Budget and policy speech by MEC of Health Sicelo Gqobana in the Eastern Cape Provincial Legislature

Honourable Speaker of the House
Honourable Premier of the Eastern Cape
Members of the Executive Council
Members of the Provincial Legislature
Traditional Leaders of the Eastern Cape
Honourable Mayors and Speakers
Hospital Board Members
Community members watching in public viewing areas
Members of the media
Members of the religious fraternity
Honoured guests

1. Introduction and Political Context

Good afternoon to you all.

I deliver this Policy and Budget Speech on the eve of the commemoration of Human Rights Day mindful of the fact that this freedom which we so much enjoy has been gotten through the blood and sweat of all freedom loving people of this country and allies. I take this time to salute those whose lives were lost in the execution of their duties in the provision of quality healthcare. May their souls rest in peace.

Let me join the multitudes of our people in congratulating the African National Congress (ANC) for reaching and celebrating its centenary – 100 years of dedicated fight for human rights, peace and prosperity.

The President in his State of the Nation address lauded the Eastern Cape Department of Health for piloting the Multi-Agency Working Group whose purpose is to ensure a corruption free department and public service.

The Premier of the Eastern Cape in her State of the Province Address was impressed with the progress made in the Eastern Cape Department of Health and the recent achievement in Auditor General’s qualified audit opinion. It is a welcomed improvement from the perennial disclaimer reports we have had in the past and we are planning to improve and get unqualified opinion. We have reduced the budget deficit from R2.8 billion to less than R750 million - despite our budget having a negative growth over the past two years. This is a sign that demonstrates our commitment to improve financial management in the department.

The government has declared 2012 as the “Year of Action” and I can assure you Honourable Members, we have taken decisive actions already in some areas. We have acted against those managers who demonstrated laissez faire approach to management and put our people at risk. We have also engaged some medically trained managers to take up their clinical duties in the health facilities.

I am not a denialist, Honourable Members, and claim all is well when it is not. Lydia T Marti in Che’s Ideas on Pedagory, says, “She underlined the constant need for self-reflection on our individual and collective behaviour to recognise our weaknesses and our mistakes, and to try to correct them. The only way to correct a mistake is by discovering it, by making it public, and the problem is solved. The only revolutionary way is to discuss the problems publicly, the problems that we have.....”

The people’s hopes Honourable Speaker find expression in their public representatives and we dare not fail them. We must demonstrate our unwavering commitment and focus on the task of providing needed services.

I must remind this House Honourable Speaker and confidently so, that this policy speech is informed by the material conditions that confront our people on the ground and I hope it will answer some of their concerns. I have travelled the length and breadth of this province visiting patients in our hospitals to determine for myself the patients’ levels of satisfaction with our service. We moved from a position of despair to the one where our people have accepted our bona fides and began to recognise the work we are doing. This speech talks of the people’s aspirations, their wants and their needs.

2. Focus on eight priorities

Honourable Speaker and Members, our Government’s Programme of Action is embodied in the eight priorities that are contained in the President’s and Premier’s addresses. Those priorities find expression in all levels of government and will ensure that we change people’s lives for the better. I will unpack the progress we have made in this current financial year and also reflect on what we are going to do in the coming financial year.

2.1 Strengthening education and building a skills and human resources base

Our government has prioritised health and education as critical social services, the latter for its role in the liberation of the masses of this country from poverty. The department remains despite its fiscal constraints, committed to the education and training of Health Professionals. In the healthcare sector, we believe that education is for the liberation of our people from the non provision of quality healthcare, preventative in nature and the ushering of promotive health.

The department has increased its investment in education and training. There were 304 bursary graduates in 2011 in the medical field and other Allied Health Professionals. A total of 1352 candidates were financially assisted by the department during the 2011 academic year. The department has R450 million budget dedicated to Health Training & Education.

We have set aside R105,7 million dedicated to the 2012 Bursary Project, and the current 2012 academic year’s number of existing bursars is 1528. Our current Cuban medical student population stands at 112. The total population of Cuban students in South African Universities is 28.

Our own Lilitha College of Education is the second largest nurses training college in SA and will be the largest if the new campuses are approved by South African Nursing Council (SANC), and had 1175 graduates at the end of 2011 and the student population in the five campuses throughout the province now stands at 3671. Twenty (20) Professional Nurses have been recruited from the clinical facilities across the province and put on a nursing education programme for one year funded by the HPTD grant.

Our focus is on expanded training of nurses programme through the reopening of satellite campuses in areas where there is a need. The reopened satellite campuses are the following; Provincial Fort Beaufort satellite, Elizabeth Donkin satellite and Cecelia Makiwane satellite. The latter satellites have also had their first intake this year.

We will further reopen the following satellites to offer sub-professional, bridging and one year midwifery programmes: Andries Vosloo, Midlands, Settlers, Holy Cross, Cala and Bhisho. The department is however awaiting South African Nursing Council approval. An amount of R14.66million has been set aside for Nursing Colleges upgrade and maintenance.

In the field of Emergency Medical Services (EMS) and in particular paramedic training, we are not sufficiently resourced and therefore we have entered into an agreement with Durban University of Technology to train 18 paramedics per year for the next three years. Eighteen (18) students have already started training.

Meanwhile we have 648 EMS personnel who graduated through Our EMS College.

2.2 Creation of decent work and growing the economy

Our contribution to creating decent work, in line with government focus on growing the economy, is demonstrated through the employment of 5 269 clinical staff as well as administrative staff. We have achieved a net gain of 1 014 Medical Officers and 143 Specialists.

The Emergency Medical Services employed 288 Interns which were placed on Maternal Obstetric Units to reduce the amount of maternal and infant mortalities. The department also employed 64 Call Centre interns and 22 people with disability to man the Provincial Disaster Management and Emergency Services Call Centre.

A total of 1 175 nurses were trained and absorbed into the mainstream, while currently we have a student population of 3 671 for potential future absorption into our service.

In the Infrastructure area, the department has employed 2 851 persons this financial year, while a further 2622 beneficiaries in the Extended Public Works Programme will benefit through technical and life skills.

2.3 The fight against crime and corruption

The department has taken a zero tolerance approach to combating fraud and corruption. We are able to report a 100% success rate in matters referred by the Fraud Management Unit for Disciplinary action. Nineteen (19) matters have been reported to the South African Police Services for criminal action.

There is also a greatly improved working relationship between the department and other agencies, such as Office of the Premier and Public Service Commission. This collaboration has impacted significantly in the Eastern Cape Province as a whole in our fight against corruption.

These reactive investigations have resulted in the actual recovery of millions for the department and future savings of hundreds of millions of rand as a result of these criminal activities being detected and stopped. Beside the disciplinary and criminal actions implemented against officials and external parties that were identified, this has also acted as a deterrent to individuals targeting the department.

These experiences have assisted us to identify critical internal control areas and systems to further curtail and prevent further fraud and corruption. An example of one such project relates to Supply Chain Management where it was found that fraud syndicates have targeted the department.

The Multi Agency Work Group (MAWG) and the Technical Support Unit of Provincial Treasury are currently assisting the Department to implement improved systems and processes to enhance our Supply Chain Management processes and Anti Corruption capacity.

Some of the activities currently underway are:

1. Fraud prevention by a declaration management system linked with Persal and the Suppliers’ database
2. Creating a central database where all irregular activities are recorded, monitored and reported on;
3. System updates relating to Supply Chain Management;
4. Increasing investigative capacity to shorten turnaround times of investigations;
5. Tracking and monitoring of all disciplinary actions to ensure zero tolerance attitude and culture is installed in the department; and
6. Implementing a “whistle blower” hotline specific to the Department of Health.

Our results to date are a clear indication of the department’s commitment to installing a proactive anti-corruption culture and eradicating systemic fraud and corruption.

The department has made recoveries totalling R86  880  275.39 in the current financial year. Future savings amount to R335  271  072.17. The department will continue in its efforts to root out corruption and fraud and work with other departments and law enforcement agencies to that effect.

3. Delivering the four Negotiated Service Delivery Agreement (NSDA) outputs

3.1 Strengthening our Health System

3.1.1 Revitalisation of Primary Health Care (PHC)

It is our strongest belief that sound foundation for any health system will have to be based on a strong PHC system. That is why we continue to plough our energies on RPHC. Our investment is also directed at the communities, both receivers and co-producers of the health system through their shaping the outcome of our system.

Through the Social Compact we continue to engage our communities, assign specific roles they need to play in shaping our PHC (through taking responsibility for their health, making decisions on the services they receive or who is being recruited for training etc.).

The other area of our focus relates to the building of specialist teams like a) ward-based PHC Teams, and in the new year 26 additional PHC will be established and 7 500 households will be visited and registered; b) School Health Teams will be established to visit identified schools and focus on eye and hearing care, immunisation, contraceptives and reproductive health; c) District Specialist Teams will be formed per each district and their focus will be on the improvement of maternal and child health services. We have set aside R60.8 million for the District Specialist Teams.

3.1.2 Focus on efficient and effective Hospital Services

One of the challenge areas has been the poorly functioning hospitals. The Hospital Management Policy has provided guidelines on the strengthening hospital services focusing in the main on the type of management that will lead these facilities.

3.1.3 Revenue generation and differentiated amenities

This is a pre-requisite for National Health Insurance (NHI) and EXCO has approved this. Treasury now needs to come up with vehicle to financially manage this intervention.

3.1.4 Quality Health Service and the Core Standards

There is a concerted effort to improve the quality of hospital services through the Norms and Standards, and this is also in line with preparing these institutions for NHI readiness. This is one of the Policy priorities and an amount of R73 million has been dedicated for this area.

3.1.5 Emergency Medical Services

The department has dedicated obstetric ambulances to be stationed in our Midwifery Obstetric Units to ensure quick responses to emergencies and impact positively on our maternal services outcomes. Already we have 36 ambulances stationed in these hospitals, and our target will be all hospitals doing caesarean sections must have an obstetric ambulance. The department has the responsibility that each ambulance has also dedicated personnel to ensure full functionality of this programme.

3.1.6 Infrastructure programme

For the very first time in 17 years, all the infrastructure money has been fully committed to major infrastructural projects. In the current financial year, no infrastructure funds were withheld by national government. With most of the mega projects on construction stage now, the infrastructure budget will be under serious pressure as from the next financial year. A process of lobbying for additional funding with the national sphere of government is under way.

The anticipated expenditure for the 2011/12 financial year will reach record high of 92 per cent of the R1.4 billion. Honourable members I am happy to report that a haematology project in PE Hospital is progressing well and is expected to be officially open on 9 May 2012. This project will make the Eastern Cape Province the third stem cell transplantation Unit in the country. Similarly, both oncology services in Frere and Livingstone hospitals are on track.

Over the 2012 Medium Term Expenditure Framework (MTEF) period, the department will spend R3.6 billion on its health infrastructure programme. Of this amount, R1.3 billion will go towards hospitals under the hospital revitalisation programme, to fund the major infrastructural upgrades of the following health facilities:

• Cecelia Makiwane Hospital
• St Patricks Hospital
• Frontier Hospital
• St Elizabeth Hospital
• Madwaleni Hospital

Maintenance of the general health infrastructure, (including both Forensic Pathology and Emergency Medical services facilities) and purchase of medical equipment remain priorities of the department. To this extent, over R700 million is expected to be spent on these items over the next coming three financial years.

The year 2012, has been earmarked to be a starting period for the piloting of the National Health Insurance (NHI). To this extent, OR Tambo has been earmarked for this pilot and the infrastructure programme is putting aside a minimum of R29 million as a top-up to the general maintenance and refurbishment and upgrade infrastructural work to be conducted in the affected facilities.

Water treatment remains one of challenges facing health facilities, especially in rural areas. We have set aside an amount of R96 million that will be spent on water and sanitation projects at various level of services within the health sector. TB still remains a threat to people’s healthy life styles. It is for this reason that the infrastructure programme will invest no less than R50 million to TB facilities.

In line with our conscious decision to ensure functional hospital services, more than R200 million was set aside to deal with all the infrastructural requirements of the affected facilities in our Rationalised Service Delivery Platform.

The following facilities have received priority for refurbishment and upgrade:

(a) Mjanyana - Engcobo
(b) Siphethu - Umzimvubu
(c) Nessie Knight – Mhlontho
(d) Khutsong - Matatiele
(e) Bambisana - Nyandeni
(f) Dora Nginza – Nelson Mandela Bay Municipality
(g) Taylor Bequest - Matatiele
(h) Zithulele – King Sabata Dalindyebo

The following clinics will get refurbishment:

• Qeto – Nkonkobe
• Tikitiki – Mhlontlo
• Tyelebane – King Sabata Dalindyebo
• Tshezi – Qaukeni
• Mgcwe – Mnquma
• Mkemane – Umzimvubu
• Bumbane – King Sabata Dalindyebo
• Ngqwaru – Intsika Yethu
• Mvezo – King Sabata Dalindyebo
• Malephelepe – Mhlontlo
• Sebeni – Umzimvubu
• Kungisizwe – Elundini
• Centuli – King Sabata Dalindyebo
• Cwele – Enyandeni
• Nqusi – Mnquma
• Vaalbank – Emalahleni

The Department of Health has determined that provision of accommodation for health care professionals is an inherent element of its infrastructure delivery. In trying to practically respond to this bold statement, the department recently entered into a Memorandum of Understanding with the Eastern Cape Development Corporation (ECDC). Various options which are cost effective on how to get the project off the ground as soon as possible are being studied.

Honourable speaker it is a well known fact that one of weaknesses in the Department of Health is a question of information management and backward technological capability. Furthermore, long distances between the service points and poor technological infrastructure in most of the health facilities compromise effective and efficient service delivery. Consequently, more financial resources are used on support services such as travelling, telecommunication and internet connectivity.

This approach has proven not to be viable and as such more innovative ways of rendering quality services have been explored by the department.

To this end I am pleased to announce that a Virtual Private Network (VPN) will be implemented by the department in the 2012/13 financial year.

3.2 HIV and AIDS and TB Clinical Programme

In line with the HIV and AIDS Policy and President’s announcement in December 2009, National has set up targets for the HIV Counselling & Testing campaign. Our current target achieved is 1.274 million of the 2 million set by the Minister. The department has planned to initiate additional 82 000 people for antiretroviral (ART) services, and ensure 250 000 beneficiaries of Home-based care services are reached. The number of Nurses Initiated on the Management of ART has risen to 1 800.

The number of Fixed Public Facilities providing ART in the province has risen from 490 to 784 and the number of patients on ART is 179 000. Over R1 billion has been set aside for the HIV & AIDS and TB Programme, and R76 million of this will be dedicated specifically to deal with and ensure HIV ARV 350 threshold policy implementation.

On the TB front, we will roll out of the Community-based TB Model, a project that was pioneered with KwaZulu-Natal (KZN). As part of this, the department is focused on increasing TB cure rate and stabilisation of HIV infection rate. As part of the roll-out, six facilities will be renovated to ensure MDR-TB patients are initiated within 48 hours and follow-up reviews take place at the facilities.

Three institutions, Khutsong, Nkqubela and Marjorie Parrish will receive digital radiology equipment that will enhance management of TB in these facilities. The GeneXpert diagnostic machine will be rolled out to further seven hospitals (St Patricks, Uitenhage, Holly Cross, Mt Ayliff, Madzikane ka Zulu, All Saints and St Barnabas) and one machine in the Amathole NHLS centre in the new year.

3.3 Maternal and Child Services

In addition to the greater support that will come from the District Specialist Teams, the main activities will be on extended training programme for the clinicians (doctors & nurses); access to basic ante-natal care services and post-natal check-ups for mother and baby. Access will further be improved by the dedicated obstetric ambulances.

Priority will be the 26 identified District Hospitals. The department has set aside R76,2 million for this programme.

4. Budget allocation for 2011/12 financial year

Hon Speaker and Members, we are tabling this budget for 2012/13 Financial Year with a cautionary note. In the past financial year we have had tremendous budgetary pressures which have impacted negatively on the 2012/13 Financial Year allocation. The new budget has demonstrated significant negative growth in critical services areas like goods and services as well as capital budget for development and maintenance of our assets – health facilities and equipment.

We have institutionalised financial and other resources management systems and practices to ensure financial discipline and prudent management culture. This we do because we want to strike a healthy balance between responding meaningfully to service delivery and also showing discipline in managing our resources.

We have already alluded to the MAWG and its potential to save us from fraud and corruption. We also believe that this will arrest fraudulent leakage of resources and unnecessary waste. Procurement systems are being developed to consolidate our earlier work in this area.

Hon Speaker and Members, we are tabling Budget Vote No 3 of the Eastern Cape Department of Health which is:

Table 1: Budget Allocation in Vote No 3 for 2012/13

Table 2 below captures the breakdown of figures in all Conditional Grants, but it
must be noted that Table 1 is inclusive of conditional grants figures.

Table 2: Conditional Grants Allocation for 2012/13

5. Conclusion

Honourable Members, as I conclude this Budget and Policy Speech, I wish to read a poem by a renowned poet Robert Frost. The poem is entitled, “The Road Not Taken.

Two roads diverged in a yellow wood
And sorry I could not travel both
And be one traveller, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair
And having perhaps the better claim
Because it was grassy and wanted wear;
Though as for the passing there
Had worn them really about the same
And both that morning equally lay
In leaves no step has trodden black
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
“I shall be telling this with a sigh
Somewhere ages and ages hence
Two roads diverged in a wood, and I,
I took the one less travelled by
And that has made all the difference.”

Honourable Members, I want this poem to motivate us to say, we have a journey which we must travel with our people to make their lives better. The task is a mammoth one and one that is not desirable because of the challenges that face our people. We need to constantly remind ourselves that our people rely on us. The satisfaction we get is when we have made a difference, no matter how small to some person’s life.

All people of this province have an interest in the department of health and we will  provide that quality health care no matter the cost.

Honourable Members and members of the public, walk this road with us, we know where we want it to lead us to. The bushes, leaves, and all other impediments will not deter us.

I wish to thank the Premier for her strategic leadership, support and guidance, the Executive Committee for its wise ideas, the Portfolio Committee for its oversight role, the Constituency MPL's across political parties.

I also wish to thank the SG and his Executive Management Team, the Primary stakeholders of the department, the District Managers and CEOs, and most importantly, the people of the Eastern Cape for their vanguard and vigilant role
they played and continue to play even this day.

I thank you.