The Provincial Government of the Western Cape Strategy to Increase Wellness in the Western Cape

We launch today our plan to increase the wellness of the people of the Western Cape. Our focus is on "wellness" because our plan goes beyond the management of disease, which is the core business of the Department of Health, to the prevention of disease, which is the business of government as a whole, civil society and, most importantly, people themselves.

To measure our progress, we have chosen a set of high-level impact indicators specific to our local circumstances and in line with the Millennium Development Goals. These are life expectancy, maternal and infant mortality, and the incidence of HIV and TB infection and the patient experience of the public health service.

There are two parts to our strategy.

The first, foundational part is to reduce the burden of disease by tackling the primary drivers of mortality and morbidity. These are HIV/Aids; TB; injuries, largely caused by inter-personal violence and road traffic accidents; non-communicable diseases such as cardio vascular disease, high blood pressure, asthma and cancers; mental illness, especially mental illness caused by substance abuse; and childhood illnesses, many of which are a function of poverty and a lack of basic sanitation services.

The second part of our strategy is to improve the quality of care we offer in managing the burden of disease at our health care facilities.

Reducing the burden of disease.

Our plan to tackle the downstream drivers of the burden of disease includes:

• A Summit on the Burden of Disease, the purpose of which will be (1) to review the latest available data on the burden of disease, (2) to review the response to the burden of disease by all levels of government and by role-players outside of government in the private sector and civil society and (3) to identify an action agenda for implementation designed to advance the collective effort of all role-players.
• The roll-out of our mass HIV Counselling and Testing Plan (HCT), which seeks to test 1.2 million people, provide ART to thirty-one thousand (31 000) new clients, keep nine-six thousand (96 000) HIV patients in care, screen 1.1 million people for TB, distribute 122 million male condoms and 1 million female condoms. The campaign is supplemented by on-going effort to encourage safe sex and provide information about TB.
• The development of a road safety strategy to reduce injuries and fatalities, in partnership with the Department of Transport, the Department of Community Safety, the City of Cape Town and other municipalities.
• The further development and implementation of our substance abuse strategy, which covers both alcohol and drug abuse, and involves extending drug intervention services to key hospitals, increasing the number and reach of drug treatment programmes, increasing the provision of psycho-social support services at schools, the implementation of the Liquor Act, the increase of aftercare and reintegration services for victims of substance abuse and the introduction of case management and monitoring and evaluation tools for all provincial substance abuse services.
• The introduction of a Healthy Lifestyles campaign designed to tackle (1) the excessive consumption of salt, unhealthy fats and sugar, (2) a lack of adequate exercise and (3) the long-term use of tobacco products. Before implementing such a campaign we will do extensive research on international best practice and carefully consider the costs and potential benefits of such a campaign.
• The implementation of a strategy to reduce childhood illness that targets both the environment in which many children live and the healthcare response to the problem. Interventions include the implementation of our human settlements strategy, which seeks to increase the number of serviced sites in informal settlements, the accelerated rollout of the Department of Health's immunisation programme, the accelerated rollout of the Department of Health's programme to prevent the transmission of HIV from mothers to their children and the on-going implementation of the Department of Health's strategy to prevent deaths caused by diarrheal dehydration.

It is crucial to understand that while illness is often an unavoidable affliction, wellness is also to a significant extent a matter of choice. Road accidents can be avoided by sticking to speed limits and not driving under the influence of alcohol and drugs; many diseases can be avoided by eating in moderation, exercising and choosing not to smoke or drink excessively; HIV infection can be avoided by engaging in safe sex. These are often difficult choices to make, and even the best intentioned of us fail sometimes, but it is nevertheless imperative that the people of the Western Cape accept personal responsibility for behaviours that lead to injury or illness.

Improving the quality of care in the public health system.

The challenge for the public health service is to deliver high quality, value for money health care. While the Western Cape Department of Health prides itself on being the best performing Health Department in the country, health services in the Western Cape continue to operate under immense pressure. Symptoms of this include the high bed occupancies in hospitals, the frequent need to divert ambulances between hospitals, an inability to timeously secure intensive care beds for critically ill patients, long waiting times at clinics and long waiting lists for surgical procedures.

The Western Cape Department of Health is currently evaluating the outcomes of Healthcare 2010, and developing a strategic and business plan for Healthcare 2020, which is scheduled for delivery on 1 August 2011.

The Healthcare 2010 strategy was overwhelmingly successful. Our Department of Health is the best run the country. It is well managed and its finances are sound. Healthcare 2010 drove the introduction of a Comprehensive Service Plan which set out the Department's delivery agenda in respect of people, equipment and infrastructure. Healthcare 2010 also focused on health services at the most appropriate level though a primary health care approach, rooting services in communities at clinics, community health centres and through home-based care.

The success of Healthcare 2010 has created an opportunity for us to take healthcare in the Western Cape to the next level. The Healthcare 2020 strategy will involve the following key elements:

• A focus on patient experience
• Improving health outcomes through monitoring and evaluation
• Enhancing Primary Health Care
• Strengthening District Services
• Building strategic partnerships

Patient experience will need to be better defined, indicators and targets identified and measured. As part of the Healthcare 2020 plan, we will develop a method of measuring patient experience, benchmark it, and then set targets for improvement.

Issued by:
Theuns Botha
Minister of Health Western Cape