DEPARTMENT OF HEALTH NORTH WEST PROVINCE PORTFOLIO REPORT 2002/3 DEPARTMENT OF HEALTH NORTH WEST PROVINCE

TEAM Dr Hugh Gosnell : HOD(DDG) Ms Rebecca Hlabatau: CF0 Mr O Mongale : CD Corporate Services Dr M Saasa-Modise : CD Strategic Health Programs Mr Molefi Mosenogi : Director Policy and Planning Mr. F P Netshipale: Director: CD

OUTLINE Provincial Health Services Overview/Background Health Services Performances(Strategic Plans) Budgetary Allocations Capital Projects including Revitilisation Projects Responses to Portfolio Committee Questions

POPULATION :3.4 MILLION DISTRICTS:4 SUB-DISTRICTS:22

STRATEGIC OVERVIEW(CONT..) 2 provincial (level 2) hospital complexes (2 provide specialist psychiatric services as well) and 1 provincial hospital 20 district hospitals 12 community hospitals 327 fixed clinics and health centres 77 mobile clinics.

FIXED PUBLIC PRIMARY HEALTH CARE FACILITIES PHC facilities Number Average population per facility Province wide 327 11,009 Bophirima (least served health district in terms of access) 81 8,000 Bojanala (best served health district in terms of access) 134 12,375 Southern 34 19,058 Central (best served in terms of both access and average population per facility) 78 9,231

Beds per 1000 uninsured people (80% of population) PUBLIC HOSPITALS Hospital type Number Number of beds (Authorised) Beds per 1000 people Beds per 1000 uninsured people (80% of population) District and community[1] 27 3 613 1.1   1.4 General (regional) 4 2 244 0.7 0.9 Central Sub-total acute hospitals 31 5 857 1.75 2.2 Tuberculoses Psychiatric [2] 2 1 520 0.5 0.6 Chronic medical and other specialised Total 7 377 2.19 2.8

STAFF ESTABLISHMENT 2002/3 15255 MALES 3498 29 53 308 3888 25% FEMALES AFRICANS INDIANS COLOUREDS WHITES TOTAL MALES 3498 29 53 308 3888 25% FEMALES 10224 19 246 878 11367 75% 13722 48 299 1186 15255

Vision Optimum health for all individuals and communities in the North West Province.

Mission To ensure access to affordable, equitable, quality, caring health services for all in the North West Province through: Community involvement and partnerships; Batho Pele Principles and the Patients’ Rights Charter; Innovation driven performance; and By valuing our people and their diversity.

Strategic Goals Providing quality health care Providing accessible, equitable and affordable comprehensive primary health care services Well functioning and competitive hospital services Improving the health status of communities through implementation of integrated health programmes

Strategic Goals Well managed and effective District Health System Competent, empowered and performance focused employees Appropriate and effective organisational systems Effective management of the Department’s finance and assets

Demographic Indicators < 15 years – 1.2 million > 49 years – 430,000 15 – 49 years – 54% of total population non-urban areas – 65% of population only 36 people / sq. km. (Gauteng 468)

Socio-economic Indicators GDP per capita – 2/3 of country average Official unemployment rate : 30.7% Piped water inside houses: 21.7% of households Using electricity for cooking : 33.8% Infant mortality rate : 36/1000 Below national 45/1000 Life expectancy at birth : 52.7 years

NUTRITION

HIV/AIDS/STI Male urethral discharge incidence decrease from 3/1000 to 2.8/1000 Syphilis prevalence rate remained at 4% (77% reduction from 1998 figure of 17%) HIV prevalence rate among antenatal clinic at tenders increases from 22.9%in 2000 to 25.2% in 2001

HIV/AIDS/STI(CONT..) 322 VCT sites established & are functional 1310 Nurses were trained in Rapid testing 664 Nurses trained in counselling PMTCT rollout district approach adopted PMTCT sites increased from 2 to 89 392 HCW Prof nurses trained in PMTCT 400 lay counselors appointed through NGO Approach Out of eighty two(82) children tested for HIV at nine months(9), only 9 tested HIV positive

HIV/AIDS/STI(CONT..) R2.6 million was spent to fund 24 HBC NGO’s. Assisted 51 other NGO’s with Home Based Care kits (refilled quarterly by Department) HBC beneficiaries increased from 6,458 to 11,473 NGO’s have conducted 28,366 visits as compared to 22,880 in 2001. More than 1333 care givers were trained in HBC Department adopted 36 affected children in circles of support/care

25.8% PMTCT PERFORMANCE JULY 2001 –DEC 2002 RUSTENBG ZEERUST TOTAL # First Antenatal (booking) visits 2970 2855 5825 # Pregnant women who accepted HIV testing 1196 1828 3024 # Antenatal clients testing positive for HIV 462 319 781 # Deliveries to women with HIV 162 165 327 # HIV positive women given Nevirapine 324 # New born babies of HIV positive mothers on PMTCT 160 166 326 # Infants tested for HIV at 9 months 26 56 82 # Infants tested HIV positive at 9 months 2 6 8 # Exclusive breastfeeding 51 81 132 # Exclusive formula feeding 101 85 186 % VCT/ PMTCT uptake 40% 64% 52% % HIV positive ( As a % of those who accepted VCT) 38.6% 17.5% 25.8%

HIV/AIDS/STI(CONT..) 24 private doctors were trained in the syndromic management of STI, as well as 320 traditional healers. 2,080 condom distribution points. 22,208,331 male condoms and 210 837 female condoms were distributed during 2002(feb 2003). Assisted in training 8,700 youth as Peer Educators in five sub‑districts.

NUMBER OF SUSPECTED AND TRUE MEASLES CASES BY REGION AND YEAR: 2000-2002 Bojanala Central Southern Bophirima Province True measles cases. 2000 37 (6 ) 4 56 (3) 13 110 9 2001 41 3 11 29 84 2002 31 1 48

NUMBER OF NEONATAL TETANUS CASES REPORTED: 2000-2002 YEAR BOJANALA CENTRAL SOUTHERN BOPHIRIMA PROVINCE RATE 2000 1 2 <1/1000 2001 2002

TB INDICATOR 2001 2002 CURE RATE 52 47 % OF TREAMENT COMPLETION WITH NO SPUTUM COLLECTION 16% 26% DOTS COVERAGE 93% STT < 48HRS 75% 80% INTERUPTION RATE 12% 11% MDR RATE 0.4% 0.5% TB INCEDENCE RATE 402/1000 409/1000

PSYCHIATRIC COMMUNITY SERVICES 2001/02 Register: 18 416 Visits: 14 610 Default: 3806 2002/03 1st Q Register: 14 503 Visits: 11 354 Default: 3 149 2nd Q Register: 14 149 Visits: 9 618 Default: 4 531 3rd Q Register: 15 963 Visits: 9 900 Default: 6 063

PSYCHIATRIC HOSPITAL SERVICES 1st Quarter: Attempted suicide 283 Acute psychiatry 779 Detox 32 Rehab 0 2nd Quarter Attempted suicide 404 Acute psychiatry 851 Detox 49 Rehab 9 3rd Quarter Attempted suicide 375 Acute psychiatry 492 Detox 45 Rehab 14

MCWH Antenatal visits per client increased from3.8 to 4.1 (higher than national norm of 3) Caesarean section rate remained 14% for last 3 years Decreased teenage pregnancy rate to 9% in 2002 from 11% in 2001 Increased TOP by 64% from 2000 in 2001 to 3300 in 2002 IMCI implementation – 85% of sub-districts Implementation of CIC 35% Maternal deaths due to HIV

NUMBER OF MATERNAL DEATHS AND ESTIMATED RATE PER 100,000 WOMEN Year Number reported 1998 34 1999 54 2000 115 2001 62

CERVICAL SCREENING PERFORMED 2002/3 SERVICE PROVIDER PERIOD NUMBER OF CERVICAL SCREENING DONE Operation Blanket: Mafikeng district 2002/2003 8,274   Klerksdorp 9,224 Potchefstroom 1,500 Moses Kotane Cancer Association 151 Moretele 1,963 Schweizer-Reneke 233 Lichtenburg 840 Odi 1,491 Total 2002/2003 23 676

NUMBER OF ASSISTIVE DEVICES ISSUED Backlog Provided by Department Nov 2000 – December 2002 Walking Aids 91 679 Wheelchairs 1350 1127 Hearing Aids 563 385 Spectacles and IOL 1034

NUMBER OF CATARACT OPERATIONS PER YEAR SINCE1996 Number cataract operations done Estimated percentage increase 1996 1185   1997 1580 25%increase 1998 1975 25% increase 1999 1518 23% decrease 2000 1675 11% increase 2001 2208 32,5% increase 2002 1854 16% decrease

Complete Decentralized PSNP Programme implemented In 2002 85% of targeted children as opposed to 58% of 2001( out of 312 000, 263 693 were fed) More than 660 women groups benefited from the initiative This ensured income for 5000 women

ORAL HEALTH SERVICES 20 new fully equipped surgeries with state of the art equipments were opened between 2000 and 2002. 80% of them in rural areas. Number of out reach clinic visits increased by 30 %Preventive services has increased by 35% Conservative dentistry services by 30 % Curative in other areas has increased by 100 % where we had no services before as new more clinics where opened.

CAPITAL PROJECTS ACHIEVEMENTS HR&R Projects Doctors Residences in 3 district hospital i.e Schweizer Reneke, Ventersdorp and Jubilee Medical/psychiatric Unit in Taung & maternity Units in Mafikeng Complex Laundry /kitchen and boilers HOSPITAL REVITILISATION Business Cases completed for 4 hospitals 11/14/2018

CAPITAL PROJECTS ACHIEVEMENTS (CONTINUE…) Clinics Projects Completed 10 clinic/CHC’s (R25Million) Clinics to be completed (R14million) 16 clinics Madibogo CHC completed in partnership with IDT(R13million). Other 3 CHC’s to be built this year also by partnership with IDT worth R17Million. 11/14/2018

SOME CAPITAL PROJECTS PLANS 2003/4 Differential amenities for 12 hospitals (total costs R18 million) Revitilisation projects started Swartruggens Hospital building started(R32m) Vryburg and Moses Kotane Hospitals to be built Ongoing projects in Mafikeng SPDU, Taung hospital Pharmacy, Laundry linen bank (R13Million) Business Cases for Moretele and Brits to be developed 11/14/2018

QUALITY ASSURANCE ACHIEVEMENTS Clinical Investigation Committee work Investigates cases of neglect/clinical mismanagement and litigation matters Cohsasa Programmes started in 21 hospitals Clinic Supervision Tools work shopped and implemented Mortality and Morbidity Meetings monthly QA Unit established and functional

Drug availability at various centres: District Hospitals Central 96.49% Bophirima 93.6% Southern 90.36% Bojanala 87%   q       Community Health Centers and Clinics Central 85.125% Bophirima 86.6% Southern 89.6% Bojanala 80%   q       Provincial Hospitals Average = 92.25%

EXPENDITURE ON PHARMACEUTICALS & SURGICALS Projected exp 2003/04 R204,707,450 (20% increase)

TOTAL Conditional Grant Budget Expenditure %Expenditure BUDGET AND EXPENDITURE PER CONDITIONAL GRANTS 2002/3 Conditional Grant Budget Expenditure %Expenditure Primary School Nutrition Programme 43,964 100% National Tertiary Services 34,750 36,446 105% Professional Training and Development 32,898 Hospital Rehabilitation/Revitalization 64,293 52,824 82% Infrastructure 20,113 13,318 66% HIV/AIDS 20,419 21,245 104% Hospital Management and Quality Enhancement 8,334 6,395 77% TOTAL 224,771 207,149 92%

BUDGET ALLOCATION & EXPENDITURE PER PROGRAMME Est Actual Variance R'000 Administration 83,233 83,888 -655 District Health Services 1,252,569 1,282,716 -10,147 Provincial Hospital Services 537,071 550,117 -23,046 Health Sciences 46,069 47,036 -967 Health Care Support Services 55,017 56,416 -3,399 Total 1,973,959 2,012,173 -38,214

FLAGSHIP PROGRAMME FARM CHILD/COMMUNITY NUTRITION/FOOD SECURITY SOCIAL GRANT ELCD FAMILY/SEXUAL/OTHER VIOLENCE SUBSTANCE ABUSE

PRIORITY PROJECTS HIV/AIDS &TB EMS QUALITY IMPROVEMENT -CLINIC SUPERVISION & HOSPITAL ACCREDITATION ATTRACTING & RETAINING STAFF HOSPITAL REVITALISATION & DIFFERENTIATED AMENITIES DEVOLUTION OF PHC SERVICES COMMUNITY DEVELOPMENT WORKERS

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