the State of the Province Address
22 February 2007
Shortly after my appointment last year I stated with great conviction that
the department should live up to its name as the Gauteng Department of Health.
Quite clearly, we are not the "Department of Illness."
This, rather obvious, observation has a profound impact on the way in which
the department looks at the services we provide across the very wide healthcare
spectrum; on the way in which we run the numerous facilities within our
administration and on the priorities we determine when we allocate budgets and
human resources.
In recent months I have personally visited 75% of our hospitals and other
healthcare facilities that are being administered by the Gauteng Department of
Health; 14 of these hospitals since the beginning of the year. Some of these
visits were anonymous or unannounced. In other instances we provided the
facilities with only a very brief advance warning.
The purpose of these visits was to gain a firsthand understanding of the
strengths and weaknesses in our provincial healthcare system, to learn from the
knowledge of managers and healthcare professionals but also to speak to
patients and visitors to our health facilities about their personal experiences
and expectations.
I was struck by the similarity of the responses I received whether it was in
Sedibeng or in Ekurhuleni, in Metsweding or in Johannesburg. A clear picture is
emerging of a healthcare system under pressure from a rapidly growing number of
patients, including from across our provincial and national borders; of a group
of dedicated healthcare professionals doing amazing work under difficult
circumstances with limited resources - but mostly of a system and a healthcare
structure that urgently need to be revitalised and in some areas
resuscitated.
I am convinced that we have to look at healthcare delivery from a fresh and
innovative perspective. One of the primary issues we have to address is that we
spend too much time, effort and resources on treatment of people in our
hospitals and medical facilities rather than on prevention and health
promotion. We have to reach people, before they reach our facilities. We have
to inform people about healthy living and prevention instead of waiting for
them to become sick and require treatment at our hospitals and clinics.
In simple terms: we have to turn the entire health system upside down. In
fact, the ideal situation would be that fewer and fewer people make use of our
facilities and services because we have encouraged them to change their
lifestyle and improve their health conditions.
I do not want to be misunderstood on this issue. We are not saying the
Gauteng Health Department is no longer focusing on healthcare, treatment and
care-giving. On the contrary, we are spending more than ever before on new
hospitals, new clinics and new primary healthcare facilities to meet the needs
of our people.
In his State of the Province Address the Premier referred to the significant
progress we are making in the provision of healthcare facilities as part of the
Twenty Priority Townships Project. We have nine new clinics that are scheduled
to be completed by November 2009 and six other major upgrades and facility
construction projects that will be delivered by the same date.
Next month we are opening the new Pretoria Academic Hospital, a world class
facility, with state of the art equipment that will deliver the best possible
medical care and treatment you can find anywhere in the world. However, if we
believe that surgery and the prescription of medicines are the only instruments
available to us in our battle against illness and disease we will not reach our
department's vision of "health for a better life."
To achieve this objective I want to announce that the department will follow
a new, pro-active and aggressive approach to promote healthy living and a
quality lifestyle among the people of Gauteng. Some of these ideas are still in
their infancy and in the next few weeks we will have broad discussions with
experts within our department but also other stakeholders in the medical field,
the private sector and the health industry to put flesh to the bones of our
proposals. I want to refer briefly to three prongs of this approach:
1. From Sunday, 1 April 2007 we will proceed with the transfer of primary
healthcare facilities from local governments and municipalities to the Gauteng
Department of Health. This will be phased in over the next two to three years
starting with Metsweding followed by Sedibeng and the West Rand. A similar
process will be followed with Emergency Medical Services also with an eye on
our preparations for the 2010 Soccer World Cup.
Most of this transfer of services may appear to be a mere bureaucratic
shuffling of people and facilities from one sphere of government to another.
But there is much more to it than what meets the eye. Primary healthcare forms
the basis of the entire system of healthcare delivery in our country and our
province. This is where we meet the basic needs of our people. If we can fix
the system at this level the rest of the healthcare picture will fall in
place.
The transfer of primary healthcare will bring with it a greater
rationalisation of services. We will eliminate the duplication of services in
one area while there is a gross lack of facilities in other parts of our
province. It will make sense from an economic and logistical perspective and
enable us to allocate our financial and human resources in a more effective
manner. Our objective is still to ensure that each and every person in Gauteng
has access to a medical facility within a five kilometre range. Improved access
to primary healthcare facilities will ease the burden on our district and
regional hospitals and improve the quality of service delivery.
The long queues at some of our facilities and the lengthy waiting times can
often be ascribed to patients going to the wrong facility for assistance and
treatment. Many of our patients who suffer from minor ailments or who are
receiving treatment for chronic conditions should be visiting primary
healthcare facilities while hospitals should only be visited by referred
patients.
Our renewed focus on primary healthcare delivery obviously means that we
will have to overhaul the system. We will have to move and allocate staff and
resources from hospitals to primary healthcare facilities. We will launch a
pilot project on "smart cards" for chronic patients at selected hospitals and
Community Health Centres to enable us to capture the data of patients and keep
reliable records.
We will extend the visiting hours at our clinics to allow people to receive
diagnosis and treatment in the evenings after work and over weekends. (A list
of 17 clinics where visiting hours will be extended is attached as Annexure
A.)
2. The second prong of our new approach will focus on HIV and AIDS
prevention and education with a special focus on voluntary counselling and
testing. Again, I want to emphasise that we are not changing or scrapping any
of the existing programmes of treatment and care. We are going full steam ahead
with our Antiretroviral treatment and Prevention of Mother-to-Child treatment
programmes and other existing campaigns.
However, it is equally true that we are not making enough headway in our
prevention campaigns. Despite all our communication efforts, despite all the
high-profile campaigns, despite all the messages going out on radio and
television, on billboards and pamphlets the rate of new HIV infections remains
alarmingly high. A key element of our campaign will, in future centre around
voluntary counselling and testing.
We want to say to each and every person in Gauteng:
* Be tested. Be proudly tested!
* Know your HIV status
* With this knowledge at your disposal, act with responsibility.
As with all the other elements of our new approach we have to reach people
and test people at the earliest possible stage. We simply cannot wait for
people who already show the symptoms of opportunistic diseases to arrive at our
facilities at a very late stage.
We will introduce a "proudly tested" campaign in Gauteng very soon. We will
need the support of all sectors of our community - schools and churches, youth
groups and sports clubs, business and organised labour, the media and the
entertainment industry - to spread the message of "proudly tested."
At the same time we will continue to strengthen our Prevention of Mother to
Child transmission of HIV programmes and plan to increase the number of people
on antiretroviral treatment to 70 000 by March 2008.
3. The final element of our new approach concerns healthy living and the
promotion of healthy lifestyles among the entire population of Gauteng.
For far too long healthy living has been regarded as something which is the
exclusive preserve of the affluent and the advantaged. Rich people go to gyms
and follow exercise programmes. Only the privileged have the ability to consume
a healthy diet, can manage and control their stress levels and have the ability
to address issues of substance abuse, obesity and good nutrition.
In Gauteng we want to change this situation around. Obviously, we want to
see the people of Sandton continue going to gyms and recreational facilities
but we also want to extend this a few hundred yards down the road into
Alexandra. And we want to see this happening in Waterkloof and in Eersterus, in
Kempton Park and in Tembisa, in Diepkloof and in Diepsloot.
We want to empower ordinary people to take control of and assume
responsibility for their own health status. We want to bring these healthy
living messages into every household in the province with the help of local
councillors, ward committees, community organisations, schools and churches but
also through a group of skilled and trained community health workers who can
assist people in dropping bad habits and adopting positive, healthy
lifestyles.
One of the key lessons I have learnt from my visits to medical facilities
and in my discussions with practitioners and clinicians is that we are treating
far too many people for diseases and complications that should be detected and
corrected much, much earlier. The overwhelming majority of people arriving at
our health facilities seek treatment related to unhealthy lifestyles. If we can
change this we will make a measurable impact on all facets of healthcare
delivery including maternal health, early childhood development and coronary
heart disease, many forms of cancer and HIV and AIDS.
Again, we will have to flesh out the details of this in the weeks to come
and I intend to consult broadly with stakeholders in the medical profession but
also with associated professions such as physios and dieticians, with medical
aid schemes, the fitness and wellness industries, sporting bodies and
educational authorities.
Finally, as you can see, the Gauteng Department of the Health wants to
continue with those programmes that have proven effective and provided us with
quality results. We want to breathe new life into programmes that have lost
their momentum for a variety of reasons. And we also want to introduce new,
positive and exciting initiatives that will mobilise the people of Gauteng
behind our shared vision of health for a better life.
Thank you.
Enquiries:
Vusi Sibiya
Tel: (011) 355 3542
Cell: 082 330 1085
Issued by: Department of Health, Gauteng Provincial Government
22 February 2007
