FREE STATE PROVINCIAL GOVERNMENT

DEPARTMENT OF HEALTH

PORTFOLIO COMMITTEE ON HEALTH

BUDGET HEARINGS

APRIL 2001

VISION STATEMENT

A healthy and self reliant Free State community

MISSION STATEMENT

The Free State Department of Health provides a quality comprehensive health care services to the Free State community optimally utilises health care resources to provide a caring and compassionate service endeavours to empower and develop all personnel to the best of their potential

STRATEGIC THEMES

THEME 1: PROMOTING THE WELL BEING OF ALL THE

PEOPLE

THEME 2: MEETING COMMUNITY DEMANDS

THEME 3: RENDER QUALITY COMPREHENSIVE

AND AFFORDABLE HEALTH SERVICES AT ALL

LEVELS OF CARE

THEME 4: EMPOWERING AND DEVELOPING ALL PERSONNEL

AND THE RELEVANT STAKEHOLDERS

THEME 5: TRANSFORMING HEALTH SERVICES TOWARDS

PRIMARY HEALTH CARE FOUNDED ON DISTRICT

HEALTH SYSTEM

THEME 6: IMPROVING THE MANAGEMENT OF HEALTH

SERVICES

KEY STRATEGIC OBJECTIVES FROM THE STRATEGIC PLAN

STRATEGIC THEME 1

PROMOTING THE WELL BEING OF ALL THE PEOPLE

Implement an integrated health promotion strategy through an inter-sectoral approach

Increased interventions in HIV/AIDS– Voluntary Counseling and Testing– Mother to child transmission– Home-based care

Ensure improved management of Tuberculosis Implement and maintain a system for improved rural health Ensure the development and rendering of Environmental Health Services Ensure the implementation of an Integrated Nutrition Programme Ensure services are accessible to people with disabilities Ensure services are accessible to personnel

STRATEGIC THEME 2

MEETING COMMUNITY DEMANDS

Cultivate an Organisational Culture that is characterised by staff that are: – Proud of being health workers– Enjoy working for the department– Caring for colleagues and the clients

Improve Customer Satisfaction at all levels of service

STRATEGIC THEME 3

RENDER QUALITY COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES AT ALL LEVELS OF CARE

Render comprehensive health care services at the most appropriate level

Improve quality and efficiency of services rendered Render affordable and equitable services

STRATEGIC THEME 4

EMPOWERING AND DEVELOPING ALL PERSONNEL AND THE RELEVANT STAKEHOLDERS

Training in line with service needs Implement Interactive Distance Education and Learning Implement ,review, maintain and monitor the induction

programme Ensure availability of health professionals Develop and implement intervention strategies to address the

impact of HIV/AIDS on health personnel Empower the community (Hospital Boards and College

Councils)

STRATEGIC THEME 5

TRANSFORMING HEALTH SERVICES TOWARDS PRIMARY HEALTH CARE FOUNDED ON DISTRICT HEALTH SYSTEM

Implement District Health Authorities in line with the Provincial Health Act (Act 8 of 1999)

Implement District Health System in line with District Health Plan per district

Ensure an extended access to 24 hour health services in all districts

Ensure and render comprehensive maternal services to rural communities

Restructure and re-organise integrated psychiatric and mental health services according to the Mental Health Bill

STRATEGIC THEME 6

IMPROVING THE MANAGEMENT OF HEALTH SERVICES

Access to and use of management information Effective Financial Management Develop and maintain Human Resource Plan Public Private Partnership Strategic Planning Ensure sensitivity for gender issues International co-operation Implementation of the PFMA Service Level Agreements (Municipalities) Loss of cohesion in Top Management Rationalisation of services

FINANCIAL RESULTS

1997/1998 - R 141 MILLION OVER EXP - 9.28%

(BUDGET R 1,518 BILLION)

1998/1999 - R 98 MILLION OVER EXP - 5.95%

(BUDGET R 1,646 BILLION)

1999/2000 - R 135 MILLION UNDER EXP - 7.83%

(BUDGET R 1,724 BILLION)

2000/2001 - R 60,3 MILLION UNDER EXP - 3.28%

BUDGET R 1,833 BILLION

BUDGET AND MTEF

BUDGET 2001/2002 - R 1,880 BILLION

MTEF 2002/2003 - R 1,985 BILLION

MTEF 2003/2004 - R2,099 BILLION

REVENUE

REVENUEPROJECTED

2000/2001

ACTUALREVENUE2000/2001

VARIANCE % MTEF2001/02

MTEF2002/03

MTEF2003/04

PATIENTFEES

R31,8 mil 40 mil 8.2 mil 25.49 33 mil 35 mil 37.7 mil

OTHERREVENUE

4.7 mil 5.5 mil 765,000 16.28 5 mil 5 mil 5 mil

TOTAL 36.5 mil 45.5 mil 8.9 mil 24.31 38 mil 40 mil 42.7 mil

HOSPITAL AND OTHER CLINICAL SERVICES

Policy decisions that will be implemented this year– Implementation of EDL

– Strategic Physical Facilities Plan

Policy decisions intended for the MTEF period– Performance Agreements with Hospitals

– Implement District Health System together with local government in line with management plan and legislation

Significant problems and constraints faced in achieving key objectives

– Improve staff morale and attitudes

– Lack of specific skills - Bio-Engineering

The impact and usefulness of conditional grants– Support Outreach Programme

Issues relevant from National policy perspective– Quality Assurance and Accreditation for all hospitals using COHSASA Programme

Recommendations– Improved equity and access

PRIMARY HEALTH CARE PROGRAMMES

Policy decisions that will be implemented this year– High dose of Vit. A to woman after delivery– Feeding of learners at identified schools

Policy decisions intended for the MTEF period– Develop and implement provincial guidelines, capacity building strategies,monitoring tools

and Health Promotion Programs for all Primary Health Care programs

Significant problems and constraints faced in achieving key objectives

– The burden of HIV/AIDS and TB epidemics divert funds and other resources needed for transformation

The impact and usefulness of conditional grants– Grants for Integrated Nutrition Program utilised appropriately– Squezze of Central Hospital Grant.

Issues relevant from National policy perspective Develop and implement Primary Health Care packages for clinics

Estimated HIV/AIDS impact Prevalence of HIV remained the same as 1999 survey - plateau phase has been reached

Recommendations– Funding need to reflect the impact of the twin epidemics of HIV/AIDS and TB

TEACHING AND TRAINING

Policy decisions that will be implemented this year Strategic areas of training

– Adult Basic Education and Training programmes– Pharmaceutical services: Assistant Pharmacists– Radiographic services:Supplementary Radiographers– Nursing services: Assistant nurses on supernumerary to be trained as

professional nurses

Bursaries– Education and training of all health professional– Award bursaries to meet the needs of the Department

Training in line with Skills Development Act– Development of skills according to the needs of the Department

PSYCHIATRIC AND MENTAL HEALTH SERVICES

Policy decisions that will be implemented this year– District Psychiatric services– bed capacity at specific levels of care

Policy decisions intended for the MTEF period– Restructure District Psychiatric Services

Significant problems and constraints faced in achieving key objectives

– To appoint and retain Psychiatrists at Regional complexes

Recommendations– Restructure psychiatric services

TB SERVICES

Policy decisions that will be implemented this year– Improve management of TB statistics– Improve DOTS to decrease defaulter rate

Policy decisions intended for the MTEF period– Training of community doctors to manage TB– Hospitalisation of TB patients in district hospitals

Significant problems and constraints faced in achieving key objectives

– Financial and personnel constraints where additional beds need to be established

Issues relevant from National policy perspective– Coordination with HIV/AIDS program to decrease the impact on the TB

program

EMERGENCY MEDICAL SERVICE

Policy decisions that will be implemented this year– Maintain a quality Provincial Emergency Medical Service– Establish a Provincial Commuter Service (patient transport)

Policy decisions intended for the MTEF period– All patient transport to be accommodated within EMS sub-directorate– Training of 20% of staff to an advanced level

Significant problems and constraints faced in achieving key objectives

– Severe staff shortage if Conditions of Employment Act is implemented and the total staff establishment is not filled

Issues relevant from National policy perspective– Provincialisation of Emergency Medical Service (EMS)

Recommendations– Guidelines for EMS regarding personnel, equipment and vehicles to be

developed and implemented

SUPPORT SERVICES

Policy decisions that will be implemented this year– Implement Antifraud and Corruption system– Implement Monitoring and Evaluation system

Policy decisions intended for the MTEF period– Implement Transport and Fleet management policy– Unlocking resources within private sector for public sector delivery

Issues relevant from National policy perspective– Implement Antifraud and Corruption system – Implement PFMA– Implement Administrative Justice and Promotion of Access to Information

legislation as well as Employment Equity Plan– Ensure Batho Pele culture and attitude change

PERSONNEL

Shortage of key staff– All health and related professions and specialists

Development and implementation of staffing norms consistent with a strategic plan

– Provincial Human Resource Plan

Critical problem areas involving Human Resource issues requiring urgent attention from government as a whole

– Implement Departmental Performance Management System– Current rewards and incentives system is still protected by collective

agreements.– Training staff in new performance management system

KEY HEALTH PROBLEMS

Trends– HIV/ AIDS is stabilising

Health service interventions– Establishment of Health Promotion strategies– Promotion of advanced midwifery training– Establishment of Disease Outbreak Response Teams in every district– Implementation of Step-down facilities and Home-based care – Establishment of Victim support Centres and training– Implementation of Cervical Screening Programs in collaboration with

CANSA– Building capacity to manage HIV/AIDS patients at Primary Health Care level – Dissemination of information to the community using the media