Minister of Health: Budget Speech

Minister of Health Budget Speech : National Assembly
5 June 2008

Madam Speaker,
Honourable Members,
My Colleagues MECs
Members of my family and friends
Distinguished Guests,
Ladies and gentlemen
 
I am honoured to present to this august House the National Department of Health’s Budget for 2008/09 for consideration.
 
Honourable Members, 2008 is also symbolic as it is the last complete financial year of the term of office of this government and close to 15 years of democracy for our people. As you know that the next general election will take place in 2009.
 
We shall focus in our speech on what the Department of Health has achieved in strengthening health service delivery. We shall also highlight what we intend to achieve in this financial year.
 
As the Department of Health, we strongly condemn the incidents of violence that have affected some parts of our country over the past few weeks. The national and affected provincial governments have been working tirelessly to respond to the acts of violence. The Department of Health has been part of the inter-sectoral collaboration to address this problem. We are responding to all the health challenges that have arisen in this regard ranging from emergency response to ensuring access to health services for those accommodated in temporary shelters.
 
This year marks the 30^th anniversary of the adoption of the Declaration on Primary Health Care (PHC), in Alma Ata, in the former Soviet Union. The philosophy of Primary Health Care has driven the transformation of the health sector in South Africa since 1994. We reshaped the health system from a fragmented, inequitable and disjointed system to a unified and integrated health system which strives to meet the health needs of all South Africans by focusing on equity, solidarity, inter-sectoral approach, community involvement and decentralization of health care delivery.  
 
Primary Health Care
 
In keeping with the philosophy of the Primary Health Care approach, it is with great pleasure that I report back to this House that access to Primary Care Services has almost doubled over the last decade. A total of more than 101 million patients used our Primary Care services in 2007/08, compared to 67 million in 1998.
 
This has been achieved through health policies that prioritized the poor, and the marginalized, and which included:
Elimination of user fees for primary health care and hospital services for prioritised groups;
Development of essential drug lists for primary and hospital levels of care;
Massive expansion of health infrastructure for the delivery of Primary Care Services through the building and upgrading of more than 1600 clinics; and
Increases in the number of health professionals employed in the public health sector, including training of midlevel workers in a range of health disciplines. 
 
To some extent the budget for the public health sector has increased to meet the increased healthcare needs and expansion of the public health sector. In 2001/02 the total public sector health budget was R29.3 billion and it increased to R53.2 billion in 2007/08. Off course, this increase does not take into account the effect of inflation.
 
Disturbing incidents in a few facilities have created a false impression that we are not doing enough to address issues of Maternal and Child Health. I wish to state categorically that the Department of Health is fully committed to improving the health status of women, mothers and children of our country and to achieving the Millennium Development Goals. Let me provide some information to demonstrate this.
 
Child Health
 
We have strengthened various health programmes to improve service delivery. In 2007/08, we fully immunized 84% of children under the age of one year, to protect them against vaccine preventable diseases. The number of children that have been confirmed by laboratory tests to have had measles in South Africa decreased from 829 in 2004 to only 31 in 2007 and we have had no deaths from measles in the last two years. However, imported cases remain a major threat to the progress we have made in this area.
 
We are continuing to ensure that we maintain our polio-free status which we achieved in 2006 and have provided update reports to the Africa Regional Certification Committee as required to maintain our polio-free status.
 
Building on the success of our immunisation programme, we are making arrangements to introduce in the public health sector two additional vaccines (Pneumococcal Conjugate and Rotavirus Vaccines) which will have a significant impact in reducing cases of diarrhoea and pneumonia and related deaths. These vaccines do not replace the continued need for safe water and proper sanitation.
 
We also provided Vitamin A supplementation to 100% of children aged 6-12 months who were seen at public health facilities and 61% of post-partum mothers. We are aiming to achieve 100% coverage amongst the latter as well. Vitamin A supplementation helps to prevent untimely deaths, blindness and illness especially from measles and diarrhoea.
 
Whilst the provision of micro and macro nutrition supplementation is important, it is more important to ensure food security for poor households in particular, and of course proper preparation of such food. This is especially important at this time of rising food prices – which disproportionately affects the poor, especially women and children.
 
About 70% of our health facilities have health workers trained in the Integrated Management of Childhood Illnesses (IMCI). We have also revised our guidelines on treatment of children in the prevention of mother to child transmission by moving from mono to dual therapy.
 
Maternal Health
 
With regard to improving maternal health, we remain the only country on the continent to have established a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD). The recommendations made by the Committee in its third report are being implemented by at least 85% of our health institutions.
 
To further strengthen our ability to meet the MDGs, we have established Specialist Committees to look into issues of Maternal Mortality; Perinatal Mortality and Mortality of children under the age of 5 years. The brief of these committees is to conduct investigations into each death and to advise me on measures that we need to take at all levels of the health system to prevent avoidable deaths.
 
The chairpersons of these committees are with us today as my guests. Professor Jack Moodley, Chair of the Committee on Maternal Mortality; Dr Sithembiso Velaphi, Chair of the Committee on Perinatal Mortality and Dr Neil Mc Kerrow, Chair of the Committee on Mortality of Children under 5 years of age. These individuals are highly trained health professionals committed to working with the Department of Health to improve the quality of health in our institutions.
 
The SA Demographic Health Survey conducted in 2003 states that our Maternal Mortality rate was at 124 per 100 000 live births and we had infant mortality rate of 43 per 1000 and under-five mortality rate of 58 per 1000. This survey is conducted every five years and we are therefore conducting another one this year to update our data on the progress being made on various health indicators including maternal and child mortality. The outcomes of this survey are independently verified by the Medical Research Council. We are convinced that our country is on track to meeting MDGs 4, 5 and 6.
 
We also commissioned a national Burden of Disease Survey to describe the pattern and distribution of diseases, disabilities and injuries seen in public and private health facilities, as well as the risk factors associated with these. The Report will be completed during this financial year and will provide reliable estimates of the national burden of disease.
 
Communicable Diseases
 
A key area of success in our response to communicable diseases is the management and control of malaria. Malaria cases have decreased from about 12 200 cases in 2006/07 to 5 200 in the 2007/08 malaria season. This represents a decrease of 57%.
 
Over the past decade and a half, HIV and AIDS became a major challenge to the gains that we were making through the Primary Health Care approach. I am therefore delighted to report to this House that through our collective efforts we have begun to reverse this trend.
 
Last year I reported a 1% decline in HIV prevalence in women attending antenatal clinics in the public health sector. The preliminary results of the 2007 HIV antenatal survey show a similar reduction. The 2007 survey found that the HIV prevalence has decreased from 29.2% in 2006 to 28.0% in 2007. HIV prevalence in the 15-19 year age group dropped from 13.7% in 2006 to 12.9% in 2007; as well a decrease was observed in the 25-29 year age group from 38.7% in 2006 to 37.9% in 2007. The rate in the 20-24 year group was stable between 2006-2007.
 
Taken together, these figures do indeed suggest that we have a trend of decreasing prevalence overall and in the younger age cohort. The full findings of the 2007 survey will be released within the next few weeks.
 
We are achieving these encouraging trends because of our intensive prevention campaigns which we believe are starting to make a difference.
 
During 2007/08, we re-launched the Khomanani campaign that focuses on increasing awareness and the need for behaviour change under the theme: Zithande.
 
During 2007/08, we distributed 3.6 million female and 309 million male condoms. More than 90% of public health facilities provide Voluntary Counselling and Testing (VCT) and the Prevention of Mother to Child Transmission (PMTCT) Services with a recorded uptake of 60%.
 
By the end of February 2008, we had cumulatively initiated more than 450 000 patients on antiretroviral treatment, in more than 310 accredited sites across the 9 Provinces. This number – which makes our programme the largest in the world – contradicts those voices that suggest that this government is not committed to providing  treatment. We shall continue to implement all the components of our National Strategic Plan on HIV and AIDS including the research and development of African traditional medicines.
 
The advent of Multi-drug Resistance Tuberculosis (MDR-TB) and Extremely Drug Resistant TB (XDR –TB) in 2006 posed a particular challenge to public health in our country. 
 
In 2007, we made available R400 million to provinces to intensify case finding and to strengthen our treatment of patients with drug resistant TB. We are implementing the new national TB strategic plan focusing on community mobilisation, decreasing the TB defaulter rate and the training of health personnel in the treatment of TB. 
 
We are already seeing signs of success. During the first 6 months of 2005, the national cure rate was 54.9%. This increased to 62.9% for the same period in 2006. The national defaulter rate is 8.8% for the first two quarters of 2006 – down from 9.7% for the same period in 2005. We are on track to meet the target of decreasing the defaulter rate to 7% as set by our President in the State of the Nation Address.
 
Already, Umsinga sub-district in KwaZulu-Natal which includes Tugela Ferry (and Church of Scotland Hospital) where the first cases of XDR TB were reported in the country has achieved a zero percent defaulter rate.
 
A new diagnostic test for drug resistant TB has been developed and will be officially launched in South Africa in July this year. This is very exciting news as it will both reduce the time it takes to screen sputa for drug resistant TB from 6-8 weeks to about a week and also lower the cost of such tests. It is also more accurate than current methods. This new method has been piloted in our public health sector laboratories in South Africa. This is a great innovation which makes a major contribution to the diagnosis of drug resistant TB.
 
Non-Communicable Diseases
 
Non-Communicable Diseases such as cancers, diabetes, hypertension and cardio vascular diseases are increasingly posing a significant threat to the health of our people. These are also known as the ‘silent killers’, since members of society are often unaware of them. 
 
Since 2004, my Department has spearheaded a number of Healthy Lifestyles activities to reduce the burden of disease from non-communicable diseases. Apart from a healthy diet and the avoidance of risky behaviour, one way to keep healthy is to participate in physical activity. To assist honourable members to increase your level of physical activity we have provided each Member with a pedometer. We challenge every member of this House to measure the distance you walk every day and to increase this distance weekly.
 
Just yesterday we had a number of healthy lifestyles activities in Gugulethu as part of the preparations for the Department’s budget vote. The activities included health screenings and physical activity which also catered for our senior citizens as part of our commitment to improve their health as well.
 
With respect to tobacco control, we are seeking to enhance the significant progress we have made in this area with the Tobacco Control Amendment Bill that is being considered bythis House. The success of our tobacco control programme is a case of best practice globally. South Africa will in November this year host the third session of the Conference of Parties to the Framework Convention on Tobacco Control.  This meeting focuses on practical steps to reduce tobacco use and its harm to human health, the economy and the environment.
 
Over the past year, food garden projects were initiated in all provinces and multimedia campaigns were conducted to promote health literacy. The first ever national Healthy Lifestyles Day was held in February 2008 and this will become an annual event as approved by Cabinet. The African Union Health Ministers have also adopted this day – the last Friday of February each year - as Africa’s Healthy Lifestyle Day.
 
It is important to alert this House to the resolution of the World Health Assembly last month to include non-communicable diseases on the list of indicators monitored in addition to the MDGs. The world is increasing becoming aware of the increasing challenge of non-communicable diseases – something we have been highlighting for a long time as South Africa.
 
Hospital Services
 
The successful delivery of Primary Care services requires support from a network of hospitals.  We have constructed 8 new hospitals since the inception of the Hospital Revitalization Programme. Three other hospitals will be completed during 2008/09 financial year.
 
Our focus is not only on improving the infrastructure but also the quality of service delivery at these facilities as well as the availability of necessary equipment. In this regard the Department of Health has established a set of core national standards reflecting the degree of excellence we wish to attain in delivering acceptable and quality health services.
 
These standards cover a broad range of performance areas. For instance with respect to safety, we will look at safe handling (and storage) of medicines, patient safety systems and infection prevention and control.
 
A total of 27 hospitals and 4 community health centres have been identified as initial focus points for appraisals based on these core-standards covering all provinces and all levels of care and the first report is expected in July.
 
Medicine regulation
 
Another area of significant progress is the reduction of the prices of medicines and pharmaceutical products.  Despite the legal challenges by some sections of the retail pharmacy industry to the medicine pricing regulations, medicine prices have been reduced by about 20% as a result of the policies of this government.
 
We gazetted a draft International Benchmarking Methodology in December 2006, which seeks to compare medicine pricing policies and practices amongst a basket of countries namely: South Africa, Australia, Canada, New Zealand and Spain. The implementation of the benchmarking process, after further consultation with the industry, should reduce the prices of medicines in our country even further.
 
Cabinet has approved that we submit for consideration of this House the Medicine Control Amendment Bill. The bill provides for the establishment of a new Regulatory Authority for Health Products which will replace the current Medicines Control Council. The Bill adopts best practices from many democracies and is an effort to further strengthen our regulatory environment whilst decreasing the time taken to certify and register new medical products and consider clinical trials. It will not centralize power in the hands of the Minister as has been mischievously suggested by some.
 
We will also be observing the African Traditional Medicine Day on the 31^st of August with excitement because of the progress we have made in developing a policy on African Traditional Medicine. We are also in the process of implementing the Traditional Health Practitioners’ Act which provides for the establishment of a council for traditional health practitioners.
 
Human Resources for Health
 
Honourable Members, our human resources are our most important asset in the delivery of health services.  It is therefore essential that we continue to create conducive and productive working environments for them. In the 2007/08 financial year, we signed a collective agreement on a new remuneration system known as the Occupation Specific Dispensation (OSD). The lessons we have learnt as the first Department to implement OSD will assist us all in improving the implementation of this remuneration system.  
 
During this financial year, the Department will continue to work with National Treasury, the DPSA and organized labour, to prepare proposals on occupational specific dispensation for other categories of health professionals. We will also continue to employ support staff like porters and administration clerks as they play an important role in the functioning of the health system.
 
Community Service for professional nurses commenced in 2008, further increasing the number of nurses available to serve our people. R10 million has been provided in the 2008/09 budget to undertake research and to develop detailed implementation plans for the recapitalization of nursing colleges, including more detailed planning on the supply and demand for nurses within the national health system.  This project will culminate in a budget bid in the next MTEF.
 
We also continue with our efforts to recruit health workers from other countries through Government-to-Government agreements. The recent cooperation agreement with the Government of Tunisia has facilitated the deployment of Tunisian doctors in hospitals in the Eastern Cape, Free State, Mpumalanga and Northern Cape.
 
We reported to this House last year that we were going to initiate a clinical associate programme as part of our interventions to address the challenge of shortage of health professionals in our country. I am pleased to announce that in January this year, the first cohort of 23 students started training at the Walter Sisulu University. The Dean of the Faculty of Health Sciences Prof. Khaya Mfenyane and a few of the students are in the public gallery and I wish to acknowledge their presence. Congratulations on being the pioneer group for this programme and I understand you have done very well in your first quarter. Keep up the good work.
 
Walter Sisulu University will have a further intake into this programme in July this year. The University of Pretoria will enrol 40 students in June this year and will have a further intake in January 2009. The University of Witwatersrand will start in January 2009 with an intake of 24 students. The University of Limpopo is working towards commencing this programme in January 2009 as well.
 
The clinical associate programme is a three programme that will produce a cadre of health professional who will work mainly in community health centres and district hospitals. Upon qualification, they will be registered with the Health Professions Council of SA with a defined scope of practice. They will be able assess patients, make a diagnosis, treat and prescribe appropriate therapy and undertake minor surgical procedures under the supervision of medical officers.
 
Health Financing
 
The National Health Act of 2003 envisages a truly integrated National Health System, consisting of both the public and private health sectors. This cannot be achieved while there are such gross inequities between these two sectors.
 
Of the R118 billion that was spent in the health sector in 2007/08, R66.4 billion (or 56.3%) was Private Sector expenditure, which serves about 7 million people, while R51.6 billion (43.7%) was utilized in the Public Health Sector, which provides services to about 40 million people.
 
Over the past years, the private health sector has been unable to increase access and also appears to be unable to contain cost escalations. At an Indaba that I hosted in September 2007, The representatives of the private health sector agreed that there was a need for government involvement and regulation in resolving these challenges.
 
In this regard, the National Health Amendment Bill has been submitted to this House for consideration. The Bill provides for the appointment of a facilitator to work with funders and providers to seek agreement on tariffs for health care services provided by the private health sector. This process should bring some transparency into the process of tariff setting in the private health care sector and assist us to contain costs.
 
The intention of this Bill is to secure the sustainability of the private health sector in our country and not to destroy it as has been suggested in some quarters.
 
Even whilst we take steps to ensure the viability of the private health sector we are also proceeding with the process of designing a national health insurance system. This is critical to the further development of our national health system in which all those who live in our country can be assured of access to affordable and good quality health care. We shall commence with the consultation process on the design of this system, based on the best components that currently exists in the public and private health sectors, during this financial year.
 
Equally so, we shall develop a policy on Health Tourism which should be finalized by October this year.
 
We also making good progress in ensuring that our health services are able to provide adequate support to the 2010 FIFA Soccer World Cup. Our emergency services are being strengthened through procurement of additional ambulances, building of EMS stations and training of emergency care technicians. We have to provide efficient services to meet the needs of both local communities and the FIFA World Cup as well.
 
Health Priorities for 2008/09
 
Given that health needs will always outstrip available resources, the health sector identifies key priorities for each planning cycle. For the financial year 2008/09, we have agreed on the following key priorities:
         I.      Strengthening Health Programmes;
       II.      Quality improvement through the development and implementation of Health Facility Improvement Plans;
      III.      Developing an Integrated National Health Information System;
   IV.      Strengthening Health Financing, in particular increasing funding for the public health sector;
     V.      Achieving further reduction in the prices of Medicines and Pharmaceutical products;
   VI.      Strengthening Human Resources for Health;
  VII.      Strengthening International Health Relations and
VIII.      Improving Management & Communication 
 
The details are contained in the Annual National Health Plan as well as the Strategic Plan of the National Department of Health that has been made available to Members.
 
National Health Information System
 
We shall, during this year, establish an Integrated National Health Information System which has as its basis an Electronic Patient Record. This means that a person who visits a health facility in any province would be allocated a unique identifier and have their medical history recorded electronically, in a Health Record. This system will be crucial for the implementation of the national health insurance system.
 
It will enable a health professional in any health facility in the country to retrieve a patient health record electronically, thus ensuring proper continuity of care. It will also save both patient and health professional time and decrease the need to repeat diagnostic tests unnecessarily. It will also decrease the amount of time patients queue for their medical records during visits to our facilities.
 
International Role
 
We will continue to strengthen our relations with our international partners, especially in Africa and countries in the south. Under our leadership as chair of the Bureau of African Ministers of Health, the AU has adopted the Africa Health Strategy and at a recent meeting of African Health Ministers also adopted an implementation plan.
 
We also hosted an African Union Workshop on Maternal, Newborn and Child Mortality Reviews which came up with proposals on interventions needed towards meeting MDGs 4 and 5 and beyond. The recommendations of this workshop have been adopted by AU Health Ministers and will be tabled for consideration by Heads of State and Government at their Summit later this year. The African Union Health Ministers have also given me the honour and responsibility to be the African Union Goodwill Ambassador and Champion for Women and Child Health.
 
South Africa will also assume the role of Chairing SADC Health Ministers in the second half of 2008. All of these responsibilities reflect the confidence and trust that our sister countries in SADC and Africa have in us.
 
We will continue to support post-conflict countries such as the DRC and Sudan in the rehabilitation of their health systems. We are assisting Namibia with setting up of a cardiac unit in that country and the unit is expected to conduct its first open heart surgery soon. We are also collaborating with Namibia on the management of Drug Resistant TB. In addition, we have concluded a number of agreements with other African countries that will enable them to refer their citizens to our tertiary hospitals. 
 
As part of the activities to mark the 30^th Anniversary of the Alma Ata Declaration, we held our National Health Consultative Health Forum on Primary Health Care and participated in the WHO/Afro Conference on Primary Health Care in Burkina Faso. We will also be attending the global celebration of this Declaration organized by the World Health Organization in October this year. We are also attending the United Nations General Assembly Special Session on HIV and AIDS in New York next week.
 
We will continue to play an active role in the development of a code of conduct for international recruitment of health personnel. This process is a result of efforts by Africa to highlight the negative effects of migration of health workers on our health systems. Our view is that all countries should make an effort to train for their own needs.
 
Strengthening Management
 
Improving health service delivery also requires appropriate management of the health system. The organizational structure of the National Department of Health will expand from 4 to 6 Branches (or Budget Programmes) with the appointment of two more Deputy Directors General, to place specific and dedicated focus on key priority areas of our work.
 
We will also strengthen our financial management systems to ensure that the Department receives unqualified audit reports going forward. I am aware of the suspension of the CFO in Eastern Cape relating to poor performance and I intend working with the provinces to strengthen financial management where this is necessary in line with the provisions of PFMA.
 
R15.1 billion has been made available for the operations of the National Department for 2008/09. In addition, a number of conditional grants are provided for and these funds are transferred to provinces by the National Department of Health for their disbursement.
 
The Hospital Revitalization Conditional Grant increases by R600 million to R2, 883 billion for 2008/09.
 
The HIV and AIDS Conditional Grant increases by R350 million to R2, 585 billion while the National Tertiary Services Grant increases by R193 million to R6,076 billion for 2008/09 financial year.
 
Madam Speaker, significant achievements have been recorded over the past decade guided by the Primary Health Care philosophy. Our priorities and budget for 2008/09 reflect our unwavering commitment to improving health service delivery to all the people of South Africa.
 
As we enter the final financial year of this term of Government, I commit myself, and the Department of Health, to do everything possible to ensure that we complete those activities which we set out to achieve between 2004 and 2009.
 
I wish to thank the members of this House for their support to the health system, and in particular wish to pay tribute to the Chairperson, Mr James Ngculu and members of the Portfolio Committee on Health. Much of the success of the Department rests with the leadership provided by my colleagues the MEC’s for Health, all of whom are present today.
 
In addition, I wish to thank the officials of my Department ably led by the Director-General, Mr Thami Mseleku and the Heads of the Provincial Departments of Health for their support.  
 
Let us all Choose a Healthy Lifestyle
 
I thank you.