VOTE 3

DEPARTMENT OF HEALTH

MTEF 2008 Vote 3 67 VOTE 03: DEPARTMENT OF HEALTH

AMOUNT TO BE APPROPRIATED 2008/09: R4,222,549,000 STATUTORY APPROPRIATION: Nil RESPONSIBLE POLITICAL HEAD: MEC for Health ADMINISTERING DEPARTMENT: Department of Health ACCOUNTING OFFICER: Superintendent General Department of Health

1. OVERVIEW

Vision Optimum health for all individuals and communities in the North West Province

Mission To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through community involvement and partnerships, Batho Pele Principles, Patient’s Rights Charter, innovation driven performance and by valuing our people and their diversity

Core functions of the department The department is responsible for the delivery of primary health care services, hospital services, forensic pathology services and emergency medical rescue services. Primary Health Care Services These services focus on the prevention of illness and the provision of basic curative health services. The services include immunization, communicable disease control, environmental health, oral and dental health, rehabilitation support, occupational health and chronic disease support. Hospital services. District hospitals cater for patients who require admission to hospital for treatment at a general practitioner level, while general hospitals cater for patients requiring admission to hospital for treatment at specialist level. Regional hospital services (secondary & limited tertiary care) Psychiatric hospitals cater for mental illnesses and rehabilitative services. Central hospitals (provincial tertiary services) provide facilities and expertise needed for sophisticated medical procedures. Emergency Medical Services The services provide emergency transport and paramedic personnel for complicated maternity cases, and victims of trauma, motor vehicle and other accidents, as well as transport for the indigent patients requiring inter-hospital and outpatient transport. Forensic Pathology Service These are directed at ensuring impartial professional evidence for the criminal justice system concerning death due to unnatural causes.

Other services to be delivered by the department • An integrated poverty reduction and empowerment strategy • Improving the health of people through: - Integrated Nutrition Programme (PSNP) in collaboration with Department of Education and Agriculture Conservation and Environment - Improving access to health facilities - Revitalization of hospitals - Fighting TB and other communicable diseases. - Improved emergency services • A programme to identify and develop infrastructure that supports social development in the province - Clinic Building Programme and Hospital Revitalization. • A programme to reverse HIV/AIDS in the province through: - Partnership with the Provincial Council on AIDS - Voluntary Counseling and Testing (VCT) - Integrated home-based care projects - Life skills programme in collaboration with the Department of Education - EAP programme - Prevention of Mother to Child Transmission (PMTCT). - Awareness programme (condom and HIV/AIDS material distribution, community campaigns) - Interdepartmental committee on HIV/AIDS • A social investment programme focused on the long-term human resource priorities for the province - Professional training programme (nurses, emergency care practitioners, other specialized skills and development) - Skills audit - Implementation of Human Resource Development. - In-service training of staff - Health system research development

MTEF 2008 Vote 3 68 Strategic goals The following strategic goals are linked to the core business of the department: • Providing quality health care • Providing accessibility, equitable and affordable Comprehensive Primary Health Care Services • Well-functioning and competitive hospitals. • Improving the health status of communities through implementation of integrated health programmes and promotion of healthy lifestyle. • Well-managed and effective District Health System (DHS) • Competent, empowered and performance focused staff • Integrated and effective organisational system • Effective management of department’s finance and assets • Effective communication, marketing and stakeholder relations management

Legislative Mandates The department delivers its health services function through mandates given through legislative and regulatory framework provided by national parliament and provincial legislature. These legislations give the basis and authority for the Department for its activities. The legislative mandates are summarized according to legislations that are of general application across all units within the department, i.e. PFMA and treasury regulations, human resources, information security, procurement and health service delivery.

The Acts, rules and regulations applicable to the department The department delivers its health services function through mandates given through legislative and regulatory framework provided by national parliament and provincial legislature. These legislations give the basis and authority for the department for its activities. These legislative mandates are summarized according to the following categories: • General - legislations that are of general application across all units within the department. • Finance legislation – PFMA and treasury regulations • Human resources • Information security • Procurement • Health service delivery For purposes of brevity only legislation key to the department’s core health service delivery function are listed here: • Constitution of the Republic of South Africa Act, 108 of 1996 Provides for the rights of access to health care services and emergency medical treatment. • National Health Act, 61 of 2003 Provides for a transformed national health system for the entire Republic • Medical Schemes Act, 131 of 1998 Provides for the regulation of the medical schemes industry to ensure consonance with national health objectives. • Medicines and Related Substances Act, 101 of 1965 Provides for the registration of medicines and other medicinal products to ensure their safety. The Act also provides for transparency in the pricing of medicines • Mental Health Care Act, 17 of 2002 Provides a legal framework for mental health in the Republic and in particular the admission and discharge of mental health patients in mental health institutions with emphasis on human rights for mental patients. • Choice on Termination of Pregnancy Act, 92 of 1996 Provides a legal framework for termination of pregnancies based on choice under certain circumstances. • Sterilization Act, 44 of 1998 Provides a legal framework for sterilizations, also for persons with mental health challenges. • Tobacco Products Control Amendment Act, 12 of 1999 Provides for the control of tobacco products, prohibition of smoking in public places and advertisements of tobacco products as well as sponsoring of events by the tobacco industry. • National Health Laboratory Service Act, 37 of 2000 Provides for a statutory body that provides laboratory services to the public health sector. • Health Professions Act, 56 of 1974 Provides for the regulation of health professions, in particular, medical practitioners, dentists, psychologists and other related health professions, including community service by these professionals. • Pharmacy Act, 53 of 1974 [As Amended] Provides for the regulation of the pharmacy profession, including community service by pharmacists • Nursing Act, 50 of 1978 [As Amended] Provides for the regulation of the nursing profession • Allied Health Professions Act, 63 of 1982 [As Amended] Provides for the regulation of health practitioners like chiropractors, homeopaths, etc and for the establishment of a council to regulate these professions • Dental Technicians Act, 19 of 1979 [As Amended] Provides for the regulation of dental technicians and for the establishment of a council to regulate the profession • Hazardous Substances Act, 15 of 1973 [As Amended] Provides for the control of hazardous substances, in particular those emitting radiation • Foodstuffs, Cosmetics and Disinfectants Act, 54 of 1972 Provides for the regulation of foodstuffs, cosmetics and disinfectants, in particular, quality standards that must be complied with by manufacturers as well as their importation sand exportation. • Occupational Diseases in Mines and Works Act, 78 of 1973

MTEF 2008 Vote 3 69 Provides for medical examinations on persons suspected of having contracted occupational diseases especially in mines and for compensation in respect of those diseases. • Council for Medical Schemes Levy Act, 58 of 2000 Provides for a legal framework for the council to charge medical schemes certain fees.

2. DEPARTMENTAL STRUCTURAL CHANGES None

3. REVIEW OF THE CURRENT BUDGET YEAR FOSAD priorities / Apex priorities • Self employment interventions in the second economy • Implementing anti poverty campaign • Ratchet up implementation of ECD programme • Intensify campaign on communicable diseases • Regularising employment and KPA designate levels

Main achievements • Implementation of comprehensive control and management plan to combat HIV and AIDS • Communicable diseases control • Emergency Medical and Rescue services • Hospital Revitalisation programme and provision of infrastructure for both clinic and Community Health Centres • Mother, Child and Women’s health.

Ongoing programmes / activities, strategically the most important contributing to the achievement of government electoral mandate. • Job creation, skills development and work experience • Continue implementation of comprehensive plan to combat HIV and AIDs • Combating tuberculosis, particularly in response to Multiple Drug Resistant and XDR Tuberculosis due to non compliance • Further expansion of the health infrastructure, including refurbishment of existing clinics and hospitals , and the strengthening of nursing colleges • Health promotion, reduction of non communicable disease and unnatural causes of death

Challenges and Developments • The service delivery environment is organized along the principles of the National District Health System. The North West Department of Health focuses strongly on accessibility and improved quality service to rural and farm communities. To this end the department has to operate a number of mobile clinics to render health service to communities that live far from fixed health facilities, owing to the province’s predominant rural character and low population density. • The Department has to contend with the fact that funding for health service is not sufficient to match desired services due to government’s competing priorities. • The HIV and AIDS epidemic places a tremendous strain on the department’s resources, but the department remains committed to combating the epidemic within its means. There is therefore effective response to the HIV and AIDS epidemic including comprehensive approach to care and treatment, coping with a phase of pressure on hospitals with acutely ill patients and HIV and AIDS orphans. • The growth of the Community Health Worker programme and the continuous increase in the uptake of the ART patients also has an impact on available resources. • The continuous lack of compliance with the referral system by patients who by-pass levels of services puts a strain on the limited resources at hospital level. • Implementation of the departmental service transformation plan will ensure proper utilization of services • There are greater demands on quality assurance with special focus on improving perception and actual quality of frontline service and reduction in waiting times. Provincialisation An extension of three months was granted to municipalities to continue with service delivery in the 2007/08. The department does not transfer funds to municipalities anymore. Priorities National priorities include: • Primary Health Care • TB Multi drug resistance (MDR) and Extreme drug resistance (XDR). • Health remuneration review • Expanding Emergency Medical and Rescue Services • Additional health professionals

In addition to these, is the new national priority for TB Multi drug resistance (MDR) and Extreme drug resistance (XDR) which has received funding from the National Treasury. Provincial priorities include: • Promoting healthy lifestyles • Contributing towards human dignity by improving quality of care • Strengthening primary health care, EMRS and hospital delivery systems • Strengthening support services • Improving governance and management of National Health System • Human resources planning, development and management MTEF 2008 Vote 3 70 • Planning, budgeting, monitoring and evaluation • Aligning, preparing and implementing legislation • Strengthening relations with stakeholders • Laboratory costs • Evaluation research • Funds have also been earmarked for skills development and training.

Other challenges : Transfer of functions due to demarcation/discontinued functions. ƒ Odi and Jubilee hospitals as well as Kudumane sub-districts have now shifted out of the province. ƒ Service Level Agreements between the two provinces of Gauteng and Northern Cape are in place in relation to the cross boundary areas. ƒ Merafong has been absorbed in the province and services have been taken over. ƒ The demarcation process has had a negative impact on service delivery in the province.

PROGRAMME 1: ADMINISTRATION Key achievements • The development of the web portal has been finalized. • Quarterly Reporting System (QRS) reports produced and submitted to Provincial Treasury and National Department of Health. • Annual report 2006/7 has been produced. • Four thousand seven hundred and thirty eight (4 738) employees have attended various skills programmes against the annual target of five thousand (5 000). • The Department’s nursing colleges have increased their intake in respect of four year diploma programme. • Gender based violence & gender mainstreaming workshops for health workers were conducted at Ngaka Modiri Molema, Bojanala, Bophirima and the Provincial Office. • Two sites at Ratlou and Ramotshere Moiloa Sub Districts were identified for youth centre renovations. • The District Councils have been established in the four districts. • The Provincial Health Consultative Forum was launched. • Training of fifty (50) governance structures for Bophirima and Southern District was held on 03- 06 December 2007. • Security and Records Management Survey was completed at 50 institutions in all four Districts. • Records Management Strategy developed. • Occupational Specific Dispensation (OSD) Phase I is being completed. • Risk Management Strategy implemented. Constraints • There are still incidences of under reporting with respect to training activities. • Delay in the finalization of the HR Plan. • Non-availability of skilled and competent investigating and presiding officers resulting in a delay in the conclusion of disciplinary cases. • In respect of the Occupation Specific Dispensation (OSD) for nurses there were incidents of interpretation and application challenges experienced. • Both nursing colleges are still experiencing shortage of transport for learners and infrastructural challenges. • Personnel capacity, finance and resources at MISS. • Monitoring of private security companies at institutional level. Remedial Actions • Expedite approval of the HR plan. • Intensive training of more presiding and investigating officers. • Regular meetings are held at national and provincial levels in order to ensure consistency in implementation of the OSD for nurses. • Tender for the outsourcing of transport is in evaluation phase. • Building needs included in the departmental infrastructure plans. • Leasing of privately owned buildings. • Implementation of Security and Records Management Survey implementation plan. • The monitoring of the implementation of the records management tender. • Implementation of Records Management Strategy.

PROGRAMME 2: DISTRICT HEALTH SERVICES Key achievements District Management: • 16 sub districts have signed Service Delivery Improvement Agreements with the governance structures. • 66 functional Work Improvement Team Strategy (WITS) teams are in place. • 43 WITS projects completed; the initial target of 36 exceeded. • 94% of clinics implement Clinic Supervision Manual (target 90%). • A doctor supports 77% of Community Health Centre(CHC) and clinics once a week. • All facilities implement uniform complaints mechanism. • 73% of facilities implement Patient Satisfaction Surveys. • 52% of clinics/CHC render 24 hour Primary Health Care (PHC) services. • 96% availability of tracer drugs. Oral Health: • 982 educational sessions conducted. • 822 schools and clinics visited by mobile clinics. MTEF 2008 Vote 3 71 • 94% operators trained. • 100% dental assistants trained. Chronic Diseases, Geriatrics and Rehabilitation: • 10% increase in the number of cataract surgeries. • 319 PHC professionals trained on priority guidelines. • 8 delegates attended International Classification on Disability and Health implementation strategy workshop 38th Biennial SA Council for the Blind Conference respectively. • 19 physiotherapy assistants attended refresher course worth 10 CPD points. • 54 therapists trained by CE Mobility on positioning, seating, prescribing and repairing of wheel chairs. • 15 Medical Social Workers attended training on Children’s Act no 38 of 2005. • 677 people screened for diabetes at Rustenburg during Diabetes Day with 51 referred for further care. • 500 participants addressed on Free Health Policy during departmental disability awareness event. • 668 wheelchairs, 170 buggies and 370 cushions procured. • 45 Occupational and Physiotherapists oriented on International Classification of Functional Health (ICF). • Joint celebration of older person’s month with Age- in –Action (Council for the aged) and Department of Social Development. • 55 older persons attended older person’s congress in Mpumalanga. • 6 older people’s house-holds were visited in Ngaka Modiri Molema and spring-cleaned during older persons month. • 300 older persons received hampers from Shoprite/Checkers and Age-in- Action. • 5 Support groups for children with cerebral palsy established. Health Promotion: • Health Promotion sub directorate participated in healthy lifestyle campaigns. • Health Promotion successfully conducted Health Literacy campaigns through Motsweding FM on weekly basis. • 48 health promoters trained on lead awareness in children. • 28 school health nurses and health promoters trained on Health Promoting Schools. Mental Health: • Mental Health Review Board is fully functional. • 80 Traditional Healers trained on mental health and substance abuse related topics. • 1 500 participants attended world Mental Health Day event at Bophelong Hospital. • 50 health professionals attended the review of the provincial Mental Health Policy workshop. Environmental health: • Assistant Director: Port Health Services has been appointed to take care as well as strengthening this service. • Wellness programme rolled out at Skilpadshek, Kopfontein and Swartkop respectively. • The number of pesticidal poisoning cases has declined with the incorporation of Garankuwa, Mabopane & Temba into the Gauteng province. Poisoning cases had been rife in the said areas. Challenges: • Shortage of Medical Doctors especially in rural areas. • Mobile vehicles too old. • Annual hospital inspections not conducted. • Only 2 hospitals implement hospital supervision manual. Remedial Action: • Develop mobile vehicle replacement plan. • Implement the annual hospital inspection for public hospitals. • Implementation of hospital supervision manual to be compulsory.

PROGRAMME 3: EMERGENCY MEDICAL SERVICES Key Achievements: • 30 new vehicles have been distributed to the districts. • Vacant posts have been filled. • New vehicles have been ordered, awaiting delivery. • All four districts have decentralized management of Emergency Medical Rescue Services (EMRS). • 95% of communities have access to a toll free number. • A Draft Disaster Management Plan has been developed. • A Provincial Disaster Management Committee has been established. Non achievement: • Upgrading of control centers is not on track. Challenges: • There are no custom built EMRS stations. • Slow registration process of vehicles by the Department of Transport. Measures to address the challenges: • Plans for the development of new bases. • Regular meetings with the Department of Transport to ensure the implementation of agreed upon plans.

PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES Key Achievements: • 100% of hospitals with patients’ satisfaction survey results. • 100% of complaints are resolved by hospitals within 25 days. • 10% clinical records audited (10% target). • All hospitals implement adverse event monitoring systems and have both PSG and maternal mortality meetings. • Perinatal Mortality and mobility monthly meetings held. MTEF 2008 Vote 3 72 • 88% of hospitals are within national norms and standard re: packages of services. • 88% of hospitals have signed Service Level Agreement (SLA) with suppliers. • All hospitals implement the following: ARV policy; policies on TB; Hypertension and diabetes policies; Health care policies for people with disabilities. Challenges: • Accreditation of hospitals by Council for Health Service Accreditation of South Africa(COHSASA). • Appointment of Governance structures in hospitals (Hospital Boards). • No hospitals managers trained on Executive Development Programme. • All hospitals are performing outside the provincial target of cost per Patient Day Equivalent(PDE). Remedial action: • Accreditation of hospitals to be part of the PMA of facility managers and CEO’S. • Expedite the appointment and training of Hospital Boards. • Stringent cost containment to be put in place with regard to Patient Day Equivalent (PDE). • Develop a strategy on Telemedicine and Public Private Partnership in the province as part of the Service Transformation Plan.

PROGRAM 5: CENTRAL HOSPITAL SERVICES Key Achievements: • Academic links established with WITS University as a form of partnership. • All hospitals are compliant with the approved business case for the National Tertiary Services Grant (NTSG). Challenges: • Failure to establish partnerships (agreements) with other stakeholders (academic institutions). • Provincial Tertiary Hospital Services admissions not on target due to lack of specialists especially in RPH and Mafikeng/ Bophelong Complex. Remedial action: • Identify academic institutions to establish partnership. • Strengthen Tertiary services at RPH and Mafikeng / Bophelong Complex.

PROGRAMME 6: HEALTH SCIENCES AND TRAINING Key Achievements • One thousand one hundred and seventy seven (1 177) nurses have been enrolled in the number of nurses in diploma courses. • One hundred and seventy one (171) nurses are in basic degree courses at the North West University. • One hundred and twenty eight (128) nurses are in post basic degree courses. • Twenty seven (27) learners have enrolled in the Emergency Care Technician programme. • Four thousand seven hundred and thirty eight (4 738) employees have been trained year to date. • Three hundred and twenty three (323) employees are registered for ABET. • One hundred and eighty six (186) employees registered for learnerships. • We have offered ninety six (96) students bursaries. • Sixty six (66) interns are enrolled on the departmental internship programme. Challenges: • Infrastructural and transport shortage for learners. • Insufficient funding for training and development. • Insufficient training facilities. • Limited accredited service providers for the community health worker programme as a result the department will not be in a position to perform well against the set target. Remedial actions: • Continue to lobby for more resources in respect of training and development budget. • Outsource transport for learners. • The infrastructural needs of the programme have been included in the departmental Capital Programme Plans. • The review of the targets for the training of community health workers in face of the limited training providers. • Leasing of privately owned buildings due to lack of accommodation

PROGRAMME 7: HEALTH SUPPORT SERVICES Key Achievements: • 94,3% essential drug availability. • 122 pharmacy assistants enrolled against a target of 143. • 15 compliance inspections conducted. • 10% of institutions implement health technology management SOP’s. • A preferred laundry model for the department is undergoing implementation. • Medical equipment procured in 28 hospitals, 28 Health Centres and 78 Clinics against the Departmental Medical Equipment Procurement plan. • 20 students completed the P2 electro medical training. • Funds for medical equipment preventative maintenance and repairs have been identified for the financial year 2007/08. • 45% of institutions reconcile First Auto and early warning report. • 60% institutions are complaint with integrated transport management strategy, plan and policy. • 100% compliance to medical vehicle replacement plan. • Four awareness campaigns conducted on Clinical and Forensic Pathology. • Two mortuaries upgraded.

MTEF 2008 Vote 3 73 Challenges: • Suppliers who do not have stock and go beyond the contractual delivery period. • Shortage of Pharmacist-Tutors who were tutoring Pharmacist Assistants. • Only 42% of expenditure on medico legal conditional grants. Remedial actions: • Follow-up is made with suppliers who go beyond the contractual delivery period and after the proper procedure is followed, in cases of vital medicines and essential surgical items, alternative suppliers are sought to buy out the items. • Improve conditions of service for Pharmacists. • Strengthen transport management strategy and priorities training on fleet management.

PROGRAMME 8: HEALTH FACILITIES MANAGEMENT Key Achievements: • IDIP programme is now fully integrated into the Department. Terms of reference for all institutional committees responsible for oversight are still to be finalized. • Projects under construction are performing well albeit the department was over spending on both infrastructure and clinic building programmes. To assist, additional funding (R64 million) has been received. • Commando building (Make shift hospital for Brits) has been completed and will be handed over to the department on the 09th January 2008. Relocation of the patients and personnel will take place afterwards. • Planning for MDR and XDR TB Units has been completed and tendering process for construction will be done during January 2008. • Most technical staff for Hospital Revitalization has been appointed and the impact is already being realized. • Tender briefing for medical equipment and furniture took place in mid December for both Moses Kotane and Vryburg Hospitals. Challenges: • Reduced funding for infrastructure for 2007/2008 as compared to the MTEF indicative figures used for planning. The targets have been reduced considerably to make sure the department remains within budget. • The backlog list is increasing due to underfunding. Therefore concentration is on the most critical replacement projects as targets will not be achieved. • Capacity of some contractors and consultant is retarding progress. Penalties are stringently being imposed by Department of Public Works on both the consultants and contractors who are not performing. Remedial actions: Spend the remaining part of 2007/2008 intensifying planning to ensure quick and efficient roll out of projects. • Prioritization on all projects particularly the backlog projects to ensure continuity in 2008/2009. • Ensure IDIP work plan is entrenched for the department to lobby for more funding. • Explore other funding sources outside government to leverage on Corporate Social Investment with PPI. • Address all administrative and project skills gap for the future.

4. OUTLOOK FOR THE COMING BUDGET YEAR During the 2008/09 financial year, the department will strive to focus on the following priority areas of delivery, derived from our strategic goals and objectives:

Implementing a comprehensive provincial response to HIV and AIDS and related diseases • A renewed vigour in dealing with communicable diseases will ensure that TB will receive particular emphasis also in the form of the new TB intervention plan.

To this effect the department has been allocated additional funding in the Comprehensive HIV and AIDS conditional grant.

During the adjustment budget the department received an amount of R30,9 m for TB MDR and XDR. The challenge is for the department to spend this money by end of March 2008. More funding has been allocated for the MTEF years.

Development of human capability and sustainable economic development and job creation • A comprehensive Human Resources plan, consistent with the unfolding countrywide Human Resources plan will be finalized. • The performance management and development system (PMDS) will be strengthened, with the understanding that it is core to continuous improvement in staff performance, and thus improved health service delivery. • Corporate services will focus on financial management training, with special attention on supply chain management. • An integrated health care management information system will be acquired and implemented in phases, within the limits of funding. • The department will intensify its skills development and training programme. Investment in infrastructure • Contribute to PGDS by identifying and implementing specific projects within and related to the DOH, specifically clinic building • Increase and strengthen facility planning and maintenance capacity. More funds are being channelled into routine maintenance. Strengthening service delivery, fighting poverty and protecting vulnerable groups in society. • Community involvement to be intensified with more community health workers in the delivery of health services. • To reinforce youth development as a cornerstone of successful health services to young people, partnership with youth formations through the provincial youth commission will be strengthened. • Strengthening the reach and effectiveness of the CHW programme and partnerships with NGOs will be a priority of the department.

MTEF 2008 Vote 3 74 • Emergency medical services in the form of ambulances and patient transport are being expanded in preparation for 2010. • Laboratory services are being prioritized as one of the biggest cost drivers for the department. • Primary Health Care services will be strengthened to improve the referral system. • Integrated Health Care Management Information Systems has been afforded a small funding for the purpose of improving management of information systems in the department. • Additional funding has been made possible for Health remuneration review; the first phase of the OSD for nurses will be finalised before the end of the 2007/08 financial year. In 2008/09 focus will be on doctors and other health professionals. • Additional health professionals (nurses and doctors) distributed between district and provincial hospitals. • As part of the department’s endeavour to strengthen service delivery, the department will be evaluating the extent to which relations are strengthened with certain stakeholders. These include universities and private health training institutes, traditional healers and leaders, NGO’s, municipalities, Provincial Council on AIDS, private and mining hospital groups, and as mentioned above, the youth commission. The importance of strengthening and coordinating with other departments i.e. Public Works, Roads, Transport & Community Safety, Sports, Arts and Culture, and Social Development cannot be overemphasized, given their contribution to issues such as attracting and retaining staff and imperatives for intra and inter cluster work. • The department commits itself to implementation of priorities set out in both the strategic plan and the annual performance plan within the limitations imposed by limited resources versus unlimited needs. • Dedicated funding for medical equipment and capital maintenance will improve on critical areas • Mortality rates are likely to worsen given the progression of the HIV and AIDS epidemic • TB cure rates are projected to increase over the MTEF but it is envisaged that funding available for TB and proper management of the programme will alleviate the problem . • Patient satisfaction is likely to improve given the stabilization of the service and a renewed focus on quality of care.

5. RECEIPTS AND FINANCING Conditional Grants The department has been allocated six national conditional grants over the three years of the MTEF. They are discussed below: National Tertiary Services This grant is meant to fund provinces to plan, modernize, rationalize and transform the tertiary hospital service delivery platform in line with national policy objectives. This grant promotes access to tertiary services by patients in rural and remote areas plus access to as wide an area as possible in the North West Province. The services are currently provided in Klerksdorp/Tshepong Complex; Mafikeng/Bophelong Complex and Rustenburg Provincial Hospitals. The increase in this grant will be due to the wider distribution of the tertiary services through the development of Vryburg Provincial Hospital.

There is also a notable increase in conditional grants with the National Tertiary Services grant increasing to R117.317 million; R133.932 million and R177.597 million from an initial allocation of R116.480 million; R132.957 million and R176.148 million over the three MTEF years. Provincial tertiary services therefore increase by 44.1 per cent from 2007/08; this increase drops to 14.2 per cent from 2008/09 to 2009/10 and grows again to 32.6 per cent in 2010/11.

Health Professional Training & Development To support the training and development of health professionals and recruitment of medical specialists. The demand in the increased output number of trained health professionals translate into more budget required. Hospital Revitalization To provide funding to enable provinces to plan, manage, modernize, rationalize and transform the infrastructure, health technology, monitoring and evaluation of hospitals and to transform hospital management and improve quality of care in line with national policy objectives. The increase in the grant is related to inflationary pressures. Comprehensive HIV/AIDS To enable the health sector to develop an effective response to the HIV/AIDS epidemic and other matters. The increasing number of patients on ARV treatment had implications for more budgets in medicines, laboratory tests and personnel for ART sites even for programmes of VCT, PMTCT, Home Based Care and Step Down. Forensic Pathology Services To provide for the transitional activities required to shift forensic mortuaries from SAPS to Provincial Departments of Health. To maintain the development and provision of comprehensive Forensic Pathology Services in order to ensure impartial professional evidence for the criminal justice system concerning death due to unnatural causes. Provincial Infrastructure Grant This is aimed at accelerating the construction, maintenance and rehabilitation of new and existing infrastructure and other health facilities. The demand in the increase of the budget is due to more projects to deliver more clinics and other health facilities for the province.

Departmental own receipts: The only meaningful revenue collected by the department is that of patient fees. The department will continue striving to maximize revenue collection by entering into agreements with medical schemes for utilization of the Designated Service Provider Network facilities and other departments such as the Road Accident Fund, South African Police Service, South African National Defence Force and Correctional Services. Satellite offices manned by RAF employees are being set up in three pilot hospitals in the province. This is meant to facilitate and expedite the process of lodging claims for motor vehicle accident victims, with the purpose of improving revenue collection.

A proposal is being made for piloting of the electronic data interchange (EDI) or medical switching which will improve the payment rate of medical aid claims.

MTEF 2008 Vote 3 75

Departmental summary of receipts Departmental Summary of Receipts 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Receipts Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Equitable Share 2,277,705 2,605,175 3,017,547 3,203,810 3,300,872 3,487,159 3,783,915 4,165,348 Conditional Grants: National Tertiary Services 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595 Professional Training Development 44,902 64,012 62,541 65,692 65,692 68,977 78,608 83,324 Hospital Revitalisation 91,337 87,998 155,856 176,966 209,166 254,030 242,800 310,500 HIV/ AIDS 72,522 100,921 141,615 156,429 156,429 205,288 264,922 309,710 Integrated Nutrition Programme 18,253 10,891 ------Infrastructure grant 22,722 - - 20,000 39,572 40,000 40,000 40,000 Medico Legal Services ------Malaria Conditional Grant ------UN funding for TB ------Forensics Pathology Services Grant - 2,230 10,971 22,835 36,235 22,158 23,334 26,433

Total Conditional Grants 288,447 337,335 440,585 523,331 588,503 707,770 783,596 947,562 Own receipts 26,838 25,650 21,174 27,377 27,253 27,620 28,920 30,120

Total funding 2,592,990 2,968,160 3,479,307 3,754,518 3,916,628 4,222,549 4,596,431 5,143,030

Departmental own receipts Departmental Own Receipts 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Tax receipts ------Casino taxes ------Horseracing ------Liquor licenses ------Motor vehicle licenses ------Non-tax receipts 26,762 24,214 18,064 26,877 26,753 16,870 18,170 19,370 Sale of goods & services (non-cap): 21,790 24,214 18,064 26,877 26,753 16,870 18,170 19,370 - Administrative fees ------Hospital fees 18,957 17,658 16,460 25,217 25,217 15,200 16,200 17,200 - Sale of goods 136 169 22 100 100 1,200 1,500 1,700 - Boarding 141 169 210 200 200 120 120 120 - Rentals 2,515 2,446 500 1,236 1,236 350 350 350 - Subsidised vehicles 24 3,711 872 - - - Sale of scrap & other current goods 17 61 - 124 - Fines, penalties and forfeits 4,972 ------Interest, dividends & rent on land: ------Interest ------Dividends ------Rent on land ------Sale of capital assets ------Land and subsoil assets ------Other capital assets (specify) ------Other capital assets (specify) ------Financial transactions 76 1,436 3,110 500 500 10,750 10,750 10,750 TOTAL OWN RECEIPTS 26,838 25,650 21,174 27,377 27,253 27,620 28,920 30,120

6. PAYMENT SUMMARY

6.1 Key assumptions The department applied the following key assumptions when compiling the budget • Salary increases and their carry through costs of 7.1% for 2007/08, 5.2% for 2009/10 and 5.1% for 2010/11 were taken into account. • A 1% pay progression and 1.5% performance award has been included in the budget provision for personnel costs • Inflation of 6.1% in 2008/09, 4.7% in 2009/10 and 4.6% in 2010/11. Other key assumptions that directly underpin the budget of this department

MTEF 2008 Vote 3 76 • Provision for health professional review remuneration in the form of Occupational Specific Dispensation with doctors, dentists and pharmacists being targeted for the 2008/09 financial year and various other groups in 2009/10 and 2010/11. • The cost drivers of the department being laboratory services and pharmaceuticals are provided for over the MTEF. • Provision for the building of additional clinics and community health centres over the MTEF has been provided. • Provision to purchase medical equipment was made. • Additional personnel adjustments in the form of OSD for health specialists has been made by National Treasury.

7. PROGRAMME SUMMARY The indicative allocation for 2008/09 financial year as reflected in the 2007/08 budget statement amounts to R4,169,928m with a final allocation amounting to R4,216,150m . The amount in excess of the current baseline includes both the National and Provincial priority programmes and projects namely the development of the service transformation plan; strengthening of human resources; strengthening physical infrastructure; improving quality of care; and strengthening strategic health programmes. Expected outcomes on the latter include accelerating HIV prevention; implementation of the TB crisis plan; and healthy lifestyles campaign. Priority projects include new clinics amounting to R50 m in 2008/09 with about 390 job opportunities created the majority of these benefiting children and women through the expanded public works programme (EPWP). Hospitals and other health facilities, upgraded projects and health routine maintenance are also adequately provided for by district.

Budget trends (Note: Details on individual programmes can be found under each relevant programme)

An overall 96.2 per cent of the budget was spent in the 2006/07 financial year, compared to 99.4 per cent in 2005/06 and 97.3 per cent in 2004/05. There has, therefore been an improvement in performance between 2004/05 and 2005/06 and a drop in expenditure for the 2006/7 financial year.

In keeping with inflation, total funding increases by R306 million, which is 8% from 2007/08 to 2008/09; by R374 million, 9% from 2008/09 to 2009/10 and R547 million which is 12% from 2009/10 to 2010/11.

In keeping with inflation, total funding increases by R299.522 million, which is 7.6 per cent from 2007/08 to 2008/09; by R365.495 million (8.7 per cent) from 2008/09 to 2009/10 and R542.048 million (11.8 per cent) from 2009/10 to 2010/11 whilst equitable share increases by R180.968 million which is 5.5 per cent from the 2007/08 adjustment budget, to 2008/09; 8.3 per cent and 10.0 percent in the outer years.

There is also a notable increase in conditional grants with the National Tertiary Services grant increasing to R117.317 million; R133.932 million and R177.597 million from an initial allocation of R116.480 million; R132.957 million and R176.148 million over the three MTEF years.

Personnel Compensation of employee’s budget comprises 50.9 per cent of the total budget for the 2007/08 financial year; 53.7 per cent for 2008/09 and 55.7 per cent in 2009/10.

Overspending on personnel was due to inadequate funding at the beginning of the financial year in 2005/06. Priority was then given to core business related positions with approval for posts being implemented at the level of the Head of Department.

The personnel budget for the two outer years of the MTEF has been increased by additional amounts for Occupational Specific Dispensation targeting health specialists. There’s a growth of 13.3 per cent from 2007/08 to 2009; 13.2 per cent to 2010 and 14.0 per cent to 2010/11.

Transfer payments Under spending in 2005/06 was due to non transfer of funds to the Independent Development Trust for construction of community health centres. Apart from that under expenditure on transfers in 2006/07 resulted from discontinuation of RSC levies.

The Independent Development Trust was used for paying stipends for the EPWP programme; for construction of community health centres and clinics on behalf of the department in the previous financial year. As from 2008/09 MTEF there are no transfers of funds for construction purposes, all funds will be kept in the vote.

The department transfers funds to the public entity being the Provincial Council on Aids ( PCA) to carry out its mandate in terms of the Act. The department also subsidises the Bureau for the Blind, assisting it to render services in the deep rural areas; and Youth Centers to deal with health related pressures, e.g. pregnancy, obesity and other health lifestyles,

Funds are also transferred to other non governmental bodies for the purpose of training community health workers and lay counsellors on health related issues e.g. hygiene.

Goods and services Under expenditure was as a result of delayed payments in respect of expenditure projected for laboratory services, late transfer of funds in respect of the Forensic Pathology Services conditional grant, and a decline in projected expenditure for payment Professional services. The impact on service delivery was, however, minimal.

MTEF 2008 Vote 3 77 Capital payments Unspent amounts resulted from on-going work on capital projects, this, however, had a minimal negative impact on service delivery. There is a decrease of 12.2 per cent from 2007/08 to 2008/09 on capital payments; this, however, increases to 5.8 per cent and 8.2 per cent in the outer two years of the MTEF.

Departmental summary of payments and estimates according to programme Departmental Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF 1: Administration 123,734 135,173 138,038 163,956 168,103 174,627 185,490 195,993 2: District Health Services 1,370,210 1,585,270 1,793,451 1,844,067 1,897,098 2,052,040 2,245,263 2,408,076 3: Emergency Medical Services 82,574 92,245 106,084 142,035 133,535 148,309 155,668 166,625 4: Provincial Hospital Services 655,391 743,845 839,267 984,063 1,024,337 1,084,885 1,224,205 1,451,300 5. Central Hospital Hospitals 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595 6: Health Sciences and Training 90,236 83,651 99,628 116,226 92,486 125,288 133,749 147,371 7: Health Care Support Services 57,489 77,304 93,809 120,555 119,438 129,023 135,430 143,061 8: Health Facilities Management 174,645 179,389 339,428 302,207 400,222 391,060 382,693 453,009

Total programmes 2,592,990 2,968,160 3,479,307 3,754,518 3,916,628 4,222,549 4,596,430 5,143,030

Departmental summary of payments and estimates - Departmental Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 1,586,425 1,764,998 1,913,655 2,061,230 1,996,435 2,268,883 2,575,317 2,938,688 Transfer payments 70,875 107,815 170,660 102,887 126,757 116,284 119,294 125,259 Administrative expenditure 96,149 109,870 132,353 134,448 139,959 143,715 158,241 165,898 Stores 325,629 357,992 422,760 479,277 497,733 508,947 529,181 573,441 Professional and special services 152,988 215,830 314,197 331,728 361,283 395,419 402,169 417,719 Other goods and services 168,205 219,596 206,359 268,302 282,508 339,919 336,724 407,657 Unauthorised expenditure ------Total Current Payments 2,400,271 2,776,101 3,159,984 3,377,872 3,404,675 3,773,167 4,120,926 4,628,662 Capital: Equipment 59,252 54,460 102,775 132,021 171,290 179,325 196,179 234,297 Land and Buildings 133,467 137,599 216,548 244,625 340,663 270,057 279,325 280,071 Infrastructure ------Other capital expenditure ------Total Capital Payments 192,719 192,059 319,323 376,646 511,953 449,382 475,504 514,368 TOTAL ECONOMIC EXPENDITURE 2,592,990 2,968,160 3,479,307 3,754,518 3,916,628 4,222,549 4,596,430 5,143,030

Departmental summary of payments and estimates according to economic classification Departmental Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 1,586,425 1,764,998 1,913,655 2,061,230 1,996,435 2,268,883 2,575,317 2,938,688 - Salaries & related costs 1,206,429 1,381,974 1,609,893 1,543,766 1,478,969 1,622,812 1,800,339 1,987,596 - Overtime 50,708 52,901 - 62,054 62,054 64,146 66,344 81,676 - Improvement in conditions of service 70,140 61,615 50,231 69,470 69,470 176,221 258,548 372,518 - Social contributions (employer share) 259,148 268,508 253,531 385,941 385,942 405,704 450,086 496,898 Transfer payments: 70,875 107,815 170,660 102,887 126,757 116,284 119,294 125,259 Provincial agencies ------Departmental Agencies: ------Public Entities 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742 - Other (Pseta) - 1,651 1,904 1,855 1,855 2,361 2,702 2,837

MTEF 2008 Vote 3 78

Municipalities: ------Regional service council levies 4,511 7,706 ------Other transfers to municipalities 19,753 26,721 17,270 - 15,115 - - - Universities and technikons ------Public Corporations: ------Subsidies on production ------Other ------Private Corporations: ------Subsidies on production ------Other - - 66,900 - - - - - Foreign governments and international trf's ------Non-profit organisations 28,293 31,638 32,845 36,888 36,043 38,693 40,589 42,618 Households: ------Social Benefits ------Other 8,318 29,549 39,111 52,402 62,002 63,488 64,261 68,062 Goods and services: 742,971 903,288 1,075,669 1,213,755 1,281,483 1,388,000 1,426,315 1,564,715 - Administrative expenditure 96,149 109,870 132,353 134,448 139,959 143,715 158,241 165,898 - Rental of equipment 6,027 1,906 - 13,468 13,468 14,114 15,110 15,866 - Stores 325,629 357,992 422,760 479,277 497,733 508,947 529,181 573,441 - Rental of buildings 9,877 4,999 - 19,724 19,724 21,256 22,981 24,131 - Professional & special services 152,988 215,830 314,197 331,728 361,283 395,419 402,169 417,719 - Maintenance & repairs 42,694 32,963 33,162 62,788 71,148 119,198 107,075 166,852 - Assets less than R5 000 66 - - 853 853 5,943 6,034 6,086 - Other 109,541 179,728 173,197 171,468 177,315 179,408 185,524 194,722 Unauthorised expenditure ------1 - TOTAL CURRENT PAYMENTS 2,400,271 2,776,101 3,159,984 3,377,872 3,404,675 3,773,167 4,120,927 4,628,662 CAPITAL Machinery & equipment 59,252 54,460 102,775 132,021 171,290 179,325 196,179 234,297 Motor vehicles & other transport 1,163 - 24,616 38,127 39,927 39,292 40,848 42,891 Equipment: ------Computers 9,140 1,178 1,285 4,024 4,031 11,517 15,529 41,230 - Office equipment & furniture 8,563 1,215 686 9,468 25,011 9,415 9,797 10,288 - Other moveable capital 40,386 52,067 76,188 80,402 102,321 119,101 130,005 139,888 Fixed capital: 133,467 137,599 216,548 244,625 340,663 270,057 279,325 280,071 - Land and subsoil assets ------Buildings 133,467 137,599 216,548 244,625 340,663 270,057 279,325 280,071 - Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 192,719 192,059 319,323 376,646 511,953 449,382 475,504 514,368 Current payments 2,400,271 2,776,101 3,159,984 3,377,872 3,404,675 3,773,167 4,120,927 4,628,662 Capital payments 192,719 192,059 319,323 376,646 511,953 449,382 475,504 514,368 TOTAL ECONOMIC CLASSIFICATION 2,592,990 2,968,160 3,479,307 3,754,518 3,916,628 4,222,549 4,596,431 5,143,030

PROGRAMME 1: ADMINISTRATION

Programme description: To conduct the overall administration and strategic management of the department with regard to District Health Services, Emergency Medical Services, Provincial Hospital Services, Health Sciences and Training, Health care Support Services and Facility management. The aims of the programme are to ensure that health services are rendered in terms of approved policies, and that comprehensive health care services are coordinated in the province. This programme has two sub-programmes namely, Office of the MEC and Management.

Key measurable objectives

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate) (target) (target) (target) Measure) Implement the % of planned 100 100 100 100 100 Skills courses Development attended as Plan and per Workplace provide relevant Skills Plan and targeted (WSP) training MTEF 2008 Vote 3 79 Implement and % of 100 100 100 100 100 maintain an employees effective assessed in performance line with PMDS management system Implementation Number of Nursing OSD 100% 100% 100% 100% of revised Occupation developed, Nursing OSD OSDs and JE OSDs and JE OSDs and JE remuneration Specific EMS OSD in approved, revisions revisions revisions levels of health Dispensations development, EMS OSD in implemented implemented implemented professionals (OSD) and Job JE revisions in development, as per PSCBC as per PSCBC as per PSCBC Evaluation (JE) development other JE Resolution 1 of Resolution 1 of Resolution 1 of revisions revisions 2007 2007 2007 implemented implemented as per PSCBC Resolution 1 of 2007 Number of NA 7 10 15 20 research reports available Monitor and Annual report Annual report Annual report Annual report Annual report Annual report evaluate the developed produced produced produced produced produced implementation of the departmental strategic plan Increase % of revenue revenue generated and generation and collected 95 96 100 100 100 collection by against target facilities Improve debt % Of 12 17 20 60 65 management outstanding accounts Ensure % Of cost 75 85 98 98 98 budgetary centres within control and budget monitoring (overspending or underspending by not more than 2%).

To expand No. of youth 16 18 20 21 21 youth friendly centres health services. established To monitor the Number of n/a 56 56 56 56 implementation institutions of the disability implementing strategy % of n/a 25% 50% 75% 100% Traditional Health Practitioners registered in the database Develop and Developed N/A Developed Implementation Implementation Implementation implement record record records management management management strategy strategy strategy To promote a % of 40% 50% 70% 90% 100% caring service complaints culture resolved within 25 days To strengthen % of n/a 30% 50% 80% 100% the Infection institutions Prevention & monitoring Control nosocomial Programme infection rates To coordinate, # of hospitals 3 7 15 22 24 MTEF 2008 Vote 3 80 monitor and accredited maintain the Hospital Accreditation Programme Provincialization % of PHC 50% 100% 100% 100% 100% of PHC services services provincialized

Develop Compliance 100% 100% 100% 100% 100% monitoring, and evaluation and implementation compliance reports plans focusing on communication policy and strategy implementation

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Office of the MEC 6,576 4,804 4,520 5,833 4,702 7,037 7,388 8,208 Management 117,158 130,369 133,518 158,123 163,401 167,590 178,102 187,785

Total programme 123,734 135,173 138,038 163,956 168,103 174,627 185,490 195,993

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 67,283 75,568 82,315 91,016 89,016 98,795 103,842 110,168 Transfer payments 3,011 4,526 4,274 6,580 15,653 6,778 7,138 7,495 Administrative expenditure 27,714 25,255 28,390 24,137 23,664 24,773 28,237 29,643 Stores 5,126 3,796 4,028 7,431 7,331 8,475 8,855 9,398 Professional and special services 4,000 5,955 4,174 7,985 8,608 8,145 8,308 8,723 Other goods and services 13,196 17,680 14,178 20,895 20,845 21,571 22,654 23,788 Unauthorised expenditure ------Total Current Payments 120,330 132,780 137,359 158,044 165,117 168,537 179,034 189,215 Capital: Equipment 3,404 2,393 679 5,912 2,986 6,090 6,456 6,778 Land and Buildings ------Infrastructure ------Other capital expenditure ------Total Capital Payments 3,404 2,393 679 5,912 2,986 6,090 6,456 6,778 TOTAL ECONOMIC EXPENDITURE 123,734 135,173 138,038 163,956 168,103 174,627 185,490 195,993

Programme summary of payments and estimates according to economic classification - - - Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 67,283 75,568 82,315 91,016 89,016 98,795 103,842 110,168 - Salaries & related costs 54,130 59,274 70,330 69,789 67,789 71,905 73,343 74,810 - Overtime 768 754 - 639 639 677 718 718 - Improvement in conditions of service 3,150 2,673 2,035 3,141 3,141 8,237 11,445 15,939 - Social contributions (employer share) 9,235 12,867 9,950 17,447 17,447 17,976 18,336 18,701

MTEF 2008 Vote 3 81 Transfer payments: 3,011 4,526 4,274 6,580 15,653 6,778 7,138 7,495 Provincial agencies - - Departmental Agencies: - Public Entities - - - Other (Pseta) - - Municipalities: - - Regional service council levies 176 213 - Other transfers to municipalities - - Universities and technikons - - Public Corporations: - Subsidies on production - - - Other - - Private Corporations: - - Subsidies on production - - - Other - - Foreign governments and international trf's - - - - Non-profit organisations 2,556 2,677 4,274 780 780 780 780 819 Households: - Social Benefits - - - Other 279 1,636 - 5,800 14,873 5,998 6,358 6,676 Goods and services: 50,036 52,686 50,770 60,448 60,448 62,964 68,054 71,552 - Administrative expenditure 27,714 25,255 28,390 24,137 23,664 24,773 28,237 29,643 - Rental of equipment 665 1,906 - 3,797 3,797 3,818 4,046 4,249 - Stores 5,126 3,796 4,028 7,431 7,331 8,475 8,855 9,398 - Rental of buildings 3,981 4,999 6,938 6,938 7,066 7,490 7,865 - Professional & special services 4,000 5,955 4,174 7,985 8,608 8,145 8,308 8,723 - Maintenance & repairs - 204 204 220 233 245 - Assets less than R5 000 - 400 400 450 500 525 - Other 8,550 10,775 14,178 9,556 9,506 10,017 10,385 10,904 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 120,330 132,780 137,359 158,044 165,117 168,537 179,034 189,215 CAPITAL Machinery & equipment 3,404 2,393 679 5,912 2,986 6,090 6,456 6,778 Motor vehicles & other transport ------Equipment: - - Computers 1,067 1,178 679 1,196 1,196 1,196 1,268 1,331 - Office equipment & furniture 1,561 1,215 - 1,469 1,469 1,567 1,661 1,744 - Other moveable capital 776 - 3,247 321 3,327 3,527 3,703 Fixed capital: ------Land and subsoil assets ------Buildings ------Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 3,404 2,393 679 5,912 2,986 6,090 6,456 6,778 Current payments 120,330 132,780 137,359 158,044 165,117 168,537 179,034 189,215 Capital payments 3,404 2,393 679 5,912 2,986 6,090 6,456 6,778 TOTAL ECONOMIC CLASSIFICATION 123,734 135,173 138,038 163,956 168,103 174,627 185,490 195,993

Transfer payments included in programme 1 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------

MTEF 2008 Vote 3 82

Other: RSC Levies 176 213 - - - - - NGO,s 1,776 1,895 1,201 - Health System Trust 380 380 380 380 380 380 380 380 Bureau for the Blind 400 400 400 400 400 400 400 439 Litigations 4,000 9,073 4,000 4,000 4,000 Salary related transfers 279 1,638 2,293 1,800 5,800 1,998 2,358 2,676 TOTAL TRANSFER PAYMENTS 3,011 4,526 4,274 6,580 15,653 6,778 7,138 7,495

Earmarked funds included in programme 1 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Evaluation research 2,000 2,000 - 2,000 2,000 2,100

TOTAL EARMARKED FUNDS - - 2,000 2,000 - 2,000 2,000 2,100

Administration is constant at between 4 per cent and 5 per cent of the total health budget.

The programme overspent by 4.9 per cent in 2005/06, notably in personnel and goods and services against full expenditure of 100 per cent in 2004/05. The unspent allocation of 4.4 per cent in 2006/07 was mainly due to a drop in personnel numbers during the last quarter of the financial year and relocation of the health service delivery chief directorate to Programme 2: District Health Services.

In keeping with inflation, the administration budget grows by 3.5 per cent from 2007/08 to 2008/09; then by 6.2 per cent and 5.5 per cent in the outer years. Actual expenditure from 2004/05 to 2005/06 increases by 9.2 per cent and by 2.1 per cent from 2005/06 to 2006/07. Expenditure budgets increase by 20.7 per cent from 2006/07 to 2007/08; 3.5 per cent from 2007/08 to 2008/09; and by 6.2 per cent and 5.5per cent in the outer two years.

PROGRAMME 2: DISTRICT HEALTH SERVICES .

Programme description: The purpose of the programme is to provide accessible, affordable and comprehensive Primary Health Care and District Hospital Services through a well-managed and effective District Health System. The programme includes district management, community health centers, clinics, community based services, other community services, HIV and AIDS, forensic pathology services, and district hospitals. Objectives: Review and develop appropriate referral patterns for Primary Health Care in all four (4) Districts. • Implement TB programme review and recommendations. • Start the process of taking over of Primary Health Care services from local and district municipalities including the monitoring of Service Level Agreements with the municipalities receiving funds from the department. • Accelerate implementation of the Comprehensive plan for HIV and AIDS. • Implement provincial EMS plans. • Ensure that all clinics and Community Health Centers have water, sanitation and telecommunication as well as provision of essential drugs (medicines). • Improve management of communicable diseases and non-communicable illnesses • Ensuring implementation of referral system from clinics and to hospitals and access to health services as well as constant supervision to strengthen, implement, monitor and evaluate policies, guidelines and protocols. • Improve the management of all children under the age of five presenting with illnesses such as pneumonia, diarrhoea, malaria and HIV. • Strengthened relations and partnership community based health providers including the following stakeholders: universities and private health training institutes, traditional healers and leaders, NGO’s, CBOs, municipalities, Provincial Council on AIDS, private and mining hospital groups, and the youth commission. • Implement and maintain a comprehensive community health worker programme. • Provide effective home based care services in the province. • Provide health professionals with technical capacity on clinical management of HIV and AIDS. • Complete the transfer of mortuary services. • Establish one crisis centre per district • Strengthen the inter-sectoral planning with the SAPS. • Establish provincial training policy. • Review and develop appropriate referral patterns from Community Health Centers and to level 2 hospitals. • Ensure accelerated implementation of the accreditation process to all district hospitals. • Strengthen the programme of hotel services and functional private wards. • Ensure provision of pharmaceutical and laboratory services.

MTEF 2008 Vote 3 83 Key measurable objectives • Review and develop appropriate referral patterns for Primary Health Care. • To roll out the accreditation programme. • Increase clinical supervision and management of PHC services. • Ensure availability of drugs (medicines). • Increase number of CHCs rendering comprehensive package 24hr PHC services. • Increase and maintain number of NGOs and CBOs partnerships with the department.. • To ensure and strengthen provision and access to VCT services. • To ensure and strengthen provision and access to PMTCT services • To provide access to home/community based care services to communities in need of care and support • Increase number of accredited ARV sites • To nutritionally manage, care and support people living with TB, HIV and AIDS • To renovate all existing mortuaries based on the audit. • Build new mortuaries • Appointment of staff • Implement recommendations on the audit of mortuary equipment • Implement the programme of accreditation of hospitals for quality assurance. • Ensure that hospitals are within the provincial target of average length of stay (ALOS) (4 days) • Ensure compliance with the Pharmacy Act.

Sub-programmes:

District Health Services

Key Measurable objectives:

Measurable Indicator (Performance 2006/07 2007/08 2008/09 2009/10 2010/11 Objective Measure) (Actual (target) (target) (target) (target)

Strengthening Batho Number of sub districts 22 21 21 21 21 Pele with annually signed and implemented Service Delivery Improvement Agreements

To implement work Number of functional WITS 0 5 9 9 9 improvement team teams per districts strategy

Number of completed 0 36 36 36 36 WITS projects

Improve clinical % of clinics implementing 78% 90% 100% 100% 100% management of PHC clinic supervision manual services

% of CHCs and clinics 65% 75% 80% 85% 90% supported by a doctor once a week

Establish a uniform % of facilities responding N/A 75% 100% 100% 100% complaints mechanism in to complaints within 25

all fixed facilities days (This objective exclude mobile health services)

To set up and maintain Number of sub districts 19 21 21 21 21 strategies that will conducting Maternal and safeguard against clinical Perinatal Mortality and risks Morbidity Meetings

Number of sub districts 22 21 21 21 21 implementing the adverse event monitoring system

To improve the quality of % of facilities 100% 100% 100% 100% 100% patient service implementing patient MTEF 2008 Vote 3 84 satisfaction surveys

Strengthen community % of sub districts with 95% 100% 100% 100% 100% participation at all levels functioning Governance

in order to promote a Structures (Meeting six caring service culture times per year)

% of Governance 50% 50% 70% 100% 100% Structures trained

To appoint all Number of District Health 0 4 4 4 4 Councils established governance structures across all levels of care and spheres

Number of Local Health 0 21 21 21 21 Committees established (in line with provincial health legislation)

To improve access to % of Clinics rendering 50% 50% 60% 70% 70% PHC services 12hr-24hr PHC services

% of mobile points 50% 50% 60% 70% 70% receiving a monthly service

Facilitate that all PHC % of facilities with water, 90% 90% 100% 100% 100% electricity and sanitation facilities have water, sanitation and telecommunication

% of facilities with 90% 90% 95% 95% 95% telecommunication

Provide essential drugs % availability of tracer 95% 95% 97% 98% 98% drugs to all PHC facilities

Maintain and improve % of scripts with 3 or less 55% 60% 80% 90% 90% items per prescription drug management and control

Ensure compliance with % of prescription 60% 80% 90% 100% 100% EDL guidelines according to EDL guidelines

Ensure that all sub % of sub districts with 60% 75% 95% 100% 100% community outreach districts have community programmes outreach programmes

To strengthen Number of sub districts 1 10 10 10 10 management of with PHC services Provincialised of Primary provincialised Health Care services at the affected municipalities

To implement and Number of municipalities 4 4 4 4 4 with signed MOU’s/MOA monitor MOU’s with District Municipalities in relation to municipal health services

Improve the quality of Number of sub districts 22 21 21 21 21 DHIS data validating their data

MTEF 2008 Vote 3 85

To promote a % of managers level 9 and 100 100 100 100 100 higher with signed PMA performance-oriented organisational culture

% employees level 1 to 8 100 100 100 100 100 with work-plans

Regular reviews of 4 per 4 per 4 per 4 per 4 per individual performance annum annum annum annum annum

District Management: Objectives: • Review and develop appropriate referral patterns for Primary Health Care in all four (4) Districts. • Implement TB programme review and recommendations. • Start the process of taking over of Primary Health Care services from local and district municipalities including the monitoring of Service Level Agreements with the municipalities receiving funds from the department. • Accelerate implementation of the comprehensive plan for HIV and AIDS. • Implement provincial EMS plans. Community health clinics Objectives: • Improve the management of all children under the age of five presenting with illnesses such as pneumonia, diarrhoea, malaria and HIV. • Ensure that all clinics have water, sanitation and telecommunication as well as provision of essential drugs (medicines). • Improve management of communicable diseases and non-communicable illnesses District Hospitals Objectives: • To review and develop appropriate referral patterns from Community Health Centers and to level 2 hospitals. • To ensure accelerated implementation of the accreditation process to all district hospitals. • To strengthen the programme of hotel services and functional private wards. • To ensure provision of pharmaceutical and laboratory services.

Provincial objectives and performance indicators for HIV & AIDS, STI and TB control

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate (target) (target) (target) Measure) ARV treatment Number of ARV 20 38 45 60 75 service points treatment service compared to point in the plan province Hospitals % of hospitals 100 100 100 100 100 offering PEP offering PEP for for occupational HIV occupational exposure HIV exposure Hospitals % of hospitals 100 100 38 48 58 offering PEP offering PEP for for occupational and occupational non occupational and non HIV exposure occupational HIV exposure Hospitals % of hospitals 100 100 100 100 100 offering PEP offering PEP for for sexual sexual abuse abuse

HTA Number of HTA 1 4 7 10 13 Intervention Intervention sites sites compared compared to plan to plan TB cases with % of TB cases with 93 >90 >90 >90 95 a DOT a DOT supporter supporter Increase male Male condom 6 7 8 9 10 condom distribution rate distribution from public sector from public health facilities sector health facilities MTEF 2008 Vote 3 86 Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate (target) (target) (target) Measure) Male condom Male condom 6 64 5 5 5 distribution distribution rate rate from from primary primary distribution sites. distribution sites. Fixed facilities Number of fixed 0 0 0 0 0 with any ARV facilities with any drug stock out ARV drug stock out Fixed PHC Number of fixed 70 75 334 400 410 facilities PHC facilities drawing blood drawing blood for for CD4 testing CD4 testing Increase STI % of STI partner 30 32 35 38 40 partner treatment rate treatment rate Increase Nevirapine uptake 40 100 100 100 100 Nevirapine rate among babies uptake among born to women with babies born to HIV women with HIV Increase Proportion of clients 85 90 93 95 97 clients HIV HIV pre test pre-test counselled counselled in fixed PHC facilities Reduce CD4 CD4 test 0 0 0 0 0 test with turnaround time at turnaround ARV treatment time >6 days service points with at ARV time >6 days treatment service points ART Number of ART 0 5 10 15 20 monitoring monitoring visits visits measured at WHO measured at performance scale WHO 1 or 2 performance scale 1 or 2 Increase TB % of TB sputa 66 70 75 75 80 sputa specimens with specimens turnaround time with <48 hours turnaround time <48 hours Increase new % of new smear 55 60 65 70 75 smear positive positive PTB cases PTB cases cured at first cured at first attempt attempt Increase the % of new MDR TB .5 <1 <1 <1 <1 proportion of cases starting diagnosed treatment MDR TB patients starting treatment Eliminate new % of STI treated 4 3 3 3 3 STI episode new episode among ART among ART patients patients Expand VCT No. of operational 466 466 466 466 466 sites sites established Improve VCT % of pre-counselled 86 90 93 95 95 uptake clients tested Improve No. of operational 329 319 324 329 329 MTEF 2008 Vote 3 87 Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate (target) (target) (target) Measure) access to PMTCT sites PMTCT Improve % HIV positive 75 78 81 85 87 PMTCT uptake pregnant women enrolled to the programme. Reduce Rate of pregnant 3 1 1 1 1 incidence of women with syphilis syphilis in infection pregnant women) Reduce % Male population 0 <3/100 <3/100 <3/100 <3/100 incidence of ≥15yrs presenting male urethral at health facilities discharge with urethral discharge % Adult population 2 4 3 3 3 presenting at health facilities with genital ulcer diseases

Improve STI % STI partners 26 30 35 40 45 partner treated treatment Increase Average male 6 7 7 7 7 access to male condoms per male condoms adult population 15- 49 yrs distributed per month Increase Average female 3 3 3 3 3 access to condoms per female female adult condoms population 15-49 yrs distributed per month Provide No. of Home based 398,728 380,000 385, 000 400,000 450, 000 effective home Care beneficiaries based care No. of active care 5230 4050 4050 4050 4050 services in the givers province No. of care givers 4215 4050 4050 4050 4050 receiving stipend No. of Home Based 319 320 325 330 414 care structures No. of NGOs 152 155 155 155 155 supported Expand the No of service points 20 38 45 60 75 implementation for antiretroviral of the therapy comprehensive No. of patients 28,378 46,000 56,000 66,000 76,000 plan on HIV enrolled on the and AIDS programme Commission No. of research and 0 1 1 1 2 research and review projects review projects commissioned in the HIV and AIDS and TB programmes. Improve TB % new patients on 53.3 47.2 65 70 75 cure rate treatment cured first time % of TB cases with 91 90 >90 >90 >90 DOTS supporters Improve smear Smear conversion 0 75 75 75 75 conversion rate Reduce % Treatment - <8 <5 <5 <5 treatment interruption interruption rate MTEF 2008 Vote 3 88 Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate (target) (target) (target) Measure) Reduce % Multi-drug <1 <1 <1 <1 incidence of resistance multi-drug resistance TB Improve % of fully 70 78 80 85 90 immunisation immunised children coverage under 1yr Sustain No. of Acute 30 12 21 22 23 surveillance of Flaccid Paralysis EPI diseases cases No of measles 1 2 0 0 0 cases Cases of neonatal 2 0 0 0 0 tetanus

Provincial objectives and performance indicators for MCWH & Nutrition.

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (estimate) (target) (target) (target) Measure) To reduce % of non – HIV 36% 34% 32% 30% 28% maternal related maternal mortality of non deaths – HIV related causes To reduce % of reduction in 36.5/1000 35/1000 33/1000 31/1000 29/1000 perinatal perinatal mortality mortality by 2% annually To manage % PHC facilities 83% 85% 90% 95% 100% common implementing IMCI childhood %PHC facilities with 45% 50% 55% 60% 65% illnesses 60% saturation through Implementation of IMCI Strategy To strengthen % professional 35% 40% 45% 50% 60% human genetics nurses trained in services human genetics %PHC facilities with 40% 45% 50% 55% 60% trained human genetics nurses %hHospitals 40% 45% 50% 55% 60% implementing the standardized birth defects data collection tool To strengthen % of health 40% 45% 50% 55% 60% human genetics professionals services trained in human genetics

To increase % of women 70% 80% 85% 90% 95% contraception utilizing utilization rate contraceptive services To increase Number of PHC 3 6 10 12 14 access to safe rendering abortion abortion services services (CTOP) To increase % of cervical cancer 15% 20% 30% 40% 50% cervical cancer screening coverage screening coverage To improve Number of 208 300 400 500 600 capacity on professional nurses management of trained on MTEF 2008 Vote 3 89 cervical cancer performing pap screening smears

To strengthen % of sub districts 70% 85% 90% 95% 100% compliance to compliant to school school health health policy policy

Nutrition

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (estimate) (target) (target) (target) Measure) To reduce % of institutions 80% 100% 100% 100% 100% severe implementing the malnutrition from WHO ten Steps to the current rates management of of 1.3% to less severe malnutrition. than 1% in children <5 yrs Number of hospitals 11 14 18 23 28 of age. accorded Baby Friendly Status.

Number of PHC facilities accorded - 3 6 9 14 Baby Friendly Status

To reduce % of children 100 100 100 100 100 stunting from the admitted to the current levels of management of 24% in children severe malnutrition <5 yrs by 2% programme (PEM Scheme)

To prevent Weighing rate 81% 70% 75% 80% 80% growth faltering among children 0-5yrs through growth Malnutrition monitoring and incidence rate promotion 2.5 2.5 2.5 2.5 2.5

Severe malnutrition admission rate 25 36 40 35 30

Case fatality due to severe malnutrition 15 11 30 25 20

MTEF 2008 Vote 3 90 To reduce % of institutions Vitamin A implementing the 100 100 100 100 100 deficiency in Vitamin A children 0-60 Supplementation m0nths. Programme.

% of children 6-11 months receiving 95 90 90 90 90 Vitamin A capsules.

% of children 12-60 months receiving 37 35 40 45 45 Vitamin A capsules.

% of post-partum women receiving 50 60 70 80 85 Vitamin A capsules.

To manage, care % of clients admitted and support into the nutrition 80 85 85 85 85 people living supplementation and with TB, HIV and support programme AIDS

To contribute to Number of food the Integrated garden projects 5 5 10 15 20 Food Security funded and Nutrition Programme

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF District Management 122,538 138,599 134,448 137,135 154,600 146,388 170,959 179,507 Community Health Clinics 234,435 277,591 299,293 331,359 322,476 352,059 379,111 398,317 Community Health Centres 342,966 378,170 399,594 435,782 410,975 460,675 487,803 512,443 Community Based Services 5,314 6,002 3,526 6,848 6,848 7,121 7,477 7,851 Other Community Services - - - 34,075 35,779 37,568 HIV/AIDS 64,618 119,552 196,943 225,929 247,279 298,993 359,688 375,740 Nutrition 10,978 10,890 9,445 12,106 11,956 12,711 13,346 14,013 Coroner Services - 16,696 22,835 36,235 22,158 23,334 26,433 District Hospitals 589,361 654,466 733,506 672,073 706,729 717,860 767,766 856,204

Total programme 1,370,210 1,585,270 1,793,451 1,844,067 1,897,098 2,052,040 2,245,263 2,408,076

MTEF 2008 Vote 3 91

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 954,983 1,046,316 1,104,018 1,137,515 1,086,405 1,246,301 1,411,854 1,535,979 Transfer payments 63,895 94,559 94,646 86,965 101,762 99,046 101,175 106,233 Administrative expenditure 37,572 50,609 58,092 57,542 62,630 60,662 68,573 71,841 Stores 187,691 213,037 281,059 284,747 305,981 294,272 299,952 327,796 Professional and special services 49,394 84,614 152,673 139,687 170,446 198,549 199,915 210,332 Other goods and services 56,894 96,135 85,641 111,117 115,557 116,887 119,363 125,332 Unauthorised expenditure ------Total Current Payments 1,350,429 1,585,270 1,776,129 1,817,573 1,842,781 2,015,717 2,200,832 2,377,513 Capital: Equipment 19,781 - 17,322 26,494 44,517 36,323 44,431 30,563 Land and Buildings - - - - 9,800 - - - Infrastructure ------Other capital expenditure ------Total Capital Payments 19,781 - 17,322 26,494 54,317 36,323 44,431 30,563 TOTAL ECONOMIC EXPENDITURE 1,370,210 1,585,270 1,793,451 1,844,067 1,897,098 2,052,040 2,245,263 2,408,076

Programme summary of payments and estimates according to economic classification - - - Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 954,983 1,046,316 1,104,018 1,137,515 1,086,405 1,246,301 1,411,854 1,535,979 - Salaries & related costs 730,294 831,728 917,070 859,257 808,147 900,482 995,261 1,045,024 - Overtime 23,600 21,852 - 24,777 24,777 25,288 25,595 26,875 - Improvement in conditions of service 42,503 35,789 31,746 38,667 38,667 95,410 142,183 202,824 - Social contributions (employer share) 158,586 156,947 155,202 214,814 214,814 225,121 248,815 261,256 Transfer payments: 63,895 94,559 94,646 86,965 101,762 99,046 101,175 106,233 Provincial agencies - - - Departmental Agencies: - - - - - Public Entities 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742 - Other (Pseta) ------Municipalities: - Regional service council levies 2,785 4,759 - - - - - Other transfers to municipalities 19,753 23,276 17,270 15,115 Universities and technikons ------Public Corporations: - Subsidies on production ------Other - Private Corporations: - Subsidies on production ------Other ------Foreign governments and international trf's ------Non-profit organisations 25,737 28,961 28,571 36,108 35,263 37,913 39,809 41,799 Households: - Social Benefits ------Other 5,620 27,013 36,175 39,115 39,642 49,391 49,624 52,692 Goods and services: 331,551 444,395 577,465 593,093 654,614 670,370 687,803 735,301 - Administrative expenditure 37,572 50,609 58,092 57,542 62,630 60,662 68,573 71,841 - Rental of equipment 3,771 5,438 5,438 5,789 6,236 6,548 - Stores 187,691 213,037 281,059 284,747 305,981 294,272 299,952 327,796 - Rental of buildings 5,091 - 8,930 8,930 9,705 10,540 11,067

MTEF 2008 Vote 3 92 - Professional & special services 49,394 84,614 152,673 139,687 170,446 198,549 199,915 210,332 - Maintenance & repairs - 12,341 13,741 13,157 14,013 14,714 - Assets less than R5 000 66 - 418 418 456 494 519 - Other 47,966 96,135 85,641 83,990 87,030 87,780 88,080 92,484 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 1,350,429 1,585,270 1,776,129 1,817,573 1,842,781 2,015,717 2,200,832 2,377,513 CAPITAL Machinery & equipment 19,781 - 17,322 26,494 44,517 36,323 44,431 30,563 Motor vehicles & other transport - 500 2,300 - - - Equipment: - - Computers 2,552 400 407 420 441 463 - Office equipment & furniture 2,645 4,100 19,643 4,305 4,520 4,746 - Other moveable capital 14,584 17,322 21,494 22,167 31,598 39,470 25,354 Fixed capital: - - - - 9,800 - - - - Land and subsoil assets ------Buildings - - - - 9,800 - - - - Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 19,781 - 17,322 26,494 54,317 36,323 44,431 30,563 Current payments 1,350,429 1,585,270 1,776,129 1,817,573 1,842,781 2,015,717 2,200,832 2,377,513 Capital payments 19,781 - 17,322 26,494 54,317 36,323 44,431 30,563 TOTAL ECONOMIC CLASSIFICATION 1,370,210 1,585,270 1,793,451 1,844,067 1,897,098 2,052,040 2,245,263 2,408,076

Conditional grants included in programme 2 Programme Summary of conditional grants 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Conditional Grant (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF HIV/AIDS 72,612 100,921 141,615 156,429 156,429 205,288 264,922 309,710 Integrated Nutrition Programme 18,253 10,891 Forensic Pathology Services 2,230 10,971 22,835 36,235 22,158 23,334 26,433

TOTAL CONDITIONAL GRANTS 90,865 114,042 152,406 179,264 192,664 227,446 288,256 336,143

Transfer payments included in programme 2 (excluding local governments) Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities: Provincial Aids Council 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742

Sub-total 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742 Other: Other NGO's providing health services 459 16,688 - - - - - Youth centres 3,875 6,000 - 1,500 - - RSC Levy 2,785 4,759 ------Community health workers (volunteers) - 12,894 28,978 35,000 35,000 45,000 45,000 47,837 Health System Trust - - Bureau for the Blind - - - NGO's: HIV/AIDS 21,403 22,961 11,883 36,108 33,763 37,913 39,809 41,799 Households (salary related transfers) 5,620 14,119 7,197 4,115 4,642 4,391 4,624 4,855

TOTAL TRANSFER PAYMENTS 44,142 71,283 77,376 86,965 86,647 99,046 101,175 106,233

MTEF 2008 Vote 3 93 Earmarked funds included in programme 2 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF TB services 12,360 34,500 35,888 42,825 42,825 44,966 Recruiting prof staff with scarce skills 4,500 Integrated Nutrition Programme 12,106 12,106 12,711 13,346 14,013 Integrated primary health care 38,849 38,849 34,464 36,187 38,538 Community Health Workers 35,000 35,000 45,000 45,000 47,250 Strengthening security 12,000 - - - - Laboratory costs 18,000 18,000 20,000 30,000 40,000 Health remuneration review 46,200 46,200 63,000 64,000 92,400 Additional health professionals 18,000 18,000 39,979 38,586 40,112 TB: MDR & XDR 30,961 17,307 30,874 64,591 Baseline adjustment 21,114 46,654 101,986

TOTAL EARMARKED FUNDS - 28,860 - 202,655 235,004 296,400 347,472 483,857

District Health Services has the highest share of the total budget at between 49 per cent and 52 per cent. Between 2003/04 and 2005/06 it has always been above 52 per cent and is now slightly reducing due to the demarcation process. There is a decrease from 52 per cent in the current financial year to around 49.6 per cent over the MTEF period.

The programme continues to receive support which includes critical functions such as Primary Health Care and community based health care in terms of improving equitable access to health-care services in the province. This programme is particularly relevant for vulnerable people, evident in the budget increase by 8.1 per cent; 9.1 per cent and 7.2 per cent in 2008/09; 2009/2010; and 2010/2011 respectively.

District Health Services overspent by 1 per cent in 2005/06, due to under- funding on personnel allocations in compared to under- spending by 1.2 per cent in 2004/05. The department did not spend the full budget in 2006/07, under-spending by 4.6 per cent, due to resignations that were not replaced and the fact that the department could not attract new professionals for Primary Health Care facilities and district hospitals. The process of absorbing pathology personnel from SAPS was also not finalised.

In line with the National Department’s district health system approach and its consequent prioritisation of hospitals, hospital services remain important and are an integral component in the provision of a comprehensive health care package.

The amount of R46.2 million budgeted for OSD in 2007/08 increases to R63 million in 2008/09; and R64 million and R92 million for 2009/10 and 2010/11 respectively. In the current financial year, the focus is on various categories of nurses according to phase- in approach. The review for doctors, dentists and other health professionals will be implemented in 2008/09 and other health professionals in the outer years.

PROGRAMME 3: EMERGENCY MEDICAL SERVICES :

Programme description: To establish and maintain well functioning emergency medical services throughout the province emergency transport and planned patient transport.

Sub-programmes: Emergency Transport Objectives: • To provide an effective medical treatment to all the pre-hospital emergencies in North West province. • To provide a prompt and appropriate response to all patients. • To provide a high quality treatment of patients. Planned Patient Transport: Objectives: • To have an appropriate fleet of vehicles, with standardized serviceable equipment fully replaced every three years. • To train and motivate staff. • To have appropriately designed E.M.S. stations. • To ensure that patients are delivered to an appropriate level of care.

Key Measurable objectives: • To upgrade and establish 4 District control centers • To strengthen communication systems • To ensure EMS college has capacity to train AEA course

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (est) (target) (target) (target) Measure) To strengthen Number of 0 1 2 4 4

MTEF 2008 Vote 3 94 Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (est) (target) (target) (target) Measure) communication control centres systems with electronic dispatch systems To upgrade % of control 75 75 100 100 100 district control centres upgrade centres To increase % of 95 95 100 100 100 access to toll communities in free number the province with access to toll free number To improve Number of 0 0 17 17 5 EMRS EMRS managers management trained in Basic Financial management

Number of 0 0 17 17 5 EMRS managers trained in vehicle management system and analysis of first auto reports To implement Number of 0 0 4 4 4 the department districts disaster implementing the management Provincial plan Disaster Management plan

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Emergency Transport 82,574 92,245 97,613 120,035 111,535 125,865 132,048 141,824 Planned Patient Transport - 8,471 22,000 22,000 22,444 23,620 24,801

Total programme 82,574 92,245 106,084 142,035 133,535 148,309 155,668 166,625

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 49,950 62,192 74,656 80,278 73,778 85,084 88,895 98,635 Transfer payments 723 3,652 296 1,715 1,715 1,801 1,890 1,985 Administrative expenditure 10,128 11,512 15,892 19,055 18,177 19,100 20,743 21,758 Stores 4,893 3,168 1,690 4,335 4,445 4,740 5,072 5,325 Professional and special services 2,672 657 1,864 1,200 2,197 1,216 1,239 1,301 Other goods and services 3,678 9,057 2,697 5,153 4,923 5,024 5,576 5,855 Unauthorised expenditure ------Total Current Payments 72,044 90,238 97,095 111,735 105,235 116,965 123,415 134,859 Capital: Equipment 10,530 2,007 8,989 27,300 25,300 28,344 29,253 30,716 Land and Buildings - - - 3,000 3,000 3,000 3,000 1,050 Infrastructure ------Other capital expenditure ------Total Capital Payments 10,530 2,007 8,989 30,300 28,300 31,344 32,253 31,766 TOTAL ECONOMIC EXPENDITURE 82,574 92,245 106,084 142,035 133,535 148,309 155,668 166,625

MTEF 2008 Vote 3 95 Programme summary of payments and estimates according to economic classification - - - Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 49,950 62,192 74,656 80,278 73,778 85,084 88,895 98,635 - Salaries & related costs 36,514 45,306 65,774 54,850 48,350 55,399 57,891 60,786 - Overtime 3,923 5,678 - 9,247 9,247 9,421 7,891 10,386 - Improvement in conditions of service 1,921 1,879 1,508 2,468 2,468 6,414 8,640 12,266 - Social contributions (employer share) 7,592 9,329 7,374 13,713 13,713 13,850 14,473 15,197 Transfer payments: 723 3,652 296 1,715 1,715 1,801 1,890 1,985 Provincial agencies ------Departmental Agencies: - Public Entities ------Other (Pseta) ------Municipalities: - Regional service council levies 131 42 - - - - - Other transfers to municipalities - 3,445 - - - - - Universities and technikons ------Public Corporations: - Subsidies on production ------Other ------Private Corporations: - Subsidies on production ------Other ------Foreign governments and international trf's ------Non-profit organisations ------Households: - Social Benefits ------Other 592 165 296 1,715 1,715 1,801 1,890 1,985 Goods and services: 21,371 24,394 22,143 29,743 29,742 30,080 32,630 34,239 - Administrative expenditure 10,128 11,512 15,892 19,055 18,177 19,100 20,743 21,758 - Rental of equipment 171 - 1,890 1,890 1,985 2,124 2,230 - Stores 4,893 3,168 1,690 4,335 4,445 4,740 5,072 5,325 - Rental of buildings 512 - 771 771 810 867 910 - Professional & special services 2,672 657 1,864 1,200 2,197 1,216 1,239 1,301 - Maintenance & repairs 1,415 - 764 764 802 858 901 - Assets less than R5 000 ------Other 1,580 9,057 2,697 1,727 1,498 1,427 1,727 1,814 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 72,044 90,238 97,095 111,735 105,235 116,965 123,415 134,859 CAPITAL Machinery & equipment 10,530 2,007 8,989 27,300 25,300 28,344 29,253 30,716 Motor vehicles & other transport - - 8,989 22,000 22,000 22,884 23,620 24,801 Equipment: - Computers 2,552 - 500 500 521 552 580 - Office equipment & furniture 2,645 - 800 800 821 832 874 - Other moveable capital 5,333 2,007 - 4,000 2,000 4,118 4,249 4,461 Fixed capital: - - - 3,000 3,000 3,000 3,000 1,050 - Land and subsoil assets ------Buildings - - - 3,000 3,000 3,000 3,000 1,050 - Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 10,530 2,007 8,989 30,300 28,300 31,344 32,253 31,766 Current payments 72,044 90,238 97,095 111,735 105,235 116,965 123,415 134,859 Capital payments 10,530 2,007 8,989 30,300 28,300 31,344 32,253 31,766 TOTAL ECONOMIC CLASSIFICATION 82,574 92,245 106,084 142,035 133,535 148,309 155,668 166,625

MTEF 2008 Vote 3 96 Transfer payments included in programme 3 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------Other: RSC Levies 131 42 ------Households (salary related transfers) 592 165 296 1,715 1,715 1,801 1,890 1,985 Merafong Cross Border 3,445

TOTAL TRANSFER PAYMENTS 723 3,652 296 1,715 1,715 1,801 1,890 1,985

Earmarked funds included in programme 3 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Emergency Medical Services 42,000 42,000 43,050 43,050 43,050

TOTAL EARMARKED FUNDS - - - 42,000 42,000 43,050 43,050 43,050

Emergency Medical Services is between 3 per cent and 4 per cent of the total health budget.

The programme under spent by 13.1 per cent in 2004/05; 5.8 per cent in 2005/06 and by 5.1 per cent in 2006/07. Under expenditure on transfers in 2006/07 resulted from discontinuation of RSC levies Expenditure budgets for the programme grow by 10.7 per cent; 4.9 per cent and then increases gradually by 6.9 per cent over the MTEF. It is natural for this programme to increase in view of the 2010 World Cup. There’s a high increase of 33.9 per cent from 2006/07 to 2007/08 compared to very low increases from 2004/05 to 2006/07.

PROGRAMME 4: PROVINCIAL HOSPITALS

Programme description: To provide level 1 to level 3 with care services through provincial hospitals regarding both in and out patient care. General and psychiatric hospitals.

Objectives: • Strengthening Batho-Pele principles. • Implement and monitor the accreditation programme. • Implementation of Patient Right’s Charter. • To review and implement the strategy on Clinical Risk management. • Support the District Heath Services to deliver on their mandate. • Strengthen hospital management and efficiency. • Review and develop appropriate referral patterns. • Implement prescripts of the Mental Health Care Act. • Review and develop appropriate referral patterns. • Implementation of Patient Right’s Charter. • To review and implement the strategy on Clinical Risk management.

Key Measurable Objectives

Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (est) (target) (target) (target) Measure) To roll out the % of hospitals 77 100 100 100 100 COHSASA accredited accreditation program To implement % of facilities 80 100 100 100 100 the work implementing improvement WITS/QIP’s team strategy Strengthening % of hospitals 100 100 100 100 100 Batho Pele and with annually MTEF 2008 Vote 3 97 to promote a signed and caring service published culture. Service Delivery Improvement Plans or Agreements

To set up and % of hospitals 100 100 100 100 100 maintain conducting strategies that monthly will safeguard Maternal and against clinical Peri-natal risk Mortality and Morbidity Meetings % of hospitals 100 100 100 100 100 implementing the adverse event monitoring system Establish a % of hospitals 100 100 100 100 100 uniform implementing complaints a uniform mechanism in complaints all fixed mechanism facilities % of Hospitals 100 100 100 100 100 implementing Patient Satisfaction surveys Increase the % of hospitals 50 70 100 100 100 accessibility of that is hospitals to accessible to people with the people disabilities with disabilities. Hospitals Reduction in 902 857 812 767 722 performing in the cost per line with the PDE by all policies of the hospitals department. % Increase in 29 35 45 55 80 revenue collection by all Hospitals. % of hospitals 77 80 90 90 90 within provincial target BOR. Number of 6 5 7 7 7 hospital within the provincial target re ALOS. % of hospitals N/A 100 100 100 100 with signed Performance Management Framework agreements with the Provincial office .

Number of 3 3 3 3 3 hospitals implementing the ARV policy

MTEF 2008 Vote 3 98 Implementation Number of 3 3 3 3 3 of a Risk hospitals Management implementing Strategy a Risk Management Strategy

Strengthen Number of 6 6 6 6 6 community hospitals with participation at functioning all levels in Governance order to Structures promote a (Meeting six caring service times per year culture with minutes available)

% of hospitals 80 100 100 100 100 complying with the Pharmacy Act To promote a % of 90 100 100 100 100 performance- managers oriented level 9 and organisational higher with culture signed PMA % employees 100 100 100 100 100 level 1 to 8 with work- plans % of hospitals 100 100 100 100 100 implementing 2 formal and 2 informal reviews of individual performance per year

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF General / Regional Hospital 531,947 599,999 693,044 814,737 855,011 896,767 1,025,473 1,242,631 Tuberculosis hospital - - - - Psychiatric/ Mental Hospital 123,444 143,846 146,223 169,326 169,326 188,118 198,732 208,669 Sub-acute, Step down and Chronic Hosp ------Dental Training Hospital ------Other Specialised Services ------Total programme 655,391 743,845 839,267 984,063 1,024,337 1,084,885 1,224,205 1,451,300

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 440,207 490,900 539,309 620,284 639,978 696,201 820,744 1,027,679 Transfer payments 2,837 3,078 2,466 2,267 2,267 2,443 2,578 2,707 Administrative expenditure 10,779 12,949 18,112 21,181 21,555 24,701 25,850 27,130 Stores 93,210 104,765 102,025 142,128 142,128 154,510 162,919 176,063 Professional and special services 57,412 80,051 93,996 105,023 111,373 108,385 109,274 109,738 Other goods and services 35,691 46,680 47,255 61,515 66,173 65,619 68,076 71,480 Unauthorised expenditure ------Total Current Payments 640,136 738,423 803,163 952,398 983,474 1,051,859 1,189,441 1,414,797

MTEF 2008 Vote 3 99 Capital: Equipment 15,255 5,422 36,104 31,665 33,165 33,026 34,764 36,503 Land and Buildings - - - - 7,698 - - - Infrastructure ------Other capital expenditure ------Total Capital Payments 15,255 5,422 36,104 31,665 40,863 33,026 34,764 36,503 TOTAL ECONOMIC EXPENDITURE 655,391 743,845 839,267 984,063 1,024,337 1,084,885 1,224,205 1,451,300 - Programme summary of payments and estimates according to economic classification Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 440,207 490,900 539,309 620,284 639,978 696,201 820,744 1,027,679 - Salaries & related costs 328,754 381,310 458,753 458,630 478,323 490,734 566,280 691,690 - Overtime 22,174 24,367 - 26,359 26,359 27,664 30,826 42,319 - Improvement in conditions of service 19,002 12,916 12,041 20,638 20,638 55,119 82,068 120,747 - Social contributions (employer share) 70,277 72,307 68,515 114,658 114,658 122,684 141,570 172,923 Transfer payments: 2,837 3,078 2,466 2,267 2,267 2,443 2,578 2,707 Provincial agencies ------Departmental Agencies: - Public Entities ------Other (Pseta) ------Municipalities: - Regional service council levies 1,213 2,408 ------Other transfers to municipalities ------Universities and technikons ------Public Corporations: - Subsidies on production ------Other ------Private Corporations: - Subsidies on production ------Other ------Foreign governments and international trf's ------Non-profit organisations ------Households: - Social Benefits ------Other 1,624 670 2,466 2,267 2,267 2,443 2,578 2,707 Goods and services: 197,092 244,445 261,388 329,847 341,229 353,215 366,119 384,411 - Administrative expenditure 10,779 12,949 18,112 21,181 21,555 24,701 25,850 27,130 - Rental of equipment 985 - - 1,957 1,957 2,112 2,271 2,385 - Stores 93,210 104,765 102,025 142,128 142,128 154,510 162,919 176,063 - Rental of buildings 147 - - 523 523 805 870 914 - Professional & special services 57,412 80,051 93,996 105,023 111,373 108,385 109,274 109,738 - Maintenance & repairs 8,757 - - 7,950 7,950 8,543 9,848 10,340 - Assets less than R5 000 - - - 35 35 37 40 42 - Other 25,802 46,680 47,255 51,050 55,708 54,122 55,047 57,799 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 640,136 738,423 803,163 952,398 983,474 1,051,859 1,189,441 1,414,797 CAPITAL Machinery & equipment 15,255 5,422 36,104 31,665 33,165 33,026 34,764 36,503 Motor vehicles & other transport ------Equipment: - Computers 1,350 486 1,644 1,644 1,704 1,816 1,907 - Office equipment & furniture 1,409 359 2,391 2,391 1,976 1,994 2,094 - Other moveable capital 12,496 5,422 35,259 27,630 29,130 29,346 30,954 32,502 Fixed capital: - - - - 7,698 - - - - Land and subsoil assets ------Buildings - - - 7,698 - - - - Infrastructure ------

MTEF 2008 Vote 3 100 Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 15,255 5,422 36,104 31,665 40,863 33,026 34,764 36,503 Current payments 640,136 738,423 803,163 952,398 983,474 1,051,859 1,189,441 1,414,797 Capital payments 15,255 5,422 36,104 31,665 40,863 33,026 34,764 36,503 TOTAL ECONOMIC CLASSIFICATION 655,391 743,845 839,267 984,063 1,024,337 1,084,885 1,224,205 1,451,300

Conditional grants included in programme 4 Programme Summary of conditional grants 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Conditional Grant (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Professional Training Development 4,595 12,465 10,615 13,665 12,465 32,547 60,642 44,545 TOTAL CONDITIONAL GRANTS 4,595 12,465 10,615 13,665 12,465 32,547 60,642 44,545

Transfer payments included in programme 4 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------Other: RSC Levy 1,213 2,408 ------Households (salary related transfers) 1,624 670 2,466 2,267 2,267 2,443 2,578 2,707 TOTAL TRANSFER PAYMENTS 2,837 3,078 2,466 2,267 2,267 2,443 2,578 2,707

Earmarked funds included in programme 4 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Health professionals Laboratory costs 12,000 12,000 20,000 20,000 20,000 Health remuneration review 30,800 30,800 42,000 56,000 56,000 Additional health professionals 12,000 12,000 24,000 30,000 30,000

TOTAL EARMARKED FUNDS - - - 54,800 54,800 86,000 106,000 106,000

The share of the total budget for Provincial Hospitals is second highest at between 24% and 26% of the total health budget.

There’s a pattern of overspending by Provincial Hospitals, by 4.8 per cent in 2004/05 following payment of backlog for obligatory pay progressions for staff performance as well as high costs and demand for laboratory services for blood tests; and 4.3 per cent in 2005/06. The marginal under expenditure of 0.2% for the 2006/07 financial year is attributed to the delays in the delivery of specialised medical equipment which is mostly imported.

From 2007/8 to 2008/09 the programme grows by 5.5 per cent; then by 12.8 per cent and 18.4 per cent in the two outer years of the MTEF.

There has been a high attrition rate of professionals but the department is trying to address that hence going back to normal performance.

The amount of R30.8 million budgeted for OSD in 2007/08 increases to R42 million in 2008/09; and R56 million for 2009/10 and 2010/11 respectively. In the current financial year, the focus is on various categories of nurses according to phase in approach. The review for doctors, dentists and other health professionals will be implemented in 2008/09 and other health professionals in the outer years. Emphasis for the 2008/09 financial year is on health specialists. Addition to that National Treasury has allocated additional amounts of R20.6 million in 2009/10 and R68.1 million in 2010 to augment Occupational Specific Dispensation for health specialists.

MTEF 2008 Vote 3 101 PROGRAMME 5: CENTRAL HOSPITAL SERVICES

Programme description: Provincial hospital tertiary services. The purpose of the programme is to provide advanced secondary and tertiary care service as well as training and research work for health care professionals including to serve as specialist referral centres for district hospitals and neighbouring provinces. The programme has one sub-programme namely, Provincial Hospital Tertiary Services. Objectives: • Improve access to tertiary health care services. • Ensure equity in the delivery of health services • Establish Partnerships with other stakeholders

Key Measurable objectives: • Development of a comprehensive business case during 2007/8 for implementation in the other the MTEF period • New targets compliance with the approved business case for the National Tertiary Services Grant. (NTSG)

Measurable Indicator (Performance 2006/07 2007/08 2008/09 2009/10 2010/11 Objective Measure) (actual) (estimate) (target) (target) target

Improve Quality Number of hospitals with 3 3 3 3 3 Assurance annually signed and published Service Delivery Improvement Plans or Agreements % of hospitals implementing 100 100 100 100 100 a uniform complaints mechanism and problems resolved within 21 days.

% accreditation and rating of 77 90 95 98 100 the hospital

% of monthly Maternal and 100 100 100 100 100 Peri-natal Mortality and Morbidity Meetings % of cases referred to 100 100 100 100 100 Patient Safety Committees % of hospitals implementing 100 100 100 100 100 patient satisfaction surveys Improve hospital 20% reduction in the cost 965 840 800 740 700 efficiency per PDE by all hospitals 20% increase in revenue 20 20 20 20 collection by all hospitals % of hospitals within 77 80 90 90 90 provincial target BOR Hospitals within the 6 5 4 4 provincial target re ALOS Number of hospitals with 0 3 3 3 2 signed Performance Management Framework agreements with the Provincial office Number of provincial 3 3 3 3 3 hospitals implementing the ARV policy % of specialists appointed 60 70 75 85 90 per hospital Strengthen Number of hospitals with 10 6 6 6 6 community functioning Governance participation at all Structures levels in order to promote a caring service culture Improve financial Number of hospitals with 3 3 3 3 3 management financial control system for system for the monitoring the grant grant FTE’s per patient 40 50 65 80 90

MTEF 2008 Vote 3 102 Improve Number of MOU with 3 3 3 3 relationship with universities tertiary institutions and private sector Number of medical aids 1 2 4 5 contracted to hospitals

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF 1. Central Hospital Services 2. Provincial Hospital Tertiary Services 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595 - - Total programme 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 14,084 16,813 20,661 24,872 24,872 26,766 28,784 30,857 Transfer payments - 49 149 113 113 122 131 138 Administrative expenditure 1,075 1,545 1,130 1,416 1,416 1,520 1,634 1,716 Stores 10,754 15,788 17,685 23,123 18,507 28,178 32,287 33,785 Professional and special services 7,800 10,885 12,944 11,265 10,119 15,374 17,196 18,056 Other goods and services 1,551 3,654 3,355 4,488 4,488 19,817 23,170 35,429 Unauthorised expenditure ------Total Current Payments 35,264 48,734 55,924 65,277 59,515 91,777 103,202 119,981 Capital: Equipment 3,447 22,549 13,678 16,132 21,894 25,540 30,730 57,614 Land and Buildings ------Infrastructure ------Other capital expenditure ------Total Capital Payments 3,447 22,549 13,678 16,132 21,894 25,540 30,730 57,614 TOTAL ECONOMIC EXPENDITURE 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595

Programme summary of payments and estimates according to economic classification Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 14,084 16,813 20,661 24,872 24,872 26,766 28,784 30,857 - Salaries & related costs 10,014 12,412 16,627 18,758 18,758 19,288 20,170 20,867 - Overtime - - 581 581 612 646 675 - Improvement in conditions of service 845 551 973 844 844 2,044 2,925 4,098 - Social contributions (employer share) 3,225 3,850 3,061 4,689 4,689 4,822 5,043 5,217 Transfer payments: - 49 149 113 113 122 131 138 Provincial agencies ------Departmental Agencies: - - Public Entities ------Other (Pseta) ------Municipalities: - - Regional service council levies ------Other transfers to municipalities ------Universities and technikons ------

MTEF 2008 Vote 3 103 Public Corporations: - - Subsidies on production ------Other ------Private Corporations: - Subsidies on production ------Other - - - Foreign governments and international trf's ------Non-profit organisations ------Households: - - Social Benefits ------Other - 49 149 113 113 122 131 138 Goods and services: 21,180 31,872 35,114 40,292 34,530 64,889 74,287 88,986 - Administrative expenditure 1,075 1,545 1,130 1,416 1,416 1,520 1,634 1,716 - Rental of equipment ------Stores 10,754 15,788 17,685 23,123 18,507 28,178 32,287 33,785 - Rental of buildings - - - - - Professional & special services 7,800 10,885 12,944 11,265 10,119 15,374 17,196 18,056 - Maintenance & repairs - - - 10,000 13,000 25,000 - Assets less than R5 000 - - - 5,000 5,000 5,000 - Other 1,551 3,654 3,355 4,488 4,488 4,817 5,170 5,429 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 35,264 48,734 55,924 65,277 59,515 91,777 103,202 119,981 CAPITAL Machinery & equipment 3,447 22,549 13,678 16,132 21,894 25,540 30,730 57,614 Motor vehicles & other transport ------Equipment: - - - - Computers - - - - 7,366 11,123 36,603 - Office equipment & furniture ------Other moveable capital 3,447 22,549 13,678 16,132 21,894 18,174 19,607 21,011 Fixed capital: ------Land and subsoil assets ------Buildings ------Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 3,447 22,549 13,678 16,132 21,894 25,540 30,730 57,614 Current payments 35,264 48,734 55,924 65,277 59,515 91,777 103,202 119,981 Capital payments 3,447 22,549 13,678 16,132 21,894 25,540 30,730 57,614 TOTAL ECONOMIC CLASSIFICATION 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595

Conditional grants included in programme 5 Programme Summary of conditional grants 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Conditional Grant (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF National Tertiary Services 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595

TOTAL CONDITIONAL GRANTS 38,711 71,283 69,602 81,409 81,409 117,317 133,932 177,595

Transfer payments included in programme 5 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------Other: Households (salary related transfers) - 49 149 113 113 122 131 138

TOTAL TRANSFER PAYMENTS - 49 149 113 113 122 131 138

MTEF 2008 Vote 3 104 This programme fluctuates between 3 per cent and 4 per cent as a share of the total health budget. The department is strengthening specialist services in regional hospitals.

The programme overspent slightly by 0.3% in 2006/07; by 4.1 per cent in 2005/06 due to under funding for the recruitment of critical clinical professionals. Payment for overtime was also exceeded.

In line with the National Department’s district health system approach and its consequent prioritisation of hospitals, hospital services remain important and are an integral component in the provision of a comprehensive health care package.

There is also a notable increase in conditional grants with the National Tertiary Services grant increasing to R117.317 million; R133.932 million; and R177.597 million from an initial allocation of R116.480 million; R132.957 million and R176.148 million over the three MTEF years. Provincial tertiary services therefore increase by 44.1 per cent from 2007/08; this increase drops to 14.2 per cent from 2008/09 to 2009/10 and grows again to 32.6 per cent in 2010/11.

PROGRAMME 6: HEALTH SCIENCES and TRAINING.

Programme description: The purpose of the programme is to provide education and training opportunities for health care personnel as well as bursaries for individuals with disadvantaged background and provide research funds to enhance research capacity as well as addressing key issues of human resource management as requested by the National Department of Health. Sub-programmes: Nurses Training Colleges: Objectives: • To ensure improved representation of disadvantaged demographic groups and Students of rural origin in nursing college intake. • To ensure proportion of mid-level training programmes. • To provide comprehensive community nursing and psychiatric nursing training. • To provide excellent post basic training. EMS Training Colleges: Objectives: • To establish a well functioning provincial EMS College. • To ensure EMS college develops capacity and attains registration to provide AEA courses Bursaries Objectives: • Provide bursary opportunities to staff and medical students within the context that bursaries in the province are managed from the Premier’s Office. Primary Health Care Training: Objectives: • Train nurses in PHC nursing and basic programmes which incorporates CBE, PBL, & RPL approaches. Training Other: Objectives : • To provide learning opportunities through the following programmes: ABET; Learnership and Internship. • Provide relevant and targeted training programs to enhance performance of all staff. • To establish provincial training policy.

Key measurable objectives: Nursing Education Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual) (estimate) (target) (target) (target) Measure) Train in basic and post Number of nurses in 908 1070 1080 1080 1080 basic diploma Number of nurses 159 171 170 170 170 trained in basic degree courses Number of nurses in 203 132 150 160 160 post basic courses Train in enrolled Number of nurses in 20 20 20 20 20 auxiliary nurses. Enrolled Auxiliary Programme. Provide relevant & Number of employees 3422 3500 3500 4500 5000 targeted training trained Implement ABET Number of employees 386 334 350 350 400 programme within the registered for ABET department Provide learning Number of unemployed 75 100 120 150 200 opportunities through youth on an internship internships programme.

MTEF 2008 Vote 3 105 Implement Number of 18.2 166 80 100 150 200 learnerships for the registered for unemployed youth learnerships (18.2) and serving officers (18.1). Number of 18.1 60 60 80 100 120 registered for learnerships Provide learning Number of bursary 102 96 101 96 120 opportunities through beneficiaries bursaries Provide training of Number of learners on 0 1268 200 250 300 CHW programme CHW Programme (one year ancillary prog )

Key measurable objectives: EMRS College

Measurable Indicator (Performance 2006/07 2007/08 2008/09 2009/10 2010/11 Objective Measure) actual (estimate) (target (target) (target)

Implement the Number of staff on 0 50 150 200 200 Emergency Care Emergency Care Technician programme Technician programme

Implement a CPD % of staff with the 0 60 100% 100% 100% programme for all opportunity to partake EMRS staff in CPD

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Nurses Training Colleges 53,544 66,027 71,670 84,568 53,712 90,786 97,278 109,076 EMS Training Colleges 1,505 2,053 2,573 3,902 3,902 4,210 4,590 4,820 Bursaries ------Primary Health Care Training 8,357 7,091 7,729 9,778 9,778 11,002 11,804 12,394 Training Other 26,830 8,480 17,656 17,978 25,094 19,290 20,077 21,081

Total programme 90,236 83,651 99,628 116,226 92,486 125,288 133,749 147,371

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 46,593 57,955 69,918 78,562 53,445 84,892 88,704 100,151 Transfer payments 324 1,896 1,904 5,150 5,150 5,991 6,274 6,588 Administrative expenditure 7,394 7,036 8,835 8,239 9,289 9,457 9,609 10,065 Stores 3,339 4,251 3,704 3,950 4,120 4,198 4,534 4,761 Professional and special services 7,414 2,637 1,873 3,547 4,387 3,691 3,859 4,052 Other goods and services 23,093 8,958 13,056 15,360 14,726 15,581 19,221 20,129 Unauthorised expenditure ------Total Current Payments 88,157 82,733 99,290 114,807 91,117 123,810 132,201 145,746 Capital: Equipment 2,079 918 338 1,419 1,369 1,478 1,548 1,625 Land and Buildings ------Infrastructure ------Other capital expenditure ------Total Capital Payments 2,079 918 338 1,419 1,369 1,478 1,548 1,625 TOTAL ECONOMIC EXPENDITURE 90,236 83,651 99,628 116,226 92,486 125,288 133,749 147,371

MTEF 2008 Vote 3 106 Programme summary of payments and estimates according to economic classification - - - Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 46,593 57,955 69,918 78,562 53,445 84,892 88,704 100,151 - Salaries & related costs 36,518 45,541 61,183 60,442 35,325 62,380 64,402 70,434 - Overtime 157 163 - 289 289 320 351 370 - Improvement in conditions of service 2,125 1,794 1,483 2,720 2,720 6,597 7,850 11,739 - Social contributions (employer share) 7,793 10,457 7,252 15,111 15,111 15,595 16,101 17,608 Transfer payments: 324 1,896 1,904 5,150 5,150 5,991 6,274 6,588 Provincial agencies ------Departmental Agencies: - Public Entities ------Other (Pseta) - 1,651 1,904 1,855 1,855 2,361 2,702 2,837 Municipalities: - Regional service council levies 123 245 - - - Other transfers to municipalities - - - Universities and technikons - - - Public Corporations: - Subsidies on production - - - - Other - - - Private Corporations: - Subsidies on production - - - - Other - - - Foreign governments and international trf's - - - Non-profit organisations - - - Households: - Social Benefits - - - - Other 201 - 3,295 3,295 3,630 3,572 3,751 Goods and services: 41,240 22,882 27,468 31,096 32,522 32,927 37,223 39,007 - Administrative expenditure 7,394 7,036 8,835 8,239 9,289 9,457 9,609 10,065 - Rental of equipment 330 - 343 343 364 385 404 - Stores 3,339 4,251 3,704 3,950 4,120 4,198 4,534 4,761 - Rental of buildings 146 - 2,562 2,562 2,870 3,214 3,375 - Professional & special services 7,414 2,637 1,873 3,547 4,387 3,691 3,859 4,052 - Maintenance & repairs 346 - 630 630 640 655 688 - Assets less than R5 000 - - - - - Other 22,271 8,958 13,056 11,825 11,191 11,707 14,967 15,662 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 88,157 82,733 99,290 114,807 91,117 123,810 132,201 145,746 CAPITAL Machinery & equipment 2,079 918 338 1,419 1,369 1,478 1,548 1,625 Motor vehicles & other transport ------Equipment: - Computers 330 260 260 273 290 305 - Office equipment & furniture 152 708 708 746 790 830 - Other moveable capital 1,597 918 338 451 401 459 468 490 Fixed capital: ------Land and subsoil assets ------Buildings ------Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 2,079 918 338 1,419 1,369 1,478 1,548 1,625 Current payments 88,157 82,733 99,290 114,807 123,810 132,201 145,746 Capital payments 2,079 918 338 1,419 1,369 1,478 1,548 1,625 TOTAL ECONOMIC CLASSIFICATION 90,236 83,651 99,628 116,226 1,369 125,288 133,749 147,371

MTEF 2008 Vote 3 107 Conditional grants included in programme 6 Programme Summary of conditional grants 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Conditional Grant (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Health Professional Training 37,292 50,099 51,926 52,027 21,171 36,430 42,256 38,779

TOTAL CONDITIONAL GRANTS 37,292 50,099 51,926 52,027 21,171 36,430 42,256 38,779

Transfer payments included in programme 6 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------SETA - 1,651 1,904 1,855 1,855 2,361 2,702 2,837 Cuban Doctors - - 3,000 3,000 3,000 3,000 3,000 RSC Levy 123 245 ------Households (salary related transfers) 201 - - 295 295 630 572 751

TOTAL TRANSFER PAYMENTS 324 1,896 1,904 5,150 5,150 5,991 6,274 6,588

Earmarked funds included in programme 6 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF SETA - 1,651 1,904 1,855 1,855 2,246 2,542 2,851 Skills Development 8,000 8,123 8,123 8,929 9,375 9,844 Skills Development - HR plan - Medical Studies Programme : Cuba - - - 8,000 8,000 4,200 4,700 4,700 Training 8,000 8,000 8,000 TOTAL EARMARKED FUNDS - 9,651 1,904 17,978 17,978 23,375 24,617 25,395

Health Sciences and Training under spent by 3.1 per cent in 2005/06 and had also under spent in 2004/05 by 4.7 per cent. Under spending on goods and services by 6.8 per cent in 2006/07 is mainly attributed to an increase in the amount of training sessions that are provided in house.

There’s no consistency in the Health Sciences and Training programme as it grows by 35.5 per cent; drops to 6.7 per cent from 2007/08 to 2009/10 and then picks up again to 10.2 per cent in 2010/11.

PROGRAMME 7: HEALTH CARE SUPPORT SERVICES.

Programme description: This programme consists of laundry, engineering, transport, forensic, orthotic and prosthetic as well as pharmaceutical services. The Medicine Trading Account is subject to pressures such as the foreign exchange rate on the cost of medicines, the high inflation rate and the increasing demand for medicines at clinic and hospital level. Sub-programmes and objectives: Laundry services Objectives • Provide effective access to laundry services in each district. • Perform option appraisal regarding alternative forms of service delivery versus internal provision of laundry services Engineering services Objectives • Plan, facilitate, manage, procurement and disposal of health technology. • Implement effective HT capacity building programme. • Implement Essential Health Technology package (EHTP). Orthotic and Prosthetic services Objectives • To ensure accessibility of orthopaedic and prosthetic services to disabled persons. • To decrease backlog of orthopaedic and prosthetic appliances Pharmaceutical services Objectives • Promote the use of standard treatment protocols. MTEF 2008 Vote 3 108 • Improve essential drugs availability. • Develop standardised code list. • Ensure upgrading of hospital pharmacies. • Recruitment and training of personnel including training of pharmacy support personnel • Financial and risk management training for pharmacy managers

Pharmaceutical Services and Medical Supplies.

Measurable Indicator 06/07 07/08 08/09 09/10 10/11 Objective actual estimate target target target Improve access % availability of 87 95 98 100 100 to essential essential medical medical supplies supplies Implement the Registered 0 Upgrading the Depot Registered 0 relevant Medical depot. depot for registered with Depot prescripts of the registration. the MCC Pharmacy Act and related legislations.

Licensed and Refurbishment Licensing of Repacking Unit 0 0 operational of the Unit. the repacking fully operational Prepacking Unit. unit.

Key measurable objectives • Implement Essential Health Technology package (EHTP) • Implement effective HT capacity building programme. • Increase orthotic and prosthetic workshops in the province. • To ensure 100% availability of EDL drugs in hospitals • Ensure compliance with the Pharmacy Act.

Health Technology The sub- programme exists to create a unified and harmonious Health Technology system that ensures optimal distribution of the limited resources in an equitable manner. The programme is made up of two (2) sub programmes, namely clinical engineering and laundry services.

Clinical Engineering Implement a % of facilities 80% 85% 90% 100% 100% Comprehensive implementing National HT SOP’s on HT Management management. policy Plan, facilitate, % of facilities 80% 90% 100% 100% 100% manage utilizing procurement & appropriate disposal of Procurement & Health disposal Technology. processes.

Laundry Services. Build capacity % of persons 65% 70% 80% 90% 100% of personnel in trained on laundry quality provision services of laundry management service Implement Number of Recommended 1 district 2 districts 4 districts 4 districts recommended districts options implementing Implementing implementing implementing laundry implementing approved approved approved approved approved management the model model model model option/s recommended laundry management options

Transport Management Measurable Indicator 2006/07 2007/08 2008/09 2009/10 2010/11 Objective (Performance (actual0 (estimates) Target Target Target Measure) Implement an % of vacant 55% of 80% of 100% of posts 100% of posts 100% MTEF 2008 Vote 3 109 appropriate posts filled vacant vacant filled filled provincial approved. funded funded post transport posts filled filled management structure Develop and % of institutions All 50% 75% 100% All four (4) implement reporting institutions institutions institutions institutions districts comprehensive transport data reporting reporting reporting reporting implementing Transport manually electronically electronically electronically the TMIS Management Information System Develop Number of All four (4) All four (4) All four (4) All four (4) All four (4) transport trained transport district district districts districts districts management officers transport transport transport transport transport capacity officers officers officers officers officers trained trained

This programme under spent by 10.1 per cent at the end of the 2006/07 financial year due to outdated equipment which results in an adverse impact on variable input costs, at some facilities. Hence, the greater part of under-spending is on goods and services. Allocation for the capital budget was increased so that the necessary machines and equipment can be procured.

Under expenditure was 14.9 per cent in 2004/05 and 25.3 per cent in 2005/06 resulting in a negative impact on service delivery. Various reasons were cited including non spending on earmarked funds for mobiles and late receipt of funds for Forensic Pathology Services.

In keeping with inflation and price escalation, Health Care Support Services increase by 8.0 per cent from 2007/08 to 2008/09; then by 4.9 per cent and 5.6 per cent in 2009/10 and 2010/11 respectively.

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Laundries 12,886 15,392 15,468 33,711 33,594 35,711 37,432 39,303 Engineering 6,353 22,720 37,597 34,521 33,721 36,215 36,244 38,916 Forensic Services - - Orthotic and Prosthetic Services 4,066 3,642 4,230 6,142 5,942 6,472 6,811 7,152 Medicine Trading Account 34,184 35,550 36,514 46,181 46,181 50,625 54,943 57,690

Total programme 57,489 77,304 93,809 120,555 119,438 129,023 135,430 143,061

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees 13,325 15,254 16,465 21,141 21,141 22,578 23,734 25,780 Transfer payments 85 55 25 97 97 103 108 113 Administrative expenditure 1,487 964 1,131 878 1,228 1,338 1,410 1,460 Stores 20,616 13,157 12,244 13,138 14,796 14,024 15,012 15,763 Professional and special services 14,889 27,425 35,049 56,128 49,928 60,059 62,378 65,517 Other goods and services 3,440 4,469 4,515 11,074 9,574 11,897 12,791 13,430 Unauthorised expenditure ------Total Current Payments 53,842 61,324 69,429 102,456 96,764 109,999 115,433 122,063 Capital: Equipment 3,647 15,980 21,939 18,099 22,674 19,024 19,997 20,998 Land and Buildings - - 2,441 - - - - - Infrastructure ------Other capital expenditure ------Total Capital Payments 3,647 15,980 24,380 18,099 22,674 19,024 19,997 20,998 TOTAL ECONOMIC EXPENDITURE 57,489 77,304 93,809 120,555 119,438 129,023 135,430 143,061

MTEF 2008 Vote 3 110 Programme summary of payments and estimates according to economic classification Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: 13,325 15,254 16,465 21,141 21,141 22,578 23,734 25,780 - Salaries & related costs 10,205 6,403 13,843 16,200 16,200 16,524 16,739 17,576 - Overtime 86 87 - 162 162 164 317 333 - Improvement in conditions of service 594 6,013 445 729 729 1,759 2,493 3,477 - Social contributions (employer share) 2,440 2,751 2,177 4,050 4,050 4,131 4,185 4,394 Transfer payments: 85 55 25 97 97 103 108 113 Provincial agencies ------Departmental Agencies: - Public Entities ------Other (Pseta) ------Municipalities: - Regional service council levies 83 39 - - - - - Other transfers to municipalities ------Universities and technikons ------Public Corporations: - Subsidies on production ------Other ------Private Corporations: - Subsidies on production ------Other ------Foreign governments and international trf's ------Non-profit organisations ------Households: - Social Benefits ------Other 2 16 25 97 97 103 108 113 Goods and services: 40,432 46,015 52,939 81,218 75,526 87,318 91,591 96,170 - Administrative expenditure 1,487 964 1,131 878 1,228 1,338 1,410 1,460 - Rental of equipment 105 - 43 43 46 48 50 - Stores 20,616 13,157 12,244 13,138 14,796 14,024 15,012 15,763 - Rental of buildings ------Professional & special services 14,889 27,425 35,049 56,128 49,928 60,059 62,378 65,517 - Maintenance & repairs 1,514 - 2,558 2,558 2,813 3,095 3,250 - Assets less than R5 000 - - - - - Other 1,821 4,469 4,515 8,473 6,973 9,038 9,648 10,130 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 53,842 61,324 69,429 102,456 96,764 109,999 115,433 122,063 CAPITAL Machinery & equipment 3,647 15,980 21,939 18,099 22,674 19,024 19,997 20,998 Motor vehicles & other transport 1,163 15,627 15,627 15,627 16,408 17,228 18,090 Equipment: - - Computers 1,289 120 24 24 37 39 41 - Office equipment & furniture 151 327 - - - Other moveable capital 1,044 15,980 5,865 2,448 7,023 2,579 2,730 2,867 Fixed capital: - - 2,441 ------Land and subsoil assets ------Buildings - 2,441 ------Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 3,647 15,980 24,380 18,099 22,674 19,024 19,997 20,998 Current payments 53,842 61,324 69,429 102,456 96,764 109,999 115,433 122,063 Capital payments 3,647 15,980 24,380 18,099 22,674 19,024 19,997 20,998 TOTAL ECONOMIC CLASSIFICATION 57,489 77,304 93,809 120,555 119,438 129,023 135,430 143,061

MTEF 2008 Vote 3 111 Transfer payments included in programme 7 Programme Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities:

Sub-total ------Other: RSC Levy 83 39 ------Households (salary related transfers) 2 16 25 97 97 103 108 113

TOTAL TRANSFER PAYMENTS 85 55 25 97 97 103 108 113

Earmarked funds included in programme 7 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Ambulances and patient transport 14,297 15,627 15,627 16,408 17,228 17,228 Roll-out of assistive devices 4,500 4,500 4,725 5,000 5,000

TOTAL EARMARKED FUNDS - 14,297 - 20,127 20,127 21,133 22,228 22,228

PROGRAMME 8: HEALTH FACILITIES MANAGEMENT

Programme description: The purpose of this programme is to plan and provide Health facilities, plan services in terms of determining the level and packages of services that facilities will provide, maintain health facilities, upgrade and rehabilitate community health centres and clinics. It is also responsible for revitalization of community, district, regional and specialized hospitals and other health related facilities, providing equipment and furniture for new facilities. Sub-programmes and objectives: Community Health Facilities: Objectives: • Develop monitoring and evaluation capacity in-terms of facilities management. • Facilities Maintenance Audit. • Plan and manage projects under construction. District Hospital Services: Objectives: • Develop monitoring and evaluation capacity in-terms of facilities management. • Plan and manage projects under construction.

Provincial Hospital Services: Objectives: • Develop monitoring and evaluation capacity in-terms of facilities management. • Plan and manage projects under construction. Other Facilities: Objectives: • Develop monitoring and evaluation capacity in-terms of facilities management. • Plan and manage projects under construction Health Maintenance: Objectives: • Plan and manage all health maintenance projects.

Key measurable objectives: ƒ Plan and manage Revitalization of district and provincial hospitals. ƒ Plan and manage upgrading of other facilities. ƒ Develop a long term maintenance plan for all facilities ƒ Conduct a facilities maintenance Audit.

Measurable Indicator (Performance 2006/07 2007/08 2008/09 2009/10 2010/11 Objective Measure) (actual) (estimate) (target) (target) (target)

Improve access to % of population with 70 75 80 85 90 hospital services. access within 25km radius of a CHC and a hospital

MTEF 2008 Vote 3 112 Improve access to % of population residing 85% 90% 92% 95% 95% Primary Health Care within 5km radius with facilities. access to PHC facility

Number of clinics 23 14 16 18 20 completed. Improve maintenance % of facilities receiving 10% 20% 30% 40% 45% of health care essential upgrades facilities. Improve hospital Number of Projects 1 2 2 1 2 services and under revitalisation infrastructure through programme revitalization. % of rural health 5% 10% 20% 25% 30% facilities with accommodation for health professionals. No of CHC’s completed 2 1 6 10 12 Strengthen No of formal NA 2 2 2 2 intersectoral agreements signed with collaboration for service providers for provision of basic basic services. services % of facilities with basic 90 95 95 95 95 services

Programme summary of payments and estimates according to sub-programme Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Sub-programme (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Community Health Facilities 49,994 34,563 53,217 60,000 60,561 50,000 50,000 50,000 Grade R in community centres - - - - District Hospital Services 77,621 70,142 191,367 176,966 209,166 254,030 242,800 310,500 Provincial Hospital Services - - - - - Central Hospital Services - - - - - Other Facilities 16,369 42,175 52,555 20,000 85,254 40,000 40,000 40,000 Health Maintenance 30,661 32,509 42,289 45,241 45,241 47,030 49,893 52,509

Total programme 174,645 179,389 339,428 302,207 400,222 391,060 382,693 453,009

Programme summary of payments and estimates Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Classification (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Current: Compensation of employees - - 6,313 7,563 7,800 8,266 8,760 9,439 Transfer payments - - 66,900 - - - - - Administrative expenditure - - 771 2,000 2,000 2,164 2,185 2,285 Stores - 30 325 425 425 550 550 550 Professional and special services 9,407 3,606 11,624 6,893 4,225 - - - Other goods and services 30,662 32,963 35,662 38,701 46,222 83,523 65,873 112,214 Unauthorised expenditure ------Total Current Payments 40,069 36,599 121,595 55,582 60,672 94,503 77,368 124,488 Capital: Equipment 1,109 5,191 3,726 5,000 19,385 29,500 29,000 49,500 Land and Buildings 133,467 137,599 214,107 241,625 320,165 267,057 276,325 279,021 Infrastructure ------Other capital expenditure ------Total Capital Payments 134,576 142,790 217,833 246,625 339,550 296,557 305,325 328,521 TOTAL ECONOMIC EXPENDITURE 174,645 179,389 339,428 302,207 400,222 391,060 382,693 453,009

MTEF 2008 Vote 3 113 Programme summary of payments and estimates according to economic classification - - - Programme Summary of Payments and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF CURRENT PAYMENTS Compensation of employees: - - 6,313 7,563 7,800 8,266 8,760 9,439 - Salaries & related costs - - 6,313 5,840 6,077 6,100 6,253 6,409 - Overtime - - - - - Improvement in conditions of service - - - 263 263 641 944 1,428 - Social contributions (employer share) - - - 1,460 1,460 1,525 1,563 1,602 Transfer payments: - - 66,900 - - - - - Provincial agencies ------Departmental Agencies: - Public Entities ------Other (Pseta) ------Municipalities: - Regional service council levies ------Other transfers to municipalities ------Universities and technikons ------Public Corporations: - Subsidies on production ------Other ------Private Corporations: - Subsidies on production ------Other - 66,900 - - - - Foreign governments and international trf's ------Non-profit organisations ------Households: - Social Benefits ------Other - - - Goods and services: 40,069 36,599 48,382 48,019 52,872 86,237 68,608 115,049 - Administrative expenditure - - 771 2,000 2,000 2,164 2,185 2,285 - Rental of equipment ------Stores - 30 325 425 425 550 550 550 - Rental of buildings ------Professional & special services 9,407 3,606 11,624 6,893 4,225 - - - - Maintenance & repairs 30,662 32,963 33,162 38,341 45,301 83,023 65,373 111,714 - Assets less than R5 000 ------Other - 2,500 360 921 500 500 500 Unauthorised expenditure ------TOTAL CURRENT PAYMENTS 40,069 36,599 121,595 55,582 60,672 94,503 77,368 126,371 CAPITAL Machinery & equipment 1,109 5,191 3,726 5,000 19,385 29,500 29,000 49,500 Motor vehicles & other transport ------Equipment: - Computers ------Office equipment & furniture ------Other moveable capital 1,109 5,191 3,726 5,000 19,385 29,500 29,000 49,500 Fixed capital: 133,467 137,599 214,107 241,625 320,165 267,057 276,325 279,021 - Land and subsoil assets ------Buildings 133,467 137,599 214,107 241,625 320,165 267,057 276,325 279,021 - Infrastructure ------Other fixed capital ------Cultivated Assets ------Software and other intangible assets ------Other ------TOTAL CAPITAL PAYMENTS 134,576 142,790 217,833 246,625 339,550 296,557 305,325 328,521 Current payments 40,069 36,599 121,595 55,582 60,672 94,503 77,368 126,371 Capital payments 134,576 142,790 217,833 246,625 339,550 296,557 305,325 328,521 TOTAL ECONOMIC CLASSIFICATION 174,645 179,389 339,428 302,207 400,222 391,060 382,693 454,892

MTEF 2008 Vote 3 114 Conditional grants included in programme 8 Programme Summary of conditional grants 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Conditional Grant (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Hospital Revitalisation 91,337 87,998 155,856 176,966 209,166 254,030 242,800 310,500 Infrastructure 22,722 - - 20,000 20,000 40,000 40,000 40,000

TOTAL CONDITIONAL GRANTS 114,059 87,998 155,856 196,966 229,166 294,030 282,800 350,500

Earmarked funds included in programme 8 Programme Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Earmarked funds (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Maintenance of health facilities -Routine maintenance 30,662 32,964 42,940 45,241 45,241 47,030 49,878 52,372 Clinic Building 30,000 27,564 25,850 60,000 60,000 50,000 50,000 50,000 Infrastructure -

TOTAL EARMARKED FUNDS 60,662 60,528 68,790 105,241 105,241 97,030 99,878 102,372

Health facilities management is about 9 per cent of the total budget, constant throughout the period under review. The programme has improved tremendously from an under-spending of 26.6 per cent in 2004/05 and 18 per cent in 2005/06 and continued to under spend by 5 per cent in 2006/07. The trend is in accordance with national health departmental objectives aimed at improving health-care related infrastructure as a key strategy to overhaul service delivery.

The budget increases by 10.9 per cent; decreases by 2.1 per cent and again rises to 18.3 per cent from 2009/10 to 2010/11.

The increasing trend is largely the result of a drive to improve and maintain the infrastructure of the department. An additional allocation was given to the department over the MTEF to provide for day to day maintenance in hospitals.

The increase in machinery and equipment relates to the need to upgrade and improve machinery and equipment within institutions. The noted decrease can be attributed to mobile health equipment not being delivered timeously as well as difficulties experienced with contracts and tenders in respect of the Hospital revitalization projects, resulting in planned equipment not being purchased.

The programme has been growing due to revitalisation, infrastructure building construction at Moses Kotane, Brits and Vryburg. Also acceleration of clinic building and maintenance of old buildings / facilities, routine maintenance, upgrading and rehabilitation of old buildings.

There is a concerted effort on the part of the department to improve and upgrade medical equipment to an acceptable level.

Furthermore, the machinery and equipment figure includes funding for the special drive to increase the Emergency Medical Rescue Services vehicles

Additional Departmental Schedules

Summary of departmental transfer payments Departmental Summary of transfer payments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Public Entities: Provincial Council on AIDS 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742

Sub-total 10,000 10,550 12,630 11,742 11,742 11,742 11,742 11,742 Other: Other NGO's providing health services 459 - 16,688 - - - - - Youth centres 3,875 6,000 - - 1,500 - - - RSC Levy 4,511 7,706 ------Community health workers (volunteers) - 12,894 28,978 35,000 35,000 45,000 45,000 47,837

MTEF 2008 Vote 3 115 NGO's: HIV/AIDS 23,179 24,856 13,084 36,108 33,763 37,913 39,809 41,799 Households (salary related transfers) 8,318 16,657 12,426 10,402 14,929 11,488 12,261 13,225 Municipalities 19,753 26,721 17,270 - 15,115 - - - Health System Trust 380 380 380 380 380 380 380 380 Bureau for the Blind 400 400 400 400 400 400 400 439 Litigations - - - 4,000 9,073 4,000 4,000 4,000 SETA - 1,651 1,904 1,855 1,855 2,361 2,702 2,837 Cuban Doctors - - - 3,000 3,000 3,000 3,000 3,000 Private Corporation (Other) - - 66,900 - - - - -

TOTAL TRANSFER PAYMENTS 70,875 107,815 170,660 102,887 126,757 116,284 119,294 125,259

Summary of departmental transfers to local government by category Departmental Summary of Transfer Payments to Local Governments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Category Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Category A ------Category B 17,997 21,200 17,237 - 12,708 - - - Category C 1,756 2,076 1,557 - 2,407 - - - Total departmental transfer 19,753 23,276 18,794 - 15,115 - - - payments to local governments

Details of departmental transfer payments to local governments Departmental Summary of transfer payments to local governments 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Name of recipient (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Type of transfer/grant Category A ------Merafong Category B 17,997 21,200 17,237 - 12,708 - - - Ventersdorp Municipality 292 328 334 - 364 - - - Leeudoringstad Municipality - - - - - Zeerust Town Council 269 359 359 - 376 ------Ottosdal Municipality - - - - Potchefstroom Municipality 3,791 3,169 3,264 - 2,858 - - - Wolmaranstad Municipality ------Maquassie Hills 1,433 1,359 1,040 - - - Foschville City Council - - - - - Makwassie City Council ------Wedella Municipality - - - - - Rustenburg City Council 557 1,004 542 - - - - Koster Town Council ------Klerksdorp Local Municipality 6,389 6,581 8,539 - 7,100 - - - Swartruggens Town Council - - - - - Kgetleng Local Authority - 744 ------Lekwa Teemane 1,362 1,204 1,502 - 1,429 - - - Mafikeng City Council 481 ------Schweizer Reneke TLC 382 505 519 - 577 - - - Mrafong 3,445 - - - Brits TLC 1,339 1,340 335 - - - - - Lichtenburg TLC - - - - - Hartebeespoort - - - - - Ditsobobotla Local Municipality 412 - - - - - Vryburg Local Council - - - - - Coligny TLC - - - - -

MTEF 2008 Vote 3 116

Naledi Municipality 773 870 803 - - - Delareyville Local Authority - - - - - Tswaing Municipality 517 292 - - 4 ------Category C 1,756 2,076 1,557 - 2,407 - - - Bophirima District Council 1,756 2,076 1,557 - 2,407 - - -

TOTAL TRANSFER PAYMENTS 19,753 23,276 18,794 - 15,115 - - -

Summary of departmental expenditure on training per programme Departmental Summary of training expenditure 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Training expenditure (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Programme 6: Health Sciences and trg 7,791 9,651 7,638 16,960 17,978 23,375 24,617 25,395 Subsistence and travel Tuition

TOTAL TRAINING EXPENDITURE 7,791 9,651 7,638 16,960 17,978 23,375 24,617 25,395

Information on training for the department Information on training 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2,011 Adj Training expenditure (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Number of staff 16,581 17,026 15,891 18,037 17,950 18,037 18,545 19,042 Number of personnel trained 6,395 6,395 6,395 8,283 8,283 7,455 7,827 8,219 - Male 1,968 1,968 1,968 3,198 3,198 2,878 3,022 3,174 - Female 4,427 4,427 4,427 5,085 5,085 4,576 4,805 5,045 Number of bursaries offered Number of interns appointed - - 133 - - - - Number of learnerships appointed - - 92 - - - - Average cost per staff member trained 1,218 1,509 1,194 2,048 2,170 3,136 3,145 3,090

Summary of departmental earmarked funds Departmental Summary of earmarked funds 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2,011 Adj Earmarked Funds (R’000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Integrated Primary Health care - - - 38,849 38,849 34,464 36,187 38,358 Emergency Medical services - - - 42,000 42,000 52,050 62,050 84,153 Health Professionals - - Community Health workers - - - 35,000 35,000 45,000 45,000 47,250 Strengthening security - 12,000 - - 8,000 - - - Integrated Nutritional Programme - - - 12,106 11,620 12,711 13,346 14,013 TB Services - - - 34,500 35,888 42,825 42,825 44,966 Ambulances and patient transport - 14,297 14,575 15,627 15,627 - - - Assistive devices roll-out - - - 4,500 4,500 4,725 5,000 5,250 Training of professionals - - - 8,000 8,000 8,000 8,000 8,400 Skills development/training - 8,000 - 8,123 8,123 8,929 9,375 9,844 SETA - 1,651 1,904 1,855 1,855 1,947 1,947 2,044 Infrastructure - - - - 54,023 - - - Evaluation and research - - - 2,000 - 2,000 2,000 2,100 Clinic building 30,000 27,564 53,217 60,000 30,000 50,000 50,000 50,000 Improving services in rural areas ------Laboratory services - - - 30,000 64,000 40,000 50,000 60,000 Skills development - HR plan ------Othotists and prothetists ------

MTEF 2008 Vote 3 117

Routine maintenance 30,662 32,964 42,940 45,241 43,338 47,030 49,878 52,372 Health remuneration review 77,000 105,000 120,000 148,400 Additional health professionals 30,000 63,979 68,586 70,112 TB: MDR & XDR 17,307 30,874 64,591 Baseline adjustment 21,114 46,654 101,986

TOTAL EARMARKED FUNDS 60,662 96,476 112,636 444,801 400,823 518,660 564,194 637,263

Summary of departmental personnel cost Departmental Summary of compensation of employees 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2,011 Adj Summary of personnel cost (R'000) Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Managers (Directors and above) - 13,625 20,594 20,778 21,167 28,278 32,755 37,669 Middle management (Deputy & - 46,899 61,632 68,997 64,001 70,497 75,897 87,281 Assistant Directors) ------Professional Staff 1,075,357 1,080,047 1,176,126 1,197,897 1,180,924 1,345,150 1,559,210 1,770,166 Other Staff 511,067 547,981 655,303 728,301 687,241 779,700 857,670 986,321 Staff additional to the establishment - 76,446 - - - - - Contract employees - - - 45,257 43,102 45,257 49,783 57,250 TOTAL PERSONNEL COST 1,586,424 1,764,998 1,913,655 2,061,230 1,996,435 2,268,882 2,575,315 2,938,687

Summary of departmental personnel numbers Departmental Summary of personnel numbers 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Adj Summary of personnel numbers Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Managers (Directors and above) 50 63 26 49 45 49 49 49 Middle management (Deputy & 737 796 237 366 342 366 384 395 Assistant Directors) - - - Professional Staff 9,172 10,362 8,781 9,808 10,522 9,808 9,933 10,160 Other Staff 6,622 6,842 6,298 7,496 6,723 7,496 7,861 8,120 Staff additional to the establishment - 549 Contract employees - - 318 318 318 318 318 TOTAL PERSONNEL NUMBERS 16,581 18,063 15,891 18,037 17,950 18,037 18,545 19,042

Summary of departmental personnel numbers per programme Departmental Summary of personnel numbers 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2,011 Adj Summary of personnel numbers Outcome Outcome Outcome Main App Estimate MTEF MTEF MTEF Administration 422 505 293 521 530 557 425 430 District Health Services 9,898 10,584 9,647 10,345 10,216 10,345 10,552 10,763 Emergency Medical Services 545 664 524 679 647 679 726 762 Provincial hospitals 4,738 5,208 4,461 5,130 5,233 4,970 5,218 5,375 Central Hospitals 86 112 86 142 136 142 156 172 Health Training and Sciences 715 811 628 933 890 933 997 1,057 Health Care support services 177 179 199 234 246 358 414 426 Health facilities management - - 53 53 53 53 57 57

Total personnel numbers 16,581 18,063 15,891 18,037 17,950 18,037 18,545 19,042 Unit cost per programme: Administration 159.44 149.64 280.94 174.69 167.95 177.53 244.33 256.20 District Health Services 96.48 98.86 114.44 109.96 106.34 120.47 133.80 142.71 Emergency Medical Services 91.65 93.66 142.47 118.23 114.08 125.24 122.44 129.39 Provincial hospitals 92.91 94.26 120.89 120.91 122.31 140.08 157.28 191.21 Central Hospitals 163.77 150.12 240.24 175.15 182.88 188.49 184.51 179.40 Health Training and Sciences 65.17 71.46 111.33 84.20 60.05 90.99 88.97 94.75 Health Care support services 75.28 85.22 82.74 90.35 86.04 63.01 57.37 60.50 Health facilities management - 119.11 142.70 147.17 155.96 153.68 165.60

UNIT COST FOR THE DEPARTMENT 95.68 97.71 120.42 114.28 111.22 125.79 138.87 154.33

MTEF 2008 Vote 3 118 Summary of personnel numbers and costs Departmental Summary of Personnel Numbers and Costs 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2,011 Category Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF Total for province Personnel numbers (head count) 16,581 17,410 15,891 18,037 17,950 18,037 18,545 19,042 Personnel cost (R'000) 1,586,424 1,764,998 1,913,655 2,061,230 1,996,435 2,268,882 2,575,315 2,938,687

Human Resource Component Personnel numbers (head count) 2,001 2,089 1,907 2,183 2,173 2,231 2,298 2,372 Personnel cost (R'000) 190,371 211,800 229,639 247,348 239,572 272,266 309,038 352,642 Head count as % of total 12.07 12.00 12.00 12.11 12.11 12.37 12.39 12.46 Cost as a % of total 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00

Finance Component Personnel numbers (head count) 4,656 4,875 4,449 5,071 5,047 5,103 5,266 5,418 Personnel cost (R'000) 444,199 494,199 535,823 577,144 559,002 635,287 721,088 822,832 Head count as % of total 28.08 28.00 28.00 28.12 28.12 28.29 28.39 28.45 Cost as a % of total 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00

Full time workers Personnel numbers (head count) 16,581 18,073 15,891 17,719 17,632 17,719 18,227 18,724 Personnel cost (R'000) 1,586,424 1,760,931 1,913,655 2,015,973 1,953,333 2,223,625 2,525,532 2,881,437 Head count as % of total 100.00 103.81 100.00 98.24 98.23 98.24 98.29 98.33 Cost as a % of total 100.00 99.77 100.00 97.80 97.84 98.01 98.07 98.05

Part-time workers Personnel numbers (head count) Personnel cost (R'000) Head count as % of total ------Cost as a % of total ------

Contract workers Personnel numbers (head count) - - - 318 318 318 318 318 Personnel cost (R'000) - - - 45,257 43,102 45,257 49,783 57,250 Head count as % of total - - - 1.76 1.77 1.76 1.71 1.67 Cost as a % of total - - - 2.20 2.16 1.99 1.93 1.95

Function specific schedule

2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 2009 2010 2011 Project Name Outcome Outcome Outcome Main App Adj Estimate MTEF MTEF MTEF Personnel payments (R'000) 1,586,425 1,764,998 1,913,655 2,061,230 1,996,435 2,268,882 2,575,315 2,938,687 Current payments (R'000) 2,323,735 2,668,286 2,989,324 3,274,985 3,277,918 3,656,884 4,001,633 4,503,406 Consultants & specialised services (R'000) 147,327 215,830 314,197 331,728 361,283 395,419 402,169 417,719 Average cost per patient transported 540 540 540 300 300 300 300 300 Maintenance & repairs 42,694 32,963 33,162 62,788 71,148 119,198 107,075 166,851 Medical services (R'000) 79,216 87,138 75,255 105,436 105,436 115,980 127,578 133,957 Medical supplies (R'000) 186,721 196,057 177,230 216,153 246,153 226,961 238,309 250,224 Medicines (R'000) 132,724 187,763 143,823 187,763 187,763 187,763 187,763 197,151 Primary Health Care (R'000) 699,939 794,360 633,452 867,594 867,594 904,276 959,122 1,007,078 Medical Equipment (R'000) 22,678 52,067 18,444 90,089 90,089 80,402 93,598 98,277 Total 5,221,999 6,000,002 6,299,082 7,198,067 7,204,119 7,956,064 8,692,861 9,713,651

Number of health professionals 9,172 10,362 8,781 8,415 8,837 9,218 9,419 9,626 - Medical Doctors (including specialists) 391 421 342 400 607 637 669 703 - Nurses 7,589 8,107 7,339 6,486 6,700 6,974 7,113 7,256 - Other medical staff 1,192 1,834 1,100 1,530 1,530 1,607 1,637 1,667 Infrastructure expenditure: - Number of hospital beds 5,995 6,010 6,225 5,236 5236 5,341 5,448 5,557 - Number of clinics 302 305 299 250 250 254 256 258

MTEF 2008 Vote 3 119

PUBLIC ENTITIES

Provincial Council on Aids Programme Summary of Expenditure and Estimates 2004/ 2005/ 2006/ 2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 Estimated 2009 2010 2011 Classification (R'000) Outcome Outcome Outcome Outcome MTEF MTEF MTEF REVENUE Tax Revenue Non-tax revenue: Sale of goods & services (non-cap) ------(specify) - (specify) - (specify) - (specify) - (specify) - (specify) - (specify) Interest, dividends & rent on land: ------Interest - Dividends - Rent on land Sale of capital assets ------(specify) - (specify) Transfers received TOTAL REVENUE ------EXPENDITURE - Compensation of employees 2,372 7,571 6,280 8,614 8,614 8,614 8,614 - Administrative expenditure 2,025 1,622 2,733 1,704 1,704 1,704 1,704 - Rental of equipment 1,203 461 - 484 484 484 484 - Stores 789 284 546 298 298 298 298 - Rental of buildings 1,220 200 810 210 210 210 210 - Professional & special services 1,576 150 731 158 158 158 158 - Maintenance & repairs 288 23 163 24 24 24 24 - Interest ------Depreciation ------Other 527 239 1,361 250 250 250 250 Transfers and subsidies - TOTAL EXPENDITURE 10,000 10,550 12,624 11,742 11,742 11,742 11,742 Surplus/(deficit) (10,000) (10,550) (12,624) (11,742) (11,742) (11,742) (11,742)

Add back: depreciation ------Sub-total (10,000) (10,550) (12,624) (11,742) (11,742) (11,742) (11,742) Less: capital expenditure - - 6 - - - - - Motor vehicles and transport - Office equipment and furniture 6 - Land and buildings - Other capital equipment Surplus/(deficit) (10,000) (10,550) (12,630) (11,742) (11,742) (11,742) (11,742) Transfers received from government 10,000 10,550 12,630 11,742 11,742 11,742 11,742 Other funding measures (specify) Other funding measures (specify) Net surplus/deficit ------

MTEF 2008 Vote 3 120

Infrastructure Spending

Summary of departmental infrastructure/maintenance projects

2004/ 2005/ 2006/2007/2008 2008/ 2009/ 2010/ 2005 2006 2007 Main Adj. 2009 2010 2011 Earmarked Funds (R’000) Outcome Outcome Outcome Approp Estimate MTEF MTEF MTEF New/upgrading projects 29,927 34,564 72,825 60,000 106,243 50,000 50,000 50,000 Maintenance projects 30,916 32,509 42,288 45,241 45,241 40,000 40,000 40,000 Hospital Revitalization 81,930 70,142 191,366 176,966 209,166 254,030 242,800 310,500 Health Facilities Maintenance - IGP 22,722 42,174 52,549 20,000 39,572 47,030 49,878 52,372 Total Infrastructure Funds 165,495 179,389 359,028 302,207 400,222 391,060 382,678 452,872

Detail of departmental infrastructure/maintenance projects Estimated MTEF expenditure Expanded Public Works (EPWP) Statistics 2008/2009 Total Exp. 2008/ 2009/ 2010/ Number of Job opportunities Persons to be trained Est. up to 2009 2010 2011 Youth Women Non People with Project name (R'000) Region Cost 2006/07 MTEF MTEF MTEF (18-35) Incl. YouthDisabilities Accredited Accredited New/upgrading projects Clinic Building Bakubung Bojanala 5,782 314 140 839 1,239 14 6 - 4 16 Boikie Tlhapi CHC Southern 22,000 628 2,000 6,000 11,372 45 12 2 6 51 Blydeville Central 4,720 - 1,232 640 2,398 4 2 - 2 4 Bethanie Bojanala 11,167 - 4,500 400 368 15 5 - 4 16 Kgakala Southern 2,360 - 250 1,910 - 8 4 - 2 10 Ceyferkuil Bojanala 4,690 211 350 969 8 4 - 2 10 Danville Central 5,010 3,885 350 - 945 8 4 - 2 10 Derby Bojanala 5,898 129 350 - 5,509 10 5 - 3 12 Glaudina Central 4,197 2,846 200 6 3 - 2 7 Segametsi - Mogaetsho Southern 7,157 30 850 3,987 - 14 6 - 3 17 Dikebu Bojanala 5,364 483 261 - - 8 4 - 2 10 Driefonein Central 5,134 3,250 200 512 - 8 4 - 2 10 Hebron Bojanala 5,796 324 2,786 - - 8 4 - 2 10 Itsoseng CHC Central 82,017 26,814 7,800 12,742 7,206 45 15 2 12 48 J.B. Marks CHC Southern 22,000 833 9,111 2,367 - 30 12 2 8 34 Khunwana Central 5,593 2,192 250 1,251 - 6 2 - 2 6 Laxey Bophirima 8,565 1,548 2,400 - - 14 6 - 2 18 Lesego Southern 3,361 - 350 - - 6 2 - 2 6 Letsopa Central 9,430 - 2,650 - - 10 4 - 2 12 Masutlhe Central 5,213 4,232 1,600 - 8 4 - 2 10 Kokosi Southern 5,500 - 470 ------Thusanang Southern 5,500 1,819 ------Loopeng Bophirima 5,357 446 2,001 - - 8 4 - 2 10 Mabule Central 5,580 3,386 200 1,244 - 8 4 - 2 10 Madikwe CHC Bojanala 2,950 167 2,083 - - 6 2 - 2 6 Makapanstadt CHC Bojanala 14,500 - 6,000 8,500 35 12 4 12 35 Mmakaunyane Bojanala 4,500 - 4,500 - 6 2 - 2 6 Makouspan Central 5,607 2,014 260 - 463 8 2 - 2 8 Reagile Bojanala 7,703 - 2,400 - 943 6 4 - 2 8 Tlapeng Bophirima 4,018 73 1,887 1,608 - 6 4 - 2 8 Tswelelang II Southern 22,000 1,000 6,000 9,900 25 6 2 8 23 Witpoort Southern 4,364 3,326 250 188 8 4 - 2 10 Sub-total - 313,033 57,131 50,000 50,000 50,000 391 152 12 102 441

MTEF 2008 Vote 3 121

Detail of departmental infrastructure/maintenance projects Estimated MTEF expenditure EPWP Statistics 2008/2009 Total Exp 2008/ 2009/ 2010/ Number of Job opportunities Persons to be trained Youth Est. up to 2009 2010 2011 Women People with Non Project name (R'000) Region Cost 2007/08 MTEF MTEF MTEF (18-35) Incl. YouthDisabilities Accredited Accredited

Upgrading and Rehabilitation of Hospitals and Health facilities Nurses College (Mafikeng) Central 22,000 4,002 14,890 6,298 - 6 2 - 2 6 Nurses College (Klerksdorp) Southern 48,000 3,197 6,900 17,097 22,680 25 6 - 4 27 Bloemhof Bophirima 9,445 1,676 5,253 - - 30 10 1 6 35 Christiana Bophirima 5,794 2,900 228 - - 12 4 - 3 13 Delareyville Bulk Pharmacy Central 5,900 - 1,500 2,900 - 8 2 - 2 8 Ganyesa Bophirima 12,084 3,982 1,900 1,702 - 14 4 - 3 15 Potchestroom Southern 4,200 - 1,543 - 8 2 - 2 8 Ventersdorp Bulk Pharmacy Southern 5,900 - 1,500 2,900 - 8 2 - 2 8 Witrand Southern 28,320 97 6,286 9,103 17,320 20 6 1 4 23 Sub-total - IGP - 141,643 15,854 40,000 40,000 40,000 131 38 2 28 143

Hospital Revitalization - Bapong CHC Bojanala 23,157 - 15,657 7,500 - 15 12 1 4 16 Bophelong Central 210,000 - 15,000 80,000 112,900 35 15 2 60 30 Brits Hospital Bojanala 410,000 4,809 50,000 147,300 197,600 60 20 2 90 30 Letlhabile CHC Bojanala 20,000 1,823 20,000 - - 15 6 1 30 15 Mabeskraal CHC Bojanala - - - - - 15 6 1 - 40 Mogwase CHC Bojanala - - - - - 15 6 - - 40 Moses Kotane Hospital Bojanala 71,000 59,526 71,000 - - 90 12 - 60 30 Naledi/Vryburg Hospital Bophirima 76,373 67,277 76,373 - - 60 9 2 60 40 Pella CHC Bojanala - - - - - 15 6 - - - Grant Management All regions 10,000 - 5,000 5,000 ------New Business Cases All regions 4,000 - 1,000 3,000 ------Total Hospital Revitalization projects 824,530 133,435 254,030 242,800 310,500 320 92 9 304 241

Health Routine Maintenance Bojanala Region Bojanala 8,160 8,160 10,588 11,229 11,791 - - - - - Bophirima Region Bophirima 8,037 8,037 8,197 8,694 9,129 - - - - - Cenral Region Central 7,738 7,738 10,063 10,673 11,206 - - - - - Centralised Maintenance Head Office 8,838 8,838 7,034 7,459 7,832 - - - - - Southern Region Southern 12,169 12,169 11,148 11,823 12,414 - - - - -

Total Maintenance projects 44,942 44,942 47,030 49,878 52,372 - - - - - Total Infrastructure Funds 1,324,148 251,362 391,060 382,678 452,872 842 282 23 434 825

MTEF 2008 Vote 3 122