The Portfolio Committee on Health and the Select Committee on Health and Social Services were jointly addressed by two of the Elders -- a group of former leaders that had been started by former President Nelson Mandela. Ms Gro Harlem Brundtland, former Prime Minister of Norway, and Mr Ricardo Lagos, former President of Chile, were in the country to promote and advise on universal health coverage. The engagement was not only to promote universal health coverage, but was also timed to assist Parliamentarians in debating and understanding the National Health Insurance Bill.
The Minister of Health informed Members that Ms Harlem Brundtland had also been Director-General of Health at the World Health Organisation (WHO), and had spearheaded many programmes promoting universal health coverage. Mr Lagos had been involved in moving Chile from a dictatorship to a democracy, and one of his major challenges had been instituting universal health coverage in his country. The previous day, the Elders had visited Charlotte Maxeke Hospital and Baragwanath Hospital in Gauteng.
Ms Harlem Brundtland told Members that the right to health was not a fundamental right in every country. It was something missing in the world. The people of SA, like all other people, deserved the right to health and that meant a health system and a finance system that covered everybody, and which offered high quality health services across the entire health system, from primary health care to a hospital system, and everything in between. For the health system to cover everyone, the principles necessary were that it had to be a publicly dominated, publicly decided and publicly funded system. The poor would be left behind if it were partially privatised, and the better-off would get the services they needed. It had to be based on employment taxation to be sustainable. The two principles were that there had to be an available health service and that one was not forced into poverty because one was sick. The basis of any universal healthcare system had to be a strong and efficient primary healthcare service.
Mr Lagos said that there were two kinds of public policies with regard to health. Firstly, there was a public policy where hospitals were provided and one went to a hospital and got what one wanted. The other way was to think from the point of view of someone who needed to go to hospital for appendicitis, surgery for bone cancer, etc. It was one thing to supply services, but another to meet the demands of the population. In Chile, it had been decided that if the government did not provide care for a disease, then a citizen could claim for it. As President of Chile, he had decided to guarantee particular services in hospitals. He had promised that after five years, 56 diseases would be attended to in hospitals without waiting lists and offering quality care. After five years, 70% of the total hospitals in Chile were involved in curing those 56 diseases. Chile made a law for public healthcare with three explicit guarantees for the people:
- Patients would be attended to in hospitals that had the capability and resources to attend to the disease;
- Patients would be attended to within no more than three months from the time of diagnosis; and
- If the patient was unable to make payment -- of it was beyond 10% of the patient’s income -- then the public sector would pay the difference.
Members had many questions for the Elders, most of which were asked in the hope that the Elders would have answers for South Africa’s situation. The country was facing massive accruals and monumental medico-malpractice claims, the Department of Health was seriously underfunded and health was on the back burner. How did the country address that? The budget was for a population of 56 to 57 million, but close on 20 million documented or undocumented foreign nationals were in the country. How could they be cared for in the health system?
Members asked how much money countries with universal healthcare contributed towards universities to educate doctors and how one prevented them from leaving the country. How had Chile overcome personnel constraints? Where was Chile currently in terms of service delivery of universal health care? What were the current costs as a percentage of gross domestic product (GDP) in Chile? What impact had the implementation of universal healthcare had on the economies of their countries? How could South Africa overcome the difficulties in introducing universal healthcare when the problem was mostly to do with corruption? How did one deal with that? How could South Africa be spending 9% of its GDP on health, but be unable to roll out universal quality healthcare for 25 years? How could South Africa retain and build capacity in the medical field?
Members explained that the problem was one of systematic corruption, so one of the concerns was how the requisite checks and balances would be included in the Bill to ensure that public money was spent on the public, and did not line the pockets of the politicians and the politically connected few. Did the Elders have any suggestions on how that could be accomplished?
Co-Chairperson Gillion welcomed all participants to what she described as an historic joint meeting of the Portfolio Committee on Health and the Select Committee on Health and Social Services. She welcomed the Minister of Health, Dr Zweli Mkhize and the Department of Health (DoH) representatives, her co-Chairperson from the Portfolio Committee on Health, and addressed a special word of welcome to the Elders -- Ms Gro Harlem Brundtland, former Prime Minister of Norway, and Mr Ricardo Lagos, former President of Chile, and their compatriots. She was very pleased to welcome them as South Africa entered a new phase in the health system of the country.
Co-Chairperson Dhlomo also extended his welcome, and said he was humbled by the gesture of the Elders in taking time out from their busy schedule all over the world to come to South Africa when the country was focused on the subject of health, which they knew so well. He assured them that their wisdom and experience was key to the task that Members had to drive. They were leaders and the Committee would listen and learn as much as they could from their experiences. As they had been friends of the first democratically elected President, President Nelson Mandela, listening to them would be like listening to President Mandela himself.
Minister of Health’s introduction
Dr Mkhize said it was an honour and a privilege to welcome the Elders. He had had the opportunity to host them the previous day and it had been an exciting programme during which he had learnt from their own insight of the work that they had done in their respective countries and all over the world. He was very pleased that they had been able to join Parliament that morning.
The previous day, the Elders had gone to the Charlotte Maxeke Hospital where they had addressed a gathering of leaders from civil society, professionals, academics, researchers and members of the civil service. They had had a very interesting meeting. Thereafter, they were given a tour of Baragwanath Hospital by Dr Bandile Masuku, the Gauteng Member of the Executive Council (MEC) for Health.
Leading the delegation were two eminent leaders amongst the Elders, a committee formed during the days of Nelson Mandela. The team of Elders looked into issues of justice, peace, quality and universal health coverage.
The first of the two Elders with them was Her Excellency Gro Harlem Brundtland of Norway, who had also been Director-General of Health at the World Health Organisation (WHO) and had spearheaded a lot of programmes in the promotion of universal health coverage as part of the WHO.
The second of the Elders was His Excellency Ricardo Lagos, former President of Chile, who was involved in moving that country from a dictatorship to a democracy. One of his major challenges had been instituting universal health coverage in Chile, and the Minister had learnt quite a lot from Mr Lagos’s experiences.
The Minister welcomed the team that was supporting the two Elders, including Rob Yates, head of the Centre on Global Health Security, Chatham House, and Prof Olive Shisana, who was in the “war room” in the Presidency focusing on health, social cohesion and fighting against violence. She had worked in the area of universal health care for many, many years, including as Director-General of the Department of Health. She was representing the President.
He invited the Elders to speak from the podium. In his culture, one did not give Elders a specific time to talk -- they could speak as long as they wished to share their wisdom.
Address by Elder Gro Harlem Brundtland
Ms Harlem Brundtland said that In 2007, Nelson Mandela had selected people that he knew from his life in national and international politics to be part of the Elders; she had been selected and had been an Elder for 12 years. The name for the group, the Elders, came from the African tradition of the village. When one had difficulty in the village, one turned to one’s elders, and so the world needed global elders that they could turn to. The mandate given to them by Nelson Mandela was to try and overcome conflict, to promote peace and human rights, and equality and justice.
She and Mr Lagos had both worked for the Secretary-General of the United Nations from 2007 onwards until the big Copenhagen Conference on Climate. Prior to that, she had led the Commission on Climate that had created the notion of sustainable development, advocating to the world that people had to stop undermining nature and make it possible for people to survive and to have decent lives. By 2015, the world was finally ready to agree to the sustainable development goals, and had done so in New York in September that year and then, in Paris, the world had reached a climate agreement.
The Elders had been promoting the ideals given to them by Nelson Mandela since 2007, during which time they had promoted climate change and sustainable development. When the world had finally decided in 2015 to accept the imperatives of sustainable development and climate change, they had looked to see where they could make a difference, and that was when they had added universal health coverage to their portfolio. The principle of universal education was carried through the world more strongly than the fundamental right to health. The right to health was not a fundamental right in every country. It was something missing in the world.
As Elders, they had visited India and Indonesia working on universal health, because those countries had not come far enough. They had looked at SA as the “country the Elders came from,” and the country that her country and Mr Lagos’s country had supported in the struggle for freedom. After 30 years, SA still did not have universal health coverage. Why not? That was one reason that they had decided to come to SA. Now the government was taking initiatives on universal health coverage and just a month ago, a Bill had been introduced in Parliament to implement universal health coverage. The Committees were responsible for trying to get it into legislation and into policy. That was why they had felt that they wanted to share their feeling that it was essential. The people of SA, like all other people, deserved the right to health and that meant a health system and a finance system that covered everybody. The reform had to cover everybody, and there had to be a high quality of health services across the entire health system. The system, from primary health care to a hospital system and everything in between, had to cover everybody.
For the health system to cover everyone, the principles necessary were that it had to be a publicly dominated, publicly decided and publicly-funded system, or the poor would be left behind. If it were partially privatised, the better-off would get the services they needed and the poor would be left behind. It had to be based on employment taxation -- that is, a surcharge on taxation which was directly added to the financing of health. The two principles were that there had to be an available health service, and that people were not forced into poverty because people were sick. It sounded great, but was not always easy to do. The right to health should be self-evident in every society. It had been done in many countries and so could it be done in SA if it were given priority and people understood that it had to be done.
Chile was a country that had done it, but there were even more recent examples of countries introducing universal healthcare with same level of economic development as South Africa, such as Thailand, which the Elders had visited. Thailand was using 3.7% of its gross domestic product (GDP), and was covering the whole population. SA was spending 8.1 % of its GDP, and there was not universal coverage. There were enormous inefficiencies in the system. There were a number of health insurance companies with high administrative costs, so it was not an efficient system. She understood the Bill covered the main aspects necessary to implement universal health care.
Ms Harlem Brundtland said that in Norway, her own country, healthcare had been introduced step by step in the last century, and had been supported by the labour unions. The health care system had started with those employed in the more dangerous professions, and then Parliament had decided to cover those with higher levels of health care needs, and in 1948, after the second World War, everyone was included in the health care system. Norway had avoided private health systems from the beginning. SA was in a different situation, much like the USA, which spent nearly 20% of its GDP on inefficient and over-used health care services, and there was no universal health care in the USA. SA had the opportunity to do the right thing and introduce universal health coverage.
Address by Elder Ricardo Lagos
Mr Lagos said he was honoured to speak to the Parliamentary Committee, but it was difficult to talk after Gro as he did not have her credentials, but he had fought against Pinochet’s dictatorship. He always told his Spanish friends that they had fought for democracy after Franco’s death, while Chile had undertaken the fight for democracy with Pinochet alive -- and for eight years as the commander-in-chief of the army. That was why it had been such a difficult transition to democracy in Chile.
Mr Lagos had become President in the year 2000, ten years after the plebiscite (national referendum) and the defeat of Pinochet. For him, the question of health was an important task because the economic system introduced by Pinochet had been very difficult to dismantle. There were two major areas of health care that had to be set up: hospital care and primary health. In 2000, primary health care in Chile enjoyed only 12% of the health budget. He thought that if they increased primary health care to 30% of the budget and improved primary health care, the need for hospital care would decrease. Secondly, he had had to take rural areas into account and thirdly, he had had to solve the problems at primary level. There had to be a resolution of people’s problems at that level. If a patient needed an x-ray or blood analysis, could it be done at the primary health care centre or did a patient have to walk 10km or 100 km to a hospital? To ensure resolution of patient issues at the primary care level, one had to ask how many physicians, specialists, x-ray machines, etc. were needed at the primary care level.
Where health care was lacking in areas of poverty, it was because the right to health was written in the Constitution but did not exist in reality. The first question was how much could be spent on primary health care and, to some extent, one never succeeded really. However, one could move different tiers of what was possible. Secondly, with regard to hospital services, every country had hospitals, nurses and physicians. The previous day, they had gone to Baragwanath Hospital, which used to be British army hospital, but was now in the middle of Soweto and everyone could get services there.
There used to be two kinds of public policies with regard to health. Firstly, there was a public policy where hospitals were provided and one went to a hospital and got what one wanted. The other way was to ask whether one could think from the point of view of someone who needed to go to hospital -- for appendicitis, surgery for bone cancer, etc. It was one thing to supply services but another to meet the demands of the population. If people did not get primary health care, the people ended up in a hospital emergency ward.
Chile had had a long, long waiting list. There had been good hospitals, and once one had entered the hospital, the person would get good care and there were no complaints, but the problem was getting into the hospital. The government of Chile had decided to be very honest. How many of the hospital services needed by the population could be offered to everyone? And how many diseases could be treated, because they could provide what was needed, and for how many diseases was the problem so great that they were a long way from being able to accept everyone who required those services? So a primary health service was the number one priority, but with regard to hospital services, the government tried to be very honest -- it would have to attend to everybody but if it could not, it was going to attend to everyone according to the diseases. How many of the pathologies could they fully attend to, and how many could they not?
Such a reform had not been easy to implement, because Chile had had a system similar to the one in SA -- 75% of the population was taken care of by the public healthcare service, and 25% went to private health care. He understood that in SA, the percentages were 84% public healthcare and 16% private healthcare. If Chile had been able to amalgamate the funds, they could have solved the problem. For example, if they said dialysis was for all, how much would the public system be able to pay and how much would they need from the private health care system? That was what the law that he had sent to Parliament had wanted, but the Opposition in Parliament had said that the government could not put the two funds together because they could not appropriate private money. This meant there was a deficit in his healthcare system, so he was clear that if Parliament did not put the two funds together, the only way to do it would be to increase taxes to increase the income of the public service. That was what he had had to do.
Secondly, when he was in the middle of discussions, it had been difficult to explain how the system would work, so a pilot system was introduced with certain diseases that would be covered 100%, and the waiting list for those diseases disappeared. There was no longer a waiting list. If the government did not provide care for a disease, then a citizen could claim for it. He had decided to guarantee particular services in hospitals. He had decided to provide treatment for 56 diseases and after five years, 70% of the total load of hospitals in Chile was involved in curing those diseases. How had Chile introduced the reform? In the first year, the government had guaranteed treatment for three diseases, and for five diseases in the second year. In the third year, ten diseases had been guaranteed. In his last year in government in 2006, the government had been able to attend to 40 diseases.
The people saw that it was possible to go step-by-step, and that was how his party had won the approval of Congress – through the pilot. How could one explain it? The people were given three guarantees. Firstly, it was guaranteed that they would be attended to in a hospital that had the capability and resources to attend to the disease; secondly, patients would be attended to in no more than three months from the time of diagnosis; and thirdly, if the patient was unable to make payment, -- if it was beyond 10% of the patient’s income -- then the public sector would pay the difference. Chile had made a law for public healthcare with three explicit guarantees: AUGE (Acceso Universal con Garantías Explícitas), or Explicit Guarantee System.
Finally, he had won. How did one find out how many appendices would have to be removed, and what did it cost? One had to work with protocols. One had to find out what it would cost to do the operation. When introducing the system, one had to be able to pay the cost of the disease to be treated. It was a public policy, because the demand would come from society. How many services could a government afford to introduce? That was what SA had to decide.
Mr Lagos admitted that he was not a physician, but merely a lawyer and economist but he understood the job of a physician and when a physician said he needed particular equipment, the protocols were there to specify exactly what was needed. There had been a lot of discussions on the protocols. The physicians in Chile had gone on strike because they did not want protocols. They had gone on strike in public hospitals in the mornings, and Mr Lagos had made them go on strike in the afternoons when they worked in the private sector.
What Mr Lagos was saying was that changes were difficult, but one had to believe in the right to health. Chile had a per capita income similar to SA, so he thought that South Africans should be discussing the issue. He warned that the system could not be changed overnight -- it had to be step by step or it was going to be too difficult. He was able to tell people about it because it was a good story, but the most difficult issue was that there were some pathologies that Chile still could not support and there was a long waiting list, but the government knew what it offered and how many people had been attended to, which was 25 million people in ten years. It was essential to go step by step. It was a lesson that he was proud to be part of.
Mr Lagos was also proud to be one of the Elders and he was happy to be in South Africa, because the Elders had started in the country.
The Co-Chairperson PC thanked the Elders for telling them that they were on a journey and not running a 100m sprint. He invited the Members to make a brief comment or ask a question.
Ms E Wilson (DA) thanked the Elders. There was no doubt that everyone in the room believed that the country needed to have a universal health care system, but sometimes one had to compare apples with apples and not apples with oranges. Norway spent more of its GDP on healthcare than any other country in the world. It had only a 4% unemployment rate and was considered one of the wealthiest countries in the world. Chile had 6.4 % unemployment and only 14% of its population living in poverty. SA was the direct inverse with far more people living in poverty and a huge unemployment rate. It made the task more difficult, because SA had to rely on the minority to carry the tax burden. She accepted that the intention was that one should not be forced into poverty when sick. SA had a situation where its Department of Health had been sick for a long time and had forced itself into poverty. It was facing massive accruals and monumental medico-malpractice claims. The Department was seriously underfunded and health was on the back burner. How did the country address that? The budget was for a population of 56 to 57 million but close on 20 million documented or undocumented foreign nationals were in the country and they had to be cared for in the health system. The plan was to give those people some services. Had the Elders faced that situation and how had they dealt with it?
Mr M Nchabeleng (ANC) (Limpopo) asked how much money countries with universal healthcare contributed towards universities to educate doctors. In SA, the government subsidised the education of doctors, but some of them qualified and left the country to work in other countries. In Canada, he had found that many doctors came from SA and Zimbabwe. One even came from Limpopo, so the money spent on training doctors ended up in affluent countries.
Mr M Sokatsha (ANC) said he had listened to the situation and it was clear that SA needed to reform the health system as soon as possible and the answer was the National Health Insurance (NHI) scheme. He had heard the Elders say that SA needed to get its base, the primary health system, correct. The Elders had given Members hope.
Mr K Jacobs (ANC) thanked the Elders for the explanation. In SA, everyone agreed that it needed a publicly decided health system with an emphasis on primary health care, which was in the Bill that was before the Committees. Services would also be delivered at the hospital level. He noted the incremental increase of 12% to 30% in the primary health care system in Chile. He appreciated Mr Lagos’ explanation of how Chile had done it, because it gave SA a better understanding of the process that the country would want to follow. Where was Chile currently in terms of service delivery of universal health care and what were the current costs as a percentage of GDP?
Ms N Ndongeni (ANC) (Eastern Cape) was comforted to know that everyone else who had gone through the journey had met challenges along the way. She thanked the Elders because, although the situations were not the same, they had taken the journey step by step and SA was taking it in phases. She was reassured that primary healthcare was the cornerstone of universal health coverage. Her colleagues were feeling more positive. There were challenges but they could be overcome.
Mr P van Staden (FF+) commented that the Elders were speaking about financing the system through taxpayers. The situation in SA was a little different, with 29% unemployment while the tax base was getting smaller and smaller. What advice could the Elders give to deal with the situation? He had read that Ireland had abolished the system after 11 years as it was too expensive and a couple of weeks earlier Britain had also reported problems with the cost of the system. What impact had the implementation of universal healthcare had on the economies of their countries?
Ms N Chirwa (EFF) explained how SA was peculiar: it was much to do with the problem that the country had with corruption. Most objectives would have trickled down to the ground, except that public servants stole and there was no accountability mechanism. For example, there was a clinic in Rustenburg that had undergone renovations from 2014 to April/May 2019. Two months later the maternity ward was non-functional and yet there had been resources for that ward. The challenge was corruption and women and children -- especially black women and children -- suffered. She wanted to suggest that the government budget for corruption so that there was money left for service delivery. Corruption happened -- it was sustained and there were no repercussions. No one in the room could deny it and it would not be solved because there was no accountability mechanism. There were no consequences for corruption in SA. If one stole in one department, one was simply moved to another department. Those who were corrupt were protected by party lines and affiliations.
Ms S Luthuli (EFF) (KwaZulu-Natal) said that when one went to clinics in rural areas, there were long queues and they were understaffed and under-budgeted. The issue of healthcare was everyone’s problem and was not linked to colour.
Ms S Gwarube (DA) had noted two key things -- not to be afraid to overhaul the health system, and that there were deep inefficiencies in the system. As colleagues had stated, everyone was in agreement with universal healthcare but one had to be realistic about the situation in the country, but also about the fact that 9% of the GDP was spent on health care. How could the country be spending that amount of money but had been unable to roll out universal quality healthcare for 25 years? An honest conversation had to be had. The Elders had to ask in their conversations with government how the GDP expenditure was so high and how over R220 billion was spent on healthcare in an inefficient manner. She added that the difficulty with the detail of the legislation was the problem of systematic corruption, so one of the concerns was how the requisite checks and balances were inserted in the Bill to ensure that public money was spent on the public and did not line the pockets of the politicians and the politically-connected few. Ultimately, it had to be understood that the opposition to certain aspects of the Bill was not opposition to a commitment to healthcare for the people of the country, but saying that how the money was spent would be important.
Ms M Sukers (ACDP) said the engagement with the Elders had helped facilitate a discussion void of the usual political noise. Given all the challenges that SA had, what would Mr Lagos say, apart from “Do it!”? What should SA do first, given the high unemployment, the corruption and the inequalities? She wanted to hear from someone who had done it before, but also with a moral imperative. Doctors and nurses had left. How had Chile overcome personnel constraints? How could SA retain and build capacity in the medical field?
Ms M Hlengwa (IFP) thanked the elders for giving the Members hope in the new era and giving them the strength to make the journey. SA was experiencing a shortage of doctors, nurses, specialists and a shortage of medicine. The country needed the NHI to uplift the poor and to give them the right to health.
Dr S Thembekwayo (EFF) noted that Ms Harlem Brundtland had said that one turned to the elders when there was a problem in the village and the mandate was to overcome conflict and to ensure development. In connection with NHI, she had said that the system should be publicly decided upon, which meant that the public should inform Parliament what needed to be done. A system should not be forced into the minds and mouths of SA people. She asked that as her discussions continued with government, Ms Harlem Brundtland should ask about such aspects.
She added that Mr Lagos had been described as a tenacious fighter for health reforms and reducing inequality while also championing diversification. A mention had been made of more taxes versus more income. How could the workers be taxed more without increasing the income to be able to pay the taxes? The rural areas had a problem due to the lack of human resources and capacity. She was talking with regard to the current healthcare problems in SA. Could the Elders make a suggestion?
Response by the Elders
Ms Harlem Brundtland
Ms Harlem Brundtland said that it was interesting to see that two main issues had emerged from the comments. The first one was linked to corruption. She was lucky in that there was very little corruption anywhere in her country, but she knew that corruption was a problem in many countries around the world so SA was not alone, although SA had bigger problem than other countries. It was a problem, not just about the NHI but about the way the country worked. It was not going to be a problem for the Health Minister, or the Committees, alone. SA had to find a way to fight corruption across the board. It was not a reason not to have the NHI. It was a reason for the President, their parties, those at provincial and municipal and all other levels to take it seriously. SA had to take control of corruption by accountability mechanisms, by the legal system and by the way that things were made transparent. It was as important for the whole education system, transportation system and all other systems everywhere in the country. It was part of a much broader, general problem that the country had to take seriously.
The other thing that had come up was how a poor country with high unemployment and low wages was going to carry the additional burden of quality reform. Many countries that had introduced universal healthcare were very poor and in a bad condition after war when they had started implementing the principles of universal healthcare. It was not an argument not to implement across the board. Investing in health created economic growth. SA would boost its economy by investing in people. It was a fact, as proved by evidence from economic analysis. Larry Summers, Secretary of the Treasury in the USA, had said that investing in universal health care would boost the economy ten times.
She added that she and Mr Lagos would speak with the President and tell him that so many of the Members had asked how to finance the NHI and to increase wages when they were too low for acceptable living conditions. SA had a number of issues to deal with, but NHI was part of what the country needed to do. SA had to clean up its society and ensure less corruption and the NHI would help to boost the economy.
Mr Lagos appreciated that there had been a contribution to the discussion by all Members.
Chile had dealt with poverty rights through health care in that every child up the age of one had to be registered with the primary healthcare system. Every adult above 60 or 65 had to be registered until he or she passed away. Otherwise, the country could have wonderful institutions and establish a decree to that effect but no one knew about the decree. The poorer one was, the less one knew about what rights one had. He had been Minister of Education and had had a problem with children leaving school early because males went fishing with their fathers and girls went with their mothers to pick fruit. He had introduced a scholarship for those who were wanting to drop out, but when he became president, he had discovered that very few people knew about the scholarship.
He agreed about the problem with the money. It was true. When Chile had its programme, there had been a huge deficit because they had been unable to get approval to combine the two funds. Then the government had tried, unsuccessfully, to increase tax on alcohol and tobacco, so it had increased taxes, which had been a very regressive approach, but 80% of the tax would be returned through the health system. Two percent of VAT had gone to healthcare, but it had increased VAT in Chile to 19%.
Mr Lagos asked if SA had done an inventory of resources. The country had to take into account human resources and doctors and the training of physicians and what upper income groups would need and what lower income groups would need, especially in terms of specialists. How was the country going to spend more in areas less opulent and less in the opulent sectors? One had to discriminate, in Education and in Health, by giving more to those who had less. Even though resources in Chile were nothing like those available in the US, life expectancy was greater in Chile than in the US.
Mr Lagos made a final point about socio-security. Life expectancy in Chile was much higher for the 50% of the population with a higher income than the 50% in the lower income group. If the haves and have-nots had different life expectancies then, after retiring, the bottom group would have a shorter life expectancy than those in the higher income group, which meant that if there was no distinction between the two groups, the poor would be subsidising the rich. It had been very difficult to introduce that discussion in his country, and that was what the world needed to talk about.
He was not going to go into the question of corruption because Gro Harlem Brundtland had done an excellent job in answering that question.
Mr Lagos said that he had been unable to talk about certain issues and that was a problem one had when one had been a President. As President, one always required the Minister to answer the difficult questions, but now he had no Ministers.
Co-Chairperson Gillion thanked the Elders for their prompt and honest answers. She asked the Minister to make the closing remarks.
Minister’s concluding remarks
Minister Mkhize told Members that he had spent the whole of the previous day with the Elders but he had learnt so many new things in the meeting. It was as if he was hearing them for the first time, and that was despite the fact that they had discussed very similar things the previous day.
The Minister noted that the Elders had responded to all the questions. Some questions had been addressed to the Elders, but Members had also been addressing each other. It was a South African discussion. It was fair as the Members represented different communities and some issues had been raised because the communities expected them to do so, but really some of the issues were such that they should be facing them amongst themselves and not in that engagement.
As Minister, he accounted to both Committees and would be engaging them on some of the issues that they had raised. The shortage of staff, medicines, resources and infrastructure were issues that were real and had been prioritised. The work ethic in the civil service had to be addressed.
On the issue of corruption, he agreed with the Elders that the Members had to be very vocal about dealing with corruption and work together with government to ensure that they could, ultimately, deal with corruption as government. There was no other way. An anti-corruption forum at the Presidential level would work to oversee that there was no corruption, not only in the national health services, but also in the NHI Fund. In the anti-corruption unit, which would include civil society, the Hawks and others who had been vocal in anti-corruption would be on the alert for corruption. They would use technology to watch the movement of transactions and money in the same way that banks watched money moving and contacted the owner of the account if something seemed to be amiss. There were commissions going on. However, nothing beat corruption like consequence management. Members had raised the issue because it was a real concern.
Another issue was the strengthening of primary healthcare. There was no way out of that, and education, water and sanitation were part of primary health care. Prevention and early screening of diseases were the anchor of health services.
SA had similar experiences to Chile in that there was high demand from those who could afford healthcare and people demanded the best. For example, some people just wanted a professor, regardless of their need.
The Minister agreed that rural areas and informal settlements were a challenge but he was grateful for the explanation of the relationship between the economy and universal health care and how many countries had been poorer. In response to how SA could spend 8% of the GDP on health and could not improve the system, the answer was simple -- there were too many distortions in the system. Too few people were spending too much on health. As Mr Lagos had said, one had to discriminate to solve social inequalities.
If successful, those who were younger would subsidise the older and would get their reward when they were older. He quoted some of the studies by the WHO about the impact of morbidity and mortality on GDP, as well as the conditions of health on GDP. He hoped that the Members were, as indicated, in support of the Bill so they could just move on
He thanked the Elders for their leadership, guidance and input.
Co-Chairperson Dhlomo said that he could offer comfort to the Elders by saying that the Portfolio Committee had deliberated on the NHI Bill and that on the previous Friday, an advertisement for SA citizens to look at the Bill, had been published. Thereafter, the Committee would be doing public hearings across the country.
He was grateful to the Minister and the Elders for joining the Committee to discuss matters of concern to Members.
The meeting was adjourned
No related documents
Dhlomo, Dr SM
Gillion, Ms M
Bara, Mr M R
Chirwa, Ms NN
Christians, Ms DC
Dyantyi, Dr PP
Gela, Ms A
Gwarube, Ms S
Hlengwa, Ms MD
Ismail, Ms H
Jacobs, Dr KL
Luthuli, Ms SA
Mkhize, Dr Z
Munyai, Mr TB
Nchabeleng, Mr ME
Ndongeni, Ms N
Sokatsha, Mr MS
Sukers, Ms ME
Thembekwayo, Dr S
Tseke, Ms GK
Van Staden, Mr PA
Wilson, Ms ER
Download as PDF
You can download this page as a PDF using your browser's print functionality. Click on the "Print" button below and select the "PDF" option under destinations/printers.
See detailed instructions for your browser here.