Government had allocated R100 million for hospital rehabilitation - work commenced. Largely planning but also physical rehabilitation.

Performed a cost centre analysis by Pricewaterhouse Coopers on 10 of our biggest hospitals. This will provide us with key information on current expenditure patterns by cost centre. This will assist in better identifying possible areas of inefficiency as a first step to decentralised management.

• Commencement of building of a new hospital at Umtata;
• Significant progress with Cato Manor (Durban);
• Completion of building of Tonga hospital (Mpumalanga)
• Commencement of community service - 1088 doctors placed in January 1999 (97% turn up); provincial breakdown as follows:

In 1998 a review of the malaria programme was concluded. Key recommendations were to:

• improve disease surveillance and target interventions
• environmental modification
• personnel protection
• early diagnosis and case management

There will be a greater focus on this area in 1999.

[NB. In 1998 23 282 cases of malaria and 158 deaths were reported as compared to 23 117 cases and 104 deaths in 1997 - largely because of heavy rains]

In August 1998 we launched a new measles elimination goal to eliminate measles in Southern Africa by the end of 2002.

Due to successful mass immunisation campaigns in 1996 and 1997 involving all children under 15 years, there has been significant drop in measles cases from 22 000 in 1992 to only 684 for 1998. Of these 684 only less than 5% have been found to be true measles on laboratory investigation.

Our surveillance for detection of Polio has improved and we are now confident about certification as a polio free country.

We are improving our management of TB using DOTS. 63 demonstration districts in the country have been set up in all provinces. Of these, 24 have achieved our target indicator of smear conversion rate of over 85%.

We now need to speed progress in the other sites. Key to this is going to be an added effort in training staff. 1500 people were trained in 1998 on implementation of DOTS.

We commenced notification of maternal deaths in December 1997. First results show us that the common causes of maternal deaths are:

• Hypertension (20%)
• Non-pregnancy related infections (mainly AIDS) (18%)
• Bleeding (14%)
• Early pregnancy losses including Septic abortions (12%)
• Pre-existing maternal diseases (11%)

We now need to ensure adequate training of our health personnel to particularly deal with these causes.

During 1998, 46 000 women accessed the services for safe terminations.

Access to these services is not uniform and we need to work hard to improve access for those in rural areas.

In 1998 we conducted the first ever comprehensive Demographic and Health Survey in the history of South Africa. This will give us a credible baseline for future planning. The detailed DHS will be released in March 1999.

Partnership against AIDS launched on 9 October 1998 by the Executive Deputy President. More participation by the public in events took place around 1 December 1998.

Need to escalate Campaign !!

Improving access:

In 1998:

• 68 new clinics were built
• 14 clinics upgraded
• 97 Residential Units added to accommodate clinic staff

Improving distribution of pharmaceuticals to rural hospitals and clinics largely due to creative partnerships with private sector. Two provinces have outsourced distribution. Three others are currently working on their tenders.

December 1998 - launched Essential Drug List (EDL) for hospital level. Also released revised EDL for Primary level.

Telemedicine

• Tender for Pilot sites closed
• For implementation around April 1999

Key legislation for 1998

• Medical Schemes Amendment Act
• Tobacco Amendment Bill
• SAMMDRA Act
• Sterilisation Act

We allocated R53 million as a conditional grant to the five under-served provinces to improve their capacity to provide tertiary services to their populations. We shall progressively build on this where appropriate.

This enables patients to be treated more comprehensively closer to where they live and nearer their families.

However we are mindful that there are some services where it will be far more cost-effective to concentrate just in a few centres.

• 25 000 cateract removals were performed in 1998;
• 284 wheelchairs were supplied

Both of these are contributing to reduction of existing backlogs.

• Implement a comprehensive policy on quality of care - including particularly the Patients Charter.
• Continue with hospital rehabilitation. R200 million has been allocated for 1999/2000.
• Complete work on definition of competencies needed to properly run our hospitals. This will be followed by a proper assessment of gaps in our current Management Teams. Appropriate personnel will be drawn in to fill those gaps before management is significantly decentralised. It is our view that it would be incorrect to decentralise if those running the services do not have the requisite minimum competencies. After all, decentralised management is aimed at ensuring efficiency and not an end in itself.
• Continue to improve our vaccination of children to improve coverage. Currently according to latest demographic and health survey - 63% of our children are fully immunised by their 1^st birthday. We need to speedily reach the 80% set by WHO.
• We shall further expand our programme of Immunisation by including HIB in July 1999.
• Consolidate/Expand training of advanced midwives to improve level of obstetric care.
• Expand availability of services for terminations of pregnancies to rural communities.

Build on partnerships against AIDS

• This year - aim is to have a sustained campaign throughout the year. We shall be ensuring that all our national days have an HIV/AIDs theme round them;
• e.g for Human Rights week - building up to 21 March 1999, we shall concentrate on issues around Non-Discrimination against those infected or affected.
• Pay attention to appropriate staffing of clinics and reliability of pharmaceutical supplies.
• Ensure improvement of availability of drugs especially those in EDL.
• Accelerate our programme on telemedicine application.
• One of the key challenges for government as a whole is to ensure predictability and reliability of provincial budgets and cashflows. This is central to good planning and effective service delivery. Particularly we need to prioritise our key programmes. eg. It should never be that provinces renege on payment for vaccines!!! or TB drugs!!!
• Provincial treasuries, in managing cashflows, should be more sensitive to sectoral priorities and impact of their decisions. Also we need to and shall be investing more on improving the management skills of our personnel in key positions.
• Speed setting up of integrated functional and inter-sectoral districts.