Honourable Speaker, Hon Newrene Klaaste;
Deputy Speaker, Hon. Mangaliso Matika;
Honourable Premier, Dr. Zamani Saul;
Chief Whip of the Majority Party, Hon. Norman Shushu;
Leader of the Opposition, Hon. McGluwa;
Members of the Executive Council;
Members of the Provincial Legislature;
Our distinguished guests and media houses present;
Ladies and gentlemen;
Madam Speaker, allow me to take this opportunity to present to you, the Northern Cape Department of Health Budget Vote 10 for the financial year 2024/25 to this august House.
The total departmental budget for the current financial year is R6.4 billion. This is a slight increase of 5,2 percent from R6,1 billion reported in the previous financial year. However, current inflation stands at 5.1 percent which in real terms translates to a nominal increase of 0.1 percent. The budget is appropriated as follows across different departmental programs:
Programme 1: Administration: R 264 977 Million
Programme 2: District Health Services: R2 941 329 Billion
Programme 3: Emergency Medical Services: R 448 052 Million
Programme 4: Provincial Hospital Services: R 522 479 Million
Programme 5: Central Hospital Services: R1 290 986 Billion
Programme 6: Health Science and Training: R 345 377 Million
Programme 7: Health Care Support Services: R 143 938 Million
Programme 8: Health Facilities Management: R 484 995 million
We are a labour intensive department with a total headcount of 6559 personnel with an addition of 2485 abnormal appointments included in this categories are community health care workers, sessional appointments etc. Consequently 58.1 percent of the appropriated budget is spent on compensation of employees.
It is imperative to note that the public health budget accounts for 87 percent of the total uninsured population in the province, which poses a huge burden on public health care services. This is further exacerbated by the un-budgeted claims that arises from medico-legal cases, which is currently sitting at R1,6 billion. The practical implication of this is that the department should fund this within their existing appropriated budget. This matter is receiving our collective attention as a sector.
Madam Speaker, last week I had an honour of attending a National Health retreat convened by the Honourable Minister of Health, Dr Aaron Motsoaledi. The retreat was attended by all MEC’s of Health, HOD’s, and key Senior Management personnel in the public and the academia from different institutions of higher learning.
Among others, one of the significant focus was on the importance of the six (6) building blocks for health care system and the impact that they have in promoting an efficient health care system, towards building a sustainable health care. It is against this backdrop that today I want us to be reminded of these building blocks as the six basic pillars of rebuilding the public health care system, as outlined by the World Health Organisation.
These are:
1. Leadership and governance
2. Access to essential medicines and other Commodities
3. Health workforce (Human Resources)
4. Health systems financing
5. Health information systems
6. Health service delivery
As part of strengthening leadership and governance, the department is going through a transitional phase, that includes among others, establishment of fully capacitated and integrated District Health Management Offices. The aim is to progressively achieve a decentralized health system over the current Medium Term Expenditure Framework (MTEF) period as part of the culture shift within the department. In addition, to improve efficiency, promote accountability and turnaround times in areas of strategic procurement and human resources for health. Madam Speaker, the signing of the National Health Insurance Bill into law by His Excellency, President Ramaphosa on the 15 May 2024 necessitates a fundamental shift in our traditional approach to the organisation and delivery of public and private health care services in the Country.
As we welcome and celebrate this noteworthy milestone towards Universal Health Coverage through NHI as a single funding source and moving towards creating an equitable health care system for both private and public health, especially in a province such as the Northern Cape with only 13 percent of the population having variable access to private health care services.Madam Speaker, the NHI remains our roadmap towards transforming the health care service platform. Allow me, therefore, to give you progress on the commitment that I presented to this august House in the 2023/24 budget address on rolling out the Contracting Units for Primary Health Care, now referred to as the Proof of Concept.Phokwane local municipality is our “Proof of Concept.” The project plan has been agreed to with National Department of Health and there is progressive implementation of this programme of action. This milestone will be used as a barometer in guiding the implementation of NHI in the province as per the envisaged transitional arrangements as stipulated in Section 57 of the NHI Act.Madam Speaker, as part of health care reforms, the department is developing a Provincial Health Bill that will provide a framework for structured health system, taking into account the obligations imposed by the Constitution, the Health Act, the National Health Insurance Act, and other laws with regard to health care services. The finalisation of the bill will be concluded by the end of the 2025/26 financial year.
Secondly, we are finalising the regulation on the licensing of private health care establishments across the Province, as part of expanding access to health care services. The process will play a critical role in providing a platform for the collaboration between the private and public sector, as we gravitate towards the implementation of the NHI.
Madam Speaker, let me also highlight that the National Department of Health through National Health Council took a resolution to have the norms and standards for licencing of private hospitals to bring a standardised approach for the country. Amongst other important mandatory structures is the establishment of the Health Advisory Committee within the office of the MEC for health, whose role is to provide expert advice on clinical governance policy reforms to the Member of Executive Council. The Advisory Committee, whose establishment will be prioritized in this financial year, it will serve an instrumental role in assisting the executing authority to discharge his mandatory responsibilities, as enshrined in the National Health Act.Madam Speaker, in line with the broad Vision of the Province, which is to build a modern, growing and successful Northern Cape, the modernisation of healthcare services will continue to be an area of major focus. It is against this background that National Department of Health is continuously engaging provinces to have a universal patient records management system for the country. The process will go a long way in assisting with the medical records and reduce our exposure on medico-legal claims.Madam Speaker, in strengthening health care systems and the acceleration of service delivery, Primary Health Care remains a critical approach in the delivery of health care services.To this effect, it is important to note that though we are pursuing this approach, it does not diminish the important curative role that our hospitals continue to play, which is in complimentary to the ideal preventative healthcare approach. Especially given our high burden of diseases.Madam Speaker, as we are dealing with the quadruple burden of diseases, which has overtime been led by HIV/AIDS and TB as the top contributors to the mortality in the country. HIV/AIDS prevalence rate for Northern Cape is sitting at 10 percent according to the District Health Information System, and remains the second lowest in the Country.The mitigating strategies to reduce the prevalence and morbidity rate is to accelerate testing, initiation and maintaining patient on treatment, which is normally referred to HIV Cascade program (95-95-95).
- The first 95 refers to patients who have been tested and knows their status.
- The second target refers to patient who knows their status and initiated on treatment.
- The last 95 refers to patients with a low viral load. (CD4 count)
As part of the targets outlined, the Province is standing at 93-76-88.
Madam Speaker, whilst the TB infections remains relatively low in the Province, Frances Baard District remains the District with the highest TB incidences in the Province. Similarly, the Department is experiencing challenges with regards to the drug resistant TB defaulter rate. Key strategies, which includes among others; case finding through advocacy and contact tracing are actively taking place at community level. The community health care workers play a pivotal role in realising this strategy.
Madam Speaker, we have also noticed a concerning trend in the rise of non-communicable diseases, among others; - Hypertension, Diabetes, Cancer and Mental Health. Added to this, is the high incidence of trauma arising from accidents and assault, which places a huge burden on the healthcare system.
- On Diabetes screening among 18-44 years: A total of three hundred and thirty-two thousand five hundred and four (332 504) clients were screened for Diabetes during the 2023/’24 financial years, against two hundred and sixty-eight thousand four hundred and three (268 403) in the 2022/23 financial year, translating to 23.8 percent increase.
- Hypertension screening among 18-44 years: A total number of four hundred and sixty-eight thousand five hundred and thirty-five (468 535) clients were also screened for hypertension during the same period, against three hundred ninety-two thousand eight hundred and thirteen (392 813) clients translating to 19 percent increase.
Madam Speaker, we are still noticing a steady surge of Maternal Mortality despite our previous gains. As a province, we stand at 115/100 000 cases against the provincial target of 110/100 000. The main causes of maternal deaths are HIV related, hypertension, obstetric haemorrhage, non-pregnancy related deaths and post-partum haemorrhage. In responding to this challenge, the department will procure additional five (5) obstetric ambulances.Madam Speaker, as part of decanting facilities to reduce the volume of patients visiting our health care facilities to improve the quality of patient care and patient experience of care, the department continues to pursue the Central Chronic Medication Dispensing and Distribution (CCMDD). Currently, we have eighty-six thousand (86 000) patients registered on this programme, of which twenty-four thousand four hundred and sixty-two (24 462) are active.In an effort to improve access to healthcare services in the far flung areas that are hard to reach and service, the department has procured 5 mobile clinics that will be given to the five districts they will be commissioned in the last quarter of this year. This will assist in curbing patients having to travel far distances to access basic health care services.To effectively reposition the district health service delivery platform more facilities will this year extend operating hours to render services in high patient volume catchment areas. Some of the facilities includes Kagisho Community Health Centre in Gasegonyana municipality that will be assisted to fully operate for 24 hours, whilst Dr Torres, Betty Gaetsewe and City Clinics in Sol-Plaatje municipality will also be given similar support to extend their operational hours from 8 to 12 hours in line with their service demands.This follows the successes learned from Galeshewe Day hospital which now operates on a 24-hour basis. We take this opportunity to encourage members of the community to make full use of the available services, which will relieve the pressure often experienced by Robert Mangaliso Sobukwe hospital. Madam Speaker, the Human Papilloma Virus (HPV) Vaccine campaign targeting the Grade 5, 9 years and older learners in public and special schools achieved 99 percent success rate. This achievement mitigates the development of cervical cancer among this cohort of learners and should be seen as future financial cost saving.
Madam Speaker, a remarkable success story has quietly unfolded over the last five years, impacting the lives of hundreds of cancer patients in the Northern Cape.
The collaboration between the Northern Cape Department of Health, through the Robert Mangaliso Sobukwe Hospital and Icon Oncology, with the shared goal of delivering the best possible care for patients needing radiotherapy services. The results of this partnership is a true example of how government and the private sector can work together when there is a shared focus and vision.Madam Speaker, since the implementation of this collaboration in October 2019, a total of 511 cancer patients in the Northern Cape have completed radiation treatment at Robert Mangaliso Sobukwe hospital. This collaboration with Medico-Med will see a total of 2 160 surgical cases performed in the 2024/25 financial year. We can report that since the start of this financial year, a total of 908 surgical operations were performed. The plan is to reduce the waiting times with much emphasis on orthopaedic cases.Our main focus for this financial year is to reduce surgical backlogs across all disciplines. To this effect, we will operationalise all our district hospital theatres through the outreach programmes spearheaded by Robert Mangaliso Sobukwe hospital specialists and with the support of our Emergency Medical Service team. These theatres have been revitalised and resourced.This intervention forms part of the broad strategy to decongest Robert Mangaliso Sobukwe Hospital to ensure that it operates according to its mandate as a specialised training institution.Madam Speaker, Investment in health care education is one of the critical pillars in strengthening health care service delivery. The MOU signed with University of Johannesburg permits the mentorship of the EMS College (CEMC) to function as a Higher Education institution in collaboration with the University of Johannesburg (UJ) to offer the Higher Certificate in Emergency Care program (NQF level 5).Madam Speaker, in the latter part of the 2023/2024 financial year, the department procured a total of 59 additional ambulances to reinforce the current fleet which ranges between 80 and 90 ambulances operating daily in the Province. In an attempt to boost the current fleet, the department is procuring additional 38 Emergency Medical Services vehicles, comprising of 30 Ambulances and 8 Patient Transports.It must be noted that our province is vast, therefore, our vehicles reach high mileages due to long distances travelling from the outer parts of the province, hence it is important to gradually increase the number of operational vehicles.Madam Speaker, health infrastructure is one of the enablers of delivering quality health care services. I am proud to announce that we have commissioned Seven (7) capital infrastructure projects, namely; Nursing College Accommodation (Phase 1), Refurbishment of the Robert Mangaliso Sobukwe hospital Kitchen, Refurbishment of Rooiwal and Raaswater Clinics, Completion of Bankhara Bodulong Clinic, Boegoeberg Clinic, and Kuruman Forensic Mortuary. This calls for more investment to be made towards the maintenance of these facilities, including the staffing thereof. In this regard, we will be working closely with National Department of Health and Provincial Treasury.
Madam Speaker, I have taken note that over the past years Mental Health has been one of the topical issue in the health arena, and as a province we have not been spared by this scourge. As a strategy to enhance mental healthcare services in the province given the geographical landscape, we will be appointing a second Mental Health Review Board to largely focus on the ZF Mgcawu and Namakwa Districts.Furthermore, there is an intervention team from National department of health to assist the in building clinical governance for mental health care services in the Province.Madam Speaker, given the current fiscal constraints and the current budget deficit it is important to recognise the role that our private donors are playing towards strengthening the delivery of health services in the province. These spin offs play a fundamental role in cushioning our budget allocation, especially health care infrastructure and programme implementation.In conclusion, Madam Speaker, allow me to thank the Honourable Premier, Dr Zamani Saul, my colleagues in the Provincial Executive Council, the Portfolio Committee on Health for their continued support, guidance and leadership as we transition towards NHI, against all vested interests.Let me take this opportunity to also thank the acting Head of Department, Mr. Mxolisi Mlatha and Executive Management Team, the entire staff establishment of the Department and the Ministry team for their continued resilience and commitment to ensure that the vision of “A modern health system delivering quality care to a growing Province” is realised.This is the time for us to work together in unison, to ensure that we realize the desired public value. Together we can do more in pursuit of a ‘’better life for all’’
I thank you.
