Information sharing meeting with the German Delegation

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24 February 2017
Chairperson: Dr P Maesela (ANC) (Acting)
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Meeting Summary

The Committee met with the delegates from the Budget Committee on Health from Germany. The delegates declared that their intention for coming to South Africa was to learn more about the South African health system and to explore opportunities for co-operation, with a focus on the issues of HIV/AIDS. The Committee and the delegates interacted and compared notes around the issues of HIV, its funding, how to tackle contrary socio-economic conditions, management of funds, how to bridge the gap between the rich and the poor in relation to provision of healthcare service and both highlighted the positive improvement in HIV/AIDS management in South Africa over the years.

The delegates were interested in the recently read budget by the Minister of Finance, and asked the Committee how it impacted on the health sector, what were the various focus areas and what the Committee would like them to know that had not been published in the newspapers.

The Committee explained that South Africa had three tiers of government, the national, provincial and local and the function of each. There were 6.4 Million South African living with HIV and the issues associated with HIV/AIDS were the treatment of infected people with antiretroviral (ARV) drugs which required a rich surveillance, the new infections and the ultimate solution through the use of vaccines for which they said several vaccines trials were underway. Members submitted that HIV issues required funds; it placed a major burden on the health budget and South Africa needed to do more on improving the socio economic conditions of people which according to them was responsible for teenage pregnancy and HIV/AIDS prevalence.

The Committee members also asked about HIV prevalence rate in Germany and what the nation was doing to address the challenges, to share information on their system and to compare the content of the social behavioral change campaign.

Meeting report

Opening remarks
The Acting Chairperson welcomed the delegation and introduced the Committee. He said the Committee was comprised of 11 members; six were from the ruling party, two from the main opposition party and three from other smaller parties.

Dr Lotzsch Gesine, The Chairperson of the Delegates (CoD) from Germany thanked the Committee for welcoming them, and introduced her team. She said that her team was the delegates from the Budget Committee on Health which comprised of 41 members and was divided into different racketeer groups. They were responsible for health and its funding. They were in South Africa to learn more about the South African health system and see if there were opportunities for co-operation. They were represented in South Africa by organizations such as the Gesellschaft for International Zusammenarbeit (GIZ) and the KFW bank, the State development bank. One of their focus areas was the challenge of HIV/AIDS. She asked different questions relating to the recent budget speech by the Minister of Finance, Mr P Gordhan. The CoD asked if health was well represented in the Committee’s opinion, what the various focus areas were and what the Committee would like to tell them about the budget that was not covered by newspapers.
The Acting Chairperson explained that South Africa had three tiers of government which were the national government, provinces and local. The national level had the function of developing policies, guidelines, norm and standards. South Africa had nine Provinces where the bulk of the implementation of health services was carried out.

Dr W James (DA) said there were 6.4 Million South African living with HIV. The issues associated with this were ensuring that all infected people were on antiretroviral drugs which required a rich surveillance, the new infections especially on young women getting monitored because it was difficult to get access to young women because of doctor patient confidentiality which hindered the adequate communication of discovery during clinical practices, also the ultimate solution through the use of vaccines as there were several vaccines trial underway. He said there was a promising vaccine that was part of the (14:25-14:26) vaccines partnership with National Institute of Health (NIH) in the United States. He further said, though HIV placed a major burden on the health budget and the money used for it could have been used to service other issues in the health sector, but there was a moral responsibility to take care of people. He submitted that, in his view, he did not think that Primary Health Care was sufficiently funded.

Mr S Emman (NPF) thanked the German delegation for hosting them two weeks ago and for the funding of HIV and AIDS in South Africa and the SADC region. He said the country had about 3.5 Million people on ARV’s which was a costly exercise. He said despite the fact that much was done, there was a need to do more on the socio-economic condition of people which was responsible for teenage pregnancy and the prevalence of HIV. He asked to know the HIV prevalence rate in Germany and what it was doing to address the challenge of HIV. He also asked the delegation to share information on their system since he would like to know if South Africa had a system with smaller units, like the districts, which would be better than the 3-tier government. 

The CoD said that HIV gave people a huge fright when it started in Germany but political development took good care of it and responded by putting educational measures in place, preventing the disease and starting all these endeavors at school level. They also established Hope centers which led to dramatic decline in HIV prevalence and it now played a smaller role than in the past. She also added that a federal office for health education was established.

A Member of the Delegates (MoD) in response to how to organize a social system within a State, stated that what led to great improvement in Germany was social partnership between employers and employees because it led to the funding of statutory health system. He said the Private Healthcare account was for only about 10% of the entire healthcare system in Germany and healthcare was largely public to ensure that access was given to the clinics, doctors and medications. Doctors, patient and healthcare providers had to work together. Medical insurance, service providers and the patients worked together. These three factors therefore reduced the responsibilities of the government. In Germany the statutory and private healthcare patient visited the same doctors and clinic, different invoices were issued for this but there were no differences in the services rendered.

The Acting Chairperson said that South Africa had two types of services; 20% top class medical system for the rich who were covered by medical aid with the private hospitals and the public care system that took care of the 80% of people who had less money and could not afford the private hospitals. Based on this, there was a need for funds to institute the National Health System and maintain it to achieve a balanced system. He said there was also a need for modern up-to-date facilities in the hospitals. He said when the Committee heard about the meeting, they were expecting the German Delegation to bring along a signed cheque to release funds to the South African system.

The CoD stated that the figure of HIV in Germany was now about 80,000 of which 500 died every year and another 3000 became newly infected people which were mostly homosexual men. She said in response to the cheque book that was expected, big cheque books did not solve problems but long term structures put in place achieved better results. What worked the best in the healthcare sector was solidarity where people paid much and took out a little, leading to a redistribution of funds that could be used for a sustainable system.

Dr S Thembekwayo (EFF) asked if it was possible to check and compare the content of the social behavioral change campaign. She said there was also a need for the provision of human resources including the increase in the doctor patient ratio which would influence efficiency.

A MoD said the experience in Germany showed that it was not always as important to improve the clinic but to focus on prevention at the bottom level of the society by increasing access to doctors and the doctors were available throughout the country. She asked how funds were distributed in the provinces, whether it was per capital or according to needs because the overriding aim was to increase equal access in all the areas of the country.

The Acting Chairperson said there was a need to indicate that the neighbouring countries constituted a challenge and increased the burden of funding because neighboring countries such as Zimbabwe, Mozambique, Lesotho and Botswana were not part of the custom union. He also acknowledged that regardless of challenges there were noticeable improvements such as decline in death rate, and increase in life expectancy because of the increased treatment of HIV through the provision of antiretroviral drugs as a result of comprehensive responses on the issue of HIV/AIDS. To scale-up on the performance, the Programme 90-90-90 was adopted. This implied that 90% of people living with HIV/AIDS were aware of their status, 90% of all who were diagnosed receive ARVs and 90% of those receiving treatment improved their viral load. He also mentioned the challenge of young people being infected as a result of socio economic conditions.

The CoD said compared with 2006, the attitude of South Africa changed over the last 10years, especially on the political side.  It was positive and encouraging to see that South Africa now openly fought HIV/AIDS. She said infection with HIV/AIDS in Germany concerned mainly the homosexuals in society and there was a huge support for them. Artists were employed to raise awareness and a significant amount of money was invested into this.

The Acting Chairperson said they would have loved to further engage the delegates on the touching but interesting subject, and hoped that the Parliament had learnt something valuable from the delegates. He thanked the delegates.

The meeting was adjourned.



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