Belot, MEC for Health, Free State Provincial Legislature
15 March 2007
Introduction
Honourable Speaker,
Madam Premier,
Honourable Members,
Distinguished guests
Mr Speaker, the efforts of the Free State Department of Health for the
2007/2008 financial year will be aimed at giving momentum to the call by our
State President 'to move forward as quickly as possible to build the South
Africa defined by a common dream'. We will work hard to fulfil our dream of a
healthy and self-reliant Free State community. I will outline our contribution
on the allocations made to the various priority areas and I wish to add my
voice to the call by our State President, Mr Mbeki, in the State of the Nation
address for all of us to take up the challenge to address the eradication of
poverty at all levels.
Set against the commitments made by the honourable Premier in the State of
the province address recently, it is imperative that we take decisive action
and provide leadership to ensure that we concretely deliver on promises
made.
Achievements of 2006/2007
Mr Speaker, the core business of the Department of Health is to ensure the
delivery of quality health services to the 2.9 million inhabitants of the Free
State. I am please to report that between April and December 2006, the
Department was able to provide services to the following number of
patients:
* Primary Healthcare facilities treated and provided healthcare services to 4
398 152 patients
* District hospitals treated 110 850 casualties; 202 502 outpatients; and 92
024 inpatients.
* Regional hospitals: 89 239 casualties; 147 124 outpatients; and 74 981
inpatients were seen.
* Tertiary institutions in the Free State treated 1 024 casualties; 138
outpatients and 23 592 inpatients.
* The Free State Psychiatric Complex treated 7 654 Outpatients and 3 224
Inpatients.
* Emergency Medical Services (EMS) handled 1 142 840 calls.
Mr Speaker, the Department of Health has also continued its proud tradition
of leading the health sector in the country.
In February 2007, the Star newspaper assessed all provincial health
departments and wrote the following about the Free State:
"The Free State has more than doubled its expenditure on primary healthcare
from R91 per patient in 2000 to R221. Health services in this flat, often
bleak, central province are better than many of the other provinces, despite a
lack of expertise and massive health challenges, many the legacy of the mining
industry that dominates the province. Increased expenditure has contributed
towards improved tuberculosis (TB) cure rates, a drop in the number of sexually
transmitted infections, a drop in the stillbirth and perinatal mortality rates,
and a well-functioning immunisation programme."
Mr Speaker, the Department was once again awarded for its financial
achievements by winning the South African Institute of Government Auditors'
first prize for the best financial annual report in the South African Public
Sector for the 2006 financial year. This is the second time in the history of
the awards, that the Department achieved this award. The Free State Department
of Health is the only department that has won the award for more than once, in
the country.
All hospitals of the Department of Health were entered onto the Council for
Health Services Accreditation of South Africa (COHSASA) programme. I am proud
to announce that to date, five hospitals in the Free State have received full
accreditation. These hospitals are the Metsimaholo, Thusanong, Mafube, and
Tokollo District Hospitals and the Dihlabeng Regional Hospital. Only nine
public hospitals in the country have received accreditation, of which five are
from the Free State.
We are very proud of our contribution to human resource development this
year. The Department welcomed 214 Community Service Health Professionals in
January 2007 and these categories include 53 medical practitioners, 26
dentists, 46 pharmacists, 20 physiotherapists, 13 radiographers, 21
occupational therapists, 14 dieticians, four speech and hearing therapists and
17 environmental health officers.
I must mention that the Department at present is supporting 164 medical
students, 12 dental students, 499 nursing students and 213 other students with
full-time bursaries (a total of 888 full-time bursaries). As a province, we
need to continually create an environment to retain these students once they
have qualified.
The Health and Welfare Sector Education and Training Authority (SETA)
approved a total of 158 learnerships for 2006/07. Of these, 93 are 18.1
learnerships and 65 are 18.2 learnerships. Learnership programmes are being
offered at various institutions in the Free State. The learnership programmes
are amongst others, Auxiliary Nursing with 69 learners, 69 learners entered the
Enrolled Nursing programme and 40 learners are doing the Post-basic Pharmacy
Assistant programme.
In terms of Pharmacy Assistant training, the department enrolled a total of
161 basic and post basic pharmacist assistant learners during 2006/07 of which
two are disabled learners. Fifty three learners completed the Post Basic
Pharmacy Assistant Course and 70 learners completed the Basic Pharmacy
Assistant Course in 2006. The latter is currently busy with their Post Basic
Pharmacy Assistant Course and 38 learners with their Basic Pharmacy Assistant
Course.
Mr Speaker, the Department of Health has made very good progress with the
implementation of the new Mental Healthcare Act. Three Mental Health Review
Boards were established and are functioning well. These Boards are responsible
for ensuring that all mental health users are admitted legally in all health
establishments and that care, treatment and rehabilitation of users is done
appropriately. The two designated facilities for the Free State, i.e. Free
State Psychiatric Hospital and Mofumahadi Manapo Mopeli Regional Hospital
continue with the admission of involuntary and assisted users, state patients
and mentally ill prisoners. 72-hours assessments are done at identified
District Hospitals.
The Department of Health has spent a total of R3 443 798 to purchase 1365
wheelchairs, 1270 repair spares, 543 walking aids and 706 hearing aids.
Assistive devices banks have been established and are fully functional in the
districts and hospitals. This makes assistive devices immediately available to
clients/patients in need and prevents long waiting periods for disabled people
to receive these. A database system was also developed and reviewed to register
people with permanent disabilities in order to receive free healthcare
services.
To reduce the backlog for hip and knee replacements, which is an expensive
service, an additional theatre for patients was recently introduced at National
Hospital. Creative ways were investigated to render this service at the other
regional hospitals. I am pleased to announce that this service commenced at
Dihlabeng Regional Hospital and will commence at Bongani Regional Hospital in
the near future.
The Department of Health received an additional R51 million during the
Adjustment Budget, to the budgeted amount of R53,373 million for health
infrastructure in 2006/07. This was as a result of the good progress made on
infrastructure projects. The Department will spend all the funding at the
following district hospitals namely, the final phase of Elizabeth Ross
Hospital, Tokollo Hospital in Heilbron, Thebe Hospital in Harrismith, Thusanong
Hospital in Odendaalsrus and Katleho Hospital in Virgina.
Other achievements which I would like to highlight are:
Construction work has been finalised at Hanipark and Geneva Primary Healthcare
clinics in Welkom. Official opening ceremonies will be conducted in due course
and I invite members of this House to attend these joyous events.
I am proud to announce that by the end of 2006, the Department purchased 52
ambulances, and 35 planned patient transport busses carrying 23 passengers have
been delivered.
The Department successfully took responsibility for Forensic Pathology
Services from the South African Police from the 1 April 2006. The Department
filled 92 of the 108 planned posts, eight additional mortuary vehicles were
purchased bringing the fleet total to 37 vehicles. All the required equipment
was purchased.
The Department of Health has achieved immunisation coverage for the Expanded
Programme on Immunisation of 92.5% under the one year olds. This is in excess
of the national target of 90%.
Following the national Minister of Health and the Premier's announcement,
Home Based Carers, Voluntary Confidential Councillors and . Directly Observed
Treatment (DOT) supporters received an increase from R500 to R1 000 per month,
in monthly stipends during the second half of 2006. We thank and appreciate the
work they do.
The following sites received accreditation to commence with anti-retrovirals
(ARVs) this year:
* Motheo District: Mantsopa District Hospital in Ladybrand, Heidedal CHC.
* In Xhariep, Kopanong: Ethembeni Clinic in Koffiefontein, in Letsemeng:
Itumeleng Clinic in Jagergsfontein.
This means that 17 out of 20 local municipalities in the Free State province
have ARV service points.
The management of TB was strengthened with the development and
implementation of the TB Crisis Plan which was launched in July 2006 at Fezile
Dabi district. "Operation Kgutlela" was launched on 24 March 2006, which was
also World TB Day, in Welkom to bring TB defaulters back to the programme. A
total of 1 706 TB defaulter patients were traced back into the programme since
the launch of this campaign.
Mr Speaker, allow me now to present the budget of the Department of Health
for the 2007/08 financial year.
The budget
The total budget allocated for the 2007/8 financial year amounts to
R3,643,438 billion. The department was allocated 9,5% more to fund it's current
activities in 2007/08 compared to 2006/07. Conditional grants and once-off
payments have contributed to this increase. An amount of R969,066 million is
conditional grant funding, R69,433 million is set aside for equipment while a
total amount of R141,329 million is budgeted for infrastructure and facilities.
The budget has been allocated to the eight programmes in the budget structure
which caters for the following:
Administration:
An amount of R209,301 million, an increase of 11,3%, has been allocated to the
programme to answer to the additional needs in management of the Department.
Provision was also made for the filling of vacant posts.
District Health Services:
The largest portion of the budget, an amount of R1,303,960 million, an increase
of 2,9%, is allocated to our Primary Healthcare Services which are rendered at
clinic level and district hospital services.
Emergency Medical Services:
An amount of R189,129 million is allocated to strengthen Emergency Medical
Services. This allocation is an increase of 25,2% which is the highest increase
of all programmes.
Regional and Central Hospital Services:
Regional and Central Hospital Services are allocated R962,153 million, an
increase of 7,8%, and R651,419 million, an increase of 6,7% respectively to
answer to the need of an increasing number of patients. There is also an
increased need for the number of institutions implementing the appropriate
service package per level of care, and for institutions to provide outreach
programmes.
Health Science Training:
Health Sciences receives R111,964 million, an increase of 13,3%, to fund the
training needs in the Department. This amount also makes provision for the
percentage increase of the student intake and the implementation of the
expanded education and training programme for mid-level workers and
professional nurses.
Healthcare Support Services:
The healthcare support services programme is allocated an amount of R64,481
million, an increase of 8,5% and specifically makes provision for the support
services including laundry services.
Health Facilities Management:
An amount of R178,910 million is allocated to the programme and will be used to
fund the current revitilisation and infrastructure projects. The increase of
18,7% in this programme is due to the fast tracking of various projects.
The Free State Growth and Development Strategy (FSGDS)
Mr Speaker, the Department of Health continues to contribute to this
important strategy to improve the quality of life of the citizens in the
following ways:
Addressing capability needs of a developmental state through effective
governance and administration
Mr Speaker, while the Department of Health continues to support
intergovernmental relations at all levels by actively participating in various
forums and committees, special mention needs to be made that, in terms of the
National Health Act, the Department has established a Provincial Health Council
and functional District Health Councils have been formed in each of the five
districts.
Hospital Boards have been established in all the hospitals in the Free State
and they will continue to hold us accountable for the management and quality of
services in our hospitals. I have announced an extension to the term they have
already served, while awaiting nominations for new board members. The call for
new nominations will appear soon in the Government Gazette. I appeal to the
Free State Community to actively participate and nominate members who will
represent their interests on the hospital boards.
The continued promotion of justice, crime prevention and security
Mr Speaker, the Department of Health has adopted a Departmental Security
Policy, which is the product of much consultation and the result of the First
Health Security Summit in 2006, which was the first in the province. This will
ensure a better co-ordinated service and a greater degree of safety for
patients and staff in the Department. We are optimistic that losses from
government assets will also improve.
The Department of Health will concentrate on the following to improve EMS
this year: we will procure 50 new ambulances and 20 response vehicles for which
R17 million was allocated. To equip these vehicles, R5 million was allocated
for purchasing of medical equipment.
Mr Speaker, a new patient booking service will be implemented to reduce the
waiting and pick-up times and delivery of patients to their respective
destinations. The department will also liaise with specialist clinics to
expedite clinic times to accommodate our clients.
To improve the quality of patient treatment, 17 bursaries were allocated to
the same number of candidates who are now pursuing studies in Emergency Medical
Care at the Central University of Technology, Free State. Short courses have
been identified and our partnership with the South African Military Health
Services will ensure that capacity is built in this area.
To improve the delivery of Forensic Pathological Services, the Department
will purchase six additional mortuary vehicles to the value of R1,8 million.
Two old mortuary vans will be scrapped. The total number of mortuary vans will
increase from 28 to 34.
Economic growth, development and employment
Mr Speaker, the Department of Health has been one of the major contributors
to infrastructure development in the Free State. This year we have four
strategies to develop infrastructure, they are Revitalisation Programmes,
Infrastructure Projects, Clinic Upgrading and Building Programmes, and the
Maintenance Programme. These projects not only improve the condition of our
health facilities, they also contribute towards job creation and the
development of skills in the Free State.
The Hospital Revitalisation Programme:
The Department has received R115 613 million for this programme as a
Conditional Grant. This grant enables the department to focus on improving and
transforming the infrastructure and health technology in our facilities as well
as modernising the facilities. This grant also provides for the transformation
of hospital management as well as our efforts to improve quality of care in our
facilities.
I am pleased to announce that additional funding was obtained for two new
projects. An amount of R5 million has been allocated for planning the new
Trompsburg Hospital. The planning of this project will be completed at the end
of May 2007. Additional to this, R7 million has been allocated for the planning
of revitalising the Free State Psychiatric Complex.
Mr Speaker, outlined below is more detail of what is planned for Boitumelo
and Pelonomi Hospitals this financial year:
At Boitumelo Regional Hospital in Kroonstad R52 413 million is allocated
towards the completion of the following projects: psychiatric unit, maternity
wards, a hall and lecture rooms as well as the upgrading of the electrical
infrastructure. R6 million of the grant allocated, will go towards purchasing
of essential equipment and R3 million towards quality and organisational
development.
At Pelonomi Regional Hospital in Bloemfontein, R21,200 million is allocated
for the upgrading of the pharmacy, orthopeadic ward, renal ward, radiology, a
covered walkway and the main intensive care unit (ICU). R2,5 million will be
spent on conducting an organisational audit to enhance the performance of
hospital. Of the allocated budget, R3 million is earmarked for procurement of
health technology and R1 million towards improvement of quality of services in
the hospital.
Infrastructure Projects
An amount of R68,683 million has been allocated for infrastructure projects
from the Provincial Infrastructure Grant. The amount of R31,833 million which,
is allocated towards the infrastructure grant, will be utilised to finalise the
following projects:
* final phase of work at Elizabeth Ross District Hospital
* Tokollo District Hospital in Heilbron
* Diamant District Hospital in Jagersfontein
* Thebe District Hospital in Harrismith
* maternity wards at Katleho District Hospital in Virginia and Thusanong
District Hospital in Odendaalsrus
* palliative care ward and ophthalmology ward at National District
Hospital
* orthotic and prosthetic workshops at Pelonomi Regional Hospital
* MDR Unit at Dr JS Moroka District Hospital.
An amount of R15 million has been allocated for building the new hospital at
Trompsburg. Contractors will be on site by September 2007.
For the new Mantsopa District Hospital in Ladybrand, an amount of R15
million has been budgeted for the planning and initial construction of the
hospital. Contractors should be on site beginning of October 2007.
Clinic Upgrading And Building Programme
An amount of R18,750 million will be allocated for the Clinic Upgrading and
Building Programme in the Free State.
R17,0 million is allocated to build new clinics in the following towns:
Bultfontein, Bothaville (Naledi clinic), Heilbron (Relebohile clinic),
Rouxville, Botshabelo (Maletsatsi Mabaso clinic) and Qwaqwa (Bolata
clinic).
R1, 75 million is earmarked to upgrade facilities at the following clinics:
Kamohelo (Winburg), Lusaka (Theunissen), Ikgomotseng (Soutpan), Thusanang
(Sasolburg), Thusanong (Odendaalsrus), Batho (Bloemfontein), Tina Moloi
(Qwaqwa).
Improvement of our facilities through maintenance
Mr Speaker, the Free State is very privileged to have what I believe, some of
the best health facilities in the country. Some of these are on par if not
better than some private institutions. We have a responsibility to maintain
these facilities and for this reason, I have created a sub-directorate that
will only concentrate on maintenance of our facilities. An amount of R18
million will be allocated for maintenance: R8 million will be for maintenance
of hospitals and R10 million to address the maintenance of clinics.
Forensic Pathology Services
The work on the new Government Mortuary in Bloemfontein has commenced in
January 2007. The upgrading of the medico legal mortuaries in Welkom and
Sasolburg, to the value of R500 000, will commence in April 2007. This will
significantly improve the working conditions of personnel at these facilities.
An amount of R1 million will be spent to erect small mortuaries in Vrede and
Smithfield, which will be utilised as holding facilities.
Health is a fundamental prerequisite for social and human development
Mr Speaker, one of the many fundamental prerequisites for social and human
development is to have a healthy population. The Department has made great
strides to reduce the burden of disease in the province. For example, no cases
of measles were detected in children last year due to an effective immunisation
campaign.
Strengthening Regional and Tertiary Hospital Services
Mr Speaker, to increase the Department's revenue, the department has also
signed contracts with several medical schemes and administrators to provide
services to medically funded patients at our hospitals, in respect of the
Minimum Prescribed Benefits. Through these contracts, the department expects to
increase its revenue streams. As part of this project, the department will
spend R500 000 to develop a differentiated facility at Mofumahadi Manapo Mopeli
Regional Hospital in 2007/08. This unit will be able to accommodate twenty
patients including children and pregnant women.
Consolidation of comprehensive primary healthcare services
Primary Healthcare Services remain the key strategy to improve access and to
deliver quality healthcare services. Our primary healthcare facilities see and
manage nearly five million patients a year and render an accessible and quality
service to our citizens. An amount of R1, 303 billion is allocated for the
provision of primary healthcare services delivered through the District Health
System. R319,345 million has been allocated for Motheo, R70,204 million for
Xhariep, R198,059 million for Lejweleputswa, R154,195 million for Fezile Dabi
and R282,549 million for Thabo Mofutsanyana. In a climate of competing for
scarce skills such as doctors, dentists and professional nurses, the Department
had to critically re-look at how services can be rendered in the most
cost-effective manner to ensure long-term sustainability and a better service
for all.
I am pleased to announce that the Department will start a pilot project of
contracting with independent private practitioners' groupings to extend
clinical services to the small rural hospitals and community health centres.
This pilot project will focus on Xhariep and the more rural areas of Motheo.
With this project we are expecting to improve access to health services to
these communities in a manner that is currently not possible. When this pilot
is assessed and found to be financially viable and sustainable, similar
projects will be extended to the rest of the province.
To further reduce the burden of disease, I would like to highlight
programmes the Department would be concentrating on:
* To reduce the burden of tuberculosis, the Department has responded to the
challenge and has strengthened infection control measures and protection of
health workers in hospitals, intensified the communication strategy and
implemented active surveillance through the tracing of contacts. Not only is
Tuberculosis on the increase as a result of patients depressed immune systems,
we have also seen this year the emergence of Extreme Drug Resistance to
Tuberculosis (XDR-TB) in the Free State. The cost to treat these patients
becomes very expensive. The emergence of XDR-TB is due to MDR patients who have
not completed their treatment. I again call upon all citizens to help and
ensure that all TB patients take their medicines regularly and complete their
course of treatment.
* To improve the provision of a comprehensive HIV and AIDS programmes, an
amount of R149 378 million has been allocated, R89 641 million has been
allocated to anti-retroviral therapy, R23 771 million to home based care (HBC),
R2 264 million to high transmission area interventions, R743 000 for
post-exposure prophylaxis sexual assault, R7 721 million for prevention of
mother to child transmission, R3 840 million for programme management
strengthening, R4 819 million for Regional Training Centre, R6 403 million for
Step Down Care and R10 176 million for voluntary counselling and testing.
* We will explore the nurse-initiated ARV trials to assess as to whether this
strategy will assist to improve access of ARVs for citizens in the Free State,
in line with the WHO guidelines.
* Prevention of mother-to-child transmission or PMTCT: the PMTCT programme will
explore CD4 count staging on HIV positive pregnant women in order to fast track
access to ARVs to 50% of the facilities rendering PMTCT services.
* The following ARV sites will become functional this year:
Motheo District:
* Mantsopa District Hospital in Ladybrand (treatment site)
Fezile Dabi District:
* Tokollo District Hospital in Heilbron (treatment site);
* Pilane Clinic in Frankfort (treatment and assessment site);
* The Expanded Programme on Immunisation will improve the immunisation rate
of children under the age of five, to 92%.
* The Department will implement a six-monthly follow-up Vitamin A campaign to
improve the Vitamin A coverage for children between the ages of one to five
from 40% to 60%. This will provide health benefits such as increasing the
body's ability to fight diseases as well as maintaining a good vision.
* The Department aims to improve the cataract surgery rate from 1 216 to 1 400
- this translates to 2 500 patients.
* It is estimated that the number of patients with diabetes in Africa and in
the Free State will double by 2025. Diabetes is increasingly occurring in
younger age groups in the productive years of life. It is a mayor cause of
disability from blindness, amputation and kidney disease. We as a Free State
Department of Health support the Diabetes Declaration and Strategy for Africa
of which our government is a signatory. During the next financial year this
department will conduct a follow-up survey to determine the rise in prevalence
of diabetes in the Free State by targeting the population of QwaQwa and
Manguang. Furthermore, the FS DoH also accepts the challenge to improve the
care of diabetes and other chronic diseases of lifestyle in the province and to
actively support the United Nations resolution on diabetes adopted on 20
December 2006. We also plan to actively create greater awareness for diabetes
amongst our people over the next few months to culminate on 14 November with
the commemoration of World Diabetes Day.
Improving quality of Healthcare Service
The COHSASA accreditation programmes will continue this year and will
receive an allocation of R1,7 million to ensure that as many of our hospitals
as possible will receive accreditation. In addition to this:
* R4,5 million will be spent over a period of two years, to implement an
adverse event management system in twenty-four hospitals. This will make an
enormous impact on the reduction of adverse events and near misses in our
hospitals.
* The Department aims to train 80% of oral health professionals in good
infection control practices. Infection control equipment in 80% of oral health
clinics will be replaced at a cost of R1,4 million.
* The Department will continue to engage the services of retired nurses in
various capacities in an effort to improve services. This will draw on the vast
experience that these nurses have to improve the quality of healthcare that is
rendered by our facilities.
Pushing of boundaries to improve human resource development
Mr Speaker, I am very pleased to inform the House that an additional category
of Health Professionals will commence with Community Service this year. The
Department will receive an additional 312 newly qualified Professional Nurses
in July 2007. We will endeavour to create an environment for them to develop
and gain the necessary experience as young health professionals. Their arrival
will contribute to strengthening our services, especially in rural areas.
In the current world climate of a lack of health professionals, it has
become imperative to improve the production of various categories of health
staff. I am pleased to inform you that the Free State has undertaken several
steps to train and increase our number of trained health professionals. We are
waiting for the finalisation of the discussions on the improvement of
conditions of nurses.
The Department has allocated R25,2 million for bursaries in 2007. A total of
261 new full-time bursaries and 94 new part-time bursaries have been allocated.
221 students have enrolled to study nursing at the Free State School of Nursing
and at the Free State University in 2007. This allocation is an ongoing trend
since 2005 and, we will reap the benefit of the increase intake of nursing
students in the beginning of 2009.
A new category of mid-level healthcare worker, the Clinical Associate will
commence training in 2008 at the Medical School of the Faculty of Health
Sciences of the Free State University. This year will be devoted to help
prepare for this development. The Clinical Associates will work hand-in-hand
with the medical practitioners in the District Hospitals in the Free State to
enhance the impact of medical services rendered.
The Department of Health has also availed 69 learnerships for the training
of Auxiliary Nurses and 93 for Enrolled Nurses. These vitally important nursing
categories are trained in eight of the Hospital Nursing Schools in the Free
State province.
The Department of Health has budgeted R18 067 million for skills development
of all the staff in the Department. This expenditure is spent according to the
skills development plans of the institutions in the Department. A total of 392
employees have also been registered for the Adult Basic Education and Training
(ABET) programme that will commence in 2007.
Mr Speaker, the contribution of the Department of Health to the Expanded
Public Works (social sector) programme can be seen in the training of 200
volunteers as Ancillary Healthcare Workers. To further address unemployment the
Department has set aside R2,2 million to award learnerships for the training of
nursing auxiliaries, enrolled nurses and basic and post basic pharmacist
assistants.
We have also allocated an amount of R5 million towards the creation of
hospital linen by Further Education and Training (FET) colleges and women's
groups to stimulate economic growth and contribute to the alleviation of
poverty.
R500 000 has been allocated from the skills development budget for
employment needs of graduate interns.
In conclusion
Mr Speaker, allow me to acknowledge and thank our guests, stakeholders and
partners in our quest to provide quality healthcare services. A special word of
thanks to the volunteers, members of our governance structures, mayors and
health councillors, management and staff of the department, chairpersons and
members of clinic committees and hospital boards, traditional healers and
traditional leaders.
I table Vote 5
I thank you.
Issued by: Department of Health, Free State Provincial Government
15 March 2007
