by MEC for Health P Nkonyeni
26 April 2006
Honourable Premier
Speaker and Deputy Speaker
Members of the Provincial Executive Council
Honourable Members of the Provincial Legislature
Chairperson and Honourable members of the Portfolio Committee on Health;
Mayors and Councillors of Local Government
Amakhosi here present
Head of Department, Dr Busi Nyembezi
Distinguished guests
Ladies and gentlemen,
The 1988 Khartoum Declaration observed "Since the human being is the centre
of all development, the human condition is the only final measure of
development. Improving that condition is essential for the poor and vulnerable
human beings who comprise the majority of our peoples in Africa. Africa's men
and women are the main factors and the ends for whom and by whom any programme
and implementation of development must be justified"
It has been eighteen years since the Declaration was made by the men and
women who were charged with looking at the condition of humanity, and we are
still faced with the insurmountable task of living up to the ideals of human
dignity through health service delivery. Honourable Chairperson, allow me first
the opportunity to reflect on a moment in time. I have been overwhelmed by the
number of words of sympathy and support from this house and so many people
within and outside of our province during my bereavements. In the past year I
lost a dear nephew in a car accident, a few months later my beloved father
passed on. Their death robbed me of the love and support that had come to
sustain me throughout my life.
In January this year I tragically lost my son Monde. His passing cut very
deep. He was what this country needed as a new generation of leaders that would
carry us through the 21st century and beyond. Your support and words of comfort
sustained me during the difficult time and I would not have done it without
you. You remind all of us that despite the valleys we go through on a day to
day basis, we continue to have unfailing support that serves to assure us of
humanity itself. Ngiyabonga kakhulu.
Olumide Adeoso, a Nigerian poet catches the imagination of the soul, when
she says
A smile that charms,
Clear as the skies
A melody in those eyes
Comfort in those arms
A voice that cuts thro glass
A rhythm that one must dance
A hymn that flows
A tune that holds
The melody lingers
It stuns the listeners
A music that holds the heart
That you certainly are
The song goes on
Deep in my heart
A gift of music of your love
That I can't part
Honourable Chairperson, ladies and gentlemen, please allow me therefore to
dedicate my budget speech to the memories of these three who were all very
close to me. Allow me also to dedicate it to the men and women in the
department of health who have passed away in the last year and well into this
month. May I also use this opportunity to pass my condolences and words of
comfort to their friends and families for the loss of their loved ones. As a
department we are sadly bruised by such loss, especially at a time when we
require all the resources we can get to fight the war against disease and
poverty.
On the 7th April 2006 we celebrated World Health Day whose theme this year
is âworking together for health.â On this day we celebrated and honoured the
role of our health workers and also focused our thoughts on the global health
workforce crisis. Healthcare is a labour-intensive industry which means it is
critical that we have strategies that will not only attract health workers to
our department but also ensure that they are continually motivated, developed
and supported so that we can retain them. This year will see our Department
amongst other things strengthening our Employee Assistance Programme as well as
putting in place programmes that will instil a culture of Life Long
Learning.
At the beginning of this year as part of the restructuring process that
commenced last year, the department appointed a team of senior managers under
the leadership of Dr Busi Nyembezi who took over from Prof Green-Thompson who
had led the Department for ten and a half years. We would like extend our
gratitude to Prof Green-Thompson for the contribution he made to healthcare
delivery in the province during his tenure and wish him well in his current
position as advisor to the national Minister of Health. The new team will
undoubtedly build on the foundation already laid in order to take the delivery
of healthcare in our province to greater heights through fighting disease,
fighting poverty and giving hope!
Honourable Chairperson in our quest to continue to improve service provision
to the people of our province, we continue to be guided by various documents
including the Freedom Charter, the Peopleâs Contract, Millennium Development
Goals and the national Department of Health priorities as well as provincial
priorities and prevailing health trends. This year will see the development of
a Health Service Transformation Plan for the province to take us through to
2014. The plan will ensure that health service provision is equitable between
and within districts. Health services will also have to be relevant to the
needs of the people and be of good quality and cost-effective. The plan will
also address the critical issue of human resources shortage using the
principles outlined in the National Human Resources Plan for Health unveiled on
World Health Day by the National Minister. This is an extremely important
exercise because workforce shortages negatively impact on our efforts to attain
both the Millennium Development Goals and address local health priorities. What
will be critical, however, is to ensure that the plan is implemented. We will
as a department pilot some of the innovative ways of attracting, developing,
rewarding and motivating staff this year.
The Wealth Report 2006 indicates that the World Health Organisation (WHO)
Region of the Americas, with 10% of the global disease has 37% of the worldâs
health workers spending more that 50% of the worldâs health financing, whereas
the African Region has 24% of the burden of disease but only 3% of health
workers commanding less 1% of world health expenditure. The report also
emphasises that the exodus of skilled professionals in the midst of much unmet
health need places Africa at the epicentre of the global health worker
crisis.
Access to healthcare is critical in improving health outcomes. In an effort
to give meaning to our mission of âdeveloping a sustainable, co-ordinated,
integrated and comprehensive health system at all levels of care based on the
Primary Healthcare Approach through the District Health Systemâ we will improve
access by providing 75 new mobile clinics, building 30 new clinics and three
new Community Health Centres this financial year. To enhance primary
healthcare, Community Care Givers will be given new skills and their pool
expanded to respond to the burden of disease. Management structures at Primary
Healthcare level will also be reviewed and strengthened.
We will be reviewing the policy for the distribution of Community Service
Officers and bursary holders to ensure equity and adequate coverage throughout
the province. The awarding of bursaries to the most needy and rural learners
has had positive results and will continue to be supported.
Honourable Chairperson to further demonstrate our commitment to access to
healthcare, we continue to strengthen our Planned Patient Transport
transporting patients between hospitals and between clinics and hospitals. In
2004/2005 we transported 99 792 patients this increased to 272 800 in
2005/2006. We intend purchasing 22 more Planned Patient Transport buses in this
financial year.
In his address at the last State of the province address, the premier of our
province, the honourable Dr Sbu Ndebele remarked that we need to work hard
towards ensuring that we deliver services in all areas of the province, to
ensure that our guests who are attracted to the serenity of our province and
the community of KwaZulu Natal are attended to within the specified response
time. To do this, we have strengthened our Emergency Medical Services by buying
new and improved vehicles to cope with the terrain of our roads. This financial
year we will procure 150 new ambulances and 87 support vehicles.
We will also employ 600 Basic Life Support Emergency Care Practitioners and
20 Advanced Life Support Emergency Care Practitioners. Honourable Chairperson,
Quality of Care is one of the indicators of health system performance and it
influences health outcomes. The province has been involved the last few years
in a quality improvement programme for hospitals. In reviewing and evaluating
the impact of the programme we have decided to use a programme that will cut
through all levels of care to ensure a continuum of quality care. Clinical
Governance, Batho Pele principles, the Patientsâ Rights Charter and our Service
Charter will be at the centre of such a programme. Poverty is at the core of
disease spread in our society. The President of our Republic, the Honourable
Thabo Mbeki made bold his statement on the issue of forging ahead with our
programme of growth and development when he remarked: âWhile we must indeed
celebrate the high levels of optimism that inspire our people, who are
convinced that our country has entered its Age of Hope, we must also focus on
and pay particular attention to the implications of those high levels of
optimism with regard to what we must do together to achieve the objective of a
better life for all our people. We have to respond to the hopes of the people
by doing everything possible to meet their expectations. â As a Department we
consistently remind ourselves that âhealth is not merely the absence of disease
but a state of physical, social and mental well-beingâ which is why we are
committed to fighting disease, fighting poverty and giving hope to the people
of KwaZulu-Natal.
The Presidentâs words echo the poignant message of the Freedom Charter and
the sentiments of the founding fathers of our movement and our heroines, Omama
u Lillian Masediba Ngoyi, Mama Victoria Mxenge, Mama Albertina Sisulu, Mama
Adelaide Tambo and many others whose selflessness, contribution, dedication and
determination continue to guide us in our struggle to provide service to our
people. Some of these ladies were health workers themselves who at some stage
of their lives dedicated themselves to looking after the sick and infirm. Our
province like many other poor areas in developing countries is facing a
challenge of communicable diseases. A few weeks ago we successfully treated a
patient with Congo fever at one of our Durban Hospitals. We will be building
and isolation ward at one of the hospitals in Pietermaritzburg this year to
strengthen our capacity to deal with some of these serious communicable
diseases. We will continue with the implementation of the Comprehensive Plan to
combat HIV and AIDS. Our Youth Health programmes will be strengthened as we
believe that this is where meaningful health promotion gains can be made. Home
based care services will be enhanced. Significant progress has been made with
the Anti Retroviral Treatment (ART) rollout programme. A total of 53 out of 55
sites that were identified to give treatment are now fully accredited and
operational. The remaining 2 sites function as complexes with nearby
facilities. This means that ARV treatment is accessible at all hospitals and in
all districts in this province. Ongoing staff training and expansion of ARV
treatment service to clinics will ensure increased and convenient access to
treatment.
The Prevention of Mother to Child Transmission Programme (PMTCT) will be
integrated with our Maternal Child and Womanâs Health Programme. Honourable
Chairperson, a total of 60 hospitals, 598 Primary Healthcare clinics, 14
Community Healthcare Centres and 43 mobiles provide Voluntary Counselling and
Testing (VCT) services. This service also provides an entry point for both
PMTCT and ART programme. In addition, there are 58 non-medical sites that have
been established which are providing VCT services.
At the World Health Organisationâs Afro Regional Committee meeting in Maputo
last August, the African Ministers of Health declared TB an emergency. We will
this coming financial year also pay special focus on the management of TB. On
National TB day on the 24th March 2006, the National Minister launched the TB
Crisis Management Plan which is designed to assist with combating TB. As a
densely populated province with high levels of poverty we are especially
vulnerable more so because TB is associated with poor socio-economic
conditions. Ethekwini, Umgungundlovu, Uthungulu and Umzinyathi districts are
the hardest hit by TB in the province. To fight disease we have moved with
speed to allocate an additional R30 million to TB management. This allocation
will enable us to appoint an additional 240 staff members to help us roll out
the TB management programme. Through this drive we intend to increase the TB
Cure Rate from 35% to 50% and reduce the defaulter rate from 16% to 14% by
March 2007. We are also seeing an increase in the incidence of Multi Drug
Resistant (MDR) TB which is the result of non-adherence to treatment. TB
treatment has to be taken over a six-month period and it is not easy for
patients to stick to treatment for such a long period unless they get support.
Most of our patients are also very poor and often find themselves having to
take treatment on an empty stomach which is very unpleasant; as a result they
stop the treatment.
The cost of treating a TB patient for six months is about R400,00 whereas
the cost of treating a patient with Multiple Drug Resistant TB is about R24
000,00. It is therefore clear that we have to make our management of TB very
robust to prevent MDR TB. Besides the financial cost of treating MDR TB, we do
not want more people in the communities infected with MDR TB.
In an effort to support our patients and ensure a comprehensive approach to
treatment we will as a department provide nutritional supplements to improve
nutritional status of vulnerable patients on TB and ARV treatment.
We will continue to improve the management of maternal and childhood
conditions. The highest percentage of children under-five are found in the
districts of Umkhanyakude, Umzinyathi and Zululand, which are the poorest
districts in the province. We are aware that poverty causes, among other
things, stunting and malnutrition. Thirty eight percent of children under the
age of six in KwaZulu-Natal have marginal Vitamin A deficiency status and
eighteen and a half percent of children one to nine years old, were reported as
stunted. Children under-five as a vulnerable group will also be provided with
micronutrient supplements including Vitamin A. To fight poverty one of our
strategic objectives for the coming years is to strengthen nutrition enhancing
programmes for all vulnerable groups.
We would like to reiterate what we said last year that poverty and ill
health are inter-twined as a result people in developing countries tend to have
worse health outcomes than developed countries because poor people are caught
up in a vicious cycle where poverty breeds ill-health and ill-health
exacerbates poverty. It is for this reason that we havecommitted ourselves to
fighting disease, fighting poverty and giving hope.
Strengthening mother and child health programmes will contribute to the
attainment of the Millennium Development Goals of reducing by two thirds the
under-five mortality ratio and by three-quarters the maternal mortality ratio
by year 2015. Non-communicable diseases and diseases of lifestyle
(Hypertension, stroke, heart attacks and diabetes) are among the 10 leading
causes of death in our province. To address this issue we will as a Department
promote healthy life styles both inside the department and with communities.
Our Employee Wellness Programme as well as the Health Promotion Programme will
be strengthened this year to enhance healthy lifestyles promotion and risky
behaviour change. The care of older persons will continue to be important. Our
health facilities will provide flu vaccines to older persons and persons at
risk. We will also continue to improve the availability of chronic medication
in all our Primary Healthcare facilities. The cataract surgery rate will be
increased and low vision services will be provided at all sight-saver
centres.
To improve the quality of rehabilitation services we will increase access to
these services, increase staff training on disabilities and rehabilitation as
well as improve equity in the provision of rehabilitation services.
Honourable Chairperson we will move to ensure integration of Mental Health
Services into the District Health System and also introduce strategies to
address substance abuse at Primary Healthcare level. In combating both
communicable and non-communicable disease we will need to work hand in hand
with communities in meaningful partnerships. We held a provincial meeting in
March with all Hospital Boards and Clinic Health Committees as a beginning of
the process of partnership development with various stakeholders. We will this
year give meaning to meaningful community participation as we intend to work
closely with communities in the planning and rendering of health services. We
will also be exploring value-adding partnerships with the private sector and
tertiary institutions. Last year in this house we indicated that in an effort
to address the issue of poverty and food insecurity the Department will open up
markets for targeted enterprises and identified pilot projects that would
engage cooperatives in the provision of curtains in four hospitals: Madadeni
Hospital in Amajuba District, Ngwelezana Hospital in uThungulu District,
Edendale Hospital in uMgungundlovu District and Prince Mshiyeni Hospital in
eThekwini District. The Pilot Project went well and is currently 90% complete.
Where there were no privacy curtains between patientsâ beds before, we now have
them, and this will maintain patient dignity in our hospitals. Healthcare is
indeed a human right. Besides this pilot project there were some other tenders
involving sewing linen goods that were awarded to co-operatives in 2005/2006.
The total value of contracts awarded to co-operatives from August 2005 to
December 2005 was R11,5 million for 147 contracts.
Honourable Chairperson to give meaning to our commitment of giving hope,
this financial year the department will extend its programme of opening up
markets to targeted enterprises through a developmentally oriented Supply Chain
Management process. Support for co-operatives will be expanded. In April we
conducted road shows explaining what service will be sourced from Co-operatives
and SMMEs and how communities have to respond to tenders. In May we will hold
an Open Day to share with SMMEs and BEE Companies what business opportunities
will be available from the Department. We will continue to be innovative in
identifying opportunities for targeted enterprises. The New Partnership for
Africaâs Development (NEPAD) clearly points out that resources such as capital,
technology and human skills that are required to launch a global war on
poverty, health issues and underdevelopment exist in abundance and are within
our grasp. We only need to be innovative and decisive. As indicated in last
yearâs budget speech we are still facing huge backlogs in infrastructure
maintenance and rehabilitation. The current estimate for maintenance and
rehabilitation of hospital infrastructure inclusive of the recently taken over
South African National Tuberculosis Association (SANTA) hospitals and the
Umzimkhulu A hospital stands at R3,5 billion.
Honourable Chairperson, our department visited Umzimkhulu in early March to
assess the situation of the health services in the area. We have taken over
three hospitals namely Rietvlei District Hospital with 205 beds, St Margaretâs
Hospital with 80 beds, Umzimkhulu Psychiatric Hospital with 320 beds and 6
clinics.
On 1 April this year we also took over the Forensic Mortuaries from the
South African Police Services. We will be refurbishing eleven of these
mortuaries this year at an estimated cost of R96 million for buildings and
equipment. We have prioritised the Districts of Umkhanyakude and Zululand to
build new mortuaries as none existed before.
As part of the hospital revitalisation programme, we are investing a
sizeable amount of money in the rebuilding of hospitals. We have signed off
business plans for the building of the new King Edward hospital and the
Revitalisation of Edendale hospital and there are seven other new hospitals to
be built or undergo complete revitalisation. Among these are new hospitals to
be built, the Dr Pixley kaSeme and Dr John L. Dube hospitals. The hospitals to
be revitalized are King George V, Madadeni, Ngwelezane, Lower Umfolozi and
Hlabisa hospitals. Our estimate for this massive work totals R349.9 million, of
the total infrastructure budget of R916,3 million.
To accelerate infrastructure development and address the backlog the
Department continues to use the services of Ithala and Independent Development
Trust (IDT). Because of the volume of work, progress has been slower than
anticipated. Cabinet has recently approved that the Department working in
partnership with Works source services of the private sector. It is our hope
that it will now be possible to fast track most of the work using this method.
This process will further enhance our efforts of opening up markets for
targeted enterprises to ensure that the previously disadvantaged groups of our
society are empowered. This will serve as our departmentâs contribution towards
the Governmentâs Accelerated and Shared Growth Initiative for South Africa
(AsgiSA). This year will also see us strengthening our Information Technology
Systems through the development of a Master Systems Plan that will be aligned
to the Health Service Transformation Plan. The province has 36 telemedicine
sites which will be activated and utilised to improve clinical care, strengthen
outreach and train our health workers.
Honourable Chairperson strengthening the quality of our health information
will also involve bridging the gap between facility and community information.
We will roll out a programme that will gather health information at community
and household level.
Budget provision
The total amount of R11,736 billion requested for the financial year, reflects
an increase of R1,434 billion compared to the revised budget for 2005/06, or a
13,9% increase. The growth in real terms will enable the Department to improve
the quality of its services. Services in certain areas of the province are
still below the minimum acceptable levels that the Department is committed to
provide and to narrow the gap of inequity. The Budget allocation will assist
the Department to address some of these issues but remains insufficient to
substantially address certain areas of concern. Four areas of concern still
are:
* the provision of primary healthcare services in certain underserved areas
still indicates a shortfall of some 200 additional clinics
* the provision of Emergency Medical and Rescue Services, which requires a 25%
increase in funds for the required service provision of which only 11% can be
addressed in the current financial year
* addressing the poor state of some of the health facilities to improve the
facility asset register to meet the demands placed on the Department, which
requires the doubling of present infrastructure activities programme
* improving the quality of services by providing additional personnel.
Revenue
The sources of funding for Vote 7: Health consist of conditional grants
amounting to R1,775 billion and an allocation from the equitable share
amounting to R9,962 billion representing an increase of R199 million or 12,60%
and R1,055 billion or 11,8%, respectively.
The Departmentâs own revenue is expected to decrease from R139,5 million to
R137,2 million as indicated in table 7.2 of the Budget Statement.
The amount requested to be appropriated will be distributed to the various
programmes as follows:
Programme 1: Administration
For this programme, which is for Head Office management functions, an amount of
R211 million, representing an increase of 8,76% is requested. The increase is
mainly due to improvement in conditions of service and the restructuring of
head office which will be completed in 2006/07. The spending on this programme
is still within the target of a maximum of 2% of the total allocation.
Programme 2: District Health Services
For the provision of District Health Services an amount of R5,438 billion is
being requested, representing an increase of R804 million or 17.35%. This
increase will cover the improvements in conditions of service as well as a
moderate development of services in underserved areas. These services include
clinics, the comprehensive management of HIV and AIDS, and combating
communicable diseases including tuberculosis, malaria and cholera, and
nutrition.
Programme 3: Emergency Medical Services
For the provision of Emergency Medical Services and amount of R453 million is
being requested, representing an increase of 10,76%. This increase is required
for the replacement of existing ambulances and a further increase in the
present fleet. The available funds are however, still insufficient to cater for
the requirements to provide an acceptable emergency medical services in the
entire province and to rollout an acceptable planned patient transport
service.
Programme 4: Provincial Hospital Services
This programme deals with Regional Hospital Services as well as hospitals
providing hospitalisation of mental health, tuberculosis and convalescent
patients. The requested allocation of R3,087 billion represents and increase of
R171 million or 5,86%.
Programme 5: Central Health Services
This programme provides facilities and expertise for sophisticated medical
procedures. It is partly funded through a conditional grant from the national
Department of Health and it increases by inflation only. An amount of R1,173
billion is requested representing an increase of R148 million or 14,5%. The
main portion of this increase results from an increase in the Provincial
equitable share. It is important to not in this regard that according to Nation
norms and the Provincial Strategic Positioning Statement, this province needs
to enhance its tertiary services from the above provision to R1,6 billion ( an
increase of R399 million) to be on par with other Provinces providing similar
services.
Programme 6: Health Sciences
This programme provides for the training health personnel such as nurses,
Emergency Medical Services practitioners and other training as well as the
granting of bursaries. The acute shortage of health professionals in all
occupational classes requires the Department to invest in the accelerated
training of these professionals. The amount of R449 million requested
represents an increase of R29 million or 6,9%. This increase will allow the
Department to continue with the increase in student nurse intake and the
granting of additional bursaries.
Programme 7: Healthcare Support Services
The amount of R9,6 million, or a 25,8% increase, is requested for the medicine
trading account to provide for the increased turnover of medicine stock due to
the ARV roll-out, increasing demands from patients as well as the increase in
the value of stock as a result of inflation.
Programme 8: Health Facilities Management
This programme is utilised for the capital expenditure and maintenance of
physical facilities of the Department. The amount of R916,3 million requested
represents and increase of R228 million or 31, 3% on the previous yearâs
revised budget. The increase is mainly due to the commencement of new
revitalization projects, building projects for Forensic Pathology Services, and
an additional allocation for day-to-day maintenance. One of the major problems
in regard to the performance of the Department in upgrading its facilities
still remains the constant underperformance of other role-players in the
capital works programme this however should be addressed by the new
approach.
Honourable Chairperson, this is the budget vote of R11,737 billion of
the
Department of Health for your consideration and approval.
We are confident that we will be able to make a meaningful contribution
towards improved health service delivery in the province. We consistently
remind ourselves that âhealth is not merely the absence of disease but a state
of physical, social and mental well-beingâ which is why we will continue to
fight disease, fight poverty and give hope.
In conclusion, may I borrow the inspirational wisdom of the Sanskrit people
who purport "Each today, well-lived, makes yesterday a dream of happiness and
each tomorrow a vision of hope. Look, therefore, to this one day, for it and it
alone is life."
Let us all strive forward to find our place in the sun and take part in
creating opportunities for our people to enjoy healthy lives. As John Ajewol, a
Nigerian poet encourages us, when he says;
I am climbing my mountain
Little by little, step by step,
Over one stone and then another,
I'll not look at my bruises,
I'll not quit else my effort will be vain.
I am climbing my mountain
Though the road may seem dim,
Success is at the corner,
But I'm getting closer to the tape.
There, I'll forget how hard it was to begin.
Siyabonga
Thank You
I am climbing my mountain
And my eyes are straight ahead.
I look not to the right or left,
Whoever stops, let them stop and wait
I will win. I won't faint. I will win!
Issued by: Department of Health, KwaZulu-Natal Provincial Government
26 April 2006
