The Minister of Health Dr Aaron Motsoaledi delivered his Health Dept Budget Vote 2015/16 speech recently in parliament, where he highlighted MomConnect project as a proud flagship project by the National Department of Health (NDOH).
Under the auspices of NDOH, Jembi has worked closely with Praekelt Foundation, HISP-SA and the CSIR to develop the backend health information exchange and registry which forms the backbone of the MomConnect system.
Learn more: MomConnect
Below excerpt of his speech ~
Let me move to the mothers of this country – the source of life and sustenance in the whole universe.
In August last year, we launched the MomConnect project at KT Motubatse clinic in Soshanguve, Tshwane Metro.
This project uses cellphone technology to register pregnant women – all pregnant women in both public and private health care. This empowers them to get all the information and instructions necessary for them to ensure a healthy pregnancy and deliver a healthy vibrant baby.
After delivery, the messages switch over to focus on information on the health needs of a new-born and will continue for up to one year after birth.
Honourable Speaker, I am very happy to announce that in a short space of only 8 months we have been able to register 383 354 pregnant women on the system. It is regarded as the largest number in the world. Before we started, Bangladesh was regarded as a world leader after registering 100 000 women in 18 months, while other countries are having only small pilot projects – nothing yet on a massive scale like we have.
The system does not only dish out information and instructions, it also enables pregnant women to ask questions and send to us unsolicited complaints and unsolicited compliments about our services. Unsolicited means that the woman sends in a complaint or a compliment without being asked, requested, provoked or prompted as is often done by researchers. This means we get to know about our services from the horse’s mouth unprovoked.
The compliments and the complaints constitute the good and the bad. Much against conventional wisdom Honourable Speaker, let me start with the good. The good is that we received 1 553 compliments in these eight months. While these compliments are diverse, there are 3 main categories worth noting:
Thanking us that the messages are very useful in guiding them about their wellbeing;
The service they received has been good;
Individual nurses who exert themselves and perform above the call of duty and are real angels to the pregnant women.
These 1 553 compliments constitutes what you will never read about in the print media or hear about in the electronic media.
What you will always hear and read about will be the bad, which I am now coming to. The bad consists of 290 complaints which we have received. Just like the compliments, they are also many and varied but again, three came out prominent:
First and the commonest of them all, are the long queues and long waiting times in our public health facilities.
Long before MomConnect, we have come across this phenomenon of long waiting times as far back as 2010 when we did our own audit of health facilities.
It is important to explain why this is so lest, some people blame us for doing nothing. We are trying day and night but it is a huge problem and hence the pregnant women on MomConnect have come across it.
Honourable Speaker, these unbearable waiting times are caused mostly by the fact that in 2004, we only had 400 000 people on ARVs. By 2009 the figure more than doubled to 923 000 and today Honourable Speaker we have 3 million people on ARVs. This figure is more than 30% of the World’s programme. There is no way clinics and hospitals will not be congested. Add to these the explosion of non-communicable diseases like Diabetes and High blood pressure, then you have very long queues in the making.
The solutions lie in making sure that very few people are forced to or have to visit a hospital and clinic and also by introducing new efficient technology systems in our health facilities.
I shall visit these issues later on in the speech.
The second major complaint which pregnant women have raised Honourable Speaker are the rude and unfriendly health workers who do not even respect the state of pregnancy.
We also picked this up in our 2010 audit.
The third is of course the non-availability of some drugs, leading to drug stock-outs – also due to the large volumes of people and difficulty in logistics which we are busy trying to resolve.
Honourable Speaker, we investigate and try to respond to each and every complaint that we pick up on MomConnect.
I wish to thank our partners who have helped us to develop and scale up this service.
The main partners were the United States Government, through its OGAC (Office of the Global AIDS Coordinator) programme and Johnson and Johnson.
MTN, Cell C and Telkom all contributed by giving 50% discount to the sms’s. Vodacom contributed by giving a 30% discount and we are happy that they are prepared to increase this very soon.
Our intention Honourable Speaker is to ensure that everyone of the 1, 2 million women who get pregnant annually register on MomConnect.
I wish to take this opportunity to acknowledge the presence in the gallery, of Ms Tshepiso Makwetla, the SAfm journalist who volunteered to be our MomConnect Ambassador. She has travelled the length and breadth of the country and encouraged pregnant women to register. We thank her for the job welldone!
Just like we contracted NICD to evaluate the impact of pneumococcal and rotavirus vaccines, we have contracted a consortium formed by the University of Stellenbosch and University of Western Cape to evaluate MomConnect to tell us the impact it has on pregnancy and child birth in our country, as well as the impact it has on care of the infant up to one year of age.
We are expecting the first results by end of this financial year.
Honourable Speaker if I may go back to the issue of health system strengthening, which needless to say will also contribute immensely to the lowering of complaints of mothers on MomConnect.
In preparation for NHI, President Zuma launched Operation Phakisa Ideal Clinic on 18 November 2014 and reported about it in this House during his State of the Nation Address.
Operation Phakisa culminated in a detailed plan for turning all our clinics and community health centres into facilities that will not only provide good clinical care but will improve the experience of patients who visit our facilities. Teams, dedicated to ensuring that all elements required for fully functional clinics are being established especially in the NHI Pilot districts. Similar teams will be established in the rest of the 52 districts in our country.
During the Operation Phakisa Ideal Clinic Laboratory, the teams were divided into eight (8) streams:
(i) Human Resources for Health;
(ii) Financial Management;
(iii) Supply Chain Management of the health facility;
(iv) Infrastructure of the health facility;
(v) Waiting times in the health facility;
(vi) Service delivery in the facility;
(vii) Institutional arrangements in the facility; and
(viii) Scale-up and sustainability in the facility
Honourable Speaker, we are aware that this is going to be a hard and long road but there is no alternative if we are to achieve our goal of Health System strengthening, and make NHI worthwhile.
While the Ideal Clinic model as implemented through Operation Phakisa is aimed at strengthening health care systems at our primary health facilities, this similar approach will eventually also be extending to our hospitals in the near future.
But as I said, I wish to reiterate that we are not labouring under any illusion that this is going to be a short and smooth road. Earlier on in this speech, I promised to revisit the issue of waiting times, which featured prominently on the complaints in MomConnect and on the results of our own health facility audits done in 2010.
I told you that it is because of huge volumes of patients which South Africa is experiencing and I also suggested that one of the solutions will be to make sure that as many patients as possible do not have to visit our health facilities.
This may make some of you to believe that we are going to chase patients away. NO!!
We are doing it by asking those patients who are stable, who do not really have to see a doctor or a nurse but who have to visit a health facility for their monthly supply, to register a collection point where they may collect their medicines, without having to queue or wait.
Collection points may be a clinic or hospital dispensary, private GP, private pharmacy or even treatment adherence clubs.
Such patients do not even have to queue for a file – they just march straight to the collection point and produce a card which they would have found in the pack they collected in the previous visit, or they produce an sms which would have been sent to them by us. Presently we have 383 989 patients on this system and we are targeting 0,5 million people.
Honourable Speaker, another project to strengthen the health care system is to deal with drug stock-outs.
Having 3 million people just for collecting ARVs only, the logistics of supplying drugs have become problematic. Demands may always exceed supply, not because of shortage in one country but due to logistical problems.
We have instituted a cellphone-based technology to deal with this. Presently this project is being conducted in 1 160 health facilities in the country, i.e. it is still in 25% of our health facilities.
A nurse has to read a barcode on every package of medicines every week, using the cellphone that we would have supplied. She or he would then send this information to a central database where it is fed into a geomap.
The facility that has a stock-out will blink a red light in the geomap and we will phone the District Pharmacist in that District to warn them.
Honourable Speaker I cannot finish this budget vote without dealing with the issue the President mentioned in the State of the Nation Address earlier this year.
I quote him, “Over the past five years, Government has scored significant gains in health care. This year, we are going to launch a massive programme to turn the tide against Tuberculosis (TB) with a special focus on three vulnerable communities, offenders at Correctional Services facilities, mineworkers and communities in mining towns”.
While the huge and successful ART programme has helped us to deal with TB, the epidemic is still very high as indicated in the President’s State of the Nation Address.
We have identified areas of the population which are very vulnerable to TB, and as the President alluded to, they are:
Correctional Service facilities;
The mines, especially Gold mines; and
Peri-mining communities or communities where there is intense mining, especially Gold mining activities.
We also used this concept of vulnerable communities to determine which districts are more affected:
District number one by far is Lejweleputswa in the Free State;
Number two is Dr Kenneth Kaunda District in North West;
Number three is Waterberg in Limpopo;
Number four is West Rand in Gauteng – especially around Carletonville;
Number five is the Bojanala District in North West;
Number six is Sekhukhune District in Limpopo.
On World TB Day, March 24, the Deputy President of the country, Mr Cyril Ramaphosa, launched the biggest TB screening programme that has ever been.
The launch took place in Orkney, for obvious reasons.
Hence screening is going on in the six Districts in Correctional Service facilities, mines, schools, crèches and indeed when you visit a health facility in these Districts for any ailment or any service you may be asked to subject yourself to TB screening. The screening may be by five oral questions and depending on your answer, it may proceed to XR via a digital XR equipment on mobile vehicles bought for this purpose through funding from the Global Fund, to sputum examination using the GeneXpert technology which every district in South Africa is now having after we started the rollout in 2011.
From the six districts, we shall move over to the big Metros, especially the Ethekwini Metro and the Cape Metro which are the most affected in terms of the TB caseloads.
From the Metros, we shall move over to the four provinces which are most affected.
I would like every Member of Parliament to join me in spreading the message about TB.
The three simple message are: Get screened, get treated if you are diagnosed to be having TB, and complete your treatment.
I would like all Members of Parliament to undergo screening for TB. It is important.
Let me just give you a glimpse of what the screening programme is revealing.
In the Correctional Service facilities, there are 160 000 inmates. The screening so far revealed 468 with ordinary TB and 17 with Drug Resistant TB. They have all been initiated on treatment and the screening process is continuing.
In the six districts I have mentioned, 36 415 community members were screened so far using the GeneXpert technology. A total of 3 256 were found to have ordinary TB and 57 were found to have Drug Resistant TB. All those did not know about their TB status before the screening. They are now all on treatment.
Honourable Speaker, just to summarise the extent of the TB epidemic in our country, when Ebola struck and you were all dying of worry and anxiety about it, the Executive Director of NICD, Prof Shabir Madhi shared a platform with me on TV in July last year to speak about Ebola. He advised South Africans not to worry a lot about Ebola as the chances of contracting if are very slim.
He said that what South Africans should worry about is TB rather than Ebola.
People phoned in and attacked the Professor and accused him for misleading them or for taking them for fools.
I am not here today to defend Prof Madhi. Facts and figures speak for themselves. Since he uttered those words, nobody in South Africa died of Ebola, but 40 542 people died of TB – but South Africans will still believe that the Professor was taking them for fools.
In conclusion, Madam Speaker, let me briefly summarise the budget request from the National Department of Health. For the 2015/16 financial year, the proposed budget that we are requesting your approval for is R36.46 billion.
This is broken down into four components as follows: R772 million is for compensation of employees; R1.579 billion is for goods and services; R33.448 billion is for transfers – these are the conditional grants that we provide to provinces; and R668 million is for capital expenditure. The total budget represents a 7.4% increase when compared to the 2014/15 budget.
I request this House to approve the budget of the National Department of Health for the 2015/16 financial year.
I thank you!
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