S Belot: Free State Health Prov Budget Vote 2006/07

15 March 2006

INTRODUCTION

Honourable Speaker,
Madam Premier,
Honourable Members,
Distinguished Guests

Mr Speaker, The mandate from the State of The Nation Address by the
Honourable State President, Mr Thabo Mbeki, is clear; that we should move
faster to address the challenges of poverty, underdevelopment and the
marginalisation that confront those caught within the Second Economy.

The State President indicated that Government is committed to respond with
all necessary seriousness and determination to all these challenges, and will
play its role to give new content to our Age of Hope.

“We must ensure that the machinery of government, especially local
government sphere, discharges its responsibilities effectively and efficiently,
honouring the precepts of Batho Pele”.

Mr Speaker, The overwhelming support and resounding victory during the last
elections is confirmation of this mandate for faster delivery. I wish to thank
all voters who participated in the elections and particularly those who voted
correctly and wisely, voting for the governing party to continue with service
delivery.

Mr Speaker, last week, this day, we celebrated International Women’s day. On
that day we also celebrated the 50th Anniversary of the March of Women against
the pass laws. We salute the women, our mothers and all our heroines!!!

Mr Speaker, the month of March is Human Rights Month, it is my privilege to
table this Budget Vote, six days before the Human Rights Day. We believe that
this budget will go a long way in addressing and reinstating the human dignity
and will instil national pride in our people. We believe that Patient Rights
are Human Rights.

Achievements in the last financial year (2005/06)

Mr Speaker, the core business of the Department of Health is to ensure the
delivery of Quality Health Services to the people of the Free State and our
country:

The following are some of the achievements recorded during the 2005/06
year
* By end of December 2005, 4 370 734 patients were treated in our primary
healthcare (PHC) facilities and 238 505 outpatients visited our District
hospitals. 190 112 outpatients were treated in the regional hospitals. 17 225
were treated at the Free State Psychiatric Complex and 146 407 were treated at
the Universitas Hospital.

* 225 019 patients were seen through our mobile clinics that render
essential Primary Health services in especially rural areas.

* The number of Emergency Medical Services calls that were handled in all
the five districts is 248 739 and 534 365 patients were transported through the
planned patient transport (Commuter transport).

* With the Implementation of the Comprehensive plan on HIV and AIDS,
approximately 12 000 patients are on the program, of which 4 675 are receiving
antiretroviral (ARV) treatment from the Department of Health and its Partners.
We have welcomed 72 newly doctors for Community Service in January 2006. This
improved the shortage of doctors.

* 65 % cure rate for new Pulmonary Tuberculosis (TB) Cases for the province
was achieved.

* I am happy to report that the consolidation of PHC Personnel from local
municipalities to the provincial s successfully completed in April 2005. A
total of 864 Health workers were transferred from local municipalities to the
provincial department of health. We are the first province to achieve this
process of strengthening the rendering of Primary Health Care. We have formally
welcomed the Primary Health Care Workers at a PHC summit in December 2005. The
challenges of pension funds and other conditions of service are being addressed
on an individual basis in collaboration with South African Local Government
Association (SALGA) Free State and the individual municipalities.

The department is currently busy with phase two of this project. This is the
transfer of Assets; Clinic Buildings; Equipment and Vehicles. All the necessary
documents for transfer of immovable assets have been sent to all
municipalities.

* The new Trauma unit at Pelonomi Hospital has been completed at a cost of
R42 million on new equipment and building upgrade.

* The Doctor’s residences and the Nurses home at Boitumelo Hospital at a
combined cost of about R30 million has been completed and equipment of about R8
million has been purchased for Boitumelo.

* The Free State received the annual award for the best performing province,
with regards to cataract surgery for the second time.

* Baby Friendly status has been awarded to Mohau Hospital (Hoopstad),
Phuthuloha Hospital (Ficksburg), Phekolong Hospital (Bethlehem) and Parys
Hospital.

* The department, for the second consecutive year, was awarded the
certificate from the South African Institute of Government Auditors for having
presented the best financial annual report in the Free State. The department
was assessed to be among the top ten departments both at national and
provincial level in the country over a period of three years.

The Budget

Mr Speaker, the budget allocated to the Health Department for the 2006/2007
– 2008/2009 Medium Term Expenditure Framework (MTEF) financial period is R3,249
billion in 2006/07, R3,469 billion 2007/08 and R3,736 billion in the 2008/09
financial year.

The R3,249 billion allocated in the 2006/07 is 27,8 % of the total of the
provincial budget of R 11,626 billion.

This budget of R 3,249 billion represents an increase of R 131 million or
4,2% more than the budget allocated in the 2005/2006 financial year.

The budget estimate has been allocated as follows per programme over the
medium term (MTEF) period

Medium term estimates

1. Programme (R) Administration
2006/07: 188 551 000
2007/08: 202 137 000
2008/09: 217 744 000

2. Programme (R) District Health Services
2006/07: 1 308 275 000
2007/08: 1 388 374 000
2008/09: 1 494 171 000

3. Programme (R) Emergency Medical Services
2006/07: 145 070 000
2007/08: 155 522 000
2008/09: 167 530 000

4. Programme (R) Provincial Hospital Services
2006/07: 840 853 000
2007/08: 901 437 000
2008/09: 971 040 000

5. Programme (R) Central Hospital Services
2006/07: 556 049 000
2007/08: 596 114 000
2008/09: 642 141 000

6. Programme (R) Health Science and training
2006/07: 91 658 000
2007/08: 98 262 000
2008/09: 105 850 000

7. Programme (R) Health Care Support
2006/07: 60 313 000
2007/08: 64 659 000
2008/09: 69 651 000

8. Programme (R) Health facilities management
2006/07: 84 849 000
2007/08: 90 963 000
2008/09: 97 986 000

Programme (R) Less Internal charges
2006/07: - 26 005 000
2007/08: - 27 879 000
2008/09: - 30 031 000

Total estimates
2006/07: 3 249 613 000
2007/08: 3 469 589 000
2008/09: 3 736 082 000

Mr Speaker, this allocation is informed by a broad consultative programme
that was followed. I was able to interact with our clients; stakeholders,
partners and personnel through health summits, like the EMS Summit; the PHC
Nurses and Health Workers Summit; the outreach workshops with the Medical
Officers in all districts; Imbizos and visits to institutions. Through these
interactions we are able to understand the challenges and the needs of the
communities in the Free State.

The Free State Growth and Development Strategy (FSGDS)

Budget Analysis according to FSGDS priorities:

Mr Speaker, the proposed budget allocation seeks to deliver on our mandate
of rendering quality comprehensive health services; as well as to contribute in
achieving the priorities of the Free State Growth and Development Strategy.

The Department of Health has to render quality health services and ensure
that it contributes to economic growth; skills development and alleviation of
poverty to the people of the Free State.

Based on the developmental objectives of the province the areas that need to
be addressed by 2014, in which the Department of Health has a major role to
play are:
* To reduce the number of households living in poverty by 5% per annum
* To reduce the infant mortality for children under 5 to 65 per 1000 life
births.
* To reduce the obstetrical maternal mortality rate from 65,5 to 20,0 per 100
000 women in the reproductive age group.
* To stabilise the prevalence of HIV and AIDS and reverse the spread
thereof
* To provide free basic Primary Health Care services to all the people of the
Free State province
* To provide adequate health infrastructure and contribute to economic growth
and development.
* Reduce blindness due to cataracts and correct refractive errors to prevent
visual impairment.
The above goals will be realised through collaboration with social partners
based on integrated development planning.

Economic Development and Employment Creation

Mr Speaker, our government has adopted a programme of Accelerated and Shared
Growth Initiative for South Africa (Asgisa).
According to our President, Mr Thabo Mbeki: “…Asgisa is not intended to cover
all aspects of a comprehensive development plan. Rather it consists of a
limited set of interventions that are intended to serve as catalysts to
accelerated growth and development.”

The Free State Province has identified that sustained economic growth is the
key to reduction of unemployment and creation of new jobs to eradicate poverty.
Investment in infrastructure development projects; empowerment of small, medium
and micro enterprises (SMMEs) and skills development have been identified as
areas of key focus.

Health Infrastructure

R84, 849 million has been allocated for the creation of health facilities in
the Free State. R53, 373 is allocated for developing infrastructure based on
approved projects and R31, 476 million is for Hospital Revitalisation, based on
Programme Implementation Plan.

Health infrastructure projects

This R53, 373 million will be used to develop the health infrastructure at
the following facilities. Dealsville Community Health Centre (R31 483 to
complete); Elizabeth Ross (R 6,555 million - Final phase); Thebe Hospital in
Harrismith (R5, 521 million - Final Phase); Tokollo Hospital in Heilbron (R6,
095 million); Diamant Hospital - Jaggersfontein (R5, 139 million); Thusanong
Hospital- Odendaalsrus (R 6, 143 million - maternity); Katleho hospital -
Virginia (R11, 973 million- maternity); MANCOFS Accommodation for health
professionals (R4, 515 million). Orthotic and Prosthetic Workshop at Pelonomi
hospital (R4,297 million); The Palliative Care Unit at National District
Hospital (R1,319 million); The MDR Unit at Dr J S Moroka Hospital in Thaba Nchu
(R1,780 million)

Hospital Revatilisation Grant

R45, 673 million is allocated for the Hospital Revitalisation. The grant is
allocated to modernise, transform infrastructure and health technology of our
hospitals in line with national objectives. It also assists to transform
hospital management and improve quality of care in line with national
policy

Mr Speaker, Boitumelo Hospital (Kroonstad) and Pelonomi Hospital
(Bloemfontein) are the only two hospitals that are funded trough the
Revitalisation grant in 2006/07.

R31, 476 million is allocated for Hospital Revitalisation Programme to
upgrade the hospitals and R14,2 million is allocated for Hospital Management
and Quality improvement programme.
* At Boitumelo Hospital R22, 13 million is allocated for the theatres; X- Ray;
maternity as well as the mechanical and electrical infrastructure.
* At Pelonomi R 8, 842 million has been allocated for the upgrading of the
Pharmacy and the ICU facilities.

R14.2 million allocated for Hospital Management and Quality Improvement
Programme is to be used for Provincial corporate economic and financial
management; Implementation of COHSASA to improve Quality of Care; Human
Resource Development; Infection Control and the Meditech Hospital Information
System.

Following a delay of getting the necessary approval to build the hospitals
in Trompsburg and Ladybrand through a PPP Project; business cases for the two
hospitals have now been concluded for them to be developed through the Hospital
Revitalisation Programme.

The following additional hospitals have been placed on the Revitalisation
Programme and approval for funding is expected in May 2006/07. The projects
will then be implemented in 2007/08. These are Mantsopa Hospital (Ladybrand);
Trompsburg Hospital; National Hospital (Bloemfontein); Dihlabeng Hospital
(Bethlehem) and the Free State Psychiatric Hospital (Bloemfontein).

R14, 297 million is allocated for the construction of the new government
mortuary in Bloemfontein. The construction is will commence in August 2006.

To improve on the management and distribution of medicines and consumables,
the Medical Depot will be upgraded. R7, 00 million has been allocated for phase
one and the programme will commence during the second quarter of 2006/07

R14, 00 million is allocated to Emergency Medical Services for Capital
Infrastructure and will be utilised as follows:
* R12, 00 million is allocated for the purchase of 20 Ambulances and 15 Planned
Patient Transport vehicles.
* R2, 00 million is for the purchase of essential basic equipment needed in the
ambulances

R29, 00 million has been allocated for Information Technology; Web
development, Clinical Engineering and Facility Planning.

Expanded Public Works Programme (Social Sector)

R21, 494 million is allocated for Home Based Care. 2 500 Home Based Carers
are placed on the programme and 1 600 have already gone through the 59 day
accredited course. 200 more Home Based Carers will be trained to be able to
render a comprehensive service to all the patients and clients.

On skills development the department has allocated 221 Bursaries to full
time students and 100 part time to address the scarce skills. An amount of R9,
710 million has been committed to date on all bursaries.

Social and Human Development

Mr Speaker, The core business of the Department of Health is to ensure the
delivery of Comprehensive Health Care Service to the people of the Free State.
The Department of Health will continue to focus on promoting the expansion of
Primary Health Care services to the rural communities to ensure equity and
access to basic services.

Comprehensive Health Care

R1, 308 billion is allocated for the provision of Primary Health Care
services through the District Health System. The services include PHC clinics;
Community Health Centres; District Hospitals; Community based health services
as well as Emergency Medical Services in all the five districts.

* R239, 70 million is allocated to provide basic PHC services through
Clinics and Community Health Centres in 20 local municipalities within all the
five districts. Access to PHC services to the rural communities is ensured by
the implementation of the rural health plan.

* R41, 494 million is provided for the provision of Forensic Pathology
Services; following the takeover of medico legal mortuaries from the South
African Police Services. 31 officers 33 vehicles have been transferred from the
SAPS. 108 posts will be filled (Forensic Pathology Specialists; Medical
Officers; Administrative and Forensic Officers) R18 million is for personnel
costs. R14, 297 million is for building the mortuary in Bloemfontein. 10
holding facilities will be established in the province across the five
districts. R1,267 million is allocated for the purchase of 8 mortuary vehicles
and essential equipment.

* Mr. Speaker, I wish to emphasis that all unnatural deaths will only be
removed after the South African Police Service (SAPS) have completed their work
on the scene.
* R505, 20 million is allocated to the district hospitals to implement the
District Hospital Package in support of Primary Health Care in all the
districts.
* In order to reduce the burden of disease a conditional grant amounting to R
142, 265 million is allocated for the Comprehensive Plan on Care, Management
and Treatment of HIV and AIDS.

* Mr Speaker, I am pleased to announce that the number of ARV sites has been
increasing each year in all the districts as we seek to expand implementation
of the Comprehensive plan to ensure access to services for the people of the
Free State. The aim is to continue to increase coverage to all the local
municipalities.

* The following new ARV sites are planned for implementation in the new
financial year
- Xhariep – Trompsburg and Jacobsdal and a Mobile clinic
- Motheo – Thaba Nchu; Ladybrand and Wepener
- Lejweleputswa – Verkeerdevlei; Theunissen; Winburg and Ventersdorp.
- Fezile Dabi – Heilbron; Koppies; Vredefort; Frankfort; Villiers and
Tweeling.
- Thabo Mofutsanyana – Ficksburg; Harrismith; Petrus Steyn and Reitz.

* We will commence with nurse-initiated training at 8 ARV sites in order to
increase access to services.

* By December 2005, a total of 75 500 clients were seen through the
Voluntary Confidential Counselling and Testing (VCCT) Programme. As we reach
100% percent coverage of VCCT in all towns, the department will increase the
number of non-medical VCCT sites from 10 to 15. A further 200 new lay
counsellors will be trained and placed on the VCCT programme.

* The department will continue to support the provision of the Prevention
from Mother-To-Child Transmission (PMTCT) at all levels of care. Furthermore
60% of all facilities will have trained health workers and lay counsellors to
implement the relevant policies and guidelines. We will ensure that 60% of
pregnant women are enrolled on the PMTCT programme.

* The department will train personnel at 80 PHC facilities on Syndromic
Management of Sexually Transmitted Illnesses (STIs).

* Following the development of a National TB Crisis management plan; which
focuses on specific districts in all the provinces, Fezile Dabi has been
identified as high priority district. A provincial plan has been developed for
implementation in Fezile Dabi to strengthen the management of TB in this
district. Included is a communication and social mobilisation campaign that
focus on improving awareness and TB cure rates with messages targeted at
specific vulnerable groups.

* Mr Speaker, on the 24 March 2006 is World STOP TB Day. The department will
hold the provincial activity in Welkom on this day. The purpose of the event
will be to launch the new campaign called “Operation Kgutlela” which is aimed
to bring all the TB defaulters back on the TB programme. Similar activities are
to be held in all the other districts before the end of March 2006.

* We will improve immunisation coverage in the Free State from 85% to 90% by
introducing the missed opportunities in the public and private facilities
especially hospitals.

* The department will promote the implementation of key recommendations, as
set out by the National Committee on Confidential Enquiries into Maternal
Deaths. We will ensure that 98% of institutions use maternity case records for
pregnant women and 60% of maternity units to use the prescribed guidelines for
management of complications that may result maternal deaths.

R840, 853 million is allocated for the Provincial Hospital Services and R
556, 049 million is allocated for the Central Hospital Services.

Health promotion and health awareness campaigns

Mr Speaker, during the tabling of the budget vote last year, I indicated
that “Chronic diseases of lifestyle like hypertension, diabetes mellitus, heart
problems, strokes and cancers are affecting our communities in great
numbers”
We have to continue implementing prevention and health promotion programmes to
address the impact of these chronic diseases of lifestyle. My department will
continue to encourage healthy lifestyle; healthy eating habits and physical
exercise among all the people.

We will observe among others the following health days as per health
calendar:
7 April 2006: World Health Day - The theme is “Working together for health”.
The focus will be on health workers as human capital that supports quality
health services. The day will be celebrated in conjunction with Occupational
Health and Safety and the implementation of the Employee Assistance Programme.
We wish to invite all sister departments and social partners to join in this
programme.

31 May 2006: World no Tobacco Day - The Theme is “Tobacco – Deadly in any
form or disguise”. The day will be celebrated within schools that are involved
in the Capacity Building for Health promotion project. The focus will be on
learners in high schools. We will work together with colleagues in
Education.

24 September 2006: World Heart Month - The theme is “How young is your
heart”. The day will bring awareness to all the communities. Activities will
focus on healthy hearts, physical activities, nutrition, obesity and weight
control and other risk behaviours.

In October 2006 a Provincial Health Promotion Conference will be held to
focus more on non communicable disease prevention.

Quality Health Care

Mr Speaker, during the first quarter of the year the department will create
the office of Ombudsperson. The Ombudsperson will be in charge of an
independent office that will seek to address complaints from the public about
quality services delivery; patient safety; service standards; patient rights
charter and the Batho Pele Principles. This office will be supported by a multi
disciplinary task team including, legal specialists, clinical specialists and
employment relations specialists amongst others.

Mr Speaker; we will benchmark on best practices in both the public and
private sectors, locally and internationally. The Departmental Toll Free Number
for Customer Care will be extended to include reaching the office of the Health
Ombudsperson. This toll free number is 0800 535554.

The department has finalised the Service Delivery Improvement Plan and a
Service Delivery Charter will be launched before the end of July 2006. The main
project in collaboration with the Department of Public Service and
Administration is aimed at improving customer relations and revitalise Batho
Pele is the “ Know your rights campaign “. The department will pay much focus
on this campaign as we seek to render quality health services that meet the
needs of the people.

The department will continue to improve the quality of health services
rendered in our facilities and a Provincial Quality Assurance Strategy and a
Comprehensive Clinical Risk Management Policy will be developed and implemented
as from June 2006.

Justice, Crime Prevention and Security

The Department of Health is part of an integrated Disaster Management Team
to safeguard against both natural and unnatural disasters

We will continue to implement and strengthen the Emergency Medical Services
Plan, by providing medical rescue, pre- and inter hospital Emergency Medical
Services and providing access to rural communities. R145 million has been
allocated for the provision of Emergency Medical Services. Of this amount R85.2
million will be spend on compensation of employees while about 35 new vehicles
(R12 million ) as well as other equipment (R2 million ) will be bought. R29
million in allocations for fuel and maintenance of EMS vehicles. R 16.8 million
is allocated for Goods and Services

Effective Governance and Administration

The Provincial Fraud Prevention and Anti-corruption strategy is being
updated and this will be marketed throughout the Department. Officials from the
Internal Audit Unit were trained in forensic auditing to identify and report on
fraudulent activities. The Departmental Toll Free Number for Customer Care will
be extended to include Fraud hotline. (The Toll Free Number is 0800 535554)

One of our goals is to develop and establish a Data Warehouse and Health
intelligence unit by 2008. An amount of R650 000 is allocated for licences to
facilitate the development of the Data Warehouse. The Data Warehouse is an
electronic information management system which turns the information in the
database into strategic decision-making tools to assist management in forward
planning, strategic thinking and decision making. The 1st phase of the Data
Warehouse will be ready by May 2006.

113 officials were trained in basic accounting principles and 9 officials
were exposed to the Applied Government Accounting Course in 2005/06. The
project will continue in 2006/07 with an additional 54 officials to be trained
in the basic course and 58 officials in the Applied Government Accounting
Course. The training will cost R 861 057.

The internal control checklist is revised annually and forms an integral
part of Financial Management of all Managers.

50 EMS vehicles and 20 departmental vehicles have been fitted with Digicore
-C – Trackers in order to reduce misuse, to the amount of R 585 732. A Software
that will monitor continuous movement of these vehicles will be installed at a
cost of R 32 806.

The Provincial Corporate office of the department has been consolidated in
one building in Bloemfontein; Bophelo House. About 645 health personnel moved
into this building coming from 7 buildings across the city. The efficiency of
having the corporate office in one building to support service delivery will be
realised.

The National Department of Health has finalised the Human Resources
Framework for the Health Sector and this will be launched by the Minister of
Health on 7 April 2006, on the World Health Day.

We will develop and adapt our Human Resources Plan in line with the national
framework.

The Provincial Health Bill will be ready for tabling in the Provincial
Legislature by June 2006. Clinic committees will be launched in line with the
National Health Act. R1,0 million has been allocated for the support and
training of governance structures (Provincial Health Council; District Health
Council; Hospital Boards and clinic Committees) to strengthen their capacity
and functioning.

Conclusion

Mr Speaker, allow me to acknowledge and thank our guests, stakeholders and
partners in our quest to provide quality health care services. A special word
of thanks to the representative of the Minister Prof. Green Thompson, the House
of Traditional Leaders, Mayors and Councillors, the Director General, Heads of
Department and Senior Managers from all departments, Chairpersons and members
of Clinic Committees and Hospital Boards, Traditional Healers; our Volunteers
and hard working personnel.

Mr Speaker, what the outcome of the elections signified is that our people
are finally convinced that our country has entered the its Age of Hope.

They are convinced that we have created the conditions to achieve more rapid
progress towards the realisation of their dreams. They are certain that we are
indeed a winning nation.

I table Vote Five.

Thank you.

Issued by: Department of health, Free State Provincial Government
15 March 2006