S Sekoati: Limpopo Health Prov Budget Vote 2006/07

28 March 2006

Honourable Speaker and Deputy Speaker
Honourable Premier
Members of the Executive Council
Chairperson of the Portfolio Committee on Health and Social Development
Honourable Members of the Legislature
Distinguished Guests
Ladies and Gentlemen

In 1994 the African National Congress adopted a National Health Plan for
South Africa. This plan was prepared with the technical support of World Health
Organization and United Nations Children's Fund (UNICEF). The plan asserts
every person's right to health. Every person has the right to achieve optional
health, and the ANC is committed to the promotion of health, using the Primary
Health Care Approach as the underlying philosophy restructuring the health
system.
Primary health care will form an integral part both of the country's health
system, and of the overall social and economic development of the
community.

The role of the community in the planning provision, control and monitoring
of services remain central to the PHC approach.

Democratically elected representatives will play a major role in the
structure of the health services.

Honourable Speaker

Health

Primary Health Care
In its efforts towards realising these goals government adopted the Clinic
Building and Upgrading Programme which continues to inform the provision of
clinics and health centres to our people.

The building and upgrading of 33 clinics is nearing completion and the
building of a new health centre in Steiloop will start in earnest this
year.

An additional 20 clinics (14 upgrades and 5 new) and the 1st phase of a
health centre at the decommissioned H C Boshoff hospital will also be built
with R117 million allocated for this project.

During the 2005/06 financial year 39 clinics were provided with a dedicated
water supply and an additional 43 clinics will be provided with water at an
estimated budget of R5 million for this budget year.

In addition a total of 71 clinics have also been provided with pollution
free sanitation services and In the coming year R8,S million will be put aside
to supply the same service to a further 106 clinics. This is a joint initiative
with the Department of Water Affairs and Forestry (DWAF).

The department has managed to electrify 38 clinics and the remaining 14
clinics with no electricity will be electrified together with 12 others that
rely either on a Solar System or use generators. In total 26 clinics will be
electrified at a cost of R7,6 million.

The provision of 24-hour security has helped to minimise cases of theft of
stock and equipment from our health institutions as well as increasing safety
of our health professionals.

This has also ensured that our clinics can operate on a 24-hour basis with
almost 80% of 435 clinics and health centres offering 24-hour service.

Honourable Speaker
The department is seriously looking at the reorganisation of the clinic
committees. This is a vehicle through which our communities express their views
about the kind of services they require at the PHC points.

In pursuance of the goal of providing primary health care for all closer to
their homes. We are providing 3 914 mobile clinic points in areas where there
are no such fixed site services. A total of 80 vehicles have been purchased and
are being converted into mobile units.

We are also busy establishing health ports that serve as information hubs in
taxi ranks, bus ranks and shopping centres providing health information to the
community. Capricorn district has already made progress in this regard and we
will be making such services available in all our districts.

It is worth mentioning and to also remind this house that all PHC services
are provided free, with women and children benefiting the most. We have
extended this free service to people with disabilities.

In his first State of the Nation Address as the President of the Republic of
South Africa, President Mandela said children under the age of six and pregnant
mothers will receive free medical care in every state hospital and clinic where
such need exists.

Many of our clinics have complied with the National Adolescent Friendly
Clinic Initiative (NAFCI) standards and have therefore been declared
adolescent-friendly. It is our intention to ensure that all our clinics are
ultimately also declared youth friendly.

It is the view of this department that we are making commendable progress to
provide quality health care to our people at the PHC level, the level that
matters most.

Emergency Medical Services (EMS)

Honourable Speaker
The department has adopted the Emergency Medical Services Expansion and
Optimisation Plan. Our objective is among others to eventually establish 52
ambulance stations in the province while we currently have 21 stations. However
in the coming financial year we will built 5 new stations at Bela-Bela, St.
Ritas, Helena Franz, Thohoyandou and Sekororo hospitals. An amount of R15
million has been set aside for these projects.

Funding for this optimisation plan has been made available in this fiscal
period with EMS allocation more than doubling to a total of 270 million.
A total of 84 new vehicles have been bought and are being converted into fully
equipped ambulances.

Communicable and non-communicable diseases
We continue to be plagued by communicable and non-communicable diseases. Our
province borders malaria prone areas in the Southern African Development
Community (SADC) Region. The main malaria areas in our country are the low -
lying north-eastern parts bordering Mozambique and Zimbabwe which include the
districts of Vhembe, Mopani and Bohlabela. From 1996 there has been an increase
in malaria prevalence in these malaria prone areas. However this sudden
Increase has been met with swift intervention by our health professionals.

Last year we sprayed 1,1 million households in the affected districts and we
plan to increase this coverage over the budget period.

Conducive conditions such as heavy floods and long droughts contribute to
the outbreak of waterborne diseases such as malaria and cholera. The province
experienced diarrhoeal outbreaks in the Vhembe, Sekhukhune and Capricorn
districts.

Due to sustained health education and proper coordination of our outbreak
response teams we were able to meet the challenge head on.

In an attempt to further combat communicable diseases; there has been an
increase in the rate of immunisation provincially. The greatest success of the
immunisation programme has been the elimination of deaths due to measles and a
reduction in the incidences of polio.

We are happy to announce that the department won the best Geriatric Care
(Old Age Care) Award in the Country.

HIV and AIDS

Honourable Speaker
On 13 March 2006 vital principles underpinning how to scale up HIV and AIDS
prevention, treatment. Care and support in Africa, and commitments to action at
regional and national level to implement these principles in practice emerged
from the African Continental Consultation on Scaling up Towards Universal
Access in Africa.

One of the key messages articulated by that meeting is a need to energise
prevention efforts as this is vital to the long term sustainability of
programmes for treatment, care and support.

In this budget year we will re-energise and mobilise an intensification of
HIV and AIDS prevention with the ultimate aim of ensuring universal access to
HIV and AIDS prevention and treatment services.

Reaching the Millennium Development Goal on HIV and AIDS - to halt and
reverse the spread of the epidemic by 2015 - requires far greater access to
prevention services than is currently available, as will be reflected.

Our prevalence rate remains lower than that of the other provinces even
though the provincial infection rate is higher at 19,3% compared to the
national rate of 29,5%.

There are strong Indications that infection rates in our province are on the
increase, except in Sekhukhune district which has recorded a steady decrease to
13,4% compared to the previous 14,1%. Up to December 2005 some 30 680 clients
were tested for HIV and AIDS of which 10 645 tested positive.

Of the most vulnerable, the age cohort of between 25 and 29 is the hardest
hit by the epidemic. The Comprehensive Care, Treatment and Management Plan is
on track. To date 28 sites have been accredited to provide a continuum of
services to those in need of the service.

A total of 503 facilities including non medical service points now offer
Voluntary Counselling and Testing (VCT).

The number of Home and Community Based Care Groups that have been funded is
182. We must commend the work that these pioneers are doing. In one quarter
they made 785 802 home visits and some 2 576 care givers receive stipends.

TB

In August 2005 tuberculosis (TB) was declared a crisis in the African
region. This has meant that efforts must be stepped up to confront the
pandemic. It is with pride to report that there has been a noted improvement in
the management of TB. The cure rate has improved from 53,6% in 2003 to 66,4% in
2004. Bohlabela district has been rated as the best second district in the
country on TB management.

The Multi Drug Resistance (MDR) TB hospital in Modimolle: H.F. Odendal is
now fully functional and was officially opened on 16 February 2006. The first
patients were admitted at this unit on 12 January 2006.

Last week we celebrated World TB day under the theme: “Auction for life
towards a nation free of Tuberculosis". We would like to urge everybody to get
tested and if required get treated as a matter of extreme urgency.

It is also essential that the six months treatment programme be strictly
adhered to.

Honourable Speaker
One area that we committed ourselves to intensify and do more work is health
promotion. Last year we launched the Vuka South Africa Move for your Health
campaign. At the centre of this campaign are efforts to reduce the burden of
diseases of lifestyle, some of which we have alluded to Heartier.
The salient features of the campaign are:
* only 30 minutes of brisk physical activity is required per day
* make sure that you eat healthy
* mobilise your family, friends, neighbours and colleagues to move and be
healthy. Take responsibility for your own health.

We will continue to intensify our public: awareness campaigns to inform our
citizens about best practices to deal with these diseases. To this end R5
million will be put aside during this budget year.

Hospital revitalisation and management and quality improvement programme

Honourable Speaker
This programme is mainly funded by means of a conditional grant. Since its
inception in 2004 a total of 4 hospitals have been upgraded.

The programme is intended to refurbish the infrastructure in hospitals. to
strengthen management and to improve the quality of care.

Both Lebowakgomo and Jane Furse Hospital are in the final completion stage
while Duokong and Nkhensani hospitals will be completed in this financial year.
An amount of R40 million has been set aside for these projects.

We have reached the tender stage for two more hospitals; Letaba and
Thabamoopo Hospital to be upgraded at an amount of R108 million.

During this budget year Maphutha Malatji Hospital will also be put under
this programme. The overall infrastructure investment in these five hospitals
is approximately R160 million for the new financial year and R14 million for
health technologies.

The reduction of the Hospital Revitalisation grant from R148 million to R2S
million for the 2006/07 financial year as well as over the MTEF has made a
serious impact on the future progress of the programme.

For the 2006/07 budget year the two grants have been combined into one with
a total of R4S million.

A total of 31 hospitals in our province have been declared baby friendly.
The Baby Friendly Hospital Initiative is sponsored by the World Health
Organisation and UNICEF and Is a world -wide effort to improve breastfeeding
rates. Based on the ten steps to successful breastfeeding, the initiative
encourages hospitals to examine their practices, make appropriate changes and
then apply for recognition as a Baby-Friendly Hospital.

This year five hospitals will be assessed and if found to be complying will
add the number of accredited hospitals.

Personnel

Honourable Speaker
Our success to provide quality healthcare for all also depends on the
availability of sufficiently and appropriately trained health staff. They
remain the cornerstone of our health system.

An equitable and fair distribution of personnel is essential in rural and
peri-urban areas of our province.

The department has awarded 386 bursaries to students studying medicine and
other health related fields in an effort to ensure that essential health
personnel will be available in the near future.
In addition to the bursaries awarded, 35 students have been sent to Cuba to
study medicine. This is a joint initiative with the National Department of
Health.

Through the twinning programmes/agreement between the Polowane and Mankweng
Hospital Complex and the University of Limpopo, we hope to attract skills that
will help close the gaps that still exist.

Efforts to recruit auxiliary nurses are continuing. A total number of 455
auxiliary nurses have recently graduated and many of them have been deployed in
clinics in rural areas and are making a huge positive impact on service
delivery, as well as in the running of mobile clinics and health ports.

During this budget year we will recruit 368 nursing assistants that have
trained in private institutions. This will be complemented by the recruitment
of auxiliary nurses through our poverty alleviation programme targeting those
coming from indigent families. Two additional nurse training centres will also
be established in the province.

Overall there is a need to accelerate the training of nurses in all
categories.

In order to further attract and retain scarce skills, the department has
embarked on the 1st phase of building new staff accommodation units. A total of
279 units form the 1st phase of this project to house both the critical and
obligatory staff at an estimated cost of R79 million. These units will be
completed in the first half of the budget year.

In the 2006/07 budget year a further R79 million will be set aside for the
second phase of this project.

In January this year the National Health Council adopted the following five
National Priorities to be implemented by provinces:
* development of service transformation plans
* strengthening of human resources
* strengthening physical infrastructure
* improving quality of care
* strategic health programmes.

These priorities will be lifted to fast track their implementation in tandem
with the National Health Council's targets and It is our view that we are
making progress to ensure compliance.

Social development

Honourable Speaker
The Social Development component of our department renders services through
three broad programmes, that is, Administration, Social Welfare Services and
Development and Research. It is our mandate to reduce poverty and the impact of
HIV and AIDS through sustainable development programmes in partnership with
implementing agencies.

Social security
Initially the department managed and administered social security net to the
poor, but this function will now been taken over by South African Social
Security Agency (SASSA).

As indicated earlier, the organisation and administration of a social
security net has been one of the important areas of activity of the department.
However from April this year this function will rest fully with SASSA.

The provision of state social grants remains one of the government's most
practical poverty alleviation programmes.

Towards a Ten Year Review Document states that in the absence of any grants
55,09% of the elderly would be in poverty and 38,02% would be in ultra-poverty.
This falls to 22,09% and 2,5% respectively if all recipients get grants. The
department is currently administering at least seven types of grants targeting
the most vulnerable women, children, the elderly, disabled and poor families
with children.
More than 1,1 million beneficiaries have been registered to receive grants and
this number is expected to increase, thus further reducing the number of people
living in poverty.

The department will however continue to offer support to SASSA until the
function is fully transferred.

Several buildings throughout the province have been leased to accommodate
the agency.

Building plans for construction of SASSA district and sub districts offices
have been completed and implementation will commence this year. R10 million has
been set aside for SASSA facilities in this current financial year.

This body will speed up delivery of social grants and ultimately cut down on
corruption in the system. The Agency will employ competent frontline staff to
process social grants applications at the point of delivery.

Skilled back office staff will ensure quicker verification and approval of
applications, using advanced technology.

Our Antifraud and Corruption Campaign on Social Grants is yielding fruits.
More than 37 000 people have come forward and applied for amnesty.

The department is currently assessing the applications to determine which
ones will be granted indemnity.

At the same time we are pursuing both civil and criminal cases against those
whO were found to be defrauding government's social grants.

To date 25 public servants from various departments have appeared before the
court and more will follow. It is our conviction that the law must take its
course. The money that was fraudulently received must be paid back to
government.

The funding of social security for the current year is done via two
conditional grants. The budget for 2006/07 has now been transferred to the
national Department of Social Development and no longer forms part of the
provincial.

It is our conviction that the Agency will free the department to focus on
improving the provision of other equally important social development
services.

Developmental welfare services

Honourable Speaker
Six Social Development one-stop centres have been completed in the current
financial year and 12 others will be completed during this year under review.
These centres provide integrated social development service like social work
services, community development services and social security services. 7 others
and two community-based rehabilitation centres will begin this year at a cost
of R38 million. Our poverty alleviation programmes remain on track, and 55
projects dealing with piggery, fence making, poultry, brick making, etc, have
been funded and strengthened in the last financial year and a further 79 new
projects will receive attention this year.

The food security programme has been restructured to encompass a
developmental paradigm. This is premised on the notion that people are the
masters of their own destiny, and instead of helping the poor in the
traditional way with handouts, we need to empower and train them to be
self-reliant.

A total of 1 320 women have been trained on fundraising, project management
and basic farming and management skills.

In the coming financial year we will distribute food parcels to 32 000
families. This move will help us to mitigate the effects of poverty among the
poorest of the poor.

One of our strategies to address poverty particularly among children is to
subsidise creches. The total number of creches that were subsidised to date is
1176. We are planning to fund 50 additional creches.

The current national standard is to subsidise creches at R9 per child per
day and our subsidy is presently at R6 per child per day. Our projection is to
increase this amount to R7,50 for the next budget year in an effort to reach
the national standard over the MTEF period.

Through our social development interventions the department managed to reach
11 803 orphans and vulnerable children and 629 child headed families. Our
programs in this regard include counselling, foster care placement, placement
in children's homes and material assistance.
Foster care placement is not without challenges. Backlogs still exist in this
area.

This is a major problem but efforts are made to address it. The department
will complete a dual - purpose Children's Home and Place of Safety in
Sekhukhune district during the course of this year.

The department currently has 92 drop in centres where children are provided
with meals, school uniforms. After-school support programmes and counselling
services. An additional 60 more drop-in centres will be established in the
coming financial year. A total of R12 million has been set aside for this
project.

Stipends have been paid to 2 750 care givers and plans are afoot to pay an
additional 2 025 care giver and bring the total number to 4 775.

The Victim Empowerment Programme will runs in collaboration with the
Department of Safety, Security and Liaison, South African Police Services and
the NGO sector. Funding for 18 victim empowerment centres has been made and
capacity building programmes for the volunteers will be commenced within the
budget period.

A total of 7 coordinators have been trained at University of South Africa
(UNISA) on coaching and mentoring skills for the centres. A Crisis Centre has
been established at Polokwane Welfare Complex and will offer 24-hour services
once all personnel have been appointed.

A community rehabilitation centre at Risongoneta has been completed and an
additional two will be built in the next financial year.

Expanded public works programme

Honourable Speaker
This is one of government’s short-to-medium term programmes aimed at reducing
unemployment, thereby alleviating poverty.

Home and Community-Based Care (HOBC) for AIDS suffers and Early Childhood
Development is areas in which there are immediate training opportunities.

Home and Community-Based Care

In 2000 the Joint Health and Social Development MINMEC endorsed the
implementation of Home and Community-Based care Programme to mitigate the
impact of HIV and AIDS in our communities. This was based on the recognition
that communities, particularly households with limited access to formal health
care, bore the blunt of the pandemic.
Home and Community-Based Care Services include:
* identification of families in need, orphans and vulnerable children
* patient care and support
* information and education
* patient and family counselling and support
* income generating projects

A total of 75 HOBC sites have been established and 36 additional sites will
be established during this budget year at an estimated cost of R3, 6 Million.
During this budget year training of volunteers will be streamlined and aligned
to the key assumptions of the Expanded Public Works Programme.

A total of 600 volunteers on level 1 and 3 will be trained during this
budget year. An amount of R6,1 million has been set aside for this work.

Early Childhood Development (ECD)

Early Childhood Development is an umbrella term that applies to the
processes by which children from birth to at least 9 years grow and thrive
physically, mentally, emotionally, spiritually, morally and socially.

However, the focus of the EPWP Is from birth to four years. The programme
targets the unemployed and/or underemployed parents and caregivers in all ECD
programmes.

A total number of 1 300 Early Childhood Development practitioners will been
trained on level 1 and 4 to Increase their capacity to generate Income and
while Improving care and learning environment for children. 700 cooks and 700
gardeners will also be trained during this budget year.

A total amount of R17,8 Million has been set aside for this work.

Population

Earlier this month we launched the State of The Province Population Report.
According to this report 39,4% of the population of this province is made up of
the youth under the age of 15, while 5,6% consists of people aged 6S years or
older.

This scenario points to serious challenges for development, especially
because the youth are the most affected by such diseases as HIV and AIDS, most
of them are unemployed and therefore more vulnerable.

We urge all the government departments and the private sector to make use of
this report in their planning. It is highly informative.

Honourable Speaker
The Health Vote remains under funded over the MTEF period as measured against
the Equitable Share Formula that stipulates a 26% share of the Provincial
Equitable Share. The allocation for the 2006/07 financial year amounts to 24%
of the Formula, that is R420,7 million less than the formula suggests. The
outer years reduces to 23,3% or an under funding of R700,9 million against the
provisions of the formula.

The department has nevertheless received an additional R524 million for the
2006/07 year above the adjustment estimates received for the current financial
year.

This results in a total growth of R1,19 billion or 31,8% additional
Equitable Share Budget over a two year period.

This presents a challenge to spend the additional funds to fund the Annual
Performance Plan that includes, the employment of additional staff catered for
as well as to spend the additional funds provided for capital requirements and
allocations for improvement of service delivery to our citizens.

The budget available for the budget year under review amounts to a total of
R5 447 933 000 that includes R506,6 million for Conditional Grants.

The Vote for Social Development also shows a steady growth above the current
financial year amounting to a 10,1% growth or R33,94 million. The budget for
the 2006/07 year stands at R431,75 million and comprises solely of the
Equitable Share as the conditional grants have been incorporated into the
allocation.
The outer years of the MTEF sees a steady growth towards funding Non-social
Security issues and increases to R 485,99 million (7,9%) and R695,4 million
(49,2%) in the outer year.

The MTEF budget does allow for the growth in developmental social welfare
services. The department looks forward to the challenges that lie ahead as
funding is becoming more readily available for the serviettes that have been
neglected while the concentration was focused on Social Security Grants over
the past number of years.

Honourable Speaker
In his State of the Nation Address this year, President Thabo Mbeki issued a
clarion call: “We must, constrained by and yet regardless of the accumulated
effect of our historic burdens, seize the time to define for ourselves what we
want to make of our shared destiny."

Ours is a programme to build a better life for all. We will not tire in our
efforts to attain and contribute to the broader efforts to attain this
goal.
We are encouraged by the selfless efforts of many of our partners. We have to
double our efforts a Province in which all can experience an Improving quality
of life, enjoy equal human rights, with access to opportunities that freedom
has brought us. We commit ourselves to do everything that is necessary and
possible to attain these objectives.
We thank you.

Issued by: Department of Health Limpopo Provincial Government
28 March 2006