Honourable Speaker
Honourable Premier
Honourable Members of the Executive
Honourable Members of the Provincial Legislature
Honourable Chairperson of the House of Traditional Leaders
Hospital boards and clinic committees
Health and medical associations
Leaders of organised business in the health sector
Leaders of the organised labour in the health sector
Leaders of the non-governmental sector
Fellow South Africans
Honourable Speaker, it is a great honour for me to present to this august House today the first Policy and Budget Speech of this term of government which relates to 2009/10.
The Department of Health recognises its responsibility to ensure that healthcare becomes what it should be: a human right for all. For health to be a human right for all, it is necessary that the health profession is an attractive and
rewarding profession and that all our healthcare facilities are places where patients, their families and the employees feel comfortable and safe.
It is with great humility and respect for the work done by health professionals in the tough and trying conditions of our province that I table this programme of action and budget today.
The clauses of the freedom charter on health commit us to:
- a preventive health scheme [to be] run by the state
- free medical care and hospitalisation (to be) provided for all, with special care for mothers and young children.
The African National Congress (ANC) has recognised that although there have been many achievements in improving access to healthcare since we took office in 1994, much more needs to be done in terms of quality of care, and by making services available to all South Africans and ensuring better health outcomes.
Taking its cue from the Millennium Development Goals, the Provincial Growth and Development Plan set three health related targets in 2004:
- reduce by two thirds the under five mortality rate by 2014
- reduce by three quarters the maternal mortality rate by 2014
- halt and reverse the spread of HIV and AIDS and tuberculosis (TB) by 2014
About two weeks ago, we received shocking news, when the Human Sciences Research Council (HSRC) reported that the prevalence of HIV among young people and adults (15 to 49) in the Eastern Cape increased by 5% between 2002 and 2008.
The study also reported that HIV prevention knowledge has declined among the population between 15to 49 years at national level, from 64.4% in 2005 to 44.8% in 2008. It has also declined in the Eastern Cape. This sends a strong message to us all to do more, not to be complacent and in denial thus perpetuate practices that continue to spread this disease in our communities.
South Africa commands huge healthcare resources compared with many middle income countries, yet the bulk of these resources are in the private sector and serve a minority of the population, thereby undermining the country’s ability to produce quality care and improve healthcare outcomes.
For a province like the Eastern Cape with high levels of poverty and unemployment, future development of the Province rests as much on a good quality health system as it does on the education system. People are our greatest resource in the Eastern Cape!
The government of South Africa has identified ten priorities for a major improvement in the healthcare system in the next five years:
- implementation of the National Health Insurance Plan
- improve quality of health services
- overhaul management system
- improved human resource management
- physical infrastructure revitalisation
- accelerate implementation of the HIV and AIDS and sexually transmitted infection (STI) plans
- attaining better health for the population
- social mobilisation for better health
- drug policy review
- research and development
Honourable Speaker and honourable members let me in the same breath acknowledge that our public health system is characterised by some weaknesses that might appear insurmountable, and these are:
- weak Financial Management Systems (FMS) and procedures, including reporting
- poor Human Resource Management (HRM)
- lack of utilisation of reliable Information and Communications Technology (ICT)
- infrastructure backlog and dilapidating facilities
- lack of total quality management
- poor performance management (both organisational and individual)
I would like to assure the citizens of the Eastern Cape that we will do everything humanely possible to improve the quality of health services and accelerate the turnaround of the departmental performance.
In our endeavour towards improving the health profile of the province we will put in place clear and measurable plans to achieve the national priorities and also address these weaknesses of our health system in the Eastern Cape.
The National Health Insurance Plan is one of the critical focus areas for the ruling party to ensure access to services by our people by bringing together the public and private sector so as to improve the quality of healthcare.
While the national Department of Health is driving policy development on this matter our responsibility at provincial level will be to create a conducive and readiness environment for its implementation.
The core business of the department, honourable Speaker, is to provide quality healthcare through a range of services, at primary, secondary and tertiary levels, in facilities such as clinics, community health centres and hospitals. Through these services, the department ensures that the nation enjoys access to a comprehensive healthcare service.
The National Health Policy identifies the district health system as the main vehicle in the improved and accelerated delivery of primary healthcare. The department’s task therefore, is to strengthen districts as the health authorities responsible for health services in line with the District Health System.
The primary healthcare programme is managed by the provincial health authority and local government. The objective is to consolidate the primary healthcare programme under one authority.
There is a need to address the challenges in the social determinants of health like poverty, nutrition, water quality, literacy, etc in order to improve the current Primary Healthcare outcomes.
We are not discouraged by these challenges but we continue to utilise the limited available resources to strive towards rendering the best possible health service to our communities.
For this financial year, the department has increased the budget of District Health Services from R4 776 681 billion to R4 935 518 billion.
1. Accelerating the implementation of HIV and AIDS and STI plans, and TB
1.1 HIV and AIDS
Honourable Speaker, our planning and response to HIV and AIDS is undermined by the escalating numbers of multi drug and extensive drug resistant tuberculosis (MDR and XDR TB), HIV and AIDS.
It is therefore important for me to explain to the members of this august house that the ANC has resolved to be at the forefront of community mobilisation and leadership around HIV and AIDS especially around awareness, prevention, voluntary counselling and testing, treatment and care. The department will continue to upscale the Comprehensive Care Management and Treatment (CCMT) of HIV and AIDS including Anti-retroviral.
In realising and institutionalising the above resolutions, the department will therefore:
- implement an integrated and comprehensive approach to prevention, treatment and care, keeping the uninfected negative by scaling up on existing prevention strategies, promoting positive living for those who are infected so as to delay the onset of AIDS and providing access to treatment and care for those who need these interventions
- reinforce the strategy of prevention by re-emphasizing and re-invigorating HIV prevention efforts, which include practising safe sex through condom usage, Voluntary Counselling and Testing, Prevention of Mother to Child Transmission (PMTCT), Post Exposure Prophylaxis (PEP), and syndromic management of sexually transmitted infections
- we will also strengthen the information, education and communication (IEC) campaigns in synergy with treatment efforts.
In line with the National Strategic Plan (NSP) for HIV and AIDS adopted in 2007, the province, led by the Provincial AIDS Council (ECAC) developed a Provincial Strategic Plan in 2007 and 2008.
The Department work with other stakeholders to accelerate the implementation of this plan and look to the AIDS Council to cement partnerships with business and civil society, particularly the countless non-governmental organisations (NGOs) and community based organisations working with HIV and AIDS with little resources.
The province of the Eastern Cape has the second highest number of TB cases in the country following KwaZulu-Natal (KZN) as per the National TB Control Programme Report 2007. A major constraint in the Eastern Cape is the scarcity of health professionals, which confirms the need for TB/HIV integration so that these scarce resources can be spread over a wide range of patients.
With the limited budget of R282 325 million that we have Hon Speaker to address this crisis, our priorities and focus this financial year will include the following:
- reducing the human suffering and socio economic burden associated with TB
- protecting the poor and vulnerable populations from TB, MDR and XDR TB
- ensuring the availability of key drugs to treat and control MDR and XDR-TB
- strengthening the infection control measures to prevent hospital acquired infections at TB health facilities.
Honourable Speaker, we remain concerned about the high level of maternal deaths and infant mortalities in our province. In addressing this challenge, the Department will continue to implement the Saving Mothers Saving Babies Project which is an attempt to reduce maternal and perinatal morbidity and mortality.
This year, honourable Speaker we are going to focus on the clinical performance of our health facilities to ensure that we respond and implement the ten key recommendations of the National Confidential Enquiries Report on Maternal
Deaths in the country.
2. Mental health services
Honourable Speaker and honourable members of the house, a number of complaints regarding psychiatric health services have been raised through the media and these issues can be characterised in terms of the infrastructure conditions of some of our Psychiatric Institutions leaving much to be desired as those institutions are old and the life span of the buildings has expired.
We will be strengthening community based mental health services to ensure that these vulnerable individuals are not gathered under the now defunct “chola chola” programme but are instead treated with dignity and respect and afforded the requisite care and support. Advertisements for community members who would like to serve in Mental Health Review Boards have come out from our side and we would like to urge members of civil society to answer the call and serve on these boards in order to be of service to their fellow citizens.
The National department of Health introduced a set of norms and standards by which all health facilities would be measured.
Butterworth Hospital was found to be lagging behind in most of the aspects that were measured under this programme, namely, infrastructure, infection control, management systems, nursing care, safety for staff and patients. In the light of these weaknesses a project of infrastructural renewal and Business process engineering in that hospital has commenced. It is our aim that this hospital becomes a flagship in the province.
I put it to you, honourable Speaker, that this is a period for partnerships and cooperation between all stakeholders. As a department we will strengthen our communication with all stakeholders, and our door will be open to all those that
have suggestions for how to improve public healthcare in the Eastern Cape. In this year we will invite all stakeholders to join us in the creation of a social compact for better health.
For the 2009/10 financial year, the department will continue strengthening health promotion and healthy lifestyles. We therefore invite the honourable members of this House to join us in our campaigns against drug, tobacco and alcohol abuse including the health promotion activities that the Department will be arranging this year. A comprehensive programme for the information of all the honourable members will be forwarded to the office of the honourable Speaker.
Honourable Speaker, the department has developed two policy documents to improve management and participatory democratic governance of health facilities. These are the Hospital Boards Policy and Clinic Committee Policy Guidelines.
Both policy documents provide a democratic process of overseeing the performance of health facilities on behalf of communities and the outcomes of that process are then reported to the Member of the Executive Council responsible for health.
The Department will continue to interact with its social partners through the Provincial Health Council, District Health Councils and Provincial Health Consultative Forum. These structures are established through the National Health Act.
Honourable Speaker, Emergency Medical Services (EMS) is a critical arm of health service delivery as they are the link between the community and a health facility. In an effort to bring services closer to the people the following activities will be undertaken by EMS this financial year:
- additional EMS bases will be established
- upgrading and equipping of the existing EMS control centres in Port Elizabeth, East London and Queenstown
- intensification of campaigns to profile the utilisation of the EMS toll free number as well as to stop hoax calls and abuse of the service
- employment of additional Emergency Care Practitioners
- development and approval of a disaster management policy and strategy to mitigate all potential disasters before, during and after the Fifa Soccer World Cup.
A budget of R484 641 million, up from the previous year's allocation of R395 000 million, has been made available to EMS to ensure that the department renders an efficient and effective Emergency Medical Service to the citizens of the Eastern Cape.
We will continue to run the aero-medical service which has gone a long way in improving the department’s ability to respond to emergencies in far flung rural areas, thus avoiding loss of life.
Honourable Speaker, the department will, in this financial year, focus on the following activities to ensure that drugs are available at all material times in all clinics and hospitals:
- the depot turnaround plan which was commenced in 2008 continue to function and has already brought about a marked improvement in the functionality of our two depots in Port Elizabeth and Mthatha
- strengthening our capacity to provide quality pharmaceutical services by ensuring ongoing recruitment and training of pharmacist assistants and auxilliary pharmacy workers
- facilitating the implementation of the Public Private Partnership (PPP) for the effective and efficient management of the pharmaceutical supply chain from the depots to the hospitals, community health centres and clinics, with a central down referral and pre-packing unit.
We have therefore allocated an amount of R59 776 million for the PPP for this financial year.
Honourable Speaker, the department provides orthotic and prosthetic services to a large community of the province. There are three existing orthotic/prosthetic centres (O&Ps) within the province which are at different levels of staffing and different level of functionality in terms of equipment and infrastructure.
The centres are the PE Provincial Hospital, East London Frere Hospital Centre and Mthatha Hospital Complex. The need for these services is determined by the number of prescriptions received from medical professionals and the number of referrals especially from the out reach programme.
Honourable Speaker, as a commitment to provide these services, i.e. artificial limbs, wheelchairs, hearing aids, callipers, braces etc, the allocation for 2009/10 has been increased from R27 948 to R29 383 million.
The department received a commitment from the Airport Company of South Africa (ACSA) who will donate 180 wheelchairs; we extend our appreciation to ACSA for this initiative which will contribute significantly in improving the quality of life for people who would otherwise remain immobile.
The department will continue contributing to the anti-poverty programme as well as implementing the high impact priority projects of the province, and further providing learning and employment opportunities for the youth.
In this regard, the Department is proud to report that it will provide opportunities for the youth, especially those who are living in the 11 poorest municipalities of the province through targeted learnership and internship programmes. For the 2009/10 financial year, the department has budgeted R45 million for this programme which is an increase from R28 million.
3. Health’s to poverty eradication programme
- 1 296 learners for the learnership programme from the 11 poorest municipalities of the province have been recruited to be part of the learnership programme.
- 300 unemployed graduates have been recruited and deployed on a 12-month basis in the different administrative, financial, human resources and information technology (IT) areas of the department including our health institutions; they will be remunerated at R5 000 per month.
The department has in the past financial years obtained disclaimer and adverse audit opinions from the Auditor-General. The historical weaknesses in financial management, supply chain management and human resource management, lack of capacity in the institutions and inadequate systems are factors that have contributed to a great extent to the negative outcomes of the department over the past years.
In this year the department will structure its financial management function to support the overall strategy of the organisation. We will rapidly build the capacity throughout the organisation to urgently address financial management.
The Department has intensified its implementation and monitoring of the Performance Management and Development System among all levels of staff, particularly the senior management cadre.
The intention is to improve the entire organisational performance. Measuring, evaluating and rewarding the effectiveness of senior management at all levels of the department is fundamental to achieving a high impact on the overall ability of the public health system to deliver on its mandate.
Honourable Speaker, I would like to take this opportunity to pay my utmost respects to the health personnel in this province. We know that health personnel work under very tough conditions in this province, both in rural and urban facilities. The under resourced nature of these facilities and the chronic shortage of staff makes for a very tough working environment, yet healthcare workers make up the mainstay of the healthcare system.
The department will implement a Human Resource Plan which will provide major improvements such as:
- detailed norms on the levels of health professionals per population ratios
- include primary, secondary and tertiary care teams
- include adequate numbers of workers at all levels of the healthcare system, including recruitment and filling of vacant posts.
There will also be a focus on increasing healthcare worker training output in the public sector. This will include reopening nursing training colleges, encouraging nurses who complete training to register for practising the profession, and possibly bringing in health workers from countries with an excess supply.
The production and the training of health professionals through the Lilitha College of Nursing, the EMS College, universities and technikons in the province and beyond will be enhanced in the next three years for their retention and the management of their performance.
In addition, a new nursing strategy is in place to address the shortage of nurses in the province as well as improving the quality of training provided at the Lilitha College of Nursing.
Honourable Speaker, are aware of the infrastructure backlogs which are prevalent in the province. We have engaged in the process of alignment of the infrastructure plans with the budget cycle on the Medium Term Expenditure Framework (MTEF) basis, by seeking the assistance of NATIONAL AND PROVINCIAL TREASURY through the Infrastructure Delivery Improvement Plan (IDIP). A provincial technical assistance team was appointed by the National Treasury and placed within the department’s Infrastructure
4. Physical infrastructure revitalisation
Development Branch. In addition we will embark on a long term infrastructure planning that would address the financing needs and strategy in order to eliminate the infrastructure backlogs during the next ten years.
For this current financial year Hon Speaker, the department has allocated R1 241 016 billion inclusive of the Infrastructure Grant for provinces, we have prioritised the following to improve access to healthcare:
- R120 805 million has been allocated for the improvement, rehabilitation, maintenance and up-scaling the building of community health facilities, i.e. community health centres and clinics as part of strengthening primary healthcare services.
- R464 504 million has been allocated for the rehabilitation, maintenance and modernisation of the district hospitals.
- R655 707 million has been allocated for the rehabilitation, maintenance and modernisation of the provincial hospitals.
Honourable Speaker and honourable members of the house, our preparations are at an advanced stage and a Provincial Outbreak Control and Response Intervention Plan has been developed based on our comprehensive Communicable Disease Outbreaks and Control framework.
The Plan has been shared with the Host City as our primary target area. The department has appointed a task team to drive the process of putting in place a comprehensive strategy for epidemic preparedness by the department.
5. International Relations
In strengthening relationships with the international community, the department intends to host a Donor Summit in mid July 2009 to be attended by international development funding partners.
The purpose of the proposed summit is to show appreciation of the value added by external donor founders in strengthening our health system as well as sharing with these partners the health resource gaps that require development aid. We anticipate that after the summit more development funding partners would be interested in allocating their aid to this province. Hon Speaker, we shall extend an invitation to yourself and Hon. Members of the House to attend the proposed summit.
Honourable Speaker, honourable members of the house, I hereby table the Budget Vote, Vote No. 3, for the Eastern Cape Department of Health which is R11 328 346 billion for 2009/10, inclusive of health priorities funding of R1226 691.00:
6. Health’s budget allocation for the 2009/10 financial year
- ICS adjustment for above normal increase R178,876
- project 5000 (Recruitment of Health Professionals) R120,000
- carry costs on cost pressures on implementation of OSD R171,284
- cost pressures on implementation of OSD (phase two) R157,857
- tuberculoses (XDR and MDR) R15,571
- reducing infant and child mortality R62,285
- medical goods and services R105,931
- to prevent the distortion of the normal operations arising
- from 2008/09 accruals R414,887
- contribution to accruals within the Infrastructure Grant
- to the Provinces (IGP) for infrastructure Priorities R 85,113
Finally, honourable Speaker, the department’s budget has been appropriated in terms of the following budget programmes of the department:
- Programmes: Health Administration
Total: 710 789
- Programmes: District Health Services
Total: 4 935 518
- Programmes: Emergency Medical Services
Total: 484 641
- Programmes: Provincial Hospital Services
Total: 2 831 727
- Programmes: Central Hospital Services
Total: 509 429
- Programmes: Health Sciences and Training
Total: 526 067
- Programmes: Healthcare Support Services
Total: 89 159
- Programmes: Healthcare Facilities Development and Maintenance
Total: 1 241 016
Total: 11 328 346
For information purposes, the above figures are also inclusive of conditional grants which are:
- Conditional grants allocation for 2009/10: Comprehensive HIV and AIDS Grant
Total: 401 727
- Conditional grants allocation for 2009/10: Forensic Pathology Services Grant
Total: 61 214
- Conditional grants allocation for 2009/10: Hospital Revitalisation
Total: 238 611
- Conditional grants allocation for 2009/10: National Tertiary Services Grant
Total: 509 429
- Conditional grants allocation for 2009/10: Health Professionals Training and Development
Total: 151 362
- Conditional grants allocation for 2009/10: Provincial Infrastructure Grant
Total: 279 483
Total: 1 641 826
I thank you.
Source: Department of Health, Eastern Cape Provincial Government
