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Honourable Speaker of the North West Legislature
Esteemed Premier
Honourable Members of the Legislature
Our Distinguished guests
Friends

This and the other budget speeches that we as Members of the Executive Councils are putting to the people of the North West Province is probably the last full final year in which we are able to continue or complete the mandate they gave to us in the second democratic elections of 1999. Even as we declare our intentions for the new financial year this should be the year in which we account for the mandate. For that reason, I will tend to look back to confirm that we as a government and a department, are still course on to confirm that we have remained true to the covenant we have with the people.

The other significance of this budget speech is that it marks the first year of the second multi-year expenditure framework. We are determining the course for the next three years. In a sense, upon the record of the past nine years, we are building a legacy for the present and future generations.

May I begin by briefly recalling the key tenets of the declarations, undertakings and promises we made to the people since we were elected for the second term under the leadership of President Thabo Mbeki.

In 1999, we were completing the command of President Mandela when he said, on the occasion of his inauguration on 10 May 1994, " We have at last achieved our political emancipation. We pledge ourselves to liberate our people from the continuing bondage of poverty, deprivation, suffering, gender and other forms of discrimination. We know it well that none of us acting alone can achieve success. We must therefore act together as a united people...."

We said then that the following would be priority tasks

* To fight the abuse of women and children.
* To start a maternal death register so as to know why women of our province were dying in pregnancy-related incidents.
* The prevention of cervical cancer, one of the biggest killers of the rural, African women.
* HIV/Aids prevention.
* Home based care.
* To defend the rights of persons with disabilities and provide services for them.
* The improvement of our hospitals.
* The preparation of the transfer of health services to local authorities.

In the year 2000, we relied on President Mbeki's words when he delivered his first State of the Nation address in February 2000. He urged us to work in an integrated manner by cooperating with other departments in accelerating service delivery and efforts to bring a better life to our people. In that year, we also identified the following as important tasks for bringing a better life to or people.

* The transformation of Emergency Medical Services so that we could reserve as a minimum, half of all the posts for women and all administrative posts for persons with disabilities.
* The introduction of a private company to help us with the distribution of medicines to our hospitals. We then said that the aim was to end the suffering of our people who were repeatedly frustrated and endangered by the shortage of medicines in our clinics and hospitals.
* The strengthening of the programme on the Choice of Termination of Pregnancy. To end the shame, pain and death of backstreet arbortions and abandoned babies.
* The decentralization of the primary school nutrition programme.
* The creation of youth centers to cater for the specific needs of the young people of our province.
* The termination of the district surgeon system so that our people could be served by new doctors who were prepared to treat them as human beings worthy of human rights and dignity.
* The promotion of the Patient Rights Charter.
* The creation of a Clinical Investigation Committee to investigate any death or injury to people who are cared for in our clinics and hospitals.
* Strengthening of community participation where the central aim was to ensure that our department is truly accountable and that at the end of the day, the majority of the victories we would score would belong to the people of our province.
* The formation of partnerships with universities like Wits University, Medunsa and Pretoria.
* The signing of management contracts with companies in the catering business for the improvements in the quality and safety of the food we give our patients in the hospitals.
* Contracting Vuna Health Care logistics for the distribution of drugs and medicines to our hospitals.
* The formation of the Provincial Council on AIDS, which brought together all citizens of the North West into a coalition against HIV and AIDS.

It is also the year in which we received the first detachment of community services doctors and dentists.

In the following year, 2001, we said we would do the following:
* Begin the final steps to transfer primary health care services to municipalities.
* Changing the Primary School Nutrition Programme from a service based on giving money to big companies to one that shared the millions of Rands amongst the women of our province especially those who are poor, single and rural.
* The engagement of small business and individuals to ensure the distribution of medicines from the hospitals to the clinics.
* The strengthening of the Voluntary Counselling Testing programme so that our people could on their own determine their HIV status.
* The beginning of the programme for the prevention of the transmission of HIV from pregnant women to their unborn babies.
* The further improvement of our hospital services by creating specialist units in Klerksdorp/Tshepong, Mafikeng and Rustenburg hospitals.
* The strengthening of our emergency medical services with the intention to ensure that every health centre has an ambulance standing next to it so that our people would stop dying from waiting for an ambulance that takes forever to arrive.
* To strengthen our fight against tuberculosis, a disease that kills our people more than HIV does.
* Expanding the programme on the immunization of children.

Last year, 2002, we set ourselves the following priorities:

* Providing the systems, tools and appropriate environment for the personnel in our department.
* Looking after the well-being of our personnel.
* Building the necessary partnerships with civil society, business and citizens.
* Providing security for our staff and patients.
* Buying the necessary equipment for our clinics and hospitals.
* Reducing staff shortage, especially in the rural arrears.
* Improving financial management and internal control.
* Improvement in performance management and development.
* Improving services for people on the farms and in the rural areas, especially the small and isolated villages.
* To continue with our fight for the rights and improvement of services for persons with disabilities.
* Strengthening home-based care.
* Continuing to bring some dignity and happiness to our elderly parents and grandparents through the provision of free eye operations for cataract blindness.
* Taking over the mortuary services so as to bring dignity, reduce the pain and end the humiliation our people have virtually come to accept as normal for every person who loses a loved one through death.
* The creation of a forensic service so as to help in the combat of sexual and other crimes while helping in the healing of the survivors.
* Supporting the Letsema programme on the basis of a partnership with our people.
* The upgrading of the levels of comfort and quality of care in our hospitals to a point where they could compete with the private hospitals in our province.

The trend and message that runs through these years is that in the early years, we defined our core business as putting the poor, the youth, the women and the children at the top of our priority. We began then to seriously focus on HIV and AIDS.

In the middle of the year, we shifted our focus to the improvement of quality of care and the strengthening of partnerships with communities, private companies and academic institutions.

In the third period, we emphasized the need to use our services to fight poverty, unemployment and strengthen our collaboration with non-governmental organizations.

In the last year, we turned towards our personnel, emphasizing the need to create an environment of security, care and support. We identified the people of farms and rural communities as deserving of being treated like full citizens of this country and deserving of human rights that so many of us take for granted.

Every year, as we did this morning, we have presented a report to the citizens of our province. By doing so, we were humbling ourselves before them, allowing them to look at the way we had served them and pass whatever judgement they deemed befitting us. The verdict we have heard year after year is that we have been faithful to our people. We have stayed true to the course.

Throughout these years, Honourable Members, for our success we relied on the support, sacrifice, wisdom and tolerance of our citizens through their communities and as individual volunteers. In particular, the care groups that have existed for many more years longer than this decade of freedom have meant the difference between failure and success of health care in rural areas. We have been able to succeed because so many of our staff members have gone beyond the call of duty so as to serve and protect our people.

It is for these reasons, Honourable Members, that we as the department have enjoyed the respect and recognition of our peers across the country. Due to the support we enjoyed from our partners and the people of the North West, we as a department have been able to:

* Touch and deliver far beyond our reach.
* See further than our mortal eyes permit.
* Hear voices and messages an ordinary ear could not have been able to pick up.

We have never found ourselves in a situation where the people shouted complaints and accusations across a gulf of demands without involvement or rights without responsibility or a joint search for solutions.

Honourable members, next year, we can look back, to a decade of a successful partnership between the department of health and the people of the North West province.

Before I set out what we intend to do for this and the next three years, I want to say to our people, "All the victories and achievements rightfully belong to you!"

This year, President Mbeki has called upon us to roll back the frontiers of poverty, improve the quality of service and to combat corruption. In addition, the President has urged us to develop a cadre of multi-skilled development workers. Amongst others, he urged us to join hands with our people and form a broad front for transformation. On the matter of Batho Pele, the quality of care and the elimination of corruption, President Mbeki called upon us to engage the workers in the public service.

I am pleased to report to you Honourable Members, that in so many ways, we have obeyed the President's command. We even went an extra mile. Starting in the month of November last year, we met the following stakeholders and partners.

* Hospital Boards, Health Committees and various Health Forums.
* Young people working in NGO's supporting the government's HIV/AIDS programme.
* Suppliers of goods and services from the Private Sector.
* Service Providers in the Primary School Nutrition Programme.
* Together with the North West Youth Commission, the Youth of the North West.
* Emergency Medical services personnel.
* Cosatu-affiliated and other unions.
* Allied and other paramedical professionals.
* The nurses in our Department.
* Supported by the Disability Desk in the office of the Honourable Premier we met people with disabilities.

The programmes, plans and budget we put before you, Honourable Members, is truly a product of genuine consultation with those who will be affected by the decisions we take on this vote. Once more we can say with a degree of certainty that what you hear today is the voice of the people. The budget you will be allocating today will be a concrete response to deeply felt needs and clearly expressed experiences, proposals and wishes. The following are key policy decisions that we wish to implement in this financial year and the rest of the Medium Term Expenditure period.

After the NGO summit, the department decided as follows:

* We want to continue the funding of NGOs that are currently on our list. We will only use the additional allocation to include new applications. However, we may very well have to reduce allocations to some of those currently in our books, so that we can redistribute the money to areas and communities with greater need.

* We want the NGOs that are especially formed by youth, to use some of the money we give them in some business venture. By so doing, we hope they will learn skills that will take them beyond the NGO sector and into the new generation of entrepreneurs.

* Our commitment to continue to fund these organisations in actual fact means that the department has created jobs to hundreds of our people. What we will require is that every year, every NGO that has received money from our department accounts for the money and the services they said they would provide. If they fail to do so, the funding will be discontinued and an alternative organisation will be funded.

It means that the government will continue to provide training and skills to the youth to enable them to be part of the economic mainstream in the future.

* Together with the Youth Commissions and the Umsombovu Fund, we have decided to start a programme to strengthen the Youth NGO's by assisting them on business skills, entrepreneurship, resource mobilisation, and the general ability to identify business opportunities.

* We also would like to take over the administration of NGO's that are in the North West but currently receive money directly from the national Department of Health.

From the Nurses Summit, we are able to report that the department has agreed to do the following:

* Security

The department is currently in the process of forwarding recommendations to the Tender Board for the procurement of security services from private companies. This move will ensure that many of our centres extend the services beyond the current limit.

* Staff Shortages

Various categories of nurses will soon be appointed. Funds have been assigned from the R120m that has been allocated to the department. The creation of these new posts has been done in line with the critical needs that have been forwarded from regions. The focus is basically on: increasing the hours of service, increasing access to rural facilities etc.

* Performance of non-nursing duties

We acknowledge that in some of our facilities, nurses are due to staff shortages compelled to perform non-nursing duties in their quest to provide care to patients. We agree that there is a need for us to move swiftly in sourcing additional resources for the creation of auxiliary services posts e.g. ward secretaries.

* Stress Management

We have taken cognisance of the fact that we currently do not have stress management and support services for medical, emergency medical services and nursing personnel. We have therefore set aside funds for the employment of regional EAP coordinators. In addition, nurses and medical personnel will be supported in seeking treatment through private service providers.

From the Suppliers Summit, we adopted the following measures and policies:

* It remains our aim and commitment to use more than R600 million we are given every year to build and strengthen business in the North West, especially those headed by Blacks, women, youth and people with disabilities.

* We will be reorganising the procurement structures within our department with substantial delegation of authority to the regions and hospitals.

* To be stricter on limiting the practices of buying out of contract or other manners of failure to honour contracts

* To approach the national Department of Health to request the handing over of contracts that provide us with goods that we can obtain in the North West.

* To enforce the Preferential Procurement Policy, with an emphasis on the inclusion of people with disability.

* We insist that the wealth and benefits should be shared with the people of the North West, especially through the creation of jobs.

* Strengthen our supply chain management by appointing a logistician and engaging the services of a private entity to help us in improving our tender administration and procurement services

* We will continue to improve our payment processing system so that we do not destroy small companies and in the process block the path to Black Economic Empowerment.

To the Allied Health Professionals we have decided on the following:

* For Career Pathing, an Assistant Director: Rehabilitation will be appointed at regional level to look after the interests of all allied health professionals.

* The appointment of another person (nurse, social worker or psychologist) at regional level to look at the Medical Social Workers, Clinical Psychologists and Mental Health Workers.

* Rather than subsidized vehicles, we will set aside targeted pool vehicles per occupational group of allied health professionals.

* An internal Continuous Personal Development Programme should be developed for the continuing medical education and training.

* The department will only subsidise conferences that provide services we cannot offer.

* A policy on accommodation should be developed. All community service persons should be given priority without segregation or discrimination. Allocation of housing should be on a first come first served basis.

* More posts for Community service personnel will be created.

* Allied health professionals should also be granted an opportunity to work more hours in other centres in the public sector at a normal rate.

* Space for physiotherapy and rehabilitation rooms should be provided for in our current building plans. Every new hospital or health centre must have an office and a room for the allied health professionals.

* Information sessions and a platform for all our managers (clinical and general) on what the allied professionals do and need for effective service delivery.
* A dedicated budget at every institution should be set aside to cater for all the allied health professionals.

On the Emergency Medical Services

* The programme should be managed within the EMS directorate without disempowering the Regional Directors, District and Institutional Managers.

* The Regional Directors, the District and Institutional Managers would have authority as far as quality and accountability were concerned. They should see to it that the same service standards, rights and benefits are enjoyed by all our citizens. On these matters, they can call upon the regional coordinators to account.

* With the creation of more posts, we should be able to absorb the qualified unemployed volunteers after due process. However, the employment of volunteers should strictly be on the basis of available, vacant funded posts.

* We will contract a private company to backup for intermediate and advanced support. This is to make up for the shortage of highly trained personnel.

* To reduce accidents and the abuse of ambulances, we will investigate the implementation of the system of vehicle tracking and management. Firstly, we will take disciplinary action against all those who have abused or destroyed our ambulances.

* By the end of June 2003, all EMS staff should be wearing the same uniform bearing the same design and colour.

* A total amount of R4 million has been set aside to deal with the expenses associated with the establishment of the control centres, which will improve communication within EMS. Mobile phones will continue to be used as a means of augmenting gaps.

To the women who were with us at the PSNP Summit, we have decided as follows:

* We will be looking at extending to October this year, the existing contracts of the women who have been feeding the primary school children.

* We will use the additional allocation this year to bring in new service providers and to expand the programme to include the young ones in Grade R.

* It is our wish to include all children up to grade 7. However, more money would be requested for the expansion to grade 7.

* We will increase the amount we pay the service providers for every child. The increase per child will be determined on two different prices, on the basis of whether the provider is in an urban or rural area (including farms).

* We will be appointing additional Assistant Directors. One for clinical nutrition and the other for community nutrition.

* Evaluation, promotion, internal awards and training opportunities for the CLOs will be created.

Our message to people with disabilities is the following:

* We will buy a Braille machine for Itireleng workshop for the Blind in Garankuwa. For every publication on health education and warning notices that we issue, we will ensure that a percentage would be determined so that Itireleng would be contracted to produce the Braille version.

* All posts that are intended for people with disabilities should be designated clearly in the adverts.

* On procurement, we had not been strict enough with our requirement that people with disabilities should be a factor (important weight) when we consider suitability of contract of suppliers.

* We will also develop a special programme for the feeding of children at centres for the people with disabled children.

* The sexual abuse of people with disabilities will be prioritised for inclusion in the training of forensic nurses.

* We will ensure a stricter application of the Sterilisation Act so that people with disabilities are not sterilised against their will or without the agreement of their families.

* We will also be doing preferential appointments of persons who would perform dual functions-core functions and sign language interpretation.

From the fruitful discussions we had with the unions, the following key points were agreed upon:

* The new performance management and development system would be implemented from 1 April 2003.

* The department will train all supervisors in the implementation of the system. In turn, the unions will educate their members.

* All backlogs in personnel evaluation, promotions and the payment of all monies due to the workers will be settled by the month of July 2003.

* Managers in all our institutions should allow the members of all registered unions to have floor or workplace meetings. These will be used for vital communication and the education of employees about various government policies and decisions.

Community Development workers

Honourable Members, to his call that we develop or strengthen a cadre of multi-skilled community development workers, we are glad to say that Mr. President, the North West Province is ready. We have thousands of men, women and young people who have chosen to work amongst our people, visiting the sick, giving health education and supporting those on treatment for diseases like cancer and tuberculosis. Very often, they draw on their own families' limited resources in order to bring relief to a neighbour.

This self-selected group of patriots and good citizens deserve to be trained and strengthened in one way or another. We, as a department have decided that from last year, we will be registering all volunteers and care groups. Once registered, they will be given a stipend. This stipend, while in line with legally prescribed minimum income will not be a salary. It will be a token of appreciation, a recognition that good Samaritans that they are, they also have needs and vulnerable to poverty.

We will be working with the National Development Agency and Health and Welfare Sector Education and Training Authorities (SETAs) to strengthen the care group organisations and train members so that they can qualify for other occupations.

Integrated Service Delivery

We are glad to report to your house, Honourable Members, that for the first time this year we are able to announce with certainty that we together with departments of Education and Social Services, Arts, Culture and Sports will work together in the following areas:

INTEGRATED SERVICE DELIVERY/PROGRAMS

(See http://www.nwpg.gov.za)

Flagship Programmes

1. Farm Child/Community
2. Nutrition/Food Security
3. Social Grants
4. ELCD
5. Family/Sexually/other Violence
6. Substance Abuse

Other Clusters

1. Water
2. Sanitation
3. Roads
4. Capital Works - Building
5. Communication
6. Housing

Other Spheres

IDP

What this agreement means is that the officials of our departments will be working jointly on these services and programmes. As Members of the Executive Council, we will synchronise our programmes so that when the one arrives at a particular place or community, the others are able to join or at least, send departmental officials and resources. By so doing, we will be carrying out the instruction of President Mbeki and ensuring that benefits to our people are multiplied.

We make all these undertakings Honourable Members, conscious of the fact that as a department, we have in the past been found wanting in the area of financial management and internal control. I have reason to believe that the past financial year was a year in which we have substantially reduced the weaknesses in our systems, increased our personnel numbers and provided the necessary training where it was required. More specifically, we have created full directorates of Internal Control and Audit Accounts and Budget Management.

In addition, we have adopted and begun implementing a Risk Prevention Strategy as well as a Fraud Prevention Plan. We will also be separating the corporate management services of hospitals and the district health services.

We trust that these measures will demonstrate and yield a better accounting for the resources you place in our custody so that we can bring a better life to our people.

Honourable Members, we will continue to build more clinics especially for rural communities. I refrain from listing the communities who will be benefiting this year only because the list is very long. Allow me to announce the shorter list of the hospitals we will be building from this financial year:

* Swartruggens in the Kgetleng River Municipality area.
* Vryburg Hospital in Naledi Municipality area.
* Ledig in the area of the Moses Kotane Municipality; I should mention Honourable Members that this hospital will be replacing Derdepoort.

Honourable Members, because they have been a recurrent declaration of intent for the past two financial years, let me report to you on the two critical programmes of the Emergency Medical Services and assignment and delegation of health services to municipalities.

On Emergency Medical Services, I am glad to report that we are closer to realising our goal of having an ambulance next to every health centre, close to and among the people. The first batch of ambulances that we have received will be distributed as follows:

Bophirima Region

Station: Taung
Institution & No. of Allocated Ambulances: Pampirestad clinic - 1;Reivilo clinic - 1

Station: Vryburg
Institution & No. of Allocated Ambulances: Huhudi clinic - 1

Station Schweizer-Reneke
Institution & No. of Allocated Ambulances: Amalia - 1

Station: Lekwa - Temane
Institution & No. of Allocated Ambulances: Utlwanang Clinic /Boitumelong Clinic - 1

Station: Kudumane
Institution & No. of Allocated Ambulances: Tshwaragano Hospital - 1

Total: 6

Bojanala Region

Station: Koster
Institution & No. of Allocated Ambulances: Reagile Clinic - 1

Station: Swartruggens
Institution & No. of Allocated Ambulances: Borelelo Clinic - 1

Station: Brits
Institution & No. of Allocated Ambulances: Letlhabile Clinic - 1

Station: Rustenburg
Institution & No. of Allocated Ambulances: Tlhanane Health Centre - 1

Total: 4

Southern Region

Station: Klerksdorp
Institution & No. of Allocated Ambulances: Botshabelo - 1

Station: Potchefstroom
Institution & No. of Allocated Ambulances: Boiki Tlhapi Clinic - 1

Station: Wolmaranstad
Institution & No. of Allocated Ambulances: Maqwasi Hills Hospital - 1

Station: Ventersdorp
Institution & No. of Allocated Ambulances: Tshing clinic - 1

Total: 4

Central Region

Station: Mafikeng
Institution & No. of Allocated Ambulances; Tshidilamolo Health Centre - 1

Station: Delareyville
Institution & No. of Allocated Ambulances: Madibogo Health Centre/ Atamelang - 1

Station: Zeerust
Institution & No. of Allocated Ambulances: Ikageleng clinic - 1

Station: Lichtenburg
Institution & No. of Allocated Ambulances: Bodibe Clinic - 1

Total: 4

Of the four response vehicles, one will be allocated to each region.

We are happy to announce that by the time of the beginning of the financial year of the municipalities in July 2003, we will have completed the processes of delegating Primary Health Care to the Bophirima District and its related municipalities. Honourable Members you may have heard that we have been in dispute with Potchefstroom over our intentions to provincialise the primary health care services that are currently delegated to that Municipality. First, I want to assure members that while the precipitating event was an annoying incident of the withholding of services from the community over the festive season, our decision is not a hostile takeover. We have had extensive consultation with the community of Potchefstroom. The Potchefstroom City Council took a resolution supporting the provincialisation. We appreciate this decision in favour for a better health service for our people.

The rights of the workers protected by the Constitution, the relevant laws, the contract between the province and the municipality will be protected. Those that are willing to work on the conditions of services that will see to the opening of clinics on weekends and holidays where necessary, are welcome to move to the province. The choice is theirs.

Honourable Speaker, next year will be ten years since we got freedom and democracy in South Africa. We trust that we as a department have been able to give a happy and healthy meaning to these years and songs of freedom. Let the praises and thanksgivings of our people go to the women and men we found in the Department of Health and those who joined later after 1994. They could only have made such sacrifices because they share with us the belief that what defines us as a people and a nation is the ability to give meaning to the idea of a common humanity that transcends our superficial differences. They too, should be counted amongst the heroes of our liberation and the continuing work for a better life in a better country for all our people.

I thank you all, Honourable Members. In particular, many thanks to the Honourable Premier, Popo Molefe, for your leadership in the pioneering years of the first two terms of democracy and freedom. Thank you, Chairperson M.A. Khunoana and Honourable Members of the Standing Committee on Health.

My heartfelt thanks go to the graying teachers who worked with my parents to nurture me for the work that I have been able to share with you.

Similarly, to my wife Kgomotso, who took over from the older generation to continue nurturing and preserving me so that I could repeatedly return to the battlefield and the task of defending our hard-worn freedoms. I say words will never be enough. Convey the message to our lovely daughters.

The tide has turned, we have reason to believe that better years are still ahead of us. A better life must come. We say so with confidence, because we are in partnership with our people.

A glorious future and a sweet, health heritage awaits the children of the North West Province and the continent of Africa and the generations that will follow them. Of this truth, we are certain, because we are prepared to spare no effort as we strive to the realization of the dreams of our forefathers.

I thank you!

Source: North West Provincial Government (http://www.nwpg.gov.za)