Budget Speech of the Department of Health and Social Development for the Financial Year 2009/10 presented at the North West Provincial Legislature by the MEC for Health Honourable Onewang Rebecca Kasienyane
7 Jul 2009
Mr Speaker and Deputy Speaker of the North West Legislature,
Honourable Premier: Mme Maureen Modiselle,
Colleagues in the Executive Council,
Members of the Provincial Legislature,
Chairperson of the Portfolio Committee on Health and Social Development,
Distinguished guests, Comrades and people of the North West province
The winds of change are blowing and the world as we know it may never be the same again! I address this august house today to advance the cause for the health and social needs of our people in full awareness of what is going on in the world, in our country and here in our province. As I stand before you and present a policy speech of this reborn Health and Social Development Department, I do so amidst many global and national challenges that seek to take from our hard earned gains as a young democracy.
The world is still reeling from a moment of madness characterised by a sudden world wide crash of the stock market, food crisis, fuel and financial crisis and the unprecedented effects of climate change. As if it is not enough, the world is now confronted by yet another pandemic, the H1N1 influenza virus which threatens to add more strain on our health and social service delivery machinery. This also has a bearing on the poverty and other related social ills.
I accept these challenges as baptism of fire on my part. I however, Mr Speaker accepted the mandate to lead the Department of Health and Social Development with a full understanding of the demanding responsibility attached to it.
Speaking at the United Nations Secretary General's Forum, Dr Margaret Chan who is the Director General of the World Health Organisation (WHO) made this worrying observation, she said and I quote:
"The crises we face are global but the consequences are not evenly felt. Developing countries have the greatest vulnerability. They will be hit the hardest and take the longest to recover. People in affluent societies are loosing their jobs, their homes and their savings. In developing countries, they will loose their lives."
Dr Chan's observation is an urgent call for us as a developing state to do more for vulnerable groups and to strengthen our health systems.
1. The merger
The merger or the rebirth of Health and Social Development is therefore a well timed occurrence. It is in this time that we need to pull all our resources together to fight poverty and diseases much better. I have already met the department's management and employees and I got a positive signal of embracing the merger. This means that we have among us people who understand government’s priorities for the next five years.
Our critics are questioning the merger simply because Health and Social Development were once separated. I have this to say to our critics, go re bagaetsho motswana wa maloba o kile a bua go re masa ke masa, a sa a sa fela.
I am confident that the Department of Health and Social Development will best deal with government's social cluster priorities to improve the health and social conditions of our people.
Review of the 2008/2009 Programme of Action and Policy Commitments for the 2009/2010 Financial Year
2. Improving the nation's health profile
2.1 HIV and AIDS Management Plan
One of the things we need to do to improve the health and social conditions of our people is to never relent in the fight against HIV and AIDS. There are four priority areas under comprehensive management of HIV and AIDS, and TB. The plan includes HIV prevention, treatment, care and support, human rights and access to justice and research, monitoring and surveillance. As the Honourable Premier has mentioned during the State of the Province Address, the department would like to follow through and strengthen support to the Provincial Council on AIDS (PCA), by collaborating with the said structure in implementing the Provincial Strategic Plan.
We are confronted with infrastructural challenges in our effort to increase access to the anti-retroviral treatment (ART) services, resulting in limited access to the service; shortage of scarce skills personnel such as dieticians, pharmacists, doctors to manage patients on the ART programme. We also are also faced with shortage of accredited trainers to increase the number of care givers trained on ancillary healthcare.
We have however, ensured that we put measures in place to effectively deal with these challenges. We have therefore planned to deal with the infrastrural challenges to increase access to ART services, planned to develop and implement accreditation plans as part of the hospital revitalisation programme. We will also solicit support from donor agencies and partners to assist with recruitment of personnel in order to deal with the challenge of shortage of scarce skills personnel to manage patients on the ART programme. The department will also continue to engage accredited service providers to train more care givers, increase use of community counsellors, provide alternative space for counselling and contract non-governmental organisations (NGOs) to training counsellors.
Informed by an updated national comprehensive strategy, the department will therefore continue vigorously with the Implementation of Comprehensive Plan to combat HIV and AIDS. This will be done by among others increasing the Number of ART accredited service points from 29 to 35; increasing the number of adults with TB screened for HIV from 50% to 60%; increasing the number of adults with HIV screened for TB from 67% to 70%.
The sexually transmitted infections (STI) guidelines have also been revised and 700 copies have been distributed to the districts. There is a noticeable increase of the incidence of STI in the province i.e. from 2,7 at the end of the 2007/08 financial year to 3,1% at the end of the 2008/09 financial year. We are also experiencing an increase of the incidence of syphilis in the province from 3,6% in 2007/08 to 4,6% in 2008/09.
We are however making progress on High Transmission Area (HTA) programme aimed at truck drivers and commercial sex workers. The Project began in 2005 as part of the province response to the national strategy on HIV and AIDS aimed at preventing the spread of STI, HIV and AIDS in the areas that cannot be reached through the awareness campaigns and day-to-day Primary Health Care services. It began with one intervention site in Zeerust in 2005.
Currently there are four intervention sites and many informal intervention sites referred to as "hot spots". Plans are underway to upgrade other two "hot spots" into intervention sites. In order to successfully implement the project, fifty two (52) peer educators have been recruited, trained and placed at intervention sites, Hot Spots as well as in communities. Furthermore we will increase the number of formal High Transmission intervention (HTA) areas or sites from four to 10.
Condom distribution and use is an important strategy in the fight against HIV and AIDS. Condoms are distributed through different mechanisms throughout the province. Apart from public health facilities, condoms are also availed to the public at entertainment places, social events, campaigns and other non-public facilities. Total number of 6 140 920 male condoms and 124 151 female condoms were distributed. There is however urgent need to demystify the question around choice condom quality. Clearly, a lot need to be done to improve on marketing of Choice condoms as a quality brand. By so saying, we mean it is still safe to use Choice condoms as guaranteed by the South African Bureau of Standards (SABS).
2.2 Care and support
We remain committed to empowering our care and support programme. By the end of June 2008, there were 414 organisations rendering the service throughout the province, 325 of which offered home community based care services. Attached to these organisations are 4 050 caregivers. Step-down care (SDC) operates under the management and supervision of hospitals. HIV and AIDS management supports these facilities by facilitating training for professional nurses and caregivers, procurement of equipment and payment of stipends to caregivers, who form the majority of human resources in these facilities. As from the end of June 2008, six step-down facilities were operational.
Ninety (90) support groups exist throughout the province, focusing not only on PLHIV but also on other programmes, such as nutrition, chronic conditions and breastfeeding support. The main objective of the programme is to draw greater involvement of PLHIV through capacity-building in terms of support group guidelines and advocacy toolkits for people living with HIV and AIDS.
On the other hand, the Department gives recognition to funding organisations that promote transformation, equity and uninterrupted access to services. The partnerships for the delivery of PHC programmes, including HIV and AIDS (PDPHCP) funded by the European Union, is aimed at strengthening partnerships with the community structures of non-governmental organisations (NGOs), community based organisations (CBOs) and faith based organisations (FBOs) to deliver PHC services, including HIV and AIDS, in the province. Sixty-five non-profit organisations were recommended for funding as part of the partnerships programme.
Our plans to support and strengthen the Home Community Based Care (HCBC) services through prevention and advocacy partnerships programmes, remains critical. In the last financial year, 39 projects have been funded. Funding of HCBC's increased from R 500 800 to R 800 000 and drop in centres from R 600 000 to R 677 000. Prevention Partnership Programmes were launched in Maquassie, Ventersdorp, Kgetleng and Ditsobotla. The department also hosted a Provincial Summit to develop a Provincial Orphaned and Vulnerable Children (OVC) Action Plan.
The summit was successfully held. We however, deferred the launch of PACCA coordinating structures to this financial year. In strengthening HCBC Centres the department intends to fund eight (8) more and further empower the other sixty (60). The department will further roll out implementation of capacity building programme for 1200 community care givers as part of EPWP (Extended Public Works Programme). We will also co-ordinate the Provincial EPWP Social Sector Steering committee and roll out funding to 36 new HCBC and drop in centres and community gardens across the province.
2.3 Tubercolusis (TB) control and other communicable diseases control
In combating tuberculosis, particularly response to multiple drug resistance TB, the department will put an extra effort in improving TB cure rate from 55% to 60% and also reduce treatment interruption rate from nine (9) to five (5). We will further ensure that we maintain the increase of Multi Drug Resistance TB (MDR TB) to less than one percent. We will indeed ensure that we strengthen social mobilisation and advocacy; designate a vehicle and a person per sub-district for defaulter management; improve TB cure rate with interventions that include appropriate case management and adherence to protocols for proof of cure. In dealing with cases of MDR and XDR TB, we will provide the infrastructure for MDR and XDR management.
Concurrently, renovations of the ward identified for MDRTB were done at Taung hospital. A ward was also identified to be used for MDR at Gelukspan and was finalised in January 2009 for renovations. Quotations were submitted on 3 of March 2009 in anticipation that renovations will resume in this financial year. Vehicles for TB defaulter tracing were distributed to Sub-Districts on 10 July 2008, whilst the TB defaulter tracer teams have been deployed in needy Sub-Districts, and they are expected to make positive contributions. The impact can be measured only after 12 months. We will continue to intensify the social mobilisation strategies for TB by among others hosting of the national World TB Day.
Mr Speaker, I remain optimistic that our fight against the number one killer (TB) will be won if our people continue to take medication and to apply proper prevention measures. Our people must learn the importance of coming forward and getting tested so that we may improve case detection through mandatory sputum collection for all suspects and VCT (Voluntary Counselling and testing) of TB and HIV.
3. Strengthening women's health services
Women's Health will always remain the department's priority, by so doing we will expand CTOP (Choice on Termination of Pregnancy) to two (2) Community Health Centres and conduct three (3) community consultation dialogues on CTOP.
Since the implementation of the Choice on Termination of Pregnancy Act, 92 of 1996 (CTOP Act) the Department designated 17 hospitals, five private hospitals and three primary health care community health centres for the provision of CTOP services. The challenge that the Department is faced with is the mushrooming of illegal termination of pregnancy services, which expose women to complications and deaths.
The target for expansion of the service in the 2009/10 financial year is to increase the current CTOP sites by eight health facilities. The cervical cancer screening programme promotes women's health by reducing mortality and morbidity due to cancer of the cervix through early diagnosis and treatment. Of women in the 30 to 59 age category 68% had been screened for cervical cancer by 2008/09 and we intend to reach out to more women in the 2009/2010 financial year.
3.1 Reduction of Maternal and Neonatal Morbidity and Mortality
The main aim of the Mother, Child and Women’s Health (MCWH) programme is to reduce maternal, neonatal and under-five mortality and morbidity. It also aims to enhance the strategies that would strengthen maternal, neonatal and child health. A worrying factor is that maternal mortality of the non-HIV-related causes increased from 36% to 44,5% by 2007/2008 financial year. HIV-related conditions and hypertension are still the leading causes of maternal deaths. The Prevention of Mother to Child (PMTCT) Strategy is implemented by the department to address maternal, neonatal and under-five mortality. A target of 32% reduction in the non-HIV-related causes of maternal deaths should be achieved by 2009/2010 financial year.
The Peri-natal Problem Identification Programme (PPIP) is used to investigate the causes of neonatal deaths and to identify the contributing factors so as to improve the quality of neonatal care. The maternal death assessment is also used to identify avoidable factors that lead to maternal deaths so as to improve the quality of maternal health services.
3.2 Reduction of under-five mortality and morbidity
Children in the under-five category die from childhood illnesses such as diarrhoea, upper respiratory tract infection, severe malnutrition and HIV-related conditions. The implementation of IMCI (Integrated Management of Childhood Illnesses) at PHC level was 80% by the 2008/2009 financial year.
The case management course in IMCI for PHC nurses and pre-service training at tertiary institutions equips nurses with skills for managing sick babies and children up to the age of five years. The focus for 2009/10 is to strengthen the implementation of the household/community component of IMCI so as to empower communities with regard to safe family practices so as to manage their children at home.
4. Mental Health
Implementation of the Mental Health Care Act, 17 of 2002 started in July 2005. Two review boards were appointed to ensure the implementation of the Act. However, towards the end of the year 2006, members of the boards resigned. One review board was revived as a provincial board and is functioning. In accordance with the Mental Health Care Act, 17 of 2002, two health establishments have been designated, namely Bophelong Psychiatric Hospital in Mafikeng and Witrand hospitals in Potchefstroom respectively.
We will therefore ensure that we continue to strengthen the existing Mental Health Review Board. We will introduce and implement norms and standards at hospitals and clinics to improve on mental health care management. Monitoring and evaluation of this programme on a regular basis will assist us to see to it that indeed the norms and standards are being adhered to. One of the main objectives of the mental health programme is an urgent need to finalise and implement the referral policy, which we will do in this financial year.
5. Oral health
The department has plans to facilitate preventive oral health services and promote conservative services. We also intend to improve access to mobile oral health services. We reached our target of reaching 200 clinics with our mobile oral health services in the 2008/09 fiscal year. As a preventative measure we intend to expand oral health services education to school and further supply a number of schools with brushing, screening and fissure sealants. Our plans for the new financial year include regular servicing of oral health equipment, regular servicing of existing oral mobiles and replacement of old mobiles, establish additional dental laboratories, appoint technicians and purchase new oral health equipment.
6. Health Promotion
Our ability to deal with chronic diseases and other lifestyle diseases depend largely on our Health Promotion programme. Health promotion is therefore not only a support programme, but it has a responsibility to implement health promotion programmes, including community projects such as Health-Promoting Schools, Healthy Cities/Villages, Healthy Environments for Children, Health Literacy, and Healthy Lifestyles.
We have made significant strides since the implementation of the healthy lifestyle programme in changing the attitudes of our people towards their own health. We therefore need provision of resources for the health promotion programme, most importantly, ensuring that there are dedicated personnel at sub-district level. In the coming financial year, we will continue with the implementation of the Healthy Lifestyle Programme; Health promoting Schools (HPS); and the Framework Convention on Tobacco Control (FCTC).
7. Eye Care Services
Mr Speaker, blindness and low vision are major causes of morbidity and have profound effects on the quality of life of many people. These disabilities inhibit the mobility and economic well-being of both the individuals affected, and their families. Many factors contribute to the high incidence of eye disease and blindness in the developing world. We therefore have plans to increase the number of glaucoma surgeries to 150 and ensure provision of necessary optical devices in the new financial year.
We reached our target of 500 optical devices hence we set ourselves a new target of 700 in the new financial year. In the 2009/ 2010 financial, we will ensure that we set aside budget dedicated for spectacles, low-vision devices and prioritise purchasing of equipment and consumables. We intend to recruit more eye care specialists in our hospitals.
8. Chronic diseases, geriatrics and rehabilitation
The Chronic Diseases, Geriatrics and Rehabilitation programme focuses on chronic diseases, cancer, rehabilitation and geriatrics. It aims to improve accessibility to quality of care and availability of services related to chronic diseases, cancer and geriatrics, and to ensure a high quality of rehabilitation service for people with disabilities in terms of the National Health Act, 61 of 2003.
The national protocol guideline on prevention and treatment has been produced and distributed to provinces for implementation. The priorities for this programme in this financial year include efforts to decrease morbidity and mortality rates for priority chronic diseases; to ensure capacity-building in non-communicable diseases (NCD) guidelines; to improve access to assistive devices and rehabilitation services to disabled persons; to provide assistive devices to people with disabilities and to increase access to free healthcare for people with disabilities.
Worldwide there is an increase in chronic diseases, with increased morbidity and mortality rates. According to World Health Organization it has been decided that chronic lifestyle diseases will be regarded as one of the priorities that needs to be addressed globally. National protocol guidelines on prevention and treatment has been produced and distributed to provinces for implementation on hypertension, type two diabetes, stroke management, osteoporosis, asthma, epilepsy, rheumatic fever and cancer.
9. Nutrition programme and management of severe malnutrition
Infectious diseases are one of the major contributions to childhood and adult malnutrition. This becomes a vicious cycle as under-nutrition or malnutrition increases morbidity and mortality from infectious diseases. Common infectious diseases, which are also associated with an increase in mortality and morbidity, are HIV and AIDS, diarrhoeal diseases and acute respiratory infections. These may also affect growth amongst children, resulting in stunting.
The WHO ten steps for managing malnutrition have been proven to be effective in the management of severe malnutrition. The strategy is aimed at reducing case fatality rate among children, improving recovery rate and reducing the hospital stay. Implementation of the World Health Organisation (WHO) ten steps strategy will expand at community level in the 2009/10 financial year. This will assist in early identification and treatment of malnutrition in the community.
The thrust of this intervention is to support clients with nutrition supplementation as an integral part of comprehensive, care, support and treatment. This programme was introduced in the 2004/05 financial year. To date a total of 83% of all clients on the ART programme are supported with meal supplements and 100% with micronutrient supplements.
We are also going to ensure that we have an integrated Nutrition Programme, by supporting the existing 14 food gardens and further ensure that one hospital is accorded Mother Baby Friendly Hospital status. Nutrition is one of the pillars of the healthy lifestyle campaign. We will continue to urge our people to eat healthy and balanced died as part of the campaign.
10. Environmental health
Environmental health services are accessible in 95% of the province. Our community environmental health services practitioners continue to improve the staffing norms of Environmental Health Practitioners (EHP). The norm is currently one EHP for every 15 000 of the population. The department has set itself a target to reduce malaria cases by 10% per year. This will be done through ensuring that about 1000 identified dwellings or structures are sprayed with indoor residual effect insecticides. One of the urgent plans that we have already started with is the implementation the North West FIFA 2009 Confederation Cup and 2010 World Cup Environmental Health strategy.
10.1 Pharmaceutical services
Through outsourcing of the management of the Mmabatho Medical Stores, availability of medicines improved from 89.5% in 2003 to 92,23% in July 2008. I can report that medical supplies for 2008/09 were at 93,6%. Our people must not listen to falls reports coming from the angels of doom who continue to purport that some of our hospitals have run out of antiretroviral drugs. Antiretroviral drugs and TB medicines are available in adequate quantities at the Medical Stores in our province. The National Department of Health has introduced the pneumococcal vaccine in the immunisation schedule and is also available at the Medical Stores and is already supplied to all our health facilities. It is however not always smooth sailing as we sometimes encounter delays in delivery of stock from the medical suppliers. Suppliers tend to go beyond the delivery date to supply stock and end up affecting availability of supplies from the Medical Stores.
We will implement a project of setting up a repacking unit at the Mmabatho Medical Stores by making available patient-ready packs to health facilities. The unit is currently being upgraded to be compliant with the requirements of the Medicines Control Council.
10.2 Emergency Medical Rescue Services
Our people have always been complaining about our Emergency Medical Rescue Services. In strengthening and improving the service the department will develop a disaster management policy plan per district and further capacitate about 144 EMRS staff members. Our EMRS College in Orkney remains a centre of excellence for revolutionalising and modernising emergencies services not only in our province but in the entire country. I am optimistic we will produce more qualified emergency care technicians through this college.
We will further continue with efforts to improve of the provincial emergency response time; popularize and increase access to the toll free number to improve our communication system and increase EMRS stations. The department has introduced the Emergency Care Technician (ECT) programme. I truly believe the 2010 FIFA World Cup will also benefit from the in-depth knowledge and skills of the Emergency Care Technicians who will be able to respond effectively to emergency medical care and disaster situations.
Our quest to beef up our governance remains on track. It is for this reason that we had over the past financial year trained governance structures and hospital boards on legislation. The training conducted concentrated on informing their existence, meetings, procedures, presentation skills, report writing, understanding service improvement plan and monitoring and evaluation in all the districts.
We are progressing well in our plans to include African Traditional Medicine into our Health system. The Department has celebrated the African Traditional Medicine day and held the consultative meeting with the Traditional Health Practitioners on the draft policy on African Traditional Medicine. The Database for registration of THP is ongoing with the assistance of twenty coordinating structures established during the consultative meeting held on the 24th of October 2008.
12. Special programmes
12.1 Strengthening services to older persons
Mr Speaker, our elderly people remain key in preserving our culture. It is a fact that the dominant cultures of the world seek to erode ours through various mediums that appeal to our young people. Yet their culture, is written and documented somewhere, whilst ours remain transmitted orally by this sector of society which lately have been subjected to abuse, suspect of witch craft and neglect.
As a department we have tried to mitigate these circumstances by introducing programs that will preserve the dignity of our elderly people. As the harshness of the scourge of HIV and AIDS rearranges our society forcefully, our elderly people have since again become, breadwinners and are heading households. The department has thus far managed to create about 39 community based care and 25 residential care services strengthened within the province.
We also managed to increase subsidy allowances for Older Person's facilities. Furthermore we also increased the Residential Care subsidy rates from R1 500 to R1 700 per person. And also the Community based care services were adjusted from the flat rate of R1 450 for 50 people to R1 500 per capita attendance. We also ensured that we strengthen the existing forums and local organising communities for older persons and intensified capacity building at all levels.
We also had to ensure that about 22 Local Organising forums for Older Persons are strengthened through capacity building. We further intend to establish four Community Based Frail Care Services in all the districts in the province. In ensuring care and proper services to our Older Persons the department will conduct four training sessions on dependency questionnaire and home based care for older persons.
12.2 Disability Programme
Disability is also now fully integrated into the broader departmental programmes. I am happy to report that progress is made on the second phase of the Sign Language training. Through our programme of People with disability the department will increase distribution of assistive devices from 4 000 to 4 200. We will also fund three new Community Based Care Services to render services to People with Disabilities.
Furthermore, we intensified capacity development on disability policies, guidelines and strategies. We have thus far 217 stakeholders trained on disability policies and strategies in the four districts to can create economic opportunities for People with Disabilities through funding of income generating projects. As a department we have funded five new community based organisations (CBOs) and nine non-governmental organisations (NGOs) for people with disabilities.
In facilitation of increase on subsidy rates for people with disabilities, we have a Residential Care subsidy rates increased from R1 500 to R1 700 per person per month, and for community based services from R7.05 to R15.00 and Itsoseng protective workshop from R5,00 to R12,00 per person.
For the revival and the launch of Disability local forums we have eight local forums launched in Dr Kenneth Kaunda and Bojanala Districts respectively. As a commitment for intensifying advocacy programmes, 9 505 people with disabilities were reached through advocacy and awareness programmes in the last financial year.
12.3 Children services
As guided by the legislative mandate to care and protect children my department strived to ensure that children within the district are protected and their rights are taken care of and respected. I must say that you would agree with me that early childhood education is key in the upbringing and nurturing our children. We audited established registered and unregistered Early Childhood Development Centres (ECD).
Resulting from that audit the following were achieved. About 1 210 sites were identified in 15 municipalities with the most deprived wards. As a result of that a temporary employment was created for 286 ECD Field workers. In massifying these institutions and strengthening them, the following was achieved: Fifty (55) new ECD sites were subsidised, 275 ECD centres strengthened through subsidy, and further increased the number from 275 to 330 benefiting 22 257 children. In this financial year we intend to subsidise 200 more new ECD services in further intensifying our ECD massification programme.
Mmusa kgotla, ke tshwenyega thata ka kgolo ya dipalopalo tsa bana ba ba nnang mo mebileng. My Department will strive to find for these vulnerable children habitable homes and further to reunite them with their families. In achieving that, we are in the process of developing a comprehensive strategy for homeless children. The department further established a Provincial and District Alliances to support the development of the strategy, and as we present this budget speech, a contract has been awarded to a contractor to build a Child and Youth Care Centre in Ngaka Modiri Molema District.
Please be informed that the sod turning took place in August 2008 and we believe the construction will be completed in time. We are focused on the improvement of the protection and development of the children, which are a national and provincial priority. Our Department will specifically complete the construction of Mafikeng Child and Youth Centre, which is a Children's Home. This will remain part and parcel of my personal mission and vision to care for children.
There is a fear of children being used in prostitution and crime in 2010. Mr Speaker, we stand firm in dealing with child trafficking, organised child crime and organised child begging. We will engage all law enforcement agencies in dealing with any form of child abuse. Rest assured Mr Speaker, rights of children will be protected under my stewardship.
12.4 Crime prevention
Mr Speaker, our prisons are now over crowded by young offenders, to an extent that they blended with hardened offenders due to shortage of space in our prisons. We must agree again that these children graduate from being petty criminals to hardened and hardcore offenders of the law. This is a menace to the future generation of the country and the society itself.
Implementation of Secure Care Centre programme for children in conflict with the law tries to proactively deal with this social ill. The Department embarked on the following in an attempt to rehabilitate these young offenders: We Integrated management systems at both the Mafikeng and Matlosana Secure Care Centres. Mmusa Kgotla, I am happy to announce that the Construction of the Rustenburg Secure Care Centre has been completed and will be launched very soon and we are concurrently running with the naming process involving all our stakeholders and communities. I'm also pleased to announce that phase one of the renovations for Reamogetswe Secure Care Centre in Madibeng has been completed.
Mmusa Kgotla, re sa lebale go re le ojwa le sale metsi, bana ba tshwanetse go nna bana. Fa ngwana a tswa mo tseleng, jaaka puso ke maikarabelo a rona go busetsa bana mo tseleng ka mekgwa ee tshwanetseng. These institutions will do exactly that. We hope that the construction of a new secure care centre in Dr. R.S. Mompati will commence in this very financial year.
Mmusa kgotla mo ngwageng ono wa ditshelete, we intend to continue with the construction of one Secure care Centre at the Dr Ruth Segomotsi Mompati District and further ensure the establishment and operationalisation of Rustenburg Secure centre. We also would like to strengthen the existing six ECD facilities in Bojanala, two in Rustenburg, two in Phokeng and two in Mogwase.
The ugly face of xenophobia created bad impression about this country. While this unacceptable behavior mushroomed countrywide, children became casualties and this to us; "Rre Mmusa Kgotla" is very unacceptable. Since then we continued to ensure care and protection of refugee children. We had intended to host provincial indaba on the needs of child refugees. Unfortunately due to unforeseen circumstances we had to defer that indaba this financial year. But however we managed to develop a database of refugee children, to keep track of those children in the province.
Ga go na ngwana wa naga! Bana ke ba rona botlhe, ebile ngwana sejo wa tlhakanelwa!
13. Building sustainable livelihoods and strong families
13.1 Poverty eradication
Mr Speaker, poverty eradication has been our objective since we took over government in 1994. It remains the department's objective to reach the MDG to halve poverty by 2014 as we seek to shake stagnation in the development of our people. In implementing the provincial poverty eradication strategy the department will oversee the functionality and the full operation of the Provincial WAR ROOM and working group. We will also co-ordinate implementation of the Poverty Eradication Strategy and prioritise the most deprived wards within four districts.
We have further established cooperatives in a bid to intensify Poverty Eradication Strategy, through our Departmental Quick Win projects including institutional bakeries. This was the beginning of the Programme of Action (PoA) and the roll out program which we will intensify in this financial year.
Furthermore, feasibility studies have been completed for the following Poverty Eradication Strategy projects:
- Marele Goat Farming Co-operative in the Dr Ruth Segomotsi Mompati District is fully operational
- a cotton value addition co-operative in the Dr Ruth Segomotsi Mompati District
- an orchard project in the Bojanala District
- four Industrial Garments one per district
- Butterfield institutional bakeries
As a department, we will continue to offer relieve to those who are in distress.
13.2 Sustainable livelihood
Mr Speaker, sustainable livelihoods in its very nature seek to empower communities to be able to take control of their own environment. Meaning that, we as a department would want to assist communities to bring solutions that will sustain them way after the intervention of government. In providing material support the department funded two existing two Flagship Programmes in Mathateng and Madikwe.
The department has once again held four districts Readira Awards and one Provincial Community Builder Award. This was in recognition of outstanding unsung heroes and heroines of our community who continue to make a difference in people’s life. In our role as a department in the moral regeneration movement, we have launched 4 District Faith Based Organization and held One Provincial Ethical Leadership Summit which was graced by Myles Munroe in the previous financial year.
14. Youth development and substance abuse programme
Mr Speaker, we are confident that the department is making headways and progress with regard to youth issues. We managed to train young people on Mobility instructors' course in partnership with Umsobomvu Youth Fund and the SA Guide Dogs Association for the Blind in the past financial year. In strengthening the Youth Development programmes the department will involve 347 young people in the Masupatsela Youth Pioneer Programme.
We will also ensure that through the National Youth Service about 330 students will be targeted in the construction of the Brits Hospital. There are already 18 existing Youth centres and we have identified two buildings for renovations at Lekwa Teemane (Bloemhof) and the Rustenburg sub-districts and those buildings will be converted to Youth Centres.
With regard to strengthening the Masupatsela Youth Pioneer programme within the province, the department rolled out the Masupatsela programme including staffing, transport, and many other resources needed to ensure that this programme comes to fruition. Already a draft business plan is available. The Department hosted a provincial Youth Summit in conjunction with the Provincial Youth Commission, and we managed to reach more than 6 000 youth across the province. The department is going to forge relations with the newly established Youth Development Agency (YDA) as a line of march from the President.
It is important to note that within this sector, drugs continue to erode the moral fibre of the society. Our key challenge is to continue to advocate for a sober society that continue to maintain that it is not "cool to get high". We are committed to implement the Secretariat Improvement Plan for the Provincial Substance Abuse Forum to abate this cancer that spreads silently with adverse repercussions. We have thus far, developed and implemented a Secretariat Improvement Plan, however we are still seeking for the competency that this post requires.
We will continue to implement the Provincial Mini Drug Master Plan in support of the National Drug Master Plan. We also are determined to implement a model for substance dependant youth in residential facilities. We have ensured that we train stakeholders on the youth models and we are pleased that this model is been piloted at Reamogetswe Secure Care Centre in Madibeng.
In intensifying the fight against substance abuse the department has already acquired a land and building has been identified. And we hope the building will be handed over soon, if all goes according to plan. In intensifying awareness and advocacy of substance abuse programmes, we have and still continue with the Ke Moja Substance Abuse Prevention Programme which is implemented in all the four districts reaching out to 7 460 youth. Above all, in this financial year we hope to establish and operationalise a State Run In-Patient Substance Abuse Centre in Ngaka Modiri Molema District. We will build a Secure Care Centre at Dr Ruth Segomotsi Mompati District and further establish and operationalise the Rustenburg Secure Care Centre. These centres will provide a secure and safe environment for children awaiting trial whilst increasing the number of diversions options.
In this financial year, the department will implement Moral Regeneration Advocacy programme.
In this financial year 2009/10 we will now involve 347 young people in the Masupatsela Youth Pioneer Programme
14.1 Victim Empowerment Programme (VEP)
Mmusa Kgotla, we managed to establish (two) centres for the development and costing of One Stop Services Centre. The first one is based in Maquassi Hills and was donated by Suid Wes to the department on 23 September 2008. The building has been renovated and management plan for the centre has been developed.
The second is Naledi One Stop Centre which is still under construction. I'm pleased to announce that an integrated task team has been established to ensure a holistic approach towards victim empowerment. On the same breath the following NGOs run centres, were funded to care and protect victims of crime, violence and abuse: Mothutlung Networks against Domestic Violence, Grace Help Centre, Madikwe Crisis Centre, Kosh Crisis Centre and Ventersdorp Crisis Centre.
However, in this financial year we intend to ensure the functionality of Maquassi Hill Multipurpose Centre which will be strengthened through resource allocation. We would like to establish one new Victim Empowerment Centre in the Dr Ruth Segomotsi Mompati.
This will further enhance access care, and strengthen protection services to victims of crime, violence and abuse. We intend to strengthen the functionality of the victim empowerment forums to ensure integration and coordinated services to the victims.
15. Family care services
The primary objective of family care services is to improve family relationships which, remains crucial in the moral regeneration of our society. In ensuring that, the department has established Reference Groups on Family Life in four Districts. We further established seven Local Family Reference Groups and developed Guidelines on Parenting Support Networks where we trained about 140 officials and stakeholders.
Furthermore, about nine NGOs were funded to provide care and protection services to families. A provincial database for organs of civil society providing family care and protection services was developed. Our plans for this financial year will largely be guided by the recommendations of the Family Conference that we held just recently.
16. Undertake the ethical leadership advocacy campaigns
In this financial year the department intends to improve family relationship to create a healthy minded society, and in that about four reference groups will be established. We will also facilitate development and implementation of programmes, enhancing parenting skills. A strategy for provision of the families’ services will be strengthened. We will strengthen access to therapeutic and family preservation services, and further undertake the Ethical Leadership Advocacy campaigns focusing on the youth and it will be rolled out to district level.
17. Human Resource and Skills Development
Mr Speaker, we need skilled and dedicated personnel to achieve the objectives and plans of all our programmes. With regard to skills and human resources, the Department of Health and Social Development will focus on key policy imperatives by ensuring that we have a reliable database of Early Childhood Development (ECD) as mentioned in the SONA and SOPA. Secondly we will expand training for nurses and auxiliary nurses, auxiliary social workers and social workers including the expansion of training institutions.
The department will continue to implement the Recruitment and Retention Strategy with a view to recruit and retain our doctors, nurses and social workers in our province. We will continue with the implementation of the Remuneration Dispensation for our health and social services professionals. Dispensation of the OSD will of course be implemented targeting medical officers, medical specialists, dentists, dental specialists, pharmacists, emergency care practitioners and social workers. It is important for our people to know who qualifies and who does not qualify for the OSD.
We will also provide learning and skills development opportunities and these will be achieved by the establishment of:
- 250 new and subsidised ECD sites from 330 to 580
- strengthening existing ECD facilities in Bojanala two (2) in Rustenburg, two (2) in Phokeng and two (2) around Mogwase and Sun City):
- provision of Skills Audit Report for the Provincial ECD services
- training for 160 post basic nurses
- 1 080 nurses training in Diploma courses
- 170 in basic degree courses
- 320 employees to be trained on ABET level 1-4
- increase students on internship from seventy-five (75) to two hundred (200)
- 90 students on bursaries including those studying in Cuba
- 100 unemployed youth serving officers to be trained as auxiliary nurses
- provide relevant training to 4500 serving officers
- training will also extend to auxiliary social workers
In the past financial year the department trained about 50 auxiliary social workers who will assist our social workers. However in the new financial year the department intends to further train 150 more auxiliary social workers as part of exit strategy for EPWP. The department has already as of February this year commenced with further enrolling of about 360 auxiliary social workers for training.
18. Facility management and infrastructure development plan
Mr Speaker, I acknowledge the fact that we are experiencing challenges in as far as infrastructure development is concerned. One of the challenges is the fact that some of our communities are still waiting to have clinics within acceptable distances or closer to their homes. There are however successes in this area and we intend to build on these successes in the new financial year. Other challenges on this issue remain lack of adequate staffing, and emergency transport in the peripheral areas of this province.
Over the past financial year, the department has been able to successfully implement the following with regard to facility management and infrastructure development:
- we developed business cases for four hospitals
- improved access to primary health care facilities up to 85%
- refurbished theatres in one hospitals
- improved hotel services standards to seven hospitals
- upgraded six boilers
- upgraded the stand-by generators of five hospitals
- upgraded HT switching and generator automation of one hospital
- upgraded electricity grid to one Hospital
I am happy to report that Vryburg and Moses Kotane Hospitals are near completion and we believe the contractors of both projects will officially handover the projects before the end of the current financial year.
The department has already in the first quarter of the new financial year started with implementation of the approved Infrastructure Programme Management Plan (IPMP), the Hospital Maintenance Plan and the Clinic Maintenance Plan. Our Victims Empowerment programme will be beefed up with the construction of one (1) Victim Empowerment Centre.
We are focused on the improvement of the protection and development of children, which are a national and a provincial priority. Our department will thus specifically complete the construction of the Mafikeng Child and Youth Care Centre, which is a Children's Home. This remains part of my personal mission and vision—to care for children.
Furthermore, we will develop a Provincial data base of Orphans and Vulnerable Children; finalise the Provincial Orphans and Vulnerable Children Action Plan; Lunch of the Provincial Action Committee on Children Infected and Affected with HIV and AIDS. A roll out plan will include district coordinating structures.
We intend to speed up building and operationalising a Patient Substance Abuse Centre in Ngaka Modiri Molema District; build a Secure Care Centre at Dr Ruth Segomotsi Mompati District and build and operationalise another one in Rusternburg. These centres as mentioned will provide a secure and safe environment for children awaiting trial whilst increasing the number of diversion and home based supervision programmes.
19. Hospital Services and tertiary services
Mr Speaker while many people can attest to many achievements in terms of improvement of services in our hospitals, we admit there are equally a number of challenges we must overcome. Some of the famous challenges that we continue to face include turn around time for resolving complaints; revenue collection and waiting time. We are still struggling to get to grips with the application and implementation of uniform National Norms and Standards. We are also still trying to apply intervention measures like uniform protocols and standard operating procedures for all major conditions.
Our hospitals remain under extreme pressure and resources are strained due to burden disease profile, for example HIV, TB, MDR and XDR. The activity load has therefore increased tremendously, with more lab tests being done and medication being prescribed. We are working hard to improve the conditions and to render quality services. Our plans to improve the situation include developing referral protocol; establishment of clinical guidelines; upgrade and develop trauma units in provincial hospitals; set up and maintain strategies that will safeguard against clinical risk.
We also intend to improve access to tertiary services; ensure equity in the delivery of tertiary services; strengthen tertiary health links with academic institutions and prioritise attraction and retention of full time specialists for tertiary services. Because of the rising costs of laboratory services and pharmaceuticals we will have to ensure tight monitoring of National Health Laboratories Services (NHLS) expenditure.
19.1 Quality Assurance
Mr Speaker, we are all constantly concerned with the quality of care in our hospitals. I can report that quality improvement programmes have been implemented in all hospitals supported by Quality Assurance Directorate and the Council for Health Services Accreditation of Southern Africa (COHSASA). Patient Safety and Adverse Events Management Programmes are also being implemented in all hospitals supported by Quality Assurance and COHSASA. We undertake to review and implement standardised clinical guidelines which are coordinated through Clinical Managers' Forum. Customer Care and Complaints Management Programmes remain essential in guiding us to improve service delivery in our hospitals. We will continue to monitor closely, the implementation and improvement of infection prevention and control programmes.
19.2 National Health Insurance
Mr Speaker, I talked earlier on about imminent change. Part of this change will come with the introduction of the National Health Insurance (NHI). The NHI is a noble idea, a ground breaking initiative by our government to protect the lives and health of our people. Now, we know there are those who are working against the NHI to protect personal interests. No one should ever be told there will be no medical aid due to the NHI Fund. This is well researched initiative that will benefit our people especially the poor. Once approved, the NHI implementation will be phased in over five years.
20. Programmes allocations for 2009/10
Mr. Speaker, we have outlined key service delivery programmes and I am confident the budget allocated will substantially assist us to deliver on the key mandate.
Allocation of limited resources to meet growing demands remains a challenge based on the growing demands of the different health and social development programmes. The current MTEF has tried to respond to priorities as identified in the Annual Performance Plan.
The final approved budget for 2009/10, amounts to R5,559,354. Viewed against individual inputs, the budget is inadequate, as evidenced by the 1% overspending at the end of 2008/09 and the subsequent R200 million accrued.
Additional resources are needed to fill gaps in the supply of anti-retrovirals (ARVs), accommodation for health workers, integrated health management information systems and laboratory services.
The ten programmes of the new Department of Health and Social Department are funded as follows:
1. Administration: R257,168
2. District Health Services: R2,494,797
3. Emergency Medical Services: R184,115
4. Provincial Hospital Services: R1,175,428
5. Central Hospitals: R134,416
6. Health Sciences and Training: R164,719
7. Healthcare Support Services: R136,038
8. Health Facilities Management: R404,691
9. Social Welfare Services: R492,105
10. Development and Research: R115,877
Total allocation: R5, 559, 354
Additional funds were made available for, amongst others, Occupation Specific Dispensation for nurses, TB MDR and XDR, reducing infant and child mortality, ongoing infrastructure projects, comprehensive HIV and AIDS, boiler maintenance and repairs, pharmaceuticals, medical supplies, EMRS and Job Shimankana Tabane hospital.
I am however confident we will do more with this budget. What I will closely guard against is corruption, fraud and maladmistration of state funds. The net is closing on corrupt officials who misuse state funds. We will have no remorse in dealing with those who are found on the wrong end of the law.
21. 2010 readiness and preparations
Mr Speaker, our province hosted a successful Confederations Cup. Our medical, EMRS, outbreak diseases and surveillance teams have done a tremendous work and are taking with us lessons learnt to the 2010 World Cup. So Mr Speaker, we are ready for 2010. We work jointly with our counterparts from Limpopo. They were impressed with our VIP, players and spectators medical centres or ports that we established at the stadium. I can say without doubt that we are ready at Health and Social Development to render quality medical services and protect our people and guests from communicable and non communicable diseases during the games.
As I get closer towards conclusion, Mr Speaker I cannot help but overemphasise the importance of our employees, doctors, nurses and social workers commitment in our effort to improve the health and social conditions of our people. In particular, I take this opportunity to thank our doctors for not taking part in the strike over the past week when doctors where on strike in some provinces. We all want to see the general working conditions of our doctors improved but what is more important above everything else is saving lives for our people. That is what "a call for duty means" and it is clear to me our doctors understand this conviction and are keeping to their oath.
I also take this opportunity to thank the African National Congress and the Honourable Premier for having afforded me the opportunity to lead this department.
To the Head of Department, Dr Lydia Sebego, the entire management and the employees of the department, thanks for the warm welcome! I must also appreciate the hard work of support personnel in my office. I know they are still trying to adjust to a new environment but they remain valuable to my work. Thanks for the unwavering support! I hope you will continue to support me in this epic journey of my life.
Mr Speaker, I have already been on a number of stakeholder interaction platforms and I am happy with the reception that I continue to receive from our labour federations and unions, governance structures, councillors, Dikgosi, Dingaka tsa Setso, the NGOs and our private sector partners.
Support from my family has remained a source from which I draw courage. I will continue to depend on my family for support and strength through out this important journey of my life.
Mmusa-kgotla, ke na le tsholofelo e tletseng ya go re "Fa re dira mmogo re ka kgona go le gontsi" ka bonnyane jo re bo filweng. Se segolo ke go re batsaakarolo le bannaleseabe ba rona ba re atamele, ba akantshane le rona, re be re dire mmogo go tlisa ditirelo tsa pholo le katlatlelo-loago mo go bagaetsho.
Ke a leboga!
Issued by: North West Health
7 Jul 2009
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