FREE STATE PROVINCIAL LEGISLATURE

2014/15 BUDGET VOTE SPEECH

DEPARTMENT OF HEALTH
PRESENTED BY DR BENNY MALAKOANE, MEC FOR HEALTH
09 July 2014

Hon. Speaker;
Hon. Premier;
Hon. Colleagues in the Legislature;
Hon. Colleagues in EXCO (Executive Council);
Hon. Mayors, Speakers and Councillors;
Director General and Heads of Departments (HoDs);
Distinguished guests.

Hon. Speaker, it was exactly two score, nineteen years and twelve days ago that the architects
of our democracy proclaimed the Emancipation Declaration otherwise known as the Freedom
Charter. This was a momentous decree within which all the desired freedoms and rights were
documented which were intended to unshackle all the motive forces of our country from the
manacles of denigrating segregation, dispossession and seemingly total and permanent
bondage.

Clearly depicted are the noble declarations that inform and continue to carve the tortuous
pathway towards attainment of the Vision that we shall: increase life expectancy through
health system effectiveness, driving system change and ensuring sustainable quality
services
Hon. Speaker, the Freedom Charter (26 June 1955) says:
A preventative health scheme shall be run by the State and;
Free medical care and hospitalisation shall be provided for all with special emphasis on
mother and child care.

Section 27,1(a) of the Constitution (Act 108 of 1996), states inter alia; everyone has the right
to have access to health care services, including reproductive healthcare


Disease Profile of South Africa: (Lancet)
The Lancet poses a question of whether South Africa is geared towards a better future when
it is plagued by a quadruple burden of disease, viz.:
1. HIV/AIDS and TB
2. Maternal, newborn and child health
3. Non-communicable diseases
4. Violence and injury and
Mental health disease = quintuple burden of disease

To this question as (sensitive exponents of ideas and fortitude) we respond that: there are
clear plans and personnel infrastructure to address each burden; even though limited
resources pose a constraining inconvenience whereupon the legitimate expectation of delivery
rests.

In the Negotiated Service Delivery Agreement (NSDA) and the ANC Lekgotla Resolutions, nine
Outputs were agreed as a fulcrum upon which healthcare service delivery will rest: the wave
of deliverance shall be stirred through improvement of health systems effectiveness by:
(i) Universal coverage and progressive implementation of NHI
(ii) Improvement of Quality of Health care
(iii) Implementation of PHC Re-engineering
(iv) Reduction of healthcare costs
(v) Improvement of human resources for health
(vi) Improvement of management and leadership
(vii) Improve health facility planning and infrastructure delivery
(viii) Reduce maternal, new-born and child mortality
(ix) Prevent and manage HIV/AIDS and TB successfully

Strengthening Health Systems Effectiveness:
At the onset of my tenure in office on the 15 March 2013, a review of the organisational
structure in line with an EXCO resolution of August 2011 was embarked upon as the entry
point of analysis of inefficiencies that were rampant across the board;
Unannounced visits were conducted and problem areas identified and decisions taken
for rectification.
Consultations and change management programs led by my office were executed post
gap identification.
An enterprise-wide balanced score card which is an Operational plan feeding the APP
was developed and is being implemented with evidence-based performance reviews
done quarterly.
A Service Delivery Improvement Plan (SDIP) was developed.
A Service Transformation Plan (STP) (which is our vision-2030) has been developed and
is ready for presentation to Cabinet for ratification and adoption.
Identified weaknesses in Central and Tertiary hospitals culminated in the
appointments of Chief Executive Officers (CEOs) and to fortify leadership and
governance
The Chief Operating Officer has been appointed to further strengthen the leadership,
governance and alignment of Level 1, Level 2 and Level 3 care.
The redeployment of certain managers/supervisors to other areas of identified
operational needs shall be implemented within the next two to three weeks.
The reliability of security officials is of grave concern. Here, definite changes are a sine
qua non.
The Deputy Director General (DDG): National Health Insurance (NHI) Project
management and facility improvement has been appointed and shall soon be
unleashed onto the unsuspecting and yet expectant communities for the fruits of his
toil. His office shall be supported and strengthened by some of the deployments that
will ensue as mentioned.
The department is working with Provincial Treasury (under PFMA s36) to bring about
financial management stability and expenditure reporting under the current financial
constraints to ensure service sustainability in the long run.
With the findings made on inefficiencies in the Finance component, it has become
necessary that changes and redeployments are be implemented within 30 days.

Programme 1: Administration (budget decreased by 5% from R261m R247m)
Under this programme, we intend to continue to implement the Health System Governance
and Accountability (HSGA) Model;
Implement the NHI programme in the pilot district and progressively roll it out into
other districts and the Mangaung Metro
Improve efficiency and effectiveness of healthcare by PHC (Primary Health Care)
facility clustering to promote pooling of resources and standardisation of quality and
governance.
Implement the system management and community accountability by strengthening
the District Health Councils (DHC), Local AIDS Councils (LAC) and District AIDS Councils
(DAC) and the Provincial AIDS Council (PAC) through inter-sectoral and
interdepartmental collaborations.
Strengthen the referral system between different levels of care including the out-reach
and in-reach programs.
Implement the priority health programs and the Core Standards of quality to create
accessibility through the Balanced Score Card (BSC) approach.

Programme 2: District Health Services (budget increased by 6% from R3.1b- R3.55b).
Hon. Speaker, District health services are enormous and complex as they are a vehicle for
delivery of PHC services to the community. These occur within districts as self-contained
segments of the national health system that is co-terminus with the statutory demarcated
municipal boundaries with its large variety of interrelated elements that contribute to health
in homes, schools, workplaces and places of commonage. This is a priority programme of all.
This I say because according to World Health Organization (WHO), the three trends that
undermine health outcomes globally are:

(a) Hospicentrism with a strong curative focus
(b) Fragmentation in approach and;
(c) Uncontrolled commercialism which undermine health as a public good
The quintuple burden of disease programmes are the mainstay of delivery of this programme
under the HSGA Model.

The 5 major programmes to be implemented under DHS are:
(i) Reduction of maternal, new-born and child mortality
(ii) Combating HIV/AIDS and reducing the burden of disease of TB
(iii) Reducing non-communicable diseases
(iv) Preventing injuries and violence
(v) Mental health services

Specific Actions as from 2014/15 onwards:
Reducing Maternal, new-born and child mortality:
We shall focus on accelerating the implementation of package of key high impact countdown
interventions to save maternal, new-born and child lives as follows:
(a) Saving 90% of mothers: (establish two caesarean section (c/s) and delivery centres in
each district, implement National Committee on Confidential Enquiry into Maternal
Deaths (NCCEMD) recommendations, Campaign on Accelerated Reduction of
Maternal Mortality (CARMMA), Prevention of Mother to Child Transmission (PMTCT),
eMTCT (elimination of Mother To Child Transmission), Nurse-Initiated Management
of Antiretroviral Treatment (NIMART) and Essential Steps in the Management of
Obstetric Emergencies (ESMOE).
(b) Saving 70% of children: (Antenatal Care [ANC], Vaccinations, Integrated Management
of Childhood Illnesses (IMCI) , Human Papilloma Virus [HPV], Nutrition)
(c) Saving new-borns: (ANC, Emergency Medical Services (EMS), Skilled attendance,
Maternal, Child, Newborn, and Womens Health [MCNWH])

Combating HIV/AIDS and reducing burden of disease on TB:
HIV/AIDS has been increasing exponentially since 1990 to 1999, it peaked between 1991 and
2001 and then took a plateau and has since stabilised. However, young people are dying
between the ages of 20-30 years in the same way as old people are dying beyond 60 years.
(Where deaths are at 2 250/100 000 people).

We shall continue to:
(1) Strengthen our HIV Counselling and Testing (HCT), HAST and treatment programmes
(2) Give government stewardship and accountability
(3) Build strong and responsible partnerships with civil society
(4) Protect human rights
(5) Intensify programme implementation (condom distribution, Medical Male
Circumcision (MMC), NIMART)


On Tuberculosis (TB):
This disease is of grave concern as we are beginning to notice a strange phenomenon of
emergence of Drug resistant TB and Extreme Drug Resistant (XDR) TB on cases that never had
TB before.
The Free State has the 3
rd
highest mortality on TB in the country and our cure rate currently
stands at 74%, against the WHO target of 85%.
The death rate nationally has more than doubled since 1997 to date, with estimated deaths
from 300 000 to more than 600 000.

We are going to:
1. Strengthen government stewardship on this disease
2. Intensify screening programme and health promotion
3. Build a strong and effective coalition with civil society formations
4. Find every suspect
5. Test every suspect
6. Treat every confirmed case
7. Trace every contacts
8. Trace and find everyone reportedly lost to treatment
9. Establish a specialised Multi-Drug Resistant (MDR) and XDR TB unit in Mantsopa
10. Establish the paediatric MDR unit in Pelonomi with 20 beds
11. Continue to support other hospitals with MDR/XDR units
12. Finalise the Ithuseng centre project for MDR/XDR for Lejweleputswa
13. Intensify feeding and fortified nutrition programme for the MDR/XDR units
14. Beat the target of 85% cure rate

Mental Health Services:
Mental health services have suffered the misfortune of being neglected over a long time. We
do recognise it as the fifth burden of disease as it is exacerbated inter alia by:

Inadequate facilities, especially for children and adolescents
Substance abuse and
Lack of timeous diagnosis and treatment

We shall be developing all our District and Regional hospitals to have full compliance with
regulations for them to admit and treat mental health patients. We shall soon be finalising
the regulations on Step-down facilities intended to admit patients with mental disorders.
We shall further continue to collaborate with the sector departments of education, social
development and SACR on programmes intended to prevent risky behaviour among the youth
and children.

DHS System Management and Accountability:
As we implement the three legs of PHC Re-engineering viz.; Ward Based Outreach Teams
(WBOT), school health program, District Clinical Specialist Teams (DCSTs) and General
Practitioners (GP) contracting, we shall (resources permitting) initially increase the WBOT
from 45 to 60 to improve outreach. We shall continue to recruit District specialists as we are
currently having the challenge of availability throughout the province.

The 600 volunteers that have previously undergone the first phase of training to become
qualified Community Health Workers (CHW) will be enrolled into the second phase of the
training programme. The second cohort will be identified and enrolled soon to enable a
guided process of availability for consideration to increase the WBOT. These shall work and
be led by Community Health nurses.

School health services will prioritise quintile 1 and 2 schools with special focus on Grades
R,1,4, and 8 in line with national policy.

The eight (8) clinics built using alternative methods shall be part of the first cohort of Ideal
Clinics in the province. These are the Tina Moloi, Bophelong, Edenburg, Phomolong,
Jacobsdal, Deneysville, Mphohadi, Rheederspark. This process shall occur in line with the
Operation Phakisa objectives intended to deliver results quickly and efficiently.

Provision and strengthening of rural health services remain pivotal in our endeavour to
improve coverage and reduce the burden of disease in remote and underdeveloped areas.

Programme 3: Emergency Medical Services (budget increased by 1% from R465m to R470m)
This programme provides Emergency Medical Services (EMS), Planned Patient Transport
(PPT) and Inter-hospital Transport (IHT)

EMS operational coverage shall within resource constraints be maintained at between
90-130 operational ambulances.
The EMS Call centres in Bethlehem, Kroonstad and Welkom will be operationalised
and the one in Bloemfontein subjected to renovation to improve efficiency of triaging
during call taking and quick dispatch for confirmed emergencies.
Replacement of old ambulances will be ideal for service efficiency especially with the
plan to improve response times to within 15 minutes for urban areas and 45 minutes
for rural areas and to this effect we shall take delivery of 60 ambulances, 10 rescue,
20 Planned patient transport vehicles.
We shall continue to strengthen our maternity ambulance services and continuously
monitor Buthelezi ambulances for their performance in the Inter-hospital transfer
services. It is imperative and it is our goal as the department to further reduce
maternal mortality to below 35% as from this financial year.

Programme 4: Regional Hospital Services; (budget increased by 4% from R1.152b to
R1.194b)
The facilities under this programme offer Level 2 specialised care including specialised
psychiatric services.

It is our mandate to reduce healthcare costs from this financial onwards. To this extent, we
shall be:
(a) Implementing a system of gatekeeping practices on prescriptions and orders of
medication, bloods, and blood products.
(b) Strengthening the regulation of private facility licensing policy and practices.
(c) Implementing the managed health care practices, capitation and reimbursement
strategies singly or in partnerships
(d) Manage and monitor implementation and compliance with overtime practices and
Remunerated Work Outside Public Service (RWOPS).
(e) Enrolling the services of specialist from various medical and legal disciplines to assess
medico-legal cases and to assist the department in processing the litigations to reduce
the exhorbitant claims on cases.
(f) Strengthen revenue collection in all hospitals and from cross border patients.
(g) Determine the necessity and implement step down facilities in all the hospitals singly
or in partnerships whichever shall be feasible.
(h) Implement and enforce compliance to proper financial management and
procurement practices.

Programme 5: Central Hospital Services: (budget increased by 6% from R1.961b to R2.079b)
These facilities offer specialised Level 3 services as they are academic institutions on the other
hand. The department shall implement interventions as mentioned for the Regional hospitals
under Programme 4.

The continued under allocation of these facilities for goods and services is going to be
reviewed and proper budgeting processes advanced.

Programme 6: Health Science Training (budget decreased by 27% from R218m to R159m)
Hon. Speaker, this is the one component that is endowed with responsibilities to perform HR
planning, Development and Management.
It forms the core of support for identification of staffing needs for implementation of health
service programmes across all facilities. The department has been experiencing challenges in
this sphere and changes and redeployments are going to be implemented within three weeks
in HR.
We shall be conducting various skill audits in line with Workplace Skills Plan (WSP) and the
findings from performance assessments and shall consider training needs in the following
categories:

1. Professional nurses in Community Health
2. Recruitment and refreshers for scarce skilled nurses in Intensive Care Unit (ICU),
Theatre, Neonatology, Oncology, and Trauma
3. EMS practitioners for attainment of Advanced Life Support (ALS).

The Department signed a Memorandum of Understanding (MOU) with Central University of
Technology (CUT). The department will soon finalise and sign the agreement with the
University of the Free State on various issues of mutual concern including research.




Programme 7: Health care support services (budget increased by 12% from R123m to
R138m)
This programme renders laundry, orthotic and Prosthetic services.
Access to prosthetic and orthotic services shall be maintained at an average of 10 000
patients within the available and this process shall be regulated to prevent abuse and
cost inefficiencies.
Laundries will continue to renew their aging equipment and fleet to bring needed
operational efficiencies. Co-operatives will further be identified to continue with
designs and making of linen, pyjamas and pillow cases for all hospitals.

Programme 8: Health Facilities Management (budget decreased by 20% from R640m to
R509m)
Revitalisation of infrastructure and its maintenance are critical to creating access and creation
of a conducive environment for healing.

The department will be strengthening the planning and project management capacity of this
component for the following services:
1. Project identification and planning
2. Preparation of project definition reports
3. Project monitoring and interventions
4. Project expenditure monitoring and reporting
5. Project Contract management

Hon. Speaker, the budget allocated to this Department is R8.1 billion. For the 2013/14
financial year, the allocation was R7.9b and for the 2014/15, the final allocation is R8.1b. this
indicates therefore that the percentage increase of the budget for Health is only 2% from the
previous allocation.

Do your accounting considering the Consumer Price Index (CPIX) and Inflation!
I hereby table the budget.

Thank You
Annexure: A
BUDGET PROGRAMME 2013/2014 CHANGE % 2014/2015
PROGRAMME 1 ADMINISTRATION 261 158 000 -5% 247 189 000
PROGRAMME 2 DISTRICT HEALTH SERVICES 3 168 972 000 6% 3 354 835 000
PROGRAMME 3 EMERGENCY MEDICAL SERVICES 465 356 000 1% 470 985 000
PROGRAMME 4 PROVINCIAL HOSPITAL SERVICES 1 152 648 000 4% 1 194 401 000
PROGRAMME 5 CENTRAL HOSPITAL SERVICES 1 961 115 000 6% 2 079 749 000
PROGRAMME 6 HEALTH SCIENCES & TRAINING 218 595 000 -27% 159 837 000
PROGRAMME 7 HEALTH CARE SUPPORT SERVICES 123 681 000 12% 138 398 000
PROGRAMME 8 HEALTH FACILITIES MANAGEMNT 640 803 000 -20% 509 948 000
TOTAL 7 992 328 000 2% 8 155 342 000

ANNEXURE A


Source of Funding 2013/14 2014/15
R'000
Allocation
Amount
% Change
Allocation
Amount
Equitable Share 5 453 995 3% 5 616 552
Infrastructure Enhancement Allocation 11 800 108% 24 500
Total Equitable Share 5 465 795 3% 5 641 052
Comprehensive HIV and AIDS 742 984 13% 843 026
Health Professions Training and Development 138 131 6% 146 419
Health Facility Revitalisation Grant 625 754 -28% 448 962
of which earmarked for Health infrastructure component 81 109 -10% 73 293
of which earmarked for Hospital revitalisation component 542 403 -32% 370 674
of which earmarked for Nursing Colleges and Schools component 2 242 123% 4 995
National tertiary Services 849 661 6% 898 091
Forensic Pathology 0
Social Sector Expanded Public Works Programme Incentive Grant 0
EPWP Integrated Grant to Provinces for Infrastructure 3 249 -4% 3 108
National Health Insurance 4 850 44% 7 000
EPWP Grant for Social Sector 0 2 580
Total Conditional Grants 2 364 629 -1% 2 349 186
Own Revenue 160 904 1% 162 104
Revenue Enhancement Allocation 1 000 200% 3 000
Total Own Revenue Allocation 161 904 2% 165 104
Total Allocation 7 992 328 2% 8 155 342