DEPARTMENT OF HEALTH

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DEPARTMENT OF HEALTH
MPUMALANGA PROVINCE

• BUDGET HEARING
• MAY 2002

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VISION

• Is a caring and humane society in which all the
  inhabitants of Mpumalanga have access to
  affordable, good quality health services.

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MISSION

• To provide and improve access to health care for
  all, and reduce inequity and to focus on working
  in partnership with other stakeholders to improve
  the quality of care on all levels of the health
  system especially preventive and promotive health
  and to improve the overall efficiency of the
  health care delivery system.

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• The following priorities were set for improving
  Health in Mpumalanga, and were confirmed by the
  MEC in her policy and budget speech.
• Tackling HIV and AIDS
• Improving Child Health
• Improving Adolescent Health
• Improving Womens Health
• Managing Rehabilitations Services
• Improving Mental Health
• Reducing Infectious and Parasitic Diseases
• Tackling Trauma and Violence
• Improving the Management Chronic Conditions
• Improving Primary Health Care

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• Improving Hospital Services
• Improving Pharmaceutical Management System
• Develop a Quality Framework
• Develop the Workforce
• Develop and maintain our Facilities
• Poverty Alleviation/PNSI
• Improve Information and Communication

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Achievements against priorities

• Much has been achieved against the priorities,
  such as

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• Tackling HIV and AIDS
• Health Promotion Practitioners were trained as
  master trainers on Voluntary Counseling and
  Training (VCT) and they in turn are training
  Health Workers on VCT.
• Life Skills programmes were introduced and
  implemented in Primary and Secondary Schools.
• Awareness and Education Campaigns were conducted
  in all the districts.

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• The Provincial Aids Council was launched as well
  as the District Councils in all the districts.
• Home Based Care Projects were initiated in the
  Province and the pilot sites for Prevention of
  Mother to Child Transmission were established at
  Shongwe and Evander.
• Our pilot sites for Neviarpine are continuing
  to provide the drug to pregnant women.

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• ? We have invested considerable time and energy
  preparing the research sites for the prevention
  of mother to child transmission of HIV programme.
• ? In addition,more Health Workers need to be
  trained in Voluntary Counseling and testing.
• ? The launching of the Provincial Aids Council
  as well as the District Aids Council marked the
  culmination of the collaboration of efforts
  between government and the stakeholders to
  strengthen the partnership against the spread of
  HIV/AIDS. Local Aids Council are in the process
  of being established.

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• However there are many challenges and
  constraints which still need to be addressed in
  this priority.

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• Improving Child Health
• The Province conducted a successful Immunization
  campaign in which all districts reached an access
  of 90 coverage. Minmec has however imposed a
  challenge for the Province to reach over 90 to
  100 coverage.
• An enhanced measles surveillance system was
  initiated and implemented.
• There is a nil return of polio cases since 1990.
• IMCI is implemented in focus areas, covering all
  our district.

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• Three of our hospitals received Baby Friendly
  Awards. (Themba, Barberton and Bethal)
• Mpumalanga still experiences a high rate of
  infant mortality which is attributed to factors
  such as HIV/AIDS, Malnutrition etc.

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• Improving Women's Health
• Guidelines on Management of main causes of
  maternal deaths were developed, launched and
  distributed throughout the Province.
• Community awareness on the major causes of
  maternal deaths were addressed during the
  pregnancy education week on radio Ligwalagwala
  and Ikwekwezi.

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• ? The management protocols for labour and
  hypertensive disorders in pregnancy had been
  completed and distributed to all facilities.
  These are used in all facilities and in
  particular those hospitals without a resident
  obstetrician.
• ? Mpumalanga has been identified as one of the
  pilot sites for the Cervical Cancer Screening and
  Coloscopy Clinic Project. The following sites
  have been identified
• Philadelpia Hospital
• Themba Hospital

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• However there is still poor reporting of Maternal
  Deaths and their causes.
• Abortion Care Programme Only 6 hospitals in the
  Province are currently implementing TOP. The
  demand for TOP services has however increased.

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• However the culture and the religious beliefs of
  the Health Workers imposed a constraint on the
  effective provision of TOP services.
• In terms of maternal mortality most of the deaths
  are attributed to HIV and AIDS, hypertension
  during pregnancy, etc.

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• Managing Rehabilitation Services
• During this period the Department issued a lot
  of assistive devices to people with disability
  such as electric wheelchairs, hearing aids,
  walking aids and prosthesis.
• 983 Wheelchairs were distributed throughout the
  Province.
• 468 Hearing Aids were issued.

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• ?A community based Rehabilitation Peer Counseling
  Programme established under the auspices of
  Disabled People South Africa, Mpumalanga is
  continuing. This programme has been extended and
  services are rendered in all 17 Municipalities
• ? 5963 Individuals have benefited from this
  programme.

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? An integrated disability service programme for
the Department has been developed as an input to
the Provincial Plan of Action on Disability
facilitated by the Office on the Status of
Disabled Persons in the Office of the Premier.
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• Improving Mental Health Services
• PHC Nurses were trained in Mental Health Care.
• Medical Officers attended workshops on Mental
  Health Care and they were trained in Mental
  Health Care, Assessment, Diagnosis and Treatment.
  

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• However the Province does not have facilities for
  chronic patients. Patients are referred to
  facilities outside the Province in particular
  Gauteng and this imposes transport and
  accommodation problems in such Provinces.
  Therefore the need to develop community based
  facilities and a chronic care facility in the
  Province.
• The Othandweni Violence Referral Centre is
  progressing well and is counseling and supporting
  on an average 80 clients per month. Clients seen
  presented with rape, other sexual offences and
  domestic violence.

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• Victim Empowerment Rooms have been established
  in hospitals such as Ermelo, Lydenburg,
  Middleburg and Witbank.
• A database of all mentally ill patients has been
  initiated and has provided information in terms
  of the magnitude of mental health problems,
  types, length of treatment, patterns of diagnosis
  and prescription. This information will form a
  basis for resource planning in mental health.

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Reducing Infectious and Parasitic
Diseases Tuberculosis. ? The TB programme was
successfully conducted. ? The availability of
TB Drugs was secured. ? The laboratory turn
around time for sputum smears remains below 48
hours average, with most of the clinics receiving
their results within 24 hours.
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? TB is treated according to the Direct Observed
Treatment Strategy (DOTS). Executed in PHC
Clinics the DOTS Programme has been effectively
implemented in the Province. ? Patients who can
not be treated on an ambulatory basis are
admitted in one of the Santa Hospitals or the
Provincial TB Hospital. TB registers are
maintained in each of the hospitals for all
patients admitted.
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? However the doubling of the mortality ratio
within 2 years a finding reflected in the
National TB Statistics does indicate the maturing
of HIV Epidemic and the urgent need for adequate
palliative care provision and dedicated TB
facilities. ? TB Management has been identified
as a National Priority and to that regard a
Medium Term Strategy was launched at Standerton
to cover 2002 to 2005.
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Malaria ? Malaria Programme received an award
for their successes. ? A field based evaluation
of local mosquito plant repellents demonstrated
that fever tea plant (Lippia javanica) provides
effective protection against malaria mosquito
bites.
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• Cholera
• The Cholera Control effort continued into the new
  financial year. Radio slots were obtained for
  health promotion. Health Promotion Material,
  water sanitizing materials were distributed.
• Training of personnel in cholera control.

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Managing Chronic Conditions ? Standard Treatment
Guidelines were developed in line with
International Best Practice and National
Guidelines. ? An essential Drug List at both
Primary and Secondary Levels of care developed
and implemented ? 23 Community Service Dentist
were appointed, the Continuing Professional
Development Programme is on-going.
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? The Dentists are given the opportunity to
rotate to more specialised services at Witbank
and Rob Ferreira, to enable them to practice
their newly acquired skills. ? In respect of
Ophthalmology Services, eye care awareness was
conducted in the Province.
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? A primary eye care network has been established
in all hospitals and several clinics in the
Ehlanzeni district, at Embhuleni, Piet Retief and
Bethal Hospitals in the Eastvaal, and Witbank
Middelburg and Philladelpia in Ekangala.
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Improving Primary Health Care Services. ? PHC was
adopted by the Province as the main strategy for
developing and promoting the health of the
communities, our goal was to bring health care
closer to our communities, ensuring an equitable
distribution of resources and encourage
individuals to fully participate in decision
making and responsibility of their own health
care.
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? It was the objective of the Department to
develop the capacity of local communities,
clinics and health centres to provide high
quality health Promotion and comprehensive PHC
Services. ? However patients bypass clinics and
go directly to hospitals where it is perceived
that they would receive a better quality of
service.
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• ? Much still needs to be done on the provision of
  an Essential PHC Package.
• ? The availability of drugs and staff at clinics
  are some of the challenges facing the Provision
  of PHC.
• ? The availability of drugs has however improved.

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• Develop a Quality Assurance Framework
• ? The Quality Assurance Unit conducted various
  workshops in all three districts on improving the
  quality in the provisioning of our health
  services.
• ? In service training on Batho Pele and the
  Patients Charter was conducted by the Quality
  Assurance Unit.

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• ? However the question posed is are we adhering
  to these principles and the Patient Charter.
• ? These principles and the Patient Charter are
  still very relevant, if we are to improve the
  quality of our services.

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? Our Province received a number of Awards to
reward good Performance namely Tonga received a
Certificate for best practices as a rural area
with external support. Lydenburg as a rural area
without external support. Middelburg received a
certificate for participation as a urban area
without external support. Lydenburg received a
trophy for the Best Managed HIV/AIDS Programme
nationally.
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Ehlanzeni District awards for best managed
HIV/AIDS TB Programme nationally. Piet Retief
certificate for best practice in Quality
Assurance Three prizes were received in the
Cecilia Makiwane Awards.
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Improving Emergency Medical Services ? The
management of EMS services was decentralized to
the Hospitals. This however posed many challenges
in the provision of EMS and the management there
of. ? Work-study eventually approved the
establishment of EMS directorate in the
Provincial Office which will attend to all issues
affecting the provisioning and management of EMS.
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? The Director EMS has been appointed. ? 30
Ambulances were purchased, as well as 30 patient
transporters. ? However our drivers will be
subjected to extensive training so as to ensure
that these vehicles are not lost due to reckless
and irresponsible driving.
40
? In service training is provided at the
training college in Barberton. ? Training
facilities are not adequate and most personnel
are still sent outside the Province to do
training. ? We will be looking however to the
possibility of developing a Training Centre in
the Province.
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Developing the Workforce. The objectives set for
achieving this priority ? The developing a
Workforce Plan for the Mpumalanga Health
Department. ? Developing a training and education
plan in support of the Workforce Plan.
Establishing a Personnel Management System. ? The
training and education plan was finally put in
place during 2001 and training programmes
conducted.
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? A workforce Plan is being finalized. ?
Performance Management System is in the process
of being finalized. ? A major constraint was the
lack of an approved organisational structure. ?
This resulted in understaffing in some areas and
a skewed distribution of personnel.
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• Improving hospital services
• ? The objective was to develop the capacity of
  district hospitals, regional and referral
  hospital complexes and where appropriate provide
  a range of secondary and tertiary care services
  in the Province.
• ? Due to an inadequate referral system our Level
  1 services experience an influx of patients and
  inappropriate admissions.
• ? Aim is reduce referral outside the Province.

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PHC centres and clinics are passed. ? This
imposes an increasing burden on our hospitals. ?
At present Level 2 services are provided at
Witbank Hospital. ? A programme has been
developed to Redistribute specialist services to
the 3 regions in the Province, namely Rob
Ferreira-Themba Hospital complex in Ehlanzeni and
outreach services at Ermelo in the Eastvaal.
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Improving Pharmaceutical Services ? Because of
the cash flow constraints experienced during the
year 2000, the early parts of 2001 initially
saw the inadequate supply of pharmaceuticals in
our facilities. However by June 2001 all accounts
for drugs were paid and the supply of drugs
improved dramatically reaching a level of 95.
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? However because of inadequately trained staff
especially in the clinics a short supply of drugs
was experienced in some clinics. ? The theft of
drugs also poses a major problem on our
resources, thus one cannot over emphasize the
stamping out of corrupt officials.
? There is a need for the training of pharmacists
to monitor the supply of essential drugs and
needless to say the revision of the Essential
Drug List is important.
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Improvement and Maintenance of our Health
Facilities There was an on going process of
upgrade our health facilities and clinics in the
Province. New Piet Retief Hospital(main
building) The building work has
commenced. Upgrading of hospitals Themba
Hospital, Witbank Hospital
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New Clinics built Mmamethlake, Nonkaneng, Seabe
and Moloto Clinics. The following upgrades are
planned for 2002/2003 Kwamhlanga Hospital, Rob
Ferreira Hospital, Philadelphia Hospital, Witbank
Hospital, Embhuleni Hospital, Themba
Hospital, Ermelo Hospital and Mmamethlake
Hospital
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Pharmaceutical Depot Clinics Amsterdam Moutse
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BUDGET 2002/2003
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Explanatory Notes Programme 1
Administration The Department was able to
control Cell phone and Telephone expenditure.
Savings effected were needed to cover over
expenditure in inventories (i.e. medicine and
equipment urgently need in the hospitals and
clinics).
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Programme 2 District Health Services Savings
effected by rationalising renting of various
former district offices and utilisation of
government buildings in terms of Cabinet
Resolution.
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Programme 3 Regional and Specialised
Services. Payment for Specialised equipment
ordered during 2001/2002 will be effected during
the first quarter of 2002/2003.
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Programme 4 Human Resource Development Adjusted
budget of R2,987 million was wrongly Gazetted by
Provincial Treasury to Programme 4 instead of
Programme 6. Used to cover over-expenditure in
programme 6.
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Programme 5 Health Care Support. Savings due to
scaling down of activities in the packaging
deport in Middleburg to the main depot at
Ekandustria.
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Programme 6 Health Facilities and Capital
Stock. The programme is overspent due to the
error as mentioned above.
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Conditional Grant Integrated Nutrition
Programme Payment to contractors and helpers for
services rendered in March, effected during April
2002. Health Professional Training and
Research Payment to both University of Pretoria
and Medunsa for joint appointees effected in
April 2002, for March services.
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Redistribution of specialised hospital
services. Specialised equipment ordered in late
2001/2002 payments to be effected during first
quarter of 2002. HR R For planning briefs, as
a result of appointment of consultants delayed
due to tender processes and repriotitization of
projects.
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Health Management Under expenditure due to
unavailability of organogram which was urgently
undertaken, for appointment of CEOs and Senior
Managers at designated hospitals.
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PROVINCIAL INFRASTRUCTURE Orders for greater
capital equipment have been issued, awaiting
delivery to effect payment.
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HIV/AIDS Investigation conducted since officials
in this Unit were discovered to be trustees of an
NGO called MPSA. Investigations were to establish
whether any government funds were transferred to
the NGO and investigations revealed that none
were transferred. The Head of Unit, has since
resigned. This had effect of delaying the
projects. New Director HIV/AIDS has since been
appointed and Business Plans are in place. There
will be monthly and quarterly reporting on
transfer to National.
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HIV/AIDS Social Awareness Campaigns have been
conducted and Business Plans are in place for
VCT, Home Based Care and PMTCT.
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Flood Reconstruction Transfer of R1 million was
effected after the Malaria season was over.
Business Plan for this financial year is
available and full allocation will be used for
the coming Malaria season, for radio slots,
medicine, mosquito nets and spraying equipment.
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• Mechanisms to improve Capacity
• Monthly and Quarterly Financial Reports submitted
  to Treasury
• Certificate signed by Accounting Officer at the
  end of the financial year.
• Liaison and Technical support to be received from
  the National Department.
• Programme Managers submit business plans on
  conditional grants

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• Service agreement signed with National for
  provision of Tertiary Services, in terms of
  National Tertiary Services Grant.

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? Quarterly reporting on tertiary service level,
and posts filled in terms of agreement. ?
Province to supply information on the training of
medical personnel in terms of the Health
Professional Training and Development Grant. ?
Compliance with Provincial Priorities. ? Reports
on Projects implementation to be submitted. ?
Quarterly and monthly financial reporting on
transfers and expenditure.
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Comment on budgetary allocation, MTEF, process
and any shortcomings and addressing of Equity. ?
The Mpumalanga Province had a budget of R1,350
billion for the 2001/2 financial year. For 2002/3
budget is R1,656 billion. ? However demands on
the budget exceed the resources available. ?
Problems of cross border influx Patients from
neighboring Provinces and countries accessing our
health care e.g.. Northern Province, Kwazulu
Natal, Gauteng, Swaziland and Mozambique.
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• ?Need for expansion of Primary Health Care
  Services.
• The impact of HIV/AIDS.The 200 HIV Survey showed
  that 29,7 of Women attending ante-natal clinics
  in the Province were HIV positive.
• This would mean that in the short term
  opportunistic diseases need to be treated,
  resulting in increased costs of interventions,
  i.e. bed occupancy, medication and laboratory
  tests.

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• Training of caregivers in Home Based Care and
  community based care needs to receive attention
  to prevent prolonged institutionalization of HIV
  infected patients. The Department plans to expand
  testing counseling and voluntary care and support
  services.
• Timeous business plans need to be prepared in
  this regard.
• Youth behavioral change will be targeted through
  intensifying life-skills programmes and social
  awareness campaigns.

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?Training of personnel to manage HIV/AIDS are
challenges to the budget, as well as ensuring
that there is adequate infrastructure. ?Further
distribution of specialised services. ?Mpumalanga
Province is poorly supplied with level 2
services. Patients are referred constantly
outside the Province. It is the aim of the
Province to move specialist services nearer to
the population. At present Level 2 services are
pounded at Witbank Hospital and to a certain
extent at Rob Ferreira. Mpumalanga has virtually
no Level 3 services.
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Consideration is given to the phasing in of the
provision of highly specialised services. ?Human
Resources Mpumalanga is rural Province.
Retention of Professional staff is a
challenge.
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Budgetary Allocation Progress towards
Equity. ?There is inequity in budgetary
allocation. ?According to the FFC Formula, 8515
ratio should be applicable, in favor of Social
Services. ?Provincially however we are at
82. ?Health is allocated, 17.1 of the
Provincial Budget, as opposed to its other
Provincial Counterparts e.g. Gauteng. ?Mpumalanga
Province, is below the National average per
capita spending as opposed to Gauteng and Western
Cape. (R600 as opposed to R1 600
Inter-Provincial)
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?Provincial Discretion on allocation of funds
between sectors. ?Conditional grants mechanism
to overcome. ?Provincial discretion, however
late transfers are problematic. ?All provinces
are moving upwards in spending pattern, but only
2,2 growth in budget.
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Department of Health Mpumalanga