Inkosi Albert Luthuli Central Hospital

HEALTH KWAZULU-NATAL Inkosi Albert Luthuli Central Hospital HEALTH KWAZULU-NATAL Inkosi Albert Luhuli Central Hospital 800 Bellair Road Cato Manor 4058 Tel: (031) 240 1000 Fax: (031) 240 1050 Email: info@ialch.co.za Website: www.ialch.co.za

In Memory of Inkosi Albert Luthuli Notes 1898-1967 Inkosi Albert Luthuli It is appropriate that during this year, inkosi Albert Luthuli, the country s first Nobel Prize laurette, recipient of the coveted Peace Prize for 1960, should be singled out for substantial additional honours by central government, as part of the Legacy Project, which acknowledges communities and individuals whose contributions helped bring freedom to South Africa. On March 20 th 2004, State President Thabo Mbeki honoured Inkosi Albert Luthuli, one of the principal architects of our democracy, during the annual Luthuli Memorial Lecture at the University of KwaZulu-Natal. A posthumous Doctor of Law degree, (LLD Honoris causa), was conferred on Inkosi Albert Luthuli. In addition, the Luthuli home at Groutville is in the process of being transformed into a museum and interpretive centre, and Inkosi Albert Luthuli s church, the United Congregational Church of South Africa in Groutville is being restored and renovated. Most importantly, the Statue of Liberty in South Africa is standing tall and strong, as evidence of the presence of Inkosi Albert Luthuli Central Hospital, named in honour of this outstanding man. Inkosi Albert Luthuli Central Hospital

Contents Project Page Our Vision, Mission and Core Values 2 Message from the Chief Executive Officer 3 Complete Commissioning 5 Improving Client Satisfaction and Increasing Clinical Utilization 6 Improving Organisational and People Management 8 Maximizing Value for Money 10 Co-ordinating & Optimizing the Public Private Partnership 12 Report by the Chairman of Impilo Consortium 14 Financials Statement of Accounting Policies and related matters 17 Income Statement 19 Balance Sheet 20 Notes to Financial Statement 21

OUR VISION A flagship tertiary and quaternary hospital OUR MISSION To provide accessible quality patient care to all persons in KwaZulu-Natal and part of the Eastern Cape CORE VALUES Quality - through the services we provide and the way we provide them Integrity - in how we deal with others Innovation - in our approach to delivery of health services Learning - by developing a culture of continuous learning and development of staff Achievement - in meeting our targets Partnership - in working together across disciplines and with the health care family throughout the province of KwaZulu-Natal Equality - in access to services and opportunities with sensitivity and respect to cultural differences Teamwork - the only way to achieve our goals Inkosi Albert Luthuli Central Hospital

MESSAGE FROM THE CHIEF EXECUTIVE OFFICER The evolution of a flagship tertiary and quaternary hospital requires progress on a number of fronts. However, in the end it is all about providing optimal patient care and quality. Inkosi Albert Luthuli Central Hospital s commitment to delivering the best clinical care possible, within a compassionate and caring environment, has continued since the hospital first opened its doors to the public on 28 June 2002. This culture of caring and excellence is sustained and enriched on a daily basis by our dedicated internal customers, both from the public and private sectors. Alongside our nurses, doctors, therapists, social workers, radiographers, pharmacists and technologists are hundreds of individuals performing a myriad of other vital functions at all hours of the day and night from administration, to food services, to security, to provision of information technology support and many others. Without the contributions of each of these dedicated internal clients, this hospital would not have achieved its vision and mission. These skilled and caring individuals work as a dynamic team, always focused on putting the patient at the top of the pyramid. As we approached the dawn of the 2005 2006 financial year, the process of Mrs F. G. Zondi developing a Strategic Plan for the coming financial year commenced. Critical and central to this process was the review of past strategic objectives and the development of revised and new strategic objectives that will support the vision and mission of this hospital. This process culminated in a re-focused strategic plan for the 2005 2006 financial year. With the active participation of the middle management cadre of the hospital, the strategic objectives that were agreed upon were then translated into a operational plan, which assisted with the budget planning and allocation process and which formed part of the dashboard used by the hospital to measure organizational performance. In terms of the operational plan, 8 priority areas were identified. The commissioning of all outstanding units was identified as priority one. At this juncture, this is important to note that Inkosi Albert Luthuli Central Hospital was commissioned in phases, with the transfer of services from King Edward, Wentworth and Addington hospitals. Whilst the transfer of most existing services from other hospitals was completed prior to the commencement of the period under review, services including Red Code Trauma and Burns, which this hospital is mandated to provide, were not commissioned. The challenge with the commissioning of these services included the creation of an organizational structure for each of these units as well as the appointment of adequate medical specialists. The posts of Head of Trauma and Head of Burn were initially advertised on Principal Specialist level. Unfortunately, no suitable applicants could be attracted. These posts were subsequently upgraded to Chief Specialist level and advertised. As a result, the Head of the Burns Unit and the Head of the Trauma Unit were appointed. Steering Committees were established to facilitate the commissioning of these units. Difficulties in appointing suitable medical staff to these units resulted in these units not being commissioned during the period under review.

The second priority that was identified in the 2005 2006 operational plan related to the provision of an environment that promotes recruitment, development, utilization and retention of skilled, specialized and motivated employees. In this regard, skills audits and the development of a hospital training and development plan had been completed. The process of identifying and devolving certain human resource and systems department functions to domain management team continued, in accordance with the devolved management philosophy of the hospital. A new medical establishment, consisting of specialists posts, was created for the clinical departments at the hospital. Priority posts were identified, advertisements placed and selections made. However, due to the national shortage of medical staff, not all of these posts could be filled. In order to get a better understanding of reasons for staff attrition, exit interview questionnaires were analysed, as a first step towards the development of a staff retention policy. To maximize value for money, inclusive of the public private partnership, was identified as priority 3. The basis of this determination entailed the implementation of activity based costing. Planning for this system included conducting research at institutions that have implemented this system, development of an implementation plan and obtaining the necessary software and configuring it to meet the needs and requirements of the cost. The implementation of activity based costing provided management at all levels with an invaluable tool for planning and monitoring. In addressing the aforementioned priority, various discussions and interactions were held with IMPILO, to put in place strategies and action plans to decrease the number of days in inventory. Although much progress was made, room still existed, at the end of the period under review, for more improvement. Mrs F. G. Zondi Chief Executive Officer Inkosi Albert Luthuli Central Hospital

Complete Commissioning In the period under review we made a few positive strides. Not as far as I would have wanted to go, but nevertheless some progress is recorded since the last report. The General Surgery unit was commissioned. This is a 32-bed ward and will include gastrointestinal work and TPN. Mr Suliman Bhayla has been appointed as the head of this unit at IALCH. There was a recommended name change, from General Surgery to Specialized Surgical Services and SMT and the other stakeholders accepted this. The Burns Unit has not been commissioned due to a lack of trained medical staff that are willing to take up posts. There were 6 Consultant posts advertised with only 1 applicant. Registrars are needed as well. The Department of Surgery is still awaiting feedback from the HPCSA regarding the creation of the additional posts for training purposes. We will have to start the unit very small and gradually increase the beds as additional medical staff is attracted to the unit. Dr M. E. L. Joshua The Trauma unit also has not been commissioned. So far progress has been made in the appointment of senior medical staff. We are also awaiting the creation of 9 registrar posts, but have a plan to commission in the meantime with borrowed posts from the various surgical departments. This is not the ideal but second best, in order to commission. For both the Burns and Trauma units the Acting Nurse Manager has assured me that there will be sufficient nursing staff to commission the units. The Professions Allied to Medicine are awaiting the restructured work force plan where the requirements for these units have been included. The Ethics meeting continues to be attended by a few interested persons. This includes Lynn Matisonn from the Philosophy department in UKZN and I want to acknowledge the contributions that she makes to the discussions. Our adverse clinical reporting is properly structured and a policy is in place. The incidents are graded in severity, and the most serious i.e. grade 4, results in a Clinical Governance meeting chaired by the Medical Manager. This is a multidisciplinary meeting and has resulted in amendments to policy and a fresh understanding amongst staff. Each Clinical Head of Department has updated the entry and exit criteria. The revised edition has been placed on both our network and the government intranet. Dr M. E. L. Joshua Medical Manager

Improving Client Satisfaction and Increasing Clinical Utilization Every client who uses a service or its product will always insist on quality. Quality is the key word in our hospital. We believe quality refers to doing or providing service right or correct the very first time. If this quality is provided or not provided our customers are encouraged to evaluate and either commend or complain through the suggestion boxes provided at the hospital or through the Public Relations office and the Quality Assurance Department. Each complaint is thoroughly attended to and the complainant is continuously informed of the proceedings until finality is reached. In cases of commendations our staff are commended and encouraged to do even better. For our internal customers, survey forms have been made available to evaluate the service. Feedback from these surveys are audited by the Audit Committee and presented to the Senior Management Team. Mrs P. P. Zungu Complaints or dissatisfaction are attended to respectively. Corrective action is taken where necessary. Obtaining the COHSASA accreditation was a great success and also a huge challenge, because the standards have to be both maintained and maximized. The Quality Steering committee holds meetings once in every two months to ensure that quality standards are improved. The hospital has been accredited as one of the Health promoting hospitals. Internal and external customers are encouraged on health promoting initiatives. This is also done through health awareness days. We congratulate our staff for achieving this goal. The hospital has been awarded accreditation of the Baby Friendly Initiative Programme. This was blessed by our Health Minister Mrs Peggy Nkonyeni at a ceremony for the province. Inkosi Albert Luthuli Central Hospital

As a health institution, we are also faced with challenges like the HIV & Aids pandemic, which end up compromising the health of our internal and external clients. The latest span of TB poses a great challenge. A TB Coordinator has been appointed and works hand in hand with the Infection Control Team, to create awareness, emphasize the importance and danger to our clients. The team ensures that they attend the Ethekwini District and Head office meetings and workshops; feedback is given to the Senior Management team. The policy review committee meets twice a month to ensure that the hospital policies are continuously updated. This promotes and maximizes quality patient care and practice to ensure improved client satisfaction & increase clinical utilization. The utilisation of the hospital departments is increasing as evidenced by the activities and statistics from outpatient clinics, wards, professions allied to medicines, theatre, intensive care units and high cares. The Impilo consortium is supportive in ensuring that quality patient care is maximized by conducting refresher and update courses to staff on the use of information technology and equipment. They are involved in our committees that require their expertise. We appreciate their continuous services. The IALCH staff will always strive to improve client satisfaction and increase clinical utilisation. We thank our staff for aspiring to this important goal. I shall pass this world but once. Therefore, any good that I can do, let me do it now, let me not defer it, for I shall never pass this way again. (Author unknown) Mrs P. P. Zungu Nursing and Quality Manager

IMPROVING ORGANISATIONAL AND PEOPLE MANAGEMENT Recruitment continued at a steady pace during the year under review. High turnover rates coupled with posts that remained vacant since commissioning due to the shortage of staff, in certain occupational categories, necessitated the placing of 122 advertisements and the appointment of 157 staff. For the first time since commissioning, 3 hospital based Chief Specialist posts, in Neonatology, Burns and Trauma, were filled. With regard to nursing posts, the total number of nurses recruited, coupled with the number that existed at the hospital, as well as posts that remained vacant since commissioning, resulted in a situation where the total number of nurses employed permanently was insufficient to meet the nursing requirements of the hospital. As a result, the Senior Management Team continued with the innovative strategy embarked on during the past 3 years, namely the appointment, on contract, of skilled and experienced nurses who had retired. The contracts of 201 of these nurses were renewed whilst an additional 29 nurses on contract were employed. Challenges in terms of creating the number and grading of posts on the PERSAL establishment that would optimally meet the service delivery needs of the hospital continued. Since late 2005, three officials from the Organisational Development and Mr D. Moodley Efficiency (OD & E) Directorate spent a significant amount of time at IALCH meeting with various Heads of Department in order to obtain inputs that would assist with the development of an appropriate structure for IALCH. By the end of the period under review, these officials had made significant progress towards a recommended structure for IALCH. Whilst this process progressed, it became necessary for IALCH Management to continue to use posts on the existing PERSAL establishment in a creative and innovative manner in order to meet service delivery needs and challenges. In this regard, it became both unavoidable and necessary that personnel, especially in the medical occupational category, be held out of adjustment against other posts. The development of management capacity continued in tandem with other training and development interventions. Due to the advanced, specialized nature and state of the art Information Management and Technology (IM&T) Systems and Medical Equipment at this hospital, IMIPLO, in terms of Schedule 32 of the Project Agreement, is required to provide training to Department of Health employees on the IM&T systems and medical equipment. All new appointees are required to undergo training in these areas. In terms of Schedule 32, IMPILO is also required to provide refresher training to staff who need to update their skills and when updates are incorporated in the IM&T systems or when new or upgraded equipment is installed. During the period under review, in respect of the IM&T systems, 291 staff received training on Basic Computers, 287 staff on MEDICOM and 17 staff on SAP. With regard to medical equipment, 180 staff received training on orientation equipment (a package of 11 pieces of common equipment in the hospital) and 86 staff on specialized equipment. During the period under review, a Workplace Skills Plan was compiled and submitted to the ethekwini District Office with a request for R 592 450.00. An amount of only R20 000.00 was allocated. A total of 92 staff attended external training/ conferences/congresses through sponsorships and with the aid of hospital funds. A total of 19 staff attended training arranged by the ethekwini District Office. This training included HIV / AIDS Management Course, Employee Assistance Training, Best Practice Hospital Management and Managing Diversity. The Senior Management Team attended workshops on the Performance Budgeting System. Towards the end of the period under review, the hospital received a Professional Fees allocation of R20 000 from the University of Kwazulu-Natal for training and development purposes. This allocation was used to afford 7 nurses the opportunity to attend assertiveness training. In January 2006, the Institutional Human Resource Development Committee was established, with representation invited from the various occupational categories. The main activities of this Committee is to determine training needs, analyse and prioritise identified training needs, develop a Workplace Skills Plan for IALCH and monitor and evaluate this plan. Inkosi Albert Luthuli Central Hospital

The year under review marked the third anniversary of the Pay Progession System. A total of 919 staff qualified and were awarded a notch increment in terms of this system. The Performance Management and Development System was introduced during the period under review. Workplans and quarterly reviews were completed in respect of 1600 staff. The Occupational Health Clinic (Wellness Centre) resides under the HRM Department. During the period under review, this clinic treated 1163 cases of chronic ailments and 3180 minor ailment cases. The Clinic attended to 53 incidents of needle-stick injuries and bloodsplashes and 32 incidents of injury on duty. Recognising that staff require assistance in managing and coping with personal and work-related problems and issues more effectively, the hospital appointed an Employee Assistance Practitioner in February 2006. Through the provision of both preventative and restorative services, this Practitioner plays a extremely important role in ensuring that staff return to being valuable assets in the hospital. As at the end of the period under review, this Practitioner attended to 12 troubled employees. Table 1 : Reasons for staff exits : 400 350 300 250 200 393 150 100 187 50 102 84 Table 2: Employment Equity: 10 0 Deceased Resignation (Career) Resignation (Personal) Retirement 4 6 Termination of Contract Termination (External) TOTAL Demographic Profile in terms of Professional Classification ( including staff employed on contract, JME and Registrar posts) Filled Professional Classification African Indian White Coloured All Races Female Male Female Male Female Male Female Male Female Male - All Professional Classifications 1311 130 309 106 65 34 64 4 1749 274 Artisan and Support 0 0 0 0 0 0 0 0 0 0 Communication and Support 1 2 0 0 0 0 0 0 1 2 Economic Advisory and Support 0 1 0 0 0 0 0 0 0 1 Health and Support 14 6 57 8 10 0 7 0 88 14 Human and Support 6 5 4 5 4 0 1 0 15 10 Line Function and Support 63 24 35 8 5 1 3 0 106 33 Manage and Support 0 4 4 3 2 0 1 0 7 7 Medical Science and Support Pers 14 24 55 66 22 30 1 1 92 121 Medical Technology and Support 5 2 13 4 3 3 0 0 21 9 Natural Science and Support 0 0 0 0 0 0 0 0 0 0 Nursing and Support 1208 62 139 12 19 0 51 3 1417 77 Social Service and Support 0 0 2 0 0 0 0 0 2 0 Mr D. Moodley Human Resources Manager

Maximizing value for money Finance provides its services in alignment with the IALCH vision, mission and strategy. Provided below is a summary of Finance s services as they relate to the perspectives to which we link. Customer Satisfaction: Collective financial stewardship is the keystone of Finance s dayto-day operations. As a support business unit in IALCH, working closely with others and responding to their requirements are central to how we do business. We maintain and provide financial information for IALCH Senior Management Team including Domain Management Teams to use in making decisions concerning the operation of the hospital. We view both external and internal customers as being equally important and make every effort to provide the highest levels of service consistent with the resources that have been made available. Maximizing Value for Money: Finance takes very seriously its role in the maximizing of value for money in IALCH. The improvement of planning and budgeting systems, expenditure and revenue management, and risk management are a key element in Mr P. B. Shezi the maximizing of the value for money. We continue to seek to make optimum use of technology and the process improvements in every facet of our operations. Human Resource Development: Finance s continued success is based on the quality of our people. A strong management emphasis is placed on the maintenance of a workplace setting that is conducive to attracting and retaining a skilled and diverse workforce. We believe the key elements of this setting to be good communication, ongoing training and recognition for a job well done. Strategic Initiatives 1. Customer Service Plan Continuously enhance levels of service delivery through the vigorous implementation of the Batho Pele - People First - principles. 10 Inkosi Albert Luthuli Central Hospital

2. Business Processes Plan Continuously pursue process improvements in every facet of departmental operations. In this regard our process improvement strategy was revamped and its implementation closely monitored. 3. Learning and Growth Plan Continuously develop staff capabilities and enhance information systems capabilities. By the end of the 2005/2006 year most of our staff members obtained recognition by the Institute for Public Finance and Auditing (IPFA). The number of multi-skilled staff was increased to half of the existing complement. 4. Finance Plan We continuously pursued courses of action that optimized the Hospital s financial stance. Maximizing value for money was pursued through the implementation of Activity Based Costing and strict control of the supply-chain management function. Mr P. B. Shezi Finance Manager 11

CO-ORDINATING & OPTIMIZING THE PUBLIC PRIVATE PARTNERSHIP The Systems Department looks at the non-core functions which are privately maintained by Impilo. This is important because without these services the hospital cannot work effectively and efficiently. The main brief is to make sure that the Hospital functions effectively and whatever needs to be delivered by Impilo is available timeously and adherence to the project Agreement and Specification is always maintained. This Department is to make sure that equipment such as Surgical, Medical, IT and consumables are delivered and the grounds and hospital should be clean and tidy at all times. This report by Systems attempts to make sure that all sections within Systems are making progress in terms of managing the Project and also providing Services such as Mortuary, Out Patient and Library. The IM&T and Medical Equipment Group is primarily responsible for the monitoring of the efficiency of all installed information management systems and technology and all commissioned medical equipment. Additional activities include the assistance with user requests for software changes, investigations into analysis of equipment incident Mr B. M. K. Mpulo reports, the evaluation of requests for additional equipment and the generation of required monthly reports for both National and Provincial Departments of Health, IALCH Senior Management and ad hoc internal reporting. Accuracy of data being captured is vitally important to ensure that management decisions are based on viable and true statistics. To this end, the Data Integrity Task Team (DITT) was instituted to motivate and ensure that all data is entered timeously, is accurate and appropriate, and where necessary, identify areas for refresh training of our staff. The completeness and accuracy of patient records has greatly improved over the past year enabling more accurate patient and activity statistics to be reported. The request for additional equipment, both medical and IT, has seen a positive downward trend, as the requirements for the tertiary services supplied at IALCH, have stabilized. Impilo, with their positive approach in the evaluation of these requests, has greatly assisted in ensuring that the quality of patient care has remained at a very high level due to the support of highly technical electronic equipment and services. Laptops, printers and workstations have seen the start of the first equipment refresh life cycle by Impilo as scheduled in the Project Agreement. 12 Inkosi Albert Luthuli Central Hospital

Facilities Management is holistic and integrated management and service provision for accommodation, housekeeping and business service requirements of the enterprise, with the objective of supporting the users in such manner as to achieve optimal productivity, continuity, compliance, sustainability and cost efficiency. The Facilities Management group has been working on a Disaster Management Plan for the entire hospital, incorporating the private partner Impilo Consortium. Such plan is in line with provincial requirements and is informed by the envisaged risks that the hospital might encounter. The Medical Library is functioning very well, as it continues to provide information service to the staff. The library houses medical journals, books, scanning and copying facilities, and provide internet access to assist with medical information. The Library Service Manager position has been filled, and this will help in the smooth running of the library. The Librarian position has been advertised and should be filled soon. The future plans include extending the library closing hours to about 8 pm on weekdays. The library is also working on introducing a small collection on the leisure reading for the staff, this will include biographies, magazines and novels. The objectives for Admissions and Revenue are to have appropriate and friendly staff to attend to our patients, to improve the working standard by being efficient and effective, as well as to have updated filing and to improve on our revenue collection. The Mortuary group is running effectively and efficiently as the team is doing very well to ensure that. Currently we will be ensuring that all the vacant positions are filled in order to provide the best service. The future plan for this department is to develop the mortuary assistants by providing the relevant trainings in order for them to work independently on weekends and holidays. Mr B. M. K. Mpulo Systems Manager 13

Report by the Chairman of Impilo Consortium We have completed year four of the fifteen year Public Private Partnership contract our Consortium has with the KwaZulu-Natal Department of Health. The Public Private Partnership allows the Department of Health to concentrate on the provision of clinical services and Impilo Consortium, to concentrate on the provision of equipment, information management and technology, facilities management and associated services at Inkosi Albert Luthuli Central Hospital. Local Community Mr T. Mnganga The past year has seen our consortium continue to meet its responsibilities in terms of the contract and development of members in the local Cato Manor Community. We have a workforce on site of over nine hundred employees and of this number sixty three percent are from the local Cato Manor area. Further to this we provide bursaries to a selected number of learners from Cato Manor who are studying at Mangosuthu Technikon and Durban University of Technology. We are also assisting in the local community with various work groups, which supply items to the hospital, from which we procure. Looking Back In my report last year I indicated that we would face a few key challenges and I am happy to report that We have maintained the ISO accreditation We continue to work with and assist the local Cato Manor community We place great effort on security, and the protection of patients, staff and assets remain a top priority We continue to follow recommendations proposed in the Compliance audit and also improve our internal monitoring systems. We continue to have a dedicated team of employees that monitor the quality and integrity of data and make improvements where required. 14 Inkosi Albert Luthuli Central Hospital

Help Desk A unique element of this contract is that the Consortium is responsible for monitoring its own performance in accordance with the performance and measurement criteria as set out in the project agreement and this is achieved via the help desk, which is a single point of contact for users to report faults (equipment not working) or request assistance (calling for a porter to move a patient). We also have an independent company that conducts quality surveys on site each month, patients as well as clinical staff are interviewed, in order to measure our quality of service in terms of the output specifications as contained in our contract. It can be seen that the FM soft category has had by a large margin the most calls since the inception of the help desk. It has around 16000 calls per month (of this 12 000 porter calls per month) compared to 1200 IM&T, 1000 FM Hard and 600 Medical Equipment calls per month. Calls Through Time by Category 15

Information Management & Technology We continue to make significant progress in the production of statistics arising out of Project Heartbeat, which is a joint effort by both parties to address accuracy of information with the ultimate aim to improve health care by allowing for informed decisions to be made. Staff training in the use of computer technology is an ongoing process and most clinical staff are now computer literate. The contract allows for the refreshment of assets in terms of their useful lives. In the area of information technology we have refreshed a server, notebooks and are currently in the process of refreshing printers and desktops. Facilities Management We follow strict planned preventive maintenance programs so as to ensure that the hospital facilities are maintained in prime condition. We identified during the remedial and completion works program, which commenced in 2001, that the screed on the hospital floors throughout most of the hospital was sub standard and would need to be repaired or replaced. The rectification program has commenced and we are currently busy in ward D3 and Trauma. Unfortunately this does create some inconvenience due to the size of the project. The rectification program will continue throughout the hospital over the next few years. The contract allows for the refreshment of assets in terms of their useful lives, furniture and related equipment is refreshed on an ongoing basis. Medical Equipment We follow strict preventative maintenance programs on all items of medical equipment, which allows the hospitals to render an uninterrupted service to patients. No clinical staff member is allowed to use any piece of medical equipment unless they have been trained on the item; training is thus an ongoing process as new clinical staff are employed or as new equipment is introduced. Medical equipment is continually being looked at and the consortium at its own cost has supplied alternative medical equipment where clinicians have requested particular items. The refreshment of medical equipment is currently taking place on a very limited scale, but from 2007 this process will increase as catered for in the contract. Conclusion We as a consortium are mindful of our position and continue to strive for excellence of service so as to ensure patient care is not compromised. Mr T. Mnganga Chairman Impilo Consortium (Pty) Ltd 16 Inkosi Albert Luthuli Central Hospital

STATEMENT OF ACCOUNTING POLICIES AND RELATED MATTERS FOR THE YEAR ENDED 31 MARCH 2006 The financial statements have been, unless otherwise indicated, prepared in accordance with the following policies, which have been applied consistently in all material respects. However, where appropriate and meaningful, additional information has been disclosed to enhance the usefulness of the financial statements and to comply with the statutory requirements of the Public Finance Management Act, Act 1 of 1999 (as amended by Act 29 of 1999), and the Treasury Regulations issued in terms of the Act and the Division of Revenue Act, Act 1 of 2005. 1. Presentation of the Financial Statements 1.1 Basis of preparation The Financial Statements have been prepared on a modified cash basis of accounting, except where stated otherwise. The modified cash basis constitutes the cash basis of accounting supplemented with additional disclosure items. Under the cash basis of accounting transactions and other events are recognised when cash is received or paid or when the final authorisation for payment is effected on the system (by no later than 31 March of each year). 1.2 Comparative figures Prior period comparative information has been presented in the current year s financial statements. Where necessary figures included in the prior period financial statements have been reclassified to ensure that the format in which the information is presented is consistent with the format of the current year s financial statements. A comparison between actual and budgeted amounts per major classification of expenditure is included in the appropriation statement. 2. Revenue 2.1 Appropriated funds Appropriate funds are recognised in the financial record on the date the appropriation becomes effective. Adjustments to the appropriated funds made in terms of the adjustments budget process are recognised in the financial records on the date the adjustments become effective. Total appropriated funds are presented in the statement of financial performance. Unexpended appropriated funds are surrendered to the National/Provincial Revenue Fund, unless approval has been given by the National/Provincial Treasury to rollover the funds to the subsequent financial year. These rollover funds form part of retained funds in the annual financial statements. Amounts owing to the National/Provincial Revenue Fund at the end of the financial year are recognised in the statement of financial position. 2.2 Departmental revenue All department revenue is paid into the National/Provincial Revenue Fund when received, unless otherwise stated. Amounts owing to the National/Provincial Revenue Fund at the end of the financial year are recognised in the statement of financial position. 3. Expenditure 3.1 Compensation of Employees Salaries and wages comprise payments to employees. Salaries and wages are recognised as an expense in the statement of financial performance when the final authorisation for payment is effected on the system (by no later than 31 March of each year). Capitalised compensation forms part of the expenditure for capital assets in the statements of financial performance. 3.2 Goods and Services Payments made for goods and/or services are recognised as an expense in the statement of financial performance when the final authorisation for payment is reflected on the system (by no later than 31 March of each year). This item excludes rental for the use of buildings or other fixed structures. 17

3.3 Unauthorised, Fruitless and Wasteful and Irregular expenditure When discovered, unauthorised expenditure is recognised as an asset in the statement of financial position until such time as expenditure is either approved by the relevant authority, recovered from the responsible person or written off as irrecoverable in the statement of financial performance. Unauthorised expenditure approved with funding is recognised in the statement of financial performance when the unauthorised expenditure is approved and the related funds are received. Where the amount is approved without funding it is recognised as expenditure, subject to availability of savings, in the statement of financial performance on the date of approval. Fruitless and wasteful expenditure is recognised as an asset in the statement of financial position until such time as the expenditure is recovered from the responsible person or written off as irrecoverable in the statement of financial performance. Irregular expenditure is recognised as expenditure in the statement of financial performance. If the expenditure is not condoned by the relevant authority it is treated as an asset until it is recovered or written off as irrecoverable. 3.4 Transfer and subsidies Transfers and subsidies are recognised as an expense when the final authorisation for payment is effected on the system (by no later than 31 March of each year). 4. Assets 4.1 Receivables Receivables included in the statement of financial position arise from cash payments made that are recoverable from another party. Revenue receivable not yet collected is included in the disclosure notes. Amounts that are potentially irrecoverable are included in the disclosure notes. 5. Liabilities 5.1 Payables Recognised payables mainly comprise of amounts owing to other governmental entities. These payables are recognised at historical cost in the statement of financial position. 18 Inkosi Albert Luthuli Central Hospital

INKOSI ALBERT LUTHULI CENTRAL HOSPITAL INCOME STATEMENT (STATEMENT OF FINANCIAL PERFORMANCE) FOR THE PERIOD ENDED 31 MARCH 2006 REVENUE Notes 2005/06 (R 000) 2004/05 (R 000) Annual appropriation 1 788,265 759,878 Departmental Revenue 2 9,106 6,994 TOTAL REVENUE 797,371 766,872 EXPENDITURE Current Compensation of employees 3 229,813 211,867 Goods and services 4 424,955 391,614 Total Current Expenditure 654,768 603,481 Transfers and subsidies 5 903 636 Expenditure for capital assets Machinery and equipment 6 167,263 156,595 TOTAL EXPENDITURE 822,934 760,712 SURPLUS/(DEFICIT) FOR THE YEAR (25,563) 6,160 Reconciliation of Surplus / (Deficit) for the year Voted Funds 7 (34,669) (834) Departmental Revenue 8 9,106 6,994 SURPLUS/(DEFICIT) FOR THE YEAR (25,563) 6,160 19

INKOSI ALBERT LUTHULI CENTRAL HOSPITAL BALANCE SHEET (STATEMENT OF FINANCIAL POSITION) AS AT 31 MARCH 2006 ASSETS Notes 2005/06 (R 000) 2004/05 (R 000) Current assets Cash and cash equivalents 9 3 0 Other financial assets 0 0 Prepayments and advances 0 0 Receivables 10 22 30 Non -current assets Investments 0 0 Loans 0 0 Other financial assets 0 0 Total assets 25 30 LIABILITIES Current liabilities Voted funds to be surrendered to the Revenue Fund 7 (34,669) (834) Departmental revenue to be surrendered to the Revenue Fund 8 9,106 6,994 Payables 11 45 162 Non-current liabilities Payables 0 0 Total liabilities (25,518) 6,322 NET ASSETS 25,543 (6,292) 20 Inkosi Albert Luthuli Central Hospital

INKOSI ALBERT LUTHULI CENTRAL HOSPITAL NOTES TO FINANCIAL STATEMENT AS AT 31 MARCH 2006 2005/06 2004/05 (R 000) (R 000) 1 Conditional grants Tertiary and Central Grant 788,265 759,878 2 Departmental revenue to be surrended to revenue fund Sale of Goods and services other than capital assets 9,106 6,994 Total Revenue 9,106 6,994 3 Compensation of Employees 3.1 Salaries and Wages Basic salary costs 150,322 139,796 Service Based 42 36 Compensative/circumstantial 7,027 6,164 Periodic payments 379 4,923 Other non-pensionable allowance 41,664 30,040 199,434 180,959 3.2 Social Contributions 3.2.1 Employer contributions Pension 19,309 20,655 Medical 11,016 10,200 UIF 2 1 Bargaining Council 52 52 30,379 30,908 Total compensation of employees 229,813 211,867 Average number of employees 1984 1951 21

2005/06 2004/05 (R 000) (R 000) 4 Goods and services Advertising 895 601 Attendance fees (including registration fees) 208 294 Drivers licences & permits 0 3 Courier & delivery services 230 124 Communication 2,831 2,019 Consultants, contractors and special services 7,132 673 Entertainment 81 20 Equipment less than R5000 9 17 Medical Consumables 68,159 54,226 Medicine 39,997 31,546 Blood 24,889 23,124 Prosthesis 6,153 7,327 Printing and publications 1,390 1,513 Travel and subsistence 23 7 Professional services 247,717 196,854 Cleansing agents 2,710 2,327 Utilities 4,456 5,326 Other non-medical goods and services 18,075 65,613 424,955 391,614 5 Transfers and Subsidies The 2004/05 figure was R615 but due to the new presentation of the Financial Statements for 2005/6 it is stated that household be disclosed as transfers and subsidies. Households 222 21 Regional Services Council 681 615 Levy 903 636 6 Expenditure for capital assets Pur/Cap/Ass:Medical&Allied Eqp 167,263 156,595 167,263 156,595 7 Voted funds to be surrendered to the Revenue Fund Opening balance Transfer from Statement of Financial Performance Voted funds not request/ not received Paid during the year (34,669) (834) Closing balance (34,669) (834) 22 Inkosi Albert Luthuli Central Hospital

2005/06 2004/05 (R 000) (R 000) 8 Departmental revenue to be surrendered to the Revenue Fund Opening balance Transfer from Statement of Financial Performance Departmental revenue budgeted Paid during the year 9,106 6,994 Closing balance 9,106 6,994 9 Cash and cash equivalents Cash on hand 1 0 Cash with commercial banks 2 0 3 0 10 Receivables Staff debtors Debt Control Tax Debt 22 4 Other Staff Debts 36 26 Salary Reversal Control 73 0 Account 22 30 11 Payables Official Imprest 0 3 Pension Receipts 39 123 Deduction Disallowance 6 36 45 162 12 Age Analysis The receivables are due to the services rendered to patients, and are disclosed to enhance the usefulness of the Financial Statement information. The 2005/06 Inkosi Albert Luthuli Central Hospital patients debts: R2,804,109 23

Notes 24 Inkosi Albert Luthuli Central Hospital