DEPARTMENT OF HEALTH

1. MPUMALANGA PROVINCE DEPARTMENT OF HEALTH BUDGET HEARING MAY 2002

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

3. 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.

4. 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 Women`s 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

5. 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

6. Achievements against priorities: Much has been achieved against the priorities, such as:

7. 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.

8. 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.

9.  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.

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

11. 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.

12. 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.

13. 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.

14.  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

15. 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.

16. 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.

17. 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.

18. 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.

19.  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.

20. 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.

21. 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.

22. 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.

23. 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.

24.  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.

25.  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.

26. 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.

27. 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.

28. 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.

29.  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.

30.  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.

31. 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.

32.  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.

33.  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.

34. 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 Patient`s Charter was conducted by the Quality Assurance Unit.

35.  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.

36.  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.

37. 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.

38. 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.

39.  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.

41. 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.

42.  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.

43. 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.

44. 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.

45. 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%.

46.  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.

47. 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

48. 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

49. Pharmaceutical Depot Clinics: Amsterdam Moutse

50. BUDGET 2002/2003