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30 March 2006

AGE OF HOPE – A NATIONAL EFFORT FOR ACCELERATED SERVICE DELIVERY OF QUALITY HEALTHCARE

Madam Speaker and Deputy Speaker of the North West Legislature,
Honourable Premier: Mme Molewa,
Colleagues in the Executive Council,
Members of the Provincial Legislature,
Chairperson of the Portfolio Committee on Health: Mme Molema,
Our stakeholders and partners in the health sector
Our Head of Department Mr Obakeng Mongale,
Management team of our department,
Distinguished guests,
Comrades and fellow South Africans

First of all I would like to acknowledge and welcome all our health workers and stakeholders. I am referring specifically to these workers Madam Speaker, because we have resolved to pay a special focus on them as they are the bearers of the torch that brings light to many hospital wards, the tonic that heals and indeed the face of our public health care.

As we outline here today key deliverables and reflect on the pressing challenges ahead, we need to take along our staff members especially those in districts and health facilities.

Madam Speaker, your staff members should be your best ambassadors and proponents of the age of hope and accelerated share growth message. There is no doubt that if we work together and share information and programmes internally we will indeed in the near future be able to stand tall and declare that, every staff member is a health promoter, a communicator and a reservoir of healthy living information.

We are gathered here today about to conclude Human Rights Month as declared by the President. It was during this month that we took stock of many human rights issues across the country. Certainly, Madam Speaker, we can not speak of human rights and exclude the health sector.

Twelve years into democracy and freedom, the country is still battling with the evils of human rights abuse. Of the worst hit are women, who are still suffering from oppression, because of gender inequity, culture, religion and socio economic status.

It is this above situation that has propelled us forward in the health sector to pay special focus to the health of our women and children. Through the adoption of the Choice of Termination of Pregnancy act no 92 of 1996, the roll out of our prevention of mother to child transmission of HIV (PMTCT) programmes in many of our clinics and intense advocacy and awareness drives around cervical cancer, breastfeeding and kangaroo mother care system we have put in place programmes that restores women’s dignity and human rights.

Access to decent and quality health care services is a fundamental human right. Driven by that core principle our department will continue to take part in building a solid base for all human rights to prevail.

As we celebrate all the achievements we made in our forward march towards a human rights and responsibility driven society, let us remember that if we deny our communities access to health services we are pouring cold water on their human rights.

Madam Speaker, these human rights are not on their own, they are supported heavily by responsibilities. As is the primary responsibility of the state to provide preventative and curative health care services, it is equally the responsibility of the citizens to live a healthy life style. It is the responsibility of our communities and individuals to take some responsibility for their health and reduce risky behaviour. The department has a healthy lifestyle programme, which we are committed to strengthen but we need communities to also take the lead in this regard.

United action to heal the nation

Our Department continues to make significant advances in our quest to transform the health system and lead a united front to heal the nation as espoused in our vision and mission.

Admittedly, these gains and victories are not without their challenges. Honourable Members, ladies and gentlemen, the transformation project in health is large.

In many instances we had to use the courts to enforce the transformation project as the material costs involved amounts to millions of rands. It is these millions of rands that obscure others to think rationally and put good health above profit.

At the core of this transformation is our ability to ensure that the best quality of care is provided to every individual who seeks care in health facilities, be it in public or private sector. Central to all these, the care must be affordable and accessible.

In response to the president’s directive, we have been able to increase the intake of student nurses at the two of our nursing colleges by two fold. However, we are experiencing infrastructure challenges which have the potential to impact negatively on proper teaching and learning.

Towards improving of service delivery at hospitals through proper delegation of authority to hospital managers, the Department has made considerable progress in cascading these delegations to sub district, programme and institutional managers.

Madam Speaker, our mandate is to work with other sectors, communities and individuals including those who claim to be in possession of some concoction that can cure any of our communicable, non communicable and chronic ailments to ensure that our people are healthy. Similarly we are supposed to provide rehabilitation services to those with chronic conditions.

All these indicate the complexities and the numerous tasks ahead which inherently require labour intensive methods. Ladies and gentlemen, honourable members, it is clear that in order for us to achieve and deliver on our core mandate, people are a critical input, asset and weapon. The importance of human resource in the health system is emphasised by the situation across the Province, which experiences high staff shortages.

There is a new phenomenon emerging in the public health sector in which various provinces including national department competes for the limited human resources available in the country. This unfortunate situation leads to serious movement of skilled professionals between those provinces that can afford to up their salary packages and those with limited budgets like the North West.

The rural nature of our province and the skewed allocation and distribution of resources amongst districts also poses a serious challenge in our aim to ensure equal access of services to all our communities.

Madam Speaker, we are buoyed by the growing support and close cooperation we receive from our social cluster departments. Acting together we are in the process of rolling out an on line childbirth register in our facilities. We have ensured that our mothers no longer had to travel long distances to register their children after birth. This latest technology is enabling our mothers to access grants for their qualifying children.

Together with the Department of Agriculture we are miles ahead with the promotion of our food gardening project and the introduction of multi-vitamin in most of our staple food like maize and bread.

In pursuit of all these we are confident that we will not be alone. We are thrilled by the growing united people’s front made up of all sectors in the health industry, which is driven by a common agenda of destroying hunger, ill health and the promotion of a healthy living for all as part of our contribution to the Accelerated Shared Growth Initiative for South Africa, popularly introduced as AsgiSA.

We are confronted by countless diseases that are ravaging the world and put a huge dent on the countries economic drive as most of the people affected are the ones that are economically active. Through collaborative effort we are engaged with various partners in this broad united front for good health, which also contribute towards our Millennium Development Goals (MDGs), the Provincial Growth and Development Strategy and lately the AsgiSA objectives.

Organisational environment and challenges

Over the years our Department made strides in improving our organisational set-up. We have expanded our human resource base by introducing key branches that will enhance our work and mandate. We have managed to develop an integrated system that ensures a dynamic link between our head office, districts and institutions.

Our quarterly review system and joint management forums enable us to evaluate and monitor progress in terms of healthcare service delivery.

It is this courage and dedication that has earned us the titles and Platinum Awards for the best performing department in 2005, best performing project and best performing directorate during the recently held Premier’s Public Service Excellence Awards.

In receiving these awards on behalf of our health workers and the people we serve.

We had promised to remain focused and disciplined in our conduct. We had promised not to be arrogant and took our newly found status to our heads and obscure our thinking.

We had promised everybody and ourselves to be strong, to talk health, happiness and prosperity to everybody we meet.

We had promised and declared that we will make everybody feel like there is something in them, to look at the sunny side of everything and make our dreams and optimism come true, to work for only the best and think only the best.

In receiving the awards, we promised to be as enthusiastic about the success of others as we are about our own, to forget and learn from the mistakes of the past and press on the greater achievements of the future. We will wear a cheerful countenance at all times and give every living person we meet a smile.
We will give so much time to the improvement of our self that we have no time to criticise others. We are too large for worry, too noble for anger, and too strong for fear, and too happy to permit the presence of trouble. We are proud to belong to a winning department of health.

Brief review of the 2005/06 programme of action

Madam Speaker, on 15 April 2005, we took stand in this august House and pledged to our people that we will amongst others do the following as part of our detailed programme of action:

* Attend to the accommodation and security needs of our health workers especially in our rural facilities.
* Develop our Human Resources Plan for health and the Employment Equity Plan.
* Resolve legal issues around Victoria Hospital public private partnership initiative.
* Complete the planning phase for the construction of Brits Hospital.
* Complete the construction of Itsoseng Health Centre and Kraaipan clinic.
* Complete the Central District business case.
* Improve our revenue collection mechanisms.
* Overhauling of the laundry services.
* Finalise the provincial health bill and fast rack the implementation of the National Health Act no 61 of 2003.
* Improve in the disbursement and expenditure on our conditional grants.
* Compliance with Acts and Treasury regulations.
* Improve budget monitoring and rollovers.
* Improve our EMS services and further spend over nine million rands for salary adjustment of some of our EMS officers.
* Prepare for takeover of mortuaries and forensic services from South African Police Services by our department.
* Purchase more ambulances and deploy them accordingly in our hard hit areas.
* Increase our Antiretroviral Therapy (ART) sites.
* Hold the MEC’s Excellence Awards.
* Appoint the Contract and Service Level Manager to oversee and monitor performance of all our contracts.
* Spend over R9 million for uniform allowances for our nurses.
* Hold the Retired Nurses summit.
* And finish the launch of all outstanding governance structures.

Madam Speaker, we stand before this august house today to declare that tremendous progress has been registered in caring out these tasks in pursuit of a better health for all our people. Among others we have finished in time the construction of Kraaipan Clinic in partnership with the Ratlou Local Municipality.

The relentless efforts by everybody who was involved in this construction particularly the management and leadership of that municipality and the local tribal authorities needs special praise. What Ratlou municipality did needs to be emulated by many of our local municipalities.

We will in this financial year embark on similar projects with this municipality as they have indeed demonstrated co-operative governance in action.

Accordingly, we managed to pay all our nurses their uniform allowances and proud to report that incidents of the past where nurses were said to be wearing pyjamas in protest are a thing of the past. As part of honouring our outstanding and committed health workers, we held as promised the MECs Excellence Awards and we are now starting to see the fruits produced by this noble initiative.

We have increased our ART sites from five in 2005 to 15 in 2006 and hope to reach 20 sites by June 2006. In keeping up to our targets and pronouncements, we have managed to spend over R32 million in normalising the salary disparities of our EMS staff and purchased more mobile vehicles and ambulances for our remote and high-risk areas.

We have jointly with the Department of Transport and Community Safety opened the Trucking against AIDS project in the busy N4 route in Zeerust.

We continued to recruit key health professionals and over the past year we have been able to advertise posts of different categories of Professional Health Workers and we are continuing to appoint Medical Officers in our flash point areas especially in the Bophirima District, which has been severely hit.

Tremendous progress has been recorded with regard to our efforts to improve and strengthen supply chain management and measures are in place to support our internal control compliance programme.

We have used over R23 million to pay stipends to 3804 community health workers.

We have completed eight clinics, in particular our Itsoseng Clinic, which was completed two weeks ahead of schedule by a group of women in construction. Furthermore we completed Dinokana Community Health Centre while Boitekong and Phedisong Community Health Centres will be completed this financial year.

Some 21 clinics are due for completion this year while construction for Moses Kotane Community Hospital and Vryburg District hospitals is continuing with speed.

Madam Speaker, the Community of Borolelo everyday wakes up to the site of a state of the art public hospital. Through our hospital revitalisation and building programme, we are proud to announce that, Swartruggens Hospital in Kgetleng Rivier Municipality is one of the two build modern hospitals in the country by our sister department, Public Works. Just a mere site of that hospital makes your heart pump more blood in recognition of the sheer beauty and well build facility.

Overall, our own detailed assessment of the implementation of our programme of action points out that, of all the concrete actions contained in our programme, some which are multi-year,

Some 76 % of those with specific time frames have been undertaken, or are being undertaken as we speak within the target date set,

Some 16 % have been or are being undertaken, though there were slight delays in terms of the timelines that we had set ourselves,

Eight percent have not been fully carried out, and the reasons behind the delays are such that we need to setup new deadlines within the limited period we have to ensure accomplishment.

Madam Speaker, what these figures vividly points out is that we have reached over 92% of our stated targets in pursuit of our drive to accelerate the provision of decent quality healthcare services. Just fewer than eight percent of our targets have not been met and that is a serious worry for us. We will indeed redouble our efforts to ensure that what is outstanding is duly completed.

Provincial Health Council

Following in the footsteps of our national department, we moved with great speed in the past year to launch our Provincial Health Council. This council is the direct counterpart to the National Health Council and is responsible for all key policy issues.

Madam Speaker, with the recent changes in the local government structures we will be looking at ways in which we can speedily initiate new members into this council and ensure that, the team convenes for its first meeting in the near future. We will pay special attention to the training needs for our new members and further ensure that District Health Councils are urgently established.

Human Resource challenges and the Provincial Growth and Development Strategy

Internships

The Department has put its hands to the plough in regard to contributing to an increase in skill levels of our unemployed youths through implementation of internship programme. Since inception we have over 90 youths placed in corporate service units such as finance, human resources, and supply chain management and information and communication technology.

Recently we entered into a memorandum of agreement with Umsobomvu Youth Fund (UYF) which agreement has seen UYF funding training courses aimed at improving skills levels of our interns.

Despite this partnership we will this year explore other avenues in which we could provide our young people with much needed internship training and further make them aware of the many career opportunities available in our sector apart from the traditional medical and clinical areas.

Learnerships

One of the purposes of the Skills Development Act is to provide an institutional framework in which to devise and implement national, sector and workplace strategies to develop and improve the skills of South African workforce, and learner-ships are integral to this purpose.

Accordingly, we have made common cause with Health and Welfare Sector Education and Training Authority (HWSETA) for the implementation of the following learner-ships, Ancillary Health Worker, Nursing Auxiliary, Enrolled Nursing and bridging course for nursing.

In addition we also have learners benefiting form the Public Sector Education and Training Authority in the following fields:

* Project management.
* Human resource management.
* Public sector accounting

ABET

As highlighted in our last year policy speech, we continued to work closely with the department of Education in the establishment of the adult basic education and training (ABET) centres in our facilities. These cater for employees who have not had the chance to complete their primary and secondary education. To date the following centres have been registered, Tshepong and Klerksdorp, Mafikeng Provincial Hospital, Witrand and Potchefstroom, Thusong and Ganyesa respectively.

Nursing education

We have managed to increase the intakes of learners at our provincial colleges of nursing, however further increase is limited by infrastructure challenges and a need for accreditation of additional clinical facilities for placement of learners for practicals.

To this end, the capital planning unit has engaged the services of architects with a view to crafting a plan that would lead to an increase in infrastructure capacity of the colleges.

The South African Nursing Council (SANC) is also expected to finalise accreditation process of additional clinical facilities for placement of learners when doing practicals.

Human resource provision for health technology

To understand the challenges this area is posing, the department has with the assistance of the Medical Research Council commissioned and completed a health technology study. This study has provided a comprehensive health technology status, the challenges and future needs.

Part of responding to this study was the provision of human resources to maintain thus ensuring that our equipments meet the required operational standards. In July this year the province will be welcoming twenty health technology student engineers form Cuba. These students will be completing their last two years of studies at the Tshwane University of Technology. This is in addition to the five other students who have already been studying at this facility.

Cuban medical programme

The programme for the training of medical students at Cuba was started in 1998. Since the programme started the following progress have been registered:

* Five students are doing community service.
* Two will begin their internship programme in February and April 2006 respectively.
* 13 students are in their sixth year and two in their fifth year at different South African Universities.
* This year we are expecting about 20 students to return to the country to continue their studies at our universities. This is out of the 77 North West student community at Cuba including the 20 health technology students.

Key priorities and deliverables for 2006/07

Taking cue from the identified national priorities, our province has factored these key deliverables into our Annual Performance Plans. We have retained our nine strategic goals.

Furthermore we slightly adjusted our strategic objectives to ensure linkage with the provision of the Provincial Growth and Development Strategy, AsgiSA and the policy pronouncements of both the State of the Nation and the honourable Premier. The following are our key priority and deliverable areas for this financial year and the rest of the Medium Term Expenditure Framework (MTEF):

Completion of the devolution process of Municipal Health services (Environmental Health) to the four district municipalities by July 2006.

We are pleased by the progress reported by our task team that is working on this project and believe once all the relevant processes have been completed we will indeed meet the stated timelines.

As a Department we will retain the services of the environmental officers as we still have the responsibility for port health, regulation of hazardous substances and vector control.

We will therefore transfer the responsibilities and functions as defined by the Municipal Structures Act no 117 of 1998, formerly known as Municipal Health Services.

We will implement national policy decision to implement provincialism in all Primary Healthcare (PHC) services that are still in some municipalities.

Some of our big local government municipalities like Rustenburg, Matlosane, and Potchefstroom are still providing primary health care services. Madam Speaker in many of these municipalities some of our clinics closes when the council office closes thus denying our people access to basic PHC services after hours.

This policy shift is necessary as the local municipalities are no longer responsible for such functions, and it is important that all PHC services be delivered comprehensively under the District Health System in a standard fashion across the province. We hope to have completed the take over process by July 2007.

We will in accordance with national Health Department decision later this year introduce the midlevel worker programme. The midlevel worker is a new cadre in the medical field, who will work under the supervision of Medical Officers, to treat patients at a basic level.

The midlevel worker will assist with medical treatment especially at our rural hospitals, which currently experiences dire needs for medical doctors and other allied health professionals.

Our Policy and Planning Unit, in partnership with the strategic planning cluster of National DoH, is involved with the development of an Integrated Health Planning Framework (IHPF), which will assist in the finalisation of our 2007/08 Performance Plan. This, ladies and gentlemen, will enable us to have a draft Annual Plan, before the beginning of MTEF process for 2007/08.

During this financial year we will before June completed the procurement process for CT scan equipments for all three provincial hospitals. The acquisition of this high technology will bring much needed specialist care for our patients in the said institutions.

The quality assurance program remains one important strategic goal since inception of the Department. Issues of quality are foundational to our vision of providing ‘Optimum Health for all’.

Quality Assurance Programme

During this financial year we will continue and sustain our commitment to the accreditation programme via the COHSASA (Council for Health Services Accreditation of Southern Africa) project. The initial three-year contract with this association ended during the past financial year. Our 21 hospitals that took part in this project registered varied progress with our flagship hospitals, Klerksdorp-Tshepong and Witrand Hospitals earning full accreditation.

Most hospitals made great strides towards full accreditation, except some which are still struggling and need additional support to meet required standards. Madam Speaker, honourable members, we have recently renewed our contract for 18 hospitals to continue with this programme for the next two years at a cost of almost R6,5 million.

Similarly we will, with renewed vigour and enthusiasm, revive and strengthen our departmental quality assurance initiatives like the Work Improvement Teams Strategy (WITS) in all our health facilities including provincial office. It is important that we keep records of these individual projects and acknowledge participants when successfully completed. The beauty of this initiative is the encouragement of participation of all levels of our staff especially lower levels in solving problems and challenges in their local area of work.

The adverse events monitoring programme via the Clinic Investigation Committee (CIC) continues to function well, but we need to strengthen its capacity to ensure speedy response to patient neglect and maltreatment cases. The CIC will be strengthened by the appointment of new members, and revision of their mandates. A senior clinical manager will be assigned to lead the committee, so that it has the necessary authority to deal with cases from our institutions.

Capital projects

During the MTEF period we will seek ways of speedily implementing the business cases for Southern, Tswaing, Ditsobotla, Zeerust, Mafikeng and Bophelong Psychiatric Hospital as part of our protracted programme to revolutionary change the face and look of our public health institutions.

The Province is engaged in a process of finalisation of a plan on the Modernisation of Tertiary Services. This plan will ensure greater access by communities to provincial tertiary services and reduce the transfer/referral of patients between provinces.

We will register progress towards completion of two hospitals, namely Moses Kotane and Vryburg, and accordingly proceed with speed with regard to the planning of the new Brits Hospital.

In addition two business cases for Rustenburg and Odi Hospitals are due for completion in July 2006.

Our three Community Health Centres projects done in partnership with IDT are due for completion and soon the people of Pella, Mogwase and Phedisong will receive state of the art modern health facilities for their usage and care.

Quality & access to healthcare

In addition to the above priority programmes, we will in the next two years strive to make the below deliverables attainable:

* Patient safety, including infection control, within the popular theme of “cleaner health is better health”.
* Staff and patient satisfaction. This will be from the perspective of staff and patients rather than only from the perspective of the department, with the theme “health through staff and patient satisfaction”.
* Intensify Community involvement in the delivery of health services by strengthening the functioning of governance structures.
* Contribute to PGDS by identifying and implementing specific projects within and related to the Department.
* Increase and strengthen facility planning and maintenance capacity.
* Develop a programme of Centres of Excellence for the three provincial hospitals.
* Have a broad referral policy that has clear definitions of health facilities according to service delivery levels i.e. CHC, District and Provincial Hospitals.
* A special focus in the next three years is placed on strengthening and enhancing tertiary services in the province, without neglecting the focus on PHC through continued development of District Health System.
* The other important initiative will be to have a rolling plan to ensure availability of Medical Officers in our most disadvantaged rural areas through the provision of postgraduate training for Family Medicine practitioners’ project.
* In pursuit of all the above, the department appreciates the AsgiSA initiatives which encourages private sector to participate in the contribution towards our Millennium Development Goals (MDGs), the Provincial Growth and Development Strategy and lately the AsgiSA objectives.

Better and reliable emergency medical and rescue services for our people

Madam Speaker, honourable members, our Emergency Medical and Rescue Services (EMRS) are the mirror in which the public judge our commitment towards Batho-Pele principles and the dictates of the patient rights charter.

We are aware of the challenges we face in the area of EMRS. We have started discussions around what will be the best structural arrangements for our EMRS services. Central to these discussions will be our resolve to have our District Health System playing a more prominent role in the running and management of EMRS.

As we join the rest of the country in preparing to host a memorable FIFA World in the African Continent, our EMRS must be able to live up to the challenge. World class EMRS service is one of the ingredients for a successful event management and planning. Madam Speaker, we will pull all stops to ensure that our EMRS services are well prepared to assist the identified World Cup venues and warm up matches venues.

We will this financial year continue to purchase more ambulances and rescue vehicles.

HIV prevention and the comprehensive plan on the management, care and treatment of HIV and AIDS

Without doubt prevention is better than cure. Prevention is the most effective intervention against the spread of HIV. The 55th session of the World Health Organisation-AFRO regional meeting in August 2005 declared 2006 a year of accelerated HIV prevention in the African region. This is largely informed by the realisation that prevention had been displaced by treatment advocacy.

In order for us to reverse this situation we need to go back to the basics and intensify our drive to promote ABC slogan with the sole purpose of reducing numbers of sexual partners and mutual monogamy and consistent and correct use of condoms.

Our HIV prevalence rate in the province has decreased from 30% in 2003 to just over 28.5% in 2004. This, Madam Speaker, does not call for complacency or a belief that we have done enough. There is still a lot of work that needs to be done to change human behaviour towards HIV and AIDS. We need to encourage a change in attitudes and adherence to good morals and healthy lifestyles.

Madam Speaker, we have in the North West, an increase in the uptake of voluntary counselling and testing (VCT), Prevention of Mother To Child Transmission (PMTCT).

We have managed to launch 18 high transmission intervention sites to educate truck drivers and commercial sex workers on the dangers of HIV and AIDS.

On the implementation of the comprehensive plan, we have recorded tremendous progress with 15 sites now providing treatment and more sites ready for accreditation. Since inception of this programme, 15 000 patients are on treatment and we hope to increase these numbers to 20 thousand at the end of the MTEF period. Over 200 new staff members have been employed and this indeed boosted our health system.

We have exceeded our patient uptake on the ART program. This has put a strain on our resources.

Support to our non-governmental organisations

Madam Speaker we are happy to report that our non-governmental sector or NGOs as they are popularly known remains a pillar of our health system. Throughout the province we are using the NGOs to extend services to targeted communities in the province.

This relationship survived a decade to date and this sector has also played a meaningful role as an employment buffer in the province. Through support to this programme we were able to extend a variety of skills such as project and financial management to communities using NGOs as a vehicle to achieve this end.

To date the province has supported a total of 148 NGOs to enable them to provide home based care, non-medical VCT, and awareness services. The amount used in this endeavour totalled R15,750 million.

In the coming financial year we will give more impetus to this relationship by ensuring that accredited training is provided to all our NGO partners.

NGO Forums together with governance structures of each NGO will also be strengthened with corporate and financial management skills that will greatly enhance the sustainability of the sector.

Communicable disease control

The main objective of this programme is to reduce diseases and deaths related to communicable diseases. The immunisation component of this programme is aimed at preventing many of the childhood communicable diseases. The impact of our immunisation programme is visible in that immunisation preventable diseases have reduced drastically in the province.

The Department is aware of the escalation in the child mortality rate. A mini study will be conducted to identify the possible causes.

Throughout the year we continued our polio eradication initiatives in the form of surveillance. Madam Speaker, it must be noted that the main aim of the polio eradication initiative is to provide information necessary for polio eradication certification.

The last case of polio in South Africa was seen in 1989; however, the World Health Organisation (WHO) needs prove of this so that certification thereof can be provided declaring our country polio free zone.

Over the past years we have been consistent and effective in responding and preventing outbreaks. These include outbreaks of, organophosphate poisoning and diarrhoea of different causes. The most recent diarrhoea outbreak was at Bloemhof where the water sources had faecal contamination. This was handled very well by a multi disciplinary and multi-sectoral outbreak response team.

Recently an outbreak of Tumbu fly infestation (non communicable disease) occurred in the province and effective measures were taken to reduce the spread thereof through appropriate health education of the public and health workers.

Tuberculosis (TB) control

The North West province has the fifth highest caseload in the country. During 2004, about 20 345 new patients were started on TB treatment.

One of our major challenges is that more often than not patients present late at facilities due to ignorance about the sickness. Poor adherence to treatment; lack of understanding of the disease; and its treatment, poses a serious challenge for us.

We need to work together to address the challenge of treatment interruption rate in order to reach the target of less than 10%. There is a need for more community volunteers (DOTS supporters) to assist in tracing patients that default on treatment and this challenge requires a response from all of us.

The National Health Council recognised the challenges related to TB and developed and adopted a TB crisis plan. The Provincial program is informed by this plan.

Madam Speaker, allow me to use your August House to once more urge everybody to join us in stopping the spread of TB. Our key messages are that TB can be cured and we need to stop its spreads now.

Environmental health

Madam Speaker, during this financial year we will strengthen our Port Health Services to accommodate the expansion and growth at the Mafikeng International Airport via the Mafikeng Integrated Development Zone (MIDZ) project.

Our malaria vector control and surveillance has succeeded in reducing outbreaks and our health care waste management project has assisted us to reduce cases of dumped medical waste that endangered our community.

Healthy lifestyles

The promotion of healthy lifestyle is proving to be successful. The province has aligned its strategies to the five key national strategies which are: physical activity, nutrition, tobacco control, combating alcohol and substance abuse and promotion of safe sex.

Health Focus Month and World Health Day

During the month of April South Africa will join the rest of the globe in celebrating World Health Day on 7 April 2006. The World Health Day will be devoted to human resources for health. On this day across the globe, hundred of organisations will host events to draw attention to the global health workforce crisis and celebrate the dignity and value of working for health.

We will on this day gather at Mafikeng Provincial hospital to celebrate the contribution of our health workers and salute those despite huge challenges are still with us in the public health system.

Throughout the month of April we will dedicate majority of our activities towards our internal staff members. Part of the programme will be our healthy lifestyle programmes, blitz of major food and meat outlets checking the quality of products, career talks on opportunities in the health sector and extension of our VCT and screening programmes to our staff members.

Ladies and gentlemen, I urge our entire province and in particular the private health sector to join us in celebrating the health month. The private health sector is encouraged to develop its own programs.

MTEF

Allocation of limited resources to meet our growing demands and challenges remains a continued problem area for all public sector organisations. This, Madam Speaker, is based on the growing needs of our different programmes and the continuing drain on the public health care system. The current MTEF allocations have attempted to respond to the priorities identified.

The final approved budget for 2006/07, amounting to R3,427 million, shows a nominal increase of 14.8% from the prior year adjusted allocation. However, when reviewed against the total budget inputs amounting to R3,7 billion, the allocation seem not to be adequate to respond sufficiently to the service delivery outputs that the department is expected to achieve.

Personnel allocation increased by 11% including improvement of conditions of service (ICS) and pay progression. However, the funds are not sufficient to address existing personnel as at 31 March 2006 and therefore filling of critical posts will be a challenge for the Department. Although much progress was made in improving health services in the province since 1994, much still needs to be done. The number of medical staff increased from 7 777 in 2002 to 9 773 in 2005. This number of medical staff is still low if it is compared with other provinces.

Conditional grants have increased marginally with special reference to the transferred South African Police Pathology and Forensic Services effective from 1 April 2006 and the Revitalisation of Hospitals grant.

The province has made earmarked funds available to address some of the gaps identifies such as : funding for EMRS, strengthening security services; skills development; community health workers; PHC shift from municipalities to the Province and the management and control of TB.

Funding gaps

The following are funding gaps which will need additional resources over and above the equitable share:
* Insufficient Antiretroviral Treatment (ART) funding particularly for drugs.
* Insufficient funding for personnel.
* Inadequate funding for accommodation for health workers.
* Lack of funding for integrated health management information system.
* Insufficient funding for laboratory services.

Programmes allocations for 2006/07

The Department has eight programmes which are funded as follows:

1. Administration: R146,656 million
2. District Health Services: R1,825,737 billion
3. Emergency Medical Services: R110,864 million
4. Provincial Hospital Services: R751,071 million
5. Central Hospitals: R69,380 million
6. Health Sciences and Training: R95,988 million
7. Health Care Support Services: R113,084 million
8. Health Facilities Management: R314,824 million
Total allocation amounts to: R3,427,604 billion

The province does not have central hospitals yet, however, the national Department of Health has developed a conditional grant (National Tertiary Services Grant - NTSG) for the development of tertiary services. The amount indicated, R69,380 million, is therefore allocated for the project. The hospitals, which benefit from this grant are the Klerksdorp/Tshepong complex, Mafikeng General and Rustenburg.

The Provincial Treasury has acknowledged that the Department is lacking behind in terms of funding in comparison with other provinces, based on the per capita expenditure figures and will therefore prioritise future allocations to the health sector in the province.

Conclusion

In conclusion, Madam Speaker, I am confident that with the funds that have been allocated to us, we will use it responsibly to change the lives of the people of the North West for them to live a healthy lifestyle.

* My gratitude goes to the Honourable Premier for her support and inspiration;
* My colleagues in the Executive Council for sharing our ideals for the betterment of the lives of the North West people;
* The Chairperson of the Health Standing Committee and its members for their support and for giving us an ear when we needed it most;
* Our tasks are also shared by our stakeholders, that is, our governance structures, NGOs and our private partners. Thank you for your support and co-operation, without you, we would not have achieved what we wanted to achieve as a department. We call upon you to continue giving us that support and further participate in the activities of the department;
* The Deputy Director General and the officials of the department of Health for doing a sterling job under difficult circumstances;
* Last but not least I’d like to thank my Husband Solly Rasmeni and my kids for their support and for tolerating me during this hectic period.

Ke a leboga.

Issued by: Department of Health, North West Provincial Government
30 March 2006
Source: North West Provincial Government (http://www.nwpg.gov.za)