Annual Report

DEPARTMENT OF HEALTH

VOTE NO. 10

ANNUAL REPORT

2016/2017 FINANCIAL YEAR

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Contents

PART A: GENERAL INFORMATION ...... 5 1. DEPARTMENT GENERAL INFORMATION ...... 5 2. FOREWORD BY THE MEC ...... 10 3. REPORT OF THE ACCOUNTING OFFICER ...... 12 4. STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF ACCURACY FOR THE ANNUAL REPORT ...... 18 5. STRATEGIC OVERVIEW ...... 19 5.1 Vision ...... 19 5.2 Mission ...... 19 5.3 Values ...... 19 6. LEGISLATIVE AND OTHER MANDATES ...... 20 7. ORGANISATIONAL STRUCTURE ...... 24 8. ENTITIES REPORTING TO THE MINISTER/MEC ...... 25

PART B: PERFORMANCE INFORMATION...... 27 1. AUDITOR GENERAL’S REPORT: PREDETERMINED OBJECTIVES ...... 27 2. OVERVIEW OF DEPARTMENTAL PERFORMANCE ...... 27 2.1 Service delivery environment ...... 27 2.2 Service delivery improvement plan ...... 28 2.3 Organisational environment ...... 30 2.4 Key policy developments and legislative changes ...... 30 3. STRATEGIC OUTCOME ORIENTED GOALS ...... 30 3.1 Strategic goals of the Department ...... 30 4. PERFORMANCE INFORMATION BY PROGRAMME ...... 31 4.1 PROGRAMME 1: ADMINISTRATION ...... 31 4.2 PROGRAMME 2: DISTRICT HEALTH SERVICES (DHS) ...... 38 4.3 PROGRAMME 3: EMERGENCY MEDICAL SERVICES (EMS) ...... 57 4.4 PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES ...... 60 4.5 PROGRAMME 5: TERTIARY HOSPITAL SERVICES ...... 66 4.6 PROGRAMME 6: HEALTH SCIENCE AND TRAINING ...... 70 4.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES (HCSS) ...... 73 4.8 PROGRAMME 8: HEALTH FACILITY MANAGEMENT (HFM) ...... 78 5. TRANSFER PAYMENTS ...... 82 5.1. Transfer payments to public entities ...... 82 5.2. Transfer payments to all organisations other than public entities ...... 82 6. CONDITIONAL GRANTS ...... 83 6.1. Conditional grants and earmarked funds paid ...... 83 6.2. Conditional grants and earmarked funds received ...... 83

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

7. DONOR FUNDS ...... 90 7.1. Donor funds received ...... 90 8. CAPITAL INVESTMENT ...... 90 8.1. Capital investment, maintenance and asset management plan ...... 90

PART C: GOVERNANCE ...... 95 1. INTRODUCTION ...... 95 2. RISK MANAGEMENT ...... 95 3. FRAUD AND CORRUPTION ...... 95 4. MINIMISING CONFLICT OF INTEREST ...... 95 5. CODE OF CONDUCT ...... 96 6. HEALTH, SAFETY AND ENVIRONMENTAL ISSUES ...... 96 7. PORTFOLIO COMMITTEES ...... 97 8. SCOPA RESOLUTIONS ...... 125 9. PRIOR MODIFICATIONS TO AUDIT REPORTS ...... 147 10. INTERNAL CONTROL UNIT ...... 148 11. INTERNAL AUDIT AND AUDIT COMMITTEES ...... 149 12. AUDIT COMMITTEE REPORT ...... 150

PART D: HUMAN RESOURCES MANAGEMENT...... 154 1. INTRODUCTION ...... 154 2. OVERVIEW OF HUMAN RESOURCES ...... 154 4. HUMAN RESOURCES OVERSIGHT STATISTICS ...... 154

PART E: FINANCIAL INFORMATION ...... 210 1. REPORT OF THE AUDITOR GENERAL ...... 210 2. ANNUAL FINANCIAL STATEMENTS ...... 221

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

1. DEPARTMENT GENERAL INFORMATION

PHYSICAL ADDRESS: INDWE (BUILDING NO. 3) NO 7 GOVERNMENT BOULEVARD RIVERSIDE PARK EXTENSION 2 NELSPRUIT 1200

POSTAL ADDRESS: PRIVATE BAG X 11285 NELSPRUIT 1200

TELEPHONE NUMBER: 013 766 3754

FAX NUMBER: 013 766 3475

EMAIL ADDRESS: [email protected]

WEBSITE ADDRESS: www.mpuhealth.gov.za

Twitter: @mpumalangahealth

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

LIST OF ABBREVIATIONS/ACRONYMS

ACRONYMS AGSA Auditor General of South Africa AIDS Acquired Immune Deficiency Syndrome APP Annual Performance Plan ARI Acute Respiratory Infections ART Anti-retroviral Treatment BANC Basic Antenatal Care BOD Burden of Disease CARMMA Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa CCMDD Central Chronic Medication Dispensing and Distribution CDC Community Day Centre CEO Chief Executive Officer CHC Community Health Centre CHWs Community Health Workers CMR Child Mortality Rate CoE Compensation of Employees COIDA Compensation of Occupational Injuries and Diseases CPIX Consumer Price Index CRDP Comprehensive Rural Development Programme CSD Central Supplier Database CSR Cataract Surgery Rate DFMLC District Financial Misconduct and Loss Control DHER District Health Expenditure Review DHP District Health Plan DHS District Health Services DHIS District Health Information System DHMIS District Health Management Information System DoE Department of Education DOH Department of Health DORA Division of Revenue Act DOTS Directly Observed Treatment Short Course DPC Disease Prevention and Control DPSA Department of Public Service and Administration DR Drug Resistant

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

ACRONYMS DSD Department of Social Development DCSSL Department of Community Safety, Security and Liaison ECD Early Childhood Development Centre EDL Essential Drug List EE Employment Equity EMS Emergency Medical Services ESMOE Essential Steps in Managing Obstetric Emergencies ETR.Net Electronic TB Register FMC Financial Management Committee GDP Gross Domestic Product HAST HIV & AIDS, STI and TB Control HCSS Health Care Support Services HCT Health Care Provider Initiated Counseling and Testing HFM Health Facilities Management HHCC Household Community Components HIV Human Immuno-Deficiency Virus HOD Head of Department HPTDG Health Professional Training and Development Grant HPV Human Papillomavirus HR Human Resources HPRS Health Patient Registration Systems HRC Human Resource Committee HRD Human Resource Development HRM Human Resource Management HST Health Sciences and Training HTA High Transmission Area HTS HIV Testing Services ICT Information Communication Technology ICSM Integrated Clinical Services Management IDP Integrated Development Plan IHPF Integrated Health Planning Framework IMCI Integrated Management of Childhood Illnesses IPT Isoniazid Preventive Therapy ISS Intenda Solution Suite

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

ACRONYMS IUCD Intrauterine Contraceptive Device KMC Kangaroo Mother Care MBFI Mother and Baby Friendly Hospital Initiative MCWH&N Maternal, Child, Women’s Health and Nutrition MDGs Millennium Development Goals MDR Multi-drug Resistant MEC Minister of Executive Council MMC Male Medical Circumcision MMR Maternal Mortality Rate MOSWASA Mozambique Swaziland South Africa Agreement MPAC Mpumalanga Provincial AIDS Council MRC Medical Research Council MTEF Medium-term Expenditure Framework MTSF Medium-term Strategic Framework

NCD Non-communicable Diseases NCS National Core Standard NDOH National Department of Health NDP National Development Plan NGO Non-governmental Organisation NHA National Health Act NHI National Health Insurance NHIRD National Health Repository and Data Warehousing NHLS National Health Laboratory Services NHS National Health Systems NPO Non-profit Organisation NSDA Negotiated Service Delivery Agreement NSP National Strategic Plan NTSG National Tertiary Services Grant OHSAS Occupational Health and Safety Management System OHSC Office of Health Standards Compliance OPD Outpatient Department OSD Occupational Specific Dispensation PCR Polymerase Chain Reaction (a laboratory HIV detection Test) PCV Pneumococcal Vaccine

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

ACRONYMS PDE Patient Day Equivalent PDOH Provincial Department of Health PFMC Provincial Financial Misconduct Committee PHC Primary Health Care PHS Provincial Hospital Services PMTCT Prevention of mother-to-child Transmission PPP Public/Private Partnership PPTS Planned Patient Transport Services PPTICRM Perfrect Permanent Team for Ideal Clinic Realisation and Maintenance PrDP Professional Driving Permit PSP Provincial Strategic Plan PTC Pharmaceutical Therapeutic Committees PWDs People with Disabilities RFQ Request for Quotation V Rota Virus RWOPS Remunerative Work outside the Public Service SADHS South African Demographic Health Survey SAICA South Africa Institute of Chartered Accountants SALGA South African Local Government Agency SANAC South African National AIDS Council SANTA South African National Tuberculoisis (TB) Association SLA Service Level Agreement SMS Senior Management Service SOP Standard Operating Procedures STATS SA Statistics South Africa STC Step Down Care STP Service Transformation Plan TB Tuberculosis THS Tertiary Hospital Services TRIC Total (patient) Remaining in Care UTT Universal Test and Treat VMMC Voluntary Medical Male Circumcision WBPHCOT Ward based Primary Health Care Outreach Teams WISN Workload Indicators of Staffing Need WHO World Health Organisation

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

2. FOREWORD BY THE MEC The Department also completed a number of infrastructure projects and some are multi-year projects which will be completed in the year 2019. However, the Department is As the Department of Health (DoH) in the province, we are doing its best to deliver state-of-the-art health facilities. tasked to improve the quality of health and wellbeing of all people of Mpumalanga by providing a needs based, people As government, we are piloting the National Health Insurance centred, equitable health care delivery system through an (NHI) in the Gert Sibande District. NHI is government’s integrated network of health care services provided by a cadre strategy to ensure that those who live below their means of dedicated and well skilled health workers. receive the same equal medical care as those that have medical aid and consult in private hospitals. In Mpumalanga, This we must achieve by following the plans outlined in the we are progressing well with the implementation of the NHI. National Development Plan (NDP) which sets out nine (9) long-term health goals which by 2030 South Africa should The Province, like the rest of the country, faces a quadruple have attained: burden of diseases like HIV and AIDS, Tuberculosis, high maternal and child mortality and non-communicable diseases. 1. Raised the life expectancy of South Africans to at least All three districts in Mpumalanga Province have shown an 70 years increase in HIV prevalence from 2012 to 2013. We have 2. Progressively improve TB prevention and cure distributed male and female condoms, initiated clients on ART 3. Reduce maternal, infant and child mortality and more work is being done to ensure that we continue to 4. Significantly reduce prevalence of non-communicable educate people about the disease. The Department is still not diseases doing well on voluntary medical male circumcision but more 5. Reduce injury, accidents and violence by 50 percent effort will be put to increase awareness. TB continues to be a from 2010 Levels killer disease in the province and the country as a whole. More 6. Complete health system reforms efforts are being done to deal with killer diseases such as 7. Primary healthcare teams provide care to families and malaria, TB, HIV and many more. communities 8. Universal health care coverage Maternal mortality and morbidity in South Africa remain very 9. Fill posts with skilled, committed and competent high. The vision is to continue to reduce maternal mortality individuals through the implementation of the provincial strategy on the reduction of maternal and child mortality (2013), to address These goals are there to assist the Department to have a clinical factors, and re-engineer primary health care to progressive direction towards the achievement of a better improve some of the community and administrative-related health care system. factors and strengthen a functional referral system as a responsive support system to hospitals It is worth noting that our population has significantly grown. According to Census 2016 survey, the population in our The Department shall continue to prioritise people’s lives by province has grown by 7.3% between the years 2011 and providing the best health care for all its citizens. 2016.

The increase in the population warrants more resources for attainment of better health outcomes. In the financial year ending 31 March 2017, performance has improved to 51%. ______from 47.7% in 2015/16. Despite the upward trajectory, we still MR GP MASHEGO need to do more. MEC: HEALTH

______DATE

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

3. REPORT OF THE ACCOUNTING OFFICER

The Mpumalanga Department of Health (DoH) has come a The Department can overcome a number of challenges long way in ensuring that the people of the ‘Place of the Rising through the implementation of the NHI and has therefore Sun’ are medically looked after. Officials in the Department ensured that 29 GPs have been contracted to serve 43 PHC have put in many hours, working hard to ensure that people of facilities in Gert Sibande. all races, young and old, women and children receive the best health care. About 87 063 patients have been enrolled on the Central Chronic Medicines Dispensing and Distribution (CCMDD) As every other sector, the Department has experienced some system. 39 General practitioners consulting rooms (park challenges, in its mission to provide quality health care. This, homes), were provided for additional space in PHC facilities. however, has not hindered nor compromised service delivery. A total of one hundred and twelve (112) Ward-based Primary The Department received qualified audit opinions in previous Health Care Outreach Teams (WBPHCOT) have been financial years. Plans have already been put in place to ensure established in the 2016/17 financial year. These WBPHCOT that the Department moves in the right direction. reach out to the communities at household level. The number of districts with fully fledged District Clinical Specialist Teams The overall performance of the Department is at 51% of its (DCSTs) will be increased from one (1) to two (2). planned target, compared to the 47.7% reported in the 2015/16 annual report, while overall expenditure has been The Department has (43) school health teams established contained at 99.8% of the budget allocation. throughout the Province, 13 which were appointed during the 2016/17 financial year. An additional 32 school health teams Triggered by the shortage of specialists (especially will be appointed in 2017/18. orthopaedic surgeons), the Department is well on course to ensuring that more doctors are head hunted to work in the Issues related to communicable and non-communicable Province. Although the Department is able to manage the diseases are well managed. HIV, Malaria and TB are also a number of patients requiring such service, more doctors are cause for concern but strategies and plans have been put in needed in all corners of the health sector. place to manage the killer diseases.

This is also capacitated by the fact that the Russia/Cuba Despite the decrease of annual budgets and increased public doctor programme is continuing, whilst more student nurses needs, the Department will remain committed to ensuring a are being enrolled in the Mpumalanga Nursing College. long and healthy life for South Africans without compromise.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

3.1 Overview of the financial results of the Department

3.1.1 Departmental receipts

2016/2017 2015/2016 Estimate Actual (Over)/under Estimate Actual (Over)/under Departmental receipts amount collection amount collection collected collected R’000 R’000 R’000 R’000 R’000 R’000 Sale of goods and 64 581 65 696 1 115 59 212 56 308 (2 904) services other than capital assets Interest, dividends and 2 457 3 871 1 414 2 675 3 523 848 rent on land Sale of capital assets 1 866 3186 1 320 1 760 1 564 (196) Financial transactions in 1 566 3 355 1 789 2 897 2 192 (705) assets and liabilities Total 70 470 76 108 5 638 66 544 63 587 (2 957)

The Department over-collected on patient fees due to the • Personnel employed in the Department who are injured meetings conducted with the hospitals and interacting with the on duty, and for whom the Department accepts liability Department of Community Safety Security and Liaison to • Persons to whom general health advisory services access the Accident Report forms. There were also sales of (including oral health and visits to ante-natal clinics) are 144 vehicles that resulted in the over collection by provided R 1 320 000. • Persons who present themselves for immunisations and other measures to combat notifiable infectious diseases 3.2 Tariff policy • School children, excluding those children whose medical Patient tariffs are determined by the National Department of and/or dental health care might be covered by a medical Health revenue steering committee approved by NHC and for aid or insurance, who are referred with a letter of authority small items is determined by the Provincial Departments from the school nursing services for basic primary oral Revenue Forum approved by Treasury. health care services, for all treatment arising from such letter of authority List of free services • Committed children, who in terms of the Child Care Amendment Act of 1996 are committed to the care of a • Any person suffering from a suspected or confirmed children’s home or foster parents communicable, formidable or notifiable disease • Any person suffering from, kwashiorkor and pellagra • Any officer of the Department who, in the performance of • Mentally disturbed patients admitted to psychiatric her/his official duties, handles or comes into contact with hospitals in terms of the Mental Health Act 17 of 2002 any drug, poison, gas, radio-active substances, radio- • Services in respect of termination of pregnancy to be therapeutic or diagnostic equipment or other electronic rendered free of charge and if complications have equipment and is for this reason required to undergo developed as a result of the termination, until the patient medical examination and treatment has been cured or the conditions as a result of the • A patient who visits a clinic or hospital on complication have stabilised. recommendation of family planning staff, including free • Pregnant women and children under the age of 6 years. transport to such clinic or hospital, for the specific purpose

of being sterilised, notwithstanding the fact that such

procedure is performed by a private doctor, however

excluding sterilisation for clinical reasons

• Post-vasectomy persons for scheduled sperm count

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

3.3 Bad debts written off Patient debts totalling to R 16 938 516.53 were written off due to, inter alia, the following: The Department has written off bad debts totalling to R 26 963 463.27 for both staff and patients in line with the • The debtors have deceased and there is no known estate Departmental debt and write off policy. • The recovery of the debt would cause undue hardship to the debtor or the debtor’s dependent because they would Staff debts R 10 024 946.74 be deprived of the minimum essential means of • R 1 633 422.67 for the South African Revenue Services livelihood. (SARS) was deemed as irrecoverable debts and • The debtor is no longer a resident of South Africa, there uneconomical to recover after all the debt collection is no apparent means of collecting the debt and there is processes and procedures were exhausted from 2013 to no evidence that the debtor has a family or business 2016 as recommended by the Auditor General during the concerns in South Africa that could lead to the debtor 2015/2016 financial year audit. returning to South Africa. • R 8 391 524.67 for staff debts was written-off after following debt management policy and processes. 3.4 Reasons for collection of more revenue in 2016/17. The Department has over-collected due to the adjustment made on patient fees for externally funded patients. Meetings held with the Road Accident Fund (RAF) stakeholders and hospitals in improving knowledge of RAF requirements improved the payments from RAF. There were auction sales of 144 vehicles which increased collection of revenue.

3.5 Programme expenditure

2016/2017 2015/2016 Programme Final Actual (Over)/ Under Final Actual (Over)/Under appropriation expenditure expenditure appropriation expenditure expenditure R’000 R’000 R’000 R’000 R’000 R’000 Programme 1 282 001 282 001 - 298 892 297 298 1 594

Programme 2 6 526 845 6 524 844 2 001 6 185 757 6 175 406 10 351

Programme 3 328 190 328 189 1 309 597 309 596 1

Programme 4 1 221 481 1 221 480 1 1 185 736 1 174 385 11 351

Programme 5 1 035 085 1 026 751 8 334 1 013 144 991 759 21 385

Programme 6 372 901 372 901 - 373 933 369 233 4 700

Programme 7 156 804 140 693 16 111 125 687 123 451 2 236

Programme 8 683 021 683 021 - 671 156 639 264 31 892

Total 10 606 328 10 579 880 26 448 10 163 902 10 080 392 83 11

The Department spent R 10 579 880 billion from the Three (3) programmes have underspent in the financial adjusted budget of R 10 606 328 billion or 99.8%. The year under review due to late submission of invoices for the improved spending of the budget resulting to an under NHI grant and delays in the procurement of medical expenditure of R26 448 million as compared to an under- equipment. spending of R 83 511 million for 2015/16 financial year.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Virements/roll-overs

Virements

Expenditure as at 31 March 2017 Expenditure Commitments Available Exp % Adjusted Fund Shifts Virement Virement Post-Virement Programme Administration 282 000 416 16 818 589 (14 574 416) 105% 267 426 000 0 14 575 000 5% 282 001 000 District Health Services 6 524 844 364 18 632 386 16 120 544 100% 6 542 488 000 0 (15 643 000) 0% 6 526 845 000 Emergency Medical Services 328 189 115 6 668 391 (3 565 115) 101% 324 624 000 0 3 566 000 1% 328 190 000 Provincial Hospital Services 1 221 480 167 12 056 693 (20 114 167) 102% 1 201 366 000 0 20 115 000 2% 1 221 481 000 Central Hospital Services 1 026 751 101 10 801 121 45 375 899 96% 1 072 127 000 0 (37 042 000) -3% 1 035 085 000 Health Sciences and Training 372 900 598 734 216 2 972 402 99% 375 873 000 0 (2 972 000) -1% 372 901 000 Health Care Support Services 140 693 135 17 618 361 19 420 865 88% 160 114 000 0 (3 310 000) -2% 156 804 000 Health Facility Management 683 020 952 29 625 049 (20 710 952) 103% 662 310 000 0 20 711 000 3% 683 021 000 Equitable Share 10 579 879 848 112 954 806 24 925 060 100% 10 606 328 000 0 0 0% 10 606 328 000

• An amount of R15 643 000 for goods and services • A saving of R2 972 000 was reduced from was reduced from programme 2 to defray programme 6 on compensation of employees to overspending in programme 8 within goods and defray overspending within programme 4 on goods services. The virement is 0% of the adjusted and services, which is 1% of the adjusted appropriation of programme 2. appropriation.

• A budget of R37 042 000 from compensation of • An amount of R3 310 000 was reduced from employees was reduced from programme 5 to defray compensation of employees in programme 7 to overspending within programme 1 on goods and defray overspending within goods and services in services and households, and programme 4 on programme 8, which is 2% of the adjusted compensation of employees and households; which appropriation. is 4% of the adjusted appropriation.

Economic classification

Expenditure as at 31 March 2017 Expenditure Commitments Available Exp % Adjusted Fund Shifts Virement Virement Post-Virement Economic classification 0% 0 0% 0 Current payments 9 753 872 245 64 476 486 43 047 755 100% 9 796 920 000 0 (36 168 000) 0% 9 760 752 000 Compensation of employees 6 686 677 840 (272 940) 36 254 160 99% 6 722 932 000 0 (27 663 000) 0% 6 695 269 000 Goods and services 3 064 888 377 64 749 426 9 099 623 100% 3 073 988 000 0 (8 505 000) 0% 3 065 483 000 Interest and rent on land 2 306 028 0 (2 306 028) 0% 0 0 0 0% 0 Transfers and Subsidies 306 487 412 1 060 094 (35 134 505) 112% 272 876 000 0 36 168 000 13% 309 044 000 Provinces and municipalities 552 213 0 81 787 87% 634 000 0 0 0% 634 000 Departmental agencies and accounts 176 686 0 57 314 76% 234 000 0 0 0% 234 000 Non-profit institutions 182 733 367 1 058 860 3 074 540 98% 187 331 000 0 0 0% 187 331 000 Households 123 025 146 1 234 (38 348 146) 145% 84 677 000 0 36 168 000 43% 120 845 000 Payment for Capital Assets 509 495 243 47 418 226 27 036 757 95% 536 532 000 0 0 0% 536 532 000 Buildings and other fixed structures 437 593 586 10 281 887 (7 983 586) 102% 429 610 000 0 0 0% 429 610 000 Machinery and equipment 71 901 657 37 136 339 35 020 343 67% 106 922 000 0 0 0% 106 922 000 Software and other intangible assets 0 0 0 0% 0 0 0 0% 0 TOTAL 10 579 879 848 112 954 806 24 925 060 100% 10 606 328 000 0 0 0% 10 606 328 000

• An amount of R27 663 000 was reduced from Rollovers compensation of employees to defray overspending A request was made amounting to R 19 383 000 comprising within households in programme 1,2,4,5, and 6 and the following: in line with S6.3 of the treasury regulations. • An amount of R8 505 000 was reduced from goods • National tertiary services Grant - R 6 652 000 and services to defray overspending within • Health facility revitalization Grant - R 2 768 000 households in programme 1. • National health insurance grant - R 699 000 • EPWP - R 1 654 000 • Voted-health care support (Engineering) - R 7 610 000

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

The requested rollover amount for the National Treasury • Bid evaluation committee (Ad hoc) Services Grant (NTSG) and Health Facility Revitalisation • Bid adjudication committee Grant (HFRG) is for the procurement of machinery and equipment, respectively. The NHI amount is for payment of During the year end review the Department established the hospital board directors payable in goods and services, while Provincial Financial Misconduct Committee (PFMC) and the EPWP is for payment of building and other fixed District Financial Misconduct and Loss Control (DFMLC). The structures. Lastly, the voted funds request for the health care overall responsibility of the PFMC /DFMLC shall be to support programme, sub-programme engineering is for investigate and preside over all reported incidents of financial payment of medical and allied equipment. misconduct and losses suffered by the Department and make recommendations to the Head: Health regarding actions to 3.6 Unauthorised fruitless and wasteful expenditure be taken. Provincial treasury circular number 14 of 2016 required all The Department has incurred fruitless and wasteful provincial Departments to utilise Intenda Solution Suite (ISS) expenditure amounting to R 2 306 000 in the current financial with effect from 01 April 2016 when doing a Request for year. This increases the prior year total of Quotation (RFQ). Due to challenges experienced with the R 13 934 000 to R16 240 000. implementation of the ISS, on the 15 August 2016 the Department requested an exemption from the The current fruitless and wasteful expenditure has been implementation of the ISS. The exemption was granted for all accrued from the Eskom account, legal fees, National Health the district offices including institutions in those districts Laboratory Services (NHLS) and municipalities. (Ehlanzeni, Nkangala, Gert Sibande and any other districts the Department might have). The exemption was however The list has been submitted to the provincial financial granted from the 26 August 2016 to misconduct committee and district financial misconduct and 31 December 2016. loss control for investigations. During the period of exemption, the Department was expected to do an Information Communication Technology 3.7 Future of the Department (ICT) assessment with the assistance of the provincial IT of all the districts on what will be needed for ISS to operate. The 3.8 Public private partnerships Department was further requested to submit the ICT report to None the provincial treasury not later than 30 November 2016 and 3.9 Discontinued activities/activities to be the measures that have been taken to or will be taken to discontinued resolve the issue. None The provincial office was not exempt from the implementation 3.10 New or proposed activities of the ISS as the exemption only applied to the district offices None including institutions in the district offices. Training was conducted by officials from the provincial treasury for all the 3.11 Supply chain management district offices including institutions in the district offices.

The Department did not have any unsolicited bid proposal With effect from 01 July 2016, Central Supplier Database during the 2016/2017 financial year. During the 2016/2017 (CSD) was implemented as the single and only list of financial year the following committees were established in prospective suppliers for the Department. The order to prevent irregular expenditure from recurring: implementation of the CSD has resulted in delays in the payments of suppliers due to non-tax complaint status. • District acquisition committee • Hospital finance committee • Economising committee • Bid specification committee (Ad hoc)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

3.12 Gifts and donations received in kind from non- In conclusion, I would like to submit my heartfelt appreciation related parties to the Executive Authority for entrusting me to ensuring that the Department delivers on its mandate. I would also like to Refer to annexure 1H page 401 under annual financial acknowledge the support I received from the sterling statement. workforce in the Department, including partners. I invite you to be part of this Department to face new challenges and 3.13 Exemptions and deviations received from the successes as we venture into the future. National Treasury

No exemptions from the PFMA or treasury and deviation from the financial reporting requirements received for the current financial year. ______DR SAVERA MOHANGI 3.14 Events after the reporting date HEAD: HEALTH None

3.15 Other

None DATE: ______

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF ACCURACY FOR THE ANNUAL REPORT

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

All information and amounts disclosed throughout the annual report are consistent.

The annual report is complete, accurate and is free from any omissions.

The annual report has been prepared in accordance with the guidelines on the annual report as issued by national treasury.

The annual financial statements (Part E) have been prepared in accordance with the modified cash standard and the relevant frameworks and guidelines issued by the national treasury.

The accounting officer is responsible for the preparation of the annual financial statements and for the judgements made in this information.

The accounting officer is responsible for establishing and implementing a system of internal control that has been designed to provide reasonable assurance as to the integrity and reliability of the performance information, the human resources information and the annual financial statements.

The external auditors are engaged to express an independent opinion on the annual financial statements.

In my opinion, the annual report fairly reflects the operations, the performance information, the human resources information and the financial affairs of the Department for the financial year ended 31 March 2017.

Yours faithfully

______DR SAVERA MOHANGI HEAD: HEALTH

DATE: ______

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4. STRATEGIC OVERVIEW

5.1 Vision

“A Healthy Developed Society”.

5.2 Mission

The Mpumalanga Department of Health (DoH) is committed to improve the quality of health and well-being of all people of Mpumalanga by providing a needs-based, people centred, equitable healthcare delivery system through an integrated network of healthcare services provided by a cadre of dedicated and well skilled health workers.

5.3 Values

• Commitment • Appropriateness • Timeliness • Collectiveness • Competency

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

5. LEGISLATIVE AND OTHER MANDATES medicines and medical devices; and for the control of persons who may compound and dispense medicines; A. CONSTITUTIONAL MANDATES and for matters incidental thereto.

In terms of the Constitution of the Republic of South Africa • Mental Health Care Act (Act No. 17 of 2002) (Act No. 108 of 1996), the Department is guided by the Provides a legal framework for the care, treatment and following sections and schedules: rehabilitation of persons who are mentally ill; to set out different procedures to be followed in the admission of • Section 27 (1) Everyone has the right to have access to such persons; to establish review boards in respect of (a) healthcare services, including reproductive every health establishment; to determine their powers healthcare. and functions; to provide for the care and administration (b) No one may be refused emergency medical of the property of mentally ill persons; to repeal certain treatment. laws; and to provide for matters connected therewith. • Section 28 (1) Every child has the right to basic health care services. • Medical Schemes Act (Act No.131 of 1998) • Schedule 4, which lists health services as a concurrent Provides for the regulation of the medical schemes national and provincial legislative competence. industry to ensure consonance with national health objectives. B. LEGAL MANDATES • Council for Medical Schemes Levy Act • National Health Act (Act No.58 of 2000) (Act No. 61 of 2003, as amended) Provides a legal framework for the council to charge Provides a framework for a structured uniform health medical schemes certain fees. system within the Republic, taking into account the obligations imposed by the constitution and other laws • Nursing Act (Act No. 33 of 2005) on the national, provincial and local governments with Provides for the regulation of the nursing profession. regard to health services and to provide for matters connected therewith. • Human Tissue Act (Act No. 65 of 1983) Provides for the administration of matters pertaining to • Pharmacy Act (Act No. 53 of 1974, as amended) human tissue. Provides for the establishment of the South African Pharmacy Council and for its objects and general • Sterilisation Act (Act No. 44 of 1998) powers; to extend the control of the council to the public Provides a legal framework for sterilisations, also for sector; and to provide for pharmacy education and persons with mental health challenges. training, requirements for registration, the practice of pharmacy, the ownership of pharmacies and the • Choice on Termination of Pregnancy Act (Act No. investigative and disciplinary powers of the council; and 92 of 1996 as amended) to provide for matters connected therewith. Provides a legal framework for the termination of pregnancies, based on choice under certain • Medicines and Related Substance Control Act circumstances. (Act No. 101 of 1965, as amended) Provides the registration of medicines intended for • Tobacco Products Control Act (Act No. 83 of 1993 human and for animal use; for the registration of medical as amended) devices; for the establishment of a Medicines Control Provides for the control of tobacco products, the Council; for the control of medicines, Scheduled prohibition of smoking in public places and for substances and medical devices; for the control of advertisements of tobacco products as well as the manufacturers, wholesalers and distributors of sponsoring of events by the tobacco industry.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• National Health Laboratory Service Act (Act No.37 • Occupational Diseases in Mines and Works Act of 2000) (Act No.78 of 1973 as amended) Provides for a statutory body that offers laboratory Provides for medical examinations on persons services to the public health sector. suspected of having contracted occupational diseases, especially in mines and for compensation in respect of • South African Medical Research Council Act (Act those diseases. 58 of 1991) Provides for the establishment of the South African • Academic Health Centres Act (Act No.86 of 1993) Medical Research Council and its role in relation to Provides for the establishment, management and health research. operation of academic health centres.

• The Allied Health Professions Act (Act No.63 of Other general legislation in terms of which the 1982 as amended) Department operates, includes, but not limited to, the To provide for the control of the practice of allied health following: professions, and for that purpose to establish an Allied Health Professions Council of South Africa and to • Child Care Act (Act No.74 of 1983) determine its functions; and to provide for matters Provides for the protection of the rights and well-being of connected therewith. children.

• Foodstuffs, Cosmetics and Disinfectants Act (Act • Public Finance Management Act (Act No.1 of 1999 No. 54 of 1972 as amended) as amended) Provides for the regulation of foodstuffs, cosmetics and To regulate the financial management in the national disinfectants, in particular quality standards that must be government and provincial governments; to ensure that complied with by manufacturers as well as the all revenue, expenditure, assets and liabilities of those importation and exportation of these items. governments are managed efficiently and effectively; to provide for the responsibilities of persons entrusted with • Hazardous Substances Act (Act No. 15 of 1973) financial management in those government Provides for the control of hazardous substances, in Departments and to provide for matters connected particular those emitting radiation. therewith.

• Dental Technicians Act (Act No. 19 of 1979) • Division of Revenue Act (Act No. 5 of 2012) Provides for the regulation of dental technicians and for Provides for the manner in which revenue generated the establishment of a council to regulate the profession. may be disbursed.

• Health Professions Act (Act No. 56 of 1974) • Promotion of Access to Information Act (Act No.2 Provides the regulation of health professions medical of 2000) practitioners, dentists, psychologists and other related To give effect to the constitutional right of access to any health professions, including community services by information held by the State and any information that these professionals. is held by another person and that is required for the exercise or protection of any rights; and to provide for • Allied Health Professions Act (Act No. 63 of 1982, matters connected therewith. as amended) Provides the regulation of health practitioners such as • Promotion of Administrative Justice Act (Act No.3 chiropractors, homeopaths, etc., and for the of 2000) establishment of a council to regulate these professions. Amplifies the constitutional provision pertaining to accessing information under the control of various bodies.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• Preferential Procurement Policy Framework • Occupational Health and Safety Act (Act No. 85 of Act, 2000 1993, as amended) To give effect to section 217 (3) of the constitution by Provides for the requirements that employers must providing a framework for the implementation of the comply with to create a safe environment for employees procurement policy contemplated in section 217(2) of the in the workplace. Constitution; and to provide for matters connected therewith. • Compensation for Occupational Injuries and Diseases Act (No. 130 of 1993, as amended) • Broad Based Black Economic Empowerment Act Provides for compensation disablement caused by (Act No. 53 of 2003) occupational injuries or diseases sustained or Provides for the promotion of black economic contracted by employees in the course of their empowerment in the manner that the state awards employment and for death resulting from such injuries contracts for services to be rendered and incidental or diseases. matters. C. POLICY MANDATES • Public Service Act (Proclamation No. 103 of 1994) • National Medium Term Strategic Framework 2014 - Provides for the administration of the public in its national 2019 and provincial spheres as well as for the powers of • Provincial Medium Term Strategic Framework 2015 - Ministers to recruit and terminate employment. 2020 • National Development Plan (NDP)–Vision for 2030 • Labour Relations Act (Act No. 66 of 1995) • National Health Systems Priorities 2009–2014 (10 Point Regulates the rights of workers, employers and trade Plan) unions. • Negotiated Service Delivery Agreement • Basic Conditions of Employment Act (Act No. 75 of • Mpumalanga Economic Growth Path 1997) • Mpumalanga strategic plan for HIV and AIDS, STIs and To give effect to the right to fair labour practices referred TB 2012 - 2016 to in section 23(1) of the Constitution by establishing and • Integrated Development Plans (IDPs) making provision for the regulation of basic conditions of • District Health Management Information System Policy employment and thereby to comply with the obligations (DHMIS), 2011 of the Republic as a member state of the International • White Paper on The Transformation of The Health Labour Organisation; and to provide for matters Sector, 1997 connected therewith. • Treasury regulations

• Public Service Regulations, 2016 • Employment Equity Act (No.55 of 1998) • Preferential Procurement Policy Framework Provides for the measures that must be put into Regulations operation in the workplace in order to eliminate

discrimination and promote affirmative action.

• Skills Development Act (Act No. 97 of 1998)

Provides for the measures that employers are required

to take to improve the levels of skills of employees in

the workplace.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

D. RELEVANT COURT RULINGS

• MEC for Finance & Economic Development, KwaZulu-Natal v Masifundisane Training (606/2012) [2013] ZASCA Public Private Partnership (PPP) – regulation 16 of the treasury regulations in respect of government Departments, promulgated in terms of the Public Finance Management Act 1 of 1999 (PMFA) – alleged that PPP not concluded in accordance with regulation 16 and PPP agreement not binding on the MEC – dispute of fact incapable of resolution on the papers – not necessary or desirable to resolve legal issue- appeal upheld

• CCMA v Law Society, Northern Provinces (005/13) [2013] ZASCA 118 The Law Society of the Northern Provinces contested the unconstitutionality of not allowing legal representation in terms of rule 25(1) (c) of the rules of the Commission for Conciliation, Mediation and Arbitration (CCMA)–the appeal was upheld and the order declaring the rule as being unconstitutional by the court a quo was dismissed with costs

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

6. ORGANISATIONAL STRUCTURE

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

7. ENTITIES REPORTING TO THE MINISTER/MEC

Name of entity Legislative mandate Financial Nature of relationship operations None None None None

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

The provision of primary health care through district 1. AUDITOR GENERAL’S REPORT: health services remains a cornerstone for a better PREDETERMINED OBJECTIVES health for all residents of Mpumalanga. In line with this

goal, the Department, through 287 primary health care The AGSA currently performs certain audit procedures facilities, could provide services to more than on the performance information to provide reasonable 7,602,668 adults and 1,846,366 children. The growing assurance in the form of an audit conclusion. The audit investment in the implementation of national health conclusion on the performance against predetermined insurance and PHC outreach programmes further objectives is included in the report to management, attests to the commitment of universal coverage and with material findings being reported under the ensuring that health services are received at Predetermined Objectives heading in the report on community or ward level to address community needs other legal and regulatory requirements section of the and expectations. The Department is rolling NHI auditor’s report. components across all districts in the Province. To

date there are 235 ward-based PHC outreach teams Refer to page 210 of the report of the auditor general, established and 451 schools are certified as health- published as Part E: Financial Information. promoting schools to provide primary prevention-

related services to wards and schools, respectively. 2. OVERVIEW OF DEPARTMENTAL Patients that need further care are referred to nearby PERFORMANCE health care facilities.

Mpumalanga Province is located in the north-eastern In addition to the 287 Primary Health Care (PHC) part of South Africa, bordered by Mozambique in the facilities and 23 district hospitals which provide district east and Swaziland in the south-east. The Province is health services, the Department is also rendering also surrounded by the following provinces: Limpopo quality curative services through 3 Regional, 5 TB in the north, Gauteng in the west, Free State in the Specialised and 2 tertiary hospitals to out-patients and south-west and KwaZulu-Natal in the south-east. The inpatients across 33 hospitals. migration from these shared borders poses a

challenge in rendering of healthcare services since The Department renders health services through a demands can never be projected accurately in terms dedicated team of 10178 health professionals (1074 of planning and resource allocation. medical practitioners, 79 medical specialists and 5 395 The DoH provides health services to the citizens of the professional nurses, 1796 enrolled nurses, 1403 Mpumalanga Province and surrounding areas of a enrolled nursing assistants, 300 pharmacists, 131 population of 4,4 million of which 88% (3,9 million) are dental specialists and practitioners). uninsured (Stats SA mid-year estimates 2016). A

comprehensive package of healthcare services is To address the shortage of suitable and qualified provided which include: health professionals, the Department awarded • District health services bursaries to 109 medical students in the Cuban • Regional, specialized and tertiary hospital services programme and 551 nursing students (310 in 2015/16 • Health care support services and 90 in 2016/17 on the Mpumalanga/KwaZulu-Natal collaboration and 151 in 2016/17 Mpumalanga College of Nursing). 2.1 Service delivery environment

To improve patient experience of care, the Department This annual report reflects the ongoing commitment of is conducting annual assessments on the National the Mpumalanga Provincial Government through the Core Standards in hospitals. Status determination for Department of Health to the country’s vision of ideal clinic realization and maintenance programme is providing a healthy life for all South Africans. implemented to strengthen quality of health care

services in PHC facilities. As a result, the Department

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

continued to cooperate with the office of health The Department is striving to improve Emergency standard compliance and through district assessor Medical Services to provide services in an efficient and teams to execute its functions of monitoring effective manner. There has been a significant compliance of health institutions and regularly improvement on the response time against the conducting audits to monitor compliance against the national norm of 15 minutes in urban and 40 minutes six ministerial quality core standards: availability of in rural areas. medicine and supply, cleanliness, values and attitudes patient safety, infection prevention and control and Considering the rural nature of the Province, the reducing waiting time. Department is improving its EMS response time against the standard. During 2016/17, 72.3% of P1 In addition, the plights of communities regarding their calls at urban areas were responded to within 15 experiences in health facilities are addressed directly minutes, while 69.5% of P1 calls from rural areas were through a complaints management system. The responded within 40 minutes. There is an Department received a total of 4 524 complaints improvement compared to the 66% reported in through the presidential hotline and/or submitted 2014/15 for response time in rural areas within 40 through health facilities’ complaints mechanisms. Of minutes. the 69.6% (3 149) complaints resolved, 94.1% (2 964) were resolved within 25 working days. This has been achieved through 845 emergency medical staff of which 43 are managers, 60 are for The successes made in the antenatal care (ANC) the Planned Patient Transport Services and 742 are Prevention of Mother-to-Child Transmission (PMTCT) emergency personnel. Furthermore, a total of 119 programme attest to the Department’s commitments to ambulances (24 obstetric and 95 operational ensuring zero infections. There has been a significant ambulances) and 26 all-terrain response vehicles was stride in reducing transmission rates and more than utilised to provide services to the community of 98% of babies are now testing HIV-negative when Mpumalanga. tested at 10 weeks. The Department provides pregnant women with an opportunity to receive early The year under review has seen improvement in the critical interventions to improve health of a mother and achievement of all planned infrastructure projects a baby. About 71% of mothers received antenatal care which expand and replace old infrastructure with services within 20 weeks after gestation and 94.9% modern high- technology structures. This will enable tested HIV-positive women were enrolled to the the Department to improve on service delivery and antiretroviral treatment (ART) programme to prevent ensure that public perception and experience is transmission from mother to infant. improved as the province prepares its self for the universal health coverage through National Health The Province is a malaria endemic area as declared Insurance (NHI). by the WHO and the Department is implementing MOSASWA agreement which is aimed at the 2.2 Service delivery improvement plan elimination of malaria in the Province. During the year under review the Department recorded a malaria case The Department has completed a service delivery facility of 0.14/1000 population in 2016/17 as improvement plan. The tables below highlight the service compared to the 0.5/1000 reported during 2015/16. delivery plan and the achievements to date.

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Table 2.2.1: Main services and standards Main services Beneficiaries Current/actual Desired standard Actual standard of service of service achievement Maternal Health All pregnant Early bookings in Increase early Early booking in services women pregnancy is above bookings in pregnancy is the set target pregnancy from current at 71,8% 55% to 68% Availability of All patients and Target could not be 95% availability of 92% availability of essential medicine clients achieved due to the essential medicine essential medicine list in all health unavailability of list in all health list in all health facilities drugs at the depot facilities facilities

Batho Pele arrangements with beneficiaries (Consultation access etc) Current/actual arrangements Desired arrangements Actual achievements

Health facilities conducting open All health facilities to conduct open 20 health facilities have conducted days days open days

Service delivery information tool Current/actual information Desired information tools Actual achievements tools Media Radio and Facebook 306 Media coverage (articles) 158 talk shows 1 320 radio adverts 4 outside broadcasts 35 Facebook 33 twitters

Publication Newsletters, posters 15 000 newsletters 07 posters for various Departmental events

Complaints mechanism Current/actual complaints Desired complaints mechanism Actual achievements mechanism Suggestion boxes Complaints resolution within 25 District hospital 93.7% working days Regional hospitals 100% Specialised hospitals 97.3% Tertiary hospitals 88.3%

Complaints register Standard complaints register Results generated from the in- house complaints management system

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

2.3 Organisational environment were raised during the protests and were resolved, and the situation was normalised. The Department has been striving to perform with limited • Removal of hospital CEO as he is not a resident of human resources at strategic management areas for the the area past ten (10) years. To address the instability, the • Demand employment of employees who were Department appointment a Head of Department together recruited through agencies, meanwhile the with 11 senior managers and 2 hospital Chief Executive Department did not appoint them in terms of section Officers (CEOs) as listed below: 197 of LRA 66 of 1995 • Critical shortage of staff • Chief Director: Financial Management • Lack of protective clothing • Chief Director: Integrated Health Planning • Change to condition of service • Chief Director: Hospital Services • Safety of employees • Chief Director: Gert Sibande District • CEO undermining the role of labour unions • Director: Management Accounting • Director: Supply Chain Management 2.4 Key policy developments and legislative • Director: Strategic Planning changes • Director: Monitoring & Evaluation (Planning) The Mpumalanga DoH has introduced the new national • Director: Hospital Services (Ehlanzeni District) policy in HIV and AIDS on test and treat which led to the • Director: MEC Support Staff escalation of expenditure of the programme on • Director: Primary Health Care (Gert Sibande District) antiretroviral and testing kits; resulting in budgetary • CEO for Ermelo Hospital constraints that had a negative effect on other • CEO for Bongani TB Hospital programmes.

However, while addressing the challenge, the following 11 3. STRATEGIC OUTCOME ORIENTED posts were vacated due to various reasons such as GOALS retirement, resignation and transfers which had a negative impact on the operations of the Department. 3.1 Strategic goals of the Department 3.1.1 To improve access to health care services • CEO for KwaMhlanga Hospital and continuously attain health care • CEO for Tintswalo Hospital outcomes • CEO for Standerton Hospital 3.1.2 Overhaul health system and progressively • CEO for Lydenburg Hospital reduce health care costs • CEO for Barberton TB Hospital • CEO for Witbank Hospital 3.2 Progress made towards achievement of • Director: Financial Accounting the five-year targets • Director: Primary Health Care • Director: Hospital Services (Gert Sibande District) Significant progress towards achievements of the five- • Director: HIV and AIDS & STIs year strategy are as follows: • Chief Director: Infrastructure Development and According to 2015 mid-year population estimates from Management Statistics SA, there is a significant increase in life expectancy from 51.6 years baseline (2012) to 56.5 The Department encountered protests by staff and years in 2016 towards the 67 year target of 2020 (55.8 communities of the following facilities. The issues raised years for males and 57.2 years for females) during the protests were resolved and the situation was The maternal mortality ratio at facility has decreased normalised. from 166.1/100 000 live births baseline to 129.6/100 000 live births in 2016/17 towards the target of 50/100 The Department encountered protests by staff and 000 live births in 2020. communities of the following facilities. The issues below

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

The Department has significantly improved the • 235 number of ward-based PHC outreach teams antenatal care programme for pregnant mothers. are established and functional and provide health Approximately 71% of all pregnant mothers in the services within the communities they are placed Province present at PHC facilities within their first • 451 number of school health teams are providing trimester (before 20 weeks) of their pregnancy to school-going children of the province with health receive further care. This is an improvement from the services 37.1% reported in 2011/12. • 227 number of facilities are connected to the internet The policy change during 2016/17 which was launched and implemented in the Universal Test and Treat In the endeavour to strengthen health system (UTT) campaign has seen an increase in the HIV effectiveness, the Department has improved testing services from 620 432 in 2014/15 to 1 053 082 communication and information management through during 2016/17. The total clients remaining on internet connectivity of 227 PHC facilities, 281 PHC treatment on the antiretroviral (ARV) programme has facilities are implementing Patient Health Registration increased dramatically from 144 069 in 2011/12 to 377 Systems (PHRS) and 286 PHC facilities implementing 288 in 2016/17. webDHIS. This has positively impacted the information flow timelines. There are 14 842 pregnant women who are on the antiretroviral treatment after tested positive for HIV and In efforts to increase access to health services, the this has seen a significant drop on the mother-to-child Department has prioritised an infrastructure delivery transmission rate from 4.5% in 2011/12 to 1.7% in plan as outlined in the Provincial priorities to deliver 2016/17 that test HIV positive when tested at 10 modern high technology facilities. The following weeks. projects have since been achieved in the past five years: The Department has recorded a significant drop in the number of children that are dying due to pneumonia, • 18 new/replacement constructions completed diarrhoea and severe malnutrition. Child under 5 years • 48 upgrades and additions completed with diarrhoea case fatality rate dropped from 4.2% • 148 renovation, rehabilitation and refurbishment. national baseline (2012) to 1.5% in 2016/17 in the direction of the <2% target of 2020. Child under 5 Furthermore, 22 clinics have achieved an ideal clinic years with severe malnutrition: case fatality rate status and 96 clinics are scoring above 70% of ideal dropped from 9% national baseline (2012) to 8.4% in clinic dashboard. 2016/17 towards <5% target of 2020. The Department has also realised improvement neonatal mortality rate 4. PERFORMANCE INFORMATION BY from 14/1000 live births national baseline (2012) to PROGRAMME 10.9/1000 progressing to 5/1000 target of 2020. 4.1 PROGRAMME 1: ADMINISTRATION The Department is piloting the NHI model launched in 2010 by the Health Minister. The NHI is aimed at Purpose providing essential healthcare to all citizens regardless of their employment status and ensure that all citizens The purpose of this programme is to provide the are accessing universal coverage of quality healthcare overall management of the Department, and provide services. The pilot in the province was through Gert strategic planning, legislative, communication services Sibande district to implement the first phase of NHI and centralised administration support through the implementation. The following components have since MEC’s office and administration. been implemented and they are being rolling out to all other districts in the province:

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

List the sub-programmes hold as a result of the moratorium placed by EXCO during the month of November 2016. • Office of the MEC • Recruitment and selection Compliance with Employment Equity Act. • Conditions of service and remuneration • Practice and administration Gender mainstreaming • Organisational strategy and planning • Planning information and PMDS It has been a challenge for the Department to appoint • Employee health and wellness females in senior management positions. In 2014/15 the Department employed 51% females in senior • Labour relations management positions which decreased to 45% in • Transformation and transversal programmes 2015/16 and declined even further in 2016/17 to 41%. • Occupational health services

• Records management Plans to improve: • Financial management • The Department is not implementing the Legal services • Employment Equity (EE) Plan in order to ensure • Communications that employment equity targets are adhered to • Internal audit when recruiting Senior Management Service • Integrated health planning (SMS) personnel. • Information technology • SMS positions are approved by Cabinet, and the EE Plan will be attached to each List the strategic objectives recommendation in order for cabinet to be aware of the employment equity targets for the • Re-alignment of human resources to DoH. Departmental needs • The Department will prioritise the appointment • Strengthening health systems effectiveness of women to SMS positions priority, but the Department is experiencing severe budget Strategic objectives, performance indicators, pressures and the position will not change in the planned targets and actual achievements next financial year.

Human Resources management Disability mainstreaming

In the year under review, the Department planned to The Department has 118 (0.59%) persons with appoint 28 of 28 executive management teams. At the disabilities employed below the 2% (405) norm. There end of 2015/16 the appointments were 11/28, which is a need to conduct an audit to determine the status further increased to 18/28 during the 2016/17 financial quo and or appoint 287 employees with disabilities to year, considering the fact that attrition rate is at 6.2% reach the 2% target. where posts are being vacated for various reasons such as terminations, retirement and transfers. The following hospitals have already achieved their 2% disability targets: Standerton specialised TB; The Department has no information officers, which Sabie; Witbank specialised TB; Carolina, Evander and posed a big threat for the quality of information being Elsie Ballot hospitals. collected at service delivery points. The Department aimed at appointing 18 information officers in the 18 Plans to improve sub-districts. During the year a total of 7 information • To conduct awareness campaigns on persons officers were appointed in Gert Sibande sub-district. with disabilities The processes in the two other districts were put on

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• Conduct an audit on the establishment to • 28 out of 33 hospitals have broadband connection determine the number of people with disabilities and were upgraded to a faster speed of 2 mbps or • All advertisements placed by the DOH must be higher circulated and brought to the attention of • 28 hospitals are implementing Patient Electronic registered disability organisations for further Information System (PEIS), to address challenges on distribution among their members. patient administration and billing. • 74 PHC facilities have installed and are implementing Information Communication Technology HPRS at Gert Sibande district.

The programme is composed of the following businesses Quality Assurance which is aimed at providing information technology supports 33 hospitals, 287 PHC facilities and 3 district To improve quality of services rendered at all health offices including head office. establishments, the Department together with the • ICT Infrastructure Office of Health Standards Compliance (OHSC) to • ICT Project Management & Governance assess facilities against National Core Standards • Health Systems & Applications and during 2016/17. • Client Support Services. The Department average performance score ranges The major achievements in the current reporting period between 39% to 84%. The table below indicates are: performance on National Core Standards measuring • 227 out of 286 PHC facilities have broadband the Six Ministerial Priority areas for tertiary and connectivity regional hospitals.

Six Priority Areas Witbank Rob Ferreira Themba Mapulaneng Ermelo

Availability of medicines 86% 89% 70% 60% 92%

Cleanliness 74% 72% 70% 78% 61%

Patient safety 79% 72% 64% 71% 78%

Infection control 77% 80% 84% 77% 81%

Waiting times 79% 66% 75% 85% 81%

Staff attitude 85% 50% 82% 84% 100%

Average 78% 76% 68% 73% 77%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

During 2016/17, the Department has prioritised the assessment of the ideal clinics programme which assess PHC facilities to be accredited as ideal for the provision of quality health care. About 22 PHC facilities attained an ideal clinic status by scoring above 70% on the ideal clinic dashboard.

The following challenges were identified at both PHC facilities and hospitals: • Shortage of essential equipment • The recommended cleaning material • Shortage of staff • Emergency trolleys not standardised, • Not all tracer medicines are available as per applicable essential drug list • Infrastructural challenges such as lack of isolation wards, • Security challenges such as lack of CCTVs, insufficient number of security officers allocated.

All health establishments have developed and are implementing quality improvement plans based on the gaps identified.

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Strategic objectives & Performance indicators, Planned Targets and Actual Achievements Programme 1: Administration Strategic Performance Actual Actual achievement Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement 2014/2015 achievement target achievement planned target 2013/2014 2015/2016 2016/2017 2016/2017 to actual achievement 2016/2017 Strengthening Audit opinion Not in plan Not in plan The Unqualified Qualified The The Department has challenges with Internal health from Auditor- Department Deapertment Controls, Limitation of Scope, Mistatements systems General received received a and Contract Management. effectiveness Qualified qualified audit Audit opinion opinions on the from AGSA. following 3 items: • Immovable tangible

35 capital

assets

• Movable tangible capital assets • Irregular expenditure Percentage Not in plan Not in plan 100% 100% 100% 0 None of hospitals (33/33 (33/33 (33/33 with maintained) maintained) maintained) broadband Re-alignment access of human resources to Percentage 80/278 34% 29% 80% 80% 0 None Departmental of fixed PHC (80/279 (227/284) 227/284 needs facilities with cumulative) broadband

access Improve Not in plan 11 10/33 28/33 18/33 (15) Appointing executive management teams in hospital 15/33 hospitals not achieved as per the

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme 1: Administration Strategic Performance Actual Actual achievement Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement 2014/2015 achievement target achievement planned target 2013/2014 2015/2016 2016/2017 2016/2017 to actual achievement 2016/2017 management planned target and the underperformance by appointing was as a result of the following: executive • Promotions and transfers management teams in all • Limited budget hospitals. Appointment in acting capacity in vacant (key executive management posts while management recruitment is in process positions)

Improve Not in plan Not in plan 1 1 1 0 None quality of (Implemented) care by developing and implementing recruitment & retention strategy Improve 1/18 None 0 maintained 18 7 /18 (11) Appointment of all 18 information officers was not achieved due to the moratorium on filling of quality of maintained information posts by appointing Continue with the utilisation of data capturers information and review the strategy of information officers in all management based on available resources. sub-districts Improve Not in plan Not in plan Not achieved 1 Withdrawn None The tender was withdrawn since this is a record from APP national competency as part of NHI management implementation for a single Information by system. Participate in the national committee

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme 1: Administration Strategic Performance Actual Actual achievement Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement 2014/2015 achievement target achievement planned target 2013/2014 2015/2016 2016/2017 2016/2017 to actual achievement 2016/2017 implementing for establishment and implementation of electronic national electronic patient record system patient record management system (EPRMS)

Linking performance with budgets

37 The programme had spent 100 percent of the adjusted budget of R282 million. The programme has achieved 50% (3 out of 6) of its planned indicators.

Sub-programme expenditure

Sub- programme name 2016/2017 2015/2016 Final Actual (Over)/Under Final Actual expenditure (Over)/under expenditure appropriation expenditure expenditure appropriation R’000 R’000 R’000 R’000 R’000 R’000 Office of the MEC 8 446 7 752 694 8 685 7 600 1 085

Management services 273 555 274 249 (694) 290 207 289 698 509

282 001 282 001 - 298 892 297 298 1 594 Total

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4.2 PROGRAMME 2: DISTRICT HEALTH uninsured population of which the Department SERVICES (DHS) provided services during 2016/17. This has negatively affected the Department to achieve its planned targets. Purpose The programme has achieved 37% of its planned targets. The purpose of the programme is to render comprehensive primary health care services to the The following are significant achievements per sub- community using the District Health System (DHS) programme: model. Sub-programmes: District management and The purpose of the programme is to render level 1 primary health care health services in district hospitals. • All three districts are implementing the NHI initiatives such as ideal clinic programme, Sub-programmes integrated school health services, eHealth, Central Chronic Medication Dispensing and • District management Distribution (CCMDD) and Ward Based Primary • District hospitals Heath Care Outreach Team (WBPHCOT), to • HIV and AIDS, STI and TB improve the universal coverage to PHC services • Maternal, Child and Women’s Health & Nutrition • Nkangala District performance on Ideal Clinic (MCWH&N) Realisation and Maintenance (ICRM) is highly • Disease Prevention and Control (DPC) commendable since they achieved 100% of targeted PHC facilities (22/22 PHC facilities Strategic objectives achieved the ideal clinic status) • 37 Health Promoting Schools established in all 3 • Improve healthcare outcomes districts making a total of 451 against the target of 30. This is aimed at increasing access to PHC Significant achievements services by school going children • To increase access to PHC services at The Department delivers most of its services to household level, 235 Ward-based Primary Health communities through the DHS platform. The Care Outreach Teams established and covering programme was adequately funded at 60% of the total 209 of the 402 municipal wards and 51 614 budget, however, Mpumalanga Province has 88% Households were profiled

District name Gert Sibande Ehlanzeni Nkangala Total WBPHCOT 99 69 67 235 Health -promoting schools 143 158 150 451 CCMDD patients 59 062 17 005 10 517 86 584

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• Patient experience of Care Survey Rate (PHC • Cervical cancer screening has improved against facilities) conducted in all PHC facilities and the the target of 70% to be at 71% patient experience of care at PHC facilities is at • The strategy of using the ward based PHC 82% which is above the target of 80% outreach teams bore positive outcomes as the • A total of 1004 complaints were received, 723 vitamin A coverage to children who 12-59 months were resolved and 95.4% (690) were resolved has increased to 55.6% against the target of 55% within 25 working days against the planned target • The stillbirth rate has improved to be at 19.8/ of 96% 1 000 against the target of 22/1000 • Operation Phakamel’Impilo has been extended • Percentage of hospitals with functional Kangaroo from taxi ranks / malls to correctional services Mother Care (KMC) units has increased to 67% centres (Witbank, Ermelo, Bethal, Barberton, against the target of 50% due to good Middelburg, Carolina and Lydenburg) implementation of mother- baby friendly health • The percentage of clients screened for mental facility and new born initiative health has increased to 11.6% against the target of 0.7% due to community campaigns that were Sub-programmes: HIV and AIDS, STIs and TB conducted under the umbrella of operation (HAST) Phakamel’Impilo • The Department distributed 2198 126 and 76 588 Sub-programmes: District hospitals 584 female and male condoms in 2016/17 • Self-assessments on National Core Standards compared to 1 828 571 and 48 441 942 conducted in all district hospitals and quality distributed in 2015/16 respectively improvement plans developed and implemented • A total of 377 288 clients have remained on to address the identified gaps antiretroviral treatment in 2016/17 as compared • Patient experience of care survey conducted in to 318 228 in 2015/16. This is as a result of the all 23 district hospitals and the patient experience adherence guidelines and the new policy of of care rate is at 76.8% against the target of 75% universal test and treat strategy • The total number of clients tested for HIV was 1 Sub-programmes: Maternal, Child and Women’s 021 048 in 2016/17 compared to 868 897 during Health & Nutrition (MCWH&N) the 2015/16 financial year • The rate of pregnant women who are booking for • TB MDR treatment success rate is related to the antenatal care services before 20 weeks has implementation of MDR TB decentralisation improved from 65.9% to 70.7% against the target policy. The purpose of decentralisation is to of 70% due to community dialogues that were increase access to initiation of treatment to conducted throughout the province patients • Strengthening of surveillance on EPI services • TB MDR treatment success rate is at 54.4% in has yielded positive results, DTaP-IPV-HepB-Hib 2016/17, compared to 45% in 2015/16 3 – Measles 1st dose drop-out rate has been • Campaigns specifically focusing on the youth decreased to -12.4% have been conducted in institutions of higher • Case fatalities of children under 5 years due to learning diarrhoea, pneumonia and severe acute • The rate of medical male circumcision has not malnutrition have all been reduced to 1.6%; 3.5% increased, a total number of 44 393 and 7.8 % respectively circumcisions were performed in the 2016/17 as • Couple year protection rate has been prioritised compared to the 38 439 done in 2015/16 as a first line of defence of maternal and child mortalities and it has been increased to 46.9% against the target of 45%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Sub-programmes: Disease Prevention and Control (DPC)

The Department is committed to the prevention of chronic disease which is known as lifestyle diseases through awareness campaigns and outreach services and all clients presenting to facilities are being screened for the following diseases: • 3 071-652 clients were screened for hypertension • 1 855 330 clients were screened for diabetes • 11.6% clients were screened for mental health disorders

The Department continues to implement the MOSWASA agreement to eliminate deaths from malaria

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: District Management Strategic Performance Actual Actual Actual Planned target Actual Deviation Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement from 2013/2014 2014/2015 2015/2016 2016/2017 planned target to actual achievement 2016/2017 Not in plan Not in plan 1 1 District 2 1 The following NHI initiatives such as Ideal Number of districts (Cumulative 2) (Cumulative 3) clinic, WBPHCOT, SHS, HPRS, and piloting NHI CCMDD were rolled out to Nkangala and interventions Ehlanzeni Districts.

41 Establish NHI Not in plan Not in plan 0 1 District 0 (1) Lack of approved guidelines from NDOH

consultation Fora (Cumulative 2) Not in plan Not in plan 9.3% 64% 33.4% (30.6%) Infrastructure challenges Percentage of fixed (26/279) (183/284) (96/287) (89/287) PHC facilities Shortage of essential equipment and the scoring above 70% recommended cleaning material on the ideal clinic

dashboard Shortage of staff Improve health Client Satisfaction Not in plan 63.95% 75% 100% 100% 0 None care outcomes Survey rate (PHC) Client Satisfaction Not in plan 100% 80% 80% 82% 2% Implementation of an ideal clinic initiative rate contributed to the improved quality of care OHH registration Not in plan Create baseline 27.3% 39% 30.9% (8.1%) The indicator was new in 2015/16 and there visit coverage was not enough baseline information to provide realistic target. Number of districts Not in plan 2 0 (1) 1 0 (1) General scarcity of specialists in the country with fully fledged (Cumulative 2) (Cumulative 1) district clinical

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: District Management Strategic Performance Actual Actual Actual Planned target Actual Deviation Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement from 2013/2014 2014/2015 2015/2016 2016/2017 planned target to actual achievement 2016/2017 specialist teams established (DCSTs) PHC utilisation rate 2.2 2.3 2.2 2.5 2.2 (0.3) Not all facilities have reached the ideal clinics status on elements such as infrastructure and shortage of doctors Complaints Not in plan Not in plan 60.8% 86% 68.% (18%) Infrastructure related complaints taking too

42 resolution rate long to be resolved

Patients not leaving contact details in the complaint forms Complaints 77.9% 98.9% 95.5% 90% 93.7% 3.7% Implementation of the complaints Improve health resolution within 25 management policy care outcomes days rate Not in plan Not in plan Not in plan 54 years 56.5 years 2.5 years Life expectancy has improved due to the following: Increased life access to health care services and expectancy antiretroviral treatment.

Number of health- 52 (337) 35 48 (414) 30 (421) 37 (451) 7 Good collaboration with Department of promoting schools Education established in all 3 districts Number of PHC 24 10 60 112 teams 112 teams. 0 None outreach teams (Cumulative 44) (Cumulative 63) (Cumulative 235)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: District Management Strategic Performance Actual Actual Actual Planned target Actual Deviation Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement from 2013/2014 2014/2015 2015/2016 2016/2017 planned target to actual achievement 2016/2017 established in sub (Cumulative (235 districts 123) cumulative) Number of school 9 0 12 26 13 (13) Delays due to the translations process for health service teams (26 Cumulative) (68 cumulative) (43 Cumulative) professional nurses established Provincial PHC R 473 R 238.11 R 416.89 R 580 R 510.17 (R 69.83) Low expenditure due to low PHC utilisation.

43 expenditure per

uninsured person

Strategic objectives & Performance indicators, Planned Targets and Actual Achievements

Programme / Sub-programme: District Hospitals

Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievemen achievement planned target to 2013/2014 2014/2015 t 2015/2016 2016/2017 actual 2016/2017 achievement 2016/2017

National Core 16/23 (69.56) 100% 100% 100% 100% 0 None Standards self- assessment rate

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: District Hospitals

Quality improvement 23/23 (100%) Not in plan 100% 100% 100% 0 None plan after self- assessment rate

Percentage of Not in plan 0% 0% 30% (7/23) 0 (30%) (7/23) Infrastructural constraints, safety and hospitals compliant security issues with all extreme and vital measures of the

44 National Core

Standards

Client Satisfaction Not in plan Not in plan 100% 100% 100% 0 None Improve health Survey rate care outcomes Not in plan 69% 80% 75% 76.8% 1.8% Implementation and monitoring of the Client Satisfaction 6 priority areas starting to yield rate positive results

4.3 days 4.3 days 4.5 days 3.7 days 4.8 days (1.1 days) Orthopaedic patients (pre-and post Average length of operation) stay longer in the hospital stay

Psychiatric patients stay longer than

72 hours in district hospitals

Inpatient bed 70.5% 70.9% 71.4% 75% 75.3% 0.3% Orthopaedic patients (pre-and post utilisation rate operation) stay longer in the hospital

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: District Hospitals

Psychiatric patients stay longer than 72 hours in district hospitals

Expenditure per PDE R 1 830 R 2 164 R 2 153 R 2,237 R 2,283.2 (R 46,2) Orthopaedic patients (pre-and post operation) stay longer in the hospitals.

Psychiatric patients stay longer than 72 hours in district hospitals

Complaints Not in plan Not in plan 70.3% 90% 72% (18%) Clinical related complaints take longer resolution rate to resolve due to the investigation processes that are required

Complaint resolution 94.5% 98% 90.6% 96% 95.4% (0.6%) Infrastructure and human resources within 25 working related challenges take long to be days rate resolved

Improve health care outcomes

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: HIV and AIDS, STI and TB (HAST)

Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual 2016/2017 achievement 2016/2017

Adults remaining on 243 374 283 932 318 228 372 014 360,037 (11 977) Some clients on treatment, files are not ART - Total updated in the Tier.net system and this results in the system reporting them to Total Children (under Not in plan Not in plan Not in plan 28 001 17 251 (10 750) have defaulted. The Department is 15 years) remaining retrieving all files of clients reported to on ART have defaulted for verification and

46 capturing

TB/HIV co-infected 60.9% Not in plan Not in plan 100% 39.7% (60.3%) Some clients decline treatment client on ART rate

Clients tested for 24.4% 26.6% 868 897 1 074 568 1 053 082 (21 486) Not all clients who are counselled opt to HIV (incl ANC) test

TB symptom 5yrs Not in plan Not in plan 12.5% 90% 39.8% (50.2%) This is a new indicator integrated from and older screened July 2016 in the DHIS There is on-going Improve health rate support to health facilities to encourage care outcomes proper recording and capturing. The baseline in 2015/16 was 12.5% and currently 42.7% has been recorded, which is a significant improvement

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: HIV and AIDS, STI and TB (HAST)

Male condom 29.3% Not in plan 30 per male 50 per male 52 per male 2 per male Overachieved due to involvement of distribution (60 990 095) NPOs and development partners in (77 703 335) 16 713 240 condom distribution

Female condom Not in plan Not in plan 1 828 571 1 315 607 1 981 572 665 965 Overachieved due to involvement of distribution NPOs and development partners in condom distribution

47 TB client treatment 80% 81.8% 88.6% >85% 87.4% 2.4% Target achieved due to training of success rate clinicians on TB guidelines

TB client lost to 5.4% 5.4% 4% <5% 5.4% (0.4%) Patients relocate to other places without follow up rate informing the facility. Difficult to trace patients who crossed the border.

Some patients give wrong addresses and others stay in informal settlements and makes it very difficult to trace the address

Health education to be given regarding the importance of reporting to the clinic when moving to another area. To give a traceable address for easy access

TB client death Rate Not in plan Not in plan 4.5% <5% 4.7% 0% None

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: HIV and AIDS, STI and TB (HAST)

TB MDR confirmed Not in plan 99.2% 95.3% 95% 99.4% 4.4% Overachieved due to decentralisation of treatment start rate multi-drug resistant (MDR) treatment to Barberton, Standerton and Bongani specialised TB hospitals

TB MDR treatment Not in plan Not in plan 45% 58% 54.4% (3.6%) High lost to follow-up and death rate success rate Late detection and initiation of treatment

48 Prevention of mother to 99.9% 99.1% 99.4% 100% 100% 0 None child transmission by increasing baby Nevirapine uptake rate

Percentage of HIV 95.8% 81.2% 84.1% 95% 86.4% (10.6%) New information systems were introduced positive clients IPT and health care workers are still getting familiarized as a result this led to poor recording

Improve TB cure rate 77% 76.1% 78.7% 85% 75.9% (9.1%) Patients are lost to follow up

The 11.5 % of patients were clinically well on observation but were unable to cough up a sputum at the end of treatment

Medical male 42 604 49 685 38 439 85 084 38 262 (46 822) The uptake of VMMC services in the circumcision performed Province is low due to preference between - Total traditional and medical circumcision

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Maternal, Child and Women’s Health & Nutrition (MCWH&N) Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 st Antenatal 1 visit 49% 56.6% 65.9% 70% 71.7% 1.7% Target achieved due to community before 20 weeks dialogues rate Mother postnatal Not in plan Not in plan 62.5% 70% 60.2 % (9.8%) Cultural issues discouraging early visit within 6 days exposure of new-borns rate

49 Improve health

care outcomes Antenatal client AZT no longer in Not in plan 95.8% 100% 94.9% (5.1%) There are data gaps in about 35 initiated on ART the policy facilities. These were identified and rate forwarded to the information unit for assistance. Data will be updated as soon as the corrections are made Infant 1st PCR test 2.1% 1.7% 1.6% <1.6% 1.7% (0.1%) Mothers not adhering to exclusive positive around 10 (6 weeks) (6 weeks) (10 weeks) (10 weeks) breastfeeding weeks rate Immunisation 71.4% 80.2% 87.1% 90% 79.7% (10.3%) National stock out of Hexavalent coverage under 1 vaccines resulted in non-achievement of year (annualised) target Measles 2nd dose 77.9% 84.2% 78.7% 90% 86.4% (3.6%) Inadequate number of mobiles to reach

coverage (1st dose) (1st dose) the early developmental centres

(annualised)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: Maternal, Child and Women’s Health & Nutrition (MCWH&N) Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 DTaP-IPV-HepB- Not in plan Not in plan (-14.3%) Less than 10% Less than (4.2%) Intensified surveillance Hib 3 – Measles 1st 14.2% dose drop-out rate Child under 5 years Not in plan 5.3 / 1 000 2.7 / 1 000 4 1.5 2.5 Implementation of integrated diarrhoea case per 1 000 Per 1000 per 1000 management of childhood illnesses fatality rate strategy

Child under 5 years Not in plan 5.3 3.7 3.6 3.4 0.2 Implementation of integrated

50 pneumonia case per 1 000 per 1 000 per 1 000 Per 1000 per 1000 management of childhood illnesses

Improve health fatality rate strategy care outcomes Child under 5 years 2.7 2.9 12.5 15 8.4 6.6 Implementation of the Provincial plan to severe acute per 1 000 per 1 000 per 1 000 per 1 000 per 1000 per 1000 reduce the SAM case fatalities malnutrition case fatality rate School Grade 1 Not in plan Not in plan 20% 28% 21.1% (6.9%) Inadequate number of School health screening coverage teams School Grade 8 Not in plan Not in plan 13.1% 15% 6.8% (8.2%) Poor recording and reporting screening coverage (annualised) Couple year 36.1% 39.7% 38.6% 45% 50.4% 5.4% Reintroduction of implants and IUCD as protection rate extra contraception methods (annualised) Cervical cancer 55% 63% 66.7% 70% 66.5% (4.5%) Allocation of individual targets for each screening coverage professional nurse (annualised)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: Maternal, Child and Women’s Health & Nutrition (MCWH&N) Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 Human Papilloma Not in plan Not in plan 102% 80% 77.2% (2.8%) Unreliable denominator from DOE virus vaccine 1st (31 325) information system. Incomplete data dose coverage from NDOH Improve health Human Papilloma Not in plan 82.5% Not in plan 80% 58.3% (21.7%) Unreliable denominator from DOE care outcomes virus vaccine 2nd (23 670) information system. Incomplete data dose coverage from NDOH Vitamin A 12- 59 36.2% 49.9% 51.4% 55% 56.1% 1.1% Use of ward based PHC outreach teams months coverage

51 (annualised)

Infant exclusively Not in plan Not in plan Not in plan 55% 35.3% (19.7%) Nationwide stock out of Hexavalent breastfed at HepB vaccine 3rd dose rate Maternal Mortality 133 108 125.3 102 129.6 /100 000 (27 /100 000) Late booking for ANC services in facility Ratio /100 000 /100 000 /100 000 per 100,000 (annualised) Inpatient early 7.8 8.3 9.3 8 9,5 /1000 (1,5 /1 000) Late booking for ANC services neonatal death rate Per 1 000 per 1 000 Per 1 000 per 1 000 Number of district 5 3 2 3 1 (2) Reprioritisation of resources to antenatal hospitals with (Cumulative 8) (Cumulative (Cumulative 14) (Cumulative care (BANC+) maternity waiting 10) 11) homes Stillbirth rate Not in plan Not in plan Not in plan 22 20.9 (1.1 Roll- out of basic antenatal care plus per 1 000 per 1000 per 1000) strategy

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives and performance indicators, planned targets and actual achievements

52 Programme / Sub-programme: Disease Prevention & Control (DPC)

Strategic Performance Actual Actual Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement target achievement planned target 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 to actual achievement 2016/2017 Clients screened Not in plan 12.9 1 368 310 100 000 3,071,652 2 907 713 Awareness campaigns and for hypertension per 1 000 outreach contributed to over achievement. All patients who visit

facility are encouraged to screening

Improve quality of Clients screened Not in plan 1.4 403 860 80 000 1,855,330 1 775 330 Awareness campaigns and health care for diabetes per 1 000 outreach contributed to over achievement. All patients who visit facility are encouraged to screening Clients screened Not in plan 0.9% 0.6% 0.7% 11.6% 10.9% Campaigns conducted in the for mental health districts and outreach program to prisons has increased screening of mental health patients

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: Disease Prevention & Control (DPC) Strategic Performance Actual Actual Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement target achievement planned target 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 to actual achievement 2016/2017 Support of the PHC at Ehlanzeni district during ideal clinic initiative to screen patients for mental health. Cataract surgery CSR 670 (3 600) CSR 718 CSR 805 CSR 1 000 (3 CSR 1,333 CSR 333 Inadequate number of rate (annualised) (2 657) 600) (1 303) (2 217) ophthalmologist and cataract surgeons Malaria case 0.73% 0.77% 0.5% 0.5 0.67% (0.17%) Lack of knowledge on malaria signs fatality rate and symptoms among the patients leading to late presentation of (annualised) 53 patients for health intervention

Imported cases due to cross boundary migration

Decrease the 0.47 0.61 0.1 0.1 0.2 (0.1 Target not achieved due to the increased breeding sites resulted incidence of local case per 1 local case per local case local case local case local case per 1 from good rainfall following the spell Malaria per 1000 000 1 000 per 1 000 per 1 000 per 1 000) 000 of drought and the return of population at risk. migrants from malaria endemic areas after holidays

Number of district Not in plan Not in plan 0 1 0 (1) Difficult to recruit and retain mental health specialists due to general scarcity of teams established specialists in the country remains a challenge

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reasons for all deviations HIV and AIDS, STI and TB (HAST)

District management and primary health care • Some of the clients on treatment files are not updated in the Tier.net system as a result of inadequate • NDOH has not finalised guidelines to establishment number of data capturers, resulting in the system of NHI consultation fora reporting them to have defaulted • The planned percentage of fixed PHC facilities • Community HIV testing services have been extended scoring above 70% on the ideal clinic dashboard to hard to reach communities was not achieved due to unavailability of equipment, • Implementation of universal test and treat has led to infrastructure challenges and human resources the improvement of HIV testing • Provincial PHC expenditure per uninsured person is • TB symptom 5yrs and older screened rate: This is a high due to shortage of lower category nursing new indicator integrated from July 2016 in the DHIS personnel in health facilities. Professional nurses data was not collected prior to July 2016 were utilised to provide the services that could have • The uptake of VMMC services in the Province is low been implemented by lower categories due to targets set very high by National DOH and the • District clinical specialist teams and mental health completion received by the male initiation schools in specialist teams could not be established due to both the public and the contracted general general scarcity of specialist in the country practitioners’ facilities • PHC utilisation rate remains being low because • Lost to follow-up rate is high due to patients relocating communities bypass PHC facilities to be seen by other places without informing the facility. Difficult to doctors that are not always available at a PHC level, trace patients who crossed the border and most poor infrastructure and long waiting times patients give wrong addresses and others stay in • Complaints resolution rate issues that are related to informal settlements and makes it very difficult to infrastructure and human resource take a long time trace them to be resolve • Drug resistant TB success rate is low due to late • The planned school health service teams could not presentation for initiation of treatment including co- be established due to the resolutions of the morbidity Provincial bargaining chamber on translations of • Patients initiated on IPT is low due to missed professional nurses opportunities in the implementation of guidelines TB • School Grade 1 screening coverage and school cure rate was not met even though 11.5% completed Grade 8 screening coverage also could not be treatment because they were unable to cough up reached due to inadequate number of school health sputum at the end of treatment teams on the ground • Cultural beliefs that newborns cannot be exposed outside the house within 6 days /within a week post District hospitals delivery

• The percentage of hospitals compliant with all Maternal, Child and Women’s Health & Nutrition extreme and vital measures of the National Core (MCWH&N) Standards could not be met due to poor infrastructure that does not meet the norms and the non-availability • Immunisation coverage under 1 year could not be of vital equipment reached due to unavailability of Hexavalent vaccine • Average length of stay is affected by orthopaedic and nationally mental health care users who tend to stay long in • Measles 2nd dose coverage could not be reached district hospitals due to inadequate outreaches to hard-to-reach areas and early childhood developmental centres

• The infant exclusively breastfed at Hep B 3rd dose

rate could not be reached due to change in

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Hexavalent 3rd dose vaccine and unavailability of increasing the number of teams by 32 teams in Hexavalent vaccine 2017/18 • Maternal mortality in facility ratio and in-patient early neonatal death increasing due to inadequate skills in District Hospitals managing obstetric emergencies • District hospitals with maternity waiting homes could • To improve the average length-of -stay by not be increased as planned because funds were supporting the tertiary health services in directed to strengthen ante-natal care and introduced implementing the orthopaedic Letsima project BANC- Plus and to have Mmamethlake Hospital to have a psychiatric ward Disease Prevention and Control (DPC) HIV and AIDS, STI and TB (HAST) • The inadequate number of ophthalmologists in the province has led to the failure of the program to meet • Strengthen data management by appointing and the planned target of cataract surgery rate training data captures at all facilities • The province has been experiencing good rains that • Improve monitoring the procurement and unfortunately increase favourable conditions for the availability of test kits to avoid interrupted supply vector breeding, therefore incidence of malaria • Conduct advocacy and communication on increased and target could not be met HTS,VMMC and ARV treatment services during • Malaria case fatality rate increased due to late campaigns presentation to of patients to clinical care • Implementation of HPRS will assist in tracing of patients who are lost to follow-up Strategy to overcome areas of under-performance • Health education to be given regarding the

importance of reporting to the clinic when moving To address the challenges that attributed in the non- attainment of targets include but not limited to the to another area following: • To implement the new short-term regimen and the importance of treatment completion District Management and Primary Health Care • Monitor all smear-positive patients started on treatment to have smear results at the end of • Suspend the establishment of NHI consultation fora treatment until NDoH finalise guidelines • Conduct patient education after diagnosis, that • To priorities the procurement of equipment and will include the importance of the end of treatment maintenance of infrastructure of facilities that have sputum investigation been earmarked to be ideal and to reach the NCS in 2017/18 Maternal, Child and Women’s Health & Nutrition • District clinical specialist teams and mental health (MCWH&N) specialist teams will be achieved by sending medical doctors to specialise and continue with headhunting • Continue with community dialogues and from universities campaigns to raise the awareness on postnatal • To improve PHC utilisation rate by increasing the visit • Ensure adequate vaccination stock through stock number of facilities visited by the doctor at least once visibility system and strengthen interaction with a week as outreach from the hospitals NDOH in case of national stock-outs • To improve resolutions of complaints by continuing to • Mobile clinics visiting the ECD centres and render implement the multiyear infrastructure maintenance immunisation health care services plan and appointment of case managers • Training of staff on the management of obstetric • School Grade R1 screening coverage and School emergencies to reduce maternal mortality in Grade 8 screening coverage will be achieved by facility ratio and inpatient early neonatal death

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• Increased the number of district hospitals with • The Department will continue to implement the maternity waiting homes by ensuring maternity MOSWASA agreement waiting home to be included in the plans of the • The malaria case fatality rate has increased. The new district hospitals to be constructed plan is to train healthcare workers on the • Pregnant women will continue to be educated on diagnosis and management of malaria cases the importance of reporting to facilities post- delivery Changes to planned targets None Disease Prevention and Control (DPC) Linking performance with budgets • To conduct cataract blitz marathon to address the backlog of patients who need to be operated on The spending was at 100% of the adjusted budget of and to advertise and fill the vacant posts R6 527 billion however there are unpaid accruals at • To strengthen the residual spraying of dwellings the end of the financial year. The programme has that are in the high malaria risk areas and to achieved 37% (26 out of 70) of its planned indicators. educate communities on the signs and symptoms of malaria and the impotency of seeking medical intervention in time

Sub-programme expenditure

2016/2017 2015/2016 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 District 332 220 341 758 (9 538) 366 470 349 625 16 845 management Community health 1 199 986 1 202 502 (2 516) 1 268 696 1 246 101 22 595 clinics

Community health 793 589 833 433 (39 844) 770 952 753 732 17 220 centres

Community based 93 045 91 150 1 895 89 112 89 841 (729) services HIV AND AIDS 1 250 097 1 120 040 130 057 936 991 936 447 544 (HAST) Integrated nutrition 13 882 13 199 683 14 902 12 667 2 235

District hospitals 2 844 026 2 922 762 (78 736) 2 738 634 2 786 993 (48 359)

Total 6 526 845 6 524 844 2 001 6 185 757 6 175 406 10 351

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.3 PROGRAMME 3: EMERGENCY MEDICAL Strategic objectives, performance indicators, SERVICES (EMS) planned targets and actual achievements

EMS has increased the number of obstetric ambulances Purpose from 18 to 24 to improve access to health care services. This had impact in reducing maternal and neonatal The purpose of Emergency Medical Services (EMS) is deaths. to provide pre-hospital medical services, inter-hospital transfers, rescue and planned patient transport The following achievements were recorded during the (PPTS) to all inhabitants of Mpumalanga Province year under review: within the national norms of response times of 15 • Established two satellite bases (Nkangala and Gert minutes in urban and 40 minutes in rural areas. Sibande districts) • Ensured compliance with Professional Driving Permit Sub-programmes (PrDP) and HPCSA registrations by all staff • Provided Emergency Medical Dispatch (EMD) • Emergency transport services training to all communication centre staff • Planned patient transport services • Prepared the college for accreditation to be able to train EMS staff and submitted a letter of intent to the Strategic objectives HPCSA • Providing in-service training for all EMS personnel in • Improve access to health care services the province also contributed towards improving access to health care services

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Emergency Medical Services (EMS) Strategic Performance Actual Actual Actual Planned Actual Deviation Comment on deviations objectives indicator achievement achievement achievement target achievement from 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 planned target to actual achievement 2016/2017 EMS P1 urban 65.25% 73% 75.5% 85% 72.3% (12.7%) Lack of monitoring system to track response under 15 ambulances turnaround time minutes rate Shortage of personnel and operational ambulances EMS P1 call response 67.5% 66% 71.5% 75% 69.5% (5.5%) Lack of monitoring system to track under 40 minutes rate ambulances turnaround time Shortage of personnel and operational 58 ambulances EMS inter-facility Not in plan Not in plan 4.6% 30% 5% (25%) long turnaround times for repairs and transfer rate maintenance Shortage of personnel and operational ambulances Improve access Improve response Not in plan Not in plan 108 105 95 (10) Shortage of personnel to operationalise to health care time by increasing the Operational Operational ambulances services number of operational ambulances ambulances ambulances Improve the use of 0% 0% 20% 60% 20% (40%) Non-compliance is due to long process resources by engagement with various stakeholders in the integrating PPTS into preparation to take-over of PPTS EMS operations Improve maternal Not in plan Not in plan 18 6 6 0 None outcomes by (Cumulative 18) (Cumulative 24) increasing the number of obstetric ambulances

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reasons for deviations senior officials including EMS director to authorise repairs with the aim of improving turn-around time. • Lack of capacity in EMS to ensure that a full fleet of Merchants are also engaged to ensure that they ambulances is operational prioritise EMS fleet when sent for repairs and • Lack of sufficient number of ambulances to ensure maintenance that capacity is increased to respond to all calls as per • Non-compliance on improving the use of the targets resources by integrating PPTS into EMS • Prolonged engagements with stakeholder resulting in operations is due to long process on engagement the delay in the integration of PPTS into EMS of various stakeholders including labour organisations and hospital management in Strategy to overcome areas of under-performance preparation for a complete take-over of PPTS. A task team was appointed during the third quarter The programme failed to achieve most of the planned of the last financial year to focus on the integration targets attributable to lack of computerised monitoring and further to conduct benchmark visit to KZN in system to track ambulances’ turnaround time and long April 2017. Strategy is to proceed with the plan of turn-around times for repairs and maintenance PPTS integration to be completed by the 1st • The absence of EMS-specific monitoring system quarter 2017/18 and the shortage of personnel with shortage in the number of operational ambulances resulted in Changes to planned targets failure to achieve the urban response under 15 minutes’ rate and EMS P1 call response under 40 None minutes. The strategy is to install a tracker system Linking performance with budgets in all vehicles to ensure they are traceable and

respond to calls on time The programme has spent 100 percent at the end of • EMS inter-facility transfer rate target not achieved the financial year and there were recorded accruals at due to long turn-around time for fleet repairs. The year end. The programme has achieved 17% (1 out of Department has already provided delegations to 6) of its planned indicators.

Sub-programme expenditure

Sub- Programme 2016/2017 2015/2016 Name Final Actual (Over)/Under Final Actual (Over)/Under appropriation expenditure expenditure appropriation expenditure expenditure

R’000 R’000 R’000 R’000 R’000 R’000

Emergency 321 382 321 913 (531) 305 481 305 351 130 medical services

Planned patient 6 808 6 276 532 4 116 4 245 (129) transport

Total 328 190 328 189 1 309 597 309 596 1

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Mapulaneng hospital has also started to function as a 4.4 PROGRAMME 4: PROVINCIAL HOSPITAL referral hospital for the first time in 2016/17 SERVICES

Other significant achievements contributing to improve Purpose quality of health care include, among others:

• Appointment of personnel (CEO and 1 psychiatrist) The purpose of this programme is to render level 1 and 2 at Ermelo hospital health services in regional hospitals and to render TB- specialised hospital services. • Commissioning of medical orthotics unit • ICU and warehouse at Ermelo hospital Sub-programmes • All regional hospitals conducted National Core Standards self-assessment and quality improvement • Regional hospital services plans • TB-specialised hospital services The Department has improved its efforts to fast-track the Strategic objectives procurement of medical equipment to ensure adequate and modern high technology is available for service • Improved quality of health care delivery. During 2016/17 the following were procured: • Themba hospital procured 3 anaesthetic machines, 2 Strategic objectives, performance indicators, ventilators (1 neonatal and 1 adult), 3 ESU machines planned targets and actual achievements and 2 infant warmers

In an endeavour to improve quality of health care services, The new TB MDR treatment has been successfully the Department has appointed six (6) Cuban specialists initiated which has seen the TB MDR treatment rate for the regional hospitals (Mapulaneng and Ermelo) to improving slightly from 45% in 2015/16 to 54% and 99.4% make secondary services accessible in the Province. of TB MDR-confirmed patients are initiated on treatment. Furthermore, Ermelo hospital is currently providing the full package of secondary services (eight core domains) while

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Regional hospitals Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 National Core Not in plan 100% 100% 100% 100% 0% None Standards self- assessment rate

Quality 3 Not in plan 100% 100% 100% 0% None

improvement plan after self- assessment rate Percentage of Not in plan 0% 0% 100% 0% (100%) Underachievement due to

61 Improved hospitals emergency trolleys not

quality of compliant with all standardised, not all tracer health care medicines are available as extreme and vital per applicable essential drug measures of the list. Infrastructural challenges National Core such as lack of isolation Standards wards. Security challenges such as lack of CCTVs, insufficient number of security officers allocated Patient Not in plan Not in plan 100% 100% 100% 0% None Satisfaction

survey rate

(regional hospital) Patient 72% 79.67% 83% 87% 87% 0% None satisfaction rate (regional hospital) Average length of 5.4 days 4.4 days 4.6 days 4.7 days 4.4 days 0.3 day Additional specialists and stay MO’s appointed

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Improved Inpatient bed 75.6% 74.1% 80.3% 75% 81.2% 6.2% Admission of level 1 patients quality of utilisation rate due to unavailability of district health care hospitals around some municipalities. Expenditure per R2 568 R2 411 R2 614 R2 722 R2 985.60 (R 263.60) Overspending on key cost patient day drivers (NHLS, blood and equivalent (PDE) medicine) and overtime expenditure Complaint Not in Plan Not in plan 58.9% 90% 58.9% (31.1%) Clinical management resolution rate complaints take longer to resolve as in-depth of investigation is required. Complaint 99.4% 93.6% 98.7% 90% 100% 10% Fully functional complaints resolution within management committees 25 working days rate

62 Improved access Not in plan Not in plan 0% 1 3 2 Appointment of Cuban

to regional (6 Cumulative) (8 cumulative) specialists services by providing the eight core specialists clinical domains Functional Not in plan 3 3 3 3 0 None adverse events committees

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: TB specialised services Strategic Performance Actual Actual Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement target achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 actual achievement 2016/2017 National Core Not in plan 80% 100% 100% 100% 0 None Standards self- assessment rate (specialised hospitals) Quality 100% Not in pan Not in plan 100% 100% 0 None

63 improvement plan

after self- assessment rate (specialised Improve hospitals) access to Percentage of Not in plan 0% 0% 100% 0% (100%) Underachievement due to health care hospitals emergency trolleys not services compliant with all standardised, not all tracer medicines are available as per extreme and vital applicable essential drug list measures of the infrastructural challenges such National Core as lack of isolation wards and Standards rented buildings in some TB hospitals (SANTA). Security challenges such as lack of CCTVs, insufficient number of security officers allocated.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Patient Not in plan Not in plan Not in plan 100% 100% 0 None satisfaction survey rate (specialised hospitals) Patient 85% 76.10% 87% 90% 85% (5%) Patients not satisfied due to satisfaction rate infrastructural challenges, (specialised which are not suitable for long hospitals) term stay Complaints Not in plan Not in plan Not in plan 90% 92.5% 2.5% Fully functional complaints resolution rate management committees (specialised hospitals) Complaints Not in plan 80% 100% 90% 97.3% 7.3% Fully functional complaints Resolution within management committees

64 25 working days

Improve rate access to Expenditure per R1 342 R1 854 R1 887 R 1 910 R 2 199 (R 289) Expenditure is high due to the healthcare new regimen of M(X)DR TB patient day services drugs and high costs to equivalent (PDE) maintain infrastructure Improve access to 100% 100% Not in plan 100% 100% 0% None TB services through effective movement of TB patients for continuity of care

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reasons for all deviations • Hospitals not compliant with all extreme and vital Strategy to overcome areas of under-performance measures of the National Core Standards due to emergency trolleys which are not standardised • The Department’s newly designed infrastructure and not all tracer medicines available as per plans will address the isolation ward required by applicable essential drug list. Infrastructural the national core standard tool. This aspect will challenges such as lack of isolation wards. improve compliance with new facility buildings Security challenges such as lack of CCTVs, like Mapulaneng hospital insufficient number of security officers allocated • The Department will strengthen blood transfusion • High expenditure per PDE was due to pressure committees and implement gate keeping on key cost drivers such as NHLS, blood, strategies. Monitoring and control of overtime medicine (new regimen of multi-drug resistant TB • The high expenditure on M(X)DR TB drugs will drugs), food, overtime expenditure and high be managed through sharing resources from the costs of infrastructure maintenance other grants like HIV AND AIDS • Complaint resolution rate is below target because most of the clinical management complaints takes Changes to planned targets longer to be resolved and this is also exacerbated by None the shortage of specialists at regional and specialised hospitals • Patient satisfaction rate low due to infrastructural Linking performance with budgets challenges, which are not suitable for long- term stay • Properties still leased from SANTA (Barberton TB The programme has spent 100 percent at the end of and Standerton TB) and the Department has no the financial year. 14 of 22 indicators where achieved. control over the maintenance of infrastructure The performance is at 64%

Sub-programme expenditure

Sub- programme 2016/2017 2015/2016 name Final Actual (Over)/Under Final Actual (Over)/Under appropriati expenditure expenditure appropriation expenditure expenditure on R’000 R’000 R’000 R’000 R’000 R’000 General (regional) hospitals 1 000 545 1 005 225 4 680 947 697 937 555 10 142

Tuberculosis (TB) 181 505 181 906 401 183 459 183 459 0 hospitals

Psychiatric/mental 39 431 34 349 5 082 54 580 53 371 1 209 hospitals

Total 1 221 481 1 221 480 1 1 185 736 1 174 385 1 151

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.5 PROGRAMME 5: TERTIARY HOSPITAL SERVICES

Purpose

The purpose of the programme is to render tertiary health care services and to provide a platform for training of health care workers and to conduct research

Sub-programmes

• Tertiary hospitals

Strategic objectives

• Improved quality of health care

Strategic objectives, performance indicators, planned targets and actual achievements

The following measures are in place to improve quality of health care services at hospital services: • Appointed 5 specialists at Rob Ferreira Hospital (2x orthopods, 1x gastroenterology, 1 paediatrician, 1 x general surgery) of which three were Cuban specialists and 7 at Witbank Hospital (2x surgery, 2x internal medicine, 1x orthopod, 1x anaesthetist and 1x maxillo facial) of which five were Cuban specialists • Three additional domains have been established: Neurosurgery, Maxillo-Facial and Gastroenterology • Additionally, C-arm, three neonatal ventilators, four defibrillators, one anaesthetic machine and four diathermy machines were procured for Rob Ferreira Hospital • A renal clinic has also been opened in May 2016 at Rob Ferreira Hospital

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Srategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Tertiary hospitals Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 National Core Not in plan 100% 100% 100% 100% 0 None Standards self- assessment rate Quality 100% Not in plan 100% 100% 100% 0 None improvement plan after self- assessment rate Percentage of Not in plan Not in plan 0% 100% 0% (100%) Infrastructural challenges hospitals such as lack of isolation

67 compliant with all wards. Security

extreme and vital challenges such as lack measures of the of CCTVs, insufficient Improve National Core number of security access to Standards officers allocated health care Patient Not in plan Not in plan 100% 100% 100% 0 None services Satisfaction survey rate Patient 0% 72.24% 74% 87% 74% (13%) Lack of in-house laundry Satisfaction rate which impacts negatively on linen availability Average length of 6.4 days 5.7 days 6.8 days 5.6 days 7.1 days (1.5%) Mental health and stay orthopaedic patients stay longer. On average mental health patients stay 29 days, and orthopaedic patients stay 18 days Improve Inpatient bed 84.3% 80.5% 81% 75% 85.8% (10.8%) By-passing of district & access to utilisation rate regional hospitals

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: Tertiary hospitals Strategic Performance Actual Actual Actual Planned target Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement 2016/2017 achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 health care Overstay of orthopaedic services and mental health patients Expenditure per R 2 696 R 2 207 R 2 785 R 3 414 R 2 910.8 R 503.2 Difficulty in recruitment patient day of specialists equivalent (PDE) Complaint Not in plan Not in plan 83.2% 90% 84.3% (5.7%) Clinical management resolution rate complaints take longer to resolve due to the in- depth investigations

68 Complaint 99.5% 100% 99.4% 90% 88.3% (1.7%) Clinical management

resolution within complaints take longer to 25 working days resolve due to the in- rate depth investigations Improved access Not in plan Not in plan Not in plan 5 3 (2) The Department had 10 to specialist (Cumulative (Cumulative 13) specialist domains in the services by 15) beginning of 2016/17. increasing the Only 3 were established number of clinical due to scarcity of specialist domain specialists and the at tertiary difficulty in retaining hospitals specialists Functional Not in plan 2 2 2 2 0 None adverse events committees

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reasons for all deviations Strategy to overcome areas of underperformance

• Hospitals not compliant with all extreme and vital • The Department’s newly designed infrastructure measures of the National Core Standards due to plans will address the isolation ward required by the NCS tool’s. This aspect will improve compliance with infrastructural challenges such as lack of isolation new facility buildings in all tertiary hospitals wards. Security challenges such as lack of CCTVs, insufficient number of security officers allocated • To identify space for mini-laundries in both hospitals and procure equipment • The patient satisfaction rate was below target due to • The Department will extend operating days of lack of in-house laundry which impacts negatively on orthopaedic surgery from three to four days availability of linen • The Department to appoint specialists to minimise • High average length of stay due to shortage of complaints and prompt surgical intervention specialists and mental health and orthopaedic patients stay longer than this standard Changes to planned targets • Complaint resolution rate is below target because None. most of the clinical management complaints take longer to be resolved and this is also exacerbated by the shortage of specialists in the hospitals Linking performance with budgets • Underachievement with improved access to specialists’ services by increasing the number of The programme has spent 99.2 percent and has clinical specialist domain at tertiary hospitals was due reported accruals at the end of the financial year. The to scarcity of specialists programme achieved 5 of the 12 performance indicators and the programme performance is at 42%

Sub-programme expenditure

Sub- programme 2016/2017 2015/2016 name Final Actual (Over)/Under Final Actual (Over)/Under appropriation expenditure expenditure appropriation expenditure expenditure R’000 R’000 R’000 R’000 R’000 R’000 Tertiary hospital 1 035 085 1 026 751 8 334 1 013 144 991 759 21 385 services Total 1 035 085 1 026 751 8 334 1 013 144 991 759 21 85

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.6 PROGRAMME 6: HEALTH SCIENCE Strategic objectives, performance AND TRAINING indicators, planned targets and actual

achievements Purpose • The Department awarded bursaries to 10

students to study medicine in Cuba The purpose of the Health Sciences and Training programme is to ensure the • A total 4 338 health care professionals provision of skills development programmes were trained on critical clinical skills in support of the attainment of the identified against the target of 2 000. This will ensure strategic objectives of the Department. a steady supply of skills required by the Department. This has contributed

positively towards the re-alignment of List the sub-programmes human resources to Departmental needs.

The collaboration with NGOs such as • Nursing training college Broadreach and Foundation for • EMS training college health Professional Development assisted in

achieving the training targets List the strategic objectives • Improve quality of health care

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

. Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Health Sciences and Training (HST) Strategic Performance indicator Actual Actual Actual Planned Actual Deviation Comment on deviations objectives Achievement Achievement Achievement Target Achievement from planned 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 target to Actual Achievement 2016/2017 Number of Bursaries Not in plan Not in plan 99 10 10 None None awarded for first year medicine students 231 Not in plan 310 250 241 (9) 151 students were admitted at the Number of Bursaries Mpumalanga Nursing College, KwaZulu- awarded for first year Natal reduced the intake from 100 to 90 nursing students which was a deviation from the MoU due

71 to resource constraints

Improve human resource Not in plan Not in plan Not in plan 2 500 2 841 341 In-house training conducted Improved efficiency by training (Cumulative (Cumulative quality of health health care workers on 5 000) 7 841) care generic programme Improve human resource 2 124 2 972 4 473 2 000 4 338 2 338 Intervention from NGO’s assisted in efficiency by training (Cumulative (Cumulative training more Health Professionals than health care professionals 3 695) 8 033) planned especially on HIV AND AIDS on critical skills related programmes Improve access to nursing Not in plan Not in plan 0 1 0 (1) No accreditation obtained. Delays from training increasing the (Cumulative 2) the South African Nursing Council in number of accredited conducting accreditation visits nursing school/ campus

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reason for deviation The Department will be reviewing targets based on the past trends and align into adequate planning process for • The shortfall in the awarding of bursaries to basic better performance of the programme nursing students was caused when the KwaZulu- Natal DoH could not take the number of students as Changes to planned targets agreed to in the agreement due to resource constraints The budget adjustments did not affect the targets in a • Efforts to get the South African Nursing Council to significant way conduct accreditation visits have not been successful. The imminent changes in the curriculum Linking performance with budgets on the training of nurses may be a reason for the delay in the accreditation of new training sites The programme has spent 100 percent of the adjusted budget and recorded accruals at year end. The Strategy to overcome areas of underperformance programme has achieved 60% (3 out of 5) of its planned indicators

Sub-programme expenditure

Sub- Programme 2016/2017 2015/2016 Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Expenditure Appropriation Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Nursing Training 186 201 181 769 4 432 179 352 179 593 (241) Colleges EMS Training 872 4 634 (3 762) 2 338 2 473 (135) Colleges Bursaries 69 469 70 575 (1 106) 43 822 43 317 505

Primary Health 3 949 4 627 (678) 6 824 4 081 2 743 Care Training Other Training 112 410 111 296 1 114 141 597 139 769 1 828

Total 372 901 372 901 - 373 933 369 233 4 700

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.7 PROGRAMME 7: HEALTH CARE SUPPORT hence the over-achievement in the manufacture and SERVICES (HCSS) issuing of devices

Blood services Purpose Two (2) new blood banks were opened, namely: Shongwe Hospital and Ermelo, thus reducing the transportation time The Health Care Support Service programmes aim to and costs to Nelspruit. improve the quality and access of health care provided 128 medical practitioners and professional nurses were through: trained in the appropriate use of blood and blood product • The availability of pharmaceuticals and other ancillaries Laboratory Services: • Rendering of credible forensic health care which The impact of in-house gate-keeping at Bethal Hospital is contributes meaningfully to the criminal justice the reduction of laboratory costs from R 500 000.00 in April system 2016 to the lowest amount of about R 200 000.00 in • The availability and maintenance of appropriate December 2016. A total reduction of about R 300 000.00 health technologies Improvement of quality of life has been achieved. by providing needed assistive devices • Coordination and stakeholder management Forensic Services involved in specialized care. • 21 Forensic Pathology Services sites are functional • Rendering in-house services within the health • Three forensic pathology specialists appointed care value chain during financial year 2016/17, allocated as follows: Ehlanzeni, Gert Sibande and Nkangala district There are three directorates within programme 7 namely: The Department managed to achieve the following: • Appointment of personnel (8 forensic officers and 6 Sub-programmes administrative officers) in Nkangala and Ehlanzeni • Laundry services • 10 Autopsy head saws were procured to address the • Health technology services major required equipment for 10 forensic mortuaries • Forensic services (Themba, Tintswalo, Lydenburg, Witbank, • Pharmaceutical services Middelburg, KwaMhlanga, Delmas, Ermelo, Evander and Embhuleni) List the strategic objectives • Improve quality of health care Pharmaceutical services The CCMDD programme was piloted in Gert Sibande Strategic objectives, performance indicators, District as an NHI pilot district and thereafter rolled out in planned targets and actual achievements Ehlanzeni. This resulted to enrolment of 87 063 patients on CCMDD reached surpassing the planned target of The achievements of the following sub-programmes 30 000 by 57 063 contributed to improving quality of health care in the Department: clinical support services, forensic services, Health technology services pharmaceutical, laundry services and health technology The Department procured equipment for various facilities services. The achievements are as follows: (2x anaesthetic machines for Piet Retief Hospital, 1x anaesthetic machine for Nelspruit CHC, 2x anaesthetic Clinical support services machines for KwaMhlanga Hospital, 1x anaesthetic The Department was able to increase the number of machine for Tintswalo Hospital, 1x 58 defibrillator machine issued orthotic and prosthetic devices from 3 500 to 5 942. for Nkangala District, 165 electric suction unit for various Ermelo hospital received its first intake 5 MOP students facilities and 1x 26 vital signs monitor procured for PHC from Tshwane University of Technology in April 2016, and hospitals)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Health Care Support Services (HCSS) Strategic Performance Actual Actual Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement target achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 actual achievement 2016/2017 Improve quality of 93.5% 82% 79% 95% 92% (3%) The shortage of stock from care by increasing contracted suppliers at availability of national level and failure to medicines and deliver the requested surgical sundries quantities at the medical depot Number of Not in plan Not in plan Not in plan 30 000 87,063 57,063 The Department rolled out patients initiated the CCMDD program in all

74 on Central Chronic districts

Medicine Dispensing and Distribution Improved (CCMDD) quality of Improve access to Not in plan Not in plan 47% 100% 80% (20%) 6 Hospitals (Bernice health care quality of care (14/30 facilities (30/30 (24/30 facilities) Samuel, Elsie Ballot, through complied) facilities) Themba, Impungwe, compliance with Tintswalo and radiation control Mmamethlake hospitals) prescripts by all did not comply with facilities with X-ray various quality control equipment radiation prescripts

Improve laundry Not in plan Not in plan Not in plan Approved Laundry model (Not approved Target not achieved due to services by laundry model report was not laundry model) consultations by the task developing a finalised team which took longer to provincial laundry finalise model

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Programme / Sub-programme: Health Care Support Services (HCSS) Strategic Performance Actual Actual Actual Planned Actual Deviation from Comment on deviations objectives indicator achievement achievement achievement target achievement planned target to 2013/2014 2014/2015 2015/2016 2016/2017 2016/2017 actual achievement 2016/2017 Number of Not in plan Not in plan Not in plan 21 18 (3) Laundry services could not hospitals providing be established at Rob laundry services Ferreira, Matikwana and Ermelo hospitals due to the prioritisation of the development of the provincial laundry model Number of orthotic Not in plan Not in plan Not in plan 3 500 5 942 2 442 Ermelo hospital received its and prosthetic first intake of 5 MOP devices issued students from Tshwane

75 University of Technology in

April 2016 Improved Number of Not in plan Not in plan Not in plan 33 31 (2) Two TB Hospitals quality of hospitals with (Standerton and Sesifuba) health care functional do not have the capacity transfusion to establish a functional committees Hospital Transfusion Committee. The neighbouring hospital committee provides services for the two hospitals Number of sites Not in plan Not in plan Not in plan 21 21 0 None rendering Forensic Pathology Services (FPS)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reason for deviation hospitals due to the prioritisation of the development of the provincial laundry model Laundry services Laundry services could not be established at Health technology services Rob Ferreira, Matikwana and Ermelo The following six (6) hospitals did not comply with Radiation Control prescript:

Name of Hospital Non-Compliance Berniece Samuels Hospital QC tests such as sensitometry test, darkroom fog test, recording of X-ray films Elsie Ballot Hospital No responsible radiographer Old X-ray unit Themba Hospital Old X-ray units – no QC tests records available for past 2 years New units – licence numbers not displayed Impungwe Hospital No responsible radiographer Required QA tests not done Tintswalo Hospital Required QA tests not done Mmametlhake Hospital Annual service & some QC tests such as sensitometry test, recording of X-ray films are not done No thermo-luminescent dosimetres (TLDs) for radiation workers.

Clinical support services i.e. Standerton TB with Standerton Hospital Two TB hospitals do not have the capacity to and Sesifuba with Ermelo Hospital conduct their own hospital transfusion committee, that is, Standerton and Sesifuba TB hospitals Pharmaceutical services

Pharmaceutical services • Training the users on RX solution to The shortage of stock from contracted improve stock management at hospital suppliers at national level and failure to level deliver the requested quantities • Improve the pharmaceutical suppliers by imposing penalty fee for late delivery of the Strategy to overcome areas of under service provider performance • Assign provincial pharmacists to be responsible for each district for close Laundry services monitoring of stock The Departmental laundry model will be implemented gradually during 2017/18 Changes to planned targets None Health technology services

The plan is to provide training to the Linking performance with budgets management of hospitals on compliance to radiation control prescript The programme has spent 89.7 percent and recorded accruals at year end. The Clinical support services programme has achieved 38% (3 out of 8) of its planned indicators The two TB hospitals without a committee will be utilising the nearby district hospitals

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Sub-programme expenditure

Sub- programme 2016/2017 2015/2016 name Final Actual (Over)/under Final Actual (Over)/under appropriation expenditure expenditure appropriation expenditure expenditure R’000 R’000 R’000 R’000 R’000 R’000 Laundries 28 145 26 725 1 420 26 339 23 704 2 635

Engineering 43 689 27 171 16 518 26 252 21 915 4 337

Forensic 68 279 69 995 (1 716) 58 784 61 998 (3 214) Pathology Services Orthotic and 3 983 3 994 (11) 4 178 3 963 215 Prosthetic Services Medicine Trading 12 708 12 808 (100) 10 134 11 871 (1 737)

Total 156 804 140 693 16 111 125 687 123 451 2 236

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

The Department has achieved all the planned targets 4.8 PROGRAMME 8: HEALTH FACILITY on health facility management as a means to improve MANAGEMENT (HFM) health facility planning and accelerate infrastructure

delivery namely: Purpose • 19 of targeted 15 health facilities that have undergone major and minor refurbishment The purpose of the programme is to build, upgrade, outside NHI pilot district renovate, rehabilitate and maintain health facilities • Service Level Agreement (SLAs) with Department of Public Works (and any other implementing agent has been established Sub-programmes • Maintenance conducted to 90/90 facilities • 31/31 Hospitals under maintenance • Infrastructure management • 3/3 Modern hi-tech hospitals construction at • Hospital revitalisation various planning phases: • Facilities management • 100% complete planning Mapulaneng hospital phase 01 Strategic objectives • 45% Mapulaneng Hospital phase 02 • 95% complete planning of Tintswalo • Improved health facility planning and accelerate Hospital infrastructure delivery. • 100% complete planning of Bethal • Re-alignment of human resource to Hospital Departmental needs Appointment of 10 cooperatives for multi-year projects Strategic objectives, performance indicators, also contributed positively on re-alignment of human planned targets and actual achievements resources to Departmental needs.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Strategic objectives & performance indicators, planned targets and actual achievements

Programme / Sub-programme: Health Facilities Management (HFM) Strategic Performance Actual Actual Actual Planned Actual achievement Deviation from Comment on objectives indicator achievement achievement achievement target 2016/2017 planned target to deviations 2013/2014 2014/2015 2015/2016 2016/2017 actual achievement 2016/2017 Number of health 0 Hospitals 19 PHC facilities 4 PHC facilities 10 Not in plan Not in plan Facilities were facilities that have 15 PHC completed planned to be

undergone major completed in and minor 2015/16, however, refurbishment in due to delays by the contractors the 4 NHI Pilot District projects overlap to 2016/17

Improved health Number of health 5 15 4 5 Hospitals 5 Hospital completed 0 None facility planning facilities that have 13 PHC and infrastructure undergone major 13 PHC completed delivery and minor refurbishment outside NHI pilot District ( excluding facilities in NHI pilot district)

Establish Service 1 SLA achieved 0 Not in plan Not in plan Not in plan 1 None Level Agreement

(SLAs) with (DoH & DPWRT) Department of Public Works (and any other

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

implementing agent) Improve access 90 90 PHC facilities 0 Not in plan 48 107 None to healthcare by maintained (Cumulative increasing Improved health 240/284) number of PHC (Cumulative 240/284) facility planning and infrastructure facilities delivery maintained Number of PHC Not in plan Not in plan Not in plan 8 8 0 None facilities (Ehlanzeni:2 (Ehlanzeni:2 constructed Gert Sibande: Gert Sibande: 5 (new/ 5 Nkangala:1) replacement) Nkangala:1) Number of Not in plan Not in plan Not in plan 31 31 Hospital Facilities 0 None

80 hospitals under maintained

maintenance Enhance patient Not in plan Not in plan 0 3 3 0 None care & safety and (Planning (Planning phase) improving phase) medical care by constructing modern hi-tech hospitals Improve Not in plan Not in plan 20 10 10 cooperatives 0 None maintenance of teams appointed for multi-year health facilities by appointed projects (2015/16- appointing 2016/17) cooperatives

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Reasons for all deviations Changes to planned targets None The four (04) Facilities (Bettys Goed,Nhlazatshe 4, Fernie and Prince Mkoloshi Clinic) were planned to Linking performance with budgets be completed in 2015/16, however, projects overlap to the 2016/17 financial year The programme has spent 100 percent and recorded Strategy to overcome areas of under performance accruals at the end of the financial year. The None programme achieved 100% (8 of 8) planned indicators.

Sub-programme expenditure

Sub- 2016/2017 2015/2016 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’000 393 291 389 276 4 015 311 221 294 978 16 243 Community health facilities 58 333 99 060 (40 727) 117 873 96 247 21 626 District hospital services

Provincial 231 397 194 685 36 712 242 062 248 039 (-5 977) hospital services - - - other facilities

Total 683 021 683 021 - 671 156 639 264 31 892

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

5 TRANSFER PAYMENTS

5.1. Transfer payments to public entities

Name of public Services rendered Amount transferred to Amount spent by the Achievements of the entity by the public entity the public entity public entity public entity None None None None None

5.2. Transfer payments to all organisations other than public entities

Name of Type of Purpose for Did the Amount Amount Reasons transferee organisation which the Department transferred spent by for the funds were comply with (R’000) the entity funds used s 38 (1) (j) of unspent by the PFMA? the entity Various non- Non-profit Community Yes 165 967 165 967 None profit organisations health services organisations

The table below reflects the transfer payments which were budgeted for in the period 1 April 2016 to 31 March 2017, but no transfer payments were made.

Name of transferee Purpose for which Amount Amount Reasons why funds were not the funds were to budgeted for transferred transferred be used (R’000) (R’000) None None None None None

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

6 CONDITIONAL GRANTS

6.1. Conditional grants and earmarked funds paid None

6.2. Conditional grants and earmarked funds received

Conditional grant 1: Health Revitalisation Grants

Department which transferred the grant Health

• To help accelerate construction, maintenance, upgrading and rehabilitation of new and existing infrastructure in health including, health technology, organisational Purpose of the grant development systems and quality assurance • To enhance capacity to deliver health infrastructure

• Number of new facilities completed • Number of facilities maintained • Number of facilities upgraded, and renovated Expected outputs of the grant • Number of facilities commissioned

In all the performance indicators and their targets, the programme achieved except on one indicator where we have over-achieved.The facilities that were planned to be completed Actual outputs achieved in 2015/16 however, overlapped to the 2016/17 financial year

Amount per amended DORA R289 730 000

Amount received (R’000) R289 730 000

Reasons if amount as per DORA was not received Not Applicable

The directorate has spent amount of R 285 115, which is 98%. Amount spent by the Department (R’000) The under spending of R4 615 was as a result of the unfilled vacant post

The underspending was as a result of the unfilled vacant post Reasons for the funds unspent by the entity

The programme has achieved 100% and on the EPWP the Reasons for deviations on performance deviation resulted due to the contractor not complying with tax (CSD)

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Department which transferred the grant Health

Posts were advertised Measures taken to improve performance

Monitoring and the key competencies deployed to track and report on progress. Risks on programme management level and on project management levels Monitoring mechanism by the receiving Department Overall management of Programme, including management and communication structures within Department Capacity to manage infrastructure

Conditional Grant 2: Expanded Public Works Programme grant

Department which transferred the grant Health

To incentivise provincial Departments to expand work creation efforts through the use of labour intensive delivery methods in the following identified focus areas, in compliance with the Purpose of the grant Expanded Public Works Programme (EPWP) guidelines

Number of people employed and receiving income through the EPWP Expected outputs of the grant Increased average duration of the work opportunities created

In all the performance indicators and their targets, the programme achieved except on one indicator where we have overachieved due the facilities that were planned to be completed in 2015/16 however overlapped to the 2016/17 financial year Actual outputs achieved The outputs of the above achievements are seen by improved living conditions of our immovable assets and equipment. Furthermore, there has been socio-economic boost to the cooperatives that have been roped in the infrastructural maintenance programme

Amount per amended DORA R2 311 000

Amount received (R’000) R2 311

Reasons if amount as per DORA was not received Not Applicable

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Amount spent by the Department (R’000) R658 000

The under expenditure was as results of the contractor that is

Reasons for the funds unspent by the entity none compliant with tax (CSD). However, the contractor has completed the project on site.

HFRG – The programme has achieved 100% and on the EPWP Reasons for deviations on performance the deviation resulted due to the contractor not complying with tax (CSD)

Request service providers to improve compliance on CSD Measures taken to improve performance

Monitoring and the key competencies deployed to track and report on progress Monitoring mechanism by the receiving Department Risks on programme management level and on project management levels

Conditional Grant 3: National Health Insurance Grant

Department/ Municipality to whom the grant has been Health transferred

Test innovations in health service delivery for implementing NHI, allowing for each district to interpret and design innovations relevant to its specific context in line with the vision for realising universal health coverage for all To undertake health system strengthening activities in identified Purpose of the grant focus areas To assess the effectiveness of interventions/activities undertaken in the district funded through this grant

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Department/ Municipality to whom the grant has been Health transferred

Selected primary health care teams equipped to provide relevant health services through integrated outreach programmes Selected primary health care facilities supported to achieve National Core Standards as part of the ideal clinic realization project Monitoring and evaluation including impact assessment of the Expected outputs of the grant effectiveness of selected primary health care teams undertaken SCM processes strengthened and streamlined through innovative interventions in pilot districts Compliance with monitoring and evaluation of targets in operational plans Impact assessment of all pilot interventions undertaken

Basic medical and non-medical equipment procured for WOBOT Basic medical equipment procured for ideal clinics Training on ICSM and primary mental health conducted Orientation of contracted GPs conducted Self-assessments conducted by District PPTICRM for Ideal Clinics

Actual outputs achieved External and internal signage procured for 75 PHC facilities Directional road signage procured for 2 sub districts; Dipaleseng and Chief Albert Luthuli Reception areas upgraded in 20 PHC facilities Evaluation/Impact assessment of WBPHCOT conducted Evaluation of SCM processes conducted

R7 546 000 and R1 774 000 roll over allocated during budget Amount per amended DORA adjustment

R9 320 Amount transferred (R’000)

None Reasons if amount as per DORA not transferred

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Department/ Municipality to whom the grant has been Health transferred

Amount spent by the Department/ municipality R7 948 (R’000)

An outstanding commitment of R1 691 850 could not be paid Reasons for the funds unspent by the entity and thus carried over as an accrual for the new financial year

Monitoring mechanism by the transferring Quarterly meeting Department Quarterly performance reports

Conditional Grant 4: comprehensive HIV&AIDS

Department/ Municipality to whom the grant has been Health transferred

Decrease the burden of disease related to the HIV and tuberculosis epidemics; to minimise maternal and child Purpose of the grant mortality and morbidity; and to optimise good health for children, adolescents and women

By 2030, zero new HIV and TB infections, zero new infections due to vertical transmission, zero preventable deaths associated with HIV and TB and zero discrimination associated with HIV, STIs and TB Expected outputs of the grant (UNAIDS) Maternal, infant and child mortality reduced (APP 2015/16), including infant mortality rate of less than 20 deaths per 1 000 live births by 2030 (NDP)

370 363 - Total clients remaining in care (TRIC) 78 982 - No. of new patients initiated on ART 76 268 191 - No. of male condoms distributed 2 205 964 - No. of female condoms distributed Actual outputs achieved 972 333 - No. of clients tested (including ANC) 43129 - No. of medical male circumcisions performed 110 447 - No of HIV positive clients screened for TB

Amount per amended DORA (R’000) 1 032 055

Amount transferred (R’000) 1 032 055

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

N/A Reasons if amount as per DORA not transferred

1 032 055 Amount spent by the Department/municipality (R’000)

N/A Reasons for the funds unspent by the entity

Approval of business plan by National Treasury, Approval of Annual Performance Plans Quarterly monitoring of district implementation plans by NDoH Monitoring mechanism by the transferring Department Provincial quarterly and annual reviews by NDoH Monthly variance and quarterly reports on performance (Financial and non-financial) in line with DORA

Conditional Grant 5: National Tertiary Services Grant Health Department/ Municipality to whom the grant has been transferred Ensure provision of tertiary health services for all South Purpose of the grant Africans

Provision of designated national tertiary services in 2 hospitals (Witbank and Rob Ferreira Hospitals). Expected outputs of the grant

National tertiary services provided as per the 2016/17 Actual outputs achieved YES list

R114 451 Amount per amended DORA

R114 451 Amount transferred (R’000)

None Reasons if amount as per DORA not transferred

R102 823 Amount spent by the Department/ municipality (R’000) Slow tender processes for procurement of medical equipment, which delayed delivery of equipment and Reasons for the funds unspent by the entity resulted in commitment of funds amounting to R6.6 million, and a rollover has been requested

Monthly and quarterly expenditure reports Monitoring mechanism by the transferring Department

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

The purpose of the grant is to ensure provision of tertiary health services for all South Africans and it is earmarked to compensate tertiary facilities for the additional cost associated with provision of these services, including cross- border patients. A budget of R114 million was allocated and 89.8% (R102 million) of the budget was spent.

Economic classification Budget Expenditure

Compensation of employees 45 486 000 45 427 429

Goods and services 44 531 000 42 296 032

Household 200 000 187 108

Machinery and equipment 24 234 000 14 991 940

During 2016/17, the NTSG funding benefited about 183 866 patients and this represents an overachievement of 22% based on the target of 150 614 patients. This means NTSG is improving access to tertiary services in the province.

Procurement of equipment enabled the tertiary hospitals to increase access of services to 183 866 patients. The following medical equipment was procured, to improve tertiary services: • Baby air shield and resuscitation • Vital sign monitor • Multipurpose monitor • Autorefractor/Keratometer • Slit lamp with digital camera • Chart projector • Adult ventilator • Anaesthetic machine • Neonatal ventilator • Defibrillators x 10 • Patient monitors x 4 • Drager VN500 ventilator • ICU ventilator

Conditional Grant 6: Health professions and Training development Health Department/ Municipality to whom the grant has been transferred To fund service costs associated with training of health science trainees Purpose of the grant on the public service platform

Provision of clinical teaching and training of health professionals in Expected outputs of the grant designated facilities

Clinical teaching and training of professionals was provided at designated facilities as per the business plan through the outreach programmes Actual outputs achieved

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

R101 646 Amount per amended DORA

R101 646 Amount transferred (R’000)

R101 646 Reasons if amount as per DORA not transferred R100 738 Amount spent by the Department/ municipality (R’000) The University of Pretoria submitted invoices late for reimbursement of salaries and travelling costs for specialists who provide training at Reasons for the funds unspent by the entity Witbank Hospital

Monthly and Quarterly expenditure report Monitoring mechanism by the transferring Department

Purpose of the grant is to support hospitals to fund service costs associated with training of health science trainees on the public service platform.

A budget of R101 million was allocated and 99.1% (R100 million) of the budget was spent.

Economic classification Budget Expenditure Compensation of employees 92 347 000 92 055 395 Goods and services 9 299 000 8 636 026 Household 0 0 Machinery and equipment 0 0

The grant enabled the appointment of 9 registrars and 7 DONOR FUNDS 46 specialists, who are providing training on the public service platform in the facilities. This goes a long way in improving critical clinical skills for health 7.1. Donor funds received professionals. Of the 43 specialists, 46 were appointed None which is 107% and is above the target. This is caused by incorrect linking of specialists’ salaries. 8 CAPITAL INVESTMENT Out of the target of 10 registrars, 9 were appointed which is 90% of the target, mainly due to unavailability of qualifying medical practitioners to participate in the 8.1. Capital investment, maintenance and registrars programme. Monthly verification of asset management plan employees linked to the grant will be done in order to ensure that salaries are drawn from the appropriate Progress made on implementing the capital, investment and asset management plan is as follows: allocation.

The Department has completed the following projects • 100% complete planning Mapulaneng Hospital Phase 01

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• 45% Mapulaneng Hospital phase 02 • 95% complete planning of Tintswalo Hospital Infrastructure projects which have been completed in • 100% complete planning of Bethal Hospital the current year and the progress in comparison to and 20% construction progress what was planned at the beginning of the year: • 60% construction progress of Mmametlhake • PHC completed within the three (03) districts Hospital • Infrastructure projects that are currently in • 31 Hospital facilities maintained progress (list projects) and when are they • 90 PHC’s facilities maintained expected to be completed

Name Projects Contract end date Mamametlhake Hospital 24-Aug-18 Sibange Clinic 23 Dec 16 Extension 8 Clinic 25 May 16 Nkangala district office 11 Apr 17 Mpakeni Clinic 23 Jan 17 Oakley Clinic 24 Sep 16 Simile Clinic 10 Nov 16 Kwamdladla Clinic Cancelled due to Community unrest or protest Mgobodzi Clinic 17 Apr 17 Marite Clinic 23 Apr 17 Mapulaneng Hospital (Phase 1) 15 Sep 17 Bethal Hospital 10 Sep 19 Mbuzini Community Health Centre 28 Feb 17 Middelburg Pharmaceutical Depot 14 Jun 17 Shongwe Hospital 17 Feb 17 Middelburg District Hospital April 2019 Rob Ferreira Hospital (compliance) 25 Sep 17 Rob Ferreira Hospital (compliance) 19 Feb 18 Rob Ferreira Hospital (Mortuary) 6 Mar 18 25 Sep 17 Themba Nursing College

Themba Hospital 25 Sep 17

Elijah Mango Nursing College 25 Sep 17

Plans to close down or downgrade any current Developments relating to the above that are facilities expected to impact on the Department’s current expenditure None • Total of R109 049 695.46 will be paid as Progress made on the maintenance of accruals infrastructure • Details as to how asset holdings have changed over the period under review, including • 90 PHC’s facilities maintained information on disposals, scrapping and loss • 31 Hospital facilities maintained due to theft

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

• No assets were disposed in this current • The infrastructure unit has developed an asset financial year register, and is update on regular basis • Measures taken to ensure that the Department’s asset register remained up-to- The current state of the Department’s capital assets, date during the period under review for example what percentage is in good, fair or bad condition:

Good Fair Bad 24 322 1

Major maintenance projects that have been Street, Ehlanzeni District Office, Delmas undertaken during the period under review in 43 Hospital, Ogies Clinic, Evander Hospital facilities namely: Steenbok Clinic, Nazareth Clinic, Siyathuthuka Clinic, Elandsfontein Clinic, Luphisi Clinic, • Extension 8 Clinic, Nhlazatshe 4 Clinic, Gert Sibande District Office, Witbank Hospital, Waterval Community Health Centre, Betty's Mthimba Clinic, Witbank Hospital, Evander Goed Clinic, Tonga Hospital, Fernie 1 Clinic, Hospital, Nelspruit CHC, Sabie Hospital, Barberton Hospital, Mthimba Clinic, Naas Thembalethu CHC, Prince Mkholishi Clinic Malaria Centre , Standerton Hospital and Marapyane CHC Mangweni Clinic, Kwamhlanga Hospital, Dludluma Clinic, Allenmansdrift B Clinic, Progress were made in addressing the maintenance Masibekela Clinic, Middleburg Hospital, Fig backlog during the period under review, for example: Tree Clinic, Mapulaneng Hospital, Thubelihle Community Health Centre, Matibidi Hospital, • 31 facilities are being maintained through in- Strydondok Clinic, Tintswalo Hospital kind grant in NHI district Ndindindi Clinic, Evander Hospital, Anderson • The backlog maintenance has reduced

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

2016/2017 2015/2016 (Over)/under Final (Over)/under Final appropriation Actual Actual Infrastructure projects expenditure appropriation expenditure R’000 expenditure R’000 R’000 expenditure R’000 R’000 R’000 New and replacement assets 70 170 36 953 33 217 121 950 2 462 119 488 Existing infrastructure assets 503 114 549 534 (-46 420) 450 062 566 258 (116 196) Upgrades and additions 143 674 148 173 (-4 499) 183 422 291 231 (107 809)

Rehabilitation, renovations and refurbishments 183 866 293 079 (-109 213) 157 862 160 033 (2 171)

Maintenance and repairs 175 574 108 282 67 292 108 778 114 994 (6 216)

93 Infrastructure transfer - -

Current 429 610 438 314 (-8 704) 123 433 128 376 (4 943) Capital 160 782 162 177 (-1 395) 463 234 453 726 9 508

Total 590 392 600 491 (-10 099) 586 667 582 102

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

1. INTRODUCTION Changes on the risk profile, including emerging risks, are reported to the Risk and Audit Committees. The Mpumalanga Department of Health has well established governance structures such as the Audit The delay in submission of progress reports by Committee and Risk Management Committee which management, allocated budget and shortage of staff are tasked with a responsibility to ensure that risks are was another challenge and more robust awareness managed, internal controls are adequate and effective will be done to ensure conformance and compliance and governance processes are implemented. The and subsequently improve performance in terms of internal audit conducted a review of compliance to service delivery and risk mitigation. governance processes, and areas of improvement were noted for implementation by management. 3. FRAUD AND CORRUPTION Management’s commitment to maintain the highest standards of governance is essential to management The Department has an approved fraud prevention of funds and resources. strategy including a policy and implementation plan. The fraud prevention strategy is on the Departmental 2. RISK MANAGEMENT intranet to ensure access by all staff. Awareness workshops are conducted regularly for both The Mpumalanga Department of Health has an management and staff at grass root level. approved risk management policy, charter, strategy and implementation plan, which have been prepared The Department relies in part on the Office of the in consultation with the Risk Committee and approved Premier to receive allegations of fraud and corruption by the Head of Department. Progress on which have been reported through the Presidential implementation of the plan is reported to the Risk Hotline. Committee and Audit Committee on a quarterly basis and Risk Committee report to Audit Committee on All proven cases of fraud and corruption are subject to quarterly basis. investigation and where appropriate, to criminal and internal disciplinary processes as required in terms of The strategic and operational risk assessment the applicable legislation. The Department has workshops was conducted from 29 March to 5 April identified tracking and monitoring of cases as one area 2016, to identify new and emerging risks and that requires improvement in the new year. determine the effectiveness of risk management strategy. 4. MINIMISING CONFLICT OF INTEREST

The risk management unit is operating with high Thus, all members of the Senior Management Service vacant rate, however, it does have the functional Risk (SMS) are required to disclose to the executive Committee with the independent chairperson and held authority particulars of all their registrable interests in 4 successful meetings during the year under review. accordance with chapter 3 of the Public Service Institutional risk registers were developed in all 3 Regulations. The objective of chapter 3 is to identify districts and 33 hospitals. Risk management any conflicts of interest in order to promote just and fair awareness workshops were conducted in 10 hospitals administrative actions of officials in senior positions to create awareness on the importance of risk and thereby to protect the public service from actions management and communicate the framework, policy that may be detrimental to its functioning. Such and strategy. disclosures take place annually. Should any conflict of interest arise it is dealt with in accordance with the The Department monitors and reports on all risks to public service regulations and related prescripts and the Risk Committee and on the significant, fraud and all SMS disclosed their financial interest for the year ICT’s risks to the Audit Committee on a quarterly basis. under review.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

With respect to Remunerative Work outside the Public • Occupational health nurse practitioners attended Service (RWOPS), the new public service regulation the health and safety train the trainer 3 days requires public officials who are or have been doing course business with the state to choose either to resign from • Health and safety committees are established in their companies or de-register their companies, or if hospitals with OH units not so, to resign from the public service. No employees • Health establishments are being audited and were granted approval from the executive authority to inspected for compliance with Occupational undertake remunerative work outside the public Health and Safety Act, 1993 (Act No.85 of 1993) service. • Health risk assessments have been conducted in 29 health establishments and three sub-districts 5. CODE OF CONDUCT • OHS policies, guidelines and procedures have been developed and approved, namely: disposal Human resources of the Department should and handling of mercury-based equipment, demonstrate a sense of duty, piety and ethical medical surveillance for all employees, medical compliance with administrative rules and regulations examination tools for sewage workers as provided for in terms of the Code of Conduct for the • Workplace TB infection prevention and control Public Services and other prescripts. In event of the risk assessments have been conducted by infringement of the Code of Conduct, management occupational hygienist and epidemiologist jointly undertakes responsibility for the correction and/or with the provincial OHS team at Shongwe, discipline thereof. Witbank TB and Impungwe hospitals • Workplace ergonomics manual and material 6. HEALTH, SAFETY AND ENVIRONMENTAL handling assessment has been carried out at ISSUES Embhuleni hospital

• N95 fit test is ongoing in health establishments The Department has a legal and social responsibility by suppliers on an appointment basis regarding the occupational health and safety of all • Workplace inspections are carried out by health employees in their working environment. This requires and safety representatives a sound occupational health and safety management • Hepatitis immunisation programme for system (OHSAS) due to hazards and risks that can employees is on-going in all health have a detrimental effect on employees. establishments

Critical legislation dealing with health, safety and Challenges environment is the Occupational Health and Safety • Delayed and outstanding payments to service (OHS) Act 85 of 1993 and Compensation of providers on injuries on duty Occupational Injuries and Diseases (COIDA) Act 130 Procurement of fit test kit for N95 respirators in of 1993 as amended. • the health establishments remains a challenge

Section 8 (1) of OHS Act, 1993 prescribe general • Procurement of equipment such as spirometers, duties of the employer to their employees which every vision screening and audiometers remains a employer shall provide and maintain, as far as challenge reasonably practicable, a working environment that is • Organogram – OH posts are not created in most safe and without risks to the health of employees. health establishment – occupational health services are being compromised The following achievements were realised to comply • OHS structure is too vertical due to lack of to the above legislations: district and sub-district coordinators

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

7. PORTFOLIO COMMITTEES

The Department had four (4) engagements with the Portfolio Committee on Health and Social Development in 2016/17 financial year. The scheduled meetings were held as follows with the matters raised by the portfolio committee: 1ST QUARTER PORTFOLIO COMMITTEE FINDINGS AND RECOMMENDATIONS 30 AUGUST 2016

No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS PROGRESS REPORT a) The Department failed to achieve all its set targets Improve on planning and ensure that The Department acknowledges the committee recommendation and will set targets are Specific, Measurable, ensure that the set targets are SMART when finalising the APP: 2017/18 Attainable, Realistic and Timebound (SMART) and supported accordingly for effectiveness and efficiency. b) The Department will conduct the physical verification of its Provide progress report on the physical Training for asset verification has been completed. Physical verification of

97 moveable assets in September 2016. The project plan has verification process on the moveable moveable assets commenced on 12 September 2016

been approved asset register (as evidence) by 30 Pilot is being undertaken at Barberton, Lydenburg, Standerton and September 2016 KwaMhlanga hospitals. The project will be rolled out to all institutions from 05 October 2016. The pilot sites were to identify the challenges and method of correction to have audit trail c) The Department failed to ensure that all doctors (specialists) Strengthen its monitoring system and The Department acknowledges the committee recommendation and has sign attendance registers and as a result this has led to the provide a detailed report (Inclusive of ensured that the system is strengthened by issuing a standard operating Department paying all 16 doctors’ hours of commuted financial implications) on the commuted procedure on monitoring overtime to all facilities to ensure that all doctors overtime without daily verification overtime paid to all doctors without daily sign attendance registers. CEOs will be held responsible to monitor verification as well as measures put in performance of commuted overtime in their facilities. The NDOH is in the place to curbing this from occurring in process of developing a national policy on commuted overtime and the future,30 September 2016 Department will align itself thereto d) The Department has rolled out the e-health strategy in Gert Provide progress on the Department’s The Department is currently assessing an internet solution from Telkom for Sibande District; currently in discussion with Telkom to discussion with Telkom (inclusive of the the best solution for all PHC facilities in Gert Sibande District provide unlimited access to the internet and also to restrict Memorandum of Understanding if any) access for use in systems that are being implemented to provide access must be limited for The solution will cost the Department an estimated R72 112 per month for monitoring purposes because payment 72 PHC facilities in Gert Sibande District has to be made and the Department

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS PROGRESS REPORT does not have unlimited budget) and also to restrict access for use in systems that are being implemented by 30 September 2016 e) One hundred and twenty-two (122) PHC facilities do not have Provide progress report on the Installation of air-conditioning units were done at 27 facilities this financial air- conditioning out two hundred and eighty-six (286) procurement and installation of air year (2016/17). An assessment for the remaining 95 PHC facilities has been provincially. However, procurement and installation is conditioners in the PHC facilities without done by service provider and DPWRT reportedly underway air conditioners provincially by 30 Quotations have been issued and the Department planned to complete all September 2016 installations in the 4th quarter for Ehlanzeni and Nkangala. Gert Sibande is catered for on the NHI pilot programme f) Programme 3: EMS has continuously failed to achieve its set Provide a detailed progress report on 96 posts for the Emergency Medical Services (EMS) were advertised. The targets; however, the Department is reportedly in the process the appointment of the 96 EMS following categories of posts were advertised: of interviewing and appointing 96 personnel with the personnel and the effect on the • 26 paramedics including ECTs

98 allocated budget of R16.5 million performance if any by 30 September • 20 intermediate level and

2016 • 50 basic life support Of the 96 posts, only 26 posts have been shortlisted and interviewed in August 2016 because the number of applicants were less compared to the other categories, EMS is working together with HR to speed up the profiling due to the volume of applications. The shortlisting and interview process will take place in the month of October with the aim to fill them from the beginning of November and December for those that require to serve notice with their previous employers. g) The Department is reportedly working to finalise the Fast-track the procurement process of The Department will finalise the procurement of essential items by end of procurement of equipment for Rob Ferreira Hospital the equipment for Rob Ferreira Hospital October 2016 and provide progress report by 30 September 2016 The Department is also in the process of ensuring that Provide progress report on the The Department will finalise the procurement of essential items by the end of h) Ermelo and Witbank Hospitals become accredited nursing accreditation of Ermelo and Witbank October 2016 school hospitals to become accredited nursing schools, by 30 September 2016.

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS PROGRESS REPORT I) Aware that an orthopaedic surgeon is a scarce skill, only five Ensure that the eight available The Department acknowledges the recommendation that outreach services (5) hospitals in the province have permanent appointed orthopaedic sessions in the other are provided in the following district hospitals on a monthly basis: Tintswalo, orthopaedic surgeons, the Department has a total of 8 hospitals without appointed orthopaedic Matikwana and Barberton surgeons currently, Rob Ferreira Hospital 2 Mapulaneng surgeons to accessibility of services; Rob Ferreira tertiary hospital supports Mapulaneng regional hospital and Hospital 1, Ermelo Hospital 1, Witbank Hospital 2 and provide progress report on the matter Witbank tertiary hospital supports Ermelo regional hospital in relation to Themba Hospital 2 (inclusive of the sessions timetable and management of complex orthopaedic cases (T1) as there is only one Cuban attendance register) by 30 September orthopaedic specialist appointed in each of the regional hospitals. The 2016 package of services nationally requires that hospitals should provide orthopaedic specialist services.

2ND QUARTER PORTFOLIO COMMITTEE FINDINGS AND RECOMMENDATIONS 21 FEBRUARY 2017

No. COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

99 (a) The Department is currently building the The Department must provide a detailed The Department is implementing seven (7) IBT construction projects and below is

Innovative Building Technology structures (IBT) progress report on the IBT construction the status to date: in the following areas: Mpakeni, Marite, Sibange projects and the status quo on the and Mgobodzi clinics. KaMdladla community in KaMdladla Clinic by 13 April 2017 Name of facility Progress the Nkomazi local municipality disputed the Marite Clinic 49% construction of the IBT structure, insisting on a Sibange Clinic 20% brick and mortar clinic. Mpakeni Clinic 45% Oakley Clinic 100% Mgobodzi Clinic 45% Khumbula Clinic 100% KaMdladla Clinic Cancelled due to community protest

(b) Various health facilities were damaged during Provide a detailed progress report on the The Department experienced storm damages to 22 facilities during 2016/17 the 2016 storm incidents. The following areas 2016 storm damage repair projects by 13 financial year and below is the status to date: were affected: Nkomazi, Thembisile and Dr JS April 2017 Moroka local municipalities. R26 million has been set aside to repair all damages

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

No. COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

Name of Facility Progress

Tonga Hospital 100% Masibekela Clinic 100% Fig Tree Clinic 100% Steenbok Clinic 100% Naas CHC 100% Naas Malaria Centre 100% Barberton Hospital 100% Empumelelweni Clinic 100%

100 Hlalanikahle Clinic 100%

Thubelihle CHC 100% Tweefontein G CHC 100% Gemsbokspruit Clinic 100% Weltevrede Clinic 100% Klipplaatdrift Clinic 100% Mamametlhake CHC 100% Debeerspruit Clinic 100% Dludluma Clinic 100% Mangweni CHC 100% Shongwe Hospital 90% Greenside CHC 70% Machadodorp Clinic 100% Tonga Hospital 100%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

No. COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

(c) The Department plans to appoint 96 personnel Provide progress report on the Interviews were completed. However, the Department could not fill the 96 positions within Emergency Medical Services in the appointment of the 96 personnel within the due to budgetary constraints. The Department had envisaged to fill the position 2016/17 financial year EMS by 13 April 2017 during the 2017/18 financial year, however, due to competing priorities and very little increase on the budget, the positions will not be filled

The Department envisages to conduct a feasibility assessment on the filling of the positions as well as the undertaking of other project to ascertain whether this can be done or not

3RD QUARTER PORTFOLIO COMMITTEE FINDINGS AND RECOMMENDATIONS: 23 MARCH 2017

101 No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

(a) The Department has a number of The Department must strengthen The Department has prioritised strengthening of monitoring and evaluations within the infrastructure development challenges – the monitoring and evaluation on the infrastructure delivery plan. A deputy director: M&E was appointed on 1 March 2016, to challenges are identified and said to being measures put in place and provide a ensure that there is active monitoring and evaluation of infrastructure delivery projects addressed. The following hospitals are most detailed progress report on the affected: Bethal, Themba, Matikwane and infrastructure development projects in The following progress has been made to date on the mentioned hospital: KwaMhlanga Hospitals the hospitals inclusive of progress reports on the other mentioned Bethal Hospital: The replacement of Bethal Hospital has commenced and is currently at challenges by 28 April 2017 20% for both phase 1 and 2. This includes the demolition of the asbestos facilities which the hospital was built of. The construction will be completed in 2019/20 financial year

KwaMhlanga Hospital: The construction of the hospital is planned to commence on the 3rd quarter of the 2017/18 financial year. The project will address challenges being experienced at the maternity and psychiatric wards

Themba Hospital: The upgrade of the maternity ward and the resource centre is planned for construction during the 4th Quarter of the 2017/18 financial year. The maternity ward will be expanded as it is currently small and dilapidated resource centre will be upgraded

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No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

Matikwane Hospital: Day-to-day maintenance and fixing of equipment are planned to be completed during the 3rd quarter of 2017/18 financial year.

(b) There are three identified centres in the Strengthen monitoring and evaluation The DOH does not have a mandate to register, licence and close NPOs. The mandate is Province: housing and caring of mentally ill on the measures put in place on the a responsibility of the Department of Social Development patients. The centres are not compliant to the closure and also provide a detailed required norms and standards and are in the report on the closure of centres by The DOH conducted an assessment of all the mental care users from affected NPOs process of being closed 28 April 2017 during March 2017. A detailed report indicates that 104 users were assessed and classified according to their conditions and geographical location

• 26/104 are from Gauteng Province • 15/104 are from Limpopo Province • 63/104 are from Mpumalanga Province Of the 63 patients from Mpumalanga, only 2/63 were referred for further treatment at

102 KwaMhlanga Hospital and others were sent to various clinics for chronic medication (c) Kwa-Mhlanga and Marapyane CHCs had Provide progress report on the KwaMhlanga CHC resumed 24-hour services on 1 April 2017. The facility received a

their operating hours reduced due to operating hours at KwaMhlanga and total number of four (4) post-community service nurses, bringing the total number of identified challenges that are said to being Marapyane CHCs inclusive of professional nurses to sixteen (16) addressed. They are however reverting to allocation of Comm. Serve nurses, this the normal operating hours as from 1 April by 28 April 2017 Marapyane CHC resumed 24-hour services on 1 April 2017 2017 The facility received four (4) post community service nurses bringing the total number of professional nurses to thirteen (13). The number of professional nurses are inadequate to ensure that night duty shift is uninterrupted. The table below indicates the current deficit:

Category Current Required Total

Professional nurses 13 4 17

Enrolled nurses 0 3 3

Pharmacists assistants 0 1 1

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No COMMITTEE FINDINGS COMMITTEE RECOMMENDATIONS DEPARTMENTAL RESPONSES

(d) The Department reported to be changing the Provide a detailed report on the Tintswalo Hospital has a total number of six (6) periodic doctors listed below: system of allocation of period doctors in allocation of periodic doctors at Tintswalo Hospital to address the challenge Tintswalo Hospital by 28 April 2017 Doctor Responsibility Day Time of shortage of doctors Dr Ndlovu OPD Monday-Friday 08:00-12:00

Dr Rodgers Family physician, OPD and Monday, Tuesday 07:30-14:30 provide anaesthesia during and Thursday operations

Dr Mcintosh Outreach Monday-Tuesday 08:00-13:00

Dr Mcintosh Outreach Wednesday 08:00-16:00

103 Dr Skepers Surgical Tuesday- 07:30-12:30 Thursday

Dr Zinn Maternity Tuesday- 07:30-12:30 Thursday

Dr Lwellin Obstetrics and Tuesday- 07:30-13:30 Gynaecology Thursday

(e) The Department reportedly does not have Prioritise the capacitation (training The Department has developed and implemented the referral policy and an enough experienced staff in casualty, and/or education) of staff in casualty, implementation plan general surgery and internal medicine unit; general surgery and internal medicine this and the inadequate referral system is unit accordingly and the referral said to attribute to the high litigations system to address the challenge of litigation (f) Almost all hospitals are not compliant to the Effectively implement the hospital The hospitals conducted a self-assessment against National Core Standards and the National Core Standards – challenges are improvement plans with strengthened quality improvement plans are in place, implemented and monitored monthly identified monitoring and evaluation and provide a progress report in this regard by 28 April 2017

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(g) The Department is struggling in terms of Put measures in place to address the The Department has put the following measures in place to address identified forensic forensic pathology services – there are many identified challenges in forensic challenges: challenges identified pathology services and provide • Two (2) forensic officer posts for Gert Sibande District will be filled to improve progress report by 28 April 2017 staffing • Additional equipment will be procured

4th QUARTER PORTFOLIO COMMITTEE FINDINGS AND RECOMMENDATIONS

No. COMMITTEE FINDINGS QUESTIONS RESPONSES QUESTIONS ON FINANCIALS I. Did the accounting officer establish the The accounting officer did not establish the reason why cash transferred was less than reason why cash transferred was less the main budget, as the Department has received all cash according to the allocated 104 than the main budget? If yes, what are budget at the end of the fourth quarter of the 2016/17 financial year. The main budget for

the reasons and what happened to the 2016/17 was R10 606 328 000 and the cash transferred was R10 606 328 funds which were not transferred? If no; 000. The accounting officer has no knowledge on what informed the question why not? II. How much of the 2016/17 budget has The Department has paid accruals amounting to R405 099 000 for the previous financial been used for settling previous financial year in 2016/17. These accruals were not classified as unauthorised expenditure because years’ “accruals” and whether the the Department has not overspent in the 2016/17 financial year accounting officer does not consider However, had the Department overspent during the 2016/17 financial year, the accruals settling previous financial years’ would be classified as unauthorised expenditure as per PFMA Act 1 of 1999 (as amended accruals with the current budget as by Act 29 of 1999) unauthorised expenditure? III. What actions did the accounting officer The accounting officer did initiate investigations on the irregular expenditure of the take upon discovery of irregular previous contracts awarded until 31 March 2016. The R67 559 789 relates to previous expenditure amounting to financial years (2015/16 and before). The irregular expenditure was investigated by the R67 559 789.77 reported to the labour relations unit and an investigations report has been finalised and recommendations Committee in the third quarter? will be implemented during the 2017/18 financial year IV. What actions did the accounting officer The accounting officer has taken the following steps upon discovery of the fruitless and take upon discovery of fruitless and wasteful expenditure in the third quarter of 2016/17:

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wasteful expenditure amounting to R Fruitless and wasteful expenditure of R1 152 493 relates to payment of one service 1 232 360.67? provider as a result of delays and court challenges from Departments of Public Works, Road & Transport (DPWR&T) and the service provider. Letter of recovery has been submitted to DPWR&T on the 9 November 2016. A follow-up letter was written on 2May 2017 to DPWR&T regarding the recovery of interest

R18 776 relates to delay in payment of Eskom accounts from different clinics and R13 496 from municipal accounts were investigated by District Financial Misconduct Committee and the R47 595 relating to a Telkom account was investigated by the Financial Misconduct and Loss Control Committee. The report is being finalised QUESTIONS FOR PROGRAMME 1

I. Did the accounting officer liaise with Yes, the accounting officer did liaise with the Department of Community Safety, Security DSSCL about the security situation in and Liaison (DCSSL) regarding security at health facilities to ensure that adequate

105 the health facilities, if yes, what are the security is provided

results of the liaison processes? Some of the requests for security personnel forwarded to DCSSL were to protect the following facilities: • Senzangakhona Clinic in Nkangala • Old KaNgwane government complex renovated clinic • KaNyamazane Community Health Centre • Stanwest Parkhomes in Lekwa Local Municipality • Lefiso Community Health Centre in Thembisile Hani Local Municipality

The Department of Health has also conducted assessments at Evander and Middelburg Hospitals to determine security needs following the number of service disruptions due to inadequate security personnel All the requests were implemented by DCSSL and the Department (DoH) transferred the required funds II. Did the accounting officer develop safety No, the Accounting officer has not developed safety plans for all facilities at this stage. A plans for all the health facilities in the draft Safety Plan has been concluded and will be consulted on with the required Province? If yes, where are the safety stakeholders (SAPS, SSA and DCSSL as well as the senior managers within the plans and how safe are the health Department)

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facilities in the Province for both staff The consultation is expected to be finalised within the first quarter of the 2017/18 financial and officials year III. Were there protests in the DoH in this Yes, the Department did experience protests during the quarter under review at the quarter? If yes, where were the protests, following facilities: what was contained in the memorandums and what action has the KwaMhlanga Hospital accounting officer put in place to The workers (DENOSA) demanded the removal of the acting Chief Executive Officer. A address the matters in the team from both provincial office as well as the Nkangala district was dispatched to memorandum? negotiate with the workers The resolution was that the Acting Chief Executive Officer be replaced and a new Acting Chief Executive Officer was appointed while awaiting finalisation of the recruitment process for the permanent appointment of the hospital CEO The situation is now normal

106 Witbank Hospital

The workers were unhappy with the infrastructural conditions of the nurses’ home. A team was dispatched to meet with the workers. The following interventions were implemented: • Painting • Plumbing • Ceiling repair

Sabie Hospital Workers were not happy with changes on overtime to the terms and conditions of services by hospital management without consultation Other issues raised were: • Procurement of staff uniforms • Shortage of staff • Post of nursing manager to be filled A team was dispatched to negotiate with both management and NEHAWU. After negotiations, the matters were addressed as follows: • Claiming of overtime – in line with the Basic Conditions of Employment Act • Procurement of staff uniform – included in the 2017/18 financial year • Shortage of staff – to be appointed according to priority list

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• Post of nursing manager to be filled – recruitment to be finalised by the second quarter of 2017/18 Themba Hospital The demand from NEHAWU was about critical shortage of staff at all levels and that the Department must fill all vacant posts The accounting officer has appointed a task team to look into organisational structure of the institution and that critical posts especially for health professionals, be prioritised. Currently the institution has been stabilised, awaiting a report from the task team on/before 15 May 2017

Matikwana Hospital A concerned group from the community of Mkhuhlu demanded the immediate removal of the CEO and other officials who are not residents of Mkhuhlu. A court interdict has been issued against the community. The institution has been stabilised and the CEO and his

107 management remain in service IV. Did the Executive Authority interact with No, the Executive Authority did not interact with Hon Khoza on her arrival at health

Hon Khoza, a Member of the facilities in the Province. The Executive Authority was not informed and learnt through the National Assembly on her arrival at media about the arrival of Hon Khoza and the concerns that were raised about Matikwana health facilities in the Province, if yes, Hospital what where the interactions and findings of the committee of the National Subsequent to the media release, the Executive Authority called the Hon Khoza and also Assembly and how will such findings be wrote to the Chair of Chairs, Hon, Cedric Thomas Frolic corrected by the Executive Authority? Following the visit the Department appointed a task team to follow-up issues that were raised including general management of the facility

The task team has completed the investigations and a turnaround strategy has been developed V. Can the accounting officer provide a The accounting officer received the following categories of cases during the quarter 4 of detailed report on the litigation cases as 2016/17: a result of motor vehicle collisions, contracts, non-compliance with legislations and medical cases (indicate

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the facility where the case emanated Type of case Total Total amount claimed and the progress on the case) number Medical Negligence 61 R547 469 852

Motor vehicle collision 10 R1 261 656.76 Unpaid services 1 R100 000.00 Non-compliance with legislation 8 R71 937.27 cases

• 29/61 medical cases are court cases and 32 are still under investigation. • 3/10 motor vehicle accident claims are court cases and 07 cases are under investigation. The Department continues to implement the litigation management strategy approved in 2016. The following have been achieved: 108 • Three (3) workshops were conducted one (1) in each district on policies and legal

matters affecting the Department, to increase the level of knowledge about litigation risks • Expenditure incurred in cases is journalised against relevant institutions in order for managers to improve patient care by utilising various medical experts’ reports which identify gaps in both nursing and clinical health care • Adverse cases are mediated to reduce costs. One maternity case of Evander Hospital will be mediated • Service Level Agreements (SLAs) on transfer of patients to private hospitals have been finalized to improve referral of patients VI How does the Accounting officer plan to The accounting officer is implementing the following strategy in ensuring that hospitals ensure that all hospitals have full have full staff complement of executive managers: complement of executive managers • All vacant executive managers (18) and CEOs (6) posts will be advertised particularly hospital CEO? during the first quarter of 2017/18 • Appointments to be effected during the second quarter of 2017/18 • In case of attrition, posts will be filled as and when required

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QUESTIONS FOR PROGRAMME 2 I. To what extent did the measures put by The measures put by the accounting officer to achieve all the targets of this programme the accounting officer to achieve all the did not succeed to a satisfactory level. However, performance on some of the indicators targets of this programme succeed during the period under review has improved as compared to the third quarter. considering the poor performance of the Department in meeting targets of this programme? II. Did the Accounting officer establish the Yes, the accounting officer is constantly monitoring the performance of all programmes impact of failure to meet the targets of including programme 2 as it is the backbone of service delivery. The impact of failure to this programmes as a programme which meet the target is amongst others: is the backbone of the health system in • High mortality and morbidity rates the Province, if yes, what is the impact. • Inadequate utilisation of PHC facilities which are meant to improve access to If no, why not? health care services The Department is implementing strategies such as the maternal and neonatal mortality

109 strategy, HIV and AIDS strategy and the Ideal Clinic Realisation and Maintenance initiative to improve performance of the programme

III. What measures did the accounting The accounting officer ensured that the Primary Health Care services are funded officer put in place to ensure the according to the norm of 60%, however the Department allocated 62% (R6 542 488 000) appropriate funding of PHC facilities? of the total budget (R10 606 328 000) during the 2016/17 financial year IV. What actions has the accounting officer The accounting officer conducted an analysis in all three Districts to determine the status put in place to ensure that all clinics have of appointed operational managers. A total number of 232/287 PHC facilities had Operational managers? appointed operational managers.

In order to address the identified gap, the Department only managed to appoint 18 Operational managers Five (5) in Gert Sibande for KwaNgema, Driefontein CHC, Hartebeeskop, Vlakplaas and Kromdraai clinics, seven (7) in Nkangala for Tweefontein G, Phola CHC, Wolwekraal, Senzangakhona, Leeufontein, Allemansdrift C CHC, De Beersput clinic and six (6) in Ehlanzeni at Buffelspruit CHC, Lillydale, Brondal, Bourkes Luck, Simile and Elandsfontein clinics during the 2016/17 financial year

By the end of the fourth quarter 250/287 PHC facilities had appointed operational managers. 37/287 PHC facilities still do not have appointed operational managers.

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In order to ensure smooth running and accountability at the facilities, senior professional nurses are delegated to take charge of PHC facilities V. Considering that the accounting officer The accounting officer is allocating mobile clinics to visit the areas which do not have a know the areas which do not have a clinic at all but need a clinic, however the frequency of visits to these points is sometimes clinic at all but need a clinic, what inconsistent and interrupted due to fleet that is old and frequently breaks down. measures have been put in place in those areas to fully access health care Currently the Department has a total number of 84 mobile clinics covering 2 561 points provision? which are distributed in the districts as follows: • Gert Sibande District has 28 mobile clinics visiting 1 116 points • Ehlanzeni District 32 mobile clinics visiting 984 points • Nkangala District 24 has mobile clinics 461 points

In some areas, for example at Luphisi, where land is available, Innovative Building Technology (IBT) structures are erected because they are cheaper and durable for up to

110 more than twenty (20) years QUESTIONS FOR PROGRAMME 3

I. Why did the accounting officer fail to Failure of the programme to achieve its targets is attributed to: ensure that this programme achieve its • Insufficient fleet, shortage of staff and lack of Computer Aided Dispatch (CAD) target considering the fact that from the system led to the accounting officer not achieving the Emergency Medical Services third quarter to the fourth quarter the (EMS) Targets. This has an impact on the number of operational vehicles to service performance of this programme has patients • The decrease in operational ambulances is due to frequent breakdown because of dropped? the age of most of the fleet which further exacerbated the above stated reasons • The Department has a fleet of 187 ambulances of which 98 are operational, the remaining 89 stands to be decommissioned due to the age and high life to date of the vehicle and repair costs • There was no procurement of operational ambulances due to the lack of funds and this resulted in the same ambulances being put back into operations However, although the Department has not achieved the targets that are national targets, the Department has improved despite the challenges mentioned as evidenced by the response rate over the past 3 years:

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Indicator 2014/15 2015/16 2016/17 Target

P1 response urban under 15 73% 75.5% 72.3% 85% minutes

P1 response rural under 40 66% 71% 69.5% 75% minutes

Increase response time by 98 98 95 105 increasing ops ambulances

Integration of PPTS into EMS 0% 20% 20% 50%

Inter-facility transfer rate 0% 4.6% 5% 10%

111

Increase in obstetric 12 18 24 18 ambulances

II. What will it take for the accounting officer In order for accounting officer to achieve the targets of this programme, the following to achieve the targets of this programme measure will be put in place: and what measures are in place to • Integration of Planned Patient Transport System into EMS ensure the performance of this programme? III. How does the accounting officer The accounting officer has put the following measures to ensure accessibility of EMS manage the EMS to ensure services to communities: accessibility of ambulances to • EMS bases are available at all municipalities to serve nearby communities in that communities? municipality • Appointed managers at different levels to ensure maximum utilisation of ambulances: • EMS bases • District office • Operations manager at head office • Most managers reside in the communities where they work and are establishing relationships with community leaders.

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IV. How effective is the communication The accounting officer has established communications centres which are located at between communities and EMS to districts as follows: ensure the speedy response time of • Ehlanzeni: district office EMS. • Nkangala: Middelburg medical depot • Gert Sibande: Evander RTC building

The communities further access the communication centres by using the toll-free numbers, which are: • 10177 for Telkom users • 112 for cell phone users across all cell phone networks Further to this, the Department has published contact details of all managers within the districts on social media as well as in newspapers V. Can the accounting officer indicate Yes, the accounting officer can indicate the norms and standards for EMS that the norms and standards for EMS and stipulates the ratio for ambulance to population and not ambulances to health facilities whether the Department meets those The ratio of ambulance to population is as follows:

112 norms particularly a ration of 1 ambulance to 10 000 population (1:10 000) ambulances to health facilities? This then means that Mpumalanga having a population of 4.4 million, there is a need to have 440 operational ambulances. Each ambulance should have 8 personnel plus 2 back up practitioners to cover for those going on leave or training. This translates to 4 400 EMS staff members The Department does not meet these norms The current total fleet is 206 ambulances, of which only 98 are operational. This means that there is a deficit of 342 ambulances Further to this, the Department has employed 802 operational personnel, 62 communication centres personnel and 42 managers within EMS, with a resulting deficit of 3 494 personnel across all qualification categories QUESTIONS FOR PROGRAMME 4 I. What measures has the accounting The accounting officer has put the following measures in place to ensure no officer put in place to ensure no inexperienced officials render critical clinical services: inexperienced official render critical • The heads of clinical departments for regional hospitals allocate medical clinical services? practitioners in the units to perform different procedures based on their level of clinical expertise and skill

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• Considering that regional hospitals provide a training platform for medical interns, the inexperienced medical interns render critical clinical care services under the direct supervision of a senior medical officer • Other clinicians’ in-service trainings are conducted during the morning meetings where they are taught how to manage and deal with complex medical conditions • Ward rounds are also used as a teaching platform for clinical personnel • The above principles apply also to nursing and allied health professionals II. What measures has the accounting The accounting officer did put measures in place to ensure adequate formal clinical officer put in place to ensure that there policies and procedures are developed and implemented. All heads of clinical are adequate formal clinical policies departments at the regional hospitals have developed and reviewed clinical policies and procedures? and procedures for the following disciplines: • Obstetrics and gynaecology • Paediatrics • General surgery • Orthopaedics

113 • Internal medicine III. What measures has the accounting The accounting officer has ensured that the regional hospitals have medical equipment

officer put in place to ensure that there maintenance plans that are monitored monthly. This is to ensure that there is no are adequate critical medical breakage of critical medical equipment due to non-servicing. In addition to this: equipment and consumables? • The Department has Clinical Engineering (CE) workshops in Ermelo, Themba and a satellite in Mapulaneng hospitals to cater for repair of medical equipment • The regional hospitals also have procurement plans that are based on the prioritised medical equipment list for each hospital • The availability of medical consumables is monitored on weekly basis as part of the medical class II supply chain IV. What measures has the accounting The accounting officer did ensure that there is effective supervision and control of officer put in place to ensure effective inexperienced officials by: supervision and control of inexperienced • Ensuring that the allocation of medical practitioners takes into consideration that the officials? junior doctors are always paired with the senior doctors, especially when taking calls after hours • Clinical managers only sign off call rosters of the different disciplines after ensuring that this principle is fully adhered to • The above principles apply also to nursing and allied health professionals

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QUESTIONS FOR PROGRAMME 5 I. What measures has the accounting The accounting officer has put the following measures in place to ensure no inexperienced officer put in place to ensure no officials render critical clinical services: inexperienced official render critical • The heads of clinical departments for tertiary hospitals allocate medical clinical services? practitioners in the units to perform different procedures based on their level of clinical expertise and skill • Considering that tertiary hospitals provide a training platform for medical interns and registrars, the inexperienced medical interns render critical clinical care services under the direct supervision of a senior doctor • Other clinicians’ in-service training conducted during the morning meetings where they are taught how to manage and deal with complex medical conditions • Ward rounds are also used as a teaching platform for clinical personnel • The above principles apply also to nurses and allied health professionals II. What measures has the accounting The accounting officer did put measures in place to ensure adequate formal clinical officer put in place to ensure that there policies and procedures are developed and implemented. All heads of clinical

114 are adequate formal clinical policies and departments at the regional hospitals have developed and reviewed clinical policies and

procedures? procedures for the following disciplines: • Obstetrics and gynaecology • Paediatrics • General surgery • Orthopaedics • Internal medicine III. What measures has the accounting The accounting officer has ensured that the regional hospitals have medical equipment officer put in place to ensure that there maintenance plans that are monitored monthly. This is to ensure that there is no breakage are adequate critical medical equipment of critical medical equipment due to non-serving and consumables? • In addition to the above, the Department has Clinical Engineering (CE) workshops in Rob Ferreira and Witbank Hospitals to cater for repairs of medical equipment • The tertiary hospitals also have procurement plans that are based on the prioritised medical equipment list for each hospital The availability of medical consumables is monitored on a weekly basis as part of the medical class II

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IV. What measures has the accounting The accounting officer did ensure that there is effective supervision and control of officer put in place to ensure effective inexperienced officials by: supervision and control of inexperienced • Ensuring that the allocation of medical practitioners takes in cognisance that the officials junior doctors are always paired with the senior doctors especially when taking calls after hours • Clinical managers only sign off call rosters of the different disciplines after ensuring that this principle is fully adhered to The above principles apply also to nursing and allied health professionals QUESTIONS FOR PROGRAMME 6 I. What measures has the accounting The accounting officer did put the following measures in place to ensure the pass rate is officer put in place to increase the pass improved: rate in the nursing colleges and the pass • The entrance requirements were reviewed to ensure that deserving students are rate of the bursary holders sponsored by recruited and to ensure that the requirements are aligned to higher education the Department? • The interviews also ensure that candidates who have a disposition towards the

115 profession are selected • These also apply to bursary holders II. Can the accounting officer provide a Yes, a summary of the results for the nursing college students and the bursary holders summary of results of the nursing in the Cuban programme is attached colleges under the Department and the pass rate of all bursary holders of the Department III. Can the accounting officer provide The accounting officer did not institute any reduction of stipend for both bursary holders reasons that resulted in the reduction of and nursing students the stipends of bursary holders and • The nursing students at KZN continue to receive the R3 000 a month stipend as nursing students? per the directive of the KZN government • The Kabokweni campus students are currently on a salary level 3 (R9 000.00). The Department is in the process of implementing the stipends for new students from the 2017/18 financial year • The medical students in Cuba receive 200 american dollars a month IV What is the admission policy of the The policy stipulates the following compulsory subjects on the grade 12 certificate: nursing colleges and how does the • English – level 4 (HG-D /SG-C or above) accounting officer ascertain that all • Life Science/ Biology/ Physiology – level 4 (HG-D /SG-C or above) • Maths – level 3 (HG-E /SG-D or above) • Geography/ Physical Science/ Agriculture – level 3 (HG-E /SG-D or above)

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students registered have met the A minimum total Admission Point Score (APS) of six subjects with highest levels should admission criteria? not be less than 25 points (excluding life orientation) Furthermore, the accounting officer ascertain admission criteria through conducting interviews to verify each applicant before selection

QUESTIONS FOR PROGRAMME 7 I. What measures has the accounting The accounting officer did put measures in place to address shortages and inadequacies officer put in place to ensure that there in the forensic pathology services as follows: are no shortages and inadequacies in Shortage of personnel – 8 forensic officers and 6 administrative personnel were appointed the forensic pathology services • 8 Ehlanzeni – 5 forensic officers and 3 administrative officers particularly: • 6 Nkangala districts - 3 forensic officers and 3 administrative officers a) Shortage of personnel • Gert Sibande - 2 forensic officer posts will be filled in 2017/18 financial b) Inadequate infrastructure year to improve staffing • Administrative officers are not included on the priority list, appointment c) Inadequate medical equipment will be done once funding becomes available d) Inadequate fleet services 116 Inadequate infrastructure – 4 new forensic mortuaries are included in the current running projects for Mamametlhake and Bethal to be completed during 2018/19. Mapulaneng and KwaMhlanga are on plan to commence construction in 2018/19 and will include forensic mortuaries

Inadequate medical equipment – 10 autopsy head saws were procured to address the major required equipment for 10 forensic mortuaries (Themba, Tintswalo, Lydenburg, Witbank, Middelburg, KwaMhlanga, Delmas, Ermelo, Evander and Embhuleni)

Inadequate fleet services – currently there are 92 pick-up trucks, of which 23 needs to be replaced due to fleet conditions. However, due to limited budget in 2017/18 fleet procurement will be prioritised in 2018/19 financial year

II. How does the accounting officer plan to The accounting officer is addressing the shortage of pharmacy personnel by appointing address the shortage of pharmacy community service pharmacist, interns and qualified pharmacists personnel? • The number of pharmacists was at 192 by the end of the third quarter • An additional 71 pharmacists were appointed during the fourth quarter of 2016/17 to bring it to a total of 263.

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• The Department still has a deficit of 86 pharmacists and 59 pharmacist assistants to ensure improved pharmaceutical services • The current number of pharmacist assistants 214 (95 Ehlanzeni, 43 Nkangala, 76 Gert Sibande and 2 head office) • The Department is reviewing the organisational structure to include the category of pharmacy personnel III. What measures did the accounting officer The accounting officer has put the following measures in place to address maintenance put in place to avoid or improve poor of equipment: maintenance of medical equipment? • Clinical engineering workshops were increased from two (2) to four (4) (Themba Hospital, Nkangala BT Clinic, replacement Rob Ferreira Hospital and renovation Ermelo Hospital) • The number of clinical engineering technicians has been increased from 5 to 28 over a period of three years • Procured 4 additional bakkies for clinical engineering workshop outreach services 117 • Annual maintenance and quality assurance tests for X-ray equipment are

scheduled to be done in the first quarter of 2017/18 in order to comply with radiation control prescripts • Furthermore, the Department plans to procure tools and test equipment for clinical engineering technicians to improve maintenance of equipment • Users will be trained on handling of medical equipment to avoid frequent breakages 6.8.1 QUESTIONS FOR PROGRAMME 8 I. What measures did the accounting officer The appointment of the contractors is a competency of the implementing agent (DPWRT) take to ensure that no incompetent however, the accounting officer did put measures in place to ensure that competent contractors are appointed by the contractors are appointed by appointing DoH officials to serve on all bid committees of Department? DPWRT (specification, evaluation and adjudication committees). II. How much in penalties has the accounting The accounting officer did not impose any penalties to contractors, time extension was officer charged against incompetent granted to all contractors that did not complete projects on time due to various reasons contractors and how much has been such as community unrest, inclement weather (rain delays) etc. However, the received so far? implementing agent (DPWRT) is administering contracts on behalf of the DoH as per the SLA

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III. How many contractors have been The Department did not terminate any contracts due to poor workmanship, instead the terminated due to poor workmanship and implementing agent DPWRT arranged sessions to cede work from the poor performing incompetency of contractors and what are contractors to good performing contractors as follows and there are no costs associated the associated costs to the Department for with a cessation: such terminations? The following four (4) projects were ceded from poor performing contractors: 1. Waterval CHC 2. Middelburg Hospital ward 15 3. Extension 8 Clinic 4. Nazareth Clinic

TRACKING HOUSE RESOLUTIONS ON ANNUAL PERFORMANCE PLAN 2016/17

No COMMITTEE COMMITTEE PROGRESS REPORT COMMITTEE UPDATED PROGRESS REPORT DURING 118 FINDING RECOMMENDATIONS RECOMMENDATIONS MAY 2017

a) There is low staff Strengthen measures put in The Department conducted a staff Ensure continuous monitoring The recommendation by the committee is morale in the place to boost staff morale and satisfaction survey and a draft action plan and evaluation Also provide noted Department – ensure that measures put in will be discussed with the Union and progress report on the action plan The matter was discussed with organised particularly in the place to addressing negative implemented in the third quarter. The in place and the measures put in labour on the 14 February 2017. It was further health facilities, more staff attitude (inclusive of following measures were put in place to place to boost staff morale by 30 agreed joint programmes will be presented to concerning is the disciplinary procedures where boost the staff morale: August 2016 negative attitude of necessary) are effectively (a) Staff development programmes e.g. the nurses in an attempt to boost the staff health workers in the implemented and also provide a bridging courses morale health facilities. detailed report in this regard (b) Implementation of salary grade The following intervention programs were also Nurses continue with progression as well as translations to the tendency of taking those who completed the bridging implemented: extended lunches – course • World Nurses Day celebrated which neglecting patients (c) Long service awards and ensuring that focused on the recognition of nurses (leaving them excellence awards are given to staff unattended) thus (d) Piloting of the work indicator staffing throughout the Department norms for clinics to improve work load

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contributing to long (e) Prioritised posts for nurses for the • Wellness Day celebrated during the last waiting time 2016/17 financial year to address staff quarter. (f) Staff attitudes challenges being addressed with Organised Labour • Debriefing programmes in reported Unions incidents conducted

• A total number of 319 nurses translated during the period from 1 April 2016 to 31 March 2017

• MEC Excellence Awards ceremony

119 conducted in December 2016

b) The Department has a Fast-track the filling of all vacant A total number of 304 posts were filled since Provide progress report to date The Department filled a total number of 2 396 7.3% vacancy rate funded posts and provide April to date on the filling of all vacant funded posts for the period from 1 April 2016 to 31 progress report posts by 30 August 2016 March 2017 c) The Department has a Effectively implement the The action plan on litigation management, Strengthen monitoring and The recommendation by the committee is high volume of litigation management strategy establishment of committees and legislation evaluation and ensure improved noted litigation cases with continuous monitoring and compliance has been developed and service delivery to avoid All paid cases have been journalised against however, the litigation evaluation and also provide presented at various forums to strengthen unnecessary litigations relevant institutions to strengthen capacity of management strategy progress report in this regard compliance Remedial action plans by nursing and clinical forums, in order to was approved in facilities will be monitored to ensure communicate policies and improve patient care January 2016 improvement of service delivery by adhering to relevant prescripts to reduce litigations

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Provincial adverse committee has been established Adverse cases are mediated to minimise legal costs

Due to budgetary constraints one (1) legal officer has been trained on mediation of cases. Four (4) legal officers will undergo similar training in 2017/18 financial year The Department has conducted 3 workshops on policies and causes of litigations in three

120 districts d) Occupational disease Intensify measures put in place The decreased number of multi drug Strengthen monitoring and The recommendation by the committee is infections have to addressing occupational resistance TB (MDR-TB) from 12 in evaluation noted improved (decreased), disease infections and provide 2014/15 to 7 MDR-TB during 2015/16 is however, the rate of progress report noted as improvement due to measures put There has been an improvement in the the decrease is so in place aiming to prevent occupational TB, observed DR-TB cases from seven (7) cases in minimal and and early diagnosis and treatment 2015/16 to one (1) case reported in 2016/17. unacceptable preventing complications such MDR-TB. The Department engaged occupational However, the Department has reinforced hygienist and epidemiologist from National the following measures: A circular has Institute for Occupational Health to conduct a been issued to all healthcare workers workplace TB Infection Prevention and Control reinforcing employee medical surveillance (IPC) risk assessment at Shongwe Hospital on (pre-placement medical, initial medical, the 19 September 2016 and Impungwe periodic and special medical examinations) Hospital on the 3 October 2016. Air monitoring

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Procurement of N95 fit test equipment in the (ventilation) measurements were also carried health establishment by managers is out to establish the effectiveness of IPC encouraged. Employees are to undergo measures in place. N95 fitness test has been fitness tests for effective use of the N95 carried out to all healthcare workers in the respirators (PPE) following health establishments: Tintswalo, Amajuba Memorial and Standerton hospitals A workplace TB risk assessment has been and PHC facilities in Lekwa and Pixley Ka conducted at Witbank TB by occupational Seme sub-districts hygienist from NIOH on the 23 March 2016, recommendations thereof will be implemented in health establishments. TB

121 awareness screening is on-going

e) The Department is Strengthen relationships with the Yes, the Department has noted the Strengthen monitoring and The recommendation by the committee is doing well on implementing agent for joint and recommendations of the portfolio evaluation noted. infrastructure continuous monitoring and committee. The accounting officer in effort to strengthen development. evaluation and also provide • Jointly DoH and DPWRT have monitoring and evaluation, has arranged for 11 progress report on all resuscitated monthly consultant Programme Operational Management infrastructure development meetings to discuss progress Meetings (POMMs) at a technical level projects • Jointly DoH and DPWRT have between the DoH and DPWRT thus to ensure resuscitated programme operational that oversight is efficiently enforced management meeting and joint operational committee meetings The NDoH has also seconded an in loco engineer that augments internal capacity on monitoring and oversight

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f) The Department will Strengthen monitoring and The Department has appointed a total of 11 Strengthen monitoring and The recommendation by the committee is continue its initiative of evaluation on the initiative to use cooperatives in the last financial year for evaluation noted using cooperatives for cooperatives for maintenance, multi-year projects (2015/16-2016/17) in all maintenance, repairs, repairs, rehabilitations and districts as follows: The NDoH continues to utilize the cooperatives rehabilitations and refurbishments and also provide 3 cooperatives for 3 projects in Nkangala on the maintenance projects. refurbishments that progress report District: commenced in • Nazareth Clinic - 5% progress The NDoH has also seconded an In loco 2015/16 F/Y. In the • Marapyane Clinic 5% progress engineer that augments internal capacity on 2016/17 F/Y, the • Thembalethu Clinic 5% progress monitoring and oversight Department will appoint cooperatives 4 cooperatives for 4 projects in Gert

122 which will benefit 10% Sibande District:

of each project they • Prince Mkholishi CHC 100% complete take part in • Nhlazatshe 4 Clinic 100% complete • Bettys Goed Clinic 95% progress • Fernie 1 Clinic 100% complete

4 cooperatives for 4 projects in Ehlanzeni District: • Oakley Clinic • Simile Clinic - 5% progress • Elandsfontein Clinic 5% progress • Mtimba Clinic - 47% progress

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g) The Department is in Fast-track the development of The specification for patient record Provide progress report on the The above bid was advertised in the the process of specifications for the Patient management system has been completed specifications for the patient Mpumalanga provincial supply chain developing Records Management System and will be submitted to treasury for record management system and management tender bulletin volume 241 specifications for the and also provide a copy to the advertising the advertisement thereof by published on 8 July 2016 with a closing date of patient records committee and the plan for provincial treasury by 30 August 12 August 2016 management system, implementation 2016 This bid was withdrawn on 30 September 2016 the pilot project was as the requirements were incorporated into the planned to commence NHI and all bidders who responded were in 2015/16 F/Y but not informed accordingly achieved h) Moloto Clinic is Provide progress report on the Moloto CHC is still functioning as an 8-hour Provide progress report on the Moloto CHC operating hours reverted back to

123 currently operating 8 performance and the plans to facility. Potential applicants submitted their performance and the plans to 24 hours following the appointment of 9 hours from 24 hours reverting the operating hours applications. The Department has recently reverting the operating hours professional nurses with effect from 1 due to shortage of back to 24 hours approved the selection panels to conduct back to 24 hours at Moloto CHC September 2016 staff. However, the interviews with suitable candidates. by 30 August 2016 Department has put Assumption of duty is planned for 1 August plans in place for the 2016 operating hours to be reverted back to 24 hours in June 2016 i) The Department is in Fast-track the development of The draft neonatal strategy has been Provide progress report on the The top management approved the neonatal the process of the strategy on the management completed to be presented in the top approval and the implementation strategy in October 2016. developing a strategy of neonatal services while management sitting for inputs and approval of the strategy and its impact on the management of intensifying measures put in thereof by 30 August 2016 The implementation was initiated after approval neonatal services to place to address this challenge and the following activities were carried out:

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addressing the with continuous monitoring and • A doctor has been sent to Wits University to challenge of high evaluation. Provide a progress specialise on neonatal care in February mortality rate – report 2017 particularly on children between 0-28 days • Equipment procured (11 x Neonatal ventilators 8 x neonatal warmers 28 x CTG machines 2 x CPAP machines some still to be delivered before end of May 2017)

124 • Training on basic antenatal care plus has

been rolled out to all facilities and implementation initiated on the 1st April 2017

• One hundred and ninety-five (195) officials were trained on help baby breath through onsite trainings

Analysis of impact of the strategy has not yet been done since the implementation of the strategy started in November 2016

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8. SCOPA RESOLUTIONS

NO SUBJECT DETAILS RESPONSE BY THE DEPARTMENT

3.1 MOVABLE AND TANGIBLE CAPITAL ASSETS (R94 825 658.00)

The committee noted that the Auditor The committee recommends the house to General reported that the Department resolve that:

did not have adequate systems to (i) The accounting officer to ensure that (i) The accounting officer has ensured that the Department has adequate systems to maintain maintain records of movable tangible the Department has adequate records of movable tangible capital assets capital assets, which resulted in major

125 systems to maintain records of assets being misstated. Assets that Assets officials have been trained to perform the physical verification and recording of the

movable tangible capital assets movable tangible assets. The Department has bought 37 scanners for verification purposes amount to R240 175 694.00 (2012/13:

R94 825 658) could not be located in the

asset register. The committee further (ii) The Department has approved Asset Management Policy. Procedure manuals have been (ii) The accounting officer must ensure noted the absence of adequate systems developed to ensure implementation of the policy. that effective systems are developed to ensure internal controls on asset and implemented to ensure effective management internal controls and provide progress Annexure A1 – Asset Management Policy The committee required the accounting in this regard by 31 July 2015 Annexure A2 – Asset Management Procedure Manuals officer to provide reasons that led to failure to ensure that adequate systems (iii) The accounting officer must ensure (iii) The accounting officer has ensured that asset management section is capacitated Director responsible for asset management has been appointed with effect from 1 August 2016. Asset to maintain records for the Department’s that the asset management section of Management officials have been trained on asset verification processes and an asset assets are in place. The committee the Department is capacitated management policy workshop has been conducted further enquired about the challenges

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faced by hospitals regarding asset management.

Upon the questions posed by the committee, the accounting officer reported that the Department has done away with the excel spreadsheet and LOGIS is utilised for asset management. The accounting officer further brought to the attention of the committee that the approved 2010 staff establishment did

126 not accommodate an asset management

component in all institutions and as a result this contributed to capacity issues within institutions, and that the organogram is being reviewed to correct the deficiency and there is continuous training of existing asset management staff

In an attempt to address the challenge, the accounting officer reported that there is ongoing engagement with the office of the AGSA in line with the approved asset management plan to ensure that all the processes followed by the Department to

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clean up the asset register, are being assessed by the AG and provincial Treasury

3.2 IRREGULAR EXPENDITURE (R1 330 006 000.00).

The committee noted that the AG’s report The committee recommends the house to resolve that: noted limitations with regard to internal

controls based on evidence that was (i) The executive authority must (i) The executive authority did not take disciplinary actions against the accounting officer and consider taking disciplinary actions against required for irregular expenditure on the official(s) for failure to prevent the irregular expenditure for 2012/2013: the accounting officer and official(s) for annual report. The AG was unable to ▪ Cause of action was prescribed failure to prevent the irregular expenditure ▪ The accounting officer in 2012/2013 is no longer in the service of the state determine whether the irregular amounting to R1 330 006 000.00 in 2012/13

127 expenditure amounting to R818 401 000- and the 2013/14 financial year

00 incurred in 2013/14 was recorded and The accounting officer did take actions against the official involved, for 2014/15 financial year investigated by alternative means. 19 officials were given final written warnings, see attached marked as Annexure A10 However, an irregular expenditure of

R511 605 000 was incurred in 2012/13 (i) The executive authority must take financial year which in total amounts to (i) The executive authority did not take disciplinary actions against the accounting officer for failure disciplinary actions against the R1 330 006 000 of irregular expenditure to report the irregular expenditure for 2013/2014, as the accounting officer in 2013/2014 is on accounting officer/ official(s) for failure awaiting condonation. temporary incapacity leave for the previous two years to timely report to Treasury the The committee required the accounting irregular expenditure amounting R818 officer to provide reasons that led to an 401 000.00 in the 2013/14 financial irregular expenditure of R1 330 006 000 year, in contravention of section 38(1) being incurred. The committee further (g) of the PFMA required the accounting officer to submit

proof that the irregular expenditure was

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reported to provincial Treasury for (ii) The accounting officer must enforce (ii) The accounting officer has enforced compliance with SCM policies by updating the supply chain condonation and that a register was kept. compliance with SCM policies and management checklist and took disciplinary steps as attached in annexure A10

The accounting officer was also required take disciplinary actions against

to provide the corrective measures which officials who contravene the policy have been put in place to ensure that (iii) The accounting officer must develop (iii) The accounting officer has introduced an electronic invoice register to monitor and ensure financial statements are recorded effective internal control systems and invoices are paid within 30 days to prevent fruitless and wasteful expenditure SCM checklist has properly and that evidence is available tools to timeously detect and prevent been introduced to ensure that procurement processes are in line with the supply chain during the audit to back-up the irregular fruitless, wasteful, irregular and regulations to prevent irregular expenditure

expenditure unauthorised expenditure as required Contracts that contributes to irregular expenditure have been identified and terminated. The In response to the questions posed by the by section 51(1) (b) (ii) of the PFMA Department entered in month-to-month contracts when advertising to obtain service providers committee, the accounting officer

128 indicated that the irregular expenditure Specification for tender to supply of pharmaceuticals has been advertised. The tender closing date is 8 December 2016

occurred as a result of non-compliance with SCM policies due to capacity Tender for food, bid specification scheduled for Tuesday, 22 September 2016 and advertising on constraints in the Department. With 25 September 2016

regards to reporting of the irregular The accounting officer has engaged the Department of Public Works, Roads and Transport for expenditure, the accounting officer the nomination of representatives in all the bid committees (BSC, BEC and BAC) where the reported that there was no condonation Departments projects are involved from provincial Treasury and a register is

kept for all irregular expenditure. In addressing the question of measures put

in place to curb the challenge, the

accounting officer informed the committee that a team of officials who

verify all the supporting documents to

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ensure compliance with the financial reporting framework has been (iv) The accounting officer must furnish (iv) The accounting officer has the following strategies to ensure that the financial statement is recorded properly established the committee with a copy of the ▪ Financial Statement unit will be appointed, Finance Structure has been approved Upon the responses provided by the strategy that will be used to ensure ▪ The Department has procured software to prepare the annual financial statement to accounting officer on the issue of that financial statements are reduce the number of errors ▪ The Department is also implementing the SAICA project irregular expenditure, the committee recorded properly and that evidence strongly felt that the responses were is available during the audit to back inadequate and required a written up irregular expenditure by response in this regard. Upon analysis of 31 July 2015 the responses and engagement with the Department, the committee was of the

129 view that the accounting officer failed to

take effective and appropriate steps to prevent the irregular expenditure as required by section 38 (1) (c) (b) 3.3 PERFORMANCE INFORMATION The committee has noted that the Auditor The Committee recommends the House to General report sampled Programmes 2, 4 resolve that:

& 5 and found that performance (i) The accounting officer must furnish (i) The Department is implementing national e-health project in Gert Sibande geared to strengthen indicators were not SMART as required the committee with proof of the information management by the national treasury’s framework for measures that have been put in • The Department is currently rolling out this project to the remaining two districts, Ehlanzeni and Nkangala managing programme performance place to ensure that reported • This include, among other, rollout of e-health systems (rationalization of registers, patient information (FMPPI). The committee performance information is valid, administration system, electronic PHC tick register, web-based DHIS, internet connectivity noted that the AGSA found that the accurate and complete in the to health facilities and filing system) reported information was not valid, 2014/15 financial year. • Target date is 31 March 2017

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accurate and complete when compared to the source information or evidence (ii) The Department conducts quarterly performance reviews provided which was attributed to lack of (ii) The accounting officer must conduct

standard operating procedures. Institutional Quarterly Performance Annexure A3 Schedule for reviews and attendance registers The committee required the accounting reviews with management and

officer to provide reasons that led to ensure that reported performance

failure to ensure that performance has valid evidence in each quarter indicators are well defined and enquired (iii) The accounting officer must ensure (iii) The NDoH has engaged national AGSA and DPME regarding revision of indicators. The Department has developed the National Indicator Data Set (NIDS) for 9 provincial Departments whether monitoring and evaluation that performance indicators are which is reviewed on an annual basis systems have been put in place to ensure SMART and provide progress report achievement of planned targets on the outcomes of the engagements Annexure A4: Communique from national DG

130 Furthermore, the committee required the between NDOH and AGSA

accounting officer to provide proof that regarding the revision of indicators measures are in place to ensure that reported performance information is valid, accurate and complete in the 2014/15 financial year Upon the findings and questions posed by the committee, the Accounting officer reported that indicators sited are prescribed by NDOH and further reported that the NDOH has been engaged through the National Health Information Systems of South Africa (NHIS/SA) Committee and other national platforms

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like the National Strategic Planning Committee meeting in redefining them. It was brought to the attention of the committee that the NDoH indicated that, AGSA will be engaged to acquire relevant information for these indicators to be revised accordingly before distributing to provinces for inclusion in their Provincial Annual Performance Plans (APPs) In addressing the question regarding monitoring and evaluation systems, the

131 accounting officer reported that a

monitoring and evaluation system which enables the review of performance information on a quarterly basis supported by District Health Management Team (DHMT) meetings conducted at district level monthly is in place. The accounting officer further informed the committee that the review of performance information at sub-district and facility levels has been introduced in the current financial year. The accounting officer reported that in 2013/14 the Department conducted an evaluation study on the

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impact of PHC supervision on PHC services and that a concept document for a 2014/15 evaluation project has been developed on HIV strategies in collaboration with Office of the Premier The accounting officer indicated that Department has rolled-out the District Health Management Information Systems (DHMIS) policy targeting operational managers from clinics, medical practitioners and all other clinical

132 personnel in the 3 districts. It was brought

to the attention of the committee that the Department also provided Standard Operating Procedures which highlight each personnel categories’ responsibility at facility level and that information should be checked and verified against the source (registers) and signed off before sending to the next level The committee was dissatisfied with the response provided by the accounting officer and requested proof in this regard

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3.4 COMPLIANCE WITH LEGISLATION

The committee has noted that the Auditor The committee recommends the house to General found that that there were no resolve that:

effective and appropriate steps to prevent (i) The accounting officer must consider (i) The Department did not have unauthorised expenditure during 2014/2015 financial year overspending as required by section 39 hence no disciplinary actions have been taken taking disciplinary actions against the (2) (a) of the PFMA. Based on this finding, official(s) for contravening Section 39 the committee required the accounting (2) (a) of the PFMA read with section 45 officer to provide reasons for failure to (d) of the PFMA prevent overspending and to indicate the

measures put in place to ensure that (ii) The accounting officer must exercise (ii) The Accounting officer has exercised monitoring on the implementation of the cost overspending is prevented. The curtailment measure policy

133 on-going monitoring on the committee further required the accounting

implementation of the cost curtailment Updated circular on austerity measures has been issued to monitor the expenditure officer to provide proof that the over measures policy spending was reported on time to the Annexure A5 – austerity measures issued MEC and provincial Treasury as required (iii) The accounting officer must keep a (iii) The accounting officer keeps the register for irregular and fruitless and wasteful by section 39 (2) (b) of the PFMA register for irregular, fruitless and expenditure. Monthly incurred irregular and fruitless and wasteful expenditure is updated on the registers wasteful expenditures In response to the questions posed by the committee, the accounting officer reported Annexure A6 – register for irregular expenditure

that that the high prevalence of HIV AND Annexure A7 – register for fruitless and wasteful expenditure AIDS resulted in the high expenditure for this programme which led to overspending in the Department. With regards to reporting of this over expenditure, the accounting officer

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indicated the over expenditure was reported on the IYM reports discussed with the MEC and submitted to provincial Treasury. In an attempt to prevent overspending, the accounting officer reported that a cost curtailment policy with the aim of reducing operational costs has been implemented

4. ANNUAL FINANCIAL STATEMENTS, PERFORMANCE REPORTS AND ANNUAL REPORTS

134

The committee has noted that the Auditor The Committee recommends the House to General found that financial statements resolve that:

were not prepared in accordance to (i) The accounting officer must strive to (i) The accounting officer has built the capacity for financial management section to ensure prescribed financial reporting framework build in-house capacity in the financial compliance with the financial reporting framework and were not supported by full and proper management section in order to Financial reporting section has been included in the financial accounting directorate. records as required by section 40 (1) (a) ensure compliance with the financial reporting framework Delegated officials have been assigned the monthly preparation of financial reports and (b) of the PFMA

The committee required the accounting (ii) The accounting officer has ensured that the delegated officials are appointed to ensure officer to provide reasons for failure to (ii) The accounting officer must ensure effective and efficient processes on the accounting officer has ensured that the delegated prepare correct financial statements in that the established task team is fully effective and efficient to ensure officials are appointed to ensure effective and efficient processes on financial reporting accordance with the prescribed financial compliance with the financial reporting The accounting officer has ensured that interim financial statements are prepared on quarterly reporting framework as required by framework basis. The Department is implementing the monthly financial statements from November 2016 until 28 February 2017 to ensure monitoring of compliance with financial reporting section 40 (1) (a) and (b) of the PFMA. framework

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4. ANNUAL FINANCIAL STATEMENTS, PERFORMANCE REPORTS AND ANNUAL REPORTS

The committee enquired about the measures put in place by the accounting officer to ensure that financial statements are prepared in accordance to the prescribed financial reporting framework and supported by full and proper records The accounting officer indicated that the Department has capacity constraints and they will continue to use the services of

135 consultants to assist in the compilation of

financial statements and transfer of skills. The accounting officer reported that as part of the measures put in place, a team of officials who are tasked to verify all the supporting documents to ensure compliance with the financial reporting framework has been established

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4.2 EXPENDITURE MANAGEMENT (R213 031 000.00)

The committee required the accounting The committee recommends the house to officer to provide reasons that led to an resolve that:

unauthorised expenditure of R213 (i) The executive authority must prepare (i) The Department has prepared the motivation to provincial Treasury, see the attachment 031 000.00 being incurred. The marked as Annexure A11/1. The Department has referred the matter to internal audit for and table a detailed motivation to the committee further asked the accounting investigation. See the attachment marked Annexure 11/2 committee for condonation of the officer to provide proof that the R213 022 277.00 unauthorised unauthorised expenditure was reported expenditure as required by treasury regulation 9.1.2.

The committee requested the accounting (ii) The accounting officer must furnish (ii) The accounting officer has attached Annexure A5 as part of the controls in place to control officer to motivate why the unauthorised

136 the unauthorised expenditure the committee with a copy of the expenditure should be condoned turnaround strategy that has been put The accounting officer indicated that in place to prevent unauthorised Department incurred over expenditure of expenditure by 31 July 2015. R39 757 000.00 in the 2005/06 financial

year. In 2006/07 the over expenditure increased by an additional R1 600 000.

The Committee was also informed that in The unauthorised expenditure amounting to 2007/08 it increased by an additional R213 022 277.00 is not condoned R87 282 277.00, in 2008/09 it increased by R5 300 000.00 and in 2010/11 it increased by R79 083 000.00. The accumulative total was R213 022 277.00

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4.2 EXPENDITURE MANAGEMENT (R213 031 000.00)

The accounting officer reported that there was an error of R8 723 in the opening balance of 2010/11 and comparative figures. The accounting officer further reported that there was an omission as the Department failed to report to relevant stakeholders. However, unauthorised expenditure was disclosed in the annual financial statements

137 The accounting officer indicated that the

percentage share received from provincial Treasury has not been commensurate with what other health Departments had been receiving from their Treasury. It was brought to the attention of the committee that the unauthorised expenditure that ensued was as a result of inadequate financial controls within the Department since 2005/06 With regards to rendering a sound motivation for condonement of the

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4.2 EXPENDITURE MANAGEMENT (R213 031 000.00)

unauthorised expenditure, the accounting officer reported that the condonement is deserved as the Department has embarked on a turnaround strategy with more stringent financial controls. The committee was, however, not convinced by the motivation and that the Department had put measures to prevent unauthorised expenditure

138

4.3 AUDIT COMMITTEE

The committee has noted that the The committee recommends the house to Auditor General found that the Audit resolve that:

Committee did not always review the (i) The accounting officer must provide (i) The Audit Committee charter for 2016/17 was developed and approved by the Honourable adequacy, reliability and accuracy of the MEC G.P Mashego on the 19 July 2016. See attached Audit Committee charter the committee with progress made by financial information provided to the Department on the process of Annexure A8 : Approved Audit Committee charter management and other users as approving of the Audit Committee required by the Treasury Regulation charter 3.1.10(d

The committee required the accounting

officer to indicate the measures put in

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4.3 AUDIT COMMITTEE

place to ensure that the Audit Committee (ii) The accounting officer must provide (ii) The accounting officer has appointed five members of the Audit Committee with the functions in accordance to the Treasury the Committee with the progress inclusion of the chairperson. The Audit Committee is functional and holds meetings as prescribed by the PFMA and Treasury Regulations Regulations 3.1.10(d) made on the appointment of the

chairperson and other members of the The accounting officer informed the Audit Committee committee that the Audit Committee Annexure A9 – Appointment letters

charter has been reviewed and recommended for approval. The accounting officer reported that the recommended Audit Committee charter

139 for 2014/15 contains the schedule of

meetings for the financial year and items to be discussed in those meetings. The accounting officer further informed the committee that the Department is in a process of finalising the appointment of additional Audit Committee members and the chairperson

4.4 PROCUREMENT AND CONTRACT MANAGEMENT (Supply Chain Management)

The committee has noted that the (i) The accounting officer must consider (i) Labour Relations was tasked with the investigation of the irregular expenditure, fruitless Auditor General found that goods and taking disciplinary actions against and wasteful expenditure for 2013/2014 financial year. The report has been submitted to

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4.4 PROCUREMENT AND CONTRACT MANAGEMENT (Supply Chain Management)

services with a transaction value of official(s) for contravening Treasury the accounting officer for the implementation of the recommendations. The report has been above R500 000.00 were procured Regulation 16A6.2 (a) and (c) in finalized without inviting competitive bids as 2013/14 financial year required by Treasury Regulations 16A6.4. The committee further noted that (ii) The accounting officer must develop (ii) The 0-9 filing was developed and is currently being implemented to ensure safekeeping of goods and services with a transaction an effective record keeping system to records value below R500 000.00 were procured ensure that relevant and accurate without obtaining the required price information is accessible and quotation as per Treasury Regulation available 16A6.1. The Committee has further

140 noted that the Auditor General found that (iii) The accounting officer must

(iii) The accounting officer has engaged the Department of Public Works, Roads and Transport major capital projects were not evaluated disapprove the implementation of any for the nomination of representatives in all the bid committees (BSC, BEC and BAC) where prior to final decision on a project, as per project that has been finalised with the the Departments projects are involved requirements of section 38 (1) (a) of the exclusion of the user (Department) PFMA

The committee has noted that the

Auditor General found that persons in the (iv) The accounting officer must develop services of the Department who had a (iv) The director: SCM has been appointed effective from 1 August 2016. adequate capacity within the private or business interest in contracts 5 administrative clerks were appointed to assist with contract management and an procurement, contract management awarded by the Department failed to additional 3 will be appointed by the end of the third quarter. A further a fixed-term and infrastructure management disclose such interests, as required by contract employee (24 months) were appointed effective from 1 November 2016 functions of the Department Treasury Regulations 16A8.4 and Public

Service Regulations 3c. The Auditor

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4.4 PROCUREMENT AND CONTRACT MANAGEMENT (Supply Chain Management)

General further stated that persons in the (v) The accounting officer must take (v) Labour Relations was tasked with the investigation of the irregular expenditure, fruitless disciplinary action against officials services of the Department whose close and wasteful expenditure for 2013/2014 financial year. The report has been submitted to who failed to declare private or family members or partners or business interest in contracts the accounting officer for the implementation of the recommendations. Circulars on associates had a private or a business awarded by the Department, as employees doing business with the State and declarations of interest were published in interest in contracts awarded by the required by Treasury Regulations employees’ pay slips 16A8.4 and Public Service Department failed to disclose such Regulations 3c interest as required by treasury regulation 16A8.4

Upon these findings, the Committee

141 required the accounting officer to provide

reasons that led to the contravention of Treasury Regulation 16A6.4 and 16A6.1, also the contravention section 38 (1) (a) of the PFMA. The committee further required the accounting officer to provide clarity on why were there no records during the audit to prove to the AGSA that bids were in fact adjudicated by relevant committees as per treasury regulation 16A6.2 (a) and (c)

In responding to the questions posed by the committee, the accounting officer

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4.4 PROCUREMENT AND CONTRACT MANAGEMENT (Supply Chain Management)

reported that approval for deviation from SCM processes was obtained as a result of the fact that it was not practical to re- advertise the bids at that point in time. The Accounting officer informed the Committee that the Department has failed to ensure the safekeeping of records consequently at the time of the request; hence records couldn’t be produced

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In addressing the question regarding the contravention of section 38 (1) (a) of the PFMA, the accounting officer informed the committee that indicated that there was a lack of technical skills and personnel within the infrastructure unit which led to the implementing agent running processes without the inclusion of the user thus contravening the PFMA

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5 HUMAN RESOURCE MANAGEMENT AND COMPENSATION

The committee has noted that the The committee recommends the house to Auditor General found that the resolve that:

accounting officer failed to adhere to (i) The accounting officer must ensure Public Service Regulations I/III/B1 with (i) The Department attended to the matter, senior managers signed performance that the human resources section regard to the performance management agreements for the 2016/17 financial year complies with Public Service systems for employees below SMS. The Regulation 1/VIII/D.8 committee further noted that not all

senior managers signed performance (ii) The Department appointed a Service provider for the verification of qualification. A service (ii) The accounting officer must ensure level agreement is being finalized agreements for the year under review as that the Department has a dedicated per the Public Service Regulation (PSR) 143 individual (s) to deal with verification 4/III/B.1. The Committee also noted the of qualifications made by potential Auditor General found that employees new recruits were appointed without following proper

processes to verify the qualification made in applications as per Public Service Regulation 1/VIII/D.8 The Department did not have HR capacity to deal with the challenges. However, key vacancies have been filled to address the matter

The committee required the accounting officer to provide reasons that led to failure to adhere to the abovementioned public service regulations and to further

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5 HUMAN RESOURCE MANAGEMENT AND COMPENSATION

provide reasons that led to the appointment of employees without following proper processes to verify the qualification made in applications The accounting officer indicated that the Department failed to follow-up with responsible managers that all performance agreements are signed with all employees as a result contravening Public Service Regulations

144 I/III/B1. With regards to failure to properly

verify claims made in applications, the accounting officer reported that the Department did not have a dedicated section to deal with verification of claims made in applications and that the function could not be outsourced due to lack of budget

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5.2 FILLING OF THE CRITICAL FUNDED POSTS

The committee has noted that the The committee recommends the house to Auditor General found that vacant resolve that: funded posts were not filled within twelve

months as per Public Service Regulation (i) The accounting officer must ensure (i) A number of funded vacancies were filled as per the recommendation of the house 1/VII/C.1A.2. The committee required that all critical vacant funded posts are the accounting officer to provide reasons filled on or before 30 September 2015 that led to failure to ensure that all funded posts are filled within 12 months as per Public Service Regulation 1/VII/C.1A.2

145 The accounting officer reported the

Department is currently reviewing its recruitment and retention strategy to ensure that it talks to the needs of the Department. Consequently, the executive council placed a moratorium on all appointments until a verification of all officials was conducted by the Department. The committee noted that the executive council guided the Department to make submissions on critical posts

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6. PROGRESS TOWARDS ACHIEVING A CLEAN AUDIT

The accounting officer has initiated the following activities to improve the audit outcome:

1. Monthly financial statements are prepared on monthly basis from December 2. Implementing SAICA projects to improve the control environment in hospitals, advise the accounting officer, Chief Financial Officer and Hospital CEOs on financial administrative processes 3. Procuring software for preparations of annual financial statements to eliminate human error during the preparation process 4. Procurement of Audit Command Language (ACL) to assist with conflict of interest, accounts payable and salary report audit

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9. PRIOR MODIFICATIONS TO AUDIT Management developed an action plan to address the REPORTS findings in the 2015/16 report. The action plan was

The Department received a qualified opinion from the monitored monthly by management and provincial a Auditor-General of South Africa (AGSA) for the for progress. Internal audit included follow-up audits 2015/16 report. The qualification was based on made by internal audit. The Audit Committee reviewed immovable tangible assets, movable tangible assets, the progress in respect of reports from management irregular expenditure, transfers and subsidies, against internal audit reports and recommended contingent liability, commitments and employee improvements compensation

Nature of qualification, disclaimer, adverse Financial year in Progress made in clearing / resolving the opinion and matters of non-compliance which it first arose matter Movable tangible capital assets 2006/2007 The Department has conducted 100% physical verification of assets which will result in the restatement of the adjustment to the opening balance and also take into account the additions, transfers in and out, disposals and losses. The Department has issued transfer forms to be used by facilities. The Department has taken a decision that the institutions will be required to report monthly on all transfers into and out of institutions Immovable tangible capital assets 2009/2010 Approved schedules and supporting documents to support the disclosures on work-In-progress which result in commitment, immovable tangible capital assets are being arranged Monthly reconciliations on current year expenditure are prepared between BAS and payment vouchers for capital commitment and Immovable tangible assets A consultant has been appointed to fair value immovable tangible assets acquired prior to 2013/2014 Commitments 2009/2010 Approved schedules and supporting documents to support the disclosures on work-in-progress which result in commitment, Immovable tangible capital assets are arranged Monthly reconciliations on current year expenditure are prepared between BAS and payment vouchers for capital commitment and immovable tangible assets Irregular expenditure 2009/2010 The Department has established a Provincial Financial Misconduct Committee (PFMC) and District Financial Misconduct and Loss Control Committees (DFMLC). These committees are established to investigate

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Nature of qualification, disclaimer, adverse Financial year in Progress made in clearing / resolving the opinion and matters of non-compliance which it first arose matter and preside over all reported instances of financial misconduct and losses suffered by the Department and make recommendations to the accounting officer regarding actions to be taken Reports on financial misconducts are compiled and forwarded to responsibility managers for investigations Financial misconduct relating to prior financial years have been forwarded to labour relations for investigation Three (3) investigation reports have been forwarded to national Treasury for condonation Transfers and subsidies 2015/2016 The Department has always classified the services rendered at the Siyathuthuka Psychiatric Hospital as transfers and budgeted and paid under transfers and subsidies instead of goods and services The accounting officer has since corrected the misclassification from the 2016/2017 financial year. Contingent liability 2015/2016 Contingent liability register and database are updated daily The basis for recording and disclosing contingent liability is based on modified cash standard (provisions and contingents updated November 2016). The Department also requests reports from the State Attorney to ensure completeness of contingent liability Employee compensation 2015/2016 The Department has established the following internal controls: • Renewed contracts for all medical practitioners doing commuted overtime • The monthly duty roster is completed before overtime is performed • Attendance registers were implemented for all medical practitioners to sign for attendance

10. INTERNAL CONTROL UNIT monitors and ensures orderly, efficient conduct of business, the safe guarding of assets, prevent and Objectives detect fraudulent activities, completeness, accuracy of The Department has an internal control unit within the accounting records and timely preparation of financial office of the chief financial officer. The unit comprises information. of the whole network of systems established in the Department to provide reasonable assurance that the Departmental objectives will be achieved. The unit

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Challenges Summary of audit work done The unit still experiences human resources challenges The internal audit reports quarterly to the Audit to execute its mandate. Committee on the progress of work conducted in accordance with the approved Internal audit plan. Achievements • The unit reviewed financial policies and The following internal audit work was completed during developed procedure manuals the year under review: • The unit rendered secretariat functions to the audit steering committee that deals with remedial • Control environment action plan on AGSA audit findings for the • Supply chain management 2015/2016 financial year and internal audit report • Annual financial statement • The unit rendered secretariat functions to the • Performance information Provincial Financial Misconduct Committee • Expenditure management (PFMC) and District Financial Misconduct and • MPAT Loss Control (DFMLC) • Ideal clinics • The unit co-ordinated the Financial Management • Asset management Capability Maturity Model (FMCMM) • Health technology • The unit co-ordinated Management Performance • Conditional grant received and transferred Assessment Tool (MPAT) that establish • Information and Communication benchmark performance, baseline performance Technology of institutions, track improvement against the • Waste management baseline performance and provide managers with • HIV AND AIDS information to inform improvement

Key activities and objectives of the Audit 11. INTERNAL AUDIT AND AUDIT Committee: COMMITTEES The Audit Committee fulfils a vital role in King III

Corporate Governance to ensure the integrity of Key activities and objectives of the internal audit integrated reporting and internal financial controls and The internal audit conducts its activities as per the the identification and management of risk. The Audit approved internal audit plan that is based on the risk Committee assists management in carrying out its assessment and approved by the Audit Committee. responsibilities as they relate to the Department in The internal audit derives its mandate from the internal terms of financial reporting, management and other audit charter reporting practices; internal controls and management

of risks as well as the compliance with laws, The internal audit exists to provide assurance and regulations and ethics. The Audit Committee further consulting activity to the Department so as to add fulfils its role by ensuring that the combined assurance value and improve operation to achieve the model is applied to provide a coordinated approach to Departmental strategic goals and objectives all assurance activities

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Attendance of Audit Committee meetings by Audit Committee members

The table below discloses relevant information on the Audit Committee members:

Name Qualifications Internal or If internal, Date Date No. of external position in the appointed Resigned Meetings Department attended Mr Kingsley • B.Com:Accounting External N/A 1 May 2015 N/A 5 Chisale • ACCA • CIA • CFE Ms • CA(SA) External N/A 1 May 2015 N/A 4 Sijabulile • B.Comm (Hons) Makhathini • B.Comm Accounting • Post Graduate Diploma :Accounting Science Mr Abel • Diploma: Commerce External N/A 1 May 2015 N/A 4 Mawela • B.Comm • B.Comm (Hons) • Masters:Business Administrativeistration Mr Roy • Bachelor of Law/LLB External N/A 1 May 2015 N/A 3 Mnisi • Post Graduate Certificate:Compliance Management

Mr Charles • B Comm External N/A 1 May 2015 N/A 4 Motau • Higher Diploma: Computer Auditing • Masters:Business Leadership • Masters:IT • Certified in Execution leadership • Certified: Human Resources Management

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1. INTRODUCTION 3. ACHIEVEMENTS

Human capital is the cornerstone of any organisation • The organisational design sub-directorate has since it ensures that the strategic objectives of the been established and the organisational organisation are achieved. The role of the human structure is under review. The organisational resource section is the provision of the following structure of the office of the chief financial officer services: was consulted with DPSA and approved by the MEC. • Human resources practices • The organisational structures for all the new PHC • Human resources organisational strategy and facilities were developed according to the WISN planning model • Performance management and development • The human resources delegations have been • Human resources utilisation and capacity reviewed and aligned to the Public Service development Regulations, 2016 • Employee relations and people management • The number of persons living with disabilities (labour relations) (PWDs) employed has increased from 66 to 119. • Employee health and wellness After an attempt was made to create awareness • Occupational health and safety on disability, more staff members disclosed their disabilities 2. OVERVIEW OF HUMAN RESOURCES • Employee health and wellness programme has managed to establish committees in the hospitals The Department employed a total number of 20 288 employees towards the achievement of health 4. HUMAN RESOURCES OVERSIGHT outcomes and deliver health services to the STATISTICS population of Mpumalanga province. • A total number of 26 medical practitioners were 4.1 Personnel related expenditure awarded bursaries towards the registrar The following tables summarises the final audited programme which is aimed at addressing the acute personnel related expenditure by programme and by shortage of medical specialists within the province salary bands. It provides an indication of the following: • The vacancy rate based on funded vacancies was • amount spent on personnel reduced to below 5% • amount spent on salaries, overtime, homeowner’s • The Department is implementing Workload allowances and medical aid Indicator for Staffing Need (WISN), a normative guide for the provision of posts in newly established primary health care facilities. • The Department continued to develop staff to address the shortage of skilled personnel within the different categories through skills development programmes and partnerships with other governments as well as institutions of higher learning and universities • The organisational structure for the branch financial management was successfully revised and submitted to the Public Service Administration Ministry and subsequently approved

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Table 4.1.1 Personnel expenditure by programme for the period 1 April 2016 to 31 March 2017

Programme Total expenditure Personnel Training expenditure Professional and Personnel Average personnel cost (R’000) expenditure (R’000) (R’000) special services expenditure as a % of per employee (R’000) expenditure (R’000) total expenditure Administration 242 950 106 187 0.00 0.00 44 5 Central hospital services 848 457 586 067 0.00 0.00 69 28 District health services 5 634 259 3 588 239 0.00 0.00 64 170 Emergency medical services 271 514 222 308 0.00 0.00 82 11 Health care support services 119 479 85 917 0.00 0.00 72 4 Health facilities management 596 878 3 649 0.00 0.00 1 0 Health science & training 323 012 212 846 0.00 0.00 66 10 Provincial hospital services 1 025 107 766 488 0.00 0.00 75 36

155 TOTAL 9 061 656 5 571 700 0.00 0.00 61 265

Table 4.1.2 Personnel costs by salary band for the period 1 April 2016 to 31 March 2017

Salary band Personnel expenditure (R’000) % of total personnel cost No of employees Average personnel cost per employee (R’000) Abnormal appointment 1 622 0.02 86 18 862 Contract (levels 1-2) 7 087 0.10 79 89 711 Contract (levels 13-16) 129 812 1.92 Contract (levels 3-5) 5 381 0.08 31 173 578 Contract (levels 6-8) 72 234 1.07 211 342 342 Contract (levels 9-12) 267 321 3.96 409 653 597 Highly skilled production (levels 6-8) 1 647 307 24.38 4 820 341 765 Highly skilled supervision (levels 9-12) 2 109 275 31.22 3 447 611 916 Lower skilled (levels 1-2) 445 198 6.59 3 135 142 009

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Salary band Personnel expenditure (R’000) % of total personnel cost No of employees Average personnel cost per employee (R’000) Other 445 0.01 9 49 494 Periodical remunerations 25 156 0.37 686 36 671 Senior management (levels 13-16) 324 634 4.80 232 1 399 283

Skilled (levels 3-5) 1 669 028 24.70 7 829 213 185 TOTAL 6 704 502 99.22 21 060 318 352

Table 4.1.3 Salaries, overtime, home owners allowance and medical aid by programme for the period 1 April 2016 to 31 March 2017

Salaries Overtime Home owners allowance Medical aid Amount (R’000 Salaries as a Amount (R’000) Overtime as a % Amount (R’000) HOA as a % of Amount (R’000) Medical aid as a %

156 Programme % of of personnel personnel costs of personnel personnel costs costs costs Administration 91 749 66.6 5 177 3.8 2 740 2 4 895 3.6 Central hospital services 472 218 65.8 95 230 13.3 20 920 2.9 28 407 4 District health services 2 925 759 67 174 335 4 162 094 3.7 200 459 4.6 Emergency medical 127 364 47.7 65 929 24.7 10 925 4.1 21 953 8.2 services Health care support 64 603 64.8 8 831 8.9 3 090 3.1 5 043 5.1 services Health facilities 5 068 75.8 37 0.6 93 1.4 163 2.4 management Health science & training 165 843 64.2 28 683 11.1 10 850 4.2 6 107 2.4 Provincial hospital services 583 827 64.6 85 810 9.5 29 860 3.3 36 243 4 Total 4 436 432 65.7 464 033 6.9 240 572 3.6 303 271 4.5

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Table 4.1.4 salaries, overtime, home owners allowance and medical aid by salary band for the period 1 April 2016 to 31 March 2017

Salaries Overtime Home Owners Allowance Medical Aid Salary band Amount (R’000 Salaries as a % of Amount Overtime as a % Amount HOA as a % of Amount Medical aid as a % of personnel costs (R’000) of personnel costs (R’000) personnel costs (R’000) personnel costs Skilled (level 1-2) 283 380 64% 13 884 3% 39593 9% 32 928 7% Skilled (level 3-5) 1 036 013 62% 121 216 7% 103 952 6% 125 967 8% Highly skilled production 1 112 592 66% 76 046 4% 61 186 4% 89 308 5% (levels 6-8) Highly skilled supervision 1 778 041 63% 253 016 9% 35 042 1% 54 480 2% (levels 9-12 Senior management (level 33 016 66% - 0% 778 2% 601 1% 13-16) Total 4 243 043 63% 464 162 7% 240 551 4% 303 284 5% 157

4.2 Employment and vacancies

Table 4.2.1 Employment and vacancies by programme as on 31 March 2017

Programme Number of posts on approved Number of posts Vacancy rate Number of employees additional to the establishment establishment filled Administrative, permanent 282.00 251.00 10.99 1.00 Central hospital services, permanent 2 072.00 1 915.00 7.58 0.00 Central hospital services, temporary 41.00 41.00 0.00 0.00 District health services, permanent 14 364.00 13 187.00 8.19 3.00 District health services, temporary 227.00 227.00 0.00 0.00 Emergency medical services, permanent 914.00 883.00 3.39 0.00 Health care support services, permanent 286.00 268.00 6.29 1.00 Health care support services, temporary 7.00 7.00 0.00 0.00 Health facilities management, permanent 30.00 25.00 16.67 0.00 Health science & training, permanent 1 003.00 961.00 4.19 0.00 Health science & training, temporary 2.00 2.00 0.00 0.00

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Programme Number of posts on approved Number of posts Vacancy rate Number of employees additional to the establishment establishment filled Provincial hospital services, permanent 2 670.00 2 449.00 8.28 0.00 Provincial hospital services, temporary 72.00 72.00 0.00 0.00 TOTAL 21 970.00 20,288.00 7.66 5.00

Table 4.2.2 Employment and vacancies by salary band as on 31 March 2017 Salary band Number of posts on approved Number of posts filled Vacancy Rate Number of employees additional to the establishment establishment 01 Lower skilled (levels 1-2), permanent 3 249.00 3 133.00 3.57 0.00

01 Lower skilled (levels 1-2), temporary 2.00 2.00 0.00 0.00

02 Skilled (levels 3-5), permanent 8 484.00 7 820.00 7.83 0.00 02 Skilled (levels 3-5), temporary 9.00 9.00 0.00 0.00 03 Highly skilled production (levels 6-8), permanent 5 264.00 4 772.00 9.35 0.00

158 03 Highly skilled production (levels 6-8), temporary 48.00 48.00 0.00 0.00

04 Highly skilled supervision (levels 9-12), 3 534.00 3 173.00 10.22 4.00 permanent 04 Highly skilled supervision (levels 9-12), 274.00 274.00 0.00 0.00 temporary 05 Senior management (levels 13-16), permanent 269.00 223.00 17.10 1.00 05 Senior management (Levels 13-16), temporary 9.00 9.00 0.00 0.00 09 Other, permanent 5.00 2.00 60.00 0.00 09 Other, temporary 7.00 7.00 0.00 0.00 10 Contract (levels 1-2), permanent 79.00 79.00 0.00 0.00 11 Contract (levels 3-5), permanent 31.00 31.00 0.00 0.00 12 Contract (levels 6-8), permanent 211.00 211.00 0.00 0.00 13 Contract (levels 9-12), permanent 409.00 409.00 0.00 0.00 14 Contract (levels 13-16), permanent 86.00 86.00 0.00 0.00 TOTAL 21 970.00 20 288.00 7.66 5.00

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Table 4.2.3 Employment and vacancies by critical occupations as on 31 March 2017

Critical occupation Number of posts on Number of posts filled Vacancy rate Number of employees additional to the approved establishment establishment Administrative related, permanent 349.00 322.00 7.74 3.00 All artisans in the building metal 72.00 66.00 8.33 0.00 machinery etc., permanent Ambulance and related workers, 658.00 637.00 3.19 0.00 permanent Artisan project and related 12.00 12.00 0.00 0.00 superintendents, permanent Auxiliary and related workers, permanent 609.00 574.00 5.75 0.00 Biochemistry pharmacology. Zoology & 10.00 9.00 10.00 0.00 Life Science. Technicians, permanent Building and Other Property Caretakers, 287.00 279.00 2.79 0.00 159 permanent

Bus and Heavy Vehicle Drivers, 18.00 18.00 0.00 0.00 permanent Cleaners in Offices Workshops Hospitals 2 784.00 2 658.00 4.53 0.00 Etc., permanent Client inform clerks(switchb recept inform 104.00 99.00 4.81 0.00 clerks), permanent Communication and information related, 4.00 4.00 0.00 0.00 permanent Community development workers, 55.00 55.00 0.00 0.00 permanent Computer programmers, permanent 1.00 1.00 0.00 0.00 Computer system designers and 4.00 4.00 0.00 0.00 analysts, permanent Dental practitioners, permanent 138.00 127.00 7.97 0.00 Dental practitioners, temporary 3.00 3.00 0.00 0.00 Dental specialists, permanent 2.00 1.00 50.00 0.00 Dental technicians, permanent 1.00 1.00 0.00 0.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Critical occupation Number of posts on Number of posts filled Vacancy rate Number of employees additional to the approved establishment establishment Dental therapy, permanent 14.00 14.00 0.00 0.00 Dieticians and nutritionists, permanent 147.00 134.00 8.84 0.00 Dieticians and nutritionists, temporary 1.00 1.00 0.00 0.00 Electrical and electronics engineering 28.00 28.00 0.00 0.00 technicians, permanent Emergency services related, permanent 252.00 242.00 3.97 0.00 Engineering sciences related, permanent 4.00 4.00 0.00 0.00 Engineers and related professionals, 4.00 2.00 50.00 0.00 permanent Environmental health, permanent 91.00 67.00 26.37 0.00 Finance and Economics related, 20.00 17.00 15.00 0.00 160 permanent

Financial and related professionals, 44.00 40.00 9.09 0.00 permanent Financial clerks and credit controllers, 214.00 202.00 5.61 0.00 permanent Food services aids and waiters, 416.00 400.00 3.85 0.00 permanent Food services workers, permanent 20.00 19.00 5.00 0.00 Forestry labourers, permanent 1.00 1.00 0.00 0.00 Health sciences related, permanent 27.00 24.00 11.11 0.00 Health sciences related, temporary 1.00 1.00 0.00 0.00 Horticulturists foresters agricul.& forestry 1.00 1.00 0.00 0.00 techn, permanent Household and laundry workers, 339.00 317.00 6.49 0.00 permanent Household food and laundry services 2.00 2.00 0.00 0.00 related, permanent Housekeepers laundry and related 12.00 10.00 16.67 0.00 workers, permanent

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Critical occupation Number of posts on Number of posts filled Vacancy rate Number of employees additional to the approved establishment establishment Human resources & organisat developm 20.00 18.00 10.00 0.00 & relate prof, permanent Human resources clerks, permanent 142.00 133.00 6.34 0.00 Human resources related, permanent 38.00 32.00 15.79 0.00 Information technology related, 2.00 1.00 50.00 0.00 permanent Inspectors of apprentices works and 1.00 1.00 0.00 0.00 vehicles, permanent Institution based personal care workers, 8.00 8.00 0.00 0.00 permanent Librarians and related professionals, 1.00 1.00 0.00 0.00 permanent Library mail and related clerks, 33.00 32.00 3.03 0.00 161 permanent

Light vehicle drivers, permanent 200.00 191.00 4.50 0.00 Logistical support personnel, permanent 25.00 25.00 0.00 0.00 Material-recording and transport clerks, 84.00 83.00 1.19 0.00 permanent Medical practitioners, permanent 877.00 744.00 15.17 1.00 Medical practitioners, temporary 320.00 320.00 0.00 0.00 Medical specialists, permanent 79.00 69.00 12.66 0.00 Medical specialists, temporary 10.00 10.00 0.00 0.00 Medical technicians/ technologists, 9.00 7.00 22.22 0.00 permanent Messengers porters and deliverers, 227.00 211.00 7.05 0.00 permanent Motor vehicle drivers, permanent 21.00 19.00 9.52 0.00 Nursing assistants, permanent 1 659.00 1 408.00 15.13 0.00 Occupational therapy, permanent 120.00 86.00 28.33 0.00

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Critical occupation Number of posts on Number of posts filled Vacancy rate Number of employees additional to the approved establishment establishment Occupational therapy, temporary 1.00 1.00 0.00 0.00 Optometrists and opticians, permanent 6.00 6.00 0.00 0.00 Optometrists and opticians, temporary 1.00 1.00 0.00 0.00 Oral hygiene, permanent 10.00 10.00 0.00 0.00 Other administrative and related clerks 1 206.00 1 144.00 5.14 1.00 and organisers, permanent Other administrative policy and related 143.00 130.00 9.09 0.00 officers, permanent Other information technology personnel, 5.00 5.00 0.00 0.00 permanent Other occupations, permanent 21.00 18.00 14.29 0.00

162 Pharmaceutical assistants, permanent 183.00 179.00 2.19 0.00

Pharmaceutical assistants, temporary 1.00 1.00 0.00 0.00 Pharmacists, permanent 365.00 298.00 18.36 0.00 Pharmacists, temporary 2.00 2.00 0.00 0.00 Pharmacologists pathologists & related 6.00 6.00 0.00 0.00 profession, permanent Physicists, permanent 1.00 1.00 0.00 0.00 Physicists, temporary 1.00 1.00 0.00 0.00 Physiotherapy, permanent 120.00 100.00 16.67 0.00 Physiotherapy, temporary 2.00 2.00 0.00 0.00 Professional nurse, permanent 5 813.00 5 386.00 7.35 0.00 Professional nurse, temporary 1.00 1.00 0.00 0.00 Psychologists and vocational 44.00 37.00 15.91 0.00 counsellors, permanent Quantity surveyors & related prof not 1.00 0.00 0.00 0.00 class elsewhere, permanent

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Critical occupation Number of posts on Number of posts filled Vacancy rate Number of employees additional to the approved establishment establishment Radiography, permanent 146.00 118.00 19.18 0.00 Radiography, temporary 3.00 3.00 0.00 0.00 Risk management and security services, 8.00 6.00 25.00 0.00 permanent Road workers, permanent 1.00 1.00 0.00 0.00 Secretaries & other keyboard operating 283.00 269.00 4.95 0.00 clerks, permanent Security officers, permanent 1.00 1.00 0.00 0.00 Senior managers, permanent 45.00 38.00 15.56 0.00 Social sciences supplementary workers, 1.00 1.00 0.00 0.00 permanent

163 Social work and related professionals, 53.00 51.00 3.77 0.00 permanent Speech therapy and audiology, 79.00 61.00 22.78 0.00 permanent Speech therapy and audiology, 2.00 2.00 0.00 0.00 temporary Staff nurses and pupil nurses, permanent 1 959.00 1 809.00 7.66 0.00 Student nurse, permanent 822.00 795.00 3.28 0.00 Supplementary diagnostic radiographers, 5.00 5.00 0.00 0.00 permanent Trade labourers, permanent 4.00 4.00 0.00 0.00 TOTAL 21 970.00 20 288.00 7.66 5.00

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4.3 Filling of SMS posts

Table 4.3.1 SMS post information as on 31 March 2017

SMS Level Total number Total number % of SMS Total number of % of SMS posts, of funded SMS of SMS posts posts filled SMS posts vacant posts filled vacant Director-General/ Head 2 2 100 0 0 of Department Salary level 16 1 1 100 0 0 Salary level 15 3 1 33.33 2 66.67 Salary level 14 12 10 83.33 2 16.67 Salary level 13 41 38 92.68 3 7.31 Total 59 52 88.13 7 11,87

Table 4.3.2 SMS post information as on 30 September 2016

SMS Level Total Total number % of SMS Total number of SMS % of SMS posts, number of of SMS posts posts filled posts vacant vacant funded SMS filled posts Director-General/ Head of 2 2 100 0 0 Department Salary level 16 1 1 100 0 0 Salary level 15 3 3 100 0 0 Salary level 14 12 10 83.33 2 16.67 Salary level 13 41 36 87.80 5 12.2 Total 59 52 88.13 7 11,87

Table 4.3.3 Advertising and filling of SMS posts for the period 1 April 2016 to31 March 2017

Advertising Filling of Posts Number of vacancies per Number of vacancies per Number of vacancies per level SMS Level level advertised in six level filled in six months of not filled in six months but months of becoming vacant becoming vacant filled in twelve months Director-General/ 0 0 0 Head of Department Salary level 16 0 0 0

Salary level 15 0 0 0

Salary level 14 0 0 0

Salary level 13 0 0 0

Total 0 0 0

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Table 4.3.4 Reasons for not having complied with the filling of funded vacant SMS - advertised within six months and filled within twelve months after becoming vacant for the period 1 April 2016 to 31 March 2017

Reasons for vacancies not advertised within six months None. Posts were advertised and re-advertised as there were no suitable candidates found

Reasons for vacancies not filled within twelve months 7 x Director and 2 x Chief Director posts were advertised but no suitable candidates were found and had to be re-advertised. Process to fill them are ongoing

The other reason why posts could not be filled was that all administrative posts were to be abolished once they are vacated in line of Exco resolution in November 2016

Table 4.3.5 Disciplinary steps taken for not complying with the prescribed time-frames for filling SMS posts within twelve months for the period 1 April 2016 to 31 March 2017

Reasons for vacancies not advertised within six months No disciplinary steps were taken as posts were advertised but could not be filled due to the Exco directive, the unavailability of qualifying candidates and they had to be re-advertised. Reasons for vacancies not filled within six months 100% compliance with the timeframes, so no disciplinary action was necessary

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4.4 Job Evaluation

Table 4.4.1 Job evaluation by salary band for the period 1 April 2016 and 31 March 2017

Salary band Number of posts on Number of jobs % of posts Posts upgraded Posts downgraded approved establishment evaluated evaluated by salary Number % of posts Number % of posts bands evaluated evaluated 01 Lower skilled (levels 1-2) 3 251 1 022 31.44 0 0.00 0 0.00 02 Skilled (levels 3-5) 8 493 1 248 14.69 10 0.80 0 0.00 03 Highly skilled production (levels 6-8) 5 312 1 668 31.40 13 0.78 0 0.00 04 Highly skilled supervision (levels 9-12) 3 808 750 19.70 14 1.87 0 0.00 05 Senior management service band A 189 64 33.86 0 0.00 0 0.00 06 Senior management service band B 50 12 24.00 0 0.00 0 0.00

07 Senior management service band C 33 9 27.27 1 11.11 0 0.00 08 Senior management service band D 6 2 33.33 0 0.00 0 0.00 09 Other 12 0 0.00 0 0.00 0 0.00

166 10 Contract (levels 1-2) 79 0 0.00 0 0.00 0 0.00 11 Contract (levels 3-5) 31 6 19.35 0 0.00 0 0.00 12 Contract (levels 6-8) 211 169 80.09 0 0.00 0 0.00 13 Contract (levels 9-12) 409 196 47.92 10 5.10 0 0.00 14 Contract band A 71 25 35.21 0 0.00 0 0.00 15 Contract band B 9 1 11.11 0 0.00 0 0.00 16 Contract band C 5 3 60.00 0 0.00 0 0.00 17 Contract band D 1 0 0.00 0 0.00 0 0.00 TOTAL 21 970 5 175 23.55 48 0.93 0 0.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.4.2 Profile of employees whose positions were upgraded due to their posts being upgraded for the period 1 April 2016 to 31 March 2017

Gender African Asian Coloured White Total Female 0 0 0 0 0 Male 0 0 0 0 0

Total 0 0 0 0 0

Employees with a disability 118

Table 4.4.3 Employees with salary levels higher than those determined by job evaluation by occupation for the period 1 April 2016 to 31 March 2017

Occupation Number of Job evaluation level Remuneration Reason for deviation employees level 0 0 0 0 0 Total number of employees whose salaries exceeded the level determined by job evaluation 0 Percentage of total employed n/a

Table 4.4.4 Profile of employees who have salary levels higher than those determined by job evaluation for the period 1 April 2016 to 31 March 2017

Gender African Asian Coloured White Total Female 0 0 0 0 0

Male 0 0 0 0 0

Total 0 0 0 0 0

Employees with a disability 0 0 0 0 0

Total number of employees whose salaries exceeded the grades determined by job evaluation None

167

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.5 Employment Changes

Table 4.5.1 Annual turnover rates by salary band for the period 1 April 2016 and 31 March 2017 Salary band Number of employees at beginning of Appointments and Terminations and Turnover rate period-April 2016 transfers into the transfers out of the Department Department Lower skilled (levels 1-2) permanent 3 572 193 70 1.96 Lower skilled (levels 1-2) temporary 3 0 0 0.00

Skilled (levels 3-5) permanent 7 717 369 244 3.16 Skilled (levels 3-5) temporary 18 0 2 11.11 Highly skilled production (levels 6-8) permanent 4 755 92 236 4.96 Highly skilled production (levels 6-8) temporary 87 1 4 4.60 Highly skilled supervision (levels 9-12) permanent 2 865 38 205 7.16 Highly skilled supervision (Levels 9-12) temporary 240 14 23 9.58

168 Senior management service band A permanent 132 12 10 7.58

Senior management service band A temporary 3 3 0 0.00 Senior management service band B permanent 35 1 2 5.71 Senior management service band B temporary 2 0 0 0.00 Senior management service band C permanent 28 3 3 10.71 Senior management service band C temporary 1 0 0 0.00 Senior management service band D permanent 5 0 0 0.00 Other permanent 2 0 0 0.00 Other temporary 7 1 0 0.00 Contract (levels 3-5) permanent 26 11 5 19.23 Contract (levels 6-8) permanent 246 196 173 70.33 Contract (levels 9-12) permanent 404 239 180 44.55 Contract band A permanent 59 29 19 32.20 Contract band B permanent 8 1 2 25.00 Contract band C permanent 5 1 0 0.00 Contract band D permanent 1 0 1 100.00 TOTAL 20 221 1 284 1 258 6.22 Senior management service band A temporary 3 3 0 0.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.5.2 Annual turnover rates by critical occupation for the period 1 April 2016 to 31 March 2017

Critical occupation Number of employees at beginning Appointments and Terminations and Turnover rate of period-April 2016 transfers into the transfers out of the Department Department Administrative related permanent 304 9 8 2.63 All artisans in the building metal machinery etc permanent 70 0 4 5.71 Ambulance and related workers permanent 651 1 15 2.30 Artisan project and related superintendents permanent 12 0 0 0.00 Auxiliary and related workers permanent 508 89 92 18.11 Biochemistry pharmakon. zoology & life scie.techni 11 0 2 18.18 permanent Boiler and related operators permanent 1 0 1 100.00 Building and other property caretakers permanent 273 8 5 1.83

169 Bus and heavy vehicle drivers permanent 19 0 1 5.26 Cleaners in offices workshops hospitals etc. permanent 2 671 171 113 4.23 Client information clerks (switchb recept inform clerks) 103 0 4 3.88 permanent Communication and information related permanent 3 0 0 0.00 Community development workers permanent 55 0 3 5.45 Computer programmers. permanent 1 0 0 0.00 Computer system designers and analysts. permanent 4 0 0 0.00 Dental practitioners permanent 119 26 19 15.97 Dental practitioners temporary 2 0 0 0.00 Dental specialists permanent 1 0 0 0.00 Dental technicians permanent 1 0 0 0.00 Dental therapy permanent 14 0 0 0.00 Dieticians and nutritionists permanent 125 35 26 20.80 Dieticians and nutritionists temporary 1 0 0 0.00 Electrical and electronics engineering technicians permanent 27 0 0 0.00 Emergency services related permanent 246 2 6 2.44

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Critical occupation Number of employees at beginning Appointments and Terminations and Turnover rate of period-April 2016 transfers into the transfers out of the Department Department Engineering sciences related permanent 3 0 0 0.00 Engineers and related professionals permanent 3 0 0 0.00 Environmental health permanent 85 14 31 36.47 Finance and economics related permanent 17 0 0 0.00 Financial and related professionals permanent 37 0 0 0.00 Financial clerks and credit controllers permanent 201 5 5 2.49 Food services aids and waiters permanent 406 12 15 3.69 Food services workers permanent 28 0 4 14.29 Forestry labourers permanent 1 0 0 0.00 Health sciences related permanent 21 1 1 4.76 Health sciences related temporary 1 0 0 0.00

170 Horticulturists foresters agricul.& forestry techn permanent 1 0 0 0.00 Household and laundry workers permanent 315 3 22 6.98 Household food and laundry services related permanent 2 0 0 0.00 Housekeepers laundry and related workers permanent 9 0 1 11.11 Human resources & organisat developm & relate prof 19 0 0 0.00 permanent Human resources clerks permanent 136 0 3 2.21 Human resources related permanent 31 0 0 0.00 Information technology related permanent 1 0 0 0.00 Inspectors of apprentices works and vehicles permanent 1 0 0 0.00 Institution based personal care workers permanent 8 0 0 0.00 Librarians and related professionals permanent 1 0 0 0.00 Library mail and related clerks permanent 33 0 1 3.03 Light vehicle drivers permanent 177 17 7 3.95 Logistical support personnel permanent 25 0 0 0.00 Material-recording and transport clerks permanent 86 0 2 2.33 Medical practitioners permanent 697 224 180 25.82

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Critical occupation Number of employees at beginning Appointments and Terminations and Turnover rate of period-April 2016 transfers into the transfers out of the Department Department Medical practitioners temporary 333 15 27 8.11 Medical specialists permanent 65 6 7 10.77 Medical specialists temporary 8 2 0 0.00 Medical technicians/technologists permanent 7 1 1 14.29 Messengers porters and deliverers permanent 228 4 16 7.02 Motor vehicle drivers permanent 20 0 2 10.00 Nursing assistants permanent 1 600 117 28 1.75 Occupational therapy permanent 103 20 36 34.95 Occupational therapy temporary 1 0 0 0.00 Optometrists and opticians permanent 6 0 0 0.00 Optometrists and opticians temporary 1 0 0 0.00

171 Oral hygiene permanent 10 0 0 0.00 Other administrative & related clerks and organisers 1 164 22 31 2.66 permanent Other administrative policy and related officers permanent 139 0 6 4.32 Other information technology personnel. Permanent 5 0 0 0.00 Other occupations permanent 22 0 4 18.18 Pharmaceutical assistants permanent 185 0 7 3.78 Pharmaceutical assistants temporary 1 0 0 0.00 Pharmacists permanent 301 61 71 23.59 Pharmacists temporary 2 0 0 0.00 Physicists permanent 1 1 0 0.00 Physicists temporary 1 1 0 0.00 Physiotherapy permanent 89 36 27 30.34 Physiotherapy temporary 2 0 0 0.00 Professional nurse permanent 5 319 111 301 5.66 Professional nurse temporary 2 0 1 50.00 Psychologists and vocational counsellors permanent 38 1 6 15.79

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Critical occupation Number of employees at beginning Appointments and Terminations and Turnover rate of period-April 2016 transfers into the transfers out of the Department Department Psychologists and vocational counsellors temporary 2 0 1 50.00 Quantity surveyors & rela prof not class elsewhere permanent 1 0 1 100.00 Radiography permanent 119 31 33 27.73 Radiography temporary 2 1 0 0.00 Risk management and security services permanent 7 0 1 14.29 Road workers permanent 1 0 0 0.00 Secretaries & other keyboard operating clerks permanent 269 5 3 1.12 Security officers permanent 1 0 0 0.00 Senior managers permanent 36 3 3 8.33 Social sciences supplementary workers permanent 1 0 0 0.00 Social work and related professionals permanent 52 0 2 3.85

172 Speech therapy and audiology permanent 62 23 21 33.87 Speech therapy and audiology temporary 2 0 0 0.00 Staff nurses and pupil nurses permanent 1 739 35 30 1.73 Student nurse permanent 698 169 20 2.87 Supplementary diagnostic radiographers permanent 5 0 0 0.00 Trade labourers permanent 4 0 1 25.00 Total 20 221 1 284 1 258 6.22

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.5.3 Reasons why staff left the Department for the period 1 April 2016 and 31 March 2017

Termination Type Number % of Total Resignations Death, permanent 98 7.79 Resignation, permanent 398 31.64 Resignation, temporary 18 1.43 Expiry of contract, permanent 446 35.45 Expiry of contract, temporary 8 0.64 Discharged due to ill health, permanent 6 0.48 Dismissal-misconduct, permanent 18 1.43 Retirement, permanent 262 20.83 Retirement, temporary 2 0.16 Other, permanent 1 0.08 Other, temporary 1 0.08 TOTAL 1 258 100.00 173 Total number of employees who left as a % of total employment 6.20

Table 4.5.4 Promotions by critical occupation for the period 1 April 2016 and 31 March 2017

Occupation Employees 1 April Promotions to Salary level promotions as a Progressions to another Notch progression as a % of 2016 another salary level % of employees by notch within a salary level employees by occupation occupation Administrative related 304 29 9.54 191 62.83 All artisans in the building metal 70 0 0.00 55 78.57 machinery etc. Ambulance and related workers 651 0 0.00 365 56.07 Artisan project and related 12 0 0.00 5 41.67 superintendents Auxiliary and related workers 508 0 0.00 366 72.05 Biochemistry pharmacol. Zoology & 11 0 0.00 11 100.00 life scie.techni Boiler and related operators 1 0 0.00 0 0.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Occupation Employees 1 April Promotions to Salary level promotions as a Progressions to another Notch progression as a % of 2016 another salary level % of employees by notch within a salary level employees by occupation occupation Building and other property 273 0 0.00 189 69.23 caretakers Bus and heavy vehicle drivers 19 0 0.00 18 94.74 Cleaners in offices workshops 2 671 3 0.11 1 781 66.68 hospitals etc. Client inform clerks(switchb recept 103 0 0.00 77 74.76 inform clerks) Communication and information 3 0 0.00 2 66.67 related Community development workers 55 1 1.82 49 89.09 Computer programmers 1 0 0.00 1 100.00 174 Computer system designers and 4 0 0.00 3 75.00

analysts. Dental practitioners 121 0 0.00 72 59.50 Dental specialists 1 0 0.00 0 0.00 Dental technicians 1 0 0.00 1 100.00 Dental therapy 14 0 0.00 5 35.71 Dieticians and nutritionists 126 0 0.00 59 46.83 Electrical and electronics engineering 27 0 0.00 16 59.26 technicians Emergency services related 246 0 0.00 76 30.89 Engineering sciences related 3 0 0.00 0 0.00 Engineers and related professionals 3 0 0.00 1 33.33 Environmental health 85 0 0.00 49 57.65 Finance and economics related 17 1 5.88 14 82.35 Financial and related professionals 37 3 8.11 22 59.46 Financial clerks and credit controllers 201 0 0.00 163 81.09 Food services aids and waiters 406 0 0.00 322 79.31 Food services workers 28 2 7.14 12 42.86

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Occupation Employees 1 April Promotions to Salary level promotions as a Progressions to another Notch progression as a % of 2016 another salary level % of employees by notch within a salary level employees by occupation occupation Forestry labourers 1 0 0.00 1 100.00 Health sciences related 22 1 4.55 0 0.00 Horticulturists foresters agricul.& 1 0 0.00 1 100.00 forestry techn Household and laundry workers 315 5 1.59 267 84.76 Household food and laundry services 2 0 0.00 2 100.00 related Housekeepers laundry and related 9 0 0.00 10 111.11 workers Human resources & organisat 19 2 10.53 14 73.68 developm & relate prof 175 Human resources clerks 136 1 0.74 110 80.88

Human resources related 31 2 6.45 21 67.74 Information technology related 1 0 0.00 1 100.00 Inspectors of apprentices works and 1 0 0.00 0 0.00 vehicles Institution based personal care 8 0 0.00 0 0.00 workers Librarians and related professionals 1 0 0.00 1 100.00 Library mail and related clerks 33 0 0.00 27 81.82 Light vehicle drivers 177 2 1.13 142 80.23 Logistical support personnel 25 0 0.00 21 84.00 Material-recording and transport 86 0 0.00 72 83.72 clerks Medical practitioners 1 030 7 0.68 207 20.10 Medical specialists 73 2 2.74 24 32.88 Medical technicians/technologists 7 0 0.00 4 57.14 Messengers porters and deliverers 228 0 0.00 162 71.05 Motor vehicle drivers 20 0 0.00 19 95.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Occupation Employees 1 April Promotions to Salary level promotions as a Progressions to another Notch progression as a % of 2016 another salary level % of employees by notch within a salary level employees by occupation occupation Nursing assistants 1 600 0 0.00 260 16.25 Occupational therapy 104 0 0.00 37 35.58 Optometrists and opticians 7 0 0.00 4 57.14 Oral hygiene 10 0 0.00 7 70.00 Other administrative Strat & related 1 164 7 0.60 974 83.68 clerks and organisers Other administrative policy and 139 3 2.16 104 74.82 related officers Other information technology 5 0 0.00 3 60.00 personnel. Other occupations 22 0 0.00 17 77.27 176 Pharmaceutical assistants 186 3 1.61 75 40.32

Pharmacists 303 1 0.33 93 30.69 Physicists 2 0 0.00 0 0.00 Physiotherapy 91 0 0.00 21 23.08 Professional nurse 5 321 85 1.60 737 13.85 Psychologists and vocational 40 0 0.00 27 67.50 counsellors Quantity surveyors & rela prof not 1 0 0.00 0 0.00 class elsewhere Radiography 121 1 0.83 53 43.80 Risk management and security 7 0 0.00 7 100.00 services Road workers 1 0 0.00 1 100.00 Secretaries & other keyboard 269 2 0.74 234 86.99 operating clerks Security officers 1 0 0.00 1 100.00 Senior managers 36 4 11.11 0 0.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Occupation Employees 1 April Promotions to Salary level promotions as a Progressions to another Notch progression as a % of 2016 another salary level % of employees by notch within a salary level employees by occupation occupation Social sciences supplementary 1 0 0.00 0 0.00 workers Social work and related professionals 52 0 0.00 19 36.54 Speech therapy and audiology 64 0 0.00 15 23.44 Staff nurses and pupil nurses 1 739 15 0.86 414 23.81 Student nurse 698 1 0.14 0 0.00 Supplementary diagnostic 5 0 0.00 5 100.00 radiographers Trade labourers 4 0 0.00 3 75.00 TOTAL 2 0221 183 0.90 8 142 40.27

177

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.5.5 Promotions by salary band for the period 1 April 2016 to 31 March 2017

Salary Band Employees 1 April Promotions to another Salary bands promotions as Progressions to another Notch progression as a % of 2016 salary level a % of employees by salary notch within a salary level employees by salary bands level Lower skilled (levels 1-2), 3 572 0 0.00 1969 55.12 permanent Lower Skilled (levels 1-2), 3 0 0.00 0 0.00 temporary Skilled (levels 3-5), permanent 7 717 29 0.38 3757 48.68 Skilled (levels 3-5), temporary 18 0 0.00 0 0.00 Highly skilled production (levels 6- 4 755 73 1.54 1532 32.22 8), permanent Highly skilled production (levels 6- 87 0 0.00 6 6.90

178 8), temporary

Highly skilled supervision (levels 9- 2 865 61 2.13 671 23.42 12), permanent Highly skilled supervision (levels 9- 240 0 0.00 48 20.00 12), temporary Senior management (levels 13- 200 14 7.00 76 38.00 16), permanent Senior management (levels 13- 6 1 16.67 4 66.67 16), temporary Other, permanent 2 0 0.00 0 0.00 Other, temporary 7 0 0.00 0 0.00 Contract (levels 3-5), permanent 26 0 0.00 0 0.00 Contract (levels 6-8), permanent 246 0 0.00 1 0.41 Contract (levels 9-12), permanent 404 4 0.99 53 13.12 Contract (levels 13-16), permanent 73 1 1.37 25 34.25 TOTAL 2 0221 183 0.90 8 142 40.27

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.6 Employment Equity

Table 4.6.1 Total number of employees (including employees with disabilities) in each of the following occupational categories as on 31 March 2017

Occupational category Male Female Total African Coloured Indian White African Coloured Indian White Unknown 0 0 0 0 5 0 0 1 6 Senior officials and managers 21 0 0 0 15 1 1 1 39 Professionals 810 10 49 160 714 12 25 210 1 990 Technicians and associate 1 660 8 2 22 5 886 66 19 291 7 954 professionals Clerks 641 2 1 7 1 245 5 4 57 1 962 Service shop and market sales 864 4 0 22 3 193 7 2 50 4 142 workers 179 Craft and related trade workers 67 0 0 2 10 0 0 0 79

Plant and machine operators 217 0 0 1 10 0 0 0 228 and assemblers Labourers and related workers 1 162 7 0 5 2 679 18 1 16 3 888 Total 5 442 31 52 219 13 757 109 52 626 20 288 Employees with disabilities 31 0 0 2 34 2 0 0 69

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.6.2 Total number of employees (including employees with disabilities) in each of the following occupational bands as on 31 March 2017

Occupational band Male Female Total African Coloured Indian White African Coloured Indian White Top management, permanent 22 0 0 4 6 0 1 0 33 Top management, temporary 0 0 0 1 0 0 0 0 1 Senior management, permanent 110 3 6 14 45 1 2 9 190

Senior management, temporary 1 0 1 3 0 0 0 3 8 Professionally qualified and experienced 596 2 16 26 2 274 33 25 201 3 173 specialists and mid-management, permanent Professionally qualified and experienced 186 0 8 34 37 0 1 8 274 specialists and mid-management, temporary Skilled technical and academically qualified 1 080 6 2 22 3 431 31 7 193 4772 180 workers, junior management, supervisors,

foremen, permanent Skilled technical and academically qualified 22 0 3 12 7 0 0 4 48 workers, junior management, supervisors, foremen, temporary Semi-skilled and discretionary decision making, 2 235 8 0 24 5 469 23 6 55 7 820 permanent Semi-skilled and discretionary decision making, 1 0 0 7 1 0 0 0 9 temporary Unskilled and defined decision making, 949 6 0 1 2 160 12 1 4 3 133 permanent Unskilled and defined decision making, 1 0 0 1 0 0 0 0 2 temporary Not available, permanent 0 0 0 0 2 0 0 0 2 Not available, temporary 2 0 1 3 0 0 0 1 7 Contract (Top management), permanent 3 0 1 1 0 0 0 1 6 Contract (senior management), permanent 25 4 5 28 4 2 2 10 80 Contract (professionally qualified), permanent 127 2 8 38 140 5 3 86 409

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Occupational band Male Female Total African Coloured Indian White African Coloured Indian White Contract (skilled technical), permanent 48 0 1 0 105 2 4 51 211 Contract (semi-skilled), permanent 5 0 0 0 26 0 0 0 31 Contract (unskilled), permanent 29 0 0 0 50 0 0 0 79 TOTAL 5 442 31 52 219 13 757 109 52 626 20 288

Table 4.6.3 Recruitment for the period 1 April 2016 to 31 March 2017

Male Female Occupational band Total African Coloured Indian White African Coloured Indian White Top management, permanent 2 0 0 0 1 0 0 0 3

181 Senior management, permanent 11 0 1 0 1 0 0 0 13 Senior management, temporary 1 0 1 1 0 0 0 0 3

Professionally qualified and experienced 10 0 2 0 25 0 0 1 38 specialists and mid-management, permanent Professionally qualified and experienced 10 0 0 1 2 0 0 1 14 specialists and mid-management, temporary Skilled technical and academically qualified 24 0 0 0 68 0 0 0 92 workers, junior management, supervisors, foremen, permanent Skilled technical and academically qualified 0 0 0 0 1 0 0 0 1 workers, junior management, supervisors, foremen, temporary Semi-skilled and discretionary decision making, 96 0 0 0 272 0 0 1 369 permanent Unskilled and defined decision making, 69 0 0 0 124 0 0 0 193 permanent Not available, temporary 1 0 0 0 0 0 0 0 1 Contract (top management), permanent 0 0 0 1 0 0 0 0 1

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Male Female Occupational band Total African Coloured Indian White African Coloured Indian White Contract (senior management), permanent 8 1 0 12 1 1 0 7 30 Contract (professionally qualified), permanent 70 1 7 23 69 5 3 61 239 Contract (skilled technical), permanent 42 0 1 0 96 2 4 51 196 Contract (semi-skilled), permanent 3 0 0 0 8 0 0 0 11 Contract (unskilled), permanent 29 0 0 0 51 0 0 0 80 TOTAL 376 2 12 38 719 8 7 122 1 284 Employees with disabilities 1 0 0 0 1 0 0 0 2

182

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.6.4 Promotions for the period 1 April 2016 to 31 March 2017

Male Female Occupational band Total African Coloured Indian White African Coloured Indian White Top management, permanent 6 0 0 2 3 0 1 0 12 Senior management, permanent 39 3 5 10 16 0 0 5 78 Senior management, temporary 1 0 1 0 0 0 0 3 5 Professionally qualified and experienced specialists and mid- 230 1 8 14 383 11 14 71 732 management, permanent Professionally qualified and experienced specialists and mid- 40 0 0 1 4 0 1 2 48 management, temporary Skilled technical and academically qualified workers, junior 458 2 1 10 1 025 11 5 93 1 605 management, supervisors, foremen, permanent Skilled technical and academically qualified workers, junior 3 0 0 2 0 0 0 1 6

183 management, supervisors, foremen, temporary Semi-skilled and discretionary decision making, permanent 1 332 3 0 4 2 403 14 5 25 3 786 Unskilled and defined decision making, permanent 576 2 0 0 1 376 11 1 3 1 969 Contract (top management), permanent 1 0 0 0 0 0 0 0 1 Contract (senior management), permanent 11 1 0 9 3 0 0 1 25 Contract (professionally qualified), permanent 23 0 0 8 21 0 0 5 57 Contract (skilled technical), permanent 1 0 0 0 0 0 0 0 1 TOTAL 2 721 12 15 60 5 234 47 27 209 8 325 Employees with disabilities 31 0 0 2 34 2 0 0 69

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.6.5 Terminations for the period 1 April 2016 to 31 March 2017

Male Female Occupational band Total African Coloured Indian White African Coloured Indian White Top management, permanent 1 0 0 0 1 0 0 1 3 Senior management, permanent 4 0 0 3 4 0 0 1 12 Professionally qualified and experienced specialists and mid- 42 0 3 4 124 1 2 29 205 management, permanent Professionally qualified and experienced specialists and mid- 14 0 2 2 2 0 0 3 23 management, temporary Skilled technical and academically qualified workers, junior 68 0 0 0 131 4 1 32 236 management, supervisors, foremen, permanent Skilled technical and academically qualified workers, junior 3 0 0 1 0 0 0 0 4 management, supervisors, foremen, temporary

184 Semi-skilled and discretionary decision making, permanent 87 1 0 1 151 1 0 3 244 Semi-skilled and discretionary decision making, temporary 0 0 0 2 0 0 0 0 2 Unskilled and defined decision making, permanent 23 0 0 0 46 0 0 1 70 Contract (top management), permanent 0 0 0 0 0 0 0 1 1 09 Contract (senior management), permanent 13 0 2 4 1 0 0 1 21 Contract (professionally qualified), permanent 47 0 4 13 70 2 8 36 180 Contract (skilled technical), permanent 32 1 1 4 91 3 1 40 173 Contract (semi-skilled), permanent 3 0 0 0 2 0 0 0 5 Contract (unskilled), permanent 29 0 0 0 50 0 0 0 79 TOTAL 366 2 12 34 673 11 12 148 1258 Employees with Disabilities 3 0 0 0 3 0 0 1 7

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.6.6 Disciplinary action for the period 1 April 2016 to 31 March 2017

Male Female Disciplinary action Total African Coloured Indian White African Coloured Indian White Final written warning 4 0 0 0 1 0 0 0 5 No outcome 9 0 0 0 3 1 0 0 13 Suspended without payment 1 0 0 0 0 0 0 0 1 TOTAL 14 0 0 0 4 1 0 0 19

Table 4.6.7 Skills development for the period 1 April 2016 to 31 March 2017

Occupational category Male Female Total 185 African Coloured Indian White African Coloured Indian White

Legislators, senior officials and managers 60 1 1 7 99 0 1 10 179 Professionals 1 299 5 4 49 3 541 20 4 64 4 986 Technicians and associate professionals 521 7 5 45 1 110 5 3 100 1 796 Clerks 190 0 0 0 338 1 2 25 556 Service and sales workers 0 0 0 0 0 0 0 0 0 Skilled agriculture and fishery workers 0 0 0 0 0 0 0 0 0 Craft and related trades workers 0 0 0 0 0 0 0 0 0 Plant and machine operators and assemblers 0 0 0 0 0 0 0 0 0 Elementary occupations 86 0 0 0 224 0 0 0 310 Total 2 156 13 10 101 5 312 26 10 199 7 827 Employees with disabilities 0 0 0 1 0 0 0 0 0

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.7 Signing of Performance Agreements by SMS members

Table 4.7.1 Signing of performance agreements by SMS members as on 31 May 2017

SMS Level Total number of funded SMS Total number of SMS members Total number of signed Signed performance agreements as posts performance agreements % of total number of SMS members Director-General/ 1 100% 1 1 Head of Department Salary level 16 1 1 1 100% Salary level 15 3 3 3 100% Salary level 14 12 10 10 100% Salary level 13 100% 41 36 36

186 Total 59 52 52 100%

Table4.7.2 Reasons for not having concluded performance agreements for all SMS members as on 31 March 2017

Reasons None

Table 4.7.3 Disciplinary steps taken against SMS members for not having concluded performance agreements as on 31 March 2017

Reasons None

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.8 Performance rewards

Table 4.8.1 Performance rewards by race, gender and disability for the period 1 April 2016 to 31 March 2017

Beneficiary profile Cost Race and gender Number of beneficiaries Number of employees % of total within group Cost (R’000) Average cost per employee African, female 4 298.00 13 699.00 31.37 62 651.97 14 577.01 African, male 1 661.00 5 391.00 30.81 23 185.18 13 958.57 Asian, female 17.00 52.00 32.69 409.70 24 100.18 Asian, male 5.00 52.00 9.62 195.35 39 069.48 Coloured, female 44.00 107.00 41.12 917.87 20 860.74

187 Coloured, male 9.00 31.00 29.03 208.29 23 143.72

Blacks, female 4 359.00 13 858.00 31.45 63 979.55 14 677.57 Blacks, male 1 675.00 5 474.00 30.60 23 588.82 14 082.88 White, female 215.00 624.00 34.46 5,019.92 23 348.48 White, male 29.00 215.00 13.49 1 348.57 46 502.34 Employees with a disability 40.00 117.00 34.19 407.12 10 178.05 TOTAL 6 318.00 20288.00 31.14 94 343.98 14 932.57

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.8.2 Performance rewards by salary band for personnel below SMS for the period 1 April 2016 to 31 March 2017

Beneficiary profile Cost Total cost as a % of the Salary band Number of Number of % of total within salary Total Cost (R’000) Average cost per total personnel beneficiaries employees bands employee expenditure

Lower skilled (levels 1-2) 1 073.00 3 135.00 34.23 6 413.71 5 977.36 0,10%

Skilled (levels 3-5) 2 308.00 7 829.00 29.48 20 416.10 8 845.80 0,31%

Highly skilled production (levels 6-8) 1 473.00 4 820.00 30.56 22 480.09 15 261.43 0,34%

Highly skilled supervision (levels 9- 1 393.00 3 447.00 40.41 40 384.72 28 991.19 0,60% 12) Other 0.00 9.00 0.00 0.00 0.00 0,00%

188

Contract (levels 1-2) 0.00 79.00 0.00 0.00 0.00 0,00%

Contract (levels 3-5) 5.00 31 16.13 46.13 9 226.97 0,00%

Contract (levels 6-8) 2.00 211.00 0.95 31.52 15 757.74 0,00%

Contract (levels 9-12) 9.00 409.00 2.20 379.42 42 157.71 0,01%

TOTAL 6 263.00 19 970.00 31.36 90 151.69 14 394.33 1,35%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table4.8.3 Performance rewards by critical occupation for the period 1 April 2016 to 31 March 2017

Beneficiary profile Cost Critical occupation Number of Number of % of total within Total Cost (R’000) Average cost per beneficiaries employees occupation employee Administrative related 163.00 322.00 50.62 3 954.19 24 258.81 All artisans in the building metal machinery etc 46.00 66.00 69.70 587.65 12 774.98 Ambulance and related workers 155.00 637.00 24.33 1 557.26 10 046.86 Artisan project and related superintendents 3.00 12.00 25.00 31.11 10 369.19 Auxiliary and related workers 236.00 574.00 41.11 2 436.61 10 324.62 Biochemistry pharmacol. zoology & life scie.techni 5.00 9.00 55.56 140.89 28 177.08 Building and other property caretakers 95.00 279.00 34.05 574.09 6 043.08 Bus and heavy vehicle drivers 13.00 18.00 72.22 108.23 8 325.04 Cleaners in offices workshops hospitals etc 940.00 2 658.00 35.36 5 944.11 6 323.52 189 Client inform clerks (switchb receipt inform clerks) 43.00 99.00 43.43 444.68 10 341.49

Communication and information related 4.00 4.00 100.00 57.51 14 376.43 Community development workers 31.00 55.00 56.36 433.67 13 989.45 Computer programmers 0.00 1.00 0.00 0.00 0.00 Computer system designers and analysts 4.00 4.00 100.00 80.80 20 199.00 Dental practitioners 24.00 130.00 18.46 1 245.13 51 880.40 Dental specialists 0.00 1.00 0.00 0.00 0.00 Dental technicians 0.00 1.00 0.00 0.00 0.00 Dental therapy 6.00 14.00 42.86 128.19 21 365.64 Dieticians and nutritionists 27.00 135.00 20.00 579.19 21 451.56 Electrical and electronics engineering technicians 1.00 28.00 3.57 17.13 17 129.67 Emergency services-related 15.00 242.00 6.20 142.62 9 507.73 Engineering sciences-related 0.00 4.00 0.00 0.00 0.00 Engineers and related professionals 0.00 2.00 0.00 0.00 0.00 Environmental health 38.00 67.00 56.72 899.69 23 675.94 Finance and economics related 10.00 17.00 58.82 294.49 29 448.92 Financial and related professionals 25.00 40.00 62.50 436.91 17 476.22

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Beneficiary profile Cost Critical occupation Number of Number of % of total within Total Cost (R’000) Average cost per beneficiaries employees occupation employee Financial clerks and credit controllers 123.00 202.00 60.89 1,589.22 12 920.52 Food services aids and waiters 204.00 400.00 51.00 1,361.82 6 675.59 Food services workers 15.00 19.00 78.95 176.02 11 734.89 Forestry labourers 1.00 1.00 100.00 6.63 6 634.52 Health sciences-related 0.00 25.00 0.00 0.00 0.00 Horticulturists foresters agricul.& forestry techn 1.00 1.00 100.00 11.98 11 980.61 Household and laundry workers 180.00 317.00 56.78 1,317.00 7 316.67 Household food and laundry services-related 0.00 2.00 0.00 0.00 0.00 Housekeepers laundry and related workers 5.00 10.00 50.00 32.42 6 483.46 Human resources & organisat developm & relate prof 15.00 18.00 83.33 297.52 19 834.42 Human resources clerks 94.00 133.00 70.68 1,351.22 14 374.68

190 Human resources-related 19.00 32.00 59.38 372.32 19 595.87 Information technology -related 1.00 1.00 100.00 20.57 20 573.03 Inspectors of apprentices’ works and vehicles 1.00 1.00 100.00 7.36 7 362.27 Institution based personal care workers 5.00 8.00 62.50 28.42 5 683.60 Librarians and related professionals 0.00 1.00 0.00 0.00 0.00 Library mail and related clerks 17.00 32.00 53.13 198.66 11 686.16 Light vehicle drivers 77.00 191.00 40.31 648.91 8 427.44 Logistical support personnel 17.00 25.00 68.00 315.86 18 580.00 Material-recording and transport clerks 38.00 83.00 45.78 379.12 9 976.94 Medical practitioners 58.00 1 064.00 5.45 3,104.83 53 531.50 Medical specialists 18.00 79.00 22.78 1,717.62 95 423.49 Medical technicians/technologists 1.00 7.00 14.29 25.85 25 845.42 Messengers porters and deliverers 106.00 211.00 50.24 846.53 7 986.12 Motor vehicle drivers 16.00 19.00 84.21 144.83 9 051.63 Nursing assistants 330.00 1 408.00 23.44 2 719.78 8 241.76 Occupational therapy 26.00 87.00 29.89 580.42 22 323.69 Optometrists and opticians 4.00 7.00 57.14 73.93 18 483.66

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Beneficiary profile Cost Critical occupation Number of Number of % of total within Total Cost (R’000) Average cost per beneficiaries employees occupation employee Oral hygiene 4.00 10.00 40.00 81.04 20 261.14 Other administrative & related clerks and organisers 513.00 1 144.00 44.84 5 589.07 10 894.87 Other administrative policy and related officers 78.00 130.00 60.00 1 417.77 18 176.57 Other information technology personnel 3.00 5.00 60.00 79.66 26 554.07 Other occupations 5.00 18.00 27.78 51.65 10 329.22 Pharmaceutical assistants 80.00 180.00 44.44 984.35 12 304.37 Pharmacists 65.00 300.00 21.67 2 684.32 41 297.27 Pharmacologists pathologists & related professional 0.00 6.00 0.00 0.00 0.00 Physicists 0.00 2.00 0.00 0.00 0.00 Physiotherapy 16.00 102.00 15.69 315.43 19,714.50 Professional nurse 1 698.00 5 387.00 31.52 38 659.23 22 767.51

191 Psychologists and vocational counsellors 13.00 37.00 35.14 505.03 38 848.54 Radiography 24.00 121.00 19.83 505.46 21 060.97 Risk management and security services 1.00 6.00 16.67 9.54 9 540.90 Road workers 1.00 1.00 100.00 6.35 6 345.05 Secretaries & other keyboard operating clerks 119.00 269.00 44.24 1 251.50 10 516.82 Security officers 1.00 1.00 100.00 9.68 9 684.89 Senior managers 1.00 38.00 2.63 42.28 42 284.97 Social science supplementary workers 0.00 1.00 0.00 0.00 0.00 Social work and related professionals 28.00 51.00 54.90 527.77 18 848.97 Speech therapy and audiology 14.00 63.00 22.22 286.80 20 485.41 Staff nurses and pupil nurses 392.00 1 809.00 21.67 3 852.64 9 828.16 Student nurse 0.00 795.00 0.00 0.00 0.00 Supplementary diagnostic radiographers 3.00 5.00 60.00 39.35 13 115.40 Trade labourers 3.00 4.00 75.00 22.07 7 356.73 Total 6 318.00 20 288.00 31.14 94 343.98 14 932.57

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.8.4 Performance related rewards (cash bonus), by salary band for senior management service for the period 1 April 2016 to 31 March 2017

Band A None None None None None None Band B None None None None None None Band C None None None None None None Band D None None None None None None Total N/A N/A N/A N/A N/A N/A

192 4.9 Foreign Workers

. Table 4.9.1 Foreign workers by salary band for the period 1 April 2016 and 31 March 2017

Salary band 01 April 2016 31 March 2017 Change Number % of total Number % of total Number % Change Highly skilled production (levels 6-8) 23 7.63 42 6.69 333 5.86

Highly skilled supervision (levels 9-12) 159 53.73 320 50.96 333 48.50

Lower skilled (levels 1-2) 1 0.34 2 0.32 333 0.30

Senior management (levels 13-16) 105 35.59 252 40.13 333 44.14

Skilled (levels 3-5) 8 2.71 12 1.91 333 1.20

TOTAL 295 100.00 628 100.00 333 100.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.9.2 Foreign workers by major occupation for the period 1 April 2016 to 31 March 2017

Major occupation 01 April 2016 31 March 2017 Change Number % of total Number % of total Number % Change Elementary occupations 1 0.34 2 0.32 1 0.30 Professionals and managers 285 96.61 608 96.82 323 97.00 Social natural technical and medical sciences 5 1.69 10 1.59 5 1.50 & supp Technicians and associated professionals 4 1.36 8 1.27 4 1.20 TOTAL 295 100.00 628 100.00 333 100.00

4.10 Leave utilisation

Table 4.10.1 Sick leave for the period 1 January 2016 to 31 December 2016

193

Salary band Total days % Days with Medical Number of % of total Average days per Estimated Cost certification Employees using employees using employee (R’000) sick leave sick leave Contract (levels 1-2) 22 50 10 .08 2.2 9.00 Contract (levels 13-16) 164 56.27 30 .23 5.45 598.00 Contract (levels 3-5) 66 56.06 12 .09 5.5 43.00 Contract (levels 6-8) 860 42.21 173 1.35 4.97 872.00 Contract (levels 9-12) 955 43.46 228 1.78 4.19 1 844.00 Highly skilled production (levels 6-8) 27 336 56.98 3 399 26.53 8.04 31 693.00 Highly skilled supervision (levels 9-12) 17 431 58.01 2 105 16.43 8.28 37 115.00 Lower skilled (levels 1-2) 14 611 62.05 1 835 14.32 7.96 6 666.00 Senior management (levels 13-16) 863 59.91 111 .87 7.77 3 302.00 Skilled (levels 3-5) 37 796 58.89 4 909 38.32 7.7 25 935.00 TOTAL 100 103 58.39 12 812 100 7.81 108 077.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.10.2 Disability leave (temporary and permanent) for the period 1 January 2016 to 31 December 2016

Salary band Total days % Days with Medical Number of % of total Average days per Estimated Cost certification Employees using employees using employee (R’000) disability leave disability leave Contract (levels 6-8) 275 100 1 .98 275 289.00 Highly skilled production (levels 6-8) 1 568 100 33 32.35 47.52 1 807.00 Highly skilled supervision (levels 9-12) 704 100 22 21.57 32 1 358.00 Lower skilled (levels 1-2) 236 100 10 9.8 23.6 109.00 Skilled (levels 3-5) 1 849 99.78 36 35.29 51.36 1 280.00 TOTAL 4 632 99.91 102 100 45.41 4 843.00

194 Table 4.10.3 Annual leave for the period 1 January 2016 to 31 December 2016

Salary band Total days taken Number of Employees using annual leave Average per employee Contract (levels 1-2) 152 5.43 28 Contract (levels 13-16) 1 241 17.47 71 Contract (levels 3-5) 436 18.17 24 Contract (levels 6-8) 4 409 17.22 256 Contract (levels 9-12) 7 065 15.29 462 Highly skilled production (levels 6-8) 105 822 21.96 4 818 Highly skilled supervision (levels 9-12) 74 472 23.21 3 209 Lower skilled (levels 1-2) 61 482 20.28 3 032 Senior management (levels 13-16) 4 560 19.24 237 Skilled (levels 3-5) 161 391 21.19 7 616 TOTAL 421 029 21.31 19 753

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.10.4 Capped leave for the period 1 January 2016 to 31 December 2016

Salary band Total days of capped Number of Employees using Average number of days taken Average capped leave per leave taken capped leave per employee employee as on 31 March 2017 Contract (levels 13-16) 21.13 105.64 Contract (levels 9-12) 54.81 164.44 Highly skilled production (levels 6-8) 189 4.3 45.56 50 615.87 Highly skilled supervision (levels 9-12) 416.34 5.55 62 96 966.4 Lower skilled (levels 1-2) 56 4.67 23.93 5 768.11 Senior management (levels 13-16) 54.66 2 732.81 Skilled (levels 3-5) 171.08 3.8 40.44 53 385.64 TOTAL 832.42 4.73 48.84 209 738.91

195 Table 4.10.5 Leave pay outs for the period 1 April 2016 and 31 March 2017

Reason Total amount (R’000) Number of employees Average per employee (R’000) Capped leave pays outs on termination of service for current financial year 23 576 521 45 251

Current leave pays out on termination of service for current financial year 3 128 179 17 473

Leave pay out for current financial year due to non-utilisation of leave for the previous cycle 62 3 20 632

TOTAL 26 765 703 38 73

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.11 HIV and AIDS and health promotion programmes

Table 4.11.1 Steps taken to reduce the risk of occupational exposure

Units/categories of employees identified to be at high risk of contracting HIV & related Key steps taken to reduce the risk diseases (if any) All healthcare workers are at risk of contracting HIV and Hepatitis through contaminated needles Post Exposure Prophylaxis (PEP) in all health establishments and a policy on management of and exposure to body fluids occupational exposures and PEP is available to all health care workers Hepatitis immunisation programme is in place in health establishments

All healthcare workers are at risk of contracting TB in the workplace HCWs are provided with personal protective equipment and clothing. N95 fit test is being carried to health care workers by suppliers. Medical surveillance and biological monitoring is carried out to HCWs. Health risk assessments are carried out and Occupational Hygienist and 196 Epidemiologists from National Institute for Occupational Health jointly with Provincial OHS Team

conducted a workplace TB Infection Prevention and Control risk assessment which included air quality monitoring to measure the effectiveness and efficiency of IPC measures that are in place

Table 4.11.2 Details of health promotion and HIV and AIDS programmes

Question Yes No Details, if yes 1. Has the Department designated a member of the SMS to implement the provisions Yes Mr J.M Khalishwayo contained in Part VI E of chapter 1 of the Public Service Regulations, 2001? If so, provide her/his name and position 2. Does the Department have a dedicated unit or has it designated specific staff Yes One official is dedicated for the performance of employee health and wellness members to promote the health and well-being of your employees? If so, indicate the programme tasks. The unit has been allocated R500 000 budget. number of employees who are involved in this task and the annual budget that is 39 occupational health units have occupational health nurse practitioners available for this purpose rendering the OHS. The provincial OHS team has 4 employees namely: One programme manager, two OHNPs and one snr administrative officer. Budget allocations: CoE= R1 451 000.00 Social contributions = R 212 000 Good and services = R200 000.

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Question Yes No Details, if yes 3. Has the Department introduced an employee assistance or health promotion Yes HIV and AIDS, TB, STI programmes programme for your employees? If so, indicate the key elements/services of this Health and productivity management. Programme. Safety health environment risk and quality management. Wellness management 4. Has the Department established (a)committee(s) as contemplated in Part VI E.5 Yes The Department has established wellness committees at 2 District offices (e) of chapter 1 of the Public Service Regulations, 2001? If so, please provide the (Ehlanzeni and Gert Sibande) and 32 of the 33 Hospitals. Each committee names of the members of the committee and the stakeholder(s) that they represent consist of atleast 15 members from all disciplines. 5. Has the Department reviewed its employment policies and practices to ensure that Yes Employee health and wellness strategy these do not unfairly discriminate against employees based on their HIV status? If HIV and AIDS policy so, list the employment policies/practices so reviewed Wellness management policy Occupational health and safety policy 6. Has the Department introduced measures to protect HIV-positive employees or Yes HIV and AIDS in the workplace policy Occupational health and safety policies 197 those perceived to be HIV-positive from discrimination? If so, list the key elements of these measures Wellness management policy

Yes 7. Does the Department encourage its employees to undergo voluntary counselling The Department in Conjuction with Government Employees Medical and testing? If so, list the results that you have you achieved Scheme and Occupational Health Officers in various health Institutions encourage and give monthly reports on officials who have undergone Voluntary Counselling and Testing. Those that test positive are enrolled to ARV treatment. 8. Has the Department developed measures/indicators to monitor and evaluate the Yes Health risks assessments and impact of its health promotion programme? If so, list these measures/indicators. staff satisfaction survey

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.12 Labour Relations

Table 4.12.1 Collective agreements for the period 1 April 2016 and 31 March 2017

Subject matter Date None

Total number of collective agreements None

Table 4.12.2 Misconduct and disciplinary hearings finalised for the period 1 April 2016 and 31 March 2017

198

Outcomes of disciplinary hearings Number % of total Absent from work without reason or permission 30 24%

Assault/attempts or threatens to assault a person 14 11.2%

Conduct self in improper/unacceptable manner 22 17.6%

Contravention any code of conduct for state 1 0.8%

Dereliction of duty (DCS) 6 4.8%

Disrespect/abusive or insolent behaviour 13 10.4%

Late coming 0 0%

Possesses or wrongfully uses property of state 4 3.2%

Prejudices administration of organisation or department 0 0%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Outcomes of disciplinary hearings Number % of total Reg 20(s) displays disrespect towards others 11 8.8%

Steals bribes or commits fraud 24 19.2%

Total 125 100%

Total number of Disciplinary hearings finalised None

Table 4.12.3 Types of misconduct addressed at disciplinary hearings for the period 1 April 2016 to 31 March 2017

Type of misconduct Number % of total

199

Absenteeism 30 24% Assault 14 11.2% Improper conduct 22 17.6% Contravention of Code of Conduct 1 0.8% Dereliction of duty 6 4.8% Disrespect or abusive behaviour 13 10.4% Wrongfully use of state property 4 3.2% Display disrespect towards others 11 8.8% Theft and fraud 24 19.2% Total 125 100%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.12.4 Grievances logged for the period 1 April 2016 to 31 March 2017

Grievances Number % of Total 71 41.52% Number of grievances resolved 100 58.48% Number of grievances not resolved 171 100% Total number of grievances lodged

Table 4.12.5 Disputes logged with councils for the period 1 April 2016 to 31 March 2017

Disputes Number % of Total Number of disputes upheld 10 14.5%

200 Number of disputes dismissed 59 85.5%

Total number of disputes lodged 69 100%

Table 4.12.6 Strike actions for the period 1 April 2016 to 31 March 2017

Total number of persons working days lost 296 Total costs working days lost 26 470.10 Amount recovered as a result of no work no pay (R’000) 26 470.10

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.12.7 Precautionary suspensions for the period 1 April 2016 and 31 March 2017

33 Number of people suspended

Number of people whose suspension exceeded 30 days 33 870 Days Average number of days suspended

Cost of suspension(R’000) 7 988 127.57

4.13 Skills development

Table 4.13.1 Training needs identified for the period 1 April 2016 to 31 March 2017

201

Occupational category Gender Number of employees Training needs identified at start of the reporting period as at 1 April 2016 Learnerships Skills Programmes & Other forms of Total other short courses training Female 85 0 30 0 30 Legislators, senior officials and managers Male 232 0 100 0 100 Female 2 813 0 2 050 0 2 050 Professionals Male 1 043 0 450 0 450 Female 3 878 0 980 0 980 Male Technicians and associate professionals 1 196 0 535 0 0

Female 5 541 0 150 0 150 Clerks Male 2 287 0 105 0 105 Female 0 0 0 0 0 Service and sales workers Male 0 0 0 0 0 Female 0 0 0 0 0 Skilled agriculture and fishery workers Male 0 0 0 0 0 Female 0 0 0 0 0

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Craft and related trades workers Male 0 0 0 0 0 Female 0 0 0 0 0 Plant and machine operators and assemblers Male 0 0 0 0 0 Female 2 227 0 65 0 65 Elementary occupations Male 986 0 35 0 35 Female 14 544 0 3 275 0 3 275 Sub Total Male 5 744 0 1 225 0 1 225 Total 20 288 0 4 500 0 4 500

Table 4.13.2 Training provided for the period 1 April 2016 and 31 March 2017

Occupational category Gender Number of employees Training provided within the reporting period as at 1 April 2016 Learnerships Skills Programmes & Other forms of Total

202 other short courses training Female 85 0 110 0 110 Legislators, senior officials and managers Male 232 0 69 0 69 Professionals Female 2 813 0 3 629 0 3 629 Male 1 043 0 1 357 0 1 357 Technicians and associate professionals Female 3 878 0 1 218 0 1 218 Male 1 196 0 578 0 578 Clerks Female 5 541 0 366 0 366 Male 2 287 0 190 0 190 Service and sales workers Female 0 0 0 0 0 Male 0 0 0 0 0 Skilled agriculture and fishery workers Female 0 0 0 0 0 Male 0 0 0 0 0 Craft and related trades workers Female 0 0 0 0 0 Male 0 0 0 0 0 Plant and machine operators and Female 0 0 0 0 0 assemblers Male 0 0 0 0 0 Female 2 227 0 224 0 224

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Elementary occupations Male 986 0 86 0 86 Sub Total Female 14 544 0 5 547 0 5 547 Male 5 744 0 2 280 0 2 280 Total 2 0288 0 7 827 0 7 827

4.14 Injury on duty

Table 4.14.1 Injury on duty for the period 1 April 2016 to 31 March 2017

Nature of injury on duty Number % of total Required basic medical attention only 351 51.4% Temporary total disablement 327 47.7% Permanent disablement 2 0,2%

203 Fatal 5 0.7% Total 685 100%

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.15 Utilisation of Consultants

Table 4.15.1 Report on consultant appointments using appropriated funds for the period 1 April 2016 to 31 March 2017

Project title Total number of consultants that Duration Contract value in worked on project (work days) Rand Appointment of a service provider to evaluate current supply chain 7 150 Days R1 1 95 280.00 management processes, to identify gaps and address impediments in Gert Sibande NHI pilot district: Mpumalanga Province Appointment of a service provider for evaluation of the effectiveness of 11 180 Days R1 163 470.00 the ward based PHC outreach teams: Mpumalanga Province Call for expression of interest for the development of a laundry business 11 3 years R2 276 981.00 model

204 Appointment of one professional service provider to develop five 15 2 months R8 994 600.00

business cases and clinical briefs for the mental health hospital, tertiary hospital, Kwamhlanga and Bethal District Hospitals and Ermelo Regional Hospital Appointment of a service provider for the rendering of personnel 16 3 years Tendered Rates suitability screening services for employment purposes Appointment of service provider for the valuation of immovable properties 10 3 months R4 000 000.00

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.15.2 Analysis of consultant appointments using appropriated funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2016 to 31 March 2017

Project title Percentage ownership by HDI Percentage management by HDI groups Number of consultants from HDI groups that groups work on the project Appointment of a service provider to evaluate current supply 100% 100% 7 chain management processes, to identify gaps and address impediments in Gert Sibande NHI pilot district: Mpumalanga Province Appointment of a service provider for evaluation of the 100% 86.67% 11 effectiveness of the ward based PHC outreach teams: Mpumalanga Province Call for expression of interest for the development of a 0 0 0 laundry business model Appointment of one professional service provider to develop 100% 100% 10

205 five business cases and clinical briefs for the Mental Health

Hospital, Tertiary Hospital, Kwamhlanga and Bethal District Hospitals and Ermelo Regional Hospital Appointment of a service provider for the rendering of 47.71% 63.06% 8 personnel suitability screening services for employment purposes Appointment of service provider for the valuation of 100% 100% 10 immovable properties

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Table 4.15.3 Report on consultant appointments using donor funds for the period 1 April 2016 to31 March 2017

Project title Total Number of consultants that worked on Duration Donor and contract value in Rand project (Work days) None

Total number of projects Total individual consultants Total duration Total contract value in Rand Work days

Table 4.15.4 Analysis of consultant appointments using donor funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2016 to 31 March 2017

206 Project title Percentage ownership by HDI groups Percentage management by HDI groups Number of consultants from HDI groups that

work on the project None

Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

4.16 Severance Packages

Table 4.16.1 Granting of employee initiated severance packages for the period 1 April 2016 to 31 March 2017

Salary band Number of applications received Number of applications referred Number of applications Number of packages approved by to the MPSA supported by MPSA Department Lower skilled (levels 1-2) N/A N/A N/A N/A

Skilled levels 3-5) N/A N/A N/A N/A

Highly skilled production (levels 6-8) N/A N/A N/A N/A

Highly skilled supervision (levels N/A N/A N/A N/A 9-12) Senior management (levels 13-16) N/A N/A N/A N/A

207

Total N/A N/A N/A N/A

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Department of Health: Mpumalanga Province Annual Report for 2016/17 Financial Year Vote No 10

Movable tangible capital assets 4. The department did not have adequate systems Report of the auditor-general to the Mpumalanga to maintain records of movable tangible capital Provincial Legislature on vote no. 10: Department assets, which resulted in major and minor assets of Health being misstated. I was unable to locate movable tangible capital assets amounting to Report on the audit of the financial statements R751 491 823 (2016: R268 939 088) recorded in Qualified opinion the asset register. Furthermore, I could not trace assets selected from the floor to the asset 1. I have audited the financial statements of the register. In addition, I was unable to obtain Department of Health set out on pages 221 to sufficient appropriate audit evidence for the 391, which comprise the appropriation amounts disclosed as a prior period error for the statement, the statement of financial position as adjustment of R318 198 000 (2016: at 31 March 2017, the statement of financial R180 117 000) on major assets. I was unable to performance, statement of changes in net assets confirm the restatement by alternative means. and cash flow statement for the year then ended, as well as the notes to the financial statements, 5. Consequently, I was unable to determine including a summary of significant accounting whether any further adjustment was necessary to policies. major assets amounting to R1 180 231 000 (2016: R1 241 112 000) and minor movable 2. In my opinion, except for the effects of the tangible capital assets amounting to matters described in the basis for qualified R222 907 000 (2016: R242 467 000) as opinion section of my report, the financial disclosed in note 39 to the financial statements. statements present fairly, in all material respects, the financial position of the Department of Health Irregular expenditure as at 31 March 2017, and its financial 6. I was unable to obtain sufficient appropriate performance and cash flows for the year then evidence for irregular expenditure, as internal ended in accordance with the Modified Cash controls had not been established to recognise Standard prescribed by the National Treasury and investigate all irregular expenditure incurred. (MCS) and the requirements of the Public I could not confirm whether all irregular Finance Management Act of South Africa, 1999 expenditure had been recorded by alternative (Act No. 1 of 1999) (PFMA) and the Division of means. Consequently, I was unable to determine Revenue Act of South Africa, 2016 (Act No. 3 of whether any adjustment was necessary to 2016) (DoRA). irregular expenditure of R6 464 630 000 Basis for qualified opinion (2016: R5 001 131 000) as disclosed in note 31 to the financial statements. Immovable tangible capital assets 3. I was unable to obtain sufficient appropriate audit 7. I conducted my audit in accordance with the evidence for completed immovable tangible International Standards on Auditing (ISAs). My assets, as I was not provided with building responsibilities under those standards are further measurements (gross building area). I was unable described in the auditor-general’s responsibilities to confirm the building measurements by for the audit of the financial statements section of alternative means. Consequently, I was unable to my report. determine whether any adjustment was necessary 8. I am independent of the department in relating to completed immovable tangible assets accordance with the International Ethics stated at R1 632 559 000 (2016: R1 256 556 000) Standards Board for Accountants’ Code of ethics in note 41 to the financial statements. for professional accountants (IESBA code) together with the ethical requirements that are

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relevant to my audit in South Africa. I have misstatement, whether due to fraud or error, and fulfilled my other ethical responsibilities in to issue an auditor’s report that includes my accordance with these requirements and the opinion. Reasonable assurance is a high level of IESBA code. assurance, but is not a guarantee that an audit conducted in accordance with the ISAs will 9. I believe that the audit evidence I have obtained always detect a material misstatement when it is sufficient and appropriate to provide a basis for exists. Misstatements can arise from fraud or my qualified opinion. error and are considered material if, individually or in the aggregate, they could reasonably be Emphasis of matters expected to influence the economic decisions of 10. I draw attention to the matters below. My opinion users taken on the basis of these financial is not modified in respect of these matters. statements.

Restatement of corresponding figures 15. A further description of my responsibilities for the 11. As disclosed in notes 39, 41 and 44 to the audit of the financial statements is included in the financial statements, the corresponding figures annexure to the auditor’s report. for 31 March 2016 have been restated as a result of an error in the financial statements of the department at, and for the year ended, Report on the audit of the annual performance 31 March 2017. report

Responsibilities of the accounting officer for the Introduction and scope financial statements 16. In accordance with the Public Audit Act of South 12. The accounting officer is responsible for the Africa, 2004 (Act No. 25 of 2004) (PAA) and the preparation and fair presentation of the financial general notice issued in terms thereof, I have a statements in accordance with the MCS and the responsibility to report material findings on the requirements of the PFMA and DoRA, and for reported performance information against such internal control as the accounting officer predetermined objectives for selected determines is necessary to enable the programmes presented in the annual preparation of financial statements that are free performance report. I performed procedures to from material misstatement, whether due to fraud identify findings but not to gather evidence to or error. express assurance.

13. In preparing the financial statements, the 17. My procedures address the reported accounting officer is responsible for assessing performance information, which must be based the department’s ability to continue as a going on the approved performance planning concern, disclosing, as applicable, matters documents of the department. I have not relating to going concern and using the going evaluated the completeness and concern basis of accounting unless the intention appropriateness of the performance indicators is to either liquidate the department or cease included in the planning documents. My operations, or there is no realistic alternative but procedures also did not extend to any to do so. disclosures or assertions relating to planned performance strategies and information in Auditor-general’s responsibilities for the audit of respect of future periods that may be included as the financial statements part of the reported performance information. 14. My objectives are to obtain reasonable Accordingly, my findings do not extend to these assurance about whether the financial matters. statements as a whole are free from material

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18. 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 defined in the general notice, for the following selected programmes presented in the annual performance report of the department for the year ended 31 March 2017:

Programmes Pages in the annual performance report Programme 2 – district health services 38 – 56 Programme 4 – provincial hospitals (regional and specialised) 60 – 65

19. I performed procedures to determine whether the reported performance information was properly presented and whether the 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.

20. The material findings in respect of the usefulness and reliability of the selected programmes are as follows:

Programme 2 – district health services

Various indicators not consistent 21. The reported denominators of the following indicators were not consistent when compared to the denominators of the indicators approved in the annual performance plan, contrary to treasury regulation 5.2.4:

Indicator Reported denominator (annual Approved denominator (annual performance plan) performance plan) Expenditure PDE (district Sum ([Inpatient days total x Total uninsured population hospitals) 1])+([Day patient total x (people without medical aid) 0.5])+([OPD headcount not referred new x 0.3333333])+ SUM([OPD headcount referred new x 0.3333333])+([OPD headcount follow-up x 0.3333333])+([Emergency headcount -total x 0.3333333]) Complaint resolution within 25 Complaints resolved Complaints received working days rate (PHC) Complaint resolution within 25 Complaints resolved Complaints received working days rate (district hospitals) Child under 5 years diarrhoea Child under 5 years with Final primary diagnosis case fatality rate diarrhoea admitted(initial diagnosis) Child under 5 years pneumonia Child under 5 years with Final primary diagnosis case fatality rate pneumonia admitted (initial diagnosis)

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Indicator Reported denominator (annual Approved denominator (annual performance plan) performance plan) Child under 5 years severe acute Child under 5 years with Final primary diagnosis malnutrition case facility rate malnutrition admitted (initial diagnosis)

Various indicators with limitations 22. I was unable to obtain sufficient appropriate audit evidence for the reported achievement of targets due to limitations placed on the scope of my work. I was unable to confirm the reported achievements by alternative means. Consequently, I was unable to determine whether any adjustments were required to the reported achievements for the following indicators:

Indicator Reported achievement OHH registration visit coverage (annualised) 30,9% Complaints resolution rate (PHC) 68% Complaints resolution within 25 working days rate (PHC) 93,7% Complaints resolution rate (District hospitals) 72% Complaints resolution within 25 working days rate (District hospitals) 95,4% Infant 1st PCR test positive around 10 week’s rate 1,7% School Grade 1 screening coverage (annualised) 21,1% School Grade 8 screening coverage (annualised) 6,8% Human Papilloma Virus Vaccine 2nd dose coverage 58,3% (23 670) Infant exclusively breastfed at HepB 3rd dose rate 35,3% Maternal mortality in facility ratio (annualised) 129,6/100 000 Malaria case fatality rate 0,64 per 1 000 Child under 5 year’s diarrhoea case fatality rate 1,5 per 1 000 Client tested for HIV (incl ANC) 1 053 082

Various indicators with limitations and disagreements 23. The department did not have an adequate performance management system to maintain records to enable reliable reporting on the achievement of targets. Sufficient appropriate audit evidence could not be provided in some instances, while in other cases the evidence provided did not agree to the recorded achievements. This resulted in a misstatement of the target achievement reported. I was unable to confirm the reported achievements by alternative means. Consequently, I was unable to determine whether any further adjustments were required to the reported achievements for the following indicators:

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Indicator Reported achievement

PHC utilisation rate 2,2

Average Length of stay (District hospitals) 4,8 Inpatient bed utilisation rate (District hospitals) 75,3% Total children (under 15 years) remaining on ART-Total 231 882 Adults remaining on ART-Total 441 045 TB symptom 5 Years and older screened rate 39,8% Mother postnatal visit within 6 day’s rate 60,2% Antenatal client initiated on ART rate 94,9% Immunisation under 1 year coverage (annualised) 79,7% Measles 2nd dose coverage (annualised) 86,4% Child under 5 years pneumonia case fatality rate 3,4 per 1 000 Child under 5 years severe acute malnutrition case fatality rate 8,4 per 1 000 Human Papilloma virus 1st dose coverage 77,2% Inpatient early neonatal death rate 9,5 per 1 000 Clients screened for diabetes 1 855 330 Clients screened for mental health 11,6% Cataract surgery rate annualised CSR 1,333 (1 303) Client Satisfaction Rate (District hospitals) 76,8% Expenditure per PDE (District hospitals) R2 283,2 Medical male circumcision performed-Total 38 262 (242 667 cumulative). Cervical cancer screening coverage (annualised) 66,5% Antenatal 1st visit before 20 weeks rate 71,7% Couple year protection rate (annualised) 50,4% Vitamin A 12-59 months’ coverage (annualised) 56,1%

Various indicators with disagreements 24. The reported achievements for the targets were misstated, as the evidence provided did not agree with the reported achievements as follows:

Planned target Reported achievement Audited value

TB Client treatment success rate (annualised) 87,4% 67,8% TB/HIV co-infected client on ART rate 39,7% 45,2% TB Client lost to follow up 5,4% 6,17% TB Client death rate 4,7% 4,2% Dtap-IPV-HBV 3- Measles 1st dose dropout rate 14,2% 14,7%

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Programme 4: provincial hospitals (regional and specialised) 25. The strategic objective was reported as ‘improve access to health care services’ while it was not included in the annual performance plan, contrary to the requirements of treasury regulation 5.2.4.

Various indicators not consistent 26. The reported denominators of the following indicators were not consistent when compared to the denominators of the indicators approved in the annual performance plan, contrary to treasury regulation 5.2.4:

Indicator Reported denominator (annual Approved denominator (annual performance plan) performance plan) Expenditure PDE (Regional Sum ([Inpatient days total x Total uninsured population hospitals) 1])+([Day patient total x (people without medical aid) 0.5])+([OPD headcount not referred new x 0.3333333])+ SUM([OPD headcount referred new x 0.3333333])+([OPD headcount follow-up x 0.3333333])+([Emergency headcount -total x 0.3333333]) Complaint resolution within 25 Complaints resolved Complaints received working days rate (Regional hospitals) Complaint resolution within 25 Complaints resolved Complaints received working days rate (specialised hospitals)

Various indicators with disagreements 27. The reported achievements for the targets were misstated, as the evidence provided did not agree with the reported achievements as follows:

Planned target Reported achievement Audited evidence 90% Complaints resolution rate (specialised 92,5% 78,7% hospitals) 90% Complaint Resolution within 25 working days 97,3% 76,7% rate (specialised hospitals) 87% Patient Satisfaction Rate (regional hospital) 87% 93,2%

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auditors in the submitted financial statements Other matters were corrected and supporting records were 28. I draw attention to the matters below. provided subsequently, but the uncorrected material misstatements and supporting records Achievement of planned targets that could not be provided resulted in the 29. Refer to the annual performance report on pages financial statements receiving a qualified audit 27 to 81 for information on the achievement of opinion. planned targets for the year and explanations provided for the under- or overachievement of a Expenditure management number of targets. This information should be 34. Effective steps were not taken to prevent considered in the context of the material findings irregular expenditure, as required by on the usefulness and reliability of the reported section 38(1)(c)(ii) of the PFMA and treasury performance information in paragraphs 22 to 28 regulation 9.1.1. The expenditure disclosed does of this report. also not reflect the full extent of the irregular expenditure incurred, as indicated in the basis for Adjustment of material misstatements qualification paragraph. Most of the irregular 30. I identified material misstatements in the annual expenditure resulted from procurement performance report submitted for auditing. These processes not having been followed. material misstatements were on the reported performance information of district health 35. Effective steps were not taken to prevent fruitless services and provincial hospitals. As and wasteful expenditure amounting to management subsequently corrected only some R2 306 000 as disclosed in note 32 to the of the misstatements, I raised material findings financial statements, in contravention of section on the usefulness and reliability of the reported 38(1)(c)(ii) of the PFMA and treasury regulation performance information. 9.1.1. Most of the fruitless and wasteful expenditure resulted from interest on late Report on the audit of compliance with legislation payments to suppliers.

Introduction and scope 36. Effective internal controls were not in place for 31. In accordance with the PAA and the general the approval and processing of payments, as notice issued in terms thereof, I have a required by treasury regulation 8.1.1. responsibility to report material findings on the compliance of the department with specific 37. Contractual obligations and money owed by the matters in key legislation. I performed department were not settled within 30 days, as procedures to identify findings but not to gather required by section 38(1)(f) of the PFMA and evidence to express assurance. treasury regulation 8.2.3.

32. The material findings in respect of the Revenue management compliance criteria for the applicable subject 38. Effective and appropriate steps were not taken to matters are as follows: collect all money due, as required by section 38(1)(c)(i) of the PFMA and treasury regulations Annual financial statements, performance report 11.2.1, 15.10.1.2(a) and 15.10.1.2(e). and annual report 33. The financial statements submitted for auditing 39. Interest was not charged on debts, as required were not prepared in accordance with the by treasury regulation 11.5.1. prescribed financial reporting framework and supported by full and proper records, as required Procurement and contract management by section 40(1)(a) and (b) of the PFMA. Material 40. Contracts and quotations were awarded to misstatements of expenditure identified by the bidders based on preference points that were not

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allocated in accordance with the requirements of information obtained prior to the date of this the Preferential Procurement Policy Framework auditor’s report, I conclude that there is a Act of South Africa, 2000 (Act No. 5 of 2000) and material misstatement of this other information, I its regulations. am required to report that fact.

41. Bid documentation for the procurement of 46. I have read the other information included in the commodities designated for local content and draft annual report and have nothing to report in production did not stipulate the minimum this regard. I have not yet received the final threshold for local production and content, as annual report containing the other information. required by preferential procurement regulation When I do receive this information, and if I 9(1). conclude that it contains a material misstatement, I am required to communicate the 42. Persons in the service of the department whose matter to those charged with governance and to close family members, partners or associates request that the other information be corrected. had a private or business interest in contracts If the other information is not corrected, I may awarded by the department failed to disclose have to re-issue my auditor’s report amended as such interest, as required by treasury regulation appropriate 16A8.4. Internal control deficiencies

Other information 47. I considered internal control relevant to my audit 43. The accounting officer of the department is of the financial statements, reported performance responsible for the other information. The other information and compliance with applicable information comprises the information included in legislation; however, my objective was not to the annual report, which includes the accounting express any form of assurance thereon. The officer’s report. The other information does not matters reported below are limited to the include the financial statements, the auditor’s significant internal control deficiencies that report thereon and those selected programmes resulted in the basis for the qualified opinion, the presented in the annual performance report that findings on the annual performance report and have been specifically reported on in the the findings on compliance with legislation auditor’s report. included in this report.

44. My opinion on the financial statements and Leadership findings on the reported performance information 48. The accounting officer did not exercise oversight and compliance with legislation do not cover the other information and I do not express an audit responsibility regarding financial and opinion or any form of assurance conclusion performance reporting and compliance as well as thereon. related internal controls.

45. In connection with my audit, my responsibility is 49. The accounting officer did not communicate to read the other information and, in doing so, policies and procedures to enable and support consider whether the other information is the understanding and execution of internal materially inconsistent with the financial control objectives, processes and statements and the selected programmes responsibilities. presented in the annual performance report, or my knowledge obtained in the audit, or otherwise Financial and performance management appears to be materially misstated. If, based on 50. Management did not review and monitor the work I have performed on the other compliance with applicable laws and regulations.

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51. Management did not prepare regular, accurate have, an impact on the matters reported in the and complete financial and performance reports department’s financial statements, reported that were supported and evidenced by reliable performance information, compliance with information. applicable legislation and other related matters. These reports did not form part of my opinion on 52. Management did not implement proper record the financial statements or my findings on the keeping in a timely manner to ensure that reported performance information or compliance complete, relevant and accurate information was with legislation. accessible and available to support financial and performance reporting. Performance audit on medical equipment, pharmaceuticals and infrastructure Governance 55. A performance audit was conducted during the 53. The audit committee and internal audit unit did year under review on the department’s not follow up on their recommendations to management of pharmaceuticals, maintenance management to ensure the timeous of medical equipment and development and implementation thereof. maintenance of infrastructure. The report covered the period 1 April 2016 to Other reports 31 March 2017. 54. I draw attention to the following engagements conducted by various parties that had, or could

Mbombela

31 July 2017

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obtained, whether a material uncertainty exists related to events or conditions that Annexure – Auditor-general’s responsibility for may cast significant doubt on the ability of the audit the department to continue as a going 1. As part of an audit in accordance with the ISAs, I concern. If I conclude that a material exercise professional judgement and maintain uncertainty exists, I am required to draw professional scepticism throughout my audit of attention in my auditor’s report to the the financial statements, and the procedures related disclosures in the financial performed on the reported performance statements about the material uncertainty information for selected programmes and on the or, if such disclosures are inadequate, to department’s compliance with respect to the modify the opinion on the financial selected subject matters. statements. My conclusions are based on the information available to me at the date Financial statements of the auditor’s report. However, future 2. In addition to my responsibility for the audit of the events or conditions may cause the financial statements as described in the auditor’s department to cease to continue as a going report, I also: concern. • identify and assess the risks of material • evaluate the overall presentation, structure misstatement of the financial statements and content of the financial statements, whether due to fraud or error, design and including the disclosures, and whether the perform audit procedures responsive to financial statements represent the those risks, and obtain audit evidence that underlying transactions and events in a is sufficient and appropriate to provide a manner that achieves fair presentation. basis for my opinion. The risk of not Communication with those charged with detecting a material misstatement resulting governance from fraud is higher than for one resulting 3. I communicate with the accounting officer from error, as fraud may involve collusion, regarding, among other matters, the planned forgery, intentional omissions, scope and timing of the audit and significant misrepresentations, or the override of audit findings, including any significant internal control. deficiencies in internal control that I identify during my audit. • obtain an understanding of internal control relevant to the audit in order to design audit 4. I also confirm to the accounting officer that I have procedures that are appropriate in the complied with relevant ethical requirements circumstances, but not for the purpose of regarding independence, and communicate all expressing an opinion on the effectiveness relationships and other matters that may of the department’s internal control. reasonably be thought to have a bearing on my independence and, where applicable, related • evaluate the appropriateness of accounting safeguards. policies used and the reasonableness of accounting estimates and related disclosures made by the accounting officer.

• conclude on the appropriateness of the accounting officer’s use of the going concern basis of accounting in the preparation of the financial statements. I also conclude, based on the audit evidence

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Table of Contents

Appropriation Statement 221

Notes to the Appropriation Statement 313

Statement of Financial Performance 315

Statement of Financial Position 317

Statement of Changes in Net Assets 319

Cash Flow Statement 320

Notes to the Annual Financial Statements (including Accounting policies) 321

Unaudited supplementary schedules 392

Annexures 394

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