Speech by Refilwe Mashigo on the Department of Health Budget Vote Debate

6 June 2007

Madame Speaker

Hon.Minister

Hon. Deputy Minister

MECs

Hon. MPs

Guests

The ANC-led government has since 1994 been involved in a transformation process that includes a new Constitution, state machinery and changing policies into a democratic society, based on the principles of non-racialism and non-sexism. Health as an essential basic service should be accessible to all the people. As a result health care infrastructure is a priority for effective service delivery in our communities.

To fulfill our contract for “A better life for all”; the government is prepared to provide high quality health care to the people of South Africa. This is their right, fought for and enshrined in the Constitution.

My topic is hospital revitalisation; a programme initiated in 2003 for completion in 20 years. Last year, I stood here and informed the house that 4 hospitals will be completed during 2006/07 namely:

  • Lebowakgomo – Limpopo
  • Jane Furse – Limpopo
  • Mary Theresa – EC
  • George - WC

Today, I stand here to inform the house that the 4 hospitals are completed and fully functional. I’ll be referring to Lebowakgomo hospital in my speech. The CEO is mrs. Morongwa Mohapi and this once poor, unhealthy hospital is now a “state of the art” institution through the hospital revitalisation grant.

The purpose of the Hospital Revitalisation Grant is to provide funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, monitoring and evaluation of hospitals in line with national policy objectives. In addition it seeks to transform hospital management and improve quality of care.

Allocations on hospital revitalisation increased since 2003 from R717,6m to R2,6b in 2009/10. 2007/08 allocation is R1,9b.
Expenditure for 2006/7 was:

Budget: R1,439b
Roll over: R319m
Amount spent by provinces: R1,560b (88.7%)

Planning and process

The 2007 State of the Nation address emphasised the importance of compliance by the departments.
Provinces must meet certain conditions and requirements as outlined in DoRA and PFMA to access the funds and for monitoring; like these mentioned below:
Provinces must:

  • Submit Project Implementation Plan for approval by NDoH before money is transferred.
  • Strategic plans must include comprehensive hospital plans, which provide a framework on which business cases are developed.
  • Submit cash flows over MTEF period, including remainder of the year.
  • Hospital revitalisation team must be appointed as guided by the Project Implementation Manual.

The dept. should monitor by:

  • Quarterly performance report by provinces.
  • Monthly financial reports
  • Quarterly visits to provinces.
  • Annual reports from provinces.

Both the National Treasury and the Dept. of Health are aware of the requirements according to DoRA before it is enacted. As a result it causes concern when qualified reports are received due to non-compliance.

Management

Hospital managers/CEOs
In the 2006 State of the Nation address, the President stated that: “By September 2006, hospital managers will be delegated the authority and held accountable for the function of the hospitals”.
All provinces have delegated authority and responsibility to the CEOs. 50% will be enrolled in formal training programmes. The questions are:

  • Do they understand the scope of their delegation?
  • Are they able to carry out the delegations?
  • Do they have enough resource to enable them to manage?

Hospital boards The board members are community representatives. They link with the communities by calling meeting and giving feed back and receiving praises and concerns about the hospitals.

Regular meetings will make communities aware of Primary Health Care and more utilisation of the clinics i.e. understanding why they should start at the clinics and that only patients with complications and when it is deemed necessary are referred to higher levels of care like hospitals through a referral system.

Batho-pele Meaning “People first” is an important tool to assess overall attitude of the hospital staff to patients. There is a Toll free no. to phone; and feed back forms for completion by patience. This tool is under utilised and problems are not picked up in time to be addressed and eliminated. People understand what Batho pele is but do not actually assist in real assessment by phoning or completing available forms; except expressions at meetings.

Quality care. Skilled, dedicated and committed health workers are needed. This also includes relevant technology, equipment and enough resources to perform the duties.

The following services, although funded separately, form an integral part of hospital revitalisation programme as they contribute towards quality care:

Emergency Medical Services. EMS and ambulances are run by provinces and training is standardised nationally. Provinces have increased the number of personnel, EMS vehicles and separated planned patients transport.

The people of Thabazimbi in Limpopo are benefiting from these: 4 shifts with 8 workers per shift and 8 ambulances. The Metro Emergency services in WC, under Dr. CC Robertson, have reduced their response time through technology. They operate from Karl Bremer Prov. Hospital, where all calls are direct to the control room and the whole operation directed and monitored from there.

Provinces like KZN, NC and WC have increased use of air ambulances.

These increases have improved the response time for emergencies in different areas with positive impact on people’s lives. It should however be stated that some provinces are still lagging behind.

Health professions training and development. Properly qualified health workers are needed and this is discussed separately in this debate.

Other professionals and technical experts are part of the human resources pool needed to give quality care.

Forensic Pathology services and mortuaries. This service is well placed at the hospitals for follow ups and proper co-ordination of information and results. Upgrading of existing mortuaries building of new ones, acquiring equipment, vehicles and staff need urgent attention.

Maintenance

Hospital structures are supposed to have a lifespan of about 20+ years. The community of Lebowakgomo is proud of its transformed hospital and thinks there is no hospital better than theirs. To them this is the ANC-led government landmark and would not like to see it neglected and deteriorate due to lack of maintenance and repair funds.

It should be clear who is responsible for maintenance of hospitals and those relevant departments should commit themselves in writing.

Social implications
Redressing the imbalances in health care services.

Dignified and responsive healthcare. A hospital will be associated with life not death as has been the case with many hospitals in the disadvantaged communities.

Jobs will be created. Many unemployed people will get jobs either permanent or temporary during the construction of hospitals. Professional staff will also be employed.
Social mobilisation. Communities need to be educated on the importance of attending local clinics as this is where PHC lies. Some patients queue for hours at hospitals only for check-ups of non-communicable diseases; which could have been done at the clinic as there is always enough supply of essential drugs. There are community structure which can be mobilised i.e. CDWs, NGOs, clinic and ward committee, to address issues of health care services. ANC has a culture of volunteerism and communities should freely avail themselves and participate in activities for the development of their communities.

Communication. There should be interaction and consultation between the different spheres of government and departments.

2010 FIFA World Cup and after.

Most referrals will be directed to public health centres.
Our health infrastructure should be up to standard to meet the needs.
Health services established for these events will benefit the communities afterwards.
The dept. will complete an inter-sectorial operational plan with other depts. and sectors.

Conclusion.

We need to catch up with the 20 years target of the programme in the remaining years. There are policies in place to assist in nearing or achieving the targeted hospitals in time.
As public representatives and members of the portfolio committee, we shall do our oversight and interact with the department for a better life for all.

The ANC supports the budget.