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Date : 29/06/2004
Source: Mpumalanga Provincial Government
Title: W Lubisi: Health & Social Services Prov Budget Vote 2004/2005


POLICY AND BUDGET SPEECH FOR 2004/05 BY MEC FOR HEALTH AND SOCIAL SERVICES, WILLIAM LUBISI, 29 June 2004

Madam Speaker,
Deputy Speaker,
Honourable Premier,
Honourable Members of the Executive Council,
Honourable Members of the Provincial Legislature,
Mayors and Councillors,
Traditional Leaders,
Ladies and Gentlemen

When the democratic dispensation was ushered in, in 1994, one of its biggest challenges was the transformation of racially based social services into services that promoted the well-being of all South Africans irrespective of race, sex or creed.

We may not have reached a stage where we can declare that our social services are fully transformed, however, over the past ten years we have made significant strides towards the attainment of a universal and equitable access to social services.

In an effort to realise this ideal, we have over the past ten years, witnessed a steady increase in government expenditure on social services. This gesture, however, was constrained by some of the realities that we have inherited. Among others, the backlog that was caused by years of racially based health and social services and the absence of appropriate skills to manage available resources more effectively and efficiently.

The central challenge to the agenda of transforming our social services, therefore, remains our ability to forge a synergy between our resources and our capacity to manage these resources.

Madam Speaker, this department is charged with the provision of quality health and social welfare services in the Province. These are probably the most critical social services through which the successful implementation of our policies will be judged.

The centrality of the role of the State in the provision of health services cannot be overemphasised. The epicentre of this policy imperative is the objective of ensuring universal access to health and social services from the most affluent metropolis to the most peripheral and historically marginalised and underdeveloped parts of our Province.

Institutional transformation

One of the foremost challenges facing the Department of Health and Social Services, undoubtedly, is the integration of the structures of the former departments of Health on one hand and Social Services, Population and Development on the other.

Madam Speaker, institutional transformation is at the cornerstone of our strategy to enhance the quality of service that we deliver to our people. The department will sharply focus on and strengthen:

* Financial management and control systems,
* Human Resource management and development,
* Records management,
* Communications and
* Internal Auditing.

In line with the above I specifically want to focus on the Internal Audit function within the Department. During this financial year we must improve the control environment and promote good corporate governance. In order to do this a fraud prevention committee and a risk management unit will be established.

Another critical aspect within the mandate of the Department of Health and Social Services is the daily and constant contact that we have with our people. It is imperative that the Batho Pele principles and the Patients Rights Charter become the embodiment of how our officials interact with our clients.

Madam Speaker, our department is experiencing an acute human resource constraint, particularly in the rural parts of our province, as a result of reluctance by some of our professionals to work in rural areas and through international recruitment especially by the developed countries.

While various interventions, such as, the rural allowance, are gradually being extended to other facilities within our province with a view to attract and retain the skills that are in short supply in the province, we appeal to workers to see themselves as agents for change, as new type of workers who are able to tie their individual talents and interests to the needs of society.

Madam Speaker, the former Department of Health had a regrettable history, which we would like to put behind us. At the same time we cannot sweep under the carpet all the wrongs of the past, particularly where corruption was discovered.

This should not be misconstrued as a witch-hunt, but it should be seen as an attempt to send a message that government resources are meant for the benefit of the people and not the enrichment of individuals through unethical ways.

The department will be instituting an inter-departmental task team to assess value for money of ongoing projects, in particular capital projects, to determine their conformity to set standards. The department's Internal Audit unit will play a critical role in these investigations.

Madam Speaker in order to ensure that these interventions have a meaningful impact within the department, an amount of R255 140 million has been allocated for the administration of the Department.

Effective health service delivery

The state of some of our health facilities has been a subject for discussion for quite a while. Madam Speaker, I am pleased to announce at this Sitting that the people have spoken and that we have not only listened, but that we are willing and ready to radically transform the state of our facilities into centres of excellence. This would be achieved through the implementation of the following key interventions:

* Primary Health Care (PHC)

Primary Health Care services remain the most effective way of realising government's objective of ensuring equitable access to health services. It is for this reason that R 1,394 billion has been allocated to this programme.

The challenge facing the department is to strengthen the components of the PHC package towards ensuring that communities receive the full basket of services at these facilities.

Currently an audit of all our PHC facilities in the Province is underway to determine their capacity compared with the national norms and standards, with a view to implement appropriate intervention mechanisms.

Various training programmes are also planned in this financial year. The University of Pretoria and the South African Military Health Services will provide the training of Primary Health Care nurses.

The Department is now charged with the responsibility to convert the Elijah Mango College of Education to a Health Sciences Training College. It is envisaged that this facility will enable the province to train different categories of health professionals. Scarce skills such as Pharmacist Assistants, Midwives, Primary Health Care Nurses, Physiotherapy Assistants and Comprehensive Nursing students will be developed at this facility. The enrolment of students at this college during this financial year will alleviate the shortage of these categories of personnel at our facilities.

It must be emphasised that for the first time 18 nurses have been identified to undergo Forensic Nursing training at the University of the Free State. These nurses will be able to deal with survivors of Sexual Assault and Abuse and train social workers on counselling and support on the Medico Legal processes.

Madam Speaker, there is still a shortage of Primary Health Care facilities in our Province. For us to be able to realise the objective of ensuring access to health services, I wish to announce that in this financial year we will commence with the construction of seven new Primary Health Care facilities at KwaNgema, Langverwacht, Warburton, Entombe, Mananga, Badplaas and Enkangala (Kungwini cross border municipality) to the value of R31 million.

An additional amount of R5, 2 million has been set aside to build accommodation for staff at rural areas. This is aimed at retaining scarce skills in these areas.

It is our intention, Madam Speaker, that by March 2005, 80% of our Community Health Centres (CHC's) be operational on a 24-hour basis.

* Emergency medical services

An amount of R84, 5 million is budgeted for this programme. This service aims to provide quality emergency care services and also to implement and manage an information system that will enhance emergency medical services in the province.

In this financial year 45 new ambulances will be purchased while the existing fleet will be properly maintained. The available resources for this service will be equitably spread throughout the Province, but it must be emphasised that there will be special attention given to rural areas.

* Hospital Services

Madam Speaker, one of the most decisive programmes aimed at revolutionising health service delivery at 26 hospitals in the Province is the introduction of an accredited quality improvement programme. The Council for Health Service Accreditation of Southern Africa (COHSASA) has been contracted to facilitate this process in our hospitals over a three-year period at a cost of R13 million.

It is a facilitated quality improvement programme, which has proved successful in four other provinces. It includes a health executive training component, which will ensure long-term sustainability of the interventions instituted.

Nationally the key programme to improve the quality of services at hospitals is the revitalisation programme. It seeks to raise the image and service levels of public hospitals to equate with what is evident in the private sector.

In the short term there will be special attention given to the aesthetic environment and cleanliness. The key components of this programme, which is receiving priority attention in the department, are as follows:
i. Organisational Development: empowering hospital management with appropriate delegations and skills to manage their facilities and be held accountable for the resources under their control.

ii. Infrastructure Development: ensuring that the physical structure of the hospital is appropriate to 21st century norms and standards and the maintenance thereof is strictly adhered to.

iii. Health Technology Management: ensuring that public hospitals have the latest and most appropriate equipment to render the necessary services to patients.

iv. Quality Assurance: ensuring that public hospitals maintain a quality of service that is in line with the level provided in the private sector, within the resources available.

The Hospital Revitalisation programme, which is funded by the National Revitalisation conditional grant at the cost of R 68,292 million in this financial year, continues at Piet Retief, Rob Ferreira, Themba and Ermelo hospitals.

Infrastructure improvement interventions to the value of R 35,724 million will be implemented at Mmamethlake, KwaMhlanga, Sabie, Evander, Embhuleni, Witbank, Groblersdal and Delmas hospitals.

Other areas of focus for this year will include strengthening our relationship with our academic partners, the University of Pretoria and MEDUNSA. This will include clinical support and training at Witbank hospital and establishing similar support services at Rob Ferreira, Philadelphia, Themba and Ermelo hospitals. The Health Professions Training and Development Grant to the value of R41, 808 million will be utilised to fund these initiatives.

The tertiary services provided at Rob Ferreira and Witbank will continue to be supported by the National Tertiary Services Grant that amounts to R41, 427 million for this financial year.

The Hospital Management and Quality improvement Grant amounting to R12, 833 million will be utilised to support the Cost Centre Accounting programme as well as fund the development of a hospital information system and training of hospital managers.

Cost centre programme

Our assessment of the state of our hospitals has revealed that the centralisation of certain functions at the Head Office has a share of its responsibility on the much talked about and unacceptable state of our hospitals. In many instances, it makes it difficult for hospital management to implement even the most basic responsibilities.

Cost centre accounting decentralises a variety of functions, in particular procurement related functions, which are currently centralised and impact negatively on the pace of service delivery in our facilities.

During this financial year, once appropriate delegations have been agreed upon, within a legal framework, certain procurement functions will be decentralised to facility level. The department will increase the number of hospitals on this programme from four to thirteen in this financial year.

In addition to the figures mentioned above for conditional grants an amount of R227, 318 million is budgeted for provincial Hospital services.

* Service level agreements

During this financial year in our quest to improve and enhance the quality of service provision the department will enter into service level agreements that will regulate and create a monitoring mechanism to measure the quality of service that is provided
* Department of Public Works (Capital projects programme including maintenance of our facilities)
* National Health Laboratory Services (Provision of laboratory tests)
* SANTA (Monitor provision of TB hospital services)
* Gauteng Department of Health (Provision of Secondary, Tertiary and Specialised Health services)
* Amalgamated Health Care (Pharmaceutical Depot management)
* Municipalities (Primary Health Care and municipal health services)
* Non-Governmental Organisations

Madam Speaker, allow me to focus on priority programmes that are aimed at rendering quality health care to our people.

* Health Information and Management and Research:

The Department of Health and Social Services is the custodian of enormous quantities of information and therefore a reliable information management system is one of the most valuable assets for the department to have.

The department is receiving assistance from the Italian Corporation in the form of technical assistance in the field of Health Information Systems. The project is expected to last for three years.

* Health Promotion

Extensive health promotion and community mobilisation is provided in addressing, among others, HIV and AIDS, Tuberculosis and Sexually Transmitted Infections, diseases of lifestyle (including Hypertension and Diabetes). It is our intention to intensify health promotion during this financial year.

Madam Speaker, I am reliably informed that physical exercise significantly reduces the risk of contracting some of the conditions I have mentioned above. I have thus recently taken membership with a local gym and I challenge honourable members of this Legislature, staff of this province and our citizens to embark on a daily programme of healthy eating and physical exercise.

Comprehensive HIV and AIDS care, management and treatment

The Comprehensive HIV and AIDS care, management and treatment plan seeks to ensure that the great majority of our citizens in the Province who are currently not infected with HIV remain uninfected. The message of prevention and of changing lifestyle and behaviour are therefore the critically important starting point in managing the spread of HIV and the impact of AIDS.

Important in supporting these efforts in the broader context are the social programmes of government and wider society that aim to reduce poverty through improving job creation, social support and education, and to bring about moral renewal.

* Voluntary Counselling And Testing (VCT)

Early counselling and testing for HIV is offered in medical and non-medical facilities. There are 158 facilities providing the service. In this year 270 additional VCT sites have been planned and community mobilisation will be maximised to encourage people to test whilst they are still healthy.

* Prevention of Mother To Child Transmission (PMTCT)

This service is provided in 112 public health facilities. We will sustain and strengthen this programme during this financial year by intensifying awareness in the community through various communication strategies.

* Home Based Care

The Home Based Care programme is the backbone of our intervention for patients who can no longer be hospitalised and to provide support to affected children and families. A cadre of Community Health Worker is being trained on the 59-day intensive training programme. These workers will be equipped to manage health and welfare needs of clients confined to their homes.

The department will continue to support 96 Community Home Based Care (CHBC) projects in the Province.

* Provision of antiretroviral drugs

Twelve hospitals have been identified as facilities for the provision of the Comprehensive HIV and AIDS Care, Management and Treatment Plan. Of these, the National Accreditation Team has already accredited Witbank, Shongwe, Embhuleni, Evander, Themba and Philadelphia hospitals.

The first patients received antiretroviral drugs at Witbank and Shongwe Hospital on the 1st of June 2004.

The Department is planning to provide anti-retroviral drugs at Embhuleni, Evander, Themba and Philadelphia on 1 August 2004.

Madam Speaker, Bethal, Piet Retief, Rob Ferreira, Tonga, KwaMhlanga and Mmamethlake hospitals will be accredited during September 2004.

* Tuberculosis

Tuberculosis continues to be a national challenge. The Department is committed to change the situation by strengthening the management of TB and improving the cure rate in the Province.

* Integrated Nutrition Programme

This programme seeks to implement the Integrated Nutrition programme focusing on Vitamin A supplementation, Food fortification, specialised supplementation and food gardens. Part of the comprehensive plan on HIV and AIDS is to give food supplements that will result in the improvement of the health status of the patient.

Malaria Control Programme

This is an important programme for the Department and the number of malaria cases notified remained stable at around 4000, considerably down from the 14000 cases reported in 2000. Due to the fact that early diagnosis and correct treatment of malaria has received high priority in the province, the fatality rate remains low at 0,55% in line with national and provincial goals.

We will, however, continue with the programme through our participation in the Lubombo Spatial Development Initiative. A dramatic reduction in malaria prevalence has been achieved with the entire Maputo Province now under insecticide spraying. The beneficial effect of this effort will soon manifest itself in Mpumalanga.

Pharmaceutical services

Most of the interventions already elaborated earlier are largely dependent on our capacity to procure and distribute drugs and medical supplies to all health facilities in the province. The biggest challenge, Madam Speaker remains the efficient management of this service.

It is for this reason that the department plans to establish a new provincial pharmaceutical depot and a pre-packaging unit by July 2006. Our objective is to ensure efficient management of the facility, as well as expeditious distribution of medicines.

Decreasing morbidity and mortality rates

In our effort to decrease morbidity and mortality rates, the department has, amongst others, intensified its focus on the Mother, Child, Women's and Youth Health programme

The Department will ensure that the Expanded Programme on Immunisation (EPI) will focus on vaccinations for polio, whooping cough and measles and strengthen the Integrated Management of Childhood Illnesses (IMCI).

Specialised Health Services

On Specialised Health Services, in this financial year the Department will begin a preparatory phase to take-over Forensic Services from the SAPS. A conditional grant of R1 million has been made available to the Department to ensure a smooth transfer of the service.

Social Assistance

Madam Speaker, the Department has as its core mandate to build a caring and integrated system of social development services that facilitates human development and improves the quality of life for our citizens, in particular for those living in poverty or confronting other vulnerabilities.

The Department plans to pay social grants to 501,722 beneficiaries during this financial year. We will also award a Social Relief of Distress to 2702 applicants. Improvement of conditions at which our people receive their grants at pension pay-points, continues to be on top of our priority list.

From the 1st of April this year, the Child Support Grant has been extended to children under the age of 11. We therefore plan to reach an additional 62 781 children this financial year. This is made possible through a conditional grant of R260, 013 million.

Madam Speaker, we will not tolerate spiralling fraud in the social security system, which robs the poorest of the poor of what is rightfully theirs. The Department will continue and intensify "Operation Buyisa" to uproot this malpractice. To date a 190 cases of fraud have been detected, resulting in the Department recovering over R119 000. I wish to make a call to all the citizens of our province to report all cases of fraud and corruption.

In order to bring the amount of grants given to beneficiaries in line with inflation, social grants have been increased from 1 April 2004 as follows:

Old age: R 740
War veterans: R 758
Disability: R 740
Foster care: R 530
Care dependency: R 740
Child support: R 170
Grant-in aid: R 160

It is envisaged that as from the next financial year, the administration of the Social Assistance grants will be taken over by the South African Social Agency, which was established by the Department of Social Development.

Social Welfare Services

Madam Speaker, 2004 has been declared the International Year of Families. All our health and social welfare promotions will incorporate awareness on all the issues pertaining strengthening of families, communities and social relations in order to promote social integration.

Child Protection

As Government and as a Department we are proud that during the ten years of democracy, we have contributed greatly in the changing of the lives of our children. Children will continue to be our primary focus and we call upon you members of this Legislature and our communities in general to join the Department as we go out to address the plight of our children.

The Child Protection Register, which was piloted at Gert Sibande District, will be rolled out to the Nkangala and Ehlanzeni districts in this financial year. The purpose of the register is to monitor trends of child abuse with a view to implement appropriate intervention mechanisms.

One of the most distressing impacts of the HIV and AIDS crisis experienced in South Africa is the number of children that are orphaned due to the death of their parents. "Operation Nakekela", which focuses on the identification and alternative placement of children will be intensified in this financial year.

Early Childhood Development (ECD) is critical to ensure that children are developed and nurtured at an early stage. In this financial year we intend to engage in an intensive skills development programme for the care-givers.

Madam Speaker, the conditions under which some of the ECD facilities are operating leave much to be desired. It is against this background that the Department will engage local municipalities and other stakeholders, as well as the private sector to assist in improving the conditions of ECD facilities.

Older Persons

We also noted with concern the increasing role that is played by Older Persons in becoming parents/foster parents to children affected or infected by HIV/AIDS. In addition, older persons' respect and dignity is being compromised, and as a result the Department has commissioned a research on the Needs of Older Persons in the Province. The findings will assist in planning and reprioritising the range of services provided for Older Persons.

Policy on Financial Awards to Not-for-Profit Organisations

The proposed Policy on Financial Awards to Not-for-Profit Organisations (NPO) is a very critical and necessary instrument that will guide the country's response to the financing of NPOs in the social development sector. This policy will facilitate transformation and redirection of services to the poor and vulnerable sectors of society.

Poverty Alleviation

Poverty is one of the social pathologies degrading the livelihoods of individuals, families, and communities. The Department has, therefore allocated R5, 151 million towards this programme.

It is therefore for this reason that in the current financial year, seven (7) new projects targeting the youth will be funded and the rest of the budget will be channelled towards the strengthening of thirty (30) existing income-generating projects, in the form of capacity building. It is our intention that all new applicants are subjected to an intensive training programme prior to funding.

For us Madam Speaker, to ensure sustainability of these interventions, there must be intersectoral collaboration with the Department of Economic Development and Planning and the Department of Agriculture and Land Administration.

Emergency Food Security

Madam Speaker, in an attempt to address the immediate need to fight hunger and food insecurity in the province, the department was allocated a grant funding of R27, 651 million.

We are planning to distribute 69129 food parcels to vulnerable households headed by children, the elderly, people with disabilities and people infected by HIV/ AIDS over a period of three months in this financial year.

In the current financial year the department has planned to increase the number of drop in centres to six in the province which are located in the following areas Tjakastad, Fernie, Hendrina, Nokaneng, Matsulu and in Nkomazi Block A. These centres provide cooked meals to people in difficult circumstances especially children who cannot cook for themselves.

Population Unit

The Population Unit will continue to provide information on population and development during the financial year to various stakeholders. The following studies will be done in the province during this financial year:

* A provincial study on Older Persons
* A provincial appraisal of Community Home Based Care Projects
* A demographic analysis of Census 2001 data.

Madam Speaker, in compliance with the Public Finance Management Act requirements and the Treasury regulations, I hereby submit the Budget Statement and the Strategic Plan and the Policy and Budget speech for the year 2004/05.

Madam Speaker, the House is requested to approve the appropriation for VOTE 10 an amount of R 5 440 479 000 for the Department of Health and Social Services.

TOTAL BUDGET 2004/05

PROGRAMME AMOUNT
1. Administration: 255 140 000
2. District Health Services: 1 469 502 000
3. Emergency Medical Services: 84 549 000
4. Provincial Hospital Services: 310 553 000
5. Central and Academic hospitals: Not applicable in the Province
6. Health Sciences and Training: 55 619 000
7. Health Care Support Services: 31 501 000
8. Health Facility Management: 143 515 000
9. Social Assistance Grant: 2 934 224 000
10. Social Welfare Services: 101 957 000
11. Development and Support Services: 50 411 000
12. Demographic Trends and Analysis: 3 508 000
TOTAL: 5 440 479 000

In conclusion, Madam Speaker, I am glad to announce that in our midst, we have staff members who have been in the civil service for a period of more than 20 years. I also acknowledge all our stakeholders who have graced this occasion.

Thank you.

Issued by: Department of Health and Social Services, Mpumalanga Provincial Government
29 June 2004

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