Deputy Chair, hon Minister, Deputy Minister, hon MECs present and all hon members, the merger of the departments of health and social development soon after the 2009 elections presented us with an opportunity to tackle challenges which face our province holistically.
It is a fact that poverty contributes to poor health outcomes; therefore, programmes which seek to eradicate poverty will have an impact on the health status of the people of Gauteng.
As government, we have come to accept that budgets that are appropriated to eradicate poverty and improve the health status of our people are not mere expenditure. We regard these as investments. A population that is ravaged by poverty and poor health care can never be productive. This approach to budget allocations underpins the manner in which we prioritise our interventions. Sustainable development and improved health outcomes will ultimately impact on the productivity of the people of Gauteng.
We are guided by the following outputs as set out in the negotiated service delivery agreement, the Millennium Development Goals and our five-year strategic plan. These are: increasing life expectancy; decreasing maternal and child mortality; combating HIV/Aids and decreasing the burden of disease from tuberculosis; strengthening the health system's effectiveness; strengthening early childhood development; preventing and reducing substance abuse; strengthening services for older persons; waging war on poverty; and mainstreaming gender, youth and disability.
Chairperson, we have prioritised reduction of child and maternal mortality. All hospitals and clinics with maternal obstetric units in Gauteng are implementing the 10 recommendations of the Saving Mothers report.
The availability of maternal obstetric ambulances and their quick response is crucial to saving the lives of women who are in labour and their infants. To this end, we will increase the number of these ambulances, which are especially dedicated to the transportation of women who are in labour emergencies, from 5 to 10.
We have also initiated a campaign to encourage pregnant women to book for antenatal visits before 20 weeks of pregnancy. This campaign is born of the fact that our records attest to low figures for women who attend antenatal clinics. The rate of antenatal visits before 20 weeks increased from 27,3% in the first quarter to 30,7% in the fourth quarter. Although the increase is encouraging, a lot of work still needs to be done to increase this number.
In order to reduce maternal and child mortality in Gauteng, we have established two committees to advise the department on methods and interventions to reduce maternal, neonatal, infant and child morbidity and mortality. These committees are called the Maternal Morbidity and Mortality Committee and the Neonatal, Infant and Child Committee. They will ensure rigorous monitoring and analysis of maternal and infant mortality in 2011- 12.
In addition, all district, regional and central hospitals, including specialised hospitals, conduct morbidity and mortality meetings each month to investigate every death and improve management of hospitals. Maternal and prenatal morbidity and mortality meetings are held in all hospitals offering maternity services on a regular basis. At these meetings, the causes of death are investigated, and issues of commonality are identified and discussed, and the appropriate interventions are implemented to reduce the occurrence of avoidable deaths and reduce mortality rates.
We will strengthen our immunisation programme to reach children who could have been missed, especially those in informal settlements. In 2010-11 the department improved measles immunisation coverage, reaching 111,5% by end of the financial year. This was possible through monitoring and evaluation visits to districts and in-service training on expanded programmes on immunisation and vaccine stock management. Vitamin A coverage for children under the age of one year and new mothers reached 104,4% and 97,8% respectively. Through the expanded programme on immunisation, which encompassed the Reach Every District Programme and the availability of vaccines, measles coverage reached 111,2%. The target on rotavirus dosage coverage was reached due to training, campaigns conducted and health education to postnatal mothers on the importance of ensuring that rotavirus vaccine is given within a 6-month period after birth.
The fact that targets for immunisation are exceeded is testament to our efforts to ensure that children whose birth has not been registered, as well as children born in other provinces and even other countries, receive their immunisation in Gauteng. Hon members, I take this opportunity to urge you to remind your constituents that every day is immunisation day at our clinics. Even our hospitals have established vaccination points for catch- up in case of missed opportunities.
We have already taken steps to increase the number of neonatal beds at Charlotte Maxeke Johannesburg Academic Hospital, Dr George Mukhari Academic Hospital and Natalspruit Hospital. Strict adherence to infection control measures is monitored very closely. Every death of a child from preventable diseases is one too many. The prevention of mother-to-child transmission of HIV programme is bearing fruit. We will continue to strengthen this programme in order to reduce the overall incidence of HIV.
This year we will also strengthen our school health services. The focus will be on screening obstacles to learning among Grade R, Grade 1 and Grade 7 pupils. Currently, school health teams visit 1 431 schools, and we will collaborate with the Gauteng department of education in this regard to reach more schools.
Chairperson, we are breaking the back of HIV/Aids. By the end of March 2010 we had 412 191 people on antiretroviral treatment, ART. Our target is to increase this number to 520 000 by the end of March 2012. In order to provide treatment closer to where people live, the number of ART sites will be increased from 162 to 366. Timeous enrolment of people on ART, while also taking into account their CD4 count, goes a long way towards warding off the onset of Aids; hence we have trained professional nurses to initiate treatment. To date, more than 600 professional nurses who work in clinics have been trained to initiate ART.
Hon members know that HIV is incurable. Therefore, our focus on prevention can never be overemphasised. Medical male circumcision will therefore be upscaled to reach 100 000 males by the end of March 2012. We have already tested more than 1 million people since the launch of the HIV Counselling and Testing Campaign. Our research shows that there is an increase in the use of condoms across all ages of the sexually active population.
Tuberculosis, TB, remains a burden to our health system. Early diagnosis and treatment will ensure that we increase the cure rate and reduce the spread of TB. TB is also the number one killer amongst HIV-positive patients. Hence we have decided that all TB patients will be screened for HIV/Aids in order to ensure that those who are co-infected and have a CD4 count which is below 350 are initiated into ART. We have noted that admission of multidrug-resistant TB patients for six months at Sizwe Hospital disrupts their livelihoods, especially if they are breadwinners. That is why we will soon launch a community multidrug-resistant programme to ensure that these patients continue receiving treatment while living with their own families.
We have procured the GeneXpert technology, which will ensure the shortening of time with regard to availability of sputum results from a whole week to two hours. This will greatly reduce the loss of patients to follow-up, as some do not come back for results. This technology is already available at Chris Hani Baragwanath Academic Hospital and Edenvale Hospital. We will also make this equipment available to the rest of the districts in the course of this financial year.
To reduce the spread of TB among families of patients, we will visit their homes and screen them for TB. Those found to be already infected will be placed on treatment immediately. Deputy Chairperson, since we embarked on this process, we have found 53 038 new cases of TB, exceeding a target of 52 000. This has been achieved through intensified case finding in door-to- door campaigns and the HIV Counselling and Testing Campaign. We will continue to ensure that TB cases are detected early so that those who are infected are placed on treatment, thus curbing the spread of infection in the community at large.
All of the above can only be achieved if we have an effective health system. An effective health system hinges on primary health care services which inspire confidence. We are re-engineering primary health care in order to improve health outcomes and reduce the need for curative services.
We have already begun to establish health posts which are located in communities. This is a service unit that is embedded in the community and at the periphery of a clinic or community health centre in which comprehensive primary health care is rendered to a definite number of households. The aim of health posts is to ensure that community-based services, including outreach services, are provided to communities on a door-to-door basis. In Gauteng, a block of 250 to 300 households or families in a community will be served by a health post.
The health and social development teams will consist of a health post doctor, professional nurse, social worker, health promoter, enrolled nurse or nursing assistant, and counsellor. They will work with appropriately trained community health workers and social auxiliary workers who are placed within specifically designated communities.
This model will reduce waiting times in the clinics, because services will be brought closer to the people. This will be achieved by taking chronic medication directly to patients at their homes, attending to minor ailments, and providing elementary care closer to where communities live.
Furthermore, health and social development problems will be detected early and attended to in time, thus increasing chances of recovery and minimising defaults on treatment. It is hoped the perceptions in the community about the quality of care ...