State of the Province Debate with the Ministry of Health

Good afternoon to you Honourable Speaker, Honourable Premier of the Western Cape, Honourable members of the provincial cabinet, Honourable members, Community leaders in the gallery, Members of the different media houses, And most importantly, good afternoon to the people of the Western Cape.

On Friday, the Premier tabled in this House the State of the Province address. While some members of this House made a concerted effort to prevent this from happening, this is a crucial stock-taking process that the people who elected us into this House are entitled to. 

Lest we forget that the people we serve require us to perform our duties and not be embroiled in futile power struggles amongst each other.

Members, let us not lose sight of why we are here.

One of the most sobering thoughts which will make any member reconsider trading theatrics for constructive engagement is this very bleak picture of health in South Africa: Recently, it was announced that the World Economic Forum’s Global Competiveness Report ranks the country’s public health system between 111th and 141st out of 142 countries. This ranking is based on the assessment of the four key indicators which are TB incidence, HIV prevalence, life expectancy and infant mortality. These statistics are not a myth. The effects of our failing health system can be felt by ordinary South Africans, daily. If you look to other health departments across the country you will see how mismanagement has completely hamstrung delivery.

Let us look at the Eastern Cape as an example, a place where I spent most of my time as a nurse and a midwife:

• The province has alone, absorbed more than an extra R1 billion every year since 2009/10 in an attempt to resolve its problems;
• National department’s study found that the estimated cost of the infrastructure backlog in the Eastern Cape would cost around R20 billion;
• In 2012, the province was reported to have 27 267 vacancies of which 16 000 were nurses positions;
• In 2012, 17 hospitals and 168 clinics were operating without piped water in the Eastern Cape;
• A national government audit in 2012 found that if the National Norms and Standards Bill were passed and applied to the Eastern Cape, most of its health facilities would have to close down.

Members, this is simply a snapshot of the bigger problems in South Africa when it comes to health.

The problem with the health system in South Africa isn’t scarce resources, it is mismanagement of already scarce resources. When comparing South Africa with countries like Mexico, Turkey and our BRICS counterpart, Brazil you will see that the money that goes into the service is similar but the outputs leave the country lagging at the bottom of every single barometer.

The National Planning Commission and National Treasury’s diagnosis of the problem can be summarised and attributed to mismanagement, poor use of scarce resources and a failure of political accountability in our health system. The Western Cape had a similar story to tell before this government took over in 2009.

The story has now changed: Indeed when the DA came to office in the Western Cape in 2009 the provincial vacancy rate for trained nurses was 34%. This has been managed down to 4%, a figure consistent with normal staff turnover. In this province we have managed to build three new district hospital to cope with the increasing pressures of our primary health care system while doing exceptionally well on the delivery of services to our people.

• We have increased the number of clients on Anti-Retro-Virals from 75,000 in 2009/10 to nearly 1.4 million people in 2012/13.
• Brought down the Prevention of Mother to Child Transmission rate from 3.6% in 2009/10 to 1.9% 2011/12 which is the lowest in the country.
• We have increased the TB Cure rate from 79.4% 2009/10 to 81.7% 2012/13, again being the highest in the country
• We have managed to increase male condom distribution coverage from 38.8% in 2009/10 to 54.1% in 2012/13. The Institute of Race Relations conducted a study which shows that the Western Cape is topping the charts once again.

Due to our history of racial segregation and alienation of black South Africans from the formal economy and the benefits of state resources, we have had to prioritise redress through upgrading infrastructure. Under this administration, the circumstances of one’s birth will not determine the quality of healthcare one receives. Our budget is spent according to the needs of the people of the Western Cape in order to bridge the gap that continues to divide the haves and the have-nots.

This is why we have spent R2.7 billion on health infrastructure over the last four years. With that money we have managed to build or upgrade:

• 17 primary health facilities,
• 12 ambulance stations or disaster management centres,
• 8 district hospitals including Khayelitsha and Mitchell’s Plain hospitals,
• 3 regional and specialised hospital projects,
• 21 central hospital projects,
• 5 pathology labs;
• The Western Cape Nursing College and
• The Western Cape Rehabilitation Centre (WCRC)

Members of this House, our delivery record is by no accident. It is because of our strong political will which is derived from the very top, the Premier of this province. It is because of the hard working men and women who are the backbone of our civil services. It is because of the commitment of this government to the people of this province. It is because of the respect we have not only for the Constitution, but for the policies and the institutions that bind us to excellence in the work that we do. This is why when it comes to leadership and governance in the Western Cape Health framework we continue to perform well. This is why this department remains one of only three in the country that continue receiving unqualified audits annually. This is also why our budget is spent wisely and to the benefit of our clients in the Western Cape.

Sadly, the same cannot be said for the members sitting on the opposite side of this House. Between Honourable Fransman’s very short stint at the Department of Health and Honourable Uys’ term in office, over R150 mil was lost to irregular and unauthorised expenditure. 

This is an occurrence that has never been repeated when the people of the Western Cape used their power at ballot box and ushered in a competent and clean government in 2009. It is no wonder these two members are unable to listen to the State of the Province Address. It is these good news of service delivery that makes them uncomfortable. I don’t blame you honourable members, the truth tends to hurt sometimes.

The increasing budgetary constraints means that we have had to realign our strategy so that we can meet the needs of the 74% of Western Cape residents who depend on the public health care system. While the demand continues to rise, the financial pot continues to fall short. This is exactly why our relationship with our private partners has been instrumental in delivering services far beyond what is possible through the fiscus. The delivery of a health service remains the sole responsibility of the Department, one that we do not take lightly or abdicate on. 

However, the reliance on government to provide services alone is a model that has proven that it does not work. Our private partners who are a group of well-balanced, diverse and BEE compliant companies assist this government to go far beyond the call of duty. This initiative is not unique to the Western Cape. It is a model that was initiated by national treasury and has since been adopted and implemented by provinces across the board. Examples of these crucial partnerships include: Our working relationship with Clicks and Dischem to roll-out much needed immunization and family planning products. This is not only convenient to our clients but is alleviates the pressures at our primary health care facilities so that waiting times are decreased. With this model, the Department provides the stocks and the private companies roll-out the service. We have over 200 establishments that we have entered into these kind of contracts with. We have managed to bring our clients much needed infrastructure upgrades through the generosity of our partners and examples include:

• The paediatric wing of the Victoria Hospital which will go a long way to assist thousands of children;
• The upgrades that have been done at the Red Cross Children’s Hospital;
• The donation of the new MRI machine in Groote Schuur;
• The roll-out of the five state-of-the-art Wellness Mobile vehicles that travel the province giving children in grade R and one access to quality healthcare and screening
• And the brand new Mossel Bay Clinic currently being built.

These partnerships and initiatives are structured by National Treasury’s rules and regulations, a process that we adhere to. Interestingly, this is also a model our former President Nelson Mandela aspired to achieve through the work of the Nelson Mandela Foundation in conceptualising the Nelson Mandela Children’s Hospital. Members, gone are days when government can sustain a delivery model that isn’t innovative and quite frankly, short-sighted. The whole-society approach isn’t just a philosophy, it is an obligation on all of us. I will be going around the province bringing awareness about wellness to our clients. This is an attempt to show people that health isn’t just about the curing of diseases, it is about taking responsibility of one’s health. 

Together with our community health-care workers, we will be educating people about the importance of making responsible choices that prevent behavioural induced illnesses. To continue the gains we have made despite the crippling financial challenges we need everyone on board. Civils society, business, religious organisations, NGOs and NPOs all need to come to the table where decisions about the future of this country are made. 

We are indeed a formidable force when we work together.

Media Enquiries: 

Colleen Smart Media Liaison Officer Western Cape Ministry of Health Tel: 021 483 5862 Email: Colleen.Smart@westerncape.gov.za