SPEECH by THEUNS BOTHA
WESTERN CAPE MINISTER OF HEALTH
DEBATE ON PREMIER’S STATE OF THE PROVINCE ADDRESS
Better Together The Western Cape Government wants to facilitate improved opportunities for the people of this province through the Better Together approach. Together with each and every citizen, together with civil society, together with business, together with other spheres of government, we are Better Together. Together we can achieve more.
The Better Together approach unfolds through our government’s strategic objectives, all of which have been formulated to build an infrastructure to facilitate economic growth and new job opportunities. As the Premier pointed out in her State of the Province address, it requires a fine balancing act to shift resources into the creation of growth and job opportunities, whilst not distracting from the greatest challenge at hand – to care for the poorest of the poor. The key is growth-creating infrastructure to be used as a powerful magnet for further investment from the private sector. This can only be achieved through good governance.
The best contribution a government can make to stimulate growth, to eradicate poverty, is to govern properly – to govern without inequity, patronage, in an open transparent and efficient manner. This is the most important thing the ANC fails with in South-Africa – to govern effectively.
Leading the way through good governance Speaker, in my address to the House I will focus on this government’s good governance model and how it has been designed to generate accountability – an important aspect for disciplined growth.
Thereafter I will talk about the health portfolio – the challenges that we face and the strategies that we have chosen to shift our resources into economic growth opportunities whilst improving our services to the poorest of the poor. I will talk about our current capital projects – the most ever in the history of the Western Cape – and also about the strategies at implementation stage on the road towards creating the wellness objective.
We receive almost daily reports of offices and systems in our neighbouring provinces that are collapsing. However, in this province good governance is going from strength to strength. The reason for this is that our governance model is based on the principles of respect for the constitution and laws of the country, a clear separation between state and party structure, the building of a professional public service and decentralisation of public service delivery.
Initially these differences are not so noticeable, but as time passes, other governments under the ANC is going from bad to worse while the Western Cape government is going from good to excellence.
To this end we have established a governance model – a provincial transversal management system. Sectoral clusters address issues transversally while line departments become the implementing agents. The system has created a system for departments to communicate with each other. Before different departments were all working in similar communities but the one unaware of the others’ programmes and action plans.
We inherited a fragmented, divided government, and as the ‘brown envelope saga’ indicates, even departments were directly opposing each other – a governance model set up for failure.
Now we see a slow integration of programmes resulting in less fragmentation, improved service delivery and less duplication and triplication of financial and human resources. The transversal management system proves – we are indeed Better Together. In this improved governance model government becomes the facilitator of the needs of our citizens, creating opportunities, creating an open opportunity society where civil society can have a direct influence in our governance model through the working committees.
Speaker, this is a serious warning that I want to put on record today. Our provincial governments in the rest of South Africa, and many central government departments, are collapsing. What happened in Limpopo, surfaced only due to the political struggle within the ANC. There are much more serious dysfunctional departments in some other provinces. ANC governance in many provinces is leading their regions into a state of collapse. There will be a tipping point and then final collapse. It is not possible to monitor and evaluate a government without tight financial discipline, qualified leadership and able management. In other provinces, Treasury has to bail out departments with massive additional spending. This can never be sustainable.
Health – an example of improved service delivery
Speaker, the proposal of the national Department of Health for a National Health Insurance is a sure sign that in ANC-governed provinces public health care is in crisis, with the exception of the Western Cape where through strong leadership and management, the appropriate systems and structure, strict control and fiscal discipline the health system is functional and delivering quality care to patients – we have a universal health care system for all.
What is the difference? The difference is this – in the Western Cape we do not deploy our political cadres, we do not entertain patronage. We appoint according to the principle of fit for purpose. We take financial responsibility.
South Africa’s current health system is divided into great extremes of quality, efficiency and customer-friendliness, which has created a situation where no single part of the system is able to meet all the needs of our patients.
We face some remarkable challenges:
- 4.6 million people depend on public health services in the Western Cape
- Our health facilities handle between 15 – 17 million patient visits annually, including patients from other provinces. This is the highest per capita figure of any region in the country
- During the previous decade 570,000 people emigrated to our province. We estimate that at some facilities close to informal settlements one of 5 patients is from other provinces and African countries.
It follows that an on-going challenge remains the available financial and human resources required to meet the demand. Fact is, we deal with it, with financial discipline, and we do not overspend. We adjust our programme and expenditure to fit the budget.
Western Cape Government Health is certainly leading the country in many areas:
- Through triple therapy, the prevention of mother-to child transmission of HIV the current transmission rate is below 3% while the number of patients placed on anti-retroviral therapy is exceeding 100 000. It is virtually impossible to acquire statistics from other provinces about their ART statistics, but the national Department of Health is quoted that 1,4 million patients are on ART countrywide. It is estimated that approximately 10% of South Africa’s population lives in the Western Cape (Stats SA) which means the Western Cape is leading the other provinces in this regard.
- New smear cure rates for tuberculosis of 80.5%, which is the highest TB cure rate achieved in South Africa. The Department is making significant progress in addressing the epidemic through the Enhanced TB Response Strategy.
- 2931 home-based carers were appointed via 145 non-profit organizations with a CBS headcount of 6 million. In all the other provinces this programme failed and the home-based carers have now all been converted to civil servants, defeating the intention of the programme through the Expanded Public Works Programme.
- Regional general specialist services at all regional hospitals, staffed by adequate numbers of general specialists providing outreach and support, with in addition a family physician training program that has enabled the deployment of an increasing number of specialist family physicians at district level.
- A chronic dispensing unit that allowed for the pre-packing of 1, 7 million prescriptions per year for ease of dispensing at primary health care facilities and thus reducing waiting times at these facilities.
- Undertook a successful mass measles immunization campaign that ended an outbreak of measles in the province.
- The prevalence of diarrhoea and the associated mortality rate, decreased with the addition of zinc and oral rehydration therapy, improvement of environmental factors and the introduction of the Rotarix vaccine.
- Since the introduction of the hand washing campaign in the Western Cape, the provincial Department of Health has recorded a remarkable decrease in diarrhoeal disease hospital deaths in children under 5 years old in the Metro. Compared to last season which reported 37 in-hospital deaths in Metro Hospitals, there have been only 4 during the same period (January to March) of this year.
- The only dedicated stand-alone children’s hospital in South Africa that provides a wide spectrum of highly specialized health care services for children which is supported by a unique trust that has raised millions of rand in donor funding from corporate and public donors to equip and refurbish the hospital.
This was achieved within the context of a very busy health services functioning within allocated budgets that handled 16,2 million primary health visits, admitted a wide range of pathology to hospitals amounting to over 2.5 million patient day equivalents, and dispatched ambulances in response to 519 228 calls. This demonstrates a well-managed service delivering on its legal and constitutional obligations.
Growing the economy through the Western Cape health sector From an economic development point of view, we regard the health sector as one of the most important areas to create economic growth. The only sustainable way to beat poverty is by creating opportunities for growth and jobs. The Western Cape has the potential to become a popular global health destination.
The lesson we have learned in the Western Cape is that we can improve healthcare for everyone. In line with this objective, we are seeking public-private partnerships so that we can both participate in the improvement of the province’s total health service effort.
We believe, and international experience supports this, that the most effective model of health care delivery involves a partnership between the state and the private sector.
Within this environment the private sector would co-operate with the state to deploy its expertise, currently only available to a small number of paying patients, to provide quality health care on a far larger scale.
It also implies a model to grow small- and medium-sized private health care enterprise1s, by offering them access to government business opportunities. In order to provide this interaction and access, we have changed the format of the Public Private Health Forum from a closed meeting to an open opportunity forum where the private sector can propose their ideas within structured sectors. We have no one formula for partnering with the private sector, but are open to discussing proposals and to finding ways to make innovative partnership solutions a reality. In a short time, this DA-government has certainly turned around the communication platform for the private sector, which was non-existent when I walked into this department in 2009.
Partnerships with the PinkDrive Mammography Unit, the Fraunhofer Institute in Germany, GVi Oncology in the Southern Cape and Clicks through the Helping Hand Trust – to name a few – expanded opportunities for our patients to obtain quality health care. This is another demonstration of our Better Together approach. Partnership initiatives such as these are non-existent in other provinces.
The Health Foundation – a new innovation In my budget speech in March I will provide more details on the establishment of the Western Cape Health Foundation. There is a great need for us to provide additional access points for basic primary healthcare services to our public patients. The Western Cape Health Foundation is a vehicle that will facilitate an increase for funds and human resource capacity in the public health domain by offering economic growth opportunities for the private sector. This will assist us to offer the poorest of the poor easier access to health services and that is the essence of Health Care 2020 – a patient-centered public health service.
Dealing with this requires stimulating competition, encouraging innovation in products and services, and encouraging primary healthcare and early intervention instead of expensive specialist and hospital-based care. That is what we mean when we talk of disease prevention, rather than treatment.
Creating wellness Prevention is the choice of the individual. It requires responsible decisions about lifestyle, eating and exercising habits. This government undertakes to care for people who take responsibility for their own health. Later this year we will make some exciting announcements about plans to identify and treat illness before it has gone too far. This supports the Better Together concept. If you take care of your health, we will take care of the health service.
The disease prevention plan resonates with the relevance of the Western Cape’s different and alternative approach towards healthcare. A healthy society will generate people who can live and work and have a happy family life. This is how we intend growing our economy and our democracy.
Health design It remains the target of this provincial government to establish a health facility within easy travelling distance for every citizen that depends on our health services.
In line with this vision, the ongoing maintenance of infrastructure remains a priority. The Western Cape provincial government’s current investment in capital projects and upgrades are the most that this Province has been working on at any given time. The total estimated cost of all capital projects for the next five years exceeds R8 billion.
I want to thank my colleague, Minister Robin Carlisle for his strong leadership at the Department of Public Works, which have restored the quality and efficiency of this department.
These projects vary in size and extent, the smallest being an ambulance station of R10 million to the largest being the R1 billion restoration and re-development of Valkenberg Hospital.
In her State of the Province address the Premier spoke about our government’s commitment to 10% energy and water savings also in hospitals. I am proud that our new hospitals – both the R530 million Khayelitsha Hospital, and the Mitchell’s Plain District Hospital that will open in March next year, and all current and future health facilities – are built in line with the latest international design trends for health facilities. With wind power generators, landscaped gardens, fountains and relaxation areas, they are truly places of healing and in line with our government’s objective of creating wellness. The Mitchell’s Plain Hospital will also feature these environmental-friendly devices.
In closing The objective of increasing wellness is about a well society – people that love the life they live and live the life they love. I believe that our health income generating strategies, infrastructure planning and disease prevention plans has the potential to facilitate a society of opportunities for the people who voted us to govern for them.