MEC Speeches
Policy and Budget Speech Vote: 10 – Department
of Health 2008/2009
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 Organisations, Traditional Healers, NGO’s
and All Social Formations
Management and Staff of the Department of Health and
Social Services
Distinguished Guests
Members of the media
Ladies and gentlemen
Today we live in very paradoxical times. In the latest
World Happiness Report researchers found that the
800,000 people interviewed around the world felt that
governments should focus on what makes people happy
rather than what makes people wealthy. This is a very
interesting perception because governments have always
focused on increasing the GDP so that people become
wealthier and therefore happier. In the study it was
concluded that there are three main closely interrelated
variables that made people feel more or less happy in
the state of their country, these variables are health
levels, followed by wealth and then provision of
education. There is a belief that capitalism leads to
unhappy people. However, when people are asked if they
are happy with their lives, people in countries with
good healthcare, a higher GDP per capita, and access to
education were much more likely to report being happy.
An interesting conclusion of this study adopted by
UNESCO, The UNHDR and the World Health Organisation, is
that South Africa ranked number 109 and the 3 least
happy countries of the 180 countries of the world are
the DRC, Zimbabwe and Burundi.
Rarely in recent years has a development in the field of
academic psychology captured such widespread attention
as the current developments in positive psychology on
the topic of happiness. Whilst academic investigation of
something as intangible as happiness may seem at first
surprising, the age long search for happiness, a primary
motive of human behaviour, has ensured a broader
audience than psychologists usually attract.
That is why in modern times the definition of health has
come to have a broad and extensive meaning and that is
why as the current government our focus has been one of
a holistic provision of services to ensure a better life
for all. From the Freedom Charter to the resolutions
taken by the ANC at its 52nd Conference in Polokwane
last year, we have been on track towards creating a
nation of happy people. We have always prioritised the
provision of health and education services and are
committed to building an economy that will ensure the
equal redistribution and access to the country’s
resources by its entire people.
Madam Speaker, a major challenge and learning curve we
have had to face as a government; and indeed it is faced
by modern democratic governments that have been in
existence for over 200 years, is that of systematic,
inter-correlating and integrated service delivery
machinery. Whilst all the departments in the province
seem to have specific mandates, these mandates speak of
one end-goal, one of building a better life for all. At
the time we are able to deliver on the mandates agreed
upon by the people of this country, we will have
succeeded in building a healthy South Africa that has a
high General Well Being indicator and not just a high
GDP indicator.
As a major building block for the country we all
envisage, having a universal health care system that can
meet the needs and demands of all the people is
something we have to achieve in the shortest time
possible. This will not be easy because as we attempt to
move forward we have to address and redress the
structural imbalances left by the legacy of the
apartheid government. As such, we as a department are
rising to the call by President Thabo Mbeki to work as
“Business Unusual: All hands on deck to speed up
change!”
1. RESTRUCTURING OF THE SERVICE DELIVERY PLATFORM
The most important aspect in ensuring increased and
efficient service delivery on our mandates is the
strengthening of our organisational capacity. Madam
Speaker as presented to this House two weeks ago, we are
seeking to have the organisation as we know it now split
into the department of Health and the department of
Social Development. We are working to finalise the
structure by the end of July 2008.
For the optimal functioning of the health system, it is
crucial that all hospitals are properly equipped with
the necessary financial and human resources including
the appointment of CEO’s by July 2008. The new
organogram will include a special projects unit to deal
with amongst others the implementation of the norms and
standards for health as well as human rights issues.
Last year we reported that work will commence on the
Service Transformation Plan (STP).The primary objective
of the development of the STP for the province is to
meet the constitutional mandate of:
“The progressive realization of improved access to basic
health services for all South Africans within available
resources”
There is a need, however, to take the opportunity to
explore new service delivery options and develop a
transformation plan for our Health Sector that will
enable the Province to achieve the objectives it has set
for itself, including improving current services and the
introduction of new, high quality health services.
It is obvious that continuing with business as usual is
not an option within the Department of Health. The
priority of the National Department of Health and
subsequently of the Department is to provide full
service packages for all levels of care. The purpose of
the STP is to develop a plan within which we shall
deliver accessible, equitable, efficient and quality
health services to the masses of our people, within
financial and human resource constraints in a manner
that is economically sustainable and can be feasibly
implemented.
It is therefore imperative that the STP is drafted and
implemented in such a way that it improves health
service delivery and increased access. To achieve this
it will be necessary to realise increases in efficiency
and to find ways to optimise both the distribution of
resources and the use of available technologies.
Madam Speaker, it is with shame that we admit that
Mpumalanga is the only province that has not finalised
its STP. We will however Madam Speaker, work
extraordinarily hard in the Spirit of Business Unusual
to have a final draft adopted by August 2008. This
failure to have the STP is a serious indictment because
the STP is the guide that must ensure a better and
efficient public health system
It is imperative that the political and administrative
leadership of this province deals with the issue of
income disparity between provinces in the health sector.
Currently Mpumalanga offers remuneration packages that
are below par when compared to other provinces. So
Mpumalanga is not only bearing the consequences of an
international shortage of medical professions, but we
are losing professionals to other provinces in the
country because they offer better remuneration packages.
Service delivery in the social development sector is
personnel driven, and as long as we don’t have the
basics to attract and retain professionals we will not
render efficient services or fulfil the Millennium
Development Goals amongst other mandates.
1.1 HUMAN RESOURCE DEVELOPMENT AND MANAGEMENT
Human resources remain the most critical input in
achieving successful health outcomes. The Public Service
Regulations requires that Departments must review their
HR Plans annually. Regrettably, the Department of Health
and Social Services has not had an HR Plan for the past
4 years.
For the financial year 2008/2009 the Department has
prioritised the review of the Human Resource Plan in
response to the Service Transformation Plan. To this end
the Department is acquiring additional capacity to fast
track this process and it is envisaged that the process
will be completed by September 2008. Included in this
process will be the review of Human Resource Policies,
which is critical for the effective and efficient
management of human resources.
1.2 OCCUPATIONAL SPECIFIC DISPENSATION FOR HEALTH
PERSONNEL (OSD)
According to Resolution 1 of 2007, Section 4,
Subsections 4.14 relating to the Health and Social
Development Sector, OSD for all categories of nurses
should be implemented with effect from 01 July 2007.
The National Department of Health allocated R94 million
for the implementation of the OSD for nurses, to date
R174 million has already been spent, which constitutes
86% over-expenditure on the allocated amount with a
carry through effect of R20m per month. A total of 6,925
nursing personnel benefited in the OSD. This constitutes
99% of the nursing personnel.
Notwithstanding, the implementation of the OSD for
nurses has been plagued by grievances arising primarily
out of lack of clarity related to specialities. The
Department in consultation with the National Department
of Health is developing guidelines on specialities.
Madam Speaker, the OSD for the remaining health care
personnel will come into effect as from 01 July 2008.
The health occupational categories that will benefit
from this are: medical doctors, dentists, medical and
dental specialists, pharmacists and emergency medical
personnel. The OSD for the remaining health occupational
categories will be addressed in the 2009/2010 financial
year.
1.3 FILLING OF VACANT FUNDED POSTS
Following the President’s and the Premier’s February
injunction regarding the filling of all funded vacant
posts by 30 June 2008, the Department undertook an audit
of funded vacancies and identified a total of 3 936
vacant funded positions which constitutes 20.6% of the
total establishment of 19 097.
In response to this call, the Department has since
February to date advertised a total of 2 833
posts both internally and in the national media. It is
envisaged that the outstanding 1 103 will be
advertised on the 15th June 2008. Furthermore the
Department has appointed an employment agency to assist
with response handling and is in the process to appoint
additional employment agencies to assist with the
secretariat function in the three districts. It is
envisaged that all funded vacancies will be filled by
August 2008. However all critical posts are prioritised
to be filled in June 2008, this includes SMS and CEO
positions.
Madam Speaker as of March 2008 the total number of
vacancies for medical doctors in the country was 5,723
and 603 of those vacancies are for Mpumalanga. This
presents a 54% vacancy rate for the province, which is
significantly higher than the national average, which is
36.9%. We felt we should flag this issue in light of the
high press coverage stating that the shortage of doctors
in the province alone is approximately 8,000.
1.4 HUMAN RESOURCE DEVELOPMENT
The growth and development of our province is dependent
on the availability the necessary skills base. The
department in this year is providing bursaries to 121
full time students and it has been allocated as follows:
| Medicine |
55 |
| Pharmacy |
26 |
| Radiography |
6 |
| Speech and Hearing Therapy |
6 |
| Dietetics/Nutrition |
6 |
| Physiotherapy |
8 |
| Occupational Therapy |
7 |
| Medical / Clinical Engineering |
7 |
There are currently 37 Students from the
Province that are studying medicine in Cuba on full
bursary.
This financial year, the Province will commence with the
clinical associate programme. This is an intervention
aimed at addressing the shortages of Health
Professionals in the Province. This is a three-year
programme that will produce a cadre of health
professionals that will work in Community Health
Services and District Hospitals. After qualification
they will be able to assess patients, make a diagnosis,
provide treatment and do minor surgery under the
supervision of a medical officer. The first group of 18
students from the province will join this programme in
July 2008 at the University of Pretoria, and 80 students
will commence with the programme in January 2009.
1.5 HEALTH INFORMATION SYSTEMS
The management of both communicable and non-communicable
diseases is fundamental in increasing the efficiency of
our responses to these diseases. The monitoring of
disease profiles and the outcomes of health
interventions is of critical importance for the
improvement of the Provincial Health System. Madam
Speaker I am happy to announce that we are currently
rolling out to the latest version of the District Health
Information System 1.4; The Department will be fully
functional on the DHIS 1.4 at the end of June 2008. This
system enables the department to collect data on an
agreed upon set of data elements from the lowest level
of the Health Care System. The Data is being used to
calculate the health indicators that were identified to
monitor the Departments performance. The availability of
Hospital Information Officers and Sub District
information officers is currently still a challenge. The
Department is aiming to appoint a heath information
officer for every hospital and sub district.
2. STRENGTHENING THE DISTRICT HEALTH SYSTEM AS THE
VEHICLE FOR THE DELIVERY OF PRIMARY HEALTH CARE
Madam Speaker, September 2008 marks the 30th Anniversary
of the Alma Ata Declaration and the adoption of the
primary health care approach by the international
community. The declaration put specific emphasis on
primary health care as a way of delivering health
services to the people of the world particularly to
those living in poverty. We as a country have adopted
the District Health System as the vehicle for the
delivery of Primary Health Care services.
Increased access to primary health care services remains
the strategic thrust of social development in our
province. The strengthening of Primary Health Care
services will therefore continue to be at the centre
stage for ensuring that the people of Mpumalanga enjoy
quality services at individual and community level
through the network of Primary Health Care facilities
and services in the Province. Our priority in addressing
the competing demands for health services will be to
develop a Primary Health Care model in line with the
service delivery framework of the National Department of
Health. This model will include the review of the
current policy guidelines, norms and standards for the
delivery of Primary Health Care so as to improve
equitable access to services; this process will be
concluded by September 2008.
The role, responsibilities, authority and accountability
of the District Health Management Team will be
strengthened as to achieve the improvement of primary
health outcomes. The implementation of Primary Health
Care Supervision is one of the essential strategies in
improving the quality of Primary Health Care Service. We
will continue to strengthen primary health care
supervision. During this year we will ensure that each
clinic and community health centre will have an assigned
facility manager. This will be complemented by dedicated
and trained primary health care supervisors who will be
assigned to a cluster of clinics within a specific
municipality. To complement the current pool of
supervisors, an additional 6 supervisors will be
appointed by the end of July 2008. These supervisors
will be expected to conduct formal clinic supervision
visits at least once per month to each of the clinics
and Community Health Centres in the Province.
One of the challenges for the effective implementation
of clinic supervision was the lack of transport. This
has been corrected and each clinic supervisor has been
provided with dedicated transport.
The Department has established a Primary Health Care
Supervision Task Team with the mandate to actively
monitor and support Primary Health Care Supervision for
us to be able to improve the Primary Health Care
supervision rate from 34% to 100% by the end of this
financial year.
Another key principle of the Primary Health Care
approach is community participation. In order to promote
ownership of health development, the communities,
through their representatives and interest groups, will
be encouraged to participate in the planning, provision,
control and monitoring of health services in their area.
Communities will be represented in governance structures
at community and district levels. Our target is that by
the end of August 2008 all Primary Health Care
facilities will have appointed Primary Health Care
facility committees.
We have also received donor funding from the European
Union to the tune of R23 million to initiate a programme
that will contribute to more accessible, affordable
Primary Health Care to the poorest communities. This
programme will assist in addressing development indices
such as poverty and unemployment, which are Apex
Priorities in War Against Poverty as pronounced by our
President in his State of the Nation address. Through
this programme, we will fund 60 Non Profit Organisations
over a period of 36 months that are providing Primary
Health Care Services to the poorest of our communities
focusing on the poverty pockets in Nkomazi, Albert
Luthuli, Mkhondo, as well as areas in Dr. JS Moroka and
Thembisile due to their low TB cure rate.
Madam speaker, the department will be moving with speed
towards the finalisation of the process with regards to
the Provincialisation of Primary Health Care services
that refers to the transfer of all Primary Health Care
services from Municipalities to the Provincial
Department of Health.
During October 2008 the department will host a
conference in celebration of the 30th Anniversary of the
Alma Ata Declaration; this year is also the 60th
Anniversary of the establishment of the World Health
Organisation. The conference will celebrate the
achievements with regards to the delivery of Primary
Health Care in the Province; it will also be a platform
to interact with stakeholders and our brothers and
sisters from other developing countries on their
successes with rolling out primary health care according
to the tenets of the Alma Alta Declaration. One of the
pillars of the primary health care approach is inter-sectoral
collaboration. In response to this, the conference will
also examine the broader social determinants of health
care such as poverty, housing, safe drinking water,
environmental pollution and sanitation, and how it could
be incorporated into the provincial primary health care
model.
Madam Speaker, we will now move to the delivery of
priority primary health care programmes.
2.1 HEALTH PROMOTION
Madam Speaker, it is our view that the Health Promotion
sub-programme has not been receiving adequate resources
and given the scope to play the crucial role necessary
to provide promotive and preventive services. The role
of health promotion is to enable our citizens to
increase control over and improve their health. If we
increase the health literacy of our communities they
will be empowered to protect themselves against diseases
of lifestyle as well as communicable diseases. People
will have a prolonged and higher quality of life if we
can decrease the incidence of illness and diseases.
Health promotion, being the foundation of preventative
measures therefore undoubtedly has considerable economic
value. Madam Speaker we are seeking to be more proactive
with a promotive and preventative approach to health
care by empowering our people to take control of their
health by providing health education and promoting
actions in support of health.
Of the top 10 causes of death in South Africa, 9 are
related to diseases of lifestyle. According to the
Medical Research Council, HIV and AIDS is the number one
killer, followed by heart disease, stroke, TB,
hypertension, diabetes and diarrhoeal diseases. All the
aforementioned can be prevented and or treated to reduce
the period of illness as well as the cost of treatment.
A major challenge within the Health Promotion Sub-programme
is the lack of resources, both human and financial. The
department will make provision for an appropriate
structure for this very important programme in the new
organisational structure and more resources will be
mobilised to ensure that effective and efficient health
promotion services are provided.
The first action is to develop an integrated health
promotion policy for the province, which will be
completed and launched in November 2008 during Health
Promotion Week. This important step will involve all the
relevant stakeholders and programmes in health promotion
and disease prevention. These stakeholders amongst
others will include other departments, for example the
Department of Culture, Sport and Recreation, the
Department of Education and the Department of
Agriculture. By providing integrated services we will be
able to stretch our resources and strengthen our health
messages. An important stakeholder is the Department of
Agriculture that is doing important work on food
security which is linked to nutrition, a crucial factor
in disease prevention.
Madam Speaker, the Health Promotion component will
continue to focus on the healthy lifestyle programme
that deals with:
- Promoting good nutrition;
- Promoting physical activity;
- Promoting safe sexual behaviour;
- Tobacco control; and
- Combating the abuse of alcohol and substance
abuse
The Department will facilitate the establishment
of inter-sectoral healthy lifestyle forums at
provincial and district level; these will be
functional by August 2008. Thereafter we will have
12 inter-sectoral community-based healthy lifestyles
interventions with a budget of R100, 000.00. We are
planning to purchase 3 mobile trucks that will bring
screening and intervention services for chronic
health conditions closer to our people, which will
be launched during the Health Promotion Week to be
held in November 2008.
2.2 TUBERCULOSIS (TB)
Madam Speaker, the department will pool all its
resources that are geared towards TB and an
integrated plan for the management of all TB cases
will be developed. A new Directorate for TB is being
created to oversee all the activities of the
Department and other stakeholders towards the
effective management of TB.
Of the R39 million available for TB in the province,
R20 million will go towards the purchasing of 2
Specialised TB Hospitals as part of the drive to
integrate the services previously rendered by SANTA
into that of the Department. The case load for TB
has risen from 15, 092 in 2006 to 18,249 in 2007.
Even though the number of XDR patients has not risen
the Department will embark on a survey to determine
the extent of XDR in the Province.
The province through the support of the EU programme
has appointed 8 TB Patient Tracer Teams. These teams
are operational in Mbombela, Nkomazi, Thembisile, JS
Moroka, Emalahleni, Steve Tswete and Pixly ka Seme,
with Mbombela having 2 teams. These tracer teams
will follow-up patients that have not returned for
treatment. This will have a direct result on
decreasing TB defaulter rate and increase the TB
Cure Rate. The TB defaulter rate for 2005 = 10,8%
and the in TB defaulter rate for the same period in
2006 = 10,4%. The expected outcome for the defaulter
rate for 2007 is 7%.
2.3 MALARIA
Madam Speaker, the Malaria Programme has performed
excellent during the 2007/2008 Financial Year and we
will continue to improve the services to our
communities within the malaria prevalent areas. The
Malaria programme concentrates on the following key
focus areas to manage and control Malaria that
includes: Intensifying activities towards malaria
elimination through vector control, disease
surveillance, epidemic preparedness and response,
effective case management, malaria information,
education and communication as well as regional
collaboration.
Vector control is done by the spraying of 500 000
structures in the highest malaria risk areas with
indoor residual spraying. Spray coverage of 85% was
achieved in the 2007/2008 financial year, which is
higher than the National target. 36 additional
temporary sprayers will be appointed to increase the
spraying coverage in Bushbuckridge.
Disease surveillance is done by visiting all the
health facilities in the high-risk areas. All cases
are recorded on the Malaria Information System,
which have set thresholds to enable the facilities
to alert the managers when the threshold is reached.
A health promotion intervention on Malaria was
intensified at school and household level. The main
messages were on early presentation for rapid
diagnose and prompt treatment. The communities’
health literacy on malaria increased and patients
present early at the facilities for treatment. The
case fatality rate for the first time in many years
has moved to 0.74% which is slightly above the
national norm of 0.5%
The province participates in the strengthening of
malaria control in the Southern African region
through the Lubombo Spatial Development initiative (LSDI).
Regular quality control and technical support visits
are conducted in Mozambique.
The department has allocated a total amount of R41
million for the Malaria Control Programme.
2.4 COMPREHENSIVE HIV AND AIDS CARE, MANAGEMENT
AND TREATMENT
Madam Speaker, from the onset we must state that our
approach to HIV and AIDS has shifted in the past
couple of years and does not focus as much on
prevention as it used to. It is our view that going
forward we need to change this approach as a matter
or urgency, and have all our people join in on our
war cry, which is Prevention! Prevention! And
Prevention!
In 2007/2008 financial year, the Department planned
to have 23, 695 patients on anti-retroviral
treatment; however by the end of the financial year
27, 001 patients were on treatment. The number of
patients was almost doubled as compared to the
2006/2007 baseline of 14, 995 patients.
For this financial year, the department will
increase the number of patients on treatment to 35,
685 and we plan to increase the number of accredited
facilities from 25 – 34.
Community Home Based Care is the most accessible
service a consumer can access nearest home, which
encourages participation by people, response to the
needs of people, encourages community life and
create responsibility.
The Department funded 105 Community Home Based Care
Organisations, with 2, 202 Care Givers receiving a
monthly stipend of R500 and R250 administration fee
per month. 523 Care Givers were trained as part of
the Expanded Public Works Programme (EPWP). This
year we will again fund 105 Home Community Based
Care Organisations, with 2, 202 Care Givers. We will
increase the number Care Givers trained to 900 as
part of the EPWP programmes and they will continue
to receive a minimum stipend of R500.
Furthermore, the department has started implementing
dual therapy in four sub-districts, namely Nkomazi
(Ehlanzeni district), Albert Luthuli (Gert Sibande),
Steve Tshwete and Emakhazeni (Nkangala district). By
March 2009, all public health facilities providing
Ante-Natal services will be providing dual therapy.
The Mpumalanga Council for AIDS was launched in
November 2007. Currently the Mpumalanga Five-year
AIDS Strategy is being developed and will be
launched on the 9th October 2008 at the celebration
of the partnership day. This will be in line with
the 2007-11 National Strategic Plan.
2.5 EXPANDED PROGRAMME ON IMMUNISATION
The main thrust of the Expanded Programme on
Immunisation is to reduce the morbidity and
mortality in children less than 5 years and is one
of the main factors toward the attainment of the
Millennium development goal 4 which relates to the
reduction of under 5 mortality. The province in the
previous year has achieved 85% Immunisation Coverage
for fully Immunised children under 5 years. The
Department conducted the National Mass Polio and
Measles Campaign during May and August 2007.
Mpumalanga reached the national target of 90%
coverage in both rounds of the campaign in children
0-5 years. The province achieved 97% Coverage for
Polio during the first round and 93.5 % during the
2nd round. The Measles coverage of 91% was reached.
During the 2007/2008 financial year the immunisation
coverage increased from 83.2% to 84%. In this
financial year we seek to ensure that immunisation
coverage is on par with the national target of 85%,
although we will be seeking to ensure that every
child in the province receives immunisations as and
when it is due. Madam Speaker we would like the
House to note that the Province is number 1 in the
country with regards to implementation of the child
immunisation programme.
The Province is currently conducting case based
measles surveillance and identified 3 positive
measles cases with no deaths reported. No outbreak
as a result of measles has occurred in the previous
financial year.
2.6 INTEGRATED NUTRITION PROGRAMME
The Integrated Nutrition Programme is one of our
priority primary health care programmes.
Interventions from this programme contribute to the
attainment of MDG 1 for alleviation of poverty and
MDG4 to reduce child morbidity and mortality.
A Provincial Protocol regarding target supplementary
feeding is currently under review, this will be
completed by 30 June 2008. The nutrition
supplementation programme is aimed at:
- Malnutrition intervention
- Prevention of Mother To Child Transmission (PMTCT)
- People living with HIV/AIDS or TB
During the 2008/09 financial year 23 691 people
infected and affected by HIV and AIDS and TB will
receive food supplementation at a total cost of R16
million.
With regards to micronutrient malnutrition control,
there is a specific focus on vitamin A
supplementation; this refers to routine
supplementation of post partum mothers and infants
under 1 year. During the 2008/09 financial year the
Integrated Nutrition Programme is planning to
further reduce the incidence of micronutrient
deficiencies in children less than 5 years, with
specific reference to vitamin A supplementation by
rolling out a campaign during the months of
September 2008 and March 2009 and reaching 80%
coverage.
Madam Speaker we are pleased to announce that 26
facilities have been accredited as Baby Friendly
Hospital compliant. Internal and external
assessments are done annually to ensure that this
status is maintained. In addition, annual training
is conducted on lactation management, in order to
have more facilities accredited.
343 Demonstration food gardens have been established
at clinics and Health promoting schools and this
year we will establish 373. These Demonstration Food
Gardens are important because they assist to educate
the public on proper nutritional eating. Madam
Speaker, nutrition is often misunderstood and it’s
impact under-estimated. Malnutrition is the lack of
sufficient nutrients to maintain healthy bodily
functions and is typically associated with extreme
poverty in economically developing countries. It is
a common cause of reduced intelligence in parts of
the world affected by famine. Malnutrition is also
as the result of inappropriate dieting, overeating
or the absence of a “balanced diet” is often
observed in economically developed countries for
example as indicated by increasing levels of
obesity. Obesity is reaching epidemic proportions in
South Africa and we are number 2 after the USA with
the highest number of obese peoples.
2.7 CHRONIC AND GERIATRIC
Madam Speaker, the Chronic and Geriatric unit mainly
deals with services in promotion, prevention and
management of diseases of lifestyle; and it also
incorporates the Traditional health practitioner’s
unit to implement the Traditional Health
Practitioner’s Act. The department will be
facilitating the establishment of the provincial
Traditional Health Practitioner Register in
preparation for the establishment of the Provincial
Traditional Health Council. This will enable the
Department to facilitate the integration of
traditional health into the mainstream public health
system.
Cancer is a chronic condition and falls within the
mandate and responsibility of the Chronic Disease
and Geriatrics programme. During this year the
Department will initiate a Cancer Register, which
will provide information on the morbidity and
mortality rate as a result of cancer. We will
increase collaboration with NGO’s such as CANSA and
other NGO’s dealing with chronic diseases.
Madam Speaker, the Chronic disease and Geriatric
programme will organise workshops to orientate
facility managers on the Fast Lane strategy for
people with chronic medication in order to reduce
the long queues at our facilities. The Department is
committing itself that all health facilities will
have the basic equipment for the diagnosis and
monitoring of chronic diseases such as Blood
Pressure machines with the appropriate set of cuffs
and blood gluco-meters by the end of July 2008.
2.8 REHABILITATION SERVICES
The department will continue to address the backlog
of assistive devices with specific focus on
eliminating the current backlog in the Bushbuckridge
area. An amount of R3, 5 million will be spent on
procurement of 650 manual wheelchairs, 21 Power
wheelchairs and 570 pairs of hearing aids to enable
more people with disabilities to participate fully
in community activities. We will continue to ensure
that only quality assistive devices are issued by
the province, this will be informed by the donation
policy for assistive devices to be completed by
August 2008. In this financial year we will complete
the electronic assistive devices register as a
monitoring and evaluation tool for this programme.
We have further committed R 3, 3 million for the
provisioning of the Community Based Rehabilitation
services in partnership with Disabled People - South
Africa (DPSA). This amount is aimed at economically
empowering 35 people with disabilities who will be
appointed as field workers at the different
municipalities, and we will further identify and
refer 6,000 people with disabilities to access
relevant government services, especially Health and
Social Services, Education and Home Affairs for the
first time in their lives. An additional 12,000
people with disabilities will receive peer
counselling and rehabilitation services.
The Department will continue to ensure that people
with visual disabilities access proper services. We
acknowledge that not much has been done for visually
impaired people in the past. In order to bridge this
gap, the department has renewed the partnership with
the Mpumalanga Branch of the South African National
Council for the Blind. An amount of R1, 1 million
has been committed to this project. This will enable
1,200 people with visual disabilities - blind and
partially sighted - to access orientation and
mobility services as well as assistive devices.
2.9 MATERNAL, CHILD, WOMEN AND YOUTH HEALTH
PROGRAMME
2.9.1 MATERNAL HEALTH
Madam Speaker, pregnancy and childbirth are natural
and should be safe events in a woman’s life.
According to the Millennium Development Goal,
maternal deaths should be reduced from 150 per 100
000 by 75% by the year 2015. In the province
maternal deaths for 2005/6 increased from 147 to 152
per 100 000 population in 2006/07. This is a
significant increase of maternal deaths. According
to the Saving Mothers report, it is reported
predominantly that HIV is a major cause of maternal
death. One of the other contributory factors is
related to late or not attending antenatal care.
In order to address the problems of anti-natal care
the Department has in the previous financial year
piloted the Basic Ante Natal Care Project. This
programme is currently implemented at 9 facilities
in the Province and it will be further rolled out to
another 15 sites by the end of this financial.
A Provincial Maternal Health Task Team was
established to assist districts to improve maternal
health services. The team developed an audit tool
for hospitals, community health centres, clinics and
mobiles; this will enable the department to measure
progress made with regards to the Saving the
Mothers’ 10 Key Recommendations. The first audit
report will be released in August 2008.
27 hospitals out of the 28 in the province are
implementing the Peri-Natal Problem Identification
Programme. This is the initiative used to identify
challenges on the management of maternal patients
and new borns. The programme was now rolled out to 8
Community Heath Centres, 4 at Nkangala and 4 Gert
Sibande District during the previous financial year.
This year we will roll it out to another 3 CHC’s one
in each district.
2.9.2 CHILD HEALTH
The Millennium Development Goal 4 for reducing child
mortality by two thirds from 1990- 2015.
The Department is also implementing the Child Health
Care Problem Identification Programme (Child PIP)
which is a strategy that is used to monitor the
outcome of children admitted in hospitals in the
province. It was found that most of the children die
of malnutrition, HIV related conditions, diarrhoea
and pneumonia. Half of children who died were
eligible for ARV therapy on the basis of clinical
staging. Child PIP are currently being implemented
in 11 hospitals. During this financial year we will
further roll out to another 5 hospitals.
96% of our Primary Health Care facilities are
implementing the integrated Management of Childhood
Illnesses strategy.
2.9.3 WOMEN’S HEALTH
During the 2007/08 the strengthening of the Cervical
Cancer screening programme had been prioritised as
an intervention that has provided access to broader
women’s health issues. The programme had remarkable
results and 41% of eligible women have been screened
for cervical cancer during 2007/08. This is an
8-fold improvement from the previous year. In this
financial year we will continue to build on the
successes and increase the number of women being
screened. Madam Speaker we chose Cervical Cancer
because it is one of the biggest killers of women in
South Africa.
3. HOSPITAL SERVICES
Madam Speaker, hospital services are a critical
facet in the provision of health services in any
public health system. Our hospitals are not well
perceived and there are many challenges in the
delivery of hospital services other than the obvious
shortages of professionals.
A business plan is being developed for the Nelspruit
Tertiary Hospital to ensure the reduction of
transfers to Gauteng and poor health outcomes. Madam
speaker the people of Mpumalanga deserve the same
level of access to level 3 or tertiary services as
elsewhere in the country. The development of
essential equipment lists for all health facilities
will respond to the report of the medical equipment
audit that will be released by 30 June 2008.
In an attempt to facilitate sustainability in the
equipment maintenance programme, we have been able
to award bursaries to 7 students to study clinical
and medical engineering. Upon completion of their
studies they will be employed by the Department to
ensure continued maintenance of medical equipment in
our facilities.
The Department will create a special projects unit
to drive the implementation of hospital standards as
part of the National Health Facility Improvement
Project. The three big hospitals in the Province
that will be part of the project this financial year
are Ermelo, Witbank and Rob Ferreira Hospitals.
During the previous year the Department developed a
framework for hospital quality improvement plans.
Madam speaker I am happy to announce that by the end
of July 2008 each hospital in the Province will have
a quality improvement plan in place. It is our
belief that the implementation of these plans will
have a positive impact on the quality of services
that are being provided in our province. This
initiative will be closely monitored and will form
part of the performance agreements of Hospital
CEO’s. With specific reference to Rob Ferreira
Hospital, in the sectional meeting we held with
hospital management we have agreed that the hospital
must, as a matter of urgency, have a
turn-around-strategy in place by the end of this
month. We are extending this challenge to all the
hospitals that are performing poorly. This is
important, especially with specific reference to Rob
Ferreira so that we start preparations for FIFA
World Cup 2010.
3.1 PHARMACEUTICAL SERVICES
The completion of the pharmaceutical depot at
Middelburg will improve the efficiency of
distribution of medication to all health facilities
in the Province. The drive to train pharmacy
assistants has assisted to help some of our District
Hospitals and Community Health Centres to function.
Pharmacy Assistants are part of the mid-level cadre
of workers that improve access to health care.
3.2 FORENSIC PATHOLOGY SERVICES
The transfer of Forensic Pathology Services from
South African Police Services to the Department of
Health and Social Services was done on the 1st of
April 2006 to date 75 Staff have been employed and
19 new Mortuaries are planned for the MTEF Period.
The programme must be commended for expert handling
of the fatal bus accident in Komatipoort on 8 April
2008 where 17 Mozambican Nationals were burnt beyond
recognition.
Further recruitment and training of professionals in
Forensic Pathology remains a challenge. To date the
province remains without a specialist.
Clinical Forensic Services is gaining momentum with
the training of 4 forensic nurses in 2007/08 and 5
more will be trained during the 2008/09 financial
year. The availability of trained nurses will
strengthen the victim empowerment programme and
ensure that evidence collected at our facilities
leads to convictions. The Department will begin with
the establishment of 15 clinical forensic centres
that will this financial year only deal with sexual
offences. The package of services will be rolled out
progressively and it is envisaged that a full
clinical forensic package will be offered by 2011.
We have to assist in increasing the number of cases
that go to court and get a conviction. Out of 2
million contact cases reported in the country, only
200,000 were convicted and part of the reason is the
performance with regards to forensics. Only 450,000
got to court and this is not good enough.
3.3 E-HEALTH
One of our special projects is the development of an
E – Health Strategy and Plan for the Department. It
is envisaged that this process will be completed by
the end of September 2008. A component of the
Service Transformation Plan will be a comprehensive
plan for the roll out of telemedicine in the
Province. This will ensure the efficiency in the
utilisation of scarce skills and provide for
improved access to health specialist services to a
wider number of people of Mpumalanga. During this
financial year Telemedicine and Teleradiology will
become operational in 10 Hospitals. Rob Ferreira,
Tonga, Themba, Piet Retief, Ermelo, Kwamhlanga,
Witbank and Shongwe will be connected to Pretoria
Academic Hospital.
3.4 EYE CARE PROGRAMME
The eye care programme which focuses on prevention
of blindness and improvement of vision has witnessed
a number of successes through innovative approaches
aimed at reaching the target population. This is one
of the most successful programmes in the department.
Cataract operations were conducted to 2762 patients
in 2007/08. This followed the screening of 53 798
clients. Furthermore, the programme conducted
refraction error screening to 11 806 patients
following which 4349 spectacles were dispensed. Key
programme partners for 2007/08 included Ster-Kinekor,
Empilweni Pension Pay out Services, Lions Club
Nelspruit, Sight Saver International and the Bureau
for Prevention of Blindness (SA). Other notable
achievements for the programme include awards
accorded such as the Premier’s Excellence Services
Award, The DPSA Public Service Innovator of the Year
(SA) Award, and the National Cecilia Makiwane
Awards.
This financial year the programme will be conducting
3 200 cataract operations after screening 50 000
patients, and will be conducting refraction error
tests to 12 000 patients with view to dispensing 4
500 spectacles.
3.5 IMPROVING QUALITY OF CARE AND EMERGENCY
MEDICAL SERVICES (EMS)
Madam Speaker, earlier this year we launched new
ambulances, which came to a total of 103. This will
be complemented by the procurement of an Emergency
Management Centre this financial year for R18
million, whereby real-time tracking of all our
ambulances will take place thus reducing response
times by directing ambulances to incidents closest
to them. An agreement has been concluded with Air
Mercy Service with regard to the Helicopter
Emergency Medical Services. We are now able to
transport scarce medical expertise around the
province within 40 forty minutes of receiving a
call, thus improving access to specialist health
care. The service has also enabled us to commence
with an outreach programme where specialists visit
district hospitals with specific emphasis on the
hospitals in the remote rural areas.
Planned Patient Transport will be transferred from
the hospitals to Emergency Medical Services by the
end of December 2008. This initiative is dependant
on the finalisation of the emergency management
centre.
All EMS vehicles will be fitted with real time
tracking devices and Driver Management modules to
assist in the identification and location of all
vehicles at all times. The Driver Management will
assist the department in analysing and assessing of
bad driving behaviour and this will also contribute
to the reduction of accidents.
Madam Speaker in meeting the 2010 FIFA requirements
this financial year we will commence the building of
5 purpose – built EMS stations in the following
areas: -
- Nelspruit
- KaNyamazane
- Kabokweni
- Matsulu
- Moloto
Madam Speaker we will also be purchasing
medical equipment to the value of R5.7million to
improve the quality of patient treatment whilst
in transit in EMS vehicles in the province. The
College of Emergency Care will be revamped to
increase the intake of students and will also be
geared towards the offering of the Emergency
Technician Courses after the approval of the new
Organogram.
The Emergency Medical Services is gearing itself
to fulfil the demands of the 2010 FIFA World Cup
by employing more Emergency Care Practitioners,
purchasing more ambulances, and equipment,
however it must be said that we are having
serious challenges that require additional
budget if this section is to be ready at the
level expected of it. EMS will purchase 15 new
rapid response vehicles, 74 ambulances and 20
Patient Transporters with a carrying capacity of
25 patients each.
4. STRENGTHENING OF PHYSICAL INFRASTRUCTURE
Madam Speaker, the slow pace in the delivery
with regards to physical infrastructure is
causing problems and hampering service delivery.
The Infrastructure Unit has always been a strong
need within the Department establishment.
Escalation of the need and bringing it to
prominence through the adoption of the
Infrastructure Delivery Improvement Plan (IDIP)
has been welcomed by the Department. It is
however important that the Unit should not be
seen as a tool for undermining or substituting
the role of Public Works. Instead, it ought to
be viewed as reinforcing the Department of
Public Work’s capacity in delivering to the same
mandate from a client department’s perspective.
It is hopd that improved capacity in the
Department of Health and Social Services will
mean more efficiency for the Department of
Public Works as the work load is shared by the
two departments.
The Department of Public Works is currently the
only implementing agency for the construction of
Infrastructure on behalf of the Department of
Health and Social Services.
Due to the workload of the Department of Public
Works alternative and Multiple Implementing
agents should be considered to address the
immense infrastructure backlog currently
experienced in the Department. Another turnkey
option for addressing the backlog on health
infrastructure is to consider alternative
methods for construction. This can include park
homes or steel structures, which are quicker to
erect, and are as permanent as brick and mortar.
A team from the province with representatives
from the department of health, public works and
Treasury visited a steel frame construction
plant in Pinetown, KwaZulu NataI. In the light
of the information collected it was found that
with the use of steel frames a M2 Mortuary can
be erected and made operational within 6 months
and a clinic within 3 months. This would elevate
the current infrastructure backlog in the
Department and if this option is used it will
have an immediate impact on health
infrastructure development. This will further
contribute to the improvement in the expenditure
of infrastructure and forensic pathology grants.
4.1 MAINTENANCE PLANS
Madam Speaker, maintenance plans will be
developed and costed for all health facilities
as the maintenance of hospitals and clinic has
largely been reactive, tending to be driven by a
philosophy of ‘don’t-fix-if-it-aint-broken’.
The result is that our structures continue to
deteriorate, and renovation backlogs increase by
the day. While rescue actions are expected from
national interventions such as the
Infrastructure Delivery Improvement Plan driven
processes, Hospital Revitalisation and the
Service Transformation Process; these cannot
produce all the expected results in a speedy
manner. The Department will require
complementary institutional arrangements for the
infrastructure unit.
5. BUDGET
Madam Speaker the budget that we submit to the
House for approval in appropriation for Vote 10:
Department of Health, is total amount of R 4,
241, 753, 000.
The budget for vote 10, Health component, is the
broken down as follows:
PROGRAMME 1: ADMINISTRATION R206, 543, 000
This programme provides policy direction,
overall strategic leadership of the whole
Department and monitoring & evaluation
PROGRAMME 2: DISTRICT HEALTHY SERVICES R2,
183, 715, 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 & AIDS.
PROGRAMME 3: EMERGENCY MEDICAL SERVICES R165,
674, 000
This programme provides emergency services and
planned patient transport services.
PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES
R569, 292, 000
This programme provides level two (2) of Health
Services and Specialised services.
PROGRAMME 5: CENTRAL HOSPITAL R538, 437, 000
This programme provides level three (3) Health
Services.
PROGRAMME 6: HEALTH SCIENCES & TRAINING R110,
309, 000
This programme provides skills development,
bursaries, medical allied training, learnership
and nursing training.
PROGRAMME 7: HEALTH CARE SUPPORT SERVICES
R79, 339, 000
This programme provides pharmaceutical services,
laundry services, orthotic and prosthetic
services and health technology workshops.
PROGRAMME 8: HEALTH FACILITIES MANAGEMENT
R388, 444, 000
This programme deals with infrastructure
5. CONCLUSION
Madam Speaker, I have just presented an overview
of what the department seeks to achieve going
forward this year. There are many issues that we
still need to attend to and also expand the
scope of services that we offer to the people of
Mpumalanga. As we complete putting in place the
necessary systems and strengthening our
institutional capacity, we will be able to make
a solid scientific case to Cabinet and to this
House for further funding because in earnest
this vote and mandate is significantly
underfunded.
At this point in time there is no denying that a
concerted and integrated approach is required
from all of us. The Millennium Development Goals
serve to illustrate that all of the challenges
we are facing are inter-sectoral and
cross-cutting, so we need to configure our
planning as such, otherwise our efforts will not
have an impact. Building a Healthy Nation is a
prerogative of everybody beginning with the
individual, and that is why we have demonstrated
in the programmes we have just outlined that our
focus is prevention and health promotion. This
cannot be understated. Taking the cue as leaders
in this campaign we have decided that we must be
what we speak, we are putting our monies where
our mouths are, literally.
In my office, 7 of the 8 staff are categorised
as obese according to the internationally
accepted measurement using the Body Mass Index
(BMI). We have therefore undertaken to live
healthier lifestyles by emulating the popular TV
programme The Biggest Loser. The MEC’s Office
has its own Biggest Loser competition taking
place with a prize incentive for whoever loses
the most in a specific period. We can’t be seen
to be preaching healthy living if we are not
living those principles. Madam Speaker, this is
on a lighter note, however it is a good
initiative that communities and friends can
follow. Changing one’s lifestyle and behaviour
is not easy, therefore a supportive structure
can make the difference between success and
failure.
Madam Speaker and Honourable Members, let me
take this opportunity to thank the Acting HOD
and her management as well the staff of the
department, your honesty, integrity and
commitment is required even more if we are to
make a real difference improving the lives of
our people.
Allow me to thank the Premier and my colleagues
in the EXCO for the support they have given and
continue to give to me. To the Portfolio
Committee Members, the success of this
department in meeting its mandate is highly
dependent on your effective oversight role.
I thank you.
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