MEC Qedani Mahlangu: Gauteng Health Prov Budget Vote 2016/17

Ladies and gentlemen,

As I rise to present the Gauteng Department of Health Budget vote 2016/17, I wish to quote the words of Deputy Chief Justice Dikgang Moseneke, speaking on the lessons he has learnt during his time serving as Deputy Chief Justice:

"The second lesson was the love I have continued to have for our people.  And they are entitled to live in a just and socially inclusive society. Where their dignity and self-worth is in-tact and well cherished. They must access quality education, they must access universal and quality healthcare, they are entitled to clean water, to sanitation, to a place that they can call home, to a habitable environment that is well preserved and in all this, a space to be simply human."

His words truly touched my heart and serve as a reminder that we are here as servants of our people to  ensure their dignity and self-worth is cherished; and that they have access to universal and quality healthcare.

The R37.4 billion allocated to the department for this financial year comes with the great responsibility of ensuring that the ANC led government uses every resource allocated to us optimally and that the decisions we take always place the needs of our patients at the centre of everything we do.

The women of our country are the bedrock on which our society is built (Wathint'abafazi, wathint'imbokdo) and to the women who have gone before us like Mama Charlotte Maxeke, Lillian Ngoyi, Bertha Gxowa and Helen Joseph we owe a great debt to build a society in which Mothers, Infants and Children are nurtured and given the care they need to realise their full potential and fulfil their hopes and dreams as healthy, active members of the broader society.

A key deliverable in providing quality care is ensuring that women and infants remain healthy during pregnancy and childbirth and also bring an end to maternal and perinatal deaths from preventable causes in all our facilities.

In the past three years, we have managed to reduce in-facility maternal mortality ratio from 154/100,000 live births, to 125/100 000 live births in 2015. Although, we have made progress in reducing maternal deaths, we need to continue to work harder and smarter to accelerate the reduction of maternal and neonatal deaths.

As part of our commitment to this objective, we are piloting a new innovation called Sense4Baby in partnership with Vodacom. This is a belt worn by the expecting mother to monitor her baby's heart rate and it also allows an ultrasound to be done using mobile technology. These innovations assist in bringing key healthcare services closer to those that need it most. 

We have a committed obstetrics and paediatrics team to work tirelessly to improve outcomes of mother and child health. To further build on the foundation laid by the programmes initiated in the previous financial year, we are strengthening our clinical teams by increasing our staff capacity and capabilities through continuous training on the management of emergencies and care of pregnant women and infants through ESMO-E (Essential Steps in Management of Obstetrics Emergencies) and PEP (Perinatal Education Programme). The skills acquired in these training programmes will enable our clinical staff to manage patients appropriately and improve patient outcomes.

Twenty Five (25) Cuban doctors have been appointed in Gauteng. This team of doctors will focus on maternal, infant and child care to ensure we improve patient health outcomes; Cuba is a world leader in Primary Health Care and the maternal mortality of 4.2 per 1000 is far lower than many first world countries, including the United States.  We value and appreciate the relationship our ANC led Government has with the Government of Cuba. We will continue to strengthen relations with Cuba in pursuance of improving the health outcomes of our people.

The number of mothers receiving antenatal care early in their pregnancy has increased through the implementation of revised Mother to Child Transmission (MTCT) guidelines and the successful roll-out of programmes supported by our development partners (i.e. Mothers to Mothers). This has reduced complications arising from HIV, as these mothers are being put on treatment and support early, thereby improving the quality of life of pregnant mothers and ultimately increasing the number of babies born without HIV as envisaged in the NDP of an AIDS free generation.

We are making good progress towards reducing complications and maternal deaths as a result of obstetrics emergencies such as Hypertension, through the roll-out of maternal homes adjacent to hospitals in order to accommodate 'high-risk' patients and ensure that they have access to emergency care should the need arise.

The Ward Based Outreach Teams (WBOTs) are the frontline Cadres of Primary Health Care which forms the cornerstone of the National Health Insurance (NHI). The budget of R5.6billion allocated to Primary Healthcare will further assist in strengthening Primary Health Care in the Province. Our 533 WBOTs in the Province play an essential role in identifying women who are pregnant at an early stage and promoting an early entry into antenatal care. 

WBOTs that are supported by an experienced primary healthcare professional are able to build trust within a community and can achieve amazing and credible results. One example of this is in Ward 96 Kya Sands Informal Settlement where Ms Johanna Novhela - a community healthcare worker - was able to successfully deliver triplets late last year. The mother and triplets may not have survived had it not been for the actions of Ms Novhela.

Madame Speaker, as part of strengthening Primary Health Care all Doctors and Nurses in management positions who are registered with the HPCSA and the Nursing Council have been instructed to do one day a week's clinical work in our Primary Health Care Facilities.

We are pleased that the medical schools have responded so positively and are increasing the intake of the number of medical students into our Universities. We are also encouraged that our universities have started to increase intake of medical students. The technology universities are also training allied health professionals.

We currently, have more than 549 Gauteng students recruited from different townships that are studying medicine in Cuba upon their return to South Africa they will inject much needed capacity and skills into our Primary Health Care System and improve the Health outcomes of our patients.   

We reaffirm our commitment to ensure that all our Primary Health Clinics reach the ideal clinic standard by 2019 as part of gearing ourselves towards ensuring that our health facilities are ready for the implementation of NHI. 

Currently, the Tshwane District is the best performing District Nationally, whilst the Laudium and Calcot Dhlephu Clinics are the best performing Gauteng Health facilities nationally.

The sustained performance of Steve Biko Academic Hospital at 96% for National Core Standards continues to be the benchmark for all our facilities.

It is very encouraging that Kalafong Hospital has improved from 68% to 81% and Mamelodi Hospital to 73%. Keep up the good work and keep improving.

There has also been improvement at Chris Hani Baragwanath Academic Hospital and Tembisa Hospital, with the hard work and dedication shown by their respective teams they will reach the benchmark of 96%. 

The performance of Charlotte Maxeke and Dr George Mukhari has declined and this is disappointing.  Continuous improvement plans are being worked on to action interventions needed to improve performance.

Madame Speaker, excellence is what we strive for and it is important to acknowledge the following centres of excellence:

Chris Hani Baragwaneth Academic Hospital:  

I wish to share with this august House the story Ms Xolile Tshabalala who is with us here today. On the 24th of February 2016 Ms Tshabalala suffered a miscarriage and was diagnosed with fibrosis which affects the uterus. 

Being in Berlin at the time Ms Tshabalala went to what she believed to be a first world facility for assistance; Ms Tshabalala was told that her condition was an African problem. They led her to believe she would never have children. Coming back home she went to the Chris Hani Academic Hospital, where she found treatment and most of all she found hope again. 

To quote from Ms Tshabalala "I was treated with such dignity and kindness. I had the top and the best specialist, who most, look like me and treated me like a human being. I was given a HIFU treatment which helped alleviate the pain, and I am hopeful that one day, I will be a mother too."

She continues:

"Family and friends still did not understand why I would chose Bara when I could go to any private hospital, but to me Bara is and will always be the best for me and many more women who suffer from the same condition. Also, I needed to prove that this institution can stand in par with the best in the world."

Through the partnership with the private sector CHBAH has developed the State Of The Art Training Centre with the modern "life-saving equipment".

The training of staff will give them a comprehensive understanding of the equipment in the wards, thus optimising the lifespan of the equipment.

The centre boasts a well-resourced e-learning (24 computers) area that will be connected to the Wits library to assist both the under- and post-graduate students with research.

There is a simulation area (dry lab) in keeping with modern teaching platforms. This area will assist our students a lot and prepare them better for laparoscopic procedures.

The centre has an auditorium and six stations fully equipped with the latest technology equipment (ICU, Accident and Emergency, Theatre, labour ward, neonatal unit, renal unit and other specialities) for practical training on equipment.

The Trauma Unit of the Chris Hani Baragwanath Academic Hospital is the busiest Trauma Centre in the world, with a workload of around 5000 severe trauma resuscitations and over 60 000 other injured patients a year. It has close links with CHBAH Burn Unit - the only one in the country that manages both adults and children with a theatre facility within the centre - which makes up the other component of the Trauma Directorate.

The task of the trauma unit is to provide initial emergency treatment, all the necessary surgical operations in General, Thoracic and Vascular surgery as well as Intensive Care, High Care and ward management to trauma victims.

It is the biggest undergraduate and postgraduate teaching unit of the department of Surgery of the University of the Witwatersrand, and also provides advanced trauma training through exchange programs with Spanish, Finnish, Greek, and German medical and surgical organisations, as well as the West African College of Surgeons and Harvard University in Boston.

One of its unique strengths stems from the fact that the consultants work in the unit 24 hours a day, 7 days a week.

Another initiative! Novo Nordisk International and South Africa donated R1 million towards the first bi-confocal camera for the detection of neuropathy in the Public Sector. This medical equipment will enable us to detect neuropathy 6 months before it becomes clinically evident, it can be used for mass screening and is mobile.

This will hopefully decrease the number of complications and foot amputations. The balance of the funds will go towards the Soweto Bus Project. The bus is envisaged to have a fundal camera for detection of eye complications and it will also house a bi-confocal camera for early detection of neuropathy. The bus will also have point of care testing for HbA1c% (average measure of glucose) and cholesterol. Vitals such as BP, weight and height will also be measured.

This service can enable mass screening and decrease the burden of work for the St John's eye hospital and other tertiary health state institutions.

Charlotte Maxeke Johannesburg Academic Hospital

• The hospital performed first immediate reconstructions with free flaps (Free TRAM or DIEP flaps) – the reconstruction was the first in the hospital.
• Cardiology Unit at the hospital has been recognised by the Premier as the centre of excellence. 
• Professor Luvhengo received the International Swan-Morton Silver Scalpel SASSIT Award as of  ASIT for teaching excellence in research supervision

Dr George Mukhari Academic Hospital (DGMAH)

Dr Pakula is the hospital's first fellow in Minimal Invasive Surgery/Laparoscopy.  Making DGMAH a leading centre in the training of minimal invasive surgery in the country and enhances the status of DGMAH/Sefako Makgatho University as an Academic Complex.

In recognition of Prof Koto's work as an academic surgeon he has been appointed as an external examiner for the College of Surgeons of Southern East and Central Africa (COSECSA).

Steve Biko Academic Hospital (SBAH)

Professor Sathekge is known for the incredible work he does in the advancement of Nuclear Medicine.  In October last year Professor Sathekge became the first black President of the College of Medicine and is also the President of the Medical Research Council (MRC)

We congratulate Profrofessor Sathekge and all the other health professionals for their outstanding achievements.

Within the confines of the R1.9 billion budget for infrastructure the following projects will be completed and undertaken in this financial year. Infrastructure projects:

• Completion of Thelle Mogoerane Hospital and the staff residences,
• New Kekanastad Community Health Centre (CHC),
• New  clinics -: Boikhutsong; Kekana Gardens; Dewagensdrift; Greenspark; Finetown; Boitumelo; Alexandra; Sangriham
• Upgrading of Sebokeng Hospital
• Upgrading of Mandisa Shiceka CHC,
• Construction of the new Lillian Ngoyi District Hospital
• Daveyton District hospital
• Upgrading of Tembisa Hospital
• Upgrading of Helen Joseph Hospital Residences
• In the previous financial year, we upgraded Lenasia South to accommodate 46 beds  and Discoverer's to 96 beds and in this financial year both facilities will be upgraded to full District Hospitals
• The Construction of the Braamfischerville clinic will start in this financial year.
• We will build a fully-fledged Community Health Care Centre (CHC) in Cosmo City in this financial year.
• The department has scheduled development projects of eight (8) Hospital facilities to meet the Revitalisation Mandate, NHI parameters, and increasing of bed supply to meet the health demand of the Province in the coming two years ending 2018/19. These Hospitals are Jubilee Hospital, Kalafong Hospital, Tembisa Hospital Yusuf Dadoo, Tambo Memorial, Khayalami/Kempton Park, Soshanguve, and Hillbrow. The estimate total costs will be R13 billion over 3 years with a turnkey solution.

Emergency Medical Services

The budget for EMS has increased to R1.2 billion for the 2016/2017 Financial Year. The allocated amount provides for the procurement of an addition150 Ambulances, 25 Primary Response Vehicles, 11 Rescue Vehicles and five Mobile Emergency Communications and Command Vehicles.

In order to optimise available fleet resources a total of 100 aging ambulances will be fully refurbished and equipped appropriately to complement the current fleet capitalisation.

Part of ensuring a proactive approach and speedy response to emergencies is through a structured voluntary program of training 1 000 Community First Responders who will be issued basic emergency equipment.  We have so far trained 370 Community First Responders in the following previously under serviced areas Zandspruit, Cullinan, Roodeerplaat, Devon, Boipatong, Swaneville, Orange Farm, Sebokeng, Evaton and Onverwaag.

In a bid to ensure heightened Clinical Standards and Governance of all clinical staff, the Lebone College of Emergency Care secured accreditation of various Medical and Rescue courses with the relevant authorities. Plans to improve compliance with the National EMS Regulations are in full swing and an amount of R40 million has been set aside as part of the budget to purchase the necessary emergency equipment.

As part of our commitment to expanding the training platform and elevating the standard of paramedic training, we have entered into an MOU with Sefako Makgatho University.

Continual improvement and integration of technology in line with the vision of the province with optimisation of current platforms are at an advanced stage of planning and implementation which includes Computer Aided Dispatch (CAD), Tracking, and Vehicle Response Monitor (VRM) and Tetra Communication systems.

EMS will soon be launching an application called Response, an ambulance tracking and dispatch project with 70 ambulances in the Tshwane District. (This is an Uber inspired technology)

Waiting Times to Improve Health Care Services

This ANC led Government pledged to reduce waiting times in our 2014 election manifesto. To this end, we have 90,000 stable patients in the Tshwane NHI District who now collect their medication in places convenient to them as at the 31^st March 2016.  Our target for the current financial year is 214,000 in this district. Patients have a choice of 148 accredited medicine pick-up points to collect their chronic medication across the Province. 

A further intervention in addition to the Lean programmes is our Partnership with Right to Care to install a next generation robot for the automated dispensing of medicines at Steve Biko Academic Hospital which will assist to process 144,000 scripts annually. 
Additional interventions include ATM type dispensing units in Alexandra and Soweto (Maponya Mall and Jabulani Mall).

Repeat prescriptions for the elderly are delivered directly to the respective Old Age Homes to ensure that the elderly are serviced as priority patients and in some areas community health workers are able to deliver chronic medicines to patients at home. Patients are monitored to ensure that they consult with their hospital doctor or clinic nurse once in six months.

Park Station is a major transport hub in Africa. In partnership with Dischem pharmacies, we have created an access point for health services. This pick-up point will be assisting approximately 2,000 patients who commute daily through the station to collect their chronic medicines from the 1^st of June and no longer having to take time off from work. 

We have started discussions with PRASA to provide a clinic and emergency services that will service commuters moving through the station and the precinct community, moving services closer to the people in line with the ANC Government's Primary Health Care Re-engineering process.

Reindustrialisation

Madame Speaker, in line with the TMR agenda we have spent R926 million   on  ARVs and approximately R737 millions of it was spent on local companies producing ARV's in different parts of the country KZN, Eastern Cape and Gauteng.  We will continue to work and support emerging pharmaceutical companies who are pursuing the local production of active pharmaceutical ingredients (API).

The ANC led government is firmly committed to buy pharmaceuticals and non-pharmaceuticals to add much needed full industrial production for essential drug list and other items. During the recent visit to the CSIR and the innovation hub, we were more than convinced that we have the capacity to support the sector better going forward. There are lessons to be learnt from Cuba. 

The RX Solution inventory management system has been implemented to improve stock management and reporting in all Hospital and District pharmacies. The dashboard allows contract managers to monitor and be aware of possible medicine shortages so that relevant interventions can be effected on time.

For the monitoring of stocks at Primary Healthcare Clinics the Stock Visibility System (SVS) is being used.  This is a mobile Application (App) that healthcare professionals use to scan medicine barcodes and enter the stock levels for ARVs, anti TB medication and vaccines. All clinics in the Johannesburg Health District (110 in total) are connected to the Stock Visibility System (SVS).  As Minister Motsoaledi indicated in his budget speech, SVS will be rolled out to all Primary Health Clinics in the next three months.

Reducing the burden of disease due to HIV and AIDS and TB

The number of people in Gauteng on life-saving antiretroviral treatment has exceeded 1 million in 2015. 

More than 500,000 men have been medically circumcised since the launch of the medical male circumcision programme in Gauteng.

Over 2 million people were reached using the PASOP platform in various campaigns such as peer education, door to door drives, community dialogues, and information campaigns. This was coupled with multimedia campaigns on various platforms covering wider audiences.

The launch of the specialised Ten81 Health Care Centre in Tshwane expanded access to comprehensive health services for some our most vulnerable people including injection drug users, sex workers, men who have sex with men, and the wider lesbian, gay, bisexual, transgender and intersex (LGBTI) community.

A very alarming statistic is that girls and young women in the age group 15-24 years account for 2,500 new infections per week in South Africa.

To stem this tide, Minster Motsoaledi announced in his budget speech that there will be a 3-year campaign focussing on girls and young women in the 15-24 cohort and the men who are infecting and impregnating them.  The campaign will have the following five objectives:

• Decreasing infections in girls and young women;
• Decreasing teenage pregnancy;
• Decreasing sexual and gender-based violence;
• Keeping girls in school until matric; and
• Increasing economic opportunities for young women to try and wean them away from sugar-daddies.

In support of the above campaign and our commitment towards an AIDS-free generation in Gauteng by 2030, and in collaboration with all our partners, we will focus our efforts on implementing a comprehensive youth-focused strategy to prevent HIV.

This will include providing appropriate healthy lifestyle information to youth in schools using the smart tablet devices supplied by the Gauteng Department of Education, and implementing the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women (DREAMS) initiative.

We will strengthen TB screening to reach 5 million people; improve TB outcomes to 90% TB treatment success rate and a 2% defaulter rate. We will also ensure an early detection and effective TB-MDR treatment initiation rate of 100% and functional MDR units in 27 targeted hospitals.

 Modernisation

Madame Speaker, the Modernisation journey of our health services is well under way. While we were of the belief that we would be further along the road with the digitisation of patient records and had pronouncements in this regard, we can assure the Honourable Premier that as he indicated in his State of the Province Address we are on track with the modernisation of our public health services by 2019.

There are three main objectives of Modernisation:

• Improve Quality Of Patient Care
• Reduce Patient Waiting Times
• Improve Revenue Collection

The overall outcome will be that there is a Single View of the Patient. This requires us to put several building blocks in place: applications interfaces to have interoperability of systems (PACS; Medicom, NHLS; RX etc.); single source of patient demographic information (IVS); digitisation historical patient information for the continuum of care; connectivity between and internally within each facility; the required hardware; proficient support staff to train and support the modernised environments.

Modernisation is the central pillar of TMR and our work as Health is underpinned by the quest to improve the quality of life of our people.

The launch of electronic Bed Management System (eBMS) is a case in point. Last month, in Tshwane at the Steve Biko Academic Cluster, we unveiled the innovative, tech savvy bed management system which allows us to better manage the 27.7 million patients annually that present to our facilities linked with EMS control room where ambulances are dispatched from and tracked live.

The eBMS allows medical staff to flawlessly identify the location of available beds across each cluster, which will enable clinical staff to improve patient movement and management. This would lead to better turnaround times and, better utilisation of resources.

Township Economy

Madame Speaker, we are proud to advise this house that the innovative AITA household profiling Application that is being used by Community Health Care Workers in Gauteng and was developed with the University of Pretoria is now being rolled out nationally.

As the department, we have identified categories in our quest to give impetus to the implementation of the Township Economy Revitalisation (TER) and as of the 31 March 2016, we have spent R 289million of our goods and services budget with Township Enterprises. An additional amount R20 million will be spent to buy linen from women co-operatives in this financial year. 

As part of optimising procurement from local black farmers, we are continuing to invest in buying fresh produce e.g. dairy, meat and fresh/processed vegetables for all our facilities.

EMS has contributed to the development of Township enterprises through the support of repair and maintenance hubs in Winterveldt, Katlehong, Soweto and Kagiso. Since the establishment of the maintenance hubs, we have to date repaired and refurbished 89 vehicles at a cost of R3.5million.  Further Township Economy initiatives include support for Cooperatives such as the Mamelodi Kasi Primary Cooperatives Limited and Reitiretse Car Wash to clean EMS vehicles.

We reaffirm our commitment to do more to support the TER and significantly increase the goods and services we procure from Township Enterprise's over this financial year.

Madame Speaker, in Robin Sharma's book the The Leader who had no title there is a quote from Margaret Mead "Never doubt that a small group of thoughtful, committed, citizens can change the world.  Indeed, it is the only thing that ever has." 

There are amazing health professionals and members of the community and we wish to thank them for working with our ANC led government to continue to improve the lives of our people.  Let me take a moment to cite two examples:

Surgeons for Little Lives led by Professor Jerome Loveland, Head of Paediatric Surgery at Chris Hani Baragwanath Academic Hospital, are committed to forging partnerships between the ANC led government, private sector, and the men and women in the street to make life saving surgery for our children possible.

The donation of the brand new Paediatric Surgery Outpatient Clinic at Chris Hani Baragwanath Academic Hospital valued at R20 million is an example how the lives of future generations can be transformed by lifesaving surgery through the collective good will of our society.

The Greek community are donating R8 million to build a UPA Emergency Medical Centres near the Greek Orthodox Church in Joburg as part of the City's Urban Regeneration Programme .  The UPA Centre will manage emergencies without a follow up visit. This intervention will alleviate pressure from Charlotte Maxeke Academic Hospital.

We are always striving to create efficiencies, improve systems and processes. To this end, we are partnering with the private sector on the following areas:

In a bid to improve accountability and most importantly the quality of healthcare in Gauteng, we have partnered with EY to remodel governance structures for hospitals – the Hospital Boards. We have taken a radical approach and appointed boards very similar to those found in the private sector, obviously within the confines of the law and relevant prescripts. Members will include higher calibre of Financial, Legal, Clinical and Governance executives.

The Boards will promote protocols that ensure that crucial information is conveyed to the right people at the right time. They can establish systems such that equipment and supplies are available when required. They can set expectations for a culture of high performance, not just from individuals but from teams that must work together.

As the first part of the CHBAH Transformation Programme, between August and December 2015, a diagnostic was performed in collaboration with BMGI; for purposes of enabling a thorough understanding of the complexity that is CHBAH, as well as the priorities within the system; and therefore allowing for more robust planning for the implementation phase. 

The implementation phase has commenced and detailed planning is underway for the more complex projects, supported pro-bono by BMGI.

We have gone further and partnered with Discovery (as part of their Corporate Social Investment) to support some of these initiatives, including reduction of surgical waiting times in respect of Orthopaedics and Cataracts; Access to the Discovery Price File - which will support our procurement decisions from both cost and quality perspectives; and Improved Revenue collection through optimisation of the Discharge Process ICD10 Coding is compulsory at all facilities. Discovery has further facilitated a twinning arrangement between CHBAH and the Massachusetts General Hospital - a comparable academic hospital in the Harvard Circuit for purposes of addressing clinical challenges.

The ANC led government is partnering with Deloitte South Africa to revise the performance contracts of senior managers. This project will help us to ensure that our employees work towards outcomes which are aligned with the priorities of the department. In addition, it will assist our managers to cascade the right set of activities throughout their respective divisions.

Finally, this ANC led Government wishes to assure the selfless leaders like Deputy Chief Justice Dikgang Moseneke who fought so hard for our Democratic South Africa. This ANC led Government will continue to put a human face in the service of our people.

We are nurturing the next generation of young inspirational leaders like Dr Oatile Phakati, Dr Sule Burger, Dr Mtshali-Hadebe (youngest hospital CEO in the country) and many others who inspire us and show us that the future of South Africa and in particular healthcare is very bright and that this ANC led Government will continue to build a country in which every person can be "simply human."

On behalf of the GCR ANC Government team led by Premier Makhura and the Executive Mayors, we affirm our genuine commitment to the TMR and to improving the lives of our people. We are on course to deliver on the mandate we pledged since 1994 as part of our liberation struggle for democracy. 

Ours is to serve and it is a tough call that requires us to do more with less, to have a greater understanding when things do not go as planned and to empathise with the people at their most vulnerable state and during difficult times.

In conclusion, Ms Tshabalala's story and the many untold stories reaffirms the narrative that we have world class services which have a made positive impact on our people's lives.  We acknowledge that things do not always go right but it is our firm commitment to double our efforts every day to give the best quality service.

Our sincere gratitude goes to our Honourable Premier, Mr David Makhura for guidance, leadership and a tough master. We also thank my colleagues in the Executive Council for their continued support and understanding. 

We thank the Health Portfolio Committee led by Honourable Nompi Nhlapho for their oversight role.

We would like to thank the HOD, Dr Barney Selebano, senior management, CEOs of our Hospitals and all health workers wherever they are; we say thank you, thank you and thank you. We must never stop serving our people.

Last but by no means least; I wish to express my utmost appreciation and gratitude to my entire family who continue to have unparalleled understanding for my absence. Your love and care is unmeasurable and it remains my source strength at all times.

God Bless Africa!!!

Thank you.