Honourable Speaker
Honourable Members of the Provincial Legislature
Colleagues
Members of the public,
Honourable Speaker, I am very grateful for this opportunity to update the house and the honourable members on the progress made in terms of certain key initiatives undertaken by the Department of Health, with specific reference to HIV and AIDS prevention, medical male circumcision (MMC), the fight against fraud and corruption and the improvement in leadership and nurse training.
Honourable Speaker, the pronouncements made by our honourable president in December 2009, served as a stark reminder to all of us, the urgent need to reaffirm our seriousness and commitment towards improving the lives of the citizens in our country. Taking our cue from these pronouncements, the Department embarked on a robust plan of action to address the HIV and AIDS pandemic in our province.
HIV and AIDS prevention initiatives
We are of the firm belief that in order to make inroads into this huge challenge, we must concentrate on prevention initiatives. In so doing, the department has responded to the presidential announcement of the testing campaign countrywide and with the launch that took place in our province at Edendale hospital, on 30 April 2010.
The drive towards increasing the number of people tested grew in leaps and bounds. The departmental target set is 3,059,234 by the end of June 2011. The total number of people tested by the end of June 2010 was 409 556, which translates to 67 percent of the quarterly target.
Although the original plan was for a phased approach, the department has ensured that the service is available in all districts in the province and this has been the case from day one of implementation.
Preparations are underway to re-launch the campaign in schools, villages and farms. Services are also conducted on an ad hoc basis at malls, churches, grant pay points, tribal courts, farms, businesses, schools and community halls.
Honourable Speaker and members, it must be noted that the introduction of the medical male circumcision has contributed positively to the increase in the number of people tested, more especially males.
The increase in the number of patients eligible for and able to access antiretroviral therapy (ART) is also increasing as a result of the HIV counselling and testing (HCT) campaign.
In addition to the total number of condoms distributed in the quarter ending June 2010 was 17 608 600 out of a target of 23 million. Whilst there are challenges with regard to the appointment of service providers in certain districts, steps are being taken to address this, in order to reach the targets and overshoot if possible.
Antiretroviral therapy
Honourable speaker, I have already alluded to the fact that as a result of the HCT campaign, we are experiencing a better outcome in terms of identification of people needing access to antiretroviral therapy and our figures for the first quarter of this financial year demonstrate this.
Based on the up scaling at primary healthcare level, the target for the first two quarters of 2010/11 is 212 clinics and to date we have achieved this service across 162 clinics, this being 76 percent of the cumulative target.
More clinics will commence antiretroviral treatment initiation in the next two months and the service will certainly be improved in this manner. The total number initiated on antiretroviral treatment as at end of June 2010 was 403 923 with 343 834 on treatment, inclusive of 33 542 children.
Honourable Speaker and members, I wish to take this opportunity to acknowledge and congratulate the University of KwaZulu-Natal delegation that represented KwaZulu-Natal at the International AIDS conference held in Vienna last week.
The trial to assess the safety and effectiveness of the vaginal microbicide one percent Tenofovir gel for the prevention of HIV infection in women in South Africa yielded promising findings which will certainly enhance our efforts as a country in the prevention of HIV and AIDS.
Male medical circumcision
In response to the call by his majesty to revive the culture of circumcision in the province, the department developed an operational plan for the roll out of this programme in KwaZulu-Natal.
To ensure buy in from the communities, the honourable premier convened a consultative meeting was with amakhosi in January 2010 and this meeting was followed by local consultative meetings with other stakeholders through the flagship programme.
The programme was launched by his majesty on 10 April 2010 in Nongoma and this launch was followed by the implementation in the whole province. The implementation is through the day to day circumcisions in the facilities and also through seasonal camps where mass circumcisions are performed.
Based on the data from the clinical trials, models have estimated that routine medial male circumcision across Sub-Saharan Africa could prevent up to six million new HIV infections and three million deaths in the next two decades.
The call by his majesty provides an opportunity for the province to implement the programme as part of the comprehensive risk reduction package to make a dent in the epidemic in this province.
The target group for adult circumcision is the age group 15 to 49 years. Of these 4 321 830 males in the province, approximately 54 percent are males of ages 15 to 49, translating to 2 333 788 males that would need to be circumcised (catch up phase).
This number excludes Jewish, Muslims and other ethnic groups that practice circumcision in the province. It would be expected that this number will be low in KwaZulu-Natal province as these groups are in a minority.
Therefore these figures are negligible for the purposes of this document. These figures have therefore been broken down into yearly targets for the next five years. A programme around neonatal circumcisions is still being discussed.
Honourable Speaker, All our district hospitals are designated to provide medical male circumcision as part of comprehensive package for HIV and AIDS management.
In this regard, additional resources have been allocated to support the added medical male circumcision function. By the end of June, a total of 5 571 male medical circumcisions have been completed.
Of this total, 2 223 circumcisions were performed at health facilities, 2 548 at camps specially set up for this and 800 or more were performed using Tara Klamp method. This device enables circumcisions to be performed safely and easily with the following benefits:
-
it is a safe and effective method
-
there is no active bleeding during surgery or in the post circumcision period
-
it is a disposable device and
-
it reduces the risk of infection.
Honourable Speaker as we speak, for the whole of this week we have a team of health practitioners from Malaysia led by the inventor of Tara Klamp, Dr A Singh, conducting training to our local doctors and male nurses on the correct use of the devise. We would be able to provide the house with comparative experience in use of both methods in the next sitting.
I must add that we have appointed a manager at head office to manage the medical male circumcision together with traditional medicine. Additional budget has been allocated to facilities to appoint additional doctors to assist with the medical male circumcision.
The department has also brought in Urologists into the programme to provide clinical oversight and training. Medical male circumcision has been integrated into the mainstream HIV budget as part of the comprehensive plan to manage HIV and AIDS.
Nurse training
Honourable Speaker, The department has shifted its focus with regard to nurse training, in an attempt to improve clinical care, enhance the nursing services provided and address the inequities in this scope of practice.
The main areas of focus are staff nurses and nursing assistants. In April 2010 we advertised 661 staff nurse posts and 611 nursing assistant posts. Commencement of duty will be in August 2010.
Of the new recruits, 290 will come from community based workers selected at community level, so that training will be localised. This demonstrates the ability to lift people out of their current situations and create job opportunities, career paths and positively contribute towards the war against poverty.
Investigations
Honourable Speaker, the department is very serious about issues of fraud and corruption that plagues government departments. As part of the turnaround strategy of the department, a number of initiatives have been introduced by the joint management team, amongst which, cases of alleged fraud and corruption are at the forefront.
A total of 27 cases have been investigated, these with serious financial prejudice to the department. As a result of these efforts, there were six dismissals, two resignations, one case withdrawn, three final written warnings and 15 pending cases to date.
These investigations are in addition to the ongoing investigation undertaken departmentally and which as at the end of June, 377 cases were under investigation.
Honourable Speaker, a disturbing trend in the public service is the abuse of certain conditions of service. One of the most challenging types of abuse is that which is associated with remunerative work outside the place of employment.
In this regard, we have all categories of staff performing remunerative work outside the public service, some with authority and others without.
Amongst other things, specialist doctors run private practices whilst holding down a full time jobs with the department, nurses engage in "moonlighting" activities inclusive of registering with employment agencies and then provide services during off periods and during leave or sick leave, other professional and non-professional personnel have business interests outside which they do not disclose and conduct business with the department and other departments within government, just to cite some of the examples.
These activities pointed to a need to review the policy on remunerative work outside the public service (RWOPS) with a view to strengthening the internal control environment and curb such activities.
The draft policy is near completion and once implemented the situation will be more aggressively monitored. A few cases of this type of misconduct have been reported to the Department and investigations are underway.
Redeployment of hospital chief executive officers
Honourable Speaker and members, you will no doubt have heard about some of the redeployments that the department has made with regard to hospital chief executive officers.
There is a perception out there that these managers have been moved out of their urban settings and sent to rural areas. It must be emphasised that the redeployments were as a result of a strategic move to ensure that we enhance efficiencies at our hospitals, especially those with serious service delivery challenges.
The managers who were redeployed were faced with overwhelming situations and in they were redeployed to other institutions in line with their skills and abilities.
There is also a developmental programme for these managers whereby their skills and leadership abilities will be enhanced. The redeployment is not a punitive measure but rather a means to ensure that we have able managers at the coal face who can respond to the needs of our people in delivering healthcare.
Conclusion
Honourable Speaker and honourable members, these small strides in our move towards improving the lives of our people, ensuring service delivery and how we utilise government resources, will certainly contribute to the broader initiatives of our government and more improvements will be realised as we change our focus to the high impact issues thus making a positive contribution for better health outcomes and social compact.
I thank you.
