MEC Magome Masike: North West Health Prov Budget Vote 2017/18

Departmental Budget Vote and Policy Speech for the financial year 2017/2018 presented to the Bokone Bophirima Provincial Legislature by the MEC for Health, Dr Magome Masike

Honourable Speaker of the Provincial Legislature,
Honourable Premier, Rre Supra Mahumapelo,
Honourable Members of the Executive Council,
Honourable Members of the Legislature,
Your Worship Executive Mayors and Mayors of our Municipalities,
Honourable Leaders of Political Parties,
Our Esteemed Traditional Leaders,
The Director General of the Bokone Bophirima Provincial Government, Dr Lydia Sebego and Other Heads of Administration in Government,
Head of the Department, Dr Thabo Lekalakala,
Leaders of Labour Federations, Academics, Civil Society, Faith Based-Organizations and Business,
Distinguished guests,
Comrades and Friends,
Ladies and Gentlemen,
Baagi ba Bokone Bophirima,
Bagaetsho Dumelang!

Honourable Speaker and the House; it is with all humility to stand before this house today few days after the people of our country have celebrated one of the most important days in the calendar of the history of our struggles for liberation. Few days ago, our people celebrated the freedom day, a day which signifies an important hallmark, of the first national general elections which ushered in the democratic South Africa. 

The 27th of April represents a milestone achievement in our forward march as a nation to achieve our historic mission of building a non-racial, non-sexist, democratic and prosperous society. We stand before you today, inspired by the same determination and collective effort, to realise the ideal objectives of our national democratic revolution, of building a new national democratic society. 

Marching into the gallows of the apartheid racist regime, our most outstanding and heroic son of our soil, Cde Solomon Kalushi Mahlangu, said the following profound last words to his mother" Mama, Mama, tell my people that I love them so much, tell them that my blood will nourish the tree that will bear the fruits of our freedom". Indeed the blood of this martyr of our revolution has nourished a tree which its fruits fermenting our new forms of struggles for the radical socio economic transformation of our society. 

We take this rare opportunity to make a clarion call to the youth, the future leaders of our society, to emulate the exemplary life and times of this great leader of our people. Cde Solomon Kalushi Mahlangu lived his entire life committed to the struggles led by our national liberation movement the ANC, to bring freedom and dignity to the entire people of our country, black people in general and the African people in particular. 

Few months ago, our leader, the Honourable Premier of Bokone Bophirima, Rre Supra Mahumapelo, delivered the State of the Province Address under the theme, “Celebrating 20 Years of the Constitution”. Indeed Honourable Premier, we here today to join you and the people of our province, to pay tribute to our constitution. 

To us, our democratic constitution has provided our people a fundamental principle of the right to health. Provision of adequate health services is essential to our agenda of radical socio economic transformation of the South African society. 

The fundamental right to health care services is provided in three sections of the South African constitution. This entails giving access to health care services including reproductive health and emergency services; basic health care for children, medical services for detained persons and prisoners and more importantly the declaration of the universal access which states that everyone has the right to have access to health services.

Honourable Speaker and the House; we therefore use the opportunity of this occasion to present the 2017/2018 budget policy speech for the department of health Bokone Bophirima province. Ours is a demonstration that we are a democratic government accountable to its own citizens. 

We hereby present the Final Budget allocation for 2017/18 and Indicative Figures for the MTEF period which is shared by eight (8) key programmes as follows:

MTEF ALLOCATION 2017/18 - 2019/20

The 2017/18 financial year total budget allocation for the Bokone Bophirima Department of Health is R10 461 340 000 (Ten Billion, Four Hundred Sixty One Million, Three Hundred and Forty Thousand Rands).

The Department is determined to make the best of this budget to meet the health needs of the citizens of Bokone Bophirima.  In doing so, a Policy on Unauthorised, Fruitless and Wasteful Expenditure has been developed.  This Policy will assist the Department to ensure that unauthorised, fruitless and wasteful expenditure is detected, recorded timeously, reported and disclosed as a note to the annual financial statements of the Department.

A number of projects were completed in the 2016/17 financial year.  They include, new Boiler at Klerksdorp Hospital, Upgrade of Witrand Hospital, Bophelong Psychiatric Hospital Phase II A (State Patient Wards) and Job Shimankana Tabane Hospital received the new 60 bed mental health unit and the renovated theatre complex. Construction has started on the new Madikwe Clinic, New Jouberton CHC and Upgrading of the Excelsius Nursing College. The following facilities were officially opened: Joe Morolong Hospital, New Bophelong Psychitric Hospital Phase IIA (State patient wards) and Upgrade of Witrand Hospital. 

Projects that will be completed in 2017/18 are: New Mmakaunyana Clinic, New Weltevrede Clinic, New Madikwe Clinic, Refurbishment of JST Hospital Ward 10, New Mathibistad CHC, Installation of new Boiler at Mahikeng Provincial Hospital (MPH), Replacement of lifts at Potchefstroon and Witrand Hospitals, Upgrading of Boitekong CHC, New Sekhing CHC and Replacement of water supply network at Itsoseng CHC.   

Construction will commence in 2017/18 on the following projects: New Staff Accommodation at Brits Hospital, New Delareyville Bulk Pharmacy, Bophelong Psychiatric Hospital Phase III (admin buildings), Refurbishment of Marcus Zenzile Clinic, Refurbishment of Steve Tshwete Clinic, Upgrading of the Gelukspan Hospital and New Motswedi Clinic. We are busy prioritizing projects and Maquassi-Hills CHC is one the projects we are closely looking into.

Budget has been allowed for continued day-to-day and statutory maintenance at facilities in the four Districts in 2017/18.  Tenders will be called for the Maintenance Projects at the following facilities: Witrand Hospital, Potchefstroom Hospital and Tlakgameng CHC.  The following maintenance work will commence: Term Contracts for maintenance and servicing of Generators in Bojanala and RSM Districts, Moses Kotane Hospital, Mafikeng Provincial Hospital, Lehurutshe Hospital, Gelukspan Hospital, Joe Morolong Hospital and Schweizer Reneke Hospital.

The North West College of Nursing which comprises of two government nursing campuses based in Mahikeng and Klerksdorp is currently embarking on major construction projects in both campuses. Construction includes student residence which will accommodate a larger number of students, and staff residence as part of the college’s retention strategy. At Mahikeng campus, phase one of the upgrades include the refurbishment of existing lecturers’ offices and construction of new blocks for residence with a capacity of 114 students. Phase one of the project at Klerksdorp campus include construction of the new 300-seater lecture theatre, student accommodation which will accommodate at least 1 200 learners and alterations to the transformer room as well as alterations to ablutions. We anticipate completing these projects in 2017/18. 

Honourable Speaker and Members of the House; South Africa and our Province, Bokone Bophirima is confronted with the quadruple burden of disease namely, HIV/AIDs and Tuberculosis (TB), Child and Maternal deaths, Non-Communicable diseases, as well as Trauma and Accidents. We need to combat this burden of disease because our goal is to improve life expectancy of mothers and babies including all citizens of Bokone Bophirima. 

We managed to screen 10,111 community members in the peri-mining communities through support of the Aurum Institute. Of the total screened, 59 tested TB positive, 513 TB contacts were traced and 7 of the contacts tested positive for TB in both Bojanala and Dr Kenneth Kaunda Districts. This was done in partnership with the Department of Correctional Services and Mines as promised in last year.  TB cure rate has significantly improved with a 86.72% cure rate against the target of 85%. Our specialists continue to investigate TB and the best way of managing it. I commend the work done by the likes of Dr Variawa in investigating TB.  We will benefit from the findings and implement the best recommendations.

We have also increase the number of people on ARVs in line with new policy directives as promised. The number of patients initiated on ART has increased from 35,605 (April to Jan 2015/16) to 40,428 (April to Jan 2016/17) mainly due to increased testing and ART initiation in line with the Universal Test and Treat Policy.

As planned, the number of MDR TB decentralized units have been increased to fourteen (14) in the sub districts. The other sub-districts do not as yet have functional sites due to budgetary constraints

Advanced Clinical Care Programme for ART & TB is also being implemented in seven sites in the province as promised, with One Hundred and Twenty Seven (127) health care workers (Nurses, Clinical Associates, Doctors and Pharmacists) trained through support of the Aurum Institute.  We are turning the tide against TB.  The Minister of Health Dr. Aaron Motsoaledi has earlier during World TB Day launched Delamanid Clinical Access Programme (DCAP) for the treatment of Multidrug-Resistant Tuberculosis (MDR-TB) as part of initiatives to manage and treat Tuberculosis in South Africa.  We believe the Delamanid drug will add to our advances in TB management and the Department is ready and eager to roll out implementation of this programme in the Province.

Twelve (12) sites were identified in all four (4) districts for the establishment of food gardens with involvement of Department of Agriculture (DOA), however there was limited progress due to unavailability of funds. The Department continues to lobby for support from other partners and stakeholders to strengthen the functionality of these establishments.

It was our promise to heighten Setsokotsane Programme with emphasise on preventative health care.  I am happy to report that, the department has continued to provide integrated services at different events and campaigns held during the year under review. These were held in Cyferskuil (STI, Condom, Pregnancy event and TB), Rotary Family Health day in Boitekong, MEC interaction with farm workers (Rothmans Farm in Madibeng) World AIDS Day in Lomanyaneng Village. The Setsokotsane campaigns led to an increase in the distribution of male condoms from 23.9% to 36.2%, however female condom distribution was reduced from 1% to 0.9% mainly due to preference of the male condom brought about by the introduction of flavored condoms.  Nine Hundred and Seventy Two (972) employees were reached with nutrition and weight control messages geared towards reduction of obesity.

Our efforts to further strengthen campaigns against Sexually Transmitted Diseases, Condom usage, lifestyle diseases and obesity continued to intensify. The province has thus conducted integrated health screening in all events and campaigns and the number of people tested for HIV increased from 537,669 to 612,482, (12.3% increase). Hypertension screening increased from 746,537 to 1,487,931 (49.9% increase) while Diabetes screening increased from 451,821 to 1,061,880 (57.5% increase).

We planned to establish a Medical Male Circumcision Center of Excellence in order to improve MMC uptake and proper management of adverse events. I can report that the Medical Male Circumcision Center of Excellence model has been developed.

The Provincial Turnaround Strategy has been developed and implemented across the four districts to improve Child Health Care particularly management of malnutrition as promised. We strengthened adherence to the WHO Ten Steps on managing malnutrition by conducting clinical audits and implementation of recommendations thereof. Children dying from malnutrition reduced from 16% to 7.7% by 3^rd quarter 2016/17.  Intervention programmes aimed at Maternal, child and infant mortality remains a key as we strive towards the NDP vision of quality life for all, increasing life expectancy to at least 70 as well as reducing maternal, child and infant mortality.  We continue to implement MomConnect to all our districts and expanding to all sub districts.

I am happy to report that four (4) high volume ordering facilities are receiving Fixed Dose Combination (FDC) through direct delivery method. Due to expansion of Central Chronic Medicine Dispensing and Distribution (CCMDD) to all the Districts, much focus on direct delivery was paid to the CCMDD service provider, as a result the number of items i.e. ARV’s and other chronic medications on direct delivery to the service provider increased from 35 items as at 31^st March 2016 to 83 items as at 28 February 2017. In 2017/18 we will increase the number of items on direct delivery to the health facilities to improve on delivery turn-around time and to relieve pressure on the Depot.

We also said that we will continue to strengthen Depot operations through replacement of obsolete IT and material handling equipment and facilitate creation of the database of suppliers for pharmaceutical and medical consumables which are not on contract. In this regard, I can report that a server, other IT equipment such as printers and scanners has been procured. Due to limited funds, other material handling equipment could not be bought. We are still working to finalise the creation of database of suppliers for items not on contract.

We have also managed to significantly improve the Medical Depot operations. I can report that air cooling system in the warehouse has been refurbished; as a result medications are stored within the recommended temperatures. Medicine availability, especially PHC (clinic) medications, has improved from 75% availability as at 31^st March 2016 to 90% availability as at 28 February 2017. This is as a result of improved monitoring of availability at PHC facilities through Stock Visibility System.

Going forward, the Department will in 2017/18, strengthen availability of hospital level medications through monitoring of stock levels using hospital dashboard to be rolled out by the National Department of Health (NDOH) to hospital Pharmacies.  Procurement of material handling equipment such as stackers, pallet jacks and others will be bought to replace old ones.

The department has partnered with private pharmacies and general practitioners to dispense chronic medication at no cost to patients.  Patients can now walk directly into their nearest pharmacy, general practitioner, supermarkets like Shoprite (MediRite) to collect antiretroviral and chronic medication. Since inception of the CCMDD model a sizeable number of dispensary points have been established across the province and are dispensing medication to over 90 000 chronic patients. The model is mostly used in the Bojanala Platinum District with 35128 patients collecting medication from convenient pick up points. Head count for chronic patients collecting medication at health facilities has dropped with more patients electing to collect medication at convenient pickup points. This has assisted us with reduction of waiting times at health facilities particularly in clinics.

In 2013 the Ideal Clinic Initiative was launched by President Jacob Zuma under the umbrella of Operation Phakisa to address deficiencies in Primary Health Care facilities (clinics) systematically, aiming for all clinics across South Africa to reach an Ideal Clinic status by the end of 2017/18.  During the 2016/17 financial year the North West Department of Health targeted 109 of its 314 clinics to become Ideal. We can now report that 86 (79%) of these 109 clinics have currently attained the ideal status.

The district break down of these ideal clinics is as follows: In Dr Ruth Segomotsi Mompati, which had already had 7 of their clinics ideal in the previous year, attained further 15 (94%) of the 16 targeted clinics are ideal - 12 achieved silver and 3  gold status.  Ngaka Modiri Molema achieved 21 (91%) ideal clinics of the target of 23 – 9 silver, 11 gold, and 1 platinum status. Dr Kenneth Kaunda has 34 (85%) ideal clinics of the 40 targeted with 18 silver and 16 gold status.  Bojanala achieved 16 (53%) ideal clinics out of the target of 30 with 7 silver, 8 gold, and 1 platinum status.  We will in 2017/18 officially launch this landmark programme and begin to aggressively implement it throughout the Province.

Ka phitlhelelo e, ra re nako e fitlhile ya gore baagi ba rona ba bone ditirelo tsa boitekanelo mo mafelo a maemo a kwa godimo! Se ke o-ne moono wa National Health Insurance (NHI).

President Jacob Zuma said in the State of the Nation Address said that “the National Health Insurance (NHI) is our flagship project that is aimed at moving South Africa towards Universal Health Coverage”.  The Province continues to strengthen health systems in the pilot district and broaden access in all our districts to ensure that our people receive quality health care where they live!

Ka phitlhelelo e, ka re a re yeng Bokone Bophirima, a re yeng!

We continue to implement a Constitutional right of access to health care. The department has as a way to improve the access to medical and primary health care services to remote rural and farming communities, benchmarked, from the Free State Province and adopted to pilot the model for the medical mobile to areas where there are no adequate health facilities and skills. This Mobile medical services provided by the private sector, for the period of three years, will start earliest 1^st June 2017 to provide a range of screening services and treatment of minor ailments through the comprehensive team of medical officers, dentist, nursing, radiographers, phlebotomist, optometry and others on a mobile bus that works seven days a week until their entire area is screened and health status determined and appropriate referral is made to other level of care.

This service will need financial injection, because it will have to be paid for the services rendered. We will pilot this service in the areas of Morokweng in Kagisano-Molopo Sub District of Dr Ruth Segomotsi Mompati and Ratlou Sub District in the Ngaka Modiri Molema District as the rural district of our province where there is inadequate medical care to rural villages.

Tuberculosis remains one of the killer diseases among curable diseases in south Africa and North west province is no exception. To this end the department has development 90,90,90 HIV / AIDS and TB strategy in which with TB a similar pilot as with medical bus services, TB mobile services will be investigated for piloting in the areas of mining towns where there are vulnerable groups to screen and treat TB patients and their contacts.  This project too is essential and will need funding from both equitable and conditional grants.

The two mobile health services will significantly reduce queues in health facilities. These will be our own Setsokotsane Mobile Health buses and they will take health services to your doorsteps in 2017/18.

The challenge of records and information management is being attended to.  A pilot on information management system is currently being implemented at Alabama Clinic. If it succeeds we will roll out to the rest of the province in phases.

We have diagnosed challenges that affect well functioning of our Emergency Medical Rescue Services (EMRS).  The challenge lies with communication.  Our EMRS challenges are also not in inter-facility but out in the villages.  In responding to the communication challenge, we identified the need to establish a single central call center to sort out the communication problem once and for all so that the ambulances can respond quickly in the Province.  We have started negotiations with Royal Bafokeng to assist in this regard in 2017 going forward.  We also identified the need of picking people up at homes when clinics are closed.  Identified hot spots are among others Zeerust, Moretele, Piet Plessis, Ratlou, Ventersdorp, Maquassi-Hills and Boitekong.  Since we started targeting these hot-spots our EMRS indicators are starting to get green because of our interventions.

To further boost our EMRS services, we will in 2017/18 procure additional 40 ambulances.  This should offset one of our mayor challenges with EMRS which is the aging fleet that spend more time on government garages than on the roads.

In the true Saamwerk-Saamtrek philosophy to enhance VTSD areas, the department has concluded various agreements with several SETA’s namely Services Seta, Public Seta, and Health and Welfare Seta. These initiatives are mainly to fund EPWP programmes with our department. The initiatives have now appropriated funds to appoint at four hundred and thirty (430) EPWP in the whole province mainly training the youth in several soft skills in our facilities to improve the façade and aesthetic appeals of the facilities. This programme will be done mainly with various municipalities and traditional houses to ensure local empowerment. The HWseta will fund the training and deployment of 100 artisans qualifying from TVET colleges which programme will be done with various TVET colleges in the province.

In implementing the Saamwerk-Saamtrek to enhance VTSD areas, we have also engaged the services Seta to assist in cooperatives and SMME development. This project will be assisting these cooperatives and SMMEs will be trained in the legislative and standards issues in the whole supply value chain. I believe the project is urgent to assist SMMEs and cooperatives to meet the highly regulated environment as we will be commissioning local production in villages and townships to create new industrialists.

Health professionals training expansion remains key to health care provision.  The Department will continue to engage student nurses on their concerns and address outstanding issues at various fora.  We moved swiftly to advertised and fill ten (10) posts of lecturers at the Mmabatho Campus of our college.  We produced a total skill mix of nurses of about 827 nurses to serve the communities.  This number includes nurses’ graduates from our colleges and North West University. 

Total newly qualified Professional nurses study leave and bursary in the Basic Nursing Programme is 366, with 319 from Colleges and 47 from North West University Mafikeng and Potchefstroom Campuses.  Post registration and Post Basic Nursing Programmes is 150.  Auxiliary and Enrolled Nursing Programmes is 311, made of 210 Auxiliary Nurses and 101 Enrolled Nurses.  As part of the public private partnership and social responsibility MTN SA Foundation has sponsored MMACON with the Multi- Media Center which we launched in September 2016.  The MTN SA Foundation will also sponsor Excelsius with the Multi- Media Center in 2017

In 2017/18, we plan to produce 654 nurses in the Basic Nursing Programmes.  The total expected newly qualified Professional nurses study leave and bursary for 2017/18 is 399.  Of this, 327 is from the Colleges and 72 from North West University, Mafikeng and Potchefstroom Campuses.  Post registration and Post basic Nursing Programmes is expected to be 126. Auxiliary and Enrolled Nursing Programmes is expected to be at 129.

Honourable Speaker and Members of the House; allow me to acknowledge that indeed we are faced with the challenge of dire shortage of health professionals particularly the nurses.  It’s a known fact that many of our nurses resigned after the misunderstanding of Government’s retirement reform. It is also a fact that we have not been able to replace all the nurses who resigned.  That being said I wish to take this opportunity to thank those nurses remain in their posts and continue to serve our people under difficult challenges.  To you, nursing is a calling and you were born to serve!

Twelve (12) students arrived in the Country in July 2016 for their final rotations. Unfortunately one of them namely Gotsemodimo Macwili passed on. I send my condolences to the family. These students have been placed at various medical universities. Furthermore six (6) students graduated in July 2016 after completing their final rotations at the different universities.  Thirteen (13) students are expected in July 2017. We envisage that approximately ten (10)   students will be graduating in July 2017.

I am happy to announce another breakthrough in health professionals training in the Province.  Job Shimankana Tabane Hospital won accreditation for training of postgraduate medical doctors to become a satellite for training specialists’ doctors with Sefako Makgatho School of Health Sciences. With this initiative, Job Shimankana Tabane Hospital plans to expand the academic training platform within the service delivery platform to cater for all other health professionals such as physiotherapists, radiographers, post-basic nurse training.  The hospital will also expand training platform in the service delivery platform to Brits Hospital and Moses Kotane Hospital-especially to cater for additional South African medical students returning from Cuba.

The Department with both universities of Witwatersrand and Sefako Makgatho have begun the process of planning for the return of about 200 South African students, who have trained in Cuba, in 2019. The planning for the expansion of these universities training platform into the North West Province has begun and it will require additional clinical teaching staff, infrastructure such as student accommodation, IT and transport to be budgeted for. This investment will be well spent as it will continue to serve the province and the country in the future when the South African Universities sustain this increased production of doctors, and, also n the near future when the North West University opens its own medical school this platform will be well prepared.    

Last year we achieved yet another milestone with the first ever heart operation in the Province.  Since that first ever heart operation, the Province continues to do remarkably well.  To date, 8 cardio thoracic operations have been done.  They include removal of tumour, cardiac bypass surgery, single and double valve replacements.

The Honourable Premier has in the State of the Province Address, announced that we are starting the process of establishing a Medical School or School for Health Professionals for our Province.  The Department is taking this mandate forward and will engage all relevant stakeholders including North West University and other academic institutions and sectors to assist the process. The Department of Higher Education and Training has asked the NWU for a detailed business plan for its Medical School Development and we attend to that requirement.

Honourable Speaker and the House; as I continue towards conclusion I thank our stakeholders in health across the Province and everywhere they are in our country.  Health care is a societal issue and therefore requires all hands on deck.  We could have not done it alone and we surely will not implement the 2017/18 policy mandates alone as a Department.  Thank you to our partners in private health care institutions and organisations.  Thank you to institutions of higher learning. Thank you to our health governance structures. Thank you to the Portfolio on Health and Social Development. We give thanks to the Office of the Auditor General and the Provincial Treasury.  I commend the role of sister departments.   

I remain indebted to my organisation African National Congress who deployed me to lead the Health Department.  Thank you to the leadership of the ANC in the Province for support.  Thank you the Honourable Premier of Bokone Bophirima Province for leadership and guidance.

Last but not least, I thank my family, wife and the children for continued support all the time.

Indeed it is only through unity and cohesion that we can overcome our challenges and attain the goals we have set for ourselves.  This unity is embedded in the Constitution of the Republic of South Africa.   As stated in our Constitution, “We, the people of South Africa believe that South Africa belongs to all who live in it, united in our diversity."

Oliver Reginald Tambo said, “It is our responsibility to break down barriers of division and create a country where there will be neither Whites nor Blacks, just South Africans, free and united in diversity”.

It is always a great pleasure to serve our people!

I thank you!