of the Johannesburg Press Club
20 September 2007
Chairperson
Ladies and gentlemen
It is an honour for me to be part of this gathering and be afforded an
opportunity to present the status of our health service delivery and future
plans.
I am also looking forward to having a constructive discussion with you as I
believe we are partners in efforts to ensure the improvement of the quality of
life of our people.
We are aware of the growing burden of disease in our province due to, among
other things, in-migration, HIV and AIDS and other socio-economic factors.
We operate within an environment of shrinking human resources and growing
demand for our services. Visits to primary healthcare facilities in Gauteng
have increased from 12,5 million in 2002 to more than 15,2 million in 2006.
This is not a peculiar South African problem where doctors and nurses want
to leave our shores.
According to the World Health Organisation (WHO) survey of 2005 there was an
estimated world-wide shortage of 4,3 million doctors, nurses, midwives and
other health support workers.
Chairperson, we have to find ways of making the existing resources available
to us stretch a little longer.
We need to do a fundamental reassessment of the way we do our business and
the manner in which we allocate the scarce resources that we have at our
disposal.
One way to go is to cut the fat and to eliminate the wastage from existing
programmes. I know that you do an astounding job in pointing out examples of
wastage and bad spending patterns in some instances.
I must assure you that we do take note of the issues you raise and we do
take steps to rectify cases of gross mismanagement and wastage at our
facilities.
One of my major priorities since my appointment has been to ensure that the
department obtains an unqualified audit from the Auditor-General, something
that has not been achieved in a number of years. I am pleased to announce that
we have reached this goal in the past financial year.
The financial controls that we put in place are beginning to bear fruit.
I have spent a significant amount of time visiting most of the facilities
administered by the Gauteng Department of Health academic hospitals, district
hospitals and primary healthcare facilities.
In the majority of cases these visits have been unannounced, or only with a
very brief notice period. I tried to use the visits to assess the services that
are rendered, through the eyes of the ordinary consumers of Gauteng men, but
mostly women and children, who visit our hospitals and clinics, who stand in
line and who require treatment from nurses or doctors or other specialists.
Let me share with you some of my observations and try and lead you into the
thinking behind what has become known as the Gauteng Health Department's
Turn-around Strategy.
Firstly we have to say that the overwhelming majority of health care
professionals in our hospitals provide excellent, first-class services to the
patients they see.
I know it is the mistakes that make the headlines, the operation that has
been botched, the baby that has unfortunately died, the diagnosis that has been
wrong and the nurse who neglected his or her duties.
But these instances are a miniscule proportion compared to the great work
that is being done in our hospitals and clinics on a daily basis. Doctors,
surgeons, nurses, interns and emergency services perform miracles on a routine
basis.
They save lives, alleviate pain, rehabilitate those that have been battered
and comfort the afflicted across our province for 24 hours a day.
And they do this despite a shortage of resources available to them, despite
their relatively low pay, despite the fact that they have to work long hours
under stressful conditions.
We have to look after our human resources with great care and a considerable
sense of gratitude. I am not only looking at the size of their pay obviously
this has to improve and we are all extremely grateful for the considerable
increases granted to nurses by the National Department of Health last week.
We also have to look at issues such as facilities for recreation and rest at
hospitals, working conditions and, yes, physical security as we learnt so
tragically from the recent incident at Chris Hani Baragwanath.
A second observation: we have to streamline the processes and introduce
systems that will make life easier for our health care workers, reduce the
pressure on our facilities and improve the quality of services we render to the
consumers of our services.
We have to ask ourselves the question why do patients come to a tertiary
academic hospital such as Johannesburg Academic to be treated for a common cold
or a headache?
Why do they then stand in queues together with patients who are suffering
from more serious ailments and thus increase the bottle-neck effect on our
services?
Is it because they do not know they can receive adequate treatment at a
clinic â which is often within walking distance? Is it because those clinics
are not accessible enough? Or is it because they had an experience of bad
service at such facilities in the past?
Thus, a second, fairly obvious, solution presents itself, improve the
quality of service at primary health care level to such a degree that people
begin to trust it, own it and treasure it as part of their daily lives.
After all, the basis of Government and ANC health policies is designed
around a strong primary healthcare system that is freely accessible and
responsive to our people. It is our intention to make it work.
As a result we are building more clinics across our province more than a
third of our annual budget is allocated to district services. We are extending
the operating hours of clinics to enable patients to visit them after work and
to facilitate access.
We are re-allocating human resources to ensure that doctors and clinicians
are also available at these facilities and thus strengthening the public's
confidence in our services.
But one of the major interventions we are making is the introduction of
modern IT and communications technology to streamline processes at health
facilities and improve the quality of the services we deliver.
It is a sad truth, that many of our facilities still do not have access to
computerised systems. In other cases, where we have computers available, the
programmes do not "talk to one another."
At many of our facilities patients have to stand in a queue to be admitted;
in another queue for a file to be opened manually, even though they have been
to the facility many times before; in another queue to be examined and
diagnosed and in yet another queue to receive medicine.
All these laborious processes clog up our system, frustrate our staff and
decrease the quality of the care we provide to our patients.
Plans are at an advanced stage to introduce modern smart card technology in
some of our districts on a pilot basis. The results will be assessed and a full
tender will be issued for the roll-out of these services throughout the
province.
Our objective is that every citizen of Gauteng must be in possession of a
health card that have details of his or her medical history, containing crucial
information about blood group, immunisation status, allergies and medicines
prescribed.
Should such a person be involved in an accident the emergency medical
service can access this information and inform the hospital where the patient
is being transported to. Should the patient arrive at a clinic or hospital his
or her entire medical history will be available to the clinician at the swipe
of a card.
If the patient is on chronic medication the prescription will be made in
advance and available for collection at any given day of the month. Should he
or she fail to collect the medicine the system will alert the hospital and
steps will be taken to track and locate the patient.
This may sound like "future music" to you but I can assure you that we are
well advanced in our planning to introduce such a system. I am convinced that
such a technology solution will significantly reduce the pressures on our
health system and our facilities and result in a vastly improved service to the
public.
Ladies and gentlemen,
We have embarked on an ambitious hospital revitalisation programme. We aim
to completely change the face of Chris Hani Baragwanath Hospital. We are going
to spend approximately R400 million to improve the hospital so that it befits
the standard of care it is well known for through out the world.
We are also on course with our plans to build a District Hospital in
Jabulani, Soweto with a view to relieve the pressure from Chris Hani
Baragwanath Hospital. Contractors are already on site.
We are also undertaking a security audit of all our hospitals, with a view
to improve safety and security of both patients and staff. Once this security
audit has been completed, we will make appropriate announcements regarding
security interventions where they will be needed.
One final observation following my visits to healthcare facilities in
Gauteng: my view is that more than 75 percent of the people who arrive at our
facilities for treatment are suffering from conditions that could have been
prevented through following a healthier lifestyle.
I am talking about conditions and diseases caused by obesity and wrong
eating habits. I am talking about conditions caused by smoking, by alcohol
abuse and by substance abuse. I am talking about lack of exercise, lack of
stress management, lack of opportunities to unwind or relax.
I am not talking "voodoo science" or unscientific "mumbo-jumbo" here. Any
medical academic and researcher worth his salt will tell you that lifestyle
diseases are far and away the biggest killer among our people.
Heart disease caused by smoking and obesity; various forms of cancer caused
by smoking and substance abuse; cardio-vascular diseases caused by stress and
lack of exercise; HIV and AIDS as well as sexual transmitted diseases (STDs)
caused by irresponsible sexual behaviours. The list goes on and on and on.
For me, part of the solutions areâ we will have to introduce measures and
create opportunities that will enable people to adopt healthy lifestyles and
rid themselves of so many unhealthy practices and dangerous habits.
Therefore, in the coming months you will see a much stronger focus from the
department on health promotion. We want to provide people with enough
information to enable them to make informed choices about lifestyle issues
practical advice on how they can control their blood pressure, how they can
follow a healthy diet, how they can exercise, how they can manage stress, how
they can stop smoking or consume alcohol responsibly.
For too long, concepts of healthy living have been associated with the
wealthy and the powerful. Affluent people go to gyms; rich people jog in the
streets or visit psychologists to help them cope with stress.
The poor and the powerless are thankful that they have a meal at the end of
the day, they do not have the means or the knowledge to think about diets and
healthy foods.
In Gauteng we want to change this mindset. We want to empower people with
the knowledge, the information and the support systems to take a greater
responsibility for their own health status.
To achieve this we will deploy trained community health workers who will go
from house to house, assess the health situation in a household and provide
family members with relevant advice.
These health workers will have an intimate knowledge of the areas where they
live and we will provide them with thorough training with the support of
non-government organisations (NGOs) and religious based organisations.
I call them "an army of volunteers" men and women who will be on the
frontline of our Healthy Living campaigns. As this concept progresses it is
quite possible that the scope of these community workers will be broadened to
also provide advice to households on government grants that can be accessed, or
to ensure that children attend schools, or to communicate government
initiatives with regards to transport or the environment.
As we progress we will engage with a wide variety of stakeholders to support
our initiatives. We are talking to the fitness industry on getting exercise
equipment into townships. We are talking to dieticians to develop nutritional
guidelines for families with meagre means at their disposal.
We are talking to our colleagues in the education department about the
introduction of some form of physical education into our schools.
At the heart of this campaign is the notion that we are the Department of
Health, not the Department of Illness. Our primary objective is to ensure that
the people of Gauteng lead healthy and productive lives rather than an
existence characterised by illness and disease.
We want to reach people, before they reach us. We want to provide them with
information and advice before they require treatment. We want to turn
healthcare delivery upside down by focusing on living rather than on dying.
From all of this it should be clear that the department broadly follows a
two-pronged approach:
* healthy living messages and support systems
* quality health care in terms of diagnosis, treatment and rehabilitation to
those that require more specialised medical interventions.
All the programmes that the Gauteng Health Department is known for will be
delivered within this framework. These include our immunisation programmes, our
maternal health support programmes, our very important TB campaigns and our
Comprehensive HIV and AIDS Programme that is generally acknowledged to be the
best in the country.
As far as this is concerned we want to encourage people to know their HIV
status through voluntary counselling and testing and we want to thank the media
organisations for highlighting this crucially important intervention.
But we want to go one step further. We want to say to the people: Know your
Health Status â of which HIV is one important component. You also need to know
whether your blood pressure is within acceptable limits or whether you show
signs of diabetes.
You have to test regularly for signs of breast or prostate cancer. You have
to detect the early signs of tuberculosis and regularly take your medication
should you have the disease.
All these factors combined will enable us to reach our goal of creating a
healthy and productive Gauteng.
Ladies and gentlemen, I want to thank you for the opportunity to provide you
with a brief overview of the Gauteng Department of Health's imaginative new
plans to turn healthcare delivery around before our term of office expires in
2009.
The media plays a very important role in this entire exercise. You can help
us to disseminate the correct information about progressive health issues to
your audiences. You can run campaigns to promote the cause of healthy
living.
A responsible and pro-active media is crucial to the survival of our
democratic system.
You have a duty to inform, explain and educate your audiences but also to
question and to analyse the decisions taken by us in government.
To report accurately on health issues requires a significant amount of
rather specialised knowledge. You have to have an adequate understanding of a
variety of disciplines ranging from anatomy and physiology to virology and
pharmacology. But in our current, ever-changing world you also encounter issues
relating to ethics, international trade, the economics of public health, policy
formulation and many others.
Every day there is a new theory that explains a particular illness or
disease; there are new quacks peddling "magic bullets", new researchers
claiming to have discovered a wonder drug. You have to separate the wheat from
the chaff for your readers.
Nowadays health issues have become globalised. The recent outbreak of South
African Revenue Services (SARS) had an impact on global trade, on agriculture,
on air travel, on the environment and on diplomatic relations between
countries.
Quite clearly it is thus incumbent on those who write on health issues or
who pen editorials on policies and programmes to have a much broader view of
society than the daily crisis that they are reporting on.
It is your responsibility to make sense of all these issues, to educate your
readers and listeners and to provide them with sufficient and balanced
information that will allow them to make informed choices.
I thank you.
Issued by: Department of Health, Gauteng Provincial Government
20 September 2007
