Health Minister speech during debate on President's State of the Nation Address


09 Feb 2009


Speech by Minister Barbara Hogan, MP, Minister of Health on the occasion of the Debate on the President’s State of the Nation Address
09 February 2009

Chairperson, Mr President, Madame Deputy President

Many people have referred to the distressing conditions in which many of our health care workers have to perform their tasks. As the Minister, and as the Ministry, it is very disturbing, when on a daily basis, you get letters of pleas and desperation. Let me read to you just one such a letter. It comes from a head of a Pediatric Unit in a very large hospital in a province of ours, and it starts, it says:

“Dear Minister Hogan, it is out of sheer frustration and absolute desperation that I write this letter to you. I am head of the Paediatric Unit at this hospital. Ours is an extremely busy unit, despite functioning only at a district level of care. At present we have a few vacant entry level medical officer posts.

At the end of this year, we will be losing 4 doctors – one of our doctors will be going to work abroad – and as a result of the moratorium that was placed on the appointment of new employees on the 13th of June this year, we are unable to advertise the posts that will be vacated at the end of the year, let alone the posts that are presently vacant. Our human resources department has sent motivation after motivation to the district and head offices, yet these posts remain frozen.
Our human resources department and senior management have tried so hard and continue to do so, but it appears that we are asking for the impossible”
– and then he asks the question: “Does anyone realize the enormity of the crisis that is looming ahead in January – we will not have enough doctors to maintain the workload, and there is going to be a total collapse in service delivery?”.

Now, this is a kind of letters that we receive. And I want to pay tribute to these people who have chosen to remain in the system, under extremely difficult circumstances, and soldier on and continue to fight the good fight.

I want to pay tribute too, to the 60 000 community-based healthcare workers, who everyday with virtually little compensation, go out and care for our people in the communities. Who look after people who are desperately ill, who themselves suffer enormous depression about having to face the scale of the problems that we face in this country.

And I want to pay tribute to the nurses, who are the backbone of our health system, who despite low wages, despite lack of recognition, continue to work in primary healthcare districts in our hospitals with vigilance, with strength, with courage. Because what we are facing here is just no simple crisis – just a matter of mismanagement, or backhand, or corruption. What we are facing is unprecedented in most countries. We have one of the highest HIV/AIDS prevalences in the world. We have one of the highest TB prevalences in the world.
We came to government in 1994, where there was hardly a PHC clinic in black communities. And so at that very moment when we were poised to roll-out healthcare to the majority of our people, we were hit by a burden of diseases that none of us anticipated, and perhaps we did not respond fast enough, but I defy any country to respond to the scale of the burden of disease which we are battling under at the moment.

And so we have certain things that we do announce and we say with triumph. In the phase of a toned down in government spending, in those early years when fiscal prudence and hostility was the name of the game and we all encouraged it, we were still able to roll-out over 1 800 clinics and community centers since 1994. This means that 95% of our people are able to reach a clinic within a 5 km radius - that is extraordinary.

It has enabled us to double our headcount usage of PHC from 67 million visits in 1998 to more than 101 million this year – people are using our facilities.

The Hospital Revitalisation Programme has seen 8 new hospitals being built since its inception a couple of years ago, and about 33 projects running currently on site.

We are improving the nurses salaries – we have started with a process and at this stage we are now seeing – despite the teething problems, a welcome return of the nurses to the nursing profession. They recognize that they are being recognized.

Let us not forget the huge and courageous battles that this government undertook in the early 2000 against pharmaceutical companies and the prices of medicines. Let us not forget the battles that were undertaken in the United States, and in this country alone. We have been able, through those battles, to reduce the prices of medicines by 30% in the last 5 years – a considerable achievement.

And we have had a number of success in other diseases in this country:

we were declared a Polio-free country a little while back;

we have reduced the incidences of Malaria significantly – and in this last year once the headcount is in we will see how significant that reduction has been;

we are battling the TB epidemic, and we are fighting it with every ounce of strength we have – we have TB tracer teams throughout the country, and we are hoping and confident that we are going to record an ever greater increase in success than we recorded in previous years.

And so we can go on on some of the achievements that we have achieved, at great cost and dedication.

But let me say that there are real issues that we do have to confront. This is not something that we say is something that we have just got to live with. In the last 2 years, particularly in the last 18 months, it is on record that every provincial health department in our country has been overspending significantly. We can play political games with that, we can point at MECs, we can do what we like, but the reality is that every provincial department of health is facing significant spending pressures.

We know that some of this is related to HIV and AIDS and the roll-out, and we are proud of the fact that we have over 700 000 people on ARVs, which exceeds the target that we had set for us for this year.

but what is it that is driving the cost of health;

what is it that is forcing a head of the department of a major hospital, of which this Paediatrician is head of a unit, to declare a moratorium on employing new people;
what is it that is forcing, as has been pointed out, limitations on stocks in hospitals so that we are running out on basics – what are those cost-drivers.

We are unable to say at this moment exactly what they are but from the National Department of Health, we have assembled a team of over 15 people, under the leadership of the ex Deputy Auditor-General, with the consent of all our MECs and our health departments which we reached at our National Health Council last week.
They are going out into each and every province – they are going to be sitting with CFOs and Heads of Department. They are going to be speaking to auditors and Accounts-General, to discover for us and bring to us what they believe are the chief cost-drivers in health at the moment.

We cannot go forward around budgeting until we know what these cost-drivers are. We anticipate that some of them are the fact that we have had extremes in inflation in this country as we have had worldwide, and these have particular implications for health in South Africa.

But we are awaiting the report of these teams urgently, because it is only once we start to understand what the cost-drivers are, are we going to understand how we budget better. Along side of that, we are drawing up and finalizing our human resources policies for health. In other words we are saying these are the numbers of people we need if we are going to have to produce. So, the whole aim at this moment in time is to improve our planning and budgeting capacities, so that we do not have these stock-outs.

But we would be misguided to believe that this in only a budgeting and managerial solution. We have to look at innovative solutions as well within our healthcare sector. And we have already – and I have spoken to these matters about a whole range of other initiatives which we have in place, which we want to roll-out within the next couple of months.

Very critical to all of this, is an understanding that both our National and Provincial Treasuries and our departments of health, need to be speaking to one another. Too often we find people dumping – saying this is treasury’s fault or treasury saying this is health’s fault. We can no longer afford those budgeting games, we are going to be speaking with one voice in addressing these issues.

But the National Health Insurance must become a very important debate in our country. We are aware that in the private sector, more money is expended on fewer people than it is in the public sector. The public sector is left to handle more people with less resources than in the private sector. This does not mean to say that we are now going to attack the private sector, take away funding from it – but every country in the world generally, in the developed countries, have moved to a National Health Insurance.

We cannot look just simply at revenues gained from the national treasury to fund health alone. We have to look at a particular form of a national health insurance, to see how we can increase the envelope for funding in health. And that will be the subject Mr President, of a long conversation in our country.

It is not going to be something that we are just simply going to impose, but the rationale for national health insurance can never be surely more persuasively argued now, when we face the critical funding shortages that we have here.

And so we look forward to that debate and we look forward to engaging. We look forward to the private sector, who have been meeting with us on a regular basis now, to explain ways in which they can assist us to achieve the targets that we want.

Finally, we want to thank the many people who been engaged in litigation against us in the National Department of Health, such as the dispensing doctors, the pharmacists, with their decision to withdraw litigation. And we are now engaging to get an interim agreement with them, so that we do not need to be involved anymore. That is the spirit of cooperation we are wanting from our country, that is the spirit that we need from all in sundry in the health sector.

And so Mr President, the health sector is facing significant challenges, but as I have said before, I am so impressed with the level of dedication, the spirit of cooperativeness and the spirit of innovation in this country, that I am certain that we will be able to make significant differences to our healthcare.

Thank you


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