Budget Speech of the Department of Health for the financial year 2011/12 presented at the North West provincial legislature by the MEC for Health, Honourable Dr Magome Masike
18 Apr 2011
Honourable Speaker of the Provincial Legislature,
Honourable Premier: Mme Thandi Modise,
Hon Members of the Executive Council,
Your Worship Executive Mayors and Mayors of our municipalities,
Hon Leaders of Political Parties,
Our esteemed Traditional Leaders,
The Director General and other Heads of administration in government,
The Acting Head of the department,
Leaders of Labour Federations, Civil Society, Faith Based- Organisations and Business,
Comrades and friends,
Ladies and gentlemen,
Dumelang Bagaetsho ba Porofense ya Bokone Bophirima!
In a few days, on 27 April to be precise, we will celebrate Freedom Day in our beloved country South Africa. This is the day that commemorates the first democratic elections held on the 27 April 1994 in our country. It is also the day that reminds us of our history, where we come from, where we are going and what we stand for. Towards this day and beyond, we will continue to urge the multitudes of our people to go out in huge numbers to vote and defend our hard earned democracy during the coming local government elections.
The African National Congress (ANC) led government has laid a solid foundation for our people to benefit from this democracy. I wish to take this opportunity to thank all my predecessor MECs for the foundation laid in pursuit of improving the health status of our people in the province.We are more than ever before ready, willing and able to improve the lives of our people. Together with our people, we can make better communities!Improving the health profile of our nation is one area that will help us to build better communities. In our quest to build better communities, the ANC led government, seeks to ensure universal access to health care services by all South Africans.
We are also in the middle of a noble programme which was initiated by the President, the Negotiated Service Delivery Agreements. This is a national effort to improve service delivery by enforcing Negotiated Service Delivery Agreements. Our national Health Minister Dr Aaron Motsoaledi, along with other ministers and MECs, signed a delivery agreement with President Jacob Zuma. The President has therefore tied us to agree to deliver and we obliged. So the President expects nothing else but delivery of quality health care services to our people.
Honourable speaker, as we all know, that the ruling party has taken a resolution in its 52nd general conference in Polokwane in 2007 that health is one of the key priorities. This resolution was taken after the realisation that for the country to prosper, we need a healthier nation. We need our people to live longer and healthier lives in order for them to contribute meaningfully to the growth of the economy and for them to grow to full potential as human beings. This has therefore put health high on the nation’s agenda. In this regard, we as the health sector, under the able leadership of the Minister, Dr Aaron Motswaledi has embarked on the road which will enable us to fully account. In order to be able to account, the health sector has picked up four, specific outcomes which are very central to the mandate of the department. These outcomes are derived directly from the ten point plan which is a roadmap for the health reform. These four outputs are increasing life expectancy, reducing maternal mortality including child mortality, reducing the incidents of HIV and the burden of TB, as well as improving health systems effectiveness.
It is our firm belief that the attainment of the other three rests squarely on the fourth one being health system effectiveness. Without an effective health system, we will not be able to achieve our desired goal of long and healthy life for all South African. We have made this observation because an effective healthy system is the foundation on which the entire health service depends. As we all know many countries that have made serious improvements in the delivery of health services, they had to start by investing in the building and strengthening of the health system. In order for us to do this Honourable Speaker, working together with the National Department of Health, we have identified that the health system needs a stronger Primary Health Care (PHC) services if it has to improve. To this end we are working on the reengineering of Primary Health Care services. This will be done as part of ensuring that health systems get stronger and better to deliver the services. We will be working very hard to reengineer PHC as part of our commitment of going back to the basics. We will be doing those simplest things that have the greatest impact on the lives of our people.
The recent National Nursing Summit dealt extensively with ways of strengthening PHC. We agreed at the Nursing Summit that one way of strengthening PHC is to restore the dignity of the nursing profession. We are going back to the basics of nursing and we are going back to the basics of PHC.
We want to promote nursing, medicine and other health related professions as a person-centered, guided by ordinary good manners, respect for human dignity, compassion, a caring attitude, and a high degree of commitment to public service, as well as a sense of duty. This will call for us to revive the unifying spirit of Ubuntu/Botho, and encourage health professionals to continue to live, and put into action the Batho Pele principles which, by the way, our province was the first to implement.
We have prioritised issues of quality of care, cleanliness, hygiene, patient safety, drug availability and infection control in our facilities. I have encouraged the Deputy Director-General (DDG) for Health Services to immediately begin the process of getting our facilities to participate in the cleanest health facility competition and to prioritise the Complaints Management System. Hospitals are being adjudicated as I speak. We will constantly monitor these critical areas of our service and we believe that by doing this, we will reduce adverse events and complaints about our services.
I have constantly said to our employees, it must be a pleasure for us to serve our people. E tshwanetse go nna boitumelo mo go rona go direla baagi ba rona!
Honourable Speaker, this country cannot afford a very costly hospi-centric and curative health care system. By going back to the basics and improving PHC we believe our people and communities will begin to regain trust in our health care services at clinic level.This will eventually lessen the burden at hospital level.We have realised that our people have been by-passing clinics and PHC services and going straight to the hospitals, even with minor illnesses that could have been dealt with at clinic level.
Honourable Speaker, allow me to remind all of us that it was in this month of April that we lost the life of the former Deputy Health Minister, my predecessor and a close comrade, the late Dr Molefi Sefularo. In paying tribute to this “Son of the Soil”, who contributed immensely to the evolution of the health industry in our country; allow me to say that we want to return Primary Health Care to the way it was during the times of Sefularo.The North West Province will always be known as a benchmark in paving the way for the implementation of Primary Health Care because of Dr Sefularo’s focused implementation of the District Health System.
Review of the 2010 / 2011 mandates
Honourable Speaker, the Department of Health shoulders some of the key Millennium Development Goals (MDGs). Over the past financial year, we worked extremely hard in fighting disease and reducing maternal, neonatal and under-five morbidity and mortality, which are some of the key MDGs.
The province has successfully implemented the use of Maternal Morbidity and Mortality Audit System (MaMMAS) to enhance the surveillance of maternal death notification. Maternal Death Assessors are doing a sterling work in their job of saving mothers, through auditing of all maternal deaths. According to the District Health Information System (DHIS), 26 January 2011, both the maternal and infants mortality rates are now decreasing with the maternal mortality ratio at 128/100k to the target of 130/100k, and the stillbirth rate 20/1000k to the target of 25/1000k. Regular maternal morbidity and mortality outreach workshops are ongoing in all the districts, creating awareness of the avoidable causes of maternal death and reinforcing best practices.
The Peri-natal Problem Identification Programme (PPIP) in the province has achieved 100% coverage in the implementing hospitals and Community Health Centre (CHCs).PPIP is a software which is used to capture the causes of neonatal deaths and to identify the contributing factors. This serves to guide targeted interventions and improve the quality of neonatal care. This implies that all our facilities in the province are conducting perinatal mortality reviews, and reaffirms Saving Babies’ undertaking that “Every Death Counts”.
The perinatal care index within the province is influenced by the quality of antenatal care provided for a particular community. The province has made strides in the coverage of Basic Antenatal Care (BANC) up from 43% to 69% this financial year.
Deaths of children in the under-five category are mostly from preventable childhood illnesses such, as diarrhoea, upper respiratory tract infection, severe malnutrition and HIV-related conditions. The province is, however, seeing an improvement in infant mortality within our facilities. According to DHIS (26 January 2011), in-hospital infant mortality rate is 5% to the target of 25%. Hundred percent (100%) of all Nursing Education institutions in the province now offer a case management course in Integrated Management of Childhood Illnesses. This course is intended to equip student nurses with skills for managing sick babies and children up to the age of five years. Implementation of Integrated Management of Childhood Illnesses at PHC level improved from 95% (2009/10 financial year) of facilities to 96% in 2010/2011 financial year.
Women's health is a key priority within the Department of Health. Since 1994, family planning services have been neglected. This will now change! No longer is Choice of Termination of Pregnancy to be used as a means of contraception. As we move towards a more preventative health system, emphasis becomes family planning. Since the implementation of the Choice on Termination of Pregnancy Act, 92 of 1996 (CTOP Act) as amended by Act 01 of 2008, the department designated 18 hospitals, five private hospitals and 14 primary health care community health centres for the provision of CTOP services. The challenge of the mushrooming illegal termination of pregnancy services will be decisively dealt with to ensure that we protect the vulnerable women from these charlatans. This will form part of the Moral Regeneration Program. All of us have a responsibility towards this very important aim.
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 between the ages of 30 and 59, 48% to a target of 50% have been screened for cervical cancer in 2010/11. We are optimistic that the department will exceed the target by the end of this financial year. Sixty Six (66) health care workers are, to date, trained on the insertion of an Intra uterine Contraception Device (IUCD) and we are committed to expanding this service. World Health Organisation’s (WHO) Ten Steps provides practical guidelines for the management of patients with severe malnutrition. We continue to strengthen the implementation of these ten steps for managing severe malnutrition at all health facilities. The guidelines seek to promote the best available therapy so as to reduce the risk of death, shorten the length of time spent in hospital, and facilitate rehabilitation and full recovery of severely malnourished children.All facilities in the province are providing Vitamin A supplementation to children of zero to five years (0 – 5 years). The coverage for children under one year (0 -12 months) is 90% and for children 12 – 59 months of age is 29%, which remains a challenge we are addressing.
Mmusakgotla, go bo tlhokwa gore mefama yotlhe ya puso e nne le maikarabelo mo go netefatseng gore bana ga ba nne ka tlala.Ngwana sejo wa tlhakanelwa!
Please note that all sectors of government have a responsibility to make sure that our children never go hungry.The province is strengthening the Prevention of Mother to Child Transmission of HIV (PMTCT) as well as Kangaroo Mother Care (KMC) with the Baby Friendly Hospital Initiative (BFHI) for safe and optimal infant feeding practices. To date eleven (11) hospitals and three Community Health Centres are designated Baby Friendly and we are seeking to increase this to full coverage.
The department achieved the establishment of Port Health Services, being one of the critical service delivery components for disease prevention and control. Six (6) Port Health officers were employed to manage three commercially designated land ports in the province, namely, Ramatlabama, Kopfontein and Swartkophek, mainly for disease, foodstuffs and hazardous substances control into the country. The department is working towards continued improvement of this service in order to have a fully-fledged service that allows rotation of staff at the service points.
The mass immunisation campaign against polio, measles and Vitamin A, targeting children under the age of 15 years, was embarked upon this year by the department. This was instrumental in curbing the continued measles outbreak that affected all areas of the province, as well as the country as a whole. All children with suspected polio infection were investigated and no polio virus was found, polio free status is sustained provincially, and nationally.
As a new initiative the department embarked on a successful vaccination campaign against H1N1 influenza virus, targeting high risk groups such as pregnant women, individuals on ARVs, people with chronic conditions and elderly people over the age of 65 years. The campaign will be repeated in the 2011/12 financial year still continuing to focus on high risk groups.
The Honourable President announced a new approach in the fight against HIV and AIDS in his 2009 World AIDS Day speech, which is in line with the 2007/11 National HIV and AIDS Strategic Plan (NSP). The HIV Counseling and testing (HCT) campaign calls upon all South Africans to know their HIV status, in order to access treatment early and reduce new HIV infection by promoting healthy lifestyles in all clients who have tested and know their status. This is regarded as the largest Campaign ever of its kind.
The announcement was influenced by HIV prevalence in Sub Sahara and South Africa itself, whereby 22.4 million (17%) of the population were affected by HIV in 2008.We are 0.7% of the population of the world and yet present 17% of the HIV and AIDS prevalence.In 2008 national HIV prevalence among pregnant women attending antenatal (ANC) was 29.3%. In North West Province the prevalence was 31%, with Dr Kenneth Kaunda District being the highest at 35%.We have, however, as the province seen changes in HIV prevalence.According to 2009 figures the HIV prevalence in pregnant women is 30%.
The objectives of the current HIV campaign will further strengthen the health systems as other resources will be channelled to it. It is, however, important to note that the campaign did not come with a separate budget and provinces were expected to implement the campaign within available funds.
North West has been a leading province in the HCT campaign, nationally.We have a national target of 15 million people that we must test by June 2011 and the North West Province is expected to contribute 998, 859 people. I am happy to report that the latest statistics indicate that we have already achieved 99% of our target and this is all because of our hard work and a good response from the people of North West. Our communication on HCT has been good and I want to encourage our Strategic Health Programme and the communication team to continue to do the good work.
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 social outlets within the community. It is envisaged that condom distribution will double in all provinces to meet the Minister’s target of two billion condoms per year by the end of the HCT Campaign. We are currently strengthening the marketing of Choice condoms as a quality brand, and working to improve consistent and correct condom usage.
We are also making progress with the High Transmission Area (HTA) programme, aimed at truck drivers and commercial sex workers and other high risk groups. This Project is part of the province’s response to the national strategy on HIV and AIDS, aimed at preventing the spread of STI, HIV and AIDS in areas that cannot be reached through standard awareness campaigns and day-to-day Primary Health Care services.Currently there are two formal intervention sites in Zeerust and Vryburg and some informal intervention sites referred to as "hot spots". Plans are underway to open an additional five intervention sites. In order to successfully implement the project, the numbers of peer educators deployed at intervention sites, Hot Spots as well as in communities, have been increased from fifty two (52) to eighty three (83).
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. There has been a marked decrease in mother to child HIV transmission, from 15.5% in 2009/10 down to 5% in 2010/11. Strategies have been put in place to continuously improve the PMTCT Programme, and further reduce mother to child HIV transmission.
Despite the fact that the province is leading in the HCT campaign, we are confronted with infrastructural challenges, and a shortage of professionals with scarce skills such as doctors, pharmacists, dieticians, psychologists. The programme has shifted from being doctor-driven to nurse-driven, and professional nurses are trained to initiate eligible clients on ARV’s.
Infrastructural challenges in the HCT program will be addressed through the purchasing of park homes as temporary structures. We plan to increase space with permanent physical structures through upgrading of our hospitals, in the future. The department will also continue to engage accredited service providers to train more care givers, increase the use of community counsellors, provide alternative space for counselling, and contract non-governmental organisations (NGOs) specialising in counselling to train counsellors.
We have, to date, accredited 51 Health Care facilities to offer ARV’s, making an increase in ARV sites from 29 to 80. We remain committed to empowering our HIV care and support programme. By the end of January 2011, there were 414 organisations rendering these services throughout the province, 325 of which offered comprehensive home-community based care services. Attached to these organisations are 5 330 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. By the end of June 2010, five step-down facilities in Mafikeng, Gelukspan, Nic Bodenstein, Taung and Potchefstroom were operational.
Hundred and thirty (130) support groups exist throughout the province, focusing not only on Persons Living with HIV but also on other HIV issues, such as nutrition, chronic conditions and breastfeeding support. The main objective of the programme is to maximise the involvement of People Living with HIV through capacity-building using support group guidelines and advocacy toolkits for people living with HIV and AIDS.
In order to uphold human rights and fulfil our legislative mandate on health and rights, the Department has forged a partnership with the University of the North West AIDS Law Clinic and paralegal cluster. They assist the department in implementing Human Rights and Access to Justice programme in the province. Care givers and traditional health practitioners have been trained on human rights in relation to health care service delivery, especially in mitigating stigma and discrimination around HIV and AIDS.
Mmusakgotla, ke santse ke gatelela molaetsa wa rona wa gore TB e a alafega fela fa molwetse a nwa ditlhare tsa gagwe sentle jaaka fa a laetswe ke ngaka.
Case finding of Tuberculosis (TB) has increased, from 33000 last year, to 34000 this financial year with an increased number of patients diagnosed during TB screening due to a HCT campaign, conducted in all districts. For TB control a courier service is available in all facilities on a daily basis which improves collecting specimen and delivering the results. In addition, the National Health Laboratory Services (NHLS) have installed 60 SMS printers covering all remote areas. This minimises the turnaround time as patients can be put on treatment immediately, which in turn, will reduce the spread of infection within communities. Facilities have been trained on how to collect quality sputum specimens, with 75% of facilities receiving results within 48hours. GeneXpert machines can diagnose patients with tuberculosis within two hours. In our effort to improve turnaround time on TB diagnosis results, we have acquired the GeneXpert machine at Tshepong Hospital. The GeneXpert tests for TB much faster and more accurate than microscopic tests that are used to diagnose the disease, which could take between three to five months to produce results.Now we will be able to diagnose TB within two (2) hours and start patients on treatment immediately.
The TB turnaround strategy has enabled the province to improve the cure rate from 56.1% at the end of 2009/10, to 63.3% at the 3rd quarter of 2010. Staff members have been trained on basic TB management and managers trained on supervision, reporting and recording. Five hundred and fifty (550) community health workers were trained on Directly Observed Treatment (DOT) short course in 2010 alone. The department will continue to improve the TB cure rate as a priority.
As a result of these TB initiatives, the number of cases of TB patients that default from TB treatment has been reduced from 9% of cases, to 8%.This has been enhanced by improved training of facility heath worker, distribution of the new TB guidelines and the use of defaulter tracer teams that are functioning in districts with particularly high TB case loads, namely Bojanala and Dr Kenneth Kaunda.
All patients diagnosed and confirmed with Multi-Drug Resistant TB are admitted to Tshepong hospital, and the waiting period has decreased because of the new systems implemented by the National Health Laboratory Service. Taung Hospital has been assessed for Multi-Drug Resistant (MTR)treatment and is now initiating treatment for patients living in the Dr Ruth Segomotsi Mompati District.
The five year anniversary of partnership programme against TB was celebrated between Klerksdorp/Tshepong Complex, local GP's and Broadreach Healthcare. This programme has successfully sustained a project whereby patients who are stable on ARV's are down referred to Local General Practitioners in the Matlosana Sub-District.
The National Department of Health TB Directorate has confirmed that the Klerksdorp/Tshepong Complex is the only hospital in the country which has successfully cured an extreme drug resistant (XDR) TB patient. The 2nd phase of the MDR TB Unit at Tshepong Hospital is now complete and functional. The MDR/XDR TB Complex behind Tshepong Hospital boasts 20 XDR TB beds and 76 MDR TB beds.
With regard to oral health, the department has added four new dental mobile trucks to ensure access to oral health services across the province and to participate in school health services.
Six additional dental surgeries have been equipped to provide preventive and conservative services, bringing the total of well equipped dental surgeries to hundred and fourteen (114).
A Substance Abuse unit has been opened and is functional at Witrand Hospital. This is the first unit of its nature in the public service to provide rehabilitation services for people with substance abuse problems. The provincial Mental Health Review Board is fully functional to ensure the protection of the mental health care user’s rights.
Three Thousand Three Hundred and Forty Six (3346) assistive devices were issued to address backlog in the province, in order to enhance the quality of life of people with disabilities.
Honourable speaker, we highly value our elderly people. Assessments of Old age homes were done at Ventersdorp, Zeerust, Lichtenburg, Wolmaranstad and Potchefstroom in order to contribute to comprehensive health services for older persons.
The department gives recognition to funding organisations that promote transformation, equity and uninterrupted access to services. Through structures like non-governmental organisations (NGOs), community based organisations (CBOs), and faith based organisations (FBOs) community care workers services are delivered in the province.Sixty-five (65) non-profit organisations were recommended for funding as part of the partnerships programme. The department has also rolled out a capacity building programme for 800 community care givers, as part of the EPWP (Extended Public Works Programme). Medical supply has been a hot topic recently. The average availability of essential medical supplies achieved for 2010/2011 was 89%. The Pharmaceutical Service plans to improve the availability of essential medical supplies such as ARV’s, TB medicines and vaccines during 2011/2012 to a target of 96% availability. Firstly, this will be done by strengthening the supply chain processes of medical supplies, secondly strengthening training on management of medical supplies (drug supply management) to reduce stock – outs due to poor management, and, by thirdly strengthening monitoring processes, to ensure appropriate utilisation of medical supplies.
We have taken a proactive decision to in-source medical stores. The department will be taking over the management of the Central Medical Stores from 1 May 2011. This will save the department approximately R6.6m. The department will take over the existing staff at the Medical Stores on a six - month contract, to ensure a smooth transition. During this period the department will put in place an effective and efficient structure, and make permanent appointments into the positions created. A visit has already been undertaken to a province which is managing their medical stores internally, in order to benchmark and implement the best practices in the field. The department envisages further savings when this structure for the management of the Medical Stores is implemented.Our Pharmaceutical Management Directorate team is already doing a sterling ground work for this process to happen and I want to thank and further encourage them to see to the success of this important project.We now have two pharmacists and one of them will be dealing specifically with ARV and TB medical supply.
Our Emergency Medical Rescue Services (EMRS) College in Orkney is now the largest EMRS College in South Africa. The accreditation of Emergency Care Technician (ECT) students has increased from 100 in 2009/10 to 200 learners in 2010/11. The department has completed 95% of a new electronic Provincial Health Operation Call Centre in Bojanala which is to be further developed to cover the entire province.This call centre will greatly enhance the monitoring and control of our vehicles especially ambulances.
Mmusakgotla, le fa re itemogela katlego mo ditirelong tsa tshoganyetso, re santse re tshwenngwa ke batho bao ba tshamekang ka megala ya tshoganyetso. Re lemoga gore bana segolobogolo ke bona ba dirisang megala botlhaswa moo e leng gore ka dinako dingwe badiri ba rona ba tshoganyetso ba tsibogela megala e seng ya nnete (hoax calls). Baagi ba tshwanelwa ke go itse gore go re ja madi a le mantsi tota go tsibogela mogala wa tshoganyetso mme fa ele maaka go raya gore madi ao a wela mo thothobolong. Re lemoga fa se, se diragalang gantsi ka malatsi a boikhutso fa bana ba le mo gae. Ke kopa bagolo ko gae le barutabana ko dikolong go re thusa go ruta bana ka botlhokwa jwa mogala wa tshoganyetso.
Honourable Speaker, over the past decade and a half, issues of gender based violence, disability and youth have become a major focus for health care services.
On issues of gender and disability we conducted a Gender and Disability Analysis on 15 policies of the department, to analyse the compliance of our policies. We have also trained 40 middle managers i.e. Hospital CEOs and Sub district managers, on Gender Mainstreaming.
For People with Disabilities, we have trained 16 young people in 2010/11 as Orientation and Mobility Instructors, of which five have already graduated. This is a service offered for visually impaired and people to facilitate daily living.This enables visually impaired people to be safe, independent and access community facilities with minimum assistance. We have also trained 68 Health Care Workers based in our health facilities, in Sign Language, in order to make the services more accessible for the hearing impaired community of the North West.
In the Youth Programme we have trained 150 young people as Peer Educators. This programme aims to prevent teenage pregnancy, early sexual activities, drugs and substance abuse, STIs, HIV & AIDS and promotes healthy lifestyles. This Peer Education programme is implemented in schools and among youth.
The department has established Traditional Health Practitioners Committees in all the sub-districts and the intention is to complete the establishment of districts committees before the end of this financial year 2011/12. The purpose of establishing these committees is to make communication easier between the department and Traditional Health Practitioners which will ensure participation and integration of such stakeholders in the entire health system. We cannot run away from the fact that we are sharing patients with our Traditional Health Practitioners and therefore we must together look at ways and means of preventing and curing diseases especially in the management of the HIV/AIDS pandemic.
The department has also re-appointed governance structures and Hospital Boards for the new term of office which will expire in 2012. These committees are the mouth piece of the Department of Health at the level of our communities. Their participation and involvement in the health system makes it easier for the government to know exactly what the communities wants in order to improve the entire health system.
Honourable Speaker, we have been able to open the renovated accident and emergency unit at Job Shimankana Tabane Hospital, and other revitalised community health care facilities in Bojanala District.Tshepong Hospital has been upgraded to create additional capacity for XDR TB and MDR TB treatments. We have increased our psychiatric hospital bed capacity with 108 beds at Witrand Hospital. The department has completed the extension and upgrading of Ganyesa Hospital Pharmacy area as well as the ARV and out-patient units.Mochwana and Tlhapeng Clinic in Kagisano have been recently completed and are ready for providing services to the communities.
We are accelerating our Gauteng dependency reduction strategy with the newly licensed radiotherapy-oncology unit at Klerksdorp hospital. The unit is already reducing the number of referrals of cancer patients to Gauteng.
I am pleased to announce that the Health Pillar contributed positively to the success of the 2010 FIFA World Cup and was rated the best pillar in the province. A legacy was created by this pillar where three new Health Centres (i.e. Mogwase, Letlhabile and Mabeskraal) and one hospital (Moses Kotane) were constructed to meet the demand of the FIFA World Cup. Other Health Facilities were revitalised e.g. Job Shimankane Tabane (JST) Hospital trauma centre. A total of 74 new ambulances were procured for the World Cup. Health promotion activities were undertaken in all 4 districts during the 2010 World Cup.
Mandates for 2011/12
As part of our mandate of decreasing maternal and infant mortality rate, we have already made strides on the coverage of Basic Antenatal Care (BANC) from 43% to 69%. In 2011/12 the department’s focus is to strengthen the implementation of the household/community component of Integrated Management of Childhood Illness so as to empower communities with regard to household /safe family practices.
Growth monitoring and promotion are an intervention that is used to detect malnutrition even before clinical symptoms become visible. Currently the weighing rate of infants is at 90%. We are hoping to reach a weighing rate of greater than 95% by the end of this financial year.
We have a turnaround strategy to train community health care workers to focus on all aspects of health promotion and prevention which includes identification of malnutrition and missed opportunities in immunisation, and to initiate referral to the local health facilities.
This financial year, we will roll out training of facility health workers, distribution of new TB guidelines and the defaulter tracer teams to the remaining districts which are Ngaka Modiri Molema and Dr Ruth Segomotsi Mompati. Phase 2 MDR units will be completed before the end of the financial year and this will give us more beds to accommodate newly diagnosed patients in each facility and closer to patients’ homes.
This financial year we are going to be analysing more policies as way of monitoring our compliance and to improve our performance on gender mainstreaming. We are going to train more health workers based in Community Health Centres and Clinics on Sign Language as these are the points of entry in the health service delivery. We will also train 25 Peer Educators on sign language so that young deaf community members may not be left behind regarding health talks and prevention programmes.
We are rolling up our sleeves up to respond to the Premier’s call on provision of sanitary pads/towels to needy girl learners. The department will provide 93 101 learners across the province with sanitary towels and the project will be launched in May 2011. This number was provided by the Department of Education after checking their provincial database of needy learners who are already at the age of requiring such services across the province. The benefits will be realised by both departments as we believe that such services will improve attendance of girl learners as well as improve school health and the uptake of contraceptives and most importantly contribute to the reduction of teenage pregnancy particularly at schools.
We intend to sustain this project by purchasing equipment which will produce sanitary towels and young people will also benefit by job creation and acquiring the necessary skills.
We believe that governance structures are important bodies that must promote public participation with the intention of advising and assisting the department to align its plans to respond to the needs of the communities. A training module is to be developed with the North West University to further capacitate governance structures and expand them to clinic level. We will, this financial year, train them on monitoring and evaluation to enhance their skills to enable them to play a meaningful oversight role to the department.
Honourable Speaker, in responding to the honourable Premier’s marching orders we are beginning the construction of Bophelong and Lichtenburg Hospitals and have started with a phased in occupation of the 120 Bed Vryburg Hospital, while the construction of Brits Hospital is continuing. Efforts are in place to increase the number of Specialists at Vryburg Hospital, but for the first few years of level 2 services, Dr Ruth Segomotsi Mompati District will still receive support from Klerksdorp/ Tshepong Hospital. We will officially open Vryburg and Moses Kotane Hospitals in this financial year.
Ba-Ga-Mothibi community will receive a Community Health Centre (CHC) to the value of R35 million!This is a very important intervention! The ANC led government cares and will always respond to the community’s health needs. We will renovate five clinics and two CHC in the Dr Ruth Segomotsi Mompati District this financial year, and they are Buxton, Tweelingspan/ Matsheng, Tosca, Dithakwaneng, Khibitshwana Clinics, Ganyesa CHC and Upgrading of Manthe CHC.
In response to the President’s call for job creation, we have carefully looked at how best these projects will create jobs for our people. We envisage that the construction of Bophelong Hospital will create 560 jobs each year for the next three financial years. The Brits Hospital project will create 120 jobs each year for the next two financial years. Construction of the Lichtenburg Hospital will create 50 jobs in the current financial year and create a further 130 jobs each year for the subsequent two years. We have ensured that these jobs are covered in the contract document of the contractors and will be monitored by the Health team and the professional team.
Honourable Premier has in her State of the Province Address, emphasised the need to strengthen social compact within the context of Public Private Partnership (PPP), in our approach to services delivery. I am happy to announce that, as the Premier has directed, we have taken this process further and engaged Anglo Platinum and Xstrata Mines as well as Sun City on their offer to build clinics for Sesfikile, Bethani and Lesetlheng communities. These projects will indeed start in the current financial year.
The department is busy with plans to reopen the Nursing School for basic nursing categories in Taung Hospital, to return Taung Hospital to its former glory of producing the bedside trained nurses and creating more jobs in the process.
Plans to Strengthen Primary Health Care from 2011 onwards
Honourable speaker and the house, we are planning to establish primary health teams in the province. Reengineering of PHC does not need a wide and very vague process, but requires focused and directed interventions.
It must be noted that over the past 16 years PHC has been theoretically the focal point of the health system and the following extract from the ANC Health Plan of 1994 illustrates, that: “The PHC approach is the underlying philosophy for the restructuring of the health system”. Much has been done to gear up the health system to implement PHC. There has been a large investment in infrastructure and building of new clinics and facilities to make health services more accessible. However, insufficient attention has been given to the implementation of the PHC approach that includes taking comprehensive services to communities emphasising disease prevention, health promotion and community participation.
Hon Speaker there is widespread global evidence that PHC is effective and makes sense especially for countries such as ours, though efforts are undermined by the overwhelming impact of HIV, which itself requires a PHC approach. What makes the case for PHC reengineering even stronger is that many of the health problems are linked to the social determinants of health (“upstream factors”) such as education and water which require inter-sectoral collaboration and which is one of the pillars of PHC.
National Department of health has now identified three most critical streams that will be used to achieve our goals faster and more efficiently. These streams are School health services, establishment of specialist teams and ward based PHC teams. I would like to spend a few minutes dealing with each so that I am well understood by everybody.
Under school health services
We all know that a school has a particular population which is very much vulnerable. This is the population that holds the key to some of the successes regarding health outcomes. It is this age group that is vulnerable to HIV and Aids, teenage pregnancy, sexual abuse, drug abuse, and other ills. We have heard of shocking stories of a school in one part of our land where over 60 learners fell pregnant in one year and we surely do not want this to happen in this province. We know of horrendous stories of sexual abuses and all sorts of bad acts that are going on in our schools and we don’t want to wait until we read about the stories in the media. We want to act and act now. We want to assure parents that their children cannot go to school as healthy children and come back unhealthy. We will be discussing this matter with our counter parts in the department of basic education to see how we can collaborate on this in order to accelerate the manner in which school health services are delivered effectively.
About specialist teams
Hon speaker, these teams will be appointed to support the delivery of health services in the district. The teams will be comprised of Gynaecologists, Family Medicine specialists, Paediatricians, Advanced Midwives and Primary Health Care nurses, among others. We will work very hard to ensure that we get these specialists to work in our districts. We will be discussing with the schools of health sciences and nursing colleges to see if we cannot be able to train these people. We will use the memorandum of agreement that we have with both WITS and University of Limpopo Medunsa campus to ensure that we appoint these specialists even if it is on joint appointment basis. We are certain that we will achieve this because we have already appointed family medicine specialist who are based at the district level in partnership with these two universities.
We will further discuss with Independent Practitioners Associations, which is an association of medical doctors, to ask them to take up sessions within the districts. We will also be discussing with private hospitals where they are available, and seek a way of entering into agreements for their specialists to do sessions in our districts to support the delivery of PHC services. We will stop at nothing in ensuring that we achieve this golden goal of improving access to the health services for our people. We want to invest in the Primary Health care area so that the patients can have confidence in the manner in which we render services. Once this confidence is regained, we are sure we will see most of our patients utilising clinics and community health centres. This will assist to reduce overcrowding of the Outpatients departments of hospitals; which if not addressed stands to undermine the quality of care for the hospitals.
Ward based PHC teams
After a successful and much spoken about international trip to Brazil, which my predecessor was part of, National Minister embarked on the process of reengineering of Primary Health Care. The success of this reengineering of PHC rests on the model that was learned from Brazil which is called Family Health Teams approach. South Africa has no intentions of bring the Brazilian model to South Africa, because we want to have our own brand which we will build using South African material and for South African landscape. Learning from the successful Brazilian model, we will be embarking on the establishment of the Primary Health Teams. These teams will be organised around the municipal wards, so that they are closest to where people live and work. They will work with the structures that are currently there on the ground. The teams will be comprised of Professional Nurse, Enrolled Nurse and a team of community health care workers. The team will be responsible to take care of a number of households within a ward, and will work closely with the Primary Health Facility for support, quality assurance and supervision. We would like to assure this house that before the end of this year, we would have established PHC teams in one district in this province with a view of rolling this out in the next three years. The decision as to which district we will start with will be taken after thorough analysis of the situation on the ground.
Improving efficiency in 2011 and beyond
The department has had a critical look at the way it is conducting its business and in the new financial year will be implementing efficiency measures in a number of areas.
I have already indicated that the department will save approximately R6.6m by in-sourcing the centralised medical depot but what is more important is understanding that we will now have a very efficient and effective medical supply system for our people once we do it ourselves.
Decentralisation of budgets and devolution of authority to the districts will be taken a step further in the new financial year to improve the pace of service delivery. Devolution of authority will be in the areas of appointments and procurement in the districts and facilities. With the emphasis on primary health care, this will go a long way in ensuring that unnecessary bureaucracy and bottlenecks in decision making are cleared.
District offices will no longer have to wait for head office approval for appointments provided posts are on the structure and have been budgeted for. Very often the waiting times for such appointments were so long that by the time they were finalised health professionals would have been snatched by other provinces.
Procurement of goods and services up to the value of R 2m can be approved at the district offices without reference to Head Office. District procurement committees have been established to handle the evaluation and adjudication of such tenders at the district level.
The performance on the maintenance budget for the last financial period was poor. More than half of the budget was spent in the last quarter of the year because of the internal challenges we had. The budget for maintenance has been decentralised to the districts to ensure that the maintenance budget is spent where it is most needed and when it is needed.
The department will ensure accountability on the management of the budget that will be devolved to the districts. It is only fair that the district management is given appropriate financial management training to ensure full accountability. To this end the Chief Financial Officer has been directed to implement financial management training for non-financial managers in the district as well as at Head Office.
Honourable Speaker and members of the Legislature, I present to you the North West Department of Health budget allocation for 2011/12 which is shared by our eight key programmes as follows:
1. Administration R294, 173 000
2. District Health Services R 3, 185,499 000
3. Emergency Medical Services R208, 251 000
4. Provincial Hospital Services R 1,502, 061 000
5. Central Hospital Services R194, 280 000
6. Health Sciences and Training R242, 242 000
7. Health Care Support Services R136, 492 000
8. Health Facilities and Maintenance R558, 444 000
Total budget allocation amounts to: R 6,321,446 billion (6 billion and 321,446 million)
In reflecting on this budget, it is important to note that the department is currently faced with the unpleasant situation where the increase in the burden of disease due to the scourge of the HIV/AIDS pandemic is not matched by a corresponding increase in its budget. The North West Province continues to have the lowest per capita health budget among the 9 provinces in the country even as it improves marginally from R1782 in 2010/11 to R1975 in 2011/12. It is required to do more with less. The department therefore, has no alternative but to seek ways of improving efficiency and extending every rand it uses as far as possible.
The annual increase in budget allocation has trailed behind inflation in the health sector. Whilst the costs of rendering health services are increasing by more than 12% per annum, the average growth rate in the budget of the department over the Medium Term Expenditure Framework period is only at 8.6%. The rising costs versus dwindling budget (in real terms) dictate that it cannot be business as usual. The department will have to strive for continuous improvement in financial management to maintain the current level of service delivery.
I conclusion Honourable Speaker, I am confident that with the funds that have been allocated to us, we will use it responsibly to improve the health profile of our nation and province.
Ke tsaya sebaka se go lebogela kemonokeng ya lona jaaka Boeteledipele jwa Porofense, Tonakgolo Mme Thandi Modise ka thotloetso le go ntshimega ka dinako tsotlhe.
Ke leboge le Komiti Khuduthamaga ya Porofense ka boineelo le tshegetso mo go tsweletseng pele maikaelelo a rona a go aga setshaba se se tsweletseng pele ebile se itekanetse ka dinako tsotlhe.
Modulasetilo wa Standing Committee sa merero ya Boitekanelo, Mme Veronica Kekesi le maloko mmogo, ke lebogela kemonokeng le go dula lo le pudi matseba mo go re gakoleleng ka mekgwa eo re ka tokafatsang ditirelo ka yona.Ke lebogela le seabe sa Provincial Health Council eo e tsweletseng gore thusa ka dikakanyo tebang le go diragatsa ditsholofetso tsa rona mo baaging.
Re le Lefapha la Boitekanelo, re dira thata le batsaakarolo ba ba farologaneng ba tshwana le di governance structures tsa rona, magosi, dingaka tsa setso, Makhanselara, Mekgatlo ya Badiri, Mekgatlo ya Sedumedi le Mefama ya Poraefete.Bagaetsho ke lebogela seabe sa lona!
Re na gape le bao ba re thusang jaaka di-Non-Governmental Organisations le di-community-based organisations.Ke lebogela tirisano mmogo ya lona mo go direng mmogo go tokafatsa matshelo a batho ba rona.
I want sincerely thank the Management Team of the Department led by the Acting HOD, Dr Andrew Robinson and the executive managers of the department.To all our employees, the doctors, the nurses, health professionals and support staff in the administration, I thank you for your dedication and hard work.
Last but not least I’d like to thank my family, my wife Mme Masike and my children for their support and for understanding that our call is to serve the nation.
“Working together we can deliver quality health services for all”
“Working together we can build better Communities”
I thank you!
Ke a leboga!
Tel: 018 387 5830
Cell: 082 964 8838
Issued by: North West Health
18 Apr 2011
[ Top ]