P Uys: Western Cape Health Prov Budget Vote 2006/07

Vote 06: Health Budget Speech 2006 by Mr Pierré Uys, Western
Cape Provincial Minister of Health, Provincial Legislature

25 May 2006

Speaker, agbare lede en gaste, dit is my voorreg om die 2006/07-begroting
vir die Wes-Kaapse Departement van Gesondheid aan u voor te lê.

Budgets by their very nature are instruments of government policy, guided by
the needs of the people who benefit from it. Budget decisions on the other hand
are never easy since they are a balance between the needs of our people on the
one hand and the resources available to us on the other.

In the Western Cape, there is no doubt, where our priority as government
lies. In his State of the Nation address President Mbeki made it clear that we
have to move faster to address the challenges of poverty and to improve service
delivery to the marginalised in our society.

Dít is 'n uitdaging wat ek glo ons gesondheidsbegroting 2006/07 die hoof
bide. Dit finansier immers 'n gesondheidsorgmodel wat daarna streef om gelyke
toegang tot kwaliteit gesondheidsorg te bied aan alle mense, daar waar hulle
woon en werk.

There is no denying the enormous progress made over the past two years.
This, due to the commitment of our Premier and our party leadership in
governing this province for the benefit of all its people and playing a
constructive role in giving new content to our Age of Hope.

My departement sal 'n daadwerklike rol speel om inhoud te gee aan ons Eeu
van Hoop deur te verseker dat ons personeel en vennote hulle
verantwoordelikhede doeltreffend en doelgerig nakom ter voldoening aan die
beginsels van Batho Pele en die Handves van Pasiënteregte.

Criticism and challenges

Speaker, my department is not without its critics and I welcome healthy and
constructive criticism. Unfortunately, the type of criticism coming from
certain quarters originates with afro-pessimists who feel threatened by the
changes being made in healthcare and the resulting progress.

Vandag is toevallig ook Afrikadag waartydens ons ons Afrika-erfenis en ons
toekoms op hierdie kontinent vier. Dit is 'n tyd om trots te sê ons is van
Afrika, en saam met ons broers en susters is ons daartoe verbind om hierdie
kontinent te help bou en te ontwikkel tot voordeel van al sy mense.

As we celebrate the many positive developments on our continent, we are
reminded that there is much to be proud of here at the southern tip of Africa
in the Western Cape. Such as the fact that our health care is on par with some
of the best available in the world, that we have modern equipment, access to
medicine and carers who really care.

Laat ek ook van hierdie geleentheid gebruik maak om ons gesondheidswerkers
te bedank wat hulself onbaatsugtig aan hierdie provinsie en die mense wat hulle
dienste nodig het wy. Vir die meerderheid van ons mense lyk dinge heelwat beter
en gaan dit nog veel beter word met betrekking tot gesondheidsorg in die
toekoms.

There are challenges and we do not shy away from addressing these in a
constructive manner. A major criticism of health services is the long waiting
periods for some services. While funding and logistics play a role, often the
shortage of specialised health workers is a major contributing factor.
In addressing this challenge, the National Health Department recently launched
its Human Resource Plan for Health. The plan indicates the training needs for
the country and outlines interventions that will improve the supply of health
workers - and the Western Cape is in full support of these measures.

Die gehaltemonitering van ons gesondheidsorg uit 'n pasiënte, personeel én
tegniese oogpunt is uiters belangrik ten einde op ons bestaande diens te kan
verbeter. Kliënte en personeeltevredenheidsopnames word op 'n jaarlikse basis
by al ons fasiliteite onderneem. Hierdie inligting word dan verwerk,
probleemareas geïdentifiseer en regstellende stappe deur die bestuur gedoen.
Hoewel alle fasiliteite oor deeltydse gehalteversekeringsamptenare beskik, is
ons ook tans besig om voltydse gehalteversekeringsbestuurders by sommige van
ons sleutelfasiliteite aan te stel.

Speaker, die departement kom al hoe meer onder die indruk van die belangrike
rol wat nie-winsgewende organisasies (NWO's) as vennote in dienslewering speel.
Die toenemende aantal pasiënte wat regdeur die provinsie deur middel van
tuisgebaseerde sorg deur NWO's behandel word, getuig van ons verbintenis in
hierdie verband.

Last year 910 home-based carers saw 8 615 patients and paid more than 190
000 visits. Clearly, this is an area in which greater coordination and guidance
from our side to the non-profit organisations (NPO) sector in helping to
address the health challenges in our province remains of vital importance. In
this regard, a particularly exciting development is the massive extension of
the expanded public works programme in the social sector during this and coming
years. In this programme, 1 430 community health workers will receive formal
training that will both enable them to provide quality care to the patients for
whom they care but also to have marketable skills and opportunities for
employment in the health sector in the future.

Another challenge we face is the ongoing promotion of community
participation through institutions such as the Provincial Health Council, the
Provincial Aids Council, District Health Councils (to be established) and
facility boards that ensure that our health facilities respond adequately to
community needs.

Furthermore, we must build and strengthen public/private partnerships
through our existing Public Private Partnership (PPP) Forum. Baie is al gedoen
om ons mense meer bewus te maak van hoe belangrik dit is om na jou gesondheid
om te sien. Dit sluit pogings in om gereelde fisiese aktiwiteit en goeie
voeding te bevorder, terwyl riskante gedrag soos rook, alkoholmisbruik en
onveilige seksuele praktyke ontmoedig word.

In conjunction with the National Department, we will continue to roll out
the healthy lifestyle awareness campaign with the focus on prevention of
communicable diseases (such as HIV and Aids as well as Tuberculosis (TB);
non-communicable diseases (such as diabetes, cancer and hypertension); and the
reduction of violence and trauma. Terwyl ons 'n beroep op ons mense doen om na
hulle gesondheid om te sien, het die staat 'n verantwoordelikheid om 'n gesonde
omgewing te skep en om toegang tot basiese dienste te verbeter wat goeie
gesondheid sal bevorder. My departement sal nie sy verpligtinge in hierdie
verband ontduik nie.

Accessible, quality health services for a healthier Western Cape

Since the people elected the African National Congress to govern in the
Western Cape in April 2004, this government has been clear in its commitment to
delivery.

Speaker, I am not going to list the many deliverables that Health Western
Cape has made over the course of the past two years in order to improve health
care in our province; safe to say they show that comprehensive and quality
health care remains a priority for this government. Furthermore, when Health
promised to deliver, we delivered what we promised.

Ons sit ons harde werk voort om gesondheidsorg meer toeganklik vir ons mense
te maak deur die inwerkingstelling van Gesondheidsorg 2010, wat binne die breër
bestek van dienstransformasie pasiënte na toepaslike sorgvlakke verskuif terwyl
dit ook die volhoubaarheid van die totale diens verseker.

A budget that makes choices
Speaker, this budget is about making choices and exercising our
responsibilities in a serious manner. It is about our appetite to govern. We
take our inspiration from the values espoused by this government in presenting
a budget that:

* delivers on this government's undertaking are to improve health
services.
* provides health care to those most in need, namely families, people with low
or no income
* enables us to take concrete steps toward making health care more accessible
and delivering services closer to the people
* for the first time with the assumption of responsibility for full personal
primary health care (PPHC) services, provides for the delivery of seamless PPHC
services in our non-metropolitan areas
* provides significant funding for new equipment, upgrading and maintenance of
our facilities throughout our province
* employs more than 23 000 people providing health services to more than 72% of
the people of this province.

R6,3 billion for health

Speaker, in lyn met hierdie regering se verbintenis tot 'n gesonder
Wes-Kaap, stort ons meer fondse in gesondheidsorg.

I am therefore announcing nearly R600 million in additional health spending,
for a total budget of R6.3 billion in 2006/07 compared with R5,74 billion in
the previous financial year. This year's health budget represents 34,4 percent
of the provincial budget. Ons finansiering kom grootliks uit die provinsiale
billike-deel, met net oor R4 miljard uit die begroting van R6,3 miljard wat op
hierdie manier herlei word. Voorwaardelike toelaes van die nasionale regering
kom op 'n bykomende R1,99 miljard te staan. Dit word aangevul deur inkomste wat
veral in ons sentrale hospitale deur die departement gegeneer word - wat 'n
verdere R297 miljoen by die begroting voeg.

A budget guided by national priorities

Speaker, a number of national priorities guide the 2006/07 budget of the
Western Cape Department of Health. Consequently, we dedicate a significant
amount of the budget to specific national priorities. These include primary
health care, HIV and Aids, tuberculosis, emergency medical services, human
resource development, information systems, the modernisation of our tertiary
services and expanded public works programme, which I described earlier.

Die hervorming van openbare-gesondheidsdienste om dit meer toeganklik te
maak, bly 'n prioriteit in hierdie begrotingstermyn. Ons strategie om inhoud te
gee aan hierdie proses, Gesondheidsorg 2010, vorder teen 'n stewige tempo. Hier
is die fokus op primêre-vlakdienste en die skakel van sodanige dienste met
gemeenskapgebaseerde sorg en, baie belangrik, ook voorkomende sorg. Ons wil
graag hê dat pasiënte op die mees toepaslike sorgvlak vir hulle behoeftes
behandel word.

Die jaar wat voorlê sal van sleutelbelang wees vir die inwerkingstelling van
dienstransformasie in lyn met nasionale beleid. Ons diensplan, wat die bloudruk
vir toekomstige dienslewering voorsien, word tans gefinaliseer, en
inwerkingstelling sal volg sodra die openbare konsultasieproses voltooi
is.
Natuurlik sal die koppeling van die nuwe infrastruktuur aan die plan langer
neem as die herskikking van dienste. Daarom sal die vorm van dienste wat in
Gesondheidsorg 2010 vervat is intussen binne die bestaande beskikbare
infrastruktuur geakkommodeer word.

With respect to infrastructure, business cases for the Khayelitsha as well
as the Mitchell's Plain hospitals have been approved. Although at a preliminary
stage of planning, it is our intention to fast track the construction of these
vital facilities. We are also taking all possible steps to expedite the process
of hospital revitalisation that will include in time the Valkenberg, Tygerberg
and the Brooklyn Chest hospitals amongst others. However, it is clear that it
will be some time before these hospitals are built and can function as an
integral part of Healthcare 2010.

Allow me, Speaker, to highlight some critical areas in our budget.

Programme one (Administration)

One initiative that I would like to highlight is the establishment of a
Directorate of Nursing. Given the critical role played by our nurses, it is my
belief that such a directorate will add focus in dealing with the challenge of
the nursing shortage. The task of the new incumbent will be to focus full-time
on serving the 11 000 nurses in our provincial health team. In modernising our
tertiary services and health services in general, I am glad to report that
there will be an increase in the funds provided for new equipment. We have
budgeted R172 million for equipment. Those who visited our facilities over the
past year would have seen a dramatic and positive change brought about by the
installation of new equipment in the facilities.

In reaksie op 'n verslag dat die gesondheidsdepartement sy
batebestuursfunksie moet versterk, oormerk hierdie begroting R3 miljoen vir
hierdie doeleinde.

Programme two (District health services)

Primary health care and the primary health care approach are extremely
important to us. It is our aim in this year to further strengthen the
management and staffing at all of these facilities. Aan die begin van Maart
vanjaar het die provinsiale departement van gesondheid bedryfsbeheer van
persoonlike primêre-gesondheidsorg-dienste (PPGS-dienste) in die
nie-metropolitaanse gebiede van die Wes-Kaap oorgeneem. PPGS-dienste in die
Stad Kaapstad volg in 'n latere stadium. As gevolg hiervan dra plaaslike
owerhede in landelike gebiede nou nie meer die finansiële las (ongefinansierde
mandaat) van persoonlike primêre-gesondheidsdienste nie, en kan hulle hulle
fondse derhalwe aanwend om ander belangrike dienste in hulle gemeenskappe te
lewer.

Die skep van 'n aaneenlopende gesondheidsdiens in ons landelike gebiede sal
bydra om ondoeltreffendhede en duplisering van dienste wat ons tans in ons
fasiliteite ervaar weens provinsiale en plaaslike-regeringspersoneel wat in
dieselfde fasiliteit werk, uit die weg te ruim. Voorts sal dit rekenpligtigheid
verbeter.

Consequent to the promulgation of the National Health Act [2003] enacted in
May 2005, Municipal Health Services [MHS] as defined in the Act became the
responsibility of local government.

Municipal Health Services include:
* water quality monitoring
* food control
* waste management
* health surveillance of premises
* surveillance and prevention of communicable diseases, excluding
immunisations
* vector control
* environmental pollution control
* disposal of the dead
* chemical safety

Exclude port health, malaria control and control of hazardous substances
that remain the responsibility of Provincial Health. Graag wil ek van hierdie
geleentheid gebruik maak om 'n beroep op ons munisipaliteite te doen om te
verseker dat munisipale gesondheidsdienste soos omskryf in die Nasionale
Gesondheidswet, gelewer word. As provinsiale minister van gesondheid is ek in
besonder besorg oor kwessies soos veilige drinkwater en sanitêre geriewe in al
ons gemeenskappe.

Speaker, this budget also enables us to take concrete steps toward making
health care more accessible and delivering services closer to the people. An
additional R4 million is budgeted to provide a package of services during
extended hours at 10 community health centres. We know if we say we stand for
an accessible, equitable service, it must be accessible also in terms of the
times that people can make use of the service. Accordingly, we plan to extend
the time during which the service is provided from normal office hours to 21:30
at the following community health centres: Delft, Khayelitsha Site B, Mitchells
Plain, Kraaifontein, Retreat, Vanguard Drive, Gugulethu, Hanover Park, Elsies
River and Grabouw.
Our HIV and AIDS programme continues to expand. We are working closely with the
National Government, NPOs and organisations like the Global Fund to provide a
comprehensive HIV and AIDS service throughout the Western Cape. The budget for
HIV and AIDS during this financial year is R235 million. National government
through the conditional grant provides the bulk of the funds, namely R115
million. The equitable share amounts to R35 million; while the Global Fund
allocated a further R85 million. Last year's budget was R161 million. Year on
year this represents a substantial increase in the allocation to HIV and AIDS
in the Western Cape and is in line with the priority given to health by
government.

Ons mikpunt vir die voorkoming van moeder-na-kind-oordrag is om 'n
sukseskoers van 97% te behaal. Dit sou beteken dat slegs drie uit elke 100
kinders van MIV-positiewe moeders uiteindelik positief sal wees. Dit is een van
ons vlagskipprogramme, en ek glo die resultate tot dusver is die belangrikste
prestasie van ons voorkomingsprogram. Ons beplan om vanjaar 48 miljoen manlike
en 180 000 vroulike kondome te versprei.

Our antenatal prevalence, and this comes from the 2004 survey, the latest we
have indicates a prevalence of 15,4% among pregnant women. Nationally it stands
at 29,5%. Even though this figure may be lower than the national average, it is
still on the increase and there is no reason to be complacent. In some areas of
our province, it is as high as 33 percent and this is where we must work the
hardest.

Daar is tans 17 053 (April 2006) pasiënte op ARV-behandeling by 43 persele
regdeur die Wes-Kaap, en ons is besig om daardie behandeling drasties te
verhoog. Pasiënte op behandeling neem tans met sowat 700 per maand toe, en ons
stel dit ten doel om teen die einde van die boekjaar 'n teiken van 22 500
pasiënte op behandeling te behaal. Nagenoeg 272 000 mense sal vanjaar
vrywillige berading en toetsing ondergaan.

Tuberculosis (TB) remains a major challenge in the Western Cape. I cannot
overemphasise the seriousness with which this disease must be treated. Last
year there were 44 000 new cases. This means that TB affects 967 per 100 000 of
the population in our province. Moreover, TB is now responsible for a third of
all deaths in HIV infected people.

In taking on this challenge, it is clear that we need to combine and
recommit our resources. To this end, we are continuing with the
provincialisation of tuberculosis hospitals. One of these hospitals, Harry
Comay, in George, is already a provincial hospital and we are moving forward
with the provincialisation of DP Marais hospital in Retreat.

Ons doel is dat alle tuberkulosehospitale teen die einde van hierdie
boekjaar hierdie hospitale se voorbeeld sal volg. Weereens wil ek die
belangrikheid van 'n aaneenlopende en rekenpligtige diens beklemtoon. Dit is
van die allergrootste belang vir ons oogmerk om vanjaar 'n genesingskoers van
72% te behaal.
Ons genesingskoers vir TB verlede jaar het na 68,7% afgeneem - iets waaroor ek
baie besorg is. Sekere gebiede van die Stad Kaapstad is 'n uitdaging, en ek sou
graag wou sien dat die departement saam met die Stad Kaapstad groter fokus op
hierdie gebiede plaas.

In taking our tuberculosis programme forward, we are also going to add an
additional R12,5 million to improve the programme at our clinics and our mobile
clinics, because this is where TB is detected and where the first contact with
our patients occurs. Another service now provided by the Department of Health
is Forensic Pathology Services (Mortuary Services). As from 1 April this year
it is a Health responsibility - and no longer that of the South African Police
Service, to remove a body from an incident or crime scene where unnatural death
is suspected and to provide the subsequent service. This service brings its own
set of challenges with an expected total of 10 000 post-mortems per year that
will take place at our facilities in the Western Cape. To provide this service
R41 million has been allocated. Major upgrading of current facilities must also
be undertaken and in this regard we will make available a further R27
million.

Programme three (emergency medical services)

Emergency Medical Services, or ambulances, and patient transport remain a
focus area in this budget. Here, I believe we are beginning to make progress,
although concern that more funding needs to be allocated to support this
service persists. During 2005, we provided R50 million to appoint 108
additional uniformed staff and bought 36 additional ambulances. From feedback
received, our communities roundly welcomed the improvements gained. This year
we budget a further R2 million for new ambulances. We will also equip those
ambulances and provide R3 million for additional staff. R3,7 million is
budgeted for patient transport vehicles (10 vehicles and R1,8 million to employ
an additional 35 drivers). To improve efficiency we have also separated the
ambulance service from patient transport.

Programme three (provincial hospitals services)
So ver dit ons psigiatriese hospitale aangaan, maak ons goeie vordering, maar
daar is steeds baie om te doen. Saam met die premier en minister Fransman het
ek onlangs die voorreg gehad om die nuwe akute toelatingsaal by Valkenberg te
open - die eerste fase van die opgradering van daardie hospitaal. Daar is ook
'n ernstige agterstand met verhoorafwagtende gevangenes wat psigiatriese
evaluering nodig het. Ons werk tans saam met die departement van justisie en
verskeie ander regeringsagentskappe om die probleem te verlig, maar die
uiteindelike oplossing is die herbou van die maksimum-sekuriteiteenheid om
vermoë uit te bou.'n Kwessie wat ek as deel van geestesgesondheid wil
beklemtoon iets wat baie belangrik is in ons gemeenskappe is dwelmmisbruik.

As die gesondheidsdepartement het ons hierdie uitdaging die hoof begin bied,
en volgende maand open ons die ontgiftingseenheid by Stiklandhospitaal wat ons
hande in hierdie stryd sal sterk. Ons het ook R2,5 miljoen bewillig om die
eenheid met sy fokus op komplekse gevalle te bedryf. Dit sal die eerste
sodanige eenheid in die openbare sektor wees met 10 beddens wat uitsluitlik
gebruik word om mense met 'n middelafhanklikheid by te staan.

Programme five (central hospital services)

Program five sentrale hospitaaldienste maak voorsiening vir die aankoop van
twee nuwe liniêre versnellers wat die broodnodige radioterapiedienste wat tans
aan kankerpasiënte gelewer word, 'n hupstoot sal gee. Finansiering ten bedrae
van R2,5 miljoen word ook geoormerk vir die nuwe MIV neuropsigiatriese diens by
Groote Schuur-hospitaal, terwyl 'n verdere R1 miljoen gebruik sal word vir die
skeiding van kinder en volwasse psigiatriese dienste by Tygerberghospitaal. In
die algemeen neem ons toewysing aan sentrale hospitale met ses persent toe.

Programme six (health sciences and training)
On staffing, I would like to say that the quality of care is affected by the
inability to recruit and train experienced and qualified health care
professionals. The attrition rate of professional nurses is 12%. In some
specialised areas of the nursing profession, like theatre, oncology and
psychiatry, it is as high as 26%. This is unacceptably high and therefore, the
budget for health sciences and training receives a boost to R43 million this
year. Currently we have 2 448 nurses in training with 366 expected to complete
their studies at the end of 2006.

However, there is no quick fix and it will take time to fill the shortage of
nurses, but we have begun to address it by investing in training and also to
invest in mentorship. In the metropolitan district health area 106 additional
nurses will be appointed. We are indeed fortunate to receive a specific
allocation in terms of Expanded Public Works Programme (EPWP). This amounts to
R20,7 million that will help us to appoint and train more home-based care
workers as well as integrated management of childhood illness community
workers, TB DOT community workers, and also ARV counsellors and VCT counsellors
really strengthening our community-based services. However, apart from
improving service delivery, it will also help to create opportunities for our
people. For the first time it will open up a career path for community workers
entering at the bottom and now really getting the opportunity of moving up
through proper training to obtain certified qualifications.

Programme seven (health care support services)
Met betrekking tot gesondheidsorg ondersteuningsdienste word daar beoog dat
ongeveer R20 miljoen oor die volgende vyf jaar nodig sal wees om verouderde
toerusting in ons wasgoeddiens te vervang. Ons begroot vanjaar R8 miljoen om 'n
tonnelwasser aan te koop wat in hierdie belangrike behoefte sal vervul. Daar
word geraam dat die totale aantal wasgoedstukke vanjaar op ongeveer 20 miljoen
te staan sal kom, waarvan 14 miljoen intern gedoen sal word.

Programme eight (health facilities management)

Speaker, on 1 April last year, funds for capital projects were placed within
our budget. In reality, however, the department does not have any executive
implementation authority with regard to these funds. This function is still
fully the responsibility and function of the Department of Transport and Public
Works. The amount budgeted for this year for health facility management in
total is R324 million, which includes funding for hospital revitalisation
(HRP), provincial infrastructure (PIG) and maintenance. With respect to the
HRP, the upgrading of the Paarl Hospital announced during the course of last
year has just commenced with the contractor on site. The revitalisation of the
George Hospital is nearing completion, work at Eben Donges is progressing
slowly and we are working hard to ensure that work at the Vredenburg Hospital
stays on track. At the same time, Khayelitsha, Mitchell's Plain and all others
will commence with planning this year.

Daar was ook 'n toename in die provinsiale infrastruktuurtoelaag wat via ons
provinsiale tesourie vanaf nasionaal in ons infrastruktuurprogram gestort word
'n toename van ongeveer R50 miljoen verlede jaar na R61 miljoen vanjaar.
Inderdaad 'n baie welkome toename.

Conclusion

In conclusion, I wish to thank everyone who participated in this budget,
including my Cabinet Colleagues, Treasury, in particular the Head of
Department, Prof Craig Househam for his leadership, the management of the
department for their support and every staff member working in Health
throughout our province for their commitment and hard work. Ten spyte van die
vele uitdagings wat ons vandag in openbare gesondheidsorg in die gesig staar,
het ek die grootste vertroue dat die regering op die regte koers is om 'n
gesonder Wes-Kaap in die toekoms te verseker.

Speaker, ek is daarvan oortuig dat hierdie begroting ons sal help om die
uitdagings voor ons te pak en ek vra dus die Huis om dit te ondersteun en te
aanvaar. Dankie.

Issued by: Department of Health, Western Cape Provincial Government
25 May 2006
Source: Western Cape Provincial Government (http://www.capegateway.gov.za)

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