Honourable Speaker;
Honourable Deputy Speaker;
Honourable Premier;
Honourable colleagues in the Provincial Executive Council (PEC);
Honourable Members of the Provincial Legislature (MPL);
Members of Mayoral Committees for Health and Social Development;
Members of Mayoral Committees for Safety and Emergency Services;
Health stakeholders.
The World Health Organisation (WHO) defines Health as “not just the absence of disease or infirmity, but it is the state of good physical, social and mental wellbeing, and that the attainment of the highest standard of health is the most important worldwide social goal whose realisation need action from other sectors, economic and social in addition to the health sector.”
It is an established fact that health policy development does not occur in a vacuum. It usually occurs within a context that is influenced by social, political and ideological considerations. The distribution of health resources mirrors the distribution of other resources in society - specifically the distribution of political and economic power (and therefore decision-making capacities) determines the nature of health policies that are developed and implemented.
A relationship exists between the nature of the economy, the political institutions in society, and the distribution of various resources, including health care. We all know that Apartheid was a policy of racial segregation and oppression which manifested itself through political and cultural oppression, social degradation and economic exploitation of the black majority. White domination in the political, social and economic spheres was entrenched through legislation.
This is what came to be known as colonialism of a special type. This ideology also permeated the health care system resulting in poor health outcomes among the oppressed majority. A fragmented under-resourced health system was therefore not accidental, in fact it was deliberate. I will just cite an example to illustrate this fragmentation: Within a 30 kilometre radius in Johannesburg, you had two hospitals reserved for white people, namely Johannesburg General (now Charlotte Maxeke Johannesburg Academic) and J.G Strydom (now Helen Joseph) and within about three kilometres from Helen Joseph, there was Coronation hospital (now Rahima Moosa) which was reserved for coloureds.
Indians who resided in Fordsburg had to travel over 30 kilometres to Lenasia hospital which is now a Community Health Centre. Then there was Baragwanath Hospital (now Chris Hani Baragwanath Academic) which was reserved for Africans.
Allocation of resources to these hospitals varied considerably. This was even evident in the health conditions that were prevalent among patients who presented at these hospitals. For example, kwashiorkor and severe malnutrition were common conditions which were treated at Coronation and Baragwanath hospitals.
This was a reflection of the social and economic conditions of the people who accessed these hospitals. While we had no homelands in what is now Gauteng province, health services were still fragmented. When the ANC took over in 1994, a fragmented health system had to be amalgamated. Since then, access to health care has been expanded. However, we are still faced with the challenge of providing quality health care.
Provision of quality health care is also dependent on other social determinants of health, which include among others; income levels, educational levels, access to housing, sanitation, and nutritional status. These influence the health status of the population. That is why government programmes are always interwoven to address all these challenges.
A proper analysis is therefore required when addressing complex health challenges that we face in our country. South Africa has a dual health system. 84% of the population does not have access to medical insurance. Yet more than 80% of the resources; both financial and human are concentrated in the private health sector which is accessed by only 16% of the population. This is clearly unsustainable.
The public health sector is faced with a quadruple disease burden which can be traced to poverty, high levels of trauma, HIV, TB, and non-communicable diseases of lifestyle such as hypertension and sugar diabetes. We therefore had to prioritise core areas of service delivery in our programmatic allocations.
Honourable Speaker,
At the beginning of the current term of office, the department encountered serious financial and service delivery problems.
These found expression in:
- Instability in the top management echelon. – A considerable number of managers were holding their positions in an acting capacity;
- Poor financial management;
- Shortage of essential drugs at our clinics and hospitals;
- Inadequate provision of Emergency Medical Services;
- Malfunctioning and unmaintained equipment at our hospitals due to among other things; contractual disputes and non-payment of suppliers;
- Inappropriate allocation of resources which include human, financial and equipment; and
- Insufficient support to Districts and other sites of service delivery in order to ensure that patients enter the health system appropriately.
To further amplify what I have just said, the department last obtained an unqualified audit in the 2006/07 financial year.
From then onward,
- we obtained a qualified audit opinion in 2007/08
- we obtained a disclaimer in 2008/09
- we obtained another disclaimer in 2009/10
- we obtained a qualified audit opinion in 2010/11 and
- we obtained another qualified audit opinion in 2011/12.
In order to address these challenges a Turn-Around Strategy was developed under the leadership of MEC Lentheng Mekgwe in March 2012 to ensure that the department moved away from organisational decline and collapse of service delivery. This entailed the involvement of staff, management, National Department of Health, National Treasury, Provincial Treasury and various stakeholders.
We identified eight core areas where we needed to intervene decisively on, and these are:
- finance and financial management;
- human Resources;
- district health services for primary health care;
- hospital management;
- medico-legal services and litigations;
- health information management and health information systems;
- communication and social mobilisation and
- health infrastructure development.
This Turn-Around Strategy was adopted by the Gauteng Provincial Executive Council in July 2012. Soon after its adoption and subsequent implementation, considerable progress has been registered in a number of areas.
Financial Management
While we continue to engage National Treasury with a view to revise the baseline for Health funding, we will strive to continue instilling fiscal discipline at all levels of the department.
The majority of our people have no alternative; they depend on public health services. We therefore have a duty to deliver quality health services!
Gauteng province, like the rest of South Africa, is facing an increasing public health funding gap over the next few years. This is influenced by changing demographics and the epidemiological profile of our province. We are addressing budget management in order to ensure that resources are allocated efficiently and that waste is eradicated or minimised.
This hinges on ensuring availability of accurate, up-to-date cost information, which is vital for budgeting and resource allocation. This will improve our ability to accurately measure health financing related indicators.
We are finalising the process of establishing a Health Processing Centre to ensure we comply with the injunction to pay suppliers within 30 days. We are also continuing to review contracts for cost effectiveness against market prices and this includes Medical Supply Depot (MSD) contracts.
Accruals
For the financial year ending 31 March 2012, we disclosed accruals to the value of R3.8 billion. This included amounts due to municipalities for transfer of payments for Emergency Medical Services (EMS), HIV and AIDS and Primary Health Care. We have made substantial progress in settling payments relating to Laboratory and Blood Services where only a fraction of amounts are owed to these service providers.
As at 31 January 2013, we had settled accruals to the value of R4.2 billion. This included commitments of the previous financial year which would have become payable in 2012/13. We have therefore settled approximately 99% of the total accruals that were owed. In this regard we have been having weekly payment runs since November 2012.
A small portion of invoices relating to prior financial years but processed in the current financial year are still undergoing a prepayment audit. This is to ensure that only legitimate invoices are paid after verification that goods and services have indeed been received.
Budget process
We have linked budget allocations to health priorities and main outcomes defined as a high priority. A cost analysis of service packages will be completed in time to inform the 2014/15 budget. We will thus move away from historical budgeting which has resulted in budget allocations that were not informed by existing priorities.
This budget vote of R27, 404, 828, 000 is therefore underpinned by the assumption that there will be no additional allocation over the Medium Term Expenditure Framework. It has taken into account the fact that the population of Gauteng has grown from 9 388 855 in 2001 to 12 272 263 in 2011 (SA Statistics, Census 2011).
Revenue Collection
Honourable Speaker;
While we acknowledge that the service we deliver is not a commodity, where revenue has to be collected we have put measures in place to ensure that this is improved.
We were thus able to collect revenue to the tune of R 61 809 849, 00 from other government departments and R 94 089 410, 00 from medical aid schemes in the 2012/13 financial year.
We also collected R 21 529 928, 00 from neighbouring provinces before the National Department of Health established a Task Team on how referrals from neighbouring or other provinces should be treated.
The Road Accident Fund collection project with Alexander Forbes will be extended for another two years.
Furthermore; the Case Management function was established in our four central hospitals to promote quality and cost effective outcomes. Through this process we envisage increased quality care and improved revenue collection.
Supply Chain Management
We have put systems in place to ensure that we elicit value for money regarding contracts we enter into. Clauses for review and evaluation six months prior to expiry are already in place regarding renewable contracts. We have begun to negotiate prices for all new contracts with the aim of reducing prices which are not market related and thus uncompetitive. In terms of equipment, maintenance contracts are also negotiated to reduce costs. During this financial year, Supply Chain Management staff will be vetted.
Human Resources
Human resources are pivotal to our service delivery imperatives. The bulk of our budget is spent on salaries. In the past financial year we had to prioritise filling of critical clinical posts. Only funded posts were replaced. We have thus abolished all vacant unfunded posts. To this end we have prioritised filling of funded clinical posts.
At the beginning of 2013, 654 professional nurses graduated from the four year Diploma Course., while 111 graduated from the four year degree course thus resulting in a total of 765 Professional Nurses that were placed for Community Service. A total of 695 Enrolled Nurses completed training during 2012. 100 student nurses who exited the 4 year course were absorbed as Auxiliary Nurses.
One hundred and sixty nine (169) enrolled nurses, on study leave from the institutions, completed the Bridging Course and were absorbed as Professional Nurses. 598 Professional Nurses, on study leave from the institutions, successfully completed post basic specialty courses in various disciplines.
With regard to the Pharmacy discipline, 34 completed Basic Pharmacist Assistant Training. 11 completed Post Basic Pharmacist Assistant training and returned to their posts in the Institutions.
This means that 45 Pharmacist Assistants completed training. 320 Basic and Post Basic Pharmacist Assistants are still in training. These additions to our recently graduated different categories of health professionals justify the allocation of R907, 967, 000 to the Health Sciences and Training Sub-programme, which includes R45, 000,000 for bursaries.
Honourable Speaker;
All new appointments have to be signed for budget confirmation and availability by the Budget Office. Community Service candidates will be replaced with equal number of vacated replacement posts. We also began a process of verifying all our employees in order to eliminate any possible ghost employees.
The department has revised its guidelines and policy on remunerated work outside of the public service to bring them in line with international best practice. Where we have employed health professionals we expect them to give us value for what we pay for. In simple terms no health professionals are permitted to perform remunerated work outside of the public service during official and regular working hours.
Artificial shortage of health professionals arising out of some of them working in the private sector while they are supposed to be providing much needed services in public hospitals will be monitored very closely. Hospital Chief Executive Officers and Clinical Heads will spearhead this monitoring.
Honourable Members, this is not a new policy. Every employee who is paid a salary has a responsibility to contribute efficiently and effectively to public health imperatives.
We have improved the turnaround time for the management of labour relations cases. We are on course to eliminate backlogs of disciplinary cases. We will also provide Witness guidelines to all employees, including those reluctant to testify on behalf of the department on clinical negligence, litigation and all labour related cases. We will continue training of new and up-skilling of existing Labour Relations officers in institutions.
We have not hesitated to act decisively where there has been evidence of fraud and corruption. To this end, since 2010, we have dismissed thirty three officials (including two Chief Directors and a Director) whom we charged, disciplined, and found guilty of fraud related misconduct.
District Health Services for Primary Health Care
The District Health System is the vehicle for the delivery of primary health care. Family health is part of District Health Services; therefore management of Family Physicians in the respective districts will remain part of the work of District Management Teams.
This will ensure that we optimise availability of these Family Physicians in clinics, especially those which render 24 hour services. As part of building capacity at District level, we will prioritise support to clinics by Sub-District Management supported by District Health Specialist Teams and Ward-Based Outreach Teams.
All five districts have now appointed dedicated Quality Assurance staff to ensure that all protocols are available and adhered to by all staff at our clinics. This includes holding monthly Maternal and Morbidity meetings, where adverse cases are reviewed and recommendations are implemented.
In order to ensure that appropriate Essential Drug List medication is available, weekly lists of drug stock outs will be provided by clinics to the Regional Pharmacists and District Management Teams. Regional Pharmacists will also visit clinics monthly to monitor stock control.
The measures I have just announced will increase our stock levels to 98%. School Health Services remain an important level of intervention. In order to improve the Health Status of our learners, we have appointed more professional nurses to ensure coverage of all Quintile 1 and Quintile 2 school in the districts.
In order to rebuild the confidence of the people of Gauteng, we have allocated R 9, 191, 756, 000 to strengthen District Health Services and ensure that the people of Gauteng enter the Health System appropriately.
Hospital Management
Health System Effectiveness cuts across all management and operational competencies in the day to day running of a hospital. All hospitals are currently reviewing and improving their systems in the areas of financial and supply management.
We have already undertaken a skills audit of the supply chain management staff in central hospitals in order to ensure that this function is performed by appropriately qualified and skilled officials. This skills audit will be cascaded to other levels of care and districts.
Hospital Managers already monitor expenditure in the first quarter of the year and adjust expenditure then conduct regular budget reviews as legislated. Constant cost containment measures are being implemented in areas such as Blood Usage and Laboratory tests.
All hospitals are reporting their activities and achievements with emphasis on compliance with the six key areas of priorities (National Core Standards). Cluster meetings are held every two months, and these are headed by Central Hospital CEOs and include all heads of facilities in the catchment area.
Emphasis is being placed on the cluster system to work as a seamless continuum of healthcare from district level to regional level up to tertiary/quaternary level. Family Medicine Practitioners also play an important role in the district streamlining of services and participating in district hospital service delivery.
We have thus allocated R6, 242, 322, 000 to our regional hospitals which include the three recently re-categorised tertiary hospitals. We are in the process of aligning our Memorandum of Agreement with the three medical universities in line with new priorities. I therefore take this opportunity to commend Medunsa, Wits and Pretoria Universities for their support to this integrated service delivery approach.
Honourable Speaker;
We are the only province with four central hospitals and three medical schools, therefore the services we render at these hospitals will always reflect this reality.
Chris Hani Baragwanath Academic hospital will commission a sixteen bed High Care Unit. In addition, equipment in the following disciplines has been prioritised, namely; Surgery, especially Orthopaedics, Mother and Child, Critical Care, and Diagnostics.
Charlotte Maxeke Academic hospital has on the other hand prioritised equipment which will be dedicated to the following disciplines; Allied and Dermatology, Accident and Emergency, Neuro Sciences, Anaesthesiology, Paediatrics, Obstetrics and Gynaecology, Internal Medicine, Gastroenterology and Cardiology, Neurosurgery, Trauma and ICU, Surgery, Orthopaedics, Cardiothoracic and Radiation Sciences.
The hospital also aims to reduce waiting times in Radiology by conducting MRI Scans on Saturdays. The Nuclear medicine OPD Saturday clinic is already functioning. The following surgical operations have also been prioritised; namely; Cataracts, Elective breast cancer, Caesarean, Paediatric surgery and Cardiothoracic surgeries.
Paediatric ICU beds will be increased from 10 to 15 through implementing efficiencies in staff allocation and rationalisation of equipment in the unit. Steve Biko Academic Hospital continues to excel. The hospital scored the highest rating amongst Central hospitals in the country in the National Department of Health Office of Core Quality Standards audits, scoring 81%.
A pair of con-joined twins from Mpumalanga were successfully separated at the hospital in February 2013. The hospital exceeded revenue target which were given by the Department for the year 2012/13. The hospital collected R67.900, 000 against the target of R63.500, 000 in revenue.
In line with the Ministerial priority on security in hospitals, Steve Biko Academic Hospital is currently installing a high-tech electronic Access Control & Security System that will monitor all persons entering and leaving the hospital using CCTV camera system as well as biometric technology. This system will also track movement of patients within the hospital to prevent patients going missing, including theft of babies.
In order to improve quality of care and reduce waiting times the hospital has prioritised purchasing equipment in the following disciplines, among others; Psychiatry, Internal Medicine, Accident and Emergency, Neurology, Obstetric and Gynaecology, Neurology, General Surgery, Critical Care, Paediatric and Medical Oncology, Orthopaedics, Gastroenterology, Radiology, Ophthalmology, Neonatal ICU and Nephrology.
Honourable Speaker;
Dr George Mukhari Academic Hospital has unique challenges, owing to the fact that it has neither regional nor tertiary referring hospitals. Furthermore the hospital treats referred and un-referred patients from North West and Limpopo provinces. Hence we have resolved to provide the hospital optimal support to ensure that it is not found wanting in its mandate to provide tertiary and quaternary services.
To this end the hospital has prioritised equipment for the following disciplines; Ophthalmology, Nuclear Medicine, Urology, Radiology, Neurosurgery, Ear, Nose and Throat, Cardio-thoracic, Orthopaedics, General Surgery, and Logistics.
In order to fulfil our mandate of providing world-class and cutting edge tertiary and quaternary services we have allocated R7, 070,131,000 to our four central hospitals.
Medico-Legal Services and Litigations
We have observed that most litigation cases arise from Obstetrics and Gynaecology services. We will therefore focus on training doctors and nurses to follow protocols and procedures when rendering these services. We will also ensure that core equipment and supplies are available and functional.
I will soon appoint a panel to advise the department on litigation cases, management of Serious Adverse Events and strengthen compliance to procedures. We will also address disappearance of patient files, I have therefore instructed hospital managers to file police reports when patient files disappear.
Health Information Management and Health Information Systems
We will invest on the Local Area Network which is the backbone of our ICT. We will introduce a hospital based patient management system. This will be conducted through a phased approach to digital storage of hospital records.
Communication and social mobilisation
Honourable Speaker;
Our communication and social mobilisation strategies will focus on Primary Health Care Re-engineering, Reducing Maternal, Infant and Child Mortalities, Reduction of the burden of HIV and AIDS and TB, Quality Improvement and addressing the Social Determinants of Health.
Reducing Maternal, Infant and Child Mortality
We continue to implement policies that seek to address and improve the health status of women and children. We are aware of the fact that some contributory factors to increased maternal and child mortality rates are not only limited to social determinants of health. We however acknowledge that as custodians of public health, we have a responsibility to ensure that those problems that are within our span of control are addressed.
To this end we will intensify our campaign to increase the number of pregnant women who attend Ante-Natal Care (ANC) services within 20 weeks of pregnancy from 20% to 40%.
We will engage Ward-Based Outreach Teams, utilise media platforms and partner with faith based communities to spread the message of early booking and attendance of Ante-Natal Care services within 20 weeks of pregnancy.
We will also train 60 doctors and 550 nurses in maternity wards in Neonatal Resuscitation skills according to standardised protocols. We will also ensure that that properly equipped Emergency Obstetric Ambulances are utilised only for that purpose.
We continue to improve neo-natal care and treatment of sick children through management of severe malnutrition and management of low birth weight new-borns through Kangaroo Mother Care at 24 of our hospitals.
We will also continue to intensify our Expanded Programme on Immunisation, “Every day is Immunisation Day” at our clinics be they local government or provincial clinics! Campaigns to promote and support of exclusive breast-feeding through accreditation of all facilities providing maternity services are underway.
Training in essential steps in the management of obstetric emergencies for skilled birth attendants including additional midwives, is continuing. Post-natal visit within six days, which includes new-born care and helping mothers to practice exclusive breast-feeding, will also be standardised.
We will continue to closely monitor implementation of the Recommendations of the Saving Mothers Report. We have thus allocated R452 800 000, to this programme.
HIV and AIDS prevention and treatment
Honourable Speaker;
We will intensify education for people exposed to high risks of HIV infection including sex workers, migrant workers, residents of informal settlements and unemployed poor women. We have targeted to distribute 214 million male condoms and 1, 2 million female condoms in 2013/14 financial year.
The uptake for Male Medical Circumcision is commendable. In the past financial year over 81 000 males were circumcised in our facilities. The target for 2013/14 is 138 841. We also collaborate with traditional leaders in our province to ensure safe initiations. We have reduced transmission of HIV from mother to child to 2, 3%. This transmission rate will be further reduced by ensuring that over 240 000 pregnant women who access Ante-Natal Care services at our clinics are tested for HIV. We re-iterate that no child should be born HIV positive in Gauteng!
All HIV positive pregnant and lactating mothers who were diagnosed as of April 2013 were put on the Fixed Dose Capsule (FDC). With the advice of medical professionals we are on course to convert those HIV positive pregnant women who are on other Anti-Retroviral Treatment regimens to the Fixed Dose Capsule.
We will increase the number of sites where people can access Anti-Retroviral Treatment from 364 to 403. The majority of these sites are clinics. The target of people to be initiated on Anti-Retroviral Treatment in 2013/14 is 126 100, including 6000 children.
While we have made progress in broadening access to treatment, we continue to emphasise responsible sexual behaviour, safe sex and regular HIV Counselling and Testing. We wish to thank the nurses for agreeing to be part of the HCT programme, including the initiation of ARV. Honourable Members we have allocated R2, 874, 650, 000 to HIV and AIDS Prevention and Treatment.
Decreasing the burden of TB
Tuberculosis remains a major cause of death among HIV positive people. In order to address the burden of diseases due to TB, we will continue to provide preventative therapy to HIV positive patients who have not yet contracted TB. HIV positive patients will be routinely tested for TB in order to reduce the incidence of co-infection.
In 2013/14, we plan to increase the TB Cure Rate to 82% and reduce the defaulter rate to less than 5%. We will trace defaulters by involving Ward-Based Outreach Teams. We will provide continuous support to patients and on-going supervision to facilities and training of staff on revised protocols.
In order to expedite early diagnosis of TB, the GenExpert machines (equipment which diagnoses TB within 24 hours) will be installed in Kalafong, Mamelodi, Pholosong, Pretoria West, Bertha Gxowa, South Rand and Heidelberg hospitals.
We have identified decentralised sites at 12 hospitals and 27 clinics for treatment of MDR-TB so that patients can choose where they prefer to be treated instead of being hospitalised and forced to be admitted at Sizwe hospital and run the risk of defaulting as they would be far from their families. This will go a long way towards ensuring that non-infectious MDR-TB patients resume productive lives speedily. This programme has been allocated R225 089, 000.
Emergency Medical Services
Honourable Speaker;
Rapid and effective emergency medical care and transport, and efficient, planned patient transport in accordance with provincial norms and standards are crucial to provision of quality health care. In line with the department’s Turn-Around Strategy, we have identified areas which require immediate intervention in this programme.
In response to the increasing demand and the need to maximise efficiency of the services, we are embarking on the re- capitalisation programme which includes human resources, vehicles, revamped ambulance stations and appropriate modern equipment.
We are in the process of strengthening strategic management and replacing un-roadworthy fleet with fully equipped ambulances and response vehicles.
To this end, the appointment of the CEO will be finalised before the end of the first quarter of the current financial year. Since November 2012, we embarked on a process to limit indiscriminate allocation of calls to private ambulances. This was as a result of a realisation that indiscriminate allocation of calls to private ambulances was in most cases not justified by unavailability of government ambulances, and it had attendant cost implications.
We implemented stringent measures where such allocations could only be authorised by District Managers, Communications Centre Managers and Operations Managers, instead of Call Centre agents. Since then expenditure on private ambulances has been reduced by over 50%.
We have already purchased 100 ambulances which will be distributed equitably to municipalities which render emergency medical services on our behalf. Of these ambulances twenty (20) are fully equipped Emergency Obstetric Ambulances. Apart from procuring more ambulances within the available budget, we will also ensure that we reduce the turn-around time for vehicle repairs and maintenance.
Through revised and more stringent Memorandum of Agreement and attendant Service Level Agreements with municipalities who render emergency medical care on our behalf, we will enhance on-going reporting and monitoring and evaluation. Focus will not be on municipal turfs, but on providing efficient and effective Emergency Medical services to the people of Gauteng.
Transfers to municipalities are made in time to ensure compliance with Service Level Agreements. We are closely monitoring the expenditure of the EMS budget to ensure that it is in inline with service delivery needs. We have thus allocated R823, 435, 000 to Emergency Medical Services.
Forensic Pathology Services
Honourable Speaker;
The Forensic Pathology Services that we render are among the best in the world. The purpose of these services is among other things; investigation of the cause of any unnatural death or sudden unexpected death, thereby assisting the SAPS in the collection of evidence and presentation thereof in court.
The service is also required to keep statistics on trends that can be used in prevention strategies for unnatural causes of death which include trauma like motor vehicle accidents, violence, drowning, suicide etc.
In June last year, we were able to transport deceased victims of the Meyerton bus crash, and conducted speedy post-mortems thus handling the tragic situation with unprecedented dignity. When we were called to assist after the Marikana shootings we were also not found wanting.
Physical examination of the corpses of those who die unnaturally has a turnaround time of 48hrs following a weekend and 24hrs during weekdays. The finalisation of autopsy reports can only be done when histopathology and toxicology results are available.
We have appointed a total of fourteen Registrars and two specialists in the Southern cluster. In the Tshwane District, we appointed one Registrar and one Medical Officer. The 2 Medical Officers posts are filled. In Ga-Rankuwa we also appointed two Registrars in order to maintain the current turnaround time for autopsies.
Vacant histopathology posts will be advertised in due course to ensure that our provincial responsibility which excludes toxicology is on track. We continue to collaborate with sister departments on sharing information that is obtained from crime and/or accident scenes in order to determine trends, patterns and possible causes. We have allocated R173 357, 000 to Forensic Pathology Services.
Infrastructure Management
Expenditure on Infrastructure management and development has been our Achilles’ heel for a number of years. In order to obviate this under-expenditure, a number of measures have been put in place. This is underpinned by acknowledging that the Department of Infrastructure Development remains our implementing agent for large scale infrastructure projects.
To this end, a Service Level Agreement (SLA) which reflects that the Gauteng Department of Health is a client and the ultimate end user of completed and maintained infrastructure will be finalised by the end of June 2013. We have also reviewed our infrastructure portfolio and its management to ensure efficiency.
We will also close off all projects which are older than three years. This will hinge on improved planning to prevent budget over-runs in future projects. We have begun scoping small works utilising current internal capacity where we procure contractors on a quotation basis if projects cost less than R500 000, 00 in order to expedite implementation.
Furthermore, hospital Chief Executive Officers have now been empowered with delegations to implement infrastructure and other requirements to a value of no higher than R1 million.
Planning for revitalisation of Jubilee, Dr Yusuf Dadoo, Tambo Memorial, Sebokeng and Kalafong hospitals will commence once the business cases are finalised by the end of June 2013, with the National Department of Health. We have allocated R2, 400, 675, 000 for Health Facilities Management.
Conclusion
When we prepared this budget, we had to prioritise core areas of service delivery in our programmatic allocations. Focus on Six Core Quality Standards will permeate our approach to service delivery and health care.
These non-negotiable six core standards are:
- values and attitudes of staff
- cleanliness of our facilities
- improved waiting times
- patient and staff safety and security
- infection prevention and control; and
- availability of medicines and supplies
These will define patient experience at our health facilities. Service delivery is now being guided by the Turn-Around Strategy which we launched and began implementing in July 2012. This Turn-Around Strategy will be implemented until the end of the current term of office. We have also linked these allocations to health priorities and main outcomes which are defined as high priority.
Honourable Speaker;
I have confidence in the dedication of our staff at all levels to continue working very hard and smartly, to justify the second biggest budget allocation in Gauteng! We are working hard to obtain an unqualified and/or clean audit in 2014.
That is why we have established an Audit Action Plan Review committee which meets monthly to track the progress on the audit action plan and makes appropriate recommendations.
This Committee consists of all the respective process owners of the audit findings in the department as well as Officials from Provincial Treasury, Gauteng Audit Services and the Office of the Auditor General.
I take this opportunity to express my gratitude to the Honourable Premier, for her sterling leadership, my colleagues in the Provincial Executive Council for their continuing support and collegiality, my comrades in the Caucus for their support, the Chairperson of the Health Portfolio Committee and its members for providing robust and diligent oversight on the work of the department, members of the Provincial Health Council for inter-governmental collaboration, family and friends for support since my appointment.
Lastly I thank all categories of staff in the department for their hard work and dedication. Mogologolo o rile “kodumela moepa thutše, gago lehumo le le tšwago kgauswi”.
Thank you.
