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Health Systems Trust Conference
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Speeches and Media Releases
 Health

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EASTERN CAPE PROVINCIAL GOVERNMENT

SPEECH DELIVERED BY MEC, DR BM GOQWANA

AT THE HEALTH SYSTEMS TRUST CONFERENCE IN CAPE TOWN

ON 12 - 13 NOVEMBER 1999

INTRODUCTION

The new constitutional dispensation in South Africa has bestowed upon us a challenge to transform the instruments of governance so that the 
dream of millions of better life for all can be realised. That dream cannot be deferred.

As we gathered here today we have accepted the responsibility and a mandate from them to ensure that we not only accelerate the delivery of 
health service to all but ensure that the service is qualitative.

As a representative of the Eastern Cape Department of Health and the servant of our people, I need to bring to your attention some 
important facts about the conditions under which we have to deliver health services and our strategic approach to the challenges we face.

Like other provinces, the Eastern Cape government inherited three different administrations which were not only politically antagonistic to 
each other, but also had totally different cultures. That cultural identification has continued to exist despite attempts to inculcate new 
ethos. The situation has been worsed by the fact that one of the administration had within itself not only racial segregated service 
delivery institutions , but also fragmented and duplicated services. The Eastern Cape Department of Health falls within this ambit.

What defines Eastern Cape from other provinces is the following:

1. Economic Status

With population of  7 million, nearly 63% is rural. 54% of the total population lives below poverty line. Being a labour reservoir for 
richer provinces, has not only robbed the province of its human resources, but also has further impoverished the province. We are the 
recipient of economically inept people from these provinces and impact negatively on our health budget. Today most of the people with 
chronic diseases are those from the mines, the farms, the fishing industry, the chemical and other heavy duty industries.

The province also shows a dichotomy of two worlds in one nation. With these two worlds emerged the legacy of the past. This explains why 
80% of the people in Eastern Cape depend on Public Health for their livelihood.

2. Health Status

Given the acute socio-economic conditions in the province, it is an undeniable fact that the Health Status of the province falls below what 
is considered to be measure of a developing country. This is reflected by a number of cases of measles, typhord, shigella and other 
preventable diseases. These cases are most prevalent in North-Eastern part of the province.

There is still a high accurance of TB with figures as high as 311/100 000. The most unfortunate situation is that nearly 50% of these cases 
are HIV positive. These are only recorded cases. The figures could be high is accurate data can be collected.

Rheumatic heart disease is still prevalent. While efforts are being made to ensure that we reach all children for immunisation, to date we 
are still at 54% which is far below than the World Health Organisation standards. HIV/AIDS has increased from 15.9% to 18% with areas such 
as Port Elizabeth, Mdantsane and KwaZulu Natal border having high recorded infections.

As said before most of these diseases are a result of multiple determinants. All these have a retrogressive effect on sustainable 
development.

3. Strategic Approaches to Accelerated Health Service Delivery

3.1 The Context

Our strategic approach to accelarated health service delivery is informed by the following:-
* Health is a pre-requisite for sustained socio-economic development.
* The provision of health service must be linked to other sectors e.g. water and sanitation, electrification, roads infrastructure, etc, 
all of which have a job creation component.
* Health should not be regarded as an expenditure but an investment. A health person contributes to socio-economic development.

3.2 Constraints

Considering the latter, the ECDOH is faced with severe budget cuts which continue to frustrate our efforts in dealing with urgent 
priorities like backlogs, equitable allocations of resources, maintaining the present deteriorating facilities, etc. This is the same for 
the whole province.

3.3 Strategic Options

The continuous under funding of the department, taking into account the socio-economic condition outlined above, leaves us with fewer 
options in meeting the health demands of our people. However, we are trying our best in the circumstances to make hard choices and adopt 
cost effective measures through:-

* Rationalising the metropole institutions e.g. East London, Port Elizabeth and Umtata.
* Down grading certain hospitals to health care centres and reduction of 24 hour service on certain chronic institutions where statistics 
are down.
* Promotion of Primary Health Care as against centralisation of services in the hospitals which takes more in terms of budgetary 
expenditure.
* We are in the process of phasing out regional health offices and improving District Health Systems. The whole function of the Primary 
Health Care is being shifted to Local Government. Our role will solely be to monitor and audit activities at that level.
* A task team is currently investigating the possibility of employing CEOs instead of using doctors as hospital superintendents.
* We also plan to decentralise the financial management into institutions.
* Improving revenue collection with a particular emphasis on these of medical aids in public hospitals.

4. Priority Areas

Our strategies are focussed on certain priority areas:

1. Primary Health Care

The Eastern Cape has a taotal number of 710 clinics.

* 167 have no electricity or have electricity problems
* 197 have no telephones.
* 226 have no water.
* 194 have accessebility problem due to lack of road infrastructure.

In our attempt to promote Primary Health Care, the department has identified these basic facilities as outmost importance therefore deserve 
priority. Secondly the we are investigating the possibility of providing incentives such as adequate accomodation and better renumeration 
for health workers especially in rural areas. Thirdly, we are busy evaluating the training of nurses in Primary Health Care which includes 
Essential Drug Listing.

2. Primary School Nutrition Programme

The nutrition programme has been experiencing problems. Children are not fed well and the poor rural women are not adequately empowered as 
it was intended. In addressing the issue the department has set up a committee to review the management of this programme and make 
recommendations as a matter of urgency.

3. Transport

As the Eastern Cape is mainly rural we specifically want to prioritise the referral system with the following mind;
* EMRS have been amalgamated into six regional centres namely, East London, Port Elizabeth, Umtata, Queenstown, Graff Reinnet and Mt 
Ayliff. This service will be solely available for emergency purposes. Upgrading, equipment and training of personnel is progressing very 
well.
* Patient transport vehicle will be used for ferrying stable patients from one clinic to hospital, hospital to hospital.
* With regards to unreachable areas we are negotiating with Red Cross for helicopter services or any other company that would do this job 
at a reasonable cost.
* The department is also engaged in educating the communities about the use of hospital vehicles, to avoid misuse, as well as hoaxes and 
other inappropriate calls from the public.

4. Mental Health Care

The policy on decentralisation of Mental Health Services is unfolding. The psychiatric patients, after having been discharged from 
hospitals, will continue their treatment at clinic, health centre or district hospital level. To meet the demand, dedicated psychiatric 
nurses are going to be placed according to catchment areas and the process has started in Region A.

5. Academic Complexes

The rationalisation of academic complexes is underway. Our main objective is to see these teaching and research institutions playing a 
major role in the delivery of health services. As a starting point is to engage them in the training of Registrars who will be expected to 
do relation. Furthermore we are looking at the development of specialist services which are non-existent at present.

6. Drugs

We are experiencing a problem of drugs being stolen from the Provincial Depot and on the way hospitals and clinics. Presently there are two 
depots Port Elizabeth and Umtata. One will serve as a halfway house. Our intention is to have drugs prepacked for a particular institution 
or a clinic. They will then be delivered in insured out-sourced transport, which will be able to reach remote areas.

The community service which will be introduced for pharmacists is expected to benefit the rural areas most.

7. Circumcision

Circumcision has come to the fore front of our agenda probable because of the many fatalities, admissions to hospitals and in some cases 
the total loss of manhood in the past few years due to botched operations. As a department we have taken an initiative to ensure that this 
custom which forms the foundation of or society is practised within the contemporary safety standards without compromising its value. The 
reported cases so far indicate that in June 1998 alone there were 23 deaths and 18 amputations and approximately 390 admissions. We are 
engaged in consultations with all the stakeholders in an attempt to bring an amicable solution to the problem.

5. Conclusion

The brief above was intended to highlight and give a picture of the health service delivery in the Eastern Cape. Delegates should not 
regard this as a lament but as an attempt to share our experience with you. As a young administration we are on a learning curve. While we 
recognise that the legacy of the past is still with us, we will be doing injustice to the people of the province not to what we can in the 
circumstances. We have commitment and the spirit to carry on. Not in the distant future these will be history.



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