Vote 06: Health Budget Speech 2006

Speaker, agbare lede en gaste, dit is my voorreg om die 2006/07-begroting vir die Wes-Kaapse departement van gesondheid aan u voor te lê.

Budgets by their very nature are instruments of government policy, guided by the needs of the people who benefit from it. Budget decisions on the other hand are never easy since they are a balance between the needs of our people on the one hand and the resources available to us on the other.

In the Western Cape, there is no doubt, where our priority as government lies. In his State of the Nation address President Mbeki made it clear that we have to move faster to address the challenges of poverty and to improve service delivery to the marginalised in our society.

Dít is 'n uitdaging wat ek glo ons gesondheidsbegroting 2006/07 die hoof bied - dit finansier immers 'n gesondheidsorgmodel wat daarna streef om gelyke toegang tot kwaliteit gesondheidsorg te bied aan alle mense, daar waar hulle woon en werk.

There is no denying the enormous progress made over the past two years. This, due to the commitment of our Premier and our party leadership in governing this province for the benefit of all its people and playing a constructive role in giving new content to our Age of Hope.

My departement sal 'n daadwerklike rol speel om inhoud te gee aan ons Eeu van Hoop deur te verseker dat ons personeel en vennote hulle verantwoordelikhede doeltreffend en doelgerig nakom ter voldoening aan die beginsels van Batho Pele en die Handves van Pasiënteregte.

Speaker, my Department is not without its critics and I welcome healthy and constructive criticism. Unfortunately, the type of criticism coming from certain quarters originates with afro-pessimists who feel threatened by the changes being made in healthcare and the resulting progress.

Vandag is toevallig ook Afrikadag waartydens ons ons Afrika-erfenis en ons toekoms op hierdie kontinent vier. Dit is 'n tyd om trots te sê - ons is van Afrika, en saam met ons broers en susters is ons daartoe verbind om hierdie kontinent te help bou en te ontwikkel tot voordeel van al sy mense.

As we celebrate the many positive developments on our continent, we are reminded that there is much to be proud of here at the southern tip of Africa in the Western Cape. Such as the fact that our health care is on par with some of the best available in the world, that we have modern equipment, access to medicine and carers who really care.

Laat ek ook van hierdie geleentheid gebruik maak om ons gesondheidswerkers te bedank wat hulself onbaatsugtig aan hierdie provinsie en die mense wat hulle dienste nodig het wy. Vir die meerderheid van ons mense lyk dinge heelwat beter en gaan dit nog veel beter word met betrekking tot gesondheidsorg in die toekoms.

There are challenges - and we do not shy away from addressing these in a constructive manner.

A major criticism of health services is the long waiting periods for some services. While funding and logistics play a role, often the shortage of specialised health workers is a major contributing factor.

In addressing this challenge, the National Health Department recently launched its Human Resource Plan for Health. The plan indicates the training needs for the country and outlines interventions that will improve the supply of health workers - and the Western Cape is in full support of these measures.

Die gehaltemonitering van ons gesondheidsorg uit 'n pasiënte-, personeel- én tegniese oogpunt is uiters belangrik ten einde op ons bestaande diens te kan verbeter. Kliënte- en personeeltevredenheidsopnames word op 'n jaarlikse basis by al ons fasiliteite onderneem. Hierdie inligting word dan verwerk, probleemareas geïdentifiseer en regstellende stappe deur die bestuur gedoen. Hoewel alle fasiliteite oor deeltydse gehalteversekeringsamptenare beskik, is ons ook tans besig om voltydse gehalteversekeringsbestuurders by sommige van ons sleutelfasiliteite aan te stel.

Speaker, die departement kom al hoe meer onder die indruk van die belangrike rol wat nie-winsgewende organisasies (NWO's) as vennote in dienslewering speel. Die toenemende aantal pasiënte wat regdeur die provinsie deur middel van tuisgebaseerde sorg deur NWO's behandel word, getuig van ons verbintenis in hierdie verband.

Last year 910 home-based carers saw 8 615 patients and paid more than 190 000 visits. Clearly, this is an area in which greater coordination and guidance from our side to the NPO sector in helping to address the health challenges in our province remains of vital importance.

In this regard, a particularly exciting development is the massive extension of the expanded public works programme in the social sector during this and coming years. In this programme, 1430 community health workers will receive formal training that will both enable them to provide quality care to the patients for whom they care but also to have marketable skills and opportunities for employment in the health sector in the future.

Another challenge we face is the ongoing promotion of community participation through institutions such as the Provincial Health Council, the Provincial Aids Council, District Health Councils (to be established) and facility boards that ensure that our health facilities respond adequately to community needs. Furthermore, we must build and strengthen public/private partnerships through our existing PPP Forum.

Baie is al gedoen om ons mense meer bewus te maak van hoe belangrik dit is om na jou gesondheid om te sien. Dit sluit pogings in om gereelde fisiese aktiwiteit en goeie voeding te bevorder, terwyl riskante gedrag soos rook, alkoholmisbruik en onveilige seksuele praktyke ontmoedig word.

In conjunction with the National Department, we will continue to roll out the healthy lifestyle awareness campaign with the focus on prevention of communicable diseases (such as HIV and Aids as well as TB); non-communicable diseases (such as diabetes, cancer and hypertension); and the reduction of violence and trauma

Terwyl ons 'n beroep op ons mense doen om na hulle gesondheid om te sien, het die staat 'n verantwoordelikheid om 'n gesonde omgewing te skep en om toegang tot basiese dienste te verbeter wat goeie gesondheid sal bevorder. My departement sal nie sy verpligtinge in hierdie verband ontduik nie.

Since the people elected the African National Congress to govern in the Western Cape in April 2004, this government has been clear in its commitment to delivery.

Speaker, I am not going to list the many deliverables that Health Western Cape has made over the course of the past two years in order to improve health care in our province; safe to say they show that comprehensive and quality health care remains a priority for this government. Furthermore, when Health promised to deliver, we delivered what we promised.

Ons sit ons harde werk voort om gesondheidsorg meer toeganklik vir ons mense te maak deur die inwerkingstelling van Gesondheidsorg 2010, wat binne die breër bestek van dienstransformasie pasiënte na toepaslike sorgvlakke verskuif terwyl dit ook die volhoubaarheid van die totale diens verseker.

Speaker, this budget is about making choices and exercising our responsibilities in a serious manner. It is about our appetite to govern. We take our inspiration from the values espoused by this government in presenting a budget that:

• delivers on this government's undertaking to improve health services;
• provides health care to those most in need, namely families, people with low or no income;
• enables us to take concrete steps toward making health care more accessible and delivering services closer to the people;
• for the first time with the assumption of responsibility for full personal primary health care (PPHC) services, provides for the delivery of seamless PPHC services in our non-metropolitan areas;
• provides significant funding for new equipment, upgrading and maintenance of our facilities throughout our province; and
• employs more than 23 000 people providing health services to more than 72% of the people of this province.

Speaker, in lyn met hierdie regering se verbintenis tot 'n gesonder Wes-Kaap, stort ons meer fondse in gesondheidsorg.

I am therefore announcing nearly R600 million in additional health spending, for a total budget of R6.3 billion in 2006/07 compared with R5,74 billion in the previous financial year. This year's health budget represents 34.4 percent of the provincial budget.

Ons finansiering kom grootliks uit die provinsiale billike-deel, met net oor R4 miljard uit die begroting van R6,3 miljard wat op hierdie manier herlei word. Voorwaardelike toelaes van die nasionale regering kom op 'n bykomende R1,99 miljard te staan. Dit word aangevul deur inkomste wat veral in ons sentrale hospitale deur die departement gegeneer word - wat 'n verdere R297 miljoen by die begroting voeg.

Speaker, a number of national priorities guide the 2006/07 budget of the Western Cape Department of Health. Consequently, we dedicate a significant amount of the budget to specific national priorities. These include primary health care, HIV and Aids, tuberculosis, emergency medical services, human resource development, information systems, the modernisation of our tertiary services and expanded public works programme, which I described earlier.

Die hervorming van openbare-gesondheidsdienste om dit meer toeganklik te maak, bly 'n prioriteit in hierdie begrotingstermyn. Ons strategie om inhoud te gee aan hierdie proses, Gesondheidsorg 2010, vorder teen 'n stewige tempo. Hier is die fokus op primêre-vlakdienste - en die skakel van sodanige dienste met gemeenskapgebaseerde sorg en, baie belangrik, ook voorkomende sorg. Ons wil graag hê dat pasiënte op die mees toepaslike sorgvlak vir hulle behoeftes behandel word.

Die jaar wat voorlê sal van sleutelbelang wees vir die inwerkingstelling van dienstransformasie in lyn met nasionale beleid. Ons diensplan, wat die bloudruk vir toekomstige dienslewering voorsien, word tans gefinaliseer, en inwerkingstelling sal volg sodra die openbare konsultasieproses voltooi is.

Natuurlik sal die koppeling van die nuwe infrastruktuur aan die plan langer neem as die herskikking van dienste. Daarom sal die vorm van dienste wat in Gesondheidsorg 2010 vervat is, intussen binne die bestaande beskikbare infrastruktuur geakkommodeer word.

With respect to infrastructure, business cases for the Khayelitsha as well as the Mitchell's Plain hospitals have been approved. Although at a preliminary stage of planning, it is our intention to fast track the construction of these vital facilities. We are also taking all possible steps to expedite the process of hospital revitalisation that will include in time the Valkenberg, Tygerberg and the Brooklyn Chest hospitals amongst others. However, it is clear that it will be some time before these hospitals are built and can function as an integral part of Healthcare 2010.

Allow me, Speaker, to highlight some critical areas in our budget.

One initiative that I would like to highlight is the establishment of a Directorate of Nursing. Given the critical role played by our nurses, it is my belief that such a directorate will add focus in dealing with the challenge of the nursing shortage. The task of the new incumbent will be to focus full-time on serving the 11 000 nurses in our provincial health team.

In modernising our tertiary services and health services in general, I am glad to report that there will be an increase in the funds provided for new equipment. We have budgeted R172 million for equipment. Those who visited our facilities over the past year, would have seen a dramatic and positive change brought about by the installation of new equipment in the facilities.

In reaksie op 'n verslag dat die gesondheidsdepartement sy batebestuursfunksie moet versterk, oormerk hierdie begroting R3 miljoen vir hierdie doeleinde.

Primary health care and the primary health care approach are extremely important to us. It is our aim in this year to further strengthen the management and staffing at all of these facilities.

Aan die begin van Maart vanjaar het die provinsiale departement van gesondheid bedryfsbeheer van persoonlike primêre-gesondheidsorg-dienste (PPGS-dienste) in die nie-metropolitaanse gebiede van die Wes-Kaap oorgeneem. PPGS-dienste in die Stad Kaapstad volg in 'n latere stadium. As gevolg hiervan dra plaaslike owerhede in landelike gebiede nou nie meer die finansiële las (ongefinansierde mandaat) van persoonlike primêre-gesondheidsdienste nie, en kan hulle hulle fondse derhalwe aanwend om ander belangrike dienste in hulle gemeenskappe te lewer.

Die skep van 'n aaneenlopende gesondheidsdiens in ons landelike gebiede sal bydra om ondoeltreffendhede en duplisering van dienste wat ons tans in ons fasiliteite ervaar weens provinsiale en plaaslike-regeringspersoneel wat in dieselfde fasiliteit werk, uit die weg te ruim. Voorts sal dit rekenpligtigheid verbeter.

Consequent to the promulgation of the National Health Act [2003] enacted in May 2005, Municipal Health Services [MHS] as defined in the Act became the responsibility of local government. Municipal Health Services include-

• water quality monitoring;
• food control;
• waste management;
• health surveillance of premises;
• surveillance and prevention of communicable diseases, excluding immunisations;
• vector control;
• environmental pollution control;
• disposal of the dead; and
• chemical safety,

but exclude port health, malaria control and control of hazardous substances that remain the responsibility of Provincial Health.

Graag wil ek van hierdie geleentheid gebruik maak om 'n beroep op ons munisipaliteite te doen om te verseker dat munisipale gesondheidsdienste soos omskryf in die Nasionale Gesondheidswet, gelewer word. As provinsiale minister van gesondheid is ek in besonder besorg oor kwessies soos veilige drinkwater en sanitêre geriewe in al ons gemeenskappe.

Speaker, this budget also enables us to take concrete steps toward making health care more accessible and delivering services closer to the people. An additional R4 million is budgeted to provide a package of services during extended hours at 10 community health centres. We know if we say we stand for an accessible, equitable service, it must be accessible also in terms of the times that people can make use of the service. Accordingly, we plan to extend the time during which the service is provided from normal office hours to 21:30 at the following community health centres: Delft, Khayelitsha Site B, Mitchells Plain, Kraaifontein, Retreat, Vanguard Drive, Gugulethu, Hanover Park, Elsies River and Grabouw.

Our HIV and Aids programme continues to expand. We are working closely with the National Government, NPO's and organisations like the Global Fund to provide a comprehensive HIV and Aids service throughout the Western Cape. The budget for HIV and Aids during this financial year is R235 million. National government through the conditional grant provides the bulk of the funds, namely R115 million. The equitable share amounts to R35 million; while the Global Fund allocated a further R85 million. Last year's budget was R161 million. Year-on-year this represents a substantial increase in the allocation to HIV and Aids in the Western Cape - and is in line with the priority given to health by government.

Ons mikpunt vir die voorkoming van moeder-na-kind-oordrag is om 'n sukseskoers van 97% te behaal. Dit sou beteken dat slegs drie uit elke 100 kinders van MIV-positiewe moeders uiteindelik positief sal wees. Dit is een van ons vlagskipprogramme, en ek glo die resultate tot dusver is die belangrikste prestasie van ons voorkomingsprogram. Ons beplan om vanjaar 48 miljoen manlike en 180 000 vroulike kondome te versprei.

Our antenatal prevalence, and this comes from the 2004 survey, the latest we have - indicates a prevalence of 15,4% among pregnant women. Nationally it stands at 29,5%. Even though this figure may be lower than the national average, it is still on the increase and there is no reason to be complacent. In some areas of our province, it is as high as 33 percent - and this is where we must work the hardest.

Daar is tans 17 053 (April 2006) pasiënte op ARV-behandeling by 43 persele regdeur die Wes-Kaap, en ons is besig om daardie behandeling drasties te verhoog. Pasiënte op behandeling neem tans met sowat 700 per maand toe, en ons stel dit ten doel om teen die einde van die boekjaar 'n teiken van 22 500 pasiënte op behandeling te behaal. Nagenoeg 272 000 mense sal vanjaar vrywillige berading en toetsing ondergaan.

Tuberculosis remains a major challenge in the Western Cape. I cannot overemphasise the seriousness with which this disease must be treated. Last year there were 44 000 new cases. This means that TB affects 967 per 100 000 of the population in our province. Moreover, TB is now responsible for a third of all deaths in HIV infected people.

In taking on this challenge, it is clear that we need to combine and recommit our resources. To this end, we are continuing with the provincialisation of tuberculosis hospitals. One of these hospitals, Harry Comay, in George, is already a provincial hospital and we are moving forward with the provincialisation of DP Marais hospital in Retreat.

Ons doel is dat alle tuberkulosehospitale teen die einde van hierdie boekjaar hierdie hospitale se voorbeeld sal volg. Weereens wil ek die belangrikheid van 'n aaneenlopende en rekenpligtige diens beklemtoon. Dit is van die allergrootste belang vir ons oogmerk om vanjaar 'n genesingskoers van 72% te behaal.

Ons genesingskoers vir TB verlede jaar het na 68,7% afgeneem - iets waaroor ek baie besorg is. Sekere gebiede van die Stad Kaapstad is 'n uitdaging, en ek sou graag wou sien dat die departement saam met die Stad Kaapstad groter fokus op hierdie gebiede plaas.

In taking our tuberculosis programme forward, we are also going to add an additional R12,5 million to improve the programme at our clinics and our mobile clinics, because this is where TB is detected and where the first contact with our patients occurs.

Another service now provided by the Department of Health is Forensic Pathology Services (Mortuary Services). As from 1 April this year it is a Health responsibility - and no longer that of the South African Police Service, to remove a body from an incident or crime scene where unnatural death is suspected and to provide the subsequent service. This service brings its own set of challenges with an expected total of 10 000 post-mortems per year that will take place at our facilities in the Western Cape. To provide this service R41 million has been allocated. Major upgrading of current facilities must also be undertaken and in this regard we will make available a further R27 million.

Emergency Medical Services, or ambulances, and patient transport remain a focus area in this budget. Here, I believe we are beginning to make progress, although concern that more funding needs to be allocated to support this service persists. During 2005, we provided R50 million to appoint 108 additional uniformed staff and bought 36 additional ambulances. From feedback received, our communities roundly welcomed the improvements gained. This year we budget a further R2 million for new ambulances. We will also equip those ambulances and provide R3 million for additional staff. R3,7 million is budgeted for patient transport vehicles (10 vehicles and R1,8 million to employ an additional 35 drivers). To improve efficiency we have also separated the ambulance service from patient transport.

So ver dit ons psigiatriese hospitale aangaan, maak ons goeie vordering, maar daar is steeds baie om te doen. Saam met die premier en minister Fransman het ek onlangs die voorreg gehad om die nuwe akute toelatingsaal by Valkenberg te open - die eerste fase van die opgradering van daardie hospitaal. Daar is ook 'n ernstige agterstand met verhoorafwagtende gevangenes wat psigiatriese evaluering nodig het. Ons werk tans saam met die departement van justisie en verskeie ander regeringsagentskappe om die probleem te verlig, maar die uiteindelike oplossing is die herbou van die maksimum-sekuriteiteenheid om vermoë uit te bou.

'n Kwessie wat ek as deel van geestesgesondheid wil beklemtoon - iets wat baie belangrik is in ons gemeenskappe - is dwelmmisbruik. As die gesondheidsdepartement het ons hierdie uitdaging die hoof begin bied, en volgende maand open ons die ontgiftingseenheid by Stiklandhospitaal wat ons hande in hierdie stryd sal sterk. Ons het ook R2,5 miljoen bewillig om die eenheid met sy fokus op komplekse gevalle te bedryf. Dit sal die eerste sodanige eenheid in die openbare sektor wees met 10 beddens wat uitsluitlik gebruik word om mense met 'n middelafhanklikheid by te staan.

Program 5 - sentrale hospitaaldienste maak voorsiening vir die aankoop van twee nuwe liniêre versnellers wat die broodnodige radioterapiedienste wat tans aan kankerpasiënte gelewer word, 'n hupstoot sal gee. Finansiering ten bedrae van R2,5 miljoen word ook geoormerk vir die nuwe MIV- neuropsigiatriese diens by Groote Schuur-hospitaal, terwyl 'n verdere R1 miljoen gebruik sal word vir die skeiding van kinder- en volwasse psigiatriese dienste by Tygerberghospitaal. In die algemeen neem ons toewysing aan sentrale hospitale met ses persent toe.

On staffing, I would like to say that the quality of care is affected by the inability to recruit and train experienced and qualified health care professionals. The attrition rate of professional nurses is 12%. In some specialised areas of the nursing profession, like theatre, oncology and psychiatry, it is as high as 26%. This is unacceptably high and therefore, the budget for health sciences and training receives a boost to R43 million this year. Currently we have 2 448 nurses in training with 366 expected to complete their studies at the end of 2006. However, there is no quick fix and it will take time to fill the shortage of nurses, but we have begun to address it by investing in training and also to invest in mentorship. In the metropolitan district health area 106 additional nurses will be appointed.

We are indeed fortunate to receive a specific allocation in terms of Expanded Public Works Programme. This amounts to R20,7 million that will help us to appoint and train more home-based care workers as well as integrated management of childhood illness community workers, TB DOT community workers, and also ARV counsellors and VCT counsellors really strengthening our community-based services. However, apart from improving service delivery, it will also help to create opportunities for our people. For the first time it will open up a career path for community workers entering at the bottom and now really getting the opportunity of moving up through proper training to obtain certified qualifications.

Met betrekking tot gesondheidsorg- ondersteuningsdienste word daar beoog dat ongeveer R20 miljoen oor die volgende vyf jaar nodig sal wees om verouderde toerusting in ons wasgoeddiens te vervang. Ons begroot vanjaar R8 miljoen om 'n tonnelwasser aan te koop wat in hierdie belangrike behoefte sal vervul. Daar word geraam dat die totale aantal wasgoedstukke vanjaar op ongeveer 20 miljoen te staan sal kom, waarvan 14 miljoen intern gedoen sal word.

Speaker, on 1 April last year, funds for capital projects were placed within our budget. In reality, however, the department does not have any executive implementation authority with regard to these funds. This function is still fully the responsibility and function of the Department of Transport and Public Works. The amount budgeted for this year for health facility management in total is R324 million, which includes funding for hospital revitalisation (HRP), provincial infrastructure (PIG) and maintenance. With respect to the HRP, the upgrading of the Paarl Hospital announced during the course of last year has just commenced with the contractor on site. The revitalisation of the George Hospital is nearing completion, work at Eben Donges is progressing slowly and we are working hard to ensure that work at the Vredenburg Hospital stays on track. At the same time, Khayelitsha, Mitchell's Plain and all others will commence with planning this year.

Daar was ook 'n toename in die provinsiale infrastruktuurtoelaag wat via ons provinsiale tesourie vanaf nasionaal in ons infrastruktuurprogram gestort word - 'n toename van ongeveer R50 miljoen verlede jaar na R61 miljoen vanjaar. Inderdaad 'n baie welkome toename.

In conclusion, I wish to thank everyone who participated in this budget, including my Cabinet Colleagues, Treasury, in particular the Head of Department, Prof Craig Househam for his leadership, the management of the department for their support and every staff member working in Health throughout our province for their commitment and hard work.

Ten spyte van die vele uitdagings wat ons vandag in openbare gesondheidsorg in die gesig staar, het ek die grootste vertroue dat die regering op die regte koers is om 'n gesonder Wes-Kaap in die toekoms te verseker. Speaker, ek is daarvan oortuig dat hierdie begroting ons sal help om die uitdagings voor ons te pak - en ek vra dus die Huis om dit te ondersteun en te aanvaar.

Dankie.