Honourable Speaker
Honourable Deputy Speaker;
Honourable Premier;
Honourable colleagues in the Provincial Executive Council; and
Honourable Members of the Provincial Legislature and
Guests
As I rise to debate the Gauteng Department of Health 2012/13 Annual Report, I am mindful of the fact the ANC Government is committed to ensure that the people of this province enjoy a relative good health for a better life.
The resounding mandate that was received by the ANC in four successive elections since 1994 continues to guide the Department in the implementation of policies and programmes that ensure the delivery of quality health services to the people of Gauteng.
I can say without any doubt that the 2012-14 Turn Around Strategy (TAS) which we launched in July 2012 laid a solid foundation for us to prioritise the delivery of quality health services and allocate resources appropriately and rationally.
We have not shied away from confronting short-comings within our own systems. We did this against an increase in the disease burden and the demand for health services. From the sheer numbers of people who use public health facilities, access to health services is no longer an issue of debate in Gauteng. Our focus is to improve the quality of services that we render.
When I tabled the 2013/14 Budget Vote in May this year, I recounted the challenges that we faced at the beginning of this term of office in 2009. I also outlined the measures we had undertaken to bring about organizational stability in the Department in order to focus on our core mandate which is the delivery of quality health services.
Honourable Speaker,
At the end of the financial year we reported accruals to the value of R3.8 billion. This included amounts due to municipalities for transfer payments for Emergency Medical Services (EMS), HIV & AIDS and Primary Health Care.
As at the 31st January 2013, we had settled accruals to the value of R4.2 billion. This included commitments of the previous financial year which would have become payable in the current financial year. We have settled approximately 99% of the total accruals that were owed. To date the department has paid amounts relating to the previous financial year to an amount of R725 million. We have decided not pay any further amounts until the process of auditing prior year invoices has been concluded. This work is being done with the assistance of the Gauteng Provincial Treasury.
Because of the financial crisis and systems problems the department faced before the development of the Turn Around Strategy, there were instances where hospital equipment would be broken and remain unrepaired for longer periods. This resulted in low morale among health professionals of all categories.
I can now confidently state that we are steadily but surely moving away from that difficult era. In order to strengthen the Turn Around Strategy, we have developed a Hospital Enhancement Plan which is being implemented in 20 of our hospitals. These are Central, Tertiary, Regional and Specialised hospitals. This enhancement plan is the basis of the Development Accord Minister of Health Dr Motsoaledi and I signed with the University of Witwatersrand in July 2013. This enhancement plan is a blueprint to stabilize hospital services. This will allow us to pay more attention on Primary Health Care which is the backbone of our health system.
Last Friday we launched the Provincial Re-engineering of Primary Health Care programme, in Orange Farm. The impact of this programme is already evident in more pregnant women coming for ante natal bookings before the 14th week of pregnancy. We have established 85 Ward Based Outreach Teams against a target of 72. These teams have already visited 48 235 households and referred 9 116 people to clinics, and seen 3 468 pregnant women. They have seen 5 744 women within six weeks of child birth. They have also seen 46 144 children under the age of five with a special focus on ensuring that they are immunized against a host of preventable diseases.They have also provided support to ensure treatment adherence to 41 559 people who are on either TB or Anti-Retroviral Treatment.
Honourable Speaker;
In order to ensure that the Turn Around Strategy is translated into practical and measurable interventions, we developed a Hospital Enhancement Plan to guide the Department beyond the current term of political office. It is being implemented in every ward, clinical area of each Regional, Tertiary, Central, and Specialized hospitals.
All levels of staff are beginning to understand that it is no longer business as usual. Clinical work is linked to proper and efficient management of resources.
We have also allowed for up to 70% direct procurement and delivery of medical supplies to the above-mentioned 20 Hospitals. While acknowledging that not all hospitals have the same capacity, we are providing appropriate support to ensure uninterrupted supply of medical supplies.
This will ensure more efficient supply to these hospitals and free up the Depot to deliver more effectively to all the District Hospitals, community health centres and clinics.
With regard to hospital equipment, we will purchase directly from supplying manufacturers. This will ensure that we exclude middlemen/women or agents to address our immediate challenge and shortages. Experience has taught us that these agents cannot be locked into maintenance contracts, thus forcing us to go back to primary producers. We will enter into term contract (3 – 5 years) with suppliers on an “as and when” required basis, based on fixed term contract prices. The tender for buying the medical equipment, is already out and is being managed. We hope this process will help us to identify industry recognised suppliers to maintain them on a database. This process is going to involve clinicians and other health professionals in decision making on the acquisition of this medical equipment to ensure accountability. The measures I have just outlined laid a firm foundation for improved service delivery.
We continued implementing cost-saving measures which we had introduced in the 2011/12 financial year. We also settled a number of debts at the Medical Supplies Depot in the first quarter of this financial year which resulted in restoration of pharmaceutical services.
Some of the drug shortages which we experienced in the year under review were largely attributed to lead times of suppliers between production of drugs and deliveries. The department spent 99% of the budget in the year under review, meaning that we were within budget. Over-expenditure on Emergency Medical Services was due to payment of accruals for goods and services and transfers to municipalities. Over-expenditure on Central Hospitals was largely due to payment of accruals and ever rising medical inflation and the cost of blood and blood products. We are working hard to monitor and reduce expenditure on laboratory tests, blood and blood products. We are also in discussion with the National Minister to deal with problems associated with the billing from the National Health Laboratory Services.
With regard to Human Resources, we are implementing the national staffing norms for all categories of staff and levels of care. This is being piloted in the Tshwane Health District as part of the preparation for implementation of National Health Insurance.
We continue with strict management of Remunerative Work Outside the Public Service (RWOPS) and overtime in alignment with service delivery needs and budget. Overtime in excess of 30% has to be approved by the Head of Department. The Minister of Health Dr Motsoaledi has put together a national team consisting of Deans of all Medical Schools and representatives of the South African Medical Association (SAMA) to work on a national framework to tightly regulate RWOPS. The National Health Council (NHC) will finalize the matter and announce how the country is going to better and effectively manage RWOPS to ensure there is no disadvantage to public health.
We are monitoring attendance, leave and absenteeism very closely, and we have not hesitated to take disciplinary action in instances of transgressions. We filled most senior management positions which had been vacant for a period of time and these include; Chief Financial Officer; Head of Infrastructure; Chief Director: Health Economics; Chief Director for District Health Support Services; and Chief Director for Information and Communication Technology.
We also appointed Chief Executive Officers for the four central and three tertiary hospitals which had been re-categorized. Filling of these posts is having a positive impact on service delivery and planned programmes. These appointments are accompanied by delegation of authority and Performance Management Agreements which are aligned to the National Service Delivery Agreement.
In the year under review, 211 144 babies were delivered at our facilities. Post-natal coverage within six weeks of birth increased from 60% to 85% for mothers and from 60% to 85, 5% for babies. We have also maintained the rate of immunization coverage at over 100% above the national target of 90%. The number of males who underwent Medical Circumcision at our facilities increased from 51 205 in 2011/12 to 94 059 in the year under review.
We have made strides on Prevention of Mother to Child Transmission of HIV. The rate of transmission stood at 2.4% in the year under review compared to 3.6% in 2011/13. We will continue to strive for 0% transmission! This is possible in Gauteng, as we believe that NO CHILD SHOULD BE BORN HIV POSITIVE!
At the end of March this year, there were 693 136 adults, and 41 172 children receiving Anti-Retroviral Treatment in public health facilities in Gauteng. This treatment is now available in 364 public health facilities. This increase is also attributed to 5 582 nurses who were trained to initiate treatment. We condemn any health worker (part time or full time) who sell ARV's or any medication to any person as it happened at the Esselen clinic.
TB continues to be number one killer among HIV positive people. More than 70% of TB patients are also HIV positive. At the end of the year under review the TB Cure Rate stood at 82, 4%. The treatment defaulter rate was at 8, 4% against the target of 5%. We have already put in place a plan this financial year to reduce the defaulter rate.
Honourable Speaker,
Just to repeat, we are continuing to strengthen hospital management. We are inculcating a culture where nurses and clinicians involve themselves and are accountable for operational management decisions by establishing management structures at Ward level, Clinical Department level and General Management level.
Clinical Managers are ensuring that clinicians take more responsibility and accountability for clinical decisions and the effective and efficient management of resources and their availability. We have prioritized strengthening management and leadership through increased delegation and authority to hospital CEOs commensurate with categories of hospitals they manage.
This is being achieved by empowering them through providing a contingency budget of between 2-4% for emergency procurement and delivery of non-negotiable items on an urgent basis to ensure that there are no stock-outs of critical and essential items.
We have increased the delegations to the CEOs of all Central Hospitals to the level as allowed for items, which are non-urgent. These delegations are being reviewed in line with the new post levels of CEOs. We have also prioritized building relationships among all categories of staff with greater involvement of nurses and clinicians in operational management processes by establishing management structures at ward level, clinical department level, and general management level.
While it is not financially prudent to budget for litigations resulting from medical negligence, we are taking pro-active measures to reduce these. To this end, we are stabilizing the leadership and management of the under-resourced Legal Services Unit. We have already appointed a Deputy Director General for Legal Services. Because Health remains a preoccupation of the Provincial Executive Council (PEC) legal advisers from other GPG departments have been seconded to the department to assist with the backlog of cases. We are also using the skills of 5 Advocates and a retired Judge to categorise all the cases so that we can decide which cases are genuine and medical negligence for which we will enter into discussions with affected parties for purposes of settling and cases we will contest in court because of false allegations against our health professionals. It should be noted that some of the lawyers at the forefront of litigations against the department were operating and making a lot of money within the Road Accident Fund space which has now being closed.
We are also finalizing a policy which bars department officials from testifying against the department in litigation cases. Hospital CEOs report disappearance of patient’s files to SAPS.
Experience has taught us that most medico-legal cases emanate from Obstetrics and Gynaecology. Therefore, focus is on training doctors and nurses to follow protocols and procedures. We will ensure that core equipment is available and functional and consumables are available. I will also appoint a panel to advise the Department on cases to manage Serious Adverse Events and strengthen compliance to procedures.
Honourable Speaker,
We continue working with the Department of Infrastructure Development to ensure that our health facilities are maintained regularly and new projects are completed within time frames.
To this end no new project is being scoped and planned without the involvement of Health Infrastructure Management officials. As a client, we have a right to input into planning and scoping of projects. Where there are bureaucratic bottle necks, there are mechanisms in place for MEC Mahlangu and I, are able to intervene politically with the HOD's of the two departments.
Honourable Speaker and Members,
We are debating the last Annual Report before the end of the current term of office. Despite the challenges that we faced as a Department, we never wavered from the mandate given to the African National Congress by the people. We will continue to implement the commitments which we made at the beginning of the term in 2009.
We have taken note of the issues that have been raised by the Health Portfolio Committee and SCOPA. The 2012-14 Turn Around Strategy which are implementing, is yielding positive results. It is no longer business as usual!
