Welcome to the Mpumalanga Provincial Government

Policy and Budget Vote Speech 2009/10 by MEC for the Department of Health, Mpumalanga Provincial Legislature, Nelspruit

28 August 2009

Honourable Speaker
The Honourable Premier
Members of the Executive Council
Honourable members of the House
Leader of House of Traditional Leaders Inkosi Mahlangu
The Acting Director General of the Province, Mr JS Mgidi
Acting Head of Department of Health, Mr JS Dlamini
Management of the Department of Health and all its employees
Leadership of labour and business
Leadership of the NGO sector
Traditional Healers Thokozani bogogo
Esteemed guests
Members of the media
People of Mpumalanga
Ladies and gentlemen

I stand here today to deliver the policy and budget speech overwhelmed by the gravity of the continued hope and trust that people of Mpumalanga and South Africa generally have once more put in our gallant movement, the African National Congress as demonstrated by the resounding victory in 22 April elections.

People of Mpumalanga have bought into the grand plan that we said once elected, we will hit the ground running. I am overwhelmed out of knowledge that 15 years into democracy and freedom, our people have shown tremendous patience in certain aspects of our work, having full confidence that indeed their turn will come.

Honourable Speaker I am overwhelmed because throughout the campaigning period when we interacted with our people throughout the width and breadth of our province we did not only hear but have seen the conditions under which they continue to live.

We know without being told that many of them continue to wake up early in the morning to be in time at our health facilities. I know without being told that many of them continue to endue long queues in our health facilities because they have no where else to go, unlike many of us. In my short period in the department many of them have written and phoned me to plead for a better service.

These and many other untold stories are indeed what overwhelms me, for I know that we have no excuse why we should continue to do things as if its business as usual when we vividly know it is not.

Today therefore Honourable Speaker and Honourable members as I present in this august house our plans for the year ahead, I do so with one thing in mind- services must be faster and better to our people.

Honourable Speaker we present our plans for the financial year ahead, amidst difficult financial situation. The financial meltdown has brought difficult moments for us, especially in the health sector. More and more people will not afford their medical aid premiums thus adding on the many people who rely on the public health sector.

This means added demand with fewer resources. Our figures show a significant growth of people that use our facilities in the last three financial years, and will continue to grow as indicated already.

The effects of the meltdown are more severe than we seem to fathom. Over the Medium Term Expenditure Framework (MTEF) period there will be marginal growth in our budget, despite ballooning medical and related costs which according to the official CPIX is in the region of 30 percent. Our present allocated medical budget can allow only for 9 percent. With the current expenditure patterns we are already focusing a shortfall in this area.

Added to this, is the strain that will be brought by the implementation of the Occupation Specific Dispensation (OSD) for additional groups of health professionals. Health delivery is a labour intensive operation therefore more than 50 percent of the allocated budget is allocated to personnel. The OSD is important because it is aimed to offset the net loss of our health professionals to private sector and overseas countries and correctly takes into account career path issues and many other necessary issues related to conditions of employment.

Honourable Speaker, a point must be made about the state of funding of Department of Health in our province. This department is acutely and chronically under funded. This is no secret, neither an excuse for not performing optimally. This situation requires collective wisdom and action.

Under these trying circumstances Honourable Speaker; my focus in the coming financial year will be on achieving greater efficiency, meaning we have to do more with the little with have. Concurrent to this, I will focus on the referral system which continues to elude us, and have adverse effects on the health delivery system.

Our work will be informed by what the urgency with which the ruling party ANC has put on ensuring better and quality health care delivery to all the people of our country. In this context I have identified some gaps since my deployment to this department which will inevitably pre-occupy our energies in the current financial year going forward.

These are; management and leadership inefficiency in the department; systems and processes; quality improvements; lack of maintenance and services to our infrastructure; poor technology management; poor supply chain management; inadequate customer care and inadequate staffing.

These gaps will be aligned with the ten point plans as identified by the National Health Council. The ten point plan focus on the following key aspects:
  1.  Provision of strategic leadership and creation of social compact for better health outcomes
  2.  Implementation of the National Health Insurance
  3. Improving the quality of health services
  4. Overhauling the health care system and improve its management
  5. Improvement of human resources
  6. Revitalisation of infrastructure
  7. Accelerated implementation of the HIV and AIDS strategic plan and the increased focus in TB and other communicable diseases
  8. Mass mobilisation for the better health for the population
  9. Review drug policy
  10. Research and development

This roadmap identifies key activities in response to priority number five of The Medium Term Strategic Framework which talks about improving the health profile of all South Africans.

Restructuring the service transformation platform

Honourable Speaker, if we are to make any dent in our pursuit of delivering better health to our people, we need to critically evaluate the current health care service delivery platform in our province. This evaluation is even more necessary in the context of the chronic resource constrains we have.

Our current health care facilities are not responsive to the service needs of our people in the province. Our population is sparsely located making it exceedingly difficult to provide static health facilities to all our people in need of these facilities.

We also have areas which are over resourced while other remains in the margins. Our current approach is doctor driven where people believe it’s only the doctor who can attend to their health need. This approach is not sustainable because we cannot practically have a doctor in every health facility.

Furthermore, we have very small facilities designated as hospitals while in fact they can perform optimally as community health centres. This evaluation is important if we are to plan ahead and project service needs in the next ten years.

The point we want to take home here is the unsustainable platform of health care service delivery; which is informed more by our past than our focus to the future and how it is positioned to respond to the present health care delivery challenges.

We have 233 eight hour operated clinics; 46 twenty four hour (or supposed to) community health centres; 23 districts hospitals offering level one care and five regional hospital offering level two and limited level three care.

The question that arises out of this numbers is whether they all offer efficient health services in their current form and shape. Is it feasible to have doctors in all these facilities’ and all other essential resources in these facilities in the foreseeable future?

In an attempt to respond to these crucial questions we carried out an analysis of the current service delivery platform. Our findings indicate that with the financial and human resource constrains that confronts us, we have no choice but to reconfigure our platform so that going forward we are able to sustain our service delivery obligations. We need to move away from the hospital based health care service delivery towards more community based health care service delivery.

Human resource management

Honourable Speaker we have already eluded to the fact that health service delivery is a labour intensive operation. This therefore requires constant innovation on how we recruit and retain scares skills personnel needed to provide services to our people.

Accordingly, we will commence an important work of drawing up the human resource plan that would take into account our unique settings and resource constrains but also leverage on our competitive edge as a province to be able to attract, but importantly retain health professionals in our province.

We know the environmental as well as the external factors which contribute to high staff turnover in our province. To solve them requires a concerted effort by all stakeholders because many of them are outside our sphere of command. Our province is the least funded amongst the province in terms of equitable share spending.

Consequently, we are the least paying province to our health professionals. Compounding this dilemma is the high cost of living in most of our cities and towns.

Mpumalanga province, unlike many other provinces have no university which means that many of our professionals interested in continuing their studies have to leave the province to be closer to where they can further their studies at the huge cost to our province. Many of our health facilities are located in deep rural areas with absolutely no social amenities for professionals, most of whom are increasingly young people.

As mentioned in the previous policy and budget speech, the department for a very long time operated with an outdated and unresponsive organisational structure. A lot of work was put in this area by my predecessor Cde Fish Mahlalela and we are now awaiting final consultation from the Department of Public Service and Administration on our new organisational structure.

Once finally approved we will begin to prioritise key service delivery posts that will have to be filled within the available resources. We will constantly come back to this August house to request for more resources in this regard.

We have also made commendable strides in the last financial year in our efforts of filling the huge vacancy rate that exist in the department of health.
In the last financial year we registered a net gain of 894 health professionals into our department.

Honourable Speaker I am happy to announce to this August House that after so many years in the Department, we now have appointed Chief Executive Officers for all hospitals.

As I indicated earlier, my focus will be to ensure that CEOs manage facilities more efficiently and effectively. I have already indicated that all of them will have to enter into performance agreements which should reflect the economic use of both human and financial resources; customer care and community responsiveness.

I want to request Honourable members of this August house to assist with political oversight in all their respective constituencies on how these health facilities are responding to the service needs of our people. I will personally handle your reports in this regard and managers will be held accountable.

Human resource development

Honourable Speaker the success towards the development of our country lies with us finding a solution to the skills gap that exists in our country. Our province is worse off in this equation given its geographic nature.

We should also understand the relationship between lack of skills and underdevelopment and poverty. Our work skills plan should therefore broadly respond to the socio-economic issues that pertain in our communities.

I have also realized a gap in terms of our thinking towards human resource development and how it links to the broader government marshal plans. The Provincial Growth and Development Strategy (PGDS) provide a broad framework as a response to our socio-economic challenges, but our plans still lacks alignment with this broad framework.

To compound the problem is the fact that even our interventions are not reflected in the Municipalities Integrated Development Plans (MIDP). This is the trajectory we must arrest.

Honourable Speaker, the department of health will spend over R32,4 million to cater for more than 786 students from the province studying in various health disciplines.

Over and above this number we also have forty seven students from Mpumalanga studying medicine in Cuba and an additional 12 students will be leaving at the end of September 2009 for Cuba. Most of these students are drawn from our municipalities with the highest multiple deprivation index.

A list of their names will be circulated to all your respective constituencies and municipalities so that they are reflected in the IDPs because the training is not only linked to human resource issues but are equally important as a development issue and a direct intervention in the war against poverty.

I must also hasten to indicate that bursary applications for the 2010 academic year are opened until 30 October 2009. Members are equally encouraged to mobilize students especially those from poor and child headed households to apply. Application forms can be accessed in our health facilities.

As part of government strategy to supplement the health professional resource base, various programs for the training of auxiliary health care workers are being explored. At present these include the clinical associates and pharmacy assistant’s programmes.

For this financial year 25 students from the province will enter the clinical associates program, 14 Pharmacist assistants and 45 emergency care technicians.

Honourable Speaker training of professional nurses continues at our college. For this financial year the college is providing training to 780 students which are at different stages of the study programmes. The current infrastructure and resources available do not allow for the department to expand this programme. This is a major challenge as we are not in a position to supply the nurses as demanded by the service needs.

Increased access to primary health care services

Honourable Speaker, the cornerstone of effective health service delivery is Primary Health Care (PHC) which correctly put more emphasis on prevention than cure and is community based.

The appointment of clinic committees and hospital boards is one element of ensuring that our health facilities are responsive to the community needs. Their functioning is therefore very much important.

Members of this august house are once more reminded of the need to populate the names of these individuals in their constituencies because they provide a vital link between communities and proper functioning of these health facilities.

What is important to note, which more often than not eludes us, is that the need for economic growth and sustainable development depends directly on a healthy nation. A nation free of disease is a productive nation.

This is why it is important to massively invest in health care not only for those who can afford but more importantly for the poor.

When we assumed governance in 1994, our health care transformation plan sought to attend to four crucial issues which remain our primary focus to date; quality, access, equity and affordability.

Our choice of primary health care and the district health system as a cornerstone of health care delivery system is premised on attending to these four important elements of the transformation plan. The introduction of the National Insurance Health Scheme is premised on nothing else but to attend to the above mentioned imperatives.

It is also in this context that I intend to focus more on the referral system of our health care system, because to date it is the missing link and once adequately attended to, can eliminate wastage and inefficient use of limited resources.

It should however be noted that this is not an easy task given the skewed allocation of health resources where you find areas that are over resourced and others not serviced at all. A typical example is what we have here in the Capital city, where we do not have a 24 hour PHC facility thus overburdening Rob Ferreira which by design should provide only level two and limited level three services.

Strengthening the referral system at all levels of care, including Primary Health care cannot therefore be overemphasised. This will contribute to cost-effective use of resources at all health facilities.

The by-pass of PHC facilities to district hospitals by patients poses a challenge to the delivery of PHC services in the province, hence a need for sustained referral system.

Honourable Speaker we will invest more resources in the health of our people living in the rural areas, in support of the government’s rural development strategy. In this regard we will officially launch the new campaign called “tirisano” which is aimed at bringing integrated services to rural areas focusing on the seven poverty stricken municipalities in our province. We will launch this campaign officially in the coming weeks.

An important element of this work is to ensure that we provide services even where we do not have static facilities. To this end, we will spend R6,1 million to procure 18 mobile clinics for Ehlanzeni district.

In Gert Sibande we have been assisted with four mobile vehicles from NGO’s called Family Health International (FHI) primarily to service Pixley Ka Seme municipality; one from Komati mine to serve Badplaas and two from Mondi Forest in partnership with Tholulwazi/Tholimpilo to cover Mkhondo and Pixley Ka Seme.

I am very thankful for the continued support of private and NGO sectors in our drive to improve health care services delivery especially to the most needy.
We have received R17,5 million from the European Union (EU) for the delivery of primary health care programme so that we can increase access to PHC through not for profit organisations.

Our focus within the Medium Term Strategic Framework is the need to speed up growth and transformation of economy to create decent work and sustainable livelihoods, building cohesive, caring and sustainable communities and improve community participation in the planning, provision, control and monitoring health services.

Honourable Speaker I have already alluded earlier to a need to improve hospital management in our province. The fact that we now have CEOs in almost all our hospitals must translate into improved service delivery to all the people in the province.

Effective hospital and health facilities management improves the health profile of all the South Africans and also results in sustainable resource management and use and this is an important element of the Medium Term Strategic Framework.

Hospitals management needs to comply with the norms and standards which are set for the facilities. The structure, process and outcome standards need to be adhered to, and quality improvement plans also need to be in place for quality service delivery.

Health programs
Health promotion

Honourable Speaker, health promotion is very crucial in our attempts to build a healthy nation. The old saying that; prevention is better than cure is important than ever before.

We need a drastic mind set change on our approach to health care. We cannot continue on a path that transfers responsibility for our well being to the state.

It is a matter of common cause that many of our health related diseases are what we call diseases of lifestyles many of which are preventable. Management and treatment of these diseases have a tremendous strain not only on our health resources but to the economy at large.

Government has put in place support mechanisms which include massive communication about a need to change our behavioural patterns in a manner in which we approach our lives. If people drink alcohol excessively knowing the effects of that, can we hold government responsible for that, if people smoke knowing very well the effects, can we still blame government, if people sleep with multiple partners without using condoms knowing the consequences is it fair to blame government, we know that overweight leads to high blood pressure, diabetes and heart diseases, but we are overweight anyway.

It is this context that we call for a drastic mind set change and take individual responsibility for our own health.

The healthy lifestyle campaign which encourage people to eat healthy and engage in physical activities remain a cornerstone in government‘s efforts of building a healthy nation.

Tuberculosis (TB)

Honourable Speaker and honourable members more work needs to be put in the fight against TB. Many of our people continue to succumb to TB despite the fact that it is preventable and curable.

I must be the first to confess that I am not convinced that enough resources in our province are invested towards the fight against TB. Although there is a noticeable improvement especially with regard to strengthening the program in that TB is now a stand alone Directorate, our TB indicators that are as follows;

Cure rate that is at 60 percent as opposed to 85 percent, defaulter interruption rate where we are at 8.8 percent against a 5 percent national norm and death rate which is at 9.9 percent as opposed to the national average of 7 percent.

Our approach honourable speaker is that it is one death too many because TB is both preventable and curable.

Mpumalanga has been affected like many provinces with regard to XDR TB that were reported in the country in recent past. We have four confirmed cases of XDR TB in our province at Witbank TB hospital. Due to the burden of MDR TB cases in our province, where we now have 249 patients on treatment with only 36 beds available, the plan is to increase the number of beds from 36 to 120 whereby each district has a 40 bed MDR unit. Further more we plan to strengthen management of MDR patients in the communities.

The contributing factors remain insufficient active community and social mobilisation, which covers prevention, early detection and proper treatment. Community support remains another critical element in the prevention and treatment of TB.

TB management and control program has been identified as a priority for the five year strategic plans of the department. This compels us to ensure necessary and adequate resources are invested in this area of work, because TB is a preventable and curable disease.

I have also instructed the communication unit and health promotion and the TB directorate to develop and implement a comprehensive communication strategy to fight TB.


Honourable Speaker eradication of malaria is high on our priorities. Our determination is to have no death reported attributed to malaria. In this regard, we will scale up our efforts especially in preparation for 2010 soccer world cup games of which Mbombela will be host. We are fortunate that the games will be played during the malaria off season.

We made commendable strides in the fight against malaria increased our spray coverage rate from 87 percent in 2007/08 to 91 percent in 2008/09. 544 654 structures were sprayed in Nkomazi, Bushbuckridge, Mbombela, Kruger National Park and Umjindi to kill malaria vector mosquitoes and thus reduce malaria transmission. Close field supervision was the main reason for the improved spray coverage.

230 temporary community spray operators were appointed on a five months contract period to assist with spraying and 30 were appointed for ten months to assist with spraying and awareness in preparation of FIFA 2010.

It is quite regrettable Honourable Members that we continue to loose lives due to malaria. We recorded 1739 in Malaria cases in 2008/2009 financial year with 12 deaths. These deaths represent 0.69 percent fatality rate which is slightly above the norm of 0.5 percent. However compared to the last two financial years, we have slightly improved from 19 reported deaths in 2007/08 and 12 in 2008/09.

We will continue to participate in the Lebombo spatial development initiative which is a collaboration of three countries; Mozambique, Swaziland and three provinces in South Africa, Mpumalanga, Kwazulu-Natal and Limpopo.

Comprehensive HIV and AIDS care, management and treatment

Honourable Speaker the dream of Africa free from HIV and AIDS should propel all of us to work hard everyday and contribute in whatever small but significant way towards making it a reality.

Latest research indicates reduction of new infection cases in our country. These are welcomed news, however we have no luxury to rest on our laurels and think the war has been won, it is in fact far from being won.

Despite the general reduction of new infection cases in the country, it is a matter of concern that in our province we have in actual fact seen an increase of new cases. At this point we have to double our efforts and harness resources and energy in a fight against HIV and AIDS.

The 2007 to 2011 National Strategic Plan (NSP) for HIV and AIDS has provided a fertile ground for all and sundry to double efforts in the war against HIV and AIDS. I have already as the secretariat of the Mpumalanga Provincial AIDS Council (MPAC) urged stakeholders to finalise our provincial strategic plan.

We are now finalising the second draft and hope to finalise this important document before the end of the third quarter.

Another critical aspect in the fight against HIV and AIDS is to ensure that we strengthen the TB and HIV collaboration. Patients who with TB need to be encouraged to test for HIV and when found positive which means they are co-infected, require a comprehensive management of the co-infection without being sent from one clinic to another. The same applies for HIV patients who are co-infected with TB.

We also need to continue to mobilise our people to test and know their status because this provides a necessary intervention that can prolong their expectancy. Honourable members, testing is not equal to public disclosure of our status but personal disclosure.

Honourable Speaker in the last financial year we had set ourselves a target to provide antiretroviral (ARVs) to 35,698 by increasing ARV rollout sites from 25 to 34 in the province.

I am humbled by the hard work that our employees have put up in this area of work because we exceeded this target and we had 46 879 people on ARVs at the end of March exceeding our by 11 181 people and increased sites to a set target.

This good news honourable member has put enormous pressure on our limited financial resources and has contributed to the accruals in the department. It will be inexcusable for us to stop initiating patients eligible for ARVs because of limited funding.

The additional 11 181 we exceeded our target with, has already added strain to our current financial year budget. Our target for this financial is to provide 70 313 people with ARVs. Current trends indicate that we are likely to exceed this target. We had planned to reach 52 000 people in the first quarter, instead we now have 54 000 people on ARVs exceeding our target by 2000 people.

This program is facing tremendous budget pressure. For us to reach the target we set for ourselves of 70 313 people we needed a budget of 280 million but only 120 million has been allocated. This amount can only sustain the current people on the program until mid-September. The wisdom of honourable members to rescue us will be highly sort.

Child health

Honourable members, child health is a cornerstone for building a prosperous nation. This programme is aimed at reducing the diseases of childhood and death as a result of these diseases amongst children. This program is also linked to the Millennium Development Goals (MDGs).

The deaths of children that are occurring in our facilities have declined in the last two years. The death rate of children under one year in our health facilities decline from 25.6 in 2007/08 to 23.4 in 2008/09 and the death rate of children under five years declined from 9.9 in 2007/08 to 8.1 in 2008/09.These are deaths of children that are occurring in health facilities.

These developments are as a result of our concerted effort which included; development of neonatal management guidelines and admission records to improve management of sick children. The introduction of Integrated Maternal and Child Health Care (MACH) Project has resulted in an alignment of prevention of mother to child transmission to the child health programme. This has seen a reduction in the transmission of HIV from mother to child.

Another important intervention has been the integrated Management of Childhood Illness (IMCI) which is an emergency care of children presenting at facilities with common childhood diseases and is now implemented in 97 percent primary health care facilities. Honourable members it is a common cultural practice that many of our people would present to traditional healers before presenting in our health facilities. It therefore becomes important for us to forge partnerships in the management of diseases.

Partnerships with traditional healers are not limited to child health but cover all aspects of our health care services. We should not be ashamed that we consult with them. In this regard, we trained 60 traditional healers in the province in child health related conditions. The other important strategy in reducing diseases and death amongst children is to ensure that they are fully immunised. We have not been to reach our immunisation coverage for children under one year because we now stand at 76 percent against the national target of 85 percent. The new vaccines for prevention of diarrhoea and pneumonia in children have been introduced and now form part of our immunisation schedule.

Maternal health

Maternal health is also one program linked to the Millennium Development Goals. This program is aimed at reducing women dying as a result of child birth.

Mpumalanga province is amongst the provinces with high rate of women dying as a result of child birth. The most contributing factor is high prevalence of HIV and AIDS; none and late presentation at health facilities during pregnancy and medical conditions like hypertension.

We have the following intervention to reduce these deaths; basic ante natal care which provides health care workers with skills to identify high risks associated with pregnancy.

The central and crucial intervention is for all pregnant women to report at health facilities when they miss one month of their menstrual period. This provides necessary management of pregnancy until birth and reduces risks associated with pregnancy.

Integrated nutrition programme

The nutrition programme is aimed at addressing nutritional needs of people living with HIV and AIDS, TB and malnutrition.

In the province, we are supporting 6 500 adults and 500 children. We are also providing vitamin A supplementation amongst children to reduce the incident of malnutrition. We also encourage food gardens in the community as part of improving nutritional status of our people.

Communicable disease control

Honourable members our province has been prone to number communicable diseases in the past. It should however be noted, that health is always at the receiving end in relation disease outbreaks. These points to a need for a collective and coordinated approach to address all causal issues many of which are environmental, infrastructure and poverty related.

We have been able to deal be many outbreaks in the province despite acute shortage of suitably skilled personnel in this area of work. The most common outbreaks in our province are diarrhoea related, cholera, rabies and hepatitis A.

On this note, I want to take this opportunity to re-assure the people of Mpumalanga that we are doing everything necessary to contain the current H1N1 Influenza. There are 134 confirmed cases in our province as of yesterday.
As we have said before, people should not panic, but report early to any health facility if they see symptoms like; high fever, headache, stomach-ache, chest pains, dry cough, sore throat and body ache. The most vulnerable sections are pregnant women, people with underlying conditions like diabetes, hypertension, heart diseases, HIV positive people and TB.

We have already instructed our health care professionals to treat every pregnant women presenting with flu like signs to be put on Tami flu medication immediately.

Hospital services

Honourable Speaker we earlier highlighted the disjuncture of service platform in our province and the big by-pass by patients.

Regional and tertiary hospitals are designed to provide level two and three services which are mainly under specialists care. However many of these hospitals are over burdened by patients who should otherwise be seen at clinics, community health centres and district hospitals.

The consequence of this by-pass leads to long queues, poor quality of care and fatigue to our health professionals. The case in point is Rob Ferreira here in the capital city which is increasingly over-stretched by level one patient because we do not have a community health centre or clinic in the vicinity.

It is in this context that we have prioritized the building of a new community health centre in Nelspruit that will operate 24 hours. This facility will be completed by January 2010 in time for 2010 FIFA World cup tournament.

Honourable Speaker, three of our five regional hospitals are under revitalisation; Rob Ferreira, Ermelo and Themba hospitals. The revitalisation program is designed to modernise the delivery of health care services, optimise management systems, procedures and structures. The other benefit of revitalisation is also to provide new buildings with low maintenance costs.

We are however concerned about the slow pace of construction of these projects most of which were to have been completed already. We are grateful that the Honourable Premier has already taken upon himself to ensure speedy delivery of these projects.

Four of the big five hospitals are part of the national core standards for health establishment the purpose of which is to serve as a guide for managers as to what we should be doing and also as a basis for measuring our own performance.

The areas of focus in this regard are; patient safety, clinical care, governance, patient experience of care, access to care, facility infrastructure and environment and public health.

Mpumalanga province is mainly a rural province and therefore finds it difficult to attract and retain suitably qualified and experienced staff such as specialists. The limited capacity within the province to deliver level 2 and 3 services impacts negatively on the province as it becomes reliant on the neighbouring Gauteng province for the provision of these services. The rapid turnover of medical staff can be contributed to the lack of a tertiary /university facility.

A case in point is that we currently have a huge backlog of patients in need of orthopaedic surgery due to a shortage of orthopaedic surgeons in the province. Rob Ferreira only has one fulltime orthopaedic surgeon and Witbank has two with more than 100 patients waiting for surgery. We cannot even transfer to private hospitals due to limited funding to these hospitals.

In response to this sad situation, we have already started development of a business plan for the new Nelspruit tertiary hospital to ensure reduction of referrals to Gauteng province.

One of the longstanding challenges of the big five hospitals is that have had managers in acting positions and this limited planning and consistency. I am proud to announce that we now have all five hospitals will fully appointed Chief Executive Officers (CEOs).

Pharmaceutical services

Honourable Speaker part of effective health care service delivery is our ability to have all essential drugs in all our facilities at all times. Since we took a decision that allows all facilities to order directly from the depot, we have seen commendable improvements of availability of drugs in our facilities.

The challenge is that most of drugs are not manufactured in South Africa and are therefore a subject of markets fluctuations and limit availability. The other challenge is that tenders for certain drugs is managed at national and due to our cash flow challenges which disrupt our payments to service providers, our credit lines are reduced thus limiting our ability to have all essential drugs at all times.

The province has for a very long time not had its own facility for depot. Leasing of this facility is very expensive. To this end, I am happy to announce that construction of our provincial depot in Steve Tshwete local municipality has been completed and will be opened in September.

The opening of this facility will enhance service delivery since we will have one-stop-service to all our facilities in the province.

Honourable speaker one of the challenges with regard to the roll out of ARVs has been shortage of trained pharmacists and pharmacists assistants who are the only people allowed by law to dispense medication.

In this regard we have collaboration with private sector to train pharmacist assistants through learner ship programme. This is the first time this programme has been run and we are the leaders in this innovation. The programme will run in Ehlanzeni as a pilot and will train 14 students this financial year through this Learner ship programme. The department is training Pas in the hospitals and this is an additional programme.

Forensic health services

Honourable members, forensic health service is a key programme in which medical knowledge is used in assisting criminal investigations. It has two important pillars which are clinical forensic medicine and forensic pathology.

Clinical forensic medicine has its focus on victims of crime such as assault, drunken driving, sexual offences and child abuse; whereas forensic pathology has the focus on investigating the causes of unnatural deaths.

Our work in the forensic pathology has assisted in the recent provincial disasters where we had to deal with many deaths and had to conduct investigations within a limited time. These include:

  • A bus accident in Piet Retief where a total of 29 people lost their lives in October 2008
  • A plane crash in Lydenburg where three people died in October 2008
  • A truck accident in Mapulaneng where 23 people died in November 2008
  • In Barberton where 19 illegal miners’ bodies were recovered underground.

With regard to clinical forensic medicine, we have been to establish a unit dedicated towards taking care of victims of violence which include sexual offences and general abuse cases. There are currently ten sites offering limited care to victims.

It remains a challenge Honourable members, is to attract suitably qualified personnel for this crucial area of work. The problem is that this important field is only taught at post graduate level in our universities.

To this end, we have successfully been able to train 25 professional nurses in clinical forensic medicine and 11 are currently undergoing training at the University of Free State. Furthermore ninety more health care professionals have received training in basic care of such victims.

Honourable Speaker we have been able to make a tremendous progress in our collective efforts to offer support and care to victims of violence by establishing the first one stop service centre in the province, called Thuthuzela care centre at Themba Hospital.

This centre aims to integrate the services of different stakeholders which include health workers, social workers, psychologist, National Prosecutions Authority and the police. This centre is being developed as a centre of excellence and by the end of this financial year we would have established another two one stop centres in Ermelo and Tonga.

Eye care programme

The eye care program is our shining example of service excellence. This programme has made the department and the province as a whole very proud due to diligence and commitment of people in this unit towards improving the lives of our people for the better. It has won departmental, provincial, national and continental awards.

In the recent campaign to do community work during Mandela Day, screened 328 and gave 291 people with reading glasses. They had only planned to see 90 people.

During the past financial year we managed to conduct 2408 cataract operation in the province. This was done after the screening of 80610 people that reported with eye care problems.

In addition refraction test were conducted on 12584 people with low vision and 4863 spectacle were dispensed.

The eye care program will continue to provide this essential service to our people in line with the vision 20/20 program. In this financial year, 3600 cataract operations will be conducted and 5000 spectacles will be dispensed to people in need. We are also very much thankful for the generous support of our partners; Impilo, Ster Kinekor, Sight Saver International, Bureau for the Prevention of Blindness and the Lions Club.

Improving quality care and Emergency Medical Services (EMS)

Honourable members, Emergency Medical Services (EMS) is very central in our pursuit of providing quality health care to the people of this province.

We know about community outcry with either late or non arrival of ambulances to calls made by communities. It is for this reason that we cannot rest until we have an efficient, effective, properly equipped EMS unit in our province that can restore confidence and faith to many of our people about our ability to respond to their needs.

The chronic challenge in these regard Honourable members is insufficient resources to match the ever increasing service demands in our province. We are very far away towards reaching the national norms which require one ambulance for every 10 000 people. In the province we currently only have 95 rostered ambulances which is 70 percent short of the required norm.

The other challenge is that our fleet do not last long due to conditions of our provincial roads thus adding pressure of maintenance to the already depleted budget. The staffing norm is that each ambulance must have ten personnel and currently our ration is one ambulance to eight personnel.

Despite these enormous challenges, we will be able to procure 53 ambulances; we have just appointed eighty six emergency care practitioners who have started earlier this month. We have also established five additional EMS stations in Mayflower, Matsulu, Komatipoort, Waterval Boven and Reitspriut.

In this financial year Honourable members we will implement the integrated computerised communication system for Emergency Medical Services. This system will directly contribute to improved quality of care which includes improved response times, data collection and management, real time tracking of ambulances and integration of planned patient transport.

Strengthening of physical infrastructure

Honourable members delivery of quality health care services requires quality infrastructure. Over the past few years we have been building new facilities, and while these are necessary and important, we have unfortunately neglected the maintenance of existing facilities.

Our focus going forward is to complete the current projects and focus on maintenance of the existing facilities. Our concern has been that many of our projects are not completed within agreed timeframes.

We are currently building seven 24 hr Community Health Centres (CHC) clinics at; Lochiel, Dwaarsloop, Kwamhlanga, Greylingstad, Xanthia, Warburton and Nelspruit.

We are also building accommodation unit for our health professionals in; Verena, Lefiso, Nokaneng, Delmas, Matsulu, Buffelshoek, Iswepe and Silindile.We are upgrading and renovating eight hospitals which are; Evander, Delmas, Witbank, Standerton, Middelburg, Barberton, Mapulaneng and Kwamhlanga.

The house is therefore requested to approve the appropriation for vote 10, an amount of R5,429,452,000 for the Department of Health.

The budget for vote 10, Department of Health, is allocated as follows:

Programme 1: Administration R274,436,000

This programme provides policy direction, overall strategic leadership of the whole Department and monitoring and evaluation.

Programme 2: District healthy services R2,762,324,000

This programme is the nucleus of the health system; it promotes access to health services by the general community through primary health care and includes amongst other programmes TB management, HIV and AIDS.

Programme 3: Emergency medical services R206,635,000

This programme provides emergency services and planned patient transport services.

Programme 4: Provincial hospital services R689,566,000

This programme provides level two of health services and specialised services.

Programme 5: Central hospital R586, 374,000

This programme provides level three health services.

Programme 6: Health sciences and training R213,781,000

This programme provides skills development, bursaries, medical allied training, learnership and nursing training.

Programme 7: Health care support services R92,676,000

This programme provides pharmaceutical services, laundry services, orthotic and prosthetic services and health technology workshops.

Programme 8: Health facilities management R603,660,000

This programme deals with infrastructure which include fixed medical equipment.

I want to thank the dedication and hard work by management and entire personnel in the department. Allow me to thank in particular Dr Sibongile Zungu for having steered the boat and wish her all the best in her new responsibilities in KwaZulu-Natal.

In the same breath allow me to welcome Dr Johnson Jerry (JJ) Mahlangu who will start on 1 September as the Superintendent General or Head of Department of Health (Honourable let me give a disclaimer, the Mahlangu clan is so big, so there is no relationship here that was on the lighter note).

The unwavering and critical support of the portfolio committee is what keeps us going. The support of my colleagues in the executive is heartening. The visionary and fatherly support of the Premier is inspiring. All clinics committees, hospital boards and statutory committees in the department, without your commitment we cannot pull alone.

Let me thank my family for their warm support and today I am joined by my brother Phillip Molatudi and my sister Tlaki Pitsi. The Secretary-General of the United Nations Ban Ki-Moon reminds us that; I quote.

“At this time of global economic downturn, we face a crossroads. We can cut back on health expenditures and incur losses in lives and fundamental capacity growth. Or we can invest in health and spare both people and economies the high cost of inaction. The cost of cutting back is just unthinkable."

I know that many in this audience do not need to be told about the significant returns we see from investing in health. Investments to scale up basic health services can bring six fold economic returns.

Healthy people have improved life expectancy, go to school, are more productive, take fewer off days from work, have lower birth rates and thus invest more in fewer children.

Health is the tie that binds all the Millennium Development Goals together. If we fail to meet our targets on health, we will never overcome poverty, illiteracy, achieve universal education and meet other MDG challenges.

I thank you.

Kea leboga

Issued by: Department of Health, Mpumalanga Provincial Government

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