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7 June 2006

Chairperson of the NCOP,
Honourable members,
And MECs present;

When I addressed this House last year, I committed the Department of Health to implementing a range of interventions aimed at strengthening the delivery of services at all levels of the health system. I am therefore pleased to return to this House to report on what we have achieved.

I will focus on both the achievements of the health sector during 2004/05 and 2005/06 as well on the priorities for 2006/07 that the National Health Council (NHC) which has representation from all three spheres of government adopted in January this year. I will also like to use this opportunity to outline our plans for utilising the resources allocated to us from the national fiscus for the financial year 2006/07.

Chairperson, in 2005 we informed the National Council of Provinces (NCOP) that we were going to finalise the National Human Resources Plan (NHRP) for health. I am glad to report to this House that on 7 April this year, we launched the NHRP for health at a function attended by the Regional Director of World health Organisation (WHO) Africa Region. The 7 April was observed as World Health Day and it was dedicated to celebrating the efforts of health workers throughout the world under theme; ‘Working Together for Health.’

Although we now have a national plan for human resources, we need to cascade this plan to provincial level. During 2006/07 we will support all provinces to develop provincial human resources plans. These plans will outline strategies for improving the production, distribution, recruitment and retention of health personnel in each province.

Health workers are the most valuable and treasured asset of our national health system.

Chairperson, this year we will finalise the discussions with National Treasury and the Department of Public Service and Administration to improve the remuneration packages of health workers. This is one of the critical aspects in our strategy to recruit and retain our health workforce.

Honourable members, we will recall that the President raised the issue of re-opening nursing colleges in his State of the Nation address in order to increase the number of nurses that we train nationally. We are set towards achieving this during 2006/07. The Department of Health is committed to ensure a steady supply of health workers to ensure good quality service delivery to communities.

We have already started with increasing the number of intake into nursing colleges in some provinces this year. For instance the number of new nursing students registered in Free State doubled from 130 in 2005 to 250 in 2006 and also in Limpopo from 100 to 210 during the same period. Gauteng increased from 689 to 862, North West from 276 to 350 and Western Cape from 522 to 538. We expect other provinces to join this upward trend in the number of students admitted to our nursing colleges.

Chairperson, Primary Healthcare (PHC) services constitute the first level of care for our communities. These health services are provided by health workers in communities, in clinics, in community health centres and in district hospitals.

The number of people utilising these services increased significantly across provinces between 2003/04 and 2004/05. This illustrate that our people have confidence in the primary health care services that the public sector provides.

In the Eastern Cape, PHC headcounts increased from 13,9 million in 2003/04 to 17,7 million in 2004/05. In KwaZulu-Natal headcounts increased from 18,5 million in 2003/04 to 18,8 million in 2004/05. In Mpumalanga figures increased from six million visits in 2003/04 to 6,5 million in 2004/05. The PHC utilisation rates for under-fives also increased in the Eastern Cape, Mpumalanga and Western Cape between 2003/04 and 2004/05.

During this financial year we will continue to support provinces as well as districts to strengthen planning, implementation, monitoring and reporting. At district level we will place particular emphasis on the production of good quality District Health Plans to amongst others, strengthen clinic supervision, improve immunisation coverage and further increase the quality and the utilisation of our PHC services.

These plans will be synchronised with the Integrated District Plans (IDPs) of local government. They will outline the level of inter-sectoral collaboration that will be reached between health and other government departments. The district health plans are beginning to contribute to the development of provincial plans.

Honourable Chairperson, the PHC approach extends far beyond the confines of health facilities and incorporates community settings where our people live and work. During 2005/06 we undertook a number of healthy lifestyles campaigns and by September 2005, 21 000 community members had participated in these campaigns initiated by the national Department.

In addition, more than 2 000 people were screened for eyesight, oral health, blood sugar, blood pressure and body mass index during these campaigns. I should add that these numbers will become significantly larger once we add the efforts of provincial departments of health.

During 2006/07, we will expand our healthy lifestyles programme to districts and local municipalities, schools and workplaces. Thousands of schools will be assisted to establish school based food gardens, to implement tobacco control programmes and the strategy on diet, physical activity and health. Health promoters will be trained in all provinces to implement this strategy. We intend that these programmes reach 5 000 schools during this year.

We also contributed during the past year chairperson to enhancing women’s health by improving access to reproductive health generally including access to Choice on Termination of Pregnancy (CTOP) services.

We produced a seven-year evaluation report on the implementation of the Choice on Termination of Pregnancy Act focusing on the period 1997 - 2004. The evaluation shows that access to Termination of Pregnancy (TOP) has increased every year over this seven-year period. About 76 percent of TOPs were conducted in the first trimester of pregnancy as recommended and about 24 percent in the second trimester.

We have also strengthened the implementation of the roll back malaria strategy in the three malaria endemic provinces which are KwaZulu-Natal, Limpopo and Mpumalanga. Between 2004 and 2005 there was a 46 percent reduction in the number of malaria cases and a 38 percent reduction in the number of deaths.

The decline in the number of malaria cases as well as fatalities is due to the increase in the number of houses covered by the indoor residual spraying programme using DDT and improved collaboration with neighbouring countries. Coverage with indoor residual spraying increased to 83 percent during 2004/05, and is set to increase further to 90 percent during 2006/07.

Our success with the responsible use of DDT has convinced the WHO to revise its own malaria control strategy which until now was largely centred on the use of impregnated bed nets. In fact the Assistant Director-General of the WHO responsible for malaria visited us in April to learn from our experiences in this regard.

Whilst we are doing well in reducing both the cases and fatalities, the case fatality rate for malaria is marginally above our own national target of 0,5 percent. Multiple factors contribute to this such as imported malaria cases in cross border areas, delayed presentation and case management challenges at health facility level.

Moving into 2006/07, I am convinced that the health sector will reverse this trend as the three malaria endemic provinces are now using the more effective artesunate-based combination therapy for malaria, training more health workers and improving coverage of indoor residual spraying as already mentioned.

Chairperson, tuberculosis (TB) continues to pose a challenge to the public health system with cure rates of 56,7 percent. Our efforts to counter this disease have focused on improving the directly observed treatment short course (DOTS) programme and improving the laboratory services amongst others.

In line with the resolution adopted by WHO/AFRO last year to declare TB an emergency, we launched a National TB Crisis Management Plan during this year’s TB Day. We have identified four districts in three provinces as focus areas due to the high number of cases and poor cure rates in these districts.

These districts are Amatole and Nelson Mandela Metro in the Eastern Cape; eThekweni Metro in KwaZulu-Natal and the City of Johannesburg in Gauteng. In developing district level plans in each of these districts we have held meetings with both the province and local government so that the plan integrates the efforts of all three spheres of government.

Chairperson, we have also strengthened our efforts to combat HIV and AIDS. We continue to implement the comprehensive plan for the management, treatment and care of HIV and AIDS. Since our last report to the NCOP, Voluntary Counselling and Testing (VCT) services are now available in all fixed clinics and community health centres in the Eastern Cape, Gauteng, Mpumalanga, Free State, KwaZulu-Natal and Western Cape and in most district health care facilities in other provinces.

Also services to prevent mother to child transmission of HIV are now offered in 100 percent of facilities in KwaZulu-Natal and the Western Cape and in about 70 percent of facilities in other provinces.

In keeping with the WHO/AFRO resolution declaring 2006 as the year of accelerated prevention of HIV, we are finalising the implementation of our accelerated HIV prevention strategy which will be more targeted in its messaging and approach.

Honourable Chairperson, Emergency Medical Services (EMS) is the interface between communities and primary health care services and hospitals in times of crisis. We have worked hard to improve this service during the last financial year.

The provision of ambulances increased in many provinces benefiting especially rural parts of the country. In four provinces Eastern Cape, KwaZulu-Natal, Mpumalanga and Gauteng a comparison of the availability of ambulances during 2003/04 and 2004/05, shows significant increases during the latter period. The number of emergency calls as well as patients transported on a routine basis increased in these provinces between 2003/04 and 2004/05.

Although the number of hoax calls to EMS has decreased it still remains a challenge. We plead with our communities not to call out ambulances when not needed as this reduces the availability of this service to those in need. A hoax call could compromise the life of a person in real need of emergency medical care.

During 2006/07 all nine provinces will produce plans to strengthen EMS. An acute shortage of paramedics still affects the provision of EMS. The Department will be addressing this as part of the implementation of the NHRP for health by accelerating the training of EMS personnel.

By strengthening our EMS for our own patients, we are also contributing to the national effort to prepare for the 2010 Soccer World Cup. I wish to assure honourable members that the health sector will be ready and able to deal with any eventuality that is posed by our hosting of the nations of the world in 2010.

Chairperson, we have also strengthened our efforts to improve quality of care at public hospitals. It is our policy that hospitals should continuously assess the quality of the services that they provide to their communities and take stock of the outcomes of service provision.

In keeping with this 100 percent of district hospitals in the Free State, Gauteng and the Western Cape have held monthly morbidity and mortality meetings. We want all clinical departments to conduct clinical audits and peer reviews. During 2006/07 we will strengthen the monitoring of complaints from users of our health services.

We will also strengthen the quality of care in hospitals by implementing hospital improvement plans in each and every hospital as of January this year. This covers minor maintenance issues like fixing of broken windows and leaking taps and includes critical matters like improvements in infection control and conducting clinical audits.

In addition, we have commenced with a process of strengthening hospital management. Delegations to hospital CEOs as well as capacity to use the delegations are under review. We are confident that we will meet the deadline of September set by the President in the State of the Nation address.

Chairperson, we wish to raise the issue of the utilisation of budgets provided to the health sector. The National Treasury acknowledged in its press release of 28 April 2006 that health sector expenditure has grown when compared to previous years. During 2005/06 the health sector spent R46,9 billion of the allocated budget of R47,2 billion, which amounts to 99,5 percent.

With regard to capital spending which was previously an area of concern, the National Treasury pointed out that provincial health departments had spent R3,8 billion of the allocated R4,1 billion for the 2005/06 financial year which amounts to 92,4 percent of the budget.

On the whole, Chairperson, provincial departments of health recorded many significant achievements during the last financial year. The budget for the public health sector has grown from R33 billion in 2002/03 to R51,7 billion in 2006/07 and stands to grow to R60,8 billion in 2008/09.

The nominal increase in provincial budgets is 11,6 percent and the real increase is 7,4 percent. The 2006/07 public health sector budget amounts to 3,02 percent of Gross Domestic Product (GDP) and 10,9 percent of government expenditure.

Chairperson, before I conclude may I take this opportunity to thank the chairperson and members of the Select Committee, my colleagues the Deputy Minister of Health and the MECs for Health and the members of South African Local Government Association (SALGA) for their support during the last financial year. I am sure that this support will continue and be strengthened during this financial year.

Chairperson, I request that this House pass the budget of the national Department of Health.

I thank you!

Issued by: Ministry of Health
7 June 2006