Department of Health Annual Report 2018/19

DEPARTMENT OF HEALTH ANNUAL REPORT 2018/19

Together, Moving Gauteng City Region Forward

GAUTENG PROVINCE HEALTH REPUBLIC OF SOUTH AFRICA DISTRIBUTION OF SERVICE PLATFORMS

EXPENDITURE PER BUDGET PROGRAMME

DISTRICT PROVINCIAL CENTRAL & EMERGENCY HEALTH SERVICES HEALTH SERVICES TERTIARY HOSPITALS MEDICAL SERVICES 14 516 480 8 746 469 17 135 226 1 330 508

FINANCIAL INPUTS ACTUAL EXPENDITURE

HEALTHCARE HEALTH SCIENCES HEALTH FACILITIES ADMINISTRATION SUPPORT SERVICES & TRAINING MANAGEMENT 339 048 1 106 708 1 536 120 1 360 786

Department of Health Annual Report 2018/19 HUMAN RESOURCES FOR HEALTH

65 821 Total Health Workforce

Clinical Nursing Engineering Support Staff Administration Professionals Professionals Support Staff 11 398 Staff 31 168 10 9 169 6 386

Allied Engineering Allied Management Professionals Professionals Support Staff 103 5 589 69 1 929

Clinical Professionals Nursing Professionals

DENTAL DENTAL REGISTRARS PRACTITIONERS 41 308 STUDENT PROFESSIONAL MEDICAL DENTAL NURSES NURSES REGISTRARS SPECIALISTS 2 437 14 897 1 215 116

MEDICAL MEDICAL NURSING STAFF NURSES SPECIALISTS PRACTITIONERS ASSISTANTS 7 424 1 276 3 430 6 410

Adminstration Staff Support Staff Management Professionals 9 169 11 398 LEVEL 13 LEVEL 14 73 23 JUNIOR LOWER LOWER JUNIOR MIDDLE MANAGERS LEVELS LEVELS MANAGERS MANAGERS (LEVELS 9-10) Management (LEVELS 1-8) (LEVELS 11-12) (LEVELS 1-8) (LEVELS 9-10) 2 Professionals 8 478 457 234 11 396

LEVEL 15 LEVEL 16 3 1

Department of Health Annual Report 2018/19 A SNAPSHOT OF HEALTH SERVICES

Reproductive health

We provided 179 689 307 contraceptives to Medroxyprogesterone injection 1 148 458 women of reproductive age Norethisterone injection 346 766 1 432 002 pills provided

183 719 women over 30 year old 33 383 implants inserted screened for cervical cancer

Maternal and Neonatal Health Child Health

268 008 pregnant women given 126 788 learners immunized for HPV antenatal care services

Supported 222 115 deliveries 167 100 learners screened for potential at our facilities learning barriers

Outreach to Households Chronic Medicine Dispensing Programme

3 374 445 visits by 490 518 patients received their ward-based outreach teams treatment through the Chronic Medicine Programme at convenient locations

Non-Communicable conditions and Rehabilitation services

2 295 851 hypertensive patients 552 537 diabetic patients treated treated

85 283 Mental health care patients 73 772 assistive devices provided to treated patients

Communicable Conditions

1 037 212 HIV patients 34 190 TB patients treated provided with treatment

Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT FINANCIAL YEAR 2018/2019

PR 223/2019 ISBN: 978-0-621-47565-4

Department of Health Annual Report 2018/19 1 TABLE OF CONTENTS PART A GENERAL INFORMATION

1. DEPARTMENT GENERAL INFORMATION 4 2. ABBREVIATIONS AND ACRONYMS 6 3. FOREWORD BY THE MEC FOR HEALTH 8 4. REPORT OF THE ACCOUNTING OFFICER 10 5. STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF THE ACCURACY OF THE ANNUAL REPORT 15 6. STRATEGIC OVERVIEW 16 7. ORGANISATIONAL STRUCTURE 17 8. ENTITIES REPORTING TO THE MEC 18 9. LEGISLATIVE AND OTHER MANDATES 18

PART B PERFORMANCE INFORMATION 1. AUDITOR-GENERAL’S REPORT: PREDETERMINED OBJECTIVES 20 2. OVERVIEW OF DEPARTMENTAL PERFORMANCE 20 3. STRATEGIC OUTCOME-ORIENTATED GOALS 26 4. PERFORMANCE INFORMATION BY PROGRAMME 27 5. TRANSFER PAYMENTS 81 6. DONOR FUNDS 82 7. CONDITIONAL GRANTS 83 8. CAPITAL INVESTMENT 87 PART C GOVERNANCE 1. INTRODUCTION 99 2. RISK MANAGEMENT 99 3. MINIMISING CONFLICTS OF INTEREST 99 4. FRAUD AND CORRUPTION 100 5. CODE OF CONDUCT 100 6. HEALTH, SAFETY AND ENVIRONMENTAL ISSUES 100 7. PORTFOLIO COMMITTEES 102 8. SCOPA RESOLUTIONS 108 9. PRIOR MODIFICATIONS TO AUDIT REPORTS 116 10. INTERNAL CONTROL UNIT 116 11. REPORT OF THE AUDIT COMMITTEE 117

2 Department of Health Annual Report 2018/19 TABLE OF CONTENTS

PART D HUMAN RESOURCE MANAGEMENT

1. INTRODUCTION 121 2. OVERVIEW OF HUMAN RESOURCES 121 3. HUMAN RESOURCES OVERSIGHT STATISTICS 122

PART E FINANCIAL INFORMATION

1. REPORT OF THE AUDITOR-GENERAL 153 2. ANNUAL FINANCIAL STATEMENTS 162

PART F MSD FINANCIAL INFORMATION 1. REPORT OF THE ACCOUNTING OFFICER 282 2. REPORT OF THE AUDITOR-GENERAL 294 3. ANNUAL FINANCIAL STATEMENTS 399

Department of Health Annual Report 2018/19 3 PART A: GENERAL INFORMATION

4 Department of Health Annual Report 2018/19 1. DEPARTMENT GENERAL INFORMATION

The Department’s service platforms nevertheless remain resilient and, ABOUT THE DEPARTMENT during the year, It was able to provide approximately 27.7 million Information about the patient visits for patients presenting at PHCs, emergency and 4-18 mandate, location and outpatient hospital Departments. Thus 183 851 additional patients messages from the MEC and the accounting visits were catered for during the year under review. This increasing o cer on performance of the Department. demand requires improved and efficient business processes which the Department is implementing using appropriate technology. Part of ADMINISTRATIVE this has involved putting in place a recovery roadmap, focusing on six OVERVIEW strategic drivers of clinical and clinical support services: Leadership A performance report outlining quality improve- 20-78 and Governance; ICT Optimisation for Evidence Based Health Care; ment, technology and Financial Discipline and Prudence; Patient Safety and Improved Health transformation agenda. Outcomes; and Human Resources for Health and Health Wellness and Happiness. DISTRICT HEALTH CARE SERVICES Performance of the priority The drivers relating to Clinical Services (Patient Safety and Improved 30-44 health programmes Health Outcomes) have resulted in the development of the Mental accessibility, treatment and support provided at primary This annual report reviews the performance of the Gauteng Health Recovery plan, the Maternal and Neonatal Health Recovery health care facilities plan and the establishment of an accreditation committee to assess including reengineering of Department of Health (GDOH) for the year 2018/2019, the final year the PHC system of the previous administration, underlining the work that the quality across the health facilities. The overwhelming evidence HOSPITAL AND Department has done in implementing the province’s generated in the Department reflects recurring underperformance in EMERGENCY these strategic programmes and they are therefore being prioritised SERVICES Transformation, Modernisation and Re-Industrialisation policy Performance of the emergency 45-59 framework. within the Recovery Road Map currently being used. medical services, various categories of hospital e ciency and quality initiatives starting with hospitals that The report reflects the milestones and difficulties that the While our focus and some of the expectations of the communities we provide specialised, tertiary care to quaternary health care services. Department has overcome, in the face of particular pressures during serve have tended to be on curative care, it is well recognised that HEALTH CARE SUPPORT the year, in ensuring that the health care needs of the people of delivery of healthcare requires a much broader approach. As part of SERVICES OVERVIEW Gauteng are met. The effects of rapid urbanisation and increased pushing back the frontiers of ill-health, the GDoH launched a A brief overview on three-year Health, Wellness and Happiness programme on 16 30-44 pharmaceutical, blood migration are amongst the Department’s greatest challenges. The and supply chain, human November 2018 with the aim of increasing health promotion and resources capacity report therefore reflects these challenges and their effects on the development initiatives health service. disease prevention for better health outcomes. and capital investments.

In developing the report and in planning for the next five years, the Despite the many challenges facing its health system, Gauteng has GOVERNANCE, Department has taken stock of government’s priorities. Gauteng is a the highest proportion of primary health facilities certified as Ideal HUMAN FINANCIAL diverse, multi-racial and multi-class society where, in providing Clinics in South Africa; this is confirmed by the Office of Health A brief overview on risk adequate health services, “the people must always come first”. This Standards Compliance which is responsible for guiding, monitoring Gauteng Provincial Government | Health | management, human 60-88 resources statistics is the spirit that drives Team Gauteng Health during this new term. and enforcing health care safety and quality standards in the Annual Report 2018/2019 overview , ﬁnancial Taking full account of the pressures and challenges that currently country’s health facilities. We have worked hard to introduce the Ideal Physical address: 45 Commissioner Street statements and legislationtin Hospitals Accreditation system in line with the Ideal Clinics System, Marshalltown prevent our public healthcare system from meeting the standards of and have appointed a panel of eight professionals as the Gauteng Johannesburg excellence to which we aspire, we must persist in our objective of Health Accreditation Committee (GHAC) whose main purpose is to 2001 improving the quality of healthcare for all the province’s residents. The GDoH is the largest health service provider in South Africa, sustain and expand the province’s Ideal Clinics status and to realise Postal address: Private Bag X085 the Ideal Hospitals system. Marshalltown serving 14,6 million residents (25 % of the country’s population). 2107 Over the past two and half decades, the province’s population has Average life expectancy in Gauteng has increased from 56 to 67 South Africa doubled and the number of patient visits almost tripled. Only 25% of the population have adequate medical aid coverage (according to years, and mother-to-child transmission of HIV has been reduced over Email: [email protected] a 2017 report by Statistics South Africa). This increases demand for the past five year term of government to 0,9% ushering in the Website address: http://www.health.gpg.gov.za public healthcare services as, when medical aid scheme benefits do possibility that South Africa will be amongst the first countries in the Facebook: Gauteng Provincial Health Department not exist or are exhausted, people turn to the public sector. world to do so. A decentralisation policy underlies this success, with Twitter: @GautengHealth delegations to strengthen district management. Instagram: @gautenghealth

Department of Health Annual Report 2018/19 5

The Department has reduced past year accruals and irregular As we chart a way forward for the next five years, we will continue expenditure and has progressively improved the rate of payments to to position ourselves as a leader in the country, particularly in suppliers within 30 days. Much more remains to be done to ensure relation to the roll-out of National Health Insurance. I encourage all that business processes become more efficient, with officials and of us to re-commit ourselves to diligence in service as we forge management held accountable for their actions and inactions in ahead towards high quality healthcare for all. In the next five years, areas of recurring underperformance. we will as a Department continue to implement the Recovery Road Map strategy and to provide the people of Gauteng with a In his State of the Province address, Gauteng Premier David Makhura transformed, responsive and effective public health service. pointed to the profound challenges relating to service delivery in the health system and that these have to be resolved as soon as possible. The financial and structural challenges facing the public healthcare system are the subject of urgent attention by the Provincial Executive Council and National Cabinet, with President Ramaphosa announcing measures to deal with these matters as part of the ______Economic Stimulus and Recovery Plan. This includes addressing Gauteng MEC for Health shortages in hospitals, making funding available to buy new medical Date equipment and linen and filling critical medical posts.

The Department has moved with speed and great care in implementing all the recommendations of the Life Esidimeni report tabled by retired Deputy Chief Justice Dikgang Moseneke. It is important to emphasise that the recommendations did not relate only to financial recourse on the part of the Department. It brought to the centre broader questions about how to position mental health as a priority for GDoH and has enhanced the Department’s partnership with the Office of Health Standards Compliance and with the Family Committee to ensure a collaborative, appropriate and professional approach to managing mental health issues. The lessons from the Life Esidimeni tragedy must compel us to ensure that nothing like it happens again. The health and wellness of the people of Gauteng are paramount and it is our responsibility to ensure that they are always provided with the best quality of healthcare.

IMCI Integrated Management Of Childhood Illnesses PMIS Project Management Information System DPME Department of Planning, Monitoring and Evaluation A&E Accident and Emergency IMCI CC Integrated Management Of Childhood Illnesses Community Component PMTCT Prevention Of Mother-To-Child Transmission DPSA Department of Public Service and Administration ACLS Advanced Cardiac Life Support IMMR In-Facility Maternal Mortality Ratio PPP Public Private Partnership The Department’s service platforms nevertheless remain resilient and, DR TB Drug-resistant Tuberculosis AET Adult Educational and Training IRS Integrated Reporting System PPE Personal Protective Equipment during the year, It was able to provide approximately 27.7 million DSD Department of Social Development AGSA Auditor-General of South Africa ISHP Integrated School Health Programme PRAAD Policy On Reasonable Accommodation And Assistive Devices patient visits for patients presenting at PHCs, emergency and ECA Emergency Care Assistant AGYW Adolescent Girls and Young Women IT Information Technology PrEP Pre-Exposure Prophylaxis outpatient hospital Departments. Thus 183 851 additional patients ECC Emergency Communication Centre AIDS Acquired Immune Deficiency Syndrome JPSA Justice Project South Africa PSC Public Service Commission visits were catered for during the year under review. This increasing ECD Early Childhood Development ALS Advanced Life Support LAN Local Area Network PSCBC Public Service Co-Ordinating Bargaining Council demand requires improved and efficient business processes which the ECT Emergency Care Training ALOS Average Length of Stay LBC Liquid Base Cytology PSETA Public Service Education And Training Authority Department is implementing using appropriate technology. Part of EHWP Employee Health and Wellness Programme ANC Antenatal Care LTDOT Long Term Domiciliary Oxygen Therapy PSRMF Public Sector Risk Management Framework this has involved putting in place a recovery roadmap, focusing on six EML Essential Medicines List AO Accounting Officer M&E Monitoring And Evaluation PSS Professional Services Support strategic drivers of clinical and clinical support services: Leadership EMS Emergency Medical Services APC Advanced Primary Care MAM Moderate Acute Malnutrition PWDs People With Disabilities and Governance; ICT Optimisation for Evidence Based Health Care; ENT Ear, Nose and Throat API Active Pharmaceutical Ingredient MDPSA Member of Directed Pension Scheme Administration QA Quality Assurance Financial Discipline and Prudence; Patient Safety and Improved Health EPWP Expanded Public Works Programme APP Annual Performance Plan MDR-TB Multi-Drug Resistant Tuberculosis RADU Remote Automated Dispensing Units Outcomes; and Human Resources for Health and Health Wellness and ERM Enterprise Risk Management APP Annual Procurement Plan MEC Member Of Executive Council RDT Rapid Diagnostic Test Happiness. ES Equitable Share ART Antiretroviral Treatment MIS Management Information System RFQ Request For Quotation ESMOE Essential Steps in Managing Obstetric Emergencies ARV Antiretroviral MMC Medical Male Circumcision RM Risk Management The drivers relating to Clinical Services (Patient Safety and Improved EXCO Executive Committee BAA Basic Ambulance Assistant MMR Maternal Mortality Rate RMC Risk Management Committee Health Outcomes) have resulted in the development of the Mental Family Violence, Child Protection and Sexual Offences Unit B-BBEE Broad-Based Black Economic Empowerment FCSU Memorandum Of Understanding Regional Training Centre MOU RTC This annual report reviews the performance of the Gauteng Health Recovery plan, the Maternal and Neonatal Health Recovery Forensic Pathology Service BHVI Brien Holden Vision Institute FPS Management Performance Assessment Tool South African Bureau Of Standards MPAT SABS Department of Health (GDOH) for the year 2018/2019, the final year plan and the establishment of an accreditation committee to assess GCRA Gauteng City Region Academy BLS Basic Life Support MPET Management Performance Enhancement Tool SADC Southern African Development Community of the previous administration, underlining the work that the quality across the health facilities. The overwhelming evidence GDE Gauteng Department of Education BMH Bheki Mlangeni Hospital MPSA Minister Of Public Service And Administration SAM Severe Acute Malnutrition Department has done in implementing the province’s generated in the Department reflects recurring underperformance in GDID Gauteng Department of Infrastructure Development BoQ Bill of Quantity MSD Medical Supplies Depot SAMEC South African Malaria Elimination Committee Transformation, Modernisation and Re-Industrialisation policy these strategic programmes and they are therefore being prioritised GDoH Gauteng Department of Health CAD Computer Aided Dispatch MSSN Management Of Small And Sick New-Borns SANC South African Nursing Council framework. within the Recovery Road Map currently being used. GHAC Gauteng Health Accreditation Committee CCMDD Centralised Chronic Medicine Dispensing and Distribution MTCT Mother To Child Transmission SAPS South African Police Service GP Gauteng Province CCPGP Co-ordinating Chamber of the Public Service Co-ordinating Bargaining Council CBC for Gauteng Province NCD Non-Communicable Disease SASSA South African Social Security Agency The report reflects the milestones and difficulties that the While our focus and some of the expectations of the communities we GP General Practitioner CDC Communicable Disease Control NCS National Core Standard SBAH Steve Biko Academic Hospital Department has overcome, in the face of particular pressures during serve have tended to be on curative care, it is well recognised that GPG Gauteng Provincial Government CEO Chief Executive Officer NDoH National Department Of Health SCM Supply Chain Management the year, in ensuring that the health care needs of the people of delivery of healthcare requires a much broader approach. As part of GPT Gauteng Provincial Treasury CFMS Clinical Forensic Medical Service NDP National Development Plan SCOPA Standing Committee On Public Accounts Gauteng are met. The effects of rapid urbanisation and increased pushing back the frontiers of ill-health, the GDoH launched a GRV Goods Receipt Voucher CFO Chief Financial Officer NDPW National Department Of Public Works SETA Sector Education And Training Authority migration are amongst the Department’s greatest challenges. The three-year Health, Wellness and Happiness programme on 16 GSSC Gauteng Shared Services Centre CHC Community Health Centre NGO Non-Governmental Organisation SIPDM Standard For Infrastructure Procurement And Delivery Management report therefore reflects these challenges and their effects on the November 2018 with the aim of increasing health promotion and HAST HIV, AIDS, STIs and TB CHBAH Chris Hani Baragwanath Academic Hospital NHA National Health Act SITA State Information Technology Agency health service. disease prevention for better health outcomes. HBB Helping Baby Breathe CHW Community Health Worker NHI National Health Insurance SLA Service-Level Agreement HC Higher Certificate CMJAH Charlotte Maxeke Johannesburg Academic Hospital NHLS National Health Laboratory Services SLU Specialised Litigation Unit In developing the report and in planning for the next five years, the Despite the many challenges facing its health system, Gauteng has HCW Health Care Waste CMR Child Mortality Rate NIDS National Information Data System SMME Small, Medium Or Micro Enterprise Department has taken stock of government’s priorities. Gauteng is a the highest proportion of primary health facilities certified as Ideal HCWM Health Care Waste Management CoE Cost of Employment NIMART Nurse-Initiated Management Of ART SMS Senior Management Service diverse, multi-racial and multi-class society where, in providing Clinics in South Africa; this is confirmed by the Office of Health HFM Health Facilities Management CoJ City of Johannesburg NMC Notifiable Medical Condition SOCP Sexual Offences Care Practitioner adequate health services, “the people must always come first”. This Standards Compliance which is responsible for guiding, monitoring HFRG Hospital Facility Revitalisation Grant COPC Community-oriented Primary Care NSI Needle Stick Injury SOP Standard Operating Procedure is the spirit that drives Team Gauteng Health during this new term. and enforcing health care safety and quality standards in the HIFU High-intensity Focused Ultrasound COPD Chronic Obstructive Pulmonary Disease NTSG National Tertiary Services Grant STI Sexually Transmitted Infection Taking full account of the pressures and challenges that currently country’s health facilities. We have worked hard to introduce the Ideal HIS Health Information System CoT City of Tshwane OD Organisational Design TB Tuberculosis prevent our public healthcare system from meeting the standards of Hospitals Accreditation system in line with the Ideal Clinics System, HIV Human Immunodeficiency Virus CPD Continuing Professional Development OHS Occupational Health And Safety Td Tetanus-Diphtheria excellence to which we aspire, we must persist in our objective of and have appointed a panel of eight professionals as the Gauteng HOD Head of Department CPSI Centre for Public Service Innovation OHSC Office Of The Health Standards And Compliance TER Township Economy Revitalisation improving the quality of healthcare for all the province’s residents. Health Accreditation Committee (GHAC) whose main purpose is to HPCSA Health Professions Council of South Africa CRO Chief Risk Officer OPD Outpatient Department TOR Terms of Reference The GDoH is the largest health service provider in South Africa, sustain and expand the province’s Ideal Clinics status and to realise HPRS Health Patient Registration System CSD Central Supplier Database PACS Picture Archiving And Communication System TR Treasury Regulation serving 14,6 million residents (25 % of the country’s population). the Ideal Hospitals system. HPV Human Papilloma Virus CT Computerised Tomography PALS Paediatric Advanced Life Support TROA Total Remaining On ART Over the past two and half decades, the province’s population has HR Human Resources DCST District Clinical Specialist Team PCU Physically Challenged Unit UCT University Of Cape Town doubled and the number of patient visits almost tripled. Only 25% Average life expectancy in Gauteng has increased from 56 to 67 HRD Human Resources Development DDG Deputy Director General PDE Patient-Day Equivalent UP University Of Pretoria of the population have adequate medical aid coverage (according to years, and mother-to-child transmission of HIV has been reduced over HWSETA Health & Welfare Sector Education & Training Authority DGMAH Doctor George Mukhari Academic Hospital PEP Post-Exposure Prophylaxis UPFS Uniform Patient Fees Schedule a 2017 report by Statistics South Africa). This increases demand for the past five year term of government to 0,9% ushering in the ICSP Internship and Community Service Programme DHIS District Health Information System PEPFAR President's Emergency Plan For AIDS Relief VHF Viral Haemorrhagic Fever public healthcare services as, when medical aid scheme benefits do possibility that South Africa will be amongst the first countries in the ICT Information and Communications Technology DID Department of Infrastructure Development PFMA Public Finance Management Act VMMC Voluntary Medical Male Circumcision not exist or are exhausted, people turn to the public sector. world to do so. A decentralisation policy underlies this success, with ICU Intensive Care Unit DOH Department of Health (national) PHC Primary Health Care WBOT Ward-Based Outreach Team delegations to strengthen district management. ILS Intermediate Life Support DORA Division of Revenue Act PHSDSBC Public Health And Social Development Bargaining Council Wits University Of the Witwatersrand PIR Project Initiation Report

6 Department of Health Annual Report 2018/19

With the support of the wide range of stakeholders concerned with and participating in our activities, we remain convinced that the province’s health care system will continue to improve. This will be supported by collaboration with the Health Sciences Faculties in our eight universities, specialised research institutions, NGOs, civil society and other stakeholders. We are also encouraged by our employees who serve daily with diligence; Through the Premier’s IMCI Integrated Management Of Childhood Illnesses PMIS Project Management Information System DPME Department of Planning, Monitoring and Evaluation A&E Accident and Emergency IMCI CC Integrated Management Of Childhood Illnesses Community Component PMTCT Prevention Of Mother-To-Child Transmission DPSA Department of Public Service and Administration ACLS Advanced Cardiac Life Support IMMR In-Facility Maternal Mortality Ratio PPP Public Private Partnership The Department’s service platforms nevertheless remain resilient and, DR TB Drug-resistant Tuberculosis AET Adult Educational and Training IRS Integrated Reporting System PPE Personal Protective Equipment during the year, It was able to provide approximately 27.7 million DSD Department of Social Development AGSA Auditor-General of South Africa ISHP Integrated School Health Programme PRAAD Policy On Reasonable Accommodation And Assistive Devices patient visits for patients presenting at PHCs, emergency and ECA Emergency Care Assistant AGYW Adolescent Girls and Young Women IT Information Technology PrEP Pre-Exposure Prophylaxis outpatient hospital Departments. Thus 183 851 additional patients ECC Emergency Communication Centre AIDS Acquired Immune Deficiency Syndrome JPSA Justice Project South Africa PSC Public Service Commission visits were catered for during the year under review. This increasing ECD Early Childhood Development ALS Advanced Life Support LAN Local Area Network PSCBC Public Service Co-Ordinating Bargaining Council demand requires improved and efficient business processes which the ECT Emergency Care Training ALOS Average Length of Stay LBC Liquid Base Cytology PSETA Public Service Education And Training Authority Department is implementing using appropriate technology. Part of EHWP Employee Health and Wellness Programme ANC Antenatal Care LTDOT Long Term Domiciliary Oxygen Therapy PSRMF Public Sector Risk Management Framework this has involved putting in place a recovery roadmap, focusing on six EML Essential Medicines List AO Accounting Officer M&E Monitoring And Evaluation PSS Professional Services Support strategic drivers of clinical and clinical support services: Leadership EMS Emergency Medical Services APC Advanced Primary Care MAM Moderate Acute Malnutrition PWDs People With Disabilities and Governance; ICT Optimisation for Evidence Based Health Care; ENT Ear, Nose and Throat API Active Pharmaceutical Ingredient MDPSA Member of Directed Pension Scheme Administration QA Quality Assurance Financial Discipline and Prudence; Patient Safety and Improved Health EPWP Expanded Public Works Programme APP Annual Performance Plan MDR-TB Multi-Drug Resistant Tuberculosis RADU Remote Automated Dispensing Units Outcomes; and Human Resources for Health and Health Wellness and ERM Enterprise Risk Management APP Annual Procurement Plan MEC Member Of Executive Council RDT Rapid Diagnostic Test Happiness. ES Equitable Share ART Antiretroviral Treatment MIS Management Information System RFQ Request For Quotation ESMOE Essential Steps in Managing Obstetric Emergencies ARV Antiretroviral MMC Medical Male Circumcision RM Risk Management The drivers relating to Clinical Services (Patient Safety and Improved EXCO Executive Committee BAA Basic Ambulance Assistant MMR Maternal Mortality Rate RMC Risk Management Committee Health Outcomes) have resulted in the development of the Mental Family Violence, Child Protection and Sexual Offences Unit B-BBEE Broad-Based Black Economic Empowerment FCSU Memorandum Of Understanding Regional Training Centre MOU RTC This annual report reviews the performance of the Gauteng Health Recovery plan, the Maternal and Neonatal Health Recovery Forensic Pathology Service BHVI Brien Holden Vision Institute FPS Management Performance Assessment Tool South African Bureau Of Standards MPAT SABS Department of Health (GDOH) for the year 2018/2019, the final year plan and the establishment of an accreditation committee to assess GCRA Gauteng City Region Academy BLS Basic Life Support MPET Management Performance Enhancement Tool SADC Southern African Development Community of the previous administration, underlining the work that the quality across the health facilities. The overwhelming evidence GDE Gauteng Department of Education BMH Bheki Mlangeni Hospital MPSA Minister Of Public Service And Administration SAM Severe Acute Malnutrition Department has done in implementing the province’s generated in the Department reflects recurring underperformance in GDID Gauteng Department of Infrastructure Development BoQ Bill of Quantity MSD Medical Supplies Depot SAMEC South African Malaria Elimination Committee Transformation, Modernisation and Re-Industrialisation policy these strategic programmes and they are therefore being prioritised GDoH Gauteng Department of Health CAD Computer Aided Dispatch MSSN Management Of Small And Sick New-Borns SANC South African Nursing Council framework. within the Recovery Road Map currently being used. GHAC Gauteng Health Accreditation Committee CCMDD Centralised Chronic Medicine Dispensing and Distribution MTCT Mother To Child Transmission SAPS South African Police Service GP Gauteng Province CCPGP Co-ordinating Chamber of the Public Service Co-ordinating Bargaining Council CBC for Gauteng Province NCD Non-Communicable Disease SASSA South African Social Security Agency The report reflects the milestones and difficulties that the While our focus and some of the expectations of the communities we GP General Practitioner CDC Communicable Disease Control NCS National Core Standard SBAH Steve Biko Academic Hospital Department has overcome, in the face of particular pressures during serve have tended to be on curative care, it is well recognised that GPG Gauteng Provincial Government CEO Chief Executive Officer NDoH National Department Of Health SCM Supply Chain Management the year, in ensuring that the health care needs of the people of delivery of healthcare requires a much broader approach. As part of GPT Gauteng Provincial Treasury CFMS Clinical Forensic Medical Service NDP National Development Plan SCOPA Standing Committee On Public Accounts Gauteng are met. The effects of rapid urbanisation and increased pushing back the frontiers of ill-health, the GDoH launched a GRV Goods Receipt Voucher CFO Chief Financial Officer NDPW National Department Of Public Works SETA Sector Education And Training Authority migration are amongst the Department’s greatest challenges. The three-year Health, Wellness and Happiness programme on 16 GSSC Gauteng Shared Services Centre CHC Community Health Centre NGO Non-Governmental Organisation SIPDM Standard For Infrastructure Procurement And Delivery Management report therefore reflects these challenges and their effects on the November 2018 with the aim of increasing health promotion and HAST HIV, AIDS, STIs and TB CHBAH Chris Hani Baragwanath Academic Hospital NHA National Health Act SITA State Information Technology Agency health service. disease prevention for better health outcomes. HBB Helping Baby Breathe CHW Community Health Worker NHI National Health Insurance SLA Service-Level Agreement HC Higher Certificate CMJAH Charlotte Maxeke Johannesburg Academic Hospital NHLS National Health Laboratory Services SLU Specialised Litigation Unit In developing the report and in planning for the next five years, the Despite the many challenges facing its health system, Gauteng has HCW Health Care Waste CMR Child Mortality Rate NIDS National Information Data System SMME Small, Medium Or Micro Enterprise Department has taken stock of government’s priorities. Gauteng is a the highest proportion of primary health facilities certified as Ideal HCWM Health Care Waste Management CoE Cost of Employment NIMART Nurse-Initiated Management Of ART SMS Senior Management Service diverse, multi-racial and multi-class society where, in providing Clinics in South Africa; this is confirmed by the Office of Health HFM Health Facilities Management CoJ City of Johannesburg NMC Notifiable Medical Condition SOCP Sexual Offences Care Practitioner adequate health services, “the people must always come first”. This Standards Compliance which is responsible for guiding, monitoring HFRG Hospital Facility Revitalisation Grant COPC Community-oriented Primary Care NSI Needle Stick Injury SOP Standard Operating Procedure is the spirit that drives Team Gauteng Health during this new term. and enforcing health care safety and quality standards in the HIFU High-intensity Focused Ultrasound COPD Chronic Obstructive Pulmonary Disease NTSG National Tertiary Services Grant STI Sexually Transmitted Infection Taking full account of the pressures and challenges that currently country’s health facilities. We have worked hard to introduce the Ideal HIS Health Information System CoT City of Tshwane OD Organisational Design TB Tuberculosis prevent our public healthcare system from meeting the standards of Hospitals Accreditation system in line with the Ideal Clinics System, HIV Human Immunodeficiency Virus CPD Continuing Professional Development OHS Occupational Health And Safety Td Tetanus-Diphtheria excellence to which we aspire, we must persist in our objective of and have appointed a panel of eight professionals as the Gauteng HOD Head of Department CPSI Centre for Public Service Innovation OHSC Office Of The Health Standards And Compliance TER Township Economy Revitalisation improving the quality of healthcare for all the province’s residents. Health Accreditation Committee (GHAC) whose main purpose is to HPCSA Health Professions Council of South Africa CRO Chief Risk Officer OPD Outpatient Department TOR Terms of Reference The GDoH is the largest health service provider in South Africa, sustain and expand the province’s Ideal Clinics status and to realise HPRS Health Patient Registration System CSD Central Supplier Database PACS Picture Archiving And Communication System TR Treasury Regulation serving 14,6 million residents (25 % of the country’s population). the Ideal Hospitals system. HPV Human Papilloma Virus CT Computerised Tomography PALS Paediatric Advanced Life Support TROA Total Remaining On ART Over the past two and half decades, the province’s population has HR Human Resources DCST District Clinical Specialist Team PCU Physically Challenged Unit UCT University Of Cape Town doubled and the number of patient visits almost tripled. Only 25% Average life expectancy in Gauteng has increased from 56 to 67 HRD Human Resources Development DDG Deputy Director General PDE Patient-Day Equivalent UP University Of Pretoria of the population have adequate medical aid coverage (according to years, and mother-to-child transmission of HIV has been reduced over HWSETA Health & Welfare Sector Education & Training Authority DGMAH Doctor George Mukhari Academic Hospital PEP Post-Exposure Prophylaxis UPFS Uniform Patient Fees Schedule a 2017 report by Statistics South Africa). This increases demand for the past five year term of government to 0,9% ushering in the ICSP Internship and Community Service Programme DHIS District Health Information System PEPFAR President's Emergency Plan For AIDS Relief VHF Viral Haemorrhagic Fever public healthcare services as, when medical aid scheme benefits do possibility that South Africa will be amongst the first countries in the ICT Information and Communications Technology DID Department of Infrastructure Development PFMA Public Finance Management Act VMMC Voluntary Medical Male Circumcision not exist or are exhausted, people turn to the public sector. world to do so. A decentralisation policy underlies this success, with ICU Intensive Care Unit DOH Department of Health (national) PHC Primary Health Care WBOT Ward-Based Outreach Team delegations to strengthen district management. ILS Intermediate Life Support DORA Division of Revenue Act PHSDSBC Public Health And Social Development Bargaining Council Wits University Of the Witwatersrand PIR Project Initiation Report

Department of Health Annual Report 2018/19 7

The Department’s service platforms nevertheless remain resilient and, during the year, It was able to provide approximately 27.7 million patient visits for patients presenting at PHCs, emergency and outpatient hospital Departments. Thus 183 851 additional patients visits were catered for during the year under review. This increasing demand requires improved and efficient business processes which the Department is implementing using appropriate technology. Part of this has involved putting in place a recovery roadmap, focusing on six strategic drivers of clinical and clinical support services: Leadership and Governance; ICT Optimisation for Evidence Based Health Care; Financial Discipline and Prudence; Patient Safety and Improved Health Outcomes; and Human Resources for Health and Health Wellness and Happiness.

The drivers relating to Clinical Services (Patient Safety and Improved Health Outcomes) have resulted in the development of the Mental This annual report reviews the performance of the Gauteng Health Recovery plan, the Maternal and Neonatal Health Recovery Department of Health (GDOH) for the year 2018/2019, the final year plan and the establishment of an accreditation committee to assess of the previous administration, underlining the work that the quality across the health facilities. The overwhelming evidence Department has done in implementing the province’s generated in the Department reflects recurring underperformance in Transformation, Modernisation and Re-Industrialisation policy these strategic programmes and they are therefore being prioritised framework. within the Recovery Road Map currently being used.

The report reflects the milestones and difficulties that the While our focus and some of the expectations of the communities we Department has overcome, in the face of particular pressures during serve have tended to be on curative care, it is well recognised that the year, in ensuring that the health care needs of the people of delivery of healthcare requires a much broader approach. As part of Gauteng are met. The effects of rapid urbanisation and increased pushing back the frontiers of ill-health, the GDoH launched a migration are amongst the Department’s greatest challenges. The three-year Health, Wellness and Happiness programme on 16 report therefore reflects these challenges and their effects on the November 2018 with the aim of increasing health promotion and health service. disease prevention for better health outcomes.

In developing the report and in planning for the next five years, the Despite the many challenges facing its health system, Gauteng has Department has taken stock of government’s priorities. Gauteng is a the highest proportion of primary health facilities certified as Ideal diverse, multi-racial and multi-class society where, in providing Clinics in South Africa; this is confirmed by the Office of Health adequate health services, “the people must always come first”. This Standards Compliance which is responsible for guiding, monitoring is the spirit that drives Team Gauteng Health during this new term. and enforcing health care safety and quality standards in the Taking full account of the pressures and challenges that currently country’s health facilities. We have worked hard to introduce the Ideal prevent our public healthcare system from meeting the standards of Hospitals Accreditation system in line with the Ideal Clinics System, excellence to which we aspire, we must persist in our objective of and have appointed a panel of eight professionals as the Gauteng improving the quality of healthcare for all the province’s residents. Health Accreditation Committee (GHAC) whose main purpose is to The GDoH is the largest health service provider in South Africa, sustain and expand the province’s Ideal Clinics status and to realise serving 14,6 million residents (25 % of the country’s population). the Ideal Hospitals system. Over the past two and half decades, the province’s population has doubled and the number of patient visits almost tripled. Only 25% Average life expectancy in Gauteng has increased from 56 to 67 of the population have adequate medical aid coverage (according to years, and mother-to-child transmission of HIV has been reduced over a 2017 report by Statistics South Africa). This increases demand for the past five year term of government to 0,9% ushering in the public healthcare services as, when medical aid scheme benefits do possibility that South Africa will be amongst the first countries in the not exist or are exhausted, people turn to the public sector. world to do so. A decentralisation policy underlies this success, with delegations to strengthen district management.

8 Department of Health Annual Report 2018/19

The Department has reduced past year accruals and irregular As we chart a way forward for the next five years, we will continue expenditure and has progressively improved the rate of payments to to position ourselves as a leader in the country, particularly in suppliers within 30 days. Much more remains to be done to ensure relation to the roll-out of National Health Insurance. I encourage all that business processes become more efficient, with officials and of us to re-commit ourselves to diligence in service as we forge management held accountable for their actions and inactions in ahead towards high quality healthcare for all. In the next five years, areas of recurring underperformance. we will as a Department continue to implement the Recovery Road Map strategy and to provide the people of Gauteng with a In his State of the Province address, Gauteng Premier David Makhura transformed, responsive and effective public health service. pointed to the profound challenges relating to service delivery in the health system and that these have to be resolved as soon as possible. The financial and structural challenges facing the public healthcare system are the subject of urgent attention by the Provincial Executive Council and National Cabinet, with President Ramaphosa announcing measures to deal with these matters as part of the ______Economic Stimulus and Recovery Plan. This includes addressing Gauteng MEC for Health shortages in hospitals, making funding available to buy new medical 31 May 2019 equipment and linen and filling critical medical posts.

Department of Health Annual Report 2018/19 9 The Department’s service platforms nevertheless remain resilient and, during the year, It was able to provide approximately 27.7 million patient visits for patients presenting at PHCs, emergency and outpatient hospital Departments. Thus 183 851 additional patients visits were catered for during the year under review. This increasing demand requires improved and efficient business processes which the Department is implementing using appropriate technology. Part of this has involved putting in place a recovery roadmap, focusing on six strategic drivers of clinical and clinical support services: Leadership and Governance; ICT Optimisation for Evidence Based Health Care; Financial Discipline and Prudence; Patient Safety and Improved Health Outcomes; and Human Resources for Health and Health Wellness and Happiness.

4. REPORT OF THE ACCOUNTING OFFICER

Programmes that previously showed areas of underperformance Awards and our own Khanyisa awards, a number have been publicly have improved since implementation of the Recovery Road Map and acknowledged for their service excellence. Public appreciation of During the year under review, the Department implemented a There were also notable improvements in financial management and The Department moved swiftly with the support of the provincial the Department has achieved an increased number of its targets those who have shown great commitment to the Department’s Recovery Plan as outlined in my introduction. The plan has six pillars, accountability. As a result, accruals were reduced from R6.8 billion government, WITS Health Consortium, Standard Bank, PEPFAR compared with the previous financial year. It is hoped that, with work is a pattern that the Department needs to maintain and three of which focus on clinical support and the remaining three on to R4.4 billion. Despite the improvements, debt collection remains a partners, the Life Health group, Zwavelstream Psychiatric Hospital even more determination and implementation of the Road Map, this reinforce. A good public healthcare system depends on the profes- the strengthening of health systems. challenge. and Nashua to ensure that service delivery was impacted minimally. trend will continue strongly. sionalism and compassion of its workers. A business continuity policy has since been approved and the The theory of change behind the pillars was that, by reshaping Matters under investigation include allegations of officials doing Department has now completed the business continuity maturity The Department has reduced past year accruals and irregular As we chart a way forward for the next five years, we will continue governance and stewardship, modernizing information and business with the state, fraudulent overtime claims, employees assessment which forms the basis for the development of business expenditure and has progressively improved the rate of payments to to position ourselves as a leader in the country, particularly in performance management systems and using such information for doing remunerative work without approval and ghost employees. continuity plans for the health facilities. suppliers within 30 days. Much more remains to be done to ensure relation to the roll-out of National Health Insurance. I encourage all decision making coupled with maximum use of competent human For the first time in the 5th term of government, the equity target for that business processes become more efficient, with officials and of us to re-commit ourselves to diligence in service as we forge resources and prudent fiscal discipline, we should be able to put the persons with disabilities was met. Although the Departmental Efforts are under way to ensure that there is continuous management held accountable for their actions and inactions in ahead towards high quality healthcare for all. In the next five years, Department in a positive performance trajectory which will see the targets have been attained, more still needs to be done in these improvement in compliance with Occupational Health and Safety areas of recurring underperformance. we will as a Department continue to implement the Recovery Road envisaged health outputs and outcomes achieved. areas to ensure that the transformation targets of 50% female SMS (OHS) regulations. Training on OHS compliance was undertaken for Map strategy and to provide the people of Gauteng with a and 2% of persons with disability are reached in accordance with all head office employees. In his State of the Province address, Gauteng Premier David Makhura transformed, responsive and effective public health service. Results from the implementation of the Recovery Plan include a the law. As part of improving efficiencies and building a pointed to the profound challenges relating to service delivery in the comprehensive governance system and management structures high-reliability organisation, the Department now has 12 hospitals Assessments have also been made pertaining to the safety of health system and that these have to be resolved as soon as possible. which take collective decisions in a transparent manner, including that are implementing Lean Management in phased in manner. The patients and staff in all health facilities. Our commitment to The financial and structural challenges facing the public healthcare 4.1 OVERVIEW OF THE DEPARTMENT’S re-establishment of secretariat services. The primary recovery percentage of hospitals with an upgraded Local Area Network (LAN) implementing the national vision as reflected in the National system are the subject of urgent attention by the Provincial Executive NON-FINANCIAL RESULTS roadmap included the development of recovery plans for priority infrastructure was also exceeded through the adoption of a lean Development Plan and the Departmental quality improvement programme, namely, Mental health care programme, the Maternal LAN infrastructure design. This resulted in an additional four initiatives aimed at improving experience of care for our Council and National Cabinet, with President Ramaphosa The current annual reporting season coincides with the final year of and Neonatal health care programme and the framework for Health, hospitals being incorporated into the LAN. communities is ever before our eyes. announcing measures to deal with these matters as part of the ______the 5th administrative term of government and the implementation Wellness and Revolution. Other fundamental changes that took Economic Stimulus and Recovery Plan. This includes addressing Gauteng MEC for Health of the Recovery Plan of the Gauteng Department of Health. Thus, place as a result of the implementation of the Recovery Plan include Despite the acute challenges to the health system, the Department In this regard, we were saddened by an increasing number of attacks shortages in hospitals, making funding available to buy new medical Date the work of the Department not only continued to focus on the decision to decentralise care to districts followed by the continued to strive for improved quality of service, as indicated by on our staff, predominantly emergency medical services staff with equipment and linen and filling critical medical posts. improving the quality of patient care but sought to strengthen delegation of various powers to district managers and hospital the fact that the GDoH has the highest proportion of clinics that are some isolated attacks at our health facilities. We will continue to use systems critical for improving patient experience of care. As a result CEOs. In addition, the Department with the support of universities Ideal Clinics in the country, at 89%. Also, 30 of its 32 Community every avenue to educate and increase the awareness of communities The Department has moved with speed and great care in of these initiatives, real improvements in key human development embarked on an initiative to strengthen sub-district clinical and Health Centres (CHCs) provide comprehensive 24 hour services. of their responsibilities to health care delivery and advocate for implementing all the recommendations of the Life Esidimeni report indicators such as average life expectancy at birth were apparent. administrative governance. Efforts to improve access to medicines saw enrolment of clients in communities that are comprised of public health activists. The tabled by retired Deputy Chief Justice Dikgang Moseneke. It is According to Stats SA, the 2017 mid-year estimates for average life the Centralised Chronic Medicine Dispensing and Distribution Department in collaboration with the Department of Community important to emphasise that the recommendations did not relate expectancy at birth for Gauteng is approximately 67 years. only to financial recourse on the part of the Department. It brought Finally, GDoH launched a Health, Wellness and Happiness programme rising to 490 518. Safety, the South African Police Service and the Private Security Revolution programme earmarked for implementation over three Industry Regulatory Authority have undertaken a process of to the centre broader questions about how to position mental health Over the five years, the Department made notable progress on years. As regards financial and human resources management and Notwithstanding the efforts of the Department to provide quality strengthening physical security at health facilities through insourcing as a priority for GDoH and has enhanced the Department’s several other strategic and developmental goals. In this regard, the leadership, the process of ensuring readiness to implement in the health care, it has been hampered by several instances of labour physical security using police reservists and community safety partnership with the Office of Health Standards Compliance and Department contributed to producing a generation of under-20s new financial year commenced by the end of the fiscal year. By the unrest, namely those by student nurses, community health workers patrollers. with the Family Committee to ensure a collaborative, appropriate that is mostly free of HIV. Significant improvement in the prevention end of March, operational plans, performance contracts and and general staff demanding payment of performance bonuses. and professional approach to managing mental health issues. The of Mother to Child Transmission (MTCT) of HIV, approaching zero demand and equipment plans were available from management. lessons from the Life Esidimeni tragedy must compel us to ensure infection rate, is slowly becoming a reality. We have managed to This is a significant improvement in management practices, as such Another significant event that unsettled the Department's that nothing like it happens again. The health and wellness of the reduce MTCT of HIV from 2% to 0.99% at ten weeks after birth and documents were never previously submitted on time. To this end, administrative operations was the fire at the Bank of Lisbon building people of Gauteng are paramount and it is our responsibility to will have increased antiretroviral coverage among pregnant women the Department has been able to resource these plans using the on the 5th of September 2018. Although the impact on service ensure that they are always provided with the best quality of living with HIV to over 90% by 2019/20. We have managed also to stimulus package. delivery of the fire was minimal, the administrative functioning of healthcare. exceed the five-year targets for the reduction of the infant mortality the Department was significantly impacted particularly in that access and under-5 mortality rates. The neonatal mortality rate, however, The Department further augmented critical posts in accordance with to records was restricted, it became difficult to account fully for With the support of the wide range of stakeholders concerned with remains stubbornly unchanged. A comprehensive recovery plan to its recovery journey through a reprioritisation exercise. Two assets and employees underwent emotional trauma. In addition, and participating in our activities, we remain convinced that the address the determinants of the deaths of new borns has been thousand posts aligned to the budget were approved by the Post there was loss of administrative productivity as support staff were at province’s health care system will continue to improve. This will be developed in this regard. In addition, the Department has also Filling Committee. In addition, it benefitted from the human home due to lack of office space, tools of their trade and operational supported by collaboration with the Health Sciences Faculties in our observed tremendous increases in the demand for health care resources capacitation grant element in the stimulus package. infrastructure. eight universities, specialised research institutions, NGOs, civil services across its various service platforms. society and other stakeholders. We are also encouraged by our employees who serve daily with diligence; Through the Premier’s

10 Department of Health Annual Report 2018/19 The Department’s service platforms nevertheless remain resilient and, during the year, It was able to provide approximately 27.7 million patient visits for patients presenting at PHCs, emergency and outpatient hospital Departments. Thus 183 851 additional patients visits were catered for during the year under review. This increasing demand requires improved and efficient business processes which the Department is implementing using appropriate technology. Part of this has involved putting in place a recovery roadmap, focusing on six strategic drivers of clinical and clinical support services: Leadership and Governance; ICT Optimisation for Evidence Based Health Care; Financial Discipline and Prudence; Patient Safety and Improved Health Outcomes; and Human Resources for Health and Health Wellness and Happiness.

Programmes that previously showed areas of underperformance Awards and our own Khanyisa awards, a number have been publicly have improved since implementation of the Recovery Road Map and acknowledged for their service excellence. Public appreciation of During the year under review, the Department implemented a There were also notable improvements in financial management and The Department moved swiftly with the support of the provincial the Department has achieved an increased number of its targets those who have shown great commitment to the Department’s Recovery Plan as outlined in my introduction. The plan has six pillars, accountability. As a result, accruals were reduced from R6.8 billion government, WITS Health Consortium, Standard Bank, PEPFAR compared with the previous financial year. It is hoped that, with work is a pattern that the Department needs to maintain and three of which focus on clinical support and the remaining three on to R4.4 billion. Despite the improvements, debt collection remains a partners, the Life Health group, Zwavelstream Psychiatric Hospital even more determination and implementation of the Road Map, this reinforce. A good public healthcare system depends on the profes- the strengthening of health systems. challenge. and Nashua to ensure that service delivery was impacted minimally. trend will continue strongly. sionalism and compassion of its workers. A business continuity policy has since been approved and the The theory of change behind the pillars was that, by reshaping Matters under investigation include allegations of officials doing Department has now completed the business continuity maturity The Department has reduced past year accruals and irregular As we chart a way forward for the next five years, we will continue governance and stewardship, modernizing information and business with the state, fraudulent overtime claims, employees assessment which forms the basis for the development of business expenditure and has progressively improved the rate of payments to to position ourselves as a leader in the country, particularly in performance management systems and using such information for doing remunerative work without approval and ghost employees. continuity plans for the health facilities. suppliers within 30 days. Much more remains to be done to ensure relation to the roll-out of National Health Insurance. I encourage all decision making coupled with maximum use of competent human For the first time in the 5th term of government, the equity target for that business processes become more efficient, with officials and of us to re-commit ourselves to diligence in service as we forge resources and prudent fiscal discipline, we should be able to put the persons with disabilities was met. Although the Departmental Efforts are under way to ensure that there is continuous management held accountable for their actions and inactions in ahead towards high quality healthcare for all. In the next five years, Department in a positive performance trajectory which will see the targets have been attained, more still needs to be done in these improvement in compliance with Occupational Health and Safety areas of recurring underperformance. we will as a Department continue to implement the Recovery Road envisaged health outputs and outcomes achieved. areas to ensure that the transformation targets of 50% female SMS (OHS) regulations. Training on OHS compliance was undertaken for Map strategy and to provide the people of Gauteng with a and 2% of persons with disability are reached in accordance with all head office employees. In his State of the Province address, Gauteng Premier David Makhura transformed, responsive and effective public health service. Results from the implementation of the Recovery Plan include a the law. As part of improving efficiencies and building a pointed to the profound challenges relating to service delivery in the comprehensive governance system and management structures high-reliability organisation, the Department now has 12 hospitals Assessments have also been made pertaining to the safety of health system and that these have to be resolved as soon as possible. which take collective decisions in a transparent manner, including that are implementing Lean Management in phased in manner. The patients and staff in all health facilities. Our commitment to The financial and structural challenges facing the public healthcare re-establishment of secretariat services. The primary recovery percentage of hospitals with an upgraded Local Area Network (LAN) implementing the national vision as reflected in the National system are the subject of urgent attention by the Provincial Executive roadmap included the development of recovery plans for priority infrastructure was also exceeded through the adoption of a lean Development Plan and the Departmental quality improvement Council and National Cabinet, with President Ramaphosa programme, namely, Mental health care programme, the Maternal LAN infrastructure design. This resulted in an additional four initiatives aimed at improving experience of care for our The current annual reporting season coincides with the final year of announcing measures to deal with these matters as part of the ______and Neonatal health care programme and the framework for Health, hospitals being incorporated into the LAN. communities is ever before our eyes. the 5th administrative term of government and the implementation Economic Stimulus and Recovery Plan. This includes addressing Gauteng MEC for Health Wellness and Revolution. Other fundamental changes that took of the Recovery Plan of the Gauteng Department of Health. Thus, shortages in hospitals, making funding available to buy new medical Date place as a result of the implementation of the Recovery Plan include Despite the acute challenges to the health system, the Department In this regard, we were saddened by an increasing number of attacks the work of the Department not only continued to focus on equipment and linen and filling critical medical posts. the decision to decentralise care to districts followed by the continued to strive for improved quality of service, as indicated by on our staff, predominantly emergency medical services staff with improving the quality of patient care but sought to strengthen delegation of various powers to district managers and hospital the fact that the GDoH has the highest proportion of clinics that are some isolated attacks at our health facilities. We will continue to use systems critical for improving patient experience of care. As a result The Department has moved with speed and great care in CEOs. In addition, the Department with the support of universities Ideal Clinics in the country, at 89%. Also, 30 of its 32 Community every avenue to educate and increase the awareness of communities of these initiatives, real improvements in key human development implementing all the recommendations of the Life Esidimeni report embarked on an initiative to strengthen sub-district clinical and Health Centres (CHCs) provide comprehensive 24 hour services. of their responsibilities to health care delivery and advocate for indicators such as average life expectancy at birth were apparent. tabled by retired Deputy Chief Justice Dikgang Moseneke. It is administrative governance. Efforts to improve access to medicines saw enrolment of clients in communities that are comprised of public health activists. The According to Stats SA, the 2017 mid-year estimates for average life important to emphasise that the recommendations did not relate the Centralised Chronic Medicine Dispensing and Distribution Department in collaboration with the Department of Community expectancy at birth for Gauteng is approximately 67 years. only to financial recourse on the part of the Department. It brought Finally, GDoH launched a Health, Wellness and Happiness programme rising to 490 518. Safety, the South African Police Service and the Private Security to the centre broader questions about how to position mental health Revolution programme earmarked for implementation over three Industry Regulatory Authority have undertaken a process of Over the five years, the Department made notable progress on as a priority for GDoH and has enhanced the Department’s years. As regards financial and human resources management and Notwithstanding the efforts of the Department to provide quality strengthening physical security at health facilities through insourcing several other strategic and developmental goals. In this regard, the partnership with the Office of Health Standards Compliance and leadership, the process of ensuring readiness to implement in the health care, it has been hampered by several instances of labour physical security using police reservists and community safety Department contributed to producing a generation of under-20s with the Family Committee to ensure a collaborative, appropriate new financial year commenced by the end of the fiscal year. By the unrest, namely those by student nurses, community health workers patrollers. that is mostly free of HIV. Significant improvement in the prevention and professional approach to managing mental health issues. The end of March, operational plans, performance contracts and and general staff demanding payment of performance bonuses. of Mother to Child Transmission (MTCT) of HIV, approaching zero 4.2 OVERVIEW OF THE DEPARTMENT’S FINANCIAL lessons from the Life Esidimeni tragedy must compel us to ensure demand and equipment plans were available from management. infection rate, is slowly becoming a reality. We have managed to RESULTS that nothing like it happens again. The health and wellness of the This is a significant improvement in management practices, as such Another significant event that unsettled the Department's reduce MTCT of HIV from 2% to 0.99% at ten weeks after birth and people of Gauteng are paramount and it is our responsibility to documents were never previously submitted on time. To this end, administrative operations was the fire at the Bank of Lisbon building The Department surpassed its revenue collection target by R272 will have increased antiretroviral coverage among pregnant women ensure that they are always provided with the best quality of the Department has been able to resource these plans using the on the 5th of September 2018. Although the impact on service million (54%). The notable improvement in revenue collection is a living with HIV to over 90% by 2019/20. We have managed also to healthcare. stimulus package. delivery of the fire was minimal, the administrative functioning of result of increased payments received from medical schemes, the exceed the five-year targets for the reduction of the infant mortality the Department was significantly impacted particularly in that access Road Accident Fund and self-paying patients. Despite this, payment and under-5 mortality rates. The neonatal mortality rate, however, With the support of the wide range of stakeholders concerned with The Department further augmented critical posts in accordance with to records was restricted, it became difficult to account fully for delays from some provinces are still encountered, with no payments remains stubbornly unchanged. A comprehensive recovery plan to and participating in our activities, we remain convinced that the its recovery journey through a reprioritisation exercise. Two assets and employees underwent emotional trauma. In addition, received from Limpopo and Mpumalanga provinces. There will be address the determinants of the deaths of new borns has been province’s health care system will continue to improve. This will be thousand posts aligned to the budget were approved by the Post there was loss of administrative productivity as support staff were at continuous engagement with revenue collecting agencies regarding developed in this regard. In addition, the Department has also supported by collaboration with the Health Sciences Faculties in our Filling Committee. In addition, it benefitted from the human home due to lack of office space, tools of their trade and operational outstanding debts. observed tremendous increases in the demand for health care eight universities, specialised research institutions, NGOs, civil resources capacitation grant element in the stimulus package. infrastructure. services across its various service platforms. society and other stakeholders. We are also encouraged by our employees who serve daily with diligence; Through the Premier’s

Department of Health Annual Report 2018/19 11 The Department’s service platforms nevertheless remain resilient and, during the year, It was able to provide approximately 27.7 million patient visits for patients presenting at PHCs, emergency and outpatient hospital Departments. Thus 183 851 additional patients visits were catered for during the year under review. This increasing demand requires improved and efficient business processes which the Department is implementing using appropriate technology. Part of this has involved putting in place a recovery roadmap, focusing on six strategic drivers of clinical and clinical support services: Leadership and Governance; ICT Optimisation for Evidence Based Health Care; Financial Discipline and Prudence; Patient Safety and Improved Health Outcomes; and Human Resources for Health and Health Wellness and Happiness.

DEPARTMENTAL RECEIPTS Programmes that previously showed areas of underperformance Awards and our own Khanyisa awards, a number have been publicly Table: Breakdown of revenue collected per source have improved since implementation of the Recovery Road Map and acknowledged for their service excellence. Public appreciation of the Department has achieved an increased number of its targets those who have shown great commitment to the Department’s 2018/19 2017/18 compared with the previous financial year. It is hoped that, with work is a pattern that the Department needs to maintain and Estimate Actual (Over)/Under Estimate Actual (Over)/Under even more determination and implementation of the Road Map, this reinforce. A good public healthcare system depends on the profes- Departmental receipts Amount Collection Amount Collection Collected Collected trend will continue strongly. sionalism and compassion of its workers. R’000 R’000 R’000 R’000 R’000 R’000

The Department has reduced past year accruals and irregular As we chart a way forward for the next five years, we will continue Sale of goods and services other than capital assets 475 648 657 -173 322 449 821 503 424 -53 603 expenditure and has progressively improved the rate of payments to to position ourselves as a leader in the country, particularly in Transfers received - - - - 1 -1 suppliers within 30 days. Much more remains to be done to ensure relation to the roll-out of National Health Insurance. I encourage all Fines, penalties and forfeits 335 97 -39 55 48 7 that business processes become more efficient, with officials and of us to re-commit ourselves to diligence in service as we forge Sales of capital assets 58 1 -1 - 401 -401 management held accountable for their actions and inactions in ahead towards high quality healthcare for all. In the next five years, 1 422 764 658 1 344 974 370 areas of recurring underperformance. we will as a Department continue to implement the Recovery Road Interest, dividends and rent on land Map strategy and to provide the people of Gauteng with a Financial transactions in assets and liabilities 31 134 131 284 -100 150 29 427 42 470 -13 043 In his State of the Province address, Gauteng Premier David Makhura transformed, responsive and effective public health service. Total 507 949 780 803 -272 854 480 647 547 318 -66 671 pointed to the profound challenges relating to service delivery in the health system and that these have to be resolved as soon as possible. The following information outlines in detail how tariffs charged by the Department were determined. The financial and structural challenges facing the public healthcare system are the subject of urgent attention by the Provincial Executive Tariff Policy Council and National Cabinet, with President Ramaphosa Patient Fee Tariff announcing measures to deal with these matters as part of the ______The Department charges according to the Uniform Patient Fee • Free health services for pregnant women and children under the Economic Stimulus and Recovery Plan. This includes addressing Gauteng MEC for Health Schedule (UPFS) tariffs for patients using public hospitals. These age of six (Notice 657 of 1994, 1 July 1994). shortages in hospitals, making funding available to buy new medical Date tariffs are determined by a steering committee consisting of the • Free primary health care services (Notice 1514 of 1996, 17 equipment and linen and filling critical medical posts. National Department of Health and the health Departments of the October 1996). nine provinces. Tariffs are reviewed and revised annually in • Termination of pregnancy (Act 92 of 1996). The Department has moved with speed and great care in accordance with Section 7.3.1 of the Treasury Regulations. Patients • Social Pensioners (Act 81 of 1967 as amended by Act 100 of implementing all the recommendations of the Life Esidimeni report accessing public institutions are classified into three main groups for 1998). tabled by retired Deputy Chief Justice Dikgang Moseneke. It is service fee determination. The classifications are listed below: • Medico-legal services for survivors of rape, assault and post important to emphasise that the recommendations did not relate mortem (Criminal Procedure Act 51 of 1977). Full Paying only to financial recourse on the part of the Department. It brought • Donors (Human Tissue Act 63 of 1965). This category of patients is liable to pay full UPFS fees for all services to the centre broader questions about how to position mental health • Children who are committed to the care of a children’s home, provided. as a priority for GDoH and has enhanced the Department’s industrial school or foster parents (Child Care Act 74 of 1983, partnership with the Office of Health Standards Compliance and Section 15). Subsidised and Exempted Patients with the Family Committee to ensure a collaborative, appropriate • Persons with mental disorders (Mental Health Act 18 of 1973). These patients are classified into six categories (PH, PG, HG, H0, H1, and professional approach to managing mental health issues. The • Treatment of infectious, formidable and notifiable diseases H2 and H3) based on statutory requirements. The PG and HG lessons from the Life Esidimeni tragedy must compel us to ensure (National Health Act 61 of 2003). categories are exempted from paying fees because of statutorily that nothing like it happens again. The health and wellness of the • Services to the formally unemployed (Unemployment Insurance determined circumstances: for example, pregnant women and people of Gauteng are paramount and it is our responsibility to Act 63 of 2001). children under the age of six. ensure that they are always provided with the best quality of • Patients receiving HIV and AIDS treatment (Notice 1 of August healthcare. 2006). The H0 category receives services free of charge only when they provide proof of status: for example, social pensioners. The H1, H2 With the support of the wide range of stakeholders concerned with and H3 category pay discounted fees which are expressed as a Meals and Crèche Fees Tariffs and participating in our activities, we remain convinced that the percentage of the fees payable by full-paying patients. The tariffs for meals and crèches are reviewed and revised annually province’s health care system will continue to improve. This will be in accordance with Section 7.3.1 of the Treasury Regulations. Tariff supported by collaboration with the Health Sciences Faculties in our adjustments are also negotiated and agreed upon with employee eight universities, specialised research institutions, NGOs, civil Free Services organisations. society and other stakeholders. We are also encouraged by our The following free services are provided in line with national and employees who serve daily with diligence; Through the Premier’s Other Tariffs provincial policies: Other tariffs such as parking and accommodation are determined externally with the involvment of relevant Departments.

12 Department of Health Annual Report 2018/19 Table: Patient Fees Debt • Health institutions to utilise the Central Supplier Database • Investigation of irregular expenditure (CSD) to obtain a list of prospective SMME suppliers in various • Continuous training on SCM processes and procedures HOSPITALS BAD DEBTS WRITTEN OFF R’000 corridors. • Ensuring technical capacity of staff Central Hospitals 251 881 • Health institutions to utilise service providers on a rotational • Consequence management Regional Hospitals 59 231 basis in procuring goods and services to promote ongoing • Ensuring that bids are awarded within the validity period to Tertiary Hospitals 47 683 competition amongst SMME suppliers. avoid extensions of contract.

District Hospitals 18 912 • Health institutions to request price quotations for requirements • Fast-tracking finalisation of the procurement process of the up to R500 000 from as many suppliers as possible that are consignment stock tender. Dental Hospitals 1 528 registered on the CSD. Tuberculosis Hospitals 44 • Health institutions to ensure the uplifting of SMME suppliers 4.6 GIFTS AND DONATIONS IN KIND RECEIVED FROM Psychiatric Hospitals 818 by encouraging subcontracting for bids above R500 000. NON-RELATED PARTIES Other specialised Hospitals 46 The Department received various donations in kind, including Despite the challenges cited above, the Department was able to computer equipment, office furniture and other machinery. TOTAL 380 142 engage with both large and small suppliers. To demonstrate our commitment to the transformation of the health sector, the 4.7 EXEMPTIONS AND DEVIATIONS RECEIVED FROM The table below summarises the performance of the appropriated budget and expenditure per programme from 2017/18 to 2018/19. Department engaged with the large suppliers to assist it to spend its THE PROVINCIAL TREASURY The Department obtained approval to deviate from the normal Table: Programme Expenditure budgets in a fair, equitable and just manner. The Department also engaged with cooperatives, small and medium enterprises (SMMEs) supply chain processes for the leasing of 45 Commissioner Street for 2018/2019 – Preliminary Unaudited 2017/2018 and Military Veterans, communicating opportunities available for staff relocated following the Bank of Lisbon fire. Final Actual (Over)/Under Final Actual (Over)/Under service provision and financing. Programme Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure 4.8 EVENTS AFTER THE REPORTING PERIOD The Department has applied for the condonation of irregular Despite the challenges, there are still best practices across some of expenditure after conclusion of the disciplinary processes of R’000 R’000 R’000 R’000 R’000 R’000 the institutions. Initiatives include implementation of the SAP implicated staff. An application for writing off previous years’ Administration 1 361 130 1 360 786 344 1 085 267 1 085 177 90 Inventory Management System at Steve Biko Academic Hospital, and expenditure is being processed. District Health Services 15 073 917 14 516 480 557 437 13 712 101 13 683 513 28 588 rolling out the SAP Inventory Management System to all institutions within the Department is under way. Emergency Medical Services 1 423 203 1 330 508 92 695 1 268 154 1 219 274 48 880 4.9 ACKNOWLEDGEMENTS AND APPRECIATION Provincial Hospital Services 8 746 469 8 686 653 59 816 7 892 663 7 892 277 386 The Department wishes to thank officials and management, In an effort to reduce the number of items procured through the including implementing partners, for their commitment to improving Central and Tertiary Hospitals 17 135 226 17 134 256 970 15 333 041 15 316 687 16 354 request for quotation (RFQ) process which results in the Department healthcare delivery in Gauteng. Additional acknowledgement goes Health Sciences and Training 1 123 296 1 106 708 16 588 928 471 918 987 9 484 paying exorbitant prices, vetting and quotation adjudication to agencies of government such as the Public Service Commission Health Care Support Services 339 156 339 048 108 289 838 289 767 71 committees were established to ensure that institutions procure (PSC) and the Human Rights Commission in helping support goods and services in a cost-effective manner. Health Facilities Management 1 559 933 1 536 120 23 813 1 683 299 1 607 777 75 522 governance in the Department. Total 46 762 330 46 010 559 751 771 42 192 834 42 013 459 179 375 The Department successfully compiled the Annual Procurement Plan 4.10 APPROVAL which was aligned to the budget and implemented stringent control The Annual Financial Statements set out on pages 162 to 279 have 4.3 VIREMENT/ROLLOVERS 4.4.2 SCM Achievements and Challenges measures to ensure that no item is procured that does not appear in been approved by the Accounting Officer. The Department applied for a roll-over of conditional grants funds Supply Chain Management (SCM) remains a challenge for the the Annual Procurement Plan. that were committed but could not be spent and any other funds Department. Problems are manifested in not spending on machinery that were not utilised before the closure of the 2018/19 financial and equipment, underspending on grants intended for machinery 4.5 IRREGULAR EXPENDITURE year. These funds were meant to assist the Department to reduce and equipment and very poor performance by SCM in meeting Irregular expenditure for the year under review amounted to R2,8 the burden of accruals. annual performance targets. Supply chain business processes, billion. This was mainly as a result of the month to month security ______technical capacity and augmenting of staff will receive priority. contracts, lack of a contract for cardio and nuclear consignment Prof M. Lukhele 4.4. SUPPLY CHAIN MANAGEMENT stock items as well as failure to follow SCM processes in procuring Accounting Officer 4.4.1 Unsolicited bid proposals concluded for the year under The Department did not meet the preferential procurement spend goods and services. review Gauteng Department of Health targets for black ownership, woman ownership, youth ownership The Department did not receive any unsolicited bid proposals. 31 May 2019 and disabled ownership. The Department has identified the 4.5.1 SCM processes and systems in place to prevent irregular expenditure following strategies in support of small, medium and Management has implemented control measures to ensure micro-enterprise (SMME) suppliers: compliance with Treasury Regulations and Instruction Notes relating to deviations from the normal procurement processes. Management will implement the following:

Department of Health Annual Report 2018/19 13 • Health institutions to utilise the Central Supplier Database • Investigation of irregular expenditure (CSD) to obtain a list of prospective SMME suppliers in various • Continuous training on SCM processes and procedures corridors. • Ensuring technical capacity of staff • Health institutions to utilise service providers on a rotational • Consequence management basis in procuring goods and services to promote ongoing • Ensuring that bids are awarded within the validity period to competition amongst SMME suppliers. avoid extensions of contract. • Health institutions to request price quotations for requirements • Fast-tracking finalisation of the procurement process of the up to R500 000 from as many suppliers as possible that are consignment stock tender. registered on the CSD. • Health institutions to ensure the uplifting of SMME suppliers 4.6 GIFTS AND DONATIONS IN KIND RECEIVED FROM by encouraging subcontracting for bids above R500 000. NON-RELATED PARTIES The Department received various donations in kind, including Despite the challenges cited above, the Department was able to computer equipment, office furniture and other machinery. engage with both large and small suppliers. To demonstrate our commitment to the transformation of the health sector, the 4.7 EXEMPTIONS AND DEVIATIONS RECEIVED FROM Department engaged with the large suppliers to assist it to spend its THE PROVINCIAL TREASURY budgets in a fair, equitable and just manner. The Department also The Department obtained approval to deviate from the normal engaged with cooperatives, small and medium enterprises (SMMEs) supply chain processes for the leasing of 45 Commissioner Street for and Military Veterans, communicating opportunities available for staff relocated following the Bank of Lisbon fire. service provision and financing. 4.8 EVENTS AFTER THE REPORTING PERIOD The Department has applied for the condonation of irregular Despite the challenges, there are still best practices across some of expenditure after conclusion of the disciplinary processes of the institutions. Initiatives include implementation of the SAP implicated staff. An application for writing off previous years’ Inventory Management System at Steve Biko Academic Hospital, and expenditure is being processed. rolling out the SAP Inventory Management System to all institutions within the Department is under way. 4.9 ACKNOWLEDGEMENTS AND APPRECIATION The Department wishes to thank officials and management, In an effort to reduce the number of items procured through the including implementing partners, for their commitment to improving request for quotation (RFQ) process which results in the Department healthcare delivery in Gauteng. Additional acknowledgement goes paying exorbitant prices, vetting and quotation adjudication to agencies of government such as the Public Service Commission committees were established to ensure that institutions procure (PSC) and the Human Rights Commission in helping support goods and services in a cost-effective manner. governance in the Department.

The Department successfully compiled the Annual Procurement Plan 4.10 APPROVAL which was aligned to the budget and implemented stringent control The Annual Financial Statements set out on pages 162 to 279 have 4.3 VIREMENT/ROLLOVERS 4.4.2 SCM Achievements and Challenges measures to ensure that no item is procured that does not appear in been approved by the Accounting Officer. The Department applied for a roll-over of conditional grants funds Supply Chain Management (SCM) remains a challenge for the the Annual Procurement Plan. that were committed but could not be spent and any other funds Department. Problems are manifested in not spending on machinery that were not utilised before the closure of the 2018/19 financial and equipment, underspending on grants intended for machinery 4.5 IRREGULAR EXPENDITURE year. These funds were meant to assist the Department to reduce and equipment and very poor performance by SCM in meeting Irregular expenditure for the year under review amounted to R2,8 the burden of accruals. annual performance targets. Supply chain business processes, billion. This was mainly as a result of the month to month security ______technical capacity and augmenting of staff will receive priority. contracts, lack of a contract for cardio and nuclear consignment Prof M. Lukhele 4.4. SUPPLY CHAIN MANAGEMENT stock items as well as failure to follow SCM processes in procuring Accounting Officer 4.4.1 Unsolicited bid proposals concluded for the year under The Department did not meet the preferential procurement spend goods and services. review Gauteng Department of Health targets for black ownership, woman ownership, youth ownership The Department did not receive any unsolicited bid proposals. 31 May 2019 and disabled ownership. The Department has identified the 4.5.1 SCM processes and systems in place to prevent irregular expenditure following strategies in support of small, medium and Management has implemented control measures to ensure micro-enterprise (SMME) suppliers: compliance with Treasury Regulations and Instruction Notes relating to deviations from the normal procurement processes. Management will implement the following:

14 Department of Health Annual Report 2018/19 5. STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF THE ACCURACY OF THE ANNUAL REPORT

To the best of my knowledge and belief, I confirm the following:

All information and amounts disclosed throughout the Annual Report are consistent. The Annual Report is complete, accurate and free from any omissions and has been prepared in accordance with the guidelines on Annual Reports as issued by National Treasury.

The Annual Financial Statements (Part E) have been prepared in accordance with the modified cash standard and the relevant frameworks and guidelines issued by National Treasury.

The Accounting Officer is responsible for the preparation of the Annual Financial Statements and the judgements made on this information.

The Accounting Officer is responsible for establishing and implementing a system of internal control designed to provide reasonable assurance as to the integrity and reliability of the performance information, the human resources information and the Annual Financial Statements.

External auditors were engaged to express an independent opinion on the Annual Financial Statements. In my opinion, the Annual Report fairly reflects the operations, performance information, human resources information and financial affairs of the Department for the financial year ended 31 March 2019.

Yours faithfully

______Accounting Officer Gauteng Department of Health 31 May 2019

Department of Health Annual Report 2018/19 15 6. STRATEGIC OVERVIEW

VISION

Daily, we provide high-quality, efficient and accessible healthcare to transform people’s lives.

MISSION

To create an effective public healthcare system in Gauteng by ensuring we have the right people, skills, systems and equipment to provide the care our patients need to live healthy, good-quality lives.

VALUES

Patient-focused: Everything we do should benefit the patient.

Accountability: We take ownership of our responsibilities and go above and beyond and expect our colleagues to do the same to achieve the best outcome for our patients.

Transparency: We make decisions based on facts and are willing to explain them to those affected by those decisions.

Ef ciency: We work efficiently to optimise the scarce resources to achieve more with less. We know that budgets are tight, and human resources are few.

Provincial values: We are passionate and contribute to patriotism, integrity, purposefulness, accountability and activism.

16 Department of Health Annual Report 2018/19 7. ORGANISATIONAL STRUCTURE

MEC: GAUTENG DEPARTMENT OF HEALTH

Head Of Department Head Office

DDG: Human CD: Information and Chief of Operations Resources & CD: Corporate Chief Financial DDG: Facility Technology (L14) (L15) OD (L15) Services (L14) Officer 9L15) Management (L15)

Dir: Health Information CD: Financial Management & CD: Infrastructure CD: Health Programs CD: Human Resources Dir:Legal & Corporate Management & Technology Management Management Secretarial Services Accounting

CD: Supply Chain Dir: IT Risk CD: Human Resources Management & Dir Heailth Care CD: Hospital Services CD: Communication Management Development Corporate Waste Management Governance

CD: Policy, Strategic Planning & Monitoring Dir: Information CD: District CD: Risk Management CD: Special Projects Systems Management

CD: Budget & CD: Infrastructure Dir: IT Infrastructure CD: Health Service Revenue Project Management Support

CD: Tuberculosisi (TB) CD: Health Economics & Financing

CD: Forensic & Medico Legal

CD: EMS

CD: Pharmacetical Services

CD: HIV & AIDS

Department of Health Annual Report 2018/19 17 8. ENTITIES REPORTING TO THE MEC

Except for the Medical Supplies Depot (MSD), a trading entity, no public entities fall under the control of the MEC. The performance of the MSD in respect of pharmaceutical services is described in Part F of this report.

The table below gives information about the MSD.

Name of Entity Legislative Mandate Financial Relationship Nature of Operations

Registered as ‘The Central The depot charges a levy of The MSD is responsible for the Medical Supplies Depot (MSD) Medical Trading Account’ 5% on stock supplied to the supply of essential medicines since 1 April 1992 under the provincial healthcare facilities. and disposable sundry items Exchequer Act, Act 1 of 1976 to the Gauteng provincial healthcare facilities.

9. LEGISLATIVE AND OTHER MANDATES

The Department derives its mandate from the South African Constitution, the National Health Act and other legislation promulgated by Parliament.

The Department’s core mandate is to: • Improve the health status of the population • Improve health services • Secure better value for money • Ensure effective organisation • Provide integrated services and programmes that promote and protect health • Assist with ensuring good quality and sustainable livelihoods for the poor, vulnerable and marginalised groups in society. In fulfilling its mandate, the Department is guided by the legislation listed in the annexure at the end of this report.

18 Department of Health Annual Report 2018/19 PART B: PERFORMANCE INFORMATION

Department of Health Annual Report 2018/19 000 1.PERFORMANCE INFORMATION

1.1 AUDITOR-GENERAL’S REPORT: PREDETERMINED OBJECTIVES

The Auditor-General of South Africa (AGSA) performs certain audit procedures on Departments’ performance information to provide reasonable assurance in the form of an audit conclusion. The audit conclusion in relation to predetermined objectives is included in the report to management, with material findings reported under the Predetermined Objectives section which deals with legal and regulatory requirements.

Refer to page 153 of the Report of the Auditor-General, published as Part E: Financial Information.

2. OVERVIEW OF DEPARTMENTAL PERFORMANCE

2.1 SERVICE DELIVERY ENVIRONMENT IN 2018/19

The Department’s service delivery catered for primary prevention Apart from work with households, the Department further increased and curative and quaternary/specialised services. As regards primary access to health through its integrated school health programme. prevention, the Department provided both educationally oriented This involved visits to 746 schools where 167 100 pupils were and outreach programmes at health facilities, households and screened for various health-related conditions which have the schools. potential to impact negatively on learning. In this regard, 86 015 learners were referred for speech, oral health, eye care and hearing As a result of these programmes access to health care services was problems and suspected TB. The table below provides a breakdown improved. For instance, the number of patients cared for at of the provision of such services. household level through the 796-strong ward-based outreach teams came to 3 374 445 patients, a 44 % increase from the previous year. Of the clients seen at household level, 63097 were referred to health facilities and/or to social workers.

Integrated school health services

Type of service 2018/19 2017/18

School learners given a deworming dose 12 632 16 986

School learners immunised 2 984 702

School learners overweight 4 060 5 264

School learners referred for eye care 9 287 9 344

School learners referred for hearing problems 2 077 1 889

School learners referred for oral health 21 535 23 660

School learners referred for speech problems 292 395

School learners referred for suspected TB 417 236

School learners underweight 1 212 1 417

Td dose at 12 years 27 202 12 956

Td dose at 6 years 27 954 13 166

20 Department of Health Annual Report 2018/19 A range of preventative and curative health care services were Significant investments are made in the prevention of HIV and provided through our primary health care facilities on an estimated related sexually transmitted diseases and tuberculosis. In the case of 21 079 658 occasions, representing the headcounts at Primary HIV, over 3 million patients counselled and tested, and those found Health Care (PHC) facilities. Hospitals, on the other hand, to be positive put on treatment. By the end of the financial year over experienced variable demand for services according to the level of 173 923 patients were placed on treatment, including 28 982 care with a significant number of patients still presenting at central pregnant women who were provided with treatment to ensure national hospitals without referral letters. prevention of mother to child transmission of HIV.

A range of initiatives are being implemented to improve access to Innovative measures are also being implemented to decongest health care services and in this regard the Department continues to health facilities and ensure that chronic medicines are provided provide 24-hour comprehensive health care services in 30 of its 32 closer to where users live and work. As a result, 490 518 clients have CHCs. All CHCs with Maternity Obstetric Units continue to provide access to various centres where they can collect their medicine 24-hour care services for supported deliveries. As a result 44 059 supplies conveniently. deliveries across our primary health care facilities were supported by a professional midwife. Complicated cases are also supported Notable improvements were also observed in rehabilitative services, through specialist obstetricians across our regional and tertiary levels with provision of various assistive devices aimed at enhancing the of care. By the end of the financial year under review, 222 115 quality of life of patients. deliveries were attended to at our various health facilities, with only 7 439 born before arrival at the hospital.

The table below shows the devices issued and requested, and the issue rate for the reporting period. Table: Assistive devices issued

Number issued Requested Issue rate

Device 2018/19 2017/18 2018/19 2017/18 2017/18 2018/19

Hearing aid 4 821 5 108 10 550 7 975 64.1% 45.7%

Orthosis 25 128 22 587 25 169 23 763 95.1% 99.8%

Podiatry 1 408 1 854 1 578 2 255 82.2% 89.2%

Prostheses 815 668 1 664 1 567 42.6% 49.0%

Walking aids 37 491 33 572 n/a 33 572 100% n/a

Wheelchairs 4 109 4 103 4 756 4 228 97% 86.4%

Total 73 772 67 892 43 717 73 360 92% -

Efforts to improve the immunity of children under five years Emergency transport services between health facilities also played a continued, in addition to other interventions aimed at improving critical role in the survival of patients. The Department in the child survival. This included immunisation of 221 437 children under financial year increased the fleet to 5 859 and helped enhance the one year on various vaccine schedules. While the numbers capacity of emergency transport personnel to ensure that these immunised increased, coverage of over 90% is still not being services are operated by highly technically qualified professionals. To reached, and REACH outreach programmes are continuing to this end, 479 147 priority patients were transported to hospitals ensure that every child is immunised. presenting with a range of conditions.

Challenges related to late presentation of children at health facilities Specialised services provided through the National Tertiary Service by health caregivers are also being tackled directly through the grants reflect an increase in demand, with over 1.4 million patients continued Integrated Management of Childhood Illnesses (IMCI) attending clinics whose services range from burns to oncology community training and health education to ensure that no child services. Various hospital related services were also provided to dies from dehydration due to diarrhoea, severe malnutrition or 5 730 255 and 887 382 patients who presented at outpatient and pneumonia. Clinical governance to help improve these areas emergency Departments, respectively. through the support of district clinical specialists is taking place.

Department of Health Annual Report 2018/19 21 2.2 ORGANISATIONAL ENVIRONMENT The period under review coincided with the fire at the Bank of On 26 June 2018, Gauteng Department of Health hosted a supplier Lisbon building and with labour unrest. Departmental responses engagement dinner at the Emoyeni Conference Centre with large included efforts to minimise any effects of the fire on service suppliers that do business with the Department. A supplier summit delivery. As a result, through its business continuity plan the at Turffontein Racecourse was also successfully held on 29 June Department prioritised units that are critical to its operations, 2018 with the SMMEs providing services to the Department. This including temporary accommodation and prioritising relocation to full-day summit brought together entrepreneurs with supply chain new premises. A relocation committee comprising of labour specialists and finance and business external stakeholders who movement representatives and management was formed to oversee facilitated the discussions which will enable the SMMEs to sustain the relocation process. themselves.

It became clear from the last quarter of the 2017/18 financial year The following summary provides highlights from the recovery that drastic measures were required to turn around the performance roadmap: trajectory of the priority health programmes including a commitment to an iron clad policy position which required LEADERSHIP, GOVERNANCE AND ACCOUNTABILITY partnership with and the consent of suppliers if the Department was i. Governance Charter developed outlines the various Executive to fare better and exercise financial prudence. Committee system and management structures of the Department. The assessment of the management structures is As a result, several key engagements were convened with various intended to rationalise them and ensure that their purpose stakeholders to help support the Department in its journey of aligns to the strategy of the Department. recovery. By the first quarter of the year under review, the MEC and ii. SOPs focusing on performance accountability from primary HOD had convened a two-day summit titled: "Commitment to health care facilities to Head Office are being implemented. Quality Health Services: Accelerating Service Delivery Accountability on performance has been changed from Improvement for Maternal, Neonatal and Child Health". The quarterly to weekly/monthly to ensure proactive dealing with summit provided a platform for 300 nursing and medical personnel, potential glitches in service delivery while addressing the policymakers, health systems leaders, specialists in reproductive, strategic objectives of the Department. maternal and child health, community representatives, health iii. A Management Performance Enhancement Tool has been information management specialists, monitoring and evaluation developed to provide a framework for assessing performance at (M&E) specialists and advocacy groups on women and child related a glance for each hospital. This will help the organisation to issues to engage on how to accelerate performance improvements ensure that management practices comply fully with legislation in services for women and neonates. and frameworks for effective governance. iv. Weekly accountability by the Big Seven hospitals is consistently A committee comprising obstetricians, neonatologists, monitored through Microsoft teams while the other platforms paediatricians, midwives and policymakers has been formed to (regional, district and sub-district hospitals) are being assisted to develop a service-oriented recovery plan. This will ensure that the achieve consistent reporting. persisting challenges pertaining to maternal and child health-related v. Loading of portfolios of evidence gained momentum during the care are addressed in a comprehensive manner covering short to third quarter, and all hospital and district folders have been long term interventions. created on the SharePoint and evidence can be uploaded.

ICT OPTIMISATION Through this committee, the Department hosted a Maternal and

Neonatal Health Summit. A recovery plan was developed, and its i. Video-conferencing implemented at three main sites in the costed implementation plan is being finalised. Through the advocacy province to help optimise management processes. of this committee, a Clinical Governance Group comprising various ii. ICT Strategy finalised. heads of clinical Departments was established to cover all other iii. LAN implemented across four hospitals, including broad access. specialities. iv. Health Patient Registration System deployed in 69% of 372 PHC facilities with 2.8 million patient registrations on the system. Another important organisational process was the finalisation of the Mental Health Recovery Plan following the conclusion of the arbitration processes.

22 Department of Health Annual Report 2018/19 FINANCIAL DISCIPLINE

Financial and SCM business processes have been re-engineered, HEALTH, WELLNESS AND HAPPINESS standardised and integrated. The tracking process for finance and i. The GDoH developed a policy framework, the first of its kind in SCM performance includes the implementation of electronic the history of the Gauteng health system, for implementation invoicing, improvement of demand plan processes, the introduction over three years. The policy is benchmarked on models from of an electronic demand management plan, workshops and other countries, e.g. Community-oriented Primary Care (COPC) strengthening of the DBAC’s controls by ensuring that all deviations in the Cuban health care system. are approved at the appropriate level. ii. The framework was launched 16 November 2019 by the HUMAN RESOURCES FOR HEALTH Gauteng Premier. iii. It provides a paradigm shift, seeking to revolutionise health i. A total of 2 056 posts were approved by the post-filling outcomes and give focus to health promotion. committee, inclusive of sessional posts. Of these, 828 were iv. It has the potential to strengthen the health sector, reversing the nursing posts in all categories. focus from treating to preventing disease. ii. All SMS personnel signed their performance contracts at the v. Disease prevention and health promotion as outlined in the beginning of the financial year. policy takes a multi-sectoral approach, with inter-Departmental iii. Training of Human Resources (HR) managers on HR ethics has collaboration bringing all Departments together to address been completed. Training of the trainer will ensure that all HR challenges that impact on the health of communities before managers are trained in this area, with a focus on HR they manifest as illnesses. professionals. Several management structures and posts that are critical to the CLINICAL recovery of the Department have been prioritised. Important posts i. The CEOs and governance structures Management Performance filled include the appointment of the two central hospital heads and Enhancement Tool (MPET) Management Information of a Chief Risk Officer for the Department. Business continuity was Performance Framework was completed with the support of the also implemented following the Bank of Lisbon building fire, Department of Planning, Monitoring and Evaluation (DPME) and assisting in minimising the impact of business interruptions. some of its components are being implemented while awaiting its automation. Finally, the Department, as part of efforts to improve governance, ii. Implementation of the Ideal Hospitals prrogramme commenced redefined the mandate of the hospital boards from advisory to with the Gauteng Health Accreditation Committee oversight. This will go a long way in improving governance and Implementation in progress. The committee was established to accountability. Key challenges relating to labour peace were also help prepare Gauteng hospitals for external assessments by the tackled head-on and efforts are being made to strengthen the Office of Health Care Standards and Compliance (OHSC). effectiveness of labour relations Departments, thus improving Inspections are continuing. relations in the health sector between labour and management. iii.A Mental Health Recovery Plan was developed and is being implemented. Additional resources have been provided to cater for mental health in the 2019/20 financial year

Department of Health Annual Report 2018/19 23 2.3 SERVICE DELIVERY IMPROVEMENT PLAN

The Department has completed a Service Delivery Improvement Plan. The tables below highlight the nature of the plan and its achievements to date. Table: Main services and standards

Desired Current/Actual Actual Main Service Beneficiaries standard of Standard Service (2018/19-2019/20) Achievement

Antenatal Services provided to Pregnant women attending antenatal 58.4% 70% Antenatal care was provided to women with a first visit before 20 care with Antenatal 1st visit before 20 64.7% of pregnant women during weeks from 58.4% to 75% weeks of gestation the first 20 weeks of pregnancy

Roll out of the pregnancy testing Women of reproductive age N/A 2500 36 153 screened for pregnancy by WBOTs at household level (5000)

Promotion of Sexual and Teenagers and youth N/A 250 000 3500 youth and teenagers who Reproductive Health services with received sexual reproductive health a focus on teenagers and youth education

WBOTS promotion of early Pregnant women N/A 10% increase During household outreach visits 540 antenatal booking and post-natal (3.3%) of pregnant women were care referred for antenatal care

1000 trained nurses and doctors Pregnant women N/A 45% of clinicians 1000 midwives, doctors, medical on ESMOE trained on associates and paramedics were ESMOE trained

Table: Batho Pele arrangements with bene ciaries

Current Standard Desired Year Cycle 2018/19 2018/19 Progress In This Reporting Period

Consultation 5 community dialogues/consultations 500 Targted Community dialogues in 3 community dialogues were conducted at least once per year per sub-districts with low uptake of early conducted Health District Antenatal care bookings (less than 50%)

1 Symposium 1 Symposium Midwifery-Obstetric New-born Conference was held and attended by 250 Midwives

1 Radio station and 1 Print Media 2 Radio stations and Print Media N/A

Courtesy Analysis of all MOMCONNECT complaints Implementation of the mitigation Analysis of the datasets in the database to determine the trends linked to strategy. Provision of Antenatal Services database is still to be carried out antenatal service and develop mitigation in a respectful manner and reduction in strategy Antenatal related complaints by 5%

Access 30151 households visited by WBOT teams 31587 households visited by WBOT During household outreach visits 8 where pregnant women were referred to teams where pregnant women were 540 (3.3%) of pregnant women facilities referred to facilities were referred for antenatal care

24 Department of Health Annual Report 2018/19 Table: Service delivery information tool

Current Current Status Desired Year Cycle 2018/19 2018/19 Progress In This Standard Reporting Period

Information Provide information pertaining 30151 households visited by 31587 households visited by During household outreach visits to pregnancy and child birth WBOT teams where pregnancy WBOT teams where pregnancy 8 540 (3.3%) of pregnant women through dialogues, care was given care was given were referred for antenatal care MOMCONNECT and SBCC materials / media / WBOT

Provide information to Provide information to 90% of pregnant women were communities pertaining to communities pertaining to registered for “stage message” – pregnancy and child birth through pregnancy and child birth information focusing on the stage dialogues, MOMCONNECT and through dialogues, of the pregnancy and until BCC materials/media/ MOMCONNECT and BCC postnatal care materials/media/

Openness and Sharing of the annual Distribute citizens report to Distribute citizens report to On an annual basis the Transparency citizens report with clients focusing on antenatal clients focusing on Department prints infographics communities based on clients antenatal clients which are distributed during planned targets community sessions on the annual performance of the Department.

Table: Complaints mechanism

Current Standard Desired Year Cycle 2018/19 Progress In This Current Status Reporting Period

Redress Resolve all received complaints within 25 Resolve all received complaints within 25 95-98% of complaints are resolved working days working days within the agreed 25 days

Resolve all received MOMCONNECT Resolve all received complaints within 10 85% of complaints were resolved complaints within 10 working days working days within 10 days

Inform patients upon consultation should All Antenatal care patients are informed Communities are made aware of there be changes in the staffing or service upon consultation should there be the changes delivery patterns changes in the staffing or service delivery patterns

Service Standards Provision of antenatal care every day five Provision of antenatal care every day 177 facilities are providing days a week from 08h00 to 16h00, five days a week as per the maternity antenatal care 5 days a week including extended service hours as per the guidelines maternity guidelines

Department of Health Annual Report 2018/19 25 3. STRATEGIC OUTCOME-ORIENTED GOALS

The following are the strategic oriented goals: Goals of the National Negotiated Service Delivery Agreement • Improve health and wellbeing with an emphasis on vulnerable of the National Department of Health groups • Increase life expectancy • Reduce the rate of new HIV infections by 50% in youth, adults • Decrease maternal and child mortality and babies in Gauteng, and reduce deaths from TB and AIDS by • Combat HIV and AIDS and decrease the burden of disease from 20% TB • Increase efficiency of service implementation • Improve health system effectiveness • Human capital management and development for better health outcomes • Organisational excellence

Table: Progress towards achievement of the 5-year targets, 2017/18-2018/19

Gauteng Goals Indicator Baseline 2018/19 Performance 2017/18

Improved health and wellbeing Under-5 mortality rate (U5MR) per 1000 live births of all citizens, with an emphasis 6.9 6.1 on children and women

Infant mortality rate (per 1000 live births) 10.1 10

Maternal mortality rate (per 100 000) 108.5 10

Neonatal mortality rate (<28 days) (per 1 000 live births) 13.6 13/1 000 live births

Reduced rate of new infections Mother-to-child transmission rate of HIV <2 months of age 0.99% 1.19% and the burden of HIV & AIDS The proportion of eligible HIV positive pregnant women initiated 94.7% 96.8% and TB on antiretroviral treatment (ART) Number of patients (adults and children) on ART 927 825 1 037 212 Medical male circumcisions 112 608 102 325 Proportion of TB treatment successes among all TB cases 87.5% (84%) 28 705/34 190 TB defaulter rate at the end of TB treatment among all TB cases 5.2% 5.2% Percentage of HIV-TB co-infected patients on ART on completion 90.3% 88.2% of TB treatment

Increased equal and timely PHC utilisation rate 1.5 visits per person 1.5 visits per person access to efficient and quality health care services, thereby preparing for the roll-out of National Health Insurance (NHI)

26 Department of Health Annual Report 2018/19 4. PERFORMANCE INFORMATION BY PROGRAMME

4.1 PROGRAMME 1: ADMINISTRATION

Purpose of the programme

To provide strategic direction and leadership; guide and support the increase was the result of encouraging employees who had not development of policy frameworks and guidelines for priority declared their disability status to do so. However, the majority of programmes; develop policies and legislation on healthcare people with disabilities do not have Health Sciences qualifications provision;and ensure that norms and standards are followed in the and particularly in medicine and nursing, and the Department has course of implementation. few vacancies in Administration and Support where people with disabilities could be placed. Ongoing prioritisation of such people Sub-programmes will include sourcing CVs from organisations working with people • Human Resource Management with disabilities and encouraging walk-in applications. • Quality Assurance • Information and Communications Technology. Efforts to improve the experience of health care services by persons with disabilities included changes to physical infrastructure at health Strategic objectives facilities. Roadshows and advocacy workshops were carried out in • Improved client satisfaction rates. three health districts and at five hospitals to sensitise staff to the • Improved achievement against national norms for health need to treat colleagues with disabilities with the dignity and professionals. respect they deserve. Workshops on Policy on Reasonable • Employment equity and diversity management. Accommodation and Assistive Devices (PRAAD) took place in most of the province’s hospitals and districts. Signi cant achievements, and strategies to address areas of underperformance QUALITY ASSURANCE HUMAN RESOURCE MANAGEMENT Efforts to improve the quality of care and patient safety and experience of health services included the establishment of a During Women’s Month, Youth Month and in August during the Gauteng Accreditation Committee which will support institutions’ Service Delivery Expos organised by the Office of the Premier, the self-assessment before external assessment by the Office of Health Department provided a range of health promotion services Care Standards. Compared with the previous reporting year, six including screening for diabetes, high blood pressure, cholesterol, priority areas across all hospitals showed performance HIV/AIDS, breast and cervical cancer and dental health. improvement. However, scores and performance levels for Cleanliness and Infection Prevention and Control still need to During the year under review, the number of people with improve, and Positive and Caring Attitudes and Patient Safety both disabilities employed increased from 450 in 2017/18 to 1100. This scored below 75%.

The table below shows average scores per level of care in relation to core standards Table: National core standards comparison report

Hospitals 2015/16 2016/17 2017/18 2018/19

Central 4/4 (100%) 4/4 (100%) 4/4 (100%) 4/4 (100%)

Tertiary 3/3 (100%) 2/3 (75%) 3/3(100%) 3/3(100%)

Regional 100% 9/9 (100%) 8/9 (88.9%) 9/9 (100%)

Districtis 82% 11/11 (100%) 11/12 (92%) 11/12 (92%)

Six Priority Areas 2015/16 2016/17 2017/18 2018/19

Availability of Medicines 80% 83% 87% 100%

Cleanliness 73% 73% 79% 86% (24/28)

Patient Safety 75% 81% 83% 89% ( 25/28)

Infection Prevention and Control 75% 85% 84% 82% (23/28)

Positive and Caring Attitude 76% 83% 87% 89% (25/28)

Waiting Times 9/11(82%) 86% 87% 89% (25/28)

Department of Health Annual Report 2018/19 27 Interventions to address patient concerns included activities to reduce INFORMATION AND COMMUNICATIONS TECHNOLOGY waiting times. However, challenges remain and are being addressed; The Department continued with the implementation of the eHealth these are descibed below. multi-year initiative aimed at strengthening the province’s health system. Two key focus areas were the ongoing implementation of a Challenges single integrated, interoperable Health Information System for The introduction of the Deliverology strategy for monitoring patient hospitals; and complete deployment of the Health Patient treatment waiting times included: Registration System (HPRS) across all Primary Healthcare facilities; effective ICT security mechanisms will be in place to safeguard • Facilities struggling with demarcating patients’ point of arrival organisational and patient data. The remaining hospitals and at all service points; with the support of the Provincial Waiting Primary Health Centres will also benefit from deployment of PACS Times Team, specific points of arrival per facility were agreed. to these facilities to enable radiology services at both service levels. • Some doctors not recording the time when they consult patients, making it difficult to measure patient treatment To assure health information systems operations across the province, waiting times. Doctors have been made aware of the need to the refresh of outdated and obsolete Local Area Network (LAN) record the time before starting each consultation. infrastructure at hospitals and Primary Healthcare facilities will • Some facilities using the Excel monitoring tool incorrectly and continue. The expansion of Business Intelligence with an emphasis changing the formula that automatically calculates waiting on artificial intelligence and automation of data collection tools will time in minutes. The facilities were informed that they must continue, as will strengthening of ICT Governance, Risk and use the tool correctly so that the original tool is saved. Compliance by implementing the ICT Governance Framework across the province’s health facilities.

PERFORMANCE INDICATORS: PROGRAMME 1 - ADMINISTRATION

Programme 1: Administration

Number of hospitals # 8/37 12/37 4 Target exceeded due to implementation by implementing Lean four additional hospitals (Mamelodi, Bheki Management Project Mlangeni, Tara and Thelle Mogoerane). The project is being implemented in a phased manner, targeting various units within hospitals. Its components include rapid training, 5-day rapid improvement week and value stream. Six hospitals are already at an advanced stage of value streaming.

Increase diversity, verification of qualifications and equity of our workforce thus increasing the number of women in senior management positions from adequate (41%) to good (50%) and the percentage of people with disabilities employed to 2% by 2019/20.

Percentage of women 46.5% 48% 46.2% (1.8%) Target could not be achieved because of in senior management (53/114) (56/117) (48/104) the termination of a female SMS member posts (117 senior in the last quarter of the year. In the new managers) financial year, the Department will target female candidates for SMS posts.

28 Department of Health Annual Report 2018/19 Programme 1: Administration

Strategic objective Actual Planned Actual Deviation Comment on deviation achievement target achievement from planned 2017/18 2018/19 2018/19 target for 2018/19 (over/(under)) Increase diversity, verification of qualifications and equity of our workforce thus increasing the number of women in senior management positions from adequate (41%) to good (50%) and the percentage of people with disabilities employed to 2% by 2019/20. Percentage of people with 0.5% 1.5% 1.5% 0% Target achieved. disabilities employed (336/67 499) (1 119/74 197)

Percentage of newly 100% 100% 100% 0% Target achieved. appointed clinical staff members with verified qualifications

Percentage of newly 23.2% 100% 0% (100%) Verification of non- clinical staff continued, appointed non-clinical staff albeit using internal mechanisms. Target members with verified not achieved due to budgetary challenges. qualifications The Department will prioritise procurement of a service provider to conduct verifications and consider policy revisions.

Enforce performance management at Senior Management Service (SMS) level thus increasing SMS signed contracts to 100% by 2019/20.

Percentage of SMS 100% 100% 100% 0% Target achieved members entering into (117/117) Performance Management Agreements within stipulated time frames

Improve the relationship between employer and employees in the workplace thus resolving grievances within 30 working days and misconduct cases within 90 days.

Percentage of 90% 100% 87.9% (12.1%) Target not achieved due to the grievances cases (327/372) unavailability of critical parties to finalise resolved within 30 grievance cases. The Department has working days developed a labour relations framework aimed at improving case management, including building labour relations capacity in institutions.

[1] There was no strategic objective statement attached to this performance indicator; this has been included as part of the Strategic Plan review that the SCM branch conducted. The results will be fully documented when the process is completed in October 2016. It includes: Maintain percentage of linen contracts awarded to women cooperatives at 100% by 2019/20; Increase percentage of hospitals procuring/buying vegetables from local farmers to 90% by 2019/20; Increase percentage of hospitals procuring dairy products from local farmers to 80% by 2019/20; Increase percentage of hospitals procuring bread from small/medium scale bakeries to 70% by 2019/20.

Department of Health Annual Report 2018/19 29 Programme 1: Administration

Percentage of budget # 40% 29.5% (10.5%) Target not achieved because of limited spent on township R86.4/R292,8 marketing of business opportunities. In enterprises against collaboration with National Empowerment identified commodities Fund and the Gauteng Enterprise Propeller, the Department has held supplier workshops to boost the township economy and will continue to strengthen marketing and improve access.

Increase revenue collection from qualifying paying patients from R527/709 million in 2013/14 to >530 million in 2019/20.

Rand value of revenue R535m R507m R780.8m R273.8m Target exceeded due to increased collected collection from medical aids, self-paying patients, Correctional Services and the Road Accident Fund as a result of continuous engagement with collection service providers.

Improve efficient and effective functioning and performance of hospitals and clinics and quality of patient care through functional hospital boards; increase to 100% and clinic committees to 100% by 2019/20.

Percentage of hospitals 77% 100% 94.6% (5.4%) All hospitals had a full complement of with functional hospital (37/37) (35/37) Board members with requisite skills. boards Functionality for 2 of the 37 hospitals however reduced due to resignations and secondments. The reasons given include lack of incentives and administrative problems. The Department fills vacancies when they arise. It will further explore ways to incentivise appointed members.

30 Department of Health Annual Report 2018/19 Programme 1: Administration Actual Strategic objective Actual Planned Deviation Comment on deviation achievement target achievement from planned 2017/18 2018/19 2018/19 target for 2018/19 (over/(under)) Improve efficient and effective functioning and performance of hospitals and clinics; and quality of patient care through functional hospital boards; increase to 100% and clinic committees to 100% by 2019/20. Percentage of Primary 76% 80% 80% 0% Target achieved Health Care (PHC) (279/369) facilities with functioning clinic committees

Implement an integrated and interoperable eHealth architecture in 100% of hospitals and clinics by 2019/2020.

Percentage of hospitals # 62% 0% (62%) Target not achieved because of delays in with health information (23/37) acquiring the Health Information System system implemented (HIS) by SITA. It is expected that the HIS contract will be concluded in the new financial year.

Percentage of PHC # 100% 68.5% (31.5 %) Target not achieved because of technical facilities’ Health Patient (372/372) (255/372) integration and data synchronisation Registration Systems challenges. These are being addressed deployed through a comprehensive programme planned for the new financial year.

Percentage of hospitals # 30% 40.5% 10.5% Target exceeded due to adoption of a lean with an upgraded Local (11/37) (15/37) LAN infrastructure design. The benefit of Area Network this design resulted in four additional infrastructure institutions (Edenvale, Heidelberg, ODI and Helen Joseph hospitals) being incorporated into the LAN project scope.

Percentage of hospitals # 62% 5.4% (56.6%) Target not achieved because NDoH, the with Health Patient (23/37) (2/37) custodian of the system only approved Registration System rollout to additional hospitals in December deployed 2018. It is envisaged that the remaining 6 facilities will be incorporated in the new financial year.

Number of hospitals # 37/37 22/37 (15) Target not achieved. The acquisition of a implementing PACS new PACS contract faced procurement delays and was not awarded as planned. It is envisaged that the 100% target will be achieved in the new financial year.

Department of Health Annual Report 2018/19 31 Programme 1: Administration

Actual Planned Actual Deviation Comment on deviation Strategic objective achievement target achievement from planned 2017/18 2018/19 2018/19 target for 2018/19 (over/(under)) Number of hospitals # 23/37 (7/37) 16 The target was not achieved due to lack of with scanned patient 62% (18.9%) (43.1%) an enabling contract. A contract has been records linked to an submitted for ratification; once approved, electronic health it should enable achievement of the target repository in the new financial year.

Receive unqualified audit opinion from Auditor-General by 2016/17 and a clean audit by 2019/20

Percentage of service 29% 100% 47.3% (52.7%) Payment of suppliers within 30 days of providers’ invoices (77 357/163 655) receipt of invoices significantly improved without dispute paid in 2018/19. However, the target could not within 30 days be achieved due to delays in clearing of work cycles. The Financial Reporting unit is to be capacitated to ensure improved payment of invoices within 30 days of receipt, including decentralisation of SCM processes to improve efficiencies.

Audit opinion from Unqualified Unqualified Unqualified Unqualified None Auditor: General

Increase broadband provision in the Department so that 100% of PHC facilities and hospitals have broadband network access and 100% of total staff have email access by 2019/2020.

Percentage of hospitals 100% 100% 100% 0% Target achieved with broadband access (37/37)

Percentage of fixed 48% 80% 47% (33%) Target not achieved because E-Gov did PHC facilities with (176/369) (297/372) (175/372) not receive the promised funding for broadband access broadband.

PROGRAMME 1: EXPENDITURE TABLES

Sub-programme 2017/2018 2018/2019: Preliminary unaudited Name Sub-programme R’000Final Actual R’000 (Over) /UnderR’000 R’000Final Final ActualR’000 (Over) /UnderR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Office of the MEC 20 358 12 349 8 009 21 581 10 038 11 543

Management 1 064 909 1 072 828 (7 919) 1 339 549 1 350 748 (11 199)

Total 1 085 267 1 085 177 90 1 361 130 1 360 786 344

32 Department of Health Annual Report 2018/19 4.2 PROGRAMME 2: DISTRICT HEALTH SERVICES Termination of Pregnancy Services Purpose of the programme Signi cant achievements and strategies to address areas of To prevent and reduce maternal deaths from unsafe abortions, the To provide comprehensive PHC services, district hospital services and underperformance Department started to provide medical abortion services in seven comprehensive HIV and AIDS care; and to deliver priority health hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, DISTRICT HEALTH MANAGEMENT AND PHC SERVICES programmes, including the nutrition programme. Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses Ward Based Outreach Teams (WBOTs) and Expanded Public and two medical doctors were trained in medical and surgical Works Programme (EPWP) The district health system, the vehicle for delivering PHC, covers a abortion. range of basic health services including health promotion, disease During the 2018/19 financial year, WBOTs increased from 775 to prevention, curative care and rehabilitation. Along with equitable 791 The team supports 44 most departures by identifying Breast Cancer Services access to decent housing, clean water, sanitation, nutrition and households’ health needs and ensuring compliance with treatment Tembisa, Thelle Mogoerane, Rahima Moosa, Sebokeng and education, PHC has been shown to have a highly significant impact regimes. The Department is currently placing all CHWs on PERSAL; Mamelodi hospitals rolled out mammogram services, with eleven on health and health outcomes. salaries will be paid through this system. During the year, 4015 hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg EPWP participants, based at clinics as data capturers, clerks, general Academic, Helen Joseph, Rahima Moosa, Kalafong, Mamelodi, Sub-programmes workers, pharmacy assistant learners and gardeners, were Steve Biko Academic, Dr George Mukhari Academic, Tembisa, Thelle contracted. Mogoerane and Sebokeng) currently offering mammography • District health management and PHC services services; 47 444 mammograms were performed during the Ideal Clinic realisation and maintenance • District hospitals reporting period. • Maternal, child and women’s health and nutrition Ideal Clinics performance improved significantly, resulting in • HIV and AIDS, STIs and TB care improved infrastructure, equipment procurement and availability of Nutrition and Food Services • Disease prevention and control medication, and fewer essential medication stock-outs. The table All health care facilities promote breastfeeding and support mothers • Forensic pathology services. below shows the progress being made in realising the Ideal Clinics in doing so; 94% of healthcare facilities provide maternity services project. accredited as Mother and Baby Friendly. During the reporting period, the percentage of severe acute malnutrition (SAM) death under 5 years was 6.8% (105 deaths) against a target of 6%.

Districts Number of Ideal Clinics % of Ideal Clinics The Vitamin A dose rate for children 12-59 months of age stood at Ekurhuleni 93/93 100% 55.1%, with 5.76% of children under 5 years on food

Johannesburg 88/111 79% supplementation. The increase in this rate of supplementation is attributed to the increased number of SAM cases identified and Tshwane 72/73 98% supplemented to prevent admissions and readmission: the revolving Sedibeng 38/38 100% door syndrome. To measure the success of the SAM Treatment West Rand 39/48 81% Protocol and provide an integrated approach to treating children Total 330/363 90% with SAM or Moderate Acute Malnutrition (MACM), training was conducted for 607 health care professionals, with SAM clinical audits and death reviews implemented in all hospitals. DISTRICT HOSPITALS One strategy directs staff and beds to units in need from those which are under less pressure. To increase surgical skills and experience at District hospitals are a key component of district health provision To promote patient recovery, reduce patient care costs and length of district hospitals, interested medical officers are encouraged to and of the referral system to PHCs. hospital stay, food services in public health establishments strive to rotate through regional hospital surgical units, and some surgical provide patients with good quality, safe, adequate, nutrious and procedures are directed to district hospitals from central hospitals. Ef ciency Measures culturally acceptable meals. Food safety standards are critical in all This reduces congestion at the central hospitals and improves Utilisation of district hospitals’ medical wards and maternity unit food service units and the national DoH carries out annual quality utilisation of district hospitals. Examples include redirection of the services is very high, reflecting the general burden of disease and the audits. In the reporting period, 31 took place with food service units elective caesarean section list to South Rand Hospital from Chris health needs of the population, with under-utilisation in paediatric achieving a score of 90%, above the national target of 75%. and surgical units. The low utilisation of the paediatric wards may Hani Baragwanath Academic Hospital and the breast clinic and theatre list to Bertha Gxowa Hospital from Charlotte Maxeke reflect the success of various child health programmes; in the case of Children in need in crèches and at pre-schools are provided with Johannesburg Academic Hospital. surgical wards, it relates to district hospitals’ inability to attract growth monitoring, health promotion and subsidised nutrition sufficiently experienced medical officers funding, with 1 013 ECD centres (50 449 beneficiaries) reached . during the year and a budget of R58 million (R5.27 per child per To improve efficiency and the ability to cope with extreme needs day). with the available resources, a number of efficiency measures have been put in place in district hospitals.

Department of Health Annual Report 2018/19 33

Obesity is a major public health problem facing the country, with its Geriatrics Communicable Disease Control and Surveillance Environmental Health services impact and cost affecting individuals, families, communities, the In collaboration with DSD, the Department ensures that the rights of It is South Africa’s aim to eliminate malaria by 2023. Gauteng is not Environmental health services are provided in all district health service and society as a whole. Training was provided for 35 older persons as outlined in the Older Persons Act No.13 of 2006 are malaria endemic but the increased movement of people (local, and municipalities and metros to enable identification and monitoring of caterers on the Gauteng Treasury database, with special emphasis protected and promoted. It fully supports the 69 old age homes foreign nationals) into the province results in increasing number of environmental conditions that may have adverse effects on public on healthy meal provision in the workplace. DoH and GDE subsidised by DSD, all of which along with some private homes are cases and deaths; free malaria chemoprophylaxis for travellers is not health; and all public hospitals have access to the services of established an Obesity Mandate Committee to develop an visited and audited to ensure compliance with the Act and with available. Two members of the Communicable Disease Control environmental health practitioners to assist management to comply Implementation Plan for the Obesity Strategy, with the focus on applicable health standards; 54 subsidised residential facilities are (CDC) team are part of the South African Malaria Elimination with environmental health related legislation. Water quality is Grade R, 1, 4, 8, 10 learners and on selected learners presenting visited weekly by a doctor from the Department. They are also Committee (SAMEC), where country decisions towards elimination monitored through sampling; during the financial year, the with obesity and overweight. A referral system to weight provided with medical supplies, oxygen therapy services and dry are made.Surveillance of notifiable medical conditions (NMCs) is a bacteriologic compliance rate was 76%; this is below the national management professionals at health care facilities is in place. dispensary including napkins. Also in collaboration with DSD, 117 pillar of communicable disease control, serving as an early warning target of 100%, with the non-compliance attributed to the practice health professionals from Ekurhuleni Health District were trained on system in preventing infectious disease outbreaks. of storing water in containers at end user level. InterDepartmental collaboration with SASSA on providing food the Elderly Abuse Strategy, and the Department supported the parcels benefited 3 634 children under the age of five presenting Active Aging Programme, with a medical team consisting of one A new web-based NMC system rolled out in all of the province’s Food safety is continuously monitored and food premises inspected, with SAM and MAM (Moderate Acute Malnutrition); the aim is to doctor, two physiotherapists and two professional nurses health care facilities has provided real-time notification of infectious particularly following the public outcry about the sale of fake and prevent children with MAM from progressing to SAM and those accompanying Team Gauteng to the National Older Persons’ Golden diseases, with all reported outbreaks attended to within 24 hours. unsound food stuffs. Joint investigation operations were conducted with SAM from regressing. Games in Bloemfontein in October 2018. All hospitals and clinics submit weekly surveillance reports. The with law enforcement agencies to address complaints; out of 55 586 target for submission is 80%; at 93%, the province has exceeded food premises inspected, 68.3 % were found to comply with food DISEASE PREVENTION AND CONTROL Long Term Domiciliary Oxygen Therapy this. safety legislation. Illegal operations, not compliant with zoning The Department Provided Long Term Domiciliary Oxygen Therapy regulations, contributed to the low compliance rate. Some premises Health Promotion (LTDOT) to 1 618 patients, of whom 8 patients are school going Annual Influenza vaccinations have been provided in all districts, were served with compliance notices and others were closed. Health promotion is a process of enabling people to increase control children and students supplied with portable freestyle oxygen with a particular focus on vulnerable groups: people with chronic over and improve their health. The Health Promotion Programme is concentrators to assist them as they attend school and university. illnesses; pregnant women; people aged 65 years and above; and During the reporting period, the premises of 530 hazardous available to people and groups of all ages and aims to increase their The aim of the programme is to prolong the life expectancy of residents of old age homes and rehabilitation centres. In 2018, 260 substances dealers were inspected in accordance with the involvement in activities that improve their lifestyles. It operates patients diagnosed with respiratory diseases such as Chronic 000 influenza vaccine doses were distributed to such facilities, Hazardous Substance Act 15 of 1973; the compliance rate was through drives and participates in campaigns, events, community Obstructive Pulmonary Disease (COPD), lung cancer and diseases attaining a coverage of 97%. 94.3%, higher than the 75% of the previous financial year. The development and health education activities. During the reporting secondary to COPD. year, the programme planned for 250 outreach health promotion improvement is attributed to intensified monitoring strategies. activities and achieved 536, conducted in a wide variety of settings Eye care Strategies to Address Underperformance in Communicable and reaching 2 793 182 people. This exceeded the target of 2 000 During the financial year, 13 626 cataract operations (957.3/mil) Disease Control and Surveillance As part of active surveillance to reduce malaria deaths and eliminate 000. were performed in 14 facilities, almost reaching the Department’s Training on malaria elimination strategies, targeting environmental the disease from the country, all malaria cases were investigated and target of 11 232 (1000/mil); 31 102 spectacles were issued to health practitioners, doctors, nurses and other healthcare in almost all cases, the patient had travelled to malaria endemic Non-Communicable Diseases (NCDs), geriatrics, and eye-care patients with refractive errors. In collaboration with Onsight, the practitioners, has been provided. malaria death audits are conducted areas. Early Detection and Treatment Impact Department established an eye clinic at Carletonville Hospital. This on all patients who die from malaria; the most common cause of During the reporting period, 2 660 857 people were counselled and Strategy to address areas of underperformance provides eye health services to the general Carletonville community fatality is patients presentating late at health facilities. A malaria screened for diabetes and 2 974 226 screened for hypertension, Awareness creation about safe water storage and food safety who previously had to travel a considerable distance to Leratong Rapid Diagnostic Test (RDT) is availed at all health care facilities to with 44 192 new diabetic patients aged 40 and older diagnosed and measures will continue, as will workshops for environmental health Hospital for such services. Through a collaboration with the Brien allow early diagnosis in the these facilities. Intravenous artesunate, started on treatment. Of 2 295 851 hypertension patient visits, 1 practitioners on food safety and water quality monitoring. Holden Vision Institute (BHVI), 13 optometrists were trained on the the drug of choice for complications of malaria, is now available in 736 640 patients (83%) had a normal blood pressure below 140/90 diagnostics course at the University of Johannesburg. public as well as private hospitals. PHC nurses in all districts have mmHg, and of 552 537 diabetes patient visits 367 711 patients been trained on the use of the rapid diagnostic test and on (73%) had normal blood glucose levels. Five optometrists trained with bursary support from the Department administering Coartem, the treatment for malaria without complications. Doctors and environmental health practitioners have Leadership and Governance – multi-sectoral approach at various training institutions were placed the West-Rand Health been trained on the management and investigation of malaria. During the financial year, the Department’s NCD Control and District (one optometrist), Sedibeng Health District (two) and

Prevention Committee, consisting of stakeholders such as academic Tshwane Health District (two). This brings the total of optometrists Information has been provided to communities about how to institutions, NGOs, advocacy groups, development partners and in the Department’s service to 62; together with the eight recognise the signs and symptoms of the disease when returning other government Departments, continued its work. It meets district-based, dedicated ophthalmic nurses, this represents a from endemic areas, protecting themselves from mosquito bites by quarterly to ensure implementation of the National capable workforce at PHC to provide comprehensive eye health care using mosquito repellents, wearing long-sleeved clothing after dusk, Non-Communicable Diseases Strategy. The Tshwane and Ekurhuleni services, helping to ensure early diagnosis, treatment, management early presentation to health facilities if not well and taking Health Districts have established their District Non-Communicable and referrals. chemo-prophylaxis before visiting malaria-endemic areas. Malaria Diseases Prevention and Control Committees as a multi-sectoral awareness events are also organised by health promoters to target approach to the prevention and management of NCDs. communities with high case loads of malaria. Rehabilitation and Therapeutic Services Burden of disease Radiography Services: Termination of Pregnancy Services Rehabilitation services see around 350 new stroke patients every As the availability of radiography services must be highly To prevent and reduce maternal deaths from unsafe abortions, the month, an enormous strain on rehabilitation and therapeutic dependable, all institutions have to ensure that their imaging and Department started to provide medical abortion services in seven services that has led to the formation of a multi-disciplinary task radiography equipment complies fully with the statutory hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, team to attend to these patients. The team is made up of staff of the requirements of the Radiation Control Directorate. Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses National Department of Health and the Universities of Stellenbosch and two medical doctors were trained in medical and surgical and the Witwatersrand. Clinical guidelines have been completed To ensure standardised norms and practices in the profession, the abortion. and it is envisaged that these will be used in public and private sector Radiography Leadership forum, led by Head Office, has been Breast Cancer Services rehabilitation services for stroke patients throughout the country. restructured to enable active engagement with all radiography, facility and district managers; HPCSA; training and development Tembisa, Thelle Mogoerane, Rahima Moosa, Sebokeng and Early Childhood Intervention committees; and higher education institutions. Mamelodi hospitals rolled out mammogram services, with eleven In line with the wider early childhood development (ECD) agenda, hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg the Department’s early childhood intervention programme has now HIV, AIDS, STIS AND TB Academic, Helen Joseph, Rahima Moosa, Kalafong, Mamelodi, been established at all general hospitals and CHCs. The aim of the Steve Biko Academic, Dr George Mukhari Academic, Tembisa, Thelle Signi cant achievements programme is to identify disability or the risk of disability in a child as Mogoerane and Sebokeng) currently offering mammography The testing target achieved (123%) had a positivity rate of 7.2%. early as possible. services; 47 444 mammograms were performed during the Particularly in the fourth quarter of the reporting year, there were reporting period. Assistive Devices improved linkages between treatment and accelerated ART During the reporting period, the rehabilitation services component initiations, with 93% of the target reached. The mother to child Nutrition and Food Services issued 81 186 assistive devices compared with 67 931 reported in transmission target rate of 1.19% was achieved; and retention in All health care facilities promote breastfeeding and support mothers the previous year. At the same time, there has been an increase in care has improved with TROA at 94%. in doing so; 94% of healthcare facilities provide maternity services demand with the overall issue rate falling to 90.8% compared with accredited as Mother and Baby Friendly. During the reporting Strategy to address areas of underperformance 92% in 2017/2018. Except for walking aids and wheelchairs, the period, the percentage of severe acute malnutrition (SAM) death There have been ART initiations at all targeted focal points, with numbers of a range of assistive devices issued and requested was under 5 years was 6.8% (105 deaths) against a target of 6%. Community Mobile Clinics providing ART services. There is a need higher than in the previous reporting period. Continuous efforts for NIMART trained clinicians at all TB focal points; for GP Care Cell were made to improve data quality, with devices reported separately The Vitamin A dose rate for children 12-59 months of age stood at Expansion where GPs provide ART to the uninsured population; and to ensure targeted interventions in the case of devices where there 55.1%, with 5.76% of children under 5 years on food for active down-referral linkages with hospitals through WBOTS. are particular challenges, such as hearing aids and prostheses. supplementation. The increase in this rate of supplementation is ACSM is to be scaled up through a range of media platforms attributed to the increased number of SAM cases identified and Social Work Services including seventeen community radio stations. Capturing of data is supplemented to prevent admissions and readmission: the revolving The provincial Social Work Programme has been engaging with being strengthened at facility level, with facility managers door syndrome. To measure the success of the SAM Treatment various stakeholders, including the Departments of Home Affairs performing daily audits of patient records and verification of data; Protocol and provide an integrated approach to treating children and Immigration, Social Development and SASSA and Education; weekly data verification at sub-district and district level; weekly with SAM or Moderate Acute Malnutrition (MACM), training was and child protection services and substance abuse service providers, submission of statistics to district offices on patients diagnosed and conducted for 607 health care professionals, with SAM clinical to address issues affecting the social determinants of health. Strong initiated by hospitals; and monthly data reviews and reports on the audits and death reviews implemented in all hospitals. emphasis has been placed on services to vulnerable groups (women, status of performance. children and older persons); addressing gender-based violence and To promote patient recovery, reduce patient care costs and length of TB CONTROL PROGRAMME substance; and child protection and mental health services. Forums hospital stay, food services in public health establishments strive to provide patients with good quality, safe, adequate, nutrious and have been set up to capacitate and liaise with these stakeholders to Signi cant achievements culturally acceptable meals. Food safety standards are critical in all improve access to these programmes. To improve the quality of The introduction and roll out of Gen-Expert as the first line of TB food service units and the national DoH carries out annual quality clinical practice, delivery of social work services at hospital and testing and diagnosis has increased the number of patients audits. In the reporting period, 31 took place with food service units district levels and adherence to legislation and policies, the Province diagnosed with TB in the province and continuous availability of TB achieving a score of 90%, above the national target of 75%. has developed and finalised SOPs; the District Mental Health drugs with necessary partner support has led to an increased Programme has incorporated the component of social work in number of patients started on treatment. Implementation of the Children in need in crèches and at pre-schools are provided with monitoring of and service provision by mental health NGOs; and, LAM test for improvement of case detection is in progress. The growth monitoring, health promotion and subsidised nutrition with district social work supervisors, has developed a province has also continued to decentralise Drug-Resistant TB (DR funding, with 1 013 ECD centres (50 449 beneficiaries) reached profession-specific tool to audit these NGOs. All district social TB) management; all sub-districts within the five districts have a during the year and a budget of R58 million (R5.27 per child per workers have been trained on the draft tool. facility dedicated to DR TB. day).

34 Department of Health Annual Report 2018/19

Prevention Committee, consisting of stakeholders such as academic Tshwane Health District (two). This brings the total of optometrists Information has been provided to communities about how to institutions, NGOs, advocacy groups, development partners and in the Department’s service to 62; together with the eight recognise the signs and symptoms of the disease when returning other government Departments, continued its work. It meets district-based, dedicated ophthalmic nurses, this represents a from endemic areas, protecting themselves from mosquito bites by quarterly to ensure implementation of the National capable workforce at PHC to provide comprehensive eye health care using mosquito repellents, wearing long-sleeved clothing after dusk, Non-Communicable Diseases Strategy. The Tshwane and Ekurhuleni services, helping to ensure early diagnosis, treatment, management early presentation to health facilities if not well and taking Health Districts have established their District Non-Communicable and referrals. chemo-prophylaxis before visiting malaria-endemic areas. Malaria Diseases Prevention and Control Committees as a multi-sectoral awareness events are also organised by health promoters to target approach to the prevention and management of NCDs. communities with high case loads of malaria. Treatment outcomes Integrated School Health Programme (ISHP) Termination of Pregnancy Services In 2018/19, of a total of 18 009 patients aged 5 and older diagnosed MATERNAL, CHILD AND WOMEN’S HEALTH AND NUTRITION During the year, 15 463 learners were identified with health To prevent and reduce maternal deaths from unsafe abortions, the with TB, 16281 (90.4%) started on treatment, exceeding the target problems and were referred for further management at PHCs and/or Department started to provide medical abortion services in seven of 90% because of community education on the importance of Maternal and New-born Health hospitals. Preventative catch-up doses of Tetanus-Diphtheria (Td) hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, testing for TB and starting on treatment immediately after diagnosis The Department continues to implement the 1st Thousand Days immunisations were given to 13 166 six-year-old learners and to 12 Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses and remaining on it. The province has appointed 44 retired nurses to Programme aimed at improving the health of children from 956 twelve-year-olds. During routine health screening, 16 986 and two medical doctors were trained in medical and surgical assist the WBOT officers with tracing lost patients in all districts. confirmation of pregnancy to 2 years of age through social learners were dewormed. Health problems identified and abortion. mobilisation and behaviour change relating to early booking for appropriately managed and/or referred included underweight (1 Social mobilisation antenatal care before 14 weeks; antenatal services, including 417), overweight (5 264), speech problems (395), oral health (23 Breast Cancer Services The provincial TB programme has partnered with development provision of early ultrasound; and promotion of exclusive 660), eye problems (9 344) and suspected TB (236). Tembisa, Thelle Mogoerane, Rahima Moosa, Sebokeng and partners and health officials in all districts to ensure community breastfeeding for at least six months to, where possible, two years. Mamelodi hospitals rolled out mammogram services, with eleven Human Papillomavirus (HPV) Vaccination Campaign 1st Dose education, social mobilisation and advocacy in fighting TB and During the reporting period, 16 060 obstetric ultrasounds were hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg and 2nd Dose related diseases. As well as its day-to-day activities, the Advocacy, performed by advanced midwives among 173 316 (64.7% of the HPV Campaign 1st Dose Academic, Helen Joseph, Rahima Moosa, Kalafong, Mamelodi, Communication and Social Responsibility (ACSM) subprogramme total) first booking visits province-wide. To protect Grade 4 girls against future cervical cancer, the Human Steve Biko Academic, Dr George Mukhari Academic, Tembisa, Thelle was engaged in an intensive package of TB care and management Papilloma Virus (HPV) Vaccination campaign was conducted in all Mogoerane and Sebokeng) currently offering mammography for the whole of March 2019. This included TB screening/testing, These took place at targeted PHC facilities as part of outreach to health districts and schools visited during the reporting year, with 1 services; 47 444 mammograms were performed during the contact tracing of TB index cases, condom distribution, VMMC satellite clinics in all five health districts. Eight hundred and forty-five 433 first doses administered. reporting period. referral and health screening. A report on this is in progress. pregnant women were referred for higher level of care for reasons Nutrition and Food Services including multiple pregnancies, gross abnormalities, abnormal body HPV Campaign 1st and 2nd Dose TB/HIV collaboration All health care facilities promote breastfeeding and support mothers fluids, low lying placenta and other potential abnormalities. Despite During the period under review, 61 031 learners received the second During the reporting period, 11 980 people were diagnosed with in doing so; 94% of healthcare facilities provide maternity services ongoing training on Essential Steps in Managing Obstetric dose of HPV against a target of 60 000. TB/HIV co-infection. 10 057 (84%) were started on ART to ensure accredited as Mother and Baby Friendly. During the reporting Emergencies (ESMOE), the in-facility maternal mortality ratio (IMMR) increased HIV immunosuppression and successful TB treatment. All period, the percentage of severe acute malnutrition (SAM) death increased in comparison to the previous year from below 110 to Adolescent and Youth Health treatment and cares strategies are carried out in collaboration with under 5 years was 6.8% (105 deaths) against a target of 6%. 122.8 per 100 000 live births. The neonatal death in-facility ratio During the reporting period, 2600 young people attended the Youth the main HIV/ AIDS programme in the province. was 13 per 1000 live births which could be attributed to training Indaba where discussions took place on teenage sexual reproductive The Vitamin A dose rate for children 12-59 months of age stood at nurses and doctors on Helping Baby Breathe (HBB), intended to health and rights, pregnancy, violence, suicide, drug and substance Drug-Resistant TB (DR TB) 55.1%, with 5.76% of children under 5 years on food improve emergency care of neonates, infants and young children, abuse and HIV and personal development. Following interventions in The TB Programme is implementing the Drug-Resistant TB (DR TB) supplementation. The increase in this rate of supplementation is and on Management of Sick and Small New-borns (MSSN), among the previous year in two schools in Orange Farm, there was a Policy, including the Decentralised DR TB policy. Centralised DR TB attributed to the increased number of SAM cases identified and other interventions. decrease in learner pregnancy. deals with admission and management of complicated cases supplemented to prevent admissions and readmission: the revolving diagnosed across the province. Decentralised management deals Child Health Programme One young person from Ekurhuleni Health district was appointed by door syndrome. To measure the success of the SAM Treatment with uncomplicated DR TB diagnosed patients who are treated and The province has started to roll out and implement the Standardised the Minister of Health to participate in the National Advisory Group Protocol and provide an integrated approach to treating children managed at the district facilities. In 2018/19, 361 patients were Paediatric Register in all hospitals; this is aligned with the National for two years; and, as a strategy to reduce the number of new HIV with SAM or Moderate Acute Malnutrition (MACM), training was diagnosed with MDR TB and started on the new drugs on the short Information Data System (NIDS) and is intended to enable correct infections among Adolescent Girls and Young Women (AGYW), the conducted for 607 health care professionals, with SAM clinical regime; 203 (56.2%) were treated successfully due to the availability recording of paediatric admissions and separations. The number of Department has rolled-out pre-exposure prophylaxis (PrEP) in the audits and death reviews implemented in all hospitals. of new drugs and patients’ adherence to treatment. Integrated Management of Childhood Illnesses (IMCI) trained and health districts in the Ekurhuleni, Johannesburg and Tshwane mentored professional nurses has increased to 501 against the To promote patient recovery, reduce patient care costs and length of Research metros. target of 400; the aim is to increase Nurse Initiatied Management of hospital stay, food services in public health establishments strive to Development partners are carrying out research on shortening the Antiretroviral Treatment (NIMART) of children and reduce infant and Reproductive and Women’s Health provide patients with good quality, safe, adequate, nutrious and long treatment of TB and on new clinical work for the province on child morbidity and mortality rates. Four hundred and fifty four Contraception and Fertility Planning culturally acceptable meals. Food safety standards are critical in all managing children with TB. The Aurum Institute and NGO Right to professional nurses were trained on HBB. In the period under review, The Couple Year Protection Rate of 54.1% translates into an food service units and the national DoH carries out annual quality Care are implementing the studies in Sizwe Tropical Diseases diarrhoea deaths increased by 2.1% to 88; the target was a decrease increased number of IUD insertions from 5 146 in 2014/15 to 7 005 audits. In the reporting period, 31 took place with food service units Hospital and in the districts. The universities are also carrying out of 1.6%. There were 132 pneumonia deaths, an increase of 2.8%, in 2018/19; 481 professional nurses, 1 doctor and 44 enrolled achieving a score of 90%, above the national target of 75%. research into TB. In June 2018, team members from the province’s against a targeted decrease of 1.6%. nurses were trained in contraceptive and fertility planning. TB programme, in collaboration with the National TB Programme Children in need in crèches and at pre-schools are provided with and the World Bank, presented two papers at the Durban TB Cervical Cancer Screening growth monitoring, health promotion and subsidised nutrition Conference; they dealt with strategies to improve TB management Training took place during the reporting period on the new method funding, with 1 013 ECD centres (50 449 beneficiaries) reached and how to use the TB budget effectively in the province. of obtaining cervical smear-liquid base cytology (LBC) to reduce the during the year and a budget of R58 million (R5.27 per child per incidence and prevalence of cervical cancer with early diagnosis and day). enrolment to care. The cervical screening rate was 52% 2018/19.

Department of Health Annual Report 2018/19 35

Prevention Committee, consisting of stakeholders such as academic Tshwane Health District (two). This brings the total of optometrists Information has been provided to communities about how to institutions, NGOs, advocacy groups, development partners and in the Department’s service to 62; together with the eight recognise the signs and symptoms of the disease when returning other government Departments, continued its work. It meets district-based, dedicated ophthalmic nurses, this represents a from endemic areas, protecting themselves from mosquito bites by quarterly to ensure implementation of the National capable workforce at PHC to provide comprehensive eye health care using mosquito repellents, wearing long-sleeved clothing after dusk, Non-Communicable Diseases Strategy. The Tshwane and Ekurhuleni services, helping to ensure early diagnosis, treatment, management early presentation to health facilities if not well and taking Health Districts have established their District Non-Communicable and referrals. chemo-prophylaxis before visiting malaria-endemic areas. Malaria Diseases Prevention and Control Committees as a multi-sectoral awareness events are also organised by health promoters to target approach to the prevention and management of NCDs. communities with high case loads of malaria. Treatment outcomes Integrated School Health Programme (ISHP) Termination of Pregnancy Services In 2018/19, of a total of 18 009 patients aged 5 and older diagnosed MATERNAL, CHILD AND WOMEN’S HEALTH AND NUTRITION During the year, 15 463 learners were identified with health To prevent and reduce maternal deaths from unsafe abortions, the with TB, 16281 (90.4%) started on treatment, exceeding the target problems and were referred for further management at PHCs and/or Department started to provide medical abortion services in seven of 90% because of community education on the importance of Maternal and New-born Health hospitals. Preventative catch-up doses of Tetanus-Diphtheria (Td) hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, testing for TB and starting on treatment immediately after diagnosis The Department continues to implement the 1st Thousand Days immunisations were given to 13 166 six-year-old learners and to 12 Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses and remaining on it. The province has appointed 44 retired nurses to Programme aimed at improving the health of children from 956 twelve-year-olds. During routine health screening, 16 986 and two medical doctors were trained in medical and surgical assist the WBOT officers with tracing lost patients in all districts. confirmation of pregnancy to 2 years of age through social learners were dewormed. Health problems identified and abortion. mobilisation and behaviour change relating to early booking for appropriately managed and/or referred included underweight (1 Social mobilisation antenatal care before 14 weeks; antenatal services, including 417), overweight (5 264), speech problems (395), oral health (23 Breast Cancer Services The provincial TB programme has partnered with development provision of early ultrasound; and promotion of exclusive 660), eye problems (9 344) and suspected TB (236). Tembisa, Thelle Mogoerane, Rahima Moosa, Sebokeng and partners and health officials in all districts to ensure community breastfeeding for at least six months to, where possible, two years. Mamelodi hospitals rolled out mammogram services, with eleven Human Papillomavirus (HPV) Vaccination Campaign 1st Dose education, social mobilisation and advocacy in fighting TB and During the reporting period, 16 060 obstetric ultrasounds were hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg and 2nd Dose related diseases. As well as its day-to-day activities, the Advocacy, performed by advanced midwives among 173 316 (64.7% of the HPV Campaign 1st Dose Academic, Helen Joseph, Rahima Moosa, Kalafong, Mamelodi, Communication and Social Responsibility (ACSM) subprogramme total) first booking visits province-wide. To protect Grade 4 girls against future cervical cancer, the Human Steve Biko Academic, Dr George Mukhari Academic, Tembisa, Thelle was engaged in an intensive package of TB care and management Papilloma Virus (HPV) Vaccination campaign was conducted in all Mogoerane and Sebokeng) currently offering mammography for the whole of March 2019. This included TB screening/testing, These took place at targeted PHC facilities as part of outreach to health districts and schools visited during the reporting year, with 1 services; 47 444 mammograms were performed during the contact tracing of TB index cases, condom distribution, VMMC satellite clinics in all five health districts. Eight hundred and forty-five 433 first doses administered. reporting period. referral and health screening. A report on this is in progress. pregnant women were referred for higher level of care for reasons Nutrition and Food Services including multiple pregnancies, gross abnormalities, abnormal body HPV Campaign 1st and 2nd Dose TB/HIV collaboration All health care facilities promote breastfeeding and support mothers fluids, low lying placenta and other potential abnormalities. Despite During the period under review, 61 031 learners received the second During the reporting period, 11 980 people were diagnosed with in doing so; 94% of healthcare facilities provide maternity services ongoing training on Essential Steps in Managing Obstetric dose of HPV against a target of 60 000. TB/HIV co-infection. 10 057 (84%) were started on ART to ensure accredited as Mother and Baby Friendly. During the reporting Emergencies (ESMOE), the in-facility maternal mortality ratio (IMMR) increased HIV immunosuppression and successful TB treatment. All period, the percentage of severe acute malnutrition (SAM) death increased in comparison to the previous year from below 110 to Adolescent and Youth Health treatment and cares strategies are carried out in collaboration with under 5 years was 6.8% (105 deaths) against a target of 6%. 122.8 per 100 000 live births. The neonatal death in-facility ratio During the reporting period, 2600 young people attended the Youth the main HIV/ AIDS programme in the province. was 13 per 1000 live births which could be attributed to training Indaba where discussions took place on teenage sexual reproductive The Vitamin A dose rate for children 12-59 months of age stood at nurses and doctors on Helping Baby Breathe (HBB), intended to health and rights, pregnancy, violence, suicide, drug and substance Drug-Resistant TB (DR TB) 55.1%, with 5.76% of children under 5 years on food improve emergency care of neonates, infants and young children, abuse and HIV and personal development. Following interventions in The TB Programme is implementing the Drug-Resistant TB (DR TB) supplementation. The increase in this rate of supplementation is and on Management of Sick and Small New-borns (MSSN), among the previous year in two schools in Orange Farm, there was a Policy, including the Decentralised DR TB policy. Centralised DR TB attributed to the increased number of SAM cases identified and other interventions. decrease in learner pregnancy. deals with admission and management of complicated cases supplemented to prevent admissions and readmission: the revolving diagnosed across the province. Decentralised management deals Child Health Programme One young person from Ekurhuleni Health district was appointed by door syndrome. To measure the success of the SAM Treatment with uncomplicated DR TB diagnosed patients who are treated and The province has started to roll out and implement the Standardised the Minister of Health to participate in the National Advisory Group Protocol and provide an integrated approach to treating children managed at the district facilities. In 2018/19, 361 patients were Paediatric Register in all hospitals; this is aligned with the National for two years; and, as a strategy to reduce the number of new HIV with SAM or Moderate Acute Malnutrition (MACM), training was diagnosed with MDR TB and started on the new drugs on the short Information Data System (NIDS) and is intended to enable correct infections among Adolescent Girls and Young Women (AGYW), the conducted for 607 health care professionals, with SAM clinical regime; 203 (56.2%) were treated successfully due to the availability recording of paediatric admissions and separations. The number of Department has rolled-out pre-exposure prophylaxis (PrEP) in the audits and death reviews implemented in all hospitals. of new drugs and patients’ adherence to treatment. Integrated Management of Childhood Illnesses (IMCI) trained and health districts in the Ekurhuleni, Johannesburg and Tshwane mentored professional nurses has increased to 501 against the To promote patient recovery, reduce patient care costs and length of Research metros. target of 400; the aim is to increase Nurse Initiatied Management of hospital stay, food services in public health establishments strive to Development partners are carrying out research on shortening the Antiretroviral Treatment (NIMART) of children and reduce infant and Reproductive and Women’s Health provide patients with good quality, safe, adequate, nutrious and long treatment of TB and on new clinical work for the province on child morbidity and mortality rates. Four hundred and fifty four Contraception and Fertility Planning culturally acceptable meals. Food safety standards are critical in all managing children with TB. The Aurum Institute and NGO Right to professional nurses were trained on HBB. In the period under review, The Couple Year Protection Rate of 54.1% translates into an food service units and the national DoH carries out annual quality Care are implementing the studies in Sizwe Tropical Diseases diarrhoea deaths increased by 2.1% to 88; the target was a decrease increased number of IUD insertions from 5 146 in 2014/15 to 7 005 audits. In the reporting period, 31 took place with food service units Hospital and in the districts. The universities are also carrying out of 1.6%. There were 132 pneumonia deaths, an increase of 2.8%, in 2018/19; 481 professional nurses, 1 doctor and 44 enrolled achieving a score of 90%, above the national target of 75%. research into TB. In June 2018, team members from the province’s against a targeted decrease of 1.6%. nurses were trained in contraceptive and fertility planning. TB programme, in collaboration with the National TB Programme Children in need in crèches and at pre-schools are provided with and the World Bank, presented two papers at the Durban TB Cervical Cancer Screening growth monitoring, health promotion and subsidised nutrition Conference; they dealt with strategies to improve TB management Training took place during the reporting period on the new method funding, with 1 013 ECD centres (50 449 beneficiaries) reached and how to use the TB budget effectively in the province. of obtaining cervical smear-liquid base cytology (LBC) to reduce the during the year and a budget of R58 million (R5.27 per child per incidence and prevalence of cervical cancer with early diagnosis and day). enrolment to care. The cervical screening rate was 52% 2018/19.

36 Department of Health Annual Report 2018/19

Breast Cancer Services Tembisa, Thelle Mogoerane, Rahima Moosa, Sebokeng and Mamelodi hospitals rolled out mammogram services, with eleven hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg Academic, Helen Joseph, Rahima Moosa, Kalafong, Mamelodi, Steve Biko Academic, Dr George Mukhari Academic, Tembisa, Thelle Mogoerane and Sebokeng) currently offering mammography services; 47 444 mammograms were performed during the reporting period.

Nutrition and Food Services All health care facilities promote breastfeeding and support mothers in doing so; 94% of healthcare facilities provide maternity services accredited as Mother and Baby Friendly. During the reporting period, the percentage of severe acute malnutrition (SAM) death under 5 years was 6.8% (105 deaths) against a target of 6%.

The Vitamin A dose rate for children 12-59 months of age stood at 55.1%, with 5.76% of children under 5 years on food supplementation. The increase in this rate of supplementation is attributed to the increased number of SAM cases identified and supplemented to prevent admissions and readmission: the revolving door syndrome. To measure the success of the SAM Treatment Protocol and provide an integrated approach to treating children with SAM or Moderate Acute Malnutrition (MACM), training was conducted for 607 health care professionals, with SAM clinical audits and death reviews implemented in all hospitals.

To promote patient recovery, reduce patient care costs and length of hospital stay, food services in public health establishments strive to provide patients with good quality, safe, adequate, nutrious and culturally acceptable meals. Food safety standards are critical in all food service units and the national DoH carries out annual quality audits. In the reporting period, 31 took place with food service units achieving a score of 90%, above the national target of 75%.

Children in need in crèches and at pre-schools are provided with growth monitoring, health promotion and subsidised nutrition funding, with 1 013 ECD centres (50 449 beneficiaries) reached during the year and a budget of R58 million (R5.27 per child per day).

Obesity is a major public health problem facing the country, with its Geriatrics Communicable Disease Control and Surveillance Environmental Health services impact and cost affecting individuals, families, communities, the In collaboration with DSD, the Department ensures that the rights of It is South Africa’s aim to eliminate malaria by 2023. Gauteng is not Environmental health services are provided in all district health service and society as a whole. Training was provided for 35 older persons as outlined in the Older Persons Act No.13 of 2006 are malaria endemic but the increased movement of people (local, and municipalities and metros to enable identification and monitoring of caterers on the Gauteng Treasury database, with special emphasis protected and promoted. It fully supports the 69 old age homes foreign nationals) into the province results in increasing number of environmental conditions that may have adverse effects on public on healthy meal provision in the workplace. DoH and GDE subsidised by DSD, all of which along with some private homes are cases and deaths; free malaria chemoprophylaxis for travellers is not health; and all public hospitals have access to the services of established an Obesity Mandate Committee to develop an visited and audited to ensure compliance with the Act and with available. Two members of the Communicable Disease Control environmental health practitioners to assist management to comply Implementation Plan for the Obesity Strategy, with the focus on applicable health standards; 54 subsidised residential facilities are (CDC) team are part of the South African Malaria Elimination with environmental health related legislation. Water quality is Grade R, 1, 4, 8, 10 learners and on selected learners presenting visited weekly by a doctor from the Department. They are also Committee (SAMEC), where country decisions towards elimination monitored through sampling; during the financial year, the with obesity and overweight. A referral system to weight provided with medical supplies, oxygen therapy services and dry are made.Surveillance of notifiable medical conditions (NMCs) is a bacteriologic compliance rate was 76%; this is below the national management professionals at health care facilities is in place. dispensary including napkins. Also in collaboration with DSD, 117 pillar of communicable disease control, serving as an early warning target of 100%, with the non-compliance attributed to the practice health professionals from Ekurhuleni Health District were trained on system in preventing infectious disease outbreaks. of storing water in containers at end user level. InterDepartmental collaboration with SASSA on providing food the Elderly Abuse Strategy, and the Department supported the parcels benefited 3 634 children under the age of five presenting Active Aging Programme, with a medical team consisting of one A new web-based NMC system rolled out in all of the province’s Food safety is continuously monitored and food premises inspected, with SAM and MAM (Moderate Acute Malnutrition); the aim is to doctor, two physiotherapists and two professional nurses health care facilities has provided real-time notification of infectious particularly following the public outcry about the sale of fake and prevent children with MAM from progressing to SAM and those accompanying Team Gauteng to the National Older Persons’ Golden diseases, with all reported outbreaks attended to within 24 hours. unsound food stuffs. Joint investigation operations were conducted with SAM from regressing. Games in Bloemfontein in October 2018. All hospitals and clinics submit weekly surveillance reports. The with law enforcement agencies to address complaints; out of 55 586 target for submission is 80%; at 93%, the province has exceeded food premises inspected, 68.3 % were found to comply with food DISEASE PREVENTION AND CONTROL Long Term Domiciliary Oxygen Therapy this. safety legislation. Illegal operations, not compliant with zoning The Department Provided Long Term Domiciliary Oxygen Therapy regulations, contributed to the low compliance rate. Some premises Health Promotion (LTDOT) to 1 618 patients, of whom 8 patients are school going Annual Influenza vaccinations have been provided in all districts, were served with compliance notices and others were closed. Health promotion is a process of enabling people to increase control children and students supplied with portable freestyle oxygen with a particular focus on vulnerable groups: people with chronic over and improve their health. The Health Promotion Programme is concentrators to assist them as they attend school and university. illnesses; pregnant women; people aged 65 years and above; and During the reporting period, the premises of 530 hazardous available to people and groups of all ages and aims to increase their The aim of the programme is to prolong the life expectancy of residents of old age homes and rehabilitation centres. In 2018, 260 substances dealers were inspected in accordance with the involvement in activities that improve their lifestyles. It operates patients diagnosed with respiratory diseases such as Chronic 000 influenza vaccine doses were distributed to such facilities, Hazardous Substance Act 15 of 1973; the compliance rate was through drives and participates in campaigns, events, community Obstructive Pulmonary Disease (COPD), lung cancer and diseases attaining a coverage of 97%. 94.3%, higher than the 75% of the previous financial year. The development and health education activities. During the reporting secondary to COPD. year, the programme planned for 250 outreach health promotion improvement is attributed to intensified monitoring strategies. Strategies to Address Underperformance in Communicable activities and achieved 536, conducted in a wide variety of settings Eye care and reaching 2 793 182 people. This exceeded the target of 2 000 During the financial year, 13 626 cataract operations (957.3/mil) Disease Control and Surveillance As part of active surveillance to reduce malaria deaths and eliminate 000. were performed in 14 facilities, almost reaching the Department’s Training on malaria elimination strategies, targeting environmental the disease from the country, all malaria cases were investigated and target of 11 232 (1000/mil); 31 102 spectacles were issued to health practitioners, doctors, nurses and other healthcare in almost all cases, the patient had travelled to malaria endemic Non-Communicable Diseases (NCDs), geriatrics, and eye-care patients with refractive errors. In collaboration with Onsight, the practitioners, has been provided. malaria death audits are conducted areas. Early Detection and Treatment Impact Department established an eye clinic at Carletonville Hospital. This on all patients who die from malaria; the most common cause of During the reporting period, 2 660 857 people were counselled and Strategy to address areas of underperformance provides eye health services to the general Carletonville community fatality is patients presentating late at health facilities. A malaria screened for diabetes and 2 974 226 screened for hypertension, Awareness creation about safe water storage and food safety who previously had to travel a considerable distance to Leratong Rapid Diagnostic Test (RDT) is availed at all health care facilities to with 44 192 new diabetic patients aged 40 and older diagnosed and measures will continue, as will workshops for environmental health Hospital for such services. Through a collaboration with the Brien allow early diagnosis in the these facilities. Intravenous artesunate, started on treatment. Of 2 295 851 hypertension patient visits, 1 practitioners on food safety and water quality monitoring. Holden Vision Institute (BHVI), 13 optometrists were trained on the the drug of choice for complications of malaria, is now available in 736 640 patients (83%) had a normal blood pressure below 140/90 diagnostics course at the University of Johannesburg. public as well as private hospitals. PHC nurses in all districts have mmHg, and of 552 537 diabetes patient visits 367 711 patients been trained on the use of the rapid diagnostic test and on (73%) had normal blood glucose levels. Five optometrists trained with bursary support from the Department administering Coartem, the treatment for malaria without complications. Doctors and environmental health practitioners have Leadership and Governance – multi-sectoral approach at various training institutions were placed the West-Rand Health been trained on the management and investigation of malaria. During the financial year, the Department’s NCD Control and District (one optometrist), Sedibeng Health District (two) and

Department of Health Annual Report 2018/19 37 Termination of Pregnancy Services To prevent and reduce maternal deaths from unsafe abortions, the Department started to provide medical abortion services in seven hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses and two medical doctors were trained in medical and surgical abortion.

Obesity is a major public health problem facing the country, with its Geriatrics Communicable Disease Control and Surveillance Environmental Health services impact and cost affecting individuals, families, communities, the In collaboration with DSD, the Department ensures that the rights of It is South Africa’s aim to eliminate malaria by 2023. Gauteng is not Environmental health services are provided in all district health service and society as a whole. Training was provided for 35 older persons as outlined in the Older Persons Act No.13 of 2006 are malaria endemic but the increased movement of people (local, and municipalities and metros to enable identification and monitoring of caterers on the Gauteng Treasury database, with special emphasis protected and promoted. It fully supports the 69 old age homes foreign nationals) into the province results in increasing number of environmental conditions that may have adverse effects on public on healthy meal provision in the workplace. DoH and GDE subsidised by DSD, all of which along with some private homes are cases and deaths; free malaria chemoprophylaxis for travellers is not health; and all public hospitals have access to the services of established an Obesity Mandate Committee to develop an visited and audited to ensure compliance with the Act and with available. Two members of the Communicable Disease Control environmental health practitioners to assist management to comply Implementation Plan for the Obesity Strategy, with the focus on applicable health standards; 54 subsidised residential facilities are (CDC) team are part of the South African Malaria Elimination with environmental health related legislation. Water quality is Grade R, 1, 4, 8, 10 learners and on selected learners presenting visited weekly by a doctor from the Department. They are also Committee (SAMEC), where country decisions towards elimination monitored through sampling; during the financial year, the with obesity and overweight. A referral system to weight provided with medical supplies, oxygen therapy services and dry are made.Surveillance of notifiable medical conditions (NMCs) is a bacteriologic compliance rate was 76%; this is below the national management professionals at health care facilities is in place. dispensary including napkins. Also in collaboration with DSD, 117 pillar of communicable disease control, serving as an early warning target of 100%, with the non-compliance attributed to the practice health professionals from Ekurhuleni Health District were trained on system in preventing infectious disease outbreaks. of storing water in containers at end user level. InterDepartmental collaboration with SASSA on providing food the Elderly Abuse Strategy, and the Department supported the parcels benefited 3 634 children under the age of five presenting Active Aging Programme, with a medical team consisting of one A new web-based NMC system rolled out in all of the province’s Food safety is continuously monitored and food premises inspected, with SAM and MAM (Moderate Acute Malnutrition); the aim is to doctor, two physiotherapists and two professional nurses health care facilities has provided real-time notification of infectious particularly following the public outcry about the sale of fake and prevent children with MAM from progressing to SAM and those accompanying Team Gauteng to the National Older Persons’ Golden diseases, with all reported outbreaks attended to within 24 hours. unsound food stuffs. Joint investigation operations were conducted with SAM from regressing. Games in Bloemfontein in October 2018. All hospitals and clinics submit weekly surveillance reports. The with law enforcement agencies to address complaints; out of 55 586 target for submission is 80%; at 93%, the province has exceeded food premises inspected, 68.3 % were found to comply with food DISEASE PREVENTION AND CONTROL Long Term Domiciliary Oxygen Therapy this. safety legislation. Illegal operations, not compliant with zoning The Department Provided Long Term Domiciliary Oxygen Therapy regulations, contributed to the low compliance rate. Some premises Health Promotion (LTDOT) to 1 618 patients, of whom 8 patients are school going Annual Influenza vaccinations have been provided in all districts, were served with compliance notices and others were closed. Health promotion is a process of enabling people to increase control children and students supplied with portable freestyle oxygen with a particular focus on vulnerable groups: people with chronic over and improve their health. The Health Promotion Programme is concentrators to assist them as they attend school and university. illnesses; pregnant women; people aged 65 years and above; and During the reporting period, the premises of 530 hazardous available to people and groups of all ages and aims to increase their The aim of the programme is to prolong the life expectancy of residents of old age homes and rehabilitation centres. In 2018, 260 substances dealers were inspected in accordance with the involvement in activities that improve their lifestyles. It operates patients diagnosed with respiratory diseases such as Chronic 000 influenza vaccine doses were distributed to such facilities, Hazardous Substance Act 15 of 1973; the compliance rate was through drives and participates in campaigns, events, community Obstructive Pulmonary Disease (COPD), lung cancer and diseases attaining a coverage of 97%. 94.3%, higher than the 75% of the previous financial year. The development and health education activities. During the reporting secondary to COPD. year, the programme planned for 250 outreach health promotion improvement is attributed to intensified monitoring strategies. Strategies to Address Underperformance in Communicable activities and achieved 536, conducted in a wide variety of settings Eye care and reaching 2 793 182 people. This exceeded the target of 2 000 During the financial year, 13 626 cataract operations (957.3/mil) Disease Control and Surveillance As part of active surveillance to reduce malaria deaths and eliminate 000. were performed in 14 facilities, almost reaching the Department’s Training on malaria elimination strategies, targeting environmental the disease from the country, all malaria cases were investigated and target of 11 232 (1000/mil); 31 102 spectacles were issued to health practitioners, doctors, nurses and other healthcare in almost all cases, the patient had travelled to malaria endemic Non-Communicable Diseases (NCDs), geriatrics, and eye-care patients with refractive errors. In collaboration with Onsight, the practitioners, has been provided. malaria death audits are conducted areas. Early Detection and Treatment Impact Department established an eye clinic at Carletonville Hospital. This on all patients who die from malaria; the most common cause of During the reporting period, 2 660 857 people were counselled and Strategy to address areas of underperformance provides eye health services to the general Carletonville community fatality is patients presentating late at health facilities. A malaria screened for diabetes and 2 974 226 screened for hypertension, Awareness creation about safe water storage and food safety who previously had to travel a considerable distance to Leratong Rapid Diagnostic Test (RDT) is availed at all health care facilities to with 44 192 new diabetic patients aged 40 and older diagnosed and measures will continue, as will workshops for environmental health Hospital for such services. Through a collaboration with the Brien allow early diagnosis in the these facilities. Intravenous artesunate, started on treatment. Of 2 295 851 hypertension patient visits, 1 practitioners on food safety and water quality monitoring. Holden Vision Institute (BHVI), 13 optometrists were trained on the the drug of choice for complications of malaria, is now available in 736 640 patients (83%) had a normal blood pressure below 140/90 diagnostics course at the University of Johannesburg. public as well as private hospitals. PHC nurses in all districts have mmHg, and of 552 537 diabetes patient visits 367 711 patients been trained on the use of the rapid diagnostic test and on (73%) had normal blood glucose levels. Five optometrists trained with bursary support from the Department administering Coartem, the treatment for malaria without complications. Doctors and environmental health practitioners have Leadership and Governance – multi-sectoral approach at various training institutions were placed the West-Rand Health been trained on the management and investigation of malaria. During the financial year, the Department’s NCD Control and District (one optometrist), Sedibeng Health District (two) and

38 Department of Health Annual Report 2018/19 Termination of Pregnancy Services To prevent and reduce maternal deaths from unsafe abortions, the Department started to provide medical abortion services in seven hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses and two medical doctors were trained in medical and surgical abortion.

Obesity is a major public health problem facing the country, with its Geriatrics Communicable Disease Control and Surveillance Environmental Health services PERFORMANCE INDICATORS: PROGRAMME 2 - DISTRICT HEALTH SERVICES impact and cost affecting individuals, families, communities, the In collaboration with DSD, the Department ensures that the rights of It is South Africa’s aim to eliminate malaria by 2023. Gauteng is not Environmental health services are provided in all district health service and society as a whole. Training was provided for 35 older persons as outlined in the Older Persons Act No.13 of 2006 are malaria endemic but the increased movement of people (local, and municipalities and metros to enable identification and monitoring of Sub-programme: District Health Management and PHC Services caterers on the Gauteng Treasury database, with special emphasis protected and promoted. It fully supports the 69 old age homes foreign nationals) into the province results in increasing number of environmental conditions that may have adverse effects on public Planned Actual Deviation Comment on deviation on healthy meal provision in the workplace. DoH and GDE Actual subsidised by DSD, all of which along with some private homes are cases and deaths; free malaria chemoprophylaxis for travellers is not health; and all public hospitals have access to the services of Strategic objective achievement target achievement from planned established an Obesity Mandate Committee to develop an visited and audited to ensure compliance with the Act and with 2017/18 2018/19 2018/19 target 2018/19 available. Two members of the Communicable Disease Control environmental health practitioners to assist management to comply (over/(under)) Implementation Plan for the Obesity Strategy, with the focus on applicable health standards; 54 subsidised residential facilities are (CDC) team are part of the South African Malaria Elimination with environmental health related legislation. Water quality is Grade R, 1, 4, 8, 10 learners and on selected learners presenting visited weekly by a doctor from the Department. They are also Committee (SAMEC), where country decisions towards elimination monitored through sampling; during the financial year, the Increase PHC facilities rendering 24 hours service provision in all CHCs; integration of mental health and rehabilitation services in with obesity and overweight. A referral system to weight provided with medical supplies, oxygen therapy services and dry are made.Surveillance of notifiable medical conditions (NMCs) is a bacteriologic compliance rate was 76%; this is below the national 100% of PHC facilities by 2019/20 management professionals at health care facilities is in place. dispensary including napkins. Also in collaboration with DSD, 117 pillar of communicable disease control, serving as an early warning target of 100%, with the non-compliance attributed to the practice Number of CHCs 30/32 30/32 30/32 0 Target achieved health professionals from Ekurhuleni Health District were trained on system in preventing infectious disease outbreaks. of storing water in containers at end user level. InterDepartmental collaboration with SASSA on providing food the Elderly Abuse Strategy, and the Department supported the providing 24-hour parcels benefited 3 634 children under the age of five presenting services Active Aging Programme, with a medical team consisting of one A new web-based NMC system rolled out in all of the province’s Food safety is continuously monitored and food premises inspected, with SAM and MAM (Moderate Acute Malnutrition); the aim is to doctor, two physiotherapists and two professional nurses health care facilities has provided real-time notification of infectious particularly following the public outcry about the sale of fake and prevent children with MAM from progressing to SAM and those Percentage of PHC 100% 100% 100% 0% Target achieved accompanying Team Gauteng to the National Older Persons’ Golden diseases, with all reported outbreaks attended to within 24 hours. unsound food stuffs. Joint investigation operations were conducted with SAM from regressing. facilities with (372/372) (372/372) Games in Bloemfontein in October 2018. All hospitals and clinics submit weekly surveillance reports. The with law enforcement agencies to address complaints; out of 55 586 integrated mental target for submission is 80%; at 93%, the province has exceeded food premises inspected, 68.3 % were found to comply with food DISEASE PREVENTION AND CONTROL Long Term Domiciliary Oxygen Therapy health services this. safety legislation. Illegal operations, not compliant with zoning The Department Provided Long Term Domiciliary Oxygen Therapy regulations, contributed to the low compliance rate. Some premises Health Promotion (LTDOT) to 1 618 patients, of whom 8 patients are school going Annual Influenza vaccinations have been provided in all districts, were served with compliance notices and others were closed. Increase the number of fully-fledged, functional Ward Based Outreach Teams from 103 to 533 by 2019/20 Health promotion is a process of enabling people to increase control children and students supplied with portable freestyle oxygen with a particular focus on vulnerable groups: people with chronic over and improve their health. The Health Promotion Programme is concentrators to assist them as they attend school and university. Number of fully 754 775 791 16 Target exceeded through the illnesses; pregnant women; people aged 65 years and above; and During the reporting period, the premises of 530 hazardous available to people and groups of all ages and aims to increase their The aim of the programme is to prolong the life expectancy of fledged, functional establishment of additional 16 teams. residents of old age homes and rehabilitation centres. In 2018, 260 substances dealers were inspected in accordance with the involvement in activities that improve their lifestyles. It operates patients diagnosed with respiratory diseases such as Chronic Ward Based Outreach More Community Health Workers 000 influenza vaccine doses were distributed to such facilities, Hazardous Substance Act 15 of 1973; the compliance rate was through drives and participates in campaigns, events, community Obstructive Pulmonary Disease (COPD), lung cancer and diseases Teams employed in Tshwane Health District. attaining a coverage of 97%. 94.3%, higher than the 75% of the previous financial year. The development and health education activities. During the reporting secondary to COPD. year, the programme planned for 250 outreach health promotion improvement is attributed to intensified monitoring strategies. Reduce Outpatient Department (OPD), Accident and Emergency Department waiting times across all facilities by 60% in 2019/20 activities and achieved 536, conducted in a wide variety of settings Eye care Strategies to Address Underperformance in Communicable and reaching 2 793 182 people. This exceeded the target of 2 000 During the financial year, 13 626 cataract operations (957.3/mil) Disease Control and Surveillance As part of active surveillance to reduce malaria deaths and eliminate Percentage of PHC # 50% 58% 8% PHC facilities have achieved the set target 000. were performed in 14 facilities, almost reaching the Department’s Training on malaria elimination strategies, targeting environmental the disease from the country, all malaria cases were investigated and facilities with average of 100 minutes. target of 11 232 (1000/mil); 31 102 spectacles were issued to health practitioners, doctors, nurses and other healthcare in almost all cases, the patient had travelled to malaria endemic treatment waiting Non-Communicable Diseases (NCDs), geriatrics, and eye-care patients with refractive errors. In collaboration with Onsight, the practitioners, has been provided. malaria death audits are conducted areas. times below agreed Early Detection and Treatment Impact Department established an eye clinic at Carletonville Hospital. This on all patients who die from malaria; the most common cause of benchmark of 100 During the reporting period, 2 660 857 people were counselled and Strategy to address areas of underperformance provides eye health services to the general Carletonville community fatality is patients presentating late at health facilities. A malaria minutes screened for diabetes and 2 974 226 screened for hypertension, Rapid Diagnostic Test (RDT) is availed at all health care facilities to Awareness creation about safe water storage and food safety who previously had to travel a considerable distance to Leratong Improve staff (health professionals and administration) attendance at PHC facilities and OPD and Accident and Emergency across all with 44 192 new diabetic patients aged 40 and older diagnosed and allow early diagnosis in the these facilities. Intravenous artesunate, measures will continue, as will workshops for environmental health Hospital for such services. Through a collaboration with the Brien health facilities by 90% started on treatment. Of 2 295 851 hypertension patient visits, 1 practitioners on food safety and water quality monitoring. Holden Vision Institute (BHVI), 13 optometrists were trained on the the drug of choice for complications of malaria, is now available in 736 640 patients (83%) had a normal blood pressure below 140/90 Percentage of PHC # 100% 100% 0% Target achieved diagnostics course at the University of Johannesburg. public as well as private hospitals. PHC nurses in all districts have facilities with staff mmHg, and of 552 537 diabetes patient visits 367 711 patients been trained on the use of the rapid diagnostic test and on (73%) had normal blood glucose levels. attendance of 90% Five optometrists trained with bursary support from the Department administering Coartem, the treatment for malaria without and above complications. Doctors and environmental health practitioners have Leadership and Governance – multi-sectoral approach at various training institutions were placed the West-Rand Health been trained on the management and investigation of malaria. Increase fixed PHC clinics with Ideal Clinic status to 100%; 100% of PHC facilities and district hospitals compliant with national core During the financial year, the Department’s NCD Control and District (one optometrist), Sedibeng Health District (two) and standards; and complete self assessments in 100% of hospitals and >95% of PHC facilities by 2019/20 Prevention Committee, consisting of stakeholders such as academic Tshwane Health District (two). This brings the total of optometrists Information has been provided to communities about how to institutions, NGOs, advocacy groups, development partners and in the Department’s service to 62; together with the eight Ideal Clinic status rate # 75% 89.2% 14.2% Target exceeded due to an additional five recognise the signs and symptoms of the disease when returning other government Departments, continued its work. It meets district-based, dedicated ophthalmic nurses, this represents a (330/370) clinics (Khutsong West, Khutsong CHC, from endemic areas, protecting themselves from mosquito bites by quarterly to ensure implementation of the National capable workforce at PHC to provide comprehensive eye health care Beverly Hills, Evaton Main and Rabie using mosquito repellents, wearing long-sleeved clothing after dusk, Non-Communicable Diseases Strategy. The Tshwane and Ekurhuleni services, helping to ensure early diagnosis, treatment, management Ridge) achieving Ideal Clinic status. early presentation to health facilities if not well and taking Health Districts have established their District Non-Communicable and referrals. chemo-prophylaxis before visiting malaria-endemic areas. Malaria Diseases Prevention and Control Committees as a multi-sectoral awareness events are also organised by health promoters to target approach to the prevention and management of NCDs. communities with high case loads of malaria.

Department of Health Annual Report 2018/19 39 Termination of Pregnancy Services To prevent and reduce maternal deaths from unsafe abortions, the Department started to provide medical abortion services in seven hospitals (Carletonville, Heidelberg, Dr Yusuf Dadoo, South Rand, Kalafong, Tembisa and Bertha Gxowa). Twenty professional nurses and two medical doctors were trained in medical and surgical abortion.

Obesity is a major public health problem facing the country, with its Geriatrics Communicable Disease Control and Surveillance Environmental Health services Sub-programme: District Health Management and PHC Services impact and cost affecting individuals, families, communities, the In collaboration with DSD, the Department ensures that the rights of It is South Africa’s aim to eliminate malaria by 2023. Gauteng is not Environmental health services are provided in all district Actual Planned Actual Deviation Comment on deviation health service and society as a whole. Training was provided for 35 older persons as outlined in the Older Persons Act No.13 of 2006 are malaria endemic but the increased movement of people (local, and municipalities and metros to enable identification and monitoring of Strategic objective achievement target achievement from planned caterers on the Gauteng Treasury database, with special emphasis protected and promoted. It fully supports the 69 old age homes 2017/18 2018/19 2018/19 target 2018/19 foreign nationals) into the province results in increasing number of environmental conditions that may have adverse effects on public (over/(under)) on healthy meal provision in the workplace. DoH and GDE subsidised by DSD, all of which along with some private homes are cases and deaths; free malaria chemoprophylaxis for travellers is not health; and all public hospitals have access to the services of established an Obesity Mandate Committee to develop an visited and audited to ensure compliance with the Act and with available. Two members of the Communicable Disease Control environmental health practitioners to assist management to comply Reduce the number of primary care patient cases seen at regional, tertiary and central hospitals by 20% in 2019/20 to increase Implementation Plan for the Obesity Strategy, with the focus on applicable health standards; 54 subsidised residential facilities are (CDC) team are part of the South African Malaria Elimination with environmental health related legislation. Water quality is utilisation of PHC services Grade R, 1, 4, 8, 10 learners and on selected learners presenting visited weekly by a doctor from the Department. They are also Committee (SAMEC), where country decisions towards elimination monitored through sampling; during the financial year, the with obesity and overweight. A referral system to weight PHC utilisation rate - 1.5% 1.6 1.5 (0.1) Target not achieved because of provided with medical supplies, oxygen therapy services and dry are made.Surveillance of notifiable medical conditions (NMCs) is a bacteriologic compliance rate was 76%; this is below the national management professionals at health care facilities is in place. total (210 796 58 / implementation of community-based dispensary including napkins. Also in collaboration with DSD, 117 pillar of communicable disease control, serving as an early warning target of 100%, with the non-compliance attributed to the practice 141 042 42) interventions aimed at decongesting clinics health professionals from Ekurhuleni Health District were trained on system in preventing infectious disease outbreaks. of storing water in containers at end user level. InterDepartmental collaboration with SASSA on providing food the Elderly Abuse Strategy, and the Department supported the which led to lower numbers presenting at parcels benefited 3 634 children under the age of five presenting health facilities. Active Aging Programme, with a medical team consisting of one A new web-based NMC system rolled out in all of the province’s Food safety is continuously monitored and food premises inspected, with SAM and MAM (Moderate Acute Malnutrition); the aim is to doctor, two physiotherapists and two professional nurses health care facilities has provided real-time notification of infectious particularly following the public outcry about the sale of fake and Percentage complaints within 25 working days will be over 95% by 2019/20 prevent children with MAM from progressing to SAM and those accompanying Team Gauteng to the National Older Persons’ Golden diseases, with all reported outbreaks attended to within 24 hours. unsound food stuffs. Joint investigation operations were conducted with SAM from regressing. Games in Bloemfontein in October 2018. All hospitals and clinics submit weekly surveillance reports. The with law enforcement agencies to address complaints; out of 55 586 Complaints resolutions 95.9% 100% 96.1% (3.9%) Target not achieved due to target for submission is 80%; at 93%, the province has exceeded food premises inspected, 68.3 % were found to comply with food within 25 working days (2 080/2 165) capacity-related challenges particularly in DISEASE PREVENTION AND CONTROL Long Term Domiciliary Oxygen Therapy this. safety legislation. Illegal operations, not compliant with zoning rate (PHCs) Ekurhuleni District The Department Provided Long Term Domiciliary Oxygen Therapy regulations, contributed to the low compliance rate. Some premises Health Promotion (LTDOT) to 1 618 patients, of whom 8 patients are school going Annual Influenza vaccinations have been provided in all districts, were served with compliance notices and others were closed. Health promotion is a process of enabling people to increase control children and students supplied with portable freestyle oxygen with a particular focus on vulnerable groups: people with chronic over and improve their health. The Health Promotion Programme is concentrators to assist them as they attend school and university. illnesses; pregnant women; people aged 65 years and above; and During the reporting period, the premises of 530 hazardous available to people and groups of all ages and aims to increase their The aim of the programme is to prolong the life expectancy of residents of old age homes and rehabilitation centres. In 2018, 260 substances dealers were inspected in accordance with the Sub-programme: District Hospitals involvement in activities that improve their lifestyles. It operates patients diagnosed with respiratory diseases such as Chronic 000 influenza vaccine doses were distributed to such facilities, Hazardous Substance Act 15 of 1973; the compliance rate was through drives and participates in campaigns, events, community Obstructive Pulmonary Disease (COPD), lung cancer and diseases Increase % of health facilities with annual quality improvement plan based on a PHC facilities self-assessment to 100%, fixed PHC attaining a coverage of 97%. 94.3%, higher than the 75% of the previous financial year. The development and health education activities. During the reporting secondary to COPD. clinics scoring above 80% on the Ideal Clinic dashboard, 90% of PHC facilities and district hospitals compliance with national core year, the programme planned for 250 outreach health promotion improvement is attributed to intensified monitoring strategies. standards and percentage of PHC facilities and district hospitals that conduct self-assessment to 100% by 2019/20 activities and achieved 536, conducted in a wide variety of settings Eye care Strategies to Address Underperformance in Communicable and reaching 2 793 182 people. This exceeded the target of 2 000 During the financial year, 13 626 cataract operations (957.3/mil) Disease Control and Surveillance As part of active surveillance to reduce malaria deaths and eliminate Hospital achieved 75% and (11/12) 11/12 11/12 0 Target achieved 000. were performed in 14 facilities, almost reaching the Department’s Training on malaria elimination strategies, targeting environmental the disease from the country, all malaria cases were investigated and more on the National Core 92% target of 11 232 (1000/mil); 31 102 spectacles were issued to health practitioners, doctors, nurses and other healthcare in almost all cases, the patient had travelled to malaria endemic Standards self-assessment Non-Communicable Diseases (NCDs), geriatrics, and eye-care patients with refractive errors. In collaboration with Onsight, the practitioners, has been provided. malaria death audits are conducted areas. rate (district hospitals) Early Detection and Treatment Impact Department established an eye clinic at Carletonville Hospital. This on all patients who die from malaria; the most common cause of Improve the efficiency of hospitals by reducing the average length of stay to less than 5 days During the reporting period, 2 660 857 people were counselled and Strategy to address areas of underperformance provides eye health services to the general Carletonville community fatality is patients presentating late at health facilities. A malaria screened for diabetes and 2 974 226 screened for hypertension, Awareness creation about safe water storage and food safety Average length of stay 4.4 days 4.5 days 4.1 days 0.4 days Within target who previously had to travel a considerable distance to Leratong Rapid Diagnostic Test (RDT) is availed at all health care facilities to with 44 192 new diabetic patients aged 40 and older diagnosed and measures will continue, as will workshops for environmental health (district hospitals) (662 745/161 050) Hospital for such services. Through a collaboration with the Brien allow early diagnosis in the these facilities. Intravenous artesunate, started on treatment. Of 2 295 851 hypertension patient visits, 1 practitioners on food safety and water quality monitoring. Holden Vision Institute (BHVI), 13 optometrists were trained on the the drug of choice for complications of malaria, is now available in Increase bed utilisation to 80% and decrease expenditure per PDE in hospitals by 2019/20 736 640 patients (83%) had a normal blood pressure below 140/90 public as well as private hospitals. PHC nurses in all districts have diagnostics course at the University of Johannesburg. 68.1% Within target mmHg, and of 552 537 diabetes patient visits 367 711 patients Inpatient bed utilisation 66.9% 70% 1.9% been trained on the use of the rapid diagnostic test and on (662 745/ rate (district hospitals) (73%) had normal blood glucose levels. 973 835.46) Five optometrists trained with bursary support from the Department administering Coartem, the treatment for malaria without complications. Doctors and environmental health practitioners have Percentage of complaints resolved within 25 working days will be over 95% by 2019/20 Leadership and Governance – multi-sectoral approach at various training institutions were placed the West-Rand Health District (one optometrist), Sedibeng Health District (two) and been trained on the management and investigation of malaria. During the financial year, the Department’s NCD Control and Expenditure per PDE R3 198 R3629 R 3 339.3 R 289.7 Target achieved Tshwane Health District (two). This brings the total of optometrists Prevention Committee, consisting of stakeholders such as academic (district hospitals) (3 307 834 273/ Information has been provided to communities about how to institutions, NGOs, advocacy groups, development partners and in the Department’s service to 62; together with the eight 990 568) recognise the signs and symptoms of the disease when returning other government Departments, continued its work. It meets district-based, dedicated ophthalmic nurses, this represents a Percentage of complaints resolved within 25 working days to be over 95% by 2019/20 from endemic areas, protecting themselves from mosquito bites by quarterly to ensure implementation of the National capable workforce at PHC to provide comprehensive eye health care using mosquito repellents, wearing long-sleeved clothing after dusk, Complaint resolution 99.4% 99.4% 99.1% 0.3% Target exceeded; the Provincial Office’s Non-Communicable Diseases Strategy. The Tshwane and Ekurhuleni services, helping to ensure early diagnosis, treatment, management early presentation to health facilities if not well and taking within 25 working days (529/534) monitoring of complaints has been Health Districts have established their District Non-Communicable and referrals. chemo-prophylaxis before visiting malaria-endemic areas. Malaria rate (district hospitals) strengthened and physical visits to facilities Diseases Prevention and Control Committees as a multi-sectoral awareness events are also organised by health promoters to target have started. approach to the prevention and management of NCDs. communities with high case loads of malaria.

40 Department of Health Annual Report 2018/19 Sub-programme: District Hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Reduce Outpatient Department (OPD), Accident and Emergency Department waiting times across all facilities by 60% in 2019/20

Percentage of hospitals 75% 66% 91.6% 25.6% Three more hospitals were measured, and with OPD average (9/12) the same was an inductive exercise in treatment waiting times preparation for an increase in 2019/20 below agreed benchmark of 180 minutes

Improve staff attendance (health professionals and administration) at PHC facilities and OPD and Accident and Emergency across all health facilities by 90%

Percentage of hospitals # 100% 0% (100%) Currently not reported on due to limited with staff attendance understanding of the tool. Training will be of 90% and above done by Quality Assurance Directorate during 2019/20 financial year.

Sub-programme: HIV And AIDS, STI And TB Control Reduce Mother to Child Transmission of HIV from 2% to <1,3% at 10 weeks after birth and from <5% to 1.38% at 18 months after birth by increasing antiretroviral coverage among pregnant women living with HIV by 2019/20

Transmission rate from 0.99% <1.38% 1.19% 0.19% Target achieved mother to child (656/55 147)

Increase the number of female condoms distributed annually from 1 451 696 to 5.6 million by 2019/20

Female condoms 7 289 873 5 091 314 3 760 346 (1 330 968) Target not achieved due to inability of the distributed new contractor to meet the condom demands, payment delays, fewer primary distribution sites in Ekurhuleni and delays in approval by SABS. The Department will be increasing PDS sites and facilitate quicker resolution of work cycles. It will also intervene through NDOH to facilitate fast-tracking of the assessments with SABS management.

Increase the proportion of the HIV positive population on ART from 80% in 2013/14 to 90% by 2019/20

Total new clients # 185 700 173 923 (11 777) The target was not achieved due to poor started on ART linkage to care. Improvement in this was observed following the introduction of linkage officers, whose functionality will be strengthened.

Department of Health Annual Report 2018/19 41 Sub-programme: HIV And AIDS, STI And TB Control

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Increase the proportion of HIV positive population on ART from 80% in 2013/14 to 90% by 2019/20

ART clients remain on 927 825 1 093 1 037 212 (56 645) The target was not achieved due to ART end of month: total 857 declining initiation trends; these improved in the last quarter of the year under review due to multi-stakeholder engagement. Strengthening the functionality of linkage officers; initiating at multiple focal points; and monitoring supervision of daily capturing to continue. TB/HIV co-infected 87.5% 90% 88.2% (1.8%) Target not achieved due to limited clients on ART rate (17 690/20051) integration across health facilities and incomplete capturing of data onto ETR.net. Monitoring supervision of daily capturing and advocate for limited rotation of technical staff to a minimum of 1 year. Increase the number of people tested for HIV, including pregnant women, from 3 257 478 in 2013/14 to 2 498 007 by 2019/20

HIV tests done - total 3 083 921 2 641 848 3 253 783 61 1 935 Multi-stakeholder and multisectoral collaboration contributed to this achievement.

Increase percentage of people treated for TB from 84% in 2013/14 to 92% of total population with HIV by 2019/20

TB clients 5 years and older 88.1% 90% 90.5% 0.5% Target exceeded due to improved contact started on treatment - rate tracing.

Increase number of male condoms distributed annually from 69 480 738 to 176 million by 2019/20

Male condoms distributed 190 349 748 160 524 172 953 486 12 429 486 Target exceeded due to increased uptake 000 of variety of scented condoms and increased primary distribution sites in Tshwane district.

Increase number of men medically circumcised from 132 095 in 2013/14 to 136 752 by 2019/20

Medical male circumcisions - 112 608 124 320 102 325 (21 995) Target not achieved due to delays in the total awarding of the General Practitioners Tender for medical male circumcision. The tender will be concluded and awarded during the 2019/20 financial year.

42 Department of Health Annual Report 2018/19 Sub-programme: HIV And AIDS, STI And TB Control

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Increase TB treatment success rate from 84.5% in 2013/14 to 90% by 2019/20

TB client treatment 84.2% 89% 84% (5%) Target not achieved. The ETR.net success rate (30998/36800) (28705/34190) erroneously reported fewer treatment successes particularly in COJ, Tshwane and Ekurhuleni. The system has since been discontinued and replaced by a more reliable system (TIER.NET). Increase the percentage of people cured of TB from 83% in 2013/14 to 85% by 2019/20 by reducing lost to follow up rate from 5.1% to 5% TB clients lost to follow 6.3% 5.5% 6.3% (0.8%) Target not achieved due to inability to up rate (2318/36800) (2149/34190) trace patients because of provision of incorrect addresses and highly mobile community. Community education on the importance of provision of correct demographic information and strengthen surveillance. Decrease TB death rate from 6.1% in 2013/14 to 5.3% by 2019/20

TB client death rate 6.2% <5% 6.3% (1.3%) Target not achieved due to late (2159/34190) presentation with advanced TB disease and high co-infection rate. Strengthen community awareness about TB and importance of early presentation.

Increase percentage of patients with MDR-TB started on treatment from 45% in 2013/14 to 80% by 2019/20 and success rate from 40% in 2013/14 to 65% by 2019/20

TB-MDR treatment success 53.1% 60% 58.0% (1.9%) Target not achieved due to high death rate (662/1246) (199/343) rates and loss to follow-up

Sub-programme: Maternal, Child and Women’s Health and Nutrition

Reduce in-facility maternal mortality ratio from 143 in 2013/14 to 85 per 100 000 live births by 2019/2020

Maternal mortality in-facility 108.5 / 100 <100 (122.8/ 100 000) 22.8/ 100 000 Target not achieved because pregnant ratio 000 live births women book late for first visit under 20 weeks and according to Saving Mothers Report, a high proportion of late booking women die due to hypertensive disorders of pregnancy. The Department will be implementing maternal quality standards for management of these disorders.

Department of Health Annual Report 2018/19 43 Sub-programme: Maternal, Child and Women’s Health and Nutrition

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Reduce neonatal mortality from 15/1 000 live births in 2013/14 to 8.5/1 000 live births by 2019/20

Neonatal death in facility 13.6 <14 13/1000 live (1/1000 live Target achieved rate births births

Increase number of mothers whose first antenatal visit is before 20 weeks from 43.7% in 2013/2014 to 70% by 2019/20

Antenatal first visit 61.4% 66% 64.7% (1.3%) Target not achieved because pregnant before 20 weeks rate 173 316/268 008 women book late for first visit under 20 weeks. Strengthen household testing by WBOTS in the new financial year to detect pregnancies well before they reach 20 weeks of gestation.

Decrease number of mothers visited within 6 days of delivery of their babies from 86.5% in 2013/14 to 85% by 2019/20

Mother postnatal visit within 70.8% 80% 75.1% (4.9%) Target not achieved. Reported data 6 days rate 166 728/222 115 include only PHC facilities as hospitals did not report on the measurement. Orientation of nursing managers and hospital information officers on the tool for reporting of postnatal visits for mothers who remain in Kangaroo Mother Care (KMC), visiting mothers and lodger mothers staying in with their sick babies.

Reduce mother to child transmission of HIV from 2% to <1.3% at 10 weeks after birth and from 3.1% to less than 2% at 18 weeks by increasing antiviral coverage among pregnant women living with HIV from 81% to 98% by 2019/20

Antenatal client starts on 94.7% 97.5% 96.9% (0.6%) Target not achieved due to late ART rate 43845/44969 28 982/29 920 presentation of pregnant women wishing to be enrolled in the PMTCT programme.

Infant 1st PCR test positive 0.99% 1.40% 0.73% 0.67% Target exceeded due to slight around ten weeks rate 510/36 541 294/40251 improvement in infant testing rate in Tshwane.

Sustain immunisation coverage at 98% for children under 1 year by 2019/20

Immunisation under 1 year 77% 98% 84.3% (13.7%) Target not achieved due to erratic coverage (200139/259772) 197525/201556 (221 437/262 623) reporting by private providers who receive state vaccines and migrant population. Establish and strengthen partnerships with private providers for improved reporting and surveillance.

44 Department of Health Annual Report 2018/19 Sub-programme: Maternal, Child and Women’s Health and Nutrition

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Increase measles 2nd dose coverage from 85% to 98% by 2019/20

Measles 2nd dose 74.5% 97% 77.2% (19.8%) Target not achieved due to erratic coverage (189446/254306) (197 844/ (202 725/ reporting by private providers who receive 203 963) 262 623) state vaccines and mobile communities. Establish and strengthen partnerships with private providers for improved reporting and surveillance. Decrease child (under 5 years) diarrhoea case fatality rate from 3% in 2013/14 to 1.56% by 2019/20

Diarrhoea case fatality rate 2.3% <1.6% 2.1% (0.5%) Late presentation of dehydrated children (88/4205) at health facilities. The Department will be adopting and implementing the death review form for diarrhoea case fatalities and continue with caregiver/community awareness on hand washing and the importance of oral rehydration at home.

Decrease child (under 5 years) pneumonia and severe acute malnutrition case fatality rate from 12% in 2013/14 to <6% by 2019/20

Pneumonia case fatality rate 2.6% <1.6% 2.8% (1.2%) Late presentation of sick children at health 132/4678 facilities. The Department will be adopting and implementing the death review form used for case fatalities and continue with caregiver and community awareness raising.

Severe acute malnutrition 6.2% <6% 6.8% (0.8%) Target not achieved due to various case fatality rate (105/1544) reasons including improper implementation of SAM treatment protocol. Increase supervision of compliance with treatment protocols whilst increasing advocacy of exclusive breastfeeding and linkages to social services where required.

Increase coverage of Grade 1 learners’ health screening in Quintile 1 – 5 public primary schools from 20% to 60% and Grade 4, 8 and 10 learners’ health screening (annualised) in Quintile 1 -2 from 10% to 20% respectively in 2019/2020

School Grade 1 learners 83 402 74000 88 200 14 200 Target exceeded due to employment of screened additional nurses to support the HPV campaign and learner screening.

School Grade 8 learners 46 612 40 000 48 818 8 818 Target exceeded due to employment of screened additional nurses to support the HPV campaign and support learner screening.

Department of Health Annual Report 2018/19 45 Sub-programme: Maternal, Child and Women’s Health and Nutrition

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Reduce the levels of unwanted pregnancies for 10 to 19 years from 5.7% to 4.2%

Delivery in 10 to 19 years 8.1% 4.4% 6.7% (2.3%) More teenage pregnancies are attended to in-facility rate 14 920/222 115 at health facilities by a skilled birth attendant.

Increase couple year protection rate from 24.9% in 2013/14 to 60% by 2019/20

Couple year protection rate 59% 55% 54.1% (0.9%) Target not achieved due to inconsistent (int) availability of injectables nationally. Expansion of choice of contraceptives for users.

Increase cervical cancer screening coverage from 41.7% in 2013/14 to 65% of women by 2019/20 Cervical cancer screening 47.4% 55% 52% 3% Target not achieved due to unavailability coverage, 30 years and of liquid-based cytology consumables. above older Continue to monitor SLA compliance.

Increase HPV vaccine coverage rate from 87.1% for 1st dose to 80% by 2019/20

HPV 1st dose 51 352 60 000 65 543 5 543 Target exceeded due to employment of additional nurses to support the HPV campaign and learner screening.

Increase HPV vaccine coverage rate for 2nd dose to 80% by 2019/20

HPV 2nd dose 57 150 60 000 61 031 1 031 Target exceeded due to employment of additional nurses to support with the HPV campaign and learner screening.

Decrease child (under 5 years) severe acute malnutrition case fatality rate from 6.1% in 2013/14 to <6% by 2019/2020

Vitamin A 12-59 months 50% 62% 55.1% (6.9%) Vitamin A capsules were out of stock in coverage the last quarter of the year under review. Provide accurate estimates of required amounts to NDOH for procurement purposes.

46 Department of Health Annual Report 2018/19 Sub-programme: Disease Prevention And Control

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Reduce cataract surgery rate from 1408 per million in 2013/14 to 1000 per million; malaria case fatality rate reduced to <0.4% by 2019/20 Cataract surgery rate 917.1 (1000/mil) 957.3/mil (42.7) Target not achieved. The DHIS does not operations have the uninsured population denominator which results in false lower surgery rates. Correct population figures on the DHIS and improve documentation.

Malaria case fatality rate 1.5% <1% 1.4% (0.4%) Most malaria cases are imported from (18/1280) malaria endemic countries. The reports of the malaria death audits indicate that patients die from complications of malaria because of late health care seeking behaviour. Reduce cataract surgery rate from 1408 per million in 2013/14 to 1000 per million; malaria case fatality rate reduced to <0.4% by 2019/20

Sexual assault prophylaxis # 100% 99% (1%) Target not achieved due to assault clients rate refusing to be provided with ARV treatment prophylaxis.

PROGRAMME 2: DISTRICT HEALTH SERVICES EXPENDITURE TABLES

Sub-programme 2017/2018 2018/2019 Name Sub-programme R’000Final Actual R’000 (Over) / UnderR’000 R’000Final Final ActualR’000 (Over)/UnderR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure

R’000 R’000 R’000 R’000 R’000 R’000

District Management 516 536 524 552 (8 016) 505 175 527 767 (22 592)

Community Health Clinics 2 425 500 2 416 248 9 252 2 472 905 2 382 980 89 925

Community Health Centres 1 778 040 1 792 265 (14 225) 2 001 669 1 941 214 60 455

Community Based Services 1 780 080 1 780 657 (577) 1 996 989 2 082 027 (85 038)

HIV/AIDS 3 957 203 3 890 431 66 772 4 465 616 4 096 480 369 136

Nutrition 55 583 49 557 6 026 58 548 55 993 2 555

Coroner Services 215 243 214 321 922 240 133 225 305 14 828

District Hospitals 2 983 916 3 015 482 (31 566) 3 332 882 3 204 714 128 168

Total 13 712 101 13 683 513 28 588 15 073 917 14 516 480 557 437

Department of Health Annual Report 2018/19 47 4.3 PROGRAMME 3: EMERGENCY MEDICAL SERVICES

Purpose of the programme The purpose of the EMS is to ensure rapid and effective emergency medical care, as well as three hundred and forty-six First Responder medical care and transport as well as efficient planned patient training sessions in vulnerable communities. transport, in accordance with provincial norms and standards. Fleet Signi cant Achievements In 2018/2019, we procured an additional ninety-five ambulances GDoH EMS has successfully provincialised City of Tshwane EMS and refurbished one hundred and ninety vehicles in the following since 1st July 2018; this has been done towards achieving categories: one hundred and thirty-five ambulances, response economies of scale and operational efficiencies in services to our vehicle, twelve transporters and forty-two logistical vehicles, to clients. improve operations efficiencies and support function in EMS. This brings the total of emergency medical services vehicles from 977 to Training and Development 1087 units. Our training facility, Lebone College of Emergency Care, has received full accreditation for Higher Certificate (HC) Emergency Human Resources Care Assistant (ECA) and Diploma in Emergency Medical Care. Our We attracted the following scarce skills and ambulance staff during first intake of twenty-four students for HC ECA started in March the year to capacitate our Operational and Emergency 2019, which makes Gauteng the only province in South Africa to Communication Centre in line with staff norms for EMS: fifteen have started this course. We have also upskilled our staff on quality advanced life support operatives, fifteen basic ambulance assistants of care through short and refresher courses, namely the training of and seventy-nine intermediate life support operatives. forty-one ambulance emergency assistants, one hundred and sixteen rescue and high angle courses, four hundred and ninety-six updates and refreshers on all qualification levels of emergency

PERFORMANCE INDICATORS: PROGRAMME 3 – EMERGENCY MEDICAL SERVICES

Programme: Emergency Medical Services

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Improve EMS response time for P1 patients within 15 minutes for primary calls in urban areas from 77.4% to 90%

EMS P1 urban response 81.2% 75% 82.3% 7.3% Target exceeded due to improvements in under 15 minutes rate (4983/6055) the steps of an emergency call, incorporating proper triage by the call taker and appropriate dispatch, with the direct involvement of managers of these calls in their areas. Also public information, education and relations programmes in communities.

Improve EMS response time for P1 rural within 40 minutes in rural areas for primary calls to 100%

EMS P1 rural response 100% 100% 100% 0% Target achieved under 40 minutes rate (156/156)

48 Department of Health Annual Report 2018/19 Programme: Emergency Medical Services

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Reduce utilization rate of inter-facility transfer clients from 31.2% to 15% by 2019/20

EMS inter-facility transfer 32.3% 20% 35% (15%) Target not achieved due to an increase in rate transfers between health institutions. The following is being done to correct the anomaly: 1. Present statistics to Cluster Heads, for mitigation through clinical heads of Departments. 2. Request the Office of DDG Clinical Services to review Referral Policy and Diversion Policy.

PROGRAMME 3: EMERGENCY MEDICAL SERVICES EXPENDITURE TABLES

Sub-programme 2017/2018 2018/2019 Name Sub-programme R’000Final Actual R’000 (Over) / UnderR’000 R’000Final Final ActualR’000 CommentR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure ondeviation

R’000 R’000 R’000 R’000 R’000 R’000

Emergency transport 1 158 450 1 125 937 32 513 1 253 364 1 168 905 84 459

Planned patient transport 109 694 93 337 16 357 169 839 161 603 8 236

Total 1 268 154 1 219 274 48 880 1 423 203 1 330 508 92 695

Department of Health Annual Report 2018/19 49 4.4 Programme 4: Provincial Hospital Services

Purpose of the programme To provide general and specialised hospital services by general Leratong Hospital procured a new CT scan machine and had a specialists through regional hospitals, TB hospitals, successful cataract surgery campaign; Sebokeng Hospital psychiatric/mental hospitals, dental training hospitals and other established mammogram services and also installed and specialised hospitals. commissioned a fluoroscopy unit; Sebokeng Hospital’s Environmental Health Unit was recognised for excellence by List of sub-programmes receiving the Alfred Nzo Award which is a national environmental • General (regional) hospitals health award. • Tuberculosis hospitals • Psychiatric hospitals. There are pressures across the platform relating to mental health care and neonatal capacity. Mental health services are in extremely Signi cant Achievements and Strategies to address areas of high demand with a capacity well below the need. A provincial underperformance initiative has been mapped out to increase capacity. Collectively and individually regional hospitals face extreme utilisation in the medical wards and maternity units. The utilisation Neonatal services across the platform are also severely constrained of the medical wards largely reflects the burden of disease in the with special emphasis on Ekurhuleni and in particular Thelle province. Initiatives to improve efficiency include daily specialist Mogoerane Regional Hospital. Thelle Mogoerane faces multiple reviews. Alternative referral pathways have been piloted to assist in human resource constraints as well as significant structural equitable distribution of maternal care across the health platform. impediments in the neonatal unit. A Provincial Task Team has been appointed by the GDoH HoD to oversee and support the hospital The caesarean section rate remains well above the expected norm management so that it can overcome these hurdles effectively. for all hospitals. The indications for a caesarean section are purely based on clinical need and so this indicator may need to be revised. The key indicators of bed utilisation rate, average length of stay and cost per patient day equivalent are all within the acceptable norm for the programme.

Performance indicators: Programme 4 - Provincial Hospitals

Sub-programme: General Regional Hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Decrease average Outpatient Department (OPD) waiting times in all hospitals by 60% in 2019/20

Percentage of hospitals # 100% 78% 22% Two hospitals, Edenvale with an average of prioritising P1-patients (9/9) 4 minutes and Mamelodi 16 minutes, were requiring immediate above the 3 minute set benchmark attention because their triaging was incorrect. A proper triage system on patients to be adhered to by all hospitals.

Percentage of hospitals # 77% 77% 0% The hospitals achieved the set benchmark. adhering to average (7/9) (7/9) waiting times of 160 minutes for P2-patients with acute injuries and pain

50 Department of Health Annual Report 2018/19 Sub-programme: General Regional Hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Decrease average Outpatient Department (OPD) waiting times in all hospitals by 60% in 2019/20

Percentage of hospitals # 77% 77% 0% The hospitals achieved the set benchmark adhering to average (7/9) (7/9) waiting times of 160 minutes for P3-patients with acute injuries and pain

Percentage of hospitals 77% 77% 0% (77%) Intervention not implemented due to with OPD average (7/9) (7/9) limited understanding of the tool. Training treatment waiting times will be done by Quality Assurance below agreed benchmark Directorate during 2019/20 FY. of 180 minutes .

Improve staff attendance across all health facilities by 90% in 2019/20

Percentage of hospitals # 100% 0% (100%) Currently not reported on due to with staff attendance of limited understanding of the tool. 90% and above Training will be done by Quality Assurance during 2019/20 FY.

Quality of care will be improved by increasing compliance with national core standards and self-assessment in all regional and specialised hospitals to 100% Hospital achieved 75% 88.9% 9/9 8/9 1/9 Thelle Mogoerane was audited by the and more on the National (100%) (88.9%) (11.1%) Office of Health Standards Compliance Core Standard (NCS) (OHSC) and obtained 70%. It is the only self-assessment rate regional hospital with an NCS assessment (regional hospital) of less than 75%. The predominant factor which contributed to this underperformance was infection prevention and control. The hospital is now implementing the new SOPs, and there is a task team appointed to provide over-sight and monitoring

Department of Health Annual Report 2018/19 51 Sub-programme: General Regional Hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Improve the efficiency of hospitals by reducing the average length of stay to less than 5.5 days, increasing bed utilisation to 85% and decreasing expenditure per patient day equivalent (PDE) in hospitals by 2019/20 Average length of stay 5.1 days 5.5 days 5.4 days 0.1 days Within target (regional hospital) (1 465 467.5 / 270 134)

Inpatient bed utilisation 79.7% 85% 84.3% 0.7% Within target rate (regional hospital) (1 465 467.5/ 1 739 080.98)

Expenditure per PDE R3 082 R3 562 R 3291.9 R 270.1 Target achieved (regional hospital) (6,544,595,239 /198 8114.5)

Increase complaints resolved within 25 working days to over 95% in 2019/20

Complaint resolution 100.5% 90% 97.2% 7.2% Target exceeded due to improved within 25 working days monitoring of complaints by the (regional hospital) Provincial Office and support visits to facilities which were assisted in implementation of the SOP.

Sub-programme: Specialised Hospitals Quality of care will be improved by increasing compliance to extramental measures core standards and self-assessment in all regional and specialised hospitals to 100%

Hospital achieved 75% 50% (4/9) (4/9) 0 Four hospitals were scheduled for and more on National 44% 44% self-assessments, and all obtained 75% Core Standards and above. Sterkfontein – 81%, Cullinan self-assessment rate – 81%, Wits Oral & Dental - 97%, (specialised hospitals) Weskoppies - 93%

52 Department of Health Annual Report 2018/19 Sub-programme: Specialised hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

The percentage of complaints resolved within 25 working days to over 95% in 2019/20

Complaints resolution 98% 90% 96.4% 6.4% Target exceeded, monitoring of complaints within 25 working days (81/84) by the Provincial Office has been rate (Specialised hospitals) strengthened, and a checklist on complaints has been developed to assist facilities to comply.

Reduce Outpatient Department (OPD, Accident and Emergency and Pharmacy departments’ waiting times across all facilities by 60% in 2019/20 Percentage of hospitals 75% 100% 100% 0% Target achieved. with OPD average (7/7) (7/7) treatment waiting times below the agreed benchmark of 180 minutes

Improve staff attendance across all health facilities by 90% in 2019/20

Percentage of specialized # 100% 100% 0% Target achieved hospitals with staff (9/9) (9/9) attendance of 90% and above

Improve the efficiency of hospitals by increasing bed utilisation to 85% and decreasing expenditure per PDE in hospitals by 2019/20

Inpatient bed utilisation # 80% 53.6% 26.4% Target not achieved because of rate (specialised hospitals) (116 301/ 216 decentralization of multi-drug resistant 833.76) tuberculosis (MDR TB) treatment and limited use of mental health beds at Cullinan Hospital due to staffing challenges. A psychiatrist has been appointed at Cullinan Hospital.

Expenditure per PDE # R2 799 R 3 437.2 (638.2) Closer monitoring of prices paid for goods (specialised hospitals) (411 457 and services to ensure market related 440.6/119 708) prices are paid

Department of Health Annual Report 2018/19 53 PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES EXPENDITURE TABLES

Sub-programme 2017/2018 2018/2019 Name Sub-programme R’000Final Actual R’000 (Over) /UnderR’000 R’000Final Final ActualR’000 CommentR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure on deviation

R’000 R’000 R’000 R’000 R’000 R’000

General (regional) hospitals 5 719 131 5 738 (18 895) 6 431 824 6 351 096 80 728

Tuberculosis hospitals 396 292 026 112 408 379 744 290 044 89 700

Psychiatric/mental hospitals 1 164 077 283 884 (74 142) 1 261 857 1 393 015 (131 158)

Dental training hospitals 535 399 1 238 219 (13 257) 581 625 560 989 20 636

Other specialised hospitals 77 764 548 656 (5 728) 91 419 91 509 (90)

Total 7 892 663 83 492 386 8 746 469 8 686 653 59 816

4.5 Programme 5: Tertiary and Central Hospitals

Purpose of the programme the ICU so that it can attract clinicians who need intensive care To provide highly specialised health care services, platforms for training. The hospital also appointed two additional orthopaedic training health workers and sites for research and to serve as specialists with interest in arthroplasty and this had a positive impact specialist referral centres for regional hospitals and neighbouring on the arthroplasty backlog. Head of department posts in psychiatry provinces. and orthopaedics were filled after they had been vacant for more than two years. Signi cant Achievements by the Tertiary and Central Hospitals Established the much-needed spiritual wellness for employees and TERTIARY HOSPITALS healthy lifestyle activities attendance has improved. The hospital’s Achievements wound clinic received a golden trophy during the Premier’s Awards. Installation of MRI scan facilities has improved services at Helen The Khanyisa Awards was received for “Most Efficient Health Care Joseph Hospital, Rahima Moosa Mother and Child Hospital, Facility – Tertiary Hospital”. Leratong Hospital, Sterkfontein Hospital, Tara Hospitalz, South Rand Hospital and Bertha Gxowa Hospital. Expansion of Mammography To improve service efficiency, the implementation of an electronic services by installing stereotactic guided vacuum assisted core biopsy queue management system to measure patient waiting time at the and a three dimensional breast tomosynthesis unit This contributes OPD reception area was introduced as well as an improved booking to accuracy of diagnosis which decreases dose radiation exposure system. This operates by phoning patients to remind them about and improves patient throughput, thereby reducing waiting times. their appointment a day prior to their visit. Patient safety has been Installation of a fluoroscopy unit in September 2018 improved prioritised through the opening of a 24/7 enquiries department. patient care as patients no longer have to go to Rahima Moosa OHSC external assessment also scored the hospital 100% in Patient Mother and Child hospital for services. Transport Services and it was evaluated as one of the cleanest hospitals in the Province. Kalafong Hospital opened a newly renovated human milk bank in 2018/19. The hospital also achieved improved Patient Experience of Care, to 87%, which was the highest among tertiary hospitals; and achieved improved performance on Core Standards Self-Assessment with a score of 91%.

Tembisa Hospital acquired a 160 slice CT scan, replacing an old 16 slice scan that had become difficult to service or repair. The hospital also appointed an intensivist to run the Adult Intensive Care Unit (ICU) and High Care Unit. The plan is to apply for accreditation of

54 Department of Health Annual Report 2018/19 Challenges There is an increasing demand for services that is leading to ever activities after strokes, rheumatoid arthritis progression and Trauma. greater headcounts in out-patient departments and accident and Several Khanyisa Awards were bestowed on Prof. Luvengho, HOD emergency (A&E) units; overflowing of wards with up to 70 patients Surgery, who received the overall top individual award; Prof. Chauke in 40 bed wards; inadequate space for mental health care patients HOD Obstetrics & Gynaecology, runner up in the individual award; who end up being admitted in medical wards; insufficient ICU beds Ms V. Yip, HOD Occupational Therapy, third runner up individual (currently only 10 beds); insufficient A&E resuscitation beds award; Radiology: Dr Smilg, HOD Breast Department, first prize for (currently only four beds); the hospital has also experienced long stay projects. patients due to families not coping with mental health care users and mentally retarded children who do not get placement; Highlights of the achievements at Chris Hani Baragwanath infrastructure challenges are evident in noncompliance with Academic Hospital (CHBAH) are: in 2018/19 the hospital managed isolation norms due to insufficient isolation facilities, especially for to fill the position of Head of Radiology which was difficult due to VHF, TB, diarrhoeal and pulmonary conditions; the lack of cashier the scarcity of this specialism; the Clinical Team’s regular ward facilities in the clinics and pharmacy; the non-availability of a rounds and other outreach activities to Bheki Mlangeni Hospital bereaved family waiting area at the mortuary and all frontline areas; (BMH) continue to prevent the overcrowding of patients in the no counselling rooms for families in the wards as well as the medical wards, providing opportunities to treat patients who are inadequate infrastructure impacting on: appropriate to central hospital level; through a Public-Private Partnership (PPP) the construction of Zakithi Nkosi Haematology • Increasing number of missing patients. Centre of Excellence has begun, and the unit will be operational by • Department of Labour inspection on 29/11/2018 with a Q2 in 2019/2020; the establishment of high volume cataract surgery prohibition notice for stores issued. Relocation of staff and services and its extension to BMH; the output for cataract surgery is stock to be done immediately. currently at 300 cases monthly between the two hospitals which will • Lack of recreational hall for events and of training venues. go a long way in reducing both the backlog and waiting times for • Old ICT infrastructure. new cases; the service was also rolled out to Lenasia South in 2018/19; establishment of the 28-bed acute surgical care unit, Kalafong Hospital had to close crèche services due to staff shortage which has significantly reduced costs, length of stay and and poor infrastructure, leading to absenteeism. The hospital also complications for patients, and has improved access and reduced experienced an increase in theft, including theft of cars from the the waiting time for surgery. institution. Shortage of staff is a challenge across all tertiary hospitals. However, though the plan is to set up similar units at BMH and Sebokeng Hospital, due to staff shortage the unit is still operating CENTRAL HOSPITALS from 08h00 to 16h00. The orthopaedic emergency surgery service Achievements has resulted in immediate access to surgery for orthopaedic patients Charlotte Maxeke Hospital added pacing to the Electrophysiology thus preventing complications and additional costs to the hospital. Laboratory: the branch of cardiology that deals with the diagnosis of The doctor who championed this initiative received a Khanyisa heart rhythm disorders and electrical activity of the heartbeat. The Award in 2018 for Best Doctor. infrastructure improvements included the installation of five new generators which are more reliable, modern and with spare parts Also at CHBAH, among the interventions to address the surgical readily available. Renovations were completed of Neonatal ICU backlog list, surgeons have continued to do operations at BMH. This (Ward 177). It has the only functional Liver Transplant Unit in South has eliminated the waiting list for the breast clinic. High-Intensity Africa and sees an increase caseload in related paediatric cases. The Focused Ultrasound (HIFU) services were established as another hospital has established improved stroke interventions, which treatment option for fibroids in 2015; the service is currently fully include immediate interventions that yield results within an hour of functional treating 8-10 women per month. This reduces the waiting a patient receiving it, with significantly improved clinical outcomes. list and time for surgical treatment, with added benefits to patients Its Radiation Oncology Breast Clinic collaborated with Cricket SA such as reduced length of stay in hospital and reduced risk of which raised over R1.68m, and promoted awareness with positive infection compared to surgery. The project was a runner-up for the messaging at a Wanderers event. Khanyisa Award. Procurement of vascular and neurosurgery C-arms, and the ENT and neurology microscopes which have been long The Occupational Therapy Master Chef and Taxi projects are outstanding, was completed in 2018/19: having this equipment on interventions implemented to assist patients in adjusting to daily

Department of Health Annual Report 2018/19 55 site will go far in reducing waiting times and improving overall Challenges patient care. CHBAH reached its 100th cochlear implant procedure At Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), in February 2018. treatment of foreign patients remains a challenge as they tend to access health services late when they are very ill. In maternity, This milestone has led the audiology department to increase the foreign patients often access health services without antenatal care, annual target for implants from 10 to 20. This was achieved as the and this contributes to morbidity and mortality (especially maternal targeted 20 cases were successfully implanted in FY 2018/19. The mortality). The institution also has challenges of ageing standing frames project emerged from a partnership between the infrastructure, which is unreliable, prone to break down, requires Physiotherapy Department and a local NGO, creating an opportunity intensive maintenance and leads to rising maintenance costs. for local economic empowerment. Through this project, patients can Because of the lack of an electronic asset management system, the have their standing frames at home regularly at a reduced hospital cannot account for all its assets. Increased waiting time in procurement cost of R200 versus almost R2000 market value, casualty has been experienced because of beds blocked by reducing the cost of coming to the hospital and prevention of more psychiatric patients waiting at casualty for admission, due to deformities if the patients are mainly dependent on hospital-based decreased bed capacity in a psychiatric ward under construction. devices. This project earned the Centre for Public Service Innovation There has been an increase of theft in the hospital, especially of (CPSI) award. The early childhood intervention clinic in the Speech copper pipes and electrical cables. and Audiology Department has grown from strength to strength over the last five years with screening services rolled out to all At CHBAH, the allocated budget is not adequate for the demands of high-risk cases in 2018/19. Through this universal screening, the serviced population. Overcrowding of psychiatric patients in the unilateral hearing loss was diagnosed in a one-month-old baby. The emergency department continued to be an issue, with concerns for clinic has an established partnership with the appropriate SETA for the safety of staff and other patients. Stakeholder meetings to training in screening for basic hearing, targeting learners with some address this challenge have resumed, and the teams are looking disabilities. Currently, six learners are in the advanced stage of forward to the implementation of sustainable solutions. Drug training and they provide extra personnel to the unit. The hospital unavailability, mainly of epileptic drugs and water for injection, is has also established an earlobe keloid intervention programme using problematic. Such challenges often emanate from the limited non-invasive treatment methods. Patients are accessing this service capacity of the contracted service providers to meet the demand. monthly. Pharmacy management continues to engage doctors about alternatives, urging them to use other procurement methods to Dr. George Mukhani Academic Hospital (DGMAH) has successfully ensure that patients’ treatment compliance is not interrupted. separated conjoined twins. It has also sustained cutting edge Nursing staff shortage continues to be a barrier to optimum use of laparoscopic procedures in the General Surgery Departments. The highly specialised beds in ICU, high care areas and the maternity hospital successfully produced pediatric and neuro surgeons. Five theatre. managers attained Advanced Management Diplomas with the Southern Business School through the Gauteng City Region At DGMAH, infrastructure is a challenge. There is 4% underfunding Academy (GCRA). A medical waste company was appointed to on the Compensation of Employees Budget. There is an abnormal remove waste that had accumulated in the hospital. A Southern referral route due to lack of tertiary and regional institutions in the African Development Community (SADC) orthotic and prosthetic cluster. There is an insufficient supply of clean linen, resulting in training project for putting running blades on children with service delivery disruptions. A fire in the doctors’ quarters led to an amputations was held. DGMAH has also managed to retain a emergency situation. There is overcrowding in the wards and OPD specialist doctor in pediatric oncology, nephrology and ICU post due to an increase in the population served. There is a need to fill training in Wits, UP, UCT, including training of and retention of key clinical HOD posts and to appoint more specialty nurses. There specialty nurses are several vacant key SMS posts in the hospital.

56 Department of Health Annual Report 2018/19 PERFORMANCE INDICATORS: PROGRAMME 5 – TERTIARY HOSPITAL SERVICES

Sub-programme: Tertiary Hospitals

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Increase compliance with national core standards to 100% in 2019/20, and complete self-assessments in all hospitals

Hospital achieved 75% (3/3) 100% 3/3 0 Target achieved and more on National (3/3) Core Standards self-assessment rate (tertiary hospitals)

Improve efficiency of hospitals by reducing average length of stay to 6.5 days, increasing bed utilisation to 85% and decreasing expenditure per PDE in hospitals by 2019/20 Average length of stay 5.8 days 6.5 days 6.1 days 0.4 days Within target (tertiary hospitals) (689 409.5/ 112 865)

Inpatient bed utilisation 85.3% 85% 87% 2% Within target rate (tertiary hospitals) (689 409.5/792 471.42)

Expenditure per PDE R3 472 R3 676 R 4 086.7 (R410.7) Target not achieved. Due to services at (tertiary hospitals) (3 978 400 higher cost at T3 level. Prudent 056/973 505.5) management of the fiscus to ensure that procurement is in accordance with demand plans.

The percentage of complaints resolved within 25 working days will be over 95% in 2019/20

Complaints resolution 100% 90% 101% 11% Target exceeded, monitoring of complaints within 25 working days: (769/760) by the Provincial Office has been rate (tertiary hospitals) strengthened and physical visitation to facilities has commenced.

Reduce Outpatient Department (OPD), Accident and Emergency departments waiting times across all facilities by 60% in 2019/20

Percentage of hospitals # 100% 100% 0% Target achieved prioritising P1 patients (3/3) (3/3) requiring immediate attention in A&E Department

Percentage of hospitals 0% 66% 100% 34% Target exceeded due to inclusion of with P2-3 patients (0/3) (2/3) 3/3 Tembisa in the assessment of waiting attended to within 160 times. minutes average treatment waiting times A&E Department

Department of Health Annual Report 2018/19 57 Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Reduce Outpatient Department (OPD), Accident and Emergency departments waiting times across all facilities by 60% in 2019/20

Percentage of hospitals 2/3 66% 100% 34% Target exceeded due to inclusion of with OPD average (2/3) 3/3 Tembisa in the assessment of waiting treatment waiting times times. below agreed benchmark of 240 minutes

Improve staff (health professionals, administration clerks, cleaners and porters) attendance at OPD and Accident and Emergency across all health facilities by 90%

Percentage tertiary 100% 100% 100% 0% Target achieved hospitals with staff (3/3) 3/3 attendance of 90% and above

PERFORMANCE INDICATORS: PROGRAMME 5 – CENTRAL HOSPITAL SERVICES

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Increase compliance with national core standards to 100% in 2019/20, and complete self-assessments in all hospitals

Hospital achieves 75% 100% 100% 100% 0% Target achieved and more on the National (4/4) (4/4) (4/4) Core Standards self-assessment rate (central hospitals)

Improve the efficiency of hospitals such that waste, expense and unnecessary effort is reduced and bed utilisation in each hospital will not be too high or too low Average length of stay 7.9 days 8 days 7.8 days 0.2 day Within target range. (central hospitals) (1 804 690.0/232 063)

In-patient bed utilisation 82.6% 85% 81.1% 3.9% Within target range. rate (central hospitals) (1 804 690/2 224 310.4) Expenditure per PDE R4 137 R4 229 R4 563.0 (R334) Expenditure higher than expected due to (Central Hospitals) (13 080 631 increased expenditure by some of the 181/2 866 central hospitals because of increased 674.667) accrual payments.

The percentage of complaints resolved within 25 working days over 95% in 2019/20

Complaint resolution 99.2% 90% 98.4% 8.4% Target exceeded due to improved capacity within 25 working days: (974/990) support through clusters systems rate (central hospitals)

58 Department of Health Annual Report 2018/19 Central Hospital Services

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Reduce Outpatient Department (OPD), Accident and Emergency departments waiting times across all facilities by 60% in 2019/20

Percentage of hospitals # 100% 100% 0% Target achieved prioritising P1 patients (4/4) 4/4 requiring immediate attention in A&E Department

Percentage of hospitals 0% 75% 100% 25% Target exceeded due to inclusion of with P2-3 patients (0/4) (3/4) 4/4 DGMAH in the assessment. attended to within 160 minutes average treatment waiting times A&E Department

Percentage of hospitals 75% 75% 100% 25% Target exceeded due to inclusion of with OPD average (3/4) (3/4) (4/4) DGMAH in the assessment. treatment waiting times below agreed benchmark of 240 minutes

Improve staff (health professionals, administration clerks, cleaners and porters) attendance at OPD and Accident and Emergency across all health facilities by 90% Percentage of central 79% 100% 100% 0% Target achieved hospitals with staff (53%) (4/4) (4/4) attendance of 90% and above

Steve Biko Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Hospital achieved 75% Yes Yes Yes 0% Target achieved and more on National Core Standards self-assessment rate (central hospitals)

Average length of stay 8 days 8 8 days 0 days Target achieved (central hospitals) (264 531/ 33 062)

In-patient bed utilisation 85.9% 85% 85.8% 0.8% Within target range rate (central hospitals) (264 531/ 308 458.8)

Department of Health Annual Report 2018/19 59 Steve Biko Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Reduce Outpatient Department (OPD), Accident and Emergency departments waiting times across all facilities by 60% in 2019/20

Expenditure per PDE R4 862 R4 676 R5 477.9 (R 801.9) Expenditure high due to payment of prior (central hospitals) (2 538 177 538/ year accruals 463 352) Complaint resolution 98.3% 90% 96.7% 6.7% Target exceeded because the Provincial within 25 working days: (177/183) Office has strengthened monitoring of rate (central hospitals) complaints and physical visitation to Steve Biko Academic Hospital (SBAH)

Percentage of hospitals # Yes Yes None Target achieved prioritizing P1 patients requiring immediate attention in A&E Department

Percentage of hospitals Yes Yes Yes None Target achieved with OPD waiting times below agreed benchmark of 240 minutes

Percentage of hospitals Yes Yes Yes None Target achieved with P2 -3 patients attended to within 160 minutes waiting time in A&E Department

Percentage central 60% Yes Yes None Target achieved hospitals with staff

Dr George Mukhari Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Hospital achieved 75% Yes No Yes Yes Target achieved. The no in the target and more on National was an omission because no Central Core Standards Hospital must never be left out of self-assessment rate assessment in any given year. (central hospitals)

Average length of stay 7.8 days 8 days 7.9 days 0.1 days Within target range. (central hospitals) (416 148/52 703)

60 Department of Health Annual Report 2018/19 Dr George Mukhari Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

In-patient bed utilisation 77.9% 85% 76.0% 9% Not within target range due to the rate (central hospitals) (416 148/ 547 renovation of wards 16 and 37 which 682) resulted in the closure of the two wards. Thus 80 beds were not available for one full quarter during the financial year.

Expenditure per PDE R4154 R4304 R 4534.6 R230.6 Payments of outstanding accruals (central hospitals) (2 741 865 resulting in over expenditure. Prudent 095/604 652.7) management and monitoring of expenditure patterns to be implemented.

Complaint resolution 98.6% 90% 96.9% 6.9% Target exceeded because the Provincial within 25 working days: (310/320) Office has strengthened the monitoring rate (central hospitals) of complaints and physical visitation to DRGMAH

Percentage of hospitals # Yes Yes None Target achieved. Triage system fully prioritizing P1 patients implemented and supported by a medical requiring immediate practitioner. attention in A&E Department

Percentage of hospitals No Yes Yes None Target achieved. with OPD waiting times below agreed benchmark of 240 minutes

Percentage of hospitals No No Yes Yes Target achieved. The No in the target was with P2-P3 patients an omission because no central hospital attended to within 160 must be left out of assessment in any minutes waiting time A&E given year. Department

Percentage of central # Yes Yes None Target achieved. hospitals with staff attendance of 90% and above

Department of Health Annual Report 2018/19 61 Charlotte Maxeke Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Hospital achieved 75% 100% Yes Yes None Target achieved and more on National Core Standards self-assessment rate (central hospitals)

Average length of stay 7.5 days 8 7.4 days 0.6 Target achieved (central hospitals) 320 720/ 43 125

In-patient bed utilisation 86.8% 85% 82.3% 2.7% Within target range rate (central hospitals) (320 720/389 863)

Expenditure per PDE R4407 R4 429 R4 842.9 (R 413.9) Abnormal expenditure for PDE, (central hospitals) (3 374 933 Department will be investigating further 847/696 887.7) with the hospital directly Complaint resolution 100% 90% 100% 10% Target exceeded due to monitoring of within 25 working days: (222/222) complaints by the Provincial Office rate (central hospitals)

Percentage of hospitals # Yes Yes None Target achieved prioritizing P1 patients requiring immediate attention in A&E Department

Percentage of hospitals Yes Yes Yes None Target achieved with OPD waiting times below agreed benchmark of 240 minutes

Percentage of hospitals Yes Yes Yes None Target achieved with P2-P3 patients attended to within 160 minutes waiting time A&E Department

Percentage of central # Yes Yes None Target achieved hospitals with staff attendance of 90% and above

62 Department of Health Annual Report 2018/19 Chris Hani Baragwanath Academic Hospital

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Hospital achieved 75% Yes Yes Yes None Target achieved and more on National Core Standards self-assessment rate

Average Length of Stay 8 days 8 Days 7.8 days 0.2 day Within target range (803 291/103 173) In-patient bed utilisation 82.6% 85% 82.1% 2.9% Within target rate (803 291/978 307)

Expenditure per PDE R3 661 R3 282 R4 016.8 R734.8 Abnormal expenditure for PDE, (4 425 654 701/1 101 Department will be investigating further 782.3) with the hospital directly

Complaint resolution 100% 90% 100% 10% Target exceeded because the Provincial within 25 working days: (265/265) Office has strengthened the monitoring rate of complaints

Percentage of hospitals # Yes Yes None The hospital achieved the set benchmark prioritizing P1 patients requiring immediate attention in A&E Department

Percentage of hospitals Yes No Yes None The hospital achieved the set benchmark with OPD waiting times below the agreed benchmark of 240 minutes

Percentage of hospitals Yes Yes Yes None The hospital achieved the set benchmark with P2-P3 patients attended to within 160 minutes waiting times in A&E Department

Percentage of central # Yes Yes None Target achieved hospitals with staff attendance of 90% and above

Department of Health Annual Report 2018/19 63 PROGRAMME 5: CENTRAL HOSPITAL SERVICES EXPENDITURE TABLE

R’000 R’000 R’000 R’000 R’000 R’000

Central Hospitals 11 839 981 11 988 788 (146 785) 13 219 797 13 218 982 815

Provincial Tertiary Hospital 3 493 060 3 329 921 163 139 3 915 429 3 915 274 155

Services

Total 15 333 041 15 316 687 16 354 17 135 226 17 134 256 970

64 Department of Health Annual Report 2018/19 4.6 PROGRAMME 6: HEALTH SCIENCES AND TRAINING

Programme Purpose The Health Sciences and Training Programme is strategically Achievements positioned to plan for, produce and manage the education, training The RTCs in collaboration with institutions of learning, NGOs, and development needs of the GDoH. It is designed to comply with development support partners such as PEPFAR and external training relevant legislative and policy mandates at the national, provincial providers have developed 63 training programmes which are meant and local level and to respond to service transformation imperatives. for healthcare workers such as doctors, professional nurses, other Priorities include support for the Service Transformation Plan, professional allied workers and Community Health Workers (CHWs). re-engineering of PHC, expansion of the HIV and AIDS, sexually These programmes address issues such as those relating to HIV and transmitted infection (STI) and TB programmes and implementation AIDS/STIs/TB, non-communicable diseases and maternal and of NHI. neonatal mortality. A number of the 63 training programmes are identified as priorities in the Annual Performance Plan (APP) of List of Sub-Programmes 2018/2019. The Professional Development Directorate includes: • Regional Training Centres (RTCs) • Professional development • Professional service support • Bursary Section • Lebone College of Emergency Care • Leadership Management and Skills Development Directorate • Employee Health and Wellness Programme Directorate

Strategic Objectives • Improve achievement of national norms for the supply of health professionals • Improve compliance with the legislative framework • Respond to the GDoH’s staff education, training and development needs.

Challenges and recommendations

Challenges Measures to overcome challenges

All HIV, AIDS, STIs and TB (HAST) related training planned for A new training plan, which was agreed upon by Tshwane HAST Tshwane district was put on hold. The District took a resolution unit, Tshwane Training Unit and Right to Care, has been to focus on mentorship for those already trained. developed according to the needs of the District. Training will commence in April 2019. The Health Promotion Officer qualification was suspended by the NDoH will inform the RTC when the review has been completed. National Department of Health (NDoH) as they were reviewing the training content.

CHW training phases 1 & 2 did not happen as NDoH in The material has been developed, and CHW skills development collaboration with I-TECHSA were developing new material that training will be conducted in 2019/20. will be used as in-service training for CHWs already trained in phases 1 & 2.

Shortage of staff due to vacant posts not filled. Three posts for Deputy Directors and four posts for clinical coordinators have been advertised and are to be filled in the first quarter of 2019/2020

Approval for filling the vacant post for Region B to be approved.

Department of Health Annual Report 2018/19 65 Challenges and recommendations

Challenges Measures to overcome challenges

The unavailability of training manuals for various training Submissions to procure manuals were made, and POs were programmes such as NIMDR TB, Kidz Alive, Adherence finally released, though late. Guidelines, Prevention of Mother-to-child Transmission (PMTCT), Advanced Primary Care (APC ) etc. due to the delay caused by a Tender for training manuals to be in place and senior managers new procurement process, procedures that are not documented to approve as soon as possible. and delays by senior managers in approving submissions.

Some of the training was shifted or cancelled by districts and Districts and supporting partners have been consulted, and supporting partners. This led to some targets not being training will take place in the new financial year. achieved, for instance: • Medical male circumcision for all categories – the District clinical specialist teams (DCSTs) will now report their supporting partner Justice Project South Africa (JPSA ) did training to the RTC, and these will form part of the RTC reports get funding from PEPFAR in 2019-2020. • ART initiation management for doctors and pharmacovigilance for professional nurses – Pulse Health lost funding from PEPFAR • Not enough training on Kidz Alive for enrolled nurses, health promoters, social workers and lay counsellors as manuals were delivered late • Trauma containment, sexual assault for professional nurses, are conducted from the Medico-Legal Unit. Regional Training Centre (RTC) staff are not trained on these programmes.

SUB DIRECTORATE – PROFESSIONAL DEVELOPMENT

The Professional Development Sub-directorate coordinates Special programmes under Sub-directorate Professional Continuing Professional Development (CPD) programmes that are Development critical for all medical doctors and allied professionals in accordance 1. Pharmacist assistant training, basic and post basic course with the requirements set by statutory bodies for professional to 2. Six months of midwifery skills training for enrolled nurses maintain their registration status. The sub-directorate also manages 3. Emergency medical care courses, e.g. basic life support (BLS), the development and accreditation of mid-level worker Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life qualifications and training for lower categories and mid-level Support (PALS) workers. This is in support of task shifting and the accreditation of 4. Structured clinical in-service training including on-boarding identified qualifications. in-service training 5. South African Cuban medical training. Structured in-service training in all health sciences related areas in teaching institutions is also coordinated. The sub-directorate participates in the development of short courses and skills programmes to bridge those skills gaps identified as critical in minimising incidences of malpractice and in achieving the strategic objectives of the Department. It also coordinates the South African Cuban Medical Programme in line with the Bilateral Cooperation Agreement between South Africa and Cuba.

66 Department of Health Annual Report 2018/19 Table: Achievements

Training Programme Planned Actual

Patient safety in-service training: PIH; post and 100 271 antepartum haemorrhage; partogram

CPD training 400 1358

Enrolled nurses: midwifery skills training programme 25 22

Pharmacist assistant training programme 12 2

Basic life support 50 104

Basic life support instructor 20 1

Table: Challenges and recommendations

Challenges Recommendations

Insufficient budget for professional development training activities including Allocate more funding. Seek sponsorship to fund purchasing training manuals. training.

Accreditation of Lillian Ngoyi CHC as BLS training centre negatively affected. Ring fence funds for patient safety courses, Training put on hold. especially life support programmes.

Termination of contract for the retired nurse midwives leading to most patient Allocate more funding. Seek sponsorship to fund safety training put on hold. training. Ring fence funds for patient safety courses, especially life support programmes.

Shortage of staff due to absenteeism following the fire at Bank of Lisbon Employ advanced midwives and neonatal nurse building. specialists by the RTC for the training of midwives. Approval for filling of posts to be granted

Department of Health Annual Report 2018/19 67 PROFESSIONAL SERVICES SUPPORT Purpose Professional Services Support (PSS) in the health sciences component Placement for community service is based entirely on service needs contributes to the development, management and support of and availability of funded vacant posts. All health professionals must medical and allied health professionals, facilitating their placements be registered with the relevant professional body, South African in institutions according to the identified needs. The sub-directorate Nursing Council (SANC), PCSA or Health Professionals Council of also facilities the accreditation of facilities for placement of interns as South Africa (HPCSA) before commencing community service. prescribed by the professional council’s quality standards and the appropriate transfer of skills to interns and community service Achievements professionals. The recruitment and management of the For 2019, the annual total of 1 430 health professionals has been appointment of foreign health professionals in accordance with placed. national policy and immigration laws are also managed under PSS. The breakdown of placement per category is presented in the Background tables below: A community service programme for medical doctors, pharmacists, dentists and allied health professionals is a legislative mandate. This applies for one year to all persons who are South African citizens and those with permanent residency who are registering.

Table: Internship programme

Category No of approved funded posts Total Placed Additional Placements

Medical interns 429 526 97

Pharmacists 61 61 0

Clinical psychologists 61 61 0

TOTAL 551 648 97

Table: One year community service placements

Category No of approved funded posts Total Placed Additional Placements

Pharmacists 85 88 3

Medical doctors 226 251 25

Dentists 15 23 8

Dieticians 54 55 1

Environmental health practitioners 34 34 0

Occupational therapists 84 91 7

Pharmacists 85 88 3

Physiotherapists 94 102 8

Radiographers 95 76 19

Speech & hearing therapists 62 62 0

TOTAL 834 870 36

68 Department of Health Annual Report 2018/19 Challenges Despite the achievements above, the Unit was faced with many The Bursary Fund challenges, such as: The Bursary Sub-directorate is responsible for health sciences human 1. Late approval of submissions by senior management resource needs. This includes scarce skills and, in consultation with 2. Late submissions for creation of posts to Office of the Premier human resources management aligned to the Human Resource Plan and Human Resource Management (HRM ) which resulted in of the Department, providing financial assistance to those applicants receiving late salaries (mid-February) undertaking external full-time studies which are intended to address 3. Internship and Community Service Programme (ICSP) double the human resource needs of the province. The unit also provides placements of health professionals financial assistance to qualifying staff members to improve 4. ICSP access not user-friendly and system frequently down performance in functional areas according to education gaps (offline) identified as a priority in the Department, and monitors return on 5. Uncertainty over commencement dates of health professionals investment by enforcing the implementation of the contractual (some cannot commence on time due to registration etc.) bursary obligation.

Recommendations We recommend that if the following can be changed and adhered to, the above issues can be resolved: 1. ICSP placement commences earlier in the year and results are communicated to all provinces by latest mid-October (not December). 2. Ensure that double placements are checked by an ICSP team or provinces are given the allocations early to check for any double placements or bursary holders of other provinces (2 weeks prior) before notifying all applicants of their final placement. 3. ICSP system must always be online for users and the national desk team to be available always for provincial coordinators. 4. ICSP guidelines should include a clause on commencement dates so that all provinces are guided lawfully as this reduces court cases and litigation.

Table: Bursary intake for 2018 academic year:

Field of study Number

MBCHB 251

Pharmacy 33

Occupational therapy 27

Dietetics 16

Oral hygiene 1

Optometry 7

Speech, audiology, pathology 21

Medical, orthotics & prosthetics 7

Clinical technology 2

Physiotherapy 22

Radiography 51

Emergency medical care 3

TOTAL 441

Department of Health Annual Report 2018/19 69 The South African Cuban Medical Training Programme

This programme was implemented as part of the Bilateral Corporation Agreement between South Africa and Cuba for training medical students. In the 2018/2019 financial year, the following obtained:

Table: SA Cuban numbers:

Items Number % of total

Integrated for 18 months in SA universities 8 6 completed MBCHB successfully in December 2018

Remaining in Cuba from 01 April to July 2018 438

Integrated in SA Universities in August 2018 73

Numbers remaining in Cuba in the 3rd and 4th quarter of 2018/2019 352

Numbers who fell ill due to mental health and were repatriated back to SA 3 1 returned to Cuba in February 2019 and will be

completing her final year of medical studies in July

2019. 2 came to SA in March 2019 and are

attending outpatient psychiatric care.

Costing:

Cost for the 18 months integration in SA universities 73 R 17 118 050 – paid 5 July 2018

Cost for the 438 students which was not paid in 2017/2018 as accrual 438 R 140 066 822 – paid 5 July 2018

Academic fees for 2018/2019 financial year 352 Invoice still not sent by National: estimated at R

107 000 000

Cost of chartered flight for 195 students 195 R 6 435 000 (to be paid in 2019/2020 financial

year).

Cost for July vacations for students on vacation 38 R 939 171.00 paid to the provider.

R 68 301 still not paid. A submission to the HoD is

with the CD Human Resource Development (HRD )

/Employee Health and Wellness Programme

(EHWP)

70 Department of Health Annual Report 2018/19 PERFORMANCE INDICATORS: PROGRAMME 6 – HEALTH SCIENCES AND TRAINING

Programme: Health Sciences and Training

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Increase employee satisfaction rate to 85 % by 2019/20 Employee satisfaction rate 50.13% 80% 54% (26% ) The Department did not reach the 80% target as planned due to employees’ dissatisfaction with the work environment specifically performance management and labour relations.

Increase access to training opportunities for staff Including heads of institutions to 95% by 2019/20 Percentage of hospital 83% 85% 124.3% 39.3% Target exceeded due to multiple training CEOs trained in leadership (30/36 46/37 programmes participated in by several and management CEOs) CEOs. Nine of them attended more than one training programme during the reporting period.

Percentage of PHC facility 71% 75% 114.8% 39.8% Target exceeded due to multiple training managers trained in (263/372) 427/372 programmes participated in by several leadership and PHC managers. Fifty-five were trained in management more than one programme during the reporting period.

Increase awareness of ethical conduct for all staff by offering code-of-conduct training to 30% of our employees in 2019/20

Percentage of employees 33% 25% 26.2% 1.2% Target exceeded because code of trained in code of conduct (8451) (17 259/65 821) conduct training was included in multiple in-house training programmes Increase the number and quality of health professionals by increasing the number of health professionals trained annually to 1 500 by 2020

Number of nursing # 1 500 1 007 (493) 1500 is a departmental target and was students graduating not achieved. Graduate output is dependent on student enrolment. Intake rates vary depending on factors such as available finances, applicants meeting the admission criteria, etc. Actual intake was 1 205. Outcomes are impacted by attrition rates which are affected by course terminations, failures and deaths.

Increase the number and quality of health professionals by increasing the number trained annually to 1 500 by 2020

Number of bursaries 50 0 0 0 The Gauteng Department Executive awarded to first-year Management Committee decided not to medical students fund due to financial constraints for the year under review as outlined in the Annual Performance Plan (APP ) of 2018/19.

Department of Health Annual Report 2018/19 71 PERFORMANCE INDICATORS: PROGRAMME 6 – HEALTH SCIENCES AND TRAINING

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/under)

Increase the number of new nursing students to fulfil replacement annually to 800 by 2019/20

Number of bursaries 984 700 671 (29) Total bursaries awarded include public awarded to first-year nursing colleges and universities. With nursing students implementation of higher education funding in 2018, some university students opted for this funding which had no contractual obligations as opposed to the GDoH nursing bursary funding. Terminations at the nursing colleges also impacted on the total number of bursaries awarded.

PROGRAMME 6: HEALTH SCIENCES AND TRAINING EXPENDITURE TABLES

R’000 R’000 R’000 R’000 R’000 R’000

Nurse training colleges 738 389 747 136 (8 767) 848 937 778 971 69 966

EMS training colleges 34 981 34 953 28 37 859 27 175 10 684

Bursaries 86 548 68 676 17 872 142 498 211 282 (68 784)

Other training 68 595 68 222 373 94 002 89 280 4 722

Total 928 471 981 987 9 484 1 123 296 1 106 708 16 588

72 Department of Health Annual Report 2018/19 4.7 PROGRAMME 7: HEALTHCARE SUPPORT SERVICES Ten facilities have started using the system for dispensing. The aim Anti-Rape strategy was developed in conjunction with all relevant is to have paperless pharmaceutical services by the year 2030 in line stakeholders, the lead department being the Family Violence Child Programme Purpose • The buy-out procedure to compensate for non-awards and with the 4th Industrial Revolution. Protection and Sexual Offences Unit (FCS) of the SAPS. The purpose of this programme is to provide support services to the poor supplier performance is lengthy and cumbersome. Both the FPS and CFMS play an important role in the government’s Department so that it can achieve its aims. The sub-programmes are: Strategy to further improve Rx performance overall strategic objective of creating safer communities and • Laundry services: Providing a laundry service to hospitals, care Strategy to address underperformance Scanners and printers purchased by NDoH have been delivered, and adopting zero tolerance for crime, especially violent crime. and rehabilitation centres and certain local authorities Strategies to address these challenges include: NDoH is in the process of delivering computers to augment those • Engineering Services: Providing a maintenance service to • Continuing with the buying out of items outside the already in use at the pharmacies. Training sessions in inventory Summary of Signi cant Achievements equipment and engineering installations, and minor contractual system, as well as those not delivered due to poor management have been held with institutions, with good outcomes. • The building of a new state of the art Johannesburg Forensic maintenance to buildings supplier performance Training in the dispensing system will be rolled out in 2019 as Pathology Service (FPS) mortuary costing R 600m. This is being • Forensic services: Providing specialised forensic and • Continuing to institute penalties on non-performing suppliers additional equipment is delivered. built in Auckland Park adjacent to Helen Joseph hospital and is medico-legal services to establish the circumstances and • Continuously and closely monitoring medicine availability so estimated 40% complete. causes surrounding unnatural deaths that action is taken immediately an early warning sign is Sub-programme: Forensic Medical Services (Pathology & • An open day on 19 April 2018 was attended by CFMS staff at • Orthotic and prosthetic services: Providing specialised orthotic noticed Clinical) Baragwanath Hospital where community, learners and and prosthetic services • Holding frequent demand planning sessions with users. This subprogramme consists of the Forensic Pathology Service and employees of the hospital were provided with information • Medical trading account (Medical Supplies Depot): Managing the Clinical Forensic Medical Service (CFMS). regarding victims, PEP, prevention of injuries and human CENTRAL CHRONIC MEDICINE DISPENSING AND the supply of pharmaceuticals and medical sundries to trafficking. DISTRIBUTION (CCMDD) hospitals, CHCs and local authorities. The FPS is divided into two regions (North and South) comprising • Debriefing sessions are done for CFMS and FPS staff. three clusters, with 11 medico-legal laboratories (mortuaries). The CCMDD programme, implemented to decongest public facilities • Community campaigns, events and training were conducted as Summary of the signi cant achievements follow: and to improve waiting times, has seen a total of 490 518 patients The CFMS has 27 facilities offering comprehensive 24-hour services. Pharmaceutical Services: enrolled by the end of the 2018/19 financial year. The 2018/19 o Child Protection Week was supported through Services are generally rendered within various facilities in the district During the year under review, the key achievements of CCMDD target of 350 000 patients was exceeded. build-up events. The main event was held on the 5th viz hospitals and clinics. All health facilities are expected to manage Pharmaceutical Services include: of June, and 1 482 children were reached during this survivors of violence, take blood for suspected drunken driving etc. • Exceeding the CCMDD target of 350 000. Currently, there are The number of patients collecting their medicines from external pick period. These come under various names such as crisis centres, 490 518 patients enrolled in the CCMDD programme. up points at the end of financial year 2018/19 was 179 653. The o Basic first aid and fire safety training was conducted post-exposure prophylaxis (PEP) centres and comprehensive • All facilities, with two exceptions, are now utilising the RX balance of patients still collect their medicine from Internal (GDoH) for 254 community members. medico-legal centres. Currently, all hospitals and some clinics offer Solution stock control system. This has improved the facilities where there is a special fast queue designed to serve them o Youth Expo Week was supported at Nasrec, with 1 PEP. Services to victims of crime have been gazetted as the monitoring of the essential medicines stock holding compared quickly. 119 community members reached. designated responsibility of the Department of Health. to the previous manual stock management. The two hospitals o Burns Week was supported, and 129 community are currently upgrading their ICT network and will soon be The Remote Automated Dispensing Units (RADU) installed in the members were reached. Purpose of the sub-programme: using the system. Johannesburg Health District at four different sites currently serves o Continuous medical education was provided to 72 The role of the FPS is, inter alia, to investigate the cause of any 27 129 patients. This innovation has increased patient convenience employees. unnatural death or sudden unexpected death, using internationally MEDICINE AVAILABILITY and flexibility in patient medicine access by offering extended o 37 clinicians were trained in a Sexual Offences Care accepted scientific methods thereby assisting the South African operating hours, which include weekends and public holidays – an Practitioner course (SOCP). Monitoring of medicine availability in the province is a key indicator Police Service (SAPS) in the collection of evidence and its extra 80 hours/month. Although initially restricted to PHCs, the o Men’s event was held on 16 November to improve of the APP. Availability of both vital and essential medicines was presentation in a court of law. The service is also required to keep RADU system has now been extended to hospitals and is thus gender relations and promote unity for 150 men. 96% for the financial year 2018/19. Ensuring medicine availability statistics on trends that can be used in prevention strategies for covering patients with chronic conditions who are stable compared o 16 Days of Activism was held with the theme “Peace increases the possibility of better health outcomes. The province unnatural causes of death. This includes trauma such as motor to just a few at the start of the programme. Begins at Home” on the 5th December in Evaton. 282 had targeted to maintain the availability of both vital and essential vehicle accidents, violence, drowning and suicide. Through its community members attended the event. partnerships with medical universities, the service appoints medical medicines at an average of 98%, as had been achieved in 2017/18, Challenges o A CFMS facility was opened in Evaton, and intake but in the reporting year challenges cited below were experienced There is a need to incorporate more external pick up sites to doctors and trains medical, legal and law enforcement practitioners started in December 2018. nationally. contribute to decongesting internal facilities. in the field of forensic medicine. o 4 238 comfort packs were issued in financial year 2018/2019. Challenges Strategy to address underperformance The CFMS manages survivors of crime with specific emphasis on o A Lodox Statscan was repaired and transferred from The main causes of being out of stock were: There is a big drive for 2019/20 to initiate more external pick up rape, domestic violence against women and man and child abuse. In Bertha Gxowa Hospital to FPS Germiston to ensure • Essential medicines not awarded on contracts due to: points. All hospitals will be enrolled on the programme in 2019. the process, it supports judicial processes through collection of that people are no longer transported to FPS • Non-participation of some pharmaceutical suppliers particularly evidence and providing expert witnesses in a court of law. The Johannesburg for necessary scans. those who are sole suppliers of specific essential medicines RX SOLUTION IMPLEMENTATION service also examines alleged perpetrators of crime. The CFMS is also • The post mortem turnaround time improved from 4 days in • Challenges in the sourcing of the active pharmaceutical The Rx Solution inventory management system has been installed at involved in taking blood from alleged drunken drivers. The Gauteng quarter 2 to 2 days in quarter 4. ingredient (API) all hospitals and at five district pharmacies. • The body release turnaround time improved at FPS Germiston • Poor supplier performance exceeding the contractual lead from 7 days in quarter 3 to 4 days in quarter 4. times

Department of Health Annual Report 2018/19 73 Ten facilities have started using the system for dispensing. The aim Anti-Rape strategy was developed in conjunction with all relevant is to have paperless pharmaceutical services by the year 2030 in line stakeholders, the lead department being the Family Violence Child • The buy-out procedure to compensate for non-awards and with the 4th Industrial Revolution. Protection and Sexual Offences Unit (FCS) of the SAPS. poor supplier performance is lengthy and cumbersome. Both the FPS and CFMS play an important role in the government’s Strategy to further improve Rx performance overall strategic objective of creating safer communities and Strategy to address underperformance Scanners and printers purchased by NDoH have been delivered, and adopting zero tolerance for crime, especially violent crime. Strategies to address these challenges include: NDoH is in the process of delivering computers to augment those • Continuing with the buying out of items outside the already in use at the pharmacies. Training sessions in inventory Summary of Signi cant Achievements contractual system, as well as those not delivered due to poor management have been held with institutions, with good outcomes. • The building of a new state of the art Johannesburg Forensic supplier performance Training in the dispensing system will be rolled out in 2019 as Pathology Service (FPS) mortuary costing R 600m. This is being • Continuing to institute penalties on non-performing suppliers additional equipment is delivered. built in Auckland Park adjacent to Helen Joseph hospital and is • Continuously and closely monitoring medicine availability so estimated 40% complete. that action is taken immediately an early warning sign is Sub-programme: Forensic Medical Services (Pathology & • An open day on 19 April 2018 was attended by CFMS staff at noticed Clinical) Baragwanath Hospital where community, learners and • Holding frequent demand planning sessions with users. This subprogramme consists of the Forensic Pathology Service and employees of the hospital were provided with information the Clinical Forensic Medical Service (CFMS). regarding victims, PEP, prevention of injuries and human CENTRAL CHRONIC MEDICINE DISPENSING AND trafficking. DISTRIBUTION (CCMDD) The FPS is divided into two regions (North and South) comprising • Debriefing sessions are done for CFMS and FPS staff. three clusters, with 11 medico-legal laboratories (mortuaries). The CCMDD programme, implemented to decongest public facilities • Community campaigns, events and training were conducted as and to improve waiting times, has seen a total of 490 518 patients follow: The CFMS has 27 facilities offering comprehensive 24-hour services. enrolled by the end of the 2018/19 financial year. The 2018/19 o Child Protection Week was supported through Services are generally rendered within various facilities in the district CCMDD target of 350 000 patients was exceeded. build-up events. The main event was held on the 5th viz hospitals and clinics. All health facilities are expected to manage of June, and 1 482 children were reached during this survivors of violence, take blood for suspected drunken driving etc. The number of patients collecting their medicines from external pick period. These come under various names such as crisis centres, up points at the end of financial year 2018/19 was 179 653. The o Basic first aid and fire safety training was conducted post-exposure prophylaxis (PEP) centres and comprehensive balance of patients still collect their medicine from Internal (GDoH) for 254 community members. medico-legal centres. Currently, all hospitals and some clinics offer facilities where there is a special fast queue designed to serve them o Youth Expo Week was supported at Nasrec, with 1 PEP. Services to victims of crime have been gazetted as the quickly. 119 community members reached. designated responsibility of the Department of Health. o Burns Week was supported, and 129 community

The Remote Automated Dispensing Units (RADU) installed in the members were reached. Purpose of the sub-programme: Johannesburg Health District at four different sites currently serves o Continuous medical education was provided to 72 The role of the FPS is, inter alia, to investigate the cause of any 27 129 patients. This innovation has increased patient convenience employees. unnatural death or sudden unexpected death, using internationally and flexibility in patient medicine access by offering extended o 37 clinicians were trained in a Sexual Offences Care accepted scientific methods thereby assisting the South African operating hours, which include weekends and public holidays – an Practitioner course (SOCP). Police Service (SAPS) in the collection of evidence and its extra 80 hours/month. Although initially restricted to PHCs, the o Men’s event was held on 16 November to improve presentation in a court of law. The service is also required to keep RADU system has now been extended to hospitals and is thus gender relations and promote unity for 150 men. statistics on trends that can be used in prevention strategies for covering patients with chronic conditions who are stable compared o 16 Days of Activism was held with the theme “Peace unnatural causes of death. This includes trauma such as motor to just a few at the start of the programme. Begins at Home” on the 5th December in Evaton. 282 vehicle accidents, violence, drowning and suicide. Through its community members attended the event. partnerships with medical universities, the service appoints medical Challenges o A CFMS facility was opened in Evaton, and intake There is a need to incorporate more external pick up sites to doctors and trains medical, legal and law enforcement practitioners started in December 2018. contribute to decongesting internal facilities. in the field of forensic medicine. o 4 238 comfort packs were issued in financial year 2018/2019. Strategy to address underperformance The CFMS manages survivors of crime with specific emphasis on o A Lodox Statscan was repaired and transferred from There is a big drive for 2019/20 to initiate more external pick up rape, domestic violence against women and man and child abuse. In Bertha Gxowa Hospital to FPS Germiston to ensure points. All hospitals will be enrolled on the programme in 2019. the process, it supports judicial processes through collection of that people are no longer transported to FPS evidence and providing expert witnesses in a court of law. The Johannesburg for necessary scans. RX SOLUTION IMPLEMENTATION service also examines alleged perpetrators of crime. The CFMS is also • The post mortem turnaround time improved from 4 days in The Rx Solution inventory management system has been installed at involved in taking blood from alleged drunken drivers. The Gauteng quarter 2 to 2 days in quarter 4. all hospitals and at five district pharmacies. • The body release turnaround time improved at FPS Germiston from 7 days in quarter 3 to 4 days in quarter 4.

74 Department of Health Annual Report 2018/19 PERFORMANCE INDICATORS: PROGRAMME 7 - HEALTHCARE SUPPORT SERVICES

Programme 7 – Healthcare Support Services

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Increase % of vital medicine available and accessible from 82% in 2013/14 to 99% by 2019/20

Percentage of vital 96.8% 98% 96.3% (1.7%) Vital medicines items not awarded on medicine availability at (406/418) contracts; poor supplier performance health facilities exceeding the lead times. EML items not on contract; buy out procedure lengthy and cumbersome. Continue with the buyout of items not on contract or not delivered including penalties on non-performing suppliers and close monitoring of medicines

Increase % of essential medicine available and accessible from 82% in 2013/14 to 99% by 2019/20

Percentage of essential 97.6% 98% 96.2% (1.8%) EML items not awarded on contracts; medicine availability at (527/538) poor supplier performance exceeding the health facilities lead times. EML Items not on contract; buy out procedure lengthy and cumbersome. Continue with the buyout of items not on contract or not delivered including penalties on non-performing suppliers and close monitoring of medicines

Increase access to chronic medication for stable patients through the use of central chronic dispensing and distribution centres and pick-up points from 0 in 2013/14 to 600 000 by 2019/20

Number of patients 410 075 350 000 490 518 140 518 Roll out of the programme beyond the enrolled on centralised pilot district and to some hospitals. chronic medicine dispensing and distribution programme (cumulative)

Department of Health Annual Report 2018/19 75 Programme 7 – Healthcare Support Services

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Improve the quality of NHLS services delivered to GDoH by increasing turn-around times for laboratory test results by 33% by 2019/20

Percentage of Gene-xpert 96.7% 90% 94.9% 4.9% Target achieved and exceeded. Periodic results available within 48 (284 765/294 reporting and continued monitoring of hours 463) the indicator has enabled the NHLS to develop appropriate intervention measures. Improve availability of essential medical equipment needed in 100% of hospitals by 2019/20

Number of hospitals with # 100% 100% 0 Target achieved. All hospitals are essential medical 37/37 37/37 procuring equipment based on the equipment recommended service package equipment list whilst awaiting finalisation of the essential equipment policy and list.

Reduce post mortem and mortuary body release turnaround time to 4 days

Post mortem turnaround # 3 days 2 days 1 day Target achieved time

Mortuary body release # 5 days 5 days 0 day Target achieved turnaround time Increase quality and access in PHC facilities through 24 hours service provision in all CHCs, integration of mental health and rehabilitation services in 100% of PHC facilities by 2019/20 Percentage of assistive 92% 71% 90.8% 19.8% Target exceeded due to large amount of devices issued hearing aids and prosthetic parts purchased from the central office to alleviate waiting lists.

PROGRAMME 7: HEALTHCARE SUPPORT SERVICES EXPENDITURE TABLES

Sub-programme 2017/2018 2018/2019 Name Sub-programme R’000Final Actual R’000 (Over) /UnderR’000 R’000Final Final ActualR’000 (Over)/UnderR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000

Laundries 213 145 208 732 4 413 251 462 250 982 480

Food Supply Services 76 692 81 035 (4 343) 87 693 88 066 (373)

Medicine Trading Account 1 - 1 1 - 1

Total 289 838 289 767 71 339 156 339 048 108

76 Department of Health Annual Report 2018/19 4.8 PROGRAMME 8: HEALTH FACILITIES MANAGEMENT

Purpose The purpose of the programme is to plan and deliver new health • Construction at Kekanastad New Clinic commenced in facilities and to refurbish, upgrade and maintain existing facilities. February 2018 • Construction at the new Eersterus Clinic in Soshanguve is 25% Strategic Objective completed Increased efficiency of service implementation through • Upgrading of psychiatric wards at Charlotte Maxeke infrastructure delivery, good governance practices and sustainable Johannesburg Academic Hospital is 75% completed maintenance of moveable and immovable assets. • Construction of new Khutsong South Clinic is 88% completed. LIST OF SUB-PROGRAMMES • District Health Services • Community Health Facilities • Provincial Hospital Services • Central Hospital Services • Emergency Medical Services • Other facilities

FUNDING SOURCES Programme 8 is funded through: • Hospital Facility Revitalisation Grant (HFRG) • Equitable Share (ES) • Extended Public Works Programme (EPWP)

SIGNIFICANT ACHIEVEMENTS

During 2018/19, there were the following significant achievements:

• A contractor for the refurbishment of nurses residences at Helen Joseph Hospital was appointed on 24 May 2018 • Construction for additions and renovations at Dilopye Clinic commenced on 23 July 2018 • A replacement contractor for the renovation of Helen Joseph psychiatric ward was appointed. Construction expected to be completed 31 May 2019 • Upgrading of Ga-Rankuwa Nursing College was completed on 5 October 2018 • Construction of New Kekana Gardens Clinic was completed on 14 December 2018, and the facility was officially opened on 6 April 2019 • New Dewagensdrift Clinic was completed on 29 July 2018

Department of Health Annual Report 2018/19 77 Performance indicators: Programme 8

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Build 10 new clinics/community health centres; commence with the construction of two additional new hospitals; refurbish 21 health care facilities by 2019/20, of which 100% will comply with the gazetted norms and standards for facilities

Number of health facilities 2 2 2 projects 0 Tshwane ward 4A has been refurbished that have undergone completed completed including the upgrading of the water major and minor reticulation system. In addition, we have refurbishment in NHI Pilot upgraded the Garankuwa Nursing District College.

Number of health facilities 1 1 0 completed (1) 3 construction projects commenced at that have undergone major completed projects Charlotte Maxeke (Pych ward and staff and minor refurbishments residence), Chris Hani Bara (staff outside NHI pilot district residence, ICU and Neonatal) and Forensic (excluding facilities in NHI Pathology building – City of Johannesburg Pilot District) (COJ). The resolution taken by Exco pertaining to infrastructure led to the deferment of planned construction.

Build 10 new clinics/community health centres by 2019/20 of which 100% will comply with the gazetted norms and standards

Number of additional 2 3 2 clinics (1) 2 of the targeted clinics completed namely clinics and community completed Completed completed Dewagensdrift and Kekana Gardens health centres constructed 7/8 clinics under construction namely: 6 under 8 under 7 under (1) Finetown, Greenspark, Kekanastad, construction construction construction Khutsong South, New Eersterust, Dilopye, Boikhutsong 1 in 5 in 4 4 additional clinics in planning phase planning planning namely: Chiawelo, Zola CHC, Dark City, Refilwe, Orange Farm

78 Department of Health Annual Report 2018/19 Performance indicators: Programme 8

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Number of additional new 9 in 10 in 11 in 1 Lilian Ngoyi Hospital: hospitals constructed or planning planning planning The new hospital was planned and designed as revitalised a district hospital, but due to current demand 0 under the designs must be changed into those for a construction regional hospital. Target not reached.

Soshanguve Hospital: Follow up meeting with CoT was held to confirm bulk services and usable space in terms of the current buffer zone on the proposed site. Target reached.

Daveyton Hospital, Khayalami Hospital, Sebokeng Hospital, Dr Yusuf Dadoo Hospital, Tambo Memorial Hospital Projects were put on hold. Target reached.

Diepsloot Hospital: Initially, the identified site was privately owned. COJ identified alternative land for transfer to GDOH. Target reached.

Jubilee Hospital: The process of acquiring an appropriate site for proposed new facilities is under way with GDoH and the Gauteng Deparment of Infrastructure Development (GDID) Town Planner discussing options with the City of Tshwane. The initial identified site was environmentally sensitive; the 2nd identified site is tribal land. Target reached.

Kalafong Hospital: Identified sites belong to City of Tshwane (CoT) and Public Works. GDID is in negotiations with the respective owners. Target reached. The CoT needs township establishment for all uses to be erected on site.

Hillbrow Hospital in planning phase. The resolution taken by Exco pertaining to infrastructure led to the deferment of planned construction.

Department of Health Annual Report 2018/19 79 Performance indicators: Programme 8

Actual Planned Actual Deviation Comment on deviation Performance indicator achievement target achievement from planned 2017/18 2018/19 2018/19 target 2018/19 (over/(under))

Number of new EMS bases # 5 in 5 In planning: 0 Target exceeded, additional 5 EMS bases revitalised planning in planning phase namely: Westonaria, Mohlakeng, Heidelberg, Devon, Dewagensdrift. Construction could not commence due to the resolution taken by Exco pertaining to Dewagensdrift base.

Number of mortuaries # 1 in 1 in planning 0 Target achieved. Bronkhorstspruit FPS refurbished planning 1 under and Johannesburg FPS are under 1 under construction planning and construction respectively construction

EXPENDITURE: PROGRAMME 8 – HEALTH FACILITIES MANAGEMENT EXPENDITURE TABLES

R’000 R’000 R’000 R’000 R’000 R’000

Community Health Facilities R 341 042 R 317 227 R 23 815 432 134 390 045 42 089

Emergency Medical Rescue R 7 046 R 1 739 R 5 307 9 628 1 299 8 329

Services

District Hospital Services R 260 789 R 214 806 R 45 983 218 580 172 998 45 582

Provincial Hospital Services R 288 934 R 282 716 R 6 218 264 803 202 304 62 499

Central Hospital Services R 311 287 R 335 462 -R 24 175 314 344 315 650 (1 306)

Other facilities R 474 201 R 455 827 R 18 374 320 444 453 824 (133 380)

Total R 1 683 299 R 1 607 777 R 75 522 1 559 933 1 536 120 23 813

80 Department of Health Annual Report 2018/19 Changes to planned targets The table below shows the main appropriation, adjustments and proposed second adjustment for the 2018/19 financial year.

2018/19 Financial Year

Category Main Adjusted 2nd adjustment Decrease Increase

New Infrastructure assets R 645 991 R 797 141 R 711 276 R 85 865 R 0

Renovations & rehabilitation R 143 500 R 173 452 R 136 017 R 37 435 R 0

Upgrades and additions R 229 700 R 142 110 R 135 410 R 6 700 R 0

Maintenance and repairs R 797 343 R 707 073 R 517 073 R 190 000 R 0

Total R 1 816 534 R 1 819 776 R 1 499 776 R 320 000 R 0

The table below shows the infrastructure allocation per funding source. The provincial equitable share (ES) reduced by R 320 million (34%) compared to the Mid-Year Adjustment Budget.

Funding Original Adjusted Second Decrease Increase budget budget adjustment Equitable Share R 939 368 R 925 368 R 605 368 R 320 000 R 0

Health Facility Revitalisation Grant R 874 842 R 892 084 R 892 084 R 0 R 0

EPWP R 2 324 R 2 324 R 2 324 R 0 R 0

Total R 1 816 534 R 1 819 776 R 1 499 776 R 320 000 R 0

5. TRANSFER PAYMENTS

Table: Transfer payments to other public entities, 2018/19

Name of Type of R’000Purpose R’000 for R’000Did the AmountR’000 Amount R’000spent ReasonsR’000 for transferee organisation which the department transferred by the entity the funds funds were comply with s (R’000) unspent by used 38 (1) (j) of the the entity PFMA? Local Government Municipalities Primary Health Care Yes 316,463 316,463 -

Local Government Municipalities HIV/AIDS Yes 67,012 67,015 -

Local Government Municipalities Emergency Yes 338,514 338,514 -

Health Welfare and Sector Non-profit Medical Services Yes 20,962 20,962 -

Training Authority institution

Universities Higher Education Learnerships Yes 13,681 13,421 Delays in tax clearance certificate Institutions

A number of Mental Health Non-profit Training of Health Yes 191,207 150,495 non-profit institutions institutions professionals did not meet the Psychiatric Community requirements Based Services

Department of Health Annual Report 2018/19 81 Name of Type of R’000Purpose R’000 for R’000Did the AmountR’000 Amount R’000spent ReasonsR’000 for transferee organisation which the department transferred by the entity the funds funds were comply with s (R’000) unspent by used 38 (1) (j) of the the entity PFMA? Expanded Public Works Non-profit Community Based Yes 120,511 120,346 A number of beneficiaries Programme institutions Services Yes terminated service

Nutrition Non-profit Nutrition supplement 58,548 55,984 A number of crèches did not meet the institutions to crèches Yes qualifying criteria HIV/AIDS Non-profit Primary Health Care 79,264 73,652 A number of non-profit institutions did not meet institutions Yes the qualifying criteria

Witkoppen clinic Non-profit Primary Health Care 13,308 13,115

institution Yes

Rehabilitation Services Non-profit Rehabilitation Yes 1,690 1,690

institutions

Nelson Mandela Children’s Non-profit Paediatric services Yes 200,000 200,000

Hospital institution Increased payments of Households Non-profit Service benefits and Yes 535,809 921,439 claims against the state and its reclassification institution households from goods and services

6. DONOR FUNDS

DONOR FUND 1

Name of donor Health care waste and occupational hygiene risk management, Mamelodi Hospital

Full amount of the funding Compass Medical Waste donated Assets to the value of R494820.00

Period of commitment None

Purpose of the funding Kickabout bucket, med waste trolley small and med waste trolley large for the patient

Expected outputs Kickabout bucket, med waste trolley small and med waste trolley large for the patient

Actual outputs achieved Kickabout bucket, med waste trolley small and med waste trolley large for the patient

Amount received in the current period (R’000) R494820.00(Kickabout bucket, med waste trolley small, med trolley large)

Amount spent by the department (R’000) None

Reasons for funds unspent

Monitoring mechanisms by the donor None

82 Department of Health Annual Report 2018/19 DONOR FUND 2

Name of donor Mevi Mercant donoted to Pretoria Paediatric Fund

Full amount of the funding R85850.00(Refrigerator, Microwave)

Period of commitment None

Purpose of the funding Refrigerator, microwave used by patient at Paediatric by the Kangaroo Mother care unit.

Expected outputs Refrigerator, Microwave used by Patient at Paediatric by the Kangaroo Mother care unit.

Actual outputs achieved Refrigerator, Microwave used by Patient at Paediatric by the Kangaroo Mother care unit.

Amount received in the current period (R’000) R10835.00 (Refrigerator, Microwave)

Amount spent by the department (R’000) None

Reasons for the funds unspent

Monitoring mechanisms by the donor None

DONOR FUND 3

Name of donor BroadReach Corporation

Full amount of the funding R23474.83 (Dell Latitude E7470)

Period of the commitment none

Purpose of the funding Dell Latitude E7470 for staff

Expected outputs Dell Latitude E7470 for staff

Actual outputs achieved Dell Latitude E7470 for staff

Amount received in the current period (R’000) R23474.83 (Dell Latitude E7470)

Amount spent by the department (R’000) none

Reasons for the funds unspent N/A

Monitoring mechanisms by the donor none

7. CONDITIONAL GRANTS

The table below shows the conditional grants and earmarked funds paid to the Department. Table 7.1: Conditional Grant: Health Facility Revitalisation Grant

Department/municipality to which the grant was GDOH transferred

Purpose of the grant The purpose of the grant, made in terms of DORA, was to:

• Help accelerate the construction, maintenance, upgrading and rehabilitation of new

and existing infrastructure in health including health technology, organisational design

(OD) systems and quality assurance (QA)

• Supplement expenditure on health infrastructure delivered through public-private

partnerships

• Enhance capacity to deliver health infrastructure.

Expected outputs of the grant Number of health facilities planned: 5

Number of facilities designed: 3

Number of facilities constructed: 6

Number of facilities equipped: 5

Number of facilities operationalised: 3

Number of facilities maintained: 88

Department of Health Annual Report 2018/19 83 7. CONDITIONAL GRANTS

The table below shows the conditional grants and earmarked funds paid by the Department. Table 7.1: Conditional Grant: Health Facility Revitalisation Grant

Department/municipality to which the grant was GDOH transferred

Actual outputs achieved Number of health facilities planned: 0 Number of facilities designed: 0 Number of facilities constructed: 1 Number of facilities equipped: 3 Number of facilities operationalised: 0 Number of facilities maintained: 7

Amount per amended DORA R 892 084 000 Amount transferred (R’000) R 892 084 000 Reasons if amount as per DORA not transferred Not applicable Amount spent by the department/municipality (R’000) R 777 939 000 Reasons for the funds unspent by the entity • Projects started construction later than anticipated • Probity process delayed procurement at GDID • Contracts had to be terminated because contractor could not complete the work • Contractor had cash flow limitations which delayed projects • Contractors performed poorly • Projects on tender were sent back to planning due to non-compliance • Late payment of invoices • Contractor abandoned site due to community unrests/service delivery protests • Late approval of planning documents • Long process to get approval of end user • Land challenges

Monitoring mechanisms by the transferring department National Health Infrastructure Progress Reviews Standard for Infrastructure Delivery and Procurement Management (SIPDM) Division of Revenue Act (DORA).

Table 7.2: Conditional Grant: National Tertiary Services Grant

Department/municipality to which the grant was National Health Department transferred Purpose of the grant Ensure the provision of tertiary health services in South Africa Compensate tertiary facilities for the additional costs associated with provision of these services Expected outputs of the grant NTSG - Service Outputs 2017/18 Target outs as per SLA 2018/19 Day patient separations - Total 170,765 Inpatient days - Total 1,768,217 Inpatient separations - Total 305,089 Outpatient first attendances 566,934 Outpatient follow up attendances 1,362,128

84 Department of Health Annual Report 2018/19 Actual outputs achieved NTSG - Service Outputs 2017/18 Measured outputs Day patient separations - Total 205,203 Inpatient days - Total 1,719,446 Inpatient separations - Total 315,024 Outpatient first attendances 587,256 Outpatient follow up attendances 1,355,237

Amount per amended DORA (R’000) R 4,390,192,000

Amount transferred (R’000)

Reasons if amount as per DORA not transferred R 4,137,620,922

Reasons for the funds unspent by the entity (R’000) This item is projected to be underspent due to the processes of sourcing quotations and finalisation of tenders regarding MTS equipment. However, there are commitments of R252 million as of 31 March 2019. The department is in the process of applying a rollover of R252 million.

Monitoring mechanisms by the transferring department Monthly, quarterly and annual monitoring of expenditure and equipment progress

Table 7.3: Conditional Grant: Health Professions Training and Development Grant

Department/municipality to which the grant was National Health Department transferred Purpose of the grant Support provinces to fund service costs associated with clinical training and supervisors of health science trainees on the public service platform

Expected outputs of the grant Increased supply of trained health professionals: medical doctors, nurses and allied health professionals

Actual outputs achieved COMMUNITY SERVICE PLACEMENTS 251 Medical Doctors 23 Dentists 55 Dieticians 34 Environmental Health Practitioners 91 Occupational Therapists 88 Pharmacists 102 Physiotherapists 76 Radiographers 62 Speech & Hearing Therapists Internship programme: 526 Medical Interns 61 Pharmacists 61 Clinical Psychologists 648 TOTAL:

Department of Health Annual Report 2018/19 85 Amount per amended DORA (R’000) Amount transferred (R’000) R 983, 712,000 Reasons if amount as per DORA not transferred Amount spent by the department/municipality (R’000) R 947,885,000 Reasons for the funds unspent by the entity (R’000) The under-expenditure is mainly attributed to slow supply chain processes with regard to procurement of and payment for training and medical equipment. There were unpaid invoices to the value of R1, 7 million and commitments amounting to R32, 3 million as of 31 March 2019. The department will apply for a roll-over amounting to R34 million. Monitoring mechanisms by the transferring department Monthly, quarterly and annual monitoring of expenditure

Table 7.4: Social Sector EPWP Incentives Grant

Department/municipality to which the grant was National Public Works (NPW) transferred Purpose of the grant To improve service delivery by strengthening and expanding social sector programmes that have employment potential Expected outputs of the grant Employment created and stipends paid to EPWP participants. Service delivery improved. Improved opportunities for sustainable jobs through work experience and training. Actual outputs achieved 58 job opportunities (Facilities Base Assistant Workers) created. 58 health facilities serviced Amount per amended DORA 1 470 000 Amount transferred (R’000) 1 470 000 Reasons if amount as per DORA not transferred N/A Amount spent by the department/municipality (R’000) 1 404 000 (96%) Reasons for the funds unspent by the entity Training was not conducted. Monitoring mechanism by the transferring department Monthly and quarterly reports (Monthly In Year Monitoring Reports and quarterly narrative reports)

86 Department of Health Annual Report 2018/19 8. CAPITAL INVESTMENT, MAINTENANCE AND ASSET MANAGEMENT PLAN

Progress made in implementing the capital, investment and asset management plan By implementing a range of capital and maintenance infrastructure projects, the programme spent 98% of its allocated budget in the 2018/19 financial year.

Table 8.1: Infrastructure projects completed during the nancial year and progress compared with what was planned at the beginning of the year

PMIS Project name CurrentR’000 Construction R’000 PlannedR’000 ActualR’000 R’000 ReasonR’000 for Project stage start date construction construction deviation Number end date as completion date at 1 April or new planned 2018 completion date 143 Boitumelo clinic Construction 29 March 2017 15 March 2018 31 March 2023 The site was handed over to the New clinic contractor prematurely on 28 March 2017. The contractor could not start with the work as the municipal approval for the project and the construction documentation were not completed. The contractor was chased off-site by the community. GDID cancelled the contract with the contractor and the project was re-advertised for tender; a new contractor is to be appointed.

241 Charlotte Maxeke Construction 09 November 30 June 2018 31 May 2019 Previous ward councillor influenced Johannesburg 2015 general workers that their rate per Academic Hospital day is supposed to be R288 instead of Upgrading and the R150 which the contractor bid renovation of the entailed. This led to community existing Psychiatric unrest which was resolved by the unit establishment of a Project Steering Committee.

179 Dewagensdrift Clinic Construction 01 August 2016 31 March 2018 29 July 2018 All construction works completed; HT Construction of the completed items need to be fitted and new clinic commissioned. The official opening took place on 26 April 2019.

129 Finetown Clinic Construction 28 September 28 February 31 January 2020 There was a contractual dispute due Construction of new 2016 2019 to the Department’s lengthy payment clinic procedures which eventually led to contract cancellation in November 2018. Replacement contractor to be appointed.

Department of Health Annual Report 2018/19 87 PMIS Project name CurrentR’000 Construction R’000 PlannedR’000 ActualR’000 R’000 ReasonR’000 for Project stage start date construction construction deviation Number end date as completion date at 1 April or new planned 2018 completion date 540 Ga-Rankuwa Nursing Construction 25 May 2015 30 July 2018 5 October 2018 Challenges were experienced with College roofs on lecture halls, linkages Upgrading and between the old buildings and the renovations to new building, Auditorium, ITC college infrastructure, ground civil works, late payment of contractor’s claims, access to the existing building, Power of Attorney. The subcontractor for ICT was only appointed in December 2017 by the main contractor following approval of ICT as a Variation Order to the contract.

6793113 Greenspark Clinic Construction 15 February 29 March 2019 30 October 2019 Progress has been slow due to cash New clinic 2017 flow problems by the contractor. Scope of work changes on the contract allowing additional extension of time. Additional scope to bulk earthworks and ICT had to be added. Delays on site due to community unrest.

291 Kekanastad Clinic Construction 27 February 14 December 31 December Construction was at 35% when the Construction of the 2018 2018 2019 contract was terminated. new clinic Replacement contractor had to be appointed.

6793111 Khutsong South Ext2 Construction 12 April 2016 31 August 2018 31 July 2019 Slow progress on site due to Clinic community unrest. Contractor off-site New Clinic due to late payments from Department. Community unrest. GDID requested additional scope.

170 Mandisa Shiceka Construction 03 October 2017 14 December 14 December The land is too small for the clinic. An Clinic 2018 2019 additional land parcel ERF 355 (a Replace current clinic portion) was requested to and upgrade to CDC accommodate parking for the clinic. The requested land is owned by the City of Tshwane, which was requested to allocate this piece of land or to relax the parking bylaws. Construction commenced for a temporary structure.

88 Department of Health Annual Report 2018/19 PMIS Project name CurrentR’000 Construction R’000 PlannedR’000 ActualR’000 ReasonR’000 for deviation R’000 Project stage start date construction construction Number end date as completion date at 1 April or new planned 2018 completion date New Kekana Gardens Construction 16 January 2016 29 June 2018 Construction of the facility has 183 Clinic completed progressed to 100% with all New clinic construction completed. ICT and medical equipment to be procured, installed and commissioned. The official opening was on 6 April 2019.

283 Tshwane District Construction 06 May 2015 09 March 2018 09 March 2018 Completion of Ward 1 has Refurbishment completed commenced; practical completion was Contract 4 A reached on 9 March 2018

Table 8.2: Infrastructure projects currently in progress and their expected completion dates

Stage PMIS Project name Construction Construction Project start date end date Number

30309905 Atteridgeville CHC Construction of new CHC Feasibility 30 November 2018 31 August 2021

84 Bertha Gxowa Hospital Upgrading of hospital Design 01 February 2020 31 March 2021

31007931 Bheki Mlangeni Hospital New Nurses Residences Feasibility 01 December 2022 31 March 2025

143 Boikhutsong CDC Replacement of existing clinic and Construction 51% - 75% 29 May 2017 29 May 2020

upgrade to new CDC

6792486 Boitumelo Clinic New Clinic Construction 1% - 25% 01 April 2020 31 March 2023

6793105 Braam Fischerville Clinic New Clinic Pre-feasibility 05 March 2020 31 March 2023

445 Bronkhorstspruit FPS Mortuary New mortuary Feasibility 06 September 2020 06 January 2022 Developments relating to the above that are expected to 212 Carletonville Hospital Refurbishment of TB ward Design 30 October 2019 31 January 2022 impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently

241 Charlotte Maxeke Johannesburg Academic Hospital Construction 76% - 99% 09 November 2015 31 May 2019 appoint contractors to implement Occupational Health and 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health Upgrading and renovation of the existing Psychiatric unit projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service 30309680 Charlotte Maxeke Johannesburg Academic Hospital Design 01 June 2019 01 July 2020 projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities Wet Services allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting 6793027 Chiawelo Clinic Replace asbestos with brick and upgrade Feasibility 15 February 2020 24 February 2022 between GDOH, GDID and GPT it was decided to intensify 2. The MECs of Health and Infrastructure Development jointly existing clinic to CHC departmental consultations by including CEOs, District approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve 428 Chris Hani Baragwanath Hospital Critical repairs and Tender 01 March 2019 11 November 2021 of all health facilities and infrastructure will be carried out in the scope of work and recommended solutions for all refurbishment of staff accommodation, walkways, future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender neo-natal ICU and Labour ward. and facility deterioration, synonymous with service documents received from GDID would be workshopped with 6793012 Cosmo City Clinic New Clinic Identified 01 April 2021 31 March 2023 interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital implications of the strategy and in line with the Standard for management for approval before contractors were appointed. 103 Dark City CHC Additions and Rehabilitation Design 02 November 2019 30 September 2021 Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all 6793117 Daveyton Main Clinic Construction of the new clinic Feasibility 01 April 2021 31 March 2024 a Project Initiation Report (PIR) must be approved by Gauteng consultations have been completed. 30309906 Dewagensdrift EMS New EMS base Design 05 August 2019 29 September 2020 Provincial Treasury before implementation can commence. 6793154 Diepkloof FPS Pre-feasibility 01 April 2021 31 March 2024 Preparation of the PIR is underway.

Department of Health Annual Report 2018/19 89

105 Dilopye Clinic Additions and rehabilitation Construction 1% - 25% 31 March 2021

319 Discoverers CHC Convert CHC into District Hospital Design 01 May 2024

6793031 Dr George Mukhari Hospital Construction of helipad Pre-feasibility 30 July 2021

350 Dr Yusuf Dadoo Hospital Revitalisation Feasibility 31 December 2024

30309678 Edenvale Hospital Upgrades Upgrading and new AET, Feasibility 01 September 2021

113 additional wards, linen room, additional theatre

6793121 Ekangala Clinic New clinic Design 01 November 2020

6793129 Eldorado CHC Construction of new CHC Feasibility 31 March 2022

129 Evaton West clinic Construction of new clinic Tender 31 March 2022

540 Finetown Clinic Construction of new clinic Construction 26% - 50% 31 January 2020

6793113 Ga-Rankuwa Nursing College Upgrading and renovations Practical completion 05 October 2018

to college

659 Greenspark Clinic New clinic Helen Joseph Hospital Construction 51% - 75% 30 October 2019

Refurbishment of Oorkant, Susan Hof, Querani and

Strydom Hof Nurses residences at the hospital

656 Helen Joseph Hospital Renovations to Psychiatric ward and Construction 1% - 25% 30 November 2021

observation units

31006404 Hillbrow District HospitalConversion of CHC into District Construction 76% - 99% 31 May 2019

6793118 Hospital. Additions and revitalisation Feasibility 31 March 2024

J Dumani CHC Extensions of the pharmacy storeroom

467 Johannesburg FPS Mortuary New mortuary Design 31 March 2024

753 Jubilee Hospital Revitalisation Construction 26% - 50% 30 November 2020

760 Kagiso CHC New CHC Identified 30 June 2027 Developments relating to the above that are expected to 759 Kalafong Hospital Revitalisation/construction of new Design 31 March 2023 impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently hospital appoint contractors to implement Occupational Health and 291 Kekanastad Clinic Construction of new clinic Feasibility 28 May 2026 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health 292 Kgabo CHC New CHC Construction 26% - 50% 31 December 2019 projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities 765 Khayalami Hospital Complete refurbishment of existing Feasibility 29 November 2022 allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting unused hospital into a functional District Hospital between GDOH, GDID and GPT it was decided to intensify 31007745 Khayalami Hospital Demolition of current empty hospital Pre-feasibility 28 June 2024 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District 6793111 Khutsong South Ext2 Clinic New clinic Feasibility 30 April 2021 approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in 6793107 Kokosi CHC New CHC Construction 76% - 99% 31 July 2019 the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender 849 Kopanong Hospital Refurbishment of Psychiatric wards Design 31 March 2022 and facility deterioration, synonymous with service documents received from GDID would be workshopped with 1 & 2 Tender 01 May 2021 interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital 161 KT Motubatse New clinic Feasibility 26 October 2020 implications of the strategy and in line with the Standard for management for approval before contractors were appointed. 6793036 Lebone college Health council upgrades Design 03 July 2021 Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng 6793048 Lehae CHC Construction of a new CHC Feasibility 28 February 2023 consultations have been completed. Provincial Treasury before implementation can commence. 31008679 Lenasia District Hospital Phase1 - Gateway Clinic Tender 01 December 2024 Preparation of the PIR is underway.

90 Department of Health Annual Report 2018/19

908 Lenasia South CHC Convert CHC into District Hospital. Tender 01 April 2020 31 March 2024

Phase 1 Gateway Clinic

30309679 Leratong Nurses Res Upgrade Feasibility 30 June 2020 30 September 2022

31006389 Lillian Ngoyi Hospital Staff accommodation Tender 01 April 2020 31 March 2025

53 Lillian Ngoyi Construct new 500 bed District Hospital Design 01 April 2020 31 March 2025

adjacent to existing CHC

170 Mandisa Shiceka Clinic Replace current clinic and upgrade Construction 76% - 99% 03 October 2017 14 December 2019

to CDC

6793112 Mayibuye clinic Construction of new clinic Design 28 October 2019 16 January 2021

180 New Eersterus Clinic Construction of new clinic in Construction 1% - 25% 31 August 2018 31 August 2023

Soshanguve

6793120 Northmead Clinic Upgrades and additions Feasibility 01 April 2020 31 March 2022

OR Tambo MOU Upgrading and renovation of the existing Identified 11 September 2019 11 September 2021

clinic using MOU

6793122 Orange Farms Replacement of Ext 7 Clinic Tender 01 December 2022 01 December 2025

195 Phedisong 4 CHC Additions and rehabilitation Design 05 October 2019 05 October 2020

6793119 Phillip Moyo CHC Extension and refurbishment of Construction 51% - 75% 31 July 2017 01 November 2020

maternity unit

Pholosong Hospital Stepdown beds Design 01 April 2017 31 March 2089

198 Pretoria North Clinic Additions and rehabilitation Design 01 April 2019 19 April 2024

202 Ramotse Clinic New clinic Design 01 July 2020 31 March 2022

6793106 Randfontein Clinic Replace small clinic and upgrade to CHC Construction 1% - 25% 31 January 2020 31 May 2022

6793149 Refentse Clinic Additions and rehabilitation. Design 01 April 2019 31 March 2021 Developments relating to the above that are expected to 205 Refilwe Clinic Replace small clinic and upgrade to CHC Design 30 April 2019 30 September 2021 impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently 629 S G Lourens Nursing College Construction of new training Design 01 April 2020 31 March 2021 appoint contractors to implement Occupational Health and facility 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health 739 Sebokeng Hospital Revitalisation Feasibility 25 July 2019 24 July 2024 projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities 6793128 Sebokeng Zone 17 Clinic Construction of new clinic Tender 31 October 2019 31 October 2020 allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting 223 South Rand Hospital Conversion and renovation of old Design 02 February 2020 02 February 2021 between GDOH, GDID and GPT it was decided to intensify compound/pharmacy 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District South Rand Hospital Maternity homes Identified 01 March 2020 02 June 2020 approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in 901 Tambo Memorial Hospital Revitalisation Feasibility 01 August 2020 28 May 2026 the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender 31006387 Tara Hospital Construction of new secure adolescent ward Design 01 August 2019 31 August 2020 and facility deterioration, synonymous with service documents received from GDID would be workshopped with Tembisa Hospital Encroachment and dolomite risk Feasibility 01 April 2020 31 March 2021 interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital Tembisa Hospital New bulk store Design 01 April 2020 30 April 2022 implications of the strategy and in line with the Standard for management for approval before contractors were appointed. 4640 Thelle Mogoerane Hospital New staff residences Handed over 25 February 2015 31 December 2017 Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng 1006 Tshwane District HospitalExternal wet services contract Practical Completion 21 January 2016 14 December 2017 consultations have been completed. Provincial Treasury before implementation can commence. 283 Tshwane District Refurbishment Contract 4 A Practical completion 06 May 2015 09 March 2018 Preparation of the PIR is underway.

Department of Health Annual Report 2018/19 91

1010 Tshwane Rehabilitation Centre Renovation and upgrading Design 30 November 2019 30 September 2023

of the facility

245 Weskoppies Hospital Condition assessment and Design 16 November 2019 01 June 2022

refurbishment of heritage buildings

Winnie Mandela CHC Construction of a new CHC Design 01 April 2021 31 March 2024

Zola Clinic Construction of a new clinic Feasibility 01 April 2021 31 March 2024

Table 8.3: Procurement of medical equipment was completed by 31 March 2018 for the following three health facilities:

Project Name (as part of Incentive Grant)

Helen Joseph Hospital

Kalafong Hospital

Tembisa Hospital

Plans to close down or down-grade any current facilities There were no plans to close or down-grade any facilities in the 2018/19 financial year.

Table 8.4: Progress was made on maintenance of the following infrastructure:

Maintenance category Final appropriation (R’000) Expenditure (R’000) % spent against budget (R’000)

Maintenance & Repairs R 514 751 R 648 866 126%

Electro-mechanical R 87 338 R 78 397 90%

EPWP R 2 324 R 2 160 93%

Total R 604 413 R 729 423 121%

Developments relating to the above that are expected to impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently appoint contractors to implement Occupational Health and 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting between GDOH, GDID and GPT it was decided to intensify 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender and facility deterioration, synonymous with service documents received from GDID would be workshopped with interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital implications of the strategy and in line with the Standard for management for approval before contractors were appointed. Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng consultations have been completed. Provincial Treasury before implementation can commence. Preparation of the PIR is underway.

92 Department of Health Annual Report 2018/19

4. Changes to asset holdings during the period under review, immovable assets is responsible for disposal of the building. including information on disposals, scrapping and loss due to Measures have been taken to ensure that the Department’s Asset theft. Register remained up-to-date during the period under review; On 5 September 2018, the GDOH Head Office in the Bank of Lisbon GDID, as custodian of immovable assets, is responsible for Building (BOL) caught fire. This was a major disaster, with the entire maintaining this register. building evacuated. The building was largely destroyed and declared unsafe for further use. GDID as the custodian of Developments relating to the above that are expected to impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently appoint contractors to implement Occupational Health and 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting between GDOH, GDID and GPT it was decided to intensify 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender and facility deterioration, synonymous with service documents received from GDID would be workshopped with interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital implications of the strategy and in line with the Standard for management for approval before contractors were appointed. Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng consultations have been completed. Provincial Treasury before implementation can commence. Preparation of the PIR is underway.

Table 8.5: Percentage of the Department’s capital assets in good, fair or bad condition The table below shows the condition ratings of facilities as per the User Asset Management Plan (UAMP) for 2018/19.

Index Number of facilities Percentage

Condition Rating C4 12 2%

Condition Rating C3 489 96%

Condition Rating C2 9 2%

Condition Rating C1 0 0%

Table 8.6:The following major maintenance projects were undertaken during the period under review.

Stage Actual PMIS Project name 2018/19 Second Project Adjustment expenditure to Number date for this financial year

81 Ann Latsky Nursing College All maintenance activities R 1 000 R 1 253

175 Auckland Park Medical Supply Depot Depot maintenance R 4 000 R 1 791

82 Bank of Lisbon Building All maintenance activities R 2 500 R 2 938

85 Bertha Gxowa Hospital All maintenance activities R 5 482 R 6 157

6793065 Bheki Mlangeni Hospital Maintenance R 2 000 R 3 215

87 Bona Lesedi College All maintenance activities R 2 300 R 1 926

31007928 Bronkhorstspruit EMS Maintenance R 2 324 R 390

30309699 Bronkhorstspruit FPS Mortuary Maintenance R 500 R 255

30309930 Bronkhorstspruit Hospital Maintenance R 2 724 R 2 451

88 Carletonville FPS Maintenance R 1 799 R 330

89 Carletonville Hospital All maintenance activities R 2 000 R 3 245

30309693 Charlotte Maxeke EMS All maintenance activities R 985 R 0

93 Charlotte Maxeke Johannesburg Academic Hospital All maintenance activities R 36 772 R 50 809

95 Chris Hani Baragwanath Hospital All maintenance activities R 38 353 R 37 297

97 Chris Hani Laundry All maintenance activities R 3 589 R 1 507

30309441 Chris Hani Nursing College Maintenance R 2 528 R 481

6792275 Cullinan Care Rehabilitation Hospital All maintenance activities R 5 587 R 10 802

30309695 Cullinan EMS All maintenance activities R 555 R 0

30309697 Diepkloof FPS Maintenance R 1 580 R 1 725

107 Dr George Mukhari Hospital All maintenance activities R 33 054 R 27 228

108 Dr Yusuf Dadoo Hospital All maintenance activities R 10 189 R 7 412

110 Dunswart Provincial Laundry All maintenance activities R 749 R 23 197

255 Edenvale Hospital All maintenance activities R 8 211 R 10 632

Department of Health Annual Report 2018/19 93 Developments relating to the above that are expected to impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently appoint contractors to implement Occupational Health and 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting between GDOH, GDID and GPT it was decided to intensify 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender and facility deterioration, synonymous with service documents received from GDID would be workshopped with interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital implications of the strategy and in line with the Standard for management for approval before contractors were appointed. Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng consultations have been completed. Provincial Treasury before implementation can commence. Preparation of the PIR is underway.

4. Changes to asset holdings during the period under review, immovable assets is responsible for disposal of the building. including information on disposals, scrapping and loss due to Measures have been taken to ensure that the Department’s Asset PMIS Stage 2018/19 Second Actual Project Project name Adjustment expenditure to theft. Register remained up-to-date during the period under review; Number date for this On 5 September 2018, the GDOH Head Office in the Bank of Lisbon GDID, as custodian of immovable assets, is responsible for financial year Building (BOL) caught fire. This was a major disaster, with the entire maintaining this register. 114 Ekurhuleni District CHCs All maintenance activities R 9 709 R 1 197 building evacuated. The building was largely destroyed and 117 Ekurhuleni District Clinics All maintenance activities R 9 605 R 3 145 declared unsafe for further use. GDID as the custodian of 121 Ekurhuleni District Health Office All maintenance activities R 500 R 860

30309931 Emergency Maintenance R 20 000 R 141 548

256 Far East Rand Hospital All maintenance activities R 7 275 R 11 399

30309694 Fochville EMS All maintenance activities R 455 R 34

134 Ga-Rankuwa FPS Maintenance R 1 523 R 1 200

135 Ga-Rankuwa Nursing College All maintenance activities R 861 R 0

30309698 Germiston FPS Maintenance R 2 323 R 880

30309700 Heidelberg FPS Maintenance R 762 R 1 159

147 Heidelberg Hospital All maintenance activities R 5 809 R 3 058

257 Helen Joseph Hospital All maintenance activities R 9 995 R 14 549

149 Johannesburg District CHCs All maintenance activities R 8 139 R 15 595

151 Johannesburg District Clinics All maintenance activities R 9 522 R 9 948

154 Johannesburg District Office All maintenance activities R 1 880 R 156

30309701 Johannesburg Forensic Mortuary All maintenance activities R 2 148 R 1 295

4664 Johannesburg Provincial Laundry All maintenance activities R 1 857 R 3 772

159 Jubilee Hospital All maintenance activities R 6 250 R 10 475

258 Kalafong Hospital All maintenance activities R 6 548 R 8 356

163 Kopanong Hospital All maintenance activities R 5 894 R 6 600

166 Lebone College of Emergency Care All maintenance activities R 1 365 R 70

294 Lebone EMS College All maintenance activities R 942 R 73

259 Leratong Hospital All maintenance activities R 10 000 R 11 360

171 Masakhane Cook freeze All maintenance activities R 289 R 2 071

173 Masakhane Laundry All maintenance activities R 6 122 R 5 413

260 MEDUNSA Oral Health Centre All maintenance activities R 2 159 R 1 799

184 New Mamelodi Hospital All maintenance activities R 6 628 R 4 286

186 Nicol House All maintenance activities R 2 443 R 2 471

188 Odi Hospital All maintenance activities R 4 148 R 1 356

190 Old Germiston Hospital All maintenance activities R 48 R 901

192 Old Mamelodi Hospital All maintenance activities R 16 134 R 4 874

266 Pholosong Hospital All maintenance activities R 8 000 R 7 756

30309702 Pretoria FPS Maintenance R 6 964 R 4 005

Pretoria Oral & Dental All maintenance activities R 1 433 R 0

199 Pretoria West Hospital All maintenance activities R 3 372 R 4 221

201 Radio Communication System All maintenance activities R 1 038 R 1 444

268 Rahima Moosa Mother and Child Hospital All maintenance activities R 7 908 R 11 035

101 Rahima Moosa Nursing College All maintenance activities R 742 R 3 660

30309703 Roodepoort FPS Maintenance R 1 140 R 633

94 Department of Health Annual Report 2018/19 Lenasia South CHC Convert CHC into District Hospital.

Phase 1 Gateway Clinic

Leratong Nurses Res Upgrade

Lillian Ngoyi Hospital Staff accommodation

Lillian Ngoyi Construct new 500 bed District Hospital

adjacent to existing CHC

Mandisa Shiceka Clinic Replace current clinic and upgrade

to CDC

Mayibuye clinic Construction of new clinic

New Eersterus Clinic Construction of new clinic in

Soshanguve

Northmead Clinic Upgrades and additions

OR Tambo MOU Upgrading and renovation of the existing

clinic using MOU

Orange Farms Replacement of Ext 7 Clinic

Phedisong 4 CHC Additions and rehabilitation

Phillip Moyo CHC Extension and refurbishment of

maternity unit

Pholosong Hospital Stepdown beds

Pretoria North Clinic Additions and rehabilitation

Ramotse Clinic New clinic

Randfontein Clinic Replace small clinic and upgrade to CHC

Refentse Clinic Additions and rehabilitation. Developments relating to the above that are expected to Refilwe Clinic Replace small clinic and upgrade to CHC impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently S G Lourens Nursing College Construction of new training appoint contractors to implement Occupational Health and facility 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health Sebokeng Hospital Revitalisation projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities Sebokeng Zone 17 Clinic Construction of new clinic allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting South Rand Hospital Conversion and renovation of old between GDOH, GDID and GPT it was decided to intensify compound/pharmacy 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District South Rand Hospital Maternity homes approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in Tambo Memorial Hospital Revitalisation the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender Tara Hospital Construction of new secure adolescent ward and facility deterioration, synonymous with service documents received from GDID would be workshopped with Tembisa Hospital Encroachment and dolomite risk interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital Tembisa Hospital New bulk store implications of the strategy and in line with the Standard for management for approval before contractors were appointed. Thelle Mogoerane Hospital New staff residences Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng Tshwane District HospitalExternal wet services contract consultations have been completed. Provincial Treasury before implementation can commence. Tshwane District Refurbishment Contract 4 A Preparation of the PIR is underway.

4. Changes to asset holdings during the period under review, immovable assets is responsible for disposal of the building. including information on disposals, scrapping and loss due to Measures have been taken to ensure that the Department’s Asset PMIS Stage 2018/19 Second Actual Project Project name Adjustment expenditure to theft. Register remained up-to-date during the period under review; Number date for this On 5 September 2018, the GDOH Head Office in the Bank of Lisbon GDID, as custodian of immovable assets, is responsible for financial year Building (BOL) caught fire. This was a major disaster, with the entire maintaining this register. 300 S G Lourens Nursing College All maintenance activities R 1 775 R 1 837 building evacuated. The building was largely destroyed and 30309696 Sebokeng EMS All maintenance activities R 1 368 R 91 declared unsafe for further use. GDID as the custodian of 737 Sebokeng FPS Maintenance R 5 000 R 486

270 Sebokeng Hospital All maintenance activities R 5 000 R 16 156

213 Sedibeng District CHCs All maintenance activities R 5 000 R 4 123

215 Sedibeng District Clinics All maintenance activities R 1 463 R 4 185

Sedibeng District Office All maintenance activities R 5 552 R 5

271 Sizwe Tropical Diseases All maintenance activities R 7 307 R 5 328

4651 South Rand Hospital All maintenance activities R 1 413 R 4 431

30309690 Springs FPS Maintenance R 6 000 R 148

275 Sterkfontein Hospital All maintenance activities R 40 000 R 5 236

229 Steve Biko Academic Hospital All maintenance activities R 6 962 R 45 829

277 Tambo Memorial Hospital All maintenance activities R 5 824 R 6 406

279 Tara H Moss Hospital All maintenance activities R 6 559 R 1 951

281 Tembisa Hospital All maintenance activities R 2 000 R 12 083

4640 Thelle Mogoerane Hospital All maintenance activities R 4 936 R 2 134

234 TMI boiler house All maintenance activities R 3 452 R 142

236 Tshwane District CHCs All maintenance activities R 5 000 R 2 268

238 Tshwane District Clinics All maintenance activities R 4 437 R 6 114

4658 Tshwane District Hospital All maintenance activities R 3 129 R 1 360

243 Tshwane District Office All maintenance activities R 2 942 R 2 181

6792272 Tshwane Rehabilitation All maintenance activities R 5 326 R 1 403

288 Weskoppies Hospital All maintenance activities R 3 464 R 14 932

246 West Rand District CHCs All maintenance activities R 11 825 R 1 113

248 West Rand District Clinics All maintenance activities R 4 774 R 6 400

6793146 West Rand District Office All maintenance activities R 1 469 R 2 675

Department of Health Annual Report 2018/19 95 Developments relating to the above that are expected to impact on the department’s current expenditure 3. On 24 December 2018, GDOH requested GDID to urgently appoint contractors to implement Occupational Health and 1. In 2018/19, there was over-expenditure on maintenance Safety (OHS) maintenance projects at various health projects. This was offset by under-expenditure on capital institutions. GDID consequently appointed Professional Service projects, leading to the department spending 100% of its Providers (PSPs) to prepare specifications and Bills of Quantities allocation for infrastructure. (BOQs) for 32 hospitals. On 10 April 2019, at a meeting between GDOH, GDID and GPT it was decided to intensify 2. The MECs of Health and Infrastructure Development jointly departmental consultations by including CEOs, District approved a new strategy according to which the maintenance Managers, Facility Managers and OHS Committees to approve of all health facilities and infrastructure will be carried out in the scope of work and recommended solutions for all future. It takes a proactive approach of preventing breakages hospitals. It was also recommended that the tender and facility deterioration, synonymous with service documents received from GDID would be workshopped with interruptions and negative consequences. Due to the financial institutions and presented to the CEOs and hospital implications of the strategy and in line with the Standard for management for approval before contractors were appointed. Infrastructure Procurement and Delivery Management (SIPDM), The programme will be implemented in 2019/20 after all a Project Initiation Report (PIR) must be approved by Gauteng consultations have been completed. Provincial Treasury before implementation can commence. Preparation of the PIR is underway.

4. Changes to asset holdings during the period under review, immovable assets is responsible for disposal of the building. Electro-mechanical projects in the 2018/19 nancial year including information on disposals, scrapping and loss due to Measures have been taken to ensure that the Department’s Asset theft. Register remained up-to-date during the period under review; PMIS Stage 2018/19 Second Actual Project Project name Adjustment expenditure to On 5 September 2018, the GDOH Head Office in the Bank of Lisbon GDID, as custodian of immovable assets, is responsible for Number date for this financial year Building (BOL) caught fire. This was a major disaster, with the entire maintaining this register. building evacuated. The building was largely destroyed and 31008660 Carletonville Hospital Compressed natural gas infrastructure R 0 R 779 declared unsafe for further use. GDID as the custodian of 30309861 Carletonville Hospital Electro-mechanical equipment R 500 R 0

30309836 Charlotte Maxeke Academic Hospital Electro-mechanical equipment R 13 000 R 19 727

30309835 Chris Hani Baragwanath Hospital Electro-mechanical equipment R 700 R 14 147

31008656 Chris Hani Baragwanath Laundry Laundry Electro-mechanical equipment R 22 000 R 6 046

30309844 Dr George Mukhari Hospital Electro-mechanical equipment R 2 900 R 0

30309862 Dr Yusuf Dadoo Hospital Electro-mechanical equipment R 700 R 0

30309825 Dunswart Laundry Electro-mechanical equipment R 12 000 R 10 443

30309826 Edenvale Hospital Electro-mechanical equipment R 500 R 0

30309824 Ekurhuleni District Clinics Electro-mechanical equipment R 1 964 R 0

30309827 Far East Rand Hospital Electro-mechanical equipment R 1 500 R 0

31008665 Heidelberg Hospital Compressed natural gas infrastructure R 0 R 779

30309857 Heidelberg Hospital Electro-mechanical equipment R 1 500 R 0

30309838 Helen Joseph Hospital Electro-mechanical equipment R 2 750 R 529

31008663 Johan Heyns CHC Compressed natural gas infrastructure R 0 R 779

30309837 Johannesburg District Clinics Electro-mechanical equipment R 3 487 R 2 584

30309839 Johannesburg Laundry Electro-mechanical equipment R 11 000 R 10 309

30309863 Leratong Hospital Electro-mechanical equipment R 900 R 0

30309847 Masakhane Laundry Electro-mechanical equipment R 166 R 0

30309840 Auckland Park Medical Supply Depot Electro-mechanical equipment R 1 000 R 185

Odi Hospital Compressed natural gas infrastructure R 0 R 779

30309828 Pholosong Hospital Electro-mechanical equipment R 1 000 R 0

Pretoria West Hospital Compressed natural gas infrastructure R 0 R 1 009

30309850 Pholosong Hospital Electro-mechanical equipment R 900 R 0

30309841 Rahima Moosa Hospital Electro-mechanical equipment R 2 490 R 3 366

30309859 Sebokeng Hospital Electro-mechanical equipment R 1 000 R 0

30309856 Sedibeng District Clinics Electro-mechanical equipment R 1 000 R 3 501

Sterkfontein Hospital Compressed natural gas infrastructure R 0 R 779

30309852 Steve Biko Hospital Electro-mechanical equipment R 400 R 0

Tambo Memorial Hospital Compressed natural gas infrastructure R 0 R 779

TMI Boiler House Piped natural gas infrastructure R 0 R 0

Tshwane District Clinics Electro-mechanical equipment R 1 000 R 1 876

Tshwane Medico-Legal Electro-mechanical equipment R 1 017 R 0

Electro-mechanical equipment Electro-mechanical equipment R 1 964 R 0

96 Department of Health Annual Report 2018/19 Table 8.7: Progress made in addressing maintenance backlogs during the period under review

Sub-programme 2017/2018 2018/2019 Name Sub-programme R’000Final Actual R’000 (Over) /UnderR’000 R’000Final Final ActualR’000 (Over)/UnderR’000 Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure

R’000 R’000 R’000 R’000 R’000 R’000

New and replacement assets R 632 306 R 612 897 R 19 409 R 710 276 R 521 837 R 188 439

Existing infrastructure assets R 994 134 R 949 298 R 44 836 R 789 500 R 944 739 -R 155 239

Upgrades and additions R 170 617 R 137 291 R 33 326 R 136 410 R 181 549 -R 45 139

Rehabilitation, renovations R 89 648 R 65 605 R 24 043 R 136 017 R 114 324 R 21 693

and refurbishments

Maintenance and repairs R 733 869 R 746 402 -R 12 533 R 517 073 R 648 866 -R 131 793

Infrastructure transfer

Current R 733 869 R 746 402 -R 12 533 R 517 073 R 648 866 -R 131 793

Capital R 892 571 R 815 793 R 76 778 R 982 703 R 817 711 R 164 992

Total 1 626 440 1 562 195 R 64 245 R 1 499 776 R 1 466 576 R 33 200

Department of Health Annual Report 2018/19 97 PART C: GOVERNANCE

Department of Health Annual Report 2018/19 9. GOVERNANCE

1. Introduction

The Gauteng Department of Health is committed to sound The following key strategic risks were identified in the 2018/2019 corporate governance in its delivery of health care services to the financial year: public. The Department assures taxpayers that systems of internal • Inadequate access to quality health services for mental health control are in place to enable effective, efficient and economical use patients. of state resources. • Increase in maternal, new-born, infant and child morbidity/ mortality. 2. Risk Management • High death rate due to an increase in the number of HIV and TB infections. The Accounting Officer (AO) of the Department takes responsibility • Inadequate resources for the Primary Health Care for implementing Enterprise Risk Management (ERM) in accordance reengineering programme. with the National Treasury Public Sector Risk Management • Serious adverse events. Framework (PSRMF). The Chief Director: Risk Management (RM) and • Poor quality of the EMS referral/call system due to incorrect Internal Control is the Chief Risk Officer (CRO) for the Department. use of the system. In compliance with the PSRMF and to embed risk management, the • Shortages of pharmaceutical supplies. Department has adopted an ERM Policy Statement which sets out its • Aging infrastructure and health technology. overall intentions with regard to ERM. • Non-adherence to prescripts. • Lack of standardised information technology platforms to A detailed Risk Management Strategy and Risk Management enable the provision of quality health care. Implementation Plan were approved and implemented for the • Delays/late payments to suppliers (30-day payment period). 2018/2019 financial year. The ERM Implementation Plan gives effect • Inadequate human capital management. to the departmental RM Policy and Strategy and outlines the roles • Inability of Supply Chain Management to support the provision and responsibilities of management and staff in embedding risk of quality health care. management in the Department. • Financial losses due to litigation. • Inability to achieve revenue targets. The Department has assessed significant risks that could have an • Fraud and corruption. impact on its ability to achieve its strategic and operational • Fruitless and wasteful expenditure. objectives. Risks have been prioritised based on their likelihood and • Irregular expenditure. impact (inherently and residually), and mitigations were agreed • Inability to function in the event of a disaster (business upon to reduce the risks to acceptable levels. Risk owners have been disruption). identified for each risk and are responsible for monitoring risk levels • Compromised safety of patients and employees. and the extent to which mitigating strategies are in place. • Insufficient, irrelevant, inaccurate and incomplete performance reports. Progress on mitigation measures is tabled at the Risk Management • Industrial action at Forensic Pathology. Committee meeting (RMC) and the Audit Committee every quarter. New/emerging risks are identified and assessed on an ongoing basis. Plans are in place to mitigate these risks. The Department has an established and functional departmental Risk Management Committee, chaired by an external chairperson, 3. Minimising Con icts of Interest to assist the Accounting Officer in carrying out his responsibilities relating to risk management. The Committee operates within Terms SMS members disclose their financial interests using the eDisclosure of Reference approved by the Head of the Department and consists system. In 2018, the Department achieved 100% (106 employees of identified risk owners for each risk, representatives of all out of 106) disclosure by the SMS members. The Department has a programmes and representatives of the four academic hospitals and circular on financial disclosures for other categories; 426 employees of Gauteng Provincial Treasury. The committee meets quarterly to were trained on the circular and how to submit disclosures on the review and assess departmental risks recorded and to evaluate the eDisclosure system. action plan’s progress in the strategic risk register.

Department of Health Annual Report 2018/19 99 The Department has rolled out phase 2 of edisclosure. Conflict of efficient for the Department, which generated over 4.7 million kg of interest is monitored for salary levels 11 and 12 and for all Finance HCW for the financial year under review. and Supply Chain staff categories. The Department carries out Various additional activities are in place to continuously increase ongoing training and awareness programmes on Other awareness and advocacy and thus ensure improved quality and Remunerative Work (ORW) and conflict of interest as well as efficiency in management of the services. These include but are not financial disclosure. The Department has communicated policies and limited to district and provincial awareness projects, awards for procedures relating to remunerative work outside the public service various categories of performance such as the facility with the best and intensively monitors submission, recording, approval and HCW services, best and runner ups for individual acknowledgements reporting on this. of achievements, HCW SETA- accredited training programmes for all categories of workers including medical doctors and allied health 4. Fraud and Corruption staff. Our training modules are registered with the HPCSA for The departmental Investigation and Integrity Management Continuing Professional Development (CPD) points, and all Directorate coordinates the investigation of various investigations in professional staff are exposed to such training. There is also a the Department. The Department has in place a Fraud Prevention distance learning module for doctors who can submit a portfolio of Plan and Whistle Blowing Policy and uses the Gauteng Ethics and evidence and also gain from the training. Anti-Corruption Hotline, the Premier’s Office and the Public Service Commission Hotline to receive allegations of fraud and corruption Highly effective and further refined M + E tools with specific for investigation. Because of the diversity of cases within the indicators have been developed over the last few years and, through Department, some forensic investigations are referred to Provincial internal auditing and inspection activities, identified risks are Treasury. amicably addressed and mitigated through regular feedback of findings and required feedback from facilities. Where required and 5.Code of Conduct identified, site-specific training is carried out, targeting areas of All employees are expected to comply with the Code of Conduct. concern. The Public Service Act requires that employees adhere to the Code. The Department has a formally appointed ethics champion who The identified risks are also included in our monthly risk register, reports directly to the Head of Department. Four departmental reported upon and discussed in the departmental Risk Management officials, some qualified as certified Ethics Officers with the Ethics Committee. Substantial progress has been made in reducing risks. Institute of South Africa, have been appointed as ethics officers. The However, late payments of contracted service providers remain a Department trained 3 612 employees on the Code of Conduct and serious challenge; when services are suspended, serious Ethics during the 2018/2019 financial year. Training for awareness life-threatening and public health problems are created which have of the Code is ongoing to ensure a strong ethical culture proven very difficult to manage effectively. underpinned by the values of the Code within the organisation. The Integrity Management Unit assists the Department to manage ethics GDoH is regarded as the benchmark provincial department of health risks through communication and awareness, conflict management, in the country, with many others using what we have developed secure reporting channels and ethics incidence monitoring and here including methodologies and practises, standard operating reporting. procedure (SOP) technical guidelines, tender specifications and the like. This situation is highly motivational for all in the Department. 6. Health, Safety and Environmental Issues Occupational Hygiene Risk Management Challenges Challenges • Late payment of service providers (sometimes up to 120 days behind). Effects • Non-collection of HCW due to late payment. • Underestimated quantities of HCW tender items due to Health Care Waste Management (HCW) additional demands. All HCW services for the collection, collection, transportation, • Incomplete rollout of the HCW disposal system. treatment and final disposal of residue/ashes and supply of re-usable • Electronic tracking system for HCW containers used not 100% and disposable containers have been outsourced to private reliable. contracted service providers. This scenario has been reviewed over • Delays in processes for the new tender award resulting in the past few years, and the outcome of due diligence processes has continuous extensions of the existing contracts, exposing the supported these arrangements as the most cost-effective and Department to possible litigation.

100 Department of Health Annual Report 2018/19 • Efficiency of penalty implementation for service failure negated • Non-compliance of HCW consumables with tender due to the late payments. requirements. This will lead to audit queries and financial loss • Some external auditor findings contradict tender and other for the Department as inferior quality containers are provided statutory requirements resulting in confused employees. to facilities. • Lack of exact role clarity with reference to roles, responsibilities • Incorrect placement of the Directorate will affect career and functions in hospitals, districts and other health facilities. development of professionals and contravention of compliance • Non-compliance of HCW consumables with tender with the professional scope of practice for registered and requirements. professional allied health personnel. • Challenges with organisational structures and HCW not being • Illegal and unprocedural migration of the Directorate of Health integrated with Environmental Health. Care Waste and Occupational Hygiene Risk Management • Unprocedural migration of environmental health directorate resulted in confusion, lack of motivation, almost unruly staff, HCW and occupational hygiene risk management to the low staff morale and decreased focused productivity. The lack Integrated Employee Health and Wellness CD. of policies from the national level leads to each province • Lack of national policies to guide the management of HCW in managing HCW differently and auditors are confused because a coordinated and uniform manner. of differences and disparities between sets of legal and other requirements. Effects Achievements • Late payments of service provider lead to suspension of services by the service provider. Serious public health nuisances • Successful awareness events in all districts. are created. • Stable and productive district and provincial forum meetings. • Non-collection of waste lead to obnoxious smells, spread of • On-going training conducted in all facilities by service infection and contravention of HCW statutory requirements providers, with increased awareness contributing to improved which can result in serious financial and legal implications for management. the Department. • Provision of spill kits at all facilities and provision of freezers at • Underestimated quantities of HCW tender items and all facilities generating anatomical waste. incomplete rollout of HCW disposal system lead to incorrect • Regular audits and peer reviews conducted at health care use of containers due to undersupply of such containers and facilities resulting in continuous improvement of facilities and durable items. management of HCW. • Partial functioning of container tracking system will lead to • Development of SOPs and technical guidelines to ensure financial loss to the Department which is paying for a system compliance with legislation creating a sense of unity, support that is not functioning properly. It will also have legal and improved standards. implications for the Department, especially related to illegal • Provision of calibrated scales at hospitals and mobile scales at dumping if the service provider fails to track the exact location all other facilities. of our HCW containers. • A reliable, scientific and comprehensive database with a • Delay of the new tender award which causes extension of the confidence interval of 98% has been established and is current tender will cause irregularities in the tender and updated every quarter. Information is a reliable strategic contravention of PFMA requirements and will lead to audit management tool for decision making. queries • Detailed strategic tender specification document developed • Non-effective penalty implementation for service failure will and recently approved for advertising which will also be used lead to the service provider not providing an effective service. as an SLA once the new awards are made. Experiences of the • Auditors contradicting findings regarding the tender and other past have been built into the provisions and HCW mix will statutory requirements will lead to confusion in facilities and again be taken to the next level of continuous improvement deviations from statutory requirements by facilities. and greater legal compliance by GDoH. • Poorly-defined role clarity results in duplications, grey areas not being addressed and central office staff being involved in operational matters instead of the policy and M+ E functions.

Department of Health Annual Report 2018/19 101 7. Portfolio Committees

The table below shows the dates of the meetings of the Portfolio Committees, the matters discussed and how the Department addressed them.

Date of meeting Matters raised How matters were addressed

16 October 2018 Plans to ensure proper (a) The Department developed a strategy to address spending Request for responses on House spending and achievement and the achievement of targets for Emergency Medical Services. resolutions emanating from the of targets under The Strategy is based on the following pillars: Health Portfolio Committee Emergency Medical • Post-filling approved for 49 Intermediate Learner Students Oversight Report on the Annual Services and Health (ILS) and 30 Ambulance Learner Students (ALS). Only 3 ALS Report of the Gauteng Facilities Management Department of Health for the and 35 ILS were appointed at 31 March 2019. Recruitment 2017/18 Financial Year process under way to fill remaining posts before the end of the financial year to increase the quality of care of circulating ambulances. • Expedite the re-advertisement of CAD tender with the involvement of the Chief Information Officer (CIO) office. This will add a resource scheduling and management component that will also assist in fleet and staff management and efficiency. • Vehicle Tracking: expedite the evaluation of an award for a vehicle tracking solution to have the added business intelligence component that will assist with fleet management; it will also increase the life span of our fleet as it will assist in curbing vehicle abuse and improve driver behaviour. • Fleet status to procure 200 ambulances as per recapitalisation plan; only managed to procure 60 ambulances (R 44 358 400.00) leaving the Department with a shortfall of 140 (R118 289 065.60) for the 2018/2019 financial year.

An indicative budget of R 156 000 000.00 has been allocated for financial year 2019/2020 to procure ambulance fleet.

• Refurbishment of ageing vehicles still in good working condition; also ensured that SLAs are in place with the fleet management provider Transit Solutions to improve efficiencies in fleet management and turnaround time of available fleet.

Achievements realised thus far:

• We have managed to improve response times by opening EMS satellite stations closer to caller locations, which has shown some positive gains on P1 response times in the specific areas. Operations have opened new EMS satellite stations in the north of Gauteng, Mamelodi, Laudium and Soshanguve Block JJ; this has increased our footprint from 34 to 37 EMS stations.

102 Department of Health Annual Report 2018/19 Date of meeting Matters raised How matters were addressed

• We increased our Public Information Education and Awareness campaigns through our social media sites (Facebook, Instagram and Twitter) and had acknowledged many followers and hits. • Gauteng EMS has invested in high-value assets and specialised equipment, not limited to low birth ventilators and 12 lead electrocardiograms (ECGs) to improve patient treatment and patient outcomes by moving critically ill patients from district and regional hospitals to academic and specialised hospitals. • By rolling out a pilot phase of Employee Self Service platforms at Head Office and with all managers, we are improving our Human Resource management practices through automation and self-service. • We have procured specialised fleet (Physically Challenged Units: PCU) that cater for the needs of wheelchair-using and physically challenged customers and patients. • We have fully rolled out two-way radio communications (Tetra radios) in all areas of Gauteng; this has decreased the use of telephonic communications and improved operational efficiencies in communication. • Our operational ICUs have been increased to eight across the province, significantly minimising expenditure on outsourcing to private service providers and giving us a market edge over our private service counterparts through our highly skilled advanced life support paramedics and multiple patient ventilators and monitors.

(b) With regard to the proper spending and achievement of targets under EMS and Health Facilities Management:

• We have expedited the approval of invoices and transfer of funds to DID. • Tracking of invoices is done jointly with DID. • Systems relating to invoice scanning (e-invoicing) have been improved. • Appointment of maintenance project contractors is being expedited. • Approval of planning documents is being expedited. • There is continuous interaction with DID involving HODs to enable better tracking of projects and expenditure. • Consequence management will be applied to officials

Department of Health Annual Report 2018/19 103 Date of meeting Matters raised How matters were addressed

Strategies to be As part of the Finance Strategy developed by the Chief Financial implemented to ensure Officer, all deviations are now tabled with the Head of adherence with SCM Department for consideration. Where deviations are required due policies and procedures to poor planning or negligence of employees, disciplinary action when procuring goods of is taken against such employees. the value above R500 000 as required by PFMA compliance checklists have been developed to ensure Treasury Regulations compliance with applicable prescripts.

In instances where the Department does not have a contract in place, it has opted to participate in the Transversal Contract arranged by the national and provincial Treasuries in line with Treasury Regulations (TR) 16A.6.5 and participate in the contract arranged by any organ of state in line with TR 16A.6.6.

Strategies to be The Department has committed to an ironclad approach where implemented to ensure spending outside the budget will not be tolerated and pooling compliance of contractual of funds is not being carried forward. obligations and monies owed being settled within Part of the strategy includes delegations of authority to 30 days institutions, specifically around turnaround times of clearing exceptions (web cycle) on an operational basis. This improves the payment rate of 30 days. Head Office is also implementing the move to electronic submission of invoices. This will also improve record keeping.

In addition to the above, an audit Implementation plan has been developed to address other audit weaknesses identified on the operational levels. Monitoring compliance with the approach is carried out every month, including weekly reporting of clearing of web cycles by institutions.

Strategies to be Internal controls around irregular expenditure have been implemented to avoid improved to curb recurring irregular expenditure. Priorities irregular expenditures and amongst these include curbing the security contract, nursing the sourcing of proper agencies and Finance/HR/Governance support partners and approvals from Provincial consignment stock irregularities that contributed significantly to Treasury the R1.7 billion incurred irregular expenditure .

Security All security contracts of the Department are on a month-to-month basis until an alternative security arrangement in all health facilities is found.

Nursing agencies The current practice is that different institutions source their nurses for Trauma, Intensive Care and Theatre Units. This has been found to constitute a splitting of orders practice and thus irregular as all contracts above R500k must be subjected to a bidding process.

This bidding process is now being carried through a cluster approach.

104 Department of Health Annual Report 2018/19 Date of meeting Matters raised How matters were addressed

Strategies to be Consignment stock implemented to ensure The current practice is that consignment stock is not subjected to adherence with SCM the manual process of the Purchase Order, GRV and invoice policies and procedures matching. This is because cataloguing of such commodities has when procuring goods of not been performed in the past; this leads to inabilities during the the value above R500 000 audit to produce sufficient appropriate audit evidence that as required by the procurement processes were followed. Treasury Regulations During year under review, cataloguing of this commodity was performed, bringing an end to irregular expenditure in this regard.

Finance/HR/Governance support partners contracts SCM regulations allow for two instances where deviating from a process of competitive bidding: in cases of emergency and where there is a sole supplier for the goods or services being sourced.

It was the view of the Department that the current partner contracts for finance and human resources constituted sole suppliers. This view was disputed by the Auditor General and thus these contracts constituted irregular expenditure as a bidding process was not followed.

The contracts were stopped on 31 December 2018 and the Department is now following a competitive bidding process. New PFMA compliance testing will take place from February 2019 to tests and ensure compliance with the PFMA.

Plans to ensure adherence The Department is committed to complying with the provisions of the Employment Equity of the Employment Equity Act (No.55 of 1998) and the targets Act by appointing people set for the recruitment of PWDs. To date, the Department has with disabilities (PWDs) achieved remarkable growth in the number of PWDs employed.

This time last year, 0.5% of GDoH employees were PWDs. By the end of the second quarter, the number had risen to 1.61% (1071 people).

Department of Health Annual Report 2018/19 105 Date of meeting Matters raised How matters were addressed

By the end of the third quarter, the number of PWDs employed by the Department had increased by 178 (from 1071 to 1178: 1.8% of all employees). This was mainly due to the campaign of encouraging employees with disabilities who had not declared their disability status to do as well as through workshops on Policy on Reasonable Accommodation and Assistive Devices (PRAAD).

Plan to reach the set target of 2% Challenges to achieving the 2% target • Critical clinical positions are prioritised when filling vacant funded posts. No applications were received from the pool of prospective applicants with disabilities. • Some PWDs are not captured as such on the PERSAL system (incorrect capturing of PWDs) • The increase in the number of employees on the staff establishment offsets the gains achieved in recruiting PWDs.

Remedies to address the challenges: What will be done • Ringfence 2% of funded vacant posts to be filled by PWDs by line managers and CEOs as and when vacant funded posts are advertised. • Correct capturing of PWDs on the PERSAL system by HR and Transformation and OD: ongoing • Marketing of bursary opportunities for learners who are interested in Health Sciences by HRD 2 Year end. • Continue with PRAAD workshops and encourage staff who have not yet declared their disability status to do so.

Reasons for not achieving Coordination between the Department of Health and the the number of health Department of Infrastructure was not as good as it should have facilities that have been. This resulted in weaknesses in project management and undergone major and monitoring of programmes between the two Departments. minor refurbishments for There were also complications in terms of contract manage- both 2016/17FY and ment, with some service providers not adhering to contractual 2017/18FY obligations. This delayed completion of some of the work.

The Department will introduce a project steering committee tasked with coordination and management of the projects being implemented by the Department of Infrastructure Development. This should lead to better management of the signed service delivery agreement (SDA) already in place.

106 Department of Health Annual Report 2018/19 Date of meeting Matters raised How matters were addressed

Plans to remedy the In the previous financial year (2017/2018), the Department, unachieved target for the jointly with the GDED, conducted two TER change manage- percentage of budget ment workshops. The purpose was to make SCM officials and spent on township those involved in SCM processes aware of the imperatives of the enterprises against TER and the target set. identified commodities The Department will resuscitate the quarterly stakeholder workshops as a means of linking township enterprises with corporates.

The Department will also implement procurement strategies that are biased towards township enterprises, and track township procurement spends from DID through the infrastructure projects that they are implementing on behalf of the Department and spent towards township-based NGOs.

Strategies to be The Department is in the process of implementing the following: implemented to ensure • Training of PHC facility staff on medicine supply achievement of the vital management. medicines target

• Weekly monitoring of the stock visibility system: stock on hand is captured weekly by the PHC facility.

• Scheduled district PTC meetings: attendees discuss and identify alternative medication to be used if a national out of stock situation occurs.

• Borrow stock from neighboring institutions in case a stock out is an isolated case for that facility.

• Seek alternative pack sizes if appropriate (Standard Treatment Guidelines).

• Continuous engagements with suppliers with regard to direct deliveries and communication with the Medical Supplies Depot (MSD) with regard to poor performance.

Department of Health Annual Report 2018/19 107 8. Scopa Resolutions 29 January 2019

REQUEST FOR RESPONSES ON HOUSE RESOLUTIONS EMANATING FROM SCOPA REPORT ON THE AUDITOR-GENERAL’S REPORT ON THE FINANCIAL STATEMENTS AND PERFORMANCE INFORMATION OF THE DEPARTMENT OF HEALTH FOR THE YEAR ENDED 31 MARCH 2018

Resolution No. Details How matters were addressed Resolved (Yes/No)

1 In terms of Rule 179 (4), 1.1 The Department will comply with the request to provide the Accounting Officer quarterly updates to SCOPA and the Health Portfolio. submits a quarterly update to SCOPA and the Health 1.2 The Department has developed a litigation strategy (still in Portfolio Committee on intensifying performance draft form) aimed at improving the management of and consequence medico-legal claims. The strategy is based on the following six management processes to pillars: mitigate instances of findings on lawsuits and i. Prevention of harm and promotion of patient safety with the provides the Committee support of internal audit processes against a risk register with with a quarterly progress report detailing the quarterly reports. effectiveness of measures put in place to address ii. Staff-related risk management, including in areas of challenges related to Performance Agreements, absenteeism, supervision and lawsuits every quarter and disciplinary action for negligence. continuing up until June 2019. iii. Appointment of an external independent expert team on Patient Safety and a Medico-legal team.

iv. Establishing a Medico-litigation Centre as a data management and intelligence centre for patient safety, mediation coordination and litigation management.

v. Implementation and coordination of mediation and legally privileged peer review processes.

vii. e-Health system that ensures interoperability and validity of data.

1.3 The litigation system will not only enable tracking of claims but monitoring of disciplinary cases instituted because of employee negligence. and civil cases instituted by the Department to recover costs incurred because of employee negligence.

i. Cases must be thoroughly researched to examine pathogenesis to exclude non-clinical causes to avoid exorbitant costs against the Department.

108 Department of Health Annual Report 2018/19 Resolution No. Details Matters raised Resolved (Yes/No)

2 The Accounting Officer ii. There is a need for a body of legal research to inform provides the Committee investigative approaches to medical litigation with a progress report regarding the effectiveness iii. Appropriate monitoring of labour by skilled birth attendants; of measures put in place to curb the recurrence of correct and consistent use of the partogram for all patients in re-statement every quarter labour and continuing up and to the end of June 2019. iv. Where there is a potential case of cerebral palsy, investigations must to be carried out immediately after birth to determine gas levels and possible anaemic condition of the pregnant woman

v. Establishment of a partnership with the Nelson Mandela Children’s Hospital to treat children born with cerebral palsy to ensure that they receive quality health care and that research into this condition is carried on a continuous basis

1.4 The following are the long-term solutions intended to deal with incidences of medical negligence:

1.4.1 Case management team staffed by well qualified legal officers

1.4.2 Clinical review team providing medical experts’ opinions

1.4.3 Consortium of attorneys to deal with cases

1.4.4 Partnership with the Specialized Investigating Unit (SIU) focusing mainly on data analysis and physical files verification to identify possible fraudulent and duplicate claims, theft of medical records and prosecutions of these cases.

1.5 The Department has already started with consequence management in respect of employees found to have been negligent and who did not follow the Patients’ Rights Charter and guidelines for the treatment of patients. The following is the report on consequence management:

1.6 As well as the above strategies, the Office of the Premier has established a Specialized Litigation Unit (SLU) to deal with all medico-legal matters. The SLU will have the following components:

1.7 The Human Resource report indicates the number of disciplinary matters investigated by the Department as part of consequence management

Department of Health Annual Report 2018/19 109 Resolution No. Details How matters were addressed Resolved (Yes/No)

2 The Accounting Officer An audit approach is being undertaken where a full set of provides the Committee disclosures are performed monthly. Reconciliation is performed with a progress report between supporting schedules and data information and weak- regarding the effectiveness nesses are reported for corrective action to senior management of measures put in place to curb the recurrence of and the Accounting Officer. re-statement every quarter and continuing up and to Request for information letters are being sent monthly, and the end of June 2019. management orientation takes place before year-end with regard to the requirements of the audit to improve the response rate and the quality of information submitted.

Operationally, an audit implementation plan was developed and is being monitored to ensure corrections and improvement in risk areas identified by the Auditor General.

Continuous engagement is taking place during the year with both infrastructure and legal services to improve internal controls in these areas as the main contributors to the material adjustments required in 2017/2018 to maintain an unqualified audit opinion. The effectiveness and efficiency of the interventions vary. Monthly reconciliations are taking place and where needed corrections are made.

Information requests are being sent to management to test response times as well as the quality of performance evidence submitted. Currently, there are still challenges in this regard that need to be addressed. The Monitoring and Evaluation Unit is working with managers to improve the quality of evidence submitted.

The AG Action Plan developed to track managements response to the risk raised by the Auditor General was not yielding the desired results due to poor responses from management. A new approach has been adopted whereby the Executive Management Commit- tee will take direct responsibility for resolution of the identified risks.

Interventions to improve cooperation between the Department and the Department of Infrastructure Development also did not prove to be effective and efficient. New monthly project steering committee meetings will be introduced.

110 Department of Health Annual Report 2018/19 Resolution No. Details Matters raised Resolved (Yes/No)

3 The Department The Department has committed to an ironclad approach where implements proper control spending outside the budget will not be tolerated. The pooling of measures to ensure that funds approach is not being carried forward, and the following have there are no further over been agreed upon: commitments and provide the Committee with a • Over-expenditure on budget will not be tolerated. To this end, a progress report detailing linking of demand plans to institutional budgets has taken the effectiveness of those place, and Purchase Orders are not being generated outside of measures every quarter and those demand plans. This ensures ring-fencing of the continuing up and until the 2018/2019 budget. end of June 2019. • Spending takes place only on necessities with heads of institutions taking responsibility for expenditure • Consequence management for over-spending or frivolous expenses; prioritisation of essential goods being acquired • Stringently controlling COE • Infrastructure budget reallocation to fund accruals • Effective management of medico-legal claims • A moderate reduction in headcount • Review of prices paid for commodities • Reviewing large and high-risk contracts to ensure effective contract management • Negotiating with suppliers owed the most money to settle accruals over three years with ring-fenced budget allocation.

Plans to collect revenue include: • Continued engagement with universities around funding of joint posts through the Academic Governance Committee. This includes discussions around research, teaching, training and service platforms and the funding of such platforms. This is to alleviate pressure on the compensation of employees’ budget that leads to accruals as it cannibalises the goods and services budget line. • Continued engagement with provinces that owe the Department: specifically Limpopo, Mpumalanga and North West.

Part of the strategy also includes delegations of authority to institutions, specifically around turnaround times for clearing exceptions (web cycle) on an operational basis. This improves the payment rate of 30 days. Head Office is also implementing the move to electronic submission of invoices. This will improve record keeping.

As well as the above, an Audit Implementation Plan was developed to address other audit weaknesses identified on an operational level; these are being monitored every month, with weekly reporting of clearing of web cycles by institutions.

Department of Health Annual Report 2018/19 111 Resolution No. Details How matters were addressed Resolved (Yes/No)

4 The Department provides The following measures have been put in place to address the the Committee with a weaknesses of predetermined objectives: progress report detailing • Since the implementation of the WEB DHIS system, the the effectiveness of Department can track data violations through data measures put in place to address weaknesses of visualisations tools built into the system; data quality indices predetermined objectives are also being tracked monthly and feedback on violations every quarter and provided to institutions for corrections to be effected on the continuing up and until the data. end of June 2019. • Through implementation of the performance accountability sessions and establishment of service intervention units, the Department has achieved higher levels of awareness in terms of tracking data management outcomes; districts that used to have poor data quality scores have consistently and significantly improved their timely submission of data and ensuring that datasets submitted are complete. • Because of the above initiatives, the Department has seen an improvement regarding the completeness of data • Training of WEB DHIS has been continuing since the previous financial years (2017/18). This training targets different groups of personnel from data capturers to programme managers at different levels. The training for data capturers aims to achieve accuracy of data captured at source points. Training for programme managers is in line with the vision to improve information by ensuring that managers can access their programme specific data to review and to analyse data about their respective programmes. By so doing, they can intervene quickly where performance is not according to plan and help identify any potential errors in the reported data. • The next sets of training were planned for the fourth quarter with emphasis laid on building capacity to carry out rapid data quality audits at the coalface. Additional workshops were provided to clinical and administrative managers so that they understand the audit requirements including the records management process and how POE can be loaded onto SharePoint to ensure that all performance claims submitted can be supported by verifiable evidence. • It is anticipated that with the roll-out of the digitised registers following rationalisation of registers that the data quality outputs will further improve. • The Department currently captures data at selected PHC facilities and plans are afoot to increase these daily data capturing sites. • The full effectiveness of the Monitoring and Accountability Governance Framework is also anticipated to be felt once compliance with the SOP expectations becomes consistent, enabling weekly performance tracking at the coalface. With its initial implementation, we have seen monthly sharing of data quality status and managers requested to account.

112 Department of Health Annual Report 2018/19 Resolution Details How matters were addressed Resolved No. (Yes/No)

5 The Accounting Officer provides An audit approach is being undertaken where a full set of disclosures the Committee with a progress are performed monthly. Reconciliation is performed to supporting report on the measures put in schedules/information and weaknesses are reported for corrective place to ensure carrying out of action to senior management and the Accounting Officer. monthly reconciliations in compliance with Section 40 (1) of the PFMA every quarter and Request for information letters are sent monthly and management continuing up and until the end of orientation takes place before year-end with regard to the require- June 2019. ments of the audit to improve the response rate and the quality of submitted information.

Operationally, an audit implementation plan was developed and monitored to ensure corrections and improvement in risk areas identified by the Auditor General.

Continuous engagement during the year is taking place with both infrastructure and legal so that internal controls are improved in these areas as the main contributors to the material adjustments required in 2017/2018 to maintain an unqualified audit opinion.

6 The Accounting Officer ensures that An Audit Implementation Plan was developed and is being monitored transparent financial and to ensure that corrective action takes place and that risk areas identi- performance management reporting fied by the Auditor General are improved. systems are regularly maintained and provides the Committee with a progress report detailing the A new approach has been adopted whereby the Executive Manage- effectiveness of measures put in ment Committee will take direct responsibility for the resolution of place in addressing matters related identified risks. to annual financial statements within 30 days of adoption hereof, and after that every quarter continuing up and until the end of June 2019.

7 The MEC provides the The Department has developed a Combined Assurance Model that will Committee with a progress strengthen monitoring of compliance, risks and internal controls. The report on measures put in place model provides for four levels of insurance to be provided before a to monitor the adequacy of matter is resolved. The first level is by management, the second by the internal controls to avoid recurrence of non-compliance Internal Control and Risk Committee, the third by Internal Audit and with applicable legislation every Auditor General and the fourth by the Audit Committee and the quarter and continuing up and Legislature. until the end of June 2019. The Department is also in the process of developing a Compliance Strategy and Compliance Framework that will be implemented and monitored by the Compliance Unit.

Compliance checklists for PFMA compliance will be introduced as from February 2019. A new Risk Management Strategy, Policy and Frame- work has been adopted and will be implemented to strengthen risk management within the Department and to improve the internal control environment.

Department of Health Annual Report 2018/19 113 Resolution Details Matters raised Resolved No. (Yes/No)

An action plan was developed to monitor progress in respect to the findings of the Auditor General. The plan will be monitored monthly. A similar action plan is being developed to monitor the Department's response to Internal Audit findings.

Gauteng Audit Services has worked with the Department to develop a three-year audit plan aimed at testing the internal control environment. These reports will then be added to the Internal Audit Action plan and monitored.

8 In terms of GPL Rule 179(4), the Internal controls around irregular expenditure have been improved to MEC provides the Committee curb recurring irregular expenditure. Priority amongst these are curbing (SCOPA) and Portfolio of security, nursing agencies and Finance/HR/Governance support Committee on Health with a partners and consignment stock irregularities that have contributed monthly report detailing its adherence and compliance to significantly to the R1.7 billion incurred irregular expenditure. the requirements of all applicable legislation to ensure that Security effective measures are All the Department’s security contracts are on a month-to-month basis. implemented to prevent irregular This is irregular in terms of the Public Finance Management Act as this expenditure as required by practice does not constitute fairness and transparency. Section 38(1)(c)(ii) and Treasury Regulation 9.1.1. Every quarter The Department is in the process of insourcing security services; this and continuing up and until the will bring an end to irregular expenditure related to security contracts. end of June 2019. Nursing agencies Current practice is that different institutions source their nurses for Trauma, Intensive Care and Theatre Units. This has been found to constitute a splitting of orders practice and thus irregular as all contracts above R500k must be subjected to a bidding process. This bidding process is now being carried out through a cluster The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is approach. satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the Consignment stock AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to Current practice is that consignment stock is not subjected to the address control weaknesses and deviations within the Department. manual process of Purchase Order, GRV and invoice matching. This is because the cataloguing of such commodities has not been performed Audit Committee Responsibility in the past. This leads to the inability during audit to produce sufficient The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury Regulation appropriate audit evidence that procurement processes were followed. 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has During the reporting year, cataloguing of this commodity was regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. performed, bringing an end to irregular expenditure in this regard. Finance/HR/Governance support partners contracts The effectiveness of internal control and Information and Communication Technology (ICT) Governance The Audit Committee has observed that the overall control environment of the Department has regressed during the year under review. Supply Chain Management regulations allow for two instances where Significant deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The deviating from the process of competitive bidding is allowed: in cases overall opinion of Internal Audit on the internal control design at the Department is adequate but ineffective. It is recommended that of emergency and where there is a sole supplier of the goods or Management pay special attention to the core business processes as most findings raised are related to the core mandate of the Department. services being sourced. Furthermore, it was reported that significant challenges are being experienced at the operational institutions and the Department should design and implement strict measures to ensure proper oversight and monitoring over them.

114 Department of Health Annual Report 2018/19

Management should urgently address the weaknesses in the performance information, especially regarding the reporting, collation and monitoring of the achievements reported. The Audit Committee concurs with and accepts the AGSA’s conclusions on the Annual Financial Statements, performance information and compliance and is of the opinion that the audited Annual Financial Statements be accepted and read together with the report of the AGSA. The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the ICT Framework issued by the Department of Public Services and Administration. Controls regarding the ICT environment and system implementation require urgent One-on-One Meeting with the Accounting Ofcer attention as many repeat findings are raised and inefficiencies experienced. Based on the unfortunate event of the Bank of Lisbon, business The Audit Committee has met with the Accounting Officer for the Department to address unresolved issues. continuity, disaster recovery and document management remain a high risk for the Department and significant effort must be made with the implementation of proper document management systems, Disaster Recovery and Business Continuity plans. One-on-One Meetings with the Executive Authority The reporting on material irregularities by the AGSA is noted. The audit committee has emphasised the need to address the matters raised in The Audit Committee has met with the Executive Authority for the Department to apprise the MEC on the performance of the Department. particular finalisation of irregular and fruitless and wasteful expenditure investigations. The collection of debtors also remains a matter of great concern. Auditor-General of South Africa The Audit Committee advised that management should implement an overall strategy to address the findings raised by the AGSA and Internal The Audit Committee has met with the AGSA to ensure that there are no unresolved issues. Audit effectively and on time.

Internal Audit The Audit Committee is satisfied that the Internal Audit plan represents a clear alignment with the key risks, has adequate information systems coverage, and a good balance across the different categories of audits, i.e. risk-based, mandatory, performance, computer and follow-up audits. The Audit Committee has noted improvement in the communication between the Executive Management, the AGSA and the Internal Audit Ms. Janice Meissner Function, which has strengthened the Corporate Governance initiatives within the Department, however further improvement is required if proper effect is to be given to combined assurance. Chairperson of the Audit Committee

Risk Management Date: 31 July 2019 Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. The Audit Committee is satisfied that the management of risk received increased attention in the latter part of the year, although there are areas that still require improvement. Management should take full responsibility for the entire Enterprise Risk Management Process and continue to support the Chief Risk Officer to even further enhance the performance of the Department.

Forensic Investigations Investigations based on the allegations of procurement irregularities, fraud, theft and negligence are being performed on matters dating back from prior periods. Some of these investigations have been finalised and others were still in progress at the reporting date. The recommendations of investigations should be implemented with decisiveness.

The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act The Audit Committee is satisfied with the content and quality of financial and non-financial quarterly reports prepared and submitted by the Accounting Officer of the Department during the year under review and confirms that the reports were in compliance with the statutory reporting framework.

Evaluation of Reporting by the Department The Audit Committee has:

It was the view of the Department that the current partner contracts for Finance and Human Resources constituted sole suppliers. This view was disputed by the Auditor General; thus these contracts constituted irregular expenditure as a bidding process was not followed. The contracts were stopped on 31 December 2018 and the Depart- ment is now following a competitive bidding process. New PFMA compliance testing will take place from February 2019 to test and ensure compliance with the PFMA.

9 The Accounting Officer intensify The Accounting Officer is currently in the process of instituting performance and consequence disciplinary action against senior managers responsible for allowing management processes to irregular expenditure to take place. These managers have been served eliminate findings on irregular with disciplinary letters and the process is unfolding. Internal controls expenditure and provides the have around irregular expenditure have been improved to curb Committee with a progress report detailing the effectiveness recurring irregular expenditure. Priority amongst these includes curbing of measures put in place to of security, nursing agency and Finance/HR/Governance support address challenges relating to partners and consignment stock irregularities that contributed signifi- irregular expenditure every cantly to the R1.7 billion incurred in irregular expenditure. quarter and continuing up and until the end of June 2019. Security All the Department’s security contracts are on a month-to-month basis. This is irregular in terms of the Public Finance Management Act as the practice does not constitute fairness and transparency. The Department is in the process of insourcing security services which will then bring an end to irregular expenditure related to security contracts.

Nursing agencies Current practice is that different institutions source their nurses for Trauma, Intensive Care and Theatre Units. This has been concluded to constitute a splitting of orders practice and thus irregular as all The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is contracts above R500k must be subjected to a bidding process. This satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. bidding process is now being carried out through a cluster approach. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to Consignment stock address control weaknesses and deviations within the Department. Current practice is that consignment stock is not subjected to the manual process of Purchase Order, GRV and invoice matching. This is Audit Committee Responsibility because cataloguing of such commodities has not been performed in The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury Regulation the past. This leads to the inability during audit to produce sufficient 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has appropriate audit evidence that procurement processes were followed. regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. During the reporting year, cataloguing of this commodity was performed, bringing an end to irregular expenditure in this regard. The effectiveness of internal control and Information and Communication Technology (ICT) Governance The Audit Committee has observed that the overall control environment of the Department has regressed during the year under review. Finance/HR/Governance support partners contracts Significant deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The Supply Chain Management regulations allow for two instances where overall opinion of Internal Audit on the internal control design at the Department is adequate but ineffective. It is recommended that deviation from competitive bidding is allowed: in cases of emergency Management pay special attention to the core business processes as most findings raised are related to the core mandate of the Department. and where there is a sole supplier for the goods or services being Furthermore, it was reported that significant challenges are being experienced at the operational institutions and the Department should sourced. design and implement strict measures to ensure proper oversight and monitoring over them.

Department of Health Annual Report 2018/19 115

Evaluation of Reporting by the Department The Audit Committee has:

9. Prior Modications to Audit Reports

The table below shows the steps taken to address matters in the AGSA’s report for the previous financial year ending 31 March 2018.

Nature of qualification, disclaimer, The financial year in which it first Progress made in resolving the matter adverse opinion and matters of arose non-compliance

None.

10. Internal Control Unit

Internal Audit and Audit Committees The table below gives details of the Audit Committee members.

Name Qualifications Internal or If the internal, Date Date Date No. of external position in the appointed ResignedResigned Meetings The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is department attended satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the Shelmadene Petzer • Chartered Accountant (SA) External - 01 September 2018 Current AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to • Certificate in the Theory of address control weaknesses and deviations within the Department. Accountancy • Advanced Executive Audit Committee Responsibility Programme The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury Regulation Janice Meissner • Chartered Accountant (SA) External - 01 October 2014 Current 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has • B. Com regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. • B. Com. Honours • B. Compt. Honours External - 08 November 2017 Current Leon Langalibalele The effectiveness of internal control and Information and Communication Technology (ICT) Governance • B. Compt. (Accounting) The Audit Committee has observed that the overall control environment of the Department has regressed during the year under review. Japie Du Plessis • National Diploma in State External - 01 October 2013 Appointed until 31 Significant deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The August 2018 Accounting and Finance overall opinion of Internal Audit on the internal control design at the Department is adequate but ineffective. It is recommended that • B. Accounting Precious Sibiya External - 01 October 2014 Contract has expired Management pay special attention to the core business processes as most findings raised are related to the core mandate of the Department. • Post Graduate Diploma in (31 August 2018) Furthermore, it was reported that significant challenges are being experienced at the operational institutions and the Department should Accounting design and implement strict measures to ensure proper oversight and monitoring over them. • Chartered Accountant (SA)

116 Department of Health Annual Report 2018/19

Evaluation of Reporting by the Department The Audit Committee has:

Audit Committee and Attendance The Audit Committee consists of the external independent Members listed hereunder and is required to meet a minimum of twice per annum as per provisions of the Public Finance Management Act (PFMA). In terms of the approved Terms of Reference (GPG Audit Commit- tee Charter), five meetings were held during the current year, i.e. three meetings to consider the Quarterly Performance Reporting (financial and non-financial) and two meetings to review and discuss the Annual Financial Statements and the Auditor-General of South Africa’s (AGSA) Audit and Management Reports.

Non-Executive Members

Name of Member Number of Meetings attended Ms. Janice Meissner (Chairperson) 04

Mr. Leon Langalibalele 04 Ms. Shelmadene Petzer 04 Mr. Japie du Plessis (Former Chairperson) 01

Ms. Precious Sibiya (Former member 01

Executive Members In terms of the GPG Audit Committee Charter, officials listed hereunder are obliged to attend meetings of the Audit Committee:

Compulsory Attendees Number of Meetings attended Mr. Mkhululi Lukhele (Accounting Officer) 05 Ms. Kabelo Lehloenya (Chief Financial Officer) 02 Mr. Chris du Preez (Chief Risk Officer) 02 Mr. Luthendo Makhadi (Acting Chief Audit Executive) 04 Mr. Kweyama Velile (Chief Audit Executive) 01

The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to address control weaknesses and deviations within the Department.

Audit Committee Responsibility The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein.

The effectiveness of internal control and Information and Communication Technology (ICT) Governance The Audit Committee has observed that the overall control environment of the Department has regressed during the year under review. Significant deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The overall opinion of Internal Audit on the internal control design at the Department is adequate but ineffective. It is recommended that Management pay special attention to the core business processes as most findings raised are related to the core mandate of the Department. Furthermore, it was reported that significant challenges are being experienced at the operational institutions and the Department should design and implement strict measures to ensure proper oversight and monitoring over them.

Department of Health Annual Report 2018/19 117

Evaluation of Reporting by the Department The Audit Committee has:

• Reviewed and discussed the audited Annual Financial Statements to be included in the Annual Report, with the AGSA and the Accounting Officer; • Reviewed the Audit Report of the AGSA; • Reviewed the AGSA’s Management Report and Management’s response thereto; • Reviewed the Department’s compliance with legal and regulatory provisions; • Reviewed significant adjustments resulting from the audit; and • Reviewed the appropriate accounting policies and relevant disclosures. The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to address control weaknesses and deviations within the Department.

Evaluation of Reporting by the Department The Audit Committee has:

118 Department of Health Annual Report 2018/19 The Audit Committee noted that the Accounting Officer attended all five scheduled Audit Committee meetings. The Audit Committee is satisfied that the Department adhered to the provisions of the GPG Audit Committee Charter. The Members of the Audit Committee met with the Accounting Officer, Senior Management of the Department, Internal Audit and the AGSA, individually and collectively to address risks and challenges facing the Department. A number of in-committee meetings were held to address control weaknesses and deviations within the Department.

Evaluation of Reporting by the Department The Audit Committee has:

Department of Health Annual Report 2018/19 119 PART D: HUMAN RESOURCE MANAGEMENT

Department of Health Annual Report 2018/19 000 12. HR OVERSIGHT STATISTICS

1. INTRODUCTION The information contained in this part of the Annual Report has been prescribed by the Minister of Public Service and Administration for all Departments in the public service.

2.OVERVIEW OF HUMAN RESOURCES

There was a marked improvement in HR information management in the past year. The branch was able to use data to inform management decisions and monitor employees’ behaviour. Analysis of all types of leave, including sick leave, helped in understanding trends and the branch will use this information to develop tools for monitoring leave. Another area of improvement was management of Compensation o Employees (CoE) which was supported by coaches and a team effort between HR and Finance. Over-expenditure was reduced, although a downside was a shortage of staff in hospitals. The Department mitigated the effects of the CoE intervention through the Economic Stimulus Package grant which targeted clinical areas and critical posts.

Expenditure on CoE is indicative of the move to PHC and preparation for NHI. Provincial hospitals have become part of districts, whose budgets have therefore increased.

Push and pull factors have continued to exert pressure on the management of HR, with high attrition rates in nursing and other clinical posts. Exit interviews show that patient load and conflict with managers contribute to high turnover, exacerbated by the policy decision to reduce post-retirement contracts.

Over the past two years, the Department has sought to increase accountability and compliance. In doing so, the Department has experienced an increase in the number of labour cases, disputes, grievances and of cases reported through Chapter 9 Institutions. Whilst this was positive, it increased Labour Relations’ workload. This has required the development of a cadre of internal and external presiding officers to improve turnaround times in all labour-related matters.

Department of Health Annual Report 2018/19 121 3. HUMAN RESOURCES OVERSIGHT STATISTICS

The tables below give HR patterns for the financial year 2018/19 Table 3.1.1: Personnel expenditure by programme: 1 April 2018 to 31 March 2019

Total Personnel Training Professional Personnel Average Employment Expenditure Expenditure Expenditure and Special Cost as Personnel (R'000) (R'000) (R'000) Services (R'000) Percent of Total Cost per Programme Expenditure Employee (R'000)

1. Administration 1,360,786 410,609 6,864 92,546 30% 323 1,273

2. District health services 14,516,480 7,762,182 4,327 45,897 53.5% 416 18,656

3. Emergency medical services 1,330,508 552,681 80 - 41.5% 302 1,832

4. Provincial hospital services 8,686,653 6,244,387 850 279,379 71.9% 295 21,132

5. Central hospital services 17,134,256 10,956,631 555 35,523 63.9% 592 18,522

6. Health sciences and training 1,106,708 762,053 11,019 - 68.9% 207 3,680

7. Health care support services 339,048 182,145 31 - 53.7% 261 698

8. Health facilities management 1,536,120 31,610 46 - 2.1% 1,129 28

- HWSETA accounts - - - - * *

MedSAS trading account - - - - * *

Total 46,010,559 26,902,298 23,772 453,345 58.5% 409 65,821

122 Department of Health Annual Report 2018/19 Table 3.1.2 Personnel costs by Salary Band: 1 April 2018 - 31 March 2019

Personnel % of Total % of Total % of Total Expenditure Personnel Personnel Personnel Salary Band (R'000) Costs Costs Costs

Lower Skilled (Levels 1 - 2) 1,313,779 4.8% 7,527 175

Skilled (Levels 3 - 5) 5,793,492 21.3% 23,365 248

Highly Skilled Production (Levels 6 - 8) 6,002,451 22.1% 16,050 374

Highly Skilled Supervision (Levels 9 - 12) 10,539,566 38.8% 12,551 840

Senior and Top Management (Levels 13 - 16) 204,049 0.8% 91 2,242

Contract (Levels 1 - 2) 95 0.0% 667 0

Contract (Levels 3 -5) 21,571 0.1% 87 248

Contract (Levels 6 - 8) 197,368 0.7% 543 363

Contract (Levels 9 - 12) 2,694,137 9.9% 2,970 907

Contract (Levels 13 - 16) 18,880 0.1% 14 1,349

Periodical Remuneration 298,734 1.1% 921 324

Abnormal Appointment 53,908 0.2% 1,035 52

Total 27,138,029 100.0% 65,821 -

Department of Health Annual Report 2018/19 123 Table 3.1.3: Salaries, Overtime, Home Owners’ Allowance and Medical aid by programme: 1 April 2018 to 31 March 2019

Salaries Salaries as % Overtime Overtime as % HOA HOA as % of Medical Ass. Medical Ass. as Total Programme (R'000) of Personnel (R'000) of Personnel (R'000) Personnel Costs (R'000 % of Personnel Personnel Cost Costs Costs Costs (R'000

Administration 382,688 1.4% 4,425 0.0% 8,404 0.0% 0.1% 15,092 410,609

District health services 6,802,656 25.3% 368,226 1.4% 232,666 0.9% 1.3% 358,633 7,762,181

Emergency medical services 476,076 1.8% 8,900 0.0% 24,254 0.1% 0.2% 43,451 552,681

Provincial hospital services 5,236,782 19.5% 562,471 2.1% 179,659 0.7% 1.0% 265,475 6,244,387

Central hospital services 9,104,579 33.8% 1,182,107 4.4% 278,684 1.0% 1.5% 391,260 10,956,630

Health sciences and training 707,634 2.6% 1,505 0.0% 22,193 0.1% 0.1% 30,722 762,054

Health care support services 136,466 0.5% 14,853 0.1% 12,015 0.0% 0.1% 18,812 182,146

Health facilities management 30,767 0.1% - 0.0% 295 0.0% 0.0% 548 31,610

HWSETA accounts -

Total 22,877,648 85.0% 2,142,487 8.0% 758,170 2.8% 4.2% 1,123,993 26,902,298

Department of Health Annual Report 2018/19 124 Table 3.1.4: Salaries, Overtime, Home Owners’ Allowance, and Medical aid by Salary Band: 1 April 2018 to 31 March 2019

Salaries Overtime Home Owners Allowance Medical Aid

Salaries as a Overtime as a Amount HOA as a % Amount Amount Medical aid % of % of (R'000) of Personnel Salaries (R'000) (R'000) as a % of Personnel Personnel Costs Programme (R'000) Personnel Costs Costs Costs

Lower Skilled (Levels 1-2) 2,307,123,594 11.3% 156,188,453 7.3% 158,538,064 20.0% 211,140,401 18.8%

Skilled (Levels 3-5) 4,257,427,901 20.8% 194,402,743 9.1% 306,625,678 38.8% 393,323,200 35.0%

Highly Skilled Production (Levels 6-8) 4,499,891,382 22.0% 133,699,851 6.3% 210,284,319 26.6% 315,069,506 28.0%

Highly Skilled Supervision (Levels 9-12) 9,305,777,826 45.5% 1,648,585,861 77.1% 114,863,506 14.5% 203,977,190 18.1%

Senior and Top Management (Levels 13-16) 102,937,697 0.5% 5,824,462 0.3% 839,907 0.1% 1,565,097 0.1%

Total 20,473,158,399 100.0% 2,138,701,370 100.0% 791,151,475 100.0% 1,125,075,394 100.0%

Department of Health Annual Report 2018/19 125 Table 3.2.1: Employment and Vacancies by Programme as at 31 March 2019

Number Number of Vacancy Number of Posts Filled Additional Programme of Posts on Posts Filled Rate Approved to the Establishment Establishment

1. Health administration 1,486 1,022 31.2% 31

2. District health services 20,587 18,411 10.6% 866

3. Emergency medical services 2,095 1,833 12.5% 1

4. Provincial health service 22,476 20,745 7.7% 1,216

5. Academic health services 20,509 18,336 10.6% 664

6. Health sciences 4,266 2,889 32.3% -

7. Health care support services 788 698 11.4% -

8. Health facility management 37 28 24.3% 7

Total 72,244 63,962 11.5% 2,785

Table 3.2.2: Employment and Vacancies by Salary Band as at 31 March 2019

Number Number of Vacancy Number of of Posts on Posts Filled Rate Posts Filled Salary Band Description Approved Additional Establishment to the Establishment

1. Lower skilled (Levels 1 - 2) 7,524 7,524 8.4% 5

2. Skilled (Levels 3 - 5) 23,450 23,450 15.2% 183

3. High skilled production (Levels 6 - 8) 16,651 16,641 11.3% 1,087

4. Highly skilled supervision (Levels 9 - 12) 15,674 15,575 13.8% 1,508

5. Senior management (Levels 13 - 16) 105 105 46.7% 2

Total 63,404 63,295 13.1% 2,785

126 Department of Health Annual Report 2018/19 Table 3.2.3 Employment and Vacancies by Critical Occupation as at 31 March 2019

Programme Number Number of Vacancy Number of of Posts on Posts Filled Rate Employees Approved Additional to Establishment the Establishment

Dental practitioner 257 218 14.4% 20

Dental specialist 153 115 20.9%

Medical practitioner 2,514 2,122 25.6% 241

Medical practitioner (intern) 1,198 968 16.2% 917

Medical specialist 2,604 2,327 10.9% 2

Emergency care practitioner 1,984 1,733 13.0%

Pharmacist 549 498 12.4% 83

Pharmacist (intern) 71 58 12.7% 62

Professional nurse 16,198 14,893 9.5% 864

Staff nurse 7,957 7,408 4.4% 23

Nursing assistant 6,962 6,404 4.6% 19

Professional nurse (student) 3,524 2,432 36.6% 7

Total 43,971 39,176 11.4% 2,238

Table 3.3.1 SMS Post information as at 31 March 2019

Total Total Number Total % of SMS % of SMS Number of Funded Number of posts Filled posts Salary Band Description of SMS SMS posts SMS posts Vacant posts Filled Vacant

Director-General/Head of Department 1 1 100% 0 0.0%

Salary Level 16 1 1 100% 0 0.0%

Salary Level 15 8 6 75% 2 25.0%

Salary Level 14 41 25 61% 16 39.0%

Salary Level 13 103 72 70% 31 30.1%

Total 154 105 49 31.8%

Department of Health Annual Report 2018/19 127 Table 3.3.2 SMS Post information as at 30 September 2018

Total Number of Total % of SMS posts Total % of SMS Funded Number of Filled Number posts SMS Level of SMS Vacant SMS posts SMS posts posts Filled Vacant

Director-General/Head of Department 1 1 100% 0.0%

Salary Level 16 1 1 100% 0.0%

Salary Level 15 8 6 75% 3 37.5%

Salary Level 14 41 25 61% 16 39.0%

Salary Level 13 103 74 70% 28 27.2%

Total 154 107 47 30.5%

Table 3.3.3 Advertising and Filling of SMS Posts 1 April 2018 to 31 March 2019

Total Total Total % of Total % of SMS Number of number of Number of SMS Number of Vacant SMS Level Funded posts SMS Vacant Funded SMS posts SMS posts Filled Funded posts SMS posts filled Advertised posts

Director-General/Head of Department 1 1 0 100% 2 0.0%

Salary Level 16 1 1 0 100% 16 0.0%

Salary Level 15 8 6 3 75% 31 25.0%

Salary Level 14 41 25 10 61% 49 39.0%

Salary Level 13 103 72 14 70% 30.1%

Total 154 105 27 31.8%

Table 3.3.4 Reasons for not having complied with the lling of funded vacant SMS posts Advertised within 6 months and lled within 12 months after becoming vacant: 1 April 2018 to 31 March 2019

Reasons for vacancies not advertised within six months

Budget constraints

Reasons for vacancies not filled within twelve months

Unavailability of senior managers to conduct the shortlisting and interviews Cancellation of scheduled Recruitment processes due to the Executive Management's urgent meetings

Table 3.3.5 Disciplinary steps taken for not complying with the prescribed timeframes for lling SMS posts within 12 months

the prescribed timeframes for filling SMS posts within 12 months

PostsReasons were for advertised vacancies notand advertised documents within were sixcaught months in the re at the Bank of Lisbon building. An erratum advertisement was placed in national newspapers and attracted one candidate.

Reasons for vacancies not filled within six months

As above

128 Department of Health Annual Report 2018/19 Table 3.4.1 Job Evaluation by Salary Band: 1 April 2018 to 31 March 2019

Posts Upgraded Posts Downgraded

Posts on Number of Jobs % of Jobs Number % of Posts Number % of Posts Salary Band Establishment Evaluated Evaluated Evaluated Evaluated

Lower skilled (Levels 1-2) 7,626 0 0 0 0 0 0

Skilled (Levels 3-5) 25,057

Highly skilled production (Levels 6-8) 14,731 0 0 0 0 0 0

Highly skilled supervision (Levels 9-12) 12,116 1 0,01 0 0 0 0

Senior management Band A 68 0 0 0 0

Senior management Band B 19 0 0 0 0 0

Senior management Band C 2 0 0 0 0 0

Senior management Band D 2 0 0 0 0 0

Contract (Levels 1-2) 2 0 0 0 0 0

Contract (Levels 3-5) 751 0 0 0 0 0 0

Contract (Levels 6-8) 580 0 0 0 0

Contract (Levels 9-12) 2,994 0 0 0 0 0 0

Contract Band A 4 0 0 0 0 0 0

Contract Band B 6 0 0 0 0 0

Contract Band C 4 0 0 0 0 0

Contract Band D 0 0 0 0 0 0 0

Total 63,962 0 0,01 0 0 0 0

Notes: Some Health lower level posts are currently being co-ordinated by the DPSA and we are awaiting the results. DPSA has also facilitated the job evaluation benchmark exercise for all Middle Managament, Supply Chain, Finance, and Risk management posts

Department of Health Annual Report 2018/19 129 Table 3.4.2 Pro le of employees whose positions were upgraded due to their posts being upgraded: 1 April 2018 to 31 March 2019

Gender African Asian Coloured White Total

Female 0 0 0 0 0

Male 0 0 0 0 0

Total 0 0 0 0 -

Employees with Disability - - - - -

Table 3.4.3 Employees with salary levels higher than those determined by job evaluation by occupation: 1 April 2018 to 31 March 2019

Occupation Number of Job Evaluation Remuneration Reasons for Employe Level Level Deviation

0 0 0 0

Percentage of Total Employed 0

Table 3.4.4 pro le of employees whose salary levels are higher than those determined by Job evaluation: 1 April 2018 to 31 March 2019 Total Gender African Asian Coloured White 0 Female 0 0 0 0 0 Male 0 0 0 0 0 Total 0 0 0 0 - Employees with Disability - - - -

Notes: Total number of employees whose salaries exceeded the level determined by job evaluation is ZERO

Table 3.5.1 Annual turnover rates by salary band: 1 April 2018 to 31 March 2019

Number of Appointments Vacancy Turnover Employees and Transfers Rate Programme Rate at Beginning of Period Into the (1 April 2018) Department

1. Lower skilled (Levels 1 - 2) 9,574 1,168 1,166 12.2%

2. Skilled (Levels 3 - 5) 25,188 437 906 3.6%

3. Highly skilled production (Levels 6 - 8) 15,952 269 1,113 7.0%

4. Highly skilled supervision (Levels 9 - 12) 12,580 635 1,045 8.3%

5. Senior management service Band A 73 1 7 9.6%

5. Senior management service Band B 20 - 2 10.0%

5. Senior management service Band C 2 - - 0.0%

5. Senior management service Band D 1 2,514 - 0.0%

6. Contracts 4,503 5,024 2,807 62.3%

Total 67,893 7,046 10.4%

130 Department of Health Annual Report 2018/19 Table 3.5.2 Annual turnover rates by critical occupation: 1 April 2018 to 31 March 2019

Number of Employees Appointments Terminations Turnover Rate and Transfers and Transfers Critical Occupation at Beginning of Period (1 April 2018) Into the Out of the Department Department

Dental practitioner 304 49 37 12.2%

Dental specialist 178 10 28 15.7%

Medical practitioner 2,578 1,158 1,153 44.7%

Medical practitioner (intern) 919 513 491 53.4%

Medical specialist 2,518 413 514 20.4%

Emergency care practitioner 1,668 110 38 2.3%

Pharmacists 557 144 183 32.9%

Pharmacists (intern) 60 59 63 -

Professional nurse 14,958 580 1,503 10.0%

Staff nurse 7,707 138 215 2.8%

Nursing assistant 6,526 107 166 2.5%

Professional nurse (student) 3,109 8 118 3.8%

Total 41,082 3,289 4,509 11.0%

Table 3.5.3 Reasons why staff left the Department: 1 April 2018 to 31 March 2019

% of Total Termination Type Number Resignations

1. Death 259 3.7%

2. Resignation 2,035 28.9%

3. Expiry of contract 3,556 50.5%

4. Dismissal: operational changes 1 0.0%

5. Dismissal: misconduct 100 1.4%

6. Dismissal: inefficiency 0.0%

7. Discharged due to ill-health 49 0.7%

8. Retirement 1,045 14.8%

9. Transfer to other public service Departments 1 0.0%

10. Other - 0.0%

Total 7,046 100.0%

Total number of employees who left as a % of total employment: 10.4%

Department of Health Annual Report 2018/19 131 Table 3.5.4 Promotions by critical occupation: 1 April 2018 to 31 March 2019

Salary Level Progression Notch Number of Promotions to Promotions as to another Progression as Employees another Salary a % of Notch within a % of Occupational Class (1 April 2018) Level Employees a Salary Level Employees by Occupation

Dental Practitioner 374 2 0.53% 17 4.55%

Dental Specialist 124 3 2.42% 5 4.03%

Medical Practitioner 3,754 24 0.64% 81 2.16%

Medical Practitioner (Intern) 947 0 0.00% 1 0.11%

Medical Specialist 1,321 11 0.83% 72 5.45%

Emergency Care Practitioner 1,669 3 0.18% 46 2.76%

Pharmacist 528 2 0.38% 42 7.95%

Pharmacist (Intern) 90 0 0.00% 0 0.00%

Professional Nurse 15,116 90 0.60% 445 2.94%

Staff Nurse 7,728 20 0.26% 467 6.04%

Nursing Assistant 6,539 16 0.24% 228 3.49%

Professional Nurse (Student) 3,120 0 0.00% 0 0.00%

Total 41,310 171 - 1,404 -

Table 3.5.5 Promotions by salary band: 1 April 2018 to 31 March 2019

Number of Number of Promotions to Progression to Notch Progression as a Employees Employees another Salary another Notch Salary Band % of Employees (1 April 2018) (1 April 2018) Level within a Salary by Occupation Level 1. Lower Skilled (Levels 1 - 2) 7,524 35 0.47% 12 0.16%

2. Skilled (Levels 3 - 5) 25,329 51 0.20% 7 0.03%

3. Highly Skilled Production (Levels 6 - 8) 16,701 64 0.38% 13 0.08%

4. Highly Skilled Supervision (Levels 9 - 12) 15,727 117 0.74% 3 0.02%

5. Senior Management (Levels 13 - 16) 114 0 0.00% 0 0.00%

Total 65,395 267 - 35 -

132 Department of Health Annual Report 2018/19 Table 3.6.1 Total number of employees (including employees with disabilities) in occupational categories as at 31 March 2019

Male Female

African Coloured Indian Total White African Coloured Indian Total White Total Occupational Category Black Black

1. Legislators, senior officials and managers 65 3 3 71 6 60 3 6 69 4 150

2. Professionals 1,774 67 420 2,261 796 1,945 84 500 2,529 993 6,579

3. Technicians and associate professionals 2,614 39 57 2,710 139 17,162 471 364 17,997 1,006 21,852

4. Clerks 2,404 47 16 2,467 55 5,472 90 14 5,576 262 8,360

5. Service workers and shop and market sales workers 2,639 20 15 2,674 51 14,363 107 17 14,487 136 17,348

7. Craft and related trades workers 0 0 0 0 0 0 0 0 0 2 2

8. Plant and machine operators and assemblers 382 8 1 391 7 32 - - 32 430

9. Elementary occupations 3,828 52 6 3,886 64 6,942 134 1 7,077 73 11,100

Total 13,706 236 518 14,460 1,118 45,976 889 902 47,767 2,476 65,821

Employees with Disabilities 268 11 4 283 35 682 34 7 723 79 1,120

Department of Health Annual Report 2018/19 133 Table 3.6.2 Total number of employees (including employees with disabilities) in occupational bands as at 31 March 2019

Male Female

African Coloured Indian Total White African Coloured Indian Total White Total Occupational Bands Black Black

1.Top management 2 - - 2 - 5 - - 5 - 7

2. Senior management 44 3 2 49 6 35 2 2 39 4 98

3. Professionally qualified and experienced specialists and 2,598 89 412 3,099 730 9,267 318 660 10,245 1,447 15,521 mid-management 31

4. Skilled technical and academically qualified workers, junior 2,584 37 2,652 129 12,637 274 172 13,083 72 16,593 management, supervisors 13 9

5. Semi-skilled and discretionary decision making 5,350 68 5,431 69 17,590 189 21 17,800 152 23,452

6. Unskilled and defined decision-making 3,128 39 60 3,227 184 6,442 106 47 6,595 144 10,150

Total 13,706 236 518 14,460 1,118 45,976 889 902 47,767 2,476 65,821

Employees with Disabilities 268 11 4 283 35 682 34 7 723 79 1,120

Department of Health Annual Report 2018/19 134 Table 3.6.3 Recruitment: 1 April 2018 to 31 March 2019

Male Female

African Coloured Indian White African Coloured Indian White Total Occupational Bands

1.Top management 1 ------1

2. Senior management 1 - - - 1 - - - 2

3. Professionally qualified and experienced specialists and 414 28 93 230 865 135 188 406 2,259 mid-management 523 20

4. Skilled technical and academically qualified workers, junior 101 3 3 18 56 196 920 management, supervisors 468 5

5. Semi-skilled and discretionary decision making 184 4 2 2 2 4 671

6. Unskilled and defined decision-making 356 5 21 34 701 12 12 30 1,171

Total 1,057 40 119 284 2,558 72 258 636 5,024

Employees with Disabilities 1 - - 1 2 - - - 4

Department of Health Annual Report 2018/19 135 Table 3.6.4 Promotions: 1 April 2018 to 31 March 2019

Male Female

African Coloured Indian Total White African Coloured Indian Total White Total Salary Band Black Black

1.Top management - - - 0 - 1 - - 1 - 1

2. Senior management 1 - - 1 - - - - 0 - 1

3. Professionally qualified and experienced specialists and 102 3 23 128 23 369 18 31 418 42 611 mid-management 6

4. Skilled technical and academically qualified workers, junior 77 1 3 81 3 764 12 782 11 877 management, supervisors, foreman and superintendents -

5. Semi-skilled and discretionary decision making 73 - - 73 286 - 286 1 360

6. Unskilled and defined decision-making 2 - - 2 26 1 - - 1 3

Total 255 4 26 285 1 1,421 30 37 1,488 54 1,853

Employees with Disabilities 1 - - 1 1 3 - - 3 - 9

Department of Health Annual Report 2018/19 136 Table 3.6.5 Terminations: 1 April 2018 to 31 March 2019

Male Female

African Coloured Indian Total White African Coloured Indian Total White Total Salary Band Black Black

1.Top management 1 - - 1 - 5 - - 0 - 1

2. Senior management 4 1 - 5 2 1,190 - - 5 2 14

3. Professionally qualified and experienced specialists and 492 29 106 627 235 1,188 72 198 1,460 482 2,804 mid-management

4. Skilled technical and academically qualified workers, junior 261 5 6 272 18 806 49 67 1,304 282 1,876 management, supervisors, foreman and superintendents

5. Semi-skilled and discretionary decision making 292 9 4 305 9 624 21 1 828 15 1,157

6. Unskilled and defined decision-making 411 5 26 442 49 3,813 18 24 666 37 1,194

Total 1,461 49 142 1,652 313 58 160 290 4,263 818 7,046

Employees with Disabilities 10 - - 10 4 - 3 - 61 8 154

Table 3.6.6 Disciplinary action: 1 April 2018 to 31 March 2019

Male Female

African Coloured Indian White African Coloured Indian White Total Disciplinary action

Disciplinary action 437 4 2 12 457 5 1 12 930

Department of Health Annual Report 2018/19 137 Table 3.6.7 Skills development: 1 April 2018 to 31 March 2019

Male Female

African Coloured Indian Total White African Coloured Indian Total White Total Occupational Category Black Black

1. Legislators, senior officials and managers 9 1 0 10 0 6 0 0 6 0 16

2. Professionals 914 47 65 1,026 11 2,446 81 37 2,564 23 3,624

3. Technicians and associate professionals 1,606 449 206 2,261 61 2,751 692 121 3,564 37 5,923

4. Clerks 1,510 311 72 1,893 49 2,664 299 69 3,032 31 4,005

5. Service workers and shop and market sales workers 201 12 4 217 1 701 4 3 708 2 928

7. Craft and related trades workers 3 0 0 3 0 1 0 0 1 0 4

8. Plant and machine operators and assemblers 1 1 0 2 0 11 0 0 11 0 13

9. Elementary occupations 661 53 14 728 12 1,713 114 12 1,839 19 2,598

Total 4,905 874 361 6,140 134 10,293 1,190 242 11,725 112 17,111

Employees with Disabilities ------

Legend

• Legislators, Senior Officials and Managers Officials responsible for determining and formulating policy and strategy, planning, directing and coordinating the policies and activities of the organisation; for example: CEOs, Senior Managers, College Principals

• Technicians and Associate Professionals This group includes occupations whose main tasks require technical knowledge and experience such as Clinical Technologists, Industrial Technicians, Environmental Health Officers, Professional Nurses

• Clerks This group includes occupations whose tasks require the knowledge and experience necessary to organise, store, compute and retrieve information such as Accounting Clerks, Stores Officers, Administration Clerks

This group includes occupations whose main tasks require the knowledge and experience necessary to provide personal and protective services such as • Service Workers and Shop and Market Sales Workers auxiliary services officers (ward attendants), Emergency Care practitioners, firefighters, food services aides

This group includes occupations whose main tasks require the knowledge and experience of skilled trades and handicrafts such as clinical photographers, • Craft and Related Trades Workers plumbers and electricians

• Plant and Machine Operators and Assemblers The main tasks of this occupational grouping involve the use of automated industrial machinery and equipment such as drivers and tradesmen’s aides

Department of Health Annual Report 2018/19 138 Table 3.7.1 Signing of Performance Agreements by SMS members as on 31 May 2019

Total Total Number Total Number Signed Reason for not Number of of SMS of signed Performance having Funded SMS members Performance Agreements as concluded posts Agreements % of Total Performance Number of Agreements SMS Level SMS members

Director-General/Head of Department: Salary

Level 16 2 1 1 100% N/A

Salary Level 15 8 6 6 100% N/A

Salary Level 14 41 25 25 100% N/A

Salary Level 13 103 74 74 100% N/A

Total 154 106 106 100% N/A

Table 3.7.2 Reasons for not having concluded Performance Agreements for all SMS members as on 31 March 2019

Director-General/Head of Department: Salary

Level 16 2 1 1 100% N/A

Salary Level 15 8 6 6 100% N/A

Salary Level 14 41 25 25 100% N/A

Salary Level 13 103 74 74 100% N/A

Total 154 106 106 100% N/A

Table 3.7.3 Disciplinary steps taken against SMS members for not having concluded Performance Agreements

Reason

None

Table 3.8.1 Performance rewards by race and gender: nancial year 2017/2018

Demographics Number of Total Total Number Cost (R'000) Average Cost Beneficiaries Employment of Funded per SMS posts Beneficiary (R)

African, Female 34,793 44,921 77.50 7253,000,632 7,272

African, Male 9,703 13,191 73.60 70,761,206 7,293

Asian, Female 377 861 43.80 2,786,326 7,391

Asian, Male 189 459 41.20 1,377,232 7,287

Coloured, Female 615 879 70.00 4,492,594 7,305

Coloured, Male 141 226 62.40 1,035,879 7,347

White, Female 1,253 2,380 52.60 9,341,676 7,455

White, Male 387 941 41.10 2,827,891 7,307

TOTAL 47,458 63,858 345,623,436 7,283

Department of Health Annual Report 2018/19 139 Table 3.8.2 Performance rewards by salary band for personnel below SMS: nancial year 2017/2018

Number of Total Percentage of Cost (R'000) Average Cost Employment Total per Salary Band Beneficiaries Employment Beneficiary

Lower skilled (Levels 1-2) 6,535 7,485 87.3% 47,572,694 7,280

Skilled (Levels 3-5) 18,633 24,154 77.1% 135,560,060 7,275

Highly skilled production (Levels 6-8) 12,758 16,676 76.5% 92,876,364 7,280

Highly skilled supervision (Levels 9-12) 9,532 15,650 60.9% 69,589,654 7,301

Periodical remuneration - - 0.0% - 0

Abnormal appointment - - 0.0% - 0

Total 47,458 63,965 - 345,598,772 7,282

Table 3.8.3 Performance rewards by critical occupation: Financial Year 2017/2018

Number of Total Percentage of Cost (R'000) Average Cost Employment Total per Salary Band Beneficiaries Employment Beneficiary

Dental practitioners 141 216 65.3% 1,021,919 7,248

Dental specialists 36 67 53.7% 262994 7,305

Emergency services related 1162 1645 70.6% 8398764 7,228

Medical practitioners 666 1790 37.2% 4,839,448 7,266

Medical specialists 552 1116 49.5% 4,095,874 7,420

Nursing assistants 5402 6647 81.3% 39,132,354 7,244

Pharmacists 261 350 74.6% 1,942,311 7,442

Professional nurse 11624 14561 79.8% 84,431,481 7,264

Staff nurses and pupil nurses 6293 7600 82.8% 45,597,688 7,246

Total 26,137 33,992 - 189,722,833 7,259

Table 3.8.4 Performance related rewards (Cash Bonus) by salary band for SMS: Financial year 2017/2018

Beneficiary Profile Cost Total Cost Total Cost as a % of Salary Band Number of Number of % of Total Average Cost Beneficiaries Beneficiaries within Salary (R'000) per the Total Personnel Employee Expenditure Band A Nil 2 0.0% 0 0 0

Band B Nil 8 0.0% 0 0 0

Band C Nil 41 0.0% 0 0 0

Band D Nil 103 0.0% 0 0 0

Total Nil 154 _ 0 0 0

140 Department of Health Annual Report 2018/19 Table 3.9.1 Foreign workers by salary band: 1 April 2018 to 31 March 2019

01-Apr-18 31-Mar-19 Change

Salary Band Number % of Total Number % of Total Number % of Total

Lower skilled 57 5.2% 60 6.3% 3 -2.0%

Highly skilled (Levels 6-8) 84 7.6% 67 7.0% -17 11.6%

Highly skilled supervision (Levels 9-12) 701 63.4% 651 67.9% -50 34.0%

Contract (Levels 9-12) 264 23.9% 181 18.9% -83 56.5%

Contract (Levels 13-16) 0.0% 0 0.0% 0 0.0%

Total 1,106 - 959 - -147 -

Table 3.9.2 Foreign workers by major occupation: 1 April 2018 to 31 March 2019

01-Apr-18 31-Mar-19 Change

Salary Band Number % of Total Number % of Total Number % of Total

Administrative office workers 8 1.0% 7 0.9% -1 1.6%

Elementary occupations 6 0.7% 6 0.8% 0 0.0%

Information technology personnel 0 0.0% - 0.0% 0 0.0%

Professionals and managers 653 78.3% 615 79.9% -38 59.4%

Social natural technical and medical sciences + supp 1 0.1% 1 0.1% 0 0.0%

Technicians and associated professionals 166 19.9% 141 18.3% -25 39.1%

Total 834 - 770 - -64 -

Department of Health Annual Report 2018/19 141 Table 3.10.1 Sick Leave: 01 April 2018 to 31 March 2019

Total Days % Days with Number of % of Total Average Estimated Total Total Medical Employees Employees Days per Cost (R'000) Number of Number of Salary Band Certification using Sick using Sick Employee Employees Employees Leave Leave using Sick using Sick Leave Leave

Contract (Levels 13-16) 40.00 90.00 7.00 0.00 6.00 163.00 48,536.00 36.00

Contract (Levels 3-5) 189.00 72.50 47.00 0.10 4.00 147.00 48,536.00 137.00

Contract (Levels 6-8) 3,064.00 73.10 564.00 1.20 5.00 3,618.00 48,536.00 2,241.00

Contract (Levels 9-12) 6,358.00 73.00 1,378.00 2.80 5.00 15,190.00 48,536.00 4,644.00

Contract Other 612.00 90.40 223.00 0.50 3.00 208.00 48,536.00 553.00

Highly skilled production (Levels 6-8) 88,404.00 83.50 12,973.00 26.70 7.00 110,729.00 48,536.00 73,848.00

Highly skilled supervision (Levels 9-12) 63,812.00 83.20 9,122.00 18.80 7.00 163,812.00 48,536.00 53,117.00

Lower skilled (Levels 1-2) 39,919.00 88.10 5,657.00 11.70 7.00 20,627.00 48,536.00 35,172.00

Other 8.00 100.00 2.00 0.00 4.00 10.00 48,536.00 8.00

Senior management (Levels 13-16) 420.00 82.90 67.00 0.10 6.00 1,681.00 48,536.00 348.00

Skilled (Levels 3-5) 122,146.00 84.00 18,496.00 38.10 7.00 94,365.00 48,536.00 102,644.00

TOTAL 324,972.00 - 48,536.00 - 7.00 410,549.00 48,536.00 272,748.00

Department of Health Annual Report 2018/19 142 Table 3.10.2 - Disability Leave (Temporary and Permanent personnel): January 2018 to December 2018

Contract (Levels 6-8) 125.00 100.00 6.00 0.20 21.00 141.00 125.00 3,599.00

Contract (Levels 9-12) 354.00 100.00 12.00 0.30 30.00 795.00 354.00 3,599.00

Highly skilled production (Levels 6-8) 19,894.00 100.00 1,086.00 30.20 18.00 25,230.00 19,894.00 3,599.00

Highly skilled supervision (Levels 9-12) 15,444.00 99.80 757.00 21.00 20.00 38,340.00 15,418.00 3,599.00

Lower skilled (Levels 1-2) 6,940.00 100.00 445.00 12.40 16.00 3,668.00 6,940.00 3,599.00

Senior management (Levels 13-16) 5.00 100.00 1.00 0.00 5.00 18.00 5.00 3,599.00

Skilled (Levels 3-5) 25,318.00 100.00 1,292.00 35.90 20.00 19,527.00 25,312.00 3,599.00

TOTAL 68,080.00 100.00 3,599.00 100.00 19.00 87,719.00 68,048.00 3,599.00

Table 3.10.3 Annual Leave: 01 April 2018 to 31 March 2019

Average Number of Total Days Salary Band Days per Employees who Taken Employee took leave

Contract (Levels 13-16) 1250.00 15.00 17.00

Contract (Levels 3-5) 923.00 10.00 90.00

Contract (Levels 6-8) 11,744.92 17.00 690.00

Contract (Levels 9-12) 48,115.76 16.00 3,052.00

Contract Other 2,301.00 8.00 275.00

Highly skilled production (Levels 6-8) 388,264.43 23.00 16,735.00

Highly skilled supervision (Levels 9-12) 305,932.28 24.00 12,835.00

Lower skilled (Levels 1-2) 163,583.87 22.00 7,493.00

Senior management (Levels 13-16) 2,081.00 22.00 95.00

Skilled (Levels 3-5) 559,511.64 23.00 24,842.00

Other 68.00 23.00 3.00

TOTAL 1,482,775.90 22.00 66,127.00

Department of Health Annual Report 2018/19 143 Table 3.10.4 - Capped Leave: 01 April 2018 to 31 March 2019

Total days of Average Average capped Number of Total number Number of Salary Band capped number of leave per Employees who of capped Employees as at leave taken days taken employee as at took Capped leave available end of period per employee end of period leave at end of

Contract (Levels 1-2) 0.00 0.00 0.00 0.00 0.00 0.00

Contract (Levels 13-16) 0.00 0.00 32.00 0.00 32.14 1.00

Contract (Levels 3-5) 0.00 0.00 0.00 0.00 0.00 0.00

Contract (Levels 6-8) 0.00 0.00 0.00 0.00 0.00 0.00

Contract (Levels 9-12) 0.00 0.00 0.00 0.00 0.00 0.00

Contract Other 0.00 0.00 0.00 0.00 0.00 0.00

Highly skilled production (Levels 6-8) 590.43 4.00 30.00 165.00 97,480.99 3,286.00

Highly skilled supervision (Levels 9-12) 741.30 5.00 33.00 154.00 100,496.40 3,053.00

Lower skilled (Levels 1-2) 5.00 5.00 22.00 1.00 770.27 35.00

Senior management (Levels 13-16) 15.00 15.00 63.00 1.00 2,500.56 40.00

Skilled (Levels 3-5) 433.02 4.00 22.00 120.00 72,113.81 3,324.00

Other 0.00 0.00 6.00 0.00 6.00 1.00

TOTAL 1,784.75 4.00 28.00 441.00 273,400.17 9,740.00

Table 3.10.5 Leave Pay-outs (Estimated)

Total Number of Average Salary Band Estimated Employees Estimated Amount Payment per (R'000) Employee (R

Annual - discounting with resignation (work days) 18,058.00 913.00 19,779.00

Annual - discounting: unused vac credits (suspension) 33.00 1.00 33,000.00

Annual - discounting: unused vacation credits (work days) 105.00 3.00 35,000.00

Annual - gratuity: death/retirement/medical retirement (work days) 32,950.00 1,010.00 32,624.00

Annual - Heads of Departments (gratuity) (work days) 5.00 1.00 5,000.00

Capped - gratuity: death/retirement/medical retirement (work days) 43,212.00 765.00 56,486.00

Capped - Heads of Departments (gratuity) (work days) 24.00 1.00 24,000.00

TOTAL 94,387.00 - -

Department of Health Annual Report 2018/19 144 Units/categories of employees identified to be at high risk of contracting HIV & related diseases (if any)

3.11. HIV/AIDS and Health Promotion Programmes

Units/categories of employees identified to be at high risk of Key steps taken to reduce the risk contracting HIV & related diseases (if any)

Health Care Professionals (Biological Exposure through cuts, Policy, protocols & PPE splashes, NSI, bites)

Table 3.11.2 Details of Health Promotion and HIV/AIDS Programmes

Question Yes No Details, if yes

1. Has the Department designated a member of the SMS to YES Dr Sipho Senabe implement the provisions contained in Part VI E of Chapter 1 Chief Director: HRD & EHWP of the Public Service Regulations, 2001? If so, provide her/his name and position.

2. Does the Department have a dedicated unit or has it YES No of staff: 4 designated specific staff members to promote the health and well-being of your employees? If so, indicate the number of Conditional Grant: 30,000,000 employees who are involved in this task and the annual budget that is available for this purpose.

3. Has the Department introduced an Employee Assistance or YES Psychosocial services Health Promotion Programme for your employees? If so, - Debriefing indicate the key elements/services of this programme. - Counselling - Resilience building

PHC Services - Management of Chronic Diseases - NIMART

4. Has the Department established (a) committee(s) as Palesa Koetsi contemplated in Part VI E.5 (e) of Chapter 1 of the Public Thabo Nkagisang Service Regulations, 2001? If so, please provide the names of Hospital HIV/AIDS Coordinators the members of the committee and the stakeholder(s) that Peer Educators they represent.

5. Has the Department reviewed its employment policies and National HIV, TB & STI Strategic Plan of Gauteng HIV & practices to ensure that these do not unfairly discriminate AIDS Strategic 2017-22 against employees on the basis of their HIV status? If so, list HR Recruitment Policy the employment policies/practices so reviewed. Medical Surveillance Policy

6. Has the Department introduced measures to protect Establishment of Support Groups HIV-positive employees or those perceived to be HIV-positive Peer Education / Wellness Champions from discrimination? If so, list the key elements of these measures.

7. Does the Department encourage its employees to undergo Wellness Days, Peer Education Programmes, Medical Voluntary Counselling and Testing? If so, list the results that Surveillance, Support Groups, STI & Condom Week you have you achieved. Results are poor 1311 tested 138 males 1173 females

8. Has the Department developed measures/indicators to MPAT Indicators monitor and evaluate the impact of its health promotion Operational Plans programme? If so, list these measures/indicators. Monthly Reports Annual Reports - Number of employees tested for HIV and know their HIV status - Number of employees tested HIV positive - Number of eligible employees who are started ART - Number of employees started on ART and are still alive and in care at 12 months after ART initiation

145 Department of Health Annual Report 2018/19 Table 3.12.1 Collective agreements: 1 April 2018 to 31 March 2019

Subject Matter Date

PHSDSBC 12 June 2018 Resolution 1 Of 2018 - Agreement on The Standardisation Of Remuneration For Community Health Workers In The Department Of Health

PHSDSBC 10 September 2018 Resolution 2 of 2018 - Agreement on payment of annual statutory registration fees

PSCBC 08 June 2018 Resolution 1 of 2018: Agreement on the salary adjustments and improvements in conditions of service for the period 2018 to 2021

PSCBC 26 October 2018 Resolution 2 of 2018: Redress of Discriminatory Pension Practices

PHSDSBC - GAUTENG CHAMBER Resolution 1 of 2018: Payment of PMDS bonusses for the 2017-2018 cycle.

Notes: The CCPGP did not sign any resolutions during the reporting period. Data supplied by Labour Relations Management & Development

Table 3.12.2 Misconduct and disciplinary hearings nalised: 1 April 2018 to 31 March 2019

Outcomes of disciplinary hearings Number % of total

Abscondment 23 3%

Dismissal 4 0.50%

Suspension without salary 45 6%

Corrective counselling 13 2%

Final written warning 219 28%

Written warning 301 40%

Verbal warning 92 12%

Withdrawn 23 3%

Not guilty 2 0.20%

Closed e.g. insufficient evidence, employees resigned, key witness not available, decease etc. 49 6%

TOTAL 771 100%

Department of Health Annual Report 2018/19 146 Table 3.12.3 Types of misconduct addressed at disciplinary hearings: 1 April 2018 to 31 March 2019

Type of misconduct Number % of total

12 June 2018 Absenteeism 246 26% Assault 27 3%

Dereliction of duties 28 3% 10 September 2018 Dishonesty 17 2%

Fraud and corruption 21 2% 08 June 2018 Improper conduct 67 7%

Insubordination 157 17%

26 October 2018 Negligence 89 10%

Theft 78 8%

Others, e.g. late coming, damage to state property, misuse of state property, irregular appointment, dress code etc. 178 2%

TOTAL 930 100%

Table 3.12.4 Grievances lodged: 1 April 2018 to 31 March 2019

Type of misconduct Number % of total

Number of grievances resolved 327 87%

Number of grievances not resolved 45 12%

Total number of grievances lodged 372 100%

Table 3.12.5 Disputes lodged with Council: 1 April 2018 to 31 March 2019

Type of misconduct Number % of total

Number of grievances resolved 86 100%

Number of grievances not resolved 42 49%

Total number of grievances lodged 44 51%

Notes: Outcome of the Disputes

Withdrawn 11 In favour of the Department 15 In favour of the applicant 03 Dismissed 04 Settled 09

147 Department of Health Annual Report 2018/19 Table 3.12.6 Strike action: 1 April 2018 to 31 March 2019

Total number of person working days lost 371.00

Total cost (R'000) of working days lost 111,226.05

Amount (R'000) recovered as a result of no work no pay 111,226.05

Table 3.12.7 Precautionary suspensions: 1 April 2018 to 31 March 2019

Number of people suspended 12

Number of people whose suspension exceeded 30 days 12

Average number of days suspended 54

Cost (R’000) of suspensions 1,550,118

148 Department of Health Annual Report 2018/19 Table 3.13.1 Training needs identi ed: 1 April 208 to 31 March 2019

Training needs at the start of the reporting period

Occupational Categories Gender Number of Learnerships Skills Programmes Other forms of Total Employees (1 & other short training April 2018) courses 1. Legislators, Senior Officials and Managers Female 76 - 8 - 8

Male 84 - 6 - 6

2. Professionals Female 3,548 - 1,500 0 1,500

Male 3,167 - 1,000 - 1,000

3. Technicians and Associate Professionals Female 19,964 0 5,500 - 5,500

Male 3,030 0 3,100 - 3,100

4. Clerks Female 5,937 1,000 3,000 - 4,000

Male 2,613 500 1,500 - 2,000

5. Service Workers and Shop and Market Sales Workers Female 15,036 - 750 -- 750

Male 2,727 - 310 - 310

7. Craft and Related Trades Workers Female 2 - 0 - 0

Male 0 - 0 -- 0

8. Plant and Machine Operators and Assemblers Female 34 - 15 - 15

Male 407 - 5 - 5

9. Elementary Occupations Female 7,436 - 2,500 -- 2,500

Male 4,057 - 1,400 - 1,400

Total 68,118 1,500 20,594 0 22,094

Notes: a. Data provided by the Directorate Human Resource Development: Skills Development b. Number of employees is as at the beginning of the reporting period (i.e. April 2018) as required by the reporting guideline. c. Learnerships, Skills Programmes and other forms of training are training needs identi ed as per Workplace Skills Plan of 2018/2018

Department of Health Annual Report 2018/19 149 Table 3.13.2 Training provided: 1 April 208 to 31 March 2019

Training needs at the start of the reporting period 6 Occupational Categories Gender Number of Learnerships Skills Programmes Other forms of Total 0 Employees (1 & other short6 training 10 April 2018) - 76 courses 0 10 2,587 1. Legislators, Senior Officials and Managers - Female 84 0 2,587 1,037 Male - 3,548 0 1,037 3,601 2. Professionals Female - 3,167 0 3,601 2,322 Male 0 19,964 0 2,322 2,846 3. Technicians and Associate Professionals Female 0 0 3,030 2,063 2,363 Male 783 0 5,937 1,942 710 Female 421 4. Clerks 2,613 0 710 218 Male - 0 15,036 218 1 Female 5. Service Workers and Shop and Market Sales Workers - 0 2,727 1 3 Male - 0

2 3 2 Female - 0 7. Craft and Related Trades Workers 0 2 11 Male - 0

34 11 1,858 Female - 0 8. Plant and Machine Operators and Assemblers 407 1,858 740 Male - 0

7,436 740 18,315 Female - 0 9. Elementary Occupations 4,057 17,111 Male 1,204 68,118 Total

Notes: a. a. Data provided by the Directorate Human Resource Development b. Number of employees is extracted from PERSAL as at the beginning of the reporting period (i.e. April 2019) as required by the reporting guideline. c. Learnerships, Skills Programmes and other forms of training is training provided as per Annual Training Report of 2018/2019

Department of Health Annual Report 2018/19 150 Table 3.14.1 Injuries on Duty: 1 April 2018 to March 2019

Nature of Injury on Duty Number % of Total

Required basic medical attention only 566 Including NSI 100.0% Temporary Total Disablement 0 0.0% Permanent Disablement 0 0.0% Fatal 0 0.0% Total 566 -

Table 3.16.1 Granting of employee-initiated severance packages for the period 1 April 2018 to 31 March 2019

Number of Number of Number of Number of Salary Band Applications Applications Applications Packages received referred to the supported by approved by MPSA MPSA Department

Lower skilled (Levels 1-2) 0 0 0 0

Skilled (Levels 3-5) 0 0 0 0

Highly skilled production (Levels 6-8) 0 0 0 0

Highly skilled supervision (Levels 9-12) 0 0 0 0

Senior management (Levels 13-16) - 0 0 0

Total 0 0 0 0

Notes: The Department does not have the competence/mandate to approve severance packages. The competence lies with the MDPSA.

151 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH GAUTENG DEPARTMENTVOTE 4 OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

PART E: FINANCIAL INFORMATION GAUTENG DEPARTMENT OF HEALTH VOTE 4 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019 REPORT OF THE AUDITOR-GENERAL TOAPPROPRIATION THE GAUTENG STATEMENT PROVINCIAL FOR THELEGISLATURE YEAR ENDED 31 MARCH 2019 ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

14. A further description of my responsibilities for the audit of the completeness and appropriateness of the performance REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS 8. As disclosed in note 19.2 to the financial statements, payables of financial statements is included in the annexure to this auditor’s indicators included in the planning documents. My procedures Opinion R2 855 623 000 exceeded the payment term of 30 days, as report. also did not extend to any disclosures or assertions relating to 1. I have audited the financial statements of the Gauteng Depart- required by treasury regulation 8.2.3. This amount, in turn, planned performance strategies and information in respect of ment of Health set out on pages 162 to 271, which comprise the exceeded the R439 466 000 of voted funds to be surrendered by REPORT ON THE AUDIT OF THE ANNUAL PERFORMANCE future periods that may be included as part of the reported appropriation statement, the statement of financial position as R2 416 157 000 as per the statement of financial performance. REPORT INTRODUCTION AND SCOPE performance information. Accordingly, my findings do not at 31 March 2019, the statement of financial performance, The amount of R2 416 157 000 would therefore have constitut- 15. In accordance with the Public Audit Act of South Africa, 2004 extend to these matters. statement of changes in net assets and cash flow statement for ed unauthorised expenditure had the amounts due been paid in (Act No. 25 of 2004) (PAA) and the general notice issued in 17. I evaluated the usefulness and reliability of the reported perfor- the year then ended, as well as the notes to the financial time. terms thereof, I have a responsibility to report material findings mance information in accordance with the criteria developed statements, including a summary of significant accounting on the reported performance information against from the performance management and reporting framework, policies. Other matter predetermined objectives for selected programmes presented in as defined in the general notice, for the following selected 2. In my opinion, the financial statements present fairly, in all 9. I draw attention to the matter below. My opinion is not modified the annual performance report. I performed procedures to programmes presented in the annual performance report of the material respects, the financial position of the Gauteng Depart- in respect of this matter. identify findings but not to gather evidence to express department for the year ended 31 March 2019: ment of Health as at 31 March 2019, and its financial perfor- assurance. UNAUDITED SUPPLEMENTARY SCHEDULES mance and cash flows for the year then ended in accordance 16. My procedures address the reported performance information, . with the Modified Cash Standard (MCS) prescribed by the 10. The supplementary information set out on pages 272 to 279 which must be based on the approved performance planning National Treasury and the requirements of the Public Finance does not form part of the financial statements and is presented documents of the department. I have not evaluated the Management Act of South Africa, 1999 (Act No. 1 of 1999) as additional information. I have not audited this/ these sched- (PFMA) and the Division of Revenue Act of South Africa, 2018 ule(s) and, accordingly, I do not express an opinion on it/ them (Act No. 1 of 2018) (Dora). RESPONSIBILITIES OF THE ACCOUNTING OFFICER FOR Basis for opinion THE FINANCIAL STATEMENTS 3. I conducted my audit in accordance with the International 11. The accounting officer is responsible for the preparation and Standards on Auditing (ISAs). My responsibilities under those fair presentation of the financial statements in accordance with standards are further described in the auditor-general’s respon- the MCS prescribed by the National Treasury and the require- sibilities for the audit of the financial statements section of this ments of the PFMA and Dora, and for such internal control as auditor’s report. the accounting officer determines is necessary to enable the 4. I am independent of the department in accordance with sections preparation of financial statements that are free from material 290 and 291 of the International Ethics Standards Board for misstatement, whether due to fraud or error. Accountants’ Code of ethics for professional accountants (IESBA 12. In preparing the financial statements, the accounting officer is code), parts 1 and 3 of the International Ethics Standards Board responsible for assessing the Gauteng Department of Health’s for Accountants’ International Code of Ethics for Professional ability to continue as a going concern, disclosing, as applicable, Accountants (including International Independence Standards) matters relating to going concern and using the going concern and the ethical requirements that are relevant to my audit in basis of accounting unless the appropriate governance structure South Africa. I have fulfilled my other ethical responsibilities in either intends to liquidate the department or to cease opera- accordance with these requirements and the IESBA codes. tions, or has no realistic alternative but to do so. 5. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. AUDITOR-GENERAL’S RESPONSIBILITIES FOR THE AUDIT OF THE FINANCIAL STATEMENTS 13. My objectives are to obtain reasonable assurance about wheth- Emphasis of matters er the financial statements as a whole are free from material 6. I draw attention to the matters below. My opinion is not modi- misstatement, whether due to fraud or error, and to issue an fied in respect of these matters. auditor’s report that includes my opinion. Reasonable assurance MATERIAL UNCERTAINTIES RELATING TO LITIGATIONS is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will always detect a 7. With reference to note 17.1 to the financial statements, the material misstatement when it exists. Misstatements can arise department is the defendant in various lawsuits. The ultimate from fraud or error and are considered material if, individually or outcome of the matters cannot presently be determined and no in aggregate, they could reasonably be expected to influence the provision for any liability that may result has been made in the economic decisions of users taken on the basis of these financial financial statements. PAYMENTS WHICH EXCEEDED VOTED FUND TO BE statements. SURRENDERED

153 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

14. A further description of my responsibilities for the audit of the completeness and appropriateness of the performance REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS 8. As disclosed in note 19.2 to the financial statements, payables of financial statements is included in the annexure to this auditor’s indicators included in the planning documents. My procedures Opinion R2 855 623 000 exceeded the payment term of 30 days, as report. also did not extend to any disclosures or assertions relating to 1. I have audited the financial statements of the Gauteng Depart- required by treasury regulation 8.2.3. This amount, in turn, planned performance strategies and information in respect of ment of Health set out on pages 162 to 271, which comprise the exceeded the R439 466 000 of voted funds to be surrendered by REPORT ON THE AUDIT OF THE ANNUAL PERFORMANCE future periods that may be included as part of the reported appropriation statement, the statement of financial position as R2 416 157 000 as per the statement of financial performance. REPORT INTRODUCTION AND SCOPE performance information. Accordingly, my findings do not at 31 March 2019, the statement of financial performance, The amount of R2 416 157 000 would therefore have constitut- 15. In accordance with the Public Audit Act of South Africa, 2004 extend to these matters. statement of changes in net assets and cash flow statement for ed unauthorised expenditure had the amounts due been paid in (Act No. 25 of 2004) (PAA) and the general notice issued in 17. I evaluated the usefulness and reliability of the reported perfor- the year then ended, as well as the notes to the financial time. terms thereof, I have a responsibility to report material findings mance information in accordance with the criteria developed statements, including a summary of significant accounting on the reported performance information against from the performance management and reporting framework, policies. Other matter predetermined objectives for selected programmes presented in as defined in the general notice, for the following selected 2. In my opinion, the financial statements present fairly, in all 9. I draw attention to the matter below. My opinion is not modified the annual performance report. I performed procedures to programmes presented in the annual performance report of the material respects, the financial position of the Gauteng Depart- in respect of this matter. identify findings but not to gather evidence to express department for the year ended 31 March 2019: ment of Health as at 31 March 2019, and its financial perfor- assurance. mance and cash flows for the year then ended in accordance UNAUDITED SUPPLEMENTARY SCHEDULES 16. My procedures address the reported performance information, . with the Modified Cash Standard (MCS) prescribed by the 10. The supplementary information set out on pages 272 to 279 which must be based on the approved performance planning National Treasury and the requirements of the Public Finance does not form part of the financial statements and is presented documents of the department. I have not evaluated the Management Act of South Africa, 1999 (Act No. 1 of 1999) as additional information. I have not audited this/ these sched- (PFMA) and the Division of Revenue Act of South Africa, 2018 ule(s) and, accordingly, I do not express an opinion on it/ them (Act No. 1 of 2018) (Dora). Programmes Pages in the annual performance report RESPONSIBILITIES OF THE ACCOUNTING OFFICER FOR Programme 2 – District Health Services 33 – 47 Basis for opinion THE FINANCIAL STATEMENTS Programme 5 – Tertiary and Central Hospital Services 54 – 64 3. I conducted my audit in accordance with the International 11. The accounting officer is responsible for the preparation and fair presentation of the financial statements in accordance with Standards on Auditing (ISAs). My responsibilities under those 18. I performed procedures to determine whether the reported performance information was properly presented and whether perfor- the MCS prescribed by the National Treasury and the require- standards are further described in the auditor-general’s respon- mance was consistent with the approved performance planning documents. I performed further procedures to determine whether the ments of the PFMA and Dora, and for such internal control as sibilities for the audit of the financial statements section of this indicators and related targets were measurable and relevant, and assessed the reliability of the reported performance information to the accounting officer determines is necessary to enable the auditor’s report. determine whether it was valid, accurate and complete. preparation of financial statements that are free from material 4. I am independent of the department in accordance with sections 19. The material findings in respect of the usefulness and reliability of the selected programmes are as follows: 290 and 291 of the International Ethics Standards Board for misstatement, whether due to fraud or error. Accountants’ Code of ethics for professional accountants (IESBA 12. In preparing the financial statements, the accounting officer is PROGRAMME 2 – DISTRICT HEALTH SERVICES code), parts 1 and 3 of the International Ethics Standards Board responsible for assessing the Gauteng Department of Health’s Various indicators for Accountants’ International Code of Ethics for Professional ability to continue as a going concern, disclosing, as applicable, 20. I was unable to obtain sufficient appropriate audit evidence to support the reasons for the variances between the planned targets and Accountants (including International Independence Standards) matters relating to going concern and using the going concern the achievements reported in the annual performance report. This was due to limitations placed on the scope of my work. I was unable and the ethical requirements that are relevant to my audit in basis of accounting unless the appropriate governance structure to confirm the reported reasons for the variances by alternative means. Consequently, I was unable to determine whether any adjust- South Africa. I have fulfilled my other ethical responsibilities in either intends to liquidate the department or to cease opera- ments were required to the reported reasons for the variances. Furthermore, the reported achievements in the annual performance accordance with these requirements and the IESBA codes. tions, or has no realistic alternative but to do so. report did not agree to the supporting evidence provided for the indicators listed below. It was impractical to determine the audited 5. I believe that the audit evidence I have obtained is sufficient and values. appropriate to provide a basis for my opinion. AUDITOR-GENERAL’S RESPONSIBILITIES FOR THE AUDIT OF THE FINANCIAL STATEMENTS No Performance indicator Reported achievement 13. My objectives are to obtain reasonable assurance about wheth- 1 PHC utilisation rate – Total 1,5 Emphasis of matters er the financial statements as a whole are free from material 2 ART client remain on ART end of month – total 1 037 212 6. I draw attention to the matters below. My opinion is not modi- misstatement, whether due to fraud or error, and to issue an 3 HIV test done – total 3 253 783 fied in respect of these matters. auditor’s report that includes my opinion. Reasonable assurance 4 Male condom distributed 172 953 486 5 TB MDR treatment success rate 58,0% MATERIAL UNCERTAINTIES RELATING TO LITIGATIONS is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will always detect a 6 Infant 1st PCR test positive around 10 weeks rate 0,73% 7. With reference to note 17.1 to the financial statements, the material misstatement when it exists. Misstatements can arise 7 Diarrhoea case fatality rate 2,1% department is the defendant in various lawsuits. The ultimate from fraud or error and are considered material if, individually or 8 Pneumonia case fatality rate 2,8% outcome of the matters cannot presently be determined and no in aggregate, they could reasonably be expected to influence the 9 HPV 1st dose 65 543 provision for any liability that may result has been made in the economic decisions of users taken on the basis of these financial 10 HPV 2nd dose 61 031 financial statements. 11 Malaria case fatality rate 1,4% PAYMENTS WHICH EXCEEDED VOTED FUND TO BE statements. SURRENDERED 12 TB client death rate 6,3% 13 School Grade 1 - learners screened 88 200 14 School Grade 8 - learners screened 48 818

Department of Health Annual Report 2018/19 154 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

Various indicators 21. The reasons for the variances between the planned targets and the reported achievements were not explained in the annual performance report for the indicators listed below. Furthermore, the reported achievements in the annual performance report did not agree to the supporting evidence provided for the indicators listed below. It was impractical to determine the audited values.

No Performance indicator Reported achievement 1 Inpatient Bed Utilisation Rate (District Hospitals) 68,1% 2 TB client treatment success rate 84% 3 Antenatal 1st visit before 20 weeks’ rate 64,7% 4 Mother postnatal visit within 6 days' rate 75,1% 5 Couple year protection rate (Int) 54,1% 6 Cervical cancer screening coverage 30 years and older 52% 7 Immunisation under 1-year coverage 84,3% 8 Severe acute malnutrition case fatality rate 6,8% 9 TB/HIV co-infected client on ART rate 88,2% 10 Antenatal client start on ART rate 96,9%

IDEAL CLINIC STATUS RATE 22. I was unable to obtain sufficient appropriate audit evidence to validate the existence of systems and processes that enable reliable reporting of actual service delivery against the indicator for the reported achievement of 89.2%. This was due to the limitation placed on the scope of my work as the information documented in the checklists completed during the assessments could not be re-performed as no corroborating evidence was provided to support the ratings in the checklists. I was unable to validate the existence of systems and processes by alternative means. Consequently, I was unable to determine whether any further adjustments were required to the reported achievement. Furthermore, the reason for variance between planned target and reported achievement was not explained in the annual performance report.

HOSPITAL ACHIEVED 75% AND MORE ON NATIONAL CORE STANDARDS SELF-ASSESSMENT RATE (DISTRICT HOSPITALS). 23. I was unable to obtain sufficient appropriate audit evidence to validate the existence of systems and processes that enable reliable reporting of actual service delivery against the indicator for the reported achievement of 91.7%. This was due to the limitation placed on the scope of my work as the information documented in the checklists completed during the assessments could not be re-performed as no corroborating evidence was provided to support the ratings in the checklists. I was unable to validate the existence of systems and processes by alternative means. Consequently, I was unable to determine whether any further adjustments were required to the reported achievement. Furthermore, the reason for the variance between the planned target of 92% and the reported achievement of 91.7% was not reported in the annual performance report.

MEDICAL MALE CIRCUMCISION – TOTAL 24. The achievement for target 124 320 reported in the annual performance report was 102 325. However, the supporting evidence provided did not agree to the reported achievement and indicated an achievement of 97 933.

VARIOUS STRATEGIC OBJECTIVES 25. The reported strategic objectives approved in the strategic plan were not consistent when compared with strategic objectives in the approved annual performance plan.

155 Department of Health Annual Report 2018/19 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

No Planned strategic objectives per annual performance plan Reported strategic objectives per annual performance report 1 Increase number of fully-fledged, functional Ward Based Increase the number of fully-fledged, functional Ward Based Outreach Teams from 130 to 775 targeted wards by 2019/20 Outreach Teams from 103 to 533 by 2019/20 2 Increase number of female condoms distributed annually from 1 Increase number of female condoms distributed annually from 451 696 to 5 600 445 million and male condoms from 69 480 1 451 696 to 5.6 million by 2019/20 738 in 2013/14 to 176 576 4 by 2019/20 3 Increase number of male condoms distributed annually from: 69 Increase number of male condoms distributed annually from 69 480 000 to 176 576 400 by 2019/20 480 738 to 176 million by 2019/20 4 Decrease TB death rate from 5,2% in 2013/14 to <5% by Decrease TB death rate from 6,1% in 2013/14 to 5,3% by 2019/20 2019/20 5 Decrease child (under 5 years) severe acute malnutrition case Decrease child (under 5 years) pneumonia and severe acute fatality rate from 6,1% in 2013/2014 to <6% by 2019/20 malnutrition case fatality rate from 12% in 2013/14 to <6% by 2019/20 6 Increase HPV vaccine coverage rate for 1st dose from 87,1% to Increase HPV vaccine coverage rate from 87,1% for 1st dose to 90% by 2019/20 80% by 2019/20 7 Increase HPV vaccine coverage rate for 2nd dose to 90% by Increase HPV vaccine coverage rate for 2nd dose to 80% by 2019/20 2019/20 8 Increase percentage of people treated for TB from 84% in Increase percentage of people treated for TB from 84% in 2013/14 to 92% by 2019/20 2013/14 to 92% of total population with HIV by 2019/20 9 Increase number of mothers whose first antenatal visit is before Increase number of mothers whose first antenatal visit is before 20 weeks from 43,7% in 2013/2014 to 65% by 2019/20 20 weeks from 43,7% in 2013/2014 to 70% by 2019/20

INCREASE NUMBER OF MEN/WOMEN AGED 15-49 TESTED FOR HIV FROM 1.8 MILLION TO 4 MILLION 26. The strategic objective approved in the annual performance plan was Increase number of men/women aged 15-49 tested for HIV from 1.8 million to 4 million. However, the strategic objective was not reported in the annual performance report.

NEONATAL DEATH IN FACILITY RATE 27. The reason for the variance between the planned target of 14 and the reported achievement of 13/1000 live births was not reported in the annual performance report and the achievement for target 14 reported in the annual performance report was 13/1000 live births. However, the supporting evidence provided did not agree to the reported achievement and indicated an achievement of 3.48. Further- more, the planned indicator and target were Neonatal death in facility rate <14, but the reported achievement referred to was 13/ 1000 live births.

MATERNAL MORTALITY IN FACILITY RATIO 28. I was unable to obtain sufficient appropriate audit evidence to support the reason for the variance between the planned target of <100 and the achievement of 122.8 / 100 000 live births reported in the annual performance report. This was due to limitation placed on the scope of my work. I was unable to confirm the reported reason for the variance by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reported reason for the variance. Furthermore, the achievement for target <100 reported in the annual performance report was 122.8/ 100 000 live births. However, the supporting evidence provided did not agree to the reported achievement and indicated an achievement of 27.96 and the planned indicator and target were Maternal mortality in facility ratio <100, but the reported achievement referred to was 122.8 / 100 000 live births.

PROGRAMME 5 – TERTIARY AND CENTRAL HOSPITAL SERVICES Various indicators 29. The reasons for the variances between the planned targets and the reported achievements were not explained in the annual performance report for the indicators listed below. The reported achievement in the annual performance report also did not agree to the supporting evidence provided for these indicators.

No Performance indicators Reported achievement Audited value 1 Inpatient Bed Utilisation Rate (Tertiary Hospitals) 87% 1042% 2 Inpatient Bed Utilisation Rate (Central Hospitals) 81% 983%

Department of Health Annual Report 2018/19 156 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

HOSPITAL ACHIEVED 75% AND MORE ON NATIONAL CORE STANDARDS SELF-ASSESSMENT RATE (TERTIARY ANNUAL FINANCIAL STATEMENTS STRATEGIC PLANNING AND PERFORMANCE MANAGEMENT HOSPITALS) PROCUREMENT OF V-BLOCKS IT INFRASTRUCTURE WITHOUT INVITING COMPETITIVE BIDS 37. The financial statements submitted for auditing were not prepared in accordance with the prescribed financial reporting framework as 51. Specific information systems were not implemented to enable the monitoring of progress made towards achieving targets, core objec- 30. I was unable to obtain sufficient appropriate audit evidence to validate the existence of systems and processes that enable reliable 64. The R538 718 000 contract for Vblocks IT infrastructure was awarded during March 2015 without inviting competitive bids as required required by section 40(1)(b) of the Public Finance Management Act. Material misstatements on commitments and contingent liabilities tives and service delivery as required by public service regulation 25(1)(e)(i) and (iii). reporting of actual service delivery against the indicator for the reported achievement of 3/3. This was due to the limitation placed on the by treasury regulations 16A6.1. identified by the auditors in the submitted financial statement were subsequently corrected, resulting in the financial statements receiving OTHER INFORMATION scope of our work as the information documented in the checklists completed during the assessments could not be re-performed as no 65. An investigation was completed on 28 September 2018 by the accounting officer, concluded that by not following a competitive an unqualified audit opinion. 52. The accounting officer is responsible for the other information. The other information comprises the information included in the annual corroborating evidence was provided to support the ratings in the checklists. I was unable to validate the existence of systems and bidding process the department suffered a financial loss of R148 921 151 as there were cheaper alternatives. report which includes the audit committee’s report. The other information does not include the financial statements, the auditor’s report processes by alternative means. Consequently, I was unable to determine whether any further adjustments were required to the reported 66. The accounting officer following the recommendation as per the investigation report, PROCUREMENT AND CONTRACT MANAGEMENT and those selected programmes presented in the annual performance report that have been specifically reported in this auditor’s report. achievement. Furthermore, reported achievement was not consistent when compared with planned target as the approved target in the • referred the matter to the National Prosecuting Authority on 24 July 2019 to consider whether criminal charges can be instituted 38. Sufficient appropriate audit evidence could not be obtained that all contracts were awarded in accordance with the legislative require- 53. My opinion on the financial statements and findings on the reported performance information and compliance with legislation do not annual performance plan was 100% (3/3). However, the target achievement in the annual performance report was 3/3. against the implicated officials. ments as a result of tender files which were destroyed by fire at the Bank of Lisbon building. cover the other information and I do not express an audit opinion or any form of assurance conclusion thereon. • referred the matter to the State Attorney on 19 July 2019 to consider possible civil claims against the implicated officials. 39. Goods and services with a transaction value below R500 000 were procured without obtaining the required price quotations, as required 54. In connection with my audit, my responsibility is to read the other information and, in doing so, consider whether the other information HOSPITAL ACHIEVED 75% AND MORE ON NATIONAL CORE STANDARDS SELF-ASSESSMENT RATE (CENTRAL • plans to take disciplinary actions against the implicate officials on or before 31 January 2020. by treasury regulation 16A6.1. Similar non-compliance was also reported in the prior year. is materially inconsistent with the financial statements and the selected programmes presented in the annual performance report, or my HOSPITALS) 67. I will follow up on the implementation of the planned actions during my next audit. 40. Goods and services of a transaction value above R500 000 were procured without inviting competitive bids as required by treasury 31. I was unable to obtain sufficient appropriate audit evidence to validate the existence of systems and processes that enable reliable knowledge obtained in the audit, or otherwise appears to be materially misstated. regulation 16A6.1. Similar non-compliance was also reported in the prior year. The non-compliance resulted in a material irregularity as 55. If based on the work I have performed, I conclude that there is a material misstatement in this other information, I am required to report reporting of actual service delivery against the indicator for the reported achivement of 100%. This was due to the limitation placed on OTHER REPORTS reported in the section on material irregularities. that fact. I have nothing to report in this regard. the scope of my work as the information documented in the checklists completed during the assessments could not be re-performed as 68. In addition to the investigations relating to material irregularities, I draw attention to the following engagements conducted by various 41. Some of the contracts were extended or modified without the approval of a properly delegated official as required by section 44 of the no corroborating evidence was provided to support the ratings in the checklists. I was unable to validate the existence of systems and parties that had, or could have, an impact on the matters reported in the department’s financial statements, reported performance PFMA and treasury regulation 8.1 and 8.2. Similar finding was identified in the prior year. INTERNAL CONTROL DEFICIENCIES processes by alternative means. Consequently, I was unable to determine whether any further adjustments were required to the reported information, compliance with applicable legislation and other related matters. These reports did not form part of my opinion on the 56. I considered internal control relevant to my audit of the financial statements, reported performance information and compliance with achievement. financial statements or my findings on the reported performance information or compliance with legislation. EXPENDITURE MANAGEMENT applicable legislation; however, my objective was not to express any form of assurance on it. The matters reported below are limited to 42. Effective and appropriate steps were not taken to prevent irregular expenditure, as required by section 38(1)(c)(ii) of the PFMA and the significant internal control deficiencies that resulted in the findings on the annual performance report and the findings on compliance VARIOUS STRATEGIC OBJECTIVES INVESTIGATIONS treasury regulation 9.1.1. The value, as disclosed in note 23 to the financial statements, may not be complete as awards to the value of with legislation included in this report. 32. The reported strategic objectives approved in the strategic plan were not consistent when compared with strategic objectives in the 69. Various investigations, based on the allegations of procurement irregularities, fraud, theft and negligence, are being performed by the R77 510 081 could not be tested due to missing/ incomplete information. The majority of the irregular expenditure disclosed in the 57. The accounting officer did not exercise adequate oversight responsibility over internal controls relating to procurement and contract approved annual performance plan. department dating back from prior periods. Some of these investigations were finalised by the Special Investigation Unit and the depart- financial statements was caused by non-compliance with the treasury regulations on competitive bidding. management and over the preparation of the annual financial statements and annual performance report. ment whilst others were still in progress at the date of this auditor’s report 43. Effective steps were not taken to prevent fruitless and wasteful expenditure amounting to R26 682 000, as disclosed in note 24 to the 58. Senior management did not ensure that sufficient controls are in place to prepare accurate and complete annual performance report annual financial statements, as required by section 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1. The majority of the fruitless and and annual financial statements that are supported by reliable information. No Planned strategic objectives per annual performance plan Reported strategic objectives per annual performance report wasteful expenditure was caused by interest levied on overdue accounts. 59. Senior management did not adequately ensure that they perform their responsibilities as outlined in the PFMA to mitigate the risk of 1 Improve efficiency of hospitals by reducing average length of Improve efficiency of hospitals by reducing average length of 44. Payments were not made within 30 days or an agreed period after receipt of an invoice, as required by treasury regulation 8.2.3. The non-compliance with laws and regulations. stay to 5.5 days increasing bed utilisation to 85% and decreasing stay to 6. 5 days, increasing bed utilisation to 85% and decreas- non-compliance resulted in a material irregularity as reported in the section on material irregularities. expenditure per PDE in hospitals by 2019/20 (Tertiary Hospital) ing expenditure per PDE in hospitals by 2019/20 MATERIAL IRREGULARITIES 2 Reduce the number of primary care patient cases that are seen Reduce Outpatient Department (OPD), Accident and Emergen- Johannesburg REVENUE MANAGEMENT 60. In accordance with the PAA and the material irregularities regulations, I have a responsibility to report on material irregularities identified at regional, tertiary and central hospitals by 20% in 2019/20 cy departments waiting times across all facilities by 60% in 31 August 2019 (Tertiary Hospital) 2019/20 45. Effective and appropriate steps were not taken to collect all money due, as required by section 38(1)(c)(i) of the PFMA. during the audit. 3 Increase compliance to extreme and vital measures of core Increase compliance with national core standards to 100% in 46. All reasonable steps were not taken to recover debts before writing them off, as required by treasury regulation 11.4.1. 61. The material irregularities identified are as follows: standards to 100% in 2019/20, and complete self- assessments 2019/20, and complete self-assessments in all hospitals 47. Bad debt was written off contrary to the requirements of the Department of Health’s write-off policy, as required by treasury regulation in all hospitals by 2019/20 (Tertiary Hospital) 11.4.2. MEDICAL CLAIMS NOT PAID WITHIN THE PERIOD SPECIFIED IN THE COURT JUDGEMENT 48. Interest was not charged on debts as required by treasury regulation 11.5.1. 62. Payments for medical claims were not made within the period specified in the court judgement, as required by treasury regulation 8.2.3. As a result of the late payments interest was charged, resulting in a material financial loss of R7 977 322, which forms part of the OTHER MATTER CONDITIONAL GRANT amount disclosed as interest on litigation in note 24 of the financial statements. 33. I draw attention to the matter below. 49. The Comprehensive HIV/AIDS,National Tertiary Services and Health Professions Training and Development were not spent for the 63. The accounting officer has not taken appropriate action in response to being notified of the material irregularity. I recommend that the ACHIEVEMENT OF PLANNED TARGETS purposes stipulated in the Schedule concerned / in accordance with the applicable framework, as required by section 17(1) of the Division accounting officer should take the following actions to address the material irregularity, which should be implemented by 31 January 34. Refer to the annual performance report on pages x to x for information on the achievement of planned targets for the year and explana- of Revenue Act (Act 1 of 2018). 2020: tions provided for the under/ over achievement of a significant number of targets. This information should be considered in the context • The accounting officer should investigate the fruitless and wasteful expenditure incurred as a result of the interest paid. CONSEQUENCE MANAGEMENT of the material findings on the usefulness and reliability of the reported performance information in paragraphs x to x of this report. • Effective and appropriate disciplinary steps should be taken against any official that the investigation found to be responsible, as 50. Disciplinary steps were not taken against the officials who had permitted irregular expenditure, as required by section 38(1)(h)(iii) of the required by section 38(1)(h) of the PFMA and in accordance with treasury regulation 9.1.3. REPORT ON THE AUDIT OF COMPLIANCE WITH LEGISLATION PFMA. • Appropriate action should be taken to determine whether the responsible official is liable by law for the losses suffered by the Introduction and scope department for the purpose of recovery, as required by treasury regulations 9.1.4 and 12.7.1. 35. In accordance with the PAA and the general notice issued in terms thereof, I have a responsibility to report material findings on the compliance of the department with specific matters in key legislation. I performed procedures to identify findings but not to gather evidence to express assurance. 36. The material findings on compliance with specific matters in key legislations are as follows:

157 Department of Health Annual Report 2018/19 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

ANNUAL FINANCIAL STATEMENTS STRATEGIC PLANNING AND PERFORMANCE MANAGEMENT PROCUREMENT OF V-BLOCKS IT INFRASTRUCTURE WITHOUT INVITING COMPETITIVE BIDS 37. The financial statements submitted for auditing were not prepared in accordance with the prescribed financial reporting framework as 51. Specific information systems were not implemented to enable the monitoring of progress made towards achieving targets, core objec- 64. The R538 718 000 contract for Vblocks IT infrastructure was awarded during March 2015 without inviting competitive bids as required required by section 40(1)(b) of the Public Finance Management Act. Material misstatements on commitments and contingent liabilities tives and service delivery as required by public service regulation 25(1)(e)(i) and (iii). by treasury regulations 16A6.1. identified by the auditors in the submitted financial statement were subsequently corrected, resulting in the financial statements receiving OTHER INFORMATION 65. An investigation was completed on 28 September 2018 by the accounting officer, concluded that by not following a competitive an unqualified audit opinion. 52. The accounting officer is responsible for the other information. The other information comprises the information included in the annual bidding process the department suffered a financial loss of R148 921 151 as there were cheaper alternatives. report which includes the audit committee’s report. The other information does not include the financial statements, the auditor’s report 66. The accounting officer following the recommendation as per the investigation report, PROCUREMENT AND CONTRACT MANAGEMENT and those selected programmes presented in the annual performance report that have been specifically reported in this auditor’s report. • referred the matter to the National Prosecuting Authority on 24 July 2019 to consider whether criminal charges can be instituted 38. Sufficient appropriate audit evidence could not be obtained that all contracts were awarded in accordance with the legislative require- 53. My opinion on the financial statements and findings on the reported performance information and compliance with legislation do not against the implicated officials. ments as a result of tender files which were destroyed by fire at the Bank of Lisbon building. cover the other information and I do not express an audit opinion or any form of assurance conclusion thereon. • referred the matter to the State Attorney on 19 July 2019 to consider possible civil claims against the implicated officials. 39. Goods and services with a transaction value below R500 000 were procured without obtaining the required price quotations, as required 54. In connection with my audit, my responsibility is to read the other information and, in doing so, consider whether the other information • plans to take disciplinary actions against the implicate officials on or before 31 January 2020. by treasury regulation 16A6.1. Similar non-compliance was also reported in the prior year. is materially inconsistent with the financial statements and the selected programmes presented in the annual performance report, or my 67. I will follow up on the implementation of the planned actions during my next audit. 40. Goods and services of a transaction value above R500 000 were procured without inviting competitive bids as required by treasury knowledge obtained in the audit, or otherwise appears to be materially misstated. regulation 16A6.1. Similar non-compliance was also reported in the prior year. The non-compliance resulted in a material irregularity as 55. If based on the work I have performed, I conclude that there is a material misstatement in this other information, I am required to report OTHER REPORTS reported in the section on material irregularities. that fact. I have nothing to report in this regard. 68. In addition to the investigations relating to material irregularities, I draw attention to the following engagements conducted by various 41. Some of the contracts were extended or modified without the approval of a properly delegated official as required by section 44 of the parties that had, or could have, an impact on the matters reported in the department’s financial statements, reported performance PFMA and treasury regulation 8.1 and 8.2. Similar finding was identified in the prior year. INTERNAL CONTROL DEFICIENCIES information, compliance with applicable legislation and other related matters. These reports did not form part of my opinion on the 56. I considered internal control relevant to my audit of the financial statements, reported performance information and compliance with financial statements or my findings on the reported performance information or compliance with legislation. EXPENDITURE MANAGEMENT applicable legislation; however, my objective was not to express any form of assurance on it. The matters reported below are limited to 42. Effective and appropriate steps were not taken to prevent irregular expenditure, as required by section 38(1)(c)(ii) of the PFMA and the significant internal control deficiencies that resulted in the findings on the annual performance report and the findings on compliance INVESTIGATIONS treasury regulation 9.1.1. The value, as disclosed in note 23 to the financial statements, may not be complete as awards to the value of with legislation included in this report. 69. Various investigations, based on the allegations of procurement irregularities, fraud, theft and negligence, are being performed by the R77 510 081 could not be tested due to missing/ incomplete information. The majority of the irregular expenditure disclosed in the 57. The accounting officer did not exercise adequate oversight responsibility over internal controls relating to procurement and contract department dating back from prior periods. Some of these investigations were finalised by the Special Investigation Unit and the depart- financial statements was caused by non-compliance with the treasury regulations on competitive bidding. management and over the preparation of the annual financial statements and annual performance report. ment whilst others were still in progress at the date of this auditor’s report 43. Effective steps were not taken to prevent fruitless and wasteful expenditure amounting to R26 682 000, as disclosed in note 24 to the 58. Senior management did not ensure that sufficient controls are in place to prepare accurate and complete annual performance report annual financial statements, as required by section 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1. The majority of the fruitless and and annual financial statements that are supported by reliable information. wasteful expenditure was caused by interest levied on overdue accounts. 59. Senior management did not adequately ensure that they perform their responsibilities as outlined in the PFMA to mitigate the risk of 44. Payments were not made within 30 days or an agreed period after receipt of an invoice, as required by treasury regulation 8.2.3. The non-compliance with laws and regulations. non-compliance resulted in a material irregularity as reported in the section on material irregularities. MATERIAL IRREGULARITIES Johannesburg REVENUE MANAGEMENT 60. In accordance with the PAA and the material irregularities regulations, I have a responsibility to report on material irregularities identified 31 August 2019 45. Effective and appropriate steps were not taken to collect all money due, as required by section 38(1)(c)(i) of the PFMA. during the audit. 46. All reasonable steps were not taken to recover debts before writing them off, as required by treasury regulation 11.4.1. 61. The material irregularities identified are as follows: 47. Bad debt was written off contrary to the requirements of the Department of Health’s write-off policy, as required by treasury regulation 11.4.2. MEDICAL CLAIMS NOT PAID WITHIN THE PERIOD SPECIFIED IN THE COURT JUDGEMENT 48. Interest was not charged on debts as required by treasury regulation 11.5.1. 62. Payments for medical claims were not made within the period specified in the court judgement, as required by treasury regulation 8.2.3. As a result of the late payments interest was charged, resulting in a material financial loss of R7 977 322, which forms part of the OTHER MATTER CONDITIONAL GRANT amount disclosed as interest on litigation in note 24 of the financial statements. 33. I draw attention to the matter below. 49. The Comprehensive HIV/AIDS,National Tertiary Services and Health Professions Training and Development were not spent for the 63. The accounting officer has not taken appropriate action in response to being notified of the material irregularity. I recommend that the ACHIEVEMENT OF PLANNED TARGETS purposes stipulated in the Schedule concerned / in accordance with the applicable framework, as required by section 17(1) of the Division accounting officer should take the following actions to address the material irregularity, which should be implemented by 31 January 34. Refer to the annual performance report on pages x to x for information on the achievement of planned targets for the year and explana- of Revenue Act (Act 1 of 2018). 2020: tions provided for the under/ over achievement of a significant number of targets. This information should be considered in the context • The accounting officer should investigate the fruitless and wasteful expenditure incurred as a result of the interest paid. CONSEQUENCE MANAGEMENT of the material findings on the usefulness and reliability of the reported performance information in paragraphs x to x of this report. • Effective and appropriate disciplinary steps should be taken against any official that the investigation found to be responsible, as 50. Disciplinary steps were not taken against the officials who had permitted irregular expenditure, as required by section 38(1)(h)(iii) of the required by section 38(1)(h) of the PFMA and in accordance with treasury regulation 9.1.3. REPORT ON THE AUDIT OF COMPLIANCE WITH LEGISLATION PFMA. • Appropriate action should be taken to determine whether the responsible official is liable by law for the losses suffered by the Introduction and scope department for the purpose of recovery, as required by treasury regulations 9.1.4 and 12.7.1. 35. In accordance with the PAA and the general notice issued in terms thereof, I have a responsibility to report material findings on the compliance of the department with specific matters in key legislation. I performed procedures to identify findings but not to gather evidence to express assurance. 36. The material findings on compliance with specific matters in key legislations are as follows:

Department of Health Annual Report 2018/19 158 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

159 Department of Health Annual Report 2018/19 REPORT OF THE AUDITOR-GENERAL TO THE GAUTENG PROVINCIAL LEGISLATURE ON VOTE NO. 4: GAUTENG DEPARTMENT OF HEALTH

Department of Health Annual Report 2018/19 160 ANNEXURE – AUDITOR-GENERAL’S RESPONSIBILITY FOR THE AUDIT

1. As part of an audit in accordance with the ISAs, I exercise professional judgement and maintain professional scepticism throughout my audit of the financial statements, and the procedures performed on reported performance information for selected programmes and on the department’s compliance with respect to the selected subject matters.

FINANCIAL STATEMENTS 2. In addition to my responsibility for the audit of the financial statements as described in this auditor’s report, I also: • identify and assess the risks of material misstatement of the financial statements whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for my opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control • obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the department’s internal control • evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the accounting officer • conclude on the appropriateness of the accounting officer’s use of the going concern basis of accounting in the preparation of the financial statements. I also conclude, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the department’s ability to continue as a going concern. If I conclude that a material uncertainty exists, I am required to draw attention in my auditor’s report to the related disclosures in the financial statements about the material uncertainty or, if such disclosures are inadequate, to modify the opinion on the financial statements. My conclusions are based on the information available to me at the date of this auditor’s report. However, future events or conditions may cause a department to cease continuing as a going concern • evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation

COMMUNICATION WITH THOSE CHARGED WITH GOVERNANCE 3. I communicate with the accounting officer regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that I identify during my audit. 4. I also confirm to the accounting officer that I have complied with relevant ethical requirements regarding independence, and communicate all relationships and other matters that may reasonably be thought to have a bearing on my independence and, where applicable, related safeguards.

161 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Appropriation per programme 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Voted funds and Direct charges R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Programme

1 Administration 1 074 130 - 287 000 1 361 130 1 360 786 344 100,0% 1 085 267 1 085 177

2 District Health Services 15 360 917 - -287 000 15 073 917 14 516 480 557 437 96,3% 13 712 101 13 683 513

3 Emergency Medical Services 1 483 203 - -60 000 1 423 203 1 330 508 92 695 93,5% 1 268 154 1 219 274

4 Provincial Hospital Services 9 030 469 - -284 000 8 746 469 8 686 653 59 816 99,3% 7 892 663 7 892 277

5 Central Hospital Services 16 818 226 - 317 000 17 135 226 17 134 257 969 100,0% 15 333 041 15 316 687

6 Health Sciences and Training 1 123 296 - - 1 123 296 1 106 708 16 588 98,5% 928 471 918 987

7 Health Care Support Services 312 156 - 27 000 339 156 339 048 108 100,0% 289 838 289 767

8 Health Facilities Management 1 559 933 - - 1 559 933 1 536 120 23 813 98,5% 1 683 299 1 607 777

Programme sub total 46 762 330 - - 46 762 330 46 010 560 751 770 98,4% 42 192 834 42 013 459

Statutory Appropriation ------

Reconciliation with Statement of Financial Performance

Add: Departmental receipts 780 803 546 916

" Actual amounts per Statement of Financial Performance 47 543 133 42 739 750 (Total Revenue) " " Actual amounts per Statement of Financial Performance Expenditure " R46 010 560 R42 013 459

Department of Health Annual Report 2018/19 162 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Appropriation per economic classification 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 42 849 173 - -287 000 42 562 173 42 139 596 422 577 99,0% 38 413 851 38 669 349

1 Compensation of employees 26 994 470 - - 26 994 470 26 902 299 92 171 99,7% 24 965 403 25 085 331

2 Salaries and wages 23 294 170 - -8 000 23 286 170 23 740 315 -454 145 102,0% 21 852 778 22 113 279

3 Social contributions 3 700 300 - 8 000 3 708 300 3 161 984 546 316 85,3% 3 112 625 2 972 052

4 Goods and services 15 854 703 - -287 000 15 567 703 15 229 503 338 200 97,8% 13 448 448 13 583 390

5 Administrative fees 5 137 - - 5 137 4 162 975 81,0% 5 575 4 212

6 Advertising 3 899 - - 3 899 1 819 2 080 46,7% 6 791 2 154

7 Minor assets 98 732 - - 98 732 22 612 76 120 22,9% 105 054 32 319

8 Audit costs: External 23 710 - - 23 710 23 276 434 98,2% 22 368 20 731

Bursaries: Employees 9 139 - - 9 139 1 285 7 854 14,1% 8 622 4 067

Catering: Departmental activities 4 940 - - 4 940 2 332 2 608 47,2% 4 842 2 600

Communication (G&S) 101 021 - - 101 021 70 437 30 584 69,7% 92 948 74 378

Computer services 359 651 - - 359 651 64 711 294 940 18,0% 289 092 264 615

Consultants: Business and advisory services 189 526 - - 189 526 370 023 -180 497 195,2% 215 299 370 900

Laboratory services 2 513 707 - -425 000 2 088 707 2 138 382 -49 675 102,4% 1 541 789 1 535 121

Legal services 17 967 - - 17 967 101 023 -83 056 562,3% 121 452 314 227

Contractors 805 706 - - 805 706 741 416 64 290 92,0% 571 824 536 468

Agency and support / outsourced services 223 617 - - 223 617 245 764 -22 147 109,9% 349 979 255 725

Fleet services (including government motor transport) 323 232 - -60 000 263 232 254 328 8 904 96,6% 237 224 235 509

Inventory: Clothing material and accessories - - - - 2 298 -2 298 - 500 3 918

Inventory: Food and food supplies 380 445 - - 380 445 331 714 48 731 87,2% 342 080 338 723

Inventory: Fuel, oil and gas 218 466 - 8 000 226 466 262 538 -36 072 115,9% 171 642 220 779

Inventory: Learner and teacher support material 3 402 - - 3 402 15 003 -11 601 440,9% 1 652 813

Inventory: Materials and supplies 40 650 - - 40 650 29 593 11 057 72,8% 43 162 37 564

163 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Appropriation per economic classification 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000

Inventory: Medical supplies 2 767 724 - 317 000 3 084 724 3 619 141 (534 417) 117.3% 2 470 058 2 618 205 - Inventory: Medicine 4 935 506 - 138 000 4 797 506 4 132 206 665 300 86,1% 3 895 518 3 826 095

Inventory: Other supplies 123 698 - - 123 698 121 992 1 706 98,6% 134 388 112 339

Consumable supplies 522 431 - 11 000 533 431 485 743 47 688 91,1% 457 197 452 908

Consumable: Stationery, printing and office supplies 164 545 - - 164 545 166 441 -1 896 101,2% 159 849 152 092

Operating leases 171 019 - - 171 019 173 127 -2 108 101,2% 118 995 143 779

Property payments 1 653 998 - - 1 653 998 1 796 426 -142 428 108,6% 1 932 427 1 965 002

Transport provided: Departmental activity 8 702 - - 8 702 317 8 385 3,6% 13 075 4 875

Travel and subsistence 37 251 - - 37 251 16 518 20 733 44,3% 35 823 22 104

Training and development 58 094 - - 58 094 23 773 34 321 40,9% 48 699 23 391

Operating payments 65 395 - - 65 395 3 062 62 333 4,7% 45 263 5 336

Venues and facilities 22 582 - - 22 582 7 045 15 537 31,2% 4 526 1 457

Rental and hiring 811 - - 811 996 -185 122,8% 735 984

Interest and rent on land - - - - 7 794 -7 794 - - 628

Interest (Incl. interest on unitary payments (PPP)) - - - - 7 794 -7 794 - - 628

Department of Health Annual Report 2018/19 164 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Appropriation per economic classification 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Transfers and subsidies 1 669 969 287 000 1 956 969 2 293 095 336 126 117,2% 1 655 504 1 858 894

Provinces and municipalities 721 989 - - 721 989 721 992 -3 100,0% 739 104 739 104

Municipalities 721 989 - - 721 989 721 992 -3 100,0% 739 104 739 104

Municipal bank accounts 721 989 - - 721 989 721 992 -3 100,0% - -

Municipal agencies and funds ------739 104 739 104

Departmental agencies and accounts 20 962 - - 20 962 20 962 - 100,0% 19 812 19 812

Departmental agencies (non-business entities) 20 962 - - 20 962 20 962 - 100,0% 19 812 19 812

Higher education institutions 13 681 - - 13 681 13 421 260 98,1% 12 061 9 786

Non-profit institutions 664 528 - - 664 528 615 281 49 247 92,6% 698 608 556 250

Households 248 809 - 287 000 535 809 921 439 -385 630 172,0% 185 919 533 942

Payments for capital assets 2 243 187 - - 2 243 187 1 572 106 671 081 70,1% 2 123 479 1 476 113

Buildings and other fixed structures 900 267 - - 900 267 785 617 114 650 87,3% 818 917 615 434

Buildings 900 027 - - 900 027 785 617 114 410 87,3% 818 917 615 434

Other fixed structures 240 - - 240 - 240 - - -

Machinery and equipment 1 342 920 - - 1 342 920 786 489 556 431 58,6% 1 304 562 860 679

Transport equipment 159 710 -5 000 - 154 710 143 970 10 740 93,1% 199 910 139 335

Other machinery and equipment 1 183 210 5 000 - 1 188 210 642 519 545 691 54,1% 1 104 652 721 344

Payment for financial assets - - - - 5 763 -5 763 - - 9 103

46 762 330 - - 46 762 330 46 010 560 751 770 98,4% 42 192 834 42 013 459

165 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 1: Administration 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000

Sub programme 21 581 - - 21 581 10 038 11 543 46,5% 20 358 12 349

1 Office of the MEC 1 052 549 - 287 000 1 339 549 1 350 748 -11 199 100,8% 1 064 909 1 072 828

2 Management 1 074 130 - 287 000 1 361 130 1 360 786 344 100,0% 1 085 267 1 085 177

Economic classification 964 214 - - 767 466 196 748 79,6% 1 010 693 907 593

Current payments 436 135 - - 410 609 25 526 94,1% 421 250 381 314

Compensation of employees 360 041 - - 964 214 359 874 167 100,0% 372 816 334 340

Salaries and wages 76 094 - - 436 135 50 735 25 359 66,7% 48 434 46 974

Social contributions 528 079 - - 360 041 356 809 171 270 67,6% 589 443 525 651

Goods and services 1 538 - - 76 094 2 128 -590 138,4% 1 451 1 903

Administrative fees 1 003 - - 528 079 1 311 -308 130,7% 3 956 1 067

Advertising 223 - - 1 538 9 214 4,0% 210 298

Minor assets 23 710 - - 1 003 23 268 442 98,1% 22 368 20 731

Audit costs: External - - - 223 - - - - 56

Bursaries: Employees 566 - - 23 710 203 363 35,9% 628 625

Catering: Departmental activities 21 433 - - - 26 705 -5 272 124,6% 20 086 12 969

Communication (G&S) 348 479 - - 566 62 532 285 947 17,9% 277 831 260 337

Computer services 47 452 - - 21 433 92 570 -45 118 195,1% 80 678 70 767

Consultants: Business and advisory services 16 167 - - 348 479 100 625 -84 458 622,4% 121 452 123 791

Legal services 376 - - 47 452 248 128 66,0% 354 303

Contractors - - - 16 167 - - - - 66

Agency and support / outsourced services 2 710 - - 376 2 849 -139 105,1% 2 557 2 512

Fleet services (including government motor transport) 29 - - - 15 14 51,7% 27 52

Inventory: Food and food supplies 40 - - 2 710 - 40 - 37 50

Inventory: Materials and supplies - - - 29 161 -161 - - 351

Department of Health Annual Report 2018/19 166 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Appropriation per economic classification 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Medical supplies - - - - 161 -161 - - 351

Inventory: Medicine - - - - 11 003 -11 003 - - 108

Inventory: Other supplies - - - - 4 667 -4 667 - 2 084 1 489

Consumable supplies 28 757 - - 28 757 118 28 639 0,4% 592 483

Consumable: Stationery, printing and office supplies 4 944 - - 4 944 1 628 3 316 32,9% 7 493 3 268

Operating leases 8 528 - - 8 528 9 968 -1 440 116,9% 15 381 3 400

Property payments 5 990 - - 5 990 4 873 1 117 81,4% 22 840 9 746

Transport provided: Departmental activity 2 - - 2 - 2 - 2 -

Travel and subsistence 7 943 - - 7 943 3 866 4 077 48,7% 7 864 3 383

Training and development 6 194 - - 6 194 6 865 -671 110,8% 1 175 7 347

Operating payments ------111

Venues and facilities 1 802 - - 1 802 839 963 46,6% 181 104

Rental and hiring 193 - - 193 358 -165 185,5% 183 334

Interest and rent on land - - - - 48 -48 - - 628

Interest (Incl. interest on unitary payments (PPP)) - - - - 48 -48 - - 628

Transfers and subsidies 2 450 - 287 000 289 450 588 392 -298 942 203,3% 2 313 165 909

Higher education institutions - - - - 566 -566 - - -

Households 2 450 - 287 000 289 450 587 826 -298 376 203,1% 2 313 165 909

Social benefits 1 074 - - 1 074 1 805 -731 168,1% 1 013 1 637

Other transfers to households 1 376 - 287 000 288 376 586 021 -297 645 203,2% 1 300 164 272

Payments for capital assets 107 466 - - 107 466 4 814 102 652 4,5% 72 261 11 744

Machinery and equipment 107 466 - - 107 466 4 814 102 652 4,5% 72 261 11 744

Transport equipment 4 753 - - 4 753 1 382 3 371 29,1% 4 485 3 549

Other machinery and equipment 102 713 - - 102 713 3 432 99 281 3,3% 67 776 8 195

Payment for financial assets - - - - 114 -114 - - -69

1 074 130 - 287 000 1 361 130 1 360 786 344 100,0% 1 085 267 1 085 177

167 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 1.1: Office of the MEC 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000

Current payments 20 918 - - 20 918 9 618 11 300 46,0% 19 732 11 647

Compensation of employees 16 059 - - 16 059 8 399 7 660 52,3% 15 150 10 265

Salaries and wages 14 501 - - 14 501 7 574 6 927 52,2% 13 680 9 344

Social contributions 1 558 - - 1 558 825 733 53,0% 1 470 921

Goods and services 4 859 - - 4 859 1 219 3 640 25,1% 4 582 1 382

Administrative fees 108 - - 108 - 108 - 102 10

Minor assets 33 - - 33 5 28 15,2% 31 -

Catering: Departmental activities 100 - - 100 34 66 34,0% 93 61

Communication (G&S) 303 - - 303 - 303 - 286 33

Fleet services (including government motor transport) 412 - - 412 254 158 61,7% 389 480

Inventory: Food and food supplies 29 - - 29 2 27 6,9% 27 11

Inventory: Materials and supplies ------33

Inventory: Other supplies ------1

Consumable supplies 67 - - 67 8 59 11,9% 63 24

Department of Health Annual Report 2018/19 168 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 1.1: Office of the MEC 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000

Consumable: Stationery, printing and office supplies 506 - - 506 37 469 7,3% 477 56

Operating leases - - - - 626 -626 - - 506

Travel and subsistence 3 113 - - 3 113 240 2 873 7,7% 2 937 112

Venues and facilities 170 - - 170 13 157 7,6% 160 54

Rental and hiring 18 - - 18 - 18 - 17 -

Transfers and subsidies - - - - 76 -76 - - -

Households - - - - 76 -76 - - -

Social benefits - - - 76 -76 - - -

Payments for capital assets 663 - - 663 303 360 45,7% 626 702

Machinery and equipment 663 - - 663 303 360 45,7% 626 702

Transport equipment 513 - - 513 238 275 46,4% 485 534

Other machinery and equipment 150 - - 150 65 85 43,3% 141 168

Payment for financial assets - - - - 41 -41 - - -

Total 21 581 - - 21 581 10 038 11 543 46,5% 20 358 12 349

169 Department of Health Annual Report 2018/19 20 358

1 064 909

1 085 267

1 010 693

421 250

372 816

48 434

589 443

1 451

3 956

210

22 368

628

20 086

277 831

80 678

121 452

354

2 557

GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 1.2: Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 943 296 - - 943 296 757 848 185 448 80,3% 990 961 895 946 Compensation of employees 420 076 - - 420 076 402 210 17 866 95,7% 406 100 371 049 Salaries and wages 345 540 345 540 352 300 (6 760) 102,0% 359 136 324 996 Social contributions 74 536 74 536 49 910 24 626 67,0% 46 964 46 053 Goods and services 523 220 - - 523 220 355 590 167 630 68,0% 584 861 524 269 Administrative fees 1 430 1 430 2 128 (698) 148,8% 1 349 1 893 Advertising 1 003 1 003 1 311 (308) 130,7% 3 956 1 067 Minor assets 190 190 4 186 2,1% 179 298 Audit costs: External 23 710 23 710 23 268 442 98,1% 22 368 20 731 Bursaries: Employees ------56 Catering: Departmental activities 466 466 169 297 36,3% 535 564 Communication (G&S) 21 130 21 130 26 705 (5 575) 126,4% 19 800 12 936 Computer services 348 479 348 479 62 532 285 947 17,9% 277 831 260 337 Consultants: Business and advisory services 47 452 47 452 92 570 (45 118) 195,1% 80 678 70 767 Legal services 16 167 16 167 100 625 (84 458) 622,4% 121 452 123 791 Contractors 376 376 248 128 66,0% 354 302 Agency and support / outsourced services ------66 Fleet services (including government motor transport) 2 298 2 298 2 595 (297) 112,9% 2 168 2 032 Inventory: Food and food supplies - - 13 (13) - - 41 Inventory: Fuel, oil and gas - - - - - 13 - Inventory: Materials and supplies 40 40 - 40 - 37 17 Inventory: Medical supplies - - 161 (161) - - 351 Inventory: Medicine - - 11 003 (11 003) - - 108 Inventory: Other supplies - - 4 667 (4 667) - 2 084 1 488 Consumable supplies 28 690 28 690 110 28 580 0,4% 529 459 Consumable: Stationery, printing and office supplies 4 438 4 438 1 591 2 847 35,8% 7 016 3 212

Department of Health Annual Report 2018/19 170 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 1.2: Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Operating leases 8 528 8 528 9 342 (814) 109,5% 15 381 2 894 Property payments 5 990 5 990 4 873 1 117 81,4% 22 840 9 746 Transport provided: Departmental activity 2 2 - 2 - 2 - Travel and subsistence 4 830 4 830 3 626 1 204 75,1% 4 927 3 271 Training and development 6 194 6 194 6 865 (671) 110,8% 1 175 7 347 Operating payments ------111 Venues and facilities 1 632 1 632 826 806 50,6% 21 50 Rental and hiring 175 175 358 (183) 204,6% 166 334 Interest and rent on land - - - - 48 (48) - - 628 Interest (Incl. interest on unitary payments (PPP)) - 48 (48) - - 628 Transfers and subsidies 2 450 - 287 000 289 450 588 316 (298 866) 203,3% 2 313 165 909 Higher education institutions - 566 (566) - - Households 2 450 - 287 000 289 450 587 750 (298 300) 203,1% 2 313 165 909 Social benefits 1 074 1 074 1 729 (655) 161,0% 1 013 1 637 Other transfers to households 1 376 287 000 288 376 586 021 (297 645) 203,2% 1 300 164 272 Payments for capital assets 106 803 - - 106 803 4 511 102 292 4,2% 71 635 11 042 Machinery and equipment 106 803 - - 106 803 4 511 102 292 4,2% 71 635 11 042 Transport equipment 4 240 4 240 1 144 3 096 27,0% 4 000 3 015 Other machinery and equipment 102 563 102 563 3 367 99 196 3,3% 67 635 8 027 Payment for financial assets - 73 (73) - - (69) Total 1 052 549 - 287 000 1 339 549 1 350 748 (11 199) 100,8% 1 064 909 1 072 828

171 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 2: District Health Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme

District Management 505 175 - - 505 175 527 767 -22 592 104,5% 516 536 524 552

Community Health Clinics 2 472 905 - - 2 472 905 2 382 980 89 925 96,4% 2 425 500 2 416 248

Community Health Centres 2 001 669 - - 2 001 669 1 941 214 60 455 97,0% 1 778 040 1 792 265

Community Based Services 1 996 989 - - 1 996 989 2 082 026 -85 037 104,3% 1 780 080 1 780 657

HIV, AIDS 4 465 616 - - 4 465 616 4 096 480 369 136 91,7% 3 957 203 3 890 431

Nutrition 58 548 - - 58 548 55 993 2 555 95,6% 55 583 49 557

Coroner Services 240 133 - - 240 133 225 305 14 828 93,8% 215 243 214 321

District Hospitals 3 619 882 - -287 000 3 332 882 3 204 715 128 167 96,2% 2 983 916 3 015 482

15 360 917 - -287 000 15 073 917 14 516 480 557 437 96,3% 13 712 101 13 683 513

Economic classification

Current payments 14 367 406 - -287 000 14 080 406 13 566 475 513 931 96,4% 12 688 348 12 713 689

Compensation of employees 7 795 903 - - 7 795 903 7 762 182 33 721 99,6% 7 093 354 7 155 763

Salaries and wages 6 699 920 - - 6 699 920 6 759 196 -59 276 100,9% 6 155 015 6 219 445

Social contributions 1 095 983 - - 1 095 983 1 002 986 92 997 91,5% 938 339 936 318

Goods and services 6 571 503 - -287 000 6 284 503 5 804 293 480 210 92,4% 5 594 994 5 557 926

Administrative fees 798 - - 798 223 575 27,9% 910 370

Advertising 564 - - 564 330 234 58,5% 1 318 220

Minor assets 25 489 - - 25 489 11 421 14 068 44,8% 27 215 14 487

Catering: Departmental activities 3 930 - - 3 930 2 070 1 860 52,7% 3 630 1 807

Communication (G&S) 42 214 - - 42 214 17 691 24 523 41,9% 37 900 28 266

Computer services - - - - 15 -15 - - 1 032

Consultants: Business and advisory services 29 080 - - 29 080 29 397 -317 101,1% 29 324 35 217

Laboratory services 1 153 872 - -275 000 878 872 956 687 -77 815 108,9% 756 855 840 331

Legal services ------6 047

Department of Health Annual Report 2018/19 172 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 2: District Health Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000

Contractors 578 780 - - 578 780 423 037 155 743 73,1% 354 331 346 772

Agency and support / outsourced services 61 179 - - 61 179 30 978 30 201 50,6% 60 903 43 563

Fleet services (including government motor transport) 33 295 - - 33 295 24 009 9 286 72,1% 38 571 34 116

Inventory: Clothing material and accessories - - - - 677 -677 - - 1 807

Inventory: Food and food supplies 85 343 - - 85 343 57 754 27 589 67,7% 64 529 63 934

Inventory: Fuel, oil and gas 75 711 - - 75 711 74 673 1 038 98,6% 85 872 52 088

Inventory: Learner and teacher support material - - - - 4 333 -4 333 - 43 -

Inventory: Materials and supplies 15 667 - - 15 667 5 615 10 052 35,8% 17 368 12 609

Inventory: Medical supplies 536 755 - - 536 755 484 008 52 747 90,2% 525 976 463 091

Inventory: Medicine 3 158 696 -12 000 3 146 696 3 021 249 125 447 96,0% 2 785 627 2 872 048

Inventory: Other supplies 29 057 - - 29 057 21 316 7 741 73,4% 35 662 35 706

Consumable supplies 129 624 - - 129 624 82 042 47 582 63,3% 126 894 107 703

Consumable: Stationery, printing and office supplies 71 595 - - 71 595 58 349 13 246 81,5% 71 104 73 320

Operating leases 37 086 - - 37 086 46 398 -9 312 125,1% 26 498 43 513

Property payments 374 169 - - 374 169 433 510 -59 341 115,9% 453 437 463 037

Transport provided: Departmental activity 1 821 - - 1 821 10 1 811 0,5% 2 145 200

Travel and subsistence 11 337 - - 11 337 7 017 4 320 61,9% 10 176 5 869

Training and development 39 696 - - 39 696 4 326 35 370 10,9% 34 671 8 428

Operating payments 59 827 - - 59 827 438 59 389 0,7% 39 638 673

Venues and facilities 15 830 - - 15 830 6 206 9 624 39,2% 4 345 1 235

Rental and hiring 88 - - 88 514 -426 584,1% 52 437

173 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 2: District Health Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Transfers and subsidies 874 495 - - 874 495 825 077 49 418 94,3% 802 260 834 240

Provinces and municipalities 383 475 - - 383 475 383 478 -3 100,0% 361 769 361 769

Municipalities 383 475 - - 383 475 383 478 -3 100,0% 361 769 361 769

Municipal bank accounts 383 475 - - 383 475 383 478 -3 100,0% - -

Non-profit institutions 464 528 - - 464 528 415 281 49 247 89,4% 411 459 406 250

Households 26 492 - - 26 492 26 318 174 99,3% 29 032 66 221

Social benefits 26 492 - - 26 492 26 150 342 98,7% 29 032 27 644

Other transfers to households - - - - 168 -168 - - 38 577

Payments for capital assets 119 016 - - 119 016 122 969 -3 953 103,3% 221 493 133 457

Buildings and other fixed structures 240 - - 240 - 240 - - -

Other fixed structures 240 - - 240 - 240 - - -

Machinery and equipment 118 776 - - 118 776 122 969 -4 193 103,5% 221 493 133 457

Transport equipment 31 688 - - 31 688 50 573 -18 885 159,6% 50 142 32 913

Other machinery and equipment 87 088 - - 87 088 72 396 14 692 83,1% 171 351 100 544

- - - - 1 959 -1 959 - - 2 127

Payment for financial assets 15 360 917 - -287 000 15 073 917 14 516 480 557 437 96,3% 13 712 101 13 683 513

Department of Health Annual Report 2018/19 174 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.1: District Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 482 908 - - 482 908 479 644 3 264 99,3% 474 305 490 090 Compensation of employees 357 790 - - 357 790 342 308 15 482 95,7% 361 055 342 554 Salaries and wages 309 394 309 394 296 346 13 048 95,8% 314 398 296 167 Social contributions 48 396 48 396 45 962 2 434 95,0% 46 657 46 387 Goods and services 125 118 - - 125 118 137 336 (12 218) 109,8% 113 250 147 536 Administrative fees 135 135 5 130 3,7% 103 63 Advertising 153 153 1 152 0,7% 467 5 Minor assets 500 500 350 150 70,0% 3 217 1 789 Catering: Departmental activities 748 748 179 569 23,9% 636 362 Communication (G&S) 8 366 8 366 4 874 3 492 58,3% 8 950 9 940 Computer services ------880 Consultants: Business and advisory services - - 15 (15) - - 6 Legal services ------76 Contractors 2 788 2 788 94 2 694 3,4% 1 868 416 Agency and support / outsourced services 1 033 1 033 286 747 27,7% 1 039 1 045 Fleet services (including government motor transport) 7 667 7 667 8 507 (840) 111,0% 7 732 14 509 Inventory: Clothing material and accessories ------362 Inventory: Food and food supplies 1 307 1 307 382 925 29,2% 1 752 560 Inventory: Fuel, oil and gas 3 104 3 104 2 197 907 70,8% 1 029 1 598 Inventory: Learner and teacher support material ------Inventory: Materials and supplies 1 890 1 890 189 1 701 10,0% 1 728 2 301 Inventory: Medical supplies 12 939 12 939 35 336 (22 397) 273,1% 10 398 33 277 Inventory: Medicine ------64 Inventory: Other supplies 3 080 3 080 2 891 189 93,9% 3 955 7 568 Consumable supplies 7 436 7 436 3 828 3 608 51,5% 9 551 4 716

175 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.1: District Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable: Stationery, printing and office supplies 16 019 16 019 16 365 (346) 102,2% 9 840 14 956 Operating leases 18 848 18 848 18 547 301 98,4% 16 325 31 307 Property payments 28 666 28 666 36 049 (7 383) 125,8% 30 366 19 993 Transport provided: Departmental activity 100 100 - 100 - 550 - Travel and subsistence 2 382 2 382 1 204 1 178 50,5% 2 085 1 435 Training and development 1 713 1 713 45 1 668 2,6% 1 522 291 Operating payments 172 172 1 171 0,6% 80 16 Venues and facilities 6 020 6 020 5 991 29 99,5% 5 1 Rental and hiring 52 52 - 52 - 52 - Transfers and subsidies 2 330 - - 2 330 2 007 323 86,1% 1 904 2 790 Households 2 330 - - 2 330 2 007 323 86,1% 1 904 2 790 Social benefits 2 330 2 330 2 007 323 86,1% 1 904 2 588 Other transfers to households ------202 Payments for capital assets 19 937 - - 19 937 45 700 (25 763) 229,2% 40 327 31 388 Machinery and equipment 19 937 - - 19 937 45 700 (25 763) 229,2% 40 327 31 388 Transport equipment 12 494 12 494 41 845 (29 351) 334,9% 16 226 21 563 Other machinery and equipment 7 443 7 443 3 855 3 588 51,8% 24 101 9 825 Payment for financial assets - 416 (416) - - 284 Total 505 175 - - 505 175 527 767 (22 592) 104,5% 516 536 524 552

Department of Health Annual Report 2018/19 176 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.2: Community Health Clinics 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 2 122 143 - - 2 122 143 2 025 577 96 566 95,4% 2 067 798 2 055 693

Compensation of employees 1 272 718 - - 1 272 718 1 280 266 -7 548 100,6% 1 205 239 1 193 224

Salaries and wages 1 103 942 - - 1 103 942 1 096 654 7 288 99,3% 1 049 989 1 017 627

Social contributions 168 776 - - 168 776 183 612 -14 836 108,8% 155 250 175 597

Goods and services 849 425 - - 849 425 745 311 104 114 87,7% 862 559 862 469

Administrative fees - - - - 1 -1 - 20 6

Minor assets 5 221 - - 5 221 3 424 1 797 65,6% 6 210 4 660

Communication (G&S) 8 801 - - 8 801 3 178 5 623 36,1% 8 392 4 487

Consultants: Business and advisory services ------500 316

Laboratory services 93 601 93 601 98 787 -5 186 105,5% 82 087 50 936

Legal services ------426

Contractors 2 398 - - 2 398 7 963 -5 565 332,1% 5 443 6 001

Agency and support / outsourced services 3 368 - - 3 368 1 209 2 159 35,9% 2 235 1 284

Fleet services (including government motor transport) 100 - - 100 73 27 73,0% 4 656 705

Inventory: Clothing material and accessories - - - - 6 -6 - - 62

Inventory: Food and food supplies 182 - - 182 23 159 12,6% 454 86

Inventory: Fuel, oil and gas 3 166 - - 3 166 1 018 2 148 32,2% 10 921 2 273

Inventory: Materials and supplies 1 578 - - 1 578 1 073 505 68,0% 2 365 1 766

Inventory: Medical supplies 50 000 - - 50 000 25 028 24 972 50,1% 93 257 36 805

Inventory: Medicine 500 947 - - 500 947 450 872 50 075 90,0% 445 250 569 779

Inventory: Other supplies 2 068 - - 2 068 1 157 911 55,9% 1 996 2 523

Consumable supplies 13 800 - - 13 800 8 561 5 239 62,0% 21 267 9 752

Consumable: Stationery, printing and office supplies 6 774 - - 6 774 5 529 1 245 81,6% 9 656 4 425

Operating leases 2 989 - - 2 989 1 720 1 269 57,5% 3 114 1 074

Property payments 153 200 153 200 135 519 17 681 88,5% 162 591 164 775

177 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.2: Community Health Clinics 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Operating leases 2 989 2 989 1 720 1 269 57,5% 3 114 1 074 Property payments 153 200 153 200 135 519 17 681 88,5% 162 591 164 775 Transport provided: Departmental activity - - - - - 50 25 Travel and subsistence 435 435 94 341 21,6% 884 43 Training and development 474 474 - 474 - 451 3 Operating payments 323 323 7 316 2,2% 760 257 Rental and hiring - - 69 (69) - - Transfers and subsidies 335 762 - - 335 762 336 893 (1 131) 100,3% 318 848 333 412 Provinces and municipalities 316 463 - - 316 463 316 463 - 100,0% 298 550 298 550 Municipalities 316 463 - - 316 463 316 463 - 100,0% 298 550 298 550 Municipal bank accounts 316 463 316 463 316 463 - 100,0% - Municipal agencies and funds - - - - 298 550 298 550 Non-profit institutions 13 308 13 308 13 115 193 98,5% 12 578 12 578 Households 5 991 - - 5 991 7 315 (1 324) 122,1% 7 720 22 284 Social benefits 5 991 5 991 7 315 (1 324) 122,1% 7 720 4 851 Other transfers to households - - - - - 17 433 Payments for capital assets 15 000 - - 15 000 19 974 (4 974) 133,2% 38 854 26 733 Machinery and equipment 15 000 - - 15 000 19 974 (4 974) 133,2% 38 854 26 733 Transport equipment 450 450 208 242 46,2% 2 500 90 Other machinery and equipment 14 550 14 550 19 766 (5 216) 135,8% 36 354 26 643 Payment for financial assets - 536 (536) - - 410 Total 2 472 905 - - 2 472 905 2 382 980 89 925 96,4% 2 425 500 2 416 248

Department of Health Annual Report 2018/19 178 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.3: Community Health Centres 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 1 982 753 - - 1 982 753 1 920 182 62 571 96,8% 1 727 804 1 760 874 Compensation of employees 1 442 477 - - 1 442 477 1 385 428 57 049 96,0% 1 218 348 1 272 815 Salaries and wages 1 246 062 1 246 062 1 192 485 53 577 95,7% 1 068 542 1 097 011 Social contributions 196 415 196 415 192 943 3 472 98,2% 149 806 175 804 Goods and services 540 276 - - 540 276 534 754 5 522 99,0% 509 456 488 059 Administrative fees 10 10 15 (5) 150,0% 14 12 Minor assets 4 795 4 795 1 714 3 081 35,7% 6 666 2 458 Catering: Departmental activities ------1 Communication (G&S) 6 878 6 878 3 744 3 134 54,4% 5 761 5 770 Computer services - - 15 (15) - - 37 Consultants: Business and advisory services ------Laboratory services 47 800 47 800 41 847 5 953 87,5% 21 981 21 256 Scientific and technological services ------Legal services ------389 Contractors 7 495 7 495 4 910 2 585 65,5% 4 714 4 823 Agency and support / outsourced services 4 955 4 955 3 259 1 696 65,8% 4 529 2 576 Fleet services (including government motor transport) 4 182 4 182 4 403 (221) 105,3% 3 342 7 428 Inventory: Clothing material and accessories - - 1 (1) - - 277 Inventory: Farming supplies ------Inventory: Food and food supplies 2 813 2 813 298 2 515 10,6% 1 940 701 Inventory: Fuel, oil and gas 20 410 20 410 17 115 3 295 83,9% 18 338 5 381 Inventory: Materials and supplies 2 591 2 591 1 544 1 047 59,6% 1 421 834 Inventory: Medical supplies 25 508 25 508 20 931 4 577 82,1% 44 438 23 890 Inventory: Medicine 231 976 231 976 287 513 (55 537) 123,9% 248 854 248 265 Inventory: Other supplies 3 701 3 701 1 621 2 080 43,8% 2 446 2 714

179 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.3: Community Health Centres 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable supplies 15 256 15 256 9 730 5 526 63,8% 15 790 9 930 Consumable: Stationery, printing and office supplies 10 503 10 503 8 898 1 605 84,7% 10 895 8 023 Operating leases 7 852 7 852 12 609 (4 757) 160,6% 847 6 219 Property payments 142 697 142 697 114 333 28 364 80,1% 116 855 136 748 Transport provided: Departmental activity ------Travel and subsistence 164 164 199 (35) 121,3% 50 241 Training and development 664 664 - 664 - 134 1 Operating payments 26 26 55 (29) 211,5% 441 85 Transfers and subsidies 7 056 - - 7 056 5 718 1 338 81,0% 6 718 6 909 Non-profit institutions - - - 16 Households 7 056 - - 7 056 5 718 1 338 81,0% 6 718 6 893 Social benefits 7 056 7 056 5 718 1 338 81,0% 6 718 6 665 Other transfers to households - - - - - 228 Payments for capital assets 11 860 - - 11 860 15 072 (3 212) 127,1% 43 518 23 963 Machinery and equipment 11 860 - - 11 860 15 072 (3 212) 127,1% 43 518 23 963 Transport equipment 1 918 1 918 2 205 (287) 115,0% 16 547 5 321 Other machinery and equipment 9 942 9 942 12 867 (2 925) 129,4% 26 971 18 642 Heritage assets - - - - Payment for financial assets - 242 (242) - - 519 Total 2 001 669 - - 2 001 669 1 941 214 60 455 97,0% 1 778 040 1 792 265

Department of Health Annual Report 2018/19 180 96 566 95,4%

-7 548 100,6%

7 288 99,3%

-14 836 108,8%

104 114 87,7%

-1 -

1 797 65,6%

5 623 36,1%

- -

-5 186 105,5%

- -

-5 565 332,1%

2 159 35,9%

27 73,0%

-6 -

159 12,6%

2 148 32,2%

505 68,0%

24 972 50,1%

50 075 90,0%

911 55,9%

5 239 62,0%

1 245 81,6%

1 269 57,5%

17 681 88,5%

GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.4: Community Based Services 2018/19 2017/18 Subprogramme: 2.4: Community Based Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Adjusted ShiftingFunds of Virement Appropriation Final Expenditure Actual Variance Expenditureas % of final Appropriation Final Expenditure Actual Appropriation Funds Appropriation Expenditure appropriationas % of final Appropriation Expenditure appropriation Economic Economic classification classification R'000R'000 R'000R'000 R'000R'000 R'000R'000 R'000R'000R'000 R'000 % % R'000R'000R'000 R'000 Current payments 1 648 673 - - 1 648 673 1 804 812 (156 139) 109,5% 1 512 352 1 513 178 Compensation of employees 1 238 350 - - 1 238 350 1 245 490 (7 140) 100,6% 1 081 261 1 121 509 Salaries and wages 1 076 549 1 076 549 1 122 091 (45 542) 104,2% 947 070 1 006 818 Social contributions 161 801 161 801 123 399 38 402 76,3% 134 191 114 691 Goods and services 410 323 - - 410 323 559 322 (148 999) 136,3% 431 091 391 669 Administrative fees 272 272 65 207 23,9% 230 47 Advertising 220 220 - 220 - 600 20 Minor assets 2 309 2 309 314 1 995 13,6% 2 205 1 622 Catering: Departmental activities 1 262 1 262 119 1 143 9,4% 1 458 768 Communication (G&S) 6 661 6 661 1 024 5 637 15,4% 4 041 2 005 Computer services ------1 Consultants: Business and advisory services - - 333 (333) - - - Laboratory services 4 014 4 014 4 726 (712) 117,7% 6 648 2 572 Contractors 7 022 7 022 3 808 3 214 54,2% 6 369 3 813 Agency and support / outsourced services 2 091 2 091 971 1 120 46,4% 922 562 Fleet services (including government motor transport) 1 000 1 000 1 135 (135) 113,5% 7 406 1 817 Inventory: Clothing material and accessories - - 33 (33) - - 37 Inventory: Food and food supplies 10 390 10 390 12 017 (1 627) 115,7% 10 228 14 132 Inventory: Fuel, oil and gas 4 954 4 954 5 824 (870) 117,6% 15 657 7 567 Inventory: Learner and teacher support material ------Inventory: Materials and supplies 644 644 70 574 10,9% 1 377 1 085 Inventory: Medical supplies 76 564 76 564 85 377 (8 813) 111,5% 53 832 56 901 Inventory: Medicine 264 745 264 745 430 547 (165 802) 162,6% 290 701 275 141 Inventory: Other supplies 593 593 402 191 67,8% 1 084 428

181 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.4: Community Based Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable supplies 7 978 7 978 (3 870) 11 848 (48,5%) 5 960 5 281 Consumable: Stationery, printing and office supplies 3 313 3 313 2 332 981 70,4% 5 157 4 096 Operating leases 1 098 1 098 276 822 25,1% 788 319 Property payments 7 078 7 078 10 217 (3 139) 144,3% 9 900 9 888 Transport provided: Departmental activity 774 774 - 774 - 568 24 Travel and subsistence 3 903 3 903 2 531 1 372 64,8% 2 965 2 310 Training and development 3 130 3 130 1 067 2 063 34,1% 2 584 1 077 Operating payments 272 272 4 268 1,5% 361 156 Venues and facilities - - - - - 50 Rental and hiring 36 36 - 36 - - Transfers and subsidies 315 521 - - 315 521 274 885 40 636 87,1% 260 098 261 887 Non-profit institutions 313 408 313 408 272 531 40 877 87,0% 257 338 257 151 Households 2 113 - - 2 113 2 354 (241) 111,4% 2 760 4 736 Social benefits 2 113 2 113 2 265 (152) 107,2% 2 760 2 638 Other transfers to households - - 89 (89) - - 2 098 Payments for capital assets 32 795 - - 32 795 2 239 30 556 6,8% 7 630 5 500 Machinery and equipment 32 795 - - 32 795 2 239 30 556 6,8% 7 630 5 500 Transport equipment 3 888 3 888 119 3 769 3,1% 824 28 Other machinery and equipment 28 907 28 907 2 120 26 787 7,3% 6 806 5 472 Payment for financial assets - 90 (90) - - 92 Total 1 996 989 - - 1 996 989 2 082 026 (85 037) 104,3% 1 780 080 1 780 657

Department of Health Annual Report 2018/19 182 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.5: HIV, AIDS 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 4 310 838 - - 4 310 838 3 952 472 358 366 91,7% 3 782 116 3 733 103 Compensation of employees 894 538 - - 894 538 935 210 (40 672) 104,5% 896 112 842 421 Salaries and wages 743 156 743 156 808 824 (65 668) 108,8% 749 390 728 682 Social contributions 151 382 151 382 126 386 24 996 83,5% 146 722 113 739 Goods and services 3 416 300 - - 3 416 300 3 017 262 399 038 88,3% 2 886 004 2 890 682 Administrative fees 6 6 - 6 - 29 9 Advertising - - 329 (329) - - 170 Minor assets 72 72 (26) 98 (36,1%) 366 304 Catering: Departmental activities 1 752 1 752 1 719 33 98,1% 1 222 563 Communication (G&S) 759 759 17 742 2,2% 279 28 Consultants: Business and advisory services 29 000 29 000 28 843 157 99,5% 28 700 34 697 Laboratory services 617 532 617 532 701 951 (84 419) 113,7% 600 444 720 171 Contractors 538 941 538 941 391 732 147 209 72,7% 316 320 316 433 Agency and support / outsourced services 11 500 11 500 1 214 10 286 10,6% 11 550 - Fleet services (including government motor transport) 809 809 28 781 3,5% 1 132 75 Inventory: Food and food supplies 13 631 13 631 6 849 6 782 50,2% 6 239 5 902 Inventory: Materials and supplies 1 1 4 (3) 400,0% 1 62 Inventory: Medical supplies 169 313 169 313 122 235 47 078 72,2% 162 860 127 594 Inventory: Medicine 2 027 533 2 027 533 1 746 195 281 338 86,1% 1 654 234 1 632 219 Inventory: Other supplies - - 2 (2) - 1 477 5

183 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.5: HIV, AIDS 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable supplies 6 742 6 742 6 507 235 96,5% 14 722 21 356 Consumable: Stationery, printing and office supplies 10 328 10 328 3 554 6 774 34,4% 13 860 21 310 Operating leases - - 19 (19) - - 101 Property payments (112 472) (112 472) 659 (113 131) (0,6%) 1 953 799 Travel and subsistence 2 888 2 888 2 282 606 79,0% 2 616 1 292 Training and development 30 521 30 521 2 973 27 548 9,7% 27 166 6 697 Operating payments 58 134 58 134 165 57 969 0,3% 37 044 24 Venues and facilities 9 310 9 310 11 9 299 0,1% 3 790 871 Rent on land - - - - Transfers and subsidies 147 476 - - 147 476 142 450 5 026 96,6% 152 174 152 871 Provinces and municipalities 67 012 - - 67 012 67 015 (3) 100,0% 63 219 63 219 Municipalities 67 012 - - 67 012 67 015 (3) 100,0% 63 219 63 219 Municipal bank accounts 67 012 67 012 67 015 (3) 100,0% - Municipal agencies and funds - - - 63 219 63 219 Non-profit institutions 79 264 79 264 73 652 5 612 92,9% 85 960 86 948 Households 1 200 - - 1 200 1 783 (583) 148,6% 2 995 2 704 Social benefits 1 200 1 200 1 783 (583) 148,6% 2 995 2 704 Payments for capital assets 7 302 - - 7 302 1 411 5 891 19,3% 22 913 4 298 Buildings and other fixed structures 240 - - 240 - 240 - - - Other fixed structures 240 240 240 - - Machinery and equipment 7 062 - - 7 062 1 411 5 651 20,0% 22 913 4 298 Transport equipment 550 550 25 525 4,5% - 19 Other machinery and equipment 6 512 6 512 1 386 5 126 21,3% 22 913 4 279 Payment for financial assets - 147 (147) - - 159 Total 4 465 616 - - 4 465 616 4 096 480 369 136 91,7% 3 957 203 3 890 431

Department of Health Annual Report 2018/19 184 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.6: Nutrition 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments - - - - 10 (10) - - - Compensation of employees - - - - 10 (10) - - - Salaries and wages - 10 (10) - Transfers and subsidies 58 548 - - 58 548 55 983 2 565 95,6% 55 583 49 557 Non-profit institutions 58 548 58 548 55 983 2 565 95,6% 55 583 49 557 Total 58 548 - - 58 548 55 993 2 555 95,6% 55 583 49 557

Subprogramme: 2.7: Coroner Services appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 231 962 - - 231 962 220 210 11 752 94,9% 207 961 209 881 Compensation of employees 195 236 - - 195 236 187 316 7 920 95,9% 172 865 179 309 Salaries and wages 165 877 165 877 165 655 222 99,9% 152 715 158 206 Social contributions 29 359 29 359 21 661 7 698 73,8% 20 150 21 103 Goods and services 36 726 - - 36 726 32 894 3 832 89,6% 35 096 30 572 Administrative fees 34 34 5 29 14,7% 30 12 Advertising 90 90 - 90 - 158 24 Minor assets 567 567 77 490 13,6% 535 193 Catering: Departmental activities 116 116 53 63 45,7% 114 110 Communication (G&S) 1 661 1 661 305 1 356 18,4% 1 777 558 Consultants: Business and advisory services - - - - - 52 25

185 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.7: Coroner Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Laboratory services 592 592 56 536 9,5% 275 211 Contractors 821 821 118 703 14,4% 775 78 Agency and support / outsourced services 2 022 2 022 855 1 167 42,3% 1 908 1 075 Fleet services (including government motor transport) 5 056 5 056 6 607 (1 551) 130,7% 4 770 5 142 Inventory: Fuel, oil and gas - - 5 (5) - 30 5 Inventory: Learner and teacher support material ------Inventory: Materials and supplies 282 282 72 210 25,5% 394 111 Inventory: Medical supplies 6 387 6 387 8 538 (2 151) 133,7% 6 210 7 948 Inventory: Medicine 38 38 3 35 7,9% - 16 Inventory: Other supplies 50 50 5 45 10,0% - 5 Consumable supplies 4 000 4 000 1 890 2 110 47,3% 3 842 1 537 Consumable: Stationery, printing and office supplies 1 000 1 000 1 179 (179) 117,9% 924 1 040 Operating leases ------Property payments 12 500 12 500 12 770 (270) 102,2% 11 827 11 813 Transport provided: Departmental activity ------Travel and subsistence 359 359 144 215 40,1% 338 218 Training and development 636 636 - 636 - 600 79 Operating payments 15 15 8 7 53,3% 37 9 Venues and facilities 500 500 204 296 40,8% 500 363 Transfers and subsidies 637 - - 637 391 246 61,4% 175 952 Households 637 - - 637 391 246 61,4% 175 952 Social benefits 637 637 391 246 61,4% 175 952 Other transfers to households - - - - Payments for capital assets 7 534 - - 7 534 4 645 2 889 61,7% 7 107 3 422 Machinery and equipment 7 534 - - 7 534 4 645 2 889 61,7% 7 107 3 422 Transport equipment 4 103 4 103 3 256 847 79,4% 3 870 1 081 Other machinery and equipment 3 431 3 431 1 389 2 042 40,5% 3 237 2 341 Payment for financial assets - 59 (59) - - 66 Total 240 133 - - 240 133 225 305 14 828 93,8% 215 243 214 321

Department of Health Annual Report 2018/19 186 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.8: District Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 3 588 129 - (287 000) 3 301 129 3 163 568 137 561 95,8% 2 916 012 2 950 870 Compensation of employees 2 394 794 - - 2 394 794 2 386 154 8 640 99,6% 2 158 474 2 203 931 Salaries and wages 2 054 940 2 054 940 2 077 131 (22 191) 101,1% 1 872 911 1 914 934 Social contributions 339 854 339 854 309 023 30 831 90,9% 285 563 288 997 Goods and services 1 193 335 - (287 000) 906 335 777 414 128 921 85,8% 757 538 746 939 Administrative fees 341 341 132 209 38,7% 484 221 Advertising 101 101 - 101 - 93 1 Minor assets 12 025 12 025 5 568 6 457 46,3% 8 016 3 461 Catering: Departmental activities 52 52 - 52 - 200 3 Communication (G&S) 9 088 9 088 4 549 4 539 50,1% 8 700 5 478 Computer services ------114 Consultants: Business and advisory services 80 80 206 (126) 257,5% 72 173 Laboratory services 390 333 (275 000) 115 333 109 320 6 013 94,8% 45 420 45 185 Legal services ------5 156 Contractors 19 315 19 315 14 412 4 903 74,6% 18 842 15 208 Agency and support / outsourced services 36 210 36 210 23 184 13 026 64,0% 38 720 37 021 Fleet services (including government motor transport) 14 481 14 481 3 256 11 225 22,5% 9 533 4 440 Inventory: Clothing material and accessories - - 637 (637) - - 1 069 Inventory: Food and food supplies 57 020 57 020 38 185 18 835 67,0% 43 916 42 553 Inventory: Fuel, oil and gas 44 077 44 077 48 514 (4 437) 110,1% 39 897 35 264 Inventory: Learner and teacher support material - - 4 333 (4 333) - 43 - Inventory: Materials and supplies 8 681 8 681 2 663 6 018 30,7% 10 082 6 450

187 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 2.8: District Hospitals 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Medical supplies 196 044 196 044 186 563 9 481 95,2% 154 981 176 676 Inventory: Medicine 133 457 (12 000) 121 457 106 119 15 338 87,4% 146 588 146 564 Inventory: Other supplies 19 565 19 565 15 238 4 327 77,9% 24 704 22 463 Consumable supplies 74 412 74 412 55 396 19 016 74,4% 55 762 55 131 Consumable: Stationery, printing and office supplies 23 658 23 658 20 492 3 166 86,6% 20 772 19 470 Operating leases 6 299 6 299 13 227 (6 928) 210,0% 5 424 4 493 Property payments 142 500 142 500 123 963 18 537 87,0% 119 945 119 021 Transport provided: Departmental activity 947 947 10 937 1,1% 977 151 Travel and subsistence 1 206 1 206 563 643 46,7% 1 238 330 Training and development 2 558 2 558 241 2 317 9,4% 2 214 280 Operating payments 885 885 198 687 22,4% 915 126 Rental and hiring - - 445 (445) - - 437 Transfers and subsidies 7 165 - - 7 165 6 750 415 94,2% 6 760 25 862 Households 7 165 - - 7 165 6 750 415 94,2% 6 760 25 862 Social benefits 7 165 7 165 6 671 494 93,1% 6 760 7 246 Other transfers to households - 79 (79) - - 18 616 Payments for capital assets 24 588 - - 24 588 33 928 (9 340) 138,0% 61 144 38 153 Machinery and equipment 24 588 - - 24 588 33 928 (9 340) 138,0% 61 144 38 153 Transport equipment 8 285 8 285 2 915 5 370 35,2% 10 175 4 811 Other machinery and equipment 16 303 16 303 31 013 (14 710) 190,2% 50 969 33 342 Payment for financial assets - 469 (469) - - 597 Total 3 619 882 - (287 000) 3 332 882 3 204 715 128 167 96,2% 2 983 916 3 015 482

Department of Health Annual Report 2018/19 188 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Economic classification Current payments 996 466 - (60 000) 936 466 890 319 46 147 95,1% 759 074 745 181 Compensation of employees 589 627 - - 589 627 552 681 36 946 93,7% 487 200 484 285 Salaries and wages 491 415 - - 491 415 462 344 29 071 94,1% 402 814 402 683 Social contributions 98 212 - - 98 212 90 337 7 875 92,0% 84 386 81 602 Goods and services 406 839 - (60 000) 346 839 333 258 13 581 96,1% 271 874 260 896 Administrative fees 2 412 - - 2 412 1 608 804 66,7% 2 811 1 600 Advertising 1 500 - - 1 500 8 1 492 0,5% - - Minor assets 8 610 - - 8 610 301 8 309 3,5% 5 010 2 074 Catering: Departmental activities 50 - - 50 16 34 32,0% 71 70 Communication (G&S) 6 934 - - 6 934 2 581 4 353 37,2% 2 434 2 342 Computer services 512 - - 512 - 512 - 504 52 Legal services 1 800 - - 1 800 110 1 690 6,1% - 146 Contractors 10 534 - - 10 534 21 250 (10 716) 201,7% 4 234 2 095 Agency and support / outsourced services 1 028 - - 1 028 412 616 40,1% 1 228 983 Fleet services (including government motor transport) 267 037 - (60 000) 207 037 213 478 (6 441) 103,1% 176 012 179 728 Inventory: Clothing material and accessories - - - - 347 (347) - - 37 Inventory: Food and food supplies 15 - - 15 4 11 26,7% 15 6 Inventory: Materials and supplies 546 - - 546 126 420 23,1% 2 212 28 Inventory: Medical supplies 20 844 - - 20 844 43 615 (22 771) 209,2% 24 526 20 911 Inventory: Medicine 1 150 - - 1 150 (8 455) 9 605 (735,2%) 588 393

189 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 3: Emergency Medical Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1 EmergencyInventory: Transport Other supplies 1 313 257364 - (60 000) - 1 253 257364 1 168 905 36 84 221459 93,3%14,0% 1 158 460 - 1 125 937 - 2 PlannedConsumable Patient Transportsupplies 169 9 974839 - - 169 9 974839 161 13 603698 (38 236724) 137,3%95,2% 109 5 728694 93 5 679337 Consumable: Stationery, printing and office supplies 1 483 7 853 203 - - (60 000) - 1 423 7 853 203 1 330 6 106 508 192 747 695 77,8%93,5% 1 268 6 353 154 1 219 6 569 274 Operating leases 37 117 - - 37 117 22 952 14 165 61,8% 12 904 13 060 Property payments 19 855 - - 19 855 13 325 6 530 67,1% 16 588 19 715 Economic classificationTransport provided: Departmental activity 5 910 - - 5 910 238 5 672 4,0% 8 910 4 512 CurrentTravel payments and subsistence 996 286466 - (60 000) - 936 286466 890 205319 46 147 81 71,7%95,1% 759 1 059074 745 749181 CompensationTraining and developmentof employees 589 690627 - - 589 690627 552 681 80 36 610946 93,7%11,6% 487 687200 484 147285 SalariesVenues andand facilitieswages 491 660415 - - 491 660415 462 344 - 29 660071 94,1% - 402 814 - 402 683 - InterestSocial andcontributions rent on land 98 212 - - - 98 212 - 90 4 380337 (47 875380) 92,0% - 84 386 - 81 602 - GoodsInterest and (Incl. services interest on unitary payments (PPP)) 406 839 - - (60 000) - 346 839 - 333 4 380258 13(4 380)581 96,1% - 271 874 - 260 896 - TransfersAdministrative and subsidies fees 341 2 412 164 - - 341 2 412 164 339 1 608 659 1 804505 66,7%99,6% 379 2 811 835 379 1 600 207 ProvincesAdvertising and municipalities 338 1 500 514 - - 338 1 500 514 338 514 8 1 492 - 100,0%0,5% 377 335 - 377 335 - MinorMunicipalities assets 338 8 610 514 - - 338 8 610 514 338 301 514 8 309 - 100,0%3,5% 377 5 010 335 377 2 074 335 Catering:Municipal Departmental bank accounts activities 338 51450 - - 338 51450 338 51416 34 - 100,0%32,0% 71 - 70 - CommunicationMunicipal agencies (G&S) and funds 6 934 - - - 6 934 - 2 581 - 4 353 - 37,2% - 377 2 434 335 377 2 342 335 HouseholdsComputer services 2 512650 - - 2 512650 1 145 - 1 512505 43,2% - 2 504500 1 872 52 LegalSocial services benefits 12 800650 - - 12 800650 1 110145 1 690505 43,2%6,1% 2 500 - 1 146336 ContractorsOther transfers to households 10 534 - - - 10 534 - 21 250 - (10 716) - 201,7% - 4 234 - 2 095536 PaymentsAgency for and capital support assets / outsourced services 145 1 028 573 - - 145 1 028 573 100 412 388 45 616 185 40,1%69,0% 129 1 228 245 94 983 613 MachineryFleet services and equipment (including government motor transport) 267145 037573 - (60 000) - 207145 037573 213100 478388 (645 441)185 103,1%69,0% 176129 012245 179 94 728613 Inventory:Transport Clothing equipment material and accessories 95 933 - - - 95 933 - 85 347 296 10 (347) 637 88,9% - 121 000 - 81 48537 Inventory:Other machinery Food and and food equipment supplies 49 64015 - - 49 64015 15 092 4 34 54811 26,7%30,4% 8 245 15 13 128 6 PaymentInventory: for financial Materials assets and supplies 546 - - - 546 - 126142 (142)420 23,1% - 2 212 - 273 28 Inventory: Medical supplies 1 48320 844 203 - - (60 000) - 1 42320 844 203 1 33043 615 508 (22 92 771) 695 209,2%93,5% 1 26824 526 154 1 21920 911 274 Inventory: Medicine 1 150 - - 1 150 (8 455) 9 605 (735,2%) 588 393

Department of Health Annual Report 2018/19 190 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

191 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 3.1: Emergency Transport 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentInventory: payments Other supplies 827 227257 - (60 000) 767 227257 729 03436 38 193221 14,0%95,0% 649 980 - 652 026 - CompensationConsumable suppliesof employees 509 9 974643 - - 509 9 643974 48713 823698 21 (3 820724) 137,3%95,7% 411 5 743728 424 5 434679 SalariesConsumable: and wages Stationery, printing and office supplies 424 7 598853 424 7 598853 407 6 663102 16 1 935751 96,0%77,7% 339 6 779353 352 6 860569 SocialOperating contributions leases 85 37 045117 85 37 045117 80 22 160952 14 4 885165 94,3%61,8% 7112 964904 71 12 574796 GoodsProperty and payments services 31719 584855 - (60 000) 25719 584855 239 13 761325 17 6 823530 93,1%67,1% 238 16 237588 227 19 592715 AdministrativeTransport provided: fees Departmental activity 2 412 - 2 412 - 1 608216 (216) 804 66,7% - 2 811 - 1 600 - AdvertisingTravel and subsistence 1 500286 1 500286 205 8 1 492 81 71,7%0,5% 1 059 - 749 - MinorTraining assets and development 8 610690 8 610690 301 80 8 309610 11,6%3,5% 5 010687 2 074147 Catering:Venues and Departmental facilities activities 660 50 660 50 16 - 660 34 32,0% - 71 - 70 InterestCommunication and rent on (G&S) land 6 934 - - - 6 934 - 2 1 581450 (1 4 353450) 37,2% - 2 434 - 2 342 - ComputerInterest (Incl. services interest on unitary payments (PPP)) 512 512 - 1 450 - (1 512450) -- 504 - 52 TransfersLegal servicesand subsidies 340 1 800564 - - 340 1 800564 339 110 356 1 690208 99,6%6,1% 379 235 - 379 146 025 ProvincesContractors and municipalities 33810 534514 - - 33810 534514 33821 250514 (10 716) - 201,7% 100,0% 377 4 234335 377 2 095335 AgencyMunicipalities and support / outsourced services 338 1 028514 - - 338 1 028514 338 412 514 616 - 100,0%40,1% 377 1 228335 377 983 335 FleetMunicipal services (includingbank accounts government motor transport) 183 338 692514 (60 000) 123338 692514 120 338 007514 3 685 - 100,0%97,0% 151 285 - 151 200 Inventory:Municipal Clothing agencies material and and funds accessories - - 347 (347) - - 377 335 - 377 33537 HouseholdsInventory: Food and food supplies 2 050 15 - - 2 050 15 842 4 1 208 11 26,7%41,1% 1 90015 1 690 6 Inventory:Social benefits Fuel, oil and gas 1 2 265050 12 265050 1 217842 1 208 48 96,2%41,1% 1 900 - 1 154 - Inventory:Other transfers Materials to householdsand supplies 546 546 - 126 - 420 - 23,1% - 2 212 - 536 28 PaymentsInventory: for capitalMedical assets supplies 14520 844573 - - 14520 844573 10043 615388 (22 45 771)185 209,2%69,0% 129 24 526245 20 94 911613 MachineryInventory: and Medicine equipment 145 1 150573 - - 145 1 150573 100 (8 455)388 45 9 605185 (735,2%)69,0% 129 588 245 94 393 613 Transport equipment 95 933 95 933 85 296 10 637 88,9% 121 000 81 485 Other machinery and equipment 49 640 49 640 15 092 34 548 30,4% 8 245 13 128 Payment for financial assets - 127 (127) - - 273 Total 1 313 364 - (60 000) 1 253 364 1 168 905 84 459 93,3% 1 158 460 1 125 937

Department of Health Annual Report 2018/19 192 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 3.2: Planned Patient Transport 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 169 239 - - 169 239 161 285 7 954 95,3% 109 094 93 155 Compensation of employees 79 984 - - 79 984 64 858 15 126 81,1% 75 457 59 851 Salaries and wages 66 817 66 817 54 681 12 136 81,8% 63 035 49 823 Social contributions 13 167 13 167 10 177 2 990 77,3% 12 422 10 028 Goods and services 89 255 - - 89 255 93 497 (4 242) 104,8% 33 637 33 304 Fleet services (including government motor transport) 83 345 83 345 93 471 (10 126) 112,1% 24 727 28 528 Consumable: Stationery, printing and office supplies - - 4 (4) - - - Operating leases - - - - - 264 Transport provided: Departmental activity 5 910 5 910 22 5 888 0,4% 8 910 4 512 Interest and rent on land - - - - 2 930 (2 930) - - - Interest (Incl. interest on unitary payments (PPP)) - 2 930 (2 930) - - Transfers and subsidies 600 - - 600 303 297 50,5% 600 182 Households 600 - - 600 303 297 50,5% 600 182 Social benefits 600 600 303 297 50,5% 600 182 Payment for financial assets - 15 (15) - - Total 169 839 - - 169 839 161 603 8 236 95,2% 109 694 93 337

193 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Economic classification Current payments 8 888 596 - (284 000) 8 604 596 8 578 867 25 729 99,7% 7 606 857 7 667 767 Compensation of employees 6 446 669 - (8 000) 6 438 669 6 244 388 194 281 97,0% 5 824 757 5 812 575 Salaries and wages 5 630 733 - (8 000) 5 622 733 5 512 747 109 986 98,0% 5 182 517 5 128 045 Social contributions 815 936 - - 815 936 731 641 84 295 89,7% 642 240 684 530 Goods and services 2 441 927 - (276 000) 2 165 927 2 334 479 (168 552) 107,8% 1 782 100 1 855 192 Administrative fees 152 - - 152 109 43 71,7% 172 172 Advertising 7 - - 7 10 (3) 142,9% 284 28 Minor assets 13 254 - - 13 254 3 539 9 715 26,7% 12 553 4 094 Catering: Departmental activities 160 - - 160 13 147 8,1% 158 2 Communication (G&S) 12 551 - - 12 551 5 871 6 680 46,8% 12 363 9 832 Computer services 583 - - 583 1 190 (607) 204,1% 660 144 Consultants: Business and advisory services 112 098 - - 112 098 247 967 (135 869) 221,2% 7 640 182 551 Laboratory services 376 952 - (150 000) 226 952 239 135 (12 183) 105,4% 203 107 117 559 Legal services ------12 025

Department of Health Annual Report 2018/19 194 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 4: Provincial Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programmeContractors 42 108 - - 42 108 53 431 (11 323) 126,9% 40 506 35 885 1 GeneralAgency Hospitals and support / outsourced services 6 707 58 824507 - (276 000) - 6 431 58 824507 6 351 83 096770 (2580 728263) 143,2%98,7% 5 719147 131651 5 738 92 026532 2 TuberculosisFleet services Hospitals (including government motor transport) 387 8 915744 - (8 000) - 379 8 915744 290 3 719044 89 5 196700 76,4%41,7% 396 11 292355 283 6 796884 3 Psychiatric/MentalInventory: Clothing Hospital material and accessories 1 261 857 - - - 1 261 857 - 1 393 463015 (131 (463) 158) 110,4% - 1 164 077 - 1 238 1 079219 4 DentalInventory: Training Food Hospitals and food supplies 581119 625584 - - 581119 625584 560122 989294 20(2 710)636 102,3%96,5% 535107 399301 548125 656627 5 OtherInventory: Specialised Fuel, Hospitals oil and gas 9143 419123 - - 9143 419123 9192 509865 (49 (90)742) 100,1%215,3% 7740 764178 8342 492327 Inventory: Learner and teacher support material 9 030 121 469 - - (284 000) - 8 746 121 469 8 686 14653 59 107 816 11,6%99,3% 7 892 122 663 7 892 29277 Inventory: Materials and supplies 10 668 - - 10 668 6 247 4 421 58,6% 9 694 9 903 Inventory: Medical supplies 597 197 - - 597 197 709 709 (112 512) 118,8% 494 139 532 477 Economic classificationInventory: Medicine 548 176 - (126 000) 422 176 308 244 113 932 73,0% 264 646 276 894 CurrentInventory: payments Other supplies 8 888 32 596077 - (284 000) - 8 604 32 596077 8 578 30 867306 25 1 771729 94,5%99,7% 7 606 30 857271 7 667 28 767774 CompensationConsumable suppliesof employees 6 446119 669202 - (8 000) - 6 438119 669202 6 244 88 388243 194 30 281959 97,0%74,0% 5 824 80 757492 5 812 85 575337 SalariesConsumable: and wages Stationery, printing and office supplies 5 630 24 733646 - (8 000) - 5 622 24 733646 5 512 27 747652 109 (3 006)986 112,2%98,0% 5 182 19 517382 5 128 20 045771 SocialOperating contributions leases 815 23 936942 - - 815 23 936942 731 25 641629 84(1 687)295 107,0%89,7% 642 19 240893 684 21 530110 GoodsProperty and payments services 2 441285 927531 - (276 000) - 2 165285 927531 2 334282 479094 (168 3 437 552) 107,8%98,8% 1 782272 100731 1 855246 192200 AdministrativeTransport provided: fees Departmental activity 152659 - - 152659 109 63 596 43 71,7%9,6% 172628 172159 AdvertisingTravel and subsistence 2 058 7 - - 2 058 7 670 10 1 388 (3) 142,9%32,6% 1 284886 989 28 MinorTraining assets and development 13 2 798254 - - 13 2 798254 3 539850 91 715948 26,7%30,4% 12 3 104553 4 094995 Catering:Operating Departmental payments activities 2 160038 - - 2 160038 258 13 1 147780 12,7%8,1% 158684 570 2 CommunicationVenues and facilities (G&S) 12 4 290551 - - 12 4 290551 5 871 - 64 680290 46,8% - 12 363 - 9 832118 ComputerRental and services hiring 583530 - - 583530 1 190124 (607) 406 204,1%23,4% 660500 144213 TransfersConsultants: and subsidies Business and advisory services 112 18 098429 - - 112 18 098429 247 21 967480 (135 (3 051)869) 221,2%116,6% 154 7 640 487 182142 551890 Non-profitLaboratory institutions services 376 952 - - (150 000) - 226 952 - 239 135 - (12 183) - 105,4% - 203137 107149 117 559 - HouseholdsLegal services 18 429 - - - 18 429 - 21 480 - (3 051) - 116,6% - 17 338 - 142 12 025890 Social benefits 18 429 - - 18 429 21 285 (2 856) 115,5% 17 338 22 913 Other transfers to households - - - - 195 (195) - - 119 977 Payments for capital assets 123 444 - - 123 444 85 328 38 116 69,1% 131 319 79 870 Buildings and other fixed structures ------16 Buildings ------16 Machinery and equipment 123 444 - - 123 444 85 328 38 116 69,1% 131 319 79 854 Transport equipment 8 896 - - 8 896 3 583 5 313 40,3% 10 338 9 618 Other machinery and equipment 114 548 - - 114 548 81 745 32 803 71,4% 120 981 70 236 Payment for financial assets - - - - 978 (978) - - 1 750 9 030 469 - (284 000) 8 746 469 8 686 653 59 816 99,3% 7 892 663 7 892 277

195 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Department of Health Annual Report 2018/19 196 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.1: General Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentConsumable: payments Stationery, printing and office supplies 6 59718 024619 - (276 000) 6 32118 024619 6 26522 524171 56 (4 448500) 125,0%99,1% 5 60114 598245 5 53415 725937 CompensationOperating leases of employees 4 57613 778281 - - 4 57613 778281 4 49918 553075 76 (4 728297) 131,2%98,3% 4 101 12 554137 4 18311 336554 PropertySalaries andpayments wages 3 213 997 620315 3 997213 315620 3 987211 557481 92 758139 99,8%99,0% 3 683 213 002296 3 704167 645525 TransportSocial contributions provided: Departmental activity 578 619 966 578 619966 511 99659 66 970560 88,4%9,5% 418 552584 478 691158 GoodsTravel and and services subsistence 2 021 1 352338 - (276 000) 1 745 1 352338 1 765 618472 (20 880280) 101,2%34,9% 1 500 1 044130 1 351 389579 TrainingAdministrative and development fees 1 91981 1 919 81 633 32 1 286 49 39,5%33,0% 2 13691 110 675 OperatingAdvertising payments 373 7 373 7 173 - 200 7 46,4% - 424 84 298 28 TransfersMinor andassets subsidies 12 7 927374 - - 12 7 927374 15 2 551884 (3 5 376510) 128,4%32,2% 11 7 937673 137 2 681373 HouseholdsAudit costs: External 12 374 - - - 12 374 - 15 884 - (3 510) - 128,4% - 11 673 - 137 373 - Bursaries:Social benefits Employees 12 374 - 12 374 - 15 884 - (3 510) - 128,4% - 11 673 - 17 396 - Catering:Other transfers Departmental to households activities 10 10 - 10 - 100,0% - 8 - 119 977 2 PaymentsCommunication for capital (G&S) assets 97 8 604831 - - 97 8 604831 69 4 024291 28 4 580540 46,8%70,8% 105 8 380860 64 7 255767 BuildingsComputer and services other fixed structures 583 - - - 583 - 1 179 - (596) - 202,2% - 660 - 7616 Consultants:Buildings Business and advisory services 250 250 - 200 50 - 80,0% - 368 - 243 16 MachineryLaboratory and services equipment 365 97 831530 - (150 000) - 215 97 831530 209 69 291467 28 6 063540 97,2%70,8% 192105 080860 10464 994751 ScientificTransport and equipment technological services 6 434 - 6 434 - 2 679 - 3 755 - 41,6% - 6 693 - 5 193 - LegalOther services machinery and equipment 91 397 - 91 397 - 66 612 - 24 785 - 72,9% - 99 167 - 1259 006558 PaymentContractors for financial assets 36 719 36 719 - 45 610750 (8 (750) 891) 124,2% - 35 956 - 31 1 052161 TotalAgency and support / outsourced services 6 70756 824303 - (276 000) 6 43156 303824 6 351 81 504096 (25 80 728201) 144,8%98,7% 5 145719 440131 5 73889 635026 Fleet services (including government motor transport) 5 690 5 690 2 017 3 673 35,4% 7 475 3 872 Inventory: Clothing material and accessories - - 123 (123) - - 1 015 Inventory: Farming supplies ------Inventory: Food and food supplies 77 129 77 129 79 227 (2 098) 102,7% 72 465 76 790 Inventory: Fuel, oil and gas 36 955 36 955 75 171 (38 216) 203,4% 34 956 33 709 Inventory: Learner and teacher support material 106 106 - 106 - 100 - Inventory: Materials and supplies 9 144 9 144 5 545 3 599 60,6% 8 355 8 815 Inventory: Medical supplies 547 238 547 238 665 483 (118 245) 121,6% 446 336 489 535 Inventory: Medicine 501 257 (126 000) 375 257 258 151 117 106 68,8% 216 122 211 065 Inventory: Other supplies 28 945 28 945 23 879 5 066 82,5% 24 189 20 155 Consumable supplies 89 175 89 175 58 028 31 147 65,1% 55 090 61 625

197 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Department of Health Annual Report 2018/19 198 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.2: Tuberculosis Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation EconomicConsumable classification supplies R'000 4 539 R'000 R'000 R'000 4 539 R'000 4 587 R'000 (48) %101,1% R'000 4 122 R'000 3 487 CurrentConsumable: payments Stationery, printing and office supplies 384 1 173461 - (8 000) 376 1 173461 287 985 614 88 847188 84,0%76,4% 393 497900 280 402987 CompensationOperating leases of employees 312 500 430 - (8 000) 304 500430 239 815 668 64 (315) 762 163,0%78,7% 315 107 - 214 397413 PropertySalaries andpayments wages 260 14 569318 (8 000) 25214 569318 205 7 613695 46 6 623956 81,5%52,3% 263 19 114000 183 8 327222 TravelSocial contributionsand subsistence 52 159 112 52 159112 33 97338 18 139121 65,2%23,9% 51 993150 31 07011 GoodsTraining and and services development 72 106 031 - - 72 031106 47 94617 24 085 89 66,6%16,0% 78 390100 66 00515 OperatingAdministrative payments fees 53 9 539 2 5 487 22,2%9,4% 50 9 25 2 VenuesAdvertising and facilities - - 8 - (8) - - 200 - 118 - RentalMinor assets and hiring 1 441530 1 441530 195 124 1 246406 13,5%23,4% 1 454500 457 166 TransfersCommunication and subsidies (G&S) 687742 - - 742687 345 887 (200) 397 129,1%46,5% 700 600 365 891 HouseholdsComputer services 687 - - - 687 - 887 - (200) - 129,1% - 600 - 891 - Consultants:Social benefits Business and advisory services 687 53 687 53 887 14 (200) 39 129,1%26,4% 600 50 891 25 LaboratoryOther transfers services to households 4 611 4 611 - 2 466 2 145 - 53,5% - 4 298 - 1 871 PaymentsContractors for capital assets 21 596141 - - 12 141596 1 964 536 1 177060 84,5%59,2% 12 076195 2 930 505 MachineryAgency and and support equipment / outsourced services 2 596593 - - 2 596593 1 536129 1 464060 21,8%59,2% 2 560 195 2 123 505 FleetTransport services equipment (including government motor transport) 1 110060 1 060110 394 87 1 666023 37,2%7,8% 1 000047 368 414 Inventory:Other machinery Food and and food equipment supplies 1 6 486390 61 390486 4 1 311449 2 079 37 67,5%97,5% 61 500148 5 2 036091 PaymentInventory: for financial Fuel, oil assetsand gas 1 060 1 060 - 23 7 1 037(7) 2,2% - 50- 174 86 TotalInventory: Learner and teacher support material 387 744 - - (8 000) 379 744 - 290 044 - 89 700 - 76,4% - 396 292 - 283 884 7 Inventory: Materials and supplies 265 265 129 136 48,7% 250 71 Inventory: Medical supplies 5 898 5 898 2 622 3 276 44,5% 5 990 2 047 Inventory: Medicine 26 899 26 899 22 009 4 890 81,8% 31 251 40 761 Inventory: Other supplies 240 240 151 89 62,9% 180 324

199 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.3: Psychiatric/Mental Hospital 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 1 253 407 - - 1 253 407 1 386 292 (132 885) 110,6% 1 015 159 1 228 441 Compensation of employees 983 332 - - 983 332 967 594 15 738 98,4% 882 806 897 685 Salaries and wages 859 786 859 786 836 708 23 078 97,3% 766 961 775 259 Social contributions 123 546 123 546 130 886 (7 340) 105,9% 115 845 122 426 Goods and services 270 075 - - 270 075 418 698 (148 623) 155,0% 132 353 330 756 Administrative fees 48 48 66 (18) 137,5% 59 52 Minor assets 2 868 2 868 572 2 296 19,9% 2 465 444 Catering: Departmental activities 148 148 - 148 - 147 - Communication (G&S) 1 955 1 955 888 1 067 45,4% 1 927 1 215 Computer services - - 11 (11) - - 68 Consultants: Business and advisory services 111 763 111 763 247 739 (135 976) 221,7% 7 157 182 270 Laboratory services 3 721 3 721 5 069 (1 348) 136,2% 2 735 1 172 Scientific and technological services ------Legal services ------Contractors 734 734 676 58 92,1% 399 170 Agency and support / outsourced services 1 165 1 165 1 013 152 87,0% 1 235 1 101 Fleet services (including government motor transport) 1 922 1 922 1 135 787 59,1% 1 869 2 167 Inventory: Clothing material and accessories - - 340 (340) - - 55 Inventory: Farming supplies ------Inventory: Food and food supplies 35 349 35 349 36 981 (1 632) 104,6% 27 688 36 734 Inventory: Fuel, oil and gas 4 841 4 841 17 511 (12 670) 361,7% 4 712 8 361 Inventory: Learner and teacher support material ------Inventory: Materials and supplies 1 139 1 139 282 857 24,8% 1 000 (2) Inventory: Medical supplies 9 817 9 817 5 909 3 908 60,2% 10 810 4 699 Inventory: Medicine 17 332 17 332 21 295 (3 963) 122,9% 14 973 17 875 Inventory: Other supplies 1 500 1 500 4 609 (3 109) 307,3% 4 171 6 158 Consumable supplies 16 473 16 473 20 159 (3 686) 122,4% 14 114 16 342 Consumable: Stationery, printing and office supplies 2 349 2 349 1 587 762 67,6% 2 054 1 548

Department of Health Annual Report 2018/19 200 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.3: Psychiatric/Mental Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentOperating payments leases 1 253 407700 - - 1 253 407700 1 386 4 292872 (132 (4 885)172) 696,0%110,6% 1 015 159235 1 228 2 441135 CompensationProperty payments of employees 98351 332209 - - 98351 332209 96747 594812 15 3 738397 98,4%93,4% 882 33 806635 897 47 685692 SalariesTransport and provided: wages Departmental activity 859 78640 859 786 40 836 708 4 23 078 36 97,3%10,0% 766 96144 775 259 1 SocialTravel contributionsand subsistence 123 546442 123 546442 130 886147 (7 340)295 105,9%33,3% 115 845525 122 426332 GoodsTraining and and services development 270 075238 - - 270 075238 418 69821 (148 623)217 155,0%8,8% 132 353367 330 75697 AdministrativeOperating payments fees 48 32 4832 66- (18) 32 137,5% - 59 32 52 70 MinorVenues assets and facilities 2 4 868290 24 868290 572 - 2 4 296290 19,9% - 2 465 - 444 - TransfersCatering: and Departmental subsidies activities 3 148 642 - - 3 148642 3 260 - 148382 89,5% - 140 147 585 3 317 - HouseholdsCommunication (G&S) 1 3 955642 - - 13 955642 3 888 260 1 067382 45,4%89,5% 13 927436 1 3 215317 ComputerSocial benefits services 3 642 - 3 642 - 3 26011 382 (11) 89,5% - 3 436 - 3 31768 Consultants:Other transfers Business to households and advisory services 111 763 - 111 763 - 247 739 (135 976) - 221,7% - 7 157 - 182 270 PaymentsLaboratory for capital services assets 3 4 721808 - - 34 721808 5 3 069272 (1 1 348)536 136,2%68,1% 28 735333 1 6 172048 MachineryScientific and equipmenttechnological services 4 808 - - - 4 808 - 3 272 - 1 536 - 68,1% - 8 333 - 6 048 - LegalTransport services equipment 540 - 540 - 675 - (135) - 125,0% - 1 498 - 2 374 - ContractorsOther machinery and equipment 4 734 268 4 734268 2 676 597 1 671 58 92,1%60,8% 6 399 835 3 170 674 PaymentAgency for and financial support assets / outsourced services 1 165 1 165 - 1 013191 (191) 152 87,0% - 1 235 - 1 101413 TotalFleet services (including government motor transport) 1 261 1 922857 - - 1 261 1 922857 1 393 1 135015 (131 787158) 110,4%59,1% 1 164 1 869077 1 238 2 167219 Inventory: Clothing material and accessories - - 340 (340) - - 55 Inventory: Farming supplies ------Inventory: Food and food supplies 35 349 35 349 36 981 (1 632) 104,6% 27 688 36 734 Inventory: Fuel, oil and gas 4 841 4 841 17 511 (12 670) 361,7% 4 712 8 361 Inventory: Learner and teacher support material ------Inventory: Materials and supplies 1 139 1 139 282 857 24,8% 1 000 (2) Inventory: Medical supplies 9 817 9 817 5 909 3 908 60,2% 10 810 4 699 Inventory: Medicine 17 332 17 332 21 295 (3 963) 122,9% 14 973 17 875 Inventory: Other supplies 1 500 1 500 4 609 (3 109) 307,3% 4 171 6 158 Consumable supplies 16 473 16 473 20 159 (3 686) 122,4% 14 114 16 342 Consumable: Stationery, printing and office supplies 2 349 2 349 1 587 762 67,6% 2 054 1 548

201 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.4: Dental Training Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 563 412 - - 563 412 548 942 14 470 97,4% 520 463 541 588 Compensation of employees 495 724 - - 495 724 459 243 36 481 92,6% 459 345 446 723 Salaries and wages 446 771 446 771 416 152 30 619 93,1% 413 173 405 212 Social contributions 48 953 48 953 43 091 5 862 88,0% 46 172 41 511 Goods and services 67 688 - - 67 688 89 699 (22 011) 132,5% 61 118 94 865 Administrative fees 10 10 2 8 20,0% 9 3 Advertising - - 2 (2) - - - Minor assets 966 966 215 751 22,3% 647 490 Catering: Departmental activities 2 2 3 (1) 150,0% 3 - Communication (G&S) 1 050 1 050 581 469 55,3% 1 156 840 Consultants: Business and advisory services 16 16 5 11 31,3% 50 3 Laboratory services 3 020 3 020 21 929 (18 909) 726,1% 3 908 9 474 Legal services ------19 Contractors 3 384 3 384 5 935 (2 551) 175,4% 2 895 3 684 Agency and support / outsourced services 270 270 845 (575) 313,0% 250 1 430 Fleet services (including government motor transport) 213 213 122 91 57,3% 950 295 Inventory: Clothing material and accessories ------9 Inventory: Food and food supplies 6 6 422 (416) 7033,3% 5 5 933 Inventory: Fuel, oil and gas 217 217 159 58 73,3% 460 83 Inventory: Materials and supplies 80 80 46 34 57,5% 46 955 Inventory: Medical supplies 32 528 32 528 32 965 (437) 101,3% 29 601 33 554 Inventory: Medicine 1 834 1 834 5 557 (3 723) 303,0% 1 493 6 218 Inventory: Other supplies 1 257 1 257 1 251 6 99,5% 1 631 1 903

Department of Health Annual Report 2018/19 202 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.4: Dental Training Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentConsumable payments supplies 563 8 362412 - - 563 8 362412 548 4 797942 14 3 565470 57,4%97,4% 520 6 350463 541 3 311588 CompensationConsumable: ofStationery, employees printing and office supplies 495 2 941724 - - 495 2 941724 459 2 281243 36 660481 77,6%92,6% 459 2 033345 446 1 823723 OperatingSalaries and leases wages 446 8 930771 446 8 930771 416 1 419152 30 7 511619 15,9%93,1% 413 7 490173 405 6 717212 PropertySocial contributions payments 48 691 953 48 691953 11 43 013091 (10 5 862322) 1593,8%88,0% 46 1 666172 17 41 809511 GoodsTravel and and services subsistence 67 68846 - - 67 688 46 89 69913 (22 011) 33 132,5%28,3% 61 11825 94 86530 TrainingAdministrative and development fees 285 10 285 10 57 2 228 8 20,0% 272 9 58 3 OperatingAdvertising payments 1 580 - 1 580 - 80 2 1 500 (2) 5,1% - 178 - 177 - RentalMinor assets and hiring 966 - 966 - 215 - 751 - 22,3% - 647 - 490 47 TransfersCatering: and Departmental subsidies activities 1 563 2 - - 1 563 2 1 380 3 183 (1) 150,0%88,3% 1 475 3 1 175 - HouseholdsCommunication (G&S) 1 563050 - - 1 563050 1 380581 183469 88,3%55,3% 1 475156 1 175840 Consultants:Social benefits Business and advisory services 1 563 16 1 563 16 1 185 5 378 11 75,8%31,3% 1 47550 1 175 3 LaboratoryOther transfers services to households 3 020 3 020 - 21 195 929 (18 (195) 909) 726,1% - 3 908 - 9 474 PaymentsLegal servicesfor capital assets 16 650 - - - 16 650 - 10 652 - 5 998 - 64,0% - 13 461 - 5 81519 MachineryContractors and equipment 163 650384 - - 16 3 650384 105 652935 (2 5 998551) 175,4%64,0% 13 2 461895 53 815684 AgencyTransport and equipment support / outsourced services 600 270 600270 845 96 (575) 504 313,0%16,0% 900 250 1 471430

FleetOther services machinery (including and equipment government motor transport) 16 050213 16 050213 10 556122 5 494 91 65,8%57,3% 12 561950 4 344295

PaymentInventory: for financial Clothing assets material and accessories - - 15- (15) - - - 78 9 TotalInventory: Food and food supplies 581 625 6 - - 581 625 6 560 989422 20 (416)636 7033,3%96,5% 535 399 5 548 5 656933

203 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.5: Other Specialised Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 89 697 - - 89 697 90 848 (1 151) 101,3% 76 140 82 611 Compensation of employees 78 902 - - 78 902 78 330 572 99,3% 65 945 70 434 Salaries and wages 66 543 66 543 66 635 (92) 100,1% 56 267 59 602 Social contributions 12 359 12 359 11 695 664 94,6% 9 678 10 832 Goods and services 10 795 - - 10 795 12 518 (1 723) 116,0% 10 195 12 177 Administrative fees 4 4 7 (3) 175,0% 4 5 Minor assets 52 52 6 46 11,5% 50 22 Communication (G&S) 200 200 33 167 16,5% 200 157 Consultants: Business and advisory services 16 16 9 7 56,3% 15 10 Laboratory services 70 70 204 (134) 291,4% 86 48 Contractors 130 130 246 (116) 189,2% 180 49 Agency and support / outsourced services 176 176 279 (103) 158,5% 166 243 Fleet services (including government motor transport) 30 30 51 (21) 170,0% 61 94 Inventory: Food and food supplies 710 710 1 353 (643) 190,6% 643 1 134 Inventory: Fuel, oil and gas 50 50 1 49 2,0% - - Inventory: Learner and teacher support material 15 15 14 1 93,3% 22 22 Inventory: Materials and supplies 40 40 245 (205) 612,5% 43 64 Inventory: Medical supplies 1 716 1 716 2 730 (1 014) 159,1% 1 402 2 642 Inventory: Medicine 854 854 1 232 (378) 144,3% 807 975

Department of Health Annual Report 2018/19 204 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 4.5: Other Specialised Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Other supplies 135 135 416 (281) 308,1% 100 234 Consumable supplies 653 653 672 (19) 102,9% 816 572 Consumable: Stationery, printing and office supplies 159 159 275 (116) 173,0% 150 476 Operating leases 34 34 448 (414) 1317,6% 31 291 Property payments 5 442 5 442 4 175 1 267 76,7% 5 134 4 952 Travel and subsistence 59 59 - 59 - 56 37 Training and development 250 250 122 128 48,8% 229 150 Transfers and subsidies 163 - - 163 69 94 42,3% 154 134 Households 163 - - 163 69 94 42,3% 154 134 Social benefits 163 163 69 94 42,3% 154 134 Payments for capital assets 1 559 - - 1 559 577 982 37,0% 1 470 735 Machinery and equipment 1 559 - - 1 559 577 982 37,0% 1 470 735 Transport equipment 212 212 46 166 21,7% 200 166 Other machinery and equipment 1 347 1 347 531 816 39,4% 1 270 569 Payment for financial assets - 15 (15) - - 12 Total 91 419 - - 91 419 91 509 (90) 100,1% 77 764 83 492

205 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Economic classification Current payments 15 815 866 - 317 000 16 132 866 16 458 011 -325 145 102.0% 14 471 001 14 633 592 Compensation of employees 10 657 379 - - 10 657 379 10 956 631 -299 252 102.8% 10 194 649 10 319 570 Salaries and wages 9 188 411 - - 9 188 411 9 798 744 -610 333 106.6% 8 931 433 9 224 717 Social contributions 1 468 968 - - 1 468 968 1 157 887 311 081 78.8% 1 263 216 1 094 853 Goods and services 5 158 487 - 317 000 5 475 487 5 498 014 -22 527 100.4% 4 276 352 4 314 022 Administrative fees 162 - - 162 68 94 42.0% 158 54 Advertising 445 - - 445 134 311 30.1% 800 558 Minor assets 49 633 - - 49 633 6 571 43 062 13.2% 50 822 10 429 Catering: Departmental activities 45 - - 45 19 26 42.2% 64 28 Communication (G&S) 16 018 - - 16 018 16 596 -578 103.6% 17 734 19 671 Computer services 10 077 - - 10 077 974 9 103 9.7% 10 097 2 881 Consultants: Business and advisory services 613 - - 613 89 524 14.5% 97 150 82 166 Laboratory services 982 830 - - 982 830 942 560 40 270 95.9% 581 769 577 214 Scientific and technological services ------Legal services - - - - 288 -288 - - 165 194 Contractors 169 411 - - 169 411 239 720 -70 309 141.5% 169 286 148 734 Agency and support / outsourced services 102 411 - - 102 411 129 999 -27 588 126.9% 139 848 118 229 Entertainment ------Fleet services (including government motor transport) 6 003 - - 6 003 6 348 -345 105.7% 6 025 6 826 Inventory: Clothing material and accessories - - - - 51 -51 - - 6 Inventory: Food and food supplies 147 304 - - 147 304 126 457 20 847 85.8% 142 863 123 287 Inventory: Fuel, oil and gas 76 248 - - 76 248 62 078 14 170 81.4% 43 494 47 046 Inventory: Learner and teacher support material ------34 Inventory: Materials and supplies 13 067 - - 13 067 16 762 -3 695 128.3% 11 698 14 371 Inventory: Medical supplies 1 609 630 - 317 000 1 926 630 2 374 133 -447 503 123.2% 1 421 051 1 597 376 Inventory: Medicine 1 226 744 - - 1 226 744 799 743 427 001 65.2% 843 786 676 246 Inventory: Other supplies 59 977 - - 59 977 64 025 -4 048 106.7% 64 932 43 213 Consumable supplies 183 445 - - 183 445 231 276 -47 831 126.1% 178 062 188 469

Department of Health Annual Report 2018/19 206 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 5: Central Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programmeConsumable: Stationery, printing and office supplies 50 368 - - 50 368 69 785 -19 417 138.6% 51 805 45 036 1 CentralOperating Hospitals leases 13 034 20 797419 -- 185 000 - 13 219 20 797419 13 218 27 822559 -7 975140 100.0%135.0% 11 839 5 689981 11 986 13 766870 2 ProvincialProperty Tertiary payments Hospital Services 3 783428 429241 -- 132 000 - 3 915428 429241 3 915379 435321 48 920 -6 100.0%88.6% 3 493429 060899 3 329426 921760 Transport provided: Departmental activity 16 818 310 226 - - 317 000 - 17 135 310 226 17 134 257 6 304 969 100.0%1.9% 15 333 1 390 041 15 316 687 4 Travel and subsistence 1 302 - - 1 302 1 342 -40 103.1% 1 616 1 528 Training and development 1 394 - - 1 394 555 839 39.8% 2 573 2 438 EconomicOperating classification payments 2 390 - - 2 390 1 555 835 65.1% 3 741 2 354 CurrentInterest payments and rent on land 15 815 866 - -- 317 000 - 16 132 866 - 16 458 3 366011 -325 -3 366145 102.0% - 14 471 001 - 14 633 592 - CompensationInterest (Incl. ofinterest employees on unitary payments (PPP)) 10 657 379 - -- -- 10 657 379 - 10 956 3 366631 -299 -3 366252 102.8% - 10 194 649 - 10 319 570 - RentSalaries on landand wages 9 188 411 - -- -- 9 188 411 - 9 798 744 - -610 333 - 106.6% - 8 931 433 - 9 224 717 - TransfersSocial andcontributions subsidies 1 468247 968640 -- -- 1 468247 968640 1 157247 887111 311 529081 78.8%99.8% 1 263196 216448 1 094226 853873 Non-profitGoods and institutions services 5 158200 487000 -- 317 000 - 5 475200 487000 5 498200 014000 -22 527 - 100.4%100.0% 4 276150 352000 4 314150 022000 HouseholdsAdministrative fees 47 162 640 -- -- 47 162 640 47 11168 529 94 42.0%98.9% 46 158 448 76 87354 AdvertisingSocial benefits 47 445 640 -- -- 47 445 640 46 134 953 311687 30.1%98.6% 46 800 448 40 558 244 MinorOther assets transfers to households 49 633 - -- -- 49 633 - 6 571158 43 -158 062 13.2% - 50 822 - 1036 429629 PaymentsCatering: for Departmentalcapital assets activities 754 72045 -- -- 754 72045 427 22019 327 50026 42.2%56.6% 665 59264 453 77828 MachineryCommunication and equipment (G&S) 754 16 018720 -- -- 754 16 018720 427 16 596220 327 -578 500 103.6%56.6% 665 17 734592 453 19 671778 ComputerTransport services equipment 10 077937 -5 000 - -- 10 5 937077 1 974354 94 103583 22.8%9.7% 10 5 475097 25 881572 Consultants:Other machinery Business and andequipment advisory services 743 613 783 5 000 - -- 748 613 783 425 86689 322 524 917 14.5%56.9% 660 97 150117 448 82 166206 PaymentLaboratory for financial services assets 982 830 - -- -- 982 830 - 942 1 915560 40-1 915270 95.9% - 581 769 - 577 2 444214 Scientific and technological services 16 818 226 - - - 317 000 - 17 135 226 - 17 134 257 - 969 - 100.0% - 15 333 041 - 15 316 687 - Legal services - - - - 288 -288 - - 165 194 Contractors 169 411 - - 169 411 239 720 -70 309 141.5% 169 286 148 734 Agency and support / outsourced services 102 411 - - 102 411 129 999 -27 588 126.9% 139 848 118 229 Entertainment ------Fleet services (including government motor transport) 6 003 - - 6 003 6 348 -345 105.7% 6 025 6 826 Inventory: Clothing material and accessories - - - - 51 -51 - - 6 Inventory: Food and food supplies 147 304 - - 147 304 126 457 20 847 85.8% 142 863 123 287 Inventory: Fuel, oil and gas 76 248 - - 76 248 62 078 14 170 81.4% 43 494 47 046 Inventory: Learner and teacher support material ------34 Inventory: Materials and supplies 13 067 - - 13 067 16 762 -3 695 128.3% 11 698 14 371 Inventory: Medical supplies 1 609 630 - 317 000 1 926 630 2 374 133 -447 503 123.2% 1 421 051 1 597 376 Inventory: Medicine 1 226 744 - - 1 226 744 799 743 427 001 65.2% 843 786 676 246 Inventory: Other supplies 59 977 - - 59 977 64 025 -4 048 106.7% 64 932 43 213 Consumable supplies 183 445 - - 183 445 231 276 -47 831 126.1% 178 062 188 469

207 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Department of Health Annual Report 2018/19 208 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 5.1: Central Hospitals 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentConsumable payments supplies 12 129 197 270461 - 185 000 12 129382 270461 12 156 671 109804 (289(26 839)343) 120,8%102,3% 11 122 125 291624 11 148 418 041560 CompensationConsumable: ofStationery, employees printing and office supplies 8 10924 623199 - - 8 10924 623199 8 47835 477522 (369(10 854)323) 144,1%104,6% 7 904 27 417995 8 00723 901026 OperatingSalaries and leases wages 7 05515 869692 7 05515 869692 7 58820 332006 (532 (4 463)314) 128,1%107,5% 6 995 2 893379 7 16310 382061 PropertySocial contributions payments 1 326 053 231507 1 326053 231507 278 890 310516 16247 921991 85,3%84,5% 323 909 453616 319 843 460965 GoodsTransport and servicesprovided: Departmental activity 4 088 270 262 - 185 000 4 273 270262 4 189 916 1 83 269346 98,0%0,4% 3 220 330 629 3 411 534 - TravelAdministrative and subsistence fees 1 13746 1 137 46 1 21966 (82)(20) 107,2%143,5% 1 01451 1 42740 TrainingAdvertising and development 1 139 260 1 139260 346 60 793200 30,4%23,1% 1 225467 704 354 OperatingMinor assets payments 36 2 205238 36 2 205238 7 943 141 29 1 262097 42,8%19,7% 34 2 471528 1 5 585741 InterestCatering: and Departmental rent on land activities 45 - - - 45 - 3 36619 (3 366) 26 42,2% - 64 - 22 - InterestCommunication (Incl. interest (G&S) on unitary payments (PPP)) 11 969 11 969 - 14 3 366575 (3(2 366)606) 121,8% - 12 788 - 15 592 TransfersComputer and servicessubsidies 235 10 450077 - - 23510 450077 238 142467 (2 9 692)610 101,1%4,6% 184 10 948097 206 2 347198 Non-profitConsultants: institutions Business and advisory services 200 000 163 200 000163 200 00063 100 - 100,0%38,7% 150 95 000900 150 82 000120 HouseholdsLaboratory services 813 35 450189 - - 813 35 450189 748 38 142882 64 (2 692)307 107,6%92,1% 387 34 948623 466 56 347638 LegalSocial services benefits 35 450 - 35 450 - 37 984288 (2 (288)534) 107,1% - 34 948 - 16431 173340 ContractorsOther transfers to households 126 727 126 727 - 205 158 902 (79 (158) 175) 162,5% - 128 891 - 118 25 174649 PaymentsAgency for and capital support assets / outsourced services 601 84 886101 - - 60184 886101 307115 174616 294(31 712515) 137,5%51,0% 529 118 409288 359 97 537585 MachineryFleet services and equipment (including government motor transport) 601 4 886584 - - 601 4 886584 307 4 174729 294 (145)712 103,2%51,0% 529 4 409311 359 5 537314 Inventory:Transport Clothing equipment material and accessories 8 075 - (5 000) 3 075 - 1 13251 1 943 (51) 36,8% - 2 775 - 3 153 5 Inventory:Other machinery Food and and food equipment supplies 593 93 811682 5 000 598 93 811682 306 87 042461 292 6 769221 51,1%93,4% 526 90 634856 356 88 384668 PaymentInventory: for financial Fuel, oil assetsand gas 58 248 58 248 - 58 1 702490 (1 (242)702) 100,4% - 25 831 - 38 2 322496 TotalInventory: Materials and supplies 13 034 8 797267 - 185 000 13 219 8 797267 13 21810 822883 (2 975616) 131,6%100,0% 11 839 7 981798 11 986 10 766773 Inventory: Medical supplies 1 236 896 185 000 1 421 896 1 749 336 (327 440) 123,0% 1 090 013 1 230 611 Inventory: Medicine 1 056 497 1 056 497 643 508 412 989 60,9% 675 895 547 649 Inventory: Other supplies 46 529 46 529 49 642 (3 113) 106,7% 56 134 31 205

209 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 5.2: Provincial Tertiary Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 3 618 405 - 132 000 3 750 405 3 785 056 (34 651) 100,9% 3 345 377 3 215 032 Compensation of employees 2 548 180 - - 2 548 180 2 478 109 70 071 97,3% 2 289 654 2 312 544 Salaries and wages 2 132 719 2 132 719 2 210 738 (78 019) 103,7% 1 936 054 2 061 656 Social contributions 415 461 415 461 267 371 148 090 64,4% 353 600 250 888 Goods and services 1 070 225 - 132 000 1 202 225 1 306 947 (104 722) 108,7% 1 055 723 902 488 Administrative fees 116 116 2 114 1,7% 107 14 Advertising 185 185 74 111 40,0% 333 204 Minor assets 13 395 13 395 (570) 13 965 (4,3%) 16 294 4 688 Catering: Departmental activities ------6 Communication (G&S) 4 049 4 049 2 021 2 028 49,9% 4 946 4 079 Computer services - - 507 (507) - - 683 Consultants: Business and advisory services 450 450 26 424 5,8% 1 250 46 Laboratory services 169 641 169 641 193 678 (24 037) 114,2% 194 146 110 576 Legal services ------854 Contractors 42 684 42 684 33 818 8 866 79,2% 40 395 30 085 Agency and support / outsourced services 18 310 18 310 14 383 3 927 78,6% 21 560 20 644 Fleet services (including government motor transport) 1 419 1 419 1 619 (200) 114,1% 1 714 1 512 Inventory: Clothing material and accessories ------1 Inventory: Food and food supplies 53 622 53 622 38 996 14 626 72,7% 52 007 34 619 Inventory: Fuel, oil and gas 18 000 18 000 3 588 14 412 19,9% 17 663 8 550 Inventory: Materials and supplies 4 800 4 800 5 879 (1 079) 122,5% 3 900 3 598 Inventory: Medical supplies 372 734 132 000 504 734 624 797 (120 063) 123,8% 331 038 366 765 Inventory: Medicine 170 247 170 247 156 235 14 012 91,8% 167 891 128 597 Inventory: Other supplies 13 448 13 448 14 383 (935) 107,0% 8 798 12 008

Department of Health Annual Report 2018/19 210 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 5.2: Provincial Tertiary Hospital Services 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable supplies 54 175 54 175 74 016 (19 841) 136,6% 55 771 40 428 Consumable: Stationery, printing and office supplies 25 745 25 745 34 308 (8 563) 133,3% 24 388 21 135 Operating leases 4 550 4 550 7 227 (2 677) 158,8% 2 796 3 488 Property payments 102 010 102 010 101 011 999 99,0% 106 446 107 300 Transport provided: Departmental activity 40 40 5 35 12,5% 1 060 4 Travel and subsistence 165 165 123 42 74,5% 602 101 Training and development 255 255 209 46 82,0% 1 348 1 734 Operating payments 185 185 612 (427) 330,8% 1 270 769 Transfers and subsidies 12 190 - - 12 190 8 969 3 221 73,6% 11 500 20 526 Households 12 190 - - 12 190 8 969 3 221 73,6% 11 500 20 526 Social benefits 12 190 12 190 8 969 3 221 73,6% 11 500 9 071 Other transfers to households - - - - 11 455 Payments for capital assets 152 834 - - 152 834 121 197 31 637 79,3% 136 183 94 241 Machinery and equipment 152 834 - - 152 834 121 197 31 637 79,3% 136 183 94 241 Transport equipment 2 862 2 862 222 2 640 7,8% 2 700 2 419 Other machinery and equipment 149 972 149 972 120 975 28 997 80,7% 133 483 91 822 Payment for financial assets - 213 (213) - - 122 Total 3 783 429 - 132 000 3 915 429 3 915 435 (6) 100,0% 3 493 060 3 329 921

211 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Department of Health Annual Report 2018/19 212 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 6: Health Sciences and Training 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programmeComputer services ------169 1 NurseConsultants: Training Colleges Business and advisory services 848 283 937 -- -- 848 283 937 778 971 - 69 283 966 91,8% - 738 507 369 747 199 136 2 EMSLaboratory Training Colleges services 37 85953 -- -- 37 85953 27 175 - 10 68453 71,8% - 34 96158 34 95317 3 BursariesContractors 142 2 075 498 -- -- 142 2 075 498 211 1 527 282 (68 548 784) 148,3%73,6% 86 742 546 68 925 676 4 OtherAgency Training and support / outsourced services 94 110 002 -- -- 94 110 002 89 280 4 4 106722 95,0%3,6% 68 306 595 68 351 222 Fleet services (including government motor transport) 1 123 2 140 296 - - - - 1 123 2 140 296 1 106 1 290 708 16 850 588 60,3%98,5% 928 1 783 471 918 2 915 987 Economic classificationInventory: Clothing material and accessories - - - - 24 (24) - - 410 CurrentInventory: payments Food and food supplies 922 150 090 -- -- 922 150 090 832 06565 90 02585 43,3%90,2% 800 115 873 796 45673 CompensationInventory: Fuel, of oilemployees and gas 850 291 4 -- -- 850 291 4 762 052 4 88 239 - 100,0%89,6% 740 162 2 738 605 5 Inventory:Salaries and Learner wages and teacher support material 742 3 281 714 -- -- 742 3 281 714 668 10 656263 (774 375) 451 324,7%90,0% 645 1 487 161 644 750 596 Inventory:Social contributions Materials and supplies 107 292 577 -- -- 107 292 577 93 355 789 13 (63)788 121,6%87,2% 95 227 001 94 122 009 GoodsInventory: and servicesMedical supplies 712 807 799 -- -- 712 807 799 703 628 013 1 (821) 786 129,2%97,5% 60 581 711 57 814 851 Inventory:Administrative Medicine fees 740 75 -- -- 740 75 422 26 318 49 57,0%34,7% 871 73 406113 Inventory:Advertising Other supplies 385 28 -- -- 385 28 326 26 59 2 84,7%92,9% 407100 323 90 ConsumableMinor assets supplies 7 481943 -- -- 7 481943 9 713535 (2 232)408 129,8%56,7% 5 353296 5 920145 Consumable:Audit costs: External Stationery, printing and office supplies 4 404 - -- -- 4 404 - 2 573 8 1 831 (8) 58,4% - 2 967 - 2 836 - OperatingBursaries: leases Employees 29 320139 -- -- 29 320139 61 097285 (3 7 777)854 262,8%14,1% 28 100622 54 292011 PropertyCatering: payments Departmental activities 13 462 72 -- -- 13 462 72 16 723 11 (3 261) 61 124,2%15,3% 13 180300 18 087 68 TravelCommunication and subsistence (G&S) 14 1 276098 -- -- 14 1 276098 3 049601 11 675049 21,6%47,1% 12 1 446977 9 234847 Training and development 5 781 - - 5 781 11 020 (5 239) 190,6% 6 011 3 636 Operating payments 400 - - 400 45 355 11,3% 200 93 Transfers and subsidies 185 146 - - 185 146 270 779 (85 633) 146,3% 119 553 109 004 Departmental agencies and accounts 20 962 - - 20 962 20 962 - 100,0% 19 812 19 812 Departmental agencies (non-business entities) 20 962 - - 20 962 20 962 - 100,0% 19 812 19 812 Higher education institutions 13 681 - - 13 681 12 855 826 94,0% 12 061 9 786 Households 150 503 - - 150 503 236 962 (86 459) 157,4% 87 680 79 406 Social benefits 1 861 - - 1 861 2 877 (1 016) 154,6% 1 956 3 721 Other transfers to households 148 642 - - 148 642 234 085 (85 443) 157,5% 85 724 75 685 Payments for capital assets 16 059 - - 16 059 3 282 12 777 20,4% 8 045 11 001 Machinery and equipment 16 059 - - 16 059 3 282 12 777 20,4% 8 045 11 001 Transport equipment 3 035 - - 3 035 1 074 1 961 35,4% 3 920 3 898 Other machinery and equipment 13 024 - - 13 024 2 208 10 816 17,0% 4 125 7 103 Payment for financial assets - - - - 582 (582) - - 2 526 1 123 296 - - 1 123 296 1 106 708 16 588 98,5% 928 471 918 987

213 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Sub Programme 6.1: Health Sciences and Training 2018/19 2017/18 Subprogramme: 6.1: Nurse Training Colleges 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Adjusted ShiftingFunds of Virement Appropriation Final Expenditure Actual Variance Expenditureas % of final Appropriation Final Expenditure Actual Appropriation Funds Appropriation Expenditure appropriationas % of final Appropriation Expenditure appropriation Economic Economic classification classification R'000R'000 R'000R'000 R'000R'000 R'000R'000 R'000R'000R'000 R'000 %% R'000R'000R'000 R'000 Current payments 828 541 - - 828 541 762 140 66 401 92,0% 715 103 725 888 Compensation of employees 799 894 - - 799 894 717 790 82 104 89,7% 695 068 694 999 Salaries and wages 698 381 698 381 628 646 69 735 90,0% 605 644 605 644 Social contributions 101 513 101 513 89 144 12 369 87,8% 89 424 89 355 Goods and services 28 647 - - 28 647 44 350 (15 703) 154,8% 20 035 30 889 Administrative fees - - 16 (16) - - - Advertising 10 10 9 1 90,0% - 2 Minor assets 628 628 67 561 10,7% 275 123 Audit costs: External - - 8 (8) - - - Communication (G&S) 973 973 562 411 57,8% 1 065 749 Computer services ------169 Consultants: Business and advisory services 18 18 - 18 - 257 43 Contractors 1 055 1 055 691 364 65,5% 52 41 Agency and support / outsourced services 50 50 - 50 - - - Fleet services (including government motor transport) 550 550 454 96 82,5% 283 1 463 Inventory: Clothing material and accessories ------158 Inventory: Food and food supplies 100 100 59 41 59,0% 95 55 Inventory: Fuel, oil and gas 4 4 4 - 100,0% 2 2 Inventory: Learner and teacher support material 2 631 2 631 10 403 (7 772) 395,3% 1 162 639 Inventory: Materials and supplies 92 92 86 6 93,5% 207 117 Inventory: Medical supplies 1 407 1 407 289 1 118 20,5% 102 267

Department of Health Annual Report 2018/19 214 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 6.1: Health Sciences and Training 2018/19 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Inventory: Medicine - - 55 (55) - 21 91 Inventory: Other supplies 385 385 301 84 78,2% 387 307 Consumable supplies 5 971 5 971 9 160 (3 189) 153,4% 3 893 4 730 Consumable: Stationery, printing and office supplies 3 035 3 035 2 022 1 013 66,6% 1 647 2 320 Operating leases 2 120 2 120 6 036 (3 916) 284,7% 2 000 5 184 Property payments 9 200 9 200 14 064 (4 864) 152,9% 8 430 14 411 Travel and subsistence 338 338 8 330 2,4% 17 7 Training and development 80 80 38 42 47,5% 140 11 Operating payments - - 18 (18) - - Transfers and subsidies 9 123 - - 9 123 13 939 (4 816) 152,8% 19 736 14 632 Higher education institutions - - - 10 000 Households 9 123 - - 9 123 13 939 (4 816) 152,8% 9 736 14 632 Social benefits 1 840 1 840 2 753 (913) 149,6% 1 936 3 608 Other transfers to households 7 283 7 283 11 186 (3 903) 153,6% 7 800 11 024 Payments for capital assets 11 272 - - 11 272 2 323 8 949 20,6% 3 530 4 108 Machinery and equipment 11 272 - - 11 272 2 323 8 949 20,6% 3 530 4 108 Transport equipment 2 035 2 035 1 074 961 52,8% 1 920 2 246 Other machinery and equipment 9 237 9 237 1 249 7 988 13,5% 1 610 1 862 Payment for financial assets - 569 (569) - - 2 508 Total 848 937 - - 848 937 778 971 69 966 91,8% 738 369 747 136

215 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 6.2: EMS Training Colleges 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 33 537 - - 33 537 26 174 7 363 78,0% 30 883 27 939 Compensation of employees 19 575 - - 19 575 15 706 3 869 80,2% 17 715 16 983 Salaries and wages 16 237 16 237 13 605 2 632 83,8% 14 710 14 646 Social contributions 3 338 3 338 2 101 1 237 62,9% 3 005 2 337 Goods and services 13 962 - - 13 962 10 468 3 494 75,0% 13 168 10 956 Advertising 18 18 17 1 94,4% 100 88 Minor assets 300 300 266 34 88,7% 6 22 Catering: Departmental activities 30 30 9 21 30,0% 150 60 Communication (G&S) 150 150 39 111 26,0% 227 94 Contractors 1 020 1 020 836 184 82,0% 690 884 Agency and support / outsourced services 60 60 4 56 6,7% 306 351 Fleet services (including government motor transport) 1 590 1 590 836 754 52,6% 1 500 1 452 Inventory: Clothing material and accessories ------252 Inventory: Food and food supplies 50 50 6 44 12,0% 20 17 Inventory: Fuel, oil and gas ------3 Inventory: Learner and teacher support material 650 650 253 397 38,9% 325 111 Inventory: Materials and supplies 200 200 257 (57) 128,5% 20 3 Inventory: Medical supplies 1 400 1 400 3 339 (1 939) 238,5% 479 547 Inventory: Medicine 740 740 367 373 49,6% 850 315 Inventory: Other supplies - - 19 (19) - 20 6

Department of Health Annual Report 2018/19 216 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 6.2: EMS Training Colleges 2018 2017/18

Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation

Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Consumable supplies 1 329 1 329 542 787 40,8% 1 290 1 136 Consumable: Stationery, printing and office supplies 500 500 475 25 95,0% 500 188 Operating leases 200 200 61 139 30,5% 100 108 Property payments 4 262 4 262 2 659 1 603 62,4% 4 870 3 676 Travel and subsistence 250 250 18 232 7,2% 215 169 Training and development 813 813 438 375 53,9% 1 300 1 381 Operating payments 400 400 27 373 6,8% 200 93 Transfers and subsidies 21 - - 21 124 (103) 590,5% 20 107 Households 21 - - 21 124 (103) 590,5% 20 107 Social benefits 21 21 124 (103) 590,5% 20 107 Payments for capital assets 4 301 - - 4 301 872 3 429 20,3% 4 058 6 892 Machinery and equipment 4 301 - - 4 301 872 3 429 20,3% 4 058 6 892 Transport equipment 1 000 1 000 1 000 - 2 000 1 652 Other machinery and equipment 3 301 3 301 872 2 429 26,4% 2 058 5 240 Payment for financial assets - 5 (5) - - 15 Total 37 859 - - 37 859 27 175 10 684 71,8% 34 961 34 953

217 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 6.3: Bursaries 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 9 139 - - 9 139 1 285 7 854 14,1% 8 622 4 015 Goods and services 9 139 - - 9 139 1 285 7 854 14,1% 8 622 4 015 Bursaries: Employees 9 139 9 139 1 285 7 854 14,1% 8 622 4 011 Communication (G&S) ------4 Transfers and subsidies 133 359 - - 133 359 209 997 (76 638) 157,5% 77 924 64 661 Households 133 359 - - 133 359 209 997 (76 638) 157,5% 77 924 64 661 Other transfers to households 133 359 133 359 209 997 (76 638) 157,5% 77 924 64 661 Total 142 498 - - 142 498 211 282 (68 784) 148,3% 86 546 68 676

Department of Health Annual Report 2018/19 218 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 6.4: Other Training 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 50 873 - - 50 873 42 466 8 407 83,5% 46 265 38 614 Compensation of employees 30 822 - - 30 822 28 556 2 266 92,6% 27 379 26 623 Salaries and wages 28 096 28 096 26 012 2 084 92,6% 24 807 24 306 Social contributions 2 726 2 726 2 544 182 93,3% 2 572 2 317 Goods and services 20 051 - - 20 051 13 910 6 141 69,4% 18 886 11 991 Administrative fees 75 75 10 65 13,3% 73 113 Minor assets 15 15 202 (187) 1346,7% 15 - Catering: Departmental activities 42 42 2 40 4,8% 30 8 Communication (G&S) 153 153 - 153 - 154 - Consultants: Business and advisory services 265 265 - 265 - 250 156 Laboratory services 53 53 - 53 - 58 17 Inventory: Clothing material and accessories - - 24 (24) - - - Inventory: Food and food supplies ------1 Inventory: Materials and supplies - - 12 (12) - - 2 Inventory: Other supplies - - 6 (6) - - 10 Consumable supplies 181 181 11 170 6,1% 170 54 Consumable: Stationery, printing and office supplies 869 869 76 793 8,7% 820 328 Travel and subsistence 13 510 13 510 3 023 10 487 22,4% 12 745 9 058 Training and development 4 888 4 888 10 544 (5 656) 215,7% 4 571 2 244 Transfers and subsidies 42 643 - - 42 643 46 719 (4 076) 109,6% 21 873 29 604 Departmental agencies and accounts 20 962 - - 20 962 20 962 - 100,0% 19 812 19 812 Departmental agencies (non-business entities) 20 962 20 962 20 962 - 100,0% 19 812 19 812 Higher education institutions 13 681 13 681 12 855 826 94,0% 2 061 9 786 Households 8 000 - - 8 000 12 902 (4 902) 161,3% - 6 Social benefits - - - - 6 Other transfers to households 8 000 8 000 12 902 (4 902) 161,3% - Payments for capital assets 486 - - 486 87 399 17,9% 457 1 Machinery and equipment 486 - - 486 87 399 17,9% 457 1 Other machinery and equipment 486 486 87 399 17,9% 457 1 Payment for financial assets - 8 (8) - - 3 Total 94 002 - - 94 002 89 280 4 722 95,0% 68 595 68 222

219 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Economic classification Current payments 302 581 - 27 000 329 581 337 043 (7 462) 102,3% 281 817 284 106 Compensation of employees 180 597 - 8 000 188 597 182 146 6 451 96,6% 168 354 162 379 Salaries and wages 154 643 - - 154 643 149 883 4 760 96,9% 138 286 132 097 Social contributions 25 954 - 8 000 33 954 32 263 1 691 95,0% 30 068 30 282 Goods and services 121 984 - 19 000 140 984 154 897 (13 913) 109,9% 113 463 121 727 Minor assets 61 - - 61 13 48 21,3% 457 42 Communication (G&S) 409 - - 409 389 20 95,1% 809 449 Contractors 98 - - 98 40 58 40,8% 371 14 Agency and support / outsourced services 382 - - 382 446 (64) 116,8% 43 1 Fleet services (including government motor transport) 2 481 - - 2 481 2 597 (116) 104,7% 306 2 609 Inventory: Clothing material and accessories - - - - 736 (736) - - 579 Inventory: Food and food supplies 28 020 - - 28 020 25 084 2 936 89,5% 27 230 25 729 Inventory: Fuel, oil and gas 22 115 - 8 000 30 115 31 701 (1 586) 105,3% 2 083 9 761

Department of Health Annual Report 2018/19 220 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 7: Health Care Support Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programmeInventory: Materials and supplies 370 - - 370 500 (130) 135,1% 426 83 1 LaundriesInventory: Medical supplies 224 491462 - 27 000 - 251 491462 250 1 894982 (1 480403) 385,7%99,8% 213 785145 208 1 226732 2 FoodInventory: Supply Services Other supplies 87 1 945693 - - 87 1 945693 88 1 316066 (373) 629 100,4%67,7% 76 1 032692 81 2 598035 3 MedicineConsumable Trading Accountsupplies 43 848 1 - 11 000 - 54 848 1 62 951 - (8 103) 1 114,8% - 58 976 1 59 246 - Consumable: Stationery, printing and office supplies 312 401 156 - - 27 000 - 339 401 156 339 344 048 57108 100,0%85,8% 289 529 838 289 267 767 Operating leases 1 900 - - 1 900 9 051 (7 151) 476,4% - 1 581 Property payments 19 177 - - 19 177 17 082 2 095 89,1% 20 303 16 317 Economic classificationTravel and subsistence 5 - - 5 - 5 - 35 - CurrentTraining payments and development 302 581 41 - 27 000 - 329 581 41 337 043 31 (7 462) 10 102,3%75,6% 281 817 78 284 106 3 CompensationOperating payments of employees 180 240597 - 8 000 - 188 240597 182 722146 6 (482)451 300,8%96,6% 168 354 - 162 1 222379 TransfersSalaries and and subsidies wages 154 645643 - - 154 645643 149 597883 4 760 48 96,9%92,6% 138 608286 132 613097 HouseholdsSocial contributions 25 645954 - 8 000 - 33 645954 32 597263 1 691 48 95,0%92,6% 30 608068 30 613282 GoodsSocial and benefits services 121 645984 - 19 000 - 140 645984 154 597897 (13 913)48 109,9%92,6% 113 608463 121 613727 PaymentsMinor assetsfor capital assets 8 930 61 - - 8 930 61 1 335 13 7 595 48 21,3%14,9% 7 457413 5 005 42 MachineryCommunication and equipment (G&S) 8 409930 - - 8 409930 1 389335 7 595 20 95,1%14,9% 7 809413 5 449005 ContractorsTransport equipment 4 468 98 - - 4 468 98 708 40 3 760 58 40,8%15,8% 4 371550 2 300 14 AgencyOther machineryand support and / outsourced equipment services 4 382462 - - 4 382462 446627 3 835(64) 116,8%14,1% 2 863 43 2 705 1 PaymentFleet forservices financial (including assets government motor transport) 2 481 - - - 2 481 - 2 597 73 (116) (73) 104,7% - 306 - 2 609 43 Inventory: Clothing material and accessories 312 156 - - - 27 000 - 339 156 - 339 736 048 (736) 108 100,0% - 289 838 - 289 579 767 Inventory: Food and food supplies 28 020 - - 28 020 25 084 2 936 89,5% 27 230 25 729 Inventory: Fuel, oil and gas 22 115 - 8 000 30 115 31 701 (1 586) 105,3% 2 083 9 761

221 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Department of Health Annual Report 2018/19 222 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 7.1: Laundries 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 CurrentConsumable: payments Stationery, printing and office supplies 217 168 182 - 27 000 244 168182 249 129 169 (4 987) 39 102,0%76,8% 206 309 278 204 13296 CompensationOperating leases of employees 154 1 900392 - 8 000 162 1 900392 159 9 051518 (7 2 874151) 476,4%98,2% 144 199 - 138 1 581043 PropertySalaries andpayments wages 133 15 757 13315 757 128 13 413382 52 375344 96,0%85,1% 120 15 903486 11211 833195 TravelSocial contributionsand subsistence 20 635 5 8 000 28 635 5 31 136 - (2 501) 5 108,7% - 23 71335 25 848 - GoodsTraining and and services development 62 79029 - 19 000 81 790 29 89 65130 (7 861)(1) 109,6% 103,4% 62 07958 66 089 - OperatingMinor assets payments 240 27 240 27 722 13 (482) 14 300,8%48,1% 388 - 1 222 6 TransfersCommunication and subsidies (G&S) 470406 - - 406470 389 500 (30) 17 106,4%95,8% 803 443 449 501 HouseholdsContractors 47017 - - 470 17 50040 (23)(30) 235,3%106,4% 299 443 50114 AgencySocial andbenefits support / outsourced services 379 470 379470 445 500 (66)(30) 117,4%106,4% 443 13 501 - PaymentsFleet services for capital (including assets government motor transport) 2 6 481810 - - 26 481810 2 1 597240 5 (116) 570 104,7%18,2% 6 306 424 2 4 609056 MachineryInventory: and Clothing equipment material and accessories 6 810 - - - 6 810 - 1 240736 5 (736) 570 18,2% - 6 424 - 4 579 056 Inventory:Transport Food equipment and food supplies 4 46820 4 468 20 708 5 3 760 15 25,0%15,8% 4 55030 2 300 9 Inventory:Other machinery Fuel, oil and equipmentgas 12 2 342736 8 000 20 2 342736 20 812532 1 810 (76) 100,4%22,7% 1 874301 5 1 755756 PaymentInventory: for financial Materials assets and supplies 355 355 - 498 73 (143) (73) 140,3% - 401 - 83 43 TotalInventory: Medical supplies 224 291 462 - 27 000 251 291462 250 726 982 (435) 480 249,5%99,8% 213 625 145 208 438 732 Inventory: Other supplies 1 575 1 575 988 587 62,7% 678 2 022 Consumable supplies 26 404 11 000 37 404 39 057 (1 653) 104,4% 41 930 39 393

223 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 7.2: Food Supply Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 85 398 - - 85 398 87 874 (2 476) 102,9% 75 538 79 974 Compensation of employees 26 205 - - 26 205 22 628 3 577 86,3% 24 155 24 336 Salaries and wages 20 886 20 886 21 501 (615) 102,9% 17 800 19 902 Social contributions 5 319 5 319 1 127 4 192 21,2% 6 355 4 434 Goods and services 59 193 - - 59 193 65 246 (6 053) 110,2% 51 383 55 638 Minor assets 34 34 - 34 - 69 36 Communication (G&S) 3 3 - 3 - 6 - Contractors 80 80 - 80 - 71 - Agency and support / outsourced services 3 3 1 2 33,3% 30 1 Inventory: Food and food supplies 28 000 28 000 25 079 2 921 89,6% 27 200 25 720 Inventory: Fuel, oil and gas 9 379 9 379 10 889 (1 510) 116,1% 1 782 4 006 Inventory: Materials and supplies 15 15 2 13 13,3% 25 - Inventory: Medical supplies 200 200 1 168 (968) 584,0% 160 788 Inventory: Other supplies 370 370 328 42 88,6% 354 576 Consumable supplies 17 444 17 444 23 894 (6 450) 137,0% 17 046 19 853 Consumable: Stationery, printing and office supplies 233 233 215 18 92,3% 220 171 Property payments 3 420 3 420 3 669 (249) 107,3% 4 400 4 484 Training and development 12 12 1 11 8,3% 20 3 Transfers and subsidies 175 - - 175 97 78 55,4% 165 112 Households 175 - - 175 97 78 55,4% 165 112 Social benefits 175 175 97 78 55,4% 165 112 Payments for capital assets 2 120 - - 2 120 95 2 025 4,5% 989 949 Machinery and equipment 2 120 - - 2 120 95 2 025 4,5% 989 949 Other machinery and equipment 2 120 2 120 95 2 025 4,5% 989 949 Total 87 693 - - 87 693 88 066 (373) 100,4% 76 692 81 035

Department of Health Annual Report 2018/19 224 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019 Subprogramme: 7.3: Medicine Trading Account 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 1 - - 1 - 1 - 1 - Goods and services 1 - - 1 - 1 - 1 - Administrative fees - - - - Contractors 1 1 1 - 1 Total 1 - - 1 - 1 - 1 - Programme 8: Health Facilities Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Sub programme 1 Community Health Facilities 432 134 - - 432 134 390 045 42 089 90,3% 341 042 317 234 2 Emergency Medical Rescue Services 9 628 - - 9 628 1 299 8 329 13,5% 7 046 1 733 3 District Hospital Services 218 580 - - 218 580 172 998 45 582 79,1% 260 789 214 807 4 Provincial Hospital Services 264 803 - - 264 803 202 304 62 499 76,4% 288 934 264 246 5 Central Hospital Services 314 344 - - 314 344 315 650 (1 306) 100,4% 311 287 335 462 6 Other Facilities 320 444 - - 320 444 453 824 (133 380) 141,6% 474 201 474 295 1 559 933 - - 1 559 933 1 536 120 23 813 98,5% 1 683 299 1 607 777 Economic classification Current payments 591 954 - - 591 954 711 652 (119 698) 120,2% 795 188 920 965 Compensation of employees 37 869 - - 37 869 31 610 6 259 83,5% 35 677 30 840 Salaries and wages 26 293 - - 26 293 29 264 (2 971) 111,3% 24 736 27 356 Social contributions 11 576 - - 11 576 2 346 9 230 20,3% 10 941 3 484 Goods and services 554 085 - - 554 085 680 042 (125 957) 122,7% 759 511 890 125 Advertising 352 - - 352 - 352 - 333 191 Minor assets 519 - - 519 223 296 43,0% 8 491 750 Catering: Departmental activities 117 - - 117 - 117 - 111 - Communication (G&S) 186 - - 186 3 183 1,6% 176 2 Legal services ------7 024 Contractors 2 324 - - 2 324 2 163 161 93,1% 2 000 1 740 Agency and support / outsourced services - - - - 155 (155) - - - Fleet services (including government motor transport) 651 - - 651 38 613 5,8% 615 7 Inventory: Clothing material and accessories ------500 - Inventory: Food and food supplies - - - - 41 (41) - - 15 Subprogramme: 8.2: Emergency Medical Rescue Services Inventory: Fuel, oil and gas ------69 552 2018/19 2017/18 Inventory: Materials and supplies - - - - (12) 12 - 1 500 398 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Inventory: Medical supplies - - - - 1 993 (1 993) - 3 000 1 959 Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation 225 Department of Health Annual Report 2018/19 Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 6 628 - - 6 628 495 6 133 7,5% 7 046 1 272 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Programme 8: Health Facilities Management 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments - 1 - - - - - 1 - - - 1 - - - 1 236 - GoodsConsumable and services supplies 100 1 - - - - 100 1 4 - 96 1 4,0% - 1 100 1 71 - Consumable:Administrative Stationery, fees printing and office supplies 334 - - 334 - 4 330 - 1,2% - 216 - 25 OperatingContractors leases 39 707 1 - - 39 707 1 25 473 14 234 1 64,2% - 36 530 1 41 953 TotalProperty payments 507 573 1 - - - - 507 573 1 649 498 - (141 925) 1 128,0% - 703 329 1 765 140 - Programme Travel8: Health and subsistence Facilities Management 222 - - 222 369 (147) 166,2% 210 352 Training and development 1 500 - - 2018/19 1 500 46 1 454 3,1% 4002017/18 397 Operating payments Adjusted 500 Shifting of - Virement - Final 500 Actual 44 Variance 456 Expenditure8,8% Final 1 000 Actual 313 Transfers and subsidies Appropriation - Funds - - Appropriation - Expenditure - - as % of final - Appropriation - Expenditure 158 appropriation Households ------158 R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Social benefits ------158 Sub programmePayments for capital assets 967 979 - - 967 979 824 468 143 511 85,2% 888 111 686 645 432 134 - - 432 134 390 045 42 089 90,3% 341 042 317 234 1 CommunityBuildings andHealth other Facilities fixed structures 900 027 - - 900 027 785 617 114 410 87,3% 818 917 615 418 2 9 628 - - 9 628 1 299 8 329 13,5% 7 046 1 733 EmergencyBuildings Medical Rescue Services 900 027 - - 900 027 785 617 114 410 87,3% 818 917 615 418 3 218 580 - - 218 580 172 998 45 582 79,1% 260 789 214 807 DistrictMachinery Hospital and Services equipment 67 952 - - 67 952 38 851 29 101 57,2% 69 194 71 227 4 264 803 - - 264 803 202 304 62 499 76,4% 288 934 264 246 ProvincialOther Hospital machinery Services and equipment 67 952 - - 67 952 38 851 29 101 57,2% 69 194 71 227 5 314 344 - - 314 344 315 650 (1 306) 100,4% 311 287 335 462 PaymentCentral Hospital for financial Services assets ------9 6 320 444 - - 320 444 453 824 (133 380) 141,6% 474 201 474 295 Other Facilities 1 559 933 - - 1 559 933 1 536 120 23 813 98,5% 1 683 299 1 607 777 1 559 933 - - 1 559 933 1 536 120 23 813 98,5% 1 683 299 1 607 777 Economic classification Current payments 591 954 - - 591 954 711 652 (119 698) 120,2% 795 188 920 965 Compensation of employees 37 869 - - 37 869 31 610 6 259 83,5% 35 677 30 840 Salaries and wages 26 293 - - 26 293 29 264 (2 971) 111,3% 24 736 27 356 Social contributions 11 576 - - 11 576 2 346 9 230 20,3% 10 941 3 484 Goods and services 554 085 - - 554 085 680 042 (125 957) 122,7% 759 511 890 125 Advertising 352 - - 352 - 352 - 333 191 Minor assets 519 - - 519 223 296 43,0% 8 491 750 Catering: Departmental activities 117 - - 117 - 117 - 111 - Communication (G&S) 186 - - 186 3 183 1,6% 176 2 Legal services ------7 024 Contractors 2 324 - - 2 324 2 163 161 93,1% 2 000 1 740 Agency and support / outsourced services - - - - 155 (155) - - - Fleet services (including government motor transport) 651 - - 651 38 613 5,8% 615 7 ------500 - Inventory: Food and food supplies - - - - 41 (41) - - 15 Inventory: Fuel, oil and gas ------69 552 Inventory: Materials and supplies - - - - (12) 12 - 1 500 398 Inventory: Medical supplies - - - - 1 993Department (1 993)of Health Annual - Report 2018/193 000 1 959226 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 8.1: Community Health Facilities 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 43 339 - - 43 339 54 608 (11 269) 126,0% 73 930 85 000 Goods and services 43 339 - - 43 339 54 608 (11 269) 126,0% 73 930 85 000 Minor assets - - 151 (151) - - 337 Inventory: Medical supplies - - 265 (265) - - 889 Inventory: Other supplies ------236 Property payments 43 339 43 339 54 192 (10 853) 125,0% 73 930 83 521 Payments for capital assets 388 795 - - 388 795 335 437 53 358 86,3% 267 112 232 234 Buildings and other fixed structures 379 742 - - 379 742 331 032 48 710 87,2% 255 412 223 316 Buildings 379 742 379 742 331 032 48 710 87,2% 255 412 223 316 Machinery and equipment 9 053 - - 9 053 4 405 4 648 48,7% 11 700 8 918 Other machinery and equipment 9 053 9 053 4 405 4 648 48,7% 11 700 8 918 Payment for financial assets - - - - Total 432 134 - - 432 134 390 045 42 089 90,3% 341 042 317 234

227 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 8.2: Emergency Medical Rescue Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 6 628 - - 6 628 495 6 133 7,5% 7 046 1 272 Goods and services 6 628 - - 6 628 495 6 133 7,5% 7 046 1 272 Payments for capital assets 3 000 - - 3 000 804 2 196 26,8% - 461 Buildings and other fixed structures 3 000 - - 3 000 804 2 196 26,8% - 461 Buildings 3 000 3 000 804 2 196 26,8% - 461 Total 9 628 - - 9 628 1 299 8 329 13,5% 7 046 1 733 Subprogramme: 8.3: District Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 116 755 - - 116 755 53 863 62 892 46,1% 98 239 86 512 Compensation of employees ------47 Salaries and wages - - - - 47 Goods and services 116 755 - - 116 755 53 863 62 892 46,1% 98 239 86 465 Minor assets - - 49 (49) - - 2 Communication (G&S) - - 3 (3) - - Contractors - - 3 (3) - -

Department of Health Annual Report 2018/19 228 Buildings 3 000 3 000 804 2 196 26,8% - 461 Total 9 628 - - 9 628 1 299 8 329 13,5% 7 046 1 733 Subprogramme: 8.3: District Hospital Services GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation EconomicFleet services classification (including government motor transport) R'000 - R'000 R'000 R'000 - R'000 35 R'000 (35) % - R'000 - R'000 7 CurrentInventory: payments Food and food supplies 116 755 - - - 116 755 - 53 863 - 62 892 - 46,1% - 98 239 - 86 51215 CompensationInventory: Materials of employees and supplies - - - - (12) - 12 - - - 47 SalariesInventory: and Medical wages supplies - - 120 (120) - - - 453 47 GoodsConsumable and services supplies 116 755 - - - 116 755 - 53 863 1 62 892(1) 46,1% - 98 239 - 86 465 3 MinorProperty assets payments 116 755 - 116 755 - 53 66449 63 091 (49) 46,0% - 98 239 - 85 985 2 CommunicationOther transfers (G&S) to households - - 3 (3) - - - PaymentsContractors for capital assets 101 825 - - - 101 825 - 119 135 3 (17 310) (3) 117,0% - 162 550 - 128 295 Buildings and other fixed structures 89 436 - - 89 436 112 987 (23 551) 126,3% 150 850 113 027 Buildings 89 436 89 436 112 987 (23 551) 126,3% 150 850 113 027 Machinery and equipment 12 389 - - 12 389 6 148 6 241 49,6% 11 700 15 268 Transport equipment - - - - Other machinery and equipment 12 389 12 389 6 148 6 241 49,6% 11 700 15 268 Total 218 580 - - 218 580 172 998 45 582 79,1% 260 789 214 807 Subprogramme: 8.4: Provincial Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 227 436 - - 227 436 127 339 100 097 56,0% 173 606 170 382 Goods and services 227 436 - - 227 436 127 339 100 097 56,0% 173 606 170 382 Minor assets - - - - - 8 000 363 Communication (G&S) ------2 Contractors ------202 Fleet services (including government motor transport) - - 3 (3) - - - Inventory: Materials and supplies - - - - - 1 500 397 Inventory: Medical supplies - - - - - 3 000 617 Consumable supplies - - - - - 1 000 40 Property payments 227 436 227 436 127 336 100 100 56,0% 160 106 168 761 Payments for capital assets 37 367 - - 37 367 74 965 (37 598) 200,6% 115 328 93 864 Buildings and other fixed structures 37 367 - - 37 367 74 965 (37 598) 200,6% 71 589 47 770 Buildings 37 367 37 367 74 965 (37 598) 200,6% 71 589 47 770 Machinery and equipment ------43 739 46 094 Other machinery and equipment - - - 43 739 46 094 Payment for financial assets - - - - Total 264 803 - - 264 803 202 304 62 499 76,4% 288 934 264 246

229 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 8.5: Central Hospital Services 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation Economic classification R'000 R'000 R'000 R'000 R'000 R'000 % R'000 R'000 Current payments 196 301 - - 196 301 201 576 (5 275) 102,7% 205 751 237 936 Goods and services 196 301 - - 196 301 201 576 (5 275) 102,7% 205 751 237 936 Minor assets - - 23 (23) - - - Contractors ------49 Agency and support / outsourced services - - 155 (155) - - - Inventory: Food and food supplies - - 41 (41) - - - Inventory: Fuel, oil and gas ------1 Inventory: Materials and supplies ------1 Inventory: Medical supplies - - 1 608 (1 608) - - - Property payments 196 301 196 301 199 749 (3 448) 101,8% 205 751 237 885 Payments for capital assets 118 043 - - 118 043 114 074 3 969 96,6% 105 536 97 526 Buildings and other fixed structures 73 133 - - 73 133 85 791 (12 658) 117,3% 105 536 97 526 Buildings 73 133 73 133 85 791 (12 658) 117,3% 105 536 97 526 Machinery and equipment 44 910 - - 44 910 28 283 16 627 63,0% - - Other machinery and equipment 44 910 44 910 28 283 16 627 63,0% - Total 314 344 - - 314 344 315 650 (1 306) 100,4% 311 287 335 462

Department of Health Annual Report 2018/19 230 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

231 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Subprogramme: 8.6: Other Facilities 2018/19 2017/18 Adjusted Shifting of Virement Final Actual Variance Expenditure Final Actual Appropriation Funds Appropriation Expenditure as % of final Appropriation Expenditure appropriation EconomicProperty classification payments R'000 (82 886) R'000 R'000 R'000 (82 886) R'000 214 062 R'000 (296 948) (258,3%)% R'000 158 257 R'000 187 716 CurrentTransport payments provided: Departmental activity 1 495 - - - 1 495 - 273 771 - (272 276) - 18312,4% - 236 616 - 339 863 - CompensationTravel and subsistence of employees 37 222 869 - - 37 222869 31 369 610 6 (147) 259 166,2%83,5% 35 210 677 30 352 793 TrainingSalaries and developmentwages 26 1 500293 26 1 500293 29 26446 (2 1 454971) 111,3%3,1% 24 400 736 27 397 309 OperatingSocial contributions payments 11 500 576 11 500576 2 34644 9 456230 20,3%8,8% 10 1 000941 3 313 484 TransfersGoods andand services subsidies (36 374) - - - (36 374) - 242 161 - (278 535) - (665,8%) - 200 939 - 309 158070 HouseholdsAdvertising 352 - - - 352 - - 352 - - 333 - 158 191 MinorSocial assets benefits 519 519 - - 519 - - 491 - 158 48 PaymentsCatering: for Departmentalcapital assets activities 318 949117 - - 318 949117 180 053 - 138 896117 56,5% - 237 585111 134 265 - BuildingsCommunication and other (G&S) fixed structures 317 349186 - - 317 349186 180 038 - 137 311186 56,7% - 235 530176 133 318 - LegalBuildings services 317 349 - 317 349 - 180 038 - 137 311 - 56,7% - 235 530 - 133 7 318024 MachineryContractors and equipment 12 600324 - - 12 600324 2 160 15 1 585164 92,9%0,9% 2 055000 1 947489 FleetOther services machinery (including and equipment government motor transport) 1 600651 1 600651 15- 1 585651 0,9% - 2 055615 947 - PaymentInventory: for financial Clothing assets material and accessories - - - - - 500 - 9 - TotalInventory: Fuel, oil and gas 320 444 - - - 320 444 - 453 824 - (133 380) - 141,6% - 474 201 - 474 69 295551

Department of Health Annual Report 2018/19 232 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

1. a Detail of transfers and subsidies as per Appropriation Act 3. Detail on payments for nancial assets (after Virement): Detail of these transactions per programme can be viewed in the Detail of these transactions can be viewed in the note on Transfers note on Payments for financial assets to the Annual Financial and subsidies, disclosure notes and Annexures (1-7) to the Annual Statements. Financial Statements. 4. Explanations of material variances from Amounts Voted 2. Detail of speci cally and exclusively appropriated amounts (after Virement): voted (after Virement):

Detail of these transactions can be viewed in note 1 (Annual Appropriation) to the Annual Financial Statements.

4.1 Per programme Final Appropriation Actual Expenditure Variance as a % of Variance R’000 Final Appropriation Administration 1 361 130 1 360 786 344 0%

District Health Services 15 073 917 14 516 480 557 437 3.7%

Emergency Medical Services 1 423 203 1 330 508 92 695 6.5%

Provincial Hospital Services 8 746 469 8 686 653 59 816 0.7%

Central Hospital Services 17 135 226 17 134 257 969 0.0%

Health Sciences & Training 1 123 296 1 106 708 16 588 1.5%

Health Care Support Services 339 156 339 048 108 0.0%

Health Facilities Management 1 559 933 1 536 120 23 813 1.5%

46 762 330 46 010 559 751 770 1.6%

Under expenditure was due to delays in the creation of posts and in payment of District Health Services the National Health Laboratory Services (NHLS) account. Underspending on the HIV and AIDS grant also contributed to the Programme underspending. All under spent funds have been committed. The Department has applied for rollovers.

Emergency Medical Services Under expenditure was due to delays in the creation of posts. All underspent resources have been committed. The Department has applied for rollovers.

Department of Health Annual Report 2018/19 233 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Final Appropriation Actual Expenditure Variance as a % of Variance R’000 Final Appropriation 4.2 Per economic classification R’000 R’000 R’000

Current payments

Compensation of employees 26 994 470 26 902 299 92 171 -

Goods and services 15 567 703 15 229 503 338 200 2%

Interest and rent on land - 7 794 (7 794) -100%

Transfers and Subsidies

Provinces and Municipalities 721 989 721 992 (3) -

Departmental Agencies and Accounts 20 962 20 962 - -

Higher education institutions 13 681 13 421 260 2%

Non-profit institutions 664 428 615 281 49 247 7%

Households 535 809 921 439 (385 630) -72%

Payments for Capital Assets

Buildings and other fixed structures 900 267 785 617 114 650 13%

Machinery and equipment 1 342 920 786 489 556 431 41%

Payments for financial assets - 5 763 (5 763) -100%

46 762 330 46 010 560 751 770 1.6%

Non-Pro t Institutions (NPOs): Non-compliance with the minimum requirements were not met by some of the NPOs resulted in under-expenditure.

Households: Over-spending in this line item was due payment of Medico Legal claims.

Payment of Capital Assets: Maintenance and Occupational Health & Safety (OHS) projects were prioritized, however, late submission of invoices by the implementing agent led to underspending within the programme. Machinery and Equipment underspending is due to long lead times for items that have already been ordered. Delays in procurement processes also contributed to the underspending. The Department has applied for roll-overs for all unspent funds to reduce accruals.

234 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE APPROPRIATION STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

Final Appropriation Actual Expenditure Variance as a % of Variance R’000 Final Appropriation 4.2 Per economic classification R’000 R’000 R’000 %

Comprehensive HIV & AIDS GRANT 4 239 277 3 965 836 273 441 6%

National Tertiary Services Grant 4 390 192 4 137 621 252 571 6%

Health PROF Training & DEV Grant 983 712 947 885 35 527 4%

EPWP Integrated Grant for PROV 2 324 2 160 164 7%

Health Facility REVIT Grant 892 084 779 939 112 145 13%

SOC SEC EPWP INCEN Grant for PROV 1 470 1 404 66 4%

Human Papillomavirus Vaccine Grant 27 312 21 670 5 642 21%

TOTAL 10 536 371 9 856 515 679 856 6%

COMPREHENSIVE HIV & AIDS GRANT HEALTH FACILITY REVITALISATION GRANT Underspending was incurred on the following items: The under expenditure was due to the late submission of invoices as • Medicine – this was due to late receipt of invoices and less well as contracts having to be terminated due to poor performance intake by the users which resulted in the underachievement of by contractors. In some instances, contractors abandoned sites due set targets. to community unrests/ service delivery protests which affected • Operating payments – a provision made for courier services projected expenditure on the grant. towards expansion of Chronic CMDD programme couldn’t be spent as the expense was paid for the National Department of The Department has submitted a roll-over application to the value of Health on behalf of the province. R112.1 million. • Non-profit institutions – a number of Non-Profit Institutions did not meet the qualifying funding criteria. HUMAN PAPILLOMAVIRUS VACCINE GRANT The Department has submitted a roll-over application to the value of The underspending on the grant is due to the delays in receiving the R273.4 million. invoices for medicine, training materials and travel claims.

NATIONAL TERTIARY SERVICES GRANT The Department has submitted a roll-over application to the value of The Department incurred the commitments to the value of R252.6 R5.6 million. million as at 31 March 2019, this is due to the nature of medical equipment procurement processes as some the items are sourced internationally. The

Department has submitted a roll-over application to the value of R252.6 million.

HEALTH PROFESSIONS TRAINING & DEVELOPMENT GRANT REPORT The under expenditure is mainly attributed to the delays from suppliers delivering medical equipment within the stipulated timeframes and this resulted in delays in processing of R1.7 million invoices and commitments amounting to R32.3 million as at 31 March 2019.

The Department has submitted a roll-over application to the value of R34.0 million.

Department of Health Annual Report 2018/19 235 GAUTENG DEPARTMENT OF HEALTH VOTE 4 STATEMENT OF FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2019

NOTES 2018/19 2017/18 R'000 R'000

REVENUE

Annual Appropriation 1 46 762 330 42 192 834 Departmental Revenue 2 780 803 546 916

TOTAL REVENUE 47 543 133 42 739 750

EXPENDITURE

Current Expenditure Compensation of Employees 3 26 902 298 25 085 331 Goods and Services 4 229 501 13 583 391 Interest and Rent on Land 5 7 794 628

Total Current Expenditure 42 139 593 38 669 350

Transfers and Subsidies Transfers and Subsidies 7 2 293 096 1 858 898

Total Transfers and Subsidies 2 293 096 1 858 898

Expenditure for Capital Assets Tangible Assets 8 1 572 107 1 476 108

Total expenditure for Capital Assets 1 572 107 1 476 108

Payments for Financial Assets 6 5 764 9 103

TOTAL EXPENDITURE 46 010 560 42 013 459

SURPLUS/(DEFICIT) FOR THE YEAR 1 532 573 726 291

Reconciliation of Net Surplus/(Deficit) for the year

Voted funds 751 770 179 375 Annual Appropriation 71 914 25 817 Conditional Grants 679 856 153 558 Departmental Revenue 2 780 803 546 916 SURPLUS/(DEFICIT) FOR THE YEAR 1 532 573 726 291

236 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2019

NOTES 2018/19 2017/18 R'000 R'000

ASSETS

Current assets 707 744 438 662

Cash and Cash Equivalents 9 685 392 283 773 Receivables 10 22 352 154 889

Non-Current Assets 142 962 115 654

Investments 11 54 000 54 000 Receivables 10 88 962 61 654

TOTAL ASSETS 850 706 554 316

LIABILITIES 717 283 449 380

Current liabilities

Voted funds to be surrendered to the Revenue Fund 12 439 466 - Departmental revenue to be surrendered to the Revenue Fund 13 70 454 57 864 Payables 14 207 363 391 516

Non-Current liabilities - -

TOTAL LIABILITIES 717 283 449 380

NET ASSETS 133 423 104 936

Represented by: Capitalisation Reserve 54 000 54 000 Recoverable Revenue 79 423 50 936

TOTAL 133 423 104 936

Department of Health Annual Report 2018/19 237 GAUTENG DEPARTMENT OF HEALTH STATEMENT OF CHANGES IN NET ASSETS AS AT 31 MARCH 2019

NOTES 2018/19 2017/18 R'000 R'000

Capitalisation Reserves Opening balance 54 000 54 000 Closing balance 54 000 54 000

Recoverable revenue Opening balance 50 936 34 746 Transfers: 28 487 16 190 Debts recovered 628 1 694 Debts raised 27 859 14 496 Closing balance 79 423 50 936

TOTAL 133 423 104 936

The amount of R54.0 million is the initial capital investment in Medical Supplies Depot (MSD). No additional investment was made during the period.

238 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 CASH FLOW STATEMENT FOR THE YEAR ENDED 31 MARCH 2019

NOTES 2018/19 2017/18 R'000 R'000

CASH FLOWS FROM OPERATING ACTIVITIES

Receipts Annual Appropriated funds received 1.1 47 543 133 42 739 750 Departmental Revenue Received 2 46 762 330 42 192 834 Interest received 2 780 039 545 942 764 974 Net (increase)/decrease in working capital (78 924) (8 140) Surrendered to Revenue Fund (1 080 517) (768 070) Current Payments (42 131 799) (38 668 722)

Interest Paid 5 (7 794) (628)

Payments for Financial Assets (5 764) (9 103) Transfers and Subsidies paid (2 293 096) (1 858 898) Net Cash Flow available from operating activities 15 1 945 239 1 426 189

CASH FLOWS FROM INVESTING ACTIVITIES

Payments for Capital Assets 8 (1 572 107) (1 476 108) Net cash Flows from investing activities (1 572 107) (1 476 108)

CASH FLOWS FROM FINANCING ACTIVITIES

Increase/(decrease) in net assets 28 487 16 190 Net cash flows from financing activities 28 487 16 190

Net increase/(decrease) in cash and cash equivalents 401 619 (33 729)

Cash and cash equivalents at beginning of period 283 773 317 502 Cash and cash equivalents at end of period 16 685 392 283 773

Department of Health Annual Report 2018/19 239 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

PART A: ACCOUNTING POLICIES

Summary of significant accounting policies The financial statements have been prepared in accordance with the following policies, which have been applied consistently in all material aspects, unless otherwise indicated. Management has concluded that the financial statements present fairly the Department’s primary and secondary information. The historical cost convention has been used, except where otherwise indicated. Management has used assessments and estimates in preparing the annual financial statements. These are based on the best information available at the time of preparation.

Where appropriate and meaningful, additional information has been disclosed to enhance the usefulness of the financial statements and to comply with the statutory requirements of the Public Finance Management Act (PFMA), Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations issued in terms of the PFMA and the annual Division of Revenue Act.

1 Basis of preparation The financial statements have been prepared in accordance with the Modified Cash Standard.

2 Going concern The financial statements have been prepared on a going concern basis.

3 Presentation currency Amounts have been presented in the currency of the South African Rand (R) which is also the functional currency of the Department.

4 Rounding Unless otherwise stated financial figures have been rounded to the nearest one thousand Rand (R’000).

5 Comparative information

5.1 Prior period comparative information Prior period comparative information has been presented in the current year’s financial statements. Where necessary figures included in the prior period financial statements have been reclassified to ensure that the format in which the information is presented is consistent with the format of the current year’s financial statements.

5.2 Current year comparison with budget A comparison between the approved, final budget and actual amounts for each programme and economic classification is included in the appropriation statement.

6 Revenue

6.1 Appropriated funds Appropriated funds comprises of Departmental allocations as well as direct charges against the revenue fund (i.e. statutory appropriation). Appropriated funds are recognised in the statement of financial performance on the date the appropriation becomes effective. Adjustments made in terms of the adjustments budget process are recognised in the statement of financial performance on the date the adjustments become effective. The net amount of any appropriated funds due to / from the relevant revenue fund at the reporting date is recognised as a payable / receivable in the statement of financial position.

6.2 Departmental revenue Departmental revenue is recognised in the statement of financial performance when received and is subsequently paid into the relevant revenue fund, unless stated otherwise. Any am ount owing to the relevant revenue fund at the reporting date is recognised as a payable in the statement of financial position.

6.3 Accrued Departmental revenue Accruals in respect of Departmental revenue are recorded in the notes to the financial statements when: • it is probable that the economic benefits or service potential associated with the transaction will flow to the Department; and • the amount of revenue can be measured reliably. The accrued revenue is measured at the fair value of the consideration receivable. Write-offs are made according to the Department’s debt write-off policy.

240 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

7 Expenditure

7.1 Compensation of employees

7.1.1 Salaries and wages Salaries and wages are recognised in the statement of financial performance on the date of payment.

7.1.2 Social contributions Social contributions made by the Department in respect of current employees are recognised in the statement of financial performance on the date of payment. Social contributions made by the Department in respect of ex-employees are classified as transfers to households in the Basis of preparation statement of financial performance on the date of payment. The financial statements have been prepared in accordance with the Modified Cash Standard. 7.2 Other expenditure Going concern Other expenditure (such as goods and services, transfers and subsidies and payments for capital assets) is recognised in the The financial statements have been prepared on a going concern basis. statement of financial performance on the date of payment. The expense is classified as a capital expense if the total consideration paid is more than the capitalisation threshold. Presentation currency Amounts have been presented in the currency of the South African Rand (R) which is also the functional currency of the 7.3 Accruals and payables not recognised Department. Accruals and payables not recognised are recorded in the notes to the financial statements at cost at the reporting date.

Rounding 7.4 Leases Unless otherwise stated financial figures have been rounded to the nearest one thousand Rand (R’000). 7.4.1 Operating leases Comparative information Operating lease payments made during the reporting period are recognised as current expenditure in the statement of financial performance on the date of payment. Prior period comparative information The operating lease commitments are recorded in the notes to the financial statements. Prior period comparative information has been presented in the current year’s financial statements. Where necessary figures included in the prior period financial statements have been reclassified to ensure that the format in which the information is 7.4.2 Finance leases presented is consistent with the format of the current year’s financial statements. Finance lease payments made during the reporting period are recognised as capital expenditure in the statement of financial performance on the date of payment. Current year comparison with budget The finance lease commitments are recorded in the notes to the financial statements and are not apportioned between the A comparison between the approved, final budget and actual amounts for each programme and economic classification is capital and interest portions. included in the appropriation statement. Finance lease assets acquired at the end of the lease term are recorded and measured at the lower of: • cost, being the fair value of the asset; or Revenue • the sum of the minimum lease payments made, including any payments made to acquire ownership at the end of the lease term, excluding interest. Appropriated funds Appropriated funds comprises of Departmental allocations as well as direct charges against the revenue fund (i.e. statutory 8 Cash and cash equivalents appropriation). Cash and cash equivalents are stated at cost in the statement of financial position. Appropriated funds are recognised in the statement of financial performance on the date the appropriation becomes effective. Bank overdrafts are shown separately on the face of the statement of financial position as a current liability. Adjustments made in terms of the adjustments budget process are recognised in the statement of financial performance on the For the purposes of the cash flow statement, cash and cash equivalents comprise cash on hand, deposits held, other short-term date the adjustments become effective. highly liquid investments and bank overdrafts. The net amount of any appropriated funds due to / from the relevant revenue fund at the reporting date is recognised as a Prepayments and advances payable / receivable in the statement of financial position. Prepayments and advances are recognised in the statement of financial position when the Department receives or disburses the cash. Departmental revenue Prepayments and advances are initially and subsequently measured at cost. Departmental revenue is recognised in the statement of financial performance when received and is subsequently paid into the relevant revenue fund, unless stated otherwise. 9 Loans and receivables Any am ount owing to the relevant revenue fund at the reporting date is recognised as a payable in the statement of financial Loans and receivables are recognised in the statement of financial position at cost plus accrued interest, where interest is position. charged, less amounts already settled or written-off. Write-offs are made according to the Department’s write-off policy.

Accrued Departmental revenue 10 Investments Accruals in respect of Departmental revenue are recorded in the notes to the financial statements when: Investments are recognised in the statement of financial position at cost. • it is probable that the economic benefits or service potential associated with the transaction will flow to the Department; and 11 Financial assets • the amount of revenue can be measured reliably. The accrued revenue is measured at the fair value of the consideration receivable. Financial assets (not covered elsewhere) Write-offs are made according to the Department’s debt write-off policy. A financial asset is recognised initially at its cost plus transaction costs that are directly attributable to the acquisition or issue of the financial asset. At the reporting date, a Department shall measure its financial assets at cost, less amounts already settled or written-off, except for recognised loans and receivables, which are measured at cost plus accrued interest, where interest is charged, less amounts already settled or written-off.

Department of Health Annual Report 2018/19 241 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

12.2 Impairment of financial assets Where there is an indication of impairment of a financial asset, an estimation of the reduction in the recorded carrying value, to reflect the best estimate of the amount of the future economic benefits expected to be received from that asset, is recorded in the notes to the financial statements.

13 Payables Payables recognised in the statement of financial position are recognised at cost.

14 Capital Assets

14.1 Immovable capital assets Immovable assets reflected in the asset register of the Department are recorded in the notes to the financial statements at cost or fair value where the cost cannot be determined reliably. Immovable assets acquired in a non-exchange transaction are recorded at fair value at the date of acquisition. Immovable assets are subsequently carried in the asset register at cost and are not currently subject to depreciation or impairment. Subsequent expenditure of a capital nature forms part of the cost of the existing asset when ready for use. Additional information on immovable assets not reflected in the assets register is provided in the notes to financial statements.

14.2 Movable capital assets Movable capital assets are initially recorded in the notes to the financial statements at cost. Movable capital assets acquired through a non-exchange transaction is measured at fair value as at the date of acquisition. Where the cost of movable capital assets cannot be determined reliably, the movable capital assets are measured at fair value and where fair value cannot be determined; the movable assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Movable capital assets are subsequently carried at cost and are not subject to depreciation or impairment.

14.3 Intangible assets Intangible assets are initially recorded in the notes to the financial statements at cost. Intangible assets acquired through a non-exchange transaction are measured at fair value as at the date of acquisition. Internally generated intangible assets are recorded in the notes to the financial statements when the Department commences the development phase of the project. Where the cost of intangible assets cannot be determined reliably, the intangible capital assets are measured at fair value and where fair value cannot be determined; the intangible assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Intangible assets are subsequently carried at cost and are not subject to depreciation or impairment. Subsequent expenditure of a capital nature forms part of the cost of the existing asset when ready for use.

14.4 Project Costs: Work-in-progress Expenditure of a capital nature is initially recognised in the statement of financial performance at cost when paid. Amounts paid towards capital projects are separated from the amounts recognised and accumulated in work-in-progress until the underlying asset is ready for use. Once ready for use, the total accumulated payments are recorded in an asset register. Subsequent payments to complete the project are added to the capital asset in the asset register. Where the Department is not the custodian of the completed project asset, the asset is transferred to the custodian subsequent to completion.

15 Provisions and Contingents

15.1 Provisions Provisions are recorded in the notes to the financial statements when there is a present legal or constructive obligation to forfeit economic benefits as a result of events in the past and it is probable that an outflow of resources embodying economic benefits or service potential will be required to settle the obligation and a reliable estimate of the obligation can be made. The provision is measured as the best estimate of the funds required to settle the present obligation at the reporting date.

15.2 Contingent liabilities Contingent liabilities are recorded in the notes to the financial statements when there is a possible obligation that arises from past events, and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not within the control of the Department or when there is a present obligation that is not recognised because it is not probable that an outflow of resources will be required to settle the obligation or the amount of the obligation cannot be measured reliably.

242 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

15.3 Contingent assets Contingent assets are recorded in the notes to the financial statements when a possible asset arises from past events, and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not within the control of the Department.

15.4 Commitments Commitments (other than for transfers and subsidies) are recorded at cost in the notes to the financial statements when there is a contractual arrangement or an approval by management in a manner that raises a valid expectation that the Department will discharge its responsibilities thereby incurring future expenditure that will result in the outflow of cash.

16 Unauthorised expenditure Unauthorised expenditure is recognised in the statement of financial position until such time as the expenditure is either: • approved by Parliament or the Provincial Legislature with funding and the related funds are received; or • approved by Parliament or the Provincial Legislature without funding and is written off against the appropriation in the statement of financial performance; or • transferred to receivables for recovery. Unauthorised expenditure is measured at the amount of the confirmed unauthorised expenditure.

17 Fruitless and wasteful expenditure Fruitless and wasteful expenditure is recorded in the notes to the financial statements when confirmed. The amount recorded is equal to the total value of the fruitless and or wasteful expenditure incurred. Fruitless and wasteful expenditure is removed from the notes to the financial statements when it is resolved or transferred to receivables for recovery. Fruitless and wasteful expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written-off as irrecoverable.

18 Irregular expenditure Irregular expenditure is recorded in the notes to the financial statements when confirmed. The amount recorded is equal to the value of the irregular expenditure incurred unless it is impracticable to determine, in which case reasons therefor are provided in the note. Irregular expenditure is removed from the note when it is either condoned by the relevant authority, transferred to receivables for recovery or not condoned and is not recoverable. Irregular expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written-off as irrecoverable.

19 Changes in accounting policies, accounting estimates and errors Changes in accounting policies that are effected by management have been applied retrospectively in accordance with MCS requirements, except to the extent that it is impracticable to determine the period-specific effects or the cumulative effect of the change in policy. In such instances the Department shall restate the opening balances of assets, liabilities and net assets for the earliest period for which retrospective restatement is practicable. Changes in accounting estimates are applied prospectively in accordance with MCS requirements. Correction of errors is applied retrospectively in the period in which the error has occurred in accordance with MCS requirements, except to the extent that it is impracticable to determine the period-specific effects or the cumulative effect of the error. In such cases the Department shall restate the opening balances of assets, liabilities and net assets for the earliest period for which retrospective restatement is practicable.

20 Events after the reporting date Events after the reporting date that are classified as adjusting events have been accounted for in the financial statements. The events after the reporting date that are classified as non-adjusting events after the reporting date have been disclosed in the notes to the financial statements.

21 Capitalisation reserve The capitalisation reserve comprises of financial assets and/or liabilities originating in a prior reporting period but which are recognised in the statement of financial position for the first time in the current reporting period. Amounts are recognised in the capitalisation reserves when identified in the current period and are transferred to the National/Provincial Revenue Fund when the underlying asset is disposed and the related funds are received.

22 Recoverable revenue Amounts are recognised as recoverable revenue when a payment made in a previous financial year becomes recoverable from a debtor in the current financial year. Amounts are either transferred to the National/Provincial Revenue Fund when recovered or are transferred to the statement of financial performance when written-off.

Department of Health Annual Report 2018/19 243 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

23 Related party transactions A related party transaction is a transfer of resources, services or obligations between the reporting entity and a related party. Related party transactions within the Minister/MEC’s portfolio are recorded in the notes to the financial statements when the transaction is not at arm’s length. Key management personnel are those persons having the authority and responsibility for planning, directing and controlling the activities of the Department. The number of individuals and their full compensation is recorded in the notes to the financial statements.

24 Inventories At the date of acquisition, inventories are recognised at cost in the statement of financial performance. Where inventories are acquired as part of a non-exchange transaction, the inventories are measured at fair value as at the date of acquisition. Inventories are subsequently measured at the lower of cost and net realisable value or where intended for distribution (or consumed in the production of goods for distribution) at no or a nominal charge, the lower of cost and current replacement value. The cost of inventories is assigned by using the weighted average cost basis.

25 Employee benefits The value of each major class of employee benefit obligation (accruals, payables not recognised and provisions) is disclosed in the Employee benefits note.

244 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

1. Annual Appropriation 1.1 Annual Appropriation

Included are funds appropriated in terms of the Appropriation Act (and the Adjustments Appropriation Act) for National Departments (Voted funds) and Provincial Departments

2018/19 2017/18 Final Actual Funds Funds not Final Appropriation Appropriation Received requested/not Appropriation received received R’000 R’000 R’000 R’000 R’000 1. Administration 1 361 130 1 361 130 - 1 085 267 1 085 267

2.District Health Services 15 073 917 15 073 917 - 13 712 101 13 712 101

3.Emergency Medical Services 1 423 203 1 423 203 - 1 268 154 1 268 154

4.Provincial Hospital Services 8 746 469 8 746 469 - 7 892 663 7 892 663

5.Central Hospitals 17 135 226 17 135 226 - 15 333 041 15 333 041

6. Health Science and Training 1 123 296 1 123 296 - 928 471 928 471

7. Health Care Support Services 339 156 339 156 - 289 838 289 838

8. Health Facilities Management 1 559 933 1 559 933 - 1 683 299 1 683 299

Total 46 762 330 46 762 330 - 42 192 834 42 192 834

1.2 Conditional grants

Note 2018/19 2017/18 R’000 R’000

Total grants received 31 10 536 371 9 755 788

2. Departmental Revenue

Note 2018/19 2017/18 R’000 R’000

Sales of goods and services other than capital assets 2.1 648 660 503 424

Fines, penalties and forfeits 2.2 95 48

Interest, dividends and rent on land 2.3 764 974

Transactions in financial assets and liabilities 2.4 131 284 42 470

Departmental revenue collected 780 803 546 916

Sales of Goods and Services include patient fees charged according to the 2018 gazetted Uniform Patient Fee Schedule (UPFS) tariffs. During the period, the Department exceeded its revenue collection target by R273.8 million.

Department of Health Annual Report 2018/19 245 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

2.1 Sales of goods and services other than capital assets

Note 2018/19 2017/18 2 R’000 R’000

Sales of goods and services produced by the Department 647 218 501 207

Sales by market establishment 36 547 28 099

Administrative fees 5 381 5 077

Other sales 605 290 468 031

Sales of scrap, waste and other used current goods 1 442 2 217

Total 648 660 503 424

“Other sales” include sales of crutches, access cards, boarding of staff, advertisements, immunisation fees, patient transport and special events for EMS. The increase of 29% in other sales is due to amplified efforts by the Department to increase revenue collection.

2.2 Fines, penalties and forfeits

Note 2018/19 2017/18 2 R’000 R’000

Fines 95 48

Total 95 48

Fines and penalties are charged in respect of illegal parking at the Department’s facilities. The increased collection is due to revised parking tariffs and the establishment of parking committees.

2.3 Interest, dividends and rent on land

Note 2018/19 2017/18 2 R’000 R’000

Interest Charged 764 974

Total 764 974

2.4 Transactions in financial assets and liabilities

Note 2018/19 2017/18 2 R’000 R’000

Receivables 46 064 26 550

Other Receipts including Recoverable Revenue 85 220 15 920

Total 131 284 42 470

246 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

3. Compensation of Employees 3.1 Salaries and Wages

Note 2018/19 2017/18 R’000 R’000

Basic salary 16 939 103 16 327 543

Performance award 692 423 16 614

Service Based 19 964 24 106

Compensative/circumstantial 2 559 298 2 362 404

Periodic payments 261 890 252 657

Other non-pensionable allowances 3 267 635 3 129 957

Total 23 740 313 22 113 281

The overall increase of 7% is due to the annual cost of living adjustment (COLA) during the period under review. The R675.8 million increase in performance award is due to payment of performance bonuses in June 2018 and December 2018. Other Non-Pensionable Allowances: Amounts disclosed under this line item represents amongst others service bonus and housing allowances. Compensative/ circumstantial: The amounts disclosed under this line item represents overtime paid to Health Professionals. Periodic payments: These are payments made to retired doctors, session doctors and employees being paid a once off salary related payment.

3.2 Social Contributions

Note 2018/19 2017/18 R’000 R’000

Employer contributions

Pension 2 032 851 1 940 728

Medical 1 123 994 1 025 907

UIF 161 157

Bargaining council 4 979 5 258

Total 3 161 985 2 972 050

Total compensation of employees 26 902 298 25 085 331

Average number of employees 66 281 67 950

Department of Health Annual Report 2018/19 247 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

4. Goods and services

Note 2018/19 2017/18 R’000 R’000

Administrative fees 4 163 4 212

Advertising 1 819 2 153

Minor assets 4.1 22 614 32 318

Bursaries (employees) 1 285 4 067

Catering 2 333 2 600

Communication 70 436 74 379

Computer services 4.2 64 712 264 615

Consultants: Business and advisory services 370 024 370 900

Laboratory services 2 138 383 1 535 120

Legal services 101 023 314 226

Contractors 741 416 536 466

Agency and support / outsourced services 245 763 255 725

Audit cost – external 4.3 23 276 20 731

Fleet services 254 328 235 509

Inventory 4..4 8 514 481 7 158 434

Consumables 4.5 652 183 604 999

Operating leases 173 128 143 780

Property payments 4.6 1 796 428 1 965 009

Rental and hiring 996 984

Transport provided as part of the Departmental activities 317 4 876

Travel and subsistence 4.7 16 515 22 104

Venues and facilities 7 045 1 458

Training and development 23 772 23 389

Other operating expenditure 4.8 3 061 5 336

Total 15 229 501 13 583 391

Other operating expenditure: Relates to courier and laundry services. Property Payments: Relates to the maintenance and utility payments for health facilities. Inventory: Relates to purchases of medication and medical supplies. Consumables: Relates to payments for laboratory consumables. Agency and support / outsourced services: Relates to payments, amongst others, for medical waste removal, payments to nursing agencies and security services. Legal Services represent legal costs paid to the State Attorney. Laboratory Services: The increase in Laboratory services is due to the payment of accruals at the beginning of 2018/19 financial year, as well as the settlement of NHLS debt in line with the agreement signed in December 2017 by the Department, Gauteng Provincial Treasury and NHLS .

248 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

4.1 Minor assets

Note 2018/19 2017/18 4 R’000 R’000

Tangible assets 22 614 32 318

Machinery and equipment 22 614 32 318

Total 22 614 32 318

4.2 Computer services

Note 2018/19 2017/18 4 R’000 R’000

External computer service providers 64 712 264 615

Total 64 712 264 615

“External Computer Service Providers” include software licences for operating systems and specialized computer services. The decrease in expenditure was due to withholding of payments of ICT projects which were under investigation.

4.3 Audit cost – External

Note 2018/19 2017/18 4 R’000 R’000

Regularity audits 23 263 20 731

Investigations 13 -

Total 23 276 20 731

“Investigations” relate to payments made for investigations done by the Special Investigation Unit (SIU). 4.4 Inventory

Note 2018/19 2017/18 4 R’000 R’000

Clothing material and accessories 2 296 3 918

Food and food supplies 331 712 338 722

Fuel, oil and gas 262 538 220 779

Learning, teaching and support material 15 003 814

Materials and supplies 29 596 37 565

Medical supplies 3 619 139 2 618 205

Medicine 4 132 205 3 826 093

Other supplies 4.4.1 121 992 112 338

Total 8 514 481 7 158 434

Other supplies consist of toiletries, plastics, paper and related items. The 18% increase in expenditure is due to an increase of demand in health care services as well as higher inflation on medical supplies.

Department of Health Annual Report 2018/19 249 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

4.4.1 Other supplies

Note 2018/19 2017/18 2 R’000 R’000

Other 121 992 112 338

Total 121 992 112 338

4.5 Consumables

Note 2018/19 2017/18 4 R’000 R’000

Consumable supplies 485 743 452 908

Uniform and clothing 116 950 109 733

Household supplies 287 549 273 960

Building material and supplies 32 313 24 900

Communication accessories - 1 078

IT consumables 11 472 8 899

Other consumables 37 459 34 338

Stationery, printing and office supplies 166 440 152 091

Total 652 183 604 999

The increase in expenditure is due to higher medical inflation and increased demand on the service platform. Household supplies: Includes linen, groceries and cleaning detergents. Other consumables: Includes fuel supplies, gas supplies, laboratory consumables and medical kits.

4.6 Property payments

Note 2018/19 2017/18 4 R’000 R’000

Municipal services 547 479 518 227

Property management fees - -

Property maintenance and repairs 646 426 778 209

Other 602 523 668 573

Total 1 796 428 1 965 009

The amount disclosed under other includes security services, cleaning and payments of laundry services.

4.7 Travel and subsistence

Note 2018/19 2017/18 4 R’000 R’000

Local 13 323 13 521

Foreign 3 192 8 583

Total 16 515 22 104

The expenditure in foreign travel decreased by 63% due to austerity measures (iron clad) put in place to curb expenditure. The amount disclosed under other includes security services, cleaning and payments of laundry services.

250 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

4.8 Other operating expenditure

Note 2018/19 2017/18 4 R’000 R’000

Professional bodies, membership and subscription fees 312 210

Resettlement costs 315 1 227

Other 2 434 3 899

Total 3 061 5 336

5. Interest and rent on land

Note 2018/19 2017/18 R’000 R’000

Interest paid 7 794 628

Total 7 794 628

The increase in interest paid amount is as a result of interest paid which was misallocated in the 2017/18 financial year. A major portion of interest paid is due to interest charged on court judgements for medico legal claims. Total interest paid for the 2018/19 financial year is R25.7 million.

6. Payments for financial assets

Note 2018/19 2017/18 R’000 R’000

Debts written off 6.1 5 764 9 103

Total 5 764 9 103

This amount represents staff and supplier debts that was written off during the year. Debts was written off in accordance with the Department’s policy and the Prescription Act. All possible measures were taken to ensure that all debt due to the Department is recovered.

6.1. Debts written off

Note 2018/19 2017/18 6 R’000 R’000

Nature of debts written off 6.1

Ex employees as supplier debts written off 5 764 9 103

Total debt written off 5 764 9 103

7. Transfers and Subsidies

Note 2018/19 2017/18 R’000 R’000

Provinces and municipalities 32 721 992 739 108

Departmental agencies and accounts Annex 1B 20 962 19 812

Higher education institutions Annex 1C 13 421 9 786

Non-profit institutions Annex 1D 615 281 556 250

Households Annex 1E 921 440 533 942

Total 2 293 096 1 858 898

Department of Health Annual Report 2018/19 251 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

8. Expenditure for Capital Assets

Note 2018/19 2017/18 4 R’000 R’000

Tangible assets 1 572 107 1 476 108

Buildings and other fixed structures 30 785 617 615 431

Machinery and equipment 28 786 490 860 677

Total 1 572 107 1 476 108

8.1 Analysis of funds utilised to acquire capital assets – 2018/19

Note Voted funds 2017/18 4 R’000 R’000

Tangible assets 1 572 107 1 572 107

Buildings and other fixed structures 30 785 617 785 617

Machinery and equipment 28 786 490 786 490

Total 1 572 107 1 572 107

8.2 Analysis of funds utilised to acquire capital assets – 2017/18

Note Voted funds Total 4 R’000 R’000

Tangible assets 1 476 108 1 572 107

Buildings and other fixed structures 30 615 431 785 617

Machinery and equipment 28 860 677 786 490

Total 1 476 108 1 572 107

8.3 Finance Lease expenditure included in Expenditure for Capital Assets

Note 2018/19 2017/18 6 R’000 R’000

Tangible assets 6.1

Machinery and equipment 75 776 81 472

Total 75 776 81 472

Finance lease expenditure relates to rental of cell phones, Government Garage vehicles as well as photocopiers.

9. Cash and cash equivalents

Note 2018/19 2017/18 R’000 R’000

Consolidated Paymaster General Account 684 181 306 223

Cash receipts 69 303

Outstanding payments - (23 890)

Cash on hand 1 142 1 137

Total 685 392 283 773

252 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

10. Receivables

2018/19 2017/18 Note Current Non-current Total Current Non-current 2017/18 9 R’000 R’000 R’000 R’000 R’000 R’000

Claims recoverable 10.1 1 511 - 1 511 552 - 552

Recoverable expenditure 10.2 1 383 - 1 383 1 327 - 1 327

Staff debt 10.3 16 949 88 962 105 911 15 690 61 654 77 344

Other debtors 10.4 2 509 - 2 509 137 320 - 137 320

Total 22 352 88 962 111 314 154 889 61 654 216 543

10.1 Claims recoverable

Note 2018/19 2017/18 10 R’000 R’000

Provincial Departments 1 511 552

Total 1 511 552

Claims Recoverable include amounts owed by other Departments due to staff transfers.

10.2 Recoverable expenditure (disallowance accounts)

Note 2018/19 2017/18 10 R’000 R’000

Disallowance Damages & Losses 1 383 1 327

Total 1 383 1 327

The disallowance damages & losses represents thefts and losses that are under investigation

10.3 Staff Debt

Note 2018/19 2017/18 10 R’000 R’000

Breach of Contract 58 189 33 030

Employees 9 122 8 049

Ex-employees 31 637 30 035

Fraud 132 20

Suppliers 6 583 5 963

GG Accidents 248 247

Total 105 911 77 344

Staff Debt includes salary related, supplier and bursary debts.

Department of Health Annual Report 2018/19 253 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

10.4 Other Debtors

Note 2018/19 2017/18 4 R’000 R’000

Other Debtors * - 135 609

Salary Disallowance Account 23 23

Salary reversal Control Account 1 930 1 629

Salary: Deduction Disallowance 19 19

Salary: Tax Debt 522 40

Garnishee 2 -

Medical Aid 13 -

Total 2 509 137 320

* Refer to Note 12 for current year balance. 10.5 Impairment of receivables

Note 2018/19 2017/18 R’000 R’000

Estimate of impairment of receivables 33 000 158 948

Total 33 000 158 948

Staff debtors older than three years are impaired as the likelihood of recoverability is low.

11. Investments

Note 2018/19 2017/18 R’000 R’000 Non-Current

Shares and other equity

Investment in Medical Supplies Depot 54 000 54 000

Total 54 000 54 000

Total non-current 54 000 54 000

The investments amount represents the initial investment in Medical Supplies Depot, no further investment was made during the period.

12. Voted funds to be surrendered to the Revenue Fund

Note 2018/19 2017/18 R’000 R’000

Opening balance - -

Transfer from statement of financial performance 751 771 179 375

Paid during the year (312 305) (179 375)

Closing balance 439 466 -

The Department is engaging Provincial Treasury to resolve the R135.6 million amount which is included in “Paid during the year”. This amount is as a result of previous years’ unauthorized expenditure surrenders and the disclosure of Health and Welfare Sector Training Authority funding in the Revenue Fund.

254 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

13. Departmental revenue to be surrendered to the Revenue Fund

Note 2018/19 2017/18 R’000 R’000

Opening balance 57 864 99 643

Transfer from Statement of Financial Performance 780 803 546 916

Paid during the year (768 213) (588 695)

Closing balance 70 454 57 864

14. Payables – current

Note 2018/19 2017/18 R’000 R’000

Amounts owing to other entities (Medical Supplies Depot) 174 627 369 606

Other payables 14.1 32 736 21 910

Total 207 363 391 516

14.1 Other payables

Note 2018/19 2017/18 14 R’000 R’000

Housing Loan Guarantees 2 -

Medical Aid - 170

Salary: ACB Recalls 661 574

Salary: Bargaining Council 12 8

Salary: Income Tax 5 852 7 798

Salary: Pension Fund 990 298

Telkom Account 10 202 -

Unauthorised expenditure 12 956 12 956

Other 2 061 106

Total 32 736 21 910

The “Unauthorized expenditure” of R12.9 million is disclosed as a result of an unresolved condonation from previous years’ unauthorized expenditure. The Department is engaging Provincial Treasury to resolve the matter.

Department of Health Annual Report 2018/19 255 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

15. Net cash flow available from operating activities

Note 2018/19 2017/18 R’000 R’000

Net surplus/(deficit) as per Statement of Financial Performance 1 532 573 726 291

Add back non cash/cash movements not deemed operating activities 412 666 699 898

(Increase)/decrease in receivables 105 229 (28 102)

(Increase)/decrease in prepayments and advances - 45

(Increase)/decrease in Payables - Current (184 153) 19 917

Expenditure on capital assets 1 572 107 1 476 108

Surrenders to Revenue Fund (1 080 517) (768 070)

Net cash flow generated by operating activities 1 945 239 1 426 189

16. Reconciliation of cash and cash equivalents for cash flow purposes

Note 2018/19 2017/18 R’000 R’000

Consolidated Paymaster General account 684 181 306 223

Fund requisition account - -

Cash receipts 69 303

Outstanding Payments - (23 890)

Cash on hand 1 142 1 137

Total 685 392 283 773

17. Contingent liabilities and contingent assets 17.1 Contingent liabilities

Note 2018/19 2017/18 4 R’000 R’000

Liable to

Claims against the Department Annex 3B 24 754 605 20 932 408

Intergovernmental payables (unconfirmed balances) Annex 5 1 543 300

Total 24 756 148 20 932 708

Claims against the Department include medico legal and civil claims and claims against state vehicle accidents. Claims against the Department are classified as contingent liabilities in line with Chapter 14, paragraph 04 of the Modified Cash Standard which defines a contingent liability as a possible obligation that arises from past events, and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Department. The Department has appointed the Special Investigation Unit (SIU) to assist with investigating medico legal related claims, with the aim of eliminating fraudulent claims.

256 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

17.2. Contingent assets

Note 2018/19 2017/18 R’000 R’000

Nature of contingent asset

Claims against employees 29 429 32 192

Total 29 429 32 192

18. Commitments

Note 2018/19 2017/18 R’000 R’000

Current expenditure

Approved and contracted 976 855 909 690

976 855 909 690

Capital expenditure

Approved and contracted 2 096 563 1 202 254

Approved but not yet contracted 12 410 461 214

2 108 973 1 663 468

Total Commitments 3 085 828 2 573 158

Included in the total commitments are commitments amounting to R1.9 billion which exceeding one year.

19. Accruals and payables not recognised 19.1 Accruals

2018/19 2017/18 R’000 R’000 Included in the above totals are the following: 30 Days 30+ Days Total Total

Sales of goods and services other than capital assets 55 653 442 232 497 885 227 317

Total 55 653 442 232 497 885 227 317

Listed by programme level Note 2018/19 2017/18 R’000 R’000

Administration 37 423 27 915

District Health Services 104 231 34 545

Emergency Medical Services 10 966 1 407

Provincial Hospital Services 176 710 64 944

Central Hospital Services 160 895 96 570

Health Training and Sciences 3 117 439

Health Care Support Services 4 543 1 497

Total 497 885 227 317

Department of Health Annual Report 2018/19 257 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

19.2 Payables not recognised

2018/19 2017/18 R’000 R’000 Listed by economic classification 30 Days 30+ Days Total Total

Goods and services 1 488 661 2 851 662 4 340 323 6 516 019

Transfers and subsidies 16 16 16

Capital assets 3 945 3 945 50 782

Total 1 488 661 2 855 623 4 344 284 6 566 817

Note Listed by programme level 2018/19 2017/18 R’000 R’000

Administration 1 257 991 1 905 746

District Health Services 485 132 648 250

Emergency Medical Services 148 394 253 011

Provincial Hospital Services 951 002 1 237 616

Central Hospital Services 1 257 063 2 393 315

Health Training and Sciences 5 787 5 109

Health Care Support Services 21 077 20 677

Health Facilities Management 217 838 103 093

Total 4 344 284 6 566 817

Included in the above totals are the following:

Confirmed balances with other Departments 101 693 244 334

Confirmed balances with other government entities 754 543 1 156 892

Total 856 236 1 401 226

20. Employee benefits

Note 2018/19 2017/18 R’000 R’000

Leave entitlement 1 007 514 907 179

Service bonus 644 633 615 324

Performance awards 404 917 712 950

Capped leave commitments 357 254 383 590

Long Service Award 19 688 16 502

Total 2 434 006 2 635 545

258 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

21. Lease commitments 21.1 Operating leases

Buildings and other Machinery and Total fixed structures equipment

2018/19 R’000 R’000 R’000

Not later than 1 year 50 187 70 272 120 459 Later than 1 year and not later than 5 years 193 277 78 113 271 390 Total lease commitments 243 464 148 384 391 848

Buildings and other Machinery and Total fixed structures equipment

2017/18 R’000 R’000 R’000

Not later than 1 year 11 460 28 339 39 799 Later than 1 year and not later than 5 years 19 207 17 386 36 593 Total lease commitments 30 667 45 725 76 392

Current year lease commitments for Buildings and Other Fixtures mainly relate to leases that will expire within the next two to five years.

21.2 Finance leases

Machinery and Total equipment

2018/19 R’000 R’000

Not later than 1 year 28 841 28 841 Later than 1 year and not later than 5 years 13 700 13 700 Total lease commitments 42 541 42 541

Machinery and Total equipment

2017/18 R’000 R’000

Not later than 1 year 23 025 23 025 Later than 1 year and not later than 5 years 6 366 6 366 Total lease commitments 29 392 29 392

22. Accrued Departmental revenue

Note 2018/19 2017/18 R’000 R’000

Sales of goods and services other than capital assets 2 982 039 2 665 804

Total 2 982 039 2 665 804

Department of Health Annual Report 2018/19 259 22.1 Analysis of Accrued Departmental revenue

Note 2018/19 2017/18 R’000 R’000

Opening balance 2 665 804 2 190 242

Less: amounts received 504 520 450 718

Add: amounts recorded 1 200 897 1 372 964

Less: amounts written-off/reversed as irrecoverable 380 142 446 684

Closing balance 2 982 039 2 665 804

22.2 Accrued Department revenue written off

Nature of losses Note 2018/19 2017/18 R’000 R’000

Patient Debts written off 380 142 446 684

Total 380 142 446 684

Patient debt is written off where the cost to recover the outstanding debt is assessed to exceed the debt owed. The Department will be investing in upgrading the ICT infrastructure to assist with patient traceability which will improve revenue collection.

22.3 Impairment of accrued Departmental revenue

Nature of losses Note 2018/19 2017/18 R’000 R’000

Estimate of impairment of accrued Departmental revenue 2 602 411 2 236 902

Total 2 602 411 2 236 902

The amount that has been impaired against accrued Departmental revenue relates to patient debts and is according to the Department’s Policy.

23. Irregular Expenditure 23.1 Reconciliation of irregular expenditure

Note 2018/19 2017/18 R’000 R’000

Opening balance 10 688 489 8 985 284

Add: Irregular expenditure – relating to prior year 570 088 351 001

Add: Irregular expenditure – relating to current year 2 292 068 1 352 204

Closing balance 13 550 645 10 688 489

Analysis of awaiting condonation per age classification

Current year 2 292 068 1 352 204

Prior years 11 258 577 9 336 285 13 550 645 Total 10 688 489

260 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

23.2 Details of irregular expenditure – added current year

Incident Disciplinary steps taken/criminal Way Forward 2018/19 proceedings R’000

Consignment Disciplinary steps finalized, Tender process at an advanced stage. 226 938 Stock condonation to be applied for.

Security Disciplinary steps finalized, Security In-Sourcing strategy to be fully 587 979 Contracts condonation to be applied for. implemented by end of the 2019/20 financial year.

Outsourced Disciplinary steps finalized, Tender to be advertised before end of the second 35 499 Nursing Staff condonation to be applied for. quarter.

South African Disciplinary steps finalized, Contract terminated. 16 284 Institute of condonation to be applied for. Chartered Accountants (SAICA)

SA Board of Disciplinary steps finalized, Contract terminated. 7 711 People Practice condonation to be applied for. (SABPP)

Institute of Disciplinary steps finalized, Contract terminated. 9 235 People condonation to be applied for. Management (IPM)

Overtime 2000 Critical Posts have been Posts are being advertised. 323 exceeding 30% approved.

Supply Chain Training and up skilling of officials is Stringent monitoring of compliance. 1 268 698 Processes not being implemented. Followed

Contracts Training and up skilling of officials is Stringent monitoring of compliance. 74 863 extensions being implemented.

Procurement of * Awaiting criminal proceedings to be concluded. 397 717 V-Blocks IT Infrastructure

Conditional Disciplinary steps finalized, Business plans sent to National Health 236 909 Grants not condonation to be applied for utilised as per business plan

Total 2 862 156

A forensic investigation was done which found that the process of procuring V-Blocks IT infrastructure was irregular. Persons implicated have been reported to the National Directorate of Public Prosecutions for investigations.

Department of Health Annual Report 2018/19 261 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

24. Fruitless and wasteful expenditure 24.1 Reconciliation of fruitless and wasteful expenditure

Note 2018/19 2017/18 R’000 R’000

Opening balance 457 696 419 778

Fruitless and wasteful expenditure – relating to current year 26 682 37 918

Less: Amounts resolved - -

Closing balance 484 378 457 696

24.2 Analysis of awaiting resolution per economic classification

Note 2018/19 2017/18 R’000 R’000

Current 484 378 457 696

Total 484 378 457 696

24.3 Analysis of Current year’s (relating to current and prior years) fruitless and wasteful expenditure

2018/19 Disciplinary steps taken/criminal proceedings Incident R’000

Interest on Litigations Corrective measures are being implemented. 12 334

Interest on overdue accounts Corrective measures are being implemented. 12 103

Interest paid by DID for Health Corrective measures are being implemented. 2 245

Total 26 682

The Department is in the process of condoning the Fruitless and Wasteful expenditure that has accumulated over the years. Processes have been put in place to reduce interest payable to Suppliers.

25. Related party transactions

Note 2018/19 2017/18 Payments made R’000 R’000

Goods and services 4 496 602 3 899 204

Total 4 496 602 3 899 204

25. Related party transactions

Note 2018/19 2017/18 Year end balances arising from payments R’000 R’000

Payables to related parties 614 687 1 023 222

Total 614 687 1 023 222

Medical Supplies Depot (MSD) is a related party to the Department. MSD is an entity of the Department and is accountable to the same Accounting Officer. All other Gauteng Provincial Government Departments’ are related parties to the Department, by virtue of being under the control of Gauteng Provincial Government Legislature.

262 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

26. Key Management Personnel

No. of 2018/19 2017/18 Individuals R’000 R’000

Political Office Bearers (MEC) 1 1 978 1 978

Level 15 to 16 5 5 288 7 655

Level 14 17 20 090 21 542

Family members of key management personnel 4 1 192 1 410

Total 27 28 548 32 585

Key management include all staff members who drive the strategy of the department. Employees who are on level 14 but are not driving the Departmental strategy are not included in this list.

27. Provisions

Note 2018/19 2017/18 R’000 R’000

OSD for Engineers - 9 274

Litigation Claims Against the Department 140 599 140 599

Performance Bonuses for 2008/2009, 2009/2010 and 2010/2011 - 413 000

Total 140 599 562 873

27.1 Reconciliation of movement in provisions – 2018/19

Legal Bonuses OSD Total provisions R’000 R’000 R’000 R’000

Opening balance 140 599 413 000 9 274 562 873

Reversal of Provision (413 000) (9 274) (422 274)

Closing balance 140 599 - - 140 599

27.2 Reconciliation of movement in provisions – 2017/18

Legal Bonuses OSD FPS Payback Total provisions R’000 R’000 R’000 R’000 R’000

Opening balance 140 599 413 000 9 274 8 805 571 678

Settlement of provision - - - (8 805) (8 805)

Closing balance 140 599 413 000 9 274 - 562 873

Department of Health Annual Report 2018/19 263 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

28. Movable Tangible Capital Assets MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019

Closing Balance Value adjustments Additions Disposals Closing Balance R’000 R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 5 826 424 - 760 151 (37 763) 6 548 812

Transport assets 528 898 - 123 353 - 652 251

Computer equipment 252 760 - 19 680 (1 114) 271 326

Furniture and office equipment 160 547 - 5 254 (714) 165 087

Other machinery and equipment 4 884 219 - 611 864 (35 935) 5 460 148

TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 5 826 424 - 760 151 (37 763) 6 548 812

2 268 Movable Tangible Capital Assets under Investigation included in the Assets Register 38 429

Machinery and equipment include assets which are under investigation due to the damage from the re which occurred during the year.

28.1 Additions ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019

(Capital Work Received in Progress current, not current costs paid and finance (Paid current lease year, received Cash Non-cash payments) prior year Total R’000 R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 786 489 11 448 (75 776) 37 990 760 151

Transport assets 143 972 - (53 195) 32 576 123 353

Computer equipment 7 331 11 053 - 1 296 19 680

Furniture and office equipment 5 089 - - 165 5 254

Other machinery and equipment 630 097 395 (22 581) 3 953 611 864

TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 786 489 11 448 (75 776) 37 990 760 151

28.2 Disposals DISPOSALS OF MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019

Sold for cash Non-cash disposal Total disposals R’000 R’000 R’000

MACHINERY AND EQUIPMENT 37 763 - 37 763

Transport assets -

Computer equipment 1 114 - 1 114

Furniture and office equipment 714 - 714

Other machinery and equipment 35 935 35 935

TOTAL DISPOSAL OF MOVABLE TANGIBLE CAPITAL ASSETS 37 763 - 37 763

The value of assets sold for cash is include in the Department’s Revenue collected under sales of scrap.

264 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

28.3 Movement for 2017/18 MOVEMENT IN TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2018

Opening Prior period Closing balance error Additions Disposal Balance R’000 R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 5 227 033 - 720 248 (120 857) 5 826 424

Transport assets 447 727 - 85 806 (4 635) 528 898

Computer equipment 228 637 - 28 438 (4 315) 252 760

Furniture and office equipment 149 853 - 14 386 (3 692) 160 547

Other machinery and equipment 4 400 816 - 591 618 (108 215) 4 884 219

TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 5 227 033 - 720 248 (120 857) 5 826 424

28.4 Minor assets

Machinery and equipment 2017/18 R’000 R’000

Opening balance 701 503 701 503

Additions 11 687 11 687

Disposals (5 852) (5 852)

TOTAL MINOR ASSETS 707 338 707 338

7 315 Minor Capital Assets under Investigations included in the Asset Register 12 538

MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31 MARCH 2018

Machinery and equipment 2017/18 R’000 R’000

Opening balance 695 636 695 636

Additions 29 457 29 457

Disposals (23 590) (23 590)

TOTAL MINOR ASSETS 701 503 701 503

Department of Health Annual Report 2018/19 265 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

29. Intangible Capital Assets MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019

Opening balance Additions Disposals Closing Balance R’000 R’000 R’000 R’000

SOFTWARE 55 637 - - 55 637

TOTAL INTANGIBLE CAPITAL ASSETS 55 637 - - 55 637

29.1 Movement for 2017/18 MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019Fkey

Opening balance Disposals Closing Balance R’000 R’000 R’000

SOFTWARE 263 244 (207 607) 55 637

29.1.1 Prior Year Adjustment

2017/18 R’000 Overstatement of Intangible Assets

Opening balance 108 334

Adjustment of Disposals (52 697)

Closing Balance 55 637

*The opening balance had to be amended as items that do not meet the de nition of Intangible Assets were capitalised.

29.1.2 Immovable Tangible Capital Assets MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2019

Opening Additions Closing balance Balance R’000 R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES 1 632 824 608 272 2 241 096

Other fixed structures 1 632 824 608 272 2 241 096

TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 1 632 824 608 272 2 241 096

4 projects were completed in the current nancial year and 13 in the previous nancial years. These projects are due to be transferred to the Gauteng Department of Infrastructure Development after all certi cation has been completed.

266 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

30.1 Additions

(Capital Work in Progress current costs and finance lease Cash Non- Cash payments) Total R’000 R’000 R’000 R’000

BUILDING AND OTHER FIXED STRUCTURES 770 532 608 272 (770 532) 608 272

Other fixed structures 770 532 608 272 (770 532) 608 272

TOTAL ADDITIONS TO IMMOVABLE 770 532 608 272 (770 532) 608 272

TANGIBLE CAPITAL ASSETS

*The difference between the amount above and R786.4 million is due to lease payments which were incorrectly allocated.

30.2. Movement for 2017/18

Opening Additions Closing balance Balance R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES 70 949 1 561 875 1 632 824

Other fixed structures 70 949 1 561 875 1 632 824

TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 70 949 1 561 875 1 632 824 R’000

30.3. Capital Work-in-progress

CAPITAL WORK-IN-PROGRESS AS AT 31 MARCH 2019

Note Opening balance Current Ready for use Closing balance Annex 7 1 April 2018 Year WIP (Assets to the AR 31 March 2019 R’000 R’000 R’000 R’000

Buildings and other fixed structures 2 306 300 770 532 (608 272) 2 468 560

TOTAL 2 306 300 770 532 (608 272) 2 468 560

The opening balance was adjusted by R255.6 million after a clean-up of the asset register was performed by the Department.

2018/19 Age analysis on ongoing projects R’000

0 to 1 Year 95 871

1 to 3 Years 422 159

3 to 5 Years 604 752

Longer than 5 Years 1 345 778

Total 2 468 560

Department of Health Annual Report 2018/19 267 GAUTENG DEPARTMENT OF HEALTH VOTE 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

30.3. Capital Work-in-progress

CAPITAL WORK-IN-PROGRESS AS AT 31 MARCH 2018

Opening balance Prior Year Current Ready for use Closing balance 1 April 2017 adjustments Year WIP (Assets to the AR) 31 March 2018 R’000 R’000 R’000 R’000 R’000

Buildings and other fixed structures 3 599 029 (434 308) 703 454 1 561 875 2 306 300

TOTAL 3 599 029 (434 308) 703 454 1 561 875 2 306 300

In the annual report of 2017/18, a printing error occurred, and a closing balance was recorded as 2 470 608 instead of 2 740 608. This error has since been corrected. The opening balance had to be amended as items that do not meet the definition of Immovable Assets were capitalised.

2017/18 Age analysis on ongoing projects R’000

0 to 1 Year 345 618

1 to 3 Years 209 030

3 to 5 Years 547 241

Longer than 5 Years 1 204 411

Total 2 306 300 R’000

30.4. Prior year errors

Correction of prior Note Amount before Prior period Restated period errors error correction error amount

Contingent Liabilities 17 25 091 851 (4 159 143) 20 932 708

268 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

31. STATEMENT OF CONDITIONAL GRANTS RECEIVED

GRANT ALLOCATION SPENT 2017/18

Division of Revenue Act/ Roll Total Amount received Amount spent by Under / % of available funds Division of Amount spent Provincial Grants Overs Available by Department Department (Overspending) spent by Department Revenue Act by Department R’000 R’000 R’000 R’000 R'000 R'000 % R’000 R’000

Comprehensive HIV and 4 239 277 AIDS - 4 239 277 4 239 277 3 965 836 273 441 94% 3 744 381 3 744 381 Health Professional Training & Development 972 759 10 953 983 712 983 712 947 885 35 827 96% 919 431 904 053 Hospital Facilities Revitalisation Grant 874 842 17 242 892 084 892 084 779 939 112 145 87% 976 828 839 444 National Tertiary Services 4 390 192 - 4 390 192 4 390 192 4 137 621 252 571 94% 4 110 484 4 110 049

Human Papillomavirus 27 312 Vaccine Grant - 27 312 27 312 21 670 5 642 79% - - EPWP Social Sector 1 470 Incentive Grant - 1 470 1 470 1 404 66 96% 2 663 2 611 EPWP Integrated Grant to - Provinces 2 324 2 324 2 324 2 160 164 93% 2 000 1 691

10 508 176 Total 28 195 10 536 371 10 536 371 9 856 515 679 856 - 9 755 787 9 602 229

Department of Health Annual Report 2018/19 269 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

32. STATEMENT OF CONDITIONAL GRANTS AND OTHER TRANSFERS PAID TO MUNICIPALITIES

GRANT ALLOCATION TRANSFER Re-allocations by Total National Treasury or DoRA and other transfers Adjustments Available Adjustments National Department NAME OF MUNICIPALITY R’000 R’000 R’000 R’000

City of Johannesburg Metro 272 638 9 420 282 058 282 061 -

City of Tshwane Metro 165 563 (60 833) 104 730 104 680 -

Ekurhuleni Metro 328 985 (9 779) 319 206 319 206 -

West Rand District Council 7 796 - 7 796 7 796 -

Sedibeng District Council 8 288 (39) 8 249 8 249 -

TOTAL 783 270 (61 231) 722 039 721 992 -

270 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 1A STATEMENT OF CONDITIONAL GRANTS AND OTHER TRANSFERS PAID TO MUNICIPALITIES (Unaudited Annexure)

GRANT ALLOCATION TRANSFER SPENT 2017/18

Re-allocations % of by National Amount available DoRA and Treasury or received Amount funds Division other Roll Total Actual Funds National by spent by Unspent spent by of Revenue Actual transfers Overs Adjustments Available Transfer Withheld Department municipality municipality funds municipality Act transfer NAME OF MUNICIPALITY R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000

Primary Health Care Category A

City of Johannesburg Metro 128 726 128 726 128 726 121 669 121 669

City of Tshwane Metro 49 837 49 837 49 837 46 541 46 541

Ekurhuleni Metro 137 900 137 900 137 900 130 340 130 340 HIV AND AIDS Category A

City of Johannesburg Metro 13 580 9 420 23 000 23 003 22 072 22 072

City of Tshwane Metro 13 591 398 13 989 13 989 12 720 12 720

Ekurhuleni Metro 23 757 (9 779) 13 978 13 978 13 236 13 236 Category B

West Rand District Council 7 796 7 796 7 796 7 424 7 424

Sedibeng District Council 8 288 (39) 8 249 8 249 7 767 7 767 Emergency Medical Services Category A

City of Johannesburg Metro 130 332 130 332 130 332 123 187 123 187

City of Tshwane Metro 102 135 40 854 40 854 95 993 95 993

Ekurhuleni Metro 167 328 (61 281) 167 328 167 328 158 155 158 155 Category C West Rand District Council

TOTAL 783 270 (61 281) 721 989 721 992 739 104 739 104

Department of Health Annual Report 2018/19 271 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 1B STATEMENT OF TRANSFERS TO DEPARTMENTAL AGENCIES AND ACCOUNTS (Unaudited Annexure)

TRANSFER ALLOCATION SPENT 2017/18

% of Roll Final Adjusted Adjustments Total Actual Available funds Appropriation Overs Available Transfer Transferred Appropriation DEPARTMENTAL AGENCY/ ACCOUNT R’000 R’000 R’000 R’000 R’000 % R’000

Health and Welfare Seta (HW-SETA) 20 962 - 20 962 20 962 20 962 100% 19 812 Total 20 962 - 20 962 20 962 20 962 100% 19 812

ANNEXURE 1C STATEMENT OF TRANSFERS TO HIGHER EDUCATION INSTITUTIONS (Unaudited Annexure)

TRANSFER ALLOCATION TRANSFER 2017/18 % of Adjusted Roll Total Actual Amount not Available funds Final Appropriation Overs Adjustments Available Transfer transferred Transferred Appropriation R’000 R’000 R’000 R’000 R’000 R’000 % R’000

University of Witwatersrand 2 000 - - 2 000 2 289 2 289 -13% 434 University of Johannesburg 5 000 - - 5 000 4 819 4 819 4% 892 Sefako Makgatho Health Science University 2 681 - - 2 681 2 702 2 702 -1% 210 University of Pretoria 4 000 - - 4 000 3 611 3 611 11% 10 525

TOTAL 13 681 - - 13 681 13 421 13 421 12 061

Department of Health Annual Report 2018/19 272 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 1D STATEMENT OF TRANSFERS TO NON-PROFIT INSTITUTIONS (Unaudited Annexure)

TRANSFER ALLOCATION EXPENDITURE 2017/18 Adjusted % of Appropriation Roll Total Actual Available funds Final Act Overs Adjustments Available Transfer Transferred Appropriation NON-PROFIT INSTITUTIONS R’000 R’000 R’000 R’000 R’000 % R’000R’000 Transfers Subsidy Chronic PSYCH Care (Life Esidimeni) - - - - 13 749 Community Based Services (Mental Health NPOs) 191 207 191 207 150 495 79% 224 367 HIV and AIDS (NGO's) 79 264 79 264 73 651 93% 85 960 Nutrition Provincial (NGO's) 58 548 58 548 55 984 96% 55 583 Community Health Clinics (Witkoppen Clinic) 13 308 13 308 13 115 99% 12 578 Community Based Services (EPWP NPOs) 120 511 120 511 120 346 100% 112 791 Community Based Services (Specialised Services NPOs & Rehabilitation) 1 690 1 690 1 690 100% 1 597 Nelson Mandela Children’s Hospital 200 000 200 000 200 000 100% 150 000

TOTAL 664 528 - - 664 528 615 281 93% 656 625

273 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019 ANNEXURE 1E STATEMENT OF TRANSFERS TO HOUSEHOLDS (Unaudited Annexure

TRANSFER ALLOCATION EXPENDITURE 2017/18 Adjusted % of Appropriation Roll Total Actual Available funds Final Act Overs Adjustments Available Transfer Transferred Appropriation HOUSEHOLDS R’000 R’000 R’000 R’000 R’000 % R’000R’000 Transfers Household Employee Benefit: Injury on Duty 9 310 - - 9 310 3 834 41% 15 545 Household Employee Benefit: Leave Gratuity 89 481 - - 89 481 96 979 108% 81 350 Household Employee Benefit: Post-retirement benefit ------

Household: Other Transfers(Cash) Household Bursaries: - (non-employee) 148 642 - - 148 642 234 174 158% 85 724 Household Claims against State (Cash) 1 376 - 287 000 288 376 586 543 203% 3 300

TOTAL 248 809 - 287 000 535 809 921 440 172% 185 919

ANNEXURE 1 F- STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS RECEIVED (Unaudited Annexure)

2018/19 2017/18 NAME OF THE DONOR NATURE OF GIFT, DONATION OR SPONSORSHIP R’000 R’000

Received in Cash

Various Donors 5 530

5 530

Received in Kind Various Items

Various Donors Computer Equipment 23 8 525

Other Machinery and 18 3 252

Equipment - -

Furniture and office equipment 46 157 6 940

Pharmaceuticals - -

Sub-Total Accommodation 46 198 18 718

TOTAL 46 203 19 248

Department of Health Annual Report 2018/19 274 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 3B STATEMENT OF CONTINGENT LIABILITIES AS AT 31 MARCH 2019

Liabilities paid/ Liabilities recoverable Opening Balance Liabilities incurred during cancelled/reduced (Provide details Closing Balance 1 April 2018 the year during the year here under) 31 March 2019 Nature of Liability R’000 R’000 R’000 R’000 R’000

Claims against the Department

Medico – Legal matters 17 542 371 4 229 890 541 961 - 21 230 300

Civil Claims 1 869 597 135 183 1 310 - 2 003 470

Vehicle Liability 12 348 600 205 - 12 743

Premature termination of contracts 1 508 092 - - - 1 508 092

TOTAL 20 932 408 4 365 673 543 476 - 24 754 605

ANNEXURE 4 CLAIMS RECOVERABLE

Confirmed balance outstanding Unconfirmed balance outstanding Total

31/03/2019 31/03/2018 31/03/2019 31/03/2018 31/03/2019 31/03/2018 GOVERNMENT ENTITY R’000 R’000 R’000 R’000 R’000 R’000

Department

Mpumalanga: Department of Health (C5) - - 26 26 26 26

Eastern Cape: Department of Health (D2) - - 26 15 26 15

Gauteng Department of Agriculture & Rural Development - 16 - - - 16

Gauteng Infrastructure Development (1G) - 13 - - - 13

National Department of Social Development (07) - - - 11 - 11

Eastern Cape Department of Education (D5) 63 63 63 63

Limpopo Department of Health and Social Development (P4) - - 345 - 345 -

Western Cape Department of Health (U3) - 199 272 199 272

SA National Defence Force (W1) - - 49 49 49 49

Free State Department of Health (V5) - - 112 - 112 -

North West Health (3Y) - 253 - 253 -

275 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 4 CLAIMS RECOVERABLE

Confirmed balance outstanding Unconfirmed balance outstanding Total

31/03/2019 31/03/2018 31/03/2019 31/03/2018 31/03/2019 31/03/2018 GOVERNMENT ENTITY R’000 R’000 R’000 R’000 R’000 R’000

Mpumalanga Department of Health & Social Services (Patient fees) - - 26 759 20 862 26 759 20 862

Department of Correctional Services (Patient fees) - - 30 920 29 532 30 920 29 532

South African Police Services (Patient fees) - - 17 811 11 216 17 811 11 216

Limpopo Department of Health and Social Development (Patient fees) - - 26 748 21 809 26 748 21 809

North West Department of Health and Social Development (Patient fees) - - 62 995 55 753 62 995 55 753

SA National Defence Force (Patient fees) - - 1 106 233 1 106 233

National Department of Justice (Patient Fees) - - 26 653 4 968 26 653 4 968

Gauteng Emergency Medical Services (Special event fees) 1 061 - - - 1 061 -

Gauteng Provincial Treasury (Provincial Revenue Fund) - - - 135 609 - 135 609

Other Government Entities - - - - -

TOTAL 1 061 29 194 521 280 525 195 582 280 554

Department of Health Annual Report 2018/19 276 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 5 INTER-GOVERNMENT PAYABLES

Confirmed balance outstanding Unconfirmed balance outstanding Total

31/03/2019 31/03/2018 31/03/2019 31/03/2018 31/03/2019 31/03/2018 GOVERNMENT ENTITY R’000 R’000 R’000 R’000 R’000 R’000

Gauteng Office of the Premier (G6) - 20 - - - 20

Department of Justice 101 638 101 499 - - 101 638 101 499

Correctional Services - 37 - - - 37

Gauteng Department of Social Development - 54 - - - 54

Eastern Cape Department of Health (D2) - 155 - - - 155

Nation Department of Public Service and Administration - 103 - - - 103

South African Police Services (90) - 79 - 140 - 219

North West Department of Health 28 28 - - 28 28

Department of Planning and Monitoring - 19 - - - 19

Limpopo Department of Health (Q7) - 32 - - - 32

Kwa Zulu Natal Department of Social Development - 27 - - - 27

Kwa-Zulu Natal Department of Health - - - 160 - 160

National Department of Public Works - 1 978 - - 1 978

Department of Defence ------

Mpumalanga Department of Health - 176 - - - 176

Department of Labour - 59 - - - 59

National Department of Health 27 140 068 - - 27 140 068

Subtotal 101 693 244 334 - 300 101 693 244 634

277 Department of Health Annual Report 2018/19 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 5 INTER-GOVERNMENT PAYABLES

Confirmed balance outstanding Unconfirmed balance outstanding Total

31/03/2019 31/03/2018 31/03/2019 31/03/2018 31/03/2019 31/03/2018 GOVERNMENT ENTITY R’000 R’000 R’000 R’000 R’000 R’000

Current - Medical Supplier Deport 614 687 1 023 222 - 614 687 1 023 222 - Medical Supplies Deport (Salary) - - - - - G-Fleet 110 194 111 082 1 543 111 737 111 082 - Special Investigating Units 29 662 22 588 29 662 22 588 - Subtotal 754 543 1 156 892 1 543 556 472 1 156 892

- TOTAL 856 236 1 401 226 1 543 857 779 1 401 526

ANNEXURE 6 INVENTORIES

Note 2018/19 2017/18 R’000 R’000

Opening balance 981 336 1 148 873

Add/(Less): Adjustments to prior year balance - (125 230)

Add: Additions/Purchases – Cash 8 514 481 7 158 435

Add: Additions - Non-cash - -

(Less): Disposals (3 503) (6 095)

(Less): Issues (8 228 071) (7 067 159)

Add/(Less): Received current, not paid (Paid current year, received prior year) - -

Add/(Less): Adjustments (186 283) (127 488)

- -

Closing balance 1 077 960 981 336

Inventory issues increased by 16% compared to the 2017/18 financial period, from R7 067 159 000 to R8 228 071 000. This was a result of increased demand for health care as well as general inflationary increases. Inventory purchases increased by 18% compared to the 2017/18 financial year in line with the increased demand for health care services provided.

Department of Health Annual Report 2018/19 278 GAUTENG DEPARTMENT OF HEALTH VOTE 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

ANNEXURE 7 MOVEMENT IN CAPITAL WORK IN PROGRESS

MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE YEAR ENDED 31 MARCH 2019

Ready for use (Asset Opening Current Year register) / Contract Closing balance Capital WIP terminated balance Nature of Liability R’000 R’000 R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES 2 306 300 770 532 (608 272) 2 468 560

Other fixed structures 2 306 300 770 532 (608 272) 2 468 560

TOTAL 2 306 300 770 532 (608 272) 2 468 560

ANNEXURE 7 MOVEMENT IN CAPITAL WORK IN PROGRESS

MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE YEAR ENDED 31 MARCH 2018

Ready for use (Asset Opening Opening Current Year register) / Contract Closing balance balance Capital WIP terminated balance Nature of Liability R’000 R’000 R’000 R’000 R’000

BUILDINGS AND OTHER

FIXED STRUCTURES 3 599 029 (434 308) 703 454 (1 561 875) 2 306 300

Dwellings

Non-residential buildings

Other fixed structures 3 599 029 (434 308) 703 454 (1 561 875) 2 306 300

Services and operating rights

TOTAL 3 599 029 (434 308) 703 454 (1 561 875) 2 306 300

Department of Health Annual Report 2018/19 279 PART F: ANNUAL REPORT GAUTENG MEDICAL SUPPLIES DEPOT (MSD)

The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. TRADING ENTITY OF THE GAUTENG DEPARTMENT OF HEALTH Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

Department of Health Annual Report 2018/19

Report of the Accounting Officer 282 Report of the Auditor-General 294 Statement of Financial Position 299 Statement of Financial Performance 300 Statement of Change in Net Assets 301 Statement of Cash Flows 302 Accounting Policies 303 Notes to the Financial Statements 311 Report of the Audit Committee - Cluster 3 328

The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

Department of Health Annual Report 2018/19 281

The Accounting Officer of the Gauteng Department of Health (the Prior to MSD online, the depot had to fax or email or physically Department) hereby submits the annual report for the Gauteng deliver the copy of the orders to the demanders for them to be able Medical Supplies Depot, to the Executive Authority of the Gauteng to receive stock from the suppliers but since the introduction of MSD Department of Health, and the Gauteng Provincial Legislature of the online, demanders are now able to see their orders on MSD online. Republic of South Africa. Prior to MSD online, suppliers had to deliver their payment packs at the depot so that they can be paid on time but with the introduction 1. General review of the state of affairs of MSD online, suppliers can now The Medical Supplies Depot (the Depot) operating as a trading entity of the department is responsible for the supply of essential Significant events that have taken place during the year (Continued) medicines to Provincial Health institutions and facilities in Gauteng. In this regard, a levy of 5% is charged on stock issued to the upload their payment packs on MSD online and their payment can Provincial Health Care Facilities. be effected timeously and if they did not submit all the required documents, their payment pack will be rejected and the reason for Essential medicines are procured on contract or quotations and their rejection will be indicated so that they are able to correct and either store these items at the Depot or orders are placed with submit the correct documentation. suppliers on behalf of institutions for direct delivery to the various institutions. Accurate usage of items, as well as money spent by The introduction of the MSD online system improved the payment of hospitals, can be obtained from the Medical Stock Administration supplier invoices to an extent that in Q3, an average of 98% of System (MEDSAS). The Economic Order Quantity (EOQ) together supplier invoices were paid within thirty (30) days. Maintenance of with the First-Expiry-First-Out, (FEFO) system is applied to ensure that the system could not be guaranteed in Q4. Thus, MSD had to correct stock levels are maintained. partially revert back to the manual document management system The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority resulting in a reduction of the percentage of suppliers paid within 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are The Depot prepares financial statements for each financial year in thirty (30) days more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National accordance with the prescribed practice (Statements of South the financial year. Department of Health. African Generally Recognised Accounting Practice- GRAP). The communicated to other provinces. financial statements are prepared and reported on accordingly. MEDSAS Personnel expenses increased due to annual salary increases as well MEDSAS has given early warnings that its life span will soon come to as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy The Medical Supplies Depot has a re-packing function, where bulk an end. After crashing in January 2018, the depot has also on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April medicine is repacked into patient ready packs. The re-packing experienced a few limitations including its inability to allow 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was expenses are recovered from the normal levy charged. Managers for monitoring antivirus and security patch updates on the MEDSAS General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of each cost centre were identified and procedures to ensure the servers and end-user workstation environments since Microsoft does year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. completeness of stock requisitioning and receiving were designed. not support the operating system. increase in distribution costs (R1.8m) and increase in expenditure on The various cost centre costs are consolidated at finance and reports repairs and maintenance (R0.6m). Free Service are timeously provided to cost centre managers for their use and This could lead to viruses not being effectively detected in the The Depot does not provide any free service. The quality control of provide a basis for comparison, monitoring and review purposes. environment. Malware could result in unauthorised access to data 2. Services rendered the medicines performed by the laboratory on site is part of the and information resulting in unauthorised activity and possible The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of 1.1 Signi cant events that have taken place during the year incorrect financial reporting. This could also result in systems being efficient procurement, quality testing, warehousing and distribution the five percent levy charge. MSD Online unavailable, due to malfunction, which can impact productivity of of essential medicines to all the Provincial Health Care Facilities in end users and ultimately affect service delivery. 3. Capacity constraints The MSD Online was introduced in April 2017 which assists in the Gauteng. The Depot ensures that Essential Medicine List (EML) medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health tracking of orders that have been placed by the depot on behalf of To circumvent this potential risk, management is in the process of evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. health institutions for their direct delivery orders. implementing a new inventory management system with at least the adjudication meetings, procurement and distribution of these items, following functionalities: as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot Prior to MSD online, orders had to be manually signed by the • Demand management; had 266 posts on the approved staff establishment, with 75 vacant. relevant pharmacists and now orders are being signed electronically • Ordering; Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of and sent off electronically to the supplier and the supplier accepts • Warehousing; samples are tested from each batch of medicines received. The the depot achieving its objectives. the order on their end as proof of acknowledgement of the order by • Issuing, and Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the the supplier. • Payment of suppliers Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

282 Department of Health Annual Report 2018/19

Implementation of new Monitoring and Evaluation document for A summary of major spending trends indicates that medicine prices the different units in the depot increased at a rate higher than the consumer price index (CPI). This has the effect that revenue increases at a higher rate and has a The monitoring and evaluation unit has developed a document for favourable influence on the net profit of the Depot. Cost the management of the different units in the depot with workplans containment measures and increased demand from healthcare and targets set to ensure that the depot achieves targets on the providers were also responsible for the improved net profit. KPI’s. The workplans are monitored on a monthly basis and that is why the depot was able to achieve all targets on the KPI’s in the operational plan. Spending Trends

Description 31 March Variance 31 March Variance 31 March Variance 31 March 2019 from Prior 2018 from Prior 2017 from Prior 2016 R Year R Year R Year R

Revenue 4 088 067 270 6.89% 3 824 656 198 28.46% 3 718 817 485 22.17% 2 894 248 189

Cost of Sales 3 893 397 373 6.89% 3 642 542 348 28.46% 3 541 730 922 24.61% 2 842 329 263

Expenditure: Personnel 70 316 592 2.90% 68 334 539 11.18% 61 460 965 0.62% 61 841 794

Expenditure: General 30 435 193 6.27% 28 639 876 -26.46% 38 944 850 32.74% 29 584 910

Net Profit 128 076 586 17.85% 108 678 509 25.68% 86 469 740 30.09% 60 447 734

The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

Department of Health Annual Report 2018/19 283

MSD was authorised to fill 23 positions in Phase 1 of the process. collated. Information from the following systems is used and The recruitment process is on-going. involves time-consuming reconciliation procedures to enable compliance with Statements of SA GRAP for disclosure purposes: Measures have been taken to strengthen the operations of the Depot and its management. Despite these challenges nonetheless • Basic Accounting System (BAS) the depot has managed to put in place compensating measures • Personnel and Salary Administration System (PERSAL) • Medical Stock Administration System (MEDSAS) The measures can be demonstrated by two of our key performance • Asset Management System (ASSETWARE) indicators: • MSDONLINE; • Manual systems to perform reconciliation procedures and • KPI 1 “Availability “refers to a situation where stock on hand at accrual based accounting the depot is sufficient to meet the demand created on MEDSAS in full, it was measured at 92.32% against a target of 90.00%. 4. Utilisation of donor funds The Depot received Fluconazole from Pfizer Laboratories for use in • KPI 2 “Service level” refers to how quickly the MSD takes to the treatment of Oesophageal Candidiasis and Cryptococcal issue stock in full on MEDSAS. The measurement of this KPI is Meningitis and a further donation of Mebendazole for the therefore time-based. This KPI ensures that all orders are issued deworming of school children from Janssen Pharmaceutical. This within 24 hours and the Service level was measured at 85.34% type of donor funding is received on a continuous basis. against a target of 80.00%. Please note that the Depot does not account for the economic Systems for measuring the indicator ‘% of orders supplied to benefit received in the Statement of Financial Performance, as the institutions on first requests’ were strengthened, and the actual Depot is considered to be only a conduit for hospitals and to control performance is calculated according to the following definition: ‘If a the receipt of donations for the Department. The donation is demand/ request (which could consist of multiple different items) is reflected in the financial statements of the Department. fulfilled 100% within 24 hours, then that order counts towards the achieving of the target. If even one item is not issued on the system The current market value of donations issued and charged at a value as part of the request within 24 hours, the order does not count as of one-hundredth of one cent (R0.0001) to all clients of the Depot. being fulfilled’. This is an extremely high standard to fulfil, but it is The total charge to health institutions for donations received specific, measurable and time- bound. Also, it holds the Depot to amounted to under R10. higher standards – meeting orders within 24 hours could have a life-saving impact at the level of institutions. However, the more rigorous monitoring system makes it appear that performance is lower than planned. A constraint to ensure effective, economical and efficient reporting exists in that information from various systems needs to be manually The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

Below is the breakdown of donations received during the nancial period.

Item Supplied by/ Quantity Market Value Total Description Arranged by Received Per Unit SEP ICN # Single Exit Price Value (SEP)

181931183 MEBENDAZOLE 500MG TABLETS; 1's Janssen Pharmaceuticals 17480 R 589.50 R 10 304 460

180963203 FLUCANAZOLE INJECTION 2MG/ML;100ML Pfizer Laboratories 3500 R 233 .37 R816 795

181791499 FLUCONAZOLE POWDER FOR ORAL Pfizer Laboratories 700 R 235.36 R164 752

SUSPENSION 50MG/5ML;35ML

180962874 FLUCONAZOLE TABLETS 200MG; 28'S Pfizer Laboratories 12520 R 2785.25 R 34 871 330

R 46 157 337

284 Department of Health Annual Report 2018/19 The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

MSD was authorised to fill 23 positions in Phase 1 of the process. collated. Information from the following systems is used and 5. Trading entities The recruitment process is on-going. involves time-consuming reconciliation procedures to enable The Medical Supplies Depot operates as a trading entity, known as management has continued to engage with suppliers in a compliance with Statements of SA GRAP for disclosure purposes: “The Central Medical Trading Account” since 1 April 1992. The number of ways such as the following: Measures have been taken to strengthen the operations of the trading entity acts as a shared supply chain for the procurement and o General meetings with all suppliers - quarterly; Depot and its management. Despite these challenges nonetheless • Basic Accounting System (BAS) provisioning of pharmaceuticals to the Department’s Health Care o One-on-one-meetings as and when necessary, and the depot has managed to put in place compensating measures • Personnel and Salary Administration System (PERSAL) Institutions in Gauteng. o Carrying out supplier satisfaction surveys by way of • Medical Stock Administration System (MEDSAS) suggestion boxes. The measures can be demonstrated by two of our key performance • Asset Management System (ASSETWARE) Comparative information A four-year comparative analysis of major accounts is disclosed indicators: • MSDONLINE; • Although it is inevitable not to have expired medicines in a depot under paragraph 1 above. • Manual systems to perform reconciliation procedures and environment and where best practices industry estimate as a • KPI 1 “Availability “refers to a situation where stock on hand at accrual based accounting benchmark is between 3% and 5% of average stock holding, 6. Organisation to whom transfer payments have been the depot is sufficient to meet the demand created on MEDSAS the Depot adopted a more conservative approach by setting a made in full, it was measured at 92.32% against a target of 90.00%. 4. Utilisation of donor funds target not exceeding 2% of the stock holding. This performance No transfer payment has been made by the Depot in this financial The Depot received Fluconazole from Pfizer Laboratories for use in indicator is reported on to the audit committee quarterly. year. • KPI 2 “Service level” refers to how quickly the MSD takes to the treatment of Oesophageal Candidiasis and Cryptococcal issue stock in full on MEDSAS. The measurement of this KPI is Meningitis and a further donation of Mebendazole for the 9 Discontinued activities 7. Public/Private Partnership (PPP) therefore time-based. This KPI ensures that all orders are issued deworming of school children from Janssen Pharmaceutical. This No activities were discontinued during the year under review. No Public Private Partnership has been entered into by the Depot in within 24 hours and the Service level was measured at 85.34% type of donor funding is received on a continuous basis. this financial year. against a target of 80.00%. 10. New/Proposed Activities Please note that the Depot does not account for the economic The Depot continues to be assisted by the Office of the Chief The following non-core services have been outsourced to the private Systems for measuring the indicator ‘% of orders supplied to benefit received in the Statement of Financial Performance, as the Information Officer (CIO) in the implementation of the possible sector which consists mostly of Black Economic Empowerment institutions on first requests’ were strengthened, and the actual Depot is considered to be only a conduit for hospitals and to control alternative to the current inventory management systems (MEDSAS) companies: performance is calculated according to the following definition: ‘If a the receipt of donations for the Department. The donation is which is due for replacement in Q2 of 2019/20. demand/ request (which could consist of multiple different items) is reflected in the financial statements of the Department. • Maintenance and support of the MEDSAS computer system; fulfilled 100% within 24 hours, then that order counts towards the 11. Supply chain management (SCM) • Distribution of stock to health care institutions; achieving of the target. If even one item is not issued on the system The current market value of donations issued and charged at a value The MSD has a fully-fledged supply chain management system in • Security of the property and vehicle access control; as part of the request within 24 hours, the order does not count as of one-hundredth of one cent (R0.0001) to all clients of the Depot. place including the Pharmaceutical Procurement Committee (PPC) • Accounting services; being fulfilled’. This is an extremely high standard to fulfil, but it is The total charge to health institutions for donations received with membership comprising of pharmacists, accountants and SCM • Maintenance, pest control and minor landscaping of the garden specific, measurable and time- bound. Also, it holds the Depot to amounted to under R10. personnel. A number of pharmaceutical items are on tenders which at the Depot; and higher standards – meeting orders within 24 hours could have a are administered at national level. The PPC, therefore, only deals • Cleaning services life-saving impact at the level of institutions. However, the more with procurement sourced from quotations for values not exceeding rigorous monitoring system makes it appear that performance is R500 000. 8. Corporate governance arrangements lower than planned. Management has, with the objective of safeguarding the assets of A constraint to ensure effective, economical and efficient reporting 12. Asset management the Depot and ensuring high quality of service delivery, prioritised exists in that information from various systems needs to be manually Management is pleased to report that it carried out a full asset the following areas: verification project on its approximately 6000 moveable assets of property, plant and equipment (PPE) as required by paragraphs • The Depot performs an annual strategic risk assessment which is 17.56 – 58 of Generally Recognised Accounting Practice (GRAP) and followed by quarterly reviews and reporting to the audit in particular GRAP 17. This standard requires an entity to assess the committee residual values of its PPE at least for each reporting period.

• The Depot has submitted the list of all critical vacant posts to the 13. Inventories post filling committee for consideration and approval. The valuation method used by the Medical Supplies Depot is the Implementation of Phase 1 authorised posts once completed moving weighted average method as per the MEDSAS: will reduce the current vacancy rate at the Depot. • ICT – Depot is currently considering the replacement of its current ineffective inventory management system (MEDSAS) with a new system. • In an effort to increase Medicines availability, the Depot

Department of Health Annual Report 2018/19 285 The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

MSD was authorised to fill 23 positions in Phase 1 of the process. collated. Information from the following systems is used and Medicine The recruitment process is on-going. involves time-consuming reconciliation procedures to enable compliance with Statements of SA GRAP for disclosure purposes: Description 31 March 2019 31 March 2018 31 March 2017 31 March 2016 Measures have been taken to strengthen the operations of the R R R R Depot and its management. Despite these challenges nonetheless • Basic Accounting System (BAS) Closing stock 208 205 999 253 425 024 170 575 222 311 096 708 the depot has managed to put in place compensating measures • Personnel and Salary Administration System (PERSAL) • Medical Stock Administration System (MEDSAS) Medicine The measures can be demonstrated by two of our key performance • Asset Management System (ASSETWARE) 31 March 2019 31 March 2018 31 March 2017 31 March 2016 indicators: • MSDONLINE; Description R R R R • Manual systems to perform reconciliation procedures and Breakages 2 306 7 633 3 288 13 273

• KPI 1 “Availability “refers to a situation where stock on hand at accrual based accounting Expired stock 1 006 956 1 166 028 2 016 734 2 568 494 the depot is sufficient to meet the demand created on MEDSAS in full, it was measured at 92.32% against a target of 90.00%. 4. Utilisation of donor funds The Depot received Fluconazole from Pfizer Laboratories for use in Control measures in place the treatment of Oesophageal Candidiasis and Cryptococcal • KPI 2 “Service level” refers to how quickly the MSD takes to Whilst the long-term solutions for ensuring efficient and effective 14. Information on predetermined objectives Meningitis and a further donation of Mebendazole for the issue stock in full on MEDSAS. The measurement of this KPI is stock management at the depot require an appropriate The Gauteng Department of Health’s Strategic Plan, was used as a deworming of school children from Janssen Pharmaceutical. This therefore time-based. This KPI ensures that all orders are issued infra-structure (new warehouse), an integrated information system basis for developing the Depot’s Operational Plan. This approach type of donor funding is received on a continuous basis. within 24 hours and the Service level was measured at 85.34% and adequate workforce in terms of numbers and skills, the ensured that the Depot’s predetermined objectives are clearly against a target of 80.00%. following short term controls have been instituted: aligned to those of the Department as far as the Depot’s relevance Please note that the Depot does not account for the economic to the Department is concerned. Systems for measuring the indicator ‘% of orders supplied to benefit received in the Statement of Financial Performance, as the • Shelf marshals continue to play a key role in the monitoring Depot is considered to be only a conduit for hospitals and to control institutions on first requests’ were strengthened, and the actual stock expiry dates and identifying items expiring in 6 months; For the year under review, the Depot had a total of six (6) the receipt of donations for the Department. The donation is performance is calculated according to the following definition: ‘If a • Stock on hand is first issued before replacement items are issued predetermined objectives which were reported on quarterly. Each of reflected in the financial statements of the Department. demand/ request (which could consist of multiple different items) is when regimens (treatment protocols) are changed; the six objectives had at least one indicator whose measurement fulfilled 100% within 24 hours, then that order counts towards the • Reviewing the list of items to be kept at the Depot; variable inputs were collected either through the current IT Systems The current market value of donations issued and charged at a value achieving of the target. If even one item is not issued on the system • Discuss regimen changes with National Department of Health to in use such as MEDSAS or collected manually or a combination of IT of one-hundredth of one cent (R0.0001) to all clients of the Depot. as part of the request within 24 hours, the order does not count as align with current stock levels; and manual systems. being fulfilled’. This is an extremely high standard to fulfil, but it is The total charge to health institutions for donations received • Back orders were reduced; specific, measurable and time- bound. Also, it holds the Depot to amounted to under R10. • Warehouse management practices were improved with the higher standards – meeting orders within 24 hours could have a introduction of trolley consolidations, streamlining of schedules life-saving impact at the level of institutions. However, the more for supervisors that assists in effective staff utilization; rigorous monitoring system makes it appear that performance is • Quality assurance processes were improved with a complete lower than planned. overhaul of the standard operating procedures. A constraint to ensure effective, economical and efficient reporting exists in that information from various systems needs to be manually

286 Department of Health Annual Report 2018/19 The Universal Test and Treat Campaign that started in September reported to the South African Health Products Regulatory Authority 2016 was a driving force behind the increase in Revenue which saw for further management. Other Provincial Medicine Depots are more orders for medical supplies being placed with the depot during alerted through the Affordable Medicines Unit at the National the financial year. Department of Health. communicated to other provinces. Personnel expenses increased due to annual salary increases as well as more scarce skills / Occupation Specific Dispensation (OSD) posts Tariff policy on the staff establishment being filled. The tariff policy for the trading account was approved on 1 April 1992 as per the Exchequer Act, Act No. 66 of 1975. Approval was General Expenditure was slightly higher in the 2018/2019 financial granted for a five percent (5%) levy on the average carrying value of year when compared to the prior year. This is mainly due to the stock issued to customer hospitals. increase in distribution costs (R1.8m) and increase in expenditure on repairs and maintenance (R0.6m). Free Service The Depot does not provide any free service. The quality control of 2. Services rendered the medicines performed by the laboratory on site is part of the The Medical Supplies Depot is responsible for the effective and administrative expenses of the Depot, which are recovered as part of efficient procurement, quality testing, warehousing and distribution the five percent levy charge. of essential medicines to all the Provincial Health Care Facilities in Gauteng. The Depot ensures that Essential Medicine List (EML) 3. Capacity constraints medicines are available to our clients at all times. This involves the The Medical Supplies Depot delivers a vital service to all the Health evaluation of samples for tender purposes, participation in tender Care Institutions in Gauteng. adjudication meetings, procurement and distribution of these items, as well as quality control of medicines distributed to our institutions. As at the end of the year under review the Medical Supplies Depot had 266 posts on the approved staff establishment, with 75 vacant. Quality control is carried out in a fully equipped laboratory, where Current year vacancy rate of 28% has a negative impact in terms of samples are tested from each batch of medicines received. The the depot achieving its objectives. Depot’s laboratory is the only public sector laboratory in South- This is as a result of a moratorium on the replacement of posts by the Africa where the findings on quality tests performed are also Department. The Department established a post filling plan committee. Having submitted a list of its most critical, vacant posts,

GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

The key performance indicators per the strategic plan based on measurable objectives and our actual achievement are reflected in the table MSD was authorised to fill 23 positions in Phase 1 of the process. collated. Information from the following systems is used and below: The recruitment process is on-going. involves time-consuming reconciliation procedures to enable compliance with Statements of SA GRAP for disclosure purposes: Deviations Measures have been taken to strengthen the operations of the # Indicator Target Actual Comments/Challenges Performance from Depot and its management. Despite these challenges nonetheless • Basic Accounting System (BAS) Target the depot has managed to put in place compensating measures • Personnel and Salary Administration System (PERSAL) 1 Percentage of EML 90.00% 92.32% 2.32 % • Target Achieved: • Medical Stock Administration System (MEDSAS) medicines available at above The Depot holds regular meetings with suppliers to ensure The measures can be demonstrated by two of our key performance • Asset Management System (ASSETWARE) the Medical Supplies proper plans are in place to avoid medicine/stock shortages. indicators: • MSDONLINE; Depot. However, suppliers would still not comply with targets they • Manual systems to perform reconciliation procedures and set themselves. • KPI 1 “Availability “refers to a situation where stock on hand at accrual based accounting Suppliers that deliver late to the depot are being penalised the depot is sufficient to meet the demand created on MEDSAS for late deliveries. MSD also procures out of stock items in full, it was measured at 92.32% against a target of 90.00%. 4. Utilisation of donor funds through Buy-out and charges the difference in price against The Depot received Fluconazole from Pfizer Laboratories for use in the contracted supplier. • KPI 2 “Service level” refers to how quickly the MSD takes to the treatment of Oesophageal Candidiasis and Cryptococcal Meningitis and a further donation of Mebendazole for the issue stock in full on MEDSAS. The measurement of this KPI is 2 Percentage of orders 80.00% 85.34% 5.34% • Target Achieved: deworming of school children from Janssen Pharmaceutical. This therefore time-based. This KPI ensures that all orders are issued satisfied in full within Above The follow-up centre is following up on all outstanding type of donor funding is received on a continuous basis. within 24 hours and the Service level was measured at 85.34% one working day. orders with suppliers and that is why MSD have achieved against a target of 80.00%. on this KPI. Suppliers that deliver late to the depot are Please note that the Depot does not account for the economic being penalised for late deliveries. Systems for measuring the indicator ‘% of orders supplied to benefit received in the Statement of Financial Performance, as the Depot is considered to be only a conduit for hospitals and to control institutions on first requests’ were strengthened, and the actual 3 Percentage of expired <2% 1.06% 0.94% •Target Achieved: the receipt of donations for the Department. The donation is performance is calculated according to the following definition: ‘If a stock. Below Suppliers that deliver short dated stock are expected to demand/ request (which could consist of multiple different items) is reflected in the financial statements of the Department. deliver stock with a protection letter which states that if the fulfilled 100% within 24 hours, then that order counts towards the stock expires at MSD, the supplier will uplift the stock and achieving of the target. If even one item is not issued on the system The current market value of donations issued and charged at a value re-imburse us for the stock that has expired. as part of the request within 24 hours, the order does not count as of one-hundredth of one cent (R0.0001) to all clients of the Depot. There are shelf marshals in every store who monitor batch being fulfilled’. This is an extremely high standard to fulfil, but it is The total charge to health institutions for donations received expiry dates of stock to ensure that stock that expires first specific, measurable and time- bound. Also, it holds the Depot to amounted to under R10. must be used first (First Expiry First Out). higher standards – meeting orders within 24 hours could have a life-saving impact at the level of institutions. However, the more 4 95% of medicines 95% 69.39% 25.61% • Target Not Achieved: rigorous monitoring system makes it appear that performance is tested within 2 Below The laboratory had sytem licence challenges. 25,61% lower than planned. working days by the of the medicines were tested beyond the required 2 A constraint to ensure effective, economical and efficient reporting laboratory. workings days. exists in that information from various systems needs to be manually 5 Percentage of staff <5% of 1.00% 4.00% • Target Achieved: turnover. staff Below The Depot has created favourable working conditions for turnover Threshold its staff participates in pharmacy month fun run as an MSD team, exercises in an in-house gymnasium at lunch time, opportunity to join the MSD choir which performs at provincial functions.

6 Percentage of 70.00% 78.65% 8.65% • Target Achieved: essential medicines Above Continuous monitoring of items that must be moved into delivered directly to the DDV procurement system in order to increase the health facilities number of items that are procured through the DDV (DDVs). system

Department of Health Annual Report 2018/19 287 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

15. SCOPA Resolutions

At a duly constituted sitting for the Gauteng Provincial Legislature held on 03 September 2018, the House adopted the following SCOPA resolutions relating to the 2017/2018 financial year:

Sitting Adopted Resolutions/Matters Raised How The Matters Were Addressed Date

03 Sep Expenditure Management: • Effective and appropriate steps were implemented to try and avoid 2018 Irregular Expenditure irregular expenditure, however, due to the nature of business to ensure Accounting officer did not always take medicines availability at all healthcare facilities across the province effective steps to prevent irregular management requested a deviation from BAC which was approved for expenditure amounting to XJM Consultants and Safranic. R5 973 944. • Distribution of Medicines Services-Safranic. This was due to delays in 1. Why were no effective and appropriate supply chain processes which have since been corrected and as such the steps taken to prevent irregular distribution contract was awarded in January 2018. expenditure as required by Section 38(1)(c)(ii) of the Public Finance • Financial Services-XJM Management Act and Treasury Permission for the advertisement of relevant posts to replace the consultants Regulation 9.1.1? was granted in December 2018. The necessary recruitment processes are currently underway and are expected to be completed during the 2018/2019 financial year.

• Cleaning Services-Fumigation Worx The process to appoint a service provider is underway to ensure that MSD does not continue to incur an irregular expenditure in this regard.

03 Sep Provide the detailed transactions of each 2018 instance of irregular expenditure including Name of Service provider Type of service rendered Value of Irregular expenditure the name of the service provider and the XJM Consultants Financial services R2,373,721 service provided. Safranic Distribution of medicines R2,936,223 services Fumigation Worx Cleaning services R664,000

03 Sep What investigations have been undertaken Name of Service Type of service Value of Irregular Action Taken 2018 regarding irregular expenditure reported in provider rendered expenditure 2017/2018 financial year and what XJM Consultants Financial services R2,373,721 • Posts have now been made disciplinary measures have been / will be available. Specifications for taken against those responsible for irregular adverts have been submitted to the department expenditure? Safranic Distribution of R2,936,22 • A new contract was awarded medicines services effective January 2018 for 3 years

Fumigation Cleaning services R664,0003 • The department is in the final stage of appointing a service Worx provider (Negotiations with selected service provider underway).

288 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

Sitting Adopted Resolutions/Matters Raised How The Matters Were Addressed Date

03 Sep Considering the numerous turn around • Unavailability of relevant posts to advertise and replace consultants (XJM 2018 strategies actioned in the Entity including Consultants) setting up the Pharmaceutical Procurement • Delay in the processes leading to the appointment of the service provider Committee, explain why the irregular (Safranic) medicine distribution. expenditure recurred? • Delay in the processes leading to the appointment of the service provider (Fumigation Worx) Cleaning Services

Name of Service Type of service Value of Irregular Root cause provider rendered expenditure

XJM Consultants Financial services R2,373,721 • Unavailability of relevant posts to advertise and replace consultants

Safranic Distribution of R2,936,223 • Delay in the processes medicines services leading to the appointment of the service provider.

Fumigation Cleaning services R664,000 • Delay in the processes Worx leading to the appointment of the service provider.

03 Sep What disciplinary steps will be taken against • A new service provider has been appointed for distribution of medicines 2018 the Accounting Officer for non-compliance • A new contract was awarded effective January 2018 for 3 years with Section 38(1)(c)(ii) of the Public Finance • MSD management has analysed the above 3 categories of irregular Management Act and Treasury Regulation expenditure. One report is complete and the others are still in progress. 9.1.1?

03 Sep 30 Days Payment • There were not enough funds to pay suppliers towards the end of the 2018 Why payments were not made within 30 financial year 2017/2018 and hence the suppliers were not paid within days or an agreed period after receipt of an 30 days. invoice, as required by Treasury Regulation 8.2.3.

03 Sep Has the Department developed a strategy to • Please refer to iron clad approach presentation which is included as 2018 address spending on non-essential items? If Annexure A – Presentation yes, provide the Committee with a copy of the strategy.

Paragraph 21-22, PG 296 Procurement and • The process of inviting competitive bids had already started and the 03 Sep Contract Management entity therefore could not afford to have the institution without any 2018 1.Why goods and services with a cleaning services, which would have compromised infection control transaction value above R500 000 were hence management requested for approval from the Accounting procured without inviting competitive Officer. bids and in some instances, deviations were approved by the Accounting Officer even though it was practical to invite competitive bids as prescribed by Treasury Regulation 16A6.1 and 16A6.4.

Department of Health Annual Report 2018/19 289 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

Sitting Adopted Resolutions/Matters Raised How The Matters Were Addressed Date

03 Sep To the Accounting Officer: Name of Service Type of service Value of Irregular Root cause 2018 provider rendered expenditure a. Provide a detailed list of all the XJM Consultants Financial services R2,373,721 • There was BAC transactions entered violating Treasury approval. Please see Regulation 16A.6.1 and 16A.6.4. attached Safranic Distribution of R2,936,223 • There was BAC medicines services approval. Please see attached

03 Sep b. Provide portfolio of evidence detailing • There was no need to take disciplinary action against any official due to 2018 the officials implicated plus the the fact that the entity applied for deviation which was approved. disciplinary steps taken against the said • Please refer to Portfolio of evidence attached. officials in respect of goods and services purchased which were approved without acquiring the sufficient quotations.

03 Sep c. The list should include the name of the Name of Service Type of service Value of Irregular Root cause 2018 provider and service rendered and the provider rendered expenditure

amount involved. XJM Consultants Financial services R2,373,721 • There was BAC approval. Please see attached Safranic Distribution of R2,936,223 • There was BAC medicines services approval. Please see attached

03 Sep d. What is the status quo of the • In both cases, there was a BAC approval for the extension of the 2018 investigations conducted for this contracts. financial misconduct?

03 Sep e. Provide the Committee with corrective • The matter has been reported to the Risk and Internal Controls Unit and 2018 measures and/or disciplinary steps that are assessing the documentation to determine circumstances around the MEC will take against the each matter. The outcome of the investigation will determine the action Accounting Officer for contravening to be taken against the Accounting Officer. Treasury Regulation 16A.6.1 and 16A.6.4.

a. Why were some quotations awarded to • The points were allocated based on the old PPPFA and not the amended Bidders based on preference that were PPPFA. The depot was not aware of the amended PPPFA at that time. not allocated and calculated in We acknowledge the incorrect application of the regulation but it must accordance with the requirements of be pointed out that no bidder was prejudiced because of the incorrect the Preferential Procurement Policy application of the regulation. Framework Act of South 2000 (Act No. 5 of 2000) and its Regulations? • Due to the fact that the correct bidder had been appointed even when the new regulations were applied, no disciplinary action was taken.

290 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

Sitting Adopted Resolutions/Matters Raised How The Matters Were Addressed Date

03 Sep 8. INTERNAL CONTROLS 2018 • The audit action plan is being monitored and progress reported on a PARAGRAPH 27-28, PG 297 LEADERSHIP quarterly basis to the External Audit committee.

The Accounting Officer did not adequately exercise effective oversight responsibility over the internal controls relating to the procurement and contract management as well as expenditure management.

To the Accounting Officer:

a. Why was the action plan to address audit findings not monitored on a timely basis by the appropriate level of management?

03 Sep What action is being taken to enhance • Middle managers are scheduled to attend a workshop on the 2017 2018 leadership in the department with PPPFA regulations emphasis on: • The Depot manager is attending a course on Albertina Sisulu Leadership Course for Health. b. lack of monitoring controls to ensure • At least 8 officials are scheduled to attend training on various areas compliance with laws and regulations inclusive of risk management and supply chain/procurement. • All pharmacists are doing short courses in Continuing Professional Development.

03 Sep c. Procurement and contract • Please see response in part (a) above 2018 management

03 Sep d. Expenditure management and revenue • The Depot produces monthly management accounts as well as monthly 2018 management. budget vs Expenditure reports in-house hence providing on-going coaching and mentoring.

Department of Health Annual Report 2018/19 291 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

Sitting Adopted Resolutions/Matters Raised How The Matters Were Addressed Date

03 Sep Other Matters of Interest Year (a) The Allegation(s) (a) The name and (a) The action taken designation of the because of the 2018 Investigations accused investigation

2015/16 Theft of medicines Mr B Nyaku, • Initially Dismissed but To the MEC: later appealed driver • Outcome of appeal: 3 months suspension 1. Provide the status report on the with no pay implementation of recommendations • Official back in his of investigations for irregular original post as driver expenditure relating to the syndicate on the alleged illicit activities identified in 2015-16 details thereof should include the following: a. The allegation b. The name and designation of the accused c. The action taken because of the investigation

03 Sep General • The control deficiencies related to operating systems, are largely due to the 2018 Information Technology Controls use of legacy systems. The replacement of the before-mentioned systems is included in the eHealth implementation architecture, which was defined What actions have the Trading Entity taken, in partnership with the Department of e-Government. in partnership with the Department of e-Government to find solutions to • The legacy systems are due to be replaced in a phased approach with some information technology controls deficiencies earmarked for replacement by the end of March 2019, and the balance by to resolve operating systems problems? the end of the 19/20 financial year.

03 Sep What action did the Trading Entity take • The ICT infrastructure was not neglected for 20 years but had been 2018 against the management for neglecting to upgraded in the last seven years. refurbish the ICT infrastructure for 20 years • The matter is part of the SIU investigation. There is a new Chief Information and over-reliance on the external service Officer who was not involved in the process and has been tasked to provider for securing the system? refurbish the ICT infrastructure in collaboration with the department of e-Government.

03 Sep Does the Trading Entity have a scheduled • The Department currently does not have an ICT infrastructure maintenance 2018 maintenance plan for ICT infrastructure? plan. The Department is in the process to migrate all the systems and data to the Provincial Fully Managed Data Centre. It is envisaged that this process will be concluded by the end of the 18/19 financial year.

To mitigate high risk to the Trading Entity, • The current disaster recovery plan is centred around the use of the VBlock provide the Committee with a progress infrastructure and related technologies. The pending migration of the report on the implementation of the disaster Departments systems and data, to the Provincial Fully Managed Data recovery plan. Centre, will result in a Disaster Recovery Plan being defined and restricted to the before-mentioned data centre.

292 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2019

16. Prior modi cations to audit reports 22. Approval and sign off There were no prior modifications to the audit reports for the entity. The financial statements set out on pages ……. have been approved by the Accounting Officer. 17. Exemptions and deviations received from the National Treasury The entity did not receive any deviations from the National Treasury or the Gauteng Provincial Treasury (GPT).

18. Investigation No Investigations were conducted for the Medical Supplies Depot MS NOCAWE THIPA (MSD) for the year ended 31 March 2019. CHIEF EXECUTIVE OFFICER GAUTENG MEDICAL SUPPLIES DEPOT 19. Other The Depot was still incurring a cost relating to price increases not 31 May 2019 recovered from demanders. This is mostly attributable to the back dated approval of contract price increases by the Gauteng Department of Finance.

20. Acknowledgement(s)/ or Appreciation Management would like to acknowledge the enormous contributions made towards the entity by all our stakeholders including our patients, the Gauteng Department of Health, Gauteng Provincial Treasury and other organs of State. Our sincere appreciation also goes to our valued suppliers especially those in the pharmaceutical industry who ensured that medicines were available to the Gauteng Medical Supplies Depot as well as all public healthcare institutions and facilities in the province. MSD management cannot forget our workforce at all levels who tirelessly ensured that the most important stakeholders, the patients, were put first.

21. Conclusion The financial year 2018/2019 has had many challenges facing both the department and the MSD. Despite these challenges management is pleased to report a success story in terms of service delivery towards the people of Gauteng. The MSD achieved 100% of all its predetermined objectives making it possible for medicines to be available in all the public hospitals and clinics in Gauteng throughout the year. We look forward to even a better year in 2019/2020.

Department of Health Annual Report 2018/19 293 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDITOR-GENERAL FOR THE YEAR ENDED 31 MARCH 2019

Report of the Auditor-General to the Gauteng Provincial Legislature on the Gauteng Medical Suplies Depot

Report on the audit of the nancial statements Opinion Restatement of corresponding gures 1. I have audited the financial statements of the Gauteng Medical 7. As disclosed in note 31 to the financial statements, the Supplies Depot set out on pages 299 to 327, which comprise corresponding figures for 31 March 2018 have been restated the statement of financial position as at 31 March 2019, the as a result of errors discovered in the financial statements of statement of financial performance, the statement of changes the entity for the year ended 31 March 2019. in net assets and the statement of cash flows for the year then ended, as well as the notes to the financial statements, Responsibilities of the accounting of cer for the nancial including a summary of significant accounting policies. statements

2. In my opinion, the financial statements present fairly, in all 8. The accounting officer is responsible for the preparation and material respects, the financial position of the Gauteng Medical fair presentation of the financial statements in accordance Supplies Depot as at 31 March 2019, and its financial with the SA Standards of GRAP and the requirements of the performance and cash flows for the year then ended in PFMA, and for such internal control as the accounting officer accordance with the South African Standards of Generally determines is necessary to enable the preparation of financial Recognised Accounting Practice (SA Standards of GRAP) and statements that are free from material misstatement, whether the requirements of the Public Finance Management Act of due to fraud or error. South Africa, 1999 (Act no. 1 of 1999) (PFMA). 9. In preparing the financial statements, the accounting officer is Basis for opinion responsible for assessing the trading entity’s ability to 3. I conducted my audit in accordance with the International continue as a going concern, disclosing, as applicable, matters Standards on Auditing (ISAs). My responsibilities under those relating to going concern and using the going concern basis standards are further described in the auditor-general’s of accounting unless the appropriate governance structure responsibilities for the audit of the financial statements section either intends to liquidate the trading entity or to cease of this auditor’s report. operations, or has no realistic alternative but to do so.

4. I am independent of the trading entity in accordance with Auditor-general’s responsibilities for the audit of the sections 290 and 291 of the International Ethics Standards nancial statements Board for Accountants’ Code of ethics for professional accountants, parts 1 and 3 of the International Ethics Standards 10.My objectives are to obtain reasonable assurance about Board for Accountants’ International code of ethics for whether the financial statements as a whole are free from professional accountants (including International Independence material misstatement, whether due to fraud or error, and to Standards) (IESBA codes) and the ethical requirements that are issue an auditor’s report that includes my opinion. Reasonable relevant to my audit in South Africa. I have fulfilled my other assurance is a high level of assurance, but is not a guarantee ethical responsibilities in accordance with these requirements that an audit conducted in accordance with the ISAs will and the IESBA codes. always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are 5. I believe that the audit evidence I have obtained is sufficient and considered material if, individually or in aggregate, they could appropriate to provide a basis for my opinion. reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. Emphasis of matter 6. I draw attention to the matter below. My opinion is not 11. A further description of my responsibilities for the audit of the modified in respect of this matter. financial statements is included in the annexure to this auditor’s report.

294 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDITOR-GENERAL FOR THE YEAR ENDED 31 MARCH 2019

Report on the audit of the annual performance report

Introduction and scope 12. In accordance with the Public Audit Act of South Africa, 2004 15. I performed procedures to determine whether the reported (Act no. 25 of 2004) (PAA) and the general notice issued in performance information was properly presented and whether terms thereof, I have a responsibility to report material findings performance was consistent with the approved performance on the reported performance information against planning documents. I performed further procedures to predetermined objectives for selected programmes presented in determine whether the indicators and related targets were the annual performance report. I performed procedures to measurable and relevant, and assessed the reliability of the identify findings but not to gather evidence to express reported performance information to determine whether it was assurance. valid, accurate and complete.

13.My procedures address the reported performance information, 16. I did not raise any material findings on the usefulness and which must be based on the approved performance planning reliability of the reported performance information for the documents of the trading entity. I have not evaluated the selected programme. completeness and appropriateness of the performance indicators included in the planning documents. My procedures Other matters also did not extend to any disclosures or assertions relating to 17. I draw attention to the matters below. planned performance strategies and information in respect of future periods that may be included as part of the reported Achievement of planned targets performance information. Accordingly, my findings do not 18. Refer to the annual performance report on page 287 for extend to these matters. information on the achievement of planned targets for the year and explanations provided for the under/overachievement of a 14. I evaluated the usefulness and reliability of the reported significant number of targets. performance information in accordance with the criteria developed from the performance management and reporting Adjustment of material misstatements 19. I identified material misstatements in the annual performance framework, as defined in the general notice, for the following report submitted for auditing. These material misstatements selected programme presented in the annual performance were on the reported performance information of medical report of the trading entity for the year ended 31 March 2019: supplies depot health care support. As management subsequently corrected the misstatements, I did not raise any Pages in the annual Programme performance report material findings on the usefulness and reliability of the reported performance information. Programme 7 – Health care support 73 - 76

Sub-programme medical supplies 287 depot

Department of Health Annual Report 2018/19 295 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDITOR-GENERAL FOR THE YEAR ENDED 31 MARCH 2019

Report on the audit of compliance with legislation

Introduction and scope 20. In accordance with the PAA and the general notice issued in 27. My opinion on the financial statements and findings on the terms thereof, I have a responsibility to report material findings reported performance information and compliance with on the compliance of the trading entity with specific matters in legislation do not cover the other information and I do not key legislation. I performed procedures to identify findings but express an audit opinion or any form of assurance conclusion not to gather evidence to express assurance. thereon.

21. The material findings on compliance with specific matters in key 28. In connection with my audit, my responsibility is to read the legislations are as follows: other information and, in doing so, consider whether the other information is materially inconsistent with the financial Annual nancial statements statements and the selected programme presented in the 22.The financial statements submitted for auditing were not annual performance report, or my knowledge obtained in the prepared in accordance with the prescribed financial reporting audit, or otherwise appears to be materially misstated. framework as required by section 40(1)(b) of the PFMA. Material misstatements on commitments identified by the 29. If, based on the work I have performed, I conclude that there is auditors in the submitted financial statement were a material misstatement in this other information, I am required subsequently corrected, resulting in the financial statements to report that fact. I have nothing to report in this regard. receiving an unqualified audit opinion. Internal control de ciencies Procurement and contract management 30. I considered internal control relevant to my audit of the financial 23. Some goods and services with a transaction value above R500 statements, reported performance information and compliance 000 were procured without inviting competitive bids and with applicable legislation; however, my objective was not to deviations were approved by the accounting officer although it express any form of assurance on it. The matters reported was practical to invite competitive bids, as required by treasury below are limited to the significant internal control deficiencies regulations 16A6.1 and 16A6.4. Similar non-compliance was that resulted in the findings on compliance with legislation reported in the previous year. included in this report. 31. The accounting officer did not exercise adequate oversight Expenditure management responsibility relating to internal controls for procurement and 24.Effective and appropriate steps were not taken to prevent contract management and the preparation of the annual irregular expenditure amounting to R10 778 051 as disclosed in financial statements. note 27 to the financial statements, as required by section 32.The entity developed a plan to address the prior year audit 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1. The findings, but the accounting officer did not provide adequate majority of the irregular expenditure was caused by oversight relating to implementation and adherence to the procurement of goods and services without following plan. competitive bidding processes.

25.Payments were not made within 30 days or an agreed period after receipt of an invoice, as required by treasury regulation 8.2.3.

Other information 26.The accounting officer is responsible for the other information. The other information comprises the information included in the annual report, which includes the audit committee’s report. The other information does not include the financial statements, the auditor’s report and the selected programme presented in the annual performance report that has been specifically reported in this auditor’s report.

296 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDITOR-GENERAL FOR THE YEAR ENDED 31 MARCH 2019

33. Senior management did not ensure that sufficient controls are in place to prepare accurate and complete annual financial statements that are supported by reliable information. This resulted in material amendments to the annual financial statements. Furthermore, there was a lack of adequate monitoring of controls to ensure compliance with laws and regulations relating to expenditure and procurement and contract management.

Johannesburg 31 July 2019

Department of Health Annual Report 2018/19 297 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDITOR-GENERAL FOR THE YEAR ENDED 31 MARCH 2019

Annexure – Auditor-general’s responsibility for the audit 1. As part of an audit in accordance with the ISAs, I exercise • evaluate the overall presentation, structure and content of the professional judgement and maintain professional scepticism financial statements, including the disclosures, and whether the throughout my audit of the financial statements, and the financial statements represent the underlying transactions and procedures performed on reported performance information for events in a manner that achieves fair presentation. the selected programme and on the trading entity’s compliance with respect to the selected subject matters. Communication with those charged with governance 3. I communicate with the accounting officer regarding, among Financial statements other matters, the planned scope and timing of the audit and 2. In addition to my responsibility for the audit of the financial significant audit findings, including any significant deficiencies statements as described in this auditor’s report, I also: in internal control that I identify during my audit.

• identify and assess the risks of material misstatement of the 4. I also confirm to the accounting officer that I have complied with financial statements whether due to fraud or error, design and relevant ethical requirements regarding independence, and perform audit procedures responsive to those risks, and obtain communicate all relationships and other matters that may audit evidence that is sufficient and appropriate to provide a reasonably be thought to have a bearing on my independence basis for my opinion. The risk of not detecting a material and, where applicable, related safeguards. misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control

• obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the trading entity’s internal control

• evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the accounting officer

• conclude on the appropriateness of the accounting officer’s use of the going concern basis of accounting in the preparation of the financial statements. I also conclude, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Gauteng Medical Supplies Depot’s ability to continue as a going concern. If I conclude that a material uncertainty exists, I am required to draw attention in my auditor’s report to the related disclosures in the financial statements about the material uncertainty or, if such disclosures are inadequate, to modify the opinion on the financial statements. My conclusions are based on the information available to me at the date of this auditor’s report. However, future events or conditions may cause a trading entity to cease continuing as a going concern

298 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT STATEMENT OF FINANCIAL POSTION AS AT 31 MARCH 2019

Figures in Rand Note 2019 2018*

ASSETS

Current Assets

Inventories 2 208 666 717 253 964 393 Trade and other receivables from exchange transactions 3 615 410 548 1 024 065 168 Cash and cash equivalents 4 242 702 338 31 419 193 1 066 779 603 1 309 448 754

Non-Current Assets

Property, plant and equipment 5 7 657 329 9 581 215 Intangible assets 6 - - 7 657 329 9 581 215

Total Assets 1 074 436 932 1 319 029 969

LIABILITIES

Current Liabilities

Trade and other payables from exchange transactions 7 381 448 557 751 495 854 Provisions 8 1 307 383 3 601 652 Finance lease obligations 9 145 963 328 057 382 901 903 755 425 563

Non-Current Liabilities

Financial lease obligations 9 166 339 312 302 166 339 312 302 Total Liabilities 383 068 242 755 737 865 Net Assets 691 368 690 563 292 104

Contributed Capital 10 104 376 790 104 376 790 Accumulated surplus 586 991 900 458 915 314

Total Net Assets 691 368 690 563 292 104 * Restated. Refer note 31.

Department of Health Annual Report 2018/19 299 GAUTENG MEDICAL SUPPLIES DEPOT STATEMENT OF FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand Note 2019 2018*

REVENUE

Revenue from exchange transactions Sale of Goods 11 4 088 067 270 3 824 656 198 Finance income 12 9 816 888 10 919 455 Other income 13 150 576 350 523 Total revenue from exchange transactions 4 098 034 734 3 835 926 176

Revenue from non-exchange transactions Penalties 14 24 194 254 12 489 525 Total revenue from non-exchange transactions 24 194 254 12 489 525

TOTAL REVENUE 4 122 228 988 3 848 415 701

EXPENSES

Employee related costs 15 (70 316 592) (68 334 539) Depreciation and amortization expense 16 (2 624 282) (4 041 579) Finance costs 17 (125 142) (220 429) Cost of goods sold 18 (3 893 397 373) (3 642 542 348) Distribution costs 19 (7 945 580) (6 191 817) Operational costs 20 (19 740 189) (18 364 580)

TOTAL EXPENSES (3 994 149 158) (3 739 695 292)

OTHER GAINS/(LOSSES) Loss on disposal of assets (3 244) (41 900) TOTAL OTHER GAINS/(LOSSES) (3 244) (41 900)

OPERATING SURPLUS BEFORE TAX 128 076 586 108 678 509

TAXATION 21 - -

TOTAL SURPLUS FOR THE YEAR NET OF TAX 128 076 586 108 678 509 * Restated. Refer note 31

300 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT STATEMENT OF CHANGES IN NET ASSETS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand Contributed Capital Accumulated Surplus TOTAL

Balance at 31 March 2017 104 376 790 350 236 805 454 613 595

Surplus for the period - 108 678 509 108 678 509

Balance at 31 March 2018* 104 376 790 458 915 314 563 292 104

Surplus for the period - 128 076 586 128 076 586

Balance at 31 March 2019 104 376 790 586 991 900 691 368 690

* Restated. Refer note 31.

Department of Health Annual Report 2018/19 301 GAUTENG MEDICAL SUPPLIES DEPOT STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand Note 2019 2018*

Cash flows from operating activities

Receipts Sale of goods and services 4 496 721 890 3 900 047 030 Finance income 12 9 816 888 10 919 455 Other receipts 150 576 211 071 Total receipts 4 506 689 354 3 911 177 556

Payments Compensation of employees (70 175 557) (66 230 539) Goods and services (4 224 073 813) (3 811 041 357) Finance costs 18 (125 142) (220 429) Total payments (4 294 374 512) (3 877 492 325)

Net cash generated from operating activities 212 314 842 33 685 231

Cash flows from investing activities

Purchase of property, plant and equipment 5 (703 640) (4 589 525)

Net cash outflow from investing activities (703 640) (4 589 525)

Cash flows from financing activities

Repayment of finance lease liability 9 (328 057) (302 154)

Net cash outflow from financing activities (328 057) (302 154)

Increase/(decrease) in cash and cash equivalents 211 283 145 28 793 552

Cash and cash equivalents at the beginning of the year 31 419 193 2 625 641

Cash and cash equivalents at the end of the year 4 242 702 338 31 419 193

*Restated. Refer note 31.

302 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.1 Basis of preparation These financial statements were prepared in accordance with the Provisions standards of Generally Recognized Accounting Practices (GRAP) Provisions are measured as the present value of the estimated future issued by the Accounting Standards Board in accordance with the outflows required to settle the obligation. In the process of Public Finance Management Act, 1999 (Act No.1 of 1999) as determining the best estimate of the amounts that will be required amended by the Public Finance Management Amendment Act (Act in future to settle the provision management considers the weighted No. 29 of 1999). average probability of the potential outcomes of the provisions raised. This measurement entails determining what the different 1.2 Presentation currency potential outcomes are for a provision as well as the financial impact The financial statements are presented in South African Rand, which of each of those potential outcomes. Management then assigns a is the functional currency of the entity. weighting factor to each of these outcomes based on the probability that the outcome will materialise in future. The factor is then applied 1.3 Rounding to each of the potential outcomes and the factored outcomes are Unless otherwise stated, all financial figures have been rounded to then added together to arrive at the weighted average value of the the nearest Rand (R). provisions.

1.4 Going concern assumption The annual financial statements were prepared on a going concern basis, which assumes that the entity will continue to operate as a going concern for at least the next 12 months.

1.5 Comparative information Prior year comparatives Where necessary, comparative figures have been reclassified to conform to changes in presentation in the current year.

1.6 Signi cant judgements and estimates The use of judgment, estimates and assumptions is inherent to the process of preparing annual financial statements. These judgements, estimates and assumptions affect the amounts presented in the annual financial statements. Uncertainties about these estimates and assumptions could result in outcomes that require a material adjustment to the carrying amount of the relevant asset or liability in future periods.

Department of Health Annual Report 2018/19 303 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.6 Signi cant judgements and estimates

Depreciation and amortization Cash and cash equivalents Depreciation and amortization recognised on property, plant and Cash and cash equivalents are measured at amortised cost using the equipment is determined with reference to the useful lives and effective interest rate method. residual values of the underlying items. The useful lives and residual values of assets are based on management’s estimation of the Cash includes cash on hand and cash with banks. Cash equivalents asset’s condition, expected condition at the end of the period of use, are short-term highly liquid investments that are held with registered its current use, expected future use and the entity’s expectations banking institutions with maturities of three months or less and are about the availability of finance to replace the asset at the end of its subject to an insignificant risk of change in value. For the purposes useful life. In evaluating the how, the condition, and use of the asset of the Cash Flow Statement, cash and cash equivalents comprise inform the useful life and residual value. Management considers the cash on hand and deposits held on call with banks. impact of technology and minimum service requirements of the assets. Trade and other payables Trade payables are initially measured at fair value plus transaction Fair value determination of property, plant and equipment costs that are directly attributable to the acquisition and are (excluding heritage assets) subsequently measured at amortised cost using the effective interest rate method. In determining the fair value of property, plant and equipment the entity applies a valuation methodology to determine the fair value Gains and losses based on any one of, or a combination of the following factors: A gain or loss arising from a change in the fair value of a financial asset or financial liability measured at fair value is recognised in - The market related selling price of the item; or surplus or deficit. - The material composition of the item; or - The item’s special features which include design, For financial assets and financial liabilities measured at amortised appendages and improvements; or cost or cost, a gain or loss is recognised in surplus or deficit when the - The item’s condition with regards to whether it is broken, financial asset or financial liability is derecognised or impaired or in a poor, fair, good or excellent condition. through the amortization process.

1.7 Financial instruments Off-setting The entity does not offset financial assets and financial liabilities in Initial recognition the Statement of Financial Position unless a legal right of set-off The entity recognises a financial asset or a financial liability in its exists and the parties intend to settle on a net basis. Statement of Financial Position when, and only when, the entity becomes a party to the contractual provisions of the instrument. This Impairments is achieved through the application of trade date accounting. All financial assets measured at amortised cost are subject to an Upon initial recognition the entity classifies financial instruments or impairment review. The entity assesses at the end of each reporting their component parts as financial liabilities or financial assets in period whether there is any objective evidence that a financial asset conformity with the substance of the contractual arrangement and or group of financial assets is impaired. to the extent that the instrument satisfies the definitions of a financial liability or a financial asset, in accordance with the If there is objective evidence that an impairment loss on financial standards of GRAP on Financial instruments - GRAP 104. assets measured at amortised cost has been incurred, the amount of the loss is measured as the difference between the asset‘s carrying Trade and other receivables amount and the present value of estimated future cash flows Trade and other receivables are initially recognised at fair value plus (excluding future credit losses that have not been incurred) transaction costs that are directly attributable to the acquisition and discounted at the financial asset‘s original effective interest rate (i.e. subsequently stated at amortised cost, using the effective interest the effective interest rate computed at initial recognition). The rate method. carrying amount of the asset is reduced through the use of an allowance account. The amount of the loss is recognised in surplus or deficit.

304 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.8 Inventories

Initial recognition and measurement Depreciation Inventories are initially recognised at cost. Cost refers to the Depreciation is calculated on the depreciable amount, using the purchase price, plus taxes, transport costs and any other costs in straight-line method over the estimated useful lives of the assets. bringing the inventories to their current location and condition. Components of assets that are significant in relation to the whole asset and that have different useful lives are depreciated separately. Subsequent measurement The depreciable amount is determined after taking into account an Inventories will be measured at the lower of cost and the net assets’ residual value, where applicable. realizable value. Inventories are stated on a weighted average moving basis with the same cost formula being used for all The assets’ residual values, useful lives and depreciation methods are inventories having a similar nature and use at the entity. reviewed at each financial year-end and adjusted prospectively, if appropriate. Redundant and slow-moving inventories are identified and written down from cost to net realisable value with regard to their estimated economic or realisable values. The amount of any reversal of any write-down of inventories arising from an increase in net realisable value is recognised as a reduction of inventories recognised as an expense in the period in which the reversal occurs.

Derecognition The carrying amount of inventories is recognized as an expense in the period that the inventory was sold, distributed, written off or consumed, unless that cost qualifies for capitalization to the cost of another asset.

1.9 Property, plant and equipment

Initial recognition and measurement The cost of an item of property, plant and equipment is the purchase price and other costs directly attributable to bring the asset to the location and condition necessary for it to be capable of operating in the manner intended by the entity. Trade discounts and rebates are deducted in arriving at the cost at which the asset is recognised. The cost also includes the estimated costs of dismantling and removing the asset.

Items of property, plant and equipment are initially recognised as assets on acquisition date and are initially recorded at cost where acquired through exchange transactions. However, when items of property, plant and equipment are acquired through non-exchange transactions, those items are initially measured at their fair values as at the date of acquisition.

Subsequent measurement Subsequent to initial recognition, items of property, plant and equipment are measured at cost less accumulated depreciation and impairment losses.

Department of Health Annual Report 2018/19 305 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.9 Property, plant and equipment (Continued) The annual depreciation rates are based on the following estimated asset useful lives:

Asset classification Average useful lives (Years)

Fixtures and fittings

Buildings 10

Motor vehicles -

Cars, minibuses, trucks 3 - 5

Plant and equipment -

Air-conditioning 4 - 15

Medical equipment 1 - 21

Radio equipment 5 - 10

Telephone system 5 - 10

Audio visual 3 - 19

Domestic equipment 3 - 16

Laboratory equipment 3 - 21

Security equipment 1 - 21

Vehicles 9 - 19

Warehouse equipment 3 - 16

Workshop and tools 3 - 21

Office furniture -

Kitchen appliances 3 - 21

Office equipment 1 - 23

Computer equipment 1 - 18

Cellphones & Accessories 2

Impairment The entity tests for impairment where there is an indication that an asset may be impaired. An assessment of whether there is an indication of possible impairment is done at each reporting date. Where the carrying amount of an item of property, plant and equipment is greater than the estimated recoverable amount (or recoverable service amount), it is written down immediately to its recoverable amount (or recoverable service amount) and an impairment loss is charged to the Statement of Financial Performance.

Where items of property, plant and equipment have been impaired, the carrying value is adjusted by the impairment loss, which is recognised as an expense in the Statement of Financial Performance in the period that the impairment is identified.

306 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.10 Intangible Assets Impairments Initial recognition and measurement The entity tests intangible assets with finite useful lives for An intangible asset is an identifiable non-monetary asset without impairment where there is an indication that an asset may be physical substance. The entity recognises an intangible asset in its impaired. An assessment of whether there is an indication of Statement of Financial Position only when it is probable that the possible impairment is performed at each reporting date. Where the expected future economic benefits or service potential that are carrying amount of an item of an intangible asset is greater than the attributable to the asset will flow to the entity and the cost or fair estimated recoverable amount (or recoverable service amount), it is value of the asset can be measured reliably. written down immediately to its recoverable amount (or recoverable service amount) and an impairment loss is charged to the Statement Intangible assets are initially recognised at cost. of Financial Performance. Where an intangible asset is acquired by the entity for no or nominal consideration (i.e. a non-exchange transaction), the cost is deemed Derecognition to be equal to the fair value of that asset on the date acquired. Intangible assets are derecognised when the asset is disposed of or when there are no further economic benefits or service potential Subsequent measurement expected from the asset. The gain or loss arising on the disposal or Intangible assets are subsequently carried at cost less accumulated retirement of an intangible asset is determined as the difference amortization and impairments. between the sales proceeds and the carrying value and is recognised in the Statement of Financial Performance. The cost of an intangible asset is amortised over the useful life where that useful life is finite. The amortization expense on intangible assets with finite lives is recognised in the Statement of Financial Performance in the expense category consistent with the function of the intangible asset.

Intangible assets with indefinite useful lives are not amortised, but are tested for impairment annually, either individually or at the cash generating unit level. The assessment of indefinite life is reviewed annually to determine whether the indefinite life assumption continues to be supportable. If not, the change in useful life from indefinite to finite is made on a prospective basis.

Amortization and impairment Amortization is charged to write-off the cost of intangible assets over their estimated useful lives using the straight-line method.

The annual amortization rates are based on the following estimated average asset lives:

Intangible Asset Average Useful Life Computer Software 3-5 years

The amortization period, the amortization method and residual value for intangible assets with finite useful lives are reviewed at each reporting date and any changes are recognised as a change in accounting estimate in the Statement of Financial Performance.

Department of Health Annual Report 2018/19 307 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.11 Leases

1.15 Irregular expenditure The entity as lessee in an operating lease Irregular expenditure is recognised as expenditure in the Statement Retirement bene t costs Assets subject to operating leases, i.e. those leases where The finance lease liabilities are derecognised when the entity’s of Financial Performance. If the expenditure is not condoned by the The Depot provides retirement benefits for its employees through a substantially all of the risks and rewards of ownership are not obligation to settle the liability is extinguished. The assets capitalised relevant authority, it is treated as an asset until recovered or written defined benefit plan for government employees. These benefits are transferred to the lessee through the lease, are not recognised in the under the finance lease are derecognised when the entity no longer off as irrecoverable. funded by both employer and employee contributions. Employer Statement of Financial Position. The operating lease expense is expects any economic benefits or service potential to flow from the contributions to the fund are expensed when money is paid to the recognised over the course of the lease arrangement. asset. 1.16 Fruitless and wasteful expenditure fund. No provision is disclosed for retirement benefits in the

"Fruitless and wasteful expenditure is defined as expenditure that financial statements as the obligation and plan assets is the The lease expense recognised for operating leases is charged to the 1.12 Contributed Capital was made in vain and would have been avoided had reasonable care responsibility of the multi-employer Government Employee Pension Statement of Financial Performance on a straight-line basis over the "The purpose of this reserve is to ensure that there are sufficient been exercised, therefore: Fund reporting under the control of National Treasury. term of the relevant lease. To the extent that the straight-lined lease cash resources to fund the working capital requirements of the • It must be recovered from a responsible official (a debtor payments differ from the actual lease payments the difference is entity. account should be raised); or The defined benefit plan is accounted for as a defined contribution recognised in the Statement of Financial Position as either lease • Written off (If responsibility cannot be determined). plan due to insufficient information being available to apply the payments in advance (operating lease asset) or lease payments Contributed capital consists of the following items: rules of the defined benefit plan. payable (operating lease liability) as the case may be. This resulting • Cash received from the Gauteng Department of Health; and Such expenditure is treated as expenditure in the Statement of asset and / or liability is measured as the undiscounted difference • Transfers from accumulated surplus based on Treasury approval Financial Performance and where recovered, it is subsequently 1.18 Events after reporting date between the straight-line lease payments and the contractual lease in terms of Treasury Regulations." accounted for as revenue in the Statement of Financial Performance. payments. Due to nature of business at the entity (where expired stock and Two types of events can be identi ed: 1.13 Revenue from exchange transactions stock breakages is inherent to its business), expired and stock • those that provide evidence of conditions that existed at the The operating lease liability is derecognised when the entity’s breakages will only be recognised as fruitless and wasteful reporting date (adjusting events after the reporting date); and obligation to settle the liability is extinguished. The operating lease Revenue is only recognised when all of the following criteria are expenditure if their total value is higher than 2% of average stock • those that are indicative of conditions that arose after the asset is derecognised when the entity no longer anticipates satisfied: holding. Qualitative consideration would also be considered to reporting date (non-adjusting events after the reporting date). economic benefits to flow from the asset. • The entity retains neither continuing managerial involvement to disclose fruitless and wasteful expenditure." the degree usually associated with ownership nor effective The entity will adjust the amounts recognised in the financial The entity as lessee in a nance lease control over the goods sold; Recovery of Irregular and fruitless and wasteful expenditure statements to reflect adjusting events after the reporting date once Leases are classified as finance leases where substantially all the risks • The amount of revenue can be measured reliably; and The recovery of unauthorised, irregular, fruitless and wasteful the event occurred. and rewards associated with ownership of an asset are transferred • It is probable that the economic benefits or service potential expenditure is based on legislated procedures, and is recognised to the entity through the lease agreement. Assets subject to finance associated with the transaction will flow to the entity and the when the recovery thereof from the responsible officials is probable. The entity will disclose the nature of the event and estimate its leases are recognised in the Statement of Financial Position at the costs incurred or to be incurred in respect of the transaction can The recovery of unauthorised, irregular, fruitless and wasteful financial effect or a statement that such estimate cannot be made in inception of the lease, as is the corresponding finance lease liability. be measured reliably. expenditure is treated as other income. respect of all material non-adjusting events, where non-disclosure

could influence the economic decisions of users taken on the basis Assets subject to a finance lease, as recognised in the Statement of 1.14 Revenue from non-exchange transactions- Penalties, gifts, . 1.17 Employee Bene ts of the financial statements. Financial Position, are measured (at initial recognition) at the lower donations, including goods in-kind of the fair value of the assets and the present value of the future Short term employee bene ts Penalties, gifts and donations, including goods in kind, shall be minimum lease payments. Subsequent to initial recognition these Short term employee benefits encompasses all those benefits that recognised as income in the period it is received provided that all of capitalised assets are depreciated over the contract term. become payable in the short term, i.e. within a financial year or the following conditions have been satisfied: within 12 months after the financial year. Therefore, short term • The amounts of the penalties, donations, gifts and goods-in-kind The finance lease liability recognised at initial recognition is employee benefits include remuneration, compensated absences can be measured reliably; measured at the present value of the future minimum lease and bonuses. • There is an existing signed contract with the supplier that payments. Subsequent to initial recognition this liability is carried at includes a paragraph on penalties; and amortised cost, with the lease payments being set off against the Short term employee benefits are recognised in the Statement of • It is probable that the economic benefits comprising of the capital and accrued interest. The allocation of the lease payments Financial Performance as services are rendered, except for non-ac- penalty, gift, donations and goods in kind will flow to the between the capital and interest portion of the liability is effected cumulating benefits, which are recognised when the specific event entity. through the application of the effective interest method. occurs. These short-term employee benefits are measured at their With regards to donations received ,Gauteng Medical Supplies undiscounted costs in the period the employee renders the related Depot does not account for the economic benefit received in the The finance charges resulting from the finance lease are expensed, service or the specific event occurs. Statement of Financial Performance, as the depot is considered to be through the Statement of Financial Performance, as they accrue. The only a conduit for hospitals and to control the receipt of donations finance cost accrual is determined using the effective interest for the Department. method.

308 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.11 Leases

Department of Health Annual Report 2018/19 309 GAUTENG MEDICAL SUPPLIES DEPOT ACCOUNTING POLICIES FOR THE YEAR ENDED 31 MARCH 2019

1.19 Related Parties Key Management Personnel

The entity has processes and controls in place to aid in the identifica- Key Management Personnel includes all persons having the authori- tion of related parties. A related party is a person or an entity with ty and responsibility for planning, directing and controlling the the ability to control or jointly control the other party, or exercise activities of the entity. This includes: significant influence over the other party, or vice versa, or an entity that is subject to common control, or joint control. Related party - The senior management team of the entity, including the chief relationships where control exists are disclosed regardless of wheth- executive officer, the pharmaceutical services director and the er any transactions took place between the parties during the director of finance and administration. reporting period. 1.20 Commitments Where transactions occurred between the entity any one or more related parties, and those transactions were not within: Commitments are recorded at cost in the notes to the financial • normal supplier and/or client/recipient relationships on terms statements when there is a contractual arrangement or an approval and conditions no more or less favorable than those which it is by management in a manner that raises a valid expectation that the reasonable to expect the entity to have adopted if dealing entity will discharge its responsibilities thereby incurring future with that individual entity or person in the same expenditure that will result in the outflow of cash. circumstances; and • terms and conditions within the normal operating parameters 1.21 Standards, amendments to standards and interpre- established by the reporting entity’s legal mandate. tations issued not yet effective.

"Further details about those transactions are disclosed in the notes The following Standards of GRAP and / or amendments thereto have to the financial statements. been issued by the Accounting Standards Board, but will only Information about such transactions is disclosed in the financial become effective in future periods or have not been given an statements." effective date by the Minister of Finance. The entity has not early-adopted any of these new Standards or amendments thereto, but has referred to them for guidance in the development of accounting policies in accordance with GRAP 3 as read with Directive 5:

Standard name and number Effective date( if applicable)

GRAP 20 - Related Party Disclosures Approved and effective for periods on or after 1 April 2019.

GRAP 105 - Transfer of Functions Between Entities Under Common Control Approved and not yet effective.

GRAP 106 - Transfer of Functions Between Entities Not Under Common Control Approved and not yet effective.

GRAP 107 - Mergers Approved and not yet effective.

GRAP 108 - Statutory Receivables Approved and not yet effective.

GRAP 109 - Accounting by Principles and Agents Approved and not yet effective.

310 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

2. INVENTORIES

Finished goods 208 205 999 253 425 024 Consumable stores 460 718 539 369 Total Inventories 208 666 717 253 964 393

The amount of inventories recognised as an expense during the period amounted to R 3 896 123 135 (2018: R 3 645 008) and details thereof are as follows: Inventory utilised in cost of goods sold 3 893 397 373 3 642 542 348 Inventory utilised in consumable stores 1 671 625 1 603 617 Write-down of inventory 1 054 137 1 198 043 Total inventory recognised as an expense 3 896 123 135 3 645 344 008

The valuation method used by the Depot is the weighted average cost.

No write down of inventory to net realizable value was required during the current year. No inventory was pledged as security (2018: Nil).

3. TRADE AND OTHER RECEIVABLES FROM EXCHANGE TRANSACTIONS

Gross Balances 614 687 499 1 023 221 913 Trade receivables - Provincial Government 4 970 974 4 970 974 Trade creditor overpayments 3 860 966 3 860 966 Stock losses - Department of Infrastructure and Development 1 635 055 1 755 261 Other receivables 625 154 494 1 033 809 114

Less: Allowance for impairment Trade creditor overpayments (4 970 974) (4 970 974) Stock losses - Department of Infrastructure and Development (3 860 966) (3 860 966) Other receivables (912 006) (912 006) (9 743 946) (9 743 946)

Net balance 615 410 548 1 024 065 168

As at 31 March 2019, the ageing of trade receivables from exchange transactions that were due but not impaired is as follows:

< 30 days 445 620 399 469 861 373 > 30 days 169 067 100 553 360 540 Total 614 687 499 1 023 221 913

Reconciliation of allowance for impairment Balance at the beginning of the year (9 743 946) (9 743 946) Allowance raised - - Debt impairment written off against allowance - - Balance at the end of the year (9 743 946) (9 743 946)

Department of Health Annual Report 2018/19 311 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

4 CASH AND CASH EQUIVALENTS

Cash and cash equivalents consists of:

Bank balance 242 700 838 31 417 693 Petty cash 1 500 1 500 Total Cash and cash equivalents 242 702 338 31 419 193

Cash and cash equivalents earn interest at floating rates based on daily bank deposit rates. The finance income is recognized in the Statement of Financial Performance.

No cash and cash equivalents were pledged as security at 31 March 2019.

The entity had the following bank accounts at 31 March 2019:

FNB Cheque Account - 62299318800 242 700 838 31 417 693 Total 242 700 838 31 417 693

312 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

Cost Accumulated Carrying value Cost Accumulated Carrying value depreciation at end of the depreciation at end of the year year 5. PROPERTY, PLANT AND EQUIPMENT Owned assets Computer equipment 4 151 830 (3 357 706) 794 124 3 666 290 (3 310 433) 355 857 Cellphones & Accessories 54 185 (35 851) 18 334 54 185 (8 758) 45 427 Fixtures and fittings 10 625 (10 625) - 10 625 (10 625) - Office furniture 5 019 652 (4 491 801) 527 851 5 047 284 (4 271 430) 775 854 Plant and equipment 23 346 008 (17 262 313) 6 083 695 23 359 094 (15 471 575) 7 887 519 32 582 300 (25 158 296) 7 424 004 32 137 478 (23 072 821) 9 064 657 Leased Assets Motor vehicles - G-Fleet 499 900 (288 983) 210 917 792 816 (399 260) 393 556 Office equipment 192 658 (170 250) 22 408 395 874 (272 872) 123 002 692 558 (459 233) 233 325 1 188 690 (672 132) 516 558 Total 33 274 858 (25 617 529) 7 657 329 33 326 168 (23 744 953) 9 581 215

2019- Reconciliation of Property Plant & Equipment Owned assets Computer equipment 355 857 684 469 (198 929) 198 331 (245 604) 794 124 Cellphones & Accessories 45 427 - - - (27 093) 18 334 Fixtures and fittings ------Office furniture 775 854 16 067 (43 699) 41 928 (262 299) 527 851 Plant and equipment 7 887 519 3 104 (16 190) 15 315 (1 806 053) 6 083 695 9 064 657 703 640 (258 818) 255 574 (2 341 049) 7 424 004 Leased Assets Motor vehicles - G-Fleet 393 556 - (292 916) 292 916 (182 639) 210 917 Office equipment 123 002 - (203 216) 203 216 (100 594) 22 408 516 558 - (496 132) 496 132 (283 233) 233 325 Total 9 581 215 703 640 (754 950) 751 706 (2 624 282) 7 657 329

313 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

2018 - Reconciliation of Property Plant & Equipment

Carrying value at Additions Disposals/ Accumulated Depreciation Carrying value beginning Impairment depreciation on Charge at end of Figures in Rand of the year disposals/ impairment the year

Owned assets Computer equipment 289 968 199 514 (158 387) 158 026 (133 264) 355 857 Cellphones & Accessories - 54 185 - - (8 758) 45 427 Fixtures and fittings ------Office furniture 999 454 101 575 (71 924) 65 754 (319 005) 775 854 Plant and equipment 6 797 352 4 373 700 (770 183) 734 814 (3 248 164) 7 887 519 8 086 774 4 728 974 (1 000 494) 958 594 (3 709 191) 9 064 657 Leased Assets Motor vehicles - G-Fleet 591 175 - - - (197 619) 393 556 Office equipment 254 960 - - - (131 958) 123 002 846 135 - - - (329 577) 516 558 Total 8 932 909 4 728 974 (1 000 494) 958 594 (4 038 768) 9 581 215

Note 1 - The Gauteng Medical Supplies Depot has 1061 assets that are fully depreciated but still in use. These are on the Asset Register with a NBV of R100,88.

Note 2 - Included in the 31 March 2018 NBV is an amount of R 3 986 680,39 relating to security equipment will be transferred to Department of Infrastructure & Development in the 2018/19 financial year.

Department of Health Annual Report 2018/19 314 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

6 INTANGIBLE ASSETS

Computer software

Cost Accumulated amortization - 82 422 Carrying value - (82 422) - Reconciliation of intangible assets: Carrying value at beginning of the year - Additions - 2 810 Disposals/ Impairment - - Accumulated amortization on disposals/ impairment - (15 732) Amortization Charge - 15 732 Carrying value at end of the year - (2 810) - 7 TRADE AND OTHER PAYABLES FROM EXCHANGE TRANSACTIONS

Trade payables from exchange transactions 372 016 667 738 071 477 Accrued leave pay* 3 605 314 3 208 367 Service bonus accrual** 2 140 531 1 995 855 Audit fee accrual 1 892 566 1 655 187 Other accruals 1 793 479 6 564 968 Total Trade and other payables from exchange transactions 381 448 557 751 495 854

At 31 March 2019, the ageing of trade payables was as follows:

< 30 days 302 478 510 433 655 240 > 30 days 69 538 157 304 416 237 Total 372 016 667 738 071 477

* A leave accrual is recognised for leave due to employees at each reporting period. The accrual for leave is calculated by multiplying the number of leave days due to each employee by a daily rate based on the total cost to the company. The accrual is expected to be realised within 12 months of the reporting date. **Service bonus is accrued and the calculation is based on employee’s number of years in service and their gross salary. It is normally paid out in the employee’s birthday month.

8 PROVISIONS Provision for Performance Bonus 1 307 383 3 601 652 Reconciliation of Provision for Performance Bonus:

Balance at the beginning of the year 3 601 652 1 497 652 Amount utilised (2 435 304) - Unused amount reversed (1 166 348) - Amount raised 1 307 383 2 104 000 Balance at the end of the year 1 307 383 3 601 652

Provision for performance bonus was calculated based on the amount paid for 2017/2018 financial year as the 2018/2019 performance appraisals were yet to be concluded at the reporting date. An incremental factor of 6,5% was applied which is the best estimate for the current year. The provision is anticipated to be paid within 12 months from the reporting date.

Department of Health Annual Report 2018/19 315 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

9. FINANCE LEASE OBLIGATIONS

Minimum lease payments Within 1 year 206 714 453 199 Within the 2nd to 5th year inclusive 191 919 398 633 398 633 851 832 Less: Future finance charges (86 331) (211 473) Present value of lease obligations 312 302 640 359

The present value of lease obligations can be analysed as follows: Within 1 year 145 963 328 057 Within the 2nd to 5th year inclusive 166 339 312 302 312 302 640 359

Disclosed as: Current liabilities 145 963 328 057 Non-Current Liabilities 166 339 312 302 312 302 640 359

The finance lease obligations at 31 March 2019 was in respect of 6 photocopier machines and a motor vehicle. The average interest rate implicit in the leases of the photocopier machines is 17,5% whilst it is 25,3% for the motor vehicle.

10. CONTRIBUTED CAPITAL

Cash received from Gauteng Department of Health* 54 000 000 54 000 000 Transfers from accumulated surplus** 50 376 790 50 376 790 104 376 790 104 376 790

* The Gauteng Department of Health contributed capital this amount to the entity to fund its working capital requirements. ** Transfers from accumulated surplus to increase contributed capital occurred in 2007 (R 26 000 000) and in 2009 (R 24 376 790) after treasury approval was obtained.

11. REVENUE FROM EXCHANGE TRANSACTIONS - SALE OF GOODS

Revenue from exchange transactions - sale of goods 4 088 067 270 3 824 656 198

12 REVENUE FROM EXCHANGE TRANSACTIONS - FINANCE INCOME

Finance income - bank balances 9 816 888 10 919 455

13 REVENUE FROM EXCHANGE TRANSACTIONS - OTHER INCOME

Parking income 88 520 89 740 Garnishee orders 43 840 40 920 Recycling of paper 1 320 69 611 Initial recognition of assets at fair value* - 139 452 Other income 16 896 10 800 TOTAL OTHER INCOME 150 576 350 523 *Initial recognition of items of property, plant and equipment found on the floor.

316 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

14 REVENUE FROM NON-EXCHANGE TRANSACTIONS - PENALTIES

Late delivery of inventory and Buy-Out-of-Contract penalties 24 194 254 12 489 525

15 EMPLOYEE RELATED COSTS

Basic salary 49 008 366 46 345 707 Allowance for acting positions 131 331 9 886 Qualification bonus 29 971 - Overtime 41 032 356 039 Standby allowance 235 355 93 492 Housing allowance 3 083 280 2 949 049 Non-pensionable salary 2 754 803 2 633 554 Service bonus 4 112 002 3 896 586 Bargaining council 16 271 15 681 Performance bonus 141 035 2 104 000 Medical aid contributions 3 936 751 3 421 323 Travel claims 35 756 57 612 Leave 455 675 453 552 Pension fund contributions 6 334 964 5 998 058 Total 70 316 592 68 334 539

At 31 March 2019, the entity's employee head count was 191 (2018: 192).

Defined benefit plan The Depot provides retirement benefits for its employees through a defined benefit plan for government employees. These benefits are funded by both employer and employee contributions. Employer contributions to the fund are expensed when money is paid to the fund. No provision is disclosed for retirement benefits in the financial statements as the obligation and plan assets is the responsibility of the multi-employer Government Employee Pension Fund reporting under the control of National Treasury.

"The entity contributes to a multi-employer pension fund on behalf of its employees. The fund has a defined benefit plan but is accounted for as a defined contribution plan due to insufficient information being available to apply the rules of the defined benefit plan. "

The reason why there is insufficient information is because the entity is not assessed separately being part of a multi-employer Government Employee Pension Fund reporting under the control of National Treasury.

The assets generated by this plan consists of contributions made by both the entity and the employees and are generally held in a separate administered fund, namely the Government Employees’ Pension Fund. This fund is administered on behalf of the entity by pension fund administrators and is governed by the Pensions Fund Act, 1956 as amended. The following rates of contribution are applied: employee contribution is 7.5 % of pensionable salary (basic salary plus annual bonus) as well as entity contribution of 13.0 % on the same basis.

Surplus/(deficit) for the year Contribution payable for the year 6 371 088 6 024 942 Contributions paid 6 334 964 5 998 058 Deficit (36 124) (26 884)

Department of Health Annual Report 2018/19 317 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

16 DEPRECIATION AND AMORTIZATION EXPENSE

Depreciation of property, plant and equipment 2 624 282 4 038 769 Amortization of intangible assets - 2 810 Total 2 624 282 4 041 579

17 FINANCE COSTS

Capitalized finance leases 125 142 220 429

18 COST OF GOODS SOLD

Cost of inventories sold 3 893 397 373 3 642 542 348

19 DISTRIBUTION COSTS

Fees for distribution costs 7 945 580 6 191 817

20 OPERATIONAL COSTS

Rental and hiring 534 010 443 875 Repairs and maintenance 2 515 468 1 964 453 Communication 346 969 311 769 Stationery and printing 1 005 920 851 214 SITA computer services 1 951 103 2 071 312 Audit fees 1 962 288 1 833 716 External training 91 902 226 770 Inventory written off 1 054 137 1 198 043 Cleaning services 1 778 519 1 893 969 Professional accounting and other advisory services 2 909 041 2 645 633 Security 3 658 299 3 265 448 Other operational costs 1 932 533 1 658 378 Total 19 740 189 18 364 580

20.1 AUDIT FEES

Current year external audit fees 1 962 288 1 833 716

21 TAXATION

No provision has been made for taxation as the entity is exempt from income taxation in terms of section 10 (1) of the South African Income Tax Act No.58 of 1962.

318 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018

22 OPERATING LEASE/ CONTRACT ARRANGEMENTS

At the reporting date the Depot had outstanding commitments under non-cancellable operating leases and/or contracts, which fall due as follows:

Minimum lease payments due Within 1 year 460 978 187 553 Within 2 to 5 years inclusive 71 473 17 100 532 451 204 653

The lease agreements are not renewable at the end of the lease terms. The operating leases are in respect of office equipment, motor vehicles and plant and equipment. There is no escalation clause in all operating leases at 31 March 2019 and thus no straight-lining adjustment was required.

Amount paid in respect of operating leases in the current year amounted to R 468 900 (2018: R 385 321).

23 RELATED PARTIES

Relationships Controlling entity Gauteng Department of Health

The Medical Supplies Depot is a trading entity under the control of the MEC of Gauteng Department of Health. All transactions with the Department of Health are considered to be related party transactions and are at arm's length.

Related party balances Amounts included in trade receivables regarding related parties:

Gauteng Department of Health 614 687 499 1 023 221 913

Related party transactions Amounts included in revenue regarding related parties:

Gauteng Department of Health 4 088 067 270 3 824 656 198

REMUNERATION OF KEY MANAGEMENT

The entity's key management personnel are the following: - Chief Executive Officer - Director : Pharmaceutical Services - Director : Finance and Administration

Department of Health Annual Report 2018/19 319 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 2019 2018 2018

23 RELATED PARTIES (Continued)

REMUNERATION OF KEY MANAGEMENT 2019 Director Director Finance Acting Director Total Pharmaceutical and Finance and Services: Mr D Administration: Administration: Malele Mr J M Smidt* Mr K M Kasumba**

Salary 727 384 237 043 523 023 1 487 450 Bonuses and performance payments 61 330 - 43 584 104 914 Expense allowance 132 441 107 460 169 173 409 074 Pension Contribution 94 560 30 816 42 495 167 871 Acting allowance - - 138 006 138 006 Total 1 015 715 375 319 916 281 2 307 315

2018 Director Director Finance Acting Director Total Pharmaceutical and Finance and Services: Mr D Administration: Administration: Malele Mr J M Smidt* Mr K M Kasumba**

Salary 682 726 554 076 497 662 1 734 464 Bonuses and performance payments 57 003 47 409 41 472 145 884 Expense allowance 122 829 251 181 160 974 534 984 Pension Contribution 88 757 72 029 40 437 201 223 Total 951 315 924 695 740 545 2 616 555

* With effect from 01 September 2018, Mr JM Smidt was transferred to the Gauteng Department of Health.

** Appointed 1 December 2017. Acting allowance only paid from July 2018.

Service in-kind

In the 2018/19 financial year, the Gauteng Department of Health rendered the services listed below at no cost to the entity:

- Corporate Services (Including Human Resources, Risk management and Finance and IT services). The value of these services could not be reliably estimated. - Remuneration of Chief Executive Officer of the entity (Ms N Thipa). Her remuneration was paid by the Department of Health. Her gross remuneration was R 1 422 012 (2018: R 1 347879).

320 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

24 RISK MANAGEMENT

General The main risks faced by the trading entity are interest rate risk, credit risks and liquidity risks. The Depot has developed a comprehensive risk strategy in terms of Treasury Regulation 3.2 in order to monitor and control these risks. The risk management process relating to each of these risks is discussed under the headings below.

Interest rate risk The entity is not exposed to significant interest rate risk as there is no internal funding other than cash and finance leases. The following table set out the carrying amount, by maturity, of the entity’s financial instruments exposed to interest rate risk:

2019 Within 1 year Within 2 - 5 years Total

F igures in Rand

Cash and cash equivalents 242 702 338 - 242 702 338 Finance lease obligations 145 963 166 339 312 302 Trade and other receivables 615 410 548 - 615 410 548 Trade payables 372 016 667 - 372 016 667

2018 Within 1 year Within 2 - 5 years Total Figures in Rand

Cash and cash equivalents 31 419 193 - 31 419 193 Finance lease obligations 328 057 312 302 640 359 Trade and other receivables 1 024 065 168 - 1 024 065 168 Trade payables 738 071 477 - 738 071 477

The entity's financial instruments are linked to the South African prime rate.

The following table demonstrates the sensitivity to a reasonable possible change in interest rates, with all other variables held constant of the entity’s surplus before taxation:

Figures in Rand Increase in Increase in 2019 interest rate by: interest rate by:

Cash and cash equivalents 1% 1% Finance lease obligations 1% 1% Trade receivables 1% 1% Trade payables 1% 1%

2018

Cash and cash equivalents 1% 1% Finance lease obligations 1% 1% Trade receivables 1% 1% Trade payables 1% 1%

Department of Health Annual Report 2018/19 321 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Credit Risk

Financial assets, which potentially subject the Depot to the risk of non-performance by counter parties, consist mainly of cash and accounts receivable, consisting of trade receivables and staff debtors. Trade accounts receivable consist of a small consumer base. The Depot limits its treasury counter-party exposure by only dealing with well-established financial institutions approved by National Treasury. Trade debtors – The Gauteng Department of Health is effectively the only client of the Depot, although deliveries occur to various health institutions.

Credit risk with regards to receivables is managed as follows:

Trade debtors – A monthly claim is compiled of all issues from the Depot to health institutions and of payments affected to suppliers for direct deliveries. This claim is normally paid within a month by Central Office as the Depot follows-up strongly on outstanding monies to ensure that there is money available to release a weekly run of payments to suppliers.

Staff debtors – Section 17, 30 and 38 of the Public Service Act indicate that any overpayment or wrongly granted remuneration to staff irrespective of whose fault it is may be recovered from the employee. There are built-in control measures in Persal to limit overpayments and adjustments have a three-tier approval process. The employee applies or provides approved documents, a practitioner records the transaction on Persal, a senior reviews the transaction on Persal and a third person is required to approve the transaction. With death, retirement or resignation there is a prescribed debt form that needs to be completed and is forwarded with the pension withdrawal form (Z102) to the Department of Finance where the staff debt is recovered before payment to the employee or employee beneficiaries occur. Where the debt recovered is inadequate the Department of Finance’s debt recovery section recovers outstanding monies.

Financial assets and liabilities exposed to credit risk at the reporting date were as follows:

Figures in Rand 31 March 2019 31 March 2018

Trade and other receivables ( less than 3 months) 614 687 499 1 023 221 913 Cash and cash equivalents (less than 3 months) 242 702 338 31 419 193 Finance lease obligation - long term (2 to 5 years) 166 339 312 302 Finance lease obligation - short term ( less than 1 year) 145 963 328 057 Trade and other payables ( Less than 3 months) 375 702 712 746 291 632

Liquidity Risk

The Depot maintains a large amount of inventory, the maximum turnover period for the inventory kept however is twelve weeks or three months.

Liquidity risk is managed as follows:

Proper stock management processes are in place where stock is ordered based on economic order quantities. The maximum turnover period of stock kept at the Depot is three months. At least a monthly exercise is done to identify slow moving items and a memo is issued to health institutions every six months with an inventory list of the items as a reminder that the stock is available.

322 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Currency Risk

The Depot does not transact with any supplier or customer outside the South African borders and this risk is therefore not directly applicable. However, this risk arises as suppliers purchase raw material from international suppliers which is subject to foreign exchange rate fluctuations. Suppliers therefore request, through an application to either National Treasury (State Tender Board) or the Department of Finance, for a price adjustment based on the fluctuation of foreign exchange rates.

Fair values

At 31 March 2019, the carrying values of cash and cash equivalents, trade and other receivables and trade and other payables approximate the fair values due to short term maturities of these assets and liabilities as disclosed below:-

Figures in Rand 31 March 2019 31 March 2018

Financial Assets

Carrying Amount 242 702 338 31 419 193 Cash and cash equivalents 615 410 548 1 024 065 168 Trade and other receivables from exchange transactions

Fair Value Cash and cash equivalents 242 702 338 31 419 193 Trade and other receivables from exchange transactions 615 410 548 1 024 065 168

Financial Liabilities

Carrying Amount Trade and other payables from exchange transactions 375 702 712 746 291 632 Finance lease obligation 145 963 328 057

Fair Value Trade and other payables from exchange transactions 375 702 712 746 291 632 Finance lease obligation 145 963 328 057

25 CONTINGENT LIABILITIES

There were no contingent liabilities outstanding as at 31 March 2019 (2018: Nil)

Department of Health Annual Report 2018/19 323 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Currency Risk

Fair values

Figures in Rand 31 March 2019 31 March 2018

Financial Assets

Carrying Amount 242 702 338 31 419 193 Cash and cash equivalents 615 410 548 1 024 065 168 Trade and other receivables from exchange transactions

Fair Value Cash and cash equivalents 242 702 338 31 419 193 Trade and other receivables from exchange transactions 615 410 548 1 024 065 168

Financial Liabilities

Carrying Amount Trade and other payables from exchange transactions 375 702 712 746 291 632 Finance lease obligation 145 963 328 057

Fair Value Trade and other payables from exchange transactions 375 702 712 746 291 632 Finance lease obligation 145 963 328 057

25 CONTINGENT LIABILITIES

There were no contingent liabilities outstanding as at 31 March 2019 (2018: Nil)

324 Department of Health Annual Report 2018/19 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

Figures in Rand 31 March 2019 31 March 2018

26 FRUITLESS AND WASTEFUL EXPENDITURE

Reconciliation of fruitless and wasteful expenditure: Opening Balance 25 742 325 25 742 325 Current year fruitless and wasteful expenditure - - Condoned or written off by relevant authority - - Transfer to receivables for recovery-not condoned - - Closing Balance 25 742 325 25 742 325

* Broken and expired stock is only recorded as fruitless and wasteful expenditure only if it exceeds 2% of the average inventory on hand.

Action taken by management regarding fruitless and wasteful expenditure

27 IRREGULAR EXPENDITURE

Reconciliation of irregular expenditure: Opening Balance 1 378 614 421 1 372 640 477 Current year Irregular expenditure** 10 778 051 5 973 944 Prior Year Incurred in the Current Financial Year - - Condoned or written off by relevant authority - - Transfer to receivables for recovery-not condoned - - Irregular Expenditure Awaiting condonement - - Closing Balance 1 389 392 472 1 378 614 421

Action taken by management regarding irregular expenditure

**Current year irregular expenditure

There are three (3) contracts that accounted for the current year irregular expenditure: - Cleaning services 1 437 794 - Security services 6 822 060 - Accounting services 2 518 197 10 778 051 Management has taken the following steps to eliminate the reoccurrence of this irregular expenditure:

• The Department is in the process of insourcing security services for the province which will include Medical Supplies Depot. • Posts for the replacement of consultants that provide accounting services were created and the recruitment process in the final stages for appointment. • The previous cleaning services contract has been terminated and a new service provider was awarded a contract with effect from October 2018.

Prior year irregular expenditure Management has referred the cases to risk management and internal control unit within medical supplies depot, who are currently in the process of assessing documentation and referral of further investigation if need arises for the amounts disclosed in the current and prior years for the process of applying for condonation (where possible),consequence management will be determined after assessment.

Department of Health Annual Report 2018/19 325 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

The effectiveness of internal control and Information and Communication Technology (ICT) Governance Figures in Rand 31 March 2019 31 March 2018 The Audit Committee has observed that the control environment of the Entity has not significantly improved during the year under 28 COMMITMENTS review. Some deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Approved, contracted and not provided for in the statement of financial position. Reports. The overall opinion of Internal Audit on the internal control design at the Entity is partially adequate and effective. Management should pay special attention to IT general controls and Occupational Health and Safety processes. Contractual commitments The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the ICT Framework issued by the - Distribution services** 9 597 615 18 052 125 Department of Public Services and Administration. Although there was some progress on the ICT internal control, special attention - Cleaning services*** 950 781 - must be given to the IT general controls as well as the implementation of the Disaster Recovery Plan and the Business Continuity Plan. - IT services 2 243 694 2 116 692 This continued to be a high risk for the Entity. - Orders placed but goods not delivered 453 560 755 663 124 551 466 352 845 683 293 368 The governance of the MSD and its reliance on the department of health requires resolution to enable it progress and effectively improve the internal control environment. Approved, not yet contracted for and not provided for in the statement of financial position. Internal Audit

- Capital Commitments 12 048 237 5 355 321 The Audit Committee is satisfied that the Internal Audit plan represents a clear alignment with the key risks, has adequate information * Restated, refer to note 32. systems coverage, and a good balance across the different categories of audits, i.e. risk-based, mandatory, performance, computer and ** Contract awarded 1 January 2018 and terminates on 31 December 2020. follow-up audits.

The Audit Committee has noted improvement in the communication between the Executive Management, the AGSA and the Internal *** Contract awarded 7 November 2018 and terminates on 6 November 2019. Audit Function, but more needs to be done to strengthen the Corporate Governance initiatives within the Entity.

Risk Management 29 CHANGE IN ACCOUNTING ESTIMATE

Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. The Audit Committee Property, Plant & Equipment original useful lives have been reassessed as per table below in the beginning of the current financial stresses that risk management should receive urgent attention. Management should take full responsibility for the entire Enterprise period to reflect the actual pattern service potential derived from the assets. The depreciation is to be calculated on a straight line Risk Management process and continue to support the risk function to even further enhance the performance of the Entity. basis for the remaining useful lives of the assets.

Asset class Useful life Forensic Investigations Computer Equipment 1 - 18 years Office Furniture 1 - 23 years Limited forensic investigations were requested for the Entity during the financial year under review. Plant & Equipment 1 - 21 years The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

The change in the useful lives of the assets had the following impact on depreciation The Audit Committee notes the content of financial and non-financial quarterly reports prepared and submitted by the Accounting The Audit Committee noted that the Chief Executive Officer attended four out of five scheduled Audit Committee meetings and was Current year (Decrease) Officer of the Entity during the year under review and confirms that the reports were in compliance with the statutory reporting duly represented. The Audit Committee is satisfied that the Entity adhered to the provisions of the GPG Audit Committee Charter in Computer Equipment (19 790) framework although significant effort must be made to further the quality of these reports . relation to ensuring that there is proper representation for the Chief Executive Officer. Office Furniture (64 410)

Plant & Equipment (1 389 288) Evaluation of reporting by the Department The Members of the Audit Committee met with the Senior Management of the Entity, Internal Audit and the AGSA, individually and The Audit Committee has: collectively to address risks and challenges facing the Entity. A number of in-committee meetings were held to address control 30 COMPARATIVES weaknesses and deviations within the Entity. • Reviewed and discussed the audited Annual Financial Statements to be included in the Annual Report, with the AGSA and the Accounting Officer; There were improvements to the presentation and disclosure in the current year. Changes to the prior year presentation and Audit Committee Responsibility • Reviewed the Audit Report of the AGSA; disclosure was also made to ensure comparability for users of the annual financial statements. No prior year figures were • Reviewed the AGSA’s Management Report and Management’s response thereto; The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury changed. • Reviewed the Entity’s compliance with legal and regulatory provisions; Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee • Reviewed significant adjustments resulting from the audit; and Charter, has regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. • Reviewed the appropriate accounting policies and relevant disclosures.

326 Department of Health Annual Report 2018/19

The Audit Committee concurs with and accepts the AGSA’s conclusions on the Annual Financial Statements, performance information and compliance and is of the opinion that the audited Annual Financial Statements be accepted and read together with the report of the AGSA.

One-on-One Meeting with the Accounting Of cer

The Audit Committee has met with the Accounting Officer for the Entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive Authority for the Entity to apprise the MEC on the performance of the Entity.

Auditor-General of South Africa

The Audit Committee has met with the AGSA to ensure that there are no unresolved issues.

Chairperson of the Audit Committee

Date: 31 July 2019 GAUTENG MEDICAL SUPPLIES DEPOT NOTES TO THE ANNUAL FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2019

The effectiveness of internal control and Information and Communication Technology (ICT) Governance Figures in Rand 2019 2018 The Audit Committee has observed that the control environment of the Entity has not significantly improved during the year under 31 PRIOR PERIOD ERROR review. Some deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The overall opinion of Internal Audit on the internal control design at the Entity is partially adequate and effective. While preparing the annual financial statements of the entity for the year ended 31 March 2019, management noted that Management should pay special attention to IT general controls and Occupational Health and Safety processes. the disclosure of commitments the entity had at 31 March 2018 was not complete. Commitments relating to IT services, The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the ICT Framework issued by the Orders placed but goods not delivered and Capital commitments were erreneously omitted from the disclosure in the annual Department of Public Services and Administration. Although there was some progress on the ICT internal control, special attention financial statements. must be given to the IT general controls as well as the implementation of the Disaster Recovery Plan and the Business Continuity Plan. This continued to be a high risk for the Entity. There is no impact on the Statement of Financial Position, Statement of Financial Performance, Statement of Changes in Equity or the Statement of Cash Flows for the year ended 31 March 2018. The governance of the MSD and its reliance on the department of health requires resolution to enable it progress and effectively improve the internal control environment. The impact on the disclosure in the annual financial statements presented at 31 March 2018 is as follows: Internal Audit As previously Correction of Restated The Audit Committee is satisfied that the Internal Audit plan represents a clear alignment with the key risks, has adequate information stated error systems coverage, and a good balance across the different categories of audits, i.e. risk-based, mandatory, performance, computer and Commitments follow-up audits. The Audit Committee has noted improvement in the communication between the Executive Management, the AGSA and the Internal Approved, contracted and not provided for in the Audit Function, but more needs to be done to strengthen the Corporate Governance initiatives within the Entity. statement of financial position. - IT services - 2 116 692 2 116 692 Risk Management - Orders placed but goods not delivered - 663 124 551 663 124 551 Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. The Audit Committee Approved, not yet contracted for and not provided for in stresses that risk management should receive urgent attention. Management should take full responsibility for the entire Enterprise the statement of financial position. Risk Management process and continue to support the risk function to even further enhance the performance of the Entity. - - Capital Commitments 5 355 321 5 355 321 Forensic Investigations

Limited forensic investigations were requested for the Entity during the financial year under review. 32 EVENTS AFTER REPORTING DATE

The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act There were no events identified after the reporting date that may have a significant impact on the entity's financial position

at 31 March 2019, its financial performance or its cash flows for the year then ended. The Audit Committee notes the content of financial and non-financial quarterly reports prepared and submitted by the Accounting The Audit Committee noted that the Chief Executive Officer attended four out of five scheduled Audit Committee meetings and was Officer of the Entity during the year under review and confirms that the reports were in compliance with the statutory reporting duly represented. The Audit Committee is satisfied that the Entity adhered to the provisions of the GPG Audit Committee Charter in framework although significant effort must be made to further the quality of these reports . relation to ensuring that there is proper representation for the Chief Executive Officer. Evaluation of reporting by the Department The Members of the Audit Committee met with the Senior Management of the Entity, Internal Audit and the AGSA, individually and The Audit Committee has: collectively to address risks and challenges facing the Entity. A number of in-committee meetings were held to address control weaknesses and deviations within the Entity. • Reviewed and discussed the audited Annual Financial Statements to be included in the Annual Report, with the AGSA and the Accounting Officer; Audit Committee Responsibility • Reviewed the Audit Report of the AGSA; • Reviewed the AGSA’s Management Report and Management’s response thereto; The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury • Reviewed the Entity’s compliance with legal and regulatory provisions; Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee • Reviewed significant adjustments resulting from the audit; and Charter, has regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. • Reviewed the appropriate accounting policies and relevant disclosures.

Department of Health Annual Report 2018/19 327

One-on-One Meeting with the Accounting Of cer

The Audit Committee has met with the Accounting Officer for the Entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive Authority for the Entity to apprise the MEC on the performance of the Entity.

Auditor-General of South Africa

The Audit Committee has met with the AGSA to ensure that there are no unresolved issues.

Chairperson of the Audit Committee

Date: 31 July 2019 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDIT COMMITTEE FOR THE YEAR ENDED 31 MARCH 2019

The effectiveness of internal control and Information and Communication Technology (ICT) Governance Report of the Audit Committee

Medical Supplies Depot The Audit Committee has observed that the control environment of the Entity has not significantly improved during the year under review. Some deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General We are pleased to present our report for the nancial year ended 31 March 2019. Reports. The overall opinion of Internal Audit on the internal control design at the Entity is partially adequate and effective. Management should pay special attention to IT general controls and Occupational Health and Safety processes. Audit Committee and Attendance The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the ICT Framework issued by the The Audit Committee consists of the external independent Members listed hereunder and is required to meet a minimum of twice per Department of Public Services and Administration. Although there was some progress on the ICT internal control, special attention annum as per provisions of the Public Finance Management Act (PFMA). In terms of the approved Terms of Reference (GPG Audit must be given to the IT general controls as well as the implementation of the Disaster Recovery Plan and the Business Continuity Plan. Committee Charter), five meetings were held during the current year, i.e. three meetings to consider the Quarterly Performance This continued to be a high risk for the Entity. Reporting (financial and non-financial) and two meetings to review and discuss the Annual Financial Statements and the Auditor-General of South Africa’s (AGSA) Audit and Management Reports. The governance of the MSD and its reliance on the department of health requires resolution to enable it progress and effectively improve the internal control environment.

Non-Executive Members Internal Audit

Name of Member Number of Meetings attended The Audit Committee is satisfied that the Internal Audit plan represents a clear alignment with the key risks, has adequate information Ms. Janice Meissner (Chairperson) 04 systems coverage, and a good balance across the different categories of audits, i.e. risk-based, mandatory, performance, computer and follow-up audits. Mr. Leon Langalibalele 04 The Audit Committee has noted improvement in the communication between the Executive Management, the AGSA and the Internal Ms. Shelmadene Petzer 04 Audit Function, but more needs to be done to strengthen the Corporate Governance initiatives within the Entity. Mr. Japie du Plessis (Former Chairperson) 04

Ms. Precious Sibiya (Former member) 01 Risk Management

Executive Members Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. The Audit Committee stresses that risk management should receive urgent attention. Management should take full responsibility for the entire Enterprise Compulsory Attendees Number of Meetings attended Risk Management process and continue to support the risk function to even further enhance the performance of the Entity.

Ms. Nocawe Thipa (Chief Executive Officer) 04 Forensic Investigations Mr. Mkhululi Lukhele (Accounting Officer) 05

Mr. Luthendo Makhadi (Acting Chief Audit Executive) 04 Limited forensic investigations were requested for the Entity during the financial year under review. Mr. Kweyama Velile (Chief Audit Executive) 01 The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

The Audit Committee notes the content of financial and non-financial quarterly reports prepared and submitted by the Accounting The Audit Committee noted that the Chief Executive Officer attended four out of five scheduled Audit Committee meetings and was Officer of the Entity during the year under review and confirms that the reports were in compliance with the statutory reporting duly represented. The Audit Committee is satisfied that the Entity adhered to the provisions of the GPG Audit Committee Charter in framework although significant effort must be made to further the quality of these reports . relation to ensuring that there is proper representation for the Chief Executive Officer. Evaluation of reporting by the Department The Members of the Audit Committee met with the Senior Management of the Entity, Internal Audit and the AGSA, individually and The Audit Committee has: collectively to address risks and challenges facing the Entity. A number of in-committee meetings were held to address control weaknesses and deviations within the Entity. • Reviewed and discussed the audited Annual Financial Statements to be included in the Annual Report, with the AGSA and the Accounting Officer; Audit Committee Responsibility • Reviewed the Audit Report of the AGSA; • Reviewed the AGSA’s Management Report and Management’s response thereto; The Audit Committee reports that it has complied with its responsibilities arising from section 38(1)(a) of the PFMA and Treasury • Reviewed the Entity’s compliance with legal and regulatory provisions; Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee • Reviewed significant adjustments resulting from the audit; and Charter, has regulated its affairs in compliance with this Charter and has discharged all its responsibilities as contained therein. • Reviewed the appropriate accounting policies and relevant disclosures.

328 Department of Health Annual Report 2018/19

One-on-One Meeting with the Accounting Of cer

The Audit Committee has met with the Accounting Officer for the Entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive Authority for the Entity to apprise the MEC on the performance of the Entity.

Auditor-General of South Africa

The Audit Committee has met with the AGSA to ensure that there are no unresolved issues.

Chairperson of the Audit Committee

Date: 31 July 2019 GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDIT COMMITTEE FOR THE YEAR ENDED 31 MARCH 2019

The effectiveness of internal control and Information and Communication Technology (ICT) Governance

The Audit Committee has observed that the control environment of the Entity has not significantly improved during the year under review. Some deficiencies in the system of internal control and deviations were reported in the Internal Audit and Auditor-General Reports. The overall opinion of Internal Audit on the internal control design at the Entity is partially adequate and effective. Management should pay special attention to IT general controls and Occupational Health and Safety processes. The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the ICT Framework issued by the Department of Public Services and Administration. Although there was some progress on the ICT internal control, special attention must be given to the IT general controls as well as the implementation of the Disaster Recovery Plan and the Business Continuity Plan. This continued to be a high risk for the Entity.

The governance of the MSD and its reliance on the department of health requires resolution to enable it progress and effectively improve the internal control environment.

Internal Audit

The Audit Committee is satisfied that the Internal Audit plan represents a clear alignment with the key risks, has adequate information systems coverage, and a good balance across the different categories of audits, i.e. risk-based, mandatory, performance, computer and follow-up audits. The Audit Committee has noted improvement in the communication between the Executive Management, the AGSA and the Internal Audit Function, but more needs to be done to strengthen the Corporate Governance initiatives within the Entity.

Risk Management

Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. The Audit Committee stresses that risk management should receive urgent attention. Management should take full responsibility for the entire Enterprise Risk Management process and continue to support the risk function to even further enhance the performance of the Entity.

Forensic Investigations

Limited forensic investigations were requested for the Entity during the financial year under review.

The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

Department of Health Annual Report 2018/19 329

One-on-One Meeting with the Accounting Of cer

The Audit Committee has met with the Accounting Officer for the Entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive Authority for the Entity to apprise the MEC on the performance of the Entity.

Auditor-General of South Africa

The Audit Committee has met with the AGSA to ensure that there are no unresolved issues.

Chairperson of the Audit Committee

Date: 31 July 2019 The effectiveness of internal control and Information and Communication Technology (ICT) Governance

The governance of the MSD and its reliance on the department of health requires resolution to enable it progress and effectively improve the internal control environment.

Internal Audit

Risk Management

Forensic Investigations

Limited forensic investigations were requested for the Entity during the financial year under review.

The quality of quarterly reports submitted in terms of the PFMA and the Division of Revenue Act

GAUTENG MEDICAL SUPPLIES DEPOT REPORT OF THE AUDIT COMMITTEE FOR THE YEAR ENDED 31 MARCH 2019

One-on-One Meeting with the Accounting Of cer

The Audit Committee has met with the Accounting Officer for the Entity to address unresolved issues.

One-on-One Meetings with the Executive Authority

The Audit Committee has met with the Executive Authority for the Entity to apprise the MEC on the performance of the Entity.

Auditor-General of South Africa

The Audit Committee has met with the AGSA to ensure that there are no unresolved issues.

Chairperson of the Audit Committee

Date: 31 July 2019

330 Department of Health Annual Report 2018/19