Acting MEC for Health commits to improving operational efficiencies

20 August 2020

The Acting Gauteng MEC for Health Jacob Mamabolo has committed to improving operational efficiencies to ensure that the Department of Health moves with speed to deliver on its mandate. MEC Mamabolo said this whilst presenting the Gauteng Department of Health 2020/2021 Financial Year first quarter report to the Gauteng Health Portfolio Committee Virtual meeting held on Thursday, 20 August 2020.

“In the clinical services the big difficulty they have, which affect the core business of the Department is mainly the support services, if you look at infrastructure, medical devices, human resources, the maintenance of infrastructure, issues around linen and many other support items, clinical staff requires, if we were to address those we will go a long to improve operational efficiencies in the Department,” said MEC Mamabolo.

The first quarter performance coincided with the COVID-19 lockdown period which impacted on the uptake of services in a number of ways. Whilst creating a balance in the provision of essential services and addressing the pandemic, the Department has committed to making sure that the current global crisis due to the pandemic is not wasted by ensuring that there is acceleration of projects which will result in sustained improved service delivery platform for the benefit of the people of Gauteng. In a bid to improve its performance, the GDoH has implemented remedial strategies which are as follows:

Implementation of a modified model of care with a special focus on community-based provision of services/interventions e.g taking family planning, growth monitoring, immunizations to the community instead of facility-based provision;

Prioritisation of routine maternal and child health services, and facility visits are underway including strengthening of mortality surveillance;

Covid-19 related assessments will be carried out to check conformity to Covid-19 rules instead of Ideal Hospital Assessment;

Further investigations are being carried out to determine the causes of data discrepancies and assess progress on targeted interventions being implemented;

Districts were encouraged to provide integrated HIV, Aids and Sexually Transmitted Infections and Tuberculosis. (HAST) services that were integrating COVID-19 at health facilities and community settings daily;

HIV testing services will be monitored weekly to ensure adhering to catch-up plan that was developed. Daily target setting at health facilities and strengthen index testing daily were also done;

Investigations are underway to determine causes of deaths for both children due to pneumonia and diarrhea;

Strengthening of mortality and morbidity surveillance across all level of care;

In terms of addressing under and over expenditure, the Department will revise the Section 40 projections during the November adjustment budget process. The effect of lockdown on the overall performance of the organization which is largely demand driven has been unsatisfactory, and this is seen in the following:

The overall target performance of the first quarter is 53% and this shows a 11% decline from Q4 of 2019/20 financial year;

The volumes of patients that were seen in PHC facilities declined significantly by 26% compared to the same period in 2019/20;

During Q1 2020, the highest volumes of patients were seen in National Central Hospitals at 49% followed by Regional Hospitals at 27%;

The COVID-19 has impacted negatively on the implementation of prioritised projects such as the number of headcounts at hospitals and PHC facilities declined, acquisition and first implementation of Health Information Systems;

Priority programmes such as HAST and Maternal Child and Women’s Health (MCWH) were affected by traveling restriction of staff which resulted to low uptake of PHC services;

The number of deaths due to diarrhea and pneumonia was higher than expected in the first quarter.

Expenditure Patterns and its remedial actions: The reasons below are based on the section-40 projections v/s actual expenditure for the first quarter:

Administration: (Over-spending) - This programme is reporting projected overspending due to continued payment (s) of medico legal claims against the state and the effects of centralisation of the Covid-19 expenses within this programme;

District Health Services- There is due delays in filling of posts from funds set aside as a contribution towards Covid-19 Human Resource capacity from reprioritisation;

Emergency Medical Services: The delays in the creation and filling of posts also adversely affected this programme while e-Gov. worked on expediting outstanding mandates; • Provincial Hospital Services: –The effects of delays indicated in the previous programmes also adversely affected the financial performance of this programme as it relates to funds that were set aside through reprioritisation as a contribution towards Covid-19 Human Resource.

Central Hospital Services: – The reported less than anticipated spending arose as a result of the non-implementation of the cost of living adjustments that were anticipated with effect from the beginning of the financial year.;

Health Sciences and Training: There were delays in filling posts dedicated for the new Gauteng College of Nursing structure as a result of the effects of lockdown for the period under review which affected the performance of the programme;

Health Care Support Services: –There was a reported increase in costs due to the effect current gas contracts and the increased demand for laundry services and food service during lock down; Health Facilities Management: There was increased spending within this programme as the service delivery platform was being prepared to effectively respond to the effects of COVID -19. Generally, less patients were presenting at various facilities for the period under review which affected the spending patterns.

Despite all the challenges the Department noted an improvement in the percentage of Primary Health Care facilities with average waiting times below 100 minutes and Antiretroviral Therapy (ART) adults who remained in care increasing by 2% in the first quarter. There was an improvement in Maternal and Child Health programme in the following measurements, Antenatal Care (ANC) for first visit before 20 weeks and Severe Acute Malnutrition (SAM) retaining performance below the threshold of 7% and declined by 84%.

Issued by Gauteng Department of Health, 20 August 2020