Speech by the MEC for Health, Ms lh Mekgwe, on the occasion of the 2012/13 Health Budget Vote Gauteng Provincial Legislature, Johannesburg
1 Jun 2012
Honourable Members of the Executive Council; and
I rise to table the 2012/13 Health Budget Vote. This is the first Budget Vote I table after Social Development was de-merged from Health as from the 01st April 2012.
Honourable Members, will recall that on the 22ndof March 2012, the Minister of Health, Dr Aaron Motsoaledi announced the 10 pilot sites for implementation of the National Health Insurance. Among those sites is Tshwane, which is our pilot in Gauteng.
I therefore take this opportunity to announce that a lot of work has been done in preparation for implementation. We have undertaken an audit of all facilities which need to be revitalised in the Tshwane District. Staffing requirements have also been identified.
The first phase of the pilot will be implemented in two sub-districts which are comprised of Hammanskraal, Atteridgeville and surrounding areas and the Tshwane City Centre.
Implementation will be rolled out to the rest of the District over a period of three years. We are collaborating with the City of Tshwane in order to establish a single District Health Authority.
Facility improvements which encompass the elements of National Health Insurance are underway in Sedibeng, and this will ensure that we are ready to expand to the rest of the province.
Honourable Members, I will share the details of our readiness with the Health Portfolio Committee. I must indicate that while on paper we have been allocated R 31, 5 million; in reality we sit with R11, 5 million because R20 million has been ring-fenced for revenue collection and management by our four Central hospitals.
As I table this R 24, 5 billion budget, I am mindful of the fact that Gauteng continues the being economic heartland of our country and our continent. We still attract people from other provinces and beyond our country’s borders. In other words we are victims of our successes!
The uninsured health population in Gauteng is estimated at approximately 77%, yet the absolute number is growing significantly. The number of visits to our Primary Health Care Facilities increased to over 20 million by 2011/2012.
While we continue to engage National Treasury with a view to revise the baseline for Health funding, we will continue to provide innovative leadership.
As we are in the middle of the fourth term of government, we have gone a long way towards realising most of the commitments we made when we were first elected in 1994.
We are aware of the challenges which still face us as we march towards twenty years of our liberation. That is why we continue being guided by the outcome: A Long and Healthy Life for All South Africans. This outcome has four outputs by which we will be judged.
These outputs are:
Increase life expectancy;
Decrease maternal and child mortality;
Combat HIV and AIDS and decrease the burden of disease from TB; and
Strengthen health system effectiveness
Honourable Members, will recall that in November 2012, an agreement was developed between the Gauteng Provincial Government, National Department of Health and the National Treasury with regard to support programs to address the challenges that were faced by the Department.
The Department was obligated to develop a 3-month plan of action to be implemented in the last three months of the 2011/12 financial year. We have stated on numerous occasions that this intervention should not be misconstrued for being put under Section 100 of the Constitution of the Republic of South Africa.
The Department is not under administration! We would have failed in our leadership duty had we not requested National Treasury to intervene.
We have developed a Turn-Around Strategy in order to address the challenges that we are facing. The basis for this Turn-Around Strategy is a Ten Point Plan towards effective health service delivery and a clean audit by 2014.
We identified the following eight (8) areas which require urgent attention:
Finance and financial management;
District Health Services;
Medico-legal services and litigations;
Health Information Management and Health Information Systems;
Communication and Social Mobilisation; and
Honourable Members, the Executive will be ratifying this Turn-Around Strategy which hinges on the following five pillars:
Strategic Leadership and desirable organisational culture;
Environmental controls for Good Governance;
Communication and Social Mobilisation;
Human Resources Management and Development; and
Health Infrastructure Development and rehabilitation.
We have already migrated some functions back from the Gauteng Department of Finance to the Department of Health. Some of these will be ultimately devolved to Districts and Central hospitals.
With regard to cost –containment measures, these are a responsibility of all layers of management and also all institutions. We identified fourteen (14) hospitals which account for more than 70% of National Health Laboratory Services costs.
In order to minimise these costs, we began implementing an Electronic Gate- Keeping system whereby unnecessary and repetitive blood tests and other investigations are being reduced and ultimately eliminated.
Implementation of this system at Chris Hani Baragwanath Academic hospital is already bearing fruit. After the first month of implementation at the 20 hospitals, savings that were realised amounted toR226, 000, and this included 1878 blood tests on which the Department saved costs.
It is therefore anticipated that the savings realised will increase as the remaining data is analyzed, and the system strengthened to ensure that all unwarranted tests are accurately recorded and all tests are included.
Progress on Accruals
Honourable Members we promised to clear all our accruals by the end of June 2012.In this regard, we have already paid more than 2 billion Rand to service these accruals, out of this 1, 3 billion Rand was paid to suppliers owed by the Medical Supply Depot.
Importantly, in April, R874 million was paid to clear the debt owed to medicine suppliers. We should therefore not run short of medication due to non-payment. We settled our debt to municipalities in April 2012.
Emergency Medical Services transfers to municipalities were paid in May 2012. Honourable Members, we still commit ourselves to clear remaining debt by the 30 June 2012.
A moratorium on filling non-critical posts continues to be enforced. Posts will only be filled on the basis of a motivation to the Head of Department.
These measures are aimed at ensuring that we plough our resources into the core mandate of the Department, and we want to ensure this august House that service delivery will not be compromised!
We are confident that these measures will yield positive results. We are also on course to improve revenue collection as evidenced in R432 million that was collected in the 2011/12 financial year.
Allow me then Honourable Speaker, to outline our priorities for the 2012/13 Financial Year.
Re-engineering Primary Health Care
We are dissolving regions and are in the process of appointing full-time District Managers. Metropolitan Districts will be managed by Chief Directors. We are also revamping sub –districts to ensure that services are brought closer to where people live.
In our endeavour to strengthen Primary Health Care services we will continue to extend hours of operation to 24 hours at Zola, Stretford, Empilisweni, Chiawelo, and Eersterus Community Health Centres in order to ease the pressure and long queues at neighbouring hospitals.
Ten health posts will be established, these will serve blocks of households in communities, focusing on health promotion and referral to appropriate levels of care.
We will continue to strengthen the Primary Health Care approach with increased focus on health promotion and prevention of infectious and chronic diseases.
Promotion of healthy lifestyle by emphasising healthy diet, physical exercise, stopping smoking, responsible use of alcohol, and responsible sexual behaviour will be defining features of our Community Based Services.
Training of Community Health Workers will be intensified to support District Health Services. We have also renewed the role of doctors, family physicians and general practitioners at Primary Health Care level.
This will include contracting of General Practitioners to work at least four hours per day in public health facilities our National Health Insurance pilot sites.
This is premised on our experience that patients continue by-passing clinics because they believe that they have to be seen by a medical doctor in order to be satisfied that they have received quality health care. We have thus increased the budget allocation aimed at strengthening District Health Services by 16% to 8, 1 billion Rand.
Reduction of Maternal, Infant and Child Mortality
Early bookings for pregnant women remain an important intervention in order to detect complications during the early stages of pregnancy. In this regard we re-enforce our message of booking before 20 weeks of pregnancy and consequences of late booking and presentation.
In order to increase access to Ante-Natal –Care services, the slogan: “Every day is Ante-Natal Care day” is being implemented at all our clinics.
We are thus educating women of child-bearing age to understand their bodies in order to detect pregnancy early. Midwives are being empowered to identify potential complications early and refer them appropriately to relevant levels of care.
Nurses will routinely enquire about the menstrual cycle of women of child bearing age so as to identify those who may be pregnant and initiate them on Ante-Natal Care.
With these interventions, we will be on course to improve the maternal mortality ratio from145 per100 000 for the previous triennium 2008 to 2010 to 100 per 100 000 live births by 2015.
A high proportion of women continue to die from cervical and breast cancers. The only way we can arrest this upward mortality trend is to test early. In this financial year, we have targeted 110 000 women for cervical cancer screening and 15 500 women for breast cancer screening.
Combating HIV and AIDS
HIV Counselling and Testing remain pivotal in our fight against the scourge of HIV and AIDS. The number of men who present for counselling and testing is increasing and this is encouraging.
We still encourage couples to undergo counselling and testing together. In 2011/12, over 1 760 000 people were tested, and we have set ourselves a target of 4 million people to be tested in 2012/13.
As part of our efforts to complement our prevention initiatives, 51 200males were circumcised in 2011/12. This year we have set ourselves a target of 138 800 males to be circumcised. We will continue working with our communities and development partners to reach this target.
The progress we are making on Prevention of Mother to Child Transmission of HIV is remarkable. We are confident that we will reduce transmission rates to less than 5%.
No child should be born with HIV infection in this day and age!!! We are committed to eliminate Mother to Child Transmission of HIV in Gauteng!
We will also increase sites which offer Anti-Retroviral Treatment from 355 to 403. This will go a long way to ensuring that treatment is available and accessible closer to where people live.
We will increase the number of nurses trained on initiating adult and children on Anti-Retroviral Treatment, in order to also increase the number of patients on treatment.
It is also our view that management of HIV and AIDS should be integrated into Primary Health Care where comprehensive care, treatment and support can be provided.
We will increase TB case finding among HIV infected clients so as to increase the number of TB/HIV co infected patients on Anti-Retroviral Treatment.
Honourable Members, in order to break the back of HIV and AIDS, we have thus increased the budget allocation for this programme by17% to 1, 9 billion Rand.
Decreasing the burden of disease from TB
The target for the TB cure rate in 2012/2013 is 82%. In order to achieve this target, patients who are on TB treatment will continue to receive treatment support through the Directly Observed Treatment Strategy where they will be assessed for other social problems within the families which may also need intervention.
We have set ourselves a defaulter rate target of 5%. In order to ensure this target, patients who miss treatment will be followed up at home in order to bring them back to the health facilities to ensure that they resume, continue and complete their treatment.
We are aware of some factors which include all forms of poverty which contributes among other things to patients failing to return to the health facilities to continue with TB treatment. We will therefore continue working together with Social Development and Rural Development Department to assist with poverty alleviation projects.
Since the introduction of the GeneXpert technology, patients are receiving results of their TB status quicker than before, resulting in treatment being initiated earlier and thereby reducing the death rate.
This technology also ensures early diagnosis of MDR-TB resulting in patients receiving their results before they are lost to follow-up. We are therefore going to increase the number of hospitals which have GeneXpert technology from the existing five (5) facilities to a total of ten (10) in the whole province.
Multi-Drug Resistant TB remains a challenge in our province. While we have one hospital which treats Multi-Drug Resistant TB, some patients are not followed up and they default and end up developing resistance.
In order to mitigate this, management of Multi-Drug Resistant TB will therefore be decentralised to districts.
Tshwane district has commenced to treat Multi-Drug Resistant TB patients locally.
Other treatment centres will be opened at Carletonville and Bertha Gxowa hospitals. We have thus allocated a budget of 213 million Rand, to reduce the burden of disease from TB.
Emergency Medical Services
We are also in the process of maximising support for Emergency Medical Services. We are regulating the operational environment to ensure full implementation of the Gauteng Ambulance Services Act of 2002.
We will strengthen the manner in which this service is rendered on our behalf by metropolitan cities, by close monitoring of Service Level Agreements we enter into with municipalities.
Appointment of a dedicated Emergency Medical Services Chief Executive Officer and a Director of Operations will be finalised shortly. Fleet management is being standardised across the province in order to ensure equitable availability of ambulances.
We are exploring innovative ways of increasing the number of Intermediate and Advanced Life Support categories of staff. This stems from the fact that our Lebone Emergency College can only accommodate a limited number of students.
We will complete re-vamping of Ambulance bases in Odi, Temba, De Wegensdrift and Carletonville by the end of this financial year.
In order to improve of response times we have budgeted 759 million Rand which is an 8% increase from the previous financial year’s budget allocation.
Forensic Pathology Services
The Conditional Grant for Forensic Pathology Services that we received since the transfer of this service from the South African Police Services, ceases at the end of March next year.
The Conditional Grant for this programme ceased at the end of the 2011/12 financial year. This programme is now funded from the equitable share.
We will advertise the position of the Chief Executive Officer shortly in order to ensure stability in the service. It is our view that this service is very strategic to our quest to reduce the incidence of trauma, sexual assault, and unnatural deaths in Gauteng.
Information that is at our disposal will be used to identify exactly where preventable deaths and acts of violence occur.
Forensic Pathology Services were migrated to the Department of Health because they contribute to health and well- being of our people. It is therefore our belief that most unnatural deaths are preventable.
Expenditure on Forensic Pathology Services will be justified by provision of intelligent information regarding prevalence and frequency of trauma, sexual assaults and unnatural deaths. This information will be shared with sister Departments and translated into preventative programmes to reduce unnatural deaths.
We will put an end to a situation where Forensic Pathologists who are our employees do private work, using our equipment, while they are supposed to be on duty at state mortuaries.
To this end, by the end of the 2012/13 financial year, hospital mortuaries will become part of Forensic Pathology Services. Hospitals will focus on saving lives! The allocation for this sub-programme has increased by 2% to 160 million Rand.
The process of re-categorisation of hospitals as per national policy is now complete. Appointment of Hospital Chief Executive Officers where they are affected by hospital re-categorisation is at an advanced stage, we will continue selecting suitably qualified candidates.
Surgical backlogs are a problem and an inconvenience to patients and families. Major surgery consumes a lot of resources which we do not readily have. Hospitals will ring-fence budgets to address surgical backlogs.
With regard to major surgery, each cluster of hospitals led by its central hospital will engage the referring hospitals on sharing the backlogs especially if they do not particularly need specialised tertiary care, for example; hip and knee replacements.
In order to reduce Cataract operations, which by their nature do not rely on ICU, all designated hospitals will dedicate more theatre time for cataract surgery, and hospitals will conduct a minimum of 90 per month. We will continue with private partnerships in order to conduct high volumes of cataract extraction during cataract week in October.
During last year’s budget vote I made a commitment regarding collaboration of different levels of care, especially with regard to management of maternal and infant mortality.
Our hospitals, especially tertiary and central hospitals continue managing births that are uncomplicated, and these should be managed at clinics with Maternal Obstetric Units and District Hospitals.
This collaboration is beginning to bear fruit. We have already appointed and deployed Principal Family Physicians to each of our districts.
These specialists will be supported by fellow specialists from Universities, Tertiary and Regional hospitals. We will institutionalise this collaboration with the effect that each district will have a direct working relationship with regional and tertiary hospitals.
For too long some specialists who focus on maternal and child mortality have been working in silos. Honourable Members, we have come to realise that interventions without appropriate institutional arrangements have no impact on service delivery.
Availability of Maternity Obstetric Ambulances and their quick response is crucial to saving the lives of women who are in labour and their infants. To this end, we have increased the allocation to Central Hospitals by 28% to6, 8 billion Rand.
The funding formula for Dr George Mukhari will be reviewed. This is against the background of the influx of patients from Brits in the North West where their hospital is being rebuilt from scratch.
Provincial hospital services have been allocated5, 7 billion Rand which is an increase of 23%.
An effective health system
All of the above hinge on an effective health system. Public perceptions are real; this is a very important element of quality assurance. That is why we have employed addition Call Centre agents to handle complaints from the public.The call centre which we established in 2009, is achieving a complaints resolution rate of above 96%.
Four years ago we initiated a project to reduce waiting times at Out-Patient Departments, and Pharmacies. Interventions such as ensuring availability of functional help desks, implementation of queue marshalling system, triage system, improvement of signage, fast queues for very ill and vulnerable patients and 3 months repeats medication for chronic patients have yielded positive results.
This project has been so successful to the point that it has since become a benchmark for other provinces including the National Department of Health. The system has been replicated to all provincial health departments.
Availability of Medicines
We are re-engineering our business processes at the Medical Supplies Depot in order to ensure constant supply and availability of medication at hospitals and clinics. In order to improve logistical efficiency of drug distribution, we are investigating the feasibility of direct delivery from the central depot to the clinics. This approach should improve quality of care at community level.
Essential Drug List medicines have been categorised into fast movers, and slow movers. Where it is absolutely necessary to use non-Essential Drug List medicines as determined by the provincial Pharmacy and Therapeutics Committee, they will be maintained at a stock holding of 6 weeks.
In order to pre-empt and mitigate shortage of chronic medication, we have obtained permission from the National Department to procure some drugs such as Tenofovir from additional suppliers. Tenofovir is available in Gauteng. Shortage of Abacavir is due to unavailability of active ingredients from manufacturers internationally.
Honourable members, to ensure constant supply and availability of medication at our hospitals and clinics, 1,4 billion Rand has been allocated towards procurement of medicine and a bulk of it will be to allocated Medical Supplies Depot.
We have reviewed maintenance contracts in order to minimise break down of medical equipment. To this end, we have allocated 427 million Rand to purchase medical equipment for our hospitals in 2012/13.
With regard to Asset Management, all Auditor General’s concerns that I reported as being implemented during the 2010/11 Annual Report debate, have been addressed.
In order to ensure that our infrastructure meets requisite standards, we have overhauled infrastructure management. We have employed a civil engineer who is being complemented by another one whose focus is on special projects.
These engineers will ensure that we expedite completion of projects and provide appropriate maintenance. In this regard we will tap on the experience that we amassed when we delivered the 2010 FIFA World Cup projects.
We are working together with the MECs for Infrastructure Development; and Finance to ensure that optimal support is provided to infrastructure management while taking into account our unique circumstances.We will focus on improving multi-year infrastructure planning and implementation as well as maintenance in all our facilities.
We have already devolved responsibilities for procurement of specialised goods and services to the sites of delivery. The New Natalspruit and Zola/Jabulani Hospitals are close to completion. The Germiston hospital was completed in November last year and was renamed after our struggle heroine, Mama Bertha Gxowa.
In 2012/13, we will continue with planning for the revitalisation of Jubilee, Kalafong, Sebokeng, Dr Yusuf Dadoo and Tambo Memorial hospitals. In addition, planning will begin for the revitalisation of two of our central hospitals through a Public Private Partnership.
We will pay special attention to the development of the requisite technical capacity to deliver on infrastructure, particularly in critical areas such as roads and transport as well as health and education infrastructure.
We have also delegated minor maintenance to hospitals in order to reduce unnecessary delays. The budget allocation for Infrastructure Management is 1, 4 billion Randmainly to sustain and complete projects that are underway.
Health professionals are a backbone of our services. Since the year 1998, we have sent 30 students to Cuba to be trained as medical doctors, out of these 29 graduated and 26 remain in our system. In September this year, we will send 100 students to Cuba to be trained as medical doctors.
By the end of January 2012, 725 nurses had completed their four year training programme. These nurses have been deployed to various hospitals and clinics through- out the province.
We are hard at work to re-furbish the Nursing College residences in Gauteng and R12 million has been set aside for this purpose.
We are monitoring student performance at all our Nursing Colleges in order to improve the pass rate. To this end a Clinical Department will be re-introduced at all Nursing Colleges.
By the end of June this year, we will have finalised appointment of Hospital Boards and the Mental Health Review Boards whose respective terms of office have expired.
We have ensured that we appoint people with requisite skills so that they add value to governance of our hospitals. These boards will ensure that in pursuit if their fiduciary responsibilities, Chief Executive Officers and hospital managers will be given space to focus on ensuring that quality health services are provided at our facilities.
As I am about to take my seat, I am mindful of the apprehension and receding hopes of the people of Gauteng, when taking into account the mammoth challenges that the Department faced in the past year.
We are turning the corner, we are stabilising service delivery. Fortitude, determination and resoluteness will pull us through the challenging times that we have been facing.
We are confident that we are indeed turning the corner; we are on course towards achieving the goals that we have set for ourselves.
I take this opportunity to express my heartfelt gratitude to the Honourable Premier for her leadership, my colleagues in the Executive for their collegiality and support, my Comrades in the ANC Caucus for their encouragement, the Chairperson of the Portfolio Committee for her unwavering support, Committee members for their robust oversight, all categories of staff for their determination to continue to serve the people Gauteng, and finally my family for their un-ending support.
Issued by: Gauteng Health
1 Jun 2012
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