Deputy Chairperson, hon Minister and Deputy Minister, my colleagues, and hon members of this House, let me join other members who have extended condolences to the Mkhize family. I also want to extend condolences to the family of one of our Cuban doctors who passed in a car accident yesterday.
I am honoured to be part of this important debate in the House on the national Health Budget Vote, which the Northern Cape fully supports. The hon Minister is indeed correct when he makes the seminal point that the entire health sector is currently at a crossroads in our country. The choices that we have to make today will determine our destiny for many years to come.
Minister Aaron Motsoaledi's service level agreement is indeed a worthy endeavour, directed at addressing the communicable and noncommunicable diseases that we face today, as well as revitalising the entire health system.
The national Ministry of Health must be applauded for the manner in which it has mobilised the entire sector towards the achievement of a clear set of goals. These goals are the four identifiable and measurable outcomes, and the 10-point plan of health. All the planning tools of the provinces have already been significantly aligned with these objectives, so that there is a clear articulation of what the intended purpose of our national health system is.
Needless to say, in the provinces our challenges differ, sometimes remarkably. This imposes particular areas of emphasis for each of the provinces, as we strive to address the health needs of our people and those of the health system itself.
Amongst the most critical of our health system challenges in the Northern Cape is the Emergency Medical Services, EMS. The national norm for the number of EMS ambulances required is 1 per 10 000 citizens. This ratio works well in urban and semiurban areas. However, due to the vast distances in rural areas that have their own peculiar and harsh conditions, this has been increased to 1,6 ambulances per 10 000 citizens.
In the Northern Cape the actual distribution of ambulances is as follows: 1 ambulance per 10 000 citizens in Frances Baard District Municipality, which is one of our biggest districts; 1,2 ambulances per 10 000 citizens in Siyanda District Municipality; 1,2 ambulances per 10 000 citizens in John Taolo Gaetsewe District Municipality; 2,3 ambulances per 10 000 citizens in Pixley ka Seme District Municipality; and 3,2 ambulances per 10 000 citizens in Namakwa District Municipality.
Clearly the backlog is huge, and the reality of having to annually replace obsolete vehicles increases this burden, given the vast distances and road conditions that ambulances have to travel in in the Northern Cape, perhaps a minimum of 400 km to 700 km from the other districts to the only facility that offers tertiary services in the Northern Cape.
It means that at any given moment we exceed the acceptable ratio of vehicles that are unavailable due to maintenance. This has the effect of dramatically reducing the number of vehicles that are available to serve the population. The reality is that countrywide you will have about 15% to 20% of vehicles being serviced at any given moment. However, in the Northern Cape this figure rises to a staggering 40%.
The national norm for the replacement of an EMS ambulance is every two years or 250 000 km, whichever comes first. In the Northern Cape we are failing to achieve this by a significant margin, with many ambulances that are significantly older than this and have travelled more than the maximum recommended number of kilometres.
This means that, in addition to routine maintenance, our ambulances repeatedly break down and require major repair work, including engine replacements. This impacts on the important function of transferring patients. We all know that in many instances the time factor in this regard is critical. Importantly, the coachwork of an ambulance needs to be in good shape.
The department is often asked why it undertakes costly major repairs of old ambulances, rather than spending that money on purchasing a new vehicle. The calculation is not always that simple. A new EMS ambulance costs an average of R450 000 which, when depreciated over three years, is equivalent to R150 000 each year. This suggests that, provided the refurbishment, repair and maintenance of an old vehicle is less than R150 000 for one year, additional service extending its lifespan may still be cost- effective. For each decision, it's a difficult prospective calculation that can often only be proven in retrospect. The Northern Cape has a total of 46 planned patient transport services vehicles. These vehicles are experiencing the same problems as the EMS ambulances: high mileage, badly damaged internal coachwork and high maintenance costs. Furthermore, these vehicles are old and out of service for long periods of time.
If the department were to replace these vehicles every three years or 300 000 km, this would necessitate replacing one third of the fleet each year, and that is 15 planned patient transport services vehicles. Typically, over recent years the department has had sufficient capital funds to replace only two to three vehicles each year.
The national norm for staffing the EMS ambulances - which is also a critical point for the Northern Cape - as prescribed by the Health Professions Council of South Africa, HPCSA, is two qualified personnel. Planned patient transport vehicles do not always require two people. However, when travelling long distances this is always the case in order to ensure the safety of the crew and patients.
Furthermore, each ambulance station needs a station manager; each subdistrict needs a subdistrict manager; and each district needs a district manager. Currently, just two districts run their own control room, and this needs to be established in all five districts. In order for the Northern Cape to achieve the prescribed minimum level of staffing, it needs to increase the number of staff from the current level of 560 to a new level of 1 823.
The estimated total spending per annum required for EMS and planned patient transport services vehicles is about R35 million. The current capital budget for these vehicles is only R12 million, giving a shortfall of R23 million a year. The estimated total spending per annum required for EMS and planned patient transport services staff is R269 million. The current budget for staff is only R87 million, giving a shortfall of R182 million. [Interjections.]
Hon Deputy Chairperson, our country is now being lauded by the global community, based on the immense work that has been accomplished in fighting the scourge of HIV and Aids, as well as TB. The department of health in the Northern Cape in its ministerial imbizo also embarked on a new strategy to prevent chronic diseases and promote healthy lifestyles. This was done in conjunction with the HIV Counselling and Testing, HCT, Campaign and TB screening in all the districts.
Stalls were set up at all the strategic places in a community, and the communities were screened for blood pressure and blood glucose, ophthalmic examinations were conducted, and women were referred to the nearest clinic for pap smears. Community members were also educated regarding the benefit of having gardens to grow their own healthy food, and eating a balanced diet. Seeds were distributed. Communities were encouraged to visit health facilities on time when they had health problems. Home visits were also conducted. Pregnant women were educated on the dangers of drinking alcohol and smoking during pregnancy. Emphasis was put on early booking and its benefits, so that they could be counselled and tested for HIV and Aids, and be put on treatment early if they were HIV-positive in order to reduce mother-to-child transmission.
Schools were also visited and learners were given health talks on substance abuse, regular exercise, general hygiene, healthy eating and also playing sport to keep fit. Kick TB soccer competitions were held, schools were presented with soccer balls, and certificates were handed out to participants.
There has been an increase in maternal deaths due to the scourge of HIV and Aids. As a result, women who visit our antenatal clinics are offered routine testing and screening for HIV and Aids, TB and chronic conditions as part of routine screening for pregnant women.
There is also a campaign that encourages women to book early or visit the nearest clinic when they have missed a period. The new clinical guidelines for the prevention of mother-to-child transmission are being implemented in all our facilities and pregnant women are being prioritised for antiretrovirals, ARVs.
Lastly, let me take this opportunity to thank the Ministry for their efforts to make sure that they implement the National Health Insurance and for their leadership. Thank you very much. [Applause.]