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Division of Revenue Act, 2017 (Act No. 3 of 2017)

Notices

Allocations to Provincial and Local Governments

Explanatory Memorandum to the Allocations set out in the attached Schedule

Frameworks for Conditional Grants to Provinces

Annexure 2 : Detailed frameworks on Schedule 4, Part A: Schedule 5, Part A; and Schedule 6 Part A grants to provinces

Health Grants

 

Comprehensive HIV, AIDS and TB Grant

Transferring department
• Heath (Vote 16)

Grant schedule
• Schedule 5, Part A

Strategic goal
• The implementation of the National Strategic Plan on HIV, Sexually Transmitted Infections and Tuberculosis (TB) 2017 - 2022
• The implementation of National Strategic Plan on malaria elimination 2012 - 2018

Grant purpose
• To enable the health sector too develop and implement an effective response to HIV and AIDS and TB grant between national and provincial government

Outcome statements
• Improved coordination and collaboration in the implementation of comprehensive HIV, AIDS and TB grant between national and provincial government
• Improved quality of HIV and AIDS and TB services including access to:
o HIV Counseling and Testing (HCT)
o TB case finding, screening and diagnosis
o Antiretroviral Treatment (ART)
o treatment for TB, including drug-resistant TB
o adherence monitoring and support
o prevention of TB
o prevention of mother-to-child-transmission (PMTCT)
o medical male circumcision (MMC)
• Improved health workers capacity at provincial and district facilities
• Strengthened health system

Outputs
• Number of new patients started on ART
• Total number of patients on ART remaining in care
• Number of male condoms distributed
• Number of female condoms distributed
• Number of exposed infants HIV positive at 10 weeks Polymerase Chain Reaction (PCR) test
• Number of clients tested for HIV (including antenatal)
• Number of MMC performed
• Number of patients on ART initiated on Isoniazid Preventative Therapy (IPT)
• Number of clients newly initiated on Bedaquiline
• Number of adherence clubs
• TB new smear positive client success rate
• 80 per cent of household structures covered with Indoor Residual Spraying

Priority outcome(s) of government that this grant primarily contributes to
• Outcome 2: A long and healthy life for all South Africans

Details contained in the business plan
• Outcome indicators
• Output indicators
• Inputs
• Key activities

Conditions
• The following priority areas must be supported through the grant:
o ART related interventions
o care and support (C &S)
o condom distribution and high transmission area (HTA) interventions
o post exposure prophylaxis (PEP)
o prevention of mother to child transmission ( PMTCT)
o programme management strengthening (PMS)
o regional training centres (RTC)
o HIV counselling and testing (HCT)
o medical male circumcision (MMC)
o TB screening, prevention, treatment
• Due to the malaria outbreak in April and May 2017, and the resultant increase in malaria cases and deaths, funds have been included and ring- fenced in this grant for malaria outbreak relief. Should the cost of the intervention exceed the amounts earmarked below, provinces may not fund any such shortfalls out of this conditional grant. The amounts per province are:

o Limpopo: R11.8 million

o Mpumalanga: R 8.0 million

• Business plans for the allocated malaria outbreak relief funds must be in line with the business plans submitted to the national department.

Allocation criteria
• Allocations are based on antenatal HIV prevalence, estimated share of AIDS cases, populations post-demarcation

Reasons not incorporated in equitable share
• HIV, AIDS and TB are key national priorities and require a coordinated response for the country as a whole and this is effectively achieved through a conditional grant

Past performance

2015/16 audited financial performance

• R13.7 billion was allocated, R13.7 billion (99.7 per cent) was transferred to provinces of which R13.7 billion (100.2 er cent) was spent by provinces

2015/16 service delivery performance

• 9 936 lay counsellors providing services at service points
• 11.9 million HIV test were conducted, (including antenatal)
• 7.5 million beneficiaries had access to HCBC services
• 3 805 health facilities offered ART services
• 3.4 million patients were on ART
• 1 614 high transmission intervention sites were in operation
• 100 per cent of primary health care (PHC) facilities offered PMTCT services
• 464 731 MMCs were performed
• 839.9 million male condoms were distributed
• 27 million female condoms were distributed

Projected life
• Ongoing in-line with National Strategic Plan on HIV and AIDS

MTEF allocations
• 2017/18: R17.6 billion; 2018/19: R19.9 billion; and 2019/20: R22 billion

Payment schedule
• Monthly instalments based on the approved payment schedule

Responsibilities of the transferring national officer and receiving officer

Responsibilities of the National Department

• Visit provinces twice a year to monitor implementation and provide support
• Report to the National Treasury on an additional set of indicators agreed upon between the two departments
• Meet with National Treasury to review grant performance on a quarterly basis
• Separate approved business plan for the malaria outbreak relief intervention to be submitted to National Treasury by 30 November 2017

Responsibilities of the Provincial Departments

• Quarterly performance output reports to be submitted within 30 days following the reporting period using standard formats as determined by the national department. Submit an electronic version to be followed by a hard copy signed by the provincial grant receiving manager
• Clearly indicate measurable objectives and performance targets as agreed with the national department in provincial departmental business plans for 2016/17 and over the MTEF

Process for approval of the 2018/19 business plans
• Submission of draft business plans by 31 October 2017
• Submission of final business plans to national Department of Health by 28 February 2018
• Submission of final business plans to National Treasury by 30 March 2018

 

 

Health Professions Training and Development Grant

Transferring department
• Heath (Vote 16)

Grant schedule
• Schedule 4, Part A

Strategic goal
• To contribute to the implementation of the national human resource plan for health through the clinical training and supervision of health science trainees in designated public health facilities in South Africa

Grant purpose
• Support provinces to fund service costs associated with clinical training and supervision of health science trainees on the public service platform

Outcome statements
• Progressive realisation of the national human resource plan for health
• Clinical training and supervision capacity established in designated developmental provinces (Northern Cape, North West, Limpopo, Mpumalanga and Eastern Cape)

Outputs

The following categories of health professionals, associated with clinical training and supervision, are funded on the public health service delivery platform:

o Number of specialists
o Number of registrars
o Number of medical officers
o Number of clinical supervisors /trainers per category in nursing, EMS and allied health and pharmacy
o Number of grant administration staff

Priority outcome(s) of government that this grant primarily contributes to
• Outcome 2: A long and healthy life for all South Africans

Details contained in the business plan
• Non-financial business plan - number of specialists, registrars, medical officers, clinical supervisors/tutors per category in nursing, EMS, allied health, pharmacy and grant  administration staff funded from the grant
• Financial business plan - allocation by economic classification to each category of clinical trainer/supervisor

Conditions
• Submission of an approved business plan 2017/18 in the prescribed format signed by the provincial Head of Department or receiving officer by 28 February 2017, and the national Department of Health (DoH) transferring officer by 31 March 2017
• Cost of personnel for the administration of grant must not exceed 1 per cent of the total grant allocation
• National Treasury and DoH to negotiate funding in 2017/18 for a review of the HPTDG in 2018/19 on the categories and numbers of students trained under grant and development of the unit costs.
• On an annual basis, each province must discuss the nature of the clinical training platform with the relevant higher education institutions in the province
• DoH to work with Department of Higher Education and Training to ensure a national, coordinated process for the planning and funding of health sciences education

Allocation criteria
• Based on historical allocations and spending patterns

Reasons not incorporated in equitable share
• Provinces give effect to the national human resource strategy by the clinical training and supervision of health science trainees on the public health service platform
• National coordination needed for health science training

Past performance

2015/16 audited financial performance

• Allocated and transferred R2.4 billion to provinces of which R2.4 billion (100 per cent) was spent by the end of the financial year

2015/16 service delivery performance

• Provincial achievements in training and development by discipline:
o 1 473 registrars
o 287 specialists
o 294 undergraduates
o 14 grant administration staff 587 post graduates nurses and allied health)

Projected life
• The grant will remain as long as health science trainees are trained and supervised on the public health service platform

MTEF allocations
• 2017/18: R2.6 billion; 2018/19: R2.8 billion; and 2019/20: R2.0 billion

Payment schedule
• Monthly instalments as per approved payment schedule

Responsibilities of the transferring national officer and receiving officer

Responsibilities of the national department

• Convene at least one annual meeting of national, provincial and facility programme managers
• Monitor the number of health science trainers/clinical supervisors that are responsible for health science training on the public health service delivery platform
• Conduct a minimum of two site visits to provinces and site visits to selected facilities on a rotational basis. Provincial visits to include facilities
• Report on a quarterly basis to the National Treasury on an additional set of indicators agreed upon between the two departments

Responsibilities of the provincial departments

• Provinces must provide the allocated amounts for individual facilities to Provincial Treasuries for gazetting as per the number of agreed upon business plans per province and be facility/cluster specific, by 29 April 2017
• Provinces must maintain a separate budget for each benefiting facility/cluster
• Each benefiting facility/cluster budget letter must be supplied by the receiving officer to the facility head by 29 April 2017
• Provinces to monitor the following categories of health science trainers/clinical supervisors on the public health service delivery platform by category:
o specialists
o registrars
o medical officers
o clinical supervisors /trainers
o grant management (admin staff)
• Submission of updated specialist details funded by the grant at facility level by 30 November 2017
• Submission of updated specialists details funded on the equitable share by 30 November 2017
o Report quarterly (by economic classification) on financial and non-financial performance in the approved expenditure areas
• Conduct a minimum of two sites visit to each budgeted facility/complex per annum and submit reports of these site visits

Process for approval of the 2018/19 business plans
• Draft business plans for 2018/19 must be submitted in the approved format by 31 October 2017
• Completion of an approved business plans, in the prescribed format, signed by each receiving officer by 28 February 2018, and the transferring officer by 25 March 2018

 

 

National Health Insurance Indirect Grant: Health Professionals Contracting Component

Transferring department
o Heath (Vote 16)

Grant schedule
o Schedule 6, Part A

Strategic goal
o To strengthen the public healthcare systems
o To assess the service delivery implications

Grant purpose
o To develop and implement innovative models for purchasing services from health practitioners in the 10 National Health Insurance (NHI) pilot sites
o To develop and implement innovative models for the dispensing and distribution of chronic medication
o A risk-based capitation model for the reimbursement of primary health care (PHC) facilities developed

Outcome statements
o Appropriate and innovative models for purchasing services from health practitioners identified and tested
o Implement an alternative dispensing and distribution model for chronic medication
o Develop a risk-adjusted capitation model for the reimbursement of primary health care (PHC) facilities

Outputs
o Innovative models for the purchasing of health care services, including:
o number of health practitioners contracted per subcategory
o number of pharmacy assistants contracted
o number of patient visits attended to by the contracted health practitioners and services provided
o number of hours worked by health practitioners
o An alternative chronic medicines dispensing and distribution model implemented
o Number of new and number of total patients registered in the programme, broken down by the following:
o Antiretroviral (ARV) Treatment
o ARV with co-morbidities
o non-communicable diseases (NCDs)
o number of pickup points (PuPs) state and non-state
o A base capitation model for the reimbursement of PHC facilities developed

Priority outcome(s) of government that this grant primarily contributes to
o Outcome 2: A long and healthy life for all South Africans

Details contained in the business plan
o Business plan for contracting health practitioners should contain roles and responsibilities of national and provincial departments
o Targets, cash flow projections as well as monitoring and evaluation plans for the following programmes:
o mental health specialist teams
o chronic medicines dispensing and distribution model
o developing a risk -adjusted capitation model
o Service level agreements (SLAs) will include information on the following:
o outcome indicators
o output indicators
o key activities and resource schedule
o monitoring and evaluation plan
o cash flow requirements for 2017/18

Conditions
o Project level administrative expenditure may not exceed three per cent of the total grant funding. No activity that is linked to the responsibility of Department of Health (DoH) but falls outside this scope may be funded through this grant
o The grant must be used to achieve the objectives of the following areas:
o development and testing of innovative models for purchasing health care services from health practitioners
o an alternative chronic care medication dispensing and distribution model
o development of a risk-adjusted capitation model for reimbursement of PHC facilities
o The DoH must put in place an evaluation strategy using independent external experts to evaluate the interventions funded through this grant. An evaluation report on lessons learnt from contracting health practitioners and their implications for NHI policy development and implementation must be produced and submitted to National Treasury

Allocation criteria
o Health facilities with the greatest need for health practitioners and where health practitioners are willing to work in the facility will be prioritised
o The alternative chronic care medication dispensing and distribution model will be implemented across the country in the ten NHI pilot districts, with priority given to previously disadvantaged areas

Reasons not incorporated in equitable share
o The importance of central coordination in development of models and the establishment of NHI to inform ongoing NHI designs

Past performance

2015/16 audited financial outcomes

o R290 million was allocated of which R280 million (96 per cent) was spent by the end of the financial year

2015/16 service delivery performance

o The data extraction from clinical files within the central hospitals has been undertaken at eight out of 10 central hospitals
o The initial financial and clinical analysis has been undertaken and the draft case mix analysis report prepared
o Phase two of the programme will continue to develop the base diagnosis related grouper has been started
o Other data sources from private partners are being sourced for the purpose of triangulation and data validation
o With regards to health practitioner contracting, 256 doctors were placed at various clinics in the NHI pilot districts

Projected life
o Subject to policy developments that will be finalised as part of the implementation of NHI

MTEF allocations
o 2017/18: R518 million; 2018/19: R337 million; and 2019/20: R355 million

Payment schedule
o Payments will be made according to verified invoices or advance payments in line with approved programme implementation plans from the service providers
o Monthly instalments which may be altered at the discretion of the National Treasury based on invoices paid

Responsibilities of the transferring national officer and receiving officer

Responsibilities of the national department

o Convene and chair all meetings of the national district health services (NDHS) committee on contracting of health practitioners and related matters through implementing innovative models for the purchasing of health care services
o Establish the necessary organisational structures and build capacity within the DoH to implement, oversee and monitor the execution of all approved projects using the three per cent administrative costs provision
o Provide the guidance and support for innovative arrangements of engaging public and private sector providers, including methods of contracting (types of contracts and payment mechanisms)
o Undertake an independent evaluation of the interventions funded through this grant using external experts
o Manage, monitor and support programme implementation
o Meet with the National Treas to review grant performance on a quarterly basis

Responsibilities of the provincial departments

o Facilitate the achievement of grant outputs
o Ensure compliance with all reporting requirements and adherence to the provisions of SLAs

Process for approval of the 2018/19 business plans
o DoH must submit final business plans to National Treasury by 30 March 2018

 

 

National Health Insurance Indirect Grant: Ideal Clinics Component

Transferring department
o Health (Vote 16)

Grant schedule
o Schedule 6, Part A

Strategic goal
o To improve quality of services at primary health care facilities

Grant purpose
o To enable the health sector to address the deficiencies in the primary health care facilities systematically to yield fast results

Outcome statements
o Improved quality health services in all primary health care facilities

Outputs
o 500 primary health care facilities peer reviewed
o Achieve a cumulative target of 1000 primary healthcare facilities obtaining an overall compliance score of 70 per cent or above
o Branding guidelines completed
o 5 per cent of clinics in NHI pilot districts branded
o Sustainability training to clinic managers of 30 per cent of clinics in NHI pilot districts

Priority outcome(s) of government that this grant primarily contributes to
o Outcome 2: A long and healthy life for all South Africans

Details contained in the business plan
o Input
o Output indicators
o Outcome indicators
o Key activities
o Risk management plans

Conditions
o Completion of a business plan by the national Department of Health (DoH) signed by the transferring officer by 24 March 2017 and submitted to the National Treasury by 31 March 2017

Allocation criteria
o Allocations are based on the number of identified facilities and their needs in each province

Reasons not incorporated in equitable share
o Ideal clinic is a key national priority and requires systematic implementation in order to achieve 740 ideal clinics and have the desired impact of improving quality health care services

Past performance

2015/16 audited financial outcome

o New grant

2015/16 service delivery performance

o New grant

Projected life
o The grant is projected to end in 2020/21

MTEF allocations
o 2017/18: R30 million; 2018/19: R50 million; and 2019/20: R53 million

Payment schedule
o Procurement will be done centrally by DoH based on the approved procurement pIan

Responsibilities of the transferring national officer and receiving officer

Responsibilities of the national department

o Improve patients' experience of care by improving quality in primary health care facilities
o Monitor and support provincial planning and implementation
o Submit a quarterly performance report to the National Treasury in terms of the 2017 Division of Revenue Act
o Meet with the National Treasury to review performance of the grant on a quarterly basis
o Strengthen the capacity of provinces to realise and maintain ideal clinic status
o Maintain the ideal clinic software

Responsibilities of the provincial department

o Provincial health departments must provide DoH with full and unrestricted access to all records and data related to the programme
o Provinces must submit provincial needs as per prescribed format by DoH
o Include the ideal clinic indicators in the provincial annual performance plans
o Delegate a person responsible for managing the Ideal clinic programme
o Provinces must develop draft implementation plans for taking over this function in 2020/21
o Submit quarterly performance reports to DoH

Process for approval of the 2018/19 business plans
o Submission of business plan signed by the transferring officer by 30 March 2018 to National Treasury

 

National Tertiary Services Grant

Transferring department
• Health (Vote 16)

Grant schedule
• Schedule 4, Part A

Strategic goal
• To enable provinces to plan, modernise, rationalise and transform the tertiary hospital service delivery platform

Grant purpose
• Ensure provision of tertiary health services for all South African citizens (including documented foreign nationals)
• To compensate tertiary facilities for the additional costs associated with provision of these services

Outcome statements
• Modernised and transformed tertiary services that allows for improved access and equity to address the burden of disease

Outputs
• Number of inpatient separations
• Number of day patient separations
• Number of outpatients first attendances
• Number of outpatients follow-up attendances
• Number of inpatient days

Priority outcome(s) of government that this grant primarily contributes to
• Outcome 2: A long and healthy life for all South Africans

Details contained in the business plan
• This grant uses national service level agreements (SLAs) which are signed between national Department of Health and each province and contains the following:
o provincial and institutional allocations
o tertiary services specifications (approved YES list) funded by the grant, by facility by province
o annual targets for inpatient separations, inpatient days, day patient separations, outpatient first visits, outpatient follow up visits per facility per province per year
o monitoring and reporting responsibilities
o validation and revision of data
o deviations or changes to tertiary services
o referral responsibilities
o approved business plan
o approved specialists funded from the grant (approved specialist detail list)
o national guidelines on definitions of tertiary services that may be funded by the grant

Conditions
• Completion of a national SLA in the prescribed format, signed by the provincial Head of Department or receiving officer by 28 February 2017, and the transferring officer by 31 March 2017
• The grant allocation to each central/provincial tertiary facility must not exceed a maximum of 65 per cent of the total facility budget
• The following amounts in the allocation to Gauteng are earmarked to fund the operations of the Nelson Mandela Children's Hospital (NMCH):
o 150 million in 2017/18
o R200 million in 2018/19
o R300 million in 2019/20
o All staff for this hospital must be procured at rates no higher than Department of Public Service and Administration approved remuneration rates
o The services offered by Nelson Mandela Children's hospital should be integrated into the service delivery platform in collaboration with relevant provinces, particularly Gauteng

Allocation criteria
• Based on historical allocations and spending patterns

Reasons not incorporated in equitable share
• There are significant cross boundary flows associated with tertiary services that are not affected by provincial boundaries due to their specialised nature

Past performance

2015/16 audited financial outcomes

• Allocated and transferred R10.4 billion to provinces, of which R10.4 billion (100 per cent) was spent by the end of the national financial year

2015/16 service delivery performance

• Provincial tertiary services performance was measured against the SLAs and the total patient activity rendered is as follows:
o Inpatient separations
o Inpatient days
o Day patient separation
o Outpatient first visits
o Outpatient follow up visits

670 415

3 932 950

298 855

1 117 783

2 666 335

Projected life
• Support for tertiary services will continue because of the need to sustain and modernise tertiary services

MTEF allocations
• 2017/18: R11.6 billion; 2018/19: R12.4 billion; 2019/20: R13.2 billion

Payment schedule
• Monthly instalments as per payment schedule approved by National Treasury with the exception of Nelson Mandela Children's Hospital where the first payment of R100 million will be made in April 2017. Payments of R25 million each will be made in July and October 2017 based on satisfactory performance

Responsibilities of the transferring national officer and receiving officer

Responsibilities of the national department

• Convene at least one annual meeting of national, provincial and facility programme managers
• Monitor expenditure by economic classification, and patient activity and provide on-site support to facilities/complexes and provinces
• Conduct a minimum of two site visits to provinces and a minimum of one site visit to facilities/complexes

Provincial visits to include facilities

• Report on a quarterly basis to the National Treasury on an additional set of indicators agreed upon between the NDoH and National Treasury

Responsibilities of the provincial departments

• Completion of a provincial SLA/memorandum of understanding signed by the receiving officer and the benefitting institution by 31 March 2017, and submission to NDoH by 28 April 2017 (due date for NMCH is 31 March 2017)
• Provinces must provide the allocated amounts for individual funded facilities/clusters to Provincial Treasury for gazetting as per the number of agreed upon business plans per province and be facility/cluster specific, by 28 April 2017
• Provinces must maintain a separate budget for each benefiting facilities
• The receiving officer must supply the head of each benefiting facility/complex with a budget letter which includes the equitable share allocation by 29 April 2017
• Conduct a minimum of two sites visit to each budgeted facility /complex per annum and submit reports of these site visits to NDoH
• Submission of updated specialists details funded by the equitable share by 30 November 2017
• Submission of updated specialist details funded by the grant at facility level by 30 November 2017
• Submission of service specifications funded at each facility by 30 November 2017
• Submission of quarterly reports in the approved expenditure areas in the prescribed format
• Provide patient utilisation data (inpatient separations, inpatient days, day case separations, outpatient first visits, outpatient follow up visits and patient-day equivalents) as per the prescribed format
• Provide the number of inpatient separations for intensive care units (ICU) and neonatal ICU (NICU) quarterly
• Provide the number of inpatient days for ICU and NICU quarterly
• Provide the average length of stay at facility level quarterly

Process for approval of the 2018/19 business plans
• Submission of draft business plans (provincial and facility) by 31 October 2017
• Completion of SLA, in the prescribed format, signed by each receiving officer by 28 February 2018 and the transferring officer by 25 March 2018