Premier Willies Mchunu on announcement of interventions in KwaZulu-Natal Health

Media statement on the announcement of interventions in KwaZulu-Natal Department of Health presented by Willies Mchunu in the KZN Legislature Committee Room, Pietermaritzburg

The KZN Department of Health has been receiving negative publicity from various stakeholders about the poor health service delivery in the province, one of which was the Memorandum issued by the South African Medical Association (SAMA) Coastal Branch which was received by the Department of Health during the protest march held by SAMA on 5 May 2017.  

As the Premier of this Province, I wish to acknowledge that the concerns raised by stakeholders are a priority of the KZN Provincial Government.  I have been in ongoing consultation with my Provincial Executive, more particularly the MEC of Health, Dr Dhlomo, and the MEC for Finance, Ms Scott. 

We have conducted an in depth investigation into the administration and management of the Department of Health and have embarked upon some major interventions.

The challenges of the department are not limited to a specific area but cut across a number of areas and are linked to competing priorities. In the main, the issues relate to various elements, some of which can be attributed to internal inefficiencies and others that are beyond the control of the department.

Many of the challenges in Health in KZN are experienced throughout South Africa. It is important to contextualise the situation the Department of Health finds itself in and the determinants that have a profound influence on the operational environment. These include:

  • The economic climate of the country, characterised by high unemployment, high cost of living, fluctuations in the Rand as a result of international financial trends, among others, impact on the public health sector in various ways – most importantly the rising cost of medicines and medical equipment.
  • Every citizen in SA is experiencing the financial pinch.  Many people who used private health care through medical aid, are now moving to the public sector, increasing the burden on public health care sector.
  • In real terms, while the equitable share allocation shows an annual increase, these funds do not entirely cover the needs of the Department of Health. The rising costs of medicine and medical machinery means that the budget allocation for Health is actually in decline. These pressures will remain during the period of fiscal consolidation, with real financial relief only expected from the national fiscus in the outer MTEF year – 2018/19.
  • 54% of the KZN population reside in rural areas and an estimated 10% of the urban population reside in under-developed informal settlements which has significant implications for service delivery and health outcomes as a result of under-development and unavailability of essential services – adding the burden on the department due to these socio-economic challenges.
  • The quadruple burden of disease continues to have a profound impact on the quality of life, productivity and life expectancy of citizens. The costs associated with the provision of core service delivery, in addressing the diseases such as TB, HIV and AIDS, chronic non-communicable diseases, among others, further contribute to the financial challenges.
  • The expansion of health services to more outlying communities and households is yielding positive results for patient care, but this comes at a cost.
  • As articulated by SAMA, the public Health sector is facing challenges in Human Resource Management, financial management, Supply Chain Management (SCM), ageing infrastructure and old equipment.

It is within this context that Provincial Government has intervened. The Health sector is an environment fraught with difficulties, and it the role of my government to address these systemic challenges with urgency and importance.

Provincial Treasury has been working closely with the Department of Health. Treasury resources were deployed earlier this year for a clear assessment of what needed to be done.   These include the following:

  • A sector audit on the department’s pharmaceuticals and the Provincial Pharmaceutical Supply Depot was undertaken by the Auditor-General (A-G) and identified a number of weaknesses in the department’s controls, as well as a number of inefficiencies, and problems relating to aging assets that require constant maintenance. Provincial Treasury is doing a cost analysis on the extent of the intervention required.
  • Provincial Treasury will be making a Section 18 intervention in terms of the PFMA to temporarily control the SCM function in the department, until such time the necessary financial management controls are in place. The work of Treasury will involve taking stock of all tenders, many of which are running on a month to month basis. These will be converted into proper contracts. Government has set timelines – the contract register will be finalised by the end of August 2017, and all tender backlogs should have been dealt with by no later than January 2018. It is planned for all period contracts to be finalised by May 2019.
  • Internal controls in the department are weak due to a lack of capacity. Treasury will deploy resources to strengthen this capacity. Immediate appointment of resources from the various Provincial Treasury panels of consultants will be made available for a period of approximately 8 months. This will be done to identify gaps and shortcomings in the department’s internal control environment, to provide training where required, and to assist where required. We believe  a credible Asset Register will be available for the 2017/18 AFS audit.
  • Work has commenced to deal with the department’s  2017/18 commitments to service providers.  Volumes of invoices are being reconciled and verified by the Treasury Team. The target date effecting payments is end of August 2017.
  • The lack of maintenance of medical equipment is being addressed. The proposed SCM intervention will focus on how best to procure medical equipment to ensure that maintenance arrangements are strengthened so that the risk of equipment “down time” is eliminated or reduced drastically.
  • An IT solution will be found to deal with the management of the National Health Laboratory Services to prevent duplication and and over-ordering of tests. The department will acquire a qualified and experienced IT and data specialist to finalise the interim solution and to develop the interface protocols. If the development is successful, IT hardware will have to be procured for the clinics. It is estimated that the system will be rolled out to all institutions within 12 months after appointment.
  • The shortage of health professionals and clinicians in particular remains one of our biggest challenges. The Health budget will be reprioritised to ensure that we fill critical posts. And with the other interventions mentioned above, the working environment will be vastly improved for our health professionals. The HR intervention includes the appointment of the Head of Clinical Unit at Grey’s Hospital Oncology Unit.  He is currently overseeing the management of patients at both Greys and Inkosi Albert Luthuli Central Hospital (IALCH).

Accelerating progress on the 2030 Agenda for Sustainable Development implies that we must embark on health awareness campaigns. We can confirm that as a result of our campaigns such as Phila Ma, which is linked to Operation Sukuma Sakhe, more women are coming forward to test for cancer.  Some of them require immediate oncology treatment which as government we are obliged to provide.

Provincial Government wants to express its appreciation to the Oncologists and Radiotherapists from the private sector who have come forward to work in designated public health institutions to provide oncology services.

We want to pay tribute to the Rainbow Oncologists, a private group consisting of Medical Oncologists; Radiation Oncologists; Haematologists as well as Oncology nurses trained in chemotherapy administration. They have agreed to provide quality health care to patients at Obstetrics and Gynaecology clinics.

Equally, we pay tribute to our health professionals and all categories of staff in the Department of Health who are working hard under extremely hard conditions. We want to congratulate them for adding meaning to government’s commitment towards quality service delivery.

Provincial Government reiterates its commitment to working with all Chapter Nine institutions including the SA Human Rights Commission and the Public Protector. We welcome the report from the SA Human Rights Commission and this will be presented before the Executive Council. We want to adopt the recommendations and ensure that a programme of action in relation to the implementation is adopted by the executive council.

This will be communicated with the Commission in line with the protocol of engagement.

As leaders of government, deployed to oversee the administration of state resources, we are committed to working with all political parties and stakeholders of society to address the challenges in the public health sector in KwaZulu-Natal.

Following the Executive Statements made in the KZN Legislature today by the MECs of Health and Finance, Provincial Government will embark in a meaningful exchange with all stakeholders in the health sector. 

We urge stakeholders to work with us, to identify any further concerns they may have, and to find workable solutions.  This will be an ongoing process of consultation and assessment. Together we must put the health of each citizen of this province at the centre of our agenda.

The challenges are great, but I firmly believe that with the commitment of all, we can look to a turnaround to create a healthy nation and province.

I thank you.

Enquiries:
Ndabezinhle Sibiya
Cell: 082 375 4742

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