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Date : 26/08/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Parliamentary Media Briefing, August 2004


SOCIAL CLUSTER PRESENTATION FOR PARLIAMENTARY MEDIA BRIEFING, PRESENTED ON BEHALF OF THE SOCIAL CLUSTER OF MINISTERS BY DR MANTO TSHABALALA-MSIMANG, MINISTER OF HEALTH, 26 August 2004

INTRODUCTION

This Social Cluster presentation is primarily focusing on progress in the implementation of the Programme of Action. The first part of the presentation focuses on those activities that had the deadline of the end of July and August. The second part deals with a set of issues, which are work in progress - with timelines that vary from short to medium-term. Lastly, we will highlight challenges that are facing the cluster in its attempt to accelerate implementation.

PART 1: IMMEDIATE PROGRAMMES

1. Human Settlement Plan August 2004

The objective of the programme on human settlement was to ensure that the Department of Housing would have designed a Plan for dealing with human settlement and social infrastructure, including rental-housing stock for the poor. The Plan should also provide employment opportunities for the unemployed.

The ministry of housing has tabled a comprehensive housing plan to Cabinet. The plan includes, among others, the following:

* The plan to expedite the provision of housing to the thousands of homeless people
* A plan to provide better living conditions for those in informal settlements
* A plan to provide rental housing in urban areas
* To create enabling environment and encourage partnership between the public and private sectors to deliver sustainable human settlements
* To engage banks within the context of the financial service charter to encourage them to increase their lending to people in both formal and informal employment sectors
* To provide better housing for those living in single-sex accommodation

Once approved by Cabinet, the plan will drastically change the delivery of housing in South Africa.

2. National School Nutrition Programme August 2004

The cluster was tasked with developing an implementation plan for the National School Nutrition Programme that is premised on community participation and mobilises communities to develop food gardens. The primary goal of the programme is school feeding, while also utilising the resources invested by government in the programme to create sustainable livelihoods for local communities.

The transfer of the programme from the Department of Health to Education was fairly smooth except for some hitches in a few provinces where the tender processes and systems used by the Department of Health had to be reviewed. The immediate goal for the Department of Education was to ensure continuity in the school-feeding scheme. The feeding scheme currently reaches 85% of the estimated 15 000 schools that the scheme is supposed to cover.

The second part of the nutrition programme focuses on creating employment opportunities for women. The cluster is focusing on the 21 Presidential nodes where women are being encouraged to form small businesses that will administer the school feeding programme to a group of schools in the area. A plan, with concrete proposals for the nodes has been developed and is ready to be presented to Cabinet. The plan seeks alternative delivery mechanisms that empower women in small businesses in the nodes.

3. Community Health Worker Policy Framework

Government is improving health service delivery by among other things, opening up opportunities for trained Community Health Workers.

Community Health Workers are community-based generalist health workers who combine competencies in health promotion, primary health care and health-resource networking and coordination. The plan to expand to 300 Home Based Care sites is on course and is due for consideration by Cabinet. This plan was developed by the target date of July 2004; however there are discussions relating to resource implications that must still be concluded before submission to the Cabinet.

4. Early Childhood Development July 2004

The directive for the Cluster with regards to the Early Childhood Development (ECD) Programme was for the Cluster to present an integrated ECD plan by the end of July 2004, with a package of all government services that are targeting children from birth to five years of age. The draft plan with a comprehensive set of ECD services, Tshwaragano Le Bana, has been developed by the ECD Interdepartmental Committee, consisting of the Office on the Rights of the Child, Departments of Education, Health and Social Development. The draft plan will be taken to Cabinet when the initial consultation of the relevant Ministers has been completed.

However, the programme of ECD continues and a lot of effort has been put on training and development of ECD practitioners. A total of 4 500 Grade R educators are currently being trained in a collaborative effort between the Department of Education and SETAs. The training will assist the practitioners in running ECD programmes. The Department of Social Development continues to register ECD sites, and the three departments are currently looking at integrating their databases to improve the understanding of the reach of ECD services.

5. Financing Protocol for Rural Development and Urban Renewal Nodes July 2004

The task for the Cluster was to develop a financing protocol for the nodal areas that are part of the Integrated Sustainable Rural Development Programme (ISRDP) and Urban Renewal Programme (URP). The intention of the financing protocol was to synchronise the financing of these programmes by the three spheres of government. The cluster met its deadline in this regard, and Cabinet is currently considering the matter.

Part of further work that the Cluster is doing in this regard includes an audit of activities of all departments in each node.

PART 2: WORK IN PROGRESS

6. Promotion of National Identity and Social Cohesion Ongoing

The directive for the Cluster was to develop a range of programmes across departments, that promote non-sexism and non-racialism; value systems; national identity and moral regeneration. The programmes driven by the Cluster include a national campaign to educate the nation on the importance of our national symbols; provide guidelines on the use of the flag; the meaning of the national coat of arms; and the national anthem.

The programme focuses on reinforcing high levels of recognition of national symbols and cultivating a sense of patriotism. A lot has been achieved to date. All the schools in South Africa have been given the national flag, textbooks that are distributed in schools are branded with a national symbol and the national order stamp series for the year 2004 has been developed.

The cluster has also developed a set of programmes that uses sports and recreation as a key lever in strengthening the social fibre. The Siyadlala Mass Participation Programme is meant to address issues relating to the promotion of national identity and social cohesion. Government has made available R20 million for the implementation of a mass participation programme particularly for the youth. The programme is aimed at facilitating participation in sport and recreation activities, especially in disadvantaged, rural, high crime and government priority nodes. The programme is closely linked to the Department's Building for Sport and Recreation Programme (BSRP) that we are going to report on later. The programme was launched in Upington, Northern Cape on 21 August 2004 and will commence in 36 hubs, four per province, throughout the country.

The hubs were identified by the provinces themselves and the programme is supported with funds transferred to the provinces in terms of the Division of Revenue Act. Cooperation agreements have been concluded with provincial departments responsible for sport and recreations that have all finalised their business plans for implementation. The programme has enhanced cooperative governance between the three spheres of government.

Mass based sport activities aimed at getting the youth involved constructively, will take place every week and will involve at least 43 200 people in the first year. The activities concerned are modified versions of the mainstream sports including mass aerobics, mass walks and fun-runs, football, handball and basketball, as well as indigenous games.

The programme is also aimed at providing opportunities for skills development amongst unemployed youth in the identified hubs who will coordinate and present these activities. These volunteers have been identified by the provinces in consultation with local communities and sports federations. More than 200 volunteers, who come from the local communities in which the activities take place, will be paid a stipend that will contribute to income generation and provide some relief in these impoverished areas. They have been and will continue to be trained in (event) management, reporting, sports promotion and activity instruction. National federations are assisting with training material.

Contracts have been signed with the local authorities for the use of facilities for the programme. An impact study of the programme has been commissioned and will be conducted by Rand Afrikaans University who won the contract after an open tender. They will measure social indicators in the communities concerned prior to the commencement of the programme and at intervals during its implementation to determine whether it is achieving the desired outcomes.

The revival of a national school sports programme is closely aligned to the mass participation programme. Discussions have been held between the Ministers of Sport and Recreation and of Education who have agreed on the joint responsibility of the two departments and the respective roles of each with regard to the programme. In this regard the Department of Education will take responsibility for the curricular aspects of the programme (including the reintroduction of Physical Education in school curricula, as well as local inter-house and inter-school sports events,) while Sport and recreation South Africa will take responsibility for the representative and competitive aspects of the programme at the regional, provincial, national and international levels. The Deputy Ministers of the two Departments are developing the formal cooperation agreement that will be concluded to implement the programme.

The Building for Sport and Recreation Programme (BSRP) is a programme aimed at creating employment, generating income and thereby reduce poverty during the building phase and subsequent management and administration of sport and recreation facilities in disadvantaged communities. The programme was intended to run for three years and was extended at the end of the 2003-04 financial year for a further year after which it will be incorporated into the Municipal Infrastructure Grant (MIG).

The development initiatives in 2004-05 are aimed at building or upgrading 109 facilities across the country. The local authorities are the programme-implementing agents with whom agreements are concluded. R132 million is available for the project in the current year. In the first quarter of this year 61 of 66 agreements have been signed and the 51 first payments have been made. A hundred project managers have been appointed. Monthly meetings are held to empower the local authorities to manage the projects and, ultimately, the facilities of which they will take ownership. Community Sports Councils have been established at 106 of the sites and 78 of these have been through training courses aimed at empowering them to co-manage the facility with the local authority. These initiatives contribute to strengthening institutional capacity. Project business plans have been received for 52 of the sites, 6 are currently out to tender and 4 projects are currently under construction.

Between 50 and 75 jobs are created at each of the facilities during the construction phase of the project that translates, roughly, into the employment of between 5450 and 8175 people. 50% of these are expected to be women 15% youth and 2% people with a disability. Once the project has been completed, permanent jobs are created for facility managers and maintenance teams while the Local Authority and the Sport Council manage and administer the facility jointly.

SRSA is in the process of revising its National Facility Plan that is intended to contribute to addressing the broader question of human settlement redevelopment. While the plan focuses on the areas with the greatest need, it is premised on the requirement that the provision of sufficient open spaces and adequate facilities for sport and recreation should form part of every housing development project.

The project as a whole has contributed immensely to cooperative governance between the three spheres of government. By the end of the current financial year, R550 million would have been invested in the facility development initiative. The estimated backlog in facilities in disadvantaged areas was estimated at R5 billion. This backlog has grown since the estimation was made in 1995.

7. Progress on the establishment of the Social Security Agency March 2005

The Establishment of the Social Security Agency is a Cabinet and Cluster priority. Government has made a commitment that the Agency will be operational by April 2005. The legislative mandate of the Agency will be to manage, administer and deliver social assistance grants to more than 8 million beneficiaries.

The Department of Social Development has made significant progress in the process of establishing the agency. Both the Social Assistance Act and the SA Social Security Agency Act, which provides the legislative framework for the establishment of the Agency, have been passed. This provides the mandate for the shifting of the social assistance delivery function from the provincial departments of Social Development to the South African Social Security Agency.

The tasks that have been concluded include;

* the establishment of a Steering Committee made up of the National and provincial managers of the Department;
* the establishment of national and provincial project teams with coordinators for various focus areas;
* the ring fencing of resources in the provinces;
* the development of policies and procedures for Human Resource Management;
* the development of an organisational design for both the National and Provincial structures;
* the development of norms and standards for service delivery; and a service delivery model;
* the development of an Information Technology plan
* And new accommodation for the Agency's National office has been obtained.

The major challenges that have been encountered relates to limited resources at both national and provincial levels to assist in various processes towards establishment of the agency.

At the beginning of the 2005/2006 financial year, the Agency will embark on a major service delivery improvement programme focused on implementing the norms and standards and installing new IT systems and to obtain approval for an infrastructure strategy.

8. Extension of the Child Support Grant 2006

The child support grant is being extended to children up to their 14th birthday and will take place over a 3-year period. In the last financial year, children of 7 and 8 years of age were able to register for the grant and during the current financial year, children aged 9 and 10 years will be the main focus.

A Child Support Grant Extension Task Team tackled operational issues of the programme. The Task Team members regularly visit Provinces to assess performance and the conditions under which the Provinces are operating. Some provinces are doing extremely well and have already exceeded their set targets, while others are not making good progress.

The national take up rate for 9 and 10 year olds was 463 000 against a set target of 391 000 which is 118% above targets. When comparing the Junes achievements of 301 000 with July's achievements of 404 000, a growth of 103 000 is achieved. This amounts to a 134% achievement.

9. Disabilities Ongoing

The Social Cluster, through the Directors General task team is finalising a common tool for determining disability for purposes of accessing various grants and services. The purpose is to ensure better alignment of the criteria to be used for access to health services and eligibility for disability grants.

An expert group has been appointed to develop an assessment tool to be used in all the assessment processes in a consistent manner. The tool is being refined by the cluster to also ensure a common use of the definition of disability, while consultations are still underway. The aim is to implement the assessment tool nationally and across departments to guarantee higher degree of reliability and equal access in all the provinces. It is envisaged that this tool will be finalised for implementation in 2005.

Other initiatives have been put in place to examine spending in the area of disability grants. Work is currently underway with Treasury to review current developments and to explore options for improving the provision of disability grants.

Together with the provinces, the cluster is looking at steps to ensure the reliability of claims for disability. Three such steps that are part of an integrity improvement plan include:

* Data interrogation to establish whether those who claim disability grants do not receive other income;
* Deployment of additional staff to ensure that temporary disability grants are reviewed in time,
* And interrogation of trends in the nature and types of disabilities and the medical practitioners who issue medical reports.

10. Farmer Support Programme Ongoing

The Cluster launched the Comprehensive Agricultural Support Programme (CASP) a week ago and its primary aim is to make provision for agricultural support to targeted beneficiaries of the land and agrarian reform programme around the following priority areas:

* Information and knowledge management
* Technical and advisory assistance and regulatory services
* Training and capacity building
* Marketing and business development
* On-farm and Off-farm infrastructure and production inputs
* As well as financial assistance

The need for CASP flows from the analysis that government has undertaken in the past years with regard to support requested by the beneficiaries of the reform programme, as well as those who are farming in the communal areas. An allocation of R750m has been made through the MTEF budget allocation. In the current financial year, transfers to the provinces will equal to R200m and for the 2005/6 financial year R250m will be made available and there will be R300m in 2006/7.

The Cluster has also developed the Agriculture Black Economic Empowerment (AgriBEE) framework that was released for comment a month ago. The Framework should be seen as a guide to help all the stakeholders work together in finding solutions that will reverse the inequities that are still prevalent in the South African agricultural sector. A number of stakeholders in the agricultural sector have contributed in the development of the framework

The framework defines the building blocks for elimination of skewed participation and inequality in the agricultural sector as a result of racially biased policies and programmes of the past. The AgriBEE frame is complementary to the other key strategic initiative of government to bring about growth, equity and employment and to ensure the sustainable management and use of the natural resources.

The objectives of AgriBEE are to eliminate racial discrimination in the agricultural sector through implementing initiatives that will include Black South Africans at all levels of agricultural activity. More specifically the goals entail access to land, employment equity and literacy.

An AgriBEE steering committee is being put into place. The committee will consolidate the inputs from different stakeholders and there will be further discussions at a two-day conference scheduled for the end of the year.

11. School infrastructure development March 2005

The primary target of the school infrastructure development programme is to ensure that there are no children learning under trees and mud structures. Provinces have been encouraged to reprioritise the construction of classrooms in their budget and also seek alternative measures such as mobile classrooms.

An additional R785 million has been allocated for capital works in the provinces for this year, which will allow for significant progress on the targets. However, indications are that the spending rate is currently at 15%, which is lower than the target of 25% by this time if the year. Spending rates tend to improve towards the end of the year as projects reach completion stage. The information available at this stage indicates that there are 1 705 schools nationally that either have classes in open air, have mud structures or have unsafe buildings. These will be monitored on a project-by-project basis by the cluster during the course of this year.

It should be noted that not all provinces were able to reprioritise budgets sufficiently in order to meet the goals of eradicating learning under trees, mud structures and unsafe schools as well the water and sanitation backlog during this financial year. The Cluster is pursuing all possible avenues to mobilise resources for the next financial year, including exploring possibilities of strengthening existing partnerships with the business community.

12. Higher Education Mergers March 2005

The implementation of the National Plan for Higher Education with regards to the rationalisation of the institutional landscape is progressing well. In total, four mergers and seven incorporations were finalised and implemented in January 2004. There were some problems in some areas that were a feature of any amalgamation processes of two or more organisations. The establishment of a fully-fledged Merger Unit in the Department of Education, dedicated to providing the necessary support to the affected institutions was very helpful in curbing problems from reaching crisis levels. The second round of mergers and incorporations will take place in January 2005.

13. Food Security Ongoing

This programme started as a means to deal with food emergencies. Last year it reached 403 991 beneficiaries. This cycle has R400 million to still support the same families since they have not yet been transferred to other means of support. However, the number of beneficiaries has decreased in some provinces because some have been transferred to other forms of government social assistance.

Processes to procure the necessary food parcels and distribute them are underway. It is envisaged that the next distribution will begin in earnest at the end of October / beginning of November 2004. One of the strategic objectives of the Programme of Action was to ensure that these beneficiaries are also supported and transferred to the Agricultural Starter Pack programme so that they can participate in securing their own subsistence. The mechanisms for financing such a programme are still under discussion.

14. Promotion of healthy lifestyles and change from risky behaviour Ongoing

The Youth Risk Behaviour Survey conducted in 2002 was presented at the World Health Assembly in Geneva in May 2004. South Africa has succeeded in putting the matter of promotion of healthy lifestyles on the international health agenda and many countries are preparing to do similar studies and look at policy implications. Multi-stakeholder discussions have taken place with a view to formulate a country strategy and a draft will be ready for consideration by Cabinet at the end of September 2004.

The Health Promoting Schools programme has been implemented in various provinces with schools setting up structures that coordinate activities and projects to promote health in schools. These include projects like the vegetable garden project, which complements the School Nutrition Programme, and school based drug prevention programme, which educates learners about dangers of tobacco and drug use. Some communities are expanding these projects beyond the school premises into the communities.

15. HIV and AIDS Ongoing

The Cabinet approved the Comprehensive Plan for the Management of HIV and AIDS in November 2003. Several steps have been taken and progress made in implementing the plan. The first major activities related to assessing the state of readiness of health facilities and accrediting them. This also involved assessing staffing and training needs, procurement issues, improving the capacity of laboratories and establishing capacity for monitoring patients.

Khomanani Social Mobilisation campaign has successfully launched the new brand of condoms called Choice and has already seen increased distribution of the product. Prevention education has spread to the nightclubs, social activity spots and shebeens across the country. Murals spreading the education message on HIV and AIDS are now becoming a common site on the walls of places where people socialise. This does not only promote education but also creates employment by artists in the communities.

Community radio stations are playing a vital role in this campaign through the links established with health promoters who regularly get invited to talk shows.

The outputs achieved thus far on other section of the Comprehensive Plan include the following:

* All provinces have started implementing the comprehensive plan
* The capacity of laboratories is being improved at a national level
* In terms of procurement of drugs there is enough stock in all nine provinces for the 85 service points that have been accredited
* The long term tender for the supply of ARVs should be finalised within the next month
* There are now 8000 persons on ARV treatment
* The nutrition component is also integral to this plan and is place
* A pharmaco-vigilance unit has been set up for the monitoring of adverse effects that may be encountered

Cabinet is being appraised on a continuous basis about the progress of implementation.

16. Tuberculosis March 2005

Integration of TB, HIV and AIDS programmes has progressed well in all the provinces including the district level. A long-term study on Multi-Drug Resistant TB is underway with first interim results being processed. Follow up of patients in this study is over a 5-year period to see how they respond to treatment.

TB control programme is being scrutinised to identify challenges in different provinces in meeting the cure rate and other targets of the programme. These challenges should be addressed immediately to improve the effectiveness of the programme.

17. Malaria Ongoing

We have now appointed a malaria information officer for each of the malaria affected provinces - KwaZulu-Natal, Limpopo and Mpumalanga - and in addition an entomologist was appointed in the Limpopo province. The collaboration on the malaria project of the Lubombo Spatial Development Initiative (LSDI) was strengthened. This project has since its inception 4 years ago, achieved malaria incident reduction of 96% in KwaZulu-Natal, 91% in Swaziland and 86% in the southern parts of Mozambique. We have managed to secure financial resources from the Global Fund to fight AIDS, TB and Malaria to the tune of US$22.5 Million for the next 5 years.

A Joint programme of co-operation on malaria was drafted with Zimbabwe, especially for cross border collaboration between South Africa and Zimbabwe. South Africa assisted Zimbabwe with 10 tonnes of Insecticide and 10 000 doses of anti-malarial drugs. These commodities assisted in containing the spread of focal malaria outbreaks in Zimbabwe. South Africa is now in discussions with Angola for collaboration on malaria control.

South Africa was given two awards - one ministerial award for political commitment to malaria control across borders and inter-country collaboration, and the second national award for malaria surveillance monitoring and evaluation.

PART 3: CHALLENGES

Generally, the Cluster is well on track with the targets that were set, though there are a few glitches here and there. The challenge that remains is sustaining the momentum that we have gained in implementing fully integrated programmes as a Cluster. The success of the programmes to date indicates that we have been able to overcome this challenge.

Issued by: Ministry of Health
26 August 2004

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