Together, Moving Gauteng City Region Forward

HEALTH Distribution of Service Platforms

Financial Inputs Actual Expenditure

R1.6 Billion R1 Billion

R14 Billion

R1 Billion

R290 Million

R8 Billion R918 Million R15 Billion

*Percentages above represent expenditure as a % of final appropriation Human Resources for Health

Total Health Workforce Nursing Professionals 32,503 Management Professionals Support Staff 112 11,797 Engineering Support Staff 10 Administration 68 118 Staff 9,370

Engineering Clinical Professionals Professionals 71 6,520

Allied Allied Support Staff Professionals Clinical 1,974 5,761 Nursing Professionals Professionals

Dental Dental Student Registrars Practitioners Dental Registrar 49 Nurses 306 3,120 Professional Nurses 15,116

Dental 32 503 Medical Specialists Registrars 6 520 124 1,221

Medical Registrar Nursing Staff Nurses Assistants Medical Medical 7,728 Specialists Practitioners 6,539 1,305 3,515

Medical Practitioner

Adminstration Support Management Staff Staff Professionals

Junior Middle Junior Middle Managers Managers Managers Level 16 level 13 Managers 80 (Levels 9-10) (Levels 11-12) (Levels 9-10) (Levels 11-12) 1 472 237 2 0

9 370 11 797 112 Level 15 Level 14 Lower Levels Lower Levels 5 26 (Levels 1-8) (Levels 1-8) 8,661 11,795 A snapshot of Health Services provided to Women, Mothers and Children

Our efforts to improve care for children and women to reduce infant and maternal morbidity and mortality, as well as to promote reproductive health and the health and well-being of children, women and youth are as follows:

256 515 pregnant women were provided We screened antenatal care services. 223 761 200 564 124 learners across all grades for couple year of protection to detection and prevention of any prevent unwanted pregancies learning barriers. were provided through our family planning services

157 582 pregnant women attended the ANC 109 236 clinics before they reached 20 weeks learners were provided screening of gestation (of their pregnancy) Provided cervical cancer services including referrals and screening for other health care interventions such as deworming, dental care 162 359 etc. women 30 years and older

Over 219 000 200 139 deliveries across our facilities were babies under 1 year fully attended to by skilled health 108 502 immunised attendants learners immunised against HPV 1 Department of Health Province of Gauteng Vote No. 4 Annual Report Financial Year 2017/2018

PR 335/2018 ISBN: 978-0-621-46642-3 PART A: GENERAL INFORMATION

2 1. DEPARTMENT GENERAL INFORMATION

Gauteng Provincial Government | Health | Telephone number: 011 355 3477 Annual Report 2017/2018 Email: [email protected] Physical address: 37 Pixley Ka Seme Street Website address: http://www.health.gpg.gov.za Marshalltown Facebook: Gauteng Provincial Health Department Johannesburg Twitter: @GautengHealth 2001 Instagram: @gautenghealth

Postal address: Private Bag X085 Marshalltown 2107 South Africa

3 CONTENTS

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

PART B: 4 PERFORMANCE INFORMATION 1. AUDITOR-GENERAL’S REPORT: PREDETERMINED OBJECTIVES 20 2. OVERVIEW OF DEPARTMENTAL PERFORMANCE 21 3. STRATEGIC OUTCOME-ORIENTATED GOALS 25 4. PERFORMANCE INFORMATION BY PROGRAMME 26 5. TRANSFER PAYMENTS 72 6. CONDITIONAL GRANTS 73 7. DONOR FUNDS 76 8. CAPITAL INVESTMENT 78

PART C: GOVERNANCE 1. INTRODUCTION 90 2. RISK MANAGEMENT 90 3. MINIMISING CONFLICT OF INTEREST 90 4. FRAUD AND CORRUPTION 91 5. CODE OF CONDUCT 91 6. HEALTH SAFETY AND ENVIRONMENTAL ISSUES 91 7. PORTFOLIO COMMITTEES 93 8. SCOPA RESOLUTIONS 103 9. PRIOR MODIFICATIONS TO AUDIT REPORTS 107 10. INTERNAL AUDIT AND AUDIT COMMITTEES 108 11. AUDIT COMMITTEE REPORT 109

PART D: HUMAN RESOURCE MANAGEMENT 1. INTRODUCTION 112 2. OVERVIEW OF HUMAN RESOURCES 112 3. HUMAN RESOURCES OVERSIGHT STATISTICS 113

5

PART E: FINANCIAL INFORMATION 1. REPORT OF THE AUDITOR-GENERAL 144 2. ANNUAL FINANCIAL STATEMENTS 153

PART F: MSD FINANCIAL INFORMATION 1. REPORT OF THE ACCOUNTING OFFICER 283 2. REPORT OF THE AUDITOR-GENERAL 295 3. ANNUAL FINANCIAL STATEMENTS 299 2. ABBREVIATIONS AND ACRONYMS

A&E Accident and Emergency ECC Emergency Communication Centre ACSM Advocacy, Communication and Social ECD Early Childhood Development Mobilisation ECDP Early Childhood Development Centre ACSM Advocacy, Communication and Social Practitioners Mobilisation ECE Estimated Capital Expenditure AET Adult Education and Training ECT Emergency Care Technician AGSA Auditor-General South Africa EE Employment Equity AIDS Acquired Immune Defi ciency Syndrome EHWP Employee Health and Wellness Programme ALOS Average Length of Stay EMIS Education Management Information System ANC Antenatal Care EML Essential Medicines List AO Accounting Offi cer EMS Emergency Medical Services APD Association for the Physically Disabled EMTCT Elimination of Mother to Child Transmission ART Antiretroviral Treatment EPWP Expanded Public Works Programme ARV Antiretroviral Virus ERM Enterprise Risk Management ASELPH Albertina Sisulu Executive Leadership ES Equitable Share Programme ESMOE Essential Steps in Managing Obstetric BAS Basic Accounting System Emergencies BLS Basic Life Support EWP Employee Wellness Programme BUR Bed Utilisation Rate EXCO Executive Committee or Council CAD Computer Aided Dispatch FBO Faith-Based Organisation CBO Community-Based Organisation FDC Fixed-Dose Combination (ARV Pill) CCMDD Centralised Chronic Medicine Dispensing and FPS Forensic Pathology Services Distribution FY Financial Year CCMT Comprehensive Care Management and Treatment GAS Gauteng Audit Services CDC Communicable Disease Control GDE Gauteng Department of Education 6 CDU Central Dispensing Unit GDF Gauteng Department of Finance CEO Chief Executive Offi cer GDID Gauteng Department of Infrastructure Development CFO Chief Financial Offi cer GDoH Gauteng Department of Health CHBAH Chris Hani Baragwanath Academic Hospital GGHH Global Green and Healthy Hospital CHC Community Health Centre GPG Gauteng Provincial Government CHW Community Health Worker HAART Highly Active Antiretroviral Treatment CIO Chief Information Offi cer HAST HIV, Aids, STIs and TB CMR Child Mortality Rate HCA Hospital Corporation of America COE Compensation of employees HCT HIV Counselling and Testing COGTA Cooperative Governance and Traditional Affairs HCWM Health Care Waste Management COJ City of Johannesburg HFRG Hospital Facility Revitalisation Grant COT City of Tshwane HIRA Hazard Identifi cation Risk Assessment CPD Continuing Professional Development HIV Human Immunodefi ciency Virus CRO Chief Risk Offi cer HOD Head of Department CVs Curriculum Vitae HPs Health Promoters DDG Deputy Director General HPTDG Health Professional Training and Development Grant DHIS District Health Information System HPV Human Papilloma Virus DHS District Health System HR Human Resources DID Department of Infrastructure Development HWSETA Health and Welfare Sector Education and DOL Department of Labour Training Authority DORA Division of Revenue Act ICDM Integrated Chronic Disease Management DPOS Daily Patient Opinion Survey ICSM Integrated Clinical Service Management DPSA Department of Public Service and ICT Information and Communication Technology Administration ICU Intensive Care Unit DR TB Drug Resistance TB IEC Information, Education and Communication DRTB Drug Resistant TB ILS Intermediate Life Support EAP Employee Assistance Programme IMCI Integrated Management of Childhood OPD Out-patient Department Illnesses OSD Occupation-Specifi c Dispensation IMCI CC Integrated Management of Childhood PACS Picture Archiving and Communication System Illnesses Community Component PASOP Prevention Avoid Stop Overcome Protect IMR Infant Mortality Rate PC Primary Care IPM Institute of Personnel Management PCR Polymerase Chain Reaction IRS Integrated Reporting System PDE Patient-Day Equivalent ISHP Integrated School Health Programme PDUs Pharmacy Dispensing Units IT Information technology PEC Patient Experience of Care ITT Intervention Task Team PET Position Emission Tomography KMC Kangaroo Mother Care PFMA Public Finance Management Act KZN Kwazulu-Natal PHC Primary Health Care LAN Local Area Network PIDS Provincial Indicator Data Set LARC Long Acting Reversible Contraception PIER Public Information Education and Relations LBC Liquid Based Cytology PLHIV People Living with HIV LE Life Esidimeni PMTCT Prevention of Mother-To-Child Transmission LMSD Leadership Management and Skills Development PPSI Provincial Patient Safety Incident Committee LOUOP Limited Obstetric Ultrasound Outreach PPSML Provincial Patient Safety Medico-Legal Programme PPT Plan Patient Transport MBFI Mother Baby Friendly Initiative PPTICRM Permanent Team for Ideal Clinic Realisation MDGs Millennium Development Goals and Management MDR-TB Multi-Drug Resistant Tuberculosis PSETA Public Service Education and Training Authority MEC Member of Executive Council PTC Pharmacy Therapeutic Committee MIS Management Information System PWD People with Disabilities MMC Medical Male Circumcision QA Quality Assurance MMR Maternal Mortality Rate 7 QIP Quality Improvement Plan MRI Magnetic Resonance Imaging QP Quadpara MSD Medical Supplies Depot SABPP South African Mobility for Blind Trust MTEF Medium-Term Expenditure Framework SAICA South African Institute of Charted NAS National Adherence Strategy Accountants NCDs Non-Communicable Diseases SAP System application and Products NCS National Core Standards SASSA South African Social Security Agency NDOH National Department of Health SOP Standard Operation Plans NDP National Development Plan TB Tuberculosis NGO Non-Governmental Organisation THIS TB/HIV Information System NHA National Health Act TOR Terms of Reference NHI National Health Insurance TROA Total Remaining on ART NHLS National Health Laboratory Services UJ University Of Johannesburg NICU Neonatal Intensive Care Unit UNICEF United Nations Children’s Emergency Fund NIDS National Indicator Data Sets UPFS Uniform Patient Fees Schedule NIMART Nurse-Initiated Management of Art UTT Universal Test and Treat NIOH National Institute of Occupational Health VLS Viral Load Suppression NPO Non-Profi t Organisation VLS Viral Load Suppression NRP Neonatal Resuscitation Programme VMMC Voluntary Medical Male Circumcision NSDA National Service Delivery Agreements WAN Wide Area Network OD Organisational Design WBOT Ward-Based Outreach Teams OHASIS Occupational Health and Safety Information WHO World Health Organisation System WISN Workload Indicator for Staffi ng Norm OHS Occupational Health and Safety XDR-TB Extreme Drug Resistant Tuberculosis OHSC Offi ce of Health Standards and Compliance ABOUT THE DEPARTMENT AND MANAGEMENT MESSAGES

2-18 Information about the mandate, location and messages from the MEC and the accounting offi cer on performance of the department.

ADMINISTRATIVE OVERVIEW

20-78 A performance report outlining quality improvement, technology and transformation agenda.

DISTRICT HEALTH CARE SERVICES

30 - 44 Performance of the priority health programmes accessibility, treatment and support provided at primary health facilities including reengineering of the PHC system

8 HOSPITAL AND EMERGENCY SERVICES

Performance of the emergency medical 45 - 59 services, various categories of hospital effi ciency and quality initiatives starting with hospitals that provide specialised, tertiary care to quaternary health care services.

HEALTH CARE SUPPORT SERVICES OVERVIEW

60 - 88 A brief overview on pharmaceutical, blood and supply chain, human resources capacity development initiatives and capital investments.

GOVERNANCE, HUMAN AND FINANCIAL ACCOUNTABILITY PATTERNS 89 - 326 A brief overview on risk management, human resources statistics overview , fi nancial statements and legislation. 3. FOREWORD BY THE MEC FOR HEALTH people and professionals. More than 1450 nursing graduates were produced, with 463 in specialist areas. The Stats SA 2017 mid-year population survey estimates that the Gauteng population is 25.4%, with female average life expectancy increasing to 69.8 years for females and male to 64.1years. Whilst the vision of a long and healthy life for all is being realised, the burden of communicable and non- communicable diseases as well as of interpersonal and motor vehicle-related trauma remains high, putting pressure on the grossly underfunded public health care system. Efforts to improve accountability saw the department maintaining an unqualifi ed audit report from the Auditor General. To ensure integrity of information, the eHealth Enterprise Architecture was approved to fast-track implementation of the Health Patient Registration System. The NHI and Medical Schemes Amendment Bills point This year was the beginning of an end of a department the way to a more integrated and universal health in crisis and on a precipice, characterised by mid- system where resources are equitably distributed, year cash depletion, high levels of medical litigation, benefi ting all citizens. Gauteng continues to lead strained labor relations and gross negligence in nationally in Ideal Clinics ratings by the national the management of the Marathon Mental Health Department of Health and in other assessments by Relocation Project. The recovery process that began the Offi ce of Health Standards Compliance. during the year has seen extensive consultations I thank the dedicated employees for holding the fort within and outside the department, a clear during the diffi cult times; they are our nation’s true 9 demonstration that management and governance heroes and heroines. With the new management failures did a disservice to the over 68 000 competent in place, the department is well positioned to health professional, support staff and health services strengthen the public health care system to optimise users. patient experience. We kick-started this recovery process determined to As we celebrate the centenaries of our forebears succeed, together with our many strategic partners, who selfl essly served our nation, Dr Nelson Rolihlahla as we work towards universal health coverage and Mandela and Dr Albertina Nontsikelelo Sisulu, we National Health Insurance. The dawn of this new are assured that through partnerships with families, era demonstrated, that despite inherited systemic communities, civil society organisations, business and issues, the public health system is a resilient essential the media we can serve our people even better. This service with a high and ever-increasing utilisation year also saw the opening of a specialised facility, the rate benefi ting the majority of citizens. During the Nelson Mandela Children’s Hospital, which we fund year, there were more than 26 million patient visits to provide highly specialised services for children in at clinics and hospital out patient departments. Africa. An estimated 219 000 deliveries were attended to by health professionals. In addition over 223 000 I appreciate the invaluable support of the Premier, learners were screened for learning barriers through the Executive Council, the Minister of Health, the the school health programme and outreach teams Vice Chancellors, the Hospital Boards, the Clinic visited over 2 million people at households. The Committees, labour representatives and many other nurse-initiated anti-retroviral treatment continues to stakeholders for their immense contributions. inspire us towards zero mother-to-child transmission I further thank members of the Provincial Legislature of HIV, with the rate declining this year from 1.7% for the feedback from their oversight work. to 0.99%. In addition to providing health care ranging from primary health care to quaternary hospital services, the health system is the largest training platform for health professionals nationally in partnership with three medical schools, nursing colleges and Dr Gwendoline M. Ramokgopa emergency medical service colleges. There are also Gauteng MEC for Health centres of excellence that are referral services for the 31 March 2018 public and private sectors. There were over 1350 professional placements for medical and allied health community services during the year, benefi ting young 4. REPORT OF THE ACCOUNTING OFFICER

Through its HIV and AIDS, STI and TB (HAST) Programmes, Gauteng has exceeded its target of testing 1.8million people to reach over 3 million people tested for HIV. Targeted testing in high HIV transmission areas and among key populations, followed by treatment, helps to improve the productivity of the population and to overcome the HIV and AIDS epidemic.

In December 2017, the Department launched the provincial implementation plan of the national strategy against HIV, AIDS, TB and STIs. There needs to be still-greater focus on vulnerable young people, and especially young women, and on high-risk populations groups such as the LGBTI community, sex workers and people in mining areas and in- mates at correctional facilities. The Department is committed to providing targeted HIV prevention Programmes such as Dreams and She Conquers, which form an important part of the provincial Girl 4.1 OVERVIEW OF THE DEPARTMENT’s NON- Child Programme. FINANCIAL RESULTS The Department continues to work to improve The Department’s work throughout the 2017/2018 the quality of its services. Seventy-fi ve percent of fi nancial year was centred around improving patient Gauteng’s health facilities (281 out of 372) have care and strengthening systems for improved ideal clinic status, the highest percentage among all 10 service delivery. During the year, there were over of the provinces. Ongoing work to improve patients’ 21 million patient visits at the Department’s clinics experience of care includes efforts to reduce waiting and community healthcare centres, with over 5 time, ensure availability of medicines , reduce staff million people making use of hospitals’ Out-Patients absenteeism and improve the management and Departments (OPDs). Services were also provided to governance of the health system. school children and households as the Department continued to respond to the increasing demand To improve data integrity and business processes of resulting from rapid urbanisation, the high burden the Department, the Executive Council approved the of disease, the success of the roll-out of the Anti- developed Gauteng e-health enterprise architecture. Retroviral (ART) Programme and the decreasing The Department continues to invest in state of the number of people with private medical aid. art medical equipment, including a Positron Emission Tomography (PET) scanner at Dr George Mukhari Despite these diffi culties, the Department has a Academic Hospital, a cyclotron scanner at Steve Biko number of achievements to its credit. According to Academic Hospital and other scanners, to the value the latest national Saving Mothers Report, since the of R36 million, at other tertiary and regional health peak in 2009, there has been a steady decline in the facilities. number and mortality ratios of institutional maternal deaths; and since 2011 there has been a decrease To strengthen partnerships with the private sector of almost 47% in the number of deaths from non- and to recognise the part played by various role- pregnancy related infections (mainly related to HIV). players in health care service delivery, during the year This decline can be attributed to the success of the the Department engaged with academic institutions, Antiretroviral Treatment Programme. private sector and civil society groups in the Gauteng Health Research and Innovation conference, With the continued implementation of the Prevention the Maternal Health Summit and commenced a of Mother To Child Transmission of HIV (PMTCT) relationship towards creating a health observatory Programme, fewer than 0.99% of babies tested HIV to track population health and provide access to positive compared with 1,7% in the previous year. research outputs. The purpose of all these initiatives The goal of zero infection in babies is gradually being is to enable evidence-based policy making and timely realised. decisionmaking within the health sector. The Department’s clinics and hospitals are the largest counselling support was provided by psychologist training platform in the country, enabling health care and psychiatrist employed in the GDOH and the professionals to train and work under the supervision Department of Social Development. of leading medical professionals. Annually, medical internship Programmes are provided to over 300 Lastly, in order to help reform mental health young people, along with 785 community service programme service delivery, the Department has posts, which are for both statutory appointments since developed a recovery plan focusing specifi cally and regulated by the Health Professions Councils of on mental health , established decentralised mental South Africa. health governance structures per district and involved all key stakeholders in the delivery of mental health During the year, the Department was involved with care. the Mental Health Summit and observed Mental Health Promotion Month. Management instability and capacity remained a challenge, with resignations of eight senior Ongoing challenges facing the Department included managers. In consultation with the Minister of accumulated accruals and large fi nancial liabilities Health and the Premier, an Intervention Task Team while demand for services and the disease burden to strengthen management capacity, systems and remained high. This required the establishment of controls and immensely contributing to the recovery an Executive Sub-Committee on Health Finances journey of the department. Additional support was consisting of the MECs of Finance, Health, Human provided through the establishment of patient safety Settlements and Cooperative Governance and structures, including streamlining the Department’s Traditional Affairs. Budget adjustments improved that governance and management structures. situation slightly, but it remained grave. This is partly due to the liabilities arising from the Life Esidimeni 4.2 OVERVIEW OF THE DEPARTMENT’S project. The Offi ce of the Premier has disclosed an FINANCIAL RESULTS amount of R1.6 billion for potential claims related Departmental Receipts to this. The Department was also involved with the arbitration process relating to Life Esidimeni, aimed Revenue collected during the 2017/2018 fi nancial at bringing healing and closure to a process painful year amount to R546 million or 114% of the 11 to patients, their families and the country as a whole. revenue target, the largest amount collected by the Department over the past three years. The amount Notwithstanding the good efforts of the Health collected is made up of patient fees (R503 million: Department in implementing policies on health, 92% of the total) and other revenue (R43 million: there are still reminders that responsiveness of the 8% of the total). Measures implemented by the health care system still need to be improved for Department resulted in increased revenue collection mental health patients. A case in point being the of R11 million compared with the same period in the recent loss of lives through Life Esidimeni which previous fi nancial year. The increase is attributed to represent just one example of the urgent need to factors which include: accelerate health reforms in order to minimise and • Increased revenue collection from Road Accident prevent any negative consequences on populations Fund, self-paying patients, North West Province, served. Mpumalanga Province and the Compensation In light of the Arbitration agreement, the department Fund. was ordered to pay claimants in lump sum not later • Improved efforts by the Department to collect all than 3 months from the date of the publication of money owed by debtors and funders. the Award, which the department complied with. In • Development and implementation of own addition, to providing funding, counselling needs and revenue enhancement strategy (10-point plan). Table: Breakdown of revenue collected per source

Departmental receipts 2017/18 2016/17 Estimate Actual (Over)/ Estimate Actual (Over)/ Amount Under Amount Under Collected Collection Collected Collection R’000 R’000 R’000 R’000 R’000 R’000 Sale of goods and services 449 821 503 424 53 603 555 742 496 653 59 096 other than capital assets Transfers received - - - - 3 045 -3 045 Sales of capital assets - - - 0 0 Interest, dividends and rent 1 344 974 368 1 280 1 749 -469 on land Financial transactions in 29 427 42 470 -13 051 28 025 36 814 -8 793 assets and liabilities Total 480 647 546 916 -66 270 585 100 538 296 46 804

Tariff Policy 1994, 1 July 1994). • Free primary health care services (Notice 1514 of Patient Fee Tariff 1996, 17 October 1996). The Department charges according to the Uniform • Termination of pregnancy (Act 92 of 1996). Patient Fee Schedule (UPFS) tariffs for patients • Social Pensioners (Act 81 of 1967 as amended by using public hospitals. These tariffs are determined Act 100 of 1998). by a steering committee consisting of the National • Medico-legal service for survivors of rape, assault Departments of Health and the nine provinces. Tariffs and post-mortem (Criminal procedure Act 51 of are reviewed and revised annually in accordance with 1977). Section 7.3.1 of the Treasury Regulations. • Donors (Human Tissue Act 63 of 1965). • Children who are committed to the care of 12 Patients accessing public institutions are classifi ed a children’s home, industrial school or foster into three main groups for the purposes of service fee parents (Child Care Act 74 of 1983, Section 15). determination. The classifi cations are listed below: • Persons with mental disorders (Mental Health Act 18 of 1973). Full Paying • Treatment of infectious, formidable and/or This category of patients is liable to pay full UPFS fees notifi able diseases (National Health Act 61 of for all services provided. 2003). • Services to the formally unemployed Subsidised and Exempted Patients (Unemployment Insurance Act 63 of 2001). • Patients receiving HIV and AIDS treatment (Notice These patients are categorised into six categories 1 of August 2006). (PH, PG, HG, H0, H1, H2 and H3) based on statutory requirements. The PG and HG categories are Meals and Crèche Fees Tariffs exempted from paying fees because of circumstances which are provided for statutorily: for example, The tariffs for meals and crèches are reviewed and pregnant women and children under the age of six. revised annually in accordance with Section 7.3.1 of the Treasury Regulations. Tariffs adjustments are The H0 category receives services free of charge only also negotiated and agreed upon with employee when they provide proof of status: for example, organisations. social pensioners. The H1, H2 and H3 category pay discounted fees which are expressed as a percentage Other Tariffs of the fees payable by full paying patients. Other tariffs such as parking and accommodation Free Services are determined externally involving relevant departments. The following free services are provided in line with national and provincial policies: The Department engages continuously with the other departments, medical schemes and other provinces • Free health services for pregnant women and on the settlement of outstanding claims for patients children under the age of six (Notice 657 of referred to Gauteng’s hospitals. Table: Patient Fees Debt Bad debt is written off in accordance with the Department’s policy and after the Department has Hospitals Bad Debts Written off taken all reasonable steps to collect the debt owed. R’000 The following are some of the debt categories Central Hospitals 326,590 written off. Regional Hospitals 59,398 • Uneconomical debts: where the cost of recovery Tertiary Hospitals 23,660 of the debt is more than the debt • Undue hardship: where the recovery of the debt District Hospitals 34,891 will result in undue hardship Dental Hospitals 1,383 • Prescribed debts: debts that prescribed as a Tuberculosis Hospitals 121 result of the Department not being able to make Psychiatric Hospitals 374 contact with the debtors Other specialised Hospitals 48 • Amounts less than R195 Total R446 684

Table: Programme expenditure

2016/2017 2017/2018 Programme Name Final Actual (Over)/ Final Actual (Over)/Under Appropriation Expenditure Under Appropriation Expenditure Expenditure Expenditure

R’000 R’000 R’000 R’000 R’000 R’000 Administration 851 940 851 488 452 1 085 267 1 085 177 90 District Health Services 11 995 850 11 992 093 3 757 13 712 101 13 683 513 28 588 Emergency Medical 1 102 221 1 010 469 91 752 1 268 154 1 219 274 48 880 Services Provincial Hospital 6 953 066 6 952 127 939 7 892 663 7 892 277 386 13 Services Central and Tertiary 13 389 397 13 387 424 1 973 15 333 041 15 316 687 16 354 Hospitals Health Sciences and 1 054 124 1 054 063 61 928 471 918 987 9 484 Training Health Care Support 258 529 248 492 10 037 289 838 289 767 71 Services Health Facilities 2 051 730 1 943 911 107 819 1 683 299 1 607 777 75 522 Management Total 37 656 857 37 440 067 216 790 42 192 834 42 013 459 179 375

The table above summarises the budget versus actual 4.3 VIREMENT/ROLL OVERS expenditure as at 31 March 2018. The Department To alleviate the effects of excess expenditure spent 99.6% of its budget in the reporting year. The on standard items within Programmes and sub- reasons for underspending of R179 375 000 were: Programmes, year-end application for shifting and • R76.9 million of the Conditional Grants could not virement was made to the Provincial Treasury. The be spent. The underspending occurred within the application was guided by Section 43 of the Public Hospital Facility Revitalisation, Health Professions Finance Management Act (PFMA) and Treasury Training and Development, National Tertiary regulation. The shifting and virement was made to Services , EPWP Social Sector Incentive and EPWP the compensation of employees, goods and services, Integrated grants. transfers and subsidies and payment for capital • Overspending of R80 thousand occurred within assets economic classifi cations. Comprehensive HIV/AIDS TB and in addition; • There was underspending of R102 million within The following divisions were mainly affected: the voted funds. • Administration • District Health Services • Emergency Medical Services • Provincial Hospital Services started and a tender process is under way to rectify • Central Hospital Services the irregular way in which the Department has been • Health Sciences and Training procuring these goods. • Health Care Support Services The Head of Department approved the shifting and 4.6 GIFTS AND DONATIONS IN KIND recommended the application, which was approved RECEIVED FROM NON-RELATED PARTIES by the Provincial Treasury. The virement approved During the year under review, the Department were for District Health Services, Emergency Medical received in kind donations of assets and cash to the Services, Central Hospital Services, Health Sciences value of R12 million. The in-kind donations ranged and Training Programmes as well as Health Care from medical equipment, printers, computers, Support Services to compensate for the overspending laptops and laminators, television sets, projectors on Administration and Provincial Hospital Services. A and wound care products. roll-over request was made to the Provincial Treasury and National Department of Health on commitments The donations assists the Department with service made but budget not spend within the Hospital delivery by providing assets which it is currently Revitalisation grant, Health Professions Training and unable to purchase because of budget constraints. Development. 4.7 EXEMPTIONS AND DEVIATIONS 4.4 SUPPLY CHAIN MANAGEMENT RECEIVED FROM THE PROVINCIAL TREASURY During the year under review, no unsolicited bid proposals were concluded. Management has The Department reported to the Provincial Treasury implemented control measures to ensure compliance eleven deviations from procurement procedures with Treasury Regulations and Instruction Notes above R500 000. relating to deviations from normal procurement processes. The Department will ensure compliance 4.8 ACKNOWLEDGEMENTS AND with the applicable legislation that regulates APPRECIATION deviations. During the 2017/18 fi nancial year, SCM The Department wishes to thank offi cials and 14 accomplished the following achievements: management including implementing partners for their commitment to improving healthcare delivery The Department exceeded the preference in Gauteng. procurement spend targets in the following categories: 4.9 APPROVAL

• BBBEE contribution: the target was 80% and the The Annual Financial Statements set out on pages Department achieved 84.92%. 143 to 280 have been approved by the Accounting • Youth contribution target: the target was 10% Offi cer. and the Department achieved 10.32%. To reduce monthly G Fleet expenditure, the Department reduced the number of GG vehicles under the permanent hire scheme from 72 to 57. Commitments for the 2016/17 fi nancial year and older were reduced from R1.1 billion as at 31 March 2017 to R96 million as at 31 March 2018. The Department went live with the SAP Inventory Management Pilot Project in the kitchen and grocery ______store at Steve Biko Academic Hospital on 26 February Prof M. Lukhele 2018. Acting Accounting Offi cer 4.5 IRREGULAR EXPENDITURE Gauteng Department of Health The Department incurred irregular expenditure of 31 March 2018 R1, 7 billion in the current year. Security contracts accounted for R679 million of this amount, primarily due to the month-to-month arrangement in place while the in-sourcing feasibility study was being carried out. Consignment stock accounted for another R469 million; cataloguing of products has 5. STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF THE ACCURACY OF THE ANNUAL REPORT

To the best of my knowledge and belief, I confi rm the Annual Financial Statements. the following: External auditors were engaged to express an All information and amounts disclosed throughout independent opinion on the Annual Financial the Annual Report are consistent. The Annual Report Statements. is complete, accurate and free from any omissions and has been prepared in accordance with the In my opinion, the Annual Report fairly refl ects guidelines on Annual Reports as issued by National the operations, performance information, human Treasury. resources information and fi nancial affairs of the Department for the fi nancial year ended 31 March The Annual Financial Statements (Part E) have been 2018. prepared in accordance with the modifi ed cash standard and the relevant frameworks and guidelines Yours faithfully issued by National Treasury.

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

The Accounting Offi cer 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 Prof. M. Lukhele Acting Accounting Offi cer Gauteng Department of Health 15 31 March 2018 6. STRATEGIC OVERVIEW Vision Accountability: We take ownership of our responsibilities and go above and beyond and expect Daily, we provide high-quality, effi cient and accessible our colleagues to do the same to achieve the best healthcare to transform people’s lives. outcome for our patients.

Mission Transparency: We make decisions based on facts and are willing to explain them to those affected by To create an effective public healthcare system in those decisions. Gauteng by ensuring we have the right people, skills, systems and equipment to provide the care our Effi ciency: We work effi ciently to optimise the patients need to live healthy, good-quality lives. scarce resources to achieve more with less. We know that budgets are tight and human resources are few. Values Provincial values: We are passionate and contribute Patient focused: Everything we do should benefi t to patriotism, integrity, purposefulness, accountability the patient. and activism.

16 7. ORGANISATIONAL STRUCTURE

MEC: GAUTENG

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

The table below gives information about the MSD.

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

9. LEGISLATIVE AND OTHER MANDATES

The Department derives its mandate from the South • Provide integrated services and Programmes that African Constitution, the National Health Act and promote and protect health other legislation promulgated by Parliament. • Assist with ensuring good quality and sustainable livelihoods for the poor, vulnerable and The Department’s core mandate is to: marginalised groups in society. • Improve the health status of the population 18 • Improve health services • Secure better value for money • Ensure effective organisation PART B: PERFORMANCE INFORMATION

19 1. PERFORMANCE INFORMATION 1.1 Auditor-General’s Report: is included in the report to management, with Predetermined Objectives material fi ndings reported under the Predetermined Objectives section of the report dealing with the legal The Auditor-General of South Africa (AGSA) and regulatory requirements section of the Auditor performs certain audit procedures on departments’ General’s report. performance information to provide reasonable assurance in the form of an audit conclusion. The audit Refer to page 144 of the Report of the Auditor- conclusion in relation to predetermined objectives General, published as Part E: Financial Information.

20 2. OVERVIEW OF DEPARTMENTAL PERFORMANCE 2.1 Service Delivery Environment in were referred during household visits to health 2017/18 facilities, social workers and home based care facilities. In addition, 33 434 learners were referred The Department had an estimated 26 608 243 for speech, oral health, eye care, hearing problems patient visits and headcounts at its OPD and PHC and suspected TB. service platforms. Its hospitals had 5 476 579 patients at their outpatient departments and The table below shows some of the screening attended to 905 201 patients presenting in their services provided to learners and the growth in emergency departments. Patient headcounts were coverage of these services. Except for deworming 21 131 664 patient visits at clinics and community doses and referrals for hearing problems, where healthcare centres. 223 761 learners were attended improvements were noted, the volumes for a range to through school health services and 2 3042 734 of services decreased during the year under review were reached through household outreach. Of those compared with the previous year. Through the headcounts seen at PHC level, 8o% were patients 5 same platform, immunisation services to prevent years of age and older and 20% (3 623 737) were diphtheria and tetanus are provided to pupils. Oral below that age. health services are provided, with pupils’ teeth scaled by oral hygienists and fi ssure sealants placed on the Access to health care services was improved through molars of primary school going children to prevent the Department’s Ward Based Outreach Teams tooth decay. (WBOTs) Programme through which 49 569 clients

Type of service 2017/18 2016/17 Growth in coverage of services Number Percent School learners given deworming doses 12530 10008 2522 25.2% School learners immunised 2984 8646 (5662) -65.5% School learners referred for eye care 9244 10533 (1289) -12.2% School learners referred for hearing problems 2069 3222 (1153) -35.8% 21 School learners referred for oral health care 21411 27456 (6045) -22.0% School learners referred for speech problems 292 268 24 9.0% Tetanus and diphtheria dose at 12 years 27199 28620 (1421) -5.0% Tetanus and diphtheria dose at 6 years 27861 32928 (5067) -15.4%

Access to affordable essential medicines is a vital To support, facilitate and develop allied, component of an effi cient health care system. To rehabilitation, therapeutic, radiography and clinical demonstrate its commitment to improving access technology, services are provided at all health to medicines, the Department runs a Centralized establishments in accordance with the provincial Chronic Medicine Dispensing and Distribution and national prescripts and statutory requirements (CCMDD) Programme for stable patients on chronic of each professional body. Strategic objectives of medicines. The Programme has private pick-up sub-programmes promote health and wellbeing, points as well as at the Department’s PHC facilities. prevent disability, restore integration and uphold During 2017/18, 410 070 patients were enrolled on the rights of vulnerable groups. There is a strong the CCMDD Programme. focus on stakeholder management and liaison with other government departments, NGOs, community- The Department provided hospital services for an based organisations, faith-based organisations and estimated 1 856 067 patients at the out-patient advocacy groups. departments (OPDs) of specialised, district and regional hospitals, an increase of 68 012 (3.8 percent) During the reporting period, the rehabilitation services from 1 788 055 in 2016/17. At the OPDs of tertiary component issued 67 892 assistive devices, with an and central hospitals, there were 3 620 512 patient overall assistive devices issue rate of 92%. The table visits during the year, an increase of 198 681 (5.8%) below shows the devices issued and requested, and from 3 421 831 of the previous year. the issue rate for the reporting period. Number issued Requested Issue rate Device 2017/18 2016/17 2017/18 2016/17 2017/18 2016/17 Hearing aid 5108 4598 7975 7382 64.1% 62% Orthosis 22587 20420 23763 21721 95.1% 94% Podiatry 1854 1731 2255 2119 82.2% 82% Prostheses 668 584 1567 1453 42.6% 40% Walking aids 33572 30873 33572 30873 100% 100% Wheelchairs 4103 3739 4228 3862 97% 97% Total 67892 61945 73360 67318 92% 92%

Except for walking aids and wheelchairs, the numbers under review, 200 139 children were immunised. The of several of the assistive devices issued relative immunisation rate was constantly maintained above to the numbers requested was larger during the 75% on a quarterly basis. year compared with the previous reporting period. Devices are reported separately to ensure targeted Substantial progress was made in screening for interventions for devices where there are challenges, diabetes and hypertension. During the year under such as in the case of hearing aids and prosthesis. review, 3 260 298 patients were screened for diabetes and 3 518 520 patients aged 40 and Signifi cant progress was made in screening for older were screened for hypertension. Despite the cervical cancer among women aged 30 years and progress made, more needs to be done to reduce the older, with an estimated 162 359 women screened, high incidence and high proportion of clients with an increase of 149 865 from 12 494 in 2016/17. uncontrolled hypertension. A total of 157 582 pregnant women attended antenatal care before 20 weeks of gestation. The Department provides preventative and curative services to HIV and TB infected patients. During All fi xed PHC facilities implement Integrated the year under review, 3 083 921 out of planned Management of Child Illnesses, an approach 2 498 007 patients were tested for HIV. To bolster 22 advocated by the World Health Organisation prevention efforts, 190 349 748 out of 200 million (WHO) for early detection and effective treatment male condoms and 7 289 873 out of 7.7 million of common health problems among pre-school female condoms were distributed. children. Vaccine-preventable related deaths among children under 5 years for disease conditions such as 2.2 Service Delivery Improvement Plan diarrhoea and pneumonia were low. The Department has completed a Service Delivery Immunisation services are provided by all clinics Improvement Plan. The tables below highlight the and some hospitals in the province. During the year nature of the plan and its achievements to date. Table 2.2.1: Main services and standards

Main services Benefi ciaries Current/actual Desired standard of Actual achievement standard of service service Pharmaceutical Patients who rely on 268 974 enrolments Medicine delivered At the end of Quarter Services public health services to 270 000 stable 4, the cumulative for their acute and patients at pick-up number of patients chronic medicine points close to their enrolled on the supply, their families, residences Programme was 410 medical personnel, 075. communities, district and hospital health services management Improve access to Mothers and new- 45 obstetric 45 obstetric 45 obstetric obstetric ambulances born babies ambulances and ambulances and ambulances and 128 combined 328 combined 292 combined obstetric/Intermediate obstetric/Intermediate obstetric/Intermediate Life Support (ILS) Life Support (ILS) Life Support (ILS) ambulances ambulances ambulances 50% Intermediate 25% Emergency Care 7.5% Emergency Life Support (ILS) care Technician (ECT) Care Technician (ECT) 50% Basic Life 50% Intermediate 11% Intermediate Support (BLS) care Life Support (ILS) care Life Support (ILS) care 25% Basic Life 79% Basic Life Support (BLS) care Support (BLS) care

Table 2.2.2: Batho Pele arrangements with benefi ciaries Current/actual arrangements Desired arrangements Actual achievements Pharmaceutical Services Professional standard (if applicable) Services provided by the service Services provided by professionals provider (Pharmacy Direct), the private registered with a professional body pick-up points and at the PHC facilities in accordance with their scope of are all provided by professionals practice registered with professional bodies and in accordance with their scope of practice. Pharmaceutical Services Legal standard (if applicable) The SOPs have been fi nalised. Chronic dispensing SOPS available Pharmaceutical Services Consultation 24 meetings held with various Consultation with stakeholders stakeholders in all districts to discuss the progress of the Programme Pharmaceutical Services Access The pick-up points include: community pharmacies, NGOs, private Total of 209 pick-up points for doctors, adherence clubs and PHCs. chronic medicines are registered Pharmaceutical Services Courtesy SMS sent to all 410 075 patient notifying them of their pick-up dates Patients are sent SMS notifi cations reminding them of their pick-up dates 2 days before collection Pharmaceutical Services Service standard Average of 98.3% medicine availability of vital and essential Current EML availability is at 84% medicines Pharmaceutical Services Value for Money This is a free service to the patient. Free service Patients can decide at which pick- up points they will collect chronic Patients will not have to travel long medication closest to their home or distance place of work. Emergency Medical Services Human Resources No project manager has been appointed specifi cally for this project The ratio of pharmacists to pharmacist to date. 23 assistants must not exceed 1:3 Courtesy: Obstetric calls answered 100% of obstetric calls answered 100% target maintained. within 30 seconds within 30 seconds Access: Priority 1 (one) response time Priority 1 (one) response time by P1 response time for obstetric services on obstetric emergencies within 30 obstetric ambulances within 30 was 97.6% for the year under review. minutes minutes improved to 99%. The P1 obstetric response time is very close to the target. Consultation Frequent consultations with Consultations take place monthly with stakeholders on obstetric ambulances District management teams, in the to discuss obstetric related form of referral meetings, and Cluster emergencies and related problems. meetings.

Table 2.2.3: Service delivery information tool

Current/actual information tool Desired information tool Actual achievements

Pharmaceutical Services Information is being provided to Posters and pamphlets for the patients in 1 offi cial language CCMDD Tshwane project already available in English, Afrikaans, isiZulu and Setswana. Information: Public Information EMS to conduct 20 PIER campaigns in EMS has formed a partnership with Education and relations (PIER) all districts and expand information to the Department of Co-Operative campaigns on EMS conducted per communities and schools. Governance and Traditional Affairs fi nancial year (COGTA) and rolled out 20 PIER campaigns. Training of Community First Aid Responders and Little Hero training in communities has been expanded. Information has also been posted on social media including Twitter, Facebook and Instagram.

Table 2.2.4: Complaints mechanism Current/actual complaints Desired complaints mechanism Actual achievements mechanism Pharmaceutical Services Redress 35 425 queries/complaints/ Consistent timeous delivery of information sharing received at the medicines Pharmacy Direct call centre and resolved within 48 hours EMS complaints acknowledged within 100% EMS complaints acknowledged 100% EMS complaints are 3-7 working days. within 3-7 working days. acknowledged within 3-7 working days. Resolving complaints within 25 95% complaints resolved within 25 95% complaints are resolved within working days from the day complaint working days from the day complaint 25 working days from the day received received. complaint received.

2.3 Organisational environment 3. The fi nancial branch was strengthened through the appointment of a Chief Financial The 2017/18 fi nancial year was diffi cult. It started Offi cer although it lost the experienced Senior with the hugely negative impact of the Ombudsman’s Management Chief Director: Budget and damning reporting on the Life Esidimeni tragedy, Revenue Unit. as a result of which almost 140 patients died. The provincial government acted with speed through 4. A sub-committee of the Provincial Executive the appointment of the MEC, Dr Ramokgopa and Council, headed by the MECs of Finance, Health the Acting HOD, Dr Kenoshi to lead the stabilisation and COGTA, was appointed to oversee the of the health department. The mission of the new ITT initiatives especially in respect of Accruals, Executive and senior management was to speedily Medico-legal litigation and critical matters of turn the situation around and ensure reputational personnel over-expenditure. A post-fi lling plan recovery for the Department. sub-committee has been established to manage recruitment for and fi lling of critical posts. 24 Initiatives undertaken during the year were as follows: 5. The Department continued to utilise SAICA partners to ensure that the target of a clean audit 1. Intervention Task Team (ITT) was appointed is achieved. Coaching and OD work is supported in November/December2017 to support the by the HRH partners IPM and SABPP. process of overhauling and transforming the governance and management systems to The Department revised the APP 2017/18 to factor in become more reactive, effi cient and effective. A the priorities of the new administration in its attempt defi nitive report, with an action plan to stabilise to restore its reputation. management and fi nancial systems, was tabled 2.4 Key Policy Developments and and adopted by EXCO for implementation. Legislative Changes

2. The Acting HOD, Dr Kenoshi, retired at the end During the year under review, there were no of February 2018 and Prof. Lukhele, the ITT Co- legislative changes relating to the Department. ordinator, was appointed as Acting HOD pending the appointment of a full-time HOD. 3. STRATEGIC OUTCOME-ORIENTED GOALS

Strategic goals of the Department: Goals of the National Negotiated Service • Improved health and wellbeing with an emphasis Delivery Agreement of the National Department on vulnerable groups of Health • Reduce the rate of new HIV infections by 50% in • Increase life expectancy. youth, adults and babies in Gauteng, and reduce • Decrease maternal and child mortality. deaths from TB and AIDS by 20% • Combat HIV and AIDS and decrease the burden • Increased effi ciency of service implementation of disease from TB. • Human capital management and development • Improve health system effectiveness. for better health outcomes • Organisational excellence Progress towards achievement of the 5-year targets, 2016/17-2018/19

GOALS INDICATOR GAUTENG BASELINE GAUTENG ACTUAL PERFORMANCE 2016/17 PERFORMANCE 2017/18 Improved health and well- Under-5 mortality rate 6.7 - in facility 6.9 being of all citizens, with (U5MR) per 1000 live births an emphasis on children and women Infant overall mortality rate 9.7 - in facility 10.1 (per 1000 live births) Maternal mortality rate 114.7/100 000 108.5 (overall per 100 000) Neonatal mortality rate (<28 13.6 - in facility 13.6 days) (per 1000 live births) Reduced rate of new Mother-to-child 1.7% 0.99% infections and burden of transmission rate of HIV <2 HIV & AIDS and TB months of age 25 Proportion of eligible HIV 94.8% 94.7% positive pregnant women initiated on ART1 Number of patients (adults 559 363 927 825 and children) on ART Medical male circumcisions 112 994 112 608 Proportion of TB treatment 87.5% 87.5% successes among all TB cases TB defaulter rate at the end 5.10% 5.2% of TB treatment among all TB cases Percentage of HIV-TB co- 67% 90.3% infected patients on ART on completion of TB treatment Percentage of diagnosed 45% 90% MDR-TB patients enrolled in a TB treatment Programme Increased equal and timely PHC utilisation rate 1.8 1.5 visits per person per access to effi cient and year quality health care services, thereby preparing for roll- out of NHI

1 Currently refl ected as ANC clients initiated on ART rate 4. PERFORMANCE INFORMATION BY PROGRAMME Programme 1: Administration

Purpose of the Programme such as screening for diabetes, high blood pressure, cholesterol, HIV/AIDS, breast and cervical cancer The purpose of this Programme is to provide strategic screening and dental screening during the Youth direction and leadership, guide and support the Month and August Service Delivery Expos organised development of policy frameworks and guidelines by the Offi ce of the Premier. for priority Programmes, develop policies and legislation on healthcare provision and ensure that There was a decline in employement of people norms and standards are followed in the course of with disabilities during the year under review due implementation. to natural attrition. These efforts were also affected by the growth in the staff establishment as the List of sub-Programmes larger the total staff establishment, the larger the number of people with disabilities the Department • Human Resource Management needs to recruit. Furthermore, few people with • Quality Assurance disabilities have qualifi cations in the Health Sciences, • Information and Communications Technology. particularly medicine and nursing. The Department Strategic objectives has few vacancies in the Administration and Support components where people with disabilities could The following strategic objectives are relevant for be placed. Efforts to prioritise such individuals Programme 1: will continue and will include sourcing CVs from organisations working with people with disabilities • Improved client satisfaction rates. and creating a database of CVs through which ten • Improved achievement against national norms people with disabilities were recruited during the for health professionals. year under review. • Employment equity and diversity management. Efforts to improve the experience of health care Signifi cant achievements, and strategies to 26 by persons with disabilities included infrastructure address areas of underperformance developments at health facilities to ensure that they Human Resource Management can accommodate these people. Road shows and advocacy workshops were conducted in three health Employment Equity districts and at fi ve hospitals to sensitise staff to treat their colleagues with disabilities with the dignity and Progress towards achieving employment equity was respect they deserve. hampered by resignations of senior female employees who left for employment opportunities elsewhere. Quality Assurance

Gender and Disability Mainstreaming National Core Standards Six Priority Areas

The Department commemorates the DPSA Women Self-assessment results relating to the Six Priority Management Week annually in August. During Areas of the National Core Standards indicate the the year under review, 33 women at SMS levels average of overall performance improvements across participated in a Women Management Seminar the different hospital levels. Except for infection where eight principles of gender mainstreaming prevention and control, all priority areas improved and the progress achieved by the Department during the year under review. were presented and discussed. The Department also provided a range of health promotion services Table: Overview of Improvements in the National Core Standards Performance

Hospitals 2014/15 2015/16 2016/17 2017/18 Central 76% 84% 83% 88% Tertiary 69% 76% 78% 86% Regional 69% 74% 81% 85% District 72% 72% 75% 80% Six Priority Areas 2014/15 2015/16 2016/17 2017/18 Availability of Medicines 77% 80% 83% 89% Cleanliness 64% 73% 73% 79% Patient Safety 70% 75% 81% 83% Infection Prevention and Control 69% 76% 85% 84% Positive and Caring Attitude 73% 76% 83% 87% Waiting Times 76% 82% 86% 87%

During the year under review, the Department performance level in the 2018/2019 fi nancial year. received 8 186 complaints from health care users. Queue management will be upgraded through the 6 893 (84%) came from health facilities, 959 were introduction of electronic ticket issuing devices. referred through the Premier’s Offi ce and 334 came from other sources such as the MEC for Health, from Information and Communications walk-in clients, the National Department of Health, Technology the Offi ce of Health Standards Compliance (OHSC) and the Public Protector. Of the complaints received For the fi nancial year 2017/18, the Department 7 129 were resolved, 6948 within 25 working days. set targets for deploying the Picture Archive and Communication System (PACS) to 54% of hospitals Reduction of waiting times at the as well as to digitised patient fi les across 32% of Department’s facilities facilities. At 95% achieved, the deviation from the 27 The aim of the project is to reduce excessive waiting PACS target was marginal. However, Patient File times as perceived by clients and as compared with Digitisation was largely unachieved because of a set benchmarks at Gauteng Department of Health change in the implementation approach. facilities. Patient waiting time is defi ned as “the time that the patient spends waiting for service/s in a The deployment of broadband connectivity to facility” per visit and is calculated from the time the all 37 hospitals was successfully completed. The patient enters a facility (taking into consideration its Department also rolled out the National Health offi cial opening time) to the time he or she leaves. Patient Registration System (HPRS) to 68% of primary healthcare facilities. Managers are focusing on solutions to reduce lengthy patient waiting times. Guidelines on measuring and The key areas of focus in the 2018/19 fi nancial year monitoring waiting times and demand side policies, will be on ensuring the deployment of broadband including clinical prioritisation of patients, are connectivity across all primary healthcare facilities; vigorously pursued. ensuring the implementation of electronic health records; Health Information System implementation, Provincial benchmarks for waiting times will be and further expansion of PACS across all facilities. reviewed for all healthcare facilities to refl ect an ideal Programme1: Administration Strategic Actual Planned target Actual Deviation Comment on deviation objective achievement 2017/18 achievement from planned 2016/17 2017/18 target for 2017/18 (over/ (under)) Implement eHealth and m-Health solutions in 37 hospitals Number of 13 202 19 (1) 19 of the 20 targeted hospitals with hospitals implementing functional PACS PACS. One hospital could solutions not implement due to delays in bid adjudication processes. To strengthen effectiveness of PACS. Number of # 12 7 (5) Seven of the target hospitals with of 12 hospitals have scanned patient scanned patient records. records There was a change in the implementation approach, and the lack of achievement will be corrected in the 2018/19 fi nancial year through use of an approved E-Health architecture.

Increase revenue collection from qualifying paying patients from R527.709 million in 2013/14 to >530 million in 2019/20 Rand value of R538,299,000 R451 mil R535 mil R84 mil over The Department has over- revenue collected collection collected by 18.6% due to increased payments from the Road Accident Fund, self-paying patients and 28 North West Province Receive unqualifi ed audit opinion from Auditor-General by 2016/17 and a clean audit by 2019/20 Percentage of # 100% 29% (71%) Cash fl ow challenges are service providers still affecting payment of paid within 30 suppliers. The Department days has started to engage with various suppliers and prioritised SMMEs, followed by large companies. Increase diversity, verifi cation of qualifi cations and equity of our workforce thus increasing women in senior management positions from adequate (41%) to good (50%) by 2019/20 and increasing the percentage of people with disabilities employed to 2% by 2019/20 Percentage of 46.6% 47% 46.5% (0.5%) Growth in the % of women in senior (54/116) (55/117) (53/114) women at SMS has been management affected by resignations posts (117 senior and natural attrition. managers) To continue to prioritise female candidates.

Percentage of 0.5% 1.8% 0.5% (1.3%) The number of persons people with (349/68 771) 350/65517 (336/67499) with disabilities decreased disabilities due to attrition. Efforts to employed address this gap include a circular sent to all health institutions which encourages employees who have not declared their disability status to do so. Percentage of # 100% 100% 0% Target achieved newly appointed clinical staff members with verifi ed qualifi cations

2 Denominator removed under target column for consistency Programme1: Administration Strategic Actual Planned target Actual Deviation Comment on deviation objective achievement 2017/18 achievement from planned 2016/17 2017/18 target for 2017/18 (over/ (under)) Percentage of # 100% 323.2% (76.8%) Budget constraints affected newly appointed the ability to achieve the non-clinical target staff members with verifi ed qualifi cations Enforce performance management of Senior Management Services (SMS) thus increasing SMS signed contracts within stipulated timeframes to 100% by 2019/20 Percentage of # 100% 100% 0% Target achieved SMS members (117/117) (117/117) entering into Performance Management Agreements within stipulated time Improve workplace relations between employer and employees thus resolving grievances within 30 working days Percentage of 77% 100% 90%4 (10%) The pending grievances grievance cases were received towards end resolved within of the March 2018. They 30 days are therefore still within the 30-day period. Receive unqualifi ed audit opinion from Auditor- General by 2017/185 and clean audit by 2019/2020 Audit opinion Unqualifi ed Unqualifi ed Unqualifi ed nun To be confi rmed at the end from Auditor- of the audit process 29 General Improve effi cient and effective functioning and performance of hospitals and clinics, hospital boards and clinic committees to be 100% staffed by 2019/20 Percentage of # 100%6 77% (23%) Target was not met due hospitals with to an inability to retain functional members. There are many hospital boards instances of absconding and resignations by board members. To replace vacated posts on a continuous basis. Percentage of # 100% 76% (279/369) (24%) 115/279 clinics do not Primary Health (369/369) have a full complement of Care (PHC) clinic committee structures. facilities with Contributory factors functional clinic include lack of stipends for committees clinic committee members. To fi ll vacated posts on a continuous basis. Increase broadband network access so that 100% of PHC facilities and hospitals have such access and 100% of Total staff have email access by 2019/20 Percentage of 99% 100% (37/37) 100% 0% Target achieved hospitals with broadband access Percentage 30% 62%7 48% (15%) The target could not be of fi xed PHC (230/369) (176/369) (54/369) achieved as the e-Gov facilities with Broadband contract came broadband access to an end. The contract will be renewed in the 2018/19 fi nancial year.

3 Numerator and denominator values removed for consistency with how the target fi gure is shown. 4

5 6 Numerator and denominator removed for consistency on the values of the respective indicator 7 The correct fi gure for the fraction (230/369) is 62%. Expenditure: Programme 1 – Administration

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure

R’000 R’000 R’000 R’000 R’000 R’000 Offi ce of the MEC 20 467 20 796 (329) 20 358 12 349 8 009 Management 831 473 830 693 780 1 064 909 1 072 828 (7 919) 851 940 851 488 452 1 085 267 1 085 177 90

Programme 2: District Health Services Purpose of the Programme capturers, fi ling clerks, cleaners, queue marshals (courtesy offi cers), gardeners and pharmacy assistant The purpose of the Programme is to provide learners. comprehensive PHC services, district hospital services, and comprehensive HIV and AIDS care and to deliver The Department has trained 11 data capturers priority health Programmes including the nutrition in advanced computer skills, 125 participants in Programme. customer care, 250 in personal fi nance and 15 as post-basic pharmacy assistants. The District Health System is the vehicle for the delivery of PHC which encompasses a range of Ideal Clinics realisation and maintenance basic health services and includes health promotion, The following table shows the progress being disease prevention, curative care and rehabilitation. made on the Ideal Clinics realisation project. PHC coupled with equitable access to decent housing, clean water, sanitation, nutrition and education has Districts Number of % of Ideal been shown to have a signifi cant impact on health Ideal Clinics Clinics 30 and health outcomes. Ekurhuleni 93/93 100% List of sub-Programmes Johannesburg 75/112 67% • District health management and PHC services Tshwane 66/73 90% • District hospitals Sedibeng 36/38 94.7% • Maternal, child and women’s health and nutrition West Rand 36/48 75% • HIV and AIDS, STIs and TB • Disease prevention and control Total 306/372 82.2% • Forensic pathology services. The target for the 2017/18 fi nancial year was to ensure that 240/372 clinics reach Ideal Clinic status. Signifi cant Achievements and This was exceeded, with 51 extra clinics reaching this Strategies to address Areas of status. Contributing to these improvements were Underperformance improved procurement of basic medical equipment, installation of water tanks, well equipped pharmacies/ District Health Management and PHC Services medicine storage with essential medicines, improved laboratory services and availability of appropriate Ward Based Outreach Teams (WBOTs) and documents in all functional primary health care units. EPWP A fi ve-year plan, focusing on clinic infrastructure, has During the period under the review, the Department been developed. Six clinics meeting the Ideal Clinic implemented various NHI-related initiatives to prescripts were built or upgraded during the year. strengthen the health system and service delivery The Health Population Registration System (HPRS), to platforms. The number of WBOTs increased from register incoming patients, has been installed in 161 719 to 759, covering the 457 poorest wards. The primary health care facilities. This should improve Department supported the service delivery platforms utilisation of the clinics and data management. through its Expanded Public Works Programme (EPWP), contracting 4 039 participants who were NHI-related innovations in the Tshwane District-NHI placed in health facilities and hospitals as data pilot district by the District Clinical Specialist Team include the production of the Road to Health Booklet Rehabilitation and Therapeutic and unique identifi ers; these are barcodes attached to the Road to Health Booklet, making it possible for Services health care workers to track all current and future Assistive Devices blood-test results in the life of children. The aim is to scale up this system for implementation throughout The Department remains committed to promoting the province and the country. The district also trained health and wellbeing, preventing disability, restoring community health workers in pregnancy testing in integration into communities and upholding the homes to enable early identifi cation of pregnancy rights of vulnerable groups. To achieve this, through and to promote early antenatal care booking. its rehabilitation services it has issued 61 945 assistive devices, with an assistive device issue rate of 92%. Additional service platforms developed in the Johannesburg Health District were the new Clinic accessibility for people with disabilities Noordgesig and Finetown clinics, the latter still under One hundred provincial clinics were assessed construction. In the West Rand, four mobile clinics to determine their accessibility to people with were procured, increasing further the number of disabilities. Surfaces at entrances scored over 50% service platforms for improved access to health care whilst ramps, toilets and signage scored low in all services. districts.

District Hospitals • Three NGOs were funded to augment rehabilitation services: South African Mobility District hospitals are a major component of a district for the Blind Trust (SAMBT), Association for the health system. Key achievements in the provision Physically Disabled (APD) and Quadpara (QP) of services and strengthening of the hospital health Association Gauteng South. system included the establishment of an Innovation • SAMBT’s 19 patients have received orientation Hub at Bertha Gxowa Hospital whilst Carletonville and mobility training and 50 low vision devices Hospital demonstrated the value that can be derived such as canes, and money templates were issued. from partnerships in health care through optometric Most of these projects took place in the last services with OneSight. Forty patients were provided 31 quarter of the year. with eye care services by this partnership, which has • 274 patients with disabilities, and/or their a potential capacity of 100 per week. Following families, were assessed, analysed and assisted by renovations, Kopanong Hospital main pharmacy APD. obtained Grade A certifi cation from the Pharmacy • QP engaged in outreach Programmes to support Council. independent living by patients with spinal cord Effi ciency Measures injuries. • Burden of disease: with the national Department The Bed Utilisation Rate for district hospitals increased of Health, the University of Stellenbosch and the from 64% in 2016/17 to 66.9% in 2017/18. The University of Witwatersrand, the Department average length of stay in these hospitals was 4.4 days established a task team to draw up clinical during the reporting year; the target of 4.5 days was guidelines for managing the rehabilitation of therefore achieved, demonstrating improvements in stroke patients. On average, 300 new stroke hospital effi ciencies. Despite these improvements, cases are seen per month in the province. challenges remain including under-utilisation of step down beds and the disease profi le of communities with a high burden of disease and where patients are admitted for longer than the average required admission periods. The strategies of improving down referral of patients from regional to district hospitals, and referring patients for home-based care where the length of stay exceeds the target, are being utilised to deal with this. Social Work Services Oral Health

To improve knowledge of the Mental Health Act and Various initiatives were implemented to ensure that ensure better placement of mental health care users oral health services continue to be provided. and other vulnerable patients, 395 social workers and other mental health care practitioners and clinicians • A tender for dentures and orthodontic appliances were trained in three workshops. In addition, the was implemented district mental health audit teams established to • An extraction to fi lling ratio of 6:1 was achieved; audit mental health NGOs now include healthcare this is below the national norm of 11:1 social workers including a profession-specifi c audit • Sefako Makgatho Health Sciences University tool has been developed in consultation with the (SMU) Oral Health Centre introduced a Saturday Mental Health Directorate and the Department of clinic in November. This reduced waiting times Social Development and is available for comment. from 100 minutes in Quarter 2 to 45 minutes in Quarter 3. There are challenges regarding the placement of • SMU and Wits Oral Health Centres conducted discharged mental health care users and other their fi rst NCS self-assessments in Quarter 3 patient categories: foreign nationals, patients despite the limitations of the tool. without identifi cation and unknown patients. These are being addressed through standard operating Partnerships are important in the provision of health procedures on unknown patients and referral care services and the Department will collaborate systems and are being strengthened in various ways with Colgate on a fi ssure sealant blitz at identifi ed including improving stakeholder liaison with the schools. It will also collaborate on improving patient Department of Home Affairs, embassies and the work fl ow at the Wits Oral Health Clinic to address Victim Identifi cation Unit. long waiting times. Radiography Services HIV, AIDS, STIs AND TB The aim of the Radiography Department is to ensure Signifi cant Achievements high-quality imaging services in all institutions with An increasing number of people in Gauteng living 32 minimal radiation risk to patients, staff and the with HIV know their HIV status. At 3 083 921 9 community. (including antenatal) clients tested for HIV, this Developments during the reporting period included: exceeded the target of 2 498 007 by 23.5% (585 914). The targeted testing for positivity, at • Roll out of RIS/PACS to address challenges 258 115, exceeded the set target of 237 766 by with access and waiting times started in the 8.5% (20 349). These successes were due to targeted radiography departments of 5 of the 23 hospitals. HIV testing services in high risk populations and high • Tender GT086/2017 for procurement of transmission areas. radiography equipment was concluded. This will result in shorter waiting times and better access Reduced mother-to-child HIV transmission achieved to specialised services. 0.99% against a set reduction target of <1.4%. The • A partnership was established with the Radiation success of the prevention of HIV vertical transmission Control Directorate of the national Department hinges on Antenatal Client Start on ART Rate of of Health to ensure safety compliance with 94.7% against a set target of 97%; outcome success imaging equipment at institutions and to avoid of 0.99% further gives evidence that the 2.3% service interruptions. gap of Antenatal Client Start on ART Rate against • A level of 91% radiation control compliance was target of 97% could be due to data quality gaps in achieved as per licence conditions for equipment reporting at source. at hospitals and district facilities. During the reporting period, there was signifi cant The need to facilitate training on NCS and radiation progress in rolling out the Integrated TB/HIV control compliance standards and strengthening Information System (THIS) on ‘ART. TIER.Net of communication with district and hospital Software’ as a common platform. Progress was also management on areas of non-compliance. made on a linked Monitoring and Evaluation System in all health districts, with 330 facilities presently on Phase 6 of the TB module integrated on ART. Tier. Net. Uninterrupted availability of ARV drugs led, in all Treatment outcomes districts, to successful rollout of anti-retrovirals by the Centralised Chronic Medicines Dispensary Previously, the TB Programme calculated outcomes and Distribution (CMDD) for patients with co- indicators based on “new smear positive” TB cases. morbidities. This led to the implementation of the As from 2017, the calculation formula changed to NAS strategy and improved linkage to care from case “all TB cases”; this affected reported TB outcomes. identifi cation through symptomatic screening and The new smear positive treatment success rate was testing to treatment initiation. 9 627.

Health Programmes continued stewardship cross- In 2016, the new smear positive treatment success cutting all health districts on the implementation of rate was 9 627 out of a total of 11 006 (87.5%). In differentiated care models of care aimed at reducing 2017, the fi gures were 36 800 and 30 998 (84.2%) overcrowding through decanting of stable clients of all TB cases out of 36 800 were successfully treated on chronic medication using, i) Adherence Clubs; ii) in 2017. Space Fast Lane Appointments; iii) CCMDD; iv) CDU’s New smear positive deaths in 2016 were 486 out and or v) PDU’s leading to increased retention in care. of 11 006 (4.4%). In 2017, the number of deaths Strategy to Address Areas of Under-performance among all TB cases was 2 273 out of 36 800 (6.2%). New smear positive losses to follow up in 2016 were As part of the strategy to prevent HIV and STIs, during 576 out of 11 006 (5.2%). In 2017, the number was the reporting period 112 608 men were medically 2 318 out of 36 800 (6.3%) . circumcised, 98% of the target of 115 000. 19 349 748 male condoms were distributed, 95% of the Social mobilisation 200 million target. To increase advocacy, community awareness and social mobilisation about prevention and 7 289 873 female condoms were distributed (94% of management of TB, the Programme set itself the the 7.7 million target). To address underperformance, target of 250 outreach community campaigns; 293 i) all Health Districts are expected to increase targeted were conducted. The aim was for the Programme to Advocacy, Communication and Social Mobilisation reach 2 000 000 people. This was exceeded, with (ACSM) aimed at increasing female condoms uptake; 33 3 014 711 people participating in the Department’s ii) civil society sectors of the Gauteng AIDS Council social mobilisation Programmes during which 81 continue to be engaged to assist with ACSM; as well 427 people were screened for TB.This achievement as iii) Global Fund Grant principal recipients and sub- was assisted by developmental partners and WBOT recipients engaged on ACSM role activities in the districts. Antenatal Client Start on ART Rate 94.7% a set target TB / HIV collaboration of 97%; overcoming underperformance includes i) targeted data quality improvement projects for Reporting on TB/HIV collaborative activities was ‘Antenatal client initiated on ART rate’ in particular affected by the calculation changes from new smear at Metropolitan Health District, Johannesburg positive cases to all TB cases. The numbers and Ekurhuleni and Tshwane, aimed at reversing and percentages of registered TB patients with known or changing practice; ii) clients initiated on ART, to HIV status were 36 609 (96.8%) in 2016 and 31 101 improve the use of standard clinical stationery by (91.3%) in 2017. Out of the above two known HIV Clinicians and Nurse Practitioners; iii) clients often status respectively, those that were positive in 2016 not captured on ART.Tier.Net at source, To improve/ were 26157 (69.2%) and 22738 (66.7%) in 2017. In strengthen systems to improve data management 2016, 23783 were started on ART (90.9%) and 19 and capturing of TROA, VLD and VLS. 899 (87.5%) in 2017. TB CONTROL PROGRAMME Drug Resistant TB (DR TB) The DR TB decentralisation process was implemented The Programme achieved an increase in screening for in a phased approach in all fi ve districts. 420 doctors TB cases from 6 444 in 2016 to 10 139 805 in 2017, and 101 nurses initiated Management of Drug a 23.7% improvement. Resistant TB training to start laboratory diagnosed Of the total screened, there were 20376 positive Rifampicin Resistant and Multi Drug Resistant TB on tests in 2016 compared with the 18 600 in 2017. DR TB treatment. In 2016, 18 223 people were diagnosed TB positive and started on treatment. The number in 2017 was 16934 (91%). Research to pregnant women attending antenatal fi rst visits during pregnancy, by the ten advanced midwives The Department’s TB allocative effi ciency project in all fi ve Health districts. During the reporting and World Bank produced a preliminary report on period, 23 060 ultrasounds were performed from key targets of costings and modelling of APP and the 98 911 fi rst booking visits province-wide, and 41 979 NSP, 2017 to 2022. at targeted limited obstetric ultrasound outreach The Department renewed the contract of tracer 62 PHC healthcare facilities with their satellites in nurses to trace loss to follow up patients and give all fi ve Health districts. Reasons for early referrals injections to drug resistant TB patients. The strategy included multiple pregnancies, gross abnormalities, includes recording at least two contact numbers per abnormal fl uids, low lying placenta and other foetal TB patient to improve the tracing process. Verifi cation abnormalities. of patients’ home addresses by CHWs during home Progressive and gradual reduction in maternal deaths visits is well implemented in some facilities. with the target of <80/ 100 000 by 2020 achievable The WBOT system is also well established and assists currently at 108.5/ 100 000 live births, noting the with tracing loss to follow ups in all fi ve districts. The importance of initiation of pregnant women on adherence strategy helps the Programme with the FDC/ART, i.e. 52.3% of pregnant women attending retention in care of TB patients through counselling antenatal care know their status, 31 432 of them are and continuous education. Quality improvement put on treatment and 90% of them have viral load implemented at Ekurhuleni and Sedibeng facilities is suppression. assisting with fi nding TB cases and linking them to Child Health Programme care. The Department has started to roll out and implement Historically, TB and HIV Programme data have been the Road to Health Booklet Unique Identifi ers for vertically managed. An integrated system was then every new born baby to assist in tracking the linkage introduced. The TB/HIV Integrated Information of all children to care treatment and support in all System (THIS) has been implemented in 70% of health facilities. Training was conducted for 144 facilities in line with the national Department of 34 managers, nurses, dieticians, doctors and health Health’s plan. The implementation targets aim to promoters from hospitals and maternity units. balance the need to scale up the initiative with an emphasis on maintaining quality service provision To reduce morbidity and mortality among children and improving data quality. Monthly monitoring of under 5 years of age, 368 professional nurses were data verifi cation, and quarterly data quality audits, trained on the Integrated Management of Childhood are being implemented. Illnesses and early initiation of antiretroviral treatment. To support decentralised management of the drug resistant TB policy, the Department continues to train Integrated School Health Programme (ISHP) doctors, nurses and allied health workers on the The Integrated School Health package of health policy and its implementation. services was provided at 934 public schools. Sub-Programme 4.2.5: Maternal, Comprehensive health screenings were conducted Child and Women’s Health and for 224 033 learners in schools with the School Nutrition Grade 1 and 8 screening coverage (annualised). A total of 25 702 learners with health problems were MATERNAL AND NEWBORN HEALTH identifi ed and referred appropriately for further management at PHC facilities and/or hospitals. Tetanus Diphtheria (Td) immunisations were given to Implementation of the 1st Thousand Days Programme 27 861 learners aged 6 and 12. Td immunizations with main focus on (Social Mobilisation and Behaviour were given to 27 119 learners. A total of 12 530 Change Strategy) early booking for antenatal care, learners were dewormed. Health problems identifi ed at least before 14 weeks, provision of antenatal and appropriately managed and referred included: care services daily, and exclusive breastfeeding for 6 underweight (1 204); overweight (4 051); speech months and beyond as mandated by the Tshwane problems (292); oral health (21 411); eye care (9 245) Declaration – promotion, protection and supporting and learners with suspected TB (417). Appropriate of the breastfeeding including in the workplace. health education was given to learners, educators In April 2017, the Department introduced the and parents. Limited Obstetric Outreach Programme, provided Human Papillomavirus (HPV) Vaccination The Province is concerned about illegal service Campaign 1st Dose and 2nd Dose providers of termination of pregnancies. On 19 October 2014, a bogus doctor and a doctor st HPV Campaign 1 Dose registered with the Health Professions Council of A total of 51 352 (65.6%) Grade 4 girls were South Africa who were conducting terminations of immunised with the HPV 1st dose. A total of 1 pregnancy illegally were arrested at Lister Building in 220 schools out of 1 519 (80.3%) were visited in Jeppe Street in Johannesburg and were subsequently February and March 2018 for the HPV 1st Dose found guilty. Vaccination Campaign. Nutrition st nd HPV Campaign 1 and 2 Dose Three facilities (Kalafong and Rahima Moosa Hospitals A total of 1 447 public primary schools out of 1 519 and Boekenhout CHC) achieved MBFI accreditation were reached during the HPV 2nd dose Campaign in in 2017/18 which translates to 94% coverage August and September 2017, and 57 150 (66.9%) of provincially. The number of children exclusively Grade 4 girls were immunised. breastfed increased to 104 173 in 2017/18 from 90 123 in the previous fi nancial year. The total number of learners immunised, and schools reached, has not been fi nalised as capturing and There was an decrease in the number of children synchronisation of HPV 1st and 2nd dose data is under 5 years receiving vitamin A supplementation, ongoings. from 1 013 615 in 2016/17 to 997 506 in 2017/18.

Adolescent and Youth Health SAM case fatalities decreased from 120 cases in the previous fi nancial year to 79 cases in 2017/18, During Youth Month 2017, the Department hosted a decline of 6.2%. This was due to the SAM young people at the Youth Health Summit held at clinical audits conducted in health facilities and NASREC. In February 2018, ten clinics were assessed implementation of the SAM treatment protocol. on the status of their provision of AYFS and are to be SAM incidents detected in health facilities decreased provided with National AYFS Accreditation. to 1884 in 2017/18 from 2334 cases in 2016/17 due to routine screening of children under 5 years old. 35 Reproductive and Women’s Health Food safety standards are critical in the Department’s Contraception and Fertility Planning food service units. NDOH audits are conducted To increase the use of long-acting reversible annually in the units. From the audits, 34 facilities contraceptives to reduce the number of unintended scored an average of 93% and 18 an average of and unwanted pregnancies, 316 professional nurses 90%; only 2 facilities scored below the threshold were trained on insertion of implants and intrauterine of 75%. To ascertain compliance with food safety devices. The number of implants inserted increased standards, SABS conducted food safety audits in 4 from 7 735 in 2016/17 to 19 560 in 2017/18 . health facilities.

Cervical Cancer Screening The food service tenders for fruit and fresh vegetables were fi nalised and allocated to local upcoming To reduce the incidence and prevalence of cervical farmers, including women and youth, with the aim cancer through early diagnosis and enrolment to of enhancing the local revitalisation Programme. care, professional nurses were trained on the new method of obtaining a cervical smear (liquid based Nutrition funding subsidised 1 083 ECD centres, with cytology: LBC). 50 926 benefi ciaries from the total budget of R55 million. Termination of Pregnancy Services Obesity Strategy orientation was conducted in To reduce the number of maternal deaths due to all provincial government departments, with a unsafe, back street abortions, 140 professional nurses special emphasis on healthy meal provision in the were trained on medical abortion and ten as Trainers workplace. DOH and GDE established an Obesity of Trainers. To improve uptake, 70 managers were Mandate Committee to develop the Implementation orientated on termination of pregnancy. Presently, Plan of the Obesity Strategy, with a focus on learners Heidelberg District Hospital is implementing medical in Grades R, 1, 4, 8 and 10. abortion as a pilot and there are plans to roll out to rest of the District Hospitals in the next fi nancial year. The number of overweight learners is used as a Carletonville Hospital rolled out medical abortion in baseline for estimating obesity in the targeted December 2017. learner population, which stands at 4 051. To prevent the National Service Delivery Agreements (NSDA), progression to SAM, there was interdepartmental Millennium Development Goals (MDGs) 4, 5 & 6 and collaboration with SASSA to provide food parcels all other priority health Programmes such as Non- to 1 705 children under 5 years old presenting with Communicable Diseases. SAM and MAM underweight for age. Health promotion is a process of enabling people to PUBLIC HEALTH increase control over and improve their own health. The health promotion Programme is available to Health Promotion people and groups of all ages and aims to increase Health promotion in the country is guided by the their involvement in activities that improve their National Health Promotion Policy and Strategy lifestyles. It operates through drives and participates 2015 – 2019. The policy provides guidelines on the in campaigns, events, community development and roles and responsibilities of Health Promoters (HPs) health education activities. at all levels towards achieving the objectives of

Sub-Programme 2.1: District Health Management and PHC Services

District Health Management and PHC Services Strategic Actual Planned Actual Deviation Comment on deviation Objective achievement target achievement from planned 2016/17 2017/18 2017/18 target 2017/18 (over/ (under)) Increase the quality of and access to PHC facilities through 24-hour service provision in all CHCs; integration of mental health and rehabilitation services in 100% of PHC facilities by 2019/20 Number of CHCs 29/35 32/32 30/32 (2) Inability to create posts required that provide 24- to man the services due to hour service fi nancial constraints. Posts to be created in Johannesburg and 36 Sedibeng Health Districts to staff the remaining 2 clinics for 24- hour service. Percentage of 100% 100% 100% 0% All PHC health facility users PHC facilities with (372/372) (369/369) are screened for key illnesses integrated mental including mental health and health services attended to regardless of their condition. Percentage of 588% 70%9 92% 22% Target exceeded assistive devices issued Increase the number of fully-fl edged, functional Ward Based Outreach Teams from 103 to 533 by 2019/20 Number of 719 78010 754 (26) Cancellation of CHW contracts fully fl edged, in the City of Tshwane in functional Ward order to appoint them on a Based Outreach permanent basis. Teams Once this process is complete, the teams will be re-established. Reduce the number of primary care patient cases seen at regional, tertiary and central hospitals by 20% in 2019/20 to increase utilisation of PHC services PHC utilisation 1.6% 2.5% 1.5% (1%) PHC utilisation has decreased rate because of community based services offered outside of the clinics whose intention is to decongest the clinics. A proposal to modify the defi nition has been sent to NDOH to consider in the upcoming NIDS review ,

8 Percentage achievement in 2016/17 Annual Report is 58%. 9 Target adjusted upward from 52% to 70%. 10 Target adjusted upward from 720 to 780 District Health Management and PHC Services Strategic Actual Planned Actual Deviation Comment on deviation Objective achievement target achievement from planned 2016/17 2017/18 2017/18 target 2017/18 (over/ (under)) Fixed PHC clinics scoring above 70% on the Ideal Clinics dashboard; 100% of PHC facilities and district hospitals compliant with national core standards and complete self-assessments in 100% of hospitals and PHC facilities by 2019/20 Ideal Clinic status # 100%13 97.8% 2.2% Target not achieved because determinations 8 of the targeted clinics at conducted COJ were under construction by 11 Perfect and could therefore not be Permanent Team assessed. Those facilities whose for Ideal Clinic construction is completed will Realisation and be included in the next cycle of Maintenance assessments. (PPTICRM) rate (fi xed clinic/CHC/ CDC) Outreach 8.9% 914% 8.6% (0.4%) Registration of household Household (OHH) Targets not achieved reason registration visit being that CHWS in the 4th coverage quarter could not perform household visits because of the National Training for CHWs whish was being piloted in the Johannesburg and Ekurhuleni District. Percentage of complaints resolved within 25 working days Complaints 89.5% 95% 91.3% (3.7%) Inability to get complainants resolution rate to come on time for redress (PHC) meetings. Some patients not staying within the area; when called, found to be in another 37 province and can only come back more than a month later. Complaints 98.6% 98.6 %15 95.9% (2.7%) Target not reached due to resolution within inability to get all complainants 25 working days to present themselves on time rate (PHC) for redress meetings. Increase % of health facilities with annual quality improvement plan based on a PHC facilities self-assessment to 100%; fi xed PHC clinics scoring above 80% on the Ideal Clinic dashboard; 90% of PHC facilities and district hospitals compliant with national core standards; percentage of PHC facilities and district hospitals that conduct self-assessment to 100% by 2019/20 Hospital achieved 100% 100% 92% (8%) Target not achieved due to 75% and more (11/11) (12/12) (11/12) Bronkhorstspruit district hospital on National Core scoring 70%, which is below Standards self- the target. The hospital is still assessment rate new and staff are currently (District Hospitals) familiarising themselves with the requirements, assisted by the Internal Assessment Unit team. Improve effi ciency of hospitals by reducing average length of stay to less than 5 days, increase bed utilisation to 80% and decrease expenditure per PDE in hospitals by 2019/20 Average length 4.4 days 4.5 days 4.4 days 0.1 days Remained within target for the of stay (District past 2 years. Psychiatric patients Hospitals) in some hospitals increase the average length of stay as they tend to be admitted for longer periods. Inpatient bed 65.1% 70% 66.9% (3.1%) Ineffi ciencies in referral patterns utilisation rate and improper access to high (District Hospitals) levels of care. Down referral system from regional hospitals to be improved to increase effi ciencies.

11 Based on the 2017/18 -2019/20 Revised Annual Performance Plan. 12 The fi gure was changed/adapted from the 2016/17 Annual Report. 13 The target was adjusted downwards from 100% to 65%. 14 The target was changed/adapted from the 2017/18 -2019/20 Revised Annual Performance Plan. 15 The target was adjusted from 95% to 98.6% District Health Management and PHC Services Strategic Actual Planned Actual Deviation Comment on deviation Objective achievement target achievement from planned 2016/17 2017/18 2017/18 target 2017/18 (over/ (under)) Expenditure R 2 766 R2 750 R3 198 R448 Over-expenditure by R448. per patient day Change in disease patterns and equivalent (PDE) chronicity of diseases results in prolonged admissions, increasing the cost per day. Percentage of complaints resolved within 25 working days to be over 95% by 2019/20 Complaints 87.5% 95% 76.9% (18.1%) Complainants not honoring resolution rate redress appointments. Weekly reminders on unresolved complaints are sent for the attention of the CEOs and District Chief Directors responsible. A complaints management checklist has been developed to assist the facilities to identify gaps that lead to failure to close complaints on time. Complaint 97.3% 98% 99.4% 1.4% Bertha Gowa & South Rand resolution within Hospitals affected the province’s 25 working days overall performance because rate. of clients not honoring redress appointments. Complaints by end of 4th quarter did not require in-depth investigation; all were resolved and closed within 38 the 25 working day period. Reduce Outpatient Department (OPD), Accident and Emergency and Pharmacy Departments waiting times across all facilities by 60% in 2019/20 Percentage of # 50% (6/12) 75% (9/12) 25% Out of 12 hospitals, only three hospitals with were struggling to achieve the OPD average set benchmark of 180 minutes. treatment Effective queue management waiting times that includes an electronic ticket below agreed device system is recommended. benchmark of Continuous support visits to 180 minutes reinforce and maintain this level of consistency for achieving the required waiting times regardless of prevailing challenges. HIV AND AIDS, STI AND TB CONTROL Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from planned 2016/17 2017/18 2017/18 target 2017/2018 (Over/(Under)) Reduce mother-to-child transmission of HIV from 2% to <1.3% at 6 weeks after birth and from 3.1% to less than 2% at 18 months after birth by increasing antiretroviral treatment among pregnant women living with HIV from 81% to 98% by 2019/20 Transmission rate 1.7% <1.4% 0.99% 0.41% Target achieved due to from mother to increased ART initiation for child HIV positive mothers during antenatal. Increase number of female condoms distributed annually from 1 451 696 to 9.2 million by 2019/20 Female condoms 6 888 638 7.7 million16 7 289 873 (410 127) Uptake of female condoms distributed is declining since the introduction of fl avoured male condoms. Training on CUPID female condom demonstration and distribution. Use PASOP and PHILA Campaigns to increase demand for female condoms. Increase the proportion of HIV positive population on ARV from 80% in 2013/14 to 90% by 2019/20 ART clients 806 993 964 58317 927 825 (36 758) Target not achieved due remain on ART to high loss to follow- end month end- up. To address the total underperformance, the Department will use Linkage Offi cers (for support) and strengthen treatment adherence counselling. TB/HIV co- 90.3% 90%18 87.5% (2.5%) Target not achieved due to 39 infected clients on challenges arising from the ART rate national integration of the ETR.Net and Tier.Net Systems affected the fi nal data output. The NDOH and system developers were notifi ed and a new version will be released to rectify the problem. Decrease 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 3 072 634 2 498 007 3 083 921 585 914 Target exceeded due to (total) collaboration with funded NGOs and developmental partners and by focusing on hard to reach areas such as informal settlements, targeted populations and hostels. Strengthen social mobilisation and advocacy of HIV Testing and introduce Index Testing. Increase percentage of people treated for TB from 84% in 2013/14 to 90% of total population with HIV by 2019/20 TB symptom 5 12 826 897 70%19 88.1%20 17.4% Target has been exceeded due years and older (screened to support provided by Tracer start on treatment only) Team nurses making follow- rate ups. Increase number of male condoms distributed annually from 69 480 738 to 250 million by 2019/20 Male condoms 196 062 536 200 million 19 0349 748 (9 650 252) Shortages of condoms for distributed distribution because suppliers are not meeting the demand.

16Target adjusted upward from 6million to 7.7 million 17 Target revised downward from 1 028 811 to 964 583 18Target adjusted upwards from 88% to 90% 19Target adjusted downward from 90% to 70%. 20 Numerator and denominator removed for consistency in the values of the respective indicator. HIV AND AIDS, STI AND TB CONTROL Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from planned 2016/17 2017/18 2017/18 target 2017/2018 (Over/(Under)) Increase number of men medically circumcised from 132 095 in 2013/14 to 135 000 by 2019/20 Medical male 112 994 115 00021 112 608 (2392) VMMC is provided by circumcisions implementing Partners PEPFAR performed (total) whose funding ended with a resultant negative impact on the targeted number of circumcisions to be performed. Strengthen demand creation for VMMC across all seasons and capitalise on the popularity in winter and Subcontracting of General Practitioners Increase TB treatment success rate from 84.5% in 2013/14 to 90% by 2019/20 TB client 87.5% 87% 84.2% (2.8%) Target not achieved due to treatment success (43320/49 793) (30 998/36 increasing number of patients rate 800) loss to follow up. Involvement of community leaders on TB awareness. Use media and improve involvement of community structures/leaders in creating TB awareness including treatment adherence and counselling. Increase the percentage of people cured of TB from 83% in 2013/14 to 85% by 2019/20 by reducing treatment defaulter rate from 5.1% to 5% 40 TB clients lost to 5.2% 5.5% 6.3% (0.8%) Diffi culty in tracing patients follow up (rate) (2241/49793)22 2318/36800 due to wrong contact information. Verifi cation of patient’s contact details at every visit to be done by WBOT. Decrease TB death rate from 6.1% in 2013/14 to 5% by 2019/20 TB client death 4.4% 5.5 % 6.2% (0.7%) Clients are defaulting from rate treatment. Strengthen treatment adherence and counselling. 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 56% 55% 53.1% (1.9%) High loss to follow up, and treatment success (662/1246) technical changes in the EDR- rate WEB reporting system.

21 Target adjusted upward from 105 000 to 115 000. 22 Target adjusted from 4.5% to 5.5%. Maternal, Child and Women’s Health and Nutrition Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/2018

Increase number of mothers whose fi rst antenatal visit is before 20 weeks from 43.7% in 2013/2014 to 70% by 2019/20 Antenatal fi rst # 90% 86.2% (3.8%) Women book their ANC visit coverage visits late. Prenatal services tracking prioritised for fi rst phase of Health Observatory implementation including capturing of General Practitioners’ data on bookings to support targeted interventions in areas with low coverage. This includes implementation of home- based pregnancy testing by WBOTs to promote early booking. Antenatal fi rst 58.4% 63% 61.4% (1.6%) Service platforms attend visit before 20 to clients from neibouring weeks (rate) countries and provinces. Prenatal services tracking prioritised for fi rst phase implementation of Health Observatory and implement Homebased pregnancy testing by WBOTs to promote early booking. 41 Increase number of mothers visited within 6 days of delivery of their babies from 86.8% in 2013/14 to 85% by 2019/20 Mother 85.9% 80% 70.8% (9.2%) Service platforms attend postnatal visit to clients from neibouring within 6 days countries and post-natal (rate) services tracking prioritised for fi rst phase implementation of Health Observatory. Upload the application on NIDS on phones and desktops of clinicians and data capturers and encourage capturing of post-delivery admissions. 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 23 Antenatal client 94.8% 97% 94.7% (2.3%) Target not reached due to starts24on ART poor clinical documentation rate of ART initiation of pregnant women and poor data management. Districts, in collaboration with the supporting partners, to start identifying projects to close the gaps identifi ed. Infant fi rst PCR 1.7% 1.45% 0.99% 0.5% Increase ART initiation of test positive HIV positive mothers during around ten antenatal care and increase weeks rate the number of trained NIMAART nurses. Continue training and treatment adherence counselling.

23 Adapted based on the 2017/18 – 2019/20 Revised Annual Performance Plan. 24 Adapted based on the 2017/18 – 2019/20 Revised Annual Performance Plan. Maternal, Child and Women’s Health and Nutrition Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/2018

Sustain immunisation coverage at 100% for children under 1 year by 2019/20 Immunisation 96.7% 97% 77% (20%) Underperformance is due to coverage under (195 509/201 (200139/259772) the increase in population 1 year 556) under 1 year. Survey to be conducted by Wits and NDOH to verify population fi gures. Decrease DTaP-IPV/HIB 3-Measles 1st dose drop-out rate from 3.5% to 2% and increase measles 2nd dose coverage from 85% to 98% by 2019/20 Measles second 105.7% 96% 74.5% (21.5%) Immunisation coverage dose coverage (195 804/203 (189 446/254 under 1 year and Measles 963) 306) second dose coverage targets were not met. The underperformance is due to the increased population under 1 year. DTaP-IPV/Hib -1.9% <10% 4.5% 5.5% Underperformance is due 3 - Measles fi rst to the increased targeted dose drop-out population fi gures. Perform rate household visits to determine levels of immunisation coverage with the support of WBOT. Decrease child (under-5 years) diarrhoea case fatality rate from 3% in 2013/14 to 1.7% by 2019/20 Diarrhoea case 1.7% <1.9% 2.3% (0.4%) Poor compliance with 42 fatality rate (122/6435) protocols. Strengthen clinical under 5–year governance and conduct. rate Conduct training on Clinical IMCI. Decrease child (under 5 years) pneumonia and severe acute malnutrition case fatality rate from 12% in 2013/14 to 5.5% by 2019/20 Pneumonia case 1.5% <1.8% 2.6% (0.8%) Delay by care-givers in fatality under 25 accessing healthcare services 5–year rate resulting in complications. Conduct training on Clinical IMCI. Severe acute 6.5% <6.5% 6.2% 0.3% Training for healthcare malnutrition 26 professionals on WHO Ten case fatality Steps on the management under 5 years of SAM contributed to the rate decline in mortality due to acute malnutrition. Increase coverage of Grade 1 learners’ health screening in Quintile I – 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 Grade 1 49.5% 84 352 83 402 (950) No dedicated School Health screened27 Nurses; Johannesburg Metro/ Learners Health District had an impact on the number of screening services that could be offered. Grade 8 35.4% 36 095 46 612 10517 Achieved due to continuing screened28 health screening at high learners schools despite the HPV campaigns at all districts except COJ. Reduce the levels of unwanted pregnancies in 10 to 19 years from 5.7% to 4.2%

25Numerator and denominator removed for consistency on the values of the respective indicator 26Numerator and denominator removed for consistency on the values of the respective indicator 27Adapted based on the 2017/18 – 2019/20 Revised Annual Performance Plan. 28Adapted based on the 2017/18 – 2019/20 Revised Annual Performance Plan. Maternal, Child and Women’s Health and Nutrition Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/2018

Delivery among # 4.6% 29 8.1% (3.5%) Increased incidences 10 to 19 years of pregnancy amongst in facility rate teenagers. Strengthen reproductive health services. Increase couple year protection rate from 24.9% in 2013/14 to 70% by 2019/20 Couple year 41% 50% 59% 9% Target exceeded due to protection rate promotion of promotion of long acting reversible contraception (LARC). Increase cervical cancer screening coverage from 41.7% in 2013/14 to 70% of women by 2019/20 Cervical cancer 50.3% 60% 47.4% (12.6%) Review Service Level screening Agreement with Metros to coverage: 30 ensure provision of services years and older daily. Increase HPV vaccine coverage rate from 87.1% for 1st dose to 80% by 2019/20 HPV fi rst dose 30 66.7% 80 850 51 352 (29 498) Target not achieved due to learners who were below 9 years at the time of vaccination. To immunise the learners who did not qualify qualifying during the 2nd Dose campaigns or the following year. nd Increase HPV vaccine coverage rate for 2 dose to 80% by 2019/20 43 HPV second 57.5% 80 850 57 150 (23 700) Target not achieved. However, dose there are improvements recorded with 2nd dose due to those learners aged 9 years and qualifi ed for vaccination. Learners who still did not qualify are to be vaccinated in the following year. Decrease child (under 5 years) severe acute malnutrition case fatality rate from 6.1% in 2013/14 to 5.5% by 2019 Vitamin A 61.5% 65% 50% (15%) Encourage provision of coverage 12-59 Vitamin A supplies to PHC- months WBOTs. Infants 44% 65% 47.4% (17.6%) Lack of information/data on exclusively breastfeeding at HepB3rd breastfed at dose by private providers HepB 3rd dose receiving vaccines from Health rate Districts. Reduce in-facility maternal mortality ratio from 143 in 2013/14 to 85 per 100 000 live births by 2019/2020 Maternal 119.2/100 31110/100 000 108.5/100 000 1.5 Increased training sessions in mortality in 000 ESMOE and reduced deaths facility ratio due to non-pregnancy related infections, mainly HIV, due to early initiation of pregnant women on FDC. Continue with ESMOE training.

30

31 Target adjusted upward from 100/100 000 to 32110/100 000. Maternal, Child and Women’s Health and Nutrition Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/2018

Reduce neonatal mortality from 15/1 000 live births in 2013/14 to 8.5/1 000 live births by 2019/20 Neonatal death 10/1000 live 9.5 13.6 (4.1) Shortage of HCA NICU beds. in facility 32rate births An audit of neonatal health services to be done in the new year as a fi rst step to address inequities in the distribution of neonatal resources.

Disease Prevention and Control Performance Actual Planned Actual Deviation from Comment on deviation indicator achievement target achievement planned target 2016/17 2017/18 2017/18 2017/2018

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 1 303/mil 10 834 /10 917.1 166.9 operations Target achieved. A dedicated rate (uninsured 834 546 operations cataract surgery center at population) Bheki Mlangeni Hospital is contributing to the improved performance. Malaria case 2.3% 1% 1.5% (0.5%) Late health seeking behaviour fatality rate of clients. Continue with social 44 (annual) mobilisation and training of health professionals on malaria management.

Expenditure: Programme 2 – District Health Services

2016/2017 2017/2018 Sub-Programme Name Final Actual (Over)/ Final Actual (Over)/ Appropriation Expenditure Under Appropriation Expenditure Under Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 District Management 484 812 457 752 27 060 516 536 524 552 (8 016) Community Health 2 121 065 2 093 485 27 580 2 425 500 2 416 248 9 252 Clinics Community Health 1 617 479 1 571 259 46 220 1 778 040 1 792 265 (14 225) Centres Community Based 1 538 841 1 574 218 (35 377) 1 780 080 1 780 657 (577) Services HIV/AIDS 3 427 610 3 424 730 2 880 3 957 203 3 890 431 66 772 Nutrition 43 371 43 562 (191) 55 583 49 557 6 026 Coroner Services 199 971 188 593 11 378 215 243 214 321 922 District Hospitals 2 562 701 2 638 493 (75 792) 2 983 916 3 015 482 (31 566) 11 995 850 11 992 093 3 757 13 712 101 13 683 513 28 588 Programme 3: Emergency Medical Services Purpose of the Programme EMS satellite stations in the north of Gauteng, Mamelodi, Laudium and Soshanguve Block JJ. This The purpose of the Emergency Medical Services has increased the number of EMS stations from 34 Programme (EMS) is to ensure rapid and effective to 37. Public information, education and awareness emergency medical care and transport as well as campaigns, through the Department’s social media effi cient planned patient transport, in accordance sites (Facebook, Instagram and Twitter) have resulted with provincial norms and standards. in a large number of followers and hits.

Signifi cant Achievements Gauteng EMS has invested in high value assets and Response times have improved with the opening specialised equipment, including low birth ventilators of EMS satellite stations close to caller locations. and 12 lead electrocardiograms (ECGs), to improve This has shown positive gains on P1 response times patient treatment and outcomes by moving critically in the various areas. Operations has opened new ill patients from District and Regional hospitals to academic and specialised hospitals. Performance indicators: Programme 3 – Emergency Medical Services

Emergency Medical Services Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Improve EMS response time for P1 patients within 15 minutes in urban areas from 77.4% to 90% and within 40 minutes in rural areas to 100% EMS P1 urban 65.3% 85% 81.2% (3.8%) The following strategies are being response under 15 used to improve P1 response times: minutes rate • Position EMS bases close to 45 caller locations, in the form of satellite or temporary EMS bases. • Use alternative forms of reasonable accommodation to DID and infra-structure management (for example: rentals and containers). • Improve operational effi ciencies to maximise limited resources: o Correct pre-classifi cation and post-classifi cation of calls in Emergency Communication centre. o Maximise current resources by strictly monitoring all types of leave and take corrective action where appropriate. o Ensure maximum vehicle availability and low vehicle downtime. • Strengthen Public Information Education and Relations (PIER) platform with COGTA to inform public of when and how to call for EMS. Emergency Medical Services Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 EMS P1 urban 65.3% 85% 81.2% (3.8%) Promote proactive Programmes response under 15 to drive down demand for minutes rate services in various communities including using social media platforms (examples: social media, news bulletins and billboards) to promote healthy life styles. EMS P1 rural 97.2% 100% 100% 0% Target achieved. response under 40 minutes rate Reduce utilisation rate of inter-facility transfer clients from 31.2% to 15% by 2019/20 EMS inter-facility 29.1% 25% 32.3% (7.3%) Target not achieved. transfer rate

Expenditure: Programme 3 – Emergency Medical Services, 2016/17 and 2017/18

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Emergency transport 1 007 179 920 275 86 904 1 158 460 1 125 937 32 523 46 Planned patient transport 95 042 90 194 4 848 109 694 93 337 16 357 1 102 221 1 010 469 91 752 1 268 154 1 219 274 48 880 Programme 4: Provincial Hospital Services Purpose of the Programme status from the South African Pharmacy Council; this is signifi cant. The hospital also opened a Family To provide general and specialised hospital services Relations Unit, the fi rst of its kind in the country. This by general specialists through regional hospitals, enables children under ten years of age to visit their TB hospitals, psychiatric/mental hospitals, dental mothers and to bond. The hospital has also launched training hospitals and other specialised hospitals. a Research and Learning Centre, sponsored by Wits List of sub-Programmes University. This will be used to conduct research that • General (regional) hospitals will improve services. • Tuberculosis hospitals Sizwe Tropical Diseases Hospital achieved a treatment • Psychiatric hospitals. success rate of 65% MDR-TB & 70% XDR and Signifi cant Achievements and Strategies to new drugs Delamanid 5 & Bedaquiline 287 were address areas of underperformance successfully rolled out.

General (Regional Hospitals) Tshwane Rehabilitation Hospital Patient Rehab Re- integration Programmes Percentage of 90% target There is general improvement in National Core of patients reaching physical rehab goals set on Standards (NCS) self-assessment and complaints admission when discharged. resolution rate within 25 working days, with the targets by hospitals. Lack of High Care beds and a shortage of ICU beds across the province continue to be a challenge as Leratong Hospital moved the Miracradle Coding demands on the system keep increasing. To address machine to Yusuf Dadoo District Hospital to reduce this, infrastructure and human resource planning will morbidity due to birth asphyxia before transfer be prioritised in the MTEF. There is also overcrowding to higher level of care; this is improving patient in neonatal, maternity, medical and surgical wards outcomes. due to increased demand.

Inter hospital relationships There is an inadequate supply of medical consumables 47 due to budget constraints as a result of increasing The hospitals Cluster Model has been implemented COE. It is expected that the “Iron Clad” fi nancial and continues to be strengthened. It improves management approach will address this. There is relationships between hospitals in the Cluster. inconsistent and inaccurate data on staff attendance Regular Cluster meetings are held to streamline care rates and waiting times in Accident and Emergency and referrals upward and downward. and in Out-Patient departments. Deliverology Mental health specialised hospital services methodology and tools will be rolled out to all hospitals to improve data collection and assessment Sterkfontein Hospital pharmacy achieved A-Grade to assist the Department to address these issues. Performance indicators: Programme 4 - Provincial Hospitals

Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/2018 2017/18 planned target 2017/18

Decrease average Outpatient Department (OPD) and Pharmacy department waiting times in all hospitals by 60% in 2019/20 Percentage of # 66% (6/9) 77% (7/9) 11% Maintaining the required waiting hospitals with OPD times refl ects good performance. average treatment The plan is to ensure that these waiting times below facilities are supported in their agreed benchmark of efforts, and to introduce the new 180 minutes version of managing waiting times.

Quality of care will be improved by increasing compliance with national core standards and self-assessments in all regional and specialised hospitals to 100% Hospital achieved 100% (9/9) 88.9% 88.9% 0% Target achieved. 75% and more on National Core Standard self- assessment rate (Regional Hospitals) Improve effi ciency of hospitals by reducing average length of stay to less than 5.2 days, increasing bed utilisation to 84% and decreasing expenditure per PDE in hospitals by 2019/20 Average length 5.1 days 5.4 days 5.1 days 0.3 days Within target range. Target of stay (Regional achieved by improving clinical Hospitals) governance (doing ward rounds daily; morbidity and mortality meetings). Burden of disease profi le 48 has increased. Acuity of patients’ conditions and late presentations in the health system. Patients stay longer due to recovery from surgery, illness. Patients wait for scopes/scans, blood results, etc. Inpatient bed 82% 83% 79.7% (3.3% ) Below target. The BUR pattern is utilisation rate seasonal as most of the catchment (Regional Hospitals) population are migrants. Expenditure R 2 679 R3 000 R3 082 R82 Over-expenditure of R82. per patient day PDE review discussions and equivalent (PDE) recalculations have been held (Regional Hospital) throughout the fi nancial year in light of the increased population and burden of disease. Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/2018 2017/18 planned target 2017/18

Decrease average Outpatient Department (OPD) and Pharmacy department waiting times in all hospitals by 60% in 2019/20 Increase complaints resolved within 25 working days to over 95% in 2019/20 Complaints 91.1% 95% 89.2% (5.8%) Most complaints not resolved resolution rate in 25 working days are complex (Regional Hospitals) and require expert opinion (once they are escalated as PSIs, the hospital must close them from their complaints register). They are managed as PSIs and can be resolved within 60 working days. Weekly reminders about unresolved complaints are sent for the attention of the CEOs and District Chief Directors responsible. A Provincial Patient Safety Incident Committee (PPSI) has been appointed to deal with such cases. A Provincial Patient Safety Medico-Legal (PPSML) team is also in place A complaints management checklist has been developed to assist facilities to identify gaps that lead to failure and to close complaints on time.

Complaint resolution 99.1% 99%33 100.5% 1.5% A number of complex cases which within 25 working were not resolved on a month to days rate (Regional month basis were carried over to Hospitals) be resolved within 25 working 49 days. Hence the resolution rate within 25 working days was exceeded. Sub-Programme: Specialised hospitals Quality of care will be improved by increasing compliance with extreme and vital measures of core standards and self-assessments in all regional and specialised hospitals to 100% Hospital achieved N/A no tool 50% 50% 0% Target achieved 75% on National from OHSC Core Standard self-assessment rate (specialised hospitals) Increase the percentage of complaints resolved within 25 working days to over 95% in 2019/20 Complaints 80% 95% 84% (11%) Most complaints that are not resolution rate resolved within 25 working days are complex and require expert opinion (they must be closed on escalation). They are then managed as PSIs and can be resolved within 60 working days. Steps that have been taken: weekly reminders about unresolved complaints are sent for the attention of the CEOs and District Chief Directors responsible. A Provincial Patient Safety Incident Committee (PPSI) has been appointed to deal with such cases; and a Provincial Patient Safety Medico-Legal (PPSML) team is in place. A complaints management checklist has been developed to assist facilities to identify gaps that lead to failure to close complaints on time.

33 Target adjusted upward from 85% to 99% Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/2018 2017/18 planned target 2017/18

Decrease average Outpatient Department (OPD) and Pharmacy department waiting times in all hospitals by 60% in 2019/20 Complaints 98.7% 99% 98% (1%) A number of complex cases which resolution within 25 were not resolved on a month to working days rate month basis were carried over to be resolved within 25 working days. This resulted in the resolution rate of within 25 working days being exceeded. Reduce Outpatient Department (OPD), Accident and Emergency and Pharmacy Departments waiting times across all facilities by 60% in 2019/20 Percentage of # 44% 75% 31% Out of 12 hospitals, only three hospitals with OPD were struggling to achieve the average treatment benchmark of 180 minutes. waiting times Effective queue management below the agreed that includes electronic ticket benchmark of 180 device systems is recommended. minutes Continuous support visits are essential to reinforce and maintain this level of consistency in achieving the required waiting times.

Expenditure: Programme 4 – Provincial Hospitals

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under 50 Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 General (Regional) Hospitals 5 004 656 5 128 521 (123 865) 5 719 131 5 738 026 (18 895) Tuberculosis Hospitals 340 629 237 470 103 159 396 292 283 884 112 408 Psychiatric/Mental Hospitals 1 028 145 1 034 589 (6 444) 1 164 077 1 238 219 (74 142) Dental Training Hospitals 503 869 470 202 33 667 535 399 548 656 (13 257) Other Specialised Hospitals 75 767 81 345 (5 578) 77 764 83 492 (5 728) 6 953 066 6 952 127 939 7 892 663 7 892 277 386 Programme 5: Tertiary and Central Hospitals Purpose of the Programme ensure that patients are treated at the right level of care. To provide highly specialised health care services, platforms for training health workers and sites for A pharmacy down-referral pilot currently running for research and to serve as specialist referral centres for MOPD chronic patients has assisted with ensuring regional hospitals and neighbouring provinces. that patients collect treatment closer to their homes; it also reduces overcrowding in pharmacies. The Signifi cant Achievements by the Tertiary and project got an award. Central Hospitals The Department has invested in specialised medical Tertiary Hospitals equipment such as an Automated Breast Ultrasound To improve the quality of care and patient experience at Dr George Mukhari Academic Hospital to enable of care, these hospitals have improved waiting times better clinical diagnosis of breast cancer. Phillips for retrieval of fi les from 4 hours to 30 minutes. A has sponsored the renovation of a room for the contributory factor has been the scanning of fi les for Fluoroscopy unit in Radiology building December electronic archiving. There were also improvements 2017. in the results of the National Health Core Standards There are pockets of excellence across the hospitals. Self Assessments, with scores improving from 59% in For example, HOD of General Surgery Professor Koto 2013 and 68% in 2016 to self-assessment results of was appointed the fi rst Black President of the South 91% by end of the 4th quarter of 2017. Previously, in African Surgical Society in 2017. the Orthopaedics departments, children were mixed with adults. A new ward for children has now been A priority for the Department is to sustain and build established. its relationships with its various stakeholders and partners, from which it derives various benefi ts. The The achievements were attained despite challenges Charlotte Maxeke Johannesburg Academic Hospital regarding staff establishment, ICT infrastructure Pink Day initiative, in collaboration with Cricket South and the increasing demand for services at Tertiary Africa, raised R1.7 million for the upgrade of Area 51 hospitals. 348: Breast Clinic for Phase 1, with an estimated cost Central Hospitals of R4.5 million.

To improve patients’ quality of life, Chris Hani Challenges Baragwanath and Bheki Mlangeni hospitals provide Paying invoices within 30 days remained a high volume cataract removal services to reduce the challenge during the reporting period. In 2018/19, backlog and waiting time for new cases. management will continue to engage suppliers to Effi ciencies in providing surgical procedures are being ensure requirements for payment are submitted realised through close monitoring and supervision timeously to reduce supplier related delays. Litigation of theatres leading to improved theatre utilisation is a high cost driver for the Central Hospitals. Efforts from 75%-80%; an increasing number of cases are being made to address medico-legal challenges. are completed daily at Chris Hani Baragwanath Long-term frustrations with infrastructure, ICT Academic Hospital. Theatre outputs have also equipment and limitations on appointments have improved and waiting time for emergency theatre caused overwork and stress for clinical staff, especially has been reduced from 24hrs to less than 4 hours. nurses. Modernisation of systems (especially HIS) To provide specialist outreach to cluster hospitals, would catalyse improvements in effi ciency. the surgical team is running four units at BMH for There is a lack of Psychiatry beds in the hospital and elective cases. Ward rounds by CHBAH specialists at patients are sleeping in the Accident and Emergency BMH (Internal Medicine) has reduced overcrowding department and short stay ward. in the internal medicine wards and also helps to Performance indicators: Programme 5 – Tertiary Hospital Services

Sub-Programme: Tertiary Hospitals Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/2018 2017/18 planned target 2017/18 Increase compliance with national core standards to 100% in 2019/20, and complete self-assessments in all hospitals Hospital achieved 75% 66% 100% 34% Target exceeded 75% and more (2/3) (3/3) on National Core Standards self- assessment rate (Tertiary Hospitals) Improve hospitals’ effi ciency by reducing average length of stay to less than 5 days, increasing bed utilisation to 82% and decreasing expenditure per PDE in hospitals by 2019/20 Average length 6.0 days 5.7 days 5.8 days 0.1 days Within target range of stay (Tertiary Hospitals) Inpatient bed 85.1% 82% 85.3% 3.3% Less than 10% deviation from utilisation rate target. Higher burden of disease seen seasonally. Expenditure R3 009 R2 900 R3 472 R572 Ongoing PDE review discussions per patient day and recalculations throughout the equivalent (PDE) fi nancial year in light of increased population and burden of disease. Percentage of complaints resolved within 25 working days will be >95% in 2019/20 Complaints 87.4 % 95% 88.2% 6.8% Most complaints not resolved within resolution rate 25 working days are complex and (Tertiary Hospitals) require expert opinion. They are 52 managed as PSI and must be closed as complaints at facilities and can be resolved within 60 working days or more. Serious complaints are more time consuming than straightforward complaints. Once classifi ed as SAEs, complaints must be closed on the complaints register. Complaints 99.8% 100%34 100% 0% Some complaints are serious in resolution within nature and take longer to resolve. 25 working days The target was not achieved as rate complex cases referred as Patient Safety Incidents (PSIs) required more detailed investigation. There are delays in attending to complaints at facility level. Complaints Committees are not functional. Weekly reminders are sent to the CEOs and District Chief Directors. A Provincial Patient Safety Incident Committee (PPSI) has been appointed to deal with complex cases. A Provincial Patient Safety Medico-legal (PPSML) team is in place to assist. A complaints management checklist has been developed to assist facilities to identify gaps that lead to failure to close complaints on time. Sub-Programme: Tertiary Hospitals Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/2018 2017/18 planned target 2017/18 Reduce Outpatient Department (OPD), Accident and Emergency and Pharmacy Departments waiting times across all facilities by 60% in 2019/20 Percentage of # 33% 2/3 1/3 To support strengthening of the hospitals with OPD (1/3) governance and referral system average treatment across the various levels of hospitals. waiting times below agreed benchmark of 240 minutes Percentage of # (1/3) 0% (0/3) 0/3 None of the hospitals are hospitals with P2-3 complying. The Department is patients attended piloting a new tool to collect data at to within 160 Helen Joseph Hospital. minutes average treatment waiting times Accident and Emergency Department Improve staff (health professionals, administration clerks, cleaners and porters) attendance at OPD and Accident and Emergency across all health facilities by 90% Percentage staff # 58% 70% 100% 30% Target exceeded attendance at OPD, Accident and Emergency Departments

Performance indicators: Programme 5 – Central Hospital Services 53

Programme: Central Hospital Services Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/2017 2017/2018 2017/2018 planned target 2017/2018

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

Hospital achieved 100% 100% 100% 0% Target achieved 75% and more (4/4) (4/4) on National Core Standards self- assessment rate (Central Hospitals) Improve effi ciency of hospitals so that waste, expense and unnecessary effort are reduced and bed utilisation in each hospital is rather optimal Average length 5.6 days 6.8 days 7.9 days 1.1 days Outliers affect the institutional of stay average. For example, psychiatric patients awaiting beds in specialist hospitals, neurosurgery patients requiring long rehabilitation, rehabilitation patients diffi cult to discharge safely into lower levels of care if they are foreign nationals or have inadequate papers. Inpatient bed 80% 78% 82.6% 4.6% On target. The BUR pattern is utilisation rate seasonal, with a spike in the winter months. Programme: Central Hospital Services Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/2017 2017/2018 2017/2018 planned target 2017/2018

Expenditure R3 814 R3 700 R4 137 R437 PDE review discussions and per patient day recalculations have been held equivalent (PDE) throughout the fi nancial year in light of the increased population and burden of disease. The percentage of complaints resolved within 25 working days will be over 95% in 2019/20 Complaint 92.5% 95% 87.8% (7.2%) • Weekly reminders about resolution rate unresolved complaints are (Central Hospitals) sent for the attention of the CEOs and District Chief Directors responsible.

• A Provincial Patient Safety Incident Committee (PPSI) has been appointed to deal with such cases. A Provincial Patient Safety Medico-legal (PPSML) team is also in place.

• A complaints management checklist has been developed to assist facilities to identify gaps that lead to failure to close complaints on time. Complaint 98.4% 98 % 99.2% 1.2% Target exceeded. resolution within 54 25 working days rate Reduce Outpatient Department (OPD), Accident and Emergency and Pharmacy Departments waiting times across all facilities by 60% in 2019/20 Percentage of # 50% 75% (3/4) Dr George There will be continuous support hospitals with OPD Mukhari visits to Dr George Mukhari average treatment Academic Academic Hospital to review its waiting times hospital was queue management system, the below agreed the only accuracy of measurement of the benchmark of 240 hospital with waiting times and the effectiveness minutes waiting times of the booking and referral system. in Q4 above 240 minutes (time was 490 minutes) Percentage of # 50% 0%(0/4) (50 %) None of the facilities are complying hospitals with P2-3 with the waiting time target for all patients attended categories of patients: e.g. P1-3. to within 160 Intervention strategies will include minutes average support visits, root causes analysis treatment waiting and corrective measures. times: Accident and Emergency Department Improve staff (health professionals and administration) attendance at OPD and Accident and Emergency across all health facilities by 90% Percentage staff # 58 70% 79% (53%) 9% (-17%) The Work-stream has developed an attendance at Annual Staff Attendance Support OPD, Accident Work Plan that visits all facilities, and Emergency with those at risk prioritised for Department intervention as required. Steve Biko Academic Hospital Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Increase level of effi ciency in Hospitals Hospital achieved 100% Yes yes None Target met 75% and more on National Core Standards self-assessment rate (Steve Biko Hospitals) Average length 8.7 days 7 days 8 days 1 day Complex and acute cases tend of stay to require long stay. Lack of step- down facilities results in patients not requiring specialist care and some no hospital care remaining for months as lower level facilities are full and Social Development have tight criteria for assisting, especially with unknown patients. Lack of staff and especially specialised nurses for critical care and operating theatres leads to cancellation of cases. Inpatient bed 84.3% 80% 85.9% 5.9 % Beds were fully utilised even though utilisation rate refl ecting overcrowding. This has negative effects including infection control and risks compromised care. Patients stay longer due to high acuity and complexity of the diseases. The high number of critical 55 care beds adds to long stays as do patients not following the referral policy. Expenditure R4 110 R4 500 R 4862 R 362 Savings and strict control of costs per patient day were applied and yielded results. equivalent (PDE)

Complaints 95% 87% 89.9% 2.9% Some complaints take long to resolution rate resolve; however, efforts are being made to manage and resolve them. Complaints 95.4% 95% 98.3% 3.3% Complex complaints come from all resolution within avenues. As legal claim, complaint 25 working days and media claim are resulting in rate delay of fi nalizing. Percentage of # yes yes none Target achieved. The ticket hospitals with OPD method for queue management average treatment is contributing outstandingly to waiting times effective sorting and prioritising of below agreed patients. benchmark of 240 minutes Percentage of # Yes Yes none 139 minutes achieved. Staff support hospitals with P2-3 and empowerment in managing patients attended waiting times to be reinforced for to within 160 sustainability of the project. minutes average treatment waiting times: Accident and Emergency Department Percentage of # 70% 62% (8%) A new Deliverology Tool will be staff attendance rolled out by end of May 2018 to at OPD, Accident accurately collect the data. and Emergency Department Dr George Mukhari Academic Hospital Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18

Hospital achieved 100% Yes Yes None Target achieved 75% and more on National Core Standards self- assessment rate Average length 8.1 days 7 days 7.8days 0.8 days Service patients from Level 1 of stay to level 3 and tertiary patients including limited theatres to support the institution, limited ICU beds resulting in prolonged occupancy and increased in burden of diseases.

Inpatient bed 78% 80% 77.9% (2.1%) Service patients from Level 1 to utilisation rate level 3 and tertiary patients. Lack of regional hospital in the cluster, resulting in high occupancy of beds.

Expenditure R 3 754 R3 800 R4154 R354 Stricter cost management will be per patient day implemented. equivalent (PDE)

Complaint 102.3% 98% 98.6% 0.6% Target exceeded. The head resolution rate count in the facility is three times higher than in any other Central Hospital. Redress meetings towards 56 resolution were held at a later stage thus the 100% achievement. Complaint 98% 98 % 98.6% 0.6 % Target achieved due to continuous resolution within implementation and practice of the 25 working days DPOS (Daily Patient Opinion Survey) rate system which enables the patients to voice their opinions before a serious challenges arises. Percentage of # No No None The hospital will have to be visited hospitals with OPD and be engaged to review its average treatment patient triaging systems and the waiting times effectiveness of the booking and below agreed referral systems. Dr George Mukhari benchmark of 240 was the only hospital with waiting minutes times for Q3 above 240 minutes (490 minutes).

Percentage of # No No None Introduction of the new version of hospitals with P2-3 managing waiting times, viewed as patients attended patient waiting time for treatment to within 160 not considering the whole patient minutes average journey, will make a difference to treatment waiting the analysis of waiting times results. times Accident and Emergency Department Percentage staff # 70% 82% 12% Data quality problems contributed attendance at to the deviation. The Deliverology OPD, Accident staff attendance tool will be and Emergency implemented and support visits Departments planned. Charlotte Maxeke Johannesburg Academic Hospital Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Increase level of Effi ciency in Hospitals Hospital achieved 100% Yes 100% 0 Target met 75% and more on National Core Standards self- assessment rate Average Length 6.7 days 7 days 7.5 days 0.5 days The hospital has no control over of Stay the disease profi le of patients. Due to the level of care offered at a Central Hospital, there are very sick patients and large numbers of referrals are received daily. Doctors do ward rounds to refer to step down facilities. Inpatient Bed 85% 78% 86.8% 8.8% C.M.J.A.H. bed occupancy ranges Utilisation Rate between 80% and 90%. The hospital is always above the target due to increased referrals from cluster hospitals and inter-provincial hospitals. Increased disease burden. Expenditure R 3 916 R3 000 R4407 R1407 With the new proposed expenditure per patient day per PDE of R4328, it must also be equivalent (PDE) taken into consideration that for Q4 cost containment measures were in place. 57 Complaint 83.7% 100% 92.9% (7.1%) Redress meetings towards resolution rate resolution were held. Complaint 100% 95% 100% 5% Complaints are dealt with resolution within promptly within 15 days to ensure 25 working days compliance and that the target is rate achieved. Percentage of # Yes Yes None Regardless of the improvement, hospitals with OPD the intervention strategies are average treatment to be reviewed including patient waiting times triaging systems; effectiveness of below agreed referral systems; and accuracy of benchmark of 240 measurement of waiting times for minutes casualty. The hospital has improved tremendously as against 276 minutes of the previous quarter.

Percentage of # Yes Yes None Staff support and empowerment hospitals with P2-3 in managing waiting times to be patients attended reinforced. Improvement of 167 to within 160 minutes against 276 of the previous minutes average quarter. treatment waiting times: Accident and Emergency Departments Percentage staff # 70% 86% (OPD) OPD on target Incomplete reports submitted from attendance at A & E; this will be addressed with OPD, Accident the managers concerned. and Emergency Departments Chris Hani Baragwanath Academic Hospital Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Increase level of effi ciency in Hospitals Hospital achieved 100% Yes Yes None Target met 75% and more on National Core Standards self- assessment rate Average Length 7.9 days 6.5 days 8 days 1.5 days Patients overstay mainly in medical, of Stay neurology and burns units as there are limited lower level beds within the cluster where they can be down referred to. Delays on diagnostics such as MRI also contribute to longer stays in the hospital. Inpatient Bed 78% 79% 82.6% 3.6% Actual performance % within the Utilisation Rate norm. In 2018/19, the Clinical HoDs will work with management to ensure that South Rand Hospital and BMH are provided with the necessary support so that the patients can be down referred to reduce overcrowding in the medical wards. Expenditure R3 641 R3 700 R3661 R39 The reported fi gure is an per patient day underestimate of the actual spend equivalent (PDE) for the period as not all invoices 58 for services received in the period were paid due to cash fl ow limitations and accruals worth R400 million that had to be paid at the beginning of the fi nancial year. Complaint 74.6% 100% 73.2% 26.8% Target not achieved. High numbers resolution rate of patients overwhelm service points at the hospital which leads to unsatisfactory treatment and high numbers of complaints. A complaints management checklist has been developed. Training on complaints management was conducted, Complaint 100% 80% 100% 20% Target achieved. resolution within 25 working days rate Percentage of # No Yes None Continuous support visits and hospitals with OPD empowerment of all staff members average treatment on reducing waiting times. waiting times below agreed benchmark of 240 minutes Percentage of # No Yes None Regardless of the improvement, hospitals with P2-3 the intervention strategies are Patients attended to be reviewed including patient to within 160 triaging systems; effectiveness of minutes average referral systems; and accuracy of treatment waiting measurement of waiting times for times: Accident casualty. and Emergency Department Chris Hani Baragwanath Academic Hospital Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Increase level of effi ciency in Hospitals Percentage staff # 70% 91% 21% Target exceeded. attendance at OPD, Accident and Emergency Departments

Expenditure: Programme 5 – Central Hospital Services

2016/2017 2017/2018

Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Central Hospitals 10 316 924 10 516 108 (244 184) 11 839 981 11 986 766 (146 785) Provincial Tertiary Hospital Services 3 072 473 2 826 316 246 157 3 493 060 3 329 921 163 139 13 389 397 13 387 424 1 973 15 333 041 15 316 687 16 354

59 Programme 6: Health Sciences and Training Programme Purpose and needs within the clusters and hindrances to spending and to develop strategies to address the The Health Sciences and Training Programme is effects of funding defi cits by submitting cluster- strategically positioned to plan for, produce and based HPTDG business plans to cater for the needs manage the education, training and development across the clusters. needs of the Gauteng Department of Health. It is designed to comply with relevant legislative and Grant expenditure reached the maximum 100% as policy mandates at national, provincial and local required by National Treasury. For 2017/18, the table level and to respond to service transformation below shows the outcomes of the grant: placements imperatives. Priorities include support for the of those professionals who qualifi ed through the Service Transformation Plan, re-engineering of training platforms and now serve either as interns or PHC, expansion of the HIV and AIDS, STI and TB as community service professionals. Programmes and implementation of NHI. Health Category January 2018 List of Sub-Programmes Placements Medical Interns The Professional Development Directorate includes: 430 Clinical Psychologist Interns • Regional Training Centres 48 • Professional Development Pharmacist Interns 62 • Bursary Section Dentists 15 • Professional Service support Dieticians 57 • Lebone College of Emergency Care Environmental Health Practitioners 36 • Leadership Management and Skills Development Medical Doctors Directorate 236 • Employee Health and Wellness Programme Occupational Therapists 86 Directorate Pharmacists 89 Physiotherapists 60 Strategic objectives 102 Radiographers • Improve achievement of national norms for the 97 supply of health professionals Speech & Hearing Therapists 62 • Improve compliance with the legislative Totals 1320 framework • Respond to GDoH’s staff education, training and Business plans for the 2018/19 fi nancial year have development needs been submitted and approved by the National • Provide employee health and wellness services to Department of Health and National Treasury for improve productivity and staff morale implementation. • Contribute to the job-creation mandate through Lean Management targeted youth empowerment Programmes. During the fi nancial year, the Lean Management Signifi cant Achievements project was moved to the HRMD and OD branch In the 2017/18 fi nancial year, the HPTDG subsidised from Communications and the Offi ce of the MEC. the Department for the cost of producing Health Lean Management, used in the business sector, Sciences professionals by funding the salaries of 553 has been identifi ed as an effective and effi cient professionals. The staff members funded ranged organisational development tool that will ensure that from specialists, registrars, clinical supervisors the Department meets its objective of doing more (including nursing and allied health professionals) with less. and grant management within the administration Twelve institutions were earmarked for the support section of the Department. introduction and implementation of Lean The DORA prescribes that support visits should Management in the reporting year, an addition of 6 be made to all grant-receiving institutions for the institutions to the 6 that were already implementing purposes of monitoring and support. In 2017/18, the practice. four cluster support meetings were held in the Due to fi nancial constraints, the unit still functions four clusters. The meetings served, among other with only 2 dedicated facilitators along with 14 purposes, to monitor current expenditure patterns trained practitioners in the different institutions. This as the Department is facing over-expenditure in COE limited the ability to expand the Programme to more and also had to deal with legal matters as four doctors units within each institution and to other hospitals have sought legal action against the Department. and clinics. The Bursary Fund However, 4 more clinics were introduced to the Lean Management practice, with training and The fund provides bursaries to external full-time implementation earmarked for the new fi nancial students in medical, allied and other related health year. professions and to internal qualifying staff members to improve performance in functional areas. A total During this fi nancial year, three hospital CEOs (from of 50 fi rst year medical students and 726 in different Dr George Mukhari, Leratong and Charlotte Maxeke) health sciences categories, for employees 104 staff were trained and coached by the Lean Management members were awarded bursaries to upgrade their international Institute, through Skype and physical skills and knowledge in functional areas. interactions. Due to fi nancial constraints, fewer CPD point related The Department participated in the Lean Summit trainings, including funding the annual registration in August 2018, with more than 30 participants with the Resuscitation Council of South Africa, were attending. Three Gauteng Lean Management carried out. The accreditation of Lillian Ngoyi CHC as practice experiences were presented at the summit, a BLS training centre is negatively affected because among international experiences shared. of the lack of BLS training manuals. Poor course attendance resulted in non-achievement of courses A team of three Gauteng employees will be like doctors HIV and AIDS training and participating in other international Lean Management summits across the globe, starting in June in America NIMDR (TB) and September in the Netherlands. Non-payment of universities resulted in accruals of R Through the Lean Management projects, there has 9m including an over expenditure of R 1.4m. This is been an average 60% reduction in patient waiting to be funded in the new fi nancial year thus reducing times at the implementing institutions. the numbers to be funded in the fi nancial year. 61 Professional Services Support Additional statutory placements by NDoH resulted in the appointment of professionals in non-funded Professional Services Support in the Health Sciences posts. component contributes to the development, The following remedial plans include a thorough management and support of medical and allied skills audit and need analysis to be carried out in all health professionals, facilitating their placement districts to ensure that training is needs based: in institutions according to the needs identifi ed. The compulsory Community Service Programme i. Reduce days of training from 10 to 5 days. for medical doctors, pharmacists, dentists and ii. Implement distance and e-learning. allied health professions is legislated. The quality iii. Encourage and motivate districts to train the of the practical skills gained during internships and courses such as IACT SGF during Quarter 1&3 to community service is based on the availability of avoid training when funds have been depleted or competent clinical mentors. the Procurement Department has closed for the fi nancial year. In the fourth quarter of 2017/2018, 1359 professionals (medical interns and community service iv. Encourage onsite, next to point of care training. in various health professionals) were placed: 429 Reduce targets and target units and facilities as medical interns, 226 medical doctors, 91 pharmacists, opposed to numbers to have more impact. 61 pharmacy interns, 97 radiographers, 54 clinical Nursing psychologists, 48 clinical psychology interns, 64 speech and hearing therapists, 102 physiotherapists, Training of nurses at undergraduate and post-basic 87 occupational therapists, 56 dieticians and 36 level. The target group includes actual and potential environmental health practitioners. Forty-seven employees. The Chief Directorate Nursing was (7 physiotherapists, 2 occupational therapists, 4 established in 2014 in line with the National Strategic pharmacists, 3 dieticians, 9 Community Service Plan for nurse education, training and practice doctors and 21 medical interns) are additional. 2012/13 to 2016/17. Its purpose was to revitalise Placement of additional professionals is a challenge the nursing profession to ensure competent and safe nursing practice. The following were the outputs of (263) PHC facility managers attended management nursing related interventions: and leadership development Programmes. A total of 4395 employees were trained on the Code of Nursing Education and Training Conduct in the public service, against a target of 3300. The number of graduates who went through the 4 public nursing colleges and 2 satellites linked to Chris In fi nancial year, 10297 staff and managers Hani Baragwanath Nursing College. In addition, the benefi ted from various skills Programmes. 1769 Department funds 4 universities (UP, SMU, WITS and managers participated in various management and UJ) to train basic nursing students. By March 2018, leadership development Programmes including the number of all categories of nurses produced was Foundational, Emerging, Middle and Senior 1451. Of these, 463 were specialists. Management Development Programmes. A total of 44 clinical managers were nominated for the Clinical One of the priorities of the Department is to improve Management Programme. maternal and child health. To this end, the Perinatal Education Programme for nurses was initiated to The Department continues to support 15 managers up-skill midwives to improve midwifery practice and who were enrolled in the Albertina Sisulu Executive prepare prospective Advanced Midwifery candidates. Leadership Programme for Health (ASELPH) in By the end of March 2018; 393 midwives had gone 2016/17 over the two-year period of the Programme through the Programme. delivery. ASELPH is a fl agship Programme developed by the National Leadership Academy in collaboration Leadership Management and Skills Development with the Universities of Pretoria, Fort Hare and (LMSD) Harvard. It aims at ensuring competent health The Leadership Management and Skills development managers who are able to steer health sector reform. Programme ensures compliance with the Skills To redress past injustices and increase the educational Development Act, the National Skills Development level of lower graded staff and improve their access Strategy III and works closely with the SETAs to meet to the career ladder, 379 participants who were a range of key requirements. 62 admitted into Adult Education and Training (AET) In the year under review, the Directorate achieved Programmes in the previous fi nancial year continued and exceeded all three APP indicators as follows: to be maintained and supported to ensure that they 83% (30) CEOs of hospitals participated in various meet all their learning outcomes. management development Programmes while 71% Performance indicators: Programme 6 – Health Sciences and Training

Programme: Health Sciences and Training Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/2017 2017/2018 2017/2018 planned target 2017/2018 (Over (Under) Increase employee satisfaction rate to 75 % by 2019/20 Employee 65.5% 75% 50.13% (24.9%) Purposive sampling and assessment satisfaction rate of staff satisfaction at two of three institutions. Increase access to training opportunities for staff Including heads of 95% institutions by 2019/20 Percentage of 69% (25%) 75% 83% 8% Target achieved and exceeded hospital CEOs (30/36 CEOs) by 8%. This was made possible trained on due to partnership with Gauteng leadership and City Region Academy (Provincial management Academy) on: online Lancaster Programme (10 CEOs); Khaedu Project (5 CEOs); Financial Management for Hospital CEO (15 CEO). Percentage of 47% 67% 71% 4% Positive responses received from PHC facility (173/372) (263/372) managers about the quality and managers trained relevance of training Programmes on leadership and offered. management Increase awareness of ethical conduct for all staff by offering code-of-conduct training to 30% of employees in 2019/20 63 Percentage of 7.5% (4 056) 20% (13 200) 33% 13% Code of conduct was integrated employees trained 8451 into the curricula of other training on code of Programmes as a stand-alone conduct module to increase the numbers trained. Increase the number and quality of health professionals by increasing the number trained annually to 1 600 by 2 020 Number of 17 50 50 0 The intake of 50 fi rst year medical bursaries awarded students was paid in the 2017/2018 to fi rst year fi nancial year. No new intake for the medicine students 2018 academic year. Increase the number of new nursing students to fulfi l replacement annually to 1000 by 2019/20 Number of 1 090 1000 984 16 Only a small number of the bursaries awarded applications received qualifi ed for to fi rst year intake. The Department will improve nursing students recruitment drives and sit in at selection of students at universities. The Gauteng universities (Wits, SMU, UP and UJ) could not reach the set target. Expenditure: Programme 6 – Health Sciences and Training

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Nurse Training Colleges 782 298 743 753 38 545 738 369 747 136 (8 767) EMS Training Colleges 38 944 31 347 7 597 34 961 34 953 8 Bursaries 162 130 217 247 (55 117) 86 546 68 676 17 870 Other Training 70 752 61 716 9 036 68 595 68 222 373 1 054 124 1 054 063 61 928 471 981 987 9 484 Programme 7: Healthcare Support Services Programme Purpose permanent hire scheme from 72 to 57 to reduce monthly G Fleet expenditure. The purpose of this Programme is to provide support • Reduced the value of prior year commitments services to the Department so that it can achieve its from R1.1 billion at 31 March 2017 to R96 million aims. The sub-Programmes are: at 31 March 2018. • Laundry services: Providing a laundry service • Went live with the SAP Inventory Management to hospitals, care and rehabilitation centres and Pilot Project at Steve Biko Academic Hospital on certain local authorities 26 February 2018. • Engineering Services: Providing a maintenance Pharmaceutical Services service to equipment and engineering installations, and minor maintenance to buildings. During the year under review, pharmaceutical • Forensic services: Providing specialised forensic services maintained medicine availability at 98% and and medico-legal services to establish the achieved its target. To improve access to medicines, circumstances and causes surrounding unnatural the Department increased enrolment on the deaths CCMDD from 268 974 to 410 075 patients. It also • Orthotic and prosthetic services: Providing formed a partnership with an NGO to implement specialised orthotic and prosthetic services remote automated dispensing units (known as • Medical trading account (Medical Supplies ATM pharmacies) at Alexander Complex, Bara Mall Depot): Managing the supply of pharmaceuticals and Ndofaye Mall; this assisted access to chronic and medical sundries to hospitals, CHCs and local medicines. authorities. Other innovations to enable business processes Summary of Signifi cant Achievements to support the modernisation policy include implementation of in-pharmacy automated Supply Chain Management dispensing robots at Helen Joseph Hospital and 64 During the year under review, no unsolicited bid Steve Biko Academic Hospital pharmacies. This frees proposals were concluded. Management has the limited human resources in pharmacy to spend implemented control measures to ensure compliance time in the wards. Previously, many pharmacists had with Treasury Regulations and Instruction Notes to be at Outpatients units, spending little time with relating to deviations from normal procurement in-patients. processes. The Department will ensure compliance The MSD in-house development of the MSD-on-line with the applicable legislation that regulates system, an electronic ordering portal and document deviations. During the 2017/18 fi nancial year, SCM management system, has improved the fl ow of accomplished the following: documents between MSD and suppliers and thus • Exceeded the Preference Procurement spend improved payment time of undisputed invoices. targets in the following categories: o BBBEE contribution target was 80%; the During the year under review, the Department Department achieved 84.92%. increased the number of facilities where Electronic o Youth contribution target was 10%; the Gate Keeping is implemented. An evaluation will be Department achieved 10.32%. done to assess the level of cost saving resulting from • Reduced the number of GG vehicles under the this. Expenditure: Programme 7 – Healthcare Support Services

Healthcare Support Services Strategic Actual Planned Actual Deviation from Comment on deviation objective achievement target achievement planned target 2016/17 2017/18 2017/18 2017/18

Establish accurate cost base for Health Department budget Percentage of 18 % 30% 16.7% (13.3%) Gauteng Provincial Treasury budget spent is responsible for establishing on township transversal contracts for these enterprises commodities. The tender for against identifi ed bread was cancelled by Gauteng commodities Provincial Treasury and the contracts for fresh vegetables and fresh fruit were only awarded on 15 May 2018. Increase % of vital medicine available and accessible from 82% in 2013/14 to 99% by 2019/20 Percentage of vital 98.6% 98% 96.8% (1.2%) Target not achieved. Late medicine available (406/418) awarding of national medicine at health facilities contracts and non-awarding of some of the items led to variability in the availability of some of the items. Sourcing through quotations was implemented as a short-term measure. However, the supply did not meet the demand. Action Plan: pursue provincial medicines contracts to prevent potential risks posed by national 65 contracts. Increase % of essential medicine available and accessible from 82% in 2013/14 to 99% by 2019/20 Percentage of 98.1% 98% 97.6% (0.4 %) Target not achieved. Late essential medicine (527/538) underperformance awarding of national medicine availability at contracts and non-awarding health facilities of some of the items led to variability in the availability of some of the items. Sourcing through quotations was implemented as a short-term measure; however, the supply did not meet the demand. Increase access to chronic medication for stable patients through 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 268 974 270 000 410 075 140 075 Target achieved. Voluntary patients enrolled participation to the CCMDD on centralised programme exceeding the chronic medicine target shows improved patient dispensing and enthusiasm for receiving distribution medication from pick up points Programme close to home or place of work. Improve quality of NHLS services delivered to GDoH by increasing turn-around times for laboratory test results by 33% by 2019/20 Percentage of 98.4% 90% 96.7% 6.7% Target achieved and exceeded. Gene-xpert results 363 779/369 284 765/294 Periodic reporting and continued available within 48 685 463 monitoring of this indicator has hours enabled the NHLS to develop appropriate intervention measures. Expenditure: Healthcare Support Services

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000

Laundries 190 488 184 992 5 496 213 145 208 732 4 413 Food Supply Services 68 040 63 501 4 539 76 692 81 035 (4 343) Medicine Trading Account 1 - 1 1 - 1 258 529 248 492 10 037 289 838 289 767 71

66 Programme 8: Health Facilities Management Purpose • Tshwane District Hospital refurbishment of Ward The purpose of the Programme is to plan and deliver 4A: completed in March 2018 new health facilities and to refurbish, upgrade and • Kekana Gardens Clinic: completed in March 2018 maintain existing facilities. • Sterkfontein Ward 5: completed in August 2017 • Chris Hani Baragwanath Academic Hospital Strategic Objective Psychiatric Ward: completed and fi nal account settled in January 2018. Increased effi ciency of service implementation through infrastructure delivery, good governance The Thelle Mogoerane Staff Residence was handed practices and sustainable maintenance of moveable over in December 2017. and immovable assets. Construction commenced for the following clinics: LIST OF SUB-Programmes • Mandisa Shiceka Clinic: commenced in October • District Health Services 2017. • Community Health Facilities • Dilopye Clinic: commenced in July 2017 • Provincial Hospital Services • Boikhutsong Clinic: commenced in May 2017 • Central Hospital Services • Emergency Medical Services Twenty-one health facilities in the NHI pilot district • Other facilities were targeted for maintenance during the fi nancial year. Maintenance in preparation for the NHI was FUNDING SOURCES undertaken and completed at all these facilities Hospital Facility Revitalisation Grant (HFRG) • Pretoria FPS The HFRG is provided by the National Department of • Pretoria West Hospital Health. Its purpose is to: • Weskoppies boundary wall • Cullinan State House Phase 1 • Help accelerate the construction, maintenance, • Jubilee Gateway Clinic upgrading and rehabilitation of new and existing • Tshwane District Hospital 67 health infrastructure including health technology, • Jubilee Hospital Organisational Design (OD) systems and Quality • Kalafong Hospital assurance (QA) • Laudium CHC • Supplement expenditure on health infrastructure • Kgabo CHC delivered through public-private partnerships • Mamelodi • Enhance capacity to deliver health infrastructure. • Refentse Clinic Equitable Share (ES) • Tshwane Rehab • Ga-Rankuwa FPS • This is a voted fund allocated by Provincial • Winterveld Clinic Government to be used for both maintenance • Zamile Clinic and capital projects. • Sokhulumi Clinic • K.T Motubatsi Clinic Extended Public Works Programme (EPWP) • Bophelong Clinic • Block The EPWP provides work opportunities through • Lethabong Clinic the use of labour intensive delivery methods in the following areas: Strategies to overcome areas of under-performance: • Maintenance of buildings • Implement projects more speedily to avoid • Landscaping and gardening projects changes to the work scope • General cleaning of hospitals. • Speedy resolution of emerging disputes • Enforce implementation of Service Level Signifi cant Achievements Agreements (SLAs) The following were completed in the fi nancial year: • Improved onsite monitoring of contractors • Tshwane District Wet Services: completed in • Ensure that competent service providers are December 2017 appointed. • Appoint adequately skilled personnel. Performance indicators: Programme 8

Health Facilities Management Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Build 10 new clinics/community health centres and 2 additional new hospitals and refurbish 21 health care facilities by 2019/20 of which 100% will comply with the gazetted norms and standards for such facilities. Number of health 0 completed 2 capital 2 0 1) The target completion date for facilities that projects Tshwane District Wet Services was have undergone 1)Tshwane 31 March 2018. It was completed major and minor District on 14 December 2017. refurbishment in Hospital 2) The target completion date for NHI Pilot District External Tshwane District Ward 4a was 28 Wet Services February 2018. It was completed contract on 09 March 2018. The delay was 2)Tshwane due to rectifi cation of defects and District cleaning of wards. Hospital Refurbishment Contract 4A Number of health 0 2 completed: 1 1 1) The target for Bophelong was facilities that 1) Bophelong not met as the project had to go have undergone back to planning because the major and minor 2) Phedisong district requested a larger clinic refurbishment 4 and not a small prototype clinic. outside NHI Pilot Project Initiation Reports (PIRs) are District being prepared; to be approved in 2018/19 before project planning commences. 68 The fi nal scope of the project needs be compiled with the Sedibeng District. The project was replaced with the CMJAH psychiatric ward due to be completed by 30 August 2018. 2) Phedisong 4 could not be completed in 2017/18 because of land challenges. The project was replaced with Sterkfontein Psychiatric Hospital – Ward 5 refurbishment. This has been completed. Health Facilities Management Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Build 10 new clinic/community health centres by 2019/20, of which 100% will comply with the gazetted norms and standards Number of additional clinics 6 completed: 2 completed 4 were not Randgate Clinic was completed in constructed and CHCs Dewagensdrift completed: the 2016/17 fi nancial year. under construction Finetown Finetown Kekana Gardens: construction 1 completed Greenspark Khutsong 100% complete. Kekanastad Dewagendrift Dewagensdrift Clinic: construction Khutsong to be 86% completed on 31 July South Kekanastad 2018. Project not completed due to change in scope of the work which Randgate 0 under construction required the construction of an (2016/17) onsite sewer treatment plant. 6 under 6 under Finetown Clinic: delays due to construction: construction public unrest. PSP back on site and Boitumelo completion to be 30 November Clinic 2018. New Eersterus Greenspark Clinic: contractor was Clinic off site due to contractual dispute Dilopye Clinic (R9.6m variation order). Contractor is now back on site and new Mayibuye completion date is 31 August 2019. Clinic Kekanastad Clinic: termination of Boikhutsong contract due to non-performance. Clinic New contractor appointed and New Orange started work on 27 February 2018. Farm Clinic New completion date is January 2019. 69 Khutsong South Clinic: construction is at 86%. Slow progress on site, due to community unrest. Construction completion planned for 31 August 2018. Boitumelo: construction at 1% - 25%; to be completed in 2019. Contractor off site due to community unrest. New Eersterust: construction is at 1% - 25%. Construction halted by City of Tshwane until approval of site development plan. Dilopye: construction is at 1% - 25%; awaits permission to occupy site from Department of Rural Development. Mayibuye: site handed over but construction did not start as a library had been constructed on the site; the site was allocated for this purpose to GDOH. Boikhutsong: construction 1 – 25%’ to be completed by 29 May 2019. Layout had to be redesigned. New Orange Farm: tender was cancelled by adjudication committee; project to be re- tendered. Construction did not commence in 2017/18 as per target. Health Facilities Management Performance Actual Planned Actual Deviation Comment on deviation indicator achievement target achievement from 2016/17 2017/18 2017/18 planned target 2017/18 Build 2 additional new hospitals and refurbish 21 health care facilities by 2019/20 of which 100% will comply with the gazetted norms and standards. Number of Jubilee, Dr 1 under 0 under 1 under 1 project under construction: new hospitals Yusuf Dadoo, construction: construction construction Lillian Ngoyi. Clinical brief was constructed Kalafong and Lilian Ngoyi 9 under 0 under approved in August 2017 by NDOH. Sebokeng Hospital planning planning Revised designs were submitted hospitals 9 under to NDOH in September 2017 are at the planning: for approval before tender can feasibility commence. Construction stage stage Soshanguve was not achieved due to queries Hospital and delayed approval of designs by Daveyton NDOH. Hospital 9 projects under planning: Khayalami Hospital • Soshanguve Hospital: clinical Diepsloot brief approved by GDOH Hospital in August 2017. City of Tshwane (COT) identifi ed Jubilee Erf 1266 Soshanguve-T as Hospital suited for construction of the Kalafong hospital. The Department Hospital has accepted the donation Yusuf Dadoo of the site. Approval of the Hospital donation of the site by COT is currently underway. Sebokeng Hospital • Business cases for Dr Yusuf Tambo 70 Dadoo, Sebokeng, Tambo Memorial Memorial, Daveyton, Hospital Khayalami and Diepsloot are planned to be submitted for approval by NDOH in 2018/19.

The table below shows the main appropriation, adjustments and proposed second adjustment for the 2017/18 fi nancial year.

Category 2017/18 Financial Year Main Adjusted 2nd Decrease Increase Adjustment New Infrastructure Assets 809 860 855 553 660 846 194 707 - Renovations & Rehabilitations 184 400 133 400 89 648 43 752 - Upgrades and Additions 251 210 342 679 170 617 172 062 - Maintenance and Repairs 356 307 757 527 705 329 52 198 - Total 1 601 777 2 089 159 1 626 440 462 719 - The table below shows the infrastructure allocation per funding source. The Provincial Equitable Share (ES) reduced by R462.72 million (58%) compared to the Mid-Year Adjustment Budget.

Funding Source 2017/18 Financial Year Main Adjusted 2nd Decrease Increase Adjustment Conditional Grant 892 665 978 828 978 828 - - Health Facility Revitalisation Grant 890 665 976 828 976 828 - - EPWP 2 000 2 000 2 000 - - Provincial Allocation 709 112 1 110 331 647 612 - - Equitable share 709 112 1 110 331 647 612 462 719 - Total 1 601 777 2 089 159 1 626 440 462 719 -

Changes to planned targets • Shift the HFRG budget to maintenance, refurbishment and upgrade of existing facilities. During the 2017/18 mid-year adjustment, the overall • Release ES to pay for accrued liabilities. budget allocation was increased from R 1.6 billion to • Work with NDOH to redirect conditional grants R2 billion. Subsequent to this, another adjustment where appropriate. was made to adjust back down to R1.6 billion. This • All savings mobilised from the reprioritisations resulted in a decrease across all funding investment will be used to settle accrued liabilities. categories. The decrease was proportionally the largest in the three non-maintenance and repair To put into effect the ITT’s recommendations, the categories. following were considered in preparation for the second adjustment: In November 2017, the Health Intervention Task Team (ITT) was appointed. Recommendations made • Projects which were on the Adjustment Estimated by the ITT and approved by the Exco Lekgotla of 5 to Capital Expenditure (ECE) were allowed an 7 February 2018 included: allocation in the second adjustment equal to 71 estimated expenditure until 28 February 2018. • As far as possible, outstanding invoices must be • Allocations were made for gas infrastructure paid from the Health Facility Revitalisation Grant and the Condition Assessment as part of the (HFRG) to reduce pressure on ES. restorative and maintenance Programme. • Construction of new infrastructure is deferred to • The total allocation for HFRG remained, while the outer years when resources can be provided and allocation for ES reduced by R462 million. The current cost cutting initiatives bear results. impact of this decision is that the R462 million • No projects will be taken from the planning to can be utilised by GDOH for goods and services. the construction phase during the next year. • Infrastructure spending will be limited to An amount of R 120 million has already been utilised conditional grant (HFRG) allocation. for goods and services.

Expenditure: Programme 8 – Health Facilities Management

2016/2017 2017/2018 Sub-Programme Final Actual (Over)/Under Final Actual (Over)/ Name Appropriation Expenditure Expenditure Appropriation Expenditure Under Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Community Health Facilities 329 448 342 166 (12 718) 341 042 317 234 23 808 Emergency Medical Rescue Services 3 700 2 602 1 098 7 046 1 733 5 313 District Hospital Services 385 549 411 742 (26 193) 260 789 214 806 45 983 Provincial Hospital Services 552 776 513 983 38 793 288 934 214 807 45 982 Central Hospital Services 473 890 421 724 52 166 311 287 335 462 (24 175) Other Facilities 306 367 251 694 54 673 474 201 474 295 (94) 2 051 730 1 943 911 107 819 1 683 299 1 607 777 75 522 5. TRANSFER PAYMENTS Transfer payments to public entities

Table 7.1: Transfer payments to public entities, 2017/18

The table below shows the transfer payments made for the period 1 April 2017 to 31 March 2018.

Name of transferee Type of Purpose for Did the Amount Amount Reasons for organisation which the department transferred spent the funds funds were comply with (R’000) by the unspent by used S 38 (1) (j) of entity the entity the PFMA? Local Government Municipalities PHC Yes 298 550 298 550 Local Government Municipalities HIV/AIDS Yes 63 219 63 219 Local Government Municipalities EMS Yes 377 335 377 335 HWSETA NPOs Learnerships Yes 19 812 19 812 Universities Higher Education Training of Yes 12 061 9 786 Institutions Student Nurses Mental Health NPOs NPOs Psychiatric Yes 142 950 142 804 Community Based Services EPWP NPOs NPOs Community Yes 112 791 112 766 Based Services Nutrition NPOs NPOs Nutrition Yes 55 583 49 557 Supplement to Crèches Witkoppen Clinic NPOs PHC Yes 12 578 12 578 HIV/AIDS NPOs NPOs PHC Yes 85 960 86 948 72 Rehabilitation Services NPOs Rehabilitation Yes 1 597 1 597 Households Leave and Service Benefi ts Yes 98 895 98 267 Injury on Duty gratuities Nleson Mandel Children’s NPOs Paediatrics Yes 150 000 150 000 Hospital Chronic Pshych Care NPOs Psychiatric Yes 137 149 0 Community Based Services

Transfer payments to all organisations other entities as these are included in the previous section. than public entities This section also provides information about funds budgeted to be transferred but not transferred, and This section provides information about transfer the reasons for this. payments to provinces, municipalities, departmental agencies (excluding public entities), higher education institutions, public corporations, private enterprises, foreign governments, non-profi t institutions and households. This excludes payments to public 6. CONDITIONAL GRANTS

Conditional grants and earmarked funds paid

The table below shows the conditional grants and earmarked funds paid by the Department.

Conditional Grant: Health Facility Revitalisation Grant

Department/municipality to which the grant was NDOH transferred Purpose of the grant • Help accelerate construction, maintenance, upgrading and rehabilitation of new and existing infrastructure in health including health technology, organisational design (OD) systems and quality assurance (QA) • Supplement expenditure on health infrastructure delivered through public-private partnerships • Enhance capacity to deliver health infrastructure. Expected outputs of the grant • Number of health facilities planned: 5 • Number of health facilities designed: 14 • Number of health facilities constructed: 9 • Number of health facilities equipped: 3 • Number of health facilities operationalised: 2 • Number of health facilities maintained: 0 Actual outputs achieved • Number of health facilities planned: 1 • Number of health facilities designed: 4 • Number of health facilities constructed: • Number of health facilities equipped: 2 • Number of health facilities operationalised: 1 • Number of health facilities maintained: 0 73 Amount per amended DORA Not applicable Amount transferred (R’000) R 976 828 Reasons if amount as per DORA not transferred Not applicable Amount spent by the department/municipality (R’000) R 839 444 Reasons for the funds unspent by the entity 86% of the HFRG was spent. Targets could not be achieved due to the following reasons: • Late approval of planning documents • Delays in procurement • Land issues • Scope changes • Community unrest • Lack of delegations • Late payment of invoices. Monitoring mechanisms by the transferring department • Monitoring mechanisms during planning are: project plans, submissions, monthly design reviews and fi nalisation meetings. • Monitoring mechanisms during construction are: monthly progress review reports and meetings. • Re-enforcement of implementation of Service Level Agreement with GDID. • Identify and address reasons for late payments. • Improve approval processes by implementing delegations. Conditional Grant: National Tertiary Services Grant

Department/ municipality to which the grant was National Department of Health transferred Purpose of the grant Ensure provision of tertiary health services for all South African citizens (including documented foreign nationals) Compensate tertiary facilities for the costs associated with provision of these services Expected outputs of the grant Actual outputs achieved Amount per amended DORA (R’000) R 4 110 484 Amount transferred (R’000) R 4 110 484 Reasons if amount as per DORA not transferred N/A Amount spent by the department/ municipality (R’000) R 4 110 049 Reasons for the funds unspent by the entity (R’000) The grant underspent by R435 000. The under-spending on machinery & equipment resulted from delays in supply chain processes. Monitoring mechanisms by the transferring department Expenditure is monitored through monthly, quarterly and annual fi nancial reports.

Conditional Grant: Health Professions Training and Development Grant

Department/municipality to which the grant was National Department of Health transferred Purpose of the grant Support provinces to fund service costs associated with clinical training and supervision of health science trainees on the public service platform Expected outputs of the grant Ensure supply of trained health professionals 74 Actual outputs achieved Medical Interns 430 Clinical Psychologist Interns 48 Pharmacist Interns 62 Dentists 15 Dieticians 57 Environmental Health Practitioners 36 Medical Doctors 236 Occupational Therapists 86 Pharmacists 89 Physiotherapists 102 Radiographers 97 Speech & Hearing Therapists 62 Totals 1320 Amount per amended DORA (R’000) R 919 432 Amount transferred (R’000) R 919 432 Reasons if amount as per DORA not transferred N/A Amount spent by the department (R’000) 904 053 Reasons for the funds unspent by the entity (R’000) The underspending of R15 million was due to delays in supply chain processes with regard to machinery and equipment. However, the department applied for a rollover of R11 million to pay invoices committed towards the end of 2017/18. Monitoring mechanisms by the transferring department Expenditure is monitored through monthly, quarterly and annual fi nancial reports. Conditional Grant: Social Sector EPWP Incentives Grant for the Province: Department of Health

Department/municipality to which the grant was transferred Purpose of the grant To incentivise provincial departments to expand work creation through the use of labour. To ensure the use of intensive delivery methods in the following focus areas in compliance with the EPWP: Road maintenance and building maintenance Low traffi c volume roads and rural roads Other economic and social infrastructure Tourism and cultural industries Sustainable land-based livelihoods Expected outputs of the grant Number of people employed and receiving income through the EPWP Average duration of the work opportunities created Income per EPWP benefi ciary Actual outputs achieved At the beginning of the 2017/18 fi nancial year, 65 benefi ciaries were enrolled into the EPWP at various health facilities Amount per amended DORA N/A Amount transferred (R’000) R2 000 000.00 Reasons if amount as per DORA not transferred None Amount spent by the department/ municipality (R’000) R1 690 500.00 Reasons for the funds unspent by the entity As a result of workers absconding or resigning from duties, the Department only spent 85% of the allocated budget. Monitoring mechanisms by the transferring department Attendance registers. Reports from institutions to which the benefi ciaries were deployed. 75 Conditional Grant: HIV and AIDS Grant

Department/municipality to which the grant was Gauteng Department of Health transferred Purpose of the grant To enable the health sector to develop and implement an effective response to HIV and AIDS and TB Expected outputs of the grant • Increased access to male and female condoms; • HIV Counselling and Testing services scaled up; • Improved access to MMC services; • Improved access to package or services for victims of sexual assault; • Increased access to and quality of PMTCT services Actual outputs achieved Number of male condoms distributed – 62 053 944 Number of female condoms distributed – 1 318 690 Number of clients test for HIV (including antenatal) – 734 516 Number of medical male circumcision performed – 11 750 Number of sexual assault cases offered ARV Prophylaxis – 1 487 %/Number of exposed infants HIV positive at 10 weeks Polymerase Chain Reaction (PCR – 10 299 Amount per amended DORA R3 744 381 Amount transferred (R’000) R3 744 381 Reasons if amount as per DORA not transferred NIL Amount spent by the department/ municipality (R’000) R3 744 381 Reasons for the funds unspent by the entity NIL Monitoring mechanisms by the transferring department Visiting the province and in a meeting, analyse the fi gures and compare to last fi nancial year 7. DONOR FUNDS

DONOR FUND 1 Name of donor The Church of Jesus Christ of Latter-day Saints Full amount of the funding R18 688.00 (television, projector, laptop and laminator) Period of the commitment None Purpose of the funding Printer, laptop and laminator for administrative use and television for the entertainment of patients Expected outputs Printer, laptop and laminator for administrative use and television for the entertainment of patients Actual outputs achieved Printer, laptop and laminator for administrative use and television for the entertainment of patients Amount received in current period (R’000) R18 688.00 (television, projector, laptop and laminator) Amount spent by the department (R’000) None Monitoring mechanisms by the donor None

DONOR FUND 2 Name of donor African Medical and Research Foundation Full amount of the funding R145 260.00 (fourteen laptops and eleven projectors) Period of the commitment None Purpose of the funding Support for the prevention, control and management of NCDs. Expected outputs Support for the prevention, control and management of NCDs. Actual outputs achieved Support for the prevention, control and management of NCDs. Amount received in current period (R’000) R145 260.00 (fourteen laptops and eleven projectors) Amount spent by the department (R’000) None 76 Monitoring mechanisms by the donor None

DONOR FUND 3 Name of donor Medhold Full amount of the funding R59 000.63 (1KS5 Getinge: autoclave) Period of the commitment None Purpose of the funding To assist with the medical care of patients. Expected outputs To assist with the medical care of patients. Actual outputs achieved To assist with the medical care of patients. Amount received in current period (R’000) R59 000.63 (1KS5 Getinge: autoclave) Reasons for the funds unspent Monitoring mechanisms by the donor None

DONOR FUND 4 Name of donor National Health Full amount of the funding R1 015 111.37 Period of the commitment None Purpose of the funding Assisting provinces to meet the Ideal Clinic requirements. Expected outputs Provinces meet the Ideal Clinic requirements. Actual outputs achieved Assisted provinces to meet the Ideal Clinic requirements. Amount received in current period (R’000) R1 015 111.37 Amount spent by the department (R’000) None Monitoring mechanisms by the donor None DONOR FUND 5 Name of donor NATIONAL HEALTH Full amount of the funding R5 150 268.78 Period of the commitment None Purpose of the funding To be used for the Health Patient Registration System (HRPS) to reach targets set out in the National Health Insurance Policy. Expected outputs To be used for the Health Patient Registration System (HRPS) to reach targets set out in the National Health Insurance Policy. Actual outputs achieved To be used for the Health Patient Registration System (HRPS) to reach targets set out in the National Health Insurance Policy. Amount received in current period (R’000) R5 150 268.78 Amount spent by the department (R’000) None Reasons for the funds unspent Monitoring mechanisms by the donor None

DONOR FUND 6 Name of donor Road Accident Fund Full amount of the funding R 450 840.36 Period of the commitment None Purpose of the funding Stretchers required for patient care in the ED, especially those requiring resuscitation. Expected outputs Stretchers required for patient care in the ED, especially those requiring resuscitation. Actual outputs achieved Stretchers required for patient care in the ED, especially those requiring resuscitation. Amount received in current period(R’000) R 450 840.36 Amount spent by the department (R’000) None 77 Reasons for the funds unspent None Monitoring mechanisms by the donor None 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 96% of its allocated budget in the 2017/18 fi nancial year.

Infrastructure projects completed during the year and progress in comparison to what was planned at the beginning of the year.

Unique Project name Stage Construction Planned Actual or Reason for deviation project start date construction new planned number end date as construction at 1 April end date as 2017 at 31 March 2018 656 Helen Joseph Construction 16 October 31 August 30 November Initial contract was Hospital: 51% - 75% 2012 2017 2018 terminated due to poor renovations to performance. New Psychiatric ward contractor appointed in and observation November 2017. Due units to the need for site establishment work, contractor commenced work in January 2018. 1006 Tshwane District Construction 21 January 31 January 14 December Completed 14 Hospital: External 76% - 99% 2016 2018 2017 December 2017 wet services contract 78 31006393 Park homes for Construction 01 July 2016 31 March 31 March Completed 31 March MDR/XDR TB 99% 2017 2018 2018

734 Sebokeng Hospital: Final 11 November 31 July 2016 23 February Completed in February construction and/ completion 2013 2017 2017 and handed over or completion to end user 31 March of Pharmacy, 2017 ICU, Radiology, Kit Store, Administration Block, Physiotherapy, Waiting Areas, existing OPD, Renal and Gate House 241 Charlotte Maxeke Construction 09 November 28 June 2017 30 August Original contract for Johannesburg 76% - 99% 2015 2018 CMJAH Psychiatric Academic Hospital: ward was terminated upgrading and due to contract dispute renovation of the on scope of work. Psychiatric unit New contractor was appointed in March 2018. New completion date is 30 August 2018.

3 Randgate Clinic: Retention 05 May 2016 31 March 31 March Construction build new clinic 2017 2017 completed on 31 March 2017 Unique Project name Stage Construction Planned Actual or Reason for deviation project start date construction new planned number end date as construction at 1 April end date as 2017 at 31 March 2018 156 Bonalesedi Retention 04 September 31 May 2016 18 April 2017 Construction has been Nursing College: 2014 completed. Project still renovations and in retention phase due additions to the to disagreement on College fi nal account between GDID/professional team and contractor. 540 Ga-Rankuwa Construction 25 May 2015 31 May 2017 31 July 2018 Delays due to delayed Nursing College: 76% - 99% receipt of permission upgrading and to occupy site. renovations to the 80% of the project College handed over to the College for utilisation; includes Auditorium, Administration Block, Library, Parking and Canteen. Outstanding is the old halls which were vacated on 15 February 2018 to give contractor access. 256 Chris Hani Construction 06 October 31 May 2017 20 December Completed and fi nal Baragwanath 76% - 99% 2015 2017 account settled on 31 Hospital: January 2018. renovations to Psychiatric wards 50 Charlotte Maxeke Construction 18 August 28 June 2017 30 November Completion of the 79 Johannesburg 76% - 99% 2014 2018 project is delayed due Academic Hospital: to additional scope revitalisation of of work and lack staff residences - of decanting space. Blocks A, D & E Project was practically completed in October 2017. Final completion delayed due to additional works as a result of the hospital roof collapse. 261 Thelle Mogoerane Final 25 February 31 August 26 October Completed on 26 Hospital completion 2015 2016 2017 October 2017 and (Natalspruit handed over to end Hospital): new staff user December 2017 residences 283 Tshwane District Construction 06 May 2015 31 March 9 March 2018 Refurbishment Hospital: 76% - 99% 2018 completed on 09 refurbishment March 2018 contract 4A on wards that are part of the on- going hospital refurbishment plan

183 New Kekana Construction 01 November 31 May 2017 31 March Construction was Gardens Clinic: 76% - 99% 2015 2018 completed 31 new clinic March 2018; awaits installation of operational equipment including health technology and furniture. Unique Project name Stage Construction Planned Actual or Reason for deviation project start date construction new planned number end date as construction at 1 April end date as 2017 at 31 March 2018 291 Kekanastad Clinic: Construction 01 February 5 May 2017 31 January Termination of construction of 51% - 75% 2016 2019 contract due to non- new clinic performance. New contractor appointed and started work on 27 February 2018. New completion date is 31 January 2019. 6793111 Khutsong South Construction 12 April 2016 31 July 2017 31 August Construction is at Ext2 Clinic: new 76% - 99% 2018 86%. Slow progress on clinic site, due to community unrest. Construction completion planned for 31August 2018. 6793112 Mayibuye Clinic: Awarded 01 May 2016 28 August 11 January Site was handed over construction of 2018 2020 to the appointed new clinic contractor to design and construct a protype clinic. Construction did not commence as a church and library had been constructed on the site after the site was allocated to GDOH. Awaiting fi nal removal of library and church 80 by GDID. 6793113 Greenspark Clinic: Construction 01 June 2016 28 September 31 August Contractor was off new clinic 1% - 25% 2017 2019 site due to contractual dispute (R9.6m variation order). Contractor is now back on site and new completion date is 31 August 2019.

Infrastructure projects currently in progress and their expected completion dates

PMIS Project Project name Stage Construction Construction end date Number start date 143 Boikhutsong CDC: replacement Construction 01 April 2017 29 May 2019 of existing clinic and upgrade to 1% - 25% new CDC 6792486 Boitumelo Clinic: new clinic Construction 29 March 2017 Contractor off-site due to 1% - 25% community unrest

156 Bonalesedi Nursing College: Retention 04 September 18 April 2017 renovations and additions to 2014 the College 50 Charlotte Maxeke Construction 30 November Completed 30 October 2017 Johannesburg Academic 76% - 99% 2018 However fi nal completion delayed Hospital: revitalisation of staff due to collapsed roof. residences - Blocks A, D & E 241 Charlotte Maxeke Construction 09 November 31 October 2018 Johannesburg Academic 51%-75% 2015 Hospital: upgrading and renovation of the existing Psychiatric unit PMIS Project Project name Stage Construction Construction end date Number start date 428 Chris Hani Baragwanath Tender 30 March 2019 31 May 2021 Hospital: critical repairs and refurbishment of staff accommodation, walkways, neo-natal ICU and Labour Ward. 253 Chris Hani Baragwanath 06 October 2015 Completed: fi nal account settled Hospital: renovations to Completed January 2018 Psychiatric wards 179 Dewagensdrift Clinic: Construction 01 August 2016 31 July 2018 construction of new clinic 76% - 99%

105 Dilopye Clinic: additions & Construction 01 May 2017 1 August 2018 rehabilitation. Extension for 1-26% fi ve rooms, fi ling room and waiting area. Repair, renovate, refurbish or rehabilitate PHC roof structure. Repair, renovate, refurbish or rehabilitate PHC water supply, drainage and sewerage; repair, renovate, refurbish or rehabilitate PHC electrical distribution. 489 Far East Rand Hospital: upgrade Tender 22 April 2013 31 March 2019 of Wards 4 & 8 129 Finetown Clinic: construction of Construction 28 September 30 November 2018 new Finetown Clinic 1% - 25% 2016

540 Ga-Rankuwa Nursing College: Construction 25 May 2015 31 July 2018 upgrading of and renovations 76% - 99% to the College 81 6793113 Greenspark Clinic: new clinic Construction 15 February 2017 31 August 2019 1% - 25%

659 Helen Joseph Hospital: Tender 1 July 2018 31 May 2022 refurbishment of Oorkant, Susan Hof, Querani and Strydom Hof nurses’ residences 656 Helen Joseph Hospital: Tender/ 16 October 2012 30 November 2018 renovations to Psychiatric ward construction and observation units 51% - 75%

467 Johannesburg FPS Mortuary: Construction 03 November 30 November 2019 new mortuary 1% - 25% 2016 31006385 Kalafong Hospital: renovations Tender 10 January 2018 30 January 2019 of nurses’ residences for Life Esidimeni 291 Kekanastad Clinic: construction Construction 1 April 2018 31 January 2019 of new clinic 51% - 75%

6793111 Khutsong South Ext2 Clinic: Construction 12 April 2016 31 August 2018 new clinic 75% - 99%

30309664 Management of the grant/ In progress NA NA capacity building

170 Mandisa Shiceka Clinic: replace Construction 30 September 30 September 2019 current clinic and upgrade to 1%-25% 2017 CDC

6793112 Mayibuye Clinic: construction Awarded 1 May 2016 11 January 2020 of new clinic PMIS Project Project name Stage Construction Construction end date Number start date 180 New Eersterust Clinic: minor Construction 01 July 2017 28 July 2018 extension of recently built CHC 1% - 25%

183 New Kekana Gardens Clinic: 15 January 2016 31 March 2018 new clinic Completed

31006388 OD & QA In progress NA NA Particle count and deep cleaning 6793122 Orange Farm Ext7 clinic Awarded; 22 October 2017 Estimated completion 30 October Construction of new clinic however, 2020 work was affected by community unrest 31006393 Park Homes for MDR/XDR TB Construction 01 July 2016 31 March 2018 51% - 75%

6793119 Phillip Moyo CHC: extension Construction 7 July 2017 30 June 2019 and refurbishment of maternity 1%-25% unit 6793106 Randfontein Clinic: replace Tender 11 January 2019 10 October 2021 small clinic and upgrade to CHC

3 Randgate Clinic: build new 05 May 2016 31 March 2017 clinic Completed

734 Sebokeng Hospital: Final 11 November 23 February 2017 82 construction and/or completion completion 2013 of Pharmacy, ICU, Radiology, Kit Store, Administration Block, Physiotherapy Waiting Areas, existing OPD, Renal and Gate House 6793128 Sebokeng Zone 17 clinic: Design 30 July 2018 30 July 2019 construction of new clinic development (prototype clinic) 212 Securing of sites of various In progress NA NA projects: various sites

918 Tembisa Hospital: Blood Bank Retention 12 September 30 September 2015 2013

261 Thelle Mogoerane Hospital Final 25 February 2015 October 2017 (Natalspruit Hospital): new staff completion residences

9 Thelle Mogoerane Hospital Final 01 November 15 June 2016 (New Natalspruit Hospital): completion 2006 build new 760 bed Regional Hospital 1006 Tshwane District Hospital: Completed 21 January 2016 14 December 2017 external wet services contract 283 Tshwane District Hospital: Completed 06 May 2015 9 March 2018 refurbishment contracts 4A on wards that form part of the on- going hospital refurbishment plan 31006406 Weskoppies Hospital: CCTV Tender 01 April 2018 31 August 2018 cameras PMIS Project Project name Stage Construction Construction end date Number start date Sebokeng Hospital: Tender May 2018 November 2019 replacement of entire medical gas reticulation and plant rooms

An Intervention Task Team (ITT) was appointed in February 2018 to review the Department’s turnaround strategy. One of the ITT’s recommendations was, because of budgetary constraints, to place certain projects on hold. The Team also recommended that all projects in the planning phase should not move into construction; however, planning needed to be concluded for the IDMS stage that each project was in. To give effect to these recommendations, the following projects were placed on hold:

PMIS Project Project name Stage Number 6793135 Albertina Sisulu Clinic: upgrade of existing clinic Identifi ed 84 Bertha Gxowa Hospital: refurbishments Concept design 31006344 Bheki Mlangeni Hospital: new staff residences Design 6793130 Bophelong Ext Clinic: construction of new clinic Initiation 6793105 Braamfi scherville CHC: construction of new CHC Feasibility 445 Bronkhorstspruit FPS Mortuary: new mortuary Design 212 Carletonville Hospital: refurbishment of TB ward Design 6793034 Carletonville Hospital: renovations Design 30309680 Charlotte Maxeke Johannesburg Academic Hospital: Wet Services Design 6793027 Chiawelo Clinic: replace asbestos with brick and upgrade existing clinic to CHC Design 6793012 Cosmo City CHC: construction of a new CHC Feasibility 103 Dark City CHC: additions and rehabilitation Design 83 31 Daveyton FPS Mortuary: new mortuary Initiation 6793114 Daveyton Hospital: new hospital Concept design 6793117 Daveyton Main Clinic: construction of additional consulting rooms Feasibility 30309923 Devon EMS: new EMS Base Identifi ed 30309906 Dewagensdrift EMS: new EMS base Design 6793154 Diepkloof FPS: address structural defects Prefeasibility 6793066 Diepsloot CHC: construction of new CHC Identifi ed 6793127 Diepsloot Hospital: new hospital Identifi ed 319 Discoverers CHC: convert CHC into District Hospital Design 6793031 Dr George Mukhari Academic Hospital: construction of new helipad Design 30309924 Dr George Mukhari Academic Hospital: hydro-therapy pool, connection of Identifi ed medical gas for plan room Dr George Mukhari Academic hospital: Hematology (Oncology), high care Identifi ed upgrade to Ward 39, OPD, chemo Lab and chemo dispensing Dr George Mukhari Academic Hospital: upgrade of main kitchen, laundry, Identifi ed archive, fi re reticulation and protection, bulk store, neonatal ICU & high care 6793144 Dr Helga Kuhn Clinic: upgrade of existing clinic Identifi ed 350 Dr Yusuf Dadoo Hospital: revitalisation Feasibility 6793025 Dunswart laundry: additions and refurbishments Identifi ed 30309678 Edenvale Hospital: upgrading and new AET, additional wards, linen room, Concept design additional theatre 113 Ekangala Clinic: 5 additional consulting rooms Design 30309904 Ekurhuleni District Offi ce: construction of new offi ce accommodation on the Identifi ed Bertha Gxowa Hospital property after the demolition of dilapidated buildings as identifi ed. 6793121 Eldorado CHC: construction of new CHC Feasibility PMIS Project Project name Stage Number 123 Empilisweni CHC: upgrades and additions Identifi ed 31006392 Ennerdale Ext 8 Clinic: conversion of consulting rooms into maternity and Identifi ed obstetric unit 6793129 Evaton West Clinic: construction of new clinic Initiation 30309903 Heidelberg Clinic: construction of new clinic Identifi ed 30309922 Heidelberg Hospital: new EMS base Identifi ed 146 Heidelberg Hospital: renovation to Maternity, OPD & Casualty and new helipad Identifi ed 31006404 Hillbrow District Hospital: conversion of CHC into District Hospital. Additions Design and revitalisation. 6793118 J Dumani CHC: extensions of Pharmacy store room Pre-feasibility 31006391 Johannesburg District: Maternity waiting rooms Identifi ed 195 Phedisong 4 CHC: additions and rehabilitation Design (on hold) 753 Jubilee Hospital: revitalisation Feasibility 161 K. T. Motubatse Clinic: construction of additional consulting rooms Feasibility 760 Kagiso CHC: new CHC Design 759 Kalafong Hospital: revitalisation Feasibility 292 Kgabo CHC: additions and rehabilitation. Add 10 consulting rooms; repair, Feasibility refurbish, renovate, rehabilitate or replace integrated facility electrical distribution 765 Khayalami Hospital: complete refurbishment of the existing unused hospital Pre-feasibility into a functional District Hospital Khayalami Hospital: demolition Demolition (on hold) 6793126 Kliptown Clinic: new clinic Identifi ed 84 6793107 Kokosi CHC: new CHC Design 849 Kopanong Hospital: refurbishment of Psychiatric wards 1 & 2 Identifi ed Kopanong Hospital: new TB wards Identifi ed 6793116 Kwa-Thema Clinic Construction of additional consulting rooms Pre-feasibility 6793134 Lakeside Estate Clinic: new clinic Identifi ed 167 Lebone College: conversion of old Maternity wing to EMS Training Centre Design 6793036 Lebone College: Health Council upgrades Design 6793048 Lehae CHC: construction of a new CHC Design 908 Lenasia South CHC: convert CHC into District Hospital Design (on hold) 30309679 Leratong Nurses Residences: upgrade Feasibility 30309521 Levai Mbatha CHC: upgrades and additions Identifi ed 31006389 Lillian Ngoyi Hospital: construction of staff accommodation for new hospital Design 53 Lillian Ngoyi: construct new 500 bed District Hospital adjacent to existing CHC Design 6793124 Magagula Clinic: construction of new clinic Identifi ed 6793143 Moroka Clinic: construction of additional consulting rooms Design 30309522 Mpumelelo Clinic: upgrades and additions Identifi ed 30309905 New Atteridgeville CHC: construction of new clinic Design 6793067 New Inner City CHC: new CHC Feasibility 182 New Kanana Clinic: construction of new clinic Feasibility 6793014 Nizamiye Clinic: upgrade of clinic Design 6793120 North Mead Clinic: construction of additional consulting rooms Initiation 30309990 Pholosong Hospital: electrical and building projects. Relocate Eskom substation Identifi ed from the current guardhouse to a new location; repair and upgrade the guardhouse. PMIS Project Project name Stage Number 30309685 Pholosong Hospital: Step-down ward Pre-feasibility 30309523 Pontsong Clinic: upgrades and additions Identifi ed 198 Pretoria North Clinic: additions and rehabilitation Design 30309925 Pretoria West Hospital: refurbishment of TB ward Identifi ed 30309526 Ratanda Ext 23 Clinic: upgrades and additions Identifi ed 30309525 Ratanda Ext 7 Clinic: upgrades and additions Identifi ed 30309524 Ratanda Main Clinic: upgrades and additions Identifi ed 205 Refi lwe Clinic: replace small clinic and upgrade to CHC Design 629 S G Lourens Nursing College: refurbishment of College Design 30309518 Savannah City/ Walkerville Clinic: construction of new CHC Identifi ed 739 Sebokeng Hospital: revitalisation Feasibility 30309519 Seibei Motsoeneng Clinic: construction of new clinic Identifi ed 30309998 SG Lourens Nursing College: construction of new training facility Design 6793133 Sicelo Clinic: new clinic Identifi ed 223 South Rand Hospital: conversion and renovation of old compound/pharmacy Design 226 Stanza Bopape Clinic: additions and rehabilitation Feasibility 31006332 Tambo Memorial Hospital: High Care Unit Identifi ed 901 Tambo Memorial Hospital: revitalisation Feasibility 231 Temba CHC: extension for twelve rooms, fi ling room, pharmacy and waiting Design area 31006387 Tara Hospital: construction of new secure adolescent ward Design Tembisa Hospital: new High Care Unit Feasibility 85 6793018 Tembisa Hospital: new Maternity theatre and Paediatric Unit Concept design (on hold due to soil conditions) 30309682 Tembisa Hospital: new store, Porters’ Station and Stretcher Bay Concept design 30309681 Tembisa Hospital: installation of diesel tank Design 30309910 Thelle Mogwerane Hospital: additional works (helipad, car park, Maternity Feasibility theatre) 6793136 Tshepiso Clinic: construction of new clinic Feasibility 1010 Tshwane Rehabilitation Centre: renovations and upgrading of facility Design 6793145 Usizolwethu Clinic: upgrade of existing clinic Identifi ed 6793131 Vischkuil Clinic: construction of a new clinic Identifi ed 6793125 Vlakfontein Clinic: new clinic Identifi ed 245 Weskoppies Hospital: condition assessment and refurbishment of heritage Design buildings 6793028 Weskoppies Hospital: storm water drainage, repairs and renovations Identifi ed 6793123 Wildebeestfontein (Orange Farm) Clinic: construction of new clinic Feasibility 6793064 Zola Clinic: replace asbestos with bricks and upgrade existing clinic to CHC Design Bheki Mlangeni District Hospital: A&E upgrade, park homes for EMS, porters, feasibility security, create external areas for mental health patients in wards Mamelodi Hospital: upgrade to and extension of bulk store Identifi ed Procurement of medical equipment was completed by 31 March 2018 for the following 12 health facilities:

Nr. PMIS Number Project Name 1 30309891 Edenvale Hospital: medical equipment 2 30309901 Far East Rand Hospital: medical equipment 3 30309895 Leratong Hospital: medical equipment 4 30309893 Mamelodi Hospital: medical equipment 5 30309892 Pholosong Hospital: medical equipment 6 30309898 Rahima Moosa Hospital: medical equipment 7 30309900 Sizwe Hospital: medical equipment 8 30309899 Sterkfontein Hospital: medical equipment 9 30309902 Tara H Moross Hospital: medical Equipment 10 30309896 Tambo Memorial Hospital: medical equipment 11 30309897 Weskoppies Hospital: medical equipment 12 30309894 Sebokeng Hospital: medical equipment

Plans to close down or down-grade any current facilities There were no plans to close down or down-grade any facilities in the2017/18 fi nancial year. Progress was made on maintenance of the following infrastructure:

Maintenance category Final Expenditure % spent against appropriation (R’000) budget (R’000) (R’000) Maintenance & Repairs 757 527 746 401 99% 86 Electro-mechanical 115 345 105 071 91% EPWP 2 000 1 690 85% Total 874 872 853 162 98%

Developments relating to the above that are Changes to asset holdings during the period expected to impact on the department’s current under review, including information on expenditure. disposals, scrapping and loss due to theft

The Maintenance budget was increased in the No immovable assets were disposed of, scrapped or adjusted appropriation from National Treasury from lost due to theft. the original budget of R356 million to R757 million in the fi nal appropriation. In spite of the challenges Measures taken to ensure that the Department’s at GDID SCM, the Maintenance allocation was Asset Register remained up-to-date during the spent; the challenges related to the fact that the period under review term contracts at GDID had expired and the process GDoH compiles its User Asset Register for vesting of establishing a new database was lengthy and with GDID. This task was undertaken and GDID prolonged. The electro-mechanical project for is in the process of compiling the Custodian Asset generators at Charlotte Maxeke Johannesburg Register which will include GDoH’s Asset Register. Academic Hospital is near completion; it is anticipated that commissioning will have been done by end May 2018.

The 15% EPWP under-expenditure was due to employees absconding and resigning. The percentage of the Department’s capital A rating of C1 indicates very poor condition and C5 assets in good, fair or bad condition excellent condition. No facilities received a rating of C1 or C5. Facilities receiving a C2 rating were staff The table below shows the condition ratings of housing, Boikhutsong Clinic, CMJAH, Dark City facilities as per the User Asset Management Plan CHC, Helga Kuhn Clinic, Jack Hindon Clinic, Michael (UAMP) for 2017/18. Maponya Clinic and Soshanguve Block JJ Clinic; Number of facilities these facilities are ear-marked for upgrading and Condition Rating C4 12 renovations. Staff housing is the responsibility of the relevant hospital, with major maintenance actions Condition Rating C3 489 planned by GDoH. Condition Rating C2 9 Condition Rating C1 0

Major maintenance projects undertaken during the period under review

PMIS Project name 2017/18 YTD Project Adjusted expenditure Number Budget (R’000) (R’000) 93 Charlotte Maxeke Johannesburg Academic Hospital: all maintenance R 45 000 R 47 173 activities 95 Chris Hani Baragwanath Hospital: all maintenance activities R 53 405 R 82 566 107 Dr George Mukhari Hospital: all maintenance activities R 28 562 R 32 762 108 Dr Yusuf Dadoo Hospital: all maintenance activities R 12 032 R 13 206 149 Johannesburg District CHCs: all maintenance activities R 11 684 R 17 480 238 Tshwane District Clinics: all maintenance activities R 9 326 R 8 896 288 Weskoppies Hospital: all maintenance activities R 22 025 R 20 596 87 Electro-mechanical projects in the 2017/18 fi nancial year

PMIS Project name 2017/18 YTD Project Adjusted expenditure Number Budget (R’000) (R’000) 30309836 Charlotte Maxeke Johannesburg Academic Hospital: electro-mechanical R 78 060 R 50 388 equipment 30309844 Dr George Mukhari Hospital: electro-mechanical equipment R 1 717 R 1 716 30309838 Helen Joseph Hospital: electro-mechanical equipment R 439 R 438 30309858 Kopanong Hospital: electro-mechanical equipment R 74 R 74 30309840 Medical Supply Depot: electro-mechanical equipment R 4 426 R 4 425 30309849 Odi Hospital: electro-mechanical equipment R 9 171 R 9 170 30309850 Pretoria West Hospital: electro-mechanical equipment R 422 R 421 30309864 Sterkfontein Hospital: electro-mechanical equipment R 9 248 R 9 248 30309830 Tambo Memorial Hospital: electro-mechanical equipment R 11 192 R 11 191 Progress made in addressing maintenance backlogs during the period under review

Infrastructure 2016/2017 2017/2018 projects Final Actual (Over)/Under Final Actual (Over)/ Appropriation expenditure Appropriation Under expenditure R’000 Expenditure R’000 R’000 Expenditure R’000 New and replacement R 742 069 R 556 764 R 185 577 R 632 306 612 897 19 409 assets Existing infrastructure R 1 259 299 R 1 350 815 -R 91 516 994 134 949 298 44 836 assets - Upgrades and R 315 850 R 275 052 -R 40 798 R 170 617 137 291 33 326 additions - Rehabilitation, R 193 108 R 149 061 R 44 047 R 89 648 65 605 24 043 renovations and refurbishments - Maintenance and R 750 341 R 926 702 -R 176 361 733 869 746 402 (12 533) repairs Infrastructure transfer - Current R 750 341 R 926 702 -R 176 361 733 869 746 402 (12 533) - Capital R 1 251 027 R 980 877 R 270 150 R 892 571 R 815 793 R 76 778 Total R 2 001 368 R 1 907 579 R 93 789 1 626 440 1 562 195 R 64 245

88 PART C: GOVERNANCE

89 1. Introduction The following key strategic risks were identifi ed in the 2017/2018 fi nancial year: The Gauteng Department of Health is committed to sound corporate governance in its delivery of health • Inadequate access to quality health services for care services to the public. The Department assures mental health patients tax payers that systems of internal control are in • Increase in maternal, new born, infant and child place to enable effective, effi cient and economical morbidity/ mortality use of state resources. • High death rate due to increase in the number of HIV and TB infections 2. Risk Management • Inadequate resources for the Primary Health Care Reengineering Programme The Accounting Offi cer (AO) of the Department • Serious Adverse Events takes responsibility for implementing Enterprise Risk • Poor quality of EMS referral/call system due to Management (ERM) in accordance with the National incorrect use of system Treasury Public Sector Risk Management Framework • Shortages in pharmaceutical supplies (PSRMF). The Chief Director: Risk Management and • Aging infrastructure and health technology Internal Control is the Chief Risk Offi cer (CRO) for • Non-adherence to prescripts the Department. • Lack of standardised information technology platforms to enable the provision of quality In compliance with the PSRMF and to embed risk health care management, the Department has adopted an ERM • Delays/late payments to suppliers (30-day Policy Statement which sets out its overall intentions payment period) with regard to ERM. A detailed Risk Management • Inadequate Human Capital Management Strategy and Risk Management Implementation Plan • Inability of Supply Chain Management to support were approved and implemented for the 2017/2018 the provision of quality health care fi nancial year. The ERM Implementation Plan gave • Financial losses due to litigation effect to the departmental RM Policy and Strategy and • Inability to achieve revenue targets outlines the roles and responsibilities of management • Fraud and corruption and staff in embedding risk management in the 90 • Fruitless and wasteful expenditure department. • Irregular expenditure The Department has assessed signifi cant risks that • Inability to function in the event of a disaster could affect its ability to achieve its strategic and (business disruption) operational objectives. Risks were prioritised based • Compromised safety of patients and employees on their likelihood and impact (inherent risks and • Insuffi cient, irrelevant, inaccurate and incomplete residual risks and mitigations were agreed upon to performance reports reduce the risks) to acceptable levels. Risk Owners • Industrial action at Forensic Pathology. have been identifi ed for each risk and are responsible for monitoring risk levels and the extent to which 3. Minimising Confl icts of Interest mitigating strategies are in place. SMS members disclose their fi nancial interests Progress on mitigation measures are tabled at the Risk using the eDisclosure system. In 2017/2018, the Management Committee (RMC) meeting and Audit Department achieved 100% (113 employees out of Committee on a quarterly basis. New/emerging risks 113) disclosure by the SMS members. are identifi ed and assed on an ongoing basis. The Department has a circular on fi nancial disclosures The Department has an established and functional for other categories; 426 employees were trained on Departmental Risk Management Committee, chaired the circular and how to submit disclosures on the by an external chairperson, to assist the Accounting eDisclosure system. Offi cer in carrying out his responsibilities relating to The Department has rolled out Phase 2 of eDisclosure. risk management. The Committee operates within Confl ict of interest is monitored intensively for salary Terms of Reference approved by the Head of the levels 11 and 12 and for all Finance and Supply Chain Department and consists of identifi ed risk owners staff categories. for each risk, representatives from all Programmes and representatives of the four academic hospitals The Department carries out ongoing training and and of Gauteng Provincial Treasury. The committee awareness Programmes on ORW and confl ict of meets quarterly to review action plan progress in the interest as well as fi nancial disclosure. strategic risk register. The Department has clearly communicated policies management of Health Care Risk Waste (HCRW) and procedures relating to remunerative work and occupational hygiene and safety within the outside the public service and intensively monitors Department. HCRW is generated on a daily basis submission, recording, approval and reporting on and its collection, transportation, treatment and fi nal this. disposal are contracted out to private companies. This type of waste contributes greatly to the 4. Fraud and Corruption Department’s risk in terms of Occupational Health and Safety (OHS). However, effective and effi cient The Departmental Investigation and Integrity control measures have been introduced and the risks Management Directorate rolled out implementation are signifi cantly reduced through regular internal of the Provincial Anti-Corruption Strategy. The auditing, inspections, development and management Department has in place a Fraud Prevention Plan and of mitigation reports. Whistle Blowing Policy and also uses the Gauteng Ethics and Anti-Corruption Hotline, coordinated The Department has worked to create a healthy by the Premier’s Offi ce, and the Public Service working environment for its employees by ensuring Commission Hotline. good work ethics and discipline through progressive human resource development and management Because of the diversity of cases within the practices and continuous awareness through Department, some forensic investigations are communication of audit and inspection outcomes to referred to Provincial Treasury. all responsible.

Fraud risk assessments were conducted at nine While numerous challenges still confront institutions institutions. Following these, the Department is regarding compliance with some aspects of developing the fraud risk registers for the 2018/19 environmental and OHS management, the fi nancial year. Implementation will be monitored on Department has established active OHS committees a quarterly basis. in most institutions and has developed an environmental management plan for introduction in 5. Code of Conduct the 2018/19 fi nancial year. Compliance with the OHS Act is still a signifi cant problem as most institutions 91 All employees are expected to comply with the Code do not have dedicated OHS. Enforcement of Section of Conduct. The Public Service Act requires that 37 (2) for contractors in health care facilities (HCFs) employees adhere to the Code. The Department requires specifi c additional attention. Dedicated has a formally appointed an ethics champion who allocated budgets for OHS are still not available in reports directly to the Head of Department. many facilities. This makes it diffi cult to implement the Programme in these institutions. Four departmental offi cials, qualifi ed as certifi ed Ethics Offi cers with the Ethics Institute of South The Department has Environmental Health Africa, have been appointed as ethics offi cers. Practitioners to ensure that environmental Programmes, as defi ned in the new National Health The Department has trained 3625 employees on the Act, 2003 (Act No. 61 of 2003), are managed, Code of Conduct and 1405 employees were trained and to coordinate the activities of local and metro on ethics during the 2017/2018 fi nancial year. governments to ensure compliance with the Training for awareness of the Code of Conduct and legislated functions. ethics is ongoing to ensure a strong ethical culture Occupational Hygiene Risk Management underpinned by the values of the Code within the organisation. The Occupational Health and Safety Act, 1993 (Act No. 85 of 1993) states inter alia that the Department The Integrity Management Unit assists the Department as an employer must: to manage ethics risks through communication and awareness, confl ict management, safe reporting • Provide for the health and safety of persons at channels, ethics monitoring and reporting. work and for the health and safety of persons in connection with the use of plants and machinery 6. Health Safety and • Protect persons other than persons at work against hazards to health and safety arising Environmental Issues out of or in connection with activities at work The Directorate: Health Care Waste and Occupational such as patients, visitors, contractors on site Hygiene Risk Management is responsible for the and those directly and indirectly affected by the Department’s activities such as the public residing segregation of waste streams and an increased near our facilities. generation rate of health care waste (HCW). These tendencies manifest daily as most Challenges segregation actions are behaviourally based. All contracted and internal training projects such as • Section 16 (2) require that (CEOs, District and induction of new staff and awareness campaigns facility managers) appoint a Health and Safety are designed to address this as a priority. Representative as mentioned in Section 17(1) of • Non- or late-payment of contractors impacts the Act. This remains a widespread problem. negatively on the services they provide. • Section16 (2)s are mandated to chair the OHS • Implementation of general waste recycling Committee’s meetings and sign the minutes; this is being investigated as a potential means of is not generally not done. reducing the quantities of HCW. • Induction on the hazards in health care settings is • Various incidences of illegal dumping were not effectively done for employees or contractors reported during the year in the province; on and this leads to poor safety practices in the investigation, these were found to be from workplace. generators in the private sector. • There are very few intervention plans to address • Incorrect organogram development; funded identifi ed hazards and risks. vacancies not fi lled. • Many HCFs do not have emergency preparedness • Delayed approval of tender specifi cations leading plans. to extensions of contract and challenges in • When facilities are upgraded or new facilities are managing them. built, OHS requirements are not put in place as a prerequisite of work practices by the appointed Effects contractor. This may compromise the health and safety of the Department’s employees, patients • Non- or late-payment of contracted service and visitors and employees of contractors on site. providers directly affects services rendered because of service suspensions. Non-collections Effects lead to nuisances such as odour, infection, exposure risks for employees, patients and 92 • Generalised non-compliance with statutory the public and possible re-emergence of drug requirements and adverse audit fi ndings resistant-pathogens or “super bugs”. • Health and safety of employees in general are • Non-compliant main storage areas affect progress compromised with rollout to the reusable system and contribute • Intervention plans relating to adverse audit to unauthorised risk waste access which leads outcomes are not received timeously and where to theft of containers. Waste therefore cannot required. be secured and this may lead to the spread of • Medical surveillance is fruitless expenditure if infection and to environmental pollution. there is no written proof of identifi ed Hazard • Inadequate general waste recycling affects the Identifi cation Risk Assessment (HIRAs) in the generation rate of HCRW. Improper management place of work. of the general waste stream leads to incorrect • Unapproved evacuation plans could lead to segregation practices and an increase in the structural/fi nancial loss and to loss of life among generation of risk waste. This impacts negatively patients and employees if evacuation of premises on audit fi ndings and allocated budget for is required. managing HCRW. • Facilities are at risk of non-compliance with the • The Global Green Health Hospital (GGHH) National Building Regulations and there is a project will substantially reduce dependence on direct impact on the spread of disease especially energy use, reduce the quantities of generated in isolation wards and theatres. HCRW and have a positive impact on the carbon Health Care Waste Management (HCW) footprint.

Challenges Achievements

• Incorrect segregation practices and an increase in • As an additional strategy to reduce the carbon generation rates of risk waste impacts negatively footprint through improved design of facilities on audit fi ndings and the allocated budget for and reduced waste generation, the Department managing HCRW during the reporting period. has started to implement the Global Green and • Behavioural management results in incorrect Healthy Hospital (GGHH) project as a pilot study in four hospitals. • The Department has an electronic tracking • The Department is in the process of implementing system in terms of which each container is bar- an Occupational Health and Safety Information coded to allow for effi cient scanning, control and System (OHASIS) in the province. This will management of HCRW being transported and contribute to improved health and safety in the treated. The risk of contractors illegally dumping workplace by providing a platform for informed the Department’s HCRW without tracing where decision-making. containers were last scanned is marginal.

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

26 May 2017 Presentation of the health budget vote 2017/18 FY

The decrease in allocation for the Health The Programme has decreased mainly within goods and Facilities Management by 18% in the current services due to revised project plans and Department’s fi nancial year whilst some of the health is scope of function readiness to implement them. dilapidating. The agreed target, out of 36, as per the Departments: The status of the upgrade and modernization APP, is to install PACS within 20 Hospitals. Quarter 1 of the health system plus ICT infrastructure achievement is 14. and the completion of the project thereof. The Storage and Server components of the upgrade (Vblock) have been completed. Additional infrastructure components (Local Area Network, Routing & Switching) are still outstanding. Broadband Fibre connectivity has been installed at most facilities but additional roll-out is still outstanding. The Department is in the process to defi ne an eHealth Architecture which will address both 93 the additional infrastructure upgrades required as well as defi ne the systems landscape which is required to achieve the eHealth objectives. Work on defi ning the eHealth architecture is currently in progress and it is anticipated the 1st version of the architecture should be available towards the end of the 2nd quarter (2017).

The clear budget allocations under the District The clear budget allocations under the Health Services Programme that will fund the Human District Health Services Programme that will Papillomavirus is R 37 704 538 (2017/18) Conditional fund the Human Papillomavirus. Grant Schedule 6 and in 2018/19. Total Number of NGOs: 129 NGOs The renewal of licenses’ to the NGOs housing Fully Licensed : 59 mentally ill users and the payment of the user subsidy thereof. Temporary Licensed : 67 (These could not yet submit all documents, e.g. Zoning Certifi cates)

No service & application not completed/new: 3

A document to this effect is attached

Payments: Payments were done to all NGOs who are having Mental Healthcare Users on 27/6/207.

This was for the months April, May and June 2017

Payments totalling R 34 549 295.35 were made to 95 bank accounts on 27/6/2017 – some NGO “houses” belonging to the same company therefore less payments (95) made compared to the number of NGOs (129)

The last NGO, namely Bokang was paid on 28/7/2017

The invoices for July will be paid in the payment run which is due now Date of meeting Matters raised How matters were addressed

02 June 2017 Fourth quarter report presentation There are 32 CHCs in the province, and all offer 24 hour Maternal and Obstetric Units services (deliveries of Detailed report on the progress made in pregnant women in labour). In addition, 27 CHCs are creation of posts in order to address shortage also 24 hour emergency services. There are plans in place of staff and offer 24 hour services to all CHCs to activate 24 hour emergency services in the remaining 5 CHCs. Johannesburg District is planning to activate emergency services at Mofolo CHC , and Sedibeng District will activate emergency services at Sharpeville CHC by the end of the year. Both districts have reprioritised budget allocation, and have identifi ed line items from which they are transferring out funds into Compensation of Employees (COE) line item to enable creation of new posts. Both districts have identifi ed vacant funded posts which they will be converting to create some of the required clinical posts. Plans for the department to address none adherence in order to improve compliance by Tools exist as designed by the National Core Standards. staff in restoration of emergency trolleys and Shift leaders check the emergency trolley at the beginning resuscitation room after use. of individual their shifts, Unit Managers checks at the beginning of the day, and Area Managers do weekly checks. Chief Directorate conducts Blitz scheduled visits and unscheduled, there is constant self-assessment conducted by Internal assessors Detailed report on awareness and educating communities on Human Papilloma Virus in • Advocacy, education and communication order to improve adherence by the parents • Addressing parents meetings in schools & door- on the vaccination Programme. to-door Campaigns by WBOTs • Slots in Community Radio Stations • Integrated School Health Awareness Week in October 2017 • Engage farmers on access to schools and 94 parents/guardians • Circulate letters to churches/Faith Based Organizations to encourage parents to sign consent for HPV immunisation, to protect the girl child from cervical cancer. Detailed report on implementation of tools to assess compliance with extreme and vital Tools exist as designed by the National Core Standards. measures of the national core standards. Shift leaders check the emergency trolley at the beginning of each shift, Unit Managers check at the beginning of the day, and Area Managers, weekly checks. Chief Directorate conducts Blitz scheduled visits and unscheduled. There is constant self-assessment conducted by internal assessors. Detailed report on new strategies to encourage pregnant women to visit the • Piloting of the household pregnancy screening clinics before 20 weeks. and testing of women by WOBTs and early referral for early booking • Door to door home visits by WBOTs • Encourage women to enrol on MOMCONNECT for staged messages and early booking • Introduction of limited obstetric care programme • Integration of health by services screening of all women at all health service points • Engage farmers on the importance of early access to PHC Services, including antenatal care Date of meeting Matters raised How matters were addressed

18 August 2017 First quarter presentation The Department reversed the MEDSAS expenditure Detailed report on the reversal of MEDSAS interface to the value of R624 842 005.63 during the expenditure and its impact on the closure of 2016/17 fi nancial year closure in order to align Department budget the cash outfl ow from the departmental bank account with the expenditure incurred on Basic Accounting System (BAS). It should be noted that even though the transactions had interfaced during 2016/17 fi nancial year, the Department would only have been be able to pay the cash in the new 2017/18 fi nancial year, i.e. the interface would have implied expenditure incurred on BAS without the supporting bank cash outfl ow.

Impact on the departmental budget: The total amount forms part of the accruals from the previous fi nancial year and has a negative impact on cash fl ow available for goods and services in the current year.

At Community Level

Detailed report on new strategies to 1. Currently in Tshwane Health District a pilot study is encourage pregnant women to visit the being conducted where Ward Based Outreach Teams clinics before 20 weeks are conducting pregnancy tests for women of child bearing age at household level to determine pregnancy status. The confi rmed pregnant are referred to the Health Facility for early Ante-Natal Care. 2. In the next Financial Year (2018/19) testing of women of child bearing age at household level in the remaining four (4) Health Districts.

At PHC Level Presently (since April 2017) there are ten (10) Advanced 95 Midwives, two (2) in each Health District who are conducting the Limited Obstetric Ultrasound Outreach Programme (LOUOP) to determine accurate gestational age in pregnant women. Roll out of LOUOP to other healthcare facilities in 2018/19. Date of meeting Matters raised How matters were addressed

18 August 2017 At Community Level

1. Training of Traditional Healers, ECD Practitioners and Community Health Workers is conducted on Community IMCI for early Identifi cation and screening for danger signs and severe malnutrition and referral to the Health Facility for timeous intervention.

At PHC Level

1. Health professionals are trained on correct classifi cation Detailed report on plans to eliminate of severe acute malnutrition and identifying signs and child fatalities due to acute malnutrition symptoms of pneumonia and diarrhoea. pneumonia and diarrhoea 2. The child is stabilised and referred to the hospital using the Interfacility Emergency Medical Services for transportation. 3. Routine Growth Monitoring and Promotion and Assessment are done for children visiting healthcare facilities to establish any signs of sickness and failure to thrive. 4. Utilisation of the Growth Monitoring Master Chart to determine the demographic nutritional status of the target population of 0 – 5 years.

At Hospital Level

1. Training of health professionals on adherence to treatment protocols as stipulated by WHO is monitored through clinical audits. 2. All underweight and severely malnourished children are referred to SASSA as an inter-departmental 96 collaboration strategy to alleviate hunger and prevent reoccurrence of severe acute malnutrition, where food parcels are issued to the families for a period of six (6) months and the situation is reviewed at the end of the cycle.

In spite of budgetary constraints, we have a total Detailed report on the lean management of (9 hospitals) that have been initiated in the Lean Project stating the status of the project methodology for continuous improvements. These are Leratong, Charlotte Maxeke, Sebokeng, Kopanong, Chris Hani Baragwaneth, Dr George Mukhari, Bertha Gxowa, Pretoria West and Tembisa hospital. These Hospitals require continous coaching and mentorship support. The primary aim is to reduce waiting time experienced by patients. The long term view is to improve operational effi ciencies in the entire value stream” in every facility- achieving tangible impact on the staff and patients experience, building capacity within Gauteng Department of Health, and ensuring that improvements are internally sustained. The model lines in respect of these hospitals are Pharmacy, Patients Records and at least one out–patient’s clinic. Additional/ new projects are in Operating Theatre, Human Resources, Radiology, Casualty, A&E, Maternity, Neo Natal and Supply Chain.

How are we building Capacity to further expand the project to all 360 facilities across Gauteng?

Through Formal training

27 of our hospital based Lean practitioners participated in a week-long advance lean Programme presented by Wits School of Engineering An examination was written in conclusion of this training.

5 Hospital based Lean practitioners were accepted for the Lean Masters Programme offered by Wits School of Engineering looking to increase the number of intakes for the academic year 2018. Date of meeting Matters raised How matters were addressed

18 August 2017 3 Masters Facilitators have received training for 3 and half years from the Lean Institute of Africa who are full time Gauteng department of health employees of the department.

The Target for People with Disabilities is 2% Currently the Adherence to the Employment Equity Act for Department is sitting at 0.5% People with Disabilities in the appointment of People with Disabilities. our employ. Our core business is the provision of health care services to the people of Gauteng and beyond our boundaries. More than 70% of our employees are professionals with clinical skills and Health Sciences base as a requirement of various professionals statutory bodies. Due to the nature of our business, it has been a challenge to recruit people with Disabilities with Health Science background because most of the vacant funded posts are in the clinical areas.

The Department is working to ensure that people with disabilities take Health Sciences as a career of choice. However, due to the tertiary institutions requirements i.e. Maths and Science few qualify for training.

Remedial Plan

A remedial plan has been put in place with the following measures:

Internships and Learnerships 2% of learners with be learners with disabilities

EPWP 2% to come from people with disabilities

Each health institution to ringfence 2% of their vacant posts in Admin and Support for people with disabilities 97

Walk in applications are encouraged

Forging partnerships with organizations that work with people with disabilities

Career Expos at universities and shopping malls

Take a Girl Child to Campaign learners with disabilities are also invited

A database of CVs from people with Disabilities has been put together

Run workshops to Encourage disclosure of Disabilities to those that have not disclosed their Disability Status

Each institution has an Employment Equity Committee with people with disability representative to ensure the interest of people with disabilities are advanced and protected.

Where people with disabilities are recruited, an EE Committee Rep with a disability sits in the shortlisting, and interview panels to monitor fairness and reasonable accommodation.

Conduct Diversity Management Workshops . Date of meeting Matters raised How matters were addressed

18 August 2017 Detailed report on tracing ART defaulters and Antiretroviral Therapy (ART) treatment initiation follows education and awareness plan to educate on the overarching principles of ‘providing people-centred the consequences of defaulting care focused and organised around the clients health needs, preferences and expectations, upholding individual dignity and respect, especially for vulnerable populations’prevention of defaulting. The ART Programme promotes and engages and supports people as well as families to play an active role in their own care by ‘informed decision-making’ thus in In the implementation of Universal Test and Treat (UTT) since 1 September 2016, all clients are fully informed of the benefi ts of ART, post HIV positive diagnosis then assessed for • psychological readiness for ART to avert defaulting, • offered routine TB symptom screening and • Cryptococcal meningitis screening owing to the risk of life-threatening immune reconstitution infl ammatory syndrome.

Once clients are on ART, Programme monitoring includes - Health Facilities using ‘early and late missed appointments lists’ generated from ART. Tier.Net system in to identify defaulting clients and intervene; • Telephonic tracing and or by text/sms reminder(s) conducted at various facilities; where unsuccessful then • Tracking and tracing conducted by Ward Based Outreach Teams’s at community level (door to door campaigns) 98 All clients are reintegrated to care after tracking and tracing; Clients who return to the facility after successful tracing and or tracking are referred to Enhanced Adherence Counselling with Psychosocial support. Provision of adequate training for data Training on WEBDHIS and Use of Information sessions capturers in order to address inaccurate data have been developed for the data capturers. A Train and data management. the Trainers (TOT) session was developed to address same issue of data inaccuracy and management. A daily Data Capturing training was completed covering about 25 facilities. Durring fi nancial year, 25 number of Data captures have been trained on WEBDHIS and Use of Information. The Department is fi nalising a survey tool to assess the level of competency of data captures in order to develop specifi c customised training on data sciences to enable them to operate: at a higher level in line with the Departments plans to digitise the health system. The fi rst group of students who were sent to Cuba in September 2011 have completed their 5 year medical Detailed report on doctors who have programme and were integrated into SA universities to completed the Cuba Programme and their complete their SA recognised MBCHB. The duration of the placement within the province integration is 18 months. They are expected to complete at end of 2018. They will commence their two year Internship Programme in January 2019. Date of meeting Matters raised How matters were addressed

9 November 2017 To increase the number of facilities All 369 facilities including the 12 District Hospitals are implementing Chronic Disease Management providing chronic and mental health services to patients. . throughout the province • Psychiatry Nursing Science still in progress • Community Nursing Science 100 and 200 (1st and 2nd levels) still in progress • Midwifery 100 and 200 (1st and 2nd levels) and Diploma in Midwifery completed and distributed to the clinical facilities • Student affairs: fi nal review January 2017 • General Nursing Science 200 (2nd Level) still in progress • General Nursing Science 300 (3rd Level) still in progress • Adult ICU Chart: review drafted and presented to ICU medical specialists in preparation for the pilot study in the clinical facilities • Paediatric ICU Chart: still in progress • Screening in place for all P1 calls at Emergency Communication Centre (ECC) on 09 December 2016 • Escalation of outstanding P1 calls in place through computer aided dispatch system (CAD) in test phase for December 2016 • Live monitoring on the air by line managers implemented on 09 December 2016 o Live monitoring by ECC Station Manager and Shift Supervisor o Live monitoring by operational Station Manager and Shift Supervisor 99 o Patient report forms (PRF) for P1 calls are being analysed by District management team to assess short comings and realign strategies • Satellite Station to be rolled out during fi ve Districts and will be reviewed in January 2017 • Medium and long term strategies are currently work in progress and ongoing o Provincialisation of City of Johannesburg, Tshwane and Ekurhuleni. o ECC CAD tender o NIDS indicators o EMS infra structure – purpose build EMS Stations o Human resource capacitation – scarces skills retention-Advanced Life Support (ALS) Date of meeting Matters raised How matters were addressed

9 November 2017 Implementation of Standard Operational The Overall Initiative Plan includes: Procedures for each level for student nurses. • Implementing the “Every Day is Antenatal Care Day” Campaign • Implementing the Social Behaviour Change Communication Strategy (SBCCS) through advocacy and health promotion and encouragement of early antenatal care attendance • Providing support for pregnant and lactating women in the work place • Strengthening the involvement of Primary Health Care Ward-Based Outreach (WBOTS) teams • Allocation of midwifery-obstetric ambulances to every healthcare facility to improve access to a skilled birth attendant • Establishing maternity homes • Provide and intensify training in the management of obstetric emergencies for midwives and doctors • Implementation of the Contraception and Fertility Planning Policy regarding the provision of contraceptive methods • Implementation of the 1st 1000 Days Strategy which is defi ned as the period from confi rmation of pregnancy to the fi rst 2 years of life which includes conception, antenatal care, labour and childbirth, postnatal care and early childhood. Specifi c interventions are aimed at during this time to raise awareness of the crucial fi rst 1 000 100 days of a child’s life. These fi rst few days are crucial for securing a child’s bright and healthy future.

17 November Detailed report on plans and support in A number of interventions are underway including an 2017 place to support Bheki Mlangeni hospital interventional team that was established by the MEC and Bronkhorspruit Hospital to achieve and the HOD to assist hospitals to respond to poor above 75% on National Core Standard Self- performance related National Core Standards Assessment. The interventions are as follows: • Management is conducting A & E walkabouts in the morning and in the afternoon and during the shift change over in different disciplines in order to be visible to the staff and patients • Hospital management, multilateral and bi-lateral meetings with organized labour are being held are held weekly and monthly • A skills audit for nurses and doctors was conducted in order to ascertain that health professionals have the necessary skills for the departments they are allocated to; this includes continuous internal in-service training programmes, developed and aligned to specifi c disciplines. • A Cluster Approach task team involving clinicians from Bheki Mlangeni and CHBAH currently working on standard operating procedures • Clinical are being audited daily • In order to reduce waiting times; a different approach on the use of Gateway clinic is being reviewed including a new referral agreement between CHBAH, BMDH and EMS. Date of meeting Matters raised How matters were addressed

17 November A similar strategy of using an interventional team 2017 approach will be employed with Bronkhorspruit Hospital, but it has not commenced yet. The hospital is still fairly new, so a lot of process are still to be put in place.

The Department is working on a plan to increase the employment of people with disabilities and has The Department to align the target for developed new ways of breaking through in the area. Employment of people with disabilities at 2% The challenge however has been that few people with as per the Employment. disabilities are studying Health Sciences and limits this opportunities. A large number of staff that fall within the revised defi nitions of disability have been requested to declare their status so that they can be added to the departmental indicators/ numbers. The Department cannot force declarations but can only encourage people to declare within their constitutional rights. The plight of the disabled must be taken seriously and therefore the Department is most concerned with self-declared disabled people who want and deserve to be given opportunities to improve their livelihood. • Complaints are no longer forwarded to the The Department should submit a report facility QA Managers but are directed to CEO’s on plans to resolve underperformance in and District Chief Directors. resolving complaints within facilities. • Weekly updates on outstanding complaints are forwarded to all relevant facilities. • A Provincial Guideline on Complaints Management has been developed to assist Managers with time frames when attending to complaints. • A Daily Patient Opinion Survey Form (DPOS) has been developed where patients are interviewed on a daily basis about their stay in the ward and care, all raised concerns are attended to 101 immediately. • A Patient Experience of Care Survey (PEC) is conducted on a quarterly basis instead on once a year. • Primary Health Care Facilities have been brought in to conduct PEC surveys. • Monthly complaints statistics are submitted to the Provincial Offi ce analysis of data is conducted and there is an allocated offi cial tasked for this.

The Department has an approved Provincial eHealth Architecture. It is anticipated that the implementation of this architecture will provide a platform for a single view Department should submit the report on of Patient, Electronic Health Records and real time health plans to strengthen data collection. information for timely and effective decision making and effective business management. As part of efforts to strengthen strategic information use with the belief that continued and transparent data use will enable improved data integrity, the Department is working on a strategy to design and implement a Health Observatory aim is to foster a culture that values and uses integrated evidence for meaningful decision making and policy development for the benefi t of Gauteng health care users. Its key objectives include : Date of meeting Matters raised How matters were addressed

17 November • Effective coordination of health information 2017 systems in the province. • Effective coordination of standardisation data collection tools, reporting and use of integrated information for evidence informed decision making • Improving access to data for analysis for internal and external parties • Improving access to health related/social sector related research outputs generated by various agencies within Gauteng Province • Storage of all sources of evidence for evidence based planning • Linking of the Ubservatory to the health information system to enable collection of routine information and independent information from external sources for monitoring health disease trends, areas of action and early warning systems • Evaluating progress on population health and sharing of health products generated through this platform • Use of the collective membership of the committee as a springboard for innovative solutions to improve performance of the health system in Gauteng

To this end, the Department is working with the private sector and a Reference Group to establish a Health Observatory whose purpose is to improve use and 102 access to health information products. In addition, the Department will work on a roadmap to strengthen Data Governance and various players such as stats SA, Measure Evaluation are providing support. This data governance includes issues pertaining to standardisation of data to be collected, indicators to be used, policies and SOPs to guide effective management of data, standardising data request forms and tools by public stakeholders. It is a project linked to the performance information strengthening project and to the Health Observatory strategy and e-health architecture.

Regular auditing and monitoring of data management processes are to continue and feedback of monthly data integrity challenges during management meetings using a dashboard is being implemented as another strategy to improve data collection management.

A survey tool to profi le all offi cials dealing with health intelligence has been developed and presented at the Health Information Monitoring and Evaluation Forum and will be used to plan for effective resourcing of offi cials dealing with health intelligence in the Department. Date of meeting Matters raised How matters were addressed

17 November Engagements with selected institution heads dealing 2017 with Public Health Interns has been done to ensure that interns in public health and also the existing capacity of public health medicine specialists is used to improve health intelligence (data collection and use for monitoring effectiveness of the health sector). These public health interns will be placed across the Sub-Districts to strengthen performance monitoring and provide data management oversight.

The Department has planned a series of training sessions on how to use Web-DHIS which captures data for reporting at facility and hospital levels. It is also providing open access Web-DHIS to management and offi cials to use with the hope that with increased access and use more offi cials will gain insight into the status of the quality of their Programme data and participate actively in efforts to improve it.

8. SCOPA Resolutions

Resolution Details Response by the department Resolved No. (Yes/No) 1 Department should intensify performance Legal Chief Directorate is represented on the No and consequence management processes Patient Safety and Medico Legal. The Department to mitigate instances of fi ndings on lawsuits has ensured that HR, LR AND HRD components and provide the Committee with quarterly that deal with Clinical Training will help with progress reports detailing the effectiveness of addressing. Management of Lawsuits and Medico measures put in place to address challenges Legal should be part of the Performance Contracts related to lawsuits commencing 30 days after of relevant Managers. Legal will submit names adoption hereof and continuing up until June of employees found to be guilty of avoidable 2018. negligence. HR through the Labour Relations Unit 103 will provide consistent support to Managers and Supervisors on all legitimate cases. Department should implement proper There is continuous work on aligning the Annual No control measures to ensure that there are no Performance Plan (APP) with the Budget. The further over-commitments and provide the main challenge has been the increasing year on Committee with a progress report detailing year targets set against a diminishing budget due the effectiveness of those measures within to increasing accruals and litigations. The Health 30 days of adoption thereof and, thereafter, Intervention team has proposed realigning the every quarter until the end of June 2018. budget with the current service, and discussions are ongoing between the Department and Gauteng Treasury to set up a separate fund to pay accruals and litigations in the new fi nancial year. The following additional operational controls have been strengthened to ensure that over- commitments are eliminated. • Cost containment measures, such as inventory management, identifi ed and being implemented • Review of how vetting is done at institutions • Revised demand plans • Enforce budget bi-lateral meetings • Ensure availability of funds before procuring • Checking budget before procuring Department should insert the payment Payment of suppliers within 30 days has been No of suppliers within 30 days as a KPI in included in the KPIs of the Acting Accounting the performance management criteria of Offi cer and relevant managers. the Accounting Offi cer and provide the The Department will also ensure that when a new Committee with a progress report within 30 Accounting Offi cer is appointed this is included in days hereof and, thereafter, every quarter her/his performance contract. until the end of June 2018. Resolution Details Response by the department Resolved No. (Yes/No) Department should provide the Committee Challenges relating to predetermined objectives No with a progress report detailing the are multifaceted and require a range of strategies effectiveness of measures put in place to and innovations to address them. Progress has address weaknesses of pre-determined been made in terms of the following: objectives within 30 days of adoption thereof • The Department has continued with the and, thereafter, every quarter until the end of DHIS web implementation. Visualisation June 2018. of data integrity enables tracking of attributes such as completeness and timeliness of data which are used to provide feedback to facilities to effect corrections on data. • As part of its oversight role in tracking data quality, dashboards are created per District and Sub-district highlighting data changes assessed on all submitted data to track any unauthorised changes in data. At the third quarter review, a resolution to lock the DHIS web tool to prevent unauthorised capturing was taken. This resolution will be implemented fully once all Districts data reporting completeness rate is achieved at over 98%. • Rationalised registers are being used across all PHC facilities to collect minimum data sets and reduce the administrative burden posed by data collection. The interventions were implemented from 2015. Evidence from the Baseline Evaluation indicates that these registers have had a positive effect on data management processes. The Department, supported by partners, has 104 helped to sustain provision of these tools to facilities to ensure continuity in their use. • The Department continues to implement a reduced indicator set of National and Provincial data sets. This reduced set has assisted data capturers and facilities to cope with the amount of reporting demands. Revised SOPs on data management have been reprinted and facilities and districts trained on the revised SOPs. • A revised SOP on performance accountability and reporting, including synchronisation of performance reporting, has also been drafted. • A tool for daily verifi cation of data is being implemented. Although this is slow, it has potential to reveal gaps in terms of compliance with SOP. • Terms of Reference to guide the established Performance Information committees have recently been developed and will assist data teams at facility and sub-district levels. • As part of efforts to strengthen strategic information use the Department is working with the private sector and a reference group to establish a Health Observatory to improve use of and access to health information products. It is also continuing work on a roadmap to strengthen data governance. Support is being provided by Stats SA and Measure Evaluation. Resolution Details Response by the department Resolved No. (Yes/No) Department should provide the Committee • An e-health enterprise architecture No with a progress report detailing the to support a comprehensive health effectiveness of measures put in place to information systems agenda has address weaknesses of pre-determined been developed and approved for objectives within 30 days of adoption thereof implementation. and, thereafter, every quarter until the end of June 2018. Department provides the Committee with a The Department has developed a detailed No progress report on measures put in place to audit action plan to address all internal control monitor the adequacy of internal controls weaknesses and areas of non-compliance to avoid recurrence of non-compliance identifi ed by the Offi ce of the Auditor General with applicable legislation within 30 days and monitors its implementation on an ongoing of adoption hereof and, thereafter, every basis. quarter until the end of June 2018. The Department monitors adherence to key controls on a quarterly basis. Department should provide the Committee The Department: No (SCOPA) and the Portfolio Committee on • Has instituted a competitive bidding Health with a monthly report detailing process for procurement of goods and its adherence and compliance with the services above the value R500 000 by requirements of all applicable legislation means of Requests for Tender (RFT), to ensure that effective measures are Request for Proposals (RFP) and an implemented to prevent irregular expenditure Open Tender System. Where the value is as required by Section 38(1)(c)(ii) and below R500 000 (inclusive of VAT) , price Treasury Regulation 9.1.1 within 30 days quotation is used. The Department has of adoption hereof and, thereafter, every adopted a phased approach to ending the quarter until the end of June 2018. quotation system. This is to ensure that it adheres to TR 16A6.1 and Practice Note No. 8 of 2007/2008. • Is sourcing goods and services from suppliers registered on CSD. • Is adhering to TR16A6.2 by adopting a Bid Committees system. 105 • Is participating, where there are no existing contracts, in the transversal contracts arranged competitively by National Treasury, National Department of Health, Gauteng Provincial Treasury, GDID and GDOE. This is in compliance with TR 16A6.4. • Has implemented procedures to handle deviations from the competitive bidding process. A circular has been distributed and signed off by the CEOs and Managers. • Has issued the Supply Chain Management Delegation of Authority, amongst other. • Has contracted SAICA to assist the Department with reducing IE. • Is providing monthly reports on identifi ed IE. Department should intensify performance With Provincial Treasury, the Department is in No and consequence management processes to the process of investigating prior year irregular eliminate fi ndings on irregular expenditure expenditure; the investigations have not been and provide the Committee with a progress fi nalised. Consequence management will be report detailing the effectiveness of measures implemented as investigations are concluded. put in place to address challenges relating to irregular expenditure within 30 days of adoption hereof and thereafter every quarter until the end of June 2018. Resolution Details Response by the department Resolved No. (Yes/No) Department should provide the Committee The Department has been working hard to No (SCOPA) and the Portfolio Committee on strengthen all of it governance structures to Health with a monthly report detailing ensure better compliance with and accountability its adherence and compliance to the in relation to applicable legislation. requirements of all applicable legislation The detailed audit action plans are based on areas to ensure that effective measures are of non-compliance with legislation as identifi ed by implemented to ensure that contractual the Auditor General. obligations are met within 30 days of adoption hereof and, thereafter, every quarter until the end of June 2018. Department should provide the Committee As previously reported, the Department has Yes with a progress report on the effectiveness developed and implemented a ten-point plan for of mechanisms and systems put in place to revenue enhancement. Its areas of focus include: address fi ndings on revenue management • Aggressive collection of debts from within 30 days of adoption hereof and funders, departments and provinces. thereafter every quarter until the end of June • Recovery of costs from universities 2018. • Ensuring timeous discharge and billing by institutions. • Progress to date is as follows • Demand letters sent to all departments, provinces and funders • Meetings held with all departments owing GDOH to negotiate payment plans. To date a payment plan has been received from Mpumalanga Province and North West Province has made payment of R1, 9 million. • The Department has written to Embassies regarding the outstanding debt owed by foreign patients. The Nigerian Embassy has been met for their further assistance in recovery of debt owed. 106 • Letters of demand has been sent to universities and engagements held with them regarding joint appointments. • Intervention has been requested from the National Minister of Labour regarding outstanding amounts owed by the Compensation Fund . • A debt book clean-up project underway at the institutions is intended to allocate receipts, write off long outstanding debts and clear off open credits. Department should submit a quarterly A wide range of alternative revenue sources has No update to SCOPA, the Health as well as the been identifi ed and the Department is working on Finance Portfolio Committees on alternative realising additional revenue from these sources. methods utilised to source revenue • Visitor parking at identifi ed hospitals • Implementation of private rates for patients with medical aids • Implementation of market related rentals for refurbished staff accommodation • Advertising at institutions • Charging fees for the use of some departmental facilities such as auditoria and boardrooms Department should provide the Committee Detailed progress reports and status of Yes (SCOPA) as well as the Health Portfolio implementation of investigations have been Committee with a progress report detailing provided. the status of the investigations including the Health Ombudsman’s report on Life Esidimeni within 30 days of adoption hereof and a quarterly progress report continuing until fi nalization thereof. 9. Prior Modifi cations to Audit Reports The table below shows steps taken to address matters in AGSA’s report for the previous fi nancial year.

Nature of Qualifi cation, Disclaimer, adverse Financial year Progress made in resolving the matter opinion and matters of non-compliance in which it fi rst arose Effective and appropriate steps were not taken 2013/2014 • Follow-up on Patient outstanding debt to collect all money due, as required by section • Issuing of summons 38(1) (c )(i)of the PFMA and Treasury regulation • The department has appointed debt collectors 11.2.1,15.10.1.2(a) and 15.10.1.2(e).As a result to follow-up on debt monthly. patient fees were impaired • Monthly reconciliation are performed with debt account • Tracing done at the hospital level. Not all payments due to creditors were settled 2012/2013 • An accruals plan was developed whereby within 30days from the date of the receipt of payments plans were negotiated with suppliers. invoice as required by section 38(1)(f)of the PFMA • A fi rm commitment to ensure that only current and treasury regulations 8.2.3 year invoices are paid using the current year budget. • Strict alignment to the demand plan • Cost containment measures in key areas Effective and appropriate steps were not always 2013/2014 • BAC head Offi ce ,all deviations are submitted taken to prevent irregular and fruitless and to the committee to obtain approval wasteful expenditure, as required by section 38(1) • Identifi cation and recording of irregular (c )(ii)of the PFMA treasury regulation 9.1.1 expenditure • Continue to improve the internal controls and close the gaps • Viewing of Purchase orders on the system and rejecting before the order is approved and released • Strengthening the Vetting committees at institutions • Cancel Three quotation system in phases • Improve on tracking of contracts to identify 107 before expiry Goods and services of a transaction value 2013/2014 • Ensure all deviations are approved by the HoD. above R500 000 were procure without inviting • Implementation of consequence management competitive bids,as required by treasury where there are cases of poor planning regulation 16A6.1.Deviations were approved by the accounting offi cer even though it was not practical to invite competitive bids, in contravention of treasury regulation 16A.6.4 Suffi cient appropriate audit evidence could 2013/2014 • Continue to maintain records of all RFQ’s not be obtained that goods and services with received and reasons where less than three the transaction value below R500 000 were quotations obtained this will be communicated procured by means of obtaining the required price through circular(re-enforcement) quotations, as required by Treasury Regulation 16A.6.1 Suffi cient appropriate audit evidence could not be 2016/2017 • Members of the DBAC and vetting obtained that all extensions or modifi cations to Committees to be apprised about the threshold contracts were approved by a properly delegated • Ensure that there is a maximum adherence to offi cial as required by section 44 of the PFMA. The the delegation non-compliance was due to the procurement of • Revise the DBAC decision form to include the goods and service. HoD’s signature The budget for compensation of employees was 2016/2017 • Application for condonation was submitted to increased without the approval of the Provincial treasury Treasury, as required by Treasury regulation6.3.1(a) and (d).The non- compliance was due to over expenditure ……… Nature of Qualifi cation, Disclaimer, adverse Financial year Progress made in resolving the matter opinion and matters of non-compliance in which it fi rst arose The fi nancial statements submitted for auditing 2017/2018 • That Senior Managers are more involved in were not prepared in accordance with the reviewing information for completeness and prescribed fi nancial reporting framework as accuracy provided by their teams for AFS required by section 40(1)(b)of the Public Finance disclosure purposes. Management Act. Material misstatements of • Adherence to timelines ensuring that suffi cient goods and services, commitments, provisions and time is allowed for review of information contingent liabilities identifi ed by the auditors provided. in the submitted fi nancial statement were • Involvement of critical contributors of the subsequently corrected, resulting in the fi nancial fi nancial statements during the entire audit statements receiving an unqualifi ed audit opinion process to ensure that matters are quickly resolved and do not result in fi ndings. • That contributors of the fi nancial statements ensures that all information is provided to Finance for disclosure and that additional information is not brought to surface only during the audit process. Need for transparency, accuracy and complete information to be provided fi rst time correctly Contracts were awarded to bidders based on 2017/2018 • Compliance checks list should be developed evaluation/adjudication criteria that differed and implemented and enforces compliance to from those stipulated in the original invitation treasury regulations. for bidding, in contravention of treasury regulations16A6.3(a).

1. Internal Control Unit Internal Control (ICC) unit is responsible for Co-ordinating the implementation of effective internal control and compliance framework towards clean audit and sound governance. Management is deemed to own the controls and the other lines of defence (including internal control unit) are to help ensure their application and viability.

108 The Internal Control Unit continuously conducts assessments and train staff during the year and recommendations are made to management at the institutions to ensure ongoing compliance to Policies and Procedures are in order to achieve a clean audit and sound governance.

10. Internal Audit and Audit Committees The table below gives details of Audit Committee members. Name Qualifi cations Internal or external If internal, Date Date No. of position in the appointed Resigned Meetings department attended Cluster Michael Sass B.Com.Accounting External 01/09/ 2016 Current 03 Audit (Pretoria University) Committee B.Com.Honours Members (UNISA) B.Compt. Honours (Unisa) Chartered Accountant CA(SA) Certifi ed Internal Auditor (CIA) M.Com.Forensic (NWU) Precious Sibiya B.Accounting External 10/10/ 2014 Current Chartered Accountant (SA) Postgraduate Diploma in Accountancy Japie du National Diploma: External 01/11/ 2015 Current Plesssis State Accounting and Finance Registered Government Auditor 11. Report of the Audit Committee Cluster 03 GAUTENG PROVINCIAL The Audit Committee noted that the Accounting Offi cer did not attend all fi ve scheduled Audit GOVERNMENT (GPG) Committee meetings and delegated a proxy to Report of the Audit Committee – Cluster 03 attend on his behalf. Therefore, the Audit Committee is satisfi ed that the Department adhered to the Department of Health provisions of the GPG Audit Committee Charter.

We are pleased to present our report for the fi nancial The Members of the Audit Committee met with the year ended 31 March 2018. Senior Management of the Department, Internal Audit and the AGSA, individually and collectively to Audit Committee and Attendance address risks and challenges facing the Department. A number of in-committee meetings were held to The Audit Committee consists of the external address control weaknesses and deviations within Members listed hereunder and is required to meet the Department. a minimum of at least two times per annum as per provisions of the Public Finance Management Act Audit Committee Responsibility (PFMA). In terms of the approved Terms of Reference (GPG Audit Committee Charter), fi ve meetings were The Audit Committee reports that it has complied held during the current year, i.e. three meetings with its responsibilities arising from section 38(1)(a) to consider the Quarterly Performance Reporting of the PFMA and Treasury Regulation 3.1.13. The (fi nancial and non-fi nancial) and two meetings to Audit Committee also reports that it has adopted review and discuss the Annual Financial Statements appropriate formal terms of reference as its Audit and the Auditor-General of South Africa’s (AGSA) Committee Charter, has regulated its affairs in Audit and Management Reports. compliance with this Charter and has discharged all its responsibilities as contained therein. Non-Executive Members The effectiveness of internal control and Name of Member Number of Information and Communication Technology 109 Meetings (ICT) Governance attended Mr. Japie du Plessis (Chairperson) 05 The Audit Committee has observed that the overall control environment of the Department has regressed Mr. Michael Sass 04 during the year under review. Some defi ciencies in Ms. Precious Sibiya 04 the system of internal control and deviations were reported in the Internal Audit and Auditor-General Executive Members Reports. The overall opinion of Internal Audit on the In terms of the GPG Audit Committee Charter, internal control design at the Department is adequate offi cials listed hereunder are obliged to attend but ineffective. It is recommended that Management meetings of the Audit Committee: should pay special attention to the core business processes as most fi ndings raised are related to the Compulsory Number of Meetings core mandate of the Department. Furthermore, due Attendees attended to the Department relying on the third parties such Mr. Ernest Kenoshi (Acting 01 as NGOs and NHLS, the Department should design Accounting Offi cer) and implement strict measures to ensure proper Mr. Mkhululi Lukhele 03 (Appointed 8 February (Acting Accounting Offi cer) 2018) oversight and monitoring of the services provided Mr. Malokolo Shai (Acting 02 by third parties. Management should also address Chief Financial Offi cer) the weaknesses in the performance information Ms. Kabelo Lehloenya 03 (Appointed 1 February as a matter of urgency. Management should also (Chief Financial Offi cer) 2018) implement the fi ndings raised by the AGSA and Mr. Johann Strauss (Chief 03 (Resigned 31 May 2018) Internal Audit on time. Risk Offi cer) Ms. Lorraine Francois (Chief 02 (Resigned 8 May 2018) The Audit Committee also reviewed the progress Audit Executive) with respect to the ICT Governance in line with the Mr. Luthendo Makhadi 02 (Appointed 10 May ICT Framework issued by the Department of Public (Acting Chief Audit 2018) Services and Administration. Controls regarding the Executive) ICT environment require urgent attention as many repeat fi ndings are raised. The Audit Committee Evaluation of Annual Financial Statements report its dissatisfaction with minimal progress made The Audit Committee has: with the implementation of the Disaster Recovery Plan and the Business Continuity Plan. This continued • Reviewed and discussed the audited Annual to be a high risk for the Department. Financial Statements to be included in the Annual Report, with the AGSA and the Accounting Internal Audit Offi cer; • Reviewed the Audit Report of the AGSA; The Audit Committee is satisfi ed that the Internal • Reviewed the AGSA’s Management Report and Audit plan represents a clear alignment with the key Management’s response thereto; risks, has adequate information systems coverage, • Reviewed the Department’s compliance with and a good balance across the different categories legal and regulatory provisions; and of audits, i.e. risk-based, mandatory, performance, • Reviewed signifi cant adjustments resulting from computer and follow-up audits. the audit. The Audit Committee has noted improvement The Audit Committee concurs with and accepts in the communication between the Executive the AGSA’s conclusions on the Annual Financial Management, the AGSA and the Internal Audit Statements, and is of the opinion that the audited Function, which has strengthened the Corporate Annual Financial Statements be accepted and read Governance initiatives within the Department, together with the report of the AGSA. however further improvement is required if proper effect is to be given to combined assurance. One-on-One Meeting with the Accounting Offi cer The Audit Committee wishes to stress that in order for the Internal Audit Function to operate at optimal The Audit Committee has met with the Accounting level as expected by the Audit Committee, the Offi cer for the Department to address unresolved shortage in human resources and skills should be issues. addressed. One-on-One Meetings with the Executive 110 Risk Management Authority Progress on the departmental risk management was The Audit Committee has met with the Executive reported to the Audit Committee on a quarterly basis. Authority for the Department to apprise the MEC on The Audit Committee is satisfi ed that the actual the performance of the Department. management of risk is receiving attention, although there are areas that still require improvement. Auditor-General of South Africa Management should take full responsibility for the entire Enterprise Risk Management Process and The Audit Committee has met with the AGSA to continue to support the Chief Risk Offi cer to even ensure that there are no unresolved issues. further enhance the performance of the Department.

Forensic Investigations Investigations based on the allegations of procurement irregularities, fraud, theft and negligence are being performed by the department dating back from prior periods. Some of these investigations have been fi nalised and others were still in progress at the reporting date. Mr. Japie du Plessis Chairperson of the Audit Committee The quality of quarterly reports submitted in Date: 31 July 2018 terms of the PFMA and the Division of Revenue Act The Audit Committee is satisfi ed with the content and quality of fi nancial and non-fi nancial quarterly reports prepared and submitted by the Accounting Offi cer of the Department during the year under review and confi rms that the reports were in compliance with the statutory reporting framework. PART D: HUMAN RESOURCEMANAGEMENT

111 INTRODUCTION OVERVIEW OF HUMAN RESOURCES A Detailed overview of HR-related matters are found The information contained in this part of the Annual under Programme 1. Report has been prescribed by the Minister for the Public Service and Administration for all departments in the public service.

112 HUMAN RESOURCES OVERSIGHT STATISTICS

The tables below give an overview of human resources patterns for the fi nancial year 2017/18.

Personnel related expenditure

The following tables summarises the fi nal audited personnel related expenditure by Programme and by salary band. In particular, it indicates the amount spent on personnel on salaries, overtime, homeowners’ allowances and medical aid.

Table 3.1.1: Personnel expenditure by Programme for the period 1 April 2017 to 31 March 2018

Total Personnel Training Professional Personnel Average Employment Expenditure Expenditure Expenditure and costs as Personnel (b) Programme (R’000) (R’000) (R’000) Special percent of Cost per Services Total Employee (R’000) Expenditure (R’000) 1. Administration 1 085 177 381 314 7,347 70,770 1% 277 1377 2. District health services 13 683 513 7 155 763 8,430 35,306 17% 372 19232 3. Emergency medical services 1 219 274 484 285 147 1% 274 1769 4. Provincial hospital services 7 892 277 5 812 575 993 46,814 14% 269 21613 5. Central hospital services 15 316 687 10,319,570 2,438 118,985 24% 540 19124 6. Health sciences and training 918 987 738 605 3,636 546 2% 172 4290 7. Health care support services 289 767 162,379 3 0% 238 683 8. Health facilities management 1,607,777 30 840 397 0% 1,028 30 HWSETA accounts MedSAS trading account Total 42 013 459 25 085 331 23,391 272,421 59.27% 3,169 68,118

Notes: a. Financial data extracted from Basic Accounting System (BAS). ƒ Personnel numbers extracted from the PERSAL system b. Employment = employees as at 31 March 2018 on the PERSAL System c. Special function: amount written off. d. Report compiled by the Directorate: Management Accounting 113 Table 3.1.2 Personnel costs by salary band for the period 1 April 2017 to 31 March 2018

Personnel % of total No of Average expenditure personnel employees personnel cost Salary band (R’000) costs per employee (R’000)

Lower skilled (Levels 1-2) 1,116,731 4.4 7523 148,442 Skilled (Levels 3-5) 5,427,546 21.5 25245 214,995 Highly skilled production (Levels 6-8) 5,393,396 21.4 16028 336,498 Highly skilled supervision (Levels 9-12) 9,593,152 38.1 12604 761,120 Senior and top management (levels 13-16) 115,679 0.5 96 1,204,994 Contract (Levels 1-2) 151 0.0 1 150,862 Contract (Level 3-5) 25,134 0.1 84 299,210 Contract (Levels 6-8) 212,707 0.8 673 316,058 Contract (Levels 9-12) 2,669,458 10.6 3123 854,774 Contract (Levels 13-16) 26,671 0.1 18 1,481,726 Periodical remuneration 250,364 1.0 845 296,289 Abnormal appointment 375,883 1.5 1878 200,151 Total 25,206,872 100 68118 370,047 Notes : a. Data extracted from Vulindlela b. Number of employees in the table refers to a head count of current employees on Persal. c. Total Personnel Cost in this table differs from Table (3.1.3) as the data sources differ (i.e. BAS and Vulindlela). ƒ The BAS system does not cater for salary bands but expenditure per item.

114 Table 3.1.3: Salaries, Overtime, Home Owners’ Allowance and Medical Aid by Programme for the period 1 April 2017 to 31 March 2018

Programme Salaries Salaries as % Overtime Overtime as % HOA (R’000) HOA as % of Medical Ass. Medical Ass. Total (R’000) of personnel (R’000) of Personnel personnel (R’000) as % personnel costs costs costs of personnel cost (R’000) costs

Administration 356,147 93% 3,603 1% 7,802 2% 13,763 4% 381 314

District health services 6,263,626 88% 345,946 5% 219,876 3% 326,316 5% 7 155 763

Emergency medical services 420,019 87% 2,815 1% 22,398 5% 39,053 8% 484,285

Provincial hospital services 4,871,985 84% 527,205 9% 170,993 3% 242,393 4% 5 812 575

Central hospital services 8,574,318 83% 1,123,155 11% 264,636 3% 357,459 3% 10 319 570 Health sciences and training 680,761 92% 1,525 0% 27,694 4% 28,624 4% 738 605

Health care support services 118,876 73% 14,564 9% 11,461 7% 17,478 11% 162,379

Health facilities management 29,677 96% 46 0% 293 1% 823 3% 30 840

HWSETA accounts 0.00% 0% 0%

Total 21,315,409 85% 2,018,859 8% 725,153 3% 1,025,909 4% 25 085 331

Notes: a. Data extracted from Basic Accounting System (BAS). b. Total Personnel Cost on this table differs from Table 2.2 as the data sources differ (i.e. BAS and Vulindlela). BAS does not cater for salary bands but expenditure per item. c. Salaries include all compensation of employees items excluding overtime, housing allowance and employer medical aid. 115 116

Table 3.1.4: Salaries, Overtime, Home Owners’ Allowance and Medical Aid by salary band for the period 1 April 2017 to 31 March 2018

Salaries Overtime Home Owners’ Allowance Medical Aid Amount Salaries as Amount Overtime as Amount HOA as Amount Medical aid as Salary bands (R’000) a % of (R’000) a % of (R’000) a % of (R’000) a % of personnel personnel personnel personnel costs costs costs costs

Lower skilled (Levels 1-2) 712,899 4.4% 31,728 1.6% 26,770 7.4% 109,345 10.6% Skilled (Level 3-5) 3,655,091 22.6% 124,310 6.2% 125,232 34.4% 399,881 38.9% Highly skilled production (Levels 6-8) 3,920,699 24.3% 125,662 6.2% 111,435 30.6% 311,859 30.4% Highly skilled supervision (Levels 9-12) 7,789,220 48.2% 1,725,985 85.7% 99,125 27.3% 204,467 19.9% Senior and Top management (levels 13-16) 87,608 0.5% 7,158 0.4% 1,087 0.3% 1,869 0.2% Total 16,165,517 100.0% 2,014,843 100.0% 363,650 100.0% 1,027,422 100.0% a. Data extracted from Vulindlela b. Totals on this table differ from Table (3.1.3) as the data sources differ (i.e. BAS vs Vulindlela).BAS does not cater for salary bands but expenditure per item. Employment and vacancies

The tables in this section summarise the position with regard to employment and vacancies.

The following tables summarise the number of posts in the establishment, the number of employees, the vacancy rate and whether any staff are additional to the establishment.

The information is presented in terms of three key variables:

Programme salary band critical occupations (see defi nition in notes below)

The Department have identifi ed critical occupations that need to be monitored. In terms of current regulations, it is possible to create a post in the establishment that can be occupied by more than one employee. Therefore, the vacancy rate refl ects the percentage of vacant posts.

Table 3.2.1 Employment and vacancies by Programme: 2017/2018

Programme NUMBER NUMBER VACANT VACANCY NUMBER OF OF POSTS ON OF POSTS POSTS RATE POSTS APPROVED FILLED FILLED ESTABLISHMENT ADDITIONAL TO THE ESTABLISHMENT 01 - Health Administration 1,273 1,068 205 16.10% 28 02 - District Health Services 20,334 18,851 1,483 7.29% 970 03 - Emergency Medical Services 1,916 1,771 145 7.57% 1 04 - Provincial Health Services 22,497 21,149 1,348 5.99% 1,399 05 - Academic Health Services 20,592 18,900 1,692 8.22% 859 06 - Health Sciences And Training 4,506 3,672 834 18.51% 1 07 - Health Care Support Services 788 683 105 13.32% 0 117 08 - Health Facility Management 37 30 7 18.92% 7 GRAND TOTAL 71,943 66,124 5,819 8.09% 3,265

Notes: a. Data was extracted from PERSAL (Establishment Report) as end March 2018.

Table 3.2.2 Employment and vacancies by salary band: 2017/2018

SALARY BAND DESCRIPTION NUMBER NUMBER VACANT VACANCY NUMBER OF OF POSTS ON OF POSTS RATE EMPLOYEES APPROVED POSTS ADDITIONAL TO ESTABLISHMENT FILLED THE ESTABLISHMENT 1. Lower Skilled (Levels 1 - 2) 8,356 7,799 557 6.67% 5 2. Skilled (Levels 3 - 5) 29,623 27,152 2,471 8.34% 85 3. Highly Skilled Production (Levels 6 - 8) 17,076 15,932 1,144 6.70% 1,803 4. Highly Skilled Supervision (Levels 16,735 15,129 1,606 9.60% 1,370 9 - 12) 5. Senior Management (Levels 13 - 16) 153 112 41 26.80% 2 GRAND TOTAL 71,943 66,124 5,819 8.09% 3,265

Notes: a. Data extracted from PERSAL (Establishment Report) as at 31 March 2018. Table 3.2.3 Employment and vacancies by critical occupations: 2017/2018

CRITICAL OCCUPATION NUMBER NUMBER OF VACANT VACANCY NUMBER OF OF POSTS ON POSTS POSTS RATE EMPLOYEES APPROVED FILLED ADDITIONAL TO ESTABLISHMENT THE ESTABLISHMENT Dental Practitioner 321 288 33 10.28% 18 Dental Specialist 99 84 15 15.15% 0 Emergency Care Practitioner 1,802 1,672 130 7.21% 0 Medical Practitioner 3,713 3,286 427 11.50% 252 Medical Practitioner (Intern) 1,031 996 35 3.39% 862 Medical Specialist 1,306 1,130 176 13.48% 2 Nursing Assistant 7,130 6,893 237 3.32% 19 Pharmacist (Intern) 72 66 6 8.33% 63 Pharmacist 539 504 35 6.49% 84 Professional Nurse 15,861 14,821 1,040 6.56% 1,361 Professional Nurse (Student) 3,753 2,960 793 21.13% 12 Staff Nurse 8,020 7,755 265 3.30% 23 GRAND TOTAL 43,647 40,455 3,192 7.31% 2,696

Notes: a. Data extracted from PERSAL (Establishment Report) as at 31 March 2018. b.This table refl ects the number of critical posts as they appear on the establishment

Filling of Senior Management Service (SMS) Posts 118 The tables in this section provide information about employment and vacancies as they relate to members of the Senior Management Service by salary level. It also provides information about advertising and fi lling of SMS posts, reasons for not complying with prescribed timeframes and disciplinary steps taken.

Table 3.3.1 SMS post information as at 31 March 2018

Total number Total number Total number % of SMS % of SMS SMS Level of funded SMS of SMS posts of SMS posts posts fi lled posts vacant posts fi lled vacant Director-General/Head of 0 0 0% 0 #DIV/0! Department Salary Level 16 1 1 100% 0 0% Salary Level 15 5 5 100% 0 0% Salary Level 14 28 28 100% 0 0% Salary Level 13 80 80 100% 0 0% Total 114 114 100% 0 0%

Table 3.3.2 SMS post information as at 30 September 2017

Total number Total number Total number % of SMS % of SMS SMS Level of funded SMS of SMS posts of SMS posts posts fi lled posts vacant posts fi lled vacant

Director-General/Head of 1 1 100% 0 0% Department Salary Level 16 1 1 100% 0 0% Salary Level 15 7 7 100% 0 0% Salary Level 14 31 31 100% 0 0% Salary Level 13 83 83 100% 0 0% Total 123 123 100% 0 0% Table 3.3.3 Advertising and fi lling of SMS posts for the period 1 April 2017 to 31 March 2018 of of lled lled fi posts posts SMS Level % of SMS % of SMS SMS posts advertised posts fi funded SMS of SMS posts funded posts Total number Total number Total Total number Total Total number Total of SMS vacant vacant funded Director-General/Head of Department 1 0 1 0% 1 100% Salary Level 16 1010%00% Salary Level 15 7 1 4 14% 0 0% Salary Level 14 31 3 13 10% 0 0% Salary Level 13 83 0 12 0% 0 0% Total 123 4 31 3% 1 1%

Table 3.3.4 Reasons for not having complied with the fi lling of funded vacant SMS, Advertised within 6 months and fi lled within 12 months after becoming vacant for the period 1 April 2017 and 31 March 2018

Reasons for vacancies not advertised within six months Most of the newly vacated positions are advertised within six months of being vacated

Reasons for vacancies not fi lled within six months Recruitment and retention of suitably qualifi ed employees/skills in critical positions is a serious challenge as these skills are not readily available. This affects turnaround times for recruitment.

Table 3.3.5 Disciplinary steps taken for not complying with the prescribed timeframes for fi lling SMS posts within 12 months for the period 1 April 2017 and 31 March 2018 119 Reasons for vacancies not advertised within six months The majority are advertised within six months. Exceptional cases are delayed due inter alia to fi nancial constraints.

Reasons for vacancies not fi lled within six months Delay by line manager in undertaking the recruitment process The need to meet gender and disability targets Successful candidates being counter-offered by their employers; this prolongs the recruitment process and results in having to headhunt or re-advertise positions 120

Job Evaluation

Within a nationally determined framework, an executive authority may evaluate or re-evaluate any job in his or her organisation. In terms of the regulations, all vacancies on Salary Level 9 and higher must be evaluated before they are fi lled. The following table gives the number of jobs evaluated during the year under review and provides statistics of the number of posts upgraded or downgraded.

Table 3.4.1 Job Evaluation by salary band for the period 1 April 2017 to 31 March 2018

Posts on Number of % of jobs Posts upgraded Posts downgraded establishment jobs evaluated evaluated Salary band Number % of posts Number % of posts evaluated evaluated

Lower skilled (Levels 1-2) 8161 0 0.0% 0 0.0% 0 0% Skilled (Levels 3-5) 29347 0 0.0% 0 0.0% 0 0% Highly skilled production (Levels 6-8) 16598 0 0.0% 0 0.0% 0 0% Highly skilled supervision (Levels 9-12) 13416 41 0.3% 0 0.0% 0 0% Senior management Band A 90 0 0.0% 0 0.0% 0 0% Senior management Band B 26 0 0.0% 0 0.0% 0 0% Senior management Band C 6 0 0.0% 0 0.0% 0 0% Senior management Band D 0 0 0.0% 0 0.0% 0 0% Contract (Levels 1-2) 4 0 0.0% 0 0.0% 0 0% Contract (Levels 3-5) 52 0 0.0% 0 0.0% 0 0% Contract (Levels 6-8) 708 0 0.0% 0 0.0% 0 0% Contract (Levels 9-12) 2985 0 0.0% 0 0.0% 0 0% Contract Band A 6 0 0.0% 0 0.0% 0 0% Contract Band B 8 0 0.0% 0 0.0% 0 0% Contract Band C 3 0 0.0% 0 0.0% 0 0% Contract Band D 1 0 0.0% 0 0.0% 0 0% Total 71411 41 0% 0 0 0 0.0% The following table provides a summary of the number of employees whose positions were upgraded due to their posts being upgraded. The number of employees may differ from the number of posts upgraded as not all employees are automatically absorbed into the new posts and some of the posts upgraded may be vacant.

Table 3.4.2 Profi le of employees whose positions were upgraded due to their posts being upgraded for the period 1 April 2017 to 31 March 2018

Gender African Asian Coloured White Total Female 00000 Male 10012 Total 00002 Employees with a disability

The following table gives the number of cases where remuneration bands exceeded the grade determined by job evaluation. Reasons for the deviation are provided in each case.

Table 3.4.3 Employees with salary levels higher than those determined by job evaluation by occupation for the period 1 April 2017 to 31 March 2018

Occupation Number of Job evaluation level Remuneration level Reasons for employees deviation 000 Total number of employees whose salaries exceeded the level determined by job evaluation 0 Percentage of total employed 0

The following table summarises the benefi ciaries of the above in terms of race, gender, and disability.

Table 3.4.4 Profi le of employees whose salary levels are higher than those determined by job evaluation for the period 1 April 2017 to 31 March 2018 121

Gender African Asian Coloured White Total Female 00000 Male 00000 Total 00000 Employees with a disability 0

Total number of employees whose salaries exceeded the level determined by job evaluation 0

Employment Changes

This section provides information about changes in employment during the fi nancial year. Turnover rates indicate trends in the employment profi le of the Department. The following tables provide a summary of turnover rates by salary band and critical occupations (see defi nition in notes below). Table 3.5.1 Annual turnover rates by salary band for the period 1 April 2017 to 31 March 2018

Number of Appointments Terminations Turnover rate employees at and transfers and transfers Salary Band the beginning into the out of the of period - Department Department April 2017 1. Lower skilled (Levels 1 - 2) 7542 274 135 0.02 2. Skilled (Levels 3 - 5) 26949 875 1036 0.04 3. Highly skilled production (Levels 6 - 8) 15542 505 1167 0.08 4. Highly skilled supervision (Levels 9 - 12) 12422 922 1173 0.09 5. Senior management service Band A 76 1 5 0.07 5. Senior management service Band B 20 0 4 0.20 5. Senior management service Band C 3 0 1 0.33 5. Senior management service Band D 1 0 0 0.00 6. Contracts 3853 2878 3077 0.80 Total 66,408 5,455 6,598 9.9% Notes: a. Data extracted from PERSAL b. Number of employees - as on 1st April 2017 c. Appointments and transfers into the Department as from the 1st of April 2017 to the 31st of March 2018 d. Terminations and transfers out of the Department as from the 1st of April 2017 to the 31st of March 2018

Table 3.5.2 Annual turnover rates by critical occupation for the period 1 April 2017 to 31 March 2018

Number of Appointments Terminations Turnover rate employees at and transfers and Critical occupation the beginning into the transfers out 122 of period - department of the April 2017 department Dental practitioner 308 49 48 15.6% Dental specialist 171 31 28 16.4% Medical practitioner 2649 1214 1180 44.5% Medical practitioner (intern) 909 486 469 51.6% Medical specialist 2484 485 523 21.1% Emergency care practitioner 1677 65 55 3.3% Pharmacist 592 206 261 44.1% Pharmacist (intern) 61 62 68 111.5% Professional nurse 14789 1099 1769 12.0% Staff nurse 7555 262 260 3.4% Nursing assistant 6771 388 213 3.1% Professional nurse (student) 4073 10 252 6.2% Total 42039 4357 5126 12.2% a. Data extracted from PERSAL b. This only represent Critical Occupations c. Number of Employees - as on the 1st April 2017 d. Appointments and transfers into the Department as from the 1st of April 2017 to the 31st of March 2018 e. Terminations and ransfers out of the Department as from the 1st of April 2017 to the 31st of March 2018 The table below identifi es the major reasons why staff left the department.

Table 3.5.3 Reasons why staff left the Department in the period 1 April 2017 to 31 March 2018

% of total Termination Type Number resignations 1. Death 264 3.5% 2. Resignation 2568 34.0% 3. Expiry of contract 3523 46.7% 4. Dismissal: operational changes 28 0.4% 5. Dismissal: misconduct 25 0.3% 6. Dismissal: ineffi ciency 0.0% 7. Discharged due to ill-health 39 0.5% 8. Retirement 929 12.3% 9. Transfer to other public service departments 6 0.1% 10. Other 160 2.1% Total 7 542 100.0%

Total number of employees who left as a % of total employment 11.4% a. Data extracted from PERSAL b. Terminations as from the 1st of April 2016 to the 31st of March 2018

Table 3.5.4 Promotions by critical occupation for the period 1 April 2017 to 31 March 2018

Employees 1 Promotions Salary level Progression to Notch April 2017 to another promotions another notch progression salary level as a % of within as a 123 Occupational Class (b) employees by a salary level % of occupation employees by occupation Dental practitioner 308 1 0.32% 28 9.09% Dental specialist 171 6 3.51% 8 4.68% Medical practitioner 2649 21 0.79% 111 4.19% Medical practitioner (intern) 909 0 0.00% 0 0.00% Medical specialist 2484 110 4.43% 107 4.31% Emergency care practitioner 1677 6 0.36% 6 0.36% Pharmacist 61 11 18.03% 50 81.97% Pharmacist (intern) 592 0 0.00% 0 0.00% Professional nurse 14789 210 1.42% 29 0.20% Staff nurse 7555 27 0.36% 18 0.24% Nursing assistant 6771 0 0.00% 77 1.14% Professional nurse (student) 4073 0 0.00% 0 0.00% Total 42039 392 0.93% 434 1.03% a. Data extracted from PERSAL b. Promotions as on the 1st of April 2017 to the 31st of March 2018 c. Number of employees as on the 1st of April 2017 Table 3.5.5 Promotions by salary band for the period 1 April 2017 to 31 March 2018

Employees Promotions Salary Progression Notch 1 April to another band to progression 2017 salary level promotions another as a % of Salary Band as a % of notch within employees employees a salary by salary by salary level bands level 1. Lower skilled (Levels 1 - 2) 7544 2 0.0% 0 0.0% 2. Skilled (Levels 3 - 5) 27030 85 0.3% 103 0.4% 3. Highly skilled production (Levels 6 - 8) 16181 63 0.4% 72 0.4% 4. Highly skilled supervision (Levels 9 - 12) 15535 392 2.5% 374 2.4% 5. Senior management (Levels 13 - 16) 118 5 4.2% 0 0.0% Grand Total 66 408 547 0.8% 549 0.83% a. Data extracted from PERSAL b. Number of Employees -as on the 1st of April 2017 c. Promotions as from the 1st of April 2017 to the 31st of March 2018

124 3.6 Employment Equity

Table 3.6.1 Total number of employees (including employees with disabilities) in each of the following occupational categories as at 31 March 2018

Male Female Occupational Category Total Total African Coloured Indian Black White African Coloured Indian Black White Total 1. Legislators, Senior Offi cials and Managers 70 3 4 77 7 61 3 6 70 6 160 2. Professionals 1852 67 429 2348 819 1935 105 501 2541 1007 6715 3. Technicians and Associate Professionals 2788 43 63 2894 136 17911 511 391 18813 1151 22994 4. Clerks 2485 51 19 2555 58 5537 96 17 5650 287 8550 5. Service Workers and Shop and Market Sales 2637 19 13 2669 58 14757 117 17 14891 145 17763 Workers 7. Craft and Related Trades Workers 00000 00022 8. Plant and Machine Operators and Assemblers 390 8 2 400 7 34 0 0 34 0 441 9. Elementary Occupations 3926 54 6 3986 71 7208 147 1 7356 80 11493 Grand Total 14148 245 536 14929 1156 47443 979 933 49355 2678 68118 Employees with disabilities 113 8 1 122 17 158 10 2 170 27 336 125 126

Table 3.6.2 Total number of employees (including employees with disabilities) in each of the following occupational bands as at 31 March 2018

Male Female Occupational Bands Total Total African Coloured Indian Black White African Coloured Indian Black White Total (a)

1.Top management 20020400406 2. Senior management 47 3 3 53 6 39 2 2 43 6 108 3. Professionally qualifi ed and experienced specialists and mid-management 2646 86 426 3158 732 9326 344 664 10334 1503 15727 4. Skilled technical and academically qualifi ed workers, junior management, supervisors 2629 40 32 2701 130 12556 304 187 13047 823 16701 5. Semi-skilled and discretionary decision-making 5623 73 18 5714 82 19102 217 24 19343 190 25329 6. Unskilled and defi ned decision making 3201 43 57 3301 206 6416 112 56 6584 156 10247 Total 14148 245 536 14929 1156 47443 979 933 49355 2678 68118 Employees with disabilities 113 8 1 122 17 158 10 2 170 27 336 ( a ) ( a ) ( b )

Table 3.6.3 Recruitment for the period 1 April 2017 to 31 March 2018

Male Female Occupational Bands African Coloured Indian White African Coloured Indian White Total (a)

1.Top management 600010007 2. Senior management 111020005 3. Professionally qualifi ed and experienced specialists and mid-management 565 23 130 244 1072 66 201 482 2783 4. Skilled technical and academically qualifi ed workers, junior management, supervisors 165 4 7 19 713 42 70 235 1255 5. Semi-skilled and discretionary decision-making 247 2 1 3 846 12 1 16 1128 6. Unskilled and defi ned decision making 528 9 20 44 1249 16 19 38 1923 Total 1512 39 159 310 3883 136 291 771 7101 Employees with disabilities 000101002 Table 3.6.4 Promotions for the period 1 April 2017 to 31 March 2018

Male Female Occupational Bands (b) Total Total African Coloured Indian Black White African Coloured Indian Black White Total (a)

1.Top management 00000000000 2. Senior management 2002021 37883 3. Professionally qualifi ed and experienced specialists and mid-management 246 4 28 278 41 728 20 52 800 31 1150 4. Skilled technical and academically qualifi ed workers, junior management, supervisors, foremen and superintendents 135 0 0 135 4 1103 14 2 1119 3 1261 5. Semi-skilled and discretionary decision-making 109 2 0 111 1 616 4 1 621 0 733 6. Unskilled and defi ned decision making 00000100101 Total 492 6 28 526 46 2450 39 55 2544 112 3228 Employees with disabilities 200206006210

Table 3.6.5 Terminations for the period 1 April 2017 to 31 March 2018

Male Female Occupational Bands (b) Total Total African Coloured Indian Black White African Coloured Indian Black White Total (a)

1.Top management 10001000000010 2. Senior management 500506107113 3. Professionally qualifi ed and experienced specialists and mid-management 559 14 144 717 268 1311 69 223 1603 477 3065 4. Skilled technical and academically qualifi ed workers, junior management, supervisors 298 7 4 309 15 1201 49 57 1307 287 1918 5. Semi-skilled and discretionary decision-making 385 8 3 396 7 884 21 4 909 23 1335 6. Unskilled and defi ned decision-making 348 4 21 373 40 699 17 22 738 50 1201 Grand Total 1605 33 172 1810 330 4101 157 306 4564 838 7542 Employees with disabilities 30031161017425 127 128

Table 3.6.6 Disciplinary action for the period 1 April 2017 to 31 March 2018

Male Female Total Total African Coloured Indian Black White African Coloured Indian Black White Total

Disciplinary action 436 4 7 447 6 583 4 4 591 14 1058 Notes : a. Data supplied by Labour Relations Management

Table 3.6.7 Skills development for the period 1 April 2017 to 31 March 2018

Male Female Occupational Category Total Total African Coloured Indian Black White African Coloured Indian Black White Total (a)

1. Legislators, senior offi cials and managers 172 0 0 172 0 251 1 0 252 0 424

2. Professionals 2 376 86 6 2 468 2 5 115 6 1 5 122 17 7 609

3. Technicians and associate professionals 960 5 2 967 16 2 004 16 6 2 154 5 3 142

4. Clerks 316 5 5 326 2 782 18 9 809 16 1 153

5. Service workers and shop and market sales workers 287 1 1 289 1 726 6 2 734 6 1 030

7. Craft and related trades workers 800803003011

8. Plant and machine operators and assemblers 31 1 0 32 0 16 0 0 16 0 48

9. Elementary occupations 691 8 3 702 1 1 271 13 5 1 289 10 2 002

Total 4 841 106 17 4 964 22 10 168 60 23 10 251 54 15 419

Employees with disabilities 400408008012 Notes: a. Data supplied by Human Resource Development : Skills Development b. Classifi cation legend: Offi cials responsible for determining and formulating policy and strategy, planning, directing and coordinating the policies and Legislators, Senior Offi cials and Managers ƒ activities of the organisation; for example: CEOs, Senior Managers, College Principals Includes offi cials whose main tasks require a high level of ƒ Professionals: professional knowledge; for example: Clinical Psychologists and Medical & Dental Practitioners

This group includes occupations whose main tasks require technical ƒ Technicians and Associate Professionals knowledge and experience such as Clinical Technologists, Industrial Technicians, Environmental Health Offi cers, Professional Nurses This group includes occupations whose tasks require the knowledge and experience necessary to organise, store, compute Clerks ƒ and retrieve information such as Accounting Clerks, Stores Offi cers, Administration Clerks This group includes occupations whose main tasks require the ƒ Service Workers and Shop and Market Sales knowledge and experience to provide personal and protective Workers services such as auxiliary services offi cers (ward attendants), Emergency Care practitioners, fi refi ghters, food services aides This group includes occupations whose main tasks require the ƒ Craft and Related Trades Workers knowledge and experience of skilled trades and handicrafts such as clinical photographers, plumbers and electricians The main tasks of this occupational grouping involve the use of Plant and Machine Operators and ƒ automated industrial machinery and equipment such as drivers and Assemblers tradesmen’s aides This group includes occupations which require relatively low/ elementary levels of knowledge and experience to perform largely simple and routine tasks involving the use of hand held tools Elementary Occupations ƒ and, in some cases, considerable physical effort and, with few exceptions, limited personal initiative and judgement; for example, cleaners and groundsmen. 129 Signing of Performance Agreements by SMS Members

All members of the SMS must conclude and sign performance agreements within specifi c timeframes. Information about the signing of performance agreements by SMS members, the reasons for not complying with the prescribed timeframes and disciplinary steps taken is presented here.

Table 3.7.1 Signing of Performance Agreements by SMS members as on 31 March 2018

Signed performance SMS Level Total number agreements Total number Total number of signed as % of total of funded SMS of SMS performance number of posts members agreements SMS members Director-General/Head of Department: Salary Level 16 1 1 100% Salary Level 15 7 7 100% Salary Level 14 29 29 100% Salary Level 13 84 84 100% Total 0 121 121 100% Table 3.7.2 Reasons for not having concluded Performance Agreements for all SMS members as at 31 March 2018

Total number Total number Total number Signed of funded SMS of SMS of signed performance posts members performance agreements SMS Level agreements as % of total number of SMS members Director-General/Head of Department: Salary Level 16 1 1 100% Salary Level 15 7 7 100% Salary Level 14 29 29 100% Salary Level 13 84 84 100% Total 0 121 121 100%

Table 3.7.3 Disciplinary steps taken against SMS members for not having concluded Performance Agreements as at 31 March 2018

Reasons Not applicable; 100% compliance. Performance Rewards

To encourage good performance, the Department granted the following performance rewards during the year under review. The information is presented in terms of race, gender, disability, salary band and critical occupation (see the defi nitions in the notes below).

130 Foreign Workers

The tables below give information about the employment of foreign nationals in the Department in terms of salary band and major occupation.

Table 3.9.1 Foreign workers by salary band for the period 1 April 2017 to 31 March 2018

1 April 2017 31 March 2018 Change Salary Band % of % of % Number total Number total Number Change Lower skilled 55 5.72% 57 6.63% 2 -2.0% Highly skilled (Levels 6-8) 110 11.43% 90 10.47% -20 19.6% Highly skilled supervision (Levels 9-12) 392 40.75% 438 50.93% 46 -45.1% Contract (Levels 9-12) 405 42.10% 275 31.98% -130 127.5% Contract (Levels 13-16) 0 0.00% 0 0.00% 0 0.0% Total 962 100.0% 860 100.0% -102 100.0% Notes: a. Data extracted from Persal

Table 3.9.2 Foreign workers by major occupation for the period 1 April 2017 to 31 March 2018

1 April 2017 31 March 2018 Change Major occupation % of % of % Number total Number total Number Change Administrative offi ce workers 9 0.9% 8 0.9% -1 1.0% Elementary occupations 6 0.6% 6 0.7% 0 0.0% Information technology personnel 1 0.1% 1 0.1% 0 0.0% 131 Professionals and managers 723 75.2% 664 77.2% -59 57.8% Social natural technical and medical sciences + supp 10 1.0% 8 0.9% -2 2.0% Technicians and associated professionals 213 22.1% 173 20.1% -40 39.2% Total 962 100.0% 860 100.0% -102 100.0% Notes: a. Data extracted from Persal 132

Leave utilisation

The Public Service Commission has identifi ed the need for careful monitoring of sick leave within the public service. The following tables give information about the use of sick leave and disability leave, with estimated cost of the leave provided.

Table 3.10.1 Sick Leave for period 01 April 2017 to 31 March 2018

Total Days % Days with Number of % of Total Average Days Estimated Total number Medical Employees Employees per Employee Cost (R’000) of days with Salary Band Certifi cation using Sick using Sick medical Leave Leave certifi cation Contract (Levels 13-16) 436.00 82.60 79.00 0.10 6.00 1 758.00 360.00 Contract (Levels 3-5) 274.00 82.50 57.00 0.10 5.00 208.00 226.00 Contract (Levels 6-8) 3 704.00 72.90 677.00 1.30 5.00 4 248.00 2 699.00 Contract (Levels 9-12) 5 749.00 73.90 1 296.00 2.40 4.00 12 777.00 4 248.00 Contract Other 925.00 93.20 274.00 0.50 3.00 292.00 862.00 Highly skilled production (Levels 6-8) 94 805.00 85.50 12 697.00 23.80 7.00 114 997.00 81 066.00 Highly skilled supervision (Levels 9-12) 65 612.00 85.20 8 801.00 16.50 7.00 147 245.00 55 904.00 Lower skilled (Levels 1-2) 46 899.00 90.20 6 202.00 11.60 8.00 22 960.00 42 303.00 Other 19.00 94.70 3.00 0.00 6.00 8.00 18.00 Senior management (Levels 13-16) 6 217.00 76.00 1 008.00 1.90 6.00 26 703.00 4 727.00 Skilled (Levels 3-5) 159 521.00 87.10 22 222.00 41.70 7.00 117 156.00 138 952.00 TOTAL 384 161.00 86.30 53 316.00 100.00 7.00 448 352.00 331 365.00

Notes: a. Data extracted from VULINDLELA Table 3.10.2 Disability leave (temporary and permanent), 01 April 2017 to 31 March 2018

Total Days % Days with Number of % of Total Average Days Estimated Total number Medical Employees Employees per Employee Cost (R’000) of days with Salary Band Certifi cation using using medical Disability Disability certifi cation Leave Leave Contract (Levels 13-16) 3.00 100.00 1.00 0.00 3.00 15.00 3.00 Contract (Levels 6-8) 85.00 100.00 14.00 0.70 6.00 97.00 85.00 Contract (Levels 9-12) 280.00 100.00 10.00 0.50 28.00 505.00 280.00 Highly skilled production (Levels 6-8) 12 519.00 100.00 520.00 25.40 24.00 15 280.00 12 519.00 Highly skilled supervision (Levels 9-12) 10 442.00 100.00 407.00 19.90 26.00 23 621.00 10 438.00 Lower skilled (Levels 1-2) 4 545.00 100.00 245.00 12.00 19.00 2 263.00 4 545.00 Senior management (Levels 13-16) 820.00 100.00 30.00 1.50 27.00 3 283.00 820.00 Skilled (Levels 3-5) 19 451.00 100.00 823.00 40.10 24.00 14 375.00 19 451.00 TOTAL 48 145.00 100.00 2 050.00 100.00 23.00 59 437.00 48 141.00

Notes: a. Data extracted from VULINDLELA 133 Table 3.10.3 Annual Leave, 01 April 2017 to 31 March 2018

Total Days Average Days Number of Taken per Employee Employees Salary Band who took leave Contract (Levels 1-2) 11.00 11.00 1.00 Contract (Levels 13-16) 3 924.52 17.00 236.00 Contract (Levels 3-5) 1 239.00 11.00 116.00 Contract (Levels 6-8) 13 583.84 17.00 801.00 Contract (Levels 9-12) 45 182.40 15.00 2 953.00 Contract (Other) 9 624.00 19.00 511.00 Highly skilled production (Levels 6-8) 340 922.69 22.00 15 556.00 Highly skilled supervision (Levels 9-12) 249 975.18 23.00 10 974.00 Lower skilled (Levels 1-2) 164 184.63 20.00 8 122.00 Other 100.00 13.00 8.00 Senior management (Levels 13-16) 46 731.42 22.00 2 166.00 Skilled (Levels 3-5) 625 809.50 22.00 28 771.00 TOTAL 1 501 288.18 21.00 70 215.00

Notes: a. Data extracted from VULINDLELA

Table 3.10.4 Capped leave, 01 April 2017 to 31 March 2018

Total Average Average Number of Total Number of days of number capped employees number employees 134 capped of days leave per who took of capped as at end Salary Band leave taken per employee capped leave of period taken employee as at end leave available of period at end of period 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) 759.44 4.00 31.00 207.00 106 733.11 3 450.00 Highly skilled supervision (Levels 775.68 5.00 35.00 147.00 102 773.72 2 943.00 9-12) Lower skilled (Levels 1-2) 18.00 6.00 20.00 3.00 1 388.72 69.00 Other 0.00 0.00 4.00 0.00 7.42 2.00 Senior management (Levels 13-16) 157.00 7.00 38.00 24.00 16 653.57 442.00 Skilled (Levels 3-5) 573.80 4.00 22.00 145.00 88 026.01 4 028.00 TOTAL 2 283.92 4.00 29.00 526.00 315 614.69 10 935.00

Notes: a. Data extracted from VULINDLELA Table 3.10.5 Leave payouts, 01 April 2017 to 31 March 2018

Total Amount Number of Average Reason (R’000) Employees Payment per Employee (R) Capped leave payouts on termination of service for current fi nancial year 92 720.00 2 179.00 42 552.00 Current leave payouts on termination of service for current fi nancial year 5 293.00 359.00 14 744.00 Leave payouts for current fi nancial year due to non-utilisation of leave in the previous cycle 40.00 3.00 13 333.00 TOTAL 98 054.00 2 541.00 38 589.00 Notes: a. Data extracted from VULINDLELA

3.11 HIV/AIDS & Health Promotion Programmes

Table 3.11.1 Steps taken reduce the risk of occupational exposure, 2017/2018

Units/categories of employees identifi ed to be at high Key steps taken to reduce the risk risk of contracting HIV & related diseases (if any) ƒ Doctors Policies and protocols are in place. ƒ Nurses High risk work areas and high workload areas identifi ed and control measures put in place ƒ Laboratory Workers Workplace training and education for employees on needle prick injuries and other biological risks and medical surveillance ƒ Cleaners working in clinical areas Proper management of medical waste ƒ Laundry workers Post-exposure prophylaxis provided to all employees exposed to biological risks. 135 ƒ Mortuary workers Personal protective equipment (PPE) provided at work. ƒ Health Care Waste Offi cers a. Data Supplied by Chief Directorate :Human Resource Development-Employee Wellness

Table 3.11.2 Details of Health Promotion and HIV and AIDS Programmes, 2017/18

Question Yes No Details, if yes 1. Has the Department designated a member X The Department has an EHWP Directorate. The of the SMS to implement the provisions EHWP Director post has been vacant since 2008. contained in Part VI E of Chapter 1 of the Offi cials are acting in the post. Public Service Regulations, 2001? If so, provide her/his name and position.

2. Does the Department have a dedicated unit X The Employee Health and Wellness Programme or have you designated specifi c staff members Directorate is responsible for promoting the health, to promote health and well-being of your wellbeing and safety of employees. employees? If so, indicate the number of employees who are involved in this task and There are three sub-directorates dealing with the annual budget that is available for this employee wellbeing: Occupational Health, purpose. Employee Assistance Programme and HIV, TB and STIs in the Workplace. Number of employees: 23, including Director’s vacant post; Director’s post: vacant, 2 Deputy Directors, 6 Assistant Directors, 1 Social Worker. 1 Senior administrator, 10 Admin Clerks, 1 Occupational Medical Practitioner, 1 Occupational Health Nurse Practitioner.

The allocated budget is: Equitable Share R10 million (1 million for goods and services); HIV Conditional Grant R30 million Question Yes No Details, if yes 3. Has the Department introduced an Employee X An Employee Assistance Programme is in place Assistance or Health Promotion Programme (internal and external services). The following for your employees? If so, indicate the key services are available to employees: Professional elements/services of the Programme. Counselling, Trauma Management, Prevention of Violence in the Workplace, Stress and Confl ict Management, Capacity Building on EAP Issues, Lifestyle Management, Pre-Retirement Services, Behavioural Risk Management Audit and Financial Wellness. Employee Wellness Centres are available in 60% of hospitals where Primary Health Care and Chronic Disease Management is available. Medical surveillance Programmes are also in place in 60% of hospitals. 4. Has the Department established (a) X There are provincial HIV, TB and STI, EAP committee(s) as contemplated in Part VI E.5 (e) and Occupational Health Committees with of Chapter 1 of the Public Service Regulations, representatives from the hospitals and Districts. 2001? If so, please provide the names of The EHWP Provincial Committee has to be revived. the members of the committee and the stakeholder(s) that they represent. 5. Has the Department reviewed the employment X Employment policies that ensure no unfair policies and practices of your department to discrimination against employees are: ensure that these do not unfairly discriminate 1. Medical Surveillance Policy against employees on the basis of their HIV 2. HIV/AIDS,STI and TB Management Policy status? If so, list the employment policies/ 3. Draft Management of TB in HCWs Policy practices so reviewed. 6. Has the Department introduced measures X With regard to EHWP, the following Programmes to protect HIV-positive employees or protect and educate employees: Capacity Building those perceived to be HIV-positive from on Reduction of Stigma and Discrimination and discrimination? If so, list the key elements of Policy on HIV and AIDs, STI and TB Management; these measures. Medical Surveillance Programme; Peer Education and Support Groups 136 7. Does the Department encourage its employees X Training on reduction of stigma discrimination, to undergo voluntary counselling and testing? management of disclosure and HIV counselling If so, list the results that you have achieved. and testing. Implementation of NSP 2017 - 2022 Framework. HCT (HTC) testing = 997 excluding HTC testing done during medical surveillance. 8. Has the Department developed measures/ X Indicators: indicators to monitor & evaluate the impact 1. Total number of employees who have received of your employee Health and Wellness HIV Counselling and Testing Programme? If so, list these measures/ 2. Total number of employees screened for TB and indicators. trained on HIV and TB co-infection 3. Total number of employees trained on the reduction of stigma and discrimination 4. Total number of employees trained on PMTCT 5. Total number of employees reporting IOD and occupational diseases 6. Total number of employees participating on Medical Surveillance Programme (pre- employment Medical Surveillance Programme) 7. Number of employees vaccinated 8. Number of employees reached through Psychosocial services

a. Data Supplied by Chief Directorate: Human Resource Development - Employee Health and Wellness Programme: HIV, STI & TB Management Labour Relations

Table 3.12.1 Collective agreements for the period 1 April 2017 to 31 March 2018

Subject Matter Date PSCBC Resolution 1 of 2017: Agreement on the amendments/improvement of certain existing pension benefi ts and creation of new benefi ts Signed: 27 June 2017 PSCBC Resolution 2 of 2017: Agreement on thresholds and procedures for the granting of organisational rights within the public service Signed: 27 June 2017 PSCBC Resolution 3 of 2017: Negotiation Protocol agreement: Wage negotiation process Signed: 27 June 2017 PSCBC Resolution 4 of 2017: Agreement on the review of the Government Employees Medical Scheme (GEMS) Signed: 5 December 2017 PSCBC Resolution 5 of 2017: Agreement on the establishment of an advisory body for the Government Housing Scheme (GEHS) Signed: 5 December 2017 PHSDSBC Resolution 2 of 2017: Framework Agreement on the Payment of Rural Allowance Signed: 1 June 2017 PHSDSBC Resolution 3 of 2017: Admission of Trade Unions to Council Signed: 21 June 2017 PHSDSBC Resolution 4 of 2017: Agreement on the Payment of Special Allowances and Danger Allowance Signed: 29 June 2017 Notes: a. Data supplied by Labour Relations Management & Development

Table 3.12.2 Misconduct and disciplinary hearings fi nalised for the period 1 April 2017 to 31 March 2018

Outcomes of disciplinary hearings Number % of total Correctional counselling 28 3.0% Verbal warning 137 14.6% 137 Written warning 349 37.2% Final written warning 221 23.5% Suspended without pay 103 11.0% Fine 0 0.0% Demotion 1 0.1% Dismissal 52 5.5% Not guilty 8 0.9% Case withdrawn 40 4.3% Total 939 100.0%

Notes: a. Data supplied by Labour Relations Management & Development

Of the 52 dismissals, 15 are abscondment cases.

2. Cases that were closed because the accused employees resigned are 26, they excluded from the total number of cases which are 939.

3. The 103 cases are acombination of sanctions i.e. fi nal written warning and suspension without salary. Table 3.12.3 Types of misconduct addressed at disciplinary hearings for the period 1 April 2017 to 31 March 2018

Type of misconduct (based on annexure A) Number % of total Conduct self in improper/unacceptable manner 85 7.7% Absenteeism 288 26.1% Negligence 161 14.6% Insubordination 127 11.5% Fraud and corruption 112 10.2% Assaults 12 1.1% Theft 79 7.2% Dereliction of duty 16 1.5% Others 186 16.9% Post desertion 36 3.3% Total 1102 100.0%

Notes: (a) Data supplied by Labour Relations Management & Development (b) In the type of misconduct listed above as others, means combination of sanctions that included: - poor performance - RWOPS - alcohol abuse - sexual harassment - late coming - abscondment - damage to state vehicles / property

Table 3.12.4 Grievances logged for the period 1 April 2017 to 31 March 2018 138 Number % of total Number of grievances resolved 257 99.2% Number of grievances not resolved 2 0.8% Total number of grievances lodged 259 100.0%

Notes: (a) Data supplied by Labour Relations Management & Development: Total number of grievance lodged in this period are 259 of the 259, 2 are pending (b) The above number of grievances lodged include: X Grievances were lodged directly with the PSC of which X are fi nalised and X awaiting closure by the PSC. X Grievance was lodged directly with the Public Protector, who refered it back to the Department. The investigation was fi nalsed and awaiting fi nal signature.

Table 3.12.5 Disputes logged with Councils for the period 1 April 2017 to 31 March 2018

Number % of Total Number of disputes upheld 82 59.9% Number of disputes pending 55 40.1% Total number of disputes lodged 137 100.0%

Notes: (a) Data supplied by Labour Relations Management & Development (b) The total number of disputes lodged include: - PHSDSBC cases - PSCBC cases - CCMA cases (c) The 55 pending cases include 10 cases waiting for awards. (d) The 82 disputes upheld, 31 cases in favour of the Department and 07 cases in favour of the applicant. “(e) The 137 cases lodged include: 56 cases deadlocked 18 cases settled 26 cases withdrawn” Table 3.12.6 Strike action for the period 1 April 2017 to 31 March 2018

Number of person working days lost 1 day Total cost (R’000) of working days lost R235,288.96 Amount (R’000) recovered as a result of no work no pay R235,288.96 Notes: a. Data supplied by Labour Relations Management & Development

Table 3.12.7 Precautionary suspensions for the period 1 April 2017 to 31 March 2018

Number of people suspended 26 Number of people whose suspension exceeded 30 days 14 Average number of days suspended 75 Cost (R’000) of suspensions R1 962 577.8

Notes: a. Data supplied by Labour Relations Management & Development

3.13 Skills development

This section highlights the Department’s activities in relation to skills development.

Table 3.13.1 Training needs identifi ed for the period 1 April 2017 to 31 March 2018

Training needs at the start of the Number of reporting period employees Skills Occupational categories Gender Learnerships Other as at 1 Programmes forms of Total April 2017 & other short training 139 courses 1. Legislators, senior offi cials and 30 managers 30 20 20 2. Professionals 2000 20 2,020 1000 1,000 3. Technicians and associate 6500 professionals 320 6,820 180 3100 3,280 4. Clerks 3300 3,300 1200 1,200 5. Service workers and shop and 750 market sales workers 750 374 374 7. Craft and related trades workers 0 0 0 0 8. Plant and machine operators 15 and assemblers 15 5 5 9. Elementary occupations 2500 2,500 1400 1,400 Total 0 500 22,194 20 22,714 Notes: a. Data provided by the Directorate Human Resource Development: Skills Development Number of employees is as at the beginning of the reporting period (i.e. April 2016) as required by the reporting guideline. b. Learnerships, Skills Programmes and other forms of training are training needs identifi ed as per the Workplace Skills Plan of 2016/2017 Table 3.13.2 Training provided for the period 1 April 2017 to 31 March 2018

Training provided within the reporting Number of period employees Occupational categories Gender Learnerships Skills Other Total as at 1 Programmes forms of April 2017 & other short training courses 1. Legislators, senior offi cials and 27 managers Female 27 Male 14 14 2. Professionals Female 2104 2,104 Male 967 967 3. Technicians and associate 2860 professionals Female 180 3,040 Male 240 1888 2,128 4. Clerks Female 30 2770 2,800 Male 25 1840 1,865 5. Service workers and shop and 740 market sales workers Female 740 Male 314 314 7. Craft and related trades workers Female 1 1 Male 4 4 8. Plant and machine operators 14 and assemblers Female 14 Male 3 3 140 9. Elementary occupations Female 1905 1,905 Male 780 780 Total 0 475 16,231 0 16,706 Notes: 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 2016) as required by the reporting guideline. c. Learnerships, Skills Programmes and other forms of training is training provided as per Annual Training Report of 2016/2017

3.14 Injury on duty

The following tables provides information about injuries on duty.

Table 3.14.1 Injuries on duty for the period 1 April 2017 to 31 March 2018

Nature of injury Number % of total Required basic medical attention only 1099 99.82% Temporary total disablement 0 0.00% Permanent disablement 1 0.09% Fatal 1 0.09% Total 1101 100.00% Notes: a. Data provided by the Department of E-Government 3.15 Utilisation of Consultants

Table 3.15.1 Report on consultant appointments using appropriated funds for the period 1 April 2017 to 31 March 2018

Total number of Duration: Contract consultants who Project Title work value worked on the days in Rand project

Appointment of consultants to support the Finance division of the Medical Supplies Depot for a period of 2 years including the contract price adjustment due to the adding of Value Added Tax (VAT) 1. XJM Consultants 2 years 5 060 232.00 Request for BAC approval of tender award: Tender GT/ GDH/116/2014 for the investigation of the “Loss To Follow- up of Patients (LTFUP)” in anti-retroviral (ARVs) treatment in Gauteng for a period of 6 months. KPMG Services (Pty) Ltd 6 months 1 563 311.71 Request for BAC approval of tender award: Tender GT/ GDH/150/2014 for Mid-Term review of the Gauteng Strategic Plan for HIV, TB and STI’s for 2012-2016. Live Moya (Pty) Ltd 4 months 1 026 696.00

Table 3.15.2 Analysis of consultant appointments, using appropriated funds, in terms of historically disadvantaged individuals (HDIs) for the period 1 April 2017 to 31 March 2018

Percentage Percentage Number of ownership by management consultants HDI groups by HDI groups from HDI Project title groups that work on the project 141 Request for BAC approval to extend the scope of services for GDOH Lean Project which is being executed by Lean Institute Africa under Purchase Order No. 4250471278 100% 100% 1 Request for BAC approval to appoint BMGI Consultants through section 10.5 of SCM Practice note no 3 of 2003 for the purpose of undertaking a comprehensive diagnostic of Chris Hani Baragwanath Academic Hospital. 100% 100% 1

Request for BAC approval to appoint two law fi rms to do legal audit of all the departmental medico litigation matters without going through competitive bidding process. 100% 100% 2 none none none none a. Data supplied by the Directorate: Supply Chain Management b. 58.14% of appropriated funds for goods and services were spent on Black Economic Empowerment (BEE) companies. 13.6 Severance Packages

Table 3.16.1 Granting of employee-initiated severance packages for the period 1 April 2017 to 31 March 2018

Salary band Number of applications received Number of applications to referred the MPSA Number of applications supported by MPSA Number of packages by approved department Lower skilled (Levels 1-2) 000 0 Skilled (Levels 3-5) 000 0 Highly skilled production (Levels 6-8) 000 0 Highly skilled supervision (Levels 9-12) 000 0 Senior management (Levels 13-16) 000 0 Total 000 0

142 PART E: FINANCIAL INFORMATION

143 Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Report of the Auditor-General to Gauteng Provincial Legislature on vote no. 4 Gauteng Department of Health

Report on the audit of the fi nancial statements

Opinion

1. I have audited the fi nancial statements of the Gauteng Department of Health set out on pages 143 to 280, which comprise the appropriation statement, the statement of fi nancial position as at 31 March 2018, the statement of fi nancial performance, statement of changes in net assets and cash fl ow statement for the year then ended, as well as the notes to the fi nancial statements, including a summary of signifi cant accounting policies.

2. In my opinion, the fi nancial statements present fairly, in all material respects, the fi nancial position of the Gauteng Department of Health as at 31 March 2018, and its fi nancial performance and cash fl ows for the year then ended in accordance with the Modifi ed Cash Standard (MCS) prescribed by the National Treasury and the requirements of the Public Finance Management Act of South Africa, 1999 (Act No. 1 of 1999) (PFMA) and the Division of Revenue Act of South Africa, 2016 (Act No. 3 of 2017) (Dora).

Basis for opinion

3. I conducted my audit in accordance with the International Standards on Auditing (ISAs). My responsibilities under those standards are further described in the auditor-general’s responsibilities for the audit of the fi nancial statements section of this auditor’s report.

4. I am independent of the department in accordance with the International Ethics Standards Board for Accountants’ Code of ethics for professional accountants (IESBA code) and the ethical requirements that are relevant to my audit in South Africa. I have fulfi lled my other ethical responsibilities in accordance with these 144 requirements and the IESBA code.

5. I believe that the audit evidence I have obtained is suffi cient and appropriate to provide a basis for my opinion.

Emphasis of matters

6. I draw attention to the matters below. My opinion is not modifi ed in respect of these matters.

Material uncertainties

7. With reference to note 20.1 to the fi nancial statements, the department is the defendant in various lawsuits. The ultimate outcome of these matters cannot presently be determined and no provision for any liability that may result has been made in the fi nancial statements.

Restatement of corresponding fi gures

8. As disclosed in note 33 to the fi nancial statements, the corresponding fi gures for 31 March 2017 have been restated as a result of errors discovered in the fi nancial statements of the department at, and for the year ended 31 March 2018. The restatement related to assets that were incorrectly included and/or omitted in the department’s asset register.

Payables which exceeded voted funds to be surrendered

9. As disclosed in note 22.2 to the fi nancial statements, payables of R3 928 108 000 exceeded the payment term of 30 days, as required by treasury regulation 8.2.3. This amount, in turn, exceeded the R179 375 000 of voted funds to be surrendered by R3 748 733 000 as per the statement of fi nancial performance. Therefore, the amount of R3 748 733 000 would have constituted unauthorised expenditure had the amounts due been paid in time. Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Responsibilities of the accounting offi cer for the fi nancial statements

10. The accounting offi cer is responsible for the preparation and fair presentation of the fi nancial statements in accordance with the MCS prescribed by the National Treasury and the requirements of the PFMA and Dora, and for such internal control as the accounting offi cer determines is necessary to enable the preparation of fi nancial statements that are free from material misstatement, whether due to fraud or error.

11. In preparing the fi nancial statements, the accounting offi cer is responsible for assessing the Gauteng Department of Health’s ability to continue as a going concern, disclosing, as applicable, matters relating to going concern and using the going concern basis of accounting unless the accounting offi cer either intends to liquidate the department or to cease operations, or has no realistic alternative but to do so.

Auditor-general’s responsibilities for the audit of the fi nancial statements

12. My objectives are to obtain reasonable assurance about whether the fi nancial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to infl uence the economic decisions of users taken on the basis of these fi nancial statements.

13. A further description of my responsibilities for the audit of the fi nancial statements is included in the annexure to this auditor’s report.

Report on the audit of the annual performance report Introduction and scope

14. In accordance with the Public Audit Act of South Africa, 2004 (Act No. 25 of 2004) (PAA) and the general notice issued in terms thereof, I have a responsibility to report material fi ndings on the reported performance information against predetermined objectives for selected Programmes presented in the annual performance 145 report. I performed procedures to identify fi ndings but not to gather evidence to express assurance.

15. My procedures address the reported performance information, which must be based on the approved performance planning documents of the department. I have not evaluated the completeness and appropriateness of the performance indicators/ measures included in the planning documents. My procedures also did not extend to any disclosures or assertions relating to planned performance strategies and information in respect of future periods that may be included as part of the reported performance information. Accordingly, my fi ndings do not extend to these matters.

16. I evaluated the usefulness and reliability of the reported performance information in accordance with the criteria developed from the performance management and reporting framework, as defi ned in the general notice, for the following selected Programmes presented in the annual performance report of the department for the year ended 31 March 2018:

Programmes Pages in the annual performance report

Programme 2: District health services 30 – 44 Programme 4: Provincial hospital services 47 – 50

17. I performed procedures to determine whether the reported performance information was properly presented and whether performance was consistent with the approved performance planning documents. I performed further procedures to determine whether the indicators and related targets were measurable and relevant, and assessed the reliability of the reported performance information to determine whether it was valid, accurate and complete.

18. The material fi ndings in respect of the usefulness and reliability of the selected Programmes are as follows: Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Programme 2: District health services Various indicators

19. I was unable to obtain suffi cient appropriate audit evidence to support the reasons for the variances between the planned targets and the achievements of the indicators listed below. This was due to limitations placed on the scope of my work. I was unable to confi rm the reported reasons for the variances by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reported reasons for the variances. Furthermore, the reported achievement in the annual performance report did not agree to the supporting evidence provided for the indicators listed below. The supporting evidence provided indicated that the achievements of these indicators were as follows.

Indicator description Reported achievement PHC utilisation rate – Total 1,5% ART client remain on ART end of month –total 927 825 HIV test done – total 3 083 921 Male condom distributed 190 349 748 Medical male circumcision – Total 112 608 Infant 1st PCR test positive around 10 weeks rate 0,99% Pneumonia case fatality under 5 year rate 2,6% Severe acute malnutrition case fatality under 5 years rate 6,2% Couple year protection rate (Int) 59% Antenatal client start on ART rate 94,7% Maternal mortality in facility ratio 108.5/100000 Various indicators

146 20. 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. The supporting evidence provided indicated that the achievements of these indicators were as follows

Indicator description Reported achievement Inpatient bed utilisation rate (district hospitals) 66,9% Antenatal 1st visit before 20 weeks rate 61,4% Mother postnatal visit within 6 days’ rate 70,8% Immunisation under 1-year coverage 77% Diarrhoea case fatality under 5 year rate 2,3% Cervical cancer screening coverage 30 years and older 47,4% HPV 1st dose 51 352 HPV 2nd dose 57 150 Neonatal death in facility rate 13,6

Various indicators

21. I was unable to obtain suffi cient appropriate audit evidence for the variances and the reported achievements of the indicators listed below. This was due to limitations placed on the scope of my work. I was unable to confi rm the reasons for the variances and the reported achievements by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reasons for the variances and to the reported achievements in the annual performance report. Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Indicator description Reported achievement. TB client treatment success rate 84,2% TB client death rate 6,2% TB MDR treatment success rate 53,1%

Various indicators

22. I was unable to obtain suffi cient appropriate audit evidence to support the reasons for the variances between the planned targets and the achievements of the following indicators reported in the annual performance report. This was due to limitations placed on the scope of my work. I was unable to confi rm the reported reasons for the variances by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reported reasons for the variances.

Indicator description Reported achievement. School grade 1 – learners screened 83 402 Malaria case fatality rate 1,5%

Various indicators

23. The reasons for the variance between the planned targets and the reported achievements were not explained in the annual performance report for the indicators listed below:

Indicator description Reported achievement. OHH registration visit coverage 8,6 School Grade 8 learners screened 46 612 147 District hospitals achieved 75% and more on national core standards self-assessment rate

24. I was unable to obtain suffi cient appropriate audit evidence to validate the existence of systems and processes that enable reliable reporting of actual service delivery against the indicator. As a result, I was unable to obtain suffi cient appropriate audit evidence for the variance and the reported achievement of the indicator due to these limitations placed on the scope of my work. I was unable to confi rm the reason for the variance and the reported achievement by alternative means. Consequently, I was unable to determine whether any adjustment was required to the reason for the variance and to the reported achievement in the annual performance report.

Ideal clinic status conducted by Perfect Permanent Team for Ideal Clinic Realisation and Maintenance rate

25. I was unable to obtain suffi cient appropriate audit evidence to validate the existence of systems and processes that enable reliable reporting of actual service delivery against the indicator. As a result, I was unable to obtain suffi cient appropriate audit evidence for the reported achievement of the indicator due to these limitations placed on the scope of my work. I was unable to confi rm the reason for the variance and the reported achievement by alternative means. Consequently, I was unable to determine whether any adjustment was required to the achievement of 78% as reported in the annual performance report. Furthermore, the reason for the variance between the planned target of 65% and the reported achievement of 78% was not reported in the annual performance report.

TB/HIV co-infected client on ART rate

26. The reason for the variance between the planned target of 90% and the reported achievement of 87,5% was not reported in the annual performance report. Furthermore, I was unable to obtain suffi cient appropriate audit evidence for the reported achievement of the target mentioned above. This was due to limitations placed on the scope of my work. I was unable to confi rm the reported achievement by alternative means. Consequently, I was unable to determine whether any adjustments were required to the achievement of 87.5% as reported in the annual performance report. Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Programme 4 : Provincial hospital services Various indicators

27. I was unable to obtain suffi cient appropriate audit evidence for the reported achievements for the indicators listed below. This was due to limitations placed on the scope of my work. I was unable to confi rm the reported achievements by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reported achievements in the annual performance report.

Indicator description Reported achievement Hospital achieved 75% and more on national core standards self-assessment-rate (regional hospitals) 88,9%

Hospital achieved 75% and more on national core standards self-assessment rate (specialised 50% hospitals)

Inpatient Bed Utilisation Rate (regional hospitals)

28. I was unable to obtain suffi cient appropriate audit evidence to support the reason for the variance between the planned target of 83% and the achievement of 79,7% reported in the annual performance report. This was due to limitations placed on the scope of my work. I was unable to confi rm 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.

Other matter

29. I draw attention to the matter below.

Achievement of planned targets 148 30. Refer to the annual performance report on pages 21 to 89 for information on the achievement of planned targets for the year and explanations provided for the under and overachievement of a signifi cant number of targets. This information should be considered in the context of the disclaimer of opinions expressed on the usefulness and reliability of the reported performance information from paragraphs 19 to 28 of this report.

Report on the audit of compliance with legislation

Introduction and scope

31. In accordance with the PAA and the general notice issued in terms thereof, I have a responsibility to report material fi ndings on the compliance of the department with specifi c matters in key legislation. I performed procedures to identify fi ndings but not to gather evidence to express assurance.

32. The material fi ndings on compliance with specifi c matters in key legislations are as follows:

Annual fi nancial statements

33. The fi nancial statements submitted for auditing were not prepared in accordance with the prescribed fi nancial reporting framework as required by section 40(1)(b) of the Public Finance Management Act. Material misstatements of goods and services, immovable assets, work-in-progress, provisions and contingent liabilities identifi ed by the auditors in the submitted fi nancial statements were subsequently corrected, resulting in the fi nancial statements receiving an unqualifi ed audit opinion.

Procurement and contract management

34. Goods and services with a transaction value below R500 000 were procured without obtaining the required price quotations, as required by treasury regulation 16A6.1. Similar non-compliance was also reported in the prior year.

35. Goods and services of a transaction value above R500 000 were procured without inviting competitive bids and, in some instances, deviations were approved by the accounting offi cer but it was practical to invite competitive bids, as required by treasury regulation 16A6.1 and 16A6.4. Similar non-compliance was also reported in the prior year. Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

36. Some contracts were awarded to bidders based on evaluation/adjudication criteria that differed from those stipulated in the original invitation for bidding, in contravention of treasury regulation16A6.3(a).

37. ome contracts were extended or modifi ed without the approval of a properly delegated offi cial as required by section 44 of the PFMA and treasury regulation 8.1 and 8.2. A similar fi nding was identifi ed in the prior year.

Expenditure management

38. Effective and appropriate steps were not taken to prevent irregular expenditure amounting to R1 703 204 117 and fruitless and wasteful expenditure amounting to R37 918 086, as disclosed in notes 26 and 27 to the annual fi nancial statements, as required by section 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1. The majority of the irregular expenditure was caused by procurement of goods and services without following competitive bidding processes, and for fruitless and wasteful expenditure is due to interest levied on overdue accounts.

39. Payments were not made within 30 days or an agreed period after receipt of an invoice, as required by treasury regulation 8.2.3.

Revenue management

40. Effective and appropriate steps were not taken to collect all money due, as required by section 38(1)(c)(i) of the PFMA. The non-compliance was due to non-collection of patient debts which were written off, totalling R446 684 000.

Conditional grant

41. The hospital facilities revitalisation grant was not spent for its intended purposes in accordance with the applicable grant framework, as required by section 17(1) of Dora.

Consequence management 149 42. Disciplinary steps were not taken against the offi cials who had incurred or permitted irregular expenditure, as required by section 38(1)(h)(iii) of the PFMA.

Other information

43. The accounting offi cer is responsible for the other information. The other information comprises the information included in the annual report. The other information does not include the fi nancial statements, the auditor’s report and those selected Programmes presented in the annual performance report that have been specifi cally reported in this auditor’s report.

44. My opinion on the fi nancial statements and fi ndings on the reported performance information and compliance with legislation do not cover the other information and I do not express an audit opinion or any form of assurance conclusion thereon.

45. In connection with my audit, my responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the fi nancial statements and the selected Programmes presented in the annual performance report, or my knowledge obtained in the audit, or otherwise appears to be materially misstated. If, based on the work I have performed on the other information that I obtained prior to the date of this auditor’s report, I conclude that there is a material misstatement in this other information, I am required to report that fact. I have nothing to report in this regard.

Internal control defi ciencies

46. I considered internal control relevant to my audit of the fi nancial statements, reported performance information and compliance with applicable legislation; however, my objective was not to express any form of assurance on it. The matters reported below are limited to the signifi cant internal control defi ciencies that resulted in the fi ndings on the annual performance report and the fi ndings on compliance with legislation included in this report. Department Of Health Vote 4 REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Leadership

47. The accounting offi cer did not exercise adequate oversight responsibility over internal controls relating to procurement and contract management and over the preparation of the annual fi nancial statements and annual performance report. In addition, disciplinary steps are not taken against the offi cials who contravene the laws and regulations. This resulted in repeated non-compliance with key laws and regulations, the annual fi nancial statements and annual performance report.

Financial and performance management

48. Senior management did not ensure that suffi cient controls are in place to prepare accurate and complete fi nancial statements and performance reports that are supported and evidenced by reliable information. This resulted in the material amendments to the fi nancial statements and material fi ndings on the annual performance report. In addition, there was a lack of monitoring controls to ensure compliance with laws and regulations including procurement and contract management, expenditure management and revenue management.

Other reports

49. I draw attention to the following engagements conducted by various parties that had, or could have, an impact on the matters reported in the department’s fi nancial statements, reported performance information, compliance with applicable legislation and other related matters. These reports did not form part of my opinion on the fi nancial statements or my fi ndings on the reported performance information or compliance with legislation

Investigations

50. Various investigations, based on the allegations of procurement irregularities, fraud, theft and negligence, are being performed by the department dating back from prior periods. Some of these investigations were fi nalised by the Special Investigation Unit and the department whilst others were still in progress at the date 150 of this auditor’s report.

Johannesburg 31 July 2018 Department Of Health Vote 4 ANNEXTURE-AUDITORS-GENERAL’S RESPONSIBILITY FOR THE AUDIT for the year ended 31 March 2018

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 fi nancial 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 fi nancial statements as described in this auditor’s report, I also:

• identify and assess the risks of material misstatement of the fi nancial statements whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is suffi cient 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 offi cer • conclude on the appropriateness of the accounting offi cer’s use of the going concern basis of accounting in the preparation of the fi nancial statements. I also conclude, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast signifi cant doubt on the Gauteng Department of Health’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 fi nancial statements about the material uncertainty or, if such disclosures are inadequate, to modify the opinion on the fi nancial statements. My conclusions are based on the information available to me at the date of this auditor’s report. 151 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 fi nancial statements, including the disclosures, and whether the fi nancial 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 offi cer regarding, among other matters, the planned scope and timing of the audit and signifi cant audit fi ndings, including any signifi cant defi ciencies in internal control that I identify during my audit.

4. I also confi rm to the accounting offi cer 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. Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018

Table of Contents

Appropriation Statement 153

Notes to the Appropriation Statement 235

Statement of Financial Performance 238

Statement of Financial Position 239

Statement of Changes in Net Assets 240

Cash Flow Statement 241

Accounting policies 242

Notes to the Annual Financial Statements 249

Annexures 270

152 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 153 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Appropriation Appropriation Voted funds and Direct charges funds and Direct Voted Adjusted Programme Programme sub total Departmental receipts 42,192,834 - - 42,192,834 42,013,459 179,375 99.6% 37,656,857 37,440,067 546,916 535,254 Appropriation per Programme Appropriation 12 ADMINISTRATION3 SERVICES DISTRICT HEALTH 4 EMERGENCY MEDICAL SERVICES5 SERVICES PROVINCIAL HOSPITAL 6 SERVICES CENTRAL HOSPITAL 1,378,154 14,003,301 7 SCIENCES AND TRAINING HEALTH 7,768,963 8 CARE SUPPORT SERVICES HEALTH 15,341,041 1,009,171 713,367 MANAGEMENT FACILITIES HEALTH Add: - - 295,538 -110,000 -291,200 - 1,683,299 Revenue) Actual amounts per Statement of Financial Performance (Total 123,700 13,712,101 - 1,268,154 - - 13,683,513 1,219,274 371,900 7,892,663 -80,700 -8,000 - 28,588 - 7,892,277 48,880 42,739,750 15,333,041 1,085,267 -5,700 15,316,687 928,471 1 085 177 99.8% 386 96.1% 16,354 918,987 - 289,838 11,995,850 11,992,093 1,102,221 1,683,299 100.0% 9,484 289,767 90 99.9% 1,010,469 1 607 777 6,953,066 13,389,397 99.0% 13,387,424 6,952,127 100% 71 75 522 1,054,124 851,940 100.0% 1,054,063 95.5% 851,488 258,529 2,051,730 1,943,911 38,192,111 248,492 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

154 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 500 - - 500 3,918 -3,418 783.6% - 13,952 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 174,599 - 40,700 349,979 215,299 263,024 370 900 - (155 601) - -25,800 - 172.3% 237,224 349,979 63,843 235,509 255,725 66,846 94,254 1,715 73.1% 99.3% 223,050 145,694 216,912 107,450 Adjusted Appropriation Appropriation cation c and technological services ------Inventory: Food and food suppliesInventory: Fuel, oil and gas 350,080 174,042 - -8,000 - 342,080 -2,400 338,723 171,642 3,357 220 779 99.0% (49 137) 307,670 128.6% 265,345 171,342 175,183 Laboratory servicesScientifi Legal servicesContractors Agency and support / outsourced services Fleet services (including government motor transport) 1,665,489 Inventory: Clothing material and accessories - -123,700 15,252 1,541,789 571,824 1,535,121 - 6,668 106,200 - 121,452 99.6% - 314,227 1,209,654 -192,775 571,824 875,027 536,468 258.7% 35,356 14,526 93.8% 748,168 533,494 485,536 Compensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 24,965,403 AdvertisingMinor assetsAudit costs: External - Bursaries: Employees 21,832,391 Catering: Departmental activities 3,133,012 Communication (G&S) 13,448,861 - Computer services - 24,965,403 Consultants: Business and advisory -413 20,387 25,085,331 - 5,575 services -20,387 -119,928 21,852,778 4,842 22,113,279 22,368 - 3,112,625 -260,501 100.5% 108,654 6,791 2,972,052 - 8,622 13,448,448 13 583 390 22,564,591 140,573 - 92,948 101.2% 23,289,574 - (134 942) - 19,522,315 - 169,092 - - 20,580,518 95.5% - -3,600 - 101.0% - 3,042,276 5,575 - 11,411,068 - - 105,054 2,709,057 11,078,374 4,842 120,000 - 22,368 4,212 32,319 6,791 2,600 8,622 289,092 20,731 1,363 72,735 92,948 264,615 2,242 2,154 1,637 4,067 74,378 24,477 75.6% 30.8% 4,637 4,555 18,570 53.7% 92.7% 91.5% 94,962 5,658 31.7% 47.2% 80.0% 20,991 3,739 35,475 343,894 4,859 18,518 6,471 93,183 207,226 2,547 8,500 88,346 3,039 1,895 Appropriation per economic classifi Appropriation Current payments 38,414,264 -413 - 38,413,851 38,400,257 13,594 100.0% 33,975,659 34,367,949 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 155 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 628 -628 - - - R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 1,652 - - 1,652 813 839 49.2% 1,486 1,477 13,075 - - 13,075 4,875 8,200 37.3% 10,085 8,618 159,849 - - 159,849 152,092 7,757 95.1% 142,027 107,346 Adjusted Appropriation Appropriation cation ce supplies Inventory: Materials and suppliesInventory: Medical suppliesInventory: MedicineInventory: Other suppliesConsumable supplies 43,162 printing and Consumable: Stationery, offi 2,477,791 - -733 3,975,018 132,388 -7,000 and subsistenceTravel - 2,470,058 476,097 and developmentTraining 2,618,205 Operating payments - - -148,147 43,162 -79,500 and facilitiesVenues 2,000 Rental and hiring - 37,564 3,895,518 on land and rent -18,900 Interest 106.0% 3,826,095 134,388 on unitary (Incl. interest Interest 5,598 payments (PPP)) 2,277,093 69,423 112,339 457,197 48,699 35,823 2,030,336 452,908 22,049 87.0% 98.2% 45,263 4,289 - - 4,526 83.6% 3,118,054 43,476 3,101,764 - 99.1% - - - 38,985 735 - 484,381 - - 48,699 35,823 - - 436,153 - 23,391 22,104 45,263 25,308 13,719 - - - 4,526 5,336 48.0% 61.7% 39,927 1,457 735 - 3,069 36,341 44,693 11.8% 984 16,006 628 25,582 32.2% 6,741 -249 -628 3,183 4,537 133.9% 2,298 - 483 100 - - Provinces and municipalitiesProvinces MunicipalitiesMunicipal bank accountsMunicipal agencies and fundsDepartmental agencies and accounts 739,104 19,812 739,104 - 739,104 ------739,104 - 739,104 19,812 739,104 - - 739,104 19,812 - 739,104 739,104 100.0% - - - 675,326 100.0% 100.0% - - 675,326 100.0% 18,869 - - 18,869 675,326 675,326 - - 675,326 675,326 Inventory: Learner and teacher support material Operating leases paymentsProperty Departmental provided: Transport activity 1,932,427 118,675 320 - - - 118,995 1,932,427 1,965,002 143 779 -32,575 (24 784) 101.7% 120.8% 1,885,115 1,895,306 111,239 93,543 Transfers and subsidiesTransfers 1,655,504 - - 1,655,504 2,039,965 -384,461 123.2% 1,390,443 1,478,853 Appropriation per economic classifi Appropriation Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

156 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 19,812 - - 19,812 19,812 - 100.0% 18,869 18,869 Adjusted 42,192,834 - - 42,192,834 42,013,459 179,375 99.6% 37,656,857 37,440,067 Appropriation Appropriation cation xed structures 818,917 - - 818,917 615 434 203 483 75.2% 1,104,764 935,367 ts 98,895 - - 98,895 98,266 629 99.4% 54,527 93,957 nancial assets - - - - 9,103 -9,103 - - 11,108 t institutions 698,608 - - 698,608 556 250 142 358 79.6% 484,058 465,844 Higher education institutionsNon-profi HouseholdsSocial benefi Other transfers to households 12,061 Buildings and other fi BuildingsMachinery and equipment - equipmentTransport 87,024 Other machinery and equipment - 185,919 - 1,304,149 1,104,239 12,061 - - 413 413 199,910 9,786 818,917 87,024 - 2,275 - - 435,676 - 1,304,562 185,919 -348,652 1,104,652 - 81.1% 860,679 533,942 721,344 - -348,023 500.6% 443,883 383,308 - 1,963 199,910 287.2% 155,700 66.0% 65.3% 818,917 139,335 1,453 223,404 1,185,991 210,227 1,018,543 615 434 60,575 646,791 317,361 540,593 203 483 69.7% 75.2% 167,448 1,104,764 106,197 935,367 Departmental agencies (non-business entities) Payments for capital assets 2,123,066 Payment for fi 413 - 2,123,479 1 476 113 647 366 69.5% 2,290,755 1,582,158 Appropriation per economic classifi Appropriation Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final 2016/17 Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

157 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 66 -66 - - 889 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2,557 - - 2,557 2,512 45 98.2% 3,953 876 20,358 - - 20,358 12,349 8,009 60.7% 39,978 20,467 20,796 - 40,700 80,678 70,767 9,911 87.7% 36,210 38,495 2017/18 693,009 713,367 - - 371,900 371,900 1,064,909 1,085,267 1 072 828 1 085 177 (7 919) 90 101.7% 831,473 100% 830,693 851,940 851,488 Adjusted Appropriation Appropriation cation OFFICE OF THE MEC MANAGEMENT Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 415,550 AdvertisingMinor assets 699,293 Audit costs: ExternalBursaries: Employees - 367,116 Catering: Departmental activities - 48,434 Communication (G&S) 5,700 283,743 311,400 Computer services - Consultants: Business and advisory 1,451 421,250 1,010,693 services - 5,700 - 381,314 628 907,593 22,368 305,700 103,100 39,936 2,456 - 372,816 - 210 15,786 - 589,443 - 334,340 89.8% - 90.5% 157,831 - 525 641 - 38,476 48,434 - 825,691 363,708 - - - 1,500 63 792 46,974 - 822,352 89.7% 357,586 1,451 - 4,300 1,460 120,000 - 89.2% 3,956 317,431 22,368 - 1,903 628 20,086 97.0% 314,179 277,831 20,731 461,983 1,067 -452 12,969 210 625 260,337 464,765 1,637 2,889 46,277 - 17,494 7,117 131.2% 298 43,408 3 92.7% 27.0% 93.7% 64.6% 56 1,310 -88 99.5% 20,991 2,456 343,509 15,075 2,220 -56 141.9% 18,518 202,357 2,351 19,957 474 164 - 217 25 - - Legal servicesContractors Agency and support / outsourced services 15,252 354 - 106,200 - 121,452 123 791 - (2 339) 354 101.9% 14,526 303 137,424 51 85.6% 347 3,831 Fleet services (including government motor transport) Programme 1: ADMINISTRATION 1: Programme Sub Programme 1 2 Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final 2016/17 Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

158 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 628 -628 - - - 2 - - 2 - 2 - 2 46 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 7,493 - - 7,493 3,268 4,225 43.6% 7,348 3,378 2017/18 Adjusted Appropriation Appropriation ts 1,013 - - 1,013 1,637 -624 161.6% 1,203 1,290 ce supplies Travel and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues Rental and hiring on land and rent Interest on unitary (Incl. interest Interest payments (PPP)) 1,175 7,864 - - - 181 - 183 ------1,175 7,864 - - 7,347 3,383 - - -6,172 4,481 181 - 625.3% 183 43.0% - 104 111 1,195 334 8,090 628 77 -111 2,969 -151 6,528 -628 57.5% 182.5% - - 231 183 1,757 - - 4 119 - Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical suppliesInventory: MedicineInventory: Other supplies 27 Consumable supplies printing and Consumable: Stationery, 37 offi 13 - Operating leases paymentsProperty - Departmental provided: - Transport - activity - 84 - - - 592 - 27 - - - - 1,381 2,000 37 5,840 13 52 and subsidies - Transfers 2,084 - 50 - Households -25 - - - Social benefi 14,000 1,489 17,000 Other transfers to households 192.6% -13 Payments for capital assets 351 592 - 13 Machinery and equipment 15,381 595 22,840 135.1% -351 2,313 483 108 26 3,400 9,746 71.4% 1,300 11,981 - 13,094 -108 109 35 11,761 - 16 - 11,761 22.1% 2,313 - 42.7% 81.6% - 214 - - - - - 1,381 - 3,920 60,500 - - 557 60,500 - 2,313 0 5,096 106 72,261 - 165,909 97 1,300 - 494 72,261 -163,596 11,744 164,272 16,782 11,744 -162,972 7172.9% 60,517 2,313 60,517 12636.3% 165,909 16.3% -163,596 2,203 16.3% 1,000 7172.9% 7,600 24,046 24,046 6,310 21,270 2,203 21,270 7,600 Programme 1: ADMINISTRATION 1: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final 2016/17 Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

159 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2017/18 713,367 - 371,900 1,085,267 1 085 267 90 100.0% 851,940 851,488 Adjusted Appropriation Appropriation nancial assets - - - - -69 69 - - 266 Transport equipmentTransport Other machinery and equipmentPayment for fi 7,276 4,485 - 60,500 - 67,776 - 8,195 59,581 4,485 12.1% 3,549 19,561 936 16,726 79.1% 4,485 4,544 Programme 1: ADMINISTRATION 1: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

160 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Shifting of Funds 477 - - 477 56 421 11.7% 332 279 389 - - 389 480 -91 123.4% 1,785 165 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ts ------1 ce supplies Operating leases and subsistenceTravel and developmentTraining and facilitiesVenues Rental and hiring and subsidiesTransfers HouseholdsSocial benefi Other transfers to households 2,937 - - 160 - - - - 17 ------2,937 ------112 - - 160 - 2,825 - 506 17 - - 54 3.8% - -506 106 - - - - 2,759 33.8% - 17 - 2,785 - - - 60 - - - - - 397 - 17 1,280 - - - - 4,384 4 - 4,383 4,384 Economic classifi Inventory: Food and food suppliesInventory: Materials and suppliesInventory: Other suppliesConsumable supplies printing and Consumable: Stationery, offi 27 - - - - - 63 - - - 27 - - - 11 - 33 16 63 -33 40.7% 1 24 - 39 26 38.1% 4 - - 60 1 - 7 - SubProgramme: 1.1: OFFICE OF THE MEC OFFICE OF 1.1: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative feesMinor assetsCatering: Departmental activities 15,150 Communication (G&S) 19,732 ContractorsFleet services (including government - motor transport) 13,680 - 1,470 4,582 93 - - 102 - - 15,150 - - 286 - 19,732 - 10,265 31 - 11,647 - 13,680 - 4,885 - - 1,470 - 8,085 - 9,344 67.8% 4,582 - 93 59.0% 4,336 921 - 102 1,382 - 14,428 68.3% 549 286 3,200 61 19,857 10,724 10 31 - 62.7% 30.2% 16,024 13,028 32 33 92 - 65.6% 9,776 253 - 1,400 5,429 9.8% 31 11.5% 5,300 948 1 89 4 - 267 - 147 232 30 - - - - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 161 Appropriation Appropriation Virement Virement Final Shifting of Funds Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets ------13 Economic classifi SubProgramme: 1.1: OFFICE OF THE MEC OFFICE OF 1.1: SubProgramme: Payments for capital assetsMachinery and equipment equipmentTransport Other machinery and equipmentPayment for fi Total 626 626 141 - 485 ------626 20,358 - 626 141 702 - 485 702 168 -76 534 -76 - -27 112.1% 112.1% 20,358 119.1% -49 12,349 610 110.1% 610 8,009 125 375 485 60.7% 375 55 321 20,467 20,796 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Expenditure Expenditure Variance Actual Expenditure Expenditure

162 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 66 -66 - - 889 2,168 - - 2,168 2,032 136 93.7% 2,168 711 39,978 - 40,700 80,678 70,767 9,911 87.7% 36,210 38,495 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 1.2: MANAGEMENT 1.2: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative feesAdvertising 400,400 Minor assets 679,561 Audit costs: ExternalBursaries: Employees - 353,436 Catering: Departmental activities - 5,700 46,964 Communication (G&S) 311,400 279,161 Computer services 406,100 - 990,961 Consultants: Business and advisory 1,349 - services 5,700 371,049 - Legal services 895,946 535 305,700 22,368 Contractors 35,051 359,136 2,456 - 95,015 - Agency and support / outsourced services 584,861 179 324,996 91.4%Fleet services (including government 15,500 - - 90.4% - motor transport) 46,964 - 34,140 - 531 293Inventory: Food and food supplies 157,831 349,280 - 805,834 Inventory: Fuel, oil and gas 1,500 46,053 53 568 - - - - 90.5% 1,349 346,862 Inventory: Materials and supplies 806,328 4,300 Inventory: Medical supplies - 911 - 3,956 90.8% 304,403 22,368 120,000 - 15,252 1,893 535 19,800 304,402 98.1% - 456,554 277,831 1,067 20,731 -544 354 179 12,936 - 459,466 564 37 260,337 2,889 1,637 44,877 13 - 106,200 140.3% - 6,864 17,494 - 298 -29 42,460 27.0% 92.7% 121,452 - - 1,306 - 65.3% 56 93.7% - -119 105.4% 123,791 - 20,991 2,456 2,073 - 343,509 -2,339 166.5% - 14,808 -56 - 18,518 385 2,351 202,357 354 101.9% - 19,725 - 134 37 13 - 14,526 217 302 41 137,424 25 17 - 52 - -41 - 20 351 85.3% 13 - - 45.9% -351 347 - 35 - 3,831 - - 213 12 - - 97 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Expenditure Expenditure Variance Actual Expenditure Expenditure

2017/18 2016/17 163 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 628 -628 - 2 - - 2 - 2 - 2 46 7,016 - - 7,016 3,212 3,804 45.8% 7,016 3,099 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ts 1,013 - - 1,013 1,637 -624 161.6% 1,203 1,289 ce supplies Economic classifi Operating leases paymentsProperty Departmental provided: Transport activity 1,381 5,840 - - 14,000 17,000 15,381 22,840 2,894 9,746 12,487 13,094 18.8% 42.7% 1,381 3,920 5,096 106 Travel and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues Rental and hiring on land and rent Interest on unitary (Incl. interest Interest payments (PPP)) 1,175 4,927 - - - 21 - 166 - - - - - 1,175 4,927 - - - 7,347 3,271 - - -6,172 1,656 21 - 625.3% 166 66.4% - 111 50 1,195 334 5,331 628 -111 -29 1,689 -168 3,744 -628 238.1% 201.2% - - 171 166 - 1,360 - - 119 - Transfers and subsidiesTransfers HouseholdsSocial benefi Other transfers to householdsPayments for capital assetsMachinery and equipment equipmentTransport 2,313 Other machinery and equipment 1,300 11,135 - 2,313 11,135 - 7,135 - - 60,500 4,000 - - - - 2,313 60,500 71,635 60,500 - 165,909 - 1,300 71,635 -163,596 11,042 67,635 164,272 60,593 7172.9% 2,313 - -162,972 11,042 8,027 12636.3% 60,593 165,909 15.4% 2,203 -163,596 59,608 4,000 15.4% 1,000 7172.9% 23,436 3,217 11.9% 3,015 23,436 1,927 20,895 2,203 19,436 985 20,895 3,217 16,671 75.4% 4,000 4,224 SubProgramme: 1.2: MANAGEMENT 1.2: SubProgramme: Inventory: MedicineInventory: Other suppliesConsumable supplies printing and Consumable: Stationery, offi 84 - 529 - - 2,000 - - 2,084 - 1,488 - 529 596 108 459 71.4% -108 70 - 86.8% - 497 - - 487 16,782 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Expenditure Expenditure Variance Actual Expenditure Expenditure

164 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - -69 69 - - 253 Economic classifi SubProgramme: 1.2: MANAGEMENT 1.2: SubProgramme: Payment for fi Total 693,009 - 371,900 1,064,909 1 079 852 (14 943) 101.4% 831,473 830,693 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 165 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 516,536 - - 516,536 524,552 -8,016 101.6% 484,812 457,752 Adjusted 14,003,301 - -291,200 13,712,101 13,683,513 28,588 99.8% 11,995,850 11,992,093 Appropriation Appropriation cation Current paymentsCurrent Compensation of employeesSalaries and wagesSocial contributionsGoods and services 7,093,354 Administrative fees 12,936,548 AdvertisingMinor assets - 6,155,015 Catering: Departmental activities - Communication (G&S) 938,339 -248,200 5,843,194 Computer services - 12,688,348 - 12,713,689 3,630 7,093,354 - 910 -25,341 - 7,155,763 -248,200 - -62,409 - 100.2% 37,900 1,318 5,594,994 6,155,015 - 27,215 - 5,557,926 100.9% 6,219,445 11,008,790 11,099,531 938,339 -64,430 37,068 - - - 6,476,540 - - - 936,318 6,633,414 101.0% 99.3% 3,630 2,021 - - - 910 - 5,615,068 4,532,250 1,807 5,785,070 99.8% 4,466,117 37,900 1,318 27,215 1,823 370 - 28,266 861,472 14,487 220 540 49.8% 9,634 848,344 12,728 1,098 - 40.7% 74.6% 53.2% 2,601 16.7% 1,032 1,825 41,000 1,727 33,496 -1,032 1,303 34,748 15,273 347 - 236 - 3,058 DISTRICT MANAGEMENT 2 CLINICS COMMUNITY HEALTH 3 CENTRES COMMUNITY HEALTH 4 COMMUNITY BASED SERVICES5 2,444,200 AIDS HIV, 6 1,852,040 NUTRITION7 1,859,080 CORONER SERVICES8 - DISTRICT HOSPITALS - -18,700 -74,000 - 2,425,500 Economic classifi -79,000 1,778,040 2,416,248 1,792,265 1,780,080 215,243 3,957,203 9,252 -14,225 1,780,657 3,103,416 55,583 -577 100.8% 99.6% - - - -119,500 1,617,479 2,121,065 100.0% - 1,571,259 2,093,485 2,983,916 - - 1,538,841 3,015,482 1,574,218 3,957,203 - 215,243 -31,566 3,890,431 214,321 55,583 66,772 101.1% 922 49,557 2,562,701 98.3% 2,638,493 6,026 99.6% 3,427,610 3,424,730 89.2% 199,971 188,593 43,371 43,562 Programme 2: DISTRICT HEALTH SERVICES DISTRICT HEALTH 2: Programme Sub Programme 1 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

166 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 1,807 -1,807 - - 5,426 43 - - 43 - 43 - 56 10 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2,145 - - 2,145 200 1,945 9.3% 1,440 817 71,104 - - 71,104 73,320 -2,216 103.1% 54,340 46,089 29,324 - 60,903 38,571 - - 29,324 - 35,217 - -5,893 - 60,903 120.1% 38,571 43,563 17,340 34,116 20,872 4,455 71.5% 23,446 88.4% 44,756 30,533 28,190 15,445 Adjusted Appropriation Appropriation ce supplies Inventory: Materials and suppliesInventory: Medical suppliesInventory: MedicineInventory: Other supplies 17,368 Consumable supplies printing Consumable: Stationery, 532,976 and offi Operating leases - paymentsProperty 2,865,127 35,662 Departmental provided: Transport - activity - 139,894 -7,000 - - 17,368 525,976 -79,500 - 2,785,627 463,091 12,609 26,498 470,437 -13,000 - 2,872,048 62,885 4,759 -86,421 126,894 35,662 - - 107,703 88.0% 103.1% 72.6% -17,000 35,706 19,191 - 2,257,090 453,437 454,719 17,243 -44 2,303,791 84.9% 418,131 463,037 26,498 15,764 100.1% -9,600 43,513 92,640 -17,015 102.1% 80,103 164.2% - 357,710 352,669 29,643 - 28,884 Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Learner and teacher support material 72,529 85,872 - -8,000 - 64,529 63,934 - and subsistenceTravel 85,872 595 and developmentTraining 52,088 99.1% 33,784 34,671 10,176 50,790 60.7% 43,460 - - 77,594 76,708 - - 34,671 10,176 8,428 5,869 26,243 4,307 24.3% 57.7% 11,779 16,446 6,443 8,719 Consultants: Business and advisory services Laboratory servicesLegal servicesContractors Agency and support / outsourced services Fleet services (including government motor transport) Inventory: Clothing material and 880,555 accessories - 354,331 -123,700 - 756,855 - - 840,331 -83,476 - - 111.0% 354,331 609,978 346,772 - 603,410 7,559 6,047 97.9% -6,047 321,786 314,534 - - 33,419 Programme 2: DISTRICT HEALTH SERVICES DISTRICT HEALTH 2: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 167 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Adjusted 14,003,301 - -291,200 13,712,101 13,683,513 28,588 99.8% 11,995,850 11,992,093 Appropriation Appropriation nancial assets - - - - 2,127 -2,127 - - 2,509 ts 29,032 - - 29,032 27,644 1,388 95.2% 19,304 24,476 t institutions 454,459 - -43,000 411,459 406,250 5,209 98.7% 409,126 382,542 Operating payments and facilitiesVenues Rental and hiring and subsidiesTransfers and municipalitiesProvinces MunicipalitiesMunicipal bank accounts 39,638 Municipal agencies and funds 4,345 845,260 361,769 Non-profi Households - Social benefi 52 - 361,769 - - Other transfers to households -43,000 Payments for capital assets - 361,769 - Machinery and equipment - - - 802,260 - equipmentTransport 39,638 Other machinery and equipment 834,240 - - 221,493 361,769 4,345 Payment for fi - - -31,980 - 673 361,769 29,032 221,493 171,351 1,235 361,769 38,965 - 104.0% - - 52 - 3,110 361,769 50,142 361,769 - - - - 773,031 1.7% - 361,769 437 - 28.4% - 753,327 100.0% - - - - 221,493 - -385 3,729 344,531 - 100.0% 133,457 221,493 1,272 29,032 171,351 - - - 840.4% 344,531 2,346 88,036 133,457 100.0% 100,544 66,221 462 38,577 50,142 88,036 -37,189 70,807 - 60.3% -38,577 - 344,531 50 32,913 60.3% 228.1% 344,531 58.7% 214,029 17,229 - - 136,726 214,029 21 - 19,374 180,387 65.6% 136,726 344,531 107,802 26,254 344,531 33,642 70 28,924 1,778 Programme 2: DISTRICT HEALTH SERVICES DISTRICT HEALTH 2: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

168 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 362 -362 - - 133 - - - - 6 -6 - - 2,725 1,039 7,732 - - - - 1,039 7,732 1,045 14,509 -6 -6,777 100.6% 187.6% 11,344 2,140 3,396 1,460 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical supplies 1,752 1,728 1,029 - 10,398 - - - - - 1,752 - - 1,728 560 1,029 10,398 1,192 2,301 1,598 33,277 -573 32.0% -569 -22,879 133.2% 155.3% 320.0% 727 1,182 7,305 500 252 3,132 6,998 236 Fleet services (including government motor transport) Inventory: Clothing material and accessories SubProgramme: 2.2: DISTRICT MANAGEMENT 2.2: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 361,055 AdvertisingMinor assets 474,305 Catering: Departmental activities - Communication (G&S) 314,398 Computer services - 46,657 Consultants: Business and advisory 113,250 services - - Legal services 636 - 103 Contractors - 361,055 - Agency and support / outsourced services 474,305 - 342,554 - 8,950 467 - - 3,217 490,090 18,501 - 314,398 -15,785 46,657 296,167 - - 113,250 - - - 94.9% - 103.3% 18,231 46,387 147,536 344,984 -34,286 432,942 - 636 - - - 103 353,634 94.2% 270 - 1,868 423,424 130.3% 303,460 8,950 362 3,217 - 99.4% 467 63 - - 307,946 87,958 9,940 274 1,789 41,524 40 69,790 5 -990 1,428 - - - 45,688 56.9% 61.2% 462 111.1% 55.6% 1,868 880 945 - 10,584 176 1.1% -880 5,469 416 128 9,517 76 1,452 1,170 630 9 - -76 22.3% 151 1,608 - - 571 75 - 2,199 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 169 Appropriation Appropriation Virement Virement Final Funds Shifting of 550 - - 550 - 550 - - - 9,840 - - 9,840 14,956 -5,116 152.0% 7,051 6,547 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 284 -284 - - 470 ts 1,904 - - 1,904 2,588 -684 135.9% 1,233 2,076 ce supplies Economic classifi Operating leases paymentsProperty Departmental provided: Transport activity and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues Rental and hiring 16,325 and subsidiesTransfers 30,366 HouseholdsSocial benefi 2,085 1,522 - Other transfers to households - Payments for capital assetsMachinery and equipment - - 80 - equipmentTransport - 1,904 5 Other machinery and equipmentPayment for fi - - 16,325 52 - 30,366 Total 40,327 - - - 31,307 19,993 2,085 1,904 1,522 40,327 - 24,101 -14,982 - 10,373 - - - - 1,435 16,226 291 191.8% - - - - 65.8% 80 - 1,904 650 1,231 - 13,192 - 5 12,627 - - - 2,790 40,327 10,169 52 68.8% 19.1% 16 11,881 - 40,327 31,388 -886 1,904 - 516,536 24,101 1 3,278 2,932 64 8,939 31,388 - 16,226 146.5% 2,790 9,825 202 1,584 1,125 - 4 8,939 20.0% 14,276 21,563 77.8% -886 52 1,303 -202 -5,337 20.0% 77.8% - 40.8% 50,567 146.5% 190 3,401 132.9% 50,567 516,536 - 30,457 43,234 - 152 1,303 55 524,552 30,457 7,333 11,488 -8,016 3,401 50 143 70 18,969 101.6% 1,325 2 484,812 457,752 SubProgramme: 2.2: DISTRICT MANAGEMENT 2.2: SubProgramme: Inventory: MedicineInventory: Other suppliesConsumable supplies printing and Consumable: Stationery, offi 3,955 9,551 ------3,955 9,551 7,568 - 4,716 -3,613 4,835 64 191.4% 49.4% -64 - 5,876 - 6,134 - - -2 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

170 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 62 -62 - - 84 500 - - 500 316 184 63.2% - - 2,235 4,656 - - - - 2,235 4,656 1,284 705 951 3,951 57.4% 15.1% 3,308 203 1,495 81 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 2.3: COMMUNITY HEALTH CLINICS COMMUNITY HEALTH 2.3: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 1,205,239 Minor assets 2,086,498 Communication (G&S)Consultants: Business and advisory - services 1,049,989 - 155,250 -18,700 881,259 - - 2,067,798 1,205,239 - 2,055,693 20 1,193,224 8,392 - 12,105 - 12,015 -18,700 6,210 - 1,049,989 - 99.4% - 1,017,627 862,559 99.0% 155,250 1,773,906 - 32,362 862,469 1,142,350 175,597 - 1,766,883 - 1,143,573 -20,347 96.9% 90 - 8,392 113.1% 991,365 20 100.0% 6,210 150,985 4,487 980,793 631,556 4,660 6 3,905 162,780 623,310 1,550 14 53.5% 75.0% 30.0% 7,535 8,217 5,752 41 5,156 - Laboratory servicesLegal servicesContractors Agency and support / outsourced services Fleet services (including government motor transport) Inventory: Clothing material and accessories 100,787 - - -18,700 5,443 82,087 - - 50,936 31,151 - - 62.1% 5,443 - 10,186 6,001 426 9,057 -558 -426 110.3% 4,517 - 4,186 - 86 Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical suppliesInventory: Medicine 454 Inventory: Other supplies 2,365 10,921 - 93,257 - - - 445,250 1,996 - - - 454 - - - 10,921 2,365 86 93,257 2,273 - 1,766 - 36,805 8,648 368 445,250 599 56,452 1,996 569,779 20.8% 18.9% -124,529 74.7% 2,523 39.5% 128.0% 3,786 -527 140 2,373 76,661 364,746 3,575 126.4% 38,516 1,923 413,534 66 - - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 171 Appropriation Appropriation Virement Virement Final Funds Shifting of 50 - - 50 25 25 50.0% - - 9,656 - - 9,656 4,425 5,231 45.8% 8,640 6,916 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 410 -410 - - 669 ts 7,720 - - 7,720 4,851 2,869 62.8% 3,475 5,273 t institutions 12,578 - - 12,578 12,578 - 100.0% 11,979 10,000 ce supplies Economic classifi Operating leases paymentsProperty Departmental provided: Transport activity and subsistenceTravel and developmentTraining Operating payments and subsidiesTransfers and municipalitiesProvinces 162,591 Municipalities 3,114 Municipal bank accountsMunicipal agencies and funds 884 451 - Non-profi - 318,848 Households 298,550 Social benefi 760 - - - Other transfers to households - 298,550 - - Payments for capital assets 162,591 - Machinery and equipment - - 298,550 - 3,114 equipmentTransport 164,775 - - - Other machinery and equipment -2,184 1,074 - Payment for fi - - 884 451 318,848 Total 298,550 38,854 2,040 - - 101.3% 333,412 298,550 7,720 38,854 760 36,354 -14,564 43 - 298,550 - 124,061 3 34.5% - - 298,550 - 104.6% 2,500 121,050 298,550 257 841 - - 448 - 1,074 298,550 - 299,787 100.0% - - 503 - - 4.9% - - 0.7% 299,879 - 284,333 38,854 338 - 100.0% 33.8% 2,444,200 2,518 26,733 38,854 284,333 - 7,720 - 36,354 872 100.0% 12,121 26,733 1,551 22,284 17,433 26,643 - 284,333 - 2,500 12,121 -14,564 -17,433 44 - 68.8% 9,711 -18,700 1,218 - 284,333 288.7% 68.8% 2,425,500 90 47,372 73.3% 2,416,248 - - - 2,410 47,372 3,475 9,252 26,054 47,372 284,333 26,054 3.6% 5,546 99.6% - 284,333 25,920 2,121,065 2,093,485 274 - 134 SubProgramme: 2.3: COMMUNITY HEALTH CLINICS COMMUNITY HEALTH 2.3: SubProgramme: Consumable supplies printing and Consumable: Stationery, offi 21,267 - - 21,267 9,752 11,515 45.9% 11,127 10,233

Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

172 2017/18 2016/17 Appropriation Appropriation Virement Virement Final ------277 - -277 - - 57 - 229 Funds Shifting of 4,529 3,342 - - - - 4,529 3,342 2,576 7,428 1,953 -4,086 56.9% 222.3% 2,811 2,374 2,781 1,931 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 2.4: COMMUNITY HEALTH CENTRES COMMUNITY HEALTH 2.4: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and services 1,218,348 Administrative feesMinor assets 1,801,804 Catering: Departmental activities - Communication (G&S) 1,068,542 Computer services - 149,806 Consultants: Business and advisory -74,000 services 583,456 - - Laboratory services 1,727,804 1,218,348 Legal services - 1,760,874 14 Contractors 1,272,815 - -33,070 Agency and support / outsourced - -54,467 5,761 services -74,000 6,666 - Fleet services (including government 1,068,542 - - motor transport) 101.9% 1,097,011 509,456 104.5%Inventory: Clothing material and - 149,806 -28,469 accessories - 1,562,366 488,059 1,141,658 64,981 - Inventory: Food and food supplies 175,804 1,545,525 - 21,397 1,146,482 Inventory: Fuel, oil and gas -25,998 102.7% - Inventory: Materials and supplies - - - Inventory: Medical supplies 994,809 95.8% 4,714 1,940 14 - 117.4% -43,000 5,761 6,666 989,291 - 420,708 146,849 1,421 18,338 21,981 5,770 12 - - 2,458 1 - 399,043 157,191 21,256 51,438 4,208 - -9 - - 2 - - - 725 - 36.9% 100.2% - - 37 4,714 85.7% 1,940 -7,000 96.7% - 8,233 6,535 4,823 18,338 -37 1,421 - 701 44,438 4,515 15 3,630 -109 5,853 5,381 389 1,239 23,890 834 12,957 4,133 20,548 - -389 - 102.3% - 587 36.1% 29.3% 53.8% 3,323 - 1,298 58.7% - - 29,592 8,058 2,581 312 1,219 28,977 17,990 9 - 1,768 24,449 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

173 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 10,895 - - 10,895 8,023 2,872 73.6% 6,060 5,179 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 519 -519 - - 410 ts 6,718 - - 6,718 6,665 53 99.2% 6,754 5,326 t institutions - - - - 16 -16 - ce supplies Economic classifi Operating leases paymentsProperty and subsistenceTravel and developmentTraining Operating payments and subsidiesTransfers Non-profi Households 116,855 Social benefi 847 Other transfers to households 134 50 Payments for capital assets - 6,718 Machinery and equipment - 441 equipmentTransport - - Other machinery and equipment - - Payment for fi - - 43,518 Total - - - 116,855 6,718 43,518 26,971 - 136,748 - - 847 - 134 -19,893 16,547 50 - - 6,718 6,219 - - 441 117.0% - -5,372 241 1 - 6,909 - - - 43,518 96,072 -191 85 -191 133 734.2% 1,852,040 43,518 - 23,963 6,718 - 26,971 95,906 356 482.0% 19,555 102.8% 23,963 1,833 0.7% 18,642 16,547 6,893 - 228 19,555 8,329 19.3% -74,000 55.1% 6,754 -175 5,321 164 -228 - 252 1,778,040 11,226 55.1% 5,326 1,792,265 48,359 69.1% 102.6% 535 -14,225 257 48,359 19,998 32.2% - - 32,689 6,754 162 100.8% 19,998 15,670 14,292 1,617,479 5,326 - 1,571,259 5,706 - SubProgramme: 2.4: COMMUNITY HEALTH CENTRES COMMUNITY HEALTH 2.4: SubProgramme: Inventory: MedicineInventory: Other suppliesConsumable supplies printing and Consumable: Stationery, offi 272,854 2,446 15,790 - - -24,000 - 248,854 - 248,265 - 2,446 589 15,790 2,714 9,930 99.8% -268 5,860 238,645 111.0% 193,588 62.9% - 9,338 9,087 - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

174 2017/18 2016/17 Appropriation Appropriation Virement Virement Final - - - 37 -37 - - 103 Funds Shifting of 7,406 - - 7,406 1,817 5,589 24.5% 3,070 904 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Inventory: Clothing material and accessories Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical suppliesInventory: Medicine 10,228 Inventory: Other supplies 1,377 15,657 - 53,832 - - - 326,701 1,084 - 10,228 - - 14,132 - - - 15,657 1,377 -3,904 -36,000 7,567 53,832 1,085 138.2% 290,701 - 56,901 275,141 8,090 292 13,988 15,560 -3,069 1,084 48.3% 78.8% 8,341 105.7% 94.6% 428 16,762 1,116 198,185 55,181 656 10,176 170,435 58,111 565 39.5% - - SubProgramme: 2.5: COMMUNITY BASED SERVICES COMMUNITY BASED 2.5: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative feesAdvertising 1,081,261 Minor assets 1,548,352 Catering: Departmental activitiesCommunication (G&S) - 947,070 Computer services - 134,191 Laboratory services -36,000 467,091 - Contractors 1,512,352 - servicesAgency and support / outsourced 1,458 1,081,261 1,513,178 - Fleet services (including government 230 1,121,509 motor transport) - -40,248 -826 - -36,000 - 922 4,041 - 600 - 2,205 103.7% 100.1% 947,070 431,091 1,006,818 134,191 - 391,669 1,277,038 - 915,605 6,648 - -59,748 114,691 - - 1,315,771 - 1,021,820 39,422 19,500 106.3% 1,458 6,369 - - - 90.9% - 230 - - 85.5% 810,274 768 361,433 919,981 4,041 - 922 - 2,205 105,331 47 600 690 293,951 - 101,839 2,005 1,622 562 183 6,648 - 52.7% 20 2,036 583 2,572 360 20.4% - 6,369 580 49.6% 1,210 4,076 73.6% 61.0% 3,813 1 3.3% 586 650 6,525 38.7% 2,556 5,039 3,190 3,817 115 59.9% 398 4,400 1,002 306 110 53 8,150 - 5,750 - 205 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 175 Appropriation Appropriation Virement Virement Final Funds Shifting of 5,157 - - 5,157 4,096 1,061 79.4% 4,831 3,861 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 92 -92 - - 99 ts 2,760 - - 2,760 2,638 122 95.6% 2,125 2,023 t institutions 300,338 -43,000 257,338 257,151 187 99.9% 250,981 250,982 ce supplies Economic classifi Operating leases paymentsProperty Departmental activity provided: Transport and subsistenceTravel and developmentTraining Operating payments 568 and facilitiesVenues and subsidiesTransfers Non-profi - Households 9,900 788 Social benefi 2,965 2,584 Other transfers to households - Payments for capital assets - - Machinery and equipment 303,098 361 - - equipmentTransport 568 Other machinery and equipment 50 - - Payment for fi - - - - Total 24 -43,000 - 7,630 9,900 - 788 2,965 2,584 544 2,760 260,098 - 7,630 9,888 6,806 261,887 - - 319 - 2,310 1,077 4.2% -1,789 - 824 12 361 - 1,507 - 469 655 - - 100.7% 50 99.9% 156 41.7% 520 - 40.5% - 77.9% - - 253,106 7,630 205 10,122 1,859,080 253,185 179 2,760 - 1,581 7,630 8,635 3,965 5,500 - 6,806 6,949 43.2% 4,736 2,098 13,385 2,130 5,500 2,066 599 - 50 5,472 -1,976 -2,098 824 -79,000 2,130 1,334 72.1% 401 1,780,080 171.6% 1,780,657 72.1% - 28 80.4% - 8,697 692 -577 2,125 796 8,697 5,163 8,697 100.0% 2,203 - - 5,163 3.4% 5,101 1,538,841 1,574,218 - 179 - 62 SubProgramme: 2.5: COMMUNITY BASED SERVICES COMMUNITY BASED 2.5: SubProgramme: Consumable supplies printing and Consumable: Stationery, offi 5,960 - - 5,960 5,281 679 88.6% 13,578 5,577 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

176 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 1,132 - - 1,132 75 1,057 6.6% 720 44 28,700 - 11,550 - - 28,700 - 34,697 -5,997 11,550 120.9% - 20,710 11,550 20,651 - 565 560 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 2.6: HIV, AIDS HIV, 2.6: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 896,112 3,782,116 AdvertisingMinor assetsCatering: Departmental activities - 749,390 - Communication (G&S) 146,722 Computer services 2,886,004 Consultants: Business and advisory - - services 1,222 - - Laboratory services 29 - Legal services 896,112 3,782,116 Contractors - - 3,733,103 842,421 Agency and support / outsourced - services 279 - - 49,013 366 - 53,691 Fleet services (including government 749,390 motor transport) 146,722 - 2,886,004 Inventory: Food and food supplies 728,682 - 98.7% - 2,890,682 94.0% - 600,444 Inventory: Materials and supplies 113,739 - - 20,708 Inventory: Medical supplies 3,261,392 -4,678 32,983 1,222 861,351 Inventory: Medicine 3,272,618 - - 6,239 - Inventory: Other supplies - 97.2% - 100.2% 316,320 770,268 29 77.5%Consumable supplies - 563 2,400,041 1 711,995 - - 162,860 - 279 149,356 2,502,350 659 - 366 9 668,682 - - 101,586 1,654,234 - 600,444 - - 1,477 46.1% 28 304 20 - - 720,171 - 170 14,722 -119,727 - - 251 6,239 - 62 316,320 - 31.0% -170 255 119.9% - 316,433 - 5,902 10.0% 162,860 - 83.1% - - 581,154 959 1 609 -113 127,594 1,654,234 337 - - - 581,152 1,632,219 35,266 1,462 376 100.0% - 1,477 62 22,015 94.6% 7 14,722 78.3% 289,403 - 298 189 - -61 - 98.7% 21,356 5 8,309 288,072 142,372 6200.0% 1,327,858 -6,634 1,472 142,335 - 8,310 1,433,617 - - 145.1% 0.3% 20 2,177 3,119 - 4 - 2,749 - - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

177 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 13,860 - - 13,860 21,310 -7,450 153.8% 10,454 9,170 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 159 -159 - - 41 ts 2,995 - - 2,995 2,704 291 90.3% - 1,396 t institutions 85,960 - - 85,960 86,948 -988 101.1% 102,795 78,189 ce supplies Economic classifi SubProgramme: 2.6: HIV, AIDS HIV, 2.6: SubProgramme: printing and Consumable: Stationery, offi Operating leases paymentsProperty and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues Rental and hiring and subsidiesTransfers and municipalitiesProvinces 27,166 1,953 2,616 Municipalities - Municipal bank accounts 37,044 Municipal agencies and funds - - - 3,790 Non-profi - 152,174 63,219 Households - Social benefi - - - - Payments for capital assets - - - 63,219 - Machinery and equipment - 27,166 equipmentTransport - 1,953 63,219 2,616 - - Other machinery and equipment - - - 6,697 Payment for fi 37,044 - 22,913 1,292 799 Total - - 20,469 152,174 3,790 - 22,913 - 1,324 63,219 22,913 1,154 152,871 101 2,995 24 - 24.7% - - 63,219 871 37,020 49.4% 63,219 -697 -101 - 40.9% - - - - 2,919 - 4,141 63,219 63,219 100.5% - 0.1% 5,533 1,653 - - - 63,219 23.0% - 4,108 22,913 - - 162,993 100.0% - 4,227 1,588 3,957,203 22,913 139,783 22,913 4,298 - - - 60,198 100.0% 808 - 520 2,995 18,615 4,298 - - 4,279 60,198 100.0% 2,704 1,881 18,615 - 18,634 233 - 18.8% - - - 60,198 291 18.8% - 18.7% 3,225 3,957,203 60,198 - 90.3% 3,890,431 19 - 3,225 12,288 3,225 66,772 60,198 - -19 12,288 12,282 60,198 - 98.3% 19 3,427,610 1,396 - 3,424,730 - 6 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

178 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------191 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 t institutions 55,583 55,583 49,557 6,026 89.2% 43,371 43,371 Economic classifi SubProgramme: 2.7: NUTRITION 2.7: SubProgramme: Current paymentsGoods and servicesInventory: Clothing material and accessories ------191 191 Transfers and subsidiesTransfers Non-profi Total 55,583 - - 55,583 55,583 - 49,557 6,026 - 89.2% 55,583 43,371 49,557 43,371 6,026 89.2% 43,371 43,562 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 179 Appropriation Appropriation Virement Virement Final Funds Shifting of ------149 52 - - 52 25 27 48.1% 50 - 4,770 - - 4,770 5,142 -372 107.8% 4,525 3,462 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Laboratory servicesLegal servicesContractors servicesAgency and support / outsourced Fleet services (including government motor transport) Inventory: Clothing material and 1,908 accessories - 275 - - - 775 1,908 - - - 1,075 - 275 833 - 56.3% 211 775 - 64 1,670 78 - 76.7% 672 697 - 240 10.1% 91 - 720 100 - 68 SubProgramme: 2.8: CORONER SERVICES 2.8: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative feesAdvertising 172,865 Minor assets 207,961 Catering: Departmental activitiesCommunication (G&S) - 152,715 Consultants: Business and advisory - 20,150 services 35,096 - - 114 - - 30 172,865 - 207,961 - 179,309 - 1,777 158 - 209,881 - -6,444 535 152,715 - -1,920 Inventory: Fuel, oil and gas 158,206 103.7% 20,150 - Inventory: Materials and supplies - - - 35,096 100.9% - Inventory: Medical supplies -5,491 21,103 159,700 Inventory: Medicine 30,572 Inventory: Other supplies - 114 103.6% 193,110 - 156,228 -953 - 30 4,524 184,504 394 104.7% 143,000 1,777 110 30 158 87.1% 137,633 12 535 6,210 16,700 - 558 4 - 33,410 24 18 193 18,595 1,219 - 96.5% 28,276 - - - 134 40.0% 342 - 31.4% - 15.2% - 36.1% 170 - 394 1,700 30 30 6,210 111 - 54 150 - 1,404 490 7,948 5 2 283 -1,738 24 184 - - 25 128.0% 28.2% 16.7% 16 5 4,200 200 4,684 -16 -5 172 5 - - 4 - - 13 - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

180 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 924 - - 924 1,040 -116 112.6% 1,500 570 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 66 -66 - - 24 ts 175 - - 175 952 -777 544.0% 167 1,036 ce supplies Operating leases paymentsProperty and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues and subsidiesTransfers HouseholdsSocial benefi 11,827 Payments for capital assets 338 600 - Machinery and equipment equipmentTransport - Other machinery and equipment 37 - - - Payment for fi 175 500 Total 7,107 ------7,107 3,237 11,827 175 - - 3,870 338 600 11,813 ------218 14 - 79 37 175 - 500 - 7,107 - - 120 99.9% 521 - 215,243 952 7,107 363 9 3,422 3,237 64.5% - 13.2% 11,290 175 -777 3,685 3,422 137 3,870 2,341 - 28 14,211 544.0% 3,685 952 48.1% 270 1,081 72.6% 896 400 - 24.3% - 48.1% 2,789 -777 72.3% 176 167 6,694 197 1,300 215,243 600 544.0% 27.9% 200 6,694 214,321 1,036 3,029 1,156 4,824 86 3,029 1,870 922 167 8 2,440 99.6% 1,036 589 199,971 188,593 Economic classifi SubProgramme: 2.8: CORONER SERVICES 2.8: SubProgramme: Consumable supplies printing and Consumable: Stationery, offi 3,842 - - 3,842 1,537 2,305 40.0% 3,700 789 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 181 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 1,069 -1,069 - - 4,537 72 - - 72 43 173 - -101 240.3% - 112 43 13 - 43 - 56 10 9,533 - - 9,533 4,440 5,093 46.6% 5,954 5,627 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 2.9: DISTRICT HOSPITALS 2.9: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 2,158,474 AdvertisingMinor assets 3,035,512 Catering: Departmental activities - Communication (G&S) 1,872,911 Computer services - 285,563 -119,500 Consultants: Business and advisory services 877,038 - 2,916,012 - 2,158,474 2,950,870 200 - 484 2,203,931 -34,858 - - -45,457 -119,500 101.2% - 1,872,911 8,700 - - 8,016 93 757,538 102.1% 1,914,934 2,508,036 285,563 1,910,892 -42,023 746,939 2,590,615 - - 2,041,409 - - 288,997 - - 10,599 102.2% -3,434 1,660,165 200 - 98.6% 484 - - - 1,780,744 101.2% 597,144 8,700 250,727 8,016 221 3 - 549,206 93 260,665 5,478 3,461 263 197 3,222 4,555 - 1 45.7% 1.5% 63.0% 43.2% 114 92 270 7,745 21 4,586 -114 1.1% 214 8,216 3,833 34 - 125 8 - 96 Laboratory servicesLegal servicesContractors servicesAgency and support / outsourced Fleet services (including government motor transport) 38,720 107,420 - Inventory: Materials and supplies - - 18,842 - -62,000 38,720 45,420 - 10,082 - 37,021 45,185 1,699 - - - 235 95.6% 18,842 99.5% - 31,072 - 15,208 10,082 9,483 23,259 3,634 5,156 6,450 8,867 -5,156 80.7% 3,632 14,065 64.0% - 13,770 11,133 - 8,200 6,617 Inventory: Clothing material and accessories Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Learner and teacher support material 51,916 39,897 - -8,000 - 43,916 42,553 - 1,363 39,897 96.9% 35,264 4,633 26,328 26,179 88.4% 48,483 44,727 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

182 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 20,772 - - 20,772 19,470 1,302 93.7% 15,804 13,846 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 597 -597 - - 795 ts 6,760 - - 6,760 7,246 -486 107.2% 5,550 7,346 ce supplies Economic classifi SubProgramme: 2.9: DISTRICT HOSPITALS 2.9: SubProgramme: Inventory: Medical suppliesInventory: MedicineInventory: Other suppliesConsumable supplies printing and Consumable: Stationery, offi Operating leases 154,981 paymentsProperty Departmental activity provided: Transport and subsistence 166,088 Travel 24,704 - and developmentTraining 68,762 Operating payments 977 - - Rental and hiring - and subsidiesTransfers -19,500 154,981 - Households - 136,945 146,588 5,424 - Social benefi -13,000 176,676 Other transfers to households 146,564 1,238 2,214 -21,695 Payments for capital assets 24,704 55,762 - - - Machinery and equipment 114.0% 22,463 equipment -17,000 24 Transport 55,131 915 - - 6,760 Other machinery and equipment 977 139,408 2,241 119,945 - 100.0%Payment for fi 631 Total 138,510 - 119,021 - - 61,144 - 151 127,656 - 90.9% 5,424 98.9% 6,760 61,144 924 50,969 92,606 1,238 2,214 826 - - - 4,493 45,902 - - 10,175 - 99.2% - - 15.5% 330 280 - 45,534 931 - 6,760 915 - 101,885 1,934 - - 908 82.8% 25,862 - - - 101,084 920 61,144 - 126 -19,102 12.6% - 26.7% 61,144 3,103,416 38,153 - 2,801 6,760 50,969 638 - 382.6% 789 22,991 1,601 38,153 437 25,862 10,175 33,342 1,791 18,616 882 - 13.8% 22,991 -19,102 5,550 17,627 62.4% -18,616 -119,500 -437 4,811 414 2,983,916 382.6% 365 62.4% 7,346 65.4% 49,115 5,364 852 3,015,482 -31,566 - 49,115 - 5,550 39,737 40,346 47.3% 211 101.1% 39,737 7,346 36,279 2,562,701 8,769 - - 2,638,493 3,458 - - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

183 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 1,228 - - 1,228 983 245 80.0% 932 345 109,694 - - 109,694 93,337 16,357 85.1% 95,042 90,194 201,812 - -25,800 176,012 179,728 -3,716 102.1% 82,393 80,664 Adjusted 1,268,460 1,378,154 - -110,000 - 1,158,460 -110,000 1,125,937 1,268,154 32,523 1,219,274 48,880 97.2% 1,007,179 96.1% 920,275 1,102,221 1,010,469 Appropriation Appropriation cation EMERGENCY TRANSPORT Fleet services (including government motor transport) PLANNED PATIENT TRANSPORT PLANNED PATIENT Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and services 487,200 Administrative fees 816,574 AdvertisingMinor assets - Catering: Departmental activities 402,814 - Communication (G&S) 84,386 329,374 Computer services -57,500 - - Legal services 2,811 Contractors 71 - 759,074 487,200 - Agency and support / outsourced services 745,181 - -57,500 484,285 1,500 - 6,734 - - 13,893 8,610 2,915 402,814 271,874 504 98.2% - - 84,386 402,683 - 260,896 - - 99.4% -1,500 10,978 -4,300 81,602 614,126 -3,600 131 - - 2,811 4,234 448,538 590,736 2,784 96.0% 71 100.0% 447,344 2,434 5,010 1,600 - - - - 96.7% 165,588 376,749 2,342 1,211 70 2,074 143,392 375,678 71,789 - - 2,936 504 56.9% - 92 1 71,666 41.4% 96.2% 4,234 2,312 52 - 98.6% - 2,095 2,057 2,078 452 6,508 146 2,139 - 61 1,813 10.3% 4,834 -146 49.5% 1,500 24 385 4,033 - - - 598 - 564 Programme 3: EMERGENCY MEDICAL SERVICES 3: Programme Sub Programme 1 2 Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

184 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 37 -37 - - 3,242 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 6,353 - 8,910 - - 6,353 - 6,569 8,910 -216 4,512 103.4% 4,398 6,050 50.6% 2,842 7,629 7,242 Adjusted Appropriation Appropriation ce supplies Inventory: Clothing material and accessories Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical supplies 15 Inventory: MedicineConsumable supplies 2,212 2,400 printing Consumable: Stationery, and offi - 24,526 - - - -2,400 - 11,628 588 - - 15 - - 2,212 - -5,900 24,526 6 - 28 20,911 - 5,728 2,184 3,615 9 588 5,679 - 1.3% 85.3% 40.0% 49 393 13,015 3,202 - 99.1% 195 12 9,391 1,710 1,843 66.8% 1,472 2 1,441 1,284 - 464 Operating leases paymentsProperty Departmental provided: Transport activity and subsistenceTravel and developmentTraining and facilitiesVenues Rental and hiring 26,904 16,588 and subsidiesTransfers and municipalitiesProvinces 1,059 Municipalities 687 - - Municipal bank accounts -14,000 Municipal agencies and funds 379,835 377,335 - Households - - - 12,904 377,335 - - - - 13,060 - 16,588 - 377,335 - -156 19,715 - - - 1,059 - - 687 -3,127 101.2% - - 379,835 377,335 - 749 - 2,500 118.9% 379,207 147 14,653 377,335 - - 377,335 310 - 13,084 13,952 628 - 540 377,335 - 377,335 - 70.7% 11,540 99.8% 21.4% 377,335 - 100.0% - - - 1,009 333,295 - 330,795 1,654 100.0% - - 2,500 331,469 - 330,795 378 - 100.0% 268 1,872 - - - 330,795 628 - 330,795 250 74.9% - - 250 330,795 2,500 - 330,795 - 674 Programme 3: EMERGENCY MEDICAL SERVICES 3: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

185 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Adjusted 1,378,154 - -110,000 1,268,154 1,219,274 48,880 96.1% 1,102,221 1,010,469 Appropriation Appropriation nancial assets - - - - 273 -273 - - 160 ts 2,500 - - 2,500 1,336 1,164 53.4% 2,500 674 Social benefi Other transfers to householdsPayments for capital assetsMachinery and equipment equipmentTransport Other machinery and equipment 181,745 Payment for fi - 181,745 60,745 - - 121,000 -52,500 - - -52,500 129,245 -52,500 - - 129,245 94,613 8,245 34,632 94,613 - - 34,632 13,128 73.2% 121,000 -4,883 536 73.2% 81,485 154,800 159.2% 39,515 -536 154,800 88,104 50,800 88,104 67.3% - 30,262 104,000 57,842 - - Programme 3: EMERGENCY MEDICAL SERVICES 3: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

186 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 37 -37 - - 3,242 1,228 - - 1,228 983 245 80.0% 932 345 177,085 - -25,800 151,285 151,200 85 99.9% 69,843 69,745 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Inventory: Clothing material and accessories Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Materials and suppliesInventory: Medical suppliesInventory: MedicineConsumable supplies 15 2,212 2,400 - 24,526 - - - - -2,400 11,628 588 - - 15 - - 2,212 - -5,900 24,526 - 6 28 5,728 20,911 - 2,184 3,615 9 588 5,679 - 1.3% 85.3% 40.0% 49 393 13,015 3,202 - 195 99.1% 12 9,391 1,710 1,843 66.8% 1,472 2 1,441 1,284 - 464 SubProgramme: 3.1: EMERGENCY TRANSPORT EMERGENCY 3.1: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesAdministrative fees 411,743 Advertising 707,480 Minor assetsCatering: Departmental activities - Communication (G&S) 339,779 - Computer services 71,964 295,737 Legal services -57,500 - Contractors - 2,811 Agency and support / outsourced 71 649,980 - services 411,743 - Fleet services (including government 652,026 - -57,500 motor transport) 424,434 1,500 - 6,734 - - 8,610 -2,046 -12,691 339,779 238,237 504 71,964 100.3% - - 103.1% - 352,860 - 227,592 - -13,081 -1,500 -4,300 10,645 519,584 71,574 376,675 -3,600 - - 2,811 4,234 500,607 103.8% 375,694 71 95.5% 390 2,434 5,010 1,600 - 316,716 - - - 142,909 99.5% 2,342 1,211 315,847 70 2,074 124,913 - - 504 59,959 2,936 - 56.9% 92 1 59,847 41.4% 4,234 96.2% 2,312 52 - 98.6% - 2,095 2,078 2,057 452 6,508 146 2,139 61 - 1,813 4,457 10.3% -146 49.5% 1,500 24 385 4,033 - - - 598 - 564 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

187 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------73 6,353 - - 6,353 6,569 -216 103.4% 6,050 2,842 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 273 -273 - - 160 ts 1,900 - - 1,900 1,154 746 60.7% 2,000 609 ce supplies Economic classifi SubProgramme: 3.1: EMERGENCY TRANSPORT EMERGENCY 3.1: SubProgramme: printing and Consumable: Stationery, offi Operating leases paymentsProperty Departmental provided: Transport activity 26,904 16,588 - - -14,000 - 12,904 12,796 16,588 108 19,715 -3,127 99.2% 118.9% 14,653 12,084 13,950 11,535 Travel and subsistenceTravel and developmentTraining and subsidiesTransfers and municipalitiesProvinces MunicipalitiesMunicipal bank accountsMunicipal agencies and funds 1,059 Households 687 379,235 377,335 Social benefi Other transfers to households - Payments for capital assets - 377,335 - - Machinery and equipment equipmentTransport 377,335 - - Other machinery and equipment - - - - Payment for fi 181,745 Total - - - 1,059 379,235 377,335 181,745 - 1,900 687 60,745 379,025 - 377,335 - - 377,335 - 749 121,000 -52,500 - 147 - 210 - 377,335 377,335 -52,500 - 310 129,245 -52,500 - - 540 99.9% 377,335 - 129,245 - 100.0% 94,613 70.7% - 8,245 332,795 21.4% 34,632 - 94,613 1,268,460 330,795 - 1,900 - 100.0% 331,404 1,009 34,632 13,128 330,795 121,000 73.2% 654 100.0% -4,883 1,690 - 536 371 73.2% -110,000 154,800 81,485 - 330,795 - 159.2% 268 210 39,515 1,158,460 -536 154,800 88,104 330,795 1,125,937 50,800 88,104 88.9% 67.3% - 32,523 - 30,262 - 104,000 2,000 330,795 97.2% 57,842 330,795 1,007,179 609 - 920,275 - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

188 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 24,727 - - 24,727 28,528 -3,801 115.4% 12,550 10,919 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ts 600 - - 600 182 418 30.3% 500 65 Economic classifi SubProgramme: 3.2: PLANNED PATIENT TRANSPORT PLANNED PATIENT 3.2: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and servicesCommunication (G&S)Fleet services (including government motor transport) 75,457 109,094 - 63,035 - 12,422 33,637 - - - - - 75,457 - 109,094 - 59,851 - - 93,155 15,606 - 63,035 15,939 12,422 - 49,823 79.3% 33,637 85.4% 10,028 13,212 33,304 71,863 2,394 94,542 - 79.0% 333 71,650 80.7% 90,129 60,033 99.0% - 11,830 59,831 22,679 11,819 - 18,479 - - 377 Operating leases paymentsProperty Departmental activity provided: Transport and subsistenceTravel and developmentTraining 8,910 and facilitiesVenues Rental and hiring and subsidiesTransfers - HouseholdsSocial benefi Total - - - - - 8,910 - - - 600 - - 4,512 - - - 4,398 - - - - 600 - 50.6% - - - - 109,694 - - - 7,629 - 264 600 - - - 7,169 -264 - - - 182 - - - - 600 - - 418 - 109,694 - 182 30.3% - - 93,337 - - - 16,357 - 418 1,000 500 - 1,000 85.1% 30.3% - 2 - 5 95,042 65 250 - 500 90,194 7 250 - 65 - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

189 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 158 - - 158 2 156 1.3% 230 83 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 7,640 - - 7,640 182 551 (174 911) 2389.4% 5,720 3,885 77,764 - - 77,764 83,492 -5,728 107.4% 75,767 81,345 396,292 - - 396,292 283,884 112,408 71.6% 340,629 237,470 Adjusted 5,638,431 - 80,700 5,719,131 5,738,026 -18,895 100.3% 5,004,656 5,128,521 1,121,077 - 7,768,963 43,000 1,164,077 - 1,238,219 123,700 -74,142 7,892,663 106.4% 7,892,277 1,028,145 386 1,034,589 100.0% 6,953,066 6,952,127 Appropriation Appropriation cation GENERAL HOSPITALS TUBERCULOSIS HOSPITALS HOSPITAL HOSPITALS paymentsCurrent Compensation of employeesSalaries and wagesSocial contributions 5,744,057 Goods and servicesAdministrative fees 7,526,570 Advertising - 5,101,817 Minor assets -413 80,700 Catering: Departmental 642,240 80,700 activities 1,782,513 5,824,757 - 7,606,857 -413 5,812,575 - 80,700 172 7,486,696 12,182 120,161 5,182,517 - - 12,553 5,128,045 284 - 99.8% 98.4% 1,782,100 54,472 642,240 5,186,081 6,738,024 1 855 192 - - - 5,344,789 6,756,206 98.9% 684,530 (73 092) -42,290 4,570,325 - - 104.1% 172 4,726,513 106.6% 1,551,943 12,553 615,756 1,411,417 284 172 4,094 618,276 - 8,459 28 100.0% 256 32.6% 16,860 9.9% 184 5,740 202 98 46 Communication (G&S)Computer servicesConsultants: Business and advisory services 12,363 660 - - - 12,363 - 9,832 660 2,531 144 79.5% 516 11,833 21.8% 8,966 - 798 Programme 4: PROVINCIAL HOSPITAL SERVICES HOSPITAL PROVINCIAL 4: Programme Sub Programme 1 2 3 PSYCHIATRIC/MENTAL 4 TRAINING HOSPITALS DENTAL 5 OTHER SPECIALISED 535,399 Economic classifi - - 535,399 548,656 -13,257 102.5% 503,869 470,202 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

190 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 1,079 -1,079 - - 2,453 122 - - 122 628 29 - 93 - 23.8% 628 110 159 2 469 25.3% 670 509 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 9,694 - - 9,694 9,903 -209 102.2% 8,307 7,973 19,382 - - 19,382 20,771 -1,389 107.2% 22,065 19,150 11,355 - - 11,355 6,796 4,559 59.9% 13,864 5,239 147,651 - 107,301 - - 147,651 92,532 - 55,119 107,301 62.7% 125,627 -18,326 51,529 117.1% 75,466 98,853 94,427 Adjusted Appropriation Appropriation ce supplies Inventory: Materials and supplies Inventory: Medical suppliesInventory: MedicineInventory: Other suppliesConsumable supplies 494,552 Consumable: Stationery, printing and offi Operating leases -413 30,271 paymentsProperty 264,646 provided: Transport Departmental activity 80,492 - and subsistenceTravel - - 494,139 - 19,893 272,731 - - 532,477 -38,338 1,886 - 264,646 - - 30,271 107.8% 276,894 80,492 - 28,774 -12,248 - - 474,685 1,497 85,337 104.6% - 272,731 396,288 19,893 -4,845 95.1% 246,200 240,499 21,110 106.0% 1,886 26,531 164,418 -1,217 102,485 - 90.3% 989 106.1% 97,038 256,489 897 17,049 - 263,271 52.4% 13,800 2,454 1,518 Laboratory servicesLegal servicesContractorsAgency and support / services outsourced Fleet services (including government motor transport) 203,107 Inventory: Clothing material and accessories Inventory: Food and food supplies - Inventory: Fuel, oil and gas 40,506 - Inventory: Learner and teacher support material - - - 40,178 203,107 117,559 - - - 85,548 40,506 - 57.9% - 35,885 141,706 40,178 4,621 12,025 -12,025 35,464 42,327 88.6% -2,149 39,673 - 105.3% 30,129 36,831 - 32,429 150,285 Programme 4: PROVINCIAL HOSPITAL SERVICES HOSPITAL PROVINCIAL 4: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

191 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 16 -16 - - - R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 120,568 413 - 120,981 70,236 50,745 58.1% 117,134 83,061 Adjusted 7,768,963 - 123,700 7,892,663 7,892,277 386 100.0% 6,953,066 6,952,127 Appropriation Appropriation xed nancial assets - - - - 1,750 -1,750 - - 1,673 ts 17,338 - - 17,338 22,913 -5,575 132.2% 9,933 22,016 t institutions 94,149 - 43,000 137,149 - 137 149 0% 74,932 83,302 Training and developmentTraining Operating payments and facilitiesVenues Rental and hiring and subsidiesTransfers 3,104 Non-profi HouseholdsSocial benefi 684 - 111,487 Other transfers to households - Payments for capital assets 500 Buildings and other fi - - structures - Buildings 130,906 - 43,000 Machinery and equipment - - 3,104 - equipmentTransport 17,338 413 Other machinery and 154,487 - equipment - Payment for fi - 130,906 995 142 890 684 - - 2,109 11 597 413 10,338 - - 131,319 500 570 - 32.1% 92.5% - - 79,870 - 114 118 17,338 213 - 51,449 8,118 84,865 131,319 142,890 -118 83.3% - 287 - 119,977 -125,552 105,318 60.8% -119,977 79,854 927 824.1% 42.6% 1,127 51,465 10,338 - 130,177 - - 60.8% 9,618 88,930 9,933 871 400 - - 130,177 720 22,016 - 88,930 93.0% 77 67 16 13,043 - -16 5,869 - - - Programme 4: PROVINCIAL HOSPITAL SERVICES HOSPITAL PROVINCIAL 4: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

192 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 8 - - 8 2 6 25.0% 10 2 91 84 - - - - 91 84 110 28 -19 56 120.9% 33.3% 54 2 49 46 660 - - 660 76 584 11.5% - 685 7,937 8,380 - - - - 7,937 8,380 2,681 5,256 7,255 1,125 33.8% 86.6% 11,028 1,929 7,266 6,286 418,552 418,552 478,691 -60,139 114.4% 412,746 434,734 Adjusted 5,521,311 4,020,854 3,602,302 -413 80,700 - 1,500,457 5,601,598 80,700 -413 5,534,725 80,700 4,101,554 66,873 4,183,336 3,683,002 - -81,782 3,704,645 98.8% 1,500,044 -21,643 102.0% 4,910,799 1,351,389 148,655 5,038,746 100.6% 3,650,935 3,849,979 3,238,189 90.1% 3,415,245 1,259,864 1,188,767 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Catering: Departmental activities Computer services Consultants: Business and advisory servicesLaboratory servicesLegal servicesContractors Agency and support / outsourced servicesFleet services (including government motor transport)Inventory: Clothing material and accessories 192,080 Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Learner and teacher - 368 support material 35,956 72,465 - - - 7,475 145,440 34,956 - - - 192,080 ------104,994 - - 87,086 100 - - 368 35,956 72,465 - - 54.7% - 145,440 31,052 76,790 - 7,475 34,956 243 129,643 -4,325 4,904 - 12,006 89,635 33,709 3,872 125 - -12,006 55,805 32,768 106.0% 86.4% 1,247 3,603 66.0% 61.6% - 100 66,389 29,408 96.4% - 51.8% 63,061 48,908 1,015 26,928 411 31,545 -1,015 9,399 - 73,878 - 28,096 10 100 4,047 150,285 - - - 110 1,675 - SubProgramme: 4.1: GENERAL HOSPITALS 4.1: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Advertising Minor assets Communication (G&S) Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

193 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------119,977 - -119,977 - - 16 16 - - -16 -16 1,161 - -1,161 ------1,240 424 - - 424 298 126 70.3% 422 137 8,355 - - 8,355 1,130 2,136 8,815 - -460 - 105.5% - - 5,790 1,130 2,136 6,580 6,693 579 675 551 - 1,461 51.2% 31.6% - 1,164 6,693 1,817 906 5,193 365 1,500 77.6% 8,000 3,130 24,189 55,090 - - - - 24,189 55,090 11,673 20,155 11,673 61,625 11,673 4,034 - -6,535 - 83.3% - 111.9% - - 77,853 - 11,673 - 98,754 11,673 67,418 137,373 11,673 -125,700 413 137,373 -125,700 - 17,396 1176.8% 1176.8% -5,723 - 5,010 149.0% 99,167 5,010 14,974 14,974 59,558 5,010 39,609 14,974 60.1% 80,847 70,431 105,447 413 105,447 - 413 105,860 - 64,767 105,860 41,093 64,751 61.2% 41,109 88,847 61.2% 73,561 88,847 73,561 446,749 216,122 -413 - - - 446,336 489,535 216,122 -43,199 211,065 109.7% 5,057 433,030 97.7% 369,228 174,555 119,089 Adjusted Appropriation Appropriation xed structures cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets nancial ts ce supplies 14,245 - - 14,245 15,937 -1,692 111.9% 14,324 14,365 Economic classifi Payments for capital assets Buildings and other fi Buildings Machinery and equipment equipment Transport Total 5,638,431 - 80,700 5,719,131 5,738,026 -18,895 100.3% 5,004,656 5,128,521 Inventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies printing and Consumable: Stationery, offi Operating leases paymentsProperty Departmental provided: Transport activity and subsistence Travel and development Training Operating payments and subsidies Transfers Households 12,137 213,296 Social benefi Other transfers to households - - 584 - - Other machinery and equipment 213,296 12,137 - Payment for fi 167,525 11,554 45,771 - 583 78.5% 584 95.2% 205,826 210,602 10,328 158 426 9,835 27.1% 582 497 SubProgramme: 4.1: GENERAL HOSPITALS 4.1: SubProgramme: Inventory: Materials and supplies Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

194 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------100 79 9 - - 9 2 7 22.2% 63 2 200 - 700 - - 200 - 700 - 200 365 335 - 52.1% 200 718 - 466 180 - - 180 324 -144 180.0% - - 250 - - 250 71 179 28.4% 152 84 1,454 - - 1,454 457 997 31.4% 712 343 5,990 - - 5,990 2,047 3,943 34.2% 8,284 2,008 51,993 78,390 - - - - 51,993 78,390 31,070 66,005 20,923 12,385 59.8% 84.2% 40,342 103,154 27,068 42,552 31,251 - - 31,251 40,761 -9,510 130.4% 39,945 20,389 393,497 315,107 263,114 - - - - - 393,497 - 315,107 280,402 263,114 214,397 113,095 183,327 100,710 79,787 71.3% 68.0% 332,876 69.7% 229,722 234,026 189,380 191,474 164,406 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Inventory: Other supplies Inventory: Medicine Inventory: Materials and supplies Inventory: Medical supplies Compensation of employees Salaries and wages Social contributions SubProgramme: 4.2: TUBERCULOSIS HOSPITALS 4.2: SubProgramme: Current payments Goods and services Administrative fees Advertising Minor assets Catering: Departmental activities Consultants: Business and advisory servicesLaboratory servicesContractors servicesAgency and support / outsourced Fleet services (including government motor transport)Inventory: Food and food suppliesInventory: Fuel, oil and gas 560 Inventory: Learner and teacher support material - 4,298 6,500 - 1,076 50 - - 1,000 50 560 ------123 4,298 - - 6,500 - - 437 1,871 - 5,036 1,076 50 2,427 1,000 1,464 22.0% 50 930 - 25 368 43.5% 77.5% 174 146 960 - 632 25 5,909 -124 6,000 86.4% 105 36.8% 50.0% 656 348.0% 4,078 - 7,000 1,400 1,000 1,105 7 50 174 278 -7 13 - - - Communication (G&S) Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

2017/18 2016/17 195 Appropriation Appropriation Virement Virement Final Funds Shifting of ------413 - -413 - - 118 - -118 - 460 - - - 400 86 -86 77 - - 29 50 - - 50 25 25 50.0% 50 303 500 600 600 - 600 ------500 - 600 600 166 600 891 891 334 891 -291 -291 33.2% -291 148.5% 148.5% 148.5% 501 - 501 501 1,887 1,887 - 1,887 150 100 - - - - 150 100 11 15 139 85 7.3% 15.0% 766 5,100 56 46 2,195 2,195 1,047 - 1,148 ------2,195 - 2,195 2,505 1,047 2,505 1,148 -310 414 2,091 -310 114.1% 633 -943 114.1% 7,252 182.1% 39.5% 7,252 1,528 6,262 1,528 990 1,053 475 4,122 - - 4,122 3,487 635 84.6% 6,579 5,573 19,000 - - 19,000 8,222 10,778 43.3% 13,510 5,587 396,292 - - 396,292 283,884 112,408 71.6% 340,629 237,470 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets nancial ts ce supplies 900 - - 900 987 -87 109.7% 3,796 1,130 Economic classifi Transfers and subsidies Transfers Households Social benefi Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipment Payment for fi Property payments Property Rental and hiring Total SubProgramme: 4.2: TUBERCULOSIS HOSPITALS 4.2: SubProgramme: Consumable supplies printing and Consumable: Stationery, offi Operating leases and subsistence Travel and development Training Operating payments and facilities Venues Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

196 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 59 - - 59 52 7 88.1% 55 45 2,465 - - 2,465 444 2,021 18.0% 3,888 3,304 10,810 - - 10,810 4,699 6,111 43.5% 6,021 5,317 882,806 766,961 115,845 132,353 ------882,806 - 766,961 - 897,685 115,845 775,259 132,353 -14,879 122,426 149,685 -8,298 101.7% -6,581 -17,332 101.1% 812,841 105.7% 113.1% 701,714 811,436 111,127 120,446 704,407 107,029 127,266 Adjusted 1,015,159 - - 1,015,159 1,047,370 -32,211 103.2% 933,287 938,702 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 4.3: PSYCHIATRIC/MENTAL HOSPITAL PSYCHIATRIC/MENTAL 4.3: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Minor assets Catering: Departmental activitiesCommunication (G&S)Computer servicesConsultants: Business and advisory servicesLaboratory servicesContractors 1,927 Agency and support / servicesoutsourced Fleet services (including government motor transport) 147 - Inventory: Clothing material and - accessories 7,157 2,735 Inventory: Food and food supplies 1,869 Inventory: Fuel, oil and gas 1,235 - - Inventory: Materials and - 399 - supplies - Inventory: Medical supplies - 1,927 - 4,712 - - - - - 1,215 - - 147 27,688 7,157 - - 2,735 - - 712 1,869 182 270 1,235 1,172 1,000 - - 63.1% (175 113) - 68 - 399 2,167 1,101 1,563 2546.7% 147 2,383 4,712 - - -68 -298 170 - 42.9% 134 5,249 1,007 8,361 115.9% 27,688 229 - 3,330 - 89.1% - - 3,862 -3,649 2,069 36,734 42.6% 1,000 120 1,143 819 177.4% 55 -9,046 - 931 680 1,028 3,735 132.7% -2 2 -55 110 3,966 25,640 623 1,002 26,278 - (0.2%) 1,532 - 875 714 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

197 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 413 -413 - - 277 4,171 - - 4,171 6,158 -1,987 147.6% - - 14,973 14,114 - - - - 14,973 14,114 17,875 16,342 -2,902 119.4% -2,228 115.8% 18,554 12,187 17,306 18,807 Adjusted 1,121,077 - 43,000 1,164,077 1,238,219 -74,142 106.4% 1,028,145 1,034,589 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 2,054 - - 2,054 1,548 506 75.4% 2,040 2,588 nancial assets nancial ts 3,436 - - 3,436 3,317 119 96.5% 2,878 4,220 t institutions 94,149 - 43,000 137,149 - 137 149 0% 74,932 83,302 Economic classifi SubProgramme: 4.3: PSYCHIATRIC/MENTAL HOSPITAL PSYCHIATRIC/MENTAL 4.3: SubProgramme: Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offi HouseholdsSocial benefi Payments for capital assetsMachinery and equipment equipmentTransport Other machinery and equipment 8,333 Payment for fi 8,333 Total 3,436 - 1,498 - - - - 6,835 - 8,333 - - 8,333 - 6,048 3,436 1,498 6,048 2,285 3,317 - 2,374 2,285 72.6% 119 6,835 72.6% -876 17,048 96.5% 3,674 158.5% 17,048 8,088 3,161 2,878 8,088 2,740 53.8% 4,220 1,833 14,308 6,255 Operating leases paymentsProperty provided: Transport Departmental activity and subsistenceTravel and developmentTraining Operating payments and subsidiesTransfers 33,635 Non-profi 235 44 367 525 97,585 - - 32 ------43,000 - 33,635 - - 235 140,585 47,692 - 367 525 44 2,135 -14,057 3 317 -1,900 141.8% 332 32 137 268 97 1 908.5% 30,199 193 2.4% 270 70 43 38,583 50 63.2% 77,810 26.4% -38 2.3% 87,522 138 441 218.8% 680 68 455 382 84 12 412 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

198 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 9 - - 9 3 6 33.3% 8 2 647 - - 647 490 157 75.7% 990 151 46,172 61,118 - - - - 46,172 61,118 41,511 94,865 4,661 -33,747 89.9% 155.2% 41,900 58,265 39,885 38,992 520,463 459,345 413,173 - - - - - 520,463 - 459,345 541,588 413,173 446,723 -21,125 405,212 12,622 104.1% 7,961 97.3% 486,448 98.1% 428,183 465,342 386,283 426,350 386,465 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 4.4: DENTAL TRAINING HOSPITALS DENTAL 4.4: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Minor assets Catering: Departmental activitiesCommunication (G&S)Computer servicesConsultants: Business and advisory servicesLaboratory servicesLegal services 1,156 ContractorsAgency and support / servicesoutsourced Fleet services (including - government motor transport) - 3 Inventory: Clothing material and 3,908 accessories 50 Inventory: Food and food supplies - 950 Inventory: Fuel, oil and gas - - - 2,895 - 250 Inventory: Materials and - supplies 1,156 ------460 - 840 - 3,908 - - 3 - - - - 50 316 5 9,474 950 2,895 - 72.7% - 250 46 - -5,566 - 3 - - 3,684 295 1,180 1,430 242.4% - - 3 - 460 19 47 -789 -1,180 655 2,752 842 - 127.3% 6.0% 572.0% - -19 83 - 31.1% - 1,196 - 5 2,405 360 377 10 938 9 - 46 - - 5,933 1,361 18.0% 235 -5,928 68 955 - -9 - 3 118660.0% - 352 -909 - 212 2076.1% - 13 63 792 - 403 64 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

199 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------47 - -47 - - 78 - -78 67 - - 116 25 - - 25 30 -5 120.0% 31 101 272 178 - - - - 272 178 58 177 214 1 21.3% 99.4% 197 273 95 19 900 - - 900 1,471 -571 163.4% 1,163 308 1,493 1,631 6,350 ------1,493 1,631 6,350 6,218 1,903 3,311 -4,725 -272 416.5% 3,039 116.7% 52.1% 6,862 6,761 5,162 - 3,462 - 7,490 1,666 - - - - 7,490 1,666 6,717 17,809 -16,143 773 1069.0% 89.7% 2,125 6,161 943 3,770 1,475 1,475 1,475 ------1,475 1,475 1,475 1,175 1,175 1,175 300 300 300 79.7% 79.7% 79.7% 1,493 1,493 1,493 681 681 681 29,601 - - 29,601 33,554 -3,953 113.4% 25,710 18,561 13,461 13,461 - - - - 13,461 13,461 5,815 5,815 7,646 7,646 43.2% 43.2% 15,928 15,928 4,063 4,063 535,399 - - 535,399 548,656 -13,257 102.5% 503,869 470,202 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 2,033 - - 2,033 1,823 210 89.7% 1,725 812 nancial assets nancial ts Economic classifi SubProgramme: 4.4: DENTAL TRAINING HOSPITALS DENTAL 4.4: SubProgramme: Inventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offi Operating leases Property payments Property provided: Transport Departmental activity and subsistence Travel and development Training Operating payments Rental and hiring ------20 - Transfers and subsidies Transfers Households Social benefi Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipmentPayment for fi Total 12,561 - - 12,561 4,344 8,217 34.6% 14,765 3,755 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

200 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 4 - - 4 5 125.0% 4 - 50 - - 50 22 28 44.0% 242 13 200 - - 200 157 43 78.5% 286 365 9,678 - - 9,678 10,832 -1,154 111.9% 9,641 9,560 76,140 65,945 56,267 - 10,195 ------76,140 65,945 - 56,267 82,611 70,434 10,195 59,602 -6,471 -4,489 12,177 108.5% -3,335 106.8% 105.9% -1,982 74,614 64,400 119.4% 54,759 79,390 65,550 10,214 55,990 13,840 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Communication (G&S) Consultants: Business and advisory servicesLaboratory servicesContractorsAgency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Food and food suppliesInventory: Fuel, oil and gas 15 86 Inventory: Learner and teacher support material 61 166 Inventory: Materials and supplies 180 Inventory: Medical supplies - - Inventory: MedicineInventory: Other supplies - - 43 Consumable supplies - - 1,402 - - 643 22 - - - - - 100 807 15 86 - 816 - 61 166 - - 180 - - 10 48 - - 243 94 - - 49 - - 43 1,402 38 5 - - -77 643 -33 131 - 2,642 22 64 55.8% 66.7% - 100 146.4% 154.1% 807 1,134 27.2% -1,240 816 -21 22 72 234 158 - -491 975 188.4% - 58 180 148.8% 572 176.4% -134 1,640 25 -168 - 220 19 - 112 - 234.0% 41 244 120.8% 100.0% 1,174 612 199 70.1% 31 583 947 - - 704 76 873 - 1,778 2 SubProgramme: 4.5: OTHER SPECIALISED HOSPITALS OTHER 4.5: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Minor assets Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

201 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 12 -12 - - 11 31 56 - - - 31 - 291 56 -260 37 938.7% 19 50 66.1% 57 52 - 229 154 154 ------229 154 154 150 134 134 79 20 20 65.5% 87.0% 87.0% 324 51 51 337 254 254 154 200 - - - 154 200 134 166 20 87.0% 34 83.0% 51 150 254 123 5,134 - - 5,134 4,952 182 96.5% 4,829 7,556 1,470 1,470 1,270 - - - - - 1,470 - 1,470 735 1,270 735 735 569 735 50.0% 701 50.0% 1,102 44.8% 1,102 1,690 1,690 952 1,567 77,764 - - 77,764 83,492 -5,728 107.4% 75,767 81,345 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets nancial ts ce supplies 150 - - 150 476 -326 317.3% 180 255 Economic classifi Property payments Property provided: Transport Departmental activity and subsistence Travel and development Training and subsidies Transfers Households Social benefi ------SubProgramme: 4.5: OTHER SPECIALISED HOSPITALS OTHER 4.5: SubProgramme: printing Consumable: Stationery, and offi Operating leases Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipment Payment for fi Total Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

202 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 158 800 - - - - 158 800 54 558 104 242 34.2% 69.8% 110 628 29 204 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 50,822 - - 50,822 10,429 40,393 20.5% 39,216 10,015 Adjusted 3,501,060 - -8,000 3,493,060 3,329,921 163,139 95.3% 3,072,473 2,826,316 8,931,433 1,263,216 4,276,352 - - - - - 8,931,433 - 1,263,216 9,224,717 4,276,352 1,094,853 -293,284 4,314,022 168,363 103.3% -37,670 7,804,354 86.7% 100.9% 8,565,030 1,273,485 3,757,239 996,071 3,510,847 11,839,981 - - 11,839,981 11,986,766 -146,785 101.2% 10,316,924 10,561,108 15,341,041 - -8,000 15,333,041 15,316,687 16,354 99.9% 13,389,397 13,387,424 14,471,001 10,194,649 - - - 14,471,001 - 14,633,592 10,194,649 10,319,570 -162,591 -124,921 101.1% 101.2% 12,835,078 13,071,948 9,077,839 9,561,101 Appropriation Appropriation cation CENTRAL HOSPITALS PROVINCIAL TERTIARY PROVINCIAL TERTIARY SERVICES HOSPITAL Compensation of employees Salaries and wages Current payments Social contributions Goods and services Administrative fees Advertising Minor assets Catering: Departmental activitiesCommunication (G&S)Computer servicesConsultants: Business and advisory servicesLaboratory services 17,734 Legal servicesContractors 10,097 - 64 581,769 97,150 - - - 169,286 - - - - 17,734 - - - - 10,097 19,671 - 581,769 97,150 -1,937 2,881 64 577,214 - - 82,166 110.9% 7,216 169,286 4,555 28 14,984 15,511 148,734 28.5% - 99.2% 84.6% 17,779 20,552 36 165,194 457,970 - -165,194 87.9% 711 43.8% 236,117 163,996 995 867 - 133,906 70 42 - 426,460 Programme 5: CENTRAL HOSPITAL SERVICES CENTRAL HOSPITAL 5: Programme Sub Programme 1 2 Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

203 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2,573 3,741 - - - - 2,573 3,741 2,438 2,354 135 1,387 94.8% 62.9% 2,080 1,385 630 960 196,448 - - 196,448 226,873 -30,425 115.5% 20,807 41,575 Adjusted Appropriation Appropriation ce supplies 51,805 - - 51,805 45,036 6,769 86.9% 47,843 33,450 Operating payments and subsidies Transfers Operating leases paymentsProperty provided: Transport Departmental activity and subsistenceTravel and development Training 429,899 5,369 1,390 1,616 320 ------429,899 5,689 - 426,760 1,390 13,870 1,616 3,139 -8,181 1,528 4 243.8% 99.3% 1,386 477,192 88 15,138 306,002 15,834 94.6% 0.3% 1,427 344 1,523 4 Agency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Clothing material and accessories 139,848 Inventory: Food and food suppliesInventory: Fuel, oil and gasInventory: Learner and teacher support material - Inventory: Materials and 43,494 supplies 6,025 Inventory: Medical supplies - Inventory: Medicine - Inventory: Other supplies 1,421,371 142,863 - - Consumable supplies - 139,848 Consumable: Stationery, printing and offi - -320 118,229 64,932 843,786 - - - 178,062 11,698 - 21,619 - 43,494 - - - 6,025 84.5% 1,421,051 - - - - 47,046 1,597,376 125,760 142,863 6,826 - -176,325 - - -3,552 108,967 123,287 - - - -801 843,786 112.4% 64,932 108.2% 19,576 6 178,062 1,333,576 676,246 11,698 113.3% 43,213 34 53,563 1,203,718 188,469 86.3% 167,540 14,371 10,865 21,719 -6 63,291 -10,407 135,692 -34 80.1% -2,673 2,000 66.6% 105,400 105.8% 618,500 122.9% - 242,288 - 615,579 13,374 - 212,622 - 12,135 - 2,318 - - Programme 5: CENTRAL HOSPITAL SERVICES CENTRAL HOSPITAL 5: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

204 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 46,448 - - 46,448 40,244 6,204 86.6% 19,807 41,575 46,448 - - 46,448 76,873 -30,425 165.5% 20,807 41,575 150,000 - - 150,000 150,000 - 100.0% - - Adjusted 15,341,041 - -8,000 15,333,041 15,316,687 16,354 99.9% 13,389,397 13,387,424 Appropriation Appropriation nancial ts t institutions assets - - - - 2,444 -2,444 - - 3,278 Other transfers to householdsPayments for capital assetsMachinery and equipment equipmentTransport Other machinery and equipment 673,592 Payment for fi 5,475 - - 673,592 -8,000 668,117 - - 665,592 - 453,778 - -8,000 - - 211,814 665,592 -8,000 5,475 68.2% 453,778 660,117 - 5,572 211,814 533,512 448,206 36,629 270,623 211,911 68.2% -97 -36,629 533,512 67.9% 101.8% 270,623 530,712 - 2,800 266,540 1,000 4,083 - Households Social benefi Non-profi Programme 5: CENTRAL HOSPITAL SERVICES CENTRAL HOSPITAL 5: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

205 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 51 64 - - - - 51 64 40 22 11 78.4% 42 34.4% 25 50 17 29 467 - - 467 354 113 75.8% 518 129 34,528 - - 34,528 5,741 28,787 16.6% 27,267 7,239 909,616 - - 909,616 843,965 65,651 92.8% 895,488 777,203 Adjusted 7,904,995 6,995,379 3,220,629 - - - - - 7,904,995 6,995,379 8,007,026 - 7,163,061 -102,031 3,220,629 -167,682 3,411,534 101.3% 102.4% -190,905 7,080,588 6,185,100 7,499,663 105.9% 6,722,460 2,795,688 2,789,428 11,125,624 - - 11,125,624 11,418,560 -292,936 102.6% 9,876,276 10,289,091 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Advertising Minor assets Catering: Departmental activities Communication (G&S)Computer servicesConsultants: Business and advisory servicesLaboratory servicesLegal services 12,788 ContractorsAgency and support / servicesoutsourced 10,097 EntertainmentFleet services (including - 387,623 95,900 government motor transport)Inventory: Clothing material and - accessoriesInventory: Food and food 118,288 - supplies 128,891 - - 4,311 - Inventory: Fuel, oil and gas - 12,788 - - - - - 10,097 - 15,592 - 25,831 387,623 95,900 -2,804 2,198 - 466,638 - - - - - 82,120 121.9% - 90,856 7,899 118,288 128,891 -79,015 4,311 13,780 10,938 97,585 118,649 21.8% - 120.4% - - - - 85.6% 5,314 14,222 20,703 10,242 274,519 164,340 25,831 -1,003 - - 185,418 -164,340 - 82.5% 92.1% 175 - 38,496 123.3% 105,180 123,474 90,856 -12,665 742 - - - - 118,407 9,565 85,329 88,668 149.0% 1,773 - 38,200 5 2,188 - 356,979 38,200 97.6% -5 - 88,492 76,756 - - - - 2,313 SubProgramme: 5.1: CENTRAL HOSPITALS 5.1: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

206 2017/18 2016/17 Appropriation Appropriation Virement Virement Final - - - 25,174 -25,174 - 1,000 - Funds Shifting of 7,798 - 2,893 - 7,798 1,014 - 1,225 10,773 2,471 - - -2,975 - - 138.2% 2,893 - - 10,382 7,174 - 1,014 -7,489 1,225 9,404 2,471 1,427 358.9% 704 1,585 12,978 -413 521 140.7% 12,327 886 57.5% 64.1% 977 730 1,364 710 349 683 2,775 - - 2,775 3,153 -378 113.6% - 3,233 56,134 - - 56,134 31,205 34,948 34,948 24,929 - 55.6% - - - - 34,948 34,948 - 56,347 31,173 -21,399 3,775 161.2% 89.2% 11,603 10,603 33,687 33,687 675,895 122,291 - - - 675,895 - 547,649 184,948 122,291 128,246 148,041 - -25,750 81.0% 121.1% 448,554 - 446,337 187,353 184,948 178,080 206,347 -21,399 111.6% 11,603 33,687 150,000 - 529,409 529,409 526,634 - - - 150,000 - 150,000 - - 529,409 529,409 - - 359,537 359,537 526,634 100.0% 169,872 169,872 356,384 67.9% 170,250 67.9% 429,045 429,045 67.7% 235,491 235,491 429,045 232,258 Adjusted 1,090,013 - - 1,090,013 1,230,611 -140,598 112.9% 1,076,394 995,126 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 2,322 -2,322 - - 2,839 ts t institutions ce supplies 27,417 - - 27,417 23,901 3,516 87.2% 29,814 25,668 Economic classifi SubProgramme: 5.1: CENTRAL HOSPITALS 5.1: SubProgramme: Inventory: Learner and teacher support materialInventory: Materials and supplies Inventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies printing Consumable: Stationery, and offi Operating leases - paymentsProperty provided: Transport Departmental activity and subsistence Travel - and development Training Operating payments and subsidies 323,453 Transfers Non-profi - 330 - - - - 34 323,453 - 319,460 -34 330 3,993 - 98.8% - 352,557 - 330 232,537 - - 44 - Households Social benefi Other transfers to households Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipment Payment for fi Total 11,839,981 - - 11,839,981 11,986,766 -146,785 101.2% 10,316,924 10,561,108 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

207 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 107 333 - - - - 107 333 14 204 93 129 13.1% 61.3% 85 110 12 75 16,294 - - 16,294 4,688 11,606 28.8% 11,949 2,776 353,600 - - 353,600 250,888 102,712 71.0% 377,997 218,868 Adjusted 3,345,377 2,289,654 1,936,054 - 1,055,723 - - - - - 3,345,377 - 2,289,654 3,215,032 1,936,054 2,312,544 - 130,345 2,061,656 1,055,723 -22,890 -125,602 96.1% 902,488 101.0% 2,958,802 106.5% 153,235 1,997,251 2,782,857 1,619,254 2,061,438 1,842,570 85.5% 961,551 721,419 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 5.2: PROVINCIAL TERTIARY HOSPITAL SERVICES HOSPITAL TERTIARY PROVINCIAL 5.2: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Advertising Minor assets Catering: Departmental activitiesCommunication (G&S)Computer servicesConsultants: Business and advisory servicesLaboratory servicesLegal services 4,946 ContractorsAgency and support / servicesoutsourced Fleet services (including - government motor transport) 194,146 - - 1,250 Inventory: Clothing material and accessoriesInventory: Food and food supplies 1,714 - 21,560 Inventory: Fuel, oil and gas - - 40,395 - - - 4,946 - - - 17,663 - - - - - 4,079 194,146 1,250 - - - 110,576 - - 52,007 - - 867 - 1,714 83,570 21,560 40,395 46 683 82.5% - - - 6 20,644 1,512 - 57.0% 30,085 1,204 -683 4,573 17,663 183,451 10,310 - 916 202 854 -6 - 3.7% 3,557 8,550 50,699 74.5% - 95.8% 88.2% 52,007 -854 - 536 9,113 - 40,522 20,580 34,619 1,300 - 48.4% 15,499 125 - 23,638 17,388 1 20 227 15,363 995 66.6% 25,091 - 13 47,200 69,481 28,644 - - 5 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

208 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------11,455 -11,455 - - 122 -122 - - - - 439 602 - - 602 101 501 16.8% 450 159 8,798 - - 8,798 12,008 -3,210 136.5% - - 1,348 1,270 - - - - 1,348 1,270 1,734 769 -386 501 128.6% 60.6% 1,350 675 281 277 2,700 - 2,700 2,419 281 89.6% 2,800 850 55,771 - - 55,771 40,428 15,343 72.5% 54,935 34,542 11,500 11,500 11,500 ------11,500 11,500 11,500 20,526 20,526 -9,026 9,071 -9,026 178.5% 2,429 178.5% 9,204 78.9% 9,204 7,888 9,204 7,888 7,888 331,358 167,891 -320 - - 331,038 - 366,765 167,891 -35,727 128,597 110.8% 39,294 257,182 76.6% 208,592 169,946 169,242 144,183 144,183 - - -8,000 -8,000 136,183 136,183 94,241 94,241 41,942 41,942 69.2% 69.2% 104,467 104,467 35,132 35,132 Adjusted 3,501,060 - -8,000 3,493,060 3,329,921 163,139 95.3% 3,072,473 2,826,316 Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 24,388 - - 24,388 21,135 3,253 86.7% 18,029 7,782 nancial assets nancial ts Economic classifi SubProgramme: 5.2: PROVINCIAL TERTIARY HOSPITAL SERVICES HOSPITAL TERTIARY PROVINCIAL 5.2: SubProgramme: Inventory: Materials and suppliesInventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offi 3,900 - - 3,900 3,598 302 92.3% 6,200 2,731 Operating leases paymentsProperty provided: Transport Departmental activity and subsistence Travel 106,446 2,476 1,060 320 - - - - - 106,446 2,796 107,300 1,060 3,488 -854 -692 4 100.8% 124.7% 1,056 124,635 2,160 73,465 0.4% 3,507 300 4 Training and development Training Operating payments and subsidies Transfers Households Social benefi Other transfers to households Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipmentPayment for fi Total 141,483 - -8,000 133,483 91,822 41,661 68.8% 101,667 34,282 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

209 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 169 -169 - - - 73 - - 58 73 - 113 - -40 154.8% 58 15 17 87 41 29.3% - 36 100 296 - - - - 100 296 90 145 10 151 90.0% 49.0% 1,029 65 415 65 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 8,622 1,446 - - - 8,622 - 4,011 1,446 4,611 847 46.5% 599 8,500 58.6% 1,895 1,716 1,478 39,961 86,546 73,595 - - - -5,000 -5,000 34,961 - 68,595 34,953 86,546 68,222 68,676 8 17,870 373 100.0% 79.4% 99.5% 38,944 162,130 70,752 31,347 217,247 61,716 60,711 - - 60,711 57,851 2,860 95.3% 59,384 42,906 809,069 - -70,700 738,369 747,136 -8,767 101.2% 782,298 743,753 881,573 820,862 705,474 115,388 - - -80,700 - -80,700 - 800,873 -60,313 740,162 -20,387 796,456 645,161 738,605 95,001 644,596 4,417 1,557 94,009 99.4% 565 99.8% 992 869,465 99.9% 810,081 804,604 99.0% 675,537 761,698 134,544 661,231 100,467 Adjusted 1,009,171 - -80,700 928,471 918,987 9,484 99.0% 1,054,124 1,054,063 Appropriation Appropriation cation NURSE TRAINING COLLEGES EMS TRAINING COLLEGES Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Advertising Minor assets Bursaries: Employees Catering: Departmental activitiesCommunication (G&S) Computer services Consultants: Business and advisory servicesLaboratory services 180 507 - - - - 180 507 68 199 112 308 37.8% 39.3% 198 330 227 153 Programme 6: HEALTH SCIENCES AND TRAINING AND SCIENCES HEALTH 6: Programme Sub Programme 1 2 3 BURSARIES 4 OTHER TRAINING Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

210 Appropriation Appropriation Virement Virement Final Funds Shifting of ------16 - - - - - 30 2 742 - - 742 581 871 925 407 - -183 - - 124.7% - - 995 - 200 581 871 489 407 814 - 406 323 -233 - 465 140.1% 84 46.6% 200 79.4% 389 681 93 566 - 730 107 - 46.5% 500 145 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 5,353 2,100 - 6,011 - - - 5,353 - 5,920 2,100 - 5,292 -567 6,011 110.6% -3,192 3,636 252.0% 3,711 2,375 1,640 5,287 60.5% 1,805 5,988 2,822 13,300 12,977 - - - - 13,300 12,977 18,087 9,234 -4,787 3,743 136.0% 71.2% 12,064 13,002 13,979 6,716 Adjusted Appropriation Appropriation ce supplies 2,967 - - 2,967 2,836 131 95.6% 3,612 2,066 Operating leases Legal services Contractors Agency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Clothing material and accessoriesInventory: Food and food supplies 306 Inventory: Fuel, oil and gasInventory: Learner and teacher support materialInventory: Materials and - supplies 1,783 Inventory: Medical supplies 2 - Inventory: Medicine 1,487 Inventory: Other supplies - - Consumable supplies 115 - Consumable: Stationery, - printing and offi - 306 payments Property - - 227 - and subsistence Travel - 351 - and development Training 1,783 Operating payments and facilities Venues - 1,487 - 2 -45 2,915 - 114.7% 115 -1,132 750 410 5 - 163.5% 60 737 73 -410 227 -3 2,287 50.4% 250.0% 42 3 122 - 915 1,320 63.5% 82 105 1,465 - 147 53.7% 11 503 1,023 113 917 Programme 6: HEALTH SCIENCES AND TRAINING AND SCIENCES HEALTH 6: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

211 Appropriation Appropriation Virement Virement Final Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Adjusted 1,009,171 - -80,700 928,471 918,987 9,484 99.0% 1,054,124 1,054,063 Appropriation Appropriation nancial ts 1,956 - - 1,956 3,721 -1,765 190.2% 1,244 3,005 Transfers and subsidiesTransfers Departmental agencies and accountsDepartmental agencies 119,553 (non-business entities)Higher education institutionsHouseholdsSocial benefi - 19,812 Other transfers to households 19,812 Payments for capital assets - Machinery and equipment - 12,061 equipmentTransport 119,553 87,680 Other machinery and - equipment 8,045 109,004 Payment for fi - 85,724 - - 10,549 3,920 - 19,812 - 8,045 91.2% 19,812 - 19,812 - - - 4,125 175,706 19,812 12,061 - - 87,680 238,643 - - 9,786 - 8,045 79,406 - - 85,724 100.0% - 11,001 2,275 3,920 100.0% 8,274 75,685 18,869 - 8,045 -2,956 81.1% 3,898 18,869 10,039 90.6% 18,869 11,001 136.7% 4,125 154,874 18,869 1,963 88.3% 22 -2,956 218,321 7,103 8,953 153,630 1,453 99.4% 136.7% 215,316 -2,978 7,704 3,616 172.2% 8,953 3,376 7,704 5,337 4,328 assets - - - - 2,526 -2,526 - - 3,112 Programme 6: HEALTH SCIENCES AND TRAINING AND SCIENCES HEALTH 6: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

212 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------2 169 -2 -169 - - 65 - 65 - 275 - - 275 123 152 102 44.7% - 775 - 295 102 267 -165 261.8% 39 182 1,065 - - 1,065 749 316 70.3% 1,145 1,254 20,035 - - 20,035 30,889 -10,854 154.2% 18,606 23,113 785,803 765,768 655,957 109,811 - - -70,700 - -70,700 - 715,103 -50,313 695,068 -20,387 725,888 605,644 694,999 89,424 -10,785 605,644 89,355 101.5% 69 - 776,808 100.0% 69 735,729 100.0% 758,202 99.9% 629,105 712,616 129,097 616,927 95,689 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 6.1: NURSE TRAINING COLLEGES NURSE 6.1: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Advertising Minor assets Communication (G&S) Computer services Consultants: Business and advisory servicesLegal servicesContractorsAgency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Clothing material and accessories 257 Inventory: Food and food supplies 283 Inventory: Fuel, oil and gas - Inventory: Learner and teacher 52 - support material - Inventory: Materials and supplies - Inventory: Medical supplies - - 2 - - - - - 1,162 257 95 - - - 283 - - 43 - 52 - 207 1,463 - - - 214 -1,180 41 - - - - 2 - 517.0% 16.7% - 1,162 11 - 95 2 - 787 - 80 158 78.8% 639 55 207 273 - - -158 - 523 2 95 100.0% 117 40 55.0% - 55 - 26 57.9% 90 2 720 10 - - 56.5% 122 898 - 201 82 70 164 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

213 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------2,508 -2,508 - 77 - - 2,844 21 - - 21 91 -70 433.3% 81 133 17 - - 17 7 10 41.2% 27 40 387 - - 387 307 80 79.3% - - 140 - - 140 11 129 7.9% 367 422 3,893 - - 3,893 4,730 -837 121.5% 3,337 4,687 2,000 8,430 - - - - 2,000 8,430 5,184 14,411 -3,184 -5,981 259.2% 170.9% 1,540 7,514 1,778 11,011 9,736 1,936 7,800 3,530 - 3,530 - 1,920 ------9,736 - 1,936 - 7,800 14,632 - 3,530 3,608 3,530 11,024 -4,896 1,920 4,108 -1,672 150.3% -3,224 4,108 2,246 186.4% -578 141.3% 1,194 -578 116.4% -326 1,194 116.4% 2,704 117.0% - 2,704 4,296 4,296 2,116 2,476 - 2,476 1,599 19,736 10,000 - - - - 19,736 10,000 14,632 5,104 74.1% 10,000 1,194 - 2,704 809,069 - -70,700 738,369 747,136 -8,767 101.2% 782,298 743,753 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 1,647 - - 1,647 2,320 -673 140.9% 1,785 1,513 nancial assets nancial ts Economic classifi SubProgramme: 6.1: NURSE TRAINING COLLEGES NURSE 6.1: SubProgramme: Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offi Operating leases Property payments Property and subsistence Travel and development Training Operating payments Transfers and subsidies Transfers Higher education institutions Households Social benefi Other transfers to households Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipmentPayment for fi Total 1,610 - 1,610 1,862 -252 115.7% 2,180 877 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

214 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------2 6 - - 6 22 -16 366.7% 200 120 100 - - 100 88 12 88.0% - - 479 850 - - - - 479 850 547 315 -68 535 114.2% 37.1% 350 600 384 597 3,005 - - 3,005 2,337 668 77.8% 3,005 2,374 35,883 22,715 19,710 - 13,168 - - -5,000 -5,000 - -5,000 30,883 17,715 14,710 27,939 16,983 - 14,646 2,944 13,168 732 90.5% 64 10,956 95.9% 34,694 99.6% 2,212 21,630 25,920 18,625 83.2% 17,291 14,917 13,064 8,629 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 6.2: EMS TRAINING COLLEGES EMS 6.2: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Advertising Minor assets Catering: Departmental activitiesCommunication (G&S)ContractorsAgency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Clothing material and accessories 227 Inventory: Food and food supplies 1,500 Inventory: Fuel, oil and gas 150 306 Inventory: Learner and teacher 690 - support materialInventory: Materials and - supplies - Inventory: Medical supplies - - - Inventory: Medicine - - - - 227 - - 20 325 - 1,500 150 - 306 94 690 1,452 - - 20 - 60 351 133 - 884 48 - - 41.4% - - 90 -45 -194 96.8% - 325 114.7% 128.1% 40.0% 20 204 1,500 3 - 252 111 900 115 150 17 642 5 20 -3 -252 214 462 157 3 3 3 - 34.2% - 85.0% 17 600 80 - 25 15.0% 567 11 302 31 950 751 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

215 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------15 30 -15 - - - 261 20 - - 20 6 14 30.0% - - 20 20 20 ------20 20 20 107 107 107 -87 -87 535.0% -87 535.0% 535.0% 50 50 50 12 12 12 100 215 - 200 - - - - 100 - 215 108 200 169 -8 93 46 108.0% 107 78.6% 100 46.5% 250 27 500 76 68 4,870 1,300 - - - - 4,870 1,300 3,676 1,381 1,194 75.5% -81 106.2% 4,550 1,050 2,968 504 4,058 4,058 2,000 ------4,058 4,058 2,000 6,892 6,892 1,652 -2,834 -2,834 169.8% 348 169.8% 4,200 82.6% 4,200 5,154 1,500 5,154 1,777 39,961 - -5,000 34,961 34,953 8 100.0% 38,944 31,347 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 500 - - 500 188 312 37.6% 700 323 nancial assets nancial ts Economic classifi SubProgramme: 6.2: EMS TRAINING COLLEGES EMS 6.2: SubProgramme: Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offi 1,290 - - 1,290 1,136 154 88.1% 320 519 Operating leases Property payments Property and subsistence Travel and development Training Operating payments and facilities Venues Transfers and subsidies Transfers Households Social benefi Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipmentPayment for fi Total 2,058 - - 2,058 5,240 -3,182 254.6% 2,700 3,377 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

216 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------4 - -4 ------6 8,622 8,622 8,622 ------8,622 8,622 8,622 4,015 4,015 4,011 4,607 4,607 4,611 46.6% 46.6% 46.5% 8,500 8,500 8,500 1,931 1,931 1,895 77,924 77,924 77,924 86,546 ------77,924 - 77,924 77,924 64,661 86,546 64,661 64,661 13,263 68,676 13,263 13,263 83.0% 17,870 83.0% 153,630 83.0% 153,630 79.4% 215,316 153,630 215,316 162,130 215,316 217,247 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 6.3: BURSARIES 6.3: SubProgramme: Current payments Goods and services Bursaries: Employees Catering: Departmental activitiesCommunication (G&S) Legal services and subsidies Transfers Households Other transfers to households Total ------30 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

217 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 73 15 - - - - 73 15 113 - -40 15 154.8% 15 - 85 54 - 2,572 - - 2,572 2,317 255 90.1% 2,442 2,404 51,265 32,379 29,807 - 18,886 - - -5,000 -5,000 - -5,000 46,265 27,379 24,807 38,614 26,623 - 24,306 7,651 18,886 756 83.5% 501 11,991 97.2% 49,463 98.0% 6,895 30,249 41,024 27,807 63.5% 31,791 29,387 19,214 9,233 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 820 - - 820 328 492 40.0% 1,127 230 Economic classifi SubProgramme: 6.4: OTHER TRAINING OTHER 6.4: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees Minor assets Catering: Departmental activitiesCommunication (G&S)Consultants: Business and advisory servicesLaboratory servicesContractorsInventory: Food and food supplies 154 Inventory: Materials and suppliesInventory: Other suppliesConsumable supplies 30 250 Consumable: Stationery, 58 - printing and offi ------170 - 154 ------250 30 - - 58 - - - 156 - 154 8 17 - - - 170 94 22 - - 41 - 62.4% 10 - 54 26.7% 29.3% 367 1 -10 250 116 - 2 48 109 - 31.8% 151 - -2 - 40 36 54 - - - - 81 - - 3 1 - 2 Travel and subsistenceTravel and developmentTraining and facilitiesVenues and subsidiesTransfers 12,745 4,571 21,873 ------12,745 4,571 - 21,873 9,058 2,244 29,604 3,687 2,327 - -7,731 71.1% 49.1% 135.3% - 12,725 4,571 20,832 6,600 20,612 1,896 - - - 2 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

218 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 457 - - 457 1 456 0.2% 457 74 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 3 -3 - - 7 ts - - - - 6 -6 - - 290 Economic classifi SubProgramme: 6.4: OTHER TRAINING OTHER 6.4: SubProgramme: Departmental agencies and accountsDepartmental agencies (non- business entities)Higher education institutionsHouseholdsSocial benefi Payments for capital assets 2,061 Machinery and equipmentOther machinery and 19,812 equipment 19,812 Payment for fi 457 - Total 457 ------2,061 - - 19,812 19,812 9,786 - 73,595 19,812 457 19,812 - -7,725 457 474.8% - - 1 - - -5,000 1 1,963 100.0% 100.0% 456 68,595 6 18,869 1,453 18,869 456 0.2% 68,222 18,869 18,869 0.2% -6 373 457 457 99.5% - 74 70,752 74 - 61,716 290 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

219 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------579 - -579 - - 121 - 10 1 - - 1 - 1 - 1 - 43 - - 43 1 42 2.3% 13 709 306 - - 306 2,609 -2,303 852.6% 2,472 2,311 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 76,692 - - 76,692 81,035 -4,343 105.7% 68,040 63,501 218,845 - -5,700 213,145 208,732 4,413 97.9% 190,488 184,992 295,538 - -5,700 289,838 289,767 71 100.0% 258,529 248,492 Adjusted Appropriation Appropriation cation LAUNDRIES FOOD SUPPLY SERVICES FOOD SUPPLY ACCOUNT Communication (G&S)ContractorsAgency and support / services outsourced Fleet services (including government motor 809 transport) Inventory: Clothing material and accessories 371 - - - 809 - 449 371 360 14 55.5% 357 873 3.8% 567 664 33 Current paymentsemployeesof Compensation Salaries and wages 174,054 Social contributionsGoods and services 287,517 AdvertisingMinor assets 143,986 - Catering: Departmental 30,068 activities - 113,463 -5,700 - -5,700 168,354 - 281,817 - -5,700 162,379 457 - 284,106 138,286 5,975 - - 132,097 -2,289 - - 30,068 96.5% 113,463 100.8% 6,189 163,124 30,282 121,727 250,023 - 95.5% - 160,696 -8,264 244,801 -214 136,331 457 107.3% 100.7% 132,493 - 86,899 26,793 42 84,105 - 28,203 415 - 9.2% 642 - 197 - 137 Programme 7: HEALTH CARE SUPPORT SERVICES CARE SUPPORT HEALTH 7: Programme Sub Programme 1 2 3 MEDICINE TRADING Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

220 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 43 -43 - - 111 426 - 529 - - 426 - 83 529 343 267 19.5% 262 292 50.5% 117 469 343 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 7,413 2,863 - - - 7,413 - 5,005 2,863 2,408 2,705 67.5% 158 7,970 94.5% 2,751 2,108 1,192 27,230 - - 27,230 25,729 1,501 94.5% 22,150 21,926 295,538 - -5,700 289,838 289,767 71 100.0% 258,529 248,492 Adjusted Appropriation Appropriation ce supplies nancial ts 608 - - 608 613 -5 100.8% 536 830 Inventory: Food and food supplies Inventory: Fuel, oil and gasInventory: Materials and supplies Inventory: Medical supplies 2,083 Inventory: Other suppliesConsumable supplies Consumable: Stationery, 785 printing and offi - 1,032 Operating leases paymentsProperty 58,976 and subsistenceTravel - and developmentTraining - - Operating paymentsRental and hiring - 2,083 20,303 and subsidiesTransfers - - 35 78 Households - Social benefi 9,761 - Payments for capital 785 - 1,032 assets - 608 -7,678 - Machinery and equipment - - 58,976 equipmentTransport 1,226 - 2,598 468.6%Other machinery and equipment 59,246 - - - 7,413 Payment for fi - -441 -1,566 - 608 - 1,429 20,303 - -270 4,550 156.2% 251.7% 16,317 2,744 - - - 35 78 100.5% - - - 359 - 3,986 40,878 - 608 1,581 - - 3 - - 80.4% 39,148 419 -1,581 - 613 - 1,222 7,413 - 16,315 75 35 608 -1,222 4,550 5,005 - 15,311 - -5 3.8% 613 - 2,300 2,408 100.8% 210 - - 68 2,250 67.5% -5 65 536 - 100.8% 50.5% - 7,970 - 4 830 - 5,862 2,751 536 - - 1,559 830 8 assets Programme 7: HEALTH CARE SUPPORT SERVICES CARE SUPPORT HEALTH 7: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

221 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------137 388 - - 388 6 382 1.5% 392 41 23,713 62,079 - - - - 23,713 62,079 25,848 66,089 -2,135 -4,010 109.0% 106.5% 21,788 42,581 24,905 40,429 211,978 149,899 126,186 - - - -5,700 -5,700 206,278 -5,700 144,199 204,132 120,486 138,043 112,195 2,146 6,156 8,291 99.0% 95.7% 182,700 93.1% 140,119 181,696 118,331 141,267 116,362 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 309 - - 309 96 213 31.1% 249 205 Economic classifi SubProgramme: 7.1: LAUNDRIES 7.1: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Advertising Minor assets Catering: Departmental activitiesCommunication (G&S)ContractorsAgency and support / servicesoutsourced Fleet services (including government motor transport)Inventory: Clothing material and accessories 803 Inventory: Food and food supplies 306 Inventory: Fuel, oil and gasInventory: Materials and - 13 299 - suppliesInventory: Medical suppliesInventory: Other supplies - Consumable supplies 301 - - - - Consumable: Stationery, printing and offi - 625 - 803 - - 678 - - 30 41,930 306 - - 449 401 299 13 - - - - 2,609 - 354 - - - 14 -2,303 301 - - - 55.9% - - 852.6% 625 5,755 285 - - 678 13 41,930 868 30 2,472 - -5,454 438 4.7% 579 39,393 2,022 401 1912.0% 2,311 565 - 9 187 - -1,344 542 2,537 -579 829 83 298.2% 70.1% 13 93.9% 21 28 - 780 - 318 23,528 30.0% 208 708 - 20.7% 121 22,880 - 281 150 272 - 10 9 115 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

222 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 1,581 -1,581 - 210 - 35 - - 35 - 35 - 65 - 1,874 - - 1,874 1,756 118 93.7% 1,530 912 15,903 - - 15,903 11,833 4,070 74.4% 12,735 12,230 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 43 -43 - - 111 ts 443 - - 443 501 -58 113.1% 396 714 Economic classifi SubProgramme: 7.1: LAUNDRIES 7.1: SubProgramme: Operating leases payments Property and subsistence Travel and developmentTraining Operating paymentsRental and hiring and subsidiesTransfers Households 58 Social benefi Payments for capital assetsMachinery and equipment - 443 equipmentTransport - Other machinery and 6,424 - equipment Payment for fi 6,424 - - Total 443 - - - 4,550 - - - 58 - - - - 443 - - 6,424 - - 218,845 - - 6,424 501 1,222 4,056 58 443 4,550 4,056 -1,222 - 2,368 -58 501 2,300 2,368 -5,700 113.1% - 63.1% - 213,145 63.1% 2,250 -58 - 7,392 396 48 208,732 50.5% 113.1% 7,392 - 2,471 4,413 714 - 5,862 - 2,471 396 97.9% - 1,559 - 190,488 714 184,992 8 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

223 Appropriation Appropriation Virement Virement Final Funds Shifting of 30 - 25 - - 30 - 1 25 29 - 3.3% 25 - - 1 20 2 220 - - 220 171 49 77.7% 220 138 27,200 - - 27,200 25,720 1,480 94.6% 22,000 21,917 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies ts 165 - - 165 112 53 67.9% 140 116 SubProgramme: 7.2: FOOD SUPPLY SERVICES FOOD SUPPLY 7.2: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesSocial contributionsGoods and services 24,155 Minor assets 75,538 Communication (G&S)Contractors 17,800 - Agency and support / services outsourced 6,355 - 51,383 Inventory: Food and food supplies Inventory: Fuel, oil and gas - - Inventory: Materials and 6 - supplies - - 69 Inventory: Medical supplies 24,155 Inventory: Other supplies 75,538 - 1,782 71 Consumable supplies 24,336 - - Consumable: Stationery, - 79,974 - 17,800 printing and offi 160 -181 6,355 - 51,383 19,902 -4,436 - 354 - 100.7% 17,046 - 4,434 55,638 105.9% -2,102 - - 23,005 - 6 - -4,255 111.8% 1,921 67,322 69 - 19,429 1,782 108.3% - 63,105 18,000 69.8% 71 - - 36 4,006 44,317 16,131 - 5,005 160 -2,224 43,676 354 - 17,046 6 33 3,298 788 224.8% 19,853 576 52.2% 71 -628 - -2,807 600 -222 250 492.5% 116.5% - 1,964 162.7% 5 17,350 156 151 121 16,268 2 - 138 5 - Economic classifi Property paymentsProperty and developmentTraining and subsidiesTransfers HouseholdsSocial benefi 20 4,400 165 - - - 165 - - - - 4,400 20 165 4,484 - 112 3 -84 165 101.9% 53 17 112 67.9% 15.0% 3,580 53 3,081 140 20 67.9% 116 4 140 116 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

224 Appropriation Appropriation Virement Virement Final Funds Shifting of 989 - - 989 949 40 96.0% 578 280 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 SubProgramme: 7.2: FOOD SUPPLY SERVICES FOOD SUPPLY 7.2: SubProgramme: Payments for capital assetsMachinery and equipmentOther machinery and equipment Total 989 989 - - - 76,692 - 989 989 - 949 949 - 40 76,692 40 96.0% 81,035 96.0% 578 -4,343 578 105.7% 280 280 68,040 63,501 Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Actual Expenditure Expenditure Expenditure Expenditure Final Final Appropriation Appropriation Appropriation Appropriation nal nal 2017/18 2016/17 2017/18 2016/17 as % of fi as % of fi appropriation appropriation Variance Variance Expenditure Variance Variance Expenditure Actual Actual Expenditure Expenditure Expenditure Expenditure

225 Appropriation Appropriation Appropriation Appropriation Virement Virement Final Virement Virement Final Funds Funds Shifting of Shifting of R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 7,046 - - 7,046 1,739 5,307 24.7% 3,700 2,602 341,042 - - 341,042 317,227 23,815 93.0% 329,448 342,166 260,789 - - 260,789 214,807 45,982 82.4% 385,549 411,742 288,934 - - 288,934 264 246 24 688 91.5% 552,776 513,983 311,287 - - 311,287 335,462 -24,175 107.8% 473,890 421,724 Adjusted Adjusted 1,683,299 - - 1,683,299 1 607 777 75 522 95.5% 2,051,730 1,943,911 Appropriation Appropriation Appropriation Appropriation cation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 COMMUNITY HEALTH COMMUNITY HEALTH FACILITIES EMERGENCY MEDICAL RESCUE SERVICES SERVICES SERVICES SERVICES Economic classifi SubProgramme: 7.3: MEDICINE TRADING ACCOUNT TRADING MEDICINE 7.3: SubProgramme: paymentsCurrent Goods and servicesContractors Total MANAGEMENT FACILITIES HEALTH 8: Programme 1 1 Sub Programme 1 - 1 - 1 - - - - 1 - 1 - 1 - - 1 1 - 1 - 1 - - 1 1 - 1 - 1 - - 1 - - 2 3 DISTRICT HOSPITAL 4 PROVINCIAL HOSPITAL 5 CENTRAL HOSPITAL 6 OTHER FACILITIESEconomic classifi 474,201 - - 474,201 474 296 (95) 100.0% 306,367 251,694 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

226 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 15 -15 - - 1 111 - 615 500 - - 111 - - - - 615 111 500 7 - - 608 105 500 1.1% 8 1,670 - - - - R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 1,500 - - 1,500 398 1,102 26.5% - 155 Adjusted Appropriation Appropriation Current paymentsemployeesof Compensation Salaries and wagesSocial contributions 35,677 Goods and services 795,188 AdvertisingMinor assets 24,736 - Catering: Departmental 10,941 activities - 759,511 Communication (G&S)Computer services - Legal services - - Contractors - - Fleet services (including 333 8,491 35,677 government motor 176 795,188 transport) - Inventory: Clothing material 30,840 - 832,944 and accessories - - Inventory: Food and food - 24,736 - supplies - -37,756 10,941 4,837 759,511 Inventory: Fuel, oil and gas - 2,000 27,356 Inventory: Materials and 104.7%supplies 890 125 3,484 86.4% - - Inventory: Medical supplies - -2,620 - 834,462 Inventory: Other supplies (130 614) - - 38,680 7,457 - Consumable supplies 8,491 110.6% 977,771 333 3,000 117.2% - 176 22,946 31.8% 26,520 795,782 750 - - - 191 - 12,160 1,100 - 20,324 954,825 - 2 7,741 2,000 142 2,622 - - - 174 - 1,740 - 8.8% - 57.4% 7,024 1.1% 3,000 - 1,498 - 260 -7,024 - 317 - 1,959 1,997 87.0% 667 1,100 1 - - 1,041 - - 2,000 17 71 229 65.3% 2,016 - - 1,029 -229 350 - 6.5% - 18 1,726 - 350 - - 20 - - Programme 8: HEALTH FACILITIES MANAGEMENT FACILITIES HEALTH 8: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

227 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 9 -9 - - - 216 - - 216 25 191 11.6% 300 28 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 69,194 - - 69,194 71,227 -2,033 102.9% 112,504 30,682 888,111 818,917 - - - - 888,111 818,917 686 645 615 418 201 466 203 499 77.3% 1,217,268 75.2% 1,104,764 966,049 935,367 Adjusted 1,683,299 - - 1,683,299 1 607 777 75 522 95.5% 2,051,730 1,943,911 Appropriation Appropriation xed ce supplies nancial ts - - - - 158 -158 - - 91 Consumable: Stationery, Consumable: Stationery, printing and offi Operating leases paymentsProperty and subsistenceTravel and developmentTraining Operating payments and facilitiesVenues 36,530 703,329 and subsidiesTransfers 210 400 HouseholdsSocial benefi 1,000 - Payments for capital - assets - - Buildings and other fi - - structures Buildings - - - Machinery and equipmentOther machinery and - - - 703,329 - equipment 36,530 - Payment for fi 69,194 - 765,146 210 400 41 954 - -61,817 - 1,000 - 818,917 (5 424) - 352 397 108.8% 313 114.8% - - 748,341 - -142 - - 3 31,525 927,438 687 167.6% 158 69,194 - 99.3% 19,162 - - 31.3% 2,200 71,227 -158 818,917 5,459 158 - -2,033 200 615 418 - 1,943 - 102.9% -158 203 499 - 112,504 96 75.2% - 1,000 - 30,682 1,104,764 935,367 91 - - 91 assets Programme 8: HEALTH FACILITIES MANAGEMENT FACILITIES HEALTH 8: Programme Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

228 Appropriation Appropriation Virement Virement Final Funds Shifting of 255,412 - - 255,412 223,316 32,096 87.4% 212,440 192,050 Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 8.1: COMMUNITY HEALTH FACILITIES COMMUNITY HEALTH 8.1: SubProgramme: Current paymentsGoods and servicesMinor assetsInventory: Medical suppliesInventory: Other suppliesConsumable supplies 73,930 paymentsProperty 73,930 Payments for capital assetsBuildings and other fi - structures - Buildings - 267,112 - Machinery and equipment - Other machinery and equipment - 73,930 - Total - - - 11,700 - 11,700 - 73,930 - - - 73,930 85,000 - - 255,412 - - 85,000 - -11,070 267,112 - - - -11,070 232,234 - 115.0% - 341,042 73,930 - - - 115.0% 889 34,878 - 117,008 83,521 11,700 229 11,700 117,008 150,116 - - 337 -889 86.9% -9,591 150,116 8,918 17 8,918 -229 255,412 212,440 113.0% -337 2,782 223,316 - - 2,782 192,050 -17 117,008 - 341,042 32,096 76.2% 76.2% 150,116 - 317,234 - 87.4% - - 23,808 212,440 - - - 192,050 93.0% - - 329,448 - - 342,166 - Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

229 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of - - - - 461 -461 - 500 - Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi Buildings Total - 7,046 - - - - 7,046 - 1,733 461 5,313 -461 24.6% 3,700 - 2,602 500 - SubProgramme: 8.2: EMERGENCY MEDICAL RESCUE SERVICES 8.2: SubProgramme: Current paymentsCompensation of employeesSalaries and wagesGoods and services paymentsProperty Payments for capital assets 7,046 - Buildings and other fi structures 7,046 - - - 7,046 ------7,046 - - - - - 1,272 7,046 7,046 - 5,774 - 1,278 - 1,278 18.1% 5,768 - 461 5,768 3,200 18.1% 18.1% -461 2,602 - - 3,200 3,200 - 2,601 - - 2,601 500 1 - - 1 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal 2017/18 2016/17 as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

230 Appropriation Appropriation Virement Virement Final Funds Shifting of ------47 47 -47 2 -47 -2 ------98,239 98,239 - - - 98,239 - 86,512 98,239 11,727 86,465 88.1% 11,774 140,864 88.0% 145,489 140,864 145,489 260,789 - - 260,789 214,807 45,982 82.4% 385,549 411,742 Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 SubProgramme: 8.3: DISTRICT HOSPITAL SERVICES DISTRICT HOSPITAL 8.3: SubProgramme: Current payments Compensation of employees Salaries and wages Goods and services Minor assets Fleet services (including government motor transport)Inventory: Food and food suppliesInventory: Medical suppliesConsumable supplies paymentsProperty - and developmentTraining Payments for capital assetsBuildings and other fi structures - - Buildings 162,550 Machinery and equipment 98,239 - Other machinery and - equipment - - Total - - 11,700 - - - - 150,850 - - - 150,850 - - - 162,550 - 11,700 - - - 7 98,239 128,295 - - - 85,985 - 453 34,255 - - - -7 11,700 12,254 - 78.9% 150,850 -453 3 15,268 150,850 15 87.5% - 244,685 113,027 - -3,568 113,027 266,253 140,864 -3 - 11,700 37,823 -15 130.5% 37,823 - 145,031 - 15,268 74.9% 74.9% - - -3,568 244,685 - - - 244,685 - 266,266 130.5% 266,266 - - -13 - - - - 1 457 -13 Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

231 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------28 1,500 - - 1,500 397 1,103 26.5% - 153 71,589 43,739 - - - 71,589 - 47 770 43,739 23 819 46,094 66.7% -2,355 278,124 105.4% 253,035 109,004 30,209 Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies Economic classifi SubProgramme: 8.4: PROVINCIAL HOSPITAL SERVICES HOSPITAL PROVINCIAL 8.4: SubProgramme: Current paymentsGoods and servicesMinor assetsCommunication (G&S)Computer servicesContractors 173,606 Inventory: Materials and 173,606 supplies Inventory: Medical suppliesConsumable supplies - - Consumable: Stationery, 8,000 - printing and offi paymentsProperty - 3,000 and developmentTraining - Payments for capital assets - - - Buildings and other fi 1,000 - 173,606 structures - Buildings - 173,606 115,328 170,382 Machinery and equipment 160,106 - - Other machinery and 170,382 - - equipment - 3,224 Total - - - 8,000 3,224 43,739 - - 98.1% - - 3,000 - 98.1% 363 - 165,648 - 71,589 - 1,000 - 165,648 2 617 230,739 115,328 - 7,637 - 160,106 230,739 - 2,383 93 864 40 - 288,934 168,761 - 4.5% -2 202 - 20.6% 21 464 43,739 -8,655 960 - 100 - - -202 - 105.4% 46,094 81.4% - 350 4.0% 71,589 1,925 164,739 - -2,355 387,128 - - 1,726 - 47 770 226,414 283,244 105.4% - 288,934 - - 23 819 109,004 264 246 - - - 16 30,209 66.7% 18 24 688 - 278,124 459 91.5% 253,035 552,776 459 513,983 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

232 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of ------49 1 -49 ------205,751 205,751 - - - - 205,751 205,751 237,936 237,936 311,287 -32,185 -32,185 115.6% 115.6% - 226,466 226,466 311,677 311,677 - 311,287 335,462 -24,175 107.8% 473,890 421,724 Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Economic classifi SubProgramme: 8.5: CENTRAL HOSPITAL SERVICES CENTRAL HOSPITAL 8.5: SubProgramme: Current payments Goods and services Contractors Inventory: Fuel, oil and gas Inventory: Materials and supplies paymentsProperty Payments for capital assetsBuildings and other fi structuresBuildings 105,536 Machinery and equipmentOther machinery and 205,751 equipment Total - - - - 105,536 - 105,536 - - 105,536 - - 205,751 - 97,526 - 237,885 - - 8,010 - -32,134 - - 105,536 92.4% - 115.6% 105,536 - 97,526 247,424 226,466 97,526 - 110,047 8,010 1 311,677 - 8,010 92.4% - 92.4% 247,424 - 247,424 110,046 110,046 ------1 - 1 Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

233 2017/18 2016/17 Appropriation Appropriation Virement Virement Final - - - 7,024 -7,024 - - - Funds Shifting of ------1,000 - 333 491 111 176 ------333 - 491 111 191 176 48 210 400 - 142 - 443 - 57.4% 111 - 176 9.8% 317 - - 1,398 - - 210 - 105 400 72 667 352 397 8 17 -142 3 167.6% 99.3% 2,200 5,000 200 1,027 2,000 - - 2,000 1,000 1,489 511 - 74.5% - 2,000 1,000 2,016 313 687 31.3% - 96 35,677 24,736 10,941 ------35,677 24,736 10,941 30,793 27,309 3,484 4,884 -2,573 86.3% 7,457 36,530 110.4% 38,680 31.8% 26,520 - 22,945 12,160 20,323 2,622 - 36,530 41 954 (5 424) 114.8% 31,525 19,162 236,616 - 200,939 - - 236,616 332 839 - (96 223) 200,939 309 070 140.7% (108 131) 181,276 158,257 137,148 153.8% 142,596 - 114,203 - 158,257 187,716 -29,459 118.6% 96,064 91,599 Adjusted Appropriation Appropriation cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 ce supplies 216 - - 216 25 191 11.6% 300 - SubProgramme: 8.6: OTHER FACILITIES OTHER 8.6: SubProgramme: Current payments Compensation of employees Salaries and wages Social contributions Goods and services Advertising Minor assets Catering: Departmental activities Communication (G&S) Legal services Contractors Fleet services (including government motor transport)Inventory: Clothing material and accessoriessuppliesand Materials Inventory: Consumable supplies 615 Consumable: Stationery, printing and offi payments Property - and subsistence Travel and development Training 100 Operating payments 500 - and facilities Venues - - - 615 - - - - - 100 500 615 - 11 - - - 89 1,670 500 11.0% - - - 350 - - 4 2 - Operating leases Economic classifi Department Of Health Vote 4 APPROPRIATION STATEMENT for the year ended 31 March 2018 Actual Expenditure Expenditure Final Appropriation Appropriation nal as % of fi appropriation Variance Variance Expenditure Actual Expenditure Expenditure

234 2017/18 2016/17 Appropriation Appropriation Virement Virement Final Funds Shifting of 235,530 - - 235,530 133 318 102 212 56.6% 121,591 113,970 Adjusted Appropriation Appropriation xed cation R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 nancial assets - - - - 9 -9 - - - ts - - - - 158 -158 - - 91 xed structures ------SubProgramme: 8.6: OTHER FACILITIES OTHER 8.6: SubProgramme: and subsidiesTransfers HouseholdsSocial benefi Payments for capital assetsBuildings and other fi structures Buildings - 237,585 Other fi Machinery and equipment equipmentTransport - - Other machinery and equipment - Payment for fi Total 2,055 2,055 - - 235,530 - 237,585 - - - - 134 265 - - 103 320 - - - 158 474,201 - - 56.5% 2,055 2,055 -158 235,530 - 125,091 - 158 947 133 318 947 114,456 - - 102 212 -158 1,108 1,108 - 56.6% 46.1% 474,201 46.1% - - 121,591 474 295 3,500 3,500 113,970 91 - - (94) 486 486 100.0% 91 - 306,367 251,694 - - Economic classifi Department Of Health Vote 4 NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2018

1. Detail of transfers and subsidies as per Appropriation Act (after Virement): Detail of these transactions can be viewed in the note on Transfers and subsidies, disclosure notes and Annexure 1 (A-H) to the Annual Financial Statements.

2. Detail of specifi cally and exclusively appropriated amounts voted (after Virement): Detail of these transactions can be viewed in note 1 (Annual Appropriation) to the Annual Financial Statements.

3. Detail on payments for fi nancial assets Detail of these transactions per Programme can be viewed in the note on Payments for fi nancial assets to the Annual Financial Statements.

4. Explanations of material variances from Amounts Voted (after virement):

Variance as Final Actual Variance a % of Final 4.1 Per Programme Appropriation Expenditure R’000 Appropriation Administration 1 085 267 1 085 177 90 0% District Health Services 13 712 101 13 683 513 28 588 0.2% Emergency Medical Services 1 268 154 1 219 274 48 880 3.9% Provincial Hospital Services 7 892 663 7 892 277 386 0.0% Central Hospital Services 15 333 041 15 316 687 16 354 0.1% Health Sciences and Training 928 471 918 987 9 484 1.0% Health Care Support Services 289 838 289 767 71 0.0% 235 Health Facilities Management 1 683 299 1 607 777 75 522 4.5% 42 192 834 42 013 459 179 375 0.4% The overall expenditure of the department is at 99.6%. Department Of Health Vote 4 NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2018

Variance as a Final Actual % of Final 4.2 Per economic classifi cation Appropriation Expenditure Variance Appropriation R’000 R’000 R’000 R’000 Current payments Compensation of employees 24 965 403 25 085 331 (119 928) 0% Goods and services 13 448 448 13 583 391 (134 942) (1%) Interest and rent on land - 628 (628) -

Transfers and subsidies Provinces and municipalities 739 104 739 104 - 0% Departmental agencies and accounts 19 812 19 812 - 0% Higher education institutions 12 061 9 786 2 275 19% Non-profi t institutions 698 608 556 250 142 358 20% Households 185 919 533 942 (348 023) -187%

Payments for capital assets Buildings and other fi xed structures 818 917 615 434 203 483 25% Machinery and equipment 1 304 562 860 679 443 883 34% Payments for fi nancial assets - 9 103 (9 103) -100% 42 192 834 42 013 459 179 375 Compensation of Employees – Overspending on this Item is due to increased headcount and funding gap on occupational specifi c dispensation for health Professionals.

236 Goods and Services - A reclassifi cation of amounts spent on mental health contracts from transfers to goods and services resulted in an over-expenditure on this item. The amount was budgeted for under trasnfers and subsidies but expenditure was reclassifi ed as goods and services after audit.

Non-profi t institutions - an amount of R 181 071 702 was budgeted for under this item, however the expenditure was reclassifi ed to goods and services after audit, resulting in an under-expenditure

Households - Overspending has been incurred due to reclassifi cation of claims e.g. medico legal claims against the department previously clasifi ed under goods and services to Household expenditure.

Machinery and Equipment – Underspending is due to delays in fi nalization of equipment specifi cations, tender process timelines and shipment of medical equipment. Department Of Health Vote 4 NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2018

Variance as Final Actual a % of Final 4.3 Per conditional grant Appropriation Expenditure Variance Appropriation R’000 R’000 R’000 R’000

Comprehensive HIV and AIDS Grant 3 744 381 3 744 381 - 0% National Tertiary Service Grant 4 110 484 4 110 049 435 0% Health Professionals Training and Development 919 431 904 053 15 378 2% EPWP Integrated Grant for Provinces 2 000 1 691 309 15% Health Facility Revitalization 976 828 839 444 137 384 14% Social Sector EPWP Incentive Grant for 2 663 2 611 52 2% Provinces 9 755 787 9 602 229 153 558 2%

A rollover was requested for Health Professionals training and Development Grant. an amount of R76 milion was spend under the Health Facility Revitilisation grant and was later moved to the equitable share, resulting in an expenditure on this grant.

237 Department Of Health Vote 4 STATEMENT OF FINANCIAL PERFORMANCE for the year ended 31 March 2018

Note 2017/18 2016/17 R’000 R’000 REVENUE Annual appropriation 1 42 192 834 37 656 857 Departmental revenue 2 546 916 535 254

TOTAL REVENUE 42 739 750 38 192 111

EXPENDITURE Current expenditure Compensation of employees 3 25 085 331 23 289 574 Goods and services 4 13 583 391 11 078 374 Interest and rent on land 5 628 -

Total current expenditure 38 669 350 34 367 948

Transfers and subsidies Transfers and subsidies 7 1 858 898 1 478 853

Total transfers and subsidies 1 858 898 1 478 853

Expenditure for capital assets 238 Tangible assets 8 1 476 108 1 582 158

Total expenditure for capital assets 1 476 108 1 582 158

Payments for fi nancial assets 6 9 103 11 108

TOTAL EXPENDITURE 42 013 459 37 440 067

SURPLUS FOR THE YEAR 726 291 752 044 Reconciliation of Net Surplus for the year Voted funds 179 375 216 790 Annual appropriation 25 817 111 409 Conditional grants 153 558 105 381 Departmental revenue 2 546 916 535 254 SURPLUS FOR THE YEAR 726 291 752 044 Department Of Health Vote 4 STATEMENT OF FINANCIAL POSITION as at 31 March 2018

Note 2017/18 2016/17 R’000 R’000

ASSETS Current assets 438 662 466 932

Cash and cash equivalents 10 283 773 319 389 Prepayments and advances 11 - 45 Receivables 12 154 889 147 498

Non-current assets 115 654 94 943

Investments 13 54 000 54 000 Receivables 12 61 654 40 943

TOTAL ASSETS 554 316 561 875

LIABILITIES Current Liabilities 449 380 473 129 Departmental revenue to be surrendered to the Revenue Fund 15 57 864 99 643 Bank related items 16 - 1 887 Payables 17 391 516 371 599 239

TOTAL LIABILITIES 449 380 473 129

NET ASSETS 104 936 88 746

Represented by: Capitalisation reserve 54 000 54 000 Recoverable revenue 50 936 34 746

TOTAL 104 936 88 746 Department Of Health Vote 4 STATEMENT OF CHANGES IN NET ASSETS for the year ended 31 March 2018

Note 2017/18 2016/17 R’000 R’000

Capitalisation Reserves Opening balance 54 000 54 000 Closing balance 54 000 54 000

Recoverable revenue Opening balance 34 746 23 548 Transfers: 16 190 11 198

Debts recovered (included in departmental receipts) 1 694 (15 747) Debts raised 14 496 26 945

Closing balance 50 936 34 746

TOTAL 104 936 88 746

The difference of R50 377 million between the capital amount as disclosed by the Medical Supplies and the Depot as refl ected in the fi nancial statements of the department is as a result of a cash injection to increase stock holdings.The transaction was funded from the depot’s own proceeds. The investment of R54 million is the initial capital outlay to the depot, no additional funds were transferred by the department 240 Department Of Health Vote 4 CASH FLOW STATEMENT for the year ended 31 March 2018

Note 2017/18 2016/17 R’000 R’000

CASH FLOW FROM OPERATING ACTIVITIES Receipts 42 739 750 38 192 111

Annual appropriated funds received 1.1 42 192 834 37 656 857 Departmental revenue received 2 545 942 533 505 Interest received 2.3 974 1 749

Net (increase)/decrease in working capital (8 140) 1 401 759 Surrendered to Revenue Fund (768 070) (1 548 724) Current payments (38 668 722) (34 367 948) Interest paid 5 (628) - Payments for fi nancial assets (9 103) (11 108) Transfers and subsidies paid (1 858 898) (1 478 853)

Net cash fl ow available from operating activities 18 1 426 189 2 187 237

CASH FLOWS FROM INVESTING ACTIVITIES Payments for capital assets 8 (1 476 108) (1 582 158) Net cash fl ows from investing activities (1 476 108) (1 582 158)

CASH FLOWS FROM FINANCING ACTIVITIES 241 Increase in net assets 16 190 11 198 Net cash fl ows from fi nancing activities 16 190 11 198

Net (decrease) in cash and cash equivalents (33 729) 616 277

Cash and cash equivalents (overdraft) at beginning of period 317 502 (298 775)

Cash and cash equivalents at end of period 19 283 773 317 502 Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

Summary of signifi cant accounting policies The fi nancial 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 fi nancial 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 fi nancial 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 fi nancial 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 fi nancial statements have been prepared in accordance with the Modifi ed Cash Standard.

2 Going concern The fi nancial 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 fi nancial fi gures have been rounded to the nearest one thousand Rand 242 (R’000). 5 Foreign currency translation Cash fl ows arising from foreign currency transactions are translated into South African Rands using the spot exchange rates prevailing at the date of payment / receipt.

6 Comparative information

6.1 Prior period comparative information

Prior period comparative information has been presented in the current year’s fi nancial statements. Where necessary fi gures included in the prior period fi nancial statements have been reclassifi ed to ensure that the format in which the information is presented is consistent with the format of the current year’s fi nancial statements.

6.2 Current year comparison with budget

A comparison between the approved, fi nal budget and actual amounts for each Programme and economic classifi cation is included in the appropriation statement. 7 Revenue

7.1 Appropriated funds

Appropriated funds comprises of departmental allocations as well as direct charges against the revenue fund (i.e. statutory appropriation).

Appropriated funds are recognised in the statement of fi nancial performance on the date the appropriation becomes effective. Adjustments made in terms of the adjustments budget process are recognised in the statement of fi nancial performance on the date the adjustments become effective. Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

7.2 Departmental revenue

Departmental revenue is recognised in the statement of fi nancial performance when received and is subsequently paid into the relevant revenue fund, unless stated otherwise.

Any amount owing to the relevant revenue fund at the reporting date is recognised as a payable in the statement of fi nancial position. 7.3 Accrued departmental revenue

Accruals in respect of departmental revenue (excluding tax revenue) are recorded in the notes to the fi nancial statements when: • it is probable that the economic benefi ts or service potential associated with the transaction will fl ow 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 8 Expenditure 8.1 Compensation of employees 8.1.1 Salaries and wages

Salaries and wages are recognised in the statement of fi nancial performance on the date of payment. 8.1.2 Social contributions

Social contributions made by the department in respect of current employees are recognised in the statement of fi nancial performance on the date of payment. 243 Social contributions made by the department in respect of ex-employees are classifi ed as transfers to households in the statement of fi nancial performance on the date of payment. 8.2 Other expenditure

Other expenditure (such as goods and services, transfers and subsidies and payments for capital assets) is recognised in the statement of fi nancial performance on the date of payment. The expense is classifi ed as a capital expense if the total consideration paid is more than the capitalisation threshold. 8.3 Accruals and payables not recognised

Accruals and payables not recognised are recorded in the notes to the fi nancial statements at cost at the reporting date. 8.4 Leases 8.4.1 Operating leases

Operating lease payments made during the reporting period are recognised as current expenditure in the statement of fi nancial performance on the date of payment.

The operating lease commitments are recorded in the notes to the fi nancial statements. Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

8.4.2 Finance leases

Finance lease payments made during the reporting period are recognised as capital expenditure in the statement of fi nancial performance on the date of payment.

The fi nance lease commitments are recorded in the notes to the fi nancial statements and are not apportioned between the capital and interest portions.

Finance lease assets acquired at the end of the lease term are recorded and measured at the lower of: • cost, being the fair value of the asset; or • the sum of the minimum lease payments made, including any payments made to acquire ownership at the end of the lease term, excluding interest. 9 Cash and cash equivalents Cash and cash equivalents are stated at cost in the statement of fi nancial position.

Bank overdrafts are shown separately on the face of the statement of fi nancial position as a current liability.

For the purposes of the cash fl ow statement, cash and cash equivalents comprise cash on hand, deposits held, other short-term highly liquid investments and bank overdrafts. 10 Prepayments and advances Prepayments and advances are recognised in the statement of fi nancial position when the department receives or disburses the cash.

Prepayments and advances are initially and subsequently measured at cost. 11 Loans and receivables 244 Loans and receivables are recognised in the statement of fi nancial position at cost plus accrued interest, where interest is charged, less amounts already settled or written-off. Write-offs are made according to the department’s write-off policy. 12 Investments Investments are recognised in the statement of fi nancial position at cost. 13 Financial assets 13.1 Financial assets (not covered elsewhere)

A fi nancial asset is recognised initially at its cost plus transaction costs that are directly attributable to the acquisition or issue of the fi nancial asset.

At the reporting date, a department shall measure its fi nancial 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. 13.2 Impairment of fi nancial assets

Where there is an indication of impairment of a fi nancial asset, an estimation of the reduction in the recorded carrying value, to refl ect the best estimate of the amount of the future economic benefi ts expected to be received from that asset, is recorded in the notes to the fi nancial statements. 14 Payables Payables recognised in the statement of fi nancial position are recognised at cost. 15 Capital Assets Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

15.1 Immovable capital assets

Immovable assets refl ected in the asset register of the department are recorded in the notes to the fi nancial 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 refl ected in the assets register is provided in the notes to fi nancial statements. 15.2 Movable capital assets

Movable capital assets are initially recorded in the notes to the fi nancial 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. 15.3 Intangible assets 245 Intangible assets are initially recorded in the notes to the fi nancial 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 fi nancial 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. Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

15.4 Project Costs: Work-in-progress

Expenditure of a capital nature is initially recognised in the statement of fi nancial 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. 16 Provisions and Contingents 16.1 Provisions

Provisions are recorded in the notes to the fi nancial statements when there is a present legal or constructive obligation to forfeit economic benefi ts as a result of events in the past and it is probable that an outfl ow of resources embodying economic benefi ts 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.

16.2 Contingent liabilities

Contingent liabilities are recorded in the notes to the fi nancial statements when there is a possible obligation that arises from past events, and whose existence will be confi rmed 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 outfl ow of resources will be required to settle the obligation or the amount of the obligation cannot be 246 measured reliably.

16.3 Contingent assets

Contingent assets are recorded in the notes to the fi nancial statements when a possible asset arises from past events, and whose existence will be confi rmed by the occurrence or non-occurrence of one or more uncertain future events not within the control of the department. 16.4 Commitments

Commitments (other than for transfers and subsidies) are recorded at cost in the notes to the fi nancial 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 outfl ow of cash. 17 Unauthorised expenditure Unauthorised expenditure is recognised in the statement of fi nancial 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 fi nancial performance; or • transferred to receivables for recovery.

Unauthorised expenditure is measured at the amount of the confi rmed unauthorised expenditure. Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

18 Fruitless and wasteful expenditure Fruitless and wasteful expenditure is recorded in the notes to the fi nancial statements when confi rmed. 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 fi nancial 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. 19 Irregular expenditure Irregular expenditure is recorded in the notes to the fi nancial statements when confi rmed. 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. 20 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-specifi c 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. 247 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-specifi c 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. 21 Events after the reporting date Events after the reporting date that are classifi ed as adjusting events have been accounted for in the fi nancial statements. The events after the reporting date that are classifi ed as non-adjusting events after the reporting date have been disclosed in the notes to the fi nancial statements. 22 Capitalisation reserve The capitalisation reserve comprises of fi nancial assets and/or liabilities originating in a prior reporting period but which are recognised in the statement of fi nancial position for the fi rst time in the current reporting period. Amounts are recognised in the capitalisation reserves when identifi ed 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. 26 Recoverable revenue Amounts are recognised as recoverable revenue when a payment made in a previous fi nancial year becomes recoverable from a debtor in the current fi nancial year. Amounts are either transferred to the National/Provincial Revenue Fund when recovered or are transferred to the statement of fi nancial performance when written-off. Department Of Health Vote 4 ACCOUNTING POLICIES for the year ended 31 March 2018

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 fi nancial 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 fi nancial statements. 24 Inventories At the date of acquisition, inventories are recognised at cost in the statement of fi nancial 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 benefi ts The value of each major class of employee benefi t obligation (accruals, payables not recognised and provisions) is disclosed in the Employee benefi ts note.

248

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

1. Annual Appropriation 1.1 Annual appropriated funds received

Included are funds appropriated in terms of the Appropriation Act (and the Adjustments Appropriation Act/ Voted funds) for Provincial Departments:

2017/2018 2016/2017 Final Actual Funds Final Appropriation Appropriation Received Appropriation received R’000 R’000 R’000 R’000

1. Administration 1 085 267 1 085 267 851 940 851 940 2.District Health Services 13 712 101 13 712 101 11 995 850 11 995 850 3. Emergency Medical Services 1 268 154 1 268 154 1 102 221 1 102 221 4. Provincial Hospital Services 7 892 663 7 892 663 6 953 066 6 953 066 5. Central Hospitals 15 333 041 15 333 041 13 389 397 13 389 397 6. Health Science and Training 928 471 928 471 1 054 124 1 054 124 7. Health Care Support Services 289 838 289 838 258 529 258 529 8. Health Facilities Management 1 683 299 1 683 299 2 051 730 2 051 730 Total 42 192 834 42 192 834 37 656 857 37 656 857

1.2 Conditional grants

Note 2017/18 2016/17 R’000 R’000

Total grants received 34 9 755 788 8 658 260 249 2. Departmental revenue Note 2017/18 2016/17 R’000 R’000 Sales of goods and services other than capital assets 2.1 503 424 496 653 Fines, penalties and forfeits 2.2 48 38 Interest, dividends and rent on land 2.3 974 1 749 Transactions in fi nancial assets and liabilities 2.4 42 470 36 814 Total revenue collected 546 916 535 254 Departmental revenue collected 546 916 535 254

Fines and penalties are charged in respect of illegal parking at facilities of the department.

2.1 Sales of goods and services other than capital assets

2017/18 2016/17 R’000 R’000 Sales of goods and services produced by the department 501 207 495 429 Sales by market establishment 28 099 40 555 Administrative fees 5 077 4 589 Other sales 468 031 450 285 Sales of scrap, waste and other used current goods 2 217 1 224 Total 503 424 496 653

Other sales refers to sale of crutches, access cards, boarding of staff, advertisements, immunisation fees, patient transport, special events for EMS.

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

2.2 Fines, penalties and forfeits

2017/18 2016/17 R’000 R’000 Fines 48 38 Total 48 38

2.3 Interest, dividends and rent on land

2017/18 2016/17 R’000 R’000 Interest 974 1 749 Total 974 1 749

2.4 Transactions in fi nancial assets and liabilities

2017/18 2016/17 R’000 R’000 Receivables 26 550 28 061 Other Receipts including Recoverable Revenue 15 920 8 753 Total 42 470 36 814

3. Compensation of employees 3.1 Salaries and Wages

Note 2017/18 2016/17 R’000 R’000 250 Basic salary 16 327 543 14 963 494 Performance award 16 614 335 045 Service Based 24 106 23 256 Compensative/circumstantial 2 362 404 2 168 333 Periodic payments 252 657 219 693 Other non-pensionable allowances 3 129 957 2 870 695 Total 22 113 281 20 580 516

Service based refers to long service awards. Other Non-Pensionable Allowances represents amongst others service bonus and housing allowances. The amount disclosed under Compensative/ circumstantial represents overtime paid to Health Professionals. Periodic payments refer to payments made to retired doctors, session doctors and employees being paid a once off salary related payment.

3.2 Social contributions

Note 2017/18 2016/17 R’000 R’000 Employer contributions Pension 1 940 728 1 784 993 Medical 1 025 907 918 831 UIF 157 253 Bargaining council 5 258 4 976 Insurance -5 Total 2 972 050 2 709 058

Total compensation of employees 25 085 331 23 289 574

Average number of employees 67 950 68 073

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

4. Goods and services Note 2017/18 2016/17 R’000 R’000 Administrative fees 4 212 4 857 Advertising 2 153 3 039 Minor assets 4.1 32 318 35 472 Bursaries (employees) 4 067 1 894 Catering 2 600 2 549 Communication 74 379 88 351 Computer services 4.2 264 615 207 224 Consultants: Business and advisory services 370 900 66 848 Laboratory services 1 535 120 875 028 Legal services 314 226 748 165 Contractors 536 466 485 534 Agency and support / outsourced services 255 725 216 912 Audit cost – external 4.3 20 731 18 518 Fleet services 235 509 107 453 Inventory 4.4 7 158 435 5 627 047 Consumables 4.5 604 999 543 495 Operating leases 143 780 93 541 Property payments 4.6 1 965 009 1 895 305 Rental and hiring 984 100 Transport provided as part of the departmental activities 4 876 8 617 Travel and subsistence 4.7 22 104 25 585 251 Venues and facilities 1 458 2 297 Training and development 23 389 16 003 Other operating expenditure 4.8 5 336 4 540 Total 13 583 391 11 078 374

Other operating expenditure relates to courier and laundry services. Property Payments relates to the maintenance and utility payments for health facilities. The item Inventory relates to purchase of medication and medical supplies. Consumables represent laboratory consumables. Agency and support / outsourced services represent amongst others waste removal, payments to nursing agencies and security services. Legal Services represent legal costs paid to the state attorney. Medico legal claims against the department were reclassifi ed to Household expenditure. The increase in the comparative on consultants: business and advisory services, laboratory services and fl eet services is as a result of invoices not paid in the prior year. Clinix and Life Esidimeni reclassifi ed as goods and services, not transfer payments.

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

4.2 M inor assets

Note 2017/18 2016/17 4 R’000 R’000 Tangible assets Machinery and equipment 32 318 35 472 Total 32 318 35 472

4.2 Computer services

Note 2017/18 2016/17 4 R’000 R’000 External computer service providers 264 615 207 224 Total 264 615 207 224

External Computer Service Providers include software licences for operating systems and specialized computer services.

4.3 Audit cost – External

Note 2017/18 2016/17 4 R’000 R’000 Regularity audits 20 731 18 518 Total 20 731 18 518

4.4 I nventory

Note 2017/18 2016/17 252 4 R’000 R’000 Clothing material and accessories 3 918 13 953 Food and food supplies 338 722 265 344 Fuel, oil and gas 220 779 175 183 Learning, teaching and support material 814 1 476 Materials and supplies 37 565 38 986 Medical supplies 2 618 205 2 030 341 Medicine 3 826 093 3 101 764 Other supplies 112 338 - Total 7 158 434 5 627 047

Other supplies consist of toiletries, plastics, paper and related items.

4.5 Consumables

Consumable supplies 452 908 436 149 Uniform and clothing 109 733 92 315 Household supplies 273 960 303 842 Building material and supplies 24 900 - Communication accessories 1 078 321 IT consumables 8 899 13 549 Other consumables 34 338 26 122 Stationery, printing and offi ce supplies 152 091 107 346 Total 604 999 543 495

Included in the item for household supplies is linen, groceries and cleaning detergents. Other consumables consist of fuel supplies, gas supplies, laboratory consumables and medical kits.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

4.6 Property payments

Note 2017/18 2016/17 4 R’000 R’000 Municipal services 518 227 24 825 Property maintenance and repairs 778 209 930 405 Other 668 573 940 075 Total 1 965 009 1 895 305

The amount disclosed under other includes security services, cleaning and payments of water and electricity.

4.7 Travel and subsistence

Note 2017/18 2016/17 4 R’000 R’000 Local 13 521 23 768 Foreign 8 583 1 817 Total 22 104 25 585

4.8 Other operating expenditure

Note 2017/18 2016/17 4 R’000 R’000 Professional bodies, membership and subscription fees 210 555 Resettlement costs 1 227 2 014 Other 3 899 1 971 253 Total 5 336 4 540

Expenditure disclosed under Other represents courier and laundry services.

5. Interest and rent on land Note 2017/18 2016/17 R’000 R’000 Interest paid 628 - Total 628 -

Interest paid relates to interest paid on the Telkom account.

6. Payments for fi nancial assets Note 2017/18 2016/17 R’000 R’000 Ex-employees debts written off 6.1 9 103 11 108 Total 9 103 11 108

6.1 Recoverable Revenue Written off

Other debt written off Ex-employee debts written off 9 103 11 108 Total 9 103 11 108 Total debt written off 9 103 11 108

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

7. Transfers and subsidies Note 2017/18 2016/17 R’000 R’000 Provinces and municipalities 35 739 108 675 326 Departmental agencies and accounts Annex 1B 19 812 18 869 Higher education institutions Annex 1C 9 786 1 454 Non-profi t institutions Annex 1D 556 250 465 843 Households Annex 1E 533 942 317 361 Total 1 858 898 1 478 853

The increase in the amount disclosed under households is as a result of reclassifi cation of Medico Legal payments from Goods and Services to Transfers and Subsidies.

8. Expenditure for capital assets Note 2017/18 2016/17 R’000 R’000 Tangible assets 1 476 108 1 582 158 Buildings and other fi xed structures 33 615 431 935 367 Machinery and equipment 31 860 677 646 791 Total 1 476 108 1 582 158

8.1 Analysis of funds utilised to acquire capital assets – 2017/18

Voted funds Aid assistance Total 254 R’000 R’000 R’000 Tangible assets 1 476 108 1 476 108 Buildings and other fi xed structures 615 431 - 615 431 Machinery and equipment 860 677 - 860 677 Total 1 476 108 - 1 476 108

8.2 Analysis of funds utilised to acquire capital assets – 2016/17

Voted funds Aid assistance Total R’000 R’000 R’000 Tangible assets 1 582 158 1 582 158 Buildings and other fi xed structures 935 367 - 935 367 Machinery and equipment 646 791 - 646 791 Total 1 582 158 1 582 158

8.3 Finance lease expenditure included in Expenditure for capital assets

Note 2017/18 2016/17 R’000 R’000 Tangible assets Machinery and equipment 81 472 66 295 Total 81 472 66 295

Finance lease expenditure relates to cell phones, GG vehicles and photocopiers.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

9. U nauthorised expenditure 9.1 Reconciliation of unauthorised expenditure

Note 2017/18 2016/17 R’000 R’000 Opening balance - 1 337 304 Less: Amounts approved by Legislature with funding - (1 337 304) Closing balance --

10. Cash and cash equivalents Note 2017/18 2016/17 R’000 R’000 Consolidated Paymaster General Account 306 223 317 565 Cash receipts 303 719 Outstanding payments (23 890) - Cash on hand 1 137 1 105 Total 283 773 319 389

11. Prepayments and advances Note 2017/18 2016/17 R’000 R’000 Travel and subsistence - 45 Total -45

12. Receivables 255 Note 2017/18 2016/17 Current Non- Total Current Non- Total current current R’000 R’000 R’000 R’000 R’000 R’000

Claims recoverable 12.1 552 - 552 2 730 - 2 730 Recoverable expenditure 12.2 1 327 - 1 327 734 - 734 Staff receivable 12.3 15 690 61 654 77 344 15 365 40 943 56 308 Other receivable 12.4 137 320 137 320 128 669 - 128 669 Total 154 889 61 654 216 543 147 498 40 943 188 441

Staff receivables represent salary related debts and bursary debts for nurses.

12.1 Claims recoverable

Note 2017/18 2016/17 R’000 R’000 Provincial departments 552 2 730 Total 552 2 730

12.2 Recoverable expenditure (disallowance accounts)

Note 2017/18 2016/17 12 R’000 R’000

Disallowance Damages & Losses 1 327 734 Total 1 327 734

Disallowance Damages & Losses represents loss or damage to assets GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

12.3 Receivables

Note 2017/18 2016/17 12 R’000 R’000 Breach of Contract 33 030 19 584 Employees 8 049 8 811 Ex-employees 30 035 25 760 Fraud 20 23 Suppliers 5 963 2 130 GG Accident 247 - Total 77 344 56 308

12.4 Other debtors

Other Debtors 135 609 127 099 Sal: Disallowance Account 23 23 Salary reversal Control Account 1 629 1 490 Salary: Deduction Disallowance 19 12 Salary: Tax Debt 40 45 Total 137 320 128 669

Other debtors represents amounts of owing to the department by the Provincial Revenue Fund as an excess surrender in 2010. The increase of this fi gure is as a result of a further excess surrender in 2017/2018.

12.5 Impairment of receivables 256 Estimate of impairment of receivables 158 948 19 322 Total 158 948 19 322

Staff debt older than 3 years is impaired.

13. Investments Note 2017/18 2016/17 R’000 R’000 Non-Current Investment in Medical Supplies Depot 54 000 54 000 Total 54 000 54 000 Total non-current 54 000 54 000

14. Voted funds to be surrendered to the Revenue Fund Note 2017/18 2016/17 R’000 R’000 Opening balance - 817 172 Transfer from statement of fi nancial performance 179 375 216 790 Paid during the year (179 375) (1 033 962) Closing balance --

An over surrender of voted funds in 2010 resulted in this amount being an asset.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

15. Departmental revenue to be surrendered to the Revenue Fund Note 2017/18 2016/17 R’000 R’000 Opening balance 99 643 79 151 Transfer from Statement of Financial Performance 546 916 535 254 Paid during the year (588 695) (514 762) Closing balance 57 864 99 643

16. Bank related items Note 2017/18 2016/17 R’000 R’000 Bank related accounts - 1 887 Total - 1 887

17. Payables – current Note 2017/18 2016/17 R’000 R’000 Amounts owing to other entities 369 606 334 030 Other payables 17.1 21 910 37 569 Total 391 516 371 599

Amount owing to others entities relates to MSD payables, only BAS interfaced amounts, total owing is disclosed on annexure 5 and accruals. 257 17.1 Other payables

Housing Key Deposits - 64 Housing Loan - 477 Medical Aid 170 394 Salary: ACB Recalls 574 3 000 Salary: Bargaining Council 8 17 Salary: Income Tax 7 798 12 013 Salary: Pension Fund 298 809 Telkom Account - 7 839 Unauthorised expenditure payable to PRF 12 956 12 956 Other 106 - Total 21 910 37 569

There is no disclosure on the Telkom account for 2017/2018 as all payments for voice services of the department were made to Telkom by 31 March 2018.

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

18. Net cash fl ow available from operating activities

Net surplus/(defi cit) as per Statement of Financial Performance 726 291 752 044 Add back non cash/cash movements not deemed operating activities 699 898 1 435 193 (Increase) in receivables – current (28 102) (130 701) Decrease in prepayments and advances 45 25 Decrease in other current assets - 1 337 304 Decrease) in payables – current 19 917 195 131 Expenditure on capital assets 1 476 108 1 582 158 Surrenders to Revenue Fund (768 070) (1 548 724) Net cash fl ow generated by operating activities 1 426 189 2 187 237 19. Reconciliation of cash and cash equivalents for cash fl ow purposes Note 2017/18 2016/17 R’000 R’000 Consolidated Paymaster General account 306 223 315 678 Cash receipts 303 719 Outstanding Payments (23 890) - Cash on hand 1 137 1 105 Total 283 773 317 502

20. Contingent liabilities and contingent assets

20.1 Contingent Liability 258 Nature of claims Claims against the department Annex 3B 25 091 551 21 812 594 Intergovernmental payables (unconfi rmed balances) Annex 5 300 14 164 Total 25 091 851 21 826 758

20.2 Contingent assets

Nature of contingent asset Claims against employees (Leave over grant) 32 192 27 816 Claim against National Health Laboratory Services - 1 559 392 Total 32 192 1 587 208

The department reached a settlement agreement with NHLS during 2017/2018.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

21. Commitments Note 2017/18 2016/17 R’000 R’000 Current expenditure Approved and contracted 909 690 944 806 Approved but not yet contracted - 42 684 909 690 987 490 Capital expenditure Approved and contracted 1 202 254 1 164 655 Approved but not yet contracted 461 214 479 664 1 663 468 1 644 319 Total Commitments 2 573 158 2 631 809

Commitments of R 1 508 000 are longer than a year.

22. Accruals and payables not recognised 22.1 Accruals

Listed by economic classifi cation 30 Days 30+ Days Total Total Goods and services 22 480 204 837 227 317 366 806 Total 22 480 204 837 227 317 366 806

Listed by Programme level 259 Administration 27 915 61 593 District Health Services 34 545 68 619 Emergency Medical Services 1 407 6 257 Provincial Hospital Services 64 944 89 834 Central Hospital Services 96 570 133 701 Health Training and Sciences 439 3 458 Health Care Support Services 1 497 3 344 Total 227 317 366 806

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

22.2 Payables not recognised

2017/18 2016/17 R’000 R’000 Listed by economic classifi cation 30 Days 30+ Days Total Total Goods and services 2 638 709 3 877 310 6 516 019 6 144 871 Transfers and subsidies - 16 16 3 126 Capital assets - 50 782 50 782 460 261 Total 2 638 709 3 928 108 6 566 817 6 608 258

Listed by Programme level Administration 1 905 746 1 726 237 District Health Services 648 250 876 626 Emergency Medical Services 253 011 219 896 Provincial Hospital Services 1 237 616 1 369 864 Central Hospital Services 2 393 315 2 193 083 Health Training and Sciences 5 109 15 515 Health Care Support Services 20 677 32 516 Health Facilities Management 103 093 174 521 Total 6 566 817 6 608 258

Included in the above totals are the following: 260 Confi rmed balances with other departments Annex 5 244 334 1 066 Confi rmed balances with other government entities Annex 5 1 156 892 1 218 225 Total 1 401 226 1 219 291

An amount of R2.5 billion disclosed as accruals was paid to suppliers subsequent to 31 March 2018. 23. Employee benefi ts Note 2017/18 2016/17 R’000 R’000 Capped leave commitments 383 590 399 654 Leave entitlement 907 179 391 223 Other 16 502 20 480 Performance bonus 712 950 338 469 Service bonus (Thirteenth cheque) 615 324 569 838 Total 2 635 545 1 719 664

The amount of R16 502 million under other represents a provision for long service awards. Performance bonus for the 2016/17 fi nancial year was not paid and was therefore carried over to the 2017/18 fi nancial year (R374 481+ R338 469)

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

24. Lease commitments 24.1 Operating leases

2017/18 Buildings and ‘Machinery Total other fi xed and structures equipment 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

2016/17 Buildings and Machinery and Total other fi xed equipment structures

Not later than 1 year 1 676 49 166 50 842 Later than 1 year and not later than 5 years 238 37 966 38 204 Total lease commitments 1 914 87 132 89 046

24.2 Finance leases **

2017/18 Machinery and Total equipment 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

2016/17 Machinery and Total equipment 261 Not later than 1 year 10 762 10 762 Later than 1 year and not later than 5 years 9 101 9 101 Total lease commitments 19 863 19 863

25. Accrued departmental revenue Note 2017/18 2016/17 R’000 R’000 Sales of goods and services other than capital assets 2 665 804 2 190 242 Total 2 665 804 2 190 242

25.1 Analysis of accrued departmental revenue

Opening balance 2 190 242 3 302 904 Less: amounts received 450 718 403 211 Add: amounts recorded 1 372 964 1 191 050 Less: amounts written-off/reversed as irrecoverable 446 684 1 900 501 Closing balance 2 665 804 2 190 242

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

25.2 Accrued departmental revenue written off

Note 2017/18 2016/17 R’000 R’000 Nature of losses Patient Debts written off 446 684 1 900 501 Total 446 684 1 900 501

25.3 Impairment of accrued departmental revenue

Note 2017/18 2016/17 R’000 R’000 Estimate of impairment of accrued departmental revenue 2 236 902 891 939 Total 2 236 902 891 939

The amount that has been impaired as accrued departmental revenue relates to self-paying patient debts that are older than 90 days. 26. Irregular expenditure 26.1 Reconciliation of irregular expenditure

Opening balance 8 985 284 6 934 443 Add: Irregular expenditure – relating to prior year 351 001 190 821 Add: Irregular expenditure – relating to current year 1 352 204 1 860 020 Closing balance 10 688 489 8 985 284 262 Analysis of awaiting condonation per age classifi cation Current year 1 352 204 1 860 020 Prior years 9 336 285 7 125 264 Total 10 688 489 8 985 284

26.2 Details of irregular expenditure – added current year (relating to current and prior years)

Incident Disciplinary steps taken/criminal 2017/18 proceedings/ Remedial action R’000

Consignment Stock Tender process underway 469 378 Security Contracts Feasibility study under way 679 066 SA Board of People Practice Referred for further investigation 5 181 Institute of People Management Referred for further investigation 5 712 Outsourced Nursing Staff Referred for further investigation 90 741 Ambulances and Helicopters Referred for further investigation 4 598 Deviations Referred for further investigation 6 764 Overtime exceeding 30% Threshold None 7 613 South African Institute of Chartered Accountants Referred for further investigation 24 156 Over-expenditure on Compensation of Employees None 119 928 Mental Health NGOs SIU investigation 3 828 Sundry Payments Referred for further investigation 194 886 Supply Chain Processes not Followed Referred for further investigation 91 354 Total 1 703 205

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

27. Fruitless and wasteful expenditure 27.1 Reconciliation of fruitless and wasteful expenditure

Note 2017/18 2016/17 R’000 R’000 Opening balance 419 778 422 628 Fruitless and wasteful expenditure – relating to current year 27.3 37 918 - Less: Amounts resolved - (2 850) Closing balance 457 696 419 778

27.2 Analysis of awaiting resolution per economic classifi cation

Current 457 696 419 778 Capital -- Transfers and Subsidies - Total 457 696 419 778

27.3 Analysis of Current year’s (relating to current and prior years) fruitless and wasteful expenditure

Incident Disciplinary steps taken/criminal 2017/18 proceedings R’000 Interest paid on overdue accounts (Standard Bank) 6 808 Interest Paid (Telkom) 628 Payments to the Sheriff (storage costs) 571 Interest paid on litigations 14 114 263 Interest on DID projects 745 Conditional Grants (Lease/ Legal Fees) 7 024 Smartpurse Contract 8 028 Total 37 918

An amount of R21.4 million was misclassifi ed under Goods and Services instead of interest paid.

28. Related party transactions Payments made Note 2017/18 2016/17 R’000 R’000 Goods and services payments to Medical Supplies Depot 3 899 204 3 056 003 Total 3 899 204 3 056 003

Year end balances arising from payments Amounts payables to related parties 1 023 222 1 097 773 Total 1 023 222 1 097 773

Related Parties include Gauteng Departments: • Medical Supplies Depot (under full control of the MEC) • Am amount of R483 million relating to year end balances payable to related parties was paid to the Medical Supplies Depot subsequent to year end.

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

29. Key management personnel No. of 2017/18 2016/17 Individuals R’000 R’000 Political offi ce bearers (provide detail below) 1 1 978 2 025 Offi cials: Level 15 to 16 7 7 655 8 066 Level 14 (incl. CFO if at a lower level) 20 21 542 21 874 Family members of key management personnel 4 1 410 1 319 Total 32 585 33 284

29. Provisions Note 2017/18 2016/17 R’000 R’000

OSD for Engineers 9 274 9 274 Litigation Claims Against the Department 140 599 140 599 Performance Bonuses for 2008/2009, 2009/2010 and 2010/2011 413 000 413 000 Backdated payments to Forensic Pathology Services - 8 805 Total 562 873 571 678

29.1 Reconciliation of movement in provisions – 2017/18

Legal Bonuses OSD FPS Payback Total provisions R’000 R’000 R’000 R’000 R’000 264 Opening balance 140 599 413 000 9 274 8 805 571 678 Increase in provision ----- Settlement of provision - - - (8 805) (8 805) Closing balance 140 599 413 000 9 274 - 562 873

Reconciliation of movement in provisions – 2016/17

Legal Bonuses OSD FSP Payback Total provisions R’000 R’000 R’000 R’000 R’000

Opening balance 299 998 413 000 9 274 - 722 272 Increase in provision - - - 8 805 8 805 Settlement of provision (159 399) - - - (159 399) Closing balance 140 599 413 000 9 274 8 805 571 678

Amount of R8 805 million was paid to the Forensic Pathology Offi cers during 2017/2018. Matters relating to OSD for engineers as well as performances bonuses have prescribed.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

30. Movable Tangible Capital Assets Opening Additions Disposals Closing balance Balance 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 offi ce 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 a. Additions ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2018

Cash Non-cash (Capital Work Received Total in Progress current, not current paid costs and (Paid current fi nance lease year, received payments) prior year) R’000 R’000 R’000 R’000 R’000 MACHINERY AND EQUIPMENT 860 678 14 668 (81 472) (73 626) 720 248 Transport assets 139 334 (53 394) (134) 85 806 265 Computer equipment 16 522 11 427 - 489 28 438 Furniture and offi ce equipment 14 883 12 - (509) 14 386 Other machinery and equipment 689 939 3 229 (28 078) (73 472) 591 618 TOTAL 860 678 14 668 (81 472) (73 626) 720 248 b. Disposals

Non-cash Total disposals Cash Received disposal Actual R’000 R’000 R’000 MACHINERY AND EQUIPMENT 120 857 120 857 Transport assets 4 635 4 635 Computer equipment 4 315 4 315 Furniture and offi ce equipment 3 692 3 692 Other machinery and equipment 108 215 108 215 TOTAL DISPOSAL OF MOVABLE TANGIBLE CAPITAL ASSETS 120 857 120 857

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

c. Movement for 2016/17

Opening Additions Disposals Closing balance Balance R’000 R’000 R’000 R’000

MACHINERY AND EQUIPMENT 4 688 730 (4 046) 711 748 (169 399) 5 227 033 Transport assets 386 071 62 226 (570) 447 727 Computer equipment 212 728 (865) 25 504 (8 730) 228 637 Furniture and offi ce equipment 132 113 21 880 (4 140) 149 853 Other machinery and equipment 3 957 818 (3 181) 602 138 (155 959) 4 400 816 TOTAL 4 688 730 (4 046) 711 748 (169 399) 5 227 033

30.1 Prior Year error

Continuous review of Assets Register revealed a miss capturing of certain fi gures (4 046) Total 4 046)

30.2 Minor assets

Machinery and Total equipment R’000 R’000 Opening balance 695 636 695 636 Additions 29 457 29 457 266 Disposals (23 590) (23 590) TOTAL MINOR ASSETS 701 503 701 503

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE YEAR ENDED AS AT 31 MARCH 2017

Machinery Total and equipment R’000 R’000

Opening balance 698 463 698 463 Additions 40 626 40 626 Disposals 43 453 43 453 TOTAL MINOR ASSETS 695 636 695 636

31. Intangible Capital Assets Opening Disposals Closing balance Balance SOFTWARE 207 910 (99 576) 108 334 TOTAL INTANGIBLE CAPITAL ASSETS 207 910 (99 576) 108 334

32. Immovable Tangible Capital Assets Opening Additions Closing balance Balance BUILDINGS AND OTHER FIXED STRUCTURES 70 949 1 561 875 1 632 824 Other fi xed structures 70 949 1 561 875 1 632 824 TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 70 949 1 561 875 1 632 824 267 32.1 Additions

Cash Non cash Capital Work Total in Progress current costs and fi nance lease payments R’000 R’000 R’000 BUILDING AND OTHER FIXED STRUCTURES Other fi xed structures 703 454 1 561 875 (703 454) 1 561 875 TOTAL ADDITIONS TO IMMOVABLE 703 454 1 561 875 (703 454) 1 561 875 TANGIBLE CAPITAL ASSETS

Movements for 2016/17 Opening Closing balance Balance R’000 R’000

BUILDINGS AND OTHER FIXED STRUCTURES Other fi xed structures 70 949 70 949 TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS 70 949 70 949

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

32.2 Capital Work-in-progress

Current year Ready For Use Closing WIP balance Opening 31 March Balance 2018 R’000 R’000 R’000 Buildings and other fi xed structures 3 599 029 703 454 1 561 875 2 470 608 TOTAL 3 599 029 703 454 1 561 875 2 470 608

Age Analysis Refl ecting on going projects

Description Amount Projects within one year 345 618 Projects Older than a year but not older than three years 209 030 Projects older than three years but not older than fi ve years 547 240 Projects running for older than fi ve years 1 638 719

Ready for use (Assets Closing Opening to the AR) balance balance / Contracts 31 March Note 1 April 2016 terminated 2017 Annexure 7 R’000 R’000 R’000

Buildings and other fi xed structures 1 972 332 1 112 753 513 944 3 599 029 TOTAL 1 972 332 1 112 753 513 944 3 599 029 268 33 Prior period error

Note 2016/17 R’000 Nature of prior period error -Work In progress 2016/17 closing 2 477 613 2016/17 as restated (3 599 029) Contingent Liabilities Opening Balance 21 959 658 Opening Balance Restated (21 812 594) Total prior period error (974 352)

Opening balance was adjusted after a clean-up of the asset register was performed.

2017/2018 GAUTENG DEPARTMENT OF HEALTH ANNUAL REPORT Department Of Health Vote 4 NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 Amount spent by department by the Amount received received department % of spent by department available funds spending) Under / (Over- Amount spent by department

by 269 Amount received SPENT 2016/17 department Available Roll Overs Total ------7 5437 543 5437- 7 - - 2 663 2 000 2 663 2 000 2 663 2 000 2 611 1 691 52 309 98% 85% 4 200 2 000 4 169 2 000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 Grants 919 431 890 665 86 163 976 828 919 431 976 828 919 431 839 444 904 053 137 384 15 378 86% 98% 777 818 865 244 672 926 865 210 4 110 484 9 669 624 4 110 484 86 163 4 110 484 9 755 787 4 110 049 9 755 787 435 9 602 229 153 558 100% 3 727 048 3 726 624 8 658 260 8 552 879 Provincial 3 744 381 3 744 381 3 744 381 3 744 381 - 100% 3 274 407 3 274 407 Division of Revenue Act/ NAME OF DEPARTMENT HIV and Comprehensive AIDS Training Health Professional & Development Hospital Facilities Revitalisation Grant Services National Tertiary National Health Insurance EPWP Social Sector Incentive Grant EPWP Integrated Grant to Provinces Total 33. OF CONDITIONAL GRANTS RECEIVED (UNAUDITED) STATEMENT

GAUTENG DEPARTMENT OF HEALTH 2017/2018 ANNUAL REPORT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 National Treasury or Treasury by National Department Re-allocations Actual Transfer 7 424 7 767 - - 7 424 7 767 7 424 7 767 - - DoRA R’000 R’000 R’000 R’000 R’000 266 928 125 254 301 731 30 000 -709 104 155 254 - 266 928 30 000 155 254 301 731 266 927 739 104 301 732 - 739 104 - - - transfers Adjustments Available Total and other

270 NAME OF MUNICIPALITY City of Johannesburg Metro Metro City of Tshwane Ekurhuleni Metro Rand District Council West Sedibeng District Council TOTAL 34. (UNAUDITED) TO MUNICIPALITIES OF CONDITIONAL GRANTS AND OTHER TRANSFERS PAID STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

Division of Revenue Act municipality % of available % of available funds spent by Amount spent by municipality Amount received by received Municipality Actual Transfer TRANSFER 2016/17

271 95 993 95 993 95 993 95 993 100% 62 850 739 104 739 104 739 104 739 104 675 326 Total Available Total 30 000 30 000 Roll Overs 7 4247 767 7 424 7 767 7 424 7 767 7 424 7 767 7 424 7 767 100% 100% 7 174 7 416 DoRA 46 541 22 072 12 720 13 236 46 541 46 541 22 072 12 720 46 541 13 23665 993 22 072 12 720 46 541 13 236 22 072 12 720 100% 13 236 22 072 12 720 44 325 13 236 100% 100% 20 310 100% 12 649 12 649 121 669 130 340 121 669 130 340 121 669 130 340 121 669 130 340 123 187 121 669 158 155 130 340 100% 100%709 104 115 875 123 187 124 133 158 155 123 187 158 155 123 187 158 155 123 187 158 155 100% 100% 117 321 150 624 transfers and other Primary Health Care Category A City of Johannesburg Metro Metro City of Tshwane Ekurhuleni Metro HIV AND AIDS Category A City of Johannesburg Metro Metro City of Tshwane Ekurhuleni Metro Category B Rand District Council West Sedibeng District Council Emergency Medical Services Category A City of Johannesburg Metro Metro City of Tshwane Ekurhuleni Metro Category C Rand District Council West TOTAL NAME OF MUNICIPALITY R’000 R’000 R’000 R’000 R’000 % R’000 ANNEXURE 1A (UNAUDITED) TO MUNICIPALITIES OF CONDITIONAL GRANTS AND OTHER TRANSFERS PAID STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 Appropriation Appropriation Appropriation Appropriation Act 2016/2017 Act 2016/2017 funds funds transferred transferred % of Available Available % of % of Available Available % of Actual TRANSFER ALLOCATION TRANSFER ALLOCATION Transfer transferred Amount not Actual Transfer 434 892 210 1 774 4 086 1 538 (1 340) (3 194) (1 328) (76%) (78%) (86%) 413 850 200 R’000 R’000 R’000 % R’000 10 525 2 388 8 137 341% 500 19 812 19 812 19 812 19 812 19 812 19 812 100% 18 869 18 869 12 061 9 786 2 275 1 963 Adjusted appropriation Available Total Total Available Total - - -

272 10 000 10 000 Adjustment 434 892 210 525 2 061 R’000 R’000 R’000 R’000 % R’000 Adjusted appropriation DEPARTMENT/AGENCY/ACCOUNT Seta (HW-SETA) Health and Welfare Total INSTITUTION NAME University of Witwatersrand University of Johannesburg University of Limpopo University of Pretoria Total ANNEXURE 1B AGENCIES AND ACCOUNTS (UNAUDITED) OF TRANSFERS TO DEPARTMENTAL STATEMENT ANNEXURE 1C INSTITUTIONS (UNAUDITED) OF TRANSFERS TO HIGHER EDUCATION STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 Act 2016/2017 Appropriation Appropriation funds transferred % of Available Available % of Actual Transfer 1 597 1 597 100% 1 521 55 583 49 557 89% 43 371 13 74985 960 12 578 - 86 948 12 578 101% 0% 100% 102 795 74 932 11 979 150 000698 608 150 000 556 250 100% - - 484 058 224 367 142 804 112 791 100% 112 766 142 060 99% 107 400 Total Available Total - - - - - 350 (900) 82 317 (81 767) Adjustments Act

1 597 273 54 832 85 960 55 233 12 578 224 717 113 691 150 000 698 608 Adjusted Appropriation Appropriation R’000 R’000 R’000 % R’000 NON-PROFIT INSTITUTIONS Transfers (Life Esidimeni) PSYCH Care Subsidy Chronic Community Based Services (Mental Health NPOs) HIV and AIDS (NGO’s) (NGO’s) Nutrition Provincial Community Health Clinics (Witkoppen Clinic) Community Based Services (EPWP NPOs) Community Based Services (Specialised NPOs & Rehabilitation) Hospital Nelson Mandela Children’s TOTAL ANNEXURE 1D OF TRANSFERS TO NON-PROFIT INSTITUTIONS (UNAUDITED) STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 Appropriation Appropriation Act 2016/2017 16 16 530530 51 51 8 5253 2526 940 8 594 29 611 funds R’000 R’000 18 71819 248 30 219 30 270 transferred % of Available Available % of Actual Transfer ----0%- Act Adjustments Available Total

274 1 371 (71) 1 300 358 230 27 556% 1 000 17 54581 07948 924 - 271 36 800 17 545 81 350 85 724 2 379 95 887 77 448 118% 14% 90% 48 322 7 275 153 630 148 919 37 000 185 919 533 944 210 227 Adjusted appropriation appropriation ce Equipment R’000 R’000 R’000 R’000 % R’000 t t: Injury on Duty t: Leave Gratuity benefi t: Post-retirement Households Transfers Household Employee Benefi Household Employee Benefi Household Employee Benefi Household: Other Transfers(Cash) Household Bursaries: (non-employee) Supplies Household Claims against State (Cash) TOTAL NAME OF ORGANISATIONReceived in cash Individual DonorsVarious Subtotal Received in kind individual donorsVarious Pharmaceutical Subtotal TOTAL Cash Received and utilised Computer Equipment OR SPONSORSHIP DONATION OF GIFT, NATURE 2017/18 2016/17 Furniture and Offi Other Machinery and Equipment ANNEXURE 1E OF TRANSFERS TO HOUSEHOLDS (UNAUDITED) STATEMENT ANNEXURE 1F AND SPONSORSHIPS RECEIVED (UNAUDITED) OF GIFTS, DONATIONS STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 2018 Closing balance 31 March 31 March 2016/17 Accruals Adjustment year paid/ reduced reduced Liabilities cancelled/ during the year incurred incurred Liabilities during the 4 384 - (4 384) - 11 268 1 194 (114) 12 348 136 684 - (136 684) - balance Opening 1 684 2831 508 092 192 005 (6 990) - - 1 869 597 1 508 092 18 467 282 3 828 969 (724 688)21 812 633 (129 310) 21 701 514 4 022 168 (872 560) (129 310) 25 091 551 1 April 2017 R’000 R’000 R’000 R’000

les. 275 nancial year 2017/2018. OSD to Nurses claim has prescribed due dormancy. NATURE OF LIABILITY NATURE Claims against the department Medico – Legal matters Civil Claims Liability Vehicle termination of contracts Premature OSD to Nurses Billing review Taisoar Total was resolved during the fi The dispute of Taisoar to reduce the liabilities with liability amount instead of payment Accruals adjustment was effected fi Opening balance was restated by 147 064 000 after a review of the previous year’s ANNEXURE 3B 31 MARCH 2018 (UNAUDITED) OF CONTINGENT LIABILITIES AS AT STATEMENT Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 outstanding Total rmed balance rmed - 190 116349 - 11 65 63 83 49 - 65 83 272 775 272 775 Unconfi ------26-- - 15-- -- 359 26-- 231 15----7-7 359 - 231 -- - -39---39 78 --- - 30 16 - 99 ------50- - 27 - 30 99 - - - - 78 16 50 - 67 27 - - (19) 16 - 20 862 89 - 16 29 532 67 11 216 19 133 - 17 407 89 4 613 20 862 29 532 (19) 11 216 19 133 17 407 4 613 1613 4 - -13 - - - 16 4

276 R’000 R’000 R’000 R’000 R’000 R’000 rmed balance outstanding 31/03/2018 31/03/2017 31/03/2018 31/03/2017 31/03/2018 31/03/2017 Confi GOVERNMENT ENTITY GOVERNMENT DEPARTMENTS Mpumalanga: Department of Health (C5) Eastern Cape: Department of Health (D2) & Rural Development Gauteng Department of Agriculture Development (1G) Gauteng Infrastructure National Department of Social Development (07) Eastern Cape Department of Education (D5) Limpopo Department of Health and Social Development (P4) Western Cape Department of Health (U3) (W1) SA National Defence Force State Department of Health (V5) Free Health (3Y) North West Gauteng Department of Social Development (5G) Account) W7 (Trading Affairs Department of Water Gauteng Department of Finance(I1) Gauteng Treasury National Department of Labour (33) National Department of Health(20) KZN Department of Health (3K) Northern Cape Department of Health (H5) Mpumalanga Department of Health & Social Services(Patient fees) Services (Patient fees) Department of Correctional South African Police Services (Patient fees) ANNEXURE 4 CLAIMS RECOVERABLE (UNAUDITED) Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 outstanding Total rmed balance rmed Unconfi -----382 - - 895 -- - - - 233 21 809- -382 895 55 753 66 - 4 - 25 - 12 852 223 233 4 968 38 405 4 - 25 - 21 809 55 753 223 2 493 135 609 12 852 66 38 405 4 968 - 2 493 135 609 - 29 30 480 280 525 97 088 280 554 127 568

R’000 R’000 R’000 R’000 R’000 R’000 277 rmed balance outstanding 31/03/2018 31/03/2017 31/03/2018 31/03/2017 31/03/2018 31/03/2017 Confi ecting on BAS. Patient Fees are included on Annexure 4 but not refl GOVERNMENT ENTITY GOVERNMENT Limpopo Department of Health and Social Development (Patient fees) Department of Health and Social Development(Patient fees) North West (Patient fees) SA National Defence Force National Department of Justice (Patient Fees) Affairs Department of Co-Operative Governance and Traditional National Department of Health (HPV Grants) National Department of Health (Cuban Programme) Revenue Fund) (Provincial Treasury Gauteng Provincial Total Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 outstanding Total outstanding Total rmed balance rmed Unconfi -3 -- -- 3 -3 -7 -- --7 -----3 70 160 - 160 70 2037---37- 54 - 79 - 2028 - 19---19- 32 52 1405427 - - - - - 219 - - 28 - 59---59- 32 - 52 27 - - - - 155103 21 - - 155 - 103 - 21 176 - - - - 176

278 1 978 913 - - 1 978 913 R’000 R’000 R’000 R’000 R’000 R’000 101 499 - - - 101 499140 068244 334 - 1 066 - 300 - - - 244 634 140 068 1 066 - rmed balance outstanding 31/03/2018 31/03/2017 31/03/2018 31/03/2017 31/03/2018 31/03/2017 Confi

ce of the Premier (G6) ce of the Premier GOVERNMENT ENTITY GOVERNMENT DEPARTMENTS Gauteng Offi Department of Justice Services Correctional Gauteng Department of Social Development Gauteng Department of Roads and Transport Eastern Cape Department of Health (D2) Nation Department of Public Service and Administration South African Police Services (90) Department of Health North West Department of Planning and Monitoring Limpopo Department of Health (Q7) Kwa Zulu Natal Department of Social Development Kwa Zulu Natal Department of Health Statistics S.A. National Department of Public Works Department of Defence Mpumalanga Department of Health Department of Labour National Department of Health Subtotal ANNEXURE 5 (UNAUDITED) INTER-GOVERNMENT PAYABLES OTHER GOVERNMENT ENTITY Current Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 (9 737) 64 983 562 149 (934 292) 5 627 647 (4 161 877) R’000 R’000 (6 095) 981 336 1 148 873 2017/18 2016/17 (125 230) (127 488) 1 148 873 7 158 435 (7 067 159) outstanding Total outstanding Total rmed balance rmed Unconfi - 646 - - - 646 279 R’000 R’000 R’000 R’000 R’000 R’000 22 588 - - 12 644 22 588 12 644 111 082 119 806 - 1 520 111 082 121 326 1 023 222 1 097 7731 156 8921 401 226 1 218 225 1 219 291 - - 300 1 023 222 14 164 14 164 1 097 773 1 156 892 1 401 526 1 232 389 1 233 455 rmed balance outstanding 31/03/2018 31/03/2017 31/03/2018 31/03/2017 31/03/2018 31/03/2017 Confi

GOVERNMENT ENTITY GOVERNMENT OTHER GOVERNMENT ENTITY Current Medical Supplies Depot Medical Supplies Depot (salary ) G-Fleet Special Investigating Unit other government Dept Total INTERGOVERNMENTAL TOTAL major category] Inventories [Per Opening balance Add/(Less): Adjustments to prior year balance - Cash Add: Additions/Purchases (Less): Disposals (Less): Issues Add/(Less): Adjustments Closing balance The amount of Additions is purchases made during the year on inventory note 4.4. ANNEXURE 6 INVENTORIES (UNAUDITED) Department Of Health Vote 4 ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018 Closing Closing balance balance Capital WIP Current Year Year Current - - 3 397 585 R’000 R’000 R’000 balance Opening Capital WIPCapital Ready for use Current Year Year Current R’000 R’000 R’000 R’000 balance Opening 3 599 0293 599 0293 599 029 703 454 703 454 (1 561 875) 703 454 (1 561 875) (1 561 875) 2 740 608 2 740 608 2 740 608

280 xed structures xed xed structures Opening balance was adjusted after a clean-up of the asset register performed. BUILDINGS AND OTHER FIXED STRUCTURES Other fi TOTAL BUILDINGS AND OTHER FIXED STRUCTURES Other fi ANNEXURE 7 (UNAUDITED) WORK IN PROGRESS 2017/18 MOVEMENT IN CAPITAL PART F: MSD FINANCIAL INFORMATION

281 Gauteng Medical Supplies Depot ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2018

TABLE OF CONTENTS Page

Report of the Accounting Offi cer 283

Report of the Auditor-General 295

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 fi nancial statements 310

Report of the Audit Committee-Cluster 03 325

282 Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

The Accounting Offi cer of the Gauteng Department Prior to MSD online, orders had to be signed by of Health (the Department) hereby submits the the relevant pharmacists and now orders are being annual report for the Gauteng Medical Supplies signed electronically and sent off electronically to Depot, to the Executive Authority of the Gauteng the supplier and the supplier will have to accept the Department of Health, and the Gauteng Provincial order on their end as proof of acknowledgement of Legislature of the Republic of South Africa. the order by the supplier.

1. General review of the state of Prior to MSD online, the depot had to fax or email or physically deliver the copy of the orders to the affairs demanders for them to be able to receive stock The Medical Supplies Depot (the Depot) operating as from the suppliers but since the introduction of MSD a trading entity of the department is responsible for online, demanders are now able to see their orders the supply of essential medicines to Provincial Health on MSD online. Care Facilities in Gauteng. In this regard, a levy of 5% is charged on stock issued to the Provincial Health Prior to MSD online, suppliers had to deliver their Care Facilities. payment packs at the depot so that they can be paid on time but with the introduction of MSD online, Essential medicines are procured on contract or suppliers can now upload their payment packs quotations and either store these items at the on MSD online and their payment can be effected Depot or orders are placed with suppliers on behalf timeously and if they did not submit all the required of institutions for direct delivery to the various documents, their payment pack will be rejected and institutions. Accurate usage of items, as well as the reason for their rejection will be indicated so money spent by hospitals, can be obtained from that they are able to correct and submit the correct the Medical Stock Administration System (MEDSAS). documentation. The Economic Order Quantity (EOQ) together with the First-Expiry-First-Out, (FEFO) system is applied to Implementation of new Monitoring and ensure that correct stock levels are maintained. Evaluation document for the different units in the depot The Depot prepares fi nancial statements for each 283 fi nancial year in accordance with the prescribed The monitoring and evaluation unit has developed practice (Statements of South African Generally a document for the management of the different Recognised Accounting Practice- GRAP). The units in the depot with workplans and targets set fi nancial statements are prepared and reported on to ensure that the depot achieves its KPI’s. The accordingly. workplans are monitored on a monthly basis and that is why the depot was able to achieve all its KPI’s The Medical Supplies Depot has a re-packing function, in the operational plan. where bulk medicine is repacked into patient ready packs. The re-packing expenses are recovered from Spending Trends the normal levy charged. Managers for each cost A summary of major spending trends indicates that centre were identifi ed and procedures to ensure the medicine prices increased at a rate higher than completeness of stock requisitioning and receiving the consumer price index (CPI). This has the effect were designed. It is possible to reconcile the relevant that revenue increases at a higher rate and has a cost centres with the records of the fi nance section. favourable infl uence on the net profi t of the Depot. This will further enhance the monitoring of some Cost containment measures and increased demand expense items through a budget process. from healthcare providers were also responsible for 1.1 Signifi cant events that have taken the improved net profi t. place during the year MSD Online

The MSD Online was introduced in April 2017 which assists in the tracking of orders that have been placed by the depot on behalf of health institutions for their direct delivery orders. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Major accounts

Description 31 March Variance 31 March Variance 31 March Variance 31 March 2018 Amount from 2017 Amount from 2016 from 2015 Amount Prior Prior Prior Amount R R Year R Year Year R Revenue 3 824 656 198 2.85% 3 718 817 485 24.61% 2 984 248 189 10.99% 2 688 733 804 Cost of Sales 3 642 542 348 2.85% 3 541 730 922 24.61% 2 842 329 263 11.85% 2 541 292 259 Expenditure: 68 334 539 11.18% 61 460 965 -0.62% 61 841 794 13.64% 54 417 817 Personnel Expenditure: 28 639 876 -26.46% 38 944 850 31.64% 29 584 910 -18.98% 36 517 781 General Net Profi t 108 678 509 25.68% 86 469 740 43.05% 60 447 734 0.12% 60 373 292

The Universal Test and Treat Campaign started in September 2016 was a driving force behind the increase in Revenue which saw more orders for medical supplies being placed with the depot during the fi nancial year.

Personnel expenses increased due to annual salary Free Service increases as well as more scarce skills posts on the staff establishment being fi lled. The Depot does not provide any free service except in the case of donated medicines which are distributed General Expenditure was slightly higher in the 2018 to health care facilities in the Province at no fee. fi nancial year when compared to the prior year. This The quality control of the medicines performed by is mainly due to the increase in distribution costs the laboratory on site is part of the administrative (R1.3m) and increase expenditure on repairs and expenses of the Depot, which are recovered as part maintenance (R1.6m) offset by a reduced cost of of the fi ve percent levy charge. security services provided (R2m) in the current year. 3. Capacity constraints 2. Services rendered 284 The Medical Supplies Depot delivers a vital service to The Medical Supplies Depot is responsible for the all the Health Care Institutions in Gauteng. effective and effi cient procurement, quality testing, storage and distribution of essential medicines to As at the end of the year under review the Medical all the Provincial Health Care Facilities in Gauteng. Supplies Depot had 263 posts on the approved staff The Depot ensures that Essential Medicine List establishment, with 71 vacant. Current year vacancy (EML) medicines are available to our clients at all rate of 27% has a negative impact in terms of the times. This involves the evaluation of medicine for depot achieving its objectives. This is as a result of tender purposes, participation in tender adjudication a moratorium on the replacement of posts by the meetings, procurement and distribution of these Department. Measures have been taken to strengthen items, as well as quality control of medicines the operations of the Depot and its management. distributed to our institutions. Despite these challenges nonetheless the depot has managed to put in place compensating measures Quality control is carried out in a fully equipped laboratory, where samples are tested from each The measures can be demonstrated by two of our batch of medicines received. The Depot’s laboratory key performance indicators: is the only public sector laboratory in South- Africa • KPI 1 “Availability “refers to a situation where where the fi ndings on quality tests performed are stock on hand at the depot is suffi cient to meet also communicated to other provinces. the demand created on MEDSAS in full, it was measured at 91.13% against a target of 90.00%. Tariff policy • KPI 2 “Service level” refers to how quickly the MSD takes to issue stock in full on MEDSAS. The The tariff policy for the trading account was approved measurement of this KPI is therefore time-based. on 1 April 1992 as per the Exchequer Act, Act No. This KPI ensures that all orders are dispatched 66 of 1975. Approval was granted for a fi ve percent within 24 hours and the Service level was (5%) levy on the average carrying value of stock measured at 87.32% against a target of 80.00%. issued to customer hospitals. Systems for measuring the indicator ‘% of orders supplied to institutions on fi rst requests’ were Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018 strengthened, and the actual performance is • Asset Management System (ASSETWARE) calculated according to the following defi nition: ‘If • Manual systems to perform reconciliation an order / request (which could consist of multiple procedures and accrual based accounting different items) is fulfi lled 100% within 24 hours, then that order counts towards the achieving of the 4. Utilisation of donor funds target. If even one item is not captured as part of the The Depot received Fluconazole from Pfi zer request within 24 hours, the order does not count Laboratories for use by AIDS patients with as being fulfi lled’. This is an extremely high standard Oesophageal Candidiasis and Cryptococcal to fulfi l, but it is specifi c, measurable and time- Meningitis and a further donation of Mebendazole bound. Also, it holds the Depot to higher standards for the deworming of school children from Janssen – meeting orders within 24 hours could have a life- Pharmaceutical. This type of donor funding is saving impact at the level of institutions. However, received on a continuous basis. the more rigorous monitoring system makes it appear that performance is lower than planned. Please note that the Depot does not account for the economic benefi t received in the Statement of A constraint to ensure effective, economical and Financial Performance, as the Depot is considered effi cient reporting exists in that information from to be only a conduit for hospitals and to control various systems needs to be manually collated. the receipt of donations for the Department. The Information from the following systems is used and donation is refl ected in the fi nancial statements of involves time-consuming reconciliation procedures to the Department. enable compliance with Statements of SA GRAP for disclosure purposes: The current market value of donations issued and • Basic Accounting System (BAS) charged at a value of one-hundredth of one cent • Personnel and Salary Administration System (R0.0001) to all clients of the Depot. The total (PERSAL) charge to health institutions for donations received • Medical Stock Administration System (MEDSAS) amounted to under R10.

Below is the breakdown of donations received during the fi nancial period. 285

ICN # Item Description Supplied by/ Quantity Market Value Total SEP Arranged by Received per Unit value Single Exit Price (SEP) 180963203 Fluconazole Injection 2mg/ Pfi zer Laboratories 4500 R224,47 R1 010 115,00 ml; 100 ml – (HIV/AIDS anti- fungal medicine) 181791499 Fluconazole Powder for Pfi zer Laboratories 900 R235,36 R211 824,00 Oral Suspension 50mg/5ml ;35ml - (HIV/AIDS anti-fungal medicine) 180962874 Fluconazole Tablets Pfi zer Laboratories 1440 R2 726,73 R3 926 491,20 200mg;28’s - (HIV/AIDS anti- fungal medicine) 181931183 Mebendazole 500mg Janssen 4780 R375,00 R1 792 500,00 tablets 150s – (Deworming Pharmaceutical medicine) R6 940 390,20

5. Trading entities Comparative information The Medical Supplies Depot operates as a trading A four-year comparative analysis of major accounts is entity, known as “The Central Medical Trading disclosed under paragraph 1 above. Account” since 1 April 1992. The trading entity acts as a shared supply chain for the procurement and 6. Organisation to whom transfer provisioning of pharmaceutical to the Department’s Health Care Institutions in Gauteng. payments have been made No transfer payment has been made by the Depot in this fi nancial year. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018 7. Public/Private Partnership (PPP) holding, the Depot adopted a more conservative approach by setting a target not exceeding 2%. No Public Private Partnership has been entered into This performance indicator is reported on to the by the Depot in this fi nancial year. audit committee quarterly. The following non-core services have been outsourced to the private sector which consists mostly of Black 9. Discontinued activities Economic Empowerment companies: No activities were discontinued during the year under • Maintenance and support of the MEDSAS review. computer system. • Distribution of stock to health care institutions. 10. New/Proposed Activities • Security of the property and vehicle access The Depot is currently being assisted by the Offi ce of control. the Chief Information Offi cer (CIO) in the preliminary • Maintenance, pest control and minor landscaping evaluation of the possible alternative to the current of the garden at the Depot. inventory management systems (MEDSAS) which is due for replacement. 8. Corporate governance arrangements 11. Supply chain management Management has, with the objective of safeguarding (SCM) the assets of the Depot and ensuring high quality of The MSD has a fully-fl edged supply chain service delivery, prioritised the following areas: management system in place including the Pharmaceutical Procurement Committee (PPC) with • The Depot performs an annual strategic risk assessment which is followed by quarterly reviews membership comprising of pharmacists, accountants and reporting to the audit committee and SCM personnel. A number of pharmaceutical items are on tenders which are administered at • The Depot has submitted the list of all critical vacant posts to the post fi lling committee for national level. The PPC, therefore, only deals with consideration and approval. This once implemented procurement sourced from quotations for values not 286 will reduce the current vacancy rate at the Depot. exceeding R500 000. • ICT – Depot is currently considering the replacement of its current ineffective inventory 12. Asset management management system (MEDSAS) with a new system. Management is pleased to report that it carried out • In an effort to increase Medicines availability, the a full asset verifi cation project on its approximately Depot management has continued to engage 6000 moveable assets of property, plant and with suppliers in a number of ways such as the equipment (PPE) as required by paragraphs 17.56 following: of Generally Recognised Accounting Practice (GRAP) o General meetings with all suppliers - quarterly; and in particular GRAP 17. This standard requires an o One-on-one-meetings as and when necessary, entity to assess the residual values of its PPE at least and for each reporting period. o Carrying out supplier satisfaction surveys by way of suggestion boxes. • Although it is inevitable not to have expired 13. Inventories medicines in a depot environment and where The valuation method used by the Medical Supplies best practices industry estimate as a benchmark Depot is the moving weighted average method as is between 3% and 5% of average stock per the MEDSAS:

Medicine

31 March 2018 31 March 2017 31 March 2016 31 March 2015 R R R R Closing stock 253 964 393 170 575 222 311 096 708 218 910 037

Medicine

31 March 2018 31 March 2017 31 March 2016 31 March 2015 R R R R Breakages 7 633 3 288 13 273 14 616 Expired stock 1 166 028 2 016 734 2 568 494 561 395 Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Control measures in place 14. Events after the reporting date Whilst the long-term solutions for ensuring effi cient The Gauteng Department of Health made an and effective stock management at the depot require overdue payment of R 250 000 000 to the Depot on an appropriate infra-structure (new warehouse), 05 May 2018 and a further R 653 316 639 received an integrated information system and adequate on the 15 May 2018 of which R 233 252 647 relates workforce in terms of numbers and skills, the to the 2017/2018 fi nancial year whilst the balance following short term controls have been instituted: of R 420 063 992 relates to the 2018/2019 fi nancial • Shelf marshals have been appointed to monitor year. There were no other events identifi ed by expiry dates and identifying items expiring in 6 management that may have had signifi cant impact months; on the entity’s fi nancial position as at 31 March • Stock on hand is fi rst issued before replacement 2018, its fi nancial performance and its cash fl ows for items are issued when regimens (treatment the year then ended. protocols) are changed; • Reviewing the list of items to be kept at the 15. Information on predetermined Depot; objectives • Discuss regimen changes with National The Gauteng Department of Health’s Strategic Plan, Department of Health to align with current stock was used as a basis for developing the Depot’s levels; Operational Plan. This approach ensured that the • Back orders were reduced; Depot’s predetermined objectives are clearly aligned • Warehouse management practices were improved to those of the Department as far as the Depot’s with the introduction of trolley consolidations, relevance to the Department is concerned. streamlining of schedules for supervisors that assists in effective staff utilization; For the year under review, the Depot had a total of • Quality assurance processes were improved with six (6) predetermined objectives which were reported a complete overhaul of the standard operating on quarterly. Each of the six objectives had at least procedures. one indicator whose measurement variable inputs were collected either through the current IT Systems 287 in use such as MEDSAS or collected manually or a combination of IT and manual systems.

The key performance indicators per the strategic plan based on measurable objectives and our actual achievement are refl ected in the table below:

# Indicator Target Actual Deviations Comments/Challenges Performance from Target 1 Percentage of EML 90.00% 91.13% 1.13 % above • Target Achieved: medicines available at The follow-up centre is following the Medical Supplies up on all outstanding orders Depot. with suppliers and that is why we have achieved on this KPI. Supplier that deliver late to the depot are being penalised for late deliveries. 2 Percentage of orders 80.00% 87.32% 7.32% above • Target Achieved: satisfi ed in full within The follow-up centre is following one working day. up on all outstanding orders with suppliers and that is why we have achieved on this KPI. Supplier that deliver late to the depot are being penalised for late deliveries. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

# Indicator Target Actual Deviations Comments/Challenges Performance from Target 3 Percentage of expired <2% 0.62% 1.38% • Target Achieved: stock. Below The introduction of shelf marshals in the warehouse store helps in the management of expiry dates. The use of the FEFO (First expiry fi rst out) principle in the warehouse stores really assisted in reducing the amount of stock that expired on our shelves. The insistence on suppliers to provide us with stock protection letters for stock that has an expiry date of less than 18 months. 4 95% of medicines tested 95% 98.86% 3.86% above • Target Achieved: within 2 working days by No tender samples were the laboratory. submitted in this quarter and therefore led to the laboratory not being under so much pressure to test many samples. 5 Percentage of staff <5% 4.90% 0.10% • Target Achieved: turnover. Below Threshold The Depot has created favourable working conditions for its employees.

6 Percentage of essential 65.00% 77.82% 12.82% • Target Achieved: medicines delivered above Continuous monitoring of items directly to health that must be moved into the facilities. DDV procurement system in order to increase the number of 288 items that are procured through the DDV system.

16. SCOPA Resolutions At a duly constituted sitting for the Gauteng Provincial Legislature held on 28 November 2017, the House adopted the following SCOPA resolutions relating to the 2016/2017 fi nancial year:

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 Department should provide the Committee • This has now been resolved as follows: with a progress report detailing the i) After all trainings are conducted; regular follow effectiveness of measures put in place to up is done to obtain the training registers from address weaknesses of pre-determined objectives within 30 days after adoption the Department. hereof and thereafter every quarter • This has been corrected, the targets are aligned continuing up until the end of June 2018. • New Indicator introduced to measure the percentage of items ordered through the Direct Delivery Method has been implemented. The target for this indicator is 70% by 31 March 2019 and we are already at 79% by 31 December 2017. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 MEC provides the Committee with a • The Penalty register is reviewed monthly for progress report on measures put in place accuracy and completeness. The Gazetted prime to monitor the adequacy of internal lending rate is used monthly to calculate penalties controls in order to avoid recurrence of prior to disclosure of amounts. non-compliance with applicable legislation • Monthly revenue reconciliation is checked and within 30 days of adoption hereof and signed off by delegated offi cials. thereafter every quarter continuing up until the end of June 2018 • Service provider has been appointed to perform verifi cation checks (Citizenship verifi cation, Qualifi cation verifi cation and previous employment verifi cation). • Reconciliation between the leave forms and leave register is performed monthly and any leave forms not submitted on time are followed up with line managers. • In addition, the HR Department now keeps a register (spread-sheet) of all non-compliant unit Managers/ Supervisors and escalates to the Depot Senior Management for action monthly. • Quarterly meetings between SITA and MSD have been revived and the fi rst meeting was held 14th of July 2017. Second meeting held 13th October 2017. • Discussions have been held with I-Chain to fi nd a solution to the password control limitations. The system is loaded on a desktop that requires a password to access the system which makes it safer for security of the system. The password to access the desktop prompts the user to change their password every month. • User access rights reviews are performed monthly. • Properly designed and controlled Authorisation Forms are now used for all new requests relating 289 to MEDSAS and RDM users accounts. • Medsas is a very old system and Microsoft no longer supports the old version operating system that MEDSAS uses and hence there are no security patches. Management has therefore engaged with the offi ce of the CIO to fi nd an alternative operating system. • MEDSAS servers have been moved to V-Block offsite. 28 Nov 2017 MEC provide the Committee (SCOPA) • CEO has been appointed in a permanent capacity and Portfolio Committee on Health with by the Accounting Offi cer (HOD) to address the a report detailing its adherence to and Non-compliance compliance with the requirements of all • The matter was highlighted to the offi ce of the applicable legislation within 30 days of Acting Head of Department (AHOD). Acting adoption hereof and thereafter every appointment letters for subsequent periods were quarter continuing up until the end of approved by the offi cial (AHOD) who has the June 2018 proper delegation for this function • In order to address the non-compliance of payments to supplier made within 30 days, the MSD implemented an online Ordering, Trace and track and Suppliers document management system on 01 April 2017 and; • Suppliers are engaged on a quarterly basis to improve communication and iron out any ineffi ciencies relating to payment packs (Order, invoice, POD and Annexure A’s). • In Q3 of 2017-2018, for instance, 56% of payments to suppliers were made within 30 days as compared to 43% in Q1. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 Department should intensify performance • A list of prior years’ irregular expenditure has and consequence management to eliminate been compiled and the investigations will be fi ndings on non-compliance with key concluded by the end of March 2018. legislation and provide the Committee with • A demand management and Annual Procurement a quarterly progress report detailing the Plan (APP) has been developed with regards to effectiveness of measures put in place to contracts that will expire soon so that the process prevent irregular expenditure commencing of competitive bidding can be started earlier 30 days after adoption hereof and before the current contract expires. thereafter every quarter continuing up until the end of June 2018 • MSD has requested the Department to transfer relevant vacant posts from the Central Offi ce and/ or healthcare institutions to MSD to be used to recruit offi cials to replace the consultants in the Financial Management Unit at MSD. • A checklist has been implemented and retrospectively applied the checklist to all procurement from 1 April 2017 going forward. The checklist reviews BEE & Tax Clearance Certifi cates and other procurement documents • The schedule form has been reviewed by the PPC to include all fi elds relevant to procurement controls and the end users of the form have been trained on how to use the form. • The pharmaceutical procurement committee (PPC) is applying strict measures in terms of checking every submission made to the committee before approval. • The newly implemented MSD online system is designed such that its built-in control checks do not allow any order to go through for approval if the value of the purchase order is above R500 000.00 290 28 Nov 2017 MEC to provide the Committee with a • The CEO has been appointed permanently by progress report on the effectiveness of the Accounting Offi cer to address leadership measures put in place to address poor challenges highlighted by the auditor-general. leadership in the Entity within 30 days of adoption hereof and thereafter quarterly • The depot is using the departmental ethics policy. continuing up until the end of June 2018 28 Nov 2017 Department submits a fi nal report of the • Management has started the process of investigation detailing the outcomes thereof investigating prior year’s irregular expenditure. within 30 days of adoption hereof Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

The following were follow-up SCOPA questions to those of the sitting of the Gauteng Provincial Legislature held on 28 November 2017 relating to the 2016/2017 fi nancial year:

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 Expenditure Management: Irregular Expenditure

Resolution 4.1.3.1.2: The Accounting Offi cer intensify performance and consequence management processes to eliminate fi ndings on non-compliance with key legislation and provide the Committee with a quarterly progress report detailing the effectiveness of measures put in place to prevent irregular expenditure commencing 30 days after adoption hereof and thereafter every quarter continuing up until the end of June 2018. Part 1: 1. Explain to the Committee why • The Medical Supplies Depot responded to all the above resolution has not been resolutions of the House of 28th November 2017. responded to? A separate report in the form of Annexure “A” was submitted to SCOPA in this regard.

2. What is the status relating to Part 2: investigations on irregular expenditure? • The investigations are still on-going

3. Provide the detailed transactions of Part 3(a) each instance of irregular expenditure including: Name of Service provider Service Provided National Bioproducts Institute Supply Medicines a) The name of the service provider 291 and the service provided. Pharmacare T/A Aspen Pharmacare Supply Medicines Fresenius Kabi South Africa Supply Medicines Cipla-Medpro (Pty) Ltd Supply Medicines Bristol Myers Squibb (Pty) Ltd Supply Medicines Sanofi –Aventis South Africa (Pty) Supply Medicines Ltd Ally Counter force CC Security services XJM Consultants (Pty) Ltd Accounting services Part 3(b) b) What investigations have been • The investigations are still on-going. Only after undertaken regarding irregular these investigations have been concluded will expenditure reported in 2016/2017 the entity be in a position to take the necessary fi nancial year and what disciplinary disciplinary action(s) towards those responsible measures have been / will be for irregular expenditure. taken against those responsible for irregular expenditure? Part 3(c) c) Considering the numerous turn • The total irregular expenditure for the year around strategies actioned in amounted to R63 956 997 compared to the department including setting R24 216 899 incurred in prior year as per note up the Irregular expenditure 20 to the fi nancial statements. Further analysis committee, explain why the of this expenditure reveals that the irregularity irregular expenditure increased relating to the appointment of the Acting CEO signifi cantly? alone amounted to R59 384 757 or approx 93% of the total expenditure. Had this been avoided, the irregular expenditure would have been R4 572 240 compared to the R24 216 899 for prior year. Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 Payment within 30 Days Resolution 4.1.4.2: In terms of GPL Rule 179 (4), the MEC provide the Committee (SCOPA) and Portfolio Committee on Health with a progress report detailing the effectiveness of measures put in place in addressing payment of service providers within 30 days of adoption hereof and thereafter every quarter continuing up until the end of June 2018.

4. Explain to the Committee why Part 4: the above resolution has not been • The Medical Supplies Depot responded to all responded to? resolutions of the House of 28th November 2017. A separate report in the form of Annexure “A” was submitted to SCOPA in this regard.

5. Provide the Committee with a progress Part 5: report detailing the adherence and • Analysis of performance relating to payment of compliance to 30 days payment for the suppliers within 30 days during the 2017/2018 period January, February and March fi nancial year is as follows: 2018. Quarter 1 – 45% Quarter 2 – 65% Quarter 3 – 89% Quarter 4 – 41%

• The current cash fl ow challenges in the department during quarter 4 have led to the regression of payment of suppliers within 30 days

292 Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

Sitting Date Adopted Resolutions/Matters Raised How The Matters Were Addressed 28 Nov 2017 Leadership, Financial Performance • There were a number of moratoriums on fi lling of Management posts. A copy of the then latest extension dated 6th January 2017 was attached and provided to Resolution 4.1.4.2: The MEC provide the SCOPA as Annexure “B”. Committee with a progress report on the effectiveness of measures put in place to • Service provider has been appointed to perform address poor leadership in the Entity within verifi cation checks (Citizenship verifi cation, 30 days of adoption hereof and thereafter Qualifi cation verifi cation and previous every quarter continuing up until the end of employment verifi cation). June 2018. • Reconciliation between the leave forms and leave 6. Provide the Committee with the register is performed monthly and any leave effectiveness of all measures put in forms not submitted on time are followed up place to address poor leadership with line managers.

• In addition, the HR Department now keeps a register (spread-sheet) of all non-compliant unit Managers/ Supervisors and escalates to the Depot Senior Management for action monthly.

• Quarterly meetings between SITA and MSD have been revived and the fi rst meeting was held 14th of July 2017. Second meeting held 13th October 2017.

• Discussions have been held with I-Chain to fi nd a solution to the password control limitations. The system is loaded on a desktop that requires a password to access the system which makes it safer for security of the system. The password to access the desktop prompts the user to change their password every month.

• User access rights reviews are performed monthly. 293 • Properly designed and controlled Authorisation Forms are now used for all new requests relating to MEDSAS and RDM users accounts.

• Medsas is a very old system and Microsoft no longer supports the old version operating system that MEDSAS uses and hence there are no security patches. Management has therefore engaged with the offi ce of the CIO to fi nd an alternative operating system.MEDSAS servers have been moved to V-Block offsite.

Part 7: 7. Provide the Committee with the revised • The revised organogram has been submitted organogram of the Entity including for approval and awaiting its approval before names and positions occupied. implemented. 28 Nov 2017 Resolution 5.2.1.1 That the Accounting • The investigations are carried out by Central Offi cer submits a fi nal report of the Offi ce and as such the MSD does not have the investigation detailing the outcomes thereof requested report. within 30 days of adoption hereof. 17. Prior modifi cations to audit The entity did not receive any deviations from the National Treasury or the Gauteng Provincial Treasury reports (GPT). There were no prior modifi cations to the audit reports for the entity. 19. Investigation No Investigations were conducted for the Medical 18. Exemptions and deviations Supplies Depot (MSD) for the year ended 31 March received from the National 2018. Treasury Gauteng Medical Supplies Depot REPORT OF THE ACCOUNTING OFFICER for the year ended 31 March 2018

20. Other 22. Conclusion The Depot was still incurring a cost relating to price The fi nancial year 2017/2018 has had many increases not recovered from demanders. This is challenges facing both our department and the MSD. mostly attributable to the back dated approval of Despite these challenges management is pleased to contract price increases by the Gauteng Department report a success story in terms of service delivery of Finance. towards the people of Gauteng. The MSD achieved 100% of all its predetermined objectives making it 21. Acknowledgement(s)/ or possible for medicines to be available in all the public hospitals and clinics in Gauteng throughout the year. Appreciation We look forward to even a better year in 2018/2019. Management would like to acknowledge the enormous contributions made towards the entity 23. Approval and sign off by all our stakeholders including our patients, the The fi nancial statements set out on pages 299 to 324 Gauteng Department of Health, Gauteng Provincial have been approved by the Accounting Offi cer. Treasury and other organs of State. Our sincere appreciations also go 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 health institutions and facilities in the province. We cannot forget our workforce at all levels who tirelessly ensured that the most important stakeholders, the patients, were put fi rst. PROF M LUKHELE ACTING HEAD OF DEPARTMENT: HEALTH 25 May 2018

294 Gauteng Medical Supplies Depot REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

Report of the auditor-general to the Gauteng Provincial Legislature on the Gauteng Medical Supplies Depot

Report on the audit of the fi nancial statements

Opinion 1. I have audited the fi nancial statements of the Gauteng Medical Supplies Depot set out on pages 299 to 324, which comprise the statement of fi nancial position as at 31 March 2018, the statement of fi nancial performance, statement of changes in net assets and statement of cash fl ows for the year then ended, as well as the notes to the fi nancial statements, including a summary of signifi cant accounting policies.

2. In my opinion, the fi nancial statements present fairly, in all material respects, the fi nancial position of the Gauteng Medical Supplies Depot as at 31 March 2018, and its fi nancial performance and cash fl ows for the year then ended in accordance with the South African Standards of Generally Recognised Accounting Practice (SA Standards of GRAP) and the requirements of the Public Finance Management Act of South Africa, 1999 (Act No. 1 of 1999) (PFMA).

Basis for opinion 3. I conducted my audit in accordance with the International Standards on Auditing (ISAs). My responsibilities under those standards are further described in the auditor-general’s responsibilities for the audit of the fi nancial statements section of this auditor’s report.

4. I am independent of the trading entity in accordance with the International Ethics Standards Board for Accountants’ Code of ethics for professional accountants (IESBA code) and the ethical requirements that are relevant to my audit in South Africa. I have fulfi lled my other ethical responsibilities in accordance with these requirements and the IESBA code.

5. I believe that the audit evidence I have obtained is suffi cient and appropriate to provide a basis for my opinion. 295 Responsibilities of the accounting offi cer for the fi nancial statements 6. The accounting offi cer is responsible for the preparation and fair presentation of the fi nancial statements in accordance with the SA Standards of GRAP and the requirements of the PFMA, and for such internal control as the accounting offi cer determines is necessary to enable the preparation of fi nancial statements that are free from material misstatement, whether due to fraud or error.

7. In preparing the fi nancial statements, the accounting offi cer is responsible for assessing the trading entity’s ability to continue as a going concern, disclosing, as applicable, matters relating to going concern and using the going concern basis of accounting unless the accounting offi cer either intends to liquidate the trading entity or to cease operations, or has no realistic alternative but to do so.

Auditor-general’s responsibilities for the audit of the fi nancial statements 8. My objectives are to obtain reasonable assurance about whether the fi nancial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to infl uence the economic decisions of users taken on the basis of these fi nancial statements.

9. A further description of my responsibilities for the audit of the fi nancial statements is included in the annexure to this auditor’s report.

Report on the audit of the annual performance report

Introduction and scope 10. In accordance with the Public Audit Act of South Africa, 2004 (Act No. 25 of 2004) (PAA) and the general notice issued in terms thereof, I have a responsibility to report material fi ndings on the reported performance information against predetermined objectives for selected programmes presented in the annual performance report. I performed procedures to identify fi ndings but not to gather evidence to express assurance. Gauteng Medical Supplies Depot REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

11. My procedures address the reported performance information, which must be based on the approved performance planning documents of the trading entity. I have not evaluated the completeness and appropriateness of the performance indicators included in the planning documents. My procedures also did not extend to any disclosures or assertions relating to planned performance strategies and information in respect of future periods that may be included as part of the reported performance information. Accordingly, my fi ndings do not extend to these matters.

12. I evaluated the usefulness and reliability of the reported performance information in accordance with the criteria developed from the performance management and reporting framework, as defi ned in the general notice, for the following selected programme presented in the annual performance report of the trading entity for the year ended 31 March 2018:

Programme Pages in the annual performance report

Programme 7 – sub-programme Medical Supplies Depot, health care support 287 – 288

13. I performed procedures to determine whether the reported performance information was properly presented and whether performance was consistent with the approved performance planning documents. I performed further procedures to determine whether the indicators and related targets were measurable and relevant, and assessed the reliability of the reported performance information to determine whether it was valid, accurate and complete.

14. I did not raise any material fi ndings on the usefulness and reliability of the reported performance information for the selected programme.

Other matter 15. I draw attention to the matter below. 296 Achievement of planned targets 16. Refer to the annual performance report on pages 287 to 288 for information on the achievement of planned targets for the year and explanations provided for the under- or overachievement of a signifi cant number of targets.

Report on the audit of compliance with legislation

Introduction and scope 17. In accordance with the PAA and the general notice issued in terms thereof, I have a responsibility to report material fi ndings on the compliance of the trading entity with specifi c matters in key legislation. I performed procedures to identify fi ndings but not to gather evidence to express assurance.

18. The material fi ndings on compliance with specifi c matters in key legislation are as follows:

Expenditure management 19. Effective and appropriate steps were not taken to prevent irregular expenditure amounting to R5 973 944, as disclosed in note 20 to the annual fi nancial statements, as required by section 38(1)(c)(ii) of the PFMA and treasury regulation 9.1.1. The majority of the irregular expenditure was caused by contracts procured without inviting competitive bids.

20. Payments were not made within 30 days or an agreed period after receipt of an invoice, as required by treasury regulation 8.2.3.

Procurement and contract management 21. Some of the goods and services with a transaction value above R500 000 were procured without inviting competitive bids. These deviations were approved by the accounting offi cer although it was practical to invite competitive bids, contrary to treasury regulation 16A6.1 and 16A6.4. Similar non-compliance was also reported in the prior year. This non-compliance was identifi ed in the procurement processes for accounting, cleaning and distribution services. Gauteng Medical Supplies Depot REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018

22. Some quotations were awarded to bidders based on preference points that were not allocated and calculated in accordance with the requirements of the Preferential Procurement Policy Framework Act of South Africa, 2000 (Act No. 5 of 2000) and its regulations. This non-compliance was identifi ed in the procurement processes for cleaning and security services.

Other information

23. The trading entity’s accounting offi cer is responsible for the other information. The other information comprises the information included in the annual report. The other information does not include the fi nancial statements, the auditor’s report and the selected programme presented in the annual performance report that has been specifi cally reported in this auditor’s report.

24. My opinion on the fi nancial statements and fi ndings on the reported performance information and compliance with legislation do not cover the other information and I do not express an audit opinion or any form of assurance conclusion thereon.

25. In connection with my audit, my responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the fi nancial statements and the selected programmes presented in the annual performance report, or my knowledge obtained in the audit, or otherwise appears to be materially misstated. If, based on the work I have performed on the other information that I obtained prior to the date of this auditor’s report, I conclude that there is a material misstatement in this other information, I am required to report that fact. I have nothing to report in this regard.

Internal control defi ciencies

26. I considered internal control relevant to my audit of the fi nancial statements, reported performance information and compliance with applicable legislation; however, my objective was not to express any form of assurance on it. The matters reported below are limited to the signifi cant internal control defi ciencies that resulted in the fi ndings on compliance with legislation included in this report.

Leadership 297

27. The accounting offi cer did not exercise adequate oversight responsibility over internal controls relating to procurement and contract management and expenditure management. This resulted in non-compliance with key laws and regulations.

28. The trading entity developed an action plan to address audit fi ndings, but adherence to the plan on key items such as procurement and contract management and expenditure management was not monitored on a timely basis by the appropriate level of management, resulting in fi ndings on non-compliance with the PFMA and treasury regulations.

Financial and performance management

29. Senior management did not ensure that suffi cient monitoring controls were in place over compliance with laws and regulations relating to procurement and contract management as well as expenditure management.

Johannesburg 31 July 2018 Gauteng Medical Supplies Depot REPORT OF THE AUDITOR-GENERAL for the year ended 31 March 2018 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 fi nancial statements, and the procedures performed on reported performance information for the selected programme and on the trading entity’s compliance with respect to the selected subject matters.

Financial statements

2. In addition to my responsibility for the audit of the fi nancial statements as described in this auditor’s report, I also: • identify and assess the risks of material misstatement of the fi nancial statements whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is suffi cient 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 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 offi cer • conclude on the appropriateness of the accounting offi cer’s use of the going concern basis of accounting in the preparation of the fi nancial statements. I also conclude, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast signifi cant doubt on the trading entity’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 fi nancial statements about the material uncertainty or, if such disclosures are inadequate, to modify the opinion on the fi nancial 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 • evaluate the overall presentation, structure and content of the fi nancial statements, including the disclosures, and whether the fi nancial statements represent the underlying transactions and events in a manner that achieves fair presentation 298 Communication with those charged with governance

3. I communicate with the accounting offi cer regarding, among other matters, the planned scope and timing of the audit and signifi cant audit fi ndings, including any signifi cant defi ciencies in internal control that I identify during my audit.

4. I also confi rm to the accounting offi cer 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. Gauteng Medical Supplies Depot STATEMENT OF FINANCIAL POSITION as at 31 March 2018

Note 31 March 31 March 2018 2017 RR ASSETS

Non-current assets 9,581,215 8,935,719

Property, plant and equipment 2 9,581,215 8,932,909 Intangible assets 3 - 2,810

Current assets 1,309,448,754 1,272,656,862

Inventories 4 253,964,393 170,575,221 Trade and other receivables from exchange transactions 5 1,024,065,168 1,099,456,000 Cash and cash equivalents 6 31,419,193 2,625,641

Total assets 1,319,029,969 1,281,592,581

NET ASSETS AND LIABILITIES

Net assets Capital and reserves 563,292,104 454,613,595 299 Medsas capital account 7 104,376,790 104,376,790 Accumulated surplus 458,915,314 350,236,805

Non-current liabilities 312,302 640,358

Financial lease obligation 8 312,302 640,358

Current liabilities 755,425,563 826,338,628

Leave pay accrual 9 3,208,367 2,778,710 Trade and other payables from exchange transactions 10 748,287,487 821,760,111 Short-term provisions 11 3,601,652 1,497,652 Finance lease obligation 8 328,057 302,155

Total net assets and liabilities 1,319,029,969 1,281,592,581 Gauteng Medical Supplies Depot STATEMENT OF FINANCIAL PERFORMANCE for the year ended 31 March 2018

Note 31 March 31 March 2018 2017 RR

Revenue from exchange transactions 12 3,824,656,198 3,718,817,485 Cost of sales 24 (3,642,542,348) (3,541,730,922) Gross profi t 182,113,850 177,086,563

Other income 12 350,523 151,236 Revenue from non exchange transactions 12 12,489,525 4,540,483

Operating expenditure 13 (96,974,415) (100,405,815) Distribution cost (6,635,692) (5,929,780) Administrative expenses (84,830,431) (87,558,429) Other expenses (5,508,292) (6,917,606)

Operating surplus before interest and tax 97,979,483 81,372,467

Finance income 14 10,919,455 5,370,085 Finance cost 14 (220,429) (272,812)

Surplus before taxation 108,678,509 86,469,740 300 Taxation 15 - -

Surplus for the period net of tax 108,678,509 86,469,740

Surplus for the period net of tax attributable to: Gauteng Department of Health 108,678,509 86,469,740 Gauteng Medical Supplies Depot STATEMENT OF CHANGES IN NET ASSETS for the year ended 31 March 2018

MEDSAS Accumulated Total Capital Surplus Account RRR

Balance at 31 March 2016 104,376,790 259,270,173 363,646,963 Prior Period POD Adjustment - 4,496,892 4,496,892 Surplus for the period - 86,469,740 86,469,740 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

301 Gauteng Medical Supplies Depot STATEMENT OF CASH FLOWS for the year ended 31 March 2018

Note 31 March 31 March 2018 2017 RR

Cash fl ows from operating activities

Cash generated from / (utilised in) operations 16 22,986,205 (6,638,477) Finance income 14 10,919,455 5,370,085 Finance costs 14 (220,429) (272,812) Net cash generated from / (utilised in) operating activities 33,685,231 (1,541,204)

Cash fl ows from investing activities

Purchase of property, plant and equipment 2 (4,589,525) (1,294,889) Proceeds on disposal of property, plant and equipment - 5,502 Net cash outfl ow from investing activities (4,589,525) (1,289,387)

Cash fl ows from fi nancing activities

(Repayment of) / Increase in fi nance lease liability 8 (302,154) 369,787 Net cash (outfl ow) / infl ows from fi nancing activities (302,154) 369,787

302 Increase/(decrease) in cash and cash equivalents 28,793,552 (2,460,804) Cash and cash equivalents at the beginning of the year 2,625,641 5,086,445 Cash and cash equivalents at the end of the Period 31,419,193 2,625,641 Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

1.1 Basis of preparation Management then assigns a weighting factor to each of these outcomes based on the probability that the These fi nancial statements were prepared in outcome will materialise in future. The factor is then accordance with the standards of Generally applied to each of the potential outcomes and the Recognized Accounting Practices (GRAP) issued factored outcomes are then added together to arrive by the Accounting Standards Board in accordance at the weighted average value of the provisions. with the Public Finance Management Act, 1999 (Act No.1 of 1999) as amended by the Public Finance Depreciation and amortization Management Amendment Act (Act No. 29 of 1999). Depreciation and amortisation recognised on 1.2 Presentation currency property, plant and equipment is determined with reference to the useful lives and residual values of the The fi nancial statements are presented in South underlying items. The useful lives and residual values African Rand, which is the functional currency of the of assets are based on management’s estimation of entity. the asset’s condition, expected condition at the end 1.3 Rounding of the period of use, its current use, expected future use and the entity’s expectations about the availability Unless otherwise stated, all fi nancial fi gures have of fi nance to replace the asset at the end of its useful been rounded to the nearest Rand (R). life. In evaluating the how, the condition, and use of the asset inform the useful life and residual value. 1.4 Going concern assumption Management considers the impact of technology The annual fi nancial statements were prepared on a and minimum service requirements of the assets. going concern basis, which assumes that the entity Fair value determination of property, plant and will continue to operate as a going concern for at equipment (excluding heritage assets) least the next 12 months.

1.5 Comparative information In determining the fair value of property, plant and equipment the entity applies a valuation methodology Prior year comparatives to determine the fair value based on any one of, or a combination of the following factors: 303 Where necessary, comparative fi gures have been - The market related selling price of the item; or reclassifi ed to conform to changes in presentation in the current year. - The material composition of the item; or - The item’s special features which include design, 1.6 Signifi cant judgements and estimates appendages and improvements; or The use of judgment, estimates and assumptions - The item’s condition with regards to whether it is is inherent to the process of preparing annual broken, in a poor, fair, good or excellent condition. fi nancial statements. These judgements, estimates and assumptions affect the amounts presented in Inventory the annual fi nancial statements. Uncertainties about Inventories that qualify for recognition must initially these estimates and assumptions could result in be stated at cost. Where inventories are acquired at outcomes that require a material adjustment to the no cost, or for nominal consideration, their cost shall carrying amount of the relevant asset or liability in be their fair value at the date of acquisition. future periods. All inventory items at year-end are stated using the Provisions weighted average cost.

Provisions are measured as the present value of In testing for, and determining the value-in-use of the estimated future outfl ows required to settle non-fi nancial assets, management is required to the obligation. In the process of determining the rely on the use of estimates about the asset’s ability best estimate of the amounts that will be required to continue to generate cash fl ows (in the case of in future to settle the provision management cash-generating assets). For non-cash-generating considers the weighted average probability of the assets, estimates are made regarding the depreciated potential outcomes of the provisions raised. This replacement cost, restoration cost, or service units of measurement entails determining what the different the asset, depending on the nature of the impairment potential outcomes are for a provision as well as the and the availability of information. fi nancial impact of each of those potential outcomes. Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

1.7 Financial instruments Off-setting

Initial recognition The entity does not offset fi nancial assets and fi nancial liabilities in the Statement of Financial The entity recognises a fi nancial asset or a fi nancial Position unless a legal right of set-off exists and the liability in its Statement of Financial Position when, parties intend to settle on a net basis. and only when, the entity becomes a party to the contractual provisions of the instrument. This is Impairments achieved through the application of trade date accounting. All fi nancial assets measured at amortised cost are subject to an impairment review. The entity assesses Upon initial recognition the entity classifi es fi nancial at the end of each reporting period whether there is instruments or their component parts as fi nancial any objective evidence that a fi nancial asset or group liabilities or fi nancial assets in conformity with the of fi nancial assets is impaired. substance of the contractual arrangement and to the extent that the instrument satisfi es the defi nitions of If there is objective evidence that an impairment loss a fi nancial liability or a fi nancial asset,in accordance on fi nancial assets measured at amortised cost has with the standards of GRAP on Financial instruments been incurred, the amount of the loss is measured as - GRAP 104 the difference between the asset‘s carrying amount and the present value of estimated future cash fl ows Trade and other receivables (excluding future credit losses that have not been incurred) discounted at the fi nancial asset‘s original Trade and other receivables are initially recognised effective interest rate (i.e. the effective interest at fair value plus transaction costs that are directly rate computed at initial recognition). The carrying attributable to the acquisition and subsequently amount of the asset is reduced through the use of stated at amortised cost, using the effective interest an allowance account. The amount of the loss is rate method. recognised in surplus or defi cit.

Cash and cash equivalents 1.8 Inventories 304 Cash and cash equivalents are measured at amortised Initial recognition and measurement cost using the effective interest rate method. Inventories are initially recognised at cost. Cost refers Cash includes cash on hand and cash with banks. Cash to the purchase price, plus taxes, transport costs and equivalents are short-term highly liquid investments any other costs in bringing the inventories to their that are held with registered banking institutions current location and condition. with maturities of three months or less and are subject to an insignifi cant risk of change in value. Subsequent measurement For the purposes of the Cash Flow Statement, cash and cash equivalents comprise cash on hand and Inventories will be measured at the lower of cost and deposits held on call with banks. the net realizable value. Inventories are stated on a weighted average moving basis with the same cost Trade and other payables formula being used for all inventories having a similar nature and use at the entity. Trade payables are initially measured at fair value plus transaction costs that are directly attributable Redundant and slow-moving inventories are identifi ed to the acquisition and are subsequently measured and written down from cost to net realisable value at amortised cost using the effective interest rate with regard to their estimated economic or realisable method. values. The amount of any reversal of any write- down of inventories arising from an increase in Gains and losses net realisable value is recognised as a reduction of inventories recognised as an expense in the period in A gain or loss arising from a change in the fair value which the reversal occurs. of a fi nancial asset or fi nancial liability measured at fair value is recognised in surplus or defi cit. Derecognition

For fi nancial assets and fi nancial liabilities measured The carrying amount of inventories is recognized as at amortised cost or cost, a gain or loss is recognised an expense in the period that the inventory was sold, in surplus or defi cit when the fi nancial asset or distributed, written off or consumed, unless that fi nancial liability is derecognised or impaired or cost qualifi es for capitalization to the cost of another through the amortisation process. asset. Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

1.9 Property, plant and equipment Subsequent measurement Initial recognition and measurement Subsequent to initial recognition, items of property, The cost of an item of property, plant and equipment plant and equipment are measured at cost less is the purchase price and other costs directly accumulated depreciation and impairment losses. attributable to bring the asset to the location and Depreciation condition necessary for it to be capable of operating in the manner intended by the entity. Trade discounts Depreciation is calculated on the depreciable amount, and rebates are deducted in arriving at the cost at using the straight-line method over the estimated which the asset is recognised. The cost also includes useful lives of the assets. Components of assets the estimated costs of dismantling and removing the that are signifi cant in relation to the whole asset asset. and that have different useful lives are depreciated separately. The depreciable amount is determined Items of property, plant and equipment are initially after taking into account an assets’ residual value, recognised as assets on acquisition date and are where applicable. initially recorded at cost where acquired through exchange transactions. However, when items of The assets’ residual values, useful lives and property, plant and equipment are acquired through depreciation methods are reviewed at each fi nancial non-exchange transactions, those items are initially year-end and adjusted prospectively, if appropriate. measured at their fair values as at the date of acquisition.

The annual depreciation rates are based on the following estimated asset useful lives:

Asset classifi cation Average useful lives (Years) Fixtures and fi ttings Buildings 10 Motor vehicles - 305 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 Lab Equipment 3 - 21 Security Equipment 1 - 21 Vehicles 9 - 19 Warehouse Equipment 3 - 16 Workshop and tools 3 - 21 Offi ce furniture - Kitchen Appliances 3 - 23 Offi ce equipment 1 - 23 Computer equipment 1 - 18 Cellphones & Accessories 2 Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

Impairment Subsequent measurement

The entity tests for impairment where there is Intangible assets are subsequently carried at cost less an indication that an asset may be impaired. An accumulated amortisation and impairments. assessment of whether there is an indication of possible impairment is done at each reporting date. The cost of an intangible asset is amortised over Where the carrying amount of an item of property, the useful life where that useful life is fi nite. The plant and equipment is greater than the estimated amortisation expense on intangible assets with fi nite recoverable amount (or recoverable service amount), lives is recognised in the Statement of Financial it is written down immediately to its recoverable Performance in the expense category consistent with amount (or recoverable service amount) and an the function of the intangible asset. impairment loss is charged to the Statement of Intangible assets with indefi nite useful lives are not Financial Performance. amortised, but are tested for impairment annually, Where items of property, plant and equipment have either individually or at the cash generating unit been impaired, the carrying value is adjusted by the level. The assessment of indefi nite life is reviewed impairment loss, which is recognised as an expense annually to determine whether the indefi nite life in the Statement of Financial Performance in the assumption continues to be supportable. If not, the period that the impairment is identifi ed. change in useful life from indefi nite to fi nite is made on a prospective basis. An impairment is reversed only to the extent that the asset’s carrying amount does not exceed the Amortisation and impairment carrying amount that would have been determined Amortisation is charged to write-off the cost of had no impairment been recognised. A reversal of intangible assets over their estimated useful lives the impairment is recognised in the Statement of using the straight-line method. Financial Performance. The annual amortisation rates are based on the Derecognition following estimated average asset lives: 306 Items of property, plant and equipment are Intangible Asset Average Useful Life derecognised when the asset is disposed of or when Computer Software 3-5 years there are no further economic benefi ts or service potential expected from the use of the asset. The The amortisation period, the amortisation method gain or loss arising on the disposal or retirement of an and residual value for intangible assets with fi nite item of property, plant and equipment is determined useful lives are reviewed at each reporting date and as the difference between the sales proceeds and the any changes are recognised as a change in accounting carrying value and is recognised in the Statement of estimate in the Statement of Financial Performance. Financial Performance. Impairments 1.10 Intangible Assets The entity tests intangible assets with fi nite useful Initial recognition and measurement lives for impairment where there is an indication that an asset may be impaired. An assessment of An intangible asset is an identifi able non-monetary whether there is an indication of possible impairment asset without physical substance. The entity is performed at each reporting date. Where the recognises an intangible asset in its Statement of carrying amount of an item of an intangible asset Financial Position only when it is probable that is greater than the estimated recoverable amount the expected future economic benefi ts or service (or recoverable service amount), it is written down potential that are attributable to the asset will fl ow immediately to its recoverable amount (or recoverable to the entity and the cost or fair value of the asset service amount) and an impairment loss is charged to can be measured reliably. the Statement of Financial Performance.

Intangible assets are initially recognised at cost. Derecognition

Where an intangible asset is acquired by the entity Intangible assets are derecognised when the asset is for no or nominal consideration (i.e. a non-exchange disposed of or when there are no further economic transaction), the cost is deemed to be equal to the benefi ts or service potential expected from the asset. fair value of that asset on the date acquired. The gain or loss arising on the disposal or retirement of an intangible asset is determined as the difference Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018 between the sales proceeds and the carrying value interest portion of the liability is effected through the and is recognised in the Statement of Financial application of the effective interest method. Performance. The fi nance charges resulting from the fi nance lease 1.11 Leases are expensed, through the Statement of Financial Performance, as they accrue. The fi nance cost accrual The entity as lessee in an operating lease is determined using the effective interest method. Assets subject to operating leases, i.e. those leases The fi nance lease liabilities are derecognised where substantially all of the risks and rewards of when the entity’s obligation to settle the liability ownership are not transferred to the lessee through is extinguished. The assets capitalised under the the lease, are not recognised in the Statement of fi nance lease are derecognised when the entity no Financial Position. The operating lease expense is longer expects any economic benefi ts or service recognised over the course of the lease arrangement. potential to fl ow from the asset.

The lease expense recognised for operating leases is 1.12 Revenue from exchange transactions charged to the Statement of Financial Performance on a straight-line basis over the term of the relevant Revenue is recognised by the entity for goods sold, lease. To the extent that the straight-lined lease the value of which approximates the consideration payments differ from the actual lease payments the received or receivable, excluding indirect taxes, difference is recognised in the Statement of Financial rebates and discounts. Position as either lease payments in advance (operating lease asset) or lease payments payable Revenue is only recognised when all of the following (operating lease liability) as the case may be. This criteria are satisfi ed: resulting asset and / or liability is measured as the • The entity retains neither continuing managerial undiscounted difference between the straight-line involvement to the degree usually associated lease payments and the contractual lease payments. with ownership nor effective control over the goods sold; The operating lease liability is derecognised when the • The amount of revenue can be measured reliably; entity’s obligation to settle the liability is extinguished. and 307 The operating lease asset is derecognised when the • It is probable that the economic benefi ts or entity no longer anticipates economic benefi ts to service potential associated with the transaction fl ow from the asset. will fl ow to the entity and the costs incurred or to be incurred in respect of the transaction can be The entity as lessee in a fi nance lease measured reliably. Leases are classifi ed as fi nance leases where 1.13 Revenue from non-exchange substantially all the risks and rewards associated transactions Gifts and donations, with ownership of an asset are transferred to the including goods in-kind entity through the lease agreement. Assets subject to fi nance leases are recognised in the Statement of Gifts and donations, including goods in kind, shall Financial Position at the inception of the lease, as is be recognised as income in the period it is received the corresponding fi nance lease liability. provided that all of the following conditions have been satisfi ed: Assets subject to a fi nance lease, as recognised in the Statement of Financial Position, are measured • The amounts of the donations, gifts, goods-in- (at initial recognition) at the lower of the fair value kind and penalties can be measured reliably. of the assets and the present value of the future • There is an existing signed contract with the minimum lease payments. Subsequent to initial supplier that includes a paragraph on penalties; recognition these capitalised assets are depreciated • It is probable that the economic benefi ts over the contract term. comprising of the donation will fl ow to the entity; and The fi nance lease liability recognised at initial • The amounts of the donations, gifts, goods-in- recognition is measured at the present value of the kind and penalties can be measured reliably. future minimum lease payments. Subsequent to initial recognition this liability is carried at amortised Gauteng Medical Supplies does not account for cost, with the lease payments being set off against the economic benefi t received in the Statement of the capital and accrued interest. The allocation Financial Performance, as the depot is considered to of the lease payments between the capital and be only a conduit for hospitals and to control the receipt of donations for the Department. Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

1.14 Borrowing costs 1.17 Employee Benefi ts

Borrowing costs directly attributable to the Short term employee benefi ts acquisition, construction or production of qualifying assets are capitalised to the cost of that asset unless Short term employee benefi ts encompasses all those it is inappropriate to do so. The entity ceases the benefi ts that become payable in the short term, i.e. capitalisation of borrowing costs when substantially within a fi nancial year or within 12 months after all the activities to prepare the asset for its the fi nancial year. Therefore, short term employee intended use or sale are complete. It is considered benefi ts include remuneration, compensated inappropriate to capitalise borrowing costs where absences and bonuses. the link between the funds borrowed and the capital Short term employee benefi ts are recognised in the asset acquired cannot be adequately established. Statement of Financial Performance as services are Borrowing costs incurred other than on qualifying rendered, except for non-accumulating benefi ts, assets are recognised as an expense in the Statement which are recognised when the specifi c event occurs. of Financial Performance when incurred. These short-term employee benefi ts are measured at 1.15 Irregular expenditure their undiscounted costs in the period the employee renders the related service or the specifi c event Irregular expenditure is recognised as expenditure occurs. in the Statement of Financial Performance. If the expenditure is not condoned by the relevant Retirement benefi t costs authority, it is treated as an asset until recovered or The Depot provides retirement benefi ts for its written off as irrecoverable. employees through a defi ned benefi t plan for 1.16 Fruitless and wasteful expenditure government employees. These benefi ts are funded by both employer and employee contributions. Fruitless and wasteful expenditure is defi ned as Employer contributions to the fund are expensed expenditure that was made in vain and would have when money is paid to the fund. No provision or been avoided had reasonable care been exercised, benefi t accounting is disclosed for retirement benefi ts 308 therefore: in the fi nancial statements as the obligation and plan • It must be recovered from a responsible offi cial (a assets is the responsibility of the multi-employer debtor account should be raised) or Government Employee Pension Fund resorting under • The Vote (If responsibility cannot be determined). the control of National Treasury.

Such expenditure is treated as expenditure in the 1.18 Events after reporting date Statement of Financial Performance and where Revenue from non exchange transactions - sale recovered, it is subsequently accounted for as of goods revenue in the Statement of Financial Performance. Due to nature of business at the MSD (where expired Two types of events can be identifi ed: stock and stock breakages is inherent to the business • those that provide evidence of conditions that of MSD), expired and stock breakages will only be existed at the reporting date (adjusting events recognised as fruitless and wasteful expenditure after the reporting date); and if their total value is higher than 2% of average • those that are indicative of conditions that arose stock holding. Qualitative consideration would also after the reporting date (non-adjusting events be considered to disclose fruitless and wasteful after the reporting date). expenditure. The entity will adjust the amounts recognised in the Recovery of Irregular and fruitless and wasteful fi nancial statements to refl ect adjusting events after expenditure the reporting date once the event occurred.

The recovery of unauthorised, irregular, fruitless The entity will disclose the nature of the event and and wasteful expenditure is based on legislated estimate its fi nancial effect or a statement that such procedures, and is recognised when the recovery estimate cannot be made in respect of all material thereof from the responsible offi cials is probable. non-adjusting events, where non-disclosure could The recovery of unauthorised, irregular, fruitless and infl uence the economic decisions of users taken on wasteful expenditure is treated as other income. the basis of the fi nancial statements. Gauteng Medical Supplies Depot ACCOUNTING POLICIES for the year ended 31 March 2018

1.19 Related Parties 1.20 Standards, amendments to standards and interpretations issued not yet The entity has processes and controls in place to aid effective. in the identifi cation of related parties. A related party is a person or an entity with the ability to control or The following Standards of GRAP and / or jointly control the other party, or exercise signifi cant amendments thereto have been issued by the infl uence over the other party, or vice versa, or an Accounting Standards Board, but will only become entity that is subject to common control, or joint effective in future periods or have not been given an control. Related party relationships where control effective date by the Minister of Finance. The entity exists are disclosed regardless of whether any has not early-adopted any of these new Standards or transactions took place between the parties during amendments thereto, but has referred to them for the reporting period. guidance in the development of accounting policies in accordance with GRAP 3 as read with Directive 5: Where transactions occurred between the entity any one or more related parties, and those transactions Standard name and number Effective date( if were not within: applicable) • normal supplier and/or client/recipient GRAP 20 - Related Party Approved and not yet Disclosures effective relationships on terms and conditions no more or GRAP 32 - Service Concession Approved and not yet less favourable than those which it is reasonable Arrangements: Grantor effective to expect the entity to have adopted if dealing GRAP 108 - Statutory Receivables Approved and not yet with that individual entity or person in the same effective circumstances; and GRAP 109 - Accounting by Approved and not yet • terms and conditions within the normal operating Principles and Agents effective parameters established by the reporting entity’s legal mandate.

Further details about those transactions are disclosed in the notes to the fi nancial statements. 309 Information about such transactions is disclosed in the fi nancial statements. 310

2. PROPERTY, PLANT AND EQUIPMENT

2018 2017 Cost Accumulated Carrying value Cost Accumulated Carrying value depreciation at end of the depreciation at end of the year year Owned assets NOTES TOTHEFINANCIALSTATEMENTS Computer equipment 3,666,290 (3,310,433) 355,857 3,625,163 (3,335,195) 289,968 Cellphones & Accessories 54,185 (8,758) 45,427 - - - fi xtures and fi ttings 10,625 (10,625) - 10,625 (10,625) - Offi ce furniture 5,047,284 (4,271,430) 775,854 5,017,633 (4,018,179) 999,454 for theyearended31March 2018 Plant and equipment 23,359,094 (15,471,575) 7,887,519 19,755,577 (12,958,225) 6,797,352Gauteng MedicalSuppliesDepot 32,137,478 (23,072,821) 9,064,657 28,408,998 (20,322,224) 8,086,774 Leased Assets Motor vehicles - G-Fleet 792,816 (399,260) 393,556 792,816 (201,641) 591,175 Offi ce equipment 395,874 (272,872) 123,002 395,874 (140,914) 254,960 Cell phones - - - 1 - 1,188,690 (672,132) 516,558 1,188,691 (342,556) 846,135

33,326,168 (23,744,953) 9,581,215 29,597,689 (20,664,780) 8,932,909 2. PROPERTY, PLANT AND EQUIPMENT continue

2018- Reconciliation of Property Plant & Equipment Carrying value Additions Disposals/ Accumulated Depreciation Carrying value at beginning of Impairment depreciation Charge at end of the the year on disposals/ year impairment

Owned assets NOTES TOTHEFINANCIALSTATEMENTS Computer equipment 289,968 199,514 (158,387) 158,026 (133,264) 355,857 Cellphones & Accessories 54,185 - - (8,758) 45,427 Fixtures and fi ttings ------for theyearended31March 2018

Offi ce furniture 999,454 101,575 (71,924) 65,754 (319,005) 775,854Gauteng MedicalSuppliesDepot 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 Offi ce equipment 254,960 - - - (131,958) 123,002 Cell phones ------846,135 - - - (329,577) 516,558

8,932,909 4,728,974 (1,000,494) 958,594 (4,038,768) 9,581,215 311 312

2. PROPERTY, PLANT AND EQUIPMENT continue 2017 - Reconciliation of Property Plant & Equipment Carrying value Additions Disposals/ Accumulated Depreciation Carrying value at beginning of Impairment depreciation Charge at end of the the year on disposals/ year impairment Owned assets NOTES TOTHEFINANCIALSTATEMENTS Computer equipment 508,619 33,998 (864,046) 823,669 (212,272) 289,968 fi xtures and fi ttings ------Offi ce furniture 1,169,342 355,151 (1,073,465) 1,057,230 (508,804) 999,454 Plant and equipment 9,949,754 213,182 (583,287) 580,954 (3,363,251) 6,797,352 for theyearended31March 2018 11,627,715 602,331 (2,520,798) 2,461,853 (4,084,327) 8,086,774Gauteng MedicalSuppliesDepot Leased Assets

Motor vehicles - G-Fleet 277,937 499,900 - - (186,662) 591,175 Offi ce equipment 251,226 192,658 (422,324) 422,324 (188,924) 254,960 Cell phones 25,737 - (122,768) 122,768 (25,737) - 554,900 692,558 (545,092) 545,092 (401,323) 846,135

12,182,615 1,294,889 (3,065,890) 3,006,945 (4,485,650) 8,932,909 Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR 3. INTANGIBLE ASSETS

Computer software

Cost 82,422 98,154 Accumulated amortisation (82,422) (95,344) Carrying value at end of the year - 2,810

Carrying value at beginning of the year 2,810 5,957 Additions - - Disposals/ Impairment (15,732) - Accumulated amortisation on disposals/ impairment 15,732 - Amortisation Charge (2,810) (3,147) Carrying value at end of the year - 2,810

4. INVENTORIES

APK 108,534,524 93,698,724 ARV 144,890,500 76,207,470 Operational stock 539,369 669,027 313 253,964,393 170,575,221

The valuation method used by the Depot is the weighted average moving basis based on cost price. There was no impairment of inventory raised at 31 March 2018 (2017: Not Impaired). Management has assessed impairment at year end individually and based on this assessment no impairment of inventory has been raised (2017: Nil).

Details of Inventory written-off during the period is as follows: Breakages 7,633 3,288 Expired stock 1,166,028 2,016,734 Inventory Count variance 24,382 (24,273) Total inventory written off 1,198,043 1,995,749

No other write down of inventory to net realizable value was required during the current year. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR 5. TRADE AND OTHER RECEIVABLES FROM EXCHANGE TRANSACTIONS

Trade receivables 1,023,221,913 1,097,772,891 Other receivables 843,255 1,683,109 (Refer to note 17 for fair values) 1,024,065,168 1,099,456,000

Trade receivables are non-interest bearing and the general terms of repayment is 30 days. There were trade receivable amounts older than 30 days as at year end, management has assessed them individually and collectively and has come to the conclusion that there is no reason to believe that these amounts will not be recovered hence no impairment of trade receivables was recognized for the year ended 31 March 2018 (2017: R Nil). These trade receivables have not been discounted due to the fact that the effect of discounting upon assessment was considered not to be material.

As at 31 March 2018, the age analysis of trade receivables that were due but not impaired is as follows:

< 30 days 469,861,373 415,326,081 > 30 days 553,360,540 682,446,810 Total 1,023,221,913 1,097,772,891 314 6. CASH AND CASH EQUIVALENTS

Bank balance 31,417,693 2,624,141 Petty cash 1,500 1,500 31,419,193 2,625,641

Cash and cash equivalents earn interest at fl oating rates based on daily bank deposit rates. The fi nance income is recognized in the Statement of Financial Performance.

7. MEDSAS CAPITAL ACCOUNT

MEDSAS capital account 104,376,790 104,376,790

Capital is used for the operating expenses of the Depot and for the purchasing of inventory. The Gauteng Department of Health provided capital of R 104 376 790, after Treasury approval was obtained. There were no movements in the current year. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR 8. FINANCE LEASE OBLIGATIONS

Minimum lease payments Within 1 year 453,199 522,584 Within the 2nd to 5th year 398,633 851,831 851,832 1,374,415 Less: Future fi nance charges (211,473) (431,902) Present value of lease obligations 640,359 942,513

The present value of lease obligations can be analysed as follows: Within 1 year 328,057 302,155 Within the 2nd to 5th year 312,302 640,358 640,359 942,513 Less: Current portion (328,057) (302,155) 312,302 640,358

9. LEAVE ACCRUAL

Balance at the beginning of the year 2,778,710 3,106,741 315 Net accrual raised during the year 429,657 (328,031) Balance at the end of the year 3,208,367 2,778,710

A leave accrual is recognised for leave due to employees at each period end. 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.

10. TRADE AND OTHER PAYABLES FROM EXCHANGE TRANSACTIONS

Trade payables 738,071,477 815,812,485 Sundry creditors 10,216,010 5,947,626 748,287,487 821,760,111

Trade payables are non-interest bearing and are generally repayable within 30 days. These accounts have not been discounted due to the fact that the effect of discounting is not signifi cant.

As at 31 March 2018, the age analysis of trade payables that were due but not impaired is as follows:

< 30 days 433,655,240 187,791,609 > 30 days 304,416,237 628,020,876 Total 738,071,477 815,812,485 Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR 11. SHORT-TERM PROVISIONS

Provision for Performance Bonus

Opening balance 1,497,652 1,529,000 Provision raised 2,104,000 1,299,287 Provision utilised - (1,330,635) 3,601,652 1,497,652

12. REVENUE AND OTHER INCOME

Revenue from exchange transactions - sale of goods 3,824,656,198 3,718,817,485 Revenue from non exchange transactions - Penalties on late delivery of supplies 12,489,525 4,540,483 Other Income 350,523 151,236 3,837,496,246 3,723,509,204

13. OPERATING EXPENDITURE

Distribution cost: 6,635,692 5,929,780 316 Fees for distribution costs 6,191,817 5,155,947 Rental and Hiring 443,875 773,833

Administrative expenses: 84,830,431 87,558,429 Staff Costs 62,336,481 55,907,512 Contribution to defi ned benefi t plan 5,998,058 5,553,453 Communication 311,769 427,935 Stationery and printing 851,214 824,288 Other administrative expenses 8,269,292 17,915,161

Fees for services: Audit fees 1,833,716 1,379,373 Repairs and Maintenance:Property, Plant and Equipment 1,964,453 271,331 Security 3,265,448 5,279,376

Other expenses: 5,508,292 6,917,606 Depreciation owned assets 3,709,192 4,084,327 Depreciation leased assets 329,577 401,324 Amortization of intangible assets 2,810 3,147 External training 226,770 374,691 Scrapping of property, plant and equipment 41,900 58,368 Inventory written off 1,198,043 1,995,749

Total operating expenditure 96,974,415 100,405,815 Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR 14. FINANCE COST AND FINANCE INCOME

Finance cost: Capitalized fi nance lease charges 220,429 272,812

Finance income: Interest received - Bank balances 10,919,455 5,370,085

15. TAXATION

No provision has been made for taxation as the Depot is exempt from income taxation in terms of section 10 (1) of the South African Income Tax Act No.58 of 1962.

16. CASH GENERATED FROM/ (UTILIZED IN) OPERATIONS

Operating surplus Before Interest and Tax 97,979,483 81,372,467

Depreciation on property, plant and equipment 4,038,769 4,485,651 Amortisation of intangible assets 2,810 3,147 317 Net movement in leave pay accrual 429,657 (328,031) Net movement in provision for Performance Bonus 2,104,000 (31,348) Gain on disposal of property, plant and equipment - (4,925) Loss on the disposal of property, plant and equipment 41,900 58,368 Inventory written off 1,198,043 1,995,749 Other non-cash items (139,450) 4,496,891 Operating surplus before changes in working capital 105,655,212 92,047,969

Movement in working capital (Increase)/Decrease in inventories (84,587,215) 138,525,738 Decrease/(Increase) in trade and other receivables 75,390,832 (655,424,368) (Decrease)/Increase in trade and other payables (73,472,624) 418,212,184 (82,669,007) (98,686,446)

22,986,205 (6,638,477)

17. 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 28.1 in order to monitor and control these risks. The risk management process relating to each of these risks is discussed under the headings below. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

17. RISK MANAGEMENT (Continued)

Interest rate risk

The entity is not exposed to signifi cant interest rate risk as there is no internal funding other than cash and fi nance leases. The following table set out the carrying amount, by maturity, of the entity’s fi nancial instruments exposed to interest rate risk:

31 March 2018 Within 1 year Within 2 - 5 Total years RRR Cash and cash equivalents 31,419,193 - 31,419,193 Finance lease obligations 328,057 312,302 640,359 Trade receivables 1,023,221,913 - 1,023,221,913 Trade payables 738,071,477 - 738,071,477

31 March 2017 R R R Cash and cash equivalents 2,625,641 - 2,625,641 Finance lease obligations 302,155 640,358 942,513 Trade receivables 1,097,772,891 - 1,097,772,891 Trade payables 815,812,485 - 815,812,485

The entity’s fi nancial 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:

Increase in Effects on 318 interest rate surplus before by: taxation 31 March 2018 R Cash and cash equivalents 1% 314,192 Finance lease obligations 1% (6,404) Trade receivables 1% 10,232,219 Trade payables 1% (7,380,715)

31 March 2017 R Cash and cash equivalents 1% 26,256 Finance lease obligations 1% (9,425) Trade receivables 1% 10,977,729 Trade payables 1% (8,158,125)

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 fi nancial 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. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018 17. RISK MANAGEMENT (Continued) Credit risk (continued)

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 week by Central Offi ce 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 benefi ciaries 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:

31 March 31 March 2018 2017 R R

Trade and other receivables ( less than 3 months) 102,322,1913 1,097,772,891 Cash and cash equivalents (less than 3 months) 31,419,193 2,625,641 Finance lease obligation - long term (2 to 5 years) 312,302 640,358 319 Finance lease obligation - short term ( less than 1 year) 328,057 302,155 Trade and other payables ( Less than 3 months) 748,287,487 821,760,111

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.

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 fl uctuations. 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 fl uctuation of foreign exchange rates. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

17. RISK MANAGEMENT (Continued)

Fair values

At 31 March 2018, 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:-

31 March 31 March 2018 2017 R R Financial Assets

Carrying Amount Cash and cash equivalents 31,419,193 2,625,641 Trade and other receivables from exchange transactions 1,024,065,168 1,099,456,000

Fair Value Cash and cash equivalents 31,419,193 2,625,641 Trade and other receivables from exchange transactions 1,024,065,168 1,099,456,000

Financial Liabilities

Carrying Amount Trade and other payables from exchange transactions 748,287,487 821,760,111 Finance lease obligation 328,057 302,155

Fair Value 320 Trade and other payables from exchange transactions 748,287,487 821,760,111 328,057 302,155

Capital Management

The primary objective of the entity’s capital management is to ensure that it maintains a strong credit rating and healthy ratios in order to support its business and maximise value.

31 March 31 March 2018 2017 R R

Trade and other payables from exchange transactions 748,287,487 821,760,111 Finance obligations 328,057 302,155 Less: cash and cash equivalents (31,419,193) (2,625,641) Net debt 717,196,351 819,436,625 Equity/capital 563,292,104 454,613,595 Capital and net debt 153,904,247 364,823,030 Gearing ratio 21% 44.52%

18. CONTINGENT LIABILITIES

There were no contingent liabilities outstanding as at 31 March 2018 (2017: Nil) Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR

19. 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 did not exceed 2% of the average inventory on hand.

20. IRREGULAR EXPENDITURE

Opening Balance 1,372,640,477 1,308,683,480 Current year Irregular expenditure** 5,973,944 63,956,997 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 1,378,614,421 1,372,640,477

**The current year irregular expenditure relates to non-compliance with supply chain management policies for a number of 321 national, provincial and Departmental contracts. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR

21. KEY MANAGEMENT PERSONNEL EMOLUMENTS

The key performance areas of the post of a Depot Manager was reviewed when the Medicines and Related Substances Control Act came into effect on 1 July 2005. In an attempt to strengthen pharmaceutical services in the province and the key performance areas of the Depot manager, a decision was made to use the post of Chief Director: Clinical Support Services on a pro-rata basis with the post of the Depot manager. This split is a time basis of 50:50. The expense related to the compensation of this post is not part of the Depot but funded in full by the Gauteng Department of Health. No loan, profi t sharing or schemes available to key personnel and all personnel of the Depot are not considered as offi ce holders as defi ned in the Public Service Act.

Director Administration: Mr J M Smidt* Salary 554,076 530,604 Bonuses and performance payments 47,409 44,937 Expense allowance 251,181 240,543 Pension Contribution 72,029 68,979 924,695 885,063 Director Pharmaceutical Services: Mr S Choma** Salary - 86,418 Bonuses and performance payments - - Expense allowance - 39,176 Pension Contribution - 11,234 322 - 136,828

Director Pharmaceutical Services: Mr D Malele *** Salary 682,726 159,375 Bonuses and performance payments 57,003 - Expense allowance 122,829 28,274 Pension Contribution 88,757 20,719 951,315 208,368

* Mr JM Smidt is remunerated by the Gauteng Medical Supplies Depot but is not actively involved in the day-to-day operations. ** Mr S. Choma is no longer remunerated by the Gauteng Medical Supplies Depot *** Mr D. Malele was appointed as Director: Phamaceutical Services on the 01 January 2017. Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR

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:

Operating leases - equipment Minimum lease payments due Within 1 year 187,553 183,722 Within 2 to 5 years 17,100 153,102 204,653 336,824

The lease agreements are not renewable at the end of the lease term and the Depot does not have the option to acquire the equipment . The lease agreements do not impose any restrictions. The lease agreements’ escalation rate is 0%.

23. RELATED PARTY TRANSACTIONS AND BALANCES

The medical Supplies Depot is a trading entity under the control of the Gauteng Department of Health. All transactions with the Department of Health are considered to be related party transactions and are at arm’s length.

Name of related party Relationship 323 Gauteng Department of Health Controlling entity

Related party balances

Gauteng Department of Health - Receivables 1,023,221,913 1,097,772,891

Gauteng Department of Health - Sales 3,824,656,198 3,718,817,485

Gauteng Department of Infrastructure Development (GDID) The building currently occupied by the Medical Supplies Depot belongs to GDID at no rental fee. Market related rentals are estimated at R9.3 million

24. COST OF SALES

Actual cost of sales prior to adjustments 3,642,529,712 3,541,730,938 Other Adjustments 12,636 (16) Cost of sales as reported 3,642,542,348 3,541,730,922 Gauteng Medical Supplies Depot NOTES TO THE FINANCIAL STATEMENTS for the year ended 31 March 2018

31 March 31 March 2018 2017 RR

25. COMMITMENTS Approved, contracted and not provided for in the statement of fi nancial position - Cleaning services - 1,040,151 - Distribution services 18,052,125 3,450,790 18,052,125 4,490,941

Time distribution of commitments that are approved, contracted and not provided for in the statement of fi nancial position < 1 year 6,657,895 4,490,941 1 - 2 years 11,394,230 - 3 - 5 years - - 18,052,125 4,490,941

26 CHANGE IN ACCOUNTING ESTIMATE Property ,Plant & Equipment original useful lives have been reassesed as per table below in the beginning of the current fi nancial period to refl ect the actual pattern service potential drived from the assets. The depreciation is to be calculated on a straight line basis for the remaining useful lives of the assets.

Asset class Useful life Computer Equipment 1 - 18 years 324 Offi ce Furniture 1 - 23 years Plant & Equipment 1 - 21 years

The change in the useful lives of the assets had the following impact on depreciation Current year (Decrease) Computer Equipment 68,495 Offi ce Furniture 132,084 Plant & Equipment 150,397 350,976

27 EVENTS AFTER REPORTING DATE

An amount of R 903 316 639 was received from the Department of Health related to outstanding trade receivables at the year end by 15 May 2018.

There were no other signifi cant events identifi ed by management that may have a signifi cant impact on the entity’s fi nancial position as at 31 March 2018, its fi nancial performance or its cash fl ows for the period then ended. GAUTENG PROVINCIAL GOVERNMENT (GPG)

Report of the Audit Committee – Cluster 03 The Audit Committee noted that the Accounting Offi cer attended all fi ve scheduled Audit Committee Medical Supplies Depot meetings. The Audit Committee is satisfi ed that the We are pleased to present our report for the fi nancial Department adhered to the provisions of the GPG year ended 31 March 2018. Audit Committee Charter in relation to ensuring that there is proper representation for the Accounting Audit Committee and Attendance Offi cer.

The Members of the Audit Committee met with the The Audit Committee consists of the external Senior Management of the Entity, Internal Audit and Members listed hereunder and is required to meet the AGSA, individually and collectively to address a minimum of at least two times per annum as per risks and challenges facing the Entity. A number of provisions of the Public Finance Management Act in-committee meetings were held to address control (PFMA). In terms of the approved Terms of Reference weaknesses and deviations within the Entity. (GPG Audit Committee Charter), fi ve meetings were Audit Committee Responsibility held during the current year, i.e. three meetings to consider the Quarterly Performance Reporting The Audit Committee reports that it has complied (fi nancial and non-fi nancial) and two meetings to with its responsibilities arising from section 38(1)(a) review and discuss the Annual Financial Statements of the PFMA and Treasury Regulation 3.1.13. The and the Auditor-General of South Africa’s (AGSA) Audit Committee also reports that it has adopted Audit and Management Reports. appropriate formal terms of reference as its Audit Committee Charter, has regulated its affairs in Non-Executive Members compliance with this Charter and has discharged all Name of Member Number of its responsibilities as contained therein. Meetings attended The effectiveness of internal control and 325 Mr. Japie du Plessis (Chairperson) 05 Information and Communication Technology Mr. Michael Sass 04 (ICT) Governance Ms. Precious Sibiya 04 The Audit Committee has observed that the overall Executive Members control environment of the Entity has continued to improve during the year under review. Some In terms of the GPG Audit Committee Charter, defi ciencies in the system of internal control and offi cials listed hereunder are obliged to attend deviations were reported in the Internal Audit meetings of the Audit Committee: and Auditor-General Reports. The overall opinion of Internal Audit on the internal control design Compulsory Attendees Number of at the Entity is partially adequate and effective. Meetings attended Management should pay special attention to IT general controls and Occupational Health and Safety Ms. Nocawe Thipa (Chief Executive 05 Offi cer) processes Mr. Malokolo Shai (Acting Chief 02 Financial Offi cer) The Audit Committee also reviewed the progress with respect to the ICT Governance in line with the Ms. Kabelo Lehloenya (Chief Financial 03 (Appointed ICT Framework issued by the Department of Public Offi cer) 1 February 2018) Services and Administration. Although there was Mr. Johann Strauss (Chief Risk 03 (Resigned 31 Offi cer) May 2018) some progress on the ICT internal control, special Ms. Lorraine Francois (Chief Audit 02 (Resigned 8 attention must be given to the IT general controls as Executive) May 2018) well as the implementation of the Disaster Recovery Mr. Luthendo Makhadi (Acting Chief 02 (Appointed 10 Plan and the Business Continuity Plan. This continued Audit Executive) May 2018) to be a high risk for the Entity. Internal Audit • Reviewed the Entity’s compliance with legal and regulatory provisions; and The Audit Committee is satisfi ed that the Internal • Reviewed signifi cant adjustments resulting from Audit plan represents a clear alignment with the key the audit. risks, has adequate information systems coverage, and a good balance across the different categories The Audit Committee concurs with and accepts of audits, i.e. risk-based, mandatory, performance, the AGSA’s conclusions on the Annual Financial computer and follow-up audits. Statements, and is of the opinion that the audited Annual Financial Statements be accepted and read The Audit Committee has noted improvement in the together with the report of the AGSA. communication between the Executive Management, the AGSA and the Internal Audit Function, which has One-on-One Meeting with the Accounting strengthened the Corporate Governance initiatives Offi cer within the Entity. The Audit Committee has met with the Accounting The Audit Committee wishes to stress that in order Offi cer for the Entity to address unresolved issues. for the Internal Audit Function to operate at optimal level as expected by the Audit Committee, the One-on-One Meetings with the Executive shortage in human resources and skills should be Authority addressed. The Audit Committee has met with the Executive Risk Management Authority for the Entity to apprise the MEC on the performance of the Entity. Progress on the departmental risk management was reported to the Audit Committee on a quarterly basis. Auditor-General of South Africa The Audit Committee is satisfi ed that the actual The Audit Committee has met with the AGSA to management of risk is receiving attention, although ensure that there are no unresolved issues. there are areas that still require improvement. Management should take full responsibility for the 326 entire Enterprise Risk Management process and continue to support the Chief Risk Offi cer to even further enhance the performance of the Entity.

Forensic Investigations

No forensic investigations were requested for the Entity during the fi nancial year under review.

The quality of quarterly reports submitted in Mr. Japie du Plessis terms of the PFMA and the Division of Revenue Chairperson of the Audit Committee Act Date: 31 July 2018 The Audit Committee is satisfi ed with the content and quality of fi nancial and non-fi nancial quarterly reports prepared and submitted by the Accounting Offi cer of the Entity during the year under review and confi rms that the reports were in compliance with the statutory reporting framework.

Evaluation of Annual Financial Statements

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 Offi cer; • Reviewed the Audit Report of the AGSA; • Reviewed the AGSA’s Management Report and Management’s response thereto; Notes

327 Notes

328 PR 335/2018 ISBN: 978-0-621-46642-3