Institutional Transformation: What the MEC promised

1. Integration of the structures of the former Department of Health and the Department of Social Services, Population and Development.

2. Focus on and strengthen:

2.1. Financial Management,

2.2. Human Resource management and development,

2.3. Records management,

2.4. Communications and

2.5. Internal Auditing.

3. Improve the control environment and promote good corporate governance.

3.1. Establish a fraud prevention and risk management committee.

4. Rural allowances to be extended

5. Institution of inter-departmental task team to assess value for money of ongoing projects, in particular capital projects, to determine their conformity to set standards.

What the Department did

1. The two former Departments were amalgamated in terms of the structure and functions.

2. The Department instituted the following:

2.1. We have developed and adopted a number of financial policies, which forms the basis on which financial transactions are concluded.

2.2. We have employed 2 440 officials especially in those areas where we had a critical shortage of staff.

2.3. A Departmental task team streamlined the filing system used by the two former departments and compiled specifications for a Provincial Tender.

2.4. A Communication strategy has been developed for the Department.

2,5. The Audit committees for the two former Departments were merged to form one committee. A new Audit Charter and Audit plan was adopted for the new Department.

3. We have established a fraud prevention committee and launched an anti-corruption hot line, which will enable civil society to blow the whistle on any cases of fraud and corruption. The number is 0800 20 45 44.

3.1. We have established the risk management unit, which will further strengthen the controls within the Department.

4. In addition to the existing National list of areas and facilities classified as rural, 5 hospitals and 41 PHC facilities have been reclassified as rural areas by the Head of Department.

5. Interdepartmental teams attend site meetings at ongoing Capital Projects to evaluate and monitor progress.

Effective Health Service Delivery: What the MEC promised

1. Strengthen the components of the PHC package towards the ensuring that communities receive the full basket of services at PHC facilities.

2. Audit of PHC facilities.

3. Various training programmes. Training of PHC nurses by the University of Pretoria and South African Military Health Services.

4. Conversion of the Elijah Mango College of Education to a Health Sciences training College.

5. Commence with the Construction of the of seven new PHC facilities at KwaNgema, Langverwacht, Warburton, Entombe, Mananga, Badplaas and Enkangala.

6. Built accommodation for staff at rural areas.

7. 80% of our Community Health Centres to be operational on a 24-hour basis,

8. Implement and manage an information system that will enhance Emergency Medical Services.

9. Purchase 45 new ambulances whilst properly maintaining existing fleet.

10, Equitable spread of resources through the Province with special attention given to rural areas.

11. Introduction of an accredited quality improvement with COHSASA (Council for Health Service Accreditation of Southern Africa) at 26 hospitals.

12. Executive Training component.

13. Continued Hospital Revitalisation programme at Piet Retief, Rob Ferreira, Themba and Ermelo Hospitals.

14. Infrastructure improvement of Mmamethlake, KwaMhlanga, Sabie, Evander, Embhuleni, Witbank, Groblersdal and Delmas hospitals.

15. Strengthen our relationship with our academic partners, University of Pretoria and MEDUNSA.

16. Provide tertiary services at Rob Ferreira and Witbank Hospitals.

17. Support the Cost Centre Accounting programme, Increase the number of hospitals on this programme from four to thirteen.

18, Fund the development of a hospital information system and training of hospital

managers.

19. Appropriate delegations for procurement functions will be decentralised to facility level.

20. Enter into service level agreements to regulate and create a monitoring mechanism to measure the quality of services

21. Receive assistance from the Italian Corporation in the form of technical assistance in the field of Health Information systems.

22. Extensive health promotion and community mobilisation.

What the Department did

1. The Department instated a Quality Assurance programme to evaluate the full implementation of the package at PHC facilities.

2. An Audit of all PHC facilities in the Province has been completed. The Audit revealed that there are significant resource shortages at PHC level especially relating to human resources, equipment and transport. The physical structure of many of our facilities is also in need of upgrading and maintenance.

The Department has developed a plan to address the gaps identified and significant progress has already been made to institute appropriate interventions.

3. The commitment to introduce various training programmes is on track and the department has initiated its own PHC nurse training programme. Eighty six professional nurses are currently being trained at Witbank Hospital in partnership with the University of Pretoria. 30 Intermediate Life Support practitioners trained. 4 394 nurses attended short courses such as Integrated Management of Childhood illnesses (IMCI), Sexually transmitted infections (STI), TB, Treatment compliance, Diabetic Care and Reproductive health. 18 Nurses trained on Forensic Nursing. 8 nurses enrolled for a one-year PHC course at the University of Limpopo. 6 nurses completed Psychiatric training.

4.We have established a Health Sciences Training College at the former Elijah Mango College of Education, The first group of 100 students started on the 1^st of March 2005 and the second group comprising of 200 students started on the 1^st of April 2005, making a total of 300 first year students. This represents a three-fold increase in the number of first year students over previous years intake.

5. In order to further intensify our PHC programme to meet set norms and standards and to bring this service within reach of our communities, those facilities earmarked for construction in the 2004/5 financial year are at various stages of completion.

6. Accommodation facilities are being constructed at prioritised rural areas.

7. In our efforts to ensure that at least 80% of our Community Health Centres render a twenty-four hour service, we are still faced with the challenge of attracting suitably skilled professionals to rural areas. The Department has however expanded the classification of rural areas for the purpose of awarding rural allowances in the Province.

8. A database has been developed which captures and updates all EMS resources and activities on a day-to-day basis.

9. The Department has procured 86 new ambulances and 23 response vehicles to strengthen the existing fleet.

10. The purchased vehicles have been distributed to areas where the workload has been most pressing in terms of the existing resources.

11. The Council for Health Service Accreditation of Southern Africa (COHSASA) conducted a baseline survey at all Hospitals during the course of last year. This survey has identified significant challenges in the area of hospital management and clinical service delivery.

12. Intervention strategies have been implemented including the first training module for Hospital Managers.

13. Piet Retief hospital, which was the first hospital to be included in the revitalisation programme, has been completed. All the other facilities earmarked under the hospital revitalisation programme for construction and improvement in the 2004/5 financial year are at various stages of completion.

14. All the other facilities earmarked under the infrastructure programme for construction and improvement in the 2004/5 financial year are at various stages of completion.

15. Posts for Specialists are advertised as joint posts with our two academic partners, the University of Pretoria and MEDUNSA. Incumbents for the posts are placed on higher levels where appropriate. Qualifying officials also receive scarce skill and rural allowances where relevant.

16. Tertiary services have been enhanced through the procurement of a CT scanner at Rob Ferreira Hospital.

17. The cost centre accounting system has been implemented at 13 hospitals, CEO and medical manager's forums have been established,

18. In our quest to provide reliable, accurate and up to date information, we have started to strengthen management structures, and invest in modern health technology. The department has entered into an agreement with the University of Pretoria to develop a telematic education network in support of health workers in rural facilities.

We have also successfully rolled out the Patient Administration And Billing system (PAAB) at all provincial hospitals. In support of the comprehensive care and treatment of HIV and AIDS plan the department is piloting the ARV module in Witbank Hospital. We are pleased to announce that Mpumalanga was the first Province to launch the ARV module. The benefits of this information module are that it is able to monitor the impact and effectiveness of the Antiretroviral treatment campaign. Future intervention strategies and the rollout in the other identified sites will be informed by lessons learnt at the pilot site.

19. In terms of the PFMA, financial delegations have been given to responsibility managers.

20. The following Service Level Agreements have been entered into by the Department:

• Department of Public Works

• Capital projects programme including maintenance of our facilities

• National Health Laboratory Services

• Provision of Laboratory tests

• Amalgamated Health Care

• Pharmaceutical Depot Management

• Gauteng Department of Health

• Provision of Secondary, Tertiary and Specialised Health Services

• NGO's (e.g. Thembalethu HBC, ACTS Community clinic)

• Various community based projects

A Health MinMEC resolution indicates that all SANTA hospitals should be integrated into provincial hospitals from the 1S' April 2005. A task team is currently finalising legal, human resource and financial management related matters for the integration into hospital services.

A meeting was held between the MEC for Local Government and the MEC for Health and Social Services regarding the devolution of municipal Primary Health Care clinics to the department. A decision was taken that a joint task team between the Department of Health and Social Services and Local Government should do a situational analysis to determine the financial implications.

The constraints are around the transfer/secondment of staff who work under different conditions of service. The staff and the Unions should be engaged before finalization of service level agreements.

21. The gains from the collaboration with the Italian Corporation have made a positive impact on our health information system: The Italian Corporation has made a commitment to invest R6 000 000 in various projects that seek to improve the management of health information systems.

22. Widespread community mobilisation has been accomplished through house-to-house visits, community meetings and visiting public places including hot spot areas. Issues addressed include HIV and AIDS, Tuberculosis, Cholera prevention, measles and polio immunisation, diarrhoea prevention, hypertension and malaria awareness.

Traditional Healers have also proven to be allies with the Department to reach our communities regarding diseases of lifestyle.

Comprehensive HIV and AIDS care, management and treatment: What the MEC promised

1. 270 additional VCT (Voluntary Counselling and Testing) sites have been planned and community mobilisation will be maximised to encourage people to test whilst they are still healthy.

2. Sustain and strengthen PMTCT (Prevention of Mother To Child Transmission) programme at 112 health facilities.

3. Training of Community Health Workers on the 59-day intensive training programme.

4. Continue to support 96 Community Home Based Care projects in the Province.

5. Provision of antiretroviral drugs at twelve hospitals.

6. Strengthening the management of Tuberculosis and improving the cure rate in the Province.

7. Implement the Integrated Nutrition Programme and give food supplements to improve the health status of the patient.

What the Department did

1. Voluntary counselling and testing services provide the entry point to the comprehensive HIV and AIDS Care, Management and Treatment programme. To date 240 VCT sites are operational in the province.

2. 210 PMTCT sites are functional within the Province.

3. Through the 59-day training programme, 1700 HBC workers have been capacitated in project management and counselling as well as basic health care.

4. Great strides have been made in strengthening the Home Based care (HBC) programme. Currently, we are providing support to 126 HBC organisations.

5. We are providing Antiretroviral drugs at eight of the identified twelve sites. The remaining four sites have been assessed for accreditation by the National Department.

6. In January 2005, a state of the art airborne infection research facility was launched at Witbank. This is a joint venture between the Department of Health and Social Services, SANTA, the Medical Research Council, Harvard School of Public Health, US Centre for Disease Control and the CSIR to address some of the unanswered questions around Multiple Drug Resistant TB transmission and other airborne infections. A multi faceted intervention plan has been developed to improve and monitor the case identification and cure rate of diagnosed patients.

7. Part of our holistic programme on nutrition places emphasis on the prevention and reduction of morbidity and mortality rates due to malnutrition. We therefore continued with the provision of specialised supplementation to nutritionally at risk children under 5 years, pregnant and lactating women, patients infected with HIV and TB as well as those on Anti Retroviral Therapy.

At present the province has 11 hospitals and 3 Community Health Centres, which are accredited as Baby Friendly.

Malaria Control Programme: What the MEC promised

1. Continued participation in the Lubombo Spatial Development Initiative.

What the Department did

1. The Malaria Control Programme is actively involved in controlling malaria in affected areas through vector control, outbreak response, disease surveillance and monitoring.

The Malaria case fatality rate of 0,47% has been achieved. A 16% reduction of reported Malaria cases was recorded compared to the reported cases in 2003.

Pharmaceutical services: What the MEC promised

1. Procure and distribute drugs and medical supplies to all health facilities in the Province.

2. Establish a new pharmaceutical depot and a pre-packaging unit by July 2006.

What the Department did

1, During the past year the revised Essential Drug List booklet was made available to all the health facilities. The provision of essential medicine in our clinics has significantly improved during the past year and will be further strengthened through direct delivery to PHC facilities from the Depot.

2. The Department has also secured a plot in Middleburg for the construction of a new Pharmaceutical Depot. This Depot will house both the existing main depot and also the pre-packing unit. The Tender for the construction of the facility have been published.

Decreasing morbidity and Mortality rates: What the MEC promised

1. Intensify focus on Mother, Child, Women's and Youth Health programme.

2. Ensure that the Expanded Programme on Immunisation focuses on vaccinations for polio, whooping cough and measles and strengthen the Integrated Management of Childhood Illnesses (IMCI).

What the Department did

1. 19 Hospitals are supported to conduct the Perinatal Problem Identification Programme (PPIP), which is an audit tool to identify causes of maternal and perinatal morbidity and mortality, A Pregnancy Education Awareness campaign was conducted at Nkangala District at the following Municipal Areas: Emalahleni, Steve Tshwete, Greater Groblersdal and Dr JS Moroka, and one main event at Ehlanzeni District- Kabokweni Community Hall. The awareness campaign was to address the importance of early booking and management of medical conditions during pregnancy.

3 health facilities have been established to be Youth Friendly sites viz Fig tree clinic, Phola-Nsikazi and Dundonald CHC, adding on the existing 25 facilities. The objective of Youth Friendly Services is to change health workers' attitude towards youth so as to reduce teenage pregnancy. As part of reducing maternal deaths due to cervical and breast cancer, the following activities were executed; Two community awareness campaigns on cervical cancer were conducted at Burgersfort and Driefontoin. Awareness on breast and cervical cancer was also done through Radio talk shows on Ligwalagwala and other local radio stations in October 2004. 3 Termination of Pregnancy Value Clarification workshops have been conducted at Barber-ton, Themba and Middleburg hospital in February 2005 to support the TOP implementers to sustain the programme.

2. The Department can report a Low Measles morbidity rate of 0.006% and a zero Measles mortality rate tor Mpumalanga. Zero Polio cases have been reported in Mpumalanga. The Household Component of IMCI is implemented at the following sites in the Province namely Phola, Siphosensimbi, Phola Nsikazi CHC and Standerton,

Specialised Health Services: What the MEC promised

1. Preparatory phase to take-over the Forensic Services from the SAPS.

What the Department did

1. A Departmental task team has been appointed to facilitate the takeover of Forensic services from the SAPS. Negotiations with SAPS are at an advanced stage.

More than what we promised

1. 23 Emergency Medical Service Station officers and 57 Emergency care practitioners were appointed. R5 600 000 worth of essential equipment and uniforms for the EMS staff were procured during the past financial year.

2. There are 12 000 insecticide treated nets (ITN) that were distributed to communities in the high-risk areas.

3. Additional Service Level Agreements signed with the Bureau for the Prevention of Blindness and the Disabled People of South Africa.