Honourable Speaker and Deputy Speaker
Honourable Premier; Mr Cassel Mathale
Members of the Executive Council (MEC’s)
Honourable Members of the Provincial Legislature (MPL’s)
Chairperson and Members of the Portfolio Committee
Executive Mayors and Mayors
Director-General and Heads of Departments present here
Leaders of Political parties and formations
Stalwarts and Veterans of our struggle
Our Esteemed Majesties
Traditional leaders and healers
Heads of institutions
Leadership of the trade union movement
Members of the hospital boards
Leaders of faith-based organisations and religious formations
Non-governmental and non-profit organisations
Members of the media
Comrades and friends
Honourable Speaker
We are presenting the budget of the Limpopo Department of Health at very challenging and trying times in the provision of health care in our province, our country and around the globe. The provision of quality health care to our people is about the recovery and restoration of the dignity of all people who might have or continue to suffer a particular disease.
The question we must all ask and seek to answer is whether we are all doing enough to prevent diseases, promote and preserve health while on the other hand respect the reality of sickness, diseases and illness that contribute in part to the reality of death.
Health is a serious matter; it’s a matter of life and death.
We must therefore work together as partners to ensure that we contribute in the management of these contradictions with the objective of building a healthy nation and a province of healthy people.
Honourable Speaker, if you will, allow me emphasise the realities of contradictions by seeking some words of wisdom from an opening paragraph of a classical Novel, Tales of Two Cities by Charles Dickens who had this to say, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us…”
Honourable Members, just as much as we acknowledge that there are contradictions in life, our people deserves better. It is therefore incumbent on all of us not only to inspire the message of hope but to ensure that our health system is transformed for the better to get us out of the “winter of despair”. In this regard, I trust that from this budget, when we talk about health care we will do so recognising that, in the words of President Nelson Mandela “every word uttered, every gesture made, will be measured against the effect it can and will have on the lives of millions of concrete, real human beings” throughout the province and beyond.
Honourable Speaker, President Jacob Zuma, during his State of the Nation Address in 2010 had this to say, “Fellow South Africans, we are seriously concerned about the degeneration of the quality of healthcare, aggravated by the steady increase in the burden of disease, in the past decade and a half”. The degeneration of the quality of health care, as the President rightly pointed out is compounded by a number of factors ranging from the acute shortage of health practitioners and professionals; inadequate resources at many of our institutions. On the other hand, there are also a number of governance factors that contributes not in a small way to the challenges we are facing in the delivery of health care in our province as Dr Motsoaledi and communities has observed.
These include but not limited to:
- Lack of proper managerial skills
- Delayed responses
- Lack of basic equipment and medicines
- Unsatisfactory maintenance and repair services
- Inadequate staffing levels in all areas
- Significant problems in clinical areas related to training
- Poor attitude of staff; Under-spending and so forth.
Some of these challenges are compounded the low staff morale which by and large characterises the Department of Health and I believe this has to change if we are serious about the delivery of quality health care to our people, most of whom depends on it for their survival.
The public health system is also forced to carry the ever increasing burden of diseases such as tuberculosis; HIV and AIDS, and other communicable diseases including lifestyle diseases like sugar diabetes, high blood pressure, stroke, hypertension, obesity etc.
It is unfortunate that our public health system concerns itself with the curative side of building a healthy nation. We believe that this system is expensive and unsustainable. It must therefore be overhauled. Primary health care with special emphasis on prevention and promotion of health is the way to go. In this regard we will implementation of the district intervention strategy to enhance service delivery at primary health care level.
The message remains clear, “prevention is better than cure”.
Our resolve to move from curative system to the much desired “promotive and preventative” health care system remains unshaken.
Honourable Speaker, it was therefore not by some coincidence that the ruling party, the African National Congress (ANC) has identified health as one of the five priorities in a move to better the lives of our people.
Under the banner of “Working together we can do more”, the ANC emphasised that “faster change, faster improvement in the conditions of all our people will be a defining feature of the new administration”.
In order to give meaning to health as a priority, the ANC government further mandated the Department of Health to develop a comprehensive plan of action that will propel us into a space where we shall say without fear of contradiction that indeed we are on the right path to build a healthy nation we all fought for, with some among us through their blood and sweat.
The implementation of the 10 Point Plan has started in earnest with the objective of improving access to health care and to reduce inequalities in the health system. I am pleased to announce that we are starting to see improvements in this regard.
Honourable Speaker
Delivering his State of the Nation Address (SONA), during the joint sitting of Parliament of the Republic of South Africa, President Jacob Zuma gave direct marching order compelling us to improve human resources at all our health facilities and hospitals when he said, “In the health sector, this year we will emphasise the appointment of appropriate and qualified personnel to the right positions. We need qualified heads of department, Chief Financial Officers, hospital Chief Executive Officers, District Health officers and Clinic Managers”.
In order for us to achieve the objective of employing and retaining qualified personnel to the right positions we will start from this year by conducting a comprehensive skills audit targeting hospital executives to determine whether their skills and qualifications are suitable to run a hospital and or a health facility. This we will do to ensure that indeed those who are entrusted with the running of health facilities are armed with a health related skills and qualifications to manage our facilities.
Those who are found wanting in this regard will be either demoted or redeployed to areas that match their level of skills. We need health professionals to run our facilities and we believe this will assist a great deal in restoring faith in the public health system. We further embarked on an intensive training programme to enhance our managerial capacity in the field of health. To this end, we are assisting a total of eleven (11) officials to pursue qualifications in health related courses.
Eight Chief Executive Officers are pursuing a Masters in Public Health and one in Advanced Diploma in Health Science Management at the University of Cape Town and University of the Witwatersrand respectively. I am pleased to announce that two have already completed their studies (Diploma in Public Health) at the University of the Witwatersrand.
I must emphasise that there shall be no hospital Chief Executive Officer (CEO) or District Health Officer appointed without the requisite qualification in health related fields.
We are making this commitment, Honourable Speaker, fully aware that we still experience a shortage of properly qualified health professionals. We are determined to manage this contradiction and at the end we will look back and proudly say: „it was the best of times…‟ and not the worst of times.
In an effort to recruit and retain a pool of qualified health professionals in our province, particularly at rural areas we continue to implement the rural allowance and the Occupational Specific Dispensation (OSD) while at the same time creating a conducive environment for improved conditions of employment for all health workers in our province.
However, the implementation of the OSD is not without challenges but find solace in the fact the national Department of Health is working hard to address these challenges. Our province for instance is regarded as rural therefore all qualify for a rural allowance which makes it difficult to recruit health professionals for posting at the most rural areas far from the city towns and townships.
Despite these challenges, in comparison with other provinces, we have not experienced a high turnover of professional nurses, instead the number increased from 13 521 to 17 316. The number of doctors has increased from 1 007 to 1 132; however the shortage is still huge.
The overall vacancy rate for medical practitioners and allied health professionals is standing at an average of 47,9 percent. We will continue to take advantage of the government to government contract we entered with Cuba, Tunisia and Iran; including the United Nations Development Programme (UNDP) to recruit medical doctors.
The Limpopo Department of Health will this financial year award a total of 375 bursaries to needy and deserving students who want to pursue studies in the health related professions with twenty five (25) of them to be awarded the Cuban Scholarship to study medicine.
I am pleased to report to this house that eight (8) recipients of the Cuban Scholarship completed their studies in Cuba and are now in South Africa to finish the last term of their studies. We wish them the best of luck during their final examinations.
HIV and AIDS
Honourable Speaker HIV and AIDS remains one of the most challenging diseases in the health sector. HIV and AIDS is a tragedy of unprecedented proportions and is unfortunately claiming more lives “than the sum total of natural disasters, famines, and floods, and the ravages of such deadly diseases as malaria.” The impact of which is devastating to families and communities; overwhelming and depleting health care services while at the same time chopping decades from life expectancy.
The reality is that South Africa leads the world in the global HIV burden. Although we account for less than one percent of the world population, we carry 17 percent of the world’s HIV burden.
It is in this context that we will during the 2011/12 financial year embark on a number prevention and treatment campaigns to turn the situation around.
In response to the HIV Counselling and Testing (HCT) campaign to have 15 Million South Africans to test for HIV, inspired by the theme “I am responsible; We are responsible and South Africa is taking the responsibility” launched by President Zuma last year, the Limpopo Provincial Government aims to get over 1.5 million people tested. To date, we have managed to test over 900 000 people. We also want to take this opportunity Honourable Speaker to encourage all members of the Limpopo Provincial Legislature and guests seated in the gallery to consider testing and to know not only their HIV status by their overall health status.
For your convenience, we have brought our mobile clinics with health professionals ready to conduct tests on-site.
We also want to urge business community and government institutions at all levels to follow the inspiring example of Eskom and Murray and Roberts who are implementing the HCT at all of their offices, plants and sites. Honourable Members would recall that Deputy President KgalemaMotlanthe visited our province this year to official launch the HCT campaign at Medupi Power Station in Lephalale.
Honourable Speaker, teens are the most vulnerable to HIV infection as the virus spikes between the ages of 15 and 24.
These are the critical years for prevention interventions, particularly during high school period. In this regard, the HCT campaign will also be extended to learners at school and student attending tertiary institutions in the province. However, this will be done with outmost care as we believe support is vital in testing teens. We will work together with the MEC for Education, Ntate Namane Masemola and other relevant role players particularly in the education sector to ensure that this campaign achieves its objectives.
In her article entitled Support Vital in testing Pupils, CatiVawda made a profound observation about the prevalence of HIV among teens and believes that high school age is a crucial time for an intervention. However, she argues that there are many practical challenges that making testing at schools a concern when she wrote,“Counselling and testing, if handled appropriately, has the potential to provide a gateway to prevention, and to treatment, care and support to teens”. If not, counselling and testing in schools could result in discrimination, mental health problems, family conflict and failure of health and social services”.
Medical Male Circumcision (MMC)
In our endeavour to reduce the rate of HIV infections, the Department of Health will this year going forward embark on a massive Medical Male Circumcision (MMC) campaign with the objective of encouraging men in our province to circumcise.
We will continue to consult and mobilise traditional leaders whom we believe are the custodians of culture, traditional healers and religious leaders to assist us in ensuring the success of this campaign.
Failure is not an option.
We hope that this campaign will inspire parents to consider circumcising their young boys early in their infant years, after all Jesus was also circumcised. “And when eight days were accomplished for the circumcising of the child, His name was called Jesus, which was so named of the angel before he was conceived in the womb”, (Luke 2: 21).
To this end, about 2393 males were circumcised in our facilities and we intend to circumcise 11 978 men during the 2011/12 financial year.
Honourable Speaker, medical male circumcision does not prevent HIV but studies have proved that there is more than 50 percent risk reduction in contracting HIV if one is circumcised. In this regard, we will continue to provide and increase the distribution both male (25 646 085) and female (175 825) condoms by 17 percent.
The correct usage of condoms will undoubtedly assist in the reduction of Sexually Transmitted Infections (STI’s), unplanned pregnancies and HIV infections.
HIV treatment
Honourable Members, treatment remain one of our key areas of focus. In this regard, i am pleased to report that following pronouncements by the President in the 2009 World Aids day, we have and continue to accelerate the expansion of Anti-retroviral treatment. To this end, facilities that are certified to provide treatment have increased from 80 to 345 and all health facilities in our province have ARV prophylaxis starter packs to administer first line Post Exposure Prophylaxis (PEP) before referral to hospital.
All HIV positive pregnant women with a CD4 count equal and less than 350 will be initiated on lifelong ART while HIV positive children under the age of one will be put on ARV treatment.
Similarly, we will intensify the Prevention of Mother to Child Transmission (PMTCT) programme and further reduce the vertical transmission in order to reduce maternal and child morbidity and mortality related to HIV and AIDS.
Maternal child women’s health
Honourable Speaker, the implementation of the Integrated Management of Childhood Illnesses (IMCI) at all our primary health care facilities remains our focal point in our endeavour to reduce infant and child mortality rate. To date 411 facilities have reached 60 percent saturation rate and we are set to increase the number to 416 this year.
We recognise that a key intervention to reduce infant and child mortality is to protect children against vaccine preventable disease. In this regard, we will endeavor to increase our immunisation coverage and extend school health services to all primary schools in the province. These include the training of nurses in IMCI to ensure that every clinic has more than one IMCI-trained nurse.
Similarly, the implementation of the lampoon initiative for new born care will continue in all hospitals with an objective to reduce facility neonatal mortality rate from 12.6 to 12 per 1 000.
Maternal health
Honourable Speaker, maternal mortality also remains a major cause for concern for us. One maternal death is one too many; however we are committed to address this matter decisively.
We are convinced that one of the most contributing factors to maternal death is the challenge of illegal “back room abortions” performed by people who do not have clinical training and or accredited to do so. We will therefore, together with the council and law enforcement agencies embark on a joint crackdown operation (Operation Hlasela) to ensure that these establishments are closed down and perpetrators are brought to book.
Similarly, we will launch a massive communication drive to encourage pregnant women to consult health facilities early in the stages of their pregnancies and frequent thereafter as directed by a medical officer.
We will further communicate a clear message to our youth that “abortion is not form contraception”. We believe that this campaign will also assist us in dealing with the challenge of teenage pregnancy and youth reproductive health. The high rate of teenage pregnancy and teen birth remain an important concern for us as they face increased risks to their health and their opportunity to build a better future diminishes. Teenage mothers are more likely to drop out of school and subsequently live in poverty than girls who delay childbearing.
TB control
Honourable Speaker, yesterday, 24 March the world and indeed our country joined in the commemoration of what is better known as World TB Day. As part of the activities towards this important day in the calendar of nations, we embarked on road shows and door to door campaigns in the province screening people for Tuberculosis (TB) and testing for HIV and AIDS and other chronic diseases with an objective to curb co-infections.
We believe TB can be managed, controlled and is curable. To date, the rate of cure has increased from 67.3 percent in 2009/10 to 70.3 percent last year; however the figure is still below the target of 85 percent by far. In the Vhembe region where we re-launched the Kick TB campaign we found that the number of TB patients and defaulters is unacceptably highland we appeal to all our people to assist us in spreading the message of hope, that TB is curable! “Lufhihaluaalafhea”.
We therefore ask you to assist us in ensuring that TB patients complete their medicine as prescribed by a doctor. Let us all refrain from stigmatisation of the disease and stop marginalising those who are infected and affected by this dreadful disease.
For our part, we have already appointed twenty (20) Tracer Teams and we will continue to intensify the Case Finding and Contact Tracing Campaign in order to reduce the number of defaulters.
The defaulter rate is too high, now standing at 7.7 percent higher than the 5 percent national target.
Emergency Medical Services
Honourable Speaker, increased access to Emergency Medical Services (EMS) and quick response by emergency medical teams remains crucial in enabling our people to reach places of care in times of emergencies.
To this end, we will be rolling out obstetric ambulances during this financial year and out of the new ambulances we have purchased, 25 of them will be converted into obstetric ambulances with five (5) ICU units to be used to transport all critical obstetric emergencies. However, in extreme medical emergencies, we will utilise the services of a helicopter.
With effect from 1 April 2011, the Emergency Medical Services will take over Planned Patient Transport with the aim of enhancing ambulance communication in a coordinated and controlled manner.
In order to improve on the response time we will further migrate from the old analogue system to the sought after digital system in all call taking and dispatch centres.
We have established 47 stations, fourteen (14) of which are custom built and designed to accommodate all EMS functions as part of the modernisation of emergency services. We will be concentrating on purchasing more response vehicles, building more base stations and strengthening training programmes.
The hospitals will also be equipped to deal with the emergencies.
Honourable Speaker, we will ensure that all our Ambulances and Patient Transport vehicles including Disaster management buses are utilised properly and for the purposes intended for. Any misuse of these facilities will be dealt with decisively.
We will not tolerate misuse of any of our ambulances and emergency vehicles as this is usually done at the expense of our people in emergency situations.
Infrastructure development
Honourable Premier,
The MEC for the provincial Treasury Honourable David Masondowas spot-on during his budget speech when he said, “health is dependent on good health facilities”.
Indeed some of our hospitals are at a “deteriorating state “as you rightfully observed and stated during the State of the province address. We are therefore determined to build and maintain adequately resourced hospitals, nursing colleges, health centres and clinics in the province.
During this financial year, we will, from to time review infrastructure and resource needs of all our health facilities as part of the ongoing hospital revitalization project. However, a transactional advisor has been appointed to conduct feasibility study for Public Private Partnership (PPP) project to build two nursing colleges in Sekhukhune and Waterberg districts, including additional 25 satellite campuses in hospitals.
Construction to upgrade sections of some hospitals through the hospital revitalisation grant will commence in earnest this year. For example, Mokopane and Elim hospitals are set to get new theatres while a Pharmacy, Out Patient Department (OPD) and Casualty will be built at Philadelphia, Voortrekkerand Mecklenburg hospitals respectively.
Honourable Speaker, staff accommodation is and has always been a challenge and has a direct impact on our ability to retain health professionals in our province. We will continue to pursue a multi-pronged strategy to purchase, build and lease staff accommodation.
In this regard, we will complete the building of staff accommodation units we announced last year while leasing the existing infrastructure. However, we acknowledge that lack of coordination and under spending contribute immensely to the non-completion of infrastructure projects. On infrastructure development we are under-spending and we cannot allow this trend to spiral out of control when the need for infrastructure is so huge.
To ensure that we spend accordingly and complete the projects on time toget value for the investment in infrastructure, we are in a process of employing qualified engineers to oversee all our projects, including the new academic hospital to be built in our province as part of the flag ship project spearheaded by the Minister of Health. It is envisaged that the new Limpopo Academic Hospital will provide a 600 bed tertiary 1 and 2 services as per the approved business case.
The hospital will provide for teaching platform and therefore all academic infrastructure requirements will be provided as part of the new Medical School.
We are confident that the academic hospital project will deliver tertiary levels of medical care and a one-stop service point thus eliminating referrals of patients out of Limpopo for specialised medical care.
Finally, Honourable Speaker, we are aware that the state of the art hospitals and facilities would have no meaningful impact on the health of our people if not accompanied by among others dedicated staff, the supply of basic medical equipment, commitment to deliver drugs and medicines.
Although we never really experienced a drug stock-out of anti-retroviral drugs, I am the first to acknowledge that shortage and the constant supply of medicines including failure of suppliers to meet good manufacturing practices remain a challenge.
However, we had since discovered that some of this challenges, particularly the maintenance and supply of basic medical equipment are compounded by lack of management and leadership at institutional level.
To this end, we have standardised the purchasing of medical equipment for all our facilities in the province. So far, the order for some medical equipment is placed and due to be delivered. The remainder of the equipment will be purchased before the end of the first quarter.
I must say, Honourable Speaker, maintenance and general upkeep of equipment remain a major challenge. In our endeavour to keep them in good working order we will include a maintenance plan in the specification.
In conclusion, Honourable Speaker we believe that “working together we can do more” to deliver on the mandate of building a healthy nation and a healthy province. I trust that all of us will give hospital board members the necessary support in discharging their responsibilities.
On the other hand, we will continue to work with all role players in the health sector, including trade union movement, traditional leaders and healers to ensure indeed we deliver access to medical care with special emphasis to primary health care. Our people as we declared earlier, deserves more.
They deserve the best medical care irrespective of their economic status and or access to medical aid. I must say we ready to deliver on our mandate in line with the National Health Insurance requirements.
I am confident that in time we would look back and declare without fear of contradiction that unlike Charles Dickens: It was the worst of times; it is now the best of times. It was the season of darkness; it is now the season of light. It was the winter of despair and now it is the spring of hope.
Honourable Speaker, allow me to thank management and staff of the department under the leadership of the Acting HOD, Mme Deliwe Nyathikazi, particularly those who are at the coal face of service delivery, including all health professionals for the sterling job they continue to do in the provision of health care to our people.
I trust that you will find creative ways to improve patient safety and waiting period at all our health facilities in the province to ensure that our people remain safe and do not stay a minute more than necessary for consultation and or collection of medicine.
To Honourable Members of the portfolio committee, thank you so much for the guidance and indeed for keeping us under the radar. We take no part of your work for granted. Na khensa swinene.
Let me also pause to appreciate Members of the Executive Council and Members of this august house, the Limpopo Provincial Legislature for the continued support, guide and encouragement.
To my ever understanding family, especially Wisane Magadzi and children; my fathers, Mokgatla o mogoloandbakgatlababohle, thank you for the love and support.
Health Budget Vote 7 (2011/12)
Honourable Speaker, delivering his budget speech for the Limpopo Provincial government, Hon. David Masondo allocated a total budget of R11, 6 billion which shows a positive growth rate of 8.2 percent year on year and 6.1 percent in the outer year of the MTEF period based on the 2010/11 adjusted appropriation budget.
He emphasised that “the growth of the department budget includes the provision made for the Occupational Specific Dispensation (OSD) for health professionals amounting to R174 million. An amount of R1.7 billion has been allocated for Conditional grants and a total of R9.7 billion allocated for National and Provincial priorities”.
Honourable Speaker, I am therefore honoured and indeed privileged to table to this house Health-Budget Vote 7 for the 2011/12 financial year to the total value of R11.6 billion for your consideration.
We commit to you, Honourable Members that we will spent it wisely and for the purposes intended for. We will certainly account for every cent at the end of the financial year as expected of us as we would do to eliminate wasteful, fruitless and unauthorised expenditure.
We have noted all the issues raised by the Auditor-General in the past financial year and promise to improve in all respect. We are aware that we are entrusted with public funds and we will administer sound financial management in pursuit of clean audit.
I must repeat, health is a matter of life and death and we dare not fail the masses of our people who entrusted us with their health and lives.
I thank you.
Inkomu.
Re a leboga.
Baie dankie.
Amandla!
|
| Adjusted appropriation | Medium-term estimates |
|
|
| R thousand |
| 2011/12 | 2012/13 | 2013/14 |
| Equitableshare | 9,143,476 | 9,778,068 | 10,294,900 | 10,879,848 |
| Conditionalgrants | 1,461,812 | 1,702,756 | 1,775,488 | 1,932,862 |
| Departmentalreceipts | 98,796 | 107,077 | 113,898 | 119,593 |
| Total receipts | 10,704,084 | 11,587,901 | 12,184,286 | 12,932,303 |
Source: Limpopo Health
