Honourable member of the mayoral committee for health in Mogale City
Senior managers from the Gauteng Department of Health
Senior managers from municipalities
Representatives from university health faculties
All categories of managers present
Esteemed researchers
Distinguished guests
Ladies and gentlemen
It brings me great pleasure to open and welcome you all to this 12th annual Prakash Vallabh Primary Health Care (PHC) Research Conference.
Programme director, it is proper to mention here today, that this annual gathering named after a selfless, dedicated son of the soil, Dr Prakash Vallabh, marks the occasion to pay tribute to his contributions to our people. He served South Africa and Gauteng in particular with distinctions at challenging times. Let me tell you something about Dr Prakash Vallabh that should inspire how we approach our daily work. He was solution driven to the challenges that he encountered at that time.
He courageously defied the inhumane policies of the apartheid regime and continued to provide health service to thousands of needy and vulnerable communities in Soweto. He would volunteer his time and energy after a hard day’s work and often weekends, seeing patients at PHC facilities in Soweto and expected no reward or favour in return.
Dr Prakash Vallabh was very passionate about immersing himself in the thick of things; hence his entire career was dedicated to delivery of quality health services through primary healthcare. When he was mowed down by blood thirsty criminals at his driveway in Lenasia, he had already laid the foundation with our government, on how primary healthcare could improve the health status of our people, especially those who did not enjoy medical insurance. Indeed he set the standard which all of us here today must look at as a benchmark for our work.
Our department continues to strive for delivery of quality health services, by availing dedicated doctors at primary healthcare level. In the ANC Election manifesto we stated that we shall invest in research and development in the health sector, including infant mortality research, HIV prevention technologies, and health status surveys.
The 2008 World Health Organisation’s report entitled Primary Healthcare: Now More Than Ever, also states clearly that “only through building and strengthening health systems will it be possible to adequately address preventable causes of morbidity and mortality”.
It is therefore heartening that this research conference was as a result of an identified need for a formalised platform for sharing research information and best practice with regard to delivery of quality health services at primary healthcare level. In other words research that is undertaken at this level is unique in the sense that the researchers themselves are health practitioners at primary healthcare level.
With their expertise they empower health professionals to be innovative in order to improve service delivery at primary healthcare level. This year’s conference under the theme ‘Implementing Change through Primary Healthcare Research,” will emphasise the need to bridge the existing gap and harmonise the working relations between budding researchers and established ones. This is a critical component for developing promising researchers.
Gauteng is the biggest province in South Africa in terms of population size. According to the Statistics South Africa mid-year population estimates, (2009), 10,5 million people live in this province. Over the past few years, on average our population has increased at a rate of 2.4 percent per year, and currently 20 out of 100 South Africans live here. The male and female breakdown of the population is 5,2 and 5,3 million respectively. Of interest to you researchers and policy makers too, is that a good 17.9 percent or 2,78 million people in Gauteng are younger than 15 years.
In Gauteng, the life expectancy at birth for women and men is 60.8 and 57.3 percent respectively; it is higher than the national average but still indicates lowering of the quality of life. The increasing number of population also means an increase in the burden of disease. In our country, Gauteng is one of the provinces with the highest HIV and AIDS prevalence.
I am highlighting these demographics in order for you to understand the policy context and direction that our merged Department is pursuing. The current global economic meltdown has also compounded our challenges. For example, Statistics South Africa (2009), reports that 360 000 jobs have been shed due to this economic melt down in the past twelve months. Out of this figure, 77 000 of the jobs were lost in Gauteng alone. Unemployment amongst women is rife in Gauteng, currently at 26 percent, when compared to 22 percent amongst men.
This has an adverse impact on vulnerable people such as the older persons, the unemployed particularly young people, children, women, people with disabilities and those living in informal settlements. The fight against HIV and AIDS is constantly pulled back by other social ills that affect these vulnerable groups, women, youth and children in particular. There is some growing evidence that Gauteng direct health information system (DHIS) has the highest number of termination of pregnancy among teenagers.
There are a number of reasons that have alluded to this state of affairs in qualitative studies that have been conducted. Many studies point to a lack of proper and holistic family planning and education, of which all these are exacerbated by poverty and disempowerment.
Programme director, if we do not address eradication of poverty adequately and become slack in our quest to combat HIV and AIDS, we will struggle to reduce child and maternal mortality. It is for this reason that we must strengthen primary healthcare, and address these issues as developmental issues instead of treating them parochially as health problems. We need to ask ourselves uncomfortable questions such as:
* Why do we still have a high rate of births before arrivals according to DHIS in certain parts of this province, if we are the geographically smallest, and have infrastructures which are well developed when compared to other provinces?
* Could it be poor management at district level?
* What is to be done from today onwards?
When I read the conference programme, I noticed that there are a number of presentations in the mother and child health sub theme, and this is commendable.
The site of implementation is not located at head office or regional offices. It is at facility level that we will achieve millennium development goals number four, five, and six.
The role of these offices in this regard entails providing support. The strategic focus for the next three years is reducing child mortality and improving maternal health, thereby accelerating progress towards achieving millennium development goals.
We have identified a need for a more comprehensive approach to achieving all millennium development goals and not only focuses on goals number four, five, and six. I dare say that we will struggle to achieve goals number four, and five (which are about reducing child mortality and improving maternal health), if we do not have an integrated approach to tackling goal one (which refers to reduction of poverty), and goal number six (which refers HIV and AIDS).
It follows therefore, that researchers must ask local questions. Managers on the other hand have an obligation to listen to these recommendations and adopt new approaches. If we apply all suggested primary healthcare interventions as outlined in the Alma Ata declaration, I have no doubt in my mind that even in the presence of HIV and AIDS we should be able to contain tuberculosis in this province.
I implore researchers and programme managers, to ask the right questions in their context, to develop new projects and improve operations and finally genuinely assess your progress routinely (monthly) with the sole aim of There is no doubt that we have very good health policies, but these alone will not guarantee delivery of quality health services.
Most of you will agree with me that it is not always insufficient budgets that are responsible for a failing health system. The per capita spending in Gauteng does not correlate with how we are performing when assessed through health outcomes. The ten points which is now our road map, which I am sure all of you can recite by heart with full comprehension as well, identifies management at strategic and operational levels as solutions to achieving better health outcomes.
If personnel and existing resources are not deployed where they are most needed, health systems generally fail. Managers at operational level should have basic knowledge of how the health care system functions in order to address shortcomings and to measure progress after corrective strategies have been implemented. Therefore primary healthcare research becomes useful when it provides information that is relevant to that particular facility or community.
In the 2009/10 Health budget speech which I tabled on 4 August 2009, I emphasised the need to prioritise the vulnerable (women, geriatrics and youth) if the province is to make a considerable improvement towards achieving millennium development goals. These groups are the ones that are mostly affected by poverty and other social ills, they are mostly dependant on government, and HIV and AIDS appears to affect them more than any other group.
I wish you well in your deliberations and trust that the knowledgeable researchers here will present work that will inspire you to go back after this conference and develop new research questions and conceptualise new projects mindful of the strategic and developmental goals and context at national and global level.
Ladies and gentleman, if research is useful at a facility level or within an operational business unit, it is almost guaranteed that it will be useful for the entire health system.
I leave you to ponder the words of one of the giants in science, Albert Einstein: “The whole of science is nothing more than a refinement of everyday thinking; we can't solve problems by using the same kind of thinking we used when we created them”.
I implore you to continue to be innovative, in order to find sustainable interventions that will address the challenges that we face as we seek to improve the health status of our people.
Issued by: Department of Health, Gauteng Provincial Government
1 September 2009
