Hospital Revitalisation Program

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Hospital Revitalisation Program

• Portfolio Committee
• 24 August 2005
• Dr Thabo Sibeko
• Chief Director Hospital Services
• Gert Steyn
• Director Hospital Revitalisation

2
Agenda

• Vision
• Purpose of Hospital Revitalisation Grant
• Process
• Brief overview of HRP Grant
• Methodology of Allocations
• Challenges
• Achievements
• Progress/Expenditure on Grant
• DoRA Conditions
• Project Management Unit
• Delay of Transfers
• Current and New Projects
• Photos

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Vision of Revitalised Hospital

• Good fully operational physical condition
• Deliver appropriate services
• to suit the populations needs
• levels of care provided
• Appropriate management system operating with
  appropriate delegations.
• Community structures to hold the hospitals
  accountable
• Appropriately equipped and resourced.
• Implementing and monitoring quality improvement
  programmes
• Equitable budget based on the population served
  and services delivered.

4
Vision of Revitalised Hospital

• Improve cost efficiency and effectiveness of
  hospitals
• Have in place sustainable Planned Preventative
  Maintenance and replacement programmes supported
  by
• appropriately qualified and trained staff
• technical resources.
• Implement all National policies.
• All health facilities will be part of a national
  health service and will operate within a
  rationalised referral system network.

5
Revitalise Hospitals
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6
REVITALISATION OF PUBLIC HOSPITALS
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Political Technical Guidance
Programme Management
Provide Technical Support
Overall provincial projects coordination and
management
Regional/ Local Facilitation of Project
Implementation process
Day to day management of project implementation
activities
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Purpose of HRP Grant

• Purpose
• To provide strategic funding to enable provinces
  to plan, manage, modernise, rationalise and
  transform the infrastructure, health technology,
  organizational management and development and
  monitoring and evaluation of hospitals in line
  with national policy objectives DoRA Act 1 of
  2005 Framework

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Process

• Provincial Responsibility
• Do prioritisation of hospitals to be revitalised
  in Province. Decisions to be made at provincial
  level
• Submit business cases according to required
  format
• Submit Project Implementation Plans according to
  required format
• Submit monthly financial and quarterly
  non-financial reports
• Implement all components of the HRP

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Process

• National Health Responsibility
• Prioritisation framework supplied, BUT province
  ultimately responsible for prioritisation
  outcome. National provides guidance on using
  system.
• Provide framework (PIM) for business cases,
  Project Implementation Plans (PIP)
• Appraise and formally approve business cases and
  PIPs
• Collect and analyse monthly and quarterly
  reports, combine into single report
• Monitor and evaluate performance on site for all
  projects
• Support provincial implementation

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Business Cases

• Provinces must submit business case to have
  project included in HRP
• Business case consists of 2 areas
• Strategic Context containing
• Strategic plan of province on health service
  delivery in hospitals
• Prioritisation of hospitals to be included based
  on
• Service delivery issues (Access to services,
  political risk, risk of delays, and other areas
  the province identifies)
• Financial issues (cost to correct, backlog of
  maintenance, condition)

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Business Cases

• 2. Priority Hospital
• Details with regard to site
• Size of hospital (beds by level of care)
• Specific details such as area per bed, cost per
  bed, admission rate, average length of stay)
• Cost
• Period of Construction
• Operational cost
• Staffing plan
• Health technology plan
• Quality Assurance plan
• Appraisal
• National Department of Health appraises all
  business cases to ensure strategic plan of
  province is adhered to and size, location, cost,
  sustainability and level of service adheres to
  National Guidelines

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Brief Overview

• MTEF Allocation

Province 2005/2006 2006/2007 2007/2008
Eastern Cape 157732 71666 102552
Free State 113082 128853 104360
Gauteng 17955 148664 133093
KwaZulu-Natal 128977 60940 81090
Limpopo 212918 123698 160690
Mpumalanga 57018 101032 117071
Northern Cape 69651 217464 234960
North West 98056 125493 106495
Western Cape 172038 202474 198987
TOTAL 1 027 427 1 180 284 1 239 298
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Methodology of Allocation

• Project/Needs based allocation
• Information utilised
• Approved business cases
• Expected cash flows per year (received from
  provinces)
• Number of active projects (currently minimum 4
  due to funding constraints)

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Methodology of Allocation

• Process to obtain available funds figure
• 2004/2005 DORA allocation amount
• ADD expected roll-over from 2003/2004
• SUBTRACT Expected expenditure for 2004/2005
• Result Expected Roll-over into 2005/2006 DoRA
  allocation

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Methodology of Allocation

• Provinces supplied expected expenditure over MTEF
  period (information from business cases and
  Project Implementation Plans)
• Expected Need calculated as follows
• Amount required for projects in provinces
• The allocation puts provinces in a favourable
  position where they will be able to spend the
  full allocation without having to cut on budget.

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Methodology of Allocation

• Allocation
• Need LESS 2004/2005 roll-over indicates 2005/2006
  allocation
• Process is repeated into outer years to determine
  allocation
• Allocation HEAVILY dependent on quality of
  information and prioritisation received from
  provinces.

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Challenges

• Delays in appointing contractors on site (public
  works related issues) ALL provinces reported
  various problems with public works
• Public Works Specific Examples
• Lebowakgomo, Jane Furse (LP) Tenders closed in
  Aug 2004, contract not yet awarded.
• Contracts awarded to inefficient contractors
  contractor awarded tender at Jane Furse after
  contractor went 80 over contract at other site.
  (LP)
• Contractor on 14 month contract at King George V
  was 6 months into contract, but already 3 months
  behind. Appeal followed, appellant received
  contract. (KZN) delayed by about 10 months
• Design/Architect/Engineers do not give input in
  design phase. Nothing from contractors
  questioned Everything goes (NC)
• Large contracts awarded to small contractors
  insufficient capacity, no capital to fund
  project, delays are inevitable. All provinces
  are troubled by this.
• Procurement Extremely slow 10 months to appoint
  completion contract at Frontier Hospital (EC)
• Lack of personnel to do quality checks on
  construction at regular intervals

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Challenges

• Provincial Capacity in Revitalisation
• Appointing Revitalisation Managers is slow
  process
• Most managers schooled in infrastructure very
  little capacity exists in Health Technology,
  Organisational Development and Quality Assurance.
• Reporting/Communication to and from provinces are
  ineffective and unreliable. Recommendation will
  be made shortly to increase accuracy, compliance
  and reliability at limited cost. Web page
  reporting model to be designed that will result
  in a more accurate, efficient data and compliance
  of HRP

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Achievements on Grant

• Progress
• 3 Hospitals finished
• Calvinia (NC) 35 Beds, District, R35m
• Colesberg (NC) 35 Beds, District, R35m
• Swartruggens (NW) 28 Beds, District, R39m
• Piet Retief (MP) 140 beds, District, R140m
• Hospitals to be completed in 2005/2006
• George (WC) 276 Beds, Regional, R78m
• Eben Donges (WC) 315 Beds, Regional, R213m
• Lebowakgomo (LP) 255 Beds, District, R105m
• Jane Furse (LP) 252 Beds, District, R110m
• Hospitals to be completed in 2006/2007
• Dilokong (LP) 244 Beds, District, R134m
• Nkenshani (LP) 290 Beds, District, R127m
• Vredenburg (WC) 80 Beds, District, R58m
• Barkley West (NC) 40 Beds, District, R40m

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Expenditure on Grant

• In 2004/2005 HRP spent 84 if KZN is excluded

KZN requested to return the allocation due to
extensive problems with Public Works
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DoRA Conditions

• All new projects commencing in 2005/06 must have
  business cases and project implementation plans
  approved before funds can be released for such
  projects
• Provincial strategic plans must include
  comprehensive hospital plans, which provide a
  framework in which business cases are
  subsequently developed
• Adhere to the process of approval of business
  plans for the 2006 MTEF

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DoRA Conditions

• Adherence to monitoring requirements
• National Department to strengthen grant
  management and capacity and business planning and
  reporting processes
• Provincial departmental strategic plans for
  2005/06 and over the MTEF to clearly indicate
  measurable objectives and performance targets as
  agreed with national department

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Project Management Unit
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Reason of Delaying Transfer
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Current and New projects
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Current and New projects
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Photos Jane Furse (LP)
Old Revitalised PMG note
Graphics not included
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Photos Dilokong (LP)
Old Revitalised PMG note
Graphics not included
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Photos Swartruggens (NW) PMG note Graphics
not included
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Photos Colesberg (NC) PMG note Graphics not
included
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Making a movie is like trying to grill a steak by
having a succession of people coming into a room
and breathing on it. Douglas Adams Should
progress in Revitalisation be as slow??
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Thank You
Together towards Revitalisation