Issued by: North West Communication Service
EXTRACTS FROM BUDGET SPEECH BY NORTH WEST MINISTER OF HELATH, DEVELOPMENT SOCIAL WELFARE, PUBLIC MEADI AND BROADCASTING (INCLUDES REFERENCES TO BBC) MADE AT MMABATHO ON THURSDAY, MAY 16.
The Department of Health and Developmental Social Welfare is committed to this year making a fundamental break with the past. Our strategic objectives for this year are the following
The continued development of health and welfare districts Affirmative Action Transformation of the civil service Accelerated delivery of health, social development and welfare service Democratisation of the service and institution in our care Equity - the elimination of privilege, discrimination and imbalances. We shall not allow ourselves any excuse, explanation or rationalisation as to why at the end of this year, we shall not have delivered substantially on these strategic objectives.
CONSTITUTIONAL PRINCIPLES
Before I proceed to demonstrate how we intend to use our departmental vote to deliver on the hopes of our people, let me begin by identifying the solid foundation on which the relationship between the people of the North West and us as elected representa- tives and civil servants is based. On Wednesday the 8th May 1996 our nation adopted the constitution that is now the supreme law of the land.
About health and social welfare, the constitution has the following to say:
1.1 Everyone has a right to life
Freedom and security of the person
2 (1)
(2) Everyone has the right to bodily and psychological integrity, which includes the right
(a) to make decisions concerning reproduction;
( b) to security in and control over their body; and not to be subjected to medical or scientific experiments without their informed consent.
Freedom of trade, occupation and Profession
22 Every citizen has the right to choose their trade, occupation or profession freely.
The practice of trade, occupation or profession may be regulated by law.
Environment
24 Everyone has the right to -
a) to an environment that is not harmful to their health or well-being; and
b)
Health care, food, water, and social security
27 (1) Everyone has the right to have access to
(a) health care services, including reproductive health care;
(b) sufficient food and water; and
social security, including, if they are unable to support themselves and their dependants, appropriate social assistance
(2)
(3) No one may be refused emergency medical treatment.
Children
28 (1) Every child has the right
(a)
(b)
(c) to basic nutrition, shelter, basic health care services, an social services;
d) to be protected against maltreatment, neglect, abuse, or degradation;
(e)......
(f) not to be required or permitted to perform work or provide services that-
I) are inappropriate for a person of that child's age; or
(II) place at risk the childUs well-being, education, physical or mental health or spiritual, moral, or social development;
This campaign has mainly been led by certain elements who in the past enjoyed positions of power and privilege throughout the years of apartheid local government. We have patiently explained ourselves and our policies, because we believed that we were genuinely misunderstood.
Many have accepted that our policies and programmes are informed by no less than an overwhelming desire to see equity, justice, good health, development and social welfare delivered to our people. I regret to say that there are a few die - hards who continue with attempts to instigate newly elected councillors against provincial government. I turn once more to the constitution of the land for a definition of the responsibilities and relationship between our department and local government in the North West Province.
Chapter 3 of the Constitution says on Co-operative Governance.
SECTION 4
Co-operative Governance
4. Government within each sphere must conduct itself in a spirit of mutual respect and trust, reflecting their mutual obligation to-
a) co-operate with each other in mutual trust and good faith by
(b) fostering friendly relation
(c) assisting and supporting each other
d) informing each other and consulting on matters of common interest
e) co-ordinating their actions and legislation with each other
f) adhering to agreed procedures and
(g) avoiding legal proceedings against each other
I am glad to report that two months ahead of the adoption of the constitution I met with the councillors responsible for health and social welfare to establish a provincial forum of elected represen- tatives on health and social welfare matters. Through this body we are confident that we shall be able to address our responsibilities in a manner of mutual respect, co-operation and co-ordinated effort. No one and nothing should succeed in promoting fragmentation and confrontation within the province.
Chapter 7 of the Constitution, Section 151 unambiguously states that R National and provincial government may not compromise or impede a municipalityUs ability or right to exercise its powers or perform its functions.
Section 152 lists among others the following as the objects of local government:
Duties of Local Authorities
1. d) to promote a safe and healthy environment
2. a municipality must strive, within its financial an administrative capacity to achieve the objects set out in sub-section (1).
The development duties of municipalities are defined in Section 153 of the Constitution as follows
(a) to give priority to the basic needs of the community, and to promote the social and development of the community.
b) participate in national and provincial development programmes.
Subsection (3) of Section 155 of the constitution states that Subject to the provisions of section 151 and 154, a provincial government has the legislative and executive power
a) to monitor the local government matters listed in schedules (4) and (5)
b) to see to the effective performance by municipalities of those matters throughout the province.
Schedule 4 list the following as FUNCTIONAL AREAS OF CONCURRENT NATIONAL AND LEGISLATIVE COMPETENCE
We believe however that the nationally adopted policy of using the district based model of service delivery and management is the best. I am happy to report that there is overwhelming support for this model from among local authority councillors
Let me me turn to those sectors which have been reduced to a cliche nowadays - the community, the NGO's and civil society. We must admit that the combined effect of our National approach of centralising donor monies and the tendency by donors to shift funding from NGOUs to the government has been the weakening of the non-government sector.
It is my sincere belief that government cannot and should not try to deliver every health and social welfare service. In order that our people must take their lives and the welfare of their communities in their hands, we must be prepared to support in cash or kind those NGO's and organs of civil society that want to make a contribution to nation-building and a better life. It is to this end that we have begun to identify for support those NGO's that have had to struggle without any support from government.
DEMOCRATISATION
Hospital Boards
We still firmly believe that the health and social welfare sector cannot be regarded as democratised until there are structures and mechanisms through which communities can be directly involved in policy formulation, planning monitoring of performance by public servants. we therefore intend introducing legislation that will create committees and boards that will ensure community involvement in community, institution and hospital-based health and social welfare services.
Mr Speaker, sir, let me turn to the votes that I bear political responsibility for.
VOTE 16 - DEVELOPMENTAL SOCIAL WELFARE
Under this vote we administer seven programmes: namely
1. Administration
2. Social Security
3. Social Assistance
4. Social Welfare Services
5. Social Development
6. Welfare Support Services
7. Welfare facilities development and maintenance
SOCIAL SECURITY AND PENSIONS
Programme 2, which is mainly social security, should be marked by better service provision to pensioners this year. All the nine provinces and the national department of welfare have agreed on privatising the payment of pensions. we in the North West were fairly advanced towards issuing tenders for the payment of pensioners by private contractors unfortunately, we were delayed by the scandal that involved the National PartyUs Abe Williams, the former national minister of welfare, who is still being investigated by the office of Serious Economic Offences for corruption and fraud relating to the privatisation of pension pay-out in the Western Cape. We should be able to invite tenders by July and privatisation should be completed by July and privatisation should be completed by September.
The capturing of information on all the former Bophuthatswana pensioners on computers has been completed and we should experience fewer problems. We are busy with an intense programme of training ex-Bophuthatswana officials in using the computer method of payment. In addition to privatisation we should also be able to pay through banks and post office branches. The attractive option of using village banks is still being explored.
Regrettably we are still experiencing losses of millions of rand through fraud perpetrated by pensioners, their families and some officials within the Department. Registration, computerisation and privatisation with the introduction of advanced finger print identification systems should substantially reduce the money lost through fraud.
Honourable colleagues, I wish to bring to the attention of your house that we have had a company, Cash Paymaster Services (C.P.S.) going around the province lobbying communities to pressurise us to move into privatisation. Unavoidably communities have also been pushing us to accept C.P.S. as the private agency.
While I grant C.P.S. the right to market themselves, I think this time their tactics border on the unethical, because they I know that the only way they can obtain a contract is through the correct tender process. If they carry on the way they have been doing, the only thing I may remember about them is that they caused me enormous political problems and tried to create undue pressure for the department.
EARLY LEARNING CENTRES
Mr Speaker I must also draw the attention of your house to inherited disparities in the support of early earning centres or creches within the North West Province. The former Bophuthatswana government used to fully fund early learning centres, with the Department of Health and Social Services providing social workers and other categories of workers while the Department of Education provided teachers.
It is unfortunately not a benefit that was enjoyed by children and communities in the rest of the North West Province. We have thus been funding an unequal service for the past two financial years.
Our Department has therefore decided to phase out full support for early learning centres in the former Bophuthatswana. In its place we will introduce a flat amount of subsidy per child that should be available to all the children and communities of the North west Province. Other than the unequal funding, there are two more reasons that made us take this decision.
Firstly, the Department of Welfare is in terms of policy only responsible for early child development while the Department of Education is responsible for early childhood education i.e. from grade 0 upwards. The Department of Education will thus not be able to continue paying the salaries of teachers at creches, nor can they afford to expand the services throughout the province even if they wanted to.
Secondly we believe that parents and communities should take primary responsibilities for early childhood development, as the people of the other parts of the North West have been doing all these years. We as the Department will continue to give support through subsidies and other forms of support.
The Department will thus stop full funding to creches and early learning centres at the end of this year i.e. end of November 1996. We trust that this is sufficient notice to all the parents and workers concerned.
SOCIAL DEVELOPMENT
Our Department is also responsible for the programmes of community and population development. We have combined the two into a single programme called social development. The general policy preference of the Department of Welfare is that population and community development should be the responsibility of all departments and sectors.
This is logical, for development cannot be made the responsi- bility of one department only. There is also consensus that the function of population development should be located in the highest possible office in the country or province. We support this view. We in the North West believe that our department should retain some capacity to contributing specifically to development, especially because we want to move away
Old Age Homes
Our history has left us a heritage of well funded and excellent facilities to take care of the aged and infirm among the white community and the urban while among the black and rural people there is virtually no service.
The reality is that we could never afford to extend the existing services for all members of society who have thus far been neglected. We therefore have adopted a policy in terms of which subsidies will be shifted from residential or institutional care to day-care centres and ambulatory programmes. It is such that we will only continue to support those facilities that admit only those aged people who cannot help themselves and need constant nursing support. We intend applying for money from the RDP Fund so that we can fund a project to upgrade the existing facilities into nursing homes for those aged people who need to be admitted to an institution.
Appeal for Registration by Black welfare NGOs
Another area of concern is the absence of or the failure of private welfare organisations in the Black communities to register for subsidy and other forms of financial support.
This years budget will still go largely to the white old aged homes and institutions. While there is political commitment on our part to distribute money more equitably, we can only fund registered organisations. We therefore appeal to organisations which are thus far not registered with the Department to come forward. They too, deserve our financial support and other forms of assistance.
Mr Speaker, I am also pleased to inform your house that the following new programmes have been activated in our province:
- Secure care Programmes for children in trouble with the Law which will be highlighted by the child protection week (l - 6/6/96).
- Coordination of services in respect of Child Abuse cases
- Departmental community services to the Aged.
- Anti - drug Awareness Campaign R IUm addicted to LifeS in support of which + 2500 in our Province signed a petition.
- Joint efforts with the Department of Education integrating Population education into Life Skills training.
- World Population Day festivities.
- Joint efforts with the office of the MEC for Safety and Security to start a project on Family Violence (including wife battering).
Our department is also participating in two major national initiatives that originate in the RDP and the PresidentUs directive.
The first one is an interdepartmental committee on the care of the offender. YouUll recall that the President had instructed that children should no longer be detained together with hardened criminals. We still donUt have adequate facilities to be used as safe detention centres. We do however promise that this time next year we will be reporting progress with this project. The second project is the flagship programme of the social welfare sector.
Through this programme we intend starting employment projects for single mothers with children. We believe that~t this programme will provide immediate poverty relief while in the long term leading to the empowerment of women, especially rural women.
NEW SOCIAL WORKERS
I am glad to report that we have recently employed a new group of social workers who shall provide services where there used to be none. The following communities will now have a social worker living among them.
- SWEIZER RENEKE - VENTERSDORP - ATAMELANG - BLOEMHOF - WOLMARANSTAD - CHRISTIANA
Due to the fact that we have only recently appointed social workers to the districts, we have not been able to break down the programme allocations on a district by district basis.
We will however try to quantify the needs at local level and make the necessary financial allocations. The 97/98 financial year will definitely see a clear division between district of all the money and resources available for social welfare services.
Vote 3 : HEALTH SERVICES
Education of Free Health Care Services
May I preface my remarks on this vote by sharing with honourable members the results of an independent evaluation of the free health care programme for pregnant women and children under six, carried out one year after the President had declared on May 24 1994. The study was conducted by the Child Health Unit of the Health Systems Trust, an independent NGO which monitors and supports health care delivery systems in the country.
The study focused on four areas of the Free Health Care (FHC) policy.
Amongst others main findings were as follows:
1. Effect on utilisation
- The FHC policy led to a rise in the attendance of patients at most public sector health facilities, and suggests that the previous system of user fees was a deterrent to people using public health services.
- There was increased attendance at antenatal clinics, and an increase in the number of women booking for antenatal care. In most facilities, there was a decrease in the proportion of unbooked deliveries in the same period
- A limited survey of district surgeons reported that the use of their services increased following the introduction of the policy.
- Some private general practitioners also reported loss of a proportion of their cash paying patients to the public sector.
- Concerns that the policy would encourage women to become pregnant were not supported by the study. Instead family planning attendances have increased at most facilities and there is no evidence of a rise in the number of births.
2. On the impact on health care expenditure the study found as follows:
- Staffing costs - the biggest recurrent health expenditure item
- were not altered by the policy.
- On the basis of the costs of drugs alone, any increase in drug expenditure attributable to the policy was estimated to be less than 1%.
- On predicted loss of revenue the study found that revenue from user fees was estimated to have dropped by about 30%, representing only 1.5% of the total public health budget.
3. The attitudes of users found that
- There is general support by health service users for the FHC policy
- Respondents felt that access to health care has improved, especially for people living in rural areas, informal settlements and on white owned farm
- There is however, concern that the health services.will not be able to cope with the extra work.
4. On the view of the health care providers the findings were as follows:
- A large proportion of public sector health workers (about 40%) believe that the FHC promotes the health of the general population. Seven out of every ten respondents felt that free health care policy helped prevent serious illness or death amongst pregnant women and children under six..
- However, the dominant opinion was that the FHC policy had aggravated a number existing problems within the health services, such as poor working conditions and low pay, a shortage of medicines, overcrowding and poor staff morale.
I must pause here, Mr Speaker, to say on behalf of the Government and the people of the North West, thank you ever so much, to all the nurses, support staff and other professional members of staff who made this programme a success in the North West.
The findings of this study confirm the view of the ANC and our Department that too many pregnant women and children used to die from preventable health problems. We believe therefore that the extension of free health care to the rest of the population at all the publicly funded primary health care facilities will result in greater benefit to our people. The concern about children above 6 years and the elderly will thus be addressed. Once more, we do not expect any dramatic increase in health expenditure. We have prepared ourselves for this greater challenge by shifting funds and redeploying staff to the districts.
We put these services and the money for them as a specific commitment to delivery within this financial year. We affirm the right of the community to monitor our performance on these and other budgeted items, and to demand the listed services. Your honourable house will receive a report this time next year, when we account for the money granted to us to provide the services we have outlined.
I am pleased to report that we have appointed within the Department an appropriately qualified project manager for the clinic building programme. Contrary to last year when we could only spend about 15% of allocated money on the clinic building programme, we are confident of spending every cent of the clinic - building programme this year. In fact we may come back to ask for more money before this financial year is over.
New programme for maintaining and upgrading hospitals
Our hospitals, which are in a general state of disrepair, will also receive concentrated, expert attention this year. The provincial and national department has just completed a thorough, scientific audit of facilities in the North West. The major finding is that our hospitals have suffered from the triple burden of neglect, and an absence of scientific property maintenance programme and repairs maintenance jobs that were always too little too late or totally inappropriate.
In fact some hospitals are so badly deteriorated that it would be more economic to demolish them and replace them with new structures. We are confident that this year is year one of a rational managerially and technically sound facilities maintenance programme. Never again will any of our health facilities sink to the state in which Bophelong, Taung and Moreteletsi and a few others are.
Talking about Bophelong, I wish to report that while substantial progress has been made with the refurbishment project, we suffered a serious set-back when the company which was contracted to do the work ran into contractual and financial problems. It is one instance which made us think more carefully about how we engage small builders or emerging companies.
While we are committed to giving contracts to emerging contractors, we want to appeal to all those that would participate in our clinic building and hospital maintenance programme to bid within their capacity, to honour contractual obligations and most important to avoid exploitation of their own employees. We do not want to hear a verdict of failure, poor workmanship or violation of human rights in the name of the RDP.
My final word on the clinic building programme is on the frustration we have suffered in trying to ensure community involvement in decision making and project management.
Frustration with slowness of community involvement - short periods called for
The poor or total absence of organisation on the one hand, and factionalism and power struggle on the other very often had us waiting for months before we could start laying the first brick. We will in future have to agree on a limit to the length of time we set aside for consultation.
I believe that once we have identified a need together with the community a two month notice of the intention to start building will be enough for the community to make its view known and for all the small builders and job creation programmes to b agreed upon. Clinics and hospitals are about life and death, we need to be moving forward and reducing backlogs all the time.
Mr Speaker, Honourable colleagues, may it please your house to know that we have begun an urgent programme of upgrading emergency medical services in our province. In a province like ours where many of our rural and black communities have known no decent ambulance service, upgrade is an understatement. Recently we have had discus- sions and debates with certain local authorities and agencies which have been providing ambulance services. It turns out that the crux of the matter is the separation of ambulances from the fire brigade, a debate that has been going on for about twenty years.
This in my view is a typical avoidance of decision making. While the opponents of separation and provincialisation are concerned about their jobs and power, we are more concerned about women in labour in labour being transported on the back of panel vans. Certain local authorities refuse to fetch patients beyond their traditional catchment area unless they are paid more by Province.
The dominance of the fire brigade over the ambulance personnel, when fire fighting as not a competency of the Department of Health, is unacceptable.
We have therefore decided to separate the ambulance services from fire brigade. This we believe will enable us to create a proper service that gives all of our people full coverage regardless of where they live.
We believe that in the process we shall create jobs for many of our people and a career path for ambulance personnel.
New facility for training ambulance personnel in North West
In view of the fact that we could only be given two places in the Gauteng ambulance training college, we have negotiated with SANDF for the use of the Klippan Army Base. Through this facility we should be able to train and produce 1200 ambulance service men and women per year.
HIV/AIDS
Before I turn to matters outside health and social welfare, I wish to draw the attention of the house to one of the biggest threats to our future as individuals, families, communities, youth and adults and ultimately the entire nation. The threat Mr speaker is HIV/AIDS.
The HIV/AIDS epidemic is well established in South Africa and in the North West Province. The exact number of people infected with HIV and/or AIDS is however not known . At present, the annual HIV surveys in women attending ante-natal clinics form the cornerstone of HIV surveillance. Results of the 1994 survey show that 6.7% of women attending ante-natal clinics in the North west Province were HIV positive.
Preliminary results of the 1995 survey show that the percentage of HIV positive Ante-Natal Care attenders has increased to 6.9% while 9.8% had syphilis. Given these rates, we estimate that in the North West 59 600 women are infected with HIV and 83 400 have syphilis. The 20 to 30 years age group is worst affected by HIV infection. The number of reported AIDS cases in the Province has increased from 1 in 1988 to over 700 by the end of 1995.
For the general population, whereas in 1994 we found 17% of all HIV tests requested to Be positive, in 1995 we found 22% of all samples tested to be HIV positive.
In numbers, 1994 found 968 out of 5000 people positive and in 1995 1582 out of 7000 infected with the virus that causes Aids. It won't be long before we are faced with that most outspoken evidence of overwhelming deaths due to AIDS - the AIDS orphans, children whose parents, single or married, have been killed by AIDS. I therefore appeal to each and everyone to make their contribution to the fight against AIDS, by practising safer sex at all times and spreading the message about the need for change in behaviour and life patterns that increase the risk of AIDS. As the slogan of COSAS goes "Each One, Teach One".
Mr Speaker, the reorganisation of the duties of the Executive Council in March added Media and Broadcasting to the Department of Health and Developmental Social Welfare.
I shall now turn to deal with these programmes, starting with PUBLIC MEDIA.
Schedule 4 of the Constitution defines subject to section 192, media services directly controlled or provided by the provincial government as a functional area of concurrent national and provincial legislative competence.
The future of Bop Broadcasting
The review of the future of Bop Broadcasting has been undertaken with the view that, first and foremost, its result must be the retention of broadcasting services within the province.
The business plan is based on a strategy designed to substan- tially reduce government subsidies and to transform BBC into a revenue generating resource for the provincial government, albeit in private hands. This is in line with the Province's adopted growth an development strategy.
Bop Broadcasting has resumed its seat in the integration process. Our position is that we will integrate all assets that are necessary for the creation of a NPBS, however, excess assets will NOT be brought into the integration process. Rather, they will be sold.
Rationalisation will entail:
Bop TV and Radio Bop to be leased through a select tender process and to operate as a commercial station either independently or through a joint venture with the North West government.
Mmabatho TV and Radio Mmabatho to be integrated into the National Public Broadcasting Service with programming that showcases the North West province.
Radio Sunshine to be operated as a community radio station funded by its future owners.
Bop properties to be administered by a newly created, stand alone company renamed the North West Broadcasting Corporation, that will own the land and buildings and lease them to the various entities, and
Rhino Recording Studios to be operated as a separate business unit from Bop Broadcasting.
Integration is expected to proceed piecemeal. That is, where agreement has been reached, integration will be implemented. Excess assets will be disposed of within the recently agreed National Framework for the disposal of state assets. It is anticipated that this entire process of integration and disposal will be completed by the end of the current financial year.
This position has now been endorsed by Mr Jay Naidoo, Minister of Post, Telecommunications and Broadcasting.
Constitutional Guidelines for Civil Servants
We shall further be bound by the new Constitution which in Chapter 10, subsection (l) of Section 195 defines the following as the BASIC VALUES AND PRINCIPLE S GOVERNING PUBLIC ADMINISTRATION.
a) A high standard of professional ethics must be promoted and maintained
b) Efficient, economic and effective use of resources must be promoted
c) Public administration must be development oriented
d) Services must be provided impartially, fairly, equitably and without bias
e) People's needs must be responded to, and the public must be encouraged to participate in policy making.
f) Public administration must be accountable
g) Transparency must be fostered by providing the public with timely, accessible and accurate information
h) Public administration must be broadly representative of the South African people, with employment and personnel management practises based on objectivity, fairness, ability and the need to redress the imbalances of the past to achieve broad representation.