Minister of Health on Social Sector Cluster

Briefing

05 May 2008

Minister of Health, Dr Mantombazana Tshabalala-Msimang, briefed members of the media on the Social Sector Cluster's progress report, submitted to Cabinet earlier this month, on the implementation of the Government's Programme of Action (POA) 2008/2009. The briefing focused on the following key strategic areas: comprehensive health care; integrated food security and nutrition programme; comprehensive social security; housing and human settlement; education; and promotion of national identity and social cohesion.

The Minister of Health was accompanied by the following Directors-General: Mr Thamsanqa Dennis Mseleku, Department of Health, Mr Itumeleng W Kotsoane, Department of Housing, and Mr Vusi Madonsela, Department of Social Development; and by the Acting Director-General of the Department of Agriculture, Dr Kgabi Mogajane. Mr Themba Wakashe, Director-General of the Department of Arts and Culture was also present.

Questions asked by members of the media included whether the Department of Health intended to apply to the consumption of alcohol measures similar to those already in place or proposed for  the consumption of tobacco. The Minister responded that the Department had already initiated, as a first step, measures requiring the health warnings on of bottles containing alcoholic beverages: it was expected that such warnings would be introduced from early 2009. The Minister was also asked about the 'flight of doctors and nurses' and the Department's progress in retaining and attracting health care staff. The Minister and the Director-General of the Department of Health both said that they were 'puzzled' by the question; the latter said that more nurses were returning, and asked if members of the media were in possession of facts of which they, the Minister and the Director-General, were unaware.

INTRODUCTION
Mr Harold Maloka, GCIS, introduced the Minister and accompanying officials. He said that this was the first round of the reporting cycle since the President's State of the Nation Address.

BRIEFING
Please refer to the annexure for the full verbatim text of the briefing.

Minutes

Q: A question was asked with regard to food security and the plan to assist the poor in their struggle with rising food prices.

A: The Acting Director-General of the Department of Agriculture replied that, with regard to food security and food parcels, in previous years the Department of Social Development had distributed food parcels. Cabinet had been advised to examine other measures, such as cash transfers or vouchers that could be targeted effectively to the vulnerable.

Q: A question was asked of the Department of Agriculture with regard to the capping of prices in order to help the poor, in which the Department of Health had thus far taken the lead. The Department of Agriculture was asked if it would be making submissions to retailers that went beyond a mere appeal.

Q: A follow-up question was asked on the estimated cost of a food security programme, and whether it was going to be focussed on food parcels or on food vouchers.

A: The Director-General, Department of Social Development, replied that a range of options was being examined. As his colleague, the Acting Director-General, Department of Agriculture, had mentioned, the Department of Social Development had previously distributed food parcels to poor households that had been negatively affected by food insecurity. That programme had been ‘riddled with a number of challenges’. At present an option was under consideration that would present fewer problems. Members of the media would be aware that the department had ‘in sourced’ various companies to procure food and distribute it. In several provinces the department had become involved in tender battles in court. These had delayed the delivery of food to those in need. Therefore the department sought a solution that would enable it to meet its obligations to the poor with minimal disruption. Options such as food vouchers were under consideration to accelerate delivery of assistance to those in need. The other option, of course, was to consider increasing cash transfers. That would reach, however, only those already included in the social assistance programme. This would still leave poor people who needed assistance but were not included in the social assistance programme. A likely outcome would be increased cash transfers for those in need who were already included in the social assistance programme, combined with food vouchers for those in need who were not included in the social assistance programme. However, the impact of ‘the spiralling food prices’ on the poor was appreciated, and those concerned were progressing rapidly towards deciding what the strategy would be, and the public would be informed shortly.

The Acting Director-General, Department of Agriculture, added that this was the initiative of an inter-ministerial committee, consisting of about eight departments, which had reported to Cabinet the previous week. All programmes in various departments were being reviewed and strengthened to ensure that aid reached the really vulnerable. Her colleague had mentioned the difficulties with the food parcels. It was government’s aim to engage in co-operation with the entire sector.

Q: a follow-up question asked for a more specific response. The Department of Health had examined the capping of high prices for medicines. The questioner asked if the Department of Agriculture would likewise seek to cap high food prices.

A: the Acting Director-General, Department of Agriculture, said that the initiative covered a whole range of measures in the short term that would impact directly on household food security, and, in the long term, on measures that would focus on production. Investment in agriculture had been declining over the years, and some farmers were leaving the profession. It was not enough merely to focus on the shortage of maize. It was also necessary to relate to the Department of Health’s campaign for healthy life-styles, promote indigenous starch-based foods and the development of technology.

The Minister added that she was grateful that the Acting Director-General, Department of Agriculture had mentioned indigenous food from KwaZulu-Natal (25m 30s), which, cooked in garlic, and served with beetroot on the side, was very tasty. She said that, with regard to possible capping of food prices, that lessons could be learned from the Department of Health, which had not, in the beginning, resorted to legislation and regulations. Firstly, the department had appealed to the conscience of the citizens of South Africa. Equally, with the Tobacco Control Bill, people used to say that it would not work. The citizens of South Africa had proven that they did have a conscience. It took a long time to meet with the pharmaceutical companies and the private sector, but then they told the health department that they had tried and failed, and asked for assistance. It was important to give the people the opportunity first of all to examine their own consciences. The Minister gave the example of a seller of rice in Thailand who had taken the decision by himself not to increase the price of the rice that he was selling, even though the wholesale price was increasing and he would therefore have to forego his previous profit margin. Primarily this was the approach that one would look for, after which, if all else failed, then government must prepare legislation. From a global perspective, it seemed that measures other than legislation and regulation were being tried first to address the crisis of rising food prices.

Q: With regard to the new tobacco control legislation, there were, according to the questioner, stricter measures ‘to make life difficult for smokers’. The questioner asked if the health department was contemplating similar measures to control the abuse of alcohol.

A: The Minister replied that the department of health was amenable to persuasion, and was open to suggestions on the subject, and in particular with regard to protecting the lives of the young it might be correct to do so. However, the health department had already taken the first step in that direction by requiring the labelling of bottles of alcoholic beverages: it was expected that this would come into effect at the beginning of 2009. The industry had been given 18 months to change their labelling to include warnings of the dangers of alcohol. Obviously it was necessary to take matters step by step. It was also important for the consumer to understand why certain measures were being taken. If legislative measures were deemed necessary, they would certainly be taken.

Q: The Minister was asked, by a correspondent of the Natal Witness, (30m 40s) if the suspension of a doctor for placing the photograph of an MEC in a waste bin was justified.  The Minister was asked if the health department was making efforts to improve the morale of rural doctors.

A: The Director-General, Department of Health, asked for time to be allowed for the appropriate disciplinary processes to unfold. It was difficult to comment at present.  It was important for any organisation to have some form of discipline. He was sure that the Natal Witness had its own disciplinary code. If the doctor concerned were innocent, he would be found innocent. It was important not to prejudge the issue. With regard to the general morale of doctors, it was not possible to generalise; in fact the morale of rural doctors was ‘very, very high in many instances’. It was therefore not appropriate to ask how to boost their morale, but rather to ask how best to support these doctors who were ‘so committed’. The department could, perhaps, start by improving their conditions, including their living conditions and salary conditions, and to ensure giving them more support in terms of assistant staff. There was a whole range of measures that the health department was taking to improve the conditions of its staff.

The Minister said that it was absolutely wrong to take an MEC’s photograph and throw it into a dustbin. There were many channels of communication and forums, even telephoning the MEC herself, in which dissatisfaction could be articulated without resorting to such a disgraceful action, which amounted to anarchy.

Q: The Director-General of the Department of Housing was asked about the investigation into the abuse of the housing subsidy scheme, which had not been mentioned in the briefing. Specifically, the questioner asked about whether a decision had been taken as to whether there was to be a general amnesty. The questioner also asked for more details of the voucher system for building materials in the rural areas.

A: The Director-General, Department of Housing, replied that last year the President had signed a proclamation allowing the Special Investigating Unit (SIU) to work with the Department in an investigation in all provinces of those cases where subsidy money had been abused. The Department had received a report within the past two weeks from the SIU. Several cases had been opened. Progress had been made, and in a week or so it was expected that it would be possible to give a comprehensive report. The matter of a general amnesty had not been resolved. The Department was waiting for the MINMAC to conclude the matter, probably in June 2008. A voucher system had been proposed for rural areas for the purchasing of building materials whereby part of the money for the building materials would come from the housing subsidy and part from the beneficiaries. It was hoped to implement the project this year.

Q: The Sunday Independent had carried a report according to which a Development Bank report stated that 7.6 million South Africans were infected by HIV. That figure, according to the questioner, was 40% higher than Government’s own figures, and, if correct, had very serious implications for health care planning. The Minister was asked if she thought that the figures were correct.

A: The Minister replied that South Africa had a serious problem with regard to statistics. She said that she was not trying to deny anything, but she wanted to say that figures should be understood in their proper context.   It was important for there to be an engagement among the sectors, and guidance was sought from those involved in research.   

Q: The Minister was asked if the health department planned to meet with the Development Bank or engage with its staff to examine the discrepancy.

A: The Minister replied that the matter was in the hands of the Department of Health.

Q: The Department of Health was asked about progress in the roll out of dual therapy for mother and child in the prevention and treatment of HIV/AIDS, and if all provinces had now begun the roll out, and if any problems had been encountered.

A: The Minister replied that in the past the Department had been very strongly urged to implement monotherapy as it was then believed to be the best. It had then been criticised for being very slow in implementing dual therapy, but it had needed time to prepare. Members of the media were asked to remember what their role had been, when the Department itself was querying the value of mono therapy. The media had campaigned for following the example of Uganda, but subsequently data had emerged which showed that Uganda’s example was incorrect. It was important to reflect on that.

The Director-General, Department of Health, said that the process of implementation, as described in the Department’s statement, was in various phases. Gauteng, and parts of KwaZulu-Natal, had begun the training of health professionals to carry out dual therapy. Other provinces were still finalising the training programme. Some provinces were much ahead of others, depending on the availability of necessary resources, but all of them have made a start.

The Minister emphasised that mono therapy had not been abandoned.

Q: The Minister was asked about the role of health professionals other than physicians in dual therapy. For example, in Natal, nurses were being trained to administer dual therapy, whereas, in a previous briefing, the Minister had appeared to disapprove the use of non-physicians in this role.

A: The Director-General, Department of Health, replied that the Nursing Act provided for nurses, under defined circumstances, to administer Schedule Four medications, but they would have to undergo thorough training, and would have to be monitored by physicians. KwaZulu-Natal was not deviating from the legal position. The Minister had been emphasising the challenges that would be faced in implementing dual therapy.

Q: A question was asked about the budget for food vouchers, and as to how many people fell outside the ‘security blanket’ as at present determined.   

A: The Director-General, Department of Health, replied that the inter-ministerial committee had submitted a preliminary report to Cabinet. The Cabinet responded by asking the committee to investigate the report’s implications in depth. So there was not yet a very specific budget. As yet a comprehensive picture was not available of the number of people who fell outside the safety net. The committee was still working on those figures. The school nutrition programme benefited approximately four million children at present.

Q: Given the increases in food prices of 20% to 25%, a question was asked as to whether Government found itself obliged to the budgetary allocations for its existing programmes, and what that would cost, and whether figures were available.

A: The Director-General, Department of Health replied that the inter-ministerial committee had examined whether it was necessary to adjust, as had been done previously, some of the social assistance programmes, such as child support grants and pensions. What the committee was doing now was the actual counting. More work would be done on this in the next week or so.

Q: The school nutrition programme was allocated R300 million. Given the rise in food prices, a question was asked as to whether the allocation for this programme should be increased and if that was what the Director-General had in mind.

This particular question was left unanswered.

Q: A question was asked about the babies who had died in the Eastern Cape from infected water, and about the tracer teams established to track patients with drug resistant tuberculosis, and whether the Department of Health had had recourse to the courts to force patients back into treatment.

A: The Minister said that with regard to the babies who had died there had been some differences in the figures. The Department of Health had sent a team to investigate this serious matter and report to the Minister. Thereafter the inter-ministerial committee had been asked to investigate. The Minister expected a final report by 06 May 2008. These deaths should be seen in the context of the social determinants of health in South Africa, for example, nutrition, gender relations, sanitation and quality of water-supply. These determinants were not the core business of the Department of Health, but it collaborated with other departments; the Department would shortly have a meeting with SALGA in this regard. There was a rigorous health promotion campaign, especially with regard to the prevention and control of diarrhoea.

With regard to recourse to the courts, the Director-General, Department of Health, said that the Department had not witnessed any increase in the number of patients with tuberculosis that it had had to take to court to enforce compliance with treatment.  Problems of non-compliance were to be found in only a few hospitals. In many hospitals patients were very co-operative.  

Q: A question was asked about housing in the Eastern Cape.

A: The Director-General, Department of Housing, said that there were a number of factors that impacted negatively on the delivery of housing in the Eastern Cape, including, in particular, the cost of transporting materials.  The Eastern Cape did not attract skilled contractors to assist in the delivery of housing, and prices of materials were much higher there. The challenges there were structural ones. The provincial department had had difficulty in recruiting staff, and the national department had sent a team to assist the provincial department and encourage developers. It was hoped that subsequently the provincial department would be able to manage the challenges by itself.

Q: The final question was about the many reports of a 'flight of doctors and nurses more exacerbated in recent months’, the shortfall of doctors and nurses in the country, and the Department's programme to retain and attract health care staff.

A: The Director-General, Department of Health, said that he was ‘puzzled’ by the alleged flight of doctors and nurses.

The Minister said that she was ‘puzzled’ too. She had not received reports of an exacerbation.

The Director-General, Department of Health, said that after the implementation of the occupation-specific dispensation, South Africa had seen more nurses coming back into the country. However, there was a trend for nurses to move from hospitals into primary health care. There was nevertheless a need for more nurses, and perhaps the provinces were not sufficiently ready to absorb nurses returning to the profession. There was nothing to suggest that there was a sudden upsurge in the numbers of doctors leaving the country, and perhaps members of the media were in possession of facts of which the Department was unaware.

No questions were asked on the promotion of national identity and social cohesion.

The briefing session was concluded.

 

Appendix:
Social Sector Cluster Briefing Document for Media Briefing
                        05 May 2008, 120 Plein Street, Cape Town


Introduction

The Social Sector Cluster submitted to Cabinet earlier this month its progress report regarding the implementation of Government Programme of Action (POA) 2008/09. In that report, we outlined the successes but also drew the attention of Cabinet to the challenges that we identified as the Cluster.

In our briefing this morning we wish to confine our report to the following key strategic areas:

  • Comprehensive Health Care
  • Integrated Food Security and Nutrition Programme
  • Comprehensive Social Security
  • Housing and Human Settlement
  • Education
  • Promotion of National Identity and Social Cohesion


Comprehensive Health Care

Our approach in dealing with this matter looks at health promotion, reduction of communicable and non-communicable diseases and the unnatural causes of death such as accidents and injuries.

The Department of Health has adopted the “healthy lifestyles” campaign as its key strategic message for the year. This campaign seeks to encourage South Africans to adopt and practice healthy lifestyles as part of decreasing the burden of disease facing the country.

The Department is increasing the number of health promoting schools from 3500 to at least 5000 schools. These schools have initiated the programmes to prevent tobacco use, development of food gardens and sports participation.

The Health portfolio committee will hold hearings on the amendments to the Tobacco Control Act on the 7th and 8th of May. Through these amendments, the Department seeks to further enhance the control of tobacco products in line with the international standards set in the Framework Convention on Tobacco Control.
Among other provisions, the amendment bill seeks to:

  • Strengthen sections which prohibit advertising, promotion and sponsorship, and the regulation of smoking in public places,
  • Introduction of picture-based health warnings,
  • The removal of misleading descriptions such as “mild” and “light” which carries a fine of R1 000 000

The Bill increases the penalties so that they become a real deterrent against contravention of the Act. The fine for the owner of a public place or employer who fails to ensure that there is no smoking in a smoke free area has been increased from R10 000 to R50 000.

The penalty for selling tobacco products to a minor (under 18 years) has been increased from R10 000 to R50 000. Also included are new offences such as: failing to protect employees from tobacco smoke pollution, selling tobacco products in a health institution and retailer not complying with point of sale conditions. The penalty for advertising and promotion has been increased from R200 000 to R1 000 000.

Regarding the control and management of malaria, we are encouraged by the fact that Limpopo and Mpumalanga have already covered over 85% of malaria risk areas with indoor residual spray for malaria vector control while KwaZulu-Natal is currently at 82%. The development and implementation of malaria health promotion activities in the three affected provinces is underway.
In line with the call by the President in the State of the Nation Address, we are working on reducing the TB defaulter rates from 10-7% through the establishment of TB tracer teams and the training of 3000 health personnel in the management of this disease.  A total of 72 TB tracer teams have been established in all the nine provinces. Each team comprises a healthcare worker, two community health workers and a data capturer. In addition, 122 healthcare workers were trained on MDR-TB management in the past two months.

On HIV and AIDS, we are happy to report that our treatment, care and support intervention is gradually gaining momentum in line with our commitment to deal with this challenge. As at February 2008, our figures show that at least 456 000 had been initiated on antiretroviral treatment and 39 759 of these are children in all 407 facilities accredited to provide this service. We now have 86% of the sub-districts having at least one service point accredited to provide comprehensive care to people living with HIV and AIDS.

Food Security and Nutrition Programme

Poverty, hunger and malnutrition continue to be one of the biggest challenges facing us. The Household Food Production Programme is one of government’s strategies of improving food security amongst the vulnerable communities. To date 15 765 food production packages have been distributed. We are also working hard in deepening our interventions around the establishment of school food gardens. To date, 6 390 vegetable gardens have been established.

With regard to the farmer support programme, a total of 903 clients have received MAFISA (Farmer Support Programme) loans and a total of R8.5 million has been disbursed in the first quarter of 2008 (Jan-March). Currently, the Land Bank and Umvimba (through all their branches) are involved in retailing MAFISA. 

In the light of the poverty and hunger that still confronts millions of our people, as the Social Cluster and indeed as government, we are concerned and worried by the escalating food prices currently affecting the world, including South Africa.

This development, in our view, makes food to be unaffordable and it defeats our goal of food security and improving nutritional status of our population. We wish to appeal to all the role-players in the industry from producers to retailers to work with government in ensuring that we do not make food, especially basic foodstuffs such as bread, milk and maize-meal totally out of reach to the millions of our people.

Comprehensive Social Security

The Social cluster briefed Cabinet on proposals on social assistance and reforming the system of retirement provisions. The Inter-Ministerial Committee endorsed the Report of the Inter Departmental Task Team and approved proposals to:
Gradually equalize the age of eligibility for the old age grant,
Ensure that the discussion on a National Health Insurance system is part of the mandate and work of the IDTT,
Extend the child support grant to children up to their 15th birthday, amongst others.

The IDTT completed a draft framework for the consolidated government position paper. This framework is aimed at ensuring the comprehensiveness of the work mandated by IMC. The Departments of National Treasury, Social Development, Labour and Health are also finalizing position papers on the various components of the social security reform.



Housing and Human Settlements

Positive results are emerging in the implementation of the comprehensive programme dealing with human settlement and social infrastructure. To date, financial institutions (Banks) indicate that R35 billion has been released for financing housing development and/or ownership. The upward movement of interest rates however has had the effect of eroding affordability as far as housing is concerned.

An inclusionary housing policy has been finalized and implemented across private and publicly driven housing development. Multiple housing projects that are designed as mixed use and mixed income housing developments serve to ensure cross subsidization and achieve inclusionary housing objectives.

Over 100 000 units are planned in projects such as Cosmo City, Olievenhoutbosch, Chief Albert Luthuli and Mogale (Gauteng), Bendor and Lephalale (Limpopo) and Klarienet (Mpumalanga). At the same time, a voucher system for building materials in rural areas to support the self-build initiative is being investigated by the Department of Housing.
The Rental Housing Act has been amended to improve the regulation of the tenant-landlord relations.

Access to Quality Education

The importance of quality education to the economic growth of our country cannot be over-emphasised. To this end, our interventions around the re-capitalisation of FET colleges to ensure relevance to the economy are continuing. By March 2008, 100% of the R595 million allocated to FET had been utilized as part of increasing output around priority skills programmes and learnerships.

The number of the Dinaledi schools has also been increased to 500 as part of our effort to double the number of Matric maths passes to 50 000 by 2009. Each of the Dinaledi schools has been provided with text books for every learner in English, Maths and Physical Sciences to the value of R12 million.

On the implementation of the Mass Literacy campaign targeted at reaching 300 000 adults, the Kha Ri Gude Campaign was officially launched in February 2008 and already 100 Master Trainers have been trained in the requirements of the campaign as well as the use of the materials developed for the campaign.

Promotion of National Identity and Social Cohesion

We have embarked on a three-year National symbols project aimed at installing a flag in every school. Phase 2 of the project has been initiated and is aimed at installing 10 000 flags in schools in all provinces. The Departments of Arts and Culture and Education have embarked on a project to make information on symbols more accessible. Since January this year, a total of 12 workshops have been held in Gauteng, North-West, KwaZulu-Natal and Northern Cape on this matter.

As part of encouraging good citizenship among our youth in particular, a Bill of Responsibility was launched in February 2008. Through this Bill, we are seeking to inculcate in our youth the responsibilities that come with rights.

Conclusion

In general, we are encouraged by the work that the Cluster is performing and progress in the implementation of the Programme of Action for 2008. 

Presented on behalf of the Social Sector Cluster by

Dr Manto Tshabalala-Msimang, MP
Minister of Health



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