Tshabalala-Msimang, MP, Budget Vote debate at NCOP
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; âWorking Together for Health.â
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 womenâs
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 yearâs
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
