Issued By: Department of Health, Gauteng Provincial Government
22 February 2002
Honourable Speaker
Honourable Premier
Honourable Deputy Speaker
Colleagues on the Executive Council
Honourable members
Distinguished guests
Fellow citizens
In debating and reflecting on the speech of 5 days ago we should remember that the critical question the Premier posed was :-
'whether we are succeeding in our efforts to build a democratic and united nation and to uplift the quality of life of all our people'
Democracy , nationhood , ability to meet basic needs and a quality life for all are what many of our people died for and many live for. These aspirations for a life where there is respect for human dignity, peace and prosperity are very dear to hearts of the young and old, of the black and white, of the men and women as well as of the rich and the poor. These are the aspirations of the people of our province, the citizens of our country, the people of our continent, Africa and peoples of the world over. These are the aspirations of Humanity against which we as a government elected by people have to judge ourselves against, together with them.
The challenges we inherited and had to deal with in the second term of this democratic dispensation were immense. We have been able to building on the foundation laid in the first term of our just, humane newfound nationhood with the help of the millions of our workers, employers, volunteers, experts and professionals in various fields as well as communities and families themselves. Unions, non-governmental organisations, community based organisations, faith based institutions, institutions of higher learning and various private companies all have a share in the progress we have been able to register half way out term.
Led by the Premier, honourable Speaker, together we fought for change and a better life for all
It is through these partnerships that the back of poverty, criminality, illiteracy, preventable diseases can be broken. It through this partnership that we can accelerate the attainment of a better quality life for all our children and our future.
Our courage to care for one another, our commitment to stand side by side and our determination to succeed have secured a better today and guarantee for continued peace, prosperity and progressive realisation of our common aspirations.
Comrade Speaker, as the social services departments we are working together to provide care and support for our people and have set standards for improving the quality of the services we render. The priority areas for an integrated response six namely: -
Our primary service to the children of the province is to keep them healthy from in-utero (conception), during delivery and after their birth. Because of the importance of the early stages of brain development conception through six years of age will remain our focus areas. The antenatal services focuses both on the health of the mother and her unborn baby.
I look forward to a time when we can also have capacity to include fathers at this early stage because both the mother and the baby need his support throughout pregnancy and the child's life. I learn other fathers to be also develop hormonal changes, with breast and abdominal enlargement as bonding takes place.
As indicated by our Premier, the Expanded Programme on immunisation has markedly reduced the risk of children suffering from and dying from vaccine preventable conditions. A total of 138 408 children under one year are fully immunized. This excludes those that were partially immunized against one or the other disease. Immunization coverage for children under one year is around 79%, with R17 million budgeted for vaccines only. With the dedication of our health workers and communities as I and MEC Mashatile witnessed in Alexandra we will reach the national target of set at 80%. The renewed Alex will indeed be a township where children come first.
Only 4 laboratories confirmed cases of measles have been reported for the year 2001. The last polio case in South Africa was in 1992 and active surveillance of acute flaccid paralysis is functioning well as reflected by the province exceeding its surveillance target for 2001. There have been no indigenous cases of neonatal tetanus (caused mainly by the infected umbilical wound due to unhygienic conditions) for the past 3 years in Gauteng.
The Primary School Nutrition Programme and Crèche Feeding Scheme are two of the targeted supplementary feeding strategies aimed at the nutritionally vulnerable. They are aimed primarily at alleviating short-term hunger by providing a snack or a meal to our most vulnerable children to improve the active learning capacity of children. The programme will be maintained. In addition, our teachers will be trained to identify needy children that will be added to the programme on an ongoing basis. Together with the MEC Jacobs we look forward to greater involvement of the school governing body and parents to support the teachers. As part of the Health month in April the department will be involved in promoting food gardens at homes and schools, in addition to the Zivuseni poverty alleviation program to be launched at the Chris Hani-Baragwanath Hospital as announced by MEC Mosunkutu.
Whilst there is evidence that we are winning the war against crime and criminality we remain committed to doing away with secondary victimizations that, in particular women and children face, as survivors of violence and abuse. Teachers are trained to identify and support children that are abused whilst medical, psychological, social, police and justice services have been made more accessible at the one stop Victim Friendly Service Centres throughout the province.
We are succeeding in our mission to build a caring ethos in the public service focused around the need of the clients and beyond the silos of individual departments. To date 26 centres are operational in the province with at least one in each health sub-district and magisterial district. In addition all the community health centres (large clinics) and hospitals offer the service.
We require a strong and determined movement for social moral regeneration and an effective medico-legal justice system to even more decisively prevent and deter terrorism meted against women, children and babies in our their own homes and hometowns, we equally need to ensure that the survivors are fully rehabilitation so that they can regain and develop optimal social and economic productivity. It is in this context, Premier that your announcement of the work that we will enhance in preventing transmission of HIV to rape survivors will be done in the absence of scientific guidelines. The National Department of Health is also providing support in engaging the appropriate scientific expertise.
Batho ba tla Pele - Se ke motheo wa nnete o o ka se weng wa Tswelopele le Thlabologo ya setshaba le matshaba.
Worldwide is it recognised that health is at the centre of economic development, and that investments in health pay dividends in terms of poverty reduction. Amidst numerous challenges and an ever-accelerating rate of change, we can demonstrate progress and achievements in numerous areas. The bulk of our services are aimed at improving the quality of life of the poor in Gauteng.
The focus of the Department of Health will remain on improving the quality of care, building the confidence of the public in our public health system, strengthening primary health care, emergency medical care and re-vitalisation of hospital services.
Quality of care
In the Gauteng Department of Health, quality initiatives started about four years ago, and was influenced by national initiatives such as the white paper on the transformation of the health sector, the Batho Pele campaign, as well as the Gauteng Provincial Government's initiatives on improving front-line services delivery. The initiative in the health department was given renewed impetus with the second term of government's strategic priorities, the recommendations of the Commission of Inquiry in Hospital Care practices and the new legislative framework.
The initiatives of the Gauteng Department of Health can be divided into the following broad categories:
An enabling environment for quality care:
· The Patients Charter and Service Pledge · Setting standards as a formal process for quality improvement · Accreditation of health care facilities · Strengthening management systems
Building the capacity for quality
· Khanyisa Service Excellence Awards · Training and capacity building
Significant strides have been made in our quest to improve the quality of care. A standard complaints system investigates and responds to complaints: information on patient rights is prominently displayed at all hospitals and clinics. Hospital Boards have been appointed in all acute hospitals to oversee hospital management and to provide community input into service delivery. We have just reviewed the effectiveness of this board and this year we will see more interaction with the public around the promotion and enforcement of the patient's rights charter. Community Health committees will also be strengthened in this regard with respect to clinics.
The Accreditation Committee, established in October 2000, completed its first year of work by covering more than a third of our hospitals. The initial report indicates the need to focus more on the customer aspects of care, such as waiting times, clean ablution facilities for patients, help desks, signage to key areas of hospitals. The Department has already started to act on the recommendations of the Committee. Each of the four central hospitals i.e. Chris Hani-Baragwanath Johannesburg, Pretoria Academic, and Ga-Rankuwa will have a director for clinical services appointed. These hospitals will also have dedicated queue managers i.e. clinically trained staff that will ensure that patients are sorted and that emergency cases are attended to in the shortest space of time. Patient liaison officers are also being appointed to help any patient, particularly frail old people or people unable to read English to find their way in our large hospitals. Planning for the upgrading of ablution facilities has started, and work will commence in the new financial year. Special efforts have been made to get nametags for all staff members. Our annual Khanyisa Service Excellence awards continue and demonstrate the many examples of innovation, creativity and excellence that is available in our public health system.
As a further indication of our commitment to improve services, the Gauteng Health Department has employed 500 new graduates into our services since the beginning of January this year to-date. Most of these new employees are from the nursing profession. This was in addition to stabilising management of institutions and filling a number of key posts across the Department.
Primary health care
The District Health Services in Gauteng provide access to a comprehensive range of services, which include preventive, promotive, curative and rehabilitative health services through 486 clinics and community health centres. The total number of attendances has increased from 4.1 million in 1997 to 9.6 million in 2000/2001 and there was an 11.6% increase in PHC attendances from 1999/2000 to 2000/2001. Apart from offering care for minor illnesses, the clinics undertake extensive management of chronic conditions (1.48 million visits in 2000/01), antenatal care (412 000 visits) and 16 674 babies were born in the primary care facilities. The primary care clinics managed a total of 320 000 consultations for the treatment of sexually transmitted diseases.
Maternal, Women and Reproductive Health
Cancer of the cervix is the most common form of gynecological cancer in South African women. It is estimated that 1 in 41 women will develop cancer of the cervix in their lifetime. Population based screening programmes (using PAP Smears) are known to significantly decrease the incidence of cancer of the cervix. The province has implemented a cervical screening project in all its districts and is offering 3 PAP smears at 10-year intervals to all women between the ages of 30 to 60 years. This will reduce the number of women developing cancer of the cervix and also reduce the morbidity and mortality associated with cervical cancer. An amount of R8-million was budgeted for in this financial year.
Tuberculosis
Significant progress has been made in the Tuberculosis Control since the implementation of the new National TB Control Programme in 1996, despite the increase of new TB cases each year. (24 863 TB cases were registered during 2000). Extensive training has been done to ensure that a TB-trained nurse is available at each health facility. Good collaboration with the National Health Laboratory Services (NHLS) has ensured rapid diagnosis. Dedicated TB Coordinators are in place at sub-district, district and provincial levels. All sub-districts have implemented the DOTS strategy and are functional Demonstration and Training Districts (DTD). This has lead to a 2% increase in the cure rate of infectious TB patients to 67%. The overall cure rate of all TB patients has also improved by 8% (to 60%).
HIV/AIDS
Increased openness on AIDS and initiatives with a range of community groups provided the space for people to come to terms with the reality and respond. A social movement on AIDS is emerging. The World AIDS Day campaign in 2001 illustrates the scale of the mobilisation on AIDS in Gauteng Province. Nine thousand people, including 7000 trained volunteers visited over 400 000 homes and provided education to well over a million people in the most needy parts of the Province.
It is also reflected in a rapid expansion of Home-based care projects. The number of projects have increased from 36 in the year 2000 to 57 in the year 2001, with a corresponding increase in funding from R3.6 million to just over R8 million. Predictably, the AIDS reality has increased people's efforts on prevention. Mothers and grandmothers are taking initiatives to protect their children. Our clinics and hospitals are well placed to provide care for people infected by HIV.
The programme on the prevention of mother-to-child transmission is part of our overall strategy for improving maternal and child health services. Within the National framework we are especially committed to making sure that our basic services are strengthened-that antenatal clinics provide better care to all women; that child health clinics can better help all children.
The programme should also be seen as part of our overall AIDS strategy. The provincial strategy will continue to address three main areas of programme activity, i.e.
As announced by the Premier we will increase the number of sites for the prevention of mother to child HIV transmission programme in Gauteng to cover all hospitals, ensuring that 80% of them are covered within 100 days. This means that the number of hospitals in the program during this period will increase from 10 to 18 in this period. We thank all health professionals and support staff as well as the academic institutions and NGO for holding our hand in this important program.
Within the next financial year all public hospitals and our large community health centres will provide the programme. The enormous task of adequately monitoring the mothers and babies for the period of at least two years is a challenge that we all have to meet. Learning also from the TB program if this support and monitoring is not adequate the expected benefits may not be realised. This support has to extend also to those mothers whose babies will still remain positive even after the intervention. During and beyond the six months period, the emphasis will also be on strengthening the district health system and primary level care (taking into account our capacity to provide support), by including those clinics that provide antenatal care and that refer to the hospitals in the programme; so as to avoid an unnecessary load on hospitals.
It is important to note the programme requires the following:
1. Training of professional and lay counsellors in the new service, 2. Ensuring the infrastructure requirements to provide the services and to ensure confidentiality of counselling, 3. The need to monitor and support mothers and their babies before and for 24 months after delivery. 4. Ensuring that the network is put in place to deal with support systems, given the stigma surrounding the disease, the fear of knowing the status and of disclosing this to partners, families and friends
Already, more than 40% of public hospitals in the Province are covered. We must not lose sight of the fact that out of any 100 HIV positive mothers about 30 babies will be HIV positive without any anti-retroviral treatment.
With Nevirapine, 15 to 20 babies will still be HIV positive. This is because the programme lowers transmission by 30% to 50% and not completely. It is important for mothers to know that there is still that chance that their babies may be HIV positive.
Mothers and babies are monitored and supported throughout the program. This means that the programme is not a panacea, it is part of an overall comprehensive strategy that deals with prevention, care and organisational support.
In terms of process, there is already a provincial steering committee and advisory group on the programme, who review pilot implementation on an ongoing basis and have provided input into planning and will assist with implementation support.
A meeting has been called with the relevant hospital and clinic managers and the existing structures to inform them of the expansion and to plan the exact dates when each site will start operating.
We are in the process of planning a special communication campaign to increase the uptake at the existing sites, and this will provide material for other sites. We will also run a special training programme for existing and new managers on support and supervision to the programme.
The steps followed at the other sites include attention to the following aspects:
We will advertise additional nursing posts to strengthen both existing programmes and those that are planned. The exact numbers will be determined, but between 50 and 100 nurse will be employed over the next 3-6 months. We will use counsellors from existing programmes and NGO's that we fund, and where necessary, additional counsellors will be appointed. Support and monitoring capacity will also be enhanced both at the provincial and regional levels.
Emergency Medical Services
With regards to emergency medical services, the Department dealt with more than 300 000 incidents during the past year. Almost a third of these were due to injuries. The management of major disasters shows the commitment and strength of our emergency services. Incidents such as the Ellis Park disaster, the roof collapse of the Kollonade show the professional competence of our emergency services staff. The anthrax scares; a total of 86, involved a major effort on the part of our emergency services. These incidents were all investigated in accordance with accepted international practice. Twenty-four new ambulances have been purchased, and almost half of these have already been delivered.
Revitalization of hospital services
The 28 provincial hospitals run a total of 16 020 approved beds, of which 2 587 are in specialised hospitals for psychiatric care, rehabilitation or infectious diseases. Collectively, these hospitals admitted about 643 377 patients in 2000/2001 and delivered 116 505 babies. An additional 4.1 million outpatient visits were made to these institutions of which approximately 945 000 visits were for emergency care (casualty visits).
The improvement in the management of our hospitals and clinics has been identified as a major priority to ensure value for money. There have been major improvements in financial management of hospitals. Last year all hospitals collected in excess of R100-million, exceeding the set target by R 30-million. Most of the R30 million was given back to institutions that exceeded their target. Indications are that Health will again exceed the target for revenue generated during this financial year. It is foreseen that the revenue of the Department will increase substantially when the proposed shared debt management centre is implemented. Tenders for the establishment of such a centre have already closed and a recommendation will be made shortly.
Management Delegations
All managers received delegated powers for finance and human resources in September last year. Together with supporting manuals and guidelines, these will enable health service managers to achieve the required level of internal control, efficiency and effectiveness in financial management in accordance with the PFMA and the Public Service and Treasury Regulations. The responses to the delegations have exceeded all expectations, and the initiative is already bearing results.
Financial Management Capacity
Dedicated funds from both provincial and national Treasury are being used for inter alia the following:
Decentralisation of minor works functions
Minor Works functions were decentralized to the regions and all hospitals at the beginning of the year. Each institution received a dedicated budget, list of functions that could be performed and the expenditure ceiling within procurement regulations. This has made a major difference, and has improved management efficiency. The turn around time has been reduced for minor repairs (e.g. broken windows, locks, leaking taps, etc).
Establishment of Facility Management Units at Hospitals
Facility Management Units (FMUs) have been established at all hospitals to manage the maintenance and repair of the hospital and clinic buildings and are being given the basic skills to assess maintenance and repair needs and identify quality control factors in repair work. These units are able to estimate costs of repairs and maintenance, and make informed decisions on the best requirements for their particular institution.
The expertise, made up of a wide-range of skills, will ensure value-for-money and be able to maintain standards of Capital projects at institutions. The activities of these FMUs will enable a significant improvement in the status of the buildings and promote a general advancement in the management of facilities and grounds. They will be able to identify early warning signs, which indicate possible maintenance problems.
The future development of these Units aims at building capacity, which will allow them to manage all facilities and grounds and undertake the planning of facility needs at their institutions.
A condition-based assessment has been completed for all hospitals in Gauteng, which evaluates each building in terms of status, together with cost estimates for repair work to be undertaken as a baseline from which to work.
Capital Projects
The budget allocation to the Department, the Infrastructure Grant from Treasury and a grant from National Health for Hospital Rehabilitation and Reconstruction have enabled the Department of Health to upgrade and improve a number of institutions.
Examples of the work that was completed during the year include:
Transformation and HRD
The department is making great strides in gender equality. Already 60% of top managers at the Head Office and regions are women. An Employment Equity Team as been established in line with the requirements of the Employment Equity Act, involving all stakeholders. Appropriate training for this Team has been undertaken, so that they are able to function effectively. A report in accordance with the Act has been submitted to the Department of Labour.
Many people have benefited from training initiatives undertaken by the department. For the first time in 2001, a dedicated course on the management of the HIV/AIDS epidemic for executive managers was conducted in the Department of Health. A separate course was conducted for is the CEOs of hospitals.
A large number of Management and Finance courses were undertaken during the year, which included general management, project management, training regarding the new delegations, patient billing systems and computer training.
Some of the healthcare training undertaken focused on quality management, pharmacy management, training of Pharmacist's Assistants and HIV/ AIDS workplace training.
For Enquiries Contact:
Popo Maja at (011) 355 3841 / 082 373 1169