Budget Policy Speech of the Department of Health for the financial year 2019/2020 presented by the MEC for Health: Honourable Madoda Sambatha at the North West Provincial Legislature
Speaker of the North West Provincial Legislature, Ms Suzan Dantjie,
Deputy Speaker of the North West Provincial Legislature, Ms Viola Motsumi,
Premier of the North West Province, Prof Tebogo Job Mokgoro,
Members of the Executive Council,
Members of the Provincial Legislature,
The Chief Whip of the Majority Party in the Provincial Legislature, Honourable Paul Sebegoe,
Executive Mayors and Speakers,
The Chairperson of the North West House of Traditional Leaders, Kgosi Moshe Mabe and all our esteemed Traditional Leaders,
The Administrator, Ms Jeanette Hunter,
The Provincial Administration and all Heads of Departments present,
Leaders of the African National Congress and Alliance partners,
Leaders of the opposition parties,
Our Traditional Health Practitioners,
Our Governance Structures – Hospital Boards, Mental Health Board, Clinic Committees and the Board for North West Nursing Colleges,
Leaders of Labour Federations, Academics, Civil Society, Faith Based-Organizations and Business,
Distinguished guests,
Members of the media,
Baagi ba North West Province,
Fellow South Africans,
Ladies and gentlemen,
Dumelang Bagaetsho!
Honourable Speaker, we come before this august house today to outline the programme of action we intend to implement in the 2019/20 financial year.
Allow me to congratulate the new Health Minister, Dr Zweli Mkhize on his appointment and to wish him well in this important and challenging portfolio. Congratulations, as well to all comrades appointed to lead and deliver services to our people in various national and provincial portfolios of the 6th Administration.
It is a special honour for me to deliver this speech on this very important day, the Nelson Mandela Day. It was on this day, 18 July that our struggle icon and stalwart, the late former President Nelson Mandela was born. This is the day that was declared the Nelson Mandela International Day by the United Nations General Assembly in 2010. The celebration of this international day recognizes and gives credence to the former President’s commitment to human rights, conflict resolution, reconciliation and people development.
The Nelson Mandela International Day is an annual celebration of Tata Madiba’s life and a global call to action for people to recognize their individual power to make an imprint and improve the world around them. A global movement for positive change begins with small actions. As each person acts, they fuel momentum toward positive change, raising awareness and expanding the reach of Mr Mandela’s values.
There is an African proverb that says: “Disease and disasters come and go like rain, but health is like the sun that illuminates the entire village.” During my tenure as Health MEC, I intend to guide the North West Department of Health to assist our communities to illuminate their lives with health. To achieve this, we will amongst others, draw inspiration from what Nelson Mandela stood for.
Honourable Speaker as you know, the North West Department of Health is currently under Section 100 (1) (b) Administration. Since its commencement in May 2018, the Administration has achieved, amongst other, the key milestones as indicated by the bulleted sections below. For the sake of keeping to my allocated time, I request that the house read through these later and allow me to progress to the rest of my speech. However, before doing so, Honourable Speaker, I would like to thank the Inter-Ministerial Task Team established by His Excellency, President Cyril Ramaphosa for their leadership and guidance in this regard. I also express gratitude towards the Administrator, Ms Jeanette Hunter and the Administration team members for their diligence in executing their task. I must applaud the Administration team who did not waste time, but started working immediately with the managers and employees of the NWDoH to improve the health service provision platform.
An agreement was reached between the Department and the Portfolio Committee on Health and Social Development that we will have a session to specifically deal with progress made by the Administration.
- Labour Relations
- Facilitated the return of workers to their offices on 21 May 2018
- Re-established the Provincial bargaining chamber
- Required structure for NWDoH labour relations unit was submitted as part of NWDoH structure for approval to DPSA
- Coaching and guidance towards improvements in cases of dereliction
- Commenced with investigations and opened police cases in cases of misconduct, dereliction of duty, corruption and fraud
- Human Resource Services
- Completed prioritisation process for filling funded vacancies with management in consultation with organised labour
- Advertised 3060 posts
- Made 1171 appointments (323 if one excludes post community service appointments)
- Completed an analysis of PMDS situation
- The PMDS review team appointed by the Minister of Health in 2018, completed their work and produced a report with findings and recommendations that the NWDoH is in process of implementing
- Completed proposed structure to fit within current budget
- Reviewed Occupational Health and Safety situation in the NWDoH and produced a report with recommendations
- Implemented the remuneration improvement determination for community health workers
- Completed a situation analysis of outstanding disputes
- Completed the implementation of outstanding pay progression incentives for non-OSD employees
- Settled outstanding disputes
- Finance and Supply Chain Management
- Advertised 20 posts and is in process of filling these
- Supported the CFO to establish a forum with all units to confirm the correctness of budget allocation
- Accrual strategy completed and implemented
- Paid 96% of accruals in 2018/19
- No growth in accruals for 2018/19
- Commenced the process of verification of invoices over R200 000
- For the year 2018/19, the department did not run out of cash/budget to pay service providers
- The verification process corrected invoices with adjustments to the amount of R21.5m in favour of the NWDoH
- Obtained and started to implement an automated invoice tracking system for monitoring payment to suppliers to progress towards paying invoices within 30 days.
- Advertised 20 key posts for filling. The Chief DIrector Financial Management commenced duty on 1 July 2019.
- Completed a review of contract management process resulting in a report with recommendations which the NWDoH is in the process of implementing.
- Commenced the process of consequence management
- Drafted an SOP for whistle blowing and commencement of investigations
- Infrastructure
- A ten-year infrastructure plan completed for health facilities. The 10-year plan is in line with current funding trends. More funding is required to shorten this implementation period and for this purpose a motivation to Provincial Treasury for improved funding was completed
- Orders have been placed for four boilers through an open tender. These are only four because of available budget. Orders for boilers for other hospitals will be placed in subsequent years
- Instituted a policy whereby all Infrastructure Development and Technical Services (IDTS) bids must now have specification, evaluation and bid adjudication committees tailored to the specific needs of the projects with focused end-user involvement
- Improved engagement with Health Programmes, Legal and Finance units and external stakeholders such as Treasuries and Public Works
- Medicine and Surgical Supplies
- Availability improved due to payment camps instituted by Administrator and the Chief Financial Officer
- Brought in experts from 3 NGOs and discovered total lack of required processes (procurement, receiving, inventory, distribution, finance management, information systems, general services, workforce, Occupational Health and Safety, facilities and equipment, stakeholder communication and management, monitoring and evaluation, regulatory issues)
- Commenced the process of implementing sustainable pharmaceutical services management with assistance of experts from the three NGOs
- Emergency Medical Services
- Developed an EMS services improvement plan and commenced implementation
- Records Management
- Commenced the process of putting out a request for information for the implementation of an automated records management system
- Security
- Centralised payment at provincial office. This enabled the Administrator to discover the poor state of documents required for verification of accuracy of invoices.
- Developed a costed plan for insourcing security services
Honourable Speaker and the House; the Department’s operations are funded through an equitable share, conditional grants, donations, financing and own receipts. The equitable share constitutes 79 per cent of the total budget for 2019/20. The Department’s budget for this year amounts to Twelve Billion, Two Hundred and Seventy Three Million, Seven Hundred and Forty One Thousand Rand (R12 273 741). The Departmental Budget will be tabled at the end of this speech.
The budget of the Department consists of eight programmes namely Administration, District Health Services, Emergency Medical Services, Provincial Hospital Services, Central Hospital Services, Health Science and Training, Health Care Support Services as well as Health Facilities and Maintenance.
The Department has eight conditional grants which are:
- Comprehensive HIV/AIDS and TB Conditional Grant within the District Health Services programme
- Human Papilloma Virus Grant within the District Health Services Programme
- Social Sector EPWP Grant within the District Health Services programme
- Health Professional Training and Development Grants within the Provincial and Central Hospitals programme
- Human Resource Capacitation Grant within the Provincial Hospitals and Central Hospitals programmes
- National Tertiary Services Grant within the Central Hospital Services programme
- Health Facility Revitalisation Grant within the Health Facilities and Maintenance programme
- Expanded Public Works Programme Grant in programme 8.
We will apply the 2019/20 budget, and probably the budget for the next five years, to 10 focus areas, namely, Universal Health Coverage through the National Health Insurance (NHI) Fund, Health Promotion and Communication to Communities, Health Service Infrastructure, Human Resources for Health, Improving quality through the Ideal Clinics and Ideal Hospitals programmes, Availability of Medicines and surgical supplies, Improved EMS Services, Implementation of the 90-90-90 Strategy for HIV and TB, Maternal Child and Women’s Health and Improved Chronic Disease Management, Improved Security Services as well as Governance and Consequence Management. These priorities place the communities of the North West Province at the center of health service provision and are in line with the African National Congress Manifesto, Chapter 10 of the National Development plan, directives from the Premier’s State of the Province Address and the priorities of the National Ministry of Health.
The purpose of the NHI is to ensure universal health coverage to all South Africans including the citizens of the North West Province. According to the World Health Organization, universal health coverage means that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, that such services should be of acceptable quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Christine Lagarde, the Managing Director of the International Monetary Fund, on 14 June 2019, in Geneva, expressed herself on social spending as a policy lever, stating that social spending is a broader concept than social protection as it includes spending on health and education which are especially critical in low-income and developing countries. She continued saying that spending on health care does not just save lives, it extends lives, improves the quality of lives and ultimately contributes to growing economies. Providing universal health access to quality services through the NHI will contribute to a healthy economy for South Africa and the North West Province. We will continue on our path of preparing for the implementation of the NHI through further roll out of the Ideal Clinic programme and through strengthening the implementation of the Ideal Hospital programme. These two programmes will assist us to pass the inspections of the Office of Health Standards Compliance. The North West Department of Health already has good practices with regard to collaboration with private, academic and non-governmental organisations. These good practices will be extended to assist the Department to meet the demands of providing quality services under the NHI.
Immediate efforts to extend access include longer operating hours of primary health care facilities. In the next 12 months, the Department will increase 24 hour service availability by an additional nine from the current 68, and this number will increase by at least ten facilities per year for the next five years, targeting the most rural communities in a manner that address equity of access to health services.
The first of these clinics will be:
- In Dr Ruth S Mompati district Sekhing CHC and Matsheng Clinic will open for 24hours and Buxton clinic 12 hours respectively;
- In Ngaka Modiri Molema district we will have the Moshana CHC, Weltevreden, and Madibogopan clinics extending the operating hours to 24 hours.
- In Bojanala district we will extend services to 24h hours in Obakeng, Bethanie and Madikwe clinics.
Honourable speaker, the difference between 24-hour access and a facility open for 24 hours must be noted. The ability to have a facility open for 24 hours depend on the available human resources to cover the different shifts within 24 hours. We will work together with the Provincial Department of Finance to obtain funding for the additional human resources required to provide 24-hour access. In the areas where we will not be able to increase hours of services immediately, we will make use of the Planned Patient Transport services to close the gap by transporting our users to the nearest available 24-hour facilities.
As part of relieving hospitals from the burden of an excess of patients who should be treated at primary health care level, the Department will also include Mafikeng Gateway Clinic and Taung Gateway Clinic to operate 24-hour services.
As part of a broad plan to deal with long queues and overcrowding in health facilities, the Department is planning to launch the Patient Appointment Booking System.
Clinical quality under the NHI will be ensured through further roll out of the Integrated Clinical Services Model (ICSM). Through this model, our patients in primary health care (PHC) are treated holistically by health professionals in one consulting room, instead of being sent around or told to come on different days just because they happen to be suffering from more than one ailment.
Universal Health Coverage through the implementation of NHI will be based on a PHC approach. This will require that we strengthen community mobilization in health promotion, screening, disease prevention, rehabilitation and early treatment of disease. The NHI will succeed if we keep the citizens of the North West Healthy where they live, work and play. We will act to improve on the implementation of our health promotion strategy as well as our system for communicating with our communities.
The media communications, in-facility communications and the health promotion work done by environmental health officers, the school health teams and community health workers will be complemented by health imbizos. In 2019/20, each district will host a health imbizo where our communities will be engaged directly on health promotion, awareness and prevention of diseases. Healthy lifestyle campaigns will become a norm and all sub-districts will upscale activities to get our people active and healthy.
To further strengthen governance and community participation in our PHC services, we are increasing the seating allowance of clinic committee members from R150 to R500 as from 1 August 2019. We are in the process of amending the Act which governs the Hospital Boards, their allowance and tools of trade will be defined in the new Act.
Honourable Speaker with regard to chronic disease management, the North West Department of Health will focus specifically on the prevention and management of HIV, TB, cancers and mental illness.
In the fight against HIV and AIDS the province has increased the number of people on ART from 176 260 in 2013/14 to 268 065 currently. We plan to increase this number to more than 300 000 in this financial year. The Department is on track with reducing maternal child transmission of HIV. We now have less than 1% of HIV exposed infants against the target of 1.5% tested positive around 10 weeks.
In the past year the number of sites providing multi-drug resistant (MDR) TB services were increased from 6 to 15. TB treatment has improved with the introduction of the new MDR TB drug, Bedaquilline, which shortens the treatment period from 24 to 9 months. This regimen change has improved treatment adherence and treatment success rate has increased from 52% in 2012 to 59% currently.
The 90-90-90 strategy for HIV and TB remains a priority for the NWDoH. This strategy is based on the rationale that there is an estimated number of people living with HIV (PLHIV) and TB in the province and the aim is to ensure that 90% of PLHIV know their HIV status and 90% of PLHIV are initiated and remain on ART treatment and 90% of those on ART are virally suppressed. For TB management 90% of high-risk groups are to be screened for TB and 90% of those with TB are to be initiated on treatment and 90% successfully treated.
In order to achieve the set 90-90-90 targets the Province will employ a contingent of youth with grade 12 for a period of six months earning a monthly stipend of R3,500 commencing from October 2019 to March 2020.
The Department is going to roll-out the Phuthuma Project which has been piloted in Bojanala District to the remaining 3 districts. The aim of Phuthuma is to fast track achievement of the 90-90-90 targets for the year 2020 with special training on how to improve with regard to lost to follow up patients on ART and TB treatment. This strategy also includes making repeat medication available to stable patients in a manner that enables them to access treatment faster and closer to their homes. This relates closely to the Central Chronic Medicine Dispensing and Distribution (CCMDD) Programme that aims to decongest healthcare facilities and increase access to care and treatment. The goal is to enrol stable patients to a courier pharmacy service where patients collect pre-dispensed and packaged medication from a designated pick up point closest to them every month. Patients with chronic diseases receive medicine every month and usually receive repeat scripts for six months.
The National Department of Health with the assistance of PEPFAR implementation partners is currently rolling out the Synchronised Communication in Health (SyNCH) system in 20 Phuthuma districts in the country of which Bojanala is one. Through this system patients who fail to collect their medication will be identified within two days. This will enable faster follow up, leading to higher treatment compliance rates. The NWDoH thus has to budget in subsequent years to roll out the SyNCH system to other districts.
We held a successful TB summit with the mining sector, SANDF, correctional services, institutions of higher learning, developmental partners and other key stakeholders to improve the management of TB in the Province and improve TB outcomes.
A successful World AIDS day Commemoration event was also held in partnership with the South African Mineral Council which was followed by formalised agreement with the mining houses to assist the Department.
The Re-establishment of Provincial Council on AIDS (PCA), as directed by the Honourable Premier in the State of the Province Address, is critical in the mobilization of our communities and resources to take the fight against HIV to a higher level. Consultation roadshows are currently underway in all districts as part of the process of establishing a fully functional PCA.
Cancer screening is done in women 30 years and older by trained professional nurses in all PHC facilities. This is done in HIV positive women irrespective of age for early detection, referral and treatment. Breast examinations are done during reproductive health consultations and women are also taught how to self-examine. The Department provides the Human Papilloma (HPV) vaccine to Grade 4 girl learners at all public schools in order to prevent cervical cancer in later stages of life. Our facilities provide services for men above 35 years of age for prostate cancer screening.
For skin and certain systemic cancers, preventive measures include campaigns raise awareness of the dangers of tobacco and alcohol use as well as the negative effects of a sedentary lifestyle. Persons diagnosed with cancer are referred to a higher level hospital for further management. All this forms part of our efforts as a Province in implementing the National Cancer Strategic Framework for South Africa 2017-2022.
Honourable Speaker, the deteriorating state of mental health amongst community members is of great concern to us and we wish to also improve on health promotion and prevention in this area. Through the Office of the Premier, we are looking forward to receiving feedback from the Department of Public Service and Administration on the organizational structure that we submitted for approval. Amongst other important aspects of the structure, we have elevated the management of mental health services to a directorate level. We will continue to appoint clinical psychologists towards our objective to improve the performance of district mental health teams. An important aspect of health promotion and secondary prevention in the area of mental health will be the education of family members with regard to their role in improving the wellbeing and conditions for mental health services users.
The department issued 535 wheelchairs in order to improve the quality of life of persons with disabilities.
Honourable Speaker, the health of women and children is an important contributor to human development in general. For the Department to progressively improve the quality of Maternal, Child and Women's Health, in its efforts to decrease morbidity and mortality, we continue to employ various methods to encourage women to visit antenatal clinics as soon as they find out that they are pregnant. Antenatal clients started on ART increased to 96% in 2018/19 from 54.1% in 2015/16 and 93% in 2017/18.
The Department of Health has revised the Guidelines for Prevention of Mother to Child Transmission to include the Essential Steps in Managing Obstetric Emergencies, Management of Listeriosis, Hepatitis, Malaria, Syphilis and TB in pregnancy. We will also strengthen collaboration with the Department of Social Development in ensuring that Early Childhood Development Centres (ECD’s) are issuing healthy meals to children below the age of 5 years.
Honourable Speaker and the House, our interventions are bearing fruit. I am happy to report that, according to Stats SA midyear population estimates, life expectancy at birth has increased for both males and females in the North West Province. The life expectancy for males has increased from 50 years in 2006 to 58 years currently. The life expectancy for females has increased from 54 years in 2006 to 65 years currently.
The Department has embarked on the reorganization of the Mmabatho Medical Store and the provincial management of pharmaceutical services, with regard to systems and human resources, in order to improve medicine availability through rational use and effective ordering, warehousing, distribution and payment systems. This is a massive process involving 13 workstreams at the Medical Store and 12 workstreams at provincial and district levels. This reorganization process has to be appropriately resourced in order to achieve the desired result of improved medicine availability in an acceptable time period.
Pharmaceuticals is the second largest budget item (after cost of employment) for provincial departments of health and the North West Department of Health is no different. The spend on pharmaceuticals in the private sector is equally high. The African National Congress, as articulated in its 2019 Election Manifesto, undertakes to establish a state-owned pharmaceutical company as part of its programme to promote an affordable and reliable supply of medication and localisation, especially in the production of vaccines and active pharmaceutical ingredients. The NWDoH will explore how the Department and the Province should take advantage of this undertaking to benefit the people of the North West economically.
The Province continues to make strides towards developing tertiary services following the gazetting of both Job Shimanakane Tabane (JST) and Klerksdorp-Tshepong (KT) hospitals as provincial tertiary hospitals in 2012. JST further registered progress in expansion of the training platform by increasing registrars (Doctors training to be specialists) through partnership with Sefako Makgatho University. JST’s CT scan became dysfunctional in 2016 and patients were referred to the Dr George Mukhari Hospital in Gauteng for scans. This inconvenience to patients from the North West came to an end at the beginning of 2019, when at the cost of R16m, a new machine, with a significantly greater capacity than its as predecessor, was installed. This piece of equipment speeds up decision making for management of patients.
Klerksdorp-Tshepong hospital remains a safety net for our province and continues to make headway in expansion of tertiary services. In April 2019, I led the hospital management and welcomed 13 new specialists across disciplines of neurosurgery, maxillo facial surgery, internal medicine, general surgery, paediatrics and obstetrics. The hospital expanded tertiary services from 13 in 2014 to 26 currently, leading to an over 20% reduction of patients being referred to Gauteng hospitals. KT in partnership with Netcare Ferncrest has successfully conducted 22 Cardiac operations and as we celebrated this milestone, I launched a similar partnership between KT Hospital and Life Ancron private hospital. This project signifies not only commitment, but action towards implementation of NHI where our patients are operated in private hospitals by our own specialist doctors and nurses, using our own consumables and only paying a facility fee.
Joe Morolong Hospital has entered into an agreement with Braun Renal Care Unit on the provision of renal dialysis services. This partnership brings this service closer to home for the people of Dr Ruth Segomotsi Mompati District. Being one of the most vast and rural districts of the Province, Dr RSM District has been relying on referring patients to other facilities especially to Klerksdorp-Tshepong Hospital.
Honourable Speaker together with Witrand and Potchefstroom hospitals, the three hospitals mentioned above, form the five of our hospitals that provide outstanding services to the communities that they serve. We however need to develop all our hospitals to once more become the pride of our Province. In this regard we will use the Ideal Hospital Framework to ensure that our hospitals have formally appointed chief executive officers, have the required staff, medication, infrastructure and equipment, are clean and provide safe environments for our patients and staff while being responsive to patients’ needs.
As part of an intervention to improve service delivery in Mahikeng Provincial Hospital, the Department plans to reconfigure services at this hospital to provide both level 1 and 2 services. This however, will only be possible after Bophelong Psychiatric Hospital has formally relocated to its new building after phase three construction has been completed.
We acknowledge the challenge of inadequate patient and administrative records management, especially in hospitals. The Department will in this financial year initiate a project of implementing electronic records management.
Forensic services continue to face challenges that include poor infrastructure and shortage of staff leading to overwhelmed specialists and mortuary assistants. The Department will explore targeted forensic mortuary maintenance or upgrades with focus on increasing shelves. Furthermore, we will explore creation and funding of four registrar posts with the view of training our own doctors towards specialising as forensic specialists. This will be done through reprioritisation of funds within the Department.
We are in the process of appointing the DDG for Hospitals and Clinical Support Services to provide improved management of our seven larger hospitals and the relevant support services.
Honourable Speaker and the House, EMS is one of our essential services and one that our people rely on heavily in times of dire need. Starting in the last financial year, the Department is gradually reducing its reliance on private EMS providers and growing our own fleet and personnel. In this regard, the Department procured in the last financial year, 20 planned patient transporters and 48 ambulances. Of these, 16 ambulances are awaiting conversion and the entire 48 ambulances still have to be registered by the Department of Community Safety and Transport Management. The attainment of our independence from private EMS providers will take some time and dedicated resources, as can be gauged from the national norms indicating that we need 360 ambulances to cover the population of the North West Province. We currently have 64 operational ambulances. We thus still need to continue our relationship with private EMS providers. This will be done through an open bidding process, signing up companies per municipality with an incentive for those willing to cover the far-flung areas.
We are on track to improve EMS response time through a centralized EMS Communication Centre and a real time vehicle tracking system. Through this center the 10177 number will be dialed toll free, and the nearest ambulances will be dispatched to the scene.
The Department will break ground with the planned procurement of one ICU ambulance for each district. The ICU ambulance will be equipped to attend to critical needs on the scene.
Honourable Speaker, the security of our staff in our facilities and institutions is of paramount importance. To this end our security services and the contribution of every security guard is valued. To improve on our payment turnaround, the payment of security companies has been centralized at provincial level since 1 April 2019. We are however still grappling with payment backlogs due to problems that were created by inefficient processes of the previous decentralized system. The Department will liaise with the Safety and Security SETA and National Skills Fund to request funding and approval of security learnerships for our unemployed youth. We have also completed a costed plan for insourcing of security services and will have to engage the Provincial Treasury with regard to the incremental implementation of this plan.
To assist with our infrastructure backlog, the Department has entered into a protocol agreement with the National Department of Health (NDOH). This agreement facilitated the procurement of eight new boilers for facilities in Ngaka Modiri Molema and Dr Ruth Segomotsi Mompati Districts. The same agreement makes provision for refurbishment of four boilers for facilities in Dr Kenneth Kaunda District and at Klerksdorp-Tshepong Hospital Complex as well as refurbishment at Christiana hospital. In Bojanala we are busy with the assessment of boilers, with the view of replacing or refurbishing those that needs to be attended to. The protocol agreement with NDoH enables the North West Department of Health to use its own resources for other priorities.
Furthermore, the Department has recently completed four CAPEX projects namely Brits Hospital Staff Accommodation, Madikwe Clinic and Boitekong CHC. Three OPEX projects recently completed include maintenance Moses Kotane Hospital, Lehurutshe Hospital and Gelukspan Hospital.
Currently the focus is on completion of the following CAPEX projects: Mmabatho College of Nursing, Mathibestad Clinic, Sekhing CHC, Jouberton CHC, Mmakaunyane Clinic, Excelsius College of Nursing and the Moses Kotane Hospital Sewer Treatment Plant, Bophelong Phase iii.
Honourable Speaker, I have given a clear directive that no new facilities are to be built unless we have the resources to staff, equip and furnish such new facilities. In line with this directive, going forward, the focus of our infrastructure improvement will be on the refurbishment and maintenance of existing health facilities to ensure that they attain Ideal Clinic and Ideal Hospital status in order to meet the National Core Standards. Refurbishments and replacement facilities planned for this year include Steve Tshwete clinic, Marcus Zinzile clinic, Motswedi Clinic, Rapulana Clinic, Witrand Psychiatric Hospital, JST Hospital, Medical Depot, MPH heating, ventilation and cooling system (HVAC), MPH laundry, kitchen and mortuary, Zeerust HVAC, Schweizer Reneke HVAC and Itsoseng water refurbishment project. The only new projects that the department will design and construct this financial year are the three new CHC’s which are Lebotloane, Manthe and Maquassi Hills.
The Department will restore services at the following burnt clinics by providing parkhomes: Motswedi Clinic, Kopela Clinic, Matloding Clinic, Sunrise Park Clinic and Ramokokastad Clinic.
An additional parkhome will also be provided in Deelpan while the planning for this clinic is underway.
Planning for the refurbishment and replacement projects for the following facilities will start in this financial year: Koster Hospital, Tlakgameng CHC, Taung Hospital, Ganyesa Hospital, Lehurutshe Hospital Phase ii, Deelplan, Potchefstroom casualty.
The Department is currently developing a methodology for ensuring that all PHC facilities and receive a maintenance visit at least twice per year while the hospitals should have dedicated maintenance teams.
The NWDoH will start a Contractor Development Programme which is aimed at a deliberate and managed process that will achieve targeted developmental outcomes to improve contractors’ grading status, performance and quality of service. This should focus on equity and targeted ownership through:
- Improving the grading status of previously disadvantaged contractors in targeted categories and grades;
- Improving the performance of previously disadvantaged contractors in terms of quality, employment practices, skills development, safety, health and the environment; and
- Improving the business management and technical skills of these contractors.
NWDoH aims to achieve the contractor development initiative through partnering with the Construction SETA. Through this partnership we also plan to engage 150 youths on a learnership programme and also create 500 jobs. The projects mentioned previously will be implemented through labour-intensive methods and will assist to generate direct and indirect local employment opportunities.
We are serious about improving the aesthetics of our facilities by ensuring consistent cleaning inside and outside. For this purpose we are procuring tractors, slashers and ride-on lawn mowers for every facility as required.
Honourable Speaker and the House, our plans to prevent and treat diseases and provide quality health care services will not materialise without the required human resources.
Over the past four years, the North West Department of Health has allowed its vacancy rate to increase rapidly through not advertising and filling posts as and when these became vacant. In May 2018, the overall vacancy rate was 19% and 28% for management posts, while in the chief financial officer’s programme the management vacancy rate was as high as 78%. This has made the Department vulnerable and unable to respond adequately to the health needs of our communities. Since the advent of the Section 100 (1) (b) Administration, the Department has advertised 3060 posts. To date we have made 1171 appointments but only 323, if one excludes the post community service appointments. The process of filling the advertised posts is too slow, due to the fact that the same depleted Department, which includes a depleted Human Resources Management Directorate, must now fill this large number of posts, while the same managers who have to constitute interview panels, also have to form part of performance review moderation committees to address the backlog of performance management and development cases. The Administrator is in the process of determining alternative means for speeding up the process of filling these vacancies.
The NWDoH continues to have a strong community service and internship programme. For this financial year, the department intends to retain all bursary holders upon completion of community service.
The number of graduates in the Cuban Medical Scholarship since inception of the Programme is standing at 113 while there are currently 314 students in Cuba. Those who are currently on internship are 32, 11 are currently on the Community Service programme, while 72 are doing final rotations in local medical universities.
Honourable Speaker and the House, the College and the University have in 2018 produced 475 nurses in both basic and post-basic courses. A New Nursing Curriculum is being introduced. To this effect two Curricula for the two nursing programmes have been submitted to the South African Nursing Council (SANC) and to the Council for Higher Education (CHE), for accreditation. While there is phasing out of the current curriculum, we will balance the next intake to match the need and budget availability. For the 2019 academic year, the North West Nursing College has enrolment of two hundred and eighty eight (288) students for the Basic Nursing and two hundred and one (201) for the Post Basic nursing Programmes.
The Department is in the process of reviewing and documenting its governance framework in line with government prescripts and good practices. This will be included in the orientation package of new staff and existing staff will be reoriented to good governance.
In 2018, we discovered multiple and continued transgressions of fraud, corruption, misconduct and dereliction of duty. This was addressed through coaching and guidance towards improvements in cases of dereliction and as a last resort commenced with investigations. The Department needs to implement automated systems to monitor compliance to prescribed supply chain processes. This will assist with early detection and correction of transgressions.
Honourable Speaker and the House, against the backdrop of the information I have shared with you, I table the North West Department of Health Budget for 2019/20.
Honourable Speaker as I conclude, I wish to remind all of us that if everyone is moving forward together, then success takes care of itself. It is for this reason that the ruling African National Congress has always believed that “together we can do more”. Moving forward together requires selflessness. His Excellency President Cyril Ramaphosa has called for this selflessness and inspired us with the spirit of “Thuma-Mina” to selflessly serve our people in the 6th Administration.
One of the guests on this day is a graduate of the Nelson Mandela- Fidel Castro Cuban scholarship, Dr Lindiwe Sidali. She is the first black African Female cardio-thoracic surgeon operating at Inkosi Albert Luthuli Hospital in KZN. She is the daughter of a mine worker who worked and resides in Wonderkop Marikana in Rustenburg. She was recruited and sent to Cuba by the North West Department of Health and after successful graduation she decided to specialize which we always encourage because Health care needs specialists. It is this specialization that took her to Inkosi Chief Albert Luthuli. If it was not for this program she would have never realised her dream of becoming a medical doctor. We celebrate her dedication and commitment to the field of health sciences and the House with your approval, Honourable Speaker, must give her a standing ovation.
Allow me to also take this opportunity to appreciate the work and leadership provided by Dr Desmond Kegakilwe who is the President of the Cuban Doctors Association. In addition, Dr Kegakilwe’s contribution through his role in the Rural Doctors Association of Southern Africa (RuDASA) has inspired us, to take seriously, the dynamics and challenges related to health care provision in rural areas.
I must take this opportunity to thank the ANC and its Alliance partners for the deployment offered to me by the movement of our people. I am also grateful for the support, inspiration and leadership provided by the Honourable Premier, Job Mokgoro.
A huge thank you to my colleagues in the Executive Council for your role in leading this Province and directing all of us in the delivery of quality services to our people.
The role of the Portfolio Committee on Health and Social Development is important in holding us accountable and I appreciate the wisdom and leadership of the members of the Committee. I also thank the Public Accounts Committee and the Auditor General for their critical role in providing oversight, accountability and governance within the democratic dictates of our country.
We are forever grateful and dependent on our governance structures like our hospital boards, mental health review boards and clinic committees. We appreciate the contributions from development partners, non-governmental organizations, faith-based organizations, religious leaders, traditional leaders, traditional health practitioners and our private sector partners.
Thank you to all the South Africans and organisations who provided input into this speech via Facebook and Twitter.
As the department, we appreciate the changed and improving attitude of our employees in all our facilities. We continue to call on the few that still has a wrong and misplaced attitude to accept change and embrace the organizational culture led by the Administrator and the MEC.
We appreciate the improved working relationship with all registered and recognised trade unions organizing in our department. Organised Labour is an important ally in the 6th Administration’s priority of building a capable and developmental state.
My sincere appreciation goes to the departmental management as led by Ms Jeanette Hunter in her role as Accounting Officer. I sincerely thank our health professionals, administrative officials and support staff for their perseverance and commitment to serve the people of North West.
I also take this opportunity to thank the former MEC for his contribution. Equally, the role of former Minister, Dr Aaron Motsoaledi must be commended. We take the baton and reach for greater heights.
Last but not least I thank my family for their support and for understanding that I am called to lead and serve our people.
I quote Nelson Mandela in saying: “A fundamental concern for others in our individual and community lives would go a long way in making the world the better place we so passionately dreamt of”.
Ke a leboga!
I thank you!
