EASTERN CAPE DEPARTMENT OF HEALTH

1
EASTERN CAPE DEPARTMENT OF HEALTH

• STRATEGIC PLAN 2003/4
• 15 April 2003

2
OVERVIEW

• The Departments Strategic Plan
• Aims to improve the health status of the Eastern
  Cape population through 8 programs with specific
  objectives, targets and indicators
• Is informed by the
• Epidemiological profile of the EC population
• Demand utilisation of health services
• Existing backlogs in service delivery
• Is aligned with the Ten Point Plan, Batho Pele,
  EC Provincial Growth and Development Strategic
  Plan and the Strategic Position Statement of the
  province

3
VISION

• A health service to the people in the Eastern
  Cape Province promoting a better quality of life
  for all.

4
MISION

• To provide and ensure accessible
  comprehensive integrated services in the Eastern
  Cape emphasizing the primary health care approach
  utilizing and developing all resources to enable
  all its present and future generation to enjoy
  health and quality of life.

5
VALUES

• The Department formulated a policy to ensure
  that all its residents have access to essential
  health services. The policy encapsulated the
  following VALUES
• Equity of both distribution and quality of
  services
• Service excellence including customer
  satisfaction
• Fair labour practices
• Good work ethic and a high degree of
  accountability
• Transparency demonstrated through consultations
  with all stakeholders in the health industry/field

6
Strategic goals and objectives of the Department
of Health

• Strategic Goal 1 Ensuring equitable access by
  all communities to essential package of services
  through DHS.
• Strategic Goal 2 Health services in the province
  meet quality standards.
• Strategic Goal 3 Communities throughout the
  province become active, responsible partners in
  health issues which affect them.
• Strategic Goal 4 Build capacity in the
  Department to support improved implementation of
  its goals.
• Strategic Goal 5 Effective utilization of the
  Departments finance and assets to achieve
  effective service delivery.

7
SECTORAL SITUATION ANALYSIS

• Size of the province 169,580 sq kms and is 13,9
  of the countrys land surface

Table A-1 Land area distribution by Province in
SA
Province EC FS GP KZN MP NC LP NW WC SA
KM2 169580 129480 17010 92100 79490 361830 123910 116320 129370 1 219 090
13.9 10.6 1.4 7.6 6.5 29.7 10.2 9.5 10.6 100
Source Pop census 1996
8
SECTORAL SITUATION ANALYSIS
Urban /Rural distribution Table A-4
Urban/Non-urban population distribution by
province (1996 census)
Province EC FS GP KZN MP NC LP NW WC SA
Urban 36.6 68.8 97 43.1 39.1 70.1 11 34.9 88.9 53.7
Non-urban 63.4 31.4 3 56.9 60.9 29.9 89 65.1 11.1 46.3
Source Pop census 1996
9
SECTORAL SITUATION ANALYSIS
District Health Services facilities by health
district
Health District Facility type No. Average population per facility
Alfred Nzo Clinics and CHCs 57 10789
Amatole Clinics and CHCs 255 7363
Cacadu Clinics and CHCs 98 4275
Chris Hani Clinics and CHCs 159 5846
N Mandela Clinics and CHCs 68 16136
O R Tambo Clinics and CHCs 163 11169
Ukhahlamba Clinics and CHCs 56 6636
Province Clinics and CHCs 856 8330
10
POPULATION PYRAMID COMPARING WESTERN AND EASTERN
REGIONS OF THE EC

11

Population by health district
HEALTH DISTRICT NUMBER SQ KM DENSITY
Alfred Nzo 614,973 8.6 8138.20 4.79 78.14
Amatole 1,877,565 26.3 23577.10 13.9 79.64
Cacadu 418,950 5.9 58244.00 34.3 7.19
Chris Hani 929,514 13 36963.70 21.8 25.15
N Mandela 1,097,248 15.4 1952.20 1.2 562.05
O R Tambo 1,820,547 25.5 15946 9.4 114.16
Ukhahlamba 371,616 5.2 26401.20 15.6 14.63
EC 7,130,480 100 169,580 100 41.95
Source Stats SA Mid-Year Population Estimates
2002
12
EPIDEMIOLOGY CHILD HEALTH

• MORBIDITY AND MORTALITY
• The IMR of 61.2 per 1000 live births is the
  highest in the country with the National figure
  of 45.2(SADHS 1998).
• The following conditions accounted for the high
  morbidity and mortality rates
• Diarrhoea
• HIV/AIDS
• Communicable diseases
• Malnutrition
• Tuberculosis
• Injuries and burns

13
WOMENS AND MATERNAL HEALTH (epidemiology cont)

• The provincial hospital maternal death rate was
  calculated at 133 maternal deaths per 100 000
  hospital deliveries.
• In 2000 108 deaths were reported and 53 of these
  were from the Eastern regions. These occurred in
  the public hospitals only.
• 32 of reported maternal deaths were
  primigravidas.
• The recent review of maternal deaths identified
  AIDS as the most common cause of maternal deaths
  at all levels of care in SA.

14
EPIDEMIOLOGY CONT MEDICAL CONDITIONS

• 1. TB Prevalence in the Eastern Cape
• There has been a dramatic rise in TB cases from
  mid-1980s and this rise is directly associated
  with HIV and improved case-finding.
• TB cases reported
• 2000 2001
• 28428 30010
• TB patients accounted for 10.2 of all medical
  admissions
• This can be attributes to improved case finding

15
ACHIEVEMENTS

• Significant improvement in the hospital
  revitalization and rehabilitation programme
• From 1994 to date the following health facilities
  have been constructed
• Completion of Nelson Mandela and its readiness to
  admit patients by the 1st of September 2003.
• Clinics
  130
  
• Community Health Centres
  5
  
• Hospital OPDs
  16
• Academic Health Resource Centres
  3

16
ACHIEVEMENTS CONT

• An increase in the utilization of primary health
  care services of 2,287,069 between 1998 an1999.
  this is increasing yearly.
• Management and Administration of the Department
  has been significantly improved through filling
  of critical posts, recruitment and appointment of
  suitable qualified personnel in all fields.
• Leave gratuities
• 90 of backlog cleared.

17
ACHIEVEMENTS CONT

• Ante-natal care (ANC) has been offered five days
  a week in 80 of clinics in 1999, a remarkable
  increase from the baseline survey when only half
  of all clinics were providing the service for the
  five working days.
• The utilization of the 9 HIV/AIDS National Policy
  Guidelines

18
ACHIEVEMENTS CONT

• Appointment of CEOs in all the Provincial/Regional
  Hospitals
• Formation of a Provincial Hospitals Coordinating
  Committee
• Implementation of the deinstitutionalization
  programme in mental health.
• PFMA Implementation with ECDOH moving to the
  third position in the Province in terms of the
  PFMA compliance matrix applied by Provincial
  Treasury

19
ACHIEVEMENTS CONT

• Budget Review Process
• Quarterly budget reviews with all
  institutions are held by the ECDOH. This has
  improved the monitoring process.
• Policy for nursing education (Nursing Education
  Bill) to assist with the rationalization of
  nursing education has been formulated and
  submitted to the legislature.
• Continuous research is taking place with yearly
  conferences to share results
• Nursing Education Bill with the Legislature

20
BUDGET
Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million) Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million) Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million) Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million) Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million) Table 1 Trends in provincial public health expenditure by budget programme in current prices (R million)
Programme 2001/02 (actual) 2002/03 (estimate) 2003/04 (budget2) 2004/05 (MTEF projection) 2005/06 (MTEF projection)
Administration 168,947 532,443 273,426 288,692 310,006
District Health Services 2,124,751 2,155,833 2,252,759 2,523,756 2,725,766
Emergency Medical Services 87,314 119,488 364,774 385,110 412,861
Provincial Hospital Services 1,237,958 1,171,894 1,736,779 2,053,528 2,306,945
Health Sciences and Training 76,756 15,531 63,690 67,053 72,561
Health Care Support Services 6,765 7,642 15,197 15,992 17,130
Health Facilities Management 189,962 349,370 411,261 377,026 469,046
Total DOH 3,892,453 4,352,201 5,117,886 5,711,157 6,314,315
Municipal own expenditure 4 4 4 5 5
Department of Public Works 27 28 30 31 33
Total (R million) 3,892,484 4,352,233 5,117,920 5,711,193 6,314,352
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RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• Please indicate the total health allocation in
  2002/03

R'000
Original Budget 2002/03 3,916,824
Roll-over from 2001/02 298,425
Additional funds allocated in Adjustments Budget 345,677
Total Allocation for 2002/03 4,560,926
22
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
2. What was the percentage real increase between
02/03 and 03/04?
Original Budget Adjusted Rands
R'000 R'000
Budget 2002/03 3,916,824 3,916,824
Budget 2003/04 5,117,886 4,804,376
Difference 1,201,062 887,552
increase 30.66 22.66
23
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
3. What was the total overspending, if any,
specify reasons. No over-expenditure was
incurred. 4. What was the total underspending, if
any, specify reasons.
R'000
Total Allocation for 2002/03 4,560,926
This is the total represents the net effect of the total under spent by the department of which the main underspending is in infrastructure.
This is the total represents the net effect of the total under spent by the department of which the main underspending is in infrastructure.
This is the total represents the net effect of the total under spent by the department of which the main underspending is in infrastructure.
This is the total represents the net effect of the total under spent by the department of which the main underspending is in infrastructure.
Total 62,800
under spent 1.38
Please note that the above figures are
provisional as the books were not closed at the
time the figures were prepared however, it is
likely that there will no under-expenditure.
24
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
5.Provide variance by programme between budgeted
allocation and actual expenditure for 2002/03
Adjusted Budget Est Actual Variance
R'000 R'000 R'000
Health Administration 242,451 242,451 0,00
District Health Services 2,391,815 2,363,455 -28,360
Provincial Hospital Services 1,405,410 1,405,410 0,00
Academic Health Services 88,756 95,139 -6,383
Health Sciences 48,688 50,136 -1,448
Health Care Support Services 9,231 9,168 63
Health Facilities Development and Maintenance 402,935 302,443 100,492
Total 4,560,926 4,498,126 62,800
25
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
6. Which health programme has received the
highest budget increase within 02/03? Provide the
reason for this. Programme 1 Health
Administration received the highest budget
increase in the 2002/03 financial year. The
reason the Personnel Budget for Critical posts
was managed under this programme Management
contract to be outsourced and managed in this
programme Increase R46,137m or 23.69 7. Which
programme has received the least increase, please
indicate why? Programme 6 Health Care Support
Services received the least budget increase in
the 2002/03 financial year The reason
Increase R70,000 or 0.75 is insufficient
budget.
26
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
8.Indicate the proportion of the budget that is
spent on personnel.
2002/03 R000 2003/04 R'000
Budget (excluding transfers) 3,947,148 4,307,850
Personnel budget 2,538,045 2,928,542
Portion of budget 64 68
27
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
9.What proportion of your 02/03 budget was
transferred to Local Government 3.06 or R143m -
proportion of the 2002/03 budget was transferred
to Local Government 10. What was the total
amount received in Donor funding, and provide a
breakdown of how the money was disbursed and
spent and the criteria used for making the
allocations. This department did not receive any
direct or Cash donor funding for the 2002/03
financial year, however the Equity Project, which
is funded by USAID, has provided technical
support, training, equipment and donated 22
vehicles with a total value of R24m
28
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 11. Give proportion of budget spending on
  personnel
• The proportion of personnel spending is
  R2,537,368 or 54.74 of the adjusted budget for
  2002/3
• 12. Give proportion of budget spent on district
  health services
• The proportion of the budget spent on
  district health services is R2,391,815or 52.44
  of the adjusted budget for 2002/3
• 13. Give proportion spent on Community Health
  Services and primary health services
• The proportion of the budget spent on
  community health services and primary health
  services is R1,053,338m or 44,56 of the adjusted
  budget for 2002/3.

29
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 14. How does the budget accommodate the
  provision of free care to the Disabled as
  announced by the President on 14 February 2003
• The Department is currently assessing the
  budgetary implications of the policy
• 15. What proportion of the Provincial Budget
  does health account for?
• The Eastern Cape Department of Health
  Budget was 17.49 for the 2002/03 and 18.32 for
  the 2003/04 financial year of the Eastern Cape
  Provincial Budget

30
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
16. Based on the 2003/04 budget allocation what
is your per capita budget allocation
Expenditure per capita for the Eastern Cape Department of Health 2003/04 Expenditure per capita for the Eastern Cape Department of Health 2003/04 Expenditure per capita for the Eastern Cape Department of Health 2003/04 Expenditure per capita for the Eastern Cape Department of Health 2003/04
Population 7,130,4801    
Per capita (total Budget) R717,75 Per Capita (Excluding Conditional Grants R634,71
In terms of the Inter Governmental Fiscal Review
(IGFR) 2003 this province at R769.00 received the
third lowest per capita allocation in South
Africa. 1 Source STATS SA Mid Year Population
Estimates 2002
31
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• CONDITIONAL GRANTS
• 17.Give the overall HIV/Aids budget allocations
  for 2003/04 and the percentage increase from
  2002/03
• The overall HIV/AIDS budget for 2003/04 is
  R71,934m which is a 17.46 increase from 2002/03
  

32
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
18. Provide variance for 2002/03 between
allocated budget and actual expenditure
Conditional Grant Total Allocation (Including Roll-overs) R000 Estimated Actual Expenditure R000 Variance R000
Central hospitals
National tertiary services 145,506 133,187 12,319
Health Professions training research 88,917 89,188 -271
HIV/AIDS 28,253 24,758 3,495
Hospital rehabilitation 109,586 130,828 -21,242
Integrated Nutrition Programme 168,063 135,463 32,600
Hospital Management Improvement 9,333 5,916 3,417
Total 549,658 519,340 30,318
33
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
19. The Eastern Cape Province breakdown of HIV
budget is (R000)
Health Grant Education Grant Social Development Grant
Eastern Cape 38,934 22,288 6,658

• The Health HIV/AIDS grant is for the following
  programmatic interventions
• VCT
• HBC
• PMTCT
• Step-down care
• Provincial Management
• Non-occupational post-exposure prophylaxis
• Commercial sex workers
• Centre of Excellence
• The Education Grant is for life skills education
  and the Social Development Grant for HBC

34
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 20. The following initiatives from the National
  Department of Health will assist with provincial
  implementation and improve the capacity to spend
• Appointment of coordinators and administrative
  staff in the key programmes VCT, HBC and PMTCT.
• Training of master trainers for VCT, Home Based
  care to fast track training
• Appropriate VCT guidelines were developed and
  distributed.
• Decentralization of funds to Districts and
  Hospitals

35
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 21. Areas that have experienced under spending in
  the last financial year and the reasons therefore
• Infrastructure Procurement of equipment
• Maintenance and
  intervention funds and roll-overs were only
  received in August 2002. Lack of trained artisans
  in institutions.
• Personnel An additional amount of R41,288 for
  critical post was not able to attract external
  applicants
• Grants the under spending occurred mainly on the
  Integrated Nutrition Programme grant owing to
  changes in the implementation structure and a
  roll over amount of R36m from the previous
  financial year.

36
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 22. An allocation was made for the provision of
  step-down facilities, please provide a progress
  report also indication how much of the allocation
  was spent
• The Eastern Cape Department of Health
  spent R1,314,077 on the provision of step-down
  facilities.

37
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS
29. Inter provincial inequity remains a major
area of concern- how is the Department addressing
this The department address this by interacting
with the NDoH who engages the National Treasury
and through the Provincial Budget Committee this
is being addressed 30. Intra- provincial
inequity still persist how is the Department
working to ensure a more equitable distribution
of funds especially at district and sub-district
level. The allocation of budget is based on the
HTP (that took equity into consideration)
38
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 31. Areas of the budget and the budget process,
  where the
• Department might require assistance / advocacy of
  the
• Committee in facilitating the necessary changes.
• It may be necessary in addressing the inequity in
  per capita
• allocation especially because of the historical
  circumstances and
• geographic nature (mostly rural with poor
  infrastructure).
• 32. Provide the number of district management
  posts and how
• many are filled provide reasons for vacancies
• There are 25 District Management posts of which
  20 are filled. The
• reason for the vacancies is that the department
  restructured the
• number of districts from 21 to 25 and had to
  change and load
• the new structure.

39
RESPONSES TO QUESTIONS POSED BY THE NATIONAL
ASSEMBLY PORTFOLIO COMMITTEE ON HEALTHPROVINCIAL
QUESTIONS

• 33. What guides your district and sub-district
  budget
• allocation e.g. formula etc.
• The allocation for district and sub-district is
  based on
• the results of the Hospital Transformation
  Project
• recommended establishments (based on equity
  considerations).
• 34. What steps have been put in place to
  facilitate
• implementation of the rural incentive scheme?
• The department has identified the areas and
  commenced with
• payments to the nursing staff only.

40
MAJOR HEALTH CHALLENGES

• Escalating HIV/AIDS
• Escalating TB prevalence
• Brain drain of health professionals especially
  doctors and nurses to countries like UK and Saudi
  Arabia. Presently the doctor patient ratio is 1
  per 3000.
• Low immunization coverage
• Legislative reforms influenced by cultural
  factors e.g. circumcision, and recognition of
  alternative medicine including traditional healing

41
MAJOR HEALTH CHALLENGES CONT

• Escalating crime calling for more security for
  staff working in primary health care facilities,
  establishment of crisis centers and counseling
  facilities for victims of abuse as well as
  calling for more collaborative endeavors with
  other sectors
• The impact of increased motor vehicle accidents
  on Emergency Medical services and other services
• Backlog in health facilities development
• High Infant and Maternal mortality

42
PRIORITIES FOR 2003/4

• To manage and improve health outcomes for
  HIV/AIDS, STDs and TB
• To reduce infant and child mortality
• To control communicable diseases
• To develop the district health system and the
  delivery of the PHC Package
• To improve emergency and patient transport
• To improve logistical and other support
• To implement the hospital revitalization
  programme
• To improve capacity and access to regional and
  tertiary services in the province
• To develop human resources for quality management
  and service delivery

43
SERVICE DELIVERY PROGRAMMES

• The core services of the department is driven
  through PROGRAMMES 2 DISTRICT HEALTH and 4
  PROVINCIAL HOSPITAL SERVICES with the remainder
  of the departments programmes offering the
  necessary support.
• There is an overlap between programmes in the
  provision of services which means that some
  interventions will not have specific budgets as
  they cut across the board

44
SERVICE DELIVERY PROGRAMMES CONT

• 1. PROGRAMME 2
• AIM TO DEVELOP AND SUPPORT DISTRICT HEALTH
  SERVICES
• BUDGET (000)
• 2003/4 2004/5
  2005/6
• R2,252,759 R2,523,756
  R2,725,766
• SUBPROGRAMMES
• District management
• Community Health Clinic Services
• Community Health Centers
• Community Based services
• Other Community Services
• HIV/AIDS
  
• Nutrition
• District Hospitals
  

45
SERVICE DELIVERY PROGRAMMES CONT

• 2.PROGRAMME 4
• AIM To provide cost effective, good
  quality, high level specialized services to the
  people of the Eastern Cape in collaboration with
  the Health Sciences Faculties
• BUDGET (000)
• 2003/4 2004/5
  2005/6
• R1,736,779 R2,053,528
  R2,306,945
• SUBPROGRAMMES
• General Hospitals
• T.B. Hospitals
• Psychiatric/Mental Hospitals

46
HIV/AIDS

• BUDGET (000)
• 2003/4 2004/5
  2005/6
• R70,947 R92,988
  114,111
• IMPROVED MANAGEMENT OF HIV/AIDS EPIDEMIC
• IMPROVE ACCESS TO VCT BY INCREASING NUMBER OF
  TESTING SITES BY 30
• IMPLEMENT POST EXPOSURE PROPHYLAXIS FOR RAPE
  SURVIVORS
• EXPAND PMTCT PROGRAMME
• IMPROVE CARE AND SUPPORT FOR PEOPLE INFECTED WITH
  AND AFFECTED BY AIDS/HIV

47
HIV/AIDSCONT

• COMMUNITY INVOLVEMENT IN HIV AIDS MANAGEMENT
  THROUGH AIDS COUNCILS
• PROVIDE SERVICES TO VULNERABLE GROUPS(CSW)
• PROVIDE CONTINUUM OF QUALITY CARE THROUGH
  PROVISION OF STEP DOWN CARE IN DESIGNATED
  HOSPITALS
• SET UP CENTRE OF EXCELLENCE IN PARTNERSHIP WITH A
  MEDICAL SCHOOL TO PROVIDE MODELS OF PREVENTION
  TREATMENT AND RESEARCH

48
TB PROGRAMME

• REDUCE THE MORTALITY AND MORBIDITY OF TB
• INCREASE TB CURE RATE BY
• IMPROVING AND MONITORING DRUG SUPPLY
• INCREASE CASE DETECTION BY SMEAR MICROSCOPY AMONG
  ALL TB SUSPECTS TO 80
• IMPROVE MDR PROGRAMME
• DECREASE TREATMENT INTERRUPTION
• EXPAND DIRECT OBSERVED TREATMENT SHORT COURSE
• FINALIZE TB ADVOCACY PLAN FOR EASTERN CAPE

49
REDUCE INFANT MORTALITY

• DECREASE IMR FROM 61,5 TO 40 PER 1000 LIVE BIRTHS
  IN 2006
• INTERVENTIONS PLANNED
• IMPROVE IMMUNISATION COVERAGE TO 85 IN 2005/6
• IMPROVE ACCESS TO PRIMARY HEALTH CARE FACILITIES
• PREVENTION OF MOTHER TO CHILD TRANSMISSION OF
  HIV/AIDS
• MANAGEMENT AND FOLLOW UP OF CHILDREN WITH
  HIV/AIDS
• IMPLEMENTATION OF INTEGRATED MANAGEMENT OF
  CHILDHOOD ILLNESSES

50
INTEGRATED NUTRITION PROGRAM

• BUDGET(000)
• 2003/4 2004/5
  2005/6
• R172,465 R202,698
  R222,133
• DECREASE MORBIDITY AND MORTALITY THROUGH
  STRATEGIC INTERVENTIONS TO PREVENT AND MANAGE
  MALNUTRITION.
• 
  INTERVENTIONS
• INTENSIFY IMPLEMENTATION OF INP AS GUIDED BY THE
  UNICEF
• CONCEPTUAL FRAMEWORK AND THE TRIPLE A
  APPROACH.
• PROMOTE COMMUNITY BASED GROWTH MONITORING.
• STRENGTHEN NUTRITION INTERVENTIONS AT HEALTH
  FACILITY AND COMMUNITY LEVELS, AND REHABILITATE
  MALNOURISHED CHILDREN.
• TO WORK WITH OTHER SECTORS IN TACKLING THE ROOT
  CAUSES OF MALNUTRITION AND POVERTY.
• FACILITATE TRANSFER OF PSNP TO THE DEPARTMENT OF
  EDUCATION

51
PROFESSIONAL HR RETENTION STRATEGY

• ENSURE ATTRACTION AND RETENTION
  OF
• PROFFESSIONAL
  STAFF
• DEVELOPMENT OF
  INCENTIVES
• PROVISION OF ACCOMMODATION FOR DOCTORS
• INDUCTION PROGRAMMES FOR COMMUNITY SERVICE STAFF
  AND INTERNS
• CREATION OF SENIOR POSTS PROMOTION OF DOCTORS TO
  HIGHER POSTS
• FILLING OF CRITICAL POSTS
• UTILISATION OF THE GRANT TO ATTRACT AND RETAIN
  STAFF
• INTENSIVE MARKETING OF THE PROVINCE

52
LEGISLATIVE REFORM

• BUDGET(000)
• 2003/4 2004/5 2005/6
• R282
• PRORITY FOR 2003/4 F/Y IS THENURSING EDUCATION
  ACT WHICH IS GOING TO GOVERN RATIONALISATION OF
  NURSING EDUCATION

53
REDUCE MATERNAL MORBIDITY AND MORTALITY

• BUDGET BOTH IN PROGRAMME 2,4 AND HPTD GRANT
• ENSURE THAT THE MMR FOR F/Y 2003/4 IS REDUCED
  FROM 133 TO 110 DEATHS PER 100 000.
• 
  INTERVENTIONS
• INCREASE LEVEL OF REPORTING AND SURVELLIANCE ON
  MATERNAL DEATHS
• IMPLEMENTATION OF MATERNAL HEALTH GUIDELINES
• INCREASE ACCESS TO MATERNAL SERVICES
• EXPAND TOP SERVICES

54
DISTRICT HEALTH SERVICES

• DELEGATION OF PRIMARY HEALTH CARE SERVICES TO THE
  DISTRICT MUNICIPALITIES.
• DEVELOPMENT AND IMPLEMENTATION OF INTEGRATED
  PLANNING IN THE DISTRICT
• CLUSTERING OF DISTRICT HOSPITALS
• DEVELOPMENT OF CLINICAL PROGRAM TO SUPPORT THE
  DISTRICT HOSPITALS (WITH SPECIALISTS SUPPORT FROM
  THE COMPLEXES AND THE FLYING DOCTORS PROGRAM)

55
PRIMARY HEALTH CARE SERVICE DELIVERY PLAN

• IMPROVE ACCESS TO PRIMARY HEALTH CARE
  SERVICES
• 
  INTERVENTIONS
• INCREASE UTILIZATION RATE BY INCREASING NUMBER OF
  FACILIITIES
• MONITOR POPULATION SERVED PER FIXED CLINIC TO
  ENSURE THAT IT FITS IT WITH THE NORMS AND PUT IN
  REMEDIAL ACTION AS NEEDED
• ENSURE INCREAS IN NUMBER OF NURSES PER PUBLIC PHC
  PER 1000 PEOPLE
• MONITOR DHS EXPENDITURE PER PERSON
• INCREASE PERCENTAGE OF FIXED PHC FACILITIES WITH
  FUNCTIONING COMMUNITY PARTICIPATION STRUCTURES
  

56
IMPROVEMENT OF EMERGENCY SERVICE DELIVERY

• BUDGET(000)
• 2003/4
  2004/5 2005/6
• R364,774
  R385,110 R412,861
• IMPROVE ACCESS TO
  EMERGENCY CARE
  
• 
  INTERVENTIONS
• FILLING OF VACANT POSTS WHICH WILL ENABLE THE
  SERVICE TO PROVIDE TWO MEN AMBULANCE CREWS WHICH
  ARE MORE EFFICIENT
• REDUCE RESPONSE TIME BY INCREASING CREW NUMBERS
  AND VEHICLES HENCE REDUCING MORBIDITY AND
  MORTALITY
• IMPLEMENT AEROMEDICAL EVACUATION PROGRAM TO
  OVERCOME THE PROBLEM OF INACCESSIBILITY IN
  CERTAIN RURAL AREAS.
• INCREASE THE NUMBER OF STAFF TRAINED IN ADVANCED
  LIFE SUPPORT

57
PROVINCIAL HOSPITALS

• BUDGET(000)
• 2003/4
  2004/5 2005/6
• R1,373,953
  R1,636,737 R1,798,376
• TO PROVIDE COST EFFECTIVE, GOOD QUALITY,
  HIGH LEVEL SPECIALISED SERVICES
• 
  INTERVENTIONS
• OPEN NELSON MANDELA ACADEMIC HOSPITAL ON 1ST OF
  SEPTEMBER
• STRENGTHEN HOSPITAL MANAGEMENT AND ORGANISATIONAL
  DEVELOPMENT
• IMPLEMENT RATIONALIZATION PROPOSAL
• IMPROVE IMPLEMENTATION OF REVITALISATION OF
  HOSPITAL SERVICES PROGRAMME
• UTILISATION OF THE HPTD GRANT TO TRAIN DOCTORS IN
  SPECIALISED SERVICES.

58
PSYCHIATRIC/MENTAL HOSPITALS

• BUDGET(000)
• 2003/4 2004/5
  2005/6
• R268,114 R316,869
  R402,652
• TO PROVIDE COST EFFECTIVE, INTEGRATED AND
  HIGH QUALITY SPECIALIZED SERVICES TO THE PEOPLE
  OF THE EASTERN CAPE
• INTERVENTIONS
• IMPLEMENT LEGISLATIVE FRAMEWORK
• RATIONALISE PSYCHIATRIC SERVICES
• DEINSTITUTIONALIZE OF MENTAL HEALTH PATIENTS
• IMPROVE ACCESS TO MENTAL HEALTH SERVICES
  ESPECIALLY IN RURAL AREAS
• ESTABLISH MENTAL HEALTH REVIEW BOARDS

59
PHARMACEUTICAL SERVICES

• Facilitate the training of Pharmacist's
  Assistants such that all Pharmacies are manned by
  this mid-level health worker.
• Recruitment and retention of Community Service
  Pharmacists to areas of greatest need.
• Monitoring of drug availability on a regular
  basis.
• Monitor drug expenditure at all levels.
• Implement a Public Private Partnership (PPP) for
  management support and Distribution of
  pharmaceutical and surgical supplies.

60
MANAGEMENT AND DEVELOPMENT OF INFRASTRUCTURE

• BUDGET(000)
• 2003/4 2004/5
  2005/6
• R411,261 R377,026
  R469,046
• TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY
  PROVIDING NEW HEALTH FACILITIES, UPGRADING AND
  MAINTAINING EXISTING FACILITIES.
• INTERVENTIONS
• COMPLETION OF 26 CLINICS
• ADVANCE PLANNING IN CAPEX PROGRAMMES.
• IMPLEMENTATION OF PROJECT MANAGEMENT TO IMPROVE
  MAINTENANCE OF FACILITIES