Social Services Mr Sipho W Lubisi
8 June 2007
Honourable Speaker and Deputy Speaker
Honourable Premier
Members of the Executive Council
Esteemed Members of the Provincial Legislature
Traditional Leadership
Labour and Business Leadership
Faith based, Traditional Healers, non-governmental organisations (NGOs) and all
social formations
Management and Staff of the Department of Health and Social Services
Distinguished guests
Members of the media
Ladies and gentlemen
Speaking at the renaming of the Tambo Memorial Hospital in Gauteng in April
1998, the former President of South Africa, Nelson Rolihlahla Mandela said
words that continue to guide our actions in the delivery of quality health
service to our people.
This is what he said:
"When we set out on the path of transformation, few of us could imagine how
complex and difficult it would be. What is clear today, however, is that the
burden of success falls on the people like yourselves, the public servants who
actually bring services to the people and who feel most directly the impact and
the uncertainties of change.
Oliver Tambo led us to freedom. Now we are engaged in an even more difficult
and demanding struggle, the struggle to rebuild and develop our country so that
all should enjoy a better life. Today our public servants, including health
workers, are custodians of the tradition of Oliver Tambo. I believe that his
long-life sacrifice will only find fulfilment if the true meaning of service to
our people is taken up by every one of us.
Whether you change the linen or stitch up wounds, cook the food or dispense
the medicines, it is in your hands to help build a public service worthy of
those who gave their lives for the dream of democracy. Let us take the lessons
from the past and leave that bitter past behind; move forward together with a
proud purpose, to achieve the kind of health care that honours the name of
Oliver Reginald Tambo."
Honourable Speaker, I borrowed from the wisdom of our great leader because I
am of the view that the message remains relevant now than it was then. There is
a need to continue to remind ourselves, particularly as public servants and
public representatives about the historic significance of the positions we
occupy, and the fact that we are indeed the principal architects of a nation
that is non-racial, non-sexist, united and prosperous.
We have a mandate to create a public service that meets the highest
professional standards, that is proud of the fact that it exists to serve the
people, is patriotic and selfless. The Human Rights Commission last week held
public hearings, whose focus was the quality of healthcare in the provinces. We
believe that comments and suggestions coming out of the hearings will empower
us to continue with our work of delivering effective and quality healthcare
services to our people.
We have made significant progress over the last 13 years in governance. We
have put in place a firm and fundamental policy framework. We have made good
economic choices, which now allow us to spend more on our social obligations.
Though challenges are immense, we remain committed to move with haste and more
vigour to ensure that our programs work, so that the commitment we made of
better life for all becomes a reality.
To realise this vision, we have put in place a programme that we believe
will help advance the struggle against poverty and accelerate provision of
quality services to all our people. Our focus amongst other things in this
financial year will be.
1. Restructuring of the service delivery platform
The size, design and location of current health facilities in the province
is mainly as a result of an inherited and fragmented health systems, from
former homelands, provincial and national administrations.
The current platform of facilities is to a large extent not in line with the
demographics and service delivery needs of our communities. This has resulted
in the inefficient and skewed distribution of resources. Work will commence
this year on the Service Transformation Plan (STP) which seeks amongst others
to redesign the service delivery platform. The STP will ensure that the
distribution of health facilities correspond to the service needs and
population spread in the province. The STP will seek to align correctly the
different levels of service provision.
It will also result in a significantly more cost effective delivery of
services through the correct configuration of facilities. This will improve the
quality of services, the retention of professionals and accessibility to
appropriate levels of care.
2. Strengthening the district health system and provincial referral
systems
We remain convinced that the District Health System (DHS) is the best model
to deliver effective, efficient and quality healthcare services to our people
in the province. Accordingly, district Health plans were developed for each of
the three health districts in response to the requirements of the National
Health Act (Chapter five). These District Health Plans will continue to direct
the efforts of the department in providing accessible, affordable and quality
health care to the majority of the communities in the Province.
Functional District Health Management teams have been established in all
Health Districts. Their main responsibility is the management of District
Health services which include community based health services, Clinics,
Community Health centres and District Hospitals.
In order to further improve the quality of Primary Healthcare (PHC), we have
adopted a model for PHC supervision, which provides for each facility to be
visited once a month by a trained PHC supervisor. To this end we have trained
179 PHC co-ordinators and facility managers in the utilisation of the clinic
supervision manual.
Honourable Speaker, sufficient progress has been made in establishing a
functional referral system amongst different levels of care in our health
system. However our communities still prefer to make hospitals the first point
of call instead of local clinic. Our hospitals, which by design should be
providing higher levels of care, continue to be burdened with cases that should
be seen in clinics and community health centres levels of healthcare. This
unfortunately suffocates resources, both human and financial, in hospitals.
This also leads to long queues and waiting times in our hospitals. This has a
potential to compromise quality of care in our facilities.
More effort will be made in this financial year to strengthen our referral
system, and to ensure maximum utilisation of clinics and Community Health
Centres (CHC) in the province. To this end the department is participating in a
pilot project at Tonga for the development of a model for referrals initiated
by the national Department of Health. The lessons learned from this project
will be rolled out to the rest of the province.
Delivery of quality and efficient healthcare services also means that our
people must get health services closer to their areas. This therefore means
that we need to continue providing services in under-served areas to address
fundamental issues of Access and Equity. Accordingly, we will be procuring two
additional mobile clinics in the Albert Luthuli local Municipality especially
for the Fernie area. An amount of R1 million has been put aside for the
project.
We have also increased our budget for patient transport, so that we can
circumvent the gaps where people still walk more than seven kilometres to
access healthcare service. We will use these vehicles when and where necessary.
Substantial progress has been made on the construction of new clinics that we
announced in the last presentation in this house. Those clinics are Siyabuswa,
Kwa-Guqa, Wakkerstroom and Block B in Nkomazi.
These facilities will be opened later in this financial year. Whilst
supporting the development of small to medium enterprises, the department does
experience challenges in the quality of the work done by some contractors for
example at the Warburton Clinic. This clinic remains uncompleted. This is now
receiving our urgent attention.
We have taken a considered decision to ensure that all clinics that had been
constructed thus far are adequately resourced to function optimally.
Accommodation remains a challenge for the department, as our nurses struggle to
find decent accommodation, especially in rural areas. We will however be
building accommodation units in various clinics. We are sure that this move
will assist us to retain nurses, especially in remote areas. Negotiations are
continuing with all relevant stakeholders, to complete the process of
transferring all municipality health clinics to the province and to devolve
municipal health services to district municipalities as required by the
National Health Act and the National Health Council resolutions.
3. Health promotion
Honourable Speaker, in our previous presentation of the policy and budget
speech we highlighted the need for a continued awareness campaigns to advocate
a message of healthy lifestyles, as a cornerstone in the fight and prevention
against many diseases in our communities. We remain convinced that many
diseases can be prevented if all of us adopt healthy life styles.
We will therefore be intensifying programs for, the promotion of healthy
life styles to address the triple burden of communicable and non-communicable
diseases as well as violence and trauma over the Medium Term Expenditure
Framework (MTEF) period. The Healthy Life Styles Programme focuses on amongst
others:
* promotion of good nutrition
* physical exercise
* safe sexual behaviour
* tobacco Control
* interventions against alcohol and substance abuse.
4. Improving quality of care and Emergency Medical Services (EMS)
When we assumed governance in 1994, we committed ourselves not only to
provide services, but to do so with utmost respect to human dignity, and in a
manner that restores faith in our communities about government services.
Quality of care is therefore central to the provision of services to our
people.
In October 2006, we launched our Service Standards in Ermelo. The standards
commit all our employees to adhere to defined minimum standards in the service
of our people. At the launch, we mentioned that, the event was an important
step in the implementation of the said services standards. Implementation of
service standards will be in phases. What is important though is that there is
commitment from all of us to get to a point of excellence, through adherence to
these standards.
As announced by the Honourable Premier in his State of the Province Address,
we will, together with National Education Health and Allied Workers' Union
(Nehawu) and other stakeholders in the province, undertake a study of the Chris
Hani-Baragwanath Improvement Project. The project is a partnership that seeks
to bring together all stakeholders in a hospital facility, to collectively
improve the working environment, and thus improve service delivery in the
hospitals. We have already started discussions with Nehawu on this project.
Through our Quality Assurance unit, we have conducted Client Satisfaction
Surveys in all our hospitals in the province in September last year. We have
assessed response times to complaints and waiting times in these hospitals and
in 30 other Primary Healthcare Facilities. These surveys show improvement from
results of previous years. Hospitals that were surveyed a year earlier did show
steady improvements and in most of them complaints are resolved within 60
days.
The department has embarked on the Council for Health Service Accreditation
of South Africa (COHSASSA) Accreditation program to improve conditions and
services in our hospitals. The department has already spent in excess of R12
million on this programme.
We have made commendable progress in providing adequate resources to our
Emergency Medical Services (EMS) ahead of the 2010 Fifa World Cup. We have
opened seven additional EMS stations in Waterval Boven, Matsulu, Malelane,
Hendrina, Kriel, Lothair and Matibidi.
In the past year we procured 68 EMS vehicles and appointed 146 personnel.
Fifty three of these vehicles are already operational and the remaining is
being converted after which they will be commissioned. Thirty five of the 42
EMS stations were audited as part of our quality assurance programme. We will
conduct the audits annually as these audits have proven to be important
monitoring tool.
In an attempt to further improve response times by our EMS, and in line with
our service standards, and preparation for 2010, we will procure an additional
83 new ambulances and response vehicles this financial year. We also plan to
lease an air ambulance service to further improve response times. We have set
aside R3 million to initiate the development of a disaster management centre
for the province.
We have successfully attended to the pay parity concerns of our employees in
the EMS unit. We will further prioritise the training and development of these
employees so that they remain in the cutting edge of technology developments,
and continue to provide excellent services. We will also establish a provincial
EMS operation centre to augment the service delivered through our three control
centres.
5. Improve management of communicable and non-communicable diseases
Management and treatment of communicable and non-communicable diseases will
continue to receive maximum attention. Progress has been made in certain areas,
whereas in other areas, more can and still needs to be done.
5.1 Tuberculosis (TB)
Since the meeting of Health Ministers, in Maputo, Mozambique in August 2005,
which took a decision to declare TB a crisis, we have been able to put in place
the Provincial Crisis Plan which has since borne commendable results. This
programme is also resident in the Head of Department's (HOD's) office as a
priority programme of the department.
Our province has made a significant progress in improving the TB cure rate
which was at 32% last year and has improved to 50,6% for the period ending
March 2007. This has been achieved in part, through the restructuring of the
Directorate: HIV, AIDS, Sexually Transmitted Infections and TB (HAST) and
intensive social mobilisation campaign.
We intend to make this program a stand alone directorate, thereby enabling
focused work which will result in improved information gathering and
processing, follow up and support to patients on treatment. During the course
of 2006, we saw a rapid increase in the number of Extreme Drug Resistant
(XDR)-TB notifications in other parts of the country. We have been fortunate in
the province that we have had only one case of confirmed XDR-TB whilst two were
reported.
However this is not a call for complacency, as we still need to continue
with our social mobilisation to ensure that our people are freed from TB. Allow
me to remind all of us and our community at large that TB is a curable disease-
all you have to do is to adhere to treatment and complete the six months course
of treatment. In the current financial year we will continue with this work,
with a target of improving our cure rate to over 60%. Our efforts will be
focused in the Nkangala District which continues to report a low cure rate.
This will also include culture survey for MDR and XDR-TB. Over 700 health
workers will be trained in the management of TB.
5.2 Malaria
Honourable Speaker we are quite pleased with the progress we have made in
the fight against malaria in the province working within the Lebombo Spatial
Development Plan. We have seen a steady decline in the number of cases recorded
and fatalities over the past few years. This improvement has been achieved
through sharing of information and strategies amongst all role players, but
more importantly through community empowerment campaigns carried out in high
risk areas.
At the end of the high transmission period ending in March, we recorded one
1 786 cases with a 0,39% fatality rate as compared to 4 222 cases recorded in
the same period a year before with a 0,49 % fatality cases. The fatality rate
is below the 0,50% which is the national norm. This financial year an amount of
R500 000 had been set aside to increase spray operators in the Bushbuckridge
Area.
5.3 Comprehensive HIV and AIDS Care, Management and Treatment
Honourable Speaker, 2007 will go down in the history as a very important
year in the fight against the HIV and AIDS pandemic. For the first time, we
have been able to draw up a collective programme of action, with clear targets
and budget allocation. All sectors of society; government, civil society,
labour, Non-governmental Organisations (NGOs), Business and traditional
healers, have jointly contributed to the development of this plan.
We believe indeed that this new found consensus will facilitate greater
partnership across society, bringing together the collective wisdom, energy and
skills of all the people to prevent the spread of HIV and AIDS and to maintain
the health and quality of life of those already infected. We also need to
double our efforts to combat stigma, ignorance and prejudice, and to empower
communities to care for people infected and affected by HIV and AIDS.
Last year we informed this house that we will increase the number of people
on antiretrovirals (ARVs). Accordingly, we have increased the numbers from 5860
to 1 4132 people receiving ARVs in the province and we are indeed hopeful that
once we have established more sites and employed sufficient staff we will be
able to increase this number.
Service points increased from eighteen to nineteen as the department had
challenges of availability of space. This challenge will be overcome through
the acquisition of at least 12 mobile facilities or park homes. An amount of R8
million has been set aside to address the infrastructural requirements for the
new ARV sites mentioned above. We have advertised posts for professionals and
once these appointments have been made, this will improve access to ARV
treatment.
We will also increase the High Transmission Area Intervention sites from 35
to 40 and step down facilities from nine to twelve. We will continue funding
home based care organisations (HBO) as they provide critical services at
community level to our people infected and affected by HIV and AIDS. Currently
we are funding 105 such organisations with a complement of 1 780 care givers
each receiving a stipend of R1 000 per month. We have trained 446 care givers
on the 59 days curriculum.
All our hospitals in the province are now offering Post Exposure Prophylaxis
services to victims of sexual assault and occupational injuries. We have also
trained 91 health professionals and 186 lay counsellors on the management of
victims of sexual assault and 145 health professionals on sexual transmitted
infections (STI) syndrome management. Most municipalities have launched their
Local and District Aids Councils and we will also be reviving the Provincial
AIDS Council to intensify the fight against HIV and AIDS pandemic.
The Deputy President Phumzile Mlambo-Ngcuka recently spoke of the need to
create a generation in Africa that is HIV and AIDS free. Important elements of
this are a need for our people to voluntarily test and know their status; so
that those who are negative remain so and generally to change our sexual
behaviour. We need to inculcate a spirit in our people to take charge and
responsibility for their sexual choices.
5.5 Expanded Programme on Immunisation (EPI)
During October 2006 an emergency polio campaign was conducted for children
0-5 years achieving 92% coverage. During the 2006/07 financial year the
immunisation coverage increased from 78% to 83,2%. The EPI programme will
continue to strengthen the immunisation programme to Reach Every Child. A
special immunisation campaign for polio and measles for children 0-5 years is
being conducted during the national campaign in May and June 2007.
5.6 Mental Health
It is one of our strategic objectives to improve access to mental health
services through the integration of mental health services into primary health
care. The basic mental health services are being provided in 231 of our primary
health care (PHC) facilities and in 28 hospitals. The Chronic Mental Healthcare
facility in Belfast is fully functional and has a total of 233 Mental Health
Service Users.
5.7 Nutrition
During the 2007/08 financial year the integrated nutrition programme is
planning to further reduce the incidence of malnutrition in children under five
years and micronutrient deficiencies in children less than five years.
The provision of nutritional supplements to vulnerable groups including
people with TB and HIV has been prioritised and an amount of R8,1 million has
been set aside for this initiative.
5.8 Rehabilitation
The department will continue to address the backlog for assistive devices
with a focus on Bushbuckridge. An amount of R3,2 million will be spent to
procure 800 wheelchairs, 35 power wheelchairs and 650 pairs of hearing aids. We
have further committed R4 million for the provisioning of community based
rehabilitation programme in partnership with the Disabled People South Africa
(DPSA). The programme aims to provide disability information to 50 000 families
and community members and facilitate access for 8 000 people with disability to
basic social services.
6. Strengthening of physical infrastructure
Honourable Speaker there is a need to ensure that our infrastructure meets
the growing demands of high client volumes at our facilities. We know that we
come from a past where some of our facilities were made to cater for specific
sections of our population and since the dawn of democracy some of them are
constrained because they now have to cater for a wider population. We also know
that, because of urban migration, more of our facilities in urban areas such as
Witbank and Nelspruit also have to provide services to more people who come
into the cities looking for a better life.
Accordingly, we plan to address these dynamics, and while there is a need to
continue building and upgrading facilities in rural areas, we should also not
neglect the highly populated urban areas. We are pleased with the progress we
have made in spending the Revitalisation and Infrastructure grants because this
has been our weakness over the past years.
Through the Revitalisation Grant, we have completed construction of 10
accommodation units for our staff at Piet Retief Hospital and internal
renovations in casualty section at Ermelo Hospital are close to completion. The
Out Patient Department (OPD) and pharmacy at Themba hospital is complete and
the construction of the mortuary is now at window level. Progress at Rob
Ferreira with the construction of maternity wards, OPD, pharmacy and casualty
is also at completion phase.
Through the Infrastructure Grant, we completed the construction of the
administration block at KwaMhlanga hospital, and the following projects are
ongoing construction of casualty, OPD, and pharmacy at Evander hospital and the
maternity ward at Sabie Hospital.
We have also completed construction of general theatres, short stay; OPD,
casualty and pharmacy in Witbank hospital; as well as OPD, casualty, the X-rays
unit and EMS station at Groblersdal Hospital, which has now been transferred to
Limpopo province.
At Delmas hospital construction of casualty, OPD, pharmacy and maternity
wards have been completed and we have now started with phase two, which is
construction of the mortuary and archives unit. At Standerton hospital we are
constructing two new wards and a parking area; construction has commenced with
the new Pharmaceutical Depot in Middleburg.
In order to address the infrastructural needs of Basic Services for PHC
Facilities R5 million rand has been allocated to provide water and sanitation
to the following clinics:
* Swallow's nest
* Bettysgoed
* Diepdale
* Fernie2
* KwaNgema
* Italia
* Grootvlei.
7. Strengthen Human Resources and Management processes
Honourable Speaker, one of the greatest challenges facing the Health sector
is an acute shortage of suitably skilled personnel. The situation is further
compounded by the exodus of locally trained professionals to other countries
overseas. Provinces such as ours, which are predominantly rural, are more
challenged and this has a significant impact on the quality of service that we
need to dispense to our communities.
Notwithstanding this challenge, we have made some commendable progress in
filling most of our funded vacant posts, especially those of professionals. In
the last financial year, we made 1 276 appointments, 930 of which were
professionals. We have also appointed more specialists and for the first time
in the province have a complement of more than 40 full time specialists working
in our hospitals. The process of appointing Hospitals Chief Executive Officers
(CEOs) is at an advanced stage and will be completed before the end of the
financial year
We have also completed two phases of devolving delegations to Hospital CEOs
and District Directors .This is in line with the District Health System, which
prioritises the decentralisation of functions to district level. These managers
now have Human Resource, procurement and financial delegations.
We have also put in place improved management processes to reduce delays.
For the first time we have put in place an annual planning calendar, to assist
managers to streamline activities, thereby resulting in more focused and
efficient management of resources. We also are in a process of finalising an
annual overtime plan, which will be approved in advance, so that payments for
overtime can be effected timeously.
In his State of the Nation Address, President Thabo Mbeki spoke of a need to
employ more social workers and nurses, expanding training of auxiliary nurses
and increasing the number of training institutions. Premier Thabang Makwetla
echoed the same sentiments in his State of the Province Address when he said,
"we will expand the training and employment of 150 nurses and nursing
assistants at a cost of R 17 million in 2007/08 financial year."
Accordingly, we will move with haste to ensure that training starts, that we
offer more bursaries to students in the province to study health disciplines,
and to increase the number of training sites for all categories of nursing.
During this financial year, the student nurse intake at the Mpumalanga College
of Nursing will draw entrants mainly from the rural and the most deprived areas
of the province and therefore contribute to socio economic opportunities for
the youth. We have awarded 450 bursaries to our students in the province to
study in various health professions.
8. African traditional medicine
The department will, through the Directorate: Pharmaceutical Services
facilitate the development of relevant structures to establish the necessary
capacity in African Traditional Medicine, Policy and Regulation thereof in our
province. The department will participate in the celebration of the African
Traditional Medicine Day and Week, which is scheduled for the week of Monday,
27 to Friday, 31 August 2007.
9. Heritage, greening Mpumalanga and tourism
As directed by the Provincial Executive Council and the Honourable Premier,
Mr Thabang Makwetla in his State of the Province Address, the department will
focus its energy on this major project of the Social Service Cluster. This
project is one of the "Big 5," which is designed to deliver macro-impact on the
socio-economic development of this province.
The department will research on the heritage value of its facilities and
assets promote the rejuvenation of our hospitals and clinics through the
planting of trees, shrubs and greenery and participate in Social Services
Cluster activities that will put Mpumalanga as the destination of choice for
local and foreign visitors and academics. Honourable Speaker, allow me to table
the budget for the Health Component of the Department of Health and Social
Services for 2007/08.
The house is therefore requested to approve the appropriation for Vote 10:
an amount of three billion, five hundred and ninety four million, six hundred
and seventy four thousand rand (R 3,594,674,000) for the Health component.
The budget for vote 10, Health Component, is allocated as follows:
Programme 1: Administration
R186,819,000 :This programme provides policy direction, overall strategic
leadership of the whole Department and monitoring and evaluation.
Programme 2: District health services
R1,892,609,000: This programme is the nucleus of the National Health System;
it promotes access to health services by the general community through primary
health care and includes amongst other programmes TB management, HIV and
AIDS.
Programme 3: Emergency Medical Services
R146,200,000: This programme provides emergency services and planned patient
transport services.
Programme 4: Provincial Hospital Services
R511,071,000 : This programme provides level two of Health Services and
Specialised services.
Programme 5: Central hospitals
This programme provides level three health services.
Programme 6: Health sciences and training
R99,138,000: This programme provides skills development, bursaries, medical
allied training, learnership and nursing training.
Programme 7: Health care support services
R87,008,000: This programme provides pharmaceutical services, laundry
services, orthotic and prosthetic services and Health services workshops.
Programme 8: Health facilities management
R249,616,000: This programme deals with infrastructure which include medical
equipment.
In conclusion Honourable Speaker, allow me to thank the Honourable Premier
and all Members of the Executive Council for their unwavering support and
leadership, to all our stakeholders, the portfolio committee for their
oversight role and to the management of the department and all staff for their
commitment to the service of our people.
Addressing World Health Organisation's Commission on Macroeconomics and
Health, Professor Jeffrey Sachs of the Harvard University said, "Let me say
that I hope we keep our voice clear and strong on the central task of raising
the health of the poor. I can be realistic and cynical with the best of
them-giving all the reasons why things are too hard to change."
We must dream a bit not beyond the feasible but to the limits of the
feasible, so that we inspire. I think we are an important voice speaking on
behalf of the world's most voiceless people today - the sick and dying among
the poorest of the poor. The stakes are high. Let's therefore speak boldly so
that we can feel confident that we have fulfilled our tasks as well as
possible.
I thank you.
Issued by: Department of Health and Social Services, Mpumalanga Provincial
Government
8 June 2007
