This Operational Plan has been prepared based on the broad direction of the Annual Performance Plan.  For this coming financial year the department will focus amongst other things the following projects:

Building the District Health System and Primary Health Care Approach

One of the Strategic Goals that the department is to implement is an effective service delivery platform through the District Health System based on the Primary Health Care approach and seamless referral system.  

In realizing this goal, the Department is currently focusing on strengthening the capacity of the District Health System in order to ensure the effective implementation of the priority health programmes, and to strengthen Primary Health Care.

This financial year the Department will continue to implement the Project of Clinics as Centres of Excellence to improve the functionality of Primary Health Care.  The target has been increased from 25 clinics to 50, reaching 200 clinics by 2010.

In terms of the Community Health Centres that are suppose to be operating on 24hour bases, the Department has identified 30 Community Health Centres throughout the province, to assist and monitor them to operate at a functional and effective optimum.  Similarly, they will operate as Centres of Excellence in the provision of 24hr services.  This number will eventually rise to include all our Community Health Centres by the year 2010.

With regards District Hospitals, which are also part of the Primary Health Care approach, the Department has identified 25 District Hospitals to be assisted to perform at a higher level of functionality and effectiveness.

Similarly, our Regional Hospitals, as well as Specialised and Tertiary Hospitals will undergo a turnaround so that we can intensify our efforts towards improving access, and the quest for quality health care.

Improving maternal health and reduce child mortality:-

We remain concerned about the high levels of maternal deaths and infant mortality.  We introduced an intervention in the last financial year in the form of the Saving Mothers, Saving Babies Project in an attempt to reduce maternal and infant mortality. Twenty district hospitals are implementing this programme.  More still needs to be done to reduce these mortalities and ensure that all new mothers and their babies enjoy an environment that is comfortable, safe and friendly.

       HIV and AIDS 

Our commitment to halt the spread of HIV and AIDS remains.  The Department is going to be working very hard this year with our partners and within the context of the National Strategic Plan on HIV and AIDS, to stop new infections especially among the young people.  The management of the Aids pandemic through the comprehensive plan remains our priority.  In improving health outcomes and better quality of life, particularly, addressing the HIV and Aids pandemic.

For this financial year, the Department has budgeted an amount of R299,420m with the following targets:-

a.   Decreasing the number of new infections by 5% and reach 20% prevalence by 2010.
b.   Upscalling treatment of patients on ARV to 40 000 next year and rising to between 80 000 and 100 000 by 2010

c.    Number of Facilities providing VCT will be increased from 803 to 834 to 754 and to cover all our facilities by 2010.

d.    Number of patients accessing Home Based Care will be increased from 121 482 to 150 000.

e.    Number of Home Based Care givers to be increased to 1000 by 2010.  This number is to integrate TB Dots and other similar categories including Health promoters.

       Tuberculosis (TB) Management:-

TB has reached crisis proportions in the country and in the Province.  Our crisis plan is focussing on three districts, i.e. Nelson Mandela, Amathole and O.R Tambo Districts because of their high number of cases. Our minimum cure rate must reach 50% by the end of the financial year.  All efforts will be made to mobilise all sectors of our communities to increase awareness about TB, and the dangers of TB, especially the extreme-multidrug-resistant strain know as MDR or XDR.  It is also important to emphasise that TB is curable.

For this financial year the Department has set the following targets:-

a)     Increase awareness and advocacy campaigns about TB and Multi and Extreme Drug resistant TB to all the communities of the Province.
b)     Improve and strengthen management of specimen transportation to improve sputum turn around time by ensuring that results of patients sputum be made available within 48hours instead of 72 hours.

c)     Implement rapid assessment of MDR & XDR -TB case finding (test all MDR-TB cases for second line drug resistance)

d)      Increase the number of TB patient counselled & tested for HIV from 16 000 to 17 000.

e)      Increase the percentage of new smear positive PTB cases cured at first attempt from 50% to 60%.

It must also be recognized that the Department also runs TB Hospitals, and has TB wards in general hospitals which allow for the treatment of TB.  The Budget for these is R147 million.  There is also donor funding for TB to the amount of R2 million.  Furthermore, because of co-infection, TB is included in the funding for treatment of HIV and AIDS.  The budget from HIV and AIDS because of co-infection is R 8m, from the expanded public works programme.  The department is providing stipends to 1422 dots, supporters for an amount of 17,64 million and the overall budget to address the crisis is R180,64 million.

      Building efficient and effective Emergency Medical Services:-

The department will continue implementing the EMS Turnaround Strategy to improve emergency medical services and patient transport. During this financial year, the Department will:-

      concentrate on the effective functioning of emergency medical services and patient transport system.

      increase staffing levels to ensure that we reduced the single crew ambulances.

      ensure that our Emergency Medical Services will be ready for the 2010 Fifa Soccer World Cup.

      increase the number of metro sub-bases (from 33to 68) to ensure that Emergency Medical Services be accessible to all communities.

      Move with in speed to build a control provincial control centre.

       Building Good Public Facilities:-|

During the last financial year, we opened the Madzikane Kazulu Memorial Hospital at Alfred Nzo District as well 32 Clinics within the Province.

Similarly this financial year, we will continue to intensify our efforts towards building better public facilities.  Over the next 3 years the Department will focus on the following priority infrastructure projects, funded from the Provincial Infrastructure Grant:-

      Build a new modern Cecilia Makiwane Hospital with 300 Level 1 beds, including 50 step down beds and 100 acute psychiatric beds, supported by two new Community Health Centres, one already completed and an additional one to be built on the western side of Mdantsane at a cost of R465m.

      Refurbish and re-arrange the Frere Hospital to a modern tertiary hospital with a fully fledged trauma unit, including 614 Level 2 BEDS AND 271 Level 3 beds, at a cost of R175m

      Upgrade Dora Nginza Hospital to a modern Level 1 hospital with 200 acute and 25 step down beds.  This process will also include relocating psychiatric services from Elizabeth Donkin Hospital to Dora Nginza with 196 beds as well as relocating Empilweni TB beds to Dora Nginza.  All these will cost R300m

      Refurbish and re-arrange the PE Provincial Hospital to a modern Level 1 hospital with 200 acute beds and 25 step down beds.

      Re-furbish and re-arrange the Livingston Hospital to a modern tertiary hospital with a fully fledge trauma unit and 405 Level 2 beds and 135 Level 3 beds.

      Refurbish and arrange Mthatha General Hospital to a modern Level 1 hospital with 200 acute beds and 25 step down beds.  This process will also include Bedford Orthortic and Prosthetic Centre as well as creating 300 MDR beds, and 200 ordinary beds at Mthatha TB Hospital.  Costs to be incurred will be R90m

      With the re-arrangement of Provincial boundaries, the Umzimkulu Psychiatric Hospital will be under Kwa-Zulu Natal. This will pose challenges for access to care, and may need the department to plan for an alternative or a replacement facility. 

         Human Resources for Health

The Department is also charged with a responsibility of recruiting, training and retaining human resources to fulfil its mandate of providing quality health care.  We are all aware that the country is challenged with the availability of health professionals and as the Department we have to intensify our efforts to recruit and retain this most critical resource.

To this effect, the department has budgeted R100 million for critical vacancies.

In addition, the Health Department has targeted the improvement of remuneration for Health Professionals. For the 2007/8 financial year, the priority will be on nurses with an allocation of R150m.

Over and above the normal recruitment and retention of health professionals, the Department has made available an amount of R 45m for Bursaries targeting specialised scarce skills.  Critical areas include the following:-

                   Pharmaceutical Services

                   Radiography

                   Occupational Therapists

                   Physio Therapist

                   Laboratory Technicians and

                   Doctors

As part of contributing to the skills development and giving young people work experience through internship and leadership, the Department has budgeted R18m for the 2007/08 financial year and will be recruiting:-

a.       550 young people for the learnership programme in the following areas:

      Pharmacists Assistances

      Enrolled Nursing

      Hospital Maintenance

      Customer Care and

      Human Resources Functions learnership

b.       200 unemployed graduates for the internship programme who will be deployed in the financial management and auditing; public health administration, health economics, human resources function, information technology and communication of the Department including our service delivery health institutions.

        Financial Management and accountability

The Department of Health received a Disclaimer of Opinion from the Auditor General for the year ended 31 March 2006. It should be noted that the department has received Disclaimers of opinion for nine years of the past ten years. The audit report highlighted serious weaknesses in the financial management of the department, these include:-

      lack of financial capacity and management in our health facilities across the Province.

      lack of proper and adequate financial controls in our health facilities including head office.

      in-adequate systems related to supply chain management, including management of contracts. 

In addressing the above matters, the Department is establishing a Financial Management Improvement Programme that will review and improve the financial policies, controls and procedures of the Department in line with the Public Financial Management Act and Treasury Regulations as well as other applicable pieces of legislation. This will include recruiting financial skills to be placed in various critical centres including corporate service centres.

Furthermore, we have started the implementation of an audit improvement plan, aimed at improving our audit outcomes. This plan is funded to the tune of R30m within the 2006/07 financial year, and will do the following:       address the 2005/06 audit queries raised by the Auditor General.

      ensure continuous improvement in our audit outcomes beyond 2005/06 financial year.

      initiate and implement financial and administrative interventions at the Head Offices, Districts and Health Facilities.

      intensify recruitment and absorption of employees with appropriate financial, human resources, supply chain management background and skills.  

       Long Term Health Plan

Our quest to ensure equitable access and quality of care, requires a long term perspective and planning horizons. At the national level, the Department of Health has introduced an Integrated Health Planning Framework on the basis of which a Service Transformation Plan must be developed.

      The purpose of the STP is to:

      define and develop an ideal health system that requires appropriate human resources in terms of numbers and quality,

      define and map out the required numbers of health facilities and equipment,

      model adequate funding, information, supply chain management, patient referral, emergency and patient transport, efficient communications, tele health, drug distribution, and laboratory systems, and finally define a service platform to be rendered by the Public Health System