Statement by the KZN Health MEC Dr Sibongiseni Dhlomo on the occasion of the Provincial Consultative Health Forum

21 November 2017

Ladies and gentlemen, we wish to welcome you to this media briefing as part of the Provincial Consultative Health Forum.

The National Health Act provides the legal framework for the establishment of national and provincial consultative health forums. These are meant to strengthen the dialogue among all partners in the health sector. It is a mechanism for engaging with the Department of Health as well as to enhance co-operation and partnerships with all our stakeholders. Although we still have challenges, we are also making good progress in some regards, such as:

Scaling up Anti-Retrovial Therapy:

The provincial government has strengthened efforts to scale up ART care and treatment services. Over a million people living with HIV in KZN are receiving ARVs. Last year (2016), government hit another milestone by announcing that people found to be HIV positive will be initiated on ART treatment immediately after they are diagnosed with HIV. The universal test and treat (UTT) approach is based on two theories: Early diagnosis and treatment will decrease the risk of HIV/AIDS and non-HIV/AIDS-related health problems in PLWH; and reduction of viral load to undetectable levels will dramatically reduce the current transmission rate of HIV. The Province KZN has taken aggressive steps maybe more than any other province since it is the worst affected in delivering the ART program. There have been remarkable policy improvements that have been implemented to ensure that people start treatment early as well as improved the quality of treatment regimens to those regimens which have less pill burden e.g. Fixed dose combination and less side effects and adverse events. The province has not only made remarkable strides in antiretroviral therapy but a number of positive health outcomes have been achieved such as:

• Reduction of Mother to child transmission
• Reduction in HIV and AIDS related deaths,

Task shifting to NIMART nurses and lay counsellors played a huge role in scaling up. This meant that services could be offered at PHC level. The province also employed lay counsellors on a full time basis which enhanced the program as they delivered comprehensive intensive patient education that facilitated adherence to ART and basic knowledge about HIV.

Due to all of these efforts, the life expectancy of South Africans has increased from 56 years to 60 years on average. Having a healthy workforce means that the country can attract more investors to the country as there are no fears of employing an ailing workforce. Countries like China and India managed to build their countries through the skilling and use of the skilled workforce at their disposal.

Medical Male Circumcision

Following a call in 2009 from His Majesty the King, the Provincial Government through the KwaZulu-Natal Department of Health embarked on a drive to promote and strengthen Medical Male Circumcision (MMC) in the Province.

Since 2010, when the Department established the KwaZulu-Natal Medical Male Circumcision Centre of Excellence, we have now circumcised more than 993 000 boys and men, which means that the 1 million target is within sight. This good work is as a result of good social mobilization activities as championed by Amakhosi, traditional healers; partners and community leaders, among others, for which we are extremely grateful.

Oncology Issues

The top 5 cancers in KZN are: Cervical cancer; Breast cancer; Colorectal Head and neck tumours; Prostate Cancer. A lot of the media focus on the issue of cancer has been on oncology, which is the advanced stage of cancer.

We are actually doing well when it comes to screening and chemotherapy. In fact, our efforts in this regard are being bolstered through the newly-launched National Cervical Cancer Prevention Policy (NCCPP) and the Breast Cancer Prevention and Control Policy. The aim of the new policy is to ensure that the early symptoms of cancer are identified early.

With the new approach, we use Liquid-Based Cytology (LBC), which is considered to be an alternative to conventional cytological investigations, also known as the Pap smear. This ensures a good quality and clean slide which is easier to interpret, and reduces the need for repeat pap smear thus saving costs.

When we talk about oncology cases in KZN… those are late cases because people do not present themselves for screening early enough. If we can mount and strengthen early detection, we will be unlikely to get more cases of advanced cancer that will require chemotherapy, radio therapy and surgery.

But until then, we have to deal with this oncology issue. The status quo is as follows:

At Grey’s Hospital we have:

• 4 permanent Oncologists
• 1 radiotheraphy machine (Linear accelerators)
• 125 per day combined patients (chemotheraphy, radiotheraphy, and new and follow up patients;

At Addington Hospital, we currently do not have an oncologist. A new machine was bought and the other one is currently under repairs. In the first and second quarter of this financial year, 250 patients have undergone Chemotheraphy.

At Inkosi Albert Luthuli Central Hospital, there are currently No permanent Oncologists. We have part-time Oncologists and also enjoy support from Grey’s Hospital. We have 4 Medical Officers and 6 registrars, who will be relocated to Provinces to complete their training. We have 3 Radiotheraphy machines (Linear accelerators).

During the first and second quarter of 2017/2018, the following oncology services were performed:

• Colposcopy – 83
• Number of Chemotherapy treatments - 2 522
• Number of Radiotherapy - 4 892
• Number of patients on waiting list colposcopy -15 (3 weeks)
• The waiting period for radiotherapy is 2-3 months.

Our Public Private Partnership with the Joint Medical Holdings group in Richards Bay has yielded the following results:

• Number of patients on Chemotherapy treatment - 43
• Number of patients on Radiation - 64
• Number of patients on waiting list - 31
• Number of patients on palliative care - 10
• Patient access scans at JMH at Richards Bay
• Patients are offered chemotherapy at Lower Umfolozi Hospital and then transported to Joint Medical House for radiation.

We recently made a presentation to the SA Human Rights Commission, detailing our plan to resolve the oncology situation as follows:

• Repair and monitoring all health technology machines regardless of contractual disputes;
• Adopt management plan to deal with the backlog eg PPP arrangements with specialists
• We also have three (3) local private oncologists assisting part-time at IALCH.
• Together with the national Department of Health, we are working on plans to import Oncologists from Cuba and/or India.

Central Chronic Medicine Dispensing and Distribution (CCMDD)

Since the launch of this CCMDD programme, more than 500 000 patients no longer have to wake up early and walk long distances to access their chronic medication. Instead, they are fetching it closer to their homes, at libraries, community halls, tribal courts and other local amenities. The medication is pre-packaged and all looks the same, which helps eliminate stigma. The CCMDD programme has reduced waiting times; improved access to chronic medication and decongested our health facilities.

Anti-illegal Termination of Pregnancy Campaign

Health and Welfare, including termination of pregnancy, was among the contemporary issues for Women’s struggle in 1900-1994. In the previous regime, hundreds of women died yearly as a direct result of illegal Termination of Pregnancy (TOP) complications. This was due to the fact that TOP could not be legally done except under the extreme health related circumstances.

In 1996 TOP was legalized in South Africa, with the implementation of the Choice on Termination of Pregnancy (CTOPA) Act.

We are pleased to report that since we intensified our Anti-Illegal Abortion Campaign in 2015, the number of women presenting to our facilities with complications after botched illegal abortions has significantly decreased.

The department measures its success by judging with the increase of the number of women who come forward for legal Termination of Pregnancy (2013 = 8 058); (2014 = 9 785); (2015= 10 152); (2016 = 14 209). There has also been a significant reduction in the number of women reporting in the facilities with Incomplete Abortions compared to the start of the campaigns. In 2014, the number stood at 10 786, and was reduced to 10 152 in 2015; and 8 633 in 2016. There has also been a marked increase in the number of facilities offering termination of pregnancies -from 14 in 2015 to 42 in 2017. There has also been a big decrease in miscarriage-related maternal deaths over the past 3 years in KZN, compared to the previous triennium 2011-2013 =53, 2014-2016 =27 (2015 =13), (2016 =5).

The KZN Department of Health, apart from the status of being the recognized pioneer on this issue, now enjoys the benefit of being the preferred custodian for valuable and trustworthy information when it comes to issues of promotion of safe TOP’s.

Ladies and gentlemen, all these successes that we have recorded do not mean that we must now rest on our laurels. We must now intensify our efforts even more.

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