Madlala-Routledge, at the RUDASA 10th Annual Conference
11 August 2006
Programme Director
Distinguished guests
It is a great pleasure for me to have been invited to the Rural Doctors
Association of Southern Africa (RUDASA) 10th Annual Conference. I would like to
take this opportunity to thank and appreciate all your endeavours and
contributions towards the development of rural health in South Africa. You have
been able to contribute positively and effectively towards sustainable rural
health development in many ways.
The Department of Health would like to acknowledge the following areas of
your contribution to rural health development in South Africa the involvement
and participation in the development of the draft rural health strategy;
1. advocacy role for adequate staffing of rural health services by
appropriately skilled healthcare workers.
2. strengthening continued professional development.
3. regular communication and support to doctors practicing in the remote and
deep rural areas including other health workers.
4. communicating and assisting with the implementation of the government
programmes.
I wish to take this opportunity to salute the contribution of each and every
one of you to the effective functioning of our health system.
At the beginning of the year, the National Health Council decided on five
priorities for health for 2006/7 in the context of our five-year strategic
plan. These priorities are:
1. service transformation plans which should be completed by each
province
2. human resources plan for health
3. quality of care
4. physical infrastructure for primary healthcare and hospitals
5. priority health programmes with specific reference to the promotion of
healthy lifestyles, tuberculosis control and prevention of HIV.
Your contribution to realise the implementation of these priorities is
welcome. These priorities need to be replicated in rural areas as well, since
we are building one health system. We have chosen to strengthen Primary
Healthcare and the District Health System especially in rural areas. The
District Health System is an ideal vehicle for the delivery of comprehensive,
integrated healthcare system and practices that are in line with "Health for
all in the 21st century". You specialist role in ensuring that Primary
Healthcare (PHC) is implemented within the District Health System cannot be
ignored. We need both private and public sectors to work together to realise
our health vision.
Some of you may recall several achievements and challenges affecting the
rural areas that were highlighted during the âhealth in the rural nodesâ
conference held during September 2004. Recommendations were also highlighted.
The draft rural health strategy was amongst others born out of that conference.
Some of the challenges raised during the conference were:
1. recruiting and retaining staff in rural areas
2. reaching an agreement on the definition of "rural"
3. patient and personnel transport and the general state of rural roads
4. high staff turn over and migration
5. training a huge volume of health professionals to supply the local and
global demand for health professionals
6. government policies and regulations that make it difficult for foreign
health professionals to work in South Africa (e.g. a foreign-trained doctor
needs a further three years of training before being registered to practise in
South Africa.
The conference agreed that there is a need for strategic direction and
guidance in district health planning from the national Department of Health.
The establishment of systems for monitoring the implementation of the district
health plans cannot be overemphasised. This should be encouraged at all levels
of the healthcare system. During the conference delegates agreed that there is
a need to build capacity to promote local operational and participatory
research. Also academic institutions should play a big role in facilitating the
process while government should develop effective strategies to address the
issues of inequities in the distribution of resources.
While the conference agreed that budgets should be decentralised to
sub-district and facility level and linked to service delivery activities. It
is imperative that the process must be accompanied by training and support,
National Treasury should consider equipment and Human Resource when allocating
funds for PHC instead of using head counts or per capita. However, the
responsibility lies with districts to produce quality data and information to
lobby for extra funding from Treasury. Supportive supervision is important for
improving quality of care and should be accompanied by clear monitoring of key
indicators. Provinces should consider budget allocations to South African
non-governmental organisations (NGOs) to continue supporting the districts in
improving service delivery and to make rural areas more visible.
Since the conference, the Department of Health has been hard at work to
address challenges in rural health development. For the benefit of all, I would
like report back on some of the achievements of the Department based on the
recommendations of the conference. All 13 rural nodes have completed their
District Health Plans (DHP) for 2004/05 and 2006/07. The reporting format has
been developed to monitor implementation of the DHP. The District Health
Expenditure Reviews preceded the DHP.
The Department has also secured funding from the European Commission to
develop capacity including research and epidemiological skills for 21 nodes.
Provinces have been allocated significant additional funding for personal PHC
services in the financial years 2006/07 to 2008/09. Municipal health services
have been listed in the Division of Revenue Act (DORA) from February 2006 with
potential benefits to the rural areas. The January 2005 Cabinet Lekgotla
resolved that departmental financial contributions to the nodal specific
projects are to be reflected in the Medium-Term Expenditure Framework
(MTEF).
The financing protocol is a planning, financing and performance management
protocol, which assist in using inter-governmental budgeting systems. It also
approved the implementation of the financing protocol. Chairperson, health has
also been identified interdepartmentally as a crucial basic service for nodal
areas for financial or technical assistance as part of the National Department
of Provincial and Local Government Integrated Sustainable Rural Development
(ISRDP) and Urban and Regional Planning (URP) branch co-ordinating the nodal
specific interventions, as part of the financing protocol for the nodal areas.
The National District Health Systems Committee has endorsed and recommended the
Draft Rural Health Strategy to the Technical Committee of the National Health
Council. The strategy has also been included in the departmental strategic plan
2006/07 and 2008/09 as an indicator to monitor service delivery in rural areas
by district health councils.
The KwaZulu-Natal province has been proactive in establishing an interim
nodal forum with the view of implementing the rural health strategy. Plans are
underway for a workshop on Integrated Sustainable Rural Development Programme
as part of the rural health strategy for October and November 2006. As part of
integrating government programmes, a joint Team of National and Provincial
programme managers provide on site nodal support on regular basis. Bilateral
engagements with relevant sectors have commenced to address issues of access to
health services in rural areas e.g. the National Department of Transport with
specific reference to the rural transport strategy to improve access roads and
public transport to rural areas.
The revitalisation of hospitals programme was initiated three years ago to
improve conditions of our health facilities. Currently, we have 42 projects
enrolled into the programme; four hospitals are to be completed in the 2006/07
financial year. These are: Jane Furse Hospital and Lebowakgomo Hospitals in
Limpopo; Mary Therese Hospital in the Eastern Cape and George Hospital in the
Western Cape. The majority of these hospitals are in rural areas. The other
three hospitals will also be officially opened during this financial year. In
addition, every hospital has been requested to develop a hospital improvement
plan that includes basic activities such as repairing of broken windows or
leaking taps to clinical audits to improve the quality of care that we provide
in all public hospitals.
It is encouraging to see nodes delivering on services needed by our
communities. Chairperson, allow me to share few examples of the nodal specific
health achievements. The Central Karoo is doing well in terms of community
based nutrition programme. They have established a sustainable gardening
project in collaboration with the Department of Agriculture and the
municipality where 10 targeted community members are assisted for
development.
By March 2006, uMkhanyakude District had sprayed 129 259 rooms to prevent
malaria. 50 clinics had demonstration gardens to capacitate clients to
establish family gardens in order to improve nutritional status and 50
facilities offer Protein Energy Malnutrition (PEM). In Zululand 180 pupils in
12 schools participated in essay competitions to promote healthy lifestyles.
Several health facilities also conducted health promotion activities. By June
2006, 2 775 clients were on antiretrovirals (ARVs). There are 11 tracer teams
in the district. Seventy one percent of clinics have demonstration gardens.
The Sekhukhune, Bohlabela, Umkhayakude, Zululand and Central Karoo have
contracted a number of NGOs through the Partnership for the delivery of PHC
programme (PDPHCP) to capacitate community carers to be able to render
community or home based services. Several nodal areas in the Eastern Cape also
benefit from the integrated PHC projects and other donor-funded projects. I
must mention to the delegates that I have been appointed as a political
champion for KwaZulu-Natal and focusing on Ugu District. The district health
system plays a major role through collaboration with the municipality to ensure
that health programmes are prioritised on the municipal Integrated Development
Plan (IDP) and that all stakeholders address them jointly.
Programme Director, for any institution or system to succeed it depends on
the resources they have. In an effort to address the shortage of skills, the
Department has conducted an extensive consultation with stakeholders to
finalise the Human Resources Plan for Health for South Africa. The plan was
launched on World Health Day on 7 April 2006.
During the consultation process, health workers raised many issues as
challenges affecting them in delivering healthcare to the people. Issues rose
ranged from inadequate remuneration, poor working conditions in some areas,
lack of suitable accommodation and other supportive amenities particularly in
rural areas.
In addressing the shortage of skills and resources, 100 students will be
admitted at the Universities of Pretoria, Walter Sisulu and Witwatersrand. Some
amongst them will commence training as clinical associates in January 2007.
This new cadre of health workers will complete a three-year degree programme
with significant on-site training in district learning centres. Upon
graduation, they will work under the supervision of medical officers in
district hospitals and primary healthcare level. The scope of practice will
include diagnosis and treatment including performing minor surgery.
The Department of Health has been working closely with the Department of
Public Service and Administration and the National Treasury on developing a
revised remuneration structure for health workers and should be ready for
implementation in the next financial year. The Department is also engaged in
several activities to address push and pull factors e.g. the issue of health
workers migrating from rural to urban areas, from public to private health
sector and from South Africa to developed countries. The Department has sought
to work with other countries to manage the health workers movement so that it
does not impact negatively on our health system.
For example the Department has an agreement with the United Kingdom (UK)
through which health workers can work in UK hospitals and return to the public
sector without loss of employment or status. Major achievements have been
reached as a result of this agreement. Since the agreement was signed in 2003,
the number of South African nurses registered with the Nursing and Midwifery
Council in UK has decreased by more than 55% from 2 114 in 2002 to 933 in 2005.
Similar other agreements are being explored with other countries which host a
significant number of South African trained professionals such as Canada.
As part of developing the second economy, the Department has contributed to
the Expanded Public Works Program (EPWP) through the community health workers
programme. The EPWP is the government's plan to create work opportunities
through providing short-term employment and training to large number of
unemployed people. This will further ensure improvement in the provision of
much needed services such as home community based Care (HCBC), health promotion
etc because of the standardised and improved training of Community Health
Workers (CHWs). These initiatives will relieve pressure on the communities and
health workers especially on rural areas.
The Department has been engaging various health stakeholders in our effort
to finalise a Charter for the Health Sector. The Charter is our attempt to
provide a coherent framework for engagement between the public and private
health sectors. It is an effort to deal with the inequities between the two
sectors as well as the transformation of the private health sector. We have
started the process of negotiating targets with respect to equity ownership
within the context of broad-based black economic empowerment. Equally important
is the need for sharing of resources, experiences and competencies between the
two sectors in the manner that strengthens the entire health system.
As much as the government has achieved a lot in the past two years, there
are still challenges which need to be addressed. Some of these are socio
economic challenges e.g. unemployment, poverty, water and sanitation as well as
priority health programmes. Our Department has declared tuberculosis (TB) as a
crisis health programme that needs accelerated attention. The National TB
Crisis Management Plan was launched in March this year to strengthen the TB
control programme in those districts with a significant number of TB cases and
unsatisfactory cure rates. These districts are the Nelson Mandela Metro and
Amatole District in Eastern Cape, Ethekwini Metro in KwaZulu-Natal and the
Johannesburg metro in Gauteng. Last week the Department held awareness blitz in
various areas to educate and encourage people to be tested for TB.
I would like to urge delegates to participate and ensure that our TB cure
rates are improved. The TB cure rates in the majority of nodal areas also need
attention; however some areas such as Umzinyathi in KwaZulu-Natal, Bohlabela in
Limpopo, Mpumalanga and Maluti, Phofung in the Free State are doing very well
in the management of the TB programme.
On HIV/AIDS, our emphasis on prevention of new infections and tackling the
link with poor nutrition has finally been endorsed by the international
community in various forums. The World Health Organisation (WHO) Africa region
declared 2006 as the year of accelerated prevention because of the
understanding of the central role of preventing new infections in responding to
this major challenge.
Your expertise, commitment and experience in dealing with these health
challenges cannot be over emphasised. The annual RUDASA Pierre Jacques Award is
a testimony to that. I would like to congratulate the recipient for the
award.
In conclusion, I commend the role of RUDASA during the past 12 years of
democracy as an important one in improving access to quality health services in
rural and remote areas. I am certain that you will continue with the tradition
of strengthening our healthcare system through advocacy for rural development
and being the voice of rural doctors regarding training and working conditions.
I hope that you will provide assistance during the implementation of the rural
health strategy and that you will extend your hand to other health
professionals.
I thank you.
Issued by: Department of Health
11 August 2006
