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  2. 2. STRUCTURE OF PRESENTATION <ul><li>KEY FOCUS AREAS OF THE PRESENTATION INCLUDE: </li></ul><ul><li>1. Outline of Medium Term Sector and Departmental Policy Priorities 2008/09; </li></ul><ul><li>2. Outline of progress towards set objectives and targets, linked to the Millennium Development Goals (MDGs); </li></ul><ul><li>3. Medium Term Expenditure Trends within the sector – including projections and budgetary additions as announced in the MTBPS; </li></ul><ul><li>4. Departmental Budget Bids not agreed for the 2009/10 budget cycle; </li></ul><ul><li>5. Budgeting challenges and unfunded mandates. </li></ul><ul><li>6. Conclusion </li></ul>
  3. 3. 1. MEDIUM-TERM SECTOR AND DEPARTMENTAL PRIORITIES 2008/09-2010/11 <ul><li>8 priorities were adopted by the National Health Council (NHC) for the National Health System (NHS) for 2008/09-2010/11 namely: </li></ul><ul><li>(i) Strengthening Health Programmes; </li></ul><ul><li>(ii) Development and implementation of Health Facility Improvement Plans; </li></ul><ul><li>(iii) Development of an Integrated National Health Information System; </li></ul><ul><li>(iv) Strengthening Health Financing; </li></ul><ul><li>(v) Achieving further reduction in the prices of Medicines and Pharmaceutical products; </li></ul><ul><li>(vi) Strengthening Human Resources for Health; </li></ul><ul><li>(vii) Strengthening International Health Relations and </li></ul><ul><li>(viii) Improving Management & Communication </li></ul><ul><li>These priorities are reflected in the Annual National Health Plan for 2008/09. </li></ul>
  4. 4. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 1 : STRENGTHENING HEALTH PROGRAMMES </li></ul><ul><li>Maternal, Child, and Women’s Health and Nutrition (Consistent with </li></ul><ul><li>Goal 4 and Goal 5 of the Millennium Development Goals) </li></ul><ul><li>A new National Strategic Plan for improving Maternal, Child and Women’s Health has been drafted; </li></ul><ul><li>National immunisation coverage of almost 88% achieved in 2008, which contributes towards protecting children against vaccine preventable diseases. Targeted suport is being provided to districts that have not yet attained the expected 90% coverage, </li></ul><ul><li>27 districts are implementing the Reach Every District (RED) Strategy; </li></ul><ul><li>Funding has been obtained from Treasury to introduce two new vaccines to curb child morbidity and mortality namely: Prevenar (Pneumococcal Conjugate Vaccine or PCV7) and Rotavirus; </li></ul><ul><li>Department is also on target towards ensuring that its facilities provide Baby-friendly services. A total of 232/545 health facilities with maternity beds have been declared baby-friendly. The target for 2008/09 is 245/545. There are strict criteria that these facilities should comply with to achieve this accreditation. </li></ul>
  5. 5. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 1 : STRENGTHENING HEALTH PROGRAMMES </li></ul><ul><li>Implementation of the Updated National Strategy Plan for HIV and AIDS (Consistent with Goal 6 of the Millennium Development Goals) </li></ul><ul><li>Health sector collectively continues to implement the Comprehensive Plan for HIV and AIDS Care, Management and Treatment; </li></ul><ul><li>Efforts at prevention are strengthened. More than 90% of public sector health facilities provide Voluntary Counseling and Testing VCT and Prevention of Mother-to-Child Transmission (PMTCT); </li></ul><ul><li>Over 80 million male condoms were distributed in the first quarter (Q1) of 2008/09, which incrementally builds towards the 2008/09 target of 450 million male condoms; </li></ul><ul><li>A total of 1.2 million female condoms were also distributed in Q1, which also contributes towards the target of 3.5 million female condoms; </li></ul><ul><li>By the end of July 2008, a total of 544 603 patients had been initiated on Antiretroviral Therapy (ART), of which 495 002 were adults, and 49 601 were children, which exceeded the NSP target; </li></ul><ul><li>Antenatal Care Survey 2007 reflects a 1% reduction in HIV prevalence between 2006 and 2007; and a 2% reduction between 2005 and 2007. </li></ul>
  6. 6. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 1 : STRENGTHENING HEALTH PROGRAMMES </li></ul><ul><li>Intensifying Campaign against Tuberculosis (TB) Strains (Consistent with Goal 6 of the Millennium Development Goals) </li></ul><ul><li>The management and control of Tuberculosis also reflects positive outcomes, with a TB cure rate of 64%, reflecting increase from 57.7% achieved in 2005, and the 62.3% recorded in 2006. </li></ul><ul><li>72 TB Tracer Teams have been appointed and placed in districts across the country to help reduce the high defaulter rate, which has decreased from 10% to 8.6%. Our target for 2008/09 is < 7%. </li></ul><ul><li>More than 80% of TB patients who presented to the health facilities in the first half of 2008 were tested for HIV; </li></ul><ul><li>Health sector is also make strides in curbing the impact of MDR-TB and XDR-TB. Clinicians have been trained in managing these 2 strains of TB; drugs are available; patients have been place in isolation as part of infection control, amongst others. </li></ul>
  7. 7. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 1 : STRENGTHENING HEALTH PROGRAMMES </li></ul><ul><li>Strengthening Malaria Control </li></ul><ul><li>5743 malaria cases were identified due to increases in malaria cases in Limpopo Province in the first 6 months of 2008. Target for 2008/09 is not more than 3 900 cases. </li></ul><ul><li>Management and control of malaria has been recognised internationally as one of the key areas of success of the public health sector in South Africa. But increased malaria cases indicate that the country cannot afford to be complacent, and should maintain its vigilant surveillance systems for both local and imported cases of malaria. </li></ul><ul><li>Ongoing implementation of the Healthy Lifestyles programme </li></ul><ul><li>An additional 10 community-based food gardens projects were established in 2008, building on the 36 projects established in Eastern Cape, KwaZulu-Natal and Western Cape in 2007/08. </li></ul><ul><li>Non-Communicable Diseases </li></ul><ul><li>Provinces have begun monitoring the implementation of the guidelines on the management of Non-Communicable Diseases (NCD). A report on the accessibility of hospitals to people with disabilities is being compiled. </li></ul><ul><li>The average waiting period for a wheelchair in the provinces is 8-10 weeks, due to lengthy procurement procedures. The target for 2008 is to further reduce this to 8 weeks. </li></ul>
  8. 8. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 2: QUALITY IMPROVEMENT THROUGH THE IMPLEMENTATION OF A HEALTH FACILITIES IMPROVEMENT PLAN </li></ul><ul><li>National Core Standards were launched by the former Minister in April 2008. These are structured around seven domains namely, patient safety, clinical care, governance and management, patient experience of care, access to care, infrastructure and environment, and public health; and cover the essential requirements for a quality assurance programme focused on the functioning of the facility itself. </li></ul><ul><li>A National Health Facility Improvement Plan has been developed for each of the 27 initial hospitals (while the work on the CHCs will start next month). The Improvement plans have been drawn up for each facility, based on the results of the appraisals conducted by teams of peers during June, July and August 2008 and measuring individual hospital performance against the National Core Standards. Progress is already evident from the 27 hospitals whose management has started developing and implementing measures to resolve areas of inadequate performance immediately. </li></ul><ul><li>Since July 2008, National, Provincial and local levels of the health system have provided supportive facilitation to implementation, monitoring and reporting of improvement initiatives across provinces. 19 hospitals have been covered to date with the remainder (in 3 provinces) scheduled for the coming weeks. Once capacity has been built in quality improvement, provincial departments will be responsible for support and scale-up, with the national department responsible for leadership, planning, standard setting and monitoring. </li></ul><ul><li>Many of our health facilities are shown to be doing well, and more should be done to share this good work with our staff and the South African public. Key challenges identified in most provinces include in patient waiting times, referral pathways and management, maintenance of facilities and utilities, management of absenteeism and disciplinary controls, lack of HR delegations, implementation of infection prevention and control policies. </li></ul>
  9. 9. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 3: IMPLEMENTATION OF AND INTEGRATED NATIONAL </li></ul><ul><li> HEALTH INFORMATION SYSTEM </li></ul><ul><li>Improve Data Management and Use </li></ul><ul><li>Performance of the health system is being monitored through a routine information system known as the District Health Information System (DHIS), established in 1996; </li></ul><ul><li>A new National Indicator Data Set (NIDS) has been developed, which outlines revised indicators and indicator definitions; </li></ul><ul><li>DHIS information is being used across all 9 Provinces for management, and for developing various plans such as Annual Performance Plans and for monitoring the implementation of these plans. </li></ul><ul><li>However, key challenges arise from the inadequate infrastructure and personnel for strengthening health information systems. </li></ul><ul><li>Implement the Electronic Patient Record </li></ul><ul><li>An Electronic Health Record is a longitudinal collection of personal health information of a single individual, entered or accepted by health care providers and stored electronically. The goals of the Electronic Health Record for South Africa are to: (i) integrate health record systems in the country by bringing together the existing health information systems, facilitating access to health records within a province and across provinces; (ii) develop a population health care base (iii) improve administration at both national and provincial level; (iv) improve the efficiency of health service delivery and (v) to enable national monitoring and evaluation of health trends. </li></ul><ul><li>A tender has been awarded by SITA. Phase O of implementation will commence in January 2009. </li></ul>
  10. 10. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 3: IMPLEMENTATION OF AND INTEGRATED NATIONAL </li></ul><ul><li> HEALTH INFORMATION SYSTEM </li></ul><ul><li>Implement Human Resources (HR) for Health Database </li></ul><ul><li>A Health Professionals Information Management System, also known as Human Resources for Health (HRH) Database is being developed. </li></ul><ul><li>The goal of this project is to generate comprehensive, accurate and reliable information about health professionals in South Africa, including their quantity, location, training & qualifications and remuneration levels. </li></ul><ul><li>Consultations have been conducted with health professional councils such as the South African Nursing Council (SANC); Health Professionals Councils of South Africa (HPCSA); Pharmacy Council and the Dental Council. These councils have a key role to play in the development of HRH Database, as they are custodians of information on health professionals located in both the public and private sectors. </li></ul><ul><li>Continuous discussions are being conducted with Government Departments such as National Treasury; Department for Public Service Administration (DPSA); and State Information and Technology Agency (SITA). </li></ul><ul><li>Future steps in the process will include the development of strategic HR reports; tracking training related information; and I-recruitment , which entails placing advertisements on website in addition to the conventional paper-based method </li></ul>
  11. 11. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 4: HEALTH FINANCING, INCLUDING DESIGNING THE </li></ul><ul><li>NATIONAL HEALTH INSURANCE SYSTEM AND </li></ul><ul><li>REDUCING THE RATE OF INCREASE OF TARIFFS IN </li></ul><ul><li>THE PRIVATE HEALTH CARE SECTOR </li></ul><ul><li>Design the National Health Insurance System (NHI) </li></ul><ul><li>NHI proposal document was presented to Cabinet in July and August 2008 by the former Minister of Health. </li></ul><ul><li>Key recommendations that were made by Cabinet were that that the proposal document should be noted as a work in progress, that the Risk Equalisation Fund (REF) legislation was currently in Parliament and that members of the Inter-Ministerial Committee on the national health insurance should meet to consider the matter and submit detailed proposals and costed options for consideration. </li></ul><ul><li>The next set of steps requires reaching consensus on matters relating to: the Basic Benefits Package (Essential Healthcare Package); the Structure of the National Health Fund; and the Role of Private Funders and Providers. </li></ul>
  12. 12. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 4: HEALTH FINANCING, INCLUDING DESIGNING THE NATIONAL HEALTH INSURANCE SYSTEM AND REDUCING THE RATE OF INCREASE OF TARIFFS IN THE PRIVATE HEALTH CARE SECTOR </li></ul><ul><li>Increase funding for the Public Health Sector </li></ul><ul><li>In September 2008, the Department presented to the Medium Term Expenditure Committee (MTEC) a Budget Bid for the health sector, focusing on 12 key priority areas. </li></ul><ul><li>These were as follows: (i) Consolidation of the implementation of strategies for the recruitment and retention of Health Care Providers in the Public Health Sector, through the Occupation Specific Dispensation (OSD); (ii) Introduction of 2 New Vaccines to improve Child Health and curb Infant and Child Mortality; (iii) Strengthening the implementation of the Community Component of the Integrated Management of Childhood Illnesses (IMCI); (iv) Implementation of a National Health System Quality Improvement Programme; (v) Strengthening Health Information System (HIS) – particularly the implementation of the Electronic Health Record for RSA (eHealth-ZA) (vi) Supporting the implementation of Emergency Medical Services (EMS) Plans; (vii) Strengthening TB Control and Management; (viii) Strengthening existing National Tertiary Services, through improved resource allocation (ix) Improved resource allocation for the Health Professionals Training and Development Grant (HPTD); (x) Expanding implementation of the Comprehensive Plan for HIV and AIDS Care, Management and Treatment (CCMT); (xi) Improving infrastructure delivery for Hospital Services and (xii) Improve infrastructure delivery for Primary Health Care . </li></ul><ul><li>As it will be shown later, only some of these priorities received additional funding from the Adjustment Budget for 2008/09 and from the Budget Bid process for 2009/10. </li></ul>
  13. 13. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 4: HEALTH FINANCING, INCLUDING DESIGNING THE NATIONAL HEALTH INSURANCE SYSTEM AND REDUCING THE RATE OF INCREASE OF TARIFFS IN THE PRIVATE HEALTH CARE SECTOR </li></ul><ul><li>Decrease costs of health care in the Private Health Sector </li></ul><ul><li>In May 2008, the Department published the National Health Reference Price List (NHRPL) for 2009 for provider groups, which allowed for an increase of 8.7% from the 2008 reference price list schedule. This was after the Department had sent an invitation to all stakeholders to submit inputs into the NHRPL 2009, with the 19th May 2008 set as the deadline for submission. </li></ul><ul><li>Of the 48 submissions received by the Department, 37 were not satisfactory for reasons such as non-representative sample size; unacceptable costing methodology and/or unacceptable coding methodology. </li></ul><ul><li>Draft schedules were gazetted on the 3 rd October 2008, based on an increase of 8.7%. A 4-week period has been allowed for comments and feedback to the Department </li></ul><ul><li>The other 11 submissions complied with the information requirements as outlined in the regulations and the Department commenced with a process of verifying them, with assistance from KPMG. </li></ul>
  14. 14. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 5: FURTHER REDUCTION IN THE PRICES OF PHARMACEUTICAL PRODUCTS </li></ul><ul><li>The Department conducted a benchmarking exercise comparing prices of medicines and pharmaceutical products in South Africa against countries such as Australia, Canada, New Zealand and Spain, which have a similar regulatory framework for medicines, including a Medicines Control Council (MCC) and respect for intellectual property rights. </li></ul><ul><li>Principle of the benchmarking exercise is that South Africans should not pay more for medicines than citizens of countries with similar features. </li></ul><ul><li>Based on the benchmarking results, the Pricing Committee finalised and submitted its recommendations to the Minister on medicine pricing in 2008. The recommendations were published in a Government Gazette in August 2008, with a time frame of 30 days provided for stakeholders to respond. Implementation of these recommendations would potentially reduce medicine prices by 30% and result in a net saving of about R3 billion. </li></ul><ul><li>However, the Pharmaceutical Industry Task Group has requested discussions with the Department prior to the implementation of the recommendations of the Pricing Committee, mainly aimed at re-negotiating the methodology used in the benchmarking exercise. </li></ul>
  15. 15. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>PRIORITY 5: FURTHER REDUCTION IN THE PRICES OF PHARMACEUTICAL PRODUCTS </li></ul><ul><li>Investigate the potential for a state-owned pharmaceutical company to reduce the costs of pharmaceuticals </li></ul><ul><li>The Department contributed to the development of the African Union (AU) Pharmaceutical Manufacturing Plan. One of the options is that South Africa would be one being one of the locii for production. </li></ul><ul><li>Develop a Policy and Legislation on African Traditional Medicine (ATM) </li></ul><ul><li>ATM Policy was published in the Government Gazette No 31271 on 25 July 2008 for comment within three (3) months from the date of publication. </li></ul><ul><li>The deadline or comment was is the 24 th October 2008. I believe that the comments, which were to be directed to the Office of the Director-Ge </li></ul><ul><li>Develop a policy and legislation for the restructuring of the Medicines Control Council (MCC) </li></ul><ul><li>The Medicines and Related Substances Amendment Bill, which provides for the restructuring of the MCC, was passed by the National Assembly, and subsequently sent to the National Council of Provinces. </li></ul>
  16. 16. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>2.6. STRENGTHENING HUMAN RESOURCES FOR HEALTH </li></ul><ul><li>Implement recruitment and retention strategies, including Memoranda of Understanding (MoUs) to regulate recruitment of South African health professionals by other countries </li></ul><ul><li>In 2008, the health sector continued its discussions with National Treasury about the provision of additional resources for the OSD, including funding for the deficit that occurred during the implementation of OSD for nurses, as well as for the implementation of OSD for medical and dental personnel. Initial outcomes from the Medium-Term Budget Policy Statement are positive. What is of greater importance however, is the availability of resources to sustain the implementation of OSD for key categories of health professionals going forward, commencing with the MTEF cycle 2009/10-2011/12. </li></ul><ul><li>Implement the Clinical Associates Programme </li></ul><ul><li>A total of 23 students were enrolled at the Walter Sisulu University (WSU) in January 2008 for the Clinical Associates Programme. </li></ul><ul><li>Implement the Occupation Specific Dispensation (OSD) for Doctors, Dentists, Pharmacists and emergency medical service practitioners </li></ul><ul><li>As indicated earlier, in the Medium Budget Policy Statement of the 21st October 2008, it was indicated that additional resources would be provided to the health sector for amongst others, new proposed salary scales for doctors, dentists, pharmacists and related professionals. </li></ul>
  17. 17. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>2.7. INTERNATIONAL HEALTH RELATIONS </li></ul><ul><li>Implement African Union (AU) Bureau Priorities </li></ul><ul><li>Copies of Africa Health Strategy in English, French and Portuguese were produced, sent to the AU and also distributed to African Health Ministers at the World Health Assembly (WHA) in May 2008. </li></ul><ul><li>Implementation Plan for the Africa Health Strategy was also approved by the Africa Union (AU) Ministers of Health at the WHA in Geneva in May 2008, and it was further endorsed by the AU Heads of State Summit in June 2008. </li></ul><ul><li>Assume the Chairpersonship of SADC Ministers of Health and implement key activities </li></ul><ul><li>South Africa assumed the Chairpersonship of SADC Ministers of Health in August 2008. </li></ul><ul><li>Provide support to the post-conflict reconstruction process in countries such as the Democratic Republic of Congo (DRC) </li></ul><ul><li>Agreement on Health Matters between South Africa and Burundi was signed on the </li></ul><ul><li>16 th September 2008, in Bujumbura; </li></ul><ul><li>An agreement with Sudan on Health matters has been finalised and is ready for signing; </li></ul><ul><li>South Africa-DRC Ministerial Review Session took place in the DRC in August 2008; </li></ul><ul><li>DRC Officials visited RSA in September 2008 to conduct discussions on various health matters including MCWH&N; TB, Hospital Services, African Traditional Medicines & Malaria. </li></ul>
  18. 18. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>2.7. INTERNATIONAL HEALTH RELATIONS </li></ul><ul><li>Successfully host key International Conferences and Meetings </li></ul><ul><li>In collaboration with WHO, UNICEF and UNFPA, South Africa hosted the AU Continental Workshop on Maternal, Neonatal and Child Mortality Reviews in April 2008. At this workshop, Africa’s Movement to Improve Maternal Health and Promote Child Survival and Development in Africa beyond 2015 was launched. </li></ul><ul><li>In November 2008, the Department will host the 3rd Session of the Conference of the Parties to the WHO Framework on Tobacco Control Convention (COP3). Preparations for this gathering of the international community in our country are proceeding well. </li></ul>
  19. 19. 2. PROGRESS TOWARDS SET OBJECTIVES AND TARGETS <ul><li>2.8. STRENGTHENING MANAGEMENT AND COMMUNICATION </li></ul><ul><li>A National Consultative Health Forum was held in April 2008 with key stakeholders, which commemorated 30 years of the Alma Ata Declaration on Primary Health Care (PHC) </li></ul><ul><li>A draft Communication Strategy has been developed that outlines a Framework for interaction with its key stakeholders. The key objectives of the strategy are to inform and educate the public on key health issues and to provide an avenue for receiving feedback from stakeholders. </li></ul>
  20. 20. <ul><li>MEDIUM TERM EXPENDITURE TRENDS WITHIN THE SECTOR – INCLUDING PROJECTIONS AND BUDGETARY ADDITIONS AS ANNOUNCED IN THE MTBPS 3.1. 2007/08 FINANCIAL RESULTS </li></ul><ul><li>Over-run due to Human Resources (HR) amounting to : R1.6 Billion; </li></ul><ul><li>Over-run due to Occupation Specific Dispensation (OSD) amounting to : R0.8 Billion; </li></ul><ul><li>Over-run due to Non H/R, non Capital expenditure (Capex) amounting to : R0.68Billion; </li></ul><ul><li>Under spent on Capex R0.94 Billion; </li></ul><ul><li>Total over-run : R1.4 Billion </li></ul>
  21. 21. 4. ADJUSTED ESTIMATES 2008/2009 <ul><li>Budget Bids: </li></ul><ul><li>OSD : 2,5billion. </li></ul><ul><li>HIV&AIDS :1billion. </li></ul><ul><li>Child Mortality Vaccines: 0.35billion. </li></ul><ul><li>Actual allocation: </li></ul><ul><li>OSD : 1billion. </li></ul><ul><li>HIV&AIDS: 0.3billion. </li></ul><ul><li>Child Mortality Vaccines: 50million. </li></ul><ul><li>Conditional grants roll over :R0.376m. </li></ul>
  22. 22. 5. HEALTH PROVINCES 2008/09 Fin Year (as at 31 July 2008)
  24. 24. 6. DISCUSSION: HUMAN RESOURCES SITUATION <ul><li>Over-run projected R5.5 billion </li></ul><ul><li>Additional allocations Received; - Improvement of Conditions of Services </li></ul><ul><li>(ICS) R1.2 billion. - Adjusted budget R1 billion. - Nett over-run R3.3 Bill </li></ul><ul><li>NDoH Estimate cost of OSD R2.8 Bill </li></ul><ul><li>Budget given by Treasury R1.5 Bill </li></ul>
  26. 26. 7.1. DISCUSSION PROJECTED CONSOLIDATED PICTURE <ul><li>In summary, additional funds received are as follows: </li></ul><ul><li>- Human Resources : R1,845m. </li></ul><ul><li>- Goods and services : R 881m. </li></ul><ul><li>Total : R2,726m </li></ul><ul><li>Viewed against the projected over expenditure of R5,500m, the over expected has been reduced to R2,800m. </li></ul>
  27. 27. 8. UNFUNDED BUDGET BIDS <ul><li>The OSD for doctors, dentists etc is not sufficient to implement the whole grouping in one year. A phased in approach is considered; </li></ul><ul><li>The percentage growth of the HIV/AIDS allocation does not match the uptake growth specifically for the ART programme; </li></ul><ul><li>Funding for the hospital Revitalization grant is not enough to address the gaps identified for short term interventions/ solutions; </li></ul><ul><li>No funding has been received for the long outstanding Health Information Management System. Alternative solutions are being considered. </li></ul>
  28. 28. 9. BUDGET CHALLENGES <ul><li>Earmarked funds for provinces emanating from national bid processes sometimes not used for the intended purposes ( provincial treasury allocations); </li></ul><ul><li>Equitable share allocations sometimes do not address actual needs by provinces; </li></ul><ul><li>Funding for retention of health professionals in the public sector remains a challenge. </li></ul>
  29. 29. 10. CONCLUSION <ul><li>Health Sector is making progress towards its Medium Term Health Sector Policy Priorities for 2008/09-2010/11; as reflected in the Department’s Strategic Plan; Estimates for National Expenditure (ENE) and the Annual National Health Plan for 2008/09; </li></ul><ul><li>Several key areas exists where limited progress is being made, due to resource constraints. </li></ul><ul><li>Many of the 12 health sector priorities that were included in the budget bid for 2009/10 have not been funded. </li></ul><ul><li>The Department and the sector as a whole are faced with the implications of this lack of funding, and its possible impact on service delivery. </li></ul>