Department of Health MEC Nomonde Rasmeni, North West Provincial
Legislature
24 May 2007
Madam Speaker and Deputy Speaker of the North West Legislature
Esteemed Premier, Mme Bomo Edna Molewa
Honourable members of the Legislature
Chairperson of the Standing Committee for Health
Department management and staff
Our distinguished guests
Friends and comrades
Ladies and gentlemen
Baagi ba Profense ya rona ya Bokone â Bophirima
Today, I am here to tell the story of the North West's Health Reform
Programme. Since the advent of democracy in 1994 South Africa is one of the few
countries in the world where wholesale transformation of the health system has
begun with a clear political commitment to, inter-alia, ensuring equity in
resource allocation, restructuring the health system according to a district
health system (DHS) and delivering healthcare according to the principles of
the primary healthcare (PHC) approach.
A significant departure from the past is the decision to create a unified
but decentralised national health system based on the DHS model.
One of the main reasons for this is the belief that this system is deemed to
be the most appropriate vehicle for the delivery of PHC when looking into the
rural nature of our country and province. This is an effort to build on work
done before by many in this province and by many more of our sons and daughters
in various parts of our province.
Honourable Speaker, I am delighted to share with the people of the North
West that our province leads way ahead on decentralisation of primary health
services. This was more evident on the current exercise that we went through of
handing over and receiving some of the cross-boarder municipalities, we gave
out parts of our district with fully decentralised services to both Gauteng and
Northern Cape.
We should continue to work together to invest in our health workers in the
provision of quality healthcare services to our people. We should together
invest in, evaluate, and revise policy we make and resolutions we take,
informed by the material conditions of our health system and the ever changing
needs of our people. "The time for talk is over; the time for action is now".
Tloga tloga e tloga gale".
Today's budget vote is dedicated to our community health workers who
sacrifice their time and energy to help our department to cope with the
challenges of providing quality healthcare. This is done without a salary or
wage, and this is done mainly by women.
We applaud in particular all these women who do all the good work despite
the challenges of cultural stereotype by some amongst our communities who still
believe that women's place is in the kitchen. Women are here to stay and this
should not be misconstrued to mean suppression of capable men, but completion
of the struggle for women emancipation and gender equality.
In her budget vote for the financial year 2005/06, the Minister of Health Dr
Manto Tshabalala-Msimang warned and highlighted the need for a paradigm shift
in the way we approach the health of our people. "We often spend the first part
of our lives undermining our own health through the way we eat, drink, and
drive and by smoking and engaging in unsafe sex. We thereafter spend the second
part of our lives trying to manage the negative health consequences of our
behaviour through costly and complex interventions.
"We cannot continue on this trajectory of destroy and repair, destroy and
repair. We need to make the right choices about our lives right from the start,
as life does not usually give us second chances." Therefore the role of
preventing ill health through healthy and safe behaviour, diet and exercise is
of paramount importance and it is the responsibility of every sector and
citizen.
The vast majority of South Africans in particular in rural provinces like
ours receive their medical care from government-run clinics and hospitals.
Throughout this democratic era, most of our black people are no longer
relegated to grossly inferior facilities. While this is an achievement on the
part of our new government, the challenge is that most of our middle and upper
class of our population still prefer an elite sphere of private practitioners
and hospitals including our health professionals. This in practice is a new
voluntary, clinical apartheid for those of our people who are still trapped in
poverty with the knowledge that most of our facilities are competing rand for
rand with the private healthcare.
Progress made in the implementation of the 2006/07 Programme of Action
We have made significant strides towards successful implementation of this
programme. I am happy to report to the house here today that we managed to
address the following:
* In an attempt to beef up our recruitment drive in the area of health
professionals, 20 health technology students are currently placed at Tshwane
University of Technology and progressing well. As is the case with our Cuban
programme, these students will service our province particularly the rural
areas upon completion of their studies.
* All four districts are completing the final draft stage as far as the
devolution process of environmental health services to the four districts is
concerned. We are also happy that a situational analysis has been conducted in
this regard. In strengthening port health services, the action plan has been
developed to ensure success.
* Provincialisation of Primary Healthcare is also on course for first July
instant. The final draft of the memorandum of understanding is ready for
signing by all parties.
* Through a structured integration plan the Southern District is actively
integrating Merafong into the North West.
* We have successfully procured Cape Town scan machines for
Klerksdorp-Tshepong, Mafikeng provincial and Rustenburg provincial
hospitals.
* Our commitment to continue and sustain the accreditation programme of our
institutions through the Council of Health Service Accreditation of Southern
Africa (Cohsasa) is also producing dividends. I am happy to report that we now
have 21 hospitals participating in the programme, three of which are provincial
hospitals. Of the three provincial hospitals; one is fully accredited; one is
at an intermediate level and the other one at entry level. We are fully behind
our institutions in this regard and are continuously capacitating them, with
the objective of having all of them accredited.
* Our drive to revive and strengthen the departmental quality assurance
initiatives (Wits or Work Improvement Teams Strategy), is gaining momentum. To
date, 65% of our facilities are implementing the Wits. Cohsasa has also
initiated Project Teams Quality Assurance initiatives which we believe will
complement our own quality assurance initiatives.
* May I also report that we are continuously monitoring that interactive
meetings with managers are held to resuscitate Wits projects in all our
institutions.
* Our challenge in this regard is, however, the shortage of personnel in PHC
facilities, but we continue to conduct Wits training to ensure capacity.
* Madam Speaker, it is our ongoing quest to provide best and qualitative
health services and this is starting to shape up by our efforts to strengthen
the Clinical Investigation Committee's (CIC) capacity and revise its mandate,
we managed to appoint new members at a more senior level whom we believe have
capacity and will add value to the committee.
* As part of our rolling plan to ensure availability of medical officers in
rural areas, we have deployed 12 Iranian doctors, all in rural hospitals, and
two specialists placed at provincial hospitals.
* The process of the development programme of Centres of Excellence through
the Tertiary Services Grants for the four provincial hospitals is in place.
* Measures have been strengthened through appointment of infection control
officials, with training programmes and implementation of national
guidelines.
* As we are more guided by our patients' opinions and suggestions, a
satisfaction survey tool has been developed through the assistance of the
Health Systems Trust. This survey tool is still being piloted in Bojanala and
based on the experiences, learned it will be rolled out to other districts.
* We have accelerated our Infrastructure Development Programme both in terms
of clinic building and hospital revitalisation.
* To deal with the increased demand for treatment, the department is
continuously accrediting new sites for the provision of anti retroviral
treatment. Since the inception of the treatment programme, to date 24 142
patients, as against the target of 20 000, are enrolled on this programme.
* We have procured 46 ambulances and they were delivered in December 2006,
44 of which are fitted with e-fuel chips. This will improve the Emergency
Medical Rescue Services (EMRS) response time. The department is concerned about
the high number of hoax calls made by the public which directly affects the
response to people in dire need of ambulance services. This practice must be
condemned in the strongest possible terms.
* The first EMRS college graduation ceremony was held on 12 December 2006,
for staff who undertook medical, rescue, communication and team building
courses. Plans to turn around this institution/directorate are unfolding.
* We held a Forensic Medical Services summit in November 2006 which included
representatives from the province, other provinces and the national department
which has resolved on key issues around implementation of a decentralised
management system of forensic services.
* The Department of Health has taken over all the medico legal mortuaries,
including equipment and vehicles from the South African Police Services and we
are ready to deliver these services.
* 547 new students were enrolled for various basic and post-basic training
programmes at the two colleges in 2006 while 35 students funded by the
department were enrolled at the North West University. Partnership was also
forged with the Health and Welfare Sector Education and Training Authority
(SETA) in respect of nursing learnership and 57 learners were enrolled in 2006
as a result.
* We are upbeat about the progress made in support of our non-governmental
organisation (NGOs) in rendering community health based care (CHBC) services. I
can report that transfer of funds to 152 NGOs was completed to support them.
Outstanding payments of stipends for the past financial year were also
cleared.
* During the last financial year we have formed fifteen structures of Women
in Partnership against AIDS (WIPAA). The aim of this partnership is to fight
the scourge of Gender Based Violence and educate women on their health and
sexual rights.
* Two new youth friendly services have been established in addition to the
fourteen youth friendly services that we already had in the province and all of
them are functional.
2007/08 financial year plans
Plans for the 2010 World Cup
Madam Speaker, like many other South Africans we are excited about the 2010
World Cup to be hosted by our country. We also acknowledge the challenges that
come with hosting this prestigious event on the world stage. It is for this
reason that as a department, our contribution and readiness must be up to
scratch. Our plans and preparations for the 2010 World Cup include the
following:
* In our endeavour to meet the Federation International Football Association
(FIFA) standards, we are earnestly preparing to revitalise our institutions to
meet the urgent demands that goes with the festive nature of the world cup,
however the challenge is availability of funds for this.
* We have budgeted R42 million for procurement of new ambulances to meet the
demand of 2010.
* We will also beef up our mobile clinics along the fan parks.
* Also critical to our readiness will be to ensure adequate training of our
EMRS personnel.
* We will equip institutions and ambulances with world class equipment.
Projects for Accelerated and Shared Growth Initiative for South Africa
(AsgiSA) and Expanded Public Works Programmes (EPWP)
The department is contributing towards the EPWP through the Clinic Building
Programme, Infrastructure Programme and the Community Health Worker Programme.
The department also encourages every infrastructure project that it undertakes
or contract out to be labour intensive, and sources the labour from local
communities where the projects are undertaken.
Included in the EPWP programme is mandatory training which ensures that
beneficiaries are exposed to both theoretical and practical work. Capacity
building for community health workers benefiting from this programme is
ongoing.
The stipends that the community health workers are receiving ensure a
sustainable household income. This programme will specifically target young
people who are unemployed. As such the department will make a contribution
towards enabling young people to meaningfully contribute to their communities
whilst acquiring skills for future survival.
In the period under review 34 projects have been completed through the
Expanded Public Works Programme (EPWP) in partnership with the Independent
Development Trust (IDT).
Skills development and acquisition
Guided by the dictates of AsgiSA, the department is committed to this
programme noting the responsibility to take more and more young people through
learnerships. They can therefore gain skills and work experience in order for
them to access jobs; and intervene to ensure proper functioning of skills
development authorities.
Through the learnership programme, a sizeable number of learners have been
deployed in the following programmes that the department has embarked on: Adult
Basic Education and Training (ABET) Programme, Nursing Education and Auxiliary
Healthcare.
The department has also entered into partnership with Msombomvu Youth Fund
to fund part of the internship programme. The approach of the department has
been to target priority programmes where skills are in need, for example supply
chain management, finance, information and communication technology, monitoring
and evaluation and lately emergency medical and rescue services. This programme
is affording the learners the opportunity to acquire skills and experience as a
way of preparing them for job opportunities in the public service and the wider
market. Most of the beneficiaries of this programme have in the past secured
jobs in the public service and a few in the private sector.
Entrenching nursing training
With a view to strengthening nurse education, an audit of nursing education
institutions was conducted by the national department of health and this has
resulted in the development of the draft national nursing strategy.
Our colleges have also submitted requests to the South African Nursing
Council (SANC) for accreditation of additional facilities for clinical
placements in order to keep pace with the increasing numbers of student
nurses.
Health posts
Great progress has been registered in regards to this programme. We have
taken over the completion of those health posts that remained uncompleted by
the municipalities and we will do everything in our power to complete the
projects this year. It must be noted that these facilities are not clinics, but
health posts, staffed by auxiliary nurses who will provide basic health
promotional and preventative services. In addition these facilities will
provide a fixed structure from which the mobile health clinics can render a
more comprehensive primary health service on scheduled visits.
HIV and AIDS
Anti-Retroviral Treatment (ART)
Through an integrative process with all departments and stakeholders the
department will begin implementation of the National Strategic Plan (2007-2011)
which is based on the following four pillars:
1. prevention
2. treatment, care and support
3. legal and human rights
4. research, monitoring and evaluation.
The success of this plan lies on reducing the numbers of new infections
which will require a very concerted effort by all stakeholders including
employers and educationalists. The department also aims to increase the numbers
on treatment by at least 10 000 to treat a total of 33 000.
Voluntary Counselling and Testing (VCT)
Most public facilities are providing Voluntary Counselling and Testing
services. The service has also been extended to some private facilities.
Personnel of different occupational categories have been trained to render this
service.
The greatest challenge is to get each and every South African to know their
HIV status, as a basic step towards preventing new infections and adopting
appropriate sexual behaviours. Now is the time for our leadership to really
lead and show the way.
Prevention of mother to child transmission (PMTCT)
Most public health facilities render PMTCT services. Mothers on the
programme experience a number of difficulties some of which are stigma related
ones. We are however convinced that as we intensify this programme we can
achieve the goal of having an AIDS free generation beyond the second decade of
freedom "Bomme ba tshwara thipa ka bogaleng".
Stigmatisation results in mothers staying away from the service and this
cause them to mix feed (breast and formula feeding) defeating the purpose and
effects of Niverapine. This may be a contributory factor to some children
testing HIV positive at the age of 12 months.
Sexually Transmitted Infections (STIs)
To strengthen STI control, sentinel surveillance sites have been established
in the province. In addition STI clinical skills are being improved through a
train-the-trainer programme and syndromic management. The challenge is to
ensure that training is cascaded to all public health facilities in the
province and to include the private sector in the treatment and management of
STIs according to protocols. Partner tracing and treatment must also be a
concerted effort between the public and the private sector.
Tuberculosis (TB) control programme
As a response to the ongoing TB epidemic the National TB crisis plan has
been developed and is being implemented. A national project manager for this
programme has been appointed. The province is establishing an Extreme Drug
Resistance (XDR) unit in addition to the already effectively functioning Multi
Drug Resistance Unit (MDR). There has been a marked decrease in the TB
treatment interruption rate. The cure rate has been improving over recent
years, but has not yet reached acceptable levels.
Extreme Drug Resistant Tuberculosis (XDR-TB) has emerged as a major threat
to public health and Tuberculosis (TB) control. It presents enormous challenges
to effective treatment and control of the disease in our country, however in
our province we have managed thus far with the very little resources we have to
do our best.
We have as a province a specialised Multi-Drug Resistant TB (MDR-TB) Unit in
the Klerksdorp/Tshepong Hospital complex. Established in 2001, it has been
recognised nationally as the best MDR-TB Unit in the country. Among other
things, the MDR-TB Unit ensures thorough screening of all possible contacts of
MDR/XDR patients to prevent further infections.
I would like to remind the people of the North West that ordinary TB is
curable, even for people who have HIV. Everyone, therefore, must play a role in
assisting our TB patients to adhere to the six months medication necessary to
cure TB, by assisting and supporting these patients to comply with treatment
schedules.
Environmental health
The department has outsourced removal and treatment of healthcare waste from
health facilities. A very successful pilot project in Ramotshere Moila Sub
District, in conjunction with the Department of Environmental Affairs and
Tourism (DEAT) is being meted out across the central district. In order to
ensure that food offered for sale conforms to food hygiene and safety standards
Food Control committees have been established.
Villages and farms along the Molopo River are regularly sprayed with indoor
residual effect insecticides to reduce the mosquito population. This is an
effort to maintain and improve on the low incidence of Malaria in our
province.
With the exclusion of port health services, malaria control and the
management of hazardous substances, those environmental health services which
are defined as municipal health services will be taken over by district
municipalities when the next financial year starts.
Non-governmental organisations (NGOs), community-based care and support
programmes
By restructuring of the department's NGO management, which will include
decentralized management through the sub-districts; we can assure our NGOs of
continued and strengthened support. This includes provision of accredited
training to NGO partners on corporate and financial management skills, based on
a prioritised needs assessment as well as implementation of the national
initiative funded by the European Union.
Entrenching community participation
We have finished the launch of all outstanding governance structures and are
now busy with training them as part of the Governance structures revival
programme. The provincial health council has been launched and a consultative
forum on health issues will be part of this year's priorities. This programme
is part of the implementation and fast tracking of the national Health Act no
61 of 2003. We have also resolved all legal issues surrounding our Private
Public Partnership (PPP) programme as it relates to Victoria Hospital
Further, we have managed to improve our interaction as government with the
people of this province through accountable public representatives, one-stop
government centres, izimbizo, governance, and the use of electronic government
services. The North West Department of Health has since the beginning of the
last financial year acknowledged the importance of having a Call Centre for
purpose of having centralised control of external enquires from our communities
about our services.
Targeted community awareness programmes will be launched soon by the office
of the MEC on a number of relevant issues such as: personal and primary
healthcare, TB and HIV and AIDS, as well as general information on the
departments programmes.
Recruitment and retention of health professionals
This is an aspect that remains among out top priorities in the public health
sector and various avenues are being pursued in this regard.
The department has benefited from government to government agreements
concluded with the Islamic Republic of Iran and the Republic of Cuba, and most
of the health professionals from these countries are placed in the underserved
areas.
The avenue of bursaries is also being used and the department and the Office
of the Premier are funding students studying for various health sciences
related fields. Some of the bursars are pursuing studies in medicine in
Cuba.
We also believe that the envisaged new dispensation in the remuneration of
health professionals will go a long was in contributing towards our capacity to
attract and retain talent in the province.
Our province must also begin to work on the benefits that may accrue from
concerted inter-sectoral collaboration to meet the challenges around
recruitment and retention that go beyond monetary ones. For instance, we need
to ensure availability of adequate and appropriate accommodation facilities,
schools, roads and other infrastructure. Further, roads infrastructure network
has to be improved in order to improve attraction capacity of the health
facilities located in the far-flung areas.
The department is very proud to announce the launch of The Guidebook for
District Hospital Managers in June. This guidebook was developed by the
department is to adopted by the national department for implementation in all
South African district hospitals to strengthen and develop hospital
management's skills.
Nursing education
During the current financial year 544 new students will be enrolled at our
nursing colleges. Three thirty eight will enrol for the four-year diploma and
206 for post basic programmes.
Fifty seven students funded by the department will study for a nursing
degree at the North West University.
One hundred and thirty learners will enrol for nursing learnerships in
2007.
Youth programmes
This year we will concentrate on upgrading the Youth Friendly Services by
developing skills and enhance capacity as well as renovating some of the
buildings that were donated to the Department of Health by municipalities and
the Department of Public Works.
Focus area will be on sexual health rights, alcohol and drug abuse, teenage
pregnancy prevention strategies and physical activities to keep them out of the
streets and ensure that they live healthy life styles. This project has already
started and will run until March 2008.
We will this financial year enter into partnership with the Umsobonvu Youth
Fund to strengthen the capacity of youth centres as well as ensure continuous
functioning and sustainability of services in the youth centres.
Empowerment of women
To build on the WIPAA structures established last year, we will this year
continue to strengthen them and launch six more structures to ensure that we
cover the whole of North West province.
We have as a department identified a gap when dealing with cases of
survivors of gender-based violence such as rape in as far as posttraumatic
stress disorder is concerned. Over and above the good referral system that we
have, we will ensure that survivors get the necessary support by forming
community fora which will take the process forward. The aim is to establish
fora within communities where community members will have an opportunity to
have a say and inform decisions about the programme.
Disabled people
Madam Speaker, the physically challenged people form part of the province's
demography. The department will continue supporting programmes that are aligned
to develop disabled further. The department remains committed to avail more
opportunities of employment and continue availing assistance devices to make
life of the disabled easier, we will continue to do all these in partnership
with various disabled organizations in the province.
Budget 2007/08
The department's strategic plan for this period has incorporated the key
National Health System (NHS) priorities.
The Administration Programme will continue to focus on strengthening of
human resources by filling health professional's posts. Our plan therefore,
will be to fill replacement vacancies as well as new posts that came about as a
result of the newly approved structure. Specific incremental allocations for
the three years of the Medium Term Expenditure Framework (MTEF), namely of R30
million, R60 million and R200 million will be used for the following
priorities:
* Funding for community services programmes to ensure that underserved
communities get access to services of health professionals.
* Increasing posts for medical internships. The introduction of the two year
medical internship will result in increased numbers of medical interns from
2008 and provinces have been requested to increase the posts in this
regard.
* Funding for student intakes in the nursing colleges. The province has in the
past used funds from conditional grants to fund posts for student intakes,
however, there is a need to gradually decrease dependence on conditional grants
funding and make provision from the equitable share.
The new remuneration dispensation for health professionals, in line with the
national bid to improve remuneration, is underway with the nursing profession
being the first category to benefit, with other categories of health
professionals targeted in subsequent phases. To implement the salary increases
an initial cost of R94 million per annum will be required, which is in excess
of the current allocation. Madam speaker, with these budgetary pressures
further allocations therefore will be necessary to accommodate this, the
associated increases in performance pay and grade progression payments as well
as the filling of new posts.
Primary healthcare delivery through the District Health Services is to be
further strengthened through the integrated decentralisation of Emergency
Medical Rescue Services (EMRS) and a similar phasing in of Forensic Medical
Services over the next two years.
The policy priorities for EMRS services included several areas:
* communication and information systems
* improved training of emergency care practitioners and development of a
regional training centre for emergency care technicians
* vehicle and equipment replacement and maintenance
* 2010 World Cup
* new ambulance models
* shorter response times (15 minutes for urban and 45 minutes for rural
areas).
All available data show that this policy priority has been strongly funded.
EMRS budgets grow by 6,3% in real terms annually, which amounts to R24 million
over the MTEF. The additional amounts added to baseline suggest that this
priority has been well funded. As such we will go a long way to improve our now
ailing service, and monitor this through a decentralised management system.
The department will continue to develop the provincial and central hospital
services to deliver the full package of services appropriate for these levels
of care. The reduction in the allocation as a result of the cross border
allocation adjustments will pose a challenge, particularly with regard to Brits
and Rustenburg provincial hospitals which are well known to this House.
The allocation for the 2007/08 financial year has dropped in comparison with
2006/07 allocation. The original allocation for 2006/07 was R190,884 million
whilst the 2007/08 allocation amounts to R176,966 million. This results in a
drop of R13,918 million. The allocation improves with the remainder of the MTEF
years with allocations of R231,966 million and R214,983 million respectively,
and an increase of R55 million for the second year and a drop of R16,983
million for the outer year.
Madam Speaker, the 2007/08 allocation for this programme is a serious
challenge for us given the backlog we have.
These hospitals are also augmented by the Tertiary Services Grant (NTSG).
Although this NTSG in a small proportion of the overall budget it does indeed
assist the department to develop these tertiary services. Overall the grant and
programme increases by 8,5% amounting to R12 million in 2007/08, R12,7 million
in 2008/09 and R9,7m in 2009/10. This is a significant growth from the
baseline.
The HIV and AIDS budget shows some growth, but not at expected levels given
the burden of the disease. The growth is at nine percent from 2006/07 which
amounts to R156,4 million against R142,3 million, which should enable us to
increase the number of people on treatment. This increase in 2007/08 financial
year would mean adding 13 000 more people on treatment.
We look forward to improving the health facilities management through the
Infrastructure Development and Improvement Programme (IDIP), which will go a
long way towards enhancing quality services being delivered through quality
facilities. Reconfiguration of our hospitals and clinics will improve patient
referrals and also ensure a seamless service.
Financial management
Madam Speaker, we have now put in place control measures to ensure full
appropriate spending. Improved monitoring and evaluation processes have been
implemented to proactively manage specific budgets that did not perform as
required last year, in particular that of conditional grants. In addition an
independent review of the entire department's financial management will greatly
assist in directing improved financial management.
Programme allocations for 2007/08
Madam Speaker, I stand here before your august house submitting for
authorisation of vote 3 2007/08 budget as follows:
Programme (R'000): 2007/2008 MTEF
1. Administration: 163,956
2. District Health Services: 1,844,067
3: Emergency Medical Services: 142,035
4: Provincial Hospital Services: 984,063
5. Central Hospital Hospitals: 81,409
6: Health Sciences and Training: 116,226
7: Healthcare Support Services: 120,555
8: Health Facilities Management: 302,207
Total allocation: 3,754,518
I am convinced that with this budget we will cover enough ground to lay a
basis for wealth through health, and we are ready "faka imali uzobona".
Our context is characterised by limited resources and increasing demands for
healthcare, and to this end, we will have to use the principle of leverage,
which has been described by one of the Architects of systems thinking, namely
Peter M Senge, as "seeing where actions and changes in structures can lead to
significant and enduring improvements". Therefore, we will leverage the skills
and talents of the committed women and men we have in our employ by working
smarter in order to achieve more with the limited resources at our disposal
without compromising the quality of services we render at various points and
level of care.
I would also like to convey my sincere appreciation to the parents
association and governing body of Witrand Hospital for their very kind donation
of an ambulance which was recently handed over to the hospital. This ambulance
will really assist the hospital and improve patient transfers and referrals. It
is acts like these, from committed community members, that foster full
community participation and ongoing improvements to the delivery of an
accountable service to communities.
In conclusion, I wish to take this opportunity to thank my colleagues in
EXCO, our Honourable Chairperson and members of the Health Standing Committee
for their unfailing support, and oversight, and guidance.
I also take this opportunity to express my gratitude to the management and
staff of the department for their commitment and loyalty as well as our various
stakeholders and partners; last but not least, I thank my dear husband and
children for their understanding and support.
I thank you
Issued by: Department of Health, North West Provincial Government
24 May 2007
