18 APRIL 2000.
Mr Speaker and Deputy Speaker
The Premier of the North West Province, Mr Popo Molefe
Colleagues in the Executive Council
Honourable Members of the Provincial Legislature
Members of the House of Traditional Leaders
Members of the Health Committees and Hospital Boards
Heads of Departments
Distinguished Guests
Ladies and Gentlemen
INTRODUCTION
Budget Speeches are important occasions for us to reflect over the long road traveled and to contemplate the distance still to be completed. We remain confident that the learning curves we have gone through over the last six years have imparted invaluable experience. We can move forward with greater speed, confident that a firm foundation has been laid for accelerated service delivery. We stand before you as health cadres of a nation at work for a better life.
When we received a new mandate to lead a process of creating a better health service for all, we had no illusions about the enormity of the challenges that lay ahead. We knew that the task of reversing centuries of deprivation and disease could not be accomplished overnight. But we also know that we cannot afford to fail legitimate expectations and hopes of millions of our people. During the first term of office, ours was, in many ways, the task of turning despair into hope. We also had to lay a foundation for a health service that responds to the health needs of all our people. In this new term of office, the challenge is to move decisively from planning and policy development to implementation. Form promises to action.
We have learnt, during the first term, that rather than assuming a defeatist posture in the face of daunting challenges, we must proceed with determination and remain focused, for obstacles in the way of progress are never insurmountable.
THE AFRICAN RENAISSANCE.
We stand on the threshold of an African Century which promises historic and unparalleled achievements for the continent. It is about time that Africa stops being the stamping ground of the five Horsemen of the Apocalypse - Poverty, Disease, War, Crime and Environmental Degradation. President Thabo Mbeki has challenged everyone to contribute to the rebirth of Africa. Health workers can play an important role in the renewal of our continent, because disease plays a prominent role in determining the capacity of nations to develop. History has shown that even in times of war, disease kills more than bullets. It is our capacity to conquer disease that will eventually determine the destiny of our province, country and continent.
The entire dream of the African Renaissance will flounder if the scourge of widespread disease persists. It is my contention that development will come to nought if we do not conquer disease. Health workers are critical to the regeneration of Africa. This recognition was given concrete expression at the recent African Renaissance Conference, which marked the launch of the South African Chapter.
The biggest threat to Africa's economic and developmental growth
is HIV
AIDS. What is there in our African customs, tradition and
culture that could offer some solutions? Apart from taking a
serious look at indigenous or traditional medicine, we need to
examine certain social practices that have been suppressed in
favour of foreign cultures and belief systems.
Initiation schools and virginity testing.
For example, the practice of initiation schools and virginity testing balanced with respect for general human rights and the right to privacy and freedom of choice in particular, are not necessarily a bad thing. I find it contradictory for people to argue that society should be more open about sex and yet condemn virginity testing as a public humiliation. Could this not be an opportunity to encourage young men and women to hold on to their virginity for as long as possible? Our call for abstention can in fact find support in this ancient cultural practice. Is the current introduction of sexual or reproductive health education in schools not a belated, though welcome compensation for the destruction of the African initiation school?
The practice of circumcision has been found to decrease the transmission of the virus which causes cancer of the cervix in women, the human papilloma virus. The Australians are currently following up on preliminary results of a study that suggests that circumcision could also limit HIV transmission.
One more example of where the health sciences and tradition can be mutually reinforcing.
Polygamy.
Among social institutions of African origin, polygamy and the extended family merit serious examination as part of the solution to HIV and the aftermaths of AIDS. Monogamy is a practice imposed on Africans ostensibly because it is civilised and respects the rights of women. The break-down of the institution of marriage and the serial monogamy of western society would suggest that even the strictest church doctrine is unable to stop men from having multiple partners. Why is it that Muslims and other communities on the west coast of Africa allow polygamy and yet do not have a rampant spread of HIV. If we had not stopped polygamy, might we have so much prostitution, breakdown of marriages and abandonment of children who end up as street children? I raise these questions conscious that they have to be addressed together with women's rights.
Extended African family
The extended African family has over the years been broken down by extreme poverty and the excessive concentration of wealth in the hands of a few elites. Could the revival of the extended African family, which still survives with difficulty among the poor, not be made possible by more inclusive grants such as the poverty alleviation grant that has been proposed by Minister Zola Skweyiya? We need to address these issues seriously, lest the African Renaissance turns into an empty sentiment and intellectual pursuit. All of us must see ourselves as key players in this big mission of the African Renaissance. We enjoin your august house, Mr Speaker, to support our efforts as the health sector in and outside government as we contribute to the second liberation of Africa.
INTEGRATED SERVICE DELIVERY
The ANC-led government places a huge premium on co-ordinated and integrated service delivery. Government departments and parastatals are increasingly rising up to the challenge of ensuring better co-ordination and integration of their programmes to ensure quality and cost-effective services to our people.
The integrated approach is intended to improve policy co-ordination and programme planning between departments and different levels of government.
In his first State of the Nation Address, President Thabo Mbeki, cited the following example, "When a clinic is built, there must be a road to access it. It must be electrified and supplied with water. It must have the requisite personnel, qualified to meet the health needs of the particular community".
We confirm our commitment to integrated service delivery.
ACCESS TO HEALTH CARE.
Access to basic health services is the primary goal of the ANC-led government. This is the policy principle that continues to underpin our approach to health service delivery. Government is fully aware that the full meaning of freedom will only be realised once all our people are freed from the legacy of deprivation and disease.
A significant number of Community Health Centres will be developed to improve access to comprehensive health care and quality of support to clinics. An effective and reliable emergency service and call system will be established throughout the province to provide this level of access to services. The number of clinics providing 24-our services will be increased in highly populated areas.
I regret to inform your house, Mr Speaker, that almost all of our people who were under the Transvaal Provincial Administration (TPA) are still denied access to health services at night, weekends and public holidays. This is mainly due to the unwillingness of health workers at this level to work extended hours. They insist that their contracts are such that they cannot help us to improve access to health care. We therefore enter the Easter Weekend with the knowledge that many clinics and health centres will be closed.
Telemedicine
Telemedicine is intended to improve the delivery of health care, especially in remote areas. It will connect highly experienced medical specialists anywhere in the world with our rural hospitals and enable these experts to give advice, teach or assist in a difficult diagnosis.
The project will help provide high quality health care to the communities of North West with the best available resources through efficient image management, communication and continuing education for total patient care.
In the next three years, we expect fourteen hospitals to have been linked to the telemedicine system. Our Tele-education programme and Information Systems will be integrated with the telemedicine system.
Emergency Medical Services
The emergency services in the province are in a crisis. Poor service delivery results from the problem of territorial provision of services by local authorities. Clearly, a situation cannot be considered to be normal when people, in desperate need of emergency assistance, are told that there will be no response because they are in the wrong area of jurisdiction. In many instances, our people are referred from one service to another. We cannot afford this state of affairs when quick or immediate response can mean the difference between life and death.
There is also a racial problem that must be addressed. In Brits, for example, some emergency service personnel refuse to respond to calls from the township ostensibly because they are on fire duty and not on ambulance duty. This problem has a negative impact on response time and is a reckless endangerment of life.
The other disturbing observation is that emergency services are almost exclusively a male domain. We will address this problem within the framework of our women empowerment and gender equality policy.
Mr Speaker, we recently gave notice to various local authorities that we will be terminating the contract in terms of which they have been providing ambulance services on our behalf. The main reason is that, after years of attempts at quiet persuasion and constructive engagement, we still have an ambulance service that is as bad as it was when we came into office in 1994.
We continue to see persistent resistance to transformation in service delivery, rampant corruption and a kind of racial cronyism that has kept the fire and emergency services in the former Transvaal Provincial Administration (TPA) areas as an enclave of white male Afrikaner domination.
In the former Bophuthatswana, the hurried transfer of the so-called national Fire and Emergency Services for certain local authorities left us with a service that was beyond our provincial influence and yet continued to behave without local accountability as was the practice and habit in the former Bophuthatswana. We hope this mistake will not be repeated.
Another problem, Mr Speaker, has been the illegal and inefficient subsidy of fire services that we have been providing to municipalities as the provincial Department of Health. In terms of part A Schedule 5 of the Constitution, Ambulance and Emergency Medical Services is our competency.
What money could have gone to the improvement of ambulance services has largely been spent on fire services, paying for rent, uniform and standby allowances of fire fighters. After careful analysis, we now know that while we thought we were sending money for the improvement of ambulance services, it went to fire services. This must stop!
You will appreciate, honourable members, that transformation has not taken root in the Emergency Medical Services. With provincialisation, we will be in a position to address all these problems and anomalies by transforming the service at all levels. We are confident that the result of our provincialisation process will ensure that we provide a truly non-racial quality and equitable service to all our people.
Drug Management and Distribution.
We inherited an inefficient and ineffective system in this province, especially in the former Bophuthatswana. The former Bophuthatswana never had an efficient drug management and distribution system. The system was mainly manual and managed by untrained personnel. This resulted in logistical problems such as drugs not being ordered, received and distributed on time.
However, in many instances, what is perceived to be drug shortage at clinics is, in fact, not shortage, but consistent with the Essential Drug List (EDL) programme. The availability of certain drugs depends on the level of care provided at each institution -whether it is a clinic, a health centre or a hospital. In practical terms, this means that certain drugs will not be found at clinics, but only in hospitals. I urge honourable members and members of the public to try and learn about this system of international best-practice so that we re all able to deal with complaints about shortage of medicines.
An investigation into the Mmabatho Medical Stores two years ago revealed large-scale theft of drugs and medicines, which resulted in the shortage of drugs and other medical supplies in our hospitals and clinics. Some members of staff were arrested and convicted.
Following our own investigations which revealed weaknesses in the management and distribution of drugs and medicines, the department decided to outsource the management of procurement, warehousing and distribution of drugs. A private company started working on the 1st of October 1999. In addition, facility managers have been trained in drug management. We are also addressing the question of improved security at the medical stores. I am pleased, Mr Speaker, to report to this house that these moves have already made a positive impact on the management, supply and availability of medicines.
Distribution beyond hospitals
While we have seen improvements in the distribution of drugs and medicines to hospitals, it is clear that the supply to clinics and health centres is still poor.
It has become clear that hospital pharmacies have limited storage space to accommodate the increasing volumes of clinic stock. Within hospital premises, some pharmacies are so inappropriately located that they are not suitable for dispatch operations. Within the district or regional setting, some pharmacies are so far from the clinics that they serve that it is not economically viable to continue using them as clinic dispatch centres. The result has been the common place misery of our people in the villages and townships arriving at a clinic only to find that there is no treatment available.
We have therefore decided to enter into new contracts for the delivery of medicines from hospitals to clinics. The department is planning the outsourcing of the service as a total package of premises, professional support to clinics and transport. The new approach will ensure the effective management of dispatch operations and professional support to clinics and health centres. We trust that in addition to improving service delivery to our people and ending their pain, this project will create jobs.
WOMEN'S HEALTH AND GENDER ISSUES.
Gender transformation is intertwined with other transformation
issues such as HIV
AIDS, Termination of Pregnancy services,
accessibility of social services and human resources development.
All our health services are geared towards ensuring accessibility
to the majority of women and the girl child.
Programmes dealing with Women's Health are already in place and other women projects such as the prevention of Violence against Women and Children are at an advanced stage of planning. The department has also established a gender post on its structure. We will be appointing a person who will deal with issues pertaining to gender equality and women empowerment in the workplace and service delivery.
I must confess though, Mr Speaker, that women in the North West are still being held back from exercising their right to choice on termination of pregnancy. This is mainly due to resistance amongst some of our personnel.
The result is that many young and adult women in distress go to other provinces to seek help. Another result is that we still continue to pick up from the veld and pit latrines dead newborn babies whose mothers have been unable to access safe termination of pregnancy in our hospitals. This, Mr Speaker, ladies and gentlemen, remains a serious challenge of women's rights.
PRIMARY SCHOOL NUTRITION PROGRAMMES.
With regards to the Primary School Nutrition Programme, I am pleased to report to this house that the crisis is over. We have implemented measures to ensure effective management of the programme as well as timeous delivery of food in our schools. The scheme ensures a better life for more than 375 000 school children who benefit from it. It contributes to the alleviaion of hunger in our schools and helps to improve the pupils' capacity to learn.
The process of decentralising the programme, which is currently underway, will benefit the local rural economies. We are determined to move to a more decentralised approach. We will do these without compromising the effectiveness of the programme.
Our department believes that the strict specification on the type of foods to be provided favours the big companies or rich individuals. We should look at basing the feeding scheme on everyday foods. The majority of us here were brought up on ordinary foods and staples peculiar to certain communities or regions. If we opened up for basic foods that can be prepared by community-based organisations or project groups, we will be creating opportunities for the development of local economies. It is particularly women who should benefit from such a new approach to the feeding scheme.
HIV
AIDS.
President Mbeki.
Mr Speaker, honourable ladies and gentlemen, a fresh and
vigorous HIV
AIDS debate has been raging forth in our country even
drawing in scientists and activists from further afield on the
African continent and overseas. This debate was sparked off by the
act of President Mbeki's engagement with the so-called dissidents.
Very rarely have we seen such a feeding frenzy accompanied by
ideological and intellectual combat around a condition or cause of
human disease.
We must thank President Mbeki for concentrating the mind of scientists and citizens like never before. If anything, the principle and right of freedom of thought and to scientific enquiry has been re-established.
People have chosen to hear the President as saying that he
doubts if HIV causes AIDS. He did not and is not suggesting so. The
President should be read correctly as asking the question : Is it
enough to repeatedly trot out statistics about Africa and more
specifically sub-Saharan Africa being the place of the highest
prevalence of HIV
AIDS. Is it correct to do so without asking what
it is about HIV, about our environment, about our practices, system
of beliefs and material conditions that make possible the kind of
horrific statistics that dominate international discussion and
economic forecasts on HIV
AIDS.
The path of least resistance.
On the occasion of his state of the Province address this year, the Honourable Premier said : "In dealing with this pandemic we must place greater emphasis on the plight of the poorest of the poor because (as Rene Sabatier of the Panos Institute observed) once the virus has entered the community, it tends towards the path of least resistance ... ". What are the characteristics of this path of least resistance?
Is this the first epidemic or pandemic to confront humanity, Africa or Southern Africa? Are these questions new? I say no. There are numerous examples in history that shows what can happen when an unfamiliar infection attacks a population for the first time.
Bubonic plaque.
The bubonic plague pandemic, otherwise known as the Black Death of fourteen century Europe i!s the chief example, followed by the cholera epidemics of the nineteenth century. We were later to see Rinderpest invading Africa in 1891, killing up to 90% of domesticated cattle as well as antelope and other wild species.
Measles.
Measles followed hard on the heels of small pox, spreading through Mexico and Peru in 1530-31. In Europe, the first outbreak of the influenza epidemic which lasted from 1556 to 1560 killed no less than 20% of the population in England. Today, in our country, the average prevalence of HIV is 20%.
In 1959 a new human disease called O'nyong nyong fever appeared in Uganda.
India was later to be host to dengue fever. Europe, Asia, the Americas, Africa have all at some point in history been confronted by new and seemingly overwhelming disease outbreaks. Political economy of disease.
What has become very clear ver time is that the chief determinant of the outcome of humanity's battle against disease and epidemics has not been the chemical or medicinal cure. Even those diseases to which we have developed immunisation and treatment continue to unequally afflict different communities between nations and within nations. Very often, it is the political economy of diseases, the class character of risk factors and chances of survival that have determined whether a people survive cholera, measles, tuberculosis or malaria.
For a long time in this country, tuberculosis appeared to be a disease of black people. So too were Kwashiorkor and marasmus -diseases of malnutrition. Those that were in economic and political power continued to espouse the view that tuberculosis was rife among Africans and so-called coloureds because of their excessive drinking and poor hygienic habits like reckless spitting. Children were dying of malnutrition because the parents did not know how to organise the meals for ptimal nutritional benefit.
Either that or there was the backward practice of parents eating before the children were provided for. The high birth rate and prevalence of sexually transmitted infections were said to be due to the near primitive tendency to unrestrained and non-selective sexual intercourse on the part of Africans.
Clearly a racist rationale for explaining the spread of disease
For malnutrition, wall charts showing groups of foods were prescribed. The question of where the money to buy the food would come from was never addressed. The slave wages in our factories, farms, mines, kitchens and public service were never questioned. For the high birth rate and sexually transmitted infections, family planning and higher morality were prescribed.
The diseases of childhood, which often wiped out half the children of every black family, therefore making it necessary to have more than the number of children compared to communities whose children had a better chance of surviving intoadulthood, were never seriously addressed. The economic powerlessness and illiteracy of women was not addressed.
This consideration alone, should make you understand why one of the first things former President Mandela did for the children and women of our country was the introduction of free health care.
For the spread of sexually transmitted infections, the powers that be never seriously questioned or sought to end migrant labour, the economic disempowerment of women and the separation of men and women from their regular sexual partners.
My argument, honourable members, is that there has been a tendency to blame the organisms that cause disease. As a solution, we prescribe medicines. In addition, we have tended to blame victims of diseases without seriously asking why they became open to the diseases in the first place. Having answered the question, our former rulers were not trying seriously to correct the obvious answer. As often happens with dreadful diseases, accusations of poor morality and weak religious faith - the sin and punishment doctrine - added the burden of guilt to the infected and affected.
Sin and Punishment Doctrine.
If you want to understand why some diseases are becoming more and more rare among black people, you will see that it is more due to improvement in socio-economic conditions, increase in knowledge and the empowerment of women.
Mr Speaker, let us, in our battle against HIV and AIDS not repeat the mistakes of our predecessors by focusing on the virus, blaming the infected and affected and promising ourselves that victory will come with a return to morality, the discovery of a vaccine or some magic injection or tablet. That is why I support those that ask the question as to why we in Sub-Saharan Africa bear the greatest burden, why is it that the African majority, the women and the poor in our country bear the greatest burden of disease. Why is it that we in South Africa should pay a hundred times for medicines that could stop mother-to-child transmission of HIV or cure diseases that come with AIDS.
I would like to state outright, Mr Speaker, that those that tend to attribute the spread of HIV to low morality and sinful behaviour risk returning to the attitudes that prevailed during the apartheid years. Those of various religious affiliations must not find themselves in alliance with the religious right in the Congress of the United States of America who, on the basis of the sin and punishment doctrine, block grants for research into HIV and AIDS or donations to African countries meant to help in the fight against HIV and AIDS.
Christianity
They should not revert to medieval attitudes such as were recorded in the earlier writings of Christianity. Cyprian, the Bishop of Carthage wrote in the year 251 a tract celebrating the plague that was raging at the time. I qoute: "Many of us are dying in this mortality, that is many of us are being freed from the world. This mortality is the bane to the Jews and pagans and enemies of Christ; to the servants of God it is a salutary departure. As to the fact that without any discrimination in the human race the just are dying with the unjust, it is not for you to think that the destruction is a common one for both the evil and the good. The just are called to refreshment, the unjust are carried off to torture; protection is more quickly given to the faithful; punishment to the faithless ... Note the anti-semitism, the religious chauvinism and the pathetic attempt at explaining away an infection when it afflicts Christians.
Islam
Let me draw from the teachings of that other great religion, Islam. Epidemic diseases had been known in Arabia in the time of prophet Muhammad. Among the traditions that Islamic men of learning treasured, as guides to life were injunction from the prophets' own mouth about how to react to disease outbreaks.
The key sentences may be translated as follows:
"He who dies of epidemic diseases is a martyr".
And again
"It is a punishment that God inflicts on whom he wills, but He has granted a modicum of clemency with respect to Believers." I quote so extensively, Mr Speaker, to emphasise the point that we should not postpone our chances of winning the battle against HIV by repeating the mistakes of our predecessors, be they political leaders, scientists, economic giants or religious leaders. The bottom line is : Until proven otherwise, HIV causes AIDS. The spread of HIV is facilitated by human behaviour. All of us are, collectively and individually, are bound to act, even if it is for self-protection. Our actions count.
ABC.
As we propagate our correct message of Abstain, Be faithful and Condomise, let us do so without the underlying attitude being that those that will be infected will be reaping the results of the sin or weakness of inability to abstain, receiving due punishment for infidelity or suffering because they neglected to use condoms when they were freely available. Let us take care of affected families and orphaned children without visiting upon them the biblical injunction which says that the children will be punished for the sins of their fathers.
Let our declaration of our determination to fight HIV, to take care of the infected and respect their rights, not be undermined by reactionary or backward attitudes. There is no place for the co-existence of optimism of the will and pessimism or laziness of the intellect. If we think rationally, question assumptions and doctrines with courage and seek solutions without compromise, Africa will be saved.
The M-Plan.
One of the rich legacies that former President Nelson Mandela left us was the M-Plan, which proved successful in challenging the might of the apartheid regime. The M-Plan hinged on the premise that the mobilisation of people at local level was the fundamental building block and primary driver of an effective mass offensive against apartheid. If people at ground level are politically organised, they are able to mobilise more people, educate each other, and collectively resist attacks from the enemy. People at local level (from street, zone and community level) are better placed to defend and take the revolution forward.
I wish to argue that the M-Plan will constitute the most
effective strategic offensive against the scourge of HIV
AIDS. The
same motive forces of the national democratic revolution must be
mobilised to launch an offensive against HIV
AIDS. The M-Plan can
be successfully used to deal a decisive blow on HIV
AIDS. It allows
every member of the community at street and local level to play a
role in the struggle against HIV
AIDS. We must involve organs of
people's power in the fight against HIV
AIDS.
In December 1999, the national government introduced the concept
of National AIDS Council to deal with the problem of HIV
AIDS. This
process is being cascaded down to provinces. The North West
Provincial AIDS Council will be launched in September 2000. This
will be preceded by the launch of Local Aids Councils and District
Councils in May and July 2000 respectively. The fundamental
objective here is to bring all sectors of society together to share
ideas, resources and fight the war against HIV
AIDS. The
Provincial, Local and District Councils provide each and everyone
of us with an opportunity to contribute In the struggle against
HIV
AIDS.
Youth and Adolescent Reproductive Health Centres.
We have heard our young people when they say that some of our health facilities are not friendly to the youth. They encounter too many obstacles as they seek information to help them cope with their sexuality, enhance their reproductive health and protect themselves against HIV and teenage pregnancy.
The department is confronting the challenge of making
reproductive health services more accessible and more user-friendly
to the youth. The department will establish multi-purpose youth
centres in the province. This has been made possible by a
partnership involving DFID
UNFPA and Planned Parenthood Association
of South Africa (PPASA). Five new centres will be opened in the
province. The youth centres will be located in the following towns;
Klerksdorp, Vryburg, Rustenburg, Mafikeng and Moretele. All these
centres will be fully functional during the course of this
financial year.
RESPECTING THE DIGNITY OF ALL OUR PEOPLE.
For hundreds of years, millions of our people were compelled to suffer violation and denial of their fundamental rights, including the right to health care services because of the colour of their skin. Our people were condemned to live and die in the most dehumanising and unhealthy conditions.
Today, our Constitution guarantees the right of access to health care services. It states unequivocally that: "Health is a right". Our department is committed to upholding and protecting the health rights of all our people. This is the call that informs the health policy of the new government.
Racism.
The adoption of the South African Constitution represented a moment of national consensus against racism. It created an environment for a society free of racial prejudice. However, the real test lies in how South Africans live up to the visions of a rainbow nation. The challenge for all of us is to work together to ensure that these principles and laws find expression in our everyday lives.
Honesty impels us to admit that there is racism within some
health institutions and private surgeries across the province.
While Klerksdorp
Tshepong Hospital Complex remains a shining
example of racial integration, the ghost of Hendrik Verwoerd
continues to rear its ugly head in hospitals like Stella and
Ottosdal.
Klerksdorp
Tshepong Complex.
Until January 1999, the Klerksdorp and Tshepong hospitals were
still managed as two different hospitals based on the apartheid
boundaries theyserved for the past 30 years. Whilst management and
staff at Klerksdorp
Tshepong have attempted to embrace the values
of a non-racial and democratic South Africa, reports from Stella
and Ottosdal suggest that these institutions still reverberate with
testimonies of some of the most subtle, and sometimes overt forms
of racism our country has ever seen. The Klerksdorp
Tshepong
Complex is both an example and a challenge to all of us. It is a
story of successful transformation through determined and sustained
effort.
Almost a month ago, we celebrated Human Rights Day. On that occasion, the ruling party called on all South Africans to intensify the struggle against racism. For us in the North West, the complete deracialisation of all health institutions, private and public, is the most fitting tribute we can pay to the people who died in Sharpeville on 21 March 1960 in protest against racist legislation.
During the course of this year, we will be doing an audit on racism within the health sector and developing an approach to deal with the problem.
Racists have no place in the new democratic South Africa.
District surgeons.
In my Budget Speech of 1998, I reported the following to this house: "We are disappointed to report to your house, Mr Speaker, that many district surgeons have not returned our gesture of reconciliation and co-operation.
We continue to see separate consulting rooms for blacks and whites". Two years later, I return to this house to report, once again, that very little has changed. Many district surgeons still reject the values of our new society. They are using every ounce of their energy to undermine all efforts at reconciliation and the transformation of the services. Our patience has been stretched beyond the limit.
In 1999, I instructed the Head of Department to set up a Task Team whose brief was to investigate the future of district surgeons and to make recommendations. We will therefore be terminating the existing contracts of the majority of the district surgeons. Those that remain will have to do so on different terms, terms that define them as a secondary level of care for the indigent people and part of the public service. A separate group of doctors led by regional specialists will be appointed to look after our medico-legal and forensic services. This, we believe, will improve our health services, improve our human rights record and our services to the courts in cases of criminal offences like rape, drunken driving and violent crimes. Batho Pele. During the course of this year, our department will celebrate the anniversary of Batho Pele. In doing so, we will be rededicating ourselves to the principles of Batho Pele. We will be saying, once again, that we will continue to put the welfare and rights of our people first. We pledge to continue providing our communities with quality health services. During these celebrations, we will also be conducting a survey to assess the impact of this process on the lives of our people.
Batho Pele remains an important social contract between our department and the people of the North West. Do not allow any of us to forget our pledges and promises.
WITs.
In our endeavour to uphold the principles of Batho Pele, this department continues to seek ways and strategies to improve service delivery to our communities. This morning, I launched the "Work Improvement Team Strategy" which I believe is another way of giving practical meaning to the implementation of Batho Pele. This strategy ensures broad participation of employees in the improvement of work processes and systems. The basic objective of WITS is to have every member of staff - from porter to professor ask themselves the question: "What am I doing to improve the service I am providing to the public and to my colleagues?" It is accompanied by appropriate rewards, capacity-building and support systems. The work improvement team strategy has successfully improved public service delivery in countries such as Botswana and Singapore. We are confident that with this strategy, we will revolutionise the health service in the North West.
Patients Rights Charter.
When we launched the Patients' Rights Charter in November last year, we were committing ourselves to putting the rights and welfare of our patients first. The Patients' Rights Charter has added greater responsibility on health workers to ensure that the rights and dignity of our people are not violated when they come into contact with us or admitted to our health facilities. The Charter also places responsibility on patients. Our commitment to Batho Pele and the Patients' Rights Charter means that we will not, as a department, afford to have a staff member who violates patients' rights and make a mockery of our adherence to the principles of Batho Pele. We want to ensure that health workers treat our patients with care and accountability. A copy of the Charter is included in your package.
Clinical Investigation Committee (CIC)
The CIC is a mechanism to ensure quality patient care. It is a departmental investigation committee established in 1997 to investigate all complaints and reports of negligence and professional malpractice. It analyses the facts and establishes the validity and seriousness of the complaints and recommends corrective measures to the department. We intend strengthening the CIC to enable it to execute its mandate more effectively. However, it is ultimately the responsibility of patients and citizens to protect and defend their own rights. In addition to our own internal disciplinary processes, I encourage members of the public whose rights have been violated to sue us! I also encourage them to approach bodies like the Human Rights Commission and the Public Protector. In addition, I wish to appeal to legal organisations to assist our people in accessing and defending their rights. In line with the principles of accountable and transparent government, the findings and recommendations of the CIC were made public late last year.
They can be found as an insert in the Citizen's Report We are aware that the numbers provided may be misleading because of poor reporting at some institutions. This s being addressed. We want to ensure that the head of the district, hospital or health centre is made accountable for reporting incidents to the CIC. The revelations of the CIC should not detract from the good service that many of our staff continue to offer to our people. I wish to congratulate hundreds of health workers across the province who epitomise Batho Pele.
They consistently go beyond the call of duty to deliver quality health care to their fellow citizens. Their commitment, dedication and personal sacrifices continue to inspire us all. They continue to help, in their own small way, to strengthen the community's confidence in the health profession and our health institutions. It is from people like these that we draw our strength and inspiration.
DEMARCATION.
The Demarcation Board has come out with far reaching recommendations that our province needs to consider very seriously. For the North West province, four district councils are proposed (category C). Ths proposal impact on the number of health regions that currently exist. Our department has already made a policy decision to have four health regions in line with the newly demarcated districts.
The former regions of Rustenburg and Odi are now considered as one region.
For the 2000
01 financial year, the budget for the region will
be one and the region will now begin to amalgamate its structures
in line with new developments. We will be implementing this
decision this month. In the meantime, we will continue with the 18
health districts, as the redemarcation work unfolds within the
province. Ultimately, we would like to have as many health
districts as there are municipalities.
Governance structures will have to be reconstituted in line with the new municipal boundaries. We may, in the interim, have to extend their current term of office, so that when the new elections take place, they do so within the framework of the new dispensation.
Decentralisation and the National Health Service.
Mr Speaker, there is commitment on our part and an expectation by the public and our counterparts at local government that once the new municipalities are elected primary health care services will be handed over to them.
We would like to decentralise health services to municipalities without compromising the national character of our health services. Health services to our people cannot be subjected to uneven quality and standards due to the different economic strengths of municipalities and the different conditions of services of the health workers currently employed by various municipalities. We must avoid the fragmentation of our national health service. We believe that an important solution will be the creation of a single unified public service in the health sector. There should be no difference between nurses and other health workers employed by the province and municipalities. Such a situation will result in equality of care and facilitate the redeployment of stff from the province to municipalities and vice versa. It will also make it easier for us to deploy staff to places of greatest need. We hope that another important benefit is that we will no longer have nurses and other workers who do not work on weekends and at night or white staff refusing to work in the townships and villages.
COMMUNITY PARTICIPATION.
Mr Speaker, on the 13th of March 2000, we held a Summit of the Governing Bodies that were elected in terms of the North West Health and Developmental Social Welfare and Hospital Governance Institutions Act, 1997. On that occasion, we asked the representatives of the people to evaluate our performance over the past financial year. We listened to their views, complaints and proposals. We also put the proposed budget to them and they advised and recommended changes where necessary. We can therefore say with certainty that this is the people's budget. This morning at the Convention Centre, we presented the Citizen's Report to the health forum, district heath committees and hospital boards.
We will continue to forge ties with organs of civil society to accelerate service delivery. Our approach to community participation proceeds from the premise that partnerships between government and civil society are fundamental to the delivery of quality health services.
Very often, lip service is paid to community participation. Articulate government leaders and powerful lobby groups continue to dominate the policy development process, and thus marginalising the disadvantaged sections of our communities. We have thus taken the route of empowering communities in a way that will enable them to participate meaningfully in the decision-making process. Experience has shown that powerful lobby groups tend to exert disproportionate influence in the consultation process at the expense of the poor, the less literate and the marginalised. Very often the poor cannot travel as fast and as easily, write to parliament or phone the department. I am, therefore, pleased to announce that our department has decided to pay modest allowances to members of the governance structures to enable them to perform their functions.
COMMUNICATION.
A few weeks ago, we launched the department's Communication Policy. The policy is intended to strengthen our relationships with organs of civil society to accelerate service delivery. Our view is that the citizens can only play a meaningful role in governance if they are fully informed about the programmes and policies of government. An informed public is the best driver of social and political transformation. It is a sure guarantee to the consolidation of our nascent democracy.
We pledge to ensure public access to information at all times,
while at the same time respecting confidentiality of information as
well as the privacy of people in our care. We pledge to provide
stakeholders with accurate, timely, appropriate and clear
information to enable them to engage effectively with us. Media.
In this regard, Mr Speaker, I wish to thank all our friends in
both the electronic and print media. A special word of thanks to
the SABC North West for helping our department to reach our people
in the remotest part of our province, especially through the
Setswana language. For those who cannot read, radio remains the
most reliable source of information, education and entertainment.
The SABC North West has been a formidable partner in health
promotion, including our campaign to roll back the frontiers of
HIV
AIDS.
They are true to the ethos of nation-building and developmental communication.
We thank our regional papers. They have consistently carried our messages, information and advice to our communities. The following papers are worth mentioning; The Mafikeng Mail, North West Record, Lentswe, Citizen, The Mirror, Beeld, Rustenburg Herald, Brits Pos, Noordwester and others. They have published about us even when we were not involved in a scandal. Thank you fellow South Africans.
OUR PARTNERS.
Business.
Meeting the basic needs of our people is the fundamental goal of the democratic government. However, the government cannot do all these things alone. We call on all sectors of society to play their roles in helping to rebuild and develop our society. I wish to congratulate companies that have responded positively to former President Nelson Mandela's personal call for business to contribute directly towards meeting the immediate basic needs of some of our most disadvantaged communities. I will note two examples here: Amplats in Rustenburg and Alpha Cement in Litchtenburg. Their positive response will mean accessible quality health services to many people to whom this has been a mere dream. Our recent agreement with Alpha Cement will ensure the effective rendering of quality primary health care services to the employees of Alpha Cement: Dudfield and the surrounding community as well as the occupational health care services to the employees of Alpha Cement: Dudfield. The people of Ramokoka will benefit a great deal from a clinic which they built in partnership with Amplats.
Alternative service delivery methods.
Since we engaged Vuna Health Care Logistics about three months ago, we have seen the improvements we referred to earlier. On the side of catering, we have seen companies like Pitseng and Royal Foods bring savings, good nutrition, efficiency and capacity-building to our hospitals, patients and personnel. These are two examples of how outsourcing is not equal to retrenchment or marginalisation for workers. As a result of this experience, we are in support of the national cabinet's decision to investigate alternative service delivery methods. We will be looking at cleaning, gardening and landscaping as well as the removal of medical waste.
Institutions of Higher Learning
We have consistently challenged institutions of higher learning to become our partners in the process of creating a new society. We ish to thank the Wits Business School who, through the School of Public and Development Management, have been supporting our programme to develop the management cadre of our department. We thank UCT's Department of Health Economics for supporting us through the Oliver Tambo Fellowship Programme.
We also thank the University of Potchefstroom and North West for supporting our nursing education programme. Pretoria University has been supporting us through Jubilee Hospital in Hammanskraal.
MEDUNSA has in turn supported us through their Department of Family Medicine at the Brits Hospital. Recently we agreed that they will extend their support to Rustenburg Provincial Hospital. We hope to conclude our discussion with Wits Medical School for specialist support to Klerksdorp, Potchefstroom and Mafikeng Hospital.
FINANCE.
Public Finance Management Act (PFMA)
The 99
2000 financial year was very challenging as we were
beginning to introduce the process of decentralising cash flow
management to cost centre level. In-service training had to be
fast-tracked to ensure that managers are sufficiently skilled on
cash-flow management. We have created cost centres in the
hospitals to enable managers of each of these sections to control
and manage their own budgets. We have delegated the powers to
managers to control their own finances more efficiently. We are
implementing improved financial information systems to assist this
process. At the same time we are embarking on continuous training
of departmental state accountants. The Public Finance Management
Act, therefore, arrives in a department that started three years
ago to prepare for this eventuality.
Revenue.
Another key objective is to improve revenue collection at facility level.
The department has established a new component on its establishment to focus on collection of revenue. An additional Assistant Director responsible for revenue collection will e appinted soon.
We still believe that some of the money collected by the institutions within our department must be retained at the collecting facility. The money could be used to improve the surroundings or as special awards for productivity and initiatives that save the department money while improving the quality of care.
HUMAN RESOURCES.
Affirmative Action.
Our commitment to Affirmative Action is unwavering. Guided by the Employment Equity Act, we will continue to empower historically disadvantaged sectors of our community to take their rightful places within the public service. I can proclaim, with confidence and pride, that in terms of race and gender, ours is one of the most representative department in the country. However, we still fall short on the representation of people with disabilities. We are determined to correct this weakness. One of the measures that we will be taking is to specify our preference for disabled persons when we advertise jobs or select people for employment. From serving a minority to serving all South Africans requires, amongst other things, the upgrading of skills and a paradigm shift to accommodate the broadened mandate. The tendency within the privileged classes to regard affirmative as reverse discrimination is disturbing.
Community service doctors.
I extend a warm hand of welcome to community service doctors, dentists and pharmacists who will be joining us soon. The dentists will start on the 1st of July this year, while the pharmacists will arrive at the beginning of next year. We are looking forward to working with you. Rest assured that you will emerge as good dentists and pharmacists, with the gratitude of our people and the knowledge that you have made a difference in their lives. What you will give up in sacrifice and community service, you will receive back shaken together, pressed down and overflowing. Dr Masudubele.
I wish to take this opportunity to congratulate young doctor who came to the North West to do community service and decided to stay beyond the compulsory one year. Twenty-eight years ago, his mother, pregnant with him, went into labour. From the township of Tlhabologong next to Coligny, she started a perilous and humiliating journey on the back of a van. The ambulance service did not easily carry black patients. She could not go to the Coligny Hospital which is on her doorstep because it was reserved for whites. She could not be admitted to the General de la Rey Hospital in Litchtenburg because it was reserved for whites. Past these two hospitals, she had to drive on to Thusong Hospital because it was for blacks, especially Batswana who were under the Bophuthatswana Territorial Authority.
After this journey of more than 60 kilometers which must have felt like a thousand miles for her, she delivered a young boy by caesarian section. She named him David. The young man went on to become a medical doctor, completing his studies in 1998. David is now a medical officer in Thusong Hospital. He started his community service at the same hospital in 1998. When his peers were lured to work in our cities, he chose to stay behind and help in the reconstruction and development of his own community. He chose to give back to Thusong what it gave to him - his life! Dr Masudubele has also recruited his wife, a dentist, to Thusong. I am certain that Dr Masudubele is motivated by the love of his people and the knowledge that for many African women, the experience that his mother went through continues to repeat itself in one way or another. We wish to thank them for their commitment to our community and the people they serve. He is a true hero.
THE ROAD AHEAD.
Our achievements and areas of weakness are there for all to see. Only our worst detractor will deny that we have made significant achievements in the last financial year. But to say we have achieved all that was to be achieved would be an exercise in self-deception. As the old adage goes, the biggest room is the room for improvement.
We have laid a firm foundation for the acceleration of service delivery. We believe that we can achieve health for all of our people. With your support and the support of our people, I believe that we will soar as high as eagles, run and never tire, stumble and get up to continue the quest for the dignity of our people through health.
TRIBUTES.
Before I conclude, Mr Speaker, I wish to pay tribute to the following people and organisations for their contribution to our successes.
Rev Dladla.
It was in this month a year ago, when Reverend Nyembezi Dladla passed away after a tragic accident. His image will, without doubt, remain indelible in the memories of those whose lives he touched. He lived a life of care and concern for others. He gave our people a lifetime of love and affection and leaves with memories all of us will always hold dear. He left behind a rich legacy of botho. His wisdom and glorious example continues to inspire us all.
Dr Manyaapelo.
The thugs that terrorise our towns and villages robbed us of one of the most distinguished community builders, Dr Bobby Manyaapelo. A disturbing trend across the country is that health professionals are increasingly becoming targets of senseless criminals. Only last year, Professor Sam Mokgokong, the only black neuro-surgeon in the country almost lost his life at the hands of armed teenagers. We think of Drs Luvhuno and Mkhari who were recently buried. In partnership with our government, let us reclaim our streets from criminals and social outcasts. Let us continue addressing the health needs of the poorest of the poor. This is the best tribute we can pay to Dr Manyaapelo and his colleagues.
Ms Ntoane.
During the course of the last financial year, we parted ways with the Head of the Department, Ms Manong Ntoane. I thank her for having helped to steer this huge ship during the transition period with remarkable vision and courage. Many of her former colleagues will agree that we survived those turbulent waters, mainly because of her decisive and devoted leadership. I wish her success in her new position. Our Staff. I wish to thank each and every member of staff for their individual contributions in helping us to successfully execute our mandate of delivery quality health care to our people. Many of them have managed, often under very trying circumstances, to save lives and restore the health of our people. They are the unsung heroes and heroines of our success story. I want each and every member of staff to know that we value their contribution to the success of this department, no matter how humble their role.
United Nations and national overseas Development Agencies.
Our thanks go to the various funding agencies that have made it possible for us to bring a better life to our people. In particular, we thank, the World Health Organisation, Department for International Development, TransAID, United Nations Family Planning Agency and the United Nations Programme on AIDS. We also thank all academic institutions that have forged links with us. Our sincere gratitude also go to the Japanese government for donating much needed medical equipment to the Mafikeng General Hospital.
NGOs.
We appreciate the support we continue to receive from organisations like Health Systems Trust, Center for Health Policy (Wits University), the National Progressive Primary Health Care Network and many others.
My family.
To Kgomotso, my wife, and the children. You remain a refuge, a source of strength and a bedrock of support that make possible my humble contribution to the task of delivering a better life to our people.
I thank you