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29 May 2008

Madam Speaker
Honourable Premier: Mme Molewa
Colleagues in the Executive Council
Members of the Provincial Legislature
Chairperson of the Portfolio Committee on health: Mamateya Mampane
Our Head of Department Dr Keneilwe Lydia Sebego
Our stakeholders and partners in the health sector
Management team of our department
Distinguished guests and comrades

Baagi ba porofensi ya Bokone-Bophirima
Dumelang!

It is with a great degree of delight that I rise to address you today. I do so, inspired by the notable strides which this government seems to have made to turn yesteryear's pessimism and despair into hope and optimism since the advent of democracy. Thereby, confirming the words of former President Nelson Mandela that "a good head and a good heart are always a formidable combination."

Madam Speaker, on the occasion of us taking office, this "good head and heart" enjoined us after our freedom to move our country forward decisively towards the eradication of poverty and underdevelopment by improving the quality of life of all our people in many critical areas of social existence including health.

Today, Madam Speaker, I am sure we can all look back with great pride and say, indeed "when freedom does not have a purpose, when it does not wish to know anything about the law engraved in the hearts of men and women, when it does not listen to the voice of conscience, it turns against humanity and society."

That we are here, have been here, and are set to be here in the next term of government is confirmation of the fact that we have not abused our freedom and the trajectory we are following is correct. Therefore, Madam Speaker, what remains for us is to harness all that we've achieved and to indeed embark on business unusual and ensure that all hands are on deck to speed up change.

It has been said that "thoughts lead on to purposes; purposes go forth in action; actions form habits; habits decide character; and character fixes our destiny." To turn this into an incorrigible truth, in 2008/09 we shall use our wherewithal to ensure that we speed up change in our bid to accelerate the advance towards the goal for "health for all". To this end, we shall marshal all our resources inclusive of all our health personnel to put all hands on deck to make sure that we deliver on our mandate to indeed create a better life for all.

This contract and promise, is what has bound us together, and shall continue to shape our character and destiny. Therefore, as I present this Budget Speech, to outline our plans for 2008/09, I shall take instruction from this undertaking and the resolutions of our fifty-second National Conference which confirmed the centrality of health in resolving the twin challenges of underdevelopment and poverty. The Apex priorities which both the president and the premier pronounced on as a mark of all our commitment to speeding up change in a business unusual mode shall also serve as an important guiding light of the course we have got to travel, and so shall other national and international policy imperatives which we have got to respond to.

However, before I outline our plans, Madam Speaker, I would like to invite this august house to join me and the rest of the world in celebrating 2008 as the 30th Anniversary of the Alma Ata Declaration (1978) and herein recommit our department to the undertakings made on the occasion of this important International Conference which was held in the former United Soviet Socialist Republic (USSR).

Amongst others, this conference adopted the Primary Health Care approach as the best approach to the delivery of health services. The conference also emphasised the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world.

Thirty years on, Madam Speaker, it is worth noting that the need for urgent action is still on. Thus, as part of our contribution towards ensuring that we eradicate the world's extreme poverty and hunger, reduce child mortality, improve maternal health, combat HIV and AIDS, malaria and other diseases, we shall work steadfastly towards the attainment of the Millennium Development Goals (MDGs) and the Apex Priorities.

Accordingly, in the year 2008/09 we shall ensure that we act steadfastly and in tandem with the rest of our colleagues to work incessantly towards the achievement of the said objectives and other health priorities which have been adopted by the National Health Council' in this penultimate period of government.

Brief review of the 2007/08 programme of action and plans for 2008/09

Madam Speaker, as many will know the transformation of our health system began a long time ago. To accelerate on its achievements, we undertook, in the year preceding, to embark on a range of measures to deliver on our mandate.

Therefore, it is with sincere humility that I stand before this august house today to give an account of our performance against the milestones we set for 2007/08. As I do this I shall also outline our plans for 2008/09 under the relevant sections. Thereafter I shall indicate the resources we require this house to support us on in order to discharge our mandate.

2010 World Cup

Madam Speaker, in preparation for the 2010 FIFA World Cup, the department had set itself a number of deliverables to achieve in the 2007/08 fiscal year. They included the revitalisation of institutions to meet the required FIFA standards, procurement of ambulances, training of EMRS personnel and upgrading of equipments used in our health institutions. I am glad to report that 60 ambulances and 12 response vehicles worth R22 million were procured in the past financial year. These ambulances and vehicles will not only be used for purposes of 2010 World Cup, but they will continuously be used to strengthen the Emergency Medical and Rescue Services (EMRS) in the province. Training of EMRS personnel in the Klerksdorp EMRS College is continuing to ensure that these procured ambulances and response vehicles have people who men them.

In 2008/09 we shall continue to strengthen these services by ensuring that there is a defined and elaborate strategy to deal with and mitigate disaster. We shall also ensure that high-tech communication tools are installed in our emergency vehicles and centres, a scheduled replacement programme is followed to replace all existing emergency vehicles that have travelled in excess of 200 000 kilometres, and emergency services personnel continue to receive high level training at our EMRS College in Klerksdorp which is a model for the country.

In 2007, we undertook to build new infrastructure and to replace old and dilapidated buildings. I am glad to report that:
* two Community Health Centres under the revitalisation programme, that is, Phela and Mogwase have been completed and are now functioning,
* nine clinics were completed,
* two Community Health Centres, that is, Phedisong and Tigane have been upgraded and extended.

This year, we will ensure that Moses Kotane and Vryburg Hospitals are completed, and handover six Community Health Centres. In a bid to strengthen revitalisation, we shall integrate health technology in the revitalisation programme and increase the number of hospitals that are on this programme. Furthermore, we shall also complete the construction and commissioning of outstanding health posts, and provide legacy projects for 2010 and beyond.

Skills Development, Nurse training and Expanded Public Works Programme (EPWP)

Guided by Accelerated Growth Initiative for South Africa (AsgiSA) and our business as a service oriented organisation, the department undertook in the previous year to build our employees' skills in different areas. We are glad to report that:
* More than five thousand five hundred employees have been sent to different training programmes to up their skills,
* Three hundred and twenty three employees were on the Adult Basic Education (ABET) programme,
* One hundred and eighty six employees registered for learnerships, whilst one hundred and forty students were on the internship programme, and
* Fifty five Community Health Care Workers were trained on a comprehensive NQF level four course,
* The department also awarded ninety six bursaries in support of various study programmes.

In the year 2008/09 the department shall continue to expand on these achievements by continuing to provide more bursaries. We shall also accelerate the training of Community Health Workers and continue with our commitment towards the development of youth skills through the internship and learnership programmes.

In our quest to produce nurses who are the backbone of our health care service delivery we shall continue to increase the intake of nurses in various degree and diploma courses. This shall be with the view to building on the achievements we made in 2007/08. In terms of this, we recorded the following progress,
* 1 207 nursing students were enrolled in nursing diploma courses,
* 168 students were enrolled for the basic nursing degree courses with the North West University,
* 136 students were enrolled for post basic diploma courses in nursing and
* 86 learners were on the auxiliary nursing learnership programme.

HIV and AIDS, sexually transmitted infections (STI) and tuberculosis (TB) (HAST)

Madam Speaker, I announced in the house last year that our department was working with other departments to ensure integration towards providing a response to HIV and AIDS. This approach I said was guided by the National HIV and AIDS Strategic Plan (2007 to 2011) that was launched by the Deputy President Ms Phumzile Mlambo-Ngcuka on the 30 April 2007. On this I am glad to report that the department conducted a collaborative and consultative process to develop a Provincial HIV and AIDS Strategic Plan (2007 to 2011) which is aligned to the National HIV and AIDS Strategic Plan (2007/2011). Different provincial government departments; including sectors such as of South African Trade Unions (COSATU), Business, People Living with HIV and AIDS, Municipalities and non-governmental organisations (NGOs) participated in the development and alignment of this strategic plan. The interventions in this strategic document are guided by the four priority areas, namely, prevention, treatment, care and support, research, monitoring and surveillance as well as human rights and access to justice.

In 2008/09, we shall accelerate the implementation of this plan by:
* Strengthening our prevention initiatives by expanding preventing mother-to-child transmission (PMTCT) services and increasing health promotion initiatives
* Strengthening treatment, care and support by increasing Voluntary Counselling and Testing (VCT) uptake and accrediting more facilities to provide Antiretroviral Therapy (ART). We shall also strengthen our partnerships with NGO's and accelerate the implementation of Orphaned and Vulnerable Children (OVC) programmes.
* Strengthening monitoring and reporting of the plan including matters of human rights and access to justice for those who are infected and affected.

To mitigate against Sexually Transmitted Infections (STIs) we shall continue to ensure that health care professionals are trained on the syndromic management of Sexually Transmitted Infections (STIs) throughout the province. This intervention shall be complemented by the distribution of both male and female condoms. The challenge however remains the reluctance of partners to come for treatment. In this regard we shall encourage partners to come forth for testing and treatment. We shall also accelerate the High Transmission Area (HTA) Programme aimed at truckers and commercial sex workers.

Madam Speaker, we all know of the urgent response required to mitigate the TB crisis. I can report that, in our province, I personally together with departmental officials conducted four TB awareness campaigns to reinforce and demonstrate commitment of the department to the control of the TB epidemic in rural communities. At these meetings the traditional and municipal structures pledged their support to the efforts of the department to fight TB.

Capacity building for facility staff, doctors and nurses was intensified in 2007. The focus was on provider initiated HIV testing and counselling of TB patients; including prevention of infections. Through this initiative, 62 percent of TB patients were tested for HIV and 57 percent of those tested were HIV positive. 87,1 percent of those who tested positive were initiated on the prophylactic treatment.

In order to accelerate on these achievements, a TB turnaround strategy has been developed and we shall fast track its implementation.

Communicable Disease Control and Non-communicable diseases

The department's response to disease outbreaks has been outstanding in 2007. We responded promptly and appropriately to all outbreaks such as Hepatitis A in Ramotshere Moiloa, Diarrhoea in Tswaing, Food poisoning at Bethel High School, suspected measles at Onkgopotse Tiro Middle School and meningococcal meningitis. Fourteen cases of malaria were reported and investigated. Upon investigation, all cases were found to be imported from areas outside the province. Case management has been intensified through training of health care professionals and also through public education and environmental management. This year we will continue to strengthen the management of communicable and non-communicable diseases.

The malaria vector control programme has been consistently implemented since 1997. One thousand and seventeen dwellings were sprayed with residual effect insecticide. Food hygiene and safety efforts were intensified amongst food vendors/hawkers during the month of October 2007 in all four districts. The food safety initiatives culminated in the celebration of World Food Day on in Rustenburg, Bojanala Platinum District. Rustenburg was targeted specifically because it is a FIFA 2010 World Cup host city in the North West Province. Healthcare Waste is successfully managed at public healthcare facilities. We will strengthen our port health services as part of preparing ourselves for the FIFA 2010 World Cup.

As part of our commitment to improve maternal, child and women's health, we shall entrust our Health Services Branch to ensure that strategies to reduce morbidity and mortality among infants, children under five years and mothers continue to be implemented and strengthened.

To improve quality of care, we shall ensure that systems to monitor the quality of clinical care in all our public health facilities are strengthened. To achieve this, we shall ensure that there is continuous implementation of Infection Control Policies (including TB infection control, as well as the management of infections in postnatal and neonatal units and maternity units), the regular conduct of clinical audits, morbidity and mortality meetings, and the supervision of Primary Health Care facilities.

Governance

We have trained governance structure members on monitoring and evaluation, report writing, presentation skills and meeting procedures. This training was intended to build the capacity of members so that they can make meaningful contribution in the running of the department. Furthermore, the Provincial Health Consultative Forum was held in August 2007 in compliance with section 61 of National Health Act which requires us to interact with the public to update them on the departmental performance and allow them more space to input to our programmes and performance. We are excited as this has shown how our communities are prepared to walk hand in hand with us towards enhancing quality health care.

As part of our commitment to this objective of promoting community participation in our affairs, we shall again this year hold another consultative forum. The passing of Traditional Health Practitioners Act no 22 of 2007 shall also provide us with an opportunity to organise and capacitate our Traditional Health Practitioners in working towards the inclusion of African Traditional Medicine into our health system.

Women empowerment

As regards women empowerment, we have established and launched six more Women In Partnership Against HIV and AIDS (WIPAA) structures, to ensure that the whole province is covered. Forty women from WIPAA have been trained as basic counsellors for survivors of gender based violence such as rape, domestic violence and child abuse.

Towards strengthening this programme, the department will form community fora to strengthen our referrals for lay counselling for survivors of gender based violence. We shall also provide basic training for Bo- Mmabosidili, caretakers and supporters of HIV negative neglected children who are prone to abuse and contracting HIV.

Disability Programme

As part of implementation of our disability programme we have trained twenty five nurses and twenty five front line personnel in the first phase of the Sign Language. This was meant to enhance the capacity of health workers in making health services more accessible for the deaf community.

This financial year, the second phase of the Sign Language training will be conducted for fifty health care workers. We are also going to train forty young people on mobility and Instructors course in partnership with Umsobomvu Youth Fund and the South African Guide Dogs Association for the Blind.

Youth Programme

Towards youth, we have managed to renovate three youth centres at Kraaipan, Borakalalo and Khutsong. These youth centres operate as one stop centres and are able to provide youth with access to clinical matters, reproductive health services and computers.

Madam Speaker, youth skills development clubs providing catering and security services have also been established and registered as businesses in five youth centres. To expand on this we will roll out this initiative to other youth centres. This shall be with a view to enhancing youth capacity to attain skills and create jobs for themselves to address the unemployment and alleviating poverty.

Human Resources

To strengthen our human resources, Madam Speaker, we shall intensify our efforts to improve the working conditions and motivation levels of all our workers. To this end, acting through our Corporate Services section, we shall continue to implement the Occupational Specific Dispensation (OSD) and expand it so that it covers a broader spectrum of health professionals like medical doctors, dentists, medical and dental specialists, pharmacists and emergency medical personnel. We shall also strengthen the recruitment, appointment and retention of personnel that are critical to the delivery of our mandate; and to peak our performance, we shall ensure that our performance management system is strengthened such that the speedy change and delivery that we are all enjoined to make true, through business unusual, are indeed a lived experience.

To improve our medical services, we shall ensure that we prioritise attraction and retention of full time specialists for our tertiary services. We shall also continue to strengthen tertiary health links with academic institutions and the private sector, as was announced by the Honourable Premier on the occasion of her State of the Province Address in this august House in February 2008. Madam Speaker, herein therefore, is our confirmation that we shall set up a Centre of Excellence, with the University of Witwatersrand Medical School and a British non-profit organisation known as Ameca to enhance the capacity of the medical personnel to respond to health concerns of rural communities. Amandla!

Programme allocations for 2008/09

Madam Speaker, to carry out our plans for the year 2008/09 the department has been allocated a total budget of R4 222,549 000. As your servants, we are indeed humbled by this appropriation. Nevertheless, Madam Speaker, we feel obligated to seek your indulgence and that of your august house to give us more support in pursuit of the those priorities which are critical to our mandate but for which there is either insufficient or no required resources.

For the house's interest, the affected priorities which require attention so that they can be fully implemented are: Integrated Health management Information systems, Upgrading of our Information and Communication Technologies infrastructure, EMRS business Plan in preparation for 2010 and Telemedicine Strategy. Beyond these, the following also require attention in order to be fully implemented: the Human Resources Plan, Transport Strategy, Health Technology strategy, Modernisation of Tertiary Services, fully fledged Medico legal services, Revenue Management including debt recovery, as well as physical infrastructure.

Therefore, Madam Speaker, it is our hope and trust that we shall indeed obtain your favourable support with regard to the priorities we have identified above. However, before I conclude I would like to invite your support, and that of this august to approve the budget vote of R4 222,549 000 of the North West Department of Health.

For efficiency and management purposes, this vote has been allocated as follows in accordance with our budget programmes:

Programme: Administration
Budget 174,628

Programme: District Health Services
Budget: 2,052,040

Programme: Emergency Medical Services
Budget: 148,309

Programme: Provincial Hospital Services
Budget: 1,084,885

Programme: Central Hospitals
Budget: 17,317

Programme: Health Sciences and Training
Budget: 125,288

Programme: Health Care Support Services
Budget: 129,023

Programme: Health Facilities Management
Budget: 391,060

Total: 4 222,549

Therefore, Madam Speaker we ask of this noble house to support this budget vote in its totality and the allocations per programme.

Conclusion

In conclusion, Madam Speaker, allow me once again to assure the people of the North West and the Legislature of the Department's commitment towards ensuring that there's successful implementation of our plans. We undertake to ensure there is prudent financial management and accountability in utilising public funds which are appropriated by this house.

As I prepare to descend from this podium, I would like to express my heartfelt thanks, as I hereby do, to the Honourable Premier of the North West Province, Mme Edna Bomo Molewa for the support and assistance and leadership she accorded the department with the greatest genius.

My heartfelt appreciation is also extended to other Members of the Executive Council, and the legislature for providing a platform for democratic debates on health matters of the province. I know the intention was never to belittle our debates but at the most to ensure that we indeed deliver on our mandate of delivering quality health care services to our people.

Madam Speaker, my thanks also go out to the Chairperson of the Standing Committee on Health and its members, the Standing Committee on Public Accounts, for relentlessly giving advice to the department and keeping us on our toes.

Lastly, let me take this opportune moment as I bow out to thank my husband Solly Rasmeni and my kids for their support and understanding throughout. You were indeed a pillar of strength I could rely on!

I thank you!

Issued by: Department of Health, North West Provincial Government
29 May 2008