Policy and budget speech for the Department of Health 2012/2013
Honourable Speaker SW Lubisi
Honourable Premier DD Mabuza
Members of the Executive Council
Honorable Members of the House
Acting Head of Department of Health Mr. Richard Mnisi
Management of the Department of Health and staff
The NGO sector
Members of the media
Ladies and gentlemen
The Buddha once said: “Every human being is the author of his own health or disease.” On the 16th October 2011, Fauja Singh who was born in India and was 100 years old fulfilled this saying, by becoming the first oldest person to complete a full-distance marathon. He participated in the 42 km Toronto Waterfront Marathon where it took him more than eight hours to cross the finish line, earning him a spot in the Guinness World Book of Records.
Honourable Speaker, it is indeed true that we are the authors of our own health or diseases. The WHO defines health as “A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.”
While genes contribute up to 30 percent impact on people’s lifespan, a healthy life-style can add up to 12 years or more to an individual’s years of living. To attain this state, an individual must be disciplined on health matters. A person might have to eat what one may not like and do what one might not enjoy. This means one must eat right and avoid fast-foods or junk food, exercise regularly, have adequate sleep, manage chronic diseases properly if one is a sufferer and avoid any risky behavior such as excessive alcohol consumption, drug abuse, cigarette smoking and irresponsible sexual behavior.
The life-style of the citizens of Mpumalanga, coupled with poverty related socio-economic ills, has resulted in a grossly diminished life expectancy of its citizens. The average life expectancy for males is 50.3 years and that of a female is 51.6 years in the province. This is below the National life expectancy of 53.3 years males and 55.2 years females. Life expectancy in developed countries is much higher and ranges between 80 and 85 years. With prioritization of health across the globe, it is expected that life expectancy will increase further in the coming decades even in developing countries.
The Department is on course to ensure that we utilize resources within our means to restore and advance the human dignity as enshrined in the constitution of the country and the Freedom Charter, by providing a better health service to all South Africans.
While the population size of Mpumalanga has increased, and the Department has expanded its infrastructure and facilities, there was no equivalent growth in the Department’s professional staff establishment. Lack of professional staff has led to under-performance by the Department on a number of key indicators over the years. According to the current staffing analysis, the vacancy rate across all professional categories in Mpumalanga stands at 61%, with medical doctors at 81%, pharmacists at 81% and professional nurses at 56%. Focus has been set in the 2012/2013 financial year to fill clinical vacant posts up to 60%.
In our quest to provide quality health care to all South Africans, and despite our human resource challenge, the burden of disease continues to weigh heavily on the Provincial health care system.
Our Province like the rest of the country faces a quadruple burden of diseases. HIV and AIDS, Tuberculosis, High Maternal and Child Mortality, Non-Communicable Diseases and Violence and Injuries continue to take a toll on the Province’s citizens. This burden contributes immensely to the decline in life expectancy for both males and females in the province and the rest of the country.
Compounding on these unfavourable conditions are the adverse socio-economic determinants such as poverty and inadequate access to essential services such as electricity, proper sanitation and access to potable water.
The Province, despite stabilizing at 34 – 35 %, has the second highest prevalence of HIV and AIDS after Kwazulu-Natal. Its high mortality rate is attributable to this epidemic. This is despite various interventions such as HCT campaigns, condom use and increased access to ARVs.
Honourable Speaker, we have commenced with the rollout of the National Health Insurance pilot programme on the 1st April 2012 as per our 10 Point Plan. Gert Sibande District municipality has been chosen by national DOH in consultation with the Department to be the pilot site for NHI in the Mpumalanga Province.
Honourable speaker, NHI is a financing system that will ensure the provision of essential health care to all citizens of South Africa (and legal long-term residents) regardless of their employment status and ability to make a direct monetary contribution to the NHI fund.
The National Health Council has adopted a list of non-negotiables to ensure that NHI is implemented successfuly namely;
- Infection Control services
- Medicines and Medical Supplies including Dry Dispensary
- Cleaning Materials and Services
- Essential Equipment and Maintenance thereof
- Laboratory Services; NHLS
- Blood Supply and Services
- Food Services and Related Supplies
- Child Health Services
- Maternal and Reproductive Health Services
- Pilot Districts with full complement of PHC Care Teams
- School Health
- District Specialist Teams
- Infrastructure Maintenance
- HIV and AIDS
- Security Services
These non-negotiables focus on the weaknesses of the South African Health System and address output 4. No health facility should be found wanting on these non-negotiables.
The Department is quite aware of challenges towards addressing these non-negotiables. We will spare no effort in working tirelessly with other sectors in the delivery on these non-negotiables.
We will also continue our work on the four key strategic outputs as part of the Negotiated Service Delivery Agreement signed off with the Honourable Premier, which are as follows:
1: Increasing Life Expectancy
2: Decreasing Maternal and Child Mortality
3: Combating HIV and AIDS and decreasing the burden of disease from Tuberculosis
4: Strengthening Health System Effectiveness
As we strive to realize outcome 2 of the Department, which is to deliver “A Long and Healthy Life for all South Africans”, we have developed an implementable programme containing specific interventions towards achieving the Department’s outputs. We have also finalized the Mpumalanga Service Delivery Agreement for 2012/13 in consultation with key Departments and stakeholders.
OUTPUT 1: INCREASING LIFE EXPECTANCY
Honourable Speaker, Statistics South Africa presents us with a grim reality that life expectancy in South Africa has been declining for the past few years. The decreasing life expectancy poses a serious challenge for future development and will always be an impediment to our vision of “A long and Healthy life for all South Africans”.
Death notifications among young adults in the 25-39 age groups had almost trebled between 1997 and 2006. The situation has since improved but the number of young people dying still exceeds those of the elderly population. It is only in an abnormal situation where the old bury the young.
According to Statistics South Africa, Life expectancy in South Africa declined between 2001 and 2006 (from 52.7 for males and 56.6 for females in 2001 to a low of 50.8 for males and 52.6 for females in 2006). There was a slight life expectancy recovery in 2010 (53.3 for males and 55.2 for females) and this is expected to prevail as interventions on the burden of disease are strengthened.
The causes of the decline in life expectancy is affected by communicable diseases such as HIV, TB, malaria, respiratory infections, and non-communicable diseases such as diabetes and cardio vascular diseases. These are compounded by high rates of maternal and child mortality, violence and trauma. Nationally, HIV and AIDS alone accounted for 770 deaths per day during the 2010/2011 financial year.
Honourable Speaker, our resolve to fight malaria is still on course. Malaria is associated with more than 1million deaths per annum in Africa. Most deaths occur in children under the age of 5 years. In South Africa, malaria control is exacerbated by management of the disease by our neighboring countries.
Our Malaria Control Strategy which uses Indoor residual spraying, is the main intervention to protect communities at risk. Our goal is to make a concerted effort to decrease the incidence of malaria. The Department has done extremely well in this programme. We have decreased our Malaria incidence from 0.41 per 1000 in 2010/2011 to 0.29 per 1000 in 2011/2012. We will continue with case management, training of health care professionals and educate our communities to seek treatment early.
OUTPUT 2: DECREASING MATERNAL AND CHILD MORTALITY
Honourable speaker the continued unnecessary deaths of mothers and children due to complications that arise as a result of pregnancy and child birth is still a worrying factor. No woman must die while bringing life into the world.
The maternal mortality ratio and the perinatal mortality in South Africa is much higher than that of countries with similar socio-economic development. The Maternal Mortality Ratio in Mpumalanga has increased from 156.8/100 000 in 2009 to 194.8/100 00 in 2010.
To deal with the high mortality in the province, we have increased the number of facilities which review maternal and perinatal deaths from 45% (2010) to 100% (2011).
We have increased the number of facilities providing Basic Antenatal Care (BANC) from 185 in 2009 to 203 in 2010 and aim to have 254 facilities by the end of the 2012/13 financial year.
In order to increase access to safe termination of pregnancy, we have increased the number of designated health facilities from 7 in 2009 to 12 in 2010, and we aim to have 15 facilities by the end of the 2012/13 financial year. The antenatal clients initiated on AZT increased from 70.4% in 2009 to 80.2% in 2010.
We are planning to increase staffing of our facilities with health professionals from the current 39% to 60% during 2012/2013 financial year. This will be the first stage towards addressing the gross under-staffing of our health facilities across the province. Proper staffing will go a long way in better management of women giving birth.
Honourable Speaker it is worrying to report that our Province has shown an increase in the under five mortality rates from 6.45 in 2009 to 6.9 per 1000 live births in 2010. The leading causes of death under for the 5 age group is Acute Respiratory Infections (ARI), Diarrhoea, Septicaemia, Severe Malnutrition and Tuberculosis
Our province also registered an increase in the infant mortality rate from 8.89 in 2009 to 9.6 per 1000 live births in 2010. The leading causes of death in the under 1 year old age group are Prematurity, Infections, Asphyxia and Diarrhoea.
During the 2012/2013 financial year, we will focus on the implementation of interventions to decrease the high maternal and child mortality rates and will intensify the implementation of an Integrated Management of Childhood Illnesses Strategy as well as the Reach Every District (RED) strategy. We will also strive to achieve immunization coverage of 90% for children under the age of one year, to ensure they are protected against preventable diseases.
OUTPUT 3: COMBATING HIV AND AIDS AND DECREASING THE BURDEN OF DISEASE FROM TUBERCULOSIS
According to the latest Antenatal Sentinel HIV and Syphilis Prevalence Survey, HIV prevalence increased from 34.7% in 2009 to 35.1% in 2010, second to KwaZulu Natal with the highest prevalence of 39.5% for 2010.
Our districts, Gert Sibande which showed an increase from 38.2% (2009) to 38.8% (2010) and Ehlanzeni from 33.8% (2009) to 37.7% (2010) were recorded 6th and 7th highest prevalence among the 52 health districts in the country whilst Nkangala showed a decline from 32.6% in 2009 to 27.2% in 2010.
In order to increase access to ARVs, the number of facilities providing Anti-retroviral (ARV) treatment were increased from 34 in 2009 to 161 in 2010.We aim to further increase this to have 278 PHC facilities and 33 hospitals providing ARV treatment by the end of the 2012/13 financial year.
Honourable Speaker, we have managed to increase the number of patients on ART from 70 064 in 2009/10 to 111 404 in 2010/11 and we plan to cumulatively increase to 172 855 in this financial year.
We welcome the adoption of the National Strategic Plan for HIV and AIDS, STI and TB 2011 to 2016 by SANAC which calls for:
- Zero new HIV and TB infections
- Zero new infections due to vertical transmissions
- Zero preventable deaths from HIV and TB
- Zero discrimination associated with HIV, STI and TB
Honourable Speaker, In order to deal with the scourge of HIV and AIDS including Tuberculosis, the department has developed its own Provincial Strategic Plan for HIV and AIDS, STI and TB 2011 – 2016 which is aligned to the NSP. We are currently finalizing an Implementation Plan for HIV and AIDS, STI and 2011 -2016. These plans will further give impetus to our fight against the scourge of HIV and AIDS.
Condom distribution for both male and female condoms, are being scaled up in the province as an intervention to reduce new infections. The distribution of male condoms increased from 38,943,442 in 2009/2010 to 77,933,100 in 2010/2011. The distribution of female condoms increased from 230 698 in 2009/2010 to 400 000 in 2010/2011. The increase in condom distribution in 2010/2011 was due to the Soccer World Cup.
We aim to distribute 48,000,000 male condoms and 100,000 female condoms by the end of the 2012/13 financial year.
Honourable Speaker, the circumcision programme was launched in November 2010. To date, the number of Male Medical Circumcision (MMC) high volume, high quality sites have been increased from 5 to 7 sites; namely Mapulaneng, Tintswalo, Themba, Tonga and Barberton Hospitals, Piet Retief, Embhuleni Hospitals .We aim to have 12 sites by the end of the 2012/13 financial year.
A total of 9 232 male medical circumcisions have been performed as an intervention to reduce new HIV infections during the 2011/12, bringing the grand total since inception of the programme to 14 002.
The cumulative target set for 2012/13 since inception of the programme, is to have 50 000 male clients medically circumcised.
We have increased the number of High Transmission Area intervention sites from 56 in 2009 to 60 in 2010 and we further aim to increase this to 68 sites by the end of the 2012/13 financial year.
The Prevention of Mother to Child Transmission (PMTCT) program plays a pivotal role in the reduction of transmission of HIV from Mother to Child. The PMTCT program is being intensified in all facilities that offer antenatal care.
Honourable speaker, the HCT Campaign was launched in 2010 and a total number of 1,426,735 people were counselled pre-test. 1,341,386 were tested for HIV and 279,516 tested positive. (This indicates an HIV testing rate of 94% and the testing positive rate to be 21.1 %). We aim to have 96% of pregnant women tested through the HCT programme.
We increased the number of non-medical sites offering HCT from 25 in 2009 to 44 sites in 2010. We plan to increase the number of non medical sites to 65 by the end of the 2012/13 financial year.
The combination of TB, HIV and MDR TB has led to a situation where TB is the number one common cause of death among South Africans. Out of a total of 20 891 TB case findings in 2010, 10 932 were from Ehlanzeni 6 763 from Gert Sibande and 3 196 from Nkangala district.
There was a decline in the TB Cure Rate for New Smear Positive Cases from 73% in 2009 to 72.2% in 2010. Mpumalanga Province, remains burdened by Tuberculosis. TB is the number one cause of death among the top ten causes of deaths in the province. The department aims to achieve an 80% TB Cure Rate by the end of 2012/13 financial year.
All HIV and AIDS and TB co-morbidity patients with a CD4 count of 350 or less, and all MDR patients who are HIV positive irrespective of their CD4 count, have been placed on ART. Interventions targeted at reducing HIV in young people by strengthening support groups and awareness campaigns on HIV and AIDS in schools are continuing.
OUTPUT 4: STRENGTHENING HEALTH SYSTEM EFFECTIVENESS IMPLEMENTATION OF THE NATIONAL HEALTH INSURANCE (NHI)
The National Health Insurance (NHI) is one of the ten key priorities of the Health Sector Programme of Action and will be implemented in phases starting from 2012, over a fourteen year period. The first five years will be a process of building and preparation with the objective of putting the necessary funding and health service delivery mechanisms in place to enable the creation of an efficient, equitable and sustainable health system in South Africa.
There are four key interventions that need to take place simultaneously:
- A complete transformation of health care service provision and delivery
- A total overhaul of the entire health care system
- A radical change of administration and management
- The provision of a comprehensive package of care, underpinned by a re-engineered Primary Health Care system
Honourable Speaker, the key focus areas for NHI are as follows:
- Re-engineering of the Primary Health Care services where we will be establishing the following teams;
- District-based Clinical Specialist Support Teams - these teams will address the high levels of maternal and child mortality and will be comprised of an anesthetist, pediatrician, obstetrician, gynaecologist, advanced midwife, family physician and a Primary Health Care professional nurse.
- School-Based Primary Health Care Services - these teams will identify all health problems that can be a barrier to learning and will provide preventive and promotive health care.
School Health Services will focus on schools in quintiles 1 and 2 and the teams will consist of a professional nurse, enrolled nurse/enrolled nursing assistant and a health promoter.
- Municipal Ward-based Primary Health Care Agents - Primary Health Care agents will be deployed in every municipal ward. Each team will be headed by a Professional Nurse with one enrolled nurse/enrolled auxiliary nurse, six community health workers, one environmental health officer and one health promotion practitioner. Each member of the team will be allocated a specific number of families/households.
The Primary Health Care Agents will provide a range of health services such as health promotion, prevention of ill health, providing information and education to communities and households on a range of health-related matters.
R11m has been set aside for the implementation during this financial year.
- Quality Improvement in Facilities
The National DOH has completed the facility audit of all our health facilities. The audit report indicate that our facilities are not fully compliant with the National Core Standards in terms of patient rights, patient safety, clinical support services, public health, leadership and governance, operational management, facilities and infrastructure.
The report also indicate limited compliance in the 6 priorities of the core standards namely cleanliness, safety and security, waiting times, staff attitudes, infection control and drug supply.
Honourable Speaker, we have successfully developed the quality improvement plans and monitored their implementation during the previous financial year.
We have set aside R39 million as part of the earmarked funding to address challenges raised during the facility audits.
- Human Resources Planning and Development:
The Department has finalized its HRD strategy and is at the final stage of approval.
In our quest to develop human resources within the department particularly nurses, doctors, pharmacists and allied health care professionals, we have provided bursaries aimed at catering for scarce skilled health professionals.
Currently we have 716 external students. Honourable Speaker, we have trained 4413 health professionals on critical clinical skills and 2623 health personnel in generic programmes during the financial year 2011/2012. We aim to have 3 additional clinical training facilities for nurses accredited, bringing the total number to 33 accredited facilities.
- Information Management and Systems:
The National Health Insurance Information System will ensure portability of services and will be electronic-based with linkages to the National Health Insurance Membership Database and accredited- and contracted health care providers. National Department of Health is currently in the process of establishing a National Health Information Repository and Data Warehousing (NHIRD) for which the rolled out to all provinces and districts has already commenced.
To date, we have 92 Primary Health Care facilities with Data Capturers. The appointment of Information Officers and Data Capturers has been prioritized for the new financial year and we aim to have Information Officers in all 18 sub-districts and Data Capturers appointed in all 278 PHC facilities by the end of the 2012/13 financial year.
- Infrastructure Development
Honourable speaker, a facility audit was done by CSIR on all our facilities and the report has clearly provided us with insight into the maintenance budget as well as the budget required for upgrading of our facilities. We have subsequently developed an Infrastructure Plan, based on the findings and recommendations of the audit report.
The delivery of health infrastructure is critical to ensure access to quality health care and for the expansion of health infrastructure as part of our Comprehensive Rural Development Strategy (CRDP). To avoid slow pace of health infrastructure delivery, we will continue to improve in critical areas such as planning, contract management and implementation monitoring and evaluation with the assistance of National Department of Health and Provincial Treasury.
Honourable speaker, we are continuing to roll out the Hospital Revitalisation Programme, with Themba, Ermelo and Rob Ferreira already on different stages of upgrading and renovation, while Lydenburg, Tintswalo, Baberton, Kwa Mhlanga Sabie, Bethal, Shongwe, Standerton, Belfast, Carolina, Matibidi will be on the planning stage during the current financial year.
Mmametlhake hospital will be upgraded from the current 62 beds to 172.
Honourable speaker, we have prioritized a number of community health centers and clinics during the 2012/2013 financial year. Contractors are already on site on the following projects;
- Tweefontein G
- Phosa Village
- Sinqobile Clinic
- Mbhejeka Clinic
The following projects are on the design stage and construction will begin in the next financial year;
- Pankop and
- Medical Devices and Equipments:
The audit that was done in all health facilities, identifying the basic medical devices and equipments required to achieve compliance to the national core standards and the six priority areas.
Earmarked funding for the Quality Improvement Plans of R19, 390,000 has been used to procure basic equipment required in each district, and delivery is awaited.
A standard equipment list has also been developed for district hospitals and Primary Health Care Facilities and we will ensure that regular maintenance schedules are adhered to. To address this challenge, we will ensure that there will be at least one (1) Clinical Engineering Workshop in each district.
- Management of facilities and health districts:
Honourable Speaker, as part of the overhaul of the health system and improvement of its management, hospitals in South Africa have been re-designated in terms of District Hospitals, Regional Hospitals, Tertiary Hospitals, Central Hospitals and Specialised Hospitals. Each level of hospital designation will be managed by a newly defined level of manager with appropriate qualifications and skills as defined by the National Health Council.
National Department of Health conducted assessments of all Chief Executive Officers and District Managers in 2010. CEOs that were found not better suited to their appointed posts were consulted and moved to posts of similar levels where they will be more productive. The vacant CEO posts have been advertised and will be filled shortly. Newly appointed CEOs will undergo intense orientation before resuming their duties.
The department has finalized a needs analysis in the province for mobile clinics in order to service the 2561 visiting points that we currently have. The analysis will assist the Department in determining and costing the exact number of mobile clinics and personnel needed to service the visiting points on a weekly basis.
Not for profit organisations:
Honourable Speaker, the Department supports a number of Not for Profit Organisations for the provision of Community Based Health Services. A total number of 148 NPO’s were funded in the 2011/2012 financial year. Through this endeavour 2935 jobs were created by the end of March 2012.
Services provided by the organisations include amongst others the following:
- Home Based Care
- Health Education and Health Promotion
- Tracing of patients defaulting on chronic medication
- Supporting patients on TB treatment (TB DOTS)
- Referral of Children to facilities for immunisation.
Comprehensive Rural Development Programme (CRDP)
Honourable speaker, the Department of Health is committed to expanding access to health services to our rural communities through the implementation of Comprehensive Rural Development Strategy. In pursuance to improving access to affordable and diverse services, 25 of the 37 PHC facilities in the CRDP sites have food gardens that are linked to Masibuyele Emasimini. The vegetables are used to support needy and vulnerable groups.
Another key focus area of the Department is to improve rural services to support livelihoods. The Department contributed in achieving this activity through funding of 38 Not for Profit Organizations in the CRDP sites.
To this end, Honourable Speaker, allow me to present the budget of the Department of Health Vote 10, and I request the house to approve the budget as presented. The total budget is (R 7,544,189 000.00) Seven billion, five hundred and forty four million, one hundred and eighty nine thousand rands.
The Breakdown of the Budget per Programme is as follows:
- PROGRAME 1: ADMINISTRATION R 200,217,000.00
The purpose of this program is to provide overall management of the Department, and provide strategic planning, legislative and communication services and centralized administrative and financial support through the MEC’s office and administration.
- PROGRAMME 2: DISTRICT HEALTH SERVICES R 4,427,144,000.00
The purpose of this program is to render comprehensive Primary Health Care Services to the community using the District Health System as a model.
- PROGRAMME 3: EMERGENCY MEDICAL SERVICES R 255,149,000.00
The purpose of this program is to provide pre-hospital medical services, inter-hospital transfers, Rescue and Planned Patient Transport to all inhabitants of Mpumalanga Province within the national norms.
- PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES R 918,947,000.00
The purpose of this programme is to render secondary health services in regional hospitals and to render TB specialized hospital services.
- PROGRAMME 5: CENTRAL HOSPITALS R 781,668,000.00
The purpose of this programme is to render secondary and tertiary health care services and to provide a platform for training of health care workers including research.
- PROGRAMME 6: HEALTH SCIENCE AND TRAINING R 234,105,000.00
The purpose of this programme is to ensure the provision of skills development programmes in support of the attainment of the identified strategic objectives of the Department.
- PROGRAMME 7: HEALTH CARE SUPPORT SERVICES R 108, 238 000.00
The purpose of this program is to improve the quality and access of health care.
- PROGRAMME 8: HEALTH FACILITIES MANAGEMENT R 618,721 000.00
The purpose of this programme is to build, upgrade. Renovate, rehabilitate and maintain facilities.
Honourable speaker, in conclusion allow me to thank the honourable Premier and all Members of the Executive Council for their unwavering support and leadership. Allow me to also thank the Portfolio Committee for its oversight. To the Acting HOD Mr Richard Mnisi, Management of the Department and the entire staff, including nurses, doctors, pharmacists, allied health workers and the support staff - I thank you for your commitment in serving our people. Let me conclude by thanking all department stakeholders who have been supportive in our work of bringing a better life to our people.Honourable speaker, I thank you.