Honourable Speaker
Honourable Members of the Executive Council, and
Honourable Members of the Provincial Legislature.
Introduction
The World Health Organisation defines Health Services as: “…the most visible part of any health system, both to users and the general public.
Health services, be they promotion, prevention, treatment or rehabilitation, may be delivered in the home, the community, the workplace, or in health facilities.
Effective health service delivery depends on having some key resources: motivated staff, equipment, information and finance, and adequate drugs.
Improving access, coverage and quality of health services also depends on the ways services are organised and managed, and on the incentives influencing providers and users.”
Honourable Speaker;
An effective health system is a pre-requisite to delivery of quality health care. This is determined by availability of suitably qualified and equitably distributed human resources, appropriately allocated budgets, sound management, availability of medicines and equipment, and sound policies.
These determinants of an effective health system continue to guide our efforts to stabilise delivery of health services in our province.
The 2011/12 financial was characterised by a myriad of challenges. We were beset by accruals, the resignation of the Head of Department, and the transfer of the Chief Financial Officer to the National Department of Health. In spite of these challenges our staff remained tenacious and continued to prioritise the interests of patients.
As I introduce the department’s 2011/12Annual Report, I invite Honourable Members to be cognisant of challenges emanating from the quadruple burden of disease, consisting of the HIV, Aids and TB epidemics, high maternal and child mortality, non-communicable diseases, violence and injury.
The increase in the number of visits to Primary Health Care facilities to 22 million is a vote of confidence in the services that we continue to deliver. Despite this increase, there are still indications that individuals continue to bypass clinics for hospitals.
In order to address this inappropriate entry into the health system, we have increased the number of medical doctors who render their services at our clinics. Every Community Health Centre has a resident doctor.
We have also appointed obstetricians and paediatricians to form the core of a specialist team in every district. All clinics in each district are being supported by this core of a specialist team.
In the year under review, we prioritised the filling of vacant posts for health professionals over and above those for administrative support. Despite the high attrition rate among health professionals, we experienced a net gain of 4 591 employees.
Reducing maternal and child mortality
Honourable Speaker,
Three of the eight Millennium Development Goals relate to Health.
We have decreased the ratio of maternal deaths in our facilities from 167.7/100 000 live births in the period 2005/07 to 145/100 000 live births for the period 2008/10.
In our quest to reduce maternal deaths, we continue to implement the recommendations of the Saving Mothers report in all health facilities that provide maternity services.
We have stepped up training on the management of obstetric emergencies; and continue to participate in the Campaign for the Accelerated Reduction of Maternal Mortality in Africa.
Service improvements included the opening of an additional Kangaroo Mother Care Unit at Tshwane District Hospital and ensuring that three out of every four new mothers were visited at home within six days of delivery.
Breastfeeding is widely regarded as an effective way of boosting infant survival rates especially in countries where poverty is widespread.
Immunisation is another critical intervention aimed at increasing child survival by eliminating deaths from preventable causes.
Immunisation services are provided daily by all clinics and some hospitals in Gauteng. Coverage of children under five years has consistently been above the national target of 90% of all children in the age group.
The percentage of children under one year who were fully immunised was 115.1% in the year under review.
Combating HIV and Aids
Good management of HIV-positive women during pregnancy is critical to reducing maternal deaths and ensuring HIV infection among babies is kept as low as possible.
Approximately eight out of 10 pregnant women (80.5%) who were HIV-positive were placed on long-term Anti- Retroviral Therapy as they were severely immuno-compromised.
Although this is primarily intended to treat the mother, it also effectively prevents transmission of HIV to the baby. HIV-positive women who do not require long-term Anti-Retroviral Therapy during pregnancy receive a shorter course of ARVs.
In Gauteng we achieved 99% coverage of babies who are born of HIV positive mothers. Only 3.6% of babies born to HIV-positive mothers proved to be HIV infected when tested at the age of six weeks, a rate which is below the national target of 5%.
By the end of the year under review, a total of 399 484 patients were receiving Anti-Retroviral Treatment, including 23 917 children. The number of adults and children who started treatment during the course of the year was 176 546.
Medical Male Circumcision (MMC) has become part of the standard range of interventions to prevent HIV-infection. Although the department increased MMC sites from 38 to 43 in the year under review, and circumcised 51 205 males, targets for this service were not met.
Reducing the burden of disease from TB
During the reporting year, a total of 53 314 TB cases were diagnosed in Gauteng and the affected individuals commenced treatment with immediate effect. Of these 81, 2% were cured.
The GeneXpert machine, which produces TB test results in a matter of hours, is currently available in five hospitals. This rapid diagnosis, which includes diagnosis of drug-resistant TB, means fewer patients are lost to treatment and succumb to Multi-Drug Resistant-TB during the gap between testing and obtaining results.
I take this opportunity to commend some of our partners who have worked selflessly to assist us to reduce the burden of disease from TB.
Non-Communicable Diseases
Honourable Speaker;
A high number of patients present at our facilities with diseases of lifestyle. In the year under review 40 656 new cases of diabetes, and 87 047 new cases of hypertension were diagnosed at our clinics.
In order to improve adherence to treatment, we assisted in the establishment of 11 support groups for people with diabetes, 9 for people with hypertension, 14 for people with epilepsy, and 1 for older persons.
Implementation of the National Health Insurance
The Tshwane Health District is being piloted of the first phase of implementation of the National Health Insurance. During this phase, pilot sites are expected to demonstrate some of the key components of National Health Insurance roll-out; including service delivery mechanisms such as contracting with General Practitioner services, revenue collection, financing, and costing of service packages.
Having taken into account funding constraints, infrastructure and staffing requirements, we opted for a phased introduction, spread over the Medium Term Expenditure Framework, for the Tshwane NHI pilot.
This will allow us to focus on areas which require intervention instead of a large-scale district wide introduction.
As part of our provincial wide readiness to implement the National Health Insurance, we established the Provincial Office of Standards Compliance in July 2011. It will focus on adherence to norms and standards, inspection, and accreditation.
All districts have inspectorates which are comprised of professional nurses, retired nurses, doctors, environmental health practitioners and health technologists.
Teams from the inspectorates monitor and report on the performance of institutions against the national core standards and on compliance with the six most critical areas for patient centred care. We are therefore confident that we will not be found wanting.
Infrastructure Development
Honourable Speaker,
In November 2011 we opened Bertha Gxowa hospital in Germiston.A major revitalisation project at Chris Hani Baragwanath Hospital was completed and handed over. The new Accident, Emergency and Trauma, Radiology Units, Out-patient Department and the Pharmacy were also commissioned during the year.
Additionalwork at Chris Hani Baragwanath Hospital included re-plumbing of two wards and refurbishment of the nurses’ residence where 18 floors were completed and lifts being repaired by the end of the year under review.
Construction of the New Natalspruit hospital was 84% complete by the end of the year under review, while Jabulani/Zola hospital was at 91%.
It is planned that construction of these hospitals will be completed by the end of the current financial year and they will be fully functional by the end of the first quarter of 2013/14 financial year.
Honourable Speaker,
We acknowledge a number of challenges which range from the slow pace of project planning and design, poor design and project management amongst others, regarding infrastructure projects.
That is why together with MEC Qedani Mahlangu, we have established inter-departmental political and technical committees with the Department of Infrastructure Development which will ensure that optimal support is provided to infrastructure management while taking into account our unique circumstances.
We will focus on improving multi-year infrastructure planning, implementation, and maintenance in all our facilities. Obstructive layers of bureaucracy will be eliminated without cutting corners and compromising quality.
To this end, we have begun to institute alternative construction procurement mechanisms, including the establishment of a database of professional service providers for the planning and management of tenders. Our aim is to expedite minor works and refurbishment projects internally through facility management units at institutions.
Financial Management
Honourable Members, will recall that in In November 2011, an agreement was developed between the Gauteng Provincial Government, National Department of Health and the National Treasury with regard to support programs to address the challenges that were faced by the department.
On average the department requires R 650 million for goods and services on a monthly basis based on commitments we have, which includes R250 million for Medical Supplies.
In spite of the shortfall that we experience, we continue to make savings on areas that we identified in November 2011.
These include savings on National Health Laboratory Services, blood services and products, Electronic Gate-Keeping which is now being implemented in 20 hospitals. Since the beginning of this financial year we have made savings of up to R65 million.
We have instituted cut –off dates for submission of invoices by hospitals. Instances of non-adherence to cut-off dates will hopefully be dealt with through disciplinary processes. There has to be consequences for recklessness and do not care attitude.
Honourable Speaker,
Despite the health systems challenges that engulfed the department during the year under review, we continued to deliver on most the targets that we set for ourselves. The tenacity and dedication of our staff ensured that the health system was kept running.
As part of our efforts to stabilise top management in the department, we appointed a new Head of Department in November 2011.
We have also recently appointed a new Chief Financial Officer; the Head of Infrastructure, and Chief Directors for District Health Support Services; Johannesburg Health District; Health Economics and Finance and Information and Communications Technology (ICT).
We have begun implementing a 2012/14 Turn –Around Strategy whose fruit will be borne in improved quality of health care. We remain committed to improve the health status of the people of Gauteng.
I therefore take this opportunity to thank the Honourable Premier for her leadership, stewardship and abundant support; my immediate predecessor Honourable MEC Ntombi Mekgwe for leading the process to develop the Turnaround Strategy, the entire Executive Council for their collegiality and support, Chairperson of the Health Portfolio Committee Mme Molebatsi Bopape, Members of the Health Portfolio Committee for providing support, encouragement and robust oversight.
We collectively have a duty to improve the health status of the people. Everything we do has to be for the benefit of the people, particularly the patients.
Introduction of the 2011/12 Annual Report by the Gauteng MEC for Health, Mr Hope Papo, MPL, Gauteng Provincial Legislature
Province
