MEC Mathabo Leeto: Free State Health Prov Budget Vote 2023/24

Honourable Speaker, Me. Zanele Sifuba
Deputy Speaker, Me. Lucy Mapena
Honourable Premier, Mxolisi Dukwana
Members of the Executive Council
Members of the Legislature
Commissioners of chapter 9 institutions
Executive Mayors, Mayors, Speakers, and Councillors
Director-General, HODs, Municipal Managers, CEOs of government entities and members of Senior Management in Government
Members of Health Governance Structures Provincial AIDS Council
Partners in Health Service Delivery Members of the Media
Leadership of the organised labour Distinguished Guests
People of the Free State Ladies and Gentlemen
Honourable Speaker

This theme will be our baseline as we continue to do our work, because our responsibility is to “Serve our People “ and account to them on the progress we are making when we spent budget allocated to the department.

Honourable Speaker

The 2023/24 Budget Vote is presented just few weeks before the commemoration of a historic day in the liberation calendar of our country.

On the 27th of April 2023, South Africa will commemorate the 29th Anniversary of the first Free Elections when South Africans where given rights to choose the government of their choice.

As we celebrate the Freedom Day we will always cherish our heroes and heroines who tirelessly and selflessness defeated and ended the apartheid system working side by side with the masses of our people.

Honourable Speaker

In 2018, the Presidential Health Summit was held with various stakeholders for critical consultations and led to development of the Presidential Health Compact with 9 pillars of identified interventions to which we unequivocally commit as the Free State department of Health and on which we shall uncompromisingly account to the stakeholders and consumers of the service packages we offer.

These pillars which for us are a call to duty and to convert into strategic objectives or government’s programme of action upon are:

Pillar 1: Augment Human Resources for Health (HRH);

Pillar 2: Ensure improved access to essential medicines, vaccines, and medical products through better management of supply chains, equipment and machinery;

Pillar 3: Execute the infrastructure plan to ensure adequate, appropriately distributed, and well-maintained health facilities;

Pillar 4: Engage the private sector in improving the access, coverage, and quality of health services;

Pillar 6: Improve the efficiency of public sector financial management systems and processes;

Pillar 7: Strengthen the governance and leadership to improve oversight, accountability, and health system performance at all levels;

Pillar 8: Engage and empower the community to ensure adequate and appropriate community- based care; and

Pillar 9: Develop an information system that will guide the health system policies, strategies, and investments.

Through the forthcoming Medium-Term Strategic Framework (MTSF), and in aligning our programme of action with the aforementioned pillars and the predetermined objectives year on year, our 2023-27 commitments would be:

1. To enable the legal framework created for the implementation of National Health Insurance (NHI) Bill and Universal Health Coverage; and roll-out quality improvement programme in public health facilities to ensure they meet quality standards required for certification and accreditation for NHI.
2. Improved quality of primary healthcare services through expansion of the Ideal Clinic Programme; and expand the primary health care system by considering the state of CHWs in the public health system with a view of absorbing them within existing resource constraints or other means possible working with strategic partners.
3. Strengthen the six core standards of quality healthcare service provision which include, facilities opening on time, having adequate staff with good attitude, safety and security for patients and staff, availability of medicines, infection control and cleanliness.
4. Improve Human resource for health by implementing WISN and the Human Resources for Health strategy by employing nurses, and deploying all Cuban trained doctors to clinics and community health centres on a fulltime basis.
5. Reconsider the current rostering and deployment of ambulances to easily be accessible to wards to improve the response times, balanced against the norm of one (1) ambulance per 10 000 population. The Call -Centres must be sufficiently staffed and be competent in call screening and ambulance deployments.
6. Support and strengthen the performance and functions of governance structures like district health councils, hospital boards and clinic committees.
7. All the identified non-negotiables shall be adhered to and prioritised in the procurement practices of all our facilities.
8. Drive national health wellness and healthy lifestyle campaigns to reduce the burden of disease and ill-health;
9. Protect children against vaccine preventable diseases; and Improve the integrated management of childhood disease services.
10. Provide good quality antenatal care.
11. Develop a comprehensive policy and implement the legislative framework to mitigate the risks related to medical litigation and medico-legal cases as a result of medical malpractice or medical negligence.
12. Support establishment of provincial nursing colleges with satellite campuses within the province.
13. Strengthen the EMS referral system upstream and downstream by entrenching referral policy and clinical referral procedures at facility level, including patient transport management system.
14. Set out an achievable trajectory of the National Development Plan 2030 long term goal targets of increasing the life expectancy of men and women to 70 years, reducing the quadruple burden of disease, reducing infant mortality rate and the under-five mortality rate of less than 20 and 30 deaths per thousand live births respectively, and the generation of under-20s largely free of HIV.
15. Strengthen the provincial health system to be responsive to any disease outbreak and pandemic in order to achieve the desired outcomes. The lessons learnt from and during the Covid 19 pandemic have been a launchpad for perfecting our pandemic response plans.

In the 2022/23 financial year, an amount of R12.711 billion was allocated to the Department, which increased by 3.7% to R13.182 billion following the budget adjustment of November 2022.

1. Administration                                                     : R332.145 million
2. District Health Services                                      : R5.555 billion
3. Emergency Medical Services                            : R907.849 million
4. Provincial Hospitals                                            : R1.752 billion
5. Central (and Tertiary) Hospitals                         : R2.954 billion
6. Health Sciences & Training                                : R339.461 million
7. Health Care Support Services                           : R179.670 million
8. Health Facilities (Infrastructure) Management : R738.951 million

Administration

The aim of the Programme is to conduct the strategic management and overall administration of the Department of Health, this includes: Policy formulation, overall management and administration support of the Department and the respective districts and institutions within the Department to ensure service effectiveness. As part of building the capacity of the department, Programme 1 was allocated R311.2 million in 2022/23. In this financial year we have allocated R332.1 million. This represents a slight increase of R20.9m.

Litigation reduction strategy

The Department is encouraged by the Special Investigating Unit proclamation signed by the state president His Excellency Mr Cyril Ramaphosa for the investigation of medico legal claims. We have noticed a huge progress resulting from similar investigations done in the Eastern Cape and we take courage of the latest Eastern Cape High Court ruling on the future medical care costs.

During the previous financial we committed to fill 637 active vacant posts, prioritising critical and clinical posts and we have appointed 574 officials and promoted 255 officials.

Much work has been done in reviewing and modernising the macro- organisational structure. Costing for the proposed structure has been finalised and the letter of verification of budget allocation on Compensation of Employees has been requested from the Provincial Treasury.

The Department of Health will not be able to achieve its health outcomes without the support and corporation of governance structures as they are critical link between the department and the community.

The department has appointed and trained hospital board members for all our hospitals to empower them for the effective execution of their responsibilities. We are however still challenged with the functionality and effectiveness of the clinic communities, especially in the Lejweleputswa district. At the moment, only 165 of the targeted 188 clinic committees are operational. We rely on the corporation with SALGA, local government, Community Development Workers (CDW), community-based organisations and leaders across all the sectors to get our District Health Councils, Hospital Boards and clinic committees to a level where they will function effectively.

The Department of Health will continuously interact with the communities on issues that affect their health. The MEC for health and management of the department will continue to utilise “Taking Primary Health Care To The People” as a platform for community engagement and to bring services closer to the people.

Honourable Speaker

We are intentional in upscaling our investment in Information and Community Technology (ICT) as a catalyst to an efficient and effect health system. In the current financial year, we completed development of an electronic invoice tracking system to monitor the payment of suppliers within 30 days. This system will be implemented in 2023/24 to address non- payment of service providers within 30 days.

I am happy to announce that we have established a working relationship with the Eastern Cape Department of Health that will see us rollout a bespoke Patient Information System (HMS2) at all district hospitals to improve patient care, revenue generation and mitigation against the increasing medico-legal exposure.

We will implement this project 12 hospitals during 2023/24 financial year. This is part of aggressive attempts to modernise public health through digiting health service. This programme will include the back scanning of paper-based patient files.

Over and above this, we have heeded the call of the Government Lekgotla for the Department to utilise technology as much as possible, to improve the services, we render in the community. In the upcoming financial year, we will invest in the following bucket of technology-driven interventions:

• Telemedicine
• Interactive engagement with patients
• Audio-visual recording of surgeries
• Queue management systems
• Advanced health technology
• Robotics in the performance of surgeries

Health Science Training

This Programme is intended to provide Education, Training and Development Programmes towards skilled workforce that is responsive to the needs of the Free State Department of Health.

In the past financial year, the programme was allocated a budget of R329.5 million, this has increased to R339.461 million.

Nelson Mandela Fidel Castro (NMFC)

The Nelson Mandela Fidel Castro Medical Training Programme is based on the principle of international solidarity with the people of Cuba. We have appointed 62 Graduates from the NMFC programme as Medical Officers. Currently, there are only 2 students completing their studies in Cuba.

EMS College

In this financial year, we have committed ourselves through the EMS College to conduct an outreach training programme on First Aid to empower 150 of the youth in our communities with skills. This is done with the objective of encouraging our people to attend to basic health challenges like treating burns and other minor ailments that ambulances are often called for.

We achieved the following throughput from our qualifications in this year:

• 4 students graduated with a Higher Certificate in EMC and there were 21 new enrolments in the 2023 academic year
• 8 students graduated with a Diploma in EMC and there were 9 new enrolments in the 2023 academic year
• 805 employees were trained and upgraded on the latest Clinical Practice Guidelines
• 100 EMS officials trained in Rescue operations

The College has successfully launched an online training platform, “Thuto Encha” to address the upgrading of EMS staff on the Clinical Practice Guidelines (CPG’s).

During the current financial year, the Department implemented skills programs targeting unemployed youth. The internship programs implemented are on work integrated learning and graduate internship program.

Two Skills Development Programmes were implemented:

• 108 TVET Learners appointed for Work Integrated Learning on 18- month contracts, and 40 of these were funded through HWSETA
• 166 Graduates were appointed for an internship programme on 24 months contract

Free State School of Nursing (FSSON)

Nursing is the backbone of the health sector, and we need to sustain the inflow of new skilled nurses. We have determined the need to restructure the curriculum to be in line with the current requirements of the profession. The school has re-opened the 4 sub-campuses for nursing education and training of learners in Higher Certificate in Nursing.

In order modernise our andragogy in response to the demand for remote learning, we have implemented an Electronic Learner Management System. FSSON is accredited by the South African Nursing Council and Council of Higher Education to offer the following programmes:

• 1-year Advanced Diploma in Midwifery for 90 students per year. The first intake will be in January 2024
• 3-year Diploma in General Nursing for 155 students per year
• 1-year Higher Certificate in Auxiliary Nursing for 155 students per year

There are currently 44 Community Health Workers studying towards a Higher Certificate in Auxiliary Nursing in 2023.

COVID-19 Response

The department’s strategy to appoint epidemiologist per district strengthened our surveillance at the peak of the COVID-19 pandemic and yielded good results. While is it difficult to tell the end of this pandemic, experts are already predicting the next one. In this financial year, we renewed COVID-19 contract appointments of 1 689 to strengthen health service delivery that is heavily burdened.

It goes without saying that healthcare workers are at the heart of any strong healthcare system. Throughout the COVID-19 pandemic, frontline workers, which include Community Health Workers, have selflessly risen to the challenge. Whether it was caring for the sick, making sure that vaccines reach the most vulnerable, testing and reporting cases or keeping routine healthcare  services  going,  their  efforts  have  been  immense.

This support is needed to equip healthcare workers to do their job properly, but also to ensure that the profession continues to be appealing, attractive and does retain the talented and dedicated people. We are proud to have attained 60.2% coverage of the eligible population vaccinated against COVID-19. This places the Free State in leading position in the whole country. We continue to encourage our communities to vaccinate at any of our clinics. All public health facilities are now COVID-19 vaccination sites. The lessons we have learned from the pandemic include, but not limited to strengthened disease surveillance and outbreak response at a district level, use of digital tools for tracking and tracing, as well as public private collaboration on healthcare provision. This was a clear demonstration that the implementation of the NHI is imperative.

Clinical Health Services

Honourable Speaker, Clinical Health Services aim to render Primary Health Care services, including community-and facility-based services, Forensic Pathology Services, District, Provincial, Tertiary and Central Hospitals. These services are the core business of the department. The Clinical Health Services are primarily concerned with the reduction of comprehensive healthcare services.

Reduction of incidences and preventable deaths due to communicable diseases

HIV/AIDS

The Department is focused on implementing the HIV 95-95-95 strategy, which entails intensifying HIV prevention, case-finding, and treatment. The strategy focuses on getting 95% of HIV positive people knowing their status, 95% of those that know their HIV status being on antiretroviral treatment (ART) and 95% of those on treatment being virally suppressed.

Honourable Speaker, I am proud to announce to this august house that the Free State performed better than any other provinces in the country, as at November 2022. Four of the 5 Free State district’s managed to be among the top 13 of the 52 districts in the country on achieving the previous strategy of 90|90|90. While the country has moved towards the revised 95|95|95 strategy. Thabo Mofutsanyana district, with the support of the USAID/Right- to-Care, is the 2nd best performing district in the country towards achieving the 95|95|95 targets. The current performance of the Free State is at 94|86|93. We are confident we will reach this target by intensifying community and index testing; welcoming clients who were lost to follow-up, back to our clinics, and strengthening treatment compliance through adherence clubs.

Tuberculosis (TB)

TB remains amongst the leading causes of death in the Free State. One of the contributing factors is high loss to follow up of TB patients was experienced at the height of COVID-19. The province implemented a successful catch up plan to bring back clients who were lost to follow up, back on treatment.

Maternal, Neonatal, Infant and Child Mortality

Neonatal mortality reduced from 15.3 per 1 000 live births to 11.9 the previous financial year. The department is implementing both the clinical outreach and in-reach programmes to improve the skills of our health care workers for reduction of mortality and morbidity rates and for safe deliveries.

Reproductive Health

The department is on course to contribute to the reduction of teenage pregnancies, through awareness, integrated school health programmes and youth friendly zones at primary health care facilities. I am proud to announce that 137 of our 223 primary health care facilities have fully functional youth zones. The implementation of the youth zones led to the Department being rewarded with a National Recognition Award by the National Department of Health.

Immunization coverage

Honourable Speaker, while the Free State has achieved a high immunization coverage of 82.7% of children under 1 year, the province has however also experienced an outbreak of measles. To date, we have 28 laboratory confirmed measles cases mainly in Thabo Mofutsanyana district , Bethlehem in particular. To reduce the spread of measles, the province is conducting an immunization campaign targeting children from 6 months to 15 years of age.

Non-Communicable Diseases

1. Our strategic policy position as government is to reduce premature mortality from Non-Communicable Diseases through prevention and treatment, by one-third. The Department will continue the screening for NCDs and put all eligible client on hypertensive and diabetic treatment. We encourage our communities to lead healthy lifestyles.

Mental Health

Orthopaedic Surgery

The backlog in Orthopaedic Surgery continues to be a major challenge owing to the high demand for services and the shortage of specialists and operating theatre time. In dealing with the backlog in the previous financial year, we have completed 131 orthopaedic procedures, on outreach, at Botshabelo and Albert Nzula Hospitals.

Renal Care Services

The department will be upgrading Renal Services to the following Hospitals during the 2023/24 financial year through procurement of more Renal Dialysis Machines and establishment of Renal water purification systems: Extra machines will be provided to increase the renal dialysis services to the Free State Population at the following facilities:

1. Mofumahadi Manapo Mopeli Regional Hospital
2. Universitas Central Hospital
3. Boitumelo Regional Hospital
4. Pelonomi Tertiary Hospital
5. Dihlabeng Regional Hospital
6. Bongani Regional Hospital

Honourable Speaker, we will further extend this service to Fezi Ngubentombi and Albert Nzula District Hospitals.

Orthotic And Prosthetic Services

One of the key priorities is to restore the dignity and livelihoods of people with temporary or permanent disabilities through the provision of orthotic and prosthetic devices. Honourable Speaker, as a department we have made significant interventions towards social and economic inclusion of our people who have lost their mobility by making assistive devices accessible to them. In this regard, we provided 72.2% and 63.9% of those identified to be eligible clients, with orthotic and prosthetic devices, respectively. The plan of the department is to half the current backlog of medical orthotic and prosthesis and to reduce the backlog by 2025.

Advanced Health Technologies

The Universitas Academic Hospital has kept up with technological advances and successfully performed knee replacement surgery on a domestic abuse survivor and 23 other patients through robotics and artificial intelligence. The results have been successful and fully justify the rationale for expansion of this programme to benefit more people. These are the benefits of the 4th industrial revolution and machine intelligence to advance health care for improved health outcomes. We will therefore continue to explore the use of robotics in other programs.

Clinical outreach was conducted by Universitas Hospital to various regional and district hospitals, across 11 different clinical disciplines. A total number of 4 816 patients were seen on outreach. There was in-reach of 15 doctors at Universitas Hospital. This programme involves the upskilling of medical officers in different disciplines.

National Health Insurance (NHI)

National Health Insurance (NHI) aims to create conditions for Universal Health Coverage. This will ensure equitable access to quality of healthcare services for the population irrespective of their socio-economic conditions. For our health facilities to participate in the NHI, they will have to attain ideal health status and be accredited by the Office of Health Standards Compliance (OHSC).

We are refurbishing our existing facilities to meet the required ideal health facility standards in preparation for the implementation of the National Health Insurance.

Honourable Speaker, the Department will put more effort into ensuring that all our hospitals are compliant with the OHSC. To this end, only 2 hospitals (Fezi Ngubentombi and Botshabelo district hospitals) have attained the platinum status.

To reduce referrals to higher levels of care, and improve access to quality healthcare, we have contracted 38 doctors under the NHI grant to render services in Primary Health Care facilities across the province.

PHC facilities rendering 24-hour service

We currently have 4 facilities in 3 districts providing 24-hour services. In this financial year, the following clinics will offer services over extended hours, from 7:30am to 19:00pm: Honeypark in Welkom, Leratong in Allanridge, Che Guvera in Sasoburg, Kgotsong in Welkom, Bloemspruit and Freedom Square in Bloemfontein, Bophelong CHC in Petrusburg).

We will retain the 63 mobile clinics that provide Primary Health Care outreach services in rural areas across the province.

Community Health Care workers (CHWs)

The health sector is working closely with the Department of Employment and Labour in finalising the implementation of the proposed sector determination for CHWs in accordance with Chapter 8 of the Basic Conditions of Employment Act. The sector has also agreed with the bargaining council (PHSDSBC) on an interim three-year contract for the CHWs.

Emergency Medical Services (EMS)

This programme is to render pre-hospital Emergency Medical Services including inter-hospital transfers, Planned Patient Transport (PPT) and emergency communications.

In the 2022/23 financial year, we had allocated R787,3 million to this crucial programme and responded to 40 424 emergency calls and in to bolster the effectiveness of the EMS, we have increased the budget by R180 million.

The department currently rosters 138 operational ambulances services for a population of 2.9 million. According to the norms and standards, we are required to have 1 operational ambulance per 10 000 population, thus the department is short of 152 rostered ambulances to meet this norm.

Healthcare Support Services

Healthcare Support Services includes Pharmaceutical Services, Laundry Services, Medical Depot, Orthotic and Prosthetic Services. Honourable Speaker, the availability of medicines serves as a litmus test on the ability of health systems to meet its objectives. This is at the heart of our community.

In line with the set target by the national department for 2022/23 Central Chronic Dispensing and Distribution (CCMDD), the Department has 351 031 clients benefitting from the CCMDD programme. 92% registered clients are currently collecting their medicine from the designated Pick-up Points.

Health infrastructure

Provision of new health facilities and the refurbishment, upgrading and maintenance of existing facilities including health technology.

The department has appointed 377 EPWP beneficiaries to support the facilities through the infrastructure enhancement earmarked funding. While this programme is meant to develop the unemployed, to prepare them for potential employment opportunities. This programme is not funded in the 2023/24 financial year and as a result it will not be implemented.

Total expenditure on the completed and continuing projects for the last financial year, as outlined below, amounted to seven hundred and forty- three million four hundred and eighty-nine thousand rands (R743,489 000.00).

In the last financial year, we successfully completed the upgrade, replacement, refurbishment, extension, and renovation of 16 existing facilities, as listed hereunder:

1. Kgalala Clinic in Thaba-Nchu
2. Boitumelo Clinic in Senekal
3. Seadimo Clinic in Thaba Nchu
4. OR Tambo Clinic in Virginia
5. Kgotsong Clinic in Welkom
6. Kgotsong Clinic in Bothaville
7. Kopano Orthotic and Prosthetics centre in Welkom
8. Doctors’ accommodation at Botshabelo Hospital
9. Specialist Eye services Block at National District Hospital
10. The HVAC at Universitas Operating Theatres (11 theatres)
11. Rouxville Clinic in Rouxville
12. Installation of New generator at Bongani Hospital
13. Installation of New generator at Parys Hospital
14. Installation of New generator at Diamant Hospital
15. Installation of New Boiler at Winburg Hospital
16. Installation of New boiler at Dr JS Moroka Hospital

Honourable Speaker, health infrastructure projects create employment and economic opportunities for the surrounding communities with emphasis on youth, women, and people with disabilities.

Infrastructure projects are multi-year in nature and some of these projects will continue in the year 2023/24 and beyond. The following Health facilities projects are still under construction:

• Gariep Dam Clinic: Planning and construction of a new replacement clinic
• Vaalrock Clinic in Brandfort: Planning and construction of a new replacement clinic.
• Bophelong Clinic in Kroonstad: Planning and construction of a new replacement clinic
• Bophelong Clinic CHC in Petrusburg: Planning and construction of a new replacement community health care centre (CHC)
• Caleb Motshabi CHC in Bloemfontein: Planning and construction of a new replacement Community Health care Centre (CHC)
• Heidedal CHC: Planning and construction of a new replacement Community Health care Centre (CHC)
• Dinaane Clinic in Thaba Nchu: Planning and construction of a new replacement clinic
• Dihlabeng Regional Hospital – is currently undergoing upgrade and extension. This project is funded and implemented by the National Department of Health.

Support Services Projects

• New Ventersburg EMS Station in Mmamahabane
• New Forensic Mortuary in Welkom, Lejweleputswa
• Refurbishment of various services at Free State Psychiatric Complex
• EMS College Bloemfontein: Refurbishment and upgrading of the EMS college

Alternative Energy – Rooftop Solar Panels (Lighting):

The National Department of Health will be providing alternative energy to 10

identified facilities by rolling out installation of Roof Top Solar Panels. The

1. Mokwena clinic
2. Gaongalelwe clinic
3. Sediba Clinic
4. Thaba Nchu clinic
5. Bongani Regional Hospital
6. Pelonomi Tertiary Hospital
7. Mofumahadi Manapo Mopeli Hospital
8. Dr JS Moroka District Hospital
9. JD Newbery District Hospital
10. Boitumelo Regional Hospital

Conclusion

Over the years since the advent of our democratic breakthrough in 1994, we have done a lot of good to reverse the tide of apartheid. We have delivered infrastructure and provided quality health care that restored the dignity of our people. It is a fact that our interventions continue to be undermined by the population growth, emerging pandemics, declining financial resources.

In this year of decisive action to advance our people’s interest to save lives, we renew our commitment to improve the living conditions of our people to ensure that we live up to the dictates of the Freedom Charter which has been aptly translated into a social compact with our people as enshrined in the