NATIONAL DEPARTMENT OF HEALTH
National Health Insurance GrantSelect Committee on Appropriations
Hearing on 3rd and 4th Quarter Expenditure 4th June 2013
Index
• Background
• Provincial Expenditure Summaries (IYM) – Q3 and Q4 figures (incl. Province specific challenges)– Total Grant Expenditure
• Summary of challenges impacting on Expenditure
• Monitoring and Evaluation matters
• Way Forward 2Select Committee on Appropriations_4 June 2013
Background
• R150 million allocated for 2012/13 FY– Each pilot District received R11.5 million
• Focus:– To test innovations that are necessary for the
implementation of NHI
– To undertake health system strengthening initiatives in identified Districts
– To provide strategic resources for supporting the pilot Districts in implementing selected health service delivery interventions
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Eastern CapeQ3 and Q4 Expenditure (R’000)
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Eastern Cape: Challenges
• Provincial office delayed notification of the availability of funds to the District
• District capacity constraints – Lack of key HR in essential categories;– Inadequate technical support
• Supply Chain hurdles – Delays in getting approvals
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Free StateQ3 and Q4 Expenditure (R’000)
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Free State: Challenges
• Reprioritisation of funds allocated to activities
• SCM hurdles
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GautengQ3 and Q4 Expenditure (R’000)
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Gauteng: Challenges
• No support/guidance from relevant officials at Provincial Office
• Significant hurdles in procurement processes
• Delays in getting information on budget codes – Staff shortages in key areas
• Lack of ability to employ staff on long term basis using NHI-CG funding e.g. clinical staff, sessional doctors, etc.
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KZNQ3 and Q4 Expenditure (R’000)
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KZN: Challenges • Structural administrative process
– Bureaucratic processes that hamper innovation
• The process for obtaining signatures needs to be streamlined – Huge delays at Provincial office
• Limited delegations to allow for activities to be undertaken– District level delegations very limited
• Significant Supply Chain hurdles– Lack of clarity regarding long delays in getting necessary
approvals 11Select Committee on Appropriations_4 June 2013
LimpopoQ3 and Q4 Expenditure (R’000)
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Limpopo: Challenges • Challenges around budget matters
– Inappropriate / incorrect budget coding
• SCM hurdles – Significant delays in getting approvals
• Challenges in identifying relevant providers to undertake some activities due to limited database
• Technical and administrative support from Province inadequate
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MpumalangaQ3 and Q4 Expenditure (R’000)
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Mpumalanga: Challenges
• Majority of the DHMT not appointed– Too many vacancies to undertake activities
• Non-existent / limited delegations to allow for activities to be undertaken– District level delegations very limited
• SCM hurdles impacting on key activities
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Northern CapeQ3 and Q4 Expenditure (R’000)
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Northern Cape: Challenges• Delays in Provincial Treasury providing information
regarding availability of funds
• SCM hurdles
• Significant delays in getting necessary approvals and lack of technical support in key areas
• Challenges in identifying relevant providers to undertake some activities due to limited database
• Contextual factors also impact on programme:
– Majority of key staff complement based in Kimberley
• DHMT has limited delegations 17Select Committee on Appropriations_4 June 2013
North WestQ3 and Q4 Expenditure (R’000)
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North West: Challenges• Incorrect capturing of budget at Provincial level
– District submitted an incorrect business plan to Provincial Treasury
• Poor prioritisation of allocated funding– Need to reprioritise to other activities
• Lack of technical support in key areas– Need Provincial NHI Coordinator– Challenges in identifying relevant providers to undertake
some activities due to limited database
• Inability to spend on Infrastructure i.e. clinics, motor vehicles, etc
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Western Cape Q3 and Q4 Expenditure (R’000)
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Western Cape: Challenges
• Delays in finalising business plan impacted on progress– Approval only granted in August 2012
• Encountered some challenges in undertaking work around Governance arrangements at Community level i.e. CHCs
– Delays in getting a supporting legal opinion on the exact roles, responsibilities and functioning of Clinic Committees
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Summary of Quarter 3 Expenditure(R’000)
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Summary of Quarter 4 Expenditure(R’000)
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DORA: Implementation
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NATIONAL HEALTH INSURANCE GRANT
Province
R thousand
Eastern Cape 11 500 11 500 11 500 11 500 8 093 100.0% 70.4% 8 093 3 407 3 229 Free State 16 500 16 500 16 500 16 500 9 337 100.0% 56.6% 9 337 7 163 7 163 Gauteng 31 500 31 500 31 500 31 500 8 066 100.0% 25.6% 8 066 23 434 12 026 KwaZulu-Natal 33 000 33 000 33 000 33 000 16 127 100.0% 48.9% 16 127 16 873 14 949 Limpopo 11 500 11 500 11 500 11 500 4 118 100.0% 35.8% 4 118 7 382 6 382 Mpumalanga 11 500 11 500 11 500 11 500 5 570 100.0% 48.4% 5 570 5 930 325 Northern Cape 11 500 11 500 11 500 11 500 8 005 100.0% 69.6% 8 005 3 495 1 578 North West 11 500 11 500 11 500 11 500 8 818 100.0% 76.7% 8 818 2 682 2 084 Western Cape 11 500 11 500 11 500 11 500 9 885 100.0% 86.0% 9 885 1 615 1 615 Total 150 000 150 000 150 000 150 000 78 019 100.0% 52.0% 78 019 71 981 49 351
Preliminary (over)/under
Roll-Overs Requested
Division of Revenue Act, 2012 (Act No.
5 of 2012)
Total availablePayment
Schedule: Year to date
Received by province:
Year to date
Provincial actual
payments
% Transferred of national allocation
% Actual payments
of total available
Preliminary outcome for
financial year
Total Expenditure by Province (%) (April 2012 – 31 March 2013)
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NHI-CG Provincial Commitments/Roll-Overs
2012/13 Financial Year
PROVINCETOTAL NHI-CG ALLOCATION COMMITMENTS
COMMITMENTS AS PERCENTAGE OF TOTAL BUDGET
EC 11 500 000.00 3 229 000.00 28.1
FS 16 500 000.00 7 163 000.00 43.4
GP 31 500 000.00 12 026 000.00 38.2
LP 11 500 000.00 6 382 000.00 55.5
KZN 33 000 000.00 14 949 000.00 45.3
MPU 11 500 000.00 325 000.00 2.8
NC 11 500 000.00 1 578 000.00 13.7
NW 11 500 000.00 2 083 765.00 18.1
WC 11 500 000.00 1 615 000.00 14.0
NATIONAL 150 000 000.00 49 350 765.00 32.9
Summary Challenges• Weak HR capacity in some Districts
• Weak Provincial technical support
• Delays in budgets being communicated to some pilot sites
– Incorrect budget capturing
• Significant Supply Chain management challenges in many Districts
• Lack of necessary delegations to perform outlined activities
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Monitoring and Evaluation Matters • Monitoring and Evaluation undertaken by Grant Management Unit
and Directorate: NHI– Financial, Health Economics and Monitoring and Evaluation skills
appointed
• All Provinces have submitted Month on Month financial data– Used to compile IYM data
• Quarterly reports and meetings with all sites – Mutually identified shortfalls and challenges;– Mutually identified “quick win” activities and interventions; – Expedited Expenditure on commitments in approved Business Plans– Assessed progress on operational plans
• Prioritisation process
• Focus on quality spending– Evidence gathering
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Way Forward (1) • Inherent underperformance in early part of the
2012/13 cycle:– NHC Intervention resulted in improvement in Q3 and Q4
• DORA framework to adjust the purpose, focus activities and funding allocations to Provinces:– Allows NDOH a stronger and more interventionist approach:– Influences the scope of work to be undertaken at National
and pilot site levels:– Changes in allocations across Districts
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Way Forward (2) • For 2013/14, the grant has been split into 2 components:
– Direct: District piloting (Schedule 5)– In-kind: GP contracting and Central Hospitals work (Schedule 6A)
• New focus areas: – Strengthening SCM;– Supporting the roll-out of PHC streams and their role within the District
referral system;– Strengthening District level Monitoring and Evaluation capacity
• Mobilised funding for appointment of Provincial NHI Coordinators:– Majority appointed to post;– Assist in coordination, project management and Monitoring and
Evaluation functions 31Select Committee on Appropriations_4 June 2013
THANK YOU
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