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11 August 2006

Programme Director
Distinguished guests

It is a great pleasure for me to have been invited to the Rural Doctors Association of Southern Africa (RUDASA) 10th Annual Conference. I would like to take this opportunity to thank and appreciate all your endeavours and contributions towards the development of rural health in South Africa. You have been able to contribute positively and effectively towards sustainable rural health development in many ways.

The Department of Health would like to acknowledge the following areas of your contribution to rural health development in South Africa the involvement and participation in the development of the draft rural health strategy;

1. advocacy role for adequate staffing of rural health services by appropriately skilled healthcare workers.
2. strengthening continued professional development.
3. regular communication and support to doctors practicing in the remote and deep rural areas including other health workers.
4. communicating and assisting with the implementation of the government programmes.

I wish to take this opportunity to salute the contribution of each and every one of you to the effective functioning of our health system.

At the beginning of the year, the National Health Council decided on five priorities for health for 2006/7 in the context of our five-year strategic plan. These priorities are:

1. service transformation plans which should be completed by each province
2. human resources plan for health
3. quality of care
4. physical infrastructure for primary healthcare and hospitals
5. priority health programmes with specific reference to the promotion of healthy lifestyles, tuberculosis control and prevention of HIV.

Your contribution to realise the implementation of these priorities is welcome. These priorities need to be replicated in rural areas as well, since we are building one health system. We have chosen to strengthen Primary Healthcare and the District Health System especially in rural areas. The District Health System is an ideal vehicle for the delivery of comprehensive, integrated healthcare system and practices that are in line with "Health for all in the 21st century". You specialist role in ensuring that Primary Healthcare (PHC) is implemented within the District Health System cannot be ignored. We need both private and public sectors to work together to realise our health vision.

Some of you may recall several achievements and challenges affecting the rural areas that were highlighted during the “health in the rural nodes” conference held during September 2004. Recommendations were also highlighted. The draft rural health strategy was amongst others born out of that conference. Some of the challenges raised during the conference were:

1. recruiting and retaining staff in rural areas
2. reaching an agreement on the definition of "rural"
3. patient and personnel transport and the general state of rural roads
4. high staff turn over and migration
5. training a huge volume of health professionals to supply the local and global demand for health professionals
6. government policies and regulations that make it difficult for foreign health professionals to work in South Africa (e.g. a foreign-trained doctor needs a further three years of training before being registered to practise in South Africa.

The conference agreed that there is a need for strategic direction and guidance in district health planning from the national Department of Health. The establishment of systems for monitoring the implementation of the district health plans cannot be overemphasised. This should be encouraged at all levels of the healthcare system. During the conference delegates agreed that there is a need to build capacity to promote local operational and participatory research. Also academic institutions should play a big role in facilitating the process while government should develop effective strategies to address the issues of inequities in the distribution of resources.

While the conference agreed that budgets should be decentralised to sub-district and facility level and linked to service delivery activities. It is imperative that the process must be accompanied by training and support, National Treasury should consider equipment and Human Resource when allocating funds for PHC instead of using head counts or per capita. However, the responsibility lies with districts to produce quality data and information to lobby for extra funding from Treasury. Supportive supervision is important for improving quality of care and should be accompanied by clear monitoring of key indicators. Provinces should consider budget allocations to South African non-governmental organisations (NGOs) to continue supporting the districts in improving service delivery and to make rural areas more visible.

Since the conference, the Department of Health has been hard at work to address challenges in rural health development. For the benefit of all, I would like report back on some of the achievements of the Department based on the recommendations of the conference. All 13 rural nodes have completed their District Health Plans (DHP) for 2004/05 and 2006/07. The reporting format has been developed to monitor implementation of the DHP. The District Health Expenditure Reviews preceded the DHP.

The Department has also secured funding from the European Commission to develop capacity including research and epidemiological skills for 21 nodes. Provinces have been allocated significant additional funding for personal PHC services in the financial years 2006/07 to 2008/09. Municipal health services have been listed in the Division of Revenue Act (DORA) from February 2006 with potential benefits to the rural areas. The January 2005 Cabinet Lekgotla resolved that departmental financial contributions to the nodal specific projects are to be reflected in the Medium-Term Expenditure Framework (MTEF).

The financing protocol is a planning, financing and performance management protocol, which assist in using inter-governmental budgeting systems. It also approved the implementation of the financing protocol. Chairperson, health has also been identified interdepartmentally as a crucial basic service for nodal areas for financial or technical assistance as part of the National Department of Provincial and Local Government Integrated Sustainable Rural Development (ISRDP) and Urban and Regional Planning (URP) branch co-ordinating the nodal specific interventions, as part of the financing protocol for the nodal areas. The National District Health Systems Committee has endorsed and recommended the Draft Rural Health Strategy to the Technical Committee of the National Health Council. The strategy has also been included in the departmental strategic plan 2006/07 and 2008/09 as an indicator to monitor service delivery in rural areas by district health councils.

The KwaZulu-Natal province has been proactive in establishing an interim nodal forum with the view of implementing the rural health strategy. Plans are underway for a workshop on Integrated Sustainable Rural Development Programme as part of the rural health strategy for October and November 2006. As part of integrating government programmes, a joint Team of National and Provincial programme managers provide on site nodal support on regular basis. Bilateral engagements with relevant sectors have commenced to address issues of access to health services in rural areas e.g. the National Department of Transport with specific reference to the rural transport strategy to improve access roads and public transport to rural areas.

The revitalisation of hospitals programme was initiated three years ago to improve conditions of our health facilities. Currently, we have 42 projects enrolled into the programme; four hospitals are to be completed in the 2006/07 financial year. These are: Jane Furse Hospital and Lebowakgomo Hospitals in Limpopo; Mary Therese Hospital in the Eastern Cape and George Hospital in the Western Cape. The majority of these hospitals are in rural areas. The other three hospitals will also be officially opened during this financial year. In addition, every hospital has been requested to develop a hospital improvement plan that includes basic activities such as repairing of broken windows or leaking taps to clinical audits to improve the quality of care that we provide in all public hospitals.

It is encouraging to see nodes delivering on services needed by our communities. Chairperson, allow me to share few examples of the nodal specific health achievements. The Central Karoo is doing well in terms of community based nutrition programme. They have established a sustainable gardening project in collaboration with the Department of Agriculture and the municipality where 10 targeted community members are assisted for development.

By March 2006, uMkhanyakude District had sprayed 129 259 rooms to prevent malaria. 50 clinics had demonstration gardens to capacitate clients to establish family gardens in order to improve nutritional status and 50 facilities offer Protein Energy Malnutrition (PEM). In Zululand 180 pupils in 12 schools participated in essay competitions to promote healthy lifestyles. Several health facilities also conducted health promotion activities. By June 2006, 2 775 clients were on antiretrovirals (ARVs). There are 11 tracer teams in the district. Seventy one percent of clinics have demonstration gardens.

The Sekhukhune, Bohlabela, Umkhayakude, Zululand and Central Karoo have contracted a number of NGOs through the Partnership for the delivery of PHC programme (PDPHCP) to capacitate community carers to be able to render community or home based services. Several nodal areas in the Eastern Cape also benefit from the integrated PHC projects and other donor-funded projects. I must mention to the delegates that I have been appointed as a political champion for KwaZulu-Natal and focusing on Ugu District. The district health system plays a major role through collaboration with the municipality to ensure that health programmes are prioritised on the municipal Integrated Development Plan (IDP) and that all stakeholders address them jointly.

Programme Director, for any institution or system to succeed it depends on the resources they have. In an effort to address the shortage of skills, the Department has conducted an extensive consultation with stakeholders to finalise the Human Resources Plan for Health for South Africa. The plan was launched on World Health Day on 7 April 2006.

During the consultation process, health workers raised many issues as challenges affecting them in delivering healthcare to the people. Issues rose ranged from inadequate remuneration, poor working conditions in some areas, lack of suitable accommodation and other supportive amenities particularly in rural areas.

In addressing the shortage of skills and resources, 100 students will be admitted at the Universities of Pretoria, Walter Sisulu and Witwatersrand. Some amongst them will commence training as clinical associates in January 2007. This new cadre of health workers will complete a three-year degree programme with significant on-site training in district learning centres. Upon graduation, they will work under the supervision of medical officers in district hospitals and primary healthcare level. The scope of practice will include diagnosis and treatment including performing minor surgery.

The Department of Health has been working closely with the Department of Public Service and Administration and the National Treasury on developing a revised remuneration structure for health workers and should be ready for implementation in the next financial year. The Department is also engaged in several activities to address push and pull factors e.g. the issue of health workers migrating from rural to urban areas, from public to private health sector and from South Africa to developed countries. The Department has sought to work with other countries to manage the health workers movement so that it does not impact negatively on our health system.

For example the Department has an agreement with the United Kingdom (UK) through which health workers can work in UK hospitals and return to the public sector without loss of employment or status. Major achievements have been reached as a result of this agreement. Since the agreement was signed in 2003, the number of South African nurses registered with the Nursing and Midwifery Council in UK has decreased by more than 55% from 2 114 in 2002 to 933 in 2005. Similar other agreements are being explored with other countries which host a significant number of South African trained professionals such as Canada.

As part of developing the second economy, the Department has contributed to the Expanded Public Works Program (EPWP) through the community health workers programme. The EPWP is the government's plan to create work opportunities through providing short-term employment and training to large number of unemployed people. This will further ensure improvement in the provision of much needed services such as home community based Care (HCBC), health promotion etc because of the standardised and improved training of Community Health Workers (CHWs). These initiatives will relieve pressure on the communities and health workers especially on rural areas.

The Department has been engaging various health stakeholders in our effort to finalise a Charter for the Health Sector. The Charter is our attempt to provide a coherent framework for engagement between the public and private health sectors. It is an effort to deal with the inequities between the two sectors as well as the transformation of the private health sector. We have started the process of negotiating targets with respect to equity ownership within the context of broad-based black economic empowerment. Equally important is the need for sharing of resources, experiences and competencies between the two sectors in the manner that strengthens the entire health system.

As much as the government has achieved a lot in the past two years, there are still challenges which need to be addressed. Some of these are socio economic challenges e.g. unemployment, poverty, water and sanitation as well as priority health programmes. Our Department has declared tuberculosis (TB) as a crisis health programme that needs accelerated attention. The National TB Crisis Management Plan was launched in March this year to strengthen the TB control programme in those districts with a significant number of TB cases and unsatisfactory cure rates. These districts are the Nelson Mandela Metro and Amatole District in Eastern Cape, Ethekwini Metro in KwaZulu-Natal and the Johannesburg metro in Gauteng. Last week the Department held awareness blitz in various areas to educate and encourage people to be tested for TB.

I would like to urge delegates to participate and ensure that our TB cure rates are improved. The TB cure rates in the majority of nodal areas also need attention; however some areas such as Umzinyathi in KwaZulu-Natal, Bohlabela in Limpopo, Mpumalanga and Maluti, Phofung in the Free State are doing very well in the management of the TB programme.

On HIV/AIDS, our emphasis on prevention of new infections and tackling the link with poor nutrition has finally been endorsed by the international community in various forums. The World Health Organisation (WHO) Africa region declared 2006 as the year of accelerated prevention because of the understanding of the central role of preventing new infections in responding to this major challenge.

Your expertise, commitment and experience in dealing with these health challenges cannot be over emphasised. The annual RUDASA Pierre Jacques Award is a testimony to that. I would like to congratulate the recipient for the award.

In conclusion, I commend the role of RUDASA during the past 12 years of democracy as an important one in improving access to quality health services in rural and remote areas. I am certain that you will continue with the tradition of strengthening our healthcare system through advocacy for rural development and being the voice of rural doctors regarding training and working conditions. I hope that you will provide assistance during the implementation of the rural health strategy and that you will extend your hand to other health professionals.

I thank you.

Issued by: Department of Health
11 August 2006