The Committee heard a briefing from the Department of Health on its strategic plan and budget 2010/11 to 2013. The briefing focused on the key government priorities starting with the vision and mission, then the context of health service delivery. The health care response included the 10 point plan of the health sector 2009-2014, and the outcome based Medium Term Strategic Framework 2010-2014. The Department had set up specific targets such as improving life expectancy, reduction of child mortality, and the reduction of HIV prevalence among the 15-24 year group, TB cure rate and the percentage of HIV pregnant women eligible for anti-retroviral treatment. The Department was allocated R25,8 billion for the next two years including conditional grants. The allocation was subdivided among the provinces and the refurbishment and building of five national hospitals. The Minister said that the government was pulling all stops to reduce the number of HIV infections because this aspect was the single largest recipient of funds from the donor community and the government. Members' concerns included the need for the reintroduction of nursing colleges to address the shortage of nurses. Some hospital managers were incompetent and that led to poor health services, and Members urged attention to this problem. The Committee had discovered that some newly built hospitals were inadequately staffed and underused while people needed health services. Members felt that consultation on the National Health Insurance was not properly done to include all stakeholders. The Minister stressed throughout the need to improve those areas where problems had been identified, and to strengthen the primary healthcare systems.
Department of Health Budget & Strategic Plan 2010/13
Dr Aaron Motsoaledi, Minister of Health, said that health was among the five key priorities for the government, alongside education, unemployment, crime, and housing. South Africa faced a quadruple burden of diseases, namely HIV/Aids and TB, Maternal and Child mortality, violence and injuries and non communicable diseases. Despite South Africa spending more on health than any African country, the child mortality rate had increased since 1990. The Department of Health (the Department, or DoH) formulated a 10 point plan that included the implementation of the National Health Insurance (NHI). The other important part of the plan was to overhaul the health care system by refocusing on primary health care and the improvement of the functionality and management of the Health System.
Dr Motsoaledi said that the Department would focus on outcomes based plan from 2010 to 2014. The four targeted outcomes were increased child and maternal life expectancy, concentrating on the efficiency of the health care system, management of HIV/AIDS and TB and the expansion of the prevention of mother to child HIV transmission. A massive campaign on HIV testing was launched, and it would be headed by the leadership in all spheres such as government institutions, traditional leaders in rural areas, trade unions, business leaders, and school principals. The campaign would coincide with a male circumcision drive, and condom distribution to 1, 5 billion people per year. Male circumcision studies in Uganda and South Africa had proved that circumcision reduced HIV transmission from males to females by 50% to 60%. He hastened to add that circumcision was not a substitute for condom use. The Zulu monarch, King Zwelithini had launched the campaign in Kwa-Zulu Natal; the next provinces would be Mpumalanga and the North West.
South Africa was heavily skewed towards the more expensive curative health systems rather than the primary health care practiced in countries like Britain. The neighbouring countries' primary health care was much better than the South African system. Countries like Swaziland would often send patients to South Africa for surgery. The general population preferred to send the sick to hospitals rather than immunise them against diseases. This often led to overburdening of the hospitals and the rise of the private health care costs for those who could afford private care. The Minister mentioned that the current polio and measles immunisation campaign was part of the drive to reduce child mortality. All HIV-positive pregnant mothers would start immediately with Anti Retro Viral (ARVs) treatment to prevent HIV transmission. He said there were two people were infected in Africa for every person on ARV. The current rise in infection rate was unsustainable because South Africa had the largest HIV treatment programme, largely funded by the donor community. The Minister said that his Department would initiate ARV treatment for all people co-infected with HIV and TB. The Department would strengthen the integration of TB and HIV services for people with a CD4 count of 350 or less.
The revitalisation of primary health care would include the accelerated delivery of health infrastructure and strengthening of primary health care teams in all 9 provinces. There were five tertiary hospitals that were identified for refurbishment through the public private partnerships. They were the Nelson Mandela Academic Hospital (Eastern Cape), Chris Hani Baragwanath (Gauteng) Dr George Mukhari (Gauteng), Limpopo Academic Hospital and the King Edward Hospital in KwaZulu Natal. Dr Motsoaledi emphasised that infrastructure alone would not work without improved patient care and satisfaction. The Minister mentioned that the national Healthcare Technology standards would be finalised during 2010/11.
The Minister briefly touched on the need to re open nursing colleges to train nurses that would work in the envisaged health care system. He noted that training of nurses at universities was not working because nursing required bedside training rather than merely the theory taught at university. The Department was busy quantifying training targets for the next 5 years to ensure proper recruitment and retention of personnel. He then spoke about improved health services for the youth, such as the provision of life skills education and the implementation of the Drug Master Plan by 2011. The Minister mentioned that community health care workers would play a leading role in the strengthening home based care. Different Departments had different community workers and that tended to duplicate services and confuse communities. He acknowledged the important role played by the non government organisations (NGOs) in the community health sector, and said there was a need for co-ordination and standardisation of work, roles and salaries, as was the case in Brazil.
Dr Yogan Pillay, Acting Director General, Department of Health, highlighted the call by the National Treasury for the reduction in budget due to lesser revenue. The Department of Health had made savings of R47 million through efficiency savings. The total allocation for the current financial year was R21,4 billion and it would increase to R23, billion and R25,8 billion for the next two years respectively. The increase would also include conditional grants such as the HIV/AIDS grant, which accounted for the largest part of the increase. The budget allocation was divided into six administrative programmes and it would be disbursed to the provinces. R10 million was set aside for the audit of Nursing Colleges Project and R160 million for the outbreak of the N1H1 virus.
The hospital revitalisation conditional grant amounted to R140 million for the Mitchell’s Plain Hospital. All provinces were required to have a Provincial Finance and Budget Unit. Other areas of importance were the forensic laboratories that had received negative press coverage in the recent past.The Measles and Polio Vaccination campaign that was under way, and the emergency Medical Services for the 2010 Soccer World Cup, were further priority areas.
The Chairperson mentioned that during the oversight visit to KwaZulu Natal and Limpopo the Committee noticed that the former mine Hospital in the Limpopo Province was not utilised effectively. The new Boschoff Hospital was under utilised because it was built far from the residential areas. She said that Hlabisa hospital in KwaZulu Natal had structural problems such as leaking pipes.
Dr Motsoaledi replied that the Boschoff hospital was built around a mine and the mine was closed at a later stage, but the expensive mine equipment could be moved to other hospitals where it could be better utilised. The Department of Public Works (DPW) was responsible for maintenance of hospitals like Hlabisa in KwaZulu Natal. When they were not properly maintained, hospital buildings fell apart. A body was set up to be responsible for the setting of standards for hospital buildings. Some hospitals were built in certain places, because the communities in those areas decided on that location as being halfway between two towns. The compromise decision would not always work because the facility was too far from both towns.
Mr M De Villiers (DA, Western Cape) said that the immunisation programme needed to be strengthened. He thought that HIV prevalence in those aged 15-24 years of age was worrisome, and he raised his concerns with the poorly managed hospitals. He enquired about steps to be taken to revive the nursing colleges. He questioned the adequacy of the HIV/AIDS prevention programmes and condom use. He enquired about the cost of the National Health Insurance.
Dr Motsoaledi said that the nursing profession required bedside training rather than university training that put more emphasis on theory. An audit of health professions personnel had been done and the nursing colleges study was on the pipeline. The previous government scrapped the hospital based nursing colleges and moved the training of nurses to universities. The majority of operating surgeons preferred to work with nurses who had received and were experienced in the necessary bedside training. He cited an example that some university trained nurses would refuse to clean patients because they felt that this was beneath them and their standard of training, whilst bedside-trained nurses were able to handle both practical and academic issues, having had practical training since matriculating. The nurses who received training from nursing colleges earned salaries from the first month of training, but poor students who aspired to be nurses could not afford to pay university training fees. He acknowledged that Western countries recruited South African nurses because of the excellent training they had undergone.
A massive communication campaign would be undertaken by the South African Aids Council which included all stakeholders from traditional leaders to religious groupings including gay, lesbian and trans-gender groupings. He said that the massive testing campaign, condom distribution, male circumcision and the Prevention of Mother to Child Transmission through the provision of ARTs would be done concurrently to stem the tide of new infections. The Department and donors would not be able to provide treatment of more HIV/AIDS cases than the existing numbers currently being treated.
Dr Motsoaledi noted that a study to ascertain the costs of the NHI was underway. NHI would work together with the strengthening of the primary health care system. The South African healthcare was skewed towards treatment rather than prevention, and this was not sustainable. He said the old adage that prevention was better than cure was still applicable. The debate around the NHI was centred on the perceived negative aspects of the NHI as leaked to the press by those people who stood to lose when the NHI was introduced.
Mr W Faber (DA, Northern Cape) asked whether there was quality evaluation of hospital managers' skills. He lamented the shortage of doctors at the newly built hospitals in Kimberley and Berkley West. He was concerned about the appointment of incompetent hospital managers. He praised the turnaround work done in Chris Hani Baragwanath Hospital. He asked the reason that clinics closed early during the day.
Dr Motsoaledi said that under-qualified hospital managers was a huge problem, as reflected by the results of a study done in Limpopo and the Eastern Cape. The problem was so severe that truck drivers and junior nurses ended up by being appointed as Chief Executive Offices. The problem of shortage of doctors was addressed with the introduction of a rural allowance for those doctors who practiced in rural hospitals. The Minister said that clinics closed early because there were no people who wanted to use their services in the late afternoons
Mr S Plaatjie (COPE, North West) asked whether the Department was doing enough to involve stakeholders around the National Health insurance. He questioned whether sufficient briefings had been done around the massive HIV/AIDS testing, because some leaders would oppose the move, especially in rural areas. He asked about the steps taken to remedy the situation where people would bypass clinics and go straight to hospitals.
Dr Motsoaledi said the South African National Aids Council involved all sectors in their decisions. Leaders from school and university principals, trade union leaders, religious leaders, women groups, youth, sports and civic society sectors would initiate the testing campaign. He said that people were more likely to follow when their leaders started the campaign to test for their HIV status. It was less expensive to deal with HIV if it was diagnosed at earlier stages. The NHI was still in its drafting stages, but there were people who benefited immensely from the present dispensation. If the primary health care system and the hospitals were properly managed, the refurbishment of the five national hospitals and the implementation of current policies would ensure that people would not have to flock to the private hospitals. Private Hospitals mushroomed when the health system collapsed. The people who could not afford private health care were systematically excluded from quality health services. The Minister said that he was aware that some clinics in rural areas did not have drugs and were situated in far away places, so communities lost faith in them and opted for hospitals. The situation could be solved only through emphasis on a working primary health care system.
The meeting was adjourned.
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