2011/12 Health and Social budget vote speech tabled by the MEC for Health and Social Development, Ms Ntombi Mekgwe, MPL, Gauteng Provincial Legislature

Honourable Speaker
Honourable Premier
Honourable Members of the Executive Council
Honourable Members

Members of the Mayoral Committees for Health and Social Development from all the municipalities of our province

Distinguished guests; ladies and gentlemen

I stand before this honourable House to report on the ground we have covered and to outline the plans of the Department of Health and Social Development for the 2011/12 financial year.

The journey to build a non-racial, non-sexist, united and prosperous South Africa that truly belongs to all who live in it, united in diversity has been led by heroes and heroines. These stalwarts of our liberation struggle left us a great legacy and history that even today continues to inspire millions of our people to carry the torch and walk the path that they traversed in their lives.

In exactly 10 days from today, we will celebrate the legacy of one such hero, former President Nelson Mandela. This year marks the third Mandela International Day and his 93rd birthday. During this month we willrecommit ourselves to making “the world a better place, one small step at a time, just as President Nelson Mandela did” We can make a difference!.

Mandela Day should serve to encourage us all to continue to build and strengthen the vibrant and strong spirit of nationhood that we have built in the last 16 years of a democratic South Africa.

In his book: Mandela’s Way, Richard Stengel makes this observation about President Mandela when he says, “Nelson Mandela is perhaps the last pure hero on the planet. He is the smiling symbol of sacrifice and rectitude, revered by millions as a living saint.”

President Nelson Mandela asserts: “It is in our hands”. Indeed it is now in our hands to revive and recommit to the values of selflessness, volunteerism, discipline and loyalty as we continue to build a non-racial, non-sexist, united and democratic society.

As I table this budget vote, I am cognisant of the fact that the political and administrative configuration of government soon after the 2009 general elections, presented us with an opportunity to tackle the challenges which face our province holistically.

It is an accepted fact that poverty contributes to poor health out-comes, therefore programmes which seek to eradicate poverty will have an impact on the health status of the people of Gauteng.

As government we have come to accept that budgets that are appropriated to eradicate poverty and improve the health status of our people cannot be viewed as mere expenditure. We regard these as investment; hence we are faced with two important choices.

We have a choice of either making populist pronouncements and commitments on which we will fail to deliver or we face reality and make sober commitments which are informed by available capacity and financial resources.

Honourable Members, we have chosen the latter. Eradicating poverty with a view to improve health outcomes is a very complex undertaking. More so, when the face of poverty has changed and the burden of disease has not abated. You will all agree with me that a population that is ravaged by poverty and poor health can never be productive.

Our programmes are therefore geared towards eradication of poverty in order to improve health outcomes and grow the economy of our province in particular, and our country in general.

Therefore, when we appropriate budgets we focus on outcomes that will have long term impact on the lives of our people. This approach to budget allocations underpins the manner in which we prioritize our interventions. Sustainable development and improved health out-comes will ultimately impact on the productivity of the people of Gauteng.

Before I deal with each area of service delivery, allow me to announce that plans are at an advanced stage to appoint the Head of Department for the Social Development branch.

This appointment will expedite administrative separation of the two departments, under one Political head. We have already ring-fenced the budgets of the respective branches. By the end of the 2011/12 financial year all systems will be in place to ensure that there is a smooth separation of the departments without compromising service delivery. As from 2012/13, Health and Social Development will have two separate budget votes.

We are therefore guided by the following outputs as set out in the Negotiated Service Delivery Agreement, the Millennium Development Goals and our Five Year Strategic Plan, and these are:

• Increasing life expectancy
• Decreasing mortality, in particular Maternal and Child Mortality
• Combating HIV and AIDS and decreasing the burden of disease from AIDS and Tuberculosis
• Strengthening Health System Effectiveness
• Strengthening Early Childhood Development
• Prevention and reduction of substance abuse
• Strengthening of services for older persons, women, youth and people with disabilities
• War on Poverty
• Gender, Youth and Disability mainstreaming.

As I table this budget of R25 262 369 000, (R25.2 billion) I am aware of the growth of the population of our province. According to Statistics South Africa, Mid-year population estimates for 2010, Gauteng comprises the largest share of the South African population.

Approximately 11,19 million people (22,4%) of the national population live in the province with approximately 19,3% (2,99 million) being younger than 15 years.

The population has increased from 10.5 million (Community Survey 2007), and from 9,1 millionin the 2001 Census. The number of visits to our clinics increased from 19 million in 2009/10 to 20.2 million in 2010/11.

It is therefore clear that the resources that are at our disposal do not match the increasing demand for services. This is compounded by the fact that our economy shed close to one million jobs during the recession. The consequence of this loss of jobs resulted in an increase in the number of people who had no medical insurance thus depending on the state for health services.

Surely the above statistics attest to an undeniable fact that public health services in Gauteng are grossly underfunded. While we will continue discussions with Treasury on this matter, it must be borne in mind that public health services are not a commodity. We have a constitutional responsibility to render these services!

Honourable Members will recall that during the 2009/10 Annual Report debate we committed the department to concrete measures that would be undertaken to improve financial management in the department.

In the past six months we have made progress in improving our financial situation. Working together with Provincial Treasury we identified priority areas that required urgent intervention.  These areas are; Asset Management, Risk Management, Revenue Collection and Reduction of Accruals.

I will therefore use this opportunity to update this august house on progress that has been made with regard to addressing these pressing issues.

We conducted physical verification of Assets for the entire department. We also identified top twelve institutions which always featured in negative audit opinions.

These are: Charlotte Maxeke Academic Hospital, Helen Joseph Hospital, Chris Hani Baragwanath Hospital, Natalspruit Hospital, Steve Biko Academic Hospital, George Mukhari Academic Hospital, Edenvale Hospital, Sizwe Tropical Disease Hospital, Emergency Medical Services, Medical Supplies Depot, and Head Offices for both Health and Social Development branches.

Honourable Members, we have built appropriate capacity in our Asset Management Directorate. We have employed managers with requisite skills and experience. Reconciliations for the 2010/11 financial year have been finalised and submitted to Treasury for further perusal. 

Compliance letters in terms of reconciliations and losses were approved and circulated to all directorates, hospitals and institutions. Compliance letters for journals have been approved for implementation.

Working together with the Office of the Auditor-General, we developed and began to implement an Action Plan to clear the Disclaimer Audit Opinion. The Auditor-General’s office continues to monitor implementation of this Action Plan.

The risk management unit has also been strengthened by appointment of senior managers with requisite experience and skills. We have also developed a security policy which will help in the implementation of information security in the department.

It is also the cornerstone for effective physical security services.

Management of physical security contracts has been a challenge characterised by poor management of contracts hence a strategy has been developed to normalise the situation.

I have stated clearly that provision of health care by the state cannot be commodified. However, in those instances, where individuals and organs of state can afford to pay for services that are rendered at our hospitals, we will ensure collection of revenue.

Honourable Members, our main source of revenue is patient fees, which contributed 75% of the overall collection. We have improved on revenue collection over the past three years by 8%.

We have utilised an accounting firm to collect revenue from medical aid schemes. Previously, medical aid claims were submitted and processed manually. It was a cumbersome process which was difficult to manage.

In order to ensure efficient revenue collection, we have implemented the Electronic Data Interchange which will enable us to submit and track claims to Medical Aid Schemes electronically. To this end, we will establish a Case Management function in the department to improve on the authorisation, updating of clinical records and coding.

Honourable Members, all of these, hinge on sound patient administration and billing processes at our hospitals. State departments such as Correctional Services, Justice and neighbouring provinces owe us huge amounts of money. I have taken it upon myself to follow up with relevant political heads where applicable so that we recover monies owed to us.

Honourable Speaker

Our financial constraints have resulted in rising accruals over a number of financial years. We have taken steps to address this problem. We have sstrengthened the Supply Chain Management function at each facility and head office by employing competent officials. 

Cost saving measures on major cost drivers items such as blood, laboratory tests and x-rays are also in place at all facilities. We have eliminated the use of consultants, restricted agency nurses to only professional nurses at selected hospitals.

Without disciplined financial management, the measures I have just mentioned will be in vain. That is why cost saving measure are part and parcel of performance agreements for all senior managers in the department. 

Honourable Speaker

We have prioritised reduction of child and maternal mortality. All hospitals and clinics with Maternal Obstetric Units implement the ten Recommendations of the Saving Mothers Report.

We will deploy four teams of specialists who will focus on maternal and child mortality in each of district. In this regard, we are in the process of finalising appointments of Principal Obstetricians; Principal Paediatricians; Advanced midwives; and Senior Primary Care Nurses.

We have already appointed and deployed principal family physicians to each of our districts. These specialists will be supported by fellow specialists from universities, tertiary and regional hospitals.

We will institutionalise this collaboration with the effect that each district will have a direct working relationship with regional and tertiary hospitals. For too long some specialists who focus on maternal and child mortality have been working in silos.

Honourable Members, we have come to realise that interventions without appropriate institutional arrangements have no impact on service delivery.

Availability and of Maternity Obstetric Ambulances and their quick response is crucial to saving the lives of women who are in labour and their infants.

To this end, we will increase the number of these ambulances which are specifically dedicated to transportation of women who are in labour emergencies by 5.

We have also initiated a campaign to encourage pregnant women to book for ante-natal visits before 20 weeks of pregnancy because too many women start ante natal care visits when it is already too late. Early booking allows us to manage maternity complications effectively.

This campaign is borne by the fact that our records attest to low figures of women who attend ante-natal clinics before 20 weeks. Vitamin A coverage for children under 1 year and new mothers reached 104.4% and 97.8% respectively.

Through the Expanded Programme on Immunization, which encompassed the “reach every district” programme, and availability of vaccines, measles coverage reached 111.2%.

Honourable Members, South Africa is the first country to introduce the pneumococcal and rota virus vaccines into the expanded programme on immunisation.

The target on roto virus dose coverage was reached due to training and health education campaigns conducted to post natal mothers on the importance of ensuring that roto vaccine is given within a 6 month period after birth. The fact that targets for immunisation are exceeded is testament to our efforts to ensure that children whose birth was not registered as well as children born in other provinces and even other countries receive their immunisation in Gauteng.

Honourable Members

We will therefore strengthen our immunisation programme to reach children who could have been missed, especially those in informal settlements. Immunisation coverage will be increased to reach over 90% in all our districts. We will conduct regular monitoring and evaluation visits to districts and in-service training on expanded programme on immunisation. Vaccine stock management will be monitored rigorously to ensure that no clinic runs out of vaccines.

We have already increased the number of neo-natal beds at Charlotte Maxeke Academic, Dr George Mukhari, and Natalspruit hospitals. Strict adherence to infection control measures is monitored very closely. The death of children from preventable diseases is one too many!

The Prevention of Mother to Child Transmission of HIV programme is bearing fruit. This programme has already reduced HIV transmission from mothers to babies from 8% in 2009/2010 to 2, 3% in our province.Even the Times newspaper reported on Friday, 10June 2011, that Gauteng has the lowest transmission rate in the country.

We will continue to strengthen this programme in order to reduce the over- all incidence of HIV.

This year we will also strengthen our school health services. Focus will be on screening for obstacles to learning among Grade R, 1, and 7 pupils.

Currently, school health teams visit 1431 schools and we will collaborate with the Gauteng Department of Education in this regard to reach more schools.

Honourable Speaker

We have allocated R1, 912 billion to strengthen our fight against HIV and AIDS.We are breaking the back of HIV and AIDS.By the end of March 2010, we had a total of 416 941 people on Anti-Retroviral Treatment.

Our target is to increase this number to 520 000 by the end of March 2012. In order to provide treatment closer to where people live, Anti Retroviral Treatment sites will be increased to 385 by the end of March 2012. As at the end of June 2010, we had 286 Anti-Retroviral Treatment sites, which are distributed as follows:

• 48 in Tshwane
• 88 in Ekurhuleni
• 15 in Metsweding
• 63 in the City of Johannesburg
• 47 in West Rand
• 25 in Sedibeng

Honourable Speaker

There is emerging research evidence that large scale treatment has reduced deaths from AIDS in South Africa. Timeous enrolment of people on Anti-Retroviral Treatment while also taking into account their CD4 count, goes a long way towards reducing serious illness and deaths from AIDS, hence we have trained professional nurses to initiate treatment.

To date, 1019 nurses and 759 mentors who work in clinics have been trained to initiate Anti-Retroviral Treatment. This intervention has shortened the waiting period for people who need to be put on treatment.Honourable Members know that HIV is incurable therefore our focus on prevention can never be over-emphasised.

Mass education to encourage safe sex through schools, wards, and non-governmental organisations (NGOs) has already reduced new HIV infections in youth between the ages of 15 to 24 years significantly.

Factors such as multiple sex partners, alcohol abuse, and transactional sex still account for the unacceptably high infection rate in our country. Services for medical male circumcision will therefore be up-scaled to reach 125 000 males by the end of March 2012.

By the middle of June this year, we had already tested more than 2, 7 million people since the launch of the HIV Counselling and Testing Campaign, last year in April.

The campaign is beginning to bear fruit as more people; especially males are coming forward to be tested for HIV and other conditions such as hypertension, and diabetes. Our research shows that there is an increase in the use of condoms across all ages of the sexually active population.

Tuberculosis (TB) remains a burden to our health system. Early diagnosis and effective treatment of TB will ensure that we increase the TB cure rate, deaths from TB, and reduce the further spread of TB. TB also continues to be the number one killer among HIV positive patients.

We have therefore decided that all TB patients will be screened for HIV in order to ensure that those who are co-infected and have a CD4 count which is below 350 are initiated into Anti-Retroviral Treatment.

HIV positive patients are also initiated on prophylaxis in case their TB infection is hidden. We have also noted that admission of Multi-Drug Resistant TB patients for up to eighteen months at Sizwe hospital disrupts their livelihoods especially if they are bread winners.

That is why we will soon launch a Community Multi-Drug Resistant programme to ensure that these patients continue receiving treatment while living with their families. These patients and families will be supported by Directly Observed Treatment Supporters (DOTS).

Honourable Members

May I take this opportunity to applaud our DOT supporters; the fact that we have consistently improved our TB cure rate is largely due to their relentless dedication.

I say to them, you might think your task is thankless, yet you have contributed to saving so many lives, may God bless you!

We have procured the Gene-expert technology which will ensure shortening of availability of sputum results from a whole week to 2 hours. This will greatly reduce the loss of patients to follow-up as some do not come back for results. This technology is already available at Chris Hani Baragwanath Academic and Edenvale hospitals. We will further avail this equipment to the rest of the districts in the course of this financial year.

To reduce the spread of TB among families of patients, we will continue to visit their homes and screen them for TB. Those found to be already infected will be placed on treatment immediately.

Honourable Speaker

Since we embarked on this process, we have found 53,038 new cases of TB, exceeding a target of 52,000. This was achieved through intensified case-finding by means door-to-door campaigns and the HIV Counselling and Testing campaign.

We will continue to ensure that TB cases are detected early so that those who are infected are placed on treatment thus curbing the spread and infection of the community at large.

Honourable Members will recall that we decided to close TB hospitals with effect from April last year.This decision was justified when one considers the amount of money that was saved.

Savings were made on rentals, security and catering. This was in response to the Ministerial injunction that management of TB should be integrated into existing health care services. Closure of TB hospitals has therefore not impacted negatively on the TB cure rate which has been improving over the years as I indicated earlier.

Honourable Members, we have thus allocated R299, 468 million to fight the scourge of TB in the 2011/12 financial year.This allocation excludes management of TB at district level.

Honourable Speaker

All of the above can only be achieved if we have an effective health system. An effective health system hinges on the primary health care approach, and services which inspire confidence.

Access to primary health care services has improved over the years. We have achieved 100% access to clinics within 5km radius in urban areas. This is the pillar of our health system. We are re-engineering primary health care in order to improve health outcomes and reduce the need for curative services.

District managers must brace themselves to conduct their business differently. It is at this level that the link between health promotion and management of diseases is pivotal. Allocation of resources will now be determined by disease patterns and trends in each district.

Of the 35 Community Health Centres in Gauteng, 30 will operate for 24 hours in order to improve access to Primary Health Care services. It is also at this level of care that we are going to co-ordinate delivery of community based services.

We have those who offer Home Based Care services, TB Directly Observed Treatment support, and HIV and AIDS Lay Counsellors.

All of them work among communities, but fragmentation of their services undermines the impact they are supposed to make. We will review the recommendations of the meeting they had with the Premier last year to ensure that this fragmentation comes to an end.

Fragmented delivery of services has proven to be costly; therefore we cannot employ the same strategies and expect different results year in, and year out.

To this end, we have already begun to establish health posts which are located in communities. This is a is a health team that is embedded in the community andat the periphery of a clinic or community health centre in which comprehensive primary health care is rendered to 250-300 households.

By the end of March 2012, we will have established Health Posts at; Orange Farm. Orlando, Lion Park, Andries Raditsela, Phenduka, Ivory Park, Atteridgeville, Refilwe, Boipatong, Mamello, Bophelong, Sharpeville, Wedela, Fochville, and Bekkersdal.

1 100 Community Health Workers are being recruited and they will be deployed to these health posts.

Our goal is to change community perceptions about quality of care at our facilities, as they will be attended to faster by dedicated teams who live among them. 112 community service doctors have been placed in the district health services including district hospitals which will support the 50 poorest wards.

A further 40 local doctors who have benefited from the department's bursary fund have also been distributed to the district health services and district hospitals where they will fulfil their contractual obligations.

In order to further strengthen Primary Health Care services, a new cadre of mid-level worker, - the clinical associate, has been developed. Training of this cadre began in 2009 with an approximate number of 198 being enrolled in first and second years at the Universities of Pretoria and Witwatersrand.

The first cohort of this cadre is expected to graduate in 2011/12. Those who have been bursary funded by the department will be distributed in the district health services where they will work under the supervision of family physicians. These family physicians will no longer be based at district offices.

They will be roving doctors who will be found where patients are, which is the clinics and district hospitals. Lines of reporting will be redefined so that they report directly to district managers.

Our people still believe that they have not received quality health care if they have not been seen by a doctor. Hence we are deploying more doctors to work at clinics, in order to discourage our people from entering the health system incorrectly. We will continue to strengthen the use of general practitioners who work on a sessional basis at our clinics. Currently, 248 out of 318 clinics are visited by a medical doctor at least once or twice a week.

In order to strengthen the district health system, we have allocated R7, 014, 851 billion, which is an increase of 18% from the previous financial year’s allocation. This increase shows our commitment to primary health care.

We will continue to collaborate with municipalities to strengthen district health services. in this regard, government took a decision that primary health care services and emergency medical services should fall under a single authority in order to ensure standardisation of services. This would in turn expedite a single public service with similar conditions of services, and further eliminate duplicated management structures. The referral system will be improved, and access to a comprehensive service package ensured.

This process will also assist in increasing access to services through extended hours, and ensure equitable resource allocation. We acknowledge that progress on this process has been uneven. We are finalising this process in district municipalities.

We will make an appropriate announcement on how commuted overtime will be regulated and monitored in order to curb abuse by some unscrupulous medical doctors. The abuse of commuted overtime costs us a huge portion of our budget.

I know this will make us unpopular in some sections of the medical fraternity. Stringent measures aimed at curbing abuse of commuted overtime will be announced at the end of July this year.

In the past financial year, we completed construction of 2 ambulance stations in Orange Farm and Dr Yusuf Dadoo Hospital. The ambulance station in Orange Farm is a flagship that will bring services closer to the community including the neighbouring informal settlement such as Weilers Farm.

In the year ahead we will build 2 ambulance stations in Bronkhorspruit and Temba. The station in Temba will benefit the communities of Temba, Hammanskraal and Kekana Gardens.

We will collaborate with municipalities to monitor response times. To this end we have allocated R703, 070 million, which is an increase of 6%.

We have also taken pro-active measures to ensure that we reduce shortage of drugs and medical supplies at our hospitals and clinics. Penalty clauses will form part of the contracts we sign with suppliers.

We have also taken steps to improve storage infrastructure for drugs and medical supplies at the medical supplies depot, in addition to hospital and regional pharmacies. We are also reconstituting pharmacy and therapeutic committees at all our health facilities to ensure on-going monitoring of stock availability at all levels.

We are committed to deliver quality infrastructure. I concede that expenditure on infrastructure budget is unacceptably low. The blame game that is often used as an excuse to attribute this state of affairs to the Department of Infrastructure Development and vice versa, will be a thing of the past.

I am working with the MEC for the Department of Infrastructure Development to ensure meeting the tight deadlines that have been set. It is in this light that I announce that the construction of Germiston hospital is at final stages of completion. The hospital will be handed over and commissioned in 2012.

The new Natalspruit hospital is also earmarked for completion in 2012. Construction of Jabulani/Zola hospital is also at full momentum after initial glitches which were reported on. We are also modernising our laundries in order to ensure that the equipment therein keeps up with linen demands at our facilities.

We have thus re-prioritised R87 million for this project in 2011/2012. Honourable Members, this project will be undertaken in phases over the Medium Term Expenditure Framework.

In the past Medium Term Expenditure Framework (M TEF), we spent R324, 760 million on social development infrastructure projects to provide quality services to our children, the elderly, and those recovering from substance abuse. These are 14 Early Childhood Development Centres in Daveyton, Ratanda, Garankuwa, Soshanguve, Katlehong, Kwa-Thema, Duduza, Tsakane, Etwatwa, Alexandra, Munsieville, and Mohlakeng townships.

We will complete construction of committed infrastructure projects as part of the 20 priority townships. The projects that are earmarked for completion in 2011/12 financial year are as follows:

• 2 Early Childhood Development centres in Protea Glen and Sharpville
• 5 Day care centres for the elderly in Duduza, Tsakane, Protea Glen, Munsieville, and Sharpeville
• 2 New Homes for the elderly in Tembisa and Mohlakeng
• A Secure Care Centre in Soshanguve.

In addition, we will continue renovating existing residences for older persons which are located in historically disadvantaged communities.

We will strengthen outreach programmes from health facilities to old age homes, children’s homes, Early Childhood Development Centres, and other social development facilities.

This will improve service delivery to beneficiaries in those facilities, for example, through the delivery of chronic medication to residences for older persons or people with disabilities. We will also fund NGOs for procurement of Occupational Health and Safety equipment (smoke detectors, fire extinguishers, and sprinklers) and assist with the establishment of Occupational Health and Safety committees.

Together with municipalities we will undertake assessments of Residences for Older Persons and Children’s Homes for safety. Over the Medium Term Expenditure Framework period, we will, place 60 social auxiliary workers at Community Health Centres and Community Development Centres.

Honourable Speaker

As a developmental state we acknowledge that our children are our country’s most precious asset and the foundation for building a caring and prosperous nation.

We also acknowledge that in order for them to grow and reach their full potential, children need an environment in which they can play, learn, explore, laugh, build friendships and be loved and cared for.

We need to ensure that the children who are not enrolled in any programme prior to Grade R receive the support they need. The expansion of Early Childhood Development services is therefore crucial for holistic development of our children.

As stated earlier, in the previous Medium Term Expenditure Framework period, we constructed 14 new Early Childhood Development Centres as part of the 20 priority projects.

Honourable Members, I take this opportunity to reiterate the plea that I made to our officials. Please be developmental in your approach. Assist those crèches which do not meet requirements for registration to qualify.

In the 2011/12 financial year we will fund 1160 Early Child Development centres in Gauteng benefitting 66 244 children. These will be distributed as follows:

• 260 in Ekurhuleni, benefitting 13 600 children
• 277 in Johannesburg, benefitting 19 857
• 208 in North Rand, benefitting 13 267 children
• 183 in West Rand, benefitting 9 520
• 233 in Sedibeng, benefitting 10 000 children.

All of these Early Childhood Development centres are located in historically disadvantaged communities. Honourable Members, we have allocated R 230 million to Early Childhood Development.

The promulgation of the Child Justice Act of 2010 has given us an opportunity to expand diversion programmes and home based care programmes for children in conflict with the law.

In line with this Act, we are responsible for assessment of all arrested children within 48 hours, before their first court appearance.By December 2010, 3337 children in conflict with the law were assessed.In the 2011/12 Financial Year, we intend to assess all children in conflict with the law in compliance with the Child Justice Act.

This willensure that we move away from a punitive and retributive system which focuses on child incarceration and retribution to a more restorative approach.

We will ensure that most of the children recommended for diversion programmes participate in these programmes, which will be expanded and strengthened to cater for 2520 of them.

We will also improve monitoring and evaluation of probation programmes to children and adults, including expanding social crime prevention and awareness programmes, strengthening after-care programmes for families of children in conflict with the law.

We will continue to provide secure care services to 1725 children in conflict with the law at Walter Sisulu Secure Care Centre- in Soweto; and Protem Secure Care Centre – in Cullinan.

We are completing construction of a new secure care facility in Soshanguve. This new facility will decrease our dependence on private service providers and enable us to render a more cost effective service.

Honourable Speaker

We have allocated R82, 851 million towards programmes that are aimed at preventing and reducing substance abuse. We cannot underestimate the untold damage that is being visited on communities, families and individuals by the scourge of substance abuse.

It is for this reason that the department is implementing a provincial strategy on the prevention and management of substance abuse. Our collaboration with the Provincial Substance Abuse Forum and Local Drug Action Committees has helped us todetermine the magnitude of the problem, to identify hotspots such as Soshanguve, Alra Park, Mamelodi, Diepsloot, Westbury, Katlehong and Reiger Park and target those groups which are mostly vulnerable to addiction.

This has been achieved through community based research where “door-to-door” visits featured strongly. To this end, we will increase availability and accessibility of inpatient and outpatient treatment centres by making use of our clinics and some of the hospitals.

We will also continue collaboration with soccer legends, who are regarded as heroes and role models by millions of our young people, to spread the message that “doing drugs is not cool”! During the 2011/12 financial year, some of our clinics will be adapted to accommodate patients from outpatient treatment centres, making the service more accessible and youth friendly.

In order to achieve this, we will train health promoters, social workers and social auxiliary social workers on substance abuse. In partnership with the Department of Economic Development and Municipalities, we have consulted on the awarding of liquor licenses.

Honourable Members you are all aware of the impact of alcohol abuse on families, gender violence, child abuse, crime. The incidents of trauma that are linked to alcohol abuse are placing an increasing burden on our services. We are in partnership with our sister departments to ensure stricter regulation of the Liquor Industry.

We will establish 8 more Local Drug Action Committees in Katlehong, Kwa-Thema, Diepsloot, Alexandra, Olivenhoutbosch, Bronkhorstspruit, and Ekangala and in Midvaal in order to strengthen our interventions at local level.

We have also prioritised expansion of care programmes to people who are treated for substance abuse among previously disadvantaged communities.

In the year ahead 26 non-profit organisations which render outpatient treatment programmes will reach 6500 beneficiaries. Furthermore, 7 in-patient treatment centres will provide services to 1820 clients. In addition, after care services, rendered to persons who have been treated for substance abuse, will reach 12 250 beneficiaries.

Honourable Members, a concoction called “Nyaope” is wreaking havoc among the youth of Tshwane townships. I appeal to communities to work with us and law enforcement agencies to identify and prosecute drug lords and runners who are responsible for visiting untold damage to our children and families.

These people are known and they need to be exposed! We will therefore intensify our programmes with young people in that region.

Honourable Speaker

Our experience has taught us that participation of boys and men in programmes that seek to reduce violence against women and children goes a long way towards reducing its incidence.

In 2011/12 financial year a total of 2140 men and boys will participate in gender based violence prevention programmes. We will therefore strengthen our partnership with men’s organisations. We will continue to fund existing shelters for women who are victims of domestic violence.

In the year ahead, 24 shelters for victims of crime and violence managed by non-profit organisations will benefit 1152 women accessing shelters for victims of crime and violence. The department has developed a plan to roll out shelters for abused women and have forged a partnership with the Department of Community Safety in establishing safe houses in communities.

Women in these shelters will be linked to economic empowerment opportunities in order to increase their self reliance. It is for this reason that we have increased the allocation towards Victim Empowerment programmes by 97% to R38, 915 million.

Honourable Speaker, services to older persons remain central to our programmes. We will therefore continue to advocate for and jealously protect the rights of older persons and promote their safety, security and health care. Some of older persons, especially those living alone in townships, are isolated and neglected.

Hence we have reprioritised our financial resources in favour of organisations which render services among historically disadvantaged elderly people. As a department we acknowledge governance problems among the non-profit organisation (NPOs) sector, with respect to governance.

Where necessary we will intervene directly in administering of funds among those funded organisations. We have prioritised those homes with poor infrastructure, and those which are heavily dependent on the department for funding.

We will continue to strengthen our community based care and support services through extension of funding to 52 home based care NPOs rendering services to 12010 frail older persons in the community.

This will include 169 service centres and luncheon clubs reaching 31156 beneficiaries. Meals will be prepared from the prototype centres, and in some instances drop in centres, and be delivered at the homes of the frail older persons. In promoting the concept of active aging, we will fund relevant non-governmental organisations (NGOs) for appropriate gym equipment for older persons.

We will therefore continue to promote healthy lifestyles programmes for older persons with special focus on golden games programme implemented in partnership with the Department of Sports Culture and Recreation and NPOs. The targeted number of older persons to be reached is 19 208.

It has become clear that older persons need to be empowered to advocate for their own rights and participate actively in their communities on issues affecting them. It is for this reason that we will restructure and strengthen the Gauteng Older Persons Forum to ensure that it carries out its mandate in line with the National Guideline for Provincial Forums.

Honourable Members, care and services to older persons have been allocated R244, 400 million.

In order to ensure that people with disabilities in Gauteng continue receiving world class services, we have reconfigured functioning and governance of Itireleng Centre for the Blind in Garankuwa.

We will continue to fund programmes for persons with disabilities, as indicated by this year’s budget allocation of R103, 481 million. We will give special attention to protective workshops for which funding will be extended to ten 10 additional facilities.

Partnerships will be strengthened with the Departments of Trade and Industry and of Labour to assist with expertise in terms of business and skills development.

Capacity building and monitoring of services rendered to persons with disabilities shall remain a priority to ensure that quality services are rendered. We will also ensure that all training centres (protective workshops) for people with disabilities are functional and productive in order to increase employment opportunities and self reliance.

The family remains the foundation of society the prosperity and cohesion of society hinges on strong families, rooted in sound values of Ubuntu, solidarity, care, support, love and respect. In order to prevent vulnerability of families we will fund 109 NGOs providing services to families.

This year we will mark 2011 International Day for Families under the theme: “Confronting Family Poverty and Social Exclusion”. It is during this celebration that outreach programmes will be extended to communities of Gauteng to raise awareness about the government’s programmes to alleviate poverty and social exclusion.

Exclusion of young people from the labour market coupled with poverty, substance abuse, crime and violence all point to the need to intervene strategically to ensure that we improve the socio-economic conditions of the youth of Gauteng. We will continue to provide training opportunities to young people in order for them to access job opportunities or become entrepreneurs. This year 250 young people will be enlisted for the Masupatsela Youth Pioneer programme.

20 NGOs will be funded to provide 2650 young people will also benefit from training in electrical, plumbing, computer, and carpentry and business skills. These young people will be linked with established companies upon completion of their training to order for them to be apprenticed appropriately.

We will also establish 7 youth centres in Thokoza, Johannesburg, Diepsloot, Orange Farm, Mamelodi, West Rand (Kagiso) and Alexandra. These will be one stop centres providing integrated services to young people such as skills development, cultural, health and reproductive programmes, and substance abuse programmes.

As part of the National Youth Service Programme, 200 young people will be trained in landscaping, life skills and computer skills. As part of their service, they will be involved in the beautification of old age homes in 20 priority townships. These young people will then group themselves into cooperatives and will provide gardening services to institutions of the department.

We have allocated R14,350 million to programmes that are aimed empowering our youth.

Honourable Speaker

We do not only fight the effects of hunger and poverty. As a developmental state, we also tackle their structural causes.To date the food banks that we launched in 2009, have provided food relief to 17 851 households.This is more than the anticipated reach of 15 000.

We will further expand this programme as part of ensuring access to nutritious food to vulnerable communities.This will be achieved with the rollout of 11 community nutrition centres in 50 priority wards identified as having the highest incidence of hunger and inequality in the province.

It is important that those who receive food assistance through these established facilities are assisted in broadening their access to knowledge and skills through which they will ultimately reduce their dependency on the state and become self reliant.

This year we intend to profile 10 000 households. These households will be linked with relevant departments for a basket of services based on the identified needs.

We will continue to work with non-governmental organisations, which provide skills development programmes and capacity building such as life skills, business skills and technical skills, particularly to women and youth who are socially excluded, in order to enable them to access economic opportunities.

Honourable Members, vulnerable children have a right to education, without being socially excluded because of their poverty status. This year 100 000 poor and vulnerable children have received free school uniforms as part of Bana Pele.

This programme enlisted 382 cooperatives that manufactured school uniforms which created 2238 jobs.

This number includes 2042 women who bear the brunt of poverty and inequality. In this financial year, the school uniform program will be further expanded to quintile two schools. We will provide sanitary towels to 50 000 school going girl-children this year. To date, 14 345 have already benefited. We are exploring a strong possibility of extending this programme to youth out of school.

In our quest to create decent work, and thus reduce poverty, we have provided 8431 interns with work exposure opportunities. About 70% of these interns have been able to secure employment in the department, in other provincial departments and also in the private sector.

Before I take my seat I would like to convey the department’s heartfelt gratitude to all our partners who assisted during the public service strike – private sector partners, NGOs, church groups, other civil society groups, MK Veterans and individuals (learners, students, professionals).

Some private hospitals assisted with patient care. Volunteers from all walks of life helped to keep skeleton services running across the province, including working in the kitchens, laundries, as porters and cleaners, in hospital mortuaries, and caring for patients.

We also extend our gratitude to all of the clinicians who worked tirelessly during the strike to keep services going, working long hours under difficult circumstances, often with minimal support. I also take this opportunity to thank all of those staff members who were conscientious and stayed at their posts during the strike, often at great risk to their safety.

They were resilient in the face of intimidations. The public service strike was an extremely painful experience at our health facilities. While the right to strike is protected and upheld, it was nevertheless disheartening to see people abandoning critically ill babies and patients; strikers barging into operating theatres – and chasing staff out. The intimidation, suffering and ugliness left wounds that will take time to heal.

Honourable Members, some sections of the private and non- governmental partners donated equipment to some clinics in Soweto, a clinic was built near Lanseria, a new Accident and Emergency Unit was built in Pholosong hospital, another one will be completed in August this year at Leratong hospital, and medical supplies. To all of you, your contribution to the social compact is immeasurable!

Honourable Speaker

I have spent a considerable amount of time speaking on operational matters instead of policy matters. This is due to the fact that there are glaring areas which need re-engineering of management towards new policy choices and expected outcomes. I have no doubt that we will attain the outcomes that we have set out.

We need to draw strength and resilience from the legacy bequeathed on us by Charlotte Maxeke, Lillian Ngoyi, Helen Joseph, Adelaide Tambo, Bertha Gxowa and Albertina Sisulu as we continue to build a truly non-racial, non-sexist, united, prosperous and democratic South Africa that belongs to all who live in it.

It is therefore fitting to use the wise words of one of our liberation stalwarts who helped shape and set the tone for our democracy. One of the central teachings of Chris Hani was to ensure that we selflessly serve the cause of humanity.

Chris Hani in his own words said, “Socialism is not about big concepts and heavy theory. Socialism is about decent shelter for those who are homeless. It is about water for those who have no safe drinking water. It is about health care, it is about a life of dignity for the old.” The above words by Chris Hani affirm our objective of a long and healthy life for all the people of Gauteng!

We recommit ourselves to the work of Chris Hani and the Triple H campaign which responds to issues of housing, hunger, and health.

I take this opportunity to thank the Honourable Premier for her leadership, my colleagues in the Executive for their collegiality, the Chairperson of the Health and Social Development Portfolio Committee, and all members for providing robust oversight to the department.

I also thank the management of the department and all categories of staff for their dedication. Lastly I extend my gratitude to my family for having been a source of strength since my deployment.

I thank you

Budget 2011/12

MTEF budget allocation – programmes

Programme	2010/11 Adjusted Appropriation	2011/12budget Allocation	2011/12 increase/ decrease
	R’000	R’000	%
1.Administration	789 216	838 735	6%
2.District Health Services	5 947 084	7 014 851	18%
3.Emergency MedicalServices	660 873	703 070	6%
4.Provincial Hospital Services	4 642 471	4 984 745	7%
5.Central Hospital Services	5 755 290	6 487 604	13%
6.Health Sciences and Training	692 682	736 022	6%
7.Health Care Support Services	158 847	163 326	3%
8.Health Facility Management	2 047 477	2 245 865	10%
9. Social Welfare Services	1 697 219	1 872 911	10%
10. Development and Research	177 279	215 240	21%
Total	22 568 438	25 262 369	12%

MTEF budget allocation – economic classification

Economic classification	2010/11 adjusted Appropriation	2011/12budget Allocation	2011/12 increase/ decrease
	R’000	R’000	%
Current payments
Compensation of employees	11 584 233	13 894 207	20%
Goods and services	6 921 984	7 288 797	5%
Transfers and subsidies
Provinces and municipalities	498 800	563 060	13%
Departmental agencies and accounts	9 702	13 182	36%
Universities and technikons	835	1 162	39%
Non-profit institutions	1 579 868	1 871 967	18%
Households	47 270	49 615	5%
Payments for capital assets
Buildings and other fixed structures	1 072 177	905 429	-16%
Machinery and equipment	853 569	674 950	-21%
Total	22 568 438	25 262 369	12%

MTEF allocation – conditional grants

Conditional grant	2010/11 adjusted appropriation	2011/12 budget allocation	2011/12 increase/ decrease
	R’000	R’000	%
Comprehensive HIV and AIDS	1 281 683	1 620 673	26%
Forensic pathology service	92 421	97 966	6%
Health professions training and development	651 701	690 803	6%
National tertiary services	2 561 154	2 759 968	8%
Hospital revitalisation	1 027 932	801 965	-22%
Infrastructure grant to province	113 618	142694	26%
EPWP incentive grant for social sector	5 100	0	-100%
Total	5 733 609	6 114 069	7%