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Opening of a clinic in Joubertina
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Speeches and Media Releases
 Health

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 EASTERN CAPE PROVINCIAL GOVERNMENT
 SPEECH BY THE MEC  GOQWANA
AT THE OPENING OF A CLINIC IN JOUBERTINA
 1 JULY 2000

Chairperson, ladies and gentlemen it is an honour for me to come and share with you not the experiences of health service delivery in 
Eastern Cape, but also our vision of equitable, quality and sustainable health service.It is indeed, a great pleasure for me to be invited 
to an occasion of this magnitude. I am also particularly please that I come to celebrate with you another milestone towards achieving a 
better life for all in this area. Since 1994 this government has committed itself to the betterment of life for all with particular 
emphasis to communities which have throughout the minority rule have never been in the governments development agenda except when 
discussing security matters.

Through the heroic struggles that you have waged as ordinary men and women you have not only shaped your destiny but have created a 
conducive environment for this government to begin to address the gross inequities of the past. Your efforts are being rewarded bit by bit. 
I have no doubt that given an opportunity this government will fulfil its commitments.

Our approach to equitable sustainable is informed by the following framework-:

The Constitution of the Republic of South Africa bestows upon us as government organ a responsibility to ensure that our people have access 
to health care services, including reproductive health care.

It is also a commitment of this government to ensure that the rural and the poor receive quality health service. Nothing more can be said 
by this commitment as President Thabo Mbeki and our leaders have constantly reminded us of it.

Besides the constitutional imperatives, Ladies and gentlemen, there are also other factors that inform us when making decision in the 
delivery of health care services to our people.

THE CONTEXT
* Health is an investment not just an expenditure i.e. healthy people can contribute to sustainable economic growth of the Eastern Cape.
* Health is a variable of many factors i.e. 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 solos, 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 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.

Defining the Eastern Cape

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 
recipients of economically inept people from these provinces and this 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.

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 worsened by the fact that one of the administrations had within itself not only racial segregated service 
delivery institutions, but also fragmented and duplicated services.

The legacy of the past is evident throughout the province. The neglected, underdeveloped and densely populated Bantustan areas had to be 
integrated with the wealthier and better serviced urban areas of the former CPA. Per capita expenditure in the former Transkei, which has 
about 54% of the population of EC, was only 35% of the health budget in 1994. Though this trend has been progressively reversed, the state 
of health service in those areas was near collapse forcing the department to pump a lot of money in the area without a significant 
improvement.

This balancing act also meant that the institutions which were in the former CPA areas had to reprioritise some of the services. This has 
been met with aggressive resistance. What became clear is that although we claim to have removed white supremacy there are strong elements 
who still live in the dark days. The Eastern Cape Department of Health falls within this ambit.

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.The following statistics are an indicative of our health status.

High-recorded cases of TB. Nationally there are 362/100 000 people and in EC the recorded cases indicate that there are 504/100 000.

* Infant mortality at national level stands at 45/1000 and in EC it is at 61.2/1000
* 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  6/10 000 nationally whereas in EC we have 1/10 000
* HIV/AIDS recorded cases in EC  18%.

Of the total number of 710 clinics, 167 have no electricity, 226 have no water, 197 have no telephones and 194 have accessibility problem 
due to bad roads. This excludes many of the hospitals in rural areas, which lack basic facilities.

Each year a significant percentage of the provincial budget of the Eastern Cape goes to three big social service departments i.e. Health, 
Welfare and Education. This is deliberate and in line with the policy of this government to invest in people and meet their basic needs. 
Since 1994 the Department of Health working within the broad national framework, sets itself very concrete tasks. These included unifying 
the fragmented and unequal services, setting up a new decentralized health model with particular emphasis on District Health System, 
improving access to essential services, especially in our most neglected rural areas, through building more clinics and health centres, 
better referral systems and good hospitals, developing relevant health programmes and, running through all these activities, improving the 
quality of life.

Since1994 the provincial health department has built a number of clinics and health centres. There is also number of clinics, which have 
been built by the private sector. Most of these clinics are in areas, which have been neglected by the previous administrations.

In South Africa we were given an impression that the only way to deliver health service is through secondary health care. The construction 
of clinics especially in rural areas marks the fundamental shift from this philosophy. Our emphasis is on Primary Health Care.This means 
that we shall do away with the notion that the hospitals are the places to go to when suffering from general illnesses.All general 
functions will be rendered at the local clinics with the nurses being the backbone of the services.

We envisage this process by ensuring that through training and orientation, nurses can investigate the cause of illnesses, analyse the 
extent of the problem and even prescribe treatment necessary where required.Some may argue that the nurse may never be able to replace the 
function of the doctor.This is not the intention.

What we are doing is simply to empower our nurses to a level where they can be equated with the general practice in the health service.In 
extreme cases, of course, patients can always be referred to bigger and more advanced institutions.

The most important aspect about primary health care system is that it is cheaper to implement, more accessible and affordable.With the 
shortage of doctors this also means that the services rendered by the doctors are going to be more focused or even specialized.

Our philosophy of Primary Health Care can never be functional unless the very buildings we keep on erecting are fully equipped and 
accessible. Water, electricity, roads and communication infrastructure, staffing and all the necessary equipment is a basic condition for 
the functioning of these clinics. There are many clinics in Eastern Cape, which do not have electricity, or water and some are not 
accessible. As a result of this most of our programmes have not met the required standards.

As part of the governments efforts to ensure that such essentials are available we have brought in all the relevant stakeholders. We are 
busy negotiating with the Department of Public Works and also Water Affairs so that water and roads are in good order. Apart from this 
initiative the Independent Development Trust has also approached us. They are giving us money so that our rural clinics can be electrified. 
There are also companies like Goldfields who are making their resources available to us.

Ladies and Gentlemen I should mention that it is disturbing to note that our rural towns in this part of the province still suffer from the 
plague of racism.What is more disturbing is the fact that the disadvantaged communities are held at ransom simple because the have no where 
to go. This is the worse violation of human rights ever to be experienced by human kind.To day I want to appeal to all health workers 
especially the district surgeons to do what is best for the people. I is an undisputed fact that their continued to provide services is 
because of the taxes that we all pay. The government will do all in its power to read all its institutions of racist practices.

I am neither White nor Black, Rural nor urban, poor nor rich and Young or old. I am a South African dedicated to improving the lives of our 
people by making health accessible to our people.

The brief above was intended to highlight and give a picture of the health service delivery in the Eastern Cape. You 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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