Programme 3 Emergency Medical Services Emergency Medical Services and Patient Transport Services

PROGRAMME 3 EMERGENCY MEDICAL SERVICES EMERGENCY MEDICAL SERVICES AND PATIENT TRANSPORT SERVICES

PURPOSE been able to access medical services. To render an efficient, effective and professional Construction of two satellite bases at Mthatha and emergency medical service to the citizens of the Queenstown was completed Eastern Cape Province Challenges in the priority areas Programme description The EMS programme saw more challenges than The emergency medical services (EMS) programme achievements. The challenges included the reduced operates primarily from five main stations namely East funding which inhibited the construction of EMS bases. London, Mthatha, Queenstown, Mt Ayliff and Port The Fleet contract was not finalized and this impacted Elizabeth. A network of 61 satellite stations throughout on the number of vehicles that was readily available for the Province is linked to the five main stations. The service delivery. Response times were negatively operation of the EMS has previously not been aligned affected to a large extent due to fewer vehicles being to the health district boundaries; five bases had been available among other reasons. operating across seven health districts with the Establishment of new ambulance bases at Cacadu Cacadu and UKhahlamba districts managed from the and UKhahlamba districts was not achieved due to NMMM and Chris Hani bases respectively. The main limited funding components of the EMS programme are: The much needed Computer aided Call-taking and 1. Emergency services (Ambulances and Aero-medical Dispatching Systems was not finalized due to services) limited funding 2. White fleet (senior official and administrative 2010 FIFA World Cup Readiness was compromised vehicles) by uncertainty around Fleet Africa contract 3. Patient Transport Service regarding the number of vehicles to be availed; the 4. Paramedic and Rescue services department had to explore other avenues to the extent of securing own fleet to deal with the problem. Programme Objectives The Fleet Management system was not To provide a reliable and efficient EMS service for implemented due to limited funding the Eastern Cape communities 309 EMS professionals did not maintain their To ensure preparedness and adequate readiness for HPCSA registration requirements and had to be the 2010 FIFA World Cup EMS needs taken out the staff pool. This impacted negatively To develop effective EMS systems that will support on availability of staff. However, the department health care delivery service instituted a recovery plan. To strive towards achievement of National Norms Further challenges regarded integration of staff & Standards from the municipalities; the department is addressing the specific labour issues Service delivery achievements relating to Achieving targeted ambulance response times priority areas remains a challenge due to fleet and staff issues. Forty six new vehicles were procured to replace Rostered ambulances decreased significantly some of the ageing fleet and damaged vehicles; partially due to the ageing fleet and non- whilst this has not improved the number of replacements following accidents. vehicles however, the vehicle available was The aim of the EMS programme nationally is to improved as the older vehicles are constantly eradicate single-man crew in ambulances; the under repairs. percentage of ambulances with single-man crew in Aero medical services provision benefitted 105 the EC province remained consistently at about needy patients who otherwise would have not 20% over the years

191 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Despite this, the number of hoax calls received and to priority 2 and 3 clients (figure 3.1) that constituted responded to remains significantly high (4 210 as the bulk of the calls (45.5% and 37.9%) respectively. against 4 843) in the previous year These are patients with moderate and minor ailments Of major concern to the programme is the large and could be responded to within one hour of number of calls (23 492) with patients who cannot receiving the call. Patients relating to 23 492 calls be located could not be located and this is largely due to To address these two latter concerns, road shows infrastructural challenges in human settlements whilst were planned to profile appropriate utilization of the large number of hoax calls (4 210) remains a EMS Toll free line but was not undertaken due to challenge to the EMS health programme. shortage of human resources. Delays in awarding the Provincial Fleet contract to a A total of 354 927 calls (Table 3.1) were received and service provider resulted in fewer ambulances than these comprised a 14% reduction in number of calls anticipated, with an average of 169 rostered per compared to the previous year. The proportions of call month; this compromised the ambulance response categories however, were similar to those seen in times. 2008/09 (figure 3.1). EMS service was mainly provided

192 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 3.1: Number of EMS calls received distributed by client category

*EMS call category 2008/09 2009/10

Deaths (in ambulance) 239 195

Hoax call 4 843 4 210

Rescued cases 5 444 4 707

Death (on arrival) 6 348 6 078

Priority 1 response 17 003 12 420

Priority 2 response 192 137 161 601

Priority 3 response 154 206 134 472

Patient refuse service 9 363 7 752

Cannot locate patient 23 624 23 492

Total 413 207 354 927

193 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Figure 3.2 shows the 10 leading health conditions transported by emergency services. Maternity and physical assault were the two leading conditions that contributed the largest numbers of patients transported (about 13% and nine percent respectively). Other trauma, MVA and Asthma each constituting about five percent of the total, form a significant group as well.

194 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 3.2: EMS - Emergency Medical Service and Planned Patient Transport Compliance Indicators, 2009/10

2007/08 2008/09 2009/10 2009/10 Indicator Type Actual Actual Actual APP target

INPUT

Total rostered ambulances No 213 208 169 320 - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

Rostered ambulances per 1000 people No 0.04 0.03 0.04 0.04

Hospitals with patient transport vehicles (units not managed by EMS % 50 10 10 0 excluded)

PROCESS

Kilometres travelled per ambulance (per annum) Kms 109 587 150 080 190 829 152 000 195 Locally-based staff with training in BLS % 59 73 74 60

Locally-based staff with training in ILS % 39 25 23 35

Locally-based staff with training in ALS % 29 29 3.9 5

QUALITY

P1 (red calls) with response times <15 min in urban areas % 51 47.8 66.9 65

P1 (red calls) with response times <40 min in rural areas % 43 54.7 68.9 45

Percentage of operational rostered ambulances with single persons % 20.5 18.7 20.9 10 2007/08 2008/09 2009/10 2009/10 Indicator Type Actual Actual Actual APP target

EFFICIENCY

Ambulance journeys used for hospital transfers % 22 24.2 20.2 40 - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

Green-code patients transported as % of total % 37.2 37 37.9 60

Cost per patient transported R 802.69 754 1235 950

Ambulances with less than 200,000kms on the clock % 97 92 69 100 196 OUTPUT

Patients transported (by PTV) per 1000 separations No 24 17 11 35

VOLUME INDICATOR

Number of emergency call-outs No 479 263 392 916 354 927 650 000

Patients transported (planned patient transport) No Not reported Not reported 207 528 463 601

*EMS manages all PTVs and dispatches these to institutions as per need Table 3.3: Performance against Provincial Targets for 2007/08 – 2009/10 Strategic Plan for EMS

Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Improve access to Number of additional 51 60 110 46 Expiry of existing service vehicles to be EMS contract and - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT procured, including delay in awarding of emergency medical new one negatively rescue vehicles affected achievement of target

Ensure availability of Number of critical Ad hoc tender on Two year aero- 139 105 Expiry of existing adequate aeromedical patients transported aeromedical services medical service EMS contract and services to the with the aeromedical was implemented – tender awarded: delay in awarding of community especially services patients airlifted new one negatively the inaccessible were not reported 139 critical patients affected achievement 197 remote areas of the airlifted of target province Improve response Percentage of red 51 47.8 55 66.9 Installation of a times calls responded to computerized call within 15 minutes of taking and dispatching call system will strengthen reliability of EMS data

Percentage of red 43 54.7 55 68.9 calls responded to within 40 minutes of call

Percentage of all calls 78 76 75 76.4 This is attributed for responded to within vehicle shortages and 60 minutes staff shortages To reduce callout Percentage of 20.5 15 20 20.9 This is attributed to serviced by one-man rostered ambulances failure to employ new crew with one-man crew staff during this financial year Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of new staff 753 55 Total = 258 9 new Staff were Budget constraints on employed BLS = 242 employed i.e CoE prevented Managers = 5 7 ALS and 2 managers further employment ALS = 11 of new staff - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Development, Number of vehicles 259 259 417 230 All 46 new vehicles management, fitted with satellite (including 46 new were fitted with monitoring & tracking system 110 new vehicles) satellite tracking evaluation of the 307 existing system. rendering functioning All 184 ambulances of emergency medical were fitted, and the rescue services rest are not ambulances

198 Computerised call Not Reported Not Reported Computerized call Not finalized The infrastructure to taking and dispatching taking & dispatching install this system is system with caller system implemented being developed at identification and fully functional various EMS developed and implemented A temporal arrangement of call taking is piloted with the EC DoH contact centre

To align EMS Metro Number of EMS Alignment plans were 2 Metro bases Additional 2 (to make New Metro Services The department must bases in line with the metro bases developed 7) EMS centres to are not yet first deal with HR STP proposal to established align with health established at Cacadu capacity issues maintain 7 Metro district boundaries. and Ukhahlamba. bases, one for each health district Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of satellite 7 2 10 2 satellite bases Construction works bases constructed or completed i.e suspended at Mt Ayliff renovated. Mthatha and due to resource Queenstown is new Queenstown bases; limitations;

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT and Mthatha was renovated.

Ensure readiness for An approved 2010 Plans were 2010 Project Unit Readiness Plan The 2010 Health 2010 FIFA Soccer FIFA Soccer World formulated for EMS was established finalized and Preparedness Plan for World Cup Cup Readiness Plan strategy to improve implemented the FIFA Soccer implemented service delivery World Cup has been finalized and ready for implementation.

199 Provide effective Number of patients 312 000 369 029 963 798 308 688 The Fleet challenges emergency care and transported in impacted negatively transportation of emergency medical on achieving the indigent patients vehicles target

Facilitate development Disaster Management No policy in place No policy in place Disaster Management Disaster management All 7 districts of Disaster Policy developed & Policy approved & policy guidelines received training on Management Policy implemented implemented finalized and the policy guideline approved by the 2010 committee.

Increase community Number of Number not Number not 150 110 Target was not awareness about EMS Campaigns conducted reported; reported; reached due to lack and facilitate to profile the Educational sessions Educational sessions of funds. responsible use of the utilisation of EMS Toll- conducted included: conducted included: EMS resources free number in Radio sessions Radio sessions schools, churches, Attending school Attending school radio and billboards career day events career day events Conducting EMS Conducting EMS workshops workshops EXPOs EXPOs Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To provide effective Number of rostered 213 208 210 169 Fleet Contract and efficient EMS ambulances (available ambulances) challenges resulted in services non-replacement of vehicles and

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT negatively affected target achievement

EMS total Kms 109 587 150 080 152 000 190 829 Decreased number of travelled per vehicles due to non- ambulance replacement resulted in drastic increased Kms travelled per vehicle 200 EMS referral cases Not reported Not reported 80 000 70 413 Limited availability of Patient Transport Vehicles. PROGRAMME 4 PROVINCIAL HOSPITAL SERVICES PROGRAMMME 4: PROVINCIAL HOSPITAL SERVICES

PURPOSE developments with regard to diseases, prevention To provide good quality, effective, efficient, and cost- and management thereof. The patients are also effective secondary and tertiary hospital service attended to in the lower health care levels, hence the Service support. Programme description - EL Hospital Complex does outreach on: ENT, The hospital Management Services is composed of five Pediatrics, Surgery, Anesthetics, O & G, Oncology, sub-programmes viz: Ophthalmology, and Clinical Support Services. - Mthatha Hospital Complex: Pediatrics, Surgery, O & 1. The three Hospital Complexes and two Regional G, Orthopedics, Ophthalmology, and Clinical Hospital Support Services. 2. TB Management - PE Hospital Complex: Ophthalmology, Oncology, 3. Specialised Services Pediatrics, Radiology, O & G, Surgery, Internal 4. Medical Services Medicine, Cardiothoracic, Anesthetics, Cardiology, Hematology, O&P, Optometry. The technical 5. Nursing Services section of Facilities management assists smaller institutions such as Somerset East, Graaff Reinet, SUB-PROGRAMME 4.1: HOSPITAL Humansdorp. COMPLEXES AND REGIONAL - Frontier: O&G, Pediatrics, Ophthalmology, Clinical HOSPITALS Support Services. - St Elizabeth: O&G, and In-reach on Ophthalmology. Programme priorities 1. To implement Academic and Service Support 2. Hospital Improving Programme programme There is no separate funding for this program. 2. To implement the National Health System priorities relating to Hospital Improving Some equipment has been received by the Programme hospitals such as for Oncology services, ventilators, renal machines. The big challenge lies with the funds 3. To implement, improve, monitor and report of to purchase and maintain equipment. early warning systems in Regional, Tertiary hospitals Quality of care is maintained – Hospital acquired infections and efficiency performance indicators are 4. To prepare and ensure readiness of the three monitored (the problem is still with ALOS, Tertiary hospitals for the 2010 FIFA Soccer World c/section rate, case fatalities), clinical audits are Cup conducted in some areas of the hospitals, patient waiting times are monitored, the number of ART Service delivery achievements on programme priorities patients registered in the Complexes and Regional hospitals is monitored and the annual target has 1. Academic and Service Support programme: been exceeded. HR- appointments have taken place in the hospitals, Provincial hospitals provide support to lower level as well as training. health facilities in the areas listed below. This is DHIS 1.3 has been converted to DHIS 1.4 aimed at assisting the health professionals to be Strengthening of DHS/ PHC: outreach programs able to deal with the patients that can be handled are conducted to District Hospitals and CHCs, and at PHC & District levels and prevent unnecessary some clinics. referrals to the higher levels of care. The doctors and other health professionals are given in-service education & training so that they are able to handle the different conditions the patients are suffering from and also to be updated on the new

202 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 3. Infrastructure: Hospital Revitalization and Challenges limiting service delivery Step down facilities - Budget constraints leading to shortage of basic Hospital Revitalization infrastructure is under material resources and inability to repair/ maintain programme 8. equipment. Step-down facilities at East London and Mthatha - Staff shortages and high vacancy rates for Hospital Complexes are still not fully functional. Specialists, health professionals, support staff. St PE Hospital Complex has a 20- bedded well Elizabeth Hospitals does not have even a single functioning step-down facility. specialist. - Difficulty to retain staff. 4. Early warning systems in Provincial hospitals - High influx of Level 1 patients to secondary and tertiary services institutions, some being Early warning systems are in place in PE Hospital inappropriate referrals, some are walk-ins and Complex and are being upgraded under the cannot be denied access provincial maintenance contract. - The referral system is not working well and poor transport for patients also poses a big challenge. 5. The 2010 FIFA Soccer World Cup Readiness - Still experiencing long waiting times in different areas of the hospitals like patient registration, The A&E building, Isolation Unit and Ward ablutions theatre, pharmacy. at Livingstone Hospital (PEHC) will be completed - Shortage of space/ beds in all the hospitals by 31 May 2010. especially in some critical areas such as Neonatal areas and Internal Medicine that are linked to change in disease burden especially the high load of The two wards at PE Provincial Hospital (PEHC) HIV related disorders. are scheduled to be completed on 04 June 2010. - Inability to separate Level 1 and Level 2 patients.

Table 4.1: Highlights on service delivery by hospital

Hospital Highlights at a glance

Frontier Regional Hospital 8 functional clinical department Reduction in complaints and increase of compliments Improved outreach and support to District Health Services Completion and Handing over of ICU, High Care, Burns, Theatre, X-Ray and 4 wards Coaching and Mentoring project for hospital Middle Management Strengthening financial management- appointing Financial Manager Strengthening of patients administration (increased staffing, changing shift system, seeking additional support from Hospital Board Ability to provide reasonable accommodation for health professionals and office support staff for heads of departments Established Clinical Engineering Dept and one clinical engineer trained in India through the Eastern Cape Blindness Prevention Program (ECBPP) - Providing Comprehensive IT support for the Western Region Successful retention of Community Service health professionals Boundary fence surrounding the hospital completed at Dora Nginza

203 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Hospital Highlights at a glance

Port Elizabeth Health Complex Midwifery Obstetric Unit (MOU) opened at Dora Nginza hospital in (PEHC – Dora Nginza, collaboration with NMB District Livingstone & PE Provincial 27% increase on cataract surgery rate as compared to previous year hospitals Functional outreach programme ART site at PE Provincial Hospital accredited and functional New controls for NHLS- laptops for individual doctors for blood results Open days for Burns, Prem Unit, Diabetes, etc. 2 food gardens at Dora Nginza and PE Provincial with community participation 20 bedded Family Medicine established at Dora Nginza New equipment for Optometry, Audiology. New digital screening units for Livingstone and PE Provincial Providing Comprehensive IT support for the Western Region Successful retention of Community Service health professionals Boundary fence surrounding the hospital completed at Dora Nginza

East London Hospital Complex Functional Clinical audit committees established per department (Cecilia Makiwane & Frere Adverse events subcommittee and reporting through the pharmaco- Hospitals) vigilance programme Quality circles monitors the daily service delivery issues with teams Complaints and compliments management process in place Introduced Chronic Drugs Down-Referral Programme & piloting use of SMS to alert patients on delivery of their drugs Retained 39 SMOs First Pilot and institution to Rollout Cost Centre Management Trained Clinical Heads of Unit ('HOD') in Cost Centre Management

204 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 4.2: Compliance Performance Indicators for Provincial Hospitals

2007/08 2008/09 2009/10 2009/10 Indicator Type Actual Actual Actual APP target

Output

1. Caesarian section rate – for regional hospitals % 31.8 35 22 37.5 - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT 2. Separations – Total Number 226 391 226 888 203,955 227,342

3. Patient day equivalent (PDE) Number 1 554 451 1 609 811 1 620 165 1 626 129

4. OPD total head count Number 804 455 859 641 1 051201 1 597 401

Quality

5. Regional hospitals with patient satisfaction survey, using 205 % 100 60 50% 100 Department of Health template

6. Regional Hospitals with morbidity and mortality meetings every % 20 100 100 100 month

7. Regional hospitals with clinical audit meetings every month % 20 17.9 100 100

Efficiency

8. Average length of stay (ALOS) in regional hospitals % 5.2 5.3 4.9 5.6

9. Bed utilization rate (BUR), based on usable beds, in regional % 73.3 75.1 75 73.7 hospitals

10. Expenditure per patient day equivalent in regional hospitals R 1,590 1,300 750

Outcome

11. Case fatality rate in regional hospitals for surgery separations % 3.8 3.7 2.5 3.4

12. Case fatality rate – total (%) % 6.5 6.2 4.2 2.5 Table 4.3: Distribution of Beds in Provincial Hospitals

Actual Performance Output Output performance Measurable Objective measures/ indicators Actual 2007/08 Actual 2008/09 Actual 2009/10

To improve quality of care Total number of usable beds in 4710 4382 4611 - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

East London Health Complex

Frere 939 875 875

Cecilia Makiwane 809 737 737

Port Elizabeth Health Complex 206 Dora Nginza 622 570 570

Livingstone 552 492 493

PE Provincial 161 148 156

Mthatha Health Complex

Nelson Mandela Academic 552 516 507

Bedford Orthopaedic 197 180 367

Mthatha General 300 329 333

Regional Hospitals

Frontier 278 254 277

St Elizabeth 300 281 296 output Explanation of Explanation target and actual and actual target variance between between variance Exceeded target by 1 Exceeded target by 850 (43%) achieved Target New policies and New to were procedures 1 patients Level at higher present due to their levels to close proximity these facilities or poor functioning be developed when a be developed need was identified 2009/10 Actual Output Actual Output 6 150 Adults = 5 536 = 614 Children 86 No new policy policy No new developed Not measured 2009/10 Annual Target Target Annual 80 1 Policy to be 1 Policy developed. 20% 4 300 Adults = 4000 = 300 Children 2008/09 Actual Output Actual Output 12 Not reported Not measured 1 074 Adults =1 006 = 68 Children 2007/08 Actual Output Actual Output Not measured Not reported Not measured 4031 Adults =3 535 = 496 Children Performance Performance measure/ Indicator measure/ Number of district hospitals supported the academic through and service support programme % of Level 1 patients 1 % of Level 2 & 3 in levels hospitals ART Number of new at patients registered hospital complexes and Regional hospitals Number of new Number of new policies and governing procedures tertiary and regional hospitals developed Objective Programme Programme To expand the To implementation of HIV comprehensive AIDS programme and the and increase ART of new number To facilitate the To implementation of policy and referral 1 patients Level reduce 2 & 3 in Levels To strengthen the strengthen To implementation and functioning of the tertiary and Regional hospital services 4.1 COMPLEXES AND REGIONAL HOSPITALS 4.1 COMPLEXES patients in Regional hospitals Tertiary and by 20%. hospitals Table 4.4: Performance against Provincial Targets for 2009/10-2011/2012 Strategic Plan Strategic 2009/10-2011/2012 for Targets Provincial against Performance 4.4: Table

207 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To monitor compliance % of invoices paid Not measured Not measured 60% paid within 30 ELHC = 71.5% Target achieved with PFMA within 30 days of days of receipt of MHC = 60.3% invoicing invoice PEHC = 83.3% St Eliz = 64.5%

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Frontier = 77,12%

To improve access and % Progress attained See programme 8: See programme 8: See programme 8: See programme 8: Performance on this service delivery by in revitalization of Health Facilities Health Facilities Health Facilities Health Facilities output is reported in revitalizing regional Frontier and St Management Management Management Management Programme 8 under hospitals Elizabeth hospitals revitalization sub- programme

Number of health Not reported Not reported Total employed: No plans to appoint professionals and health professionals

208 MOs appointed in Frontier = 72 in the revitalization hospitals under St Eliz = 46 program at Frontier revitalization programme

Number of hospitals 3 complexes Functionality of step 1 Regional hospital No Step down Plans to establish a establishing a step- down facilities at all 3 (Frontier) established. step down facility at down facility complexes is the Frontier regional inadequate and needs hospital were to be strengthened suspended due to a re-focus in finalizing the neonatal unit (which is now fully functional).

PEHC Dora Nginza : 20 beds out of planned 40 fully functional at 90% occupancy Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Build capacity for 2010 Number of hospitals Casualty units only Procurement process Complexes = 3 PEHC A&E Unit is PEHC: A&E Unit to FIFA Soccer World with Accident & not finalized yet at Regional hospitals=2 complete and ready be ready by 31 May Cup Readiness Emergency (A&E) Livingstone (PEHC); for the 2010 FIFA 2010. Could not Units fully established NMAH (Mthatha World Cup appoint Trauma

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Complex) has Specialist (Advertised established unit; Mthatha HC has a & tried to head-hunt ELCH and the fully established A&E with no success) regional hospitals still Unit that is well have Casualty unit. equipped;

Health professional Cecilia Makiwane is appointed and under revitalization trained. programme and the Casualty will be

209 CMH Casualty not constructed through revamped due to this process shortage of funds

To improve quality of Number of Total number of Total number of 20% lower than Total number of Account for variance care in provincial complaints relating to complaints received – complaints received- 2008/09 output complaints received: No numbers received hospitals in line with quality of care Not measured not measured 212 from MHC and PEHC the National Systems reduced Priorities ELHC= 94 Regional Hospitals St Eliz= 63 received more Frontier= 55 compliments than complaints

% of complaints 50% 44% 70% ELHC: 85.6% ELHC- Complaints resolved in 30 days MHC: 36.1% more on clinical PEHC: 45% issues and Frontier: 96.75% administration. St Elizabeth: 83% Mthatha – more complaints on hotel services. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of provincial Not reported Not reported 10 10 Target achieved hospitals with functional audit committees in place - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT % of audit 20% 17.9% 80% Province = 76.5% The main challenge is committees holding Mthatha. This is being audit meetings at ELHC = 70% addressed and already least once a month i.e MHC = 41% a structured program Clinical audit rate PEHC = 100% is in place for 2010- Frontier = 96.4% 11. St Eliz =75%

Number of hospitals Not measured Not measured 3 Complexes 1 hospital complex Planning for the 210 with hub and spoke 2 Regional hospitals PEHC developed development of Tele- systems for Tele- Tele-trauma Medicine is at medicine developed advanced stage for the other hospitals in the PEHC.

Average length of stay 5.2 5.3 4.9 days 5.6 It is highest at in facility (ALOS - Bedford Orthopedic days) Hospital because of the orthopaedics has a longer ALOS.

Bed utilization rate 73.3% 75.1 75% 73.7 Even though the BUR on usable beds (%) is within the norm, Internal Medicine has a BUR of more than 100% due to HIV related illnesses and this puts a strain overall on the services Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Caesarean section 31.8 35 22 37.5 High rate is due to rate (%) disease burden. Nelson Mandela Academic Hospital

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT has the highest rate at 75%.

Case fatality rate for 3.8 3.7 2.5 3.4 This is still higher surgery separations than the norm due to (%) the burden of disease

Number of cataract 2 853 3 237 5200 4627 Below norm due to operations financial pressure in performed the last quarter 211 Strengthen infection Number of hospitals 1 (St Elizabeth) 2 (St Elizabeth and 5 i.e. 5 i.e. 3 hospital Target achieved control measures in reporting on ELHC) 3 hospital complexes complexes and two hospitals nosocomial infections and two Regional Regional hospital hospital

Highest recorded <0.7% <1.4% <1% 1% nosocomial infection rate at any one point in time

To conduct staff and Number of patient 3 complexes & 2 3 complexes & 2 2 surveys (1 patient, 1 All Complexes and Study not conducted patient satisfaction and staff satisfaction Regional hospitals Regional hospitals staff) per institution the Frontier hospital at St Elizabeth due to surveys surveys conducted conducted studies financial constraints per institution. but used the complaints/compleme nts inputs to gauge. There were more complements than complaints. A survey will be done 2010-11 SUB PROGRAMME 4.2: TB CONTROL Reduce the human suffering and socio economic burden associated with TB. PURPOSE: Home visits are being conducted to households for To control the spread of TB, manage individuals MDR and XDR-TB patients by a team of social infected with the disease and reduce the impact of the workers, and infection control nurses from MDR disease in the communities. centres. The purpose of home visits is to conduct house-hold assessment and provide health education with regard to infection control measures and MDR- TB Control programme is composed of the TB to significant others to prevent them from following sub programmes: contracting the disease. 5 (Themba, P.Z. Meyer, TB Management Winterburg, TB hospitals, Marjorie Parish and Marjery TB HIV sub-programme Parkes) were accredited as ART sites as a means to Advocacy, Communication and Social Mobilization reduce morbidity and mortality amongst the co- (ACSM) subprogramme infected patients. Inpatient Care Protect poor and vulnerable populations from Programme Priorities TB, TB/HIV, multidrug-resistant and extreme Achieve universal access to high quality diagnosis drug resistant and patient –centred treatment TB. Community – based activities and support: TB Reduce the human suffering and socio economic awareness and education among EC communities was burden associated with TB done in collaboration with the EC DOH partners (9 Protect poor and vulnerable populations from TB, NGO's) in the form of TB awareness campaigns and TB/HIV, multidrug-resistant and extreme drug workshops on basic TB information at Makana sub- resistant TB. district and Alfred Nzo. A TB big walk in partnership Support development of new tools and enable with SANTA was held in three districts, Alfred Nzo, their timely and effective use. Amathole and Cacadu. Imbumba Yamakhosikazi Conduct surveys to determine provincial Akomkhulu (IYA) played a leading role in supporting prevalence of XDR-TB treatment adherence programs by using traditional Ensure availability of Key drugs to treat and control councils as treatment points for patients on treatment XDR-TB. in the community. Awareness and Infection control at home is further increased through Radio slots using Strengthen infection control measures to protect WSU, Grahamstown, Cacadu and Mhlobo Wenene to staff. disseminate message on management of contacts and Capacitate health professionals, on the use of new infection control at home. drugs, clinical management and adverse event reporting. Ensure availability of Key drugs to treat and control XDR-TB. Service delivery achievements on programme An MDR-TB Clinical Review Committee for M(X) DR- priorities: TB was established in October 2009, in order to provide advice and recommendations on regimens for Achieve universal access to high quality patients who are not showing progress. XDR-TB diagnosis and patient –centered treatment. Drugs are available and there are new drugs added to The introduction of the Line Probe (TB Rapid Test) has regimens from group 5 drugs, as Salvage Therapy for reduced the Turn Around Time for the TB Culture patients who do not convert after 6 months. results from 6 weeks to 7 days, resulting in early diagnosis of patients and commencement of treatment Strengthen infection control measures to as soon as they are diagnosed with MDR-TB. The TB protect staff. Public Private Mix (TB/PPM) Project has been All the 10 TB hospitals have developed infection established, with General Practitioners at the Nelson Control plans in line with the infection Control Mandela Metro, which resulted in improvement in Guidelines, The N95 Masks, are available and used by clinical management of TB patients. staff as Personal protection mechanism. M(X) DR-TB

212 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 institution (Jose Pearson and Fort Grey) and 3 TB Challenges limiting service delivery hospitals (Marjery Parkes, Khotsong and Winterburg) There has been a challenge of unavailability of First have Extraction Fans and UV-Lights installed, as an Line Anti –TB drugs, especially Streptomycin due to additional protection for the staff. the fact that suppliers could not meet the demand throughout the country. Capacitate health professionals, on the use of Limited Budget poses a challenge in implementing new drugs, clinical management and adverse some of the activities like the installation of event reporting. mechanical Ventilation for all the TB hospitals 635 Health Professionals, 240Doctors and 395 Nurses including out patients in General hospitals. have been trained on Clinical management of TB, No surveys were conducted due to lack of funds. TB/HIV, MDR and XDR-TB management. This will be considered in the next financial year (2010/ 2011)

213 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 4.4: Performance against Provincial Targets for 2009/10-2011/2012 Strategic Plan

Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

4.2 TB MANAGEMENT

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT To reduce the number PTB incidence rate 645 877 900/100,000 857/100 000 of new TB cases in the (annualized) province by implementing national Total number of 55 984 62 846 62 000 64 913 TB Control guidelines clients diagnosed with TB (all types of TB)

Total number of 42 628 58 203 60 000 56 975 clients diagnosed with

214 pulmonary TB

% of suspected cases 3% 3% 2-10% 4% testing positive for TB

% of new smear 7.3% 7.3% 6% 7.4% positive patients interrupting treatment

% of new smear 46% 58% 68% 57.7% positive patients converting at 2 months % of new smear 61% 60.3 (14 402 of 23 65% 57.2% positive patients 891) cured at first attempt

% of test results 66.9% 70.3% 75% 75% Target achieved received within 48 hrs Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

TB/HIV

To strengthen Number of TB 1 4 4 5 Target achieved integration of TB/HIV hospitals newly - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT accredited as ART sites

Number of TB clients Not measured 1477 5000 3376 newly registered on ART programme

% of TB clients 73% 78% 80% 70.6 screened for HIV

215 % of co-infected 95% 97% 98% 78.% Poor recording and patients on CPT reporting and prophylaxis capturing of HIV information on ETR

INPATIENT CARE

To strengthen infection Number of TB Not reported 2 9 9 Target achieved control measures in TB hospitals with hospitals by developing infection control infection control plans plans

To strengthen Number of MDR MDR guidelines 2 2 (Jose Pearson 1 (Majorie Parrish) implementation of centres adhering to reviewed by the and Marjorie Parrish MDR/XDR TB appropriate MDR/ national Department Satellite unit) management guidelines XDR-TB regimens of Health

To ensure optimal Bed utilization rate Not reported 73.1% 85% 71.5% Affected by Marjorie utilization of the TB (BUR) in TB hospitals Parrish TB hospital hospitals which is utilized as an MDR satellite. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Not measured % of ordinary TB 51.3 50% retreatment patients hospitalized for more than 3 months - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT % of MDR TB Not measured Not measured Less than 45% 38.5 Target achieved patients hospitalized for more than 6 months

% of XDR TB patients Not measured Not measured Less than 50% 49.1 Target achieved hospitalized for more than 12 months

216 Cost per patient per Not reported Not reported Ordinary TB – R350 R465 day

Not reported Not reported MDR TB – R800 R1560.30

Not reported Not reported XDR TB – R1,000 R1661.87

To enhance and Number of non - Not measured Not measured 1 (Nkqubela) 1 (Nkqubela) Target achieved strengthen TB governmental TB management hospitals provincialised Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of SANTA 0 0 5 4 hospital properties purchased

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Interim Provincial Not measured Not measured MDR/XDR TB clinical 1 adhoc MDR/ XDR- Target achieved MDR/XDR TB clinical review committee TB Clinical Review review committee approved & fully Committee is in place established functional and functional

ADVOCACY, COMMUNICATION AND SOCIAL MOBILISATION (ACSM)

To increase awareness Number of TB None 2 4 7 Target exceeded due about TB among awareness events to support by Eastern Cape conducted amongst partners 217 communities by Eastern Cape conducting TB events Communities

Number of 1 4 4 6 Target exceeded due stakeholder TB to support by imbizos conducted partners

No. Stake holder Not measured Not measured 4 4 Target achieved Engagements held with house of traditional leaders No. of Consultation 4 4 Not measured Not measured Due to budget Forums with constraints councillors

Number of Radio 10 47 30 27 Budget constraints Slots /transmissions implemented

Number of print Not measured Not measured 3 6 Target exceeded due media adverts to support by partners Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

TB communication Not measured Not measured TB communication - Not funded strategy developed strategy approved

Number of health 2 100 2 636 1 500 1270 - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT professionals trained 405 doctors 635 -Health on TB, MDR/XDR TB 1716 nurses Professionals and TB/HIV guidelines 240 –Doctors 395 – Nurses

Number of quarterly Not measured Not measured 4 4 Target achieved TB reviews sessions held

Number of sessions No private –public Not measured Not measured 2 Public Private Mix 1 Still strengthening the 218 held by the Private- mix forum existed sessions one already started at Public Mix Forum NMM SUB-PROGRAMME 4.3: SPECIALISED SERVICES

PURPOSE To provide cost-effective, equitable, accessible and integrated Mental Health Services,

Programme description The Specialized Services sub-programme is composed of three components and provides: Psychiatric Hospitals Services

Table 4.6: Mental Health Facilities in the EC Province

Mental Hospital Location Number of beds Fort England Hospital Grahamstown 313 Elizabeth Donkin Hospital Port Elizabeth 171 Tower Hospital Fort Beaufort 400 Komani Hospital Queenstown 440 Mental Health Unit East London CMH, East London 50 Flagstaff Holy Cross 4 Libode St Barnabas 33 Mthatha Mthatha Academic Hospital 60

ECDOH Mental Health Service Subsidiaries/ Collaborators

Esidimeni Centres (3) 975: Kirkwood Kirkwood 700 PE Algoa 145 EL Nkqubela 130 Aftercare Haven PE 60 Capricorn PE 10

Programme priorities o Developing a child psychiatric Unit in Port 1. To expand psychiatric services within the Province Elizabeth by 2. To facilitate implementation of the Mental Health Establishing a 20 bedded observation Unit at Care Act No.17 of 2002 Fort England hospital Developing a child psychiatric Unit in Port 3. Challenges limiting service delivery Elizabeth Budget for transport and accommodation for the 2. To facilitate implementation of the Mental Health training of clinicians and district hospitals on the Care Act No.17 of 2002 implementation of Mental Health Care Act was not available. Service delivery achievements and progress Non-availability of multi disciplinary team that form made on programme priorities up clinical c audit team due to reluctance of 1. To expand psychiatric services within the Province specialists to work in rural areas leads to clinical by audit not conducted in Flagstaff and Libode. o Establishing a 20 bedded observation Unit at Fort England hospital

219 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 4.7: Highlights on service delivery

Hospital Highlights at a glance

Fort England Hospital Serves as a Tertiary Psychiatric Hospital. Have 313 bedded capacity. It has a dedicated Maximum Security Unit which is a wing attached to the Institution. It is used for Forensic Observation for all cases referred by the courts in the whole country.

Serves as training institution for Clinical Psychologists, Nursing students It is the first institution outside Mthatha Hospital complex to have a structured programme for medical students' undergraduate training as part of the decentralized Academic complex.

It also renders Drug and Substance abuse Rehabilitation Unit for the Province. Admission is on a voluntary basis.

FEH also conducts outreach services to surrounding Institutions around Makana District and Nkonkobe to improve access to Psychiatric services.

Elizabeth Donkin Functions as an Acute Psychiatric Hospital for the Western part of the Province. Have a196 Hospital approved beds but utilizing 171 usable beds. (25 bedded ward was burnt down but not replaced.)

EDH is faced with a chronic problem relating to infrastructure. Has been unable to make renovations to improve the outlook and to provide proper therapeutic accommodation for the care of mentally users referred to the facility. The main reason is that EDH was commissioned to accommodate TB Patients and was later changed to accommodate or serve as a Psychiatric Hospital. The second reason was reluctance by Province to spend financial resources on EDH while a plan for relocating of EDH TO Dora Nginza was on process.

The delay is resulting to negative access to psychiatric care to those users who require inpatient care and compromised quality of care that is being rendered.

There is a challenge of leadership/ management for EDH which has resulted to long use of acting managers causing disputes as it also contravenes departmental employment policies (Acting Policies, Labour Relation policies). There are many unresolved disputes. This is having an impact on the supervision and service delivery at this institution.

Tower Hospital Serves as a Rehabilitation centre for Mental Health Users for the entire Province. Have 400 approved beds. Users undergo group therapies Occupational Therapy and trained on Leather works, shoe repairs and gardening.

Due to mindset of the public and other institutions, who continue to refer users who are non rehabilitative for long term care when they are unable to place them in other facilities. This leads to low number of cases admitted who can undergo rehabilitation and thus resulting to low total number of discharges as a rehabilitation centre especially since it is serving the province.

Due to rurality of the location it finds difficulty to compete with urban institutions when attracting clinicians. Has high vacancy rate for clinical staff.

220 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Hospital Highlights at a glance

Komani Hospital Provides acute and long term Psychiatric care for the Mental Health Users admitted in the Facility. Has a large catchment area since it is also admitting users from the Eastern part of the Province (since the closure of UMzimkhulu).

It also caters for Forensic Observations to cases referred by Courts although it has a limited capacity (has 10 observation beds).

Komani was unsuccessful to attract a fulltime Psychiatrist it is utilizing a retired Psychiatrist on contract. Because of challenges with clinicians it is providing limited outreach services than it is supposed to render. Has also high vacancy rate (clinical).

Komani is also providing a Thuthuzela Care Centre for the rape victims, child & domestic violence. The centre is staffed by Komani Hospital.

Mental Health Units: These units serve as dedicated facilities to treat acute mental health users. East London Flagstaff Due to number of reasons linked to financial resources, attempts to increase the number of Libode beds in all these Units could not be accomplished. Mthatha East London & Mthatha Mental Health Units serves as training facilities approved by HPCSA for doctors as well as nursing students from Walter Sisulu, UFH, Lilitha Nursing College and Natal. They are also providing outreach / in reach services to District Hospitals.

EC DOH Mental The Province is utilizing these Life Care Centres to provide Health Service chronic-rehabilitative Mental Health Care since the capacity of the Public hospitals is Life Esidimeni limited. They also have chronic non-rehabilitative users, which by definition are a Centres responsibility of Social Development. Aftercare Haven Capricorn It also utilizes the 2 Halfway Houses as a support for community based services. Their services are important for preparation and empowerment of the users for integration back into their communities.

221 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 4.4: Performance against Provincial Targets for 2009/10-2011/2012 Strategic Plan

Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

SPECIALISED SERVICES

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT To facilitate Number of facilities Not measured Not measured 20 16 Training need to be compliance with district hospitals conducted at the Mental Health care Act conducting 72hour other four facilities in (MHCA) assessment order to comply with the MHCA. (These are: Bhisho Hospital, Grey Hospital, Frere Hospital & Mthatha General) 222 Number of clinicians Not measured Not measured 20 14 Target not achieved trained on Mental due to resource Health Care Act limitations. The (clinicians) programme needs to mobilize resources required i.e budget for transport and accommodation for the trainees

Number of facilities Not measured Not measured 36 34 assessed using the Standard assessment Tool

To ensure the Number of quarterly Not measured Not measured 12 12 All three Regional functionality of the 3 meetings held by Mental Health Review Regional Mental Health Regional Mental Boards held meetings Review Boards Health Review every quarter Boards Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To facilitate functioning Number of meetings Not measured Not measured 16 4 2 meetings were held of the Hospital board held by Hospital (4 Quarterly by each of the two in all psychiatric Boards meetings for each of hospitals Elizabeth institutions the 4 psychiatry Donkin and Komani

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT hospitals ) hospitals during the second and the third quarters.

The term of office of the board members from the other 2 hospitals, the Tower and the Fort England expired. New board

223 members have been appointed

Facilitate improvement Average length of stay Not measured Not measured Mental health unit: Mental health Unit = of efficiency indicators in institutions Acute - 30 days 32 days (no. of days) Not measured Not measured Psychiatry hospital: 124 days Patients stay longer Long term – 90 days due to under- developed community-based psychiatric services which is linked to staff shortages

Bed Utilisation Rate 80 80 80 86 Again the pressure is –based on usable due to the under- beds (%) developed community-based psychiatric services Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To establish 20 beds % Progress made in Project not started as Project not started as 50% progress Space for the Budgetary constraints for child and renovations yet yet achieved establishment of the have resulted in adolescent Mental child and adolescent delays in the move Health users in PE Mental Health Unit and in establishing the

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT has been identified at unit. Dora Nginza hospital however, refurbishment has not commenced as yet. To increase the Number of new beds None None 20 No beds established The building was first number of beds in established as yet; renovated and this is observation Unit at now completed. Fort England hospital Procurement of 224 equipment and recruitment of additional staff will happen during 2010/11 financial year

To support Number of meetings Not measured Not measured 8 (4 for each 4 Target not met due management conducted management to austerity measures structures by holding structure ) by the Department quarterly meetings (Hospital triad and Meeting could not be Psychiatrists) held due to belt tightening exercise by the province

To ensure protocols Number of hospitals Not measured Not measured 8 8 Target achieved and guidelines are having protocols and available and guidelines implemented in all psychiatric hospitals Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To enhance quality of Number of Not measured Not measured 8 4 This target had been care in psychiatric psychiatric hospitals achieved. All 4 hospitals by conducting with clinical audit Psychiatric hospitals clinical audits committees has established

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT clinical audit committees. The other four Mental Health Units make use of the clinical audit committees of the hospitals to which they are attached.

Number of hospitals Not measured Not measured 8 6 Flagstaff and Libode 225 conducting clinical Mental Health units. audit meetings Non-availability of quarterly multi disciplinary team that form up clinical c audit team due to reluctance of specialists to work in rural areas leads to clinical audit not conducted in Flagstaff and Libode.

To develop and Number of patients Not measured Not measured 16 615 16 646 Source of evidence is strengthen outreach seen at community- being prepared for programmes to based level M&E to see District Health Services and training of Number of District Not measured Not measured 60 28 Target not achieved health professionals facilities with health due to budget professionals trained limitations on Mental Health service? Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To improve quality of Number of Not measured Not measured 8 1 Only the Tower care in Mental Health institutions Hospital conducted institutions by conducting patient the survey. conducting staff and satisfaction survey Other Psychiatric

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT patient satisfaction hospitals awaited surveys Standardised tool

To provide institutions with standard questionnaire tool in the next financial year

Number of Not measured Not measured 8 1 Only the Tower

226 institutions Hospital conducted conducting staff the survey. satisfaction surveys Other Psychiatric hospitals awaited Standardised tool

To provide institutions with standard questionnaire tool in the next financial year

Percentage of Not measured Not measured 90 % 80.5% Initially the complaints resolved institutions were within 25 days working on a target of 30days, hence the disrepency. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To hand over non- Number of non- Not measured Not measured 478 0 Processed held over. rehabilitative chronic rehabilitative chronic There was a review Psychiatric patients Psychiatric patients and a decision to to Social Development taken over by Social keep as is until there

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Development is a full take over in two years (as the alternative would result in increased costs for both departments

To re-establish a Public A PPI established Not measured Not measured Service Level The tender process Processed held over. Private Initiative (PPI ) Agreement (SLA) was initiated and bid There was a review for chronic signed specifications are and a decision to 227 rehabilitative finalized keep as is until there Psychiatric Services is a full take over in two years (as the alternative would result in increased costs for both departments SUB-PROGRAMME 4.4: MEDICAL Service delivery achievements and progress made on SERVICES programme priorities

PURPOSE The programme has attained well with respect to To provide strategic direction and coordinate the stabilizing the platform in so far as the Internship and development, implementation of and compliance with Community Service Practitioners programmes are departmental policies in order to ensure efficient concerned to the extent that the province is delivery of medical services increasingly attracting more and retaining more of these practitioners. We have increased the absorptive Programme description platform for CSP but are limited by number allocated per province by National which is also limited by The Medical Services sub-programme production capacity from Medical Schools The programme in essence concerns itself with issues affecting the category Medical Health Care Professionals from cradle to grave i.e. Medical Interns, The programme has achieved 98% compliance with Medical Officers, Registrars and their training and respect to HPCSA registration by Medical Clinicians. Medical Specialists. So as such we deal with all issues With respect to PMDS compliance it is now around affecting this full spectrum of these professionals. It will 80% compared to a paltry less than 20% before then be appreciated that we deal primarily with the inception of the programme individual professionals, the institutions they work at eg Accredited Internship Training institutions, Hospital The policy on Commuted Overtime has been Complexes and District Hospitals. Our scope of reviewed with recommendations to stream line the operation encompasses professional conduct, process to ensure elimination of audit queries with statutory requirement compliance, service standards respect to the control and management of the system and working conditions. The programme is cross cutting in the Department from HR, Salaries, Clinical Challenges limiting service delivery Governance, Clinicians Forum, Complexes, District The major set back contributing to slow progress has Hospitals, HPTD, IHRM, Communications etc been non allocation of budget to the programme for External Stake Holders include HPCSA, NDoH, two consecutive financial years as well as non Medical Schools, Colleges of Medicine of South Africa, availability of staff and office space Professional bodies such as SAMA, and including placement and Recruitment Agencies To implement most of the programme objectives we We are also involved with Foreign Qualified doctors have had to beg from HPTD grant to do the work we which links up with Foreign Work Force and Home have done Affairs Department some times Some of the objectives have not been able to get off Programme priorities the ground e.g. Standard Clinical Protocols due to lack 1. To produce standardized clinical protocols of funding for the programme 2. To review and ensure compliance with COT policy 3. To realign approach to Gazetting of CSP posts SUB-PROGRAMME 4.5: NURSING towards establishment of clustered functional Level SERVICES 2 hospital units to improve the quality of District Health Services delivery PURPOSE 4. To realign approach to Gazetting of CSP posts and To co-ordinate, provide strategic direction and guide align some along the lines of establishing functional efficient, professional and caring Nursing Service units in order to improve the quality of medical service delivery Programme description 5. Review RWOPS Policy and enhance compliance The nursing services provide guidance and support in 6. Engage cross boundary provinces (FS, NC, KZN addressing challenges facing nursing services in the and WC) to finalize cross boundary policies for province with a view to: Tertiary Care services - Promote quality patient care through redress of nurse related clients complaints and putting

228 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 internal controls in place. The draft Uniform policy was tabled at provincial - Putting Batho-Pele into practice bargaining chamber in 2009; consultation has been - Adherence to the patients right charter finalized. The policy has been finalized in terms of - Addressing nursing transformation issues in colours to be used and submitted to the policy relation to: department for final control and approval o Nursing Practice Workshops were held to develop Provincial o Nursing leadership Nursing Strategy o Social positioning The nursing directorate chose nurses for the Cecilia Makiwane awards and best nurse initiated o Nursing resources and projects in the province that represented the o Nursing regulation Province at National. Two nurses received certificates at national and one nurse received an Programme priorities award for the project presented. 1. To enhance nursing management and leadership The nursing services participated in the piloting of 2. To formulate and develop policies relating to the national core standards in the province and Nursing Service also participate in the review of the standards for 3. To restore the image of nursing and promote use in the different provinces. professionalism and caring ethics Monitoring of quality was done in six hospitals and 4. To promote and improve the quality of nursing in-service training was conducted by the practice directorate on gaps on quality issues 5. To improve the conditions of service for nurses Six A&E professional nurses from PEHC received thereby promoting nursing as a career of choice in training from Net Care whilst nurses and doctors the Eastern Cape Province iat ELHC casualty received training on first aid, resuscitation, ATLS in preparation for the 2010 Service delivery achievements and progress FIFA Worldcup made on programme priorities A reporting tool was developed for managers and Challenges limiting service delivery is used to report activities in the different Budget constraint is a major challenge institutions; 20 institutions including the three There is a need to train nurse leaders complexes have reported on the tool. All Staffing norms for the Province are not available institutions are encouraged to use the tool. The hence there is a shortage of nursing personnel; reporting tool assist the nursing services these need to be developed directorate to monitor different but specific activities in the institutions to pinpoint There are still challenges with nursing conduct and implementation areas that most need support. It ethics, and these will be the focus for the 2010- also serves to inform the nurse managers of the 11year activities in their own institutions.

229 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 4.4: Performance against Provincial Targets for 2009/10-2011/2012 Strategic Plan

Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

4.4 MEDICAL SERVICES - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT To review medical Number of policies Unit was not in place Not measured 2 2 services policies reviewed

Establish standardized Number of Unit was not in place Not measured 5 0 There was no budget protocol for Standardized allocated to this management of disease protocols developed activity conditions Enhance functionality Number of CSPs Unit was not in place Not measured 190 155 This is the number of of District health deployed CSP allocated to the 230 medical services EC DOH by the national DOH

To ensure compliance % of SMS Clinical Unit was not in place Not measured 100% 100% Target achieved with good governance Managers signed policy framework performance agreement

% of SMS members Unit was not in place Not measured 100% 80% No effective control undergone measures by clinical performance governance heads assessment for Clinicians to develop 2008/09 a Clinical Governance Framework during the next financial year.

To ensure compliance Percentage of SMS Unit was not in place Not measured 100% 100% Target achieved with good governance Clinical Managers policy framework submitted Financial Disclosure forms Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Percentage of medical Unit was not in place Not measured 100% 98% doctors registered with HPCSA

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT 4.5 NURSING SERVICES

To strengthen the Number of nursing No policies 5 draft policies 4 policies Development of two Two policies on functioning of nursing policies and developed – new unit developed policies, the Uniform major adverse events services guidelines developed policy and the reporting and council 1 Guideline on Provincial Nursing registration still to be management of Strategy is well developed hampered community service progressing and in by budget constraints nurses developed advanced stage. to get stake holders together

231 1 procedure on 100 copies of draft reporting on nursing provincial strategy activities developed were circulated for comments and inputs during the last quarter of the financial year

Consultation on Uniform policy finalized and the policy is ready for approval. Final discussions at National level are pending. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of nursing Not measured Not measured 84 institutions that A tool to monitor Although the tool institutions have community the use of community was distributed to all implementing service nurses and nursing guidelines the 84 institutions policies and students was distributed to 20 that cater for com-

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT guidelines hospitals serve nurses, evidence exists only for the 20 hospitals that there is implementation

Number of Not measured 8 10 13 Target achieved Professional nurse trained in trauma nursing science 232 To promote and instill Proportion of Consolidated and Consolidated and 50% 0 There is an professionalism and complaints due to reported under reported under agreement with the caring ethos lack of Customer Care: Customer Care: customer care professionalism Programme 1 Programme 1 department that with resolved within 7 the review of their days policy on reporting, nursing complaints need highlighting as the nurses are in majority and most of their time is next to a patient Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To increase patient Percentage of health Nursing quality 6 institutions piloted 100% 7% (6) of facilities are The provincial safety through facilities implementing standards not yet national core implementing the nursing quality implementation of quality measuring developed standards national core measuring tool has quality improvement tool standards. thus far been put on

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT tools and methods hold as the national DOH is piloting and rolling out the core standards. The nursing tool look specifically into nursing quality improvement

To facilitate compliance % of nurses Not measured 1 477 100% 100% Target achieved with legal requirement registered with the (99.3%)

233 of the nursing Nursing Council statutory body

To upgrade Emergency % of nurses in Not measured Not measured 100% PEHC A&E Unit is Mthatha HC has a preparedness for 2010 emergency areas complete and ready fully established A&E and beyond capacitated for for the 2010 FIFA Unit that is well emergency World Cup equipped; preparedness Six professional Due to limited nurses from PEHC budget, all funds were received training from channeled to Net Care. establish the PEHC A&E unit as this is the host City for the 2010 FIFA World Cup.

Cecilia Makiwane is under revit programme and the Casualty is under construction PROGRAMME 5 CENTRAL HOSPITAL SERVICES - PROVINCIAL TERTIARY SERVICES PROGRAMME 5: Central Hospital Services - Provincial Tertiary Services

Purpose Outreach (Academic and Service Support) To provide strategic funding to enable tertiary programme has been conducted in 13 domains and institutions to plan, modernize, rationalize and Clinical Support Services to 76 District Hospitals transform the tertiary hospital service delivery and 18 PHC facilities platform in line with National policy objectives Readiness for the 2010 FIFA World Cup: including improving access and equity. Establishment of the PE A&E Unit Tertiary services funded by the NTSG outputs Programme description versus national norms and budgeting To provide designated National Tertiary Service levels in four (4) institutions namely, East London Hospital Can you give an account of the increase in Complex, Mthatha Hospital Complex, Port Elizabeth numbers for the follow-up and total inpatient Hospital Complex, and Fort England Psychiatric day?? Hospital as agreed between the Provincial Department Disease burden increases numbers and this has of health and these institutions. financial implications and therefore a need for increased budget allocation. Programme Priorities Establishment of Oncology Units in Port Elizabeth Challenges limiting service delivery (state key and East London challenges) Tertiary service delivery and development Budget constraints, impacting negatively on service To implement Academic and Service Support delivery programme Staff shortages with high vacancy rates leading to poor service delivery Service delivery achievements on programme High influx of Level 1 patients affecting negatively priorities on tertiary services Agreements were signed between EC Department Inability to separate Level 1 and higher levels of of Health and the CEOs of the institutions care. Establishment of Oncology Units in PE and EL which is at 90% complete, opening July 2010

235 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 5.1: Highlights on service delivery

Hospital Highlights at a glance

East London Hospital Complex The Complex has 14 HPCSA accredited departments with 35 Registrars (Cecilia Makhiwane & Frere in training posts and 9 specialists that have qualified. In Research and Hospitals) Development the East London Hospital Complex boasts of 9 publications in Peadiatric Surgery, 2 in General Surgery, 2 in Internal Medicine and 54 in O&G. Walter Sisulu University has appointed 7 senior specialist from the East London Hospital Complex as Associate Professors. The Complex has been positively considered by HPCSA for its application for academic accreditation of Dermatology and Nephrology. First Doctor of Pharmacy program run with Rhodes University in SA. And the Complex and the Complex has appointed the 1st Doctor of Pharmacy graduate. New digital Mammography unit installed at Frere Oncology project at Frere to operate in July 2010 12 x Renal dialysis machines – R2,5m, 1 x C-arm image intensifier - R1,4m,

Port Elizabeth Health Complex The first successful Stem Cell transplant for the Eastern Cape (Patients (PEHC – Dora Nginza, will no longer be referred to Western Cape for this service) Livingstone & PE Provincial Appointment of 6 Principal Specialists in Pediatrics, Cardiologist, hospitals Radiologist, Dermatologist, 7 Clinical Psychologists, 2 clinical supervisors for Radiography training Having the only centre offering Vitreoretinal surgery (163 cases in the year- from Queenstown, East London and Mthatha) Functional outreach programme New controls for NHLS laptops for individual doctors for blood results Doctor of Pharmacy program in place with 2 students Open days for Buns, Premature babies Unit, Diabetes, etc. Registrar training program produced specialists in Pediatrics, Anesthetics and Surgery- 8 graduated in 2010

Mthatha Academic Hospital 64 Slice CT-scanner installed and functioning Maxillo-facial unit developed

236 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 output Explanation of Explanation target and actual and actual target variance between between variance Longer average length Longer average due to of stay Orthopedics Bedford Nelson Mandela Academic Hospital is Hospital. a referral District Tambo OR been has always There has been delay has been delay There in completion of the establishment of oncology units that prioritized in are and this is MTS, in the caused delays starting with the planned 4 services having a higher rate having 70%. of over Corrective measure measure Corrective PHC is to strengthen services 2009/10 Actual Output Actual Output 5.7 73.7 39.8 Progress made in Progress building construction reported under 8 programme 0 2009/10 Annual Target Target Annual Establishment of Oncology Units completed in PE and EL 4 i.e. Radiology Renal Burns Spinal 4.9 days 75% 22 2008/09 Actual Output Actual Output Oncology equipment but was purchased not installed; construction of oncology building under way Not measured 5.3 75.1 35 2007/08 Actual Output Actual Output Business plan developed Not measured 5.2 73.3 31.8 Performance Performance measure/ Indicator measure/ Bed utilization rate on usable beds (%) section Caesarean rate (%) Number of business Number of business cases developed length of stay Average in facility (ALOS - days) % Completion of oncology units Objective Programme Programme To facilitate To of improvement To develop a develop To To establish new establish new To Oncology Units in PEHC and ELHC efficiency indicators prioritized MTS plan Table 5.2: National Tertiary Service Grant Tertiary National 5.2: Table

237 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Case fatality rate for Not measured 6.2 2.5 3.4 surgery separations - %

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Case fatality rate: Not measured 6.2 5% non-surgical (%)

To ensure that the Number of hospitals Not measured Not measured 8 (or 3 hospital 4 i. e 3 hospital expenditure is aligned reporting on complexes) complexes and one to the designated nosocomial infections Regional hospital services and tertiary numbers meet national Number of 29 29 36 36 Target achieved norms designated services funded by the NTSG including medical 238 equipment and buildings

Number of tertiary 90 117 104 675 82 000 101 991 patients: total 1st visit

Number of tertiary 209 868 236 304 191 415 253 343 patients: Follow-up visit

Total inpatient days 353 370 375 512 197 388 441 452

Total inpatient 39 236 53592 24 076 14 247 separations Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To build capacity for Number of A&E Unit Not measured 1 2 1 Limited funds were 2010 FIFA Soccer established with (at Nelson Mandela (EL and PE (PE complex) channeled towards World Cup Readiness Equipment Academic Hospital) Complexes) establishment of the by establishing a fully PE hospital complex

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT equipped A&E Unit at as PE is the host city PEHC for the 2010 FIFA World Cup. However, the casualty at Cecilia Makiwane hospital is being upgraded under the hospital revitalization programme

239 Number of staff Not measured Not measured According to training 6 Prof Nurses in PE. trained towards A&E needs of each unit establishment hospital In EL 8 Prof Nurses, 3 Enrolled and 4 Nursing Auxiliaries PROGRAMME 6 HEALTH SCIENCE & TRAINING PROGRAMME 6: HEALTH SCIENCES AND TRAINING

Aim o 35 Cleaning and hygiene learners graduated in To provide training, development and academic September 2009 support to all Health professionals and employees in o 51 Internal audit technicians completed the the Province of the Eastern Cape programme contributing to improving departmental financial management capacity Programme Description o Three students completed Masters degree in This Programme comprises of the following Medical Informatics sub-programmes: o New intakes of health professionals into entry Nursing Training College – for training of all level system: 291 Medical Interns; 836 categories of Nursing Personnel community service health professionals Emergency Medical Services Training College – for training of ambulance and rescue personnel A more detailed progress analysis of the Health Bursaries – to provide bursaries for health-related Sciences and Training clinical and corporate courses for candidates from within & outside the Department of Health Lilitha Nursing College Training Other – to develop the knowledge, skills & The goal of the Nursing Strategy for South Africa is to attitude of the personnel in all occupational achieve and maintain an adequate supply of nursing categories, with a focus on health professionals professionals who are appropriately educated, distributed and deployed to meet the health needs of Programme Priorities all South Africans. The strengthening of the nursing To implement programmes for attraction and profession will ensure increased access to the basic retention of essential human resource skills package of health services by our people, especially in through creation of ECDOH pool of health rural and underserved communities and to ensure personnel through bursary, internship and universal coverage. learnership programmes; increased exposure of health science students to EC rural Health In 2009/2010, the human resource development Services; active Recruitment of health professionals (HRD) component focused on the following (graduates for entry level posts, including nursing; components of the strategy: foreign qualified; retired nurses). Good quality education and training To provide ongoing training and skills development Accessibility of nursing to all South Africans for health workers, ensuring appropriate skills to Good leadership in all aspects of nursing impact on health status of people in EC province Enhancing and maintaining professionalism amongst To improve staff morale by motivating and enabling members of the nursing profession employees to achieve high performance through implementing results-driven Performance Management & Development System, creating Progress in 2009/2010 opportunities for personal growth and career The South Africa Nursing Council (SANC) has development, and providing academic & service revisited the memorandum that was circulated in support, especially to Health Professionals working 2008/2009 and the deadline for the legacy in rural areas qualifications has been moved to 30 June 2012, the intention is to transform nursing education in the Programme Achievements country. In summary the changes being introduced are Recruitment and Retention of critical skills: to recognise only certain qualifications and the phasing out of legacy qualifications. o 139 health professionals with bursaries from ECDOH graduated end December 2009 o 303 ENAs, 340 ENs commenced learnership in This is an attempt to address service delivery September 2009 with 211 ENAs placed in needs so that the demands for high numbers of permanent posts nursing professionals with the right skills mix to meet health status and service demands, are met. o Four medical registrars completed fellowship This necessitates changes in the scopes of practice exams as specialists and are in ECDOH employ

241 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 of the various categories of nursing. Implications of this memorandum for Lilitha Nursing College Under programme 8, work commenced on the therefore were that: breaking down of the Cecilia Makiwane Hospital All new programmes have to be accredited with campus as the first of four phases that will ultimately SANC before 30 June 2012 when the new see the Lilitha Nursing College with new provincial programmes are set to commence headquarters, new lecture rooms and four blocks of 30 June 2012 will be the last intake for the legacy flats accommodating 850 nursing students. programmes and these students will have to complete within the required 4years at minimum Challenges in 2009/2010 and 2 additional years at maximum The challenge with infrastructure is that the need far exceeds the funds available on the Department. The SANC only issued regulations supporting this Allocation of a Facilities Manager specifically for Lilitha process late in the 3rd quarter of 2009/2010 leaving Nursing College to quantify the needs and advocate very little time for final planning and budgeting going then with national Department of health for access to forward. As a follow-up to the proposal developed by increased funding specifically for infrastructural the Department and NMMMU in 2007/2008, in August revitalisation of the College is recommened. National of 2008/2009, Atlantic Philanthropy granted R13,8m to auditing of nursing education facilities in the province NMMMU to assist the ECDOH in a 3year project to has commenced in a step towards quantifying needs. transform nursing education in the EC. During the first phase, the governance for the project was The Department also engaged Fort Hare University institutionalised, the project team appointed and the through a project sponsored through the HPTD grant situational analysis was conducted in 2008/2009. A to develop e-learning material. This material will be detailed assessment of needs of all stakeholders to used to standardise the practical and make the determine the focus areas of the project was also demonstrations available across all campuses. completed. ICT network for the college institutions including This project focuses on: examination office remains a challenge. The ICT Management and leadership development to section has been engaged as part of 2010/2011 improve governance of the College; operations. Funding of this project has been a Recurriculisation of training programmes delivered challenge as it requires huge amounts to be invested in by Lilitha to meet the national transformation enterprise architecture. Cash flow problems during agenda; 2009/2010 hampered progress that had been planned. Training of nurse educators with an aim to improve This in turn affect the quality of the examinations failure rates delivery output as it has to be produced manually. Advocacy for the college Performance Indicators of Lilitha Nursing The one area critical to nursing education is that the College environment must be conducive to education and During 2009/2010, 3,417 nurses were in training training. Nursing homes, classrooms and education through the Lilitha Nursing College (see table 6.1 material are in dire need of revitalisation. To this end in below for breakdown by course). The intake at the 2009/2010, the College focussed on improving beginning of 2009 was 1,561 new students inclusive of infrastructure, and machinery and equipment within all programmes offered at Lilitha. the available funding envelopes available as it is not adequately catered for in the Programme 8 budget. This remains the major challenge in terms of ensuring quality service delivery.

242 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 6.1: Enrolment at the Lilitha Nursing College distributed by year level and course of study

2009/10 2009/2010 Planned Actual Intake

Category 1st years 1st years 2nd year 3rd year 4th year Total 2009

PN 512 682 665 533 363 2 243

Bridging 200 100 140 240

Post Basic 125 150 150

Midwifery 250 86 86

EN 240 240 255 495

ENA 240 303 303

Total 1 567 1561 1 060 533 363 3 517

Table 6.2: The number of graduates and pass rates for all programmes offered at Lilitha Nursing College including Post Basic, One year Midwifery ENs and ENAs at the end of each year is listed below by Campus:

Campus Yr 1 Yr 2 Yr 3 Yr 4 Avg

EL 412 250 102 114 83.31

Mthatha 166 174 83 72 67.91

PE 114 92 58 72 77.07

Queenstown 138 138 67 49 71.02

Lusikisiki 109 96 43 18 88.38

Total Number 939 750 353 325

Avg 60.16 61.5 66.2 89.5 69.34

The best performing campuses are Lusikisiki with an average pass rate of 88.38% despite the extremely challenging environment that this campus has to operate in, followed by the East London campus with an average pass rate of 83.31% with the satellite campuses performing better on sub professional and Bridging programmes. Post Basic (specialist programmes) programmes generally performed poorly in this academic year across the province. The intake was 150 and only 42% of them managed to be meet the minimum competency requirements.

During the phase one of the Atlantic Philanthropy project, the capacity of the tutors has also been assessed to identify developmental needs which could impact positively on the student performance. The project has started to capacitate the personnel and managers of the college, short learning programmes in operation include assessor and moderation courses, and library management. The latter is important for to promote resource based learning amongst tutors and students.

All nurses at Lilitha sign a contract with the Department and honour their obligations to serve the communities of the Eastern Cape for four years immediately after completing their studies. These nurses are automatically absorbed into the Community Service Programme in ECDoH health facilities. This has contributed positively to the growth in the number of nurses in the province consistently for the past three years.

243 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 2. EMS College

The outputs for the EMS College during 2009/2010 are shown in Table 6.2 below and are as follows: 1,398 passed all courses out of a total of 1,892. There were 322 failures thus an average pass rate of 77%

Table 6.3: Summary of All Courses conducted by the EMS College, 2009

Quarter Total Passed Failed Re-writes Pass Rate

Quarter 1 495 448 34 4 91

Quarter 2 657 419 238 12 64

Quarter 3 153 134 19 0 88

Quarter 4 587 397 31 2 68

Total 1 892 1 398 322 18 77

The poor pass rate during Quarter 2 relates to the Advanced Emergency Assistants (AEA) qualifying exams (see Table 6.4 below.

Table 6.4 Pass rates by Course taken during Quarter 2

Successful Programme Group Total Passed Failed Re-writes BAA Updates (CPD) EMS practitioners 60 52 8 2 AEA Updates (CPD) EMS practitioners 23 21 2 2 AEA Course 1/09 EMS practitioners 20 20 0 0 AEA Qualifying Exams EMS practitioners 250 67 183 N/A AEA Course 2/09 EMS practitioners 18 14 4 8 ECG Updates (CPD) EMS practitioners 33 33 0 0 High Angle Rescue 3/09 EMS practitioners 11 2 9 0 High Angle Rescue 4/09 EMS practitioners 12 6 6 0 Vehicle Rescue EMS practitioners 10 8 2 0 Fire S & Rescue EMS practitioners 10 10 0 0 First – Aid Lilitha Col: East London 132; 15; 123 9 0 Peddie Hospital 51 15 0 0 Motherwell Care Haven 36 15 0 ACLS Overview PE Complex Doctors 12 12 0 0 (Dr Jones) Total Learners 657 419 238 12

244 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 In Quarter 4, the poor pass rate can be attributed to a high number of failures amongst the Correctional Services personnel. This course normally has a good success rate amongst Health department personnel so it might just be that the Correctional services personnel had to adapt to an unusual set of learning principles. The same tutors that have had good success with the Health department employees were used for Correctional services.

The Department once more did commence the ECT programme since the remaining requirement was the appointment of suitably qualified lecturer with a National Diploma. The EMS programme has agreed to second staff to the College to assist with accreditation of the college for the Emergency Care Technician midlevel worker programme in 2009/2010. The approval of the College organogram is also critical to attract the appropriate skills at an attractive salary level into the College. The OSD will also assist in making the College environment an attractive place of employment option. Please also explain the huge numbers who failed the AEA exams (183)

Table 6.5: Quarter 4 EMC College pass rate

Quarter 4 Group Total Passed Failed Successful Re-writes BAA Refresher EMS Personnel 23 18 5 0 AEA EMS personnel 18 16 2 2 Level-1 First Aid Correctional 492 309 24 0 Service & Other Rescue EMS Personnel 0 0 0 0 Practitioner – BLS – Paediatrics DNH paediatric 12 12 0 0 Dr. Jones nursing staff Mmims EMS Personnel 18 18 0 0 Hims Nursing Staff 24 24 0 0 Total Learners 587 397 31 2

Bursaries

The Department sponsored a total of 1,300 bursary holders during 2009/2010 although 1,525 had been the original target. A reduction in the budget from R96milion to R72million accounts for this reduction in numbers.

Table 6.6 Pass rate amongst DOH bursars

2009

All Students Graduates 2009/2010

Category Target Actual % Final yr Actual % Pass students passed

Grand Total Sponsored 1525 1300 85 139 124 89

External Candidates 1247 1097 88 139 124 89

Internal Candidates 278 203 73 0 0 0

Students on Cuban prgm 82 67 82 8 7 88

Bursary holders Rural Origin 1144 975 85 74 70 95

Bursary holders women 852 726 85 83 80 96

Bursary holders African 1052 897 85 106 92 87

245 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 In 2008/2009, the Department doubled its investment in the number of students sponsored for undergraduate health studies at universities across the country from R45m to R96m. This allowed an opportunity for 1,014 students to be sponsored. The careful selection of students also resulted in a decreased drop-out rate from 19 last financial year to 15 this year.

Table 6.7: Below lists the total number of bursary holders by field of study as well as for graduates. The medical and nursing categories remain the main focus of sponsorship in this programme.

External bursars Distribution of bursaries by field of study Total no. of bursars No of graduates

B Cur 465 0

MBChB 432 93

Pharmarcy 104 18

Dentistry 25 7

Dental therapy 2 2

Dental technology 1 1

Dietetics 6 2

Physiotherapy 22 3

Occupational therapy 17 5

Speech and hearing 6 2

Optometry 7 3

Environmental health 1 1

Oral hygiene 2 1

Clinical psychology 1 0

Paramedics 1 0

Audiology 5 1

Total 1097 139

The outputs of the bursary programme contributing to the pool of health professionals absorbed into the Department of Health employ, are indicated in the table6.8 below and compared to the preceding years.

246 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 6.8: Outputs of Bursary programme for 2007 to 2009

2007 Actual 2008 Actual 2009

Actual Criterion No % No % Target Actual %

External Candidates 584 70.2 1,014 87 1525 1300 85

Internal Candidates 248 29.8 151 13 1247 1097 88

Grand Total Sponsored 832 100 1,165 100 278 203 73

No of Graduates from Cuban 9 - 9 - 82 67 82

19 Failure/drop-out 2.3 15 1.3 0 15 1.2 (1 died)

Bursary holders Rural Origin 483 58 885 76 1144 975 85

Bursary holders women 508 61 827 71 852 726 85

Bursary holders African 85 82 955 82 1052 897 85

Total number of Graduates 119 - 165 97 139 124 89

The graduates are recruited into the Eastern Cape for their internship and community service years and through the contractual system meet their obligations to the Department after these years. There is a special project to trace the 96 bursary defaulters from preceding years.

The Department also invests in 203 of our own employees' further development as can be seen in the table below:

Table 6.9: Number of DOH employees' graduates by level of study

Internal bursars

Distribution No of graduates by level of study

Masters 64

Honours 3

Btech 4

Degree 47

Diploma 82

Certificates 3

Total 203

247 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 6.10: Performance against Targets from the APP and Operational Plans 2009/10

Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Retention of % of all bursars 64% 78% 90% of all bursars 88% Review completed. undergraduate and retained in ECDoH retained in ECDoH Department in - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT postgraduate bursars employment employment process of tracing any upon graduating, defaulters. ensuring representation of rural areas in allocating bursaries

53% from rural origin % of all bursars are 81% 76% 75 % of all bursars 85% in 07/08 from rural origin are from rural origin (n-650) 248

% reduction of Determine baseline 50% reduction of 45% debtors of defaulters debtors Tracking of bursary Tracking of bursary defaulters and defaulters and recouping debt owed

To use the workplace % of learnership 85% 90% 60% of learnership 60% Posts not filled due to to train candidates in candidates in ENAs on permanent Departmental over- interns/learnerships permanent permanent employ 211 expenditure for and prepare them for employment employment (n=350) 2009/2010. employment internally Appointments were and externally in the deferred to identified 7 fields of 2010/2011 study

% of intern 239 interns placed 350 interns placed 50% of intern 0 No budget allocation candidates in candidates in in the 2009/2010 for permanent permanent internships and employment employment learnerships; hence no new intakes Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

a) Training, developing % of registrars Baseline study 100% (n=3) 75% of registrars 100% (n=4) All WSU campuses and retaining medical trained in EC who completed & trained in EC who were accredited by registrars in the EC in are employed upon improvement strategy are employed upon HPCSA for registrar accordance with graduation developed graduation training. Areas that

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT service delivery needs need focussed intervention are internal medicine across all campuses and ENT in Mthatha. Dermatology dept. Was accredited in Frere as a training dept for registrars with 2 posts

249 Total no. of registrars = 103 This number changes as new ones are added and others graduate.

b) Train, develop and % of nurses trained in 90% 99% 85% of graduating 100% retain nursing student EC who are nurses trained in EC graduates employed upon retained in ECDoH graduation Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

c) Active recruitment % of community 62% 68% 55% of community 72% The Department did of interns and service health service health the recruitment of community service professionals professionals comserves in an health professionals for absorbed into entry- absorbed into entry- integrated manner.

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT entry-level posts level posts level posts (n=1,000) Had a team comprising of all stake holders in the program from H/O , District Offices , CSC's and Health facilities working together towards a common goal i.e. ensuring a better

250 life for health professionals in our hospitals and reduction of disatisfiers in health facilities.

Rehiring retired nurses Number of retired 68 Absorb 100 retired 67 retired nurses Budget deficit limited & other critical staff nurses employed in nurses the number of for college ECDoH contracts that could be extended for retirees Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

a) Develop and % of graduates Commenced clinical Yr 1: 24 new intake Year 3 clinical 23 will graduate in Total number of implement mid-level absorbed into associate twinning Jan Yr 2: 23 have associate complete June 2010 clinical Associate worker training ECDoH employ 2008 progressed from work study for entry- students is =47 programme/s 2007/2008 level posts

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Post creation process for absorption of the 3rd years in posts in 2011 is being negotiated with the Organisational Development component in Integrated Human

251 Resources. This category of midlevel workers will be an asset in the hospitals and definitely reduces the work load of doctors and nurses

% of graduates 48 ECT students to Students were not This training of 48 absorbed into be placed in placed ECT students did ECDoH employ programme at end not take place 2009 because the workplace was not accredited. Attempts to attract two potential candidates with the necessary NDip qualification into the College failed. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of b) Develop and Graduates constitute Three students Year 3 employees with implement new a pool of people completed Masters graduates to Masters Medical training programmes with this scarce degree in Medical commence diploma Informatics in response to skill and develop Informatics and certificate course

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT service delivery information training accreditation

eHealth No of institutions Initiation of project Go live at St Patrick's 6 6 Total number of with full package of March 2010 institutions with full telemedicine package is 6. applications Remaining 19 will be completed within the first 4 months of 2010/2011

252 No of facilities with Initiation of project 23 50 56 facilities with Exceeded the target Mindset implemented active satellite by 6 facilities now for health promotion migration underway. in process of and education Extended time for implementing more tele radiology site mostly clinics because of site and district hospitals readiness. Additional 8 SLA for tele hospitals radiology has been Humansdorp , Bisho signed hosp ,Grey , Cofimvaba , All Saints , St Banarbas, Tafalofefe, Butterworth. They are marked for tele radiology. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

PHC support through Site readiness 50 facilities with 50 clinics/CHC with Tender completed Target exceeded. clinic connectivity assessments infrastructure in place applications for 53 clinics and completed CHC's for clinic connectivity - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

Impact assessment 78% Research Conduct impact impact assessment by Medical Research done as per identified methodology assessment by MRC MRC not done Council could get indicators completed ethical approval ; to be done in the first quarter of 2010

Implementation of % of component 78% 82% 85% of component 90% WSP, ensuring a focus submitting WSP submitting WSP on skills required for: quarterly reports quarterly reports 253 CLINICAL (n=77) MANAGEMENT LITERACY Skills audit completed Skills audits Skills audit not Implementation of CORPORATE completed for finance completed across the OSD and HROPT MANAGEMENT and for supply chain province. diluted the attempts management to complete the audit. Buy-in from line managers was inadequate. This will be redreeed with the CSC managers during 2010/2011

Train critical health professionals Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

a) Through DHM&L Number of DHM&L Launched leadership 35 grdauates Graduates for 2009 60 students 60 candidates programme, so that graduates behaviours Total of 60 graduated graduated they are able to candidates 138 students are manage and provide 56.25% fall within currently registered

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT effective PHC services the hospital at a district level programme 43.75% are from PHC services

b) Through formal Implementation of Implementation of Not done Procurement process management and formal M&L IDP for all SMS halted due to lack of leadership programme sustainable budget available development programme 254 PROGRAMME 7 HEALTH CARE SUPPORT PROGRAMME 7: HEALTH CARE SUPPORT SERVICES

PURPOSE To increase access for maintenance and repair of The purpose of this programme is to render clinical assistive devices support services to mainstream clinical activities To improve and advance provision of assistive devices to persons with disabilities Programme description To build capacity in O&P centres The Health Care Support Services Programme is To increase access for maintenance and repair of composed of two Directorates namely: assistive devices 1. Transversal Health Services with five sub- programmes: Service delivery achievements Orthotic and Prosthetic Services 93 Outreach service points-visited on regular Laboratory services basis-440 visits Rehabilitation services Vacancy rate in O&P Centres reduced from 48% to Radiology services 41.7% by appointing 8 new persons Social Work services PE O&P Centre accredited; therefore 2 out of 3 2. Pharmaceutical Services O&P centres are accredited– Focus to be at Mthatha O&P Centre to improve infra-structure Improvement in supply of orthotics and prosthetics 7.1 TRANSVERSAL HEALTH due to overtime work as reflected in statistics SERVICES Service delivery challenges ORTHOTIC AND PROSTHETIC SERVICES Poor infra-structure and Equipment at Mthatha O&P Centre. Purpose Limited Compensation of Employees Budget to To render specialized clinical Orthotic and Prosthetic employ more staff. Services Limited Goods and service budget that affect supply on demand Sub-programme priorities Identification and employment of candidates to To improve and advance provision of assistive man repair centres. devices to persons with disabilities To build capacity in O&P centres

256 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 output Explanation of Explanation target and actual and actual target variance between between variance Budget and austerity constraints measures None of the applications submitted was the accepted by training institution at Finalization delayed hospital complex CEO level Target achieved Target Budget shortfall on CoE 2009/10 Actual Output Actual Output 1 0 1 (PE) Draft policy EL: 21 EL: 3 Mthatha: 69 PE: EL = 126 Mthatha = 36 PE = 276 8 2009/10 Annual Target Target Annual O&P policy and developed approved EL: 21 EL: 3 Mthatha: 69 PE: 126 EL: 36 Mthatha: 276 PE: 12 5 8 1 (PE) 2008/09 Actual Output Actual Output O&P policy not available 24 Numbers not recorded previously 13 0 15 plus 12 on stream 3new 0 2007/08 Actual Output Actual Output O&P policy not available 22 Numbers not recorded previously 104 0 12 on stream 0 Performance Performance measure/ Indicator measure/ Number of O&P as accredited centres training centres O&P policy Approved Number of posts filled Number of O&P learnerships trained Number of student (new) intake No of O&P functional No of O&P functional serviceoutreach points established Number of visits to serviceoutreach points conducted Objective Programme Programme To facilitate To of O& P accreditation centres O&P improve To In conjunction with to build O&P HRD, in the capacity province In conjunction with In conjunction with to reduce HRM, vacancy rate of 48% in 10% by O&P centres To improve improve To services reducing by waiting time accessibility of services of people with disabilities Table 7.1.1 O&P: Provincial Objectives and Performance for Orthotic and Prosthetic ServicesOrthotic for Prosthetic and Performance and Objectives Provincial 7.1.1 O&P: Table

257 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To improve Number of clients 1 748 1 752 1 500 1 671 Target achieved manufacture of issued with wheel orthotics and chairs prostheses

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Improve supply of % of clients issued Not measured Not measured 50% 0 Human resource and prostheses with prostheses budgetary constraints within 6 months following initial assessment Number of clients 504 2 753 3 000 4 078 Target achieved issued with Prostheses

% of clients issued Not measured Not measured 60% 0 Human resource and 258 with hearing aids budgetary constraints within 2 months following initial assessment

Number of clients 1 084 691 740 718 All applicants supplied issued with hearing aids

Number of clients 5 946 6 511 7 000 9 680 Target achieved issued with Orthoses

O&P database Existing system Existing system Develop and maintain Database developed Database designed inadequate with inadequate with O&P database but not implemented but not yet functional. regards to reporting regards to reporting as yet Piloting has to be done but shortage of computers at EL O&P pilot site presenting a challenge Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Modern O&P No new equipment No new equipment Fully equipped O&P Equipment was not No funds under Equipment purchased purchased purchased Centres purchased Capital budget.

Service level SL Agreement was Agreement not SLA signed & SLA not signed Supplier did not - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT agreement in place signed 105 signed due to delays implemented supply satisfactory with Amputee club of prostheses supplied by the supplier to reports. B.A.C S.A to provide provide satisfactory terminated the prostheses for people reports relationship with disabilities in the Eastern Cape 259 SUB PROGRAMME : LABORATORY SERVICES TRANSVERSAL HEALTH SUPPORT Achievements Programme priorities 38 Emergency Blood Refrigerators have been provided over the three year cycle Laboratory services: Relationship between service providers (NHLS & SANBS) and the department is well managed by Facilitates and enhance timely provision of efficient the regular review of the services level agreements laboratory service to health facilities to ensure the provision of essential services. Transport management In terms of a service improvement plan the Facilitates and enhance provision and availability of department and NHLS agreed to implement an IT blood products in health facilities intervention to reduce turnaround time (TAT) for Provide ongoing training & skills development for laboratory specimen results by connecting the clinical health support professionals health facilities to NHLS laboratory information Facilitate remodeling of blood services system via the web and this will ultimately be finalized by the 1st quarter 2010. Radiology services Development and implementation of radiographic Challenges quality assurance program Inadequate budget allocation for NHLS & SANBS Control, monitoring and evaluation of the with subsequent irregular payments and non- radiography services and silver recovery program payments of these accounts. Facilitate the placement of community service Poor utilization of the available turnaround time radiographers (TAT) interventions with a resultant perceived Standardization of radiographic equipment poor/ extended TAT, e.g. clinics have serious poor Coordination of tele-radiology program in the recording and reporting concerning the recording province for possible total roll-out of true TAT of results immediately these reports reach the clinic whether by telephone, SMS and Rehabilitation services return of hard copies of results. Co-ordination of community service programme Facilitation of strengthening of rehabilitation RADIOLOGY SERVICES departments in the province Facilitation of the provision of ongoing training and Achievements skills development for rehabilitation of health Implementation of quality management in all workers institutions rendering radiology services Assessment of people with disabilities for an Implementation of the silver recovery programme appropriate prescription of an assistive device on a three year contract basis Implementation of uniform radiology protocols in Social Work Services all institutions Implementation of quality assurance programme Successful completion of training of radiographers The standardization of social work activities in all in undergraduate and post graduate courses hospitals within the province Acquisition of new radiology equipment in various Facilitation of the training and skills development of hospitals all social workers Implementation of tele-radiology in underserved areas Service delivery achievements on programme priorities Challenges Underfunding for radiology consumables in all health facilities Misaligned budget for the replacement and maintenance by the infrastructure directorate

260 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 REHABILITATION SERVICES SOCIAL WORK SERVICES

Achievements Achievements One Hundred and eleven rehabilitation health Training and workshop on ethics and professional professionals community service therapist placed in conduct were conducted by South African Council for the Province Social Service Professions. Fifteen occupational therapy assistants (OTA) managed through to the final occupational therapy Challenges technician (OTT) examinations of the HPCSA budgetary constraints , limited ability to conduct support visits and training programmes Challenges District hospitals do not have adequate equipment for rehabilitation services and this impact negatively on service delivery. The outreach clinics for rehabilitation programme are not rendered in all rural / disadvantaged communities due to transport constraints in the various districts. High Vacancy Rate for rehabilitation health professionals

261 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 output Explanation of Explanation target and actual and actual target variance between between variance Poor reporting Poor to NHLS delayed install the requisite equipment SANBS planned to build a blood bank in but there Kokstad in delays were securing the land Target reporting Poor reporting Poor 2009/10 Actual Output Actual Output 396 092 (44%) 0 0 24 5 1 Nelson Mandela Bay 2009/10 Annual Target Target Annual 2 Health Districts Alfred Chris Hani and 24 24 7 540000 (60%) per province 2 Hospital complexes PE & Mthatha 2 Regional hospitals and St Frontier Elizabeth Nzo 2008/09 Actual Output Actual Output 2 24 14 1 Not measured EL hospital complex implementing a web- based system 2007/08 Actual Output Actual Output 2 2 LSAs supported on TB programme 18 0 Not measured Consultation with web- NHLS around based systems Performance Performance measure/ Indicator measure/ Number of health districts with 24 hour operational Blood Bank No. of health districts No. of specimen No. of hospitals No. No. of LSAs that No. of LSA that No. achieving 48 hour achieving TAT received results establishing connection to NHLS LIMS data base (WWDisa) and access specimen results implement the 48 project TAT hour standardized achieve within 48 hours (60%) TAT of 24 – 48 hrs TAT laboratoryfor results Objective Programme Programme To facilitate To of blood restructuring bank sites To establish To connection to NHLS Management Lab Info data base and access specimen results Reducing TAT for for TAT Reducing Monitor Service plan in Improvement laboratory specimen results term of: term of: Table 7.1.3: Provincial Objectives and performance indicators for Clinical Support Clinical for indicators Management performance and Objectives Provincial 7.1.3: Table

262 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To facilitate review of SLA with SANBS SLA in place Draft document in Service level SLA renewed and SLA document with reviewed place agreement with approved SANB Service and SANBS amended & effect necessary approved

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT amendments

To facilitate the Number of district 20 25 35 38 establishment of hospitals rendering 5 new 10 new Emergency Blood maternity services Services (EBS) with established Emergency Blood Services (EBS)

Ensure access of Blood No. of Emergency 4 4 23 38

263 Products to District Blood Services Hospitals stocked with Blood Products

Facilitate payment of Proportion of health 17.7% 17% 90% 27% Budget shortfall and NHLS accounts within institutions paying (12/124) (132/147) (39/147) austerity measures 30 days NHLS within 30 days of receipt of invoice (Health facilities include, district hospitals, CHCs, Clinics and CSCs)

Development, Number of Final document in Document Revised, All institutions All institutions implementation, institutions with place printed and circulated monitoring and Radiographic Quality evaluation of Assurance radiographic quality programme in place assurance programme and implemented Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Control, monitoring Number of All institutions All institutions All All and evaluation of the institutions with silver recovery signed contract in program place. - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

Radiology service Facilitate Not measured Not measured Uniform radiology Radiology Protocols protocols not uniform development of protocols in place circulated to all uniform radiology health facilities service protocols in all levels of care

To co-ordinate Number of 36 26 35 24 NDoH determines community service radiographers the provincial program for allocated for allocation 264 radiographers community service

To standardize Number of health 53 7 64 4 new radiology There was budget radiographic facilities with new equipment shortfall equipment standard equipment.

Tele-radiology Number of health None None 23 8 The limitation was Radiology not available facilities implementing Tele-radiology in due to unavailability in all underserved tele-radiology in place in underserved of data lines in the areas underserved areas areas targeted hospitals

Radiology services in Number of health 35 41 45 26 Due to budgetary institutions monitored facilities with constraints not all the and evaluated radiology service targeted hospitals visited for monitoring were visited purposes Facilitate training and Number of 71 89 40 78 The final figure in all empowerment for all radiographers trained categories is radiology personnel in Diagnostics contingent on the number of applications receive Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Number of 2 2 10 2 radiographers trained in Radiotherapy

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Number of 0 1 5 2 radiographers trained in nuclear medicine

Number of 3 5 10 2 radiographers trained in ultrasound

To increase No of outreach clinic 16 16 25 25 accessibility of service service points

265 for people with conducted for people disabilities with disabilities

To facilitate training for Number of 20 40 60 40 The therapists that the harmonization of rehabilitation health were trained from an acceptable professionals trained other regions left the assessment tool for Province and only the free health services for Eastern Region people with disabilities continued training To facilitate Number of people 1 748 1755 1400 1654 distribution of assistive assessed for devices in the province wheelchairs (wheel-chairs and hearing aids) Number of people 1 084 691 800 834 assessed for hearing aids Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To co-ordinate Number of allied 113 122 130 111 Community Service community service health professionals health professionals program for clinical allocated for have a liberty to support professionals community service choose where they

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT can be placed

Enhance improvement Number of 0 0 15 15 in rehabilitation Occupational therapy services through assistants upgraded training to upgrade to technicians Occupational therapy Assistants to Occupational therapy technicians 266 To establish norms and Provincial norms and Norms and standards Revised draft Provincial norms and Not yet approved standards for social standards for social were implemented document was standards for social work services in the work service developed and work service Eastern Cape Province developed circulated approved and circulated.

Number of Social 0 0 110 147 Work Officers trained on profession specific fields Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Meetings with the Not measured Not measured 4 Quarterly meeting 4 meetings conducted Social Work Officers' of the Social Work forum & Managers to Officers' forum facilitate

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT implementation and monitoring of norms & standards

Improve external and Number of DPO's 20 40 15 8 internal and NGO's and communication to government harness service departments actively delivery involved in social

267 work services. PHARMACEUTICAL SERVICES appropriate staffing norms, culture of learning and continuing professional development and promote rational and safe use of medicines PURPOSE Ensure implementation of the Public Private To render effective pharmaceutical services that will Partnership for the effective and efficient ensure equitable access to safe, cost-effective and management of the Pharmaceutical Supply Chain quality pharmaceutical care to all the people in the from the Depots to the hospitals, community Eastern Cape Province and to promote rational use by health centres and clinics, with a central down all. referral and pre-packing pharmacy

Programme description Improving access to drugs Pharmaceutical service involves the provision of o It has been a challenge to achieve this priority, medicine to the patients when they come to the but we have tried to keep on track by ensuring pharmacy after having been seen by a doctor or nurse that the pharmacy staff who handle the medicine, prescriber. The medicines so needed by the patient especially the chronic ones like Anti-Retrovirals must be there at all times, having been ordered by the (ARVs), are given in-service training so as to keep pharmacist from the supplying depot, which depot up to date with the changing guidelines and new must have ordered enough of the medicines required drugs being introduced. by all the hospitals and clinics in the province from the pharmaceutical companies who make these medicines in enough quantities to supply them when ordered Implementation of M&E plan based on tenders that were given to them to make o The M&E Plan for pharmaceutical service has such medicines and supply them when they are been done with the development provincial required for a limited period of time, whereupon they goals, objectives, activities and indicators which will be paid by the depot that orders the medicines. If will now be used as a framework to report on the pharmaceutical company does not supply these this programme by everybody providing it. We medicines or supplies them late or in short supply, are now in the process of conducting a survey then the depot will not have medicines to supply the to assess the level of pharmaceutical service hospital or clinic that will then not be able to supply delivery so that we can identify what the the patient whenever they need the medicines. blockages are and what we have to do to unblock them. Sub-programme priorities The increasing need for quality pharmaceutical care Strengthen programme capacity has been brought about by the advent of rapidly scaling o During this financial year, we have managed to up on the Comprehensive Care, Management & train even our pharmacy support staff to be Treatment plan for HIV AND AIDS and the able to provide ARVs at their facilities, under development of MDR & XDR TB. The following the supervision of a pharmacist. activities will thus be prioritized during the next three years to meet these challenges: Other high level achievements o We have registered for training 106 Improve access to drug supplies to ensure their pharmacist's assistants as required by availability for patient use in all facilities within the pharmaceutical legislation. They will qualify by allocated budget at all material times the end of 12months and will be responsible Facilitate compliance to good governance through and accountable for their actions as part of the implementation of a monitoring and evaluation pharmaceutical service delivery team which is plan to promote quality of pharmaceutical service in great demand now with the shortage of and systems by health facility pharmacies in pharmacists and the need to scale up the accordance with Good Pharmacy Practice norms provision of ARVs and TB medicines. and standards legislation o We have managed to license all our hospitals as Strengthen the capacity to provide quality of pharmacies that provide pharmaceutical pharmaceutical services by adequate, competent services and are in compliance to good and appropriate human resources who adhere to pharmacy practice standards as required by the

268 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Implementation of PPP – This project did not take Improving access to drugs – Because of the off. At the last minute when it had to be uncertainty of the pharmaceutical PPP, the capacity implemented, there was a change in the strategy on to manage the access to drugs such that the how to provide this public private partnership. This patients always have medicines whenever they has created a great deal of uncertainty and lack of need them could not be achieved. progress in the management of the depots and the Most of our Community Health Centres could not distribution of medicines throughout the province. be licensed and registered as centres that comply Staff shortages at the depots could not be with good pharmacy practice standards mainly addressed as necessary as the implementation of because they do not have a pharmacist and the the PPP was a constraint to any long term plans. infrastructure and equipment are not up to the Drug supply was therefore at an all time low required standards. because there were not enough personnel to handle this part of pharmaceutical service delivery and thus ensure that orders are followed up to ensure that we get deliveries on time and in full.

269 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 output Explanation of Explanation target and actual and actual target variance between between variance Target achieved Target It has been a the challenge for district hospitals to implement the down of their referral medicines to chronic the clinics due to staff shortages at the hospital and the clinic, shortage of equipment to ensure security of the items and transport to medicines supply the hospital to from clinic. 2009/10 Actual Output Actual Output 80% 90% 0 2009/10 Annual Target Target Annual 85% 90% 47 district hospitals to implement down system of referral their chronic especially medicines, ARVs 2008/09 Actual Output Actual Output Ranges between 94% Ranges between and 99% 76% Ranges between and 85% 60% 2/3 (EL and PE) hospital complexes and 1/2 regional hospitals (Frontier) established have system. referral down 2007/08 Actual Output Actual Output 60% Not reported 2 PE and EL Performance Performance measure/ Indicator measure/ % of essential drugs % of essential drugs the Depot at available at all times Number of hospitals that have implemented down system of referral medicines, chronic ARVs especially Percentage of tracer of tracer Percentage in all drugs available facilities at all times Objective Programme Programme To ensure improved improved ensure To access to drug supplies using the state tender contracts procurement their system to ensure patients' for availability all use in all facilities at material times with monitoring of their monthly pharmaceutical expenditure Table 7.2.1: Performance against Provincial Targets from 2009/10 to 2010/11 APP for the Pharmaceutical Services the Pharmaceutical for APP to 2010/11 2009/10 from Targets Provincial against Performance 7.2.1: Table

270 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

% of facilities with Not reported Only about 10% of 75% There was a huge monthly district hospitals under allocation of pharmaceutical procured within the budget for expenditure within allocated budget. pharmaceuticals

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT allocated budget Most other hospitals hence facilities and clinics overspent overspent what was really an under allocation which was not informed by either past consumption or burden of disease in that population, but but the fact that the

271 department did not have enough funds and had to cut down on all its allocations.

Facilitate compliance Number of health 92 hospitals 92 hospitals to good governance facilities complying through with pharmaceutical implementation of a services legislation monitoring and and issued with evaluation plan to NDOH licenses promote quality of Hospitals=92 pharmaceutical service CHCs = 32 and systems by health facility Pharmacies in hospitals & community health centres in accordance with Good Pharmacy Practice (GPP) norms and standards as set down by South African Pharmacy Council Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

16 CHCs 16 CHCs

Number of health 78 (85%) hospital 92 facilities recorded (district, regional, - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT with SAPC in tertiary & accordance with GPP specialized) norms and standards pharmacies are Hospitals = 92 recorded with SAPC CHCs = 32 in accordance with GPP norms & standards

Not measured as Not measured as 16/32 (50%) CHCs 16 posts not yet created posts not yet created are recorded with

272 SAPC in accordance with GPP norms & standards services Number of standard 0 12 24 33 operating procedures developed & disseminated to institutions in compliance with norms and standards

Number of districts Outreach programme 6 of 7 districts have All 7 districts to have 0 The plan was to have that conducted was conducted been reached by the conducted outreach district pharmacists outreach and targeting the schools campaign through and pharmacy appointed who will pharmacy awareness and universities in the outreach awareness activities then conduct these activities at least once PE region programmes awareness campaigns. a year But due to budgetary constraints this did not happen, hence this was not achieved. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Monitoring & No M&E Plan No M&E Plan Monitoring & Monitoring & Evaluation Plan for Evaluation Plan for Evaluation Plan Pharmaceutical Pharmaceutical completed Services developed Services approved &

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT implemented

Strengthen the Number of districts Not measured as All 7 districts with 0 This target was not capacity to provide with District posts not yet created District Pharmacy met due to budgetary quality pharmaceutical Pharmacy managers managers constraints. services by adequate, competent and Number of district 50 31 appropriate human hospital pharmacies resources who adhere with community to appropriate staffing service pharmacists 273 norms, culture of placed learning and continuing professional Number of 15 Post Basic 105 Pharmacist's 107 enrolled with the development and Pharmacist's Pharmacist's Assistant Assistants trained at service provider promote rational and Assistants trained & trained in hospital level as basic Health Science safe use of medicines registered with SAPC Grahamstown and post basic Academy as basic and post pharmacist's basic pharmacist's assistants to be assistants. Some will deployed to the 50 be retained in the clinics which are hospital complexes, centres of excellence, district hospitals & community health some deployed to the centres 50 clinics which are centres of excellence, community health centres Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

To ensure effective and Plan submitted, Busy developing the Plan submitted, PPP Contract PPP contract signed Activities on this efficient Treasury TA3 necessary documents Treasury TA3 Management Plan put contract suspended implementation of the approval granted but in terms of the PPP approval granted but into place with until further notice supply chain put in abeyance. Guidelines put in abeyance. appropriate resource

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT management process Revised management Revised management allocation through a PPP plan for turnaround plan for turnaround strategy to be strategy to be 274 PROGRAMME 8 HEALTH FACILITIES MANAGEMENT PROGRAMME 8: HEALTH FACILITIES MANAGEMENT

Purpose: Conduct regular inspection of all health facilities to The purpose of the Health Facilities Management is to ensure legal compliance in terms of Occupational improve access to health care services through Health and Safety Act provision of new health facilities, upgrading and Capture all projects on GIS and asset database revitalization as well as maintenance of existing Implementation of PPP's to complement facilities including the provision of appropriate health infrastructure funding care equipment Implementation of PGDP strategies Provide accommodation for health professionals Programme description: The Health Facilities Management is composed of Program Performance Review three sub-programmes viz: The analytical review of programme performance 1. Health Facilities Planning: encompasses planning, focuses on new policies introduced during the 2008/09 design, construction of new and replacement financial year, as well as policy amendments which facilities came into effect during the 2009/10 financial year. 2. Health Facilities Maintenance: this includes general Major constraints and challenges hampering the maintenance of buildings and servicing of building programme performance are highlighted, together with equipment & mechanical plant the programme achievements for the 2009/10 financial 3. Hospital Revitalization Programme: revitalization of year. This section provides information about the health facilities through infrastructural activities performed, the progress made and the development, health technology management, outputs achieved against the set targets at the end of quality assurance and organizational development the financial year by the Health Facilities Management programme. The programme experiences a number of Programme Objectives challenges relative to the health facility needs and The objectives of Health Facilities Management demands primarily due to inadequate budget. This are to: leads to poor and/or non-payment of contractors and Facilitate and provide infrastructural support in consultants as well as inadequacy in addressing the terms of the construction of the new buildings and service delivery needs on a broader scale. Challenges the upgrading of the existing structures for health are further experienced with the contractors as well, services delivery, as well as other organisational both on the financial and competency level and these building requirements has proved to delay progress in a number of affected Facilitate general maintenance in all sphere of the projects. Whilst the Maintenance sub-programme is organisation important & critical for the day to day functioning of Facilitate the provision of essential equipment in the facilities, it unfortunately the one that is hardest hit health facilities and experiences major financial challenges considering Ensure the implementation of PGDP requirements their output against the plans. It is hoped that the by engaging SMME contractors in health facilities DOH planning moving forward will take serious management projects consideration of the limitations and short-comings Promote skills development in general maintenance highlighted in the sub-programme. Detailed Maintain the fixed assets at health facilities programme achievements and challenges are according to industry regulations highlighted in the section below.

Programme priorities: Service Delivery achievements on programme The implementation of the Service Transformation priorities: Plan and further prioritization of building and Sub-programme: Health Facilities Planning upgrading of primary health care facilities where (achievements) necessary Completed construction of 19 new clinics Elimination of maintenance and capital works Completed upgrading of 3 dilapidated (mud backlogs by upgrading and revitalizing existing structure) clinics facilities Construction of Sada CHC completed Enhancing the maintenance of all health facilities Construction of Idutywa CHC in progress through provision of appropriate and essential Planning of Maluti CHC completed equipment Planning of Letitia Bam and Flagstaff CHCs in Accelerated planning of health facilities progress management using standardized room design Upgrading of Casualty / OPD at Victoria completed guides according to national norms Upgrading of four hospitals viz Uitenhage, Building a pool of first line in-house maintenance Madwaleni, Holy Cross and Aliwal North hospitals teams including clinical engineering technicians is at practical completion stage

276 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Upgrading of the Oncology Unit at Livingstone and Sub-Programme: Frere hospitals in progress Construction of the New Accident and Emergency Maintenance (achievements) Centre at Livingstone hospital completed Sterilizing equipment to the value of R2m bought Upgrading of Service Buildings at Cecilia Makiwane and delivered to Frere hospital. hospital in progress Purchasing of X-Ray equipment to the vale of R4m Construction of Student Nurses Accommodation at tendering stage. at Cecilia Makiwane in progress Purchasing of delivery beds and other related Provision of temporary accommodation for nurses equipment to the value of R1m towards Saving at Cecilia Makiwane hospital in progress Mothers… saving babies' project to go out on Planning of Jose Pearson TB hospital in progress tender during the second quarter. Carried out inspection and renewed licenses in 18 Tender for purchasing of low and medium private hospitals equipment i.e. ventilators, monitors etc has been Conducted inspections and renewed licenses for 7 awarded. renal units 15 hospitals provided with medical equipment. Conducted inspections and renewed licenses for 8 Maintenance contract for servicing of plant and step-down facilities machinery in 20 institutions randomly inspected Building maintenance in progress at 7 hospitals Water and sanitation upgraded at Mjanyana Sub-programme: hospital Hospital Revitalization (achievements) Challenges limiting service delivery St. Lucy's Hospital (Dr. Malizo Mpehle Depletion of current 2009/10 budget due to Memorial Hospital) accruals to the value of R320m. Construction of Health Professional Large scale projects required to meet 2010 World Accommodation, OPD /Casualty, Admin Block, Cup requirements (e.g. Livingstone Accident & Maternity, Male and female general wards, surgical Emergency Centre) with inadequate funding. wards, paediatric ward and physiotherapy Delayed payments to contractors / service completed providers thus resulting to slow progress and vacation of construction sites. St. Patrick's Hospital Additional costs incurred due to late payments to Construction of professional accommodation and suppliers i.e interest claims and extension of time Administration Block is 98% towards completion. claims. Upgrading of water, sewerage, electricity Consultants and Contractors in the construction rectification, construction of dispensary, paediatric industry are currently over-committed because of ward, male and female general ward theatre, the huge infrastructure development programme kitchen, mortuary, laundry are progressing well. throughout the province. This leads to slower progress on site if there is no close monitoring. Frontier Hospital The Eastern Cape has very few CIDB registered Construction of the Eye Unit has been completed Contractors at higher grades. This poses a Construction of theatre and ICU, Ward C challenge as some of the projects (hospitals) have (Medical), Ward E3, X-Ray and Pharmacy, higher budgets where only contractors in these Substation, Ward B (Medical) and Ward E are grades can be appointed. progressing well. Inadequate budget for projects either on planning Construction of 2 new wards and mortuary in or construction phases thereby hindering rapid progress infrastructure service delivery and thus costing more due to inflation. This has a limiting factor as St. Elizabeth the value chain is long i.e. loss furniture etc. as well Construction of the kitchen has been completed. as reducing the number of facilities to be built. Construction of staff accommodation is 90% towards completion. Construction of Mortuary and Labour Theatre in progress

277 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 8.1: PHC Facilities Under Construction in 2009/10 by Health Districts

Total Number of Projects, 2009/10 Completed 2009/10 District Total Progress Municipality at end 2009/10 Replacements/ New Total New Upgrades Total Upgrades

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Alfred Nzo 3 3 6 2 0 2 4

Amathole 13 3 16 7 2 9 7

Chris Hani 1 0 1 0 0 0 1

OR Tambo 12 6 18 8 3 11 7 278

Ukhahlamba 4 2 6 2 2 4 2

Cacadu 0 1 1 0 0 0 1

Total 33 15 48 19 7 26 24

* Projects in table refer to all facilities where construction works were in progress during the 2009/10 financial year Table 8.2: Construction Projects of New and Replacement Clinics and CHCs

Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) ALFRED NZO Mparane (new) 2007/08 June 2009/10 Completed

Sebeni (new) 2008/09 September 2010/11 The original contract was

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT terminated due to non- performance by the contractor during 2007/08, but unfortunately even the completion contractor failed to perform as expected. The project is behind schedule

Rhode (replacement) 2008/09 June 2010/11 Completion contractor appointed during 2009/10. remedial work delayed 279 progress on site Dundee (replacement) 2009/10 June 2010/11 Behind schedule due to slow progress by the contractor. Completing contractor on site to speed-up outstanding works

Madlangala (new) 2007/08 May 2009/10 Completed

Mkemane (replacement) 2009/10 June 2010/11 Lack of experience and limited finances has delayed the completion of the project. Project behind schedule but pushing to finish by June 2010

AMATHOLE Bengu (replacement) 2007/08 April 2009/10 Completed

Wesley (replacement) 2006/07 April 2009/10 Completed

Mpukane (new) 2007/08 June 2010/11 Completed Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) Nqusi (replacement) 2008/09 September 2010/11 Completing contract experiencing financial difficulties and as a result is behind schedule. As the contract is having a cession with ECDC is being assisted to

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT complete the outstanding works. Option of termination of the contract for the second time is out as it will cause further delays. Further, the contract was severely affected by late payments by the department.

Mgcwe (new) 2006/07 2010/11 Contract terminated due to

280 non-performance by the contractor. At present the Bid documents with the Bid Award Committee to be awarded

Masiphile (new) 2008/09 April 2009/10 Completed

Thembalethu (new) 2008/09 April 2009/10 Completed

Kotyana (new) 2006/07 April 2009/10 Completed

Hobeni (new) 2006/08 April 2009/10 Completed

Tyatha (new) 2008/09 June 2009/10 Completed

Ncera (new) nurses' home 2008/09 June 2010 Behind schedule due to delays by ESKOM power connection. Eskom is busy with the upgrading of lines. However, buildings are complete but final completion can only be achieved once connection has been done Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) Dutywa CHC (new) 2006/07 June 2010 Building construction complete but awaiting ESKOM connection.

Mt. Coke (phase 11-upgrade) 2008/09 April 2010 Completed

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Nontyatyambo/NU2 (new) 2003/04 April 2010 Practical completion. Behind schedule due to the contractor failing to the snagging. Quotes are being invited to get a completing contractor. However, beneficial occupation was achieved to utilise the facility.

Qeta (new) May 2009/10 May 2010/11 Behind schedule due to budget 281 constraints

Ntsitho (new) May 2009/10 May 2010/11 Behind schedule due to budget constraints

CHRIS HANI Ngqwaru (new) 2006/07 September 2010/11 Project falling behind due to slow progress by the contractor. Buildings are complete with exception of the sceptic tank which needs to be re-done and pedestrian gate. The contractor is attending to the snagging and leaking sceptic tanks. Once outstanding work is done, final delivery will be achieved. Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) OR TAMBO Palmerton (replacement) 2009/10 October 2010 Original contract terminated due to slow progress by the contractor. Second contractor is on site to complete. Project is behind schedule.

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Malephelephe (new) 2007/08 November 2010/11 Contractor behind schedule but is being assisted to complete by ECDC

Mbadango (new) 2007/08 April 2010 Completed

Nqaqhu (replacement) 2006/07 November 2010/11 Behind schedule. Quotations have been invited to get a contractor to finish outstanding works. Buildings

282 are complete except snagging.

Tikitiki (new) 2007/08 November 2010/11 Behind schedule because the contractor is experiencing cash flow problems

Mdeni (new) 2007/08 July 2009/10 Completed

KTC (new) 2007/08 April 2009/10 Completed

Libode (replacement) 2007/08 May 2009/10 Completed

Mbotyi (new) 2007/08 November 2010/11 Building complete but awaiting ESKOM power connection

Nqanda (replacement) 2006/07 June 2009/10 Complete but delayed by ESKOM power upgrade. Building occupied. Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) Ntafufu (replacement) 2008/09 October 2010/11 Behind schedule because the contractor lacked capacity and fell behind schedule however, they got into a joint venture arrangement with a capable contractor as a result progress

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT improved dramatically on site

Qokolweni (replacement) 2008/09 June 2009/10 Completed

Zwelebhunga (new) 2007/08 May 2009/10 Completed

Mngungu (new) 2007/08 April 2009/10 Completed

Phahlakazi (new) 2007/08 April 2009/10 Completed 283 Qolombane (new) 2007/08 April 2009/10 Completed

Gqubeni (new) 2007/08 June 2010/11 Practical completion achieved but waiting for electricity connection

Ngqwara (replacement) 2007/08 April 2009/10 Completed

UKHAHLAMBA Bethania (new) 2005/06 June 2009/10 Completed

Kungisizwe (new) 2007/08 July 2010/11 Practical completion achieved but contractor attending to snagging. Building being utilised. Start Date District Project Name Expected Completion Date Comments on progress (Financial Year) Thaba-Lesoba (new) 2008/09 June 2010/11 Late payments delayed the contractor

Sterspruit (new) 2006/07 April 2009/10 Completed

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Ngxaza (replacement) 2004/05 April 2009/10 Completed

Hlangalane (replacement) 2007/08 May 2009/2011 Completed

CACADU Walmer 14th Ave (upgrade) 2009/10 June 2010/11 Original contract terminated due to non-performance. Completing contractor on site. 284 output Explanation of Explanation target and actual and actual target variance between between variance See list of completed 8.2 Table clinic in of Non-payment contractors delayed on site performance Finalization of planning phase next for deferred due to year inadequate budget See list of completed See list of completed 8.2 Table clinic in No planning done due to budget constraints 2009/10 Actual Output Actual Output 7 clinics completed 1 CHC (Sada) completed Construction of Idutywa CHC in progress Planning of Maluti CHC completed; planning of Letitia Bam & Flagstaff CHCs in progress 2 site visits conducted Site handing- over 19 clinics completed; 0 work progress site progress work inspection 2009/10 Annual Target Target Annual Site visits conducted 3 times per year Construction of 19 Construction of 19 clinics to be completed from (carried over 08/09 F/Y) 5 7 2 (Sada & Idutywa) 3 2008/09 Actual Output Actual Output Not reported 24 18 12 1 CHC 1 CHC 2007/08 Actual Output Actual Output Not reported 14 22 4 clinics completed; 16 clinics in progress Construction 3 CHCs in progress Planning of 1 CHC completed Performance Performance measure/ Indicator measure/ Number of CHCs planned for Development. of site Frequency visits conducted Number of clinics planned for development Number of clinics dilapidated upgraded Number of CHCs built Number of new Number of new clinics built Objective Programme Programme Monitoring and of evaluation projects infrastructure Planning, Development Development Planning, Planning, Development Development Planning, Planning, Development Development Planning, Sub-directorate: Planning Sub-directorate: and management of health facilities and management of health facilities and management of and management of health facilities Table 8.3: Performance against Provincial Targets for 2009/10 – 2011/2012 Strategic Plan Strategic – 2011/2012 2009/10 for Targets Provincial against Performance 8.3: Table

285 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Monitoring and Number of Total = 13 Total = 35 18 private hospitals Total = 37 Could not inspect evaluation of private institutions (private Private hospitals: 13 Private hospitals: 17 Private hospitals: 18 other health facilities health facilities health facilities) Renal Units: 9 Renal Units: 7 due to non-availability inspected for Step down facility: 9 Step down facility: 8 of a pool vehicle

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT compliance purposes Public hospitals:2 and licenses renewed Poly clinic: 1 Rehab:1

Monitoring and Infrastructure Planning in line with Turn-around strategy Turn Around Strategy Turn-around strategy evaluation Development Infrastructure approved reviewed reviewed and Strategy and Plan Development implemented reviewed Strategy and Plan

Monitoring and Number of reports Project progress Reports on the Reports on 4 Consolidated 286 evaluation provided report meetings held progress or programme reports on on monthly basis performance of performance infrastructure project jointly with DPW and infrastructure provided on monthly, performance were PMTs projects presented at quarterly, annually produced monthly monitoring and ad hoc basis meetings

Upgrading of health Number of district Construction 5 district hospitals 5 i.e 1 hospital (Victoria) is facilities hospitals upgraded underway in 12 Uitenhage in progress; hospitals: St Barnabas hospital Holy Cross kitchen was Madwaleni 4 hospitals are at Komani completed; Victoria practical completion Aliwal North Aliwal North phase i.e St Barnabas Construction work at Holy Cross Midlands 4 hospitals viz Aliwal North Victoria Uitenhage, Victoria, Uitenhage Uitenhage Midlands & Aliwal Madwaleni Steynsburg North ongoing; Madwaleni Cofimvaba Construction work Zithulele was terminated at Glen Grey Komani and Holy Cross hospitals Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Upgrading of health Number of provincial Upgrading of 6 Upgrading in progress 3 hospitals Construction is Delay in the approval facilities hospitals upgraded hospitals underway in 2 hospitals i.e underway at Frere of a variation order viz: Cecilia Makiwane, Hospital; at Livingstone has Upgrading of Trauma hindered progress in

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Livingstone and Oncology Units Frere Hospital Contractor for this project PE Provincial at Cecilia Makiwane building of bunkers Dora Nginza and Livingstone Livingstone and to procure Mthatha Gen hospitals progressing oncology equipment Bedford Orthopaedic well. is on site at Livingstone; Projects at Dora Nginza & PE Contractor to build Provincial hospitals Oncology OPD and were put on hold. Wards will be going

287 out on tender in November 09 and is anticipated to be on site in February 2010

Upgrading of health Accommodation for Provide nurses' Provision of Temporal Construction of Temporal facilities health professionals temporary temporary accommodation for accommodation and accommodation provided accommodation at accommodation in nurses provided at civil works in provided - Cecilia Makiwane progress CMH progress accommodation rented from Border Tech whilst construction is in progress. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Upgrading of Cecilia Upgrading of service Upgrade of Cecilia Construction of Construction behind Makiwane Phase 2B – buildings at CMH in Makiwane Phase 2B Service Buildings in schedule due to Service Buildings progress service building progress but behind payment delays schedule - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Upgrading and Construction of Upgrade of CMH Contractor is on site construction of CMH Student Nurses' Phase 3 student nurse and civil works are in – Phase 3 – Student College and college and progress Nurses' Training accommodation in accommodation College and progress accommodation

Sub-directorate: Maintenance 288 Provision of essential Number of health 120 47 5 15 Medical equipment equipment to health facilities provided procured for All facilities with essential Saints, Midlands, equipment Isilimela, Holy Cross, Aliwal North, Butterworth, Livingstone, Tafalofefe, Burgesdorp, Steynsburg , Empilisweni and 4 hospitals at UKhahlamba district

Equipment also procured for 10 clinics Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

A comprehensive 5 Number of hospitals Not done Not done 20 health facilities Business plan was Business plan was to year Healthcare where Equipment approved be implemented with Equipment plan plans are completed, equipment audit documented and project. However, this

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT approved did not happen due to financial constraints

Provide emergency Number of facilities Emergency repairs Emergency repairs All clinics, CHCs and 2 Facilities completed Delays in starting repairs services to all provided with done on need basis carried out in hospitals with i.e Zone 8 clinic and with repair contracts. clinics/CHCs and emergency building institutions where emergency requests Cofimvaba hospital DPW is sorting out hospitals repairs needed submitted roof repairs issues raised by the specifications Mortherwell in committee on the

289 Cacadu was handed management of over for repairs and emergency service planning for contractors before Ngonyama CHC in going out on tender progress

Improve power backup Number of RGK60 No simulations at Conduct and All hospitals, 24hr Power simulations Control system could system and monitoring controllers installed hospitals conducted document simulations clinics and CHC conducted in 40 not be installed due for all hospitals, 24 hr Number and and documented at all institutions by Hospitals to financial clinics and CHC frequency of power prior to 2008 December 2008 constraints failure simulations conducted and documented

Transfer funds to Number of facilities Day to day Maintenance funds 85 clinics, Funds transferred to Project could not be institutions outside of provided with day to maintenance funds transferred to some 20 Hospitals 18 district hospitals fully implemented CME for day to day day estate not sufficient for institutions 2 colleges and Nelson Mandela due to financial estate management maintenance funds. transfer and ensuring 2 EMS academic hospital constraints maintenance is performed Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Implementation of the Number and type of Maintenance of Maintenance of 35 hospitals 10 Institutions IPMP completed but Centres of institutions where facilities not carried facilities carried out undergoing major lacks funding Maintenance CME programme is out and documented on 11 hospitals and 3 Colleges maintenance: 4 Excellence CME implemented and prior to 2008 27 clinics 1EMS hospitals and 4 clinics

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Programme for documented completed Hospitals, EMS, 2 Forensic Colleges Forensic Mortuaries 3 hospitals awarded mortuaries and Clinics/CHCs (Built 100 clinics and Civil environment)

Improve energy Number of projects Not done Not done 3 hospitals 2 hospitals - Project consumption and cost where energy and Butterworth and implementation not efficiencies at cost efficient Grey hospitals' achieved due to

290 hospitals methods have been heating project at delays in contractor employed and planning phase payments documented at hospital level

Optimize Maintenance Number of hospitals Not done Not done 45 hospitals and 16 20 Hospitals New Organogram contracts for the where maintenance CHCs inspected proposed in order to laundry and kitchen contracts are improve monitoring equipment, HVAC, optimized in lined Monitoring tool and contract Refrigeration, Steam with the contract developed based on management reticulation, Minor stipulations and standards electrical, Sterilizing accepted industry 2 new engineering equipment, Medical gas standards works inspectors and vacuum and Lift have been appointed installations, Standby and are currently generator sets, Fire engaged in and fire prevention monitoring contract equipment all in place. and inspecting deviations at various institutions. Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Upgrade water and Number of Water Not done Not done 2 hospitals Designs for upgrading Delays on the waste water and and sanitation Plants of sanitation plant at generation of works sanitation plants upgraded to meet the All Saints in orders is hampering requisite standards completion phase. progress for these

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT and documented projects

Audit of all Healthcare Number of hospitals Not done Not done 20 health facilities Business plan Bidding did not equipment where Audit, bar- approved commence due to coding and inventory unavailability of funds lists are completed and documented as per approved business plan

291 Maintenance of Number, type and Not done Not done Maintain all life Expression of interest Bidding did not medical equipment at class of equipment support equipment memo approved commence due to hospitals maintained through SLA in all unavailability of funds hospitals

Provide new reliable Laundry Equipment Not done Not done Ironer for Frere Butterworth boiler Constraint in plant and machinery to installed, hospital laundry and on order; implementation were hospitals commissioned and boiler for due to delays in operational Butterworth hospital Frere VO documents contractor payments for laundry equipment being compiled for approval by BAC DPW.

Planning of civil work for boiler installation in progress Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output

Sub-directorate: Hospital Revitalization

Number of projects Mary Theresa 12 projects at 6 Construction works underway in 6 hospitals: completed in Hospital handed over hospitals upgraded - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT revitalization facilities to beneficiary through revitalization ST. LUCY'S (Dr Malizo Mpehle Memorial) HOSPITAL communities grant namely: Main Hospital: Was completed and handed over on 30 March 2010. Frontier, St Lucy's, Snagging by this date was still outstanding. Madzikane kaZulu, St Gateway Clinic: Paving and electricity installations are in progress. Patrick's, and St Wall and floor tiling have been completed. Contractor is busy with Elizabeth installation of carpet and sanitories. Lights, fans and air conditioning have been installed. Painting in the nurses residents is in progress EMS: The contractor was awarded tender. Site establishment was

292 done and the contractor started with earthwork foundations, digging of trenches and prepared to pour concrete.

The Project has however, not progressed since August 2009 because of poor financial capability of the contractor. A warning letter was issued to the contractor by the principal agent to speed up the process before its contract could be terminated

ST. PATRICK'S HOSPITAL PHC Gateway Clinic Construction of building was completed and is now occupied Upgrading CAS/OPD, Maternity, etc.: Drawings and designs were completed; tender document bills are in preparation Administration Block: Brickwork for the administration block is completed. Block 1, 2, 3: Painting, tiling, ceiling and water facilities have been completed. The contractor is busy with inside and outside final finishings that is installation of fascia board, skirting and quadrant. Actual Output Actual Output Actual Output Explanation of Programme Performance Annual Target 2007/08 2008/09 2009/10 variance between Objective measure/ Indicator 2009/10 target and actual

Block 4, 5 and 6: The contractor is busy with roofing and plastering of internal walls. Block 7: Roofing has been completed and the contractor is busy with painting and tiling. - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT

Professionals Accommodation: Single Units (Block 1- 6): Internal finishings have been completed; the snagging is still outstanding. Landscaping in this area is progressing well. Family Units: Roof erected on all family units; contractor now busy with internal finishings. Dormitory: 64 single rooms with communal 2 lounges, bathrooms and 2 kitchens. Roofing has been partially erected and the levelling of 293 roads is progressing well.

FRONTIER HOSPITAL

CAS/OPD: The project is on planning stage. New Ward Block: The contractor's performance has not been satisfactory. Attempts to improve the performance were done with no success. The contractor has since applied for the termination of contract as a result of non-payment. New Ward Block (2): Roofing is completed; the contractor was busy with glazing and plastering. Mortuary: Roofing and plastering has been completed. Contractor is busy with painting of internal wall. Paediatric ward: Drawings, designs, and tender document bills are done and completed. Advertisement will be done at the beginning of 2010/11 financial year Phase 3 including Eye Clinic: Identified snags were rectified. The project is now completed and all buildings are occupied and fully functional Actual Output Actual Output Actual Output Explanation of Programme Performance Annual Target 2007/08 2008/09 2009/10 variance between Objective measure/ Indicator 2009/10 target and actual

ST ELIZABETH'S HOSPITAL

Trauma, Theatres: Drawings and designs are completed. Advertisement was delayed by addition of a helipad. - E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Kitchen: Construction of the kitchen was completed and installation of kitchen equipment was done. Practical completion expected in April 2010. Training of kitchen staff on new equipment still to be done, delayed by non-payment by the Deaprtment Mortuary: Construction of mortuary superstructure and roofing are completed. Painting has commenced and is progressing well. The contractor is preparing for paving the area and finishing off the aprons. Most of the mortuary equipment has been delivered onsite but is awaiting installation. 294 Labour Theatre: Superstructure brick work, roofing, both inside and outside plastering are all completed.

Professional Staff Accommodation: Construction of the superstructure brickwork on both Block A and B at 1st and 2nd floor levels are completed. The project is at roofing stage. Superstructure brickwork on Blocks C and D at first floor level has commenced. The superstructure brickwork for all garages is completed; roofing has commenced.

Resource Centre: The project has not been awarded yet. The process has been delayed by the Bid Award. Actual Output Actual Output Actual Output Explanation of Programme Performance Annual Target 2007/08 2008/09 2009/10 variance between Objective measure/ Indicator 2009/10 target and actual

Number of district Complete planning Continue planning for The Business case for Madwaleni hospital has been completed and is hospitals planned for for 2 hospitals. Madwaleni hospital awaiting provincial approval before it could be forwarded to NDoH phased upgrade for approval.

- E ASTERN C APE D EPARTMENT 2008/09 A NNUAL R EPORT Organisational No. of appropriate All vacant positions Continue with 27 appointments were made for both St Patrick and St Elizabeth Development and Appointments made at the Head office funding of hospital. filling of critical posts at Head office and in and 4 institutions appointments institutions filled. 10 appointments for St Patrick's hospital 17 appointments for St Elizabeth hospital

Provide and maintain No. of Revitalisation 4 Institutions Procure equipment Kitchen and mortuary equipment procured for St Elizabeth regional equipment in all Institutions provided provided with for all four hospital Revitalisation Projects with essential equipment and institutions equipment equipment

295 maintained PART C REPORT OF THE AUDIT COMMITTEE EASTERN CAPE DEPARTMENT OF HEALTH REPORT OF THE AUDIT COMMITTEE FOR THE YEAR ENDED 31 MARCH 2010

Introduction

We are pleased to present our report for the financial year ended 31 March 2010

Committee members and meetings

The committee is composed of four members. These are Ms. Loren Smith CA(SA), (Chairperson), Mr. Mohammed Dukander CA(SA) CIA, Dr Bukelwa Mbulawa-Hans, and Mr. Harris Gxaweni.

The following is a schedule of meetings attended by the current members to 31 March 2010: -

26 May 2009 28 July 2009 20 2 November 03 March 2010 August 2009 2009 Ms L Smith P P P P P Chairperson B Mbulawa-Hans P A P P P (Doctor) Mr M Dukander P P P P P (Appointed March Mr H Gxaweni P P A P P (Appointed on the 8th September

Key The effectiveness of the internal control systems; P = Present The effectiveness of the internal audit function; A = Apology The risk areas of the Department's operations to be covered in the scope of internal and external Audit Committee Responsibility audits; The adequacy, reliability and accuracy of the The Audit Committee also reports that it has adopted financial information provided to management and appropriate formal terms of reference as its Audit other users of such information; Committee Charter in line the PFMA section 76(i)(a) Any accounting and auditing concerns identified as read with Treasury Regulation 3.1.8. The Committee a result of internal and external audits; has regulated its affairs in compliance with this The Department's compliance with legal and Charter, and has discharged its responsibilities as regulatory provisions; contained therein. The activities of the internal audit function, including its annual work programme, coordination Duties and responsibilities with the external auditors, the reports of significant recommendations and the responses of The Audit Committee is responsible for the following management to these recommendations; and duties:

297 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 The scope and results of the external audit Risk management function function, its cost-effectiveness, as well as the independence and objectivity of the external Risk Management is a proactive discipline that involves auditors. scenario planning and that is intended to provide reasonable assurance that the department will achieve The Audit Committee is also responsible for: its objectives. King III principle 2.2 states that the Reporting to the Department and the Auditor- board, (executive authority in the case of a General where a report implicates any member(s) government department) “should appreciate that of the accounting officer in fraud, corruption or strategy, risk, performance and sustainability are gross negligence; inseparable.” Communicating any concerns it deems necessary to the Executive Authority and the Auditor- The Audit Committee is not comfortable that General; enterprise risk management processes are being Confirming the internal audit charter and internal effectively implemented in the department. There is audit plan; need for a risk management culture to be instilled Encouraging communication between, senior and within the department. This should start with the executive management, Internal Audit department appointment of a Chief Risk Officer, the custodian of and the Auditor-General; risk management, in order for such person to create Conducting investigations within its terms of risk awareness, institutionalize and embed risk reference; and management throughout the organisation and facilitate Reviewing the Annual Financial Statements prior to communication and coordination of the process. the annual audit for approval by the Superintendent General. The Department needs to focus on risk management as there are no procedures in place to ensure that We believe that we have complied with the above departmental risks are being addressed. The responsibilities during the year. We would like to department still does not have an approved Risk highlight that the level of support offered by Management Policy and Risk Management Strategy. Management of the Department is lacking and hence The Risk Committee met twice during the year and this has further hindered the progress of the only reported once to the Audit Committee. The Department to obtain an improved audit opinion. Audit Committee is therefore unable to provide assurance that the risks are being managed within the Department. Effectiveness of Internal Control Furthermore, the committee is concerned that a The controls were found to be ineffective by both number of allegations of fraud and corruption within internal and external audit for the year under review. the Department are not being investigated in a timely The leadership of Department will have to establish manner. processes to ensure that for the next year controls are improved. Both risk management and fraud risk management have not been properly managed and this had a Internal Audit Function negative affect on the Department. The Audit Committee believes that this directorate requires the The committees' role is to coordinate and monitor immediate attention of Senior Management to ensure the activities of the internal audit function. The that they are capacitated and work effectively. committee is able to report on the effectiveness and efficiency of the unit. The internal audit capacity was Evaluation of Annual Financial improved during the year and hence they have been able to meet their audit plan for the year under review. Statements This has resulted in thirty four internal audit reports issued during the year under review. These The Chief Financial Officer assured the committee recommendations should be implemented by the that the statements comply with relevant Department. requirements relating to:

298 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Treasury formats and guidelines for the financial Conclusion statements. Performance against the budget for the financial We believe that the audit committee has performed year. their duties as required by the Public Finance Explanations on disclosure issues. Management Act and have provided input to the Material variances from previous years. leadership of the Department however this has not been implemented and hence the Audit Report is that The financial statements were not found to comply of a Disclaimer of Opinion. with the above by the Auditor General. Furthermore, it was identified that the version of the financial The Leadership of the Department will have to statements reviewed by the Audit Committee were in establish and implement an immediate action plan to fact different to the version submitted to the Auditor deal with the weaknesses within this Department in General on the 31 May 2010. This requires order to prevent a similar report in the next financial investigation by the Department and the Audit year. Committee has tasked the Superintendent-General to resolve this matter. The Committee concurs and accepts the findings of the Auditor General. The Committee is not satisfied that the major financial risks of the Department are appropriately managed.

This committee will continue monitoring the progress made in addressing the issues raised by the Auditor- General in the management letter to the Department. L Smith Audit Committee Chairperson The department does not have an approved on behalf of the Audit Committee Organizational Performance Management Policy and 11 August 2010 Strategy. The Committee therefore does not have the comfort that organizational performance is being effectively managed beyond head office.

299 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 ANNUAL FINANCIAL STATEMENTS

Table of contents page

Report of the Accounting Officer 301

Report of the Auditor-General 324

Appropriation Statement 334

Notes to the Appropriation Statement 357

Statement of Financial Performance 360

Statement of Financial Position 361

Statement of Changes in Net Assets 362

Cash Flow Statement 363

Accounting Policies 364

Notes to the Annual Financial Statements 373

Disclosures Notes to the Annual Financial Statements 385

Annexure to the Financial Statements 404

300 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PART D ANNUAL FINANCIAL STATEMENTS REPORT OF THE ACCOUNTING OFFICER FOR THE YEAR ENDED 31 MARCH 2010

Report by the Accounting Officer to the Executive basics” PHC approach (social determinants of Authority and /Provincial Legislature of the Republic of health), and emphasizing the centrality of clinic and South Africa. Community Health Centre is pivotal to the foundation of our health system; 1. GENERAL REVIEW OF THE STATE OF FINANCIAL AFFAIRS. The emphasis on the revitalisation of primary health care means that the Department must develop a fully decentralised health care system. This requires The department received an adjusted budget of a redesigned organisational structure which R11,77bn. At the end of the financial year, 102, 68% devolves accountability and responsibility for public of the budget had been spent resulting in an overall health and associated services to the District and over expenditure of R315,14m which translates to sub-district levels. 2.68% of the budget. Initiating income Generation projects in identified Included in the adjusted budget is an allocation hospitals to increase our attraction and retention of towards prior year accruals the detail of which is revenue. This will not only increase our revenue covered under the section “significant events that base but will also build a nucleus of facilities have taken place during the year” towards readiness for National Health Insurance (NHI) policy implementation. The department's over expenditure is mainly attributed to the increase in compensation of Reforming our Supply Chain Management system by employee costs arising primarily from the absence building elements of transparency and efficiency and of funding and/or shortfalls in the funding of the aligning with the PHC revamping initiatives; building Human Resource Operating Project Team (HROPT), strong Local Economic Development (LED) the more than budgeted for improved conditions initiatives at local level; of service and Occupation Specific Dispensation (OSD). These are unfunded/partially funded mandates and policy decisions that are not aligned Re-engineering our business processes and building with the budget allocations including carry through high efficiency levels. This will also be aligned with costs as well as budget pressures manifesting in building the requisite austerity culture in the service delivery frontline costs such as laboratory department to achieve greater value from the little services, pharmaceutical, surgical supplies & vaccines resources that we have; and departmental fleet including emergency medical services. Increasing Human Resources capacity by recruiting the required personnel and increasing production of The Department committed itself to the principle our nursing personnel. The new government has of health services continuing uninterrupted through identified Health reform as one of the important accommodating accruals into the next financial year priorities in this term of government. and applying a bridging overdraft facility to fund core services. 1.1.1 Financial Management and Capacity The Department has consistently experienced In compliance with the requirements of S39 of the weak financial management as reflected by poor Public Finance Management Act, the Department audits. routinely reported monthly to Treasury the impending overspending of the 2009/2010 vote and The Office of the Accountant-General and the main divisions within the vote. Technical Assistance Unit, National Treasury undertook a financial management improvement 1.1 Important policy decisions and strategic pilot project and the Eastern Cape Department issues facing the department of Health was one of the identified pilot sites. The pilot project purpose was to undertake a Building a strong Primary Health Care (PHC) comprehensive financial management situation foundation through Social Compact and analysis, identify key financial management focus mobilization of our communities, increasing areas to assist the Department of Health to Community Healthcare Worker capacity, “back-to- identify the root causes of the negative audit

302 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 outcomes, identify lessons learnt from the audit announced a massive HIV testing and counselling processes, develop strategies and interventions campaign and the extensive expansion of the to achieve clean audits in the future. provision of Anti Retro Viral Treatment to be undertaken throughout the country. At the same time the Inter-Governmental Relations (National Treasury) together with the In line with the call to improve access to HIV Eastern Cape Provincial Treasury undertook a and AIDS services, the department went on a detailed situation assessment and rationale for campaign preparing clinics ensuring that Primary rapid interventions in the Department of Health Health Care facilities and in particular Nurse and Education (14 August 2009). Both situation Initiated Antiretroviral Treatment (NIMART) analysis assessments found that 64% of issues using predetermined national regimens is ready raised in 2004/2005 Audit Report were still and prepared to implement this new policy from prevalent in 2008/2009. Issues consistently the 1st April 2010; all new drugs needed were raised by the Auditor-General are mainly the made available at both depots; test kits for the Department's weak financial management, weak HIV Counseling and Testing campaigne available implementation of Supply Chain Management, in all districts. By March 2010 a total of 61 poor Asset Management, Inadequate Human primary health care facilities were assessed and Resource Management, poor Corporate ready to roll out the programme. Governance and weak management of Conditional Grants. 1.1.3 TB services To address the challenges of TB the department The general perception is that the Department bought four SANTA institutions and also took lacks management responsibility and over Nkqubela TB hospital from Life Esidimeni. A accountability which has negatively affected its 32 bedded wing at Majorie Parish Hospital has ability to deliver quality health services. been renovated to assist with extra beds for MDR patients. To improve compliance at Nelson It is in this context that the newly appointed Mandela Metro and Buffalo City, TB tracer teams Superindent-General approached National were introduced to do follow ups and prepare Treasury for swift intervention to facilitate and clinics to receive discharged patients from ensure that public trust in the public health hospitals. system is restored. 1.1.4 Integrated Human Resource Plan Accordingly, the National Treasury Technical The Department is required to ensure that it Assistance Unit (TAU) is currently providing meets the targeted recruitment of personnel to technical assistance services to the Department currently under-serviced areas, as well as a with the Organisation Design for the Finance constant supply of highly skilled and trained Cluster. health professionals. The Human Resources Plan is in place as a framework to guide strategic This support with the re-design of the Finance planning around human resources. The Management Unit of the Department aims to framework is being adjusted to align it with improve the efficiency and effectiveness of the norms to be applied in the planning and staffing department's financial management processes within a service environment. There is a shift in and structures. emphasis from a hospi-centric approach to that of the revitalisation of PHC. The major challenge facing the department remains that of lack of personnel with financial An allocation of R127m has been set aside in management qualifications, skills and 2010/2011 for the recruitment of the following competence as well as integrated financial critical skills: systems, these manifests in the poor (a) Foreign Qualified health professionals performance and negative audit opinions that we (doctors predominate this group) have been obtaining in the past years. (b) Medical specialists (radiologists for the income generation projects; absorption of 1.1.2 New Anti Retroviral Therapy (ART) Policy EC registrars; internal physicians; etc) The government is committed to the fight (c) Enrolled nurses and Enrolled Nursing against HIV and AIDS epidemic and TB and to Assistants that will graduate from the Lilitha give effect a new policy on ART was rolled out. Nursing College in August and September, During the world Aids day the President respectively

303 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 (d) Community Service health professionals In August 2006, the Executive Council (EXCO) when they complete their obligations in decided that debts of employees that were December through to February overpaid be written-off. It also invited all (e) Bursary holders that will honour their employees with genuine claims to submit such contractual obligations for consideration by Heads of Departments. Departments were also directed to identify all affected employees and cost their debts for In addition, 594 employees have been appointed submission to the Provincial Treasury in in the past years for various projects as part of a accordance with procedures for a write-off. provincial program to provide unemployed graduates with opportunities to gain experience in the public sector. These employees receive a The Department complied with the resolution stipend. As the Department restructures in the i.e. submission for remittance of debts at year ahead in support of the emphasis in policy Treasury as well as invited employees to submit on revitalising PHC, permanent posts will be genuine claims. However, because the EXCO advertised creating opportunities for these decision did not reverse the HROPT findings employees for permanent employ. nor did it give criteria for considering employee claims, the department got locked into a two year dispute with affected employees and their 1.2 Significant events that have taken place trade unions, over criteria for processing such during the year claims.

1.2.1 Implementation of Phase 2 OSD for In April 2009 the department followed Medical cluster instructions for processing claims as Negotiations on the OSD for the Medical implemented in other departments. These Cluster came to an end on 30 June 2009 with an processes resulted in mass promotions, in principle framework agreed between parties. effectively promoting every employee employed Trade unions went out on a consultative process prior to 30 April 1994 that claims to have and signed an agreement on the 7 August 2009. stagnated due to the HROPT findings. The payment of the phase 2 in terms of this signed agreement has been effected what is the The HROPT is an unfunded mandate and during value of payments?. the year R389m was paid to 1 006 employees.

With the high vacancy rates for these categories, 1.2.3 Change of Political Head and Accounting commuted overtime system will be maintained Officer to ensure that provision of services is not threatened. Two thirds of the province is rural There was a General Election in the country and as a result there is a high salary bill for the with resultant new government being elected rural/nodal allowances. Again, the maintenance of into office. A new Member of the Executive this incentive is critical to maintain event the Council for the Eastern Cape Department of current post levels. Health, the Hon. P Masualle resumed office in May 2009. A new accounting officer Dr. Siva Pillay was appointed in January 2010 and the 1.2.2 Human Resource Operating Project Team acting Accounting Officer Mr. P. Zitumane also (HROPT) resigned his post of Chief Operations Officer in The HROPT refers to a number of March 2010. rationalization processes that took place in the EC Provincial Administration during 1994-1996. 1.3 Major projects undertaken or completed It was a process set-up by the provincial administration to review and correct employee during the year ranks and salary levels in accordance with During the year under review the major projects established prescripts of the Public Service that were undertaken are mainly infrastructure Commission. and are continuing from previous financial years. These are disclosed under the notes on immovable assets in the Annual Financial As a result of this rationalization exercise, some Statements and are further covered in the employees were declared to be irregularly Annual report. promoted, whilst others were inadvertently demoted. This resulted in some employees being overpaid and others underpaid.

304 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 1.4 Spending trends The table below shows the high level financial performance of the Department at the end of the financial year. Detailed performance by Programme is shown in the Appropriation Statement in the Annual Financial Statements.

Adjusted Budget Expenditure Variance Expenditure as a % of Budget R'000 R'000 R'000 11,773,927 12,089,071 315,144 102,68%

Reason for the (over)/under expenditure Programme 3: Emergency Medical Services - for Programmes with significant under expenditure of R10,5m The under-expenditure on payments for Capital Assets variances of R13,2m arose from inter alia orders made for the outright purchase of new ambulances which only Programme 1: Health Administration - Under arrived in the 2010/11 financial year. expenditure of R70,8m The under-expenditure on Goods and Services and Programme 4: Provincial Hospital Services - Capital Assets was caused by insufficient cash flow in over expenditure of R454,9m the last quarter of the financial year. The programme overspent its budget for compensation of employees by R471,8m caused mainly by no funding Programme 2: District Health Services - over received for the HROPT payments and the carry expenditure of R419,3m through costs related thereto as well as unfunded / The programme overspent its budget for compensation partially funded mandates of Phases 1 and 2 Occupation of employees by R521,6m caused mainly by unfunded Specific Dispensation payments and the related carry Human Resource Operating Project Team (HROPT) through costs. This is attributed to policy decisions payments and the carry through costs related thereto made but have not been aligned with the budget as well as unfunded / partially funded mandates of Phase allocations. 1 and 2 Occupation Specific Dispensation payments and the carry through costs related thereto, wherein the The under-expenditure on Transfers and Subsidies of respective policy decisions have not been aligned with R9,5m relating to households, was caused by insufficient the budget allocations. cash flow in the last quarter of the financial year.

The over-expenditure on Compensation of Employees Programme 5: Provincial Tertiary Service - is expected to remain a challenge as the carry through under expenditure of R75,1m costs of HROPT and OSD mandates that resulted in the over expenditure in the current year have not been The Department submitted an application for rollover compensated by sufficient new funding. of R75,1m conditional grant funds to the Provincial Treasury in respect of the National Tertiary Services Conditional Grant. The under-spending in machinery & The over expenditure on goods and services was equipment and buildings & other fixed structures is caused primarily by the increase of Pharmaceutical attributable to inter alia the non completion of the and Surgical Sundries expenditures associated with the Turnkey project to supply Linear Accelerators and ever increasing burden of disease within the Province. Computerised Tomography (CT) Scans for the Oncology sites at Livingstone Hospital in Port Elizabeth The under-expenditure on Transfers and Subsidies and Frere Hospital in East London (Bid No relates to municipal transfers outstanding at year end SCMU305/06 – 0253) as well as delays in the delivery for which there was insufficient cash flow. of various items of medical equipment purchased within the hospital complexes in the Province, including world The Department submitted an application for a rollover cup 2010 readiness. of R56m conditional grant funds to the Provincial Treasury in respect of Comprehensive HIV/Aids Conditional Grant.

305 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Programme 6: Health Sciences & Training - 1.5 Unauthorised expenditure under expenditure of R33,2m The programme overspent its budget for compensation The department has for the year under review of employees by R14,3m caused mainly by no funding incurred unauthorised expenditure amounting to received for the HROPT payments and the carry R874,3m on its vote mainly due to over through costs related thereto as well as unfunded / spending in the compensation of employees. partially funded mandates of Phases 1 and 2 Occupation Payments to the value of R389m were made to Specific Dispensation payments and the related carry employees whose salary levels and ranks were through costs . This is attributed to policy decisions adjusted through the HROPT process. In April made but have not been aligned with the budget 2009 the department followed a directive from allocations. the Office of the Premier to follow procedures for processing claims as implemented in other The Department submitted an application for rollover departments. These processes resulted in mass of R45,5m conditional grant funds to the Provincial promotions, effectively promoting every Treasury in respect of the Health Professions Training employee employed prior to 30 April 1994 that and Development Grant. The rollover relates to the claims to have stagnated due to the HROPT under-expenditure of R22,2m on transfers to findings. The resultant expenditure was not Universities, which were not effected at e year end and budgeted for and as such the HROPT is an the payments for capital assets of R20,2m which had unfunded mandate. not been processed. The issues relating to HROPT are still being Programme 7: Health Care Support Services – deliberated at Provincial level and as such the under expenditure of R11,8m department awaits the outcome of an audit The programme under spent its budget for initiated by the Office of the Premier regarding Compensation of Employees by R7,2m, goods and all the cases. services by R5,9m and Payment for Capital Assets by R8,5m as a result of delays in the timeous finalization of Expenditure relating to Partnership for Delivery the medical depot organogram and subsequent of Primary Health Care (PDPHC) programme appointment of personnel, payment of unitary fees which is funded by the EU was paid from the following the non award of the PPP Concession voted funds (equitable share). EU funds had not Agreement in the current financial year. been received from the Provincial Treasury, an unauthorised expenditure amounting to R8,15m Programme 8: Health Facilities Development and Maintenance – under expenditure of was incurred. R351,7m The Department submitted an application for the The balance of the unauthorised expenditure of rollover of R80,6m conditional grant funding to R379m can be attributed insufficient funds to Provincial Treasury in respect of the Hospital cover carry through costs of adjustments in Revitalisation Grant and R23,2m for the Infrastructure compensation of employee and funding shortfalls Grant to Provinces. or non funding of mandates and policy decisions.

The Department committed itself to the principle of 1.6 Irregular Expenditure health services continuing uninterrupted through accommodating accruals into the next financial year and Irregular expenditure amounting to R1,14bn applying a bridging overdraft facility to fund core (known errors and extrapolations) relating to services. incorrect procurement processes and non adherence to financial delegations of authority The department is engaged in discussions with the was reported by the Auditor-General in the Provincial Treasury, National Treasury and the National 2008/09 audit report and this was a qualification department of Health in respect of the financial matter. In order to resolve or clear the position of the department. qualification, the department is required to review all expenditure batches for the past financial years to determine the extent and value

306 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 of irregular expenditure. With the huge volumes 2.1 The following services are rendered by the of transactions going through our financial Department: system the department has weighed the cost 2.1.1 Primary Health Care Services through the and the benefit of such an exercise, and implementation of the District Health concluded that it will not be in a position to Services restate the prior year figures. 2.1.2 Emergency medical and rescue services to all the parties of the Province During the year irregular expenditure of 2.1.3 The provision of hospital and specialised R373,1m was incurred and relates to incorrect services in collaboration with Health Science procurement processes and non adherence to Faculties of various higher institutions of learning financial delegations, R7,4m of this amount within the Province relates to expenditure on leases of machinery 2.1.4 Specialised services, such as clinical orthotic and and equipment for which contracts were prosthetic services entered into through the National Treasury RT3 2.1.5 Training of all health professionals employed by transversal tender. the ECDoH 2.1.6 New health facilities and revitalisation of Disciplinary action was taken against officials dilapidated facilities who made or permitted irregular expenditure. 2.1.7 Health Facilities Development and Maintenance, Final written warning letters were issued and planning and construction of new clinics and some officials were either dismissed or hospitals, rehabilitation of existing hospitals and suspended. Details of irregular expenditure for clinics replacement and maintenance of capital the current financial year are disclosed in Note equipment. 28 of the disclosure notes to the Annual Financial Statements 2.2 Tariff Policy Health Services tariffs are determined by the 1.7 Fruitless and wasteful Expenditure National Department of Health (NDoH) for all provinces through the implementation of the An amount of R16,8m was incurred as fruitless Uniform Patient Fees Schedule (UPFS). The and wasteful expenditure mainly in respect of ECDoH tariffs in respect of H1 patient category interest paid to Fleet Africa, Infrastructure differ from those set by NDOH in respect of consultants and other service providers, R8,9m services rendered at facility levels 2 and 3, and has been condoned after due processes had also in respect of services rendered by a been undertaken in line with the guidelines. The Specialist. This is because the ECDoH had only balance is in respect of the cases under implemented UPFS 4 years after it was investigation. introduced as a national Policy. A phased approach is being followed to avoid drastic tariff 2. Services rendered by the department increases.

2.3 Free Services The Eastern Cape Department of Health in terms of its Constitution provides health care services to There are certain circumstances under which the people of the province. The Department is patients will receive services free of charge structured in 8 programmes. The core services are independently of their classification as full paying delivered through the four programmes, namely: or subsidized patients. Such circumstances include infectious, formidable diseases, pregnant women and children. Also patients classified District Health Services - Programme 2 under H0 category receive free services. It was Emergency Medical Services - Programme 3 not possible to quantify the cost of the free Provincial Hospital Services - Programme 4 services rendered. Central Hospital Services - Programme 5 2.4 Inventories The remaining programmes offer the necessary Inventory at the end of the year is valued at cost support in the rendering of health care. on a First-in-First-out basis (FIFO). The closing stock figures represent inventory counted at the

307 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 hospitals, depots, Local Service Area (LSA), The department is not only challenged in terms stores, wards and theatres. of the skills shortage but also in the numbers that are supporting the core functions. The Stock holding at year end decreased by 14% special focus continued on bolstering HR and compared to the previous financial year; this can finance capacity in the past year. The focus was be attributed to the decrease in purchases from on re-skilling of employees on the functional the 3rd quarter of the financial year due to the areas where they are currently placed. Special introduction of austerity measures to contain programmes include a Masters programme for over expenditure. 14 hospital managers, finance and supply chain management training with PFSA, HR PERSAL In the year under review the department is training and clinical training programmes in TB, required to provide disclosure on inventory HIV and AIDS, and other core disciplines. The such as purchases, issues, obsolete/redundant details will be contained in the Annual Training stock and losses in Annexure 6 of the AFS. This report. is a change from the previous financial year where inventory was disclosed in the Accounting The Executive Leadership and Management Officer Report. Development programme was suspended whilst awaiting the permanent appointment of the two In order for the department to comply with the executive members. This team will in fact drive disclosure requirements integrated inventory the programme. The cash flow programme management system is a prerequisite. Currently interrupted the procurement of the services to there is no integrated inventory management assess SMS competency. This will be resumed system and stock is maintained in MEDSAS at within the context of the agreed leadership the depots, LOGIS and RX Solution at the development programme. complexes and manual systems at district hospitals, LSA's, clinics and CHC's. As a result of 4. Utilisation of donor funds lack of systems the risk of human error is high and internal controls are weak to non existent 4.1 European Union – R 19 300 000 mainly at the district hospitals, LSA's, CHC's and clinics. All of these will impact on the The Partnership for Delivery of Primary Health completeness and accuracy of figures disclosed Care (PDPHC) programme is implemented in Annexure 1L in the AFS. It is from this through an agreement signed between the background that the department applied for an ECDOH and the EU National programme exemption from Provincial Treasury. (Agreement between the National Department of Health and the European Union) and includes An inventory management policy is being HIV/AIDS. Funds are utilised towards developed in line with the inventory strengthening the delivery of primary health care management framework. Procedure manual will services, supporting Non Profit Organisations also be developed in the new financial year. that provide services in partnership with the department. 3. Capacity constraints Through this programme 36 Non-Profit Organizations (NPO's) were contracted to Generally the issue of Human Resource (HR) render community –based services in the form capacity remains a challenge with high vacancy of Home based care, Voluntary Testing and Care rates reported across all levels of service (VCT), TB DOTS etc. delivery. There has been some improvement in the vacancy rate from 58% to 56% according to the approved organogram. This figure will come The department received a notification from down significantly when one deletes vacant National Treasury in April 2009 that EU donor posts that are unfunded during the current funds amounting to R19, 3m were transferred to MTEF from PERSAL. the Provincial Treasury; however these had not been transferred to the department at the end of the financial year.

308 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 During the year under review the following equipment. The Department does not take results were evident: responsibility for the financial implications Improved access to primary health care incurred by the technical assistant. The support services by many local communities has been effective since it is mainly the transfer Improved utilization rate in health facilities of skills from the Japanese medical equipment due to improving referral system between expert to the local personnel. The support was NPO's and Local health facilities approved by the Accounting Officer. Community –based Health Services provided by Care Givers assisted in harmonizing and 4.4 The Fred Hollows Foundation – South improving the continuum of care. Africa Contributed immensely in many communities A Memorandum of Agreement (MOU) was by recruiting personnel into the NPO's and entered into between the department and the paying stipend every month to all those “The Fred Hollows Foundation of South Africa” contracted by NPO's to create a sustainable eye care programme that ensure rendering of a comprehensive eye care Selected sub districts were operating in an service package consistent with the level of care integrated district health systems. of each partner institution in the Eastern Cape The partners (NPO's) were able to define Province. The foundation operates in five sites, St their role, negotiate and implement service Elizabeth Hospital; Frontier Hospital; East partnerships with Provincial Health London Complex; PE Complex; and these form Department and LSA's within district the critical part of the province's five eye care municipalities for the delivery of Primary nodal points of the foundation. Health Care services especially those related to HIV. Systems and processes have been put in place 4.2 Italian Cooperation intended to ensure minimal incidences of stock outs of eye care consumables in the sites that The cooperation between the department and are supported by the foundation. the donor entails support towards the provision of technical assistance to be able to deal with communicable diseases as well as procurement 4. Trading entities and public entities of equipment. The support was accepted by the Accounting Officer and an agreement was signed There are no trading or public entities under the by the National Department on behalf of the EC control of the Eastern Cape Department of and KZN provinces. The total project funding is Health. R2,729,645.15 over a period of 3yrs from 2008 - 2010. 5. Organisations to whom transfer

During the year under review equipment to the payments have been made value of R557k was donated to different sections at Head office. The assistance also included The department utilises various institutions, among others the procurement of an economist government entities, Universities, Technikons and and 3 temporary staff to the value of R257,7k. NPO's as vehicles to deliver services to the The support from the Italian Cooperation was a communities of the province. The nature of success due to the coordination mechanisms put services to be rendered and relationship with in place by both the donor and the department. these organisations is governed by Service Level Agreements. During the year under review the 4.3 Japan International Development department transferred R202,6m to 26 Cooperation Agency (JICA) municipalities not all funds could be transferred JICA supported a project of the maintenance (R106,2m not transferred) as a result of cash and management of medical equipment. The shortages. Transfers were made to 18 funding is in the form of a technical assistant Provincially Aided Hospitals (PAH's) for the (personnel) based in the Department to assist provision of Primary Health Care Services. with the development of a model on the Monitoring of these institutions was done to maintenance and management of medical ensure that the allocated funds were spent as

309 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 planned. Both the municipalities and PAH's fully proceeding with the contract were too great expended the funds they were allocated in the given the time that had elapsed and the strong period under review. possibility of a challenge by unsuccessful bidders. Accordingly, the Department informed National Funds were transferred to various Universities Treasury that it had decided to terminate the and Technikons for the provision of Health procurement of the pending Pharmaceutical Sciences, Training & Development. The supply chain PPP project; and confirmed its department monitored these institutions to intention to update the project's feasibility study ensure that the allocated funds were spent as and procurement documentation with the planned. All Institutions fully expended the funds intention of commencing a new PPP they were allocated in the period under review. procurement process.

7. Public private partnerships (PPP) 7.2 Humansdorp Hospital Co-Location The concession agreement was concluded on 27 June 2003 with Metro Star Hospital Life 7.1 Pharmaceutical Supply Chain Management Services and the Finance, Healthcare Ltd (previously Afrox Healthcare Ltd) Design, Construction and/or and the Public Private Partnership continued in Rehabilitation and Operation and the delivery phase throughout the financial year. Maintenance of Pharmaceutical Depots and Management Support to the 7.3 Upgrading and Refurbishment of the Port Department Alfred & Settlers Hospitals in Port Alfred and Grahamstown and the establishment In 2003, the Department initiated processes in of co-located private hospital facilities terms of Treasury Regulation 16 to determine The concession agreement was signed on 7 May the appropriateness of procuring the 2007 and incorporates the Port Alfred and management of its two pharmaceutical depots Settlers District Hospitals and the Public Private and the distribution of pharmaceuticals Partnership continued in the delivery phase therefrom to the hospitals, clinics and throughout the financial year. community health centres in the Province via PPP. 7.4 Accommodation for Clinical Staff at St Elizabeth's Hospital (Lusikisiki) PPP A feasibility study was completed and the Department's application for Treasury Approval I The Department had identified a need for fully (TA I) was granted on 08 April 2004. serviced accommodation for staff employed at St Elizabeth's Hospital in Lusikisiki. This project accordingly involved the design, construction, Request for Proposals were issued in December financing and administration of accommodation 2004 wherein a preferred bidder and reserve for clinical staff at Saint Elizabeth's Hospital in bidder were selected. Negotiations with the Lusikisiki. preferred bidder ultimately failed, and in May 2007, were terminated; the reserve bidder, was invited to negotiate. Negotiations were A protracted impediment in the procurement concluded in early 2009 and the process of process has been the lack of agreement from the reaching financial close commenced. local Municipality for the Department to acquire the required land adjacent to the hospital. In the meantime however, the situation in the Eastern Cape was changing in a manner that This has resulted in the de registration of this would ultimately affect the conclusion of the project from the PPP database in the current project. financial year, with an option to re–register the project at any stage that the land issue has been resolved. After discussions with internal and external stakeholders and the obtaining of a legal opinion, the Department decided that the risks of

310 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 8. Corporate governance arrangements Ensuring that risk management is embedded throughout the department. 8.1 Risk Management The Accounting Officer is responsible for Senior management is accountable for the ensuring that the department has and maintains process of risk management and the systems of effective and appropriate systems of Internal internal control. This, together with the Risk Control, Risk Management and Internal Audit. Management Policy and Framework forms the key basis for the department's approach to risk In the financial year under review, the management. department established a Risk Management division which is involved in the day-to-day risk The Chairperson of the Risk Committee management activities of the department. Two reported through to the Audit Committee. The Managers from Internal Audit were transferred day-to-day responsibility of identifying, evaluating to this unit. However, the critical position of the and managing risks resides with management. Chief Risk Officer, has not been filled, and will be advertised in the new financial year. It is the Notwithstanding the actions noted above, Chief Risk Officer's duty to oversee the risk embedding and institutionalising risk management process, to ensure that risk management and appropriate risk responses assessments are performed and reported on, remains a challenge at the department. This is and to ensure the necessary actions and evidenced through the inherently high risk communication is in place to enable a risk aware ratings assigned by management to key risks, culture in the department. whilst mitigating controls are noted to be either inadequate in their design, and/ or are not The risk mitigating efforts of the department are operating as intended (effectiveness). The also supported by the Internal Control and Pre- oversight of the total Risk Management has also Audit Units, who report to the Chief Financial not been adequate. Officer. During the financial year under review, the In the financial year under review, the Internal Audit Unit assisted the department in department formed a Risk Management the risk management process by facilitating Committee. This Committee comprises several risk assessments, and advising on key members of Executive Management, and the policy and procedure infrastructure integral to Committee has an approved Terms of Reference. the risk management process. Once the Risk The department also has a Risk Management Management function is fully operational, it is Policy and Risk Management Framework. envisaged that the Internal Audit Unit will give independent assurance on the risk management During the financial year under review, the Risk processes at the department. However, it is likely Management Committee met twice, namely on that the Internal Audit Unit will need to 29 October 2009 and 26 November 2009 continue to support the Risk Management respectively. function of the Department in the coming financial year. The Internal Audit Unit regularly engages with Executive Management to identify The Risk Management Committee is key strategic risks pertaining to the department, tasked to ensure that management is and thus ensures that high risk exposures are continuously: identified for management's action. Identifying and assessing the risks facing the department. Some of the remedial steps to improve risk Developing procedures to measure and management at the department in the 2010/11 quantify identified risks. financial year include: Putting appropriate controls and action plans Capacitating the newly established Risk in place to mitigate risk. Management function. Reporting appropriately on risks and Appointing a Chief Risk Officer. controls. Ensuring the Risk Management Committee operates

311

EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 in terms of its approved Terms of Reference. specialised forensic investigations department Inviting a member of the Audit Committee to resides within the Internal Audit Unit, and Risk Management Committee meetings. reports directly to Head Internal Audit & Risk Appropriate accountability and reporting Assurance Management Services. processes for the Risk Management Committee. All incidents reported on the fraud hotline are Strengthening the Internal Control and Pre- logged onto a case register and are investigated. Audit Units. Regular feedback is sent to the Office of the Increased training and awareness on risk Director General at the Eastern Cape Office of management throughout the department. the Premier. The status with regards to attending Further risk identification workshops. to reported cases is also reported on to the Audit Committee at its regular meetings. 8.2 Fraud Prevention Policies An approved Fraud Prevention Policy is in place. In the financial year under review, sixty four (64) The Policy encompasses a Fraud Prevention Plan, incidences of alleged irregularities were Fraud Policy Statement, Fraud Response Plan reported through the fraud hotline. Ensuring and a Whistle Blowing Policy. that all reported irregularities are followed up and investigated is a challenge to the In 2009/10, the department undertook a process department, given its current financial position. of reviewing the Fraud Prevention Strategy. That However, the department is actively seeking process was finalised, and the Strategy has been inter-governmental support on this matter, and endorsed by the Risk Committee and Good is also seeking ways to recover monies on Governance Committee, and is awaiting final investigations performed. approval. The Good Governance Committee oversees and monitors implementation of the 8.3 Internal Audit Fraud Prevention Strategy. Internal Audit operates in terms of an approved Internal Audit Charter, which is the approved The department encourages its stakeholders to term of reference. report matters of fraud to the Provincial fraud hotline and the call centre/ hotline of the The Accounting Officer is responsible for department, which act as whistleblower ensuring that appropriate systems of internal mechanisms available to all employees of the control are maintained to ensure that the department, patients and the public at large to departments' assets are safeguarded, managed report fraudulent and unethical behaviour of any and losses arising from fraud and/or illegal nature (including unethical medical behaviour). activities are minimised. It is management's These channels ensure the anonymity of all responsibility to ensure that controls are information received and the protection of the appropriate to manage risks to acceptable level. employees reporting these incidents. The Internal Audit Unit is a function established The department's Fraud Prevention Policy at Head Office level, which reports to the Audit outlines a “zero tolerance” approach towards Committee, and which also assists Executive fraud and corruption. Accordingly all identified Management and the Audit Committee in the matters that have a criminal element are effective discharge of their responsibilities, by reported to the South African Police Services means of independent financial, internal control and any other appropriate law enforcement and operational systems reviews. To assist in agency. building capacity of the Internal Audit Unit, and thus position the Unit to meet the needs and The fraud hotline is but one of the mechanisms challenges of the department, the department (in available to employees, suppliers, patients and 2008/09) entered into a co-sourced internal the public to report incidents of fraud and audit contract with a consortium consisting of corruption. Internal and External parties can PricewaterhouseCoopers SizweNtsaluba and contact the departments' forensic unit by Umnombo Consulting. This contract will run for telephone, email or request a meeting. The a period of four years until September 2012.

312 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Thirty two (32) audit assignments were 8.4 Effectiveness of the Audit Committee conducted by the Internal Audit Unit during the Throughout the year under review, the Audit financial year under review. Reports on these Committee operated in terms of an approved assignments are communicated to the process Audit Committee Charter, which was the owners, Executive Management, the Accounting Committees approved terms of reference. The Officer, the Audit Committee and the Auditor committee comprises of four external members, General. all of whom are not employed by the department. The reports issued by Internal Audit in the financial year under review, identified a number The Audit Committee comprises Ms. L. Smith of areas where internal controls were adequate, (Chairperson), Mr. M. Dukandar, Dr. B. Mbulawa- inadequate or partially adequate, and in many Hans and Mr. HH Gxaweni. The members are instances were not operating as intended/ thus all independent of the operating activities of ineffective. These reports are issued to the department. The Committee is appointed on management with recommendations by the a three year term, which is reviewed annually. Internal Audit Unit on how to remedy deficiencies identified and to manage risk to an During the previous financial year, the term of acceptable level. Management has accepted the office for three of the members came to an end; recommendations made by the Internal Audit however, their term was extended for another Unit; however, implementing the recommenda- year within their three year cycle. tions will be pose a challenge to management. This is due to a range of reasons, including inadequate resources and budgets for implementing controls and systems.

Attendance at meetings during the year ended 31 March 2010 was as follows:

Name 26/05/09 28/07/09 20/08/09 02/11/09 03/03/10

Ms. L. Smith √ √ √ √ √

Mr. M. Dukandar √ √ √ √ √

Dr. B. Mbulawa-Hans √ A √ √ √

Mr. HH Gxaweni √ √ A √ √

√ - Attended A – Apology

Further information relating to the Audit Committee, as 9. Discontinued activities/activities to be required by the PFMA and National Treasury discontinued Regulations is included in the Audit Committee's Report, which is incorporated in the annual report of the department. For the year under review no activities were discontinued. Further information relating to the Audit Committee as required by the PFMA & Treasury Regulations will be 10. New/proposed activities included in the Audit Committee report which will be incorporated in the annual Financial Statements of the For the year under review, there were no new or Department. proposed activities

313 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 11. Asset Management be made to fair value those assets in terms of the fair valuation model to be developed by the 11.1 Movable Assets Provincial Treasury in the new financial year. The Public Finance Management Act (Act 1 of 1999 as amended by Act 29 0f 1999) and 11.2 Immovable Assets Treasury Regulations stipulate that the The immovable fixed assets register for the department must manage and safeguard its department is maintained by the Department of assets, this entails amongst other things Public Works. . However it is important to raise maintaining Fixed Assets Registers where all an issue that my Department has full use of assets are recorded. The department has and these assets. Building/properties completed maintains asset registers for all 756 clinics and during the year amounting to R674,8m have CHC's, 96 hospitals and administration offices. been transferred to the Department of Public These are maintained in an excel spreadsheet Works. with basic minimum controls such as passwords built in to protect data integrity. 12. Events after the reporting date

Newly acquired assets are bar coded and taken HROPT into the asset register at cost. Reconciliation The departments awaits the final outcome of the between BAS and the fixed asset register is investigations commissioned by the Office of the performed on a monthly basis. Consolidation of Premier in order to finalise this process the registers is done at HO where additional controls were introduced to track changes and safeguard integrity of data. 13. Provincialisation of Provincially Aided Hospitals The challenge with asset management however has been that despite the existence of fixed At the request of the provincially aided hospitals asset registers completeness thereof has been the department started the process to found to be lacking. The Auditor-General has in provincialise them after the balance sheet date. his audit raised findings of assets that are in the asset registers but cannot be found on the floor 14. Performance information and vice versa. This is an indication of weakness in the asset verification process and inadequate supervision. The department undertook a situational analysis and engaged in sessions to inform development Secondly due to the inavailability of of a new strategic plan in compliance with the documentation to support purchases of assets PFMA requirements. The new strategic plan from 2000 -2004 some assets are captured in 2009/10 – 2014/15 maps out the new the asset register with R1 values. This has an departmental goals and objectives in line with impact on the value of opening balances in the the new government priorities and the 10 point asset registers. Where values for these assets plan. were ascertained during the year an adjustment to prior year opening balance has been effected As the department is preparing for the audit of in the disclosure note and immovable annexure the performance information, a number of schedule. systems are being put in place. This includes the strengthening of the planning process at facility An application to the Provincial Treasury to level to ensure that the implementation of the disclose some asstes at R1 was made to which a strategic plan is carried out and could be response was that “an accounting policy measured at all levels. For the first time in prescribed by National Treasury on the initial 2009/10, the health facilities were assisted to and sub-sequent recognition of assets would develop their operational plans in line with the suffice to cover the department. Assets are Annual Performance Plan and the Operational therefore recorded at R1.00 as cost or fair value Plan of the Province. could not be determined. Efforts will however

314 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 To improve the quality of data, the department 15. SCOPA resolutions has embarked on integrating the EMS with the EC DOH Call Centre. This is meant to enhance The Standing Committee on Public Accounts service delivery whilst enhancing data quality as (SCOPA) held its hearing on the 23rd November well. The EC DOH Call Centre System is 2009 and the department appeared to deliberate undergoing a customization process to on the 2007/08 written responses. The accommodate EMS call taking. Ambulance client department has not received recommendations calls and dispatch times will be logged and from the committee. monitored in order to measure ambulance response times more accurately. 16. Prior modifications to audit Electronic patient registers were developed from reports the existing health facility patient registers and these are currently being tested internally. These An action plan to deal with the matters reported will replace the manual patient registers and will in the audit report was developed and enhance data flow from the facilities as the data implemented and it incorporated matters in the captured will be backed up and accessed at audit report including those noted as important district and provincial level the following day, in the management report. Senior managers had thereby cutting data delivery time at Head Office the responsibility to provide leadership and by one month. 160 Data capturers were trained guidance, ensure that action plans are and will be employed in the new financial year implemented and audit issues are resolved. and placed in the facilities Progress was monitored regularly and reporting done.

The following are matters that resulted in adverse opinion as well as matters of non-compliance:-

Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Adverse Opinion Departmental Revenue: In common with 2004/05 Not resolved: Inadequate assessment of patients similar organisations, it is not feasible for the in order to classify them accordingly is a challenge Department to institute accounting controls as the patients do not bring the necessary over cash collections from patients prior to supporting documentation. Most institutions use initial entry of the collections in the accounting manual systems and error rate is high. Process of records. Accordingly, it was impracticable for us reconciling manual receipts to BAS has been to extend our examination beyond the receipt introduced, however due to lack of financial actually recorded. Under these circumstances, it management and accounting skills which prevail in was not possible to confirm the completeness of the hospitals, only a few are mastering it. Further patient revenue included in the R79.8 million lack of supervision and integrated systems sales of goods and services other than capital contributes greatly to the findings of the AG. assets in note 3 to the annual financial statements. Departmental Revenue: It was found that 2005/06 This matter is resolved. Hospitals are required to incorrect and outdated patient tariffs were used confirm in writing the implementation of revised at some institutions. In addition, reconciliations tariffs. Monthly reconciliations of monthly rentals and reviews of rental income for accommo- are done. dation provided by the department are not performed at all institutions, and the amounts recorded in the accounting system could therefore not be validated in cases where discrepancies were identified to the tenant registers. Consequently, sales of goods and services other than capital assets in note 3 to the annual financial statements are overstated by R19.3 million.

315 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Compensation of employees: Sufficient 2004/05 Matter not resolved appropriate audit evidence in support of basic salaries, allowances and periodic payments as disclosed in note 5 to the annual financial statements could not be provided, resulting in an overstatement of R59 million, R212 million and R7 million respectively.

Compensation of employees: Consequently, Matter not resolved compensation of employees as disclosed in the statement of financial performance and note 5 to the financial statements is overstated by a total of R278 million.

Goods and Services: In terms of the basis of 2004/05 This matter is resolved as there is now an preparation as disclosed in accounting policy understanding of the accounting treatment of note 1.1, the annual financial statements are transactions from systems that operate on a prepared under the cash basis of accounting different accounting basis cash and accrual. which requires transactions and other events to be recognised when cash is received or paid. Actual payments for pharmaceutical inventory purchases were not recognised on this basis but rather when the inventory was issued to the various institutions. Consequently, goods and services as disclosed in the statement of financial performance and note 6 to the financial statements are understated by R17.1 million, and voted funds to be surrendered are overstated by the same amount.

Transfers and subsidies: Transfer payments 2004/05 Accounting treatment of transactions has been amounting to R32 million did not satisfy the resolved. definition of a transfer payment, but was rather expenditure paid to a supplier for goods and services. Consequently, goods and services expenditure was understated by R32 million and transfer payments was overstated by the same amount.

Payables: Journals totalling R41.8 million that 2004/05 A policy to regulate or guide the preparation, were posted to the payables suspense accounts submission, approval, processing, delegations and did not have adequate and appropriate uathorisation of all journals was developed and documentation to support the transactions that implemented. Further processing of journals was they represented. Some journals did not have centralised and a senior manager made adequate descriptions and narrations to enable a responsible to ensure that all journals comply with reader of the journals to fully understand the the policy and also approves all journals. purpose of the journal. Certain journals were approved by officials who did not have the appropriate authority to authorise them. Consequently, it was not possible to confirm the accuracy or completeness of payables included in the statement of financial position and note 17 to the financial statements.

316 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Contingent liabilities: The department could 2005/06 A process to properly record and verify liability in not provide sufficient appropriate audit evidence respect of claims against the department was to substantiate claims of R170.6 million. Claims undertaken and new listings for the financial years against the department are also overstated by 02/03; 03/04; 04/05; 05/06; 06/07; 07/08 and 08/09 R15.8 million as a result of numerous capturing were compiled. Confirmation of the balances was errors on the current year claims list. received from the State Attorneys for all the years. For the 09/10 year the AFS has been amended to incorporate all these submissions.

Contingent Liabilities: As a result, contingent 2005/06 The contingent liability disclosed in Note 20 for liabilities as disclosed in note 20 to the financial the 2009/10 is accurate for the claims against the statements are overstated by R1 86.4 million. department.

Commitments: Approved and Contracted 2004/05 An official of the department is a member of the Capital Commitments of R835.2 million are Bid Award Committee of DPW. This is essential so disclosed in note 21 to the financial statements. that the department will know and have This disclosure is overstated by R91 .7 million, as information on all contracts awarded by DPW. sufficient appropriate audit evidence to Strengthening of controls and identifying where substantiate this amount could not be provided. events occur so that commitments can be traced to the source to ensure completeness.

Commitments: In addition, Approved and 2004/05 An official of the department is a member of the Contracted Current Commitments were found Bid Award Committee of DPW. This is essential so to be incomplete due to contracts awarded but that the department will know and have not included as commitments, as well as the information on all contracts awarded by DPW. omission of outstanding orders not yet delivered Strengthening of controls and identifying where at year end. Other long term commitments were events occur so that commitments can be traced only disclosed for part of the committed time to the source to ensure completeness. period. Therefore, the understatement on Approved and Contracted Current Commitments as disclosed in note 21 to the financial statements is R62.1 million. Accruals: An adequate record of outstanding 2004/05 The department uses manual spreadsheets to payments for goods and services received was monitor payments, track invoices and determine not maintained by the department. The manual accruals. The risk of human error is high, therefore accrual schedules prepared were found to have completeness and accuracy of information is numerous deficiencies as some invoices were compromised. The department has strengthened raised as accruals but had already been paid, and controls around this area by introducing in other instances the latest invoices were not reconciliation between the payment monitoring captured as an accrual. The ageing of the accruals tool, BAS disbursements and commitments to was based on the date invoices were received ensure eliminate the issues raised by the Auditor- and not the actual date that the goods or services General. The department is currently exploring were received, and the majority of the systems that could be implemented. outstanding accruals were for periods greater than 30 days. Supplier statements differed materially from amounts disclosed as accruals. Therefore, the net understatement of accruals as disclosed in note 22 to the financial statements is R1 05.9 million.

317 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Employee benefits: Included in disclosure 2004/05 This matter has not been resolved. A process of note 23, employee benefits, is the departments' updating leave records and personnel files with leave entitlement of R256 million and capped leave was initiated during the year but has not leave commitments of R804.8 million. Leave been completed. The department will continue records have not been regularly updated or did with this process in the 2010/11 financial year. not always exist and leave forms were not timeously filed on leave files or not filed at all. The leave records on the payroll system have been used as the basis for the calculation of leave entitlement and capped leave. In the absence of sufficient appropriate audit evidence pertaining to leave records, it was not possible, even by alternative procedures, to verify the existence, accuracy and completeness of the leave entitlement and the capped leave commitments. Receivables for departmental revenue: 2004/05 The matter has not been resolved; however Due to the lack of an audit trail from the compensating systems such as development of admission to the discharging of a patient it was process flows to improve the flow of patient files not possible to confirm that all patients were from entry to exit to facilitate billing were actually charged for services rendered. In some implemented. cases the correct account to be debited could not be identified, and it could therefore not be To confirm completeness and accuracy of billed confirmed that the debtor had been raised. services, the patient folder is required. The current Consequently, it was not possible, even by system allows patients to carry their own folders alternative procedures, to confirm the when they consult with clinical, and in the end the completeness of receivables for departmental patients leave institutions with the folders/f iles. revenue as disclosed in note 25 to the financial statements. Lack of audit trail of patient movement is as a result of lack of integrated electronic systems to record all activities relating to patients from entry to exit.

Receivables for departmental revenue: In 2004/05 Process of ageing of debtors is done manually and addition, the department does not have an is prone to human error. Institutions lack the adequate ageing process for patient debts to capacity to perform debt management and follow identify debtors outstanding for greater than a up. year. Testing confirmed that the majority of debtors are long outstanding and it could not be HO Revenue unit provides training on an ongoing confirmed that these accounts are recoverable. basis, monitoring and oversight takes place Consequently, the amounts written off and monthly. Further debt management policy has disclosed in note 25.1 are understated by R35.2 been revised to take care of the issues raised. million and resulting in receivables for departmental revenue being overstated by the same amount.

318 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Irregular Expenditure: Reflected in 2004/05 There are several processes or procedures that disclosure note 26 of the annual financial must be followed to resolve or clear irregular statements is an amount of R395 million relating expenditure. to irregular expenditure identified by the department for the financial year under review. The department has condoned irregular The department has not disclosed irregular expenditure after the due processes were expenditure identified during the audit to the followed. Officials were charged for making or value of R334.9 million (2007-08: R807.68 permitting irregular expenditure and disciplinary million) which was incurred during the current action taken. financial year as a result of incorrect procurement processes being followed and non- Secondly to clear irregular expenditure for the adherence to financial delegations of authority. prior financial years, the department is required to review all expenditure batches from previous years and determine the value of irregular expenditure. It is not feasible to perform this exercise.

Irregular expenditure: According to note 2004/05 Disciplinary action was taken against all officials 26.2, irregular expenditure, timeous disciplinary who made or permitted irregular expenditure. measures were not taken in all instances against 460 cases/incidences were identified during the officials of the department. Furthermore, a year. consortium was appointed to assist in investigating officials responsible for making or permitting irregular expenditure payments. A report has been issued to the department containing the details of such digressions, yet the department has not implemented or acted upon the majority of the recommendations. Therefore, as a result of the above, the closing balance of disclosure note 26 is understated by R1,14bn.

Fruitless and wasteful expenditure: The 2004/05 The amount related to interest paid to Fleet Africa department incurred and disclosed fruitless and which emanated from an unfavourable contract wasteful expenditure amounting to R14.6 million entered into between DOT and Fleet Africa on as a result of a court order issued emanating behalf of the province. This amount has from a claim by a supplier for the late payment of subsequently been condoned. invoices. Furthermore, the department has not disclosed fruitless and wasteful expenditure No action was taken in this area, however SCM, identified during the audit to the value of R10 payment and internal control processes were million which was incurred during the current reengineered to create seamless proactive financial year as a result of Value added tax (VAT) processes of preventing and detecting and payments to suppliers not registered for VAT. correction of transactions processed.

Movable tangible capital assets: Movable 2008/09 The balance of assets as disclosed in the AFS was tangible capital assets of R265.2 million as incorrect and was adjusted to align/agrre to the disclosed in note 33 to the financial statements balance of assets in the fixed assets registers. This has been reduced by an amount of R403 million is a continouos process until the fixed assets in order to align the opening balance per the registers values are corrected. Provincial Treasury financial statements to the opening balance per is assisting departments with fair valuation of the consolidated fixed asset register. assets.

319 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Movable tangible capital assets: The fixed 2004/05 When assets are received at the institutions they asset registers from the various institutions are bar coded and taken into the fixed asset which are used as a basis for the consolidated register. Verification of assets is performed at fixed asset register, are incomplete and institutions. inaccurate as a significant number of assets were not included in the asset registers, not all the However weaknesses in the verification of assets fields on the asset registers were completed and have been identified that in some institutions not certain assets could not be located for all assets are counted. Strengthening internal verification purposes. In addition, the asset controls is an ongoing process. registers of some of the institutions were not included in the consolidated fixed asset register. The controls over the maintenance and preparation of the asset registers to avoid unauthorised and inaccurate adjustments are not adequate and the asset registers are maintained on spreadsheets and do thus not provide a proper audit trail.

Movable tangible capital assets: Included 2004/05 Misallocation of transactions within economic under tangible capital expenditure are assets less classification emanates from incorrect use of the than R5 000 that have been incorrectly classified. Standard Chart of Accounts as a result of changes This has resulted in an overstatement of tangible made every year. Misallocations will happen from capital expenditure as disclosed in note 9 to the time to time this is an inherent risk associated financial statements of R9.3 million and with processing of large volumes of transactions. expenditure on assets less than R5 000 in note During the year a number of misallocations were 6.1 is understated by the same amount. identified and journals were processed to reallocate expenditure. Treasury have been approached to assist the department with training on the use of SCOA.

Movable tangible capital assets: Transfers in 2008/09 The matter has been resolved. However a system and transfers out as reflected on the fixed asset to ensure that all assets purchased by HO register do not offset, resulting in the balance of (Programmes) on behalf of institutions has to be movable tangible capital assets as disclosed in implemented. Weaknesses in controls result in note 33 being overstated by an amount of R4 some assets not accounted for million (Infrastructure/Revitalisation). The department in the 2010/11 financial year will focus in this area.

Movable tangible capital assets: Disposals 2004/05 Matter not resolved. The institutions still carry made during the year are not reflected in the assets that should be disposed of. A project to financial statements. Due to the inadequate dispose of assets will be undertaken in the processes and controls in place to record 2010/11 financial year disposals, I was unable to determine the full extent of this understatement.

Movable tangible capital assets: As a result, I 2004/05 was unable to verify the existence, completeness and accuracy of the amounts disclosed in note 33 to the financial statements.

320 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Immovable assets: Disclosed in note 35 to the 2008/09 The department together with DPW undertook a financial statements are immovable assets project to update immovable asset register with acquired during the current financial year of erf numbers and title deeds. R146.8 million, relating to the construction of buildings. The department failed to provide information relating to the erf numbers and title deeds for the land on which these buildings were constructed. It was therefore not possible, even through alternative procedures, to determine the legal ownership of the land and the department to which the immovable assets i.e. buildings acquired during the year need to be transferred to in terms of the guidelines provided by National Treasury.

Immovable assets: The aggregate value of 2008/09 Matter has been resolved. work-in-progress projects brought forward from the prior year per the department's register of work-in-progress is R275 million less than the corresponding amount disclosed in the prior year financial statements. Due to the department not being able to provide an analysis of this balance, I was unable to verify the completeness and accuracy of this amount.

Immovable assets: A recent National Treasury 2008/09 The immovable assets register is maintained by directive required the Department to analyse all Department of Public works. immovable assets in use into various categories. The department has not performed this analysis on its opening balance of immovable assets due to the lack of title deeds and other supporting information. In accordance with the directive, these assets have been excluded from the register by means of a current year adjustment to the opening balances of R1 .45 billion.

Comparative figures: The audit report on the 2004/05 Not all misstatements have been corrected. financial statements for the year ended 31 March 2008 contained an adverse opinion as a result of material misstatements and significant uncertainties in the prior year. Management has not corrected all the misstatements identified and therefore most of the corresponding figures are still misstated.

321 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Nature of qualification, disclaimer, Financial year Progress made in clearing/resolving the adverse opinion and matters of non- in which it matter compliance first arose

Non compliance with applicable legislation

Public Finance Management Act Matter not resolved. Quarterly reports for transfer payments made to other institutions were not submitted for audit purposes and is a contravention of Section 38(1)(j) of the PFMA.

Payments were not made within 30 days of date 2004/05 Matter not resolved of receipt of invoice and is a contravention of Section 38(1)(f).

Purchase orders have been signed by officials 2004/05 Officials were issued with delegations and are who do not have delegated powers and is a aware of their limits. Letters of warning have been contravention of Section 44 of the PFMA. issued to officials who contravened the act.

Division of Revenue Act 2004/05 Matter not resolved The Department did not comply with Sections 11(5) and 12(1) of the Division of Revenue Act, 2008 (Act No 2 of 2008) in that the reports required to be submitted in terms of these sections were not submitted timeously.

The Department did not comply with Section 2004/05 Matter not resolved 24(1) of the Division of Revenue Act, 2008 (Act No 2 of 2008) in that insufficient audit evidence/supporting documentation could be provided for audit purposes to verify that the targets and budgets as per the approved Business Plans have been achieved and expended.

17. E xe m p t i o n s a n d d ev i a t i o n s In the current year the department has complied received from the National and expenditure for finance and operating leases has been split to correct the accounting Treasury treatment and disclosure. Prior year figures have not been restated. Department applied to be exempted from the disclosure of inventory however, no exemptions 18.2 Contingent Liabilities have been received from National Treasury. 18.2.1 Occupational Specific Dispensation 18. Other (OSD) underpayment

18.1 Leases OSD is a special dispensation that creates a In terms of SCOA Circular 4 of 2008/09, finance differentiated remuneration system and career lease transactions should be funded from the paths for certain categories of employees. department's capital budget therefore the capital Conservative interpretation of the OSD portion of the finance lease payments must be framework (e.g. using the number of posts in the included in capital expenditure. In the prior year organogram as a norm to decide number of this treatment was not applied, expenditure on qualifying nurses) led to underpayment of 1006 all machinery and equipment purchased under nurses. the RT3 contract were disclosed as operating leases.

322 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Following the implementation of the OSD in appropriate levels but not to deduct 2007/'08, an interpretation and application overpayments. All of these nurses have been dispute raged over 9 months. This dispute was adjusted to appropriate levels. resolved by an arbitration award in August 2009. Immediately after, provinces were directed to With some parts of the OSD framework still in implement the award, albeit nothing was said dispute, the numbers and estimates of where the extra funding will come from. The overpayments might change as the debt owed OSD underpayments have largely resulted from has not been fully determined. the broadened scope of the arbitration award. 18.4 Accruals The 1006 nurses will be translated and paid an Due to the size of the department and the estimated R229m. This estimation is backdated manual processing of transactions the to 1 July 2007, the original implementation date. department has a challenge with completeness Provincial Treasury has agreed that the of accruals. The department is investigating the Department pays all arbitration award cases out use of integrated financial management system. of the 2010/'11 budget which would be off-set in the next mid-term budget estimates. 18.5 Bad Debts 18.2.2 Human Resource Operating Project Team The department is unable to write off the bad (HROPT) debts due to lack of funding for this purpose. Following the implementation of the HROPT a Provincial Treasury has been approached to decision to hold the process was made by provide funding. EXCO and instructed that all payments made and all pending claims must be audited. A firm of auditors Granton Thomson was appointed to 18.6 Related Parties audit all cases as to whether these satisfy Last financial year the department extracted requirements for promotion. The Office of the information from the database for the purpose Premier is coordinating the audit. of identifying related parties. This involved the analysis and comparison of employee The cost of the pending claims amounts to information from PERSAL payment database to R421m payment thereof will depend on the the CIPRO database. The results are being outcome of the audit. investigated.

18.2.3 Claims against the department The AG in the prior year raised a qualification on contingent liability to the value of R170m where supporting documentation and listings 19. Approval could not be provided. An action plan to deal with the issue was developed. A process to properly record and verify liability was The Annual Financial Statements set out on pages 334 undertaken and new listings with supporting to 403 have been approved by the Accounting Officer. documentation for the financial years 02/03; 03/04; 04/05; 05/06; 06/07; 07/08 and 08/09 were compiled. Confirmation from the State Attorneys for all these years was received. .

……………………………… 18.3 Contingent assets SUPERINTENDENT GENERAL 31 MAY 2010 18.3.1 Occupational Specific Dispensation (OSD) overpayments

Overpayments of OSD resulted from either translation of a category or person to a level or notch higher than supposed to. The department post Arbitration Award has confirmed 77 cases that were overpaid. Thus far, the Department was directed to only adjust overpaid staff to

323 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 REPORT OF THE AUDITOR-GENERAL TO THE EASTERN CAPE PROVINCIAL LEGISLATURE ON THE FINANCIAL STATEMENTS OF VOTE No. 3: DEPARTMENT OF HEALTH FOR THE YEAR ENDED 31 MARCH 2010

REPORT ON THE FINANCIAL STATEMENTS

Introduction 1. I was engaged to audit the accompanying financial statements of the Department of Health, which comprise the appropriation statement, the statement of financial position as at 31 March 2010, and the statement of financial performance, statement of changes in net assets and cash flow statement for the year then ended, and a summary of significant accounting policies and other explanatory information, as set out on pages 334 to 403.

Accounting Officer's responsibility for the financial statements 2. The accounting officer is responsible for the preparation and fair presentation of these financial statements in accordance with the modified cash basis of accounting determined by the National Treasury, as set out in accounting policy note 1.1 and in the manner required by the Public Finance Management Act of South Africa, 1999 (Act No. 1 of 1999)(PFMA) and the Division of Revenue Act of South Africa, 2009 (Act No. 12 of 2009)(DORA). This responsibility includes: designing, implementing and maintaining internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error; selecting and applying appropriate accounting policies; and making accounting estimates that are reasonable in the circumstances.

Auditor-General's responsibility 3. As required by section 188 of the Constitution of South Africa and section 4 of the Public Audit Act of South Africa, 2004 (Act No. 25 of 2004) (PAA) and section 40(2) of the PFMA, my responsibility is to express an opinion on these financial statements based on conducting the audit in accordance with the International Standards on Auditing and General Notice 1570 of 2009 issued in Government Gazette 32758 of 27 November 2009. Because of the matters described in the Basis for disclaimer of opinion paragraphs, however, I was not able to obtain sufficient appropriate audit evidence to provide a basis for an audit opinion.

Basis for disclaimer of opinion

Commitments 4. The commitments schedule did not contain all relevant information and as a result it was not possible to trace tenders awarded prior to year end to the commitments schedule. Furthermore, the department did not provide adequate supporting documentation for the amounts reflected in the commitments schedule. Consequently, it was not possible to confirm the accuracy, validity and completeness of capital and current commitments of R9.4 billion (2008-09: R2.2 billion) as disclosed in note 23 to the financial statements.

Accruals 5. The department failed to maintain adequate records of outstanding payments for goods and services received but not yet paid. The manual schedules prepared in support of the R1.3 billion (2008-09: R600.9 million) disclosed as accruals in note 24 to the financial statements were found to be inaccurate as certain invoices raised as accruals had already been paid and, in some instances, the amounts on the accruals listing did not agree to the amount per the supplier statements and other supporting documentation. Furthermore, the department did not provide adequate supporting documentation for all amounts included in the accruals listing. 6. Consequently, it was not possible to determine the full extent to which accruals as disclosed in note 24 to the financial statements are valid, accurate and complete.

324 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Employee benefits 7. The department did not provide adequate supporting documentation for the amounts of R858.5 million (2008- 09: R804.8 million) disclosed as capped leave commitments and R292.7 million (2008-09: R256 million) disclosed as leave entitlement in note 25 to the financial statements. Furthermore, the department did not maintain adequate records of leave taken and not all employees who had leave balances at year end were included in the supporting schedules for leave entitlement. It was therefore not possible to determine the accuracy, validity and completeness of capped leave commitments and leave entitlement as disclosed in note 25 to the financial statements.

8. Other employee benefits of R285.7 million, which includes Occupation Specific Dispensation (OSD) accruals of R204.3 million and other Human Resource accruals of R81.4 million, is overstated by R8.8 million as a result of amounts being incorrectly calculated. Furthermore, adequate supporting documentation and details of all the transactions making up these amounts were not provided for audit purposes. It was therefore not possible to determine the accuracy, validity and completeness of other employee benefits disclosed in note 25 to the financial statements.

Contingent liabilities 9. The department did not provide adequate supporting documentation for contingent liabilities relating to Human Resource Operating Project Team (HROPT) of R420.9 million and OSD of R25.1 million. It was therefore not possible to verify the accuracy, validity and completeness of other contingent liabilities of R445.9 million as disclosed in note 22.1 to the financial statements

10. Included in note 22.1 are housing loan guarantees of R16.6 million which include guarantees that have been released by the bank, amounts for which no guarantees are in place with the bank or accounts that have been closed. Housing loan guarantees are therefore overstated by R10.8 million.

Compensation of employees 11. Adequate supporting documentation for backdated and arrear salaries of R404 million, relating to HROPT and OSD as detailed in item 1.2 in the accounting officer's report, as well as allowances and bonuses of R219 million (2008-09: R212 million) was not provided for audit purposes. As a result, even through alternative procedures, it was not possible to verify the validity and accuracy of these payments as disclosed in note 5 to the financial statements.

12. Furthermore, incorrect payments were made to employees resulting in basic salaries being overstated by R30.5 million (2008-09: R59 million) and staff debt of R5.9 million (2008-09: R5.2 million), included in receivables as disclosed in note 15 to the financial statements, being understated by this amount.

Movable assets 13. The department prepared a consolidated fixed asset register which was used as the basis for the amount of R481.1 million (2008-09: R265.3 million) disclosed in note 33 to the financial statements for movable tangible capital assets and minor assets of R105.6 million (2008-09: R33.1 million) as disclosed in note 33.4 to the financial statements. These assets were overstated by R154.9 million as a result of assets recorded in the consolidated fixed asset register which could not be physically verified, assets recorded at the incorrect amounts, assets received before year end but not yet paid not recorded, and assets in the district fixed asset registers not recorded in the consolidated fixed asset register. Under these circumstances, it was not possible to determine the extent to which assets may have been misappropriated and if the amounts disclosed in the financial statements are free of material misstatements whether caused by fraud or error.

14. Furthermore, not all assets selected from the floor were recorded in the consolidated fixed asset register. It

325 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 was not possible to determine the total value of this understatement as the cost of the assets not recorded could not be determined.

Expenditure for capital assets 15. Expenditure for buildings and other fixed structures of R712.3 million, as disclosed in note 10 to the financial statements, does not agree to the cash additions to immovable tangible capital assets of R674.8 million as disclosed in note 35.1 to the financial statements. A reconciliation of these amounts reflected payments of R21.4 million which were incorrectly allocated to goods and services instead of buildings and other fixed structures and an amount of R16.3 million which was incorrectly allocated to expenditure for buildings and other fixed structures instead of machinery and equipment for which correcting journal entries had not been processed on the accounting system.

16. Further identified misallocations of R22.6 million were included in the reconciliation, however information included in the payment batches and other supporting documentation for these items was not sufficient and appropriate to determine whether or not the amounts were correctly allocated. Project expenditure on the work-in-progress register did not agree to amounts on the accounting system, resulting in a difference of R13 million and a further R6.8 million is still under investigation by the department. Under these circumstances, it was not possible to determine the total impact of this difference on expenditure for capital assets – buildings and other fixed structures, expenditure for capital assets – machinery and equipment, expenditure for goods and services, movable assets and cash additions to immovable assets as reflected in the statement of financial performance and the notes to the financial statements.

Departmental revenue 17. Receipts were not always issued for cash received and patients who did not qualify for free services were not always charged for services rendered. Furthermore, patient files were not all submitted for audit purposes and supporting documentation included in the patient files submitted were not always adequate to determine whether the tariffs charged were correct.

18. Consequently, it was not possible to determine the accuracy, validity and completeness of patient fee income of R51.3 million (2008-09: R58.8 million) included in sales of goods and services other than capital assets of R73.6 million (2008-09: R79.8 million) as disclosed in note 3.1 to the financial statements, and receivables for departmental revenue of R77.5 million (2008-09: R81.9 million) as disclosed in note 27 to the financial statements. Due to the inadequate internal controls and the lack of segregation of duties, the risk of fraud could not be excluded.

Receivables for departmental revenue 19. The department did not provide adequate supporting documentation for bad debts written-off of R14.8 million included in the amount of R71.1 million reflected as amounts written-off/reversed as irrecoverable in note 27.1 to the financial statements. Further, no interest has been charged on patient fee debt. Consequently, it was not possible to verify the completeness, accuracy and validity of this amount and the extent to which receivables for departmental revenue of R77.5 million, as disclosed in note 27.1, may be misstated.

20. The corresponding figure for amounts written-off/reversed as irrecoverable of R19.4 million and disclosed in note 27.1 is understated by R35.2 million as the department did not have an adequate ageing process in the prior year to identify debtors outstanding for greater than one year. These amounts have been written- off/reversed in the current year and are included in the current year amounts written-off/reversed as irrecoverable of R71.1 million.

Irregular expenditure

326 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 21. Irregular expenditure relating to the current year is understated by an amount of R954.5 million (2008-09: R334.9 million) as a result of non-adherence to financial delegations of authority and non-compliance with supply chain management regulations identified during the audit. Irregular expenditure of R721.3 million as disclosed in note 28 to the financial statements is therefore understated by R2.1 billion and the corresponding figure of R348.4 million understated by R1.1 billion. The possibility of irregular expenditure being incurred as a result of fraud could not be excluded.

Receivables 22. Interest charged on ex-employee debts of R63.3 million, included in other debtors of R69.5 million as disclosed in note 15.5 to the financial statements, was incorrectly calculated. Furthermore, ex-employee debts approved for write-off and amounts handed over to the debt collectors did not reconcile with the long outstanding debt included in note 15.5. As a result, it was not possible to determine the validity, accuracy and completeness of other debtors as disclosed in note 15.5 and debt receivable interest included as payables in note 19.2 to the financial statements.

Payables 23. Journals totalling R41.8 million, posted to the payables suspense accounts in the prior year, did not have adequate and appropriate documentation to support the transactions that they represented. These journals also did not have adequate descriptions and narrations to enable a reader of the journals to fully understand the purpose of the journal and certain journals were approved by officials who did not have the appropriate authority to authorise them. Consequently, it was not possible to determine the accuracy and completeness of payables of R13.4 million (2008-09: R43.7 million) as disclosed in the statement of financial position and note 19 to the financial statements.

Transfers and subsidies 24. The corresponding figure for transfer and subsidies paid of R518.9 million, as disclosed in the statement of financial position, is overstated by R32 million as payments made to a supplier did not satisfy the definition of a transfer payment. Consequently the corresponding figure for goods and services of R3 billion as disclosed in the statement of financial position is understated by this amount.

Fruitless and wasteful expenditure 25. Fruitless and wasteful expenditure of R8.5 million (2008-09: R14.6 million) as disclosed in note 29 to the financial statements is understated by R10.4 million as a result of Value Added Tax (VAT) payments made in the previous financial year to suppliers who were not registered for VAT.

26. Fruitless and wasteful expenditure of R16.8 million was incurred and disclosed during the current year as a result of interest incurred on late payments, traffic fines, amounts paid in error and cancellation of events. Of this amount, R8.9 million was condoned during the year and the remaining portion is still under investigation or at the disciplinary stage.

Disclaimer of opinion 27. Because of the significance of the matters described in the Basis for disclaimer of opinion paragraphs, I have not been able to obtain sufficient appropriate audit evidence to provide a basis for an audit opinion. Accordingly, I do not express an opinion on these financial statements.

Emphasis of matter 28. I draw attention to the matters below. My opinion is not modified in respect of these matters:

327 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Basis of accounting 29. The department's policy is to prepare financial statements on the modified cash basis of accounting determined by National Treasury, described in accounting policy note 1.1.

Restatement of corresponding figures 30. Claims against the department of R450.8 million as disclosed in the prior year financial statements has been restated in the current year to reflect an amount of R199.9 million in note 22 to the financial statements. This is due to the majority of these claims being brought forward from prior year without adequate supporting documentation to substantiate these claims and they have not been confirmed by the State Attorneys. These claims are also long outstanding and there have been no proceedings on these claims during the current and previous financial year.

Unauthorised expenditure 31. Disclosed in the statement of financial performance and note 11 to the financial statements is unauthorised expenditure of R1.1 billion. Unauthorised expenditure of R874.3 million was incurred during the current year as a result of overspending on compensation of employees in programme 2: District Health Services and programme 4: General Hospital Services. The reasons for this overspending are set out in note 4 to the appropriation statement and section 1.4 of the accounting officer's report.

Material underspending 32. Goods and services were underspent by R182.8 million, transfers and subsidies by R140.1 million and payments for capital assets by R364.2 million as disclosed in the appropriation statement. This underspending has resulted in poor service delivery as objectives of the department have not been achieved and infrastructure projects have been significantly delayed. Furthermore, interest and penalties could be incurred due to late payment of accounts.

Accruals 33. Disclosed in note 24 to the financial statements are accruals of R186.5 million which exceed the payment terms of 30 days as detailed in Treasury Regulation 8.2.3. This amount in turn exceeds the voted funds to be surrendered as per the statement of financial performance by R186.5 million. This amount would therefore have constituted unauthorised expenditure should the amounts due have been paid in time.

Additional matters 34. I draw attention to the matter below. My opinion is not modified in respect of this matter:

Unaudited supplementary schedules 35. The supplementary annexures set out on pages 404 to 419 do not form part of the financial statements and are presented as additional information. I have not audited these schedules and accordingly I do not express an opinion thereon.

REPORT ON OTHER LEGAL AND REGULATORY REQUIREMENTS 36. In terms of the PAA of South Africa and General Notice 1570 of 2009, issued in Government Gazette No. 32758 of 27 November 2009 I include below my findings on the report on predetermined objectives, compliance with the PFMA, DORA, Treasury Regulations as published in Government Gazette No. 23463 dated 25 May 2002 (TR), Public Service Act of South Africa, 1994 as amended by Act No. 30 of 2007 (PSA), National Environmental Management Act, 1998 (Act No. 107 of 1998) (NEMA), Occupational Health and Safety Act of South Africa, 1993 (Act No. 85 of 1993) (OHS) and the Medicines and Related Substances Control Act, 1965 (Act No. 101 of 1965) (MRSC) and financial management (internal control).

328 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Findings

Predetermined objectives

Non-compliance with regulatory and reporting requirements

Lack of effective, efficient and transparent systems and internal controls regarding performance management (applicable at an overall performance management level) 37. The accounting officer did not ensure that the department has and maintains an effective, efficient and transparent system and internal controls regarding performance management, which describe and represent how the institution's processes of performance planning, monitoring, measurement, review and reporting will be conducted, organised and managed, as required in terms of section 38(1)(a)(i) and 38(1)(b) of the PFMA.

38. Actual outputs reported in the quarterly reports were different to the actual outputs reported in the annual report as there is no cut-off on the District Health Information System (DHIS). This has resulted in information reported in the quarterly reports being adjusted after it has been reported to the National Department of Health. Therefore, the department did not facilitate effective performance monitoring as required by Treasury Regulation 5.3.1.

Usefulness of information 39. The following criteria were used to assess the usefulness of the planned and reported performance: Consistency: Has the department reported on its performance with regard to its objectives, indicators and targets in its approved annual performance plan, i.e. are the objectives, indicators and targets consistent between planning and reporting documents? Relevance: Is there a clear and logical link between the objectives, outcomes, outputs, indicators and performance targets? Measurability: Are objectives made measurable by means of indicators and targets? Are indicators well defined and verifiable, and are targets specific, measurable, and time bound?

The following audit findings relate to the above criteria:

Changes to planned performance not disclosed in annual performance report 40. It was found that changes to the indicators from the approved annual performance plan for the year under review, were not disclosed and explained as required in terms of the relevant National Treasury preparation guide.

Reported indicators not reliable when compared to source information 41. It was found that 33% of the planned and reported indicators were not clear, with an unambiguous definition to allow for data to be collected consistently.

Reported indicators not reliable as inadequate supporting source information was provided 42. It was found that 93% of the planned and reported indicators were not verifiable, as it was not possible to adequately validate the processes and systems that produce the indicator.

329 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Reliability of information 43. The following criteria were used to assess the usefulness of the planned and reported performance: Validity: Has the actual reported performance occurred and does it pertain to the entity i.e. can the reported performance information be traced back to the source data or documentation? Accuracy: Amounts, numbers and other data relating to reported actual performance has been recorded and reported appropriately. Completeness: All actual results and events that should have been recorded have been included in the reported performance information.

The following audit findings relate to the above criteria:

Reported indicators not reliable when compared to source information 44. Based on the source information or evidence provided to support the reported indicators, it was found that 33% of the reported indicators for the selected programmes were not valid, accurate and complete.

Reported indicators not reliable as inadequate supporting source information was provided 45. The validity, accuracy and completeness for 86% of the reported indicators for the selected programmes could not be established as sufficient appropriate audit evidence and/or relevant source documentation could not be provided for audit purposes.

Compliance with laws and regulations

Public Finance Management Act of South Africa, 1999 (Act No. 1 of 1999)(PFMA) Non-adherence to legislation 46. Section 38(1)(f) of the PFMA requires the accounting officer to settle all contractual obligations and pay all money owing within the prescribed period. Treasury Regulation 8.2.3 requires the department to settle all payments due to creditors within 30 days from receipt of invoice. The department did not make all payments within the prescribed timeframe of 30 days.

47. Section 38(1)(j) of the PFMA requires the accounting officer to obtain written assurance from an entity stating that the entity implements effective, efficient and transparent financial management and internal control systems before transferring any funds to the relevant entity. If such written assurance is not or cannot be given, the transfer of the funds must be rendered subject to conditions and remedial measures requiring the entity to establish and implement effective, efficient and transparent financial management and internal control systems. The quarterly reports for transfer payments made to other institutions did not include written assurance from the entity, as required in terms of section 38(1)(j).

Treasury Regulations (TR) Non-adherence to legislation 48. TR 8.3.4 requires the person in charge at the respective pay-points to certify, on the date of payment, that all persons listed on the payroll report are entitled to payment. The payroll report must be returned to the chief financial officer within 10 days of being certified in terms of TR 8.3.5 and the accounting officer must ensure that all pay-point certifications have been received. The payroll reports were not always certified and returned to the chief financial officer within the required timeframes.

330 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Public Service Regulations, 2001 as amended by Government Notice No. R.937 of 2 October 2009 (PSR) Non-adherence to legislation 49. Chapter 3.C.1 of the PSR requires every designated employee to, not later than 30 April of each year, disclose to the relevant executive authority particulars of all her or his registrable interests in respect of the period 1 April of the previous year to 31 March of the year in question. Not all departmental designated employees have disclosed their registrable interests as required.

Division of Revenue Act of South Africa, 2009 (Act No. 12 of 2009)(DORA) Non-adherence to legislation 50. Sections 13(4)(a) and (b) of DORA requires the department to indicate in the annual report the extent to which the province met the conditions provided for and the steps taken to deal with non-compliance with the conditions provided for in the relevant framework of such an allocation and the provisions of the Act. This information has not been included in the annual report.

51. The department did not provide sufficient audit evidence/supporting documentation to verify that the targets and budgets as per the approved business plans were achieved and expended in terms of the purpose and conditions, as is required by section 26(1) of DORA.

52. The department did not submit all reports required in terms of sections 11(5) and 12(1) of DORA within the required timeframes.

Public Service Act of South Africa, 1994 as amended by Act No. 30 of 2007 (PSA) Prohibited actions 53. Chapter VII 30 of the PSA states that no employee shall perform or engage him or herself to perform remunerative work outside his or her employment in the relevant department, except with the written permission of the executive authority of the department. Departmental officials performed remunerative work outside their employment with no prior written permission from the accounting officer.

National Environmental Management Act, 1998 (Act No. 107 of 1998) (NEMA) and Occupational Health and Safety Act of South Africa, 1993 (Act No. 85 of 1993) (OHS) Prohibited actions 54. Section 28 of NEMA and section 8 of OHS requires the department, as the generator of medical waste, to adequately dispose of such waste. The following was found during the audit: Not all disposal certificates were provided for audit purposes to certify that the process of disposal had been completed. Medical and normal waste is mixed, resulting in medical waste being disposed of at normal waste refuse sites and not incinerated as required. Medical waste storage sites were found to be inadequate and flood or storm water could result in medical waste entering the surface water of surrounding areas. Not all employees wear the appropriate protective gear when working with medical waste. Disposal bins and medical waste sites were not adequately marked as such.

Medicines and Related Substances Control Act, 1965 (Act No. 101 of 1965) (MRSC) Prohibited actions 55. The department has contravened the regulations of GNR.510 relating to the MRSC in the following instances: Certificates confirming the destruction of medicine could not always be provided for audit purposes (regulation 27). Evidence that the destruction or disposal of medicines and scheduled substances was conducted timeously and in such a manner to ensure that they are not retrievable was not provided (regulation 36).

331 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Poor storage facilities and access controls to expired medicine and scheduled substances were identified (regulation 8).

INTERNAL CONTROL 56. I considered internal control relevant to my audit of the financial statements and the report on predetermined objectives and compliance with the PFMA, DORA and Treasury Regulations, but not for the purposes of expressing an opinion on the effectiveness of internal control. The matters reported below are limited to the deficiencies identified during the audit.

Leadership 57. An environment that is conducive to good accountability and service delivery through positive attitude, integrity, competence and ethical behaviour has not been established within the department. Management's philosophy and operating style does not promote effective control over reporting.

58. Oversight responsibility over the preparation of financial statements, report on predetermined objectives, compliance with the laws and regulations and internal control was not exercised by the accounting officer. Leadership has not ensured that there is a process in place to ensure that reviews take place before submission. This was also evidenced by the numerous instances of non-compliance with laws and regulations and the internal control deficiencies that were noted throughout the audit process. Personnel are not aware of the allocation of duties, responsibilities and lines of reporting, resulting in a lack of segregation of duties and the opportunity for fraudulent activities to take place. This is as a result of an organisational structure that does not support and promote a system for proper recording, monitoring and supervision of controls.

59. The lack of decisive action to mitigate emerging risks, implement timely corrective measures and address non performance was evident by the failure of management to adequately address the internal and external audit findings in a timely manner. The department has also failed to properly analyse the control weaknesses and implement appropriate follow-up actions that adequately address the root causes. This has resulted in the qualifications from the prior year report being repeated in the current year.

60. Furthermore, leadership is not taking the audit committee seriously. This is evidenced by: Requests for management information not being submitted; Meetings are not being attended by all relevant officials; and Recommendations made are not being implemented.

Financial and performance management 61. Quality, reliable monthly financial statements and management information is not prepared by the department. Although the department prepares and submits In-Year-Monitoring reports on a monthly basis to the Provincial Treasury, these reports do not contain information as is required to be included in the financial statements. The department attempted to prepare interim financial statements throughout the year; however these did not include all amounts for the relevant disclosure items. These financial statements were also not adequately reviewed and corrective measures not implemented to address shortcomings as identified by internal audit and the interim audit conducted by the AGSA.

62. The department does not have enough individuals who understand the financial reporting framework and performance management requirements. This was especially evident at the districts and hospitals, where the sources of the financial information are prepared. The department relied upon short-term contracted staff for the preparation of the financial statements and most of the financial reporting requirements.

63. The department does not have proper record keeping and record management processes in place to ensure that the documentation supporting the amounts and disclosures in the financial statements are properly filed and easily retrievable. Information requested for audit purposes was not readily available and significant delays were experienced throughout the audit process. In some cases, the documentation was not received at all which resulted in a limitation of scope being placed on the audit.

332 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 64. The department does not have adequate financial management systems in place. The financial system of the department does not address the requirements of an accrual basis of accounting, and manual systems have been implemented for the reporting of the disclosure items in the financial statements. These systems are not appropriate to facilitate the preparation of the financial statements and performance reports. The manual and automated controls are not designed to ensure that transactions have occurred, are authorised and are completely and accurately processed.

Governance 65. Risk identification and management processes are not designed to identify changes in processes or risks and verify that the design of underlying controls remain effective. The department has not selected and developed internal controls to prevent, detect and correct material misstatements in financial reporting and reporting on predetermined objectives.

66. Segregation of duties to prevent fraudulent transactions and misappropriation of assets is not adequate. The department has a fraud prevention plan; however the plan has not been fully implemented and used as per the requirements of the applicable legislation.

OTHER REPORTS

Investigations 67. An investigation is being conducted to probe the manner in which the HROPT process was conducted within the department. The investigation aims to establish whether the funds expended were in accordance with the Provincial Executive Council decision to settle the long outstanding payments. The investigation was still ongoing at the reporting date.

68. An independent consulting firm was appointed by the accounting officer to conduct an investigation against departmental officials for the alleged irregular use of the fixed wing aircraft. Disciplinary actions have been instituted against eight departmental officials and the recovery value has been agreed between the service provider and the department. Criminal proceedings are being instituted against the alleged officials.

Performance audits 69. A performance audit was conducted on the infrastructure delivery process at the department during the year under review. The audit is currently in the reporting phase and the findings will be reported in a separate report.

70. A performance audit on consultants is being conducted and is currently in the execution phase.

East London

30 July 2010

333 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 59 333 1,562 5,949 5,718 61,797 52,011 38,760 499,075 509,277 405,733 414,382 4,344,633 2,629,970 R'000 Actual Expenditure - 2008/09 1,000 2,000 8,000 12,821 77,907 52,400 78,027 95,728 493,808 498,474 404,463 412,946 Final 4,269,403 2,538,350 R'000 Appropriation - 90.3% 53.4% 80.2% 87.6% 23.0% 60.4% 51.4% 60.1% 101.7% 111.6% 100.7% 116.7% 101.3% 100.0% % % of final final % of appropriation Expenditure as as Expenditure - 16 385 (18) 5,003 3,455 9,536 65,814 13,254 75,062 (3,178) (1,269) 107,779 (530,533) (463,245) R'000 Variance - 115 1,063 5,734 20,229 10,069 24,460 100,388 415,307 112,944 615,363 436,870 465,492 3,242,959 5,120,571 R'000 Actual Expenditure - 500 1,045 33,483 19,605 99,119 10,737 27,915 415,323 188,006 681,177 544,649 462,314 Final 2,779,714 4,590,038 R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 4,252 (4,252) R'000 Funds Shifting of of Shifting - 500 1,045 33,483 19,605 99,119 10,737 23,663 415,323 188,006 681,177 544,649 462,314 2,779,714 4,594,290 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Programmes Current payment Current and subsidies Transfers Payment for capital assets for capital Payment payment Current and subsidies Transfers Payment for capital assets for capital Payment payment Current and subsidies Transfers Payment for capital assets for capital Payment payment Current and subsidies Transfers Payment for capital assets for capital Payment payment Current and subsidies Transfers Payment for capital assets for capital Payment 2. Health Services District 1.Administration Health 3. Medical Services Emergency 4. General Hospital Services 5. Central Hospital Services

334 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - (6) 2,081 1,239 19,735 44,621 426,347 101,873 293,101 641,170 R'000 Actual 10,498,181 10,499,420 Expenditure - 2008/09 3,000 4,500 1,328 40,511 54,694 436,749 116,786 287,764 748,458 Final R'000 10,637,789 10,639,117 Appropriation - - 4.9% 76.2% 50.1% 78.4% 73.7% 72.3% 98.9% 102.1% 102.7% 102.7% % % of final final % of appropriation Expenditure as as Expenditure - - 250 9,660 1,904 22,158 20,127 (9,046) 105,088 246,653 R'000 (315,160) (315,160) Variance - - 99 1,405 70,775 20,201 56,920 293,903 642,488 431,716 R'000 Actual 12,087,666 12,089,071 Expenditure - 250 2,003 1,421 92,933 40,328 72,565 398,991 889,141 422,670 Final R'000 2009/10 11,772,506 11,773,927 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - 250 2,003 1,421 92,933 40,328 72,565 398,991 889,141 422,670 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted 11,772,506 11,773,927 Appropriation Programmes And Maintenance Current payment payment Current and subsidies Transfers Current payment payment Current and subsidies Transfers Payment for capital assets for capital Payment Current payment payment Current and subsidies Transfers Payment for capital assets for capital Payment Current payment payment Current Payment for capital assets for capital Payment TOTAL 6. Training And Health Science 7. Clinical Support Services 8. Development Health Facilities Statutory Appropriation Statutory Subtotal

335 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 1,239 12,518 R'000 Actual 10,511,938 10,498,181 10,499,420 Expenditure 2008/09 1,328 28,934 21,000 Final R'000 10,637,789 10,639,117 10,689,051 Appropriation 98.9% 102.7% 102.7% % % of final final % of appropriation Expenditure as as Expenditure - R'000 (315,160) (315,160) Variance 1,405 15,492 R'000 Actual 12,087,666 12,089,071 12,104,563 Expenditure - 1,421 12,531 Final R'000 2009/10 11,772,506 11,773,927 11,786,458 Appropriation - - - VOTE 3 VOTE R'000 Virement - - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting 1,421 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted 11,772,506 11,773,927 Appropriation Programmes Current payment payment Current TOTAL Subtotal Statutory Appropriation Statutory Actual amounts per statement of financial performance (Total revenue) (Total performance Actual amounts per statement of financial Reconciliation with statement of financial performance Reconciliation with statement of financial Actual amounts per statement of financial performance (Total expenditure) (Total performance Actual amounts per statement of financial ADD Aid assistance ADD Departmental receipts Aid assistance

336 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 14,559 22,254 234,284 260,098 101,847 703,461 118,377 6,083,841 2,959,460 R'000 Actual 10,498,181 Expenditure - 2008/09 20,549 234,316 257,609 116,786 743,826 366,526 Final 5,907,368 2,990,809 R'000 10,637,789 Appropriation - 94.3% 65.5% 99.7% 78.8% 69.3% 74.0% 65.2% 115.7% 102.7% % % of final final % of appropriation Expenditure as as Expenditure 592 (707) 22,158 11,059 193,781 106,281 249,806 114,382 (10,318) R'000 (315,160) Variance (1,002,194) 707 82,293 24,971 10,318 201,570 210,058 712,317 214,227 7,396,072 3,235,133 R'000 Actual 12,087,666 Expenditure - 36,030 307,851 210,650 104,451 962,123 328,609 Final 6,393,878 3,428,914 R'000 2009/10 11,772,506 Appropriation ------VOTE 3 VOTE R'000 Virement ------APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 33,785 Appropriation per economic c;lassication per Appropriation 128,037 (29,533) (132,289) R'000 Funds Shifting of of Shifting - 36,030 307,851 210,650 104,451 928,338 358,142 6,265,841 3,561,203 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted 11,772,506 Appropriation Programmes Payments for capital assets for capital Payments Transfers and subsidies and subsidies Transfers Current payments Current Total Buildings and other fixed structures Buildings and other fixed Provinces and municipalities Provinces Departmental agencies and accounts and technikons Universities Households Compensation of employees Goods and services on land and rent Interest Financial transactions in assets Machinery and equipment

337 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 1,239 1,239 R'000 Actual Expenditure 2008/09 1,328 1,328 Final R'000 Appropriation 98.9% 98.9% % % of final final % of appropriation Expenditure as as Expenditure 16 16 R'000 Variance 1,405 1,405 R'000 Actual Expenditure 1,421 1,421 Final R'000 2009/10 Appropriation - - VOTE 3 VOTE R'000 Virement - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting 1,421 1,421 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Member of executive committee / committee Member of executive parliamentary officers Total Direct changes against the against changes Direct Fund Revenue National/Provincial

338 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 1,239 1,239 R'000 Actual Expenditure 2008/09 1,328 1,328 Final R'000 Appropriation 98.9% 98.9% % % of final final % of appropriation Expenditure as as Expenditure 16 16 R'000 Variance 1,405 1,405 R'000 Actual Expenditure 1,421 1,421 Final R'000 2009/10 Appropriation - - VOTE 3 VOTE R'000 Virement - - APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting Statutory Appropriation per economic classification Appropriation Statutory 1,421 1,421 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Current payments Current Compensation of employees Total Program 1 Per Economic 1 Per Program classification classification

339 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 5,083 1,562 5,949 493,992 506,586 R'000 Actual Expenditure - 2008/09 5,083 1,000 12,821 488,725 507,629 Final R'000 Appropriation - 80.3% 90.4% 55.3% 89.8% 101.7% % % of final final % of appropriation Expenditure as as Expenditure 370 (18) 1,088 4,633 64,726 70,799 R'000 Variance - 4,440 1,063 5,734 610,923 622,160 R'000 Actual Expenditure 370 1,045 5,528 10,367 675,649 692,959 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting 370 1,045 5,528 10,367 675,649 692,959 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Current payment Current assets for capital Payment payment Current and subsidies Transfers assets for capital Payment Detail per sub-programme Total 1.2 MANAGEMENT 1.1 THE MEC OFFICE OF

340 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 814 1,562 5,951 294,328 203,931 506,586 R'000 Actual Expenditure - 2008/09 1,000 12,821 297,855 195,953 507,629 Final R'000 Appropriation - 99.9% 76.3% 53.4% 89.8% 101.7% % % of final final % of appropriation Expenditure as as Expenditure 226 (18) 5,003 71,428 (5,840) 70,799 R'000 Variance 5,840 1,063 5,734 379,956 229,567 622,160 R'000 Actual Expenditure - 1,045 10,737 380,182 300,995 692,959 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement - - - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 30,252 (30,252) R'000 Funds Shifting of of Shifting - 1,045 10,737 349,930 331,247 692,959 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation classification Programme 1 Per Economic 1 Per Programme Payment for capital assets for capital Payment Transfers and subsidies to: and subsidies Transfers Current payments Current Machinery and equipment Total Households Compensation of employees Goods and services on land and rent Interest

341 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 4 7 15 52 73 485 11,040 366,354 933,149 234,873 451,042 272,974 R'000 Actual Expenditure - - - - - 2008/09 4,000 16,200 319,641 926,061 234,316 379,846 272,974 Final R'000 Appropriation - - - - 83.9% 73.1% 65.7% 29.1% 93.6% 104.8% 120.6% 126.8% % % of final final % of appropriation Expenditure as as Expenditure 326 (15) (96) (52) (128) 2,360 2,826 20,040 105,661 (19,339) (171,527) (115,659) R'000 Variance 96 52 15 134 128 7,674 12,270 290,902 547,412 419,608 202,190 1,005,714 R'000 Actual Expenditure - - - - 460 14,630 10,500 310,942 431,753 400,269 834,187 307,851 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - - - - 460 14,630 10,500 310,942 431,753 400,269 834,187 307,851 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation CLINICS CENTRES SERVICES Current payment Current and subsidies Transfers assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Details per Sub- Programme 2.1 DISTRICT MANAGEMENT 2.2 COMMUNITY HEALTH 2.3 COMMUNITY HEALTH 2.4 COMMUNITY BASED

342 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 56 780 7,314 5,541 77,292 62,369 52,334 44,354 318,312 196,502 1,880,785 R'000 Actual 4,915,707 Expenditure - - 2008/09 8,500 5,853 7,000 84,424 62,052 47,035 44,854 383,083 179,734 Final 1,870,211 R'000 4,845,784 Appropriation - 50.0% 81.7% 99.2% 99.6% 82.6% 70.4% 100.0% 100.0% 119.9% 100.4% 467.8% 108.1% % % of final final % of appropriation Expenditure as as Expenditure - 3 492 (11) (48) (623) 4,474 33,952 94,159 10,761 (3,946) (382,907) R'000 (419,299) Variance 6 48 733 5,019 47,018 10,666 51,257 57,495 33,884 164,804 420,724 2,304,050 R'000 Actual 5,581,901 Expenditure - 6 736 1,073 47,007 15,140 62,018 67,836 57,987 164,181 514,883 Final 1,921,143 R'000 5,162,602 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation 6 (6) 430 APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for (430) 3,816 (3,816) R'000 Funds Shifting of of Shifting - - 306 1,073 50,823 11,324 62,024 67,836 57,987 164,181 515,313 1,921,143 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 5,162,602 Adjusted Appropriation SERVICES Current payment Current assets for capital Payment payment Current and subsidies Transfers assets for capital Payment payment Current assets for capital Payment payment Current assets for capital Payment payment Current and subsidies Transfers assets for capital Payment Details per Sub- Programme 2.5 COMMUNITY OTHER 2.6 AIDS HIV/ 2.8 SERVICES CORONER 2.7 NUTRITION TOTAL 2.9 DISTRICT HOSPITALS

343 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - - 11,092 14,877 44,456 17,341 234,302 260,098 3,146,050 1,187,491 R'000 Actual 4,915,707 Expenditure - - - 2008/09 9,549 44,854 33,053 234,316 254,609 Final 3,078,019 1,191,384 R'000 4,845,784 Appropriation - - 65.5% 99.7% 93.8% 83.1% 92.3% 116.4% 100.5% 100.0% 108.1% % % of final final % of appropriation Expenditure as as Expenditure - 592 907 (707) 2,382 1,072 (6,507) (1,704) 106,281 (521,615) R'000 (419,299) Variance 707 1,704 11,518 13,723 11,679 12,782 201,570 210,058 3,706,366 1,411,794 R'000 Actual 5,581,901 Expenditure - - 11,518 14,630 14,061 13,854 307,851 210,650 Final 3,184,751 1,405,287 R'000 5,162,602 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 4,252 13,688 (17,940) R'000 Funds Shifting of of Shifting - - 9,602 11,518 14,630 14,061 307,851 210,650 3,202,691 1,391,599 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 5,162,602 Adjusted Appropriation classification Programme 2 Per Economic 2 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Provinces and municipalities Provinces Departmental agencies and accounts and technikons Universities Households Compensation of employees Goods and services on land and rent Interest Financial transactions in assets and liabilities Machinery and equipment

344 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 8,054 52,011 397,679 457,744 R'000 Actual Expenditure 2008/09 2,000 52,400 16,883 387,580 458,863 Final R'000 Appropriation 23.0% 60.4% 98.3% 97.9% 100.0% % % of final final % of appropriation Expenditure as as Expenditure 385 283 13,254 (3,461) 10,461 R'000 Variance 115 20,229 16,055 449,437 485,836 R'000 Actual Expenditure 500 33,483 16,338 445,976 496,297 Final R'000 2009/10 Appropriation - - - - - VOTE 3 VOTE R'000 Virement - - - - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting 500 33,483 16,338 445,976 496,297 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation TRANSPORT SERVICES TOTAL Current payment Current Current payment Current and subsidies Transfers assets for capital Payment Details per Sub- Programme 3.2 PATIENT PLANNED 3.1 EMERGENCY MEDICAL

345 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 56 32,034 19,977 250,702 154,975 457,744 R'000 Actual Expenditure - 2008/09 2,000 26,880 25,520 248,603 155,860 458,863 Final R'000 Appropriation - 98.2% 23.0% 98.5% 29.5% 97.9% 101.2% % % of final final % of appropriation Expenditure as as Expenditure 385 220 3,056 13,034 (3,460) (2,774) 10,461 R'000 Variance 115 5,449 2,774 14,780 299,192 163,526 485,836 R'000 Actual Expenditure - 500 15,000 18,483 295,732 166,582 496,297 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement - - - - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 8,314 (8,314) R'000 Funds Shifting of of Shifting - 500 15,000 18,483 287,418 174,896 496,297 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation classification Programme 3 Per Economic 3 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Households Compensation of employees Goods and services on land and rent Interest Machinery and equipment

346 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 185 5,533 8,074 1,244 29,442 226,820 345,013 2,058,137 R'000 Actual 2,674,448 Expenditure - - 2008/09 8,000 4,006 55,821 18,200 218,529 355,430 Final 1,964,391 R'000 2,624,377 Appropriation 2.0% 55.9% 99.8% 83.0% 95.9% 41.0% 19.4% 122.8% 114.0% 115.7% % % of final final % of appropriation Expenditure as as Expenditure 649 970 7,180 5,592 1,386 2,050 16,608 (8,911) (480,501) R'000 (454,978) Variance 20 964 492 9,085 27,352 72,544 392,731 260,110 2,590,117 R'000 Actual 3,353,416 Expenditure 990 2,350 2,542 32,944 16,265 63,633 409,339 260,759 Final 2,109,616 R'000 2,898,438 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting 990 2,350 2,542 32,944 16,265 63,633 409,339 260,759 2,109,616 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 2,898,438 Adjusted Appropriation HOSPITAL HOSPITALS Current payment Current and subsidies Transfers assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Details per Sub- Programme TOTAL 4.3 MENTAL PSYCHIATRIC 4.2 TB HOSPITALS 4.1 GENERAL (REGIONAL)

347 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 106 (12) 1,956 5,730 38,654 604,853 2,023,161 R'000 Actual 2,674,448 Expenditure - - 2008/09 8,000 5,300 72,727 677,701 Final 1,860,649 R'000 2,624,377 Appropriation - - 98.7% 51.4% 88.8% 122.3% 107.0% 115.7% % % of final final % of appropriation Expenditure as as Expenditure - - 8,566 9,535 3,498 (4,767) (471,810) R'000 (454,978) Variance - - 10,070 27,601 72,787 654,541 2,588,417 R'000 Actual 3,353,416 Expenditure - - 19,605 31,099 68,020 663,107 Final 2,116,607 R'000 2,898,438 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 86,403 (86,403) R'000 Funds Shifting of of Shifting - - 19,605 31,099 68,020 749,510 2,030,204 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 2,898,438 Adjusted Appropriation classification Programme 4 Per Economic 4 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Provinces and municipalities Provinces Households Compensation of employees Goods and services on land and rent Interest Machinery and equipment

348 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 59 333 414,382 414,774 R'000 Actual Expenditure - 2008/09 95,728 412,946 508,674 Final R'000 Appropriation - 60.1% 87.6% 100.0% % % of final final % of appropriation Expenditure as as Expenditure - 16 75,062 75,078 R'000 Variance - 415,307 112,944 528,251 R'000 Actual Expenditure - 415,323 188,006 603,329 Final R'000 2009/10 Appropriation - - - - VOTE 3 VOTE R'000 Virement - - - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - 415,323 188,006 603,329 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation SERVICES Current payment Current and subsidies Transfers assets for capital Payment Details per Sub- Programme 5.1 TERTIARY PROVINCIAL TOTAL

349 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 59 333 79,234 335,148 414,774 R'000 Actual Expenditure - 2008/09 25,925 69,803 117,653 295,293 508,674 Final R'000 Appropriation - 66.1% 56.8% 87.6% 100.0% 100.0% % % of final final % of appropriation Expenditure as as Expenditure - - 16 22,323 52,739 75,078 R'000 Variance - 88,396 43,503 69,441 326,911 528,251 R'000 Actual Expenditure - 88,412 65,826 326,911 122,180 603,329 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement - - Appropriation per programme per Appropriation 276 APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for (276) 19,000 (19,000) R'000 Funds Shifting of of Shifting - 88,688 46,826 326,635 141,180 603,329 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation classification Programme 5 Per Economic 5 Per Programme Payment for capital assets for capital Payment Transfers and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Households Compensation of employees Goods and services Machinery and equipment

350 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - 26 3,436 2,330 1,418 86,388 94,418 14,881 243,211 101,847 547,955 R'000 Actual Expenditure - - 2008/09 5,424 1,600 10,237 86,402 28,674 241,788 103,135 116,786 594,046 Final R'000 Appropriation - - - 25.4% 59.9% 94.5% 99.0% 76.2% 51.0% 94.0% 105.4% % % of final final % of appropriation Expenditure as as Expenditure - - 739 (59) 1,268 1,056 4,001 22,158 18,918 33,239 (14,841) R'000 Variance - - 59 432 1,576 73,948 70,775 19,710 68,517 287,674 522,692 R'000 Actual Expenditure - - - 1,700 2,632 72,518 74,687 92,933 38,628 272,833 555,931 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - - - 1,700 2,632 72,518 74,687 92,933 38,628 272,833 555,931 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Details per Sub- Programme COLLEGES Current payment Current and subsidies Transfers Current payment Current and subsidies Transfers Current payment Current assets for capital Payment Current payment Current assets for capital Payment Payment for capital assets for capital Payment Payment for capital assets for capital Payment 6.4 OTHER TRAINING 6.4 OTHER 6.3 BURSARIES 6.2 EMS TRAINING COLLEGE TRAINING 6.2 EMS 6.1 TRAINING NURSING TOTAL

351 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 26 404 6,611 13,124 266,729 159,214 101,847 547,955 R'000 Actual Expenditure - - 2008/09 23,111 17,400 269,785 166,964 116,786 594,046 Final R'000 Appropriation - - 96.3% 76.2% 53.8% 47.8% 94.0% 105.1% % % of final final % of appropriation Expenditure as as Expenditure - - 5,287 7,149 22,158 12,978 33,239 (14,333) R'000 Variance - - 8,309 70,775 11,892 294,443 137,273 522,692 R'000 Actual Expenditure - - 92,933 15,458 24,870 280,110 142,560 555,931 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 18,258 (18,258) R'000 Funds Shifting of of Shifting - - 92,933 15,458 24,870 261,852 160,818 555,931 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation classification Programme 6 Per Economic 6 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Universities and technikons Universities Households Compensation of employees Goods and services on land and rent Interest Machinery and equipment

352 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - - 2,081 21,177 23,444 46,702 R'000 Actual Expenditure - 2008/09 3,000 4,500 24,948 29,746 62,194 Final R'000 Appropriation - - - 97.4% 67.0% 76.2% % % of final final % of appropriation Expenditure as as Expenditure 725 250 (99) 2,003 14,920 17,799 R'000 Variance - - 99 26,674 30,246 57,019 R'000 Actual Expenditure - 250 2,003 45,166 27,399 74,818 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - 250 2,003 45,166 27,399 74,818 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation Details per Sub- Programme PROSTHETIC SERVICES PROSTHETIC ACCOUNT Current payment Current assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment TOTAL 7.2 MEDICINE TRADING 7.2 MEDICINE 7.1 ORTHOTIC AND 7.1 ORTHOTIC

353 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - - 237 8,359 2,081 36,025 46,702 R'000 Actual Expenditure - - 2008/09 3,000 4,500 19,467 35,227 62,194 Final R'000 Appropriation - - - 4.9% 79.5% 77.5% 76.2% % % of final final % of appropriation Expenditure as as Expenditure - - 250 7,179 8,466 1,904 17,799 R'000 Variance - - - 99 27,787 29,133 57,019 R'000 Actual Expenditure - - 250 2,003 34,966 37,599 74,818 Final R'000 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement - - - - - Appropriation per programme per Appropriation 768 APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for (768) R'000 Funds Shifting of of Shifting - - 250 2,003 34,198 38,367 74,818 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE Adjusted Appropriation classification Programme 7 Per Economic 7 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Machinery and equipment Departmental agencies and accounts Households Compensation of employees Goods and services on land and rent Interest

354 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 (6) 32,605 40,190 11,994 152,019 220,306 246,016 231,141 934,265 R'000 Actual Expenditure - 2008/09 29,159 36,816 17,000 164,186 221,789 321,464 245,808 Final R'000 1,036,222 Appropriation - 64.5% 56.5% 77.8% 63.1% 69.3% 85.2% 13.6% 72.7% % % of final final % of appropriation Expenditure as as Expenditure - 8,848 66,845 48,422 47,818 65,705 10,800 103,303 351,741 R'000 Variance - 1,700 16,084 86,726 169,876 176,502 107,943 377,560 936,391 R'000 Actual Expenditure - 24,932 12,500 153,571 218,298 279,805 155,761 443,265 Final R'000 1,288,132 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement ------Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for R'000 Funds Shifting of of Shifting - 24,932 12,500 153,571 218,298 279,805 155,761 443,265 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 1,288,132 Adjusted Appropriation SERVICES FACILITIES SERVICES RESCUE Details per Sub- Programme Payment for capital assets for capital Payment Current payment Current assets for capital Payment Current payment Current and subsidies Transfers assets for capital Payment Current payment Current assets for capital Payment 8.3 PROVINCIAL HOSPITAL HOSPITAL 8.3 PROVINCIAL 8.2 DISTRICT HOSPITAL 8.1 HEALTH COMMUNITY 8.4 EMERGENCY MEDICAL TOTAL

355 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 (6) 15,278 27,429 277,823 613,741 934,265 R'000 Actual Expenditure - 2008/09 15,337 272,427 617,756 130,702 Final R'000 1,036,222 Appropriation - 87,8% 73.2% 73.9% 52.6% 72.7% % % of final final % of appropriation Expenditure as as Expenditure - 1,603 32,419 103,485 214,234 351,741 R'000 Variance - 11,515 36,043 282,388 606,445 936,391 R'000 Actual Expenditure - 13,118 68,462 385,873 820,679 Final R'000 1,288,132 2009/10 Appropriation ------VOTE 3 VOTE R'000 Virement - - Appropriation per programme per Appropriation APPROPRIATION STATEMENT STATEMENT APPROPRIATION for the year ended 31 March 2010 31 March ended the year for 2,258 14,785 (2,258) (14,785) R'000 Funds Shifting of of Shifting - 10,860 83,247 388,131 805,894 R'000 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 1,288,132 Adjusted Appropriation classification Programme 8 Per Economic 8 Per Programme Payment for capital assets for capital Payment Transfers and subsidies and subsidies Transfers Current payments Current TOTAL Buildings and other fixed structures Buildings and other fixed Provinces and municipalities Provinces Compensation of employees Goods and services Machinery and equipment

356 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2010

1. Detail of transfers and subsidies as per Appropriation Act (after Virement):

Detail of these transactions can be viewed in the note 3.5 on Transfers and subsidies, disclosure notes and Annexure 1 (A-H) to the Annual Financial Statements.

2. Detail of specifically 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 financial transactions in assets and liabilities

Detail of these transactions per programme can be viewed in the note 3.3 on Financial transactions in assets and liabilities to the Annual Financial Statements.

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

4.1 Per Programme Final Actual Variance Variance Appropriation Expenditure R'000 as a % of Final Appropriation Health Administration 694,380 623,565 70,815 10.20%

Due to austerity measures per circular 7 and 51 of 2009, the programme realised savings in Goods and services

District Health Services 5,162,602 5,581,901 (419,299) (8.12%)

Compensation of employees over-spent its budget by R521.615 million. This was caused mainly by payments for HROPT, Phases 1 and 2 OSD and the carry through costs related thereto. Goods and services were over-spent by R6.507 million. The main contributors to this over-expenditure is from the sub-programme 2.2 in relation to drugs and vaccines.

Transfers and subsidies under-spent their budget by R107.780 million. Municipal transfers account for 98.6% of this under-expenditure. Municipalities / entities which mainly contributed to this under-expenditure are Nelson Mandela Metro (R53.1 million), Buffalo City (R19.1 million), Amathole District Municipality (R15.5 million) and Ukhahlamba District Municipality (R8.2 million)., Apart from insufficient cash flow to pay these transfers, the under-spending municipalities signed their Service Level Agreements with the Department very late.

Emergency Medical Services 496,297 485,836 10,461 2.11%

R13.034 million of the under-expenditure in this programme relates to Payments for Capital Assets. It is made up of orders made for the outright purchase of new ambulances but which could only be paid in the 2010/11 financial year.

357 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2010

General Hospital 2,898,438 3,353,416 (454,978) (15.70%)

Compensation of employees over-spent its budget by R471.810 million. This was caused mainly by payments for HROPT, Phases 1 and 2 OSD and the carry through costs related thereto. Goods and services were under- spent by R8.566 million, (mainly from TB and Psychiatric Hospitals sub-programmes) and Transfers and subsidies relating to households of R9.535 million. This under-expenditure was caused by insufficient cash flow available at year end arising from a restricted year end bank overdraft facility of R400 million.

Central Hospital Services 603,329 528,251 75,078 12.44%

The under-expenditure is predominantly in payments for capital assets. It relates to machinery and equipment and buildings and other fixed structures in terms of the near completion of the Turnkey provision of Linear Accelerators and Computerised Tomography Scans for the Oncology sites at Livingstone and Frere Hospitals. A rollover application has been submitted to Provincial Treasury in respect of the National Tertiary Services Grant.

Health Science and Training 555,931 522,692 33,239 5.98%

Compensation of employees over-spent its budget by R14.333 million. This was caused mainly by payments for HROPT, Phases 1 and 2 OSD and the carry through costs related thereto. Transfers to Universities and Technikons and Payments for Capital Assets under-spent by R22.158 million and R20.127 million respectively. Challenges with insufficient cash flow availability at year end was responsible for the under-expenditure. The Department has applied for a rollover of funds from the Health Professions Training and Development Grant.

Clinical Support Services 74,818 57,019 17,799 23.79%

The programme under-spent on Compensation of employees (R7.179 million), Goods and services (R8.466million) and Payment for Capital assets (R1.904 million). This was due to the delays in the timeous finalisation of the medical depot organogram and subsequent appointment of personnel, payment of unitary fees following the non award of the PPP Concession Agreement in the 2009/10 financial year.

Health Facilities Development and Maintenance 1,288,132 936,391 351,741 27.31%

The main under-spent items are Payment for Capital assets at R246.653 million and Goods and services at R103.485 million. In general, the under-expenditure was caused by insufficient cash flow available at year end. The Department has submitted an application for the rollover of conditional grant funding to Provincial Treasury in respect of R80.6 million and R23.2 million for the Hospital Revitalisation and Infrastructure Grant to Provinces Grants respectively.

358 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE APPROPRIATION STATEMENT for the year ended 31 March 2010

4.2 Per Economic classification Final Actual Variance Variance Appropriation Expenditure as a % of Final Appropriation R'000 R'000 R'000 R'000 Current payments: Compensation of employees 6,395,299 7,397,477 (1,002,178) (15.67%) Goods and services 3,428,914 3,235,133 193,781 5.65% Interest and rent on land 10,318 (10,318) Financial transactions in assets and liabilities 707 (707)

Transfers and subsidies: Provinces and municipalities 307,851 201,570 106,281 34.52% Departmental agencies and accounts 210,650 210,058 592 0.28% Universities and technikons 104,451 82,293 22,158 21.21% Households 36,030 24,971 11,059 30.69%

Payments for capital assets: Buildings and other fixed structures 962,123 712,317 249,806 25.96% Machinery and equipment 328,609 214,227 114,382 34.81%

Compensation of employees: Compensation of employees for the Department over-spent its budget by R 1.002178 billion. This was caused mainly by payments for HROPT, Phases 1 and 2 OSD and the carry through costs associated with that.

Goods and services: Due to austerity measures per Circulars 7 and 51 of 2009, savings in Goods and services were realised in Programme 1. Other programmes under-spent their budgets due to the cash flow challenges that the Department faced at year end, wherein payments to a number of creditors could not be made. Of the sub-programmes that contributed to the under-expenditure, HIV/AIDS contributed the most as they could not spend the funding received during adjustment in full. This however did not adversely affect service delivery except that it put a lot of strain on the Department's creditors.

Transfers and subsidies: Transfers and subsidies under-spent their budget by R140.090 million. Municipal transfers account for 75.9% of this under-expenditure. Municipalities / entities which mainly contributed to this under-expenditure are Nelson Mandela Metro (R53.1 million), Buffalo City (R19.1 million), Amathole District Municipality (R15.5 million) and Ukhahlamba District Municipality (R8.2 million)., Apart from insufficient cash flow to pay these transfers, the under-spending municipalities signed their Service Level Agreements with the Department very late. One cannot say with certainty whether service delivery was adversely affected or not.

Payment for capital assets: The main under-spent item is Buildings and other fixed structures and Machinery and equipment. The main programmes contributing to this under-expenditure are Programmes 5 and 8. Rollovers for the affected conditional grants (National Tertiary Services Grant, Hospital Revitalisation Grant, Health Professions Training and Development Grant and Infrastructure Grant to Provinces) have been applied for from Provincial Treasury.

In relation to Programme 8, the Department has submitted an application for the rollover of conditional grant funding to Provincial Treasury in respect of R80.6 million and R23.2 million for the Hospital Revitalisation and Infrastructure Grant to Provinces Grants respectively.

359 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

STATEMENT OF FINANCIAL PERFORMANCE for the year ended 31 March 2010

Note 2009/10 2008/09 R'000 R'000 REVENUE Annual appropriation 1 11,772,506 10,637,789 Statutory appropriation 2 1,421 1,328 Departmental revenue 3 12,531 28,934 Aid assistance 4 - 21,000

TOTAL REVENUE 11,786,458 10,689,051

EXPENDITURE Current expenditure Compensation of employees 5 7,397,478 6,085,080 Goods and services 6 3,235,130 2,959,462 Interest and rent on land 7 10,318 14,559 Financial transactions in assets and liabilities 8 707 266 Aid assistance 4 15,492 12,518 Total current expenditure 10,659,125 9,071,885

Transfers and subsidies 518,893 618,483 Transfers and subsidies 9 518,893 618,483

Expenditure for capital assets Tangible capital assets 10 926,545 821,570 Total expenditure for capital assets 926,545 821,570

TOTAL EXPENDITURE 12,104,563 10,511,938

SURPLUS/(DEFICIT) FOR THE YEAR (318,105) 177,113

Reconciliation of Net Surplus/(Deficit) for the year Voted funds (315,144) 139,697 Departmental revenue 17 12,531 28,934 Aid assistance 4 (15,492) 8,482 SURPLUS/(DEFICIT) FOR THE YEAR (318,105) 177,113

360 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

STATEMENT OF FINANCIAL POSITION for the year ended 31 March 2010

Note 2009/10 2008/09 R'000 R'000 ASSETS Current assets 1,175,590 319,104 Unauthorised expenditure 11 1,071,303 197,026 Fruitless and wasteful expenditure 12 3,651 3,651 Cash and cash equivalents 13 - 10,164 Prepayments and advances 14 9 80 Receivables 15 92,500 108,183 Aid assistance receivable 4 8,127 -

TOTAL ASSETS 1,175,590 319,104

LIABILITIES

Current liabilities 1,172,758 315,953 Voted funds to be surrendered to the Revenue Fund 16 679,129 251,333 Departmental revenue to be surrendered to the Revenue Fund 17 11,370 13,551 Bank overdraft 18 468,873 - Payables 19 13,386 43,704 Aid assistance unutilised 4 - 7,365

TOTAL LIABILITIES 1,172,758 315,953

NET ASSETS 2,832 3,151

Represented by: Recoverable revenue 2,832 3,151

TOTAL 2,832 3,151

361 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

STATEMENT OF CHANGES IN NET ASSETS for the year ended 31 March 2010

Note 2009/10 2008/09 R'000 R'000 Recoverable revenue Opening balance 3,151 1,579 Transfers: (319) 1,572 Debts recovered (included in departmental receipts) (1,408) (134) Debts raised 1,089 1,706 Closing balance 2,832 3,151

TOTAL 2,832 3,151

362 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

CASH FLOW STATEMENT for the year ended 31 March 2010

Note 2009/10 2008/09 R'000 R'000 CASH FLOWS FROM OPERATING ACTIVITIES Receipts 11,853,742 10,634,313 Annual appropriated funds received 1.1 11,772,506 10,521,883 Statutory appropriated funds received 2 1,421 1,328 Departmental revenue received 3 79,815 90,102 Aid assistance received 4 - 21,000

Net (increase) in working capital (888,841) (141,593) Surrendered to Revenue Fund (213,333) (206,052) Current payments (9,784,848) (8,951,891) Transfers and subsidies paid (518,893) (618,483) Net cash flow available from operating activities 20 447,827 716,294

CASH FLOWS FROM INVESTING ACTIVITIES Payments for capital assets 10 (926,545) (821,570) Net cash flows from investing activities (926,545) (821,570)

CASH FLOWS FROM FINANCING ACTIVITIES Increase/(decrease) in net assets (319) 1,572 Net cash flows from financing activities (319) 1,572

Net (decrease) in cash and cash equivalents (479,037) (103,704)

Cash and cash equivalents at beginning of period 10,164 113,868

Cash and cash equivalents at end of period 21 (468,873) 10,164

363 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

The Financial Statements have been prepared in accordance with the following policies, which have been applied consistently in all material aspects, unless otherwise indicated. However, where appropriate and meaningful, additional information has been disclosed to enhance the usefulness of the Financial Statements and to comply with the statutory requirements of the Public Finance Management Act, Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations issued in terms of the Act and the Division of Revenue Act, Act 2 of 2006.

1. Presentation of the Financial Statements

1.1 Basis of preparation

The Financial Statements have been prepared on a modified cash basis of accounting, except where stated otherwise. The modified cash basis constitutes the cash basis of accounting supplemented with additional disclosure items. Under the cash basis of accounting transactions and other events are recognised when cash is received or paid.

1.2 Presentation currency

All amounts have been presented in the currency of the South African Rand (R) which is also the functional currency of the department.

1.3 Rounding

Unless otherwise stated all financial figures have been rounded to the nearest one thousand Rand (R'000).

1.4 Comparative figures

Prior period comparative information has been presented in the current year's financial statements. Where necessary figures included in the prior period financial statements have been reclassified to ensure that the format in which the information is presented is consistent with the format of the current year's financial statements.

1.5 Comparative figures - Appropriation Statement

A comparison between actual amounts and final appropriation per major classification of expenditure is included in the Appropriation Statement.

2. Revenue

2.1 Appropriated funds

Appropriated funds are recognised in the financial records on the date the appropriation becomes effective. Adjustments to the appropriated funds made in terms of the adjustments budget process are recognised in the financial records on the date the adjustments become effective.

Total appropriated funds are presented in the Statement of Financial Performance.

Unexpended appropriated funds are surrendered to the National/Provincial Revenue Fund. Amounts owing to the National/Provincial Revenue Fund at the end of the financial year are recognised in the Statement of Financial Position.

2.2 Statutory Appropriation

Statutory appropriations are recognised in the financial records on the date the appropriation becomes effective. Adjustments to the statutory appropriations made in terms of the adjustments budget process are recognised in the financial records on the date the adjustments become effective.

364 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

Total statutory appropriations are presented in the Statement of Financial Performance.

Unexpended statutory appropriations are surrendered to the National/Provincial Revenue Fund. Amounts owing to the National/Provincial Revenue Fund at the end of the financial year are recognised in the Statement of Financial Position.

2.3 Departmental revenue

All departmental revenue is recognised in the statement of financial performance when received and is subsequently paid into the National/Provincial Revenue Fund, unless stated otherwise.

Any amount owing to the National/Provincial Revenue Fund at the end of the financial year is recognised as a payable in the statement of financial position.

No accrual is made for the amount receivable from the last receipt date to the end of the reporting period. These amounts are however disclosed in the disclosure note to the annual financial statements.

2.3.1 Tax revenue

Tax revenue consists of all compulsory unrequited amounts collected by the department in accordance with laws and or regulations (excluding fines, penalties & forfeits).

Tax receipts are recognised in the Statement of Financial Performance when received.

2.3.2 Sales of goods and services other than capital assets

The proceeds received from the sale of goods and/or the provision of services is recognised in the Statement of Financial Performance when the cash is received.

2.3.3 Fines, penalties & forfeits

Fines, penalties & forfeits are compulsory unrequited amounts which were imposed by a court or quasi-judicial body and collected by the department. Revenue arising from fines, penalties and forfeits is recognised in the Statement of Financial Performance when the cash is received.

2.3.4 Interest, dividends and rent on land

Interest, dividends and rent on land is recognised in the Statement of Financial Performance when the cash is received.

2.3.5 Sale of capital assets

The proceeds received on sale of capital assets are recognised in the Statement of Financial Performance when the cash is received.

2.3.6 Financial transactions in assets and liabilities

Repayments of loans and advances previously extended to employees and public corporations for policy purposes are recognised as revenue in the Statement of Financial Performance on receipt of the funds.

Cheques issued in previous accounting periods that expire before being banked are recognised as revenue in the Statement of Financial Performance when the cheque becomes stale. When the cheque is reissued the payment is made from Revenue.

Forex gains are recognised on payment of funds.

365 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

2.3.7 Transfers received (including gifts, donations and sponsorships)

All cash gifts, donations and sponsorships are paid into the National/Provincial Revenue Fund and recorded as revenue in the Statement of Financial Performance when received. Amounts receivable at the reporting date are disclosed in the disclosure notes to the financial statements.

All in-kind gifts, donations and sponsorships are disclosed at fair value in an annexure to the financial statements.

2.4 Direct Exchequer receipts

All direct exchequer receipts are recognised in the Statement of Financial Performance when the cash is received.

All direct exchequer payments are recognised in the Statement of Financial Performance when final authorisation for payment is effected on the system (by no later than 31 March of each year).

2.5 Aid assistance

Aids assistance is recognised as revenue when received

All in-kind aid assistance is disclosed at fair value on the date of receipt in the annexures to the Annual Financial Statements

The cash payments made during the year relating to aid assistance projects are recognised as expenditure in the statement of financial performance when final authorisation for payments is effected on the system (by no later than 31 March of each year)

The value of the assistance expensed prior to the receipt of funds is recognised as a receivable in the statement of financial position.

Inappropriately expensed amounts using aid assistance and any unutilised amounts are recognised as payables in the statement of financial position.

All CARA funds received must be recorded as revenue when funds are received. The cash payments made during the year relating to CARA earmarked projects are recognised as expenditure in the statement of financial performance when final authorisation for payments effected on the system (by no later then 31 March of each year)

Inappropriately expensed amounts using CARA funds are recognised as payables in the statement of financial position. Any unutilised amounts are transferred to retained funds as they are not surrendered to the revenue fund.

3. Expenditure

3.1 Compensation of employees

3.1.1 Short-term employee benefits

Salaries and wages comprise payments to employees (including leave entitlements, thirteenth cheques and performance bonuses). Salaries and wages are recognised as an expense in the Statement of Financial Performance when final authorisation for payment is effected on the system (by no later than 31 March of each year). Capitalised compensation forms part of the expenditure for capital assets in the Statement of Financial Performance.

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ACCOUNTING POLICIES for the year ended 31 March 2010

All other payments are classified as current expense.

Short-term employee benefits that give rise to a present legal or constructive obligation are disclosed in the disclosure notes to the financial statements. These amounts are not recognised in the Statement of Financial Performance or Position.

3.1.2 Post retirement benefits

The department provides retirement benefits (pension benefits) for certain of its employees through a defined benefit plan for government employees. These benefits are funded by both employer and employee contributions.

Employer contributions (i.e. social contributions) to the fund are expensed when the final authorisation for payment to the fund is effected on the system (by no later than 31 March of each year). No provision is made for retirement benefits in the financial statements of the department. Any potential liabilities are disclosed in the financial statements of the National/Provincial Revenue Fund and not in the financial statements of the employer department.

The department provides medical benefits for certain of its employees. Employer contributions to the medical funds are expensed when final authorisation for payment to the fund is effected on the system (by no later than 31 March of each year).

3.1.3 Termination benefits

Termination benefits such as severance packages are recognised as an expense in the Statement of Financial Performance as a transfer (to households) when the final authorisation for payment is effected on the system (by no later than 31 March of each year).

3.1.4 Other long-term employee benefits

Other long-term employee benefits (such as capped leave) are recognised as an expense in the Statement of Financial Performance as a transfer (to households) when the final authorisation for payment is effected on the system (by no later than 31 March of each year).

Long-term employee benefits that give rise to a present legal or constructive obligation are disclosed in the disclosure notes to the financial statements. These amounts are not recognised in the Statement of Financial Performance or Position.

3.2 Goods and services

Payments made for goods and/or services are recognised as an expense in the Statement of Financial Performance when the final authorisation for payment is effected on the system (by no later than 31 March of each year). The expense is classified as capital if the goods and services were used for a capital project or an asset of R5000 or more is purchased. All assets costing less than R5000 will also be reflected under goods and services.

3.3 Interest and rent on land

Interest and rental payments are recognised as an expense in the Statement of Financial Performance when the final authorisation for payment is effected on the system (by no later than 31 March of each year). This item excludes rental for the use of buildings or other fixed structures. If it is not possible to distinguish between payment for the use of land and the fixed structures on it, the whole amount should be recorded under goods and services.

367 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

3.4 Financial transactions in assets and liabilities

Debts are written off when identified as irrecoverable. Debts written-off are limited to the amount of savings and/or under spending of appropriated funds. The write off occurs at year-end or when funds are available. No provision is made for irrecoverable amounts but amounts are disclosed as a disclosure note.

Forex losses are recognised on payment of funds.

All other losses are recognised when authorisation has been granted for the recognition thereof.

3.5 Transfers and subsidies

Transfers and subsidies are recognised as an expense when the final authorisation for payment is effected on the system (by no later than 31 March of each year).

3.6 Unauthorised expenditure

When discovered unauthorised expenditure is recognised as an asset in the statement of financial position until such time as the expenditure is either approved by the relevant authority, recovered from the responsible person or written off as irrecoverable in the Statement of Financial Performance.

Unauthorised expenditure approved with funding is recognised in the Statement of Financial Position when the unauthorised expenditure is approved and the related funds are received. Where the amount is approved without funding it is recognised as expenditure, subject to availability of savings, in the Statement of Financial Performance on the date of approval.

3.7 Fruitless and wasteful expenditure

Fruitless and wasteful expenditure is recognised as expenditure in the Statement of Financial Performance. If the expenditure is recoverable it is treated as an asset until it is recovered from the responsible person or written off as irrecoverable in the Statement of Financial Performance.

3.8 Irregular expenditure

Irregular expenditure is recognised as expenditure in the Statement of Financial Performance. If the expenditure is not condoned by the relevant authority it is treated as an asset until it is recovered or written off as irrecoverable in the Statement of Financial Performance.

3.9 Expenditure for capital assets

Payments made for capital assets are recognised as an expense in the Statement of Financial Performance when the final authorisation for payment is effected on the system (by no later than 31 March of each year).

4. Assets

4.1 Cash and cash equivalents

Cash and cash equivalents are carried in the Statement of Financial Position at cost.

For the purposes of the Cash Flow Statement, cash and cash equivalents comprise cash on hand, deposits held, other short-term highly liquid investments and bank overdrafts.

368 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

4.2 Other financial assets

Other financial assets are carried in the Statement of Financial Position at cost.

4.3 Prepayments and advances

Amounts prepaid or advanced are recognised in the Statement of Financial Position when the payments are made.

Pre-payments and advances outstanding at the end of the year are carried in the Statement of Financial Position at cost.

4.4 Receivables

Receivables included in the statement of financial position arise from cash payments made that are recoverable from another party or from the sale of goods/rendering of services.

Receivables outstanding at year-end are carried in the statement of financial position at cost plus any accrued interest. Amounts that are potentially irrecoverable are included in the disclosure notes. All debts older than one year are included in the provision and other current debts which on evaluation appear to be irrecoverable are included in the provision disclosure.

4.5 Investments

Capitalised investments are shown at cost in the Statement of Financial Position. Any cash flows such as dividends received or proceeds from the sale of the investment are recognised in the Statement of Financial Performance when the cash is received.

Investments are tested for an impairment loss whenever events or changes in circumstances indicate that the investment may be impaired. Any loss is included in the disclosure notes.

4.6 Loans

Loans are recognised in the Statement of Financial Position at the nominal amount when cash is paid to the beneficiary. Loan balances are reduced when cash repayments are received from the beneficiary. Amounts that are potentially irrecoverable are included in the disclosure notes.

Loans that are outstanding at year-end are carried in the Statement of Financial Position at cost.

4.7 Capital assets

4.7.1 Movable assets

A capital asset is recorded on receipt of the item at cost. Cost of an asset is defined as the total cost of acquisition. Where the cost cannot be determined accurately, the movable capital asset is stated at fair value. Where fair value cannot be determined, the capital asset is included in the asset register at R1.

Subsequent expenditure of a capital nature is recorded in the Statement of Financial Performance as “expenditure for capital asset” and is capitalised in the asset register of the department on completion of the project.

Repairs and maintenance is expensed as current “goods and services” in the Statement of Financial Performance.

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ACCOUNTING POLICIES for the year ended 31 March 2010

4.7.2 Immovable assets

A capital asset is recorded on receipt of the item at cost. Cost of an asset is defined as the total cost of acquisition. Where the cost cannot be determined accurately, the immovable capital asset is stated at R1 unless the fair value for the asset has been reliably estimated.

Work-in-progress of a capital nature is recorded in the Statement of Financial Performance as “expenditure for capital asset”. On completion, the total cost of the project is included in the asset register of the department that legally owns the asset or the provincial/national department of public works.

Repairs and maintenance is expensed as current “goods and services” in the Statement of Financial Performance.

5. Liabilities

5.1 Voted funds to be surrendered to the Revenue Fund

5.2 Departmental revenue to be surrendered to the Revenue Fund

Amounts owing to the National/Provincial Revenue Fund at the end of the financial year are recognised in the Statement of Financial Position at cost.

5.3 Direct Exchequer receipts to be surrendered to the Revenue Fund

All direct exchequer fund receipts are recognised in the Statement of Financial Performance when the cash is received.

Amounts received must be surrendered to the relevant revenue fund on receipt thereof. Any amount not surrendered at year end is reflected as a current payable in the Statement of Financial Position.

5.4 Bank overdraft

The bank overdraft is carried in the Statement of Financial Position at cost.

5.5 Payables

Recognised payables mainly comprise of amounts owing to other governmental entities. These payables are recognised at historical cost in the Statement of Financial Position.

5.6 Contingent liabilities

Contingent liabilities are included in the disclosure notes to the financial statements when it is possible that economic benefits will flow from the department, or when an outflow of economic benefits or service potential is probable but cannot be measured reliably.

5.7 Contingent assets

Contingent assets are included in the disclosure notes to the financial statements when it is possible that an inflow of economic benefits will flow to the entity.

370 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

5.8 Commitments Commitments are not recognised in the Statement of Financial Position as a liability or as expenditure in the Statement of Financial Performance but are included in the disclosure notes. 5.9 Accruals Accruals are not recognised in the Statement of Financial Position as a liability or as expenditure in the Statement of Financial Performance but are included in the disclosure notes. 5.10 Employee benefits Short-term employee benefits that give rise to a present legal or constructive obligation are disclosed in the disclosure notes to the financial statements. These amounts are not recognised in the Statement of Financial Performance or the Statement of Financial Position. 5.11 Lease commitments Finance leases are not recognised as assets and liabilities in the statement of financial position. Finance lease payments are recognised as an expense in the statement of financial performance and are apportioned between capital and interest portions. The finance lease liability is disclosed in the disclosure notes to the financial statements. Operating lease payments are recognised as an expense in the statement of financial performance. The operating lease commitments are disclosed in the disclosure notes to the financial statements. 6. Receivables for departmental revenue Receivables for departmental revenue are disclosed in the disclosure notes to the annual financial statements. 7. Net Assets 7.1 Capitalisation reserve The capitalisation reserve comprises of financial assets and/or liabilities originating in a prior reporting period but which are recognised in the Statement of Financial Position for the first time in the current reporting period. Amounts are transferred to the National/Provincial Revenue Fund on disposal, repayment or recovery of such amounts. 7.2 Recoverable revenue Amounts are recognised as recoverable revenue when a payment made in a previous financial year becomes recoverable from a debtor in the current financial year. 8. Related party transactions Specific information with regards to related party transactions is included in the disclosure notes. 9. Key management personnel Compensation paid to key management personnel including their family members where relevant, is included in the disclosure notes. 10. Public private partnerships A description of the PPP arrangement, the contract fees and current and capital expenditure relating to the PPP arrangement is included in the disclosure notes.

371 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ACCOUNTING POLICIES for the year ended 31 March 2010

11. Provisions Provisions are disclosed when there is a present legal or constructive obligation to forfeit economic benefits as a result of events in the past and it is probable that an outflow of resources embodying economic benefits will be required to settle the obligation and a reliable estimate of the obligation can be made.

12. Inventory Inventories that qualify for recognition are initially reflected at cost. Where inventories are acquired at no cost, or for nominal consideration, their cost shall be their fair values as at the date of acquisition. All inventory items at year end are reflected using the FIFO cost formula.

372 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

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:

Final Actual Funds Funds not Appropriation Appropriation Recieved requested/ received not 2008/09 received R'000 R'000 R'000 R'000 Health Administration 692,959 692,959 - 529,891

District Health Services 5,162,602 5,162,602 - 4,762,812

Emergency Medical Services 496,297 496,297 - 434,008

General Hospital Services 2,898,438 2,898,438 - 2,497,388

Central Hospital Services 603,329 603,329 - 508,674

Health Science and Training 555,931 555,931 - 633,473

Clinical Support Services 74,818 74,818 - 67,602

Health Facilities Development and Maintenance 1,288,132 1,288,132 - 1,088,035

Total 11,772,506 11,772,506 - 10,521,883

1.2 Conditional Grants

2009/10 2008/09 R'000 R'000

Total grants received 1,897,341 1,170,411

Provincial grants included in Total Grants received 279,483 156,370

2. Statutory Appropriation

Member of executive committee/parliamentary officers 1,421 1,328 Total 1,421 1,328

Actual Statutory Appropriation received 1,421 1,328

373 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

3. Departmental revenue Sales of goods and services other than capital assets 3.1 73,598 79,844 Interest, dividends and rent on land 3.2 239 200 Financial transactions in assets and liabilities 3.3 5,978 10,058 Total revenue collected 79,815 90,102 Less: Own revenue included in appropriation 17 67,284 61,168 Departmental revenue collected 12,531 28,934

3.1 Sales of goods and services other than capital assets Sales of goods and services produced by the department 73,408 79,650 Sales by market establishment 4,590 4,074 Administrative fees 1,196 1,805 Other sales 67,622 73,771 Sales of scrap, waste and other used current goods 190 194 Total 73,598 79,844

3.2 Interest, dividends and rent on land Interest 239 200 Total 239 200

3.3 Financial transactions in assets and liabilities Receivables 2,359 1,346 Stale cheques written back 348 - Other Receipts including Recoverable Revenue 3,271 8,712 Total 5,978 10,058

374 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2009/10 2008/09 R'000 R'000 4. Aid assistance 4.1 Aid assistance received in cash from RDP Local Opening Balance 1,215 1,215 Closing Balance 1,215 1,215

Foreign Opening Balance 6,150 (2,332) Revenue - 21,000 Expenditure (15,492) (12,518) Current (15,492) (12,518) Closing Balance (9,342) 6,150

4.2 Total assistance Opening Balance 7,365 (1,117) Revenue - 21,000 Expenditure (15,492) (12,518) Current (15,492) (12,518) Closing Balance (8,127) 7,365

Aid assistance receivable (8,127) - RDP (8,127) - Aid assistance unutilised - 7,365 RDP - 7,365 Closing balance (8,127) 7,365

375 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2009/10 2008/09 R'000 R'000 5. Compensation of employees 5.1 Salaries and wages Basic salary 5,037,604 4,134,759 Performance award 8,268 4,588 Service Based 8,666 5,864 Compensative/circumstantial 584,493 553,172 Periodic payments 38,475 14,941 Other non-pensionable allowances 814,568 622,322 Total 6,492,074 5,335,646

5.2 Social contributions Employer contributions Pension 608,010 498,246 Medical 294,792 250,104 Bargaining council 2,602 1,084 Total 905,404 749,434

Total compensation of employees 7,397,478 6,085,080

Average number of employees 46,535 40,611

376 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

6. Goods and Services Administrative fees 3,618 1,774 Advertising 11,268 24,696 Assets less then R5,000 6.1 28,463 52,970 Bursaries (employees) 68,704 84,143 Catering 20,307 28,333 Communication 72,910 106,248 Computer services 6.2 40,522 40,353 Consultants, contractors and agency/outsourced services 6.3 1,062,765 768,689 Entertainment 505 471 Audit cost – external 6.4 18,304 15,364 Inventory 6.5 1,232,238 1,167,832 Operating leases 299,703 297,151 Owned and leasehold property expenditure 6.6 236,443 201,203 Transport provided as part of the departmental activities 21,299 290 Travel and subsistence 6.7 69,997 95,874 Venues and facilities 9,438 10,842 Training and staff development 22,437 30,593 Other operating expenditure 6.8 16,209 32,636 Total 3,235,130 2,959,462

6.1 Assets less than R5,000 Tangible assets 28,463 52,970 Machinery and equipment 6 28,463 52,970 Total 28,463 52,970

6.2 Computer services 6 SITA computer services 38,354 38,161 External computer service providers 2,168 2,192

Total 40,522 40,353

377 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

6.3 Consultants, contractors and agency/outsourced services Business and advisory services 86,134 41,241 Infrastructure and planning 7,827 123,108 Laboratory services 408,974 277,395 Legal costs 40,681 9,435 Contractors 295,127 140,877 Agency and support/outsourced services 224,022 176,633 Total 1,062,765 768,689

6.4 Audit cost – External Regularity audits Performance audits 16,895 14,615 Forensic audits 1,325 749 Other audits 84 - Total 18,304 15,364 Information systems audit - R84 000

6.5 Inventory Food and food supplies 125,496 131,205 Fuel, oil and gas 39,662 32,890 Other consumable materials 87,053 74,899 Maintenance material 17,742 51,938 Stationery and printing 54,912 49,800 Medical supplies 907,373 827,100 Total 1,232,238 1,167,832

6.6 Owned and leasehold property expenditure Municipal services 74,936 47,472 Other 161,507 153,731 Total 236,443 201,203 Other comprises of Security, laundry, cleaning, gardening services and related

6.7 Travel and subsistence Local 69,719 95,135 Foreign 278 739 Total 69,997 95,874

6.8 Other operating expenditure Professional bodies, membership and subscription fees 87 313 Resettlement costs 5,856 4,267 Other 10,266 28,056 Total 16,209 32,636

378 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

7. Interest and Rent on Land Interest Paid 10,318 14,559 Total 10,318 14,559

8. Financial Transactions in Assets & Liabilities Material losses through criminal conduct 707 266 Other material losses 8.1 707 266 Total 707 266

8.1 Other material losses 8 Nature of other material losses Incident Disciplinary Steps taken/ Criminal proceedings Theft of Computer Reported to SAPS 554 168 Theft of Audio Visual equip. Reported to SAPS 25 12 Theft of Equipment Reported to SAPS 43 78 Theft of Cell phones Reported to SAPS 25 8 Theft of Software Reported to SAPS 60 - Total 707 266

9. Transfers and subsidies Provinces and municipalities Annex1A,Annex1B 201,570 234,284 Departmental agencies and accounts Annex1C 210,058 260,098 Universities and technikons Annex1D 82,293 101,847 Households Annex 1H 24,972 22,254 Total 518,893 618,483

379 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

NOTES 2009/10 2008/09 R'000 R'000

10. Expenditure for capital assets

Tangible assets 926,545 821,570 Buildings and other fixed structures 35.1 712,317 703,461 Machinery and equipment 33.1 214,228 118,109

Total 926,545 821,570

10.1 Analysis of funds utilised to acquire capital assets – 2008/09

Voted funds Aid assistance Total R'000 R'000 R'000

Tangible assets 926,545 - 926,545 Buildings and other fixed structures 712,317 - 712,317 Machinery and equipment 214,228 - 214,228 Total 926,545 - 926,545

10.2 Analysis of funds utilised to acquire capital assets – 2007/08

Total assets acquired 821,570 - 821,570 Buildings and other fixed structures 703,461 - 703,461 Machinery and equipment 118,109 - 118,109 Total 821,570 - 821,570

380 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000 11. Unauthorised expenditure Reconciliation of unauthorised expenditure Opening balance 197,026 77,032 Unauthorised expenditure – discovered in current year 16 874,277 119,994 Unauthorised expenditure awaiting authorisation / written off 1,071,303 197,026

Analysis of awaiting authorisation per economic classification Capital 243,882 243,882 Current 818,900 (55,377) Transfers and subsidies 8,521 8,521 Total 1,071,303 197,026

11.1 Details of unauthorised expenditure – current year 2009/10 Incident Disciplinary steps taken/criminal proceedings R'000

Over expenditure prog 2 Awaiting approval by legislature 419,299 Over expenditure prog 4 Awaiting approval by legislature 454,978 Total 874,277

2009/10 2008/09 R'000 R'000 12. Fruitless and wasteful expenditure Reconciliation of fruitless and wasteful expenditure Opening balance 3,651 3,651 Fruitless and wasteful expenditure awaiting condonement 3,651 3,651

Analysis of awaiting condonement per economic classification Current 3,651 3,651 Total 3,651 3,651

13. Cash and cash equivalents Consolidated Paymaster General Account - 10,390 Disbursements - (226) Total - 10,164

14. Prepayments and advances Staff advances 2 32 Travel and subsistence 7 48 Total 9 80

381 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2008/09 2007/08

Note Less than One to three Older than Total Total one year years three years R'000 R'000 R'000 R'000 R'000

15. Receivables Claims recoverable 15.1 5,881 (3,006) 3,276 6,151 30,477 Annex 4 Trade receivables 15.2 806 59 4,382 5,247 5,180 Recoverable expenditure 15.3 5,704 1,442 (1,468) 5,678 3,168 Staff debt 15.4 3,139 637 2,161 5,937 5,188 Other debtors 15.5 25,738 5,100 38,649 69,487 64,170 Total 41,268 4,232 47,000 92,500 108,183

Note 2009/10 2008/09 R'000 R'000 15.1 Claims recoverable 15 National departments 271 400 Provincial departments 5,880 30,077 Total 6,151 30,477

15.2 Trade receivables 15 Suppliers 5,247 5,162 Hospital debt 18 Total 5,247 5,180

15.3 Recoverable expenditure (disallowance accounts) 15 Dishonoured Cheques 75 75 Disallowances damages and losses 512 512 Salary Rebates 5,091 2,581 Total 5,678 3,168

15.4 Staff debt 15 Private Telephone Calls 182 182 Salary Debt 5,664 4,886 GG Accident - 18 State Guarantee 91 102 Total 5,937 5,188

15.5 Other debtors 15 Salary & Deductions 550 2,752 Ex Employees 63,318 57,872 Other debtors 5,619 3,546 Total 69,487 64,170

A provision of R70,834 million as disclosed in note 32 has been made against receivables of R92,500 million disclosed above. These debts have been disclosed as potentially irrecoverable as they are older than a year and have been handed over to the debt collectors for recovery where applicable.

382 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000 16. Voted funds to be surrendered to the Revenue Fund Opening balance 251,333 221,416 Transfer from statement of financial performance (315,144) 139,697 Add: Unauthorised expenditure for current year 11 874,277 119,994 Voted funds not requested/not received 1.1 - (115,906) Paid during the year (131,337) (113,868) Closing balance 679,129 251,333

17. Department revenue to be surrendered to the Revenue Fund Opening balance 13,551 15,633 Transfer from Statement of Financial Performance 12,531 28,934 Own revenue included in appropriation 67,284 61,168 Paid during the year (81,996) (92,184) Closing balance 11,370 13,551

18. Bank Overdraft Consolidated Paymaster General Account 468,873 - Total 468,873 -

19. Payables - current Amounts owing to other entities 481 9,039 Clearing accounts Annex 5 306 210 Other payables 19.1 12,599 34,455 Total 19.2 13,386 43,704

19.1 Clearing accounts Salary Garnishee order 303 208 Salary finance and other institutions 3 2 Total 306 210

19.2 Other payables Debt receivable interest 8,309 - Pension recoverable 4,188 - Donor funding - 23,625 Other payables - 9,240 Salary ACB recall 102 1,590 Total 12,599 34,455

383 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000 20. Net cash flow available fro operating activities Net surplus/(deficit) as per Statement of Financial Performance (318,105) 177,113 Add back non cash/cash movements not deemed operating activities 765,932 539,181 (Increase)/decrease in receivables – current 15,683 (9,750) (Increase)/decrease in prepayments and advances 71 67 Increase/(decrease) in payables – current (30,318) (11,916) Expenditure on capital assets 926,545 821,570 Surrenders to Revenue Fund (213,333) (206,052) Voted funds not requested/not received - (115,906) Own revenue included in appropriation 67,284 61,168 Net cash flow generated by operating activities 447,827 716,294

21. Reconciliation of cash and cash equivalents for cash flow purposses (468,873) 10,390 Consolidated Paymaster General account - (226) Disbursements (468,873) 10,164 Total

22. Contingent liabilities and contingent assets

21.1 Contingent liabilities Liable to Nature Motor vehicle guarantees Employees Annex 3A - 26 Housing loan guarantees Employees Annex 3A 16,561 24,106 Claims against the department Annex 3B 447,542 199,870 Other departments (interdepartmental Annex 5 - 582 unconfirmed balances) Other Annex 3B 445,932 - Total 910,035 224,584

22.2 Contingent assets Nature of contingent asset OSD 4,782 82,070 Total 4,782 82,070

384 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

OSD Background

OSD is a special dispensation that creates a differentiated remuneration system and career paths for certain categories of employees. The process that was followed was: Profiles of every nurse were compiled (qualifications, experience, area of work, etc) Each nurse was translated onto the general stream (phase 1)with specialty nurses translated (as per qualification and area of work) to the specialty stream; All transactions were subjected to verification by an HR manager (at Head Office) and financials were reviewed by an accountant. Will the department pay the underpayments Following its implementation in 2007/08, an interpretation and application dispute raged over 9 months. This dispute was resolved by an arbitration award in August 2009. Immediately after, provinces were directed to implement the award, albeit nothing was said where the extra money will come from.

The outcome of the Arbitration Award resulted in two scenarios in the Eastern Cape: (a) Underpayment of 1,006 nurses (b) Overpayments to 77 nurses

Underpayments Conservative interpretation of the OSD framework (e.g. using the number of posts in the organogram as a norm to decide number of qualifying nurses) led to underpayments.

The AGSA's findings of 1,767 underpayments were reviewed in a joint process led by the NDOH. This finding predates the Arbitration Award. Once the award was issued, the Department then reviewed all OSD transactions effected against the baseline of nursing personnel. This latter process resulted in 1,006 nurses being confirmed as having been underpaid.

The OSD underpayments have largely resulted from the broadened scope of the arbitration award. The 1,006 nurses will be translated and paid an estimated R229million. This estimation is backdated to the 1 July 2007, the original implementation date. Provincial Treasury has agreed that the Department pays all arbitration award cases out of the 2010/11 budget which would be off-set in the next mid-term budget estimates.

2009/10 2008/09 R'000 R'000 23. Commitments Current expenditure Approved and contracted 219,649 93,262 Approved but not yet contracted - 120,745 219,649 214,007

Capital expenditure Approved and contracted 705,818 835,240 Approved but not yet contracted 8,568,028 1,107,094 9,273,846 1,942,334

Total Commitments 9,493,495 2,156,341

385 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

30 Days 30+ Days Total Total

24. Accurals Listed by economic classification 848,049 179,338 1,027,387 492,906 Goods and services 128,694 - 128,694 47,683 Transfers and subsidies 167,209 28 167,237 46,721 Buildings and other fixed structures 1,940 7,018 8,958 13,582 Machinery and equipment - 102 102 32 Software and other intangible assets - 1,145,892 186,486 1,332,378 600,924 Total

Note 2009/10 2008/09 R'000 R'000

Listed by programme level 247,918 90,797 Health Administration 500,627 200,005 District Health Services 3,462 39,883 Emergency Medical Services 193,969 99,964 General Hospital Services 26,096 4,106 Health Science and Training 95,921 27,219 Clinical Support Services 264,385 138,950 Health Facilities Development and Maintenance 1,332,378 600,924 Total Annex 5 Confirmed balances with other departments 481 8,457 Total 481 8,457

25. Employee benefits 292,650 256,074 Leave entitlement 194,686 169,859 Service bonus (Thirteenth cheque) 819 9,849 Performance awards 858,474 804,794 Capped leave commitments 285,729 105,570 Other 1,632,358 1,346,146

386 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Buildings and Machinery Vehicles other fixed and structures equipment Total 26. Lease commitments

26.1 Operating leases expenditure 2009/10 Not later than 1 year 360,887 7,368 307 368,562 Later than 1 year and not later than 5 years 300,739 4,302 112 305,153 Total lease commitments 661,626 11,670 419 673,715

Buildings and Machinery other fixed and 2008/09 Land structures equipment Total Not later than 1 year - 8,822 53,221 62,043 Later than 1 year and not later than 5 years - 2,945 10,459 13,404 Total lease commitments - 11,767 63,680 75,447

Buildings and Machinery other fixed and Land structures equipment Total 26.2 Finance leases expenditure **

2009/10 Not later than 1 year - - 9,407 9,407 Later than 1 year and not later than 5 years - - 8,245 8,245 Total lease commitments - - 17,652 17,652 LESS: finance costs (2,255) (2,255) Total present value of lease liabilities - - 15,397 15,397

Buildings and Machinery other fixed and 2008/09 Land structures equipment Total Not later than 1 year 3,034 3,034 Total lease commitments 3,034 3,034 LESS: finance costs - - Total present value of lease liabilities 3,034 3,034

**This note excludes leases relating to public private partnership as they are separately disclosed to note no.31.

387 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

27. Receivables for departmental revenue 77,445 81,904 Sales of goods and services other than capital assets 77,445 81,904 Total

27.1 Analysis of receivables for departmental revenue 81,904 65,173 Opening balance 51,997 46,004 Less: amounts received 118,634 82,123 Add: amounts recognised 71,096 19,388 Less: amounts written-off/reversed as irrecoverable 77,445 81,904 Closing balance

28. Irregulaar expenditure

28.1 Reconciliation of irregular expenditure

Opening balance 348,351 139,122 Add: Irregular expenditure – relating to prior year - 187,518 Add: Irregular expenditure – relating to current year 373,128 394,997 Less: Amounts condoned (222) (373,286) Irregular expenditure awaiting condonation 721,257 348,351

Analysis of awaiting condonation per age classification Current year 372,906 209,229 Prior years 348,351 139,122 Total 721,257 348,351

388 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2009/10 R'000 28.2 Details of irregular expenditure - current year

Incident Disciplinary steps taken/criminal proceedings Non- Compliance SCM Various Condoned 222 Non- Compliance SCM Various Dismissed 525 Non- Compliance SCM Various Final written warning 23,571 Non- Compliance SCM Various Official transferred 444 Non- Compliance SCM Various Official/s suspended 1,180 Non- Compliance SCM Various Official/s retired 72 Non- Compliance SCM Various Official/s resigned 1,427 Non- Compliance SCM Various No sanction contracts availed 56,844 Non- Compliance SCM Various Official's contract expired 282 2009/2010 virement analysis Over-expenditure by item 127,917 Various finance leases Under investigation 1,789 Non- Compliance SCM Various Not required 7,791 Non- Compliance SCM Various Not required 695 Lifecare expenditure Not required 150,369 Total 373,128

28.3 Details of irregular expenditure condoned

Incident Condoned by (condoning authority) Non- Compliance SCM – Grahamstown TB Accounting Officer 13 Non- Compliance SCM – Grahamstown TB Accounting Officer 12 Non- Compliance SCM – Grahamstown TB Accounting Officer 13 Non- Compliance SCM – CT Enterprises Accounting Officer 33 Non- Compliance SCM – Joint Force Security Accounting Officer 24 Non- Compliance SCM – CP Scheppel Accounting Officer 71 Non- Compliance SCM – Vetus Schola Prot Accounting Officer 46 Non- Compliance SCM – Triple E Training Accounting Officer 5 Non- Compliance SCM – Soyisile Indlala GT Accounting Officer 4 Non- Compliance SCM – Rennies Travel Accounting Officer 1 Total 222

28.4 Details of irregular expenditure recoverable (not condoned)

Incident Non- Compliance SCM 441,182 2009/2010 virement analysis 127,917 Various finance leases 1,789 Lifecare 150,369 Total 721,257

389 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Notes 2009/10 2008/09 R'000 R'000

29. Fruitless and wasteful expenditure

29.1 Reconciliation of fruitless and wasteful expenditure

Opening balance 14,559 Fruitless and wasteful expenditure – relating to prior year 653 - Fruitless and wasteful expenditure – relating to current year 16,800 14,559 Less: Amounts condoned (23,473) - Fruitless and wasteful expenditure awaiting condonation 8,539 14,559

Analysis of awaiting condonation per economic classification Current 8,539 14,559 Total 8,539 14,559

2009/10 R'000 29.2 Analysis of Current year’s fruitless and wasteful expenditure

Incident Disciplinary steps taken/criminal proceedings

Interest various Condoned 8,914 Interest various Disciplinary stage 8,539

Total 17,453

2009/10 2008/09 R'000 R'000

30. Key management personnel No. of Individuals

Political office bearers 1 1,405 1,239 Officials: Level 15 to 16 5 5,383 4,877 Level 14 (incl. CFO if at a lower level) 19 16,033 16,709 Total 22,821 22,825

390 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2009/10 2008/09 R'000 R'000 31. Public Private Partnership

Contract fee paid 42,223 4,103 Fixed component 41,616 4,103 Indexed component 607 -

Analysis of indexed component - 272 Goods and services (excluding lease payments) - 272

Capital/ (Liabilities) 13,333 13,333 Property 13,333 13,333

1. Humansdorp Hospital Co-Location PPP

The Eastern Cape Department of Health (ECDoH) recognised the potential for the establishment of a private facility in partnership with the existing Humansdorp district hospital, as well as the need to optimally use the available resources at the hospital and allow the development and expansion of the hospital by the private sector.

This led to its decision to embark on a Public Private Partnership, as regulated by the Treasury Regulations to the Public Finance Management Act, No 1 of 1999 through the conclusion of an Agreement on 27 June 2003 with Metro Star Hospital Life Healthcare Ltd (previously Afrox Healthcare Ltd).

Terms of the agreement / Obligations to acquire or build items of property, plant and equipment / Other rights and obligations (e.g. major overhauls)

The Project embarked on by the Concessionaire through the conclusion of this Agreement, involves the granting of Concession Rights by the Provincial Government to the Concessionaire against the payment of variable concession fees and: the construction of a thirty bed private facility 3 bed high care unit the enlarging of the current Humansdorp hospital entrance and administration area for use by both Parties the enlarging of the casualty and outpatient ward including two consulting rooms and a dentist room the building and/or upgrade of two new operating theatres a new CSSD a new radiology unit a new laboratory and the refurbishment and upgrade of the existing Humansdorp hospital, which includes: o the painting of all interiors and exteriors o the reparation and replacement (where necessary) of all ceilings o the reparation and replacement (where necessary) of all floors o the upgrading of electrical and mechanical installations o the upgrading of fire detection and nurse calling units o the reparation and replacement (where necessary) of all windows, inclusive of existing specialized units and facilities, to be made available to the private sector party on the basis that the facilities shall consist of those being exclusively used by the private sector and others being jointly used by the Department and the private sector for the duration of this Agreement

391 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

The Concessionaire further provides maintenance and facility management services to the Humansdorp hospital in return for the payment of service payments to the Concessionaire by the Provincial Government.

Nature and extent of rights to use specified assets

As described above.

Obligations to provide or rights to expect provision of services

The Provincial Government has granted to the Concessionaire, the exclusive right during the Concession Period to: o use and operate the project facilities o carry out operations to combine the different strengths of both government and private sector for the more efficient utilization of government resources o add on existing resources through private sector investment o improve maintenance of existing resources through the creation of income generating activities for the benefit of both the Concessionaire and the Department.

And further as provided for in terms of the Agreement: o to construct and install the additional project facilities (including the installation of furniture, equipment, fixtures and fittings, as the case may be) strictly in accordance with the design documents and construction requirements; o generate, charge and collect revenues from the operation and management of the project facilities during the concession period; o use the concession area and project facilities for the purposes of the project, whether exclusively or jointly with the Provincial Government o and provide the Services to the Provincial Government against payment of Service Payments in accordance with the Payment Mechanism by the Provincial Government.

Obligation to deliver or rights to receive specified assets at the end of the concession period

The Concessionaire has, and will have, no title, ownership, limited ownership, lien, or leasehold rights or any other rights of title with regard to the existing project facilities which vest and shall remain to vest in the Provincial Government, for the duration of the agreement, as well as after expiry or earlier termination thereof.

The Department shall become owner of all movable additional project facilities with effect from expiry or earlier termination of this agreement and the Department shall become owner of all immovable additional project facilities and additional project facilities which are in any way affixed to the concession area or improvements thereon (such as fixtures, fittings and equipment) as soon as the same are affixed, but excluding such equipment and furniture which are listed and excluded from additional project facilities as defined.

Renewal and termination options

The agreement shall automatically be terminated on expiry of the twenty – one year concession period, unless terminated earlier in accordance with the provisions of the agreement.

392 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2009/10 2008/09 R'000 R'000 Contract Fee

Variable component This is based on forecast real profit target

Contract fee paid – Unitary Charge Fixed component 754 683 Building, Mechanical & Electrical Comp 527 592 Cleaning & Domestic 228 294 Gardens & Grounds 317 400 Laundry 341 453 Security 156 207 Waste Management 877 970 Catering Services 542 504 VAT Thereon - 3,742 4,103

Current expenditure Goods and services (excluding leases) - 272

Capital/(Liabilities) Property 13 ,333 13 ,333

Total 17,075 170,708

2. Upgrading and Refurbishment of the Port Alfred & Settlers Hospitals in Port Alfred and Grahamstown and the establishment of co-located private hospital facilities

Description of the arrangement The concession agreement was signed on the 7th of May, 2007 and incorporates the Port Alfred and Settlers District Hospitals.

It incorporates the financing, design, upgrade and refurbishment of the facilities and provision of operational and associated services including hard and soft facilities management and life-cycle maintenance, refreshment and replacement of selected equipment (including medical equipment, medical instrumentation and Durables), IM&T and furniture at the above-named Hospitals together with the co-location of private hospital facilities to be operated by the Private Party, all in terms of a Public Private Partnership, as regulated by the Treasury Regulations to the Public Finance Management Act, No 1 of 1999.

The Department at year end is currently paying the Unitary Fee on the Port Alfred component of the project and paying the Development Fee on the Settlers component of the project.

The Port Alfred co-location District Hospital was opened by former Health MEC, Ms P Majodina in February 2009 and the Settlers co-location District Hospital was opened by Health MEC, Mr P Masualle in January 2010.

393 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

Terms of the agreement / Obligations to acquire or build items of property, plant and equipment / Other rights and obligations (e.g. major overhauls)

30 private beds Private pharmacy Private administration Two Private consulting rooms 60 public beds Public outpatients facility Public Pharmacy Public administration Shared facilities for Labour ward, Maternity ward, Radiology, Casualty, Theatres, CSSD, Kitchen & staff facilities, mortuary, stores, linen areas and plant and workshop areas The refurbishment and upgrading of existing facilities at the Port Alfred and Settlers Hospitals includes: o roof construction which will be double pitched timber trusses with concrete roof tiles to suitable pitch; o rainwater goods which are to be fibre cement, positioned to divert rain water from roofs to storm water channels and painted with suitable exterior paint; o floor construction which is to be concrete surface beds, screeded to receive floor finish. Floor finishes and skirting will be suitable for cleaning as per service specification; o brick walls, external and internal to be plastered with one coat of cement plaster and painted with suitable interior and exterior paint; o the ceilings are to be vinyl clad gypsum suspended ceilings with exposed T's suspended from trusses. Flush plastered suspended ceilings in theatres only; o aluminium windows with opening sections where required by regulations and suitable glazing all in accordance with applicable regulations; and o all steel doorframes to be galvanised door frames painted with suitable interior and exterior paint where applicable. Internal doors to be hollow core doors painted with suitable interior paint.

Nature and extent of rights to use specified assets

As described above.

Obligations to provide or rights to expect provision of services

The Provincial Government has granted to the Concessionaire, the exclusive right during the Concession Period to:

use and operate the project facilities carry out operations to combine the different strengths of both government and private sector for the more efficient utilization of government resources; add on existing resources through private sector investment; and improve maintenance of existing resources through the creation of income generating activities for the benefit of both the Concessionaire and the Department.

394 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

And further as provided for in terms of the Agreement:

to construct and install the additional project facilities (including the installation of furniture, equipment, fixtures and fittings, as the case may be) strictly in accordance with the design documents and construction requirements; generate, charge and collect revenues from the operation and management of the project facilities during the concession period; use the concession area and project facilities for the purposes of the project, whether exclusively or jointly with the Provincial Government; and provide the Services to the Provincial Government against payment of Service Payments in accordance with the Payment Mechanism by the Provincial Government.

Obligation to deliver or rights to receive specified assets at the end of the concession period

The rights of use of the Project Site and Facilities afforded to the Private Party shall not confer or be deemed to confer upon the Private Party a right of ownership, mortgage, pledge, lien, a lease, a licence or any other security interest or right of limited ownership in the Project Site or any of the Facilities other than Rights of Way for purposes of performing the Project Deliverables. Title to the Project Site and Facilities, including all improvements thereto, shall at all times vest in the Institution without Encumbrance.

The Private Party shall upon expiry or early termination of this Agreement, subject to the provisions of this Agreement, hand over the Facilities (including the Private Facilities) to the Institution free of any Encumbrance or of any liabilities or debt, and shall not, save as provided for in this Agreement, be entitled to payment of any amounts in connection therewith.

Renewal and termination options

The agreement shall automatically be terminated on expiry of the seventeen year concession period, unless terminated earlier in accordance with the provisions of the agreement.

2009/10 2008/09 R'000 R'000 Contract Fee

Contract fee paid Fixed component 37,874 7,4

Current expenditure Goods and services (excluding leases) 607 62

395 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

2. Pharmaceutical Supply Chain Management Services and the Finance, Design, Construction and/or Rehabilitation and Operation and Maintenance of Pharmaceutical Depots and Management Support to the Department

In 2003, the Eastern Cape Department of Health initiated processes in terms of Treasury Regulation 16 to determine the appropriateness of procuring the management of its two pharmaceutical depots and the distribution of pharmaceuticals therefrom to the hospitals, clinics and community health centres in the Province via PPP.

A team of transaction advisors was appointed in June 2003. A feasibility study was completed and the Department's application for Treasury Approval I (TA I) was granted on 08 April 2004.

The project contemplated the following: Rehabilitation and upgrade of the Mthatha and Port Elizabeth pharmaceutical depot facilities; Operation and maintenance of the upgraded Mthatha and Port Elizabeth facilities; Operation of the pharmaceutical supply chain for the Department; Supply and distribution of pharmaceuticals to all clinics, community health centres and hospitals in the province; Via an appropriate ICT infrastructure, gather, maintain and disseminate information required for the operation of the Department's pharmaceutical supply chain; and Provide management support to the Department's main office.

Request for Qualifications were issued in July 2004, which resulted in a short-list of four bidders. Request for Proposals were issued in December 2004 wherein a preferred bidder and reserve bidder were selected.

Negotiations commenced with the preferred bidder; however, the key member of the consortium resigned and the preferred bidder was requested to replace it in terms of the consortium change provisions of the PPP manual. These processes consumed a great deal of time.

However, the negotiations ultimately failed, and in May 2007, they were terminated and the reserve bidder, was invited to negotiate. Negotiations were concluded in early 2009 and the process of reaching financial close commenced.

In the meantime however, the situation in the Eastern Cape was changing in a manner that would ultimately affect the conclusion of the project.

After discussions with internal and external stakeholders and the obtaining of a legal opinion, the Department decided that the risks of proceeding with the contract were too great given the time elapsed and the strong possibility of a challenge by unsuccessful bidders.

Accordingly, the Department informed National Treasury that:

The Department had decided to terminate the procurement of the pending Pharmaceutical supply chain PPP project; and

396 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

The Department confirmed its intention to update the project's feasibility study and procurement documentation with the intention of commencing a new PPP procurement process.

4. Accommodation for Clinical Staff at St Elizabeth's Hospital (Lusikisiki) PPP

The Department had identified a need for fully serviced accommodation for staff employed at St Elizabeth's Hospital in Lusikisiki. This project accordingly involved the design, construction, financing and administration of accommodation for clinical staff at Saint Elizabeth's Hospital in Lusikisiki.

A protracted impediment in the procurement process has been the lack of agreement from the local Municipality for the Department to acquire the required land adjacent to the hospital.

This has resulted in the de registration of this project from the PPP database in the current financial year, with an option to re – register the project at any stage that the land issue has been resolved.

2009/10 2008/09 R'000 R'000

32. Provisions

Potential irrecoverable debts Private enterprises 5,024 4,317 Staff debtors 2,798 3,141 Other debtors 60,194 44,218 Recoverable expenditure 2,818 - Total 70,834 51,676

Provisions Other – HROPT - 360,900 - 360,900 Total 70,834 412,576

An amount of R70,834 million as disclosed above is in relation to receivables of R92,500 million disclosed in note 15. These debts have been disclosed as potentially irrecoverable as they are older than a year and have been handed over to the debt collectors for recovery where applicable.

397 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

33. Movable Tangible Capital Assets

MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Opening Curr. Year Additions Disposals Closing balance Adjust-ments balance to prior year balances

R'000 R'000 R'000 R'000 R'000

MACHINERY AND EQUIPMENT 265,292 16,310 199,762 (237) 481,127 Transport assets 51 258 737 - 1,046 Computer equipment 27,087 471 23,913 (203) 51,268 Furniture and office equipment 23,702 (10,350) 10,902 - 24,254 Other machinery and equipment 214,452 25,931 164,210 (34) 404,559

TOTAL MOVABLE TANGIBLE CAPITAL ASSETS 265,292 16,310 199,762 (237) 481,127

33.1 Additions

ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Cash Non-cash (Capital Received Total Work in current, not Progress paid current costs (Paid current and finance year, received lease prior year) payments) R'000 R'000 R'000 R'000 R'000

MACHINERY AND EQUIPMENT 212,281 4,799 (4,631) (12,687) 199,762 Transport assets 737 - - - 737 Computer equipment 22,261 1,123 - 529 23,913 Furniture and office equipment 15,412 92 (4,631) 29 10,902 Other machinery and equipment 173,871 3,584 - (13,245) 164,210

TOTAL ADDITIONS TO MOVABLE TANGIBLE CAPITAL ASSETS 212,281 4,799 (4,631) (12,687) 199,762

398 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

33.2 Disposals

DISPOSALS OF MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Sold for cash Transfer out Total Cash or destroyed disposals Received or scrapped Actual

R'000 R'000 R'000 R'000 MACHINERY AND EQUIPMENT - 237 237 - Computer equipment - 203 203 - Other machinery and equipment - 34 34 -

TOTAL DISPOSAL OF MOVABLE TANGIBLE CAPITAL ASSETS - 237 237 -

33.3 Movement for 2008/09

MOVEMENT IN MOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2009

Opening Additions Disposals Closing balance balance

R'000 R'000 R'000 R'000

MACHINERY AND EQUIPMENT 155,198 110,094 - 265,292 Transport assets - 51 - 51 Computer equipment 8,657 18,430 - 27,087 Furniture and office equipment 8,157 15,545 - 23,702 Other machinery and equipment 138,384 76,068 - 214,452

TOTAL MOVABLE TANGIBLE ASSETS 155,198 110,094 - 265,292

399 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

34 Minor Assets

MINOR ASSETS OF THE DEPARTMENT AS AT 31 MARCH 2010

Intangible Heritage Machinery Biological Total assets assets and assets equipment

R'000 R'000 R'000 R'000 R'000 Minor assets - - 105,595 - 105,595 TOTAL - - 105,595 - 105,595

Number of minor assets at cost - - 205,345 - 205,345 TOTAL NUMBER OF MINOR ASSETS - - 205,345 - 205,345

MINOR ASSETS OF THE DEPARTMENT AS AT 31 MARCH 2009

Intangible Heritage Machinery Biological Total assets assets and assets equipment

R'000 R'000 R'000 R'000 R'000 Minor assets 9 - 33,131 - 33,140 TOTAL 9 - 33,131 - 33,140

34. Intangible Capital Assets

MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Opening Current Year Additions Disposals Closing balance Adjust-ments Balance to prior year balances R'000 R'000 R'000 R'000 R'000 COMPUTER SOFTWARE 803 76 756 (60) 1,575 TOTAL INTANGIBLE CAPITAL ASSETS 803 76 756 (60) 1,575

400 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

34.1 Additions

ADDITIONS TO INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010 Cash Non-Cash (Develop-ment Received Total work in current year, progress – not paid current costs) (Paid current year, received prior year) R'000 R'000 R'000 R'000 R'000 COMPUTER SOFTWARE 686 - - 70 756 TOTAL ADDITIONS TO INTANGIBLE CAPITAL ASSETS 686 - - 70 756

34.2 Disposals

DISPOSALS OF INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Sold for cash Transfer out Total Cash or destroyed disposals Received or scrapped Actual

R'000 R'000 R'000 R'000 COMPUTER SOFTWARE 60 60 TOTAL DISPOSALS OF INTANGIBLE CAPITAL ASSETS 60 60

34.3 Movement for 2008/09

MOVEMENT IN INTANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2009

Opening Additions Disposals Closing balance balance

R'000 R'000 R'000 R'000

COMPUTER SOFTWARE 293 510 - 803 TOTAL INTANGIBLE CAPITAL ASSETS 293 510 - 803

401 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

35. Immovable Tangile Capital Assets

MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Opening Current Year Additions Disposals Closing balance Adjustments Balance to prior year balances R'000 R'000 R'000 R'000 R'000 BUILDINGS AND OTHER FIXED STRUCTURES - - - - - Dwellings - - - - -

TOTAL IMMOVABLE TANGIBLE CAPITAL ASSETS - - - - -

In terms of the constitution of the Republic of South Africa, 1996 (Act No. 108 of 1996), the President has allocated a functional mandate to the Department of Public Works to be the custodian and manager of all national governments' fixed assets, for which other legislation does not make another department or institution responsible. This mandate is also confirmed through the Appropriation Act. The State Land Disposal Act, 1961 (Act No. 48 of 1961) furthermore mandates the Minister of Public Works to carry out certain functions..

Cash expenditure relating to buildings and other fixed structures of R674,791 million as disclosed in note 35.1 to the annual financial statements relates to purchases of land and improvements to land and buildings. In terms of the legislation mentioned above, the land on which these improvements took place is owned by the Department of Public Works, and therefore these improvements to immovable property do not accrue to the Department of Health. These improvements therefore will be reflected in the register of Public Works as the ownership of land vests with the Department of Public Works and are not reflected as immovable tangible capital assets in note 35 to the annual financial statements.

402 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

35.1 Additions

ADDITIONS TO IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2010

Cash Non-cash (Capital Work Received Total in Progress current, not current costs paid and finance (Paid current lease year, received payments) prior year) R'000 R'000 R'000 R'000 R'000 BUILDING AND OTHER FIXED STRUCTURES 674,791 - (674,791) - - Dwellings 674,791 - (674,791) - - TOTAL ADDITIONS TO IMMOVABLE TANGIBLE CAPITAL ASSETS 674,791 - (674,791) - -

35.2 Movements for 2008/09

MOVEMENT IN IMMOVABLE TANGIBLE CAPITAL ASSETS PER ASSET REGISTER FOR THE YEAR ENDED 31 MARCH 2009

Opening Additions Disposals Closing balance balance

R'000 R'000 R'000 R'000

BUILDING AND OTHER FIXED STRUCTURES - 146,788 (146,788) - Non-residential building - 146,788 (146,788) - TOTAL IMMOVABLE TANGIBLE ASSETS - 146,788 146,788 -

403 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 - - 95,265 414,774 120,897 223,901 301,432 157,726 R'000 Amount spent by department 1,313,995 - - 2008/09 of 90,324 Act 508,674 140,641 290,927 300,522 156,370 R'000 Division Revenue 1,487,458 - - 82% 86% 86% 88% 104% 100% % % of funds available available spent by department - - 53,882 528,235 124,352 204,048 425,817 255,100 R'000 SPENT Amount spent by department 1,591,434 4,345 1,175 by 61,214 603,329 171,106 282,987 493,702 279,483 R'000 Amount received department 1,897,341 4,345 1,175 61,214 Total R'000 603,329 171,106 282,987 493,702 279,483 Available 1,897,341 ------1,175 1,175 R'000 Other VOTE 3 VOTE Adjustments ------4,345 91,975 96,320 DORS R'000 Adjustments for the year ended 31 March 2010 31 March ended the year for - - - - - GRANT ALLOCATION GRANT 93,900 19,744 44,376 Roll Overs R'000 158,020 - - ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS ANNUAL THE TO ANNEXURES PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH CAPE DEPARTMENT THE EASTERN OF PROVINCE 61,214 509,429 151,362 238,611 401,727 279,483 R'000 Grant Provincial Provincial Division of Revenue Act Revenue 1,641,826 NAME OF DEPARTMENT National Tertiary Services Grant Tertiary National Health Professionals and Health Professionals Grant Development Hospital Revitalisation Grant Hospital Revitalisation AIDS HIV/ Comprehensive Pathology Forensic provinces grant to Infrastructure 2010 World Cup Health World 2010 Strategy Grant Preparation EPWP Incentive TOTAL STATEMENT OF CONDITIONAL GRANTS RECEIVED OF CONDITIONAL STATEMENT

404 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1B STATEMENT OF UNCONDITIONAL GRANTS AND TRANSFERS TO MUNICIPALITIES

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT GRANT ALLOCATION TRANSFER SPENT 2008/09

Amount Roll Adjustments Total Actual % of Amount Amount % of Total NAME OF MUNICIPALITY Overs Available Transfer available received by spent by available Available funds Municipality municipality funds spent transferred by municipality R'000 R'000 R'000 R'000 R'000 % R'000 R'000 % R'000

Nelson Mandela Metro 91,852 - - 91,852 38,785 42% 38,785 38,785 100% 85,757

Amahlathi 2,093 - - 2,093 2,093 100% 2,093 2,093 100% 1,990 405

Baviaans 524 - - 524 524 100% 524 524 100% 335

Blue Crane route 2,721 - - 2,721 1,214 45% 1,214 1,214 100% 3,034

Buffalo City 44,865 - - 44,865 25,802 58% 25,802 25,802 100% 20,796

Camdeboo 2,200 - - 2,200 2,200 100% 2,200 2,200 100% 2,196

Gariep 3,277 - - 3,277 3,277 100% 3,277 3,277 100% 2,929

Ikhwezi 485 - - 485 216 45% 216 216 100% 440

Inxuba Yethemba 2,897 - - 2,897 3,153 1.09% 3,153 3,153 100% 4,840

King Sabatha Dalindyebo 16,209 - - 16,209 16,209 100% 16,209 16,209 100% 9,323

Kouga 1,672 - - 1,672 361 22% 361 361 100% 1,510

Lukhanji 9,910 - - 9,910 9,910 100% 9,910 9,910 100% 7,488

Makana 3,780 - - 3,780 3,780 100% 3,780 3,780 100% 5,302 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1B - (continue) STATEMENT OF UNCONDITIONAL GRANTS AND TRANSFERS TO MUNICIPALITIES

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT GRANT ALLOCATION TRANSFER SPENT 2008/09

Maletswai 2,620 - - 2,620 2,015 77% 2,015 2,015 100% 1,755

Matatiele/ Qaukeni 2,515 - - 2,515 595 24% 595 595 100% 2,255 406 Mnquma 4,983 - - 4,983 2,429 49% 2,429 2,429 100% 1,885

Ndlambe 3,040 - - 3,040 3,040 100% 3,040 3,040 100% 2,904

Nkonkobe 3,722 - - 3,722 2,149 58% 2,149 2,149 100% 1,432

Nxuba 2,771 - - 2,771 2,771 100% 2,771 2,771 100% 1,987

Sakhisizwe 1,136 - - 1,136 245 22% 245 245 100% 1,387

Senqu 540 - - 540 540 100% 540 540 100% 529

Sundays River Valley 2,293 - - 2,293 2,293 100% 2,293 2,293 100% 2,003

Amathole District Municipality 22,423 - - 22,423 6,877 31% 6,877 6,877 100% 23,766

Cacadu DM 45,911 - - 45,911 45,911 100% 45,911 45,911 100% 19,769

Chris Hani DM 20,001 - - 20,001 20,001 100% 20,001 20,001 100% 13,173

Ukhahlamba DM 13,411 - - 13,411 5,180 39% 5,180 5,180 100% 15,531

307,851 - - 307,851 201,570 201,570 201,570 234,316 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1C STATEMENT OF TRANSFERS TO DEPARTMENTAL AGENCIES AND ACCOUNTS

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT 2008/09 Adjusted Roll Adjustments Total Actual % of available Final Appropriation Act Overs Available Transfer funds transferred Appropriation Act DEPARTMENT / AGENCY / ACCOUNT R'000 R'000 R'000 R'000 R'000 %

Hewu ------4,6752 Aberdeen 6,613 - - 6,613 6,531 99% 4,954 Adelaide 15,609 - - 15,609 15,609 100% 10,419 BJ Vorster 9,479 - - 9,479 9,479 100% 6,879 407 Dordrecht 8,583 - - 8,583 8,583 100% 6,371 Indwe 10,739 - - 10,739 10,739 100% 7,237 Jamestown 4,883 - - 4,883 4,883 100% 3,889 Jansenville 7,658 - - 7,658 7,658 100% 8,568 Komga 5,725 - - 5,725 5,725 100% 4,661 Lady Grey 10,616 - - 10,616 10,616 100% 7,499 Maclear 12,387 - - 12,387 12,387 100% 8,855 Molteno 8,259 - - 8,259 8,259 100% 5,586 Newhaven 6,884 - - 6,884 6,884 100% 5,937 St Francis 6,717 - - 6,717 6,699 100% 4,484 Sterkstroom 4,993 - - 4,993 4,993 100% 3,333 Stutterheim 17,908 - - 17,908 17,908 100% 12,538 Sundays River 10,625 - - 10,625 10,625 100% 7,348 Tarkastad 9,225 9,225 9,225 100% 8,623 Willowmore 7,277 - - 7,277 7,277 100% 6,252 Hospices 46,470 - - 46,470 45,978 99% 87,424 210,650 - - 210,650 210,058 257,609 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1D STATEMENT OF TRANSFERS TO UNIVERSITIES AND TECHNIKONS

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT TRANSFER ALLOCATION TRANSFER 2008/09

Adjusted Roll Adjustments Total Actual Amount not % of available Final Appropriation Overs Available UNIVERSITY/TECHNIKON Transfer Transferred funds Appropriation Act transferred Act

R'000 R'000 R'000 R'000 R'000 R'000 % R'000

RHODES UNIVERSITY ------1,077

WALTER SISULU UNIVERSITY 104,451 - - 104,451 82,293 22,158 27% 107,765 408 NELSON MANDELA METROPOLITAN

UNIVERSITY ------200

UNIVERSITY OF FORT HARE ------7,744

104,451 - - 104,451 82,293 22,128 - 116,786 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1H STATEMENT OF TRANSFERS TO HOUSEHOLDS

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT TRANSFER ALLOCATION EXPENDITURE 2008/09

Adjusted Roll Adjustments Total Actual % of available Final HOUSEHOLDS Appropriation Act Overs Available Transfer funds transferred Appropriation Act R'000 R'000 R'000 R'000 R'000 % R'000

Transfers

Districts 14,630 - - 14,630 13,723 94% 9,549

Clinical H/Comp 19,605 - (18) 19,587 10,070 51% 8,000 409

Others 1,795 - 18 1,813 1,178 65% 3,000

Total 36,030 - - 36,030 24,971 20,549 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1I STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS RECEIVED

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT 2008/09 2007/08 NAME OF ORGANISATION NATURE OF GIFT, DONATION OR SPONSORSHIP R'000 R'000

Received in kind National Health Laboratory Services Computer equipment 352 - Broadreach Health Care Small assets and stationery 3,036 - Broadreach Health Care Technical assistance 6,179 Crazy Cow Company Assets – TV and DVD's Children's ward 1 - National Department of Health Fridges donated for vaccination campaign 3,103 - 410 Italian Cooperation Various assets donated to HO SOP, International Liaison Office 558 - Italian Cooperation Technical assistance 1,373 - ASPEN Golf shirts 27 - Primedia Plasma TV Screen 6 - MMDP Quantity Surveyors 1 - Copy World Printing of certificates 5 - Roche Products Computer to be used for Radiotheraphy 1 - Medical Dep TV, Kettle, Microwave donated to doctors 4 - Wheelchair Foundation Wheelchairs donated to patients 12 - Dr Morel Ultrasound machine – placement of nerve blocks 140 - School of International Training TV and DVD player for patient entertainment 1 - African Health Placements Edblo base sets, duvet covers, paint, vinyl 10 - African Health Placements Desktop for HIV Unit 5 - Carl and Emily Fuchs Foundation Aeris compressor, other machinery, flights 168 - Indwe Risk Services Renovation of children's ward 5 - VODACOM Company 192 Full HD, 52 inch LCD display, studio cardio condenser 249 - PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1I STATEMENT OF GIFTS, DONATIONS AND SPONSORSHIPS RECEIVED

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT 2009/10 2008/09 NAME OF ORGANISATION NATURE OF GIFT, DONATION OR SPONSORSHIP R'000 R'000

That's it Tuberculosis HIV and AIDS Parkhome – TB and HIV integration 834 - Lomnin Platinum Mine Assets – Desktop 14 - Fishers Bedroom Botique Various assets – TVs and DVD Players 16 - RAMAS Water dispensers 24 - Beares Assets–TVs 4 - Cash, childrens clothes 1 -

411 Cartcath School Albany Business Assets 3 - MAKRO Microwave 1 - Japan International Cooperation Agency Compensation of expert for equipment maintenance and associated costs 1,736 - Received in kind Computer Equipment / Office Furniture 2,882

TOTAL 17,869 2,882 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 1J STATEMENT OF AID ASSISTANCE RECEIVED

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT OPENING REVENUE EXPENDITURE CLOSING NAME OF DONOR PURPOSE BALANCE BALANCE R'000 R'000 R'000 R'000

Received in cash European Union Partnership for the delivery of primary health care including HIV/AIDS in the Eastern Cape 8,512 - 15,492 (6,980)

Global Fund Programme to support the ECDOH in the prevention and control of communicable diseases (1,147) - - (1,147) 412

Subtotal 7,365 - 15,492 (8,127)

TOTAL 7,365 - 15,492 (8,127) PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 3A STATEMENT OF FINANCIAL GUARANTEES ISSUED AS AT 31 MARCH 2010 – LOCAL

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Guarantor Original Opening Guarantees Guarantees Revaluations Closing balance Guaranteed Realised institution guaranteed balance draw downs repayments/ 31 March 2009 interest for losses not capital 1 April 2008 during the cancelled/ year ended 31 recoverable i.e. amount year reduced/ March 2009 claims paid out released during the year

R'000 R'000 R'000 R'000 R'000 R'000 R'000

ABSA Motor vehicles - 26 - (26) - - Subtotal - 26 - (26) - - 413 ABSA Housing 8,035 (3,094) 4,941 Permanent (Peoples NBS) Housing 1,879 (1,879) - Standard Bank Housing 3,865 (1,201) 2,664 Nedbank Housing 989 (255) 734 Nedbank (BOE) Housing 90 - 90 BOE Bank Ltd Housing 25 - 25 Nedbank LTD (NBS) Housing - 1,029 1,029 FNB (Firstrand) Housing 2,930 (579) 2,351 FNB (Saambou Bank) Housing 939 (521) 418 Peoples Bank (FBC Fid) Housing 888 (33) 855 GBS Mutual Housing 140 2 142 Hlalo Financial Services Housing 18 (5) 13 Meeg Housing 75 - 75 Southnet Financial Housing 10 - 10 Services PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 3A - (continue) STATEMENT OF FINANCIAL GUARANTEES ISSUED AS AT 31 MARCH 2010 – LOCAL

R'000 R'000 R'000 R'000 R'000 R'000 R'000

Old Mutual (Nedbank) Housing 3,673 (947) 2,726

414 Green Start Home Loan Housing 10 (10) - Investec Housing 57 - 57 NHFC Housing 25 - 25 UNIQUE Housing 385 (52) 333 SA Home Loans Housing 73 - 73 Subtotal - 24,106 - (7,545) - 16,561 - - TOTAL - 24,132 - (7,571) - 16,561 - - PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 3B STATEMENT OF CONTINGENT LIABILITIES AS AT 31 MARCH 2010

Opening Liabilities incurred Liabilities Liabilities Closing - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Nature of Liability Balance during the year paid/cancelled/reduced recoverable(Provide Balance 1 April 2009 during the year details hereunder) 31 March 2010 R'000 R'000 R'000 R'000 R'000

Claims against the department Legal liabilities 965 965 2004/05 4,364 - - - 4,364 2005/06 3,322 - - - 3,322

415 2006/07 26,605 - - - 26,605 2007/08 26,607 - - - 26,607 2008/09 138,007 - - - 138,007 Current year - 247,672 - - 247,672

Subtotal 199,870 247,672 - - 447,542

Other OSD - 25,071 - - 25,071 HROPT - 420,861 - - 420,861 Subtotal - 445,932 - - 445,932

TOTAL 199,870 693,604 - - 893,474

Opening balances are restated, closing balances adjusted for payments made during the year. PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 4 CLAIMS RECOVERABLE

Confirmed Unconfirmed - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT balance outstanding balance outstanding Total Government Entity 31/03/2010 31/03/2009 31/03/2010 31/03/2009 31/03/2010 31/03/2009 R'000 R'000 R'000 R'000 R'000 R'000

Department EC: Department of Education - 922 112 139 112 1,061 Health KZN 3,438 2,890 - - 3,438 2,890 416 Health NW - 16 - - - 16 EC: Department of Sport, Recreation, Arts and Culture - - 8 408 8 408 Mpumalanga: Health and social - - 142 92 142 92 Department of Health: Gauteng 448 - 33 233 481 233 Department of Health: Limpompo - - 159 375 159 375 Department of Public works - - 254 163 254 163 Free State: Health - - 21 30 21 30 Agriculture and land affairs - - - 12 - 12 SAPS - - 62 28 62 28 Correctional Services: National Department - - 94 280 94 280 Public Works: National Department - - 7 37 7 37 Justice: National Department - - 43 38 43 38 Office of the Premier: EC - - 36 29 36 29 Northern Cape Department of Health - - 92 63 92 63 Safety, Security and Liaison - - - 3 - 3 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 4 - (continue) CLAIMS RECOVERABLE

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Confirmed Unconfirmed balance outstanding balance outstanding Total Government Entity 31/03/2010 31/03/2009 31/03/2010 31/03/2009 31/03/2010 31/03/2009 R'000 R'000 R'000 R'000 R'000 R'000

Provincial Treasury - - - 23,625 - 23,625 Conversions - - 980 980 980 980 Legislature - - 74 92 74 92 417 Economic Affairs EC 10 - - - 10 - Housing EC 8 - - - 8 - Home Affairs - - 9 - 9 - Education WC - - 17 - 17 - Health WC - - 48 - 48

Subtotal 3,904 3,828 2,191 26,627 6,095 30,455 Other Government Entities SASSA: EC - - - 8 - 8 SASSA: NATIONAL - - 11 11 11 11 NPA - - - 3 - 3 SANDF - - 45 - 45 Subtotal - - 56 22 56 22 TOTAL 3,904 3,828 2,247 26,649 6,151 30,477 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

ANNEXURES TO THE ANNUAL FINANCIAL STATEMENTS for the year ended 31 March 2010

ANNEXURE 5 INTER-GOVERNMENT PAYABLES

DEPARTMENTS Current WC Health 168 - - 2 168 2 KZN Health - - - 8 - 8 418 EC Treasury 167 8,457 - - 167 8,457 KZN Education - - - 6 - 6 Legislature EC - - - 139 - 139 Health North west 6 - - 6 6 6 Free State Health 15 - - 1 15 1 Correctional Services - - - 10 - 10 National Public Works - - - 20 - 20 Water Affairs - - - 5 - 5 SAPS 10 - - 374 10 374 Gauteng Shared Services - - - 11 - 11 Office of the Premier – Limpompo 17 - - - 17 - Justice 3 - - - 3 - Economic Affairs 25 - - - 25 - Local Government : EC 52 - - - 52 - Local Government : WC 10 - - - 10 - Agriculture 8 - - - 8 - Subtotal 481 8,457 - 582 481 9,039 Total 481 8,457 - 582 481 9,039 PROVINCE OF THE EASTERN CAPE DEPARTMENT OF HEALTH VOTE 3

DISCLOSURE NOTES TO THE ANNUAL FINANCIAL STATEMENT for the year ended 31 March 2010

ANNEXURE 6 2009/10 INVENTORY R'000

Inventory Opening balance 271,344 Add/(Less): Adjustments to prior year balance (10,181) Add: Additions/Purchases – Cash 1,232,238 Add: Additions - Non-cash - (Less): Disposals (1,370) (Less): Issues (1,224,993) Add/(Less): Adjustments (10,913)

Closing balance 256,125

419 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 PART E HUMAN RESOURCES OVERVIEW REPORT Actual against against Standards Achievement Achievement Details in report 7 on Program Details in report 8 on Program Details in report 2 on Program Details in report 3 on Program Details in report 4 on Program Details in report 6 on Program Service Standard of Standard Fair Fair Satisfactory Satisfactory Satisfactory Excellent Potential Potential Customers Anyone with Anyone deformity skeletal in the province/ HDI Contractors Established contractors/users of Health facilities General Public General Public General Public Prospective medical students/WSU & other Medical Schools Actual Customers General Public General Public General Public student/WSU & other Health Profession deformities/HDI with skeletal People Established contractors/ users of health facilities Medical Schools Contractors Main Services Maintenance , Rehabilitation and construction of new of new Rehabilitation and construction Maintenance , health facilities Orthotic and Prosthetic ServicesOrthotic and Prosthetic Training & Development of Health Professionals in the of Health Professionals & Development Training Emergency Medical ServiceEmergency Medical & Specialised Services Hospital rendering Provincial Services 2 & 3 Level Primary service district health health care through province system TABLE 1.1: Main Service for Service Delivery Improvement and Standards Service Main Service for Delivery Improvement 1.1: TABLE

421 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Actual Achievements

Reported in program Reported in program reports Potential Potential Customer

General Public health Traditional service providers Actual Customer The programme flying doctor programme from the from doctor programme flying The programme to district hospitals & clinics to 3 hospital complexes specialist services provide Actual Achievements Actual Academic and service hospitals supportprovincial by in most rural areas coverage Assist in improving Services communities to rural brought teleradiology and teleECG sites have Teledermatology, All users of health services in the facilities, Portfolio All users of health servicesthe facilities, in to District Hospitals been established Committee, SCOPA, departmental staff and SCOPA, Committee, communities. associations, professional Registering bodies and inside Institutions of higher learning NGOs and CBOs, and outside the province Type of Arrangement of Type eHealth programme servicesAeromedical Community servicehealth professionals for clinics of mobile Deployment Access Strategy programmes and inreach Outreach Through health governance structure, namely clinic namely structure, health governance Through Committees & Hospital Boards. Committees & Hospital Legislature. Provincial the Appearances before General meetings with staff. General meetings with in health facilities. Suggestion boxes District Health Councils approve the DHPs for each district the DHPs for approve District Health Councils and Provincial Health Council and Provincial TABLE 1.2: Consultation Arrangements for Customers for Arrangements Consultation 1.2: TABLE

422 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 complaints related to complaints related Actual Achievements Actual Actual Achievements Actual Actual Achievements Actual Reported in the Quality Health Care Assurance Systems ReportAssurance Systems Reported in the Quality Health Care all and receives 0800 32364 is available number A toll free Assist in improving coverage in most rural areas coverage Assist in improving Services to rural communities brought been established telradiology and teleECG sites have Teledermatology, to the 3 hospital complexes from doctor programme flying Theprogramme Academic and serviceAcademic Hospitals to District hospitals supportprovincial by health services, management issues and staff attitude health services, district hospitals & clinics to provide specialist servicesspecialist clinics to provide district hospitals & Details in programme reports Details in programme in this machine reflected quarterly and are health messages weekly Daily, learnerships and internships on services, Disseminate to the public information Complaints and Redress Complaints and Redress Access Strategy Complaint Mechanism Type of Information Tool of Information Type Complaint boxes at Hospitals, CHCs and Clinics at Hospitals, Complaint boxes Mechanism Manual complaints to lodge Use of the departmental 24 hour Call Centre Website/ Internet Website/ Media briefing, radio talkshows, service directory and Impilo Newsletter; radio talkshows, Media briefing, Quarterly on performance. reports Machine Comp Poly Regularly updated Brochures and information pamphlets on services such as TB, campaigns; TB, pamphlets on services and information such as Brochures and quarterly Conference Annual Research Annual Reports, Publishing eHealth programme servicesAeromedical Outreach and inreach programmes inreach and Outreach Community service professionals health for of mobile clinics Deployment Epidemiological notes; TABLE 1.5: Complaint Mechanism 1.5: TABLE TABLE 1.4: Service Delivery Access Strategy Service Delivery 1.4: TABLE TABLE 1.3: Service Delivery Access StrategyAccess Service Delivery 1.3: TABLE

423 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 37996 37996 37996 37996 37996 37996 37996 37996 37996 Employment 1 0 8 2 8 68 10 98 195 tion of (R'000) Average Average Cost per Employee Employee Employees Employees Compensa- 1.2% 48.7% 56.3% 77.2% 61.2% 61.2% 16.7% 66.4% 61.6% Total Total tion of percent of percent Compensa- Expenditure Employees as as Employees 0 0 0 0 0 0 0 0 0 (R'000) Services and Special and Special Professional Professional 0 0 0 0 0 0 0 0 0 (R'000) Training Training Expenditure 88 396 27 787 11 515 381 362 299 192 294 443 3 706 366 2 588 417 7 397 478 n of (R'000) Employees Employees Expenditure Compensatio 57 019 623 565 528 251 485 836 936 391 522 692 5 581 901 3 353 416 12 089 071 (R'000) Total Voted Voted Total Expenditure Programme Z=Total as on Financial Systems (BAS) Z=Total Ehw:health facilities dev&maint Ehw:health facilities dev&maint Ehw:health science & training services hospital Ehw:provincial Ehw:district health servicesEhw:district health Ehw:emergency medical service and support servEhw:health care Ehw:administration servicesEhw:central hospital TABLE 2.1 - Personnel costs by Programme costs by 2.1 - Personnel TABLE

424 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Employees Number of Number 13 430 1 196 9 214 5 139 8 461 7 866 150 195 719 777 63 61 47 271 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 7 467 475 (R'000) Cost for Cost for Department and Transfers Transfers and 7 467 475 Total Personnel Personnel Total including Goods 63 655 90 383 19 072 87 612 848 467 327 629 221 786 320 962 809 937 105 611 236 171 333 363 Average Average Cost per Cost per Employee (R) Employee 156 491 Compensation Compensation 6 1 19 2.4 1.7 0.9 2.1 3.3 0.7 0.1 26.8 35.1 99.1 Cost for Cost for Department Percentage of Percentage Total Personnel Personnel Total (R'000) 76 131 63 888 51 026 5 513 1 418 355 1 998 244 2 622 233 175 731 450 237 127 270 159 464 249 387 7 397 478 Employees Cost Cost Employees Compensation of Compensation Salary Bands TOTAL Contract (Levels 13-16) Contract (Levels Remuneration Periodical Appointment Abnormal Contract (Levels 3-5) Contract (Levels 6-8) Contract (Levels 9-12) Contract (Levels Highly skilled supervision (Levels 9-12) Highly skilled supervision (Levels 13-16) Senior management (Levels 1-2) Contract (Levels Lower skilled (Levels 1-2) skilled (Levels Lower 3-5) Skilled (Levels 6-8) (Levels Highly skilled production TABLE 2.2 - Personnel costs by Salary costs by band 2.2 - Personnel TABLE

425 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 42 227 697 35 221 300 103 322 869 578 413 384 910 Total Total 2 071 421 (R'000) Cost per Cost 7 467 475 Personnel Personnel 3 Programme Programme - 6.8 4.8 2.8 3.6 0.1 2.6 7.3 2.4 4.1 3.9 of Cost Medical Ass. as % Ass. Personnel Personnel - 6 51 320 9 174 1 276 9 245 20 416 99 221 155 083 Ass. Ass. 294 792 (R'000) Medical - 3 3.1 1.8 1.4 0.1 2.2 3.6 1.4 2.6 2.4 of Cost Personnel Personnel HOA as % HOA - 5 25 506 596 9 161 5 781 5 533 61 396 98 964 181 967 HOA HOA (R'000) - - - 6 0 1.4 1.6 2.8 1.2 2.9 48.4 Cost as % of Overtime Overtime Personnel Personnel - - - 8 5 245 8 543 3 719 58 705 17 034 123 508 216 762 (R'000) Overtime Overtime - 1.3 81.3 50.5 51.8 70.3 66.2 85.1 52.2 67.5 134.2 % of Cost Personnel Personnel Salaries as Salaries - 184 352 7 355 47 264 199 342 198 761 168 469 1 763 157 (R'000) 2 652 720 Salaries 5 037 604 Programme TOTAL Prg6: health sciences & training Prg6: support services health care Prg7: health facilities management Prg8: Prg2: district health services Prg2: emergency medical services Prg3: service hospital provincial Prg4: Pr1: health administration health administration Pr1: district health services Pr2: administration Prg1: Medsas expenditure Medsas expenditure TABLE 2.3 - Salaries, Overtime, Home Owners Allowance and Medical Aid by Programme by Aid Medical and Allowance Owners Home Overtime, 2.3 - Salaries, TABLE

426 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 7 467 Band (R'000) 76 366 64 132 53 050 5 530 1 431 314 2 013 761 2 654 050 160 527 250 536 176 449 451 805 129 956 Total Personnel Personnel Total Cost per SalaryCost per 0 0 2.7 2.3 0.4 0.4 0.6 6.6 6.8 4.2 2.9 1.3 3.9 of Cost Medical Ass. as % Ass. Personnel Personnel

1 625 Ass. Ass. (R'000) Medical 0 0 2 2.6 2.6 0.2 0.3 1.1 6.6 4.5 1.5 2.4 2.4 % of Cost HOA as HOA Personnel Personnel

3 130 HOA HOA (R'000) 0 0 0 10 0.2 0.8 0.7 4.1 0.1 9.4 2.9 12.6 18.4 Cost as % of Overtime Overtime Personnel Personnel

16 414 (R'000) Overtime Overtime 0 72 0.4 67.2 67.8 66.9 65.1 83.4 83.8 78.7 67.5 73.1 67.5 % of Cost Personnel Personnel Salaries as Salaries 5 037 - 38 758 84 620 63 726 53 740 673 1 450 752 1 775 352 126 292 168 995 303 799 970 897 Salaries (R'000) Salaries Salary bands Abnormal Appointment Abnormal TOTAL Contract (Levels 13-16) Contract (Levels Remuneration Periodical Contract (Levels 3-5) Contract (Levels 6-8) Contract (Levels 9-12) Contract (Levels Highly skilled supervision Senior management 13-16) (Levels 1-2) Contract (Levels Lower skilled (Levels 1-2) skilled (Levels Lower 3-5) Skilled (Levels Highly skilled production TABLE 2.4 - Salaries, Overtime, Home Owners Allowance and Medical Aid by Salary by Aid Band Medical and Allowance Owners Home Overtime, 2.4 - Salaries, TABLE

427 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 1 0 0 0 110 111 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 39.8 25.6 15.8 60.6 21.7 57.7 75.4 51.7 -200 27.9 -51.4 -42.3 Vacancy Rate Vacancy 3 48 13 109 166 976 212 1691 1955 19841 12982 37996 Number of Number Posts Filled Posts 1 72 57 33 149 223 1247 7941 2810 46928 26861 52714 Posts Number of Number Programme TOTAL Prg6: health sciences & training, Temporary Temporary health sciences & training, Prg6: Permanent support services, health care Prg7: Permanent health facilities management, Prg8: Prg3: emergency medical services, Permanent Permanent services, emergency medical Prg3: Permanent service, hospital provincial Prg4: Temporary service, hospital provincial Prg4: Permanent health sciences & training, Prg6: Prg1: administration, Permanent Permanent administration, Prg1: Permanent services, district health Prg2: Temporary services, district health Prg2: Pr2: district health services, Permanent Permanent district health services, Pr2: TABLE 3.1 - Employment and Vacancies by Programme at end of period at Programme by Vacancies and 3.1 - Employment TABLE

428 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 5 0 0 0 1 2 3 0 0 0 21 17 47 15 111 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 0 0 0 0 0 53 -9.1 57.7 26.8 54.1 66.8 27.9 -35.8 -46.7 -66.3 Vacancy Rate Vacancy 91 63 36 44 150 195 719 777 153 7767 1196 5144 8285 13376 37996 Number of Number Posts Filled Posts 67 63 33 30 92 205 195 719 777 1196 11203 28437 24951 18354 52714 Posts Number of Number Salary Band Contract (Levels 9-12), Permanent Permanent 9-12), Contract (Levels Permanent 13-16), Contract (Levels TOTAL Senior management (Levels 13-16), Permanent Permanent 13-16), Senior management (Levels Permanent 1-2), Contract (Levels Permanent 3-5), Contract (Levels Permanent 6-8), Contract (Levels Highly skilled production (Levels 6-8), Permanent Permanent 6-8), (Levels Highly skilled production Temporary 6-8), (Levels Highly skilled production Permanent 9-12), Highly skilled supervision (Levels Temporary 9-12), Highly skilled supervision (Levels Lower skilled (Levels 1-2), Temporary Temporary 1-2), skilled (Levels Lower Permanent 3-5), Skilled (Levels Temporary 3-5), Skilled (Levels Lower skilled (Levels 1-2), Permanent Permanent 1-2), skilled (Levels Lower TABLE 3.2 - Employment and Vacancies by Salary by of period at end Band Vacancies and - Employment 3.2 TABLE

429 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 3.3 - Employment and Vacancies by Critical Occupation at end of period

Critical Occupations Number of Number of Vacancy Rate Number of Posts Posts Filled Posts Filled Additional to the Establishment

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Administrative related, Permanent 553 493 10.8 22

All artisans in the building metal machinery etc., Permanent 500 298 40.4 0

Ambulance and related workers, Permanent 2 188 1935 11.6 0

Artisan project and related superintendents, Permanent 30 16 46.7 0

Auxiliary and related workers, Permanent 1 938 1038 46.4 2 430 Auxiliary and related workers, Temporary 1 1 0 0

Boiler and related operators, Permanent 268 81 69.8 0

Building and other property caretakers, Permanent 123 59 52 0

Bus and heavy vehicle drivers, Permanent 3 4 -33.3 0

Chemists, Permanent 135 107 20.7 0

Civil engineering technicians, Permanent 1 1 0 0

Cleaners in offices workshops hospitals etc., Permanent 5 398 4757 11.9 16

Cleaners in offices workshops hospitals etc., Temporary 4 3 25 0

Client inform clerks(switchb recept inform clerks), Permanent 582 245 57.9 0

Communication and information related, Permanent 84 73 13.1 0 Critical Occupations Number of Number of Vacancy Rate Number of Posts Posts Filled Posts Filled Additional to the Establishment

Community development workers, Permanent 4 0 100 0

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Computer programmers., Permanent 4 1 75 0

Custodian personnel, Permanent 129 3 97.7 0

Custodian personnel:, Permanent 5 0 100 0

Dental practitioners, Permanent 39 92 -135.9 0

Dental practitioners, Temporary 22 10 54.5 0

431 Dental specialists, Permanent 240 2 99.2 0

Dental technicians, Permanent 54 1 98.1 0

Dental therapy, Permanent 1 12 -1100 0

Dieticians and nutritionists, Permanent 12 91 -658.3 0

Electrical and electronics engineering technicians, Permanent 9 13 -44.4 0

Emergency services related, Permanent 19 5 73.7 0

Engineering sciences related, Permanent 306 3 99 0

Engineers and related professionals, Permanent 4 10 -150 0

Environmental health, Permanent 325 120 63.1 0

Farm hands and labourers, Permanent 161 0 100 0 4 0 2 0 0 0 0 1 0 0 0 0 1 0 0 0 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 72 100 48.9 97.7 89.4 55.6 87.6 90.2 99.9 -33.3 -1200 -3180 -5340 -1400 -892.1 -47300 Vacancy Rate Vacancy 0 4 4 1 58 87 18 15 825 299 164 189 111 474 816 1002 Number of Number Posts Filled Posts 6 5 3 1 1 23 15 145 676 101 171 549 196 1 132 1 128 1 615 Posts Number of Number Critical Occupations Information technology related, Permanent Permanent technologyInformation related, Permanent and vehicles, works Inspectors of apprentices Human resources & organisat developm & relate prof, Permanent Permanent prof, & relate developm & organisat Human resources Permanent clerks, Human resources Permanent related, Human resources Household and laundry workers, Permanent Permanent Household and laundry workers, Permanent and laundryHousehold food services related, Permanent laundry workers, related and Housekeepers Head of department/chief executive officer, Permanent Permanent officer, Head of department/chief executive Permanent Health sciences related, Temporary Health sciences related, Financial and related professionals, Permanent Permanent professionals, Financial and related Permanent controllers, credit Financial clerks and Permanent servicesFood aids and waiters, Permanent professionals, & rel. General legal administration Finance and economics related, Permanent Permanent related, Finance and economics

432 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 41 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 84 100 100 83.7 83.8 99.2 94.2 82.1 83.2 88.5 98.5 -40.1 -8530 -199.9 -1046.2 -1372.9 -1120.8 Vacancy Rate Vacancy 0 3 0 51 13 30 83 62 103 298 236 293 863 120 213 1031 5389 Number of Number Posts Filled Posts 26 70 24 10 168 494 244 537 204 749 152 632 224 1 797 1 670 1 456 6 596 Posts Number of Number Critical Occupations Motor vehicle drivers, Permanent Permanent drivers, Motor vehicle Permanent Nursing assistants, Permanent Occupational therapy, Medical specialists, Temporary Temporary Medical specialists, Permanent Medical technicians/technologists, Permanent Messengers porters and deliverers, Medical practitioners, Permanent Permanent Medical practitioners, Temporary Medical practitioners, Permanent Medical specialists, Light vehicle drivers, Permanent Permanent drivers, Light vehicle Permanent Logistical support personnel, Permanent and transport clerks, Material-recording Librarians and related professionals, Permanent Permanent professionals, Librarians and related Permanent Library clerks, mail and related Permanent Life sciences related, Judges, Permanent Permanent Judges, Permanent & other commun, interpreters Language practitioners

433 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 1 0 0 0 0 0 7 0 0 0 0 2 1 0 0 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 0 0 0 100 -1.1 41.1 66.7 14.5 98.6 93.8 91.6 -350 -280 -188.9 -714.3 -1533.3 -128100 Vacancy Rate Vacancy 1 9 4 6 2 8 6 0 26 49 19 77 264 106 342 8323 1282 Number of Number Posts Filled Posts 1 9 2 4 6 6 3 5 1 7 97 42 584 918 261 180 9 729 Posts Number of Number Critical Occupations Professional nurse, Permanent Permanent nurse, Professional Temporary nurse, Professional Permanent counsellors, Psychologists and vocational Physicists, Permanent Permanent Physicists, Permanent Physiotherapy, Temporary Physiotherapy, Pharmacists, Permanent Permanent Pharmacists, Temporary Pharmacists, Permanent professiona, Pharmacologists pathologists & related Other machine operators, Permanent Permanent Other machine operators, Permanent Other occupations, Permanent Pharmaceutical assistants, Other administrat & related clerks and organisers, Permanent Permanent and organisers, clerks related Other administrat & Permanent officers, policy and related Other administrative Permanent technologyOther information personnel., Optometrists and opticians, Permanent Permanent Optometrists and opticians, Permanent Oral hygiene,

434 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 1 0 7 0 0 0 0 0 0 0 0 0 0 0 0 111 the Number of Number Posts Filled Filled Posts Additional to Additional Establishment 25 100 17.8 78.6 11.5 92.1 44.9 66.7 82.6 93.1 99.3 65.5 45.2 90.9 27.9 -7800 -2715.4 -10633.3 Vacancy Rate Vacancy 0 1 4 4 4 3 18 38 79 29 175 117 322 366 314 2400 1269 37996 Number of Number Posts Filled Posts 1 3 1 3 84 13 23 58 84 33 573 573 213 480 156 2 711 2 301 52714 Posts Number of Number Critical Occupations Trade related, Permanent Permanent related, Trade Permanent planners, Work TOTAL Student nurse, Permanent Permanent Student nurse, Permanent Supplementary radiographers, diagnostic Permanent labourers, Trade Shoemakers, Permanent Permanent Shoemakers, Permanent professionals, and related Social work Permanent and audiology, Speech therapy Permanent and pupil nurses, Staff nurses Secretaries & other keyboard operating clerks, Permanent Permanent operating clerks, & other keyboard Secretaries Permanent Security guards, Permanent Senior managers, Risk management and security services, Permanent Permanent security services, Risk management and Permanent Road workers, Permanent and quality inspectors, health Safety Radiography, Permanent Permanent Radiography, Temporary Radiography,

435 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 % of Posts Posts Evaluated Downgraded Downgraded 0 0 0 0 0 0 0 0 0 Posts Posts Number of Number Downgraded 0 0 0 0 0 0 0 0 0 0 0 0 0 % of Total Posts Posts Evaluated Upgraded Upgraded 0 0 0 0 0 0 0 0 0 0 0 0 0 Posts Posts White Upgraded Number of Number 0 0 0 0 175 200 123.1 103.3 136.9 108.1 125.7 123.2 118.6 Coloured Evaluated % of Posts % of Posts 7 2 0 0 0 0 337 101 9643 5070 22110 25230 62500 Jobs Jobs Asian Evaluated Number of Number 4 1 0 0 0 0 82 268 7832 4690 21409 18428 52714 Posts African Number of Number Salary Band Beneficiaries Employees with a Disability Employees Female Female Male Total TOTAL Senior Management Service Band B Senior Management Service Band C Senior Management Service Band D Skilled (Levels 3-5) Skilled (Levels 6-8) (Levels Highly skilled production 9-12) Highly skilled supervision (Levels A ServiceSenior Management Band Lower skilled (Levels 1-2) skilled (Levels Lower TABLE 4.1 - Job Evaluation 4.1 - Job TABLE TABLE 4.2 - Profile of employees whose positions were upgraded due to their posts being upgraded upgraded due to whose positions were of employees 4.2 - Profile TABLE

436 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 4.7 4.7 8.5 4.9 5.9 13.3 2450 269.2 Turnover Rate Turnover 6 2 0 0 0 0 8 35 12 49 354 429 641 447 Terminations 2 0 0 1 0 0 0 0 0 0 352 539 870 1215 Appointments 2 1 0 0 2 13 15 177 303 127 5030 7606 7586 13062 2009) Beginning of Beginning Period (April (April Period Employment at Employment Salary Band Other, Temporary Temporary Other, Senior Management Service Band C, Permanent Permanent Senior Management Service Band C, Permanent Senior Management Service Band D, Permanent Other, Highly skilled supervision (Levels 9-12), Temporary Temporary 9-12), Highly skilled supervision (Levels Permanent A, Senior Management Service Band Permanent Senior Management Service Band B, Highly skilled production (Levels 6-8), Permanent Permanent 6-8), (Levels Highly skilled production Temporary 6-8), (Levels Highly skilled production Permanent 9-12), Highly skilled supervision (Levels Lower skilled (Levels 1-2), Temporary Temporary 1-2), skilled (Levels Lower Permanent 3-5), Skilled (Levels Temporary 3-5), Skilled (Levels Lower skilled (Levels 1-2), Permanent Permanent 1-2), skilled (Levels Lower TABLE 5.1 - Annual Turnover Rates by SalaryRates by Band Turnover Annual 5.1 - TABLE

437 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Salary Band Employment at Appointments Terminations Turnover Rate Beginning of Period (April 2009)

Contract (Levels 1-2), Permanent 164 4 299 182.3

Contract (Levels 3-5), Permanent 1441 68 70 4.9 - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Contract (Levels 6-8), Permanent 937 743 690 73.6

Contract (Levels 9-12), Permanent 438 486 391 89.3

Contract (Band A), Permanent 57 13 21 36.8

Contract (Band B), Permanent 3 3 3 100

438 Contract (Band C), Permanent 2 3 0 0

Contract (Band D), Permanent 1 0 1 100

TOTAL 36967 4299 3458 9.4 7 4 0 0 0 0 50 2.8 8.3 3.6 6.1 5.9 8.3 8.1 2.3 6.6 6.1 33.3 21.4 Turnover Rate Turnover 3 1 1 4 9 4 0 0 3 0 1 0 3 18 30 19 39 75 328 Terminations 3 0 0 0 6 0 0 0 0 0 0 4 15 30 45 17 30 94 378 Appointments 3 3 1 1 2 12 66 51 84 12 49 361 234 108 112 224 1665 1144 4717 Period Period (April 2009) Beginning of Beginning Employment at Employment Occupation Conservation labourers, Permanent Permanent Conservation labourers, Permanent Custodian personnel, Permanent Dental practitioners, Client inform clerks(switchb recept inform clerks), Permanent Permanent clerks), inform recept Client inform clerks(switchb Permanent related, and information Communication Permanent workers, Community development Permanent printing workers, Compositors typesetters & related Bus and heavy vehicle drivers, Permanent Permanent drivers, vehicle Bus and heavy Permanent technicians, Cartographic and related surveying Permanent Chemists, Permanent hospitals etc., Cleaners in offices workshops Auxiliary and related workers, Permanent Permanent Auxiliary workers, and related Permanent operators, Boiler and related Permanent caretakers, Building and other property Agriculture related, Permanent Permanent related, Agriculture Permanent All artisans in the building metal machinery etc., Permanent workers, Ambulance and related Permanent superintendents, and related Artisan project Administrative related, Permanent Permanent related, Administrative TABLE 5.2 - Annual Turnover Rates by Critical Occupation Critical Rates by Turnover Annual 5.2 - TABLE

439 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Occupation Employment at Appointments Terminations Turnover Rate Beginning of Period (April 2009)

Dental practitioners, Temporary 7 0 1 14.3

Dental specialists, Permanent 1 0 0 0

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Dental therapy, Permanent 7 2 0 0

Dieticians and nutritionists, Permanent 71 30 15 21.1

Diplomats, Permanent 1 0 0 0

Electrical and electronics engineering technicians, Permanent 14 1 2 14.3

Emergency services related, Permanent 274 1 1 0.4

Engineering sciences related, Permanent 5 0 1 20 440 Engineering sciences related, Temporary 1 0 0 0

Engineers and related professionals, Permanent 7 0 0 0

Environmental health, Permanent 152 26 32 21.1

Farm hands and labourers, Permanent 53 0 1 1.9

Finance and economics related, Permanent 138 10 5 3.6

Financial and related professionals, Permanent 101 5 1 1

Financial clerks and credit controllers, Permanent 292 39 4 1.4

Fire fighting and related workers, Permanent 3 0 0 0

Food services aids and waiters, Permanent 693 53 50 7.2

Food services workers, Permanent 7 0 0 0

General legal administration & rel. professionals, Permanent 1 0 0 0

Handymen, Permanent 1 0 0 0 1 0 0 0 0 4 0 0 2.6 1.3 6.6 4.2 1.7 6.1 3.2 1.1 1.6 100 36.3 Turnover Rate Turnover 1 0 1 1 0 1 3 4 0 0 0 0 1 1 3 17 34 63 375 Terminations 8 3 4 2 1 8 6 0 1 0 0 1 3 10 28 27 45 45 494 Appointments 6 1 1 1 9 1 9 39 80 71 31 87 229 854 187 101 259 1033 1031 Period Period (April 2009) Beginning of Beginning Employment at Employment Occupation Medical equipment operators, Permanent Permanent Medical equipment operators, Permanent Medical practitioners, Library mail and related clerks, Permanent Permanent Library clerks, mail and related Permanent drivers, Light vehicle Permanent Logistical support personnel, Permanent and transport clerks, Material-recording Inspectors of apprentices works and vehicles, Permanent Permanent and vehicles, works Inspectors of apprentices Permanent & other commun, Language practitioners interpreters Permanent professionals, Librarians and related Human resources & organisat developm & relate prof, Permanent Permanent prof, & relate developm & organisat Human resources Permanent clerks, Human resources Permanent related, Human resources Permanent technologyInformation related, Home-based personal care workers, Permanent Permanent workers, care Home-based personal Permanent Household and laundry workers, Permanent and laundryHousehold food services related, Permanent laundry workers, and related Housekeepers Head of department/chief executive officer, Permanent Permanent officer, Head of department/chief executive Permanent Health sciences related,

441 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 40 1.6 8.1 2.3 5.7 4.5 3.9 4.1 45.1 37.7 39.9 17.6 14.3 10.3 Turnover Rate Turnover 0 0 1 0 0 1 4 8 0 0 3 37 22 37 25 75 89 23 25 214 Terminations 2 2 6 0 0 0 0 0 1 0 2 0 7 34 20 81 44 74 152 550 Appointments 1 1 3 1 82 20 43 22 10 56 21 29 435 199 131 644 459 223 5163 1356 Period Period (April 2009) Beginning of Beginning Employment at Employment Occupation Pharmaceutical assistants, Permanent Permanent Pharmaceutical assistants, Permanent Pharmacists, Temporary Pharmacists, Other information technology personnel., Permanent Permanent technologyOther information personnel., Permanent Other machine operators, Permanent Other occupations, Temporary Other occupations, Oral hygiene, Permanent Permanent Oral hygiene, Permanent clerks and organisers, Other administrat & related Permanent officers, and related policy Other administrative Motor vehicle drivers, Permanent Permanent drivers, Motor vehicle Permanent Nursing assistants, Permanent Occupational therapy, Permanent Optometrists and opticians, Medical specialists, Temporary Temporary Medical specialists, Permanent Medical technicians/technologists, Permanent Messengers porters deliverers, and Permanent managers, Middle Medical practitioners, Temporary Temporary Medical practitioners, Permanent Medical specialists,

442 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 0 25 7.5 1.5 11.1 52.9 24.5 33.3 60.4 10.7 Turnover Rate Turnover 1 1 0 0 0 0 0 1 1 0 2 0 0 0 27 75 25 58 838 Terminations 0 0 1 0 0 1 9 0 3 0 3 0 0 0 28 65 61 117 1222 Appointments 9 4 3 5 3 7 0 1 6 2 4 1 51 92 68 96 335 306 7800 Period Period (April 2009) Beginning of Beginning Employment at Employment Occupation Secretaries & other keyboard operating clerks, Permanent Permanent operating clerks, & other keyboard Secretaries Permanent Security guards, Rank: Unknown, Permanent Permanent Unknown, Rank: Permanent Risk management and security services, Permanent Road workers, Permanent health and quality inspectors, Safety Psychologists and vocational counsellors, Permanent Permanent counsellors, Psychologists and vocational Temporary counsellors, Psychologists and vocational Permanent Radiography, Temporary Radiography, Probation workers, Permanent Permanent workers, Probation Permanent nurse, Professional Temporary nurse, Professional Physicists, Permanent Permanent Physicists, Permanent Physiotherapy, Temporary Physiotherapy, Permanent machine operators, Printing and related Pharmacologists pathologists & related professiona, Permanent Permanent professiona, & related Pharmacologists pathologists Permanent workers, related lithographic and Photographic

443 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 6 0 0 0 11 10 6.3 6.1 3.6 9.4 100 28.8 42.3 Turnover Rate Turnover 3 0 0 8 0 1 4 12 17 11 139 514 3458 Terminations 5 4 0 0 6 0 0 6 12 10 18 278 4299 Appointments 1 8 4 49 14 10 26 155 111 200 2206 1783 36967 Period Period (April 2009) Beginning of Beginning Employment at Employment Occupation Supplementary diagnostic radiographers, Permanent Permanent Supplementary radiographers, diagnostic Permanent labourers, Trade Permanent operators, plant and related Water TOTAL Speech therapy and audiology, Permanent Permanent and audiology, Speech therapy Permanent and pupil nurses, Staff nurses Permanent Student nurse, Shoemakers, Permanent Permanent Shoemakers, Permanent Social sciences related, Permanent Social sciences supplementary workers, Permanent professionals, and related Social work Security officers, Permanent Permanent Security officers, Permanent Senior managers,

444 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 36967 36967 36967 36967 36967 36967 36967 36967 36967 36967 36967 36967 36967 Total Total Employment 3458 3458 3458 3458 3458 3458 3458 3458 3458 3458 3458 3458 3458 Total 0 0 0 0 0.1 0.2 1.7 0.8 2.2 0.2 4.1 0.1 9.4 Total Total Employment Percentage of Percentage 0 0.7 0.1 1.8 0.1 8.9 1.7 1.1 0.1 100 18.6 23.5 43.5 Total Total Resignations Percentage of Percentage 1 4 2 5 59 37 24 61 307 813 642 1503 3458 Number 9.4 Termination Type Termination Resignations as % of Employment Dismissal-misconduct, Permanent Permanent Dismissal-misconduct, Permanent Retirement, Temporary Other, TOTAL Transfers, Permanent Permanent Transfers, Permanent Discharged due to ill health, Temporary Discharged due to ill health, Resignation, Permanent Permanent Resignation, Temporary Resignation, Permanent Expiry of contract, Temporary Expiry of contract, Death, Permanent Permanent Death, Temporary Death, TABLE 5.3 - Reasons why staff are leaving the department leaving are staff why 5.3 - Reasons TABLE

445 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 5.4 - Promotions by Critical Occupation

Occupation Employment Promotions Salary Level Progressions Notch at Beginning to another Promotions as to another progressions of Period Salary Level a % of Notch within as a % of (April 2009) Employment Salary Level Employment

Administrative related 361 52 14.4 3 0.8

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Agriculture related 2 0 0 0 0 All artisans in the building metal machinery etc. 234 12 5.1 0 0 Ambulance and related workers 1665 32 1.9 0 0 Artisan project and related superintendents 12 1 8.3 0 0 Auxiliary and related workers 1144 14 1.2 11 1 Boiler and related operators 49 0 0 0 0

446 Building and other property caretakers 108 0 0 0 0 Bus and heavy vehicle drivers 12 0 0 0 0 Cartographic surveying and related technicians 3 0 0 0 0 Chemists 112 0 0 0 0 Cleaners in offices workshops hospitals etc. 4717 6 0.1 1 0 Client inform clerks(switchb recept inform clerks) 224 5 2.2 0 0 Communication and information related 66 3 4.5 0 0 Community development workers 3 1 33.3 0 0 Compositors typesetters & related printing workers 1 0 0 0 0 Conservation labourers 51 0 0 0 0 Custodian personnel 1 0 0 0 0 Dental practitioners 91 3 3.3 3 3.3 Dental specialists 1 0 0 0 0 Occupation Employment Promotions Salary Level Progressions Notch at Beginning to another Promotions as to another progressions of Period Salary Level a % of Notch within as a % of (April 2009) Employment Salary Level Employment

Dental therapy 7 0 0 0 0

Dieticians and nutritionists 71 8 11.3 0 0

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Diplomats 1 0 0 0 0

Electrical and electronics engineering technicians 14 3 21.4 0 0

Emergency services related 274 8 2.9 0 0

Engineering sciences related 6 0 0 0 0

Engineers and related professionals 7 1 14.3 0 0

Environmental health 152 1 0.7 0 0 447 Farm hands and labourers 53 0 0 0 0

Finance and economics related 138 14 10.1 0 0

Financial and related professionals 101 7 6.9 0 0

Financial clerks and credit controllers 292 16 5.5 0 0

Fire fighting and related workers 3 0 0 0 0

Food services aids and waiters 693 11 1.6 0 0

Food services workers 7 0 0 0 0

General legal administration & rel. professionals 1 0 0 0 0

Handymen 1 0 0 0 0

Head of department/chief executive officer 9 1 11.1 2 22.2

Health sciences related 854 33 3.9 2 0.2

Home-based personal care workers 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.2 1.6 0.2 1.1 Notch as a % of as a % of progressions progressions Employment 0 0 0 0 0 0 0 3 3 0 1 0 0 0 1 0 0 0 0 to another to another Salary Level Progressions Progressions Notch within Notch within 0 0 7 0 0 0 2.6 3.8 2.3 5.6 2.6 5.7 9.5 0.3 0.5 4.6 9.1 9.9 100 a % of Salary Level Salary Level Employment Promotions as Promotions 1 0 3 6 4 6 0 2 2 5 0 0 4 0 1 72 13 17 10 to another to another Promotions Promotions Salary Level 9 6 1 1 1 21 31 87 39 80 71 187 644 187 101 259 229 1256 1031 of Period of Period (April 2009) at Beginning at Beginning Employment Employment Occupation Medical specialists Medical technicians/technologists Messengers porters and deliverers Material-recording and transport clerks Material-recording Medical equipment operators Medical practitioners Librarians and related professionals professionals Librarians and related Library clerks mail and related drivers Light vehicle Logistical support personnel Information technology Information related and vehicles works Inspectors of apprentices & other commun Language practitioners interpreters Housekeepers laundry and related workers laundry workers and related Housekeepers prof & relate & organisat developm Human resources clerks Human resources related Human resources Household and laundry workers Household and laundry workers and laundryHousehold food services related

448 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.2 1.9 Notch as a % of as a % of progressions progressions Employment 0 0 1 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 to another to another Salary Level Progressions Progressions Notch within Notch within 0 0 0 0 0 0 0 0 0 1 0.5 5.7 4.1 1.8 1.8 0.3 7.3 4.1 37.2 10.3 a % of Salary Level Salary Level Employment Promotions as Promotions 0 2 0 0 0 4 0 0 1 0 3 6 0 0 16 12 18 14 19 138 to another to another Promotions Promotions Salary Level 4 1 1 1 1 6 1 98 55 29 82 20 43 22 459 438 209 7809 5163 1356 of Period of Period (April 2009) at Beginning at Beginning Employment Employment Occupation Probation workers workers Probation nurse Professional counsellors Psychologists and vocational Physicists Physicists Physiotherapy machine operators Printing and related Other occupations Pharmaceutical assistants Pharmacists workers related lithographic and Photographic Other administrat & related clerks and organisers Other administrat & related officers and related policy Other administrative technologyOther information personnel. Other machine operators Nursing assistants Occupational therapy Optometrists and opticians Oral hygiene Middle managers managers Middle drivers Motor vehicle

449 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3.9 3.8 0.3 0.1 Notch as a % of as a % of progressions progressions Employment 6 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 43 to another to another Salary Level Progressions Progressions Notch within Notch within 0 0 0 1 0 0 0 0 0 0 0 0 0 9.7 4.5 6.1 6.1 3.6 1.9 15.4 85.7 a % of Salary Level Salary Level Employment Promotions as Promotions 0 0 0 5 4 0 3 0 1 0 0 0 0 6 0 0 15 22 19 12 698 to another to another Promotions Promotions Salary Level 0 1 5 3 7 8 4 49 92 68 14 10 26 200 335 155 111 309 2206 1783 36967 of Period of Period (April 2009) at Beginning at Beginning Employment Employment Occupation Trade related related Trade operators plant and related Water TOTAL Staff nurses and pupil nurses and pupil nurses Staff nurses Student nurse Supplementary radiographers diagnostic labourers Trade Social sciences related Social sciences related Social sciences supplementary workers professionals and related Social work and audiology Speech therapy Security guards Security guards Security officers Senior managers Shoemakers Road workers Road workers and quality inspectors health Safety operating clerks & other keyboard Secretaries Radiography Radiography Unknown Rank: security servicesRisk management and

450 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 0.2 1.6 0.1 0.3 6.2 0.1 Notch as a % of as a % of progressions progressions Employment 0 0 0 0 0 1 1 1 6 6 0 0 9 19 43 to another to another Salary Level Progressions Progressions Notch within Notch within 0 0 0 0 0 0 11 0.9 3.9 6.3 0.1 0.8 3.6 3.6 1.9 a % of Salary Level Salary Level Employment Promotions as Promotions 0 0 0 0 8 4 7 0 0 17 98 16 275 273 698 to another to another Promotions Promotions Salary Level 2 13 63 145 177 303 164 937 438 5030 7606 7586 1441 13062 36967 of Period of Period (April 2009) at Beginning at Beginning Employment Employment Salary Band Contract (Levels 9-12), Permanent Permanent 9-12), Contract (Levels Permanent 13-16), Contract (Levels TOTAL Other, Temporary Temporary Other, Permanent 1-2), Contract (Levels Permanent 3-5), Contract (Levels Permanent 6-8), Contract (Levels Highly skilled supervision (Levels 9-12), Temporary Temporary 9-12), Highly skilled supervision (Levels Permanent 13-16), Senior management (Levels Permanent Other, Skilled (Levels 3-5), Permanent Permanent 3-5), Skilled (Levels Permanent 6-8), (Levels Highly skilled production Temporary 6-8), (Levels Highly skilled production Permanent 9-12), Highly skilled supervision (Levels Lower skilled (Levels 1-2), Permanent Permanent 1-2), skilled (Levels Lower TABLE 5.5 - Promotions by Salary by Band 5.5 - Promotions TABLE

451 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 3 44 13 135 262 365 160 308 9860 7876 3527 2366 13212 37996 Total Total 0 0 0 3 6 10 47 33 11 60 223 312 537 1232 White White Female, Female, Female, Female, 0 1 21 15 24 81 64 54 7251 4942 1865 1702 10564 26530 Total Total Total Total Female, Female, Female, Female, 3 0 0 0 0 1 2 1 0 2 4 73 24 106 Indian Indian Female, Female, Female, Female, 0 2 0 2 4 1 1 3 670 306 140 105 1103 2334 Female, Female, Female, Female, Coloure Coloure 0 0 21 13 21 75 62 47 1652 9437 1595 6578 4636 24090 African African Female, Female, Female, Female, 0 4 0 0 8 95 92 15 86 65 49 12 274 688 Male, Male, Male, Male, White White 1 3 17 65 59 116 589 176 346 1076 2019 2300 2838 9546 Total Total Total Total Male, Male, Male, Male, 2 0 2 5 2 0 1 0 1 4 1 13 109 139 Male, Male, Male, Male, Indian Indian 2 1 0 2 4 45 23 29 11 100 175 213 161 755 Male, Male, Male, Male, Coloure Coloure 0 3 14 57 47 867 101 542 151 317 2676 2082 1842 8652 Male, Male, Male, Male, African African Occupational Categories Occupational with disabilities Employees Elementary occupations, Elementary occupations, Temporary Permanent Other, TOTAL Plant and machine operators Permanent and assemblers, Elementary occupations, Permanent Clerks, Permanent Permanent Clerks, Service and sales workers, trades Craft and related Permanent workers, Professionals, Temporary Temporary Professionals, and associate Technicians Permanent professionals, and associate Technicians Temporary professionals, Legislators, senior officials senior officials Legislators, Permanent and managers, Permanent Professionals, Permanent Permanent TABLE 6.1 - Total number of Employees (incl. Employees wit h disabilities) per Occupational Category per Occupational wit h disabilities) (SASCO) Employees (incl. of Employees number Total 6.1 - TABLE

452 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 8 44 91 153 142 7767 8285 13376 Total 8 0 7 21 12 180 361 448 White Female, Female, 4 3 37 42 23 9473 6119 5823 Total Total Female, Female, 1 4 0 0 2 0 45 11 Indian Female, Female, 1 0 0 5 1 702 490 827 Female, Female, Coloure 4 3 35 35 22 5584 4985 8767 African Female, Female, 0 16 30 20 40 79 176 162 Male, Male, White 5 16 58 41 55 1111 1852 3644 Total Total Male, Male, 2 0 3 5 2 11 63 10 Male, Male, Indian 1 0 9 0 1 93 301 212 Male, Male, Coloure 5 13 38 38 49 955 3430 1541 Male, Male, African Occupational Bands Occupational Semi-skilled and discretionary decision Semi-skilled and discretionary decision Skilled technical and qualified academically junior management, workers, Skilled technical and qualified academically junior management, workers, Professionally qualified and qualified Professionally and experienced specialists Permanent mid-management, and qualified Professionally and experienced specialists Temporary mid-management, Top Management, Permanent Permanent Management, Top Senior Management, Permanent making, Permanent Permanent making, Temporary making, supervisors, foremen, foremen, supervisors, supervisors, foremen, foremen, supervisors, Temporary Temporary Permanent Permanent TABLE 6.2 - Total number of Employees (incl. Employees with disabilities) per Occupational Bands per Occupational with disabilities) Employees (incl. of Employees number Total 6.2 - TABLE

453 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Occupational Bands Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total African Coloure Indian Total White African Coloure Indian Total White

Unskilled and defined 1945 93 2 2040 15 2938 142 1 3081 8 5144 decision making, Permanent Unskilled and defined 4 1 3 8 19 1 0 0 1 8 36 decision making, Temporary

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Contract (Top Management), 1 0 1 2 1 1 0 0 1 0 4 Permanent

Contract (Senior 35 0 6 41 3 13 0 1 14 1 59 Management), Permanent

Contract (Professionally 195 23 30 248 100 287 31 36 354 75 777 qualified), Permanent

Contract (Skilled technical), 122 8 1 131 19 423 55 3 481 88 719 Permanent 454

Contract (Semi-skilled), 47 1 0 48 0 143 4 0 147 0 195 Permanent

Contract (Unskilled), 234 12 0 246 8 849 76 2 927 15 1196 Permanent

TOTAL 8652 755 139 9546 688 24090 2334 106 26530 1232 3796 3 4 1 2 2 16 68 539 486 743 352 870 1215 4299 Total Total 0 0 2 0 0 1 0 2 9 60 91 52 54 270 White White Female, Female, Female, Female, 0 0 3 0 0 0 48 351 237 490 169 640 960 2898 Total Total Total Total Female, Female, Female, Female, 0 0 0 3 0 0 0 0 8 0 4 0 18 33 Indian Indian Female, Female, Female, Female, 0 0 4 0 0 0 0 14 22 49 19 88 48 244 Female, Female, Female, Female, Coloure Coloure 0 0 3 0 0 0 44 337 197 438 142 548 912 2621 African African Female, Female, Female, Female, 0 0 0 5 2 1 1 2 0 0 23 68 24 126 Male, Male, Male, Male, White White 1 1 0 2 1 12 20 108 171 244 187 121 138 1005 Total Total Total Total Male, Male, Male, Male, 0 0 9 0 2 0 0 1 1 2 0 0 13 28 Male, Male, Male, Male, Indian Indian 0 0 0 9 0 0 1 0 12 14 14 16 13 79 Male, Male, Male, Male, Coloure Coloure 1 1 0 1 1 87 11 92 19 155 230 178 123 898 Male, Male, Male, Male, African African

Occupational Bands Occupational TOTAL with disabilities Employees Contract (Semi-skilled), Contract (Semi-skilled), Permanent Contract (Unskilled), Permanent Contract (Senior Permanent Management), Contract (Professionally Permanent qualified), Contract (Skilled technical), Permanent Semi-skilled and discretionary decision Unskilled and defined Permanent decision making, Management), Contract (Top Permanent Professionally qualified and qualified Professionally and experienced specialists Temporary mid-management, Skilled technical and qualified academically Top Management, Permanent Permanent Management, Top and qualified Professionally and experienced specialists Permanent mid-management, TABLE 6.3 - Recruitment TABLE

455 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 8 1 4 8 2 1 18 24 104 292 281 741 Total Total 1 0 0 0 1 0 2 0 2 21 11 36 White White Female, Female, Female, Female, 6 1 1 5 7 0 0 5 65 164 202 456 Total Total Total Total Female, Female, Female, Female, 0 0 0 1 0 0 0 0 0 2 1 4 Indian Indian Female, Female, Female, Female, 5 1 0 0 0 4 0 0 1 23 28 62 Female, Female, Female, Female, Coloure Coloure 5 1 0 5 3 0 0 4 60 139 173 390 African African Female, Female, Female, Female, 0 2 7 0 0 0 0 3 0 0 18 30 Male, Male, Male, Male, White White 0 2 0 3 9 1 1 15 89 61 38 219 Total Total Total Total Male, Male, Male, Male, 0 2 4 1 0 0 0 1 1 0 0 9 Male, Male, Male, Male, Indian Indian 0 4 9 6 0 0 0 1 0 0 13 33 Male, Male, Male, Male, Coloure Coloure 0 9 2 0 2 7 1 1 72 51 32 177 Male, Male, Male, Male, African African

Occupational Bands Occupational Employees with disabilities Employees Contract (Professionally Contract (Professionally Permanent qualified), Contract (Skilled technical), Permanent TOTAL Contract (Top Management), Management), Contract (Top Permanent Contract (Senior Permanent Management), Semi-skilled and discretionary Permanent decision making, Unskilled and defined Permanent decision making, Professionally qualified and qualified Professionally and experienced specialists Permanent mid-management, Skilled technical and qualified academically junior management, workers, Top Management, Permanent Permanent Management, Top Senior Management, Permanent supervisors, foremen, foremen, supervisors, Permanent Permanent TABLE 6.4 - Promotions TABLE

456 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 6.5 - Terminations

Occupational Bands Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total African Coloure Indian Total White African Coloure Indian Total White

Senior Management, 0 0 2 2 2 3 0 0 3 1 8 Permanent

Professionally qualified and 50 6 7 63 14 229 19 1 249 28 354

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT experienced specialists and mid-management, Permanent Professionally qualified and 11 1 0 12 6 12 0 0 12 5 35 experienced specialists and mid-management, Temporary Skilled technical and 88 4 0 92 8 272 43 0 315 32 447 academically qualified workers, junior management, supervisors, foremen,

457 Permanent

Skilled technical and 19 0 4 23 9 11 0 1 12 5 49 academically qualified workers, junior management, supervisors, foremen, Temporary

Semi-skilled and 175 11 2 188 6 380 48 0 428 19 641 discretionary decision making, Permanent

Semi-skilled and 3 0 0 3 6 2 0 0 2 1 12 discretionary decision making, Temporary

Unskilled and defined 147 1 0 148 1 254 24 1 279 1 429 decision making, Permanent

Unskilled and defined 2 0 0 2 2 1 0 0 1 3 8 decision making, Temporary Occupational Bands Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total African Coloure Indian Total White African Coloure Indian Total White

Contract (Top Management), 1 0 0 1 0 0 0 0 0 0 1 Permanent

Contract (Senior 16 0 1 17 2 4 0 0 4 1 24 Management), Permanent

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Contract (Professionally 96 7 11 114 50 150 12 11 173 54 391 qualified), Permanent

Contract (Skilled technical), 92 14 5 111 30 391 58 8 457 92 690 Permanent

Contract (Semi-skilled), 16 0 0 16 0 54 0 0 54 0 70 Permanent

Contract (Unskilled), 90 3 0 93 0 199 3 0 202 4 299 Permanent 458 TOTAL 806 47 32 885 136 1962 207 22 2191 246 3458

Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total African Coloure Indian Total White African Coloure Indian Total White

Employees with disabilities 0 0 0 0 0 1 0 0 1 0 1

TABLE 6.6 - Disciplinary Action

Disciplinary Male, Male, Male, Male, Male, Female, Female, Female, Female, Female, Total Not action African Coloured Indian Total White African Coloure Indian Total White Available

Demotion 0 0 0 0 0 1 0 0 1 0 1 0

Suspended 1 0 0 1 0 1 0 0 1 0 2 0 without payment TOTAL 1 0 0 1 0 2 0 0 2 0 3 0 7 039 7 804 6 840 7 719 6 565 7 830 8 781 13 222 16 886 10 973 14 796 19 189 (R) Average Cost Average per Beneficiary 88 44 96 764 190 1 901 1 269 1 030 3 044 1 614 3 852 8 140 Cost (R'000) 9 2.8 7.8 1.6 2.7 2.8 3.6 4.2 3.9 1.9 2.4 14.5 Total Total Employment Percentage of Percentage 55 681 106 139 752 9517 1228 8626 2331 24078 26515 37996 Total Total Employment 3 5 8 99 29 96 61 390 236 492 270 927 Number of Number Beneficiaries Demographics TOTAL TOTAL White, Female Female White, Male White, with a disability Employees Coloured, Male Coloured, Female Blacks, Total Male Blacks, Total Asian, Female Female Asian, Male Asian, Female Coloured, African, Female Female African, Male African, TABLE 7.1 - Performance Rewards by Race, Gender and Disability and Gender Race, by Rewards 7.1 - Performance TABLE

459 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 7.2 - Performance Rewards by Salary Band for Personnel below Senior Management Service

Salary Band Number of Total Percentage of Cost (R'000) Average Cost Beneficiaries Employment Total per Beneficiary Employment (R)

Lower skilled (Levels 1-2) 228 5139 4.4 980 4 298

Skilled (Levels 3-5) 238 13430 1.8 1 207 5 071 - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Highly skilled production (Levels 6-8) 321 8461 3.8 3 449 10 745

Highly skilled supervision (Levels 9-12) 136 7866 1.7 2 465 18 125

Contract (Levels 1-2) 2 1196 0.2 7 3 500

Contract (Levels 3-5) 0 195 0 0 0

Contract (Levels 6-8) 0 719 0 0 0

460 Contract (Levels 9-12) 2 777 0.3 32 16 000

Periodical Remuneration 0 61 0 0 0

Abnormal Appointment 0 9214 0 0 0

TOTAL 927 47058 2 8140 8781 0 0 0 0 0 0 0 0 0 4 333 6 000 4 324 8 313 4 556 6 255 2 000 15 000 18 500 11 810 (R) Average Cost Average per Beneficiary 6 0 0 0 0 0 0 0 0 0 2 26 15 41 813 133 407 248 344 Cost (R'000) 0 4 0 0 0 0 0 0 0 0 2 50 22 5.7 9.1 7.2 5.3 9.2 4.9 Total Total Employment Percentage of Percentage 2 3 1 1 1 1 11 68 41 14 50 106 106 223 418 229 4735 1760 1125 Total Total Employment 0 0 0 9 0 0 0 0 1 6 1 1 0 0 22 21 55 16 188 Number of Number Beneficiaries Critical Occupations Computer programmers. Computer programmers. Conservation labourers Custodian personnel Communication and information related related and information Communication workers Community development printing workers Compositors typesetters & related Cartographic surveying and related technicians Cartographic and related surveying Chemists hospitals etc. Cleaners in offices workshops clerks) inform recept Client inform clerks(switchb Boiler and related operators Boiler and related caretakers Building and other property drivers vehicle Bus and heavy All artisans in the building metal machinery etc. All artisans in the building metal machinery etc. workers Ambulance and related superintendents and related Artisan project Auxiliary workers and related Administrative related related Administrative related Agriculture TABLE 7.3 - Performance Rewards by Critical Occupation Critical by Rewards 7.3 - Performance TABLE

461 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Critical Occupations Number of Total Percentage of Cost Average Cost Beneficiaries Employment Total (R'000) per Beneficiary Employment (R)

Dental practitioners 2 96 2.1 28 14 000

Dental therapy 0 8 0 0 0

Dieticians and nutritionists 3 82 3.7 38 12 667 - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Diplomats 0 1 0 0 0

Electrical and electronics engineering technicians 0 15 0 0 0

Emergency services related 0 180 0 0 0

Engineering sciences related 1 4 25 31 31 000

Engineers and related professionals 2 8 25 69 34 500

462 Environmental health 1 129 0.8 8 8 000

Farm hands and labourers 17 50 34 76 4 471

Finance and economics related 7 137 5.1 77 11 000

Financial and related professionals 3 91 3.3 50 16 667

Financial clerks and credit controllers 6 259 2.3 41 6 833

Fire fighting and related workers 0 3 0 0 0

Food services aids and waiters 21 709 3 102 4 857

Food services workers 0 7 0 0 0

General legal administration & rel. professionals 0 1 0 0 0

Handymen 0 1 0 0 0

Head of department/chief executive officer 0 10 0 0 0

Health sciences related 10 853 1.2 122 12 200 0 0 0 0 0 0 0 7 000 5 133 7 714 8 714 4 975 5 195 7 000 5 600 4 000 15 000 29 600 17 167 17 833 (R) Average Cost Average per Beneficiary 0 0 0 0 0 0 8 0 15 35 77 54 61 42 28 296 103 199 400 107 Cost (R'000) 0 0 0 0 0 0 0 2.4 7.1 5.8 9.6 4.1 0.7 5.9 7.6 7.5 2.5 1.9 28.6 19.4 Total Total Employment Percentage of Percentage 4 2 1 1 8 42 70 73 21 31 80 11 259 171 240 683 200 103 1350 1010 Total Total Employment 0 0 6 0 6 6 5 2 0 0 1 0 5 7 7 0 10 40 77 15 Number of Number Beneficiaries Critical Occupations Medical specialists Medical technicians/technologists Messengers porters and deliverers Material-recording and transport clerks Material-recording Medical equipment operators Medical practitioners Librarians and related professionals professionals Librarians and related Library clerks mail and related drivers Light vehicle Logistical support personnel Human resources related related Human resources technology Information related and vehicles works Inspectors of apprentices & other commun Language practitioners interpreters Housekeepers laundry and related workers laundry workers and related Housekeepers prof & relate & organisat developm Human resources clerks Human resources Home-based personal care workers workers personal care Home-based Household and laundry workers and laundryHousehold food services related

463 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 6 050 4 643 7 000 2 667 7 500 7 838 13 346 17 400 24 000 13 333 12 851 20 000 (R) Average Cost Average per Beneficiary 0 0 0 0 0 0 0 0 7 8 0 87 65 24 15 40 121 347 290 100 1 902 Cost (R'000) 0 6 0 0 0 0 0 0 0 0 4.5 0.2 1.8 2.6 0.1 2.5 3.4 6.9 10.1 13.6 12.8 Total Total Employment Percentage of Percentage 1 3 1 9 4 1 1 3 26 56 38 81 22 72 333 257 112 8297 5398 1075 1159 Total Total Employment 5 0 0 1 1 3 2 0 3 5 0 0 0 0 0 0 14 37 20 26 148 Number of Number Beneficiaries Critical Occupations Probation workers workers Probation nurse Professional counsellors Psychologists and vocational Photographic lithographic and related workers workers related lithographic and Photographic Physicists Physiotherapy machine operators Printing and related Other occupations Pharmaceutical assistants Pharmacists professiona Pharmacologists pathologists & related Other administrative policy and related officers and related policy Other administrative technologyOther information personnel. Other machine operators Occupational therapy Occupational therapy Optometrists and opticians Oral hygiene and organisers clerks related Other administrat & Middle managers Middle drivers Motor vehicle Nursing assistants

464 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 0 0 0 0 8778 2 333 5 000 4 200 8 560 5 000 10 000 29 000 15 500 14 500 15 792 27 000 (R) Average Cost Average per Beneficiary 0 7 0 0 0 0 0 0 0 5 0 10 29 29 10 21 217 379 214 108 8137 Cost (R'000) 0 0 0 0 0 0 0 0 0 25 8.3 6.5 0.1 4.1 2.4 6.6 6.8 1.6 2.8 2.4 12.1 Total Total Employment Percentage of Percentage 4 6 1 1 4 4 12 31 49 50 27 62 14 116 209 361 367 141 2392 1297 37996 Total Total Employment 2 5 0 0 0 0 0 0 1 0 4 1 1 0 2 3 0 25 14 24 927 Number of Number Beneficiaries Critical Occupations Trade related related Trade operators plant and related Water TOTAL Staff nurses and pupil nurses and pupil nurses Staff nurses Student nurse Supplementary radiographers diagnostic labourers Trade Social sciences supplementary workers Social sciences supplementary workers professionals and related Social work and audiology Speech therapy Security officers Senior managers Shoemakers Social sciences related Road workers Road workers and quality inspectors health Safety operating clerks & other keyboard Secretaries Security guards Radiography Radiography Unknown Rank: security servicesRisk management and

465 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 0 0 0 0 0 (R'000) Cost SMS Cost SMS Personnel Personnel 0 0 0 0 0 % of SMS % of SMS Wage Bill Wage 0 0 0 0 0 (R) Average Average Cost per Cost per Beneficiary 0 0 0 0 0 Cost (R'000) 0 0 0 0 0 of Total Total of Percentage Percentage Employment 2 97 10 104 213 Total Total Employment 0 0 0 0 0 Number of Number Beneficiaries SMS Band TOTAL Band B Band C Band D Band A A Band TABLE 7.4 - Performance Related Rewards (Cash Bonus) by Salary Band for Senior Management Service Salary Senior Management by for Band (Cash Bonus) Rewards Related 7.4 - Performance TABLE

466 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 -13 -13 -13 -13 -13 -13 -13 -13 -13 -13 -13 Total Total ment Employ- Change in Change 366 366 366 366 366 366 366 366 366 366 366 Total Total End of Period ment at Employ- 379 379 379 379 379 379 379 379 379 379 379 Total Total ment at Employ- of Period Beginning Beginning 0 0 7.7 -7.7 100 69.2 76.9 -23.1 -15.4 107.7 -115.4 Total tage of of tage Percen- 3 2 0 1 0 -1 -9 15 -14 -10 -13 ment Employ- Change in Change 0.8 1.4 4.9 3.3 1.4 1.6 0.3 1.9 100 51.6 32.8 Total tage of of tage Percen- 3 5 5 6 1 7 18 12 189 120 366 End of Period ment at Employ- 4 0.8 1.1 7.1 3.2 0.8 0.5 1.3 100 53.6 27.7 Total tage of of tage Percen- 3 4 3 2 5 27 12 15 203 105 379 Period ment at Employ- Beginning Beginning Salary Band Abnormal Appointment Abnormal TOTAL Contract (Levels 6-8) Contract (Levels 9-12) Contract (Levels 13-16) Contract (Levels Remuneration Periodical Skilled (Levels 3-5) Skilled (Levels 6-8) (Levels Highly skilled production 9-12) Highly skilled supervision (Levels 13-16) (Levels Senior management Lower skilled (Levels 1-2) skilled (Levels Lower TABLE 8.1 - Foreign Workers by Salary by Band Workers 8.1 - Foreign TABLE

467 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 8.2 - Foreign Workers by Major Occupation

Major Occupation Employ- Percen- Employ- Percen- Change in Percen- Total Total Total ment at tage of ment at tage of Employ- tage of Employ- Employ- Change in Beginning Total End of Total ment Total ment at ment at Employ- Period Period Beginning End of ment

Administrative office workers 1 0.3 2 0.5 1 -7.7 379 366 -13 - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Elementary occupations 3 0.8 3 0.8 0 0 379 366 -13

Other occupations 1 0.3 1 0.3 0 0 379 366 -13

Professionals and managers 370 97.6 355 97 -15 115.4 379 366 -13

Service workers 1 0.3 1 0.3 0 0 379 366 -13

Social natural technical and medical 2 0.5 4 1.1 2 -15.4 379 366 -13

468 Technicians and associated professionals 1 0.3 0 0 -1 7.7 379 366 -13

TOTAL 379 100 366 100 -13 100 379 366 -13 364 956 140 237 1474 1575 18713 55521 37692 33246 149918 tion Total Total medical certifica- days with days number of number 22795 22795 22795 22795 22795 22795 22795 22795 22795 22795 22795 Total Total Leave using Sick using Sick number of number Employees Employees 95 656 974 357 679 339 3 955 75526 16 716 20 348 31 407 Cost (R'000) Estimated Estimated 6 5 5 6 8 8 8 7 6 5 7 Average Average Days per Days Employee 1 0.3 1.5 0.1 0.2 1.5 100 11.9 35.7 25.1 22.7 Leave % of Total Total % of using Sick using Sick Employees Employees 47 66 25 350 336 225 2722 8144 5715 5165 22795 Leave using Sick using Sick Employees Employees Number of Number 91.4 89.7 85.9 88.9 87.1 98.4 94.5 86.7 83.7 90.3 88.8 tion with % Days % Days Medical Certifica- 272 385 155 1142 1600.5 1700.5 20484.5 61906.5 43869.5 37401.5 168917 Total Days Total Salary Band Contract (Levels 9-12) Contract (Levels 13-16) Contract (Levels TOTAL Senior management (Levels 13-16) (Levels Senior management 1-2) Contract (Levels 3-5) Contract (Levels 6-8) Contract (Levels Lower skilled (Levels 1-2) skilled (Levels Lower 3-5) Skilled (Levels 6-8) (Levels Highly skilled production 9-12) Highly skilled supervision (Levels TABLE 9.1 - Sick Leave for Jan 2009 to Dec 2009 2009 to Jan for Leave 9.1 - Sick TABLE

469 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 9.2 - Disability Leave (Temporary and Permanent) for Jan 2009 to Dec 2009

Salary Band Total Days % Days Number of % of Total Average Estimated Total Total with Employees Employees Days per Cost number of number of Medical using using Employee (R'000) days with Employees Certifica- Disability Disability medical using tion Leave Leave certifica- Disability tion Leave

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Lower skilled (Levels 1-2) 2803 100 134 14.1 21 543 2803 953 Skilled (Levels 3-5) 9229 100 364 38.2 25 2 462 9229 953 Highly skilled production (Levels 6-8) 9314 100 285 29.9 33 4 262 9314 953 Highly skilled supervision (Levels 9-12) 4055 100 163 17.1 25 3 639 4053 953 Senior management (Levels 13-16) 29 96.6 2 0.2 15 67 28 953 Contract (Levels 6-8) 52 100 3 0.3 17 20 52 953

470 Contract (Levels 9-12) 24 100 2 0.2 12 23 24 953 TOTAL 25506 100 953 100 27 11016 25503 953 TABLE 9.3 - Annual Leave for Jan 2009 to Dec 2009

Salary Band Total Days Taken Average days per Number of Employees who Employee took leave

Lower skilled (Levels 1-2) 95280.48 21 4592

Skilled (Levels 3-5) 251462.92 21 11965 - E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Highly skilled production (Levels 6-8) 171768.48 21 8014

Highly skilled supervision (Levels 9-12) 173503.84 23 7652

Senior management (Levels 13-16) 2738 20 140

Contract (Levels 1-2) 15557.76 15 1062

Contract (Levels 3-5) 2757 18 157

471 Contract (Levels 6-8) 7630 13 574

Contract (Levels 9-12) 8548.84 15 572

Contract (Levels 13-16) 836 15 56

TOTAL 730083.32 21 34784 0 21 55 10 77 62 121 5268 1394 1398 5111 3848 4924 5119 15627 2009 Number of Number 31 December 31 December Employees as at Employees per Employee (R) per Employee Average Payment Payment Average 2307 5664 1449 6509 6287 2 84404 15238 33 372668 382786 519515 896 931 1396827 capped leave leave capped available at 31 at available December 2009 Total number of number Total Employees Number of 3 2 2 6 3 7 91 406 416 509 1445 0 46 leave 4766 4 720 Number of Number took Capped took Capped Employees who Employees 60 73 99 85 89 (R'000) 110 103 145 106 101 126 Total Amount Total 2009 leave per leave 31 December employee as at as employee Average capped capped Average 4 5 6 6 9 6 4 4 6 5 6 Average Average taken per taken employee number of days days of number 9 52 18 31 12 11 341 1997 2695 3126 8292 taken Total days of of days Total capped leave leave capped Reason

Capped leave payouts on termination of service on termination 2009/10 for payouts leave Capped termination of service on 2009/10 for payout leave Current TOTAL Leave payout for 2009/10 due to non-utilisation of leave for the previous cycle cycle the previous for of leave 2009/10 due to non-utilisation for payout Leave Contract (Levels 9-12) Contract (Levels 13-16) Contract (Levels TOTAL Contract (Levels 1-2) Contract (Levels 3-5) Contract (Levels 6-8) Contract (Levels Skilled (Levels 3-5) Skilled (Levels 6-8) (Levels Highly skilled production 9-12) Highly skilled supervision (Levels 13-16) (Levels Senior management Lower skilled (Levels 1-2) skilled (Levels Lower Table 9.5: Leave Payout Leave 9.5: Table TABLE 9.4 - Capped Leave for Jan 2009 to Dec 2009 to Dec Jan 2009 for Leave 9.4 - Capped TABLE

472 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 Table 10.1: Details of Health Promotion and HIV/AIDS Programmes

Question Yes No Details, if yes

1. Has the department designated a member of the SMS to implement the provisions Yes Mrs T Govender, Senior Manager, contained in Part VI E of Chapter 1 of the Public Service Regulations, 2001? If so, Employee Wellness provide her/his name and position.

2. Does the department have a dedicated unit or have you designated specific staff Yes

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT members to promote health and well being of your employees? If so, indicate the number of employees who are involved

3. Has the department introduced an Employee Assistance or Health Promotion Yes EAP, HIV/AIDS in the workplace, OHS, Sport Programme for your employees? If so, indicate the key elements/services of the and Recreation, Spiritual Care programme

4. Has the department established (a) committee(s) as contemplated in Part VI E.5 (e) of Yes Govender T- EWP; Cafu M - EWP: COID; Chapter 1 of the Public Service Regulations, 2001? If so, please provide the names of the Soxunjwa P -SASAWU; Gxagxana Z - OHS Rep; members of the committee and the stakeholder(s) that they represent. Bongco ZB -SCM; Mjamba K - SPU; Tom Te -

473 HRD; Nano P - DENOSA; Tafeni Z - IGR; Mkalipi P EWP: OHS; Matu LF - EWP; Mxalisa ZH -EWP; Poyo N - NEHAWU; Charles J - ER Madikazi- HP; Putu N - HIV/AIDS; Mhlongo B - EHS; Kama N - INP; Mehlo - EMS

5. Has the department reviewed the employment policies and practices of your Yes HR Policies department to ensure that these do not unfairly discriminate against employees on the basis of their HIV status? 6. Has the department introduced measures to protect HIV-positive employees or those Yes Comprehensive HIV/AIDS Workplace perceived to be HIV-positive from discrimination? If so, list the key elements of these programme aligned to the NSP and DPSA EHW measures. Framework

7. Does the department encourage its employees to undergo Voluntary Counseling and Yes 13,9% prevalence rate Testing? If so, list the results that you have achieved.

8. Has the department developed measures/indicators to monitor & evaluate the impact of Yes Reporting system and indicators of blood your health promotion programme? If so, list these measures/indicators. pressure, blood sugar, cholesterol and BMI measured through health profile research and job saatisfaction and psychosocial indicators. 95 95 95 95 95 95 95 95 11 11 11 Total Total 9 0 0 10 33 13 35 100 9.1 100 90.9 of Total of Percentage Percentage of Total of Percentage 0 0 9 33 10 31 12 95 1 0 0 10 11 Date Number Number 0 0 Subject Matter Number of grievances addressed Number of grievances Outcomes of disciplinary hearings Not resolved Not resolved Resolved TOTAL Not Guilty / Insufficient evidence Dismissal TOTAL Verbal Warning Verbal Warning Written Warning Written Final Suspension Corrective Counselling Corrective TABLE 11.3 - Grievances Lodged 11.3 - Grievances TABLE TABLE 11.1 - Collective Agreements 11.1 - Collective TABLE TABLE 11.2 - Misconduct and Discipline Hearings Finalised 11.2 - Misconduct and Discipline TABLE

474 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2009/10 TABLE 12.1 - Training Needs identified

Occupational category Gender Total

Female Male

Legislators, senior officials & managers 345 122 467

Professionals 4312 2458 6770

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Technicians and associate professionals 2659 278 2937

Clerks 3006 392 3498

Artisans and trade labourers 10 57 67

Plant and Machinery Operators 368 186 554

Elementary occupations 380 122 502

TOTAL 11080 3615 14795 475

TABLE 12.2 - Training Provided

Occupational category Gender Total

Female Male

Legislators, senior officials & managers 165 34 199

Professionals 3497 2741 6238

Technicians and associate professionals 307 94 401

Clerks 3500 2922 6422

Artisans and trade labourers 26 110 136

Plant and Machinery Operators 104 1733 1837

Elementary occupations 2076 1345 3421

TOTAL 9675 8979 18654 TABLE 13.1 - Injury on Duty(New cases reported April 2009 - March 2010)

Nature of injury on duty Number % of total

Required basic medical attention only 178 67.2

Temporary Total Disablement 81 30.6

Permanent Disablement 1 0.4

- E ASTERN C APE D EPARTMENT 2009/10 A NNUAL R EPORT Fatal 5 1.9

Total 265 100

TABLE 14.1 - Report on consultant appointments using appropriated funds

BID NUMBER NAME OF DESCRIPTION AMOUNT SERVICE PROVIDER SERVICE/GOODS AWARDED

SCMU3-P08/09-00483 Neil Lavelott Technical Assistance in Asset R 499 968.00 476 Management for a period of 12 months

SCMU3-P09/10-0015 Sala-ukulandelwa Women's Trading Provision of assessment for AIDS R 450 984.00 training, testing, information and counselling centres SCMU3- Agency for Re-Innovation and Conducting of study to monitor R 1 347 480.00 Development adherence of TB Guidelines at all levels SCMU3-P09/10/0070 Council for health Service Accreditation Conducting extensive audits for legal R 136 087.50 of Southern Africa compliance in 20 selected primary health care facilities

SCMU3-P09/10/00124 The East London Institute for the Training of 102 NPO management staff R 296 574.00 Leadership Advance and Development in financial management

SCMU3-08/09-0281 SPF Info Shop Training of community Health Care R 10 133 674.30 Workers SCMU3-P09/10-00118 ELCB Analysis and data capturing of bids R 177 758.89

SCMU3-P09/10-00113 Ukhozi Consulting and Cleaning Service Performance Moderation for 150 PMDS R 150 500.00 members Fraud prevention line: 0800 701 701 24 hour Call Centre: 0800 032 364 Website: www.ecdoh.gov.za