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Policy Speech 2000/01
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Speeches and Media Releases
 Health

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EASTERN CAPE PROVINCIAL GOVERNMENT

DEPARTMENT OF HEALTH

POLICY SPEECH 2000/2001

MEC: DR. BEVAN GOQWANA

13 MARCH 2000

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TABLE OF CONTENTS

I. INTRODUCTION

THE CONTEXT

ECONOMIC STATE OF THE PROVINCE

HEALTH STATUS OF THE PROVINCE

II. DEPARTMENT OF HEALTH: A REVIEW OF PROGRAMME BUDGETS FOR 2000/2001

PROGRAMME 1: HEALTH ADMINISTRATION

PROGRAMME 2: DISTRICT HEALTH SERVICES

PROGRAMME 3: PROVINCIAL HOSPITAL SERVICES

PROGRAMME 4: ACADEMIC HEALTH SERVICES

PROGRAMME 5: HEALTH SERVICES

PROGRAMME 6: HEALTH CARE SUPPORT SERVICES

PROGRAMME 7: HEALTH FACILITIES DEVELOPMENT AND MAINTENANCE

III. SUMMARY AND WAY FORWARD

ANNEXURES:

Annex 1: Eastern Cape Department of Health: Vision, Mission, Policy and Transformation Agenda / Plans
Annex 2: EC Reconstruction and Rehabilitation Programme
Annex 3: Comparisons of 1998/99 Actual Expenditure with 1999/2000 and 2000/01 Allocation by Major Expenditure Categories



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The Honorable Speaker,
The Premier,
Members of the Executive Committee,
Honorable Members, and
Members of the public and representatives of the media.

I. INTRODUCTION

The time has come for us who have been charged with the responsibility of providing sustainable health service to the people of Eastern 
Cape, not only to translate the legislative framework into concrete solutions, but also to implement them.

In his opening address to the Legislature in February 2000, the Premier of the Eastern Cape said,

"The opening address is an attempt by a government to explain why a particular policy route will be preferred to others. It is an attempt 
to argue for legitimacy and moral correctness of its policies".

For five years, we sat in this house debating the legitimacy and moral correctness of our policies and they have been legitimised. From the 
very onset we knew very well that the course of action we are taking enjoys overwhelming support of the rural poor, the destitute, and all 
those who support democratic transformation of our society.

Today my job is to inform the public through this house about our priorities and how, where and on what the money will be spent on, such 
that it can add value to the health of the taxpayers and the citizens of Eastern Cape. In doing so Mr. Speaker, I need to explain to this 
house what informs our approach in deciding on the priority programmes.

THE CONTEXT

* Health is an investment, not just an expenditure. We need to recognise that healthy people can contribute to sustainable economic growth 
of the Eastern Cape.

* Health is a variable of many factors e.g. poverty dictates the health of individuals, our social behaviour determines what type of health 
we will have and the level of education determines our health too. This implies that we cannot work in isolation, but other departments 
need to be taken abroad, hence the clusters and Cabinet Committees are very crucial for effective and sustainable service delivery.

* I need to remind people that you can never render health service to all the people to the extent that there is no mortality. All of us 
will die one day in circumstances beyond our control, regardless whether you have been getting the best health service or not. Even with 
the best health workers people still die of diseases of which 25% are curable, 50% are controlled and 25% die despite whatever you can do.

* The challenge is to combat the curable diseases and those that can be controlled. This can be achieved through research of those diseases 
and also educating our people, which Primary Health Care is doing. The same applies to the availability of drugs. They are not always a 
solution, never mind being expensive. They are also the cause of some diseases at times.

* The fourth thing I want to remind you of is that, the economic state of a country is not proportional to how healthy the country is. I 
know of countries that are very poor and have the best health care for their people. There are also rich countries that have the worst 
health care.
Before I proceed I also need to give consideration to the following macro-level factors:

ECONOMIC STATE OF THE PROVINCE

Mr. Speaker, I am not an Economist, I am a medical doctor and a servant of the people, but I know of one thing. Our province presents a 
dichotomy, which is a completely new anathema in a developing world. I have always highlighted the fact that our province is two worlds in 
one. There is the "First World" and the "Third World". Our moral argument that legitimises our courses of action, is that the "Third World" 
forms the majority of the people of this province, wherein:

* 64% of the people are rural and 90% of these are Africans,
* 99% of these are Africans and poor,
* 70% of the rural have no toilets, and
* 48% are unemployed.
* We are a labour reservoir of rich provinces. These people only come back when they are economically inept and in need of health care 
service.

These statistics suggest that 80% of our people depend on the Public Health System. Very few have access to private health care. Perhaps it 
is time we should think and debate how we can get a slice from the Private Sector, which has billions untapped and serving the privileged 
few.

HEALTH STATUS OF THE PROVINCE

Our province is very "unhealthy". I want to share with you some of the indicators, which make me say we are unhealthy. These include the:

* High-recorded cases of TB. Nationally there are 362 per 100,000 people and in EC the recorded cases indicate that there are 504 per 
100,000.
* Infant mortality at national level stands at 45 per 1000 and in EC it is at 61.2 per 1000
* Access to Primary Health Care is at 61% nationally and in EC it is at 52%.
* Immunisation is at 63,4% nationally and in EC it is at 52% far below than the WHO standards.
* Medical doctors  6 per 10,000 nationally whereas in EC we have 1 per 10,000.
* HIV/AIDS recorded cases in EC is estimated at 18%.
* The absence of sanitary facilities has resulted in the outbreak of dysentery and typhoid in certain areas.

These statistics are actually from our "Third World", which is rural and poor. Without making any divisions or trying to divide South 
Africa, the people we talking about are Africans. This is a challenge to all of us. A clear analysis of the situation suggests that we have 
not managed to achieve equity. In the light of this we have found it necessary to ensure that there is an equitable distribution of 
resources.

This implies that we should make sure that to improve is to introduce equity. I do not wish to lament about apartheid, but what is clear is 
that apartheid was active. Its legacy is visible throughout the province. We need to be active in reversing those evils. We have to 
recommit ourselves and look forward to improve our peoples lives. We can forgive those who were actively involved, but we cannot forget. 
The trauma that this generation was exposed to will take another generation to eradicate. It is like yesterday and it is worse when we see 
that the remnants are still active, for example, those hospitals and surgeries, which still have two doors, disguised in the form of 
private patients and non-paying patients.

In whatever way, Mr. Speaker, one defines the entrances: as long as the Black people still use separate entrance that is racism in form and 
content. As long as some people feel that we should rather have duplicated services because they do not want to be treated or work at Dora 
Nginza or Cecilia Makiwane, racism still remains part of our life.

Mr. Speaker and honorable members, having argued for our moral legitimisation, I must now draw your attention to the Department of Healths 
priorities for the financial year 2000/2001.

These priorities are based on the following major policy interventions:

* Emphasis on equitable redistribution and redeployment of resources to disadvantaged and the rural underdeveloped areas.

* The rationalisation and integration of available resources in our institutions.

* Skills development and continued professional development amongst the cadre ship of the department with emphasis on Financial and 
Personnel Management Processes.

* Increasing partnership between the Private, Public and Non-government Organisations (NGO) sectors in quality service delivery through 
selected pilot projects.

The successes of these policies rely on effective integration in implementation of service delivery processes throughout the governmental 
and NGO sectors.

Let me now turn to review and present you with the budget and the programme allocations for 2000/2001.

II. DEPARTMENT OF HEALTH: A REVIEW OF PROGRAMME BUDGETS FOR 2000/2001

PROGRAMME 1: HEALTH ADMINISTRATION

AIM

To conduct the overall management and administration of the Health Department and to provide Managerial and logistical support to all the 
following 6 programmes.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 1      129,475         112,946         113,690         744     0.66%
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The Health Administration allocation for 2000/2001 has increased by R744 thousand compared to the 1999/2000 allocation. The allocation for 
personnel in this programme has increased by more than R10 million.

A major task for this programme will be the streamlining of its Human Resource Management and Development plans.

A key project will be the Personnel Expenditure Verification, which aims to root out "ghosts" forever. To this end a joint Task Team set up 
by this Department, the Finance/Treasury Department and Q-Data consultants, who will scrutinise each PERSAL salary payment. The results of 
this exercise are expected before the end of May 2000. This project will also ensure the retirement of all employees over the age of 65 
years and the absorption or retirement all our casual labourers.

Besides the elimination of ghosts these exercises will effectively reduce the number of personnel currently additional to the approved 
institutional establishments.

A nagging anomaly in our institutions is the imbalance between professional and non-professional personnel  the former being rapidly 
reduced and the latter raised to unaffordable levels. The aforementioned project will enable us to use the resultant savings to fill 
critically needed professional and managerial posts in our institutions.

Rank promotion backlogs will be cleared out during the first month of this financial year. It is projected that this exercise would have 
cost our department R460 million paid out mainly in the last financial year.

The Department will be awarding R2,54 million in bursaries during this financial year. The majority of these will be for Medical and 
Paramedical Diplomas and Degrees. A total number of 112 students from previously disadvantaged families stand to benefit from this 
programme.

A total of 3,723 currently employed personnel will be trained in the following critical fields:

* Financial Management Systems;
* Quality Service Delivery;
* Labour Relations;
* Performance Management;
* Job Description Development; and
* Drug Management.

Importantly, these macro-level interventions will develop financial and personnel management skills. A Resource Centre has been established 
in order to instill the culture of learning within the Department.

The office of the MEC will ensure that all senior managers at district, institutional and provincial levels sign performance agreement 
contracts with his office. In turn, the accounting office will sign an employment contract with the MEC. This process will enhance 
performance assessment, ensure accountability and increase productivity and commitment throughout the management echelons.

A major managerial and administrative focus will be focused on Pharmaceutical Services. The aim is to provide drugs to all hospitals and 
clinics in the province in the most cost-effective manner. This is guided by the EDL policy.

We have two provincial depots. One is based in Umtata and the other in Port Elizabeth. The depots operate with funds generated from a 
handling fee charged on sales to hospitals and clinics. The finances are managed through the MEDSAS trading account with the application of 
strict financial controls. While the distribution of drugs is still a problem, the Department is acting to improve and prioritise 
programmes aimed at strengthening this support service.

The Department plans to outsource the warehousing and delivery of medicines. In line with this strategy, the lead-time to all facilities 
will be reduced to two weeks. This will result in lower inventory levels and the introduction of "just in time" principles for purchasing. 
Currently these activities cost approximately R8 million per annum. We anticipate savings of about R2 million per annum, once this plan has 
been implemented.

The theft of medicine is still high throughout the supply chain. We are introducing bar coding of parcels as part of the outsourcing plan. 
This will reduce pilferage which is estimated at about 15 -20%, by at least 5% within the current financial year.

We are going to pilot the independent decentralised management of purchasing of pharmaceuticals by one provincial hospital, one district 
hospital and a few clinics in one health district/sub district. The aim of this endeavor is increased efficiency by eliminating the costs 
of depot operation. Partnerships with private wholesaler/s will also be investigated.

With regard to personnel development, about 250 pharmacy assistants will be trained and registered with the Pharmacy Council in 2000/2001. 
Training material is currently being developed. European Union funding for this initiative will be sourced through the National Department 
of Health.

PROGRAMME 2: DISTRICT HEALTH SERVICES

AIM

The aim of this programme is to render PHC services at all clinics, community health centers and district hospitals including provincially-
aided hospitals, SANTAS, Life Care centers and Attics. This is a priority programme within the Department of Health.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 2      1,650,305       1,555,464       1,787,110       231,646         14.89%
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The District Health Services allocation for 2000/2001 has been increased by R231 million compared to the 1999/2000 allocation. The 
allocation for personnel in this priority programme has increased by R 216 million.

HIV/AIDS

The Department fully appreciates the "ring-fencing" of additional funds dedicated to the campaign against the HIV/AIDS scourge, which has 
been declared a national priority by President Mbeki. The R100 million ring fenced provincially will ensure an integrated implementation 
process led by the Departments of Health, Education and Welfare. A business plan costing R33m is ready to be rolled out throughout the 
Province from the 1st April this year. Civil Society is urged to join us in this campaign to save lives and our economy.

Links between HIV/AIDS and Tuberculosis has compelled the Department to focus on a TB treatment, control and eradication campaign. To this 
end we pledge to achieve an 85% cure rate of all new smear positive cases. We encourage the Private and NGO sectors to join us, especially 
in our Directly Observed Treatment (DOTS) programme, as we extend this programme to all parts of the Province.

A Provincial HIV/AIDS Council will be the vehicle for political commitment of all levels of Government, Civil Society and Trade Unions. 
This forum will ensure an integrated approach to implement and funding has been promised by the private sector. Provincial initiatives for 
the treatment and support to the ever-increasing number of full-blown AIDS sufferers will be intensified. A home-based care approach, 
supported by the community will be pursued with special attention to orphaned children and others in distress. The provision of home care 
kits, to manage opportunistic diseases have been included in the budget for this project.

Access to voluntary counselling and testing centers will be increased. Most of these will be community-based and non-medical. The training 
of counsellors at Fort Hare University and the University of Port Elizabeth will be intensified.

Youth education programmes will be coupled with drama and other communication programmes. All forms of media will be employed.

Traditional Circumcision

Civil society, traditional leaders and healers together with the organs of state, should join hands to save our sons from ongoing 
mutilations and death resulting from "blotched" circumcisions. The age-old tradition of circumcision, vested within our proud African 
Culture is in danger of adulteration and at the same time being confronted with the challenge of modernisation.

Our Department alone will not succeed in stemming the tide of the unpleasant health burden being forced onto our young men and communities. 
We as a Department are spearheading an initiative to tackle this problem. In addition, and in line with President Mbekis proclamation, 
this Province needs to review and adopt the necessary legislation. We urgently need to apply our collective minds and conscientiousness to 
this bold challenge.

Ongoing Projects Within the Department of Health

The National and Eastern Cape Departments of Health, in collaboration with the EQUITY Project, initiated a number of district health 
systems interventions to address the increased access to Primary Health Care services. This transformation project has contributed to 
strengthening the equitable and cost effective delivery of Primary Health Care services within the Eastern Cape province. This year we 
shall continue building on the objectives and results of the project.

Access to health services has increased and management of services has improved. For example, 82% of our clinics now display catchment area 
maps compared to 43% just 2 years ago. These maps show the distribution of the catchment population, helping the staff ensure full delivery 
of services. In addition, 84% of our clinics now have active community health committees.

In pursuit of accountability and in an effort to decentralise management through delegation, we shall enter into Performance Agreement 
Contracts with all our provincially aided hospitals, SANTAS, Life Care Hospitals and local government health service providers. We will 
initiate the extension of these later in the year, to our own clinics and district hospitals.

Drug Supply Management

The availability and management of drugs, at depots and health facility levels, is being strengthened. Current efforts particularly focus 
on health facilities around Umtata and Mount Ayliff. Utilising the national guidelines, as expressed through the Essential Drugs Programme 
(EDP), we shall deploy pharmacists in our health districts. Our 24 community services pharmacists will be deployed in our district 
hospitals and we will continue on the job training of our estimated 200 pharmacy dispensary assistants.

Low priority medicines, like cough mixtures, and dangerous anti-diarrhea mixtures, will be phased out due to their ineffectiveness. This 
will result in savings of an estimated R6 million per year. These savings are urgently needed to cover for the increased purchases of some 
effective medicines.

Emergency Medical Services

A major revamp of our Emergency Medical Services is already underway. We shall implement the separation of "Emergency Medical Care" from 
"Patient Transport Services". The latter will be a responsibility and function of our hospitals.

All Emergency Medical Services will be overseen by the Provincial Office, while the day-to-day operations will be managed through the newly 
functional Metros in Port Elizabeth, East London, Queenstown, Graaf Reinet and Umtata. A sixth Metro is tentatively planned in Kokstad. Our 
plans require the upgrading of the communication systems, especially in the erstwhile Transkei, and the recruitment and training of more 
specialised personnel.

Mental Health

In this health sub-programme, we shall initiate pilot sites on the prevention of personal violence. This will commence in Mqanduli, 
Lusikisiki and Mdantsane. This year we will also commission the Umtata Hospital Violence Referral Centre, which will target abused children 
and women.

All our Primary Health Care facilities and community hospitals will liaise with their respective communities in their, now-mapped catchment 
areas, to ensure care for both acute and chronic mental health sufferers. A number of our nurses and Primary Health Care clinicians are 
currently receiving extensive training in psychiatric, psychological and mental health care.

Maternal, Child and Womens Health

A recent study, carried out throughout South Africa, indicates that the number of maternal deaths has increased. Fortunately this trend can 
be reversed, as the causes are preventable. To this end, we shall ensure that all our clinics and health centers provide access to 24-hours 
maternal services. Drugs and transport will be available. A comprehensive training programme for Primary Health Care clinicians and nurses 
is being implemented. Our 400 Nurses have already completed comprehensive training in Primary Health Care skills. To control the primary 
causes of these deaths (caused by Hypertension and Obstetric Haemorrhages are amongst the 5 major causes), treatment protocols on the 
management of these high-risk conditions will be distributed to all our facilities.

We shall encourage women and the youth to clamor for access to user-friendly reproductive health services. We are targeting the prevention 
of unwanted teenage pregnancies. We call on civil society to insist on and collaborate with the implementation of the maternal death 
notification programme and to facilitate choice as expressed in the Termination of Pregnancy Act of 1996. A total of 14 institutions, 
spread throughout our Province, now offer these services.

Expanded Programme on Immunisation

The performance of this sub-programme is steadily improving. We are overcoming limitations in transport, adequate clinic infrastructure and 
trained personnel. We shall involve the community in identifying immunisation defaulters and in educating mothers through continuous 
campaigns. We aim to increase immunisation coverage from 53% to 85%.

Integrated Nutrition Programme

This sub-programme will intensify its focus on infants, deserving school going children, and disadvantaged communities. To this end we 
shall continue to engage women driven SMMEs whose activities target the above-mentioned groups. The provincial Social Needs Cluster, will 
drive the implementation of the new community-based poverty alleviation programmes. Malnourished children will receive food supplements. 
Nutrition education and breast-feeding will be promoted.

District Health System

The Provincial Health Act of 1999 now provides the enabling environment to further implement the District Health System which is a core 
priority of the National Health Department. Guided by this Act, Primary Health Care services will be devolved, in a carefully planned and 
phased approach, to local government structures. The newly demarcated District Councils and our Metropolitan area (Port Elizabeth) will be 
seats of the District Health Authorities envisaged to manage Primary Health Care services. Devolution will tremendously increase services 
as well as the responsiveness of these services to community needs.

A phased approach to the replacement of our health regions by District Health Authorities (DHA) has significant managerial, financial and 
personnel implications. A task group is currently analysing the issues involved and developing the required strategies and implementation 
plans.

One stop centres for delivery of integrated services will be the cornerstone of this major public service transformation. Needless to say, 
managerial and logistic infrastructure will be put in place to systematically support the DHA and their health facilities. The Hospital 
Personnel Transformation Project (mentioned earlier on) will be vital in dealing with the personnel implications of the devolution process.

Redeployment and retraining of personnel will be tempered with negotiation, freedom of choice and constructive, incentive-driven 
persuasion.

PROGRAMME 3: PROVINCIAL HOSPITAL SERVICES

This programme aims to provide cost-effective, high level care and specialised health services and to reduce the experience of illness, and 
also to teach and do research for medical, paramedical and post-graduate students.

In the Province we have 8 provincial hospitals namely: Umtata General, Frere, Cecilia Makiwane, Livingstone, St. Elizabeth, Frontier, Dora 
Nginza and P.E. Provincial and 5 psychiatric hospitals namely: Elizabeth Donkin, Tower, Fort England, Umzimkulu and Komani.

Provincial hospitals are also referral centres, which receive patients from district and community hospitals.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 3      1,074,661       1,007,844       1,047,063       39,219  3.89%


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The Provincial Hospital Services allocation for 2000/2001 has increased by more than R39 million compared to the 1999/2000 allocation. The 
allocation for personnel in this programme has increased by R110 million.

Amongst the various ongoing projects in our provincial hospitals we can mention these prioritised ones:

* The Rationalisation of Metropolitan Hospitals in Port Elizabeth and East London project is directed at rational utilisation of available 
hospital beds, elimination of duplication of service, introduction of cost-containment measures and strengthening of efficient and 
effective management processes.

* The Hospital Management Decentralisation project is aimed at building managerial systems and capacity in provincial hospitals. The 
central strategy is to employ Chief Executive Officers (CEO) in these hospitals, who in turn will ensure completion of the rationalisation 
process and the utilisation of cost-effective management innovations in their hospitals, which will function as independent cost centers.

* The Hospital Personnel Transformation project is critical for adequate personnel deployment in correspondence with individual hospital 
workloads and services and its key performance indicators.

* This year we shall implement the Hospital Management Enhancement project in 8 of the above-mentioned hospitals. It is evident that pilot 
projects in Kwa Zulu Natal produced remarkable cost containment and savings results, calculated at R137 million per annum. Savings are 
likely to be less in the Eastern Cape, but our Department considers all financial savings to be a priority. These hospitals will receive an 
updated computerised Patient Billing System, which will enhance revenue collection processes. Through new ventures in Public Private 
Partnership, we shall increase utilisation of these hospitals by the private sector and thus, increase our access to medical aid revenue. 
The success of the Uitenhage Hospital Private/Public partnership pilot has spurred us on to initiate similar projects in the Port Elizabeth 
and East London Metropoles. Proposals from the Private Sector  doctors and hospital groups are currently being scrutinised and prepared 
for implementation.

This financial year will also see the introduction of specialised care for vigorous treatment and care for opportunistic infections, which 
are increasingly affecting our HIV positive and fully-blown AIDS communities.

The highly specialised forensic unit for psychiatric patients in Grahamstown will be fully commissioned to operate as a National referral 
center.

The Specialised Services Redistribution Grant, valued at R35,5 million, will enhance services previously done at tertiary institutions 
outside the Eastern Cape Province. In the business plan we have prioritised the following interventions, amongst several others:

* A refurbished radiotherapy unit in Frere Hospital;

* A new CT scan for Umtata General Hospital;,

* A paediatric oncology and neo-natal intensive care unit in Cecilia Makiwane Hospital; and

* A spiral CT scanner for Livingstone Hospital in Port Elizabeth.



PROGRAMME 4: ACADEMIC HEALTH SERVICES

AIM

This programme is a conditional grant for the training of Health Professionals in institutions (e.g. district, and regional / provincial 
and academic hospitals). The grant ensures support to these institutions for equipment, administration and research costs incurred for 
training of students.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 4      17,386  47,700  52,830  5,130   10.75%
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The Academic Health Services allocation for 2000/2001 has increased by R5 million compared to the 1999/2000 allocation. The conditional 
grant is provided by the National Department of Health.

Through this programme our effort to develop the Eastern Cape Academic Health Service Complex is beginning to bear results. The UNITRA 
Faculty of Medicine is spearheading the training and retention of post-graduate specialists in fields such as surgery, mental health, 
gynaecology and obstetrics. Gradually, capacity is being redeployed from the University of Cape Town (UCT) and Stellenbosch University to 
our teaching hospitals.

The new Nelson Mandela Academic Hospital (NMAH) currently under construction in Umtata will be part of the complex. The complex includes 
two functioning health resource centres in Port Elizabeth and East London. A third such centre will be commissioned in Queenstown, during 
the course of this financial year.

PROGRAMME 5: HEALTH SERVICES

AIM

To produce and retain appropriately skilled nurses to serve in a Primary Health Care supportive environment, as well as, undertaking 
research and development of nursing care systems.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
Programme 5      44,154  45,576  46,289  713     1.56%


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The Health Sciences allocation for 2000/2001 has increased by R713 thousand compared to the 1999/2000 allocation. The allocation for 
personnel in this programme has increased by more than R5 million.

TRANSFORMATION OF NURSING EDUCATION

The Higher Education Act of 1999 now places nursing education under the Department of Education. The logistics of transferring all nursing 
colleges to that department are underway.

Nursing educators, now on the establishment of our hospitals, must be identified and transferred to this programme. This will make this 
final transfer to the Department of Education easier when the final decision is made.

Debates are presently taking place on what model(s) the Province should adopt for the regulation and control of nursing education. The 
process will be completed by May 2000.

CURRICULUM SHIFTS

In support of the Primary Health Care policy, 3,445 practising nurses have had their Primary Health Care clinical and management skills 
strengthened and upgraded through departmental activities supported by the EQUITY Project. All nursing colleges will initiate community-
based education activities.

Tertiary institutions, universities offering nursing programmes, are including Primary Health Care and rural development modules in their 
nursing curricula. Continuous Quality Improvement of Care is the focus of nursing services in line with Batho Pele.

A patient care evaluation tool is now in use in all our hospitals. These efforts will continue to be strengthened during the coming year. 
In short the objective is to ensure that "All patients should be satisfied with the quality of nursing that they receive from our 
Department".

PROGRAMME 6: HEALTH CARE SUPPORT SERVICES

AIM

To render comprehensive, supportive clinical and non-clinical health care services. Clinical services are divided into Clinical and 
Orthotic / Prosthetic Services.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 6      15,113  13,702  13,510  (192)   -1.40%


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The Health Care Support Services allocation for 2000/2001 has decreased by R192 thousand compared to the 1999/2000 allocation. The 
allocation for personnel in this programme has increased by more than R1, 5 million.

This service will receive 4.4% less than its 1999/2000 allocation. The allocation to this programme is for two service components, viz: -

1.  Clinical services which are mainly Orthotic / prosthetic services in East London and Port Elizabeth Hospitals; and

2.  Non-Clinical Services which are mainly laundry services (including Frere, Livingstone, and Elizabeth Donkin hospital laundries).

CLINICAL SERVICES

Previously all these services were only located in the formerly advantaged areas of our province, while the populations in the previously 
disadvantaged areas were dependent on erratic visits from the main service centres.

From 2000, the Department will upgrade the Bedford Orthopaedic Centre in Umtata to a specialised spinal unit centre.

ASSISTIVE DEVICES

With the assistance through the National Department of Health and the Flemish Funding of maintenance of assistive devices projects, will 
commence at Frontier Hospital at Sibabalwe People with Disability Trust (NGO) in Umtata and at Bedford Orthopaedic Centre. The aim is to 
reduce wheelchair and hearing aids backlogs. Disabled people will be trained to maintain their own wheelchairs.

NON-CLINICAL SERVICES

Laundry services are not part of the core function of the health service. Innovative transformation processes to outsource this function 
through private partnerships will be investigated and pursued. This process will be guided by thorough consultation and involvement of all 
stakeholders.

PROGRAMME 7: HEALTH FACILITIES DEVELOPMENT AND MAINTENANCE

AIM

To provide for new health facilities, upgrade and maintain existing facilities.

BUDGET ANALYSIS

         Actual Exp 98/99 000'   Allocation 99/00
 000'    Allocation 00/01
 000'    Variance 000'   % Variance
PROGRAMME 7      91,024  88,658  203,896         115,238         129.98%


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The Health Facilities Development and Maintenance allocation for 2000/2001 has increased by R115 million compared to the 1999/2000 
allocation. This 129% increase is due to the acceleration of construction of the Mandela Academic Hospital in Umtata and the inclusion for 
the first time of the Hospital Rehabilitation conditional grant in the Departments budget.

The strategic foci of the Department of Health are, among others:

* Inter-regional equity; and

* Improved access to health care.

In an effort to address these strategies, the following projects are underway:

* The Nelson Mandela Academic Hospital is being built in Umtata. Construction was initiated in 1999 and will be concluded in November 2001. 
The total cost of this facility will be nearly R400 million, half of which is coming from the National Department of Health. When the 
facility is completed it will redress the disparity of tertiary services between the former Cape Provincial Administration area and the 
former Transkei parts of the Province.

* The Reconstruction and Rehabilitation of 34 hospitals in the Province is underway. The project will transform existing hospitals to reach 
modern standards, which will attract even private doctors and their patients. The hospitals will thus be able to raise and retain more 
revenue. The Department produced a strategic plan for rehabilitation of all hospitals in the Province. On the strength of submission of a 
quantified and costed plan, the National Department of Health had made these funds available. The R&R conditional grant to the Eastern Cape 
is R84 million for 2000/2001, nearly triple last years allocation of R27, 1 million (See Annex2).

Maintenance  an amount of R21 million has been allocated to manage the maintenance of the following contracts: -

* Steam and hot water boilers;
* Air conditioning and refrigeration;
* Generators; and
* Pollution control (water quality monitoring) equipment among a host of others.

Clinic upgrading, equipping and staffing of non-operational clinics as well as incentive for nurses in the deep rural clinics will be 
addressed using the additional funds (R4,5 million) ring-fenced by the MEC for Finance. The Department of Health is preparing a business 
plan to access these funds as indicated in the 2000/2001 Budget Speech of MEC for Finance.

This brief synopsis therefore covers the 2000/2001 Department of Health budget allocations to programmes.

Mr. Speaker let me conclude my presentation with the following points.

III. SUMMARY AND WAY FORWARD

The Department of Health has come a long way in the past year. Financial controls have been strengthened. The backlog associated with rank 
promotions has been paid. The Hospital Personnel Transformation Project has been initiated. Pharmaceutical supplies have become more 
reliable. Physician services were strengthened through our community service participants. Construction of the Mandela Academic Hospital 
has accelerated and several buildings are nearing completion.

Mr. Speaker, I believe that these are notable accomplishments. On the other hand, our Department faces important challenges. In particular, 
we are challenged, along with other provincial departments, by several mandates.

National service standards appear better suited to the more adequately financed and economically stronger provinces. Meanwhile, it may be 
apparent that the national allocations do not appear to adequately address the backlogs, especially the lack of health and education 
facilities. Our social needs and obligations in particular, appear to exceed what might be regarded as standard proportion of our 
Provincial budget.

Mr. Speaker, our Province faces major budgetary challenges. In the Department of Health, the mandated increases in personnel costs, 
including transfers to partner institutions, and conditional grants exceed the generous total increase in our allocation.

The improvements in conditions of service, and rank and leg promotions continue to outstrip the increases in our core allocations. Other 
operating expenditures must, therefore, be reduced, thereby threatening the quality of services. This is a serious challenge to our 
department and, surely, to other departments.

The Department of Health is doing its best to meet these challenges. We are right-sizing some services and seeking private sector 
collaboration in others. We are launching initiatives to increase revenues and revenue retention, recently approved by the MEC for Finance. 
We are also initiating the implementation of the new Public Finance Management Act, and three of our senior finance officers have already 
been trained in its application and implications.

These and other measures may not be sufficient to bridge the gap between our resources and the cost of the services, to which our growing 
population has a constitutional right. Our Department seeks, therefore, to collaborate with its sister departments in the search for 
strategic collaborative solutions to this and other challenges facing our Province.

Mr. Speaker, the greatest challenge facing the Province is the HIV/AIDS epidemic. A successful strategy to deal with this epidemic must 
involve every citizen of our Province, and all the resources we can afford with which to address it.

Lastly, but not least, the Department faces a major challenge to ensure the equitable provision and development of health services, 
particularly in our rural communities around Umtata, Mount Ayliff and Umzimkulu.

We are actively seeking to redeploy and redistribute personnel and other resources into these areas. We are also seeking donor funding to 
supplement our resources with those of donors and the private sector. As previously mentioned, private sector institutions have already 
committed support for one important project to alleviate the suffering of AIDS patients in three rural sub-districts in this under-
resourced area.

Mr. Speaker, you can be assured that our Department will make transparent and the best possible use of the resources appropriated to it by 
this legislature and also stands ready to collaborate with all other departments to ensure the most rapid and equitable development for the 
citizens of our Province.

Phambili.

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