Annual Performance Plan : 2017/18 - 2019/20

1 Annual Performance plan 2017 /18 2019 /20 KWAZULU-NATAL DEPARTMENT OF HEALTH Fighting Disease, Fighting Poverty, Giving Hope TABLE OF CONTENT FOREWORD BY THE EXECUTIVE AUTHORITY .. 5 STATEMENT BY THE HEAD: HEALTH .. 7 OFFICIAL 8 Annual Performance plan 2017 /18 2019 /20 .. 8 PART A: STRATEGIC OVERVIEW .. 9 STRATEGIC OVERVIEW .. 11 Vision, Mission and Values .. 11 Strategic Goals .. 11 Situation Analysis .. 19 Demographic Profile .. 19 Socio-Economic Profile .. 22 Epidemiological Profile/ Burden of Disease .. 23 Organisational Environment .. 30 Organisational Structure and Human Resources .. 30 Performance against 2015- 2019 Strategic Goals .. 33 Revision of Legislative and Other Mandates .. 50 Constitutional Mandates .. 50 Legal Mandates .. 51 Policy Mandates .. 52 Planning Frameworks .. 53 Planned Policy Initiatives .. 55 Strategic Planning Process .. 57 Overview of the 2017 /18 Budget and MTEF Estimates.

2 59 Expenditure Estimates .. 60 Expenditure Trends .. 62 PART B: PROGRAMME & SUB-PROGRAMME PLANS .. 65 PROGRAMME 1: ADMINISTRATION .. 67 PROGRAMME 2: DISTRICT HEALTH SERVICES .. 81 Sub-Programme: Primary Health Care .. 82 Sub-Programme: District Hospitals .. 94 Sub-Programme: HIV, AIDS, STI & TB 101 Sub-Programme: Maternal, Neonatal, Child & Women s Health and Nutrition .. 110 Sub-Programme: Disease Prevention & Control .. 127 PROGRAMME 3: EMERGENCY MEDICAL SERVICES .. 139 PROGRAMME 4: PROVINCIAL HOSPITALS (REGIONAL AND SPECIALISED) .. 147 Sub-Programme: Regional 148 Sub-Programme: Specialised TB Hospitals .. 154 Sub-Programme: Specialised Psychiatric Hospitals .. 159 Sub-Programme: Chronic/ Sub-Acute Hospitals .. 163 Sub-Programme: Oral and Dental Training Centre .. 167 PROGRAMME 5: CENTRAL AND TERTIARY HOSPITALS .. 173 Sub-Programme: Tertiary Hospitals (Greys, King Edward Vlll & Ngwelezana Hospitals) .. 175 Sub-Programme: Central Hospital (Inkosi Albert Luthuli Central Hospital).

3 180 PROGRAMME 6: HEALTH SCIENCES AND TRAINING .. 189 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES .. 199 PROGRAMME 8: HEALTH FACILITIES MANAGEMENT .. 209 PART C: LINKS TO OTHER PLANS .. 219 INFRASTRUCTURE PROJECT plan .. 221 Annual Performance plan 2017 /18 2019 /20 KWAZULU-NATAL DEPARTMENT OF HEALTH 2 Fighting Disease, Fighting Poverty, Giving Hope CONDITIONAL GRANTS .. 230 PUBLIC ENTITIES .. 231 PUBLIC PRIVATE PARTNERSHIPS .. 233 PART D: 2015- 2019 STRATEGIC plan REVIEW .. 235 2015 2019 Strategic plan Changes .. 236 CONCLUSION .. 243 BIBLIOGRAPHY .. 244 ABBREVIATIONS .. 246 PART E: ANNEXURES .. 251 Annexure 1: Addendum to the 2016/17 2018/19 Service Delivery Improvement plan .. 251 Annexure 2: Population-Based 258 Annexure 3: 2017 /18 2019 /20 APP Indicator Descriptions .. 262 TABLES Table 1: Strategic Goals, Objectives and Objective Statements .. 12 Table 2: (A1) Alignment of Macro 17 Table 3: Impact indicators and targets.

4 18 Table 4: Changes to Districts and Local Municipalities .. 19 Table 5: Change in age cohorts between 2001 and 2016 .. 21 Table 6: (A2) Health Personnel 2015/16 .. 31 Table 7: Admissions per 1 000 population .. 38 Table 8: Diarrhoea, Pneumonia and Severe Acute Malnutrition admissions and deaths .. 46 Table 9 (A2): Expenditure Estimates Summary of Payments and Estimates (R 000) .. 60 Table 10 (A3): Summary of Provincial Expenditure Estimates by Economic Classification (R 000) .. 60 Table 11: (A4) Trends in Provincial Public Health Expenditure (R 000) .. 62 Table 12: Conditional Grants Expenditure Trends (R 000) .. 63 Table 13: 2015- 2019 Strategic plan Targets .. 69 Table 14: (ADMIN2) Strategic Objectives, Indicators and Targets .. 70 Table 15: (ADMIN3) Quarterly and Annual Targets .. 76 Table 16: (ADMIN4 a) Expenditure Estimates (R 000) .. 78 Table 17: (ADMIN4 b) Summary of Payments and Estimates by Economic Classification (R 000).

5 78 Table 18: Risk Management .. 80 Table 19: (DHS1) District Health Service Facilities by Health District (DHIS - November 2016) .. 82 Table 20: (DHS2) Situation Analysis Indicators .. 86 Table 21: 2015- 2019 Strategic plan Targets .. 88 Table 22: (DHS3) Strategic Objectives, Indicators & Targets .. 89 Table 23: (DHS4) Quarterly and Annual Targets 2017 /18 .. 93 Table 24: (DHS5) Situation Analysis Indicators .. 95 Table 25: 2015- 2019 Strategic plan Targets .. 97 Table 26: (DHS6) Strategic Objectives, Indicators and Targets .. 97 Table 27: (DHS7) Quarterly and Annual Targets .. 100 Table 28: (DHS8) Situation Analysis Indicators 2015/16 .. 102 Table 29: 2015- 2019 Strategic plan Targets .. 104 Table 30: (DHS9) Strategic Objectives, Indicators and Targets .. 105 Table 31: (DHS10) Quarterly and Annual Targets .. 109 Table 32: (DHS11) Situation Analysis Indicators .. 111 Table 33: Strategic plan 2015- 2019 Targets .. 115 Table 34: (DHS12) Strategic Objectives, Indicators and Targets.

6 116 Table 35: (DHS13) Quarterly and Annual Targets .. 125 Table 36: (DHS14) Situation Analysis Indicators .. 128 Table 37: Strategic plan 2015- 2019 Targets .. 129 Annual Performance plan 2017 /18 2019 /20 KWAZULU-NATAL DEPARTMENT OF HEALTH 3 Fighting Disease, Fighting Poverty, Giving Hope Table 38: (DHS15) Strategic Objectives, Indicators and Targets .. 129 Table 39: (DHS16) Quarterly and Annual Targets .. 133 Table 40: (DHS17 a) Summary of Payments and Estimates (R 000) .. 134 Table 41: (DHS17 b) Summary of Payments and Estimates by Economic Classification (R 000) .. 135 Table 42: Risk Management .. 137 Table 43: (EMS1) Situation Analysis Indicators .. 140 Table 44: Strategic plan 2015- 2019 Targets .. 141 Table 45: (EMS2) Strategic Objectives, Indicators and 141 Table 46: (EMS3) Quarterly and Annual Targets .. 143 Table 47: (EMS4 a) Expenditure Estimates .. 144 Table 48: (EMS4 b) Summary of Provincial Expenditure Estimates by Economic Classification.

7 144 Table 49: Risk Management .. 146 Table 50: 2015- 2019 Strategic plan Targets .. 149 Table 51: (PHS1) Strategic Objectives, Indicators and Targets .. 150 Table 52: (PHS2) Quarterly and Annual Targets .. 153 Table 53: (PHS3 a) Strategic Objectives, Indicators and Targets .. 155 Table 54: (PHS4 a) Quarterly and Annual Targets .. 158 Table 55: (PHS3 b) Strategic Objectives, Indicators and Targets .. 160 Table 56: (PHS4 b) Quarterly and Annual Targets .. 162 Table 57: (PHS3 c) Strategic Objectives, Indicators and Targets .. 164 Table 58: (PHS4 c) Quarterly and Annual Targets .. 166 Table 59: Strategic Objectives, Indicators and Targets .. 167 Table 60: Quarterly and Annual Targets .. 168 Table 61: (PHS5 a) Summary of Payments and Estimates (R 000) .. 168 Table 62: (PHS5 b) Summary of payments and expenditure by Economic Classification (R 000) .. 169 Table 63: Risk Management .. 171 Table 64: Strategic plan 2015- 2019 Targets.

8 174 Table 65: (C&THS1) Strategic Objectives, Indicators and Targets .. 176 Table 66: (THS2) Quarterly and Annual Targets .. 179 Table 67: (C&THS3) Strategic Objectives, Indicators and Targets .. 181 Table 68: (C&THS4) Quarterly and Annual Targets .. 184 Table 69: (C&THS7 a) Summary of Payments and Estimates (R 000) .. 185 Table 70: (C&THS7 b) Summary of Payments and Estimates by Economic Classification (R 000) .. 185 Table 71: Risk Management .. 187 Table 72: Strategic plan 2015- 2019 Targets .. 190 Table 73: (HST1) Strategic Priorities, Indicators and Targets .. 191 Table 74: (HST2) Quarterly and Annual Targets .. 193 Table 75: (HST4 a) Expenditure Estimates (R 000) .. 194 Table 76: (HST4 b) Summary of Provincial Expenditure Estimates by Economic Classification (R 000).. 195 Table 77: Risk Management .. 197 Table 78: Strategic plan 2015- 2019 Targets .. 201 Table 79: (HCSS1) Strategic Objectives, Indicators and 202 Table 80: (HCSS2) Quarterly and Annual Targets.

9 205 Table 81: (HCSS4 a) Expenditure Estimates (R 000) .. 206 Table 82: (HCSS4 b) Summary of Payments and Estimates by Economic Classification (R 000) .. 206 Table 83: Risk Management .. 208 Table 84: Strategic plan 2015- 2019 Targets .. 210 Table 85: (HFM1) Strategic Objectives, Indicators and Targets .. 210 Table 86: (HFM3) Quarterly and Annual Targets .. 213 Table 87: (HFM4 a) Expenditure Estimates (R 000).. 214 Table 88: (HFM4 b) Summary of Provincial Expenditure Estimates by Economic Classification (R 000) .. 215 Table 89: Risk Management .. 217 Annual Performance plan 2017 /18 2019 /20 KWAZULU-NATAL DEPARTMENT OF HEALTH 4 Fighting Disease, Fighting Poverty, Giving Hope Table 90: Infrastructure Project List ( 2017 /18 MTEF) .. 221 Table 91: Conditional Grants .. 230 Table 92: Public Entities (State Aided) .. 231 Table 93: Public Private Partnership .. 233 Table 94: Strategic plan 2015- 2019 Changes .. 236 Table 95: Assessment of the 2016/17 2018/19 SDIP.

10 252 Table 96: 2017 /18 2018/19 SDIP Enhancement plan .. 254 Table 97: Comparison of population-based indicators (DHIS population and Stats SA estimates) .. 258 GRAPHS Graph 1: District proportion of total KZN population and population density .. 20 Graph 2: KZN population pyramids 2001 and 2016 .. 21 Graph 3: Population pyramid 2014 2016 .. 21 Graph 4: Education attainment, 20 years and older .. 23 Graph 5: Life expectancy at birth .. 23 Graph 6: Ten leading underlying natural causes of death in KZN .. 24 Graph 7: Seven leading non-natural causes of death in KZN .. 24 Graph 8: Maternal mortality in facility ratio .. 25 Graph 9: HIV prevalence amongst antenatal women .. 25 Graph 10: Infant and Under-5 mortality .. 26 Graph 11: Pneumonia, diarrhoea and severe acute malnutrition (under-5) incidence .. 26 Graph 12: Severe Acute Malnutrition, Pneumonia and Diarrhoea deaths .. 27 Graph 13: Clients remaining on ART .. 28 Graph 14: TB notification rate per 100 000 population.