Budget Speech 2014 - 2015 for Department of Health


Moving South Africa Forward!
Towards universal access to health care - Vision 2030

Honourable Speaker of the Provincial Legislature,
Honourable Premier: Mr Supra Mahumapelo,
Hon Members of the Executive Council,
Hon Members of the Legislature,
Your Worship Executive Mayors and Mayors of our Municipalities,
Hon Leaders of Political Parties,
Our Esteemed Traditional Leaders,
The Acting Director General Professor Tebogo Job Mokgoro and Other HODs,
Acting Head of the Department, Kgosi Konrad Motlhabane,
Leaders of Labour Federations, Civil Society, Faith Based-
Organizations and Business,
Comrades and Friends,
Ladies and Gentlemen,

Dumelang Bagaetsho ba Bokone Bophirima!

Honourable Speaker and Members of the House, I present this Budget Policy Vote for the Department of Health which I believe will demonstrate that we are "Moving the Bokone Bophirima Province Forward" towards universal access to health care for all.  South Africa has evolved. We have moved from the colonial occupation of the Cape in 1652 and the segregation period between 1910 and 1948, from the rise of apartheid in 1948 to the period of protest and resistance through to the Rivonia Trial of 1964. Fast-forwarding to 1990 we had moved through to the unbanning of the African National Congress (ANC) and other liberation movements. With the end of apartheid and the birth of democracy in 1994, we have moved further forward as this year (2014) we celebrate 20 years of democracy in our country and 20 years of health care service delivery to our people!

As we move South Africa and our Province forward, the 20 years of health service delivery has meant mainstreaming Primary Health Care (PHC), with the mandate to address those marginalized by apartheid and introduce a people-oriented health care system, one that fulfils the needs of our people by ensuring that primary health care is available at public sector clinics throughout South Africa and it is ‘free’ at the point of delivery. We carry this vision with us as we move forward to 2030.

As the former United State President, Theodore Roosevelt once said, "It is only through labor and painful effort, by grim energy and resolute courage, that we move on to better things."

Our trajectory is captured by the UN Secretary-General Ban Ki-moon who recently at the Millennium Development Goals (MDGs) Advocates’ field trip to Africa, challenged Sub-Saharan Africa to "set the stage for an ambitious and transformative, new sustainable development agenda that addresses emerging challenges of the people and planet and ensures a life of dignity for all".

We move Bokone Bophirima forward guided by Chapter 10 of the National Development Plan (NDP), "Promoting Health" which set out the vision and clear targets including, amongst others, reduction of maternal and infant mortality; increase average male and female life expectancy at birth to 70 years; have a generation of under 20’s free of HIV and AIDS; significantly reduce the burden of diseases both communicable and non-communicable and implement the National Health Insurance (NHI) in phases, complimented by relative reduction in the cost of private healthcare, supported by better human resources and systems.

This term and its new administration present an opportunity to move forward health service delivery at a faster rate.  The Department of Health has looked into the mandate of the current term of government with regard to public health service delivery and decided that this mandate can be best achieved by singling out five key Departmental priorities which are:

Honourable Speaker and Members of the House, we will implement these five key departmental priorities by properly mapping out utilization of both our human and financial resources. The Department of Health budget allocation for 2014/15 which will allow us to implement these key priorities is distributed among our eight (8) key programmes in the MTEF period as follows:
Programme                                         Final Allocation for 2014/15 and Indicative
                                                                Figures for the MTEF Period
                                                                  2014/15            2015/16             2016/17
                                                                  (R’000)              (R’000)              (R’000)
Administration                                        255,369            287,256             310,364
District Health Services                        4, 295,604        4,580,837         5,013,201
Emergency Medical Services             283,941             298,683            314,513
Provincial Hospital Services               2,003,787         2,241,412        2,380,024
Central Hospitals                                  237,264             248,178            261,331
Health Sciences and Training            321,778             334,869            388,032
Health Care Support Services           141,871             150,516            158,493
Health Facilities Management            634,408            695,191            100,298
Total                                                         8, 174,022        8, 836,942       8, 926,257

Conditional Grants and earmarked funds are already included in the baseline allocation.

Honourable Speaker and Members of the House, the Department’s budget for the 2014/15 financial year as outlined above shows a reduction of 2.1% compared to that of the prior year. The Department also entered the current financial year with accruals of R416 million.  Taking this situation against the fact that inflation in the medical sector is over 10% over the same period, the Department will have to improve efficiency of spending in order to achieve the laudable objectives and targets set out in its annual performance plan.

The Department is currently undergoing a re-structuring exercise which is aimed at trimming down on the administration component and moving resources to funding more hands at the coal face of service delivery at health facility and institutional levels. I am proud to mention that the North West Department of Health is one of only few provincial health departments that have managed over the last few years to keep its head above the waters. With the envisaged cost cutting and efficiency measures, I am sure that the Department can continue to provide quality public health services to the people of the Bokone Bophirima Province in the face of dwindling financial resources.

Honorable Speaker and Members of the House, allow me to update this House on progress made in health infrastructure development we promised the people during the 2013/2014 financial year.  I am happy to report that the Department has completed Tweelingspan/ Matsheng, Buxton, Magogwe, Lekgophung, Madibe a Makgabana and Mosweu clinics.  We have officially opened Itsoseng Community Health Center.  Brits Hospital is now fully functional and was officially opened by the Honorable Minister of Health, Dr. Aaron Motsoaledi, in April 2014.

Honorable Speaker and Members of the House, these new infrastructure development projects have resulted in increased access to health services by users and nearby villages.  Brits Hospital alone has ensured increased access to a complete package of district hospital services for the nearly 450 000 population of Madibeng Sub District while at the same time minimizing interprovincial transfer of patients who need generalist clinical care.

In 2014/15, we will officially open Lekgopung and Madibe a Makgabana clinics in the Ngaka Modiri Molema District.  In Bojanala, Tlhabane and Mathibestad CHCs will also be officially opened.  This will further bring much needed relief to Job Shimankana Tabane (JST) Hospital patient influx as these new facilities will come with comprehensive package of care.       

We promised to further decentralize Multi Drug Resistance (MDR) units to Bojanala and Ngaka Modiri Molema districts. I can report that two (2) MDR units have been developed at Job Shimankana Tabane Hospital (JST) and Gelukspan District Hospital respectively and they are fully functional. This has ensured more access to community-based management of TB, improved diagnosis of drug resistant TB and increased access to treatment and care.

Bophelong Psychiatric Hospital, JST Hospital (upgrading), Witrand Psychiatric Hospital and Mathibestadt CHC are under construction or upgrading and will be completed in the current financial year.  Work has also started at Boitekong CHC, Sekhing CHC and Moshana Clinic. We are also planning to construct four (4) new clinics at Weltevreden, Madikwe, Mmakaunyane and Maqwasie Hills.

The Department is embracing the "RRR" repositioning, rebranding, and renewal programme as espoused by the Honourable Premier.  We are intending to indentify, for each district, a clinic to be branded to as "ideal clinic" by exploring the PHC Social Franchise clinic model which will be branded in such a way that people know the kind of service to expect of it and the public to have confidence in the ability of the service to deliver efficient service.

We have set aside a budget of R100m for maintenance on thirty (30) facilities across the province and decentralized maintenance budget to the district. Constant monitoring and support will be provided to ensure that all these facilities are well maintained within 2014/15.

The Honourable Premier, Supra Mahumapelo, has in the State of the Province Address called for the Department to "revise the policy governing the operating hours of all clinics particularly in rural areas". I am happy to report progress on this mandate.  The following CHCs and clinics have converted to 24 hours from 12 and 7 hours respectively; Tswelelopele, Lebotloane, Mokgola,  Ganalaagte, Kopela, Driefontein, Makgobistad, Sunrise Park and Oukasie.  Clinics to move from 7 or 8 to 12 hours with future plans to convert to 24 hours include Ramokoka, Moruleng, Mafikeng Gateway, Lonely Park, Setlopo, Itekeng, Magogwe, Rapulana, Tsetse, Bakubung, Modderkuil, and Koedoesrand.  The Department has also moved to provide services where there was limited service before like in Greater Taung where a small Mogopela community which has been served by a mobile, now has a five day clinic.  A long term plan will be to provide at strategically located CHCs and clinics, adequate doctor support.

We will allocate the 126 community service professional nurses to needy areas to cater for extended hours of service by the third quarter of 2014/15.  Implementation of 24 hour service in all health facilities will require additional funding and other resources.

The Honourable Minister of Health, Dr Aaron Motsoaledi, has in the Health Budget Vote referred to HIV/AIDS and TB as "the first and biggest burden".  It is true, ladies and gentlemen, this is the epidemic of our challenge that requires all of us to unite, mobilize resources and tackle head on.  That is why the Minister has reported on a "far reaching decision" of the 20th International AIDS Conference which is to "bring an end to HIV/AIDS by 2030" by ensuring that in 2030; 90% of people know their status; 90% of those that are HIV positive are on treatment and 90% of those on treatment are virally suppressed.  The Department of Health and the Province will change the initiation of ARTs as the WHO guidelines  recommend a higher CD4 count threshold from time to time.
In our efforts to increase access to HIV and AIDS services, I can report that all fixed facilities are initiating Antiretroviral Treatment (ART). Some of the mobile clinics in Ngaka Modiri Molema have already started to initiate patients on ART, and the plan is to roll out to other mobile clinics across the Province in 2014\15.

The Province has increased its coverage in monitoring ART programme through the implementation of Tier.net system. We started with paper based reporting, and currently two hundred and fifty seven facilities (257) are on electronic system. One Hundred and eighty five thousand three hundred and two (185 302) patients were on ART by the end of financial year March 2013/14.  The aim is to roll out the system to all our PHC facilities to ensure coverage and effective programme reporting and monitoring in 2014/15.

The Antenatal Sero Surveillance Report (2012) indicated that HIV prevalence in the Province has decreased from 30.2% in 2011 to 29.7% in 2012, just slightly above the National prevalence of 29.5%. Dr Kenneth Kaunda is the only district where a decrease in the HIV prevalence has been noted, from 36% to 29.1%. Otherwise an increase has been registered in  other districts, Bojanala District from 33.9% to 35%, Ngaka Modiri Molema from 24.9% to 25% and Dr Ruth Segomotsi Mompati from 20.5% to 24.3%.

Advocacy and social mobilization have been intensified to improve HIV Counseling and Testing (HCT) while there is Male Medical Circumcision (MMC) and condom distribution uptake towards reduction of new HIV infections. New MMC high volume site was officially launched at Phokeng Health Center in Bojanala with the support of CHAPS (Centre for HIV and AIDS Prevention Studies) thus increasing the provincial high volume sites to three (3).  MMC mobiles were officially launched during World AIDS Day to support Ngaka Modiri Molema and Dr. Ruth Segomotsi Mompati. The MMC uptake has therefore improved from 18 365 to 37 396 while male condom distribution improved from 18 665 096 to 28 847 888. In 2014/2015, the Province will target key populations (i.e. Lesbians, Gays, Bisexual and Transgender) for key HIV prevention message. We will also increase payment of stipend for all Community Health Workers linked to our health facilities from R1500 to R2000 effective from 1st July 2014.

The Province has established two new de-centralized MDR TB (Multi Drug Resistance TB) units at Ngaka Modiri Molema and Bojanala districts, which brings the total for the Province to four (4). This will reduce the patient load at Tshepong Hospital, increase access to treatment and care for effective management of patients with MDR TB and further reduce the spread of infections. Gene Expert is rolled out to all peripheral laboratories in the Province.

The TB campaign culminated with World TB Day commemoration in the Dr Kenneth Kaunda District where I visited Klerksdorp Correctional Services and 125 inmates were screened. Four inmates tested positive for TB and one (1) was diagnosed with Multi – Drug Resistant TB.  Honourable President Jacob Zuma has, in the State of the Nation Address, called for expansion of the mass HIV prevention communication campaigns as we build on the success of our HIV and AIDS treatment and support programme.  In the light of this mandate, the Department plans to expand TB and Drug Resistant TB services to the mines and correctional services in Bojanala and Dr Kenneth Kaunda Districts in 2014/15.

The Province’s Maternal Child and Women’s Health and Nutrition Programme remains one of the key Millennium Development Goals (MDGs) priorities.  The Minister has announced a "ground breaking" MomConnect Project to be launched on 21 August 2014 as part of Women’s month programmes.  MomConnect will seek to register by cellphone all the pregnant women in any one year in our country. Through MomConnect, all the registered pregnant women will receive "sms" messages appropriate to their stage of pregnancy. These messages will advise them on what to do at any stage of their pregnancy. It will encourage them to start antenatal care early and to test for Hypertension, HIV/AIDS, Diabetes and other conditions very early during pregnancy. It will emphasize on starting PMTCT early at 14 weeks.  This innovation, MomConnect, will give power to the pregnant woman to seek health and demand good treatment. After delivery of the baby, MomConnect will still continue for up to a year. Only that this time, the "sms" messages will include advice on the baby like, among others, exclusive breastfeeding, immunization, family planning for the mother, oral rehydration during diarrhea and check-up periods at the clinic.

We promised to develop and implement strategies to reduce teenage pregnancy in schools in collaboration the Department of Education.  I am pleased to report that the strategy was developed by the interdepartmental Integrated School Health Task Team and is being implemented.  The new Contraception and Fertility policy guideline is implemented across the Province. Four hundred (400) Health Professionals were trained on the insertion of sub dermal implant which last for three (3) years. This latest and new intervention emphasizes long lasting contraceptive methods and has multiple benefits as it will also reduce clinical visits and easily reversible should one consider being pregnant. 

The District Specialist Teams (DCST’s) are also functional and in place in all the Districts. Their presence will lead to increase of targeted health professionals’ training which will have positive impact in reducing maternal and neonatal, infant and child mortality rates across the province.  Teenage pregnancy rate was at 7% against a target of <10% while cervical cancer screening improved from 58% in 2012/13 to 62.4% in 2013/14. Integrated Chronic Disease management (ICDM) has been rolled out in full scale.

The Maternal Mortality Ratio (MMR) in the Province continues to decline according to the Tenth Interim Report on National Confidential Inquiry into Maternal Deaths in South Africa (2011 – 2012). The ratio declined from 229 in 2008 -2010 report to 145.6 deaths /100k live births. The Province is ranked 3rd among the nine (9) Provinces in the reduction of MMR. The reduction is attributed to the MCWH forum which I chair to ensure management commitment, quality of care and implementation of interventions that are geared towards decreasing maternal and child morbidity and mortality.

I am happy to report that in-facility mortality for children under five years of age has reduced from 7% in 2012/13 to 6.6% in 2013/14.  Eleven (11) facilities were accorded Mother and Baby Friendly Initiative (MBFI) status which brings the total of such facilities to 35. This initiative will improve safe infant feeding practices and strengthen maternal health thus improving maternal and child health outcomes.

Furthermore, the Department has continued to scale up Essential steps in Managing Obstetric Emergencies (ESMOE) and Basic Antenatal Care (BANC) skills for doctors and midwives.  Early Antenatal Care booking improved from 43% to 50.6% due to increased awareness on importance of early booking and dangers of late booking through community dialogues and mass mobilization. We decided to decentralize the High Risk clinics to Primary Health care facilities. This will minimize frequent long distance travelling by pregnant women and further reduce financial burden of travelling costs. Mother to Child HIV transmission rate is within the norm at 2.3% against a National target of <3%.

Honourable Speaker and Members of the House, we always maintain that health is a social service which should be approached in an integrated manner.  The Department of Health is also working closely with sister Departments of Education (DOE) and Social Development (DSD), and has developed meal guide for Early learning centers, and continues to train educators on those menus, growth monitoring and nutrition supplementation for children under five years.  In an effort to improve Vitamin A supplementation for children aged twelve (12) to fifty nine (59) months, Community Health Care workers are administering Vitamin A at household level. 

We are pleased that 72.2 % of mothers delivered at health facilities. In an effort to improve facility delivery and to ensure skilled birth attendance for the high risks mothers and those staying very far from facilities, the Province  increased the number of  Maternity Waiting Homes from thirteen (13) in 2012/13 to eighteen (18) in 2013/14.   The new ones are at Moretele, Makapanstadt, Bapong in Madibeng, Itsoseng and Klerksdorp Hospital.  The Integrated School Health Programme (ISHP) was launched in August 2013 at Ikageng Township in Potchefstroom and the Department procured 16 School Health services vehicles in order to improve access to the programme. 

In effort to prevent cervical cancer among women later in life, the Department managed to administer HPV vaccine for grade 4 girl learners 9 years of age and above. Ninety (90%) of learners were reached against a National target of 80%, with 95% school coverage.  The Department will continue with the second round HPV campaign, which will be an annual event.

Honourable Speaker and Members of the House, it is our resolve that prevention of non-communicable diseases is within our hands. We say to our people, "health care is self care"!  Our main emphasis is on physical activity, healthy diet, preventing obesity and the emerging epidemic of obesity and the companion "partners" of hypertension, diabetes and raised cholesterol l(coronary heart disease), as well as early treatment of young people to prevent Rheumatic Heart Disesase (which are still unnecessarily prevalent especially in rural areas). Emphasis is equally placed on prevention of harmful effects of tobacco and excessive alcohol usage. In addition to heightened health awareness and education campaigns, the Department will organize periodic and regular physical activities for both employees and recipients of health services at provincial, district and facility levels.

We will strengthen strategies for communicable diseases control with focus on effective outbreak management, implementation of malaria and measles elimination, and polio eradication initiatives. These will be achieved through improved surveillance systems that would make it possible to identify the index cases and manage them to prevent outbreaks, among others. It should be noted that the Province has continued to maintain its malaria free status.  The Department will continue to provide effective immunization programme to the children of the Province, whose results have seen no cases of measles being reported in the past financial year, and no cases of polio since 1989 in the country.  We shall keep accurate statistics and case reporting of infectious conditions to safeguard the gains we have made.

I can confidently report that the Province is ready for Ebola! It is also important to report that there is no Ebola in the country but we are not taking chances.  Fifty (50) biosafety packages have been delivered to Klerksdorp Hospital in our Province and each has 610 PPEs (Personal Protective Equipment). Our entry ports are also under tight surveillance and health officials are monitoring all travellers for related symptoms.

I am happy to report to the House that the phased-in implementation of the National Health Insurance (NHI) is progressing well at the pilot District despite challenges experienced.  We also note that the ruling party, the African National Congress, has expressed in its Election Manifesto that, on health "Our flagship programme in the next five years and beyond is the National Health Insurance (NHI), which will help us move forward to universal health coverage at affordable cost".

In order to meet the NHI requirements, the Department set out to among others improve training on nursing, EMRS, and medical care to strengthen Primary Health Care (PHC) and health care service delivery towards a well functioning NHI. 

We also promised to enhance the pilot District’s capacity in the areas of District Health Planning and Monitoring and Evaluation.  One of the key interventions is strengthening the referral system based on a re-engineered primary health care platform with a particular focus in rural and previously disadvantaged areas.  We also promised that Community Health Workers (CHW) will be provided with equipment for screening of chronic disease throughout the pilot District.  Further, that twenty two (22) Pharmacists assistants will be trained in Post basic and thirty five (35) nurses will be trained on drug supply management.

I am happy to report to the House that there is significant progress particularly at the pilot site.  Nurses and facility managers have been trained in drug supply management.  The progress made has led to improved drug availability in the clinics.

In Ngaka Modiri Molema alone thirty two (32) nurses were identified to be trained in Forensic Nurse Training.  Eight (8) have graduated, seven (7) are currently at University of Free State.  Seventy four (74) Retired nurses were also trained.  In the Dr Ruth Segomotsi Mompati District eighteen (18) upgraded their qualifications from Basic Ambulance Course to Ambulance Emergency Assistants.  The District capacity in monitoring and evaluation was enhanced through training of representatives of governance structures of all levels from the District.

We have also revised the referral policy to include the new re-engineered primary health care services and the new policy is now being implemented in all the Districts. The streamlined referral system leads to patients being treated at the correct level of care and is expected to contain health expenditure.

We are continuously seeking to improve on the response time of our emergency medical rescue vehicles.  I can report that to attain this objective, twenty (20) new ambulances have been procured in the first quarter of the 2014/15 financial year already.  A total of R14 million has been set aside to purchase 30 more ambulances during the 2014/15 financial year. A further R84.25 million will be channeled towards EMRS Satellite Stations and a new planned patient transport model. 

We realized that our ambulances are also been delayed because sometimes the cases done by EMRS are not necessarily emergencies but patients requiring transport.  In dealing with this challenge the Department intends to start procuring patients transport to ferry patients.  The new patient transport model will provide basic transport for patients from clinics to community health centers and hospitals. This would free up ambulances to concentrate only on responding to emergency calls. Together with acquisition of new ambulances this will help improve response time as emergency vehicles are placed closer to communities they serve. The response time has reduced as the ambulance drivers are able to find the callers homes more easily.  Impact evaluation will be done to measure change due to referral systems strengthening. 

Ten (10) obstetric ambulances were converted and launched in March 2014 at Moses Kotane Hospital and distributed as follows: Bojanala (3), Dr Kenneth Kaunda (2), Ngaka Modiri Molema (2) and Dr Ruth Segomotsi Mompati (3). Nine (9) more obstetric ambulances will be procured in 2014/15.  This will increase the Obstetric ambulances from ten (10) to twenty (20) within the Province.

We have also in this new financial year 2014/15 already unveiled two mobile dental clinics which will help improve access to oral health services in rural and farming communities. The dental clinics have been allocated to Bojanala and Ngaka Modiri Molema Districts. This is in addition to the four that were allocated to sub-districts in 2011 in order to replace the existing old mobiles. These dental mobile clinics will be used to provide services to unequipped clinics and schools in the above mentioned Districts. 

We can now report on a full expansion of Ward Based Primary Health Outreach Teams (WBPHCOT) with small expansion at other (3) non-pilot districts. The expansion is attributed to effective recruitment and utilization of retired nurses.  We have deployed these retired nurses to facilities as team leaders. As a result, we are beginning to see improved access to Primary Health Care, in particular, preventive and promotive health aspects. Furthermore, there has been increase in early bookings of Antenatal clients and reduced defaulter rate of chronic clients.

On Health Information Systems and steps to improve the non financial performance data, the Department has been awarded R920 000.00 by the Belgian-South African Study and Consultancy Fund to evaluate Routine Health Information Systems (RHIS).  A ten (10) month study to conduct a cross-sectional base-line assessment of the RHIS has started. This assessment will guide the Department to improve the performance and information data systems and IT infrastructure, in a scientific manner, to ensure that the Department becomes a truly responsive health service provider, based on quality and timely data and information.

I also promised this House to have a specific emphasis on the Non- Negotiable aspects of health service delivery which are: Infection control and Cleaning; Constant supply of Medicines, essential drugs, medical supplies including dry dispensary; Medical waste; Blood supply and SANBAS; Food services and relevant Supplies; Security services and relevant supplies; Laundry services as well as Essential equipment and maintenance of equipment.

I can now report that all facilities in Bojanala have been evaluated for compliance with the National Core standards. Compliance rates ranged from 36-90%.  We have also installed CCTV at all hospitals to improve security. Introduction of the Non-negotiable mandates has resulted in improved security of our staff and patient, more efficient laundry services at all health facilities.

The Department of Health as stakeholder believes victims of violence should be afforded all the necessary health services including counseling, testing, treatment and prevention of diseases. In the Ngaka Modiri Molema District alone six "Kgomotso" Clinics which will be staffed by trained Forensic Nurses were identified to serve and assist victims of violence. These clinics are situated at Thuthuzela Centre in Mafikeng Provincial Hospital, Ratlou CHC, Itsoseng CHC, Delareyville CHC, Lehurutshe and Gelukspan District Hospitals.  We are planning to establish two (2) more Thuthuzela Care Centres at Brits Hospital in Bojanala District and Joe Morolong Hospital in Dr Ruth Segomotsi Mompati District in 2014/15.

We are working around the clock to improve laundry services across the Province and have since started the process of procuring three (3) laundry machines for Mahikeng Provincial Hospital (MPH). This move is a step closer to establish a central laundry for the Ngaka Modiri Molema District.

Human Resource Training and Development remains one of the critical factors of health care service delivery.  We have over the years experienced dire shortage of health professionals and this has not only been a challenge for the Province or the country but the world. Also the retention of staff and the prevention human capital drainage (so-called brain drain) is a global challenge.  As a Province, we have made significant efforts to tackle this challenge and continue to do so.  The Cuban Medical Programme and training of nurses are key interventions in this regard.  We have significantly increased intake of students to be trained as doctors in Cuba.  In 2011 we only managed to send 11, we sent 97 in 2012 and in 2013 we increased the number significantly to 180.  We aim to keep the intake above 100 in 2014/15 as shortage of health professionals particularly in rural areas need to be addressed.  We are currently only able to produce 500 nurses but our plan is to produce 1000 nurses per academic year.

The Clinical Associates programme together with the Wits Initiative for Rural Health Education (WIRHE) Scholarship programme are the other programmes intended to produce more of the much needed health professionals.  I can report that thirty nine (39) graduates who received bursaries from the Province are now serving in hospitals in all four (4) Districts of the Province. They are a very positive clinical presence, helping with quality care for daily patients in the emergency and outpatient departments, and assisting with procedures in the wards and operating theatres. There are twenty eight (28) North West students in training on the Wits Bachelor of Clinical Medical Practice programme, supported by Department of Health bursaries.  They undertake at least two (2) of their three (3) years of training at health facilities within the province and will be enticed to stay permanently. 

The Wits Initiative for Rural Health Education (WIRHE) Scholarship programme, funds disadvantaged students from the province to study for health professional degrees. They are supported and mentored by the WIRHE programme, undertake vacation work in their local health facilities, and work back in the districts on graduation.  WIRHE has produced thirty eight (38) health professional graduates from and for the Province, most of who are currently working in their respective districts. This includes medical doctors, pharmacists, physiotherapists and occupational therapists. There are currently a further fifty five (55) students on training at Wits, Medunsa and Pretoria universities. This programme is a unique partnership between the Province and the Wits University Centre for Rural Health. 

We are also providing training and development opportunities for the youth through internship and learnership programmes. For 2014/15, we have a target to recruit 131 for the internship group programmes and 120 data capturers.  In the learnership programme our target is 113 auxiliary nursing and 30 enrolled nursing.  The Department has also started to facilitate a process of accrediting the Regional Training Centers to offer accredited courses for Health Care Providers and introduction of CHW Qualification Programme for NQF level 5 as an exit strategy from the programme.

Honourable Speaker and Members of the House, health as a service requires all of us as partners -  private sector, civil society and government to work together to fight and prevent diseases, build health infrastructure and invest in the health of the future generation as we move Bokone Bophirma forward.

Gape re leboga Tonakgolo le Minister of Water Affairs ka go tsibogela leroborobo la Letshololo (Diarrhea) ko Bloemhof le mathata a pholo a a ileng a tlhaga ka ntlha ya thoromo ya lefatshe ko mahelong a a ileng a amega.

We are forever endeared to the great deeds and social investment of the mining sector, the Royal Bafokeng Platinum Mines, Extrata Mines, Impala Platinum Mines, SAMANCOR, Lonmin and Rustenburg Platinum Mines.  We acknowledge the support of the Hospice sector, National Lotteries Board, Rustenburg Health Forum and many other organizations who have partnered with us. We appreciate and recognize all these partnerships for their role and investment into the health of our people.

Motlotlegi Mmusakgotla; ntetle jaaka ke ya bokhutlong gore ke lebogele kemonokeng le seabe sa batsaakarolo mo tsamaisong ya ditirelo tsa boitekanelo mo Bokone Bophirima.  Ke leboga thata boeteledi pele jwa Motlotlegi Tonakgolo Supra Mahumapelo, jaaka a re eteletse pele mo loetong lwa paka eno ya dingwaga tse dingwe gape tse tlhano go tsaya Bokone Bophirima re e isa kwa pele. Ke leboga le lekoko la African National Congress (ANC) le le nthomileng gape mo Lefapheng la Boitekanelo gore re tswelele pele ka kgaratlho ya go totakafatsa matshelo a bagaetsho.

Go maloko otlhe a Kgotlhakhuduthamaga ya Profense, badiri ka nna le maloko a Social Cluster, ke lebogela tshwaragano mo go direleng setshaba mmogo. Ke rata go leboga le Modulasetilo le Maloko a Standing Committee ga mmogo le Modulasetilo le maloko a Provincial Health Council.

I take this opportunity to also thank the management team of the Department, led by Acting HOD, Kgosi Motlhabane. I thank you for your support all the time.  I also thank all our employees for their dedication and commitment. I believe together we can "Move Bokone Bophirima Forward". 

Re ikgantsha ka seabe sa mekgatlho ya baagi, ya sedumedi, magosi, dinkgaka tsa setso,  maphata a poraefete ga mmogo le mekgatlho ee sa ikabang mo maitekong a rona a go tokafatsa boitekanelo jwa setshaba.  Baagi ba Bokone Bophirima, ke a lo leboga!

Ke ikaegile ka tshegetso le lorato lwa mosadi wa me, Mme Mosamo Masike, gammogo le bana kwa gae. Ke lebogela tshegetso le lorato. Motsoga pele o rile, "Kgetsi ya tsie e kgonwa ka go tshwaraganelwa". Bagaetsho, ke leboga go menagane!

Albert Einstein has said, "life is like riding a bicycle. To keep your balance you must keep moving."  And together "We are Moving Bokone Bophirima Forward"!

Ke a leboga!
I thank you!