Eastern Cape Department of Health 2010/11 budget vote presentation by MEC P Masualle, Bhisho
21 Apr 2010
Honourable Speaker Honourable Premier Honourable members of the Executive Honourable members of the Provincial Legislature Honourable Chairperson of the House of Traditional Leaders Leaders of the opposition parties Executive mayors and councillors Hospital boards and clinic committees Health and medical associations Leaders of organised business in the health sector Leaders of the organised labour in the health sector Leaders of the non-governmental sector Fellow South Africans
The President of the Republic has declared this year as the “Year of Action” and the line of sight has been provided for all of us to respond to the challenges of our lifetime. To remind the honourable members of the House, the State President indicated that we must:
confront the fact that life expectancy at birth, has dropped from 60 years in 1994 to just below 50 years.
make interventions to lower maternal mortality rates, to reduce new HIV infections and to effectively treat HIV and Tuberculosis.
reduce infant mortality through a massive immunisation programme reinstate health programmes in schools
implement all the undertakings made on World Aids Day relating to new HIV prevention and treatment measures and
also continue preparations for the establishment of a National Health Insurance system.
It is therefore against this background that the Department will direct its energies with the limited resources at its disposal to ensure that we make 2010 a Year of Action for better Health Outcomes. Ours is a commitment we make and the commitment we shall strive to fulfil.
Honourable Speaker, I therefore invite all the Honourable Members of this august house, our communities, their leaders, the non governmental sector including our faith based and traditional leaders to join us in this quest to transform the provision of health care in the Province so that those who utilise our Public Health Facilities can have an improved and satisfactory patient experience.
In presenting our Budget and Policy Speech it is important that we reflect on our current financial year; contextualise the main challenges faced by the health sector at this time in our democracy; move forward and outline our new health programme and how we intend implementing it; and lastly, present our budget.
It is pleasing to report that Project 5 000 over the past three years has realised the filling of 3 258 posts through an expenditure of R460 million. As recent as the beginning of this year we were able to attract and appoint 72 doctors into our system.
We also welcome five orthotic and prosthetic graduates from training in Tanzania this current financial year, and the latter acquisition will assist us in wiping out backlogs in services to our people with disability challenges.
Despite challenges related to the interpretation of the Resolution on Occupational Specific Dispensation (OSD) for Health Professionals, we have to date translated 15 751 nurses to the OSD in Phase 1, and during Phase 2 (Medical Cluster and Social Workers) the department translated 2 628 health professionals including doctors, specialists, dentists, pharmacists, EMS personnel and social workers.
The department has built and completed 18 clinics from its Infrastructure Programme. In addition to this we have opened Dr Malizo Mpehle Memorial and Settlers Hospitals.
It is the policy and intention of government to consolidate provision of health services. We have to this effect concluded negotiations towards the provincialisation of the following Provincial Aided Hospitals: New Haven, Stutterheim and Aberdeen. We would encourage others to do likewise. We are also committed and confident that the provincialisation of PHC services from municipalities will soon be concluded. It is important to realise this consolidation of health services in that it will assist the efficient and effective implementation of the revitalised primary health care (PHC) approach. We will work closely with all the involved stakeholders especially municipalities to ensure that as a collective we deal with all the outstanding matters related to this process.
Honourable Speaker, we have accredited 85 additional facility sites, implemented the new dual therapy for our patients and increased patients on the ARV Programme to 96 000. All our MDR and XDR TB institutions have been accredited to provide ARV services, and we have established a 32 bed satellite MDR unit at Marjorie Parish TB Hospital. The department has established a MDR TB Review Board with the responsibility to overseer all the issues pertaining to our MDR TB patients.
Honourable Speaker, the whole health system needs great overhauling and transformation to provide accessible quality services that are founded on Primary Health Care approach. It is true that we should not forget that in 1994 we inherited an apartheid modelled health system. The interventions sought in the past have been obstructed by a number of stakeholders who benefited from that system. It is for this reason that the ANC government has elevated and prioritised the importance of transforming the Health System in the country.
Since 1996, the Public healthcare system has continued to be underfunded relative to the needs. The funding levels have failed to keep pace with medical inflation which currently runs at 10%; the growing population; and emerging burden of diseases that is driven by HIV and AIDS, non-communicable diseases alcohol related traffic deaths and trauma. As a direct consequence of this our province has the second worst per capita funding in the country.
The unintended consequences of this scenario have been the ever-expanding unequal expenditure between the private and public sector with:
Poor staff morale and migration to private sector however this has only been arrested with the OSD initiatives.
The increasing medical inflation with escalation in hospital based care costs
The erosion of PHC and DHS services
Decaying infrastructure due to delayed and under funded maintenance programme.
The other critical challenges relate to poor pharmaceutical management system; poor administration and some pockets of corruption in the system; and underdeveloped Emergency Medical Services.
Honourable Speaker, to address most of these challenges, we confirm the centrality of government driven transformation directing available resources to the neediest areas in terms of services. We are making a Clarion Call to go back to basics: build a strong and sustainable PHC foundation, and build a system that will provide a platform towards establishment of the National Health Insurance.
Our main focus will be on the following:
Build a strong Primary Health Care foundation through social mobilisation of our communities towards a Social Compact, increasing Community Healthcare Worker capacity. We would like to emphasise the centrality of the clinics and Community Health Centres as central pillars of our approach, following the old maxim, “Prevention is better than cure”. At sub-district level this system will be driven by District Health Authority
Initiate Income Generation projects in identified hospitals to increase our attraction and retention of revenue. This will not only increase our revenue base but will also build a nucleus of facilities towards readiness for NHI policy implementation. We have already begun discussions with Treasury on the modalities of this plan particularly the revenue retention component
Reforming our Supply Chain Management system by building elements of transparency, efficiency and decentralisation. Aligned with the PHC revamping initiative, our procurement system will be geared towards strengthening Local Economic Development (LED) initiatives and expose as many people, local entrepreneurs to economic opportunities
Re-engineering our business processes and build high efficiency levels. This will also be aligned with building the requisite austerity culture in our department to achieve greater value from the little resources that we have
Increasing Human Resources capacity by recruiting the required personnel and increasing production of our nursing personnel. It is our intention that we create the necessary balance between health professionals and administrative personnel.
Revamping our Emergency Services Capabilities by securing additional fleet on top of those provided by the centralised fleet contract. The whole system of managing and coordinating our emergency response capability will be overhauled with the view to improving our response times and the management of limited resources.
We shall continue to be guided overall by the Ten Point Plan on Health as the pivotal programme to remedy our health system with focus on strengthening and reforming public health system especially the hospital managerial and service delivery capacity; providing policy and the readiness of our facilities to implement the National Health Insurance system; and dedicating the country to an intensified and sustained implementation of the new health programme (especially HIV and AIDS programme) to ensure drastic reduction in mortality and achieving better health outcomes.
The new PHC Initiative will mobilise leadership and communities and build the Social Compact. We will work closely with other sector partners to ensure that, there is dedicated and identified programmes to deal holistically with all the social determinants of health (for an example alcohol abuse, traffic accidents). We are committed to work closely with local government in the provision of basic services (e.g. water and sanitation) as these will have positive impact on the health status of our communities. This programme will be rolled out with the main focus in Intsika Yethu Municipality, Kind Sabatha Dalindyebo, and Uitenhage in the Metro in the new financial year.
We will focus on a patient-centred Quality Improvement Programme and all our facilities are expected to and will be monitored on their implementation of the minimum six prioritised Core Standards:
Infection prevention & control
Availability of drugs in our facilities
All our hospitals will be required to fast-track implementation of these standards through development of plans, improving waiting times, developing patient-focused and caring culture, and implementing infection control measures and processes.
Our Over-arching Programme: The Ten Point Plan
Honourable Speaker, our intention is to establish strong hospital based services that will back-up the Primary Healthcare (PHC) Programme. In this case, we will expedite the skills audit for all the hospital management teams, ensure they are adequately equipped and thereafter give them the relevant delegations so that they can perform their responsibilities and be fully accountable. This decentralised management system is part of the plan to strengthen our public health system at all levels.
We have commenced a concerted drive to recruit the required health professionals and other critical administration staff into the health system. The strategies will include transformation of our hospitals to attract not only private patients but also private specialists. Our intention is to use these specialists as catalysts who will in turn train and attract other clinicians. We are also going to increase training capacity for our nursing personnel for all categories.
As reported previously we will put in place a training and recruitment drive to attract community health workers (CHWs) for our PHC programme. In this regard we have targeted 2 000 CHWs. Aligned with the Social Compact the CHW will drive non-facility PHC programme at community level, and thus contribute in reducing unnecessary facility visits especially at hospital level.
Honourable Speaker, our Infrastructure Programme was driven to achieve our committed targets in the FIFA 2010 World Cup and to this extent we have built a state of the art Accident and Emergency Centre in Port Elizabeth to provide needed emergency hospital services during this period and beyond.
We are finalising the Oncology Units in East London and Port Elizabeth with modernised and latest equipment, and Cecilia Makiwane Hospital has been put on the Revitalisation Programme. In the new year we will focus on effective maintenance programme through increased budget allocation, and we will fast-track the revitalisation of our hospitals.
We have set aside R741 million (including R690 million from HIV and AIDS conditional grant) to strengthen our fight against HIV and AIDS as well as related conditions:
At the beginning of the year, we will implement an intensified campaign on counselling and testing by the citizenry of our province and we are targeting 2 million people having tested for HIV status;
We will target all HIV positive pregnant mothers and tuberculosis (TB) patients with a CD4 count of 350 or less for the roll-out of the ARV programme
All HIV positive babies and multi-drug resistant/extremely dug resistant (MDR/XDR) TB patients will be put on the ARV programme irrespective of their CD4 count levels
We will increase access and coverage for the Prevention of Mother to Child Transmission (PMTCT) to 95%
Our home-based care programme is targeting 60 000 patients this new financial year.
We have rededicated our efforts to fight the TB epidemic with its dangerous streams (multi-drug resistant and extremely drug resistant TB forms), and we have set aside R342 million this year. Our programme will focus on:
Fully integrated TB and HIV & AIDS Programme with all our TB patient receiving ARV according to the new clinical guidelines;
We have set aside 100 beds at Nkqubela Hospital to admit acute MDR TB patients;
The department will implement the Community-based MDR TB programme to manage patients that have come out of the acute phase. This will be fully developed with support systems in the community.
A new single beds unit with 40 beds for MDR TB patients will be established at Jose Pearson Hospital this financial year. This is the new model that will reduce cross infection and will benefit our staff and other patients.
Although these two programmes will translate into a huge responsibility and need for additional resources, we will strive to provide these services to the designated groups so that we realise better health outcomes for our people.
For too long we have had major challenges around availability of basic medicines and drugs in our PHC facilities. We have put in place a Pharmaceutical public-private partnership (PPP) process that will be fast-tracked to achieve better management capabilities at the two depots, and an efficient distribution to our facilities. Our main focus is zero stock-out levels for essential drugs at PHC level.
Honourable Speaker, Honourable members of the House, I hereby table the Budget Vote, Vote No. 3, for the Eastern Cape Department of Health which is R13 billion for 2010/11
Health Administration: 592 417
District Health Services: 6 031 872
Emergency Medical Services: 574 790
Provincial Hospital Services: 3 414 389
Central Hospital Services: 557 137
Health Sciences and Training: 566 522
Health Care Support Services: 130 442
Health Care Facilities Development and Maintenance: 1 473 303
Total: R13 340 872
For information purposes, the above figures are also inclusive of Conditional Grants which are:
Conditional grants allocation for 2010/11 (R'000)
Comprehensive HIV and AIDS Grant: 690 940
Forensic Pathology Services Grant: 69 345
Hospital Revitalisation: 360 660
National Tertiary Services Grant: 557 137
Health Professionals Training and Development: 160 444
Provincial Infrastructure Grant: 331 782
Total: 1 838 526
Budget as per economic classification
Current payments: 11 404 533
Compensation of employees: 7 919 339
Goods and services: 3 485 194
Transfers and subsidies, (Total): 654 327
Provinces and municipalities: 299 763
Departmental agencies and accounts: 195 962
Universities and technikons: 108 291
Households: 50 311
Payments for capital assets: 1 282 012
Buildings and other fixed structures: 877 247
Machinery and equipment: 404 765
Total economic classification: 13 340 872
Honourable Speaker, It is no exaggeration that the health sector faces immense challenges. These challenges however are not insurmountable. We have faced before extremely difficult situations and through our resilience and our death defying commitment to succeed, united in action, we emerged as victors. I have not the slightest doubt that in the daunting challenges as they may appear, when we act together, victory is certain.
I take the opportunity to thank the Members of the House and the Portfolio Committee for its rigorous oversight and support which I welcome the most, Colleagues in the Exco for their understanding and support. I also thank the Premier for her leadership and above all my organisation the ANC for affording me the opportunity to serve the people of the Eastern Cape.
Last but not least, the officials of department of Health under the stewardship of Dr Siva Pillay.
Let us all support our campaign of knowing your status in terms of HIV and AIDS. I am responsible, we are responsible and South Africa is responsible!!!!
Working together we can make a meaningful impact in fighting the challenges confronting healthcare in the province.