Social Cluster

Q: The Minister of Health was asked to expand on the efforts to regulate the private health care sector. It was also asked who was being targeted in the sector.

A: The Minister of Health responded that it included the entire sector. All hospitals, pharmacies and related bodies would be covered by the regulations. She noted that at the end of 2007 private hospitals had hiked their tariffs to above the inflation rate. The Department had engaged in discussions with them to reconsider the hikes. Some had obliged whereas others had not. The Minister preferred not to mention names. However, she made mention that Netcare had agreed to reconsider hikes in anaesthetic gases. The Department was actively holding discussions with the sector in order to reach agreement. The idea was to try to keep the prices in the sector as affordable and reasonable as possible. The Minister referred to the price fixing debacle involving pharmaceutical giant Adcock-Ingram and said that this had been very disturbing. The Minister had sent out a letter of appreciation to the Competition Commission for the sterling work it had done.

Q: The Minister of Health was asked why it had taken so long for dual therapy protocols to be put in place. It was also asked why Dr Colin Pfaff had been disciplined for using dual therapy when it was well within World Health Guidelines.

A: The Minister of Health responded that there were processes to follow, and going beyond these would constitute a violation. The Department of Health had its own policies and guidelines that needed to be followed. When the use of dual therapy had first emerged, it had not been an easy exercise. She said that there were so many scientific uncertainties. There was furthermore a choice between dual and triple therapy. The aim was to have protocols that were easy to follow. Minister Tshabalala-Msimang pointed out that a disciplinary matter was between the employer and the employee. Hence the matter was between the Provincial Department of Health in Kwazulu Natal and Dr Pfaff. She pointed out that Dr Pfaff had not contacted her office to intervene on the matter.

Q: The Minister of Health was asked what was being done about TB and what was the number of cases that had been confirmed. One of the issues was concerned with the isolation of patients for long periods of time. It was asked how these patients were assisted financially to maintain their families, given that they were hospitalised for long periods of time. The Minister was also asked about the legal issues involved in keeping patients in isolation for so long even though many wished to leave.

The Minister was additionally asked to comment on issues of staffing and the availability of hospital beds.

The Minister was finally asked if she would be getting a Deputy Minister in the near future.

A: The Minister agreed to furnish figures on confirmed Multi Drug Resistant (MDR)  and Extensively Drug Resistant (XDR) TB cases before the end of the briefing. She said that the Department was vigilant on diagnosing MDR and XDR TB. The problem first reared its head in Kwazulu Natal. The problem was one that affected the whole continent and an overall plan was needed to combat it. Assistance from the World Health Organization and others was needed if progress was to be made. The Minister said that the Department did have diagnostic technology at its disposal, and that measures had been put in place. Patients were often kept in isolation for up to 12 months. Dr Msimang said that hospitals tried to make it as comfortable as possible for patients as they were a threat to their own communities. She noted that in the Western and Eastern Cape regions patients had escaped over the 2007 festive season in order to be with their families. These individuals had to be returned by way of court interdicts. The Minister said that patients were assisted financially by way of disability grants. The biggest challenge was to ensure that treatments were completed.

Q: The Minister of Arts and Culture, Dr Z Pallo Jordan was asked to comment on the negative reactions over the proposed National Oath. It was also asked when discussions on it would be taking place.

A: Minister Jordan said that he was not aware of the extent of the reactions. He said that he was unable to give an actual commencement date for discussions. It was however in the public domain, and was being discussed. Minister Jordan stated that he did not understand why there were negative reactions to the National Oath as the principles underlying it had been taken directly from the Constitution. He joked that perhaps people did not know what was in the Constitution.

Q: The Department of Housing was asked how the Housing Development Agency Bill was to play a role in housing delivery.

A: Mr Mziwonke Dlabantu, Acting Deputy Director General of Housing, responded that the Housing Development Agency Bill dealt with the location of land. The bill redressed apartheid spatial planning and would allow people to cross-racial lines.

Q: The Department of Housing was asked how much of the R40 billion that financial institutions had given for housing had actually been spent. It was also asked how many houses had been built with the money.

A: Mr Dlabantu said that at the implementation of the programme he believed the figure to be at R28 billion. He said that once the figure was verified an announcement would be made. It was felt that the spirit of the Charter had been received well by all participants. The idea was to meet the goals of the programme. It was not merely a question of figures alone.

Q: Mr Dlabantu was asked how the Department intended to legislate against informal settlements.

A: Mr Dlabantu responded that a programme was in progress. A strategy was needed for the formalisation of settlements. Legislation was needed to prevent informal settlements from increasing. In many instances individuals who received houses from government often rented out their previous informal settlement houses.

Q: The Minister of Health was asked for an indication of timeframes for the adoption of dual therapy. Figures on MDR and XDR types of TB were also requested.

A: Minister Tshabalala-Msimang said that figures would be made available before the end of the briefing. She said that legislation for the protection of dual therapy patients had been considered. Some of the requirements were that dual therapy should be licensed and that doctors administering it should go for additional training. There was thus the need to mobilise additional resources. The Minister said that some provinces were ready to administer dual therapy whereas others were not. She said that a meeting would be held to interrogate the implementation plan. She added that the implementation would not take too long. The development of policy and guidelines had first to be completed.

Q: The Minister of Health was asked hypothetically if Gauteng was ready for implementation and Kwazulu Natal was not, would the one not be able to start without the other.

A: Minister Tshabalala-Msimang responded that provinces that were able to start had the right to go ahead. She however said that a proper implementation plan was needed. The Minister said that it was the prerogative of the province to implement.

Q: Ms Lindiwe Hendricks, Minister of Water Affairs and Forestry, was asked what was to replace the bucket system of toilets.

A: Minister Hendricks said that the replacement depended on the municipality of the area. Factors influencing the decision were geography, resources and availability of water. In areas where there was sufficient water, flush toilets would be installed. In areas where water was scarce, easy-loos or Ventilated Improved Pit (VIP) toilets would be installed. The VIP toilets were upgradable and were more dignified than the bucket system.
 
Q: Mr Dlabantu was asked why the Housing Development Agency was not part of the Department of Housing. The Agency apparently worked closely with municipalities.

A: Mr Dlabantu said that efficiencies had to be considered. Issues of land were local issues. The Agency would have the capabilities to bring various parties together for development.

Q: Mr Dlabantu was asked what strategies the Department of Housing had for house invasions.

A: Mr Dlabantu responded that everyone was aware of the sophisticated nature of processes and said that he did not wish to speculate.

Q: Minister Hendricks was asked to comment on the possibility of South African water supply infrastructure collapsing.

A: Minister Hendricks gave the assurance that South Africa was not facing a water crisis. There was also not a problem of water contamination and the water quality in South Africa was considered to be one of the best in the world. A water quality monitoring system was also in place and it was currently being used in the Free State. There was however contamination of water in certain mine areas and pollution in rivers and dams. Cleanups had taken place in the short term and in the medium term infrastructure would be upgraded. Minister Hendricks said that water infrastructure was taking a strain with the ever increasing population. 

Q: The Minister of Health was asked what specific regulations there were for the private health sector.

A: Minister Tshabalala Msimang responded that it was a question of negotiation and the terms were confidential. She said that the Department never knew what the terms were. It was hoped that there would be greater transparency. Prices were far too high and the need for regulation was evident.

Q: The Minister of Health was asked to comment on the claim by NGOs that she was dragging her feet on the implementation of dual therapy.

A: Minister Tshabalala- Msimang said that she was the first to express concerns over mono therapy. The Department of Health had to evaluate the impact of nevirapine. The Department did however not have enough time to investigate the implications of administering dual therapy. 

Q: The Minister of Health was advised that these complaints from NGOs that the Department of Health had been dragging its feet on the implementation of dual therapy had arisen over the past 12 to 18 . The previous response given by the Minister applied to issues in the past.

A: Minister Tshabalala-Msimang felt that the Department was moving as fast as it could. She said that she supported the use of dual therapy.

Q: Mr Dlabantu was asked what percentage of house owners that had received houses from the Department had been given title deeds.

A: Mr Dlabantu said that he would have to check the statistics.

Q: Minister Hendricks was asked how sure she was that water was safe in South Africa.

A: Minister Hendricks responded that water quality was continuously being monitored in South Africa. In 2006 a dam safety rehabilitation programme and a river health programme had been started. Regulations were also in place to penalise those who polluted.

Q: The Minister of Arts was told that there were talks that certain individuals wished to seek legal recourse against the National Oath being introduced at schools. Minister Jordan was also asked what action would be taken against schools who did not comply.

A: Minister Jordan said that he did not understand why people would want to go the legal route on the issue. He was not certain what the stance of the Department of Education was on non-compliance by schools. It was nevertheless felt that there was little room for non-compliance by government schools.

Q: Minister Jordan was asked whether the process on the standardisation of names had been done piecemeal.

A: Minister Jordan responded that the matter had been legislated since 1998. There had been procedural compliance. The issue now was about getting everyone on board. Public consultations would be announced.

Q: The Minister of Arts was asked what the capital of South Africa was.

A: Minister Jordan stated that Pretoria was the capital and that Tswane was the municipality.

The briefing was concluded.

Social Cluster Briefing
14 February 2008

As the Social Sector Cluster, we appreciate the opportunity to discuss with you the programme of action of government for the year 2008. As you know, there are two Social Cluster briefings this morning. This session will focus on Health, Human Settlement and Social Cohesion while the next session will address issues of Poverty Alleviation, Social Security and Second Economy Interventions.

We aim to complete the work on the comprehensive social security system, benefiting from the consultations that have started with social partners.

The progress made in the implementation of the Programme of Action for 2007/2008 constitutes a basis for implementation of the Programme of Action for 2008/09. Therefore, while we highlight the focus areas for this year, we will also reflect on the progress made last year.

Social Cohesion

Efforts to improve social cohesion amongst all South Africans are being intensified. As part of popularization of national symbols to promote national identity, 1817 flags have been installed in schools. Positive values and national identity are also promoted through the indigenous music and oral history project.

A draft National Pledge/National Oath has been completed and national discussions involving communities on the draft National Pledge/National Oath will be held as part of promoting the South African national identity.

Nation wide public hearings on the standardization of geographical name changing will also be held to promote an over arching sense of belonging to South Africa.

The implementation of Social Cohesion Framework is being intensified to address threats to Social Cohesion which are lack of a common purpose and shared values; and lack of tolerance and respect for others’ rights. The aim is to create peaceful existence of citizens, free from deprivation, whether in terms of basic needs, human rights or in terms of culture, language and intellectual expression.

Comprehensive Health care

Promotion of healthy lifestyles continues to be a critical intervention in addressing the major causes of death in our country, which are communicable and non-communicable diseases as well injuries and trauma.

The 22nd of February has been declared a national healthy lifestyles day. We will be using this day to galvanize all South Africans to participate in all the five elements of the healthy lifestyle campaign which are:

Promotion of good nutrition
Regular physical activity
Tobacco control
Interventions against alcohol and substance abuse
And promotion of safe sexual behaviour

Part of our nutrition interventions is the mandatory addition of vitamins and minerals to all maze meal and wheat flour to address micronutrient deficiencies and improve well being. To assist millers to comply with the food fortification programme, I am glad to announce our readiness to pay a once off subsidy of R23 million for purchase of fortification equipment. The grant awards a 100% subsidy for micro and small enterprises while medium-sized and large millers are given a grant of 75% and 50% of their capital expenditure, respectively.

Wheat flour is a critical vehicle for delivery of much needed micro-nutrients to our people. It is that context that we condemn bread price fixing not only as a bad business practice, but as major barrier in improving health of people affected by micronutrient deficiencies.

We will be intensifying our efforts to address the challenge of non-communicable diseases such as diabetes, asthma and hypertension. Our focus is on raising awareness and promoting screening, early diagnosis and management of these diseases.

As outlined in the State of the Nation address, we are intensifying implementation of the National Strategic Plan against HIV and AIDS with prevention of HIV infection through the ABC strategy remaining the cornerstone of our response.

The programme for prevention of mother to child transmission of HIV has been expanded to 90% of facilities with an uptake of 60%. Treatment protocol has been improved to include dual therapy and this intervention will be expanded during this year.

More than 585 000 people are benefiting from Home and Community Based Care services provided through more than 2600 NGO’s/CBO’s. By the end of October 2007, more than 66 000 Caregivers had been trained and more than 2800 of these received Ancillary Health Care training (NQF Level 1).

The number of patients initiated on treatment was at 408 218 by the end of November 2007 and these services are available in 366 health facilities (including Correctional Centres and SANDF)

On TB, our focus is on the implementation of the five year strategic plan to improve cure rate and reduce defaulter rate from 10 to 7% this year. More than R400 million has been made available to strengthen our response to Multiple Drug Resistant and XDR TB. We are determined to ensure that more than 3000 health workers are trained in TB management during the course of the year.

As you have witnessed since the beginning of this year, we are paying particular attention to improving accessibility and affordability of private health care. Already our interventions are beginning to bear fruits with the review of exorbitant hospital tariff increases for 2008. Private hospitals are also agreeing to comply with the single exit price legislation with regard to the billing for anaesthetic gases which was previously overcharged.

Building from the progress made in the regulation of medicine prices, we are developing regulations that should empower the Department of Health to regulate the private health sector. The aim is to create transparency and curb escalating costs that are driven by various factors throughout the private healthcare delivery system. These regulations should be out for public comment by April.

The case of collusion amongst pharmaceutical companies bidding for state tenders that made headlines this week highlights once again the urgent need for government intervention to address unscrupulous practices and increase transparency in this sector. The Department of Health will be reviewing all tenders awarded to the companies implicated in this case to establish whether there were any irregularities.

Preparation for the implementation of the risk equalization fund (REF) has been completed and is awaiting the passing of the Medical Schemes Amendment Bill this year for full implementation.

Housing and Human Settlement

The focus of the Department of Housing in the coming financial year will be its programme of slum eradication and the implementation of the lessons, learnt from the Breaking New Ground Strategy to expedite delivery of housing for the poor and middle income groups. Housing delivery will continue to be fast tracked with the objective of accommodating all those seeking homes within formally planned settlements by 2014.

To achieve this objective Government and its partners seek to increase the current delivery rate of 300000. Our target is the delivery of 500000 housing units. To enhance and expedite the increased delivery, the Department of Housing has strengthened its capacity to directly assist provinces to enhance provincial project management capacity and streamline planning process for effective and faster delivery.

In addition, the department will continue to focus on increasing the number of affordable housing for those who earn between R3 500 – R7500 through the Memorandum of Understanding signed with the Banks.   The department is also finalising processes to ensure access to housing for Veterans of the struggle against apartheid within the overall comprehensive social security programme of Government. Work with Social Contract partners to remove all the obstacles and blockages that inhibit the speedy delivery of human settlements will continue.

We are hoping that the NCOP will shortly debate and pass into legislation the Social Housing Act (SHA). With the implementation of the SHA, we will be subsidizing the creation of various forms of rental accommodation and thus contribute to our goal of the elimination of slums by 2014. Non-governmental organizations and the private sector will be encouraged to participate in the programme and access the grants that will become available through this act.  We are hoping that this will go a long way to alleviate the shortage of rental accommodation and encourage innovation in the rental market.

Every new home in the country will become energy efficient. In addition to the prescripts in the National Housing Code and the Cabinet statement on this matter, the department of housing is finalizing energy regulations that will become part of the national building regulations. The National Homebuilders Registration Council (NHBRC) will continue to the minimum standards set by government and will have the authority to stop any contractor who does confirm .

As part of its programme to access well located land, the department has finalized its negotiations with Transnet and Department of Public Works to acquire a significant portion of land for human settlements. The moratorium on the sale of land by municipalities will ensure an additional supply of parcels of well located land. This land will be transferred to the Housing Development Agency.

In terms of the department’s parliamentary programme, this year will see the introduction of the Housing Development Agency Bill (HDA).  The Agency will enable government to finally redress apartheid spatial planning. The key instrument of the agency will be the release of well-located land and serviced sites for human settlement programmes. Once the bill is signed, Thubelisha Homes and Servcon will be integrated into the HDA.  We are expecting the HDA to serve as a catalyst for social cohesion, racial integration, job creation, and economic growth. 

Finally the Department of Housing is support the provincial legislative processes to prevent the mushrooming and re-emergence of informal settlements and slums around the country.

Basic services - Water and Sanitation

In February 2005 Government made a commitment to eradicate the bucket sanitation system that was in use by 252 254 households in formal established areas. 

In an unprecedented effort involving partnerships with key stakeholders and a massive resource allocation of R1,8 billion through the Municipal Infrastructure Grant, municipalities managed to replace 81% of the buckets by December 2007 with flush toilets. The remaining 19% (49 010) are at advanced stages of construction and will be completed shortly. Unsuitable ground conditions, a lack of bulk water supply and material supply shortages have caused delays in some instances.  We believe that the bucket replacement programme has brought dignity to the lives of over one million South Africans.

Following from the lessons with implementing the bucket eradication programme, government is applying a similar integrated and programmatic approach to accelerate universal access to water, sanitation and electricity. The aim is that by 2014 all our settlements are decent and sustainable and all households in these settlements at least have access to basic services.

As part of government’s human settlement programme, the DPLG, together with DWAF, DME and the Department of Housing will work with each province to coordinate and support the development and implementation of an infrastructure delivery programme specific to each municipality to meet the national targets. In 2008 this delivery programme will focus mainly on accelerating access to water.

It is estimated that up to 90% of the total population will have access to basic water supply services by end of 2008 through the addition of another 250 000 households. Just over 1 million households will still remain without basic water supply by end of the 2008. By the end of the current MTEF period (2009/10), this backlog will be reduced to about 870 000 households.

It will be possible to supply all people living in existing houses with a basic water supply by 2012. Water to people in informal houses will be provided through an integrated programme driven by Housing and to be completed by 2015.

With regard to provision of free basic water, at least 73% of indigent households and 77% of all households in the country have benefited.

Conclusion

Our view is that significant progress has been made in improving the social conditions of the people of South Africa. However, there are still many challenges that still need to be addressed before our goal of a better life for all can be attained.

Presented by

Dr Manto Tshabalala-Msimang
Minister of Health

On behalf of the Social Sector Cluster