This media briefing is intended to update the public regarding the progress made in the implementation of the government’s Programme of Action. From the onset of the current term of governance we committed to make Health one of the key priorities of government, several milestones have been achieved in respect of modernizing, growing and developing a successful health system. Through the vicissitudes imposed by factors beyond the health system the department has been able to make strides and maintain our services intact. The burden of diseases illuminated by the outbreak of COVID – 19 and a constrained economic environment.
This media briefing is intended to communicate to the people of the Northern Cape the work that we continue to do in changing their lives for the better; including the strides we continue to make in laying the basis for Universal Health Coverage; by building a health system that responds to the pertinent issues faced by the population.
The total budget allocation for the department for 2023/2024 is R6.108 billion and there is an anticipated growth of R449.067 million or 7.4 percent over the MTEF (Medium Term Expenditure Framework). Furthermore, it should be noted that conditional grant allocation accounts for 29.3 % of the total departmental allocation for 2023/2024. As at the end of the third quarter the Department spent 76% from the allocated amount of R6.108 billion for 2023/24, the Department will continue to monitor the spending over the remaining months of the current financial year prevent any funds to be surrendered to the revenue fund.It should also be noted that despite the improved access of provision of health care services the department experienced budget cuts of R39 340 million in-year mainly from conditional grants allocations as implemented by National Treasury.
During the budget assessment period we received a once off allocation of R280.886 mainly to cover the improvement of Conditions of Service (ICS).
The management of unwanted expenditure remains one of the key focus areas within the department, it is encouraging to note that for the past two years the department did not incur any unauthorised expenditure which is a positive note towards building a sustainable financial management system.As part of strengthening the financial management systems and ensuring stability in the department the Premier has commissioned an extensive support program that is aimed at improving financial management systems within the department. The process will be a joint project between Provincial Treasury and Health. As part of reducing Irregular Expenditure for health we have appointed the project manager through office of the Premier (OTP) to lead the legacy project for possible investigation and condonation.
STATUS OF ORGANOGRAM
The Northern Cape Department of Health received concurrence from the Minister of Public Service and Administration on the Proposed Organisational Structure of which was officially signed off by the Member of the Executive Council. This is a major milestone, enabling us to better plan and acquire appropriate skills to execute our mandate of Better Health and Better Care. The next phase is the implementation thereof, of which a plan is developed that will guide the overall implementation of the approved organizational structure.
The underlying philosophy and principles that inform design of the departmental structure was aligned with the values and principles enshrined in chapter 10 of the constitution, which is fairness, equitable service delivery, efficient and effective use of resources, transparency and accountability.
The strategic departure purely based on the set strategic goals. This organizational structure will enhance efficiency, clarify roles and responsibilities which will lead to an improve organizational culture. The fragmentation and duplication are addressed through a more structured reporting line, were the span of control was prioritized to ensure that management takes place in a more accessible manner.
The paragraph on leadership gap that has been raised previously in the management report will slowly creep out as the structure clarifies reporting lines which establishes communication flow for improved decision making.
INTERNS AND COMMUNITY SERVICE INTAKE 2024
The Internship and Community Service programme is an essential aspect of the retention and improvement of our human resources for health.
A total of 295 posts were gazetted and 281 were allocated. From the 281 a total of 215 reported for duty as follows from January and the remaining late starters to join by the 30th of April 2024. This cohort was equally distributed across the province. Of note the Department has received 60 medical officers (Community Services) and 36 Medical Interns who are placed only at RMSH as a training platform. The rest of other categories include audiologists, dentists, environmental health officers, etc.
This cohort of cadres strengthens the service platform especially in rural areas where it is not easy to attract and retain professionals. The Department offers them permanent employment to service these rural areas. In the current financial year, a total of 14 who completed their community service in lieu of completion of recruitment and retention process. From our bursary holders we have retained 23 doctors who are currently placed in our facilities.
BURSARY PROGRAMME
From 2018/19 to 2023/24 financial years, the Department issued 289 bursary holders and to date 245 have been retained in the system. This depicts about 85% retention which is exceptional in strengthening the healthcare service delivery. The presence of professionals enables the province to broaden access to much needed healthcare services. We are strengthening our collaboration with the Premiers bursary fund so that we are able to appoint health professionals from the province who are beneficiaries of the Premiers Bursary Fund.
At the end of last year, we sent 10 young people to commence their medical studies in Cuba from rural areas. A total of two hundred and forty-eight (248) applications were received and the long list (meet basic requirements) made up of one hundred and fifty-three (153) applicants. The number of applicants far exceeded our expectations following a hiatus as we had no intake for the Cuban programme for a couple of years. We will be having another intake in the new financial year.
Total of thirty- four (34) were shortlisted and interviewed leading to the final ten (10).
The final list of the ten (10) students that fully satisfied all selection and required criteria consisted of candidates from all 5 districts of Northern Cape.
HENRIETTA STOCKDALE NURSING STUDENT INTAKE
The last intake of the legacy qualifications was in December 2019. It was therefore, mandatory for all nursing education institutions to adhere to the revised qualifications and curriculum. All nursing education institutions developed curricula aligned to the national qualification framework. Due to capacity constraints at both the Council for Higher Education and the South African Nursing Council, the accreditation procedure was significantly delayed. Before any new nursing training programs could begin, accreditation from the governing bodies is mandatory.
Henrietta Stockdale Nursing College has submitted curriculum for the R169 and R171 Higher Certificate and Diploma programs, respectively. The College obtained ultimate approval in November 2023 for the Diploma Programme. At this time, they are still anticipating final approval from the Council on Higher Education for the Higher Certificate Programme (Assistant Nurse Qualifications). Approval was granted for 30 Diploma students for the R171 Training programme. The advanced diploma in midwifery has also been submitted to the South African Nursing Council in November 2023 for evaluation.
The advert was published in November 2023 and a total of 2246 applications were received. These applications included prospective students who were matriculants and those who are community health workers, assistant nurses and staff nurses.
The breakdown of the applications received are as follows:
Total Number received: 2246
Number of applicants meeting the minimum requirements: 393
Number of applicants rejected: 832
Number of applications created: 840
Number of applications incomplete: 35
Number of Applications withdrawn: 12
Number of intake approved 30
The high number of applications highlights the urgent need to establish the satellite campuses in the province so that the output of the college can effectively deal with shortage of nurses at our facilities. If nurses trained are from local children, they will definitely service their communities after completion of studies.
DOCTORS AND NURSES IN THE PROVINCE
There are a total of 513 medical officers in the province, of which 293 are at RMSH. This is one area where the province is doing well the only challenge is the distribution. There is unequal distribution where the pressure is more at RMSH and the lower level Doctors referring cases due to limitation of skills. The department however, took a decision to centralize the appointment of medical officers to address the unequal distribution and further provide training to of which a process has been started to centralize the appointment of doctors. Vacant doctors’ posts are replaced as they exit the system.
The Department has a total of 2539 nurses (different categories), spread across the province. The challenge of retaining nurses still remains as there is high attrition of nurses which leads those remaining being overburdened. The approved HR plan for the department places special focus in retaining nurses. To further strengthen this the shortage of nurses, the department continues to fund nurses in improving their skills such as clinical nurse speciality, midwifery and theatre nurses. Hence a joint partnership with Stellenbosch University.
ACCESS TO QUALITY HEALTH CARE SERVICES
Working towards Universal Health Coverage through the NHI, the Department has made major strides in improving the standard of healthcare rendered in our health facilities. To date a reasonable number of facilities achieved satisfactory performance and have been issued with a four- year compliance certificates by the Office of the Health Standards Compliance (OHSC). This means that these facilities are ready to be accredited for NHI. In other words, it is important to understand that even us as public facilities we need to comply with OHSC standards. NHI participation as a provider is not automatic but dependent on OHSC compliance.
To increase the access to quality healthcare services and strengthen clinical patient management in the district facilities, the department:
• Has procured 10 mobile vehicles to service the remote under-serviced areas
• Will be opening 3 clinics -2 in ZFM- Boegoeberg, Raaswater, and 1 in JTG- Bankhara Bodulong, Nursing College Phase 1 and Kuruman mortuary before end of March 2024.
• Will be extending operational hours at City Clinic, Betty Gaetsewe, Winston Torres on the 1 March 2024 to relieve pressure at Robert Mangaliso Sobukwe Hospital
• Galeshewe Day Hospital shall be opened for 24 hrs on the 15 February 2024
• Has increased the uptake of patients participating in the Centralised Chronic Medicine Dispensing and Distribution (CCMDD) and the external pick up points (EPUPS) in order to decongest the facilities and improve patient of care
• Is continuously strengthening Integrated Clinical Service Management (ICSM) to enhance positive perception of care. We encourage patients to participate in the appointment system
In strengthening community participation, fostering governance and engendering local management accountability, clinic committees and hospital boards members have been appointed. To further encourage public participation, the Department has improved the visibility of complaints boxes availing the pens and papers. This important for us in line with the desire increase the level of participation of the patients/ communities to services rendered.
The appointment of Outreach Team leaders and school health nurses to strengthen community based services, further decongesting the facilities will be concluded before end of March 2024. Similarly, before the end of the year all operational managers and sub-district managers would have been appointed.
IMPROVEMENT OF ACCESS TO TERTIARY SERVICES
As part of improving access to oncology services the Department has commenced with the process of building a radiation centre which includes amongst other the procurement of the linear accelerator and planning for the bunker. The commissioning of the oncology centre which includes radiotherapy services and nuclear medicine is expected to be finalised in 2025/26 financial year. As part of the developmental services within our Tertiary Hospital (RMSH) we have successfully added Neurosurgery and vascular surgery all managed by medical specialists including Haematology that is managed within oncology in additional to our service package.
STATUS OF EMERGENCY MEDICAL SERVICES
Since the start of term of the current administration the government procured 150 ambulances. For the 2023/24 financial year the Department procured 49 ambulances. Preparations have already started to procure 30 ambulances for the 2024/25 financial year.
The EMS College has an annual intake of 30 students for the Higher Certificate in Emergency Care. This is done in conjunction with the University of Johannesburg. The intention is to upscale our current personnel and provide opportunities for young people of our province.
AMBULANCES IN OPERATION - 92
AMBULANCES IN MERCHANT - 73
NO OF AMBULANCES PROCURED - 49
NO OF AMBULANCES AUCTIONED - 55
The Department has implemented a Computer Aided Dispatch System within the EMS Call Centres. The system is intended to ensure that all calls are properly recorded and prioritized for the purpose of responding to patients in good time. This initiative provides the Department with the ability to voice record all calls, locate the caller and dispatch the nearest available ambulance to the caller. We are pleased to announce that the Call Centre number is free of charge to the callers requiring the emergency services. The number that is used for Frances Baard, Pixley ka Seme and John Taolo Gaetsewe Districts is 0800 001 218 whereas for Namakwa and ZF Mgcawu is 08000 001217.
PHARMACEUTICAL SERVICES
The Department has a Stock Visibility System (SVS) that is used to monitor medicine availability in the facilities. The acceptable norm for availability of medicine is 80%, anything lower than 80% causes concern. So far the Department has not scored below 80%, as it is committed in ensuring that communities have medication. Some areas have experienced sporadic and variable lower percentages in districts due to systemic or nationwide challenges that affect the supply and demand.
Most of the time the shortages result from items affected by external SCM processes and or national as well as international supplier in such cases the facilities with more stock will loan those without at all to ensure that patients are not disadvantaged. SVS makes it easy to monitor which facility has more stock of the items. Some items are negatively affected by international challenges as a result alternative options had to be utilised.
The availability of tools of trade at some facilities has affected the effectiveness of SVS hence the facilities are repurposing the gadgets that were available for Covid-19 to monitor stock availability.
LICENSING OF PRIVATE FACILITIES
The Department of Health is developing Northern Cape Private Health Establishment Bill that will address all issues regarding issuing of licenses, formalise governance, implement the fee structure and ensure accountability of procedures. It will also assist in streamlining sourcing relevant patient and health-related reports from the private facilities as some do not feel obliged to report to the Department. This Bill once finalised will replace Regulation 158 (governing the establishment of private hospitals and unattached theatres).
Additionally, there are no norms and standards in the province that enhance the implementation of R158, hence the issuance of licenses to private facilities has previously been applied inconsistently without reference to an approved policy nor Standard Operational Procedures.
All private facilities have to pay for registration, commissioning, inspections and annual renewal of licenses that will assist revenue collection as well as accountability.
The fifteen (15) private health establishments have been licensed by the Northern Cape Department of Health since 2011 to date.
The Bill will have an implication for the allocation of licenses informed by the need for the equitable allocation of beds in lieu of the rollout of NHI. The equitable distribution and access to health care services is an essential aspect of Universal Health Coverage. We have strengthened our current assessment of facilities in respect of their compliance with their licenses. A committee of fifteen officials composed of various specialities has been appointed to enhance accountability and compliance with OHSC standard. Importantly private facilities are encouraged to apply for the annual renewal of their licenses within 90 days before expiration. Annual renewal of licenses is not automatic.
The Department is working hard to tie all the knots as we enter the last mile of the current administration. The provincial government as a whole is striving to put the department of health on a better footing and path for the advancement of Universal Health Coverage. We thank both the public and the many exemplary public servants who work for and share our vision for quality public health care.
ISSUED BY : Northern Cape Department of Health
