Honourable Speaker and Deputy Speaker
Premier of Northern Cape
Leader of Government Business 
Members of the Executive Council
Leader of the Opposition Party 
Honourable Members of the Legislature
Chairperson and Members of the Portfolio Committee on Health
Chairperson and Members of the Provincial AIDS Council                                     
Acting Head of Department and Senior Managers in the Department of Health
Representatives of Organised Labour
Health workers and Stakeholders 
Distinguished guests
Members of the Media
Ladies and gentlemen
Comrades and Friends,
I take this occasion to express my gratitude for the opportunity given to us to present the 2023/2024 Budget Vote 10 before this august house. We present this budget vote as we enter into our final year which concludes our five-year term in office since 2019.
Madam Speaker, the health sector serves the people of South Africa through its vision of ‘A Long and Healthy Life for All South Africans’ and its mission to improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability. Towards achieving this vision, Government positioned the health sector to play a critical role in producing healthy and productive citizens, in order to ascertain this far reaching country’s socio-economic development.
The health sector is one of the key drivers in reducing morbidity, mortality, poverty and ultimately promote socioeconomic growth. The bi-causal positive links between a healthy population and the country’s inclusive socioeconomic growth is a well-documented fact in literature: Individuals who are healthier are able to be employed and earn income to improve their livelihood and support their families and communities.

At the advent of democracy in 1994, a great vision existed for the transformation of the health system in South Africa that works for all.  Access to good quality, effective and efficient health services was aspired by communities irrespective of individual socioeconomic status or residential areas, to uplift the living standards of our people.
Madam Speaker, the adoption by provincial government of the programme that seeks to ‘create a provincial roadmap for decisive action through resilience, hard work and progress,’ should be viewed as the cornerstone in the building of our province to achieve the ANC model of a society that truly cares.
Therefore, we find it appropriate to acknowledge first and foremost that the overall state of health care in the Province has greatly improved despite some intrinsic challenges. We stand firm in our commitment to continue implementing all steps and measures to ensure its sustainable recovery to further strengthen the delivery of health care services to all communities across the Northern Cape.

Madam Speaker, improvement in the population health status not only demands a well-functioning health system, but also improvements in the living and working conditions. This makes a strong case for better inter-sectoral collaboration programmes as well as provision of health services in more efficient and effective ways so that each Rand spent in the health sector has great value.On the 13th June 2023, Parliament passed the National Health Insurance (NHI) Bill paving the way for universal healthcare. We are elated that the bill will now go to the National Council of Provinces for concurrence before it goes to the President for consideration.
This marks a critical step or milestone for the country towards achieving Universal Health Coverage through the NHI which aims to provide equitable access to quality health services for all South Africans, irrespective of their socio-economic status.It is for this very reason that we have no option but to implement a health policy that requires a substantial shift that necessitate a massive health system reform - the National Health Insurance (NHI). Without a shadow of a doubt, its full implementation will see the healthcare system reorganized, based on values of justice, fairness and social solidarity to leave no patient behind the services they deserve.
The department has commenced with activities aimed at launching the Contracting Unit for Primary Health Care (Cup) towards NHI roll out at Phokwane local municipality. To this effect, a concrete project plan has been developed. The department is significantly supported by National Department of Health in this regard. This exercise coincides with the provincial endeavour to reset the healthcare service delivery platform.

Madam Speaker, as the Northern Cape Department of Health we fully support the Presidential Health Compact as it is a cornerstone document for health – one that binds us as a collective to the commitment of overcoming the challenges in our public and private health care systems, in preparing the healthcare system for the introduction of the National Health Insurance (NHI).We also appreciate that the Presidential Health Summit resolved to add a tenth pillar to the Health Compact which focuses specifically on Pandemic Prevention, Preparedness, Response and Recovery.Madam Speaker, on 5th May 2023, the World Health Organization (WHO) ended the global emergency status for Covid-19, more than three years after its original declaration (since 30th January 2020). The virus which has killed more than 6.9 million globally and 3 250 people in the Province should now be managed along with other infectious diseases. This means Covid-19 will no longer be treated as a vertical programme but rather integrated within the existing policies on infectious diseases. (In other words, COVID-19 is no longer a public health emergency).
At this point, allow me to take this opportunity once more to convey my sincere gratitude to the men and women who keeps our public health care system running relatively well, despite the challenges we are confronted with.Indeed, this would not have been possible, as majority of these health workers performed their work beyond the call of duty and demonstrated a citizen-centred and patient care attitude. We owe these health workers, managers and all role-players a huge debt of gratitude! We thank you very much.

Madam Speaker, we are proud to announce the recent appointment and training of over 1200 members from various communities across the Northern Cape to serve in hospital boards and clinics committees. These structures have been created to provide an avenue for communities to give an input into planning, delivery, organisation and evaluation of health services, as well as to play an oversight role in the development of health policies and the provision of equitable health services. Furthermore, these members are spread across 133 primary healthcare facilities, 11 hospitals and 33 community healthcare centres in the Province. We wish them well and further commit to provide them with all the necessary support during their 3-year term of office.
Madam Speaker, our Country’s overarching goal is to ensure that by 2030, we should achieve a life expectancy rate of at least 70 years and that the generation of under-20s is largely free of HIV. In terms of the life expectancy rate, our Province currently stands at 57 for men and 63 for women, respectively.
On maternal Mortality ratio of 110/100 000 live births, our Province achieved 80/100 000 live births in the previous financial year. There is an improvement with infant mortality rate of less than 20 deaths per 1000 live births and an under-five mortality rate of less than 30 per 1000. Notwithstanding this improvement, we have seen an increase on the clinical signs of Severe Acute Malnutrition amongst a significant number of children in our communities, this reflective of the constraint economic indicators in our society. This calls for the strengthening of a collective response to the Social Determinants of Health beyond the health sector.  TOGETHER WE CAN DO MORE.
The total number of people estimated to be living with HIV/AIDS in the Province is over 113 000. In terms of incidence by age group, HIV infection has been dropping slightly during the past three financial years (2020/2021 to 2022/2023), with the most decline recording among the youth (15 – 24 years), where HIV positivity rate decreased from 3.1% (2019/2021) to 1.9% (2022/2023).

In terms of care and treatment for people living with HIV, retention of clients into Antiretroviral Treatment Therapy (ART) has improved significantly, where the number of people on treatment increased from 62 471 (March 2021) to 68 863 (March 2023), representing an increase of 10%, largely thanks to the resuscitation of adherence clubs, improved counselling and transition to better treatment regimens.
Madam Speaker, the annual TB incidence rate dropped in 2020 largely due to the impact of Covid-19 lockdowns. We subsequently seen an increase in the number of TB incidences. By end of 2022, the Province registered 7 000 new TB infections, which is 11% higher than the number of infections registered in 2021.
Our Province exceeded its TB screening target by December 2022, where 78 000 people were screened for TB through community based campaigns. This improved the Province TB screening rate to above 85%, which is close to the 90-90-90 Strategy target. It is important to note that the scourge of TB remains rife in the community, where the disease continue to be the number 1 underlying cause of death. There are still many patients who do not take their medication consistently and this presents a risk to our communities.
Madam Speaker, in order to conduct strategic management, technical support to core programmes and overall administration of the Department, a total of R252 million or 4% cent of the purse has been set aside in the 2023/24 financial year.
In a measure to address staff shortages, R12 million worth of posts will be filled during the 2023/24 financial year with the following hospitals being prioritised to enhance revenue collection, Robert Mangaliso Sobukwe Hospital, New Mental Health, Dr Harry Surtie, Connie Voster, Dr. van Niekerk and De Aar hospital.
The recruitment process of 204 personnel including doctors, nurses, allied health workers and support staff worth an amount of R139 million was concluded and they have assumed duty on the 1st of April 2023.

The vacancy rate of the department stands at 16,73%, which is above the Department of Public Service and Administration (DPSA) threshold of 10%. Currently, the number of personnel acting in higher positions is affecting decision making, continuity and causes instability within the Department. In addressing this impasse, we resolved to expedite the process of filling all vacant and funded posts especially at senior management level.
Madam Speaker, District Health Services focus is to provide comprehensive, integrated and sustainable health care services based on the Re-Engineering Primary Health Care approach through the District Health System. The budget allocated for the 2023/24 financial year amounts to R2.7 billion. This programme still has the largest allocation of the department with 46 percent of all available funds and includes budget allocations of the District Health Information System Grant which covers the Comprehensive HIV/AIDS Component, District Health Component and National Health Insurance Grant as well as Social Sector EPWP. The Health Information System Grant has an allocation of R716 million and National Health Insurance Grant allocation of R43 million while the Social Sector EPWP is allocated R5 million.​
Madam Speaker, the Department has also made significant strides in the revival and improvement of the uptake on Central Chronic Medication Dispensing and Distribution (CCMDD) to improve Patient Experience of Care (PEC) and waiting times at public health facilities. The Province currently stands at 80% Patient Experience of Care and 1:35 Hours waiting times- all within the required norms.
As part of strengthening the delivery of healthcare services in the districts, in line with policy directive, and to ensure appropriate referral pathways, the department remains committed to establish a Sol Plaatje District Hospital. This will be informed by the District Health Service Strategy Review process and the imminent implementation of the NHI policy.

The National Health Insurance policy implementation seeks to provide a scientifically determined spatial planning informed by a catchment population of the district. It is therefore, against this background that the department is putting all efforts to ensure that Galeshewe Day Hospital functions optimally as the Community Health Centre that will render full service package to alleviate pressure at Robert Mangaliso Sobukwe Hospital.
Madam Speaker, with regards to Health Sciences and Training, we have allocated R181 million this financial year to develop a dedicated ethical educated workforce to acquire knowledge and principles in the provision of nurses, emergency medical care and other health professions, empowering them to translate their knowledge, skills and attitude to complement a comprehensive health care services approach in the Province.
Madam Speaker, as at June 2023, the department had appointed a total of 3 287 young people ranging between the ages of 21 to 35 years. This intervention is inclusive of clinical and non-clinical personnel which reflects a major milestone in reducing youth unemployment in our Province. This is a good story to be told, over and over again!
A key priority that stands out for the department in this roadmap is the professionalization of healthcare services, including both core and essential support services. The Department in collaboration with HWSETA, has successfully trained and absorbed 99 Post-Basic Pharmacists, who have been equitably distributed across the province. This is in addition to the 11 852 unemployed youth across different departments who, as announced by the Honourable Premier in the SOPA, have benefitted from skills development programmes such as internships, learnerships, artisanship, just to name a few. Madam Speaker, this is directly responding to the theme for this month, “Accelerating youth economic emancipation for a sustainable future.”The Henrietta Stockdale Nursing College has been accredited for both the Higher Certificate and the Diploma in Nursing Science in line with the new Higher Education standards. The Department is only awaiting the final approval from the South African Qualifications Authority (SAQA) to allow our Nursing College to prepare for the first intake of the new nursing qualifications.

Madam Speaker, in a measure to address the lack of nursing specialities in our Province, we have for the first time in few years sent 35 nurses to do their specialities which range from; Primary health care, trauma nursing, health services management, infection prevention and control.
On the other hand, our Emergency Medical Services College have since obtained a provisional accreditation certificate to train a one-year qualification which is a replacement of the entry qualification in this profession. This college has already started to enrol 30 students for a one-year programme.
Madam Speaker, the Department also participate in the recruitment of candidates from poor communities to study medicine in Cuba through the Mandela-Castro Medical Collaboration Programme. Inferring from its name, this programme was conceptualised in the year 2000, by the two esteemed great statesmen, President Nelson Mandela and President Fidel Castro of the republic of South Africa and Cuba respectively.
This year, 26 students have successfully completed their medical studies and will be graduating in July. This will increase the current pool of Mandela-Castro Medical Collaboration Programme doctors to 147 in total, since inception. Of these medical doctors, 77 are currently on internship whereas 70 is comprised of grade one medical officers and community service doctors. 5 of the Seventy 70 medical officers have reneged on their contractual obligations and this translates to 92.8% performance output of the professional yield of Mandela-Castro Medical Collaboration Programme doctors in various health care facilities in the Northern Cape. We plan to have an intake of 10 students in the Mandela Castro Cuban Medical Programme in the 2023/2024 financial year.
Madam Speaker, an overall allocation to deliver tertiary services at Robert Mangaliso Sobukwe Hospital, which are accessible, appropriate, effective to communities and also providing a platform for training health professionals is in the budget that is being tabled and amounts to R1.3 billion. This programme receives more than 22 percent of the total allocation of the department.
As part of modernization of tertiary services, the Robert Mangaliso Sobukwe Hospital has been allocated an amount of R408 million through the National Tertiary Services Grant.

The following equipment has been acquired as a mechanism to strengthen the provision of tertiary health care services in the Northern Cape:
- The Optical Coherence Tomography (OCT) which impacts positively towards shaping up the Ophthalmology Services. The number of Ophthalmology cases drastically reduced by nearly 70% and the waiting time for surgical procedures reduced by 6 weeks for this specific discipline.
- The Neurosurgery microscope and Neuro-navigation system brought excitement in the turnaround time for Neurosurgical procedures, as it promotes early detection / diagnosis and improved surgical outcomes.
Madam Speaker, access to Oncology services remains one of the significant challenges in the health care system due to patients presenting at an advanced stage for cancer treatment. It is to this end that we have set aside approximately R106 million through conditional grant, to fund the establishment of a Radiation Therapy Centre in Robert Mangaliso Sobukwe Hospital. In the interim, the department has four (4) Chemo Therapy Centres across the Province which are fully equipped. In collaboration with the private sector, a 5th centre will be established in the Namakwa district.
As part of Infrastructural Rehabilitation Programme, the installation of the Lifts at Robert Mangaliso Sobukwe Hospital is progressing exceptionally well with 4 out of 9 already commissioned. This is a huge relief for our patients especially those in the maternity ward.
Madam Speaker, there is an intensified effort to look at building additional capacity through gradual replacement of the 2 boilers at Robert Mangaliso Sobukwe hospital and setting up of a provincial linen bank, in the interim. The plan is to ultimately have a Provincial Laundry established.
The next phase of our digital patient record system will be implemented starting at Robert Mangaliso Sobukwe Hospital. We successfully piloted it in Galeshewe Day Hospital and we can indicate that our system even links with Home Affairs to ensure that we have the correct and latest data of our patients.
Madam Speaker, long waiting theatre times is impacting on prolonged hospital stay and increase inter- facility transfers. As part of reducing the surgical back logs, the Department has conducted 120 cases during the surgical marathon between May and June this year. A joint public private collaboration has been initiated and the impact will be closely monitored as the program progresses. Furthermore, we are collaborating with Medi-Clinic to reduce surgical backlogs by utilising their theatres. This project will be piloted in July as part of Mandela month programme.
Madam Speaker, in recent years there has been a significant increase in the number of Forensic State Patients (FSPs). Overcrowding of State Patients in Department of Correctional Service Centres is however not unique to just some provinces, but notably also places a huge burden on the Northern Cape-DCS Centre.
The Northern Cape Mental Health Hospital (NCMHH) management in collaboration with the Department of Correctional Services facilitated the transfer of 15 State Patients on 08 - 09 May 2023. This intervention will have a meaningful impact and alleviate the pressures at the DCS Centre by resourcing our Mental Health facility and ensure that all beds are fully operationalised.
Madam Speaker, a total of R425 million has been allocated to render Emergency Medical Services, special operations, planned patient transport as well as providing disaster management services in the Province.
In the previous financial year, a total of 79 ambulances to the value of R60 million were procured with full conversions. The Department has already received partial delivery of this consignment.
This morning, the Department has launched 20 new ambulances and 10 new Patient Transport Vehicles. Plans are afoot to procure additional vehicles towards the end of the fourth quarter in the current financial year.

Madam Speaker, we acknowledge that the vast geographical area of Northern Cape makes the availability of Emergency Medical Services more challenging. Furthermore, the conditions of our roads contributes to the rapid aging of the department’s fleet, and the delay in maintenance and repairs is having a negative impact on response times as the majority of the available fleet is often out of service.
The department will address the issues of staff shortages. The intention is to turn things around in order to improve the response time of ambulances to the citizens of our Province. There is a need to urgently appoint ambulance emergency care officers to the minimum of 350 in the short term plan. The appointment of these officials will bring the total EMS personnel to at least 1040 personnel to operationalise 130 ambulances at any given time.
Madam Speaker, the department has since operationalised the two call centres in Kimberley and Upington. This initiative has proven to be effective and benefitting the citizens of the province in that there are more calls that are captured now with the digital system installed as opposed to the paper based system of call records. Our call volume moved from around 4000 calls to 10000 calls a month since we introduced the system. The calls to the call centres will be zero rated, meaning they will be free of charge from the patients.
The solution includes Smart Patient, a smartphone app for patients needing provincial, municipal, or community-based healthcare where they can log a medical assistance request on their phone, as well as Smart Dispatch, a computer-aided emergency services dispatch system enabling users to make an emergency service request via SMS, USSD, e-mail, phone, and Smart Patient app. This initiative is responding to the vision of the Province in modernising our services for better outcomes.
Madam Speaker, a total budget allocated to Health Care Support Services for this financial year is R137 million. From this budget, specialised forensic medical services accounts for R49 million to meet the objectives of the Department.

A new mortuary in Kuruman will be operationalized in this financial year. Furthermore, plans are underway to construct a new forensic mortuary in the Frances Baard district. A total of four (4) Forensic body fridges have been procured for Kimberley and Postmasburg Forensic Mortuaries. We can assure members of the communities that all mortuary fridges are currently fully operational with optimum storage space for storing the deceased with dignity.
On Orthotic and Prosthetic services, from the total budget of Health Care Support Services the sub programme accounts for R13 million.
This service aims to re-integrate persons with disabilities back into society. This would include patients that need amongst others, artificial limbs, body bracing (braces for the back, splints for knees, wrists). The provincial team will provide outreach services on a monthly basis to attend to identified cases.
This service was lacking because of shortage of professional staff. The Department has since appointed three such professionals. While this might not be sufficient, it will however, assist greatly with the roll out of this program. An amount of R5.3 million is set aside for the procurement of assistive devices.
The Medico legal contingent liability amounts to R 2.1 billion comprising of 93 active cases. Most of these cases are birth injuries which results in Cerebral Palsy.
Madam Speaker, to ensure an effective and efficient delivery of infrastructure and provision of technical support services to the Department. We have set aside R510 million, inclusive of R465 million from the Health Facility Revitalisation Grant to complete outstanding infrastructure projects and maintenance of facilities thereof.
Madam Speaker, the Heuningvlei Clinic was successfully opened in December last year, with expectations of positive spin offs on service delivery resulting in improvement of patient experience of care. Similarly, building of the Dithakong CHC, will through a partnership with South 32 mine commence during August 2023.
Boegoeberg Clinic and Bankhara Bodulong are reaching final practical completion. We anticipate to officially open these facilities by end of July 2023.
Designs for the construction of the new Lorato Park clinic in Kimberley, has been finalised and updated accordingly to suit the ideal clinic specifications. The construction phase will commence in the second quarter of the current financial year.
Furthermore, an amount of R15 million has been committed for the planning phase of the new Schmitsdrift clinic.  

Madam Speaker, for the 2023/24 financial year, the department has been allocated an amount of R6.1 billion. This includes allocations of six conditional grants amounting to R1.7 billion, as follows:
Programme 1: Administration​​​:​R252 million
Programme 2: District Health Services​​:​R2.7 billion.
Programme 3: Emergency Medical Services​:​R425 million
Programme 4: Provincial Hospital Services​:​R495 million
Programme 5: Central Hospital Services​​:          R1.3 billion
Programme 6: Health Sciences and Training​: ​R181 million
Programme 7: Health Care Support Services​: ​R137 million
Programme 8: Health Facilities Management​:​R510 million.
While this is a very marginal increase of 3.7% when compared to the Budget tabled last financial year, the budget allocations over the MTEF are stable and grow steadily.
The budget that is presented today makes no provision for wage increases in terms of the general salary adjustments for inflation. This is in line with recommendations from the National Treasury. It also seeks to support the national government’s fiscal consolidation in respect of the overall wage bill and hence no vacant posts are funded. Included in the baseline for the 2023/24 financial year is a general reduction of R19 million towards Department of Roads and Public Works for the settlement of rates and taxes.

Furthermore, the Department has been allocated an additional amount of R200 million in 2023/24 financial year and R626 million over the 2023 MTEF. 
These funds are allocated as follows: R97 Million Compensation of employee’s baseline adjustment, R12 million towards Revenue Enhancement initiatives, R18 million towards NHLS baseline adjustment, R65 million towards ART, TB and Medicine baseline adjustment and R8.6 million towards Fuel, oil and gas baseline adjustment.
In conclusion, allow me to take this opportunity to express my gratitude to the Honourable Premier, Dr Zamani Saul, and the Members of the Executive Council, as well as the Portfolio Committee on Health, for the support given to me in the lead up to this day. We as a team have committed to the call of ensuring that we succeed in our mandate to provide quality health care services to ALL.
We also thank all our health frontline staff, and officials of the department under the leadership of the Acting Head of Department, Dr Dion Theys, as well as my Ministerial staff, for their unwavering support in all our endeavours.
I thank you.