operations.
The following internal audit work was completed during the year under review: • Information Technology Governance review • Management Performance Assessment Tool certification • Interim Financial Statements review • Annual Financial Statements review • Human Resource Management - Labour relations • Human Resource Management – Leave management • Audit of Performance Information • Supply Chain Management • Fraud Risk evaluation • Asset management • Conditional Grant Controls review
The internal audit unit also attended and contributed to the departmental risk management committee meetings and ad hoc management meetings as and when requested.
2.5.12 Audit Committee
Key activities and objectives of the audit committee: The Executive Council of the Northern Cape Provincial Government has established Cluster Audit Committees for the twelve (12) Provincial Departments. The Health Cluster Audit Committee deals with three (3) departments including the Department of Health. The Audit Committee assists the department by providing advice relating to the reporting process, the system of internal control, the risk management processes, the internal and external audit process and the departments processes for monitoring compliance with laws and regulations and the code of conduct.
The Audit Committee consists of the members listed below. It meets as frequent as mandated by the approved Audit Committee charter and as often as it deems necessary. During the financial year under review, four (4) meetings were convened as per its charter.
The table below discloses relevant information on the audit committee members Audit committee member three year contracts expired on 30 September 2014. The Provincial Executive Council renewed some audit committee members and appointed additional audit committee members during December 2014. Audit committee membership and attendance up to 30 September 2014:
100 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Name Qualifications Internal or If internal, Date Contract No. of external position in appointed expired Meetings the depart- attended ment Anushka Phd (International External n/a 27 September 30 September 3 Ramlall Finance), MBA (Finance 2011 2014 Management), Post Grad Diploma (Financial Management), B.Com Admin (Political Sci- ence) Frans van Der LLB, B Iuris, Dip Iuris External n/a 27 September 30 September 3 Westhuizen 2011 2014 Bongani Post Graduate Diploma in External n/a 27 September 30 September 3 Ngqola Business Management, 2011 2014 Certified Information Systems Auditor (CISA), Higher Diploma in Computer Auditing, Bachelor of Commerce (Information Systems)
Audit committee membership and attendance up to 31 March 2015: Name Qualifications Internal or If internal, Date Date No. of external position in the appointed Re- Meetings department signed attended Bongani Ngqola Post Graduate Diploma External n/a 2 December n/a 2 in Business Management, 2014 Certified Information Systems Auditor (CISA), Higher Diploma in Computer Auditing, Bachelor of Commerce (Information Systems) Frans van Der LLB, B Iuris, Dip Iuris External n/a 2 December n/a 2 Westhuizen 2014 Charles Motau B Com (Accounting and External n/a 12 December n/a 2 Economics), 2014 Higher Diploma in Com- puter auditing, Master’s Degree in Busi- ness Leadership and Master’s Degree in Infor- mation Technology Bafedile Lenkoe Magister in Public Admin- Internal Chief Director 12 December n/a 1 istration (MPA) 2014 Phemelo Kegak- Bachelor of Veterinary Internal Acting Chief 12 December n/a 0 ilwe Medicine and Surgery Director 2014
Report of the Audit Committee
We are pleased to present our report for the financial year ended 31 March 2015.
Audit Committee Responsibility
The Audit Committee reports that it has complied with its responsibilities arising from Section 38 (1) (a) (ii) of the Public Finance Management Act and Treasury Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has regulated its affairs in compliance with this charter and has discharged all its responsibilities as contained therein.
The Effectiveness of Internal Control
The Audit Committee noted with concern the weaknesses in the system of internal control in the Department of Health. The weakness of system of internal control is attributed from the lack of proper governance and leadership challenges. There is
101 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15 a need for significant improvement for the system of internal control in the areas of Internal Control, Risk Management and Compliance.
Internal Audit Effectiveness The internal audit function carries its mandate according to the Internal Audit charter approved by the Audit Committee. Internal Audit function is responsible for an independent and objective evaluation of the system of internal control. The Internal Audit is required to identify and report any significant internal control risks and exposure to the attention of Department senior management and the Audit Committee.
The Audit Committee notes with satisfaction the independence and objectivity of Internal Audit function. The Internal Audit function has identified and reported through comprehensive internal audit reporting the significant control weaknesses to management and the Audit Committee.
A Combined Assurance Plan has been developed for the department and Internal Audit coordinated its assurance efforts with those of the Auditor-General South Africa.
Internal Audit function has also undergone an external evaluation by the IIASA and has successfully implemented some of the recommendations that came out of the external review during the year of the review.
Risk management
The Northern Cape Department of Health has established and implemented a Risk Management system, however the system needs significant improvement. The Audit Committee made several recommendations, however these were not successfully implemented under the year of the review.
In-Year Management and Monthly/Quarterly Report
The department has been reporting monthly and quarterly to the relevant Treasury as is required by the PFMA.
Evaluation of Financial Statements
The Audit Committee has reviewed and noted with concern the annual financial statements prepared by the Department for the year under review. The Audit Committee noted that, although there is improvement of the Annual Financial Statements from the previous financial years, there is still a need for significant improvement.
The Audit Committee notes with concern the leadership challenges, and in particular the absence of Chief Financial Officer (CFO) to be one of many contributing factors to the state of finances as presented in the annual financial statements.
Auditor-General’s Report
For the year under review the department was able to move from 9 qualification areas to 8 qualification areas and a minor reduction in other matters reported by the Auditor-General. The department was not successful to eradicate more qualifications and other reporting areas as it did not compile a comprehensive audit rectification plan with action owners, timeframes and monitoring responsibilities. Most ofthe recommendations made by the Audit Committee were not implemented by the department resulting in repeat findings by internal audit and the Auditor-General.
The Audit Committee concurs and accepts the conclusions of the Auditor-General on the annual financial statements and is of the opinion that the audited annual financial statements be accepted and read together with the report of the Auditor- General.
The Audit Committee is satisfied with the independence of the External Auditor from the department and the commitment to keep Audit Committee informed on the audit affairs of the Department.
______Bongani Ngqola Chairperson of the Audit Committee Department of Health Date: 28 August 2015 102 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.6. Part D: HUMAN RESOURCE MANAGEMENT 2.6.1. Introduction
• The status of human resources in the department
Providing efficient and effective human resource systems has been one of the key focus area raised of the department over the years. The importance of strengthening human resource capacity still however remains a challenge within the Department. In addressing the challenge, the department has taken appropriate steps which included skills analysis within the Directorate and the organisation at large. This process led to the restructuring of the unit, where a number of officials were relocated to Human Resource Management as part of capacity building and with the anticipation that the skills possessed by these individuals will assist in dealing with the current challenges faced by the Unit.
As part of improving service delivery the Department made strides to have an approved organogram. The proposed structure was presented to Executive Committee (Exco) and forwarded to the Minister of Public Service Administration for approval.
The office of the Auditor General has over the number of year’s highlighted records management as one of the root causes that played a significant role in the audit outcomes of the unit. It is against this background that the Chief Directorate Co-operate services took an initiative to establish a records management unit as part of auxiliary services. The Directorate also launched its Human Resource forum in November 2014 to provide a plant form where all Human Resource officials across the province meet to share their experiences around the issues of Human Resource.
• Priorities and their impact
◦ Review and align the Provincial Human Resource Plan with the service delivery platform The Department has an approved Human Resource Plan for the Medium Term Expenditure Framework period 2012/13 - 2014/15 with the adjusted Human Resource Management Planning Implementation report submitted on a yearly basis depending on the changes to the action plan, Medium Term Expenditure Framework (MTEF) plan or changes within the Department as a result of a merge or a split between Departments.
Human Resource Planning has been used as a tool in ensuring that capacity issues are adequately addressed across all levels within the Department as well as informing recruitment and retention strategies.
◦ Improve Performance Management and Development Systems and processes The alignment between the performance of the Department and the Performance Management Development System of employees remains a fundamental issue in addressing service delivery. Initiatives have been made by the Department by facilitating workshops across Districts to share knowledge on the role played by PMDS as a tool that can be used to measure performance of the individuals as opposed to only being an incentive tool.
• Workforce planning and key strategies to attract and recruit a skilled and capable workforce
As part of staff capacity building, staff members are awarded bursaries yearly to enhance their skills within their areas of responsibility. The Department is also awarding external bursaries to youth who want to study in the Health Professions within the Northern Cape as part of youth development and increasing of health professionals within the Province aimed at improving quality healthcare. These mechanisms are used as part of staff retention and recruitment. The Department has an approved Retention Policy which aims to retain critical and scarce skilled employees with emphasis on succession planning and development to retain employees.
In responding to the challenges of high staff turnover rate, the department is in the process of developing a retention strategy and a recruitment plan for all vacancies of critical or scarce occupations. The objective of this is to improve the vacancy rate and to create employment for citizens of the Northern Cape. The increase in the CEO budget of the Department has led to an overall increase in the internship opportunities provided.
• Employee Performance Management
There has been an improvement in the management of employee performance; this is evident in the increased number of submissions made by the relevant managers. The submission rate of Performance Agreements of Senior Managers (SMS) members is at 100%, which could have influenced the overall increase of submissions in the Department. Strides have also been made to capacitate managers in managing poor performance of employees and not only reward good performance.
103 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Training has been conducted across the districts as part of the intervention strategy of highlighting to employees the importance of Performance Management Development System (PMDS) towards adding value for their future employment growth and the importance of fully participating in the process. The department is in a process of reviewing all the Job Descriptions of Senior Managers to ensure proper alignment between their Key Performance Areas and operational plans of the department.
• Employee Wellness Programmes
The role played by Wellness Management in providing Individual and Organisational Wellness which focus on improving work life balance plays a key role in the performance of employees. Due to budget pressures and infrastructure constraints the programme was unable to secure a site during the 2014/2015 financial year, however there are measures put in place to ensure that there is a dedicated site for Employee Health and Wellness within the department. Senior Managers were appointed as Health and safety representatives in relation to their area of responsibility. The appointed Safety Health Environment Risk and Quality (SHERQ) Manager will play a contributing role in ensuring that the unit improves on its service delivery mandates.
Challenges and measures planned to overcome them
Challenges and Concerns Proposed corrective action • Poor Leave management • Develop a training roll out plan to address all the service benefits risk areas. • Vacancies not filled within four (4) months • Develop a recruitment plan for 2015/16 for the placement of block adverts • Reporting lines not properly aligned to staff • Draft functional structure of units in line with the corporate struc- ture • The lack of Standard Operating Procedures • Benchmark with other Employee Health and Wellness Units from other sector departments to share relevant information • Lack of Employee Health and Wellness Site • Utilise Kimberley Hospital Wellness site as a provincial departmen- tal site • Managers not conducting exit interviews • To make exit interviews a compulsory management function • Districts fail to capture PMDS on PERSAL • To improve communication and training of Human Resource Man- agement Practitioners throughout the province to ensure captur- ing of PMDS documents timely
Future human resource plans/ goals
• Review and align the Provincial Human Resource Plan with the service delivery platform • Improve Performance Management and Development Systems and processes
2.6.2. Human Resources Oversight Statistics 3.1. Personnel related expenditure
TABLE 3.1.1 – Personnel expenditure by programme for the period 1st April 2014 and 31 March 2015
Programme Total Expendi- Personnel Training Profes- Personnel cost as Average ture (R’000) Expenditure Expenditure sional and a percent of total personnel cost (R’000) (R’000) Special expenditure per employee Services (R’000) (R’000) Administration 215 018 97 720 0 0 45.4 15 Central hospital services 764 909 528 282 0 0 69.1 79 District health services 1 613 876 892 365 0 0 55.3 133 Emergency medical 234 691 148 419 0 0 63.2 22 services Health care support 83 587 56 727 0 0 67.9 9 services Health facilities 397 933 6 958 0 0 1.7 1 management 104 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme Total Expendi- Personnel Training Profes- Personnel cost as Average ture (R’000) Expenditure Expenditure sional and a percent of total personnel cost (R’000) (R’000) Special expenditure per employee Services (R’000) (R’000) Health sciences and 65 614 26 725 0 0 40.7 4 training Provincial hospital 290 627 180 052 0 0 62 27 services Z=Total as on Financial 3 714 663 1 937 246 0 0 52.2 289 Systems (BAS)
TABLE 3.1.2 Personnel costs by salary bands for the period 1 April 2014 and 31 March 2015
Salary Bands Compensation of Percentage of Total Average Compensa- Number of Employees Cost Personnel Cost for tion Cost per Employee Employees including Transfers Department (R) (R’000) Lower skilled (Levels 1-2) 787 0 131 167 6 Skilled (Levels 3-5) 544 588 27.8 157 441 3459 Highly skilled production (Lev- 411 692 21 290 128 1419 els 6-8) Highly skilled supervision (Lev- 675 305 34.4 566 531 1192 els 9-12) Senior management (Levels 107 731 5.5 1 297 964 83 13-16) Contract (Levels 3-5) 25 706 1.3 238 019 108 Contract (Levels 6-8) 35 595 1.8 211 875 168 Contract (Levels 9-12) 116 716 6 478 344 244 Contract (Levels 13-16) 21 709 1.1 1 447 267 15 Periodical Remuneration 4 160 0.2 462 222 9 Abnormal Appointment 2 496 0.1 11 556 216 TOTAL 1946485 99.2 281325 6919
105 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.1.3 Salaries, Overtime, Home Owners Allowance and Medical Assistance by programme for the period 1 April 2014 and 31 March 2015
Programme Salaries Salaries Overtime Overtime HOA HOA as % Medical Ass. Medical Ass. as % Total Personnel Cost (R’000) as % of (R’000) as % of (R’000) of Personnel (R’000) of Personnel Cost per Programme Personnel Personnel Cost (R’000) Cost Cost Administration 78473 76.4 505 0.5 1750 1.7 3196 3.1 102697 Central hospital services 372390 70.1 67073 12.6 10024 1.9 16694 3.1 531560 District health services 649031 71.7 21584 2.4 26869 3 34899 3.9 905442 Emergency medical services 98532 66.1 8150 5.5 6045 4.1 8660 5.8 149022 Health care support services 37820 69.9 2927 5.4 1869 3.5 2929 5.4 54117 Health facilities management 5960 54.2 10 0.1 38 0.3 111 1 11005 Health sciences 19066 71.1 2880 10.7 274 1 552 2.1 26828 Provincial hospital services 129877 71.8 9924 5.5 5967 3.3 5871 3.2 180798 TOTAL 1391149 70.9 113053 5.8 52836 2.7 72912 3.7 1961469
TABLE 3.1.4 Salaries, Overtime, Home Owners Allowance and Medical Assistance by salary band for the period 1 April 2014 and 31 March 2015
Salary bands Salaries Salaries as % of Overtime Overtime as % HOA (R’000) HOA as % of Medical Ass. Medical Ass. as (R’000) Personnel Cost (R’000) of Personnel Personnel Cost (R’000) % of Personnel Cost Cost Lower skilled (Levels 1-2) 531 63 9 1.1 40 4.7 82 9.7 Skilled (Levels 3-5) 368149 67.4 10937 2 32611 6 38325 7 Highly skilled production (Levels 6-8) 294901 71.2 6106 1.5 12408 3 19165 4.6 Highly skilled supervision (Levels 9-12) 485089 71.1 48899 7.2 7610 1.1 14522 2.1 Senior management (Levels 13-16) 73983 66.9 19253 17.4 153 0.1 736 0.7 Contract (Levels 3-5) 24198 94 631 2.5 0 0 0 0 Contract (Levels 6-8) 34128 95.7 201 0.6 12 0 6 0 Contract (Levels 9-12) 92591 79 21365 18.2 2 0 24 0 Contract (Levels 13-16) 15085 68.7 5653 25.8 0 0 53 0.2 Periodical Remuneration 0 0 0 0 0 0 0 0 Abnormal Appointment 2495 93.6 0 0 0 0 0 0 TOTAL 1391150 70.9 113054 5.8 52836 2.7 72913 3.7
106 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.2 Employment and Vacancies
TABLE 3.2.1 – Employment and vacancies by programme as on 31 March 2015 Programme Number of posts Number of Vacancy Number of posts on approved es- posts filled Rate filled additional tablishment to the establishment Administration, Permanent 416 236 43.3 1 Central hospital services, Permanent 1753 1477 15.7 0 Central hospital services, Temporary 8 14 -75 0 District health services, Permanent 4359 3103 28.8 1 District health services, Temporary 38 39 -2.6 0 Emergency medical services, Permanent 997 816 18.2 0 Emergency medical services, Temporary 4 4 0 0 Health care support services, Permanent 316 220 30.4 0 Health facilities management, Permanent 18 14 22.2 3 Health sciences, Permanent 69 50 27.5 0 Provincial hospital services, Permanent 951 721 24.2 0 TOTAL 8929 6694 25 5
TABLE 3.2.2 Employment and vacancies by salary band as on 31 March 2015
Salary band Number of posts Number of posts Vacancy Number of posts on approved es- filled Rate filled additional to tablishment the establishment Lower skilled (Levels 1-2), Permanent 19 4 78.9 0 Lower skilled (Levels 1-2), Temporary 6 6 0 0 Skilled (Levels 3-5), Permanent 4591 3451 24.8 0 Skilled (Levels 3-5), Temporary 6 8 -33.3 0 Highly skilled production (Levels 6-8), Per- 1863 1401 24.8 0 manent Highly skilled production (Levels 6-8), Tem- 14 18 -28.6 0 porary Highly skilled supervision (Levels 9-12), 1755 1167 33.5 0 Permanent Highly skilled supervision (Levels 9-12), 20 21 -5 0 Temporary Senior management (Levels 13-16), Perma- 116 79 31.9 0 nent Senior management (Levels 13-16), Tem- 4 4 0 0 porary Contract (Levels 3-5), Permanent 108 108 0 0 Contract (Levels 6-8), Permanent 168 168 0 0 Contract (Levels 9-12), Permanent 244 244 0 4 Contract (Levels 13-16), Permanent 15 15 0 1 TOTAL 8929 6694 25 5
107 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.2.3 – Employment and vacancies by critical occupations as on 31 March 2015
Critical Occupations Number of Posts Number of Vacancy Number of Posts on approved Posts Filled Rate Filled Additional establishment to the Establishment Administrative related, Permanent 240 164 31.7 0 All artisans in the building metal machinery etc., 10 5 50 0 Permanent Ambulance and related workers, Permanent 824 716 13.1 0 Architects town and traffic planners, Permanent 1 1 0 1 Archivists curators and related professionals, Perma- 1 1 0 0 nent Artisan project and related superintendents, Perma- 17 10 41.2 0 nent Auxiliary and related workers, Permanent 157 109 30.6 0 Biochemistry pharmacologist. zoology & life science 6 4 33.3 0 technician, Permanent Boiler and related operators, Permanent 1 0 100 0 Building and other property caretakers, Permanent 15 4 73.3 0 Bus and heavy vehicle drivers, Permanent 45 18 60 0 Cleaners in offices workshops hospitals etc., Perma- 1015 803 20.9 0 nent Cleaners in offices workshops hospitals etc., Tempo- 3 3 0 0 rary Client information clerks (switchboard receptionist 27 21 22.2 0 inform clerks), Permanent Community development workers, Permanent 2 2 0 0 Computer programmers., Permanent 1 1 0 0 Computer system designers and analysts., Perma- 1 1 0 0 nent Dental practitioners, Permanent 55 43 21.8 0 Dental specialists, Permanent 1 1 0 0 Dental technicians, Permanent 1 1 0 0 Dental therapy, Permanent 12 9 25 0 Dieticians and nutritionists, Permanent 80 55 31.3 0 Dieticians and nutritionists, Temporary 1 1 0 0 Electrical and electronics engineering technicians, 3 0 100 0 Permanent Emergency services related, Permanent 81 60 25.9 0 Engineering sciences related, Permanent 2 2 0 1 Engineers and related professionals, Permanent 9 7 22.2 1 Environmental health, Permanent 39 24 38.5 0 Finance and economics related, Permanent 1 1 0 0 Financial and related professionals, Permanent 6 5 16.7 0 Financial clerks and credit controllers, Permanent 73 25 65.8 0 Food services aids and waiters, Permanent 97 76 21.6 0 Food services workers, Permanent 5 4 20 0 General legal administration & rel. professionals, 1 1 0 0 Permanent Head of department/chief executive officer, Per- 1 1 0 0 manent Health sciences related, Permanent 22 14 36.4 0 Household and laundry workers, Permanent 210 156 25.7 0
108 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupations Number of Posts Number of Vacancy Number of Posts on approved Posts Filled Rate Filled Additional establishment to the Establishment Housekeepers laundry and related workers, Perma- 6 5 16.7 0 nent Human resources & organisational development & 3 1 66.7 0 relate prof, Permanent Human resources clerks, Permanent 5 4 20 0 Human resources related, Permanent 2 1 50 0 Information technology related, Permanent 12 4 66.7 0 Leather workers, Permanent 1 1 0 0 Legal related, Permanent 2 1 50 0 Library mail and related clerks, Permanent 3 2 33.3 0 Light vehicle drivers, Permanent 51 39 23.5 0 Material-recording and transport clerks, Permanent 7 5 28.6 0 Medical practitioners, Permanent 561 401 28.5 0 Medical practitioners, Temporary 34 37 -8.8 0 Medical research and related professionals, Perma- 2 1 50 0 nent Medical specialists, Permanent 33 17 48.5 0 Medical specialists, Temporary 6 10 -66.7 0 Medical technicians/technologists, Permanent 9 5 44.4 0 Messengers porters and deliverers, Permanent 130 113 13.1 0 Motor vehicle drivers, Permanent 2 2 0 0 Nursing assistants, Permanent 1071 868 19 0 Occupational therapy, Permanent 87 66 24.1 0 Occupational therapy, Temporary 2 2 0 0 Optometrists and opticians, Permanent 2 1 50 0 Oral hygiene, Permanent 2 2 0 0 Other administration & related clerks and organis- 990 620 37.4 0 ers, Permanent Other administrative policy and related officers, 122 99 18.9 0 Permanent Other information technology personnel., Perma- 35 13 62.9 0 nent Other occupations, Permanent 22 21 4.5 0 Pharmaceutical assistants, Permanent 45 38 15.6 0 Pharmacists, Permanent 204 152 25.5 1 Pharmacologists pathologists & related professional, 7 0 100 0 Permanent Physiotherapy, Permanent 91 63 30.8 0 Printing and related machine operators, Permanent 2 2 0 0 Professional nurse, Permanent 1733 1303 24.8 0 Professional nurse, Temporary 3 3 0 0 Psychologists and vocational counsellors, Perma- 22 15 31.8 0 nent Psychologists and vocational counsellors, Tempo- 1 1 0 0 rary Radiography, Permanent 131 107 18.3 0 Secretaries & other keyboard operating clerks, 5 4 20 0 Permanent Security guards, Permanent 4 2 50 0 Security officers, Permanent 2 2 0 0
109 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupations Number of Posts Number of Vacancy Number of Posts on approved Posts Filled Rate Filled Additional establishment to the Establishment Senior managers, Permanent 26 14 46.2 1 Shoemakers, Permanent 1 1 0 0 Social work and related professionals, Permanent 27 21 22.2 0 Speech therapy and audiology, Permanent 41 32 22 0 Staff nurses and pupil nurses, Permanent 282 218 22.7 0 Supplementary diagnostic radiographers, Perma- 2 2 0 0 nent Trade labourers, Permanent 30 24 20 0 Trade/industry advisers & other related profession, 2 0 100 0 Permanent TOTAL 8929 6694 25 5
3.3. Filling of SMS Posts
TABLE 3.3.1 SMS post information as on 31 March 2015
SMS Level Total number of Total number of % of SMS posts Total number % of SMS posts funded SMS posts SMS posts filled filled of SMS posts vacant vacant 16 1 1 100% 0 0% 15 1 1 100% 0 0% 14 6 5 83% 1 17% 13 38 28 74% 10 26%
TABLE 3.3.2 SMS post information as on 30 September 2014
SMS Level Total number of Total number of % of SMS posts Total number % of SMS posts funded SMS posts SMS posts filled filled of SMS posts vacant vacant 16 1 1 100% 0 0% 15 1 1 100% 0 0% 14 6 5 83% 1 17% 13 38 26 68% 12 32%
TABLE 3.3.3 Advertising and filling of SMS posts for the period 1 April 2014 and 31 March 2015
SMS Level Total number of Total number of % of SMS posts Total number % of SMS posts funded SMS posts SMS posts filled filled of SMS posts vacant vacant 16 1 1 100% 0 0% 15 1 1 100% 0 0% 14 6 5 83% 1 17% 13 38 26 68% 12 32%
110 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.3.4 reasons for not having complied with the filling of funded vacant SMS- Advertised within 6 months and filled within 12 months after becoming vacant for the period 1 April 2014 and 31 March 2015
Reasons for vacancies not advertised within six months Review of the organizational structure and alignment of core functions/grouping of related core functions for enhancement of service delivery
Reasons for vacancies not filled within six months Review of the organizational structure and alignment of core functions/grouping of related core functions for enhancement of service delivery
Table 3.3.5 Disciplinary steps taken for not complying with the prescribed timeframes for filing SMS posts within 12 months for the period 1 April 2014 and 31 March 2015
Reasons for vacancies not advertised within six months Not applicable in view of the above mentioned process
3.4. Job evaluation
TABLE 3.4.1 Job Evaluation by Salary band for the period 1 April 2014 and 31 March 2015
Number of posts Number of % of posts Posts Upgraded Posts downgraded Salary band on approved Jobs Evalu- evaluated Number % of posts Number % of posts establishment ated by salary evaluated evaluated bands Lower skilled (Levels 19 0 0 0 0 0 0 1-2), Permanent Lower skilled (Levels 6 0 0 0 0 0 0 1-2), Temporary Skilled (Levels 3-5), 4591 442 9.6% 442 9.6% 0 0 Permanent Skilled (Levels 3-5), 6 0 0 0 0 0 0 Temporary Highly skilled pro- 1863 1 0.05% 1 0.05% 0 0 duction (Levels 6-8), Permanent Highly skilled pro- 14 0 0 0 0 0 0 duction (Levels 6-8), Temporary Highly skilled supervi- 1755 0 0 0 0 0 0 sion (Levels 9-12), Permanent Highly skilled supervi- 20 0 0 0 0 0 0 sion (Levels 9-12), Temporary Senior management 116 0 0 0 0 0 0 (Levels 13-16), Perma- nent Senior management 4 0 0 0 0 0 0 (Levels 13-16), Tem- porary Contract (Levels 3-5), 108 0 0 0 0 0 0 Permanent Contract (Levels 6-8), 168 0 0 0 0 0 0 Permanent
111 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Number of posts Number of % of posts Posts Upgraded Posts downgraded Salary band on approved Jobs Evalu- evaluated Number % of posts Number % of posts establishment ated by salary evaluated evaluated bands Contract (Levels 244 0 0 0 0 0 0 9-12), Permanent Contract (Levels 13- 15 0 0 0 0 0 0 16), Permanent Lower skilled (Levels 19 0 0 0 0 0 0 1-2), Permanent
TABLE 3.4.2 – Profile of employees whose salary positions were upgraded due to their posts being upgraded for the period 1 April 2014 and 31 March 2015
Beneficiary African Asian Coloured White Total Female 292 0 83 0 375 Male 48 0 20 0 68 Total 340 0 103 0 443 Employees with a disability 2
TABLE 3.4.3 – Employees with salary levels higher than those determined by job evaluation by occupation for the period 1 April 2014 and 31 March 2015
Occupation Number of em- Job evalua- Remuneration Reason for ployees tion level level deviation 0 0 0 0 - Total number of employees whose salaries 0 exceeded the level determined by job evaluation
TABLE 3.4.4 Profile of employees who have salary levels higher than those determined by job evaluation for the period 1 April 2013 and 31 March 2014
Notes If there were no cases where the salary level were higher than those determined by job evaluation, keep the heading and replace the table with the following:
Total Number of Employees whose salaries exceeded the grades determined by job evaluation in 2014/15 -
3.5. Employment changes Table 3.5.1 – Annual turnover rates by salary band for the period 1 April 2014 and 31 March 2015
Salary Band Number of Appointments Terminations and Turnover Employees at and transfers transfers out of Rate Beginning of into the depart- the department period April 2013 ment Lower skilled (Levels 1-2), Permanent 2 0 0 0 Lower skilled (Levels 1-2), Temporary 6 0 0 0 Skilled (Levels 3-5), Permanent 3291 306 246 7.5 Skilled (Levels 3-5), Temporary 9 0 2 22.2 Highly skilled production (Levels 6-8), 1438 114 219 15.2 Permanent
112 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Salary Band Number of Appointments Terminations and Turnover Employees at and transfers transfers out of Rate Beginning of into the depart- the department period April 2013 ment Highly skilled production (Levels 6-8), 18 0 4 22.2 Temporary Highly skilled supervision (Levels 9-12), 1179 71 177 15 Permanent Highly skilled supervision (Levels 9-12), Tem- 29 0 10 34.5 porary Senior Management Service Band A, Per- 44 1 6 13.6 manent Senior Management Service Band A, Tem- 4 0 1 25 porary Senior Management Service Band B, Perma- 8 0 1 12.5 nent Senior Management Service Band B, Tem- 2 0 0 0 porary Senior Management Service Band C, Per- 25 0 1 4 manent Senior Management Service Band D, Per- 1 0 0 0 manent Contract (Levels 3-5), Permanent 161 23 51 31.7 Contract (Levels 6-8), Permanent 123 150 69 56.1 Contract (Levels 9-12), Permanent 196 181 96 49 Contract (Band A), Permanent 12 1 2 16.7 Contract (Band B), Permanent 2 0 1 50 Contract (Band C), Permanent 1 0 0 0 TOTAL 6551 847 886 13.5
TABLE 3.5.2 – Annual turnover rates by critical occupation for the period 1 April 2014 and 31 March 2015
Critical Occupation Number of Appointments Terminations and Turnover employees at and transfers transfers out of the Rate beginning of into the depart- department period April 2013 ment Administrative related, Permanent 175 5 17 9.7 All artisans in the building metal machinery 8 0 3 37.5 etc., Permanent Ambulance and related workers, Perma- 659 70 24 3.6 nent Architects town and traffic planners, Per- 1 0 0 0 manent Artisan project and related superintendents, 11 0 2 18.2 Permanent Auxiliary and related workers, Permanent 115 7 30 26.1 Biochemistry pharmacologist. zoology & life 4 0 0 0 science technician, Permanent Building and other property caretakers, 9 0 5 55.6 Permanent Bus and heavy vehicle drivers, Permanent 12 6 1 8.3 Cleaners in offices workshops hospitals etc., 825 40 75 9.1 Permanent Cleaners in offices workshops hospitals etc., 3 0 0 0 Temporary Client inform clerks(switchboard reception- 23 1 4 17.4 ist inform clerks), Permanent 113 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupation Number of Appointments Terminations and Turnover employees at and transfers transfers out of the Rate beginning of into the depart- department period April 2013 ment Communication and information related, 1 0 0 0 Permanent Community development workers, Perma- 2 0 0 0 nent Computer programmers., Permanent 1 0 0 0 Computer system designers and analysts., 0 1 0 0 Permanent Dental practitioners, Permanent 33 24 14 42.4 Dental specialists, Permanent 1 0 0 0 Dental technicians, Permanent 1 0 0 0 Dental therapy, Permanent 9 0 0 0 Dieticians and nutritionists, Permanent 51 12 8 15.7 Dieticians and nutritionists, Temporary 1 0 0 0 Electrical and electronics engineering tech- 1 0 0 0 nicians, Permanent Emergency services related, Permanent 33 33 0 0 Engineering sciences related, Permanent 1 1 0 0 Engineers and related professionals, Perma- 4 0 1 25 nent Environmental health, Permanent 32 11 11 34.4 Finance and economics related, Perma- 1 0 0 0 nent Financial and related professionals, Perma- 6 0 1 16.7 nent Financial clerks and credit controllers, Per- 23 7 4 17.4 manent Food services aids and waiters, Permanent 82 1 7 8.5 Food services workers, Permanent 4 0 0 0 General legal administration & rel. profes- 1 0 0 0 sionals, Permanent Head of department/chief executive of- 1 0 0 0 ficer, Permanent Health sciences related, Permanent 15 0 1 6.7 Household and laundry workers, Permanent 158 9 13 8.2 Housekeepers laundry and related workers, 4 1 0 0 Permanent Human resources & organisational develop- 2 0 1 50 ment & relate prof, Permanent Human resources clerks, Permanent 4 0 0 0 Human resources related, Permanent 1 0 0 0 Information technology related, Permanent 4 0 0 0 Leather workers, Permanent 1 0 0 0 Legal related, Permanent 1 0 0 0 Library mail and related clerks, Permanent 3 0 1 33.3 Light vehicle drivers, Permanent 40 2 3 7.5 Material-recording and transport clerks, 5 0 0 0 Permanent Medical practitioners, Permanent 376 140 90 23.9 Medical practitioners, Temporary 43 0 14 32.6 Medical research and related professionals, 1 0 0 0 Permanent
114 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupation Number of Appointments Terminations and Turnover employees at and transfers transfers out of the Rate beginning of into the depart- department period April 2013 ment Medical specialists, Permanent 15 3 2 13.3 Medical specialists, Temporary 14 0 3 21.4 Medical technicians/technologists, Perma- 7 0 2 28.6 nent Messengers porters and deliverers, Perma- 107 16 8 7.5 nent Motor vehicle drivers, Permanent 2 0 0 0 Nursing assistants, Permanent 878 72 123 14 Occupational therapy, Permanent 54 29 16 29.6 Occupational therapy, Temporary 2 0 0 0 Optometrists and opticians, Permanent 1 0 0 0 Oral hygiene, Permanent 2 1 1 50 Other administrative & related clerks and 620 34 57 9.2 organisers, Permanent Other administrative policy and related of- 103 2 11 10.7 ficers, Permanent Other information technology personnel., 5 3 0 0 Permanent Other occupations, Permanent 16 0 0 0 Pharmaceutical assistants, Permanent 45 38 15.6 0 Pharmacists, Permanent 204 152 25.5 1 Pharmacologists pathologists & related 7 0 100 0 professional, Permanent Physiotherapy, Permanent 91 63 30.8 0 Printing and related machine operators, 2 2 0 0 Permanent Professional nurse, Permanent 1733 1303 24.8 0 Professional nurse, Temporary 3 3 0 0 Psychologists and vocational counsellors, 22 15 31.8 0 Permanent Psychologists and vocational counsellors, 1 1 0 0 Temporary Radiography, Permanent 131 107 18.3 0 Secretaries & other keyboard operating 5 4 20 0 clerks, Permanent Security guards, Permanent 4 2 50 0 Security officers, Permanent 2 2 0 0 Senior managers, Permanent 26 14 46.2 1 Shoemakers, Permanent 1 1 0 0 Social work and related professionals, Per- 27 21 22.2 0 manent Speech therapy and audiology, Permanent 41 32 22 0 Staff nurses and pupil nurses, Permanent 282 218 22.7 0 Supplementary diagnostic radiographers, 2 2 0 0 Permanent Trade labourers, Permanent 30 24 20 0 Trade/industry advisers & other related pro- 2 0 100 0 fession, Permanent
TOTAL 8929 6694 25 5
115 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.5.3 – Reasons why staff left the department for the period 1 April 2014 and 31 March 2015
Termination Type Number % of total resignation Death, Permanent 36 4.1 Resignation, Permanent 451 50.9 Resignation, Temporary 3 0.3 Expiry of contract, Permanent 211 23.8 Expiry of contract, Temporary 14 1.6 Discharged due to ill health, Permanent 1 0.1 Dismissal-misconduct, Permanent 27 3 Dismissal-inefficiency, Permanent 15 1.7 Retirement, Permanent 126 14.2 Other, Permanent 2 0.2 TOTAL 886 100
Table 3.5.4 Promotions by critical occupation for the period 1 April 2014 and 31 March 2015
Occupation Employees as Promotions Salary Level Progressions Notch at 1 April 2014 to another Promotions as a to another progressions salary level % of Employees Notch within as a % of by occupation a Salary Level Employees by occupation Administrative related 175 2 1.1 66 37.7 All artisans in the building 8 0 0 6 75 metal machinery etc. Ambulance and related 659 5 0.8 276 41.9 workers Architects town and traffic 1 0 0 0 0 planners Archivists curators and related 0 0 0 1 0 professionals Artisan project and related 11 0 0 8 72.7 superintendents Auxiliary and related workers 115 0 0 71 61.7 Biochemistry pharmacology. 4 0 0 2 50 zoology & life science .technical Building and other property 9 0 0 5 55.6 caretakers Bus and heavy vehicle drivers 12 0 0 7 58.3 Cleaners in offices workshops 828 0 0 632 76.3 hospitals etc. Client inform 23 0 0 10 43.5 clerks(switchboard receptionist inform clerks) Communication and 1 0 0 0 0 information related Community development 2 0 0 0 0 workers Computer programmers. 1 0 0 1 100 Dental practitioners 33 0 0 14 42.4 Dental specialists 1 0 0 0 0 Dental technicians 1 0 0 0 0 Dental therapy 9 0 0 6 66.7
116 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Occupation Employees as Promotions Salary Level Progressions Notch at 1 April 2014 to another Promotions as a to another progressions salary level % of Employees Notch within as a % of by occupation a Salary Level Employees by occupation Dieticians and nutritionists 52 1 1.9 19 36.5 Electrical and electronics 1 0 0 0 0 engineering technicians Emergency services related 33 0 0 13 39.4 Engineering sciences related 1 0 0 1 100 Engineers and related 4 0 0 3 75 professionals Environmental health 32 0 0 10 31.3 Finance and economics 1 0 0 0 0 related Financial and related 6 0 0 1 16.7 professionals Financial clerks and credit 23 2 8.7 15 65.2 controllers Food services aids and 82 0 0 47 57.3 waiters Food services workers 4 0 0 3 75 General legal administration 1 0 0 0 0 & rel. professionals Head of department/chief 1 0 0 1 100 executive officer Health sciences related 15 2 13.3 2 13.3 Household and laundry 158 0 0 131 82.9 workers Housekeepers laundry and 4 0 0 2 50 related workers Human resources & 2 0 0 1 50 organisational development & relate prof Human resources clerks 4 0 0 2 50 Human resources related 1 0 0 1 100 Information technology 4 0 0 0 0 related Leather workers 1 0 0 0 0 Legal related 1 0 0 1 100 Library mail and related clerks 3 0 0 2 66.7 Light vehicle drivers 40 0 0 26 65 Material-recording and 5 0 0 0 0 transport clerks Medical practitioners 419 19 4.5 76 18.1 Medical research and related 1 0 0 1 100 professionals Medical specialists 29 1 3.4 6 20.7 Medical technicians/ 7 0 0 4 57.1 technologists Messengers porters and 107 0 0 86 80.4 deliverers Motor vehicle drivers 2 0 0 2 100 Nursing assistants 878 0 0 44 5
117 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Occupation Employees as Promotions Salary Level Progressions Notch at 1 April 2014 to another Promotions as a to another progressions salary level % of Employees Notch within as a % of by occupation a Salary Level Employees by occupation Occupational therapy 56 1 1.8 12 21.4 Optometrists and opticians 1 0 0 0 0 Oral hygiene 2 0 0 1 50 Other administration & 620 13 2.1 147 23.7 related clerks and organisers Other administrative policy 103 2 1.9 50 48.5 and related officers Other information technology 5 0 0 7 140 personnel. Other occupations 16 0 0 18 112.5 Pharmaceutical assistants 37 0 0 13 35.1 Pharmacists 130 7 5.4 56 43.1 Pharmacologists pathologists 2 0 0 0 0 & related professional Physiotherapy 59 1 1.7 18 30.5 Printing and related machine 2 0 0 2 100 operators Professional nurse 1269 27 2.1 57 4.5 Psychologists and vocational 15 0 0 7 46.7 counsellors Radiography 100 5 5 41 41 Secretaries & other keyboard 5 0 0 2 40 operating clerks Security guards 2 0 0 1 50 Security officers 2 0 0 0 0 Senior managers 16 0 0 0 0 Shoemakers 1 0 0 1 100 Social work and related 24 0 0 11 45.8 professionals Speech therapy and 31 0 0 10 32.3 audiology Staff nurses and pupil nurses 210 2 1 8 3.8 Supplementary diagnostic 2 0 0 2 100 radiographers Trade labourers 26 0 0 25 96.2 TOTAL 6551 90 1.4 2094 32
118 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.5.5 – Promotions by salary band for the period 1 April 2014 and 31 March 2015
Salary Band Employees 1 Promotions Salary Level Progressions Notch April 2014 to another Promotions as a to another progressions Salary Level % of Employees Notch within as a % of by salary level a Salary Level Employees by salary band Lower skilled (Levels 1-2), 2 0 0 0 0 Permanent Lower skilled (Levels 1-2), 6 0 0 0 0 Temporary Skilled (Levels 3-5), 3291 10 0.3 1493 45.4 Permanent Skilled (Levels 3-5), 9 0 0 1 11.1 Temporary Highly skilled production 1438 23 1.6 359 25 (Levels 6-8), Permanent Highly skilled production 18 0 0 2 11.1 (Levels 6-8), Temporary Highly skilled supervision 1179 45 3.8 183 15.5 (Levels 9-12), Permanent Highly skilled supervision 29 0 0 5 17.2 (Levels 9-12), Temporary Senior management (Levels 78 6 7.7 33 42.3 13-16), Permanent Senior management (Levels 6 0 0 2 33.3 13-16), Temporary Contract (Levels 3-5), 161 0 0 1 0.6 Permanent Contract (Levels 6-8), 123 0 0 3 2.4 Permanent Contract (Levels 9-12), 196 5 2.6 4 2 Permanent Contract (Levels 13-16), 15 1 6.7 8 53.3 Permanent TOTAL 6551 90 1.4 2094 32
119 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.6 Employment Equity
The tables in this section are based on the formats prescribed by the Employment Equity Act, 55 of 1998.
Table 3.6.1 – Total number of employees (including employees with disabilities) in each of the following occupational categories as on 31 March 2015
Occupational Categories Male, Male, Coloured Male, Male, Total Male, Female, Female, Female, Female, Female, Total African Indian Blacks White African Coloured Indian Total White Blacks Legislators, senior officials and man- 10 1 0 11 1 4 0 0 4 0 16 agers, Permanent Professionals, Permanent 106 55 44 205 140 81 112 43 236 194 775 Professionals, Temporary 4 6 0 10 25 1 0 1 2 11 48 Technicians and associate profes- 238 85 2 325 14 677 686 12 1375 298 2012 sionals, Permanent Technicians and associate profes- 0 0 0 0 0 0 0 0 0 6 6 sionals, Temporary Clerks, Permanent 147 87 0 234 3 277 134 1 412 32 681 Service and sales workers, Perma- 304 289 3 596 18 665 554 0 1219 42 1875 nent Craft and related trades workers, 2 10 0 12 5 0 0 0 0 0 17 Permanent Plant and machine operators and 31 26 0 57 1 3 0 0 3 0 61 assemblers, Permanent Elementary occupations, Perma- 281 151 0 432 2 445 311 0 756 6 1196 nent Elementary occupations, Temporary 0 1 0 1 0 0 2 0 2 0 3 Other, Permanent 1 0 0 1 0 1 1 1 3 0 4 TOTAL 1124 711 49 1884 209 2154 1800 58 4012 589 6694
120 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.6.2 – Total number of employees (including employees with disabilities) in each of the following occupational bands as on 31 March 2015
Occupational Bands Male, Male, Male, Male, Total Male, Female, Female, Female, Female, Female, Total African Coloured Indian Blacks White African Coloured Indian Total White Blacks Top Management, Permanent 6 1 2 9 10 1 0 0 1 4 24 Senior Management, Permanent 15 5 6 26 14 6 1 2 9 6 55 Senior Management, Temporary 0 0 0 0 3 0 0 0 0 1 4 Professionally qualified and 132 71 19 222 89 305 329 17 651 205 1167 experienced specialists and mid- management, Permanent Professionally qualified and 4 2 0 6 12 1 0 0 1 2 21 experienced specialists and mid- management, Temporary Skilled technical and academically 151 95 2 248 16 444 501 4 949 188 1401 qualified workers, junior management, supervisors, foremen, Permanent Skilled technical and academically 0 3 0 3 5 0 0 1 1 9 18 qualified workers, junior management, supervisors, foremen, Temporary Semi-skilled and discretionary decision 732 480 1 1213 15 1310 869 1 2180 43 3451 making, Permanent Semi-skilled and discretionary decision 0 0 0 0 2 0 1 0 1 5 8 making, Temporary Unskilled and defined decision making, 1 0 0 1 0 1 1 1 3 0 4 Permanent Unskilled and defined decision making, 0 2 0 2 3 0 1 0 1 0 6 Temporary Contract (Top Management), 0 0 0 0 1 0 0 0 0 0 1 Permanent Contract (Senior Management), 4 0 2 6 5 0 0 0 0 3 14 Permanent Contract (Professionally qualified), 33 14 17 64 31 19 31 28 78 71 244 Permanent Contract (Skilled technical), Permanent 20 5 0 25 3 37 47 4 88 52 168 Contract (Semi-skilled), Permanent 26 33 0 59 0 30 19 0 49 0 108 TOTAL 1124 711 49 1884 209 2154 1800 58 4012 589 6694
121 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.6.3 – Recruitment for the period 1 April 2014 and 31 March 2015
Occupational Bands Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total African Coloured Indian Total Blacks White African Coloured Indian Total White Blacks Senior Management, Permanent 0 0 0 0 1 0 0 0 0 0 1 Professionally qualified and experienced 13 1 2 16 15 14 12 1 27 13 71 specialists and mid-management, Permanent Skilled technical and academically 16 4 1 21 0 44 34 0 78 15 114 qualified workers, junior management, supervisors, foremen, Permanent Semi-skilled and discretionary decision 91 40 0 131 1 126 48 0 174 0 306 making, Permanent Contract (Senior Management), 1 0 0 1 0 0 0 0 0 0 1 Permanent Contract (Professionally qualified), 22 9 15 46 27 13 17 25 55 53 181 Permanent Contract (Skilled technical), Permanent 19 2 0 21 3 30 42 5 77 49 150 Contract (Semi-skilled), Permanent 7 2 0 9 0 11 3 0 14 0 23 TOTAL 169 58 18 245 47 238 156 31 425 130 847
Table 3.6.4 Promotions for the period 1 April 2014 to 31 March 2015
Occupational Bands Male, Male, Male, Male, Total Male, Female, Female, Female, Female, Female, Total African Coloured Indian Blacks White African Coloured Indian Total White Blacks Top Management, Permanent 1 0 2 3 8 0 0 0 0 2 13 Senior Management, Permanent 5 1 6 12 7 0 0 2 2 5 26 Senior Management, Temporary 0 0 0 0 2 0 0 0 0 0 2 Professionally qualified and experienced 29 20 3 52 36 34 48 7 89 51 228 specialists and mid-management, Per- manent Professionally qualified and experienced 2 0 0 2 3 0 0 0 0 0 5 specialists and mid-management, Temporary Skilled technical and academically 56 58 1 115 9 93 90 2 185 73 382 qualified workers, junior management, supervisors, foremen, Permanent
122 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Occupational Bands Male, Male, Male, Male, Total Male, Female, Female, Female, Female, Female, Total African Coloured Indian Blacks White African Coloured Indian Total White Blacks Skilled technical and academically 0 0 0 0 0 0 0 0 0 2 2 qualified workers, junior management, supervisors, foremen, Temporary Semi-skilled and discretionary decision 377 263 0 640 11 519 324 0 843 9 1503 making, Permanent Semi-skilled and discretionary decision 0 0 0 0 0 0 1 0 1 0 1 making, Temporary Contract (Senior Management), 2 0 2 4 2 0 0 0 0 3 9 Permanent Contract (Professionally qualified), 5 0 1 6 0 0 2 1 3 0 9 Permanent Contract (Skilled technical), Permanent 0 0 0 0 0 1 2 0 3 0 3 Contract (Semi-skilled), Permanent 0 0 0 0 0 1 0 0 1 0 1 TOTAL 477 342 15 834 78 648 467 12 1127 145 2184
Table 3.6.5 – Terminations for the period 1 April 2014 to 31 March 2015
Occupational Bands Male Female Total Male, Male, Male, Male, Total Male, Female, Female, Female, Female, Female, African Coloured Indian Blacks White African Coloured Indian Total White Blacks Top Management, Permanent 0 0 0 0 1 0 0 0 0 0 1 Senior Management, Permanent 3 1 0 4 0 3 0 0 3 0 7 Senior Management, Temporary 0 0 0 0 1 0 0 0 0 0 1 Professionally qualified and experienced 14 12 3 29 11 50 50 4 104 33 177 specialists and mid-management, Permanent Professionally qualified and experienced 0 1 1 2 8 0 0 0 0 0 10 specialists and mid-management, Temporary Skilled technical and academically 22 17 0 39 4 63 78 1 142 34 219 qualified workers, junior management, supervisors, foremen, Permanent
123 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Occupational Bands Male Female Total Male, Male, Male, Male, Total Male, Female, Female, Female, Female, Female, African Coloured Indian Blacks White African Coloured Indian Total White Blacks Skilled technical and academically 0 0 0 0 3 0 0 1 1 0 4 qualified workers, junior management, supervisors, foremen, Temporary Semi-skilled and discretionary decision 54 30 0 84 4 78 71 0 149 9 246 making, Permanent Semi-skilled and discretionary decision 0 0 0 0 2 0 0 0 0 0 2 making, Temporary Contract (Senior Management), 0 0 0 0 1 0 1 0 1 1 3 Permanent Contract (Professionally qualified), 9 5 6 20 21 12 6 15 33 22 96 Permanent Contract (Skilled technical), Permanent 6 3 0 9 0 14 23 3 40 20 69 Contract (Semi-skilled), Permanent 20 3 0 23 0 18 10 0 28 0 51 TOTAL 128 72 10 210 56 238 239 24 501 119 886
124 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.6.6 Disciplinary action for the period 1 April 2014 to 31 March 2015
Disciplinary Action MALE FEMALE African Coloured Indian White African Coloured Indian White TOTAL Abuse of sick leave 0 0 0 0 0 0 0 0 0 Dishonesty 1 1 0 0 0 0 0 0 2 Late coming 1 0 0 0 0 0 0 0 1 Assault 0 0 0 0 2 0 0 0 2 Gross insubordination 2 0 0 0 0 1 0 0 3 Insolence 3 1 0 0 0 1 0 0 5 Intentional or negligent damage to the employee 3 0 0 0 0 0 0 0 3 or client of the employer, co-worker
Intoxication 4 1 0 0 0 0 0 0 5 Gross absenteeism 3 1 0 0 2 4 0 0 10 Insubordination 1 1 0 0 1 0 0 0 3 Abuse of government vehicle 0 0 0 0 0 0 0 0 0
Gross negligence 1 0 0 0 0 0 0 0 1 Dereliction of duties 5 1 0 1 0 0 0 0 7 Fraud 4 1 0 0 2 1 0 0 8 Remunerative Work outside of Public Service 0 0 0 0 0 0 0 0 0 Misrepresentation 0 0 0 0 0 0 0 0 0 Negligence 1 0 0 0 1 0 0 0 2 Abuse of State property 0 0 0 0 0 0 0 0 0 Bringing the Name of the Department into Disre- 2 1 0 0 0 0 0 0 3 pute Absenteeism 10 2 0 0 1 0 0 0 13 Theft 1 1 0 0 1 0 0 0 3
125 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Table 3.6.7 – Skills development for the period 1 April 2014 to 31 March 2015
Occupational Male Female categories African Coloured Indian White African Coloured Indian White Total Medical Doctors 609 582 13 149 498 476 15 121 2463 Professional Nurses 77 74 2 18. 63 60 3 15 314 Non-Professionals 260 248 5 63 213 203 4 52 1502 HRM Practitioners 14 13 1 3 11 11 1 3 57 HRD practitioners 3 2 0 0 6 2 0 0 13 Senior Administration 6 5 0 0 5 4 0 0 20 Officers and Adminis- tration Officers Finance Practitioners 18 17 1 4 15 14 0 4 73 SDF’s 4 3 1 0 4 0 0 0 12 Psychologist 0 0 0 2 0 0 0 0 2
3.7. Signing of Performance Agreements by SMS Members
Table 3.7.1. Signing of Performance Agreements by SMS members as on 31 May 2014
SMS Level Total number of Total number of Total number of signed Signed performance agree- funded SMS posts SMS members performance agree- ments as % of total number ments of SMS members 16 1 1 1 100% 15 1 1 1 100% 14 6 5 5 100% 13 38 28 28 100%
Table 3.7.2 Reasons for not having concluded Performance agreements for all SMS members as on 31 March 2015
Reasons None
Table 3.7.3 Disciplinary steps taken against SMS members for not having concluded Performance agreements as on 31 March 2015
Reasons None
126 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.8. Performance Rewards
TABLE 3.8.1 Performance Rewards by race, gender, and disability for the period 1 April 2014 to 31 March 2015
Race and Gender Beneficiary Profile Cost Number of Total number of % of total within Cost (R’000) Average Cost Beneficiaries employees in group per employee group African, Female 13 2152 0.6 124 9 559
African, Male 13 1120 1.2 96 7 396
Asian, Female 1 58 1.7 14 13 992
Asian, Male 0 49 0 0 0
Coloured, Female 7 1800 0.4 43 6 198
Coloured, Male 9 709 1.3 54 6 046
Total Blacks, Female 21 4010 0.5 182 8 650
Total Blacks, Male 22 1878 1.2 151 6 844
White, Female 10 588 1.7 87 8 739
White, Male 1 208 0.5 14 13 529
Employees with a disability 0 10 0 0 0
TOTAL 54 6694 0.8 433 8 021
TABLE 3.8.2 Performance Rewards by salary bands for personnel below Senior Management Service for the period 1 April 2014 to 31 March 2015
Salary Bands Beneficiary Profile Cost Number of Number of % of total Total Cost Average Total cost as a % of the beneficiaries employ- within (R’000) cost per total personnel ees salary employee expenditure bands Lower skilled (Levels 1-2) 0 6 0 0 0 Lower skilled (Levels 1-2) Skilled (Levels 3-5) 29 3459 0.8 139 4 793 Skilled (Levels 3-5) Highly skilled production 15 1419 1.1 144 9 600 Highly skilled production (Levels 6-8) (Levels 6-8) Highly skilled supervision 10 1192 0.8 150 15 000 Highly skilled supervision (Levels 9-12) (Levels 9-12) Contract (Levels 3-5) 0 108 0 0 0 Contract (Levels 3-5) Contract (Levels 6-8) 0 168 0 0 0 Contract (Levels 6-8) Contract (Levels 9-12) 0 244 0 0 0 Contract (Levels 9-12) Periodical Remuneration 0 9 0 0 0 Periodical Remuneration Abnormal Appointment 0 216 0 0 0 Abnormal Appointment TOTAL 54 6821 0.8 433 8019 TOTAL
127 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.8.3 – Performance Rewards by critical occupations for the period 1 April 2014 to 31 March 2015
Critical Occupations Beneficiary Profile Cost Number of Number of % of total Total Cost Average beneficiaries employees within (R’000) cost per occupation employee
Administrative related 8 164 4.9 106 13 250 All artisans in the building metal machinery 0 5 0 0 0 etc. Ambulance and related workers 2 716 0.3 11 5 500 Architects town and traffic planners 0 1 0 0 0 Archivists curators and related professionals 0 1 0 0 0 Artisan project and related superintendents 1 10 10 14 14 000 Auxiliary and related workers 3 109 2.8 17 5 667 Biochemistry pharmacology. zoology & life 1 4 25 17 17 000 science .technical Building and other property caretakers 0 4 0 0 0 Bus and heavy vehicle drivers 0 18 0 0 0 Cleaners in offices workshops hospitals etc. 13 806 1.6 55 4 231 Client inform clerks(switchboard receptionist 0 21 0 0 0 information clerks) Community development workers 0 2 0 0 0 Computer programmers. 0 1 0 0 0 Computer system designers and analysts. 0 1 0 0 0 Dental practitioners 0 43 0 0 0 Dental specialists 0 1 0 0 0 Dental technicians 0 1 0 0 0 Dental therapy 0 9 0 0 0 Dieticians and nutritionists 0 56 0 0 0 Emergency services related 0 60 0 0 0 Engineering sciences related 0 2 0 0 0 Engineers and related professionals 0 7 0 0 0 Environmental health 0 24 0 0 0 Finance and economics related 0 1 0 0 0 Financial and related professionals 0 5 0 0 0 Financial clerks and credit controllers 0 25 0 0 0 Food services aids and waiters 1 76 1.3 5 5 000 Food services workers 0 4 0 0 0 General legal administration & rel. 0 1 0 0 0 professionals Head of department/chief executive officer 0 1 0 0 0 Health sciences related 0 14 0 0 0 Household and laundry workers 4 156 2.6 21 5 250 Housekeepers laundry and related workers 0 5 0 0 0 Human resources & organisational 0 1 0 0 0 development & relate professions Human resources clerks 1 4 25 7 7 000 Human resources related 0 1 0 0 0 Information technology related 0 4 0 0 0 Leather workers 0 1 0 0 0 Legal related 0 1 0 0 0
128 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupations Beneficiary Profile Cost Number of Number of % of total Total Cost Average beneficiaries employees within (R’000) cost per occupation employee Library mail and related clerks 0 2 0 0 0 Light vehicle drivers 0 39 0 0 0 Material-recording and transport clerks 0 5 0 0 0 Medical practitioners 0 435 0 0 0 Medical research and related professionals 0 1 0 0 0 Medical specialists 0 27 0 0 0 Medical technicians/technologists 0 5 0 0 0 Messengers porters and deliverers 3 113 2.7 16 5 333 Motor vehicle drivers 0 2 0 0 0 Housekeepers laundry and related workers 0 5 0 0 0 Human resources & organisational develop- 0 1 0 0 0 ment & related professionals Human resources clerks 1 4 25 7 7 000 Human resources related 0 1 0 0 0 Information technology related 0 4 0 0 0 Leather workers 0 1 0 0 0 Legal related 0 1 0 0 0 Library mail and related clerks 0 2 0 0 0 Light vehicle drivers 0 39 0 0 0 Material-recording and transport clerks 0 5 0 0 0 Medical practitioners 0 435 0 0 0 Medical research and related professionals 0 1 0 0 0 Medical specialists 0 27 0 0 0 Medical technicians/technologists 0 5 0 0 0 Messengers porters and deliverers 3 113 2.7 16 5 333 Motor vehicle drivers 0 2 0 0 0 Nursing assistants 0 868 0 0 0 Occupational therapy 1 68 1.5 13 13 000 Optometrists and opticians 0 1 0 0 0 Oral hygiene 0 2 0 0 0 Other administration & related clerks and 8 620 1.3 70 8 750 organisers Other administrative policy and related 4 99 4 44 11 000 officers Other information technology personnel. 0 13 0 0 0 Other occupations 0 21 0 0 0 Pharmaceutical assistants 1 38 2.6 7 7 000 Pharmacists 1 151 0.7 8 8 000 Physiotherapy 2 63 3.2 22 11 000 Printing and related machine operators 0 2 0 0 0 Professional nurse 0 1306 0 0 0 Psychologists and vocational counsellors 0 16 0 0 0 Radiography 0 107 0 0 0 Rank: Unknown 0 4 0 0 0 Secretaries & other keyboard operating clerks 0 4 0 0 0 Security guards 0 2 0 0 0 Security officers 0 2 0 0 0 Senior managers 0 14 0 0 0
129 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Critical Occupations Beneficiary Profile Cost Number of Number of % of total Total Cost Average beneficiaries employees within (R’000) cost per occupation employee Shoemakers 0 1 0 0 0 Social work and related professionals 0 21 0 0 0 Speech therapy and audiology 0 32 0 0 0 Staff nurses and pupil nurses 0 218 0 0 0 Supplementary diagnostic radiographers 0 2 0 0 0 Trade labourers 0 24 0 0 0 TOTAL 54 6694 0.8 433 8019
TABLE 3.8.4 Performance related rewards (cash bonus), by salary band, for Senior Management Service for the period 1 April 2014 to 31 March 2015 Salary Band Beneficiary Profile Cost Number of benefi- Number of % of total within Total Cost Average Total cost as a % of ciaries employees band (R’000) cost per the total personnel employee expenditure Band A 63 0 0 0 0 0 Band B 10 0 0 0 0 0 Band C 24 0 0 0 0 0 Band D 1 0 0 0 0 0 Total 98 0 0 0 0 0
TABLE 3.9.2 Foreign Worker by major occupation for the period 1 April 2014 and 31 March 2015
Major Occupation 1 April 2014 31 March 2014 Change Number % of Total Number % of Total Number % change Elementary occupations 2 2.2 1 1 -1 -16.7 Professionals and managers 88 96.7 95 97.9 7 116.7 Technicians and associated 1 1.1 1 1 0 0 professionals TOTAL 91 100 97 100 6 100
Table3.10. Leave Utilisation
TABLE 3.10.1 Sick leave for the period 1 January 2014 to 31 December 2014 Salary Band Total % days with Number of Em- % of total Average Estimated days medical ployees using employees days per Cost certification sick leave using sick employee (R’000) leave Lower skilled (Levels 1-2) 4 100 2 0 2 2 Skilled (Levels 3-5) 20629 87.9 2524 52.2 8 11 195 Highly skilled production (Levels 9213 84.9 1174 24.3 8 9 275 6-8) Highly skilled supervision (Levels 6666 86.2 858 17.7 8 11 993 9-12) Senior management (Levels 241 81.7 35 0.7 7 830 13-16) Contract (Levels 3-5) 329 88.8 60 1.2 5 185 Contract (Levels 6-8) 424 74.8 81 1.7 5 372 Contract (Levels 9-12) 435 72.2 97 2 4 634 Contract (Levels 13-16) 28 67.9 5 0.1 6 88 TOTAL 37969 86.5 4836 100 8 34574
130 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.10.2 Disability leave (temporary and permanent) for the period 1 January 2014 to 31 December 2014
Salary Band Total % Days with Number of % of Total Average Estimated Total number Total number Days Medical Employees Employees Days per Cost of days with of Employees Certification using using Employee (R’000) medical using Disability Disability certification Disability Leave Leave Leave Skilled (Levels 3-5) 1982 100 81 54 24 1 119 1982 150 Highly skilled 2112 100 38 25.3 56 1 939 2112 150 production (Levels 6-8) Highly skilled 1634 100 29 19.3 56 3 056 1634 150 supervision (Levels 9-12) Senior manage- 42 100 2 1.3 21 170 42 150 ment (Levels 13-16) TOTAL 5770 100 150 100 38 6284 5770 150
TABLE 3.10.3 Annual Leave for the period 1 January 2014 to 31 December 2014
Salary Band Total Days Taken Average days per Number of Employees who Employee took leave Lower skilled (Levels 1-2) 34 17 2 Skilled (Levels 3-5) 72677.64 22 3327 Highly skilled production (Levels 6-8) 33275.25 22 1519 Highly skilled supervision (Levels 9-12) 28978.09 22 1289 Senior management (Levels 13-16) 1709 20 85 Contract (Levels 3-5) 1718.92 13 129 Contract (Levels 6-8) 1507 15 99 Contract (Levels 9-12) 2796 16 176 Contract (Levels 13-16) 420 26 16 TOTAL 143115.9 22 6642
TABLE 3.10.4 Capped leave for the period 1 January 2014 to 31 December 2014
Salary Band Total days of Average Number of Average capped leave capped leave number of Employees who per employee as at 31 taken days taken per took Capped December 2014 employee leave Skilled (Levels 3-5) 188 4 42 22 Highly skilled production (Levels 6-8) 210 6 37 34 Highly skilled supervision (Levels 263 7 39 36 9-12) Contract (Levels 6-8) 4 4 1 0 TOTAL 665 6 119 28
131 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.10.5 Leave pay-outs for the period 1 January 2014 to 31 December 2014
The following table summarises payments made to employees as a result of leave that was not taken.
REASON Total Amount Number of Employees Average payment (R’000) per employee Leave pay-out for 2014/15 due to non-utilisation of 10 1 10000 leave for the previous cycle Capped leave pay-outs on termination of service for 9 350 419 22315 2014/15 Current leave pay-out on termination of service for 4 241 297 14279 2014/15 Total 13601 717 18969
3.11. HIV & AIDS and Health Promotion Programmes
TABLE 3.11.1 Steps taken to reduce the risk of occupational exposure
Units/categories of employees identified to be at high risk of con- Key steps taken to reduce the risk tracting HIV & related diseases (if any) Employees in clinical areas, i.e. doctors, nurses, medical students, • The HIV and AIDS, STI and TB in the workplace general workers and paramedics are more at risk of contracting policy was approved, which identifies the HIV and related diseases. prevention of occupational exposure to potentially infectious blood and blood products as a key focus area. • Protocols are in place on infection control measures • Implementation of targeted awareness and education initiatives. • Implemented strategies for mainstreaming HIV and AIDS and human rights issues. • Implemented initiatives to reduce alcohol and substance abuse amongst employees.
TABLE 3.11.2 – Details of Health Promotion and HIV & AIDS Programmes (tick the applicable boxes and provide the required information)
Question Yes No Details, if yes 1. Has the Department designated a member of the SMS ✓ Dr Mbulawa to implement the provisions contained in Part VI E of Chief Director Corporate Services Chapter 1 of the Public Service Regulations, 2001? If so, provide her/his name and position. 2. Does the Department have a dedicated Unit or has it ✓ (See attachment) designated specific staff members to promote the health and well-being of your employees? If so, indicate the number of employees who are involved in this task and the annual budget that is available for this purpose. 3. Has the Department introduced an Employee ✓ Wellness Management, Health and Productivity, Assistance or Health Promotion Programme for your Safety Health Environment Risk and Quality, HIV/ employees? If so, indicate the key elements/services of AIDS. Kimberley Hospital provides a facility for this Programme. infected public servants. 4. Has the Department established (a) committee(s) as ✓ contemplated in Part VI E.5 (e) of Chapter 1 of the Public Service Regulations, 2001? If so, please provide the names of the members of the committee and the stakeholder(s) that they represent.
132 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Question Yes No Details, if yes 5. Has the Department reviewed its employment policies ✓ Wellness Management, SHERQ and practices to ensure that these do not unfairly HIV/AIDs, STIs and TB in the Workplace, Health discriminate against employees on the basis of their and Productivity Policy HIV status? If so, list the employment policies/practices so reviewed. 6. Has the Department introduced measures to protect ✓ HIV/AIDs, STIs and TB in the Workplace Policy. HIV-positive employees or those perceived to be Health and Productivity, Safety Health HIV-positive from discrimination? If so, list the key Environment Risk and Quality (SHERQ) elements of these measures. 7. Does the Department encourage its employees to ✓ (See Attachment) undergo Voluntary Counselling and Testing? If so, list the results that you have achieved. 8. Has the Department developed measures/indicators ✓ Implement Health Promotion Strategy to monitor & evaluate the impact of its Health Promotion Programme? If so, list these measures/ indicators.
Attachments Staff members promoting the health and well-being of employees
Provincial Office M. De Freitas B. Hoffman Kimberley Hospital Complex Dr J. Koetzee Dr B. Marrero De Armas Dr A. Robertson Sr D. Petersen Sr V. Itebogeng T. Lekwene
7. HCT Report 2014/15
1. HIV TESTING TOTAL NUMBER OF ADULTS > 15 YEARS CHILDREN PEOPLE MALE FEMALE < 15 YEARS a. CLIENTS PRE-TEST COUN- 170 DO NOT WRITE HERE SELLED FOR HIV b. CLIENTS TESTED FOR HIV 170 73 97 0 c. CLIENTS TESTED HIV POSITIVE 0 0 0 0 2. TB SCREENING a. CLIENTS SCREENED FOR TB 64 b. CLIENTS REFERRED FOR CLINI- 11 CAL DIAGNOSIS OF TB
3. SCREENING FOR OTHER CONDITIONS a. CLIENTS SCREENED FOR 98 BLOOD PRESSURE b. CLIENTS SCREENED FOR 27 DIABTIES c CLIENTS SCREENED FOR 0 ANEMIA
133 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.12. Labour relations
The following collective agreements were entered into with trade unions within the department. TABLE 3.12.1 Collective agreements for the period 1 January 2014 and 31 March 2015 Total number of collective agreements None
• Collective Agreements are signed nationally and implemented provincially
TABLE 3.12.2 – Misconduct and disciplinary hearings finalised for the period 1 April 2014 and 31 March 2015
Outcomes of disciplinary hearings Number % of total Correctional counselling 2 6% Verbal warning 0 0% Written warning 1 4% Final written warning 7 25% Suspended without pay 5 19% Fine 0 0% Demotion 0 0% Dismissal (Discharge for operational requirements) 5 19% Transfer Out 1 4% Case withdrawn 5 19% Resignations 1 4% Total 27 100%
If there were no agreements, keep the heading and replace the table with the following:
Total number of Disciplinary hearings finalised 71
TABLE 3.12.3 – Types of misconduct addressed at disciplinary hearings for the period 1 April 2014 and 31 March 2015 Type of misconduct Number % of total Abuse of sick leave 0 0% Dishonesty 2 3% Late coming 1 2% Assault 2 3% Gross insubordination 3 4% Insolence 5 7% Intentional or negligent damage to the employ or client of the employer, 3 4% co-worker Intoxication 5 7% Gross absenteeism 10 14% Insubordination 3 4% Abuse of government vehicle 0 0% Gross negligence 1 2% Dereliction of duties 7 10% fraud 8 11% RWOPS 0 0% Misrepresentation 0 0% Negligence 2 3% Abuse of State Property 0 0% Bringing the Name of the Department into Disrepute 3 4% Absenteeism 13 18% Theft 3 4% Total 71 100%
134 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TABLE 3.12.4 – Grievances lodged for the period 1 April 2014 and 31 March 2015
Number % of Total Number of grievances resolved 79 64% Number of grievances not resolved 44 36% Total number of grievances lodged 123 100%
TABLE 3.12.5 – Disputes lodged with Councils for the period 1 April 2014 and 31 March 2015
Number % of Total Number of Conciliations 14 48% Number of Conciliations finalised 3 10% Number of Arbitrations 6 21% Number of Arbitrations finalised 6 21% Total number of disputes lodged 29 100%
TABLE 3.13.6 – Strike actions for the period 1 April 2014 and 31 March 2015
Total number of person working days lost - Total cost (R’000) of working days lost - Amount (R’000) recovered as a result of no work no pay R0.00
TABLE 3.13.7 – Precautionary suspensions for the period 1 April 2014 and 31 March 2015
% Total Number of people suspended 49 Number of people who’s suspension exceeded 30 days 49 Average number of days suspended 87 Cost of suspensions (R’000) R2 509 233.10
13. Skills development
Table 3.13.1 Training needs identified for the period 1 April 2014 and 31 March 2015
Occupational Categories Gender Number of Training provided within the reporting period employees as at Learnerships Skills Programmes Other Total 1 April 2014 & other short forms of courses training Medical doctors Female Male Professionals Female 118 118 Male 82 82 Non-Professional Female Male Support Staff Female 340 340 Male 280 280 Other Female Male Skilled agriculture and Female fishery workers Male Craft and related trades Female workers Male
135 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Occupational Categories Gender Number of Training provided within the reporting period employees as at Learnerships Skills Programmes Other Total 1 April 2014 & other short forms of courses training Plant and machine Female operators and assemblers Male Elementary occupations Female 236 236 Male 190 190 Sub Total Female 694 694 Male 552 552 Total 6695 1246 1246
Table 3.13.2 Training provided for the period 1 April 2014 and 31 March 2015
Occupational Categories Gender Number of Training needs identified at start of reporting period employ- Learnerships Skills Other forms Total ees as at 1 Programmes of training April 2014 & other short courses Medical doctors Female 0 0 36 0 36 Male 0 0 44 0 44 Professionals Female 1105 1105 Male 1358 1358 Non-Professionals Female 578 578 Male 474 474 Support Staff Female 54 224 278 Male 7 184 191 Other Female 228 228 Male 86 86 Skilled agriculture and fishery workers Female Male Craft and related trades workers Female Male Plant and machine operators and Female assemblers Male Elementary occupations Female 23 23 Male 18 18 Sub Total Female 54 2171 2225 Male 7 2187 2274 Total 6695 61 4358 4419
3.14. Injury on duty
TABLE 3.14.1 Injury on duty for the period 1 April 2014 and 31 March 2015
Nature of injury on duty Number % of total Required basic medical attention only 25 0.37 Temporary Total Disablement 25 0.37 Permanent Disablement 14 0.21 Fatal 5 0.07 Total 69 1.03
136 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
15. Utilisation of consultants
Table 3.15.1 – Report on consultant appointments using appropriated funds for the period 1 April 2014 and 31 March 2015
Project Title Total number of consultants that Duration: Contract value in worked on the project Work days Rand Tat I-CHAIN 1 Company (48 resources) As per the Service Level R8 892 000.00 Including (Asset Verification) worked on the project Agreement under Project VAT Project Directors – 1 Time Frames, the project Project Manager – 1 date commencement is Team Leaders – 6 the 28/10/2013 – Verifiers – 33 Completion date was Data Cleaners – 3 31/05/2014 FMV Specialists – 2 Reconciliation Specialist – 1 Training & Support Manager – 1
Table 3.15.2 Analysis of consultant appointments using appropriated funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2015 and 31 March 2015
Project Title Percentage ownership by Percentage man- Number of Consultants from HDI groups agement by HDI HDI groups that work on the groups project Asset Verification/Developing 51% HDI – 6 Data Cleaners – 3 of Asset Register (I-Chain is a 51% majority Non-HDI – 4 Team Leaders – 4 owned BBBEE company) Training & Support Manager – 1 Project Director – 1 Verifiers – 33
Table 3.15.3 – Report on consultant appointments using Donor funds for the period 1 April 2014 and 31 March 2015
Project Title Total Number of consultants that Duration: Donor and Contract worked on the project Work days value in Rand None None None None
Table 3.15.4 – Analysis of consultant appointments using Donor funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2014 and 31 March 2015
Project Title Percentage ownership by Percentage manage- Number of Consultants HDI groups ment by HDI groups from HDI groups that work on the project Not applicable Not applicable Not applicable Not applicable
3.16. Severance Packages
Table 3.16.1 Granting of employees initiated severance packages for the period 1 April 2014 and 31 March 2015
Salary band Number of applications Number of Number of Number of received applications referred applications packages to the MPSA supported by MPSA approved by department 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
6. Part E: Financial Information
6.1. Report of the Auditor General
Report of the auditor-general to the Northern Cape Provincial Legislatureon vote no. 10: Department of Health
Report on the financial statements
Introduction
1. I have audited the financial statements of the Department of Health set out on pages 145 to 243 which comprise the appropriation statement, the statement of financial position as at 31 March 2015, the statement of financial perfor mance, statement of changes in net assetsandcash flow statement for the year then ended, as well as the notes, comprising a summary of significant accounting policies and other explanatory information.
Accounting officer’s responsibility for the financial statements
2. The accounting officer is responsible for the preparation and fair presentation of these financial statements in accordance with the Modified Cash Standardprescribed by the National Treasuryand the requirements of the Public Finance Management Act of South Africa, 1999 (Act No. 1 of 1999) (PFMA)and Division of Revenue Act of South Africa, 2014 (Act No. 10 of 2014) (DoRA), and for such internal control as the accounting officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.
Auditor-General’s responsibility
3. My responsibility is to express an opinion on these financial statements based on my audit. I conducted my audit in accordance with the International Standards on Auditing. Those standards require that I comply with ethical requirements, and plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.
4. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgement, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.
5. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my qualified audit opinion.
Basis for qualified opinion
Immovable tangible capital assets
6. I was unable to obtain sufficient appropriate audit evidence for the corresponding figure relating to disposals of immovable assets due to the status of the accounting records. I was unable to confirm this by alternative means. Consequently, I was unable to determine whether any adjustment to the corresponding figure relating to disposals of immovable assets stated as R1 510 824 000 in note 31.3 to the financial statements was necessary.
Movable tangible capital assets
7. I was unable to obtain sufficient appropriate audit evidence for the movable tangible capital assets relating to major and minor assets due to the status of the accounting records. I was unable to confirm these by alternative means. Consequently, I was unable to determine whether any adjustment to the major movable capital assets stated as R820 017 000 (2014: R691 177 000) and minor movable capital assets stated as R155 920 000 (2014: R135 435 000) in note 29 to the financial statements was necessary.
138 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
In addition, the department did not recognise movable tangible capital assets relating to major and minor assets in accordance with the capital assets chapter of the Modified Cash Standard. I was not able to determine the full extent of the understatement as it was impracticable to do so.
Intangible capital assets
8. I was unable to obtain sufficient appropriate audit evidence for the intangible capital assets, due to the status of the accounting records. I was unable to confirm this by alternative means. Consequently, I was unable to determine whether any adjustment to the intangible capital assets stated as R4 640 000 (2014: R3 695 000) in note 30 to the financial statements was necessary. In addition, the department did not recognise intangible capital assetsin accordance with the capital assets chapter of the Modified Cash Standard. I was not able to determine the full extent of the understatement for the current and previous years as it was impracticable to do so.
Accruals
9. The department did not disclose all accruals at year-end in accordance with the general departmental assets and liabilities chapter of the Modified Cash Standard as the system used to account for accruals was not adequate. I was not able to determine the full extent of the understatementfor the current and previousyears as it was impracticable to do so.
Commitments
10. I was unable to obtain sufficient appropriate audit evidence for commitments due to the status of the accounting records. I was unable to confirm this by alternative means. Consequently, I was unable to determine whether any adjustment to commitments stated as R875 909 (2014: R1 215 225 000) in note 20 to the financial statements was necessary. In addition, the department did not disclose all commitments at year-end in accordance with the provisions and contingents’ chapter of the Modified Cash Standard as the systems used to account for commitments were not adequate. I was not able to determine the full extent of the understatement for the current and previousyears as it was impracticable to do so.
Irregular expenditure
11. The department did not include all the transactions relating to irregular expenditure in note 25 to the financial statements, as required by section 40(3)(b)(i) of the PFMA. The department made payments in contravention of the supply chain management requirements, resulting in irregular expenditure being understated by R103 381 300 (2014: R13 179 637).
Accrued departmental revenue
12. I was unable to obtain sufficient appropriate audit evidence relating to accrued departmental revenue due to the status of the accounting records. I was unable to confirm thisby alternative means. Consequently, I was unable to determine whether any adjustment to accrued departmental revenue stated as R91 879 000 (2014: R82 339 000) in note 24 to the financial statements was necessary. In addition, the department did not disclose all accrued departmental revenue at year-end in accordance with the general departmental assets and liabilities chapter of the Modified Cash Standard as the system used to account for accrued departmental revenuewas not adequate. I was not able to determine the full extent of the understatement for the current and previous years as it was impracticable to do so.
Compensation of employees
13. I was unable to obtain sufficient appropriate audit evidence for the comparative expenditure relating to compensative/ circumstantial as commuted overtime worked could not be confirmed. I was unable to confirm this by alternative means. Consequently, I was unable to determine whether any further adjustment relating to the comparative figure for compensative/ circumstantial stated as R164 250 000 in note 4.1 to the financial statements was necessary.
Qualified opinion
14. In my opinion, except for the possible effects of the matters described in the basis for qualified opinion paragraphs, the financial statements present fairly, in all material respects, the financial position of the Department of Health as at 31 March 2015 and its financial performance and cash flows for the year then ended, in accordance with the Modified Cash Standard prescribed by the National Treasury and the requirements of the PFMA and DoRA.
Emphasis of matters
15. I draw attention to the matters below. My opinion is not modified in respect of these matters. 139 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Significant uncertainties
16. With reference to note 19 to the financial statements, the department is the defendant and the claimant in several lawsuits. The ultimate outcome of the matters cannot currently be determined, and no provision for any liability and asset that may result has been made in the financial statements.
Restatement of corresponding figures
17. As disclosed in note 32 to the financial statements, the corresponding figures for 31 March 2014 have been restated as a result of errors discovered during 31 March 2015 in the financial statements of the Department of Health at, and for the year ended, 31 March 2014.
Material underspending of the budget
18. As disclosed in the appropriation statement, the department has materially underspent the budget on programme 8: Health facilities managementby R61 873 000.
Payables
19. Payables, which exceed the payment term of 30 days as required in treasury regulation 8.2.3, amounted to R202 248 000. This amount, in turn, exceededthe voted funds to be surrendered of R44 008 000 as per the statement of financial performance by R158 240 000. The amount of R158 240 000 would therefore have constituted unauthorised expenditure had the amounts due been paid in a timely manner.
Additional matter
20. I draw attention to the matter below. My opinion is not modified in respect of this matter.
Unaudited supplementary schedules
21. The supplementary information set out on pages 235 to 245 did not form part of the financial statements and is presented as additional information. I have not audited these schedules and, accordingly, I do not express an opinion thereon.
Report on other legal and regulatory requirements
22. In accordance with the Public Audit Act of South Africa, 2004 (Act No. 25 of 2004) (PAA) and the general notice issued in terms thereof, I have a responsibility to report findings on the reported performance information against predetermined objectives for selected programmes presented in the annual performance report, compliance with legislation and internal control. The objective of my tests was to identify reportable findings as described under each subheading but not to gather evidence to express assurance on these matters. Accordingly, I do not express an opinion or conclusion on these matters.
Predetermined objectives
23. I performed procedures to obtain evidence about the usefulness and reliability of the reported performance information for the following selected programmes presented in the annual performance report of the department for the year ended 31 March 2015: • Programme 2: District health services on pages 39 to 61 • Programme 5: Tertiary hospital services on pages 70 to 75
24. I evaluated the reported performance information against the overall criteria of usefulness and reliability.
25. I evaluated the usefulness of the reported performance information to determine whether it was presented in accordance with the National Treasury’s annual reporting principles and whether the reported performance was consistent with the planned programmes. I further performed tests to determine whether indicators and targets were well defined, verifiable, specific, measurable, time bound and relevant, as required by the National Treasury’s Framework for managing programme performance information (FMPPI).
26. I assessed the reliability of the reported performance information to determine whether it was valid, accurate and complete.
140 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
27. The material findings in respect of the selected programmes are as follows:
Programme 2: District health services
Reliability of reported performance information
28. The FMPPI requires auditees to have appropriate systems to collect, collate, verify and store performance information to ensure valid, accurate and complete reporting of actual achievements against planned objectives, indicators and targets. We were unable to obtain the information and explanations we considered necessary to satisfy ourselves as to the reliability of the reported performance information. This was due to the fact that the auditee could not provide sufficient appropriate audit evidence in support of the reported performance information as well as to the auditee’s records not permitting the application of alternative audit procedures.
Programme 5: Tertiary hospital services
Reliability of reported performance information
29. The FMPPI requires auditees to have appropriate systems to collect, collate, verify and store performance information to ensure valid, accurate and complete reporting of actual achievements against planned objectives, indicators and targets. I was unable to obtain the information and explanations Iconsidered necessary to satisfy myselfas to the reliability of the reported performance information. This was due to the fact that the auditee could not provide sufficient audit appropriate evidence in support of the reported performance information as well as to the auditee’s records not permitting the application of alternative audit procedures.
Additional matters
30. I draw attention to the following matters:
Achievement of planned targets
31. Refer to the annual performance report on pages 23 to 83 for information on the achievement of planned targets for the year. This information should be considered in the context of the material findings on the reliability of the reported performance information in paragraphs 28 and 29 of this report.
Adjustment of material misstatements
32. I identified material misstatements in the annual performance report submitted for auditing on the reported performance information for programmes 2 and 5. As management subsequently corrected only some of the misstatements, I identified material findings on the reliability of the reported performance information.
Compliance with legislation
33. I performed procedures to obtain evidence that the department had complied with applicable legislation regarding financial matters, financial management and other related matters. My findings on material compliance with specific matters in key legislation, as set out in the general notice issued in terms of the PAA, are as follows:
Strategic planning and performance management
34. Effective, efficient and transparent systems of risk management and internal control with respect to performance information and management were not maintained, as required by section 38(1)(a)(i) of the PFMA.
Financial statements, performance and annual reports
35. The financial statements submitted for auditing were not prepared in accordance with the prescribed financial reporting framework and supported by full and proper records, as required by section 40(1)(a) and (b) of the PFMA. Material misstatements of expenditure and disclosure items identified by the auditors in the submitted financial statements were
141 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
subsequently corrected and the supporting records were provided subsequently. However, the uncorrected material misstatements and supporting records that could not be provided resulted in the financial statements receiving a qualified audit opinion.
Procurement and contract management
36. Sufficient appropriate audit evidence could not be obtained that goods and services of a transaction value above R500 000 were procured by means of inviting competitive bids, as required by treasury regulation16A6.1.
37. Invitations for competitive bidding were not always advertised in at least the government tender bulletin and Contraction Industry Development Board (CIDB) website, as required by treasury regulation 16A6.3(c) and CIDB regulation24.
38. Contracts were awarded to bidders who did not submit a declaration of past supply chain practices such as fraud, abuse of Supply Chain Management (SCM) system and non-performance, which is prescribed in order to comply with treasury regulation 16A9.2.
39. Contracts and quotations were awarded to suppliers whose tax matters had not been declared by the South African Revenue Services to be in order, as required by treasury regulation16A9.1(d) and the Preferential procurement regulations.
40. Contracts and quotations were awarded to bidders who did not submit a declaration on whether they are employed by the state or connected to any person employed by the state, which is prescribed in order to comply with treasury regulation 16A8.3.
41. Persons in service of the department who had a private or business interest in contracts awarded by the department failed to disclose such interest, in contravention oftreasury regulation 16A8.4 and public service regulation (PSR) 3C.
42. Persons in service of the department whose close family members, partners or associates had a private or business interest in contracts awarded by the department failed to disclose such interest, in contravention of treasury regulation16A8.4.
Human resource management and compensation
43. Appointments were made in posts which were not approved and funded, as required by PSR1/III/ F.1(a) and (d).
44. Employees were appointed without following a proper process to verify the claims made in their applications, in contravention of PSR 1/VII/D.8.
45. Funded vacant posts were not filled within 12 months, as required by PSR 1/VII/C.1A.2.
Expenditure management
46. Effective steps were not taken to prevent unauthorised, irregular as well as fruitless and wasteful expenditure, as required by section 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1.
47. Contractual obligations and money owed by the department were not settled within 30 days, as required by section 38(1) (f) of the PFMA and treasury regulation 8.2.3.
Revenue management
48. Appropriate processes were not developed and implemented to provide for the identification, collection, recording, reconciliation and safeguarding of information about revenue, as required by treasury regulation 7.2.1.
49. Effective and appropriate steps were not taken to collect all money due, as required by section 38(1)(c)(i) of the PFMA and treasury regulations 11.2.1, 15.10.1.2(a) and 15.10.1.2(e).
50. Interest was not charged on staff debts, as required by treasury regulation 11.5.1.
Asset management
51. Proper control systems to safeguard and maintain assets were not implemented, as required by section 38(1)(d) of the PFMA and treasury regulation 10.1.1(a).
142 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Consequence management
52. Effective and appropriate disciplinary steps were not taken against officials who made or permitted unauthorised expenditure, irregular expenditure as well as fruitless and wasteful expenditure, as required by section 38(1)(h)(iii) of the PFMA and treasury regulation 9.1.3.
Internal control
53. I considered internal control relevant to my audit of the financial statements, annual performance report and compliance with legislation. The matters reported below are limited to the significant internal control deficiencies that resulted in the basis for qualifiedopinion, the findings on the annual performance report and the findings on compliance with legislation included in this report.
Leadership
54. The leadership did not monitor adequately the existing action plan to ensure that corrective actions were taken when required and within the required timeframes. This resulted in similar previous financial year material findings re-occurring in the current financial year.
55. The leadership did not ensure that the department compliedwith applicable legislations. Material findings relating to PFMA and other applicable legislations, including SCM policy, were identified in the current financial year. The department’s internal processes and systems did not prevent material non-compliances, irregular, unauthorised as well as fruitless and wasteful expenditure.
56. The leadership did not timely followup and correct previously identified internal control deficiencies relating to information technology (IT)as the position of the chief information officer was vacant as no suitable candidate could be obtained during the interview process and other positions atthe IT unit werefilled towards the end of the financial year.
Financial and performance management
57. The collation of different information from various units for incorporation to the final financial statements and annual performance report wasnot done timeously to allow for sufficient and adequate reviews. This resulted in the material amendments to the financial statements and annual performance report. The action plan to address the previousyear’s audit findings was implemented towards the end of the financial year, resulting in not fully addressing the previousyear’s audit findings. In addition, the department did not perform an asset count for the current financial year and the asset registers were not updated timeously.
58. The underlying systems and controls were inadequate to provide reliable evidence to support the reporting on predetermined objectives for programmes selected for auditing. Registers and schedules were not used at all facilities throughout the year to ensure the completeness of information.Furthermore, information wasnot adequately stored to ensure that it was easily retrievable.
59. The department did not review and monitor compliance with applicable legislations. The department did not have a delegated employee who was trained to address and monitor new legislative changes affecting the department.
Governance
60. A risk management strategy was in place; however, due to the late staffing of the risk management unit the risk was not assessed during the year under review in all units within the department.
Other reports Investigations
61. The department was commissioned to investigate into grant spending by the select committee on social services. The investigation was still in progress at the date of this report.
143 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Kimberley 31 July 2015
144 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
6.2 Annual Financial Statements
Appropriation per programme
2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of Appropriation Expenditure final appropriation
R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000
Programme
1. Administration 160 812 - 12 882 173 694 192 331 -18 637 110.7% 167 616 171 647 2. District Health Services 1 604 902 - 13 596 1 618 498 1 633 011 -14 513 100.9% 1 486 556 1 465 611 3. Emergency Medical Services 273 089 - -13 827 259 262 242 847 16 415 93.7% 231 955 199 910 4. Provincial Hospital Services 255 835 - 9 880 265 715 292 594 -26 879 110.1% 214 569 201 082 5. Central Hospital Services 791 172 - -2 346 788 826 767 519 21 307 97.3% 719 640 739 655 6. Health Sciences 109 383 - -685 108 698 104 251 4 447 95.9% 88 845 86 012 7. Health Care Support Services 89 675 - -4 417 85 258 85 263 -5 100.0% 85 898 84 524 8. Health Facilities Management 473 120 - -15 083 458 037 396 164 61 873 86.5% 481 909 453 360
Subtotal 3 757 988 - - 3 757 988 3 713 980 44 008 98.8% 3 476 988 3 401 801 Statutory Appropriation ------TOTAL 3 757 988 - - 3 757 988 3 713 980 44 008 98.8% 3 476 988 3 401 801
145 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2014/15 2013/14
Final Actual Final Actual Appropriation Expenditure Appropriation Expenditure
TOTAL (brought forward) 3,757,988 3,713,980 3,476,988 3,401,801
Reconciliation with statement of financial performance
ADD
Departmental receipts - -
NRF Receipts - -
Aid assistance 142 69
Actual amounts per statement of financial performance (total revenue) 3,758,130 3,477,057
ADD
Aid assistance 344 1,083
- -
Prior year unauthorised expenditure approved without funding
Actual amounts per statement of financial performance (total expenditure) 3,714,324 3,402,884
146 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appropriation per economic classification
2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Economic classification Current payments 3 076 275 (10 243) - 3 066 032 3 089 133 (23 101) 100.8% 2 814 162 2 814 100 Compensation of employees 1 956 167 (13 299) - 1 942 868 1 936 740 6 128 99.7% 1 786 361 1 786 195 Salaries and wages 1 718 438 (6 294) - 1 712 144 1 713 243 (1 099) 100.1% 1 560 846 1 565 296 Social contributions 237 729 (7 005) - 230 724 223 497 7 227 96.9% 225 515 220 899 Goods and services 1 120 108 3 056 - 1 123 164 1 150 049 (26 885) 102.4% 1 027 801 1 026 321 Administrative fees 13 105 - - 13 105 2 875 10 230 21.9% 11 187 2 900 Advertising 7 003 (250) 271 7 024 11 946 (4 922) 170.1% 8 522 6 326 Minor assets 20 321 (52) (5 929) 14 340 20 472 (6 132) 142.8% 36 134 24 910 Audit costs: External 11 000 - - 11 000 13 076 (2 076) 118.9% 12 189 10 548 Bursaries: Employees 653 (4) 12 661 1 813 (1 152) 274.3% 340 848 Catering: Departmental activities 5 482 - 801 6 283 10 118 (3 835) 161.0% 3 873 5 667 Communication 11 883 - - 11 883 18 543 (6 660) 156.0% 26 038 18 185 Computer services 15 670 (550) - 15 120 23 004 (7 884) 152.1% 23 528 20 812 Consultants: Business and advisory 7 185 - 117 7 302 17 947 (10 645) 245.8% 15 159 4 588 services Infrastructure and planning services 6 096 - - 6 096 - 6 096 - - - Laboratory services 147 649 - 72 147 721 88 758 58 963 60.1% 94 186 98 116 Scientific and technological services ------Legal services 6 877 - - 6 877 3 504 3 373 51.0% 5 164 4 718 Contractors 81 019 (74) (1 150) 79 795 98 541 (18 746) 123.5% 56 687 64 351 Agency and support / outsourced services 85 078 - 432 85 510 83 967 1 543 98.2% 65 879 73 667 Entertainment 200 - - 200 - 200 - 400 297 Fleet services 39 412 - 20 39 432 65 114 (25 682) 165.1% 50 049 56 937 Housing ------Inventory: Clothing material and supplies 5 414 (325) (88) 5 001 1 630 3 371 32.6% 3 479 1 314 Inventory: Farming supplies 54 - (46) 8 9 (1) 112.5% 14 67 Inventory: Food and food supplies 18 627 - 5 18 632 20 287 (1 655) 108.9% 13 610 18 668 Inventory: Fuel, oil and gas 37 903 - 2 37 905 15 640 22 265 41.3% 20 853 15 500 Inventory: Learner and teacher support 200 - - 200 - 200 - - - material Inventory: Materials and supplies 1 880 (32) 13 1 861 4 072 (2 211) 218.8% 4 275 3 413 Inventory: Medical supplies 141 604 3 499 255 145 358 124 602 20 756 85.7% 111 318 110 901 147 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appropriation per economic classification
2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Medicine 188 043 3 506 375 191 924 186 748 5 176 97.3% 190 140 221 531 Medsas Inventory Interface ------Inventory: Other supplies ------Consumable supplies 26 986 - 1 012 27 998 40 611 (12 613) 145.0% 23 968 28 349 Consumable: Stationery, printing and 16 965 (192) 1 352 18 125 19 191 (1 066) 105.9% 18 769 12 361 office supplies Operating leases 41 765 - - 41 765 62 984 (21 219) 150.8% 56 067 51 466 Property payments 106 680 1 030 1 082 108 792 134 095 (25 303) 123.3% 89 243 102 180 Transport provided: Departmental activity 5 - - 5 2 329 (2 324) 46580.0% 300 3 040 Travel and subsistence 40 132 (90) - 40 042 59 925 (19 883) 149.7% 53 996 46 257 Training and development 27 268 (3 410) (41) 23 817 5 254 18 563 22.1% 22 709 10 715 Operating payments 3 449 - (42) 3 407 3 668 (261) 107.7% 1 287 5 011 Venues and facilities 4 435 - 1 475 5 910 9 327 (3 417) 157.8% 8 438 2 656 Rental and hiring 65 - - 65 - 65 - - - Interest and rent on land - - - - 2 343 (2 343) - - 1 584 Interest - - - - 2 343 (2 343) - - 2 900
Transfers and subsidies 105 065 10 243 - 115 308 138 764 (23 456) 120.3% 76 298 84 440 Provinces and municipalities 8 782 (67) (421) 8 294 2 218 6 076 26.7% 7 693 5 296 Provinces 8 182 (67) (786) 7 329 1 850 5 479 25.2% 26 - Provincial Revenue Funds ------26 - Provincial agencies and funds 8 182 (67) (786) 7 329 1 850 5 479 25.2% - - Municipalities 600 - 365 965 368 597 38.1% 7 667 5 296 Municipal bank accounts 600 - 365 965 368 597 38.1% 7 504 5 133 Municipal agencies and funds ------163 163 Non-profit institutions 76 992 - 421 77 413 80 506 (3 093) 104.0% 41 573 41 626 Households 19 291 10 310 - 29 601 56 039 (26 438) 189.3% 27 032 37 518 Social benefits 6 714 1 636 - 8 350 9 867 (1 517) 118.2% 143 143 Other transfers to households 12 577 8 674 - 21 251 46 172 (24 921) 217.3% 26 889 37 375
Payments for capital assets 576 648 - - 576 648 486 648 90 580 84.3% 586 528 503 261 Buildings and other fixed structures 434 520 1 729 (10 574) 425 675 356 283 69 392 83.7% 425 100 396 446 Buildings 434 520 1 729 (10 574) 425 675 356 283 69 392 83.7% 424 720 396 066 Other fixed structures ------380 380 Machinery and equipment 142 128 (1 795) 9 744 150 077 128 840 21 237 85.9% 160 918 106 306 148 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appropriation per economic classification
2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Transport equipment 59 947 (2 000) (6 122) 51 825 39 052 12 773 75.4% 36 028 2 917 Other machinery and equipment 82 181 205 15 866 98 252 89 788 8 464 91.4% 124 890 103 389 Intangible assets - 66 830 896 946 (50) 105.6% 510 509
Payments for financial assets ------3 757 988 - - 3 757 988 3 713 980 44 008 98.8% 3 476 988 3 401 801
Programme 1: Administration 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. Office of the MEC 9 068 - 557 9 625 9 714 -89 100.9% 5 706 5 797 2. Management 151 744 - 12 325 164 069 182 618 -18 549 111.3% 161 910 165 850 Total for sub programmes 160 812 - 12 882 173 694 192 331 -18 637 110.7% 167 616 171 647
Economic classification Current payments 157 502 - 6 432 163 934 178 638 (14 704) 109.0% 160 685 161 108 Compensation of employees 97 849 - - 97 849 97 652 197 99.8% 88 921 88 921 Salaries and wages 85 232 - - 85 232 86 115 (883) 101.0% 78 685 75 525 Social contributions 12 617 - - 12 617 11 537 1 080 91.4% 10 236 13 396 Goods and services 59 653 - 6 432 66 085 80 657 (14 572) 122.1% 71 764 72 014 Administrative fees 1 030 - - 1 030 842 188 81.8% 291 815 Advertising 530 - 249 779 810 (31) 104.0% 582 813 Minor assets 209 - 1 422 1 631 1 491 140 91.4% 703 1 344 Audit costs: External 11 000 - - 11 000 13 076 (2 076) 118.9% 12 189 10 548 Bursaries: Employees - - 9 9 9 - 100.0% 48 44 Catering: Departmental activities 100 - 800 900 883 17 98.1% 603 795 Communication 7 137 - - 7 137 3 907 3 230 54.7% 16 884 16 448 Computer services 2 801 - - 2 801 14 541 (11 740) 519.1% 2 505 13 775 Consultants: Business and advisory 4 550 - 117 4 667 13 509 (8 842) 289.5% 1 122 1 998 services
149 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appropriation per economic classification
2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Infrastructure and planning services ------Laboratory services ------Scientific and technological services ------Legal services 6 852 - - 6 852 3 504 3 348 51.1% 5 164 4 695 Contractors 600 - 226 826 886 (60) 107.2% 466 837 Agency and support / outsourced - - 20 20 20 - 100.0% - 91 services Entertainment 200 - - 200 - 200 - 400 297 Fleet services 8 600 - - 8 600 4 604 3 996 53.5% 13 065 4 579 Housing ------Inventory: Clothing material and supplies ------4 Inventory: Farming supplies ------Inventory: Food and food supplies - - 5 5 5 - 100.0% 115 23 Inventory: Fuel, oil and gas ------Inventory: Learner and teacher support ------material Inventory: Materials and supplies - - 12 12 12 - 100.0% 1 5 Inventory: Medical supplies - - 42 42 42 - 100.0% - - Inventory: Medicine ------10 Medsas Inventory Interface ------Inventory: Other supplies ------Consumable supplies 900 - - 900 877 23 97.4% 672 696 Consumable: Stationery, printing and 1 800 - 973 2 773 2 548 225 91.9% 3 106 2 531 office supplies Operating leases 3 200 - - 3 200 2 446 754 76.4% 6 933 2 103 Property payments 2 500 - 1 082 3 582 3 653 (71) 102.0% 1 048 1 146 Transport provided: Departmental activity ------Travel and subsistence 6 500 - - 6 500 10 683 (4 183) 164.4% 5 399 7 388 Training and development 500 - - 500 158 342 31.6% - 53 Operating payments 382 - - 382 369 13 96.5% 218 494 Venues and facilities 262 - 1 475 1 737 1 783 (46) 102.7% 250 460 Rental and hiring ------Interest and rent on land - - - - 328 (328) - - 173 Interest - - - - 328 (328) - - 173 150 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Appropriation per economic classification
2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000
Transfers and subsidies 199 - 17 216 4 090 (3 874) 1893.5% 215 3 823 Provinces and municipalities - - 17 17 17 - 100.0% 26 - Provinces - - 17 17 17 - 100.0% 26 - Provincial Revenue Funds ------Provincial agencies and funds - - 17 17 17 - 100.0% 26 - Municipalities ------Municipal bank accounts ------Municipal agencies and funds ------Non-profit institutions 105 - - 105 - 105 - - - Households 94 - - 94 4 073 (3 979) 4333.0% 189 3 823 Social benefits 94 - - 94 310 (216) 329.8% - - Other transfers to households - - - - 3 763 (3 763) - 189 3 823
Payments for capital assets 3 111 - 6 433 9 544 9 604 (60) 100.6% 6 716 6 716 Buildings and other fixed structures - - 813 813 813 0 99.9% 1 211 1 211 Buildings - - 813 813 813 0 99.9% 1 211 1 211 Other fixed structures ------Machinery and equipment 3 111 - 5 223 8 334 8 371 (37) 100.4% 5 367 5 368 Transport equipment ------Other machinery and equipment 3 111 - 5 223 8 334 8 371 (37) 100.4% 5 367 5 368 Intangible assets - - 397 397 420 (23) 105.8% 138 137
Payments for financial assets Total 160 812 - 12 882 173 694 192 331 -18 637 110.7% 167 616 171 647
151 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.1 Office of the MEC 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 8 963 - 528 9 491 9 580 -89 100.9% 5 657 5 748 Compensation of employees 4 650 - - 4 650 4 223 427 90.8% 3 216 3 216 Goods and services 4 313 - 528 4 841 5 356 -515 110.6% 2 441 2 532 Interest and rent on land ------
Transfers and subsidies 105 - - 105 56 49 53.3% 30 30 Provinces and municipalities ------Non-profit institutions 105 - - 105 - 105 - Households - - - - 56 -56 - 30 30
Payments for capital assets - - 29 29 78 -49 269.0% 19 - Buildings and other fixed structures ------Machinery and equipment - - 29 29 78 -49 269.0% 19 - Intangible assets ------
Payments for financial assets ------Total 9 068 - 557 9 625 9 714 -89 100.9% 5 706 5 797
152 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.2 Management 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 148 539 - 5 904 154 443 169 058 -14 615 109.5% 155 028 155 360 Compensation of employees 93 199 - - 93 199 93 429 -230 100.2% 85 705 85 705 Goods and services 55 340 - 5 904 61 244 75 301 -14 057 123.0% 69 323 69 482 Interest and rent on land - - - - 328 -328 - - 173
Transfers and subsidies 94 - 17 111 4 034 -3 923 3634.2% 185 3 793 Provinces and municipalities - - 17 17 17 - 100.0% 26 - Non-profit institutions ------Households 94 - - 94 4 017 -3 923 4273.4% 159 3 793
Payments for capital assets 3 111 - 6 404 9 515 9 526 -11 100.1% 6 697 6 697 Buildings and other fixed structures - - 813 813 813 0 99.9% 1 211 1 211 Machinery and equipment 3 111 - 5 194 8 305 8 293 12 99.9% 5 348 5 349 Intangible assets - - 397 397 420 -23 105.8% 138 137
Payments for financial assets ------Total 151 744 - 12 325 164 069 182 618 -18 549 111.3% 161 910 165 850
Programme 2: District Health Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. District Management 102 213 - 8 004 110 217 150 478 -40 261 136.5% 92 584 105 128 2. Community Health Clinics 335 704 - 987 336 691 352 338 -15 647 104.6% 324 376 326 983 3. Community Health Centres 247 759 - 1 464 249 223 234 967 14 256 94.3% 232 863 212 354 4. Other Community Services 74 409 - 1 375 75 784 73 574 2 210 97.1% 94 205 94 205 5. HIV/ AIDS 383 820 - 203 384 023 357 894 26 129 93.2% 340 137 331 546 6. Nutrition 4 356 - 11 4 367 3 918 449 89.7% 3 732 3 467 7. Coroner Services - - 113 113 4 386 -4 273 3881.4% - - 8. District Hospitals 456 641 - 1 439 458 080 455 456 2 624 99.4% 395 528 395 928 Total for sub programmes 1 604 902 - 13 596 1 618 498 1 633 011 -14 513 100.9% 1 483 425 1 465 611
153 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 2: District Health Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000
Economic classification Current payments 1 473 773 - - 1 473 773 1 491 093 (17 320) 101.2% 1 386 349 1 386 372 Compensation of employees 899 139 (7 005) - 892 134 892 135 (1) 100.0% 853 008 866 155 Salaries and wages 754 399 - - 754 399 785 047 (30 648) 104.1% 746 619 759 114 Social contributions 144 740 (7 005) - 137 735 107 088 30 647 77.7% 106 389 107 041 Goods and services 574 634 7 005 - 581 639 597 843 (16 204) 102.8% 533 341 519 203 Administrative fees 1 186 - - 1 186 1 429 (243) 120.5% 317 637 Advertising 5 341 - - 5 341 8 930 (3 589) 167.2% 7 366 4 534 Minor assets 10 086 - - 10 086 13 360 (3 274) 132.5% 16 245 6 805 Audit costs: External ------Bursaries: Employees 158 - - 158 204 (46) 129.1% - 141 Catering: Departmental activities 4 611 - - 4 611 7 202 (2 591) 156.2% 2 263 3 971 Communication 1 563 - - 1 563 10 930 (9 367) 699.3% 5 804 517 Computer services 4 809 - - 4 809 5 665 (856) 117.8% 5 701 4 927 Consultants: Business and advisory 1 506 - - 1 506 193 1 313 12.8% 14 037 166 services Infrastructure and planning services ------Laboratory services 102 223 - - 102 223 63 932 38 291 62.5% 64 881 75 432 Scientific and technological services ------Legal services ------Contractors 23 104 - - 23 104 27 647 (4 543) 119.7% 10 709 15 068 Agency and support / outsourced services 40 982 - - 40 982 45 124 (4 142) 110.1% 31 212 37 337 Entertainment ------Fleet services 3 049 - - 3 049 15 338 (12 289) 503.1% 8 910 5 534 Housing ------
154 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 2: District Health Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and supplies 1 315 - - 1 315 113 1 202 8.6% 1 591 213 Inventory: Farming supplies 8 - - 8 2 6 25.0% 14 30 Inventory: Food and food supplies 15 451 - - 15 451 16 447 (996) 106.4% 10 137 15 404 Inventory: Fuel, oil and gas 6 392 - - 6 392 1 701 4 691 26.6% 2 897 2 099 Inventory: Learner and teacher support ------material (1 341) - - (1 341) 1 619 (2 960) (120.7%) 3 778 911 Inventory: Materials and supplies 62 492 3 499 - 65 991 63 146 2 845 95.7% 49 251 32 914 Inventory: Medical supplies 153 768 3 506 - 157 274 145 406 11 868 92.5% 167 695 188 974 Inventory: Medicine ------Medsas Inventory Interface ------Inventory: Other supplies 13 876 - - 13 876 23 700 (9 824) 170.8% 13 542 14 548 Consumable supplies Consumable: Stationery, printing and office 10 203 - - 10 203 7 167 3 036 70.2% 12 216 5 678 supplies Operating leases 17 925 - - 17 925 27 003 (9 078) 150.6% 9 964 23 129 Property payments 67 806 - - 67 806 76 870 (9 064) 113.4% 54 618 56 612 Transport provided: Departmental activity 5 - - 5 942 (937) 18840.0% 300 2 049 Travel and subsistence 19 888 - - 19 888 25 765 (5 877) 129.6% 26 466 16 971 Training and development 2 744 - - 2 744 755 1 989 27.5% 5 281 781 Operating payments 1 754 - - 1 754 1 742 12 99.3% 1 004 1 988 Venues and facilities 3 665 - - 3 665 5 511 (1 846) 150.4% 7 142 1 833 Rental and hiring 65 - - 65 - 65 - - - Interest and rent on land - - - - 1 114 (1 114) - - 1 014 Interest - - - - 1 114 (1 114) - - 1 014 Rent on land ------
Transfers and subsidies 89 600 - (689) 88 911 86 720 2 191 97.5% 52 114 49 782 Provinces and municipalities 8 462 - (689) 7 773 1 697 6 076 21.8% 7 501 5 133 Provinces 7 862 - (689) 7 173 1 694 5 479 23.6% - - Provincial Revenue Funds ------Provincial agencies and funds 7 862 - (689) 7 173 1 694 5 479 23.6% 7 501 5 133
155 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 2: District Health Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Municipalities 600 - - 600 3 597 0.5% 7 501 5 133 Municipal bank accounts 600 - - 600 3 597 0.5% - - Municipal agencies and funds ------Non-profit institutions 76 252 - - 76 252 79 450 (3 198) 104.2% 40 969 41 004 Households 4 886 - - 4 886 5 572 (686) 114.0% 3 644 3 645 Social benefits 4 386 - - 4 386 5 572 (1 186) 127.1% Other transfers to households 500 - - 500 - 500 -
Payments for capital assets 41 529 - 14 285 55 814 55 199 615 98.9% 48 093 29 457 Buildings and other fixed structures - - 648 648 648 - 100.0% -556 -556 Buildings - - 648 648 648 - 100.0% -556 -556 Other fixed structures ------48 342 29 706 Machinery and equipment 41 529 - 13 248 54 777 54 162 615 98.9% - - Transport equipment - - - - 3 740 (3 740) - 48 342 29 706 Other machinery and equipment 41 529 - 13 248 54 777 50 422 4 355 92.0% 48 093 29 457 Intangible assets - - 389 389 389 - 100.0% 307 307
Payments for financial assets ------Total 1 604 902 - 13 596 1 618 498 1 633 011 (14 513) 100.9% 1 486 556 1 465 611
156 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.1 District Management 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 101 838 - - 101 838 142 969 -41 131 140.4% 97 934 101 908 Compensation of employees 76 431 - - 76 431 89 809 -13 378 117.5% 87 674 85 815 Goods and services 25 407 - - 25 407 53 155 -27 748 209.2% 10 260 16 093 Interest and rent on land - - - - 5 -5 - - -
Transfers and subsidies 24 - - 24 230 -206 958.3% 186 218 Provinces and municipalities 24 - - 24 25 -1 104.2% 239 -949 Non-profit institutions ------1 318
Households - - - - 205 -205 - 1 265 1 167
Payments for capital assets 351 - 8 004 8 355 7 279 1 076 87.1% 3 009 3 003 Buildings and other fixed structures - - - - -1 881 1 881 - - - Machinery and equipment 351 - 7 615 7 966 8 771 -805 110.1% 3 009 3 003 Intangible assets - - 389 389 389 - 100.0% - -
Payments for financial assets
Total 102 213 - 8 004 110 217 150 478 -40 261 136.5% 101 129 105 129
157 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.2 Community Health Clinics 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 326 495 - - 326 495 347 421 -20 926 106.4% 317 429 317 486 Compensation of employees 222 137 - - 222 137 217 847 4 290 98.1% 219 838 197 704 Goods and services 104 358 - - 104 358 129 537 -25 179 124.1% 97 591 119 748 Interest and rent on land - - - - 37 -37 - - 34
Transfers and subsidies 8 578 - -689 7 889 2 611 5 278 33.1% 7 582 5 218 Provinces and municipalities 7 768 - -689 7 079 1 511 5 568 21.3% 5 243 4 063 Non-profit institutions ------1 544 261 Households 810 - - 810 1 100 -290 135.8% 795 894
Payments for capital assets 631 - 1 676 2 307 2 306 1 100.0% 4 279 4 279 Buildings and other fixed structures ------556 -556 Machinery and equipment 631 - 1 676 2 307 2 306 1 100.0% 4 835 4 835 Intangible assets ------
Payments for financial assets ------Total 335 704 - 987 336 691 352 338 -15 647 104.6% 329 290 326 983
158 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.3 Community Health Centres 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 243 534 - - 243 534 229 528 14 006 94.2% 208 164 204 547 Compensation of employees 174 332 -7 005 - 167 327 149 664 17 663 89.4% 139 394 135 157 Goods and services 69 202 7 005 - 76 207 79 797 -3 590 104.7% 68 770 69 051 Interest and rent on land - - - - 67 -67 - - 339
Transfers and subsidies 1 725 - - 1 725 1 475 250 85.5% 1 230 1 230 Provinces and municipalities 70 - - 70 42 28 60.0% 1 230 1 230 Non-profit institutions ------Households 1 655 - - 1 655 1 433 222 86.6% - -
Payments for capital assets 2 500 - 1 464 3 964 3 964 - 100.0% 3 743 3 743 Buildings and other fixed structures ------Machinery and equipment 2 500 - 1 464 3 964 3 964 - 100.0% 3 436 3 436 Intangible assets ------307 307
Payments for financial assets ------Total 247 759 - 1 464 249 223 234 967 14 256 94.3% 213 137 209 520
159 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.4 Other Community Services 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 72 508 - - 72 508 68 954 3 554 95.1% 90 572 90 598 Compensation of employees 47 107 - - 47 107 50 669 -3 562 107.6% 66 639 71 811 Goods and services 25 401 - - 25 401 18 285 7 116 72.0% 23 933 18 777 Interest and rent on land ------10
Transfers and subsidies 901 - - 901 2 245 -1 344 249.1% 2 915 2 915 Provinces and municipalities ------789 789 Non-profit institutions 901 - - 901 2 110 -1 209 234.2% 2 126 2 126 Households - - - - 135 -135 - - -
Payments for capital assets 1 000 - 1 375 2 375 2 375 - 100.0% 692 692 Buildings and other fixed structures ------Machinery and equipment 1 000 - 1 375 2 375 2 375 - 100.0% 692 692 Intangible assets ------
Payments for financial assets ------Total 74 409 - 1 375 75 784 73 574 2 210 97.1% 94 179 94 205
160 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.5 HIV/ AIDS 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 280 347 - - 280 347 254 158 26 189 90.7% 285 424 284 447 Compensation of employees 77 520 - - 77 520 73 418 4 102 94.7% 82 636 124 212 Goods and services 202 827 - - 202 827 180 740 22 087 89.1% 202 788 160 233 Interest and rent on land ------2
Transfers and subsidies 76 451 - - 76 451 77 930 -1 479 101.9% 38 617 38 617 Provinces and municipalities 600 - - 600 100 500 16.7% - - Non-profit institutions 75 351 - - 75 351 77 340 -1 989 102.6% 38 617 38 617 Households 500 - - 500 490 10 98.0% - -
Payments for capital assets 27 022 - 203 27 225 25 806 1 419 94.8% 27 112 8 482 Buildings and other fixed structures - - 99 99 99 - 100.0% - - Machinery and equipment 27 022 - 104 27 126 25 707 1 419 94.8% 27 112 8 482 Intangible assets ------
Payments for financial assets
Total 383 820 - 203 384 023 357 894 26 129 93.2% 351 153 331 546
161 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.6 Nutrition 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 4 331 - - 4 331 3 879 452 89.6% 3 164 3 164 Compensation of employees 1 704 - - 1 704 995 709 58.4% 1 409 1 409 Goods and services 2 627 - - 2 627 2 884 -257 109.8% 1 755 1 755 Interest and rent on land ------
Transfers and subsidies - - - - 3 -3 - - - Provinces and municipalities ------Non-profit institutions ------
Households - - - - 3 -3 - - -
Payments for capital assets 25 - 11 36 36 - 100.0% 303 303 Buildings and other fixed structures ------Machinery and equipment 25 - 11 36 36 - 100.0% 303 303 Intangible assets ------
Payments for financial assets
Total 4 356 - 11 4 367 3 918 449 89.7% 3 467 3 467
162 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.7 Coroner Services 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments - - - - 4 265 -4 265 - - - Compensation of employees - - - - 1 558 -1 558 - - - Goods and services - - - - 2 698 -2 698 - - - Interest and rent on land - - - - 9 -9 - - -
Transfers and subsidies - - - - 8 -8 - - - Provinces and municipalities - - - - 8 -8 - - - Non-profit institutions ------
Households ------
Payments for capital assets - - 113 113 113 - 100.0% - - Buildings and other fixed structures ------Machinery and equipment - - 113 113 113 - 100.0% - - Intangible assets ------
Payments for financial assets ------Total - - 113 113 4 386 -4 273 3881.4% - -
163 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2.8 District Hospitals 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 444 720 - - 444 720 439 919 4 801 98.9% 383 662 384 222 Compensation of employees 299 908 - - 299 908 308 175 -8 267 102.8% 255 418 250 047 Goods and services 144 812 - - 144 812 130 747 14 065 90.3% 128 244 133 546 Interest and rent on land - - - - 997 -997 - - 629
Transfers and subsidies 1 921 - - 1 921 2 217 -296 115.4% 1 584 1 584 Provinces and municipalities - - - - 11 -11 - - - Non-profit institutions ------
Households 1 921 - - 1 921 2 206 -285 114.8% 1 584 1 584
Payments for capital assets 10 000 - 1 439 11 439 13 320 -1 881 116.4% 8 955 8 955 Buildings and other fixed structures - - 549 549 2 430 -1 881 442.6% - - Machinery and equipment 10 000 - 890 10 890 10 890 - 100.0% 8 955 8 955 Intangible assets ------
Payments for financial assets ------Total 456 641 - 1 439 458 080 455 456 2 624 99.4% 394 201 394 761
164 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 3: Emergency Medical Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. Emergency Transport 273 089 - -13 827 259 262 242 847 16 415 93.7% 231 955 199 910 Total for sub programmes 273 089 - -13 827 259 262 242 847 16 415 93.7% 231 955 199 910
Economic classification Current payments 216 118 - (9 198) 206 920 207 459 (539) 100.3% 191 026 191 236 Compensation of employees 145 336 - - 145 336 148 403 (3 067) 102.1% 130 987 133 777 Salaries and wages 124 636 - - 124 636 128 731 (4 095) 103.3% 105 197 113 667 Social contributions 20 700 - - 20 700 19 672 1 028 95.0% 25 790 20 110 Goods and services 70 782 - (9 198) 61 584 58 518 3 066 95.0% 60 039 57 249 Administrative fees - - - - 7 (7) - - - Advertising 100 - - 100 204 (104) 204.0% 82 - Minor assets 7 849 - (7 106) 743 743 - 100.0% 1 492 413 Audit costs: External ------Bursaries: Employees ------3 Catering: Departmental activities 100 - - 100 53 47 53.0% 80 39 Communication 1 414 - - 1 414 1 281 133 90.6% 204 49 Computer services 500 - - 500 1 499 0.2% 310 1 Consultants: Business and advisory services ------Infrastructure and planning services ------Laboratory services ------Scientific and technological services ------Legal services ------Contractors 4 000 - (2 092) 1 908 677 1 231 35.5% 7 663 3 060 Agency and support / outsourced services 23 - - 23 47 (24) 204.3% 20 88 Entertainment ------Fleet services 22 950 - - 22 950 43 784 (20 834) 190.8% 30 880 41 112 Housing ------165 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 3: Emergency Medical Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and supplies 3 000 - - 3 000 499 2 501 16.6% 1 878 - Inventory: Farming supplies ------Inventory: Food and food supplies ------6 Inventory: Fuel, oil and gas 20 500 - - 20 500 1 613 18 887 7.9% 10 374 4 013 200 - - 200 - 200 - - - Inventory: Learner and teacher support material 300 - - 300 9 291 3.0% 197 284 Inventory: Materials and supplies 1 432 - - 1 432 1 278 154 89.2% 735 1 341 Inventory: Medical supplies 702 - - 702 51 651 7.3% 673 ------Inventory: Medicine ------Medsas Inventory Interface 1 368 - - 1 368 2 174 (806) 158.9% 1 545 186 Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and office 150 - - 150 606 (456) 404.0% 340 121 supplies Operating leases 2 993 - - 2 993 3 645 (652) 121.8% 1 556 3 951 Property payments 851 - - 851 165 686 19.4% 260 831 Transport provided: Departmental activity ------Travel and subsistence 1 400 - - 1 400 1 475 (75) 105.4% 1 077 1 236 Training and development 750 - - 750 - 750 - 575 - Operating payments 200 - - 200 44 156 22.0% 98 512 Venues and facilities - - - - 162 (162) - - 3 Rental and hiring ------Interest and rent on land - - - - 538 (538) - - 210 Interest - - - - 538 (538) - - -
Transfers and subsidies 350 - (121) 229 229 - 100.0% 306 306 Provinces and municipalities 320 (67) (121) 132 132 - 100.0% 163 163 166 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 3: Emergency Medical Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Provinces 320 (67) (121) 132 132 - 100.0% - - Provincial Revenue Funds ------Provincial agencies and funds 320 (67) (121) 132 132 - 100.0% - - Municipalities ------163 163 Municipal bank accounts ------Municipal agencies and funds ------163 163 Non-profit institutions ------Households 30 67 - 97 97 - 100.0% 143 143 Social benefits 30 67 - 97 97 - 100.0% 143 143 Other transfers to households ------
Payments for capital assets 56 621 - (4 508) 52 113 35 159 16 954 67.5% 40 623 8 368 Buildings and other fixed structures - 1 860 - 1 860 1 860 - 100.0% 5 386 5 386 Buildings - 1 860 - 1 860 1 860 - 100.0% 5 386 5 386 Other fixed structures ------Machinery and equipment 56 621 (1 911) (4 508) 50 202 33 248 16 954 66.2% 35 172 2 917 Transport equipment 56 621 (1 911) (4 508) 50 202 27 590 22 612 55.0% 34 072 2 917 Other machinery and equipment - - - - 5 658 (5 658) - 1 100 - Intangible assets - 51 - 51 51 - 100.0% 65 65
Payments for financial assets ------Total 273 089 - (13 827) 259 262 242 847 16 415 93.7% 231 955 199 910
167 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3.1 Emergency Transport 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 216 118 - -9 198 206 920 207 459 -539 100.3% 191 026 191 236 Compensation of employees 145 336 - - 145 336 148 403 -3 067 102.1% 130 987 133 777 Goods and services 70 782 - -9 198 61 584 58 518 3 066 95.0% 60 039 57 249 Interest and rent on land - - - - 538 -538 - - 210
Transfers and subsidies 350 - -121 229 229 - 100.0% 306 306 Provinces and municipalities 320 -67 -121 132 132 - 100.0% 163 163 Non-profit institutions ------Households 30 67 - 97 97 - 100.0% 143 143
Payments for capital assets 56 621 - -4 508 52 113 35 159 16 954 67.5% 40 623 8 368 Buildings and other fixed structures - 1 860 - 1 860 1 860 - 100.0% 5 386 5 386 Machinery and equipment 56 621 -1 911 -4 508 50 202 33 248 16 954 66.2% 35 172 2 917 Intangible assets - 51 - 51 51 - 100.0% 65 65
Payments for financial assets Total 273 089 - -13 827 259 262 242 847 16 415 93.7% 231 955 199 910
Programme 4: Provincial Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. General (Regional) Hospitals 197 227 - 1 950 199 177 223 307 -24 130 112.1% 161 394 149 624 2. Tuberculosis Hospitals 13 198 - 1 644 14 842 14 661 181 98.8% 7 817 6 294 3. Psychiatric/Mental Hospitals 45 410 - 6 286 51 696 54 626 -2 930 105.7% 45 358 45 164 Total for sub programmes 255 835 - 9 880 265 715 292 594 -26 879 110.1% 214 569 201 082
Economic classification Current payments 254 260 - 6 364 260 624 285 800 (25 176) 109.7% 209 913 197 048 Compensation of employees 174 999 - 2 615 177 614 180 044 (2 430) 101.4% 140 849 140 251 168 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 4: Provincial Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Salaries and wages 153 293 - 2 615 155 908 159 227 (3 319) 102.1% 120 965 123 838 Social contributions 21 706 - - 21 706 20 817 889 95.9% 19 884 16 413 Goods and services 79 261 - 3 749 83 010 105 731 (22 721) 127.4% 69 064 56 782 Administrative fees 155 - - 155 29 126 18.7% 146 23 Advertising 169 - 22 191 841 (650) 440.3% - 272 Minor assets 145 - 104 249 820 (571) 329.3% 181 282 Audit costs: External ------Bursaries: Employees 16 - - 16 18 (2) 112.5% 104 17 Catering: Departmental activities 117 - - 117 429 (312) 366.7% 342 158 Communication 792 - - 792 328 464 41.4% 651 382 Computer services 3 537 - - 3 537 654 2 883 18.5% 2 572 870 Consultants: Business and advisory - - - - 8 (8) - - 6 services Infrastructure and planning services ------Laboratory services 3 458 - 72 3 530 1 746 1 784 49.5% 4 105 1 321 Scientific and technological services ------Legal services 25 - - 25 - 25 - - 23 Contractors 2 361 - 725 3 086 25 518 (22 432) 826.9% 2 046 3 397 Agency and support / outsourced 14 340 - 811 15 151 9 615 5 536 63.5% 12 191 10 874 services Entertainment ------Fleet services - - 20 20 313 (293) 1565.0% 9 100 Housing ------
169 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 4: Provincial Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and supplies - - 2 2 310 (308) 15500.0% - - Inventory: Farming supplies ------Inventory: Food and food supplies 2 823 - - 2 823 2 602 221 92.2% 3 061 2 002 Inventory: Fuel, oil and gas 3 389 - - 3 389 2 711 678 80.0% 3 315 2 631 Inventory: Learner and teacher support ------material 651 - - 651 795 (144) 122.1% 59 68 Inventory: Materials and supplies 8 045 - 213 8 258 10 270 (2 012) 124.4% 13 671 7 633 Inventory: Medical supplies 8 247 - 375 8 622 5 190 3 432 60.2% 5 600 4 757 Inventory: Medicine ------Medsas Inventory Interface ------Inventory: Other supplies 4 068 - 1 012 5 080 5 590 (510) 110.0% 1 866 3 676 Consumable supplies Consumable: Stationery, printing and 615 - 385 1 000 5 252 (4 252) 525.2% 626 425 office supplies Operating leases 3 647 - - 3 647 4 388 (741) 120.3% 4 221 2 957 Property payments 21 046 - - 21 046 25 774 (4 728) 122.5% 13 348 13 861 Transport provided: Departmental activity - - - - 245 (245) - - - Travel and subsistence 1 208 - - 1 208 1 538 (330) 127.3% 950 934 Training and development 76 - 8 84 8 76 9.5% - 29 Operating payments 331 - - 331 489 (158) 147.7% - 84 Venues and facilities - - - - 250 (250) - - - Rental and hiring ------Interest and rent on land - - - - 25 (25) - - 15 Interest - - - - 25 (25) - - 15 Rent on land ------
Transfers and subsidies 979 - 365 1 344 1 634 (290) 121.6% 766 144 Provinces and municipalities - - 365 365 365 - 100.0% - - Provinces ------Provincial Revenue Funds ------Provincial agencies and funds ------Municipalities - - 365 365 365 - 100.0% - -
170 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 4: Provincial Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Municipal bank accounts - - 365 365 365 - 100.0% - - Municipal agencies and funds ------Non-profit institutions ------Households 979 - - 979 1 269 (290) 129.6% 766 144 Social benefits 979 - - 979 1 079 (100) 110.2% - - Other transfers to households - - - - 190 (190) - 766 144
Payments for capital assets 596 - 3 151 3 747 5 160 (1 413) 137.7% 3 890 3 890 Buildings and other fixed structures - - 2 422 2 422 2 422 - 100.0% 2 826 2 826 Buildings - - 2 422 2 422 2 422 - 100.0% 2 563 2 563 Other fixed structures ------263 263 Machinery and equipment 596 - 685 1 281 2 667 (1 386) 208.2% 1 064 1 064 Transport equipment ------Other machinery and equipment 596 - 685 1 281 2 667 (1 386) 208.2% 1 064 1 064 Intangible assets - - 44 44 71 (27) 161.4% - -
Payments for financial assets ------Total 255 835 - 9 880 265 715 292 594 (26 879) 110.1% 214 569 201 082
171 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
4.1 General (Regional) Hospitals 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 196 320 - 1 550 197 870 221 604 -23 734 112.0% 160 912 149 361 Compensation of employees 129 930 - 1 550 131 480 135 783 -4 303 103.3% 104 121 104 474 Goods and services 66 390 - - 66 390 85 796 -19 406 129.2% 56 791 44 874 Interest and rent on land - - - - 25 -25 - - 13
Transfers and subsidies 469 - 365 834 1 229 -395 147.4% 282 63 Provinces and municipalities - - 365 365 365 - 100.0% - - Non-profit institutions ------Households 469 - - 469 864 -395 184.2% 282 63
Payments for capital assets 438 - 35 473 474 -1 100.2% 200 200 Buildings and other fixed structures ------Machinery and equipment 438 - 35 473 474 -1 100.2% 200 200 Intangible assets ------
Payments for financial assets ------Total 197 227 - 1 950 199 177 223 307 -24 130 112.1% 161 394 149 624
172 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
4.2 Tuberculosis Hospitals 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 12 834 - 1 065 13 899 13 899 - 100.0% 4 795 3 467 Compensation of employees 9 489 - 1 065 10 554 11 042 -488 104.6% 1 438 1 438 Goods and services 3 345 - - 3 345 2 857 488 85.4% 3 357 2 029 Interest and rent on land ------
Transfers and subsidies 206 - - 206 25 181 12.1% 195 - Provinces and municipalities ------Non-profit institutions ------Households 206 - - 206 25 181 12.1% 195 -
Payments for capital assets 158 - 579 737 737 - 100.0% 2 827 2 827 Buildings and other fixed structures - - 398 398 398 - 100.0% 2 563 2 563 Machinery and equipment 158 - 181 339 339 - 100.0% 264 264 Intangible assets ------
Payments for financial assets ------Total 13 198 - 1 644 14 842 14 661 181 98.8% 7 817 6 294
4.3 Psychiatric/Mental Hospitals 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 45 106 - 3 749 48 855 50 297 -1 442 103.0% 44 206 44 220 Compensation of employees 35 580 - - 35 580 33 219 2 361 93.4% 35 290 34 339 Goods and services 9 526 - 3 749 13 275 17 078 -3 803 128.6% 8 916 9 879 Interest and rent on land ------2
Transfers and subsidies 304 - - 304 380 -76 125.0% 289 81 Provinces and municipalities ------Non-profit institutions ------Households 304 - - 304 380 -76 125.0% 289 81
173 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
4.3 Psychiatric/Mental Hospitals 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Payments for capital assets - - 2 537 2 537 3 949 -1 412 155.7% 863 863 Buildings and other fixed structures - - 2 024 2 024 2 024 - 100.0% 263 263 Machinery and equipment - - 469 469 1 854 -1 385 395.3% 600 600 Intangible assets - - 44 44 71 -27 161.4% - -
Payments for financial assets ------Total 45 410 - 6 286 51 696 54 626 -2 930 105.7% 45 358 45 164
Programme 5: Central Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. Provincial Tertiary Hospital Services 791 172 - -2 346 788 826 767 519 21 307 97.3% 719 640 739 655 Total for sub programmes 791 172 - -2 346 788 826 767 519 21 307 97.3% 719 640 739 655
Economic classification Current payments 769 093 (1 315) (2 615) 765 163 749 252 15 911 97.9% 688 841 701 498 Compensation of employees 530 716 - (2 615) 528 101 528 101 - 100.0% 491 838 475 616 Salaries and wages 501 569 - (2 615) 498 954 474 193 24 761 95.0% 437 984 421 762 Social contributions 29 147 - - 29 147 53 908 (24 761) 185.0% 53 854 53 854 Goods and services 238 377 (1 315) - 237 062 221 151 15 911 93.3% 197 003 225 882 Administrative fees 266 - - 266 64 202 24.1% 16 311 Advertising 537 (250) - 287 287 - 100.0% 20 411 Minor assets 500 - - 500 1 093 (593) 218.6% 11 001 1 239 Audit costs: External ------Bursaries: Employees 78 (4) - 74 74 - 100.0% - 87 Catering: Departmental activities 149 - - 149 181 (32) 121.5% - 151 Communication 156 - - 156 411 (255) 263.5% 1 250 463 Computer services 2 500 (550) - 1 950 1 950 - 100.0% 12 168 971 Consultants: Business and advisory 286 - - 286 852 (566) 297.9% - 547 services
174 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 5: Central Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Infrastructure and planning services ------Laboratory services 41 968 - - 41 968 23 080 18 888 55.0% 25 000 21 333 Scientific and technological services ------Legal services ------Contractors 30 555 - - 30 555 19 792 10 763 64.8% 9 745 21 470 Agency and support / outsourced services 28 227 - - 28 227 28 446 (219) 100.8% 22 820 24 409 Entertainment ------Fleet services 70 - - 70 506 (436) 722.9% - 425 Housing ------Inventory: Clothing material and supplies 1 008 (325) - 683 683 - 100.0% - 1 007 Inventory: Farming supplies - - - - 7 (7) - - - Inventory: Food and food supplies - - - - 1 232 (1 232) - 87 1 218 Inventory: Fuel, oil and gas 7 424 - - 7 424 9 613 (2 189) 129.5% 4 082 6 413 Inventory: Learner and teacher support ------material 1 000 - - 1 000 1 063 (63) 106.3% - 1 495 Inventory: Materials and supplies 64 925 - - 64 925 45 251 19 674 69.7% 41 468 66 393 Inventory: Medical supplies 25 119 - - 25 119 36 101 (10 982) 143.7% 16 745 27 677 Inventory: Medicine ------Medsas Inventory Interface ------Inventory: Other supplies 5 659 - - 5 659 4 493 1 166 79.4% 5 025 4 868 Consumable supplies Consumable: Stationery, printing and 2 950 (186) - 2 764 2 305 459 83.4% 1 000 2 414 office supplies Operating leases 10 000 - - 10 000 16 921 (6 921) 169.2% 27 077 13 078 Property payments 12 699 - - 12 699 21 720 (9 021) 171.0% 18 699 24 899 Transport provided: Departmental activity - - - - 1 142 (1 142) - - 991 Travel and subsistence 1 500 - - 1 500 1 427 73 95.1% - 1 427 Training and development 232 - - 232 1 586 (1 354) 683.6% 800 383 Operating payments 569 - - 569 871 (302) 153.1% - 1 783 Venues and facilities ------19 Rental and hiring ------Interest and rent on land ------
175 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 5: Central Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Interest ------
Transfers and subsidies 1 860 1 315 421 3 596 3 596 - 100.0% 1 805 9 163 Provinces and municipalities ------Provinces ------Provincial Revenue Funds ------Provincial agencies and funds ------Municipalities ------Municipal bank accounts ------Municipal agencies and funds ------Non-profit institutions 635 - 421 1 056 1 056 - 100.0% 604 622 Households 1 225 1 315 - 2 540 2 540 - 100.0% 1 201 8 541 Social benefits 1 225 1 315 - 2 540 2 540 - 100.0% - - Other transfers to households ------1 201 8 541
Payments for capital assets 20 219 - (152) 20 067 14 671 5 396 73.1% 28 994 28 994 Buildings and other fixed structures 11 300 (553) (152) 10 595 10 595 - 100.0% 6 070 6 070 Buildings 11 300 (553) (152) 10 595 10 595 - 100.0% 6 070 6 070 Other fixed structures ------Machinery and equipment 8 919 553 - 9 472 4 076 5 396 43.0% 22 924 22 924 Transport equipment ------Other machinery and equipment 8 919 553 - 9 472 4 076 5 396 43.0% 22 924 22 924 Intangible assets ------
Payments for financial assets ------Total 791 172 - -2 346 788 826 767 519 21 307 97.3% 719 640 739 655
176 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
5.1 Provincial Tertiary Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 769 093 -1 315 -2 615 765 163 749 252 15 911 97.9% 688 841 701 498 Compensation of employees 530 716 - -2 615 528 101 528 101 - 100.0% 491 838 475 616 Goods and services 238 377 -1 315 - 237 062 221 151 15 911 93.3% 197 003 225 882 Interest and rent on land ------
Transfers and subsidies 1 860 1 315 421 3 596 3 596 - 100.0% 1 805 9 163 Provinces and municipalities ------Non-profit institutions 635 - 421 1 056 1 056 - 100.0% 604 622 Households 1 225 1 315 - 2 540 2 540 - 100.0% 1 201 8 541
Payments for capital assets 20 219 - -152 20 067 14 671 5 396 73.1% 28 994 28 994 Buildings and other fixed structures 11 300 -553 -152 10 595 10 595 - 100.0% 6 070 6 070 Machinery and equipment 8 919 553 - 9 472 4 076 5 396 43.0% 22 924 22 924 Intangible assets ------
Payments for financial assets ------Total 791 172 - -2 346 788 826 767 519 21 307 97.3% 719 640 739 655
Programme 6: Health Sciences & Training 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. Nurse Training College 54 488 -1 684 -685 52 119 51 769 350 99.3% 47 748 45 098 2. Other Training 31 971 -5 114 - 26 857 7 042 19 815 26.2% 5 759 5 756 3. Primary Health Care Training 1 362 - - 1 362 27 1 335 2.0% 481 297 4. Bursaries 21 562 6 798 - 28 360 45 413 -17 053 160.1% 34 857 34 861 Total for sub programmes 109 383 - -685 108 698 104 251 4 447 95.9% 88 845 86 012
177 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 6: Health Sciences & Training 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Economic classification Current payments 95 663 (8 674) - 86 989 61 059 25 930 70.2% 63 552 63 370 Compensation of employees 43 535 (5 264) - 38 271 26 725 11 546 69.8% 25 440 25 253 Salaries and wages 43 535 (5 264) - 38 271 24 333 13 938 63.6% 21 748 23 100 Social contributions - - - - 2 392 (2 392) - 3 692 2 153 Goods and services 52 128 (3 410) - 48 718 34 334 14 384 70.5% 38 112 38 113 Administrative fees 10 454 - - 10 454 390 10 064 3.7% 10 408 1 049 Advertising 95 - - 95 142 (47) 149.5% 29 106 Minor assets 913 - - 913 468 445 51.3% - 1 166 Audit costs: External ------Bursaries: Employees 401 - - 401 1 469 (1 068) 366.3% 188 556 Catering: Departmental activities 330 - - 330 1 299 (969) 393.6% 260 489 Communication 348 - - 348 77 271 22.1% 185 119 Computer services 1 423 - - 1 423 84 1 339 5.9% 95 130 Consultants: Business and advisory 843 - - 843 309 534 36.7% - 121 services Infrastructure and planning services ------Laboratory services ------Scientific and technological services ------Legal services ------Contractors - - - - 976 (976) - 97 152 Agency and support / outsourced 496 - - 496 - 496 - - - services Entertainment ------Fleet services - - - - 48 (48) - - - Housing ------
178 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 6: Health Sciences & Training 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and ------57 supplies ------Inventory: Farming supplies ------Inventory: Food and food supplies 198 - - 198 - 198 - 180 152 Inventory: Fuel, oil and gas ------Inventory: Learner and teacher support - - - - 2 (2) - - - material ------215 Inventory: Materials and supplies ------Inventory: Medical supplies ------Inventory: Medicine ------Medsas Inventory Interface ------Inventory: Other supplies Consumable supplies 361 - - 361 408 (47) 113.0% 59 542 Consumable: Stationery, printing and 666 - - 666 732 (66) 109.9% - 394 office supplies Operating leases 3 290 - - 3 290 8 421 (5 131) 256.0% 10 5 740 Property payments 150 - - 150 780 (630) 520.0% - 936 Transport provided: Departmental ------activity Travel and subsistence 8 610 - - 8 610 15 419 (6 809) 179.1% 16 180 16 363 Training and development 22 875 (3 410) - 19 465 2 720 16 745 14.0% 9 535 9 395 Operating payments 167 - - 167 109 58 65.3% 86 111 Venues and facilities 508 - - 508 481 27 94.7% 800 320 Rental and hiring ------Interest and rent on land ------4 Interest ------4 Rent on land ------
Transfers and subsidies 12 077 8 674 - 20 751 42 234 (21 483) 203.5% 21 075 21 075 Provinces and municipalities ------Provinces ------Provincial Revenue Funds ------179 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 6: Health Sciences & Training 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Provincial agencies and funds ------Municipalities ------Municipal bank accounts ------Municipal agencies and funds ------Non-profit institutions ------Households 12 077 8 674 - 20 751 42 234 (21 483) 203.5% 21 075 21 075 Social benefits - - - - 15 (15) - - - Other transfers to households 12 077 8 674 - 20 751 42 219 (21 468) 203.5% 21 075 21 075
Payments for capital assets 1 643 - (685) 958 958 - 100.0% 4 218 1 567 Buildings and other fixed structures - 74 - 74 74 - 100.0% - - Buildings - 74 - 74 74 - 100.0% - - Other fixed structures ------Machinery and equipment 1 643 (89) (685) 869 869 - 100.0% 4 218 1 567 Transport equipment 1 643 (89) (685) 869 - 869 - 1 216 - Other machinery and equipment - - - - 869 (869) - 3 002 1 567 Intangible assets - 15 - 15 15 - 100.0% - -
Payments for financial assets ------Total 109 383 - -685 108 698 104 251 4 447 95.9% 88 845 86 012
180 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
6.1 Nurse Training College 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 52 768 -1 684 - 51 084 50 803 281 99.4% 44 109 44 110 Compensation of employees 37 936 -1 684 - 36 252 25 185 11 067 69.5% 25 304 23 322 Goods and services 14 832 - - 14 832 25 618 -10 786 172.7% 18 805 20 788 Interest and rent on land ------
Transfers and subsidies 77 - - 77 394 -317 511.7% 97 96 Provinces and municipalities ------Non-profit institutions ------Households 77 - - 77 394 -317 511.7% 97 96
Payments for capital assets 1 643 - -685 958 572 386 59.7% 3 542 892 Buildings and other fixed structures - 74 - 74 74 - 100.0% - - Machinery and equipment 1 643 -89 -685 869 483 386 55.6% 3 542 892 Intangible assets - 15 - 15 15 - 100.0% - -
Payments for financial assets ------Total 54 488 -1 684 -685 52 119 51 769 350 99.3% 47 748 45 098
6.2 Other Training 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 31 971 -6 990 - 24 981 5 166 19 815 20.7% 5 759 5 755 Compensation of employees 3 718 -3 580 - 138 138 - 100.0% 136 132 Goods and services 28 253 -3 410 - 24 843 5 028 19 815 20.2% 5 623 5 623 Interest and rent on land ------
Transfers and subsidies - 1 876 - 1 876 1 876 - 100.0% - 1 Provinces and municipalities ------Non-profit institutions ------Households - 1 876 - 1 876 1 876 - 100.0% - 1
Payments for capital assets ------Buildings and other fixed structures ------Machinery and equipment ------Intangible assets ------Payments for financial assets ------Total 31 971 -5 114 - 26 857 7 042 19 815 26.2% 5 759 5 756 181 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
6.3 Primary Health Care Training 2014/15 2013/14 Adjusted Shifting of Funds Virement Final Actual Variance Expenditure Final Actual Appropriation Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 1 362 - - 1 362 27 1 335 2.0% 481 297 Compensation of employees - - - - 27 -27 - - - Goods and services 1 362 - - 1 362 - 1 362 - 481 297 Interest and rent on land ------
Transfers and subsidies ------Provinces and municipalities ------Non-profit institutions ------Households ------
Payments for capital assets ------Buildings and other fixed structures ------Machinery and equipment ------Intangible assets ------
Payments for financial assets ------Total 1 362 - - 1 362 27 1 335 2.0% 481 297
182 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
6.4 Bursaries 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 9 562 - - 9 562 5 063 4 499 52.9% 13 203 13 208 Compensation of employees 1 881 - - 1 881 1 375 506 73.1% - 1 799 Goods and services 7 681 - - 7 681 3 688 3 993 48.0% 13 203 11 405 Interest and rent on land ------4
Transfers and subsidies 12 000 6 798 - 18 798 39 964 -21 166 212.6% 20 978 20 978 Provinces and municipalities ------Non-profit institutions ------Households 12 000 6 798 - 18 798 39 964 -21 166 212.6% 20 978 20 978
Payments for capital assets - - - - 386 -386 - 676 675 Buildings and other fixed structures ------Machinery and equipment - - - - 386 -386 - 676 675 Intangible assets ------
Payments for financial assets ------Total 21 562 6 798 - 28 360 45 413 -17 053 160.1% 34 857 34 861
183 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 7: Health Care Support Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. Engineering 18 879 169 - 19 048 19 649 (601) 103.2% 18 415 18 519 2. Laundries 6 359 48 - 6 407 10 263 (3 856) 160.2% 9 540 10 483 3. Ortholic and Prostetic Services 9 822 (217) (1 277) 8 328 6 603 1 725 79.3% 6 244 4 850 4. Forensic Services 29 610 - (1 905) 27 705 18 297 9 408 66.0% 27 572 27 179 5. Medical Trading Account 25 005 - (1 235) 23 770 30 451 (6 681) 128.1% 27 258 23 493 Total for sub programmes 89 675 - (4 417) 85 258 85 263 (5) 100.0% 89 029 84 524
Economic classification Current payments 84 436 (254) (983) 83 199 83 204 (5) 100.0% 84 191 83 758 Compensation of employees 56 605 - - 56 605 56 721 (116) 100.2% 51 975 52 879 Salaries and wages 48 500 - - 48 500 49 190 (690) 101.4% 47 190 45 601 Social contributions 8 105 - - 8 105 7 531 574 92.9% 4 785 7 278 Goods and services 27 831 (254) (983) 26 594 26 477 117 99.6% 32 216 30 816 Administrative fees 5 - - 5 30 (25) 600.0% - 18 Advertising - - - - 19 (19) - 400 54 Minor assets 619 (52) (349) 218 458 (240) 210.1% 2 929 1 720 Audit costs: External ------Bursaries: Employees - - 3 3 3 - 100.0% - - Catering: Departmental activities - - 1 1 10 (9) 1000.0% 397 11 Communication 373 - - 373 1 480 (1 107) 396.8% 1 037 151 Computer services 100 - - 100 109 (9) 109.0% 100 134 Consultants: Business and advisory ------services Infrastructure and planning services ------Laboratory services ------200 - Scientific and technological services ------Legal services ------Contractors 9 793 (74) (9) 9 710 10 402 (692) 107.1% 11 169 10 900 Agency and support / outsourced 1 010 - (399) 611 609 2 99.7% 740 868 services Entertainment ------Fleet services 4 743 - - 4 743 450 4 293 9.5% 3 050 5 128 Housing ------
184 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 7: Health Care Support Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and supplies 91 - (90) 1 25 (24) 2500.0% 10 33 Inventory: Farming supplies 46 - (46) - - - - - 31 Inventory: Food and food supplies 353 - - 353 - 353 - 20 3 Inventory: Fuel, oil and gas - - 2 2 2 - 100.0% 5 192 Inventory: Learner and teacher support ------material 1 270 (32) 1 1 239 141 1 098 11.4% 240 618 Inventory: Materials and supplies 4 710 - - 4 710 4 588 122 97.4% 3 501 2 216 Inventory: Medical supplies 207 - - 207 - 207 - 20 15 Inventory: Medicine ------Medsas Inventory Interface ------Inventory: Other supplies 754 - - 754 3 262 (2 508) 432.6% 3 259 3 434 Consumable supplies Consumable: Stationery, printing and 381 (6) (6) 369 540 (171) 146.3% 1 027 446 office supplies Operating leases 710 - - 710 138 572 19.4% 356 470 Property payments 1 628 - - 1 628 3 336 (1 708) 204.9% 520 3 435 Transport provided: Departmental ------activity Travel and subsistence 901 (90) - 811 845 (34) 104.2% 2 288 875 Training and development 91 - (49) 42 18 24 42.9% 235 27 Operating payments 46 - (42) 4 12 (8) 300.0% 213 37 Venues and facilities ------500 - Rental and hiring ------Interest and rent on land - - - - 6 (6) - - 63 Interest - - - - 6 (6) - - 63 Rent on land ------
Transfers and subsidies - 254 7 261 261 - 100.0% 17 147 Provinces and municipalities - - 7 7 7 - 100.0% 3 - Provinces - - 7 7 7 - 100.0% - - Provincial Revenue Funds ------
185 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 7: Health Care Support Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Provincial agencies and funds - - 7 7 7 - 100.0% - - Municipalities ------3 - Municipal bank accounts ------3 - Municipal agencies and funds ------Non-profit institutions ------Households - 254 - 254 254 - 100.0% 14 147 Social benefits - 254 - 254 254 - 100.0% - - Other transfers to households ------14 147
Payments for capital assets 5 239 - (3 441) 1 798 1 798 0 100.0% 1 690 619 Buildings and other fixed structures - 348 - 348 348 - 100.0% 117 117 Buildings - 348 - 348 348 - 100.0% - - Other fixed structures ------117 117 Machinery and equipment 5 239 (348) (3 441) 1 450 1 450 0 100.0% 1 596 502 Transport equipment 1 683 - (929) 754 672 82 89.1% 740 - Other machinery and equipment 3 556 (348) (2 512) 696 778 (82) 111.7% 856 502 Intangible assets ------Payments for financial assets ------Total 89 675 - (4 417) 85 258 85 263 (5) 100.0% 89 029 84 524
186 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
7.1 Engineering 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 18 879 - - 18 879 18 881 -2 100.0% 18 246 18 246 Compensation of employees 10 008 - - 10 008 9 540 468 95.3% 9 375 9 368 Goods and services 8 871 - - 8 871 9 341 -470 105.3% 8 871 8 878 Interest and rent on land ------
Transfers and subsidies - 169 - 169 169 - 100.0% - 104 Provinces and municipalities ------Non-profit institutions ------Households - 169 - 169 169 - 100.0% - 104
Payments for capital assets - - - - 599 -599 - 169 169 Buildings and other fixed structures ------117 117 Machinery and equipment - - - - 599 -599 - 52 52 Intangible assets ------
Payments for financial assets ------Total 18 879 169 - 19 048 19 649 -601 103.2% 18 415 18 519
187 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
7.2 Laundries 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 6 359 - - 6 359 10 209 -3 850 160.5% 9 532 10 446 Compensation of employees 5 891 - - 5 891 5 733 158 97.3% 5 492 5 578 Goods and services 468 - - 468 4 476 -4 008 956.4% 4 040 4 868 Interest and rent on land ------
Transfers and subsidies - 48 - 48 48 - 100.0% - 29 Provinces and municipalities ------Non-profit institutions ------Households - 48 - 48 48 - 100.0% - 29
Payments for capital assets - - - - 6 -6 - 8 8 Buildings and other fixed structures ------Machinery and equipment - - - - 6 -6 - 8 8 Intangible assets ------
Payments for financial assets ------Total 6 359 48 - 6 407 10 263 -3 856 160.2% 9 540 10 483
188 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
7.3 Orthotic and Prosthetic Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 8 111 -217 - 7 894 6 169 1 725 78.1% 6 110 4 716 Compensation of employees 2 503 - - 2 503 2 824 -321 112.8% 2 332 2 584 Goods and services 5 608 -217 - 5 391 3 345 2 046 62.0% 3 778 2 132 Interest and rent on land ------
Transfers and subsidies ------Provinces and municipalities ------Non-profit institutions ------Households ------
Payments for capital assets 1 711 - -1 277 434 434 0 99.9% 134 134 Buildings and other fixed structures - 348 - 348 348 - 100.0% - - Machinery and equipment 1 711 -348 -1 277 86 86 0 99.7% 134 134 Intangible assets ------
Payments for financial assets ------Total 9 822 -217 -1 277 8 328 6 603 1 725 79.3% 6 244 4 850
189 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
7.4 Forensic Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 27 927 - -983 26 944 17 536 9 408 65.1% 26 858 26 905 Compensation of employees 20 043 - - 20 043 13 175 6 868 65.7% 17 098 18 472 Goods and services 7 884 - -983 6 901 4 355 2 546 63.1% 9 760 8 385 Interest and rent on land - - - - 6 -6 - - 48
Transfers and subsidies - - 7 7 7 - 100.0% 14 14 Provinces and municipalities - - 7 7 7 - 100.0% - - Non-profit institutions ------Households ------14 14
Payments for capital assets 1 683 - -929 754 754 - 100.0% 1 337 260 Buildings and other fixed structures ------Machinery and equipment 1 683 - -929 754 754 - 100.0% 1 337 260 Intangible assets ------
Payments for financial assets ------Total 29 610 - -1 905 27 705 18 297 9 408 66.0% 28 209 27 179
190 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
7.5 Medical Trading Account 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 23 160 -37 - 23 123 30 409 -7 286 131.5% 23 445 23 445 Compensation of employees 18 160 - - 18 160 25 449 -7 289 140.1% 17 678 16 877 Goods and services 5 000 -37 - 4 963 4 960 3 99.9% 5 767 6 553 Interest and rent on land ------15
Transfers and subsidies - 37 - 37 37 - 100.0% 3 - Provinces and municipalities ------3 - Non-profit institutions ------Households - 37 - 37 37 - 100.0% - -
Payments for capital assets 1 845 - -1 235 610 5 605 0.8% 42 48 Buildings and other fixed structures ------Machinery and equipment 1 845 - -1 235 610 5 605 0.8% 42 48 Intangible assets ------
Payments for financial assets ------Total 25 005 - -1 235 23 770 30 451 -6 681 128.1% 23 490 23 493
191 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 8: Health Facilities Management 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1. District Hospital Services 287 453 - (15 083) 272 370 195 588 76 782 71.8% 315 455 286 816 2. Provincial Hospital Services 185 667 - - 185 667 200 576 (14 909) 108.0% 166 454 166 544 Total for sub programmes 473 120 - (15 083) 458 037 396 164 61 873 86.5% 481 909 453 360
Economic classification Current payments 25 430 - - 25 430 32 629 (7 199) 128.3% 29 605 29 710 Compensation of employees 7 988 (1 030) - 6 958 6 959 (1) 100.0% 3 343 3 343 Salaries and wages 7 275 (1 030) - 6 245 6 407 (162) 102.6% 2 614 2 689 Social contributions 713 - - 713 552 161 77.4% 729 654 Goods and services 17 442 1 030 - 18 472 25 338 (6 866) 137.2% 26 262 26 262 Administrative fees 9 - - 9 84 (75) 933.3% 9 47 Advertising 231 - - 231 713 (482) 308.7% 351 136 Minor assets - - - - 2 039 (2 039) - 3 624 11 941 Audit costs: External ------Bursaries: Employees - - - - 36 (36) - - - Catering: Departmental activities 75 - - 75 61 14 81.3% 75 53 Communication 100 - - 100 129 (29) 129.0% 100 56 Computer services ------4 Consultants: Business and advisory services - - - - 3 076 (3 076) - - 1 750 Infrastructure and planning services 6 096 - - 6 096 - 6 096 - - - Laboratory services ------30 Scientific and technological services ------Legal services ------Contractors 10 606 - - 10 606 12 643 (2 037) 119.2% 14 330 9 467 Agency and support / outsourced services - - - - 106 (106) - - - Entertainment ------Fleet services - - - - 71 (71) - - 59 Housing ------
192 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 8: Health Facilities Management 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Clothing material and supplies ------Inventory: Farming supplies ------6 Inventory: Food and food supplies - - - - 1 (1) - - 12 Inventory: Fuel, oil and gas ------Inventory: Learner and teacher support material ------Inventory: Materials and supplies - - - - 431 (431) - - 32 Inventory: Medical supplies - - - - 27 (27) - - 189 Inventory: Medicine ------98 Medsas Inventory Interface ------Inventory: Other supplies ------Consumable supplies - - - - 107 (107) - - 399 Consumable: Stationery, printing and office 200 - - 200 41 159 20.5% 200 352 supplies Operating leases - - - - 22 (22) - 230 38 Property payments - 1 030 - 1 030 1 797 (767) 174.5% - 460 Transport provided: Departmental activity ------Travel and subsistence 125 - - 125 2 773 (2 648) 2218.4% 500 1 063 Training and development - - - - 9 (9) - 6 843 47 Operating payments - - - - 32 (32) - - 2 Venues and facilities - - - - 1 140 (1 140) - - 21 Rental and hiring ------Interest and rent on land - - - - 332 (332) - - 105 Interest - - - - 332 (332) - - 105 Rent on land ------
Transfers and subsidies ------Provinces and municipalities ------Provinces ------Provincial Revenue Funds ------Provincial agencies and funds ------Municipalities ------
193 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Programme 8: Health Facilities Management 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Municipal bank accounts ------Municipal agencies and funds ------Non-profit institutions ------Households ------Social benefits ------Other transfers to households ------
Payments for capital assets 447 690 - (15 083) 432 607 363 535 69 072 84.0% 452 304 423 650 Buildings and other fixed structures 423 220 - (14 305) 408 915 339 523 69 392 83.0% 410 046 381 392 Buildings 423 220 - (14 305) 408 915 339 523 69 392 83.0% 410 046 381 392 Other fixed structures ------Machinery and equipment 24 470 - (778) 23 692 24 012 (320) 101.4% 42 258 42 258 Transport equipment - - - - 7 050 (7 050) - - - Other machinery and equipment 24 470 - (778) 23 692 16 962 6 730 71.6% 42 258 42 258 Intangible assets ------
Payments for financial assets ------Total 473 120 - (15 083) 458 037 396 164 61 873 86.5% 481 909 453 360
194 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
8.1 District Hospital Services 2014/15 2013/14 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 21 058 - - 21 058 13 640 7 418 64.8% 10 313 10 328 Compensation of employees 4 356 -1 030 - 3 326 2 3 324 0.1% - - Goods and services 16 702 1 030 - 17 732 13 578 4 154 76.6% 10 313 10 223 Interest and rent on land - - - - 60 -60 - - 105
Transfers and subsidies ------Provinces and municipalities ------Non-profit institutions ------Households ------
Payments for capital assets 266 395 - -15 083 251 312 181 948 69 364 72.4% 305 142 276 488 Buildings and other fixed structures 252 925 - -14 305 238 620 173 114 65 506 72.5% 276 655 248 001 Machinery and equipment 13 470 - -778 12 692 8 834 3 858 69.6% 28 487 28 487 Intangible assets ------
Payments for financial assets ------Total 287 453 - -15 083 272 370 195 588 76 782 71.8% 315 455 286 816
195 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
8.2 Provincial Hospital Services 2014/15 2013/14
Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation expenditure appropriation
Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 4 372 - - 4 372 18 989 -14 617 434.3% 19 292 19 382 Compensation of employees 3 632 - - 3 632 6 957 -3 325 191.5% 3 343 3 343 Goods and services 740 - - 740 11 760 -11 020 1589.2% 15 949 16 039 Interest and rent on land - - - - 272 -272 - - -
Transfers and subsidies ------Provinces and municipalities ------Non-profit institutions ------Households ------
Payments for capital assets 181 295 - - 181 295 181 587 -292 100.2% 147 162 147 162 Buildings and other fixed structures 170 295 - - 170 295 166 409 3 886 97.7% 133 391 133 391 Machinery and equipment 11 000 - - 11 000 15 178 -4 178 138.0% 13 771 13 771 Intangible assets ------
Payments for financial assets ------Total 185 667 - - 185 667 200 576 -14 909 108.0% 166 454 166 544
196 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1. Detail of transfers and subsidies as per Appropriation Act (after Virement):
Detail of these transactions can be viewed in the note on Transfers and subsidies, disclosure notes and Annexure 1 (A-C) to the Annual Financial Statements.
2. Detail of specifically and exclusively appropriated amounts voted (after irement):V
Detail of these transactions can be viewed in note 1 (Annual Appropriation) to the Annual Financial Statements.
3. Detail on payments for financial assets
Detail of these transactions per programme can be viewed in the note on Payments for financial assets to the Annual Financial Statements.
4. Explanations of material variances from Amounts Voted (after Virement):
4.1 Per programme Final Actual Variance Variance as Appropriation Expenditure R’000 a % of Final Appropriation Administration 173 694 192 331 (18 367) -11% District Health Services 1 618 498 1 633 011 (14 513) -1% Emergency Medical Services 259 262 242 847 16 415 6% Provincial Hospital Services 265 715 292 594 (26 879) -10% Central Hospital Services 788 826 767 519 21 307 3% Health Sciences 108 698 104 251 4 447 4% Health Care Support Services 85 258 85 263 (5) 0% Health Facilities Management 458 037 396 164 61 873 14%
Administration – (R18.367 million) The programme overspending was due to claim against the department, interest on overdue accounts and outstanding payments from prior year that are processed centrally such as computer services, security services, consulting fees and audit fees.
The spending is being reprioritised in line with the approved Cost containment measures and Treasury was consulted to assist with the impact of accruals.
District Health Services – (R14.513 million) The programme overspends mainly on the goods and services. These goods &services were overspend due to accruals specifically on security services, municipal services, consumable supplies, medical waste and interest on overdue accounts, machinery & equipment, outsourced professional staff, operating leases and telephone costs.
The spending is being reprioritised in line with the approved Cost containment measures and Treasury was consulted to assist with the impact of accruals
Emergency Medical Services – R16.415 million The department had reprioritised the budget by implementing the strategy of replacing vehicles with mileage exceeding 250 000 kilometres, in order to improve emergency response time and cut down on repairs and maintenance cost.
However, there were supply chain delays by the department. This delay was further affected by cash flow constraints affecting the payment of suppliers, in which case the suppliers wanted payments before conversion of vehicles takes place.
The department had committed R16.954 million towards the procurement of emergency mobiles, in order to make the vehicle ready for service delivery, the department has issued another tender for the conversion of vehicles into ambulance including the supply and installation of equipment to be mounted as outlined above. The vehicles have been delivered to relevant service providers for conversion and mounting the required equipment. A roll over has been requested to mitigate this effect.
197 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Provincial Hospital Services – (R26.879 million) This programme overspends its budget due to the impact of accruals that could not be paid during the 2013/14. The programme overspend on goods & services and machinery & equipment specifically on outsourced medical services, operating leases, security services and municipal services. The operationalisation of Dr Harry Surtie Regional Hospital is funded over three year periods, however full operationalisation of certain clinical units such as pharmacy were accelerated due to service delivery demands.
The spending is being reprioritised in line with the approved Cost containment measures and Treasury was consulted to assist with the impact of accruals.
Central Hospital Services – R21.307 million The department experienced delays of deliveries by suppliers; this was partly due to cash flow constraints affecting the payment of suppliers.
The department had committed R2.176 million towards the procurement of medical equipment and office automation devices; a further R17.489 million had committed towards the procurement of goods & services mainly the laboratory services and blood supplies which have a direct impact on the patient care.
The committed funds have been requested as a roll over.
Health Sciences – R4.447 million The compensation underspends due to delays on the recruitment of 200 auxillary nurses. However, the programme grossly overspends on transfers to the Cuban Programme in the form of bursaries. The strategy has been sought for recruitment of 200 auxillary nurses.
The budget bid to fund the Cuban Programme was presented to National Department of Health and the Provincial Treasury for consideration.
Health Care Support Services – (R5 000) The programme almost breaks even, despite the budget pressures affecting infrastructure needs of the forensic medical services and provincial medical depot.
Health Facilities Management – R61.873 million The programme underspends due to delays in appointing contractor of Port Nolloth, termination of contractor for Kagung Clinic and slow progress on Mental Health project. The acceleration plan has been developed and the implementing agents are constantly monitored for adherence to the service level agreements (SLA). The department could not spend all funds allocated. A roll over has been requested for the funds that were already committed.
4.2 Per economic classification Final Actual Variance Variance as Appropriation Expenditure a % of Final Appropriation R’000 R’000 R’000 R’000 Current payments Compensation of employees 1 942 868 1 936 740 6 128 0% Goods and services 1 123 164 1 153 719 (30 555) -3% Interest and rent on land - 2 343 (2 343) -100%
Transfers and subsidies Provinces and municipalities 8 294 2 218 6 076 73% Non-profit institutions 77 413 80 506 (3 093) -4% Households 29 601 52 749 (23 148) -78%
Payments for capital assets Buildings and other fixed structures 425 675 356 283 69 392 16% Machinery and equipment 150 077 128 498 21 579 14% Intangible assets 896 923 (27) -3%
Payments for financial assets - - - -
198 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Explanation of variances
Compensation of employees – R6.128 million An allocation of R4.082 million was earmarked funds for SCM and Financial Management and a further R2.046 million which was set aside for training of 200 auxillary nurses. These funds had not yet been utilised at the end of financial year, due to administrative delays.
Therefore, an amount of R6.128 million unutilised funds will be surrendered to the Provincial Revenue Fund.
Goods and services – (R26.900 million) The department experienced cash flow constraints due to the impact of accruals; this negatively affected the payment of suppliers and resulted into further unauthorised expenditure. The items that were mainly overspend are travel costs, operating leases, fleet services, maintenance costs, cleaning materials and uniform/clothing materials.
The department implemented cost containment measures to reduce the spending and to accommodate the impact of accruals. These cost containment measures have been implemented to focus spending to core mandate of the department. These measures will be continue to be implemented until the financial sustainability has been reached.
Interest and rent on land – (R2.343 million) The overspending was caused by interest on overdue accounts amount to R2.343 million. The department could not pay suppliers from the equitable share during the last two months of 2013/14 financial year, due to cash flow constraints.
Provinces and municipalities – R6.076 million The budget for transfers to municipalities was underspend since some of the primary health care clinics at the Sol Plaatjie Municipal area were provincialised during the second quarter; while the clinics at ZF Mgcawu District Municipality was planned for the 2015/16 financial year. The department is gradually filling the vacant posts from own budget to sustain service delivery.
The unutilised funds will be surrendered to the Provincial Revenue Fund, since these funds are earmarked.
Non-profit institutions – (R3.093 million) The transfer to non-profit institutions was overspending mainly due to significant reduction in the Social EPWP grant allocation which reduced by R2.179 million in the current year. However, the expenditure was curbed by use of equitable share.
Households – (R26.438 million) The transfers to Cuban Programme and local universities overspend by R26.904 million to upscale the skills capacity within the health sector. The department is over-committed on bursaries due to inability to attract and retain skilled personnel.
A budget bid was prepared and presented to the Provincial Treasury and National Department of Health for consideration.
Buildings & Other Fixed Structures - R69.392 million The department under spend due to delays in appointing contractor of Port Nolloth, termination of contractor for Kagung Clinic and slow progress on Mental Health project. The acceleration plan has been developed, resulting in additional budget required.
A roll over amounting to R69.021 million has been requested, to this effect.
Machinery & Equipment – R21.237 million The under spending is caused mainly by delays in the procurement of emergency vehicles and medical equipment. The department had committed R16.954 million towards the procurement of emergency vehicles and a further R2.176 million towards the procurement of medical equipment and office automation devices, which was negatively affected by cash flow constraints. A roll over has been requested to this effect.
199 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
4.3 Per conditional grant Final Actual Variance Variance as Appropriation Expenditure a % of Final Appropriation R’000 R’000 R’000 R’000
Comprehensive HIV and AIDS Grant 355 972 354 004 1 968 1% Health Facility Revitalisation Grant 464 910 395 519 69 391 15% Health Professions Training & Dev 76 697 76 697 - 0% National Tertiary Services Grant 298 727 291 526 7 201 2% National Health Insurance 7 000 3 975 3 025 43% EPWP Incentive Grant 2 115 2 115 - 0% EPWP Social Services Grant 7 337 7 337 - 0%
Explanation of variances:
Comprehensive HIV & Aids Grant - R1.968 million The grant underspends with minimal amount of R1.968 million which results from delays of delivery by suppliers.
The department had committed R1.277 million towards procurement of mobile truck, office equipment and uniform for officials. A roll over has been requested on this grant.
Health Facility Revitalisation Grant - R69.391 million The under-expenditure was caused by factors beyond control the department and the implementing agents. A number of projects were negatively affected, and the department had to reprioritise the use of funds in some projects, namely, De Aar Hospital, Kagung Clinic and Port Nolloth CHC projects.
The department had committed R14.630 million towards further construction of Kimberley Mental Health Hospital. Kimberley Mental Health Hospital project was allocated a budget of R128.029 million, an additional budget of R30.000 million was made available to the project following cash flow projections from the project manager. The total budget increased to R158.029 million of which R143.399 million was spent. The under-expenditure to this project is therefore R14.630 million. The project experienced slow delivery despite the fact that several interactions and reprogramming of project activities with the Department of Roads and Public Works, as an implementing agent, took place.
The department had further committed R9.9 million towards construction of Kagung Clinic. The Contractor for Kagung clinic was terminated due to poor workmanship and slow delivery. A projection of R 9.9 million will be required to further continue with the project. The remaining under spending was reprioritised to other projects.
The department had further committed R18.988 million towards construction of new De Aar District Hospital. De Aar Hospital project experienced several industrial actions. The industrial actions came to an end after discussions with the workforce took place, but their impact caused major delays in terms of delivery. The project was initially allocated R 200.000 million, in which the department underspend by R42.019 million. The remaining under spending was reprioritised to other projects.
The department had further committed R25.503 million towards medical equipment for Kimberley Hospital and capital equipment needs at Curomed building as a facility to be used by the department effectively from 01 April 2015. This project was funded from under spending reprioritised from De Aar Hospital, Kagung Clinic and Port Nolloth CHC projects.
A roll over has been requested on this grant.
Health Professions Training & Development Grant (R nil) The department has spent all the allocated funds in line with the approved business plan.
National Tertiary Services Grant - R7.201 million The under spending result from delays in supplier delivery, as a control measure the department assigned as officials to do order chasing.
The department had committed R5.785 million towards High Care Unit upgrading and medical equipment. A roll over has been requested on this grant. 200 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
National Health Insurance (NHI) - R3.025 million The expenditure is far below the grant allocation due to delays in the implementation of business plan and vacancy on the position of NHI Project Manager.
An official was appointed in November 2014 to act in the position of NHI Coordinator which was already late, considering other challenges. However, interviews were held in January 2015, which will only assist to accelerate grant performance in the new financial year.
An amount of R0.330 million had been committed. A roll over has been requested on this grant.
EPWP Integrated Grant (R nil) The department has spent all the allocated funds in line with the approved business plan.
Social Sector EPWP Incentive Grant (R nil) The department has spent all the allocated funds in line with the approved business plan.
Note 2014/15 2013/14 R'000 R'000 REVENUE
Annual appropriation 1 3,757,988 3,476,988 Departmental revenue 2 - - Aid assistance 3 142 69
TOTAL REVENUE 3,758,130 3,477,057
EXPENDITURE
Current expenditure Compensation of employees 4 1,936,739 1,786,195 Goods and services 5 1,150,039 1,032,701 Interest and rent on land 6 2,373 1,584 Aid assistance 3 344 1,083 Total current expenditure 3,089,495 2,821,563
Transfers and subsidies Transfers and subsidies 7 138,762 84,440 Total transfers and subsidies 138,762 84,440
Expenditure for capital assets Tangible assets 8 485,122 496,371 Intangible assets 8 945 510
Total expenditure for capital assets 486,067 496,881
TOTAL EXPENDITURE 3,714,324 3,402,884
SURPLUS/(DEFICIT) FOR THE YEAR 43,806 74,173
Reconciliation of Net Surplus/(Deficit) for the year
Voted funds 44,008 75,187 Annual appropriation (37,577) 24,272 Conditional grants 81,585 50,915 Aid assistance 3 (202) (1,014) SURPLUS/(DEFICIT) FOR THE YEAR 43,806 74,173
201 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Note 2014/15 2013/14 R'000 R'000 ASSETS
Current assets 252,382 159,313
Unauthorised expenditure 9 236,856 145,220 Cash and cash equivalents 10 - 8 Prepayments and advances 11 631 802 Receivables 12 14,895 12,526 Aid assistance receivable 3 - 757
TOTAL ASSETS 252,382 159,313
LIABILITIES
Current liabilities 252,008 158,935
Voted funds to be surrendered to the Revenue Fund 13 135,645 101,693 Departmental revenue and NRF Receipts to be 14 7,131 7,302 surrendered to the Revenue Fund Bank overdraft 15 106,975 47,296 Payables 16 868 296 Aid assistance unutilised 3 1,389 2,348
TOTAL LIABILITIES 252,008 158,935
NET ASSETS 374 378
Represented by: Recoverable revenue 374 378 TOTAL 374 378
Note 2014/15 2013/14 R'000 R'000
Recoverable revenue Opening balance 378 403 Transfers: (4) (25) Debts recovered (included in departmental (4) (28) receipts) Debts raised - 3 Closing balance 374 378
TOTAL 374 378
Note 2014/15 2013/14 R'000 R’000
202 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
CASH FLOWS FROM OPERATING ACTIVITIES
Receipts 3,801,067 3,518,445 Annual appropriated funds received 1.1 3,757,988 3,476,988 Departmental revenue received 2 42,649 41,388 Interest received 2.2 288 - Aid assistance received 3 142 69
Net (increase)/decrease in working capital (93,262) 358,588 Surrendered to Revenue Fund (144,800) (204,761) Current payments (2,995,486) (2,793,473) Interest paid 6 (2,373) (1,584) Transfers and subsidies paid (138,762) (84,440) Net cash flow available from operating activities 17 426,384 792,775
CASH FLOWS FROM INVESTING ACTIVITIES
Payments for capital assets 8 (486,067) (496,881) Proceeds from sale of capital assets 2.3 - 1,775 Net cash flows from investing activities (486,067) 495,106
CASH FLOWS FROM FINANCING ACTIVITIES
Increase/(decrease) in net assets (4) (25) Net cash flows from financing activities (4) (25)
Net increase/(decrease) in cash and cash equivalents (59,687) 297,644
Cash and cash equivalents at beginning of period (47,288) (344,932)
Cash and cash equivalents at end of period 18 (106,975) (47,288)
Summary of significant accounting policies The financial statements have been prepared in accordance with the following policies, which have been applied consistently in all material aspects, unless otherwise indicated. The historical cost convention has been used, except where otherwise indicated. Management has used assessments and estimates in preparing the annual financial statements. These are based on the best information available at the time of preparation. Where appropriate and meaningful, additional information has been disclosed to enhance the usefulness of the financial statements and to comply with the statutory requirements of the Public Finance Management Act (PFMA), Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations issued in terms of the PFMA and the annual Division of Revenue Act. 1 Basis of preparation The financial statements have been prepared in accordance with the Modified Cash Standard. 2 Going concern The financial statements have been prepared on a going concern basis. 3 Presentation currency Amounts have been presented in the currency of the South African Rand (R) which is also the functional currency of the department.
203 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
4 Rounding Unless otherwise stated financial figures have been rounded to the nearest one thousand Rand (R’000). 5 Foreign currency translation Cash flows arising from foreign currency transactions are translated into South African Rands using the exchange rates prevailing at the date of payment / receipt. 6 Comparative information 6.1 Prior period comparative information Prior period comparative information has been presented in the current year’s financial statements. Where necessary figures included in the prior period financial statements have been reclassified to ensure that the format in which the information is presented is consistent with the format of the current year’s financial statements. 6.2 Current year comparison with budget A comparison between the approved, final budget and actual amounts for each programme and economic classification is included in the appropriation statement. 7 Revenue 7.1 Appropriated funds Appropriated funds comprises of departmental allocations as well as direct charges against the revenue fund (i.e. statutory appropriation). Appropriated funds are recognised in the statement of financial performance on the date the appropriation becomes effective. Adjustments made in terms of the adjustments budget process are recognised in the statement of financial performance on the date the adjustments become effective. The net amount of any appropriated funds due to / from the relevant revenue fund at the reporting date is recognised as a payable / receivable in the statement of financial position. 7.2 Departmental revenue Departmental revenue is recognised in the statement of financial performance when received and is subsequently paid into the relevant revenue fund, unless stated otherwise. Any amount owing to the relevant revenue fund at the reporting date is recognised as a payable in the statement of financial position. 7.3 Accrued departmental revenue Accruals in respect of departmental revenue (excluding tax revenue) are recorded in the notes to the financial statements when: · it is probable that the economic benefits or service potential associated with the transaction will flow to the department; and · the amount of revenue can be measured reliably. The accrued revenue is measured at the fair value of the consideration receivable. Accrued tax revenue (and related interest and / penalties) is measured at amounts receivable from collecting agents. 8 Expenditure 8.1 Compensation of employees 8.1.1 Salaries and wages Salaries and wages are recognised in the statement of financial performance on the date of payment. 8.1.2 Social contributions Social contributions made by the department in respect of current employees are recognised in the statement of financial performance on the date of payment. Social contributions made by the department in respect of ex-employees are classified as transfers to households in the statement of financial performance on the date of payment.
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8.2 Other expenditure Other expenditure (such as goods and services, transfers and subsidies and payments for capital assets) is recognised in the statement of financial performance on the date of payment. The expense is classified as a capital expense if the total consideration paid is more than the capitalisation threshold. 8.3 Accrued expenditure payable Accrued expenditure payable is recorded in the notes to the financial statements when the goods are received or, in the case of services, when they are rendered to the department. Accrued expenditure payable is measured at cost. 8.4 Leases 8.4.1 Operating leases Operating lease payments made during the reporting period are recognised as current expenditure in the statement of financial performance on the date of payment. The operating lease commitments are recorded in the notes to the financial statements. 8.4.2 Finance leases Finance lease payments made during the reporting period are recognised as capital expenditure in the statement of financial performance on the date of payment. The finance lease commitments are recorded in the notes to the financial statements and are not apportioned between the capital and interest portions. Finance lease assets acquired at the end of the lease term are recorded and measured at the lower of: · cost, being the fair value of the asset; or · the sum of the minimum lease payments made, including any payments made to acquire ownership at the end of the lease term, excluding interest. 9 Aid Assistance 9.1 Aid assistance received Aid assistance received in cash is recognised in the statement of financial performance when received. In-kind aid assistance is recorded in the notes to the financial statements on the date of receipt and is measured at fair value. Aid assistance not spent for the intended purpose and any unutilised funds from aid assistance that are required to be refunded to the donor are recognised as a payable in the statement of financial position. 9.2 Aid assistance paid Aid assistance paid is recognised in the statement of financial performance on the date of payment. Aid assistance payments made prior to the receipt of funds are recognised as a receivable in the statement of financial position. 10 Cash and cash equivalents Cash and cash equivalents are stated at cost in the statement of financial position. Bank overdrafts are shown separately on the face of the statement of financial position. For the purposes of the cash flow statement, cash and cash equivalents comprise cash on hand, deposits held, other short-term highly liquid investments and bank overdrafts. 11 Prepayments and advances Prepayments and advances are recognised in the statement of financial position when the department receives or disburses the cash. Prepayments and advances are initially and subsequently measured at cost.
205 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
12 Loans and receivables Loans and receivables are recognised in the statement of financial position at cost plus accrued interest, where interest is charged, less amounts already settled or written-off. 13 Investments Investments are recognised in the statement of financial position at cost. 14 Impairment of financial assets Where there is an indication of impairment of a financial asset, an estimation of the reduction in the recorded carrying value, to reflect the best estimate of the amount of the future economic benefits expected to be received from that asset, is recorded in the notes to the financial statements. 15 Payables Loans and payables are recognised in the statement of financial position at cost. 16 Capital Assets 16.1 Immovable capital assets
Immovable capital assets are initially recorded in the notes to the financial statements at cost. Immovable capital assets acquired through a non-exchange transaction is measured at fair value as at the date of acquisition. Where the cost of immovable capital assets cannot be determined accurately, the immovable capital assets are measured at R1 unless the fair value of the asset has been reliably estimated, in which case the fair value is used. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Immovable capital assets are subsequently carried at cost and are not subject to depreciation or impairment. Subsequent expenditure that is of a capital nature is added to the cost of the asset at the end of the capital project unless the immovable asset is recorded by another department in which case the completed project costs are transferred to that department. 16.2 Movable capital assets
Movable capital assets are initially recorded in the notes to the financial statements at cost. Movable capital assets acquired through a non-exchange transaction is measured at fair value as at the date of acquisition. Where the cost of movable capital assets cannot be determined accurately, the movable capital assets are measured at fair value and where fair value cannot be determined; the movable assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Movable capital assets are subsequently carried at cost and are not subject to depreciation or impairment. Subsequent expenditure that is of a capital nature is added to the cost of the asset at the end of the capital project unless the movable asset is recorded by another department/ entity in which case the completed project costs are transferred to that department.
206 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
16.3 Intangible assets Intangible assets are initially recorded in the notes to the financial statements at cost. Intangible assets acquired through a non-exchange transaction are measured at fair value as at the date of acquisition. Internally generated intangible assets are recorded in the notes to the financial statements when the department commences the development phase of the project. Where the cost of intangible assets cannot be determined accurately, the intangible capital assets are measured at fair value and where fair value cannot be determined; the intangible assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Intangible assets are subsequently carried at cost and are not subject to depreciation or impairment. Subsequent expenditure that is of a capital nature is added to the cost of the asset at the end of the capital project unless the intangible asset is recorded by another department/ entity in which case the completed project costs are transferred to that department. 17 Provisions and Contingents 17.1 Provisions Provisions are recorded in the notes to the financial statements when there is a present legal or constructive obligation to forfeit economic benefits as a result of events in the past and it is probable that an outflow of resources embodying economic benefits or service potential will be required to settle the obligation and a reliable estimate of the obligation can be made. The provision is measured as the best estimate of the funds required to settle the present obligation at the reporting date. 17.2 Contingent liabilities Contingent liabilities are recorded in the notes to the financial statements when there is a possible obligation that arises from past events, and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not within the control of the department or when there is a present obligation that is not recognised because it is not probable that an outflow of resources will be required to settle the obligation or the amount of the obligation cannot be measured reliably 17.3 Contingent assets Contingent assets are recorded in the notes to the financial statements when a possible asset arises from past events, and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not within the control of the department 17.4 Commitments Commitments are recorded at cost in the notes to the financial statements when there is a contractual arrangement or an approval by management in a manner that raises a valid expectation that the department will discharge its responsibilities thereby incurring future expenditure that will result in the outflow of cash
207 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
18 Unauthorised expenditure Unauthorised expenditure is recognised in the statement of financial position until such time as the expenditure is either: · approved by Parliament or the Provincial Legislature with funding and the related funds are received; or · approved by Parliament or the Provincial Legislature without funding and is written off against the appropriation in the statement of financial performance; or · transferred to receivables for recovery. Unauthorised expenditure is measured at the amount of the confirmed unauthorised expenditure. 19 Fruitless and wasteful expenditure Fruitless and wasteful expenditure is recorded in the notes to the financial statements when confirmed. The amount recorded is equal to the total value of the fruitless and or wasteful expenditure incurred. Fruitless and wasteful expenditure is removed from the notes to the financial statements when it is resolved or transferred to receivables for recovery. Fruitless and wasteful expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written- off as irrecoverable. 20 Irregular expenditure Irregular expenditure is recorded in the notes to the financial statements when confirmed. The amount recorded is equal to the value of the irregular expenditure incurred unless it is impracticable to determine, in which case reasons therefor are provided in the note. Irregular expenditure is removed from the note when it is either condoned by the relevant authority, transferred to receivables for recovery or not condoned and is not recoverable. Irregular expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written-off as irrecoverable. 21 Changes in accounting policies, accounting estimates and errors Changes in accounting policies that are effected by management have been applied retrospectively in accordance with MCS requirements, except to the extent that it is impracticable to determine the period-specific effects or the cumulative effect of the change in policy. In such instances the department shall restate the opening balances of assets, liabilities and net assets for the earliest period for which retrospective restatement is practicable.
Changes in accounting estimates are applied prospectively in accordance with MCS requirements.
Correction of errors is applied retrospectively in the period in which the error has occurred in accordance with MCS requirements, except to the extent that it is impracticable to determine the period-specific effects or the cumulative effect of the error. In such cases the department shall restate the opening balances of assets, liabilities and net assets for the earliest period for which retrospective restatement is practicable. 22 Events after the reporting date Events after the reporting date that are classified as adjusting events have been accounted for in the financial statements. The events after the reporting date that are classified as non-adjusting events after the reporting date have been disclosed in the notes to the financial statements. 208 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
23 Capitalisation reserve The capitalisation reserve comprises of financial assets and/or liabilities originating in a prior reporting period but which are recognised in the statement of financial position for the first time in the current reporting period. Amounts are recognised in the capitalisation reserves when identified in the current period and are transferred to the National/Provincial Revenue Fund when the underlying asset is disposed and the related funds are received 24 Recoverable revenue Amounts are recognised as recoverable revenue when a payment made in a previous financial year becomes recoverable from a debtor in the current financial year. Amounts are either transferred to the National/Provincial Revenue Fund when recovered or are transferred to the statement of financial performance when written-off.
25 Related party transactions A related party transaction is a transfer of resources, services or obligations between the reporting entity and a related party. Related party transactions are recorded in the notes to the financial statements when the transaction is not at arm’s length.
1. Annual Appropriation
1.1 Annual Appropriation Included are funds appropriated in terms of the Appropriation Act (and the Adjustments Appropriation Act) for National Departments (Voted funds) and Provincial Departments:
2014/15 2013/14 Funds not Appropriation Final Actual Funds requested/ received Appropriation Received not received R’000 R’000 R’000 R’000 Administration 173,694 173,694 - 167,616 District Health Services 1,618,498 1,618,498 - 1,538,255 Emergency Medical Services 259,262 259,262 - 231,955 Provincial Hospital Services 265,715 265,715 - 214,569 Central Hospital Services 788,826 788,826 - 719,640 Health Sciences 108,698 108,698 - 88,845 Health Care Support Services 85,258 85,258 - 34,199 Health Facilities Management 458,037 458,037 - 481,909
Total 3,757,988 3,757,988 - 3,476,988
1.2 Conditional grants
Note
2014/15 2013/14 R’000 R’000 Total grants received 33 1,212,758 1,178,929 - - Provincial grants included in Total Grants received 209 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2. Departmental revenue
Note 2014/15 2013/14 R’000 R’000 Tax revenue Sales of goods and services other than capital assets 2.1 41,236 39,673 Interest, dividends and rent on land 2.2 288 - Sales of capital assets 2.3 - 1,775 Transactions in financial assets and liabilities 2.4 1,413 1,715 Total revenue collected 42,937 43,163 Less: Own revenue included in appropriation 14 42,937 43,163 Departmental revenue collected - -
1.1 Sales of goods and services other than capital assets
Note 2014/15 2013/14 2 R’000 R’000 Sales of goods and services produced by the department Sales by market establishment 4,969 4,335 Administrative fees 1,791 1,776 Other sales 34,476 33,562
Total 41,236 39,673
1.2 Interest, dividends and rent on land
Note 2014/15 2013/14 2 R’000 R’000 Interest 288 - Total 288 -
1.3 Sale of capital assets
Note 2014/15 2013/14 2 R’000 R’000 Tangible assets - 1,775 Machinery and equipment 29 - 1,775
Total - 1,775
1.4 Transactions in financial assets and liabilities
Note 2014/15 2013/14 2 R’000 R’000 Other Receipts including Recoverable Revenue 1,413 1,715 Total 1,413 1,715
210 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
3. Aid assistance
Note 2014/15 2013/14 R’000 R’000
Opening Balance 1,591 2,605 Prior period error - - As restated 1,591 2,605 Transferred from statement of financial performance (202) (1,014) Closing Balance 1,389 1,591
1.1 Analysis of balance by source 2014/15 2013/14 Note R’000 R’000 3 Aid assistance from other sources 1,389 1,591 Closing balance 1,389 1,591
1.2 Analysis of balance 2014/15 2013/14 Note R’000 R’000 Aid assistance receivable 3 - (757) Aid assistance unutilised 1,389 2,348 Closing balance 1,389 1,591
4. Compensation of employees 1.1 Salaries and Wages
Note 2014/15 2013/14 R’000 R’000 Basic salary 1,294,451 1,176,335 Performance award 433 70 Service Based 1,938 2,424 Compensative/circumstantial 174,111 164,250 Periodic payments 457 410 Other non-pensionable allowances 241,850 231,357 Total 1,713,240 1,574,846
The comparative figures have been restated to better reflect the fair presentation of financial statements. The restatement is due to incorrect classification of expenditure in the 2013/14 financial year.
1.2 Social contributions
Note 2014/15 2013/14 R’000 R’000
211 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Employer contributions Pension 150,280 137,601 Medical 72,974 73,514 UIF 1 2 Bargaining council 244 232 Official unions and associations - - Insurance - - Total 223,499 211,349
Total compensation of employees 1,936,739 1,786,195
Average number of employees 6,994 6,731
5. Goods and services
Note 2014/15 2013/14 R’000 R’000 Administrative fees 2,875 2,892 Advertising 11,946 6,330 Minor assets 5.1 20,486 24,627 Bursaries (employees) 1,813 849 Catering 10,122 5,653 Communication 18,541 18,192 Computer services 5.2 23,005 20,808 Consultants: Business and advisory services 17,947 4,587 Laboratory services 88,757 98,113 Legal services 3,504 4,718 Contractors 98,540 70,431 Agency and support / outsourced services 83,969 73,733 Entertainment - 297 Audit cost – external 5.3 13,076 10,737 Fleet services 65,251 56,939 Inventory 5.4 352,985 371,403 Consumables 5.5 59,801 40,866 Operating leases 62,988 51,462 Property payments 5.6 134,073 102,426 Transport provided as part of the departmental activities 2,329 3,029 Travel and subsistence 5.7 59,925 46,184 Venues and facilities - 2,628 Training and development 5,253 10,716 Other operating expenditure 5.8 12,991 5,081 Total 1,150,177 1,032,701
212 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.1 Minor assets
Note 2014/15 2013/14 5 R’000 R’000 Tangible assets Machinery and equipment 18,979 23,019 Intangible assets Software 1,507 1,608 Total 20,846 24,627
1.2 Computer services
Note 2014/15 2013/14 5 R’000 R’000 SITA computer services 3,423 4,402 External computer service providers 19,582 16,406 Total 23,005 20,808
1.3 Audit cost – External
Note 2014/15 2013/14 5 R’000 R’000 Regularity audits 13,076 10,737 Total 13,076 10,737
1.4 Inventory
Note 2014/15 2013/14 5 R’000 R’000 Clothing material and accessories 1,628 1,280 Farming supplies 8 69 Food and food supplies 20,288 18,668 Fuel, oil and gas 15,637 15,502 Materials and supplies 4,074 3,450 Medical supplies 124,603 110,903 Medicine 186,747 221,531 Total 352,985 371,403
1.5 Consumables
Note 2014/15 2013/14 5 R’000 R’000 Consumable supplies 40,610 28,504 Uniform and clothing 8,935 6,317 Household supplies 30,007 18,702 Building material and supplies 534 70 Communication accessories 203 2 IT consumables 587 733 Other consumables 344 2,680 Stationery, printing and office supplies 19,191 12,362 Total 59,801 40,866
213 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.6 Property payments
Note 2014/15 2013/14 5 R’000 R’000 Municipal services 54,297 45,135 Property maintenance and repairs 727 - Other 79,049 57,291 Total 134,073 102,426
1.7 Travel and subsistence
Note 2014/15 2013/14 5 R’000 R’000 Local 56,067 41,292 Foreign 3,858 4,892 Total 59,925 46,184
1.8 Other operating expenditure
Note 2014/15 2013/14 5 R’000 R’000 Professional bodies, membership and subscription fees 31 538 Resettlement costs 2,145 2,513 Other 10,815 2,030 Total 12,991 5,081
6. Interest and rent on land
Note 2014/15 2013/14 R’000 R’000 Interest paid 2,235 1,584 Total 2,235 1,584
7. Transfers and subsidies
2014/15 2013/14 R’000 R’000 Note Provinces and municipalities 34 2,217 5,295 Non-profit institutions Annex 1A 80,506 41,626 Households Annex 1B 56,039 37,479 Total 138,762 84,440
214 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
8. Expenditure for capital assets
Note 2014/15 2013/14 R’000 R’000 Tangible assets 485,122 496,371 Buildings and other fixed structures 31 356,282 388,676 Machinery and equipment 29 128,840 107,695
Intangible assets 945 510 Software 30 945 510
Total 486,067 496,881
The following amounts have been included as project costs in Expenditure for capital assets Compensation of employees 6,958 3,343 Goods and services 25,657 26,262 Total 32,615 29,605
1.1 Analysis of funds utilised to acquire capital assets – 2014/15 Voted funds Aid assistance Total
R’000 R’000 R’000 Tangible assets 485,122 485,122 Buildings and other fixed structures 356,282 - 356,282 Machinery and equipment 128,840 - 128,840
Intangible assets 945 945 Software 945 - 945
Total 486,067 - 486,067
1.2 Analysis of funds utilised to acquire capital assets – 2013/14
Voted funds Aid Total assistance R’000 R’000 R’000 Tangible assets 496,371 - 496,371 Buildings and other fixed structures 388,676 - 388,676 Machinery and equipment 107,695 - 107,695
Intangible assets 510 - 510 Software 510 - 510
Total 496,881 - 496,881
215 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.3 Finance lease expenditure included in Expenditure for capital assets
Note 2014/15 R’000 Tangible assets 13,935 Machinery and equipment 13,935
Total 13,935
9. Unauthorised expenditure
1.1 Reconciliation of unauthorised expenditure Note 2014/15 2013/14 R’000 R’000 Opening balance 145,220 506,632 Prior period error - - As restated 145,220 506,632 Unauthorised expenditure – discovered in current year (as restated) 91,636 26,506 Less: Amounts approved by Parliament/Legislature with funding - (387,918) Unauthorised expenditure awaiting authorisation / written off 236,856 145,220
1.2 Analysis of unauthorised expenditure awaiting authorisation per economic classification
2014/15 2013/14 R’000 R’000 Capital 1,413 - Current 207,752 134,270 Transfers and subsidies 27,691 10,950 Total 236,856 145,220
1.3 Analysis of unauthorised expenditure awaiting authorisation per type
2014/15 2013/14 R’000 R’000 Unauthorised expenditure relating to overspending of the vote or a main 236,856 145,220 division within a vote Total 236,856 145,220
1.4 Details of unauthorised expenditure – current year
Incident Disciplinary steps taken/criminal 2014/15 proceedings R’000 Overspending on vote Under investigation 91,636 Total 91,636
10. Cash and cash equivalents
Note 2014/15 2013/14 R’000 R’000 Consolidated Paymaster General Account Cash receipts - 7 Disbursements - 1 Total - 8 216 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
11. Prepayments and advances
Note 2014/15 2013/14 R’000 R’000 Travel and subsistence 631 802 Total 631 802
12. Receivables
2014/15 2013/14 R’000 R’000 R’000 R’000 R’000 Less than One to Older than one year three years three years Total Total Note Recoverable expenditure 12.1 1,935 482 - 2,417 2,291 Staff debt 12.2 2,755 3,525 6,198 12,478 10,235 Total 4,690 4,007 6,198 14,895 12,526
1.1 Recoverable expenditure (disallowance accounts) Note 2014/15 2013/14 12 R’000 R’000 Salary: Income tax 526 - Salary: ACB recalls - 201 Salary: Tax debt 76 106 Salary: Deductions disallowance 23 - Salary: Pension fund 40 167 Salary: Recoverable 1,751 1,771 Disallowance dishonoured cheques 1 4 Disallowance miscellaneous - 36 Salary: Medical aid - 6 Total 2,417 2,291
1.2 Staff debt Note 2014/15 2013/14 12 R’000 R’000 Debt receivable 12,478 10,235 Total 12,478 10,235
13. Voted funds to be surrendered to the Revenue Fund
Note 2014/15 2013/14 R’000 R’000 Opening balance 101,693 164,786 Prior period error - - As restated 101,693 164,786 Transfer from statement of financial performance (as restated) 44,008 75,187 Add: Unauthorised expenditure for current year 9 91,636 26,506 Paid during the year (101,692) (164,786) Closing balance 135,645 101,693
217 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
14. Departmental revenue and NRF Receipts to be surrendered to the Revenue Fund
Note 2014/15 2013/14 R’000 R’000 Opening balance 7,302 4,114 Prior period error - - As restated 7,302 4,114 Own revenue included in appropriation 42,937 43,163 Paid during the year (43,108) (39,975) Closing balance 7,131 7,302
15. Bank Overdraft
Note 2014/15 2013/14 R’000 R’000 Consolidated Paymaster General Account 106,975 47,296 Total 106,975 47,296
16. Payables – current
Note 2014/15 2013/14 R’000 R’000
Clearing accounts 16.1 79 291 Other payables 16.2 789 5 Total 868 296
1.1 Clearing accounts Note 2014/15 2013/14 21 R’000 R’000 Salary: Income tax - 235 Salary: Garnishee order 79 56 Total 79 291
1.2 Other payables Note 2014/15 2013/14 21 R’000 R’000 Cancel cheque/re-issue 48 - Disallowance miscellaneous 175 - Salary: Deduction disallowance - 1 Damage vehicles 3 3 Salary: Disallowance account - 1 Salary: ACB recalls 562 - Outstanding payments 1 - Total 789 5
218 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
17. Net cash flow available from operating activities
Note 2014/15 2013/14 R’000 R’000 Net surplus/(deficit) as per Statement of Financial Performance 43,806 74,173 Add back non cash/cash movements not deemed operating activities 382,578 718,602 (Increase)/decrease in receivables – current (2,369) (2,279) (Increase)/decrease in prepayments and advances 171 (226) (Increase)/decrease in other current assets - 387,918 Increase/(decrease) in payables – current 572 (319) Proceeds from sale of capital assets - (1,775) Expenditure on capital assets 486,067 496,881 Surrenders to Revenue Fund (144,800) (204,761) Surrenders to RDP Fund/Donor - - Voted funds not requested/not received - - Own revenue included in appropriation 42,937 43,163 Other non-cash items - - Net cash flow generated by operating activities 426,384 792,775
18. Reconciliation of cash and cash equivalents for cash flow purposes
Note 2014/15 2013/14 R’000 R’000 Consolidated Paymaster General account (106,975) (47,296) Cash receipts - 7 Disbursements - 1 Total 106,975 (47,288)
19. Contingent liabilities and contingent assets 1.1 Contingent liabilities
Note 2014/15 2013/14 R’000 R’000 Liable to Nature Housing loan guarantees Employees Annex 2A 1,665 1,349 Claims against the department Annex 2B 276,579 244,079 Intergovernmental payables (unconfirmed balances) Annex 4 3,564 2,889 Total 281,808 248,317
Comparative figures have been restated to better reflect the fair presentation of the annual financial statements. The restatement is as a result of omission error which was not detected.
219 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.2 Contingent assets
Note 2014/15 2013/14 R’000 R’000 Nature of contingent asset Labour matters 1,486 1,611 Motor vehicle accidents 38 38 OSD overpayments 1,958 1,958 Others 930 930 Total 4,412 4,537
Comparative figures have been restated to better reflect the fair presentation of the annual financial statements. The restatement is as a result of omission error which was not detected 20. Commitments
Note 2014/15 2013/14 R’000 R’000 Current expenditure Approved and contracted 444,016 460,719 Approved but not yet contracted - - 444,016 460,719 Capital expenditure Approved and contracted 431,893 754,506 Approved but not yet contracted - - 431,893 754,506 Total Commitments 875,909 1,215,225 Commitments longer that one year
Bursary commitments R202,775,000
Operating and finance leases R482,000
Other maintenance contracts R68,858,000
The comparative figures have been restated to better reflect the fair presentation of financial statements. The restatement is as a result of commitments which were not disclosed in the prior year.
21. Accruals and payables not recognised
2014/15 2013/14 R’000 R’000 Listed by economic classification 30 Days 30+ Days Total Total Goods and services 102,271 164,368 266,639 166,687 Interest and rent on land Transfers and subsidies Capital assets 18,193 37,880 56,073 47,286 Other 1330 844 2174 968 Total 121,794 203,092 324,886 214,941 220 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Note 2014/15 2013/14 R’000 R’000 Listed by programme level Administration 23,177 29,110 District Health Services 115,580 81,501 Emergency Medical Services 32,371 15,845 Provincial Hospital Services 22,038 10,860 Central Hospital Services 84,248 34,301 Health Sciences and Training 1,863 9,542 Health Care Support Services 8,933 899 Health Facilities Management 36,676 32,883 Total 324,886 214,941
Note 2014/15 2013/14 R’000 R’000 Confirmed balances with other departments Annex 5 41 4,543 Total 41 4,543 Accruals are generally due to budget shortfall resulting in shortage of cash to settle all commitments of the department. 22. Employee benefits
Note 2014/15 2013/14 R’000 R’000 Leave entitlement 69,077 64,601 Service bonus (Thirteenth cheque) 48,202 45,969 Performance awards 29,289 27,689 Capped leave commitments 38,530 42,806 Other 1527 1861 Total 186,625 182,926 Comparative figures have been adjusted to better reflect the fair presentation of annual financial statements. The adjustment is due to the understatement of the leave provisions during the 2013/14 financial year. 23. Lease commitments 1.1 Operating leases expenditure
Buildings and Specialised other fixed Machinery and military structures equipment 2014/15 equipment Land Total Not later than 1 year 18,381 15,332 33,713 Later than 1 year and not later than 16,081 1,910 17,991 5 years Total lease commitments 34,462 17,242 51,704
Buildings and Specialised other fixed Machinery and military structures equipment 2013/14 equipment Land Total Not later than 1 year 24,379 14,588 38,967 Later than 1 year and not later than 3,040 3,996 7,036 5 years Total lease commitments 27,419 18,584 46,003
221 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Operating lease expenditure covers mainly residential leased property for departmental health professional on the scarce list. These are mainly medical doctors.
1.2 Finance leases expenditure**
Buildings Specialised and other Machinery and military fixed equipment 2014/15 equipment Land structures Total Not later than 1 year 26,976 26,976 Later than 1 year and not later 24,038 24,038 than 5 years Total lease commitments 51 041 51 041
Buildings Specialised and other Machinery and military fixed equipment 2013/14 equipment Land structures Total Not later than 1 year 20,087 20,087 Later than 1 year and not later 20,228 20,228 than 5 years Total lease commitments 40,315 40,315
Finance lease expenditure covers mainly leases on administrative motor vehicles, cell phones and medical machinery & equipment.
24. Accrued departmental revenue
Note 2014/15 2013/14 R’000 R’000 Sales of goods and services other than capital assets 91,879 82,339 Total 91,879 82,339
1.1 Analysis of accrued departmental revenue Note 2014/15 2013/14 R’000 R’000
Opening balance 82,339 70,953 Less: amounts received 27,936 24,962 Add: amounts recognised 52,620 52,237 Less: amounts written-off/reversed as irrecoverable 15,144 15,889 Closing balance 91,879 82,339
The comparative figures have been restated to better reflect the fair presentation of the annual financial statements. The adjustment is due to the recognised amount understated in the prior year.
222 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.2 Accrued department revenue written off Note 2014/15 2013/14 R’000 R’000
Nature of losses Patient debt written-off 15,144 15,889 Total 15,144 15,889
1.3 Impairment of accrued departmental revenue
Note 2014/15 2013/14 R’000 R’000 Estimate of impairment of accrued departmental revenue 60,334 46,185 Total 60,334 46,185
25. Irregular expenditure
1.1 Reconciliation of irregular expenditure
Note 2014/15 2013/14 R’000 R’000 Opening balance 3,629,533 2,972,128 Prior period error - 85,317 As restated 3,629,533 3,057,445 Add: Irregular expenditure – relating to prior year - (107,779) Add: Irregular expenditure – relating to current year 537,169 679,867 Closing balance 4,166,702 3,629,533
Analysis of awaiting condonation per age classification Current year 537,169 747,048 Prior years 3,629,533 2,882,485 Total 4,166,702 3,629,533
1.2 Details of irregular expenditure – current year
Incident Disciplinary steps taken/criminal 2014/15 proceedings R’000 Infrastructure projects with irregularities None 314,039 Goods and services obtained without following SCM 223,130 processes Total 537,169
1.3 Prior period error
Note 2013/14 25 R’000 Nature of prior period error Relating to 2013/14 85,317 Omission of irregular expenditure 85,317
Total 85,317 223 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.4 Details of the non-compliance where an institution was not represented in a bid committee for contracts arranged by other institutions Incident 2014/15 R’000 Infrastructure contracts awarded through our implementing agents 314,039 Total 314,039
26. Fruitless and wasteful expenditure
1.1 Reconciliation of fruitless and wasteful expenditure
Note 2014/15 2013/14 R’000 R’000 Opening balance 35,636 22,305 Prior period error - 55 As restated 35,636 22,360 Fruitless and wasteful expenditure – relating to prior year - 368 Fruitless and wasteful expenditure – relating to current year 6,212 12,908 Fruitless and wasteful expenditure awaiting resolution 41,848 35,636
1.2 Analysis of awaiting resolution per economic classification
2014/15 2013/14 R’000 R’000 Current 31,699 25,457 Capital 10,179 10,179 Total 41,878 35,636
1.3 Analysis of Current year’s fruitless and wasteful expenditure
Incident Disciplinary steps taken/criminal 2014/15 proceedings R’000 Interest on overdue accounts None 2,235 Medico-legal claims None 3,829 Other None 148 Total 6,212
1.4 Prior period error
Note 2013/14 26 R’000 Nature of prior period error Relating to 2013/14 55 Omission of fruitless and wasteful expenditure in prior years 55 Total 55
224 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
27. Related party transactions
There were no financial transactions not at arm’s length relating to related parties. However, the department leases certain property from the Department of Roads and Public Works at nil value. The properties are:
· For certain infrastructure and development projects, the processes are managed and maintained by the Department of Roads and Public Works. · The department also leases vehicles from the Northern Cape Fleet management entity and these transactions are at arm’s length.
28. Key management personnel
No. of 2014/15 2013/14 Individuals R’000 R’000 Political office bearers (provide detail below) 1(1) 1,564 1,666 Officials: Level 15 to 16 1(1) 1,322 1,251 Level 14 (incl. CFO if at a lower level) 10(9) 8,219 7,628 Family members of key management personnel 3(3) 1,312 2,581 Total 12,417 13,126
29. Movable Tangible Capital Assets
MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015
Opening Additions Disposals Closing balance Balance R’000 R’000 R’000 R’000
MACHINERY AND EQUIPMENT 691,177 128,840 820,017 Transport assets 61,044 39,052 - 100,096 Computer equipment 36,935 9,341 - 46,276 Furniture and office equipment 31,328 3,891 - 35,219 Other machinery and equipment 561,870 76,556 - 638,426
TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 691,177 128,840 - 820,017
225 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.1 Additions
ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Cash* Non- (Capital Work Received Total cash** in Progress current, not current paid costs and (Paid current finance lease year, received payments) prior year) R’000 R’000 R’000 R’000 R’000
MACHINERY AND EQUIPMENT 128,840 128,840 Transport assets 39,052 - - - 39,052 Computer equipment 9,341 - - - 9,341 Furniture and office equipment 3,891 - - - 3,891 Other machinery and equipment 76,556 - - - 76,556
TOTAL ADDITIONS TO MOVABLE 128,840 - - - 128,840 TANGIBLE CAPITAL ASSETS
1.2 Disposals
DISPOSALS OF MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Sold for Transfer out or Total Cash cash destroyed or disposals Received scrapped Actual R’000 R’000 R’000 R’000
MACHINERY AND EQUIPMENT - - - - Transport assets - - - - Computer equipment - - - - Furniture and office equipment - - - - Other machinery and equipment - - - -
TOTAL DISPOSAL OF MOVABLE TANGIBLE CAPITAL - - - - ASSETS
1.3 Movement for 2013/14
MOVEMENT IN TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2014 Opening Prior Additions Disposals Closing balance period Balance error R’000 R’000 R’000 R’000 R’000
MACHINERY AND EQUIPMENT 592,214 (91,598) 198,832 8,271 691,177 Transport assets 106,074 (39,051) 2,292 8,271 61,044 Computer equipment 18,258 1,321 17,356 - 36,935 Furniture and office equipment 17,151 521 13,656 - 31,328 Other machinery and equipment 450,731 (54,389) 165,528 - 561,870
TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 592,214 (91,598) 198,832 8,271 691,177
226 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.4 Minor assets
MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31 MARCH 2015 Specialised Intangible Heritage Machinery and Biological Total military assets assets assets equipment assets R’000 R’000 R’000 R’000 R’000 R’000
Opening balance - - - 135,435 - 135,435 Additions - 1,507 - 18,978 - 20,485 Disposals TOTAL MINOR ASSETS - 1,507 - 154,413 - 155,920
Specialised Intangible Heritage Machinery Biological Total military assets assets and assets assets equipment Number of R1 minor assets ------Number of minor assets at cost ------TOTAL NUMBER OF MINOR ASSETS ------
MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31 MARCH 2014 Specialised Intangible Heritage Machinery Biological Total military assets assets and assets assets equipment R’000 R’000 R’000 R’000 R’000 R’000 Opening balance - - - 93,387 - 93,387 Prior period error - - - (366) - (366) Additions - - - 42,414 - 42,414 TOTAL MINOR ASSETS - - - 135,435 - 135,435
Specialised Intangible Heritage Machinery Biological Total military assets assets and assets assets equipment Number of R1 minor assets - - - 3,515 - 3,515 Number of minor assets at - - - 85,694 - 85,694 cost TOTAL NUMBER OF - - - 89,209 - 89,209 MINOR ASSETS
30. Intangible Capital Assets
MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Opening Additions Disposals Closing balance Balance R’000 R’000 R’000 R’000
SOFTWARE 3,695 945 - 4,640
TOTAL INTANGIBLE CAPITAL ASSETS 3,695 945 4,640
227 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.1 Additions
ADDITIONS TO INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Cash Non- (Develop-ment Received current Total Cash work in progress – year, not paid current costs) (Paid current year, received prior year) R’000 R’000 R’000 R’000 R’000
SOFTWARE 945 - - - 945
TOTAL ADDITIONS TO INTANGIBLE 945 - - - 945 CAPITAL ASSETS
1.2 Movement for 2013/14 MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2014 Opening Prior period Additions Disposals Closing balance error Balance R’000 R’000 R’000 R’000 R’000
SOFTWARE 1,474 48 2,173 - 3,695
TOTAL INTANGIBLE CAPITAL ASSETS 1,474 48 2,173 - 3,695
31. Immovable Tangible Capital Assets
MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Opening Additions Disposals Closing balance Balance R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED 103,435 34,378 - 137,813 STRUCTURES Dwellings - - - - Non-residential buildings 103,435 34,378 - 137,813 Other fixed structures - - - -
TOTAL IMMOVABLE TANGIBLE CAPITAL 103,435 34,378 - 137,813 ASSETS
228 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
1.1 Additions
ADDITIONS TO IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Cash Non-cash (Capital Work in Received current, Total Progress current not paid costs and finance (Paid current year, lease payments) received prior year) R’000 R’000 R’000 R’000 R’000
BUILDING AND OTHER FIXED 355,796 - (321,418) - 34,378 STRUCTURES Dwellings - - - - - Non-residential buildings 355,796 - (321,418) - 34,378 Other fixed structures - - - - -
TOTAL ADDITIONS TO 355,796 - (321,418) - 34,378 IMMOVABLE TANGIBLE CAPITAL ASSETS
1.2 Disposals
DISPOSALS OF IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2015 Sold for Transfer out or Total Cash cash destroyed or disposals Received scrapped Actual R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED STRUCTURES Dwellings - - - - Non-residential buildings - - - - Other fixed structures - - - -
TOTAL DISPOSALS OF IMMOVABLE - - - - TANGIBLE CAPITAL ASSETS
1.3 Movement for 2013/14 MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2014 Opening Prior period Additions Disposals Closing balance error Balance R’000 R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED STRUCTURES Dwellings Non-residential buildings 687,837 822,987 103,435 1,510,824 103,435 Other fixed structures 1,335 (1,335) - - -
TOTAL IMMOVABLE TANGIBLE CAPITAL 689,172 821,652 103,435 1,510,824 103,435 ASSETS 229 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Note 2013/14 41.3 R’000 Nature of prior period error The error was as a result of an error which was not detected at the time of the publishing of the AFS. 206 690 Total 206 690
1.4 Immovable assets valued at R1
IMMOVABLE ASSETS VALUED AT R1 IN THE ASSET REGISTER AS AT 31 MARCH 2015 Buildings and other Heritage Land and Total fixed structures assets subsoil assets R’000 R’000 R’000 R’000
R1 Immovable assets - - - - TOTAL - - - -
IMMOVABLE ASSETS VALUED AT R1 IN THE ASSET REGISTER AS AT 31 MARCH 2014 Buildings and other Heritage Land and subsoil Total fixed structures assets assets R’000 R’000 R’000 R’000
R1 Immovable assets - - TOTAL - -
1.5 S42 Immovable assets
Assets subjected to transfer in terms of S42 of the PFMA – 2014/15
Number of Value of assets assets R’000
BUILDINGS AND OTHER FIXED STRUCTURES Dwellings - - Non-residential buildings - - Other fixed structures - -
TOTAL - -
Assets subjected to transfer in terms of S42 of the PFMA – 2013/14
Number of Value of assets assets R’000
BUILDINGS AND OTHER FIXED STRUCTURES 232 1,717,694 Dwellings - - Non-residential buildings 232 1,510,824 Other fixed structures - -
TOTAL 232 1,510,824
230 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
32. Prior period errors
1.1 Correction of prior period errors Note 2013/14 R’000 Assets Contingent assets: Labour matters (46) Accrued departmental revenue: Amounts recognised 15,023 Immovable Assets (206,690) Net effect 191 713
Accrued departmental revenue was restated as a result of the understatement of prior year billing. Immovable assets were restated due to an error which resulted to a negative closing balance of the completed assets which was reported at financial year ending 31 March 2014.
The correction was necessary to fairly present the annual financial statements.
Note 2013/14 R’000 Liabilities: Contingent liability: Claims against the department 10,705 Commitments: Current 224,590 Employee benefits: Leave entitlement 365 Net effect 235,660
Contingent liabilities and commitments were restated due to the understatement that occurred in the prior year.
The restatement was necessary to fairly present the annual financial statements.
231 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
33. STATEMENT OF CONDITIONAL GRANTS RECEIVED
GRANT ALLOCATION SPENT 2013/14 Division of % of Revenue Amount available Division Act/ received Amount Under / funds of Amount NAME OF Provincial Roll DORA Other Total by spent by (Overspending) spent by Revenue spent by DEPARTMENT Grants Overs Adjustments Adjustments Available department department department Act department R’000 R’000 R'000 R'000 R’000 R'000 R'000 R'000 % R’000 R’000 Comprehensive 342,789 13,183 - - 355,972 355,972 354,004 1,968 99% 321,150 302,259 HIV and AIDS grant Health professions 76,697 - - - 76,697 76,697 76,697 - 100% 72,356 77,395 training and development grant National tertiary 298,727 - - - 298,727 298,727 291,526 7,201 98% 282,618 282,616 services grant Hospital ------388,274 378,839 revitalisation grant Health ------90,154 71,660 infrastructure grant Nursing colleges ------5,103 2,453 and schools grant National health 7,000 - - - 7,000 7,000 3,975 3,025 57% 6,428 6,528 insurance grant Expanded public 2,115 - - - 2,115 2,115 2,115 - 100% 3,330 2,605 works programme incentive grant for provinces Social sector 7,337 - - - 7,337 7,337 7,337 - 100% 9,516 8,798 expanded public works programme for provinces Health facility 421,428 13,482 - 30,000 464,910 464,910 395,519 69,391 85% - - revitalisation grant 1,156,093 26,665 - 30,000 1,212,758 1,212,758 1,131,173 81,585 93% 1,178,929 1,133,153
All funds transferred in terms of the Division of Revenue Act were deposited into the primary bank account of the province. All infrastructure grants namely Hospital revitalisation grant, Health infrastructure grant and Nursing colleges and schools grant were consolidated into one grant known as the Health facility revitalisation grant. This commenced in the 2014/15 financial year.
232 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
34. STATEMENT OF CONDITIONAL GRANTS PAID TO MUNICIPALITIES
GRANT ALLOCATION TRANSFER Re-allocations Division by National of Treasury Revenue Roll Total Actual Funds or National Act Overs Adjustments Available Transfer Withheld Department NAME OF MUNICIPALITY R’000 R’000 R'000 R'000 R'000 % Conditional Grants Emthanjeni municipality 1,114 - - 1,114 - 1,114 - //Khara Hais municipality 3,881 - - 3,881 984 2,897 - Nama Khoi municipality 100 - - 100 - 100 - Sol Plaatjie municipality 2,767 - - 2,767 624 2,143 - Pixley Ka Seme district municipality 100 - - 100 - 100 - Frances Baard district municipality 100 - - 100 - 100 - Gamagara municipality 100 - - 100 - 100 - Ubuntu municipality 149 - - 149 - 149 - Sub-total 8,311 - - 8,311 1,608 6,703 -
Unconditional Grants NC051 Richtersveld municipality ------NC052 Nama Khoi municipality 66 - - 66 22 44 - NC054 Kamiesberg municipality ------NC055 Hantam municipality 5 - - 5 1 4 - NC055 Karoo Hoogland municipality 5 - - 5 - 5 - NC057 Khai-Ma municipality 4 - - 4 - 4 - NC071 Ubuntu municipality ------NC072 Umsobomvu municipality ------NC073 Emthanjeni municipality 67 - - 67 48 19 - NC074 Kareeberg municipality ------NC075 Renosterberg municipality ------NC075 Thembelihle municipality ------NC077 Siyathemba municipality 36 - - 36 - 36 - NC078 Siyancuma municipality 14 - - 14 - 14 - NC079 Karoo District municipality ------NC081 Mier municipality 6 - - 6 - 6 - NC082 !Kai! Garib municipality 3 - - 3 - 3 - NC083 //Khara Hais 67 - - 67 380 52 - NC084 !Kheis 3 - - 3 - 3 - NC085 Tsantsabane 2 - - 2 - 2 -
233 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
GRANT ALLOCATION TRANSFER Re-allocations Division by National of Treasury Revenue Roll Total Actual Funds or National Act Overs Adjustments Available Transfer Withheld Department NAME OF MUNICIPALITY R’000 R’000 R'000 R'000 R'000 % NC085 Kgatelopele ------NC091 Sol Plaatjie 80 - - 80 100 (20) - NC092 Dikgatlong - - - - 2 - - NC093 Magareng 4 - - 4 - 4 - NC094 Phokwane 8 - - 8 - 8 - NC452 Ga-Segonyana 81 - - 81 56 25 - NC453 Gamagara 21 - - 21 - 21 - Sub-total 472 - - 472 609 230 -
Total 8,782 - - 8,783 2,217 6,932
ANNEXURE 1A STATEMENT OF TRANSFERS TO NON-PROFIT INSTITUTIONS
TRANSFER ALLOCATION EXPENDITURE 2013/14 Adjusted % of Approp-riation Available Appro-priation Act Adjust-ments Total Actual funds Act Roll overs Available Transfer transferred NON-PROFIT INSTITUTIONS R'000 R'000 R'000 R'000 R'000 % R'000 Transfers Thabisho NGO ------8,700 Legatus NGO 10,215 - - 10,215 10,215 100% 9,100 Northern Cape Aids Forum 6,392 - - 6,392 6,392 100% 8,200 Nightingale Hospice 2,042 - - 2,042 2,950 144% 6,964 Moeder Theresa Hospice 2,764 - - 2,764 3,791 137% 5,700 Helen Bishop Orthopaedic After-Care Home 2,670 - - 2,670 2,110 79% 2,808 Aganang Aids Services Organisation 4,771 - - 4,771 4,302 90% - Boikobo Health Care 5,990 - - 5,990 6,703 112% - Boitumelo NPO 2,056 - - 2,056 1,863 91% - Bophelong Care Centre 635 - - 635 635 100% -
234 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
TRANSFER ALLOCATION EXPENDITURE 2013/14 Adjusted % of Approp-riation Available Appro-priation Act Adjust-ments Total Actual funds Act Roll overs Available Transfer transferred NON-PROFIT INSTITUTIONS R'000 R'000 R'000 R'000 R'000 % R'000 Cecilia Makiwana Hospice 588 - - 588 808 137% - Dingleton Community Health Workers 1,502 - - 1,502 1,693 113% - Diocese Aids Ministry NPO 1,648 - - 1,648 2,231 135% - Diocese Keimoes Upington 1,901 - - 1,901 446 23% - Drydo Home Based Care 4,103 - - 4,103 4,591 112% - Ebenezer Youth Group 2,838 - - 2,838 663 23% - Education Support Services Trust 1,672 - - 1,672 2,346 140% - Grassroot Soccer SA 543 - - 543 353 65% - Hope Christian Home Based Care 1,954 - - 1,954 1,887 97% - Hopetown Home Based Care Hospice 696 - - 696 955 137% - Hospice Health 810 - - 810 1,137 140% - Institute for Disability Innovation - - - - 1,001 - - Kgatelopele NPO 1,593 - - 1,593 1,593 100% - Maggie Samboer Hospice 1,559 - - 1,559 2,138 137% - Maruping Health Care 4,765 - - 4,765 5,332 112% - Masiphele NGO 3,102 - - 3,102 3,097 100% - Mobile HIV Counselling and Testing 629 - - 629 629 100% - Napwa Northern Cape NGO 599 - - 599 599 100% - Phutadichaba Home Based Care 1,345 - - 1,345 1,341 100% - Re-Action Consulting (PTY) LTD - - - - 862 - - Renosterberg Gemeenskaap Projek 961 - - 961 1,318 137% - The Little Big Soup Kitchen NGO 716 - - 716 1,004 140% - Thusanang Home Based Care 3,746 - - 3,746 4,192 112% - Williston Drop-in Centre 947 - - 947 1,329 140% - TOTAL 75,752 - - 75,752 80,506 41,472
235 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 1B STATEMENT OF TRANSFERS TO HOUSEHOLDS
TRANSFER ALLOCATION EXPENDITURE 2013/14 Adjusted % of Appropriation Available Appro-priation Act Roll Adjust-ments Total Actual funds Act Overs Available Transfer Transferred HOUSEHOLDS R'000 R'000 R'000 R'000 R'000 % R'000 Transfers H/H EMPL S/BEN: LEAVE GRATUITY 7,227 - - 7,227 9,840 136% 4,495 H/H CLAIMS AGAINST STATE (CASH) - - - - 3,829 - 380 H/H: BURSARIES (NON-EMPLOYEES) 12,064 - - 12,064 42,219 330% - H/H: INJURY ON DUTY - - - - 26 - - H/H: DONATIONS & GIFTS - - - - 125 - - TOTAL 19,291 - - 19,291 56,039 4,875
ANNEXURE 1C STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS RECEIVED
2014/15 2013/14
NAME OF ORGANISATION NATURE OF GIFT, DONATION OR SPONSORSHIP R’000 R’000
Received in cash KHC CEO awards Donations (cash) 20 - Gray construction KH CEO awards - 20 Kimvent vending KH CEO awards - 5 Old Mutual group KH CEO awards - 10 Ortho Sol Dev. (PTY) LTD Research & development orthopaedic division 122 34 Subtotal 142 69
Received in kind National Department of Health Furniture & equipment - 342 Karibuni security services KH CEO awards - 150
236 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
2014/15 2013/14
NAME OF ORGANISATION NATURE OF GIFT, DONATION OR SPONSORSHIP R’000 R’000 Khoi linen & textile KH CEO awards - 13 Fedics catering services KH CEO awards - 52 Cooling solutions KH CEO awards - 8 DNS suppliers KH CEO awards - 4 Medical gas solutions KH CEO awards - 15 Mekan engineers KH CEO awards - 18 Techmed Africa KH CEO awards - 30 Tshenolo resources KH CEO awards - 6 Right to care Furniture & equipment - 8 Subtotal - 646
TOTAL 142 715
ANNEXURE 1D STATEMENT OF AID ASSISTANCE RECEIVED
NAME OF DONOR PURPOSE OPENING CLOSING EXPENDI- BALANCE REVENUE TURE BALANCE R'000 R'000 R'000 R'000 Received in cash European union 769 - - 769 Global fund 781 - - 781 Belgium fund (481) - - (481) TOTAL 1,069 - - 1,069
237 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 1E STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS MADE
2014/15 2013/14 NATURE OF GIFT, DONATION OR SPONSORSHIP (Group major categories but list material items including name of organisation R’000 R’000
Made in kind Donations made by the Member of Executive Council 55 322 TOTAL 55 322
ANNEXURE 2A STATEMENT OF FINANCIAL GUARANTEES ISSUED AS AT 31 MARCH 2014 – LOCAL
Original Opening Guarantees Guarantees Revaluations Closing Guaranteed Realised guaranteed balance draw downs repayments/ balance interest for losses not capital 1 April 2014 during the cancelled/ 31 March year ended recoverable amount year reduced/ released 2015 31 March i.e. claims Guarantor Guarantee in during the year 2015 paid out institution respect of R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 Motor vehicles
Subtotal
Standard Bank Housing 1,517 439 - (14) - 425 - - Nedbank Limited Housing 581 167 - - - 167 - - Firstrand Bank Housing 951 349 - - - 349 - - Nedbank (INC) Housing 124 16 - - - 16 - - ABSA Bank Housing 3,097 585 - (53) - 532 - - Old Mutual Housing - 16 - - - 16 - - People’s Bank Housing 67 13 - - - 13 - - Nedbank (NBS) Housing 122 54 - - - 54 - - Old Mutual Housing - 93 - - - 93 - - (NEDB/P) TOTAL 6,549 1,732 - (67) - 1,665 - -
The comparative figures have been restated to better reflect the fiar presentation of the annual financial statements.The restatement is as a result of there being no bank confirmations supporting these figures. 238 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 2B STATEMENT OF CONTINGENT LIABILITIES AS AT 31 MARCH 2015
Opening Liabilities paid/ Liabilities Closing Balance cancelled/ recoverable Balance Nature of Liability Liabilities incurred reduced during (Provide details 31 March 1 April 2014 during the year the year hereunder) 2015 R’000 R’000 R’000 R’000 R’000 Claims against the department Medico-legal cases 93,079 33,167 8,182 - 118,064 Breach of contract 79,812 7,604 - - 87,416 Motor vehicle accidents 454 74 71 - 457 Labour matters 4,916 80 - - 4,996 Other 65,883 872 1,108 - 65,646 TOTAL 244,144 41,796 9,361 - 276,579
Comparative figures have been restated to better reflect the fair presentation of the annual financial statements.The restatement is as a result of omission error which was not detected
ANNEXURE 3 CLAIMES RECOVERABLE
Confirmed balance Unconfirmed balance Cash in transit at year end 2014/15 * outstanding outstanding Total Receipt date up Government Entity to six (6) working days after year 31/03/2015 31/03/2014 31/03/2015 31/03/2014 31/03/2015 31/03/2014 end Amount R’000 R’000 R’000 R’000 R’000 R’000 R’000 Department Department of Justice & - - 10 10 10 10 - - Constitutional Development Department of Water Affairs - - - 11 - 11 - - Northern Cape Department of - - 30 - 30 - - Education - Free State Department of Health - - 564 531 564 531 - - Gauteng Department of Health - - 320 63 320 63 - - 239 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
Confirmed balance Unconfirmed balance Cash in transit at year end 2014/15 * outstanding outstanding Total Receipt date up Government Entity to six (6) working days after year 31/03/2015 31/03/2014 31/03/2015 31/03/2014 31/03/2015 31/03/2014 end Amount R’000 R’000 R’000 R’000 R’000 R’000 R’000 Kwa-Zulu Natal Department of - - - 73 - 73 - - Health Northern Cape Department of - - 94 94 94 94 - - Public Works Northern Cape Department of - - - 51 - 51 - - Transport, Safety & Liaison Northern Cape Provincial Treasury - - 56 - 56 - - - Western Cape Department of - - 519 261 519 261 - - Health Limpopo Department of Health - - 1 - 1 - - - Western Cape Cultural Affairs & - - - 7 - 7 - - Sport Northern Cape Office of the Premier - - - 159 - 159 - - Northern Cape Co-operative - - - 9 - 9 - - Governance, Human Settlement & Traditional Affairs National Department of Public - - 2 - 2 - - - Works North West Department of Health - - 24 - 24 - - - Northern Cape Department of - - 195 - 195 - - - Social Development National Department of Health - 3,316 - 3,316 - - - - - 5,131 1,269 5,131 1,269 - -
240 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 4 INTER-GOVERNMENT PAYABLES
Confirmed balance Unconfirmed balance Cash in transit at year end outstanding outstanding TOTAL 2014/15 * Payment date up GOVERNMENT ENTITY to six (6) working days before year 31/03/2015 31/03/2014 31/03/2015 31/03/2014 31/03/2015 31/03/2014 end Amount R’000 R’000 R’000 R’000 R’000 R’000 R’000 DEPARTMENTS Current National Department of Health - - 55 294 55 294 - - Department of Justice & Constitutional - - 391 391 391 391 - - Development Northern Cape Department of Roads & - - 2,476 632 2,476 632 - - Public Works Eastern Cape Department of Health - 41 - 64 - 105 - - Free State Department of Health - - 4752 4502 4,752 4,502 - - Limpopo Department of Health ------North West Department of Health - - 7 - 7 - - - North West Provincial Treasury ------Northern Cape Office of the Premier - - 66 1,235 66 1,235 - - Western Cape Department of Health - - 76 34 76 34 - - South African Police Service - - 13 - 13 - - - PALAMA ------Kwa-Zulu Natal Department of Health - - 14 14 14 14 - - Northern Cape Provincial Treasury - - - 136 - 136 - - Northern Cape Department of Transport, - - - 76 - 76 - - Safety & Liaison Northern Cape Department of - - - 13 - 13 - - Environment & Nature Conservation Free State Department of Social - - 6 - 6 - - - Development Northern Cape Department of Education - - 210 - 210 - - -
Subtotal - 41 8,066 7,391 8,066 7,432 - -
241 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 5
INVENTORIES
Inventory Note Quantity 2014/15 Quantity 2013/14 R’000 R’000 Opening balance - 48,352 - 53,940
Add/(Less): Adjustments to prior year balance - (4) - -
Add: Additions/Purchases - Cash - 241,001 - 214,202
Add: Additions - Non-cash - - - -
(Less): Disposals - - - -
(Less): Issues - (237,981) - (217,325)
Add/(Less): Adjustments - (6,013) - (2,465)
Closing balance - 45,355 - 48,352
Comparative figures have been adjusted to better reflect the fair presentation of the annual financial statements. The adjustment is due to the incorrect capturing of the opening balance for the 2013/14 financial year.
242 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
ANNEXURE 6 MOVEMENT IN CAPITAL WORK IN PROGRESS
MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE YEAR ENDED 31 MARCH 2015 Opening Current Year Completed Closing balance Capital WIP Assets balance R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED STRUCTURES 927,970 355,796 (34,378) 1,249,388 Dwellings - - - - Non-residential buildings 927,970 355,796 (34,378) 1,249,388 Other fixed structures - - - -
TOTAL 927,970 355,796 (34,378) 1,249,388
MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE YEAR ENDED 31 MARCH 2014 Opening Prior period Current Year Completed Closing balance error Capital WIP Assets balance R’000 R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED 642,707 - 388,698 (103,435) 927,970 STRUCTURES Dwellings - - - - - Non-residential buildings 642,707 - 388,698 (103,435) 927,970 Other fixed structures - - - - -
TOTAL 642,707 - 388,698 (103,435) 927,970
243 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
244 NORTHERN CAPE DEPARTMENT OF HEALTH ANNUAL REPORT 2014/15
245