Health Budget: Limpopo, Eastern Cape, and North West Province Submissions

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Health

07 June 2004
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Meeting Summary

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Meeting report

HEALTH AD HOC COMMITTEE
8 June 2004
HEALTH BUDGET: LIMPOPO, EASTERN CAPE, AND NORTH WEST PROVINCE SUBMISSIONS

Chairperson:
Mr L Ngculu (ANC)

Documents:
Limpopo presentation
Eastern Cape presentation
Eastern Cape Annual Report 2003 / 2004
Eastern Cape Strategic Plan
Eastern Cape Budget Statement
North West Budget presentation
North West Annual Report

SUMMARY
The Health Departments of the Limpopo Province, Eastern Cape and North-West Province presented the Committee with their 2004 / 2005 budgets. Each of the departments made detailed and wide-ranging presentations covering aspects such as strategic goals and objectives, challenges and future priorities. All three provinces lamented their current budget allocations as too low and one of the main reasons for problems with services delivery. Committee Members noted that all three provinces had received increased budgets for the current financial year and asked in-depth and searching questions about service delivery, staff shortages, shortages of medical supplies and the status of anti-retroviral (ARV) programmes.

MINUTES
Limpopo Province
The delegation comprised of Limpopo MEC, Mr C Sekwate, Dr Manzini, the Head of Department and Mr M Mofokeng, the Chief Financial Officer (CFO).

Dr Manzini started the briefing with an overview of the demographics of the province. Much time was spent on elaborating on the core functions of the health department. The aim was to keep it in line with the National Department's ten-point plan. Re-organising support services and legislative reform were amongst the core functions mentioned. The committee was also given a allocation and expenditure breakdown of the department's budget for the years 1997/98 - 2003/04. Dr Manzini also made a point of identifying priority areas of focus within the department's strategic plan. Improvements on health administration, district health and emergency medical services were amongst the priority areas identified. Lack of funding was a recurring point throughout the briefing.

Mr Sekwate noted in conclusion that he hoped the Committee appreciated what constraints the department faced as a result of being under-funded.

Discussion
Mr M Waters (DA) asked whether anti-retroviral (ARV) rollouts had already commenced in the province. He asked for figures on the rollouts. He also asked what the professional vacancy figures for doctors, nurses and pharmacists were. Mr Waters referred to the department's list of top ten deadly diseases and asked why tuberculosis (TB) had been ranked ahead of HIV/AIDS. He felt that HIV/AIDS was probably the root cause of the majority of the TB cases.

Dr Manzini noted that the department was battling with service delivery. The department had only recently been supplied with ARV stock and rollouts would commence in the near future. She noted that supplies were limited to three months of stock and felt that it would hamper rollouts. Mr Sekwane said that ARV rollouts would commence once sufficient stock had been received. He noted that there was also a lack of personnel to handle the rollouts.

The Chair felt the rollouts of ARV's were important in the broader battle against HIV/AIDS. He stated that pharmaceutical companies had requested information on HIV/AIDS programmes to be better informed on the demand for ARV's. This would facilitate the supply thereof.

Continuing her response, Dr Manzini stated that staff vacancies were a major challenge but all efforts were being made to address it. The department agreed to provide the Committee with the relevant figures.

She agreed that HIV/AIDS was often the cause of many underlying diseases. She however explained that the department's figures on TB did not include those persons who had contracted TB via HIV/AIDS.

An ANC Member asked what steps the Department had taken to address under-funding.

Dr Manzini said that all efforts were being made to communicate the department's concerns to government. It was felt that the province's budget allocation was incorrect and insufficient.

Mr S Njikelana (ANC) asked for clarity on priority funding. He also asked what had been done to address infrastructure problems such as water, sanitation and electricity provision at clinics. He also asked whether public participation projects had received funding.

Mr Sekwane noted that the presentation had not systematically provided priority funding figures. Dr Manzini said that municipal services to hospitals and clinics were being upgraded. Work had already commenced on 112 clinics.

Ms C Dudley (ACDP) asked how the decrease in the numbers of pharmacists had impacted upon the delivery of medicines. She also asked whether NGO's were funded by conditional grants. In addition, she asked how the department was going to achieve its aim of decreasing the numbers of HIV/AIDS infected persons. Ms Dudley referred to the department's eight ARV delivery sites and asked what the department's hopes for them were. She asked for comment on the issue of mother to child transmissions.

Dr Manzini said that there were various programmes in place to deal with HIV/AIDS. She confirmed that NGO's had been funded from conditional grants and provincial budgets. This was especially true for HIV/AIDS programmes. Programmes were in place at hospitals and clinics to deal with mother to child transmissions. They were linked to HIV/AIDS programmes.

Ms M Manana (ANC) asked whether the department kept track of persons it had awarded study bursaries to and whether these persons were regularly assessed. She also asked why speech therapy services had not been developed into a fully-fledged health category.

Dr Manzini said that bursary recipients were monitored. On completion of their studies internships were also provided for them. She said that qualified speech therapists were being trained.

Dr A Luthuli (ANC) asked what plan the department had to deal with its funding problems. This was especially a concern given the ever-increasing number of patients and the dwindling numbers of personnel. Dr Luthuli noted that quality of care would be detrimentally affected.

Dr Manzini said that addressing the department's lack of funding was a major problem. She reiterated her previous comments and said that the issue was complex.

Ms P Tshwete said that she had expected malaria to be on the department's top ten causes of death.

Dr Manzini explained that malaria deaths had occurred but that it had not been consistent over a long period of time. She noted that many people had been alarmed when there had been a severe outbreak over a short period of time.

Ms R Mashigo (ANC) asked for more detail on the department's plans to upgrade its mobile clinics. She also asked how the department coped with the burden of cross border patients.

Dr Manzini stated that 104 vehicles were to be converted to mobile clinics. The process would be completed by the end of July 2004. Dr Manzini pointed out that the department was well aware of the cost implications of cross border services. She pointed out that health care knew no boundaries.

Dr I Cachalia (ANC) asked what the business hours for clinics in the province were. He also asked if clinics were open over weekends. The department was asked to comment on the working conditions and accommodation of doctors in the province.

Dr Manzini noted that clinics were open from 7am to 4pm. She however noted that staff was on standby after 4pm. She conceded that doctors' accommodation in rural areas were poor. The department had initiated public-private partnerships in order to address the problem. The department had agreed to subsidise these partnerships.

The Chair was concerned about the department's funding problems. He felt it would have a directly detrimental effect on service delivery.

Ms B Ngcobo (ANC) asked where the department parked its fleet of vehicles as she had security concerns. Dr Manzini said that the department had in the past experienced problems with vehicle theft. The problem was however being addressed.

Mr Njikelana asked what the budgets for hospital boards were. Dr Manzini stated that budgets have been set aside for hospital boards.

Ms S Rajbally (MF) asked why there were so many vacancies for doctors, nurses and other health professionals. Dr Manzini noted that a variety of factors contributed towards the high vacancy rate. She mentioned high staff turnover rates, the rural nature of the province and funding constraints as factors.

An ANC Member commented that it seemed that the department's budget had not been allocated based on need. The Chair reacted that budgetary allocations were done in accordance with formulas. A scientific method was used.

Ms O Kasienyane (ANC) asked what was being done to achieve reliable ambulance services. She said that complaints had been received about unreliable ambulance drivers. She also asked about the possible causes of infant and child deaths.

Dr Manzini said the department was in the process of separating patient transport and ambulance emergency services. She said that attempts were made to change the attitudes of all personnel. The department had education programmes in place for the prevention of infant and child deaths.

Ms Tshwete asked whether incentives had been offered to TB community workers. Dr Manzini stated that incentives had been offered to TB community workers. They had been offered incentives of R1000.

Eastern Cape Presentation
Dr B Goqwana (Health MEC) said the inequalities in the province were the worst in the country. He commented that it was extremely difficulty to attract health professionals to the province due to its rural nature. He suggested that the National Department of Health allocate funds according to norms and standards of general practice.

Dr Mkezi (Department spokesperson) led the committee through the presentation document. After providing a brief historical overview, he indicated that in 2002 the province had launched Vision 2014 which was a provincial growth and development plan. This had been followed in 2003 with a turn-around plan to strengthen delivery and management and to increase access to health services. The province had also implemented legislative reforms at this time. He stated that the province was now in a position to function properly and to deliver health services to the people. He listed the province's key objectives as, among others, reorganisation of support services; legislative reform; improving quality of care; revitalising hospital services; delivery through the district health system; decreasing mortality rates through strategic intervention and improving human resource development and management.

Discussion
Ms Luthuli (ANC) asked how many Anti-Retroviral (ARV) rollout outlets existed and how they were managed. She enquired whom the Department's radio programme reached and the success rate of the province in attracting scarce skills.

Mrs C Dudley (ACDP) asked whether the Emergency Services budget had decreased and whether the revitalisation programme at Rietvlei Hospital had started. She asked who benefited from the learnership programme and how it was run.

Mr M Waters (DA) asked how many vacancies existed and for what professions. He enquired whether the province had forwarded its business plan for ARV rollout to the National Department and requested clarity on the number of patients that received ARV treatment.

A Committee Member asked how the Province dealt with deaths due to circumcision.

Dr B Goqwana responded that the ARV rollout business plan had been forwarded to the national Department and that seven hospitals had started treatment programmes. He said that many people phoned in to the province's Health slot on radio with questions regarding health and service delivery. A National Health Department representative indicated that addendums to the business plan were still outstanding.

Dr B Goqwana said that there were monetary and non-monetary strategies in place to deal with recruitment of professionals. The monetary strategy was facilitated by the National Health Department. Non-monetary strategies were facilitated by the province and included aspects such as the improvement of infrastructure, entertainment opportunities and crèches for children. Municipalities currently controlled the ambulance service, but this service was being provincialised to ensure that ambulances were available to anyone who needed it regardless of what region they were from.

Dr B Goqwana said that deaths from circumcision since 1996 came to a total of 272 people. Since the promulgation of the Traditional Circumcision Act, 42 people have appeared in court. These harsh measures ensured that the problem decreased dramatically.

As no Department of Water Affairs existed in the province, the National Department of Health worked directly with District Councils on specific health threats. About 1 000 school leavers benefited from the learnership programme.

He said the infant mortality rate was very high and TB was spreading. There were 14 000 vacancies in the Health Department of which 1 584 were professional staff, 687 medical staff, 169 specialists and 45 registrars.

Ms Rajbally (Minority Front) asked whether the Nelson Mandela Academic Hospital would be a hospital for patients and where the 88 upgraded hospitals were situated.

Dr B Goqwana said that rural incentives in inhospitable areas worked well in attracting nurses. There were definite improvements in recruitment of staff, but a lot more needed to be done. He responded that the Nelson Mandela Hospital was a referral hospital and that it was currently in the commissioning phase.

North West Province
Mr M Mayisela (MEC for Health) stated that the province wanted to ensure optimum health for all individuals and communities as well as access to quality care. The provincial health department was customer and performance driven to ensure the best possible level of health service delivery

. The provinces strategic goals included providing quality health care;

accessible, equitable and affordable comprehensive services;

well-functioning and competitive hospital services; implementation of integrated health programmes; a

well-managed and effective District Health System;

competent, empowered and performance focused employees; a

ppropriate and effective organisational systems and

effective management of the Department's finance and assets


Discussion
Mrs C Dudley asked whether the TB infection rate had increased and what the reasons were for the low TB cure rate. She also asked whether the Department had considered a possible relationship between the TB that cattle carry and that of humans.

A Committee Member asked what criteria were used in determining which disabled persons benefited from the free health services provided by the province.

Mr M Waters asked how many patients were in the ARV treatment programme and how many sites had been established for ARV treatment roll out.

Dr Modise responded that four sites had been accredited with ARV treatment status. Three of these sites have completed all training and staffing requirements. The fourth site experienced difficulties in attracting professionals.

Dr Modise added that twenty patients in Klerksdorp were currently receiving ARV treatment. The main problem with curing TB was the interruption rate in treatment. She said that she was not aware of any studies done that linked TB found in cattle with TB found in humans. There had been an increase in TB due to the HIV/TB link. Free medical care for the disabled was only extended to disabled persons without medical aid benefits and only included the provision of assistive devises such as wheelchairs, spectacles, hearing aids and walking sticks.

The Chairperson said that the question of free health to disabled persons must be forwarded to the National Department of Health for clarity and guidance so that a uniform position could be reached. The Chairperson enquired whether the shortages of medical supplies were due to a shortage in the pharmaceutical companies or whether there were other reasons.

Dr Modise responded that the reason for the shortages lay with pharmaceutical companies as the North West Province had to wait four months for supplies and when it finally arrived it came in "drips and drabs". She commented that their current supplies would only last for three months.

The Chairperson asked whether slackness on the part of the province in ordering stock were not to blame for late supplies.

Dr Modise responded that the Department's Pharmaceutical Manager struggled in sourcing drugs as provinces such as Gauteng and the Western Cape depleted the supplies of pharmaceutical companies.

Mr Moloko commented that pharmaceutical companies ran out of stock because no figures were available on the needs of each province.

The Chairperson commented that most private companies were driven by profit and not the well-being of patients and were therefore not concerned whether patients completed the full treatment or not. He suggested that the National Department of Health re-look at the issue of ARV rollout especially in relation to availability of supplies and that the Pharmaceutical Directorate address the Committee on the issue.

Ms R Kasienyane (ANC) asked whether training of doctors included forensic pathology and enquired about who did post-mortem examinations. She also asked why there were always delays in the payment of claims submitted by service providers of Integrated Nutrition programmes.

Mr B Pule (UCDP) asked to what extent the budget was decentralised and whether payments were done in a centralised manner or not. He enquired about what the province was doing about attracting more psychiatrists.

Mr I Cachalia (ANC) asked what the service hours at clinics were, how the province dealt with its transport and ambulance services and what services the province outsourced.

Dr Modise responded that there were no serious payment backlogs for service providers and that backlogs that had occurred might have been due to problems experienced with accounting mechanisms.

Mr Mongale (Deputy Director-General) commented that the District Surgeon portfolio had been done away with and that three forensic specialists had been appointed at three district hospitals. The province was training more medical officers in forensic medicine. The province was taking control of South African Police Services (SAPS) mortuaries; audits of all mortuaries have been done and their staff establishments had been completed.

Mr Mongale commented that the School Nutritional Programme had been transferred from the Department of Health to the Department of Education and the former would therefore no longer deal with payment for Nutritional Programmes.

Mr Mongale commented that the country had a shortage of psychiatrists and that these shortages were not only felt in the North West Province, but also in other provinces. The Health Service Delivery branch would be targeting specialised people in order to increase the number of psychiatrists employed at provincial hospitals. Clinical Psychologists have relieved a lot of the pressure on the Department relating to psychiatric services. Some clinics have extended their hours from 7 to 24 hours per day. The security services have been outsourced completely whilst the province was considering outsourcing laundry services.

Dr Luthuli asked for a breakdown of staffing and recruitment done per hospital department.

Mr S Njikelana requested clarification on "hotel" services. He asked what the ratio was between personnel and non-personnel services and what improvements had been made in local capital expenditure.

Mr Mongale responded that the province was struggling with the staffing of rural hospitals and public health clinics. The province was doing better with attracting nurses, but not doctors.
The province started with the refurbishment of some hospitals with the aim of setting up private suits for private patients. Discussions with medical aid schemes have started with the aim of enhancing the "hotel" programme.

Mr Mongale commented that areas with strong hospital boards provided the Department with good community partnerships. Where health professionals knew the community was involved they tended to act more patient friendly.

The Chief Financial Officer of the Department responded that personnel expenses comprised 62% and non-personnel expenses made up 38%. In previous years, the Department had not done well with personnel expenditures therefore a concerted effort had gone into improving this.
Capital expenditure had increased by 12 % over the previous financial year.

The meeting was adjourned.

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