A) Consolidate the achievements of the previous 5 years especially as regards improving access to PHC (Primary Health Care) services for all citizens of our Country. In this regard there will be specific focus on the following activities.

(i) Eradicate Polio, sustain gains made in reducing the burden due to Measles - Aim for elimination of Measles by 2002 largely by increasing routine coverage to 90% (from current 82%) and carrying out targeted Measles campaigns.

Countrywide to achieve 90% full immunisation at first birthday with at least 80% attained in each Province.

(ii) Ensure 100% availability of drugs in the EDL for PHC in all facilities. To achieve this, we need to both popularise and train health workers on the EDL, improve stock management and ensure reliability of pharmaceutical distribution to all our facilities.

(iii) Ensure appropriately trained personnel are available in all our PHC facilities.

(iv) Reduce Maternal Mortality and improve reproductive choice.

(v) Provision of assistive devices for those with disabilities.

(B) A key challenge for us is to improve the functioning of our hospital sector. We need to make our hospitals operate more efficiently; be more responsive to the users; provide a conducive work environment for staff; see the right patients at the right level of care through introduction of a referral system.

Central to the success of all these initiatives is the introduction of a System of Decentralised Management in all our hospitals. This would enable managers to manage more effectively and have the necessary agility to respond rapidly to changing situations.

We are commencing this financial year with decentralising management to 15 hospitals countrywide including the 10 biggest hospitals in the country.

A critical element for this decentralisation is to ensure that our Management Teams are equipped with the necessary competencies to carry out this task. A companion component of improving, overall, our hospitals is to speed up implementation of the hospital rehabilitation programme.

We all need to implement appropriate incentive schemes to support the management reforms. One such scheme being worked out together with provincial treasuries is Revenue Retention.

(C) Improve the Quality of Care throughout the health system.

Currently the Department is working with other stakeholders on such initiatives as:

1) The Patient's Charter

2) Peer review Systems

3) Continuing Health Personnel Education

4) Appropriate and effective Complaints Systems.

We intend entrenching some of the key principles of these initiatives in the national Health Bill to be tabled next year (2000).

We need to make the point also that to sustain this initiative and entrench a culture of quality - our training institutions need to review selection criteria; the content of curricular as well as confronting the difficult challenge of ensuring that our educators themselves are appropriate role models for the younger generation. In particular we need to promote a caring ethos in our health workers; create conducive work environments; empower communities to interact constructively with our institutions to ensure their needs are met; empower individual users to claim their right to dignity.

(D) Speed up transformation of training institutions. In particular ensure greater accommodation of those from previously disadvantaged backgrounds especially women and the rural.

(E) Escalate the War Against HIV/AIDS and TB. In particular:

- ensure a truly multi sectoral response building on the Partnership Against Aids launched by the former Deputy President, on October 1998. In this regard a meeting of the different sectors is to be held on the 6th July 1999.

- Provide care and support for the growing number infected or affected.

- Establish a particularly robust programme for the Youth as the most vulnerable group. In this regard, work with the Department of Education to ensure an effective Life Skills Programme in all schools. A major consultation on the Youth Programme is to be held on 28-30 July 1999.

- As a specific health sector intervention, ensure effective treatment of Sexually Transmitted Diseases.

- Participate in international efforts in search of an HIV/AIDS Vaccine.

- Speed up implementation of the DOTS strategy to reduce direct burden of TB as well as its contribution as the Aids defining illness in our environment.

(F) Unfold a Telemedicine network to support our Primary Care system.

Currently there are 28 sites to commence in July as pilot phase. Building

on these, we need to build a comprehensive network over the next 5 years.

This initiative will also link some of our institutions with counterparts in the

SADC Region and could contribute significantly to the vision of the African

Renaissance.

(G) Expand partnerships between the Public and Private Sectors to maximise benefits for our country. Some key initiatives in this regard include:

· Continuing to expand contracting out of non clinical services where appropriate.

· Enter into lease agreements for hospital equipment.

Explore the value of Private Finance Initiatives in the provision particularly of physical infrastructure in the health sector.

· Increase the number of Private "fee paying" patients seen and admitted in our hospitals. The aim should be to use revenue generated to improve the overall quality for the entire public hospital sector to the benefit of those dependant on this sector.

Use private sector resources subject to mutually agreed conditions to the benefit of those dependant on the public sector.

Also build strong partnerships with other State Departments to improve functioning of government. We need to plan in a much more integrated manner and stop working in Silos.

NGOs and CBOs play an important role that complements the efforts of government. We shall seek to strengthen ties with them with a view to continuously identifying areas for collaborative action.

(H) Speed up development of District Health System with particular focus on ensuring service integration and effective multi sectoral interventions at this level.

This process will be given momentum by the work of the demarcation board. We need to speedily establish intersectoral districts so as to give effect to the imperative of integrated planning.

(I) SOCIAL HEALTH INSURANCE

We need to work closely with other sectors, especially Welfare, Labour and Finance towards the establishment of a social health insurance as part of a comprehensive social security system.

This would enable those in employment to make a contribution to the cost of their care and enable us to provide better health care for all South Africans.