Mpumalanga MEC for Health GP Mashego delivers the 2015/16 Policy and Budget Speech
Honourable Speaker of the Provincial Legislature BT Shongwe
Honourable Deputy Speaker BD Dube
Honourable Premier DD Mabuza
Members of the Executive Council
Honourable Members of the Legislature
Leader of the House of Traditional Leaders kgosi Lameck Mokoena
Director-General of the province Dr Nonhlanhla Mkhize
Head of the Department Dr Aggrey Morake
AlI Heads of Departments
Management of the Department and all employees
Leadership of labour and business
Leadership of the NGO sector
Traditional Healers
Members of the media
Ladies and gentlemen
Honourable Speaker, thank you very much for affording us this opportunity to table the Policy and Budget Speech of the Department of Health for the current financial year of 2015/16.
We are meeting here today during the Africa Month. Three days ago we celebrated Africa day as the province in Nkomazi.
I must say Honourable Speaker, South Africa has however been shamed before the eyes of the world, as a result of the actions of criminals parading as xenophobic individuals, who are a tiny minority of our population.
Undoubtedly, these cowardly attacks have shamed all of us and have tarnished the good image of our country, which was earned through decades of struggles in pursuit of a humane and just society, free of racism, sexism, xenophobia and other forms of intolerance.
Honourable Speaker, I would like to take this opportunity to thank many South Africans who have united across the country to take a stance against these attacks, thus affirming our unity and identity of Ubuntu.
One of the aims and objective of the ruling party is the "liberation of Africans in particular and black people in general from political and economic bondage". This means uplifting the quality of life of all South Africans, especially the poor. Understanding the triple challenges facing our country which is poverty, unemployment and inequalities, we in our health system. Hence the honourable Premier, Mr. DD Mabuza in his state of the province address last year said "the people of the province spoke in favour of a total overhaul of the health care system in the province".
We do agree that the Department has its share of challenges however, we have moved with speed to address a number of them. I must humbly thank our Honourable Premier Mr. DD Mabuza for the wonderful role he played together with his office and the Provincial Treasury in assisting the Department to deal with its challenges in the previous financial year.
As stated by the Honourable Minister for Health Dr Aaron Motsoaledi in his Policy and Budget speech for 2015/16, I quote "Let me remind Honourable Members that South Africa now has a plan. The first ever South African Plan, pre-and post-apartheid. The National Development Plan."
Indeed Honourable Speaker, we are working towards the realization of the National Development Plan which implore us to: Increase life expectancy to 70 years by 2015, Have a generation of under 20's free of HIV and AIDS, Reduce maternal and child mortality, Significantly reduce the burden of diseases both communicable and non communicable, Implement the National Health Insurance (NHI) in phases complimented by relative reduction in the cost of private health care, supported by better human resources and systems.
Last year we had accruals amounting to almost R800 million and today as I speak, the Department managed to settle a huge sum of this bill. In order to prevent the same situation, the department is now implementing a turnaround strategy with more stringent controls.
The Department did not have appointed managers that can lead the department and take accountability whilst a large number of health professionals exited the system due to a misconception of the interpretation of the pension regulation.
Honourable Speaker, there was a much read about shortage of medications in our various health facilities. This is however not true and was re-iterated by our Honourable Minister of Health, Dr Aaron Motsoaledi during a press conference held in Pretoria on Sunday the 24th of May 2015 where he dismissed the allegations.
We are however in a process of ensuring that Mpumalanga does not find itself in a situation where we completely run out of medications. We are currently busy with the appointment of a service provider that will ensure that proper systems are put in place to ensure that the supply of medication is effective, stock shortages are easily detected and there are no expired medications.
We have called on all managers to share information as to which health facilities have a shortage of medication. The once with more stock will then be able to supply those that are in short of that particular medication.
Honourable Speaker, the shortage of health professionals is a national problem hence we have a back log of patients waiting for orthopedic surgery. We have made interventions as we care about our citizens. On Saturday, I will be launching "Operation Letsema" in Rob Ferreira hospital where orthopedic doctors from other provinces will be assisting us to deal with the back log of these patients.
All this is done as the Department of Health; we strive to realize Outcome 2, which is to deliver "A Long and Healthy Life for all South Africans".
Honourable Speaker, I can confirm that the implementation of the National Health Insurance which seeks to ensure universal coverage of healthcare to all South Africans irrespective of their socio-economic status is currently going very well. This was emphasized by his Excellency President Jacob Zuma when he delivered the January h Statement I quote ".We remain committed to providing universal health care to our people and the ANC is happy to report that the National Health Insurance Scheme is now being moved to more pilot sites that will cover all nine province ". Indeed our people will go a long way in benefitting from this scheme.
Honourable Speaker, the life span of our people remains important. According to Statistics SA's Mid-year population estimates in 2014, South Africa's population now stands at just over 54 million with Mpumalanga contributing 4 229 300 which is translated to a contribution of 7.8 percent to the national population .
In Mpumalanga, the provincial average life expectancy has increased from the 50.2 for males that we reported last year to 56.9 this year. Female's life expectancy has also increased from the previously unchanged life expectancy of 53 years to 60.1 this year.
This was achieved thorough the continued roll out and sustenance of the household community components (HHCC) of the Integrated Management of Childhood Illnesses (IMCI), were an additional 11 sites were added to the previously reported 47 sites. This brings the total number of sites to 58 whilst an additional 22 have been planned for the 2015/16 financial year.
The Department believes that the additional sites will increase the impact on child survival, growth and development by improving key household preventative practices thus immensely increasing the life expectancy of Mpumalanga's citizens.
Honourable Speaker, health promotion and disease prevention is essential to reduce the healthcare burden of children and adolescents. Health Promotion Schools help to combat the global burden of childhood obesity by promoting healthy eating behaviour and encouraging higher levels of physical activity.
We can proudly announce that an additional 35 Health Promoting Schools were launched in 2014. This brings the number to 57 when combined to the 22 Health Promoting Schools launched in 2013. A total of 25 additional Health Promoting Schools are targeted for 2015/16 financial year.
The Department also established 74 Healthy lifestyle support groups with an intention to continue to address good nutrition, physical activity, and safe sexual behavior, reduction of tobacco and alcohol abuse.
The increase on the support groups now brings the number to a total of 159 support groups. An additional 20 healthy lifestyle support groups are targeted for 2015/16.
Honourable Speaker, the malaria disease remains one of the killer diseases in the Southern African Development Community (SADC) region. In spite of the fact that there was an increase in malaria in the SADC region; our province has managed to contain the situation. Three thousand nine hundred (3 900) malaria cases were notified which is slightly lower than the previous year of 4 904 cases. There was a decrease in the number of deaths related to malaria from 36 to 29 last financial year.
The strategies of surveillance, indoor residual spraying, malaria case management, vector surveillance and malaria awareness played a key role to this effect. In the 2015/16 financial year, we are targeting to spray 480 000 households in Bushbuckridge and Nkomazi, Kruger National Park and Sabie Sand Park. This will be complemented with the appointment of 340 additional temporary spray operators hence in the last financial year we recruited 321 temporary spray operators under the Expanded Public Works Programme (EPWP).
Honourable Speaker, we will continue to place our focus on Emergency Medical Services (EMS). We have heard the outcry of our people with regard to the alleged unsatisfactory work provided by our Emergency Medical Services which ranges from late or non-arrival to scenes when a call for EMS has been logged, reasons being unroadworthy EMS vehicles.
In addressing these challenges Honourable Speaker, the department has purchased 30 ambulances, three Planned Patient Transporter Service buses, as well as 14 all terrain response vehicles to replace the ageing fleet.
In ensuring that we continue to strengthen this service, the department is planning to procure another 20 Ambulances and 12 all-terrain response vehicles in the 2015/16 financial year to replace the ageing fleet and have roadworthy vehicles on the road. We will also increase the number of EMS personnel by appointing more in the current 2015/16 financial year.
Honourable Speaker, the effort to ensure that we prevent deaths of mothers and children due to complications that occurs as a result of pregnancy and child birth is on going.
It is a pleasure to report that the maternal mortality was significantly reduced in the province from 133/100 000 live births in 2013/14 to 109/100 000 in 2014/15.This is below the provincial Millennium Development Goal (MDG) target of 117/100 000 live births. The achievement can be attributed to multi-pronged strategies that were implemented to curb the avoidable factors that contribute to these mortalities which include, the establishment of an additional three more ,aternity waiting homes, adding to the five already established, thus bringing the number to eight.
Our plan in the 2015/16 financial year is to reduce maternal mortality to 105 per 100 000 live births. This will be achieved as we are planning to train 20 Professional Health Workers per district on Essential Steps on Management of Obstetric Emergencies (ESMOE).
The department is planning to increase the number of waiting homes to 11 in the new financial year. This will address a number of problems which include non-availability of transport and geographically far areas.
Honourable Speaker, the child mortality rate has slightly decreased from 10.7 per 1 000 live births in the 2014/15 financial year to 7.8 per 1 000 live births currently. This is however still far above the set target of 5/1 000 live births.
Last financial year we committed to recruit more specialists in order to strengthen the establishment of District Clinical Specialist Teams who provide support to primary health care facilities in the quest to reduce maternal and child mortality. The Department has managed to recruit two specialists. Our plan in the 2015/16 financial year is to recruit more specialists for the two Districts.
The Mom-connect programme which was launched by our Honourable Health Minister, Dr Aaron Motswaledi is playing a vital role in raising community awareness. It empowers our pregnant women and new mothers with healthcare massages through a cellphone program. Community awareness campaigns are being conducted throughout the province and the implementation of Mom-connect will be strengthened.
Honourable Speaker, the province adopted the resolution of vaccinating all girls who are aged between 9 and 12 years and are in Grade 4 with human papilloma virus (HPV) vaccine to prevent them from attaining cervical cancers that are caused by the human papilloma virus. The province managed to reach 91 percent of public schools.
We are planning to conduct the human papilloma virus campaign to vaccinate all girls who are in Grade 4 in all public schools twice a year. We have already conducted the first round in March 2015 whilst with the second round is planned for October 2015.
Our province has heeded the call by the South African National Aids Council (SANAC) to ensure that we put our heads together with the private sector, lngoma forum, Traditional leaders, non-governmental organisations (NGOs) and nonprofit organisations in order to find solutions on how we can reduce the spread of the HIV/AIDS pandemic.
Last year we reported that a total of 648 665 HIV tests were done and those who tested positive were linked to care.
Our plan is to continue implementing HIV Counseling and Testing (HCT), targeting key population like farm workers, youth, sex workers, High Transmission Area (HTA) hotspots and link them to care.
The number of patients on Anti-Retroviral Treatment (ART) has increased from 243 374 patients in 2013/14 to 265 685 in the 2014/15 financial year.
With the implementation of new Policy Guidelines for Anti-Retroviral Treatment (ART) (CD4 -350 to 500) and Prevention of Mother-to-child Transmission (PMTCT) Option B+, the province is planning to initiate a further 74 493 new patients on anti-retroviral treatment. This new policy will further assist in increasing life expectancy. In the 2015/16 financial year we are targeting to have 354 991 clients remaining on ART (Cumulative).
Honourable Speaker, male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficiency would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection. That is why we have increased the number of male medical circumcision (MMC) high volume, high quality from 28 in 2012/13 to 33 sites in 2013/14 financial year.
I am proud to announce that a total of 54 public health facilities are offering Voluntary Male Medical Circumcision (VMMC) services in the province. Out of 54 facilities 28 are hospitals and 26 are Primary Health Care facilities.
Our plan is to continue to work closely with the general practitioners and traditional initiation schools' surgeons, through lngoma Forum, to increase access to Voluntary Male Medical Circumcision services points. We are targeting to perform 150 000 circumcisions in the 2015/16 financial year.
Winter has arrived, and as we all know that this is the time where initiation schools are conducted, we are continuing to ensure that through our relationship with the Department of Co-operative Governance and Traditional Affairs, House of Traditional Leaders and in particular, the lngoma Forum, we jointly ensure that no illegal initiation schools are conducted and that we do not experience more deaths of initiates. The Department will also continue to deploy medical teams to various lngoma sites to provide medical screening and ensure hygienic conditions at various sites. We have procured six bakkies for supporting traditional initiation activities.
The male condom, distributed in the 2014/15 financial year was a success. Our plan in the 2015/16 financial year is to ensure that each and every male has a supply of 20 condoms per month. Surely there is no excuse for unprotected sex. We must admit that we have not done enough to market the female condom in the previous financial year. In this financial year; we will strengthen our marketing strategy to popularise the female condom.
Honourable Speaker, we will ensure that all TB and HIV co-infected clients are put on treatment irrespective of the CD4 count as per the policy guideline.
The Prevention of Mother to Child Transmission (PMTCT) programme continues to play a pivotal role in the reduction of transmission of HIV from mother to child. All pregnant women are now put on lifelong therapy as per the new policy guidelines that were implemented since the 1st of January 2015.
The department has recorded a reduction in mother to child transmission from 2.3 percent to 1.8 percent; a positive move towards reducing infant mortality. We shall therefore continue to make sure that our pregnant women are initiated on lifelong treatment regardless of the CD4 count.
It is a known fact that TB is one of the killer diseases in the country. Previous statistics have shown that in our province, we are still not meeting the requirement, although the provincial TB cure rate has been gradually improving. In the year 2010 they were standing at 72.7percent, 76.5 percent in (2011) and 77 percent in 2012, which is still below the National target of 85 percent. We will continue to work hard towards meeting the national target of 85 percent of the TB cure rate by strengthening patient support and programme supervisory capacity and capability during this current financial year.
Honourable Speaker, we are also going to ensure that the newly introduced multidrug resistant tuberculosis (MOR TB) drug is used in our health facilities. Our plan is to establish the Provincial TB Review Committee.
Whilst on this matter, Honourable Speaker, I must inform the house that we are in a process of swapping lmpungwe hospital to be a TB hospital, whilst the Witbank TB hospital will become a general hospital. This decision was informed by the geographical location of the two facilities in that Witbank TB is central to the public.
The Department will continue to implement the Turnaround Strategy for HIV & AIDS, Sexually Transmitted Infections (STls) and Tuberculosis (TB) to reduce HIV infection to below 40 percent in Gert Sibande and below 30 percent in both Ehlanzeni and Nkangala Districts. Our overall plan in the 2015/16 financial year is to ensure that we continue to protect the human rights of people living with HIV, as well as the rights of women, children, and members of vulnerable and key populations. Our province will continue with the implementation of the set objectives which are:
- Mobilizing people to know their HIV and TB status
- Supporting people with key prevention messaging
- Promoting key HIV and TB prevention interventions
- Increasing incidence of health seeking behaviour.
- Increasing early access to HIV and TB treatment, care and support for those in need.
- Increasing testing and linkage to treatment, care and support for society, including key populations.
By addressing all these objectives, we are responding to the call by his Excellency President Jacob Zuma which he pronounced during the 8 January statement and said "South Africa has turned a corner in the fight against HIV and AIDS and Tuberculosis. But we want to remind our people that many people still lose their lives to these two preventable diseases. All people, in our country, must take responsibility for ensuring that they are active in combating these and other communicable diseases".
A lot more work still needs to be done in the new financial year of 2015/16. We have started with the filling of vacant posts in the Infrastructure programme. The filling of the posts will ensure that good progress is recorded in our infrastructure programme.
This will also ensure that the piloted NHI programme in Gert Sibande, which is in line with the re-engineering of our Primary Health Care facilities progresses well. We all know that Primary Health Care is the heart beat of any sustainable health system globally, hence our re-engineering efforts focuses on a number of streams which include,
- Establishment of Primary Health Care District Clinical Specialist Teams (DCSTs).
- Establishment of Ward-based PHC Outreach Teams (WBOTs).
- Strengthening of the Integrated School Health Program (ISHP).
- Contracting of General Practitioners (GPs) for Primary Health Care centers.
- Establishment of Ideal clinics.
By the 2014/15 financial year, the Department managed to establish 60 Ward-based Primary Health Care Outreach Teams (WBOTs) in seven (7) Local Municipalities of Gert Sibande District.
The Ward-based PHC Outreach Teams are also playing a vital role as they render preventive and promotive health care interventions at household level, compile household profile and update annually, providing Information and education to communities on health related matters. Our plan is to increase the number by adding 60 more Ward-based PHC Outreach Teams in the new financial year. The WBOT will be supplied with medical equipment and kit bags to make their work easier.
The Department is also funding 228 NPOs who are greatly assisting us with provision of Community Based Health Services such as follow-up visits on
- Pregnant women
- Children below 5 years
- People living with disabilities
- Persons on chronic medications
Honourable Speaker, in the 2015/16 financial year we are going to increase the number of funded non-profit organisations (NPOs) to 268 in relation with the rollout of Ward Based Outreach Teams and the Ideal Clinic initiative.
In order to ensure that they are closely monitored we will appoint 66 Home Based Care (HBC) support coordinators at sub-district level for data capturing in line with the number of active Non Profit Organizations per district which are twenty per district.
Hounarable Speaker, I must inform the house that Wisani Home-based Care in Bushbuckridge has outshined all the other NPOs in the country by obtaining position one in Performance Excellence Awards. They have put us on the map and it is for this note that I will be officially opening their donated structure very soon.
As part of strengthening the Integrated School Health Program (ISHP), we have appointed 14 School Health Teams in Gert Sibande and an additional sixteen (16) more teams will be appointed in the new financial year of 2015/16.
Honourable Speaker, Our President, his Excellency Jacob Gedleyihlekisa Zuma launched the "Operation Phakisa 2" the Ideal Clinic initiative which aims to improve service delivery in our clinics nation-wide. I am proud to say that two of our facilities, Buhlebempilo and Nthoroane in Gert Sibande are quickly improving to reach the status of an Ideal Clinic.
Our plans of contracting general practitioners (GPs) for Primary Health Care centers are well on course. In the previous financial year we contracted 10 doctors and we managed to increase with an additional 21 doctors (through the FPO Consortium) and they render services in 28 clinics. We are planning to recruit more doctors to cover the 72 clinics in Gert Sibande.
Recently there were reported challenges by the media in some of our clinics which include Khumbula and Jerusalem. I can report to the house that I visited all these clinics and indeed the situation was appalling.
We have requested the assistance of the National Department of Health to intervene by erecting the IBT (Innovative Building Technology structures) at Khumbula and Jerusalem. The IBT structures are currently being rolled out in other provinces which have similar challenges.
I can confidently state that the Innovative Building Technology structures are reliable as they are quick to erect, has a durability of a minimum of 50 years and complies with the health norms and standards.
As part of speeding up the programme of ideal clinics in the province, together with the National Department of Health, we are in a process of constructing five (5) new Primary Health Care facilities in the following areas.
- A new Community Health Care in Nhlazatshe 6
- A new Community Health Care in Vukuzakhe
- A new Community Health Care in Mkhondo
- A new Community Health Care in Msukaligwa
- A mini -hospital in Balfour.
In addition to the above new projects, the National Department of Health is also rolling out comprehensive maintenance programme in all facilities at Gert Sibande District.
I am happy to announce that we have successfully managed to operationalize some of our clinics which were considered to be white elephants.
I can confirm that Greenside Community Health Care Center in Mammethlake and Wakkerstroom are now operational. We have made interventions at Sinqobile clinic in Daggakraal and we can report that progress is at an advanced stage.
Honourable Speaker, our partnerships with the private sector which is aimed at enhancing our Primary Health Care provision is advancing with speed. In the last financial year we had partnerships with various stakeholders such as Eskom which leased us two of their school health buses in the Gert Sibande District and Nkangala District. These buses are providing basic health care services to learners in various schools. We also partnered with Sasol which has committed to build a clinic in Embalenhle extension 14.
Sasol has previously played a vital role as they also donated health equipment in some of our clinics. We have companies like SAMANCOR Group, a mining company in Emalahleni which has built a clinic in the Ackerville area. This is a state of the art clinic which I will be officially opening soon.
Anglo American Mine has built a complete structure, Rooikoppen Community Health Care Center in Standerton and the University Research Company based in Pretoria has built three Pre-fabricated clinic structures in the Ehlanzeni, Nkangala and Bohlabela Districts. Dwarsrivier Mine in Lydenburg has just donated a 500 meters pavement leading to the Mashishing clinic. We are busy finalising other partnerships with more private sector companies thus promoting the Public Private Partnership (PPP) initiative.
Honourable Speaker, in order to ensure that health provision in our hospitals is effective; we have appointed Chief Executive Officers (CEO's) in most of our health facilities. Only hospitals such as Shongwe, Matikwane, Ermelo (whose CEO was appointed in Rob Ferreira), Bethal, Bongani TB, and Standerton TB are still without CEO's. All the posts have been advertised and processes to fill them are underway. We have and are appointing almost all operational managers in our clinics.
So far, all the appointed CEO's and operational managers are moving in the right direction in assisting the Department to improve health services in the province. Their work is complemented by the services rendered by the hospital boards and clinic committees.
We will ensure that we continuously appoint and replace governance structures as and when their term of office expires.
Our target for the 2015/16 financial year is to make sure that all Hospitals CEO's and District Managers have formal delegation of authority. We will conduct induction on delegations whilst we closely monitor their implementation.
Honourable Speaker, the Rapid Implementation Unit projects (RIU) which the Premier spoke about in the State of the Province Address is continuing to add value to the maintenance and renovations programme of the department.
We have also taken note of the ageing infrastructure, plant and equipment in our Health Care Facilities. We are commencing with maintenance, repair, rehab and refurbishment of 107 healthcare facilities in the 2015/16 financial year. This will also include backup generators.
We have been experiencing challenges with the non-availability of medical waste storage, fencing and guard houses in some of our facilities. We have ensured that a budget of about R25 million is allocated to ensure that this is addressed.
While this is happening, we have also planned to procure 16 mobile clinics that will be distributed to all the areas which do not have Primary Health Care facilities.
In order to recognise young and upcoming contractors, we have planned to use the services of cooperatives in some of our projects for maintenance, repairing, rehabilitation & refurbishment. We will be engaging the Department of Economic Development, Environment and Tourism for cooperatives database.
Honourable Speaker, as pronounced by our Honourable Premier Mr DD Mabuza in his state of the province address, we are planning to enhance patient care & safety and improve medical care by constructing ten (10) state of the art Modern hi-tech hospitals.
Our Honourable Premier took us to Italy where we saw state of the art hospital facilities. The trip was an eye opener as it gave us a picture of what we should be planning as a province in terms of health service delivery. Indeed the partnerships that the Premier has signed on behalf of the province will go a long way in helping us to realize the construction of the state of the art health facilities. Hospitals such as Ermelo, Mapulaneng, Mamethlake, Middelburg and Bethal will become our first state of the art hospitals.
The trip also opened a working partnership as we explored the possibility of doctor exchange programme between Puglia and Mpumalanga Provincial Government. It also assisted us to pursue opportunities to train Mpumalanga health professionals in Puglia. Above all, it helped us to identify best practices on how documents can be customised in our provincial hospitals. That is in relation of moving from manual to electronic filing.
We are also engaging the KwaZulu-Natal Department of Health on an exchange programme on the training of our nurses.
Honourable Speaker, allow me to present to the House the proposed budget for the Department for 2015/16 for your consideration.
Programme 1: Administration R251 078 000.00
Programme 2: District Health Services R6 210 384 000.00
Programme 3: Emergency Medical Services R325 837 000.00
Programme 4: Provincial Hospital Services R1 169 333 000.00
Programme 5: Central Hospital Services R1 050 413 000.00
Programme 6: Health Science And Training R294 926 000.00
Programme 7: Health Care Support Services R126 842 000.00
Programme 8: Health Facilities Management R566 996 000.00
The total budget of the Department of Health for the 2015/16 financial year is R9 995 809 000.00.
s a department we remain committed in delivering better health care for all the people of our province so that we realize the aspirations of the Freedom Charter and the Constitution.
As a province we are working together to realise our collective aspirations of building a developmental state. Let us all remember that we are running a marathon, which demands endurance, stamina and refusal to be defeated.
Finally, I would like to thank the Honourable Premier DD Mabuza, Director-General, Head of Department and the entire staff of the department for their hard work, dedication and constructive support.
I would like to thank the Chairperson of the Portfolio Committee, members of the Committee, Members of the Select Committee on Public Accounts (SCOPA), Members of the Provincial Legislature as well as all members of the Executive Council for their support, constructive criticism and oversight guidance they provide us in the execution of our mandate.
I would like thank the African National Congress (ANC) for having made it possible for me to be been given the responsibility of leading one of the most challenging Department's in the province.
I would like to thank my wife, children and family for their unwavering support as we continue to execute our mandate and serve our nation.
Let us remember that the Freedom Charter request of us to serve our people. Minthiro ya vulavula
Kea ya leboga Ndza Khensa
