Theme of the launch: Re-engineering Primary Health Care
Programme Director- Thamsanqa Isaac
European Union (EU) Commissioner for Development - Mr Andris Piebalgs
Excellency - Ambassadors and High Commissioners
Mayoral Office Representative of the City of Tshwane: MMC for Health
Distinguished guests
Local Community Representatives
Ladies and gentlemen
It is my greatest pleasure to launch this most important programme of support from the EU on Primary Health Care. This support is again mostly appreciated by my department and comes at the right time when my department is busy re-engineering Primary Health Care in South Africa.
The Primary Health Care Sector Policy Support programme being launched today was jointly developed by the European Union and the South African (EU-SA) Department of Health. This new 2011 Primary Health Care Sector Budget Support programme has a total financial commitment of approximately R1,2 Billion.
It was signed in February 2011 by the Finance Minister on behalf of the Department of Health and the EU Commissioner. It is fully aligned to NDSA output number 4: Strengthening of Health Systems. In particular, the re-engineering of the Primary Health Care System. The first trench worth R350 million will be transferred in October/November 2011.
It is with noting Commissioner, that this launch of the Primary Health Care Sector Policy Support Programme (PrimeCare SPSP) by the European Union (EU), comes alongside the SA-EU Presidential Summit to be held on the 15 September 2011 in SA at Kruger National Park.
The summit follows the successful third SA-EU Summit held in Brussels on 28 September 2010, and will take place in the context of the on-going political dialogue under the auspices of the SA-EU Strategic Partnership and the SA-EU Trade, Development and Cooperation Agreement (TDCA).
The summit will be led by President Jacob Gedleyihlekisa Zuma. His EU counterparts in attendance will be Mr Herman Van Rompuy, President of the European Council and Mr José Manuel Barroso, President of the European Commission.
In 2007, South Africa and the EU elevated their relations to a strategic partnership under the Môgôbagôba dialogue thereby affording the Heads of State from South Africa and the EU an opportunity to meet at a summit level to discuss and share views not only on bilateral agendas but also on international issues of mutual interest.
The meeting between the leaders of SA and the EU also seeks to cement the strong political and economic relations that continue to exist between the two.
The EU is one the most influential regional bodies in international politics with two of its members in the United Nations Security Council and four in the Group of Eight (G8). Economically, the EU has a potential market of about 500 million inhabitants and contributes 20% in the global economy with the combined gross domestic product (GDP) of US$15, 1 trillion.
Furthermore, the EU is South Africa's largest trading partner and a source of most of SA's Foreign Direct Investment (FDI), which amounted to R995 billion in 2009. In addition, there are 1,3 million tourists from the EU countries that visited South Africa in 2010, making the EU one of SA`s main tourism market.
South Africa and EU also continue to discuss and share insights with regards to Africa, especially on how best the EU could spend its ODA in Africa especially on infrastructure development. Cooperation between the EU and South Africa is governed by agreements ratified by the high level EU Council. SA and the EU have signed a Trade, Development and Cooperation Agreement (TDCA) in October 1999, which forms the basis for comprehensive cooperation between SA and the EU that covers the political dialogue, cooperation in trade and trade related issues, economic cooperation, development cooperation and cooperation in other fields such as science, technology, cultural and social sectors.
The provisions of the development cooperation between SA and the EU as outlined the TDCA are fully complying with the contents and processes of EC development policy as laid down in the "European Consensus" - adopted by the Council in 22 November 2005.
The European Consensus underlines the overriding objective of poverty reduction in line with UN Millennium Development Goals (MDGs). The consensus also adds to the MDGs the objectives of good governance and the respect for human rights.
It reinforces the commitment towards coordination and harmonisation of development activities, in particular within member states, and seeks to strengthen the link with other EU policies such as foreign and security policy, trade policy, migration and employment policy.
In the Health Sector, the EU/SA Joint Cooperation Council is the platform for development cooperation between the parties. Health economics and financing and the crisis in the human resources for health have been identified as priority areas in the current health dialogue. In particular, at the recent EU/SA health dialogue in July 2011, the parties agreed to mobilise technical assistance for the National Health Insurance(NHI) in support of policy consultation and capacity building.
Sector since 1994, EU has made financial commitments of some Euro 170 million towards the Health mainly to support Primary Health Care to address HIV and AIDS including the NGO's.
Currently the European Union is funding to the Department of Health on three significant programmes:
1. Partnerships for the delivery of Primary Health Care (PHC) programme:
The Partnerships for the Delivery of Primary Health Care including HIV and AIDS (PDPHCP) was launched in 2001 as a six year European Commission (EC) funded programme. The programme initially supported five of South Africa`s nine provinces (Western Cape, Eastern Cape, Limpopo, Gauteng and KwaZulu-Natal).
The total estimated budget for the programme was 50 million Euro, which was to be transferred in two tranches. Due to the late start of the programme only 25 million Euro could be transferred to the department. This phase was implemented from April 2005 to March 2008.
Following requests from the four provinces not included in the initial PDPHCP (i.e. Mpumalanga, Free State, North West and Northern Cape) it was determined that an Expanded Partnerships for the Delivery of Primary Health Care, HIV and AIDS Services Programme (EPDPHCP) should be initiated.
The EPDPHCP started in 2007 to include all nine provinces and is coming to an end in December 2011. The total estimated budget for this phase is 45 million Euros.
The purpose of this programme is to establish partnerships within communities to improve health service delivery in the nodal areas of the country. It focuses specifically on strengthening co-operation between non-profit organisations (NPO) service providers (NGOs andcommunity based organisations(CBOs) and Government to strengthen the District Health System (DHS), through the creation of formal partnerships for the delivery of PHC services, including HIV and AIDS in the nodal rural areas.
In general the implementation of this programme is highly successfully in all nine provinces in 45 participating districts. It has significantly contributed to the government goal of creation of decent jobs and job opportunities, estimated at 23 000 in partnership with civil society.
To date, 1200 NPO’s were supported and funded to render a critical part of the Primary Health Care Service -Community and House hold care to 470 000 users or beneficiaries.
This service is provided by 19 534 Community Care Givers who received a stipend of about a R1000 per month. It has a staff component of 152 and currently has 132 staff members.
2. Support for Comprehensive Plan for HIV and AIDS treatment, care and cupport (SuCop) - concluded 2010:
The agreement was signed for the Support of the Comprehensive Plan for HIV and AIDS Care, Management and Treatment (SuCoP) on 3 December 2004. The total grant support is Euro 25.
SuCoP is funded eight projects which are; (1) District Health (2) Hospital Management (3)Social Health Insurance (4) Medicines Regulatory Affairs (5) Human Resources (6) Health Promotion (7) Financial Management and (8) Health Finance and Economics.
SuCoP Programme was targeted in the following manner:
- At national, provincial and district level in the development and strengthening of management, financial management, clinical management and knowledge, skills and systems to implement the Comprehensive Plan for HIV and AIDS Care, management and treatment
- By securing changes in the regulatory framework leading to improved and more timely delivery of service, e.g. by enhancing the capacity and effectiveness of the established pharmaco-vigilance processes which monitor the efficacy of the drugs that are being used and in particular adverse effects;
- By improving detection, treatment and follow-up of both of those with HIV and AIDS and specifically those with TB and mental Illness;
- Widening the scope and coverage of the Health Promotion Programme and healthy lifestyle promotion and significantly increasing the population reached by these programmes.
3. Primary Health Care Sector Budget Support Programme:
The new 2011 Primary Health Care Sector Budget Support programme has a total financial commitment of approximately R1,2 Billion. It was signed in February 2011 by the Finance Minister on behalf of the Department of Health and the EU Commissioner.
The main area of support is NDSA output number 4: Strengthening of Health Systems. In particular the re-engineering of the Primary Health Care system. The First trench worth R350 million will be transferred in October/November 2011.
The overall objective of the programme is to contribute to the re-engineering of PHC, improve access to public health services and to increase quality of service delivery through the district health system.
Just to remind the Commissioner that the Theme of launch today is: "Re-engineering Primary Health Care System"
Currently, the health department intends to overhaul the health system by basing service delivery on a re-engineered PHC system in order to effectively address health care challenges faced by the South African people. It will reverse the current system of delivery which largely focuses on curative hospital based services to a decentralised community based primary health care system.
The reengineering of the Health Care System will be according to three main streams. The first stream will be a district based model. In this model a team of five specialists or clinicians shall be deployed in each district. These teams will specifically focus on maternal and child mortality. This will help us arrive at our Millennium Development Goals (MDGs).
These teams will consist of:
- Principal obstetrician
- Principal paediatrician
- Principal family physician
- Advanced midwife
- Senior primary care nurse
In this case Commissioner, I have consulted all the Deans of the eight medical schools in our country, the professional associations of paediatricians, obstetricians, family physicians, the colleges of medicines of South Africa responsible for specialist training and the nursing fraternity at the recently held and successful nursing summit.
I am happy to announce that there is overwhelming support from the above mentioned stakeholders. It is my intention that by the end of this calendar year, we should be far ahead in implementing this initiative. In this initiative, the creation of the posts at district level has never existed before and is totally new in the public service. We are absolutely determined to make sure that this model is implemented.
Once appointed, these teams will deal with guidelines and protocols at our Antenatal Care Clinics, Labour wards, Post-natal Healthcare and Paediatrics and Child Health Clinics. They will follow up on every case of mortality to make sure that mortality meeting are held for every single incident, to deal with the cause at hospital level immediately rather than waiting for research studies and results later.
The specialist teams will deal with training of interns, as well as community service doctors and medical officers. Additionally, they will focus on midwives and their practice in helping to bring down maternal mortality. They will also assist primary healthcare (PHC) nurses on following up on patients in their communities, especially for post natal care. Overall there will be a link between prevention of disease and the management and cure of diseases.
The second stream of re-engineering PHC is a School Health programme which will be launched with the Ministers of Basic Education and Social Development. A task team has been established about eight weeks ago and is working around the clock to deal with these issues.
This stream of PHC will deal with basic health issue like eye care problems, dental problems, hearing problems, as well as immunisation programmes in our school. It will move further on to deal with more complex problems like contraceptive health rights that will include issues such as teenage pregnancy and abortions, at contraception, as well as HIV and AIDS programs among learners. Added to this will be drugs and alcohol in school.
Again Commissioner there has been extensive consultation on this issue and hence the task consists of all relevant stakeholders from the three departments, NGOs dealing with children, universities and individual experts who know a lot about children. When the team has completed its work, we will start implementation in the poorest schools in quintile 1 and 2, which are also far from the nearest health centres.
The last stream will be a ward based PHC model which will deploy at least 10 well trained PHC workers per ward. This method is being put to good use in Brazil where 30 000 of such people called community healthcare agents have been deployed to various communities. I was also highly encouraged when the Minister of Health in India announced during the Moscow gathering last month that in his country they are deploying 800,000 such cadres and they call them healthcare activists.
It will be incorrect not to mention that this programme is meant to strengthen the partnerships within communities to improve health service delivery in the nodal areas of the country. It focuses specifically on strengthening cooperation between NPO service providers (NGOs and CBOs) and Government to strengthen the District Health System (DHS), through the creation of formal partnerships for the delivery of PHC services, including HIV and AIDS in the nodal rural areas.
Let me also mention that Community Health Workers will play a critical role in relation to educating the public on good health practices and healthy life styles. They will be supported at primary care level by nurses and health workers and health promoters.
I cannot end my talk without mentioning that the NHI system will be introduced over the next 14 years. This will increase accessibly and facilitate better distribution of our health resources- both financial and human. I am not going to go into details of why we are doing this or exactly what NHI will look like. I urge you though to carefully examine the Policy on NHI which was published on 12 August 2011.
In January 2011, the Minister of Health met with all Heads of Missions (Ambassadors, High Commissioners, UN Heads) and other delegations of Development Partners to launch the Aid Effectiveness Framework For Health In South Africa in a bid to strengthen the development cooperation and to improve the management and coordination of ODA for health in South Africa.
The frame work has played a crucial role in ensuring the Development Partners coordinate and align their intervention programmes to the NSDA and the Annual Performance Plan. The EU`s PrimeCare SPSP is an example of that alignment.
On that note, the EU delegation is mostly thanked for their willingness and commitment to align with the national health strategy, modality of funding which is primarily untied budget support and commitment to re-engineering of the PHC which is the cornerstone of a revitalised service delivery commitment by the government.
I thank you.
