Gauteng Provincial Legislature
Honourable Speaker and Deputy Speaker
Honourable Premier
Honourable Members of the Executive Council
Members of Mayoral Committees for Health and Social Development
Honourable Members
Deans of Medical Schools
Comrades and friends
Ladies and gentlemen
It is an honour and privilege for me to table this budget a few weeks after we celebrated the 91st birthday of one of our gallant fighters and icon of our struggle for liberation. We continue to be motivated and inspired by what this giant of our struggle stood for.
We are therefore proud to be home to a state of the art specialist paediatric academic and tertiary referral hospital providing child- centred hospital which will be built and named after him.
Professor Muhammad Yunus aptly summarised what this giant stood for when he delivered the seventh Nelson Mandela Annual Lecture.
He said: "You lifted people from their insignificance. You gave people honour and dignity, irrespective of their race, colour or religion. You became the symbol of the human spirit. You raised the bar to an all-time high to show the world the height a human being can reach in moral strength. You will remain an inspiration for ever."
Honourable Speaker,
As I table this budget vote we begin a journey towards raising the bar to an all time high in bringing quality health services to the people of Gauteng. Recent developments in the global economy suggest that current market driven model has failed. This provides us as a country and a province with an opportunity to do things differently in the provision of public health services.
Mr Ban–Ki–Moon, the General Secretary of the UN said: "In these times of recession what is required is more investment in the health sector and strengthening of the public health system."
The ANC Manifesto continues to guide us as we seek to achieve better health outcomes and improve the health care of the people of Gauteng. The new mandate received on 22 April 2009, enjoins us to pursue programmes that will make a difference in the lives of the people, the majority of whom are poor, vulnerable and dependent on the public health system.
These are the people who typically have to wake up early, sometimes borrow money, travel long distances, and wait in long queues, only to be turned away from public health facilities. This must come to an end! We are on course to "Create a World of Our Choice", as Professor Yunus said, We have chosen right over wrong, humility over arrogance, nobility over being dis-honourable. We need to go back to the values espoused by one of the Greek philosopher, named Hippocrates for doctors, and Florence Nightingale, for nurses. These two pioneers entreat all of us to remain committed to the highest standard of service in providing healthcare.
Honourable members will not dispute that government has an obligation to provide quality health care; this fact propelled the national Department of Health to develop a ten point plan as a means to address health specific challenges.
We are equally guided by the same Plan as we continue to ensure that our programmes respond to the imperatives of the new political mandate.
Honourable Speaker,
Soon after I was appointed to this portfolio, I met and interacted with patients, doctors, nurses, and other health professionals, support staff and a broad spectrum of stakeholders, in a quest to identify areas which need urgent attention.
During this interaction, the commitments as stated in the Manifesto became even more urgent. In line with our mandate we have reprioritised expenditure within the budget which will improve the public Health System. This budget of R16 589 941, 000 will assist us to deal with the following shortcomings in our health services:
- patients being turned away from health facilities
- overcrowding due to high patient volumes and the increase in the burden of disease
- poor environmental conditions at our facilities for both patients and staff
- intermittent interruption in the supply of medication
- failure to procure appropriate and adequate medical equipment
- inappropriate deployment of managers with requisite skills at service delivery sites
- backlog of surgical operations.
Honourable Speaker,
In order to create a better health service which is patient-centred, we are taking bold steps that will be a testament that, indeed the World we seek to Create will be attained in our lifetime.
We are engaging national and provincial treasuries to improve sound financial management controls, supply chain management, and address the concerns raised by the Auditor General. As a matter of fact we cannot continue to overspend as if we are the only government department that is under pressure to deliver services in the country.
Failure to adhere to Public Finance Management Act (PFMA) regulations, will force Treasury to implement stringent measures for us to comply. We are going to introduce measure to do away with inefficiencies, such as poor contract management, duplications amongst others.
We must learn to do more with less and think outside the box and explore partnership with the private sector. Managers at all levels will be held responsible and accountable for failure to comply with Treasury regulations. All contracts are being reviewed, we will proceed with those that are in line with our mandate, and those that are not will be terminated. We will defer implementation of those that are relevant but not urgent.
We are taking measures to deal with equipment that is condemned and obsolete, repairing what needs to be repaired and replacing where it is required.
We have taken measures to arrest the shortage of drugs, consumables, shrinkage of linen and food at our facilities which are essential for running health facilities. It is unacceptable for people to come to hospitals and clinics and for them not to be given drugs or not get a balanced meal.
All hospitals in Gauteng with effect from 1 September will no longer sell unacceptable food in hospital shops, as part of ensuring healthy lifestyles. We recognise that some health professionals are taking advantage of the system because of poor controls; going forward we will not tolerate those who are abusing overtime, sessional arrangements or Remunerated Work Outside the Public Service (RWOPS).
We are in the process of reviewing RWOPS to ensure that it is the patients who ultimately benefit from this arrangement. That said, Honourable Speaker, let me speak to the 10 Point Plan and illustrate how our programmes will contribute towards achieving better health outcomes.
Provision of strategic leadership
In order to provide strategic leadership, we launched Operation Kuyasheshwa La on 25 June 2009. Our focus in the current financial year will therefore, be to improve, stabilize and sustain service delivery by means of decisive intervention measures.
We have already begun strengthening management at District level in order to ensure that appropriate support is provided to fixed and mobile clinics, Community Health Centres and District Hospitals.
For the health system to function optimally, the district Health System needs to work. Services that are delivered at district level need to inspire confidence among the people. By this we mean that there is a need for doctors and nurses of all categories to be available at these institutions at all times.
Reliable supply of consumables and medication which are in line with the Essential Drug List is a non negotiable. This includes an efficient referral system from primary health care facilities to regional, tertiary and quaternary hospitals.
People who are referred to central hospitals will only be those who require tertiary or quaternary care. This will be enforced from January 2010 when an additional 900 level 1 beds have been opened and this information communicated to the public (Discoverers: 200, Lenasia: 200 and 500 beds from the private sector).
Improving the quality of health services
In our endeavour to further improve the quality of health care, we will continue to increase the number of facilities with extended hours and those that operate for 24 hours. In extending hours of operation we will ensure availability of staff, equipment and medication. Availability of additional staff will require partnerships with GPs and SAMA. By the beginning of October details of this plan will be finalised.
We will improve our working relationship with municipalities to provide seamless services and strengthen environmental health. In line with the Executive Council approval of our plans for 2009/10, we will assign the primary health care function to the three metropolitan municipalities. Details of funding, staffing, medication and consumables will be finalised by the end of the year to ensure properly funded healthcare as described by the World Health Organisations (WHO).
As part of improving the quality of healthcare, the Manifesto enjoins us to reduce waiting times at facilities. This will mean improving admission processes and the management of files to ensure the processes are effective. Doctors must do rounds in a way that ensures that they can also see patients at outpatients department and special clinics.
Waiting times will be reduced by fast queues for the elderly, people with disabilities and pregnant women, and additional queue marshals will be introduced to assist patients. An additional measure will be to issue three month's supply of medication to stable chronic patients. We will expand the Kgatelopele project wherein we distribute chronic medication to stable patients through Community Health Workers.
A key part of improving quality is responding to the concerns of our people. In June this year, we launched a Central Call Centre to handle patient complaints 24 hours a day. This has gone a long way in providing redress to aggrieved patients and their next of kin, for example those who have been denied access or have been waiting for surgical operation. Calls are taken by retired nurses and other health professionals. We can confidently say that the call centre is answering this need.
Management of bed occupancy and diversion of ambulances
Honourable Speaker, This has been addressed to deal with the fact that ambulances are sometimes diverted from facility to facility because of bed shortages. We will ensure that all patients presenting at our health facilities are assessed and stabilised before being referred to the appropriate level of care.
This principle must apply whether patients arrive via ambulance or private transport. As a result of improved management, the number of weekly diversions has come down from 88 per week, to 11 per week. Patients being turned away from clinics and hospitals must come to an end!
Critical Care beds (ICU and high care)
We will provide 50 more Critical Care Beds in addition to the current 460.
Emergency Medical Services:
To strengthen the referral systems, 37 planned patient transport vehicles will be purchased. These vehicles will help to ensure that ambulances are used for emergencies and not for routine transportation of patients between facilities, and is part of our efforts to improve response times in emergencies.
In preparation for the 2010 FIFA Soccer World Cup, the accident and emergency departments at the central and regional hospitals will be made ready to provide the required services. Doctors completing their Masters in Emergency Medicine will support preparations for 2010 readiness, and beyond.
With regard to Forensic Medical Services: At mortuaries there is often no waiting area for grieving families or relatives. Families need to be able to take comfort from the fact that their loved ones are kept in a dignified environment.
This will be addressed by improving conditions in the following mortuaries: Bronkhorspruit, Springs and Johannesburg in all other mortuaries ozonisers will be installed and dysfunctional fridges will be repaired or replaced.
Medical equipment
In this financial year, we will provide medical equipment, basic and major items, such as; PET-CT scan and anaesthetic machine at Chris Hani Baragwanath Hospital, mammography units at three regional hospitals, cardiac cathlab and heart-lung machine at Dr George Mukhari Hospital In addition, we will provide clinics, Community Health Centres, and District hospitals adequate equipment so as to allow clinicians to function optimally.
Honourable Speaker,
It is often said that the health of a nation is reflected by how it treats its vulnerable citizens, in particular, the elderly.
To this end:
- 18 000 cataract operations will be performed on the elderly in Gauteng to restore their sight
- 4 500 senior citizens will receive dentures
- 100 orthopaedic joint replacement operations will be performed to address the surgical backlog.
- communicable disease control has been strengthened at ports of entry.
Overhauling the healthcare system and improve its management
Hospital management must manage in a decisive, integrated manner that will remove the silo mentality. Managers must no longer manage by remote or from their offices.
Managers must be intimately involved in the running of hospitals and clinics. They must supervise all levels of workers and will be held responsible for appropriate management for the hospital in terms of budget, HR and patient care. Henceforth, every employee shall wear their nametag in all health facilities and at head office.
We have already established Regional Management Support Teams to provide necessary support to hospital managers. Chief Executive Officers of hospitals shall be held accountable for service delivery at their facilities. As soon as the delegation system is completed in full, CEO posts will be advertised because of the additional responsibilities that will accompany these appointments.
The grading system will be applied to determine the appropriate level of remuneration, recognising that the current levels are not suitable for the amount of work and budgets they run. We will revise the performance agreements of hospital Chief Executive Officers in order to align them with the priorities of the new term of office. In order to strengthen management and provide quality health care, head office will be lean and mean. The days of an ever expanding head office are over.
This means that the role of central office will change partly due to the merger and also because of the reconfiguration of responsibilities that will be delegated to the districts and hospitals. Managers are expected to be at sites of service delivery in order to obtain first hand reports.
Honourable Speaker,
In line with our decision to reprioritise resources from non-core to core services, the following decisive measures have been taken:
- we have cut back on the use of consultants
- terminated contracts for consultants who perform the work that could be performed by employees in the department
- accelerated the filling of vacant funded clinical and other support posts crucial to service delivery.
With these imperatives in mind, a decision was taken to discontinue the services of 3P Consulting. We have also terminated contracts of senior officials who were remunerated as consultants. These steps among others have been taken in the interest of good governance and improved service delivery.
We have also prioritised 10 hospitals at which service delivery will be turned around in the next two years. These hospitals will be turned into centres where quality care will be the order of the day, namely:
- Chris Hani Baragwanath Academic
- Charlotte Maxeke Johannesburg Academic
- Steve Biko Academic
- Natalspruit
- Helen Joseph
- Leratong
- Tambo Memorial
- Edenvale
- Pholosong
In partnership with the DBSA there are six additional hospitals that will be improved: Kalafong, Odi, Jubilee, Dr George Mukhari, Sebokeng and Tembisa. These hospitals are located in historically disadvantaged communities. Focusing on these areas will go a long way towards improving the quality of care in the province.
Improvement of human resources
We need to do more to demonstrate that all health care workers are valued for the contribution they are making in the public healthcare sector. Without them there would be no health system to speak of. The merger of the two departments will bring added value in terms of the two groups of skilled professionals and complementary services together, more commonality than differences.
In line with the premier's call to remove labour brokers, we are committed to phasing out the use of agencies to employ nurses and pharmacists. At Chris Hani Baragwanath Hospital, for example, we have employed more than 1 000 nurses of all categories 80 porters, 100 cleaners, and 20 security guards in the very short space of time. We have employed 200 nurses at Charlotte Maxeke etc.
Only a cynic will not acknowledge that we are indeed contributing towards creating decent jobs as these employees are now part of the system! In order to provide adequate numbers of health professionals at all levels of our health care system, we will continue to increase the intake of nursing students, nursing assistants, pharmacy assistants, and other allied health professionals at our training institutions.
By the end of the financial year, 1 850 nurses, 100 pharmacy assistants and 90 Emergency Care Technicians will have graduated. All of these health professionals will be deployed at public hospitals and clinics. In partnership with the faculties of health sciences and oral health we will continue to increase the number of doctors, dentists and allied workers, through the provision of bursaries, extended teaching platforms and providing specialist and sub specialist training posts.
Honourable members,
In line with our quest to reduce poverty and create decent jobs as enjoined by the Manifesto, this year we will assist in establishing eight co-operatives which will benefit from our procurement budget at Chris Hani Baragwanath Academic, Charlotte Maxeke-Johannesburg Academic, Steve Biko Academic, Helen Joseph, Leratong, Sebokeng and Tembisa hospitals. These co-operatives will be managed and owned by women from historically disadvantaged communities.
For example, the new Accident and Emergency Unit, which we will soon open at Chris Hani Baragwanath Hospital, will have support services such as cleaning, porters and patient attire being provided by these co-operatives. Towards the end of August, as part of our commitment to building partnerships, we will host a Imbizo for Nurses, where we will deliberate on among other things; measures that we shall take to re-introduce the caring ethos that historically nurses have been admired for.
We will ensure that in Gauteng nursing back to basics in line with the Florence Nightingale pledge; with bed to bed ward rounds and hand-overs; where the sister in charge is accountable for supplies, and equipment; and where no nurse will turn off machines just so they can get some sleep. Nurses will be empowered to be advocates for patients. We will phase in ward assistants to free up nurses to focus on clinical nursing care.
Revitalisation of infrastructure
Key to improving quality and access is the revitalization of facilities. The Accident and Emergency and Trauma unit at Chris Hani Baragwanath Hospital is almost complete, and will be opened around August this year. Honourable Members, Chris Hani Baragwanath Hospital sees an average of 420 patients per day at its Accident and Emergency Unit, and 65% of these are trauma cases.
We will commence upgrading of JC Dumani Community Health Centre in Vosloorus, and additional consulting rooms will be built at Esangweni Community Health, in Tembisa. Before the end of this year we will also open the Eersterus Community Health Centre.
The new Mamelodi Hospital is almost complete and will be ready for official opening by the end of September. The specialised MDR and XDR wards at Sizwe Hospital are also complete. These wards, which have 46 seclusion beds, will provide isolation and appropriate clinical care to these patients. As the Honourable Premier announced in the State of the Province Address, a feasibility study will be conducted around reopening Hillbrow and Kayalami in Kempton Park.
As part of building the capacity of the state to deliver, the department will build capacity to monitor projects to ensure they completed on time within budget. Completion of these projects will reduce pressure on existing facilities and will improve service delivery.
Accelerated implementation of the HIV and AIDS strategic plan and the increased focus on tuberculosis and other communicable diseases
Honourable Speaker,
Tuberculosis remains a national priority. While we acknowledge the strides that we have made in improving the TB cure rate, we have set ourselves a target of increasing it from 75,6% to 80% by the end of the financial year.
Collaboration with our partners has yielded positive results regarding improving the improved TB cure rate, therefore these partnerships will be strengthened.
We are committed to reducing new HIV infections by 50% at the end of 2011. At the centre of our efforts will be intensified mass education which will focus on schools, ward based education, workplaces and using Non Governmental Organisations (NGOs) to reach high risk groups.
This mass education drive is aimed at changing behaviour by encouraging safe sex, and responsible sexual behaviour. We will therefore continue in our efforts to encourage communities to access Voluntary Counselling and Testing. All our clinics and hospitals offer this service. Many HIV positive people present themselves when their conditions have already deteriorated, requiring additional resources because they have to be treated at tertiary level.
I therefore take this opportunity to re-iterate the call to all our people, especially men, to test for HIV at any health facilities in order to be advised on what steps to take depending on their HIV status. It is essential to know your status because if you know you can take the necessary steps to prolong your life.
The campaign to know your status is ongoing and we invite the Honourable members and the public at large to participate and encourage others to know their status. We will also increase the number of people receiving Anti-Retroviral Treatment at our sites from 185 000 to 300 000 (which is 115 000 new patients), including 20 000 children, by the end of March 2009.
We need to improve infrastructure to support this programme, and it is within our budget. Our aim is to provide anti-retroviral treatment to 80% of eligible HIV positive people, at designated facilities, by the end of 2011, in line with the ANC Manifesto commitment.
Mass mobilisation for better health
The merging of the two departments will strengthen psychiatric and social welfare services. The ANC government has always prioritised maternal and child health. We acknowledge that more efforts are required to decrease maternal, child and infant mortality rates.
As part of our collaboration with municipalities we will ensure the availability of antenatal care at all primary health care facilities. This will also enable us to increase the coverage of PMTCT. Health facilities must strengthen the implementation of the recommendations of the confidential enquiry into maternal deaths, saving children and babies’ reports.
In order to minimise maternal mortality we will continue to train midwives in management of obstetric complications. Protocols to manage these complications must be available at all facilities including private facilities. Breast and cervical cancer screening for women, and prostate and testicular cancer screening for men, will be intensified. Men over 40 and women over 20 are encouraged to go for regular testing.
Honourable Speaker,
Our target for full immunisation coverage for children under the age of one is 93%. We will strive to reach all children who have not been immunised through our Expanded Programme of Immunisation. The implementation of the new vaccines will be fully implemented this financial year.
While we acknowledge that in-migration and temporary migration distort our actual immunisation coverage, we will employ creative ways of extending coverage to those who might have been missed. Interventions focusing on Metsweding, one of the 18 most deprived districts, have begun to bear fruit, and health outcomes in the district are improving.
To empower young people around sexual and reproductive rights families need to play an active role. We recognise the problem of teenage pregnancy and the fact that these young people face problems accessing contraceptive services. We will continue to ensure that facilities are youth friendly and that contraceptives are available, along with the promotion of healthy lifestyles.
Creation of social compact for better health outcomes
For all of the above to succeed, buy-in of all stakeholders is required, which will depend on the success of social mobilization and building cohesive communities. Hospital board members must not just sit in board meetings but must play an active oversight role, identifying problems and being advocates for patient rights.
Clinic committees must do the same thing, and ensure that patients understand their rights and the patients' charter. In cases of medical negligence, regulatory bodies for categories of health professionals, such as the HPCSA and SANC, must ensure that action is swift and justice is done.
The role of civil society is also crucial; individuals and groups must identify problems and report them to the CEO or other authorities, and if not addressed, report direct to the MEC.
Implementing the national health insurance
The objective is to put into place the necessary funding and service delivery mechanisms to enable the creation of an efficient, equitable and sustainable health system in South Africa. It will be based on the principles of the right to health, social solidarity and universal coverage.
The National Health Insurance (NHI) hinges on a functioning public health system. This is also linked to ensuring that patients access health care at appropriate levels. We have therefore begun deploying family physicians to clinics in order to strengthen primary health care service delivery. This will stem the flow of patients with minor ailments to regional and tertiary hospitals.
The issues dealt with in this speech will contribute to getting Gauteng ready for implementation and we will work hard as a province so that we don't fail the nation. If we succeed in doing what is outlined above we will be in the position to implement the NHI.
Conclusion
As I have just tabled the first budget vote in our fourth term of government, I am mindful of the challenges that lie ahead. I acknowledge the dedication of thousands of health workers who continue to put patients first. I want to believe that all of us who are in the health care sector will put shoulder to the wheel, no matter the working conditions, no matter the difficulties that lie ahead – shortage of resources.
What will be the central thrust is that the health of our nation is more important than our individual needs. Mahatma Gandhi said, 'be the change you want to see'. We are also obliged to ensure that this Health System is responsive to the needs of our people. For this to become a reality, all stakeholders, especially health professionals, must come to the party.
We have agreed that in Gauteng, we will not tolerate practices which send a wrong message to poor people that government and civil servants do not care.
We have taken decisive steps to prove that our commitment to being patient centred is not just a gimmick; we will work together because united we stand but divided we fall. Our people deserve better and we dare not fail them!
To the healthcare workers: we may not be the best employer. Without you and your skills, dedication and commitment there would be no health system to speak of.
Working together is one of the non-negotiable. We have to work together for the benefit of our people. Labour issues cannot be an excuse for non-delivery of quality health care. We must find ways to resolve our differences without loss of life.
To the people of Gauteng: We know that the public healthcare system is not perfect. 'Looking on the bright side does not make you blind to the problems around you, but helps you to see them in a positive light' do not throw the baby out with the bathwater.
We have positive energy and it is possible to create the world of our choice and together we can because we have done it before. The last line of the Hippocratic Oath states:
"So long as I maintain this oath faithfully, without corruption, may it be granted to me to partake of life fully in the practice of my art, gaining the respect of all men and women (sic) for all time. However, should I transgress this oath and violate it, may the opposite be my fate." To the Honourable Premier, thank you for your leadership.
To Colleagues in the Executive Council, thank you for your support. To the Chairperson of the Health and Social Development Portfolio Committee, Honourable Molebatsi Bopape and members of the committee, keep us on our toes at all times and be robust with your oversight role.
To the Heads of Departments of Health and Social Development, Mrs Sybil Ngcobo and Mr Bheki Sibeko, thank you very much for holding fort during the merger of the two departments.
I would like to announce that Dr Abul Rahman will be staying on as Chief of Operations, his experience will be invaluable. We are truly grateful to have someone like him in our team. To all management and employees I say thank you
To support staff in the office of the MEC I say thank you for being there at all times, Unwele Olude!
To the team that put this speech together, thank you.
Lastly, I thank my family for putting up with constant absence. You remain pillar strength for me and are grateful to part you.
Ngiyabonga!
