APPROPRIATION
BILL
(Second Reading Debate)
Vote
5: Health – R2.052 681 billion
The
SPEAKER: We then proceed to Motions. Motion 1 reads as follows:
That leave be granted that the Second Reading Debate on the
Appropriation Bill be continued.
The hon MEC, Ms Tsopo.
Ms M. A. TSOPO (MEC):
Hon Speaker, the Premier of the Free State, Ms Winkie Direko, colleagues
in the Free State Executive Council, Members of the Provincial Legislature,
Members of Parliament and Provincial Delegates to the National Council of
Provinces, Marena le Dikgosi (Traditional Leaders), mayors and councillors, distinguished
guests, ladies and gentlemen, it is with pride that I stand here to deliver my
third Budget Speech as the MEC responsible for Health in the Free State
Province.
I stand
here before the
He gives strength to the weary, and to him
who lacks might, He increases power.
Yes,
indeed, in this journey we are likely to tire along the way, but if we call
upon Him who is our Creator, we will gain strength.
In the
year that we proudly celebrate the fifth anniversary of our Supreme Law, the
Free State Department of Health has again taken firm strides to improve access
to quality health services in this Province, as prescribed in Section 27 of the
Constitution (108/1996).
The
Constitutional imperative is that the State must take reasonable legislative
and other measures within its available resources to achieve the progressive
realisation of the right to access health care services, including reproductive
health care and the right to emergency medical treatment.
The
preamble of the Free State Provincial Health Act, (8/1999) states that the Free
State Provincial Government is committed to ensure a healthy and self-reliant
Free State community by providing acceptable, affordable, effective, integrated
and comprehensive health services.
National
legislation, policies and the National Strategic Framework guide the delivery
of health services. It is further
informed by Provincial legislation, policies and the Free State Development
Plan.
These
imperatives and guidelines are instilled into the Departmental Strategic
Plan. The Strategic Plan that I table in
this House today, is a product of interaction between the management and myself
in September and October 2001 to chart the way forward for the next three
financial years to conclude the present term of Government. I believe it will meet the main concerns of
the communities of the
May I
use this opportunity to thank the management of the Department for their sense
of purpose, commitment and hard work to produce this document we all can be
proud of?
Our
strategic plan serves as the guiding torchlight in a tunnel of darkness. Without a plan we are lost. It tells us where we are going as the
Department and this is important. In the
words of Lewis Carroll:
If you do not know where you are going, any
road will take you there.
Speaker,
ladies and gentlemen, the purpose of the Budget Speech is also to account on
the outcome of the previous budget.
In a
report to the Health and Social Development Committee of the Legislature, I
reported that the Department met almost all the commitments I had made in this
House. For the sake of time; the
Department has produced a scorecard that indicates how the Department has fared
in the 2001/2002 financial year. I hope
all Members and the public in the gallery received these documents. May I also indicate that the full account
will be part of the Annual Report, which will be published with the financial
reports, as determined by the Public Finance Management Act (PFMA)?
A
summary of the achievements I am going to mention is as follows:
1.
All
vacant top management posts, including the post of Senior Manager HIV/AIDS and
Communicable Diseases were filled.
2.
The
availability of medicines and medical consumables were drastically improved by
various interventions, including the outsourcing of the distribution to health
facilities.
3.
New
and replacement equipment purchased include R40 million worth of:
·
Basic
equipment for primary health care facilities and district hospitals;
·
A
computerised Tomography at
·
Computerised
Tomography and Bucky units and a Flouroscopy unit worth R5.6 million at
·
A
state-of-the-art Magnetic Resonance Imaging Scan worth about R14 million at
·
The
recently launched I-Cam (Interactive Learning, Communication and Management)
system worth about R11 million.
4.
598
critical service and administrative posts were filled.
5.
The
two prevention of mother-to-child-transmission of HIV/AIDS (PMTCT) research
sites were successfully implemented.
This programme reached 3 461 pregnant women from July 2001 to January
2002. Of these women, 2 508 received
counselling and 402 mothers and 152 babies received Nevirapine.
6.
The MUCPP (Mangaung and University of the Free State Community
Partnership Program) community health centre in Mangaung and four clinic
buildings were completed and upgraded.
7.
The following clinics are now providing 24-hour services: Heidedal Community Health Centre (CHC); MUCPP
CHC; Clinics B, J, K, M and U in Botshabelo;
Gaongalelwe and Dinare clinics in Thaba Nchu, PAX clinic in
Viljoenskroon; Kgothalang in
Virginia; Kgotsong in Thabong and
Ventersburg and Namahadi and Tebang clinics in Thabo Mofutsanyana.
8.
A
prosthetic and orthotic workshop for the Thabo Mofutsanyana district was
established at
9.
53
ambulances, 19 patient transport vehicles, twelve rescue vehicles and 21
response vehicles were purchased during this particular financial year. Two hundred and seventy eight emergency care
practitioners were appointed to improve the quality of our emergency medical
service.
10.
One
hundred and eleven new bursaries to an amount of R3.135 million were allocated
in the 2001/2002 financial year.
11.
1
790 cataract operations were done and the Department of Ophthalmology saw 130
children at the
12.
Regarding
the disabled, the Department has started with the process of training frontline
personnel to equip them with the skills of using Sign Language, so that they
can be in a position to communicate with Deaf people.
We are also having on the cards the
establishment of the Vocational Evaluation Centre, which will serve the
disabled people well in terms of evaluating and preparing them for the job
market.
Again we have budgeted an amount of R50 000
to purchase therapeutic toys for children with mental disabilities. These toys will help them in training their
minds psychologically.
These
achievements and others indicate that I lead a Department at work to address
the needs of the
For us
these achievements are imperative. They
are stepping stones towards the realization of dignity for our people and we
will continue to work hard until this dignity is fully restored to all. It is only through hard work that we can
achieve this. As Feodora Dostoyevsky
puts it:
Originality and a feeling of one’s own
dignity are achieved through hard work and struggle.
There
are no major policy shifts in this budget, as would be expected of a government
in midterm. There are, however, fine
adjustments to existing programmes and projects for further improvements, as
well as rededication on major public health programmes. The major thrusts are still:
1.
The
strengthening of primary health care (PHC) services;
2.
The
implementation of the district health system;
3.
The
strengthening of level I and level II hospitals in support of PHC;
4.
The
improvement of quality of care in all our facilities;
5.
Decisively
dealing with the HIV/AIDS and other communicable diseases; and
6.
Efficient
and effective management of resources, including personnel.
In
support of the people development goal of the Free State Development Plan, the
Department of Health commits itself to the following goals:
1.
Reducing
the burden of HIV/AIDS and TB;
2.
Effective
and efficient management of resources;
3.
A
functional district health system;
4.
Effective
marketing and communication of health services;
5.
Developed
and empowered personnel and stakeholders;
6.
Providing
appropriate infrastructure; and lastly
7.
Accessible
and quality services at all levels.
The
Free State Provincial Government, like any other provincial or national
government in the world, is faced with increasing and competing demands against
limited resources. The role of policy
makers worldwide is therefore to prioritise programmes and projects with
maximum impact and value for money. I
believe this budget is a further step towards a healthy and self-reliant
*In the new financial year the
focus will be on the following priority programmes:
1. HIV/AIDS
·
Improvement
of all interventions in the packet, with the focus on the expansion of
voluntary confidential counselling and testing to 30% of our health facilities.
·
The
establishment of home based care in partnership with NGOs in 50% of the towns.
·
The
creation of at least one interim care facility in each district.
·
NGOs
will be trained to improve their capability to work in partnership with the
Government.
·
The
two research points for the prevention of mother-to-child-transmission of HIV
will be strengthened to increase the taking in of patients.
These
interventions will help stabilise the pandemic.
2. Tuberculosis
(TB)
·
On
·
More
Directly Observed Treatment System (DOTS) helpers will be recruited. The Department is considering the payment of
a remuneration of R500 to DOTS helpers in the new financial year;
·
The
new MDR (Multi-drug Resistance) unit that will be built at
3. Extended
Programme on Immunisation (EPI)
*The Extended Programme on Immunisation will be empowered
according to the recommendations of the World Organisation on Health. The proclamation and the safe-keeping of
vaccines, especially at Thabo Mofutsanyana, will be upgraded. There will be committment and care will also
be taken with contagious diseases, with the support of the whole of South
Africa as a country without polio. Regular vaccinisation will be provided to
increase the market in order to acquire the target of 75%.
4. Finding
of breast and cervical cancer
*Breast cancer and cervical cancer
remain one of the biggest causes of deaths under women in this Province. These cancers can be cured if it is found
early and treated appropriately. Last
year 3 155 new patients with cervical cancer were treated at the
Testing
programmes such as self-examination of the breasts by patients themselves and
Pap smears will be extended this year.
In this regard we will work closely with NGOs such as CANSA
(Cancer Association of South Africa).
5. Privatisation
of Institutions
*The Department of Health provides
sterling health services on a regular basis.
However, some residents, including the Members of this Legislature,
believe that private services are better than those of this Department. We are going to fight those who are spreading
wrong information about the privatisation of health institutions.
6. Quality
of Health Care
·
#The Department will continue with
its continuous quality improvement plan.
This programme requires appropriate and functional equipment, clean and
safe health facilities and friendly, caring and appropriately trained
personnel.
·
The
accreditation process by COHSASA (Council for Health Service
Accreditation of Southern Africa) has commenced and the newly created quality
improvement unit will ensure the sustainability of this programme. The aim of this programme is to reduce the
unusual and medico-legal incidents by 50% within three years.
7. The implementation of Health Services at
District levels
*The Provincial Health Association
(PHA), five districts on health services and the Advisory Body on Health, which
were established in terms of the Standing Rules on Health in the
This
Provincial Health Association, together with the five districts on health, will
implement the policies in those districts.
My
sincere gratitude to the MEC for Local Government and Housing, the hon Member,
Mr Lechesa Tsenoli, for his endeavour and co-operation by joining hands and
working together with us during the process.
The
The
recommendations and resolutions that were taken during the conference that was
held in August last year concerning the services on health will be implemented.
8. Health Services at rural areas
The living conditions of the poorest of the poor and the negligence towards
our rural residents are the greatest challenges to our Government. The Department plays a pivotal role with
regard to the National Policy on Integrated Development Strategy and the Free
State Development Plan to develop Maluti-a-Phofung. The Department will build clinics at
Bluegumbush and Tseki and also refurbish and renovate the Elizabeth Ross
hospital at Namahadi. The construction
of a new hospital for psychiatric patients will be undertaken in due course.
However, our central role is to ensure quality and effective and efficient
service delivery in health, in collaboration with developmental rural district,
which is subsidised by the Health System Trust.
The Department will also focus on farm workers. There will be negotiations with farm owners
and their unions to ensure that farm workers have access to health
services. The Department will provide 28
mobile clinics and also employ additional people to ensure better service
delivery.
I appeal to the hon Members of this House to accompany my Department on our
site visit with the mobile clinics to different places as part of Letsema
in April 2002.
9. Care of vulnerable groups
·
#The Department will run targeted
programmes for people with disabilities, older persons, the youth and victims
of family and sexual abuse in collaboration with other Government departments,
relevant commissions and NGOs.
·
The
Department will continue to make health services accessible to people with
disabilities, including the training of front line workers in Sign
Language.
·
The
centres for the victims of family and sexual abuse will be rolled out in the
whole Province in collaboration with relevant Government departments.
·
This
Department and the Department of Social Development are presently piloting the
provision of health services at pay points as well as the assessment panels for
disability grants. The responsible MEC, Ms Marshoff, will expand further on
these initiatives.
THE BUDGET
A major
departure in this Budget Speech to previous ones is that this budget will be
presented according to the organisational structure of the Department, rather
than the programme structure of Vote 5.
The
purpose of this departure is to provide the budget geographically and per
function so that hon Members and the public can understand what the budget is
addressing in their own localities.
The
budget allocated to the Health Department for the 2002/2003 financial year is R
2.052 681 billion, which is 22% of the total of the Provincial Budget of R9.263
521 billion.
This
budget is R172 708 million or 9,19% more than the initial budget allocated in
the 2001/2002 financial year. The
increase is nominal and does not take inflation into consideration. In real terms the increase is less than 3%.
In
terms of the MTEF, the budget will increase to R2.175 794 billion in 2003/2004,
and R2.335 400 billion in 2004/2005.
It is
clear that there is little new money to introduce new programmes. An analysis done in the Department showed
that in real terms the Department is allocated less for its comparable
activities in 2002/2003 than it was allocated in the budget for 2001/2002. The Department accepts this challenge and
will strive to improve its efficiency to release resources to fund the existing
programmes.
The
budget is composed of:
1)
R1.493
040 billion from the equitable share;
2)
R491.626
million from conditional grants from the National Department of Health and
National Treasury; and
3)
R68.015
million from Provincial revenue.
62% of
the budget will be spent on personnel, as compared to 64% during the 2001/2002
financial year. The actual number of
personnel in the Department changed from 14 688 at the end of February 2001
compared to 14 444 at the end of February 2002.
The
total budget for personnel in the 2002/2003 financial year amounts to R1.282
362 billion.
R94.786
million or 4,62% of the budget, compared to R85.385 million or 4,54% of the
2001/2002 budget, will be spent on equipment.
Major equipment to be purchased includes:
(i)
A
“C” arm unit;
(ii) A heart sonar ultra-sound machine
for mobile echocardiograms;
(iii)
X-RAY
mobile units;
(iv) An ultra sonic machine; and
(v)
An
ECG and Defibrillator with pulse oxymeter.
R312.993
million or 15,25% will be spent on stores and live stock standard items. This is an increase of R52.255 million from
the 2001/2002 financial year.
The depreciation
of the
The
budget is allocated as follows to the various functional clusters of the
Department, according to the organisational structure:
1. HEALTH
SUPPORT CLUSTER
The
health support cluster receives R 249 329 751 million or 14,6% of the 2002/2003
budget. This cluster comprises of the
following directorates:
a)
Human
Resource Management;
b)
Human
Resource and Organisational Development;
c)
Health
Programmes and Health Support Services, and
d)
HIV/AIDS
Communicable Diseases.
The purpose of the health support cluster is
to ensure efficient and effective utilisation of resources throughout the
Department of Health in the
The critical success factors for the health
support cluster are to provide enabling policies and procedures to support the
mission of the line functions, co-ordinate and support the development of health
programmes, manage resources effectively and efficiently, audit performance,
ensure external and internal networking as well as training and capacity
building.
Health
Programmes Directorate
The
Health Programmes Directorate receives R21.578 million.
This
Directorate develops policy and monitors the implementation of primary health
care programmes, non-personal health, maternal, child health and nutrition,
oral health, chronic diseases and rehabilitation throughout the
The budget
includes a conditional grant of R39.393 830 million for the Integrated
Nutrition Programme. Of this amount R 23.907 856 million is allocated to the
Primary School Nutrition Programme.
Human Resources Management Directorate
The
Human Resources Management Directorate provides a professional human resource
service to ensure effective and efficient staffing of the Department of Health
with a trained, skilled, motivated and productive workforce.
The
Directorate renders personnel provisioning and maintenance functions and
promotes sound labour relations in the Department of Health. This Directorate receives R4.181 million.
Human Resource and Organisational Development
Directorate
The
Human Resource and Organisational Development Directorate receives R81.116
million.
This
Directorate manages training and bursaries for staff and individuals outside
the Department.
For
this financial year, the Free State School of Nursing received R47.953 million
and the
Health Support Services Directorate
The
Health Support Services Directorate receives R107.047 million. This amount
includes the following conditional grants:
Hospital revitalization (R17 million), flood relief fund (R14.2 million)
and infrastructure grant (R18 million).
The
Health Support Services Directorate manages pharmaceutical services, diagnostic
services, technical services, laundry services and information and technology.
HIV/AIDS and Communicable Diseases
Directorate
The
HIV/AIDS and Communicable Diseases Directorate receives R23.978 million. This amount includes a conditional grant of
R13.953 million.
It
needs to be stressed that this is not the only money spent on HIV/AIDS. The bulk of HIV/AIDS expenditure is in the
clinical health services cluster. This Directorate facilitates and monitors the
implementation of HIV/AIDS programmes such as Voluntary Confidential
Counselling and Testing (VCCT), Home Based Care (HBC), Prevention of
Mother-to-Child-Transmission (PMTCT) of HIV/AIDS and Sexually Transmitted
Diseases (STD), including Tuberculosis.
2. FINANCE
GROUP
*The Finance Group receives R27.1
million or 1,4% of the budget. The group
exists of:
·
The
Directorate Financial Management and Internal Audit;
·
The
Directorate Financial Administration and Logistics; and
·
The
Sub-directorate Strategic Planning.
This
group is responsible for the implementation of the Public Finance Management
Act (PFMA). It includes the rolling down
of financial responsibilities from programme managers to cost management and
responsibility centrums in the Department from the beginning of the financial
year.
This
budget includes a R2 million conditional grant for financial management.
·
The
Directorate: Financial Management and
Internal Audit will compile the Audit Manual and strive continuously to
increased financial efficiency through training and audit procedures.
·
Risk
evaluation and a plan to prevent fraud will be established and used to guide
the internal audit plan.
·
A
control list to help cost centre managers in this regard will be used in all
institutions in the 2002/2003 financial year.
*There has been an improvement in finances after the
implementation of new infrastructure.
The main priority in my Department is to have savings. During the current financial year, 2002/2003,
revenue exceeding R56 million has been budgeted for. In nominal terms this is an increase of 10%
above our projections during the last financial year of 2001/2002.
Although there is a slight increase, one must appreciate the fact that the
Health Department in the Free State, as compared to sister health departments
in the country, is in a better position.
The accounting officers and service coordinators are responsible for good
governance, service delivery and the implementation of control measures for the
paying of salaries in the Department.
The implementation of the agreement for tendering procedures within the
Directorate for Tender Procurement supports the Institutional Tender
Committees, which, for the first time during the new financial year, is in a
high position. R2 million will be
allocated for depot account.
*The sub-directorate of the Departement working on the
policy of the Department has successfully managed to implement the Public
Finance Management Act (PFMA). The
reports regarding the outcome and service delivery according to the objectives
of the Departement will be reported on on a quarterly basis during this year.
3. HEALTH
SERVICES FACILITIES AT CLINICS
Health personnel are responsible for intensive service delivery at all
levels for the Free Staters. This is a task
team that provides information on basic health care facilities, emergency
medical services and ambulances. They
also provide 24-hour district hospital services in all the districts and
regional hospitals, special services at psychiatric hospitals and also
professional services that are provided at Universitas Hospital.
These services are provided at three regional hospitals namely eastern,
northern and southern regions, together with the complex that renders
professional services for health on provincial level.
The task team that renders services at health clinics have been allocated
R1 737 553 054 billion, or 84% in nominal terms, of our budget. This is an increase of R142 855 531 million,
or 8% in nominal terms, as compared to the budget allocation in 2001/2002. The allocation as per complex is as follows:
3.1.
#The Southern Free State Regional Complex,
which consists of health facilities that provide levels I and II care to the
people of Xhariep and Motheo districts, received R456.653 351 million.
This amount is made up of what I have
indicated there.
The hours of service at Koffiefontein clinic,
Thaba Nchu clinic and Wepener clinic will be extended to provide 24-hour
services before December 2002.
The hours of service of the following clinics
will be extended during the 2003/4 financial year: Reddersburg, Rouxville and Hobhouse and
Dewetsdorp, Exelsior and Tweespruit in 2004/2005.
The new clinics commissioned in the
The contract for the co-location of beds, a
Public Private Partnership project will be concluded this year. The upgrading of
3.2
The Complex, which consists of the facilities
that provide level I and II care to the people of Lejweleputswa and
To further improve access to the primary health
care package, 24-hour services will be available at Kroonstad Community Health
Centre (Tshepong), Hennenman clinic, Kganya clinic at Koppies, Masilo clinic
and Thabong clinic before November 2002. Services at the following clinics will
be extended during the 2003/2004 financial year: Brandfort, Refengkgotso at
Deneysville, and Phedisong at Villiers.
The new clinics commissioned in the
The implementation of the satellite campus of
the Faculty of Health Science at
An obstetric high care unit will be
established and R3.5 million worth of equipment will be purchased. Two Principal Specialists posts will also be
advertised before the end of the 2002/2003 financial year.
R80 million will be spent on the
revitalisation of
3.3. Eastern
The Eastern Free State Regional Complex
consists of the same levels and the budget is R306.421 579 million.
Five new clinics and twelve upgraded clinics
were commissioned during the 2001/2002 financial year.
To further improve access to the primary
health care package, 24-hour services will be extended to Marquard and Petrus
Steyn clinic by December 2002.
The following clinics will be included in the
2003/2004 financial year: Thabang, Tsheseng, Tshiame, Kestell, Rosendal,
Fouriesburg, Petrus Steyn, Lindley and
3.4. Academic
Health Services Complex
The Academic Health Services Complex (AHSC)
comprises all the services offered at Universitas and the psychiatric
hospitals.
Universitas renders levels III and IV
healthcare services and the psychiatric hospital (Oranje) renders psychiatric
services up to tertiary level.
The total budget of the Academic Health
Services Complex is R482 590 985 million.
This allocation is divided further into R93 652 000 million for the
psychiatric complex and R389 938 985 million for
R27 million will be spent on current and
capital equipment, the renovation of the maternity unit will be completed and
the Private Public Partnership (PPP) will be implemented during the new
financial year.
3.5.
Services for
Medical Advisory Council
*The
Directorate: Medical Advisory Council in
Health renders emergency services, a co-operative communication team,
constitutional services and support medical services. The sub-directorate for marketing and
upliftment of health services will be established this year. Emergency health services will be
incorporated under the directorate of the Executive Officer of the Regional
Complex during this current year. This will enable flexibility and effective
and efficient service delivery in emergency situations. The budget allocation for the Medical
Advisory Council is R92 086 314 million.
Added to that allocation is R80 531 000 for emergency health services
and R7 505 695 million has been allocated for corporate services on
communication. The outstanding amount is
for judicial services, medical support and medical forensic services.
Thirteen ambulances and two additional
vehicles will be allocated for emergency services. R3 million has been allocated for two
co-operative offices and R500 000 is budgeted for communication infrastructure.
CHALLENGES
#Despite the plans and the budget
indicated above, challenges and obstacles remain. These challenges will require resolute
political leadership and strong and decisive management. These challenges include the following:
1.
The
HIV/AIDS pandemic.
2.
Emergency
medical services.
3.
Caring
and compassionate personnel – hence this year we are ensuring that Mr Shuping
delivers babies, so that he can really take care of those particular hospitals
in the Province that are really unable to ensure caring and passionate
services. He is a man, but he already
has two babies.
The Department is considering training of
frontline staff in excellent service delivery.
Those who are not prepared to change, will have to leave this caring
Department.
4.
Managerial
responsibility. The challenge for institutional managers to accept managerial
responsibility, including personnel and financial responsibility, remains
despite improvements in the last twelve months.
The Department will provide the necessary training and support to
managers during the financial year.
5.
Revenue
generation, Mr Dingani, is one of the challenges that are facing us. We will have to continue to forge ahead with
the breakthroughs we have made in this regard, as we are not looking back.
CONCLUSION
In
conclusion, I commit my Department to the clarion call made by President Mbeki
in his State of the Nation Address.
The
Department will participate in Letsema and create opportunities to
communities to participate in partnership with the Free State Provincial
Government to roll back the frontiers of poverty in the
I am
constantly reminded by Psalm 92 verse 13, which reads:
The righteous man will flourish like the palm
tree, he will grow like a cedar in
I want
to thank my party, the ANC, for providing me with clear policies to implement
and the hon Premier for entrusting such an important portfolio to me. Lastly, all my colleagues in the Executive
Council and Members of this House and the Portfolio Committee I am reporting to
under the Chairpersonship of the hon Member, Mr Tate Makgoe, for their support
and encouragement.
I want
to express my deepest gratitude to the dedicated and committed personnel who,
on a daily basis, day and night, provide a sterling service to the communities
of the
The
following was said about this Department in the latest review of the PMTCT
(Prevention of Mother-to-Child Transmission) research sites:
The Free State Department of Health is blessed with a stable leadership. There is relatively little conflict within the Department of Health and the MEC provides