The Committee welcomed an information sharing with a delegation of Members of Parliament from New Zealand on their way to a conference in Zambia. The Chairperson explained the structure of South Africa's government briefly and expressed the importance of the Portfolio Committee on Health in their role of ensuring the healthcare system functions well nationally. The Chairperson mentioned the challenges they face particularly with HIV/AIDS and tuberculosis.
Members addressed the incidence of HIV/AIDS in South Africa and how the disease puts pressure on South Africa. Members asked for guidance and ideas about how structure the distribution of money and resources between different regional areas of the country, and how capital investment could be shared in the country. The issue of attracting and maintaining healthcare professionals was also raised and the Members questioned how New Zealand suggests keeping those professionals. Members addressed the high rates of noncompliance with drug taking and poor medication collection and administration as well as the growing problem of drug resistance in South Africa. Members addressed smoking and indicated that South Africa has ratified the World Health Organisation's (WHO) convention on smoking to discourage smoking through legislation and the use of taxation.
The delegation from New Zealand addressed the equity and distribution issues associated with resources and said there is a weighting formula to distribute resources among their twenty health boards. Even though New Zealand manages to attract healthcare professionals from around the world, they often lose those professionals to larger countries like Australia. HIV/AIDS in New Zealand is much less prolific as the country is separated by distance and remote borders so there are only roughly 2700 cases of HIV/AIDS in New Zealand.
New Zealand does not experience many problems with TB because there were large-scale vaccinations but they have problems with other diseases like rheumatic fever. New Zealand aims to be smoke-free by 2025 and they have taken on a number of measures such as banning smoking in public areas and point of sale restrictions as well as plain packaging measures. The cost of cigarettes in New Zealand is approximately R200 for a packet and the 10% excise duty ensures that this will keep rising to discourage smoking. The ideas shared between the Committee and the delegation were deemed useful and although the countries have vastly distinct problems, it came away with a greater understanding of how well New Zealand's healthcare functions.
The Chairperson thanked the delegation from New Zealand for sitting in on the Committee meeting. She noted the different socio-economic challenges faced by New Zealand, yet hoped that the information sharing would be useful. The Committee is comprised of six permanent African National Congress (ANC) members, three from the Democratic Alliance (DA), and then a few representatives from other parties. The Chairperson stressed the importance of the Committee’s function to oversee the Department of Health (DOH) in their activities in all the nine provinces, which is a very challenging task for the Committee.
The Chairperson addressed the issues faced by South Africa in terms of health. The severe human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) situation in South Africa has led the Committee to be charged with dealing with the pandemic through lifestyle programmes that urge members of the public to know their status and reduce transmission. The South African National Aids Council (SANAC), set up by Deputy President, uses the help of civil society and government to push forward programmes to deal with HIV/AIDS.
On other health-related matters, the Chairperson mentioned the upcoming White Paper on National Health Insurance in South Africa and the submissions for that are expected by 12 May 2016. This is quite an intense programme aimed at serving those people who face poor social health conditions as a result of poverty and persistent socio-economic structural inequality. The Committee, as a whole, is committed to changing the social conditions of the vast majority of South Africans. The other issue that the Committee faces is that of tuberculosis (TB) and the Chairperson highlighted the importance of TB screening and tests for all South Africans. TB is a disease that can affect anyone and the Committee is dedicated to leading by example through putting themselves through those tests and screenings. The Chairperson noted how important having the delegation from New Zealand would be in terms of exchanging ideas and best policy practice and for South Africa to get ideas to restructure its primary healthcare services.
Dr W James (DA) mentioned how problematic it is that the second largest component of South Africa’s budget is healthcare, yet the outcomes remain poor. The solution would be a total reform of the healthcare system so that it is does not put pressure on the fiscus. Dr James said that the proposed National Health Insurance (NHI) would require an additional third of the current budget, resulting in costs of R75 billion by the year 2025 for South Africa. It is therefore, imperative that the system is changed and overhauled without spending any more.
Dr H Volmink (DA) raised questions on how the Committee could learn from the New Zealand delegation. He inquired about a workable compensation mechanism for those who are unable to work due to injury or other circumstances. He also asked after New Zealand’s primary health organisations and how they work and are funded. On the issue of distribution, Dr Volmink questioned how equity is achieved in distributing money and resources between New Zealand’s twenty designated health boards. The issue of infrastructure and capital investment was also raised and he asked how it works and how it is maintained. He asked for elaboration on the matter of disability and the challenges surrounding compensation with respect to New Zealand’s Accident Compensation Corporation (ACC). When a country deals with structural inequality, he asked what policy choices should be made to address those inequalities.
Mr A Shaik Emam (NFP) commented on the incidence of HIV/AIDS, TB and even the growing threat of diabetes in South Africa. He said that South Africa’s three tier system of government between local, provincial and national government is challenging and he asked for guidance in terms of the system used in New Zealand to best deal with that. Mr Shaik Emam mentioned how the Committee is aiming to improve people’s lives and that is why they are pushing for the introduction of the NHI. Yet, he asked how South Africa could accelerate the process of bettering people’s lives giving challenges that South Africa faces in terms of attracting medical professionals to provide adequate healthcare. He mentioned how New Zealand faces limited challenges relating to HIV/AIDS. The introduction of drugs intended for sex workers to stop the spread of the diseases is a potential idea and he asked if it had worked in New Zealand and how it would be different.
Mr S Marais (DA) said that the acquiring and maintaining of good healthcare infrastructure is South Africa’s biggest burden. The incidence of TB and HIV/AIDS remains high and it is clear that the issue is out of control. The issue lies with opportunistic diseases such as TB and pneumonia that cause greater problems with HIV/AIDS. The fact that people are quite ignorant about the disease in South Africa is yet another challenge. There is a large degree of non-compliance with taking treatment or merely even the collection of prescribed medication. He said that people had been trained to go out and administer medication and make sure that people are taking their medication. Even though those people are not healthcare professionals, it is a good way to ensure that people take their medication. The issues around TB are mounting because there is an increasing amount of drug resistance wherein patients do not recover properly and often then end up being admitted to hospital, which is another additional cost.
Dr P Maesela (ANC) mentioned the high incidence of HIV/AIDS in sub-Saharan Africa and that there are roughly 6.5 million South Africans living with HIV and as such, there needs to be a plan to combat the disease. The plan undertaken by the Deputy President and SANAC encourages people to be tested to know their status and this broader plan follows the World Health Organisation (WHO) regime for treatment. It found that with children and mothers who are started on treatment immediately, the risk of mother-child transmission is much lower. The programme has also started to screen and test sex workers, as well as dispense more than one billon condoms and promote the benefits of circumcision, which can reduce the incidence of infection by more than 60%. Under SANAC, there is an understanding that HIV/AIDS is not a death sentence, and with a reduction from 6% to 1.4% of mother-to-child infection reduction, the battle against these diseases can be won. Dr Maesela stressed the seriousness of TB as a primary cause of death associated with HIV/AIDS and that, as government, drastic steps must be taken to treat infection to save people’s lives.
Mr A Mahlalela (ANC) thanked the delegation for meeting with the Committee and sharing their experiences. South Africa’s infant democracy and previously fragmented health system pose challenges for the country. Tobacco is another concern of the Committee; South Africa operates under the WHO convention with respect to tobacco. South Africa’s Tobacco Products Control Act of 1993 was amended in 2007 and again in 2009 in order to meet the protocols of the WHO convention. In terms of total control, the legislation does allow for public smoking, yet there are restrictions in terms of sponsorships and advertising, but there still has to be a balance between the right to smoke and the right to a healthy environment. The measures in place are growing as the National Treasury imposes a sin tax to discourage smoking behaviour. These regulations are important yet, self-regulation is an important factor too. South Africa looks to the WHO, which has come up with additional systems of how to better cap smoking and, thus protect non-smokers so that the harmful effects of smoking do not affect non-smokers, too.
The Chairperson thanked the Members for their questions and comments and handed over the floor to the New Zealand delegation for responses.
Ms Annette King, Delegation Leader: New Zealand House of Representatives, thanked the Members for their contribution. She said she had been privileged to meet Mr Nelson Mandela on his state visit to New Zealand during his presidency, at a time when there was a lot of discussion about HIV/AIDS, and as such, it is interesting to hear what has become of those issues. In New Zealand roughly NZD 15 billion is spent on health services, which accounts for almost 6.3% of their Gross Domestic Product (GDP). New Zealand has a universal healthcare system such that for some there is no cost relating to healthcare, and for others there little cost. This a nationwide system that is funded from taxation and is subsequently distributed among the twenty district health boards (DHB). This distribution is allocated by government using a formula with weighting to achieve equity, which is based on unmet needs, age, disability, geographical areas and other such determinants. The boards are predominantly elected; seven are elected and four are appointed by the Ministry of Health.
Ms King said the funding formula is given to primary health organisations and after this, the DHB have the responsibility to make sure the money is correctly used. On capital investment, the decisions are made by the National Health Board, who divide the capital budget to ensure that all services are provided in the public sector. Ms King addressed the healthcare workforce and said New Zealand has a planning committee for that to monitor where professionals are needed. They experience difficulty too with graduates and noted that it is hard to staff rural areas. New Zealand has had some success recruiting young people into medical school out of rural areas and to which they are likely to return, yet they do not have a magic answer. She mentioned that New Zealand attracts a lot of healthcare workers from the Pacifica islands and even the Philippines but unfortunately, a lot of them leave for Australia so the challenge is experienced in this respect in New Zealand, too.
Ms King mentioned the HIV/AIDS situation in New Zealand and said that it has not been an issue for the country. This is largely because of the distance and borders, whereas South Africa has mainland borders and an easier freedom of movement. There are roughly 2700 people in New Zealand living with HIV but this is made better by early access to antiretrovirals (ARVs) and other programmes to reduce the incidence of infection. New Zealand did an early needle exchange programme so that intravenous drug users could exchange their used needles for fresh needles to reduce the spread of infection. New Zealand also has legalised prostitution so that the industry is regulated and sex workers are tested. Access to condoms has also been helpful but the main determinant has also been education. Ms King said that there are roughly 260 new infections of HIV in New Zealand a year and only eighty come from within New Zealand’s borders and the rest are due to visitors.
Ms King thanked the Committee for the information on TB although it is not a big problem in New Zealand. They face issues with diseases like rheumatic fever but TB was addressed quite early in New Zealand with compulsory vaccinations. However, smoking is an issue in New Zealand just as it is in South Africa. The challenges relate to the reduction of consumption and the prevalence of smoking, with the goal of New Zealand being smoke-free by 2025. New Zealand was an early ratifier of the WHO convention and the latest deterrent is the plain packaging design. The idea is also to increase the tax on cigarettes each year. The current excise duty in New Zealand is 10% and they have found that the greatest deterrent has been price increases. New Zealand has also undertaken different measures has as banning smoking in workplaces, bars and nightclubs, as well as being hidden at point of sale such that customers have to request cigarettes as they are not on display.
Ms Tracey Martin, Member of Delegation: New Zealand House of Representatives, mentioned the accident fund and its functions. She said that it works through general practitioners (GPs) and a form is completed and rehabilitation after the accident is encouraged. This programme was pushed for twenty years and is funded through employees and employers and also other mechanisms like car registration fees. The issue of GPs in rural areas is difficult as there are not many and workforce planning can be challenging but they hope to raise the status associated with the healthcare profession to encourage young people to go into those industries. This is particularly important for New Zealand as they have an ageing population. Ms Martin commented on New Zealand’s Maori community and said due to the recent history of inequality, they have focused educational programmes on increasing those outcomes and maintaining good service levels. The tobacco issue has been prevalent in New Zealand but they focus on education within schools such that it is within the curricula to discourage young people from smoking.
Mr Andrew Bayly, Member of Delegation: New Zealand House of Representatives, spoke about the ACC and said that there were roughly NZD 30 billion invested into those funds, and it has been professionally and independently managed. Smoking is prevalent within the Maori communities where almost 15% of young women smoke. The cost for a packet of cigarettes equates to roughly R200 and yet they are still advocating for another 10% increase to further discourage smoking. Mr Bayly said that the healthcare system is New Zealand biggest sector and they spent roughly NZD 16 billion on it. There are large hospitals that have specialised expertise and then smaller regional hospitals as well as integrated family care centre, which will be situated in smaller rural areas. New Zealand’s prime concern is also about procuring quality drugs for the country yet it is difficult to deal with large pharmaceutical companies and New Zealand’s free trade agreements, which affect their interaction with their policies.
Ms Elliot addressed a question raised with respect to how their healthcare system in New Zealand is monitored and responded that the monitor is the parliamentary system. The Select Committee has a lot of power due to the fact that there is only one chamber of parliament so that system is used to make sure the workings are ethical and efficient.
The Chairperson thanked the delegation for the extensive information and hoped that the Committee would draw lessons from the discussion. She asked that they meet in future to share ideas about teenage pregnancy, drug use and even traditional healing.
Ms Elliot thanked the Committee and asked that any queries be directed to the Ambassador and invited the Committee to visit their parliament in the future.
The meeting was adjourned.
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