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Vote 07 and Vote 12 Budget Speech Delivered by the MEC for Health and Social Development Hounarable Seaparo Sekoati for the Financial Year 1st April 2006 to 31st March 2007Honourable Speaker and Deputy Speaker
In 1994 the African National Congress adopted a National Health Plan for South Africa. This plan was prepared with the technical support of World Health Organization and UNICEF. The plan asserts every person’s right to health. “Every person has the right to achieve optional health, and the ANC is committed to the promotion of health, using the Primary Health Care Approach as the underlying philosophy for restructuring the health system. Primary health care will form an integral part both of the country’s health system, and of the overall social and economic development of the community. The role of the community in the planning provision, control and monitoring of services remain central to the PHC approach. Democratically elected representatives will play a major role in the structure of the health services.” Honourable Speaker HEALTH PRIMARY HEALTH CARE In its efforts towards realizing these goals government adopted the Clinic Building and Upgrading Programme which continues to inform the provision of clinics and health centres to our people. The building and upgrading of 33 clinics is nearing completion and the building of a new health centre in Steiloop will start in earnest this year. An additional 20 clinics (14 upgrades and 5 new) and the 1st phase of a health centre at the decommissioned H. C. Boshoff hospital will also be built with R117 million allocated for this project. During the 2005/06 financial year 39 clinics were provided with a dedicated water supply and an additional 43 clinics will be provided with water at an estimated budget of R5 million for this budget year. In addition a total of 71 clinics have also been provided with pollution free sanitation services and in the coming year R8,5 million will be put aside to supply the same service to a further 106 clinics. This is a joint initiative with the Department of Water Affairs and Forestry (DWAF). The department has managed to electrify 38 clinics and the remaining 14 clinics with no electricity will be electrified together with 12 others that rely either on a Solar System or use generators. In total 26 clinics will be electrified at a cost of R7, 6 million. The provision of 24 hour security has helped to minimize cases of theft of stock and equipment from our health institutions as well as increasing safety of our health professionals. This has also ensured that our clinics can operate on a 24 hours basis with almost 80 % of 435 clinics and health centres offering 24 hours service. Honourable Speaker The department is seriously looking at the reorganization of the clinic committees. This is a vehicle through which our communities express their views about the kind of services they require at the PHC points. In pursuance of the goal of providing primary health care for all closer to their homes, we are providing 3914 mobile clinic points in areas where there are no such fixed site services. A total of 80 vehicles have been purchased and are being converted into mobile units. We are also busy establishing health ports that serve as information hubs in taxi ranks, bus ranks and shopping centres providing health information to the community. Capricorn district has already made progress in this regard and we will be making such services available in all our districts. It is worth mentioning and to also remind this house that all PHC services are provided free, with women and children benefiting the most. We have extended this free service to people with disabilities. In his first State of The Nation Address as the President of the Republic of South Africa, President Mandela said “children under the age of six and pregnant mothers will receive free medical care in every state hospital and clinic where such need exists”. Many of our Clinics have complied with the National Adolescent – Friendly Clinic Initiative (NAFCI) standards and have therefore been declared adolescent-friendly. It is our intention to ensure that all our clinics are ultimately also declared youth friendly. It is the view of this department that we are making commendable progress to provide quality health care to our people at the PHC level, the level that matters most. EMERGENCY MEDICAL SERVICES (EMS) Honourable Speaker The department has adopted the Emergency Medical Services Expansion and Optimization Plan. Our objective is among others to eventually establish 52 ambulance stations in the province while we currently have 21 stations. However in the coming financial year we will built 5 new stations at Bela-Bela, St. Ritas, Helena Franz, Thohoyandou and Sekororo hospitals. An amount of R15 million has been set aside for these projects. Funding for this optimization plan has been made available in this fiscal period with EMS allocation more than doubling to a total of 270 million. A total of 84 new vehicles have been bought and are being converted into fully equipped ambulances. COMMUNICABLE AND NON – COMMUNICABLE DISEASES We continue to be plagued by both communicable and non- communicable diseases. Our province borders malaria prone areas in the SADC Region. The main malaria areas in our country are the low - lying north-eastern parts bordering Mozambique and Zimbabwe which include the districts of Vhembe, Mopani and Bohlabela. From 1996 there has been an increase in malaria prevalence in these malaria prone areas. However this sudden increase has been met with swift intervention by our health professionals. Last year we sprayed 1, 1 million households in the affected districts and we plan to increase this coverage over the budget period. Conducive conditions such as heavy floods and long droughts contribute to the outbreak of waterborne diseases such as malaria and cholera. The Province experienced diarrheal outbreaks in the Vhembe, Sekhukhune and Capricorn districts. Due to sustained health education and proper coordination of our outbreak response teams we were able to meet the challenge head on. In an attempt to further combat communicable diseases, there has been an increase in the rate of immunization provincially. The greatest success of the immunization programme has been the elimination of deaths due to measles and a reduction in the incidences of polio. We are happy to announce that the department won the best Geriatric Care (Old Age Care) Award in the Country. HIV and AIDS Honourable Speaker On 13 March 2006 vital principles underpinning how to scale up HIV and AIDS prevention, treatment, care and support in Africa, and commitments to action at regional and national level to implement these principles in practice emerged from the African Continental Consultation on Scaling up Towards Universal Access in Africa. One of the key messages articulated by that meeting is a need to energize prevention efforts as this is vital to the long – term sustainability of programmes for treatment, care and support. In this budget year we will re-energize and mobilize an intensification of HIV and AIDS prevention with the ultimate aim of ensuring universal access to HIV and AIDS prevention and treatment services. Reaching the Millennium Development Goal on HIV and AIDS – to halt and reverse the spread of the epidemic by 2015 – requires far greater access to prevention services than is currently available, as will be reflected. Our prevalence rate remains lower than that of the other provinces even though the provincial infection rate is higher at 19, 3% compared to the national rate of 29, 5%. There are strong indications that infection rates in our province are on the increase, except in Sekhukhune district which has recorded a steady decrease to 13, 4% compared to the previous 14, 1%. Up to December 2005 some 30,680 clients were tested for HIV and AIDS of which10, 645 tested positive. Of the most vulnerable the age cohort of between 25 and 29 is the hardest hit by the epidemic. The Comprehensive Care, Treatment and Management Plan is on track. To date 28 sites have been accredited to provide a continuum of services to those in need of the service. A total of 503 facilities including non medical service points now offer Voluntary Counseling and Testing (VCT). The number of Home and Community Based Care Groups that have been funded is 182. We must commend the work that these pioneers are doing. In one quarter they made 785,802 home visits and some 2576 care givers receive stipends. TB In August 2005, Tuberculosis was declared a crisis in the African region. This has meant that efforts must be stepped up to confront the pandemic. It is with pride to report that there has been a noted improvement in the management of TB. The cure rate has improved from 53, 6% in 2003 to 66, 4% in 2004. Bohlabela district has been rated as the best second district in the country on TB management. The Multi Drug Resistance (MDR) TB hospital in Modimolle: H.F. Odendal is now fully functional and was officially opened on 16 February 2006. The first patients were admitted at this unit on 12 January 2006. Last week we celebrated World TB day under the theme: “Action for life towards a nation free of Tuberculosis”. We would like to urge everybody to get tested and if required get treated as a matter of extreme urgency. It is also essential that the six months treatment programme be strictly adhered to. Honourable Speaker One area that we committed ourselves to intensify and do more work is health promotion. Last year we launched the “Vuka South Africa - Move for your Health” campaign. At the centre of this campaign are efforts to reduce the burden of diseases of lifestyle, some of which we have alluded to earlier. The salient features of the campaign are:
We will continue to intensify our public awareness campaigns to inform our citizens about best practices to deal with these diseases. To this end R5 million will be put aside during this budget year. HOSPITAL REVITALIZATION AND MANAGEMENT AND QUALITY IMPROVEMENT PROGRAMME Honourable Speaker This programme is mainly funded by means of a conditional grant. Since its inception in 2004 a total of 4 hospitals have been upgraded to date. The programme is intended to refurbish the infrastructure in hospitals, to strengthen management and to improve the quality of care. Both Lebowakgomo and Jane Furse Hospital are in the final completion stage while Dilokong and Nkhensani hospitals will be completed in this financial year. An amount of R40 million has been set aside for these project We have reached the tender stage for 2 more hospitals; Letaba and Thabamoopo Hospital to be upgraded at an amount of R108 million. During this budget year Maphutha Malatji Hospital will also be put under this programme. The overall infrastructure investment in these 5 hospitals is approximately R160 Million for the new financial year and R14 million for health technologies. The reduction of the Hospital Revitalization grant from R148 million to R29 million for the 2006/07 financial year as well as over the MTEF has made a serious impact on the future progress of the programme. For the 2006/07 budget year the two grants have been combined into one with a total of R49 million. A total of 31 hospitals in our province have been declared baby -friendly. The Baby Friendly Hospital Initiative is sponsored by the World Health Organization and UNICEF and is a world -wide effort to improve breastfeeding rates. Based on the ten steps to successful breastfeeding, the initiative encourages hospitals to examine their practices, make appropriate changes and then apply for recognition as a Baby -Friendly Hospital. This year 5 hospitals will be assessed and if found to be complying will add the number of accredited hospitals. PERSONNEL Honourable Speaker Our success to provide quality health care for all also depends on the availability of sufficiently and appropriately trained health staff. They remain the cornerstone of our health system. An equitable and fair distribution of personnel is essential in rural and peri-urban areas of our province. The department has awarded 386 bursaries to students studying medicine and other health related fields in an effort to ensure that essential health personnel will be available in the near future. In addition to the bursaries awarded, 35 students have been sent to Cuba to study medicine. This is a joint initiative with the National Department of Health. Through the twinning programmes/agreement between the Polokwane/ Mankweng Hospital Complex and the University of Limpopo, we hope to attract skills that will help close the gaps that still exist. Efforts to recruit auxiliary nurses are continuing. A total number of 455 auxiliary nurses have recently graduated and many of them have been deployed in clinics in rural areas and are making a huge positive impact on service delivery, as well as in the running of mobile clinics and health ports. During this budget year we will recruit 368 nursing assistants that have trained in private institutions. This will be complemented by the recruitment of auxiliary nurses through our poverty alleviation programme targeting those coming from indigent families. Two additional nurse training centres will also be established in the province. Overall there is a need to accelerate the training of nurses in all categories. In order to further attract and retain scarce skills, the department has embarked on the 1st phase of building new staff accommodation units. A total of 279 units form the 1st phase of this project to house both the critical and obligatory staff at an estimated cost of R79 million. These units will be completed in the first half of the budget year. In the 2006/07 budget year a further R79 million will be set aside for the second phase of this project. In January this year the National Health Council adopted the following five National Priorities to be implemented by provinces:
These priorities will be lifted to fast track their implementation in tandem with the National Health Council’s targets and it is our view that we are making progress to ensure compliance. SOCIAL DEVELOPMENT Honourable Speaker The Social Development component of our department renders services through three broad programmes, that is, Administration, Social Welfare Services and Development and Research. It is our mandate to reduce poverty and the impact of HIV and AIDS through sustainable development programmes in partnership with implementing agencies. SOCIAL SECURITY Initially the department managed and administered social security net to the poor, but this function will now been taken over by South African Social Security Agency (SASSA). As indicated earlier, the organization and administration of a social security net has been one of the important areas of activity of the department. However from April this year this function will rest fully with SASSA. The provision of state social grants remains one of the government’s most practical poverty alleviation programmes. Towards a Ten Year Review Document states that “In the absence of any grants 55, 09% of the elderly would be in poverty and 38, 02 % would be in ultra- poverty. This falls to 22, 09% and 2, 5% respectively if all recipients get grants.” The department is currently administering at least seven types of grants targeting the most vulnerable – women, children, the elderly, disabled and poor families with children. More than 1, 1 million beneficiaries have been registered to receive grants and this number is expected to increase, thus further reducing the number of people living in poverty. The department will however continue to offer support to SASSA until the function is fully transferred. Several buildings throughout the province have been leased to accommodate the agency. Building plans for construction of SASSA district and sub districts offices have been completed and implementation will commence this year. R10 million has been set aside for SASSA facilities in this current financial year This body will speed up delivery of social grants and ultimately cut down on corruption in the system. The Agency will employ competent frontline staff to process social grants applications at the point of delivery. Skilled back office staff will ensure quicker verification and approval of applications, using advanced technology. Our Anti-fraud and Corruption Campaign on Social Grants is yielding fruits. More than 37 000 people have come forward and applied for amnesty. The department is currently assessing the applications to determine which ones will be granted indemnity. At the same time we are pursuing both civil and criminal cases against those who were found to be defrauding government ‘s social grants. To date 25 public servants from various departments have appeared before the court and more will follow. It is our conviction that the law must take its course. The money that was fraudulently received must be paid back to government. The funding of social security for the current year is done via two conditional grants. The budget for 2006/07 has now been transferred to the National Department of Social Development and no longer forms part of the provincial fiscus. It is our conviction that the Agency will free the department to focus on improving the provision of other equally important social development services. DEVELOPMENTAL WELFARE SERVICES Honourable Speaker Six Social Development One Stop centres have been completed in the current financial year and 12 others will be completed during this year under review. These centres provide integrated social development service like social work services, community development services and social security services. Construction of 7 others and 2 Community Based Rehabilitation Centres will begin this year at a cost of R38 million. Our poverty alleviation programmes remain on track, and 55 projects dealing with piggery, fence making, poultry, brick making, etc, have been funded and strengthened in the last financial year and a further 79 new projects will receive attention this year. The food security programme has been restructured to encompass a developmental paradigm. This is premised on the notion that people are the masters of their own destiny, and instead of helping the poor in the traditional way with handouts, we need to empower and train them to be self – reliant. A total of 1, 320 women have been trained on fundraising, project management and basic farming and management skills. In the coming financial year we will distribute food parcels to 32 000 families. This move will help us to mitigate the effects of poverty among the poorest of the poor. One of our strategies to address poverty particularly among children is to subsidize crèches. The total number of crèches that were subsidized to date is 1176. We are planning to fund 50 additional crèches. The current national standard is to subsidize crèches at R9 per child per day and our subsidy is presently at R6 per child per day. Our projection is to increase this amount to R7.50 for the next budget year in an effort to reach the national standard over the MTEF period. Through our social development interventions the department managed to reach 11 803 orphans and vulnerable children and 629 child headed families. Our programs in this regard include counseling, foster care placement, placement in children’s homes and material assistance. Foster care placement is not without challenges. Backlogs still exist in this area. This is a major problem but efforts are made to address it. The department will complete a dual - purpose Children’s Home and Place of Safety in Sekhukhune district during the course of this year. The department currently has 92 drop – in – centres where children are provided with meals, school uniforms, after- school – support programmes and counseling services. An additional 60 more drop- in centres will be established in the coming financial year. A total of R12 Million has been se aside for this project. Stipends have been paid to 2750 care givers and plans are afoot to pay an additional 2025 care givers and bring the total number to 4775. The Victim Empowerment Programme is run in collaboration with the Department of Safety, Security and Liaison, South African Police Services and the NGO sector. Funding for 18 victim empowerment centres has been made and capacity building programmes for the volunteers will be commenced within the budget period. A total of 07 coordinators have been trained at UNISA on coaching and mentoring skills for the centres. A Crisis Centre has been established at Polokwane Welfare Complex and will offer 24 hour services once all personnel have been appointed. Community rehabilitation centre at Risongoneta has been completed and an additional two will be built in the next financial year. EXPANDED PUBLIC WORKS PROGRAMME Honourable Speaker This is one of government’s short - to - medium term programme aimed at reducing unemployment, thereby alleviating poverty. Home and Community Based Care for AIDS suffers and Early Childhood Development are areas in which there are immediate training opportunities. Home and Community Based Care In 2000 the Joint Health and Social Development MINMEC endorsed the implementation of Home and Community Based care Programme to mitigate the impact of HIV and AIDS in our communities. This was based on the recognition that communities, particularly households with limited access to formal health care, bore the brunt of the pandemic. Home and Community Based Care Services include:
A total of 75 HCBC sites have been established and 36 additional sites will be established during this budget year at an estimated cost of R3, 6 Million. During this budget year training of volunteers will be streamlined and aligned to the key assumptions of the Expanded Public Works Programme. A total of 600 volunteers on level 1 and 3 will be trained during this budget year. An amount of R6, 1 Million has been set aside for this work. Early Childhood Development (ECD) Early Childhood Development is an umbrella term that applies to the processes by which children from birth to at least 9 years grow and thrive physically, mentally, emotionally, spiritually, morally and socially. However, the focus of the EPWP is from birth to 4 ½ years. The programme targets the unemployed and /or underemployed parents and caregivers in all ECD programmes. A total number of 1300 Early Childhood Development practitioners will been trained on level 1 and 4 to increase their capacity to generate income and while improving care and learning environment for children. 700 cooks and 700 gardeners will also be trained during this budget year. A total amount of R 17, 8 Million has been set aside for this work. POPULATION Earlier this month we launched the State of The Province Population Report. According to this report 39, 4% of the population of this province is made up of the youth under the age of 15, while 5, 6% consists of people aged 65 years or older. This scenario points to serious challenges for development, especially because the youth are the most affected by such diseases as HIV and AIDS, most of them are unemployed and therefore more vulnerable. We urge all the government departments and the private sector to make use of this report in their planning. It is highly informative. Honourable Speaker The Health Vote remains under funded over the MTEF period as measured against the Equitable Share Formula that stipulates a 26 % share of the Provincial Equitable Share. The allocation for the 2006/07 financial year amounts to 24 % of the Formula, that is R 420.7 million less than the formula suggests. The outer years reduces to 23.3 % or an under funding of R 700.9 million against the provisions of the formula. The department has nevertheless received an additional R 524 million 11.9 % for the 2006/07 year above the adjustment estimates received for the current financial year. This results in a total growth of R 1.19 billion or 31.8% additional Equitable Share Budget over a two year period. This presents a challenge to spend the additional funds to fund the Annual Performance Plan that includes, the employment of additional staff catered for as well as to spend the additional funds provided for capital requirements and allocations for improvement of service delivery to our citizens. The budget available for the budget year under review amounts to a total of R 5 447 933 000 that includes R 506.6 million for Conditional Grants. The Vote for Social Development also shows a steady growth above the current financial year amounting to a 10.1 % growth or R 33.94 million. The budget for the 2006 / 07 year stands at R 431.75 million and comprises solely of the Equitable Share as the conditional grants have been incorporated into the allocation. The outer years of the MTEF sees a steady growth towards funding Non-Social Security issues and increases to R 465.99 million (7.9 %) and R 695.4 million (49.2 %) in the outer year. The MTEF budget does allow for the growth in developmental social welfare services. The department looks forward to the challenges that lie ahead as funding is becoming more readily available for the services that have been neglected while the concentration was focused on Social Security Grants over the past number of years. Honourable Speaker In his State of the Nation Address this year, President Thabo Mbeki issued a clarion call: “We must, constrained by and yet regardless of the accumulated effect of our historic burdens, seize the time to define for ourselves what we want to make of our shared destiny.” Ours is a programme to build a better life for all. We will not tire in our efforts to attain and contribute to the broader efforts to attain this goal. We are encouraged by the selfless efforts of many of our partners. We have to double our efforts a Province in which all can experience an improving quality of life, enjoy equal human rights, with access to opportunities that freedom has brought us. We commit ourselves to do everything that is necessary and possible to attain these objectives. We thank you.
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