Date: 03/06/2004
Source: Free State Provincial Government
Title: S Belot: Free State Health Prov Budget Vote 2004/2005
2004/2005 VOTE 5 BUDGET SPEECH BY MEC FOR HEALTH, MR SAKHIWO BELOT, Free State Legislator, 3 June 2004
Mr Speaker, honourable Mr M Dukwana
Madam Premier, Ms B Marshoff
My colleagues in the Free State Executive Council
Members of the Provincial Legislature
Members of Parliament and Provincial Delegates to the National Council of Provinces
Marena le Dikgosi
Mayors and Councilors
Distinguished Guests
Ladies and Gentlemen
It is a privilege that I stand here to deliver the budget vote speech of the department of Health in the Free State Province.
Mr Speaker, Robert Taylor of the International Finance Corporation reminded us of the international health care context when he said:
"Governments worldwide are grappling with rising health costs and increased demand for healthcare services. A number of factors are pushing demand and costs, such as aging populations, changing disease patterns, and increased use of high-cost technology and prescription drugs."
As we proudly celebrate 10 years of democracy and freedom, I am proud to announce that the Free State Department of Health has again taken firm strides to improve access to quality health services in this province despite the challenge of rising health costs and increasing demand for healthcare. Prioritisation and rationing is therefore inevitable.
Poverty, lack of shelter, lack of safe water, lack of sanitation, poor nutrition and lack of education expose our people to ill health. Unhealthy people cannot contribute to the economy. The role of the health system is better health status for the community, fairness in access and responsiveness to people's expectations. Health services are not just about curative services, but also about health promotion, prevention of ill health and rehabilitation.
Mr. Speaker, many positive advances have been made in health care for the Free State since 1994. As we celebrate the 10th year of our hard fought for democracy, I wish to report to this house that our people enjoy better access to health care than ever before. The achievements are as a result of thorough and proper planning by the ANC led provincial government.
Honourable members, allow me to share some of the achievements of this department against the ANC manifesto of 1994 and 1999.
ACHIEVEMENTS IN THE LAST 10 YEARS
1. 1994 MANIFESTO
As we celebrate, let me remind you what we said then:
The 1994 ANC election manifesto stated that "Democracy means more than just the vote. It must be measured by the quality of life of ordinary people - men and women, young and old, rural and urban. It means giving all South Africans the opportunity to share in the country's wealth, to contribute to its development and to improve their own lives." The Manifesto further committed the ANC to implement affordable primary health care to ensure that all South Africans are guaranteed basic treatment. Prevention will be the priority, and resources will be directed especially at rural areas and poverty-stricken communities. An ANC government will, in its health programme, do the following:
* promote safe motherhood and play a major role in caring for the nation's children through programmes of immunisation, nutrition and free health care for children under five;
* introduce measures to make medicines more affordable;
* direct major resources at combating TB, AIDS and other sexually-transmitted diseases, cancer and other plagues;
* facilitate the integration of traditional health practice.
After the 1994 elections, the ANC led Free State provincial government without hesitation took up the challenge. The late Ms Senorita Ntlabati led the amalgamation of several apartheid departments to establish a single provincial health and welfare department. The policy of Primary heath care was implemented. Free health care for pregnant women and children under 5 was implemented in 1994 to promote save motherhood and improve child survival. The first step towards accessible comprehensive primary health care services was the introduction of free primary health care for all from July 1996. The Primary school nutrition programme was launched as a presidential lead programme in 1994. A total of R321 275,640 million was spent in the Free State providing a single meal to hungry children in the last 9 years. The immunisation programme was expanded and changed to be in line with international trends. Immunisation campaigns were conducted annually to prevent mortality and morbidity due to preventable diseases. Through these interventions, we are now almost at the brink of declaring the Free State polio free. Prevention campaigns to combat HIV and AIDS were implemented. A new Tuberculosis control programme was introduced. Bacteriological diagnosis of Tuberculosis was introduced. The policy on the syndromic management of sexually transmitted infections introduced resulted in lower rates of neonatal syphilis. The department in partnership with the Cancer Association of South Africa, implemented a mobile service to screen women for cervical and breast cancers. The department of health commenced a process to organise traditional healers in the Free State province.
Mr. Speaker, this is a synopsis of what this department and therefore the ANC led government did to bring a better life for all in our first 5 years of democracy.
2. 1999 MANIFESTO
One of the goals we espoused in the 1999 was "speeding-up delivery of basic needs" we promised to develop a comprehensive, affordable and accessible National Public Health System, financed in part by a Social Health Insurance programme, that government would improve health care by improving the availability of doctors and nurses, especially in clinics and the rural areas; ensuring availability of affordable medicines in line with our national drugs policy, improving the management of hospitals and clinics - with community participation, act decisively to attack preventable illnesses through, amongst others, our immunisation programme, and measures to combat TB, and developing campaigns against drug, tobacco and alcohol abuse.
In partnership with all sectors of society, government would continue to give absolute priority to HIV/AIDS programmes by increase efforts to mobilise popular awareness of the seriousness of the epidemic, continue to fund research to find a cure for AIDS and review existing laws to ensure people who are HIV positive are not discriminated against.
Ladies and Gentlemen, my predecessor, Ms Mantsheng Tsopo and the department achieved these objectives. The Department increased the number of doctors and health professionals especially in rural areas by expanding the Cuban doctors' programme, implementing a 1 year community service programme for doctors and dentists which was extended to 10 professional occupational groups.
The department spent R 4 667 703 for the first phase of implementing salary parity for local government employed PHC health care workers to encourage them to stay in small towns. A rural allowance and a scarce skills allowance to recruit and retain health professionals, was introduced from July 2003 at a cost of R18 034 099.
The department improved the availability of medicines by introducing the Essential drug list, training PHC nurses in drug supply management, training Pharmacy assistants and out sourcing the distribution of medicines. Hospital management was improved by the implementation of the Provincial Hospital Act resulting in the appointment of Chief Executive Officers and the establishment of hospital boards. The hospitals were grouped into complexes and those that required focused attention such as Mofumahadi Manapo Mopeli hospital and Katleho hospital successfully underwent organisational performance improvement interventions. Integrated management of childhood illnesses was implemented. The immunisation coverage increased to 78% in 2003. Through the implementation of the DOTS system, the new smear positive TB cure rate doubled to more than 70% in 2003. The department established the Alcohol and Drugs Abuse Research and prevention Centre to combat the abuse of alcohol and drugs. Educators and high school learners were provided with training.
ACHIEVEMENTS IN THE LAST FINANCIAL YEAR
Mr Speaker, Honourable members the purpose of the budget vote speech is also to account on the outcome of the previous budget. I proudly wish to report to this house that the Department has again met almost all the commitments made by my predecessor in this house. Mr. Speaker in the interest of time, the department has produced a score-card that indicates how the department has fared in the 2003/2004 financial year. I hope all members and the public in the gallery received these documents. May I also indicate that the full account will be part of the annual report, which will be published with the financial reports as determined by the Public Finance Management Act. A summary of the achievements is as follows:
1. Maternal health
The Department of health aims to reduce the deaths of women during pregnancy, childbirth and the puerparium. These deaths can in the main, be avoided. The confidential enquiry into maternal deaths and notification of death of a woman during pregnancy, childbirth or the puerparium was made compulsory. Treatment guidelines were developed and implemented to deal with common causes of maternal deaths as reported in the "Saving mothers report." Studies were conducted on the causes of death of pregnant women during anaesthesia. The availability of emergency drugs and blood was improved, additional equipment has been procured, and medical officers are being trained in the provision of spinal anaesthesia. May I use this opportunity to thank Dr Lamacraft, a principal Anaesthetic specialist for her hard work in this regard. The 150 reported maternal deaths in 2003 are higher than the 107 reported in 2002. This is due to better reporting and the impact of the HIV and AIDS pandemic.
2. Infrastructure
The department successfully completed 10 new clinics, 6 clinic-upgrading projects and 11 hospital projects in the 2003/2004 financial year.
3. Purchase and replacement of equipment
X-ray machines to a total value of R3 159 254, are being procured for Mohau, Katleho, Dr JS Moroka, Embekweni, Phekolong, Nketoana and Botshabelo hospitals.
The department is also procuring a new state of the art linear accelerator for cancer treatment to the value of R12 426 000 million and upgrading an existing linear accelerator to the value of R3 722 100.
4. People with disabilities
People with disabilities now receive free health services. The budget for the provision of assistive devices was increased from R1, 5 million in 2002/2003 financial year to R2, 7 million in the 2003/2004 financial year. Assistive Device Repair Workshops were established at Stoffel Coetzee, Diamant, Mantsopa, Thusanong and Elizabeth Ross District Hospitals, and at Bophelong Community Health Centre. A total of 97 caregivers from all districts for disabled children have been trained in the utilisation of therapeutic toys. The department produced video-tapes with HIV and AIDS messages for deaf people in the province.
5. Child health
The Baby Friendly Hospital Initiative promotes breastfeeding to ensure warmth, bonding and care for babies born at health facilities. Bongani-, Botshabelo-, Embekweni- and National hospitals were awarded baby friendly status in 2004. Moroka Hospital was re-assessed and managed to retain its baby friendly status. The implementation of the Baby Friendly Hospital Initiative is in process at Diamant, Metsimaholo-, Mofumahadi Manapo Mopeli-, Pelonomi-, Thusanong- and Nala hospitals.
THE BUDGET
The budget allocated to the Health Department for the 2004/2005 financial year is R 2 730 596 000, which is 22% of the total of the provincial budget of R12, 543 billion. This budget is R 138,16 million or 5,33% more than the budget allocated in the 2003/2004 financial year. The increase is nominal and does not take into consideration inflation. In real terms the increase is 0,83%.
In terms of the MTEF, the budget will increase to R 2 972 196 000 in 2005/2006 and R3 184 012 000 in 2006/2007.
The budget is composed of R1 913 519 000 from the equitable share, R733 857 000 from conditional grants and R83 220 000 from provincial own revenue.
BUDGET ANALYSIS ACCORDING TO ECONOMIC CLASSIFICATION
R 1, 653,751 000 or 60,6% of the budget is set aside for compensation of employees. R 795, 000 000 (29%) will be used to procure goods and services. R 104, 829 000 (3,8%) is allocated for transfer payments mainly to municipalities. The budget for buildings and infrastructure is R 121 389 000 (4,4%) and for capital equipment is R55, 624 000 or 2% of the total budget.
BUDGET ANLYSIS ACCORDING TO FUNCTIONAL CLUSTERS
The budget is allocated to the various functional clusters of the department according to the organisational structure as follows:
1. HEALTH SUPPORT CLUSTER
The Health Support Cluster receives R480 176 928 or 17% of the 2004/2005 budget. This cluster comprises of the following directorates: Human Resource Management, Human Resource and Organisation Development, Health Programmes and Specialised Health Services. The purpose of the Health Support Cluster is to ensure efficient and effective utilization of resources throughout the Department of Health in the Free State. The following priority projects and programmes will be implemented by the cluster:
1. Hospital Revitalization
The revitalisation of Boitumelo and Pelonomi hospital will continue in this financial year. The department will in this financial year call for proposal for the PPP project to replace Mantsopa hospital and to build a new hospital at Trompsburg after the feasibility study has been approved by national Treasury.
The Department has set aside R10 million for the maintenance of health facilities this year. This will be our contribution to the expanded public works programme. I will make further announcements later in this regard as soon as I have finalised the proposal with the management.
2. Clinic Building and Upgrading Programme
The following clinics will be built in this financial year: Marantha clinic at Brandfort (R2 100 000), Hanipark in Welkom (R3 500 000), Geneva in Odendaalsrus (R3 700 000), Winburg clinic (R3 600 000), and Bethulie clinic (R4 200 000). Phase 2 of Qibing clinic at Wepener will be completed to a total of R2 900 000.
Planning for the following clinics will commence in this financial year: Bethlehem, Viljoenskroon and Reitz.
3. Immunisation Campaign
An immunisation campaign for measles and polio will be conducted during July 2004 through out the province and a mop up campaign will be conducted in August 2004.
4. Hospital Information System
The Meditech hospital information system will be implemented at Bongani hospital this year, iCAM will be expanded to include broadcasting directly to desk top computers.
5. Comprehensive Care and Treatment of HIV and AIDS Plan
The implementation of the Antiretroviral component of this plan commenced at the Bongani site in May. 4 other sites will be operational before the end of this year. The department budgeted about R30 million for this program and hopes to place at least 2100 patients on Antiretrovirals before the end of this financial year.
6. Skills Development
The following leanerships will be implemented: 5 Auxiliary nursing, 50 enrolled nurses, 10 Basic Pharmacy assistants and 50 Ancillary Health care. R11, 094,348 million is made available to continue paying for our bursary holders and for at least 70 additional bursaries at the beginning of the 2005 academic year. The department is presently visiting high schools in the province to promote health professions and to market our bursary scheme.
7. Community Service
The community service programme for health professionals will be extended to professional nurses from 2005
2. FINANCE CLUSTER
The Finance cluster receives R 53 725 230 or 2% of the budget. It comprises of the Financial Management and Internal Audit Directorate, Financial Administration and Logistics Directorate and the Strategic Planning sub-directorate.
The cluster will implement the following projects and programmes:
1. Supply chain management, which will be implemented before the end of this calendar year.
2. Risk management
A comprehensive risk management strategy will be developed this financial year.
3. Implementation of the PFMA
The Basic Accounting System is being implemented in a decentralized basis to promote accountability and responsibility at all levels of the department.
4. Combat fraud and corruption The department will conduct specialised investigations with the office of the Auditor General to combat fraud and corruption.
5. Revenue generation
The department will collect the budgeted revenue of R 64,989 million at the end of this financial year.
6. Strategic management
The department will investigate the position of the information and data analysis unit in relation to the strategic management unit to streamline the use of data in planning.
3. CLINICAL HEALTH SERVICES
The Clinical Health Services Cluster is responsible for the provision of quality comprehensive health services at all levels of care to the people of the Free State. It is a service delivery and line function cluster that provides Primary Health Care Services, Emergency Medical Services and Patient transport, and all levels of Hospital Services. The cluster is also responsible for corporate communication and services marketing, health promotion and quality improvement These services are rendered in three geographical regional complexes namely Eastern, Northern and Southern regional complexes as well as the Academic Health services complex that serves the whole province.
The cluster will implement the following projects and programmes in this financial year:
1. Emergency medical services plan
2. Services marketing and Corporate Identity strategy
3. School health services and Health Promotion
4. Quality improvement programmes to enhance patient safety
5. District health system and consolidation of Primary Health Services before devolution of these to district municipalities
6. Rural health services strategy, which aims to improve access of services to rural communities
7. Expand Rural Allowance to other rural areas to support the retention of health professionals in rural areas
8. Public Private Partnership
9. Plan to transfer medico-legal mortuaries from the South African Police Services to the Provincial Department of health
The Clinical Health Services cluster is allocated R2 227 230 842 or about 81,6% of the total budget. The allocation per health complex indicates how resources are allocated in each district for the benefit of the people in the area and is as follows:
1.1. Southern Free State Regional Complex:
The Southern Free State Regional Complex which consists of health facilities that provide levels I and II care to the people of Xhariep and Motheo districts receives R627, 605,251. This amount is made up of R148,5 million for Primary Health Care Services, R186,3 million for District Hospitals and R268,2 million for Pelonomi Regional Hospital and R2,294 million for the office of the General Manager.
The following is a highlight of deliverables:
1. Implement the ARV component of the Comprehensive HIV AIDS plan at Diamant and National hospitals
2. Implement a gateway clinic at National District Hospital to reduce patient waiting time at casualty
3. Establish a specialist dental unit at Pelonomi hospital to deal with more complicated dental problems
4. Operationalise the new trauma unit at Pelonomi hospital
5. Establish the ARV Centre of excellence at Pelonomi hospital
6. Implement 24- hour services at Heidedal Community Centre to improve accessibility
1.2. Northern Free State Regional Complex
The Northern Free State Regional Complex which consists of the facilities that provide level I and II care to the people of Lejweleputswa and Northern Free State districts receives R471, 7 million. This budget is further broken down into R148, 89 million for Primary Health Care Services, R 128,417 million for District Hospitals and R187, 435 million for the Bongani/Boitumelo Regional Hospital Complex and R 4, 663 million for the office of the General Manager
The following will be implemented:
1. Further develop and Implement the Regional Hospital Complex between Bongani and Boitumelo Hospitals
2. Revive the Maxillo - Facial Surgery service at Boitumelo Hospital
3. Implement the ARV component of the Comprehensive HIV and AIDS plan at Bongani Hospital and at Metsimaholo District Hospital this year
4. Continue with revitalisation at Boitumelo Hospital by awarding the remaining contracts in Phase I as well as finalising planning of Phase II
5. Implement the Meditech hospital information system at Bongani Hospital.
1.3. Eastern Free State Regional Complex
The Eastern Free State Regional Complex which consists of Health facilities that provide levels I and II care to the people of Thabo Mofutsanyana district receives a budget of R376, 96 million. This amount is composed of R116, 69 million for Primary Health Care Services, R 120,632 million for District Hospitals and R134,03 million for the Dihlabeng/ Mofumahadi Manapo Mopeli Regional Hospital Complex and R3,67 million for the office of the General Manager.
The following will be achieved:
1. Implement further the Regional Health Complex between Dihlabeng and Mofumadi Manapo Mopeli hospitals
2. Further Implement eye care services, renal services and psychiatric services at Mofumadi Manapo Mopeli hospital
3. Render outreach services regarding Optometry services and Gynaecology services
1.4. Academic Health services Complex
The Academic Health Services Complex (AHSC) comprises all the services offered at Universitas and the Free State Psychiatric Complex Hospitals. Universitas renders levels III and IV healthcare services and the Free State Psychiatric Complex renders psychiatric services up to tertiary level. The AHSC also provides a platform for training, education and research activities of the Faculty of Health Sciences of the University of the Free State. The total budget of the Academic Health Services Complex is R 565,29 million. This allocation is divided further into R 111,495 million for the Psychiatric Complex, R 452,043 million for Universitas Hospital and R1, 752 million for the Office of the General Manager: AHSC.
The following will be achieved:
1. Implementation of the new mental health Act upon promulgation
2. Re-launch of the ADAPRREC (Alcohol and Drug Abuse Prevention, Rehabilitation and Research Centre) to provide primary healthcare training and research on alcohol and drug abuse
3. COHSASA accreditation of the Free State Psychiatric Complex and Universitas hospital
1.5. Medical Support Services
The Medical Support Services directorate in the Clinical Health Services cluster manages Emergency Medical Services, Corporate Communication, Legal Services, Licensing of Private Facilities and Support of Governance Structures, as well as Services Marketing and Health Promotion. The budget of R158, 808 million has been allocated for the directorate.
The following projects will be implemented by this directorate:
1. Develop a costed plan to take over Medico legal mortuaries from the South African Police services after approval by the Executive Council
2. Procure 15 Emergency Medical Services vehicles with medical support and rescue equipment
3. Phase in the implementation of School Health Services in each district
4. Develop and implement a Clinical Risk Management policy to improve patient safety
5. Conduct a hand-washing campaign to promote good hygiene and minimize cross infection
6. Launch the new control centre with digital equipment in the next 3 months
7. Provide capacity training to all governance structures
CHALLENGES
In the words of President Thabo Mbeki during his February 2004 State of the Nation address, I quote
"Almost ten years after its liberation from white minority rule, our country still faces many challenges."
"The burden of disease impacting on our people, including AIDS, continues to be a matter of serious concern, as do issues that relate to the fact that many of our people, including the youth, lack the education and skills that our economy and society needs."
The Department of Health will vigorously implement its strategic plan. National health strategic framework and the Free State development plan inform the strategic plan. The goals of the Department for the next year are:
* Reduce the burden of HIV, AIDS and Tuberculosis on society and the health care system
* Manage all health resources effectively and efficiently in line with the Public Finance Management Act
* Implement the District Health System according to national and provincial legislation
* Market and communicate health services to communities effectively
* Develop and empower all personnel and stakeholders
* Build and maintain appropriate health infrastructure
* And most importantly provide accessible and quality health services at all levels.
CONCLUSION
Mr. Speaker, in conclusion, may I firstly thank my Party the ANC for the privilege and honour to lead the Free Sate Department of Health. I want to assure this house and the people of the Free State that government is committed to building a healthy nation while taking into consideration what Robert Taylor said: " Governments worldwide are grappling with rising health costs and increased demand for healthcare services. A number of factors are pushing demand and costs, such as aging populations, changing disease patterns, and increased use of high-cost technology and prescription drugs".
These few weeks I have spent in the department, I have experienced a very professional and dedicated management and personnel team, which is committed to deliver quality health care. I believe we will all form a formidable team.
I look forward to working with members of all statutory bodies in the department, Health Councillors and all Mayors, all volunteers and the respective non-governmental organizations.
May I use this opportunity to congratulate St Nicholas' children's' hospice for receiving an international award at the 15th World Congress of Children's Hospice International in 2003.
Mr Speaker, I wish to thank every member of the department and management at all levels for their loyalty and commitment.
May I also thank the support staff in my office, and the Head of the Department Dr Litlhakanyane for their assistance and support.
Let us all work for a "healthy and self-reliant community".
I thank you.
Issued: Department of Health, Free State Provincial Government
3 June 2004
Source: Free State Provincial Government
Title: S Belot: Free State Health Prov Budget Vote 2004/2005
2004/2005 VOTE 5 BUDGET SPEECH BY MEC FOR HEALTH, MR SAKHIWO BELOT, Free State Legislator, 3 June 2004
Mr Speaker, honourable Mr M Dukwana
Madam Premier, Ms B Marshoff
My colleagues in the Free State Executive Council
Members of the Provincial Legislature
Members of Parliament and Provincial Delegates to the National Council of Provinces
Marena le Dikgosi
Mayors and Councilors
Distinguished Guests
Ladies and Gentlemen
It is a privilege that I stand here to deliver the budget vote speech of the department of Health in the Free State Province.
Mr Speaker, Robert Taylor of the International Finance Corporation reminded us of the international health care context when he said:
"Governments worldwide are grappling with rising health costs and increased demand for healthcare services. A number of factors are pushing demand and costs, such as aging populations, changing disease patterns, and increased use of high-cost technology and prescription drugs."
As we proudly celebrate 10 years of democracy and freedom, I am proud to announce that the Free State Department of Health has again taken firm strides to improve access to quality health services in this province despite the challenge of rising health costs and increasing demand for healthcare. Prioritisation and rationing is therefore inevitable.
Poverty, lack of shelter, lack of safe water, lack of sanitation, poor nutrition and lack of education expose our people to ill health. Unhealthy people cannot contribute to the economy. The role of the health system is better health status for the community, fairness in access and responsiveness to people's expectations. Health services are not just about curative services, but also about health promotion, prevention of ill health and rehabilitation.
Mr. Speaker, many positive advances have been made in health care for the Free State since 1994. As we celebrate the 10th year of our hard fought for democracy, I wish to report to this house that our people enjoy better access to health care than ever before. The achievements are as a result of thorough and proper planning by the ANC led provincial government.
Honourable members, allow me to share some of the achievements of this department against the ANC manifesto of 1994 and 1999.
ACHIEVEMENTS IN THE LAST 10 YEARS
1. 1994 MANIFESTO
As we celebrate, let me remind you what we said then:
The 1994 ANC election manifesto stated that "Democracy means more than just the vote. It must be measured by the quality of life of ordinary people - men and women, young and old, rural and urban. It means giving all South Africans the opportunity to share in the country's wealth, to contribute to its development and to improve their own lives." The Manifesto further committed the ANC to implement affordable primary health care to ensure that all South Africans are guaranteed basic treatment. Prevention will be the priority, and resources will be directed especially at rural areas and poverty-stricken communities. An ANC government will, in its health programme, do the following:
* promote safe motherhood and play a major role in caring for the nation's children through programmes of immunisation, nutrition and free health care for children under five;
* introduce measures to make medicines more affordable;
* direct major resources at combating TB, AIDS and other sexually-transmitted diseases, cancer and other plagues;
* facilitate the integration of traditional health practice.
After the 1994 elections, the ANC led Free State provincial government without hesitation took up the challenge. The late Ms Senorita Ntlabati led the amalgamation of several apartheid departments to establish a single provincial health and welfare department. The policy of Primary heath care was implemented. Free health care for pregnant women and children under 5 was implemented in 1994 to promote save motherhood and improve child survival. The first step towards accessible comprehensive primary health care services was the introduction of free primary health care for all from July 1996. The Primary school nutrition programme was launched as a presidential lead programme in 1994. A total of R321 275,640 million was spent in the Free State providing a single meal to hungry children in the last 9 years. The immunisation programme was expanded and changed to be in line with international trends. Immunisation campaigns were conducted annually to prevent mortality and morbidity due to preventable diseases. Through these interventions, we are now almost at the brink of declaring the Free State polio free. Prevention campaigns to combat HIV and AIDS were implemented. A new Tuberculosis control programme was introduced. Bacteriological diagnosis of Tuberculosis was introduced. The policy on the syndromic management of sexually transmitted infections introduced resulted in lower rates of neonatal syphilis. The department in partnership with the Cancer Association of South Africa, implemented a mobile service to screen women for cervical and breast cancers. The department of health commenced a process to organise traditional healers in the Free State province.
Mr. Speaker, this is a synopsis of what this department and therefore the ANC led government did to bring a better life for all in our first 5 years of democracy.
2. 1999 MANIFESTO
One of the goals we espoused in the 1999 was "speeding-up delivery of basic needs" we promised to develop a comprehensive, affordable and accessible National Public Health System, financed in part by a Social Health Insurance programme, that government would improve health care by improving the availability of doctors and nurses, especially in clinics and the rural areas; ensuring availability of affordable medicines in line with our national drugs policy, improving the management of hospitals and clinics - with community participation, act decisively to attack preventable illnesses through, amongst others, our immunisation programme, and measures to combat TB, and developing campaigns against drug, tobacco and alcohol abuse.
In partnership with all sectors of society, government would continue to give absolute priority to HIV/AIDS programmes by increase efforts to mobilise popular awareness of the seriousness of the epidemic, continue to fund research to find a cure for AIDS and review existing laws to ensure people who are HIV positive are not discriminated against.
Ladies and Gentlemen, my predecessor, Ms Mantsheng Tsopo and the department achieved these objectives. The Department increased the number of doctors and health professionals especially in rural areas by expanding the Cuban doctors' programme, implementing a 1 year community service programme for doctors and dentists which was extended to 10 professional occupational groups.
The department spent R 4 667 703 for the first phase of implementing salary parity for local government employed PHC health care workers to encourage them to stay in small towns. A rural allowance and a scarce skills allowance to recruit and retain health professionals, was introduced from July 2003 at a cost of R18 034 099.
The department improved the availability of medicines by introducing the Essential drug list, training PHC nurses in drug supply management, training Pharmacy assistants and out sourcing the distribution of medicines. Hospital management was improved by the implementation of the Provincial Hospital Act resulting in the appointment of Chief Executive Officers and the establishment of hospital boards. The hospitals were grouped into complexes and those that required focused attention such as Mofumahadi Manapo Mopeli hospital and Katleho hospital successfully underwent organisational performance improvement interventions. Integrated management of childhood illnesses was implemented. The immunisation coverage increased to 78% in 2003. Through the implementation of the DOTS system, the new smear positive TB cure rate doubled to more than 70% in 2003. The department established the Alcohol and Drugs Abuse Research and prevention Centre to combat the abuse of alcohol and drugs. Educators and high school learners were provided with training.
ACHIEVEMENTS IN THE LAST FINANCIAL YEAR
Mr Speaker, Honourable members the purpose of the budget vote speech is also to account on the outcome of the previous budget. I proudly wish to report to this house that the Department has again met almost all the commitments made by my predecessor in this house. Mr. Speaker in the interest of time, the department has produced a score-card that indicates how the department has fared in the 2003/2004 financial year. I hope all members and the public in the gallery received these documents. May I also indicate that the full account will be part of the annual report, which will be published with the financial reports as determined by the Public Finance Management Act. A summary of the achievements is as follows:
1. Maternal health
The Department of health aims to reduce the deaths of women during pregnancy, childbirth and the puerparium. These deaths can in the main, be avoided. The confidential enquiry into maternal deaths and notification of death of a woman during pregnancy, childbirth or the puerparium was made compulsory. Treatment guidelines were developed and implemented to deal with common causes of maternal deaths as reported in the "Saving mothers report." Studies were conducted on the causes of death of pregnant women during anaesthesia. The availability of emergency drugs and blood was improved, additional equipment has been procured, and medical officers are being trained in the provision of spinal anaesthesia. May I use this opportunity to thank Dr Lamacraft, a principal Anaesthetic specialist for her hard work in this regard. The 150 reported maternal deaths in 2003 are higher than the 107 reported in 2002. This is due to better reporting and the impact of the HIV and AIDS pandemic.
2. Infrastructure
The department successfully completed 10 new clinics, 6 clinic-upgrading projects and 11 hospital projects in the 2003/2004 financial year.
3. Purchase and replacement of equipment
X-ray machines to a total value of R3 159 254, are being procured for Mohau, Katleho, Dr JS Moroka, Embekweni, Phekolong, Nketoana and Botshabelo hospitals.
The department is also procuring a new state of the art linear accelerator for cancer treatment to the value of R12 426 000 million and upgrading an existing linear accelerator to the value of R3 722 100.
4. People with disabilities
People with disabilities now receive free health services. The budget for the provision of assistive devices was increased from R1, 5 million in 2002/2003 financial year to R2, 7 million in the 2003/2004 financial year. Assistive Device Repair Workshops were established at Stoffel Coetzee, Diamant, Mantsopa, Thusanong and Elizabeth Ross District Hospitals, and at Bophelong Community Health Centre. A total of 97 caregivers from all districts for disabled children have been trained in the utilisation of therapeutic toys. The department produced video-tapes with HIV and AIDS messages for deaf people in the province.
5. Child health
The Baby Friendly Hospital Initiative promotes breastfeeding to ensure warmth, bonding and care for babies born at health facilities. Bongani-, Botshabelo-, Embekweni- and National hospitals were awarded baby friendly status in 2004. Moroka Hospital was re-assessed and managed to retain its baby friendly status. The implementation of the Baby Friendly Hospital Initiative is in process at Diamant, Metsimaholo-, Mofumahadi Manapo Mopeli-, Pelonomi-, Thusanong- and Nala hospitals.
THE BUDGET
The budget allocated to the Health Department for the 2004/2005 financial year is R 2 730 596 000, which is 22% of the total of the provincial budget of R12, 543 billion. This budget is R 138,16 million or 5,33% more than the budget allocated in the 2003/2004 financial year. The increase is nominal and does not take into consideration inflation. In real terms the increase is 0,83%.
In terms of the MTEF, the budget will increase to R 2 972 196 000 in 2005/2006 and R3 184 012 000 in 2006/2007.
The budget is composed of R1 913 519 000 from the equitable share, R733 857 000 from conditional grants and R83 220 000 from provincial own revenue.
BUDGET ANALYSIS ACCORDING TO ECONOMIC CLASSIFICATION
R 1, 653,751 000 or 60,6% of the budget is set aside for compensation of employees. R 795, 000 000 (29%) will be used to procure goods and services. R 104, 829 000 (3,8%) is allocated for transfer payments mainly to municipalities. The budget for buildings and infrastructure is R 121 389 000 (4,4%) and for capital equipment is R55, 624 000 or 2% of the total budget.
BUDGET ANLYSIS ACCORDING TO FUNCTIONAL CLUSTERS
The budget is allocated to the various functional clusters of the department according to the organisational structure as follows:
1. HEALTH SUPPORT CLUSTER
The Health Support Cluster receives R480 176 928 or 17% of the 2004/2005 budget. This cluster comprises of the following directorates: Human Resource Management, Human Resource and Organisation Development, Health Programmes and Specialised Health Services. The purpose of the Health Support Cluster is to ensure efficient and effective utilization of resources throughout the Department of Health in the Free State. The following priority projects and programmes will be implemented by the cluster:
1. Hospital Revitalization
The revitalisation of Boitumelo and Pelonomi hospital will continue in this financial year. The department will in this financial year call for proposal for the PPP project to replace Mantsopa hospital and to build a new hospital at Trompsburg after the feasibility study has been approved by national Treasury.
The Department has set aside R10 million for the maintenance of health facilities this year. This will be our contribution to the expanded public works programme. I will make further announcements later in this regard as soon as I have finalised the proposal with the management.
2. Clinic Building and Upgrading Programme
The following clinics will be built in this financial year: Marantha clinic at Brandfort (R2 100 000), Hanipark in Welkom (R3 500 000), Geneva in Odendaalsrus (R3 700 000), Winburg clinic (R3 600 000), and Bethulie clinic (R4 200 000). Phase 2 of Qibing clinic at Wepener will be completed to a total of R2 900 000.
Planning for the following clinics will commence in this financial year: Bethlehem, Viljoenskroon and Reitz.
3. Immunisation Campaign
An immunisation campaign for measles and polio will be conducted during July 2004 through out the province and a mop up campaign will be conducted in August 2004.
4. Hospital Information System
The Meditech hospital information system will be implemented at Bongani hospital this year, iCAM will be expanded to include broadcasting directly to desk top computers.
5. Comprehensive Care and Treatment of HIV and AIDS Plan
The implementation of the Antiretroviral component of this plan commenced at the Bongani site in May. 4 other sites will be operational before the end of this year. The department budgeted about R30 million for this program and hopes to place at least 2100 patients on Antiretrovirals before the end of this financial year.
6. Skills Development
The following leanerships will be implemented: 5 Auxiliary nursing, 50 enrolled nurses, 10 Basic Pharmacy assistants and 50 Ancillary Health care. R11, 094,348 million is made available to continue paying for our bursary holders and for at least 70 additional bursaries at the beginning of the 2005 academic year. The department is presently visiting high schools in the province to promote health professions and to market our bursary scheme.
7. Community Service
The community service programme for health professionals will be extended to professional nurses from 2005
2. FINANCE CLUSTER
The Finance cluster receives R 53 725 230 or 2% of the budget. It comprises of the Financial Management and Internal Audit Directorate, Financial Administration and Logistics Directorate and the Strategic Planning sub-directorate.
The cluster will implement the following projects and programmes:
1. Supply chain management, which will be implemented before the end of this calendar year.
2. Risk management
A comprehensive risk management strategy will be developed this financial year.
3. Implementation of the PFMA
The Basic Accounting System is being implemented in a decentralized basis to promote accountability and responsibility at all levels of the department.
4. Combat fraud and corruption The department will conduct specialised investigations with the office of the Auditor General to combat fraud and corruption.
5. Revenue generation
The department will collect the budgeted revenue of R 64,989 million at the end of this financial year.
6. Strategic management
The department will investigate the position of the information and data analysis unit in relation to the strategic management unit to streamline the use of data in planning.
3. CLINICAL HEALTH SERVICES
The Clinical Health Services Cluster is responsible for the provision of quality comprehensive health services at all levels of care to the people of the Free State. It is a service delivery and line function cluster that provides Primary Health Care Services, Emergency Medical Services and Patient transport, and all levels of Hospital Services. The cluster is also responsible for corporate communication and services marketing, health promotion and quality improvement These services are rendered in three geographical regional complexes namely Eastern, Northern and Southern regional complexes as well as the Academic Health services complex that serves the whole province.
The cluster will implement the following projects and programmes in this financial year:
1. Emergency medical services plan
2. Services marketing and Corporate Identity strategy
3. School health services and Health Promotion
4. Quality improvement programmes to enhance patient safety
5. District health system and consolidation of Primary Health Services before devolution of these to district municipalities
6. Rural health services strategy, which aims to improve access of services to rural communities
7. Expand Rural Allowance to other rural areas to support the retention of health professionals in rural areas
8. Public Private Partnership
9. Plan to transfer medico-legal mortuaries from the South African Police Services to the Provincial Department of health
The Clinical Health Services cluster is allocated R2 227 230 842 or about 81,6% of the total budget. The allocation per health complex indicates how resources are allocated in each district for the benefit of the people in the area and is as follows:
1.1. Southern Free State Regional Complex:
The Southern Free State Regional Complex which consists of health facilities that provide levels I and II care to the people of Xhariep and Motheo districts receives R627, 605,251. This amount is made up of R148,5 million for Primary Health Care Services, R186,3 million for District Hospitals and R268,2 million for Pelonomi Regional Hospital and R2,294 million for the office of the General Manager.
The following is a highlight of deliverables:
1. Implement the ARV component of the Comprehensive HIV AIDS plan at Diamant and National hospitals
2. Implement a gateway clinic at National District Hospital to reduce patient waiting time at casualty
3. Establish a specialist dental unit at Pelonomi hospital to deal with more complicated dental problems
4. Operationalise the new trauma unit at Pelonomi hospital
5. Establish the ARV Centre of excellence at Pelonomi hospital
6. Implement 24- hour services at Heidedal Community Centre to improve accessibility
1.2. Northern Free State Regional Complex
The Northern Free State Regional Complex which consists of the facilities that provide level I and II care to the people of Lejweleputswa and Northern Free State districts receives R471, 7 million. This budget is further broken down into R148, 89 million for Primary Health Care Services, R 128,417 million for District Hospitals and R187, 435 million for the Bongani/Boitumelo Regional Hospital Complex and R 4, 663 million for the office of the General Manager
The following will be implemented:
1. Further develop and Implement the Regional Hospital Complex between Bongani and Boitumelo Hospitals
2. Revive the Maxillo - Facial Surgery service at Boitumelo Hospital
3. Implement the ARV component of the Comprehensive HIV and AIDS plan at Bongani Hospital and at Metsimaholo District Hospital this year
4. Continue with revitalisation at Boitumelo Hospital by awarding the remaining contracts in Phase I as well as finalising planning of Phase II
5. Implement the Meditech hospital information system at Bongani Hospital.
1.3. Eastern Free State Regional Complex
The Eastern Free State Regional Complex which consists of Health facilities that provide levels I and II care to the people of Thabo Mofutsanyana district receives a budget of R376, 96 million. This amount is composed of R116, 69 million for Primary Health Care Services, R 120,632 million for District Hospitals and R134,03 million for the Dihlabeng/ Mofumahadi Manapo Mopeli Regional Hospital Complex and R3,67 million for the office of the General Manager.
The following will be achieved:
1. Implement further the Regional Health Complex between Dihlabeng and Mofumadi Manapo Mopeli hospitals
2. Further Implement eye care services, renal services and psychiatric services at Mofumadi Manapo Mopeli hospital
3. Render outreach services regarding Optometry services and Gynaecology services
1.4. Academic Health services Complex
The Academic Health Services Complex (AHSC) comprises all the services offered at Universitas and the Free State Psychiatric Complex Hospitals. Universitas renders levels III and IV healthcare services and the Free State Psychiatric Complex renders psychiatric services up to tertiary level. The AHSC also provides a platform for training, education and research activities of the Faculty of Health Sciences of the University of the Free State. The total budget of the Academic Health Services Complex is R 565,29 million. This allocation is divided further into R 111,495 million for the Psychiatric Complex, R 452,043 million for Universitas Hospital and R1, 752 million for the Office of the General Manager: AHSC.
The following will be achieved:
1. Implementation of the new mental health Act upon promulgation
2. Re-launch of the ADAPRREC (Alcohol and Drug Abuse Prevention, Rehabilitation and Research Centre) to provide primary healthcare training and research on alcohol and drug abuse
3. COHSASA accreditation of the Free State Psychiatric Complex and Universitas hospital
1.5. Medical Support Services
The Medical Support Services directorate in the Clinical Health Services cluster manages Emergency Medical Services, Corporate Communication, Legal Services, Licensing of Private Facilities and Support of Governance Structures, as well as Services Marketing and Health Promotion. The budget of R158, 808 million has been allocated for the directorate.
The following projects will be implemented by this directorate:
1. Develop a costed plan to take over Medico legal mortuaries from the South African Police services after approval by the Executive Council
2. Procure 15 Emergency Medical Services vehicles with medical support and rescue equipment
3. Phase in the implementation of School Health Services in each district
4. Develop and implement a Clinical Risk Management policy to improve patient safety
5. Conduct a hand-washing campaign to promote good hygiene and minimize cross infection
6. Launch the new control centre with digital equipment in the next 3 months
7. Provide capacity training to all governance structures
CHALLENGES
In the words of President Thabo Mbeki during his February 2004 State of the Nation address, I quote
"Almost ten years after its liberation from white minority rule, our country still faces many challenges."
"The burden of disease impacting on our people, including AIDS, continues to be a matter of serious concern, as do issues that relate to the fact that many of our people, including the youth, lack the education and skills that our economy and society needs."
The Department of Health will vigorously implement its strategic plan. National health strategic framework and the Free State development plan inform the strategic plan. The goals of the Department for the next year are:
* Reduce the burden of HIV, AIDS and Tuberculosis on society and the health care system
* Manage all health resources effectively and efficiently in line with the Public Finance Management Act
* Implement the District Health System according to national and provincial legislation
* Market and communicate health services to communities effectively
* Develop and empower all personnel and stakeholders
* Build and maintain appropriate health infrastructure
* And most importantly provide accessible and quality health services at all levels.
CONCLUSION
Mr. Speaker, in conclusion, may I firstly thank my Party the ANC for the privilege and honour to lead the Free Sate Department of Health. I want to assure this house and the people of the Free State that government is committed to building a healthy nation while taking into consideration what Robert Taylor said: " Governments worldwide are grappling with rising health costs and increased demand for healthcare services. A number of factors are pushing demand and costs, such as aging populations, changing disease patterns, and increased use of high-cost technology and prescription drugs".
These few weeks I have spent in the department, I have experienced a very professional and dedicated management and personnel team, which is committed to deliver quality health care. I believe we will all form a formidable team.
I look forward to working with members of all statutory bodies in the department, Health Councillors and all Mayors, all volunteers and the respective non-governmental organizations.
May I use this opportunity to congratulate St Nicholas' children's' hospice for receiving an international award at the 15th World Congress of Children's Hospice International in 2003.
Mr Speaker, I wish to thank every member of the department and management at all levels for their loyalty and commitment.
May I also thank the support staff in my office, and the Head of the Department Dr Litlhakanyane for their assistance and support.
Let us all work for a "healthy and self-reliant community".
I thank you.
Issued: Department of Health, Free State Provincial Government
3 June 2004
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