Budget Vote speech by Gauteng MEC for Health Brian Hlongwa for the 2007/2008 financial year

8 June 2007

Introduction

Honourable Speaker,

I table this budget in the middle of the third term of our democratic government. The track record of the ANC government over the past 13 years testifies to the fact that we have made strides in ensuring that health care is accessible to our people.

Communities who had no access to basic health care, enjoy access to services which were a pipe dream to those of us who were raised when basic health care was a privilege for a minority.

The poor and vulnerable have benefited from the programmes that we implement in our province. Indeed the age of hope is not only a pipe dream, but it continues being realized on a daily basis.

The expansion of basic health services has also presented us with immense challenges, in terms of ensuring that quality health care is delivered in our facilities.

Honourable Speaker,

According to Census 2001, 23.9% of households in Gauteng live in informal housing as compared to 16.4% for South Africa as a whole. The percentage of Gauteng households without toilets is low (3.6%) as compared to for the country as a whole (13.6%).

Improved access to running water, sanitation and health services has reduced infectious diseases as the major cause of death in childhood. There however remains a relatively small area with poor sanitation and limited access to clean and sanitized water, located in the mainly rural Metsweding District Municipality. This poses a potential threat for outbreaks of water-borne diseases and other health crises.

According to the Health Systems Trust (2006), the uninsured population in Gauteng as at 2005, stood at 77.5%. This was an increase from 73.1%, which was the figure that was estimated by the 1999 Household Survey. This increase in uninsured population invariably results in additional pressures on the public health care system in the province, as this sector of the population are the main users of public health facilities.

In addition, when one considers the escalating costs of medical care, we are likely to witness greater numbers of the population having to turn to the public sector for their health needs.

A review of the health status of the population of Gauteng shows a complex and wide scope of conditions or illnesses related to poverty, malnutrition, emerging and re-emerging communicable diseases such as HIV and AIDS and tuberculosis.

Poverty also is the major contributor to trauma and violence. In addition, there is a high prevalence of chronic diseases of lifestyle such as hypertension, diabetes and mental illness.

Honourable Speaker,

We need to be frank with ourselves and reconfigure health and health care in order to ensure that the priorities that we set, the programmes that we embark on, and resources that we employ in provision of health and health care are all informed by reality.

For many years we have allowed health to be defined by what it is not. For many years our programmes have been driven by an assumption that poor health should define what we are about.

I have argued previously that health should not be mystified and be defined in negative terms. I have even gone further and stated that I am not the MEC for Diseases and Illnesses. When the Honourable Premier appointed me as MEC he proclaimed that I WOULD BE THE MEC FOR HEALTH.

This proclamation implied that I would be responsible for a department that must ensure that the people of Gauteng remain healthy.

One of the key strategic objectives of the Gauteng Provincial Government is to ensure that that we strive towards a productive and healthy people of Gauteng.

That productivity cannot be achieved as long as our people suffer the burden of illnesses that are either a result of poverty, ignorance and or self indulgence in some extreme cases.

Honourable Speaker,

The manner in which we spend our resources will have to change drastically if we are to ensure that the resources that have been made available to us assist us in achieving our objectives.

Having inherited a fragmented health system has resulted in spending patterns and deployment of other resources that had no bearing on the real situation within which our people live.

A skewed pattern of expenditure towards a hospital-centred health care system, resulted in acceptance of disease trends and patterns that should never be part of our province, if one considers the amount of money that is spent on our health system.

Gauteng province has the fourth largest economy in Africa, after Egypt, Tunisia and South Africa itself. Yet our health outcomes are not proportional to the financial resources that are spent on our health system. Poor countries with scarce resources continue to achieve better health outcomes, when compared to us.

As I table this budget of R12.052 billion, I am mindful of the fact that it amounts to a 15. 8% increase from the budget allocation of 2006/2007.

Policy Imperatives

This budget allocation is congruent with policy imperatives that have an impact on how we as a department conduct our business. The following policy imperatives impacted on this increase:

• Demarcation of provincial boundaries
• Transfer of TB beds to the Provincial Department
• Transfer of Emergency Medical Services and Primary Health Care from municipalities to the Provincial Department.
• Transfer of Mortuaries and Forensic Pathology services from the South African Police Services.

With regard to demarcation of provincial boundaries, we have been allocated R426 million. While we have ceded Carletonville Hospital to the North West provincial government with effect from 1 April 2007, we have also taken over Odi and Jubilee Hospitals and 17 clinics and Community Health Centres (CHCs) which refer patients to these hospitals, as well as two CHCs that were formally administered by the Mpumalanga Provincial Government.

We have provincialized TB Beds and in support of this policy decision we have been allocated R31.8 million.

Forensic Pathology Services

In April 2006, 12 Forensic Pathology mortuaries were transferred to our Department. During the financial year, medico-legal investigation of 14 897 deaths were performed at these mortuaries. We have also developed a body identification website which will become fully operational within the next six months.

With regard to these services, R83.749 million has been allocated for this financial year which will be used to render the services and also address some of the infrastructure backlogs that we inherited, as well as ensuring that high tech Information Technology is employed in order to bring these services in line with modern service requirements.

Transfer of Primary Health Care Services to the Provincial Department

Honourable Speaker,

We have already begun a process to transfer Primary Health Care and Emergency Medical Services from municipalities to the Provincial Department. Due diligence studies have been completed, detailed business plans drafted and consultations with affected parties are underway.

This process will be phased in to ensure that there is minimal disruption of services.

We have already assumed full funding responsibility for the provision of Primary Health Care at District municipalities. We have already taken over the provision of Emergency Medical Services from Metsweding District as from 01 April 2007 and are currently in the process of negotiating with municipal unions for the transfer of PHC staff from Metsweding.

We will begin transfer of staff and assets from West Rand and Sedibeng District municipalities as from 01 July 2007 and complete the process by April 2008.

With regard to provision of Primary Health Care in metropolitan municipalities, the status quo remains in terms of joint funding and joint provision of these services in the interim phase, until the process of this transfer is finalized.

Honourable Speaker,

The decision to transfer Primary Health Care and Emergency Medical Services is not only a policy one, it is in line with both the constitution and legislation.

Schedule 4 Part A of the Constitution of the Republic of South Africa determines health services as a concurrent competency of National and Provincial Government. Schedule 4 Part B of the Constitution determines municipal health services as the competency of Local Government.

The National Health Act, of 2003 defines municipal health services as a list of Environmental Health Services. Section 25 of the Act lists the general functions of provincial departments, including comprehensive primary health services.

R23 million has been allocated in order to bridge funding that will result from us taking full funding responsibility for these services at the level of District Councils.

Reducing the Burden of Disease

Child Health

We continue our campaigns to ensure that the Expanded Programme on Immunization (EPI) reaches all children under five years in the province. We have now ensured that "Every Day is an Immunization Day" at all our clinics.

The impact of the 2004 mass immunization campaign and the launch of the 'Every day is an Immunization Day' campaign have resulted in immunization coverage increasing to 91.6% in the 2006/07 financial year. We have allocated R10 million for this campaign in this financial year. This allocation excludes programmes that are conducted at district level.

Women's Health

Honourable Speaker

The 2002 to 2004 data of the triennial Saving Mothers Report released by the Minister of Health, estimates a maternal mortality ratio of 149.4 per 100 000 live births for Gauteng. The major direct causes of deaths have been identified as hypertension in pregnancy, obstetric haemorrhage, pulmonary embolism and acute collapse, pregnancy-related sepsis, abortion, and ectopic pregnancy.

Indirect causes of death include non-pregnancy related infection (mostly due to HIV and AIDS) and pre-existing medical diseases and AIDS remain the number one cause of death in the province and the country.

The 1998 to 1999 report on cancer in South Africa indicated that cancer of the cervix is the second most common cancer amongst women worldwide. The South African rates in black women are the highest, followed by coloured women.

The department continues to implement the cervical cancer screening programme to reduce the incidence amongst women of child bearing age. Women who visit our clinics to access other health services and those who specifically request breast cancer examinations are examined at the same clinics and where abnormalities such as breast lumps are detected, we refer them to hospitals for further management.

Last year alone, 8 861 women underwent mammography. Last year we also screened 100 939 women for cervical cancer, and 8 725 were found to have abnormal smears and were referred for appropriate management and care. We will continue to focus on the early detection of these conditions.

Reducing the Burden of TB

Honourable Speaker,

TB remains a challenge. The cure rate is very low when one takes into consideration the amount of money we spend on programmes to combat it. We still experience the highest burden of TB.

In fact, we are part of the countries that account for 80% of all cases in the world. The rate of TB infection has almost doubled in Gauteng since 1996. The cure rate of TB has improved from 64% to 68.8%, but still falls short of the National target of 70%.

This low cure rate is largely due to patients failing to present themselves early at our facilities when they have TB symptoms, and also failure to complete prescribed treatment regimens. HIV and AIDS have also compounded the challenge posed by TB in our province.

This situation has been further worsened by the emergence of a new multi-drug resistant TB which has resulted in numerous deaths.

We will intensify programmes which are aimed at ensuring that TB is detected early, that people present themselves early at our facilities if they show TB symptoms, and finish their course of treatment if they have been confirmed as having TB.

We succeeded in increasing the cure rate of TB from 62% to 72% in Johannesburg, over a period of four months. If this can be achieved in Johannesburg, surely it can be replicated throughout the province. We have set aside R17 million for infection control, drugs, laboratory costs, TB facility revitalization and campaigns to mobilize and educate our communities on the scourge of TB.

Strengthening the District Health System

Honourable Speaker,

The bedrock of our health system is the District Health System, of which Primary Health Care is the foundation. We have taken a conscious policy decision to strengthen the District Health System.

We have invested in building clinics in those areas where there were none and also in upgrading those clinics which were not serving the health needs of our people optimally.

In the past financial year we opened new clinics in the following areas:

• Laudium Community Health Centre and Maternal Obstetric Unit
• Klipkruisfontein Clinic

Comprehensive services are now being offered in our clinics. These services include among others, child and maternal health and HIV and AIDS prevention. The fact that visits to our primary health care clinics have increased to 12.5 million by 2002, and to over 15.2 million by the end of the financial year 2006 / 2007, is evidence of expanded access to services that were inaccessible to our people.

This increase in the number of visits is on the one hand a vote of confidence in the services that we deliver. However, on the other hand it could be interpreted to mean that the burden of illness is increasing.

We will strive to deliver quality health care at this level in order to reduce unnecessary long queues at our hospitals.

We will extend hours of service at 15 of our clinics in order to ensure that people who require primary health care services do not walk into our hospitals when they could be helped at an appropriate level of care. The following clinics will have their hours of service extended:

In order to achieve the above we have increased the overall allocation for District Health Services by 25.6% to R3.193477.

This amount has been allocated to ensure that quality health care services are delivered at our clinics.

Honourable Speaker,

I would also like to announce that in the next eight weeks we will demolish Phedisong 4 Clinic in Garankuwa, and open a new clinic that was built and is across the road. The clinic that will be demolished is un-inhabitable and not suitable for delivery of health services. We will also open the following health facilities:

• Dark City Community Health Centre with a Maternal Obstetric Unit in Ekangala. This facility will operate on a 24 hour basis.
• Endayeni Clinic in Tembisa.
• Greenfields Clinic. This is a fulfilment of a commitment that was made during the 2002 Presidential imbizo in the same area.
• Johan Deo Community Health Centre, in Evaton.
• Mandela-Sisulu Clinic, in Orlando West
• Bristlecone Clinic, in Orange Farm
• Eersterus Community Health Centre, in Eersterus.

Honourable Speaker,

I take this opportunity to commend my colleagues who are Members of the Mayoral Committees responsible for Health and Emergency Services in the Metropolitan and District Councils for the leadership they have provided since we reconstituted the Provincial Health Council after the local government elections last year.

Almost all of them, including myself, were new in our respective portfolios, but that has not deterred us from executing the mandate that was entrusted to us.

Community Based Health Care Services

We will intensify Community Based Health Care services as part of the primary health care package by ensuring that we deal decisively with the causes of illnesses that are preventable. Diseases of lifestyle that are associated with poor nutrition, obesity, smoking, and ineffective stress management will be tackled head on.

We will increase the number of Community Health Workers by a further 1000 in order to reach more households in our endeavour to reduce the burden of illnesses such as hypertension, diabetes, TB and HIV and AIDS. An amount of R295 million has been set aside to achieve this.

This implies that health promotion programmes will be informed by the disease burden that is prevalent in each sub-district, with each facility serving a cluster of wards.

Provision of a Rapid Emergency Medical Service

Honourable Speaker.

Provision of Emergency Medical Services is also a constitutional responsibility of Provincial Government. We have already begun taking over provision of this service at Metsweding on 01 April 2007. Service delivery has improved within the district due to the provision of an additional vehicle for obstetric deliveries and vehicle for planned patient transport to move non-emergency patients. In addition, we have opened an ambulance base in Ekangala. Additional staff has been temporarily appointed until permanent appointments are in place, which will increase the staffing complement for Metsweding, hence improving service delivery tremendously.

We will also take over the provision of Emergency Medical Services in Sedibeng District with effect from 01 July 2007. We will proceed to Johannesburg Metropolitan Council with effect from 01 October 2007.

During the provincialisation process temporary ambulance bases will be identified. As part of the upgrading and improvement of Emergency Departments and the creation of an integrated comprehensive emergency care system, permanent ambulance bases will be added to existing healthcare facilities. This will ensure appropriate communication between the components of the health system and assist in making decisions on hospital closures, delays in hand over of patients, appropriate notification of EMS of mass casualties and improvement in the delivery of the package of health services.

The process in other metropolitan councils and the West Rand District will be phased in to ensure that there is equity in service delivery and norms and standards are adhered to. We will make an announcement with regard to the details of this process in due course.

Approximately R30.75 million will be spent on replacement of vehicles and expansion of the planned patient transport. R580 000 will be spent on replacement and revitalisation of capital equipment in upgrading all additional vehicles.

The training for Emergency Medical Services staff and upskilling the staff to meet the norms and standards is under way, and Lebone Provincial College will be increasing the outputs in alignment with the Norms and Standards. Additional control centre staff will be appointed and trained by February 2008.

Implementation of an EAP focusing on Critical Incident Stress Management for all Emergency Care personnel will begin in February 2008, which will assist in the management of the operational staff and empowering them during their operational duties.

A state of the art command centre in Midrand will be finalised by November 2007, in conjunction with the Department of Local Government Disaster Management. This will ensure that during and after the provincialisation process, all Emergency Services will continue to be available in the case of an emergency at all levels, such as Medical, rescue, fire, SAPS, amongst others.

Preparations for the 2010 World Cup falls under this programme. An amount of R502 341 million has been budgeted for the EMS programme.

Community awareness campaigns and utilization of community services through training and volunteer programs will begin taking place in November 2007.

Reducing New HIV and AIDS Infections

Honourable Speaker,

Since the launch of the HIV and AIDS Comprehensive Treatment and Care Programme, including anti-retroviral treatment (or ART) which was commenced in April 2004, more than 400,000 people have been assessed. We have accredited 47 facilities to provide ART and 46 of these are public health facilities, including Johannesburg Prison. Currently there are more than 75 000 people on ART. The partnership with private international NGOs increased the number of patients on ART, and this is highly appreciated. We will continue working with them to ensure that more people access the comprehensive care, treatment and support, including ART.

All our clinics provide Prevention of Mother to Child Transmission of HIV services except 2% which are in the Tshwane/Metsweding region. I am pleased to announce that we will extend this service to all our clinics in the province in this financial year.

In line with the National Comprehensive HIV and AIDS Strategy, we will ensure that the components of community mobilization coupled with treatment and care complement each other. We are cognisant of the targets that have been set by the Strategy that was adopted at a national level.

We believe that in order to stem the tide of HIV and AIDS, more efforts and energy will be employed on increasing the number of people who access Voluntary Counselling and Testing. We will launch the "Proudly Tested" campaign in the course of this financial year.

It is only when we de-stigmatize testing for HIV that we will be able to know exactly what we are dealing with. This does not mean that we will no longer focus on treatment and care. The HIV and AIDS programme has received an 11.9% increase to the tune of R577.014 million.

Nutrition

We have budgeted R31 million in this financial year for nutrition supplements which are also available for poor patients with debilitating and chronic diseases. A total of 1400 crèches, will be funded with over 26 000 children benefiting from the integrated nutrition programme. I call upon our officials to interact directly with crèches and not only rely on umbrella bodies or intermediaries that apply for funding on their behalf.

This will enhance the health and welfare of our children and limit risks for diseases and injury. Parents should make sure that not only are the crèches registered but also that they have a health certificate. Health promoters and environmental health officials will need to work together with communities in this regard.

Hospital Services

Honourable Speaker,

Our hospitals boast of world renowned centres of excellence.

Some of which are the following:

• Wound therapy, Neurosurgery and Ophthalmology , corneal and Renal transplant units in the Dr George Mukhari Hospital
• Renal and Hand units in the Chris Hani Baragwanath Hospital
• Trauma, Oncology and Paediatric Nephrology units and the Haemophilia Centre in the Johannesburg Hospital
• Neuro-physiology unit and Oncology units in the Pretoria Academic Hospital
• Spinal and Paediatric Oncology units at Kalafong Hospital
• Spinal unit in Natalspruit Hospital.

I am proud to say that some of the specialists who practice in the private health sector, were actually trained in our hospitals.

We have made efforts to reduce queues and waiting times at our hospitals. We are cognizant of the challenges that the burden of disease is posing on our hospitals. We have invested financial resources in the past financial year to reduce long queues at our hospital pharmacies.

We undertook refurbishment of pharmacies in hospitals in order to reduce waiting times for patients who have been seen by health professionals and also those who collect chronic medication on a regular basis. Refurbishments at the following hospitals have been completed:

• Kopanong Hospital ,
• Pholosong Hospital,
• Dr Yusuf Dadoo Hospital,
• Edenvale Hospital,
• Far East Rand,
• Weskoppies Hospital,

All pharmacies at the above hospitals were refurbished at the cost of R40 million.

We are on course to complete refurbishment of the following pharmacies in the current term of office at the cost of approximately R120 million rand.

• Leratong Hospital,
• Heidelberg Hospital,
• Helen Joseph Hospital,
• Kalafong Hospital,
• Ekurhuleni Region Pharmacy, and
• Hillbrow Regional Pharmacy.

Honourable Speaker,

We acknowledge that in order for our hospitals to deliver quality health care services, we need to implement the Service Transformation plan which will ensure the management of patients is at the appropriate level of the healthcare service.

We have ten District Hospitals that are supposed to be the referral points for clinics. We have eleven Provincial hospitals that are supposed to render a secondary level of care, and four central hospitals that are supposed to treat patients who require tertiary health care.

However, we still have a situation where a regional hospital such as Kalafong, renders 33% tertiary services, while it is supposed to be a regional hospital.

We need to correct this anomaly. That is why we continue to overspend, and over extend our resources. We will define service packages that are to be rendered at appropriate levels of care.

We delegated financial, human resource, and procurement functions to Hospital managers last year, in order to ensure seamless functioning of these institutions. We embarked on a programme to build capacity of hospital managers in collaboration with the University of Kwa-Zulu Natal and Wits University.

We are aware of concerns that funds that allocated under this programme might not be sufficient. However, we need to address our spending patterns, what informs our budgets and the priorities that we set.

As long as we continue to deliver services at inappropriate levels, we will continue to overspend instead of consolidating our programmes and formulate budgets that are activity based.

The infrastructure backlogs that are prevalent at our hospitals are huge, some of the hospitals are a hundred years old. We have set aside funds to address this.

We will also make an announcement very shortly with regard to rationalization of Folateng Units. We have been forthright and faced reality with regard to those Folateng Units that have a business case for continuing to function, and we have also been realistic and will make appropriate announcements in due course.

The amount of R3 008 568 that has been allocated for provincial hospitals is an increase of 8.03% from the allocation of the previous financial year.

Central Hospitals

Honourable Speaker, our Central Hospitals, namely; Chris Hani Baragwanath Hospital, Johannesburg Hospital, Pretoria Academic Hospital and Dr George Mukhari Hospital render specialized health services to patients who come from across our boundaries and borders.

In March 2007 we officially opened a new Pretoria Academic Hospital which has world class equipment.

Honourable Speaker,

These hospitals provide highly specialized services, training and research. We will continue to relieve these hospitals of Level One services in order to ensure that they focus on their core business, that is, provision of specialized care and treatment. In order to achieve this objective, we have allocated these hospitals a total of R3 516 165 billion, which is an increase of 9.02%.

Human Resources

Honourable Speaker,

We have finalized our Human Resources Strategy. This involved all stakeholders, including the labour formations. We hold the view, that without health professionals, there is no health system to speak of.

I take this opportunity to salute those of our health professionals who have taken a conscious decision to remain with the public health sector, in spite of being promised greener pastures, either outside of the public health sector, or beyond our shores.

Indeed, you are a source of strength and inspiration, when one considers the pressures that you face at our facilities, due to a number of factors.

I am pleased to announce that we have decided to reopen some of the nursing colleges currently not in operation. This will allow us to produce more nurses in shorter periods. In Gauteng, we have committed ourselves to doubling the number of nurses entering the profession over the medium term framework. We will be doing so at a rate of 20% per year and have already exceeded our initial targets.

Plans are also underway to reopen Coronation Nursing College as a campus of the Chris Hani Baragwanath Hospital's Nursing College.

Our department has also embarked on marketing programmes aimed at encouraging more people to choose nursing as a career. We have participated in career exhibitions and made presentations at different high schools. We are optimistic that all these interventions will increase the number of people choosing this noble career.

Honourable Speaker,

As evidence of our endevour to address the challenge that is posed by shortage of health professionals, we have increased this year's allocation by 40.6% to R338.820 million.

Health Facilities Management

We have conducted an in-depth appraisal of the conditions and maintenance requirements of our facilities. We have prioritised revitalization of our health facilities and purchase of modern equipment to meet our service needs.

We have prioritised strategic partnerships and collaboration with its major stakeholders, to enhance service delivery. The Department continues to implement the revitalisation projects at Chris Hani Baragwanath Hospital Accident and Emergency and outpatient departments.

We will enter into a Public Private Partnership (PPP) to perform the revitalisation and upgrading of the Chris Hani Baragwanath Hospital. Our commitment to build nine new clinics and three new hospitals in the Medium Term Expenditure Framework is well on schedule.

In the 2007/2008 financial year the following projects will be completed:

Honourable Speaker,

We have prioritised construction of a District Hospital in the vicinity of the Chris Hani Baragwanath hospital, in order to ensure that upon completion, all patients with minor ailments will no longer present themselves at Chris Hani Baragwanath Hospital. Construction of a District Hospital in Daveyton is also aimed at ensuring that people who live in that catchment area have access to hospital care. We have therefore allocated R1 092 263 for this programme, which amounts to 25.28% increase from the allocation of the past financial year.

Conclusion

We are on course to improve the health status of the people of Gauteng. We are also on course to improve the quality of services that are delivered at our facilities. In partnership with the people of Gauteng, who are our primary clients, our staff, and other stake holders, we will endeavour to make this age of hope a reality in their lifetime.

I take this opportunity to express my heartfelt gratitude to:

• The Honourable Premier, for his sterling leadership,
• The National Minister for her leadership in the National Health Council and wish her speedy recovery,
• The Acting Minister for ably holding fort,
• My colleagues in the Executive Council,
• The Chairperson of the Health Portfolio Committee, Dr RAM Salojee, for his leadership and oversight role,
• Members of the Provincial Health Council
• All categories of staff in the Gauteng Department of Health
• My beloved wife Joeline, two daughters, and son

I thank you.