ANNUAL REPORT DEPARTMENT OF HEALTH PROVINCE OF MPUMALANGA
2019/2020 FINANCIAL YEAR
Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
DEPARTMENT OF HEALTH
PROVINCE OF MPUMALANGA
VOTE NO. 10
ANNUAL REPORT
2019/2020 FINANCIAL YEAR
3 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
TABLE OF CONTENTs PART A: GENERAL INFORMATION 1. LIsT OF ABBREVIATIONs/ACRONYMs ...... 7 2. FOREWORD BY THE MEC ...... 12 3. REPORT OF THE ACCOUNTING OFFICER ...... 15 4. sTATEMENT OF REsPONsIBILITY AND CONFIRMATION OF ACCURACY FOR THE ANNUAL REPORT ...... 21 5. sTRATEGIC OVERVIEW ...... 22 a. Vision ...... 22 b. Mission ...... 22 c. Values ...... 22 6. LEGIsLATIVE AND OTHER MANDATEs ...... 22 7. ORGANIsATIONAL sTRUCTURE ...... 25 8. ENTITIEs REPORTING TO THE MINIsTER/MEC ...... 25
PART B: PERFORMANCE INFORMATION 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 ...... 32 3. sTRATEGIC OUTCOME ORIENTED GOALs ...... 32 4. PERFORMANCE INFORMATION BY PROGRAMME PROGRAMME 1: ADMINIsTRATION ...... 33 PROGRAMME 2: DIsTRICT HEALTH sERVICEs (DHs) ...... 38 PROGRAMME 3: EMERGENCY MEDICAL sERVICEs...... 50 PROGRAMME 4: PROVINCIAL HOsPITAL sERVICEs ...... 53 PROGRAMME 5: TERTIARY HOsPITAL sERVICEs ...... 57 PROGRAMME 6: HEALTH sCIENCE AND TRAINING ...... 59 PROGRAMME 7: HEALTH CARE sUPPORT sERVICEs (HCss) ...... 62 PROGRAMME 8: HEALTH FACILITY MANAGEMENT (HFM) ...... 65 5. TRANsFER PAYMENTs ...... 70 6. CONDITIONAL GRANTs ...... 72 7 DONOR FUNDs ...... 81 8. CAPITAL INVEsTMENT ...... 81
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PART C: GOVERNANCE 1. INTRODUCTION ...... 84 2. RIsK MANAGEMENT ...... 84 3. FRAUD AND CORRUPTION ...... 84 4. MINIMIsING CONFLICT OF INTEREsT ...... 85 5. CODE OF CONDUCT ...... 85 6. HEALTH sAFETY AND ENVIRONMENTAL IssUEs ...... 85 7. PORTFOLIO COMMITTEEs ...... 86 8. sCOPA REsOLUTIONs ...... 150 9. PRIOR MODIFICATIONs TO AUDIT REPORTs ...... 155 10. INTERNAL CONTROL UNIT ...... 156 11. INTERNAL AUDIT AND AUDIT COMMITTEEs...... 156 12. AUDIT COMMITTEE REPORT ...... 159
PART D: HUMAN REsOURCE MANAGEMENT 1. INTRODUCTION ...... 162 2. OVERVIEW OF HUMAN REsOURCEs ...... 162 3. HUMAN REsOURCEs OVERsIGHT sTATIsTICs ...... 164
PART E: FINANCIAL INFORMATION 1. REPORT OF THE AUDITOR GENERAL ...... 209 2. ANNUAL FINANCIAL sTATEMENTs ...... 219
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PART A: GENERAL INFORMATION
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LIST OF ABBREVIATIONS/ACRONYMS ACRONYMS AIDs Acquired Immune Defciency 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 Offcer CHC Community Health Centre CHWs Community Health Workers CMR Child Mortality Rate CoE Compensation of Employees CPIX Consumer Price Index CsR Cataract surgery Rate 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 sort Course DPC Disease Prevention and Control DPsA Department of Public service and Administration DR Drug Resistant DsD Department of social Development DPWRT Department of Public Works Roads and Transport
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ACRONYMS DOTs Directly Observed Treatment sort Course DPC Disease Prevention and Control DPsA Department of Public service and Administration DR Drug Resistant DsD Department of social Development DPWRT Department of Public Works Roads and Transport ECD Early Childhood Development Center EDL Essential Drug List 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-defciency Virus HOD Head of Department HPTDG Health Professional Training and Development Grant HPV Human papillomavirus HR Human Resources HRC Human Resource Committee HRD Human Resource Development HRM Human Resource Management HsT Health sciences and Training HTA High Transmission Area
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ACRONYMS ICT Information Communication Technology IDP Integrated Development Plan IHPF Integrated Health Planning Framework IMCI Integrated Management of Childhood Illnesses IPT Isoniazid Preventive Therapy 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 MPAC Mpumalanga Provincial AIDs Council MRC Medical Research Council MTEF Medium-term Expenditure Framework MTsF Medium-term strategic Framework NCD Non Communicable Diseases 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
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ACRONYMS NHs National Health systems NPO Non-proft Organisation NsDA Negotiated service Delivery Agreement NsP National strategic Plan NTsG National Tertiary services Grant OPD Outpatient Department OsD Occupational Specifc Dispensation PCR Polymerase Chain Reaction (a laboratory HIV detection Test) PCV Pneumococcal Vaccine PDE Patient Day Equivalent PDOH Provincial Department of Health PHC Primary Health Care PHs Provincial Hospital services PMTCT Prevention of mother-to-child Transmission PPP Public/Private Partnership PPTs Planned Patient Transport services PsP Provincial strategic Plan PTC Pharmaceutical Therapeutic Committees RV Rota Virus sADHs south African Demographic Health survey sALGA south African Local Government Agency sANAC south African National AIDs Council sOP standard Operating Procedures sTATs sA statistics south Africa sTC step Down Care
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ACRONYMS sTP service Transformation Plan TB Tuberculosis THs Tertiary Hospital services TRIC Total (patient) Remaining in Care WHO World Health Organisation
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MEC: HEALTH Hon. Sasekani Manzini
3. FOREWORD BY THE MEC
The year 2020 has not been kind to us as South Africans and the world. We have experienced a health crisis
has unmasked the inequalities that exist in our society and especially in the health sector and has proven that government is the greatest pillar in times of crisis and both the private and the public health sectors have been exposed that they cannot survive without each other.
We have made great strides to deal with the global pandemic and have worked together both as the private and public sectors. Our collaborations have seen us navigating the global health crisis and saving lives in
rural settings had to navigate these unknown waters carefully and we managed to contain the spread of the
doctors, physicians, nurses, community healthcare workers and all other workers in the health sector both in the private and public sectors.
The global pandemic has also triggered the urgency for the implementation of the National Health Insurance (NHI) which aims to equalise the health provision in our society base on the principle ‘each according to need’
in making the NHI a reality and this we have seen in the province with the piloting of the NHI in Gert Sibande District and subsequently rolled out in all the three (3) health districts. This has not been a smooth sail but we are improving our plans from the lessons learnt from all the piloting sites to make sure that we perfect the system as it gets ready to be implemented on a larger scale and become a reality for all South Africans.
detected early because they did not have money to get tests done. The NHI which we have termed the ‘New Jerusalem’ is on the horizon and will assist in dealing which such avoidable deaths. The NHI is premised on primary health care and prevention which will assist hundreds of thousands of our people if not millions in making sure that they have access to quality health care.
12!" # Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Public consultations on the NHI bill continue and our people are encouraged to set aside time and go and participate in making sure that their voices are heard and taken into consideration when the bill is fnally passed into law. The NHI is a game changer that our people are going to beneft both rich and the poor, health care will be made accessible to all who need it regardless of one’s socio-economic status. The National Development Plan (NDP) vision 2030 has promised our people quality health care and the NHI is the vehicle through which it will be ushered in order to achieve the Sustainable Development Goal number three (3) which is Universal Health Coverage (UHC) by 2030.
The NDP identifes health as one of the direct and immediate measures to attack poverty and further notes that “strengthen primary health-care services and broaden district-based health programmes, such as the community health worker and midwife programmes, and health education” (NDP Executive Summary Report. 2011:18) is the key to achievement. Health care is put at the centre of attacking poverty through the district-based programme and hence as a Department, plans are already in place and we have started the implementation of District Development Model by launching a Clinic-Based Model which encourages collaboration between the Department and the Community as well as all stakeholders that contributes in social determinants of health. COVID-19 has necessitated the fast tracking of the implementation of the community healthcare workers (CHW) model because CHWs played and continue to play a very crucial role in our fght against COVID-19 and other co-morbidities.
The NDP highlights health as one of the enabling milestones “provide afordable access to quality health care while promoting health and wellbeing” (NDP Executive Summary Report. 2011:24). This is exactly what the NHI seeks to achieve and we are grateful that we are en-route to realising this goal, of quality of health care for all South Africans. This is cited because the plan noted health as one of the nine (9) primary challenges facing South Africa noting that “The public health system cannot meet demand or sustain quality” (NDP Executive Summary Report. 2011:). Hence health has been put a one of the primary objectives that the NDP should prioritise in making sure that we improve the quality of life for all South African. Health care is envisioned as one of the key elements for a decent standard of living for a healthy nation and a productive one and we aim to achieve the targets set out in the NDP by 2030 which is 10 years from now. Thus it gives me great pleasure that plans are already in place and the implementation process is already being rolled out with some of the pilots happening
The NHI is government delivering on the promise of the charter which stated that: “A preventative health scheme shall be run by the state. Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children “Freedom Charter).
This will be achieved as highlighted in the NDP by implement the scheme in a phased manner, focusing on:
• Improving quality of care in public facilities
• Reducing the relative cost of private medical care
• Increasing the number of medical professionals
• Introducing a patient record system and supporting information technology systems (NDP Executive Summary Report. 2011: 62).
The department has established a registrars training programme, which is aimed at ofering bursaries to doctors employed by the department who are interested in training as specialist in all the diferent disciplines. We have also obtained the accreditation from the department of high education to start training our nurses with the new nursing curriculum, this we do so to ensure that we continue to produce quality nurses on a regular basis.
The department continues to recruit and train staf members; we are prioritizing critical post in all our appointments. The process of appointments and training of stuf remains an on-going process of the department; we are doing all this in a quest to improve our quality healthcare service and to remain the hope of the sick and vulnerable in the province.
Our main focus as a health sector in South Africa in the current Mid-term Strategic Framework (MTSF) 2019 – 2024 is to progressively achieve Universal Health Coverage through the implementation of NHI and improving
13 MEC: HEAL TH Hon. Sasekani Manzini Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 life expectancy at birth targeting 70 years by 2030.
I am pleased to indicate that life expectancy at birth in the country has been increasing from 54 years in 2006 to 65.5 years in 2020.
The people of Mpumalanga also continue to live longer as their life expectancy at birth has been increasing from 54.1 years in 2006 to 64.3 years in 2020.
More interestingly is that in SA on average females compared to males continue to live longer from 55.7 in 2006 to 68.5 years in 2020 while males are at 62,5 years in 2020 from 52.3 years in 2006. The same trend is observed in Mpumalanga where females’ life expectancy is at 66.8 years from 55.7 years in 2006 compared to males who live up to 61.8 years in 2020 from 52.5 years in 2006.
The above are attributable to the interventions on the management of HIV and AIDS as the deaths have been declining due to increasing number of people on the Antiretroviral treatment and the decline in infant and child mortalities as well as the reduction of maternal mortalities in the province.
I call on all of us to put our shoulders to the wheel in making sure that the NHI becomes a lived reality and happens in our lifetime and as I have argued COVID-19 has shown that we need it now more than ever to make sure that our people have quality health care and save lives.
The World Health Organisation defnes health care workers as and I quote “people whose job it is to protect and improve the health of their communities. Together these health care workers, in all their diversity, make up the global health workforce” end quote
It is in this vain that I say the value of health care workers in our Department should be highly appreciated and our workers in the Department should take pride in their respective responsibilities which is solely based on service delivery and being of service to our people in the quest of saving life hence the centrality of your work is around the people that you serve. I will be failing in my duties if I do not sincerely thank and appreciate your unwaving commitment to the delivery of quantity healthcare services to the people of Mpumalanga.
______
MS. SJ MANZINI (MPL) DATE
MEC: HEALTH
14 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
HEAD: HEALTH Dr. Savera Mohangi
4. REPORT OF THE ACCOUNTING OFFICER
4.1 Overview of the operations of the department The fnancial year 2019/20 closes when the world is faced with global pandemic of the Coronavirus, also known as COVID-19. The World Health Organization (WHO) declared COVID-19 to be a Public Health Emergency of International Concern (PHEIC) on 30th January 2020, and subsequently a pandemic on 11th March 2020, as COVID-19 has affected almost every country in the world. This Health crisis was a test of the health system globally. As a country, South Africa had the frst imported confrmed case of COVID-19 on the 5th of March 2020 – and since then, the number of COVID-19 cases has increased sharply affecting all the nine provinces to a cumulative number of 754 256 as of 17 November 2020. Mpumalanga had the frst confrmed positive COVID -19 case in the Nkomazi local municipality on the 11th of March 2020 after a history of international travel to Italy. The numbers increased cumulatively to 30 758 as of the 17th of November 2020 affecting all municipalities in all the three (3) Health Districts with Nkangala leading at 10 753, followed by Ehlanzeni at 10 318 and lastly Gert Sibande at 9 687 COVID-19 cases. The Province had a recovery rate of 29 747 (97%) cases that were positive and regrettably 612 (2%) COVID-19 deaths have been recorded on the 17th November 2020 -this means the province case fatality rate is at 2% below the national average. I must commend all our Health Care Workers for their self-less dedication in the fght against the pandemic and more importantly is to appreciate the conduct of all citizens in the province for their contribution in preventing the spread of COVID-19 by complying with all Health protocols that were issued by the Department of Health. The 6th Administration has developed government priorities and health is priority number two (2) which is a continuous commitment to provide a healthy life for all South African citizens as outlined by the 2030 National Development Plan (NDP). The Department will in the next fve years, continue to work tirelessly in preparing the environment for implementation of the National Health Insurance (NHI) which is a vehicle for equitable distribution of the health system to achieve the Sustainable Development Goals (SDGs). The aspirations of the Department as planned in the Annual Performance Plan of 2019/20 has improved with the overall performance at 60%, which is a signifcant improvement from the 54% reported in the previous fnancial year of 2018/19, despite the COVID – 19 pandemic that may have impacted on service delivery during the month of March 2020. There is also a frm commitment to improve the fscal and supply chain management in the Department and this is evident by the continuous improvement in the audit outcomes from the Auditor General of South Africa (AGSA). The Department has achieved its planned target of an unqualifed audit opinion for the frst time in a decade and for this achievement, I give credit to the whole
15 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 management team and staff of the department, for their hard work, dedication, determination and commitment. The NDP target for improving life expectancy at birth to 70 years by 2030 is on track. The province has a life expectancy of 64.3 years in 2020 from 54.1 years in 2006. This is attributable to a number of health interventions such as the improvement in the management of HIV and AIDS as deaths have been declining due to increasing number of people accessing Antiretroviral treatment. Furthermore, is the decline in infant and child mortalities as well as the reduction of maternal mortalities in the province. Our infrastructure delivery programme remains a priority in order to prepare a conducive environment for the NHI and increase access to the 88% uninsured citizens of the province. The Department has been battling with high exposure to contingent liabilities due to suspected medical negligence and this affects our operations as unbudgeted court orders and settlements must be paid. The Department developed a litigation strategy which focuses on the reduction of litigation costs, and progress has been made in this regard through mediation, negotiation, out of court settlement and court. Furthermore, the strategy also promotes prevention of medical negligence through practicing ethical clinical governance and quality of healthcare services by all healthcare professionals. Our vision is to remain focussed to ensure that despite challenges, we still provide the best medical care to all our citizens. Provision of Specialised services – Oncology and radiology platforms The Department is improving access to specialist services in the province, through expansion of the service delivery platform and partnering with academic institutions. The oncology services were introduced in Rob Ferreira hospital during 2019/20 FY, and patients from the province continue to beneft from this services. Currently we are only providing chemotherapy. From the 1st of April 2020, Radiology services are rendered in the two tertiary hospitals (Witbank and Rob Ferreira) and two regional hospitals (Mapulaneng and Ermelo). The four hospitals each have a fulltime Radiologist onsite available weekdays. This has improved the turnaround time for reports and timely clinical intervention. The introduction of the above mentioned specialist services will ensure that our citizens requiring these services do not have to travel long distances i.e Gauteng province in order to be serviced. 4.2 Overview of the fnancial results of the department The Department was allocated an adjusted budget of R14 280 909 000 for 2019/2020 fnancial year which is 8,9% higher than the 2018/19 fnancial year. An amount of R14 257 736 000 was spent for 2019/2020 fnancial year which is 8% higher than the 2018/19 fnancial year. The Department has improved its Annual Financial Statement outcomes by achieving unqualifed audit report when compared with 2018/2019 fnancial year audit. The Department has managed to improve in relation to its fnancial health which has improved payment of service providers, reduction of irregular expenditure and prevention of unauthorised expenditure.
16 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Departmental receipts
Departmental 2019/2020 2018/2019 receipts Final Actual (Over)/ Estimate Actual (Over)/Under Under Collection Appropriation Amount Collection Amount Collected Collected
R’000 Amount R’000 R’000 R’000 R’000 Collected
Sale of goods and 88 372 68 751 (19 621) 73,826 63,828 (9,998) services other than capital assets
Interest, dividends 5 283 6 936 1 653 4,166 6,515 2,349 and rent on land
Sale of capital 4 324 2 767 (1 557) 288 4,138 3,850 assets
Financial 3 754 3 553 (201) 1,143 4,264 3,121 transactions in assets and liabilities
Total 101 733 82 007 (19 726) 79,423 78,745 (678)
Revenue Management
The Department has collected revenue amounting to R82 million (81%) against a target of R101.7 million. The under collection was due to challenges with the collection on RAF. The Department has also encountered challenges relating to tracing of debt in the Patient Electronic Information System (PEIS). The Department plans to strengthen its strategy to improve revenue collection in 2020/21 fnancial year.
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Programme Expenditure
2019/2020 2018/2019 Final Actual (Over)/ Final Actual (Over)/Under Programme Name Appropriation Under Appropriation Expenditure Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Programme 1 430,379 430,375 4 289,609 289,363 246 Programme 2 8,905,608 8,905,608 - 8,031,721 8,031,679 42 Programme 3 419,062 419,058 4 363,422 363,412 10 Programme 4 1,434,783 1,434,782 1 1,368,773 1,368,773 0 Programme 5 1,303,516 1,302,292 1,224 1,224,452 1,222,888 1,564 Programme 6 414,643 414,548 95 365,839 365,838 1 Programme 7 240,512 220,316 20,196 157,928 157,928 0 Programme 8 1,132,406 1,130,757 1,649 1,317,847 1,256,062 61,785 Total 14 280 909 14,257,736 23,173 13,119,591 13,055,943 63,648
The Department has spent 99.8 percent of its adjusted budget for the period 2019/20 fnancial year compared to 99.5 percent in the previous fnancial year. Programme 7 underspent due to sub-programme Medicine trading account being used as trading account for medicine and medical supplies accounts. Underspending on machinery was due to late delivery of imported medical equipment’s owing to many countries being lockdown restrictions due to COVID 19.
Virements
• An amount of R1, 966, 000 will be reduced from Programme 3 to defray overspending in Programme 2. The Virement is 1.1% of the Adjusted Appropriation of Programme 3.
• A Saving amounting to R9, 894,000 from Programme 4 will be utilised to defray overspending in Programme 2 which is 0.7% of the Adjusted Appropriation.
• A budget of R10, 555, 000 will be reduced from Programme 6 to cover overspending in Programme 2. The Virement is 2.5% of the Adjusted Appropriation of the programme.
• An amount of R20, 900,000 will be reduced from Programme 7 to defray overspending in Programme 1 and 2. The Virement is 8% of the Adjusted Appropriation of the Programme.
• A budget of R68, 292,000 will be reduced from Programme 8 to cover overspending in programmes 2. The Virement is 5.7% of the Adjusted Appropriation of the programme.
The year-end Virements were effected on the adjusted budget which entails moving funds from compensation of employees to defray overspending on goods and services on key accounts, departmental agency and accounts for Skills Levy. A budget from buildings and other fxed structures was utilised to set off spending on machinery and equipment for medical equipment. All the Virements were within the permitted limit of 8% as prescribed by Treasury Regulations.
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Rollovers Requested
Conditional Grants R‘000
National Tertiary Service Grant 1 036 Total 1 036
National Treasury Service Grant Delayed delivery of medical equipment ordered Unauthorised, Fruitless and Wasteful Expenditure
The Department did not incur any unauthorised expenditure during the year under review. Details of fruitless and wasteful expenditure incurred for the 2019/20 fnancial year can be summarised as follows:
Opening balance 2,866
Fruitless and wasteful expenditure – relating to current year 4,885
Less: Amounts recoverable -4,580
Closing balance 3,171
The Department is prioritising interest bearing accounts in order to avoid recurrence of fruitless and wasteful expenditure Future plans of the department None Public Private Partnerships None Discontinued activities / activities to be discontinued None New or proposed activities None Supply chain management (SCM) During the year under review, the Department not receive unsolicited bid proposals. The following SCM processes and systems are in place to prevent irregular expenditure 1. Supply Chain Management committees that ensures compliance in the procurement of goods and services (Economising committee, Hospital Finance Management committees, District Acquisition committees, Bid Evaluation committee and Bid Adjudication Committee) 2. Supply Chain Management checklist 3. Supply Chain Management policy and procedure manual
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The table below indicates challenges experienced in SCM and how they were resolved during the year under review.
No Challenges Solutions 1 Implementation of the Preferential Procurement Policy at Conducted information sharing sessions with all the districts facilities (District offces and hospitals) and hospitals on the implementation of the Preferential Procurement regulation of 2017 2 Contract administration and management Employed additional staff in the contract management unit and in the process of training contract management staff together with other role players in contract management
Gifts and Donations received in kind from non-related parties The Department received in-kind goods and services as indicated in Annexure XXX on the Financial Statements.
Exemptions and deviations received from the National Treasury There were no exemptions and deviations received from National Treasury during the year under review. The only deviation or exemption received from National Treasury on the 28th of April 2020 was related to COVID-19 procurement processes.
Events after the reporting date Due to the outbreak of the COVID-19 pandemic the province, like the rest of the country has developed and implemented controls to fght the spread of the virus. Strategic plan has been developed to guide the departmental spending to curb the spread. Several guidelines and regulations were also issued by mainly National Treasury and National Department of Health which were complied with.
National Department of Health and Provincial Treasury has further adjusted 2020/2021 budget of the department to fght the spread of the virus amounting to R1 572 622 221 of which R1 billion was addition from Provincial Treasury, R33.9 million from Disaster Relief Grant and others funds were reallocation from 2020/2021 fnancial year budget Other None Conclusion In conclusion, I would like to express my deepest and humbled appreciation to the Executive Authority (MEC) and Premier for entrusting me with this challenging and yet exciting responsibility to implement the mandate of the Department of Health. I would also like to appreciate the support received from the National Department of Health through the National Health Council (NHC). I will be doing injustice if I fail to heartedly appreciate the entire workforce of the Department for their sterling and unwavering support. Your dedication kept me going day on day to ensure the citizens of Mpumalanga receive the best quality health care during the fnancial year under review. Let’s continue with this spirit as we embark on a new challenging fnancial year that is clouded by COVID-19. We need even more your selfess dedication.
Let us ALL stay safe from COVID-19 and wear a mask at all time.
______DATE:______DR SAVERA MOHANGI HEAD:HEALTH
20 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
5. STATEMENT OF RESPONSIBILITY AND CONFIRMATION OF ACCURACY FOR THE ANNUAL REPORT
To the best of my knowledge and belief, I confrm 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 modifed cash standard and the relevant frameworks and guidelines issued by the National Treasury.
The Accounting Offcer is responsible for the preparation of the annual fnancial statements and for the judgements made in this information.
The Accounting Offcer 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 fnancial statements.
The external auditors are engaged to express an independent opinion on the annual fnancial statements.
In my opinion, the annual report fairly refects the operations, the performance information, the human resources information and the fnancial affairs of the department for the fnancial year ended 31 March 2020.
Yours faithfully
______DATE: ______DR SAVERA MOHANGI HEAD:HEALTH
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6. STRATEGIC OVERVIEW control of the council to the public sector; and to provide for pharmacy education and training, requirements for registration, a. Vision the practice of pharmacy, the ownership of pharmacies and “A Healthy Developed Society”. the investigative and disciplinary powers of the council; and to provide for matters connected therewith. • Medicines and Related Substance Control Act, (Act No. 101 b. Mission of 1965 as amended) The Mpumalanga Department of Health is committed to improve Provides the registration of medicines intended for human and the quality of health and well-being of all people of Mpumalanga for animal use; for the registration of medical devices; for the by providing needs based, people centred, equitable health care establishment of a Medicines Control Council; for the control delivery system through an integrated network of health care of medicines, Scheduled substances and medical devices; for services provided by a cadre of dedicated and well skilled health the control of manufacturers, wholesalers and distributors of workers. medicines and medical devices; and for the control of persons who may compound and dispense medicines; and for matters incidental thereto. c. Values • Mental Health Care Act (Act No. 17 of 2002) • Commitment Provides a legal framework for the care, treatment and • Appropriateness rehabilitation of persons who are mentally ill; to set out different • Timeliness procedures to be followed in the admission of such persons; to establish Review Boards in respect of every health establishment; • Collectiveness to determine their powers and functions; to provide for the care • Competency and administration of the property of mentally ill persons; to repeal certain laws; and to provide for matters connected therewith.
7. LEGISLATIVE AND OTHER MANDATES • Medical Schemes Act (Act No131 of 1998) Provides for the regulation of the medical schemes industry to ensure consonance with national health objectives. A. CONSTITUTIONAL MANDATES In terms of the Constitution of the Republic of South Africa (Act • Council for Medical Schemes Levy Act (Act 58 of 2000) No. 108 of 1996), the Department is guided by the following sections and schedules: Provides a legal framework for the Council to charge medical schemes certain fees. • Section 27 (1): “Everyone has the right to have access to – • Nursing Act (Act No 33 of 2005) (a) health care services, including reproductive health care; Provides for the regulation of the nursing profession. (3) No one may be refused emergency medical treatment: • Human Tissue Act (Act No 65 of 1983) • Section 28 (1): “Every child has the right to basic health care services…” Provides for the administration of matters pertaining to human tissue. • Schedule 4, which lists health services as a concurrent national and provincial legislative competence. • Sterilisation Act (Act No. 44 of 1998) Provides a legal framework for sterilisations, also for persons with mental health challenges. B. LEGAL MANDATES • Choice on Termination of Pregnancy Act (Act No. 92 of 1996 as amended)
• National Health Act (Act No. 61 of 2003) Provides a legal framework for the termination of pregnancies, based on choice under certain circumstances. Provides a framework for a structured uniform health system within the Republic, taking into account the obligations imposed • Tobacco Products Control Act (Act No. 83 of 1993 as by the constitution and other laws on the national, provincial and amended) local governments with regard to health services and to provide Provides for the control of tobacco products, the prohibition of for matters connected therewith. smoking in public places and for advertisements of tobacco • Pharmacy Act (Act No 53 of 1974, as amended) products as well as the sponsoring of events by the tobacco industry. Provides for the establishment of the South African Pharmacy Council and for its objects and general powers; to extend the • National Health Laboratory Service Act (Act No.37 of 2000)
22 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provides for a statutory body that offers laboratory services to the amended) public health sector. To regulate the fnancial management in the national government • South African Medical Research Council Act (Act 58 of 1991) and provincial governments; to ensure that all revenue, expenditure, assets and liabilities of those governments Provides for the establishment of the South African Medical are managed effciently and effectively; to provide for the Research Council and its role in relation to health research. responsibilities of persons entrusted with fnancial management in those government; and to provide for matters connected • The Allied Health Professions Act (Act No.63 of 1982 as therewith. amended) • Division of Revenue Act (Act 5 of 2012) To provide for the control of the practice of allied health professions, and for that purpose to establish an Allied Health Provides for the manner in which revenue generated, may be Professions Council of South Africa and to determine its functions; disbursed. and to provide for matters connected therewith. • Promotion of Access to Information Act (Act No 2 of 2000) • Foodstuffs, Cosmetics and Disinfectants Act (Act No. 54 of To give effect to the constitutional right of access to any 1972 as amended) information held by the State and any information that is held by Provides for the regulation of foodstuffs, cosmetics and another person and that is required for the exercise or protection disinfectants, in particular quality standards that must be of any rights; and to provide for matters connected therewith. complied with by manufacturers as well as the importation and • Promotion of Administrative Justice Act (Act No 3 of 2000) exportation of these items. Amplifes the constitutional provision pertaining to accessing • Hazardous Substances Act (Act No. 15 of 1973) information under the control of various bodies. Provides for the control of hazardous substances, in particular • Preferential Procurement Policy Framework Act, 2000 those emitting radiation. To give effect to section 217 (3) of the constitution by providing • Dental Technicians Act (Act No. 19 of 1979) a framework for the implementation of the procurement policy Provides for the regulation of dental technicians and for the contemplated in section 217(2) of the Constitution; and to provide establishment of a Council to regulate the profession. for matters connected therewith. • Health Professions Act (Act No. 56 of 1974) • Broad Based Black Empowerment Act (Act No. 53 of 2003 Provides the regulation of health professions in particular, Provides for the promotion of black economic empowerment in medical practitioners, dentists, psychologists and other related the manner that the state awards contracts for services to be health professions, including community services by these rendered and incidental matters. professionals. • Public Service Act (Proclamation No. 103 of 1994) • Allied Health Professions Act (Act No. 63 of 1982, as Provides for the administration of the public in its national and amended) provincial spheres, as well as for the powers of Ministers to Provides the regulation of health practitioners such as recruit and terminate employment. chiropractors, homeopaths, etc., and for the establishment of a • Labour Relations Act (Act No. 66 of 1995) council to regulate these professions. Regulates the rights of workers, employers and trade unions. • Occupational Diseases in Mines and Works Act (Act No 78 of 1973 as amended) • Basic Conditions of Employment Act (Act No. 75 of 1997) Provides for medical examinations on persons suspected of To give effect to the right to fair labour practices referred to in having contracted occupational diseases, especially in mines section 23(1) of the Constitution by establishing and making and for compensation in respect of those diseases. provision for the regulation of basic conditions of employment and thereby to comply with the obligations of the Republic as a • Academic Health Centres Act (Act No.86 of 1993) member state of the International Labour Organisation; and to Provides for the establishment, management and operation of provide for matters connected therewith. academic health centres. • Employment Equity Act (No 55 of 1998) Provides for the measures that must be put into operation in Other general legislation in terms of which the Department the workplace in order to eliminate discrimination and promote operates, includes, but not limited to, the following: affrmative action. • Child Care Act (Act 74 of 1983) • Skills Development Act (Act 97 of 1998) Provides for the protection of the rights and well-being of children. Provides for the measures that employers are required to take to improve the levels of skills of employees in the workplace. • Public Finance Management Act (Act No 1 of 1999 as
23 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
• Occupational Health and Safety Act (Act No. 85 of 1993 as Public Private Partnership (PPP) – regulation 16 of the treasury amended) regulations in respect of government Departments, promulgated in terms of the Public Finance Management Act 1 of 1999 (PMFA) Provides for the requirements that employers must comply – alleged that PPP not concluded in accordance with regulation with, in order to create a safe environment for employees in the 16 and PPP agreement not binding on the MEC – dispute of fact workplace incapable of resolution on the papers – not necessary or desirable • Compensation for Occupational Injuries and Diseases Act to resolve legal issue- appeal upheld. (No. 130 of 1993 as amended) • CCMA v Law Society, Northern Provinces (005/13) [2013] Provides for compensation disablement caused by occupational ZASCA 118 injuries or diseases sustained or contracted by employees in the The Law Society of the Northern Provinces contested the course of their employment and for death resulting from such unconstitutionality of not allowing legal representation in terms injuries or diseases. of rule 25 (1) (c) of the rules of the Commission for Conciliation, Mediation and Arbitration (CCMA) – the appeal was upheld and C. POLICY MANDATES the order declaring the rule as being unconstitutional by the court a quo was dismissed with costs. • National Medium Term Strategic Framework 2014 – 2019. • Provincial Medium Term Strategic Framework 2015 – 2020. • National Development Plan (NDP) – Vision for 2030 • National Health Systems Priorities 2009–2014 (10 Point Plan) • Negotiated Service Delivery Agreement • Mpumalanga Economic Growth Path • Mpumalanga strategic plan for HIV and AIDS, STIs and TB 2012 - 2016 • Integrated Development Plans (IDPs) • District Health Management Information System Policy (DHMIS), 2011 • White Paper on The Transformation of The Health Sector, 1997 • Treasury regulations • Public Service Regulations, 2016 • Preferential Procurement Policy Framework Regulations D. RELEVANT COURT RULINGS • MEC for Finance & Economic Development, KwaZulu- Natal v Masifundisane Training (606/2012) [2013] ZASCA
24 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 None None IONAL STRUCTURE None Name of entity Legislative mandateNone Financial relationship Nature of operations 8. ORGANIS AT TO THE MEC 9. ENTITIES REPORTING
25 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PART B: PERFORMANCE INFORMATION
26 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
1. AUDITOR GENERAL’S REPORT: PREDETERMINED OBJECTIVES
The AGSA currently performs certain audit procedures on the performance information to provide reasonable assurance in the form of an audit conclusion. The audit conclusion on the performance against predetermined objectives is included in the report to management, with material fndings being reported under the Predetermined Objectives heading in the Report on other legal and regulatory requirements section of the auditor’s report.
Refer to page 207 of the Report of the Auditor General, published as Part E: Financial Information.
2. OVERVIEW OF DEPARTMENTAL PERFORMANCE 2.1 Service Delivery Environment • Albeit COVID-19 pandemic which was declared as a health emergency by WHO after identifying a cluster of cases of Pneumonia in Wuhan, in China, the cause of the sickness, Coronavirus (SARS-CoV-2) was named Coronavirus disease 2019 (COVID-19) by the Chinese authorities on 7th January 2020 (Li et al. 2020). Globally the cases started to increase forcing countries to impose lockdown measures. South Africa imposed its lockdown measures on the 15th of March 2020 after observing a cluster of outbreaks since the frst diagnosed imported case on the 05th of March 2020. This took place in the last month of the last quarter for the fnancial year under review and forced the health system to divert its resources towards preventing, reducing and management of the pandemic.
• The Mpumalanga Department of Health which services a population of 4 679 786 according to the 2020 mid-term Stats SA population estimates (accessed 20 October 2020, 23h58), which further indicates that approximately 84% of the citizens are uninsured and dependant on the public sector, while 16% is insured and mostly utilise the private healthcare facilities.
• However, the COVID – 19 pandemic has disrupted access to health care facilities due to lockdown, even though measures were put in place to ensure continuity of care to those who needed further care and treatment. The headcounts and out-patients’ data dropped dramatically as well as casualty admissions just to mention few. This has therefore, seen the Department performing at 60%, which is an improvement from the 54% reported in the previous fnancial year of 2018/19, despite COVID – 19 that may have impacted on the supply and demand of services to the citizens of the place of the rising sun, Mpumalanga.
27 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
2.2 Service Delivery Improvement Plan
The department has completed a service delivery improvement plan. The tables below highlight the service delivery plan and the achievements to date. Main services and standards Main services Benefciaries Current/actual Desired standard of Actual achievement standard of service service Provision of All pregnant Reduce maternal Reduce maternal mortality Maternal mortality reduced to maternal health women mortality to to 141/100 000 67.1/100 00 services 141/100 000 All citizen within Improve EMS P1 Improve EMS P1 Response EMS P1 Response within 15 Mpumalanga Response within 15 within 15 minutes in urban minutes in urban areas has been Province minutes in urban areas areas to 73% 43.5% in this fnancial year. to 73% Improve EMS P1 Improve EMS P1 Response EMS P1 Response within 40 Response within 40 within 40 minutes in rural minutes in rural areas has been minutes in rural areas areas to 69% 51% in this fnancial year. to 69%
Batho Pele arrangements with benefciaries (Consultation access etc.)
Current arrangements Desired arrangements Actual achievements
Health facility to conduct Open All health facilities to conduct Open 139 health facilities conducted Open Days Days Days
28 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Service delivery information tool
Current information tools Desired information tools Actual achievements Radio slots on Mpumalanga Total number of radio slots All radio slots honoured and information communicated Community Radio Stations 260 1. Eyethu FM 2. Bushbuckridge FM 3. Barberton (BCR) FM 4. Emalahleni FM 5. Nkomazi FM 6. Voice of Hope (VOH) FM 7. Voice of Community (VOC) FM 8. Mkhondo FM 9. Rise FM 10. Kangala FM 11. Moutse FM Radio slots on SABC Radio 48 slots All radio slots have been honoured Stations 24 Ligwalagwala FM Ikwekwezi FM 24 Ikwekwezi FM Ligwalagwala FM Radio slots on Mpumalanga Total number of radio adverts All radio adverts honoured and information communicated Community Radio Stations 260 1. Eyethu FM 2. Bushbuckridge FM 3. Barberton (BCR) FM 4. Emalahleni FM 5. Nkomazi FM 6. Voice of Hope (VOH) FM 7. Voice of Community (VOC) FM 8. Mkhondo FM 9. Rise FM 10. Kangala FM 11. Moutse FM Radio adverts on SABC Radio 48 adverts All radio adverts have been honoured Stations 24 Ligwalagwala FM Ikwekwezi FM 24 Ikwekwezi FM Ligwalagwala FM Social Media Facebook 365 post done on Facebook Twitter 365 post on Twitter Other mediums Posters 50 posters designed Media statements 52 Media statements issued Newsletters 4 publications done
29 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Complaints mechanism
Current complaints Desired complaints mechanism Actual achievements mechanism Complaint, Compliment and • Patients and their representatives must Some complaints are lodged externally, for Suggestion Boxes available in utilise the Complaint, Compliment example with the Offce of Health Standards all Health Establishments and Suggestion Boxes in all Health Compliance, National Department of Health, Establishments to lodge complaints Human Rights Commission, Public Protector, Premier’s Offce, Member of Executive • Health Establishments must open Council’s offce, Offce of the Head: Health or suggesti boxes at least once per month. any offce instead of the Health Establishment where the dissatisfaction occurred. Complaint Management All Health Establishments must have Some Health Establishments do not have Committees are available in Complaint Management Committees and appointed Complaint Management Committees Health Establishments and sit sit monthly to analyse and develop quality or where appointed, they are not meeting on a to analyse and develop quality improvement plans for all complaints, monthly basis as required. improvement plans for all compliments and suggestions received complaints, compliments and suggestions received Complaint, compliments Complaint, compliments and suggestion Registers not used consistently and suggestion registers registers must be available and utilised in all are available in all Health Health Establishments Establishments Verbal complaints can be lodged Verbal complaints can be lodged with the Most Health establishments do not create with the manager of the relevant manager of the relevant unit at Health an ideal environment for patients or their unit at Health Establishments Establishments, especially where urgent representatives to lodge complaints intervention is required.
2.3 Organisational environment Due to fnancial constraints, the Department has reviewed the current organizational structure which was approved in 2010. The review considered current occupied posts with warm bodies and considered critical posts to be flled during the fnancial year under review. A draft organisational structure has been sent to the Offce of the Premier which has 23 235 active posts and 21 021 warm bodies. The Department has flled the following key positions: • The post of Chief Director: Infrastructure Development and Technical Services has been flled through the promotion of the Director: Infrastructure Planning. • The post of Chief Director: Supply Chain and Asset Management has been flled through a promotion of the Director: Supply Chain Management. The vacated post was advertised and will be flled during the 2020/21 fnancial year. • The post of Chief Director: Primary Health Care has been flled through the promotion of the Director: Maternal, Child and Wom- en’s Health. The vacated post was advertised and will be flled during the 2020/21 fnancial year. • The post of Director: Emergency Medical Services has been flled after being vacated through a transfer of the post incumbent to Limpopo Province. • The Director: Quality Assurance has been flled for the frst time in the Province. The post incumbent was a Chief Executive Offcer of Barberton hospital and has been replaced through a transfer of the Chief Executive Offcer of Barberton TB hospital. • The post of Chief Executive Offcer – Ermelo hospital has been flled through the appointment of the Chief Executive Offcer of Evander hospital. The vacuum at Evander hospital has been closed through the transfer of the Chief Executive Offcer of Carolina hospital. The vacant post at Carolina hospital has been advertised and will be flled during the 2020/21 fnancial year. • The post of Director: Corporate Services – Nkangala District has been flled for the frst time. The post incumbent has vacated a post of Corporate Manager at Ermelo hospital and the vacant post was advertised and will be flled during the 2020/21 fnancial year.
30 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
• The Department has appointed a Chief Director: Clinical Governance on a contractual basis to assist in the intervention strategy as a result of increasing number of litigations. However, the post of Director: Legal Services still remains vacant after an attempt to fll and the recruitment process was interrupted by the change in the administration since all SMS posts in Mpumalanga are approved by the Executive Council.
The following key positions remain unflled:
• The post of Chief Executive Offcer – Sabie hospital was vacated through the death of the post incumbent and the post will be flled during the 2020/21 fnancial year.
• The post of Chief Executive Offcer – Mapulaneng hospital was vacated through retirement of the post incumbent. The post was advertised and no qualifying candidate applied. The post has been re-advertised and will be flled during the 2020/21 fnancial year.
• The post of Chief Executive Offcer – KwaMhlanga hospital was vacated through the resignation after the long illness of the post incumbent. The post was advertised, interviews conducted and the post will be flled during the frst quarter of the 2020/21 fnancial year.
• The post of Chief Executive Offcer – Mmametlhake hospital was vacated through the resignation. It was advertised and should be flled during the 2020/21 fnancial year.
• The post of Senior Clinical Manager – Witbank hospital was vacated through the retirement of the post incumbent. It was ad- vertised and no suitable candidate has applied. Head-hunting of a qualifying candidate will take place to ensure that the vacant position is flled during the 2020/21 fnancial year.
• Human resource priorities for the year under review and the impact of these.
• The Department has prioritized to fll 440 posts
• Workforce planning and key strategies to attract and recruit a skilled and capable workforce.
• Employee performance management.
• Employee wellness programmes.
• Highlight achievements and challenges faced by the department, as well as future human resource plans /goals.
The following posts have been advertised:
• Director: Legal Services
• Director: Mental Health
• Director: Primary Health Care
• Director: Maternal Child and Women’s Health
The Chief Director: Human Resource Management and Development was seconded to act as a Head of Department for the Department of Education in the Province since March 2019. This has left a vacuum and is grossly affecting the human resource operations.
The Chief Director: Integrated Health Services has been on temporary disability leave from the second quarter of the 2019/20 fnancial year due to ill health and the Director: Policy and Planning resigned during the frst quarter of the same fnancial year. The vacant post has been advertised and should be flled during the 2020/21 fnancial year. Both positions are very critical for the planning, monitoring implementation and reporting.
There were unprotected strikes at Rob Ferreira hospital resulting from allegations of corruption levelled against management. There were also protests at Mapulaneng and Witbank hospitals on safety issues. There were community and staff protests at Mmametlhake on irregular appointments.
31 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
2.4 KEy POLICy DEVELOPMENTS AND LEGISLATIVE CHANGES The department did not have any legislative changes. DPSA has issued a Guide for Members Executive with effect from 08 June 2019. This guide provides for benefts, tools of trade and allowances to which Members of Executive and their family members are entitled in the execution of a Member’s duties. This guide seeks to provide administrative and support assistance to a Member in ensuring good governance with regard to cost effectiveness and effciency. The Guide effective from 08 June 2019 made provision for appointment of 13 members of staff in the Offce of the Members of the Executive Council. The Guide was later amended on 20 November 2019 which resulted in the reduction of the number of staff to 5. The Department implemented PHSDSBC Resolution 2 of 2018 on Payment of Annual Statutory Registration Fees in Respect of Health and Social Development Professionals. This resolution regulates the payment mechanism for the Registration Fees by means of Persal system for statutory bodies as mandatory in the Health and Social Development sectors. This initiative will assist in the monitoring of potential risk and compliance with registration requirements for appointment and practice as stipulated in the respective statutory professional bodies in the Department. The Department implemented PHSDSBC Resolution 4 of 2017 on Agreement on the Payment of Special Allowance and Danger Allowance. The purpose of this resolution is to provide a special allowance for qualifying Forensic Pathology Offcers and Other Employees who are performing the same function under the direct supervision of the responsible medical offcer within the Health Sector. This was implemented with effect from 01 April 2019.
3. STRATEGIC OUTCOME ORIENTED GOALS
The Department has aligned the National Development Plan 2030 into the fve (5) year mid-term strategic framework. The report on the strategic goals is provided for in the programme performance tables Part B of this report.
32 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4. PERFORMANCE INFORMATION By PROGRAMME
PROGRAMME 1: ADMINISTRATION
Purpose
The purpose of this programme is to provide the overall management of the Department, and provide strategic planning, legislative, communication services and centralised administrative support through the MEC’s offce and administration.
List the sub-programmes • Offce of the MEC • Human Resources Management and Development (HRM&D) • Financial and Supply Chain Management (Finance) • Legal Services • Communications • Internal Audit and Risk Management • Integrated Health Planning (IHP) • Information Communication and Technology (ICT)
Summary of Achievements The Department has over the years developed internal controls to improve the effciency and effective implementation of programmes to achieve service delivery by improving fscal and prudent management. This is confrmed by the improvement in the audit outcomes by Auditor general of South Africa (AGSA). The Department has achieved its target of unqualifed audit outcome in the 2019/2020 fnancial year.
33 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 The Department did not achieve the planned target of improving Hospital Management by appointing Executive Management teams in all hospitals due to resignations and promotions. posts The following CEO’s remains vacant due death in Sabie, resignation KwaMhlanga, promotion in Barberton, lateral transfer in Carolina to Evander and a retirement Mapulaneng hospital. The posts of Clinical TB Managers for the hospitals, Barberton, Hospital are vacant, Tintswalo while the Finance Managers’ post for Sabie and Elsie Ballot remain vacant and the Corporate Manager’s post for TB and Elsie Ballot, Witbank Barberton Hospitals are also vacant. The Department plans to fll these posts during the 2020/21 fnancial Comment on deviations 5/28 (CEOs – 5/28 NSM – 02/32 Clinical Managers – 05/32 Finance Managers – 02/32 Corporate Managers – 03/32) Deviation from planned target 2018/2019 Actual Achievement Actual 2019/2020 23/28 23/28 (CEOs – 23/28 NSM – 30/32 – Managers Clinical 27/32 – Managers Finance 30/32 – Managers Corporate 29/32) Planned Target 2019/2020 28/28 Actual Achievement 2018/2019 24/28 26/28 CEOs 24/32 Clinical Man- agers 30/32 Nursing Ser- vice Managers 29/32 Finance Man- agers 28/32 Managers Corporate Actual Achievement 2017/2018 follows: 26/28 CEOs 30/32 Finance Managers 31/32 Corporate Managers 32/32 Nursing Service Managers Actual Achievement 2016/2017 10/33 The status is as Performance Indicator Improve Hospital Management by appointing Executive Management teams in all hospitals. (Key Management Positions) Programme / Sub-programme: Administration Programme / Sub-programme: Strategic objectives Re-alignment of human resource to Departmental needs Strategic objectives & Performance indicators, Planned Targets and Actual Achievements
34 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations year. None None None None Deviation from planned target 2018/2019 0 0 0 0 Actual Achievement Actual 2019/2020 1 Implemented 18 maintained 1 Planned Target 2019/2020 1 18 maintained 1 Unqualifed Unqualifed Actual Achievement 2018/2019 1 Implemented 18 Information offcers appointed 1 Actual Achievement 2017/2018 1 Qualifed Qualifed Actual Achievement 2016/2017 1 0 maintained 7/18 Not in plan Not in plan The Department received Audit Qualifed Opinion Performance Indicator Improve quality of care by developing and implementing Recruitment & Retention strategy Improve quality of information by appointing information offcers in all sub- districts Communication strategy developed Programme Performance/ Customized Indicators (Sector Indicators) Audit opinion Auditor- from General Programme / Sub-programme: Administration Programme / Sub-programme: Strategic objectives Strengthening Health Systems Effectiveness
35 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations None None Deviation from planned target 0 0 Actual Achievement Actual 2019/2020 100% (33/33 maintained) 100% (287/287) Planned Target 2019/2020 100% (33/33 maintained) 100% (287/287 maintained) Actual Achievement 2018/2019 100% (33/33 maintained) 100% (287/287 maintained) Actual Achievement 2017/2018 (33/33 maintained) 29% (80/279 cumulative Actual Achievement 2016/2017 from AGSA. from Not in plan 100% 34% Indicator Percentage of Hospitals with broadband access Percentage of fxed PHC facilities with broadband access Programme / Sub-programme: Administration Programme / Sub-programme: Strategic objectives Performance
36 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Changes to planned targets None Linking performance with budgets
The programme has achieved 86% of its planned targets as compared to the 100.0% of fnancial expenditure in the year under review.
Sub-programme expenditure
Sub- Programme 2019/2020 2018/2019 Name Final Actual (Over)/ Final Actual (Over)/Under Appropriation Under Appropriation Expenditure Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Offce of the MEC 15 154 15 154 - 8 628 7 899 729 Management Services 415 225 415,221 4 280 981 281 464 ( 483) Total 430 379 430 375 4 289 609 289 363 246
37 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PROGRAMME 2: DISTRICT HEALTH SERVICES (DHS)
Purpose
The purpose of the programme is to render comprehensive Primary Health Care Services to the community using the District Health System model.
List the sub-programmes • District Management • Health Programmes • Primary Health Care • Health Care Support • Clinical Support Services • HIV/AIDS and TB List the strategic objectives • Improve health care outcomes Summary of Achievements
Management of District Health Services
To reduce costs and ensure effcient use of resources, there is reduction in the average length of stay, which is at 4.1 days against the target of 4.2 days.
There is an increase in complaint resolution rate within 25 working days for District Hospitals from 96% in 2018/19 fnancial year to 97.8% in the year under review against the set target of 95.5% which refects an effort in the improvement of the quality of health care services.
Maternal, Child, Women and youth Health To improve management of maternal and child health care services, the Department has developed a strategy to amplify implementation of programmes focusing on the reduction of maternal and infant mortalities. To decrease maternal morbidity and mortality. The Department has managed to achieve the following: • Antenatal 1st visit before 20 weeks’ rate is at 77,3% against the target of 75%. • The Mother postnatal visit within 6 days’ rate is at 69.89% against the target of 65,5%. • The Department also managed to initiate 99.2% of Antenatal client on ART against the target of 98% in the current fnancial year. • The cervical cancer screening coverage 30 years and older is at 84.3% against the target of 80%
The above performance has contributed in the reduction of maternal mortality from 92, 4/100 000 in 2018/19 to 67, 1/100 000 in the year under review.
The Department has also managed to achieve the following with regard to the reduction of child morbidity and mortality: • The infant 1st PCR test positive around 10 weeks’ rate is at 0.91% against the target of 1.3%. • The immunisation under 1-year coverage is at 96, 6% against the target of 90%. • 30 702 School Grade 1 - learners screened for learning barriers and health related challenges against the target of 25 870. • Vitamin A 12-59 months’ coverage is at 65.7% against the target of 60% The Department has managed to exceed the target of cataract surgery rate of 1600 to 1728 due to the project that involved both private and public doctors. The Department reduced the malaria case fatality rate to 0.3% against the target of 0.5% in the year under review.
38 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 implementation of CCMDD programme where patients now visits external Pick medication their collect to (PUP) Points up thus decongesting the PHC facilities The Department establish 28.9% only (35/121) in managed 93.4% Ehlanzeni, (71/76) to in 60% (54/90) in Gert Nkangala. This is due Sibande to inadequate implementation and of SOPs and guidelines e.g. ICSM at PHC facility level. Delay in goods the delivery of The by procured Department budget has service in set implementation of ideal 2020/21 facility framework. aside to providers. a expedite the take time to relating be resolved to e.g. Infrastructure those challenges. Comment on deviations 0.2 Reduced PHC headcount visits due to the (1.1%) Some of the raised complaints (10.8%) (31/287) Deviation from planned target 2019/20 2 96.8% 55.74% (160/287) Actual Achievement 2019/2020 2.2 98% 66.5% (191/287) Planned Target 2019/2020 2.1 96.8% 46.3% (133/287) Actual Achievement Actual 2018/2019 2.1 95% 99.3% (285/287) Actual Achievement Actual 2017/2018 2.2 93.7% Not in plan Actual Achievement 2016/2017 PHC (PHC) within 25 days rate Utilisation resolution Ideal clinic status rate rate – total Complaints Performance Indicator Programme / Sub-programme: District Management Strategic objectives Improved quality of health care Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
39 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 relating to Infrastructure challenges. Comment on deviations Comment on deviations Target Achieved. Target Low catchment population in some of the hospitals (e.g. Elsie Ballot, Waterval Boven, Barberton). NDOH is currently working on a hospital reclassifcation project and with low catchment hospitals are included in the project. Incorrect classifcation of some of the hospital (e.g. Same staff establishment as per normal district hospitals) NDOH is currently working on a hospital reclassifcation project and with low catchment hospitals are included in the project. increase the to attributed is Achievement in the number of complaints and resolved within 25 working days. received Deviation from planned target 2019/20 Deviation from planned target 2019/2020 7.7% R 239 2.3% Actual Achievement 2019/2020 Actual Achievement 2019/2020 67% 97.8% Planned Target Planned 2019/2020 Planned Target 2019/2020 Actual Achievement Actual 2018/2019 Actual Achievement 2018/2019 Actual Achievement Actual 2017/2018 Actual Achievement 2017/2018 Actual Achievement 2016/2017 4.8 days 4.2 days75.3% 4.4 days 69.5% 4.2 days 69.7%R 2 283.2 4.1 days 75% R 2 433.3 R 2 952 0.1 R 2 650.0095.4% R 2 889 96% 96% 95.5% Actual Achievement 2016/2017 Performance Indicator Average Length Average of Stay (district hospitals) Inpatient Bed Utilisation Rate (district hospitals) Expenditure per PDE (district hospitals) Complaint Resolution within 25 working days rate (District Hospitals) rate (PHC) Performance Indicator Programme / Sub-programme: District Management Strategic objectives Programme / Sub-programme: District Hospitals Strategic objectives Improved quality of health care Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
40 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 relating to Infrastructure challenges. Comment on deviations Comment on deviations There was suffcient stock, however the however stock, suffcient was There uptake is still a major problem. Continue engaging and following up with suppliers and NDOH for support and assistance. To procure buffer condoms stock at on the 2020/21. fnancial year, male beginning of the marketing continue also will Department the use of female condoms National challenge DHIS. to Web Tier.net transition from on NDOH has resolved systems the challenge and the new system will be implemented during the 2020/21 fnancial year. lost-to- clients 321 28 had province The collect that clients particularly follow-up, medication from ARV their Comment on deviations Target Achieved. Target Low catchment population in some of the hospitals (e.g. Elsie Ballot, Waterval Boven, Barberton). NDOH is currently working on a hospital reclassifcation project and with low catchment hospitals are included in the project. Incorrect classifcation of some of the hospital (e.g. Same staff establishment as per normal district hospitals) NDOH is currently working on a hospital reclassifcation project and with low catchment hospitals are included in the project. increase the to attributed is Achievement in the number of complaints and resolved within 25 working days. received Deviation from planned target 2019/20 Deviation from planned target 2019/2020 7.7% R 239 2.3% Actual Achievement 2019/2020 Deviation from planned target 2019/202020 Actual Achievement 2019/2020 67% 97.8% Planned Target Planned 2019/2020 Actual Achievement 2019/202020 Planned Target 2019/202020 Planned Target 2019/2020 Actual Achievement Actual 2018/2019 Actual Achievement 2018/209 72.3% 82% 47.9% (34.1%) Actual Achievement 2018/2019 Actual Achievement Actual 2017/2018 Actual Achievement 2017/2018 78.9% Actual Achievement 2017/2018 Actual Achievement 2016/2017 4.8 days 4.2 days75.3% 4.4 days 69.5% 4.2 days 69.7%R 2 283.2 4.1 days 75% R 2 433.3 R 2 952 0.1 R 2 650.0095.4% R 2 889 96% 96% 95.5% Actual Achievement 2016/2017 1 981 572 1 040 630 1 951 650 1 500 000 1 231 300 (268 700) 79.5% 360 037 905 411 464 569 521 028 514 347 (6 681) Actual Achievement 2016/2017 Performance Indicator Female condom distribution Improve TB Improve cure rate Programme Performance/ Customised indicators (Sector indicators) client ART remain on end of ART month -Total Performance Indicator Average Length Average of Stay (district hospitals) Inpatient Bed Utilisation Rate (district hospitals) Expenditure per PDE (district hospitals) Complaint Resolution within 25 working days rate (District Hospitals) rate (PHC) Performance Indicator Programme / Sub-programme: District Management Strategic objectives Programme / Sub-programme: District Hospitals Strategic objectives AND TB (HAST) AIDS, STI AND Programme / Sub-programme: HIV Strategic objectives Improved quality of health care Improve health Improve care outcomes Strategic objectives & Performance and Actual indicators, Achievements Planned Targets Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
41 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ply of these commodities from suppliers in that suppliers had inadequate stock levels at all ordering intervals. Continue engaging and following up with assis- and support for NDOH and suppliers tance. at condoms male on stock buffer procure To 2020/21 year, fnancial the of beginning the fnancial year PICT PICT and community based HIV has testing increased the testing capacity in our facilities. system version that addresses algorithm for Tier.net & Web DHIS transition Tier.Net. from The challenge has been resolved and the new system will be deployed in 2020/21 fnancial year. Comment on deviations facilities. Fewer clients have been initiated due to the impact of COVID-19. ART on clients of number the increase will Facilities registered into CCMDD. Deviation from planned target 2019/2020 Actual Achievement 2019/2020 Planned Target 2019/2020 Actual Achievement 2018/2019 62 703 737 67 150 600 75 499 519 46 723 200 (28 776 319)sup- inconsistent experienced program The 96.2% 93% 96% 68.8% (27.2%)updated of out roll National with Challenges Actual Achievement 2017/2018 52 per male (77 703 (77 male per 52 335) 1 053 082 1 302 122 1 080 154 1 082 313 1 638 906 556 593 The implementation of Index Testing, 39.7% Actual Achievement 2016/2017 Male condom distributed HIV test done - total TB/HIV co- infected client rate ART on Performance Indicator Programme / Sub-programme: HIV AND AIDS, STI AND TB (HAST) AIDS, STI AND Programme / Sub-programme: HIV Strategic objectives Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
42 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations The abrupt termination contract of of the reduced the department’s capacity URC by to offer VMMC in USAID, and outside our facilities. The province will participate in the national tender for the provision of VMMC services. Achievement attributed increase number to of TB confrmed the cases which were patients were started on treatment. that High death rate of 8.5% and high lost-to-follow-up rate of 8.7% trace to WBPHCOT using Continue TB lost to follow up. Conducted training for Traditional health practitioners, Allied Health professionals, nurses and doctors as part of build-up activities for the TB day 2020 even World Deviation from planned target 2019/2020 (14 075) (6.9%) Actual Achievement 2019/2020 Planned Target 2019/2020 Actual Achievement 2018/2019 79 187 81 049 66 85372.5% 52 778 94.9%87.1% 90% 84.9% 101.06% 88% 11.06% 81.1% Actual Achievement 2017/2018 38 262 39.8% 87.4% Actual Achievement 2016/2017 Medical male circumcision – Total TB symptom 5yrs and older started on treatment rate TB client treatment success rate Performance Indicator Programme / Sub-programme: HIV AND AIDS, STI AND TB (HAST) AIDS, STI AND Programme / Sub-programme: HIV Strategic objectives
43 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 course of TB treatment course of TB to trace Continue using WBPHCOT lost-to-follow-up. health Traditional Conducted training for practitioners to assist in referring patients TB. with affected Allied Health professionals, Trained nurses and doctors as part of build-up TB day 2020 event activities for the World facilities. Other patients have underlying conditions. chronic Continue using WBPHCOT to trace lost to follow up. TB Conducted training for Traditional health practitioners to assist in referring patients TB. with affected nurses professionals, Health Allied Trained for activities build-up of part as doctors and TB day 2020 event. the World implementation of the new short term regimen. medication Comment on deviations (3.7%) Patient get lost-to-follow-up during the (3,5%)care health to patients of presentation Late 0.2% Improved MDR-TB success rate due to Deviation from planned target 2019/2020 Actual Achievement 2019/2020 Planned Target 2019/2020 Actual Achievement 2018/2019 4.3% 4.3% <5% 8.5% 56.7% 54.2% 61% 61.2% Actual Achievement 2017/2018 5.2% 6.6% <5% 8.7% 4.7% 54.4% Actual Achievement 2016/2017 5.4% TB client death Rate TB MDR treatment success rate Performance Indicator TB client lost to follow up rate Programme / Sub-programme: HIV AND AIDS, STI AND TB (HAST) AIDS, STI AND Programme / Sub-programme: HIV Strategic objectives
44 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Target exceeded due to Target implementation of routine pregnancy screening on all women of child bearing age dialogues in PHC facilities achieved due to community Target dialogues in PHC facilities. facilities has contributed to overachievement Comment on deviations Some of the candidates were not not were candidates the of Some per as position the for suitable requirement. Deviation from planned target 2019/2020 (6) 77.3% 2,3% 69.89% 4.39%99.2% exceeded due to community Target 1.2% 0.91% 0,39% Community dialogues in PHC Actual Achievement 2019/2020 24 75% (57389/76518) (47710/72839) 98% (13328/13600) (235/18043) Planned Target 2019/2020 30 Actual Achievement 2018/2019 16 Actual Achievement 2017/2018 32 (75 cumulative) 65.9% 73.8% 76% 62.5% 63.4%95.8% 67.7%1.6% 99% 65.5% 1.1% 99% 0.9% 1,3% Actual Achievement 2016/2017 13 (43 cumulative)
st visit before 20 weeks rate Mother postnatal visit within 6 days rate Antenatal client ART initiated on rate Infant 1st PCR test positive around 10 weeks rate Performance Indicator Strategic Objective/Provincial Indicators Number of School Health Teams Service established Programme Performance/Customized Indicators (Sector Indicators) Antenatal 1 Programme / Sub-programme: Maternal, Child and Women’s Health & Nutrition (MCWH&N) Programme / Sub-programme: Maternal, Child and Women’s Strategic objectives Improve health care outcomes Strategic objectives & Performance indicators, Planned and Targets Actual Achievements
45 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Baby Breath (HBB) Shortage of neonatal beds and skill on care Out- reach services including activation in TVET colleges TVET Out- reach services including activation in & Triphasil) stock outs that started last year mostly Nkomazi and BBR and Nkomazi mostly year last started that outs stock Triphasil) & Ehlanzeni New tender for the provision of Contraceptives signed by National for implementation in 2020/2021. New tender for the provision of Contraceptives signed by National for implementation in 2020/2021. Late presentation to health facilities by affected community members for health intervention. Support the implementation of house hold community component of IMCI in identifed areas Target achieved. Continue with the implementation of IMCI strategy Target Poor implementation of IMCI strategy at facility level. level. facility at strategy IMCI of implementation Poor fnancial 2020/21 during strategy IMCI of implementation the Strengthen year. Conducted catch-up campaigns and data verifcation. Target exceeded due to catch-up campaigns and data verifcation. Target Comment on deviations 4% 6,6% Deviation from planned target 2019/202 11,2/1000 (1,2/1000)Help and neonates sick and small of management on skills Inadequate 84.3% 4.3% 48.6% (16.4%) Effects of contraceptives mostly preferred by teenagers (Nur Isterate 14.7% (3.7%) Inconsistence supply of injectable methods. 17 837 7 837 Appointment of new teams 30 702 10 115 Appointment of new teams 10.6% (1.6%) 2,3% 0,2% 2,1% (0, 1%) 94,0% 96,6% Actual Achievement 2019/2020 10,0/1000 (639/70995) (740232/923374) (776787/1195057) (8012/72839) (89/986) (92/3667) (62/3075) (75535/83928) 90% (72930/81034) Planned Target 2018/2019 11.5 per 1 11.5 000 Actual Achievement 2018/20 9.7 per 1 000 Actual Achievement 2017/2018 9.3 Per 1 000 66.7% 78.7% 89.9% 80% 38.6% 62.4% 64% 65% Not in plan 12.5% 14.8% 11% 13.1% 9661 18 097 10 000 20% 20 587 35 040 20 587 12.5% 9.1% 9.1% 9% 3.7 per 1000 2.4% 2.7% 2.5% 2.7 per 1000 1.9% 2.3% < 2% 78.7% 89.2% 85.9% 90% 87.1% 90.4% 97.1% Actual Achievement 2016/2017 Neonatal death in facility rate Cervical cancer screening coverage 30 years and older Couple year protection rate (Int) Delivery in 10 to 19 years in facility rate School Grade 8 - learners screened School Grade 1 - learners screened Severe acute case malnutrition fatality rate Pneumonia case fatality rate Diarrhoea case fatality rate Measles 2nd dose coverage Immunisation under 1 year coverage Performance Indicator Improve health care outcomes Programme / Sub-programme: Maternal, Child and Women’s Health & Nutrition (MCWH&N) Programme / Sub-programme: Maternal, Child and Women’s Strategic objectives
46 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 in hospitals and primary health care facilities and continued community health education. Overachievement due to the collaboration project between private doctors and public health sector workers who jointly hospital. Tonga took part in conducting cataract surgeries and Help Baby Breath (HBB) Shortage of neonatal beds and skill on care maternal health forum, Post death support visits Workers (CHW) in providing Vitamin A at household level. A (CHW) in providing Vitamin Workers Comment on deviations Deviation from planned target 2019/2020 0.3% 0.2% Malaria case management training for health professionals 1 728 128 11,2/1000 (1,2/1000) Inadequate skills on management of small and sick neonates 67.1/ 100 000 73.9/100 000 Increased support on health system strengthening through 65,7% 5 ,7% Target achieved due to the utilisation of Community Health Actual Achievement 2019/2020 1,600 (639/70995) 141 per 100 000 Live Births (100/70988) (212404/352587 Planned Target 2019/2020 CSR 336.1 (1 493.1) 11.5 per 1 00011.5 10,0/1000 92.4 per 100 000 Live Births Actual Achievement 2018/2019 1.02% 0.60% 0.5% CSR 313 (1 157) 9.7 per 1 000 120 per 100 000 Actual Achievement 2017/2018 0.5 per 1 000 CSR 805 (2 657) 9.3 Per 1 000 1205.3 per 100 000 51.4% 58.3% 66% 60% Actual Achievement 2016/2017 102% 30 876 28 589 81900 39 211 (42 689) included boys in Grade 4 Target Malaria case fatality rate Cataract surgeries rate Neonatal death in facility rate Maternal mortality in facility ratio Vitamin A A Vitamin 12-59 months coverage HPV 2nd dose Not in Plan 23 292 22 907 81900 31 552 (50 348) included boys in Grade 4 Target Performance Indicator HPV 1st dose Programme / Sub-programme: Disease Prevention & Control (DPC) Strategic objectives Improve quality of health care Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
47 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Strategy to overcome areas of under performance
The low uptake of female condoms is still a major challenge in the province. The programme experienced inconsistent supply of these commodities from suppliers in that suppliers had inadequate stock at all ordering intervals.
In order to avoid shortages, the Department will procure buffer stock of both male and female condoms. The Department will scale up distribution with the assistance of Partner NGOs at various sites, distribute at Ummemo (Traditional Leaders Councils) once lockdown conditions are eased to ensure that men’s health is integrated into the programme. Additionally, the Department will activate the youth sector to popularise female condom usage and strengthen relations of the Department with various private companies, sustain and maintain the condom Friday campaigns all year round and integrate the advocacy plan with health promotion to ensure the integration of COVID- 19 sustainable prevention programme.
With regard to ART Clients Remain on ART, the province had 28 321 clients lost-to-follow-up, particularly clients that are collecting their ARV medication from facilities. Facilities will increase the number of clients registered into CCMDD programme.
The implementation of Index Testing, Provider Initiated Counselling and Testing (PICT) and community based HIV testing has increased testing capacity in our facilities.
The abrupt termination of the contract of URC by USAID, reduced the department’s capacity to offer VMMC in and outside our facilities. The province will participate in the national tender for the provision of VMMC services. There is a need to implement transversal contracting in Gert Sibande District.
With regard to Antenatal 1st visit before 20 weeks rate, there has to be consistent screening of women of child bearing age for pregnancy and same day booking for ANC Daily and weekly monitoring by Operational Managers.
In order to deal with Antenatal client initiated on ART rate, regular data review and verifcation have assisted to correct under reporting.
With regard to Infant 1st PCR test positive around 10 weeks rate, Viral loads are monitored during pregnancy to ensure suppression before delivery. Babies born of HIV positive mothers are followed up to ensure that Nevirapine drops are administered in line with protocol.
Continuous education in communities is required in order to address challenges of improving TB cure rate and TB/HIV co-infected client on ART rate. Diagnosed TB patients are started on treatment immediately in order to deal with TB symptoms, 5 years and older started on treatment rate. There is a need to continuously implement the WBPHCOT initiative in order to address the challenge of lost-to-follow-up. Patients are also provided with information on an on-going basis to encourage them to present themselves early at health facilities. There has to be effective management of patients with underlying chronic conditions. There is improved MDR-TB success rate due to the implementation of the new medication short-term regimen. Conducted daily and weekly monitoring by operational managers.
48 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Changes to planned targets
None
Linking performance with budgets
The Department has achieved 44% of planned target in the year under review and expenditure is at 100.0%
Sub-programme expenditure
2019/2020 2018/2019
Sub- Programme Final Actual (Over)/Under Final Actual (Over)/Under Name Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000
District 467 717 467 741 ( 24) 380 497 380 496 1 Management Community Health 1 694 358 1 694 383 ( 25) 1 454 549 1 443 409 11 140 Clinics Community Health 1 105 267 1 105 234 33 943 598 952 990 ( 9 392) Centres Community Based 19 264 18 895 369 19 076 18 317 759 Services
HIV/AIDS (HAST) 2 019 143 2 014 642 4 501 1 898 883 1 888 810 10 073
Integrated 10 105 10 038 67 10 832 10 012 820 Nutrition
District Hospitals 3 589 754 3 594 675 ( 4 921) 3 324 286 3 337 645 ( 13 359)
Total 8 905 608 8 905 608 - 8 031 721 8 031 679 42
49 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PROGRAMME 3: EMERGENCy MEDICAL SERVICES
Purpose
The purpose of Emergency Medical Services is to provide pre-hospital medical services, inter-hospital transfers, Rescue and Planned Patient Transport to all inhabitants of Mpumalanga Province within the national norms of 15 minutes in urban and 40 minutes in rural areas.
List the sub-programmes
• Emergency Transport
• Planned Patient Transport
List the strategic objectives
• Improve access to health care services
Summary of Achievements
The following achievements were recorded during the year under review:
• The set target of 30 obstetric ambulances was achieved, and this will improve EMS response to maternal and neonatal emergencies and will in turn have a positive impact on reducing maternal and child mortality.
• Integration of Planned Patient Transport Services (PPTS) in Gert Sibande District has achieved the 40% set target as a result of the following measures:
• Appointment of a PPTS District Coordinator
• Procurement of PPTS vehicles which include 6 Crafters, 3 Polo sedans, 1 VW Caddy and 1 Nissan bakkie.
• Inter-facility transfer rate improved from 9.9% to 43.8% exceeding the 25% set target.
• 450 EMS personnel attended the debriefng session, in groups, as an attempt to deal with challenges related to Post Traumatic Stress Disorder and to improve staff morale.
• Procurement and distribution of 35 new ambulances to replace the ageing feet.
50 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 patient referrals. Emergency Control Centres are paper based. The Emergency Control Centres are paper based. accurate reporting on response time is currently diffcult accurate reporting on response time is currently diffcult. None None There is a shortage of operational ambulances and staff There is a shortage of operational ambulances and staff to achieve the desired objective Comment on deviations 18.8% The target was exceeded due to increased number of (18) (29.5%)The Emergency Control Centres are paper based. 0 0 (32) Deviation from planned target 2019/2020 43.8% 51% 43.5% 6 (cumulative 30) 40% 68 Actual Achievement 2019/2020 6 (cumulative 30) 100 Planned Target 2019/2020 9.9% 25% 63.4% 69% 63.3% 73% 0 (cumulative 24) 20% 40% 88 Actual Achievement 2018/2019 5% 24 20% 96 Actual Achievement 2017/2018 5% 69.5% 68% 72.3% 71% 6 (cumulative 24) 20% 95 Actual Achievement 2016/2017 EMS inter-facility transfer rate. EMS P1 rural response under 40 minutes rate. Programme Performance/Customized Indicators (Sector Indicators) EMS P1 urban response under 15 minutes rate. Improve maternal outcomes by increasing the number of Obstetric ambulances. Improve the use of resources by integrating PPTS into EMS operations. Strategic Objective/Provincial Indicators Improve response time by increasing the number of Operational Ambulances. Performance Indicator Improve access to health care services Programme / Sub-programme: Emergency Medical Services (EMS) Strategic objectives Strategic objectives & Performance indicators, Planned Targets and Actual Achievements
51 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provide reasons for all deviations
The section did not meet the target of increasing the number of operational ambulances. The average number of operational ambulances is 68 against the target of 100. This underperformance can be attributed to the shortage of ambulances as result of frequent mechanical breakdowns associated with an aging feet. Personnel shortage is also a contributory factor as more personnel are required to man ambulances.
The targets for urban and rural response times were not achieved. Currently reporting on the response times is not accurate as the Emergency Communication Centres are not equipped to correctly to record response times.
Strategy to overcome areas of under performance
• Procurement of Emergency Management System to address the inaccuracies of response time.
• Procurement of 67 new ambulances to replace the ageing feet and work towards achieving the baseline of 100 operational ambulances.
• Appointment of additional staff to man the baseline operational ambulances.
Changes to planned targets
None.
Linking performance with budgets
The Department has achieved 50% of its planned targets for this programme in the year under review and expenditure is at 100.0%.
Sub-programme expenditure
Sub- Programme 2019/2020 2018/2019 Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000
Emergency Medical 410 178 410 174 4 356 220 357 395 ( 1 175) Services Planned Patient 8 884 8 884 - 7 202 6 017 1 185 Transport 419 062 419 058 4 363 422 363 412 10 Total
52 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES Purpose The purpose of this programme is to render level 1 and level 2 health services in regional hospitals and to render TB specialized hospital services. List the sub-programmes • Regional Hospital Services • TB Specialised Hospital Services
List the strategic objectives • Improved quality of health care
Signifcant achievements To improve provision of quality healthcare at all three (3) Regional Hospitals, the Department has functional adverse events committees. The appointment of a Senior Clinical Manager in Mapulaneng is envisioned to strengthen the management and response to patient safety incidences and clinical supervision. Ermelo regional hospital increased the number of active ICU beds to four to increase its capacity to manage referrals within the Gert Sibande District. The committees meet on a monthly basis and on ad hoc basis to discuss adverse events, identify gaps and recommend measures to address identifed gaps.
53 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations None Daily ward rounds Acute Less number of patients admitted in the Sub the overall utilisation average TB wards affected and Blood, NHLS and Bandages & dressing. longer to resolve, mostly due shortage of specialists Deviation from planned target 22019/2020 0 (5.4) (11.2%) Complaints related to clinical management takes Actual Achievement 2019/2020 3 Planned Target 2019/2020 3 Actual Achievement 2018/2019 3 Actual Achievement 2017/2018 3 Actual Achievement 2016/2017 3 4.4 days 4 days81.2% 0.2 days 77.9%R 2 985.6 4.7 days R 3 281.6 (7.6%)100% 4,3 days R 3 858.4 75% 0.4 89.1% R 3,272 69,6% R 4,01.4 94.4% (R739.4) 90% The high expenditure is due to over on 78.8% Indicator Strategic Objective/Provincial Indicators Functional Adverse Events Committees Programme Performance/Customized Indicators (Sector Indicators) Average Length of Stay (Regional Hospitals) Inpatient Bed Utilisation Rate (Regional Hospitals) Expenditure per PDE (Regional Hospitals) Complaint Resolution within 25 working days rate (Regional Hospitals) Programme / Sub-programme: Regional Hospitals Strategic objectives Performance Improved quality of health care Strategic objectives & Performance indicators, Planned Targets and Actual Achievements
54 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 The strengthening of hospital complaints management committees resulted in the improved Management of complaints. Comment on deviations Deviation from planned target 2019/2020 Actual Achievement 2019/2020 Planned Target 2019/2020 Actual Achievement 2019/2020 Actual Achievement 2018/2019 97.3% 100% 98.6% 95% 100% 5% Achievement 2017/2018 Complaint Resolution within 25 working days rate (Specialised Hospitals) Performance Indicator Actual Programme / Sub-programme: TB Specialised Services Strategic objectives Improve access to health care services Strategic objectives & Performance and Actual indicators, Achievements Planned Targets
55 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provide reasons for all deviations
Inpatient Bed Utilisation Rate (Regional Hospitals) due to less number of patients admitted in the sub-acute and TB wards which affected the overall average.
The Complaint Resolution within 25 working days rate (Regional Hospitals) was not achieved as some of the complaints are related to clinical management of patients, especially whilst waiting for specialists’ clinical intervention.
Strategy to overcome areas of under performance
Monitor the trend of bed utilisation and review the number of usable beds where applicable. The department plans to repurpose some of the wards to increase number of high care beds in the regional hospitals. The department is in the process of headhunting specialists for the base clinical domains for regional hospitals to increase the pool of specialists.
Changes to planned targets
None
Linking performance with budgets
The programme achieved 33% of its planned APP targets for the year under review, while expenditure is contained at 100.0%.
Sub-programme expenditure
Sub- 2019/2020 2018/2019 Programme Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 General 1 246 913 1 247 026 ( 113) 1 127 902 1 142 554 ( 14 652) (Regional) Hospitals Tuberculosis (TB) 139 298 139 185 113 196 817 182 362 14 455 Hospitals
Psychiatric/ 48 572 48 571 1 44 054 43 857 197 Mental Hospitals
Total 1 434 783 1 434 782 1 1 368 773 1 368 773 -
56 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
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.
List the sub-programmes
• Tertiary Hospitals
List the strategic objectives
• Improved quality of health care
Signifcant Achievements
The following achievement were made during the fnancial year:
• The frst Oncology Chemotherapy services in the province were established at Rob Ferreira hospital in August 2019 to cater for patients throughout the province.
• A four bedded neonatal ICU was commissioned at Witbank hospital, to improve access to neonatal critical care, the beds will be increased in a phase in approach
• The tertiary hospitals strengthened provision of specialised services through additional appointments of 13 x Medical specialists (1 x Neurosurgery, 1 x Paediatric, 1x Dermatology, 1x ENT, 1x Anaesthesiology,1x Obstetrics & Gynaecology, 3 X Internal medicine, 1x Opthalmology,1x Psychiatry, 1 x Maxillo Facial, 1 x Head of Unit ENT, 5 specialist Nurses Oncology, 1 Pharmacist Oncology
• A total of 36 Registrars enrolled for specialist training in different disciplines
• Procurement of 62 medical equipment to strengthen clinical management of patients, which included 1x Ventilators; 1x Holter ECG Machine 1x Digital X-ray Machine-Fixed, 1x Digital C-Arm Machine Theatre, 1x Neonatal Mobile Portable X-Ray, 1x Opthalmology microscope, 8x ECG Machines, 31x Mobile Suction with Battery Backup,56x Wall Mounted Patient Monitor with ECG, 62x Infusion Pumps
57 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 management committees resulted in the improved Management of complaints. high bed utilisation at tertiary level Comment on deviations 0 None Deviation from planned target 2019/2020 Actual Achievement 2019/2020 2 2 Planned Target 2019/2020 2 Actual Achievement 2018/2019 2 Actual Achievement 2017/2018 88.3% 98.20% 98.2% 90% 92.7% 2.7% The strengthening of hospital complaints R 2 910,8 R 3 161,6 R 4 889,91 R 4,105 R 4,124.4 (R19.40) The expenditure per PDE is within acceptable norms, 85.8% 79.8% 81.3% 75% 75.9% 0.9% Orthopaedic and mental health patients contributed to the 7.1 days 6.1 days 6.9 days 6 days 5.5 days 0.5 days ALOS is within acceptable norm 2 Actual Achievement 2016/2017 Complaint Resolution within 25 working days rate (Tertiary Hospitals) Expenditure per PDE (Tertiary Hospitals) Inpatient Bed Utilisation Rate (Tertiary Hospitals) Programme Performance/Customized Indicators (Sector Indicators) Average Length of Stay (Tertiary Hospitals) Strategic Objective/Provincial Indicators Functional Adverse Events Committees Indicator Improve access to health care service Programme / Sub-programme: Tertiary Hospitals Programme / Sub-programme: Tertiary Strategic objectives Performance Improved Quality of Health Care Strategic objectives & Performance indicators, Planned Targets and Actual Achievements
58 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provide reasons for all deviations
Bed utilization rate of 76% against a target of 75% is due to Orthopaedic and mental health patients staying for longer periods in the tertiary hospital
Strategy to overcome areas of under performance
• The Department will continue conducting orthopaedic operations during 2020/21.
• Appointment of orthopaedic specialists and Psychiatrists in both the tertiary hospitals
Changes to planned targets
None
Linking performance with budgets
The Department under this programme achieved 60% of its planed targets, while expenditure is at 99.9%.
Sub-Programme expenditure
Sub- Programme Name 2019/2020 2018/2019 Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Tertiary Hospital Services 1 303 516 1 302 292 1 224 1 224 452 1 222 888 1 564 Total 1 303 516 1 302 292 1 224 1 224 452 1 222 888 1 564
PROGRAMME 6: HEALTH SCIENCE AND TRAINING
Purpose
The purpose of the Health Sciences and Training programme is to ensure the provision of skills development programmes in support of the attainment of the identifed strategic objectives of the Department.
List the sub-programmes
• Nursing Training College.
• EMS Training College Health.
List the strategic objectives
• Improve quality of health care
Signifcant Achievements
This programme has persistently been able to provide training to a little more health workers than originally planned. This is brought about as a result of continued support from NGO’s who are able to provide training for health workers with private funding. The department is also able to utilize internal facilitators to provide skills development initiatives to its employees and beyond. This has made the department to be able to respond effectively to the demands in the provision of quality health care in the province.
The Department has also been able to enrol more nursing students into the diploma programme in an effort to cover the backlog on the upgrading of staff nurses. The introduction of the bursary programme for students in this programme has made available signifcant savings on the Compensation budget.
The training of more nurses will improve the nurse patient ratio and also provide quality nursing care required by all patients. The production of more nurses will also reduce the vacancy rate in the department.
59 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 to be enrolled in order cover the backlog as legacy diploma programme was drawing to a close. More training was provided with the assistance of NGO’s The programme aimed for accreditation was discontinued by the HPCSA Comment on deviations 130 Additional nursing students had 216 (1) Deviation from planned target 2019/2020 Not applicable None None 1 210 5216 0 Actual Achievement 2019/2020 80 5000 0 1 Planned Target 2019/2020 90 5 830 0 Actual Achievement 2018/2019 250 6 104 10 Actual Achievement 2017/2018 Actual Achievement Actual 2016/2017 241 4 338 10 New indicator New indicator New indicator Number of Bursaries awarded for frst year nursing students Improve human resource effciency by training health care professionals on critical skills Programme Performance/Customized Indicators (Sector Indicators) Bursaries of Number awarded for frst year medicine students Improve access to EMS training by increasing the number of accredited EMS colleges Strategic Objective/Provincial Indicators Performance Indicator Improved quality of health care Programme / Sub-programme: Health Sciences and Training (HST) Programme / Sub-programme: Health Sciences and Training Strategic objectives Strategic objectives & Performance indicators, Planned Targets and Actual Achievements Services1. are rendered the by Department of Basic Education with effect henceforth from 2017/18
60 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provide reasons for all deviations
Additional nursing students had to be enrolled in order to cover the backlog as the legacy diploma programme was drawing to a close and the assistance of NGO in training Health Care workers.
Strategy to overcome areas of under performance
The department has not experienced under performance per se on this programme
Changes to planned targets
None
Linking performance with budgets
The programme has achieved 67% of the planned APP targets for the fnancial year under review, while expenditure is at 100.0%.
Sub-programme expenditure
Sub- 2019/2020 2018/2019 Programme Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000
Nursing Training 188 881 188 847 34 149 276 151 241 ( 1 965) Colleges EMS Training 3 707 3 845 (138) 4 559 4 287 272 Colleges Bursaries 47 214 46 698 516 61 685 60 397 1 288
Primary Health 3 363 3 363 - 5 374 5 376 (2) Care Training Other Training 171 478 171 795 (317) 144 945 144 537 408
Total 414 643 414 548 95 365 839 365 838 1
61 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PROGRAMME 7: HEALTH CARE SUPPORT SERVICES (HCSS) Purpose
The Health Care Support Service programmes aim to improve the quality and access of health care provided through: • The availability of pharmaceuticals and other ancillaries. • Rendering of credible forensic health care that contributes meaningfully to the criminal justice system. • The availability and maintenance of appropriate health technologies improvement of quality of life by providing needed assistive devices. • Coordination and stakeholder management involved in specialized care. • Rendering in-house services within the health care value chain.
There are three directorates within programme 7 namely:
List the sub-programmes
• Laundry Services • Health Technology Services • Forensic Services • Pharmaceutical Services
List the strategic objectives
• Improve quality of health care.
Signifcant Achievements Medical equipment to the value of R 96, 6 million purchased and delivered to District, Regional, Tertiary Hospitals and EMS. The availability of medical equipment will enhance the quality of care provided and the management of patients.
62 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations Shortage of active ingredients for some of the drugs and failure by suppliers to deliver the requested amounts Increased establishment of Pick up Points and monitoring of performance Non Compliance at Phola Phola at Compliance Non equipment X-ray Replace CHC. been not has and old is it since years. some for operational do to Radiographer a Assign Outreach services Delays in completion of laundry in in laundry of completion in Delays Witbank hospital. Target exceeded due to to due exceeded Target of manufacturing in assistance at Interns and students by devices centres. MOP None None Deviation from planned target 2019/2020 (10%) 106 701 (3%) (1) 1 399 0 0 Actual Achievement Actual 2019/2020 85% 97% (29/30) 22/33 5 649 28 21 Planned Target 2019/2020 95% (295/310) 100% (30/30) Actual Achievement 2018/2019 (262/310) 90% (27/30) 21 28 21 21 Actual Achievement 2017/2018 86.7% (26/30) 92% 89% 84% Achievement 2016/2017 87 063 186 407 261 551 244 000 350 701 80% (24/30) 31 33 28/28 23/33 5 942 5 277 4 754 4 250 21 20 21 21 Improve quality of care by increasing availability of medicines and surgical sundries at the Medical Depot. Performance Indicator Actual Number of patients initiated on Central Chronic Medicine Dispensing and Distribution (CCMDD) Improve access to quality of care through compliance with Radiation Control prescripts by all facilities with X-Ray equipment Number of hospitals providing laundry services Number of Orthotic and Prosthetic devices issued Number of hospitals with functional transfusion committees Number of sites rendering Forensic Pathology Services (FPS) Programme / Sub-programme: Health Care Support Services (HCSS) Strategic objectives Improved quality of health care Improved quality of health care Strategic objectives & Performance indicators, Planned Targets and Actual Achievements Actual and & Performance Targets objectives Strategic Planned indicators,
63 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Provide reasons for all deviations
At Phola Nsikazi CHC there was no audit done. The X-ray equipment is old and has not been operational for some years. No Radiographer appointed on site.
The target for number of hospitals providing laundry services could not be achieved due to the delays in the completion of the Witbank Hospital laundry.
Strategy to overcome areas of under performance
Replace X-ray equipment at Phola Nsikazi CHC since it is old and has not been operational for some years. Assign a Radiographer to do outreach at Phola CHC.
The projection for the completion of the laundry service in Witbank will be closely monitored to ensure adherence to time lines.
Changes to planned targets
None
Linking performance with budgets
The programme performed exceptionally well at 71% and expenditure is at 91.6%.
Sub-programme expenditure
Sub- 2019/2020 2018/2019 Programme Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000
Laundries 41 791 41 284 507 31 028 30 878 150
Engineering 37 148 36 484 664 23 335 18 477 4 858
Forensic 94 558 94 542 16 84 597 86 450 Pathology ( 1 853) Services Orthotic and 5 903 5 448 455 4 500 4 191 Prosthetic 309 Services Medicine Trading 61 112 42 558 18 554 14 468 17 932 ( 3 464)
Total 240 512 220 316 20 196 157,928 157,928 -
64 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
PROGRAMME 8: HEALTH FACILITy MANAGEMENT
Purpose
The purpose of the programme is to build, upgrade, renovate, rehabilitate and maintain health facilities.
List the sub-programmes
• Infrastructure Management
• Hospital Revitalisation
• Facilities Management
List the strategic objectives
• Improved health facility planning and accelerate infrastructure delivery
• Re-alignment of human resource to Departmental needs
Signifcant Achievements
The Department has completed the following clinics
New Clinic
• Vukuzakhe clinic (co-funded with NDOH)
• Nhlazatshe clinic (co-funded with NDOH)
• Msukaligwa Clinic, Ethandukukhanya CHC and Balfour CHC – Project started
• Oakley clinic – Completed
• Schuzendal Clinic Phase 1: Construction of IBT Structures, septic tank, electricity and water - completed
• Schuzendal Clinic Phase 2: Construction of new perimeter fence, medical waste area, carports – completed
• Kamdladla clinic – project has started and progressing well
65 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Upgrading work completed.
• Rob Ferreira Hospital [Part A] Renovations and alterations to the existing nurses accommodation building at Rob Ferreira(Relocation of services)
• Mapulaneng Hospital: Immediate temporary Works and Major remedial works at Mapulaneng Hospita
• Middelplaas Clinic: Construction of IBT Structures, septic tank, electricity, and water (Phase 1) and upgrading of existing guardhouse
• Newtown Clinic: Construction of a new Ablution Block and Septic Tank
• Tintswalo Hospital: Upgrading of the existing kitchen (Backlog maintenance)
• Rob Ferreira Hospital: Mortuary.
• Mthimba clinic: Renovation and alterations (Backlog maintenance)
• Mananga clinic: Renovation and alterations (Backlog maintenance)
• Siyabuswa CHC: Renovations (Backlog maintenance)
• RTC Training: Upgrading of student accommodations (Backlog maintenance)
Security fencing
• Matsulu clinic – Erection of new concrete palisade fence.
• Nkwalini clinic – Erection of New concrete palisade fence.
• Mangweni clinic – Erection of New concrete palisade fence
• Msogwabo clinic – Erection of New concrete palisade fence
• M’Africa CHC – Erection of New steel palisade fence
• RTC Training – Erection of New concrete palisade fence.
• Justicia clinic – Erection of New concrete palisade fence
66 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 None Comment on deviations Deviation from planned target 2019/2020 0 None 0 8 Ehlanzeni: 2 KaNyamazane Clinic – contractor appointed busy with contract documents Oakley Clinic - 98% Gert Sibande: 5 Balfour Clinic -Contractor appointed doing site establishment, progress (1%) Clinic- 100% Vukuzakhe Nhlazatshe Clinic - 100% Msukaligwa Clinic - 15% Ethandukukhanya Clinic – 15% Nkangala: 1 Pankop Clinic - 58% Actual Achievement Actual 2019/2020 5 Ehlanzeni: 2 (Oakley & Kanyamazane) Gert Sibande: 5 (Balfour, Vukuzakhe, Msukaligwa, Ethandukukhanya and Nhlazatshe 6 Nkangala: 1 (Pankop) 8 2019/2020 5 (Cumulative 287/287 Ehlanzeni (2) Kanyamazane Clinic: Mbombela Bulk Earthwork is 100% Oakley Clinic : Progress is 80% Gert Sibande (5) Clinic: Progress Vukuzakhe is 52% Nhlazatshe 6 Clinic: Progress is 62% Msukaligwa Clinic: Contractor appointed awaiting fnalization of documents Balfour Mini Hospital: briefng done Tender Ethandukukhanya Clinic : briefng done Tender Actual Achievement 2018/2019Actual Planned Target Goromane Clinic: Progress is 100% Makoko Clinic: Progress is 100% Luphisi Clinic: Progress of Clinic structure is 100% Luphisi Clinic : Guardhouse, Refuse area, waiting area – Progress is 100% Ntunda Clinic –progress is 100% Actual Achievement 2017/2018 6 (cumulative 14) Ehlanzeni: 5 Gert Sibande: 7 Nkangala: 2 39 (Cumulative 279/287) 8 (Ehlanzeni: 2 Gert Sibande: Actual Achievement 2016/2017 90 PHC facilities maintained Number of PHC facilities constructed (new/ replacement) Strategic Objective / Provincial Indicators Improve access to healthcare by increasing number of PHC facilities maintained. Performance Indicator Programme / Sub-programme: Health Facilities Management (HFM) Strategic objectives Improved health facility planning and infrastructure delivery
67 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Backlog maintenance requested by districts None not enough for the main contractor to subcontract cooperatives Comment on deviations Deviation from Deviation planned target 2019/2020 12 0 (15) Scope of work was 43 TB, New 4 Planning (Witbank Impungwe Psychiatric, New and New Tertiary Witbank Witbank District Hospitals – Early stages of planning Business cases and Clinical Briefs are done 4 (Construction) Ehlanzeni: 1 Mapulaneng Hospital : Contractor appointed, busy with contract documents Gert Sibande 1 Bethal Hospital : 90% Nkangala: 2 Mmamethlake Hospital : 22% New Middelburg Hospital : 48% 0 Actual Achievement Actual 2019/2020 31 4 Planning (Witbank TB, New Impungwe Psychiatric, New and Tertiary Witbank New Witbank District Hospitals 4 (Construction) Ehlanzeni: 1 (Mapulaneng) 1 Gert Sibande: Bethal Nkangala: 2 (Mmammethlake & New Middelburg) 15 cooperatives appointed (cumulative 43) Planned Target 2019/2020 Actual Achievement Actual 2018/2019 Ehlanzeni (1) Mapulaneng Hospital: Phase 1: Progress is 91% Phase 2: Progress is 100% Phase 3: Design stage is complete waiting for confrmation to go out on tender Gert Sibande (1) Bethal Hospital : Progress is 83,4% Nkangala (1) Middelburg Hospital : Progress is 28% 18 cooperatives appointed (28 Cumulative) Actual Achievement 2017/2018 3 Planning phase teams appointed Not in Plan 31 31 0 20 10 Actual Achievement 2016/2017 Number of Hospitals under maintenance Enhance patient care & safety and improving medical care by constructing Modern hi- tech hospitals Improve maintenance of health facilities by appointing cooperatives Indicator Strategic Objective / Provincial Indicators Programme / Sub-programme: Health Facilities Management (HFM) Strategic objectives Performance Improved health facility planning and infrastructure delivery
68 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Comment on deviations None None Deviation from planned target 2019/2020 0 0 Actual Achievement Actual 2019/2020 6 Hospitals 5 PHC 4 Planning TB, New Impungwe (Witbank Psychiatric, New Witbank and New Witbank Tertiary District Hospitals – Early stages of planning Business cases and Clinical Briefs are done 4 (Construction) Ehlanzeni: 1 Mapulaneng Hospital : Contractor appointed, busy with contract documents Gert Sibande 1 Bethal Hospital : 90% Nkangala: 2 Mmamethlake Hospital : 22% New Middelburg Hospital : 48% Planned Target 2019/2020 6 Hospitals 5 PHC 2 Hospitals 6 PHC Actual Achievement Actual 2018/2019 14 PHC completed 5 Hospitals Matikwane Hospital Renovation of roof – progress is 100% Witbank Hospital – progress is 100% Psychiatric ward – Project on planning Schuzendal Clinic: Progress is 55% Middelplaas Clinic: progress is 90% Ntunda Clinic: progress is 100% Goromane Clinic: Progress is 100% Makoko Clinic: Progress is 100% Luphisi Clinic: Progress of Clinic structure is 100% Luphisi Clinic : Guardhouse, Refuse area, waiting area – Progress is 100% Actual Achievement 2017/2018 25 PHC* (cumulative 40) 4 Hospitals 10 PHC Actual Achievement 2016/2017 19 PHC facilities completed 5 Hospital completed 13 PHC completed Performance Indicator Programme Performance / Customized Indicators (Sector Indicators) Number of health facilities that have undergone major and minor refurbishment) in NHI Pilot District Number of health facilities that have undergone major and minor refurbishment outside NHI pilot District ( excluding facilities in NHI Pilot District) Programme / Sub-programme: Health Facilities Management (HFM) Strategic objectives
69 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Changes to planned targets
None.
Linking performance with budgets
The programme performed exceptionally well at 71% and expenditure is at 99.9%.
Sub-programme expenditure
Sub- Programme 2019/2020 2018/2019 Name Final Actual (Over)/Under Final Actual (Over)/Under Appropriation Expenditure Appropriation Expenditure Expenditure Expenditure R’000 R’000 R’000 R’000 R’000 R’000 Community Health 787 491 806 694 ( 19 203) 953 308 887 194 66 114 facilities District hospital Services 77 971 55 632 22 339 97 387 106 098 ( 8 711) Provincial Hospital 266 944 268 431 ( 1 487) 267 152 262 770 4 382 Services Other Facilities 0 0 0 0 0 0 Total 1 132 406 1 130 757 1 649 1 317 847 1 256 062 61 785
5. TRANSFER PAyMENTS 5.1. Transfer and Subsidies 2019/2020
DESCRIPTION EXPENDITURE
R’000 Skills Development Levy 42,758 Licences 184 Provinces and Municipalities 1,504 Home Base Care Services 261,702 District Health Services 71,728 Injury On Duty 24 Leave Gratuity 28,389 Claims Against State(Cash) 45,531 Bursaries(Non-Employee) 42,153 Donations & Gifts(Cash) 33 TOTAL 494,006
5.2. Transfer payments to all organisations other than public entities
Name of Public Entity Services rendered by the Amount transferred to Amount spent by the Achievements of the public entity the public entity public entity public entity
None None None None None
70 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
5.3. Transfer payments to all organisations other than public entities
The table below refects the transfer payments made for the period 1 April 2019 to 31 March 2020
Name of Type of Purpose for Did the Amount transferred Amount spent by the Reasons transferee organisation which the dept. entity for the (R’000) funds were comply funds used with s 38 unspent (1) (j) of the by the PFMA entity Various Non-proft Community Yes R335 188 000.00 R333 430 480.00 None non-proft organisations health services organisation
The table below refects the transfer payments which were budgeted for in the period 1 April 2019 to 31 March 2020, but no transfer payments were made.
Name of transfer Purpose for which the Amount budgeted for Amount transferred Reasons why funds funds were to be used were not transferred (R’000) (R’000)
None None None None None
71 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
6. CONDITIONAL GRANTS 6.1. Conditional grants and earmarked funds paid
Conditional Grant 1: Comprehensive HIV, AIDS and TB Grant
Mpumalanga Department of Health Department/ Municipality to whom the grant has been transferred Decrease the burden of disease related to the HIV and tuberculosis Purpose of the grant epidemics; to minimise maternal and child 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 Expected outputs of the grant TB and zero discrimination associated with HIV, STIs and TB (UNAIDS
514 605 Total clients remaining on ART (TROA)
98% Antenatal client initiated on ART rate
1 635 933 Clients tested (including ANC)
Actual outputs achieved 52 632 Medical male circumcision performed
206 981 HIV positive clients screened for TB
101.2% TB symptom 5yrs and older started on treatment rate
58% TB MDR treatment success rate R 1 998 197 Amount per amended DORA (R’000)
R 1 998 197 Amount transferred (R’000)
N/A Reasons if amount as per DORA not transferred
R 1 998 197 Amount spent by the department/ municipality (R’000)
N/A Reasons for the funds unspent by the entity
Monthly variance report
Quarterly DoRA report Monitoring mechanism by the transferring department Quarterly grant reviews
72 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 2: Health Facility Revitalisation Grant
Department/ Municipality to whom the grant has been transferred Mpumalanga Department of Health
The purpose of the grant is to help accelerate construction, maintenance, upgrading and rehabilitation of new and existing infrastructure in Health including; Health Purpose of the grant Technology, Organizational Developments Systems and Quality Assurance; to enhance capacity to deliver health infrastructure
Expected outputs of the grant The fnal infrastructure developed for service delivery
31 Hospital were maintained on day to day maintenance.
100% Refurbishment of Mthimba clinic
100% Construction of Toilets & Fence at Mangweni clinic
100% Refurbishment of Clau Clau clinic
98% Construction of Oakley clinic
Actual outputs achieved 100% Refurbishment of sewerage plant at Shongwe Hospital
100% Kitchen upgrade at Tintswalo Hospital
100% Kitchen & Laundry at Mapulaneng Hospital
Furthermore, the maintenance of life serving equipment’s were done
Amount per amended DORA (R’000) R 344 915
Amount transferred (R’000) R 344 915
Reasons if amount as per DORA not transferred N/A
Amount spent by the department/ municipality (R’000) R 344 915
Reasons for the funds unspent by the entity N/A
Monthly variance report Quarterly DoRA report Monitoring mechanism by the transferring department Quarterly grant reviews
73 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 3: Health Professions Training and Development Grant
Mpumalanga Department of Health Department/ Municipality to whom the grant has been transferred
Support provinces to fund service costs associated with clinical training and supervision of health science trainees on Purpose of the grant the public service platform.
Provision of clinical teaching and training of health Expected outputs of the grant professionals in designated facilities.
Clinical teaching and training of health professionals was provided as per business plan through outreach services. • 8 registrars - registered in different feld of speciality • 34 specialists - provided clinical training to other health Actual outputs achieved professionals • 11 clinical supervisors (Nurse preceptor) - provided clinical teaching to student nurses
R120 901 Amount per amended DORA (R’000)
R120 901 Amount transferred (R’000)
N/A Reasons if amount as per DORA not transferred
R120 859 Amount spent by the department/ municipality (R’000)
N/A Reasons for the funds unspent by the entity
Monthly variance report
Monitoring mechanism by the transferring department Quarterly DoRA report
Quarterly grant reviews
74 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 4: Human Papillomavirus Vaccine Grant
Mpumalanga Department Of Health Department/ Municipality to whom the grant has been transferred
To enable the health sector to prevent cervical cancer by making available HPV vaccination for grade four school girls in Purpose of the grant all public and special schools.
Reduce prevalence of certain types of cancer later in life Expected outputs of the grant caused by Human Papilloma Virus amongst girls 9 years and older. Actual output achieved for 2019/ 2020:
Actual outputs achieved HPV 1st dose 31 552
HPV 2nd dose 43 384 R15 353 Amount per amended DORA (R’000)
R15 353 Amount transferred (R’000)
N/A Reasons if amount as per DORA not transferred
R15 163 Amount spent by the department/ municipality (R’000)
Reduced number of HPV teams during the frst round after Reasons for the funds unspent by the entity the budget adjustment resulted in reduction in the number of rented vehicles. Monthly variance report Quarterly DoRA report Monitoring mechanism by the transferring department Quarterly grant reviews
75 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 5: National Tertiary Services Grant
Mpumalanga Department of Health Department/ Municipality to whom the grant has been transferred
Ensure provision of tertiary health services in South Africa; to compensate tertiary facilities for the additional costs associated with provision of these services. Purpose of the grant
Provision of designated national tertiary services in 2 Expected outputs of the grant hospitals (Witbank and Rob Ferreira hospital), with the following targets: National tertiary services provided as per the YES list for 2019/20
• Day Patient separation – 16,994
Actual outputs achieved • In patient Days – 126,484 • In Patient separation – 28,612
• Outpatient 1st attendance – 25,428
• Outpatient follow-up attendance – 46,390 R124 390 Amount per amended DORA (R’000)
R124 390 Amount transferred (R’000)
N/A Reasons if amount as per DORA not transferred
R123 202 Amount spent by the department/ municipality (R’000)
Outstanding deliveries of medical equipment and surgical Reasons for the funds unspent by the entity consumables.
Monthly variance report Quarterly DoRA report Monitoring mechanism by the transferring department Quarterly grant reviews
76 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 6: Expanded Public Works Programme Integrated Grant for Provinces
Mpumalanga Department of Health Department/ Municipality to whom the grant has been transferred
To incentivise provincial departments to expand work creation efforts through the use of labour intensive delivery methods in the following identifed focus areas, in compliance with the Expanded Public Works Programme guidelines: road maintenance and the maintenance of buildings: low traffc volume roads and rural roads; Other economic and social Purpose of the grant infrastructure ‘: tourism and cultural industries sustainable land based livelihoods waste management
The fnal infrastructure developed for service delivery Expected outputs of the grant
Hospitals were maintained on day to day maintenance. Actual outputs achieved
R 2 126 Amount per amended DORA (R’000)
R 2 126 Amount transferred (R’000)
N/A Reasons if amount as per DORA not transferred
R 2 126 Amount spent by the department/ municipality (R’000)
N/A Reasons for the funds unspent by the entity
Monthly variance report Quarterly DoRA report Monitoring mechanism by the transferring department Quarterly grant reviews
77 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 7: Social Sector Expanded Public Works Programme Incentive Grant for Provinces
Department/ Municipality to whom the grant has been Department of Health transferred
To incentivise the provincial social sector departments identifed in 2019 in Social Sector EPWP log-frame to Purpose of the grant increase job creation for focusing on the strengthening and expansion of social services programme that have employment potential.
326 volunteers (56 Clinic Admins and 268 CHW’s) Expected outputs of the grant recruited and paid stipend.
323 volunteers (51 Clinic Admins and 272 CHW’s) Actual outputs achieved recruited and paid stipend
Amount per amended DORA (R’000) R15 464
Amount transferred (R’000) R15 464
Reasons if amount as per DORA not transferred N/A
Amount spent by the department/ municipality (R’000) R15 102
Reasons for the funds unspent by the entity 5 Clinic Admins were never recruited.
Monthly variance report Monitoring mechanism by the transferring department Quarterly DoRA report Quarterly grant reviews
78 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Conditional Grant 8: National Health Insurance Grant
Department/ Municipality to whom the grant has been Mpumalanga Department of Health transferred
To expand the healthcare service benefts through Purpose of the grant the strategic purchasing of services from healthcare providers
Implementation of strategic purchasing platform for Expected outputs of the grant healthcare providers Number of Health Practitioners contracted
22 Medical Practitioners Contracted in Gert Sibande District 31 Medical Practitioners Contracted in Ehlanzeni District from 01 January 2020 - 31 March 2020 Actual outputs achieved 36 Primary Health Care Facilities serviced by contracted Medical Practitioners, coverage is 47% (36/76) 42 999 Patients seen by the contracted Medical Practitioners
Amount per amended DORA (R’000) R 21 136
Amount transferred (R’000) R 21 136
Reasons if amount as per DORA not transferred N/A
Amount spent by the department/ municipality (R’000) R 21 136
Reasons for the funds unspent by the entity N/A
Monthly variance report Monitoring mechanism by the transferring department Quarterly DoRA report Quarterly grant reviews
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Conditional Grant 9: Human Resource Capacitation Grant
Department/ Municipality to whom the grant has been transferred Mpumalanga Department of Health
To adequately skill and capacitate health professionals in Purpose of the grant service delivery platform
Enhance access to medical, clinical and allied health services through human resources capacitation by managing Expected outputs of the grant and sustaining the 251 appointments made during the last quarter of the 2018/19 Financial Year.
Managing and sustaining the 251 appointments made during Actual outputs achieved the last quarter of the 2018/19 Financial Year
Amount per amended DORA (R’000) R60 243
Amount transferred (R’000) R60 243
Reasons if amount as per DORA not transferred N/A
Amount spent by the department/ municipality (R’000) R 60 243
Reasons for the funds unspent by the entity N/A
Monthly variance report Monitoring mechanism by the transferring department Quarterly DoRA report Quarterly grant reviews
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7. DONOR FUNDS 7.1 Donor Funds Received None 8.CAPITAL INVESTMENT 8.1 Capital investment, maintenance and asset management plan
The Department has completed the following projects during the year under review: • 100% Goromane Clinic • 100% Makoko Clinic • 100% Luphisi Clinic Structure • 100% Luphisi Clinic: Guardhouse, Refuse area, waiting area • 100% Ntunda Clinic • 100% Embhuleni Hospital: 100% (Backlog maintenance) • 100% Themba Hospital Workshop: Backlog maintenance • 100% Tonga Hospital: Backlog maintenance • 100% Witbank Hospital: Renovation of EMS station • 100% Refurbishment of sewerage plant at Shongwe Hospital • 100% Tintswalo Hospital: Kitchen upgrade • 100% Mapulaneng Hospital: Kitchen & Laundry • 100% Themba Hospital: Fencing • 100% Matibidi Hospital: Upgrading of OPD & Casualty • 100% Ntunda Clinic • 100% Goromane Clinic • 100% Makoko Clinic • 100% Matikwane Hospital Renovation of roof • 100% Witbank Hospital
The Department has the following projects in progress during the year under review: • 31 Hospital Maintained (Day to day) • 90% Amajuba Hospital: Backlog maintenance • 50% Witbank Hospital: Construction of new Laundry building and Renovation of Mental ward • 70% Tintswalo Hospital: Renovation of Mental Health • Psychiatric ward – Project on planning • 55% Schuzendal Clinic • 90% Middelplaas Clinic • 68% Pankop Clinic • 46% Middelburg Hospital • 4% Rob Ferreira Hospital (Nurses Accommodation - Phase 2A) • 20% Mmametlhake Hospital (Phase 3)
The Department is currently upgrading Bethal and Mmamethlake Hospital. It is also planning to downgrade existing Witbank tertiary Hospital to District in the next 5 years. Planning for the construction of a new Tertiary hospital has commenced. The Department has managed to maintain 33 Hospitals, 287 PHC facilities including refurbishment of Witbank Hospital EMS, Leandra EMS and KwaMhlanga Forensic Hospital Mortuary.
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The following developments may impact on the department’s current expenditure: • Renovations of the 3 EMS stations (Moloto, Nelspruit and Embhuleni) and erection of concrete palisade fences in various PHC facilities. • The Department has completed the User Assets Management Plan (UAMP) to ensure that the department’s asset register is up-to-date during the period under review.
Department’s capital assets (Poor, Fair, Good and excellent)
Index Number of facilities Percentage Poor 11 3% Fair 236 74% Good 66 20% Excellent 8 3% 321 100%
2018/2019 2019/20 Infrastructure projects 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
New and replacement assets 428 696 473 585 (45 112) 377 411 360 265 17 146
Existing infrastructure assets 779 990 636 033 143 957 520 796 533 089 (12 293)
• Upgrades and additions 539 037 408 329 130 708 229 825 244 751 (14 926)
• Rehabilitation, renovations 17 211 14 385 2 826 15 674 13 315 2 359 and refurbishments
• Maintenance and repairs 223 742 213 319 10 423 275 297 275 023 274
Infrastructure transfer 0 0 0 0 0 0
Infrastructure 2018/2019 2019/2020 R’000 R’000 • Current 79 733 93 430 (13 697) 145 814 145 153 661 • Capital 29 412 57 397 (27 985) 88 035 87 609 426 Total 1 317 831 1 260 445 57 386 1 132 056 1 126 116 5 940
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PART C: GOVERNANCE
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1. INTRODUCTION The Mpumalanga Department of Health has established functional governance structures which include the Audit Committee, Risk Management and Ethics Committee which are tasked with the responsibility of ensuring that risks are mitigated or managed, internal controls are adequate and effective and governance processes are implemented to achieve intended service delivery within prudent fscal management. Furthermore, internal audit conducts reviews of compliance to governance processes, and areas of improvements are identifed and implemented by management. This includes an audit of pre- determined objectives, ICT, SCM, and fnancial.
2. RISK MANAGEMENT The Mpumalanga Department of Health has an approved risk management policy, strategy and implementation plan which were prepared in consultation with the Risk Committee and approved by the Head of Department on 14th June 2019. Progress on the risk management implementation plan is reported to the Risk Management and Risk & Ethics Committees on a quarterly basis. The Department conducts annual risk assessment workshops which also includes a fraud risk assessment and risk registers are being updated regularly. All emerging risks are reported to the Management and risk management committee meeting. The strategic risk assessment workshop was conducted on 04th February 2019 whilst the operational risk assessment workshops were conducted from 07 to 24 February 2019 and the assessment reports were fnalised in March 2019. The Risk Management unit operates with a moderate vacancy rate however it has a functional Risk and Ethics Committee with an independent chairperson which held 4 successful meetings during the year under review. Institutional risk registers were reviewed in the 3 districts and 33 hospitals. Risk management awareness workshops were conducted in the 3 districts and sub-districts targeted at district management teams and risk champions to create awareness on the importance of risk management and communicate the framework, policy and strategy. The Department monitors and reports on all risks to the Risk & Ethics Committee and to the Audit Committee quarterly on signifcant, fraud and ICT risks. Changes on the risk profle including new and emerging risks are reported quarterly to the Risk and Audit Committees. The Department noticed minimal progress in the management of risks and this could be attributed to the following: a. Continuous amending of mitigating plans for risks associated with the existence of the department demonstrating lack of long term planning to adequately address root causes; b. The forward shifting of mitigating plans resulting in overcrowding activities to be undertaken this could therefore be translated as over achievement in that specifc quarter whereas such an activity had a different planned due date; c. Lack of ownership on risks which cuts across Programmes (e.g. unaffordable healthcare costs, poor records management, and a high number of litigation cases and inadequate collection of revenue). The Department established an internal Risk Management Committee chaired by the Chief Financial Offcer constituting of representatives from all programmes whose primary role is to provide proper and timely reports to the Accounting Offcer on the state of risk management, together with aspects requiring improvement accompanied by the recommendations to address such issues and quarterly reports to the Risk & Ethics Committee that is chaired by an independent chairperson, any material changes to the risk profle and performance of the Department.
3. FRAUD AND CORRUPTION The Department has an approved fraud prevention strategy, policy, and implementation plan, and whistleblowing policy. The fraud prevention strategy and whistleblowing policy are available on the departmental intranet to ensure access by all employees. Fraud, anti-corruption and ethics management awareness workshops are conducted regularly for management and employees at grass root level. The Department relies on various channels to receive allegations for fraud and corruption such as the Offce of the Premier, National Anti-corruption Hotline, Public Service Commission and irregularities identifed by Internal Audit. All proven allegations of fraud and corruption are subjected to an investigation and where appropriate criminal or/and internal disciplinary processes are instituted against those found guilty as required in terms of applicable legislation. The cases received are either reported on the national anti-corruption hotline or / and via the offce of the Accounting Offcer which are allocated either to the Forensic Investigation unit within the department or Integrity Management unit in the Offce of the Premier for further investigation.
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4. MINIMISING CONFLICT OF INTEREST
Commitment by the department to maintain the highest standards of governance is fundamental to the management of public fnances and resources. Users want assurance that the department has good governance structures in place to effectively, effciently and economically utilize state resources, which are funded by the tax payer.
5. CODE OF CONDUCT
The Department applies the code of conduct for public service as a legislative framework that governs the performance of service by public servants in relation to performance of services, relationship with the public, relationship with the legislature and relationship amongst the employees themselves. The process followed if an employee breaches the Code of Conduct is as follows: The Head of Department issues a notice to invite representation from the perpetrator to give reasons why he/she must not be charged with misconduct for breach of the code of conduct. In this notice the employee is given 5 working days to respond. Upon the expiry of the 5 days’ notice based on the representation referred above, the Head: Health applies her/his mind as to whether the reasons are justifable to excuse the employee from being charged with misconduct or not. If the reasons provided are not justifable, the employee is subjected to misconduct enquiry in terms of Public Service Bargaining Council (PSCBC) Resolution 1 of 2003.
6. HEALTH SAFETy AND ENVIRONMENTAL ISSUES
Section 19 (1) of the Occupation Health and Safety Act states: An employer shall in respect of each workplace where two or more health and safety representatives have been designated, establish one or more health and safety committees and, at every meeting of such a committee as contemplated in sub-section (4), consult with the committee with a view to initiating, developing, promoting, maintaining and reviewing measures to ensure the health and safety of his employees at work. The Health and Safety Committee Terms of Reference which should serve as a direction to the committee members has been developed, discussed and signed by the Head: Health. Health and Safety Representatives and Committee members have been appointed and accepted through signing of appointment letters. Health and Safety Committees are available and functional in 28/33 hospitals and Provincial offce. Amajuba Memorial and Elsie Ballot hospital convene combined H&S Committee meetings. The Department engaged National Institute for Occupational Health (NIOH) and the International Labour Organisation (ILO) to conduct the Health Wise Training for Health and Safety representatives per district in order to capacitate them with the basic knowledge to identify hazards and risks and develop mitigating strategies. This training was conducted during October 2019 and February 2020 and contributed positively to the health and safety compliance standard. The effective monitoring of policies and SOPs is on-going. Workplace place safety inspections are being carried by the Provincial OHS managers and the health and safety representatives in facilities.
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7. PORTFOLIO COMMITTEES
RESPONSES TO QUESTIONS RAISED TO THE DEPARTMENT OF HEALTH ON THE QUESTIONS EMANATING FROM THE 1st QUARTER RESPONSES
NO. QUESTION RESPONSE
a. Records of the theft cases Together with the Department of The Department together with the Department of Community, are on the rise in the Community Safety, Security and Liaison, Safety and Liaison hold monthly and special bilateral meetings health facilities strengthen security measures put in with contracted security service providers under the auspices place in the health facilities and improved of the Department of Community Safety, Security and Liaison compulsory security checks amongst whereby progress on compliance to the SLA is enforced by other monitoring that all amounts incurred by the Department due to incidents of theft/lost are recouped from the invoices submitted by the Department of Community Safety, Security and Liaison. This keep the contracted security service provider on high alert.
The Department of Community Safety, Security and Liaison appointed Monitoring Offcers across the Province to conduct compulsory site checks to monitor compliance of the contracted security service providers to the SLA.
b. Ambulance Health Consider and plan for the Advanced The Health Professions Council of South Africa (HPCSA) has Personnel are notably Health Care Services training for all discontinued the short course on Advanced Life Support and without Advanced Health Ambulance Health Personnel as such both provincial and private colleges are no longer Care Services training for accredited to offer any short course leading to an Advanced critical emergency cases, Life Support qualifcation. The Department is currently critical emergency calls engaging with Central University of Technology in an attempt are allegedly ignored till it to have a formal agreement to present an Emergency Medical is too late for the patients Preparatory Programme which seeks to improve the matric or other alternatives are results of the current workforce which will enable them to soft by the patients. meet the minimum requirement for Advanced Life Support courses which are offered by Universities. Further to this, the Department in partnership with Limpopo Department of Health is negotiating with the University of Limpopo with a view to introduce Emergency Medical Care qualifcations in the university and subsequently allow qualifying personnel from both provinces to register with the university for Emergency Medical Care programmes.
c. The department placed an Submit progress report on the delivery of 20 ambulances have been delivered to the government garage order for 35 ambulances the 35 ordered ambulances, inclusive of and are currently undergoing processes to register them such in the 1st quarter, the the list of the benefcial health facilities as Certifcate of Fitness (COF), Weight bridge certifcates, delivery of the ordered licensing as well as the installation of a tracking device. ambulances, inclusive of Delivery of the remaining 15 was delayed by the recent strike the list of the benefciary affecting the trucking industry resulting in the delay in delivery health facilities. of panel vans to the converter. The converter has undertaken to deliver all outstanding vehicles by the 11th of October 2019. The Department aims to launch the 20 ambulances as soon as they have been allocated with licences in order to ensure that service delivery is improved.
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NO. QUESTION RESPONSE
d. The Accounting Offcer has Submit an updated and detailed The Department has managed to resolve all the disputes and reportedly paid R 574 228 progress report on the settlement of all outstanding invoices have been processed for payment. 000 of the total R 574 464 accruals 000 accruals and payables, except R236 000 due to invoice disputes
e. The department reported Submit a detailed updated progress The department has reduced the number by 213, a backlog of that there was a backlog of report on the performance of cataract 6490 additional operations will be conducted as the medical 6 703 patients waiting for surgeries, inclusive of progress on cataract surgeon who assisted the department with cataract cataract surgery, by 30 June the flling of vacant posts advertised surgeries has now come back to the department and will 2019, the department had in June 2019 of Ophthalmologists to resume duties on the 1st of October 2019. The recruitment managed to conduct a total address the backlog. process is on-going. of 133 cataract surgeries, provincially
f. The department recorded a Submit an updated and detailed The Accounting Offcer has paid a total amount of R3 083 total of R 10 091 billion on progress report on the settlement 571.55 during the 1st quarter 2019/20 and R 10 091 billion litigations for the 2018/19 of litigations, both those recorded in during the 2019/19 fnancial year. Paid litigations are closed fnancial year, and a total 2018/19 fnancial year and 1st quarter and no further engagements are conducted by the department. amount of R 25 111 861.83 of 2019/20 fnancial year. has reportedly been paid to date. R 3 083 571.55 was paid for contingent liabilities (litigations) recorded in the 1st quarter of 2019/20 fnancial year.
g. There are eleven unresolved Submit progress report on the All matters on the Presidential Hotline for the frst quarter cases emanating from the resolution of the noted cases have been resolved and closed. (see attached latest report). Presidential hotline and six emanating from the Presidential Annexure XX unresolved cases from the hotline and the Satise Silalele The six matters on the Satise Silalele have not yet been Satise Silalele campaign campaign resolved because the Department is unable to access the system due to license which must be obtained from the Offce of the Premier (OTP). The OTP was contacted and they need the Department to second someone to work on the system. The Department will soon appoint someone who will undergo training and deal with all outstanding issues on Satise Silalele.
h. There is a new vacancy in the Provide progress report on the flling The Accounting Offcer is in the process of advertising the post Legal Unit, HR processes is of the vacant and funded post in the of Assistant Director in the next External Advert in September reportedly underway to fll the Legal Unit. 2019 and it is envisaged that the process of flling this post will post. be not later than 01 December 2019
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NO. QUESTION RESPONSE
i. The department reportedly aims Provide progress report on the The ten CCA/ ECP posts will be included on the next to advertise ten Critical Care advertisement of the ten CCA/ECP posts scheduled advert. Assistants/Emergency Care for the EMS, during second quarter Practitioner (CCA/ECP) posts 2019/20 FY as part of the priority posts. for the EMS, during second quarter 2019/20 FY as part of the priority posts. j. The department wrote a letter Submit a detailed progress report on The department in-conjunction with the of DPWRT is done (dated 07 August 2019) to the readiness of the site hand - over by with the drawings and specifcation and bill of quantities Mbombela Local Municipality Mbombela Local Municipality, for the however still waiting for the Mbombela Local Municipality to request an update to the construction of the Kanyamazane CHC to handover the bulk earthworks and services. readiness of the site earthworks and possible date of the site to be handed over for the construction of the new KaNyamazane CHC.
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RESPONSES ON QUESTIONS FROM PORTFOLIO COMMITTEE ON THE DEPARTMENT OF HEALTH SECOND QUARTER PERFOMANCE REPORT 2019/20
NO. QUESTION RESPONSE
QUESTION OF EXPENDITURE I. Why did the Accounting Offcer spend at The Accounting Offcer did not spend 25% of the budget for second quarter 23.8% in this quarter which is below the 25% due the following reasons: treasury guide? • Programme 3- EMS underspending due to delays in delivery of Planned Patient Transport vehicles, response vehicles and ambulances. • Programme 6-Health Sciences and Training Programme underspending due to invoices for Cuban Programme not yet received from National Department of Health estimated at R17 million. • Programme 7- Health Care Support Programme underspending due to delays in the procurement of medical equipment in the awarding process. • Programme 8 – Infrastructure underspending due to delays in various key infrastructure projects. II. Did the Accounting Offcer record any irregular Yes, the Accounting Offcer did record irregular expenditure in second expenditure in this quarter, if yes indicate the quarter. The irregular expenditure incurred during the second quarter is following, amounting to R 5 948 914 which relates mainly to previous year contract. a. how much was it, b. from which unit, Tender Description Amount Incurred c. who caused it and Perishable and non-perishable food R 5 123 905 d. what actions have been taken supplies e. which services were procured f. from which service provider The letters for investigations are issued on monthly basis to relevant responsible managers. The Accounting Offcer appointed the District Financial Misconduct and Loss Control Committees in the three Districts and Provincial Financial Misconduct Committee to conduct investigations. The investigation reports for the second quarter will be fnalised by the third quarter. (d) The Accounting Offcer has not taken any action as the investigation reports have not been fnalised. They will be fnalised in the 3rd quarter The bid for the supply and delivery of perishable and non-perishable food was evaluated, adjudicated and awarded on 01st December 2017. Of the 13 appointed service providers, 6 were declared irregular due to the following: • Copy of ID certifed older than required three months • Copy of the certifed copy was not original • Not all items on pricing schedule included • Documents certifed after closing date
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NO. QUESTION RESPONSE
III Did the Accounting Offcer record any fruitless Yes, the Accounting Offcer did record fruitless and wasteful expenditure and wasteful expenditure in this quarter, if in the quarter amounting to R 49 777. yes indicate the following: a. How much was it Description Amount Incurred b. From which unit Eskom R1 531 c. Who incurred it Municipalities R4 700 d. What caused it Regional Training Centre R43 546 e. What actions have been taken Letters for investigations are issued on monthly basis to relevant responsible managers. The Accounting Offcer appointed the District Financial Misconduct and Loss Control Committees in the three districts and Provincial Financial Misconduct Committee to conduct investigations. The investigation reports for the second quarter will be fnalised by the third quarter. (e) The Accounting Offcer has not taken any action as the investigation reports have not been fnalised. They will be fnalised in the third quarter. • Eskom interest relates to late payment of invoices for electricity • Municipalities charged interest for late payment of invoices for electricity and water • Regional Training Centre relates to invoice for late cancellation of booking for venue hire (No show).
IV Did the accounting Offcer pay all service • No, the Accounting Offcer did not pay all service providers within providers within 30 days, if no indicate the 30 days due to the following challenges experienced: following: • Service providers could not submit invoices on time due to wrong a. Why were the service providers not paid delivery points. within 30 days • Failure to comply on the CSD registration. b. Which service providers are affected • Disputes on the order amount v/s the invoice amount and network c. What is the amount not paid within 30 days failure. d. What Actions has been taken by the • Accounting Offcer • The total amount of R6 477 852.43 not paid within 30 days is detailed as per attached Annexure C and letters for reasons on the payment delay was also issued to chief users by the Accounting Offcer. • • (d) The Accounting Offcer has not taken any action as the investigation reports have not been fnalised. They will be fnalised in the third quarter.
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NO. QUESTION RESPONSE
V. Did the Accounting RESPONSES ON QUESTIONS FROM PORTFOLIO COMMITTEE ON THE DEPARTMENT Offcer pay any contingent OF HEALTH SECOND QUARTER PERFOMANCE REPORT 2019/20 liabilities in this quarter, if (b) Institution (c) Reasons for (a) Amount (d) Action taken by Accounting yes indicate the following: name contingent liability paid Offcer Witbank Hospital Patient admitted R15 714 628 Investigation on the matter not for delivery with concluded a. Amount paid Caesarean Section b. Institutions or unit during 2013. The that caused the baby was premature contingent liability with congenital abnormality and c. Reason of the developed respiratory contingent liability distress. The minor d. Actions taken by the was rendered blind Accounting Offcer as a result of bilateral retinopathy of prematurity ascribed to negligence of Witbank staff in subjecting the minor to excessive level of oxygen and failing to have him screened by the ophthalmologist. Piet Retief Botched circumcision R2 273 9 Doctor’s contract lapsed before Hospital of the minor child which investigations can be concluded led to amputation of and home affairs never the penis Rob Ferreira Cerebral Palsy R17 800 000 Investigation on the matter not Hospital concluded M a p u l a n e n g Patient admitted for R1 000 000 Investigation on the matter not Hospital delivery 2015, the concluded placenta was retained in the deceased body as a result she suffered haemorrhagic shock which resulted in her death. d Can the Accounting Yes, the Accounting Offcer can the provide the cost incurred in the quarter under review for Offcer provide the the following items totalling R 101 684: cost incurred in No. Item Cost R’000 this quarter for the 1 Fuel, oil and lubricants R40 046 following items: 2 Cleaning materials R8 457 a. Fuel, oil and 3 Electricity R31 608 lubricants 4 Travelling subsistence R21 573 b. Cleaning materials TOTAL R101 684 c. Electricity d. Travelling subsistence
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NO. QUESTIONS FOR PROGRAMME 1
II Can the Accounting Offcer indicate if the information Yes, the Accounting Offcer can indicate that the performance information contained in the second quarter is accurate, reliable contained in the second quarter is accurate, reliable and useful with audit and useful with audit evidence, considering that the AG evidence. The Department is implementing the following measures to ensure that for the past three years raised issues with reliability, the issues raised by the Auditor General for the past three years on the reliability, accurate, valid and usefulness of the information on accurate, valid and usefulness of performance information are addressed: predetermined objectives? • All 18 sub-district Information offcers are appointed. • Implementing the District Health Management (DHMIS) policies, DHMIS Standard Operating Procedures (SOPs) and Data fow policies at all levels. • Implemented an online web based DHIS system in all sub-districts, districts and at provincial level to assist with the turn-around time for the collected and reported information and maximizing that quality methods (validation processes and checking that information) is accurate. • Implementing monthly reconciliations in all facilities as per requirement from the Auditor General. • The Health Patient Registration System (HPRS) has been rolled out in all 3 District this is aimed at improving registration of patients and fling methods by ensuring that fle numbers are captured as well in the system • The HPRS pilot at hospital level has commenced with an assessment and linkage with the Patient Electronic Information System (PEIS) • The Internal Audit unit will conduct an audit on performance information for the 1st and 2nd quarters of 2019/20 FY
Furthermore, the Department will conduct data clean-up in November 2019 for the 6 months’ data and another data clean-up is planned for March 2020.
The audit outcome from the Auditor General has improved for the past 3 fnancial years as per the table below:
2016/17 Fy 2017/18 Fy 2018/19 Fy Audit Outcome Audit Outcome Audit Outcome Programme 2: Programme 2: Programme 2: Disclaimer Disclaimer Qualifed Programme 4: Programme 4: Programme 5: Qualifed Unqualifed Unqualifed
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NO. QUESTIONS FOR PROGRAMME 1
III When will the MEC develop the Health Act of The MEC can confrm that: Mpumalanga in response to sections 31(5) and 42 (2) of the National Health Act which the a. The 1st draft bill has been developed and consultation will be conducted with department indicated to table into the Provincial COGTA for inputs on the Bill before 30th November 2019, as it affects the Legislature by the end of the second term, 30 budgets of municipalities. September 2019? b. The development of the Act is the responsibility of Legislative sub directorate. a. What has the MEC done so far to ensure Due to staff shortage in the Legal Services Directorate, the sub directorate is that the Health Act of Mpumalanga handling matters assigned to the two sub directorate. The remaining offcial has is developed and presented to the taken over litigation fles for litigation sub-directorate which made it diffcult to Mpumalanga Provincial Legislature? focus on legislative matters alone. b. Can the MEC ascertain if the Act could c. The Department provided training to one offcial who subsequently left the not be developed because an offcial has Department in July 2019. The remaining offcial will attend training in 2020/21 resigned from the Department of Health and fnancial year. whether the development of the Act was the d. Due to lack of capacity, the current structuring of the Legislative sub-directorate sole responsibility of one offcial? deals with matters assigned to both Litigation and Legal advisory sub- directorates. The remaining offcial will attend training in 2020/21 fnancial year. c. Has the MEC taken the two offcials from the legal section of the department to a e. The step by step process is as follows: “crusher course” in preparation of them to Process Time Frame draft the Bill to the Mpumalanga Provincial • Presentation of the draft Bills 30 November 2019 with COGTA and incorporate Legislature inputs d. Can the MEC ascertain the reasons except • Submission to State Law January 2020 the resignation of an offcials, for not having Advisers for inputs on the draft developed the Bills as per sections 31(5) and 42 (2) of the National health Act. • Legislative draft course February 2020
e. Can the MEC indicate when will the Bills • Consultation with relevant January 2020 be developed and sent to the Mpumalanga stakeholders for inputs Provincial Executive Council and the • Amendment of draft Bills further April 2020 Mpumalanga Provincial Legislature and discussions with state law advisers for certifcation present the step - by - step plan towards • Submission to EXCO for further May 2020 that process? discussion and approval • Public hearings July 2020 • Revision of the Bill September 2020
• Finalisation of the Bill and October 2020 approval by EXCO
93 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
iV Can the Accounting Offcer indicate the challenges of flling The Accounting Offcer did not experience any challenges of flling all posts in the Hospital Executive Management Teams in the the posts of Hospital Executive Management Teams except for Sabie response include the following: & Matibidi Finance Managers due to labour disputes. No suitable candidates were found for Mapulaneng and Ermelo hospitals, a a. Which hospitals have a full complement of Hospital suitable candidate was headhunted for Ermelo hospital, the process of Executive Management Teams and which Hospitals do headhunting for Mapulaneng hospital is underway not have and indicate the vacancy and the longevity of the vacancy as well as the time in which the vacancy (a) Out of the 32 hospitals, 21 have a full staff complement and 11 still will be flled? have unflled vacancies (Sesifuba TB hospital is operating as a TB ward for Ermelo hospital). The vacancy rates are as follows: b. Indicate members of the Hospital Executive • Chief Executive Offcer – 28% (9/32) Management teams which have resigned, promoted or • Clinical Manager – 22% (7/32) asked to act elsewhere in this quarter and who is acting • Nursing Service Manager – 12% (4/33) on those vacancies created? • Finance Manager – 9% (3/33) • Corporate Manager – 13% (4/32)
Annexure D: – List of Vacant Posts for Executive Management Teams (b) The following table refects the list of hospitals executive managers vacated posts
Facility Post Date Reason for Name of Name vacated vacation Person Acting Barberton Chief 20190831 Promoted Madonsela Hospital Executive to a Senior SE Offcer Manager post Barberton Nursing 20190930 Resignation Maree A Hospital Service Manager Barberton Clinical 20190831 Resignation Dr C Eche Hospital Manager Barberton Corporate 20190531 Retirement None Hospital Manager on grounds of Carolina Nursing 20190531 Resignation Ms S. Hospital Manager Magagula Elsie Finance Never Not Not Ballot Manager flled applicable applicable Hospital Elsie Corporate Never Not Not Ballot Manager flled applicable applicable Hospital
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NO. QUESTION RESPONSE
Facility Post Name Date vacated Reason for Name of Person vacation Acting Embhuleni Corporate Manager 20181031 Promotion Mr NP Mudau Hospital Matibidi Clinical Manager 20170228 Transfer to Witbank None Mapulaneng Chief Executive 20190701 Retirement Makhura R. Hospital Offcer Mapulaneng Clinical Manager 20190701 Resigned Dr Maebela Hospital Sabie Hospital Chief Executive 20190928 Deceased Dr R Mnisi Offcer Sabie Hospital Finance Manager Never flled Not applicable Not applicable Standerton TB Clinical Manager 20150131 Resigned None Tintswalo Nursing Service 20180501 Promotion of offcer Ms Ubisi Hospital Manager to CEO Tintswalo Clinical Manager 20180101 Resigned Dr Mathebula Hospital Waterval Clinical Manager Never flled Not applicable Not applicable Boven Witbank TB Chief Executive 20190131 Transfer Ms M.K. Matlala Hospital Offcer Witbank TB Clinical Manager 20190131 Resigned None Hospital Witbank TB Corporate Manager 20190331 Retired None Hospital
V Did the Accounting Offcer Yes, the Accounting Offcer has reviewed that organogram. The organogram refects all warm review the organogram of the bodies and critical posts that have been prioritized for the current fnancial year in order for the department, if yes, indicate organisational structure to be within the available budget. The posts that will be added into the which post will be added into organogram are refected on the attached Annexure. the organogram and which The following table refects a summary of posts to be abolished in the organogram posts will be abolished; if TITLE ABOLISHED POSTS TOTAL no, why not considering the ADMINISTRATIVE LINE FUNCTION AND SUPPORT 107 commitments of the department PERSONNEL in the frst quarter to review the AGRICULTURAL RELATED AND SUPPORT PERSONNEL 15 organogram? ARTISAN AND SUPPORT PERSONNEL 7 DEVELOPMENTAL PROGRAMMES 1 EMERGENCY SERVICE AND RELATED PERSONNEL 49 ENGINEERING RELATED AND SUPPORT PERSONNEL 13 HEALTH ASSOCIATED SCIENCES AND SUPPORT 233 PERSONNEL MANAGEMENT AND GENERAL SUPPORT PERSONNEL 201 MEDICAL SCIENCES AND SUPPORT PERSONNEL 407 NURSING AND SUPPORT PERSONNEL 292 NURSING ASSISTANT 65 PROFESSIONAL NURSE 426 SOCIAL SERVICES AND SUPPORT PERSONNEL 2 STAFF NURSE 130 GRAND TOTAL 1948
95 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
VI Can the Accounting Offcer indicate why there were no PHC Yes, the Accounting Offcer can indicate the following: fxed with broadband access in this quarter considering the commitment of the department during the frst quarter a) The Accounting Offcer did not mislead the Legislature responses that “… the activity is planned to be completed by at the time of reporting. The service provider was the end of the second quarter of the 2019/20 fnancial year”? appointed February 2019. However, there where unforeseen contractual issues that the Department a. Did the Accounting Offcer mislead the Provincial could not agree on with the service provider. Legislature, if no what should the Legislature consider to accept that it was not deliberately misled? b) A new service provider has since been appointed by the Department. The outstanding PHC facilities will be connected before end of the 4th quarter of 2019/20 FY VII Can the Accounting Offcer restate the reasons for the The Accounting Offcer can indicate: departmental failure to update its website on a monthly basis The Department failed to update its website on a monthly as per the operational plan; considering that the Offce of the basis because the Department misinterpreted the Premier, through Mr EB Jansen indicated that “departments correspondence from the Offce of the Premier about the should continue updating their website so that once the appointment of SETA as being responsible to develop the portal is completed will export the content to the new portal”? new websites hence forth. The Department was of the (in fact other Mpumalanga Government Websites have been opinion that the old website will no longer be used, hence updating) the failure to update.
a. Did the Accounting Offcer mislead the Committee The Department has since contacted the Offce of the when responding to question on the Website on the Premier for clarity and yes, the website has now been APP when she responded that ““… all the icons will updated and it will be done monthly until the new website be active once the project is completed by the end of has been fnalised. October 2019”. This is because not even one icon on the website has been updated. a. No, the Accounting Offcer did not mislead the Committee when responding to questions on the b. With the Website not updated, where does the website on the APP. The date of October 2019 was department publish its APP and Annual Reports which committed by the Offce of the Premier during a should have been uploaded on the website as per Provincial Communicators Forum meeting which took relevant Treasury Guide? place on the 21st of August 2019 that all the icons will be live by this date. c. Can the Accounting Offcer indicate when will the b. The Department has uploaded all APP, Annual Report, departmental website be update with relevant and MEC’’s Policy and Budget Speeches and other relevant current information and all icons on the website information on the website from 2012/2013 fnancial updated? year up to the 2019/2020 fnancial year. The documents can be found on the website under the (Resource d. Is the department not considering to develop a Center icon) departmental APP to supplement the Website? c. The Departmental website is now updated and all icons are operational with relevant updated information.
d. Yes, the Department already has a functional intranet site. The APP is also uploaded onto the Departmental website.
96 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
VIII Did the Accounting Offcer assess the performance of the various Yes, the Accounting Offcer did assess the performance of the Districts and what measurers have been put in place to assist various districts and all three districts are different from each other. Ehlanzeni District to perform at the level of the other District; this Ehlanzeni District is unfortunately the biggest district compared to is because many responses of the department in the frst quarter the other two districts with more facilities both Primary Health Care refect challenges care more in Ehlanzeni than the other three and Hospitals. The following measurers have been put in place to district such as: assist Ehlanzeni District to perform better in the following identifed a. High vacancy rate of the Clinic Operational Managers areas: b. Doctors no longer visiting clinics because of transport c. WBPHCOT not functional because of inadequate transport a. The Department has advertised and is in the process of flling d. More facilities without a doctor 18/21 Operational Managers vacant posts in Ehlanzeni. The e. More cases report on Satise Silalele. 18 OPMs will commence duties on the 1st December 2019. The three posts are the newly vacated posts which are in process to be advertised
b. The Department is giving an approval to Health Professionals to use their own cars and claim for the fuel used. c. All outreached teams are coordinating their outreach points in order for them to be able to share the available transport. d. The initiative of contacting GPs for Ehlanzeni and Nkangala will assist in increasing the number of doctors seeing patients in PHC.
e. The post of Quality Assurance Manager in Ehlanzeni has been advertised to ensure that the services rendered in Ehlanzeni district health facilities are of quality and thus reduce complaints. XI Can the Accounting Offcer indicate the diffculty in complying with The Accounting Offcer has diffculty in complying with the HRH the HRH normative guides for Community Health Centres and how normative guides for Community Health Centre because the and when will the Accounting Offcer adhere to the HRH Normative workload is not in line with the WISN requirements. guides for Community Health Centres? PHC facilities that are classifed as Community Health Centres do not meet the criteria as per WISN but are treated as 24 hour Clinics with Maternity and Obstetric Unit. A CHC is supposed to have all the relevant sections and equipment required in a CHC. A CHC is supposed to have an OPD, Casualty, Maternity Unit, Theatre, Wards and Administration Component.
The minimum PHC headcount required for the CHC is 65 895 and a maximum of 105 432. Most of the facilities are not meeting the criteria because they have a headcount which is below the minimum benchmark. WISN uses the annual workload of the previous fnancial year. From 2017/18 fnancial year all new PHC facilities were staffed according to the WISN requirements.
The attached Annexure refects which PHC facilities are not meeting the WISN criteria in terms of the workload and the highlighted 11 are the only facilities that meet the WISN criteria in terms of the workload. Annexure: F – CHC Facilities not meeting minimum criteria
97 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
X Can the Accounting Offcer bring a report detailing how The Accounting Offcer managed to resolve all the Six (6) cases that they have solved the following issues that came from the were reported on the Presidential Hotline. The cases were resolved as Presidential Hotline: follows.
a. INC 000019202984 by Sibongile Kheswa a. INC 000019202984 by Sibongile Kheswa
REPORTED CASE HOW IT WAS RESOLVED The Complaint (Sibongile The complainant, Ms Sibongile Kheswa) a Standerton Kheswa was called on the 06th citizen reported that her of December 2018 around sister was admitted at 13:20 to acknowledge the Hospital on the 7th of August complaint. 2018 and the hospital does not change her clothes. The hospital management denied any ill treatment to the When she asked why they patient. do not change her clothes she was told that the sister The hospital reported that the refuses. The client said she sister of the patient, Ms Khwesa changed her clothes herself was verbally abusive towards and the offcials did not deny the staff in such that she her doing so. ordered them not to change her sister’s clothes as she would be So she kept on visiting doing it herself. The staff did not the hospital to change her yield to her demand of changing sister as the hospital did the patient’s clothes herself as not take responsibility of the this is not protocol. The staff patience. The next thing continued to do their duties by she found was her sister changing the patient’s clothes growing sores and when she as required. reported that to the offcials they told her that there is The matter was redressed and nothing they can do as the closed. doctor was not available.
She further said that the hospital did not even feed the patient. She further said that she left a blanket and the offcial gave it to someone without her permission.
She further said that the patient has further grown a sore under her foot but the offcial said they were not aware of that. The name of the patient is Ms. Letta Ndaba at ward 4 room 12 bed 3
98 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
b. INC 000019296172 by Lucky Mkhonto b. INC 000019296172 by Lucky Mkhonto
REPORTED CASE HOW IT WAS RESOLVED The Complaint (Lucky The patient was contacted by the Mkhonto) went to Kromdraai Department from the date of the clinic on the month of July receipt of the complaint in August 2015. He was prescribed 2015 but his cellphone, which is the medication to use in the only means of contacting him, his eyes. He said that after was always off. The Department using the medication he managed to get hold of Mr Mkhonto got blind and would like in August 2019 and he narrated his to be compensated by story that said he was blinded after the Department of Health. utilising medication from Kromdraai Complainant is therefore clinic. requesting Presidential Hotline to intervene and He was then booked for an assist on the matter. appointment at Bethal Hospital where he was treated.
It was discovered that the medication that was prescribed for his eyes had expired and this caused his eyes to be temporarily blind. He has since regained his sight after getting treatment from Bethal hospital
c. INC 000019351429 by Bheki Ncongwana c.INC 000019351429 by Bheki Ncongwana
REPORTED CASE HOW IT WAS RESOLVED The Complaint (Bheki The patient came into the Ncongwane) said that he Emergency unit walking, has sent his father to Rob accompanied by his son with a Ferreira Hospital on the history of chest, body and back 29th of October 2018. He pain. said that his father has been sleeping on the bench He was triaged at 16H55. The without medication since patient was seen by the doctor at Monday and was only 16H59. Upon assessment by the given a bed on the 31st of doctor, the patient was alert, vitals October 2018. The client normal, chest clear and provisional said that his father is not diagnosis made was Lower getting better due to lack Respiratory Tract Infection. Chest of medical/ ignorant of the X-ray done, bloods collected. hospital. Grandfather: Obed Mr Mawela was admitted in the Mawela, File no.14/04441 medical ward on the 8th November Complainant is therefore 2018, and unfortunately demised requesting Presidential on the 9th November 2018 due to Hotline to intervene and his disease condition. assist.
99 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
d. INC 000019408383 by Anna Thamahane d. INC 000019408383 by Anna Thamahane
REPORTED CASE HOW IT WAS RESOLVED The Caller stated that she got The Department after receiving sick on the 3rd of December 2018 the complaint from the Presidential at 03:00AM. She then called an Hotline called the complainant ambulance for assistance. She who indeed narrated that she complained about the person who was ill treated by an offcial in the was assisting her over the phone. call centre. The Department then She mentioned that she gave her contacted the EMS Manager in the an attitude and ended up putting provincial offce about this matter the phone down on her ear. She and could not trace back Ms Annah was not assisted at all. on the system.
Complainant is therefore When asked if she still needs to requesting Presidential Hotline to be assisted she stated that she intervene and assist on the matter managed to get transport to the health facility and has since been healed.
e. INC 000019438032 by Dion Jabulani e. INC 000019438032 by Dion Jabulani
REPORTED CASE HOW IT WAS RESOLVED The Caller complained about the The Department investigated the Department of Health. He said the complaint and it was discovered Department has been funding an that the allegations are not true. organisation called Kubonakele Home Based Care and Peer The Department knows the Education since 2004 which is organization (Kubonakele Home based in Loopspruit Farm in Kwa Based Care and Peer Education) Mhlanga under Thembisile Hani It is functioning and is covering Local Municipality. the most neglected area which are farms He said, the organisation is no longer functioning but they are receiving funding each year from the Department of Health. He alleged that the members of the organisation are using funding money for their personal beneft and using the name of the organisation to get funds. He said most of the members are employed while people of the community are suffering especially in the farm areas. They want to know where are their offces, who are the people receiving money and they are requesting for a meeting with them including the Department offcials who are approving the funding. They are asking for intervention from PHL
100 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
f. INC 000019438042 by Dr M Nezam f. INC 000019438042 by Dr M Nezam
REPORTED CASE HOW IT WAS RESOLVED The employed citizen is an Iranian Doctor The doctor concerned had a who was invited to work in the Republic of contract which he was aware was South Africa under a GOV-GOV contract in expiring in August 2018. He was August 2006. informed by both the hospital and Provincial offce that when the Since then every three years his contract contract expires, the post will be and visa had to be renewed until August re-advertised which was done. 2018 without any notice. The Head Offce didn’t renew the contract and didn’t issue All contracts for foreign nationals endorsement for Home Affairs to renew his are to be approved by NDOH, permit. which indicated that only the DG can give such approval He tried all over with his Medical Manager depending on whether provinces to fnd out the reasons but failed. The only have funds. thing that Head Offce of Mpumalanga said is that his job must be advertised. As soon as NDOH approved the extension, a 12 months Finally on 30 August 2018 his contract and appointment contract was issued visa expired and while he was working in to the doctor. theatre. HR called him orally that he must not come back to work because he doesn’t have visa and contract.
On 10 October 2018 they issued him a letter for Home Affairs to get his visa but it will take About 8-12 weeks. In Head Offce they had signed his contract and forwarded to the National Department of Health to approve but no response so far.
In 2016 he was awarded a Diploma in Anaesthesia from the College of Medicine of South Africa. Since 01 September 2018 he has been jobless without any other income while his daughter is studying in University of Pretoria.
His son is in grade 6 and his wife is a housewife. Hospital had rented him an accommodation but after a few months they stopped paying the rent and agency wanted to throw them out but with the help of neighbour’s they were given 2 weeks to pay the rents himself (he had to sell his wife car to pay the outstanding).
Hospital promised to Reimbursement but after a few months they stopped it. He is asking an order to Pay his outstanding Salary as soon as possible from the 01/09/2018
101 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE g. Can the Accounting Offcer provide a detailed report on the Yes, the Accounting Offcer can give a detailed report on the cases in a exact cases which were reported in the frst quarter refecting statistics format (Attached is the detailed statistics of the complaint). It that Satise Silalele received and recorded cases about the must be noted that the Satise Silalele app is still being developed. It currently department of Health which were: provides cases in a statistics format.
a. 466 cases were reported It does not categorise the details on the cases per Department, parastatal or b. 60 related to corrupt activities municipalities. Cases are clustered in one basket. This makes it diffcult to c. 81 medicine shortage trace and fnalise all the cases as the offcial working with the cases has to d. 34 surgical delay go through all the national cases which are more than 6000 on the system.
However, three offcials have been seconded to work on the system so that all the cases can be attended to and fnalised. h. Did the Accounting Offcer experience strikes in the quarter The Accounting Offcer did experience one incident of strike action at Rob under review, if yes, which facility and what was contained Ferreira Hospital. The content of the memorandum or list of demands were in the memorandum? not submitted in writing, however, upon consultations with the leadership of the Union involved, during the strike management negotiations, the issue of protective clothing and or uniforms was raised as the cause of action. The issue pertaining the quality of uniform has since been resolve with the unions and the service provider.
i. Can the Accounting Offcer provide progress on this Due to budgetary constraints, the organisational structure has not been commitment made in the frst quarter “The Accounting aligned to the WISN but it has been reviewed based on the warm bodies, Offcer is currently reviewing the organisational structure critical posts that have been identifed for the current fnancial year, and to be in line with WISN and the process is planned to be posts that were vacated during the current fnancial year where replacements fnalised by the end of September 2019”? have been requested. WISN is unaffordable, however, the organisational structures for the new PHC facilities are aligned to WISN.
102 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
7.1.3 QUESTIONS FOR PROGRAMME 2
I Did the Accounting Offcer put Yes, the Accounting Offcer did put measures in place to contain the higher expenditure per PDE measures to contain the higher in hospitals by : expenditure per PDE and how • Implementing the gate keeping system on the use of NHLS and Blood in facilities effective are those measures and • The implementation of standardised food menu throughout the province will the expenditure per PDE be • Have tenders that supplies commodities like groceries, cleaning materials at market related contained in the third quarter? prices versus the procurement through quotations which is expensive and uncontrollable • Initiated a pilot project of rationalising staff in Nkomazi health facilities which will allow the appointment of lower categories especially in hospitals and the distribution of professional nurses where there is a shortage.
The outcome of the above measures can only be assessed at the end of the fnancial year because the Expenditure per Patient Day Equivalent is an annual indicator II Can the Accounting Offcer indicate Yes, the Accounting Offcer can indicate the programmes and activities to increase female programmes and activities deployed condom intake: by the department to increase female condom intake? • The Advocacy, Communication and Social Mobilization (ACSM)strategy is being implemented by executing activities as outlined in the Operational Plan of the HIV, AIDS, STIs and TB Chief Directorate. The aim of the ACSM plan is to educate, raise awareness, promote a supportive environment and positively infuence reproductive health behaviours, including correct and consistent use of condoms to prevent unwanted pregnancies and the transmission of HIV and other sexually transmitted infections.
• HIV Prevention messages are also communicated through radio slots. -In terms of radio slots, 12 slots with SABC (Both Ligwalagwala and Ikwekwezi radio stations) and 24 x Combo Radio slots in all community radio stations within the Province.
• Information, Education and Communication (IEC) material is also distributed to the communities. Information and Education is provided during Health Campaigns and by Social Mobilisation Offcers and Condom Logistics Offcers. Health facilities are also used as distribution sites.
• Female condoms are distributed at conventional (health facilities) and non-conventional sites (public toilets, taverns etc). Condom Friday campaigns are conducted at identifed hotspots, such as border gates and truck stops. Over 8000 pieces of both male and female condoms have been distributed during the Condom Friday Campaigns in Gert Sibande district.
• All three districts were required to develop Condom Friday Plans. The plan is currently being rolled-out in the Gert Sibande district. Ehlanzeni and Nkangala Districts will fnalize preparations Condom Friday by end of November 2019.
• The National Department of Health will conduct a training workshop on the 22nd 2019 on the female condom targeting the Condom Logistic Offcers, Social Mobilization Offcers and the Health Promotion Offcers. All sub-districts will participate in the training workshop.
103 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
7.1.3 QUESTIONS FOR PROGRAMME 2
III Did the Accounting Offcer develop Yes, the Accounting Offcer developed measures to improve departmental performance measures to improve departmental on all the TB related performance targets, as follows: performance on all the TB related • Utilisation of the Ward-based Outreach Teams for patient support performance targets, what are those • Integration into the Operation Phuthuma Strategy for close monitoring measures and how effective are they a) Yes, the National Department of Health responded to the indication of the challenge of a.Did the National Department of the Department in data capturing for TB related data through the release of the Tier.Net Health respond to the indication of version 1.12.8 to enable reporting of quarterly DS-TB data into webDHIS. the Challenge of the Department in data capturing for TB related data and what was the response of the National Department of Health. Provide proof. II What measures has the Accounting • The Accounting Offcer can indicate that literature has proven that the use of IMCI Offcer put in place to improve the Strategy contributes to the reduction of child mortality however there is a need to implementation of the Integrated have all nurses who are providing healthcare services to children be trained and Management of Childhood Illness and monitored to implement the strategy accordingly. Therefore, the Accounting Offcer how effective are the measures? has put in place the following measures to improve the implementation of the Integrated Management of Childhood Illness: • 184 Professional nurses were trained during the second quarter on Integrated Management of Childhood Illness to increase the number of trained IMCI nurses to ensure that children are treated using the IMCI Strategy • 18 IMCI Champions will be trained through the support of National during the 4th quarter of 2019/20 FY. The Champions will ensure that they provide mentoring and bedside training to all nurses who are IMCI trained to ensure that they implement the strategy properly. • The Department is reviewing the PHC Supervision Policy to strengthen the monitoring and evaluation on the implementation of services in PHC facilities like IMCI by the PHC Supervisors • The Department believes that the measure will yield positive outcomes in the coming future.
V Can the Accounting Offcer indicate the Yes, the Accounting Offcer can indicate the following in relation to School Health teams: following in relation to School health teams: a. The Department is having 58 effective and functional school health teams out of 121 needed teams. a. The number of effective and b. None, because all teams are teams because they need to be led by Professional functional school health teams nurses. b. Number of the school health team c. The Department is in advanced stages of recruiting 55 additional teams who will not functional because of shortage start the service in December 2019 and the remaining 8 teams will be prioritised in of professional nurses the next fnancial year c. Time frame in which the Accounting Offcer will add professional nurses to lead the School Health Teams
104 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
7.1.3 QUESTIONS FOR PROGRAMME 2
VI Can the Accounting Offcer indicate the Yes, the Accounting Offcer can indicate the following in relations to Cataract Surgery: following in relations to Cataract Surgery: a. How many Cataract surgeries were a. The Tshemba Foundation has managed to operate 10 cases in September 2019 as an performed under the SLA with initial trial phase of the project. The agreed upon plan of the donation was to have the Itshemba Foundation in this quarter Foundation operating 1000 cases per quarter. The Foundation started by conducting a and how many will be performed in the trial with 10 patients. third quarter? In August 2019 the foundation operated about 10 cataract surgical cases, further surgical b. How many cataract surgeries were cases are planned and targeting 94 for the 3rd quarter 2019/20 (October 44, 50 performed in this quarter in line with November) the MOU with SANPB and how many b. 37 cataract surgeries were conducted by the Council for the Prevention of Blindness will be performed in the third quarter? and the Department is in process of renewing the contract and increase the number of tours to be conducted to try and reduce the cataract backlog in the province. Planned c. How many Cataract surgeries has for the third quarter is 112. been performed at Rob Ferreira Hospital since the appointment of an c. 62 Cataract surgeries have been conducted in Rob Ferreira hospital Ophthalmologists and how many will The Department is planning to conduct a campaign during the 3rd quarter 2019/20 be performed in the third quarter? where all Provincial Medical Cataract surgeons including the Ophthalmologist from Rob Ferreira Hospital will be addressing the backlog cataracts in the province. d. Has the department headhunted the Ophthalmologists for Witbank Hospital d. Yes, Ophthalmologist has been offered an appointment letter and will resume duties on as per the commitment made during the the 1st Janury 2020. frst quarter responses to questions?
VII Did the Accounting Offcer reconsider the Yes, the Accounting Offcer did reconsider the previous response to open the Msogwaba previous response to open the kaMsogwaba Clinic to operate for 24 hours Clinic for 24 hours and work with the The Department has conducted a security risk analysis and the contractor has already been department of Community Safety, Security appointed to erect palisade fence and a proper gate for the clinic in preparation for the and Liaison to tighten safety in and around extension of operating hours. the clinic, if no, why not considering the view of the Committee to open the clinic 24 hours A meeting with Clinic Committee members has been planned to be held by the end of as it was planned by the Department? November 2019 after the palisade fence has been erected to request the committee to review the resolution that was previously taken.
Thereafter SAPS and DCSSL including Organised Labour will be engaged. VIII Can the Accounting Offcer indicate a The Accounting Offcer responded to the analysis on the 1st quarter 2019/20 FY performance detailed step- by – step Plan to open the of the Department, and committed that KwaZamokuhle clinic will have its hours of operation KwaZamokuhle Clinic for 24 hours from extended to 12 hours with effect from 1st November 2019. January 2020 as per the response of the There have been some delays in extending the hours of operation and the facility will start Accounting Offcer in the frst quarter? on the 18th November to operate 12 hours a day 7 days a week. The Department will not be able to extend the operational hours to 24 hours from January 2020 because of fnancial constraints. • There is still a need to appoint 4 more Professional nurses with Midwifery and PHC trained to bring the total number of Professional nurses to 22 • Appoint 2 extra cleaners who will be able to cover night duty services • Appoint a Pharmacist to manage the Pharmacy of the CHC • Appoint a residing Doctor or contact a doctor that will support the CHC The Department will prioritise that the facility start to operate 24 hours by the end of the second quarter of the next fnancial year depending on the availability of funds.
105 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
7.1.3 QUESTIONS FOR PROGRAMME 2
IX In the First quarter, the Accounting The Department is consenting all health professionals who are doing outreach services to Offcer indicated Doctor’s visit that use their own cars and claim for the fuel used according to the national policy on tariffs for has stopped because of shortage the use of motor transport. of transport, Can the Accounting Offcer indicate a plan to ensure that The Department has also managed to put aside R3 million to be used to contract GPs to the Doctor’s visit to PHC because visit PHC facilities that are not visited by doctors prioritising the deep rural facilities. The of transport is relaunched and current targeted number is 60 doctors for Ehlanzeni and Nkangala districts. implemented? X Can the Accounting Offcer indicate The Accounting Offcer has planned the following as measures to improve the performance how will she improve the performance of WBPHCOT in Ehlanzeni: of WBPHCOT in Ehlanzeni District that had no transport as a reason of • Offcials who own cars are given approval to use their vehicles and claim back for fuel dysfunctional? used
The short term plan is to have all the outreach teams coordinating their outreach points in order for them to be able to share the available transport. XI Since the frst quarter meeting, what The Accounting Offcer has put the following measures in place to ensure: measures has the Accounting Offcer put a. Enough PHC supervisors are appointed? in place to ensure: · The Department is having 31 of appointed PHC Supervisor plus 7 allocated supervisors out of 57 needed to conduct supervision in 287 PHC facilities. a. Enough PHC supervisors are · Department is currently busy reviewing the District Health Management Model to come up with a most effective and effcient model to be implemented in the province. The appointed? model will determine the need for PHC supervisors as well as rationalization of the b. PHC supervisors visit each facility currently available program managers to be used for PHC supervision. at least once per month as per the KRA of the PHC supervisors? b. PHC supervisors visit each facility at least once per month as per the KRA of the c. How has the Accounting Offcer PHC supervisors? improved the availability of · The policy on PHC supervision is being reviewed to strengthen the implementation of supervision in PHC facilities transport to PHC Supervisors to do · The implementation of the model will promote the rationalization of the currently their work? available program managers to be used for PHC supervision and increase the number of supervisors
c. How has the Accounting Offcer improved the availability of transport to PHC Supervisors to do their work? · Offcials who own cars are given approval to use their vehicles and claim for fuel used
106 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 3
I Is the Accounting Offcer still The Accounting Offcer can indicate that the complaints regarding shortage of ambulances is not convinced after the NHI concerning and is indeed a crisis that requires special focus and the following areas need to be public hearings that shortage of addressed: ambulances in Mpumalanga is • Vehicles: ambulances, rapid response and support vehicles a crisis which require cabinet’s • Equipment: Intermediate Life Support and Advanced Life Support for the above vehicles shift of focus and direction • Personnel with requisite skills mix: on how to turn it around, and • Intermediate Life Support indicate what needs to be • Advanced Life Support done? • Infrastructure • Large stations • Medium stations • Small stations • Satellite stations The above areas need to be addressed in order for the programme to comply with the Emergency Medical Services Regulations which were promulgated by the Health Minister in 2017. The following progress can be reported: • Thirty fve (35) new ambulances were purchased to replace the ageing feet thus reducing the time ambulances spend at the merchants and increasing availability • Purchasing of equipment for 50 ambulances R12 000 000 The following is planned: • R50 million for the Computer Aided Dispatch system starting with critical modules during MTEF period. • Purchasing 50 new ambulances at a cost of R 46 950 000 for 2020/21 FY I How long does it take for The period taken to repair ambulances vary according to the nature of the repairs required. ambulances to be repaired, • Scheduled service takes 1 business day and how does the Accounting • Minor repairs take 1-2 business days Offcer plan to reduce the time ambulances spend with • Major repairs depend on the period taken to obtain the necessary authorizations from the mechanics? following: • Transit Solutions • Government Motor Transport and Departmental approvals An average of six (6) weeks turn- around time is what it takes for ambulances to be attended to when requiring major repairs. Major accident repairs
3 quotations are required before any work can be carried out and the duration of completing the work is diffcult to estimate however an average of three (3) months seems to be the norm. The department is engaging the merchants on a regular basis to address the delays and to speed up the turnaround time of ambulance repairs
II Has the Accounting Offcer Yes, the Accounting Offcer has advertised the posts of 10 x CCA/ECP during the second quarter of advertised the posts of 10 x 2019/20. The posts were advertised on the 11th of October 2019 and the closing date was the 25th CCA/ ECP during the second of October 2019. Profling has been completed and the shortlisting process and interviews will be quarter of 2019/20 as indicated conducted before the end of November 2019 and the targeted date for appointments will be the end in the frst quarter responses? of the fourth quarter 2019/20 FY.
III How are the engagements of A request for approval to exceed 30% overtime for critical services has been sent and awaiting the department with DPSA to response from DPSA. With the current vehicle shortage, overtime alone will not solve the poor obtain approval to exceed 30% performance on EMS. The Department has however procured 35 ambulances to replace the ageing overtime and whether the poor feet and R46 950 000 will be allocated for the procurement of ambulances in the new fnancial year. performance on EMS is going to be solved by more overtime?
107 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 3
V Do the current pool of operational No, the number of current operational ambulances is far less than the desired number in ambulances have the necessary staff accordance with the available staff. The shortage of ambulances is based on the number to operate ambulance services, if yes of operational ambulances that we have and National norms. EMS staff requirements in how many offcials and their categories accordance with the norms is 100 Emergency Care Offcers at a cost of R23 100 000 are needed for the 58 operational and 10 Advanced Life Support practitioners at a cost of R6 300 000. Further to this, staff ambulances and what is the current requires to be issued with full uniform costing R4 700 000. shortages on the operational 58 ambulances? VI Currently, there are 58 operational To cater for pre-hospital and inter-facility transfers the department requires at least 120 ambulances in Mpumalanga, can operational vehicles at a cost of R112 680 000 and ambulance equipment at a cost of the Accounting Offcer indicate how R28 800 000, however based on the National norm of 1 ambulance to 10 000 population, many more ambulance are needed to Mpumalanga should have a total of 445 ambulances. The norm further dictates that for suffciently service Mpumalanga and every 5 ambulances there must be 1 pool ambulance to ensure uninterrupted service due to what is the total cost to procure those routine service, maintenance and repairs. ambulances? VII Will the department consider introducing Yes, the department will consider introducing modern technologies after the installation of modern technologies such as the APP the CAD as a basic system on which other technologies that can be integrated to enhance that is used similar to Bolt and Uber to get performance. Due to the current fscal challenges, the Department is unable to be creative the public to use to access ambulances? and innovative.
VIII Can the Accounting Offcer provide an The Department has been unable to fund the CAD system with the current fnancial update on the procurement of the CAD challenges. The Department will consider R50 million for the Computer Aided Dispatch system? system starting with critical modules over the MTEF period beginning in the 2020/21 FY if there are no budget cuts.
108 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 4
I Can the Accounting Offcer indicate The target for inpatient bed utilisation rate was not achieved due to the following reasons: why in this programme inpatient bed • The sub-acute ward in Mapulaneng hospital was not fully utilised during the second utilisation was not achieved and also quarter as it was being used for Orthopaedic patients, resulting in doctors referring indicate why Expenditure per PDE was fewer patients to this ward still higher even though inpatient bed • The decentralisation of management of TB patients resulted in TB hospitals having utilisation was low? less admissions as most patients are given treatment to take home and are referred to the clinics except very ill patients. The Expenditure per PDE was higher due to payment of accruals for Blood, NHLS, and orthopaedic implants. II Can the Accounting Offcer provide a The Accounting Offcer has the following plan in place to have the required specialists and plan to ensure that hospitals have the reduce the vacancy rate: required specialists and the vacancy rate • Headhunting is ongoing of specialist in regional and specialised • Offering bursaries to doctors to train as specialists, with the aim of increasing the pool hospitals is reduced? of specialists in the province. The bursary has a work back obligation. • Partnering with academic institutions to support the accreditation of the tertiary hospitals for training of registrars
III Can the Accounting Offcer provide plan To ensure that the regional hospitals provide all the services prescribed in each of the to ensure that regional hospitals provide regional hospitals, the plan of the Accounting Offcer is to appoint specialists in the following all the services prescribed to be provided clinical domains that are still not provided for: at a regional hospital? • Themba hospital: Radiology, offer of appointment has been issued to a headhunted Radiologist • Ermelo hospital: Psychiatry and Orthopaedics headhunting on going • Mapulaneng hospital: Radiology and Psychiatry headhunting ongoing
Furthermore, headhunting is also done for the existing disciplines to increase their capacity.
109 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 5
I Can the Accounting Offcer indicate plans Yes. The Accounting Offcer can indicate the plans to offer the Tertiary services which are to offer Tertiary Hospital services which not offered in the province. The department is planning to establish the tertiary services are not rendered in the tertiary hospitals in the two hospital in phase in approach to ensure sustainability. The services have been in the province and indicate when will the prioritised as follows: services be offered? • Medical Oncology commenced 2nd quarter 2019/20 • Radiation Oncology is planned for 2020/21 for Rob Ferreira and a full oncology unit for the new Witbank tertiary hospital is included in the clinical brief • Nephrology services: a comprehensive Nephrology Services planned for 2019/21 inclusive of renal dialysis to be offered in both Witbank and Rob Ferreira hospitals • ENT: is planned for 3rd quarter 2019 for both Witbank and Rob Ferreira hospitals • Cardiology Services OPD clinic to be established in 2020/21 in Rob Ferreira hospital • Burns Unit will be part of the New Witbank Tertiary hospital • Attached is an Annexure with the tertiary services that are not provided with time frames.
II What plans and how far have they been The Accounting Offcer has put the following plans to deal with the bypass of lower levels of implemented that the Accounting Offcer care to tertiary hospitals: has put to deal with the bypass of lower • Conducting outreach services, especially the Family Medicine department to reduce the level of care to Tertiary Hospitals and to number of patients going to the tertiary hospitals for consultation. The Family Medicine deal with “unnecessary” referral to the Departments in both Rob Ferreira and Witbank hospitals send doctors to PHC facilities tertiary hospitals? on a weekly basis for outreach services. • Capacitating Medical Offcers in district and regional hospitals in different disciplines
III What are the fnancial implications of The fnancial implications for tertiary hospitals dealing with level 1 and level 2 patients are tertiary hospitals dealing with level 1 and the following: 2 patients and entrenched is the problem? • The cost of treating one inpatient per day (EPDE) at a tertiary hospital for six months is R3 543, which is more costly than treating a patient in primary health care facility- the district hospital EPDE is R2 650. • These patients end up being seen by specialists at tertiary hospitals at a high cost and this is not sustainable.
110 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 7
I Why did the Accounting Offcer fail to On average stock availability for the pharmaceutical is 80% (1st quarter: 83.1%) and ensure 95% availability of medicine and surgical is 91.6% (1st quarter: 90.4%) at the Depot. surgical sundries at the medical depot and how has these affected availability Stock availability has decreased from the frst quarter to the second quarter of fnancial of medicine in hospitals and clinics. year 2019/2020 for pharmaceutical items from 83.1% to 81% however an increase in What does it mean that the problem has availability for surgical items at 91.6% as compared to 90.4.% at the end of 1st quarter. worsened when compared with the frst quarter? The Depot has failed to achieve 95% availability and is at 81% -reasons for the decrease in stock availability in the pharmaceuticals is due to supplier constraints experienced in: • Anti-psychotic medication • Contraceptives • Anti-hypertensive (specifcally Enalapril) • ARV`s
The Depot has implemented remedial actions which include the escalation to National Department of Health, opening of new stock codes to procure on quotations and consultation with speciality to recommend alternative treatment. All actions were put in place, to ensure that 95% availability of pharmaceutical and surgical items.
The following action has been taken: • Stock codes have been opened for contraceptives pack size 84`s (Oral dosage forms) • Stock codes have been opened for Anti-psychotic medication Sertraline 50mg, Sertraline 100mg, Citalopram 10mg • Recommendations have been made to Mpumalanga Pharmaceuticals Therapeutic Committee (MPTC) with regards to supply challenges • Stock are procured on quotations received from the NDOH • Mpumalanga Pharmaceutical Depot (MPD) has consulted with a psychiatrist from Witbank for possible treatment alternatives • Alternative pack size and strength options are recommended • Continuous follow ups with suppliers are done
Suppliers have also not yet stabilised in second quarter due to new awarded contracts.
The problem has not worsened because it is not the same pharmaceutical items that were affected in the frst quarter. Limited quantities were issued to facilities to minimize the impact of shortage at the Clinics and Hospitals.
II Can the Accounting Offcer indicate The Accounting Offcer can indicate the reasons for underspending in this programme as the reasons for underspending in this follows: programme and its implication on the • Late appointment of contractor for the implementation of the projects. various infrastructural development in • Slow and poor performance of the contractors the department? • Late award of the Medical equipment
The implications for the late completion of the projects is affecting access to health facility.
111 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
QUESTIONS FOR PROGRAMME 7
III Can the Accounting Offcer Yes the Accounting Offcer can indicate that: indicate the number of Number of • CCMDD Programme is implemented in 307 facilities. facilities implementing the CCMDD • CMMDD Collection or pick up points are 457 in the province which includes Programme and how many CCMDD 307 internal and 150 external. collection or pick up points have • 335 578 patients registered or enrolled on CCMDD been established in the province and • 49 206 patients currently enrolled for external pick up points how many patients are enrolled in it?
IV Did the Accounting Offcer Yes, the Accounting Offcer can report the following challenge encountered in the encounter challenges in CCMDD quarter under review: in this quarter and if yes, how have • Three (3) Pick-up Points (PUP) were closed due to various reasons such as those challenges been overcome? non-compliance to SLA, shutting down of PUP or change of ownership of PUP and new owner not interested.
Remedial action: • Patients were redirected to the closest PUP, communication to patients was sent via the service provider.
4.8. PROGRAMME ANALySIS: PROGRAMME 8
NO. QUESTION RESPONSE
Can the Accounting Offcer provide Yes, the Accounting Offcer can provide an update that the bid for the an update to the construction of Ka- construction of Ka-Nyamazane community Health Centre (CHC) closed on the Nyamazane CHC? 12 November 2019 and the Department of Public Works, Roads and Transport is currently busy with tender evaluation.
II Can the Accounting Offcer provide Yes, the Accounting Offcer can provide an update that the Department through an update on the construction of Department of Public Works, Roads and Transport has appointed 3 contractors Mapulaneng Hospital refecting the on the 20th November 2019. Soft site hand over/Sod turning took place on the 22 following: January 2020, Contractors are currently sourcing the construction permit which is a requirement from the Department of Labour.
a. The contractors appointed a. The contractors appointed • Ruwacon (PTY) LTD Maseno JV – Phase 3 A b. The percentage of work done • Barzani Development (PTY) LTD – Phase 3 B c. The percentage and exact • Stefanutti Masibone JV – Phase 3 A amount of money spent up to date b. Work done – Planning & procurement 100% and Construction 0% d. Challenges encountered in the c. Expenditure to date R37 216 000 /R 76 988 000 (consultant phase) construction of the hospital d. Challenge: One of the unsuccessful bidders is challenging the appointment of the other contractors and DPWRT legal services is handling the matter.
112 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
RESPONSES TO ORAL QUESTIONS RAISED DURING THE MEETING OF THE PORTFOLIO COMMITTEE ON HEALTH AND SOCIAL DEVELOPMENT, THURSDAy, 28 FEBRUARy 2019, COMMITTEE ROOM NO. 4/5, 08H00 – 11H00 NO. QUESTION RESPONSE
The issue around accruals, has been The Department acknowledges that the issue of accruals has been coming for far coming for too long. The budget of too long. the Department is approved with no As per defnition of fruitless and wasteful expenditure per PFMA is expenditure indication of accruals and it is not which was made in vain and would have been avoided had reasonable care been budgeted for. Does this mean its exercised. fruitless and wasteful expenditure? The accruals relates to expenditure incurred and the Department has received value for money and correct procurement processes were followed. Therefore, the accruals could not be classifed as fruitless and wasteful expenditure.
The approved budget for the Department was not suffcient and budget pressure of R 851 229 000 was reported to the Portfolio on Offce of the Premier, Finance and Economic Development during the 2018/19 FY Budget adjustment. The Portfolio has requested the Provincial Treasury to assist the Department.
Accruals of R 851 071 000 which was not cash backed could have been unauthorized expenditure had the Department managed to process the invoices as at 31 March 2018. How much is the correct fruitless and The Department has incurred fruitless and wasteful expenditure of R 547 162 as at wasteful and where was it incurred? 30 September 2018 and during the third quarter of 2018/19, fruitless and wasteful expenditure incurred was at R 2 000. The expenditure for the R 547 162 is mainly due to late payments to service providers.
Service Providers Amount Municipalities 8 717 Eskom 10 489 Government Pension fund 72 108 Mabuza Charmaine 243 527 NHLS 208 905 Telkom 3 416 Grand Total 547 162
113 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
In the response of (c) on page 2 of 44 The Department manages the budget and expenditure on monthly basis to the department responded that “ the avoid overspending at fnancial year end. The Department has the below department will not overspend, however projections for the accruals and payables as at 31st of March 2019. accruals and payables are estimated above R1 billion No. Nature of the Budget Pressure- 2019/20 FY A m o u n t R'000 The department must indicate: 1 Payables: (Invoices received before 31 March 2019)- 645 612 Key Accounts (i) Would the R1 billion accruals be within 2 Accruals (Invoices not received before 31 March 283 200 2019)- Key Accounts) the budget of the department or will the 3 Infrastructure accruals 25 000 department have the R1 Billion to settle 4 Compensation of Employees (Overtime) 20 000 these “accruals” and “Payable” at the end 5 Non-Key Accounts 46 600 of the fnancial term, if yes how considering Total Estimated Accruals and Payables 1 020 412 response 1 (a) and if no how can they be classifed as accruals not unauthorised The items that contributed to the accruals have been insuffciently budgeted expenditure because the department has for therefore the estimated accruals and payable above R1 billion is not cash spent way above the voted funds. backed. Unauthorized expenditure relates to overspending of a vote or a main division within a vote; or expenditure that was not made in accordance with the purpose of a vote or, in the case of a main division, not in accordance with the purpose of the main division. The accruals could not be classifed as unauthorized expenditure as the invoices were not released for payment.
114 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Medical negligence is a National The areas of big concern in the province around medical negligence are: issue, in the province where • Obstetrics and Gynaecology: involving babies born with Celebral Palsy and are the areas of big concerns maternal deaths due to complications during delivery except the lawyers and what • Orthopaedic patients who whilst waiting for operation experience deformities and/ are the reasonable steps to curb or complications related to delayed operations medical negligence? The Department has developed a litigation Strategy to reduce the medical negligence cases which among others focuses on the following. • Orthopaedic patients – the department is continuing to headhunt and appoint Orthopaedic Specialist to reduce the waiting time, two additional specialists have been appointed during the 3rd quarter 2018/19 FY, one in Mapulaneng and the 2nd one in Rob Ferreira. This is the frst time that Mapulaneng has an Orthopaedic Specialists and he is also doing outreach services in Matikwane hospital. Rob Ferreira has now 3 full time specialists • Obstetrics and Gynaecology – The Department has contracted the Obstetrics and Gynaecology Specialists to support KwaMhlanga and Mmamethlake where more Obstetrics and Gynaecological mortalities are experienced. District Clinical Specialists are supporting all District hospitals to upscale skill capacity on management of Obstetric Emergencies. The quality Improvement Initiative project on reduction of Maternal and Child mortality is piloted in Themba hospital and its referring hospitals through the support of Medical Research Council (MRC) and CHAI (Clinton Health Foundation) • Furthermore, the strategy aims to reduce the cost of litigation through a mediation process. • A Medical specialist has been appointed to look into improving clinical management and assess current claims to determine validity of such claims. • A post for Director: Legal services will be advertised on the 10th of March 2019 and recruitment will be prioritised for 2019/20.
Additionally, the Department has put in place the following measures to minimize medical negligence: • Established Patient Safety Committee to monitor and manage incidences of patient safety. The committees are established at Provincial, District and hospital level • Monitoring implementation of guidelines and protocols • Conducting of Clinical Audits in all disciplines • Consequence management where there is a clear case of negligence by staff • Progressively improving on record management
115 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Provide progress on the The table below indicates a breakdown of budget and expenditure for all new hospital breakdown cost of all new that are currently at different state of completion. hospitals and the total budget and the expenditure. Project Name Project cost Exp. To date Progress to date (R’000) (R’000) Bethal Hospital R 629 901 R 269 268 83% – Upgrading of the Hospital Mmamethlake R 454 030 R 436 404 Phase 1 – 100% Hospital – Upgrading of Phase 2 – 100% the Hospital Phase 3 – Not commenced New R 1 141 140 R 188 014 29% Middelburg Hospital – Construction New R 2 364 321 R 160 086 Phase 1 – 91% Mapulaneng Hospital Phase 2 – 100% Construction Phase 3 – Not commenced. What is legality and validity of The Department has appointed the service provider for “procurement, warehousing and the contract for the medical distribution of pharmaceuticals”. The contract effectively started from 01st of May 2018 warehouse? for a period of three (3) years. Offce of Auditor General of South Africa has audited the procurement processes for the award and no fndings have been identifed. The contract for the medical warehouse is legal and valid for a period of three (3) years from date of appointment.
An offcial unlawfully and The offcial was subjected to a disciplinary hearing and meted with 2 months’ salary intentionally shot a member of suspension without pay and a fnal written warning. This was a decision of an independent the public at Mapulaneng hospital Presiding Offcer. who was standing at casualty and the court awarded R 140 000. Why is the Department only issuing a warning letter?
116 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
The issue of accruals is affecting The Department is currently in discussions with the Provincial Treasury on how to the Department, is the strategy to mitigate the increasing accruals and payables. Nevertheless, the Vote is implementing address accruals working, If not stringent austerity measures and has established effciency projects to reduce health what went wrong? costs which will ultimately have positive impact on the reduction accruals and payables.
The Department will need cash injection to normalize the accruals, normal accruals are estimated at R 600 million based on the month of March 2019 invoices that should be processed in April each fnancial year.
The Orthopaedic ward is a The department acknowledged the concern raised about the quality of care in the problem, it takes 4 – 7 days for Orthopaedic wards and the staff attitude. The department received the petition as stated patients to be attended and and the matter has already been referred to the Head of Orthopaedic in Rob Ferreira it’s mainly caused by the staff hospital and the department will prioritize the petition and include petitioner to the lists. attitude and the name of the patient who sent a petition is not on the waiting list for operations. The Department acknowledges the challenge of staff attitude and continuous Customer Care training is provided. The Quality Assurance unit in the hospitals investigate all complains and where the staff is found to be at fault corrective measures are taken. Patients are encouraged to report any untoward behaviour by the staff for redress. During Open Days the community is informed of the Patients’ Rights and complaint mechanisms. How can the department avoid The Department has put in place the following measures to minimize medical negligence: medical negligence that is • •Established Patient Safety Committee to monitor and manage increasing the accruals, can incidences of patient safety. The committees are established at Provincial, District and the department strengthen hospital level disciplinary measures • •Monitoring implementation of guidelines and protocols
• •Conducting of Clinical Audits in all disciplines
• •Consequence management where there is a clear case of negligence by staff
• •Progressively Improving on record management
The Department is strengthening disciplinary measures as follows:
• •All cases of medical negligence must be referred to institutional adverse events committees if the recommendation of the latter is to the effect that there is gross negligence by an offcial of the Department and the state cover is lost, the offcial concerned must be subjected to a disciplinary process and the fndings be reported to the relevant statutory councils or bodies. What is the challenge with The challenge with medicine availability is at the Depot due to failure of suppliers to availability of medicines, is it a deliver required quantities of stock to the depot. The suppliers are contracted by the Depot or clinics? NDOH, however, in cases where there is shortage of a particular drug the patients are given an alternative treatment.
117 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Has the Dental equipment in Rob The autoclaves in the Dental department have not been repaired, however, an order has been Ferreira fxed? printed to repair two Autoclaves out of the four, and follow ups are done with the service provider. The service provider anticipates to complete repairs by the 31st of March 2019.
There is no functional Dental lab at The hospital does not have a functional Dental Lab due to budget constraints although the Rob hospital for four years, when will department acknowledges that this is also a priority area, this is not planned for in the 2019/20 FY the Department fx the issue? due to other competing priorities.
Why is medicine expiring at the The stock management system is outdated, this is the system that monitors available stock and Depot when there are employees at make it easier for the monitoring of stock that is nearing expiration. National Department is rolling the depot? out stock management system in all Provinces. Mpumalanga is on the list of Provinces that will receive this stock management system.
The department is currently using the RX Solution in all the hospital and the SVS is implemented in the PHC facilities to monitor stick movement.
Posts are not flled due to budget The Department is in the process of prioritizing critical posts to be flled and will fnalize the constraints, the Department must process before the end of current fnancial year. revisit its planning on appointment of Staff to prioritize critical posts. However, due to the current economic climate in the country the Public Service needs to reduce its wage bill which has become unsustainable. Compensation of Employees (CoE) Budgets are not allowed to be increased above the infation target set by National Treasury.
The Department must reassign resources to improve effciency and ensure critical vacancies are flled whilst remaining within its CoE budget ceiling.
The Department has implemented a number of effciency projects in order to improve effciency ensuring improved service delivery such as: • Utilizing overtime funding to appoint staff where staff shortages results in overtime • Reviewing of the staff establishment to ensure alignment with service delivery needs. • Development of clear staffng norms in order to ensure that staffng is in line with service delivery needs and resources is diverted from non-critical posts to critical posts.
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NO. QUESTION RESPONSE
PMDS must be implemented fully and The Department is developing guidelines on the implementation of PMDS. Training on the equally to avoid picketing, e.g Tintswalo guidelines is planned for management in all facilities. Hospital
Department transferred a non- While the Doctor was at Shongwe Hospital he was charged with misconduct for violation performing Dr to Tintswalo, and the of procurement processes, found guilty and sanctioned with a 2 months’ salary suspension same Dr is still not performing, why is the without pay. The transfer of the Doctor concerned was not informed by non-performance, Dept transferring non-performing staff? instead he was transferred in compliance with section 14(3)(b) of the Public Services Act No. 30 of 1997 as amended wherein the Executive Authority is empowered to effect a transfer on the basis of public interest.
In Tintswalo a pharmacist assistant The Department acknowledges the concern raised and the matter will be addressed. The took more than 2 hours to dispense pharmacy was fooded with water due to leaking roof and this also increased the patient medication after the Dr has prescribed. waiting time. The Department must address this matter as it has a potential of litigation?
What is actual progress of the new The Accounting offcer has noted concerns and the below progress can be reported: Mapulaneng hospital as there is nothing that is taking place at the hospital? Project Name Project cost Exp. To date Progress to date
(R’000) (R’000) New Mapulaneng R 2 364 321 R 160 086 Phase 1 – 91% Hospital Phase 2 – 100%
Phase 3 – Not commenced.
In the response (i) on page 1 of 44 the (i) The Department appointed the bursary holders in funded posts that were vacated department indicate amongst other that throughout the year thus replacing staff who were included in the Cost per Head who will not be able to absorb 110 bursary terminated their services with the Department during the 2018/19 Financial Year. holders because of the budget reduction. The remaining 65 bursary holders were appointed utilizing the Presidential Stimulus The department must indicate: Package. (i) How will it treat the 110 bursary (ii) Failure to translate nurses and non-implementation of grade progression for nursing holders and whether there is no staff will contribute to the number of avoidable and unnecessary grievances. The other way to absorbed them conduct of the department will constitute an act of unfair labour practice and gross (ii) What are the labour relations violation of a potential of an employee’s career path. implication for the department’s failure to translate nurses and settle grade progression for Nursing Staff.
119 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Annexure A on Austerity Measures does not refect the (i) The Department has managed to save R 40 million on overtime which was broad aspects of overspending of the department and reduced during the budget adjustment and R 4 million was saved on food the measures are not costed. project and has assisted hospital to stay within the budget on food in 2018/19 FY. The other projects are in progress because they are complex in nature. The department must indicate: (ii) The Department austerity measure did not include litigations, medical (i) What was the total savings that the HOD aimed to supplies, and medicine and laboratory services; however, the Department has achieve through the austerity measures and to date initiated effciency projects. The effciency projects included food, overtime, how much has been saved and what is its impact on medicine, coals, medical implants and utilities. the rising accruals. (ii) Why does the Austerity measure fail to deal with the cost drivers of accruals such as litigations, medical supplies, and medicine and laboratory services? Annexure B is not a report of the Financial Misconduct The Accounting Offcer would like to acknowledge the oversight as Financial Committee, but it is three letter written by CFO to SE Misconduct Committee report was supposed to have been attached. Motau asking investigation and disciplinary steps Financial Misconduct Committee report dealing with R 547 162 has been against CEO of Standerton for R283.04. A letter from attached as Annexure A. CEO to SE Motau for irregular expenditure of R 1 129 320 asking investigation and disciplinary steps against Miss Motau and Mr Mamogale are the DDGs responsible while actual J Mothlamme. A letter written by CFO to the same CFO investigations is conducted by the relevant managers and hospital CEOs. requesting the CFO to investigate and discipline Mr Investigations were not at all times concluded within 30 days but concluded Mahlalela R 1 129 320. within the quarter. (i) Why did the Accounting Offcer put an irrelevant annexure? (ii)Did Miss Motau and Mr Mamogale respond within the 30 days they were given on 7 January 2019, if yes what was the outcome, if no why not considering the letters written to them? (iii )The Accounting Offcer provide the relevant annexure dealing with the R 547 162 wasteful and fruitless expenditure as asked in the question? Annexure C does not comply with the PFMA and PFMA The Accounting Offcer has reported all the irregular expenditure incurred to regulations on the reporting of irregular expenditure. Provincial Treasury as required by PFMA 38 (g). The HOD should have written to the Provincial Treasury to report the irregular expenditure together with the Annexure B: Proof of reporting the irregular expenditure register of Irregular expenditure? (i) Can the Accounting Offcer explain how an irregular expenditure is reported in accordance to the PFMA and can she show proof of reporting it according to the PFMA because the proof submitted is not compliant with the PFMA?
120 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Annexure F: Austerity measures on catering The Department has not realized savings on catering however for fscal The Annexure refect broad austerity measures not only control. Further and new savings could not be realized because the austerity catering: measures have been in place for the past fve fnancial years. However, the (i)Can the Accounting Offcer indicate how much other projects are in progress because they are complex in nature. The 145% she intended to save on catering as per the austerity expenditure was due to the use of an incorrect account at the nursing college. measure on catering and further indicate how much This error was corrected in January 2019. has she saved up to date and whether the austerity measures are effective or ineffective considering that by end of third quarter catering was already at 145% In response xii (b) on page 13 of 44 the department is Yes, the Accounting Offcer can indicate the amount paid and the number of indicating that legal fees are as a result of the offce cases referred to OTP as follows: of the premier contracting private attorneys to assist all departments including the department of health in (i) R 9 585 444.88 was paid to private attorneys for the 3rd quarter 2018/19. The defending the litigation cases. Departments are allowed to participate in the contracts awarded by another government institutions. Currently in the province there are other contracts Can the Accounting offcer indicate the following: awarded by Provincial Treasury and other Departments are participating such as Traveling agencies, furthermore, Department of Public Works, Roads and (i) How much has the department of health paid towards Transport (DPWRT) awarded other contracts on behalf of other government the attorneys appointed by the Premier’s Offcer and institutions for construction and maintenance of buildings and other fxed whether does the PFMA allows such an arrangement structures. where the Premier’s Offcer source services but are paid by the department of health? SCM to respond on (ii) A list is attached marked Annexure C this one. It is currently diffcult to indicate the value derived from contracting the private attorneys as litigation in the high court may take more than fve years and (ii) How many cases has the Accounting offcer referred of which majority of cases have not been fnalized. Those that have been to the attorneys appointed by the Offce of the Premier fnalized are the once where plaintiff’s withdraw on technicalities raised by our and what were the outcomes per case; considering defense attorneys but not on merits. the outcome per case and the amount paid by the department would the accounting offcer indicate if value has been derived from contracting external Attorneys? Annexure I1 and I2 are nor reader-friendly. Annexure D1 and D2 has been attached. (i) Can the accounting Offcer submit reader- friendly editions of Annexure I1 and I2.
121 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION RESPONSE
Response ii on page 19 of 44 does not make The Department is targeting to have the discussion document a frm statement for the MEC to prepare which will include both inputs from internal and external the legislation. In the second quarter, the stakeholders by April 2019. The Bill will thereafter be submitted department indicated that will complete the to the Executive Council for approval. Once the Executive process in the next fnancial period. So the process is fnalized, the Bill will be introduced to the Provincial MEC must establish the Act. Legislature for processing and passing. Response (c) on Page 22 of 44 is vague. The MEC did not replace a legislation with a policy, however, The MEC must provide a legislation not a in the absence of Provincial Health Act, the MEC used the policy. The MEC must answer the question National Health Act as a guide and developed a guideline for on which prescripts did the MEC use to the establishment of Governance structures in the province. replace a legislation with a policy? The MEC has capacitated an offcial within Legal unit in the Department with legislation drafting and will commerce with drafting the Provincial Health Act during the 2019/20 FY.
Mmametlhake hospital was advertised and The post of CEO Witbank TB hospital will be advertised on 03 withdrawn in order to transfer the CEO of March 2019 and an appointment should be made during the Witbank TB frst quarter of 2019/20 fnancial year. TB Specialized hospitals have been reclassifed and will no longer require to have CEOs without a medical background and the advert will be for a CEO/Clinical Manager. The Department is allowed to issue an erratum to either withdraw or correct an advert if the post is no longer required to be flled. What is the criteria set by the Department on The Department is guided by the National Health Act 61 of the appointment of hospital boards? 2003 in the setting of criteria for the appointment of Hospital Board members, Section 41 sub-section 8 indicates that the boards may include not more than fve persons with expertise in areas such as accounting, fnancial management, human resources management, information management and legal matters. Sub-section 7(d) indicates that there must be not more than three representatives of the communities served by the hospital, including special interest groups representing users:
If the Dept cannot appoint a Director for The post of Director: Legal Services will be advertised on Legal and how will the issue of litigations the 10th of March 2019 and recruitment will be prioritised for going to be addressed. 2019/20 FY
122 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
RESPONSES ON ANALySIS OF THIRD QUARTER PERFORMANCE REPORT OF THE DEPARTMENT OF HEALTH (2019/20)
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
I Can the Accounting Offcer indicate why Yes, the Accounting Offcer can indicate that the Programme is this programme overspend, even after overspending due to payment of long outstanding invoices for the programme got an increase during private attorneys which were only submitted in November 2019 budget adjustments, can this be a case by the Offce of the Premier. The Department has, during the of poor budgeting and projections for this 2019 MTEC, registered a budget pressure with the Provincial programme? Treasury, however the budget pressure could not be funded. This is not due to poor budgeting and projections for this programme but delay in receiving invoices. II Did the Accounting Offcer reconsider the No, the Accounting Offcer has never issued a communique to disallow departmental decision to disallow patients to park patients to park inside the health facilities. The decision taken was that inside health facilities? the driver will drop-off the patient inside the facility and park outside thereafter. The issue of parking outside the health facilities affects the people visiting patients only. This decision is weighed against the safety of both staff and patients in the health facilities, whose safety is threatened by criminal activities. The risk is highest during visiting hours, where a patient was shot and killed in Witbank hospital in November 2019. This decision was agreed upon during the Honourable Premier’s consultation with organised labour after the tragic incident. Hospital CEOs and District Managers have been requested to engage municipalities and to identify areas where access to parking for visitors can be controlled.
123 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
III Can the Accounting Offcer provide resolutions of Yes, the Accounting Offcer can provide resolutions of the joint Safety the joint Safety Summit with the Department of Summit and a brief update on the implementation of those resolutions. Education and DCSSL and provide a brief update Resolutions: on the implementation of those resolutions? • Issue of infrastructure must be addressed to suit policy requirements • Review of Safety and Security policies is required to ensure its effectiveness • There must be visible signage for safety in health institutions • There must be outreach and involvement of communities relating to safety to prevent strikes and unrests. • Improve communication of policies • The departments must insource security responsibilities A brief update on the implementation of the resolutions: • A tender to invite service providers for the installation of the electronic Security systems (CCTV cameras and panic buttons) has been advertised in December 2019 and the closing date was 14 February 2020. • Burglar bars have been installed at critical areas e.g. Paediatrics, Casualty, Maternity, Mental health wards as well as all PHC facilities. • Assessment for fencing in all hospitals has been completed except the PHC facilities where installation will be done in a phased-in approach after the completion of assessment by the end of February 2020. • A program for creating awareness about security issues in the health facilities has been developed, this includes print and radio slots which commenced on the 4th December 2019 with both Ligwalagwala and Ikwekwezi FM. • The Department is in the process of developing an organisational structure which will ensure that all facilities have Security Managers who will ensure that all issues of security are addressed in the specifc facility. Currently the Security personnel resides at Provincial Offce only and the exercise undertaken will ensure that the security management is cascaded to facilities for proper management.
124 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
IV Did the MEC and Accounting Offcer conduct Yes, the MEC and the Accounting Offcer did conduct unannounced unannounced to health facilities in this quarter, if yes, visits to health facilities during the quarter under review. The which facilities were visited, what has been found following health facilities were visited: and how it be redressed if needs be, if no, why not considering the target in the operational plan? Category No Medical Interns 1st year 26 Medical Community Service 17 Medical Offcers 10 Medical Specialist 1 Total 54
• Ermelo hospital – The hospital was clean and there were no patients waiting to be attended to and the staff had a positive attitude. Visitors interviewed were also satisfed with the information provided to them.
• Themba Hospital – There was a long waiting time in Pharmacy, analysis revealed poor management and utilization of staff. The Pharmacy Manager was called back to assist in reducing the waiting time for the day. The Department has commenced with the procurement process of a queue management system. The expected implementation date is 01st May 2020.
• Evander hospital – The hospital was clean from the gate to the grounds and inside the facility. The staff attitude was positive despite the fact that Casualty was a bit short staffed.
Did the MEC convene MuniMEC in this quarter and • No, the MEC did not convene MuniMEC in the quarter under what are the issues raised in the MuniMEC in relation review due to other competing activities. to health delivery in the Province? • The MuniMEC is scheduled to take place on the 13 March 2020.
125 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
V Did the department inspect and renew licences of Private • Yes, the Department did inspect and renewed licenses of Health Establishment? And what is the view of the private health establishments, which is conducted annually department on the fnding of the Competition Commission using R158, the regulation pertaining to the control of report released on 30 September 2019 particularly on Private Hospitals. the following statements in the report “The commission • The Department acknowledges the fndings however it is has concluded that private healthcare is plagued by the mandate of the National Department of Health together high and rising costs of medical cover, signifcant over- with the Board of Health Care funders (BHF) to standardise utilisation without a demonstrative improvement in health pricing of services in private hospitals. outcomes - and a “milking of the system” due to a lack of controls by the Department of Health. It says the department has not reined in the private sector, hasn’t used existing powers to manage the market, failed to ensure regular reviews, and not held regulators, such as the Health Professions Council of SA and the Council for Medical Schemes, suffciently responsible, which has enabled “uncompetitive and ineffcient behaviours within the sector”. The report further concluded that “We are concerned that although the National Health Act was enacted 16 years ago, its key provisions - in particular, those relating to the licensing of facilities, reference lists, the creation and publication of a national database on fnancing and pricing of healthcare goods and services - have not yet been implemented.”
126 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
VII Did the Accounting Offcer approve 16 research proposal in No, the Accounting Offcer only received 13 x research proposals, of this quarter and what are the titles of the researches and how which 7 x were approved, whereas 6 x applicants had outstanding will they improve quality health provision in the Province? documents to submit before their studies could be considered.
Title Beneft to the province 1. Emergency department The study intends to collect the nurses’ knowledge attitudes necessary input from emergency practice behaviours and department nurses themselves in beliefs towards intimate the management of intimate partner partner violence violence patients. The results of the study can guide improvement and implementation of practices. 2. Internal control systems The study intends to examine the affecting progression to internal control systems affecting clean audit outcomes in progress towards clean audit Mpumalanga provincial outcomes in the Mpumalanga departments provincial departments, and thereby recommending strategies for improving audit outcomes. 3. Evaluation of the potential The overall goal of this study is to benefts of decanting stable model the potential impact of decanting patients after 6 months newly initiated ART patients into repeat on ART in public clinics in prescription collection strategies after South Africa 6 months on ART on viral suppression and retention at public sector clinics in South Africa, and has the potential to change prescription guidelines. 4. Assessing the The aim of this study is to explore user hypothetical acceptability, perspectives about MAP (micro-array usability, and programmatic patch) technology which contains ft of microarray patches hundreds of thin, small, drug-loaded (MAP) for HIV pre-exposure micro needles. The study was prophylaxis (PrEP) and as conducted to determine the needs for a multipurpose prevention design refnements. This technology technology (MPT): A could provide a new protection option qualitative study for adolescent girls and young women in low- and middle-income countries who are at greatest risk of HIV infection and unintended pregnancy, ultimately contributing to a reduction in HIV incidence and unintended pregnancies in this population.
127 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
Title Beneft to the province 5. South African Population This study was intended Research Infrastructure Network (SAPRIN). to obtain accurate data on A National Research population dynamics (births Infrastructure of Health and and deaths by cause) to Demographic Surveillance System (HDSS) Nodes enable the close monitoring of a range of health and development indicators, and to compute precise individual exposure periods that support advanced studies in a range of felds; these speak to critical life course stages including childhood, adolescence, adulthood and later life phases. It is also intended to assist the department to monitor vaccine coverage rates within the province. 6. Hearing patterns The information collected through this of patients following proposed study, is intended to inform substitution of MDR- the standard operating procedures TB regimen containing in audio logical management of the kanamycin with regimen affected patients during treatment and containing Bedaquiline after the treatment is fully completed. 7. Survey of Procedures This study will address an important and Resources for Initiating gap in the current knowledge around Treatment of HIV in Africa: ART initiation and what can be done to The SPRINT Study reduce the already high proportion of patients who are being lost from care after testing positive. There is currently almost no information available on how to reduce these pre-ART losses.
128 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
VII Did the Audit Committee make Yes, the Audit Committee does make recommendations to the Department and recommendation to the Department, they are as per the attached Resolution Register. These if yes what are the recommendations and how are they implemented by the Department? IX Can the Accounting Offcer indicate the Yes, the Accounting Offcer can indicate the elements of the Siyabhadala which elements of the Siyabhadala Invoice indicates the dates from the receiving point of the invoice to the authorization Monitoring System and how has this of it. Once the receiver receives the invoice, he or she will register it on the improve the payment of invoices in the system. The same with the capturer, pre authoriser and fnal authoriser. This is to Department? track where delays occurred and the department will be able take the necessary steps with the affected offcial/s. It has helped the Department to improve on the turnaround time of paying invoices within 30 days. It must be noted for the period under review, 99% of invoices were paid within 30 days. X Did the Accounting Offcer monitor The Department received coverage in various media platforms that included media coverage of the department newspapers, various radio stations and online news. in the third quarter, if yes what was • The Department was covered on the launch of Ambulances, covered and what is the response of the • NHI Roadshows both Departmental and by National Portfolio Committee department or how will it improve the • Murder of a patient in Witbank hospital performance of the department? • Strikes by hospital health professionals demanding security to be upgraded after a patient was killed in Witbank hospital, • Welcoming of New Year and Christmas babies.
Although the Department received a bit of positive coverage, most of the stories were negative, clouded by the killing of the patient in Witbank hospital which prompted workers to down tools and it spread to other hospitals in the province.
The Department has introduced a number of contingency plans to minimise negative coverage: • Improving security measures in hospitals. • Limit visitors from entering the hospitals with their cars. • Increased number of security guards in hotspot areas. • Issued media statements on positive news. • Utilise radio slots on Community Radio Stations and SABC stations to communicate the good work the Department does.
The Department also utilises social media platforms like Facebook and Twitter to showcase the good work of the Department.
129 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.2. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 2
NO. QUESTION RESPONSE
Did the Accounting Offcer Yes, the Accounting Offcer has developed measures to improve performance of TB related develop measures to targets as listed below: improve departmental performance on all the Indicator Target Performance Reason for Remedial action Effectiveness TB related performance deviation targets, what are those TB/HIV 96% 64.1% National The National measures and how co-infected challenge Department of client on on Health released effective are they since ART rate Systems V1.12.8 Tier.Net the department has failed transition update for sub- to achieve them from from District level. frst quarter until the third Tier.Net system to The Province quarter ? webDHIS. updated the Districts and sub- Districts regarding the new version and trainings were conducted for clinicians and Data Capturers.
44 x Data Capturers were appointed at Ehlanzeni District and trained on TB Module in Tier. net on 25 -29 November 2019 to ensure accuracy of TB outcomes data TB client 88% 78.3% High death Work with treatment and high partners and success Lost to Community based rate follow up organization to rates trace TB contacts and defaulters in areas of high defaulter rate viz. Emalahleni and Govan Mbeki.
130 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.2. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 2
NO. QUESTION RESPONSE
Did the Accounting Offcer Yes, the Accounting Offcer has developed measures to improve performance of TB related targets as develop measures to listed below: improve departmental performance on all the TB Indicator Target Performance Reason Remedial Effectiveness related performance targets, for action what are those measures deviation and how effective are they TB/HIV co- 96% 64.1% N a t i o n a l The National since the department has i n f e c t e d challenge Department of failed to achieve them from client on on Systems Health released frst quarter until the third ART rate transition V1.12.8 Tier.Net quarter ? f r o m update for sub- Tier.Net District level. system to webDHIS. The Province updated the Districts and s u b - D i s t r i c t s regarding the new version and trainings were conducted for clinicians and Data Capturers.
44 x Data Capturers were appointed at Ehlanzeni District and trained on TB Module in Tier.net on 25 -29 November 2019 to ensure accuracy of TB outcomes data TB client 88% 78.3% High death Work with treatment and high partners and s u c c e s s Lost to Community based rate follow up organization to rates trace TB contacts and defaulters in areas of high defaulter rate viz. Emalahleni and Govan Mbeki.
131 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
Indicator Target Performance Reason for Remedial action Effectiveness deviation TB client <5% 9.6% Patients get Partner with Traditional lost to lost to follow Leaders and Traditional follow up up during the health practitioners to rate course of TB educate the community treatment on TB treatment adherence.
TB client <5% 8.4% Late Intensify TB awareness death rate presentation through WBPHCOT and of patients at other Community outreach health care services as well as facilities Advocacy Communication and social Mobilization
TB MDR 61% Long term High Lost to Bedaquilline treatment was Bedaqualine and treatment Regimen= 49.8% follow up and rolled out from Witbank TB the new short success rate high Death hospital to TB specialised term Regimen is Short term rate hospitals according to the effective as TB Regimen= 71.1% guidelines for TB MDR clients do not have management. to stay 18months on treatment with the A short term regimen for risk of defaulting TB MDR is provided for eligible clients at Witbank Tb specialised hospital
132 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.1. PROGRAMME ANALySIS: QUESTIONS FOR PROGREAMME 1
NO. QUESTION RESPONSE
What measures has the • To improve the implementation of the Integrated Management of Childhood Illness in the third quarter, Accounting Offcer put the Accounting Offcer applied the following measures: in place to improve the • Trained 49 x Professional Nurses on Integrated Management of Childhood Illnesses from Ehlanzeni implementation of the district. Integrated Management • Monitored the implementation of the strategy through review of patients fles of Childhood Illness and • Made provision of Road to Health Booklet to all children irrespective of lack of legal documentation. how effective are the • Integrated with other programmes: Expanded Programme on Immunisation and Integrated Nutrition measures? Programme for effective service delivery where the immunisation under 1-year coverage reached 92.8% against the target of 90%. • Implemented the Reach Every Child strategy (REC) on immunisation by ensuring that all facilities are immunising children daily. • Monitored the implementation of Infant and Young Child Feeding policy through conducting quarterly reviews in collaboration with SASSA. • Supported the Leave No Young Child Behind Project at Nkomazi sub-district by conducting catch up and mop –up immunisation programmes. • Visited the Early Childhood Development centres (ECD) to render health services through mobile and School Health Services to render services once a year.
• Impact of the measures: • The Department acknowledges that to date, no impact has been realised in relation to the above measures since the neonatal and child mortality rates remain above the set targets. • The impact is only on severe acute malnutrition case fatality under 5 years’ rate which is at 9% against the target of 9%. • The Department will continue monitoring the implementation of the guidelines and measures that are put in place and then address the identifed gaps. • The identifed gaps to be addressed are as follows: • The plan for 2020/21 is to train Community Health Workers (CHW) on Household Integrated Management of Childhood Illness (IMCI) component to empower caregivers on danger signs and importance of seeking early medical attention. • The Department has set aside R22 000 000.00 to procure diagnostic tools and equipment in Clinics to contribute to the reduction of neonatal Mortality • Delayed seeking medical intervention is being addressed through community dialogues and awareness campaigns • Failure to identify danger signs by care givers will be addressed by implementing the plan for 2020/21 which is aimed at training Community Health Workers (CHW) on Household IIMCI component to empower caregivers on danger signs and importance of seeking early medical attention. • Inadequate growth monitoring by clinicians when children present at health facilities will be addressed by monitoring the implementation of Infant and Young Child Feeding policy.
133 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.3 PROGRAMME ANALySIS: QUESTIONS FOR PROGRAMME 3
NO. QUESTION RESPONSE
Has the Accounting Offcer interviewed and appointed the • The profling of the applications has been completed. Shortlisting 10 x CCA/ ECP as refected in the frst quarter? scheduled for 21 February 2020 and interviews will be conducted on 28 February 2020.
Did the Accounting Offcer determine what needs to Yes, the Accounting Offcer determined the following measures to address be done for the EMS response times to be met, if yes, the response times. provide what needs to be done and when will it be done as well as at what cost? • A dispatch system: The Accounting Offcer committed R50 million for the 2020/21 fnancial year for the procurement of an Emergency Management System for call taking, which includes a Computer- Aided Dispatch (CAD) module, which will accurately record response times.
• Additional ambulances: 67 x ambulances will be prioritised in 2021 FY.
• Adequate Equipment: An audit of medical equipment was fnalised and new equipment for the new ambulances and all other operational vehicles amounting to R28.8 million, will be purchased in the 2021 fnancial year.
134 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.4. PROGRAMME ANALySIS: PROGRAMME 4
NO. QUESTION DEPARTMENTAL RESPONSES
I. Can the Accounting Offcer indicate why in this programme Yes, the Accounting Offcer can indicate that the inpatients Bed Utilisation inpatient bed utilisation was not achieved and also indicate Rate was not achieved due to a low uptake in the step-down wards however, why did Expenditure per PDE was still higher even though compared to the 2nd quarter the utilisation rate has increased from 68.6% inpatient bed utilisation was low? to 71.05% in the 3rd quarter against a target of 75% .
The Expenditure per PDE is R3,385 against a target of R3,272 due to payment of incentive bonuses for staff during the 3rd quarter. In addition, the payment of NHLS, SANBS and implantable sets also contributed to the high Expenditure per PDE.
II. Can the Accounting Offcer provide a plan to ensure that Yes, the Accounting Offcer did provide the following strategies to reduce hospitals have the required specialists and the vacancy the vacancy rate of specialists in the regional hospitals: rate of specialist in regional and specialised hospitals is • Offering bursaries to doctors to train as specialists through the reduced? Registrar Programme, with the aim of increasing the pool of specialists in the province. The bursary has a work back obligation. To date 35 Registrars have been admitted on the programme. • Partnering with academic institutions to support the accreditation of the tertiary hospitals for training of Registrars • Headhunting of specialists is ongoing • Appointing Registrars from other provinces, who are still awaiting for their fnal year examinations results, as Medical Offcers, and translating them into specialists as soon as they are registered with the Health Professionals Council of South Africa (HPCSA) as specialists.
NO. QUESTION DEPARTMENTAL RESPONSES
III Can the Accounting Offcer provide plan to ensure that Yes , the Accounting Offcer can indicate that the regional hospitals are regional hospitals provide all the services prescribed to be expected to provide eight core clinical specialists domains and currently: provided at a regional hospital? • Themba hospital provides all the eight core domains • Ermelo hospital does not have Orthopaedics and Psychiatry • Mapulaneng hospital does not have Psychiatry and Radiology (no CT- Scan)
The plan for the Department is to increase the number of specialists per clinical specialists domain as most of the domains are run by one specialist, and this is not suffcient to provide coverage for the whole month. This will be done through headhunting of specialists and appointing Registrars doing their fnal year from other provinces
135 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.5. PROGRAMME ANALySIS: QUESTIONS FOR PROGRAMME 5
NO. QUESTION DEPARTMENTAL RESPONSES
I. What measures has the Accounting Offcer put in place to The Accounting Offcer has developed the following measures and systems curb the bypass of district hospitals and regional hospital to curb patients bypassing level 1 and 2 of health service and jumping to by patients to tertiary hospitals and how effective are those tertiary hospitals by: measures considering the persistence of the problem. • Conducting outreach services, especially the Family Medicine department to reduce the number of patients going to the tertiary hospitals for consultation • Capacitating Medical Offcers in district and regional hospitals in different disciplines.
4.6. PROGRAMME ANALySIS: QUESTIONS FOR PROGRAMME 6
NO. QUESTION DEPARTMENTAL RESPONSES
I. Why did the Accounting Offcer record low expenditure • The Accounting Offcer recorded low expenditure due to the fact that for this programme for this quarter and at the end of the the bursary payment for the Cuban Medical students, is still to be quarter? processed in the fourth quarter as this is the time when the invoice is received.
II. Can the Accounting Offcer provide 2019 pass rate and • The Accounting Offcer can indicate that out of the 69 X medical graduation rate of bursars of the department and the students who were doing fnal year, 48 x passed their examinations, College of the department? achieving a pass rate of 70%. • The 2019 examinations for the Nursing students are still in progress and a conclusion on the pass rate cannot be made at this stage.
III. Can the department indicate if there is a challenge in • The Department can indicate that it does train Pharmacist Assistants training pharmacy assistants considering the vacancy rate from time to time. One of the challenges experienced is the attrition of pharmacy assistants and how does the department plan rate as the students opt for better opportunities as well as the number to improve the development of pharmacist assistants? of accredited pharmacists to act as mentors. • The recruitment is also limited by the availability of Pharmacists registered as tutors with the South African Pharmacy Council (SAPC). • The Department will continue to recruit and train Pharmacist Assistants within the available resources.
IV. Can the Accounting Offcer indicate the number of • The Accounting Offcer can indicate that 27 Intermediate Life Support Intermediate Life Support graduates supported or graduates were supported by the Department in the form of study produced by the department for public health? assistance, in the year under review. These are offcials already employed by the department.
136 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.7. PROGRAMME ANALySIS: PROGRAMME 7
NO. QUESTION DEPARTMENTAL RESPONSES
I. Why did the Accounting Offcer fail to ensure 95% Medicine and surgical sundries availability for the 3rd quarter, were 80% and availability of medicine and surgical sundries at the 88% respectively. The Accounting Offcer failed to ensure 95% availability medical depot and how has these affected availability of of medicine and surgical sundries due to challenges as outline as follows: medicine in hospitals and clinics • Contracted suppliers cannot keep up with the current demand • Non-awards of some of essential items on tenders resulting in long quotation procurement processes and no guarantee of supply. • Transition from expired to new tenders – if the previous contracted tender supplier did not deliver as per the lead times, excessive initial lead times on the new tender increase the possible stock out periods. This also creates a situation whereby suppliers deliver multiple orders at the same time. • Inconsistent ordering from facilities results in inconsistent ordering by the Medical Depot in order to keep up with the demand. This affects planning of suppliers as well. • Suppliers do not keep to contracted lead times and continuously postpone delivery dates.
Remedial action • Supplementary tenders have been awarded which assists in availability. • All newly awarded tenders are assessed in order to determine items which have not been re-awarded on tender as well as possible alternatives that have been awarded on tender but is not coded in the province. Recommendations are made accordingly to the Provincial Pharmaceutical and Therapeutic Committee (MPTC) • Bulk stock are procured if available and repacked into the pack size • New stock codes have been opened and orders placed on quotation • Warning letters are issued to suppliers not adhering to lead times and delivery dates. In the instance that suppliers still do not adhere after the third warning letter is issued, the matter is escalated. • The provincial contracts were advertised for surgical items
II. Can the Accounting Offcer indicate the number of facilities • Reports of shortages of clean linen have been indicated in Witbank reporting clean linen stock outs in this quarter and how has hospital. The hospital does not have an in-house laundry however, this problem been addressed? plans are underway for the construction of the mini-laundry. In case of clean linen stock-outs the hospital liaise with nearby hospitals to get additional linen especially if it is linen for the operating theatres
III. Can the Accounting Offcer indicate the number of Number Yes the Accounting Offcer can indicate that: of facilities implementing the CCMDD Programme and • CCMDD Programme is implemented in 307 facilities. how many CCMDD collection or pick up points have been • CMMDD Collection or pick up points are 457 in the province which established in the province and how many patients are includes 307 internal and 150 external. enrolled in it? • 335 578 patients registered or enrolled on CCMDD • 49 206 patients currently enrolled for external pick up points
IV. Did the Accounting Offcer encounter challenges in Yes, the Accounting Offcer can report the following challenge encountered CCMDD in this quarter and if yes, how have those in the quarter under review: challenges been overcome? • Three (3) Pick-up Points (PUP) were closed due to various reasons such as non-compliance to SLA, shutting down of PUP or change of ownership of PUP and new owner not interested.
Remedial action: • Patients were redirected to the closest PUP, communication to patients was sent via the service provider.
137 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.8. PROGRAMME ANALySIS: PROGRAMME 8
NO. QUESTION DEPARTMENTAL RESPONSES
I. Can the Accounting Offcer provide an update to the Yes, the Accounting Offcer can provide an update that the bid for the construction of Ka-Nyamazane CHC? construction of Ka-Nyamazane community Health Centre (CHC) closed on the 12 November 2019 and the Department of Public Works, Roads and Transport is currently busy with tender evaluation.
II. Can the Accounting Offcer provide an update on the Yes, the Accounting Offcer can provide an update that the Department construction of Mapulaneng Hospital refecting the through Department of Public Works, Roads and Transport has appointed following: 3 contractors on the 20th November 2019. Soft site hand over/Sod turning took place on the 22 January 2020, Contractors are currently sourcing the a. The contractors appointed construction permit which is a requirement from the Department of Labour. b. The percentage of work done c. The percentage and exact amount of money spent up a. The contractors appointed to date • Ruwacon (PTY) LTD Maseno JV – Phase 3 A d. Challenges encountered in the construction of the • Barzani Development (PTY) LTD – Phase 3 B hospital. • Stefanutti Masibone JV – Phase 3 A
b. Work done – Planning & procurement 100% and Construction 0% c. Expenditure to date R37 216 000 /R 76 988 000 (consultant phase) d. Challenge: One of the unsuccessful bidders is challenging the appointment of the other contractors and DPWRT legal services is handling the matter
138 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
RESPONSES TO QUESTIONS ON AN ANALySIS OF FOURTH QUARTER PERFORMANCE REPORT OF THE DEPARTMENT OF HEALTH (2019/20)
NO. QUESTION DEPARTMENTAL RESPONSES
4.8. PROGRAMME ANALySIS: PROGRAMME 8
Did the Accounting Offcer record any irregular Yes, the Accounting Offcer did incur irregular expenditure in this quarter: expenditure in this quarter, if yes indicate the following: a. A total amount of R 9 141 238.09 was incurred as irregular expenditure a. how much was it, in the quarter under review. b. from which unit, b. The services were from the Supply Chain Management, Impungwe c. who caused it and and Witbank hospital. d. what actions have been taken c. Chief Director: Financial Accounting, CEOs of Impungwe and Witbank e. which services were procured hospital in the quarter under review. f. from which service provider d. Investigation letters were sent to responsible managers to account for g. In the past three years (inclusive of this fnancial the irregular expenditure and take appropriate steps. period), can the Accounting Offcer provide e. Services procure were food contract, private hospital ICU and information on personnel disciplined for incurring photocopier services. irregular expenditure, if none, why not? f. Refer to attached Annexure A. g. Disciplinary action has been taken to managers as per attached Annexure B.
Annexure A: Report on irregular expenditure for fourth quarter. Annexure B: Letters of personnel disciplined for incurring irregular expenditure
Did the Accounting Offcer record any fruitless and Yes, the Accounting Offcer recorded fruitless and wasteful expenditure in wasteful expenditure in this quarter, if yes indicate this quarter: the following: a. An amount of R 41 466.55 was recorded as fruitless and wasteful a. How much was it expenditure. b. From which unit b. From various institutions (List attached as Annexure C) c. Who incurred it c. District Managers (Nkangala and Ehlanzeni), Director: EMS, Chief d. What caused it Director: PHC and CEOs (Mapulaneng, Mammetlhake, Shongwe, e. What actions have been taken Tintswalo and Rob Ferreira Hospitals). d. Late payments of electricity and municipal accounts and wasteful expenditure. e. Investigation letters were sent to responsible managers to account for the fruitless and wasteful expenditure and take appropriate steps.
Annexure C: Report on fruitless and wasteful expenditure
139 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 1
Can the accounting Offcer indicate the challenges relating The Department’s overall performance on the appointment of Executive
to flling all executive management teams in hospitals and Management team is achieved at 89%. The flling of vacancies is infuenced
indicate how will this challenge be addressed? by staff turnover. The plan is to fll all vacated posts during the 2020/21
fnancial year. Did the Accounting Offcer align the PHC organizational No, the Accounting Offcer has not aligned the PHC organizational structure
structure to WISN and indicate if the department is able to to WISN and have not implemented due to unaffordability of the WISN
implement WISN and if not indicate the challenges? staffng requirements. Furthermore, an EXCO resolution was taken in
the Province for all Departments to review their organizational structures
based on the current warm bodies and critical posts as a result of budgetary
constraints in the Provincial Administration. Can the Accounting Offcer indicate the elements of the HR The elements of the HR Plan are as follows:
Plan and what the HR plan seek to achieve and whether • Recruitment and Selection
with the current budget the HR plan could be achieved. • Human Resource Development
• Performance Management
• Employee Health & Wellness Programme
• Implementation of the Employment Equity Act
The HR plan seeks to achieve adequate production and provision of skilled
healthcare professionals.
The budget is inadequate to achieve the HR plan elements, however, the
Department prioritizes the flling of critical posts in the beginning of the
fnancial year based on the allocated budget for CoE.
140 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR DISTRICT HEALTH SERVICES
I. Did the Accounting Offcer develop measures to Yes, the Accounting Offcer has developed measures to improve improve departmental performance on all the TB related performance of TB related targets as listed below: performance targets, what are those measures and how effective are they since the department has failed to TB/HIV co-infected on ART and Cure rate The algorithms for Tier.net and WebDHIS systems were not aligned and achieve TB related targets? affected the performance of the two indicators. Namely: TB/HIV co-infected on ART rate and TB cure rate.
The National Department of Health has updated the TB/HIV information System Software. Tier.net (version 1.13) has been released. Upgrading of the Tier.net from version 1.12.6 to version 1.13 will be completed by the 30th of June 2020 at both facility and sub-district levels.
TB client treatment success rate The target for TB success rate could not reached due to high lost to follow up and death rates. However, there is signifcant increase on the Drug Resistance – TB treatment success rate for the short regimen as compared to the long regimen.
The following measures are in place: • Expansion of all oral bedaquilline short term regimen • Trained Allied Health professionals, nurses and doctors on TB management, adherence to the national policy guidelines, and on treatment outcome indicators. • Health education was conducted at Schools and TVET colleges to improve TB patient management, • Training and mentoring to clinicians on new regimen. • Occupational Health and Safety offcers in PHC facilities conducted TB education, screening and testing, private and mining sector as part of build-up activities for the World TB day 2020 event. • To improve lost to follow up, TB awareness events, radio talk shows and comprehensive health screening including HIV Testing Services & TB were conducted in all districts in order to fnd the missing TB patients and educate the community on the importance of completing TB treatment. • Department will continue using WBPHCOT to trace TB lost to follow up. • To reduce the death rate due to late presentation of TB patients at Health care facilities, the Department conducted training on TB screening for Traditional Health Practitioners in all districts; this will assist patients who frst visit Traditional Health Practitioners before Health care facilities.
The measures put in place such the introduction of oral Bedaquilline short- term regimen and the upgrading of the Tier.net is intended improve the effectiveness of management and outcomes of TB treatment.
141 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR DISTRICT HEALTH SERVICES II. How effective are the measures put by the The World Health Organization (WHO) researched the measures put Accounting Offcer to improve the implementation of in place and proven effective in contributing to the effective Integrated the Integrated Management of Childhood Illness and Management of Childhood Illnesses. However, the effectiveness of how effective are the measures? the strategy also depend on the timeous presentation of children for health intervention in our facilities. This is often a challenge in the province as the community needs constant education to comprehend the behavior change of presenting to health facility when children are not well.
The following measures are put in place: • The training is rolled to CHWs on household IMCI • The communities, parents and guardians are being provided with knowledge through media platforms of education and awareness on reporting early for healthcare these include radio slots and distribution of IEC material in local languages • The Child Health Clinics have been integrated to Expanded Immunization(EPI) Clinics to ensure that no sick child is missed during a clinic visit
The measures are effective as: • Children are being brought in for their immunizations as per schedule • Parents/guardians are cooperating during immunization catchup campaigns • The use of media platforms particularly the radio has resulted to noticeable behavior change as parents are bringing children for healthcare which show reception of the knowledge shared • Parents/guardians are empowered in that they now report to the receptionist on their arrival at the health facility if they are bringing a very sick baby.
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NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 3
I. How effective are the measures put by the The measures put in place by the Accounting Offcer to improve Accounting Offcer to improve ambulance response ambulance response time are proving and the acceleration plan is time and how will these measures be accelerated for as follows: achievement of this targets • To improve accurate response times, R 50 million has been earmarked to procure an Emergency Management System with call taking and dispatch modules in the 2020/2021 FY. • Procured 67 new EMS vehicles, which are at conversion stage to replace the ageing feet. • Planned Patient Transport Services will be launched in the 2020/21 FY to deal with Planned (Booked) Patients and non–emergency transport to alleviate non-emergency call responded to by ambulances
The above measures are intended to improve the response time for both rural and urban emergency calls. To accelerate the above measures, the PPTS will be expanded to Ehlanzeni and Nkangala in the 2020 II. Can the Accounting Offcer indicate as to the reasons The Accounting Offcer can indicate that the few operational the province has so few operational ambulances at ambulances are due to an ageing feet that has frequent breakdowns 67, indicate how are the 67 ambulances distributed and prolonged turnaround time from merchants. and what measures will be put in place to increase the number of daily operational ambulances. The distribution of the 67 ambulances is as follows: • Ehlanzeni District – 20 • Gert Sibande District – 23 • Nkangala – 24
The Department plans to have 100 operational ambulances daily by supplementing the feet with new ambulances that have been procured.
143 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 3
I. How effective are the measures put by the The measures put in place by the Accounting Offcer to improve Accounting Offcer to improve ambulance response ambulance response time are proving and the acceleration plan is time and how will these measures be accelerated for as follows: achievement of this targets • To improve accurate response times, R 50 million has been earmarked to procure an Emergency Management System with call taking and dispatch modules in the 2020/2021 FY. • Procured 67 new EMS vehicles, which are at conversion stage to replace the ageing feet. • Planned Patient Transport Services will be launched in the 2020/21 FY to deal with Planned (Booked) Patients and non–emergency transport to alleviate non-emergency call responded to by ambulances
The above measures are intended to improve the response time for both rural and urban emergency calls. To accelerate the above measures, the PPTS will be expanded to Ehlanzeni and Nkangala in the 2020/21 FY and the 67 ambulances will be operationalized in the third quarter of 2020/21.
II. Can the Accounting Offcer indicate as to the reasons The Accounting Offcer can indicate that the few operational the province has so few operational ambulances at ambulances are due to an ageing feet that has frequent breakdowns 67, indicate how are the 67 ambulances distributed and prolonged turnaround time from merchants. and what measures will be put in place to increase the number of daily operational ambulances. The distribution of the 67 ambulances is as follows: • Ehlanzeni District – 20 • Gert Sibande District – 23 • Nkangala – 24
The Department plans to have 100 operational ambulances daily by supplementing the feet with new ambulances that have been procured.
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NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 4 I. Can the Accounting Offcer indicate the process The Accounting Offcer can indicate that currently there is no process undertaken to classify Ermelo Hospital as a rural undertaken to classify Ermelo hospital as a rural hospital. However, hospital the intention to request rural allowance for Ermelo hospital is to improve the recruitment and retention of specialists. The steering committee at National Department of Health is considering the reclassifcations of hospitals throughout the country. II. Can the Accounting Offcer indicate how effective are The Accounting Offcer can indicate that the following measures put the measures put to deal with the undermentioned in place are intended to improve effectiveness of the programme: challenges and a. Expenditure per PDE? a. Expenditure per PDE b. Average length of Stay c. Inpatient bed utilisation rate Expenditure per PDE is monitored through IYM reports, the target was not reached due to payment of accruals, however, the measures put in place to improve effciency are effective and listed as follows:
• Monitor budget utilisation • Implement Electronic Gate Keeping • control utilization of blood and blood products
b. Average length of stay (ALOS)
The Department has established a specialist-training programme to train medical offcers on various specialist domains aimed at improving average length of stay and improve quality of care. To date a total of 36 medical offcer are on the training programme at different academic levels
The planned intervention for having specialists is to offer bursaries to medical offcers to go and train as specialist, this takes 4-5 years and the impact will be realized long term.
c. Inpatient bed utilisation
The measures for managing bed utilisation rate are effective, as the utilisation rate for the regional hospital is 68.1%, which is within the acceptable range.
145 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 4
III.. Can the Accounting Offcer indicate the process The Accounting Offcer has established a Registrar programme with undertaken to ensure the flling of Specialist position the aim of increasing the pool of specialists in the province, currently in the regional hospitals? 36 registrars are enrolled on the programme at different levels of training.
The registrar programme offers bursaries to Medical Offcers training to be COVID 19 specialists. These Medical offcers sign a contract with a work back obligation to ensure that after completion training the specialist serve back the people of the province.
The other approach taken by the department is to continue to headhunt specialist for the critical clinical domains and do incidental appointments as per available specialties. IV. Can the Accounting offcer provide further briefng on The non-compliance with professional clinical standards and the risk of doctors and clinicians not complying with protocols is a potential risk that was identifed which could affect professional clinical standards and protocols and patients care and management. The risk is caused by clinicians what causes this challenge and how will be solved? that are trained in different clinical platforms, which results in them using different approaches to management of common conditions.
To mitigate this risk the clinical teams conduct clinical audits to monitor and enforce compliance. In addition, the protocols are reviewed regularly to keep abreast with new technological developments in the management of diseases. V Can the Accounting Offcer provide plan to ensure that The plan to ensure that regional hospitals provide the all the services regional hospitals provide all the services prescribed prescribed is to headhunt specialists and to encourage medical to be provided at a regional hospital? offcers to train as Registrars.
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NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 4
III.. Can the Accounting Offcer indicate the process The Accounting Offcer has established a Registrar programme with undertaken to ensure the flling of Specialist position the aim of increasing the pool of specialists in the province, currently in the regional hospitals? 36 registrars are enrolled on the programme at different levels of training.
The registrar programme offers bursaries to Medical Offcers training to be COVID 19 specialists. These Medical offcers sign a contract with a work back obligation to ensure that after completion training the specialist serve back the people of the province.
The other approach taken by the department is to continue to headhunt specialist for the critical clinical domains and do incidental appointments as per available specialties. IV. Can the Accounting offcer provide further briefng on The non-compliance with professional clinical standards and the risk of doctors and clinicians not complying with protocols is a potential risk that was identifed which could affect professional clinical standards and protocols and patients care and management. The risk is caused by clinicians what causes this challenge and how will be solved? that are trained in different clinical platforms, which results in them using different approaches to management of common conditions.
To mitigate this risk the clinical teams conduct clinical audits to monitor and enforce compliance. In addition, the protocols are reviewed regularly to keep abreast with new technological developments in the management of diseases. V Can the Accounting Offcer provide plan to ensure that The plan to ensure that regional hospitals provide the all the services regional hospitals provide all the services prescribed prescribed is to headhunt specialists and to encourage medical to be provided at a regional hospital? offcers to train as Registrars.
147 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 5
I. How effective are the measures put by the Accounting The measures put in place by the Accounting Offcer to curb the Offcer to curb the bypass of district hospitals and bypass of patients are effective as the outreach teams conduct visits regional hospital by patients to tertiary hospitals? to district hospitals and PHC facilities. This ensure that patients are seen at the lower level and do not have to go to a tertiary hospital for review of treatment or any other minor ailment. II. What measures has the accounting offcer put The outreach programme to regional hospitals are conducted by the in place to strengthen outreach programmes to specialists from the tertiary hospitals, excluding Family Medicine, regional hospitals? which only visit district and PHC facilities.
In the clinical domains where there are two or more specialist outreach services are conducted. The outreach programme will be strengthened through continued appointment of additional specialists at tertiary hospitals.
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 6
I. Why did the Accounting Offcer record low The Accounting Offcer recorded low expenditure for this programme expenditure for this programme for this quarter and in the quarter under review due to among others resignations of at the end of the quarter? PHC lecturers at the Nursing college and delays in the integration project of nursing schools to the college budget. The project will be fnalized during 2020/21 FY.
II. Can the Accounting Offcer indicate how Covid 19 Yes, the Accounting Offcer can indicate how COVID-19 has affected has affected the tuition in the various health schools the tuition in the various health schools and Nursing College. and Nursing College and how will the institution All contact-learning sessions were suspended from the 23rd of ensure the rescue of the academic year, if it has March 2020. From the 1st of June 2020, the fnal year students, the been affected? bridging course, midwifery and PHC students have been recalled back to their respective clinical areas through the risk-adjusted approach.
A recovery plan has been developed by the college and has been rolled out with effect from 01 June 2020.
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NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 7
I. Can the Accounting Offcer provide the reasons for The Accounting Offcer can confrm that the overspending is due such high overspending in this programme? to the R25 mill in-kind grant for medical equipment that NDOH allocated to the province. The over expenditure was a preliminary expenditure whilst awaiting NDOH to carry over the costs. This has since been addressed.
II. Can the Accounting Offcer indicate the reasons Yes, the Accounting Offcer can provide reasons for the failure to for the failure in the under mentioned targets and achieve the under mentioned targets: measures put in place to improve their performance: a.Availability of medicine a. Improve quality of care by increasing availability of •Poor supply of critical medicines like contraceptives and medicine and surgical sundries at the medical depot antipsychotics and diabetic treatment due to shortage of active b. Number of hospital providing laundry services ingredients from the manufacturers. planned •Due to COVID-19 pandemic, there has been an increase in the c. ANumber of hospital with functional transfusion demand of certain surgical and pharmaceutical items and the supply committees thereof is strained
b.Hospitals providing laundry services •Delays in completion of the designs and commencement of construction of the laundry in Witbank hospital led to an underachievement of 22/23 hospital laundries.
c.Hospitals with functional transfusion committee •The Committees that failed to meet their scheduled meetings in the fourth quarter were due to the COVID-19 pandemic outbreak during March 2020.
NO. QUESTION DEPARTMENTAL RESPONSES
QUESTIONS FOR PROGRAMME 8
I. Can the Accounting Offcer provide a detailed The Accounting Offcer can provide a detailed report of all facility report on all facility reconstruction, refurbishments, reconstruction, refurbishments, upgrades that are taking place as per the attached Annexure D. upgrades that are Annexure D: Report on facility reconstruction, refurbishments and upgrades.
II. Can the Accounting Offcer indicate the whether the The Accounting Ofcer can confrm that the installation of a concrete process of fencing Msogwaba Clinic is complete palisade fence is complete. The contractor without additional costs considering that the palisade fencing is poorly put as part of the retention period (project liability period) rectifed the with a variety of gateway holes and unstable palisade part of collapsed fence. which can be pushed ?
149 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
8. SCOPA RESOLUTIONS
NO. Subject Details Response by the department R e s o l v e d (yes/No) 5 CONTIGENT LIABILITy 5.1 The Auditor General (i) The Executive The Executive Authority has considered taking disciplinary No found that contingent Authority must actions against the Accounting Offcer however the liabilities were take disciplinary contingent liability was incurred mainly due to Medical overstated by R115 actions against Negligence by Health Professionals or quality challenges 587 622 and was the Accounting in different facilities. unable to obtain Offcer for incurring suffcient appropriate contingent liabilities audit evidence for amounting to R115 The Accounting offce has drafted the revised litigation cases amounting 587 622 strategy which is currently under consultation. to R 69 085 028. In addition, the Auditor General was unable to determine if any further adjustments were necessary to contingent liabilities state at R 7 888 073 000 6. RESTATEMENT OF CORRESPONDING FIGURES 6.1 The Auditor General The Accounting Accounting Offcer did not take disciplinary actions against No has found that the Offcer must take offcials as the restatement of prior year was a correction of corresponding fgure disciplinary actions prior year fnancial fgures. for 31 March 2017 against offcial(s) who have been restated could submit accurate The restatement of corresponding fgures has assisted because of an error information. to Department to clear the previous qualifcation relating discovered during the to Immovable, Tangible Capital Assets, Movable Tangible year ended 31 March Capital Assets and Irregular Expenditure. 2018 in the fnancial The department anticipates having restatement of prior statements of the year fgures on current qualifcation paragraph regarding department contingent liability.
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NO. Subject Details Response by the department R e s o l v e d (yes/No) 7. ACCRUALS 7.1 The Auditor General (i) The Executive Accruals and Payable not recognized of the Department of No found that the payables Authority must Health for the 2017/18 fnancial year was not cash-back. in the fnancial take disciplinary statements which actions against the Section 29 (1) of the PFMA provides that If an annual exceed the payment Accounting Offcer budget is not passed before the start of the fnancial year, term of 30 days for incurring accruals the Department may not spend the budget for that fnancial amounted to R 181 year exceeding 10%. 671 000. This amount The accruals and payable not recognized of the Department exceeded the voted amounted to R851 million in 2017/18 fnancial year which funds surrendered of represented 6.5% of the budget for 2018/19 fnancial year. R 77 040 000 by R 104 631 000 The Executive Authority could not take disciplinary actions against the Accounting Offcer as the accruals of the previous years had an effect in the 2017/18 fnancial year because they were not cash backed. A strategy on reduction of accruals was developed and implemented hence a reduction in 2018/19 FY and 2019/20 FY (ii) The Accounting The Accounting Offcer has noted the recommendations No Offcer must ensure and the following processes are put in place to ensure that invoices are invoices are paid within 30 days: paid within 30 days as it is required · Funds are released on weekly basis based on by Treasury available cash. Regulations · Standing orders are created on recurring services and infrastructure projects. The department continues to monitor the payments age analysis and in the second quarter 98% of 2019/20 FY the invoices were paid within 30 days. The Accounting The Accounting Offcer has developed a strategy to reduce No Offcer must accruals over the Medium Term Expenditure Framework develop a system and Provincial Treasury is in the process to implement that will ensure the an invoice tracking system which will assist with the department does not management of invoices. have accruals Accruals are defned as transactions where a service was rendered or goods were delivered however the service provider or supplier has not billed the transaction before the end of the fnancial year.
Therefore the Department will normally have accruals due to services or goods delivered in March which are billed in the following month (April). However, the Department has incurred payables amounting to R376.798 million in 2018/19 fnancial year as compared to R585.625 million in 2017/18 fnancial year. These payables were due to recurring payables from previous fnancial years and price escalations on non-negotiable and key accounts.
The Department is awaiting Provincial Treasury to fnalize the process of acquiring the invoice tracking system and implementation thereof. The department currently is using manual register to track progress on payments.
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NO. Subject Details Response by the department R e s o l v e d (yes/No) 8. IRREGULAR EXPENDITURE 1 The Auditor General (i) The Executive The Executive Authority could not take disciplinary actions No found that the Authority must against the Accounting Offcer as the irregular expenditure department incurred take disciplinary is incurred from the multi-year tenders awarded in previous irregular expenditure actions against fnancial years. of R 309 920 000 for the Accounting failure to follow proper Offcer for incurring tender processes. irregular expenditure The Accounting Offcer has already investigated and took amounting R 309 disciplinary steps on the irregular expenditure for the 920 000 in the previous fnancial years. 2017/2018 fnancial year Description of Services Amount R’000 Participating in contracts arranged by the Offce of 13 577 the Premier for legal services.
Perishable and non-perishable goods 78 751 Outsourcing of the Procurement, Warehousing 213 546 and Distribution of Pharmaceutical and surgical sundries.
TOTAL 305 274 Based on the legal principle “of double jeopardy” and employee/offcer cannot be disciplined twice for the same offence emanating from the same facta probanda (multi- year tenders awarded in previous fnancial years). · Offce of the Premier has awarded new contract on Legal services from the 1st June 2019. · The department has awarded the pharmaceutical surgical sundries contract from the 01st May 2018 · Perishable and non-perishable has been advertised and closed, currently bid committees are busy with the procurement processes. (ii) The Accounting The Accounting Offcer can provide the progress report No Offcer must provide as attached for other irregular expenditure amounting to the progress report R4 245 701.00. after the Financial Misconduct Committees concluded its investigations on the irregular expenditure.
(iii) The Executive The Executive Authority could not take disciplinary actions No Authority must take against the Accounting Offcer as the irregular expenditure disciplinary actions is incurred from the multi-year tenders awarded in previous against Accounting fnancial years. Offcer for failure to follow proper tender processes.
152 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. Subject Details Response by the department R e s o l v e d (yes/No) 9. PREDETERMINED OBJECTIVES 9.1 The Auditor General (i) The Accounting The Accounting Offcer could not take disciplinary actions No was unable to obtain Offcer must take against offcials because this was a health system the information disciplinary actions challenge. The National Department of Health has piloted and explanation against offcial(s) the Health Patient Registration System (HPRS) of the considered necessary who failed to ensure National Health Insurance in Gert Sibande District and to ascertain reliability that Performance will be rolled out to the other two districts. In the main, and validity of the Information is reliable the reason for unreliability of performance information was reported performance as required by the due to patient records not kept in health facilities (Road to information. Auditor General. Health Cards and antenatal cards). These cards are kept with patients so that they can access treatment wherever they are. The Accounting Offcer can report that, the Health Patient Registration System has been further rolled out in all 3 Districts (Gert Sibande, Nkangala & Ehlanzeni) at Primary Health Care level. Currently it is implemented in 267/287 PHC facilities. To further strengthen the performance information the National Department of Health will also implement the Health Patient Registration System at Hospital level. Assessment for readiness on HPRS has been done at Witbank hospital which will then form a base for the rollout of the HPRS system once the linkage has been fnalized between the existing Patient Electronic Information System (PEIS) and the Health Patient Registration System (HPRS). (ii) The Accounting The Accounting Offcer has put the following measures in No Offcer must place to strengthen the monitoring system: strengthen the monitoring system · Lessons learned in the Gert Sibande NHI pilot district and provide evidence are being rolled out in all districts to improve validity, to the Committee completeness and accuracy such as. that the department o HPRS system has been installed in all PHC facilities had put measures and it will be integrated with the hospitals system to be and systems to installed in 2019/20. ensure that reported performance is o To ensure functionality of the HPRS system, 140/287 valid, accurate and PHC facilities are connected to broadband and complete. 147/287 will be connected by September 2019. o To ensure availability of fles, flling cabinets were procured and installed in Tintswalo, KwaMhlanga, Ermelo and Rob Ferreira Hospitals and more (4 facilities) will be installed over the next MTEF. o 18 sub-district Information Offcers appointed in all sub-districts to ensure data verifcation is conducted prior to reporting and compliance with District Health Management Information System (DHMIS) policy. o Data quality clean-up was conducted for facilities prior to the fnalization of the 2018/19 dataset. · The Department has developed a frontline service delivery monitoring plan to monitor performance of all facilities.
Training on the District Health Information System (DHIS) has been conducted for all Sub-district Information Offcers. The training focused on tools that are aimed at data quality and validating information. Furthermore all 3 Districts will conduct data clean-up sessions for the 9 months data followed by a Provincial data-clean up. The Data clean-up is necessary to align the reported data with source document at facility levels. The Internal Audit unit is also fnalizing internal audits for the 1st and 2nd Quarter 2019/20
153 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. Subject Details Response by the department R e s o l v e d (yes/No) 10 PROCUREMENT AND CONTRACT MANAGEMENT 10.1 The Auditor General (i) The Executive The Executive Authority could not take disciplinary actions No found that some Authority must against the Accounting Offcer for contravening Treasury bid documents for take disciplinary Regulation 16.A 6.1 because the Accounting Offcer is the procurement actions against the currently investigating the transgression to determine of commodities for Accounting Offcer responsible offcials. The investigation process will be local content and for contravening fnalized at the end of the second quarter 2019/20 fnancial production did not Treasury Regulation year. meet the stipulated 16.A6.1 minimum threshold for local production and (ii) The Accounting The Accounting Offcer did not take disciplinary measures No content as required by Offcer must take against offcials for failure to adhere to SCM prescripts as the 2017 Preferential disciplinary measure the investigations are currently being fnalised. Procurement against the offcials Regulation 8 (2) for failure to adhere to SCM prescript. 11. EXPENDITURE MANAGEMENT
11.1 The Auditor (i) The Executive The Department has fnalized the investigation on the No General has found Authority must occurrence of the unauthorized expenditure through the that effective and take disciplinary internal audit offce. The investigation report states that the appropriate steps actions against Department could not avoid the expenditure by putting the were not taken to the Accounting lives of patients at risk. prevent unauthorized, Offcer for incurring irregular as well as unauthorized fruitless and wasteful expenditure The department has requested condonement of the expenditure as amounting R33 unauthorized expenditure amounting to R 33 million required by section million 38(1)(C) of the PFMA and Treasury (ii) The Accounting The Department has fnalized the investigation on the No Regulation 9.1.1 Offcer must take occurrence of the unauthorized expenditure through the disciplinary actions internal audit offce. The investigation report states that the against offcial(s) Department could not avoid the expenditure by putting the responsible for lives of patients at risk. the unauthorized expenditure after the The department will continue to ensure that in its processes investigations have it avoids the occurrence of the unauthorised expenditure. been concluded. It will continue to monitor where necessary and take appropriate steps as required by applicable prescripts
(iii) The Accounting The Department has fnalized the investigation on the No Offcer must ensure occurrence of the unauthorized expenditure through the that money is internal audit offce. The investigation report states that the recovered from the Department could not avoid the expenditure by putting the offcial(s) responsible lives of patients at risk. for the unauthorized expenditure.
154 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NO. Subject Details Response by the department R e s o l v e d (yes/No) 12 REVENUE MANAGEMENT
12.1 The Auditor General (i) The Accounting (i) The Department has established a Task Team to improve No has found that effective Offcer must revenue collection which mainly focus on improving and appropriate steps take disciplinary revenue in high impact hospitals. A debt collector was were not taken to measures against appointed towards the end of 2018/19 fnancial year for the collect all money due offcial(s) for not collection of monies owed to the state amounting to over as required by Section ensuring effective R200 million. 38 (1)(c)(i) of the and appropriate PFMA and Treasury steps to collect Regulations 11.4.1; all money due as The Department currently collaborates with the Provincial 11.4.2; 11.5.1 required by Section Treasury to improve revenue collection for the Department. 38 (1)(c)(i) of the A special budget for the procurement of computers, patient PFMA and Treasury fles and photocopier machines amounting to R10 million Regulations 11.4.1 was allocated in 2019/20 fnancial year. The Departmental task team meets once a month to review activities on the improvement of revenue collection. Debt collector and Road Accident Fund service provider provides monthly performance reports on Revenue collection. Computers (200 desktops) and patient fles were procured for the improvement of patient administration. A draft Patient Administration policy is at 70% completion and should be fnalized before the end of the fnancial year. The Department will benchmark with other provinces to improve collection. 13. LEADERSHIP
13.1 The Auditor General (i) The Executive (i) The Executive Authority did not take disciplinary No found that the Authority must actions against the Accounting Offcer due to the following Accounting Offcer did take disciplinary measures put in place to mitigate the fnding: not exercise oversight actions against responsibility the Accounting · Establishment of the Departmental Budget regarding fnancial Offcer for failure to Committee that meets quarterly to review and performance exercise oversight expenditure and revenue trends. reporting and responsibility · Financial Statements Review Teams including compliance with regarding fnancial Internal Audit. legislation. and performance reporting and · District and Provincial Review Sessions held compliance with quarterly legislation in the · Provincial Finance and Information Support Teams department. to improve internal controls, governance, and accountability in facilities
9. PRIOR MODIFICATIONS TO AUDIT REPORTS
Nature of qualifcation, Financial year in which it frst Progress made in clearing / resolving the matter disclaimer, adverse arose opinion and matters of non-compliance Contingent Liability 2015/2016 The Department has developed standard operating procedures to clearly indicate the processes within the legal services sections. The prior year modifcations to the audit report have been resolve hence the Department has improved the audit outcome to Unqualifed audit opinion
155 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
10. INTERNAL CONTROL UNIT
The operation of the internal control system is the responsibility of the relevant line managers. However due to occurrence of repeat audit fndings, there is a need to strengthen the competency to implement and review controls in the Department.
Key activities and objectives of the internal control unit:
The competency cuts across the internal control unit within the Department and is not purely about fnancial internal control. It is a management system, culture and set of values designed to ensure that the Department is managed effciently and effectively, with the appropriate policies and procedures that promotes the achievement of its overall goals and objectives.
Summary of internal control unit work done:
• Monitor the implementation of fnancial policies through systems • Served as secretary of the Provincial Financial Misconduct committee • Chaired Accident, Damaged, Theft, Loss and Disposal committee • Review all user rights • Review registration of user and monitor workfow management • Review segregation of duties on monthly basis • Review and monitor all users log on violations • Review all users activities on monthly basis • The review of syscon activities • Submit report EM032 for value of stock with no consumption • Submit report RM033 for encountering the value of surplus and requirement stock • Review report KPI 3 for maintaining the required captured date ,issue capture date and number of issues
11. INTERNAL AUDIT AND AUDIT COMMITTEE The Internal Audit Unit and Audit Committee derive their mandates from the Internal Audit Charter and Audit Committee Charter.
Key activities and objectives of the internal audit:
The Internal Audit Unit conducts its activities as per the Internal Audit Plan that is based on the risk assessment and approved by the Audit Committee.
The Internal Audit Unit exists to provide assurance and consulting activity to the Department to add value and improve operations to enable the Department to achieve its strategic goals and objectives.
Summary of audit work done:
The Internal Audit Unit reports quarterly to the Audit Committee on the progress of work conducted in accordance with the approved Internal Audit Plan.
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The following internal audit work was completed during the year under review:
• Annual Financial Statement Review • Supply Chain Management and Expenditure Management • Performance Information Review • Ideal Clinics Standards • Asset Management • Conditional Grant Received and Transferred • HealthCare Waste Management • Pharmaceutical Services • Information and Communication Technology • Contingent Liabilities
Key activities and objectives of the Audit Committee:
The Audit Committee fulfls a vital role in corporate governance to ensure the integrity of integrated reporting and internal controls and the identifcation and management of risks. The Audit Committee assists management in carrying out its responsibilities relating fnancial management and other reporting practices, internal controls and management of risks as well as compliance with laws, regulations and ethics.
157 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
The table below discloses relevant information on the Audit Committee members: Name Qualifcations Internal If internal, Date Date o. of or position appointed Resigned Meetings external in the attended department Mr Abel Mawela • Diploma in Commerce External N/A 1 May 2015 N/A 6
• B. Comm
• B. Comm (Hons)
• Masters degree-Business Administration Dr Charles • B Comm External N/A 1 May 2015 N/A 4 Motau • HDip Computer Auditing
• Masters -Business Leadership
• Masters degree -IT
• Certifed in Execution Leadership
• Certifed in Human Resource Management
• Doctorate Computer Science Mr Ayanda • Bachelor of Commerce External N/A 1 December N/A 6 Wakaba 2018 • Honours: Bachelor of Commerce
• Masters of Business Management and Admin
• Advance Diploma in Accounting Science Ms Nomfundo • Bachelor of Law/LLB External N/A 1 September N/A 2 Madonsela 2019
158 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
12. AUDIT COMMITTEE REPORT
We are pleased to present our report for the fnancial year ended 31 March 2020.
Audit Committee Responsibility The Audit Committee reports that it has complied with its responsibilities arising from Section 38 (1) (a) (ii) of the Public Finance Management Act and Treasury Regulation 3.1.13. The Audit Committee also reports that it has adopted appropriate formal terms of reference as its Audit Committee Charter, has regulated its affairs in compliance with this charter and has discharged all its responsibilities as contained therein.
The Effectiveness of Internal Control The Department of Health has a system of internal control to provide cost effective assurance that the Department’s goals and objectives will be economically, effciently and effectively achieved. Our review of the fndings of the Internal Audit work, which was based on the risk assessments conducted in the department revealed certain internal control weaknesses, which were then raised with the Department.
The following internal audit work was completed during the year under review: • Annual Financial Statement Review • Supply Chain Management and Expenditure Management • Performance Information Review • Ideal Clinics Standards • Asset Management • Conditional Grant Received and Transferred • HealthCare Waste Management • Pharmaceutical Services • Information and Communication Technology • Contingent Liabilities
The following were areas of concern: • Contract management not effectively exercised. • High increase of Litigation cases. • Increase in the number of cases settled out of court with larger amounts. • Increase of Irregular expenditure on Rapid Implementation Unit (RIU) • Payments not made within 30 days from date of receipt of an invoice. • Inadequate implementation of quality improvement plans • Inadequate tools utilised for data collection. • Difference between District Health Information System (DHIS), input forms and registers • Inappropriate segregation of healthcare waste. • Inadequate monitoring of Waste Management Service Level Agreement. • Assets selected from the Assets Register could not be physically verifed. • Readiness to deal with COVID-19 pandemic The Audit Committee will monitor progress made in implementing action plans developed and implemented by management. In-year Management and Monthly/Quarterly Report
The Audit Committee is satisfed with the content and quality of monthly and quarterly reports prepared and issued by the Department of Health as required by the PFMA.
Evaluation of Financial Statements The Audit Committee has reviewed the fnancial statements prepared by the Department of Health.
159 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Auditor General’s Report We have reviewed the Department of Health’s implementation plan for audit issues raised in the previous year and we are satisfed that the matters have been adequately addressed.
The Audit Committee concurs and accepts the conclusion of the Auditor-General on the Annual Financial Statements and is of the opinion that the Audited Annual Financial Statements be accepted and read together with the report of the Auditor-General.
Independence of the Audit Committee The Audit Committee is independent of management in the execution of its duties.
Internal Audit The Audit Committee is satisfed that the internal audit function is operating effectively and that it has addressed the risks pertinent to the Department of Health in its audits.
Appreciation
The Audit Committee appreciates the assistance and cooperation of management in assisting in the discharge of its responsibilities.
______Abel Mawela Chairperson of the Audit Committee Mpumalanga Department of Health Date: 31/07/2020
160 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 PART D: HUMAN RESOURCE MANAGEMENT
1.
161 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
1. INTRODUCTION The Department has over the past few years’ prioritised human resource for health as cornerstone for the provision of quality health care workers in preparation for the attainment of universal health coverage for the citizens of Mpumalanga and the Country in general. This will be attained through the introduction of the National Health Insurance (NHI). The role of the human resource management and development provides the following services in support of building skilled human capital for the NHI. • Human resources practices • Human resources organisational strategy and planning • Performance management and development • Human resources utilisation and capacity development • Employee relations and people management (labour relations) • Employee health and wellness • Occupational health and safety
2. OVERVIEW OF HUMAN RESOURCES
Status of human resources in the department.
Due to fnancial constraints, the Department has reviewed the current organizational structure which was approved in 2010. The review considered current posts occupied with warm bodies and considered critical posts to be flled during the fnancial year under review. A draft organisational structure has been sent to the Offce of the Premier which has 23 235 active posts and 21 021 warm bodies.
The Department has flled the following key positions:
• The post of Chief Director: Infrastructure Management has been flled through the promotion of the Director:
• The post of Chief Director: Primary Health Care has been flled through the promotion of the Director: Maternal, Child and Women’s Health. The vacated post was advertised and will be flled during the 2020/21 fnancial year.
• The post of Director: Emergency Medical Services has been flled after being vacated through a transfer of the post incumbent to Limpopo Province.
• The Director: Quality Assurance has been flled for the frst time in the Province. The post incumbent was a Chief Executive Offcer of Barberton hospital and has been replaced through a transfer of the Chief Executive Offcer of Barberton TB hospital.
• The post of Director: Corporate Services – Nkangala District has been flled for the frst time. The post incumbent has vacated a post of Corporate Manager at Ermelo hospital and the vacant post was advertised and will be flled during the 2020/21 fnancial year.
• The post of Chief Executive Offcer – Ermelo hospital has been flled through the appointment of the Chief Executive Offcer of Evander hospital. The vacuum at Evander hospital has been closed through the transfer of the Chief Executive Offcer of Carolina hospital. The vacant post at Carolina hospital has been advertised and will be flled during the 2020/21 fnancial year.
• The Director: Quality Assurance has been flled for the frst time in the Province. The post incumbent was a Chief Executive Offcer of Barberton hospital and has been replaced through a transfer of the Chief Executive Offcer of Barberton TB hospital.
• The post of Director: Corporate Services – Nkangala District has been flled for the frst time. The post incumbent has vacated a post of Corporate Manager at Ermelo hospital and the vacant post was advertised and will be flled during the 2020/21 fnancial year.
• The Department has appointed a Chief Director: Clinical Governance on a contractual basis to assist in the intervention strategy as a result of increasing number of litigations. However, the post of Director: Legal Services still remains vacant after an attempt to fll and the recruitment process was interrupted by the change in the administration since all SMS posts in Mpumalanga are approved by the Executive Council.
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The following key positions remain unflled: • The post of Chief Executive Offcer – Sabie hospital was vacated through the death of the post incumbent and the post will be flled during the 2020/21 fnancial year. • The post of Chief Executive Offcer – Mapulaneng hospital was vacated through retirement of the post incumbent. The post was advertised and no qualifying candidate applied. The post has been re-advertised and will be flled during the 2020/21 fnancial year. • The post of Chief Executive Offcer – KwaMhlanga hospital was vacated through the resignation after the long illness of the post incumbent. The post was advertised, interviews conducted and the post will be flled during the frst quarter of the 2020/21 fnancial year. • The post of Chief Executive Offcer – Mmametlhake hospital was vacated through the resignation. It was advertised and should be flled during the 2020/21 fnancial year. • The post of Senior Clinical Manager – Witbank hospital was vacated through the retirement of the post incumbent. It was advertised and no suitable candidate has applied. Head-hunting of a qualifying candidate will take place to ensure that the vacant position is flled during the 2020/21 fnancial year. • Human resource priorities for the year under review and the impact of these. • The Department has prioritized to fll 440 posts • Workforce planning and key strategies to attract and recruit a skilled and capable workforce. • Employee performance management. • Employee wellness programmes. • Highlight achievements and challenges faced by the department, as well as future human resource plans /goals.
The following posts have been advertised and • Director: Legal Services • Director: Mental Health • Director: Primary Health Care • Director: Maternal Child and Women’s Health
The Chief Director: Human Resource Management and Development was seconded to act as a Head of Department for the Department of Education in the Province since March 2019. This has left a vacuum and is grossly affecting the human resource operations.
The Chief Director: Integrated Health Services has been on temporary disability leave from the second quarter of the 2019/20 fnancial year due to ill health and the Director: Policy and Planning resigned during the frst quarter of the same fnancial year. The vacant post has been advertised and should be flled during the 2020/21 fnancial year. Both positions are very critical for the planning, monitoring implementation and reporting.
163 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3. HUMAN RESOURCES OVERSIGHT STATISTICS 3.1. Personnel related expenditure
Programme Total expenditure Personnel Training Professional Personnel Average (R’000) expenditure expenditure and special expenditure personnel cost (R’000) services as a % of total per employee (R’000) expenditure expenditure (R’000) (R’000) ADMINISTRATION 474 398.00 149 784.00 0.00 0.00 31.60 578.00
ASSETS & LIABILITIES 203.00 - 4.00 0.00 0.00 - 2.00 0.00
CENTRAL HOSPITAL 1 314 235.00 884 054.00 0.00 0.00 67.30 437.00 SERVICES DISTRICT HEALTH SERVICES 8 711 255.00 5 464 544.00 0.00 0.00 62.70 372.00
EMERGENCY MEDICAL 419 029.00 297 410.00 0.00 0.00 71.00 326.00 SERVICES HEALTH CARE SUPPORT 390 406.00 123 512.00 0.00 0.00 31.60 440.00 SERVICES HEALTH FACILITIES 1 133 112.00 29 469.00 0.00 0.00 2.60 614.00 MANAGEMENT HEALTH SCIENCE & 366 673.00 218 905.00 0.00 0.00 59.70 211.00 TRAINING PROVINCIAL HOSPITAL 1 448128.00 1 112 763.00 0.00 0.00 76.80 413.00 SERVICES RECEIPTS OBJECTIVE 0.00 0.00 0.00 0.00 0.00 0.00
Total 14 257 440.00 8 280 438.00 0.00 0.00 58.10 377.00
Table 3.1.2 Personnel costs by salary band for the period 1 April 2019 and 31 March 2020
Salary band Personnel expenditure % of total personnel cost No. of employees Average personnel cost per (R’000) employee (R’000) 01 Lower skilled 565 798.00 6.70 172 289.00 8 411 038.00 (Levels 1-2) 02 Skilled (Levels 1 850 771.00 22.00 259 757.00 8 411 038.00 3-5) 03 Highly skilled 2 233 730.00 26.60 407 318.00 8 411 038.00 production (Levels 6-8) 04 Highly skilled 2 890 939.00 34.40 815 268.00 8 411 038.00 supervision (Levels 9-12) 05 Senior 58 597.00 0.70 1 148 961.00 8 411 038.00 management (Levels >= 13) 09 Other 127 325.00 1.50 430 152.00 8 411 038.00 10 Contract 2 318.00 0.00 463 600.00 8 411 038.00 (Levels 1-2) 11 Contract 1 078.00 0.00 154 000.00 8 411 038.00 (Levels 3-5) 12 Contract 96 172.00 1.10 277 153.00 8 411 038.00 (Levels 6-8)
164 Salary band Personnel expenditure % of total personnel cost No. of employees Average personnel cost per Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 (R’000)Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financialemployee Year(R’000) Vote No 10 13 Contract 469 162.00 5.60 864 018.00 8 411 038.00 (Levels 9-12) 14 Contract 2 331.00 0.00 1 165 500.00 8 411 038.00 (Levels >= 13) 18 Contract Other 15 199.00 0.20 45 918.00 8 411 038.00 19 Periodical 26 270.00 0.30 35 278.00 8 411 038.00 Remuneration 20 Abnormal 6 538.00 0.10 38 160.00 8 411 038.00 Appointment TOTAL 8 346 229.00 99.20 380 464.00 8 411 038.00
Table 3.1.3 Salaries, Overtime, Home Owners Allowance and Medical Aid by programme for the period 1 April 2019 and 31 March 2020
Salaries Overtime Home Owners Allowance Medical Aid
Programme Amount Salaries as a Amount Overtime Amount HOA as Amount Medical aid (R’000 % of personnel (R’000) as a % of (R’000) a % of (R’000) as a % of costs personnel personnel personnel costs costs costs ADMINISTRATION 141 489.00 77.80 3 802.00 2.10 3 694.00 2.00 6 710.00 3.70
CENTRAL 665 652.00 74.60 93 668.00 10.50 24 788.00 2.80 39 498.00 4.40 HOSPITAL SERVICES DISTRICT 4 374 422.00 78.80 190 212.00 3.40 196 792.00 3.50 276 056.00 5.00 HEALTH SERVICES EMERGENCY 203 824.00 68.00 27 923.00 9.30 14 420.00 4.80 29 277.00 9.80 MEDICAL SERVICES HEALTH CARE 95 252.00 74.10 9 945.00 7.70 3 831.00 3.00 6 809.00 5.30 SUPPORT SERVICES HEALTH 24 332.00 79.60 15.00 0.00 529.00 1.70 374.00 1.20 FACILITIES MANAGEMENT HEALTH 172 458.00 76.90 26 946.00 12.00 3 051.00 1.40 4 156.00 1.90 SCIENCE & TRAINING PROVINCIAL 848 496.00 77.00 73 159.00 6.60 36 087.00 3.30 49 922.00 4.50 HOSPITAL SERVICES TOTAL 6 525 924.00 77.60 425 668.00 5.10 283 192.00 3.40 412 802.00 4.90
165 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.1.4 Salaries, Overtime, Home Owners Allowance and Medical Aid by salary band for the period 1 April 2019 and 31 March 2020
Salaries Overtime Home Owners Medical Aid Allowance Salary band Amount Salaries Amount Overtime Amount HOA as Amount Medical aid (R’000 as a % of (R’000) as a % of (R’000) a % of (R’000) as a % of personnel personnel personnel personnel costs costs costs costs 01 Lower skilled (Levels 1-2) 400 854.00 70.80 12 208.00 2.20 49 512.00 8.80 43 457.00 8.50 02 Skilled (Levels 3-5) 1 352 005.00 72.60 63 533.00 3.40 108 5.80 144 8.10 838.00 364.00 03 Highly skilled production 1 753 415.00 78.00 59 291.00 2.60 81 386.00 3.60 113 5.70 (Levels 6-8) 836.00 04 Highly skilled supervision 2 333 865.00 79.90 181 953.00 6.20 42 342.00 1.40 64 825.00 2.40 (Levels 9-12) 05 Senior management 51 312.00 80.40 0.00 0.00 966.00 1.50 617.00 1.00 (Levels >= 13) 09 Other 127 290.00 100.00 0.00 0.00 17.00 0.00 0.00 0.00 10 Contract (Levels 1-2) 2 283.00 96.00 14.00 0.60 10.00 0.40 0.00 0.00 11 Contract (Levels 3-5) 1 006.00 92.50 19.00 1.70 4.00 0.40 40.00 0.20 12 Contract (Levels 6-8) 94 220.00 97.50 1 341.00 1.40 11.00 0.00 130.00 0.20 13 Contract (Levels 9-12) 359 685.00 76.30 107 311.00 22.80 80.00 0.00 48.00 0.00 14 Contract (Levels >= 13) 2 013.00 79.40 0.00 0.00 27.00 1.10 0.00 0.00 18 Contract Other 15 168.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00 19 Periodical Remuneration 26 270.00 99.40 0.00 0.00 0.00 0.00 0.00 0.00 20 Abnormal Appointment 6 538.00 94.10 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL 6 525 924.00 77.60 425 668.00 5.10 283 3.40 367 4.70 192.00 315.00 3.2. Employment and Vacancies Table 3.2.1 Employment and vacancies by programme as on 31 March 2019
Programme Number of posts Number of posts Vacancy Rate Number of employees on approved flled additional to the establishment establishment ADMINISTRATION, 287.00 258.00 10.10 0.00 Permanent CENTRAL HOSPITAL 2 193.00 1 998.00 8.90 172.00 SERVICES, Permanent CENTRAL HOSPITAL 31.00 31.00 0.00 0.00 SERVICES, Temporary
DISTRICT HEALTH 15 520.00 13 969.00 10.00 492.00 SERVICES, Permanent DISTRICT HEALTH 197.00 197.00 0.00 0.00 SERVICES, Temporary EMERGENCY MEDICAL 937.00 911.00 2.80 0.00 SERVICES, Permanent HEALTH CARE SUPPORT 287.00 275.00 4.20 1.00 SERVICES, Permanent HEALTH CARE SUPPORT 6.00 6.00 0.00 0.00 SERVICES, Temporary HEALTH FACILITIES 70.00 48.00 31.40 7.00 MANAGEMENT, Permanent
166 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Programme Number of posts Number of posts Vacancy Rate Number of employees on approved flled additional to the establishment establishment HEALTH SCIENCE & TRAINING, 810.00 721.00 11.00 47.00 Permanent HEALTH SCIENCE & TRAINING, 1.00 1.00 0.00 0.00 Temporary PROVINCIAL HOSPITAL 2 840.00 2 550.00 10.20 140.00 SERVICES, Permanent PROVINCIAL HOSPITAL 56.00 56.00 0.00 0.00 SERVICES, Temporary TOTAL 23 235.00 21 021.00 9.50 859.00
Table 3.2.2 Employment and vacancies by salary band as on 31 March 2020
Salary band Number of posts on approved Number of posts flled Vacancy Rate Number of employees establishment additional to the establishment 01 Lower Skilled (Levels 1-2), 3 460.00 3 284.00 5.10 0.00 Permanent
02 Skilled (Levels 3-5), Permanent 7 863.00 7 125.00 9.40 1.00
03 Highly Skilled Production (Levels 6 113.00 5 482.00 10.30 78.00 6-8), Permanent
03 Highly Skilled Production (Levels 2.00 2.00 0.00 0.00 6-8), Temporary
04 Highly Skilled Supervision (Levels 4 186.00 3 528.00 15.70 2.00 9-12), Permanent 04 Highly Skilled Supervision (Levels 18.00 18.00 0.00 0.00 9-12), Temporary
05 Senior Management (Levels >= 13), 62.00 51.00 17.70 0.00 Permanent 09 Other, Permanent 356.00 356.00 0.00 47.00
09 Other, Temporary 271.00 271.00 0.00 0.00
10 Contract (Levels 1-2), Permanent 5.00 5.00 0.00 4.00
11 Contract (Levels 3-5), Permanent 7.00 7.00 0.00 1.00
12 Contract (Levels 6-8), Permanent 347.00 347.00 0.00 329.00
13 Contract (Levels 9-12), Permanent 543.00 543.00 0.00 397.00
14 Contract (Levels >= 13), Permanent 2.00 2.00 0.00 0.00
TOTAL 23 235.00 21 021.00 9.50 859.00
167 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.2.3 Employment and vacancies by critical occupations as on 31 March 2020 Critical occupation Number of posts Number of posts flled Vacancy Rate Number of employees on approved additional to the establishment establishment ADMINISTRATIVE RELATED, Permanent 359.00 322.00 10.30 3.00 ALL ARTISANS IN THE BUILDING METAL 65.00 60.00 7.70 0.00 MACHINERY ETC Permanent AMBULANCE AND RELATED WORKERS, 628.00 618.00 1.60 0.00 Permanent ARTISAN PROJECT AND RELATED 13.00 11.00 15.40 0.00 SUPERINTENDENTS, Permanent AUXILIARY AND RELATED WORKERS, 494.00 440.00 10.90 0.00 Permanent BASIC TRAINING, Permanent 10.00 10.00 0.00 0.00 BIOCHEMISTRY PHARMACOL. ZOOLOGY & 284.00 265.00 6.70 0.00 LIFE SCIE.TECHNI, Permanent BUILDING AND OTHER PROPERTY 19.00 16.00 15.80 0.00 CARETAKERS, Permanent BUS AND HEAVY VEHICLE DRIVERS, 2.00 1.00 50.00 0.00 Permanent CIVIL ENGINEERING TECHNICIANS, Permanent 2 845.00 2 692.00 5.40 0.00 CLEANERS IN OFFICES WORKSHOPS 97.00 89.00 8.20 0.00 HOSPITALS ETC Permanent CLIENT INFORM CLERKS(SWITCHB RECEPT 4.00 4.00 0.00 0.00 INFORM CLERKS), Permanent COMMUNICATION AND INFORMATION 52.00 51.00 1.90 0.00 RELATED, Permanent COMMUNITY DEVELOPMENT WORKERS, 1.00 1.00 0.00 0.00 Permanent COMPUTER PROGRAMMERS., Permanent 4.00 4.00 0.00 0.00 COMPUTER SYSTEM DESIGNERS AND 125.00 101.00 19.20 16.00 ANALYSTS., Permanent DENTAL PRACTITIONERS, Permanent 3.00 3.00 0.00 0.00 DENTAL PRACTITIONERS, Temporary 1.00 1.00 0.00 0.00 DENTAL SPECIALISTS, Permanent 1.00 0.00 100.00 0.00 DENTAL TECHNICIANS, Permanent 30.00 27.00 10.00 1.00 DENTAL THERAPY, Permanent 179.00 145.00 19.00 22.00 DIETICIANS AND NUTRITIONISTS, Permanent 1.00 1.00 0.00 0.00 DIETICIANS AND NUTRITIONISTS, Temporary 29.00 29.00 0.00 0.00 ELECTRICAL AND ELECTRONICS 30.00 29.00 3.30 0.00 ENGINEERING TECHNICIANS, Permanent EMERGENCY SERVICES RELATED, Permanent 295.00 279.00 5.40 0.00 ENGINEERING SCIENCES RELATED, 21.00 15.00 28.60 6.00 Permanent ENGINEERS AND RELATED PROFESSIONALS, 13.00 5.00 61.50 1.00 Permanent ENVIRONMENTAL HEALTH, Permanent 99.00 60.00 39.40 19.00 FARM HANDS AND LABOURERS, Permanent 2.00 2.00 0.00 0.00 FINANCE AND ECONOMICS RELATED, 19.00 17.00 10.50 0.00 Permanent
168 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
FINANCIAL AND RELATED PROFESSIONALS, 18.00 18.00 0.00 0.00 Permanent FINANCIAL CLERKS AND CREDIT 44.00 42.00 4.50 0.00 CONTROLLERS, Permanent FOOD SERVICES AIDS AND WAITERS, 236.00 218.00 7.60 0.00 Permanent FOOD SERVICES WORKERS, Permanent 461.00 436.00 5.40 0.00 FORESTRY LABOURERS, Permanent 20.00 19.00 5.00 0.00 HEAD OF DEPARTMENT/CHIEF EXECUTIVE 1.00 1.00 0.00 0.00 OFFICER, Permanent HEALTH SCIENCES RELATED, Permanent 1.00 0.00 100.00 0.00 HEALTH SCIENCES RELATED, Temporary 24.00 17.00 29.20 0.00 HORTICULTURISTS FORESTERS AGRICUL.& 1.00 1.00 0.00 0.00 FORESTRY TECHN, Permanent HOUSEHOLD AND LAUNDRY WORKERS, 1.00 1.00 0.00 0.00 Permanent HOUSEHOLD FOOD AND LAUNDRY SERVICES 1.00 1.00 0.00 0.00 RELATED, Permanent HOUSEKEEPERS LAUNDRY AND RELATED 343.00 318.00 7.30 0.00 WORKERS, Permanent HUMAN RESOURCES & ORGANISAT 15.00 10.00 33.30 0.00 DEVELOPM & RELATE PROF, Permanent HUMAN RESOURCES CLERKS, Permanent 10.00 10.00 0.00 0.00 HUMAN RESOURCES RELATED, Permanent 20.00 15.00 25.00 0.00 INFORMATION TECHNOLOGY RELATED, 146.00 138.00 5.50 0.00 Permanent INSPECTORS OF APPRENTICES WORKS AND 41.00 36.00 12.20 0.00 VEHICLES, Permanent INSTITUTION BASED PERSONAL CARE 1.00 1.00 0.00 0.00 WORKERS, Permanent LIBRARIANS AND RELATED PROFESSIONALS, 1.00 1.00 0.00 0.00 Permanent LIBRARY MAIL AND RELATED CLERKS, 7.00 7.00 0.00 0.00 Permanent LIGHT VEHICLE DRIVERS, Permanent 1.00 1.00 0.00 0.00 LOGISTICAL SUPPORT PERSONNEL, 23.00 21.00 8.70 0.00 Permanent MATERIAL-RECORDING AND TRANSPORT 86.00 83.00 3.50 0.00 CLERKS, Permanent
169 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of posts Number of posts flled Vacancy Rate Number of employees on approved additional to the establishment establishment MEDICAL PRACTITIONERS, Permanent 1 185.00 898.00 24.20 313.00 MEDICAL PRACTITIONERS, Temporary 269.00 269.00 0.00 0.00 MEDICAL RESEARCH AND RELATED 1.00 1.00 0.00 0.00 PROFESSIONALS, Permanent MEDICAL SPECIALISTS, Permanent 80.00 64.00 20.00 0.00 MEDICAL SPECIALISTS, Temporary 8.00 8.00 0.00 0.00
MEDICAL TECHNICIANS/TECHNOLOGISTS, 14.00 11.00 21.40 0.00 Permanent MESSENGERS PORTERS AND DELIVERERS, 234.00 213.00 9.00 0.00 Permanent MOTOR VEHICLE DRIVERS, Permanent 30.00 25.00 16.70 0.00 NURSING ASSISTANTS, Permanent 1 564.00 1 481.00 5.30 0.00 OCCUPATIONAL THERAPY, Permanent 126.00 91.00 27.80 24.00 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 7.00 30.00 0.00 OTHER ADMINISTRAT & RELATED CLERKS 1 486.00 1 330.00 10.50 1.00 AND ORGANISERS, Permanent OTHER ADMINISTRATIVE POLICY AND 138.00 128.00 7.20 0.00 RELATED OFFICERS, Permanent OTHER INFORMATION TECHNOLOGY 5.00 5.00 0.00 0.00 PERSONNEL., Permanent OTHER OCCUPATIONS, Permanent 17.00 16.00 5.90 0.00 PHARMACEUTICAL ASSISTANTS, Permanent 179.00 170.00 5.00 0.00 PHARMACEUTICAL ASSISTANTS, Temporary 1.00 1.00 0.00 0.00 PHARMACISTS, Permanent 430.00 352.00 18.10 67.00 PHARMACISTS, Temporary 1.00 1.00 0.00 0.00 PHARMACOLOGISTS PATHOLOGISTS & 6.00 6.00 0.00 0.00 RELATED PROFESSIONA, Permanent PHYSICISTS, Permanent 1.00 1.00 0.00 0.00 PHYSICISTS, Temporary 1.00 1.00 0.00 0.00 PHYSIOTHERAPY, Permanent 151.00 116.00 23.20 41.00 PHYSIOTHERAPY, Temporary 1.00 1.00 0.00 0.00 PROFESSIONAL NURSE, Permanent 6 657.00 6 147.00 7.70 225.00 PSYCHOLOGISTS AND VOCATIONAL 39.00 32.00 17.90 0.00 COUNSELLORS, Permanent QUANTITY SURVEYORS & RELA PROF NOT 2.00 2.00 0.00 0.00 CLASS ELSEWHERE, Permanent RADIOGRAPHY, Permanent 188.00 151.00 19.70 34.00 RADIOGRAPHY, Temporary 2.00 2.00 0.00 0.00 RISK MANAGEMENT AND SECURITY 9.00 6.00 33.30 0.00 SERVICES, Permanent ROAD WORKERS, Permanent 2.00 2.00 0.00 0.00
170 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of posts Number of posts flled Vacancy Rate Number of employees on approved additional to the establishment establishment SECURITY OFFICERS, Permanent 1.00 1.00 0.00 0.00 SENIOR MANAGERS, Permanent 44.00 35.00 20.50 0.00 SOCIAL WORK AND RELATED 50.00 48.00 4.00 0.00 PROFESSIONALS, Permanent SPEECH THERAPY AND AUDIOLOGY, 114.00 74.00 35.10 36.00 Permanent
SPEECH THERAPY AND AUDIOLOGY, 2.00 2.00 0.00 0.00 Temporary STAFF NURSES AND PUPIL NURSES, 1 850.00 1 639.00 11.40 0.00 Permanent STUDENT NURSE, Permanent 650.00 554.00 14.80 50.00 SUPPLEMENTARY DIAGNOSTIC 5.00 5.00 0.00 0.00 RADIOGRAPHERS, Permanent TRADE LABOURERS, Permanent 3.00 3.00 0.00 0.00 TOTAL 23 235.00 21 021.00 9.50 859.00
3.3 Filling of SMS Posts Table 3.3.1 SMS post information as on 31 March 2020
SMS Level Total number of Total number of % of SMS posts flled Total number of SMS % of SMS posts funded SMS posts SMS posts flled posts vacant vacant Director-General/ Head of 1 1 100% 0.00 0.00% Department
Salary Level 16 1 1 100% 0.00 0.00%
Salary Level 15 2 2 100% 0.00 0.00%
Salary Level 14 12 12 100% 0.00 0.00% 41 37 90.25% 4 9.75% Salary Level 13
Total 57 53 92% 4 8.0%
Table 3.3.2 SMS post information as on 30 September 2016
SMS Level Total number of Total number of % of SMS posts flled Total number of % of SMS posts funded SMS posts SMS posts flled SMS posts vacant vacant Director-General/ 1 1 100% 0.00 0.00% Head of Department Salary Level 16 1 1 100% 0.00 0.00% Salary Level 15 2 2 100% 0.00 0.00% Salary Level 14 12 12 100% 0.00 0.00% Salary Level 13 41 37 90.25% 4 9.75% Total 57 53 92% 4 8.0%
171 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.3.3 Advertising and flling of SMS posts for the period 1 April 2019 and 31 March 2020
Advertising Filling of Posts
SMS Level Number of vacancies per level Number of vacancies per Number of vacancies per level not flled advertised in 6 months of becoming level flled in 6 months of in 6 months but flled in 12 months vacant becoming vacant
Director-General/ Head of 0.00 0.00 0.00 Department
Salary Level 16 0.00 0.00 0.00 Salary Level 15 0.00 0.00 0.00 Salary Level 14 0.00 0.00 0.00
Salary Level 13 4.00 0.00 0.00
Total 0.00 0.00 0.00
Table 3.3.4 Reasons for not having complied with the flling of funded vacant SMS - Advertised within 6 months and flled within 12 months after becoming vacant for the period 1 April 2019 and 31 March 2020
Reasons for vacancies not advertised within six months 2 x Post were vacated due to promotion 1 x Post was vacated due to retirement of the CEO 2 x Post were re-advertised
Reasons for vacancies not flled within twelve months Post were interviewed and delayed to be confrmed for appointment Post were advertised due to no fnalisation of the recruitment processes on time which is in line with the Employment practices
Table 3.3.5 Disciplinary steps taken for not complying with the prescribed timeframes for flling SMS posts within 12 months for the period 1 April 2019 and 31 March 2020
Reasons for vacancies not advertised within six months None
172 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.4. Job Evaluation Table 3.4.1 Job Evaluation by Salary band for the period 1 April 2019 and 31 March 2020
Salary band Number of posts Number % of posts Posts Upgraded Posts downgraded on approved of Jobs evaluated Number % of posts Number % of posts establishment Evaluated by salary evaluated evaluated bands 01 Lower Skilled (Levels 1-2) 3 452.00 0.00 0.00 0.00 0.00 0.00 0.00 02 Skilled (Levels 3-5) 7 675.00 0.00 0.00 0.00 0.00 0.00 0.00 03 Highly Skilled Production 6 203.00 0.00 0.00 0.00 0.00 0.00 0.00 (Levels 6-8) 04 Highly Skilled Supervision 4 349.00 0.00 0.00 0.00 0.00 0.00 0.00 (Levels 9-12) 05 Senior Management 41.00 0.00 0.00 0.00 0.00 0.00 0.00 Service Band A 06 Senior Management 15.00 0.00 0.00 0.00 0.00 0.00 0.00 Service Band B 07 Senior Management 2.00 0.00 0.00 0.00 0.00 0.00 0.00 Service Band C 08 Senior Management 3.00 0.00 0.00 0.00 0.00 0.00 0.00 Service Band D 09 Other 608.00 0.00 0.00 0.00 0.00 0.00 0.00 10 Contract (Levels 1-2) 5.00 0.00 0.00 0.00 0.00 0.00 0.00 11 Contract (Levels 3-5) 5.00 0.00 0.00 0.00 0.00 0.00 0.00 12 Contract (Levels 6-8) 342.00 0.00 0.00 0.00 0.00 0.00 0.00 13 Contract (Levels 9-12) 530.00 0.00 0.00 0.00 0.00 0.00 0.00 14 Contract Band A 2.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL 23 235.00 0.00 0.00 0.00 0.00 0.00 0.00
Table 3.4.2 Profle of employees whose positions were upgraded due to their posts being upgraded for the period 1 April 2019 and 31 March 2020
Gender African Asian Coloured White Total Female 0.00 0.00 0.00 0.00 0.00 Male 0.00 0.00 0.00 0.00 0.00 TOTAL 0.00 0.00 0.00 0.00 0.00
Employees with a disability None
Table 3.4.3 Employees with salary levels higher than those determined by job evaluation by occupation for the period 1 April 2019 and 31 March 2020
Occupation Number of employees Job evaluation level Remuneration level Reason for deviation 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total number of employees whose salaries exceeded the level determined by job evaluation 0 Percentage of total employed 0
173 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.4.4 Profle of employees who have salary levels higher than those determined by job evaluation for the period 1 April 2019 and 31 March 2020
Gender African Asian Coloured White Total Female 0.00 0.00 0.00 0.00 0.00 Male 0.00 0.00 0.00 0.00 0.00 TOTAL 0.00 0.00 0.00 0.00 0.00
Employees with a disability 0.00 0.00 0.00 0.00 0.00
Total number of Employees whose salaries exceeded None the grades determine by job evaluation
3.5. Employment Changes Table 3.5.1 Annual turnover rates by salary band for the period 1 April 2019 and 31 March 2020
Salary band Number of employees at beginning Appointments and Terminations and Turnover of period-1 April 2019 transfers into the transfers out of rate department the department 01 Lower Skilled (Levels 1-2) Permanent 3 167.00 253.00 57.00 1.80 02 Skilled (Levels 3-5) Permanent 7 424.00 454.00 182.00 2.50 03 Highly Skilled Production (Levels 6-8) 5 105.00 155.00 166.00 3.30 Permanent 03 Highly Skilled Production (Levels 6-8) 2.00 0.00 0.00 0.00 Temporary 04 Highly Skilled Supervision (Levels 3 427.00 181.00 193.00 5.60 9-12) Permanent 04 Highly Skilled Supervision (Levels 20.00 0.00 2.00 10.00 9-12) Temporary 05 Senior Management Service Band A 34.00 2.00 2.00 5.90 Permanent 06 Senior Management Service Band B 9.00 0.00 0.00 0.00 Permanent 07 Senior Management Service Band C 2.00 0.00 0.00 0.00 Permanent 08 Senior Management Service Band D 2.00 0.00 0.00 0.00 Permanent 09 Other Permanent 206.00 134.00 2.00 1.00 09 Other Temporary 290.00 7.00 24.00 8.30 10 Contract (Levels 1-2) Permanent 20.00 32.00 1.00 5.00 11 Contract (Levels 3-5) Permanent 34.00 5.00 2.00 5.90 12 Contract (Levels 6-8) Permanent 197.00 314.00 212.00 107.60 13 Contract (Levels 9-12) Permanent 485.00 426.00 364.00 75.10 14 Contract Band A Permanent 2.00 3.00 3.00 150.00 TOTAL 20 426.00 1 966.00 1 210.00 5.90
174 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.5.2 Annual turnover rates by critical occupation for the period 1 April 2019 and 31 March 2020
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2019 into the department out of the department
ADMINISTRATIVE 327.00 12.00 15.00 4.60 RELATED Permanent
ALL ARTISANS IN 62.00 0.00 2.00 3.20 THE BUILDING METAL MACHINERY ETC. Permanent
AMBULANCE AND 635.00 0.00 9.00 1.40 RELATED WORKERS Permanent
ARTISAN PROJECT 12.00 0.00 1.00 8.30 AND RELATED SUPERINTENDENTS Permanent
AUXILIARY AND 459.00 15.00 24.00 5.20 RELATED WORKERS Permanent
BIOCHEMISTRY 10.00 0.00 0.00 0.00 PHARMACOL. ZOOLOGY & LIFE SCIE. TECHNI Permanent
BUILDING AND 255.00 21.00 6.00 2.40 OTHER PROPERTY CARETAKERS Permanent
BUS AND HEAVY 17.00 0.00 1.00 5.90 VEHICLE DRIVERS Permanent
CIVIL ENGINEERING 1.00 0.00 0.00 0.00 TECHNICIANS Permanent
CLEANERS IN 2 668.00 169.00 88.00 3.30 OFFICES WORKSHOPS HOSPITALS ETC. Permanent
175 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2019 into the department out of the department
CLIENT INFORM 94.00 3.00 4.00 4.30 CLERKS(SWITCHB RECEPT INFORM CLERKS) Permanent
Critical occupation Number of employees at Appointments and Terminations and Turnover rate beginning of period-April 2019 transfers into the transfers out of the department department
COMMUNICATION 4.00 0.00 0.00 0.00 AND INFORMATION RELATED Permanent COMMUNITY 53.00 0.00 2.00 3.80 DEVELOPMENT WORKERS Permanent COMPUTER 1.00 0.00 0.00 0.00 PROGRAMMERS. Permanent
COMPUTER SYSTEM 4.00 0.00 0.00 0.00 DESIGNERS AND ANALYSTS. Permanent DENTAL 103.00 18.00 17.00 16.50 PRACTITIONERS Permanent DENTAL 3.00 0.00 0.00 0.00 PRACTITIONERS Temporary DENTAL 1.00 0.00 0.00 0.00 SPECIALISTS Permanent DENTAL 1.00 0.00 1.00 100.00 TECHNICIANS Permanent DENTAL THERAPY 19.00 10.00 0.00 0.00 Permanent
DIETICIANS AND 135.00 33.00 22.00 16.30 NUTRITIONISTS Permanent DIETICIANS AND 1.00 0.00 0.00 0.00 NUTRITIONISTS Temporary
ELECTRICAL AND 29.00 0.00 0.00 0.00 ELECTRONICS ENGINEERING TECHNICIANS Permanent
176 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of employees at Appointments and Terminations and Turnover rate beginning of period-April 2019 transfers into the transfers out of the department department
EMERGENCY 286.00 0.00 8.00 2.80 SERVICES RELATED Permanent ENGINEERING 8.00 6.00 0.00 0.00 SCIENCES RELATED Permanent
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2018 into the department out of the department
ENGINEERS 3.00 2.00 0.00 0.00 AND RELATED PROFESSIONALS Permanent
ENVIRONMENTAL 51.00 23.00 13.00 25.50 HEALTH Permanent
FINANCE AND 1.00 0.00 0.00 0.00 ECONOMICS RELATED Permanent
FINANCIAL 17.00 1.00 0.00 0.00 AND RELATED PROFESSIONALS Permanent FINANCIAL CLERKS 40.00 0.00 1.00 2.50 AND CREDIT CONTROLLERS Permanent FOOD SERVICES 211.00 10.00 3.00 1.40 AIDS AND WAITERS Permanent FOOD SERVICES 416.00 44.00 16.00 3.80 WORKERS Permanent
FORESTRY 18.00 0.00 0.00 0.00 LABOURERS Permanent
HEALTH SCIENCES 1.00 0.00 0.00 0.00 RELATED Permanent
HEALTH SCIENCES 18.00 0.00 1.00 5.60 RELATED Temporary
HORTICULTURISTS 1.00 0.00 0.00 0.00 FORESTERS AGRICUL.& FORESTRY TECHN Permanent
177 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2018 into the department out of the department
HOUSEHOLD AND 1.00 0.00 0.00 0.00 LAUNDRY WORKERS Permanent
HOUSEHOLD FOOD 320.00 25.00 15.00 4.70 AND LAUNDRY SERVICES RELATED Permanent
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2018 into the department out of the department
HOUSEKEEPERS 8.00 2.00 1.00 12.50 LAUNDRY AND RELATED WORKERS Permanent HUMAN RESOURCES 15.00 1.00 0.00 0.00 & ORGANISAT DEVELOPM & RELATE PROF Permanent
HUMAN RESOURCES 131.00 11.00 2.00 1.50 CLERKS Permanent
HUMAN RESOURCES 32.00 1.00 3.00 9.40 RELATED Permanent
INFORMATION 1.00 0.00 0.00 0.00 TECHNOLOGY RELATED Permanent
INSPECTORS OF 1.00 0.00 0.00 0.00 APPRENTICES WORKS AND VEHICLES Permanent INSTITUTION BASED 7.00 0.00 0.00 0.00 PERSONAL CARE WORKERS Permanent
LIBRARIANS 1.00 0.00 0.00 0.00 AND RELATED PROFESSIONALS Permanent LIBRARY MAIL AND 30.00 1.00 0.00 0.00 RELATED CLERKS Permanent LIGHT VEHICLE 181.00 8.00 7.00 3.90 DRIVERS Permanent LOGISTICAL SUPPORT 22.00 0.00 1.00 4.50 PERSONNEL Permanent MATERIAL- 84.00 0.00 1.00 1.20 RECORDING AND TRANSPORT CLERKS Permanent
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Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2019 into the department out of the department
MEDICAL EQUIPMENT 2.00 0.00 0.00 0.00 OPERATORS Permanent
MEDICAL 809.00 439.00 328.00 40.50 PRACTITIONERS Permanent
MEDICAL 287.00 7.00 23.00 8.00 PRACTITIONERS Temporary
MEDICAL RESEARCH 1.00 0.00 0.00 0.00 AND RELATED PROFESSIONALS Permanent
MEDICAL SPECIALISTS 65.00 6.00 9.00 13.80 Permanent
MEDICAL SPECIALISTS 10.00 0.00 2.00 20.00 Temporary
MEDICAL 8.00 2.00 1.00 12.50 TECHNICIANS/ TECHNOLOGISTS Permanent MESSENGERS 221.00 11.00 12.00 5.40 PORTERS AND DELIVERERS Permanent
MOTOR VEHICLE 21.00 5.00 3.00 14.30 DRIVERS Permanent
NURSING ASSISTANTS 1 468.00 125.00 16.00 1.10 Permanent
OCCUPATIONAL 94.00 33.00 34.00 36.20 THERAPY Permanent
OPTOMETRISTS AND 6.00 0.00 0.00 0.00 OPTICIANS Permanent
OPTOMETRISTS AND 1.00 0.00 0.00 0.00 OPTICIANS Temporary
ORAL HYGIENE 9.00 0.00 2.00 22.20 Permanent
179 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2019 into the department out of the department
OTHER ADMINISTRAT 1 238.00 174.00 22.00 1.80 & RELATED CLERKS AND ORGANISERS Permanent
OTHER 126.00 6.00 3.00 2.40 ADMINISTRATIVE POLICY AND RELATED OFFICERS Permanent
OTHER INFORMATION 5.00 0.00 0.00 0.00 TECHNOLOGY PERSONNEL. Permanent
OTHER OCCUPATIONS 16.00 1.00 1.00 6.30 Permanent PHARMACEUTICAL 177.00 0.00 6.00 3.40 ASSISTANTS Permanent
PHARMACEUTICAL 1.00 0.00 0.00 0.00 ASSISTANTS Temporary
PHARMACISTS 315.00 99.00 60.00 19.00 Permanent
PHARMACISTS 2.00 0.00 1.00 50.00 Temporary
PHARMACOLOGISTS 6.00 0.00 0.00 0.00 PATHOLOGISTS & RELATED PROFESSIONA Permanent
PHYSICISTS Permanent 1.00 0.00 0.00 0.00
PHYSICISTS Temporary 1.00 0.00 0.00 0.00
PHYSIOTHERAPY 106.00 55.00 44.00 41.50 Permanent
PHYSIOTHERAPY 1.00 0.00 0.00 0.00 Temporary
PROFESSIONAL 5 640.00 243.00 279.00 4.90 NURSE Permanent
180 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Critical occupation Number of employees at Appointments and transfers Terminations and transfers Turnover rate beginning of period-April 2019 into the department out of the department
PSYCHOLOGISTS 39.00 0.00 7.00 17.90 AND VOCATIONAL COUNSELLORS Permanent RADIOGRAPHY 2.00 0.00 0.00 0.00 Permanent
RADIOGRAPHY 136.00 41.00 27.00 19.90 Temporary
RISK MANAGEMENT 2.00 0.00 0.00 0.00 AND SECURITY SERVICES Permanent
ROAD WORKERS 6.00 0.00 0.00 0.00 Permanent
SECRETARIES & 1.00 0.00 0.00 0.00 OTHER KEYBOARD OPERATING CLERKS Permanent SECURITY OFFICERS 253.00 6.00 5.00 2.00 Permanent
SENIOR MANAGERS 1.00 0.00 0.00 0.00 Permanent
SOCIAL WORK 35.00 2.00 2.00 5.70 AND RELATED PROFESSIONALS Permanent SPEECH THERAPY 46.00 2.00 1.00 2.20 AND AUDIOLOGY Permanent
SPEECH THERAPY 67.00 39.00 32.00 47.80 AND AUDIOLOGY Temporary
STAFF NURSES 2.00 0.00 0.00 0.00 AND PUPIL NURSES Permanent
STUDENT NURSE 1 828.00 68.00 18.00 1.00 Permanent
SUPPLEMENTARY 6.00 0.00 1.00 16.70 DIAGNOSTIC RADIOGRAPHERS Permanent TRADE LABOURERS 2.00 0.00 0.00 0.00 Permanent
TOTAL 20 426.00 1 966.00 1 210.00 5.90
181 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.5.3 Reasons why staff left the department for the period 1 April 2019 and 31 March 2020
Termination Type Number % of Total Resignations
01 Death, Permanent 84.00 6.90
01 Death, Temporary 2.00 0.20
02 Resignation, Permanent 292.00 24.10
02 Resignation, Temporary 16.00 1.30
03 Expiry of contract, Permanent 571.00 47.20
03 Expiry of contract, Temporary 8.00 0.70
06 Discharged due to ill health, Permanent 2.00 0.20
07 Dismissal-misconduct, Permanent 8.00 0.70
07 Dismissal-misconduct, Temporary 3.00 0.20
09 Retirement, Permanent 223.00 18.40
10 Other, Temporary 1.00 0.10
TOTAL 1 210.00 100.00
182 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.5.4 Promotions by critical occupation for the period 1 April 2019 and 31 March 2020
Occupation Employees 1 April Promotions to Salary level Progressions to Notch progression 2019 another salary level promotions as a another notch as a % of % of employees within a salary employees by by occupation level occupation Administrative Related 327.00 13.00 4.00 206.00 63.00 All Artisans In The Building Metal 62.00 2.00 3.20 49.00 79.00 Machinery Etc. Ambulance And Related Workers 635.00 0.00 0.00 556.00 87.60 Artisan Project And Related 12.00 0.00 0.00 11.00 91.70 Superintendents Auxiliary And Related Workers 459.00 3.00 0.70 303.00 66.00 Biochemistry Pharmacol. Zoology 10.00 0.00 0.00 6.00 60.00 & Life Scie.Techni Building And Other Property 255.00 0.00 0.00 214.00 83.90 Caretakers Bus And Heavy Vehicle Drivers 17.00 0.00 0.00 13.00 76.50 Civil Engineering Technicians 1.00 0.00 0.00 0.00 0.00 Cleaners In Offces Workshops 2 668.00 6.00 0.20 2 152.00 80.70 Hospitals Etc. Client Inform Clerks(Switchb 94.00 1.00 1.10 76.00 80.90 Recept Inform Clerks) Communication And Information 4.00 0.00 0.00 4.00 100.00 Related Community Development Workers 53.00 0.00 0.00 46.00 86.80 Computer Programmers. 1.00 0.00 0.00 1.00 100.00 Computer System Designers And 4.00 0.00 0.00 2.00 50.00 Analysts. Dental Practitioners 106.00 1.00 0.90 89.00 84.00 Dental Specialists 1.00 0.00 0.00 0.00 0.00 Dental Technicians 1.00 0.00 0.00 0.00 0.00 Dental Therapy 19.00 0.00 0.00 8.00 42.10 Dieticians And Nutritionists 136.00 0.00 0.00 102.00 75.00 Electrical And Electronics 29.00 0.00 0.00 31.00 106.90 Engineering Technicians Emergency Services Related 286.00 8.00 2.80 200.00 69.90 Engineering Sciences Related 8.00 0.00 0.00 4.00 50.00 Engineers And Related 3.00 0.00 0.00 2.00 66.70 Professionals Environmental Health 51.00 0.00 0.00 35.00 68.60 Farm Hands And Labourers 1.00 0.00 0.00 0.00 0.00 Finance And Economics Related 17.00 0.00 0.00 14.00 82.40 Financial And Related 40.00 2.00 5.00 28.00 70.00 Professionals Financial Clerks And Credit 211.00 5.00 2.40 152.00 72.00 Controllers Food Services Aids And Waiters 416.00 9.00 2.20 323.00 77.60
183 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Occupation Employees 1 April Promotions to Salary level Progressions to Notch progression 2019 another salary level promotions as a another notch as a % of % of employees within a salary employees by by occupation level occupation Household And Laundry Workers 320.00 4.00 1.30 229.00 71.60 Household Food And Laundry 5.00 0.00 0.00 2.00 40.00 Services Related Housekeepers Laundry And 8.00 1.00 12.50 7.00 87.50 Related Workers Human Resources & Organisat 15.00 0.00 0.00 8.00 53.30 Developm & Relate Prof Human Resources Clerks 131.00 6.00 4.60 81.00 61.80 Human Resources Related 32.00 2.00 6.30 20.00 62.50 Information Technology Related 1.00 0.00 0.00 1.00 100.00 Inspectors Of Apprentices Works 1.00 0.00 0.00 0.00 0.00 And Vehicles Institution Based Personal Care 7.00 0.00 0.00 7.00 100.00 Workers Librarians And Related 1.00 0.00 0.00 1.00 100.00 Professionals Library Mail And Related Clerks 30.00 1.00 3.30 27.00 90.00 Light Vehicle Drivers 181.00 4.00 2.20 145.00 80.10 Logistical Support Personnel 22.00 0.00 0.00 11.00 50.00 Material-Recording And Transport 84.00 1.00 1.20 70.00 83.30 Clerks Medical Equipment Operators 2.00 0.00 0.00 0.00 0.00 Medical Practitioners 1 096.00 3.00 0.30 322.00 29.40 Medical Research And Related 1.00 0.00 0.00 0.00 0.00 Professionals Medical Specialists 75.00 4.00 5.30 26.00 34.70 Medical Technicians/Technologists 8.00 2.00 25.00 7.00 87.50 Messengers Porters And 221.00 0.00 0.00 126.00 57.00 Deliverers Motor Vehicle Drivers 21.00 3.00 14.30 14.00 66.70 Nursing Assistants 1 468.00 1.00 0.10 622.00 42.40 Occupational Therapy 94.00 0.00 0.00 51.00 54.30 Optometrists And Opticians 7.00 0.00 0.00 8.00 114.30 Oral Hygiene 9.00 0.00 0.00 10.00 111.10 Other Administrat & Related 1 238.00 29.00 2.30 961.00 77.60 Clerks And Organisers Other Administrative Policy And 126.00 4.00 3.20 68.00 54.00 Related Offcers Other Information Technology 5.00 0.00 0.00 1.00 20.00 Personnel. Other Occupations 16.00 0.00 0.00 12.00 75.00 Pharmaceutical Assistants 178.00 3.00 1.70 106.00 59.60 Pharmacists 317.00 0.00 0.00 140.00 44.20 Pharmacologists Pathologists & 6.00 0.00 0.00 6.00 100.00 Related Professionals
184 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Occupation Employees 1 April Promotions to Salary level Progressions to Notch progression 2019 another salary level promotions as a another notch as a % of % of employees within a salary employees by by occupation level occupation Physicists 2.00 0.00 0.00 0.00 0.00
Physiotherapy 107.00 0.00 0.00 35.00 32.70
Professional Nurse 5 640.00 497.00 8.80 2 476.00 43.90
Psychologists And Vocational 39.00 0.00 0.00 28.00 71.80 Counsellors Quantity Surveyors & Rela Prof 2.00 0.00 0.00 0.00 0.00 Not Class Elsewhere Radiography 138.00 3.00 2.20 64.00 46.40
Risk Management And Security 6.00 0.00 0.00 6.00 100.00 Services Road Workers 1.00 0.00 0.00 0.00 0.00
Secretaries & Other Keyboard 253.00 0.00 0.00 227.00 89.70 Operating Clerks Security Offcers 1.00 0.00 0.00 0.00 0.00
Senior Managers 35.00 3.00 8.60 16.00 45.70
Social Work And Related 46.00 0.00 0.00 13.00 28.30 Professionals Speech Therapy And Audiology 69.00 0.00 0.00 30.00 43.50
Staff Nurses And Pupil Nurses 1 828.00 52.00 2.80 847.00 46.30
Student Nurse 559.00 0.00 0.00 0.00 0.00
Supplementary Diagnostic 6.00 0.00 0.00 6.00 100.00 Radiographers Trade Labourers 2.00 1.00 50.00 2.00 100.00
TOTAL 20 426.00 675.00 3.30 11 493.00 56.30
185 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.5.5 Promotions by salary band for the period 1 April 2019 and 31 March 2020
Salary Band Employees 1 April Promotions to Salary bands Progressions to Notch progression as 2019 another salary promotions as a % another notch within a % of level of employees by a salary level employees by salary salary level bands 01 Lower Skilled (Levels 1-2), 3 167.00 0.00 0.00 2 448.00 77.30 Permanent 02 Skilled (Levels 3-5), 7 424.00 101.00 1.40 4 534.00 61.10 Permanent 03 Highly Skilled Production 5 105.00 379.00 7.40 2 732.00 53.50 (Levels 6-8), Permanent 03 Highly Skilled Production 2.00 0.00 0.00 1.00 50.00 (Levels 6-8), Temporary 04 Highly Skilled Supervision 3 427.00 187.00 5.50 1 617.00 47.20 (Levels 9-12), Permanent 04 Highly Skilled Supervision 20.00 0.00 0.00 9.00 45.00 (Levels 9-12), Temporary 05 Senior Management 47.00 8.00 17.00 20.00 42.60 (Levels >= 13), Permanent 09 Other, Permanent 206.00 0.00 0.00 0.00 0.00 09 Other, Temporary 290.00 0.00 0.00 39.00 13.40 10 Contract (Levels 1-2), 20.00 0.00 0.00 0.00 0.00 Permanent 11 Contract (Levels 3-5), 34.00 0.00 0.00 0.00 0.00 Permanent 12 Contract (Levels 6-8), 197.00 0.00 0.00 1.00 0.50 Permanent 13 Contract (Levels 9-12), 485.00 0.00 0.00 92.00 19.00 Permanent 14 Contract (Levels >= 13), 2.00 0.00 0.00 0.00 0.00 Permanent TOTAL 20 426.00 675.00 3.30 11 493.00 56.30
186 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.6 Employment Equity Table 3.6.1 Total number of employees (including employees with disabilities) in each of the following occupational categories as on 31 March 2020
Occupational category Male Female Total African Coloured Indian White African Coloured Indian White 01 - SENIOR OFFICIALS AND 16.00 0.00 0.00 16.00 0.00 17.00 1.00 1.00 19.00 MANAGERS 02 - PROFESSIONALS 860.00 11.00 39.00 910.00 145.00 858.00 12.00 43.00 913.00 03 - TECHNICIANS AND 1687.00 9.00 2.00 1698.00 22.00 6328.00 64.00 19.00 6 411.00 ASSOCIATE PROFESSIONALS 09 - LABOURERS AND 707.00 2.00 1.00 710.00 6.00 1366.00 9.00 5.00 1380.00 RELATED WORKERS 08 - PLANT AND MACHINE 849.00 4.00 0.00 853.00 19.00 148.00 8.00 2.00 3158.00 OPERATORS AND ASSEMBLERS UNKNOWN 62.00 0.00 0.00 62.00 1.00 9.00 0.00 0.00 9.00 05 - SERVICE SHOP AND 215.00 0.00 0.00 215.00 0.00 11.00 0.00 0.00 11.00 MARKET SALES WORKERS 04 - CLERKS 1218.00 6.00 0.00 1224.00 3.00 2688.00 16.00 1.00 2 705.00 01 - SENIOR OFFICIALS AND 6.00 0.00 0.00 6.00 0.00 18.00 0.00 0.00 18.00 MANAGERS 07 - CRAFT AND RELATED 5620.00 32.00 42.00 5694.00 196.00 14443.00 10.00 71.00 14624.00 TRADE WORKERS TOTAL 16.00 0.00 0.00 16.00 0.00 17.00 1.00 1.00 19.00
Table 3.6.2 Total number of employees (including employees with disabilities) in each of the following occupational bands as on 31 March 2020
Occupational Male Female Total band
African Coloured Indian White African Coloured Indian White
01 Top 1.00 0.00 0.00 1.00 0.00 2.00 0.00 1.00 3.00 Management, Permanent
02 Senior 27.00 0.00 0.00 27.00 0.00 18.00 1.00 0.00 19.00 Management, Permanent
03 811.00 6.00 8.00 835.00 45.00 2 399.00 35.00 23.00 2 457.00 Profesionally qualifed and experienced specialists and mid- management, Permanent
187 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Occupational band Male Female Total
African Coloured Indian White African Coloured Indian White
03 Profesionally 6.00 0.00 1.00 7.00 2.00 2.00 0.00 1.00 3.00 qualifed and experienced specialists and mid-management, Temporary 04 Skilled technical 1267.00 4.00 1.00 1272.00 19.00 4 016.00 31.00 5.00 4 052.00 and academically qualifed workers, junior management, supervisors, foremen, Permanent 04 Skilled technical 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 and academically qualifed workers, junior management, supervisors, foremen, Temporary 05 Semi-skilled 1972.00 7.00 0.00 1979.00 15.00 5 074.00 16.00 7.00 5 097.00 and discretionary decision making, Permanent 06 Unskilled and 1016.00 5.00 0.00 1021.00 1.00 2 244.00 15.00 1.00 2 260.00 defned decision making, Permanent
07 Not Available, 106.00 2.00 0.00 108.00 0.00 246.00 1.00 0.00 247.00 Permanent
07 Not Available, 183.00 0.00 7.00 190.00 43.00 36.00 0.00 0.00 36.00 Temporary
09 Contract (Senior 2.00 0.00 0.00 2.00 0.00 0.00 0.00 0.00 0.00 Management), Permanent
10 Contract 158.00 8.00 15.00 181.00 66.00 192.00 4.00 27.00 223.00 (Professionaly Qualifed), Permanent 11 Contract 67.00 0.00 0.00 67.00 5.00 206.00 7.00 6.00 219.00 (Skilled Technical), Permanent
12 Contract (Semi- 2.00 0.00 0.00 2.00 0.00 5.00 0.00 0.00 5.00 Skilled), Permanent
13 Contract 2.00 0.00 0.00 2.00 0.00 3.00 0.00 0.00 3.00 (Unskilled), Permanent
TOTAL 5620.00 32.00 42.00 5694.00 196.00 14443.00 110.00 71.00 14624.00
188 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.6.3 Recruitment for the period 1 April 2019 to 31 March 2020
Occupational band Male Female Total
African Coloured Indian White African Coloured Indian White
02 Senior Management, 2.00 0.00 0.00 2.00 0.00 0.00 0.00 0.00 0.00 Permanent
03 Professionally qualifed 50.00 1.00 3.00 54.00 6.00 105.00 0.00 2.00 107.00 and experienced specialists and mid-management, Permanent
04 Skilled technical and 47.00 0.00 0.00 47.00 0.00 103.00 1.00 0.00 104.00 academically qualifed workers, junior management, supervisors, foremen, Permanent 05 Semi-skilled and 115.00 0.00 0.00 115.00 0.00 337.00 0.00 0.00 337.00 discretionary decision making, Permanent
06 Unskilled and defned 96.00 0.00 0.00 96.00 0.00 156.00 1.00 0.00 157.00 decision making, Permanent
07 Not Available, Permanent 43.00 1.00 0.00 44.00 0.00 88.00 1.00 0.00 89.00
07 Not Available, Temporary 7.00 0.00 0.00 7.00 0.00 0.00 0.00 0.00 0.00
09 Contract (Senior 3.00 0.00 0.00 3.00 0.00 0.00 0.00 0.00 0.00 Management), Permanent 10 Contract (Professionally 123.00 6.00 13.00 142.00 45.00 149.00 3.00 26.00 178.00 qualifed), Permanent
11 Contract (Skilled technical), 60.00 0.00 0.00 60.00 5.00 179.00 7.00 7.00 193.00 Permanent
12 Contract (Semi-skilled), 1.00 0.00 0.00 1.00 0.00 4.00 0.00 0.00 4.00 Permanent
13 Contract (Unskilled), 8.00 0.00 0.00 8.00 0.00 24.00 0.00 0.00 24.00 Permanent
TOTAL 555.00 8.00 16.00 579.00 56.00 1 145.00 13.00 35.00 1 193.00
189 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.6.4 Promotions for the period 1 April 2019 to 31 March 2020
Occupational band Male Female Total
African Coloured Indian White African Coloured Indian White
02 Senior Management, 13.00 0.00 0.00 13.00 0.00 13.00 1.00 0.00 14.00 Permanent
03 Professionally qualifed 438.00 5.00 13.00 456.00 28.00 1 175.00 18.00 16.00 1 209.00 and experienced specialists and mid-management, Permanent 03 Professionally qualifed 5.00 0.00 0.00 5.00 0.00 1.00 0.00 0.00 1.00 and experienced specialists and mid-management, Temporary
04 Skilled technical 685.00 4.00 2.00 691.00 16.00 2 287.00 20.00 5.00 2 312.00 and academically qualifed workers, junior management, supervisors, foremen, Permanent 04 Skilled technical 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 and academically qualifed workers, junior management, supervisors, foremen, Temporary
05 Semi-skilled and 1433.00 5.00 0.00 1438.00 8.00 3 151.00 12.00 4.00 3 167.00 discretionary decision making, Permanent
06 Unskilled and defned 721.00 4.00 0.00 725.00 1.00 1 710.00 9.00 1.00 1 720.00 decision making, Permanent
07 Not Available, 33.00 0.00 0.00 33.00 3.00 3.00 0.00 0.00 3.00 Temporary
10 Contract (Professionally 23.00 3.00 3.00 29.00 22.00 29.00 2.00 1.00 32.00 qualifed), Permanent
11 Contract (Skilled 1.00 0.00 0.00 1.00 0.00 0.00 0.00 0.00 0.00 technical), Permanent
TOTAL 3352.00 21.00 18.00 3391.00 78.00 8 369.00 62.00 27.00 8 458.00
190 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.6.5 Terminations for the period 1 April 2019 and 31 March 2020
Occupational band Male Female Total
African Coloured Indian White African Coloured Indian White
02 Senior Management, 1.00 0.00 0.00 1.00 0.00 1.00 0.00 0.00 1.00 Permanent
03 Professionally qualifed and 36.00 1.00 1.00 38.00 5.00 131.00 2.00 0.00 133.00 experienced specialists and mid-management, Permanent 03 Professionally qualifed and 0.00 0.00 0.00 0.00 1.00 0.00 0.00 0.00 0.00 experienced specialists and mid-management, Temporary
04 Skilled technical and 53.00 1.00 1.00 55.00 2.00 98.00 1.00 0.00 99.00 academically qualifed workers, junior management, supervisors, foremen, Permanent 05 Semi-skilled and 70.00 0.00 0.00 70.00 1.00 107.00 2.00 0.00 109.00 discretionary decision making, Permanent
06 Unskilled and defned 19.00 0.00 0.00 19.00 0.00 36.00 2.00 0.00 38.00 decision making, Permanent
07 Not Available, Permanent 2.00 0.00 0.00 2.00 0.00 0.00 0.00 0.00 0.00
07 Not Available, Temporary 17.00 0.00 2.00 19.00 4.00 1.00 0.00 0.00 1.00
09 Contract (Senior 3.00 0.00 0.00 3.00 0.00 0.00 0.00 0.00 0.00 Management), Permanent 10 Contract (Professionally 87.00 3.00 13.00 103.00 35.00 143.00 3.00 15.00 161.00 qualifed), Permanent 11 Contract (Skilled technical), 41.00 0.00 0.00 41.00 0.00 112.00 2.00 5.00 119.00 Permanent
12 Contract (Semi-skilled), 0.00 0.00 0.00 0.00 0.00 2.00 0.00 0.00 2.00 Permanent
13 Contract (Unskilled), 0.00 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 Permanent
TOTAL 329.00 5.00 17.00 351.00 48.00 632.00 12.00 20.00 664.00
191 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.6.6 Disciplinary action for the period 1 April 2019 to 31 March 2020
Disciplinary action Male Female Total African Coloured Indian White African Coloured Indian White 80 3 63 146
Table 3.6.7 Skills development for the period 1 April 2019 to 31 March 2020
Occupational category Male Female Total
African Coloured Indian White African Coloured Indian White
Legislators, senior offcials and managers 10 0 0 0 17 0 0 0 27
Professionals 1887 2 1 3 3314 2 2 5 5216
Technicians and associate professionals 258 0 0 0 444 0 0 0 702
Clerks 279 0 0 0 659 0 0 0 938
Service and sales workers 0 0 0 0 0 0 0 0 0
Skilled agriculture and fshery 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 0 0 0 0 0 0 0 0 0 assemblers
Elementary occupations 80 0 0 0 100 0 0 0 180
Total 2514 2 1 3 4534 2 2 5 7063
Employees with disabilities 0 0 0 0 0 0 0 0 0
192 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.7 Signing of Performance Agreements by SMS Members Table 3.7.1 Signing of Performance Agreements by SMS members as on 31 May 2019 SMS Level Total number of funded Total number of Total number of signed Signed performance agreements as % SMS posts SMS members performance agreements of total number of SMS members Director-General/ 0 0 0 0 Head of Department Salary Level 16 1 1 1 100% Salary Level 15 1 1 0 0% Salary Level 14 11 11 10 99% Salary Level 13 38 38 27 79% Total 51 51 38
Table 3.7.2 Reasons for not having concluded Performance agreements for all SMS members as on 31 March 2020 Reasons None Notes • The reporting date in the heading of this table should be aligned with that of Table 3.7.1.
Table 3.7.3 Disciplinary steps taken against SMS members for not having concluded Performance agreements as on 31 March 2020 Reasons No Disciplinary steps taken Notes • The reporting date in the heading of this table should be aligned with that of Table 3.7.1.
3.8 Performance Rewards To encourage good performance, the department has granted the following performance rewards during the year under review. The information is presented in terms of race, gender, disability, salary bands and critical occupations (see defnition in notes below).
Table 3.8.1 Performance Rewards by race, gender and disability for the period 1 April 2019 to 31 March 2020
Benefciary Profle Cost Number of Number of % of total within group Cost (R’000) Average cost per Race and Gender benefciaries employees employee African Male 1689 5515 31% 7 412 468.44 51 229.44 Female 4461 14034 32% 27 025 834.88 40 750.63 Asian Male 4 52 8% 2 255 912.32 50 013.04 Female 17 66 26% 33 604 842.35 27 291.32 Coloured Male 7 33 21% 164 882.36 11 981.11 Female 41 116 35% 884 693.88 26 940.65 White Male 28 220 13% 4 228 439.47 26 099.76 Female 166 573 29% 110 625.73 39 564.16 Total 6413 20 609 104 407 969.58
193 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.8.2 Performance Rewards by salary band for personnel below Senior Management Service for the period 1 April 2019 to 31 March 2020
Benefciary Profle Cost Total cost as a % of Salary band Number of Number of % of total Total Cost Average cost benefciaries employees within salary (R’000) per employee the total bands personnel expenditure Lower Skilled (Levels 1-2) 1340 3105 43% 9 464 253.48 7 073.08 10%
Skilled (level 3-5) 2164 7536 35% 22 508 362.71 12 343.42 21%
Highly skilled production 1481 5205 35% 25 217 867.83 18 028.90 24% (level 6-8) Highly skilled supervision 1309 3810 29% 47 217 357.82 30 692.03 45% (level 9-12) Total 6231 19 656 104 407 969.58 100%
Table 3.8.3 Performance Rewards by critical occupation for the period 1 April 2019 to 31 March 2020
Salary band Benefciary Profle Cost
Number of Number of % of total within Total Cost (R’000) Average cost benefciaries employees salary bands per employee Engineers 1 4 25% 46 888.58 46 888.58 Medical Specialist 9 50 18% 887 606.61 84 214.61 Total 10 54 9 34496.19 131 103.19
Table 3.8.4 Performance related rewards (cash bonus), by salary band for Senior Management Service for the period 1 April 2019 to 31 March 2020
Salary band Benefciary Profle Cost Total cost as a % of the Number of Number of % of total within Total Cost Average cost total personnel benefciaries employees salary bands (R’000) per employee expenditure Band A 0 0 0 0 0 0 Band B 0 0 0 0 0 0 Band C 0 0 0 0 0 0 Band D 0 0 0 0 0 0 Total 0 0 0 0 0 0
194 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.9 Foreign Workers Table 3.9.1 Foreign workers by salary band for the period 1 April 2019 and 31 March 2020
01 April 2019 March 31 2020 Change Critical occupation Number % of total Number % of total Number
Highly skilled production 12.00 4.50 15.00 6.70 3.00 - 6.80 (Levels 6-8) Highly skilled 237.00 88.80 188.00 84.30 - 49.00 111.40 supervision (Levels 9-12) Lower skilled (Levels 1.00 0.40 1.00 0.40 0.00 0.00 1-2) Other 13.00 4.90 15.00 6.70 2.00 - 4.50
Senior management 1.00 0.40 1.00 0.40 0.00 0.00 (Levels 13-16) Skilled (Levels 3-5) 3.00 1.10 3.00 1.30 0.00 0.00
TOTAL 267 100.00 223.00 100.00 - 44.00 100.00
Table 3.9.2 Foreign workers by major occupation for the period 1 April 2019 and 31 March 2020
01 April 2019 March 31 2020 Chang Critical occupation Number % of total Number % of total Number
Administrative offce 1.00 0.40 0.00 0.00 - 1.00 2.30 workers Elementary occupations 1.00 0.40 1.00 0.40 0.00 0.00
Professionals and 258.00 96.60 215.00 96.40 - 43.00 97.70 managers Social natural 3.00 1.10 3.00 1.30 0.00 0.00 technical and medical sciences+sup Technicians and 4.00 1.50 4.00 1.80 0.00 0.00 associated professionals TOTAL 267.00 100.00 223.00 100.00 - 44.00 100.00
195 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.10.3 Annual Leave for the period 1 January 2019 to 31 December 2019
Salary band Total days taken Number of Employees using annual Average per leave employee Contract (Levels 1-2) 76.00 5.00 15.00 Contract (Levels 13-16) 15.00 15.00 1.00 Contract (Levels 3-5) 455.00 8.00 58.00 Contract (Levels 6-8) 3 762.00 15.00 258.00 Contract (Levels 9-12) 8 815.92 16.00 540.00 Contract Other 1 707.00 14.00 123.00 Highly skilled production (Levels 6-8) 121 378.19 23.00 5 336.00 Highly skilled supervision (Levels 9-12) 84 525.34 24.00 3 483.00 Lower skilled (Levels 1-2) 68 525.54 22.00 3 079.00 Other 30.00 30.00 1.00 Senior management (Levels 13-16) 1 091.00 22.00 50.00 Skilled (Levels 3-5) 159 199.68 22.00 7 135.00 TOTAL 449 580.67 22.00 20 079.00
Table 3.10.4 Capped leave for the period 1 January 2019 to 31 December 2019
Salary band Total days of capped Number of Employees Average number of days Average capped leave leave taken using capped leave taken per employee per employee as on 31 March 2019 Contract (Levels 1-2) 0.00 0.00 0.00 0.00 Contract (Levels 0.00 0.00 0.00 0.00 13-16) Contract (Levels 3-5) 0.00 0.00 0.00 0.00 Contract (Levels 6-8) 0.00 0.00 0.00 0.00 Contract (Levels 9-12) 0.00 0.00 33.00 0.00 Contract Other 0.00 0.00 0.00 0.00 Highly skilled 160.00 4.00 43.00 36.00 production (Levels 6-8) Highly skilled 136.02 3.00 56.00 49.00 supervision (Levels 9-12) Lower skilled (Levels 2.00 2.00 16.00 1.00 1-2) Other 0.00 0.00 1.00 0.00 Senior management 0.00 0.00 59.00 0.00 (Levels 13-16) Skilled (Levels 3-5) 57.00 3.00 37.00 20.00 TOTAL 355.02 3.00 46.00 106.00
196 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.10.5 Leave payouts for the period 1 April 2019 and 31 March 2020
Reason Total amount (R’000) Number of employees Average per employee (R’000) ANNUAL - DISCOUNTING WITH 5 051.00 207.00 24 401.00 RESIGNATION (WORK DAYS) ANNUAL - DISCOUNTING: UNUSED 29.00 1.00 29 000.00 VACATION CREDITS (WORK DAYS) ANNUAL - GRATUITY: DEATH/ 8 127.00 276.00 29 446.00 RETIREMENT/MEDICAL RETIREMENT(WORK CAPPED - GRATUITY: DEATH/ 15 870.00 185.00 85 784.00 RETIREMENT/MEDICAL RETIREMENT(WORK TOTAL 29 78.00
3.11. HIV/AIDS & Health Promotion Programmes Table 3.11.1 Steps taken to reduce the risk of occupational exposure
Units/categories of employees identifed to be at high risk of Key steps taken to reduce the risk contracting HIV & related diseases (if any) All Healthcare workers are at risk of contracting HIV and Post Exposure Prophylaxis (PEP) is accessible and available in all Hepatitis through contaminated needles and exposure to health establishments and a policy on management of occupational body fuids exposures. Hepatitis immunization program is in place in health establishments. Post Exposure Policy has been reviewed. PPE monitoring tool is being used in the health establishment for appropriate use of PPE by HWs. Hepatitis immunization programme on going.
All Healthcare workers are at risk of contracting TB in the HCWs are provided with Personal Protective Equipment and clothing. workplace Medical surveillance and biological monitoring is carried out to HCWs. Health Risk Assessments are carried out and Occupational Hygienist and Epidemiologists from National Institute for Occupational Health jointly with Provincial OHS Team conducted a workplace TB Infection Prevention and Control Risk Assessment and HealthWise train the Trainer workshop for OHNPs, Environmental and Infection Prevention and Control Practitioners inclusive of all worker. Walkthrough Risk Assessment was conducted which included air quality monitoring to measure the effectiveness and effciency of IPC measures that are in place. Health establishments were supplied with N95 Fit Test are carried out to healthcare workers in health establishments by IPC Practitioners and OHNPs.
197 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.10 Leave utilisation Table 3.10.1 Sick leave for the period 1 January 2019 to 31 December 2019
Salary band Total day % Days with Number of % of total Average days Estimated Medical Employees employees per emplo Cost (R’000 certifcation using using disability disability leave leave Contract (Levels 1-2) 49 83 12 0 4 26 Contract (Levels 3-5) 34 94 14 0 2 29 Contract (Levels 6-8) 996 78 198 1 5 1181 Contract (Levels 9-12) 1142 72 250 1 5 2801 Contract Other 302 87 79 0 4 76 Highly skilled production (Levels 29394.50 93 3637 28 8 41 607 6-8) Highly skilled supervision (Levels 19603.00 92 2295 17 9 52 138 9-12) Lower skilled (Levels 1-2) 4835.50 96 1904 14 8 8332 Other 1 0 1 0 1 1 Senior management (Levels 198 93 25 0 8 903 13-16) Skilled (Levels 3-5) 36460.50 95 4559 35 8 31083 TOTAL 103016 94 12974 100 8 138177
Table 3.10.2 Disability leave (temporary and permanent) for the period 1 January 2019 to 31 December 2019
Salary band Total day % Days with Number of % of total Average days Estimated Medical Employees employees per emplo Cost (R’000 certifcation using using disability disability leave leave Contract (Levels 6-8) 28 100 1 0 28 31 Contract (Levels 9-12) 87 100 2 1 44 195 Highly skilled production 1709 100 31 26 55 2444 (Levels 6-8) Highly skilled supervision 1245 100 24 20 52 3355 (Levels 9-12) Lower skilled 522 100 16 13 33 293 (Levels 1-2) Skilled (Levels 3-5) 2586 100 43 36 60 2107 TOTAL 6177 100 117 100 53 8425
198 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.11.2 Details of Health Promotion and HIV/AIDS Programmes (tick the applicable boxes and provide the required information)
Question Yes No Details, if yes
1. Has the department designated a member of the SMS to implement the provisions 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 39 Occupational Health Units and seven (8) or has it designated specifc staff members Sub-districts have implemented Occupational to promote the health and well-being of your Health Services. 52 Occupational Health Nurse employees? If so, indicate the number of Practitioners in the health establishments. employees who are involved in this task and the Budget allocation is within their respective annual budget that is available for this purpose. Health Establishments. The Provincial OHS Team has 4 employees namely: One Programme manager, two OHNPs and One Snr Admin. Offcer. Budget Allocations: CoE= R 2 893 000.00, Social Contributions = R 360 000, Good and Services = R250 000 3. Has the department introduced an Employee Wellness Management Assistance or Health Promotion Programme HIV/AIDS /TB Management for your employees? If so, indicate the key Yes elements/services of this Programme. SHERQ Management Health and Productivity Management
4. Has the department established (a) Mr T.E Nkosi. committee(s) as contemplated in Part VI Mr N.F Tshabalala. E.5 (e) of Chapter 1 of the Public Service Regulations, 2001? If so, please provide the Mr S. Sithole. names of the members of the committee and Mr J. Muthwa the stakeholder(s) that they represent. Mr S. Mathebula Ms M. Soko Ms B. Marutle. Ms W. Msibi. Yes Mr B. Mathebula. Mr M. Shabangu. Mr M. Ngutshane. Mr. G. Malapane. Ms. B. Malatjie. Mr. J. Sibiya. Ms. W. Mogaule. Mr H. Mokhile. Mr J. Nkosi
199 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Question Yes No Details, if yes
5. Has the department reviewed its employment Polices are not approved, the programme works policies and practices to ensure that these do not with draft policies. unfairly discriminate against employees on the basis of their HIV status? If so, list the employment policies/ practices so reviewed.
NO
6. Has the department introduced measures to The draft HIV/AIDS Policies has a clause on protect HIV-positive employees or those perceived to confdentiality of infected and affected employees. be HIV-positive from discrimination? If so, list the key It also has a clause on non-discrimination of elements of these measures. employees infected or affected with HIV/AIDS. YES The occupational health and safety policies covers also the confdentiality and non-discrimination of employees infected by HIV/AIDS
7. Does the department encourage its employees to Five) HIV Testing and Counselling Services (HTS) undergo Voluntary Counselling and Testing? If so, list Counsellors have been assigned to render HTS at the results that you have you achieved. Bongani and Witbank TB Hospitals Occupational Health units and four (4) are assigned at Riverside Clinic Government Complex and 39 Occupational Health Units render HIV Testing and Counselling Services to employees in their respective clinics. On average 3500 employees are provided with Occupational Health Services monthly inclusive of Yes HTS. 286 healthcare workers were exposed to contaminated blood and were offered HIV Testing and Counselling Services. HIV/AIDS prevalence of the department as per GEMS report is 3169 Employees on PEP are 288. Male Circumcision as per GEMS report is 2560 8. Has the department developed measures/ GEMS report on employees registered on the indicators to monitor & evaluate the impact of its chronic programmes. health promotion programme? If so, list these Yes PILLIR report. measures/indicators.
200 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.12 Labour Relations Table 3.12.1 Collective agreements for the period 1 April 2019 and 31 March 2020
Subject matter Date Total number of Collective agreements None
Table 3.12.2 Misconduct and disciplinary hearings fnalised for the period 1 April 2019 and 31 March 2020
Outcomes of disciplinary hearings Number % of total Correctional counselling - - Verbal warning 2 4% Written warning 4 7% Final written warning 5 9% Suspended without pay 16 30% Fine - - Demotion - - Dismissal 3 6% Not guilty 2 4% Case withdrawn 22 40% Total 54 100%
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Table 3.12.3 Types of misconduct addressed at disciplinary hearings for the period 1 April 2019 and 31 March 2020
Type of misconduct Number % of total
Absenteeism 36 24%
Assault 19 13% Gross insubordination 24 15% Gross Negligence 10 6% Dereliction of Duties 5 3% Information Disclosure 1 1% Misuse of State Property 10 6% Drinking on duty 1 1% Nepotism 1 1% Intimidation and victimization 2 1% Fraud 11 7% Sexual Harassment 3 2% Abscondment 5 3%
Unacceptable Conduct 9 5% Theft 13 8% Sleeping on duty 1 1% Discrimination 2 1% Abuse of power 2 1% Fruitless / wasteful expenditure 1 1% TOTAL 156 100%
Table 3.12.4 Grievances logged for the period 1 April 2019 and 31 March 2020
202 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Grievances Number % of Total
Number of grievances resolved 22 30%
Number of grievances not resolved 51 70%
Total number of grievances lodged 73 100%
Table 3.12.5 Disputes logged with Councils for the period 1 April 2019 and 31 March 2020
Disputes Number % of Total Number of disputes upheld 27 55% Number of disputes dismissed 22 45% Total number of disputes lodged 49 100%
Table 3.12.6 Strike actions for the period 1 April 2019 and 31 March 2020
Total number of persons working days lost 3 Days Total costs working days lost 427 180.00 Amount recovered as a result of no work no pay (R’000) 427 180.00
Table 3.12.7 Precautionary suspensions for the period 1 April 2019 and 31 March 2020 Number of people suspended 18 Number of people who’s suspension exceeded 30 days 11 Average number of days suspended 13 Months Cost of suspension(R’000) 1 429 561.67
203 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.13 Skills development Table 3.13.1 Training needs identifed for the period 1 April 2019 and 31 March 2020
Occupational category Gender Number of Training needs identifed at start of the reporting period employees as at 1 April 2019 Learnerships Skills Other Total Programmes forms of & other short training courses Legislators, senior offcials and Female 26 0 18 0 18 managers Male 27 0 11 0 11 Professionals Female 1735 0 3500 0 3500 Male 900 0 1500 0 1500 Technicians and associate Female 5729 40 450 0 490 professionals Male 1913 20 310 0 330 Clerks Female 5491 0 665 0 665 Male 2098 0 300 0 300 Service and sales workers Female 0 0 0 0 0 Male 0 0 0 0 0 Skilled agriculture and fshery Female 0 0 0 0 0 workers Male 0 0 0 0 0 Craft and related trades workers Female 0 0 0 0 0 Plant and machine operators and Male 0 0 0 0 0 assemblers Female 0 0 0 0 0 Elementary occupations Male 0 0 0 0 0 Female 2210 0 200 0 200 Sub Total Male 1009 0 120 0 120 Female 15191 40 4833 0 4873 Total Male 5947 20 2241 0 2261 21138 60 7074 0 7134
204 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.13.2 Training provided for the period 1 April 2019 and 31 March 2020
Occupational Gender Number of Training provided within the reporting period category employees as at 1 Learnerships Skills Other forms of Total April 2019 Programmes training & other short courses Legislators, Female 26 0 17 0 17 senior offcials Male 27 0 10 0 10 and managers Professionals Female 1735 0 3323 0 3323 Male 900 0 1893 0 1893 Technicians Female 5729 43 401 0 444 and associate Male 1913 8 250 0 258 professionals Clerks Female 5491 0 659 0 659 Male 2098 0 279 0 279 Service and Female 0 0 0 0 0 sales workers Male 0 0 0 0 0 Skilled Female 0 0 0 0 0 agriculture and Male 0 0 0 0 0 fshery workers Craft and Female 0 0 0 0 0 related trades Male 0 0 0 0 0 workers Plant and Female 0 0 0 0 0 machine Male 0 0 0 0 0 operators and assemblers Elementary Female 2210 0 100 0 100 occupations Male 1009 0 80 0 80 Sub Total Female 15191 43 4500 0 4543 Male 5947 8 2512 0 2520 Total 21138 51 7012 0 7063
205 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
3.14 Injury on duty The following tables provide basic information on injury on duty. Table 3.14.1 Injury on duty for the period 1 April 2019 and 31 March 2020
Nature of injury on duty Number % of total Required basic medical attention only 541 77.84% Temporary Total Disablement 151 21.73 Permanent Disablement 0 0 Fatal 3 0.43% Total 695 100%
3.15 Utilisation of Consultants Table 3.15.1 Report on consultant appointments using appropriated funds for the period 1 April 2019 and 31 March 2020
Project title Total number of consultants that worked Duration Contract value in on project (work days) Rand None None None None
Table 3.15.2 Analysis of consultant appointments using appropriated funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2019 and 31 March 2020
Project title Percentage ownership by HDI Percentage management by Number of consultants from HDI groups groups HDI groups that work on the project None None None None
Table 3.15.3 Report on consultant appointments using Donor funds for the period 1 April 2019 and 31 March 2020
Project title Total Number of consultants that worked on project Duration Donor and contract value in Rand (Work days) None None None None
206 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Table 3.15.4 Analysis of consultant appointments using Donor funds, in terms of Historically Disadvantaged Individuals (HDIs) for the period 1 April 2019 and 31 March 2020
Project title Percentage ownership by Percentage management by Number of consultants from HDI groups that HDI groups HDI groups work on the project None None None None 3.16. Severance Packages Table 3.16.1 Granting of employee initiated severance packages for the period 1 April 2019 and 31 March 2020
Salary band Number of applications Number of applications Number of applications Number of packages received referred to the MPSA supported by MPSA approved by department Lower skilled (Levels 1-2) 0.00 0.00 0.00 0.00 Skilled Levels 3-5) 0.00 0.00 0.00 0.00 Highly skilled production (Levels 6-8) 0.00 0.00 0.00 0.00 Highly skilled supervision(Levels 9-12) 0.00 0.00 0.00 0.00 Senior management (Levels 13-16) 0.00 0.00 0.00 0.00
Total 0.00 0.00 0.00 0.00
207 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 PART E: FINANCIAL INFORMATION
ANNUAL FINANCIAL STATEMENTS FOR MPUMALANGA DEPARTMENT OF HEALTH VOTE 10 For the year ended 31 March 2020
208 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
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Table of Contents
Appropriation Statement 219
Notes to the Appropriation Statement 260
Statement of Financial Performance 262
Statement of Financial Position 264
Statement of Changes in Net Assets 266
Cash Flow Statement 267
Notes to the Annual Financial Statements (including 268 Accounting policies)
Annexures 320
218 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Actual Actual Expenditure 13,055,943 Expenditure 2018/19 2018/19 Final Final 13,119,591 Appropriation Appropriation % R’000 R’000 100.0% 1,368,773 1,368,773 100.0% 363,422 363,412 100.0% 289,609 289,363 fnal as % of appropriation 1 4 4 Variance Expenditure Actual 2019/20 14,257,736 Expenditure Actual e Expenditure Final 14,280,909 Appropriation Appropriation - - 14,280,909 14,280,909 14,257,736 14,257,736 23,173 23,173 99.8% 99.8% 13,119,591 13,119,591 13,055,943 13,055,943 - 1,303,516 1,302,292 1,224 99.9% 1,224,452 1,222,888 Appropriation per programm Virement Final 2019/20 - - - (68,292) 1,132,406 1,130,757 1,649 99.9% 1,317,847 1,256,062 - (20,900) 240,512 220,316 20,196 91.6% 157,928 157,928 - (10,555) 414,643 414,548 95 100.0% 365,839 365,838 - - (9,894) 1,434,783 1,434,782 - (1,966) 419,062 419,058 - 97,370 8,905,608 8,905,608 - 100.0% 8,031,721 8,031,679 - 14,237 430,379 430,375 Funds Shifting of APPROPRIATION STATEMENT for the year ended 31 March 2020 STATEMENT APPROPRIATION R’000 R’000 R’000 R’000 R’000 R’000 421,028 416,142 1,303,516 8,808,238 14,280,909 14,280,909 Adjusted Appropriation Subtotal TOTAL 8.Health Facilities Management 1,200,698 7.Health Care Support Service 261,412 6.Health Sciences and Training6.Health Sciences and 425,198 5.Central Hospital Service 4.Provincial Hospital Service 1,444,677 3.Emergency Medical Service 2.District Health Services Programme 1.Administration TOTAL (brought forward) TOTAL Reconciliation with statement of fnancial performance ADD Actual amounts per statement of fnancial performance (total revenue) Actual amounts per statement of fnancial performance (total expenditure)
219 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - Actual expenditure 2018/19 Final Appropriation - 202 % R’000 R’000 100.0% 32,205 35,631 as % of fnal appropriation - 100.0% 6,683,821 6,706,068 - 100.0% 17,194 18,859 - 100.0% 5,089 4,413 3 100.0% 7,662,953 7,662,953 3 100.0% 979,132 956,885 8 100.0% 6,287 5,776 2 100.0% 33,575 24,515 1 2 Variance Expenditure - Actual Expenditure 2 Appropriation Virement Final 2019/20 Appropriation per economic classifcation Funds Shifting of - 2 - R’000 R’000 R’000 R’000 R’000 R’000 7,079 1,427 91 8,597 6,903 1,694 80.3% 10,125 4,170 4,606 667 (94) 5,179 5,061 118 97.7% 3,449 3,391 9,224 (1,611) - 7,613 7,613 11,236 11,236 5,469 2,590 19,295 19,287 18,146 1,780 - 19,926 19,926 39,174 67,561 951 (9,848) 16,035 - 56,160 57,713 55,826 57,711 334 99.4% 35,853 38,914 62,906 1,287 65,073 129,266 129,265 110,740 110,740 (1,822) (916) 108,002 107,742 260 99.8% 103,572 113,936 276,731 6,314 (65,911) 217,134 208,689 8,445 96.1% 187,734 200,566 607,505 (10,434) (15,520) 581,551 581,378 173 100.0% 501,083 495,105 159,522 (13,943) 6,421 152,000 151,092 908 99.4% 107,052 102,012 105,295 1,795 10,334 117,424 117,517 (93) 100.1% 103,458 114,691 8,420,581 - (140,748) 8,279,833 8,279,830 7,402,292 (46,583) (129,635) 7,226,074 7,226,074 1,018,289 46,583 (11,113) 1,053,759 1,053,756 4,557,074 - 72,037 4,629,111 4,607,610 21,501 99.5% 3,908,388 3,913,891 12,977,655 - (68,711) 12,908,944 12,892,325 16,619 99.9% 11,571,341 11,577,331 Adjusted Appropriation Salaries and wages Social contributions Minor assets Administrative fees Audit costs: External Advertising Catering: Departmental activities Computer services Communication Consultants: Business and advisory services Laboratory services Contractors Legal services Agency and support / outsourced services Fleet services Inventory: Clothing material and supplies Compensation of employees Goods and services Economic classifcation Current payments
220 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------487 - 487 - 779 963 537 399 - - - 11,630 - 13,000 - - 1,995 - 9,586 ------4,885 (4,885) - 4,885 (4,885) - - - - - 673 671 2 99.7% - 1,359 1,504 (145) 110.7% 1,083 2,326 - 1,359 1,504 (145) 110.7% 1,083 2,326 - - 1,359 1,504 (145) 110.7% 1,083 2,326 ------9,281 494,191 494,006 185 100.0% 449,974 449,900 - - - - - 15,052 164,099 1,747,509 1,742,727 4,782 99.7% 1,596,921 1,616,131
- - - 16 (16) 711 711 (30) (8) 940 842 (40) 1,742 1,741 1 99.9% 969 (99) 520 1,390 1,385 5 99.6% 1,066 665 750 (750) 121 (121) 1,359 1,359 4,134 448 (38) 4,544 4,258 286 93.7% 2,257 2,562 5,217 134 (89) 5,262 4,462 800 84.8% 5,291 4,713 2,050 (2,050) 58,114 58,114 (6,586) (1,548) 49,980 49,884 96 99.8% 57,084 50,690 86,884 5,569 (1,917) 90,536 89,358 1,178 98.7% 71,139 66,803 41,968 902 (849) 42,021 41,689 332 99.2% 19,716 17,871 86,930 (1,016) (2,920) 82,994 82,993 1 100.0% 87,998 79,159 484,910 556,877 (5,642) (96,847) 454,388 454,904 (516) 100.1% 376,668 358,588 167,132 9,393 (6,211) 170,314 168,403 1,911 98.9% 93,900 118,661 1,568,358 Provincial Revenue Funds 1,359 Provinces Interest Rental and hiring Venues and facilities Venues Operating payments Training and development Training Transport provided: Transport Departmental activity Travel and subsistence Travel Property payments Operating leases Consumable: Stationery, Consumable: Stationery, printing and offce supplies Consumable supplies Inventory: Medical suppliesInventory: Medicine 496,178 1,936 (218) 497,896 497,125 771 99.8% 411,944 434,707 Inventory: Other supplies Inventory: Materials and supplies Inventory: Learner and teacher support material Inventory: Fuel, oil and gas Inventory: Food and food supplies Inventory: Farming supplies Provinces and municipalities Interest and rent on land Transfers and subsidies Transfers
221 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------5,683 (5,683) 14,007 66 12,953 27,026 28,413 (1,387) 52,247 105.1% 6,683 4,822 17,065 63,752 32,258 58,609 5,143 91.9% 21,801 21,364 33,044 33,044 - - 9,281 9,281 42,325 42,325 42,941 42,941 (616) (616) 101.5% 101.5% 14,359 14,359 14,185 14,185 115,319 115,319 - - 115,319 116,130 (811) 100.7% 108,168 124,443 335,188 - 101,312 - (66) 335,188 818,344 (12,953) 333,431 626,746 88,293 - 626,746 1,757 - 87,717 59,430 191,598 877,774 (3,836) - 99.5% 576 (3,836) - 622,910 865,722 139,351 326,364 622,910 63,266 (6,683) 618,331 99.3% 12,052 308,946 254,864 58,444 618,331 4,579 91,103 191,112 247,391 98.6% 4,579 1,098,276 188,782 99.3% 92,185 7,473 1,028,712 99.3% 984,944 2,330 97.1% 984,944 896,065 98.8% 113,332 896,065 132,647 91,531 111,283 Other transfers to households Other machinery and equipment Households Social benefts Payments for capital assets Buildings and other fxed structures Buildings Machinery and equipment equipment Transport Payments for fnancial assets Departmental agencies and accounts Departmental agencies and accounts Non-proft institutions
222 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 2 625 104 803 R’000 5,715 4,413 2,156 7,899 32,907 17,939 18,859 24,005 115,370 115,370 113,829 133,309 289,363 247,249 281,464 Actual expenditure 3 2018/19 911 911 438 106 Final Appropriation % R’000 as % of fnal appropriation - 100.0% - 100.0% - 17,141 - 100.0% 100.0% 17,194 - - 100.0% 100.0% - 29,314 4,559 100.0% - 100.0% 248,727 - 100.0% 2,370 - 100.0% 8,628 1 100.0% 116,155 7 99.4% 1 100.0% 29,482 1 100.0% 133,296 4 100.0% 289,609 4 100.0% 280,981 24 100.0% 115,431 (36) 100.4% 5,509 R’000 Variance Expenditure 6 32 937 Actual Expenditure 6 32 937 R’000 R’000 1,178 1,171 7,553 7,553 9,201 9,237 19,926 19,926 20,018 20,018 56,584 56,584 72,148 72,147 12,815 12,815 15,154 15,154 129,177 129,176 216,315 216,291 365,510 149,195 365,510 149,194 430,379 430,375 415,225 415,221 Final Appropriation Virement 2019/20 - 15,582 - 9,242 - - 13,128 (2,454) - 14,237 - (752) - 14,989 5 - 31 - 40 3,056 29 - 708 (153) 265 - (708) (2,301) (270) - R’000 R’000 1,780 - 4,469 3,075 (9,301) - Funds Shifting of 1 3 906 913 R’000 6,105 5,271 7,823 19,463 18,146 65,885 62,906 15,906 132,186 200,733 352,382 151,649 416,142 400,236 Adjusted Appropriation Social contributions Administrative fees Communication Contractors Audit costs: External Salaries and wages Advertising activities Departmental Catering: Computer services Consultants: Business and advisory services Legal services Minor assets Offce of the MEC Goods and services Compensation of employees Economic classifcation Current payments Programme 1: ADMINISTRATION Programme 1: Total for sub programmes Total Sub programme 1. 2. Management
223 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - 33 111 111 111 - - - 184 40 - - - 100 100.0% 343 156 - - - 100.0% 100.0% 100.0% 3,164 1,384 1,780 3,137 1,384 1,753 - 100.0% 3,164 3,137 - - 100.0% - - 100.0% 12,212 100.0% 100.0% 10,122 518 418 774 332 - - - 100.0% - 100.0% 2,982 100.0% 2,824 2,982 4,165 2,427 4,060 - 100.0% 4 100.0% 289,609 289,363 9 97.6% 1,260 1,423 4 100.0% 37,718 38,977 1 13 97.0% 308 236 39 98.2% 1,395 2,731 (1) 100.0% 240 203 - 25 25 (25) (25) 52 - - - 52 - 5,420 5,420 414 ------67 (15) - 380 - - 380 371 859 - - 859 1,006 (147) 117.1% 1,083 1,292 859 - - 859 1,006 (147) 117.1% 1,083 1,292 859 - - 859 1,006 (147) 117.1% 1,083 1,292 146 686 287 540 (500) - 525 - 209 433 186 1,274 420 1,274 186 496 (131) - 365 365 200 2,043 - 2,243 2,242 3,000 - 2,394 5,394 5,394 1,563 4,687 446 4,172 277 5,006 (1,594) - - - 2,009 4,964 2,578 2,010 4,964 2,578 1,570 589 - 2,159 2,120 10,112 10,112 - 2,511 12,623 12,623 13,112 13,112 - 4,905 18,017 18,017 13,112 13,112 - 4,905 18,017 18,017 49,409 - (3,796) 45,613 45,471 142 99.7% 35,375 36,262 49,789 - (3,796) 45,993 45,842 151 99.7% 36,635 37,685 50,648 - (3,796) 46,852 46,848 13,641 611 - 14,252 14,252 416,142 - 14,237 430,379 430,375 Transport equipment Transport Other machinery and equipment Total Machinery and equipment Other transfers to households Payments for capital assets Households Social benefts Provincial Revenue Funds Provinces Provinces and municipalities Training and development Training and facilities Venues Rental and hiring Interest and rent on land Interest and subsidies Transfers Operating payments Consumable supplies printing and Consumable: Stationery, offce supplies Operating leases Property payments and subsistence Travel Agency and support / outsourced services Fleet services Inventory: Other supplies Inventory: Food and food supplies
224 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - 1 1 111 111 Actual Actual expenditure expenditure - - - - 2018/19 2018/19 Final Final Appropriation Appropriation - % R’000 R’000 - % R’000 R’000 100.0% 5,904 5,593 as % of fnal appropriation as % of fnal appropriation 1 Variance Expenditure Variance Expenditure - - Actual Actual Expenditure Expenditure - 25 (25) - Appropriation Appropriation - 859 1,006 (147) 117.1% 1,083 1,291 - Virement Final Virement Final 2019/20 2019/20 - 4,905 18,017 18,017 - 100.0% 3,164 3,137 - - (3,796) 4,905 45,767 18,017 45,616 18,017 151 99.7% - 100.0% 36,635 37,685 3,164 3,137 - - (3,796) 46,626 46,622 4 100.0% 37,718 38,976 - - 15,373 210,496 210,471 25 100.0% 112,707 111,524 - (1,493) 140,086 140,086 - 100.0% 127,392 127,716 - 13,880 350,582 350,582 - 100.0% 240,099 239,351 - - 226 226 - 100.0% - - - - (961) - 209 9,109 - 5,819 9,108 5,820 226 (1) 226 100.0% - 2,724 100.0% 2,305 - (752) 14,928 14,928 - 100.0% 8,628 7,898 Funds Funds Shifting of Shifting of - - 859 226 226 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 5,610 13,112 13,112 13,112 13,112 49,563 50,422 10,070 15,680 195,123 141,579 336,702 Adjusted Adjusted Appropriation Appropriation Machinery and equipment Households Provinces and municipalities Interest and rent on land Goods and services Compensation of employees Households Provinces and municipalities Compensation of employees Goods and services Payments for capital assets Transfers and subsidies Transfers Transfers and subsidies Transfers Current payments Economic classifcation Economic classifcation Current payments 1.1 Offce of the MEC 1.2 Management
225 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Actual expenditure 2018/19 Final Appropriation % R’000 R’000 as % of fnal appropriation Variance Expenditure Actual Expenditure Appropriation Virement Final 2019/20 Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 3,412 328 (94) 3,646 3,640 6 99.8% 2,734 2,615 5,965 4,936 1,000 (252) (485) 333 6,480 5,017 6,472 4,250 8 767 99.9% 84.7% 3,917 5,696 3,620 1,975 24,047 103 (415) 23,735 23,729 6 100.0% 21,742 24,560 13,058 - (2,953) 10,105 10,038 67 99.3% 10,832 10,012 21,648 - (2,384) 19,264 18,895 369 98.1% 19,076 18,317 679,731 35,290 247,860 (4,949) 4,420 710,072 (67,526) 710,100 184,754 (28) 184,647 100.0% 107 662,329 99.9% 644,179 165,906 178,169 425,320 - 42,397 467,717 467,741 (24) 100.0% 380,497 380,496 1,611,319 1,611,319 - 83,039 1,694,358 1,694,383 (25) 100.0% 1,454,549 1,443,409 2,917,901 - 140,753 3,058,654 3,064,804 (6,150) 100.2% 2,665,275 2,667,633 4,827,536 (35,290) (45,797) 4,746,449 4,747,197 (748) 100.0% 4,349,957 4,367,394 8,808,238 - 8,425,168 97,370 5,507,267 8,905,608 - 8,905,608 - 90,007 (50,746) 8,515,175 - 5,456,521 8,522,290 5,457,297 (7,115) 100.0% (776) 8,031,721 100.1% 8,031,679 100.0% 7,677,561 7,679,413 5,012,286 5,011,573 2,091,167 - (72,024) 2,019,143 2,014,642 4,501 99.8% 1,898,883 1,888,810 Adjusted Appropriation Catering: Departmental activities Communication Minor assets Social contributions Advertising Administrative fees Salaries and wages District Management Community – Based Services 1,093,267 - 12,000 1,105,267 1,105,234 33 100.0% 943,598 952,990 Goods and services Compensation of employees Total for sub programmes Total Economic classifcation Current payments 7. District Hospitals 6. Nutrition Programme 2: DISTRICT HEALTH SERVICES Programme 2: DISTRICT HEALTH Sub programme 1. 2. Community Health Clinics 3. Community Health Centres 4. 5. AIDS HIV/
226 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------207 207 207 2 - - 9,567 - 562 - - - - - 6,092 99.8% 4,061 377 99.8%99.8% 297 779 138 779 100.0% 4,188 4,553 100.0% 25,148 20,008 100.0% 91,691 82,342 1 1 1 1 1 4 - 2 ------189 189 (189) 189 (189) (189) - 2 ------2 - - 1,287 55,831 57,118 57,118 - 100.0% 2,723 2,724 - - - - - 121 (121) - 750 (750) - 400 317 (249) 468 467 224 401 - 625 624 354 (80) 497 - 67 (89) 274 475 274 475 - 100.0% - 100.0% 228 522 184 490 1,666 (1,037) - 629 628 1,878 793 - 2,671 2,417 254 90.5% 1,171 1,367 35,892 6 17,811 53,709 53,707 2 100.0% 44,745 53,683 36,019 (25,579) (473) 9,967 9,966 51,519 776 - 52,295 52,295 - 100.0% 52,004 58,558 50,121 (586) (2,920) 46,615 46,615 - 100.0% 51,147 46,519 56,665 27,980 4,766 16,786 (3,184) (95) (4,202) (1,144) 58,247 (302) 26,741 58,262 12,282 26,857 (15) 12,281 (116) 100.0% 100.4% 32,388 11,648 45,414 10,323 35,440 2,464 (3,029) 34,875 34,855 20 99.9% 24,038 21,795 510,927 3,272 (13,015) 501,184 501,184 - 100.0% 404,006 398,242 262,925 8,396 (6,294) 265,027 265,020 7 100.0% 223,032 221,275 103,914 (3,671) (1,047) 99,196 99,192 1,437,603 7,975 167,044 1,612,622 1,619,829 (7,207) 100.4% 1,475,242 1,487,923 Interest Interest and rent on land Fleet services Inventory: Clothing material and supplies Contractors Laboratory services Legal services Agency and support / outsourced services Inventory: Farming supplies Computer services Inventory: Food and food supplies Inventory: Fuel, oil and gas Inventory: Materials and supplies Rental and hiring Interest and rent on land Inventory: Other supplies Inventory: Medical supplies Inventory: Medicine Venues and facilities Venues Consumable supplies printing and Consumable: Stationery, offce supplies Operating leases Property payments Transport provided: Departmental Transport activity and development Training Travel and subsistence Travel Operating payments
227 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - 3,006 - - 100.0% 8,031,721 8,031,679 - 9 9 93.8% 93.8% 204 204 156 156 71 100.0% 333,581 333,295 - - 335,188 333,431 1,757 99.5% 326,364 308,946 - - 146 146 137 137 - - - - 146 146 - - 8,683 8,683 - - 8,515 8,515 17,198 9,928 17,198 (172) 18,893 18,893 (1,695) 191 (1,695) 109.9% 9,947 109.9% 4,805 7,013 7,013 24,193 5,142 21,187 48.3% 8,222 8,942 39,053 39,053 - - (1,152) (1,152) 37,901 37,901 30,857 30,857 7,044 7,044 81.4% 81.4% 20,579 20,579 18,971 18,971 335,188 - 344,017 - 8,515 352,532 352,461 8,808,238 - 97,370 8,905,608 8,905,608 Departmental agencies and accounts Departmental agencies Non-proft institutions Payments for capital assets Machinery and equipment equipment Transport Social benefts Other transfers to households Other machinery and equipmentTotal 29,125 172 (1,343) 27,954 26,052 1,902 93.2% 12,357 10,029 Households Transfers and subsidies Transfers
228 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - 7 16 R’000 Actual Actual expenditure expenditure - 2018/19 - 1 2018/19 R’000 R’000 R’000 3,818 6,071 2,124 2,124 1,693 3,947 4,885 4,776 4,885 4,776 61,105 58,988 Final Final Appropriation Appropriation - % 100.0% 1,068,025 1,049,070 100.0% 6,671 6,006 - - % 100.0% 310,689 310,654 as % of fnal appropriation - - 100.0% 100.0% 2,572 2,572 4,590 4,590 as % of fnal 1 1 1 100.0% 6,671 6,006 appropriation (8) 100.0% 377,281 383,727 (26) 100.0% 1,445,306 1,432,813 (19) R’000 - 100.0% - 100.0% 371,794 369,649 - 100.0% - 100.0% 4 1 100.0% 1 (4) Variance Expenditure Variance Expenditure 19 R’000 - 4 Actual Expenditure Actual Expenditure - - 1 R’000 Appropriation Appropriation - R’000 2019/20 2019/20 Virement Final Virement Final - (21,850) - 63,678 327,037 327,033 132,989 132,989 - 41,828 460,026 460,026 - - - 569 4,095 4,094 - - - - 2,237 2,237 - 569 1,857 1,857 - - 3,596 3,621 (25) 100.7% - - 3,596 3,621 (25) 100.7% - (3,516) 1,177,800 1,177,799 - - 80,226 83,742 1,681,341 1,681,367 503,541 503,549 - - (321) 7,309 7,308 - - - 3,134 3,134 (321) 5,708 5,708 7,309 5,708 5,708 7,308 R’000 Funds Funds Shifting of Shifting of - 1 - R’000 R’000 R’000 R’000 R’000 R’000 3,526 2,237 1,288 3,596 69,311 69,311 R’000 7,630 2,574 2,574 7,630 348,887 418,198 419,799 1,601,115 1,601,115 Adjusted Adjusted Appropriation Appropriation Goods and services Compensation of employees Interest and rent on land Departmental agencies and accounts Non-proft institutions Households Machinery and equipment 3,596 Economic classifcation Economic classifcation Current payments 2.2 Community Health Clinics Current payments Compensation of employeesGoods and services 1,181,316 Interest and rent on land 2.1 District Management Machinery and equipment Transfers and subsidies Transfers Households Payments for capital assets Transfers and subsidies Transfers Payments for capital assets
229 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 9 48 48 Actual Actual expenditure expenditure - - - 2018/19 2018/19 Final Final Appropriation Appropriation - % R’000 R’000 % R’000 R’000 99.9% 583 581 100.0% 750,468 756,269 as % of fnal as % of fnal appropriation appropriation 1 1 67 66 99.1% 99.0% 6,060 5,477 5,301 4,720 (4) Variance Expenditure Variance Expenditure 4 Actual Actual Expenditure Expenditure - Appropriation Appropriation Virement Final 2019/20 2019/20 Virement Final - - 10,230 (11,244) 1,101,408 825,862 1,101,408 825,861 - 100.0% 943,000 948,789 - - 21,474 275,546 - 275,543 3 100.0% 192,532 192,511 - 1,770 3,454 3,454 - 100.0% 598 4,153 - 1,770 3,454 3,454 - 100.0% 598 4,153 - - 405 372 33 91.9% - - 405 372 33 91.9% - 540 1,345 1,344 - - (2,384) (2,924) 7,710 - 6,365 - 7,643 - 6,299 - 11,554 11,554 11,252 11,252 302 302 97.4% 97.4% 13,016 13,016 13,016 13,016 Funds Funds Shifting of Shifting of - 405 405 R’000 R’000 R’000 R’000 R’000 R’000 805 1,684 1,684 R’000 R’000 R’000 R’000 R’000 R’000 9,289 254,072 11,554 11,554 11,554 11,554 10,094 1,091,178 Adjusted Adjusted Appropriation Appropriation Compensation of employees 837,106 Goods and services Interest and rent on land Households Machinery and equipment Economic classifcation Current payments 2.3 Community Health Centres Transfers and subsidies Transfers Economic classifcation Current payments Compensation of employees Goods and services and subsidies Transfers Non-proft institutions 2.4 Community Based Services Payments for capital assets
230 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 9 47 47 30 Actual Actual expenditure expenditure - - - 9 2018/19 2018/19 Final Final Appropriation Appropriation - - - - - 362 471 % R’000 R’000 % R’000 R’000 as % of fnal as % of fnal appropriation appropriation (41) Variance Expenditure Variance Expenditure ------41 Actual Actual Expenditure Expenditure - - - - - 146 (146) Appropriation Appropriation Virement Final Virement Final 2019/20 2019/20 - - (2,953) 10,105 - 10,038 894 67 840 99.3% 54 10,832 94.0% 9,965 1,477 1,219 - (2,953) - - 9,211 - - 9,198 13 99.9% 9,355 8,746 Funds Funds Shifting of Shifting of ------894 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 14,831 14,831 - - - - 14,831 14,831 7,798 7,798 7,033 7,033 52.6% 52.6% 5,111 5,111 4,281 4,281 13,058 12,164 207,213 - 321,397 27,492 - 234,705 235,607 - (902) 321,397 100.4% 320,088 186,633 1,309 205,037 99.6% 311,595 294,286 321,397 - - 321,397 319,942 1,455 99.5% 311,224 293,806 1,754,939 1,547,726 - (72,024) - (99,516) 1,682,915 1,686,756 1,448,210 (3,841) 1,451,108 (2,898) 100.2% 100.2% 1,582,177 1,590,243 1,395,544 1,385,176 Adjusted Adjusted Appropriation Appropriation Compensation of employees Interest and rent on land and subsidies Transfers Economic classifcation Current payments Goods and services Departmental agencies and accounts Non-proft institutions 2.5 HIV/ AIDS 2.5 HIV/ 2.6 Nutrition Households Payments for capital assets Machinery and equipment Economic classifcation Current payments Compensation of employees Goods and services Transfers and subsidies Transfers Households
231 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Actual expenditure - 145 2018/19 Final Appropriation - % R’000 R’000 as % of fnal appropriation - 100.0% 2,689,517 2,684,604 8 94.5% 2 2 194 100.0% 100.0% 147 3,912 3,912 3,860 3,860 Variance Expenditure Actual Expenditure - 121 (121) 145 137 Appropriation 2019/20 Virement Final Funds Shifting of - - - 145 - - R’000 R’000 R’000 R’000 R’000 R’000 3,137 - 3,042 6,179 7,728 (1,549) 125.1% 1,788 10,985 3,282 - 3,042 6,324 7,865 (1,541) 124.4% 1,982 11,132 12,591 - (831) 11,760 11,758 12,591 - (831) 11,760 11,758 614,024 - 73,788 687,812 691,073 (3,261) 100.5% 628,875 637,904 3,536,586 - 35,084 3,571,670 3,575,052 (3,382) 100.1% 3,318,392 3,322,653 Adjusted Appropriation Households Machinery and equipment Departmental agencies and accounts Interest and rent on land Goods and services Compensation of employees 2,922,562 - (38,704) 2,883,858 2,883,858 Payments for capital assets Transfers and subsidies Transfers Economic classifcation Current payments 2.7 District Hospitals
232 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - 6 Actual expenditure - - 25 18 31 10 2018/19 101 94 Final Appropriation - - 419 % R’000 R’000 100.0% 45,659 47,828 100.0% 356,220 357,395 100.0% 291,058 291,774 as % of fnal appropriation 1 4 1 Variance Expenditure - - 6 3 66.7% Actual Expenditure - - (80) 80 9 Appropriation Virement Final 2019/20 Funds Shifting of - - - 9 - - 97 (97) - 15 109 130 254 334 (80) 131.5% 747 232 - 979 979 - 100.0% 222 - 977 1,199 1,199 - 100.0% R’000 R’000 R’000 R’000 R’000 R’000 1,569 (200) 338 1,707 1,707 - 100.0% 1,327 100 12,719 14,146 14,151 (5) 100.0% 1,067 1,308 49,285 (101) (8,814) 40,370 40,370 - 100.0% 39,813 39,764 70,909 - 11,294 82,203 82,203 - 100.0% 60,588 60,035 15,642 - (6,758) 8,884 8,884 - 100.0% 7,202 6,017 47,985 3,510 - 51,495 51,494 405,386 - 4,792 410,178 410,174 421,028 - 382,961 (1,966) 312,052 419,062 - - (3,340) 419,058 (14,634) 379,621 4 297,418 379,620 297,417 100.0% 1 363,422 100.0% 363,412 351,646 351,809 264,067 (3,510) (14,634) 245,923 245,923 - 100.0% 245,399 243,946 Adjusted Appropriation Inventory: Other supplies Consumable supplies Catering: Departmental activities Communication Fleet services Inventory: Medical supplies Contractors Minor assets Administrative fees Salaries and wages Social contributions Emergency Transport Emergency Goods and services Compensation of employees Sub programme 1. 2. Transport Planned Patient for sub programmes Total Economic classifcation Current payments Programme 3: EMERGENCy MEDICAL SERVICES MEDICAL Programme 3: EMERGENCy
233 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------1,165 - 1,034 - - - - 1,034 - 1,034 - - 131 131 261 222 299 241 647 697 599 410 - - - - - 99.9% 99.7% 99.7% 1 1 1 1 ------46 - 100.0% - - - - 1 46 ------381 381 381 - 100.0% 9 - (8) 60 (60) - 807 - 62 869 866 3 99.7% 500 - - 500 498 2 99.6% 155 149 140 (103) 1,303 - 1,598 1,598 - 100.0% 500 - - 500 498 2 99.6% 290 50 - 340 340 - 100.0% 984 (210) 293 1,067 1,066 500 - - 500 498 2 99.6% 307 307 - - 62 62 369 369 368 368 5,091 (3,054) - 2,037 2,037 - 100.0% 15,991 140 3,975 20,106 20,106 - 100.0% 17,928 17,672 37,260 37,260 32,169 - 3,054 - 1,312 1,312 1,312 38,572 36,535 38,572 38,572 36,535 38,572 - - - 100.0% 100.0% 100.0% 11,776 11,177 11,776 10,438 10,028 10,438 421,028 - (1,966) 419,062 419,058 4 100.0% 363,422 363,412 Provincial Revenue Funds Rental and hiring Interest Travel and subsistence Travel and development Training Operating payments and facilities Venues Transport provided: Transport Departmental activity Provinces Operating leases Property payments Consumable: Stationery, Consumable: Stationery, printing and offce supplies Social benefts Transport equipment Transport Other machinery and equipment Interest and rent on land Provinces and municipalities Total Households Machinery and equipment Transfers and subsidies Transfers Payments for capital assets
234 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - 131 R’000 Actual Actual expenditure expenditure - - - 1,165 - 1,034 - 2018/19 2018/19 R’000 Final Final Final Appropriation Appropriation % R’000 R’000 % 99.7% 100.0% 291,058 291,774 100.0% 100.0% 100.0% 7,202 6,017 100.0% 7,202 6,017 as % of fnal appropriation as % of fnal appropriation - 100.0% 60,588 60,035 - 100.0% 4,574 4,421 - 100.0% 4,574 4,421 1 100.0% 351,646 351,809 1 3 99.7% 2 99.6% 1 R’000 Variance Expenditure Variance Expenditure 866 498 368 R’000 Actual Actual Expenditure Expenditure 869 500 369 Appropriation Appropriation - 62 62 2019/20 2019/20 Virement Final Virement Final - (7,821) 1,179 1,179 - - (7,821) 1,179 1,179 - - 1,063 7,705 7,705 - - 1,063 7,705 7,705 - - 4,481 378,442 378,441 - (14,634) 297,418 297,417 - 19,115 81,024 81,024 - - - - 249 30,867 30,867 - 249 30,867 30,867 Funds Shifting of Funds Shifting of 807 500 307 R’000 R’000 R’000 R’000 R’000 R’000 9,000 9,000 6,642 6,642 R’000 R’000 R’000 R’000 61,909 30,618 30,618 373,961 Adjusted Adjusted Appropriation Appropriation Compensation of employees 312,052 Goods and services Provinces and municipalities Goods and services Households Machinery and equipment Machinery and equipment Economic classifcation Current payments 3.2 Planned Patient Transport Economic classifcation 3.1 Emergency Transport Current payments Transfers and subsidies Transfers Payments for capital assets Payments for capital assets
235 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - 9 57 Actual expenditure - - 5 15 19 2018/19 133 R’000 R’000 Final Appropriation - - - - % 99.2% 100.0% 44,054 43,857 100.0% 10,527 9,686 100.0% 44,298 44,059 as % of fnal appropriation 1 1 1 1 Variance Expenditure ------Actual Expenditure - - - - 95 90 5 94.7% Appropriation Virement Final 2019/20 - (36,436) 139,298 139,185 113 99.9% 196,817 182,362 18 - 132 131 Funds Shifting of ------75 20 - 10 (10) - 114 114 R’000 R’000 R’000 R’000 R’000 R’000 8,415 1,753 - 10,168 10,167 2,621 927 - 3,548 3,548 - 100.0% 3,120 2,874 1,401 (1,401) - 8,002 1,713 - 9,715 9,716 (1) 100.0% 8,134 8,296 46,521 - 2,051 48,572 48,571 42,924 3,357 (2,221) 44,060 44,060 - 100.0% 40,140 39,463 46,731 561 12,986 60,278 60,277 12,026 (260) - 11,766 11,766 - 100.0% 16,917 17,634 993,600 (3,441) (38,732) 951,427 951,345 82 100.0% 915,478 916,819 126,552 3,441 - 129,993 129,981 12 100.0% 120,011 118,671 318,471 - 24,845 343,316 343,475 (159) 100.0% 327,056 327,032 1,438,623 1,120,152 - (13,887) - (38,732) 1,424,736 1,081,420 1,424,803 1,081,326 (67) 94 100.0% 100.0% 1,362,545 1,035,489 1,362,563 1,035,490 1,222,422 175,734 9 - 1,444,677 24,491 1,246,913 - 1,247,026 (9,894) (113) 1,434,783 1,434,782 100.0% 1 1,127,902 1,142,554 100.0% 1,368,773 1,368,773 Adjusted Appropriation Economic classifcation Current payments Compensation of employees Salaries and wages Programme 4: PROVINCIAL HOSPITAL SERVICES HOSPITAL Programme 4: PROVINCIAL 2. Tuberculosis Hospitals Tuberculosis 2. Sub programme 1. General (Regional) Hospitals 3. Psychiatric/ Mental Hospitals for sub programmes Total Social contributions Administrative fees Goods and services Minor assets Catering: Departmental activities Communication Computer services Consultants: Business and advisory services Laboratory services Contractors Agency and support / outsourced services Fleet services Inventory: Clothing material and supplies Inventory: Farming supplies
236 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - 69 41 41 20 20 10 10 10 ------81 101 104 107 107 - 1,128 - 1,060 ------2 (2) 2 (2) - - - - 33 33 - 100.0% ------33 89 57 - 146 147 (1) 100.7% 159 18 - 177 177 - 100.0% 105 - - 105 37 68 35.2% 105 - - 105 37 68 35.2% 335 601 224 1,160 1,160 - 100.0% 9,921 (316) - 9,605 9,605 - 100.0% 5,617 7,740 2,362 162 - 2,524 2,525 (1) 100.0% 1,483 1,238 1,819 (535) - 1,284 1,284 - 100.0% 5,799 4,982 2,629 508 - 3,137 3,137 - 100.0% 2,328 2,516 2,263 (21) - 2,242 2,242 - 100.0% 2,120 2,074 3,137 - 3,782 6,919 6,851 68 99.0% 6,228 6,200 3,032 - 3,782 6,814 6,814 - 100.0% 6,121 6,180 3,032 - 3,749 6,781 6,781 - 100.0% 6,121 6,180 2,917 2,917 - - 211 211 3,128 3,128 3,128 3,128 - - 100.0% 100.0% 2,582 (601) (13) 1,968 1,968 - 100.0% 23,873 (1,341) - 22,532 22,532 - 100.0% 22,434 18,890 91,846 (4,656) 5,290 92,480 92,644 (164) 100.2% 75,215 80,429 32,238 77 9,999 42,314 42,314 - 100.0% 64,041 66,478 28,953 (631) (1,209) 27,113 27,113 - 100.0% 22,338 20,437 1,444,677 - (9,894) 1,434,783 1,434,782 1 100.0% 1,368,773 1,368,773 Inventory: Food and food supplies Inventory: Fuel, oil and gas Inventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing Consumable: Stationery, and offce supplies Operating leases Property payments Transport provided: Departmental Transport activity Travel and subsistence Travel Training and development Training Operating payments Interest and rent on land Interest Transfers and subsidies Transfers Departmental agencies and accounts Departmental agencies Households Social benefts Other transfers to households Payments for capital assets Machinery and equipment equipment Transport Other machinery and equipment Total
237 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - 12 41 Actual expenditure - - - 2018/19 71 Final Appropriation - % R’000 R’000 as % of fnal appropriation Variance Expenditure Actual Expenditure - 2 (2) 67 29 38 43.3% Appropriation Virement Final - 20,539 1,238,108 1,238,259 (151) 100.0% 1,122,158 1,136,956 - 247 2,474 2,474 - 100.0% - 3,705 - 247 6,264 6,264 2,474 2,474 - 100.0% - 100.0% 5,673 5,586 - (9,946) 967,419 967,407 12 100.0% 900,857 901,141 - 3,705 6,331 6,293 38 99.4% 5,744 5,598 - - - - 30,485 270,689 - 270,850 (161) 100.1% 221,301 235,774 2019/20 Funds Shifting of - 67 R’000 R’000 R’000 R’000 R’000 R’000 2,227 2,227 2,559 2,626 977,365 240,204 1,217,569 Adjusted Appropriation Compensation of employees Machinery and equipment Households Departmental agencies and accounts Goods and services Interest and rent on land Current payments Economic classifcation 4.1 General (Regional) Hospitals Payments for capital assets Transfers and subsidies Transfers
238 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 8 10 10 Actual expenditure - - 2018/19 36 Final Appropriation % R’000 R’000 100.0% 61,701 47,401 as % of fnal appropriation 1 Variance Expenditure ture Actual Expendi- 38 8 30 21.1% 654 654 - 100.0% 654 654 - 100.0% Appropriation Virement Final - (36) - (36) - 77 550 550 - 100.0% 448 594 - (36,477) 138,056 137,973 83 99.9% 196,333 181,750 - (7,691) 24,055 24,054 - (28,786) 114,001 - 113,919 - 77 82 - 588 99.9% 558 134,632 134,349 30 94.9% 484 602 2019/20 Funds Shifting of 38 511 511 690 690 473 R’000 R’000 R’000 R’000 R’000 R’000 31,746 174,533 142,787 Adjusted Appropriation Current payments Machinery and equipment 4.2 Tuberculosis Hospitals 4.2 Tuberculosis Payments for capital assets Economic classifcation Compensation of employees Households Goods and services and subsidies Transfers Departmental agencies and accounts
239 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 6 Actual Actual expenditure expenditure 2018/19 10 2018/19 226 130 R’000 R’000 Final Final Appropriation Appropriation % R’000 R’000 % 100.0% 44,054 43,857 100.0% 9,621 11,622 as % of fnal appropriation as % of fnal appropriation 1 1 100.0% 44,054 43,857 1 Variance Expenditure Variance Expenditure 9 - 100.0% 85 80 51.5% Actual Actual Expenditure Expenditure 9 Appropriation Appropriation - 2019/20 Virement Final 2019/20 Virement Final - 15,455 387,211 386,999 212 99.9% 370,581 370,561 - - (8,154) (23,609) 1,263,033 875,822 1,261,812 1,221 874,785 1,037 99.9% 99.9% 1,189,923 1,189,766 819,342 819,077 - - 1,303,516 1,302,292 1,224 99.9% 1,224,452 1,222,888 - - 1,303,516 1,302,292 1,224 99.9% 1,224,452 1,222,888 4 - 2,051 48,572 48,571 - 2,051 48,572 48,571 Funds Shifting of Funds Shifting of 5 181 (16) - 165 R’000 R’000 R’000 R’000 R’000 R’000 10,665 (9) 1,380 12,036 12,035 96,708 1,923 - 98,631 98,631 - 100.0% 91,640 89,604 371,756 802,723 (1,923) (23,609) 777,191 776,154 1,037 99.9% 727,702 729,473 1,271,187 1,303,516 1,303,516 R’000 R’000 R’000 R’000 R’000 R’000 Adjusted 46,521 46,521 Appropriation Adjusted Appropriation Catering: Departmental activities Minor assets Administrative fees Social contributions Salaries and wages Provincial Tertiary Hospital Tertiary Provincial Services Goods and services Goods and services Compensation of employees 899,431 Economic classifcation Current payments Economic classifcation Current payments 4.3 Psychiatric/ Mental Hospitals SERVICES HOSPITAL Programme 5: CENTRAL Total for sub programmes Total Sub programme 1.
240 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - 128 - 128 50 46 73 167 97 608 531 - - - - 1,419 - 13,000 93.8% 99.8% 1,207 742 99.9% 1,669 1,401 100.0% 14,377 13,717 100.0% 16,915 18,103 100.0% 107,089 121,001 100.0% 44,845 40,008 100.0% 3,153 3,014 1 1 1 1 1 1 1 1 ------28 (28) 28 (28) 15 - - - - - 16 - 627 624 3 99.5% - - - - - 687 1,687 1,686 1 99.9% 2,484 2,484 ------44 - - - - - 70 30 - 100 100 - 100.0% 100 (84) - 583 908 (294) - 614 613 1,000 1,218 381 - 1,599 1,598 3,823 (277) - 3,546 3,546 - 100.0% 4,176 3,303 7,146 288 - 7,434 7,434 - 100.0% 3,999 4,897 3,362 (196) - 3,166 3,165 40,635 4,085 - 44,720 44,720 - 100.0% 33,402 32,813 12,869 926 - 13,795 13,794 47,549 (7,000) 20,585 61,134 61,190 (56) 100.1% 57,638 61,730 26,167 (4,052) - 22,115 22,114 46,706 10,594 (7,069) 50,231 50,230 53,654 (17,063) (284) 36,307 36,131 176 99.5% 56,937 57,400 116,115 116,115 12,639 843 129,597 129,596 Interest Operating payments Transport provided: Transport Departmental activity Travel and subsistence Travel Property payments Operating leases Inventory: Fuel, oil and gas and oil Inventory: Fuel, Inventory: Other supplies Consumable: Stationery, printing and offce supplies Fleet services Inventory: Food and food supplies Inventory: Materials and supplies Inventory: Medicine Consumable supplies Agency and support / outsourced services Inventory: Medical supplies Contractors Laboratory services Communication Interest and rent on land Transfers and subsidies Transfers
241 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 8 8 60 60 47 47 18.0% 18.0% 41 41 9 9 60 - 100.0% 50 60 50 - - 1,303,516 1,302,292 1,224 99.9% 1,224,452 1,222,888 - 7,467 38,796 38,794 2 100.0% 32,045 30,638 - 7,467 38,796 38,794 2 100.0% 32,045 30,638 - 7,467 38,796 38,794 2 100.0% 32,045 30,638 - - - - - 687 1,637 1,677 (40) 102.4% 2,437 2,476 50 66 (66) 60 50 884 66 627 1,577 1,617 (40) 102.5% 2,377 2,416 950 31,329 31,329 31,329 1,303,516 Other machinery and equipment Other transfers to households Departmental agencies Social benefts Total Machinery and equipment Departmental agencies and accounts Households Payments for capital assets
242 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 8 Actual expenditure - 128 2018/19 47 Final Appropriation - % R’000 R’000 18.0% as % of fnal appropriation 1 99.9% 2,484 2 2 100.0% 2,484 100.0% 32,045 32,045 30,638 30,638 41 Variance Expenditure 9 28 (28) Actual Expenditure - 50 Appropriation 2019/20 Virement Final Funds Shifting of - - - 50 - - 950 - 687 1,637 1,677 (40) 102.4% 2,437 2,476 R’000 R’000 R’000 R’000 R’000 R’000 1,000 - 687 1,687 1,686 31,329 - 7,467 38,796 38,794 371,756 - 15,455 387,211 386,999 212 99.9% 370,581 370,561 1,271,187 - (8,154) 1,263,033 1,261,812 1,221 99.9% 1,189,923 1,189,766 Adjusted Appropriation Compensation of employeesGoods and services Interest and rent on land 899,431 - Departmental agencies and accounts (23,609)Households 875,822 874,785 Machinery and equipment 1,037 99.9% 819,342 819,077 Transfers and subsidies Transfers Payments for capital assets 31,329 - 7,467 38,796 38,794 Economic classifcation Current payments 5.1 Provincial Tertiary Hospital Services 5.1 Provincial Tertiary
243 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - Actual expenditure - 2018/19 193 215 91 230 454 695 113 586 Final Appropriation - 200 133 % R’000 R’000 as % of fnal appropriation Variance Expenditure - - 60 - 100.0% Actual Expenditure - 60 412 684 242 684 170 - 58.7% 100.0% Appropriation Virement Final 2019/20 Funds Shifting of - 60 - - - - 240 (8) 493 725 685 40 94.5% 370 645 162 49 281 - (7) (242) - 162 102 60 63.0% R’000 R’000 R’000 R’000 R’000 R’000 3,707 8,593 - - - (5,230) 3,707 3,363 3,845 3,363 (138) - 103.7% 100.0% 4,559 5,374 4,287 5,376 26,567 61,262 3,422 (5,590) - (1,394) 24,399 59,868 24,272 127 58,818 1,050 99.5% 98.2% 22,463 52,393 21,080 54,510 57,528 - (10,314) 47,214 46,698 516 98.9% 61,685 60,397 160,625 425,198 - - 335,558 10,853 274,296 (10,555) 247,729 171,478 - 414,643 (3,422) - 171,795 (9,492) 414,548 (2,508) (8,098) (317) 326,066 241,799 95 266,198 100.2% 325,642 242,552 266,824 100.0% 424 144,945 (753) (626) 365,839 144,537 99.9% 100.3% 365,838 100.2% 286,380 211,524 233,987 288,557 212,967 234,047 Adjusted Appropriation Nurse Training CollegesTraining Nurse 194,745 Primary Health Care - (5,864) 188,881 188,847 34 100.0% 149,276 151,241 Consultants: Business and advisory services Communication Computer services Programme 6: HEALTH SCIENCES AND TRAINING SCIENCES Programme 6: HEALTH Minor assets Catering: Departmental activities Total for sub programmes Total Economic classifcation Current payments Compensation of employees Salaries and wages Social contributions Goods and services Administrative fees 3. Bursaries 5. Other Training Sub programme 1. 2. Colleges Training EMS 4. Training
244 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - 79 - 24 791 27 134 30 32 32 141 278 213 429 274 225 191 - 1,018 1,010 - 100 - - - 195 - 93.2% 99.9% 100.0% 8,748 8,622 100.0% 9,766 9,632 1 4 1 1 ------55 10 - 100.0% ------59 10 495 489 6 98.8% - 1,479 777 702 52.5% 1,701 1,475 - 888 887 - 150 150 - 100.0% ------59 - - 67 - (57) 16 (16) 798 (265) (38) 304 - - 304 334 (30) 109.9% 160 (10) 4,756 - (1,094) 3,662 3,661 4,756 4,756 - - (1,094) (1,094) 3,662 3,662 3,661 3,661 1 100.0% 9,766 9,632 1,806 (327) 3,217 (2,329) 2,551 2,006 772 948 17 (85) 3,340 2,869 3,448 2,966 (108) (97) 103.2% 103.4% 2,590 1,062 2,829 815 1,166 - 569 1,735 1,735 - 100.0% 1,216 1,219 84,884 32,743 32,743 - 52,141 - 51,837 - 31 9,281 - 9,281 - (9,250) 84,915 42,024 (9,250) 42,024 85,245 42,891 42,758 (330) 42,758 42,587 (734) 42,487 (734) 42,153 404 100.4% 101.7% 434 101.7% 69,693 14,001 99.1% 14,001 67,649 99.0% 14,001 55,692 14,001 55,668 53,648 52,857 27,972 1,174 (1,128) 28,018 27,746 272 99.0% 25,366 26,759 20,027 (329) (916) 18,782 18,782 - 100.0% 17,244 19,337 425,198 - (10,555) 414,643 414,548 95 100.0% 365,839 365,838 Total Other machinery and equipment Machinery and equipment Venues and facilities Venues and subsidies Transfers Departmental agencies and accounts Departmental agencies Households Social benefts Other transfers to households Payments for capital assets equipment Transport Operating payments Travel and subsistence Travel and development Training Property payments Consumable: Stationery, printing Consumable: Stationery, and offce supplies Operating leases Inventory: Other supplies Consumable supplies Inventory: Medical supplies Inventory: Learner and teacher support material Inventory: Clothing material and supplies Agency and support / outsourced services Fleet services Inventory: Fuel, oil and gas Contractors
245 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Actual expenditure 2018/19 24 108 24 108 Final Appropriation % R’000 R’000 99.7% as % of fnal appropriation - 100.0% 113,724 113,349 2 100.0% 147,740 1 149,574 2 100.0% 1 34,016 99.7% 36,225 31 31 98.2% 98.2% 1,512 1,512 1,559 1,559 Variance Expenditure Actual Expenditure tion Appropria- - 304 303 - 304 303 2019/20 Virement Final - - (1,353) (1,353) 1,759 1,759 1,728 1,728 - (4,511) 186,818 - 186,816 - (5,590) 141,248 141,248 - - 1,079 45,570 45,568 Funds Shifting of 304 304 R’000 R’000 R’000 R’000 R’000 R’000 3,112 3,112 44,491 tion 191,329 Adjusted Appropria- Payments for capital assets 3,112 Machinery and equipment Current payments Compensation of employees 146,838 Households Economic classifcation Goods and services and subsidies Transfers 6.1 Nurse Training Colleges 6.1 Nurse Training
246 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 33 33 Actual Actual expenditure expenditure - - 2018/19 2018/19 Final Final Appropriation Appropriation - - % R’000 R’000 % R’000 R’000 as % of fnal as % of fnal appropriation appropriation - - Variance Expenditure Variance Expenditure - - Actual Expenditure Actual Expenditure - - Appropriation Appropriation - 1,573 1,664 (91) 105.8% 1,458 1,443 Virement Final 2019/20 2019/20 Virement Final ------3,707 2,679 1,028 3,845 3,409 436 (138) (730) 103.7% 592 127.2% 42.4% 4,559 4,336 4,254 223 4,137 117 Funds Shifting of Funds Shifting of R’000 R’000 R’000 R’000 R’000 R’000 4,118 4,118 - (1,064) 3,054 2,881 173 94.3% 4,559 6,097 1,573 - 5,691 - (1,064) 4,627 4,545 82 98.2% 6,017 7,540 - - 51,837 - (9,250) 42,587 42,153 434 99.0% 55,668 52,857 51,837 - (9,250) 42,587 42,153 434 99.0% 55,668 52,857 R’000 R’000 R’000 R’000 R’000 R’000 3,707 1,028 Adjusted Appropriation Adjusted Appropriation Households Goods and services Compensation of employees Transfers and subsidies Transfers Households Compensation of employeesGoods and services and subsidies Transfers 2,679 Current payments Economic classifcation Economic classifcation Current payments 6.2 EMS Training Colleges 6.2 EMS Training 6.3 Bursaries
247 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 36 36 834 R’000 Actual expenditure - - 2018/19 966 R’000 Final Appropriation - - % as % of fnal appropriation - 100.0% 5,374 5,340 - - Variance Expenditure - - R’000 R’000 Actual Expenditure - - 837 1,030 (193) 123.1% R’000 Appropriation - - - R’000 2019/20 Virement Final - (5,230) 3,363 3,363 - - - - (5,230) 2,526 2,333 193 92.4% 4,408 4,506 Funds Shifting of - - 837 R’000 R’000 8,593 7,756 Adjusted Appropriation Households Goods and services Compensation of employees Economic classifcation Current payments 6.4 Primary Health Care Training Transfers and subsidies Transfers
248 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 614 R’000 Actual expenditure - 2018/19 R’000 Final Appropriation - % as % of fnal appropriation Variance Expenditure 31 (31) R’000 R’000 Actual Expenditure - R’000 Appropriation - Virement Final 2019/20 - 2,722 118,172 118,170 2 100.0% 110,061 110,612 - 1,313 127,551 127,073 478 99.6% 122,690 121,849 - (1,409) - - 9,281 9,379 9,281 42,024 8,903 42,024 476 42,789 42,758 (765) 94.9% (734) 101.8% 12,629 101.7% 14,001 11,237 14,001 14,615 14,001 - - 259 1,903 1,933 (30) 101.6% 8,254 8,073 - 259 1,903 1,933 (30) 101.6% 8,254 8,073 R’000 R’000 Funds Shifting of - R’000 1,644 1,644 10,788 32,743 32,743 115,450 115,450 126,238 Adjusted Appropriation Compensation of employees Goods and services Departmental agencies and accounts Households Machinery and equipment 6.5 Training Other 6.5 Training Economic classifcation Current payments Transfers and subsidies Transfers Payments for capital assets
249 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - 103 R’000 Actual expenditure 9 2018/19 186 363 908 1,083 R’000 Final Appropriation - % as % of fnal appropriation Variance Expenditure - - 190 8,211 2.3% 146 (29) 124.8% R’000 R’000 Actual Expenditure - 117 117 R’000 Appropriation Virement Final 2019/20 - (30,975) 89,904 64,292 25,612 71.5% 33,292 36,519 - - (860) - (33,529) (20,900) 5,903 61,112 - 240,512 - (35,881) 42,558 5,448 220,316 (4,906) 18,554 213,692 20,196 455 123,788 69.6% 187,831 91.6% 92.3% 123,516 25,861 14,468 157,928 4,500 272 87.9% 17,932 157,928 99.8% 4,191 151,084 117,792 155,390 118,871 - - 889 - 11,038 1,562 41,791 37,148 94,558 41,284 36,484 94,542 507 664 16 98.8% 98.2% 100.0% 31,028 23,335 84,597 30,878 18,477 86,450 - - Funds Shifting of - 117 - - R’000 R’000 R’000 8,328 (39) 112 8,401 6,763 1,014 (15) 182 1,181 1,053 128 89.2% 26,110 26,110 15,265 1,232 (271) 16,226 16,226 - 100.0% 15,375 15,494 94,641 40,902 92,996 113,429 113,429 (1,232) (4,635) 107,562 107,290 272 99.7% 102,417 103,377 120,879 261,412 249,573 128,694 Adjusted Appropriation Orthotic and Prosthetic Services Laundries Social contributions Salaries and wages Goods and services Administrative fees 4. Minor assets 5. for sub programmes Total Account Trading Medicine Economic classifcation Current payments Compensation of employees Sub programme 1. 2. 3. Engineering Forensic Services Programme 7: HEALTH CARE SUPPORT SERVICES Programme 7: HEALTH Catering: Departmental activities Communication
250 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------7 73 116 116 115 115 115 115 115 115 148 100 - - - - - 22 149 202 131 602 1,258 155 210 254 254 254 - - 2,784 - - - 100.0% 1 10 81.5% - - - - 44 23 (23) 23 (23) 49 18 73.1% 49 18 73.1% 49 18 73.1% 543 - 100.0% 391 73 84.3% 205 - 100.0% 139 - 100.0% - - - - - 5,683 (5,683) 54 67 67 67 543 464 205 139 - 5,685 5,192 493 91.3% 5,538 1,887 - 9,066 7,377 1,689 81.4% 6,480 10,838 - - 1,922 1,829 93 95.2% 1,385 2,101 - 1,334 1,078 256 80.8% - - - - - 139 ------14,028 - 21,985 21,986 (1) 100.0% 6,590 2,423 - - - 953 4,768 4,767 - (20,900) 240,512 220,316 20,196 91.6% 157,928 157,928 - - - 14,981 26,753 26,753 - 100.0% 6,590 2,423 - - - 14,981 26,753 26,753 - 100.0% 6,590 2,423 - - - - - 89 116 - 37 17 - 67 67 67 543 161 216 87 6,064 (379) 5,557 (135) 768 6,190 6,190 - 100.0% 3,979 5,695 2,050 (2,050) 2,070 (148) 1,412 (78) 2,705 246 1,138 4,089 3,452 637 84.4% 3,548 2,858 7,957 3,815 11,772 11,772 11,772 11,772 23,741 (14,675) 50,968 14,000 (33,529) 31,439 19,394 12,045 61.7% 16,140 2,807 128 19,075 17,069 2,006 89.5% 6,641 10,252 261,412 Contractors Fleet services Inventory: Fuel, oil and gas Agency and support / outsourced services Inventory: Medical supplies Inventory: Medicine Inventory: Other supplies Consumable supplies Consumable: Stationery, printing and offce Consumable: Stationery, supplies Operating leases Property payments Transport provided: Departmental activity Transport and subsistence Travel Operating payments Venues and facilities Venues Interest and rent on land Interest Payments for fnancial assets Transfers and subsidies Transfers Other machinery and equipment Households Transport equipment Transport Total Social benefts Machinery and equipment Payments for capital assets
251 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 57 57 R’000 Actual expenditure 2018/19 195 195 R’000 Final Appropriation % 96.7% as % of fnal appropriation - - 100.0% 100.0% 3,187 3,187 3,186 3,186 1 1 96.7% 506 215 291 98.6% 98.8% 98.2% 27,646 17,281 10,365 27,635 17,888 9,747 R’000 Variance Expenditure 29 29 R’000 Actual Expenditure 30 30 Appropriation - - - 35,133 18,646 16,487 34,627 18,431 16,196 26 26 2019/20 Virement Final - 863 6,628 6,628 - 863 6,628 6,628 - - - - - Funds Shifting of 4 4 R’000 R’000 R’000 R’000 5,765 5,765 35,133 18,646 16,487 Adjusted Appropriation
Machinery and equipment Compensation of employees Goods and services Households 7.1 Laundries Economic classifcation Current payments Payments for capital assets Transfers and subsidies Transfers
252 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - R’000 Actual expenditure - 2018/19 R’000 Final Appropriation - % as % of fnal appropriation - 100.0% 13,966 14,069 - - 100.0% 100.0% 2,278 2,278 (1,893) (1,893) Variance Expenditure 23 (23) R’000 R’000 Actual Expenditure - R’000 Appropriation - - 8,514 7,827 687 91.9% 7,091 6,301 Virement Final 2019/20 - - - (2,024) - (2,024) 22,159 13,645 21,495 13,645 664 97.0% 21,057 20,370 - - 13,062 13,062 14,989 14,989 14,989 14,989 R’000 R’000 Funds Shifting of - R’000 8,514 1,927 1,927 24,183 15,669 Adjusted Appropriation Compensation of employees Goods and services Machinery and equipment Economic classifcation 7.2 Engineering Current payments Interest and rent on land Payments for capital assets
253 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 58 58 58 58
Actual expenditure 59 59 59 59 2018/19
R’000 R’000 1,125 1,125 1,130 1,125 1,125 1,130 83,413 83,413 72,577 85,262 10,836 73,036 12,226 Final Appropriation
% 54.1% 54.1% 100.0% 100.0% 100.0% Expenditure as % of fnal fnal of % as appropriation (2) 100.0% (2) 100.0% Variance 20 20 17 20 20 17
Actual Expenditure 37 37 37 37
R’000 R’000 R’000 4,881 4,881 4,880 1 4,881 4,881 4,880 1 76,392 76,392 76,392 - Final Appropriation (26) (26) (1,919) 2019/20 Virement - - 635 - 89,640 2,554 - 89,642 13,248 13,250 - - 953 - 953 Shifting Shifting of Funds 63 63 63 63
R’000 R’000 R’000 3,928 3,928 3,928 3,928 78,311 78,311 89,005 89,005 10,694 Adjusted Appropriation Compensation of of Compensation employees Goods and services Households Machinery and equipment 7.3 Forensic Services Economic classifcation Current payments Transfers and subsidies Payments for capital capital for Payments assets
254 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - - - R’000 R’000 Actual Actual expenditure expenditure - - - - - 2018/19 2018/19 R’000 R’000 Final Final Appropriation Appropriation - % % as % of fnal as % of fnal appropriation appropriation - 100.0% 1,005 1,020 - 100.0% - 100.0% (1) 101.0% (1) 101.0% 57 99.6% 12,963 12,858 456 92.1% 4,500 4,191 456 90.3% 3,495 3,171 R’000 R’000 Variance Expenditure Variance Expenditure 104 104 152 152 R’000 R’000 Actual Actual Expenditure Expenditure - 5,683 (5,683) 103 103 152 152 R’000 1,118 1,118 1,118 R’000 Appropriation Appropriation - 4,682 4,226 - 13,987 13,930 - - - R’000 2019/20 2019/20 Virement Final Virement Final - (963) 5,800 5,344 - 103 - - (963) - 103 - (33,529) 60,960 36,723 24,237 60.2% 14,468 17,932 - - (33,529) 46,973 22,793 24,180 48.5% 1,505 5,074 - - - Funds Funds Shifting of Shifting of - - - 152 152 R’000 R’000 R’000 6,763 2,081 4,682 R’000 R’000 94,489 13,987 80,502 Adjusted Adjusted Appropriation Appropriation Economic classifcation Economic classifcation 7.4 Orthotic and Prosthetic Services Account 7.5 Medicine Trading Current payments Machinery and equipment Compensation of employees Goods and services Payments for capital assets Current payments Compensation of employees Goods and services Payments for capital assets Machinery and equipment Payments for fnancial assets
255 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------64 45 130 936 R’000 Actual expenditure - - - - - 2018/19 50 50 119 119 139 530 R’000 Final Appropriation - - - - - % 99.8% as % of fnal appropriation - 100.0% 19,703 18,812 - - 1 35 79.7% 37 53.8% (3) 912 99.8% 283,772 283,772 109 99.6% 795 15,189 67.6% 16,722 2,487 1,318 200 56.3% 412 258 98.3% 8,148 11,471 R’000 Variance Expenditure - - - 3 43 137 258 499 133 (133) R’000 Actual Expenditure - - - - 80 172 458 500 258 737 1,499 (762) 203.4% R’000 Appropriation - 2,450 1,655 - - - 77,971 266,944 55,632 268,431 22,339 (1,487) 71.3% 100.6% - 267,152 97,387 262,770 106,098 - - - - - 24,634 24,222 - - - - (150) 2,925 3,034 (109) 103.7% 4,514 2,090 R’000 2019/20 Virement Final - - (101,092) 2,431 421,111 29,471 424,817 29,471 (3,706) 100.9% 303,475 302,584 - (68,292) - 787,491 (68,292) 806,694 1,132,406 1,130,757 (19,203) 102.4% 1,649 953,308 99.9% 887,194 1,317,847 1,256,062 - (103,523) 391,640 390,728 ------Funds Shifting of - - 500 - - - 30 50 172 458 258 737 R’000 R’000 6,018 (2,943) 1,103 1,347 27,040 21,022 2,943 2,581 26,546 26,437 77,971 23,779 855 522,203 495,163 1,200,698 Adjusted Appropriation Community Health Facilities 855,783 Compensation of employees Programme 8: HEALTH FACILITIES MANAGEMENT FACILITIES Programme 8: HEALTH Salaries and wages Economic classifcation Current payments Administrative fees Sub programme 1. 2. District Hospital Services for sub programmes Total Social contributions Minor assets Catering: Departmental activities Goods and services 3. Provincial Hospital Services 266,944 Communication Consultants: Business and advisory services Computer services Laboratory services Contractors Agency and support / outsourced services Fleet services Inventory: Medical supplies Inventory: Other supplies
256 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - - 3 15 15 15 342 438 - - - 94 20 16 16 16 640 - - - - - 100.0% 2,568 2,567 - 100.0% 1 29 100.0% 42,407 47,295 85 85.5% 17 97.6% 471 73.7% 246 93.8% 2,778 2,000 350 350 350 426 99.5% 29,412 57,398 426 99.5% 29,412 57,398 - - - 502 696 - 4,618 (4,618) - 4,618 (4,618) 587 713 350 350 350 - - - 1,793 1,322 ------32,800 - (3,836) 710,945 (3,836) 622,910 705,940 622,910 618,331 5,005 618,331 4,579 99.3% 4,579 99.3% 1,014,356 99.3% 984,944 953,463 984,944 896,065 896,065 - - - - 36,636 88,035 87,609 - (68,292) 1,132,406 1,130,757 1,649 99.9% 1,317,847 1,256,062 7 - - 356 706 231 350 350 350 2,570 (777) 3,759 382 (201) 3,940 3,694 3,000 3,200 (252) 5,948 5,948 71,577 830 (3,510) 68,897 68,868 16,208 57 (5,221) 11,044 11,043 51,399 48,399 (3,200) 36,888 82,087 81,661 373,450 (3,482) (94,591) 275,377 276,154 (777) 100.3% 223,742 217,163 678,145 626,746 626,746 1,200,698 Consumable supplies Consumable: Stationery, printing Consumable: Stationery, and offce supplies Operating leases Property payments and subsistence Travel Training and development Training Operating payments Interest and rent on land Interest Transfers and subsidies Transfers Households Social benefts Payments for capital assets Buildings and other fxed structures Buildings Machinery and equipment Other machinery and equipment Transport equipment Transport Total
257 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 130 130 R’000 627 R’000 Actual expenditure Actual expenditure - - 2018/19 - - 2018/19 R’000 R’000 Final Final Appropriation Appropriation - - % - % as % of fnal appropriation as % of fnal appropriation Variance Expenditure Variance Expenditure 179 (179) 179 (179) R’000 R’000 R’000 R’000 4,618 (4,618) Actual Expenditure Actual Expenditure - - - Appropriation - - - - 77,971 77,971 55,453 55,453 22,518 22,518 71.1% 71.1% 97,387 97,387 105,968 105,968 Appropriation - Virement Final 2019/20 Virement Final 2019/20 ------(101,092) 200,295 224,065 (23,770) 111.9% 128,888 131,276 - 36,908 62,113 62,125 (12) 100.0% - - 2,431 (103,523) 190,239 10,056 214,442 5,005 (24,203) 5,051 112.7% 49.8% 123,192 5,696 126,044 5,232 - - 32,800 (4,108) 587,196 525,083 582,629 520,504 4,567 4,579 99.2% 99.1% 824,420 824,420 755,918 755,291 Funds Shifting of Funds Shifting of - - - R’000 R’000 R’000 R’000 77,971 77,971 R’000 R’000 R’000 R’000 7,625 25,205 301,387 293,762 554,396 Adjusted Appropriation Adjusted Appropriation Machinery and equipment Compensation of employees Goods and services Interest and rent on land Buildings and other fxed structures 529,191 Current payments Economic classifcation Goods and services Payments for capital assets Buildings and other fxed structures 8.1 Community Health Facilities Economic classifcation 8.2 District Hospital Services Current payments Payments for capital assets
258 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 15 15 R’000 Actual expenditure 2018/19 16 16 R’000 Final Appropriation - - % as % of fnal appropriation Variance Expenditure - 350 - 350 R’000 R’000 Actual Expenditure Appropriation - - - 220,816 19,415 201,401 200,573 20,243 24,466 176,107 (5,051) 25,294 90.8% 126.0% 87.4% 174,587 14,007 160,580 171,178 13,580 157,598 - 350 - - 350 45,778 67,858 (22,080) 148.2% 92,549 91,577 Virement Final 2019/20 - - - - - (272) 25,922 25,484 438 98.3% 29,412 56,771 - - - 272 19,856 42,374 (22,518) 213.4% 63,137 34,806 Funds Shifting of 350 350 R’000 R’000 R’000 R’000 19,415 26,194 45,778 19,584 220,816 201,401 Adjusted Appropriation Current payments Compensation of employees Goods and services and subsidies Transfers Economic classifcation Households Machinery and equipment Payments for capital assets Buildings and other fxed structures 8.3 Provincial Hospital Services
259 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2020
1. Detail of transfers and subsidies as per Appropriation Act (after Virement):
Detail of these transactions can be viewed in the note on Transfers and subsidies, disclosure notes and Annexure 1 (A-H) to the Annual Financial Statements.
2. Detail of specifcally and exclusively appropriated amounts voted (after Virement):
Detail of these transactions can be viewed in note 1 (Annual Appropriation) to the Annual Financial Statements.
3. Detail on payments for fnancial assets
Detail of these transactions per programme can be viewed in the note on Payments for fnancial assets to the Annual Financial Statements.
4. Explanations of material variances from Amounts Voted (after Virement): 4.1 Per programme Final Actual Variance R’000 Variance as Appropriation Expenditure a % of Final Appropriation Health Care Support Services 240,512 220,316 20,196 8.40%
The Programme underspent due to the sub programme Medicine Trading Account being used as trading account for medicine and medical supplies accounts.
4.2 Per economic classifcation Final Actual Expenditure Variance Variance as Appropriation a % of Final Appropriation R’000 R’000 R’000 R’000 Current payments Compensation of employees 8,279,833 8,279,830 3 0.00% Goods and services 4,629,111 4,607,610 21,501 0.46% Interest and rent on land - 4,885 (4,885) 0.00%
Transfers and subsidies Provinces and municipalities 1,359 1,504 (145) -10.67% Departmental agencies and accounts 42,325 42,941 (616) -1.46% Higher education institutions - - - 0.00% Public corporations and private enterprises - - - 0.00% Foreign governments and international - - - 0.00% organisations Non-proft institutions 335,188 333,431 1,757 0.52% Households 115,319 116,130 (811) -0.70%
Payments for capital assets Buildings and other fxed structures 622,910 618,331 4,579 0.74% Machinery and equipment 254,864 247,391 7,473 2.93% Heritage assets - - - 0.00% Specialised military assets - - - 0.00% Biological assets - - - 0.00% Land and subsoil assets - - - 0.00% Intangible assets - - - 0.00%
Payments for fnancial assets - 5,683 (5,683) 0.00%
The Department underspent in Goods and Services for medicine and medical supplies items. Underspending on machinery was due to late delivery of medical equipment which are imports.
260 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
4.3 Per conditional grant Final Actual Expenditure Variance Variance as Appropriation a % of Final Appropriation R’000 R’000 R’000 R’000
Community Outreach Services Component 250,397 250,336 61 0.02% HIV & AIDS Component 1,659,953 1,659,640 313 0.02% Malaria Elimination Component 27,514 27,514 - 0.00% Tuberculosis Component 60,333 60,707 (374) -0.62% Hospital Facility Revitalisation Grant 344,915 343,722 1,193 0.35% National Health Insurance Grant (Health Professional 21,136 22,368 (1,232) -5.83% Contracting Subcomponent) Health Professions Training and Development Grant 120,901 120,859 42 0.03% Human Papillomavirus Vaccine Grant 15,353 15,163 190 1.24% Human Resources Capacitation Grant 60,243 111,589 (51,346) -85.23% National Tertiary Services Grant 124,390 123,202 1,188 0.96% Expanded Public Works Programme Incentive Grant for 2,126 2,126 - 0.00% Provinces Social Sector Expanded Public Works Programme 15,464 15,102 362 2.34% Incentive Grant for Provinces
The Department overspent on Human Resource Capacitation Grant because of the segment fund being inactive as such was not made to take the overspending to equitable fund.
261 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
STATEMENT OF FINANCIAL PERFORMANCE for the year ended 31 March 2020 Note 2019/20 2018/19 R'000 R'000 REVENUE Annual appropriation 1 14,280,909 13,119,591 Statutory appropriation - - Departmental revenue 2 - - NRF Receipts - - Aid assistance - -
TOTAL REVENUE 14,280,909 13,119,591
EXPENDITURE Current expenditure Compensation of employees 3 8,279,830 7,662,953 Goods and services 4 4,607,610 3,913,891 Interest and rent on land 5 4,885 487 Aid assistance - -
Total current expenditure 12,892,325 11,577,331
Transfers and subsidies Transfers and subsidies 7 494,006 449,900 Aid assistance - -
Total transfers and subsidies 494,006 449,900
Expenditure for capital assets Tangible assets 8 865,722 1,028,712 Intangible assets - -
Total expenditure for capital assets 865,722 1,028,712
Unauthorised expenditure approved without funding 9 - -
Payments for fnancial assets 6 5,683 -
TOTAL EXPENDITURE 14,257,736 13,055,943
SURPLUS/(DEFICIT) FOR THE yEAR 23,173 63,648
Reconciliation of Net Surplus/(Defcit) for the year Voted funds 23,173 63,648 Annual appropriation 20,198 57,747 Conditional grants 2,975 5,901 Departmental revenue and NRF Receipts 13 - - Aid assistance - - SURPLUS/(DEFICIT) FOR THE yEAR 23,173 63,648
262 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Reconciliation of Net Surplus/(Defcit) for the year Voted funds 23,173 63,648 Annual appropriation 20,198 57,747 Conditional grants 2,975 5,901 Departmental revenue and NRF Receipts 13 - - Aid assistance - - SURPLUS/(DEFICIT) FOR THE yEAR 23,173 63,648
263 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
STATEMENT OF FINANCIAL POSITION as at 31 March 2020 Note 2019/20 2018/19 R’000 R’000 ASSETS
Current assets 295,226 335,352 Unauthorised expenditure 9 234,705 234,705 Cash and cash equivalents 10 35,181 73,155 Other fnancial assets - - Prepayments and advances - - Receivables 11 25,340 27,492 Loans - - Aid assistance prepayments - - Aid assistance receivable - -
Non-current assets - - Investments - - Receivables 11 - - Loans - - Other fnancial assets - -
TOTAL ASSETS 295,226 335,352
LIABILITIES
Current liabilities 292,721 332,639 Voted funds to be surrendered to the Revenue Fund 12 277,267 319,755 Departmental revenue and NRF Receipts to be surrendered to the 13 11,385 8,061 Revenue Fund Bank overdraft - - Payables 14 4,069 4,823 Aid assistance repayable - - Aid assistance unutilised - -
Non-current liabilities Payables - -
TOTAL LIABILITIES 292,721 332,639
264 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Note 2019/20 2018/19 R’000 R’000
NET ASSETS 2,505 2,713
Note 2019/20 2018/19 R’000 R’000
Represented by: Capitalisation reserve - - Recoverable revenue 2,505 2,713 Retained funds - - Revaluation reserves - -
TOTAL 2,505 2,713
265 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
STATEMENT OF CHANGES IN NET ASSETS for the year ended 31 March 2020 Note 2019/20 2018/19 R’000 R’000
Capitalisation Reserves Opening balance - - Transfers: Movement in Equity - - Movement in Operational Funds - - Other movements - - Closing balance - -
Recoverable revenue Opening balance 2,713 1,266 Transfers: -208 1,447 Irrecoverable amounts written off - - Debts revised - - Debts recovered (included in departmental receipts) 2,505 2,713 Debts raised -2,713 -1,266 Closing balance 2,505 2,713
Retained funds Opening balance - - Transfer from voted funds to be surrendered (Parliament/ - - Legislatures ONLY) Utilised during the year - - Other transfers - - Closing balance - -
Revaluation Reserve Opening balance - - Revaluation adjustment (Housing departments) - - Transfers - - Other - - Closing balance - -
TOTAL 2,505 2,713
266 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
CASH FLOW STATEMENT for the year ended 31 March 2020
Note 2019/20 2018/19 R’000 R’000 CASH FLOWS FROM OPERATING ACTIVITIES Receipts 14,360,149 13,194,198 Annual appropriated funds received 1.1 14,280,909 13,119,591 Statutory appropriated funds received - - Departmental revenue received 2 72,304 68,092 Interest received 2.2 6,936 6,515 NRF Receipts - - Aid assistance received - -
Net (increase)/decrease in working capital 1,398 -4,720 Surrendered to Revenue Fund -143,864 -154,117 Surrendered to RDP Fund/Donor - - Current payments -12,887,440 -11,577,324 Interest paid 5 -4,885 -487 Payments for fnancial assets -5,683 - Transfers and subsidies paid -494,006 -449,900 Net cash fow available from operating activities 15 825,669 1,007,650
CASH FLOWS FROM INVESTING ACTIVITIES Distribution/dividend received - - Payments for capital assets 8 -865,722 -1,028,712 Proceeds from sale of capital assets 2.3 2,767 4,138 (Increase)/decrease in loans - - (Increase)/decrease in investments - - (Increase)/decrease in other fnancial assets - - (Increase)/decrease in non-current receivables - - Net cash fows from investing activities -862,955 -1,024,574
CASH FLOWS FROM FINANCING ACTIVITIES Increase/(decrease) in net assets -208 1,447 Increase/(decrease) in non-current payables - - Net cash fows from fnancing activities -208 1,447
Net increase/(decrease) in cash and cash equivalents -37,494 -15,477 Cash and cash equivalents at beginning of period 72,675 88,152 Unrealised gains and losses within cash and cash equivalents - Cash and cash equivalents at end of period 16 35,181 72,675
267 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2020
Summary of signifcant accounting policies The fnancial statements have been prepared in accordance with the following policies, which have been applied consistently in all material aspects, unless otherwise indicated. Management has concluded that the fnancial statements present fairly the department’s primary and secondary information. The historical cost convention has been used, except where otherwise indicated. Management has used assessments and estimates in preparing the annual fnancial statements. These are based on the best information available at the time of preparation. Where appropriate and meaningful, additional information has been disclosed to enhance the usefulness of the fnancial statements and to comply with the statutory requirements of the Public Finance Management Act (PFMA), Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations issued in terms of the PFMA and the annual Division of Revenue Act. 1 Basis of preparation The fnancial statements have been prepared in accordance with the Modifed Cash Standard. 2 Going concern The fnancial statements have been prepared on a going concern basis. 3 Presentation currency Amounts have been presented in the currency of the South African Rand (R) which is also the functional currency of the department. 4 Rounding Unless otherwise stated fnancial fgures have been rounded to the nearest one thousand Rand (R’000). 5 Foreign currency translation Cash fows arising from foreign currency transactions are translated into South African Rands using the spot exchange rates prevailing at the date of payment / receipt. 6 Comparative information 6.1 Prior period comparative information Prior period comparative information has been presented in the current year’s fnancial statements. Where necessary fgures included in the prior period fnancial statements have been reclassifed to ensure that the format in which the information is presented is consistent with the format of the current year’s fnancial statements. 6.2 Current year comparison with budget A comparison between the approved, fnal budget and actual amounts for each programme and economic classifcation is included in the appropriation statement. 7 Revenue
7.1 Appropriated funds Appropriated funds comprises of departmental allocations as well as direct charges against the revenue fund (i.e. statutory appropriation). Appropriated funds are recognised in the statement of fnancial performance on the date the appropriation becomes effective. Adjustments made in terms of the adjustments budget process are recognised in the statement of fnancial performance on the date the adjustments become effective. The net amount of any appropriated funds due to / from the relevant revenue fund at the reporting date is recognised as a payable / receivable in the statement of fnancial position. 7.2 Departmental revenue Departmental revenue is recognised in the statement of fnancial performance when received and is subsequently paid into the relevant revenue fund, unless stated otherwise. Any amount owing to the relevant revenue fund at the reporting date is recognised as a payable in the statement of fnancial position.
268 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
7.3 Accrued departmental revenue Accruals in respect of departmental revenue (excluding tax revenue) are recorded in the notes to the fnancial statements when: · it is probable that the economic benefts or service potential associated with the transaction will fow to the department; and · the amount of revenue can be measured reliably. The accrued revenue is measured at the fair value of the consideration receivable. Accrued tax revenue (and related interest and / penalties) is measured at amounts receivable from collecting agents. Write-offs are made according to the department’s debt write-off policy 8 Expenditure 8.1 Compensation of employees 8.1.1 Salaries and wages Salaries and wages are recognised in the statement of fnancial performance on the date of payment. 8.1.2 Social contributions Social contributions made by the department in respect of current employees are recognised in the statement of fnancial performance on the date of payment. Social contributions made by the department in respect of ex-employees are classifed as transfers to households in the statement of fnancial performance on the date of payment. 8.2 Other expenditure Other expenditure (such as goods and services, transfers and subsidies and payments for capital assets) is recognised in the statement of fnancial performance on the date of payment. The expense is classifed as a capital expense if the total consideration paid is more than the capitalisation threshold. 8.3 Accruals and payables not recognised Accruals and payables not recognised are recorded in the notes to the fnancial statements at cost at the reporting date. 8.4 Leases 8.4.1 Operating leases Operating lease payments made during the reporting period are recognised as current expenditure in the statement of fnancial performance on the date of payment. The operating lease commitments are recorded in the notes to the fnancial statements. 8.4.2 Finance leases Finance lease payments made during the reporting period are recognised as capital expenditure in the statement of fnancial performance on the date of payment. The fnance lease commitments are recorded in the notes to the fnancial statements and are not apportioned between the capital and interest portions. Finance lease assets acquired at the end of the lease term are recorded and measured at the lower of: · cost, being the fair value of the asset; or · the sum of the minimum lease payments made, including any payments made to acquire ownership at the end of the lease term, excluding interest. 9 Aid Assistance 9.1 Aid assistance received Aid assistance received in cash is recognised in the statement of fnancial performance when received. In-kind aid assistance is recorded in the notes to the fnancial statements on the date of receipt and is measured at fair value. Aid assistance not spent for the intended purpose and any unutilised funds from aid assistance that are required to be refunded to the donor are recognised as a payable in the statement of fnancial position. 9.2 Aid assistance paid Aid assistance paid is recognised in the statement of fnancial performance on the date of payment. Aid assistance payments made prior to the receipt of funds are recognised as a receivable in the statement of fnancial position.
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10 Cash and cash equivalents Cash and cash equivalents are stated at cost in the statement of fnancial position. Bank overdrafts are shown separately on the face of the statement of fnancial position as a current liability. For the purposes of the cash fow statement, cash and cash equivalents comprise cash on hand, deposits held, other short-term highly liquid investments and bank overdrafts. 11 Prepayments and advances Prepayments and advances are recognised in the statement of fnancial position when the department receives or disburses the cash. Prepayments and advances are initially and subsequently measured at cost.
16.2 Movable capital assets Movable capital assets are initially recorded in the notes to the fnancial statements at cost. Movable capital assets acquired through a non-exchange transaction is measured at fair value as at the date of acquisition. Where the cost of movable capital assets cannot be determined reliably, the movable capital assets are measured at fair value and where fair value cannot be determined; the movable assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Movable capital assets are subsequently carried at cost and are not subject to depreciation or impairment. Biological assets are subsequently carried at fair value. Subsequent expenditure that is of a capital nature forms part of the cost of the existing asset when ready for use.
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16.3 Intangible assets Intangible assets are initially recorded in the notes to the fnancial statements at cost. Intangible assets acquired through a non-exchange transaction are measured at fair value as at the date of acquisition. Internally generated intangible assets are recorded in the notes to the fnancial statements when the department commences the development phase of the project. Where the cost of intangible assets cannot be determined reliably, the intangible capital assets are measured at fair value and where fair value cannot be determined; the intangible assets are measured at R1. All assets acquired prior to 1 April 2002 (or a later date as approved by the OAG) may be recorded at R1. Intangible assets are subsequently carried at cost and are not subject to depreciation or impairment. Subsequent expenditure of a capital nature forms part of the cost of the existing asset when ready for use. 16.4 Project Costs: Work-in-progress Expenditure of a capital nature is initially recognised in the statement of fnancial performance at cost when paid. Amounts paid towards capital projects are separated from the amounts recognised and accumulated in work-in-progress until the underlying asset is ready for use. Once ready for use, the total accumulated payments are recorded in an asset register. Subsequent payments to complete the project are added to the capital asset in the asset register. Where the department is not the custodian of the completed project asset, the asset is transferred to the custodian subsequent to completion. 17 Provisions and Contingents
17.1 Provisions Provisions are recorded in the notes to the fnancial statements when there is a present legal or constructive obligation to forfeit economic benefts as a result of events in the past and it is probable that an outfow of resources embodying economic benefts or service potential will be required to settle the obligation and a reliable estimate of the obligation can be made. The provision is measured as the best estimate of the funds required to settle the present obligation at the reporting date. 17.2 Contingent liabilities Contingent liabilities are recorded in the notes to the fnancial statements when there is a possible obligation that arises from past events, and whose existence will be confrmed only by the occurrence or non-occurrence of one or more uncertain future events not within the control of the department or when there is a present obligation that is not recognised because it is not probable that an outfow of resources will be required to settle the obligation or the amount of the obligation cannot be measured reliably. 17.3 Contingent assets Contingent assets are recorded in the notes to the fnancial statements when a possible asset arises from past events, and whose existence will be confrmed by the occurrence or non-occurrence of one or more uncertain future events not within the control of the department. 17.4 Capital commitments Capital commitments are recorded at cost in the notes to the fnancial statements. 18 Unauthorised expenditure Unauthorised expenditure is recognised in the statement of fnancial position until such time as the expenditure is either: · approved by Parliament or the Provincial Legislature with funding and the related funds are received; or · approved by Parliament or the Provincial Legislature without funding and is written off against the appropriation in the statement of fnancial performance; or · transferred to receivables for recovery. Unauthorised expenditure is measured at the amount of the confrmed unauthorised expenditure. 19 Fruitless and wasteful expenditure Fruitless and wasteful expenditure is recorded in the notes to the fnancial statements when confrmed. The amount recorded is equal to the total value of the fruitless and or wasteful expenditure incurred. Fruitless and wasteful expenditure is removed from the notes to the fnancial statements when it is resolved or transferred to receivables or written off. Fruitless and wasteful expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written-off as irrecoverable.
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20 Irregular expenditure Irregular expenditure is recorded in the notes to the fnancial statements when confrmed. The amount recorded is equal to the value of the irregular expenditure incurred unless it is impracticable to determine, in which case reasons therefor are provided in the note. Irregular expenditure is removed from the note when it is either condoned by the relevant authority, transferred to receivables for recovery, not condoned and removed or written-off. Irregular expenditure receivables are measured at the amount that is expected to be recoverable and are de-recognised when settled or subsequently written-off as irrecoverable. 21 Changes in accounting estimates and errors Changes in accounting estimates are applied prospectively in accordance with MCS requirements. Correction of errors is applied retrospectively in the period in which the error has occurred in accordance with MCS requirements, except to the extent that it is impracticable to determine the period-specifc effects or the cumulative effect of the error. In such cases the department shall restate the opening balances of assets, liabilities and net assets for the earliest period for which retrospective restatement is practicable. 22 Events after the reporting date Events after the reporting date that are classifed as adjusting events have been accounted for in the fnancial statements. The events after the reporting date that are classifed as non-adjusting events after the reporting date have been disclosed in the notes to the fnancial statements. 23 Principal-Agent arrangements The department is party to a principal-agent arrangement for the management of the procurement, warehousing, distribution and information management for pharmaceuticals and surgical sundries. In terms of the arrangement the department is the principal and is responsible for requisitioning supplies through the agent. All related revenues, expenditures, assets and liabilities have been recognised or recorded in terms of the relevant policies listed herein. Additional disclosures have been provided in the notes to the fnancial statements where appropriate.
24 Departures from the MCS requirements Management has not departed from MCS requirements
25 Capitalisation reserve The capitalisation reserve comprises of fnancial assets and/or liabilities originating in a prior reporting period but which are recognised in the statement of fnancial position for the frst time in the current reporting period. Amounts are recognised in the capitalisation reserves when identifed in the current period and are transferred to the National/Provincial Revenue Fund when the underlying asset is disposed and the related funds are received.
26 Recoverable revenue Amounts are recognised as recoverable revenue when a payment made in a previous fnancial year becomes recoverable from a debtor in the current fnancial year. Amounts are either transferred to the National/Provincial Revenue Fund when recovered or are transferred to the statement of fnancial performance when written-off. 27 Related party transactions A related party transaction is a transfer of resources, services or obligations between the reporting entity and a related party. Related party transactions within the Minister/MEC’s portfolio are recorded in the notes to the fnancial statements when the transaction is not at arm’s length. Key management personnel are those persons having the authority and responsibility for planning, directing and controlling the activities of the department. The number of individuals and their full compensation is recorded in the notes to the fnancial statements. 28 Inventories At the date of acquisition, inventories are recognised at cost in the statement of fnancial performance. Where inventories are acquired as part of a non-exchange transaction, the inventories are measured at fair value as at the date of acquisition. Inventories are subsequently measured at the lower of cost and net realisable value or where intended for distribution (or consumed in the production of goods for distribution) at no or a nominal charge, the lower of cost and current replacement value. The cost of inventories is assigned by using the weighted average cost basis.
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29 Public-Private Partnerships Public Private Partnerships are accounted for based on the nature and or the substance of the partnership. The transaction is accounted for in accordance with the relevant accounting policies. A summary of the signifcant terms of the PPP agreement, the parties to the agreement, and the date of commencement thereof together with the description and nature of the concession fees received, the unitary fees paid, rights and obligations of the department are recorded in the notes to the fnancial statements. 30 Employee benefts The value of each major class of employee beneft obligation (accruals, payables not recognised and provisions) is disclosed in the Employee benefts note.
31 Transfers of functions Transfers of functions are accounted for by the acquirer by recognising or recording assets acquired and liabilities assumed at their carrying amounts at the date of transfer. Transfers of functions are accounted for by the transferor by derecognising or removing assets and liabilities at their carrying amounts at the date of transfer.
32 Mergers Mergers are accounted for by the combined department by recognising or recording assets acquired and liabilities assumed at their carrying amounts at the date of the merger. Mergers are accounted for by the combining departments by derecognising or removing assets and liabilities at their carrying amounts at the date of the merger.
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NOTES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2020 1. Annual Appropriation
1.1 Annual Appropriation Included are funds appropriated in terms of the Appropriation Act (and the Adjustments Appropriation Act) for National Departments (Voted funds) and Provincial Departments:
2019/20 2018/19 Final Actual Funds not Final Appropriation Funds not Appropriation Funds requested/ Appropriation received requested Received not /not received received R’000 R’000 R’000 R’000 R’000 ADMINISTRATION 430,379 430,379 - 289,609 289,609 - DISTRICT HEALTH SERVICES 8,905,608 8,905,608 - 8,031,721 8,031,721 - EMERGENCY MEDICAL 419,062 419,062 - 363,422 363,422 - SERVICES PROVINCIAL HOSPITAL 1,434,783 1,434,783 - 1,368,773 1,368,773 - SERVICES CENTRAL HOSPITAL SERVICES 1,303,516 1,303,516 - 1,224,452 1,224,452 - HEALTH SCIENCES AND 414,643 414,643 - 365,839 365,839 - TRAINING HEALTH CARE SUPPORT 240,512 240,512 - 157,928 157,928 - SERVICES HEALTH FACILITIES 1,132,406 1,132,406 - 1,317,847 1,317,847 - MANAGEMENT Total 14,280,909 14,280,909 - 13,119,591 13,119,591 -
1.2 Conditional grants
Note 2019/20 2018/19 R’000 R’000 Total grants received 34 2,702,725 2,389,168
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2. Departmental revenue
Note 2019/20 2018/19 R’000 R’000 Tax revenue - - Sales of goods and services other than capital assets 2.1 68,751 63,828 Fines, penalties and forfeits - - Interest, dividends and rent on land 2.2 6,936 6,515 Sales of capital assets 2.3 2,767 4,138 Transactions in fnancial assets and liabilities 2.4 3,553 4,264 Transfer received - - Total revenue collected 82,007 78,745 Less: Own revenue included in appropriation 13 82,007 78,745 Departmental revenue collected - - 2.1 Sales of goods and services other than capital assets Note 2019/20 2018/19 2 R’000 R’000 Sales of goods and services produced by the department 68,230 63,242 Sales by market establishment 10,351 12,184 Administrative fees 2,568 - Other sales 55,311 51,058 Sales of scrap, waste and other used current goods 521 586 Total 68,751 63,828
Other sales include Private healthcare licence applications, duplicate certifcates, medical reports, boarding services, commission on insurance and garnishee, course fees, day care fees, immunisation fees, patient fees, private patient fees, patient transport, special events, cremation/ mortuary fees and photocopies and fax fees.
2.2 Interest, dividends and rent on land
Note 2019/20 2018/19 2 R’000 R’000 Interest 6,936 6,515 Dividends - - Rent on land - - Total 6,936 6,515
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2.3 Sale of capital assets Note 2019/20 2018/19 2 R’000 R’000 Tangible assets 2,767 4,138 Buildings and other fxed structures - - Machinery and equipment 29 2,767 4,138 Heritage assets - - Specialised military assets - - Land and subsoil assets - - Biological assets - -
Intangible assets - - Software - - Mastheads and publishing titles - - Patents, licences, copyright, brand names, trademarks - - Recipes, formulae, prototypes, designs, models - - Services and operating rights - -
Total 2,767 4,138
2,.4 Transactions in fnancial assets and liabilities Note 2019/20 2018/19 2 R’000 R’000 Loans and advances - - Receivables 3,082 - Forex gain - - Stale cheques written back 9 - Other Receipts including Recoverable Revenue 462 4,264 Gains on GFECRA - - Total 3,553 4,264
Other receipts include recovery of previous departmental debt, domestic services, staff debt, cash surpluses, previous year’s expenditure and stale cheques.
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3. Compensation of employees 3.1 Salaries and Wages Note 2019/20 2018/19 R’000 R’000 Basic salary 5,336,084 4,937,202 Performance award 110,969 120,078 Service Based 6,768 5,866 Compensative/circumstantial 798,337 749,628 Periodic payments 25,779 20,520 Other non-pensionable allowances 948,137 872,774 Total 7,226,074 6,706,068
Other Non - pensionable allowances include Capital remuneration, Housing allowances, Non - pensionable allowances not separately provided for and Service bonus.
3.2 Social contributions Note 2019/20 2018/19 R’000 R’000 Employer contributions Pension 639,746 588,064 Medical 412,339 366,868 UIF - - Bargaining council 1,537 1,953 Offcial unions and associations - - Insurance 134 - Total 1,053,756 956,885
Total compensation of employees 8,279,830 7,662,953
Average number of employees 20,974 20,859
The Department had 19483 permanent employees, 1183 contracted employees, 619 periodical appointments, 272 sessional appointments, and 81 abnormal appointments, 1 temporary and 1 political appointment at the end of March on the establishment.
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4. Goods and services
Note 2019/20 2018/19 R’000 R’000 Administrative fees 208,689 200,566 Advertising 19,287 5,776 Minor assets 4.1 6,903 4,171 Bursaries (employees) - - Catering 5,061 3,391 Communication 55,826 38,913 Computer services 4.2 57,711 24,515 Consultants: Business and advisory services 7,613 4,413 Infrastructure and planning services - - Laboratory services 581,378 495,105 Scientifc and technological services - - Legal services 129,265 35,632 Contractors 151,092 102,012 Agency and support / outsourced services 107,742 113,934 Entertainment - - Audit cost – external 4.3 19,926 18,859 Fleet services 117,517 114,692 Inventory 4.4 2,322,845 2,129,996 Consumables 4.5 210,092 136,533 Housing - - Operating leases 49,884 50,690 Property payments 4.6 454,904 358,587 Rental and hiring 1,741 963 Transport provided as part of the departmental activities 671 399 Travel and subsistence 4.7 89,358 66,803 Venues and facilities 1,385 665 Training and development 4,462 4,713 Other operating expenditure 4.8 4,258 2,563 Total 4,607,610 3,913,891
Other operating expenditure includes Couriers and delivery services, Non-life insurance and Printing and publication cost
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4 .1 Minor assets
Note 2019/20 2018/19 4 R’000 R’000 Tangible assets 6,903 4,171 Buildings and other fxed structures - - Biological assets - - Heritage assets - - Machinery and equipment 6,903 4,171 Transport assets - - Specialised military assets - - Intangible assets - - Software - - Mastheads and publishing titles - - Patents, licences, copyright, brand names, trademarks - - Recipes, formulae, prototypes, designs, models - - Services and operating rights - - Total 6,903 4,171
4.2 Computer services
Note 2019/20 2018/19 4 R’000 R’000 SITA computer services 16,636 5,634 External computer service providers 41,075 18,881 Total 57,711 24,515
4,3 Audit cost – External
Note 2019/20 2018/19 4 R’000 R’000 Regularity audits 19,926 18,859 Performance audits - - Investigations - - Environmental audits - - Computer audits - - Total 19,926 18,859
4.4 Inventory
Note 2019/20 2018/19 4 R’000 R’000 Clothing material and accessories - - Farming supplies - - Food and food supplies 82,993 79,158 Fuel, oil and gas - - Learning, teaching and support material - - Materials and supplies - -
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Medical supplies 497,125 434,708 Medicine 1,742,727 1,616,130 Medsas inventory interface - - Other supplies - - Total 2,322,845 2,129,996
4.5 Consumables
Note 2019/20 2018/19 4 R’000 R’000 Consumable supplies 168,403 118,662 Uniform and clothing 36,082 29,879 Household supplies 113,338 72,184 Building material and supplies - - Communication accessories - - IT consumables 1,157 229 Other consumables 17,826 16,370 Stationery, printing and offce supplies 41,689 17,871 Total 210,092 136,533
Other includes Gifts and awards, Fuel supplies, Building supplies, Notice Boards, Hardware, Laboratory consumables and Bags and accessories
4.6 Property payments
Note 2019/20 2018/19 4 R’000 R’000 Municipal services 162,740 130,882 Property management fees - - Property maintenance and repairs 285,584 220,344 Other 6,580 7,361 Total 454,904 358,587
Other includes Cleaning services. Firefghting, Pest control, Laundry services and Safety and Security.
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4.7 Travel and subsistence
Note 2019/20 2018/19 4 R’000 R’000 Local 87,537 61,636 Foreign 1,821 5,167 Total 89,358 66,803
4.8 Other operating expenditure
Note 2019/20 2018/19 4 R’000 R’000 Professional bodies, membership and subscription fees 923 501 Resettlement costs 1,352 780 Other 1,983 1,282 Total 4,258 2,563
Other includes Couriers and delivery cost, Non-life insurance and Printing and publications.
5. Interest and rent on land
Note 2019/20 2018/19 R’000 R’000 Interest paid 4,885 487 Rent on land - - Total 4,885 487
6. Payments for fnancial assets
Note 2019/20 2018/19 R’000 R’000 Material losses through criminal conduct - - Theft - - Other material losses - - Purchase of equity - - Extension of loans for policy purposes - - Other material losses written off - - Debts written off 6.1 5,683 - Forex losses - - Debt take overs - - Losses on GFECRA - - Total 5,683 -
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6.1 Debts written off
Note 2019/20 2018/19 6 R’000 R’000 Nature of debts written off Other debt written off Bad Debt Written Off 5,683 -
Total 5,683 -
Total debt written off 5,683 -
7. Transfers and subsidies
2019/20 2018/19 R’000 R’000 Note Provinces and municipalities 35 1,504 2,326 Departmental agencies and accounts Annexure 1B 42,942 14,185 Higher education institutions - - Foreign governments and international organisations - - Public corporations and private enterprises - - Non-proft institutions Annexure 1F 333,430 308,946 Households Annexure 1G 116,130 124,443 Total 494,006 449,900
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8. Expenditure for capital assets
Note 2019/20 2018/19
R’000 R’000 Tangible assets 865,722 1,028,712 Buildings and other fxed structures 31 618,331 896,065 Heritage assets - - Machinery and equipment 29 247,391 132,647 Specialised military assets - - Land and subsoil assets - - Biological assets - -
Intangible assets - - Software - - Mastheads and publishing titles - - Patents, licences, copyright, brand names, trademarks - - Recipes, formulae, prototypes, designs, models - - Services and operating rights - -
Total 865,722 1,028,712
8.1 Analysis of funds utilised to acquire capital assets – 2019/20
Voted funds Aid assistance Total
R’000 R’000 R’000 Tangible assets 865,722 - 865,722 Buildings and other fxed structures 618,331 - 618,331 Heritage assets - - - Machinery and equipment 247,391 - 247,391 Specialised military assets - - - Land and subsoil assets - - - Biological assets - - -
Intangible assets - - -
Software - - - Mastheads and publishing titles - - - Patents, licences, copyright, brand names, trademarks - - - Recipes, formulae, prototypes, designs, models - - - Services and operating rights - - -
Total 865,722 - 865,722
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Analysis of funds utilised to acquire capital assets – 2018/19
Voted funds Aid assistance Total R’000 R’000 R’000 Tangible assets 1,028,712 - 1,028,712
Buildings and other fxed structures 896,065 - 896,065 Heritage assets - - - Machinery and equipment 132,647 - 132,647 Specialised military assets - - - Land and subsoil assets - - - Biological assets - - -
Intangible assets - - -
Software - - - Mastheads and publishing titles - - - Patents, licences, copyright, brand names, - - - trademarks Recipes, formulae, prototypes, designs, models - - - Services and operating rights - - -
Total 1,028,712 - 1,028,712 9. Unauthorised expenditure 9.1 Reconciliation of unauthorised expenditure
Note 2019/20 2018/19
R’000 R’000
Opening balance 234,705 234,705
Prior period error -
As restated 234,705 234,705
Unauthorised expenditure – discovered in current year (as restated) - -
Less: Amounts approved by Parliament/Legislature with funding - -
Less: Amounts approved by Parliament/Legislature without - - funding and derecognised Capital - -
Current - -
Transfers and subsidies - -
Less: Amounts recoverable - -
Less: Amounts written off - -
Closing balance 234,705 234,705
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Analysis of closing balance
Unauthorised expenditure awaiting authorisation 147,423 147,423
Unauthorised expenditure approved without funding and not 87,282 87,282 derecognised Total 234,705 234,705
The Department has R 87 282 million approved without funding and it will be written off with future savings.
9.2 Analysis of unauthorised expenditure awaiting authorisation per economic classifcation
2019/20 2018/19 R’000 R’000 Current 121,982 121,982 Capital - - Transfers and subsidies 25,441 25,441 Total 147,423 147,423
9.3 Analysis of unauthorised expenditure awaiting authorisation per type
2019/20 2018/19 R’000 R’000 Unauthorised expenditure relating to overspending of the vote or a main 118,574 118,574 division within a vote Unauthorised expenditure incurred not in accordance with the purpose of the 28,849 28,849 vote or main division Total 147,423 147,423
10. Cash and cash equivalents
Note 2019/20 2018/19 R’000 R’000 Consolidated Paymaster General Account 39,133 75,273 Cash receipts - - Disbursements -4,224 -2,126 Cash on hand 272 8 Investments (Domestic) - - Investments (Foreign) - - Total 35,181 73,155
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11. Receivables
2019/20 2018/19 Current Non-current Total Current Non-current Total R’000 R’000 R’000 R’000 R’000 R’000 Note Claims ------recoverable Trade receivables ------Recoverable ------expenditure Staff debt 11.1 19,533 - 19,533 19,044 - 19,044 Fruitless 11.3 4,580 - 4,580 5,476 - 5,476 and wasteful expenditure Other receivables 11.2 1,227 - 1,227 2,972 - 2,972 Total 25,340 - 25,340 27,492 - 27,492
11.1 Staff debt
Note 2019/20 2018/19 11 R’000 R’000
Ex-Employees 16,812 16,021 Employees 2,416 2,708 GG Accident 305 315 Total 19,533 19,044
11.2 Other receivables
Note 2019/20 2018/19 11 R’000 R’000 Inter- Departmental Claims 1,224 1,224 Suppliers 1,822 1,748 SAL:Pension Debt: CA -1,721 - SAL:ACB Recalls: CA -399 - SAL: Deduction Disall Acc:CA 15 - SAL: Disallowance Account: CA -1 - SAL:Reversal Control :CA 703 - SAL:Tax Debt: CA -416 - Total 1,227 2,972
The Other Debtors includes: Department of Health Gauteng, Eastern Cape, and Department of Correctional Services.
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11.3 Fruitless and wasteful expenditure
Note 2019/20 2018/19
11 R’000 R’000
Opening balance 5,476 5,476 Less amounts recovered - - Less amounts written off -5,476 - Transfers from note 24 Fruitless and Wasteful 4,580 - Expenditure Interest - - Total 4,580 5,476
11.4 Impairment of receivables
Note 2019/20 2018/19 R’000 R’000 Estimate of impairment of receivables 12,358 10,717 Total 12,358 10,717
Impairment for Staff Debt already approved but not implemented. 12. Voted funds to be surrendered to the Revenue Fund
Note 2019/20 2018/19 R’000 R’000 Opening balance 319,275 333,147 Prior period error -480 As restated 319,275 332,667 Transfer from statement of fnancial performance (as restated) 23,173 63,648 Add: Unauthorised expenditure for current year 9 - - Voted funds not requested/not received 1.1 - - Transferred to retained revenue to defray excess expenditure - - (PARLIAMENT/LEGISLATURES ONLY) Paid during the year -65,181 -77,040 Closing balance 277,267 319,275
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13. Departmental revenue and NRF Receipts to be surrendered to the Revenue Fund
Note 2019/20 2018/19 R’000 R’000 Opening balance 8,061 6,393 Prior period error As restated 8,061 6,393 Transfer from Statement of Financial Performance (as restated) - - Own revenue included in appropriation 2 82,007 78,745 Transfer from aid assistance - - Transfer to voted funds to defray expenditure (Parliament/ - - Legislatures ONLY) Paid during the year -78,683 -77,077 Closing balance 11,385 8,061
14. Payables – current Note 2019/20 2018/19 R’000 R’000
Amounts owing to other entities - - Advances received - - Clearing accounts 14.1 4,069 4,823 Other payables - - Total 4,069 4,823 14.1 Clearing accounts
Note 2019/20 2018/19 14 R’000 R’000 Description (Identify major categories, but list material amounts) SAL:Pension Debt - 1,339 SAL:ACB Recalls - 65 SAL:Pension Fund 956 71 SAL:Tax Debt - 683 SAL:Reversal Control - -469 SAL:Garnshee Order 172 129 SAL:Bargaining Councils 1 1 SAL:Income Tax 3,572 2,986 SAL:Medical Aid 19 18 Other -651 - Total 4,069 4,823
Others include SAL: Subscription Prof Bodies and SA:Interface Controll:CA
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15. Net cash fow available from operating activities
Note 2019/20 2018/19 R’000 R’000 Net surplus/(defcit) as per Statement of Financial 23,173 63,648 Performance Add back non cash/cash movements not deemed operating 802,496 944,002 activities (Increase)/decrease in receivables 2,152 -5,939 (Increase)/decrease in prepayments and advances - - (Increase)/decrease in other current assets - - Increase/(decrease) in payables – current -754 1,219 Proceeds from sale of capital assets -2,767 -4,138 Proceeds from sale of investments - - (Increase)/decrease in other fnancial assets - - Expenditure on capital assets 865,722 1,028,712 Surrenders to Revenue Fund -143,864 -154,597 Surrenders to RDP Fund/Donor - - Voted funds not requested/not received - - Own revenue included in appropriation 82,007 78,745 Other non-cash items - - Net cash fow generated by operating activities 825,669 1,007,650
16. Reconciliation of cash and cash equivalents for cash fow purposes
Note 2019/20 2018/19 R’000 R’000 Consolidated Paymaster General account 39,133 74,793 Fund requisition account - - Cash receipts - - Disbursements -4,224 -2,126 Cash on hand 272 8 Cash with commercial banks (Local) - - Cash with commercial banks (Foreign) - - Total 35,181 72,675
289 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
17. Contingent liabilities and contingent assets 17.1 Contingent liabilities
Note 2019/20 2018/19 R’000 R’000 Liable to Nature Motor vehicle guarantees Employees - - Housing loan guarantees Employees Annex 3A 157 157 Other guarantees - - Claims against the department Annex 3B 9,636,156 9,616,069 Intergovernmental payables (unconfrmed balances) Annex 5 5,607 19,410 Environmental rehabilitation liability - - Other - - Total 9,641,920 9,635,636
Claims against the department arise in the course of the department’s normal operations, which is the provision of health care. The amount and timing of the cash fows relating to the claims against the department is highly uncertain.
17.2 Contingent assets
Note 2019/20 2018/19 R’000 R’000 Nature of contingent asset OSD Overpayments - 20,122
Total - 20,122
The Department approved the amount owed by employees to be written off as not economical to recover.
290 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
18. Capital commitments
Note 2019/20 2018/19 R’000 R’000 Specify class of asset 1.1 Immovable assets (WIP) 3,540,045 1,319,417 1.2 Movable assets (Machinery and equipment) 103,661 7,946 Total 3,643,706 1,327,363
In terms of the changes in the MCS for commitments, the Department is only reporting on Capital commitments.
19. Accruals and payables not recognised 19.1 Accruals 2019/20 2018/19 R’000 R’000 Listed by economic classifcation 30 Days 30+ Days Total Total Goods and services 74,328 - 74,328 173,676 Interest and rent on land - - - - Transfers and subsidies - - - - Capital assets 14,481 - 14,481 30,862 Other - - - - Total 88,809 - 88,809 204,538
Note 2019/20 2018/19 R’000 R’000 Listed by programme level PR1: Administration Services 16,779 34,106 PR2: District Health Services 31,619 113,919 PR3: Emergency Medical Services - - PR4: Provincial Hospital Services 3,986 7,933 PR5: Central Hospital Services 8,483 13,838 PR6: Health Sciences & Training Services - 1,438 PR7: Health Care Support Services 19,605 32,373 PR8: Health Facility Management Services 8,337 931 Total 88,809 204,538
291 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
19.2 Payables not recognised
2019/20 2018/19 R’000 R’000 Listed by economic classifcation 30 Days 30+ Days Total Total Goods and services 17,640 8,484 26,124 335,321 Interest and rent on land - - - - Transfers and subsidies 3,268 157 3,425 208 Capital assets 10,411 1,856 12,267 1,883 Other 109,201 - 109,201 32,514 Total 140,520 10,497 151,017 369,926
Note 2019/20 2018/19 R’000 R’000 Listed by programme level
PR1: Administration Services 8,900 28,290 PR2: District Health Services 4,160 199,576 PR3: Emergency Medical Services 94 13,602 PR4: Provincial Hospital Services 1,789 35,770 PR5: Central Hospital Services 2,783 28,739 PR6: Health Sciences & Training Services 317 23,827 PR7: Health Care Support Services 337 1,010 PR8: Health Facility Management Services 23,436 6,598 Other- Compensation of Employees 109,201 32,514 Total 151,017 369,926
Note 2019/20 2018/19 Included in the above totals are the following: R’000 R’000 Confrmed balances with other departments Annex 5 1,023 24,641 Confrmed balances with other government entities Annex 5 - - Total 1,023 24,641
292 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
20. Employee benefts
Note 2019/20 2018/19
R’000 R’000 Leave entitlement 387,567 344,775 Service bonus 219,694 200,798 Performance awards 70,423 115,633 Capped leave 223,305 227,962 Other 5,744 6,586 Total 906,733 895,754
Other is for the long services awards for the next twelve months. Included in leave entitlements are negative leave entitlements amount to R5, 744 million.
21. Lease commitments 21.1 Operating leases
Buildings Specialised and other Machinery military fxed and 2019/20 equipment Land structures equipment Total R’000 R’000 R’000 R’000 R’000 Not later than 1 year - - 10,724 28,907 39,631 Later than 1 year and not later than 5 years - - 39,392 34,010 73,402 Later than fve years - - 39,297 - 39,297 Total lease commitments - - 89,413 62,917 152,330
Buildings Specialised and other Machinery military fxed and 2018/19 equipment Land structures equipment Total R’000 R’000 R’000 R’000 R’000 Not later than 1 year - - 4,019 16,657 20,676 Later than 1 year and not later than 5 years - - 6,321 9,006 15,327 Later than fve years - - - - - Total lease commitments - - 10,340 25,663 36,003
The DOH has a total number of 10 leased buildings as follows: Offce space, Accommodations, Clinics and Warehouse with a minimum escalation ranging from 5,50% and maximum 10%
293 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
22. Accrued departmental revenue
Note 2019/20 2018/19 R’000 R’000 Tax revenue - - Sales of goods and services other than capital assets 283,050 215,466 Fines, penalties and forfeits - - Interest, dividends and rent on land - - Sales of capital assets - - Transactions in fnancial assets and liabilities - - Transfers received - - Other - - Total 283,050 215,466
The receivables in respect of goods and services represent the total debt (R283 million) based on recoverability of patient debts. There were no write offs during the year in respect of patient fees. A provision for bad debts of R 124 334 million has been provided 22.1 Analysis of accrued departmental revenue
Note 2019/20 2018/19 R’000 R’000
Opening balance 215,466 155,872 Less: amounts received 34,686 32,590 Less: services received in lieu of cash - - Add: amounts recorded 102,270 92,184 Less: amounts written-off/reversed as irrecoverable - - Less: amounts transferred to receivables for recovery - - Closing balance 283,050 215,466
The difference between closing and opening balance is due to reclassifcation of provision for bad debts.
294 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
22.2 Accrued department revenue written off
Note 2019/20 2018/19 R’000 R’000
Nature of losses Write Off RAF (Road Accident Fund) - - Patient Fees written off on the stand alone system - -
Total - -
22.3 Impairment of accrued departmental revenue
Note 2019/20 2018/19
R’000 R’000
Estimate of impairment of accrued departmental revenue 111,976 189,002 Total 111,976 189,002
The R 111 976 million has been provided and approved to be written off in 2020/2021 fnancial year.
23. Irregular expenditure 23.1 Reconciliation of irregular expenditure
Note 2019/20 2018/19 R’000 R’000 Opening balance 3,805,728 3,666,829 Prior period error - As restated 3,805,728 3,666,829 Add: Irregular expenditure – relating to prior year - - Add: Irregular expenditure – relating to current year 122,157 138,899 Less: Prior year amounts condoned -251,927 - Less: Current year amounts condoned - - Less: Prior year amounts not condoned and removed - - Less: Current year amounts not condoned and removed - - Less: Amounts recoverable (current and prior year) - - Less: Amounts written off - - Closing balance 3,675,958 3,805,728
Analysis of awaiting condonation per age classifcation
295 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Current year 122,157 138,899 Prior years 3,553,801 3,666,829 Total 3,675,958 3,805,728
23.2 Details of current and prior year irregular expenditure – added current year (under determination and investigation)
Incident Disciplinary steps taken/criminal 2019/20 proceedings R’000 Non Compliance of SCM Processes Under Investigation 122,157
Total 122,157
23.3 Details of irregular expenditure condoned
Incident Condoned by (relevant authority) 2019/20 R’000 Litigation Contract Provincial Treasury 69,911 Rapid Implementation Unit Provincial Treasury 182,016 Total 251,927
24. Fruitless and wasteful expenditure 24.1 Reconciliation of fruitless and wasteful expenditure
Note 2019/20 2018/19
R’000 R’000
Opening balance 2,866 16,557
Prior period error -
As restated 2,866 16,557
Fruitless and wasteful expenditure – relating to prior year - -
Fruitless and wasteful expenditure – relating to current year 4,885 487
Less: Amounts recoverable -4,580 -13,934
Less: Amounts written off - -244
Closing balance 3,171 2,866
296 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
24.2 Details of current and prior year fruitless and wasteful expenditure – added current year (under determination and investigation)
Incident Disciplinary steps taken/criminal 2019/20 proceedings R’000 Late Payment to Service Providers Still under investigation 305
Fruitless identifed during Audit for recovery Still under investigation 4,580 Total 4,885
24.3 Details of current and prior year fruitless and wasteful expenditure (Not in the main note)
2019/20 R’000 Prior year disclosure still under investigation 487 Total 487
25. Related party transactions Note 2019/20 2018/19 R’000 R’000 In kind goods and services provided/received List in kind goods and services between the department and the related party Department of Public Works provides offces at Government Complex - - at no cost Provincial Treasury Provides Financial Systems - - Provincial Treasury provides Interns and pay on behalf of the - - Department National Health Department pay services rendered by (SAICA) South - - African Institute for Chartered Accountants - - Total - -
297 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
26. Key management personnel No. of 2019/20 2018/19 Individuals R’000 R’000 Political offce bearers (provide detail below) 1 1,883 1,870 Offcials: Level 15 to 16 3 4,935 4,920 Level 14 14 16,029 13,701 Family members of key management personnel 6 4,348 3,870 Total 27,195 24,361
The disclosure is based on the top management structure.
27. Provisions Note 2019/20 2018/19 R’000 R’000 Please specify 1. Grading for level 9 and 11 to 10 and 12 respectively 24,329 26,592 2. OSD Under Payment and Provision for Middelburg 178,250 651 3. Provision for Retention 13,557 47,545 4. Provision for Litigation 85,402 40,600
Total 301,538 115,388
Provision for Middelburg – arose as results of bigger hospitals been constructed and resulted in reimbursement of costs incurred to comply with IUSS. The amount is payable within 2020/2021 fnancial year.
Provision for retention – funds are retained from different projects during the construction period of the projects. The amounts are payable six months after the completion of the projects.
Provision for litigations – merits have been conceded and department is still determining the quantum for eleven litigations against the state. The litigation will be paid after court order has been issued.
298 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
27.1 Reconciliation of movement in provisions – 2019/20 Grading OSD Under Retention Litigation Total Payment and provisions Provision for Middelburg R’000 R’000 R’000 R’000 R’000
Opening balance 26,592 651 47,545 40,600 115,388 Increase in provision - 178,250 - 44,802 223,052 Settlement of provision -2,263 - -33,988 - -36,251 Unused amount reversed - -651 - -651 Reimbursement expected from - - - - - third party Change in provision due to - - - - - change in estimation of inputs Closing balance 24,329 178,250 13,557 85,402 301,538
Reconciliation of movement in provisions – 2018/19 Grading OSD Under Retention Litigation Total Payment and provisions Provision for Middelburg R’000 R’000 R’000 R’000 R’000
Opening balance 15,571 640 37,885 37,425 91,521 Increase in provision 11,021 11 9,660 19,100 39,792 Settlement of provision - - - -7,742 -7,742 Unused amount reversed - - - - - Reimbursement expected from - - - - - third party Change in provision due to change - - - -8,183 -8,183 in estimation of inputs Closing balance 26,592 651 47,545 40,600 115,388
299 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
28. Non-adjusting events after reporting date
Due to the outbreak of the COVID-19 pandemic the province, like the rest of the country has developed and implemented controls to fght the spread of the virus. Strategic plan has been developed to guide the departmental spending to curb the spread. Several guidelines and regulations were also issued by mainly National Treasury and National Department of Health which were complied with.
National Department of Health and Provincial Treasury has further adjusted 2020/2021 budget of the department to fght the spread of the virus amounting to R1 572 622 221 of which R1 billion was addition from Provincial Treasury, R33.9 million from Disaster Relief Grant and others funds were reallocation from 2020/2021 fnancial year budget.
29. Movable Tangible Capital Assets MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020 Opening balance Value Additions Disposals Closing adjustments Balance R’000 R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - - Heritage assets - - - - -
MACHINERy AND EQUIPMENT 1,477,915 - 264,613 34,359 1,708,169 Transport assets 362,419 - 58,609 17,790 403,238 Computer equipment 93,558 - 30,507 2,203 121,862 Furniture and offce equipment 66,967 - 14,201 816 80,352 Other machinery and equipment 954,971 - 161,296 13,550 1,102,717
SPECIALISED MILITARy ASSETS - - - - - Specialised military assets - - - - -
BIOLOGICAL ASSETS - - - - - Biological assets - - - - -
TOTAL MOVABLE TANGIBLE 1,477,915 - 264,613 34,359 1,708,169 CAPITAL ASSETS
300 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
29.1 Additions ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020
Cash Non-cash (Capital Work Received Total in Progress current, not current paid costs and (Paid fnance lease current year, payments) received prior year)
R’000 R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - -
Heritage assets - - - - -
MACHINERy AND 247,391 17,222 - - 264,613 EQUIPMENT
Transport assets 58,609 - - - 58,609
Computer equipment 20,066 10,441 - - 30,507
Furniture and offce 13,416 785 - - 14,201 equipment
Other machinery and 155,300 5,996 - - 161,296 equipment
SPECIALISED MILITARy - - - - - ASSETS
Specialised military assets - - - - -
BIOLOGICAL ASSETS - - - - -
Biological assets - - - - -
TOTAL ADDITIONS TO 247,391 17,222 - - 264,613 MOVABLE TANGIBLE CAPITAL ASSETS
301 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
29.2 Disposals DISPOSALS OF MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020 Sold for cash Non-cash Total disposals Cash Received disposal Actual R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - Heritage assets - - - -
MACHINERy AND EQUIPMENT 34,359 - 34,359 2,767 Transport assets 17,790 - 17,790 2,767 Computer equipment 2,203 - 2,203 - Furniture and offce equipment 816 - 816 - Other machinery and equipment 13,550 - 13,550 -
SPECIALISED MILITARy ASSETS - - - - Specialised military assets - - - -
BIOLOGICAL ASSETS - - - - Biological assets - - - -
TOTAL DISPOSAL OF MOVABLE 34,359 - 34,359 2,767 TANGIBLE CAPITAL ASSETS
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29.3 Movement for 2018/19 MOVEMENT IN TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2019 Opening Prior period Additions Disposals Closing balance error Balance R’000 R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - - Heritage assets - - - - -
MACHINERy AND EQUIPMENT 1,371,396 16,473 139,195 49,149 1,477,915 Transport assets 359,062 2,160 25,098 23,901 362,419 Computer equipment 82,135 539 11,292 408 93,558 Furniture and offce equipment 65,157 594 1,601 385 66,967 Other machinery and equipment 865,042 13,180 101,204 24,455 954,971
SPECIALISED MILITARy ASSETS - - - - - Specialised military assets - - - - -
BIOLOGICAL ASSETS - - - - - Biological assets - - - - -
TOTAL MOVABLE TANGIBLE 1,371,396 16,473 139,195 49,149 1,477,915 CAPITAL ASSETS
29.3.1 Prior period error Note 2018/19 R’000 Nature of prior period error Relating to 2018/19 [affecting the opening balance] Prior Period error on Capital Asset (Asset from foor not on 29 16,473 FAR) Total prior period errors 16,473
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29.4 Minor assets MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE yEAR ENDED AS AT 31 MARCH 2020 Specialised Intangible Heritage Machinery and Biological Total military assets assets equipment assets assets R’000 R’000 R’000 R’000 R’000 R’000
Opening balance - - - 256,954 - 256,954 Value adjustments - - - 4,324 - 4,324 Additions - - - 7,874 - 7,874 Disposals - - - 6,705 - 6,705 TOTAL MINOR - - - 262,447 - 262,447 ASSETS
Specialised Intangible Heritage Machinery and Biological Total military assets assets equipment assets assets Number of R1 ------minor assets Number of - - - - 151,187 minor assets at 151,187 cost TOTAL - - - - 151,187 NUMBER 151,187 OF MINOR ASSETS
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MOVEMENT IN MINOR ASSETS PER THE ASSET REGISTER FOR THE yEAR ENDED AS AT 31 MARCH 2019
Specialised Intangible Heritage Machinery Biological Total military as- assets assets and equip- assets sets ment R’000 R’000 R’000 R’000 R’000 R’000
Opening balance - - - 253,440 - 253,440 Prior period error ------Additions - - - 5,475 - 5,475 Disposals - - - 1,961 - 1,961 TOTAL MINOR - - - 256,954 - 256,954 ASSETS
Specialised military Intangible assets Heritage assets Machinery and Biological assets Total assets equipment
Number of R1 minor ------assets
Number of minor as- - - - 150,861 - 150,861 sets at cost
TOTAL NUMBER - - - 150,861 - 150,861 OF MINOR ASSETS
29.4.1 Prior period error Note 2018/19 R’000 Nature of prior period error Relating to 2018/19 Prior Period error on Minor Asset (Asset from Floor not on FAR) 29 4,324 Total prior period errors 4,324
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30. Intangible Capital Assets MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020 Opening Value Additions Disposals Closing balance adjustments Balance R’000 R’000 R’000 R’000 R’000
SOFTWARE - - - -
MASTHEADS AND PUBLISHING - - - - TITLES
PATENTS, LICENCES, COPyRIGHT, - - - - BRAND NAMES, TRADEMARKS
RECIPES, FORMULAE, 4,388 - - 4,388 PROTOTyPES, DESIGNS, MODELS
SERVICES AND OPERATING - - - - RIGHTS
TOTAL INTANGIBLE CAPITAL 4,388 - - - 4,388 ASSETS
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30.1 Movement for 2018/19
MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2019 Opening Prior period Additions Disposals Closing Balance balance error R’000 R’000 R’000 R’000 R’000
SOFTWARE - - - - -
MASTHEADS AND PUBLISHING - - - - - TITLES
PATENTS, LICENCES, COPyRIGHT, - - - - - BRAND NAMES, TRADEMARKS
RECIPES, FORMULAE, PROTO- 4,388 - - - 4,388 TyPES, DESIGNS, MODELS
SERVICES AND OPERATING - - - - - RIGHTS
TOTAL INTANGIBLE CAPITAL AS- 4,388 - - - 4,388 SETS
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31. Immovable Tangible Capital Assets MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020 Opening Value Additions Disposals Closing balance adjustments Balance R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED 867,276 - 152,908 591,642 428,542 STRUCTURES Dwellings - - 44,313 44,313 - Non-residential buildings 602,683 - 20,691 502,847 120,528 Other fxed structures 264,592 - 87,903 44,482 308,013
HERITAGE ASSETS - - - - - Heritage assets - - - - -
LAND AND SUBSOIL ASSETS - - - - - Land - - - - - Mineral and similar non-regenera------tive resources
TOTAL IMMOVABLE TANGIBLE 867,276 - 152,908 591,642 428,542 CAPITAL ASSETS
308 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
31.1 Additions
ADDITIONS TO IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020 Cash Non-cash (Capital Received Total Work in Pro- current, not gress cur- paid rent costs (Paid current and fnance year, re- lease pay- ceived prior ments) year) R’000 R’000 R’000 R’000 R’000
BUILDING AND OTHER FIXED 618,331 44,313 -509,736 - 152,908 STRUCTURES
Dwellings 9,894 44,313 -9,894 - 44,313
Non-residential buildings 516,108 - -495,417 - 20,691
Other fxed structures 92,329 - -4,425 - 87,903
HERITAGE ASSETS - - - - -
Heritage assets - - - - -
LAND AND SUBSOIL ASSETS - - - - -
Land - - - - -
Mineral and similar non-regener------ative resources
TOTAL ADDITIONS TO IMMOV- 618,331 44,313 -509,736 - 152,908 ABLE TANGIBLE CAPITAL ASSETS
309 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
31.2 Disposals
DISPOSALS OF IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020
Sold for Non-cash disposal Total disposals Cash cash Received Actual
R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED - 591,642 591,642 - STRUCTURES
Dwellings - 44,313 44,313 -
Non-residential buildings - 502,847 502,847 -
Other fxed structures - 44,482 44,482 -
HERITAGE ASSETS - - - -
Heritage assets - - - -
LAND AND SUBSOIL ASSETS - - - -
Land - - - -
Mineral and similar non-regenerative - - - - resources
TOTAL DISPOSALS OF IMMOVABLE TANGIBLE CAPITAL - 591,642 591,642 - ASSETS
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31.3 Movement for 2018/19
MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2019
Opening Prior period Additions Disposals Closing balance error Balance
R’000 R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED 128,983 - 899,712 161,420 867,276 STRUCTURES
Dwellings 8,042 - - 8,042 -
Non-residential buildings 80,405 - 625,592 103,313 602,683
Other fxed structures 40,536 - 274,120 50,065 264,592
HERITAGE ASSETS - - - - -
Heritage assets - - - - -
LAND AND SUBSOIL ASSETS - - - - -
Land - - - - -
Mineral and similar non------regenerative resources
TOTAL IMMOVABLE TANGIBLE 128,983 - 899,712 161,420 867,276 CAPITAL ASSETS
311 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
DISPOSALS OF IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2020
Sold for Non-cash disposal Total disposals Cash cash Received Actual
R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED - 591,642 - STRUCTURES 591,642
Dwellings - 44,313 44,313 -
Non-residential buildings - 502,847 - 502,847
Other fxed structures - 44,482 44,482 -
HERITAGE ASSETS - - - -
Heritage assets - - - -
LAND AND SUBSOIL ASSETS - - - -
Land - - - -
Mineral and similar non-regenerative - - - - resources
TOTAL DISPOSALS OF IMMOVABLE TANGIBLE CAPITAL - 591,642 591,642 - ASSETS
312 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
31.3 Movement for 2018/19
MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE yEAR ENDED 31 MARCH 2019
Opening Prior period Additions Disposals Closing balance error Balance
R’000 R’000 R’000 R’000 R’000
BUILDINGS AND OTHER FIXED 128,983 - 899,712 161,420 867,276 STRUCTURES
Dwellings 8,042 - - 8,042 -
Non-residential buildings 80,405 - 625,592 103,313 602,683
Other fxed structures 40,536 - 274,120 50,065 264,592
HERITAGE ASSETS - - - - -
Heritage assets - - - - -
LAND AND SUBSOIL ASSETS - - - - -
Land - - - - -
Mineral and similar non------regenerative resources
TOTAL IMMOVABLE TANGIBLE 128,983 - 899,712 161,420 867,276 CAPITAL ASSETS
313 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
31.4 Capital Work-in-progress CAPITAL WORK-IN-PROGRESS AS AT 31 MARCH 2020 Opening balance Current Ready for Closing bal- 1 April 2019 year WIP use (Assets ance to the AR) 31 March / Contracts 2020 Note terminated Annexure 7 R’000 R’000 R’000 R’000
Heritage assets - - - -
Buildings and other fxed structures 1,207,709 509,736 - 1,717,445 Machinery and equipment - - - - Intangible assets - - - - TOTAL 1,207,709 509,736 - 1,717,445
Number of projects 2019/20
Age analysis on ongoing projects Planned, Planned, Construction not Construction Total started started R’000 0 to 1 Year 7 5 55,924 1 to 3 Years 4 6 236,038 3 to 5 Years 2 8 1,425,483 Longer than 5 Years - - - Total 13 19 1,717,445
Payables not recognised relating to Capital WIP Note 2019/20 2018/19 R’000 R’000 [Amounts relating to progress certifcates received but not paid at 10,349 30,862 year end and therefore not included in capital work-in-progress] - 1,299
Total 10,349 32,161
314 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
CAPITAL WORK-IN-PROGRESS AS AT 31 MARCH 2019 Ready for use (Assets Opening to the AR) ) balance Prior period Current year / Contracts Closing balance Note 1 April 2018 error WIP terminated 31 March 2019 Annexure 7 R’000 R’000 R’000 R’000 R’000
Heritage assets - - - - - Buildings and 1,200,365 - 856,728 849,385 1,207,709 other fxed structures Machinery and - - - - - equipment I n t a n g i b l e - - - - - assets TOTAL 1,200,365 - 856,728 849,385 1,207,709
Number of projects 2018/19
Age analysis on ongoing projects Planned, Planned, Construction Construction Total not started started R’000 0 to 1 Year 2 3 11,509 1 to 3 Years 5 10 1,195,443 3 to 5 Years - 1 757 Longer than 5 Years - - - Total 7 14 1,207,709
315 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
32. Principal-agent arrangements
32.1 Department acting as the principal
2019/20 201819
R’000 R’000
Include a list of the entities acting as agents for the department, the fee paid as compensation to the agent and any other transactions undertaken Management Fee 204,739 198,704
Total 204,739 198,704
The Department has entered into a Service Level Agreement with Safarmex for the management of the procurement, warehousing, distribution and information management for pharmaceuticals and surgical sundries.
The Department will have to apply emergency procurement should the services be terminated without suffcient notice, there are no fnancial implication directly linked to termination of contract with the service provider.
33. Prior period errors Note Amount bef Prior period Restated error correction error Amount 2018/19 2018/19 2018/19 R’000 R’000 R’000 Expenditure: Prior Period error on Capital Asset (Asset from Floor Note 1,371,396 16,473 1,387,869 not on FAR) 29.3 Prior Period error on Minor Asset (Asset from Floor Note 256,954 4,324 261,278 not on FAR) 29.4
Net effect 1,628,350 20,797 1,649,147
The prior period error relates to assets from foor not on the FAR when physical verifcation was done.
316 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Note Amount bef error Prior period Restated correction error Amount 2018/19 2018/19 2018/19 R’000 R’000 R’000 Liabilities: Correct PYE Claims Against the Note17 10,091,249 -475,180 9,616,069 Department (Annex 3B) Correct PYE Closing balance funds to be Note 12 319,755 -480 319,275 surrendered Correct PYE Net cash fow from operating Note 15 154,117 480 154,597 activities Correct PYE reconciliation of cash and Note16 75,273 -480 74,793 cash equivalent on cash fow Correct PYE Provisions for Litigation Note 27 36,600 4,000 40,600 Net effect 10,676,994 -471,660 10,205,334
The Prior year error on Note 17 and Note 27 relates to duplications and closed cases found during consolidation of all cases for the Department. The corrections on Note 12, 15 and 16 relates to unspent cash.
Note Amount bef error Prior period error Restated correction Amount
2018/19 2018/19 2018/19
R’000 R’000 R’000
Other:
Correct PYE Fruitless and Wasteful Note 5,476 -5,476 - 11.3
Net effect 5,476 -5,476 -
The Prior year error relates to Fruitless and wasteful expenditure written of in the previous fnancial year but not effected on the system.
317 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------2018/19 Amount spent by 1,744,102 department of Act Division Revenue 2,389,168 2,383,267 1,744,627
de- % of % of funds SPENT spent by available part-ment 313 100% - (Over- Under / spending)
de- Amount spent by 1,659,640 part-ment - - - by Amount received depart-ment - Total Total Available - 15,464 15,464 15,102 362 98% 15,021 14,653 - - - 124,390 124,390 2,126 123,202 2,126 1,188 2,126 99% 123,341 - 121,944 100% 2,322 2,320 - 344,915 344,915 343,722 - 120,901 1,193 120,901 100% 120,859 364,539 364,538 42 100% 121,653 121,297 GRANT ALLOCATION GRANT Other Ad- Other just-ments - 33,741 2,702,725 2,702,725 2,752,328 -49,603 - - - - 18,681 - 60,243 60,243 111,589 -51,346 185% - - 70,547 250,397 250,397 250,336 61 100% - - - -303 26,400 27,514 60,333 27,514 60,333 27,514 60,707 - -374 - -6,076 101% 100% 15,353 - - 15,353 15,163 190 99% 17,665 14,413 - -96,644 1,659,953 1,659,953 - - 21,136 - 21,136 21,136 22,368 -1,232 106% - Ad- DORA DORA just-ments Roll Overs - - - - of R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2,126 - vincial Grants 15,437 27 27,817 33,933 - - 41,562 18,654 2,775 Division 179,850 - 122,993 1,397 344,915 - 120,678 223 Act/ Pro- Revenue 2,664,562 4,422 1,756,597 - Comprehensive HIV Aids Grant and Community Outreach Services Component National Tertiary Ser- National Tertiary vices Grant Expanded Works Public Incentive Programme Grant Provinces for Social Sector panded Public Works Ex- Programme Incentive Grant for Provinces HIV & AIDS Compo- nent NAME OF GRANT Malaria Elimination Component Tuberculosis Compo- nent Revi- Facility Hospital talisation Grant Human Resources Capacitation Grant National Health In- (Health Grant surance Contract- Professional ing Subcomponent) Health Professions and Develop- Training ment Grant Human Papillomavi- Grant rus Vaccine 34. GRANTS RECEIVED OF CONDITIONAL STATEMENT
318 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------2,326 2,326 2018/19 Amount spent by 1,744,102 department of Act 2018/19 Division Revenue 2,389,168 2,383,267 1,744,627 of Act Actual transfer
Division Revenue de- % of % of funds SPENT - - 1,083 1,083 % spent by available part-ment 313 100% - Treasury Treasury or National by National Department (Over- Re-allocations Under / spending) - - de- Funds TRANSFER Withheld Amount spent by 1,659,640 part-ment - - - by Amount received Actual Transfer depart-ment - Total Total 1,359 1,359 1,504 1,504 2019/20 Total Total Available Available - 15,464 15,464 15,102 362 98% 15,021 14,653 - - - 124,390 124,390 2,126 123,202 2,126 1,188 2,126 99% 123,341 - 121,944 100% 2,322 2,320 - 344,915 344,915 343,722 - 120,901 1,193 120,901 100% 120,859 364,539 364,538 42 100% 121,653 121,297 R’000 R’000 R’000 R’000 GRANT ALLOCATION GRANT Other Ad- Other just-ments - - - 33,741 2,702,725 2,702,725 2,752,328 -49,603 - - - - 18,681 - 60,243 60,243 111,589 -51,346 185% - - 70,547 250,397 250,397 250,336 61 100% - - - -303 26,400 27,514 60,333 27,514 60,333 27,514 60,707 - -374 - -6,076 101% 100% 15,353 - - 15,353 15,163 190 99% 17,665 14,413 - -96,644 1,659,953 1,659,953 - - 21,136 - 21,136 21,136 22,368 -1,232 106% - Ad- DORA DORA GRANT ALLOCATION GRANT Roll Overs Adjustments just-ments R’000 R’000 1,359 1,359 Roll Overs DoRA DoRA transfers and other - - - - of R’000 R’000 R’000 R’000 R’000 R’000 R’000 R’000 % R’000 R’000 2,126 - vincial Grants 15,437 27 27,817 33,933 - - 41,562 18,654 2,775 Division 179,850 - 122,993 1,397 344,915 - 120,678 223 Act/ Pro- Revenue 2,664,562 4,422 1,756,597 - 35. MUNICIPALITIES TO AND OTHER TRANSFERS PAID GRANTS OF CONDITIONAL STATEMENT Comprehensive HIV Aids Grant and Community Outreach Services Component National Tertiary Ser- National Tertiary vices Grant Expanded Works Public Incentive Programme Grant Provinces for Social Sector panded Public Works Ex- Programme Incentive Grant for Provinces HIV & AIDS Compo- nent NAME OF GRANT Malaria Elimination Component Tuberculosis Compo- nent Revi- Facility Hospital talisation Grant Human Resources Capacitation Grant National Health In- (Health Grant surance Contract- Professional ing Subcomponent) Health Professions and Develop- Training ment Grant Human Papillomavi- Grant rus Vaccine NAME OF MUNICIPALITy Department of Community Liason Safety, Security, TOTAL 34. GRANTS RECEIVED OF CONDITIONAL STATEMENT 62.
319 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 184 R’000 14,185 14,001 Final 2018/19 Appropriation % 61% 99% % of Transferred Available funds Available 184 TRANSFER R’000 42,942 42,758 Actual Transfer 301 R’000 Total Total Available - R’000 9,281 43,325 9,281 43,024 for the year ended 31 March 2020 - - - Roll TRANSFER ALLOCATION TRANSFER Overs Adjustments ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS FINANCIAL ANNUAL THE ANNEXURES TO 301 R’000 R’000 34,044 33,743 Adjusted Appropriation COM:LICENCES TOTAL SKILLS DEVELOPMENT LEVY LEVY SKILLS DEVELOPMENT DEPARTMENTAL AGENCy/ ACCOUNT AGENCy/ DEPARTMENTAL ANNEXURE 1B ACCOUNTS AND AGENCIES DEPARTMENTAL OF TRANSFERS TO STATEMENT
320 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - 62,063 308,946 308,946 Final 2018/19 Appropriation - - % R’000 % of funds Available Available transferred - - EXPENDITURE Actual Transfer - - Total Total Available - 335,188 333,430 - - - 261,951 - 261,702 335,188 100% 333,430 246,883 - 73,237 71,728 98% ments Adjust------Roll overs TRANSFER ALLOCATION TRANSFER - - R’000 R’000 R’000 R’000 R’000 73,237 335,188 335,188 261,951 Act Adjusted Appropriation Appropriation Transfers NPI: District Health Services NON-PROFIT INSTITUTIONS NPI: Home Base Care Services Subsidies TOTAL ANNEXURE 1F NON-PROFIT INSTITUTIONS OF TRANSFERS TO STATEMENT
321 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - - 60 124,443 124,443 Final 2018/19 Appropriation - - % R’000 2% 1,064 99% 52,857 110% 31,194 100%100% 39,268 % of Transferred Available funds Available - - 24 33 EXPENDITURE Actual Transfer - - Total Total Available - 115,319 116,130 - - - 115,319 116,130 33 33 (26) 1,240 R’000 R’000 R’000 - - - 12,979 - (3,736) 25,786 (9,250) 45,673 28,389 42,587 45,531 42,153 - - - - - Roll Overs Adjust-ments TRANSFER ALLOCATION TRANSFER - - - R’000 R’000 1,266 12,807 49,409 51,837 115,319 115,319 115,319 115,319 Act Adjusted Appro-priation Appro-priation Transfers ON DUTY S/BEN:INJURY H/H EMPL GRATUITY S/BEN:LEAVE H/H EMPL STATE(CASH) AGAINST H/H:CLAIMS H/H:BURSARIES(NON-EMPLOYEE) H/H:DONATIONS&GIFTS(CASH) HOUSEHOLDS Subsidies TOTAL ANNEXURE 1G HOUSEHOLDS OF TRANSFERS TO STATEMENT
322 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
ANNEXURE 1H STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS RECEIVED 2019/20 2018/19 NAME OF ORGANISATION NATURE OF GIFT, DONATION OR SPONSORSHIP R’000 R’000 Received in kind Capitec Bank Lex mark Printer - 1 Standard bank List blue with oak chairs - 1 Bar Fridge - 1 Blue Maroon Chairs - 2 Orange Chairs - - Drawer Set - 2 Filling Cabinet steel - - Filling Cabinet wood - - Desk table - 1 Sasol Mine Toyota Hino Cab Truck - 1,500 Old Mutual OMF Table with Cabinet Drawers - 6 Sanlam Spectacles - 19 University of Pretoria Hearing AIDS - 57 university of Witwatersrand Computer - 3 Ndlovu Care Group Motor Vehicle Isuzu - 234 Motor Vehicle Ford - 277 Motor Vehicle Nissan - 141 Life Cosmos Hospital Beds - 10 Barberton Mines Bee company Drawer Filling Cabinet - 9 Litter Pedal Bin - 3 Notice Boards Standards 1000mmx 1200mm - 9 Chrome de lux 3 seater - 64 Chrome de lux 5 seater - 45 Allegro Desk - 16 Offce Operator Chair - 5 Boardroom Table - 7 Visitor (Boardroom ) Char - 15 Bassinet Complete with Crib - 5 34L Microwave Metallic (Defy ) - 2 Double door Fridge D320 Metallic (Deft ) - 6 Combi C 300 Eco W/M Fridge and Freezer (Defy ) - 4 Defy Bar Fridge 120l White - 2 Steel angle units (2. 1M high with 5x305M - 39
323 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Mel chip white linear ( 1. 8M High with 5x305M - 34 Accu-Check Instan Kit ( Glucose Meter ) - 1 Accu-Check Instan STR - 1 Blood pressure Mon. Arm (Medium Cuff) - 6 Blood pressure Mon. CF D 2SNG (Large Cuffs) - 1 Thermometer - - Step Double FM0052 - 5 Trolley Anae FM088 2 Drawers - 15 Suction pump askir 230 35x21x18CM - 5 Stretch 4 fold - 3 Drip Stand - 1 Digital Baby Scale - 1 HB Meter - 1 W/A Junior pocket 95001 diag 1 - 12 Scale bremed/digital 7780 SM27-200KG - 1 Wheelchair deluxe - 4 Patella Strap neoprene MX Universal - - Nebuliser easy breathe MX - 1 USAID Visitor Chair - 50 Laminating Machine - 2 Ring binding Machine - 3 Water Cooler - 2 Book shelve 5 tier - 2 Book shelve 5 tier - 3 Credenza - 2 Desk 1600x750 - 7 Round Table1200 - 3 Stationery Cabinet - 4 Table with steel pole - 25 Stationery Cabinet - 2 Tea trolley krost - 2 Urn salton 20l - 1 Microwave LG - 1 Fridge defy - 4 Reception unit - 9 laptop lenova - 101 laptop lenova T50 - 9
324 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
laptop unit trolly - 11 Project screen - computer lab 2 - 2 PA-System-computer - 1 White Board-Computer - 1 12M Container classrooms - Computer - 500 Kearneys Payicader - 141 M/Benz 309 CDI Sprinter - 110 Right to care Baby scale - 2 Adult scale - 16 Baumanometers - 4 Wall room thermometers - 5 Bar Fridge - 3 Credenza - 4 Desk offce - 12 Chair visitor - 20 Plastic chair - 2 Foot stool - 4 Notice Boards - 7 Examination Couch - 12 Hospital bed - 38 Pedal Bins - 3 Safarmex Medical Logistics (PTY) Memory Sticks 1 - LTD A5 Notes books 1 - Scythe Pens - - Golf Shirts 3 - Girt Bag 4 -
325 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
Medimerchant (PTY) LTD Trolley - - Ventilator : Respronics Bipad Vision 13 - Respiratory Care Africa (PTY)LTD Neopuff Infant Resuscitato, T. pience and resus kit 19 - Fisda Circuit 5 - Minosa Trading & Projects Fridges KIC Doors 35 - Health System Trust Computers 2,535 - Barcode Scanners 635 - Signature Pads 602 - Ruoters 229 - Range extenders 20 - Wineless USB 77 - Vodacom Simcards 63 - MTN Simcards 9 - Telkom Simcards 4 - Electrical Extensions cords 23 - Multi - Plus 23 - Ngondonqond Business interprises TV Sets 3 - Brackers - - Subtotal 4,304 3,708
TOTAL 4,304 3,708
326 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 - 60 60 R’000 2018/19 - 33 33 R’000 2019/20 Made in kind Ms E N Makhukhula I Nyathi T Ms TOTAL NATURE OF GIFT, DONATION OR SPONSORSHIP DONATION OF GIFT, NATURE (Group major categories but list material items including name of organisation ANNEXURE 1J AND SPONSORSHIPS MADE OF GIFTS, DONATIONS STATEMENT
327 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------Accrued guaranteed interest for year ended 31 March 2020 ------R’000 R’000 Revaluations due to infation rate move- ments Closing balance 31 March 2020 - - 56 - 101 157 - - - - - 157 - - - - Revaluation due to foreign currency movements ------Guarantees repayments/ cancelled/ re- duced during the year ------Guarantees draw downs during the year - - - - 56 Opening bal- ance April 2019 1 - - - 101 - 157 - - 157 - - R’000 R’000 R’000 R’000 R’000 R’000 Original guaranteed capital amount Subtotal Other Subtotal TOTAL Guarantee in respect of Motor vehicles Subtotal Housing Guarantor institution 0017 ABSA 0017 0152 Mpumalanga Housing Board ANNEXURE 3A ANNEXURE 31 MARCH 2020 – LOCAL AT AS GUARANTEES ISSUED OF FINANCIAL STATEMENT
328 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
- - - - Closing Balance 31 March 2020
- - - 9,474,227 - - - - - 7,555 119,259 - 35,115 9,636,156 - 9,636,156 details (Provide Liabilities hereunder) recoverable
- - - - 935 500 the year cancelled/ Liabilities paid/ reduced during
- - - - R’000 R’000 R’000 R’000 the year Liabilities incurred during
- - - - R’000 5,656 2,834 31,699 3,916 118,660 118,660 18,389 17,790 Balance Opening 9,405,893 1,154,584 1,086,249 9,561,907 1,179,723 1,105,475 9,561,907 1,179,723 1,105,475 1 April 2019 1 Medical Negligence Accident Motor Vehicle Claims against the department Unpaid Services Other Subtotal Subtotal TOTAL Other Subtotal Environmental Liability Nature of Liability ANNEXURE 3B 31 MARCH 2020 AT AS OF CONTINGENT LIABILITIES STATEMENT
329 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------R’000 201920 * ------Cash in transit at year end up to six (6) Receipt date working days after year end Amount ------Total 83 42 51 - 1,804 - - 1,804 - - 421 - 480 - - 258 - 469 outstanding 83 42 51 421 480 258 469 Unconfrmed balance - 1,804 - 1,804 ------outstanding ------Confrmed balance R’000 R’000 R’000 R’000 R’000 R’000 31/03/2020 31/03/2019 31/03/2020 31/03/2019 31/03/2020 31/03/2019 TOTAL Department of Health National Department Development, Land of Agriculture, Rural Department of Health KwaZulu Natal Department of Health Gauteng Department of Mpumalanga Social Development Department of Health North West Province Department of Health North West Departmen t Department of Education Mpumalanga Government Entity ANNEXURE 4 CLAIMS RECOVERABLE
330 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------R’000 ------up to six (6) working days Payment date Cash in transit at year end 2019/20 * before year end Amount ------640 - - 64 - 390 - TOTAL 10 18,732 90 - - 445 3,013 ------319 319 ------64 - 2 - - - outstanding Unconfrmed balance ------3,013 31 - - - 640 - - - 18,732 10 - 388 - 90 414 200 1,549 5,566 19,346 5,766 20,895 319 319 outstanding 1,023 24,641 5,607 19,412 6,630 44,053 Confrmed balance R’000 R’000 R’000 R’000 R’000 R’000 31/03/2020 31/03/2019 31/03/2020 31/03/2019 31/03/2020 31/03/2019 GOVERNMENT ENTITy DEPARTMENTS Current Department of Health North West Department of Public Mpumalanga Transport Works Roads and Offce of the Premier Mpumalanga Department of Education Mpumalanga Department of Health Eastern Cape Department of Health Limpopo Department of Health Gauteng Department of Justice Department of Security Community Safety and Department of Health KwaZulu - Natal Department of Labour Department of Public National Transport Works Roads and Subtotal ANNEXURE 5 INTER-GOVERNMENT PAyABLES
331 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 ------1,023 24,641 5,607 19,412 6,630 44,053 1,023 24,641 5,607 19,412 6,630 44,053 Non-current Subtotal OTHER GOVERNMENT ENTITy Current TOTAL Subtotal Non-current Subtotal TOTAL INTERGOVERNMENT PAyABLES TOTAL
332 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 59,456 (2,565) R’000 TOTAL - - 315,257 - 304,908 - - (11,995) - - - - (177,011) - - - - (61,692) - - 2,149,409 - - (1,965,951) R’000 inventory category of Insert major ------R’000 inventory category of Insert major - - - - 101 (317) 8,667 3,367 2,601 200,895 (208,579) R’000 Normal Inventory Warehouse Warehouse 59,356 (5,166) 306,590 301,541 (11,995) (61,375) (177,011) 1,948,514 (1,757,372) R’000 Inventory Pharmaceutical Inventories for the year ended 31 March 2020 Opening balance Add/(Less): Adjustments to prior year balances Add/(Less): Additions/Purchases – Cash Add: Additions - Non-cash Add: (Less): Disposals (Less): Issues Add/(Less): Received current, not paid received prior year) (Paid current year, Adjustments Add/(Less): Closing balance ANNEXURE 6 INVENTORIES
333 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
ANNEXURE 7 MOVEMENT IN CAPITAL WORK IN PROGRESS
MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE yEAR ENDED 31 MARCH 2020
Ready for use (Asset register) / Current year Contract Closing Opening balance Capital WIP terminated balance R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - Heritage assets - - - -
MACHINERy AND EQUIPMENT - - - - Transport assets - - - - Computer equipment - - - - Furniture and offce equipment - - - - Other machinery and equipment - - - -
SPECIALISED MILITARy ASSETS - - - - Specialised military assets - - - -
BIOLOGICAL ASSETS - - - - Biological assets - - - -
BUILDINGS AND OTHER FIXED STRUCTURES 1,207,709 509,736 - 1,717,445 Dwellings - 9,894 - 9,894 Non-residential buildings 1,188,062 495,417 - 1,683,478 Other fxed structures 19,647 4,425 - 24,072
LAND AND SUBSOIL ASSETS - - - - Land - - - - Mineral and similar non-regenerative resources - - - -
SOFTWARE - - - - Software - - - -
MASTHEADS AND PUBLISHING TITLES - - - - Mastheads and publishing titles - - - -
PATENTS, LICENCES, COPyRIGHT, BRAND - - - - NAMES, TRADEMARKS Patents, licences, copyright, brand names and - - - - trademarks
334 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
RECIPES, FORMULAE, PROTOTyPES, DESIGNS, - - - - MODELS Recipes, formulae, prototypes, designs, models - - - -
SERVICES AND OPERATING RIGHTS - - - - Services and operating rights - - - -
TOTAL 1,207,709 509,736 - 1,717,445
MOVEMENT IN CAPITAL WORK IN PROGRESS FOR THE yEAR ENDED 31 MARCH 2019 Ready for use (Asset register) / Opening Prior period Current year Contract Closing balance error Capital WIP terminated balance R’000 R’000 R’000 R’000 R’000
HERITAGE ASSETS - - - - - Heritage assets - - - - -
MACHINERy AND EQUIPMENT - - - - - Transport assets - - - - - Computer equipment - - - - - Furniture and offce equipment - - - - - Other machinery and equipment - - - - -
SPECIALISED MILITARy ASSETS - - - - - Specialised military assets - - - - -
335 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NOTES:
336 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NOTES:
337 Department of Health: Mpumalanga Province, Annual Report for 2019/20 Financial Year Vote No 10
NOTES:
338 Annual Report for 2019/20 Financial Year Vote No 10 INDWE (BUILDING NO.3) NO. 7 GOVERNMENT BOULEVARD RIVERSIDE PARK EXTENSION 2 NELSPRUIT 1200
PRIVATE BAG X 11285 NELSPRUIT 1200
013 766 3754 013 766 3475 [email protected] www.mpuhealth.gov.za
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Annual Report for 2019/20 Financial Year Vote No 10