Honourable Speaker of the Provincial Legislature, Mr Supra Mahumapelo,
Honourable Premier: Mme Thandi Modise,
Hon Members of the Executive Council,
Your Worship Executive Mayors and Mayors of our Municipalities,
Hon Leaders of Political Parties,
Our Esteemed Traditional Leaders,
The Acting Director General and other Heads of Administration in Government,
The Head of the Department, Maj Gen (Dr) Mokhethi Radebe,
Leaders of Labour Federations, Civil Society, Faith Based-
Organisations and Business,
Comrades and Friends,
Ladies and Gentlemen,
Dumelang Bagaetsho ba Porofense ya Bokone Bophirima!
I am standing before you to give a picture of a 100 year evolution of the health care system! It is an end of an era and a beginning of a new era in the health care system of the world but especially of our country and province. Our liberation movement, the ruling party, the African National Congress (ANC) is celebrating its 100th birthday. How befitting it is that this world revolution of the health care system is taking place when this liberation movement which has led South Africans to their political emancipation, is now in government? The ANC is in government to see to the success of the revolution in the health care system of our country.
Allow me to take one page out of this 100 pages of the health revolution story and pay tribute, salute and remember among others Dr Xuma, Dr Naicker and Dr Dadoo who provided leadership under the Doctors' Pact of 1947 which united our people across racial divides and paved way for the adoption of the Freedom Charter. There are many other activist health workers of the time who remained true to their profession as they continued to provide essential health services and care for the injured during mass protests against oppression. We salute them all!
Mmusakgotla; re ka bona katlego mo go fetoleng selebego sa mokgwa-tsamaiso wa ditirelo tsa boitekanelo fela fa re ka dirisa matlole ao re tlaa rebolelwang gompieno sentle. Dikgwetlo tsa rona di sa le dintsi mme re ka dira pharologanyo ka bonnyane jo re bo newang gompieno.
Finances and the Budget Allocation
The Department has for the past two years successfully attained an unqualified audit report. This achievement happened after a long vigorous fight to address all the reported findings that led to qualifications and through the effective implementation of the audit recommendations, this was achieved. The Department is amongst the two health departments from all other Provinces that attained an unqualified audit report in the country. We want to improve our finances by building on this success in 2012/13.
We will continue to work hard in addressing all other matters of emphasis as a contribution towards “Provincial clean audit 2014 project”.
In terms of expenditure the department spent R6 380 255 billion of its budget for last year which translates to 99.5% of the total budget allocation. The under spending was mainly on conditional grants and application has been made for rollover of unspent funds in compliance with Section 20 of the Division of Revenue Act (Act No. 6 of 2011). The department made every attempt possible to improve efficiency and value for money, with a strong commitment to reduce wastage and ineffective spending. We endeavor to improve on payment of creditors within 30 Days.
Honourable Speaker and members of the Legislature, I present to you the North West Department of Health budget allocation for 2012/13 which is shared by our eight (8) key programmes as follows:
- Administration: R248 171
- District Health Services: R3 511 549
- Emergency Medical Services: R240 158
- Provincial Hospital Services: R1 745 976
- Central Hospital Services: R211 765
- Health Sciences and Training: R262 322
- Health Care Support Services: R134 038
- Health Facilities and Maintenance: R605 329
Total budget allocation amounts to: R6,959 308 billion
This represents 8.5% growth compared with the budget for the immediate preceding financial year. The budget of the Department increases from R6, 959 billion to R7,545 billion and R7,980 billion respectively for the two outer years of the MTEF period.
Review of the 2011/12 mandates
Honourable Speaker; we begin to review the 2011/12 financial year with the mandates.
The Fight Against Communicable Diseases
In the province we continue to record overall positive outcomes. In the past three years, the province has improved integrated care to patients that are co-infected with both TB and HIV from 18% in 2008 to an impressive 76% in 2010. It is with excitement to report that we are the first province, to cure Extreme Drug Resistant (XDR) TB Patient as confirmed by the National Department of Health. Our MDR and XDR Unit in Klerksdorp credits its success to the dedicated team of Health Professionals, who work under the auspices of the Department of Internal Medicine.
The province’s treatment outcome also improved from 40.3% to 69.8% (i.e. over 20% cure rate improvement) with patients defaulting treatment also showing a decrease from 10,8% to 7.8%. These MDR and XDR cure rates are the best in the country. However, we still need to urge those who are receiving treatment to complete full course of treatment which is at least for six months, as prescribed by health professionals.
Yes, there is a drop in the TB defaulter rate but we are concerned that it remains high at 8% regardless of our efforts to educate our communities. We therefore require intensified public education on this matter.
The Province continues to do well in the HCT campaign, and as of December 2011 the HIV testing rate was 93%. The annual HIV prevalence survey among pregnant women, showed a decline in the province, from 30% to 29.6 %, in the year 2009 and 2010 respectively. The Prevention of Mother-to-Child Transmission of HIV (PMTCT) Programme was strengthened, and all pregnant women were encouraged to know their HIV status, by participating in the HIV Counseling and Testing (HCT) programme, in order to increase access to treatment and care.
The number of Community Caregivers increased from to 5 330 to 6 439. The number of PLHIV (People Living with HIV) support groups also expanded from 90 to 150.
Non Communicable Diseases
Malwetsi a sa tshelanweng go tshwana le sukiri, malwetsi a pelo, kgatelelo ya madi le a mangwe, a tlhoka rona gore re tlhokomele boitekanelo jwa rona. E tshwanetse go nna kgwetlho mo go mongwe le mongwe go tshela botshelo jo bo itekanetseng. Se se ka fokotsa thata mokgweleo o o sa tlhokegeng o malwetsi a a rwesang ditirelo tsa rona tsa pholo. Motho yo mongwe le yo mongwe o tshwanetse go ela tlhoko se a se jang ka dinako tsotlhe. A re fokotseng letswai, sukiri le mafura mo dijong. Go tlhokega gape gore re ikatise ka dinako tsotlhe le go dula re tlhola seemo sa HIV, sa kgatelelo ya madi, sukiri le boima jwa mmele gore re kgone go tsaya ditshwetso tse di siameng ka matshelo a rona. Re tlhoka gore baagi botlhe ba nne le seabe mo go ageng setshaba se se itekanetseng.
Cleanliness
There have been quite a number of achievements we can be proud of. The cleanest Community Health Center (CHC) in the country is also from our province. We initiated a successful cleanest facility award and now many of our facilities are working hard to maintain this new brand that we have created.
Medical Supplies
I joined the Department in the wake of a growing crisis of medical supply to our health facilities. We promised to turn around the situation by substantially increasing availability of drugs and medicine. I am happy to report that the situation has improved and continue to improve. The availability of anti-retroviral and TB drugs has consistently been at 96% - 100% since we took control of the medical depot in 2011.
I need to emphasise that turning around the medical depot is work in progress. The expanded pharmacy at both Ganyesa Hospital and Bloemhof CHC will help with bulk storage of medication and other essential drugs to substantially add to our efforts of ensuring constant availability of medication in our facilities.
Recruitment, training and retention
Honourable Speaker, We have undertaken a recruitment drive to attract foreign Specialists. To-date a Specialist Radiologist and Specialist Orthopaedic Surgeon have joined Klerksdorp-Tshepong. A Neurosurgeon arrived in mid March this year and the Mahikeng Provincial Hospital has also finally appointed a physician after a long struggle in the history of its existence. This hospital also opened a four bedded Neonatal Unit. The impact is that the mortality has decreased drastically in the medical unit. We continued to improve the effectiveness of our health system through our specialised hospitals by appointing two full time Psychiatrists for both Bophelong and Witrand Hospitals. The average length of stay and bed occupancy rate have improved for both hospitals.
This coupled with regular training programme for nurses and primary care doctors resulted in reducing the in-hospital pediatric death rate in the Ngaka Modiri Molema District by 29.7% (death rates in 2010 was at 4.7% and in 2011, 3.3%).
Efforts to capacitate our nursing colleges continue as we produce more of the much needed human resource for health. In this regard, one thousand two hundred and twenty three (1223) learners enrolled for the Diploma in Nursing and Midwifery programme, three hundred and eight (308) for post basic programmes, one hundred and ninety six (196) nurses enrolled in basic degree courses. Furthermore, one hundred and six (106) nurses completed training in December 2011 and are placed in health care facilities for community service while sixty seven (67) Emergency Care Technicians (ECT) learners are on training. We have ninety one (91) students on our bursary programme and we sent 12 students to study medicine in Cuba in the 2011/12 financial year.
The University of Limpopo-MEDUNSA campus and Bojanala district have cemented their academic link, by starting a student rotation within JST Hospital and other facilities in the district. Fourteen (14) specialists in Bojanala have been appointed on joint academic posts with MEDUNSA. A total of fifty four (54) undergraduate medical students and seven (7) registrars are undergoing training in Bojanala district at any one time. Through collaborative efforts, the National Research Foundation has awarded Medunsa and Bojanala District a 2.5 million grant to develop a research chair on Sustainable Rural Development.
We are still battling with the retention of qualified doctors. Efforts are underway to remedy this challenge and Dr Ruth Segomotsi Mompati District is now seeing a good doctors’ retention rate after enforcing the recall of all Cuban Medical Programme doctors who are from that district. When we send our children to Cuba to study medicine, they must know we do so because we want them to come and work in our hospitals when they complete their studies. I am happy to announce that, this year we are sending 50 more students to study medicine in Cuba. We have increased the intake significantly from the 12 that we sent last year.
Infrastructure development
The Public Private Partnerships continue to find expression in our endeavours and Klerksdorp Tshepong Hospital Board has engaged 10 local Matlosana Businesses to donate funds in refurbishing 7 wards in Tshepong
We just officially opened Bloemhof Community health Center and new clinics in Tlapeng, Moshwana and Mmamutla villages in the Dr Ruth Segomotsi Mompati District. Ganyesa Hospital has also received a mayor boost with extension of the hospital’s Pharmacy and Casualty area. Mmamutla and Tlapeng are replacement clinics which further enhance our infrastructure revitalisation programme.
We said last year that we are going to contribute towards the national effort of job creation through our capital projects. In this regard, I can assure the people of North West that we have also prioritised building of a number of community health centers and clinics for 2012/2013. The construction of Buxton, Tweelingspan and Sikhing Clinics will start in August 2012 and will create 300 local jobs.
The main Bophelong Psychiatric Hospital construction project will start in July 2012 and we estimate that it will create 800 local jobs this year. The Lichtenburg Hospital project will start in September 2012 and it will create 300 local jobs. The Brits Staff Accommodation project to start in September 2012 and expected to create 200 local jobs. The designs for the extensions of Mmabatho and Excelsius Nursing Colleges has started, these projects are expected to create 1000 local jobs. In the construction of Moses Kotane, Potchefstroom, Lichtenburg and Taung nursing schools, we estimate that 400 local jobs will be created. The extension to Job Shimankane Tabane Hospital will start in August 2012 and it will create 800 local jobs.
Last year we met with the community of Sekhing in Taung and promised them a CHC. We performed sod-turning and I can announce that the construction of Sekhing, Maquassi Hills, Mathibestadt and Jouberton CHC’s will start in August 2012 and we estimate 600 local jobs that will be created.
Shortage of transport to render health services remains a thorn in the flesh. The fact that there is no vehicle replacement strategy is not helping the situation. Compounding this challenge is the long turnaround time for repairs on vehicles. Our vehicles especially the red fleet spent more time in garages than on the road, as they are not suitable for the conditions in which they are used. We need to correct this in future procurement of the red fleet.
The Department will also continue to increase access to assistive devices for people with disabilities, and also to continue to assess compliance to improved accessibility to people with disabilities within the health facilities.
While we continue to improve on maintenance of health facilities, there are still too many old buildings with structural defects. We are also still battling with inadequate space to render quality services. Some facilities are also not yet compliant to the newly introduced National Core Standards.
Re-engineering of primary health care
Le fa go na le go le go ntsi mo re ka go shupang jaaka katlego le tswelelopele, go sa ntse gona le dikgwetlho tse dintsi tseo re tshwanelang go di fenya. Dikgwetlho tse di tlhoka gore rona jaaka batsaakarolo, baagi le puso re nne ngata e le nngwe. Bagaetsho, fifing go tshwaranwa ka dikobo mme ebile mabogo dinku a thibana.
Mmusakgotla, re santse re na le bothata jwa bontsi jwa balwetsi bao ba tlogelang ditheo tsa pholo tsa selegae ebile di le gaufi le bona mme bafetela ka tlhamalalo kwa maokelong magolo go bona ditirelo. Se se tlisa kgatelelo e kgolo kwa maokelong go feleletse go na le mela e me leele le go leta sebaka.
Public Health studies have shown that out of every 100 sick patients only 5 need to see a doctor, currently 40-60 percent of patients seen in hospitals could receive optimal care at PHC level.
Honourable Speaker, PHC Re-engineering is also about improving the quality of care and it will gain momentum in 2012/13. Implementation of this massive programme is already in motion and our foot soldiers are already on the ground doing work and changing lives. There is hope and our people are beginning to see what we mean when we talk about taking health care services closer to them.
In terms of the Strategic Health Programmes, the efforts to reduce maternal and child death is still a high priority in 2012 and beyond. We are concerned that we still have a significant proportion of women (about 16%), who currently deliver babies outside health facilities. We will intensify efforts to improve delivery within health care facilities so that mothers can have access to professional health care during delivery. We also have prioritised procurement of obstetric ambulances which will be used to transport pregnant women who are in labour to facilities with maternity services.
Integrated Management of Childhood Illnesses (IMCI) remains a key strategy for managing our children and we will now put more emphasis on monitoring implementation. We intend to roll out child problem identification programme to all hospitals where children are managed.
Honorable Speaker, in 2011/2012 the department committed to increase Basic Antenatal Care (BANC) sites from 169 to 219. By December 2011, 290 sites were implementing BANC.
Emergency Medical Rescue Services (EMRS) will be one of the areas of utmost attention. The Department will have to aggressively respond to the plight of our communities and we must improve the response time for this to happen. We therefore have plans to establish and fund EMRS satellite stations in the districts to improve response times. We are on course to Reengineer Emergency Medical Services (by training, discipline, access and communication) to improve the response times of ambulances to all communities to be in line with national targets.
National Treasury has just awarded a tender for aeromedical services which is going to be used for specialised services to remote areas. In cases some of our patients in remote areas are in urgent need of specialised services, a specialist will be sent to them via aeromedical services.
We therefore want to officially launch the PHC Re-Engineering Programme this year and roll it out beyond the current pilot sites. In implementing PHC re-engineering, we will be focusing on reviving school health service, integration of chronic models and outreach teams to homes of patients. We are hopeful this will substantially improve waiting times for other clients as well as reducing the work load at secondary level of care. We also want to integrate mental health into the chronic model as part of this programme starting from the current financial year.
National Health Insurance
Healthcare is one of the top social and economic drivers of the world today. The rising cost of medical care is one such a driver. Disparities in health outcomes are the most obvious example of an unbalanced and unjust health system. Upon Receiving an Honorary Doctorate from Harvard University in Boston on the 18th September 1998 President Nelson Mandela said that, “The greatest single challenge facing our globalised world is to combat and eradicate its disparities”.
Currently, our country is facing a quadruple burden of disease namely, HIV/AIDS and TB, Child and Maternal deaths, Non-Communicable diseases, as well as Trauma and Accidents. As a rural province, we are one of the hardest hit by both the global economic meltdown and the quadruple burden of diseases.
Increasing life expectancy is therefore our top priority and we want to improve life expectancy of mothers and babies including all citizens of the North-West. We must work even harder to combat incident of sexually transmitted infections including HIV and AIDS and decrease the burden of disease from TB. The main contributor to our low life expectancy is mainly due to unhealthy lifestyles.
It is reported that 50% of the difference in economic growth between rich and poor countries is connected to bad health and lower life expectancy. It was stated by philosophers more than a thousand years ago and still rings very true today: “Health is our greatest wealth”.
The implementation of the National Health Insurance (NHI) finally started on the 1st of April with identified pilot sites in the country. Dr Kenneth Kaunda District is our pilot site in the province. A special conditional grant has been set aside to fund the pilot projects. The piloting will help us finalise how the service benefits will be designed, how the population will be covered and how the services will be delivered under NHI. As we have announced previously, NHI will be implemented in phases and we will make announcement at every stage.
Our Government deemed it fit to initiate a process of establishing a healthcare financing system that will make sure that all citizens of South Africa (including legal long-term residents) are provided with equitable, universal access and coverage of essential healthcare services, regardless of their employment status and ability to make a direct monetary contribution to the NHI fund.
Going forward
Honourable Speaker and the House; we get to the 2012/2013 financial year with a strong resolve to improve where we left off in 2011/12. We are not demoralised by our past failures and challenges nor are we blinded by our past successes. We want to make the best out of this financial year by building on our successes and take health care service delivery to greater heights in our province.
We want to start by paying attention to the emphasis on infrastructural development and job creation as highlighted by the President and the Premier on the State of the Nation and Province Addresses. In the State of the Nation Address, President Jacob Zuma emphasised the need to industrialise the country through infrastructure development to create more jobs. Healthcare infrastructure development is also crucial for social and economic development as it will not only improve the quality of healthcare but will also contributes towards job creation. A modern healthcare system which delivers high quality care is not only beneficial to individual citizens and their quality of life but is also one of the building blocks for economic development of the country as a whole. In other words, the economic growth of a country is directly connected to the quality of care it provides.
In building on our TB successes, we will start establishing MDR TB units in all the districts in the current financial year. We want to do this to improve the management of the TB patients, through the use of global funds. The eligibility criteria of initiating patients at CD four counts of 350 will still be strengthened. We will improve accessibility of services through expansion of ARV services to all of our facilities and increase the frequency of mobile visits to farming communities. This year, we will improve on the management of care givers payment by decentralising it with the necessary support. Conditional grants for HIV and AIDS will also be managed at the district level.
We faced over the years serious challenges caused mainly by a skewed healthcare financing system which results in an increased burden of disease because the majority of the population and those suffering the greatest ill-health cannot access good quality healthcare. With the introduction of the NHI, there will be provision of a package of services that will extend to prevention of diseases and promotion of good health, compliance with quality standards, acceptance of capitation as a method of payment instead of fee for service and appropriate pricing mechanisms.
We are overhauling the healthcare system and improving its management because that is what we need for the NHI to succeed. In order to obtain maximum quality under NHI, we need to radically improve the quality of services rendered in our public health facilities. This means massive investment in improvement of health infrastructure, both buildings and equipment.
I now come to other matters of importance and resources needed to make health care provision a reality.
In increasing our human resource capacity, we will continue to improve training on nursing, EMRS and medical care to strengthen PHC and health care service delivery towards a well functioning NHI.
As we move forward, focused to turn around the face of health care in our province, there certain basic core standards that must be complied with. I wish to draw the attention of managers in my Department to the following non-negotiotiables:
- Infection control and cleaning
- Medicines, Essential drugs and Medical supplies including dry dispensary
- Medical waste
- Blood supply and services: SANBS
- Food services and relevant supplies
- Security services
- Laundry services
- Essential equipment and maintenance of equipment
Honorable Speaker and Members of this House will agree with me that, given the limited financial resources and the many healthcare needs enumerated above, the importance of prudent financial management in the department cannot be over emphasised. The Department will accordingly strive to do more with less as it continues to look for better ways of conducting its business in the new financial year and beyond. The three E’s of economy, efficiency and effectiveness will be our watchword as we try to extend the use of every Rand that is voted in the budget to achieve value for money.
Honourable Speaker; as I proceed towards conclusion, allow me to thank the Honourable Premier for the support she continues to give me and the Department. I thank my political home the African National Congress (ANC) and its leadership in this province for the political wisdom to implement the ideals of the Freedom Charter and allowing me to be the one to lead the Health Department in this time and era in the implementation of these ideals which are now becoming a reality in the form of the NHI.
To the all members of the Provincial Executive Committee; colleagues and fellow MECs, I thank you for your unwavering support all the time. To the Chairperson and members of the Standing Committee on Health and Social Development; the Chairperson and members the Provincial Health Council; thank you for your vigilance and advices.
To the HOD, Major General (Dr) Mokhethi Radebe and his management team in the Department, I thank you for your support all the time. To all our employees, the doctors, the nurses, health professionals and support staff in the administration, I thank you for your dedication and hard work.
I wish to state that stakeholder involvement was key to our achievements in the past financial year and is certainly what we need to overcome our challenges in 2012/13 and beyond. I would like to acknowledge the valuable contribution made by our developmental partners, community based organisations, traditional leaders and healers, Faith Based Organisations and the private sector including our mines for the role and enthusiasm they have shown in caring for the health of our people. Allow me to mention Lonmin, Xtrata, Anglo-Ashanti, Sun City and the Royal Bafokeng.
Our sister Department of Social Development, Women, Children and People with Disabilities assisted us with profiling of households. This assisted in the identification of health problems in specific areas. All our Social Cluster Departments, I thank you for your role and I further challenge you to strengthen the integrated approach to services delivery. The role of the Department of Home Affairs and the National Prosecution Authority is also commendable in our day to day work.
I commend the role of our academic partners especially the North-West University, Medunsa and the University of Witwatersrand for their varied contributions to the Department and partnerships.
A special tribute to Dr Angelika “Mmathapelo” Krug who has left our country and province for her native Germany after providing health care services to our rural communities for over 30 years.
Dear to my heart, I thank my wife Mme Masike, the family and the children for standing by my side all the time and for always understanding the demands of my work which most of the time denies me of quality time with them.
Lastly, I thank the citizens of the North West Province, our clients, the patients and various communities for showing patience and understanding that we shall overcome. It is written in the book of Ecclesiastes 9:11; “The race is not for the swift, nor the battle to the strong…”
I have faith, together we shall overcome because working together we can deliver quality health services for all!
“Working together we can build better and healthy Communities”
I thank you!
Ke a leboga!
