National Tertiary Services Grant
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Transferring department
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Grant schedule
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Strategic goal
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| • | To enable provinces to plan, modernise, rationalise and transform the tertiary hospital service delivery platform |
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Grant purpose
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| • | 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 |
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Outcome statements
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| • | Modernised and transformed tertiary services that allows for improved access and equity to address the burden of disease |
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Outputs
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| • | Number of inpatient separations |
| • | Number of day patient separations |
| • | Number of outpatients first attendances |
| • | Number of outpatients follow-up attendances |
| • | Number of inpatient days |
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Priority outcome(s) of government that this grant primarily contributes to
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| • | Outcome 2: A long and healthy life for all South Africans |
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Details contained in the business plan
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| • | 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 specialists funded from the grant (approved specialist detail list) |
| o | national guidelines on definitions of tertiary services that may be funded by the grant |
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Conditions
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| • | 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 | 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 |
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Allocation criteria
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| • | Based on historical allocations and spending patterns |
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Reasons not incorporated in equitable share
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| • | There are significant cross boundary flows associated with tertiary services that are not affected by provincial boundaries due to their specialised nature |
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Past performance
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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 |
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2015/16 service delivery performance
| • | Provincial tertiary services performance was measured against the SLAs and the total patient activity rendered is as follows: |
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| o | Outpatient follow up visits |
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670 415
3 932 950
298 855
1 117 783
2 666 335
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Projected life
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| • | Support for tertiary services will continue because of the need to sustain and modernise tertiary services |
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MTEF allocations
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| • | 2017/18: R11.6 billion; 2018/19: R12.4 billion; 2019/20: R13.2 billion |
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Payment schedule
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| • | 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 |
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Responsibilities of the transferring national officer and receiving officer
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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 |
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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 |
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Process for approval of the 2018/19 business plans
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| • | 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 |
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