Honourable Speaker;
Honourable Deputy Speaker;
Honourable Premier;
Honourable colleagues in the Provincial Executive Council; and
Honourable Members of the Provincial Legislature.
As I rise to introduce 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 the province enjoy good health for a better life. The mandate that was received by the ANC government 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 therefore introduce this Annual Report against the background of strides we have made to stabilise the department. I can say without equivocation that the Turn-Around Strategy which we launched in July in the year under review laid a solid foundation for us to prioritise delivery of quality health services and allocate resources appropriately.
You will recall that 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. I also outlined the measures we had undertaken to bring about organisational stability in the department in order to focus on our core business which is delivery of quality health services.
Honourable Speaker,
A lot of work has been done in this regard. 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 of Emergency Medical Services (EMS), HIV and AIDS and Primary Health Care.
As at 31 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. A small portion of invoices relating to previous financial years but processed in the current financial year is undergoing a prepayment audit. There were instances where hospital equipment would be broken and remain unrepaired and this resulted low morale among health professionals of all categories.
I can now confidently state that we are steadily moving away from that era. In order to crystalize the Turn around Strategy, we have developed a Hospital Enhancement Plan which is being implemented in 20 of our hospitals. This Enhancement plan is a blue print to stabilise hospital services.
It will guide us beyond the current term of office. It will permeate every ward, and every clinical area of each hospital. All levels of staff are beginning to understand that it is no longer business as usual.
We have also allowed for 70% direct procurement and delivery of medical supplies to the Central, Tertiary, Regional and Specialised Hospitals. While acknowledging that not all hospital will have the same capacity, we will provide appropriate support.
This will ensure more efficient supply to these hospitals and free up the Depot to deliver more effectively to District Hospitals and Primary Health Facilities.
With regard to hospital equipment, we will purchase directly from suppliers. This will ensure that we exclude middlemen/women or agents to address 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 (three to five years) with suppliers on an “as and when” required basis, based on fixed term contract prices.
We are in the process of identifying up to ±10 industry recognised suppliers and maintain them on a database. This will require that clinicians are involved in decision making, in order to ensure accountability.
Our primary mandate is provision of Quality Health Care; economic empowerment is secondary Therefore resources which are at our disposal will be used to improve health care at our facilities. 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 Gauteng Medical Supplies Depot in the first quarter of the financial year which resulted in restoration of pharmaceutical services at the depot.
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. We only over-spend on two programmes; namely Emergency Medical Services by 8% and Central Hospitals by 4.4%. 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.
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 allocation. Overtime in excess of 30% has to be approved by the Head of Department.
We are monitoring attendance, leave and absenteeism very closely, and we have not hesitated taking 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-categorised. 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.
With regard to District Health Services, we have appointed Specialist Teams in all five of our districts; this includes establishing 50 Ward Based Outreach Teams, and 50 School Health Teams. This will allow us to focus on health promotion and prevention of illness. Our thrust is on increasing the percentage of pregnant women who book for antenatal care before 20 weeks.
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 immunisation coverage at 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!
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.
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%.
Honourable Speaker,
We continue to strengthen hospital management. We are inculcating a culture where nurses and clinicians involve themselves and are accountable for operational management processes by establishing management structures at Ward level, Clinical Department level, and General Management level.
Clinical Managers are ensuing that clinicians take more responsibility and accountability for clinical decisions and the effective and efficient management of resources and their availability.
We have prioritised strengthening management and leadership through increased delegation and authority to hospital CEO’ 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 CEO’s of all Central Hospitals to the level as allowed for items, which are non-urgent. These delegations will be reviewed in line with the new post levels of CEO’s. We have also prioritised 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 stabilising the leadership and management of the under-resourced Legal Services unit.
We will appoint a Deputy Director-General for Legal Services in the current financial year. We are also finalising 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 will be on training doctors and nurses to follow protocols and procedures. We will ensure that core equipment is available and functional. I will also appoint a panel to advise the department on cases, 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 will be scoped and planned without the involvement of our 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 to intervene politically. That is why Honourable Members, we have not rushed to open Jabulani/Zola and New Natal Hospitals. The reason being we want to be satisfied that all required equipment is installed and tested. We owe this to our people who have waited for too long. We cannot render services in facilities which are not fully functional.
Honourable Members,
This is the last Annual Report I present to this august house before the end of the current term of office. Despite the challenges that we faced as a Department, we never wavered from the mandate of our people through the African National Congress. We will continue to implement the commitments which we made at the beginning of the term in 2009.
I take this opportunity to that the Honourable Premier for her leadership, my predecessor MEC Ntombi Mekgwe, my colleagues in the Executive Council for their collegiality, members of the ANC Caucus for their support, and the Chairperson of the Health Portfolio Committee and its members for their robust oversight.
I also thank the Chief Financial Officer of the department, Mr Ndoda Biyela, for holding fort for the past ten months as the Acting Head of Department.
At the same breath I welcome the new Head of Department, Dr Hugh Gosnell, who assumed his duties on 2 September this year, I am confident he will guide the department to fulfil its constitutional mandate.
Without our dedicated staff we will not have weathered the storms that we faced!
Fact sheet
Department’s achievements as outlined in the 2012/13 annual report
- To strengthen primary healthcare, a ward based outreach teams are now functioning in 49 municipal wards alongside school health teams and district health specialists’ teams.
- The department provided a total of 43 251 assistive devices such as wheelchairs and hearing aids to persons with disabilities, including children.
- 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 immunisation coverage at above the national target of 90%.
- A total of 151 000 children benefitted from the department’s tooth brushing projects
- Education in correct hand washing technique benefitted 104 103 learners from 138 schools
- More than 700 child minders and 150 community members received training on how they could contribute to the management of childhood diseases.
- 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 2011/12. We will continue to strive for 0% transmission!
- At the end of March this year, there were 693 136 adults, and 41 172 children receiving Anti-Retroviral Treatment in 364 sites (an increase from 359 in the previous financial year) in Gauteng.
- The department achieved Mother and Baby Friendly accreditation for an additional five institutions, bringing the total number to 48 facilities.
- Dedicated health services for teenagers and young adults were strengthened and the number of youth friendly services was increased to 121 facilities.
- In order to improve the diagnosis of TB, including the drug resistant forms of TB, we have expanded the availability of GeneXpert machines to an additional seven institutions.
- 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%.
- The overall headcount of patient visits to PHC facilities in province increased from 22 711 585 in 2011/12 to 23 063 294 in 2012/13, presenting a two million increase on the number of expected visits.
- In addition, 1 853 400 patients attended Out-Patient Departments (OPDs) at regional hospitals and 2 597 531 were seen at OPDs of central hospitals.
- Significant progress has been made in relation to screening for cervical cancer among women aged 30 years and older. Presently about 44% are being screened. The target is to increase screening coverage to 70% by 2019/20 financial year.
