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MEC's visit to Tafa Lofefe Hospital
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Speeches and Media Releases
 Health

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EASTERN CAPE PROVINCIAL GOVERNMENT

SPEECH DELIVERED BY THE M.E.C. FOR HEALTH DR BM GOQWANA

ON A VISIT TO TAFA LOFEFE HOSPITAL.

07 JANUARY 2000.

I am very much honoured to have been invited to come and share your views on health service delivery in this district. This visit should be 
seen as part of the ANC governments philosophy to reach out even to the remote areas especially in rural areas where people were never in 
the previous governments agenda. I am also particularly pleased because I come here six months after the elections not before. This is an 
indication of the seriousness upon which the present government is committed to ensure that people in the rural areas receive quality 
health service.

Tafalofefe is a remote yet essential institution in this area. It is even difficult to reach by modern transport. The legacy of the past 
neglect is evident everywhere in this hospital. The conditions under which our health workers provide health service are demotivating. The 
statistics, which have been mentioned, give a gloomy picture of what Tafalofefe is at present and the type of service the people of the 
area receive. In fact people with a lot of money would consider going to the Provincial Institutions or Private Hospitals rather than being 
treated in this hospital.

Given this picture I particularly pleased that even under these conditions you have dedicated Hospital Board and Health Workers who 
understand that there is no tunnel without an end and that where it ends there is light. Certainly time has come for the people of this 
area to get quality service. This can no longer be postponed.

Chairperson, allow me to put the governments perspective on quality health service. President Thabo Mbeki in his opening address at the 
Parliament on 25 June 1999, committed the government to delivery to the poorest of the poor through integrated development programme for 
the rural areas. President Mbekis interpretation of the integrated programme with reference to health is that -:

1.  " we must ensure that when a clinic is built, there must be a road to access it. It must be electrified and supplied with water.
2.  It must have requisite personnel, qualified to meet the health needs of the particular community.
3.  The safety and security of the personnel and material resources, which are part of the institution, must be guaranteed".

What more else can be said about our governments commitment to better life for all?

Mr MC there are certain things that I need to bring to your attention. Many people come to my office requesting the erection of a new 
hospital or building a new complex within the existing hospital, which is tantamount to building a new hospital. Several reasons are 
mentioned most of which relate to poor service delivery. Now I must mention that there is a difference between poor service delivery and 
the state of the buildings. You can have a state of the art building with all the machinery yet have poor service. If the people who are 
employed and paid for delivering service are not committed then therefore people will continue to receive poor service.

In many of our hospitals especially those in rural areas there is a tendency for laxity. The problem is not only encountered with health 
workers but also with those auxiliary employees. There are many cases of theft of property and some officials fail or even refuse to be 
accountable for the resources they manage. Unfortunately, Tafalofefe has recorded its name on the list. These things contribute to bad 
service delivery. As President Thabo Mbeki has pledged, such practices will be put under strict spot light. We are not going to leave any 
stone untouched. In fact we do not have untouchables.

The erection of a new complex depends on various factors. Unlike the previous regime, we are not going to do the duplication of services. 
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 in these 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.

This should not be interpreted, as saying the buildings will not be renovated when necessary. With the little budget we have we are going 
to ensure that these hospitals and clinics are on top of the list for renovations.

We envisage this process by ensuring that through training and orientation of nurses so that they 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 specialised.

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 this region, 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 are companies like Goldfields who are making their resources available to us.

We are also investigating measures to provide monetary incentives to all health workers working in rural areas. In fact I have made it a 
point that this is going to start in this Financial Year. The affected personnel must be patient. I have their circumstances at heart.

Ladies and Gentlemen, let me make something clear. When it was said the people from where the project is situated should be considered 
first when job opportunities come, it was not a mistake. Given the financial constraints in the Province at this stage it is impossible to 
employ new people. What the government is doing is to identify qualified personnel and redeploy them to the clinics.

The realities out there are, to say the least, most astonishing. As an example, if one looks at the Health priorities of the metropolitan 
areas of the East London and PE, the concerns are with highly specialised equipment such as CT scanners being switched off, etc. within the 
very same province, Bambisana in Lusikisiki or Greenville in Bizana the concern is with providing electricity of the hospital or the 
building of the out patient department which is non-existent. Currently the Health Department is receiving a lot of negative coverage not 
because we are sitting down and doing nothing, but, that when resources are distributed equally those who have been privileged are feeling 
the pinch. They are trying all the tricks to discredit this government. I want to assure you that as long as I am still heading this 
department I will make sure that those areas that were neglected before receive priority in resource distribution.

Allow me Master of Ceremonies to touch another important aspect in health service delivery. Unlike other provinces, 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 Eastern Cape Department of Health falls within this ambit.

The reality of the situation is that when we said we are transforming we only focussed on transforming the departments at national level 
and concentrating on reorientating the attitudes of the whites. Little did we realise that there are people especially those from the 
homeland administration need to be transformed. We find ourselves in a situation where we have a problem with our own brothers and sisters. 
The most unfortunate situation is that in the course of their activities they tend to consciously or unconsciously do the enemys job. The 
challenge is upon us to ensure that we do not resist change. Change is painful in the beginning but the fruits are enormous.

Mr MC it would be wrong for me not to say something about the disease that threatens the survival of human kind. HIV/AIDS started as myth 
but today it is a reality. The initial awareness campaigns focussed on urban areas and in fact they are still more urban biased. The latest 
statistics indicate that more and more rural population is getting affected especially women.

What is particularly disturbing is that the highest rate of infections is between the ages of 17 years and 34 years. (These are our 
children; these are the leaders of tomorrow). When considering this, the following come to mind -:

- reduction in the life expectancy.
 - a possibility of a generation gap.
 - the impact this will have on human resources.
 - the amount of resources that will be used to sustain life.

Given this scenario as most people get infected it will surely have an impact on sustainable economic growth. The most contributing factors 
will be -:

- the hours lost in workplace due to increasing number of sick leaves.
 - a increasing expenditure on health services thereby putting a lot of pressure on the limited budget.
 - the high premiums to be paid by the this age group on insurance policies as companies will try to cover for the risks.
 - the resources which will be used to care for the affected i.e. orphans, destitute, etc.

According to the latest studies 35% of all HIV positive patients will develop full blown AIDS within five years time. Mathematically this 
means that in the Eastern Cape alone we will have approximately 131 250 patients suffering from AIDS. On average such patients are likely 
to spend between 30 to 60 days in hospital. With a costly rate of R400 per day per patient in our hospitals, this number of AIDS patients 
will cost the taxpayer anything up to R525 million per year. This is without the consideration of the inflation rate. The truth of the 
matter is that we will find it very difficult to afford that for the health services will simply collapse under the pressures.

In view of this the Eastern Cape Government has instituted Provincial Aids Council to be headed by the Premier whose main function is to 
coordinate HIV/AIDS activities and to advise the cabinet on all matters pertaining to HIV/AIDS.

The Council will be a multi-sectoral, comprising of trade unions, faith based organisations, NGOs, business community, traditional 
leaders, etc.

Apart from the council the government is already providing service to both the infected an affected through -:

- provision of non-pharmacological therapy in the form of distigmatisation, provision of counselling services, encouraging nutrition 
programmes and physical exercise, encouraging home-based care, etc.
 - provision of pharmacological therapy in the form of treatment of opportunistic infections e.g. TB, Pneumonia, etc. the government is 
also researching on other drugs, which are acclaimed to reduce the transmission of the virus from mother to child.

It should be noted that the availability of a drug does not mean that the problem has been solved. There are certain misconceptions, which 
we have to be cleared.There is no drug that can cure HIV/AIDS at this moment. This means that the fight against the virus is far from over.
 The provision of drugs should be measured against the ability of the state coffers to absorb the costs. We are talking of job creation, 
housing, security and other social programmes, which demand a lot of financial injection.

The government is also promoting partnership with the NGOs, which are active in the field by channelling funds to them. It is hoped that 
through this funding we will be able to reach remote areas and pass the message.

Master of Ceremonies, on this day I want to put a challenge to the youth, especially the young and promising and also those who seem to 
lose hope. I was born in rural areas. I grew up here. The conditions at the time were far worse than they are today. It was a remote area 
with no communication and roads infrastructure. Today I am a qualified physician and a specialist in the field. During that time nobody 
thought there would ever be a specialist from this area, but here am I today. I wanted to serve my people. It so happen that what I have 
been doing in the past years was not enough. I had to sacrifice all the niceties of being a Physician to head this department. It is a 
sacrifice because what I am getting is far less than when I was doing my private practice. I felt that it is better to suffer than let your 
own people suffer. The message I want to pass today is simple, "let us not lose hope, there is always a light at the end of the tunnel. You 
must not allow your unfortunate circumstances to determine your future".

The concept of African Renaissance is an attempt to reinvent Africa, to regain its dignity and unlocking its potential. This concept should 
not be defined in such a way that it loses its meaning. Renaissance should begin at home. We must move away from attitude of being 
disadvantaged and expecting miracles to happen, to being actively involved in shaping our destiny. We must be proud of ourselves without 
downgrading others.

Conclusion

This new millennium must begin with people, united in diversity, determined ever before to shape their destiny. With all this I hope we 
will be able to overcome some of the social evils that threaten our society, e.g. crime, corruption, abuse of any kind, rape, etc. Our next 
100 years must be marked by better life for all with people having jobs and enjoying greater security.

We must enjoy it for it is the last for this generation. It is unthinkable that we can last until the next 100 years, we will all disappear 
whether we like it or not, but when we pass this world we must make sure that we have contributed in unity of diversity.

Thank you,

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