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MEC's Policy speech
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Speeches and Media Releases
 Health

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 EASTERN CAPE PROVINCIAL GOVERNMENT
 PRESENTATION OF POLICY SPEECH FOR 2001/2002
FOR THE HEALTH DEPARTMENT
BY MEC DR BEVAN GOQWANA
7 MARCH 2001



TABLE OF CONTENTS

1. INTRODUCTION
 1.1 Infrastructure
 1.2 Disease Profile
 2. CHALLENGES FOR 2001/2002
 3. TRANSFORMATION STRATEGIES TO IMPROVE SERVICE DELIVERY
 3.1 Re-organisation of the Department of Health
 3.2 Targeted ten institutions as pilot intervention in the year 2001/2002
 3.3 District Development
 3.4 Quality of Care
 3.5 HIV / AIDS
 3.6 Drugs Supply and Management
 3.7 Primary Health Care Programmes
 3.8 Management Issues
 3.9 Infrastructure Development
 4. 2001/2002 BUDGET FOR THE EC DEPARTMENT OF HEALTH
 5. CONCLUSION
 ANNEXURES:
Annex 1: ECDOH Achievements 2000/2001

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Honourable Speaker,
Premier,
Members of the Executive Council,
Honourable Members,
Heads of Departments,
Distinguished guests, and
 Representatives of the Media.

1. INTRODUCTION

We have completed another year in our second term of democracy. I am proud to present a policy speech, which has been drawn from my 
personal experiences of the past financial year 2000/2001. This policy speech 2001/2002 will outline our resolve to deliver efficient, 
effective, appropriate and equitable service to the people of Eastern Cape Province.

Health, like other line function departments in Eastern Cape, has done a lot to bring services to our communities. These interventions have 
improved the health infrastructure as well as numbers of people having access to such services.

I am also proud to say to you today that the Eastern Cape Department of Health (ECDOH) is better positioned to take the decisive steps, 
towards contributing to a better quality of life for all the people of the Eastern Cape province and especially many people who sacrificed 
their lives to ensure that future generations will enjoy the "fruits of liberty".

In just one year we have managed to create conditions for which our constitutional obligations can be realised.

Honourable Speaker, allow me to tabulate some of the concrete achievements of the ECDOH, during the 2000/2001 financial year:

1.1 Infrastructure

* 14 Clinics were completed and opened last year, bringing Primary Health Care Services to more than 170,000 citizens in this province, 
mostly in rural areas where there were none. This brings to a total of 142 clinics that have been built since 1994.
* 18 projects were completed under hospital rehabilitation programme. These include amongst other things OPDs which were left three years 
ago incomplete.
* 107 rural clinics were electrified through partnership with Independent Development Trust.
* 47 refrigerators and 94 two-way radios were installed in these clinics.
* The upgrade of our IT System and network and connection, which has been extended to 11 rural hospitals, telemedicine project between 
Umtata General, St. Elizabeth and Livingstone Hospitals and training.

1.2 Disease Profile

* Our statistics indicate that in the year 2000 there has been a significant decrease in the TB occurrence in the province. TB wards were 
closed in Qumbu and Tsolo and are used as gateway clinics, because of the successes scored through the DOTS system.
* Sexual Transmitted Diseases (STDs) e.g. syphilis have shown a steady decline from 4.4 in 1999 to 3.3 in 2000. The HIV occurrence amongst 
the 20 year olds has remained the same, which is an indication that our efforts to combat HIV infection in the province are bearing fruits.
* Immunisation coverage has significantly improved.
* The following districts of Mount. Frere, Cradock and Uitenhage received awards for Best Practices in Health District System nationally.
* Through our partnership with other stakeholders we have launched the Bambisanani home based care.

There are many more achievements that I could mention which bear testimony to our service delivery. Some of these are listed in Annex 1. We 
are on course!.

These major indicators point to the excellent work that has been done to place our province on a path to achieving a quality of life for 
all. We are confident that this year the ECDOH in conjunction with other departments will register some major victories in improving the 
health status of the people of this province.

Once more, we would like to claim that we have never been better positioned than we are today to achieve the progress we have to attain 
with regard to our challenges.

Contrary to the negative image that has been painted by some forces opposed to transformation, the morale of our health workers, especially 
doctors and nurses is building up because for the first time they are beginning to see the light at the end of the tunnel.

On many occasions Honourable Premier, I have been humbled when I am being approached by people who were advantaged by the previous system 
acknowledging the wrongs of the past, not only pledging their support to the health departments initiatives on transformation but to offer 
their intellectual contribution.

I would take this opportunity and acknowledge the role that has been played by the following doctors:

* Dr. Jacobs, in Livingstone Hospital. He used to publicise whatever he saw as a problem in that hospital. As a result of that the Eastern 
Cape hospitals were seen to be falling apart. Today, he is the one who always approaches my office with suggestions on how best to manage 
the situation. He has also been persuading other doctors not to leave Eastern Cape. This doesnt mean that one doesnt accept constructive 
criticism but the problem is people going to the media before the issue is discussed.
* Dr Le Roux, who is the leader of the Community Service doctors in Eastern Cape. I have held discussions with him where he has not only 
expressed his concern about the lack of doctors in Eastern Cape but also made positive suggestions on how this can be dealt with. He has 
made things easier for us because he has gone out of his way, with dedication, to persuade other doctors to stay in the province, 
especially in rural areas.
* Dr. Bernard Mundell and Dr Hendrik Hanekom have played a very strategic role in the transformation of the Medical Association of South 
Africa (MASA). Dr. Mundell was initially opposed to the presence of Cuban doctors in South Africa but later acknowledged their role. He has 
even chosen to work in one of our underprivileged hospitals i.e. Cecilia Makiwane Hospital.

These and many other doctors, and other health professionals, I have note mentioned, who have directly contributed to health sector 
transformation, not only contribute to improved health service delivery to our communities, but also to nation building. They had a choice 
of leaving this province because they had nothing to lose but they have chosen not to because they understand the challenges that we face. 
Give praise where it is deserved! It is heartening to see that many South Africans responded to the notion that each and every one has a 
responsibility and a role to play in transformation and building a new nation.

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2. CHALLENGES FOR 2001/2002

Honourable Speaker, despite all these successes we are still faced with many challenges, that we are hopeful that they will soon become 
history if we commit ourselves to act in unity and have passion for development.

One of the major challenges we are still facing is "transformation". This however is a process and needs to be addressed in a planned and 
phased manner. When the process of transformation took off in 1994, it was perceived as directed towards changing the attitudes of the 
white community. We forgot that even the previously disadvantaged communities also need to be transformed. There are those who still 
believe that they are second class or third class citizens. Some are still engaged in unproductive activities like infighting amongst 
themselves, the power struggles, etc.

My philosophy is that having a big budget doesnt mean that we can deliver good health service or lack of money results in bad service. The 
core issue is about how we manage our budget and our commitment to provide quality services within the available resources.

Honourable Speaker, health is at the end in the line of service delivery. However, the legacy of the past has put the Department of Health 
at the forefront. The health status of any country depends on various factors. If people are more educated, there is less poverty and more 
food then their health status will be significantly improved.

I cannot fight for a bigger budget at the expense of other departments e.g. Education, Welfare or Agriculture. In fact these are the 
departments that should be having fair share of the budget allocations, so that they can be able to improve the quality of life for our 
people. Nevertheless, I am not saying that health should be given a smaller budget. It is important to note that, in health we believe that 
all other services are complementary in the development of a health nation. Health is an investment that will contribute positively to a 
productive nation.

I want to remind you 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 citizens. Cuba not a rich country and its per capita expenditure in health very low but 
Cuba is well renowned for its superior health care service.

We have the greatest challenge to recruit and retain professional staff in the rural areas. This hampers effective delivery of our services 
in these disadvantaged and rural areas.

We have a duty to realign current health districts with the new demarcated municipal areas and to ensure that the process of devolving 
certain health services to local government in line with the National District Health Systems policy is enhanced.

We are also concerned about the deteriorating security environment in our institutions and here Mr. Speaker, I will cite the recent attack 
on our staff by criminal elements at Mjanyana Hospital.

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3. TRANSFORMATION STRATEGIES TO IMPROVE SERVICE DELIVERY

The Department of Health has undertaken a series of strategic work sessions to restructure and reorganise, to provide efficient, effective, 
appropriate and equitable services. Our efforts are not only directed at organisational structure, but also at producing a health cadre 
that is technically skilled, fully committed and having the values to ensure caring ethos when delivering our services.

The following critical focus areas of intervention were identified:

3.1 Re-organisation of the Department of Health

An amount of R7 million has been set aside to build management capacity in the Provincial office, that is capable to strategically steer 
the organisation to achieve its vision and objectives. In line with the resolution of the Executive Council, the department will replace 
regional offices with revamped health districts to deliver cost-effective health services.

3.2 Targeted ten institutions as pilot intervention in the year 2001/2002

The Department of Health has targeted the three complexes (Umtata, Port Elizabeth and East London) for rationalisation of services. The 
department has commenced a process to recruit the CEOs to manage these complexes, SEOs and EOs to manage the other institutions (Frontier 
etc.).

Management support system (using R12 million) will be brought on board to support the finalisation of CEO process. The objective is to turn 
around performance in these units, establish best practices and at the same time supporting local economic development.

The department has resolved to consolidate hospital health services in one branch (Health Services Branch). The process to separate budget 
of the district hospitals from the clinic will begin in earnest during this financial year.

Issues that impeded appropriate spending on conditional grants were resolved. The new financial year should realise correct planning and 
implementation on these programs.

3.3 District Development

The ushering of the last phase of Local Government transformation on the 5th December 2000, will enhance our relationship with local 
government and ensure that delivery of services is strengthened. The department will restructure its delivery units (districts) to be in 
line with the newly demarcated districts municipality areas to ensure meaningful coordination and political accountability. The department 
will take responsibility to co-ordinate services in those areas that devolution to local government has not taken place. We are working 
within the IPSP program of district development. The department will contribute its part in the delivery on the above and other programs 
within Social Services Cluster.

The resolutions of the Health MINMEC (in February 2001) has given unequivocal guidelines in the establishment of appropriate structures 
between the Province and Local Government, what services will be devolved to municipalities and various mechanisms to achieve that. It is 
imperative that democracy is deepened in the delivery of District Health Services and mechanism will be developed to ensure close 
cooperation with local elected representatives. The establishment of Provincial Health Authority will be one of such processes. It is 
however heartening, Mr Speaker, to report that such initiative and interaction between our department and local government (e.g. Nelson 
Mandela Metro) commenced some time before the December elections. This process will intensify within the new financial year.

Each district will develop service plans, which will cover at least all the essential services that the department is required to provide. 
Governance structure (Boards and community health committees) will be established to meaningfully provide participatory democracy at 
community level.

The Integrated Sustainable Rural Development Strategy has implored us to plan and deliver (as departments) in unison. It is our unwavering 
commitment to work as a department within this strategic framework of the province. The Department of Health will not be found wanting on 
this aspect.

3.4 Quality of Care

As indicated above this will be one of our priority areas. The Patients Rights Charter , which has been officially launched in the Eastern 
Cape with the support of the Honourable National Minister of Health, will be rolled-out. Each and every institutional / District manager 
will be required to sign a pledge to ensure that the charter is communicated, internalised by staff, and fully implemented in all our 
facilities. Representative Boards will be established for all hospitals and the department will ensure that the regulatory framework is 
provided.

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3.5 HIV / AIDS

The Department of Health has been tasked to co-ordinate all the HIV /AIDS programs in the province. I would like to thank our Premier and 
my colleagues for the political foresight shown and the resolve to commit resources to fight this scourge. As indicated, collectively the 
Province committed R50 million, to develop programs for implementation in different departments. Our department will be responsible for R38 
million of the above amount. We promise to undertake the task of co-ordinating this responsibility without fail.

Various partnerships will be put in place to manage delivery of HIV/AIDS services. I am happy to announce that we have established and 
staffed an HIV/AIDS unit that is ready to deliver. The following focus areas are mentioned:

* The strengthening of the Eastern Cape Provincial AIDS Council with the intention to roll it out into Local Aids Councils (LACs) at Local 
Government level. We commit ourselves to establish and launch the first LAC within the next six-months.
* The HIV/AIDS awareness campaign will be intensified. The revamp of the Health Promotion unit in the department will assist in the 
implementation of awareness campaigns.
* Treatment of opportunistic infections. Our staff in all our institutions and clinics will be trained to recognize and treat opportunistic 
infections.
* Research and Voluntary Counselling and Testing Sites (VCT). We have six VCT and 2 research sites (Nevarapine sites) in the Province. The 
National Department of Health is assisting us to develop and implement these programmes.
* Care of the sick. The Departments of Health and Welfare will develop home based care programmes to care and support the very ill patients 
and orphans

3.6 Drugs Supply and Management

The department has recognised drug and pharmaceutical products as one of our cost drivers and priority areas. We are currently finalising 
the process of outsourcing distribution of drugs and bar coding of bulk supplies.

An amount of R5 million is set aside to improve management in our depots to prevent pilferage and also to develop drug management systems. 
Clinic drugs budget will be delinked from the hospital supply.

The establishment of pharmaceutical and therapeutic committees (PTCs) in all institutions and districts is our priority. We will develop 
computerized stock and formulary management system.

3.7 Primary Health Care Programmes

In addition to HIV/AIDS strategy, the department will focus on TB program by purchasing transport to improve sputum results and DOTS 
system. Focus also will be on developing alternative delivery strategy in the school feeding nutrition program (PSNP).

3.8 Management Issues

The Department of Health, will focus on training and development / consolidating management systems. The department will continue and 
finalise the process of rationalising nursing colleges. This does not only ensure cost-effective delivery of training services, but it is 
also in line with the transformation agenda.

We are gravely concerned about debt control on the departments assets and we are committed to developing asset and fleet management 
systems.

One percent of the budget will be given to HWSETA. The department engaged consultants to work on Hospital Transformation Project (HTP) and 
we are committed ourselves to manage the implementation of that outcome. COHSASA was commissioned to assess and evaluate our institutions 
with the aim of eventual accreditation. There is an opportunity to link up this intervention with the CEO management system in ten 
earmarked hospitals.

National Cabinet resolved to transfer medico-legal services from SAPD to the Provincial Departments of Health. The department will finalise 
this process in the new financial year. As decided at the Health MINMEC meeting, the department is also proceeding to "provincialise" 
Emergency and Rescue Services this year.

3.9 Infrastructure Development

We committed ourselves to revamping and upgrading our institutions. An amount of R135 million has been set aside to finalise the building 
of the Nelson Mandela Academic Hospital, An amount of R69 million was received from National Health for Revitalisation and Rehabilitation 
program. We set aside R34 million to maintain our facilities. The department will upgrade project management capacity to deal with our 
infrastructure projects.

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4. 2001/2002 BUDGET FOR THE EC DEPARTMENT OF HEALTH

Honourable Speaker, Premier and Members of the Provincial Legislature, allow me to present to you the 2001/2002 budget.

Table 1, 2 and Figure 1 below provide an overview of the 2001/2002, budget allocation and the allocations per Programme.

         1998/99         1999/00         2000/01         2000/01         2001/02         Increase (+)
BY PROGRAMME     Actual  Actual  Estimated       Adjusted        Allocation     Decrease (-)
         Exp    Exp     Exp      Estimates       Budget         (d & e)
(All amounts in R'000)   A       b       c       d       e       f
1. Health Administration         144,120         122,615         122,844         126,819         177,267         28%
2. District Health Services      1,654,518       1,975,977       2,018,447       1,966,189       1,995,786       1%
3. Provincial Services   1,075,135       1,219,282       1,200,490       1,265,106       1,292,718       2%
4. Academic Health Services      17,386  40,872  51,616  52,830  55,865  5%
5. Health Sciences       44,152  44,713  37,596  50,068  46,711  -7%
6. Health Care Support Services  15,114  16,204  11,831  14,955  8,840   -69%
7. Health Facilities Develop Maintenance         91,037  76,686  177,810         226,348         258,000         12%
Total   3,041,462        3,496,349       3,620,634       3,702,315       3,835,187       3%

Table 1: EC DOH Expenditure and Budget 1998/99 and Budget Allocation 2001/2002 by Programme

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% allocations    1998/99         1999/00         2000/01         2000/01         2001/02
BY PROGRAMME     Actual  Actual  Estimated       Adjusted       Allocation
         Exp    Exp     Exp      Estimates       Budget
(All amounts in R'000)   a       b       c       d       e
1. Health Administration         4.7%    3.5%    3.4%    3.4%    4.6%
2. District Health Services      54.4%   56.5%   55.7%   53.1%   52.0%
3. Provincial Services   35.3%   34.9%   33.2%   34.2%   33.7%
4. Academic Health Services      0.6%    1.2%    1.4%    1.4%    1.5%
5. Health Sciences       1.5%    1.3%    1.0%    1.4%    1.2%
6. Health Care Support Services  0.5%    0.5%    0.3%    0.4%    0.2%
7. Health Facilities Develop Maintenance         3.0%    2.2%    4.9%    6.1%    6.7%
Total   100.0%   100.0%  100.0%  100.0%  100.0%

Table 2: EC DOH Expenditure and Budget 1998/99 and Budget Allocation 2001/2002 by Programme - by %

Notes to Tables and Figure:

1. Programme 5: Bursary responsibility was moved to Programme 1.
2. In Programme 6 all non-clinical support services (e.g. Laundry) have been moved to Programme 3.

Note that Column (e) provide the data for the 2001/2002, budget allocation and the allocations per Programme. In Table 1 Column (f), 
compares the allocation between the 2000/2001 adjusted estimate to the 2001/2001 allocation.

Figure 1: Budget Allocation 2001/2002 by Programme

Ladies and Gentlemen, the budget allocation for 2001/2001 is focused on:

* District development;
* Infrastructure development;
* Transformation of hospital services; and
* Transformation of our medical depots to deliver effectively.

We pledge and commit ourselves to deliver on this budget "commitment made is commitment honoured".

5. CONCLUSION

In conclusion, Honourable Speaker, I want to thank various people for the different roles that they have played.

* To the Premier, I want to say your leadership and coaching which was provided with honesty and integrity has breathed a new hope of life 
to the province in spite of many challenges. Premier, today I want to recommit myself and the Provincial Department of Health, to your 
noble vision.
* To my colleagues, Members of the Executive Council, I am encouraged and humbled by your great support during my difficult times. Your 
messages of support and suggestions made me to walk tall.
* The Honourable Members of this House are thanked for carrying their responsibilities in a professional and balanced way. I am sure that 
your critical comments that were made by the various members were meant to develop and grow the department.
* My heartfelt acknowledgement goes to the ANC / SACP / Cosatu alliance for the political guide and direction they have given me as a 
political head of this department. Your contribution is greatly appreciated.
* The Eastern Cape Department of Health management and staff for their assistance. Presently, I am able to do political work, without being 
bogged down by administrative issues. I have no doubt that you will face the new challenges with vigour and more determination.
* My office has been instrumental in drafting this document and the support given me during the dark days. Some of the journalists could 
have a problem when coming to my office but we have managed to deal with them professionally.
* I want to thank those communities who have not managed to go to media to voice their support but chose to phone, or to stop me in the 
corridors of shopping centres or write to my office and the department to have their voices heard and also messages of hope and support to 
our initiatives, encouraging the department and myself. I am glad to report that those negative media reports made me strong in my resolve 
to execute my responsibilities. Instead of us submitting we have chosen to work hard so that ordinary citizens of this province get value 
of their trust in us.
* Honourable Speaker, as a family man, I cannot forget to recognise their role. Firstly, my kids especially accepted the change what with 
some could have been a bitter pill to swallow. That includes my six-year-old friend. What has surprised me is their quick grasp of the 
political situation, young as they are. Secondly, my wife has been my pillar of strength. At the beginning, she was not happy that I had 
accepted a full-time political responsibility. When I was under attack she was the one who sent a message, I quote:

"Continue with politics and I will make all possible measures that your work is thorough and the support you need will be there at all 
times. Fight on!. Dont ever think of quitting. Continue with your vision for the people of the Eastern Cape and South Africa. I know you 
are not corrupt, I know you are not a coward, I know you are honest and a man of integrity. Fight on."

Today, I want to say to you. I am on course!. I thank you.

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ANNEXURES:

Annex 1: ECDOH Achievements 2000/2001

Infrastructure

* 15 hospitals and 9 clinic projects were completed
* 15 clinics were officially opened
* 46 clinics were connected to solar energy and 61 to the Eskom grid
* 47 refrigerators and 94 two-way radios were installed in our clinics
* Fort England forensic unit (psychiatric) was completed
* Highly specialized equipment and telemedicine facility
* HART Project was implemented for assessment of children with hearing impairment

Management projects

* Hospital Transformation Project process being finalized
* COHSASA project initiated and reaching approximately 100 hospitals
* Rationalization of the 3 complexes (EL, PE, Umtata) commenced
* Distribution of drugs outsourced to prevent pilferage
* 3rd orthotic / prosthetic centre established at Bedford Orthopaedic Centre

Programmes

* Successful implementation of DOTS (TB) with closure of TB wards in Tsolo and Qumbu
* Smear conversion on TB increased from 64% to 72%
* 3 health districts achieved recognition in national DHS competition and won awards
* Patient Rights Charter launched at Bisho by national Minister of Health
* 80% of targeted 972,781 children fed through PSNP project
* Supervision in the clinics increased from 60% to 77%
* Access to 5-day antenatal services increased from 51% to 81%
* HIV counselling services increased from 73% to 91%
* Availability of drugs increased by 9% (TB) and 30% (STDs)

Achievements Capital Projects

Projects completed : Hospitals

PROGRAMME /PROJECTS      REGION  BRIEF PROJECT DESCRIPTION       LOCATION
Bambisana Hospital -Restoration  E       Renovations     Lusikisiki
Canzibe Hospital         D       O.P.D.  Ngqeleni
Holy Cross Hospital     E        O.P.D.  Flagstaff
Isilimela Hospital      D        O.PD.   Port St Johns
Livingstone Hospital     A       Exterior Renovations    Port Elizabeth
Nompumelelo Hospital    C        O.P.D   Peddie
Victoria Hospital        C       Kitchen Block, ward Block       Alice
St Barnabas Hospital     D       O.P.D   Libode
Umtata General Hospital  D       Administration Block, Casualty and OPD  Umtata
Butterworth Hospital     C       Theatre, CSSD and Paediatric Ward       Butterworth
Zitulele Hospital        D       O.P.D   Mqanduli
Andries Vosloo Hospital         A        Electrical upgrade, and upgrade of boilers     Somerset East
St Margaret Hospital     E       Electrical Restoration  Tabankulu
Sipetu Hospital  E       Electrical Repairs, Connection  Tabankulu
Health Resource Centre Queenstown        B       New Resource Centre     Queenstown


Projects completed : Clinics

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NAME     DISTRICT        REGION  FUNDER
Mqanduli Clinic  Mqanduli        D       RDP
Dungu Clinic     Tabankulu       E       RDP
Mvoti Clinic     Umzimkulu       E       RDP
Bilatye Clinic   Lady Frere      B       RDP
Cwecweni Clinic  Engcobo         D       RDP& DEPART.
Bengu Clinic     Lady Frere      B       RDP
Ndonga Clinic    Lady Frere      B       BMW
Ndayinzima (Tshobeni)    Tabankulu       E       Petronet
Msendo Clinic    Willowvale      C       Amatola District Council

Projects completed and officially opened

NAME     DISTRICT        REGION  FUNDER  DATE
Aerovale Clinic  Somerset East   A       Micro projects  30.5.2000
Mwaca Clinic     Mt Ayliff       E       RDP     5.5.2000
Daliwonga Clinic         Bizana  E       Vodacom         15.6.2000
Mangqamzeli Clinic       Tabankulu       E       Microprojects   7-7-2000
Maxhwele Clinic  Umtata  D       Community       19-08-2000
Qaqa Clinic      Tabankulu       E       I.D.T.  14-09-2000
Queensmercy Clinic       Maluti  E       I.D.T.  6-10-2000
Rolweni Clinic   Mt Fletcher     E       R.D.P.  28-10-2000
Mzongwana Clinic         Maluti  E       R.D.P.  13.10.2000
Mvoti Clinic     Umzimkhulu      E       R.D.P.  28-10-2000
Katkop clinic    Qumbu   D       I.D.T.  17-11-2000
St Barnabas OPD  Libode  D       R&R     27.11.2000
St Augustine Clinic      Tsolo   D       Private         1-12-2000
Ntywenka Clinic  Tsolo   D       Bid Vest Comp   4-12-2000
Pabalong Clinic  Maluti  E       IDT     15-12-2000

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