Modern, Growing, Successful Province

The Budget Vote Speech 2010/11 of the Department of Health

Presented by MEC Mxolisi Sokatsha, in the Northern Cape Provincial Legislature, Kimberley

May 6th 2010

Mister Speaker and honourable members of the House, allow me to commence my address by reminding the House that the democracy we enjoy did not come on its own. It was a long journey via the Dolorosa of agony, and some made the ultimate sacrifice with their lives. A failure, on our part, to treasure and defend this democracy, would be a declaration that we do not deserve the future we helped to build.

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Mhlali-ngaphambili, ngubani na onokukhanyela ukuba uphuhliso olwenzeke kule minyakana idlulileyo, lungunobangela wemibhiyozo nemincili? Mazidlobe zidlokove iintlinziyo ngenxa yeminyaka yenkululeko, neminyaka yentatho-nxaxheba kawonke-wonke. Masigcadiye, sigcolote sizive ubuntu kwilizwe loobawo mkhulu. Nomhlaba uyamemelela, uyabulela, uyadomboza nemiphefumlo iyandondoza. Ngazwinyesithi. "Nkosi sikelela I-Afrika. Siyavuma sithi, "Camagu-ilizwe lelethu nomhlaba ngowethu".

Mister Speaker in the health sector, too, the past years saw history-making developments, ranging from putting new and relevant legislation in place, and an institutional framework capable of putting the health system of South Africa on a growth path, while restoring the dignity of our people, by upholding the philosophy of “Health Care for All”.

We, as the Department of Health, take pride at being party to the creation of a new culture in the health care arena in SA - that of Social Dialogue, anchored on reaching consensus among the social partners, on the implementation of the National Health Insurance.

Geagte Speaker, as ons terug kyk na die afgelope jaar, en ons berei ons voor vir die komende jare, kan ons nie anders as om geinspireer te wees deur die wyse waarop ons voorouers gestand gebly het, deur die krag van kennis, om vir almal ‘n toekoms te bou, wat ons vandag ervaar en gebaseer is op die verlede, wat hulle daardie tyd deur gemaak het.

Imbongi yesizwe jikelele, uESK Mqhayi, uthi:

“Phindela phesheya nto kaDube!
Phindela phesheya Mafukuzela!
Nkamel’ethwal’iinzingo zeAfrika;
Ithwal’iingxakeko neembandezelo zayo,
Ikhe yathwal’ezinye yaziphumeza,
Yathwal’ezinye, ezinye, kwanezinye;
Thole lenkunzi yaseMpumalanga,
Bath’ukuyibiza nguMafukuzela.

Phindela phesheya mfo wakwa Senzangakhona;
Ndibev’apha isimbonono;
Bathi, “Kwathi kwathi Afrika mayibuye,”

Mqhayi dedicated this poem to Dr John Langalibalele Dube, the first President of the African National Congress (ANC), one of those who remained optimistic that, beyond the dark days of colonial oppression, there is better life for South Africans. It is on the shoulders of the giants of the calibre of Mafukuzela, Solomon Tshekisho Plaatje and others, that today, we are able to say that we are a free people. We owe it to their memory that we, too, make our contribution in this era of a knowledge society.

Mister Speaker, never before had knowledge been as indispensable as it is today. Allow me to look back at the year that just ended, and share with this House some of the exciting moments we experienced and challenges we encountered.

In search of knowledge, from those who do not source it from books and websites, I undertook a campaign to establish ministerial advisory bodies in the form of provincial and district health councils, hospital boards and clinic committees, and visited health facilities, where I met the most amazing people of our Province who, through our programmes, saw their quality of life improved. This has proved to be a great source of information on how the government services impact on the lives of the people. I am pleased to say that, today, some of those people we are working together with, in some of the health improvement projects we sponsor, have honoured this day by their presence here.

I must be upfront, Mister Speaker, and take this opportunity to thank all the health stakeholders and communities for their contribution and dedication towards addressing the challenges facing us today.

Allow me to mention a few of these:

It is important to point out that, arising from these stakeholder deliberations, a common understanding has emerged in critical areas affecting the health sector. Firstly, the broader context underpinning our legislative framework including the objectives of our policies and their redistributive role in better health outcomes towards improved health profile of our people in the province.

Secondly, Mister Speaker, we have begun dealing with the institutional and operational weaknesses, identified in our discussions with our key stakeholders. One of the first areas that we dealt with related to the information gaps that existed at the time. We consequently commissioned research, looking at various aspects of the functioning of our health facilities. One of these studies looked at the overall efficiency and efficacy of facility management. For the first time, we now have objective data that confirms our long held suspicion that, our patients are not safe, cleanliness leaves a lot to be desired, poor quality of care, dilapidated infrastructure and capacity of our facilities to deliver quality health care, resulting to medico-legal litigations.

In view of this, we have to closely examine the role and functions of our management, in a manner that would enhance service delivery towards improved health outcomes.

Mister Speaker, I am honoured to present, to this august House, the Northern Cape Department of Health’s Budget for 2010/11 for consideration.

Honourable Members, we shall focus in our speech on what the Department of Health has achieved in strengthening health service delivery. We shall also highlight what we intend to achieve in this financial year.

Healthcare Effectiveness

In keeping with the philosophy of the healthcare effectiveness approach, it is with great pleasure that I report back to this House that access to health care services has increased over the last year. A total of more than 3,7 million patients used our health facilities in 2009/10.

This has been achieved through health policies that prioritized the poor and the marginalized, and which included:

  • Massive expansion of health infrastructure, for the delivery of Primary Care Services, through the building and upgrading of more than eight(8) facilities and eighteen(18) sites accredited as ARV sites,
  • Increase in the number of health facilities from two-hundred and twenty-eight (228) to three-hundred and four (304). However, a new set of challenges is born to upgrade the facilities, poor road conditions and inadequate staffing, as a result of the cross- boundary developments, and
  • Increase in the number of health professionals employed in the public health sector, including training of mid-level workers, in a range of health disciplines.

To some extent the budget for the public health sector has increased, to meet the increased healthcare needs and expansion of the public health sector. In 2008/09 the total provincial budget for the Department was R1.8 billion, and it increased to R2.6 billion in 2009/10. Of course, this increase does not take into account the full effect of inflation and cost escalation.

Disturbing incidents, in a few facilities, have created a false impression that we are not doing enough to address issues of maternal- and child health. I wish to state, categorically, that the Department is fully committed to improving the health status of women, mothers and children of our country, and to achieving the Millennium Development Goals (MDGs). Let me provide some information to demonstrate this assertion.

Child Health

We have strengthened various health programmes to improve service delivery. In 2009/10, we fully immunized 93.2% of children under the age of one year, to protect them against vaccine-preventable diseases.

The number of children that have been confirmed by laboratory tests to have had measles, in Northern Cape, increased from 0 in 2008 to only 69 in 2009 and we have had no deaths from measles in the last two years. However, imported cases remain a major threat to the progress we have made in this area.

Building on the success of our immunization programme, we implemented a new immunization programme in the public health sector, two additional vaccines (pneumococcal conjugate and rotavirus vaccines) which had a significant impact in reducing cases of diarrhoea and pneumonia and related deaths. These vaccines do not replace the continued need for safe water and proper sanitation.

We also provided Vitamin A supplementation to 70% of children, aged 6-12 months, as well as to children aged 1 yr – 6yrs, who were seen at public health facilities, and 77.2% of post-partum mothers. We are aiming to achieve 90% coverage amongst the latter as well. Vitamin A supplementation helps to prevent untimely deaths, blindness and illness, especially from measles and diarrhoea.

Whilst the provision of micro- and macro nutrition supplementation is important, it is more important to ensure food security for poor households in particular, and of course proper preparation of such food. This is especially important at this time of rising food prices – which disproportionately affects the poor, especially women and children.

About two-hundred and three (203) of our health workers have been trained in advanced midwifery, maternal health and basic ante-natal care, to reduce maternal mortality. We have also revised our guidelines on treatment of children, in the prevention of mother-to-child transmission, by moving from mono- to dual therapy. In addition, we up-scaled monitoring of maternal- & peri-natal mortalities, through our quarterly reviews. Lastly, we rolled out the child-health campaigns in all district, in September 2009, where 70% of children were reached.

Maternal Health

With regard to improving maternal health, we implemented the new guidelines on Prevention of Mother-to-Child transmission, by the training of professional nurses.

To further strengthen our ability to meet the MDGs, we have established Specialist Committees, to look into issues of maternal mortality; peri-natal mortality and mortality of children under the age of five (5) years. The brief of these committees is to conduct investigations into each death, and to advise me on measures that we need to take at all levels of the health system, to prevent avoidable deaths.

The SA Demographic Health Survey, conducted in 2008/09, states that our maternal mortality rate was at 274 per 100,000 live births, and we had an infant mortality rate of 14 per 1 000 and under-five mortality rate of 16 per 1 000. This survey is conducted every five years and we are, therefore, conducting another one this year, to update our data on the progress being made on various health indicators, including maternal and child mortality. The outcomes of this survey are independently verified by the Medical Research Council. We are convinced that our province and country is on track to meeting MDGs 4, 5 and 6.

We also commissioned a provincial burden of disease survey, to describe the pattern and distribution of diseases, disabilities and injuries seen in the public and private health facilities, as well as the risk factors associated with these. The Report will be completed during this financial year and will provide reliable estimates of the provincial burden of disease.

Communicable Diseases

Over the past decade and a half, HIV and AIDS became a major challenge to the gains that we were making through the primary healthcare approach. I am therefore delighted to report to this House that through our collective efforts we have begun to reverse this trend.

The estimated HIV prevalence rate among pregnant women has decreased significantly since 2005. On a year-to-year comparison, the provincial HIV prevalence rate among pregnant women decreased from 16.5% in 2007 to 16.2% in 2008. The observed trends in the last three years suggest stabilization but trends in the epidemic should be observed over a period of time in order to avoid incorrect conclusions and perceptions.

During his watershed announcement on World AIDS Day, December 1st, 2009, the Honourable President Jacob Zuma made the following announcement.

Our message is simple:

  • We have to stop the spread of HIV;
  • We must reduce the rate of new infections;
  • Prevention is our most powerful weapon against the epidemic;
  • All South Africans should take steps to ensure that they do not become infected, that they do not infect others, and that they know their status.”

As the Northern Cape Department of Health, we planned our response to this message through a mass HIV Counselling and Testing (HCT) programme, a Campaign which was launched on the 30th of April 2010, by the Honourable Premier, Hazel Jenkins. This campaign is intended to make our communities aware of the effects of HIV and stigma coupled with it. Build-up programmes started during the STI and Condom week, which took place between 8 - 12 February 2010 towards the recent launch.

Despite the fact that the Northern Cape HIV prevalence rate was the second lowest in the country, syphilis prevalence remains the highest in the country. The provincial syphilis prevalence has increased from 5.4% in 2007 to 6.8% in 2008. This increase brings to a halt the progress made in the years, 2005 – 2007, on which significant decline in trends was noted.

During 2008/09, we distributed 3.6 million female and three-hundred and nine (309) million male condoms. More than 90% of public health facilities provide voluntary counseling and testing (VCT) and the prevention of mother to child transmission (PMTCT) services with a recorded uptake of 60%.

By the end of March 2010, we had cumulatively initiated more than nineteen thousand six-hundred and sixty-five (19665) patients on anti-retroviral treatment, in more than eighteen (18) accredited sites, across the five (5) districts.

We shall continue to implement all the components of both our National- and Provincial Strategic Plans on HIV & AIDS, measured through following interventions:-

  • Decrease in HIV infection rate from 16.5% to 16.2% (Oct 2008/09);
  • Launch of the Provincial AIDS Council on the 17th of November 2009 by the Honourable Premier, Hazel Jenkins;
  • Increased the distribution male condoms from 2 million to 3.8 million;
  • 5556 new clients on ARV treatment (total 19665);
  • 92 additional Home-based Care Givers (total 1378);
  • Stipends for caregivers have been increased from R1 000 pm to R1 500 pm, as well as a thirteenth cheque offered.


Honourable Members, this budget speech coincided with last day of TB Indaba, intended to assess our TB case load and remedial measures, towards a TB-free Northern Cape.

The advent of multi-drug resistant tuberculosis (MDR-TB) and extremely drug-resistant TB (XDR–TB), in 2006, posed a particular challenge to public health in our country and Province.

The number of TB, MDR and XDR TB in the Province is on the rise. The number of new TB cases increased from 6127 in 2004, to 8192 in 2008. This marks an increase in the TB incidence rate from 552 per 100 000 population to 738 per 100 000 population.

However, we are already seeing signs of success, through steady improvement, in the cure rate (62.3%) in 2008, with defaulter rate of 5.9% (2008) compared to defaulter rate of 13% (2007), due to the implementation of tracer project in both the Pixley ka Seme and Frances Baard districts.

More than 80% TB defaulters have been traced, through the TB tracer project, and resumed TB treatment. Successes in the reduction of the TB case load could be ascribed to the following measures;

  • 118 Health professionals trained on TB management;
  • 92 Health professionals training on Drug Resistant TB;
  • Provincial Clinical Review Committee established;
  • 2 Medical officers appointed at West End Hospital and Gordonia Hospital DR-TB units; and
  • TB Directorate established.

The MDR-TB prevalence study will be conducted during the 2010/2011 financial year.

Non-Communicable Diseases

Non-communicable diseases such as cancers, diabetes, hypertension and cardio-vascular diseases are increasingly posing a significant threat to the health of our people. These are also known as the ‘silent killers’, since members of society are often unaware of them.

My Department has spearheaded a number of healthy-lifestyle activities to reduce the burden of disease from non-communicable diseases. Apart from a healthy diet and the avoidance of risky behaviour, one way to keep healthy is to participate in physical activity. To assist Honourable Members to increase your level of physical activity, we challenge every member of this House to measure the distance you walk every day and to increase this distance weekly.

Just yesterday we had a number of healthy-lifestyle activities, as part of the preparations for the Department’s budget vote. The activities included health screenings and physical activity which also catered for our senior citizens as part of our commitment to improve their health as well.

Hospital Services

The successful delivery of primary care services requires support from a network of hospitals. We have constructed three (3) new hospitals since the inception of the Hospital Revitalization Programme.

The new refurbished Paediatric Intensive Care Unit was officially opened in January 2010, with state-of-the-art equipment, and was done in partnership with BHP Billiton and Carte Blanche, to the value of R5 million. This is a critical investment for our child-health services at the Kimberley Hospital Complex.

The kitchen at Kimberley Hospital Complex was upgraded in collaboration with the new service provider to the amount of R3, 7 million.

This will ensure that food services at the hospital comply with the highest standards and meet the needs of the patient’s dietary requirements. An upgraded plated-system for serving of all meals has been introduced as from the 1st July 2009, which will cost an additional R5 million per annum.

The kitchen at West End Hospital has been fully operational since 1st July 2009. The total cost of upgrading and recurring catering services was R22, 2 million per annum. Linen to the value of R2.5 million was procured to address theatre and other essential linen needs. These will address service delivery concerns and offer equal quality of service as in any private hospital.

The Clinical Resource Centre at Kimberley Hospital was refurbished in collaboration with Management Sciences for Health (MSH), a sub-division of USAIDS. The purpose of the Clinical Resource Centre is to provide all staff of the Department of Health with access to information, in order to enhance patient care. The unit is equipped with ten (10) computers connected to the Internet, textbooks and electronic journals, for research purposes.

In addition, Kimberley Hospital is also implementing a system that will allow laboratory results to be retrieved directly from the National Health Laboratory Services to the service point. This will result in saving money from duplicate tests being done. Laboratory results of patients transferred from institutions within the Province will also be accessed on the system.

Previously the Department had announced that it will be upgrading the lifts at Kimberley Hospital. Today I would like to announce that all lifts have been installed. This will ensure that the movement of patients to the ICU Unit will be speedy, and response to patient needs will be quicker.

Forensic Pathology

Honourable Speaker, the Forensic Pathology section of the Department of Health had an ongoing project to upgrade the mortuaries and we are proud to announce that four(4) mortuaries are completed and will be officially opened during this coming financial year namely:- Keimoes, Kakamas, Pofadder and Postmansburg. Through this endeavor we believe that we will be able to provide a dignified service to our communities.

During the past year we had fourteen (14) more in addition to the forty-six(46) practitioners from across the Criminal Justice Cluster involved in training of the integrated approach to the examination, treatment and support of survivors of sexual assault and gender based violence. These professions play an invaluable role in the empowerment of victims as well as preparation of such survivors for the subsequent criminal trials.

Infrastructure Projects

The overall improvement of the Department, based on the current turn-around strategy is intended to show commitment to improving access to health care services.

Construction of the new Gordonia Hospital in Upington is in progress. This facility is targeted for completion by end of 2011. It is a state of the art facility with a cost estimate of R836 million.

Four (4) other clinics were completed during 2008/09 financial year.

Construction of the following clinics has commenced, namely, Norvalspont, Groot Mier, Mapoteng, Boitshoko and Riemvasmaak. The constructions are targeted for completion during August/September 2010. These clinics are inclusive of the staff accommodation. We have completed the construction of a new clinic at Hondeklipbaai.

Our focus is not only on improving the infrastructure, but also the quality of service delivery at these facilities, as well as the availability of necessary equipment. In this regard, the Department of Health has established a set of core national standards, reflecting the degree of excellence we wish to attain in delivering acceptable and quality health services.

These standards cover a broad range of performance areas. For instance with respect to safety, we will look at safe handling (and storage) of medicines, patient safety systems and infection prevention and control.

Medicine Regulation

All our pharmacies have being upgraded to comply with the requirements of the Pharmacy Council, as some were operating on the basis of a temporary license. The establishment of secondary depots in the districts is at advanced planning stages.

Refrigerated vehicles will be acquired for the pharmaceuticals within the current medium term; this will improve stock availability in health facilities, and ensure cool storage during the transportation of drugs.

Human Resources for Health

Honourable Members, our human resources are our most important asset in the delivery of health services. It is therefore essential that we continue to create conducive and productive working environments for them.

The Department has translated all doctors, pharmacists, dentists and emergency medical services (EMS) personnel to the OSD provisions, and is currently busy with an audit, for the second phase, which relates to the number of years’ experience accumulated. The number of translations is three-hundred and eleven (311) doctors, forty seven (47) pharmacists, thirty two (32) pharmacy assistants and twenty three (23) dentists.

The current establishment is being aligned to the new OSD post structure and the Department has compiled the service records of the Medical Officers on the MMS and SMS packages.

Translations of five-hundred and twenty-one (521) EMS personnel have been finalised. A Provincial Task Team was established and funding for all these categories was provided during the adjustment budget of 2009.

The Department is busy with the costing for the implementation of the Arbitration Award for the OSD for nurses. This is part of our continued quest to ensure that we create quality jobs in the health sector, and make it attractive to young people to enter these essential professions.

Mister Speaker, our initial vacancy rate of 41% has been reduced to 39%, with a target of further 25% reduction in 2010-2011.

We have made two strategic appointments in the executive management level in the form of Chief Directors for Corporate Services and Hospitals, Emergency Medical Services & Hospital Revitalization, to strengthen both strategic and operational management.

Over the next three (3) years, the Department will spend R195 million on the training and development of health professionals, which includes bursaries for matriculants, unemployed youth and serving employees.

This investment will ensure that the quest for the production of appropriately qualified health professionals and workers is realized.

Honourable members, our skills development strategy is yielding results, as ten (10) students on the Cuban Medicine programme will be returning in July 2010, to South African universities, to conclude their final year of study. Twenty seven (27) students are still studying in Cuba.

Furthermore, fifty- one (51) qualified students are doing community service on Nursing and Radiography while ten (10) are on Internship, doing Clinical Psychology and MBCHB. We are also in the process of absorbing eighty-four (84) nursing assistants and sixty-seven (67) staff nurses.

Our Data Capturers Internship Programme has produced thirty-nine (39) successful students and twenty-two (22) Basic Pharmacy Assistant Learnership graduates. All these students will be absorbed into the Department at the completion of their studies, as contractually agreed upon by both parties. In total we have three hundred and fifty-five (355) students studying in the Medical and Allied Sciences.

Mister Speaker, gradually, step by step, we are realising our dream of providing health to all our people, where they live, as our statistics and records signal another achievement, by the end of this financial year, whereby sixty-three (63) learners would have completed their Nursing Diploma.

Already thirty-eight (38) learners have commenced with their Community Service on the 1st of January 2010, and other twenty-five (25) commenced on the 1st of April 2010.

Honourable Speaker, the Henrietta Stockdale Nursing College has been able to turn itself around, from the period of despair which it had been catapulted into, and is now firmly poised to better serve its historical purpose. I am proud to announce that the Nursing Council for the College has lifted the moratorium on training of a new cohort of nursing students and, as a result, sixty (60) students will be recruited in June 2010, aimed at addressing the health training needs and challenges in our Province.

The Nursing College is already putting in place systems and plans for a new intake of the sixty (60) students for the four-year course, within the current financial year, after a long struggle for accreditation with the Nursing Council.

Improvement of financial management

The Department has appointed a Chief Financial Officer, Director: Supply Chain Management, two Directors: Financial & Accounting and Deputy Director: Budget Management.

All district offices have been capacitated through the establishment of fully fledged financial- and supply-chain units. These appointments will ensure that there is a significant improvement in key areas in financial management and accountability, so as to ensure smooth financial delegations to districts and facilities.

During this financial year, the Department will continue to work with Provincial Treasury, the DPSA and organised labour, to prepare proposals on occupational specific dispensation for other categories of health professionals. We will also continue to employ support staff like cleaners, porters and administration clerks, as they play an important role in the functioning of the health system.

We shall also continue with our efforts to recruit health workers across the breath and length of our country, and beyond our shores.

We reported to this House last year that we were going to initiate a clinical associate programme, as part of our interventions to address the challenge of shortage of health professionals, in our Province.

I am pleased to announce that, eighty-four (84) Data Capturers, of whom thirty-nine (39) are of the 2008/09 in-take, were absorbed in the Department; one-thousand four-hundred (1400) Home-Based Care Givers/DOTS supporters and eighteen (18) Pharmacy Assistants who graduated in January this year, and a few of the students and graduates are in the public gallery, and I wish to acknowledge their presence. “Congratulations on being the pioneer group for this programme, and I understand you have done very well…. Keep up the good work”.

Health Financing & Delivery

The National Health Act of 2003 envisages a truly integrated National Health System, consisting of both the public- and private health sectors. This cannot be achieved while there are such gross inequities between these two sectors.

Towards end of May 2010, we have committed to host a Health Indaba, where stakeholders and interested parties will equally participate in discussing our health-care provision. The intention of this Health Indaba is to further assess the progress we have made in the delivery of health care, and explore service delivery mechanisms in our Province, through a broader stakeholder consultative engagement. Even whilst we take steps to ensure equitable share between both public- and the private health sector, we are also proceeding with the process of designing a national health insurance system.

Emergency Medical Services

We are also making good progress in ensuring that our health services are able to provide adequate support to the 2010 FIFA Soccer World Cup. Our emergency services are being strengthened through procurement of twenty-five (25) replacement ambulances, six (6) responsive/rescue vehicles and one (1) command and control vehicle.

Our total fleet stands at one-hundred and eighty-five (185) vehicles, whilst we require two-hundred and forty (240) vehicles for a highly effective and efficient emergency medical service.

In addition, we provided our five-hundred and sixty-nine (569) EMS personnel with necessary tools and equipment, in order to save lives at the point of contact, coupled with training of emergency care technicians.

Ladies and gentlemen, all these measures are intended to provide efficient services to meet the medical needs of both local communities and our visitors, the Uruguay team, as well.

Health Priorities for 2010/11

Given that health needs will always outstrip available resources, the health sector has identified key priorities for each planning cycle.

For the financial year 20010/11, we have agreed on the following key priorities:

  1. Provision of strategic leadership and creation of social compact for better health outcomes;
  2. Implementation of national health insurance plan;
  3. Improve quality of health services;
  4. Improved human resource management;
  5. Overhaul the health-care system and improve its management;
  6. Revitalization of physical infrastructure;
  7. Accelerated implementation of the HIV & AIDS plan and reduction of mortality due to TB and associated diseases;
  8. Mass mobilization for better health for the population;
  9. Review drug policy;
  10. Research and development.

The details are contained in the Annual Performance Health Plan, as well as the Strategic Plan of the Department of Health, which have already been made available to Members.

In order to ensure that the Department improves on health services, in line with the ten (10) point plan, the following key activities will be undertaken during the 2010/11 financial period:

1. Improve health outcomes, through strategic leadership, in health management:

A number of interventions will be undertaken by the Department, to ensure that health outcomes are properly managed. The Department will establish eight (8) functional hospital boards and establish five (5) district health councils, in the 2010/11 financial period. These will also be strengthened by the production of five (5) district health plans, by March of each financial period, which will detail what the Department intends doing in each district, over the MTEF period.

2. Improving the quality of Health Service, with particular emphasis on the 18 Health district project:

Moshaweng, under the John Taolo Gaetsewe District, is one of the 18 districts that have been identified to receive increased support in improving maternal, neo-natal, child and women's health and nutrition, at all levels of the health care system. The Department will ensure that 50% of hospitals have quality improvement plans.

3. Overhauling the health care system and improving its management:

The Department will ensure that the Health care system is properly managed, by appointing twelve (12) hospital managers who are trained in leadership, health management and governance. All districts will produce district health expenditure reports, to give an indication of how the public funds have been spent, and also guide the Department as to how much resources are needed, per district. In addition to this, the Department will appoint twelve (12) health area managers, across the Province.

Lastly, the department has committed to further train addition (10) students on the Cuban Medicine programme during June/July 2010,

4. Accelerated implementation of the HIV & AIDS strategic plan and the increased focus on TB and other communicable diseases:

A notable increase will be seen in the provision of Anti Retroviral Treatment, as the Department enrols 6 000 new HIV & AIDS patients on the ART programme.

This will be done in line with the Presidential mandate, for accelerated HIV & AIDS programmes. This announcement came in line with the key goals of the National Strategic Plan (NSP) for HIV & AIDS 2007 – 2011, which are:

  • To reduce the number of new infections (especially among young people in the 15-24 age group).
  • To reduce the impact of HIV & AIDS on individuals, families, communities, and society.

The Department also plans to improve the HIV testing rate (excluding ante-natal) to 98%.

In trying to improve the health status of people living with HIV & AIDS, the percentage of accredited ART service points, with nutritional services, will increase to 100%.

The management of Sexually Transmitted Infections (STI`s) will be improved by training more Health Care Professionals in the Syndromic Management of STI’s, and to increase the distribution of female condoms to at least forty-five thousand (45 000). There are new guidelines that make for extended criteria for ART initiation for HIV positive, pregnant women, co-infected patients with a CD4 count of less than 350mm3, and HIV positive children under the age of one (1) year irrespective, of their clinical status.

Lastly, the department has put a target of 2880 per year for male circumcision within the male population group aged between 15 -49 years.


Tuberculosis is a major cause of illness and death, worldwide. Thus the Department is planning to improve the cure rate of new positive patients, at first attempt, to 68% and improve the cure rate of new MDR cases, at first attempt, to 15%. Furthermore, the TB interruption rate will be improved from 5.9% to 5.4%. The default tracer project will be rolled out in all districts, thus improving the defaulter rate by 0.5%. As part of the Department’s intervention, in prevention and treatment of TB, the Department will improve TB infection control strategies and strengthen involvement of stakeholders. In addition, the West End Hospital DR-TB unit will be refurbished, and an additional forty (40) bed facility will be opened, to address the inadequate bed capacity for MDR- and XDR-TB infection control, security and patient recreation.

Maternal, infant and child mortality

Various interventions will be implemented to reduce maternal, infant and child mortality, including the roll out cervical cancer screening. With regard to maternal mortality continuous training will be provided to capacitate sixty (60) midwives on Maternal Health and train sixty (60) professional nurses on Midwifery. In addition to this, 300 health care workers will be trained on PMTCT.

To address infant mortality, 100% of new born babies and 90% Ante-natal Care clients will receive AZT; this will be extended to 100% over the MTEF period.

Tertiary Hospital Services

Kimberley Hospital is currently offering some tertiary services, even though it is not a Tertiary Hospital. To strengthen this, an amount of R225, 948 million has been allocated to further improve on the current services and also to introduce new services. It is, therefore, the aim of the Department to introduce Hip & Knee Replacement Surgery, in the 2010/11 financial year, and to introduce Radiation Oncology and Cardiology over the MTEF, in Kimberley Hospital.

Infrastructure Projects

Due to issues pertaining to maintenance of health facilities across the Province, it is clear that, going forward, the Department will need to implement clear strategies, to improve infrastructure and equipment in particular.

It will accelerate the infrastructure improvement programmes, by commencing with the construction of the following projects, under the 2010/11 financial period.

For the year 2010/2011 we have also taken into account the need to factor in the Presidential Development Nodes in our appropriated budget for the revitalization of health infrastructure.

In response to rural development and increased access to health services, the Department has prioritized construction of new clinics at both Ga-Mopedi and Deorham communities, in the John Taolo Gaetsewe District, in this financial year. Secondly, Tshwaragano Hospital will be refurbished to address the poor structural conditions experienced at the hospital. In addition, our gratitude goes to the Department of Roads and Public Works for local labourers appointed, through the Extended Public Works Programme at the Tshwaragano Hospital, in an attempt to keep the facility clean, as required for infection control.

Upgrading of the casualty at Galeshewe Day Hospital will start in August 2010.

The new Mental Health Hospital is not yet complete. The implementing agent, the Department of Roads and Public Works, terminated the contract and the matter is with the Court of law. The Department of Health is awaiting a decision from the implementing agent as to when the construction works will resume.

Honourable Members, we completed the construction of, and officially opened the, Pampierstad clinic at a cost of R6 million, the Hartswater clinic at a cost of R6 million and the Olifantshoek clinic also at a cost of R6 million. The new Hondeklipbaai clinic with a fully-fledged pharmacy will be opened in May 2010. Construction of a new Community Health Centre will commence at Williston during the 2010/11 financial year.

These are all projects that were announced last year, and these activities respond to the question of what it is we are doing, to revitalize primary health care facilities.

For the year 2010/2011 we have also taken into account the need to factor in the Presidential Development Nodes, in our appropriated budget, for the revitalization of health infrastructure.

To this end, we will construct a new Community Health Centre (CHC) in Williston, at an estimated cost of R24 million, which is scheduled to commence in October 2010, and another R1 million, for the upgrading of the current Williston CHC, which will commence in August 2010.

The Tshwaragano Hospital will be refurbished to address the poor structural conditions experienced at the hospital, at a cost of R4 million.

The following clinics are being constructed in the 2010/11 financial year Norvalspont, Groot Mier, Mapoteng, Boitshoko and Riemvasmaak. Construction at these facilities, which will include staff accommodation will be completed during September/October 2010 and the estimated budget for each facility is R6 million.

Ladies and gentlemen, the Honourable Premier Ms Hazel Jenkins has already announced that the construction of the new Gordonia Hospital, in Upington, is progressing well. This facility has reached thirty-six (36) percent completion and is targeted to be completed during the 2011/12 financial year. It is a state-of-the-art facility, with a cost estimate of R836 million.

The Construction of the new De Aar Hospital with an estimated cost of R343 million is now scheduled to commence in this financial year. A new business case, for the construction of Postmasburg Hospital, has been submitted to the National Department of Health, for approval.

Lastly, access roads to most facilities remains a huge challenge as a consequence access roads will be rehabilitated at the following facilities namely Richmond, Warrenton, Douglas and Kakamas.

Strengthening Management

Improving health service delivery also requires appropriate management of the health system. The organizational structure of the Department of Health will expand, with the appointment of a permanent Head of Department, District Health Chief Director, District Directors and more middle management members, to place specific and dedicated focus on key priority areas of our work.

We will also strengthen our financial management systems to ensure that the Department receives unqualified audit reports going forward. I am aware of the poor financial performance and I intend working with the districts to strengthen financial management, where this is necessary, in line with the provisions of the Public Finance Management Act (PFMA).

R2.6 billion has been made available, for the operations of the Department, for 20010/11. In addition, a number of conditional grants are provided for and these funds are transferred to the Province, by the national Department of Health, for their disbursement.

Ladies and gentlemen, this is the budget of the Department of Health, for the 2010/11 financial period:

Programme: Administration – R106, 621 000

Programme: District Health Services – R1,194 888 000

Programme: Emergency Medical Services – R148 239 000

Programme: Provincial Hospital Services – R617 986 000

Programme: Health Sciences & Training – R74 028 000

Programme: Health Care Support Services – R28 825 000

Programme: Health Facilities Services – R486 714 000

Total Budget: R2 657 301 000

In addition, grant allocations have been increased significantly as outlined below:

  • The Hospital Revitalization Conditional Grant increases by R80 million to R420, 218 million;
  • The Health Professions Training and Development Conditional Grant increases by R3 million to R61, 802 million;
  • The Infrastructure Conditional Grant decreases by R18, 816 million to R66, 496 million; due to the fact that, during 2009/10 financial period, the grant allocation included an amount of R12,7 million, which was suspended under the 2008/09 financial period, and reimbursed under 2009/10 financial period;
  • The Forensic Pathology Services Conditional Grant decreases by R8, 425 million to R22, 868 million, as a result of the additional allocation of R11, 106 million, which had been received under the 2009/10 adjustment budget;
  • The HIV & AIDS Conditional Grant increases by R68,603 million to R182,306 million, while the National Tertiary Services Grant increases by R52,707 million to R225,948 million.

Mister Speaker, significant achievements have been recorded over the past year, guided by the primary healthcare philosophy.

Our priorities and budget, for the 2010/11 financial period, reflect our unwavering commitment to improving health service delivery to all the people of our Province.

As we enter this financial year, I commit the Department of Health and myself, to do everything possible to ensure that we complete those activities, which we have set out to achieve, during 2010/2011 financial year.


I would like to thank all who make our advances possible - the Acting Deputy Director-General, Dr Dion Theys, his hard working, committed and competent team of officials, Ministerial Advisory Statutory Bodies (Provincial and District Health Councils, Hospital Boards and Clinic Committees) that provide much needed advice and, in particular, wish to pay tribute to the Chairperson of the Portfolio Committee on Health, Mr Kagisho Molusi, and members of the Portfolio Committee on Health - all of whom play a unique and critical role in enabling us, not only to dream a new health order, but to also contribute towards manufacturing a new reality for our Department. This is why we do say, without equivocation, that "Asijiki, siyaphambili"

Kuninzi esikwenzileyo. Kusekuninzi nekusafuneka sikwenzile. Indlela isende ngaphambili. Kufuneka sizise utshintsho nenguqu kwiindawo abantu abahlala kuzo. Indima eselisiyihambile iyabonakala, abo banamehlo okubona, bayabona.

Let us all choose a healthy lifestyle.

I thank you.

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