Health Budget Vote at the National Council of Provinces
I would like to congratulate the honourable minister on his budget vote, and in particular the acknowledgment that the quality of health services in the public health system has to drastically undergo a metamorphosis.
HIV and AIDS and TB
Whilst I appreciate that the emphasis is on HIV and AIDS and TB as the largest drivers of morbidity and mortality in South Africa, the efficient implementation of plans remains the challenge. In the 2012/2013 financial year the Western Cape achieved 96% of the HIV Counselling and Testing target - that is 804 446 of 834 842 - and the new target for 2013/2014 has been set at 938 104.
In his reference to the NHI, the national minister announces that the White Paper will be ready soon. Although I look forward to the White Paper, I wish to mention that to date the Western Cape has not yet received response to our inputs on the Green Paper. It is my understanding that the White Paper will be published in the coming months. I hope that the national minister and his team have incorporated some of the proposals of the Western Cape.
I wish to reiterate that whilst the Western Cape Government is participating in the Eden NHI pilot, this does not indicate unqualified support for the as yet not formally tabled policy document for NHI.
The reason for the Western Cape participation is the belief that the province can contribute to the development of the best ultimate model.
The Western Cape Government policy is one of Universal Health Care for All which is supported by the World Health Organization, but through a model of a functioning health system at provincial level without the centralizing of all funding and management through the National Department.
However, the Western Cape Government believes there is a better alternative. Our alternative proposal is Universal Healthcare for All. The primary health care structure in the Western Cape has been tested and universally applauded for its success as a nurse-driven structure that provides basic medical services to the people who depend on public health services. Patients are referred to regional and specialized facilities according to their medical needs, and government provides the linkage through transport infrastructure. The model is based on worldwide trends and leverages the system’s strengths, minimizes its deficiencies and delivers good health services in a responsible and sustainable manner.
We believe that the NHI proposals are a misdiagnosis of the healthcare system's ailments, and that the current approach will not cure it. The true illness is low-quality healthcare outcomes which compromises the health of the nation and makes it virtually impossible to achieve the developmental improvements that we desire.
The only way to improve the health of the population is to make sure that healthcare is fully-accessible and of a high-quality. While the public sector provides the requisite level of accessibility, it does not even begin to approach a quality offer. This is why so many people seek private healthcare, despite its costs. This, then, is the great challenge for the public sector: to enhance its level of quality so that it can actually improve the health of the population.
A key issue is good governance that, we believe, must be based on good business principles – financial discipline, efficiency, equality, modernization, monitoring and evaluation. A highlight during the past financial year was the Department receiving an award from the Auditor-General in recognition of the continual improvements made to financial management processes.
The lesson we have learned in the Western Cape is that it is possible to improve healthcare for everyone by strengthening the positive elements of the public sector and removing its deficiencies on a planned and sustained basis. Our policies in the Western Cape are working to achieve this at a provincial level. There is no reason why these strategies cannot work for the rest of the country as well.
All that is currently being undertaken by Western Cape Government through the support of the NHI pilot project is to strengthen health services in the Eden District and to provide the country with viable models of health care that have worked and will continue to provide quality patient centered health care services.
Roll-out of HPV vaccines
The national minister announced that in consultation with the Minister of Finance and the Minister of Basic education, national government has decided to commence to administer the HPV vaccines as part of the School Health Programme as from February next year.
We support this initiative, but on requesting this information from my department, and whether the Western Cape is geared and ready to roll out the HPV vaccines as from the beginning of February, I was informed that the Department is awaiting formal communication from the National Department of Health on this programme.
The current vaccine budget allocation does not include the HPV vaccine which is proposed to be administered to 9 and 10 year old in Quintile 1, 2, 3 and 4 schools. Although, it is expected that National Treasury will provide the funding in the adjustment budget later this year, my Department has not yet received confirmation of this.
According to the 9 and 10 year population figure of 110 365, based on the R500.00 per single dose it will cost the province R 165,547,500.00 (R1 500.00/learner).
Using the uppermost bracket of R750.00 per single dose it will cost the province R 248,321,250.00 (R2 250.00/learner).
These figures take into consideration that 3 doses of the vaccine would be administered per 9 and 10 year old learner.
The current human resource capacity within the school health programme in the province is not yet geared to take on the administration of the vaccine to the targeted 9 and 10 year old learners, without compromising the current Integrated School Health programme implementation.
Buy-in from the Education Department will be essential as the learners will be accessed during academic time, specifically as these learners (aged 9 and 10 years) are in the intermediate phase at school.
The concept of increasing wellness as a public health management strategy, is taking root across the world in countries facing the challenge of high risk factors for disease. Within the framework of the Western Cape Government’s fourth strategic objective of “Increasing Wellness”, the department has moved into the arena of addressing health issues in a transversal manner. This transversal approach heralds a new approach to governance. The whole of society approach recognises the increasing need to work across traditional boundaries to deliver results. The requires a unified ethos across the public service, and is in line with the vision for this provincial government to be the best run regional government in the world.
In the Western Cape we are implementing the strategy with the departments that create infrastructure – Local Government, Transport and Public Works and Economic Development – and the departments that can support the well-being of the people who live and work in the province - Education, Social Development and Agriculture.
In the Western Cape our strategic objective of Increasing Wellness is geared towards prevention and detection. The focus on prevention is through the increase of knowledge and creating awareness of health risk behaviours and identifying the social determinants that increase health risks. Our projects are geared to provide information for positive behaviour change.
The systems focus to increase the early detection of risk factors and diseases and identify high-risk individuals and poorly controlled cases for referral to appropriate healthcare providers.
In order to affect behaviour modification successfully, requires a patient centred approach, where the individual needs and health of the patient comes first.
In order to better understand and improve the patient experience, the Department piloted a SMS and telephonic hotline for certain facilities during 2012/13 where complaints were logged and tracked to ensure resolution. The hotline proved to be a great success and will be rolled out across all facilities going forward.
No response to meeting requests
Speaker, I would like to use this opportunity to draw the attention of the House to my repeated letters to the National Minister for a meeting to discuss the issues that affect service delivery in the Western Cape – the short supply of medication, the centralisation of hospitals, implementation protocols for NHI, not yet signed by the Western Cape Department of Health. Despite several written requests, I have to date received no response to my requests for a meeting.