Hansard: Appropriation Bill: Vote No 15 - Health

House: National Assembly

Date of Meeting: 12 Apr 2010

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Minutes

START OF DAY

TUESDAY, 13 APRIL 2010

PROCEEDINGS OF THE EXTENDED PUBLIC COMMITTEE – OLD ASSEMBLY

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Members of the Extended Public Committee met in Old Assembly Chamber at 14:06.

House Chairperson Ms M N Oliphant, as Chairperson, took the Chair and requested members to observe a moment of silence for prayers or meditation.

The HOUSE CHAIRPERSON (Ms M N Oliphant)


Start of Day

The HOUSE CHAIRPERSON (Ms M N Oliphant): Hon members, I will now call the hon Minister to open the debate. However, I must at the outset indicate to members that another debate has to resume immediately after this debate. Therefore, I will be very strict regarding the time that has been allocated to members. If, for example, a member is told that his or her time has expired, the member must respect that.

The MINISTER OF HEALTH: Chairperson, hon members of the House, distinguished guests, ladies and gentlemen, I am honoured to present to this esteemed House the national Department of Health's policy priorities and budget for 2010-11 for your consideration. I wish to start by paying tribute to a gallant son of the soil who was also a member of this House and would have been sitting next to me here today, hon Dr. Molefi Sefularo, who passed away on 05 April 2010.

For over 30 years, I have personally known the hon Sefularo as a comrade in the struggle for the emancipation of the people of South Africa, as well as a colleague, friend and a fellow student, and, subsequently, a fellow medical practitioner. He was a highly talented, gifted and astute person who was always humble and easy to work with.

Testimony to these characteristics were the many people who paid similar tributes to his life and work during the official memorial ceremony held in Pretoria on 8 April, and again during the funeral service held at the University of Limpopo's medical campus on Saturday, 10 April, and at many other memorial services, including the one that just took place in this very House 10 minutes ago. It was indeed appropriate that Dr Sefularo's funeral service was held on the campus that he transformed as a student leader and at which he studied and graduated as a medical doctor.

The late Dr Sefularo was a stalwart in the mammoth task of liberating this country from the bondage of oppression and inequality, as well as in the transformation of the health sector to an accessible and equitable system providing quality services to all South Africans. We all know that he was passionate about communities and their welfare. He was particularly interested in ensuring that we strengthen primary health care in our country.

Among many other projects, the late Deputy Minister of Health worked tirelessly to ensure the health sector's readiness for the Fifa World Cup in 2010. Our health services are ready to provide comprehensive health services to hundreds of thousands of football fans from the 31 nations that will visit our shores in 2010, as well as people from our own country. Dr Sefularo dedicated his time and energy to visiting all the ealth facilities in the cities where World Cup games will be held to ensure that we are indeed ready.

He has fought a good fight, he has finished the race, and he has kept his faith. What is left is for us to honour him by dedicating ourselves to completing the work. I, therefore, wish to dedicate this budget speech to the memory of Dr Sefularo. I request members of the House to join me in conveying our deepest condolences to Mrs Kgomotso Sefularo, their children and the extended family.

Chairperson, this is a historic year in many respects. Apart from the Fifa World Cup - which this year will be held for the first time on African soil– in which the Department of Health played a very prominent role, it is also the 20th anniversary of the release from prison of our icon, former President Nelson Mandela. Nelson Mandela dedicated 66 years of his life to the struggle for emancipation. He sacrificed his own freedom for almost three decades to ensure that all South Africans can enjoy liberty. No tribute to Madiba can ever be adequate or commensurate with his contribution to the attainment of our freedom. The least that we can do is to strive to perpetuate his legacy in our lifetime.

This year marks the second year of implementation of our 10-point programme for transforming the health sector into a well-functioning health system capable of producing improved health outcomes. I just want to take this opportunity to remind you that we have a 10-point programme, and there's no way we can deliver a budget speech without referring to it.

Our 10-point programme has the following priorities: the provision of strategic leadership and the creation of a social compact for better health outcomes; the implementation of the National Health Insurance; improving the quality of health care; the overhauling of the health-care system and improvement of its management; the improvement of human resource management, the revitalisation of infrastructure; the accelerated implementation of the HIV and Aids and sexually transmitted diseases national strategic plan 2007-2011; the reduction of mortality due to TB and associated diseases; the mobilisation of our communities for better health for the population; a review of the drug policy and the logistics of drug supply; and the strengthening of research and development.

Since our last budget speech, which I delivered in this very House on 30 June 2009, a solid foundation has been laid for the attainment of the goals we have set ourselves in the 10-point programme. Our 10-point programme has been endorsed by a wide range of stakeholders in the health sector, including trade unions, medical associations, nursing organisations, most of the private health sector, and, indeed, NGOs and civil society. The 10-point programme also received support at the public service summit held between 10 and 12 March 2010. We wish to thank all our partners for endorsing this programme. This means that they will all support us in its implementation. We hope that the hon House will do the same.

Having successfully popularised the 10-point programme, we wish to draw the attention of the House to the outcome-based approach for improving health service delivery, which was announced by the President of the Republic in his state of the nation address earlier this year. President Jacob Zuma also emphasised the need to fundamentally transform the health system. He also listed health as one of the five key priorities of government.

I wish to remind this House of the health situation in the country that requires our collective and sustained attention. One, life expectancy in South Africa has declined. For the period between 1985 to 1994, Statistics SA estimated life expectancy at birth to be about 54,12 years for males and 64,38 for females. In 2009, Statistics SA estimated life expectancy at 53,5 years for males and 57,2 years for females.

Two, maternal mortality and child mortality in our country are unacceptably high. Three, South Africa carries a significant burden of diseases from HIV/Aids and TB, which are regarded to be the highest in the whole world. Four, South Africa has a predominantly curative health system that places less emphasis on prevention of diseases and health promotion. Over the last 10 years, there was an inadvertent shift of emphasis from primary health care, which was adopted by the first democratic government as the foundation of our health care delivery system, towards a predominantly curative health system.

Five, the ineffectiveness of the health system and provision of poor quality of health services has led to many people wrongly but increasingly believing that private health care is the only way possible towards meeting the health-care needs of the whole country. A prominent health expert, who has contributed significantly to strengthening the national health service in the United Kingdom, recently remarked to me that South Africa's health care system has a larger private health care sector even than that found in the United Kingdom. He also remarked on how little preventive and promotive care we are providing in our health care system, as compared to curative health care

Clearly, decisive, systematic and quantifiable interventions must be implemented to address these adverse trends. In response to this, in January 2010 the Cabinet agreed on a set of concrete outcomes that must emerge from our interventions to transform the health-care sector over the next four years. These outcomes can be classified into four broad main categories, namely: one, increasing the life expectancy of South Africans; two, combating HIV and AIDS; three, decreasing the burden of diseases from tuberculosis; and, four, improving the health system's effectiveness by strengthening primary health care and reducing the cost of health care in our country.

Based on these four broad categories, during the period 2010-2014 the health sector needs to produce the following 20 outcomes: increased life expectancy at birth; reduced child mortality; decreased maternal mortality; managing HIV prevalence and improving the quality of life of people living with HIV and AIDS; reduction of new HIV infections; expanding access to the prevention of mother-to-child transmission programme; improved TB case finding; improved TB treatment outcomes; improved access to antiretroviral treatment for HIV and TB coinfected patients; decreased prevalence of drug-resistant TB; revitalisation of primary health care; improved physical infrastructure for health-care delivery; improved patient care and satisfaction; accreditation of health facilities for quality; enhanced operational management of health facilities; improved access to human resources for health; improved health-care financing; strengthened health information systems, including strengthening information, communication and technology; improved child services for the youth; and, lastly, expanded access to home-based care and community health workers.

These 20 deliverables provide additional specificity to the 10-point programme of the health sector for the period between 2010 and 2014. The prioritisation of these outcomes does not imply that we will not do everything else that needs to be done. These priorities, however, do reflect things we must do with added urgency. The key policy priorities for the health sector for the period 2010-11 to 2012-13 will strengthen our ability to meet the health-related millennium development goals.

Our maternal mortality ratio must decrease from the estimated 400 to 625 per 100 000 live births to 100 or less per 100 000 live births over the next four years. We will implement a number of interventions to achieve this. These include: one, increasing access to health-care facilities, including the possible provision of waiting-mothers homes; increasing the percentage of pregnant women who book for antenatal care before 20 weeks' gestation; increasing the percentage of maternal care facilities which review maternal and prenatal deaths and address identified deficiencies; and, lastly, enhancing the clinical skills of health workers and improving the use of clinical guidelines and protocols, which, unfortunately, are no longer used much in our health facilities.

We have also developed strategies to enhance our prevention of mother-to-child transmission programme to ensure that by 2014-15 less than 5% of babies are born HIV positive. In fact, the executive director of UNAIDS, Mr Michel Sidibe, has asked all countries to implement plans to virtually eliminate mother-to-child transmission of HIV. We are determined to achieve this because we believe no child should be born HIV positive. Our child mortality must decrease from the current 69 deaths per 1 000 live births to not more than 30 to 45 deaths per 1 000 live births. The health sector will continue to ensure that children less than one year of age are fully vaccinated against pneumococcal infection and rotavirus. International evidence has shown this - together with other key strategies - to be an effective intervention in ensuring child survival.

Other key interventions to improve child health will include increasing the percentage of eligible infants receiving treatment for HIV/Aids; increasing the percentage of mothers and babies who receive postnatal care within six days of delivery; increasing the proportion of nursing and training institutions that teach the Integrated Management of Childhood Illnesses; increasing the proportion of schools which are visited by a school health nurse; and, lastly, conducting health screening of learners in Grade 1 in poor schools.

We need to prepare to deal with H1N1 influenza as we are entering the winter season. Unlike last year, this year we do have a vaccine.

Following advice from the World Health Organisation, WHO, and our own experts, between 05 and 10 April 2010 - we have actually started already – we will prioritise vaccination against H1N1 in the following manner: we will vaccinate 80 000 children under the age 15 years who are living with HIV/Aids; we will vaccinate 10 000 officials at our ports of entry; we will vaccinate 700 000 pregnant women; we will vaccinate 1 million adults with HIV/Aids who receive treatment at our antiretroviral treatment, ART, clinics; and we will also target 900 000 people living with chronic heart and lung diseases because of what H1N1 did to them last year.

During this month, we will also have a national measles and polio vaccination campaign. I am happy to announce that I launched this massive campaign at Benoni West Primary School yesterday. It will end on 28 May 2010. Our target is to vaccinate 15 million children between the ages of six months and 15 years against measles. Yesterday, the preliminary report indicated that we have vaccinated 210 209 in one day. [Applause.]

We need, also, to vaccinate 5 million children under the age of 5 years against polio. By yesterday, the preliminary vaccination which was started was completed, and 148 380 children were vaccinated. [Applause.] I request you to assist the Department of Health by speaking to our constituencies about the importance of immunisation. Prevention is better than cure. We have the means to eliminate measles and polio. This means having a fully immunised community now and in the future. That is why reaching this 15 million kids and 5 million is important for us.

In keeping with our targets in our outcome-based approach, we must increase the tuberculosis, TB, cure rate from the present 64% to 85% by 2014-15. Based on a review of the TB Control Programme by the WHO, we have developed concrete and clear strategies in each province.

During this financial year, we will train 3 000 health workers in the management of TB. We will also expand our TB DOTS Programme and train 2500 community health workers.

A key strategy to strengthen TB control is social mobilisation. Working together with the Desmond Tutu TB Centre and other development partners, we have developed a social mobilisation campaign called Kick TB 2010. This campaign builds on the excitement generated by the 2010 Fifa World Cup and aims to help combat TB and the stigma associated with it by linking it with soccer.

The campaign will target 250 000 learners who will be drawn from diverse schools and backgrounds across all nine provinces to be agents for TB control and management. We have already started with 10 000 kids who received soccer balls that have TB messages all over them.

As mentioned earlier, the largest public health problem that faces South Africa today and drives many of our pandemics and significantly reduces our life expectancy is HIV/Aids. The most important task that faces us is to reduce by 50% the number of new HIV infections by 2011-12 and to initiate on antiretroviral treatment, ART, 80% of eligible people living with HIV/Aids

As announced by President Zuma on World Aids Day in December 2009, we started on 01 April 2010 to provide ART to pregnant women with a CD4 count of 350 or less to enhance maternal survival. Antiretroviral treatment is also being provided to people coinfected with TB and HIV/Aids at a CD4 count of 350. This will contribute significantly to reducing morbidity, disease progression and mortality associated with TB and HIV/Aids

In addition, HIV-positive pregnant women are now receiving dual therapy from 14 weeks of pregnancy and not 28 weeks, as it was previously. This will happen until post delivery. Most importantly, HIV/Aids and TB are being integrated and will be treated under one roof. This means that all public health facilities that provide TB treatment must, over this financial year, be strengthened to also provide treatment for HIV/Aids.

By the end of March 2010, only 496 accredited public health facilities were providing antiretroviral treatment. We have decided that all our public health-care facilities should, over time, provide antiretrovirals, ARVs. I am happy to report that we have prepared an additional 519 public health facilities and they have started to provide ARVs as from 01 April 2010 - that is 13 days ago. [Applause.] We now have more than 1 000 public health facilities that are initiating eligible patients on treatment.

Some people were skeptical about our resolve to implement the new treatment guidelines as announced on World Aids Day. I wish to assure this House that we are extremely determined. [Applause.]

However, this does not mean that we are not experiencing a few teething problems in the implementation of these new treatment policies and strategies. We do have our own problems, such as human resource capacity, supply and logistical problems in some facilities. However, these are not insurmountable problems and we are addressing them.

I mentioned, possibly as early as last year, that the prices that South Africa pays for ARVs are significantly higher than all other countries. This has been confirmed by our international development partners and has been said publicly by the executive director of UNAIDS during his speech at the World Aids Day event last year, when he shared a platform with President Zuma.

This is despite the fact that South Africa has the largest ARV programme in the whole world. To us it does not make sense. We must be able to purchase ARVs at the lowest prices as we are the largest consumer of ARVs in the whole world. We must benefit from economies of scale. If we continue doing things the way we are doing, the fiscals will be overburdened.

Let me put it here in this House once and for all, there is no choice. We must purchase ARVs at the lowest possible cost from whatever source can guarantee us the lowest prices, whether inside or outside the country. We will do so.

I have to inform this House that this position has already generated opposition from some of our local pharmaceutical manufacturers. They have claimed that this approach will result in job losses. I believe this is a type of blackmail and I will never bow down to it. We need to understand that, unless we take a decisive action, we will not overcome the challenge that HIV/Aids presents. This is why the new ARV tender specifications will be prepared in a way that opens the way for us to purchase ARVs at the lowest possible price. I will not compromise on this one. Let me say, however, that this policy applies to antiretroviral only and not to other pharmaceutical products that are sold in our country.

Many people, especially the media, focussed on the aspects of President Zuma's speech on World Aids Day which dealt with treatment only. In his speech, he focussed on both treatment and the importance of prevention. As I have already mentioned, we commenced the implementation of new treatment guidelines on 01 April 2010.

However, the mainstay of our approach must remain prevention, prevention and prevention. [Applause.] As you have might have heard already, South Africa will initiate the largest HIV counselling and testing campaign ever undertaken. The Cabinet has taken a decision on 10 March 2010 that the campaign must be launched on 15 April 2010, with the President and Deputy President leading the campaign and being the first to test.

They have subsequently requested that 15 April be reviewed, as both of them will be out of the country on that date. We have accordingly postponed the launch of the HIV counselling and testing, both national and provincial, to a later date, which will be announced as soon as the Presidency is available.

This ambitious campaign seeks to mobilise the majority of South Africans to get tested for HIV /Aids. We aim to provide HIV counselling and testing to 15 million South Africans by the end of June 2011. The President will lead the campaign nationally. We have met with colleges and universities. Rectors will lead the campaign and be the first to test in their universities. The superintendents and chief executive officers, CEOs, of hospitals will do the same in their hospitals. We hope that in this House, the Hon Speaker, Chief Whips and leaders of parties will be the first to test. [Applause.]

We hope that hon members will be the first to test in their constituencies. All leaders must lead their flock. We are also hoping equally that ministers of religion will be the first to test in their churches. [Applause.] Traditional leaders will be the first to test in their villages. Every leader must take responsibility.

We also have a report from the Lancet that shows that South Africa is going through four main pandemics, not only HIV/Aids. The report mentions the pandemic of HIV/Aids as being number one. Then there is the issue of maternal and child mortality; noncommunicable diseases; and violence and injuries.

For this reason, when you arrive at the testing station for HIV/Aids tests, we will also take your blood pressure to see if you have hypertension; we will do a blood-sugar test to see if you have diabetes; we will do a haemoglobin test to see if you have anaemia; and we will also do a TB screening. We believe that all these tests will be offered in all the testing stations.

A huge outcome that must also be achieved is the effectiveness of the health sector in terms of the revitalisation of infrastructure; improving quality of health care; overhauling the health system; and reducing the ever-escalating costs of health-care provisioning.

We are going to go through this House to pass a law that will help us establish an office of standard compliance that will guide us on patient safety; infection and prevention control; availability of medicine; cleanliness; waiting times; and positive and caring attitudes to patients.

We also promise in our 10-point programme the overhauling of the health-care system in terms of turning it towards primary health care and also taking the efficiency and the functionality of our health-care institutions. With the help of the Development Bank of South Africa, DBSA, we are already far advanced in that function.

Most countries globally are searching for strategies to reduce the costs of health-care delivery while improving access and quality. The establishment of a National Health Insurance system will go a long way to ensure this. Through the NHI we will ensure universal access to quality and affordable health services for all South Africans.

Our major objective of pursuing the NHI is to put in place the necessary funding and health service delivery mechanisms that will enable the creation of an efficient, equitable and sustainable health system for all South Africans. With the ever-widening gap between the rich and the poor - a gap regarded to be one of the biggest in the world - we have no option morally, economically, socially or otherwise but to move in this direction. More than any other country, South Africa needs to establish an NHI.

I shall now turn to the budget of the national Department of Health for 2010-11. The budget of this Department grows by 16% from R18 billion in 2009-10 financial year to R21,5 billion in 2010-11. Policy areas that received additional funding will include HIV/Aids grant; hospital revitalisation; mass immunisation; and stabilisation of personnel. The Department has also received donor funding to help us in our indabas.

In conclusion, let me take this opportunity to thank the many people whom I worked with last year for their significant contributions to the turning around of our health system.

Finally, we believe that we are on course towards improving the health profile of all South Africans. As we have done today, we will return to this House in the future to report on the milestones that we are achieving in partnership with the people of South Africa. I request this House to approve the budget of the Department of Health for 2010-11 and 2012-13. I thank you. [Applause.]

The HOUSE CHAIRPERSON (Ms M N Oliphant): Thank you hon Minister. Hon Minister, I just want to indicate that I have given you one minute extra. I will therefore take one minute from the 10 minutes you have for your response.

Mr M B GOQWANA


The HOUSE CHAIRPERSON (Ms M N Oliphant)

Mr M B GOQWANA: Chairperson, Ministers here present – I saw other Ministers coming in – I also noticed officials of the Department of Health here, the Board of Healthcare Funders of South Africa, BHF, and the National Health Laboratory Service, NHLS, I greet you all. It is indeed sad that we have an unoccupied seat here because of the death of our Deputy Minister. I wish to extend my condolences to his family.

We believe that the budget for Health can and must be passed. This is despite the fact that, when we look at the challenges of backlogs versus the health budget, both nationally and provincially, we feel that health is underfunded. I am saying this while understanding very well that funding does not make things happen if there is no passion and determination. If one is passionate, one can make things happen, even with limited funding. Similarly, if there is money but no passion and determination, nothing will ever happen.

What brings us hope is that when one looks at this department, it seems to have turned the corner. It is headed in a positive direction, and, as the ANC, we have developed the hope that, with the Minister's passion and determination, things are going to happen in the Department of Health. Well done to the Minister! We really commend him for the work that he has done. [Applause.]

We must remember that everything always starts with a dream. The dream is followed by an internalisation of the problem, and this is followed by passion and determination. As I said, one might have money, but if one does not have passion and determination, nothing will ever happen.

The department has a 10-point plan which makes it for easy for us to monitor and see whether or not it is moving in the right direction. However, over and above that, the department has 20 outcome-based results that we will be able to use to monitor it. Obviously – for this is a new thing in the Department of Health and it tells us that the department is serious about changing itself to make it responsive to our people – this is going to help us this year and in the years to come. As good and easy as these outcomes are, we, as the ANC, need to assist in certain contexts to make sure the outcomes are achieved.

Let me say that the Department of Health does face challenges, but with the vigour and passionate determination that we have seen in its leadership, we are very hopeful that things are going to change.

Let me mention a few things that, if they happen, will obviously enable us to achieve these outcomes. Firstly, the public service has got to transform, and we have got to make sure that we sing from the same hymn sheet as the Minister with regard to his passion and determination. If we fail to do this, and fail to make sure that we are passionate and determined, we'll be unable to achieve what we want to achieve. When we are servants, we need to be humble at all times and be prepared to help, even if it's not our terrain. We need to make sure that we help those who need help from us, and we must always remember that "I am what I am because of others".

Secondly, we need to make sure that we address corruption. I'm told that, in medicine, there is a condition called "being squint". Being squint is whenone eye looks in one direction while the other looks in another direction. I think it is imperative that we have people who are not squint but look in one direction, because if one looks in different directions, one will have a result that is not right and service delivery will not happen. So, I call upon us, when we accept to be servants of the people, not to look at other things, otherwise we will never be able to achieve the outcomes. We need to make sure that we deal with corruption head on, if we want to make sure that we achieve the outcomes that we are talking about.

If we still have a divided, unequal and distorted health service in South Africa, we can forget about dealing with these challenges. Hence, we talk of universal coverage for everybody that is going to assist everybody. In fact, we are unhealthy because we are unequal; we are divided. Those who have good services will always be affected and infected by those who don't. That is why we are talking about the National Health Insurance, the NHI. In fact, if we think that we can retain these unequal and distorted health services, we might as well say that those who have good health services must keep apart from those who don't have good health services. This takes us back to apartheid, a situation to which the ANC will never go back. [Applause.]

One might find, for example, that someone from a place that does not have good health services and who has dormant TB goes to look for work where there are good health services, and that person, because he does not know that he has dormant TB, starts infecting those who have good health services! All of us then become collectively unhealthy. So, we definitely need this National Heath Insurance. How we do it is going to be the question, but it is needed in order for us to have a good health-care service and be able to achieve our outcome targets.

Primary health care has not worked well, despite it being the policy of the ANC and the policy of government. There are many reasons that have made it not work, but we hope that, with the new vigour and passion within the department, that is going to change.

Let me mention something that is very important, which I think is one of those things that caused primary health care to not succeed.

There are four levels of health care: primary, secondary, tertiary and quaternary health care. For example, if I'm sick with minor flu, I can go to the Nelson Mandela Academic Hospital. However, it is more expensive to treat my minor flu at that institution than had I gone to a primary health-care institution.

What one would suggest is that we take the tertiary and the quaternary services and make them national competencies and leave the provinces to handle primary and secondary health care. This will ensure that provinces have enough money to run their competencies from their equitable budgets. If that does not happen, the provinces will keep on using their small equitable shares to render services that are tertiary and quaternary. That will never allow us to reach where we want to reach.

I am suggesting that we probably need to think about leaving primary and secondary health care to the provinces and take tertiary and quaternary services to the national level. I am referring to both human and financial resources, so that people can be deployed.

In any case, those are the areas that are handled by national. These interprovincial referrals would actually stop, because our referral system is still very poor.

We need to review those laws that restrict the national Minister from intervening when provinces have problems, as the person who answers at the end of the day is the national Minister. We need to review those laws so that we are able to achieve the outcomes that we want to achieve. Most of the things happen in provinces, but the national department has to answer for those problems.

The policy on public-private partnership by the ANC and government has not changed. Part of the problem is that I don't think we have a good understanding of what is going on in the private health-care system. However, we need to know what's going on but not in a way that interferes with it. Our attempts at understanding must not be made in a vindictive, arrogant and divisive way, but should be done so that we understand where we can come together. The public sector could work with the private sector for the better outcomes of our country.

The private health-care industry, especially hospitals – not that they don't do primary health care, but there's very little that goes to primary health care – are mostly dealing with curative medicine. I think we need to see how we can promote primary or preventive health care in the private health-care sector. We know profit might be lower than what you would want, but we can have innovative ways of making it happen.

To achieve these outcomes, we need human resources. There are areas which are training health workers, be it doctors, nurses or paramedics. But I don't think we understand what is happening in our universities; in the colleges of medicine; in our nursing colleges; etc. We need to understand whether they are producing the cadres that we want as the ANC, cadres who will carry on with these outcomes that we are talking about. We probably need to sit with the medical universities; nursing colleges; colleges of medicine; etc to see how we can find a way of getting a cadre that we think will be able to do what we need to do, especially with such good outcomes from the Department.

On the other hand, in primary health care, we have people who are called "health promoters". Those people are doing primary health care; they teach people what needs to be done. But there are health promoters who have not been placed properly, so that they could help in these outcomes that we are talking about. In the Eastern Cape, there seems to be an association of health promoters. They could be used to make sure that we promote the primary health care that we are talking about. They should be registered with the Health Professions Council of SA, HPCSA.

The achievement of these outcomes is paramount to the ANC to make sure that when they say health is a priority, it becomes indeed a priority. It might not be visible to the people outside, but the Department has started turning a corner. We are hopeful that things are going to happen, as long as we make sure – repeating what I've said – that the public service is passionate and determined with or without funding. Not that there must be no funds, but nobody should do nothing because they claim there are no funds when there is passion. Passion can make things happen.

We need to separate the primary health care and the secondary health care from the tertiary and quaternary services for obvious reasons. We obviously need to change our attitudes and to remember that umntu ngumntu ngabanye abantu [A person is a person because of others]. We are the servants of the people. [Applause.]

The launches that the Minister talked about are something that we support as the ANC and we will always make sure that we are there. I'm hoping that other leaders will follow. We will make sure that we do it. The only thing that we probably need to think of, especially with the HIV issue, is how to make sure that people use the 1,2 billion condoms. In using them, we need to think of how we dispose them off so that the environment is not affected by the 1,2 billion condoms. It has to be done.

The Department has changed gear and are moving in that direction. Minister, we want to commend you for leading this ship in the right direction. As the ANC, let's work hard, as if this is the only year we have to ourselves. Let's make sure that things happen within a very short space of time. We need to make sure that the mess that has happened will change to be good messages. We need to make sure that the tears that have fallen for certain people are changed to smiles. Let's change the negatives to positives. Thank you, Chairperson. [Applause.]

Mr M WATERS


Mr B M GOQWANA

Mr M WATERS: Chairperson, may I start by expressing our condolences to the ANC, Dr Sefularo's colleagues, and to his friends and family on his untimely death. I know we are going to be having a debate on condolences tomorrow in the House, and I will express the DA's full respects then.

Health care, or the lack of it, is a matter of life and death. For too long, the vast majority of South Africans in the public sector have been subjected to declining quality of health care, longer queues and ever-increasing waiting lists for treatments and operations. Without sound financial management, it is impossible to provide basic health care on a day-to-day basis, let alone project what amount will be needed in following years.

There is an urgent need for an improved financial management process within the South African public health sector. Expenditure in many provincial health departments is currently inefficient and ineffective. These provincial departments and the national department in general do not have the ability to undertake a comprehensive budgeting process, reliably project expenditure, manage and control expenditure and evaluate cost-effectiveness.

This lack of capacity has resulted in significant overexpenditure in key areas, an inability to adequately determine clear cost drivers and causes for expenditure, a lack of strategic planning with clear objectives when additional funds are required and inefficient expenditure and losses.

In a reply to a parliamentary question, the nine provincial health departments had, as of 31 December 2009, an estimated budget deficit of R5,7 billion, which is more than double that of the previous financial year. This may not reflect the severity of the situation, as economists predict that a probable R6 billion to R7 billion has been deferred to the 2010-11 financial year. This reflects a massive funding gap, and it is uncertain how exactly the department and Treasury plan to address this huge shortfall.

It appears that the unannounced strategy is to part fund the shortfall indirectly by clawing back R2 billion through below-inflation remuneration increases. Given, however, that a minimum of R7 billion is needed to deal with the Occupational Specific Dispensation, OSD, this will leave a R5 billion shortfall.

The DA's concern is that this has not been made explicit and most of the provinces and Treasury are hiding the real health deficit. So, what has caused the financial crisis? Due to the lack of skills within the department and a hopelessly outdated Persal system, the cost of OSD was grossly underestimated, as the department did not know how many nurses it had, what skills they had, and on what level they were employed.

While the OSD underestimation exacerbated the financial crisis in health care, this was, in fact, the final straw that broke the back of what is, for the most part, a shambolic and disgraceful administration of health care. The reason for this crisis lies in the inept management prevailing in most provincial health departments.

The Auditor-General's report for most provincial health departments comprises long lists of reports on wasteful expenditure, expenditure that cannot be accounted for, assets that have vanished, debts that had not been paid, duplicated payments, lack of sufficient controls, staff who cannot be found - ghost workers, performance payments that cannot be justified, payment for goods and services which were not received, and on and on. For the past five years, the national health department has received qualified Auditor-General reports, largely because it has not been able to obtain quarterly performance reports from the provinces.

Despite this, Minister, there has been no accountability with regards to financial management or mismanagement. Unless there are consequences for mismanagement, the current unacceptable and unsustainable situation will continue. We need to know in addition to the overspent amount, how much has been deferred to the 2010-11 financial year? In order to rectify the situation, the DA would like to make a few proposals. For effective budget management, it requires active strategic leadership from the head of the department, HOD, or the accounting officer and the chief financial officer who provides support to the HOD.

Since there may be different levels of commitment and capacity within the provinces, it is necessary to assist the HOD with guidance and, where necessary, instruction from the national Department of Health. It is key that these issues be a standing agenda item at report-back sessions to the HODs and when the Minister meets with the provincial MECs for health on a regular basis.

Secondly, financial leadership and management are required to develop and manage the process on a day-to-day basis. This requires in-depth data analysis skills, understanding of the information available, understanding of budget management, understanding of health finances, the ability to interact with health managers and understand the businesses of health. The managers in the financial management component must be able to confidently communicate with and advise the chief financial officers and the HODs of the various departments on the financial status of their respective departments at all times.

Thirdly, due to the lack of budgeting and technical skills at institutional level, as well as the inability to understand and interpret data, urgent training of line managers and financial staff in the districts and at health institutions is needed. With the hopefully overall improved data and a better understanding of the data, health as a sector would be able to provide better motivations to national and provincial Treasuries for funding. With such skills, the health sector would also be able to accurately determine whether the sector is adequately funded for new policy mandates, determine needs by comparing current staffing and funding levels to accepted norms, determine the cost of proposals with detailed supporting documents for submission to national and provincial treasuries and determine the levels of funding of various provinces, compared to patients numbers they see.

Chairperson, we heard today from the Minister the 10 priorities of the department, of which the DA supports most. The second priority, the national health insurance, NHI, we cannot comment on because we still waiting for the document, Minister. You promised that on 30 June last year. These priorities were also mentioned in last year's budget, and we hope that this year will be the year of action, where we start meeting targets specifically with child and maternal mortality rates.

We welcome the u-turn in the fight against HIV/Aids, and the DA supports the campaign that the Minister mentioned of encouraging people to get tested and to know their status with regard to prevention. The Minister also mentioned that the President will be leading this campaign, and I hope he understands that it's a great responsibility and eyes, particularly of the youth, will be on him, and he dare not falter again, if he is going to lead the campaign in prevention.

The Minister also mentioned the cost of antiretroviral drugs, ARVs, and I have raised this with the Minister before in the portfolio committee. The Medicines Control Council, MCC, has not approved generic ARV drugs for nearly four years, which would greatly reduce the cost of ARVs to the country, and the Minister needs to address this as a matter of urgency with the MCC. Incidentally, the Minister mentioned that the H1N1 vaccine still hasn't been approved by the MCC, so that also needs to be addressed as a matter of urgency.

While South Africa currently offers near-universal health cover, the quality of health care in the public sector is of great concern to the DA. One driving factor of the poor quality of health care is the chronic lack of medical professionals. In a reply to a parliamentary question – that's another one – the number of doctors qualifying in South Africa actually fell between 2004 and 2008, from 1 394 doctors to 1 306, despite our country's desperate need for more doctors.

Put together with the fact that about 17% of doctors leave South Africa after they have qualified, we are facing a very grim scenario. The drop in graduates was largely the result of a decline in output at universities in provinces where the need for doctors is the most acute - Limpopo, the Eastern Cape and the Free State. At the University of Limpopo, for example, the number of graduates fell by more than a third, from 238 to 150. One solution is to bring in the private health sector to assist, particularly with the practical side of the training of medical students.

The lack of nurses is another concern and, if it were not for the private sector that now produces about 52% of all nurses, our health system would be on its knees. We hear year after year that the nursing colleges that were closed down by this government are to be reopened, but as far as I know not one has yet been reopened. Given the fact that we need to produce tens and tens of thousands of nurses, one would have expected this government to act in an urgent manner, given the severity of the crisis.

Our human resources plan is basically nonexistent, and the old plan is based on questionable figures and deliberately excluded the private sector. We urgently need a new plan that is based on accurate figures of how many nurses and doctors are actually working in our country and how, as a country, we can effectively optimise all available resources to increase our work force.

The unacceptable level of the maternal mortality rate needs urgent attention, which the Minister did mention in his speech. One of the driving factors, but not the only one by any stretch of the imagination, is that mothers are deterred from attending antenatal and postnatal clinics, due to the fact that they have to wait in long queues for the entire day before they are seen to. It is high time that scheduling of appointments is implemented at all antenatal clinics. This will allow a woman to arrive, say, half an hour before her appointment and not waste her entire day when she could be doing other things.

Chairperson, if we are to improve the quality of health care for all the people, we must start moving to a health system that allows choice - open opportunity - such as allowing patients the choice to choose a pharmacy of their choice near their places of work or home in order to collect their repeat prescriptions instead of having to take a day's leave, travel a long distance to their hospital, only to find the queue snaking out the door, then having to wait in the queue all day and sometimes not being able to collect their medication, due to stock outs or due to the fact that they never reached the front of the queue.

There are many innovative measures that can be put in place that will improve the quality of health care without increasing the cost of health care. In fact, some of measures I have mentioned today will actually reduce the costs. We need to, as a matter of urgency, investigate all these possibilities in order to improve the quality of health care for the vast majority of our people. I thank you, Chairperson. [Applause.]

Mr D A KGANARE


Mr M WATERS

Mr D A KGANARE: Hon Chairperson, hon Minister, hon members and invited guests, the occasion of this debate is engulfed by the loss to South Africa of one of the most committed revolutionaries produced by the struggle against apartheid, the late Deputy Minister of Health, Comrade Molefi Paul Sefularo. It is with this sense of loss that the Congress of the People is participating in this debate.

Hon Chairperson, the budget is the vehicle through which the government is supposed to deliver its promises to the people of South Africa. It is the barometer through which the success and failure of government can be measured.

During a similar debate last year, Cope expressed its unwillingness to support the 2009/10 budget of the department while raising several issues, which I don't think are worth repeating now as they are already on record. We need to look forward. The problems that have been raised must be resolved in order for the nation to retain its confidence in the public health services. Let me give you a synopsis of what transpired during the previous financial year.

In the Eastern Cape, health facilities are understaffed and consequently the department is for all intents and purposes dysfunctional. Whistle-blowers are victimised and forced to resign, making a mockery of the act that was intended to protect them. This means that in this particular province, corruption is institutionalised. There are allegations that overspending to the magnitude of R1,8 billion had occurred and that, even so, creditors were not paid. Maladministration has led to a shortage of drugs and medicines.

The saga of ARV shortages and the illegal dumping of medical waste in the Free State are well documented. Bad planning saw quantities of expired medicine being disposed of when that money could have been allocated for ARVs. It has always been the case of the money being there but without a credible plan for its utilisation.

In Gauteng, the Chris Hani and Charlotte Maxeke hospitals also ran out of drugs. The MEC in Limpopo appointed his cronies to provide information technology systems in order to profit thereby. In KwaZulu-Natal, hospitals are generally dysfunctional due to a shortage of staff and overspending resulted in communities in Mpumalanga not getting quality health care.

The newly built clinics in De Aar, in the Northern Cape, had no drugs. The same applied for clinics in Barkley West, Richmond and Hanover. In this province, allegations are rife that management for the 2010 budgethas neither skills nor the requisite qualifications.

In the North West, there are ambulances but no staff, and the roads are such that ambulances and equipment cannot reach the people who need urgent medical attention.

The Western Cape has a shortage of forensic laboratories, with 5 000 samples at Salt River mortuary having to be discarded because they could not be analysed on account of having expired. At Groote Schuur, the neurology ward had no toilet seats, toilet paper, soap or hand towels. This is a hardy perennial and yet the situation lingers. For Cope, these concerns have to be addressed before we can even begin to talk about accessibility to quality health care.

To your credit, hon Minister, your enthusiasm and commitment gives some hope to the people of South Africa that a turnaround is possible. We will work with you to help you achieve your noble ideas and objectives.

Cope believes that the primary health-care model should be strengthened considerably. Therefore, all clinics should have medication, appropriate health professionals and access to emergency medical services.

During the constituency period, I paid a visit to clinics within the Frances Baard District Municipality. At the clinics in Galeshewe, Kimberley, there are no doctors, pharmacists and vaccines for children. Only municipal clinics have UV lights. The provincial ones don't have UV lights and consequently four professional nurses became infected with TB. Thus the working conditions there are very bad.

I hope that the Minister will ensure that during the immunisation campaign there will be adequate vaccines because at these Galeshewe clinics, immunisation has not taken place for the past three months. In this case the problem is clearly not with management at these clinics but at the level above them.

Access to quality health is not confined only to the building of new clinics. Cope believes that implementing a proper human resources development programme is vital. It is for this reason that Cope welcomes the department's commitment to the re-opening of nursing colleges. The training of skilled labour is never a waste of money because exporting excess skilled labour is to the benefit of the country's economic development.

The role of community caregivers should be acknowledged by providing them with standardised training programmes and having their qualifications accredited.

Access to quality health care by all South Africans is something we must speed up. The escalation in medical costs is a matter of utmost concern for Cope. The need to keep specialist fees in an affordable range, have a single national hospital insurance scheme in place and promote primary health care very aggressively are topics that need to be thrown open for public discussion. Cope recognises that these are burning issues requiring all parties involved to subscribe to a mutually agreed upon policy so that the interests of the caregivers and of the afflicted are protected equally.

Cope believes that within the National Health Insurance, NHI, there should be scope for medical aid societies to operate as part of an integrated system of care provision. Those who can finance their health care needs should not be punished for this. Cope is convinced that this win-win approach will contribute towards improving the effectiveness of our health-care system.

Cope is also conscious of the fact that the burden of diseases is a formidable challenge. HIV/Aids is merely one of these burdens. It recognises that the way forward in dealing with HIV/Aids is to provide determined and focused leadership from the top.

In this regard, we were encouraged by the announcement of the President of the Republic of South Africa on World Aids Day last year. It is unfortunate that the hon President is incapable of abiding by the ABC message. To him it is merely the case of "do as I say and not as I do". This is incomprehensible, seeing that he is the President.

I am not surprised by this reaction of the ANC...[Interjections.] [Time expired.] [Applause.]

Ms H S MSWELI
Mr D A KGANARE

Ms H S MSWELI: Chairperson, the IFP wishes to express its condolences on the death of our Deputy Minister of Health, Dr Sefularo. According to the IFP president's recent statement, Dr Sefularo's death has left the country poorer. "We have lost the considerable talent and experience of a man dedicated to serving South Africa," he said.

The Department of Health is, however, faced with many challenges and priorities. The greatest burden currently facing our public health facilities is that of HIV and TB. We should all accept that not much progress has been made in preventing the spread of tuberculosis. And that South Africa's performance in fighting TB has always been inadequate, resulting in a very low cure rate.

We are in danger of not reaching the goal of halving prevalence and death rates by 2015, and of not meeting our millennium development goals. The government is well aware that it has to double its efforts to deliver better outcomes. We need a change of mind-set and a greater sense of urgency to confront the scourge of TB. Programme managers, whose responsibility it is to implement government programmes against TB, and our partners, whose daily work it is to assist us as a country to deliver better outcomes, should not be satisfied only with drafting crisis plans.

Everyone should work in partnership to ensure that society gets involved in the fight against TB. We must promote more testing and greater openness, so that HIV is regarded as being no different from TB, diabetes or hypertension. The IFP regards testing for HIV as important, not so that government knows who is positive or not, but so that when men and women want to conceive children, they know their status.

The Department of Health also needs to work together with the prison command structures to ensure that condoms are provided to inmates in our prisons in order to avert the escalating prevalence of HIV infection. We can run as many HIV programmes as we like, including education, testing and the provision of anti-retroviral drugs to prisoners, but as long as the issue of unprotected sex is not addressed, HIV transmission will continue unchallenged.

The IFP, however, welcomes the implementation of the updated HIV treatment guidelines, which were recently published by the South African National Aids Council, Sanac. This will enable pregnant women, HIV-positive infants and people with HIV and TB to access treatment in the early stages of their infection. There are a million people who are still in need of treatment.

The closure of some nursing colleges by the government, citing funding as a reason, did not assist in the production of nurses. We are calling on government to re-open the training colleges that were closed, to accommodate those who were interested in pursuing a career in nursing.

The government should always bear in mind that poor salaries drive nurses away from the profession and the country. There is a shortage of nurses with post-basic qualifications, experience in intensive-care theatre, and neo-natal intensive care.

Success in the steadily worsening public health services will depend on efficient management and administration. Health districts need to be strengthened and co-ordination between hospital, clinics and mobiles in rural areas needs to be improved. Monitoring and evaluation of health bodies constitute another critical element in the continuous improvement of our health system.

We want to remind the Minister that, in the state of the nation address, the President spoke about the dire need to improve the health-care system. [Time Expired.] Thank you.

Ms M C DUBE


Ms H S MSWELI

Ms M C DUBE: Chairperson, hon Minister, hon members, let me begin by expressing my most heartfelt condolences to the family of Comrade Molefi Sefularo and acknowledge with gratitude the significant contribution he made in health. May we all continue with the work he started.

Chairperson, an extract from the book Life and Flowers by Maurice Maeterlinck should inspire all of us to effect social change. It says:

Let us listen only to the experience that urges us on; it is always higher than that which throws or keeps us back. Let us reject all the counsels of the past that do not turn us towards the future.

This means that we need to change our mind-set from the effects of the past towards what we see as our future, in order to achieve the vision of a better life for all.

I rise to participate in an event of great importance because of the impact that the outcome of this debate will have on our people. This is not a process to be taken lightly by MPs, as the overwhelming majority of our people have entrusted the ANC to be its vanguard movement.

Budget debates afford parliamentarians the opportunity to reflect on the performance of the Department of Health during the period under review. However, it must also give us pause to reflect on our own performance as parliamentarians and for me as an ANC member.

This organisation has a proud history of fighting for the disadvantaged and oppressed and we must do everything possible not to violate that history. Millions of our people placed their faith in the ANC-led government. Therefore, it is incumbent upon us to ensure that the delivery of services required by our people happens.

Health is one portfolio that is always controversial and will remain so for the foreseeable future. While we have succeeded in many areas, we need to increase our efforts in bringing health care closer to the people, especially in rural and remote communities.

The quality of care and achieving better health outcomes should be given priority. However, this depends on people. The shortage of skills is well known, but we need to ensure the retention of the skills we have.

It is essential that we improve the working conditions of health workers and provide opportunities to study further. Government should also provide incentives to attract health workers to work in remote or rural areas. Clearly, this presents a challenge that cannot be resolved overnight.

Another critical area is the support that community involvement provides through home-based care and mobilising communities during crises. We need to strengthen this partnership with communities and also improve the management and monitoring of these workers.

To achieve social and economic justice, government has to intervene and act against corruption, implement measures to reduce waste and increase efficiency. A key challenge towards achieving social justice is the eradication of poverty, the related social ills and health challenges.

Chairperson, one way of effecting social change is to deal with the issue of human resources. This prevailing challenge for the health sector is considered to be reaching a major crisis. The problem is not only the shortage of health professionals but also the disparity of distribution between provinces. This disparity also exists between the private and public health sectors.

This creates a serious challenge for the community to meet the millennium development goals but it also creates a challenge to improve the health system's effectiveness.

South Africa followed the global trend of focusing on primary health care to ensure health care for all our people. This meant the reorientation and realignment of the health workforce – a huge challenge in itself, but necessary.

Adding to this challenge is the ever-increasing burden of diseases – exacerbated by the impact of HIV and Aids. A change in lifestyle and behaviour is obviously necessary, and therefore education is critical to create awareness of preventing lifestyle diseases.

This can be the start for all of us to change within ourselves and leave behind that legacy of experiences that holds us hostage to the past and prevents us from effecting social change in a meaningful way.

For people to achieve optimal health, they have to exercise greater control over all aspects of their lives. In this regard, it is critical to let go of the pain of the past but carry on learning from the lessons of the past.

The strategic plan, in facilitating capacity development within the health system, indicates the following: Pushing the national human resources plan for health by March 2012; introducing mid-level health workers and community health workers; strengthening human resource planning in the provinces; increasing the number of student clinical associates from 99 to 180 by 2012/13; finalising the policy on community health workers by March 2011; increasing the number of emergency-care technicians; recruiting health professionals through agreements with other countries who have an excess of such professionals.

We lose many health professionals to the private sector. This is why the envisaged public-private partnership and the introduction of a National Health Insurance are so important. The involvement of the private sector in providing health care is critical. As we know, there are considerable resources in the private sector that will assist with the demand for health care. This will close the "shortage of skills" gap and, with the introduction of Occupational Specific Dispensation, should assist with the retention of staff. However, it is still extremely difficult to employ health professionals to work in the remote and rural areas where most of our people live. We have to find ways of making it attractive for health professionals to work in those areas. Currently, we seem to attract only foreign health professionals to those areas.

As parliamentarians, our role is twofold: we legislate and we exercise oversight over government and its related institutions. Engaging with the Budget is one way of exercising oversight through which one takes stock of the outcomes of the previous year's operations.

A key element to providing services to our people is to foster a culture of public service as a means to achieve our transformatory objectives that must result in a better life for all. In other words, Batho Pele speaks about the Budget linking to the outputs.

The Patients' Rights Charter outlines the rights of patients as well as their responsibilities. As parliamentarians we must ensure that this is prominently displayed in the health facilities in our constituencies. This forms part of ensuring that the rights of patients are not violated as well as of our ongoing campaign of building a caring nation. The service provided by professionals should be of the same standard that they demand for themselves.

Through these mechanisms and interaction with our communities, we can effect the social change we need in order to advance to that better life for all. The world is astounded by our country's achievements and stable democracy. This did not happen by accident; the ANC continues to demonstrate that its core values are based on democracy.

Not enough can be said about developing a healthy nation that results in a prosperous nation and country.

To achieve optimal outcomes, it is important that careful planning is done to maximise the performance of our health system. Human resource planning for health has gained international prominence, spurred by the extensive international migration of health professionals.

Planning is considered a vital activity but it is important to note that the task of health workforce planning is complicated by many global diseases and challenges. It is also essential for any organisations to ensure that its human resources are capable of meeting its operational objectives. [Time expired.] [Interjections.] I support the Budget. [Applause.]

The TEMPORARY CHAIRPERSON (Mr T S Farisani): Hon members, we are doing very well when it comes to the volume of whispering but sometimes I do get to share in secrets that are being shared from where I sit. Please, make it a little softer. Thank you.

Ms C Dudley


Ms M C DUBE

Ms C DUDLEY: Chairperson, the ACDP expresses sincere condolences to the hon Minister and to family and friends of Dr Molefi Sefularo.

The ACDP put a question to the hon Minister on the 9 March 2010 regarding the allegations that the swine flu or H1N1 vaccine is potentially high risk. I was not fighting with the hon Minister, but giving the Minister an opportunity to reassure people that their concerns were misplaced. But the Minister chose not to. We were grateful, however, that the campaign then appeared to be postponed but now we hear that the campaign has gone ahead, this month, and hundreds of thousands have been targeted. No assurances have been given that allegations have been investigated, despite further questions to the hon Minister.

Doctors and scientists have said that the vaccine has been insufficiently tested and can cause dangerous neurological side effects. It has been implicated in causing abortion and sterility and the dangers to children are not yet known. It is said to contain 500 times the acceptable mercury level for drinking water.

In addition, accusations that drug companies manipulated the World Health Organisation into downgrading its criteria for a pandemic form the basis of an enquiry being conducted by the Strasbourg-based human-rights group, the Council of Europe. Professor Ulrich Keil, a WHO adviser on heart disease, said the decision to downgrade criteria has led to a gigantic misallocation of health budgets. Since the vaccine was withdrawn in the United States, some suspected it would be sold to Third World countries to recoup financial losses. The ACDP is concerned that the South African public may be at risk, as no assurances have been given that these serious allegations and warnings have been investigated. Hon Minister, what plans are in place to ensure that the public is well informed regarding risks before this immunisation campaign begins - from what you've said, it has begun – and, of course, has this been budgeted for?

The ACDP welcomes reports that from this month, the new health department policy is that infants born to HIV-positive mothers will receive the anti-HIV drug nevirapine from birth to six weeks or for as long as they are breastfed. In addition, we understand that new mothers will be assessed to see whether they are eligible for lifelong antiretroviral therapy before they are discharged. This is good news.

The ACDP is pleased to see the aggressive stance being taken in engaging all of South Africa's health-care organisations and workers in the HCT or HIV counselling and testing campaign, and in the drive against TB. Has the requirement that all health-care workers in the public sector routinely offer HCT to all people who enter a health facility for any ailment been adequately budgeted for and are measures in place to ensure payment for private-sector service within reasonable timeframes?

Past underperformance of the HIV Conditional Grant, due largely to failures of the provinces to adequately fund the remainder of the health-care system, is still a concern. [Time expired.] Thank you.

The TEMPORARY CHAIRPERSON (Mr Farisani): I must advise the first table that they have not taken my warning seriously. If you speak so loudly that I can't hear a member, I won't be able to intervene when I need to, please.

Ms M V MAFOLO: Chairperson, hon Minister of Health, Ministers and Deputy Ministers present, hon members of the portfolio committee, hon members, our guests and officials, warm greetings. We are meeting at a time when we are struggling with the reality of the loss of our dear and beloved Deputy Minister of Health, Dr Molefi Sefularo. However, we draw comfort from the fact that his spirit will always serve as an inspiration for us to do more. His never-ending courage and legacy will urge all of us to pick up from where he ended. God will strengthen us and continue to offer the family guidance and comfort. May the gracious Lord bless and sustain the family of the late Deputy Minister of Health.

I take pride in participating in this important session that touches on the precious lives of our people, the Health Budget Vote for 2010. The discussion takes place at a most crucial time, when the world faces serious health challenges such as HIV and Aids, tuberculosis and N1H1, to mention a few.

Critical to this is what the ANC-led government has done to improve the quality of life for South Africans. Answers to these questions hinge on the clarion call in the Freedom Charter that "there shall be access to health for all". The ANC government is committed to the promotion of a preventive health scheme under the state and free medical care and hospitalisation with care for mothers and young children.

Setswana:

Re le mmuso o o eteletsweng pele ke ANC, re semeletse ka metseletsele le mananeo a a ikaeletseng go tlhabolola le go tokafatsa seemo sa pholo mo nageng. Re ka atlega tota fa re dirisana le setšhaba gonne re dumela gore mabogo dinku a a thebana. Ke ka jalo re nang le moono o o reng...

English:

... working together, we can do more. [Applause.] It is our intention to accelerate the fight against HIV and Aids and other diseases in order to achieve this objective. We will accelerate efforts to mobilise available resources in both the private and public health sectors to ensure that there are improved health outcomes to benefit the South African population across all races.

You will agree with me that for all these to yield fruit, our Budget needs to be expansionary. During the 2008-09 financial year, expenditure in the public sector was a total of R83,8 billion. It is now estimated that for 2010-11 approximately R99,7 billion expenditure in the public sector would be required. The private sector expenditure was R111,9 billion in 2008-09, while it is estimated to be R121,5 billion in 2010-11. These figures indicate huge spending in the private sector, compared to the public sector. Funding in the public sector equals about 4% of GDP and 14% of the main Budget. What impression do we get from these figures? Among others, it is that the ANC-led government is passionate about improving the provision of health services.

Although much has been achieved, there remains a need to strengthen the resources of the public health system in a number of areas, such as personnel, communicable diseases, high infant mortality and life expectancy. We specifically intend to improve the number of staff and the infrastructure and to develop necessary skills for staff to accelerate delivery of effective and efficient health services.

No one can deny the historic and central importance of the National Health Insurance. Its basic aim is to ensure that every South African, rich or poor, black or white, is covered in this scheme. No upfront payments should bar South Africans from receiving medical services. [Applause.]

We are saying we want the National Health Insurance to yield a more fruitful outcome. We are calling on all the workers and the poor of our country to wage a war for the transformation of the health sector. This will be achieved when we encourage communities to participate in the running of hospital boards that are inclusive and representative of communities and stakeholders.

I reiterate: working together we can do more. It is high time that people start owning decisions that directly affect their lives. This communicates the exact fruits of freedom. People must develop pride in health institutions and we are prepared to passionately protect the gains of our struggles. Participatory leadership and engagement will help us advance collective governance in the health sector.

Setswana:

Mangwe a maikaelelo a rona ke go rotloetsa badiri le baagi go tsenela botokololo jwa diboto tsa dikokelo, go thusa go lwantsha bosenyi le bobodu jo bo iphitlhileng ka go tlhatlhosa ditlhwatlhwa mo thekong ya didiriswa mo ditheong tsa pholo.

English:

The 10-point plan, proposed by the Minister of Health, for the medium-term strategic framework for 2009-14 is the best tool that informs community partnership and campaigns to accelerate health services for all. Take, for instance, the point of mass mobilisation for better health for the masses. It is high time that the community gets informed about the health issues affecting their lives. It is in the context of this mass mobilisation that the entire society will be taken on board with relevant knowledge on how to act in a manner that will help them avoid possible infection. This is a bold initiative and we are willing to participate in getting the community directly involved in this undertaking. This will help in populating important information concerning healthy lifestyles. It is the intention of the ANC-led government to revitalise the infrastructure of the entire health system. This, among other points, is an acknowledgement that a lot still needs to be done.

Indeed, we believe that absolutely no force has the capacity to derail our progress. We are determined to achieve the best for our people.

Setswana:

Mo Tekanyetsongkabo e, re tlile go netefatsa gore go nna le tlhabololo ya maokelo. Re tobile tlhabololo ya mafaratlhatlha a tsa pholo kwa dinaga magaeng le metse setoropong, re lebile bogolo ditleleniki le maokelo. Re ikaelela go katisa le go ngoka baoki mme re bule dikholetšhe tsa ikatiso ya baoki. Kabo ya ditirelo tsa pholo e tlile go tsenyeletsa kwelotlase ya tshwaetso ya mogare wa HIV le Aids ka 50% go fitlhela tirelo ya pholo, botsamaisi le boetapele jo bo tlhabolotsweng.

English:

We have successfully rolled out the programme on the provision of ARVs at health facilities, though not at all of them. However, we still feel that we need to strengthen the capacity to monitor the side effects of ARVs. Linked to this is the need to create awareness, particularly in the rural areas. Again, we have scaled up HIV prevention and addressing the challenges of TB. In addition to these successes, we have reduced the child HIV infection rate through beefing up the prevention of mother-to-child transmission of HIV up to 95%.

Let me draw your attention to the strategic approach made in the White Paper of 1997 and the National Health Act of 2003. This approach has given meaning to bringing services closer to the people through the District Health System, which served as a vehicle for delivery of health services through primary health-care facilities like community health centres, fixed clinics, mobile clinics, health posts, satellite clinics and municipal clinics with limited packages.

It is very important to note that the district hospitals support the primary health-care facilities through doctor's visits and the supply of drugs as well as medical supplies. As part of overhauling our health system and improving its management, we are committed to ensure that the primary health-care services are delivered for eight hours, five days per week in small communities and all municipal clinics; 12 hours five days per week; 12 hours seven days a week; 24 hours seven days per week; and one day per month for mobile clinics and health posts.

We will have sleepless nights to ensure that the goals and targets we set for ourselves are realised. Our people deserve the best, effective and efficient health services and you can be assured that we are fully committed to provide.

Hon members will appreciate the fact that in 2008-09 alone, primary health-care facilities marked a 10% improvement. It is clear that follow-ups are pivotal in ensuring that there is adherence to directives for service delivery, especially on facilities designated to improve the health of our people. We are proud to have been in the forefront regarding the visits in question, and we will continue doing so as the ANC-led government, in partnership with the relevant stakeholders. Together, each achieves more. This will also inspire us to pull together for the common good of our society. Over and above that, we intend specifically to do the following to improve the quality of services to our people and also as a way of building on the achievement: do an audit on infrastructure, conduct an audit on primary health-care facilities and package health-care services, and ensure that human resources deliver the package of primary health care.

In conclusion, these are just a few of the plans we would like to put in place for the betterment of our services to the people of South Africa. We have invested in the passion that the ANC has for a healthy society - the Budget will be increased to achieve the goals of quality health services to our people. Our eyes are fixed on the best of the best for our people. I'm confident that as the ANC-led government we will achieve, irrespective of the size of the storm. Challenges define our determination to deliver and yes, we will finally make it.

The Divine Fellowship Ministry will be up heading a public testing campaign in North West, at Schweizer-Reneke in Mamusa. I shall be the first one there with them to test. [Applause.] I therefore challenge all Members of Parliament in North West to join me in their different constituencies. The ANC supports the Budget Vote.

Setswana:

Ke a leboga. [Legofi.]

Ms E MORE


Mrs M V Mafolo

Ms E MORE: Chairperson, hon Minister, Deputy Ministers present, hon members of the House and guests, I will focus on the primary health-care approach and the management and delivery of the district health system.

Hon Minister, health is a human right enshrined in our Constitution and is a priority for our nation. In 1994 in South Africa, the introduction of a model for a people-orientated health-care system and the mainstreaming of primary health care was a dream and an idea whose time had come. It signalled a dramatic shift.

The big challenge came when people needed to translate the national policies of the new government into effective practices to enhance service delivery. A lot has been said about hospital revitalisation, but primary health-care revitalisation is always in future plans. This is very weird, because it is the entry point of the entire health system in terms of a basic health approach and disease management. I believe that had we started with the revitalisation of primary health care, we would be far by now. We should have focussed on a preventive health-care system and not on the expensive, unsustainable curative health-care system we are currently running.

Health promotion and education should be delivered more through field work or mobile clinics. The national Department of Health developed a comprehensive and integrated package and a set of norms and standards. Fifty-three health districts were established and, as one of its priorities, the promotion of a healthy lifestyle was a critical programme. But, 14 years since democracy, and nine years since the comprehensive introduction of the norms and standards, the promise of primary health care in South Africa remains largely unfulfilled.

We still have problems, such as poor service delivery of basic primary health care; the lack of delivery of the very comprehensive services that we are talking about; low levels of managerial competence; poor referral systems; lack of accountability; and a misalignment of the policies with the management of primary health care. These are still challenges. A primary health-care audit was commissioned during 2007-08 to generate comprehensive information on primary health-care infrastructure and services. To date this has not been done.

Only now, during the 2010-11 to 2012-13 planning cycle, will the department conduct this audit. Does it mean the government has been allocating budget to district health during this time without having comprehensive information? This is unacceptable. The ANC-led government must stop postponing. Many processes are either "in process" or "in planning for the future".

More should be done because South Africa needs health services now. Monitoring and evaluation of the efficiency and the effectiveness of our system should be an ongoing process, not something to be done nine years later. South Africans do not want free primary health care services; they want access to free and high-quality primary health-care services.

According to the briefing by the Department of Health to the committee, there was a 10% increase in the number of patients accessing the primary health-care facilities between 2007-08 and 2008-09. But, the question remains, was this increase due to the beautiful services that we are offering, to the community having confidence in us as Department of Health, or is the increase due to the lack of health promotion and education and the increase in the burden of disease? The answer is that no analysis has been done to assess the reason for the increase. I think it is very important for such an analysis to be done.

Health care is not about numbers but about impact. It's about significant behavioural change, measurable reduction in the burden of disease... [Applause.] ...improving health conditions and securing better health for all.

New evidence indicates that access to public service remains a challenge to the poorest and the sick. The changing profile of disease and the rise in the occurrence of chronic illness continue to increase the demand on the primary health-care system.

The poorly managed and understaffed centres are unable to absorb the emerging pressure. The decline in life expectancy and high levels of maternal and infant mortality indicate the inability of the current district health system to cope with the needs. Challenges of quality and coverage of health remain, despite the structural transformations and reforms that had been effected over the past 15 years.

Hon Minister, the time has come to match words with action. The nation is looking to you, sir, to lead in delivering as promised.

Sesotho:

Batho ba kgathetse ke ditshepiso tsa bophelo bo botle empa ba sa bone tema. Letona, Setjhaba se a fela ha re phetiseng.

English:

The challenge to provide a qualityprimary health-care system in South Africa is a great one. This further compromises the ill health of patients and staff. Statistically, there is a huge disparity between the number of trained primary health-care nurses and the number of patients seen per day. The lack of resources, support and sustained and committed leadership at the highest level of government and medical establishment stifles delivery.

Careful consideration of the skills and competencies needed in the primary health-care system is critical to its success. This paralysis of strategic uncertainty and operational inertia cannot be tolerated anymore. The department needs more resources and systems to overhaul the delivery of health as a whole. A lot of money is wasted on consultants' fees and travelling. We need a fresh approach to explore the introduction of a "train the trainer" type of training programme in primary health care.

We in the DA firmly believe that no society can prosper without an affordable, high-quality and easily accessible health system. Such a system requires both a dependable primary care network that prevents diseases and treats minor illnesses, and a quality secondary and tertiary network to provide hospital-based care for more serious illnesses.

In conclusion, hon Minister, the district health system or primary health-care facilities are failing the health system as a whole and, as long as we do not fix the problem ... [Time expired.] Thank you. [Applause.]

Mrs T E Kenye


Ms E MORE

Ms T E KENYE: Chairperson, hon Minister and hon members, I wish to express my sincerest condolences to the family of the Deputy Minister, Comrade Molefe Sefularo. It is indeed a tragic loss for his family and the people of South Africa. We are grateful for his tireless efforts to improve health care, and we must all continue with what he has started. Hamba kahle, comrade.

It is not possible to reverse decades of inequity and oppression in such a short period of our democracy. However, despite this, the ANC-led government has achieved much since 1994, namely the expansion of free primary health care; an expanded health infrastructure; the building of clinics and hospitals; the ongoing revitalisation of health-care facilities; the largest antiretroviral, ARV, roll-out programme in the world; and numerous pieces of legislation.

Despite these achievements and improving access to health care, much more needs to be done to improve the quality of care that, in turn, ensures better health outcomes.

Our apartheid legacy left us with a fragmented, inequitable and fractured health system, creating enormous challenges to ensuring delivery of health care. A bold and more holistic approach is needed, hence the need for the National Health Insurance, NHI, for which the basis has been laid.

Further to this, the ministerial advisory committee, MAC, has been established, as envisaged in the National Health Act 61 of 2003. This will not solve our challenges but will assist in expanding the delivery of health services to our people. It will also create the public-private partnerships that are so necessary to achieve the kind of outcomes we desire and to which our people are entitled.

Members of the Portfolio Committee on Health will provide the support that the Minister of Health needs to advance the transformation of the health system and give expression to the ideas of the Freedom Charter and our Constitution.

The more fortunate should become more conscious of the plight of the 86% of our population who do not enjoy the benefits of medical aid. This consciousness or social solidarity must mobilise all of us to ensure that no one in South Africa is being deprived of the right to health care. [Applause.]

South Africa enjoys a much bigger health budget than most developing countries, but we are faced with the challenge of an increasing burden of disease, HIV/Aids, and our most regrettable legacy of apartheid - poverty.

The constant migration of people from rural to urban areas seeking work opportunities places an enormous burden on provinces to deliver services. This raises the question of creating a flexible budget that takes into account the migration issue, not only of our own people but of citizens from other African states.

The Department of Health, in motivation for Budget Vote 15, has given us their strategic plan. There are six programmes along with the key outcomes that are expected to be achieved. As parliamentarians, we must hold them to account and monitor their progress towards achieving these outcomes.

It is unacceptable for the Department to, year after year, receive qualified audits, while we acknowledge that there has been obvious improvements. As parliamentarians, it is our duty to ensure that this does not continue. We urge the Department to be open and honest with us at all times about the challenges it faces and which impact on delivery. There are plans to implement.

We have to work together to achieve the kind of outcomes we all desire. This can be achieved through open, honest and robust engagement with each other. After all, we are doing this for the people who gave us, the ANC, the mandate to implement our policies determined at Polokwane.

To achieve the desired outcomes requires greater leadership at national level. In this regard, the national level will need to focus its attention on placing greater emphasis on primary health care which will strengthen the district health system.

In 2008, the world celebrated three decades of the Declaration of Alma-Ata on primary health care. In the South African political context, this celebration had a profound impact, having seen the transformation of our country into a democratic dispensation where access to health care had been enshrined as a human right in our Constitution. Much has changed in the world since the signing of the declaration, and this has presented us with opportunities and threats also.

The transformation in our country affords us the opportunity to implement primary health-care policies and programmes that benefit our people. In whatever way we look at it, we are seized with the challenge of translating the democratic culture into community-based health-care delivery. It is clear that we need to merge modernised technical processes and aspects of primary health care with a humane, people-centred approach.

It is gratifying to see that there is an attempt at greater efficiency and providing a more cost-effective service through efficiency savings. The 2010-11 budget provides for a number of key policy priorities that will take the country forward to improved health care, such as expanding the treatment of HIV/Aids; ongoing hospital revitalisation; stabilising personnel expenditure; and addressing backlogs in the forensic laboratories.

Of utmost importance is the strategic health programmes that focus on HIV/Aids and TB control and management. Now, TB has its own complications of drug resistance, that is, multidrug resistant TB, MDR-TB, and extremely drug resistance TB, XDR-TB.

Another key objective is reducing maternal and child mortality and increasing immunisation coverage. Equally critical is reducing the malaria fatality rate. It is envisaged to reduce it by 1% annually. It is correct to acknowledge that there are many challenges to improving health care. At the same time, it is correct to also admit that with the Department's new 10 Point Plan, and through identifying key outcomes, these challenges can be overcome.

As parliamentarians given the responsibility of exercising oversight over the Department of Health, it is critical to discharge our duties diligently and without fear or favour. Working together, we can do more. This is what is demanded of us by the people who mandated the ANC to implement this policy that will transform their lives and lead to a better life for all.

Health care certainly has its own challenges. Recently, in March this year, there were threats of disruption of services due to the delay in implementing the Occupation Specific Dispensation, OSD.

Since 1996, the heath-care system in the country has continued to be underfunded with regard to its needs. The funding levels have failed to keep pace with current medical inflation, which is running at 10%; the growing population and emerging burden of diseases that is driven by HIV/Aids; noncommunicable diseases; and alcohol-related traffic deaths and trauma.

The unintended consequences of this scenario have been the ever-expanding unequal expenditure between the private and public sectors. In the public sector, this has resulted in the erosion of primary health care and district health services. The changing burden of diseases has exacerbated this and brought more pressure to bear on our primary health-care system.

What is also disturbing is the continued interdistrict funding inequity. In 2007-08, the district with the highest per capita budget expenditure was Namakwa in the Northern Cape, with R633 per capita expenditure as compared with the worst district of Lejweleputswa in the Free State, with R191 per capita expenditure.

We propose that more funding must be directed at primary health-care level. It is not only politically correct but more cost effective and makes a lot of business sense. When we are faced with challenges of financial resources, we need to do more with the little we have - that is the primary health-care approach.

The Department of Health conducted a 15-year review of the performance of the health sector and identified management and leadership at all levels as key witnesses. Another challenge is the appointment of permanent staff in senior management because we find people acting in a position for long periods. This causes instability in the system, which we can ill afford.

Having said this, we are certain that these challenges will be addressed and resolved. Therefore, we must work together, side by side, throughout our term for the betterment of the lives of our people until we achieve a better life for all. Therefore, the ANC supports this Budget. I thank you. [Applause.]

The MINISTER OF HEALTH


Mrs T E KENYE

The HOUSE CHAIRPERSON (Ms M N Oliphant): Hon member, I would like to apologise to hon members for calling the Minister before the hon member. I think old age is catching up with me. However, since we are debating health issues, the Minister can probably assist! I will now, therefore, call the hon Minister to respond. [Applause.]

The MINISTER OF HEALTH: Chairperson, let me start with Mrs More from the DA. I want to thank you, Madam, for being my disciple on primary health care. You really support it, but you have a funny way of expressing that. [Laughter.] You understand what is meant by primary health care. I hope you are going to work with us in making sure that the dream of primary health care lives on. Therefore, you will be our partner in that regard. I hope you do belong to the health committee so that you may go around with us. The issue of HIV/Aids counselling and prevention is also part of primary health care. I hope you will be in the forefront in the fight against HIV/Aids. Thank you.

Let me also respond to hon Dudley from ACDP. Madam, you know, it's a pity that Rev Meshoe has just left this House. I would have preferred to address you in his presence because he is the leader of your party. I'm not sure why fate has dealt such a heavy hand to the people of this country. During the week the Deputy Minister passed away, I phoned my parliamentary officer to ask him to make an appointment for me to speak to Rev Meshoe about you. I had an idea that you were going to do exactly what you have done. I wanted him to speak to you. Unfortunately, the Deputy Minister passed away and I stopped the parliamentary officer. I think you are beyond understanding. I want the leader of your party.

You see, you are not fighting, hon member. You are not only careless but you are also extremely callous and destructively reckless. You are not fighting, that was not the point. You are also not only fighting with the people of South Africa ... [Interjections.]

The HOUSE CHAIRPERSON (Ms M N Oliphant): Order, hon members!

Ms C DUDLEY: Hon Chairperson, I rise on a point of order: I'm sorry, it would be unparliamentary for the Minister to be calling me "callous" and the various other things he's been saying. {Interjections.]

The MINISTER OF HEALTH: Chairperson, I rise on a point of order: What she has done is callous and reckless, honestly. I did try that day to guide her, but it's a pity... You are not only fighting the people of this country, you actually want to murder them with what you are doing.

The HOUSE CHAIRPERSON (Ms M N Oliphant): Hon Minister, ... Yes, hon member?

Mr M J ELLIS: Chairperson, I rise on a point of order: The Minister is talking up there about one member wanting to murder people. Surely that has to be out of order and unparliamentary?

The HOUSE CHAIRPERSON (Ms M N Oliphant): Hon member, that is why I was calling on the hon Minister. Hon Minister, can you withdraw the word "murder"?

The MINISTER OF HEALTH: Okay, I withdraw.

The HOUSE CHAIRPERSON (Ms M N Oliphant): Thank you.

The MINISTER OF HEALTH: Chairperson, I want to tell her exactly what I'm talking about. The hon member accessed the internet and read half-baked information. The internet can be "garbage in and garbage out", if information is not synthesised.

What you have done is like shouting "Fire!" in a tree that is packed with children. There are examples of that all over the world. The issue of the side effects of medicine - I said this that day - is not something that is debated in Parliament. It is something that is decided upon by scientists who have been well trained, because these are very sensitive issues.

Two weeks ago I was with Lord Nigel Krisher at the British embassy. He was bemoaning the fact that one of these "internet scientists" posted a wrong statement on the internet that the measlesvaccine caused autism. Parents got scared; deadly scared. And the rate of immunisation in Britain, a developed country, fell by 15%. There was a measles outbreak because they believed that person.

As I'm standing here, let me tell you what happened in Nigeria. I thought you belonged to a Christian church, but it looks like there is a church called scientology. One of their members said exactly the same thing about the side effects of vaccinations. In Nigeria they spread the story that the vaccine caused infertility and will spread HIV/Aids. People boycotted it. Do you know what happened? In 2003, the rate of children with polio increased by more than 100% in Nigeria. You can go and check that because you like browsing the internet. It increased by more than 100% because of this issue.

As if that was not enough, a drug that was being tested for meningitis - not related to immunisation - caused certain side effects in some people. They related this again to vaccination. Then the religious leaders encouraged people to boycott vaccination. There was a health breakdown again.

When they lifted the ban in 2007, the number of children who had polio - remember that polio is a disability - declined by 80%. I am mentioning these facts because people believe. Lord Nigel told us that in Britain they even tried to call doctors to speak on TV to reverse the destruction, but they failed. People listen to you if you are a leader in government.

How do I describe a statement that a body like the World Health Organisation can be bribed? Do you know what that will lead to? This is the body which in 1970 eliminated small pox from all corners of the world through immunisation. The allegation that it is being bribed to take wrong decisions will kill humanity. That is what was just said; it's murder. If people lose confidence in the World Health Organisation, believe that it can be bribed and will send wrong vaccination into the whole world, what will happen to us? What will happen to us?

That is what I'm saying because these things come from the World Health Organisation. We learn from them and we emulate everything from them. If a statement is made by a Member of Parliament, people out there might believe it because they believe that if one is a Member of Parliament, one has something between one's ears. Then they will start believing and listening to you. That is why I said such irresponsible statements will lead to murder.

If we started talking about side effects here, do you know what will happen to human beings? Why don't you leave that to doctors? Even aspirin has very serious side effects, but is still given to people and doctors explain that to them. You don't stand up in Parliament and tell people that there are side effects here and this might happen to you. If they listen, it will lead to what happened in Nigeria and Britain. I don't want it to happen in South Africa. I don't want it. [Applause.] That is why I feel this is out of order. It's like saying, can somebody stand here and say an Act has been passed because Parliament has been bribed. Would you agree? Can you bribe Parliament? [Interjections.]

I am not talking about former President Mbeki; I'm talking about what that lady said. I'm not sure why you are involving him in this. All I'm saying is, if a member of this Parliament stands up, or somebody from outside said this or that Act has been passed because Parliament was bribed, what would happen to the country? Do you agree as Members of Parliament that you can't be bribed?

But you'll say so about the World Health Organisation; an organisation that is caring for the life of our people. Do you know how it works? They bring scientists from all walks of life. How do you bribe them? I think these wild statements must be stopped. Please, with due respect, this must be stopped. [Interjections.]

I don't want to bring up again what happened to the people of Nigeria but I think maybe we need to see a child with polio, measles, etc. How can this be said just after I have launched these campaigns? Just after I've launched such very big campaigns, statements like these are being made. [Interjections.] No, it's unacceptable.

The HOUSE CHAIRPERSON (Ms M N Oliphant): Order, hon members. Hon Minister, please take your seat for a while. The time is not up yet. I'm presiding here. Members have raised their concerns during the debate, and the Minister is responding to what members have said. If you don't want the Minister to respond, just say so and I will adjourn this House. Hon Minister, you may continue.

The MINISTER OF HEALTH: Chairperson, if hon Mike Waters could be honest with me, I raised this issue in the portfolio committee. When I was presenting my strategic plan, I said this carelessness must stop. Hon Mike Waters said they agreed with us that members must take responsibility because they will scare people unnecessarily. It was debated in the portfolio committee and I was happy for that support. Please, I don't want people out there to be given the wrong information about these sensitive issues. [Interjections.]

Hon Mike Waters, we actually agree with you on the issue of financial management. Coincidentally, just yesterday we had a national health council, where we adopted a financial management turnaround strategy. We are hopeful it will work. I also made an appointment with the Minister of Finance to call all the MECs for Health and MECs for Finance in all the provinces to sit down and look into these issues. We agree with you wholeheartedly that we will not be able to turn our situation around if we don't look at these issues. We are already implementing information from integrated support teams on this. We hope that it will go very well. We are also implementing the recommendation of the Accountant-General. The Accountant-General has sat with us and showed us some of these weak points.

We have even asked the national chief financial officer to form a team of chief financial officers to look into these issues. We really want to improve that situation. We agree with you wholeheartedly. How can you improve the health-care system if the financial management is not improving?

I also need to correct the issue of nursing colleges. It is not thisgovernment that closed nursing colleges. This happened in 1985 - and I know because I was a doctor then - when a decision was taken that all nurses must only train at university. It's not us. I stood against it at that time. I'm still against it and we are reversing it. Some of the colleges are already being opened. When I was still MEC of Education in Limpopo, I handed over two colleges to the Department of Health to use them as nursing colleges. This decision was taken in 1985 and it was a wrong one. That is why we are determined and busy reversing it. [Applause.] We are definitely going to do so. [Applause.]

The issue of human resources is a global problem. Believe me, the ministers of health in Africa have agreed that in May 2010 we are putting it before the World Health Assembly in Geneva. It must be discussed because it's a very big problem, especially the issue of doctors leaving developing countries for the developed world. However, I was surprised the other day when I was told that Canada has the same problem. They were saying - you know, it was a very strange statement - if it was not for South Africa, they would have collapsed because their doctors are leaving for the United States. That means it is just an issue of people moving from poorer countries to richer ones, where even Canada loses doctors to the United States and then has to rely on South Africa.

In that same conference of the World Health Organisation, a finger was pointed at me, saying that we are destroying the whole continent because doctors come to South Africa. Therefore, this is an issue that the world needs to look at. In fact, they are definitely looking at it and we are dead sure we will get answers. Thank you, hon Chairperson. [Applause.]

The HOUSE CHAIRPERSON (Ms M N Oliphant): Hon members, I wish to announce that there will be a sitting of the National Assembly at 14:00 tomorrow to debate a motion of condolence on the untimely passing away of the Deputy Minister of Health, Dr Sefularo. I also want to inform the members that the Extended Public Committee, EPC, on Labour will meet at 16:30 at E249, and the EPC on Transport will meet at 16:30 here in the Old Assembly. That concludes the debate and the business of this Extended Public Committee. This committee will now rise.

Debate concluded.

The committee rose at 16:17.

END OF TAKE


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