Health: Minister's Budget Speech


29 Jun 2009



Hon Chairperson
Honourable Members of the House,
Distinguished Guests, 
Ladies and gentlemen.
Good afternoon.

It is an honour for me to present to this House the Budget of the National Department of Health for 2009/10, for your consideration. I am presenting this budget at a very challenging time in the history of health care in our country and around the world as a whole.

Let me start with the world:
There are two contemporary about healthcare around the world:
the ever threatening H1N1 Influenza which has spread so widely that it has moved up to stage 6. Fortunately it is not virulent but just spreading widely. However I must state that it is under control.
In our country we are able to control it despite the fact that we were having many visitors from all over the world in recent weeks; the second issue is the global economic meltdown. It has a great bearing on healthcare around the world, and especially in third-world countries like ours. For this reason, the United Nations Secretary-General, Mr Ban Ki-Moon convened a Secretary’s General Forum on Advancing Global Health in the Face of Crisis two weeks ago at the UN Headquarters.

His rational was that the world has learnt during previous economic crises that social outcomes are the first to suffer, and the least to recover during such crises.

He went on to point that during such crises, countries are tempted to cut on social spending such as health. The results are that while rich people inside rich nations may lose their jobs and assets like mansions, luxury cars and other property, these they may recover when the economy recovers. But in poor countries, poor people may lose their life through extreme poverty and poor healthcare, and they will never ever recover this lost life after the crises.

Hence I wish to bring this message home to my own country, that this is the time the poor need protection more than ever before, to cushion them from the devastating effects of these crises. Coming back home the challenges are overwhelming.

During the State of the Nation Address, the President of the Country, his Excellency Mr Jacob Zuma said: “fellow South Africans, we are seriously concerned about the degeneration of the quality of healthcare, aggravated by the steady increase in the burden of disease, in the past decade and a half”.

We have no option, but to be fired up to take the bull by the horns in tackling these state of affairs, and deal with it decisively.

Unfortunately, the present events within the public health sector does not help the situation either. Chairperson, I need to mention that we as the governing party started being concerned sometimes back. Hence the resolution at the ANC 2007 Limpopo Conference, that Health and Education be top priorities for the next 5 years and beyond.

To this end, the Government adopted a 10 point plan which is our programme for the next 5 years. The public health system is also forced to carry the ever increasing burden of diseases, obviously made worse by poverty, HIV and AIDS, and other communicable diseases. However, Hon Chairperson, let me accept and acknowledge upfront that some of the factors contributing in no small measure to the problems the health system is carrying, are the following:
lack of managerial skills within health institutions;
failure to cut on identified deficiencies;
delayed response to quality improvement requirements;
unsatisfactory maintenance and repair services;
poor technological management;
poor supply chain management;
inability of individuals to take responsibility for their actions;
poor disciplinary procedures and corruption;
significant problems in clinical areas related to training and poor attitude of staff; and lastly
inadequate staffing levels in all areas

We are going to be facing all these issues head on and we will do so without fear and favour. We owe it to our country that these issues be tackled head on.

Hon Chairperson, some of the issues I have mentioned as contributing factors to the problems the health system is facing are very urgent and will be dealt with urgently. For instance, Gauteng Provincial Government has already launched “Operation kuyasheshwa-la” to deal with such urgent matters.

Our Programme of Action however with its 10-point plan, has been designed to deal with the issues systematically and in a sustainable manner. Its implementation will be both decisive and incisive.
Hence Hon Chairperson, our 2009/10 - 2009/14 will allocate resources for the following ten priorities in line with the Programme of Action:
provision of strategic leadership and creation of a social compact for better health outcomes
While issues of strategic leadership are very clear, I wish to add up the social compact part of this point speaks to “working together we shall achieve more”
            Mooney (2008) also states that:
“The view of patients as passive receivers of health care is being replaced by one of communities as equal partners in decision making about health care priorities, contributing their opinions alongside those of bureaucrats and policy makers”
We shall follow this line very closely.

Implementation of a National Health Insurance (NHI)
Hon Chairperson, in recent weeks there has been a ranging debate in the public arena about the intended introduction of the NHI by Government. This debate was introduced prematurely by people who wanted to scuttle the NHI as an unworkable system. South Africans were urged to run for cover because the NHI is going to be a marauding monster that will destroy everything that you hold dear in the health care system of the country.

Hon Chairperson, while I am not yet presenting an official document as yet on NHI, because it is a policy that is still to come (though very soon), I wish to make the following known:
the present system of healthcare financing can no longer be allowed to go on, because it is simply unsustainable. No way can we perpetuate a system whereby we spend 8.5% of the GDP whereas 5% caters for 14% of the population or 7 million people,  on the remaining 3.5% caters for a whooping 84% of the population or 41 million people. Nowhere in the civilised world can you find that state of affairs;

the present model of healthcare financing is just outright primitive, and we are going to abandon it. The General Secretary of the United Nations, Mr Ban Ki-Moon, on the 15 June 2009, which is just two weeks ago, had this to say: “out of pocket expenditure, is the worst form of healthcare financing”. That says it all.

Critics of the NHI were hard at work to prove that we are going to overburden the rich, and the economy will not cope.

Hon Chairperson, what is NHI? – it is a system of universal healthcare coverage where every citizen is covered by healthcare insurance, rich or poor, employed or unemployed, young or old, sick or very healthy, black, white, yellow or people of whatever persuation.

It is this part about covering the poor and the unemployed that is bringing discomfort and unprecedented anger in the minds of the enemies of NHI. Let me read the following paragraph of the speech made by Dr Margaret Chan – Director-General of the World Health Organisation (WHO), at the meeting of the United Nations. Dr Chan was the Minister of Health in Hong Kong before taking over as Director-General of WHO: “Fairness, I believe, is the heart of our ambition in global health”. A quest for greater fairness dominated the agenda of the UN Forum.

We see this as our concern about vulnerable populations and about health systems that exclude the poor. We see this in your support for global health initiatives and funding mechanisms that redistribute some of the world’s riches towards health needs of the poor.

On the issue of fairness, let me again state the obvious. Our word is dangerously out of balance also on matters of health. Differences within and between countries, in income levels, opportunities, and health status are greater today than at any time in the recent history.

She went on to say: “let me make another obvious point – a health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. Properly managed and financed health systems that strive for universal coverage contribute to social cohesion and stability.
Hon Chairperson, the aims and objectives of NHI is to achieve exactly what the WHO Director-General has alluded to – nothing more, nothing less.

Accelerated Implementation of the HIV and AIDS Plan and increased focus on TB and other communicable diseases
Hon Speaker, let me go back to the President’s State of the Nation Address: “we must work together in the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50% in the year 2011.  We want to reach 80% of those in need of ARV treatment by 2011.

Hon Chairperson, here is the score-card on HIV and AIDS challenge that South Africa is facing.
This year, on the 9th of June, The Human Sciences Research Council, together with its partners the Medical Research Council, Centre for AIDS Development, Research and Evaluation and the National Institute of Communicable Diseases published a report on HIV based on interviews and testing of a random sample of the population in South Africa during 2008. The survey included people of all races, age groups, rural and urban and all provinces. The researchers concluded that
The epidemic is stabilizing at 11% between 2002 and 2008;
HIV prevalence at national level decreased by nearly half among children aged 2-14 years, between 2002 and 2008;
HIV prevalence decreased slightly among youth aged 15-24 from 2005  to 2008;
Encouragingly there was a substantial decrease in new HIV  infections in 2008, in comparison to 2002 and 2005, especially for the single age groups 15, 16, 17, 18, and 19;
What was most encouraging was the change in behavior among South Africans. More South Africans for all age groups protected themselves against HIV infections by using condoms. More than 95% know where to access condoms and use has increased;
Furthermore, half of South Africans now know their HIV status, which means that the message on “know your status campaign” is being heeded;
 The researchers also reported that there has been an increase in exposure to one or more HIV/AIDS communication programmes from 2005 to 2008 with 90.2% of youth aged 15-24 years being reached,  followed by adults 83.6% of 25-49 years and 62.2% of adults 50 years and older;
However, despite these successes, there is still some unevenness in infections as well as behaviour change. 
HIV prevalence is still highest in KwaZulu-Natal (15.8%) and Mpumalanga (15.4%). 
It is also still highest among young women, aged 25-29 years, where a third of the women are HIV positive.
Among all provinces, Free State continues to have high rates of multiple partnerships, perhaps due to the migratory labour patterns in that area.

We take note of the recommendations made by the researchers, especially that we need to introduce targeted interventions in some provinces with high HIV prevalence.

Secondly, that we assist young women who want to have children, to do so without risking HIV infection. We plan to support research that will generate evidence to be used in attaining this goal.

We furthermore, support that we intensify our efforts to help provinces implement interventions aimed at reducing rates of multiple sexual partners, including intergenerational sex. 
We also take the recommendation that we should consider implementing provider-initiated HIV testing in all health care facilities.

Finally, we take seriously the concern that Khomanani should increase its reach and coverage to all South Africans, particularly those who are aged 50 years and older.

I would like to thank the following people for continuing to undertake research that informs policy and programme development on HIV and AIDS; these are Dr. Olive Shisana, Professor Leickness Simbayi, Professor Thomas Rehle and their staff at the HSRC as well as their colleagues from the MRC and CADRE especially Dr Warren Parker. Finally, the support of the US President’s Emergency Plan for AIDS Relief in conducting this important study is very much appreciated.

Hence Hon Speaker, we will work with provinces in 2009/10 to ensure that 80% of HIV-exposed infants receive ARVs for PMTCT (based on dual therapy). This figure will increase to 95% over the two years of the MTEF 2010/11 and 2011/12. The proportion of pregnant women who are tested for HIV will be increased from 80% in 2009/10 to 95% in 2010/11 and 2011/12.
To strengthen the prevention of mother-to-child transmission of HIV, 80% of pregnant women who are eligible will be placed on ARV Prophylaxis based on dual therapy in 2009/10.
This figure will increase to 95% in the outer 2 years of the MTEF period. 30% of eligible pregnant women will be placed on HAART in 2009/10. this service will be expanded to cover 50% of pregnant women in 2010/11 and 75% in 2011/12. South Africans, and men in particular, will be encouraged to do voluntary counselling and testing (VCT). In line with the result of the research by the Human Science Research Council (HSRC) and others, we will increase distribution of male condoms from 283 million to 450 million in 2009/10, and 45 million condoms in the other years of the planning cycle. Female condom distribution will increase from 4.5 million in 2009/10 to 5 million in 2010/11 and 2011/12.
We will start 215 000 new patients on ARVs and grow the figure to 320 000 in 2011/12. This figure of patients will add to the 781 465 people already on treatment.

overhauling the healthcare system and improve its management
We will draft proposals for legal reforms to unify the public health service. We shall also develop a decentralised operational model including new governance arrangements.
Hon Speaker, we shall also finalise delegations for all managers at all levels of the public health system. We will spend attention on hospital managers or CEOs to ensure decentralisation of management. We shall also strengthen health specific management capacity for programmes and facilities, especially hospitals. In this case we shall:
evaluate all CEOs of hospitals to ensure that they meet the minimum requirements for effective management of the set facility and institute corrective measures where indicated, including retraining and/or redeployment;
do a feasibility study for establishment of a leadership academy of health managers.
In further overhauling the health system, we will evaluate and strengthen the district health system and primary health care
Improved human resource planning, development and management
Improving the quality of the health services
revitalisation of health infrastructure
mass mobilisation for better health for the population
review of drug policy
strengthen research and development

In conclusion, Hon Speaker, I wish to appraise this House, about the issues of Occupational Specific Dispensation (OSD)

I thank you

30 JUNE 2009

Mr. Speaker,
Minister of Health, Dr Aaron Motsoaledi
Honourable Members of the House
Distinguished Guests,
Ladies and gentlemen

Let me start by congratulating all government departments, FIFA and the Local Organising Committee on hosting an extremely successful Confederation Cup.  Let me also congratulate Bafana Bafana who have made us very proud. They have improved their game. They played well.

We have shown the world that South Africa and indeed Africa is not only capable of hosting the World Cup, but can outshine many other countries in organizing this great event.

Mr Speaker, now that the 2009 FIFA Confederations Cup is behind us we can pause and reflect on how the health system met its obligations in the provision of health and medical services for the tournament.

In general the provision of these services is considered successful and the detailed planning and preparation that took place has resulted in an incident-free tournament.

However, there are also areas where we believe that we can improve. A thorough debrief will take place mid July 2009. Lessons learnt will be carried forward, as we begin to prepare for the 2010 FIFA World Cup.

With the World Cup involving ten (10) stadia, as opposed to the four (4) used for the Confederation Cup, now is not the time to rest on our laurels. The Health Sector Preparations Workgroup will critically revisit its plans in minute detail to ensure that all aspects are suitably prepared for.

The World Health Organisation (WHO), working together with the Department of Health, sent a nine-member delegation of experts in communicable disease and mass gatherings to South Africa to evaluate the implementation of communicable disease control strategies during the 2009 FIFA Confederation’ Cup. This team commended us for the good work that was done. It also left us with minor recommendations.

The first identified case of swine flu in South Africa occurred during the visit of the WHO delegation. It provided the delegation the opportunity to observe firsthand how we, as a country, dealt with the incident. The reports received were positive. The delegation gave us the assurance that they would continue to support our efforts to ensure that we have a 2010 tournament that is free of any disease outbreak. To this end exchange and training programs will take place over the next 10 months.

I am confident as I stand here today that I will be able to tell the nation in April 2010 that the Department of Health, along with its partners, are fully prepared to ensure that we are more than adequately ready for the 2010 FIFA World cup.

Mr Speaker let me now turn to the priority issue of improving quality of care. Our patients and their families, and the communities we come from, are the most important voices that we will be listening to during this year as we move towards implementing more equitable and higher quality care through health systems strengthening. We will also continue the recent successful efforts to work with our own staff and the many partners who are passionate about improving the quality of care in our country. We will formalise some of these relationships by appointing a number of our recognised experts to advise us on accepted best practice on an ongoing basis.

Since starting work last year, the Office of Standards Compliance had already initiated the process of reviewing and benchmarking performance against national standards in a number of hospitals and community health centres. This was followed by support to improve identified areas of weakness. In this financial year the national standards and assessment tools have been revised to ensure the most critical areas where quality or safety could be at risk are adequately covered, for both hospital and primary level care. These standards will be extensively publicized and used throughout the health system to guide our work and our managers.

We will continue to review progress in relation to our previous findings in every province, as well as rolling out the performance review and benchmarking exercise so that we cover a quarter of our facilities this year. In doing this, we will be seeking the most effective ways to ensure that such an exercise is credible and provides our department at all levels with an objective assessment of our problems and the underlying or contributory causes, thus enhancing accountability.

It is important at the same time to build our own capacity to make best use of the findings. These reports will give a detailed guide to managers both at facility level and those who provide support at provincial and national levels as to what needs to be done to reach the required standard. The aim is to enable all these facilities to receive recognition as having met the required standard.

To turn quality challenges around, we will use the methods shown internationally to be most effective. We will be pulling together a network of 100 targeted quality improvement projects around the country. These will be focused on measures to protect the safety of our patients including through the prevention of health-care acquired infections, long waiting times, plus basic cleanliness and maintenance of our facilities.

Through these projects, we will be able to improve poorly functioning system, weak management and poor supervision, and hopefully motivate and energise our staff working at delivery level as well as identify and effectively solve some of the impediments to their work.  This focus at delivery level is what in the end will make the services as a whole work for the benefit of our patients.

One particular mechanism that is widely used in the private sector to improve quality is through proactively analyzing and addressing the complaints and concerns of our users, both in terms of providing an explanation (and an apology) to them and taking strong measures to avoid their future recurrence. This will be the main aim of our national 24-hour toll free line, which will start operation during this financial year. It will work in close collaboration with all the provincial centres.

As the Honourable Minister has indicated, the implementation of the NHI represents a defining moment for the South African health system. It has been a long and winding road and many alternative considerations have been put on the table as to how best the country can achieve universal coverage.

In the 1994 ANC’s National Health Plan, it was clearly envisaged that the introduction of a mandatory prepayment-based, the national health insurance will go a long way towards the progressive realisation of ensuring that the South African population have coverage and access to adequate, good quality and affordable health care within the public and private sectors.

Ke nako - It is time to implement such a system, which is based on access to health services that are provided in a manner that effectively addresses the inequities of the past and also ensures that there is a unified national health system that accords our citizens sufficient financial risk protection from catastrophic health-related expenditures and improves the health outcomes of the population.

Mr. Speaker, a key area in the strengthening of the health system and the implementation of the NHI is an integrated Health Information System (HIS).The World Health Assembly (WHA) has identified the need to strengthen the health information systems in member states. The WHA subsequently identified the Health Metrics Network to facilitate evaluations and to develop strategic plans based on the needs to achieve this important objective within member states.
Some of the areas that would need attention in order to strengthen the country HIS are addressing
the current fragmented HIS sub-systems into an integrated country HIS;
capacity building of the HIS staff;
establishment of an integrated national data warehouse for all data sources and paying particular attention to enabling tracking of human resources, equipment, physical status of facilities and expenditure tracking; and
methods and estimation of provincial national health accounts, chronic disease surveillance, cause of death certification and survey methodologies.

The successful implementation of the National Health Insurance (NHI) will need a very strong ICT infrastructure. It is therefore paramount that an Integrated National Health Information System which will cater for all service providers, public and private, is developed as part of an e-Health Strategy.

South Africa has embarked on a process of acquiring an Electronic Health Record (EHR) for South Africa. The State Information Technology Agency (SITA) and the Department of Health will establish the requirements for implementing an Electronic Health Record for South Africa.

Mr Speaker, we have prioritized the improvement of service delivery in our hospitals. The Department of Health launched the Health Facilities Improvement Plan (HFIP) with twenty seven (27) hospitals throughout the country. The Minister has already directed that each province add at least ten (10) hospitals to this pool. The twenty seven hospitals were appraised against core standards that were across seven domains namely patient safety, patient clinical care, patient experience of care, patient access to care, management and leadership, infrastructure and environment/facilities management, and public health. Facilities were a mixture of district, regional, and tertiary hospitals across seven provinces. In working with the facilities we moved closer to creating good ownership and team building of all the internal stakeholders of the facilities facilitated over six (6) months.

Our focus on hospital improvement plans will deal with patient experience of care in the health facilities the environment, management of waiting time, attitude of staff and facility management.

In addition we will address the backlog of equipment that needs to be provided for health workers to use. There are standards that are being developed to assist in the procurement and maintenance of these health technologies, so that levels of hospitals and health facilities have the appropriate technology. We are modernising equipment for cancer treatment. Along with this increased attention to technology, there shall be emphasis on the appropriate maintenance training. We shall also focus on equipment that is necessary for strengthening primary health care. We shall collaborate with other role players, including academic, research, donor and non-governmental organisations in this regard.

Emergency Medical Services are at the centre of enabling our people to reach places of care in times of emergencies. With the aim at reaching the targets of the Millennium Development Goals of reducing maternal and child deaths by 75 and 67 percent respectively, the response of the EMS teams is crucial. To this end we are embarking on the modernization of emergency services. We will be concentrating on purchasing more response vehicles, building more base stations and strengthening training programmes. The hospitals will also be equipped to deal with the emergencies, particularly maternity emergencies.

Last but not least is the importance of cleanliness of our facilities. The environmental health supervision will be increased, with the engagement of communities and other partners in creating a conducive environment for the patients and the health workers. Hospitals indeed need to be places for healing and rehabilitation.

Mr Speaker, this budget shows that government is committed to health system strengthening.

I urge all members to approve the budget.

Thank you. Re a leboga.



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