Minister of Health on 2014 Millennium Development Goals (MDGs) progress

Meeting report

The chairperson, Mr B M Goqwana (ANC), welcomed the Minister of Health, Dr Aaron Motsoaledi, who had been invited to address the portfolio Committee on the Department of Health’s progress in meeting those Millennium Development Goals (MDGs) which related to health matters.

Sketching the background, Dr Motsoaledi said the Millennium Declaration, signed by world leaders in 2000, incorporated eight MDGs. Of these, three dealt with health, and incorporated targets for achievement by 2015:

Reduction of child mortality -
Target:  Reduce by two-thirds (66%) the infant mortality rate.
Improvement in maternal health
Target:  Reduce by three-quarters (75%) the maternal mortality ratio.
Combat HIV & AIDS, malaria and other diseases.
Target:  Halt and begin to reverse the impact of HIV & AIDS and malaria.
While South Africa was coping well in meeting other MDG targets, such as poverty and hunger eradication, universal primary education, gender equity, environmental sustainability and the establishment of global partnerships for development, the whole of sub-Saharan Africa was in “deep trouble” in dealing with its health commitments. An exception was malaria, where South Africa was winning the war against this disease through the use of DDT.

Dr Motsoaledi said while the rest of the world was able to focus on non-communicable diseases (NCDs), such as such as diabetes, heart and respiratory ailments, South Africa was saddled with a “quadruple burden” in the form of HIV & AIDS, maternal, newborn and child health diseases, violence and injuries, as well as NCDs, where the incidence was well above the global average..  He pointed out that NCDs were driven by four factors – smoking, alcohol, diet and exercise – and if these factors were properly controlled, most of the country’s health problems would decrease significantly.

Referring to the link between HIV and tuberculosis (TB), he said there were 22 countries where TB was prevalent, and South Africa ranked number one for annual infections per 100 000 of population – and 73% of patients were found to be HIV positive. The impact of AIDS on the death rate had been significant since 1997, with a swift and noticeable swing towards young people, and females in particular. When young women died from AIDS, this often could be linked to increased child mortality. Furthermore, women were far more capable of maintaining a family environment, and in their absence, a climate conducive to drug and alcohol abuse, criminality and violence, was often created. Statistics showed that up to the age of 34, more women were HIV positive than men, peaking at 32,7% in the 25 to 29 age group.  Overall, 39% of premature deaths in South Africa were the result of HIV/AIDS, with the next highest causes being inter-personal violence and injury (7,5%), TB (5%) and traffic accidents (4,1%).  South Africans’ life expectancy at birth – 56 years for women and 51 years for men – was 13 years below what it would be without HIV.

Turning to maternal mortality, Dr Motsoaledi said that 59% of maternal deaths between 2005 and 2007 were tested for HIV, and 79% were found to be infected. The annual number of still births was 20 000, with most of them premature or pre-term births, and this was driven by HIV/AIDS.  In the area of child mortality, the rate for children under five had risen from 59 per 1 000 live births in 1998, to 104 in 2007. The MDG target for 2015 was 20 per 1 000 live births. He bemoaned the fact that many young girls were using abortions as a form of contraception, and said that this pointed to the need for greater attention to be paid to family planning – a badly neglected area in sub-Saharan Africa. The abortion rate seemed to peak in January, at a time when young girls were going back to school or starting a new job. He also criticised the fact that young people were exposed to advertisements such as those promoting penis enlargements and strong erections, and felt that these messages needed to be countered by the Department of Health (DoH). Maternal mortality rates were also much too high – and still increasing. The 2015 MDG target was 38 maternal deaths per 100 000 live births, but in South Africa this had risen from 150 in 1998 to 625 in 2007.

The DoH had identified four outputs necessary to promote a long and healthy life for all South Africans. These were increasing life expectancy, decreasing maternal and child mortality, combating HIV and AIDS and decreasing the burden of disease from TB, and strengthening the effectiveness of the health system. It was planned to re-engineer the health care system so that the current model, which placed advanced medical care at the top of the priority list, and primary health care at the bottom, could be replaced by an ideal service delivery platform in a mature National Health Insurance (NHI) system, which placed the main emphasis on primary health care. This would take the pressure off the hospitals, as the majority of South Africans could be treated at multi-disciplinary clinics.

The Government had adopted a universal approach to HIV. All pregnant women and TB-HIV co-infected people with a CD4 count of 350 or less would receive treatment. Prevention of mother-to-child transmission would start at 14 weeks, instead of 28 weeks, while all babies born HIV positive (70 000 newborns a year) would be treated on diagnosis, regardless of their CD4 count. This would significantly reduce infant mortality rates.

The prevention strategy for HIV/AIDS covered nine different aspects, but only in the area of providing safe blood transfusions could South Africa claim to be fully successful.

The strategy to improve maternal health involved increasing the proportion of health facilities providing basic ante-natal care, increasing the percentage of mothers and babies receiving post-natal care within six days of delivery, increasing the percentage of eligible HIV positive pregnant women placed on Highly Active Antiretroviral Therapy, and increasing the proportion of designated health facilities providing Choice on Termination of Pregnancy (CTOP). The latter intervention would help to reduce the incidence of back-street abortions.

Dr Motsoaledi outlined a three-pronged approach to dealing with tuberculosis, a highlight of which was the use of the new Gene Xpert technology, which had revolutionized the diagnosis of TB. It was now possible to know the result of testing within two hours, and to positively identify the disease in 98% of testing. Various models of the equipment had been made available at key areas around the country and, with the assistance of international bodies such as the World Health Organisation, the new technology would be rolled out over the next 24 months. With this approach, there was a realistic prospect of eliminating TB completely.  The other two facets of the programme were the introduction of family visits – professional teams visiting all 407 000 families of TB contacts – and the establishment of high-tech multi-drug resistant (MDR) hospitals in each province.

Discussion
Ms M Segale-Diswai (ANC) referred to the shortage of nurses, many of whom had been recruited into the private sector, and said that while clinics and health centre buildings were being refurbished, there were often no nurses to provide patients with care. She wanted to know what was being done about training of nurses. She also drew on her own experience as a nurse, making afternoon home visits to patients, and asked whether this could be done in future.

Dr Motsoaledi said the shortage of medical personnel was a worldwide phenomenon. In South Africa, a three-day summit had resulted in the creation of a Nursing Compact, which had focused on the fragmented nature of training – a problem that existed even prior to 1994. In terms of the Compact, task teams had been set up to implement its recommendations. He said he fully supported the concept of nurses going into the communities on family visits. He agreed that clinics were being refurbished, but the Department faced the problem that there were no norms or standards to determine what equipment needed to be installed in each clinic. As a result, money was often spent on expensive high-tech equipment which added to the cost structure but did little to improve service delivery. A task team had now been set up to establish the norms and standards for what was essential for each clinic. These requirements would become part of the tendering process, and it was therefore important to ensure that there tender boards included qualified medical professionals.

Ms C Dudley (ACDP) said the Minister’s statistics indicated that 1 000 people were dying of AIDs daily in South Africa, and enquired if this figure was realistic.

Dr Motsoaledi said he believed the figure was realistic, particularly when one considered that with the death rate doubling between 1997 and 2006, the determining figure had to be AIDS.

Ms Dudley said she was concerned that medical aids would not cover the cost of supplying contraceptives to its members, which she felt was a contributory factor in the country’s high abortion rate.

Dr Motsoaledi said it was not normal for girls to seek abortions, but he knew of an instance where a girl had had three abortions in six months.  The Abstinence, Be faithful, Condomise (ABC) programme did not seem to be working effectively, and this emphasized the need to promote the concept of preventing pregnancy.

Ms Dudley proposed that testing for AIDS should be made compulsory, so that it would become the norm and remove the stigma associated with the disease.

The Minister said he believed voluntary testing was a better alternative at this stage, and suggested that Parliamentarians could assist by setting an example. Traditional leaders were also being briefed on the concept of voluntary testing for circumcision initiates.

Mr M Waters (DA) asked whether the DoH had established specific targets for the number of doctors and nurses to be trained in order to overcome the current shortages.

Dr Motsoaledi said the country currently had eight medical schools and five teaching hospitals, and 1 200 doctors were being trained each year. Facilities needed to be expanded so that this figure could be trebled. In Cuba, the number of medical schools had been increased from one in 1966, to its current level of 26.

Mr Waters asked whether any research had been conducted to indicate the impact of the decade of “AIDS denialism” on the country.

The Minister acknowledged that the impact had been detrimental, but said no research had been undertaken because it would have involved the use of scarce resources.

Ms E More (DA) said that poverty played a role in the health problems identified by the Minister, and asked whether research had been carried out on the effect of social grants.

Dr Motsoaledi said this issue had been debated in Parliament, where it had been suggested that these grants contributed to the increase in teenage pregnancies. However, the evidence to support this was inconclusive, as many girls did not register for these grants, and others opted for abortions.  It was time for teenage pregnancies to be considered an “accident”, rather than the norm. He agreed that poverty made girls vulnerable to “sugar daddies”, who were able to lure them into “inter-generational” sexual liaisons through money and food.

Ms More said a recent oversight visit by members of the Committee had revealed a lack of awareness at grass roots level of the Department’s plans, and how they should be implemented.

The Minister said the problem stemmed from each province focusing on its own area of influence, rather than looking at the overall picture. He was addressing this by visiting each province in turn, addressing MECs, provincial health officials, mayors, municipal managers and even private practitioners, so that the DoH’s plans were better understood.

Ms B Ngcobo (ANC) asked whether the Government was planning to take any action regarding alcohol and tobacco advertising.

Dr Motsoaledi said there was a need for healthy lifestyle adverts to counter the use of sporting idols to promote smoking and drinking, which was not acceptable.

Ms Ngcobo asked whether there was a link between HIV/AIDS and malaria.

The Minister said that HIV/AIDS sufferers had lower resistance to diseases such as malaria, but he was pleased to report that malaria had been brought under control in South Africa.

Ms Ngcobo asked whether it would be possible to increase the number of female condoms available to women.

Dr Motsoaledi said the number had been increased to six million this year, although the rate of increase was greater for male condoms, which cost only 24 cents each, compared to R8 for female condoms.

He urged Parliamentarians to set an example in the identified lifestyle areas of smoking, alcohol, diet and exercise.

The Chairperson thanked the Minister for identifying the challenges needing to be faced to meet the MDGs, and adjourned the meeting.