Budget Policy Speech of the Department of Health for the financial year 2023/2024 presented by the MEC for Health: Honourable Madoda Sambatha at the North West Provincial Legislature
Speaker of the House, Honourable Susan Dantjie, Deputy Speaker, Honourable Lenah Miga,
Chief Whip of the majority party. Honourable Lazy Mokgosi,
Premier of the North West Province, Honourable Kaobitsa Bushy Maape, Honourable Members of the Executive Council,
Honourable Members of the Provincial Legislature,
Chairperson of the North West House of Traditional Leaders, Kgosi Ofentse Thari Maotwe II,
Executive Mayors and Mayors of North West Municipalities, Leaders of political parties,
Director General in the Office of the Premier,
The Superintendent-General of the Department, Mr Obakeng Mongale, Other Heads of Departments,
Leaders of faith-based organisations,
Leaders of trade unions and civil society organisations,
Leaders of academic institutions, partner organisations and the private sector, Our Traditional Health Practitioners,
Our Governance Structures – Hospital Boards, Mental Health Review Board, Clinic Committees and the Council for North West Nursing Colleges, Distinguished guests,
Members of the Media,
Baagi ba North West Province, Fellow South Africans,
Ladies and gentlemen,
Dumelang! Good Morning!
Just last month on the 27th of April, our country celebrated a historic freedom day. Our province hosted the national celebration at which President Cyril Ramaphosa urged all of us to safeguard the gains of our democracy and to build on them because we owe it to the generations to come. Access to health care for all our people is one of the gains of our democracy. It is also a basic, fundamental and a Constitutional right which the liberation movement, the African National Congress, its alliance partners and other struggle frontiers fought for.
This ANC-led government is committed to continue the fight for access to health care such that when COVID-19 emerged as a threat to access to health, government introduced extraordinary measures including the state of emergency to ensure that our people are not denied access. Following on the heels of the COVID-19 pandemic, the country is now dealing with the outbreak of measles and mumps diseases, the two conditions that largely affect children. As I speak, the Department is embarking on a growing Provincial Measles Vaccination Campaign which currently stands at 216 confirmed cases from a total of 960 cases confirmed nationwide. The National Institute for Communicable Diseases (NICD) has also issued a provincial alert against the rising numbers of Mumps disease, especially in the Dr Kenneth Kaunda District as we are currently standing at 155 confirmed cases. I therefore urge parents, guardians and care givers to monitor children’s “Road to Health” cards to ensure that all necessary vaccines such as Polio, Measles, Mumps and others are duly administered to children.
We promised to integrate COVID-19 vaccination into other services in health facilities. I can attest to the fact that our health facilities are now providing
COVID-19 vaccination services as part of the broader health delivery programmes. It was always anticipated that we will get to this point where COVID-19 is contained because of the efforts that have been made through multi-sectoral collaboration which has now led us to achieve the population immunity we sought. It is not surprising that the World Health Organization (WHO) has now declared that COVID-19 is no longer a global health emergency, marking a symbolic end to the pandemic. This was recently confirmed by the WHO Director-General Dr Tedros Adhanom Ghebreyesus who also cautioned that the fact that COVID-19 is no longer a global emergency "does not mean COVID-19 is over as a global health threat." He further warned that the risk of new variants still remains.
It is therefore prudent that we continue to encourage all of our population groups particularly the most vulnerable like those with comorbidities to vaccinate. While we celebrate the fact that COVID-19 is no longer a global health threat, we must never forget unsung heroes of the COVID-19 struggle, our health care workers. We lost some of our frontline health care workers to COVID-19 and I am here to honour their selflessness and the high price they paid to save the nation. They will always be remembered. I also salute all our health care workers who continue to confront this struggle on all fronts including now also against measles and mumps.
Honourable Speaker and the House; the Department has enjoyed a steady progress as we continue to build on the success and the foundation of Section
100 (1) (b). We are therefore intentional in our effort to fast-track implementation of the remaining mandates of the Administration as well as strengthen and improve the audit outcomes.
This is evident in the fact that the department has managed to maintain its
unqualified audit opinion. In an effort to further improve, we have developed a Post Audit Action Plan (PAAP) to address matters of emphasis as raised by the Auditor-General (AGSA) and it has been reviewed by both Provincial Internal Audit (PIA) and the office of the Accountant General. Progress on the implementation of action plans is continuously being monitored.
Progress has been registered on the remaining activities of the Section 100 (1) (b), which are:
- Facilitate the approval of the Ideal Organisational Structure for the department
- Correcting the budget baseline for the Department to eliminate the on- going problem of accruals
- Stabilisation of the pharmaceutical section
- Improve spending on infrastructure budget
- Automation of Records Management
- Conclusion of key misconduct cases
I can report that, on facilitation of the ideal organisational structure approval, preliminary costing of EMS offices, EMS stations, forensic pathology services, medical depot and for Nursing as well as our EMS College has been completed. Focus group sessions were held with the District Health Services Branch to finalize structure models of Primary Health Care platforms and structure models for community health centres and clinics were completed.
The department continues to engage the Provincial as well as National Treasuries to correct the budget baseline and further eliminate the on-going problem of accruals. Provincial Treasury will be convening further discussions on this matter.
The Section 100 (1) (b) intervention has also made significant strides in ensuring availability of medicine and the department is continuing to maintain optimum medicine availability.
Automation of records management is progressing and thus far, approval has been granted for the clinical module pilot project which is to be run over a period of six (6) months at three health facilities in the province which are Klerksdorp Hospital, Taung District Hospital and Tlhabane CHC.
Successful facilities will be sustained beyond the three months pilot phase through the existing maintenance and support contract. In respect of electronic administrative records, specifications have been revised and in the process of approval.
The last remaining activity of the Section 100 (1) (b) is the finalisation of cases of misconduct. I can report that the Department continue to adopt a rigorous approach in tackling corruption, maladministration and any case of misconduct. We are resolute in ensuring that all these cases of misconduct are finalized within the minimum timeframe as directed by the law. I am pleased to report that, all these cases are at advanced stage with some having reached conclusion.
I can also report that, following the publication of the SIU investigations report on the PPE contracts, the Accounting Officer as expected has acted on all recommendations on disciplinary cases cited in this report for implementation. Guided by the sound relationship with our internal stakeholders and our cooperation through the formal available structures, we have availed all the necessary information to them for implementation of these recommendations with ease. We shall forever remain indebted to their cooperation and dedication.
The department is also assisting the SIU and DPCI (HAWKS) with various cases that are being investigated in terms of Proclamation R23 of 2020.
Madam Speaker, this financial year, the infrastructural interventions as the basis to improve our facilities and the basis for our facilities to be ready for the delivery of the National Health Insurance (NHI) and readiness for compliance with the Ideal Clinic or Ideal Hospital status will be as follows:
In the Ngaka Modiri Molema, the refurbishment of Gelukspan Hospital has resumed and while the contractor was appointed there are issues that must still be resolved between the contractor and the department. Once the project is finished the Hospital will be officially renamed “Prof Mokhobo Hospital” in recognition of the as Country's first black cardiologist, Professor Mokhobo who served in the first team of specialist negotiating on behalf of the first Democratic government the famous Nelson Mandela/ Fidel Castro Medical Student Exchange Programme. This will be in recognition of the role played by Prof Mokhobo in the country’s Cuban Medicine Exchange programme, and his overall contribution to our health system. The Department will give the Professor Mokhobo Foundation a special right to select at least four students (one per District) within the total number allocated to the Province on any intake for the Cuban Medical Student Exchange programme. Practically this means if the Province has a total of 20 students, the Department will select 16 and Professor Mokhobo Foundation will select 4 students but the criteria will remain a government prerogative.
The refurbishment of Lehurutshe Hospital will be done in this financial year. Upgrading of Motswedi clinic to a Community Health centre is resuming this financial year and the contractor has been appointed. The Department has
realized challenges of space in Mahikeng Provincial Hospital (MPH), hence we have approved a project for additional 100 beds in that hospital. This hospital will hospital will be renamed Kgosi Dick Montsioa Hospital in honour of the late paramount Chief of the Barolong, who was a veteran of the liberation movement, the ANC and a struggle icon.
The third phase of Bophelong Psychiatric Hospital has been approved and awarded for construction starting this financial year. This hospital will also be renamed to be Paul Daphne Hospital, a befitting honour for a selfless and dedicated revolutionary who contributed to the emancipation of the people of South Africa and later served the ANC-led government in the North West Province with dignity and display of true values of a public servant.
On the basis of dolomitic conditions discovered more than 10 years ago and reconfirmed through a report that was commissioned by the Department of Health in 2022 to ascertain the status of the old discovery of dolomitic condition in Thusong Hospital, the Department is proceeding with the long taken decision to decommission Thusong Hospital. The MEC has consulted the community of Ditsobotla especially the catchment areas of Thusong Hospital, arising out of this decision the following service delivery interventions are implemented in Ditsobotla and the main priority being strengthening patients care and better working conditions for our employees:
- The department is upgrading Itsoseng Community Health centre to become a District Hospital replacing Thusong Hospital, in this regard the Department agreed with the proposal during MEC public consultation not to remove the Hospital from the township to Lichtenburg town. This Hospital is now moved from the small community of Shiela to the more populated community of Itsoseng.
- Renovations have been done in the old Poly Clinic. This is to establish a 24hour service clinic to take away clinic services from the community health center that is being upgraded to a District Hospital. The 24hour Poly Clinic will be officially opened in July 2023 and this means an extra space available for the Itsoseng District Hospital.
- As we speak the Traditional council of Sheila has offered land to the Department for the purpose of deployment of a clinic standard compliant alternative building material (not later than October 2023) and later construction of the clinic.
- General De la Rey Hospital is now a stand-alone District Hospital with funded refurbishment programme in this financial year and this is meant to close any gap that may arise whilst Itsoseng District Hospital is still under construction. This means that Ditsobotla Local Municipality will now have two District Hospitals. General De la Rey Hospital will be renamed to be Edna Molewa Hospital, the first woman Premier of the North West Province, who also held various national ministerial roles and a former workers activist who also played many roles towords South Africa’s liberation.
With the service delivery gap in Tswaing because of the down grading of the then Delareyville District Hospital to Community Health Centre and the none existence of the District Hospital in Ratlou, the Department will start a process of planning and designing a District Hospital in the centre of Ratlou and Tswaing. The process of community consultation, development of business case and appointment of consultants will be done in this financial year. The Delareyville Bulk Pharmacy will be officially opened in February 2024 and will have both staff establishment, storage and distribution of medicines function in operation.
The Mafikeng campus of the North West Nursing College is under construction, and the approach will be partial occupation of each area of the college confirmed to be ready for occupation. The official opening of the Nursing campus is estimated at the end of November 2023.
On access to hospital services, with effect from August 2023, whilst remaining part of Ngaka Modiri Molema, Ottosdal will officially access hospital services in Dr Kenneth Kaunda in the Nic Bodenstein Hospital and Klerksdorp Tshepong Hospital because of their geographic location and distance between Ngaka Modiri Moleman hospitals and Dr KK Hospitals from Ottosdal. This service delivery improvement change will necessitate the review and adjustment of staff establishment and number of beds for Nic Bodenstein Hospital.
In the Dr Kenneth Kaunda District, construction has started in Steve Tshwete Clinic. This clinic will be officially opened in October 2023 and will immediate start operating 24hours. A contractor has been appointed for an additional space in Potch Hospital, and construction has also started at Marcus Zenzile clinic. In Boskuil, whilst the community and surrounding areas are served with the mobile clinic, the Department will procure a park home clinic and this park home should be available not later than November 2023 and immediately after commissioning this park home clinic shall then operate five days per week.
The design for the Community Health centre in Marquassi-Hills extension 10 has been finished, with the demand from the same Municipality to have the Hospital (Nic Bodenstein) to be constructed anew because of the age of the building and expensive maintenance demand. The Department will not have budget to construct a community health centre with new staff and a new District Hospital. However, the Department is working with the national Department
of Health to consider having the CHC ready designs with the old business case reviewed for a District Hospital in the same land that was availed for the Community Health Centre and only once construction has been completed Nic Bodenstein Hospital could formally relocate to the new Hospital.
The Ventersdorp Bulk Pharmacy will be officially opened in February 2024 and will have both staff establishment, storage and distribution of medicines function in operation. Ventersdorp Hospital was downgraded to a status of a CHC, but now with the population growth and growing disease burden and the need for district hospital services in the area, the Department will upgrade the CHC back to the original status of District Hospital with review of its staff structure, service package and infrastructure improvement. The Department is in the process of increasing the bed capacity by 20 additional beds. This facility will also be renamed Rita Ndzanga Hospital, a struggle heroine for the people of Ventersdorp and the rest of the country. She is also a recipient of the Order of Luthuli in recognition of her lifetime contribution to the struggle for workers’ rights and to the realisation of a non-racial, non-sexist, free and democratic South Africa.
The North West Nursing College, Excelcius campus is under construction, and the approach similar to the Mafikeng campus will be partial occupation of each area of the college confirmed to be ready for occupation. The official opening of the Nursing campus will be at the end of November 2023. Jourbeton CHC has been officially opened by His Excellency President Cyril Ramaphosa on 27 April 2023.
The Department has taken a view that Klerksdorp Tsepong Hospital complex should be renamed Dr Molefi Sefularo Hospital Complex. This is to recognize the role played by Dr Sefularo in the health fraternity in the ANC, in
the North West Department of Health and in the country as he served as the MEC of Health and then as Deputy Minister until his untimely death. From 1986 to 1991 he worked as a Senior Medical Officer at Thusong Community Hospital in Itsoseng. He then worked as the National Policy Co-ordinator at the National Progressive PHC Network between 1992 and 1993. Dr Sefularo also served as the Publicity and Information Secretary of the African National Congress (ANC) of the Itsoseng Branch up to 1993. In addition he served as Health Desk Chair of the ANC in Klerksdorp in the region of the Western Transvaal (now North West Province). In 1993 he began lecturing at Wits University until 1994.
Potchestroom Hospital is to be renamed as Josia Mpama Hospital, One of our struggle icons who led the 1928 campaign against residential permits in the Potchefstroom area after the local municipality tried to impose a system of lodger’s permits for Africans and one of the organisers of the 1929-1930 anti- pass campaign.
In the Bojanala District, refurbishment at Job Shimankana Tabane (JST) Hospital is in the bid stages whilst the design and business case stages have started in the project of the new Tertiary Hospital in Bojanala. The issue of availability of land has been resolved between the Department and Royal Bafokeng, and we are in the processing of finalising a memorandum of agreement (MOA). The mining houses still have commitment to their partnership with the Department of Health in this project. I can report that the working relationship with the mining companies and the mining industry in our Province is at the highest level in the area of delivery of health services. Arising from this partnership the following clinics developments were done by the mines, working with the Department:
Sibanye Stillwaters is currently upgrading the infrastructure of Marikana clinic and good progress has already been registered. When completed this clinic will be upgraded to a Community Health centre, whilst Sibanye Stillwaters is busy with Infrastructure the department will be dealing with reviewing the staff establishment for CHC and appointment with contracts starting from 01 April 2024. Mfidikwe Clinic, is under infrastructure improvement by Sibanye Stillwaters. When finished the NWDoH will increase its operational hours to 12h00 per day for 7 days per week. This clinic will be officially opened on 02 December 2023 and will be renamed Dr Keabetswe Rakoma clinic, in recognition of the young Cuban Medical student who died whilst in final year at Walter Sisulu Medical School.
Freedom Park Clinic which is a donation project by Impala has been completed and is ready to be handed over to the Department of Health. Lencoe Clinic was done by Amandabelt and is ready for handover to the Department of Health. Sonop Clinic was done by Sibanye Stilwaters and is ready for handover to the Department of Health while Hoekfontein Clinic which is done by Eland mine is still under construction. The Northam Platinum Mine, in partnership with the Department will commence the construction of Ramokoka clinic as a replacement facility. The project is currently at the final phase of the design stage. This will ensure full restoration of primary health care services to this community.
Koster Hospital original project for 2022 for the refurbishment of the hospital has been changed to construction of the new Hospital to replace the current Hospital. This arose out of the engagements led by the Mayor of Kgetleng Rivier Municipality. Following consultation with the community, the community requested a new hospital and as a listening government we accepted the proposal. Currently the issue of new Hospital in Koster is in the planning phase.
Lebotlwane Community Health Center project is in the final stages of planning and design and this is one of the priority projects for the Department.
In the Dr Ruth Sekgomotsi Mompati District, a contractor has been appointed and taken to for Ganyesa Hospital. Joe Morolong Hospital water challenge has been resolved and we appreciate the working relationship we had with unions and the District Executive Mayor including Naledi Municipality in this project. Taung Hospital, which is a refurbishment project will start before October 2023.
Madam Speaker, as the Department we must apologize to the people of Lekwa Temane on the delays experienced for reconstruction of the burnt Christiana Hospital. The main delay was caused by the project insurance claim between the National Department of Health and the contractor, and the delay by the Department on procurement of the alternative building material for temporal hospital structures. As I speak the procurement has been done for 38 bed facility which could be available in three months period and procurement for additional beds is still in process.
We should appreciate the donation by FNB for health technology and beds for the Hospital and the donation was received last year (2022). According to our revised plans the temporal structures for Christiana Hospital will be finalized before the end of October 2023. Currently service delivery is rendered through referrals and staff have temporarily been deployed to other facilities. The community should be happy that primary health care delivery has been restored in the town clinic that was also burnt last year. This clinic structure is now operational and will only be officially opened immediately after the Christiana Hospital 38 bed structure is available and ready in October 2023. Manthe
Community Health Center project is in the final stages of planning and design and this is one of the priority projects for the Department of Health.
Madam Speaker, the Department continues to focus its attention on maintenance of the existing health facilities through various programmes and term contracts that are being implemented. One on the implementation strategies for maintenance is through a Contractor Development Programme. We are in a process of appointing the project management consultants for this programme in the first quarter of 2023/24 financial year. In addition, a procurement process of Contractors will be done in the second quarter of 2023/24 financial year to fast-track implementation. A target of 44 contractors was set and the Terms of Reference (specification) for the targeted contractors in the category of CIDB Grade 2 to 5 is being developed. This programme is meant to advance three interrelated objectives as development of local SMME’s (grade 2-5 all specialities), poverty alleviation and empowerment through infrastructure, and strengthening maintenance of the current infrastructure.
Hospital and Clinical Support Services Branch is responsible for seven
(07) Hospitals made of 2 Tertiary Hospitals, 3 Regional Hospitals and 2 Specialized Hospitals. For the financial year 2022-23 tertiary hospitals saw a total of 523 115 patients (average of 43 593 per month). Regional Hospitals saw a total of 223 243 (average of 18 604 per month) while Specialized Hospitals saw a total of 33 383 patients (with an average patient visits of 2 781 per month) at the Outpatient Departments.
A total number of 18 768 operations were performed in Tertiary Hospitals and
11 035 in Regional Hospitals. The Caesarean Sections accounts as follows: Tertiary Hospitals conducted 5627 Caesarean Sections whilst Regional Hospitals
performed 3974. This accounts for 30% of operations in Tertiary Hospitals and 36% in Regional Hospitals.
All the three acute regional hospitals have been equipped with CT Scans with the resultant improved management and treatment of trauma and medical emergencies. Furthermore, the second cancer radiation therapy machine is now functional at the Klerksdorp/Tshepong hospital complex. We also procured neuro-navigation unit and anaesthetic machines. Some of the scarce skills such as Radiation oncologist, Radiologist, and specialist nurses have been appointed.
The Department has employed different categories of Community Health Workers who support different programmes to enhance health services at a local level. The Community Health Worker Programme focuses on maternal and child health, HIV/AIDS, TB and STIs, and Non Communicable Diseases. The different programmes supported are HIV Counselling and Testing (HCT), Home Based Care (HBC) and High Transmission Areas (HTA). We also have different categories of the CHWs in respect of the mentioned programmes which are categorized as Community Counsellors, Caregivers and Peer Educators.
The following are issues raised by the National Bargaining Council to ensure compliance with Community Health Worker Programme Policy which the Department is adhering to:
- Ensuring standardisation of payment of Community Health Workers in the Department
- Ensure adequate protection for payment of Community Health Workers through the PERSAL system
- Ensure the development of Standard Operating Procedure (SOP) for recruitment, selection, appointment, placement and remuneration of Community Health Workers.
- Ensure appropriate implementation and management of dispute resolution
- Implementation and management of Occupational Health and Safety processes for all Community Health Workers that is COIDA and UIF.
- The National Minimum Wage (NMW) Commission has also requested inputs in its investigation into the protection of Community Health Workers (CHWs) in South Africa. It had started an investigation into the wages and conditions of employment in the Community Health Workers (CHW) sector.
- It was reiterated that the terms of reference of the investigation are: “to investigate the wages and conditions of employment of the Community Health Workers in the health sector, with a view to establish a sectoral determination prescribing minimum wages and conditions of employment”.
- During the past year the department has employed 200 community health workers on a permanent basis, as Administration Clerks, Data Capturers, Pharmacy Assistants, Cleaners, Porters and student nurses.
Madam Speaker, with the serious health challenge and exposures by our institutions of higher learning students, the Department is going to establish a working relationship with the Higher Health, a unit responsible for health within the DHET. This relationship will be managed through an MOU between the NWDoH and Higher Health NW, which will focus on access to quality health care by the students. The MOU will also allow for the delivery of campus health services more relevant to students (as Youth friendly services). Furthermore, the Department will launch a Provincial programme of access to free sanitary pads by the students in the institutions of higher learning in the Province in August 2023.
Madam Speaker, with all the improvements in service delivery there needs to be a dedicated attention if we are to directly deal with and address the number of service delivery complaints that are sent or telephonically shared directly with
the MEC or with members of the Portfolio Committee. The following are key areas but not limited to:
On Quality assurance and service satisfaction, our people or clients are faced with different attitudes in the facilities, though there is an established culture of complaints or compliments or suggestion boxes administered with governance structures across the Province. It is clear that patients or clients prefer direct communication with either the MEC or members of the Portfolio Committee. True to their preferred option there is no complaint registered with the MEC or with the Portfolio Committee that has not been resolved to the satisfaction of the complainant and even quicker than the complaints resolution in the APP. The only challenge is that these many complaints resolved in time are not counted in the Departmental performance in the Annual Report or quarterly reports. In order to close this gap the Department is exploring the establishment of an official service delivery call centre operational for 24 hours which will have all communication modes and feedback mechanism to the complainants.
Through this service delivery call centre the Department will be able to introduce telephone bookings for facilities (clinics and hospitals) and home visits for the veterans and people with severe disabilities.
Mental health will continue to be strengthened and expanded as part of ensuring access by all our people. In the 2023/24 financial year, the 72 hour mental health observation services will be expanded by officially opening the Boitekong CHC Mental Health Unit. This financial year will also see the commencement of Phase 3 of Bophelong Psychiatric Hospital which is expected to expand access to mental health upon completion.
Emergency Medical Services (EMS) have been strengthened by purchasing and licensing 70 ambulances and 27 other red fleet vehicles including response cars, and planned patient transporters. The first 50 ambulances were launched by the Hon. Premier in Westvaal in August 2022 and the other 20 were launched by the MEC of Health in December 2022.
EMS has achieved the response time target for Priority 1 (Emergencies) for the better part of this financial year. However, the category P2, P3 response times are lagging behind. All vehicles have tracking devices installed that allows real time tracking thus improving availability. As promised in the last budget speech, the Department completed the project to centralise EMS command and control at a provincial level and this has already started to bear fruits of improved operations of EMS.
Furthermore, the strengthened implementation of Planned Patient Transport system to uplift more non-emergency patients from clinics and CHC's has helped improve response times due to availability of ambulances. I am happy to announce that the North West College of Emergency Care is accredited for Continuous Professional Development and Clinical Practice Guidelines through University of Johannesburg. In this financial year, we will focus on EMS communication centre and availability of ambulances through Full Maintenance Lease (FML).
Medicine availability remains a key strategic imperative that the Department will continue to pursue. Through continued implementing of the 5 Pillar Intervention Plan and the recommendations emanating from a report of experts that was appointed by both treasuries, the Department can report that:
In the current financial year, the medicine availability has been stabilized above 81%. As at the end of February 2023, ARVs was at 89,5%, Expanded Programme of Immunisation remained above 93,4%, Contraceptives 94.6%, TB at 79%, Oncology 81,7% and Diabetes Mellitus 85.8%. Medicine availability management is further improved by a reporting rate of 94.8% which has allowed us to actively manage medicine distribution effectively.
Furthermore, the financial management of pharmaceuticals has been improved resulting in 99% of the 2022/23 accruals being paid as well as operating the first ten months of the financial year without accounts being put on hold. The business processes in the Medical Depot has been improved to an extent that the accreditation was moved from grade C to grade A by the Pharmacy Council.
However, what remains is the medicine budget baseline that is still not in line with the services demands. The Department will continue to engage both provincial and national treasuries in seeking solutions to this matter.
As part of interventions, the Department managed to set up Pele Boxes through a partnership with developmental partners. Pele Boxes are smart lockers used as part of the facility fast lane modality. It provides stable chronic patients with medication from the locker at any time even after hours without assistance of any health worker.
Pele Boxes expand access and reduce patients waiting time to only two minutes, improves patient compliance and therefore health outcomes. So far the Department has Pele Boxes installed at twenty (20) facilities across the four districts. The Department intends to set up 3 new Pele Boxes in the financial year 2023-2024 in collaboration with relevant partners.
Madam Speaker, the 90-90-90 target strategy to address HIV and TB has been increased to 95-95-95 targets by NDOH in line with UNAIDS. Ninety three percent (93%) of the people living with HIV know their HIV status in the province. Seventy-three percent (73%) of those that are HIV positive are initiated and retained on care. Some are co-infected with HIV and TB. In that instance they are first initiated on TB treatment. In relation to the third 95 the Province is at 84% viral suppression of HIV positive clients initiated on treatment. The Province will continue to implement Phuthuma project in the four districts collaborating with developmental partners and other stakeholders in the effort to achieve the 95-95-95 targets.
The good news is that HIV positivity rate among clients tested reduced from 2.1% in 2021/22 to 1.8% by December 2022/23, while among the 15-24 years excluding ante natal clients reduced from 1% to 0.95%. The reported number of victims of sexual assault cases offered Post exposure prophylaxis (PEP) in public health facilities was 990 from April to Dec 2022. The Province is offering oral Pre- Exposure Prophylaxis (PrEP) in 197 health facilities and 5416 clients were put on the programme by December 2022. A total of 413 916 female and 16 545 607 male condoms were distributed from April to December 2022. The number of medical male circumcisions performed from April to December 2022 was 14 942, which is a decline from 2021/22 financial year. More efforts will be made to promote this service in this current financial year.
Madam Speaker, the whole of society in the North West Province must embark on actions aimed at preventing Non-Communicable Diseases (NCD's). Together with mental health, the NCDs are regarded as leading causes of mortality, morbidity and disability in South Africa (SA), with the NCDs accounting for 57.8% deaths in 2017 according to the Statistics SA Mortality Report (2017). In dealing with this challenge, the National Department of Health has developed the National Strategic Plan (NSP) for the prevention and control of non- communicable diseases in South Africa which we must all join hands to implement for a healthy society.
This NSP for the prevention and control of non-communicable diseases aims to have 25 million people screened annually for high blood pressure and glucose as a surveillance mechanism to ensure early detection and diagnosis. This calls for mass mobilisation of society at large and most importantly our primary health care (PHC) services must have a strong focus on health promotion to keep people healthy and to prevent secondary complications where people unfortunately have already fallen ill.
As part of preventing the NCDs through health promotion, our people must be encouraged to avoid the five key risks factors relating to chronic illness, namely dietary intake, lack of physical activity, tobacco use, harmful alcohol and drug use, and unsafe sexual behaviours. Successful health promotion interventions enables people to improve control over their health and its determinants, thus supporting the achievement of a more prosperous, just and sustainable future. The stakes are high and require full commitment by the whole of government and the whole-of-society.
Madam Speaker, with the leadership of the Premier and the Deputy Minister of Health, the North West Ex-miners Intervention has been activated by setting up of a governance structure and a task team. The Promulgation of the North West Ex-miners Intervention Programme Provincial Steering Committee and North West Ex-mineworkers Council was done and an Ex-mineworkers Intervention Summit was successfully held in May 2022. Benchmarking was also conducted in the Eastern Cape Province during June 2022 and from this visit and summit, a 5-year Strategic Plan has been developed. We have further been able to establish a Project Management Unit and 4 District coordinating Units.
A comprehensive and integrated resource mobilisation and funding plan was developed, and the province participated in the national budget bid for funding from National Treasury for execution of the ex-miners project. The province requires a minimum of R 291 million (out of the national bid of 1.1 billion rand). As part of the ex-mine workers project the NWDOH Established and activated One-stop-Centres in all 4 Districts:
- DKK: Westvaal Hospital activated in August 2022
- RSM: Old Vryburg Hospital activated in September 2022 and this will shift to Joe Morolong Hospital
- Bojanala: Andrew Suffy Memorial Hospital was activated in September 2022 and this will shift to Job Shimankana Hospital
- NMM: Mafikeng Provincial Hospital one stop centre was activated in October 2022.
A total amount of R4 189 010.61 has thus far been paid to successful beneficiaries.
The Department continues to work with various partners and governance structures to strengthen special programmes that provide services to the needy and vulnerable groups. A Disability Disclosure awareness campaign was conducted for Dr Kenneth Kaunda District employees while a health talk was held for the community with disabilities in the Dr Ruth Segomotsi Mompati District.
We also launched the Youth Zone Activations at 16 health facilities in all the four districts. A benchmarking workshop aimed at sharing the best practice on
implementation of Youth Zone Activations was done. All Senior Managers of the department participated in the Public Service Women Management Week activity. We also successfully held the Departmental event on 16 Days of activism for no violence against women and children.
The new Traditional Health Practitioners Committees were re-established comprising of 19 Sub-districts, 4 districts and 1 Provincial THP Committee and I had an interaction session with the newly established Executive Committee of the THPs as part of soliciting their input into health service delivery.
These Committees will coordinate smooth integration of traditional medicine into the primary health care system towards the realization of a Universal Health coverage for all South Africans by 2030.
Madam Speaker, one of the Strategic Goals in the Department’s Strategic Plan is to improve human resources for health by ensuring appropriate appointments, adequate training and accountability measures. Throughout the years the Department has made great strides in building capacity of its employees and unemployed youth from disadvantaged communities based on the Training Needs Analyses that have been conducted annually. Bursaries have been awarded to internal as well as unemployed youth to pursue studies in Allied Health Programmes as well as in medicine. This will still continue in the next financial year to improve service delivery.
During the 2022/23 financial year the NW Department of Health permanently employed a total of 1418 previously unemployed people through various advertisements and competitive selection. . In this financial year, 2023/24 NWDoH has identified 1429 replacement posts which could be filled provident National Treasury allocates the shortfall on the COLA adjustment.
Furthermore, in this financial year some of the areas that need attention are the up skilling of our internal staff who are employed as artisans and maintenance personnel in our health facilities. Such a skills programme must be able to equip the identified officials to operate as general residential repairers. These officials will be able to replace, repair and maintain minor domestic failures related to carpentry, plumbing, painting, electricity, flooring, window, gardening and fencing.
Another area that the Department will be focusing on is Supply Chain Management (SCM). Challenges that have been identified within this area are lack of appropriate SCM skills; some people in SCM posts with inappropriate qualifications; need for ongoing training and capacity building as the pool of candidates applying for posts with appropriate skills is limited which makes the filling of posts even if advertised challenging.
Moreover, twenty (20) new recruits made of 10 males and 10 females were added into the Nelson Mandela-Fidel Castro Cuban Medical Programme and a farewell for these learners was held in October last year. We also arranged an orientation-cum-teambuilding session for these recruits. Madama Speaker, the Cuban Medical Students programme has enrolled a total of 607 students since its inception. To date, a total of 407 have graduated and majority are now serving our communities particularly in rural areas. The total number of disqualified learners is 71, those deceased is 5 while another 5 have been affected by the new municipal border demarcations. We currently have 46 students in South Africa who are with the local universities in their final year. Those on internship are 199, another 123 is doing community service while 64 are currently serving bursary obligations post qualification.
Three (3) senior managers have been accepted into the Oliver Tambo Fellowship Programme (OTFP) to pursue Post Graduate Diploma in Health Leadership offered by the University of Cape Town. Another twelve (12) managers (mixed group of SMS and MMS) were accepted into the Albertina Sisulu Executive Leadership Programme in Health (ASELPH) offered by the University of Pretoria while one (1) Senior Manager was accepted for a two- year programme in Epidemiology and Biostatics offered by the University of Pretoria.
I am happy to report that, as part of creating learning and job opportunities for the youth, the Health and Welfare Sector and Education Authority (HWSETA) has approved funding for the following Programmes: Internship: Fifteen (15): TVET learners and Pharmacy Assistant Programme (Employees: (Basic: Thirty (30); Post Basic: Fifteen (15).
Furthermore, the approved ideal staff structure is currently undergoing consultation processes, which in turn will have a positive impact on improvement of appointments of personnel as well as filling of critical and replacement posts to reduce the vacancy rate. The Department continues to replace staff that leave its employment. Although an increase in the budget allocation for compensation of employees is necessary, professionals are appointed as far as possible upon completion of community service through competing for advertised posts. It is important to note that our COE budget does not allow us to appoint all health professionals who complete community service, resulting in some having to be released from their bursary obligation even before they serve.
Honourable Speaker and the House, I am happy to report that progress has been registered with the conditional accreditation for the North West College of
Nursing which has been approved by the South African Nursing Council to provide training in three programmes, namely; Diploma in Nursing, Higher Certificate in Auxiliary Nursing and Diploma in Midwifery.
The Nursing College has prioritised the Primary Nursing Care, Midwifery, Child Care Nursing, Critical Nursing Care, Mental Health Care and Trauma Nursing specialist postgraduate diploma programmes in line with the burden of disease in the Province. However there is a shortage of lecturers with appropriate postgraduate qualifications. In order to address the challenge encountered by the Nursing College, the Department has prioritised bursaries for lecturers to ensure that they acquire the required qualifications that will allow the College to meet the skill mix demands of the province.
The College of Emergency Care is hard at work to get its accreditation finalized with the Council of Higher Education (CHE) and the Health Professions Council of South Africa (HPSCA). This College is also committed to up-skill its personnel as part of its accreditation needs, hence the Department has prioritized the awarding of bursaries to Emergency Care personnel and the unemployed youth.
Budget per Programme and MTEF Allocation
Honourable Speaker and the House; I present to you the health budget allocation for the 2023/24 financial year which is R 15 219 592 (Fifteen Billion Two Hundred Nineteen Million Five hundred and ninety-two thousand) as indicated by North West Provincial Treasury. The budget is spread amongst the eight programmes and economic classifications of the Department as follows:
FINAL ALLOCATION FOR 2023 BUDGET PER PROGRAMME
PROGRAMMES - R'000 - WORDS
Administration - 1 024 488 - One billion, twenty four million and four eighty eight thousand
District Health Services - 7 555 308 - Seven billion, five hundred and fifty five million, three hundred and eight thousand
Emergency Medical Services - 465 965 - Four hundred and sixty five million, nine hundred and sixty five thousand
Provincial Hospital Services - 2 183 729 - Two billion, one eighty three million, seventy hundred and twenty nine thousand
Central Hospital Services - 2 241 007 - Two billion, two hundred and forty one million, seven thousand
Health Science and Training - 285 856 - Two hundred and eighty five million, eight hundred and fifty six thousand
Health Care Support Services - 771 576 - Seven hundred and seventy one million, five hundred seventy six thousand
Health Facilities Maintenance - 691 663 - Six hundred and ninety one million, six hundred sixty three thousand
Total - 15 219 592 - Fifteen billion, two hundred and nineteen million, five hundred and ninety two thousand
Honourable Speaker and the House; it is without a doubt, health care is everybody’s business and that is why the Department wishes to acknowledge the partnerships we have with the private sector and the broader health stakeholders in provision of health services across the province. We continue to enjoy a solid partnership with the Rustenburg Health Forum which consists of a collective membership of the Department in the Bojanala District and the mining houses of the entire district. This partnership has made significant strides in the past towards injection of resources in improving access to health services in the mining and peri-mining areas. We need to focus more on establishing such working relationship with cement manufacturers dominantly based in Ngaka Modiri Molema. In Dr KK we have a solid working relationship with Harmony Gold and this is evident in the deliberation between Harmony
Gold and the Department on the future of Westvaal Hospital. This engagement must be extended to other mining houses. The contribution of Sibanye Mine who has approved a budget to purchase emergency vehicles by the end of April 2023 is a big plus in our efforts to improve ambulance response time.
We remain indebted to the valuable contribution, leadership, oversight and guidance from the Provincial Executive Council (EXCO) led by the Hon. Premier and his Office, the Provincial Treasury, Auditor-General and Portfolio Committee.
I recognise the role of different labour unions in all our facilities and urge them to continue to be a partner in addressing all issues that affect our employees and who are their members, and we should also value the principles enshrined in the Constitution on the “Right to strike” governed through the bargaining process as not opposed to the “Right to access Health care”
At facility level, the role of our Governance structures remain valuable as representatives of our communities in health care delivery. A word of appreciation also goes to the management structure of the department led by the SG. Let me also acknowledge all our staff members at all levels including nurses, doctors, community health workers and staff in the administration whom we rely on to provide service-friendly and quality health services to our people.
I take this opportunity to congratulate my predecessor, the former MEC for Health in the North West Province, Dr Magome Masike who was recently appointed the new Registrar/CEO of the Health Professional Council of South Africa (HPCSA). I wish him well in this responsibility that is important for regulation of registration of healthcare professionals, a mandate necessary for the advancement of the NHI.
Madam Speaker, the goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. Our country is determined to implement the National Health Insurance (NHI) and in the North West Province, we continue to strive towards universal health coverage and NHI through a number of programmes. In the 2023/24 financial year, there will be extra funding for oncology services and we will further increase the number of health professional contracting through NHI funding.
For a community or country to achieve universal health coverage, several factors must be in place, including:
- A strong, efficient, well-run health system that meets priority health needs through people-centred integrated care (including services for HIV, tuberculosis, malaria, non-communicable diseases, maternal and child health) by:
- informing and encouraging people to stay healthy and prevent illness;
- detecting health conditions early;
- having the capacity to treat disease;
- And helping patients with rehabilitation.
- Affordability – a system for financing health services so people do not suffer financial hardship when using them. This can be achieved in a variety of ways.
- Access to essential medicines and technologies to diagnose and treat medical problems.
- And lastly, a sufficient capacity of well-trained, motivated health workers to provide the services to meet patients’ needs based on the best available evidence. That’s what we strive for and together we can make it happen. Let us therefore work together to improve access to health care for all our people! Let us grow North West together!
I thank you!
