Hansard: Appropriation Bill : Debate on Vote No 16 –Health

House: National Assembly

Date of Meeting: 30 May 2011


No summary available.




Tuesday, 31 May 2011 Take: 53

TUESDAY, 31 MAY 2011



Members of the Extended Public Committee met in Committee Room E249 at 14:02.

House Chairperson Mrs F Hajaig, as Chairperson, took the Chair and requested members to observe a moment of silence for prayers and meditation.




(Appropriation Bill)

The MINISTER OF HEALTH: Hon Chairperson, fellow Cabinet colleagues, Deputy Minister of Health and other Deputy Ministers, hon members of the House, distinguished guests, ladies and gentlemen, it's a great honour and privilege to present to the House the national Department of Health's policy priorities and budget for the financial year 2011-12 for your consideration.

I am presenting this speech at a time when the health care system is at crossroads. We may choose the best route or the worst one ever, which will of course make our situation worse than what it is now. The choice lies with us as South Africans in general, and as elected leaders in particular.

Last year, I signed a performance agreement with the President in what we call Negotiated Service Level Agreement, NSLA. According to this agreement, the health sector must provide four identifiable and measurable outputs with the ultimate aim of ensuring a healthy life for all South Africans.

Over and above these four identifiable outcomes, which we have set ourselves to achieve, we also have a 10 point programme which I presented to this House in 2009. This plan further guides us on how to go about achieving our outcomes.

Extensive studies commissioned by the prestigious British Medical Journal the Lancet, but conducted by our own scientists and researchers in South Africa, has clearly revealed that South Africa is going through four major pandemics. Put differently, the country is faced with a quadruple burden of disease. It is important for members to understand what these four pandemics are, in order for them to understand how we arrived at the outcomes agreed upon with the President.

The first, most severe and extensive burden or pandemic is that of HIV/Aids and TB. The second is unacceptably high, and I emphasise, unacceptably high maternal and child mortality. The third is an alarming and ever-increasing incidence of noncommunicable diseases, that is high blood pressure and other cardiovascular diseases; diabetes mellitus; chronic respiratory disease; various cancers, as well as mental health. The fourth and last one is the one that every South African knows about because we worry about it on a daily basis because the media, both print and electronic, have taken it upon themselves that they will speak about it on a daily basis. That is the pandemic of violence and injury.

If only all four pandemics could be spoken about together on a daily basis, that would be a very good start for our country. Yes, I accept that some of the media and members of the public talk a lot about child mortality. But, they do not do so with an interest to help our country to achieve solutions to the four pandemics that our country is sadly faced with. They do so as an instrument to attack individual public hospitals and individual health workers in a form of witch hunting. Of course this is not helpful in our daily search for solutions for our country.

Having said so, these four pandemics are occurring in the face of a reasonable amount of health expenditure as a proportion of the Gross Domestic Product, GDP. Available evidence indicates that we spend 8,7% of the GDP on health, the bulk of which, as is commonly known, is unfairly spent in the private sector. This expenditure is significantly more than any other country on the African continent and in some instances even outside our continent. A serious anomaly here is that our health outcomes are much worse than those of countries spending much less than us.

Evidently, there is a very serious underlying problem that needs our attention. The effects of our burden of disease are clearly aggravated by inequitable distribution of human and financial resources between the public and private sector whereby resources are seriously skewed in favour of the private sector, which serves only 16% of the population, in contrast to the public sector which serves a whopping 84% of the population.

I will now go through these pandemics one by one because I want each and every member to understand fully what our country is faced with.

The first pandemic, as I said, that of HIV and Aids and TB, if I were to summarise it, I would say that we in South Africa are only 0,7% of the world's population but we are carrying 17% of the HIV/Aids burden of the world. We have got the highest TB infection rate per population and our TB and HIV coinfection rate is the highest in the world, at 73%. A total of 35% of child mortality and 43% of maternal mortality are attributable to HIV and Aids. One in every three pregnant women presenting at our public antenatal clinics is HIV positive.

Surely this needs very serious and extraordinary measures. Hence the announcement by the President, on the World AIDS Day in December 2009, came as a big relief to many people who are given the responsibility of fighting this illness.

These measures, of starting antiretrovirals, ARVs, when the CD4 count is 350 or less in pregnant women and HIV and TB coinfected people, of starting Prevention of Mother to Child Transmission, PMTCT, at 14 rather than 28 weeks and of treating HIV positive newborns regardless of CD4 count has gone a long way in reversing the tide of HIV/Aids. We started these measures in April 2010.

We are looking forward to a day, not very far away, whereby commencing treatment at CD4 count of 350 will be universal, and not only for specific target groups. This is imperative in light of the newly released research findings that starting ARVs very early has given huge benefits for prevention of HIV and for protecting individuals against TB.

Before these new measures were implemented, the scenario as of end February 2010, which is the end of the financial last year, was as follows: Only 490 health centres then were able to provide ARVs as accredited ART service points. I am very proud to announce that the figure has grown to 2 205 health care centres providing ARVs. This has increased access to treatment in a manner unimagined just over a year ago. Our target is that all 4 000 health care outlets should be accredited as ARV centres by the end of the year.

Only 250 nurses were certified to provide ARVs by February last year. Once more I am proud to mention that the number has now grown from 250 to 2 000 nurses who are certified and trained, further increasing access. Our target still remains 4 000 nurses to be certified by the end of the year.

Before the HIV Testing and Counselling, HCT, campaign launched by the President on 25 April 2010 at Natalspruit Hospital, only 2 million South Africans were testing annually. I am once more very happy to mention that since the launch of the campaign only a year ago already 11,9 million South Africans have tested and the figure is growing every month.

Many South Africans want to know their status. Hence, we will take the campaign further. I wish to announce that on 12 June we shall, together with the National House of Traditional Leaders and the Congress of Traditional Leaders of South African, Contralesa, launch a massive HIV Counselling and Testing Campaign at village level. The launch will be at Mafefe village, in Limpopo.

Before the campaign as at end of February 2010, we had 923 000 people on ARVs and now, due to the campaign and the increase in access made possible by the expansion programme I have mentioned above, 1,4 million people are now on treatment.

We have been able to reduce the prices of ARVs by 53%. The significance of this is that we can now expand coverage to treatment and put more patients on treatment. As we achieve universal coverage at 350 it means that a further reduction process will be necessary.

As part of our programme to expand treatment and in an effort to reduce the burden of HIV/Aids and TB, we will be providing treatment to inmates in all our correctional services, who have been diagnosed and put on HIV and AIDS and TB treatment. We will be working with the Department of Correctional services and have already signed an agreement in this regard.

I have time and again expressed my worry and regret at the number of newborns who are born HIV positive. It is a big strain on our emotions and the psyche of the nation and it causes untold problems with the health care system, as I have mentioned earlier.

I am, once more, extremely excited to inform you that in next few days, at the HIV conference in Durban, the Medical Research Council, MRC, researchers will release figures that show that there has been a significant reduction of transmission of HIV/Aids from mother to child by six weeks post delivery. It reveals that reduction of 50% transmission has been achieved. Of note is the significant reduction in the province of KwaZulu-Natal because of a very effective PMTCT programme there. This is to be celebrated because it is a first sign that by 2015 we may be able to eliminate the phenomenon of mother to child transmission of HIV.

On 24 March 2011, World TB day, I announced our three-pronged strategy to deal with TB. Firstly, we have acquired the new Gene Xpert technology. This total revolution in the diagnosis of TB is the first ever breakthrough developed after more than 50 years of relying on microscopy and culture. With the Gene Xpert technology, diagnosis of TB takes only two hours. It used to take up to a week. Whilst the microscopy method served us well for the past 50 years, its sensitivity was only at 72%, meaning that 28% of people with TB could be misdiagnosed or missed.

The sensitivity with Gene Xpert is at 98%, meaning that we may only miss 2% of the diagnosis. More so, it used to take us at least three months to know that a patient has multidrug resistant TB, MDR-TB. Now we are able to know that within only two hours. We have distributed 30 of these machines in districts that have high case loads of TB. We will be rolling these out to every district in the next six months and to every facility in the next 18 months.

The second strategy that we have implemented is that of active case finding for TB. We have put together teams of five people each, starting in February this year, to trace TB contacts, that is to visit families of patients on our database, who are being treated for TB. There are 407 000 such families in South Africa and all of them need to be screened for TB, in the light of our knowledge that every TB patient has the capacity to infect 15 others in his or her lifetime.

I am happy to announce that since we started these household visits in February this year, we have already visited 41 000 families and screened 112 000 people. Our aim is that by world TB day next year we should have visited at least 200 000 families.

It is important for me to disclose that in the past, before the advent of Gene Xpert technology, tracing TB contacts and screening them using ordinary microscopy, as we have been doing for the past 50 years, we would detect between 2 and 7 % of TB in the screened population. Since the introduction of Gene Xpert, in March this year, we are now detecting 18% of TB cases. The simple fact here is that we have been under detecting TB even when it was there. This means that we are now putting more people on treatment early on and reducing the pool of infective people. This means that we stand a better chance, more than ever before, to turn the tide against TB.

We know that it will mean more money from the fiscus, as it happened with HIV/Aids and more work for health workers in the initial stages. In the long run the amount of money needed, and the demand of work from health workers will be markedly reduced.

So, this is the miracle brought to us by Gene Xpert technology and house visits. May I add that we are the first country in the whole of Africa to have acquired this technology. [Applause]. Yes, you can applaud, it's not illegal. We wish to thank the World Health Organisation, WHO, for making it available to us and the United States Agency for International Development, USAID for helping us to acquire it.

The third strategy against TB is that we have unveiled nine specially designed MDR hospitals using technology from Council for Scientific and Industrial Research, CSIR. These hospitals, at least one per province, have been made possible by generous donation of R100 million from the global fund. This design markedly reduces the chances of health workers, particularly nurses, from being infected with MDR-TB by their patients. Unfortunately, patients have to stay for 18 months in these hospitals. Hence, it is imperative that we increase our household visits so that we stop TB from spreading and prevent our people from developing MDR-TB.

A lot has been said about the high maternal and child mortality in our country. You have noted that most of our interventions in HIV and Aids are directed at pregnant women and children. We will work hard to reduce these mortalities in these targeted groups. Remember that maternal mortality is not just death of a woman; but it is death of a woman because she dare fell pregnant. She becomes vulnerable by bringing somebody into this world. We know that even the mortality brought upon by HIV/AIDS is disproportionally affecting young women of childbearing age more than men. This can't be right. It leaves the country with lots of orphans. We now have no less than 1,3 million orphans in our country and most of them are maternal orphans.

This type of situation cannot be allowed to go on in. It has more negative societal consequences beyond health care, which is crime, poor educational outcomes, teenage pregnancies and abortions and total social disorientation of young husbands. It is a well known fact that young husbands lose direction in life if they lose their partners early on. This does not happen to women, of course.

Female partners are known to have a stabilising effect on the lives of young people. South Africa is fast losing this social stability due to the high maternal mortality, which according to evidence at our disposal affects the young women more than the older ones. We will have to run serious campaigns in immunisations. We also know that breastfeeding is a time honoured strategy in child survival, medical sciences has proven that. For this reason, we will call a big breastfeeding summit in August this year.

The issue of noncommunicable diseases is a very less spoken about in our country and it's our third pandemic. It is also not very clearly understood, even though it preceded HIV and AIDS by several decades. This is because HIV and AIDS came as such a shock to the whole nation, such that many strong civil society groups were formed.

Last week, I tried to bring this issue of noncommunicable diseases to members of the Portfolio Committee on Health, but unfortunately some people in the media got excited because they thought I was specifically raising the issue of dietary behaviour of Members of Parliament. [Laughter.] It is, therefore, very important for me to explain this matter clearly for parliament to understand.

Noncommunicable diseases, generally referred to as NCDs, are diseases that are not propagated by germs from one person to another. In fact, it is safe to say that the germ that propagates NCDs is the human being!

I am saying so, because NCDs are not only biomedical, but they are largely diseases of lifestyle. These are divided roughly into four categories namely: High blood pressure and other diseases of the heart and blood vessels; diabetes mellitus and a few other metabolic disorders; chronic respiratory diseases and asthma; the cancers and let me not forget mental health. I am adding to these the high increasing incidents of mental health. These diseases are driven by four identifiable risk factors. These are smoking; harmful use of alcohol; unhealthy eating behaviour, that is diet; lack of physical activity.

If these four risk factors and related unhealthy behaviours are removed the world would be a safer place to live in. The question is, just how serious is this problem of noncommunicable diseases? Is it global or is it only in a few countries? Well, the answer is it is a fast growing global phenomenon and becoming more devastating in Sub-Saharan Africa because it is adding to the already existing problems of communicable or infectious diseases that have been plaguing Africa for centuries.

So serious is the issue of NCDs that the WHO and the United Nations, UN, called all Ministers of Health to Moscow, on 28 to 29 April 2011, in what was called the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Conference. The outcome of this conference is a document formally referred to as the Moscow Declaration. I have decided to make copies of this declaration available to members. Even members in the public gallery must get copies of this declaration. It's important for humanity.

In summary, the Moscow Declaration deals with the following issues: It notes that policies that address behavioural, social, economic, as well and environmental factors associated with NCDs should be rapidly and fully implemented. It further emphasises that prevention and control of NCDs requires leadership at all levels. It recognises that a paradigm shift is imperative in dealing with NCDs, as NCDs are not caused only by biomedical factors, but are also influenced by behavioural.

The Moscow Declaration says that the rationale for action is that, worldwide, NCDs are important causes of premature deaths, striking hard the most vulnerable and poorest populations. Subsequently they impact on lives of billions of people and can have devastating financial impact that impoverishes individuals and their families, especially in low and middle income countries.

It goes on to state categorically that examples of cost-effective interventions to reduce the risk of NCDs which are affordable in low-income countries and could prevent millions of premature deaths every year, include measures to control tobacco, reduce salt intake and reduce harmful use of alcohol. It says particular attention should be paid to promote healthy diets, that means low consumption of saturated fats and trans-fats, salt and sugar and high consumptions of fruits and vegetables and physical activity in all our daily living.

According to the Moscow Declaration the control and prevention of NCDs needs the whole of government at all levels. Lastly it states that the effective control and prevention of NCDs needs the active and informed participation of leadership, individuals, families and communities, civil society, private sector, where appropriate, employers, health care providers and the international community.

It is with this background that I mentioned this issue to Members of Parliament last week. Unfortunately, they said I was mentioning it because there's some gravy train going on in Parliament. I want to state that this is a very serious matter, and it can't be turned into a circus.

Just to demonstrate what I'm talking about let me give you a few figures. In South Africa, for instance, out of 100 percentage points, the following points have been allocated by the MRC as risk factors in diseases: It says that as a risk factor unsafe sex is allocated 31,5 points; interpersonal violence - 8,4 points; alcohol harm - 7 points; tobacco smoking - 4 points; excess body weight - 2,9 points; childhood and maternal underweight - 2,7 points; unsafe water and sanitation - 2,6 points; high blood pressure - 2,4 points; diabetes - 1,26 points; high cholesterol - 1,4 points; low food and vegetable intake - 1,1 points; low physical activity - 1,1, etc.

Sometime in 2009 Members of this Parliament questioned me about renal dialysis for people with kidney failure. A wrong debate about why government does not increase the number of dialysis machines within public hospitals ensued. This is a wrong debate. It is no different from asking why government is not increasing the number of mortuaries in our country because they are in demand. The intelligent question we should be asking is why so many people need dialysis. In the Gauteng alone the total number of patients on chronic dialysis is 561, with 238 on the waiting list. This is in a province that is regarded as being well-resourced. What happens to the other provinces? A single patient on dialysis will cost R150 000 per annum in the public sector and about R300 000 in the private sector. More so, these patients have to be in hospital three times a week for a minimum of 4 hours a day, whether they are employed or not.

What causes this? We know that 40 to 60% of people with end stage renal failure it's due to high blood pressure at an average age of 39 years. What is the main risk factor for high blood pressure? It is smoking, lack of exercise and high salt intake. So, instead of demanding more dialysis machines and subsequently demanding new kidneys to an extent that the rich are trying to concoct schemes to steal kidneys from the poor, as it happened recently in our country, we must reduce the prevalence of hypertension by eliminating the risk factors.

The need for targeting tobacco and alcohol has already been outlined, no matter how much noise financially powerful people and institutions make about it, I can stake my life, we are going to fight with our bare knuckles to achieve this, particularly a ban on advertising of tobacco and alcohol. It is a point of no return and the sooner the tobacco and alcohol industry understand this, the better. There's no way of pulling back. [Applause.]

In South African, the average consumption of salt is 9,8 grams per day, when physiologically you need only 4- 6 grams. So, we are consuming more than two times the required amount. In Britain they have taken the lead. Since 2006, they have reduced salt intake in foodstuff by 40%.

In South Africa, scientists have demonstrated that if we reduce salt in just one food commodity, bread, we will save 6 500 lives per annum. In Britain, in just the second year of reduction of salt intake by 10%, they saved 6 000 lives and saved 1,5 billion British Pounds.

Another issue which is extremely important which ranks number five in the MRC, after unsafe sex, injuries and violence, alcohol and tobacco, is high body mass index or excess body weight. This coupled with lack of exercise, which is ranked as risk number 12, is very important. It is an international problem, so it is not only in South Africa; it is a fast-growing phenomenon. In South Africa, it is increasing amongst school-going children. In 2002 only 17,2% of school children were regarded as overweight, but it is now 19,7%, 2008. This means that those who moved from being overweight to being obese were 4% in 2002 and they are now 5,3%.

What this means is that presently 23% of school children can be classified as either obese or overweight. This is fast approaching a quarter of the school-going population. Consequently there will be devastating on the population. In the general population the national income dynamic study shows that 60% of women and 35% of men are either obese or overweight. If you consider women over 37 years the figure rises to 70% of women who are classified as either overweight or obese. This is why the Moscow Declaration is so important.

Let me give just one example from Australia. They have agreed to ban advertising of foodstuffs on free to air TV from 18:00 to 09:00 and 16:00 to 09:00 on weekdays. On weekend mornings when children tend to watch more TV, they have banned it from 06:00 to 12:00. On children's programmes, like cartoon networks, they've banned advertising of these foodstuffs altogether. Eighty-six percent of Australians agree with this. [Applause.]

On the issue of injury and violence, Unisa, together with the MRC, has proved that while when we talk about arrive alive we only talk about those who have died, they have proven that for every person who dies of injury, 30 times more are hospitalised and three times more are treated for less serious injuries and discharged. It further states that depending on the cause, severity and circumstances of the injury, many of these results in varying degrees of physical, psychological, educational social and economic disadvantages.

I know that many people believe that the speech will not be complete until I have spoken about the National Health Insurance, NHI. There are two groups of people in this case. There are those who very much concerned and legitimately so, there are also those who are driven by greed that will shame even the devil who believe that they can do everything in their power to stop the NHI. I just want to mention that we haven't stopped; we are very busy. But, the present health care system, whether public or private, can be identified by four very clearly identifiable negatives.

Firstly, it is extremely unsustainable; secondly, it is very destructive; thirdly, it is extremely costly; fourthly and lastly it is hospicentric or curative. We are going to make sure that we re-engineer the health system into three basic streams – at the district level, in the community and at school level. I will give you the details later.

The TEMPORARY CHAIRPERSON (Mrs F HAIJAIG): Hon Minister, your time has expired.

The MINISTER OF HEALTH: Can I just then request this House to adopt the departmental budget for 2011-12 amounting to R25 307 554? Thank you. [Applause.]




The TEMPORARY CHAIRPERSON (Mr M C MABUZA): Hon members, we thank the Minister in particular for making us aware of obesity, we fight the same bat in karate.

Dr M B GOQWANA: Chairperson, hon Minister, Deputy Minister, I see there are a lot of people from the entities that have to do with health. We welcome you. I see there are deans and the chairperson of the Health Partners South Africa, HPSA, is here. Director-General for Health, DG, this is the first budget probably that the ANC feels that it must be passed and this is the first time that you are here with us. We are hoping that you are going to handle this budget very well and we congratulate you for being appointed to be the Director-General for Health and we welcome you.

Let me start from the beginning. We are overseeing a department that I think is very important. It is important in the sense that all of us here and all over the world, the first entry to this world is through health and we exit through health. What the health workers and the department is doing is trying to increase that gab between entry and exit. If you want to do it well it has to be done by people that are honest, humble, and passionate and that are working with integrity. If you happen to make a mistake obviously you shorten that gab between the entry and the exit.

Last year we voted a certain amount of money to the department and we gave them the money under the umbrella of hope, hoping that they were going to do the things they said they were going to do. I must say we commend the department. The department and its leadership did exactly what they said they were going to do. We commend and are happy with how they have done things. We have seen drug prices and I am sure all of us have seen that they have dropped especially the HIV and the antiretroviral, ARV, drugs.

We have seen medical schools getting more money to make sure that we produce more doctors, more nurses and more health workers. We have seen Medunsa becoming a stand alone as against combining with other universities and a new medical faculty going to come out from Limpopo. We have seen plans to upgrade five big hospitals including Mthatha General Hospital and some hospitals which I am not going to mention because of time constrains.

We have seen hospitals and clinics being built even one Multidrug-Resistant, MDR, Hospital in KwaZulu-Natal, KZN. We have seen people testing for HIV and Aids without fear because of the HIV Counselling and Testing, HCT, that have been started by the Department of Health. We have seen HIV positive patience, babies and mothers with CD4 count below 350 getting antiretrovirals, ARVs. While we applaud that they are being treated but more than the treatment they are getting the most important thing is that those people that are on ARVs, their viral load drop so low that they can't infect the people they go out with or what ever they do because of the viral load that becomes low.

We have seen primary health care being prioritised by the department and in fact being re-engineered. In KZN we have seen people that are walking from house to house doing primary health care. We have seen the GeneXpert that the Minister was talking about. All these things were done by the department in the budget that we have given them, which is why we commend the department. We have actually seen the nursing summit that was hosted here in South Africa boosting the moral of the nurses making them stay in South Africa and probably contributing in a very high moral in what we are doing in South Africa.

We have seen auditing of the chief executive officers, CEOs, though we have not received the reports. We have seen auditing of the nursing colleges in South Africa. We commend the department. Though we are happy with the budget that we have given you Minister and the department, we are not oblivion of the fact that there are still huge challenges that are facing us. These challenges obviously some of us we know them. The quality of our health care, there is still a lot that needs to be done, but we know the department is doing something about it.

The child mortality and the challenges that go with it is still a very big challenge. Even maternal mortality, the challenge of the burden of tuberculosis, TB, HIV, the non-communicable diseases that we have talked about is a very big challenge. The bottom line to all this things is that if we can have the universal coverage that is going to cover everybody obviously that will help us in making sure that everybody is covered and all this challenging things are going to be sorted out.

We have seen human resource shortages especially in the rural areas Minister, I nearly said Madam Minister I am sorry, Minister. I have forgotten the past and we have seen universities trying to help in this regard of shortages. There is one challenging thing the interface between the public and the private probably we have not done very well in looking at the private health care system but this is something probably we have to work on. Not in a bad way but in a manner that everybody gets coverage as a person.

Another challenge Minister, which I think we have a policy on. I think we are talking about resistance with the antiretrovirals but we should considering resistance with antibiotics. It is so easy for any doctor to prescribe antibiotics and that causes a problem for the whole country and in fact my self included if somebody tells me that I have flue it's so easy for me to prescribe antibiotics.

We are going to rich a stage where we are not going to have any antibiotic that is working in South Africa if we don't develop a policy. Not only with the antibiotics even the veterinary surgeons they need to assist us because they give antibiotics to animals and those animals we it their meat which have those antibiotics and we end up eating it. So when that policy is made we must make sure that it is combined with the veterinary surgeon.

The other challenge is about the traditional healers in South Africa. [Laughter.]

The Temporary House chairperson (Prof L B G NDABANDABA): On a point of order: Speaker, not a Madam.

Dr M B GOQWANA: Ok, maybe I like the 50% and I go by a 50% so I like the madams. Another challenge is the traditional healers. I am not going into details about the traditional healers. I am going to say two things about them that, as the committee we need call them because we need to understand the way they do things. I want to say a big percentage of South Africans are attending them. Either "Nichodimusly" or during the day, but a lot of us are attending them.

The second thing that makes me to talk about them, my background is from the conventional or the western medicine, but I want to say I am a descendant of Sotjhenge, of Malalaza, of Sibakhulu, of Dlamini, of Solomon. On the other side I am descended of Khuboni, of Bhele, of Langa, of Nodoli. I am saying this for those people's names that I have mentioned were there before 1652. Before 1652 there were no conventional medicines or western medicines. [Applause.] The fact that I am here standing in front of you does not mean they never got ill. At some stage they got ill. The fact that I am standing here it means that somebody treated them well at that particular time. So that is why I am standing in front of you, if that be the case then it means there are good traditional healers. The question is do we know the good ones and do we know the bad ones. I think that is the challenge. [Applause.]

Chairperson, solutions to a problem usually brings a challenge another challenge it is not a matter of not acknowledging the solution even if there are challenges brought by the solution. I want to say what they are saying is that the child and maternal mortality have increased in South Africa.

What they are not saying is that the statistics that we do today covers every corner, unlike during the apartheid time, when statistics was only for the homelands when they wanted to bring down things but we cover every area in a very honest fashion. What they say is that there is a shortage of personnel in our institutions. What they are not saying is that our personnel that we train is too good in so much that it is wanted by the whole world especially the developing countries. What they are not saying is that because of the good clinics and hospitals that have been build that has outgrown the number of personnel that is there, but it does not mean that we are not actually handling that situation.

What they say is that in 17 years there is very little done by the ANC but what they are not saying is that 17 is not even a quarter of 300 years of indignity, disposition, dehumanisation and oppression. That calls me to say, lets not be derailed by those who do not recognise the challenges we are trying to sort out but let us be focused and endeavour to make sure that we go forward. I want to say I am a descended of Dlamini. Thank you. [Applause.]



The TEMPORARY CHAIRPERSON (Prof L B G NDABANDABA): We thank the hon Dr Goqwana, who has reminded the House of many things about our roots. Our next speaker is hon Waters, for 10 minutes.

Mr M WATERS: Thank you Chairperson. It is very refreshing to tell the Minister that he is passionate about health and has got his finger on the pulse. I have been on the Committee for several years and I come from the dark days, when we were in the Health Committee. So, I would really say it is a professional Minister.

I like to welcome the appointment of the Deputy Minister. We have not actually formally met but welcome Deputy Minister, and we wish you all the best in your position. As well to the DG, sitting behind me, welcome DG, with your appointment to the department.

In last year's budget speech, I raised the issue of the dire financial situation many provincial health departments find themselves in. It is still unclear if there has been any improvement in the situation. Hopefully the Minister can shed some light onto the matter, as to why the need for the stabilisation funds and which provinces will be benefitting from it? We need to know how the situation is being managed and obviously we need complete transparency in this regard.

Hopefully the Chief Financial Officer, CFO, will now be appointed permanently; not acting. I think she had been acting now for about two or three years, Minister.

Today I will speak on a few of the pandemics the Minister raised in his speech, and unfortunately due to time constraints, I will not be able to touch on all of them. Our country Achilles heel is now undoubtedly our shocking child and maternal mortality figures which the Minister has mentioned. Our inability to save the lives of mothers and children is an indictment on how we have prioritised the Millennium Development Goals since they were first set some 11 years ago.

When one in ten children will not live to see the fifth birthday, it surely must have the alarm bells ringing and serious questions need to be asked as to why a country with our infrastructure and budget will in all probability fail to meet our Millennium Development Goals, MDGs, while countries with far less resources have left us wanting and will reach their goals.

In 1998, our under five mortality rate was 59 per 1 000 or that is 5,9%. In 2010, it has risen to a 104 per 1 000 or 10,4%. That is a massive 76% increase in the very period we were, as a nation, supposed to be working tirelessly towards reducing child mortality and achieving our MDG target. Our target by the way is 20 deaths per 1000; that is 2%. Meaning our current child mortality rate is five times higher than it should be.

The situation with regards to maternal mortality is far less uncertain, simply because 11 years into the MDG programme we still have not determined a uniform measuring tool for maternal mortality. The most obvious cause of action would have been back in 2 000, to establish how we were going to measure our maternal mortality rate in order for us to measure our maternal mortality rate in order for us to track our progress and monitor our interventions.

Without the standardised measuring tool one wonders how the government was going to measure with any form of accuracy if we were on track to meet our goal. According to our own country's report, our maternal mortality rate has increased from 369 deaths per 100 000 live births in 2001 to 626 deaths per 100 000 in 2007. This is a 70 % increase. Our country's target is 38 out of every 100 000 deaths. So, we are currently at 16 times higher the rate.

While the department may dispute the figures in the country's report, saying it is not as high as 626 deaths, we actually do not know what the actual figure is. Why are we facing such a dramatic increase in child and maternal mortality rates? When the Minister came before the Health Portfolio Committee last week, and today, he repeated a lot of what he said to us. It was clear that the department sees Human Immunodeficiency Virus, HIV, and Acquired Immune Deficiency Syndrome, Aids, as one of the main reasons for increased child and maternal mortality.

It is evident that the number of people dying in the prime between the ages of 20 to 40 years is increasing year on year, and that the majority of these people are women. In essence, HIV Aids is a gender biased disease. It affects more women than men. The Minister also attributed the doubling of the number of deaths in South Africa over the past decade to Aids and stated that there were roughly 1 000 deaths per day due to HIV Aids.

Let me be clear when I say this. Individuals must take responsibility for their own health, and remaining HIV negative is one such responsibility. Similarly, if a person is HIV positive, then living a healthy lifestyle is to that individual's responsibility.

However, one has to look deeper in order to understand why was it that the HIV pandemic managed to obtain such an iron grip in our country, and why so many people not only became infected, but ignored sound scientific evidence. Unfortunately you do not have to look too far.

Do you all remember the decade of denialism? The decade of denialism is not the only reason though for the spread of HIV in South Africa, but it certainly is one of the major contributing factors that we live with today. Do you remember when the President of our country questioned the link between a virus and a syndrome?

When Health Minister said – no, not you Minister, the previous Health Minister said – that ARVs were poisonous! When concoctions of lemon juice, beetroot and garlic were promoted; instead of approved medicine. Some of you remained silent during the decade of denialism. He has got a mouth now!

Every crack in the world was allowed to promote their deadly untested portions with impunity. I do, and so many of you in this House remember that. We must never again be intimidated into silence like we were during the decade of denialism. Never again! [Applause.] So, I am glad to see hon Turok has found his voice.

We are now witnessing, firsthand, the consequences of this denial through the 1 000 deaths per day, and the increased child maternal mortality rates. Our health system is creaking under the additional pressure placed on it, and it is simply not coping. In addition, we now have according to the government's own report, 2,1 million maternal orphans. I know the Minister mentioned a figure of 1,3 million. Whether is 2,1 million or 1,3 million, the figure is; it is a disgrace!

We have 870 000 double orphans - meaning that they have lost both mom and dad - in this country. While nothing will bring back the hundreds of thousands of people who have died from Aids, an apology and recognition of our failures will be a start. There is a great relief that the decade of denialism s over and that some proven scientific evidence is an order of the day.

While recognising the immediate past, we must now as MPs and society as a whole join hands in combating the scourge once and for all through supporting the efforts of what the Minister has mentioned here today, and what the department is trying to achieve in breaking down the walls of stigma and ignorance. As I have said, we must never again be intimidated into silence.

The DA welcomes the initiatives announced by the President last year, Minister, on World Aids Day, and would encourage that the department looks at the recommendations of the latest report which we alluded to that suggest that by hitting hard and hitting early, we can combat the scourge of HIV Aids.

Another consequence of the HIV pandemic is that of Tuberculosis, TB, which the Minister has also mentioned. It has become the biggest natural killer in South Africa. Today, we have one of the highest rates of TB in the world, with over 74 000 people dying of TB in 2008, up from 22 000 dying of TB in 1995; that is a 339% increase.

It is estimated that over 480 000 South Africans are infected with TB and that we have 28% of the world's population with dual HIV and TB infections. In general, South Africa is not succeeding in getting TB under control, which is clearly demonstrated by cure rates which remain below the World Health Organisation, WHO, target of 85%.

Progressively increasing incidents and prevalence of Multi-Drug-Resistant Tuberculosis, MDR TB, and Extensively Drug-Resistant Tuberculosis, XDR TB, are also reported. If cure rates are not at least 85%, then the residual and treated TB which exist in communities will be spreading to more people. Rather than being brought under control, what we are doing by not having cure rate of 85% is basically breeding TB rather than curing it.

There are many factors that need to be addressed in order to improve cure rates. One important one is that South Africa is achieving quite well is that in the case of detection rate, which the Minister has alluded to.

South Africa also has good treatment regimes and good approaches to isolating and treatment resistance of TB, MDR and XDR. Where we are weak is around treatment adherence support. The World Health Organisation standards are DOTS, which South Africa has implemented relatively well.

However, despite good DOT coverage, we are not seeing improved outcomes. Many agree that this is because patients do not take their medication correctly and do not complete their course.

Government has invested heavily in infrastructure development, for example, the new TB hospitals which the Minister mentioned. However, these hospitals focus on treating the failure of TB control and do little to improve broader cure rates. The DA believes improving cure rates rests primary on improving treatment adherence, which requires two fundamental areas of investment.

Firstly, better DOTS, which is not only training but far more regular meaningful mentoring. Secondly, building better relationships with patients. In conclusion, I reiterate the DA's commitment to fighting HIV and associated consequences. I thank you very much. [Time expired.] [Applause.]



Mr D A KGANARE: Chairperson, Ministers and Deputy Ministers present here, hon members of Parliament; this Budget Vote takes place when the health challenges are immense and requires progressive resolution. For us to assess progress, we have to look at challenges, compare achievements and chart the way forward to ensure that the challenges get reduced. We also have to assess whether the budget allocated will enable the department to put a dent on the health challenges facing the country.

In dealing with the health challenges, we should be guided by the Freedom Charter which states that and I quote:

"A preventative health scheme shall be run by the state; free medical care and hospitalisation shall be provided for all; with special case for mothers and children."

I'll deal with you later. [Interjections.] In addition, section 27(a) of the Constitution state that and I quote:

"Everyone has a right to have access to health care services, including reproductive health care."

Some of the challenges can be summarised as poor response times by ambulances, lack of staff in hospitals, shortage of medicine and lack of appropriate equipment. At the workshop held in Johannesburg on the planned National Health Insurance Scheme, the participants raised concerns about too many a times patients' lives are put at risk by public health institutions. At the same workshop, stories were told about hospitals with new equipments but none of the staff knew how to use them.

On 17 August 2010, hon Minister, I wrote you a letter concerning the bad treatment of the patient, Ms Eunice Thembani, received at Worcester Hospital. Hon Minister, you neither bothered to aknowledge receipt of such letter nor even respond to it. I don't know what to make of this but probably that is how ANC defines democracy; which is the government of the ANC by the ANC for the ANC.

Whilst on the issue of women and children, the private hospitals have created a new industry; birth by caesarean section. Despite the World Health Organisation stating that caesarean section should be performed only as a life saving measure when there is a risk of foetal or maternal death. There are gynaecologists who allocate a day weekly just to perform caesarean sections. Apart from this being driven by greed, it is a violation of women's rights to a noninterventional normal vaginal birth.

This is done in private hospitals because they believe that what they do in their hospitals is their business. Since the hon Minister is the Minister of Health and not the Minister of public health, I therefore call upon you to monitor this unethical conduct of private hospitals and take appropriate actions in this regard. I will not even talk illegal body parts transplants which have been well reported by the media. Maybe, the Portfolio Committee of Health should start making the private hospitals to account about these unethical activities.

I hope that the establishment of the office of standards compliance will ensure that private hospitals are also monitored and evaluated as public facilities will be. One of the most serious challenges is the shortage of staff. The department should develop a clear human resource human resource development strategy with clear achievable targets. This strategy is long overdue, after more than 16 years of democracy; we don't have to wait for 300 years.

The President in his state of the nation address emphasised the training of doctors and nurses, as well as the revitalisation of 105 nursing colleges and refurbishment and renovations of hospitals and clinics. This should be one of the department's performance indicators.

The infrastructure development is vital because the Treasury report highlighted the programme to upgrade existing hospitals as one of the most disappointing projects. Though they overspent on staff, the nine provincial health departments together left a quarter of the capital budget unused. The hon Minister has, in this regard, been quoted saying and I quote:

"In February, this year, R813 million of the infrastructure money could not be spent and had to be taken back to Treasury. It's a tragedy that we are faced with; it needs an urgent solution."

Hon Minister, the solution must be provided by yourself and your colleagues in public works.

I'm raising this because if one goes to the Chris Hani Baragwanath Hospital, one finds committed and determined management and staff until one goes to wards. At these wards, the roof does not only leak but one can lie in bed and clearly count stars on a clear night. The staff can do nothing about this because it is due to the failure of public works to perform, despite the availability of funds.

This leads me to raise the issue of security at public hospitals and clinics. Hon Minister, I asked you a question for a written response concerning security at the Dr James Moroka Hospital in Thaba Nchu. Whilst the question is specific, it represents a general concern about at all our health hospitals. The question is: Are we waiting of what happened at Pelonomi Hospital to happen before we do anything? At Moroka Hospital, staff and patients are at risk. On a month end, Saturday evening, drunken hooligans can get in and out of hospital threatening staff. At the gate, one person is clearly waiting for pension and is more like a gatekeeper than a security and expected to provide security for the whole hospital.

I am aware that the bulk of the budget will be transferred to provinces and municipalities. This transfer should be monitored and necessary intervention be taken where lapses take place. That's why Cope believes that the whole Eastern Cape Department of Health should be under administration. Hon Minister, this province is in crisis and requires urgent intervention. The fact that it does not appear in the media regularly, it does not mean that all is well.

I wish to thank the director-general and her staff for the manner in which they interact with the portfolio committee. In this regard, I wish to congratulate the hon Minister for the good appointment. I also wish to thank all the other institutions which appeared before the portfolio committee during the previous year. I thank you. [Applause.]



Mrs H S MSWELI: hon Chairperson, adequate health care for all citizens is paramount in any country in the world. In South Africa and during the current Medium-Term Expenditure Framework, MTEF, period the department is aiming to level the playing field by providing equal levels of healthcare to all by reducing inequality in the health system increasing and improving the quality of care and public facilities. In order to achieve these aims we are spending a greater percentage of our gross domestic product, GDP, on health than any other Brazil, Russia, India and China, BRICs, country, and yet we still score worse on indicators such as tuberculosis and mortality rates.

Our hospitals remain ill-equipped or damaged equipment. Sanitary conditions in most of our hospitals are below standard and this has in many instances led to the deaths of infants and adults. Whilst we are making progress in the fight against HIV and Aids, the question must always be asked: "Are doing all that we can". We applaud government's turnaround in launching national HIV counselling and testing campaign last year, but we still have much to recover. Nearly one in three women aged 25 to 29 and more than a quarter of men aged 30 to 34 are living with HIV. National proportions indicate that between 17 and 19% of the male and female population aged 15 to 49 are HIV positive.

Anti-retroviral, ARV, medication must be provided to these people and we urge the department to set a goal that triples the current number of people on ARV medication by 2015. HIV/Aids also hinder us in our efforts at the eradication of most sinister of illnesses. We want to see greater efforts by the Department at Community level and strengthening of critical health systems at a national level. In Khayelitsha in the Western Cape 73% of HIV infected residents also have tuberculosis making these two diseases jointly one of the greatest scourges we have ever faced in this country and every effort should be made to eliminate them from our population.

We now have young women resorting to the practice of abortion as a form of birth control. The results from this practice can be disastrous and potentially harmful both physically and psychological to the mother and we wish to see far greater initiatives by the department aimed at educating our young adults against this practice and potential health risk associated therewith. Within the department itself, the IFP like to see the implementation and adherence to strict governance and accountability measures and the improvement of primary health care services.

In conclusion we wish the Minister and her department every success for 2011. The IFP supports the Budget Vote.



Mr M H HOOSEN: Hon Chairperson, allow me to firstly to thank the hon Minister for her frank assessment of some of the challenges that lay ahead of this department. Whilst we recognise the many advances that I have been made, there is indeed much work that needs to be done in order to provide the more effective and quality healthcare service especially to the very poor in our country. Our public healthcare sector remains largely creative in nature and more attention must be focused on prevention.

This recognition has to be the first step in building a healthier nation for the future. Inline with our belief that health education forms the cornerstone of any preventative healthcare strategy, we must advocate for greater investments in preventative of healthcare whilst at the same time addressing the current challenges in reducing the burden of disease.

We are encouraged by the mass education campaigns on tuberculosis, TB, and the immunisation of children across the country. The outreach programmes to conduct home visits for TB testing is a positive step but there remains insufficient treatment centres to arrest the spread of TB. Whilst the establishment of new TB centres is a step in the right direction, the more we test, the more we will have to treat. Notwithstanding all of these entire positive measures, South Africa still remains as one of the leading countries in the world in respect of TB infections.

Unless we make a greater investment into a vaccine for TB, we will continue chasing a moving target. In a recent presentation the Portfolio Committee, South African TB vaccine initiative, who are the world leaders in research and development of a TB vaccine, estimated that we could have a vaccine by 2016, if we make a greater investment into the research. This disease is more prevalent in the poorest of communities. They are the most vulnerable in our society and we must therefore make much a greater investment into TB vaccine research and development.

The impact of alcohol abuse in our country significantly impacts in our ability to address the huge healthcare challenges, especially in relation to HIV/Aids, TB and other diseases. Irresponsible behaviour linked to the high rates of alcohol abuse contributes directly to the violent crime rate, high vehicle accident rate and many other social contact crimes. In the end, the public healthcare sector has to shoulder all the burden of treating millions of South Africans who are victims of crime as a result of alcohol abuse.

The millions of rands that we spend annually on alcohol related trauma treatment, could have been better spent on reducing our burden of disease and building a healthier nation. We must therefore continue to advocate for a most sober society and fight alcohol abuse with the same vigour as we do on smoking. In closing, with today being World No Tobacco Day, the WHO organisation estimates that in about ten years time, smoking will kill more people than HIV/Aids, TB, car accidents, suicide and murder combined. The ID would like to add its voice to support the initiative to encourage more South Africans to abstain from smoking for at least 24 hours. I thank you.



Ms M C DUBE: Hon Chairperson, hon Minister and Deputy Minister, hon Members of Parliament, ladies and gentleman, let me start by saying the ANC supports the budget. Accelerated work must be undertaken to further revitalise and improve our public health care system and to attend to the intense pressure and challenges facing health services. Intervention must include appointing qualified personnel and improving infrastructure, such as rebuilding dilapidated clinics and hospitals.

I want to talk about noncommunicable disease. When we are hungry we buy food to eat; if we are looking for entertainment, we watch movies and go to our friends and chill around for some stuff which is bottles of something. But, when we fall ill, we all don't have a choice but go to a doctor. However, unlike food and movies, no one really enjoys getting sick. There is wisdom in the old saying: "Prevention is better than cure".

To improve the health status of the population and achieve the health-related Millennium Development Goals 4,5, and 6 which are reducing child mortality, improving maternal health and combating TB, malaria and other communicable diseases, it has become more urgent and critical to intervene to reduce child mortality and maternal mortality rates which are unacceptably high.

The ANC government is working hard to ensure an uptake in the Prevention of Mother-to-Child Transmission of HIV, the main cause of child mortality. Strengthening community organisation and mobilisation is central to ANC-led government efforts to improve the health status of all South Africans.

The ANC government will continue with existing campaigns and develop new ones, whilst overseeing, implementing and monitoring them. This is part of raising awareness and informing the public about changing harmful practices and adopting protective practices, including antitobacco, anti-alcohol and substance abuse campaigns. Mobilising the community to adopt healthy diets, exercise, encourage pregnant women to use Prevention of Mother-to Child Transmission and encourage people to get tested for HIV, high blood pressure and diabetes.

The existing national drug policy and strategy is undergoing review so as to support effective implementation of the National Health Insurance, NHI, and strengthen the managerial and technical capacity of government. Government should conduct the feasibility surveys for the establishment of a state-owned pharmaceutical company. Government will continue to invest in research and development in the health sector, including infant mortality research, HIV prevention technologies, health status surveys, development of new medicines and indigenous knowledge systems.

The ANC has an enormous responsibility, as the leader of the society and as the only organisation capable of uniting all the people of South Africa around a common vision, to encourage people to adopt a healthy lifestyle. I am confident that we can control obesity in South Africa. Obesity is the second most important cause of global mortality and mobility after smoking and both of them are preventable.

The pursuit of household and national food security is a constitutional mandate of the ANC government. We have to create an environment which ensures that there is adequate food available to all, now and in the future and that hunger is eradicated. The ANC is already putting in place an emergency food relief programme on a mass scale, in the form of food assistance projects, like soup kitchens, to the poorest household and communities. This programme will be linked to existing mass mobilisation activities on the ground.

I, therefore, call upon government and social partners to absorb and apply cost-effective interventions at individual and community levels with a view to addressing preventable diseases. Actions recommended include embarking on methodical awareness campaigns; spreading the word diligently; sensitising people to the importance of healthy diet and exercise; building capacity for overweight, high blood pressure, diabetes, ulcers, asthma, cancer detection, prevention and treatment thereof; implementing and scaling up early detection, interventions and providing adequate treatment, including paying attention to patients wellbeing and spiritual support.

All members of society should protect their own health by preventing the aforementioned disease, seeking the right information on risk factors, avoiding occupational and environmental hazards and taking part in decision-making on all issues that affect their health and their families. Lack of knowledge is leading to the causes of chronic diseases. Public education and awareness is critical in our fight against chronic disease.

I want to encourage all South Africans to go for regular health screening. Our government is encouraging people to know their health status by testing for blood pressure, glucose levels, cholesterol, etc.

I am heartened that the ANC-led government is concerned about the impact of breast cancer on females. Through the various initiatives undertaken since the dawn of democracy in South Africa, we have made significant progress in the fight against breast cancer. Unsafe food causes many acute and lifelong diseases, ranging from diarrhoeal diseases to various forms of cancer.

In health, progress has been recorded through the expansion of free primary health care. We have expanded health infrastructure, including the building and upgrading of 1,600 clinics and 18 new hospitals. Many public hospitals have been revitalised and refurbished. We have increased the antiretroviral treatment roll-out programme with more than 480 000 people enrolled. There were a number of successful initiatives to combat smoking.

The ANC government is expanding access to food production schemes in rural and semi-urban areas to grow their own food with the implementation of food gardens, and by providing tractors, fertilisers and pesticides. Other measures support existing community schemes which utilises land for food production in schools, health facilities, churches, urban and traditional authority areas.

In summing up, I would like to emphasise that there is a great need to raise awareness of the importance and benefit of physical activity among the population. Educate all South Africans by conducting physical activity programmes and build capacity among individuals implementing physical activity; create a supportive environment that facilitate participation in physical activity. I would also like to congratulate the Minister, the Deputy and the director-general, DG, who are heading this department to the right direction. [Thank you.] [Applause.]



The DEPUTY MINISTER OF HEALTH: Hon Chairperson, I want to acknowledge the presence of the Minister and Deputy Ministers that are here, Members of the Executive Council, MECs, members of the portfolio committee, members of the Select Committee on Health, distinguished guests, as well as leaders from various institutions in the health sector that are here with us today, it is my privilege to address this august House on the occasion of the Health Budget Vote debate for the financial year 2011-12.

I want to first start, lest I do not have enough time, by thanking the Minister of Health, Dr Aaron Motswaledi, for his stewardship of the health sector, also to thank MECs, as well as officials from both the national and provincial departments, and the contribution of our various partners in the health sector, for ensuring that we put the health sector on cause to provide for our people a long and healthy life.

I also want to acknowledge the contribution of my predecessor, the Late Dr Molefi Sefularo, and we are building on the gains and progress that have been made in the past years led by the ANC government.

I want to remind members that inasmuch as we have this high burden of disease, as outlined by the Minister, in the four epidemics that we are facing, South Africa has shown that it has what it takes to deal decisively with problems that afflict it from time to time. I would like to remind us that we are building the health system for a better life for South Africans. We have to date, almost done away with some diseases of extreme poverty, which medical students of today can hardly see in their training. These include diseases like kwashiorkor and marasmus; we hardly see measles, whereas it was rife amongst our communities. We also have early reports that say the policies in reducing tobacco in our country are yielding results. It is reported that the oesophageal cancer in the Eastern Cape is also on a decline.

Forty percent of the primary health care facilities that we have in our country have been built during this democratic era. We are also on track to be recognised as having eliminated malaria during this period. The Minister has outlined that we are facing these challenges before us.

I would also like to share with you that the burden of disease and death in our country is not only at social level, but it is also strangulating our economy. It is estimated that the indirect cause to our economy and society, due to cardiovascular diseases, is about R8 billion annually. What is more concerning is that 70% of deaths are of people younger than 55 years of age and almost 195 people die a day from cardiovascular diseases. The good news however, is that 80% of these diseases and deaths are preventable.

Our storyline therefore is that we need to realise that our health is in our hands. As we move towards the end of the Move your life, Move for your health Campaign, which will promote prevention of noncommunicable diseases, we expect every municipal ward and district in our country to know about the burden of noncommunicable disease and the burden of HIV/Aids, as well as maternal and child mortality in their communities. We expect every municipal ward and district in our country to understand the risk factors, and we have already begun programmes towards reducing these risks. It is important, as member Dube has said, that we need to be methodical as we tackle these challenges that face us.

We recognise also that people with HIV, are also vulnerable to noncommunicable diseases. Pregnant mothers may also have underlying noncommunicable diseases, and our children are also facing an increased risk of obesity. We have to realise that our collective effort in dealing with the totality of disease burden in our community is essential.

It is in this regard that we are leveraging on the Eight City Campaign to also have people testing for the various risk factors for noncommunicable diseases, such as, high blood pressure, glucose, cholesterol, as well as to know their body mass index, BMI.

We aim to reduce the burden of noncommunicable diseases and conditions in our country by between five to 10% by 2014. We will focus specifically on hypertension, diabetics, obesity, mental illness, blindness as well as oral diseases.

Over the Medium-Term Expenditure Framework, METF, we will verify baselines of noncommunicable diseases per district, alongside those communicable diseases, and aim to reach 25% of districts this year. The Strength and Primary Health Care Model, that the Minister alluded to, will serve as a platform that we will use to achieve these goals. It will be discussed later, and led by the Minister himself, as well as the family teams that would be introduced in each ward of the 4000 or so, in our country, and the school health programmes.

The health sector, mini drug master plan to deal with, amongst others, alcohol abuse, has already been approved by the National Health Council on which MECs sit. We have also commissioned research to examine the impact of alcohol abuse on tuberculosis, TB, outcomes.

On mental health; we will adopt and implement strategies to improve forensic mental health service, and assist provinces to build community mental services as part of the Provincial Aids Campaign, PAC, package, including building partnerships with Non-Governmental Organisations, NGOs, and community-based organisations. The implementation of the Mental Health Act 17 of 2002 will be closely monitored.

We will be hosting a multisectoral summit where we will launch the multisectoral strategy against noncommunicable diseases, later this year, as part and parcel of preparing for the heads of summit meeting on noncommunicable diseases in September.

A national healthy lifestyle programme with high profile multisectoral leadership in society, similar to the South African National AIDS Council, Sanac, under the theme: Move for health, Move to life Campaign, will be built. Research and innovation gabs as well as priorities for surveillance will also be identified, to enhance the effectiveness of prevention and treatment of diseases of lifestyle.

It is clear that whilst we have a programme to deal decisively with LCDs, we need more resources, and must ensure that resources that we have are used efficiently. We must also ensure that the budget allocated by provincial departments, are also adequate and used efficiently. In this regard, prevention remains more affordable and better than cure.

Any effective health system must operate an effective, reliable and quality-driven epitymology and disease surveillance system, so that we identify new emerging disease early, track our success in various interventions and remain vigilant on outbreaks and re-emerging diseases. Currently, we will be developing an electronic-based surveillance system able to deal with monitoring the Millennium Development Goals, MDGs, as well as the national service delivery agreements. We will also establish an on time integrated surveillance system in the public health facilities and districts, to monitor not only LCDs but also to leverage on the work we are already doing with monitoring the Counselling and Testing, HCT, and Antiretroviral Treatment, ART, programmes, but will also include the burden of injuries in this regard.

We have adopted a three tier approach to strengthening our recording and reporting of patients on ART. This approach takes into consideration the diverse to information and communication technology, ICT, in our facilities. Indeed we have many pilots that seek to use mobile technology in our country. Together with the Department of Communications we are developing a strategy to use mobile technology applications, to strengthen recording, reporting and also supporting patience that are on chronic medication.

One example will be the use of cellphones by community health workers, to report on their house visits so that we can have real time information on health conditions in families that they visit. This is building on the work that was started during the World Cup, as part of the legacy thereof.

One research and development; we will support and monitor the functions of the National Health Research Ethics Council, NHREC, the National Health Research Committee, NHRC, which is advisory to the Minister as well as institutions, like the Medical Research Council, MRC, the Health System Trust, HST, and others, in order to ensure that the research agenda is aligned to the priorities of the country.

It is our conviction that alignment of all of us on the four priority areas for the country, will indeed make us succeed in increasing the life expectancy of South Africans, and also achieving the MDGs and the NSDA objectives.

In terms of health facilities, infrastructure management, we have also made an effort to ensure that health technology is enhanced, and we will soon be publishing for comment the essential health technology package, and will be discussing this not only with our sister departments at the provincial level, but also with the private sector.

The Minister has already alluded to the achievements we have made in reducing the cost of pharmaceuticals, particularly the antiretrovirals, ARVs. We have set up a process of establishing a central drug procurement authority working with Treasury and the various provinces. In this regard, we will ensure that we have an enabling system to help the South African purse to save resources, but also to afford the South Africans a reliable access to pharmaceutical products and medical devices as part of our preparations towards a more effective and sustainable national insurance system.

We will improve the registration of medicines. We know that there is a backlog in this regard, and reduce the time taken to reach the market through reducing the backlogs that are there and through training and aggressively recruiting evaluators, managing clinical trials and performing inspections on an ongoing basis. This will entail the recruitment and retention strategies for pharmacists and other experts.

The Council of Medical Scheme in this budget will receive R4, 194 million from this budget, and its primary objective is to protect the right and entitlements of all members of medical schemes. With the leadership of the Minister, we are also in communication with the medical id schemes to invest as well in health promotion and disease prevention, and not only in treatment of diseases and their complications.

The National Health Laboratory Services will receive R82, 167 million to provide quality, affordable and sustainable health laboratory and related public health services. Already, we have interacted with the laboratory services, and we have seen in this budget a reduction in essential laboratory services. This will be a relief to provinces and various institutions that use the service.

I have already mentioned the M-Health programme.

In conclusion, I would like to say that in terms of making sure that we achieve our health objectives, we have also ensured that we work, not only with provinces, but with various stakeholders so that indeed all of us can embrace these changes that we are coming up with for the health sector. It is important as well to note that the burden of disease and death is not only on individual families, it is also on breadwinners, mothers and fathers, also on the workers of our country. It is a burden to our economy and successes in reducing the burden of disease and death, which some of the members have alluded to the fact that it has doubled over the past decade or so. It will be a relief to our economy. Thank you very much. [Applause.]



Adv A de W ALBERTS: Chair, the Minister and his department must be commended for taking health care in South Africa in the right direction. However, a lot of work still remains for many hospitals and clinics, as many do not pass the basic sanitary quality levels and are inadequately staffed. The inadequate stock of basic and critical medical supplies and medicines also remain worrying. If a woman who is about to give birth contacts our party and pleads that we have to move her to another hospital as the one that she is in is known for its high fatality rates, then we must understand that our health care system is in many respects still third world. Even more can be said about a maternity ward where newborn babies have a better chance of dying than be given the care they deserve, also a sad reality of our country.

Over and above the material lack in many hospitals and clinics, it is also quite evident that there exists a lack in the spiritual dimension. For instance, when hospital workers go on strike without regard for human life, then something is seriously wrong in our country. The FF Plus agrees that hospital staff must be paid a decent wage, as their work is, like that of the police force and teachers, a thankless job. However, when human life comes into play, unions must be more responsible in their approach, and government more amenable.


'n Ander voorbeeld van die gebrek aan etiek is die houding van baie van die hospitaalpersoneel wat nie met die nodige empatie met hulle pasiënte omgaan nie. Terwyl daar baie is wat pasiënte met respek behandel, is daar ook diegene wat afgestomp van die pyn van hulle pasiënte tewerk gaan. Indien ons daarop wil reken dat ons 'n gemeenskap is wat respek het vir ons medemens en wat menseregte hoog op prys stel, dan moet ons ingesteldheid ook reg wees. Die VF Plus beskou die behandeling van pasiënte met die nodige empatie en sorg as deel van die Christelike etos wat die lewe op aarde meer draaglik maak. Minister, dit is ons plig om dit in Suid-Afrika se hospitale en klinieke uit te leef.


Related to the above, is the manner in which we deal with AIDS. The department states that prevention remains the cornerstone of HIV and AIDS interventions, and that, indeed, makes sense. However, prevention undertaken by the propagation of safe sex is not the only answer. What we need in South Africa is a sense of responsibility stemming from the Christian perspective of abstinence and responsible stable relationships. This ethos will, over time, ensure that the vexing problems of single parents, broken families, unwanted children, abuse of children and a proliferation of abortions, which is in essence murder of the unborn, become a relic of the past.


Ons wil dit ook aan die minister stel om versigtig te werk te gaan met die nasionale gesondheisversekering. Selfs president Obama het aspekte van gesondheidsorg ongereguleerd gelaat juis omdat die VSA nie genoeg fondse het om ObamaCare in sy volle omvang te dra nie. Suid-Afrika, 'n ontwikkelende staat, is nog minder in staat om so 'n enorme program van stapel te laat loop. Die kernrede is ons klein belastingbasis wat al hoe meer onder druk geplaas word. Met verskeie skuilbelastings wat in werking gestel word, soos tolhekfooie en koolstofbelasting, word die klein middelklas belastingbetaler al hoe meer ontneem van die vermoë om self entrepreneurs te word en werk te skep, en ons moet daarop ag slaan in die toekoms.


I thank you, Chairperson.



Mrs C DUDLEY: Chair, the ACDP is acutely conscious of the fact that maternal and child mortality has escalated and shows no signs of decreasing. We are, however, encouraged by the Minister's proactive, considered approach to the multiple challenges impacting on these statistics and support efforts to get to and target the real causes. The ACDP will support the budget.

The ACDP is concerned that nationally we are continuing to provide equitable funding for increasingly inequitable services. Provinces are funded for a full range of services at the various levels of care, but they have not developed the capacity to deliver those services. Because of this, patients migrate to provinces where services are delivered. It is inconvenient for patients and a tremendous burden on provinces which are not funded for the additional load. Funding hospitals at a national level as you have suggested may be a necessary response, but would it not be better to ensure that provinces, where capacity does exist, receive the increased funding to facilitate that capacity?

In recent years, the issue of a critical shortage of doctors has been acknowledged and the department has spoken about steps being taken to alleviate the situation. The ACDP is concerned that measures have either been inadequate or not prioritised, as no visible improvement in the situation is evident. What incentives are in place at the moment to attract doctors and surgeons to or back to South Africa? There are only 27 paediatric surgeons registered in this country – one paediatric surgeon for almost two million children. What do we have to do to attract and retain health professionals and are we doing it?

Hon Minister, are we taking seriously the continued dissatisfaction and growing concerns of the few doctors that we do have left working in South Africa? The ACDP has called for a re-evaluation of legislation and the consideration of the need to establish an independent regulatory body for doctors and for dentists. Not only to ensure greater integrity in dealing with professional misconduct and clinical negligence, but to build confidence within the medical profession.

Primary health care delivery, we know, presently faces many problems and doctors are saying that for poorer communities access to a GP is often impossible. Clinics are swamped and people with conditions like tonsillitis and appendicitis who cannot get a doctor's attention are at risk.

The SA National AIDS Council is increasingly conspicuous by its lack of engagement on important HIV and TB challenges. The Council receives substantial funding, has a clear mandate and over a dozen staff members. But it is not delivering. Stakeholders want to see SANAC driving the development of a new national strategic plan on HIV/AIDS, which presently takes approximately 1 000 lives a day.

Lastly, concerns regarding the new Nursing Act stem from the fact that regulations are still not available so the Act is not fully operational, a concern, I am sure, for you as well. Thank you. [Time expired.]



Ms M J SEGALE-DISWAI: Hon Chairperson, hon Minister, hon Deputy Minister, hon Members of Parliament, treasured guests in the gallery, ladies and gentlemen, the Freedom Charter of the ANC commits us to a preventive health service run by the state; free medical care and hospitalization provided for all, with special care for mother and young children. Although there have been many achievements in improving access to health care, much more needs to be done in terms of quality of care, and by making service available to all South Africans through ensuring better health outcomes.

South Africa commands huge health resources compared with some of the developing countries, yet, the bulk of theses resources are in the private sector, as the Minister has already alluded, and it serve a minority of its population, thereby undermining the country's ability to produce quality care and improving health care outcomes. The ANC is determined to end the huge inequalities that exist in the public and private sector by making sure that these sectors work together.

South Africa is one of the few countries in the world where transformation of the health system has begun with a clear political commitment to ensure equity in resource allocation, restructure the health system according to a district health system and delivering health care according to primary health care approach.

The ANC-led government inherited a highly fragmented and bureaucratic system that provided health services in a discriminatory manner. Services for whites were better that those for blacks. Those in the rural areas were significantly worse off in terms of access to service, compared to their urban counterparts. Expenditure on tertiary services was prioritised above Primary Health Care services.

The ruling party, ANC, takes the health of the nation very seriously. This is reflected in the manner in which it has been behaving since we came back from Polokwane conference. Very serious actions and steps were taken since then, and this include among others, the appointment of the Minister, Dr Aron Motswaledi, who works hands on with his department. The Minister and the Deputy Minister have been tasked with the responsibility of steering the Department of Health so that it can achieve long and healthy life for all South Africans.

Given how far we have come from, as a country, I am confident that this mammoth task is not insurmountable. All it needs is that no one must take his or her eye off the ball because if we do, we may reverse the gain that has been made over many years. I am not about to say that the road has been easy because, indeed, no one said that the road would be easier, but that our energy and determination must match the long stretch that we still have to travel.

We are, thus far, fully aware that whatever we have achieved was made possible by the ever hard-working and dedicated staff. They do their best under trying circumstances to deliver health services to the communities. These communities are not like me, you and others who are privileged. They have no second choice. They are looking up to the nurses to help them, come rain or sunshine. Some of these nurses are working in the far flung-areas of our country; others in areas where there is no network connection for mobile phones; some in areas where there is no access to reliable public transport, no choice for school for their children and no shopping centres, etc.

In spite of all these, they continue to deliver service no matter what, much against all odds. I know this because I come from among these people both as a resident, a health professional and a former manager. There are areas of concern such as shortage of drugs, dirty facilities, uncaring ethos, poor infection control, etc. These are the service deliveries that do not need money to solve, but need sheer management.

I know for the fact that some of the reports that we read in the media about our health services are, indeed, correct that the patients get badly treated. But, I also know, as we all do, that there are hundreds who are doing their job with such a selfless commitment. I do not think the few should spoil the good work that is being done. I want to pay special tribute to such nurses

The government, as we have already had, has built over 1 600 new clinics in the past 17 years, as part of the endeavour to increase access, expansion of service and ensure equitable distribution of health services. This enabled an old lady who was previously forced to use her last cent that was supposed to feed her grand children to catch a taxi to the clinic, to visit the clinic just where she lives. This enabled the young woman who would have missed her chance for family planning to easily pop in and have the service provided.

This enabled the mother with a mentally ill child to have the child seen by the nurse on the day of her appointment with greater ease. This assist a man with small welding workshop with a cut on his finger to easily get it sutured at the clinic.

These are the things that have been achieved among others, but we know that lot more still have to be done because, indeed, a journey of 1 000 miles begins with a step. I am confident that we are on course to getting to the apex of this long and steep mountain called health for all. This goal is attainable in our lifetime.

We are of a firm view that it remains the responsibility of the state to care for its population, hence our undying commitment for the introduction of national health insurance. We are also not oblivious to the fact that a lot of work still needs to be done to ensure that the introduction of national health system becomes a success much against the expectations of the doomsayer. The foundation of the success of the introduction of national health insurance is the effective health system. The success of the effective health system is a well-grounded and -founded primary health care because, indeed, primary health care remains the bedrock and the bone marrow of health service.

In this regard, I would like to urge the Department of Health to fast track the revitalisation of primary health care as it is captured in the annual performance plan. This is the only hope that the service delivery for our people can improve for the better. We must be ready, as the portfolio committee, to lend a hand to ensure that the good plans that the department has produced come to fruition. I am making this clarion call because it has been discovered that a healthy nation needs a healthy system, and a healthy health system needs a healthy primary health care approach. For everything to be achieved, we need the stronger and effective primary health care, now than ever.

The ANC wants the Department of Health to spend the money that has been allocated to start with the primary health care and the rest will follow. Perhaps we need to say primary health care first, and the rest shall be added unto. The Department of Health must demonstrate that it is serious about primary health care and as we work together with the department, we need to see that coming very sharply.

I want to say, people cannot be denied good health because they chose to live in rural areas. They cannot be punished for being born in Mamelodi, Ledig, Musina, Umlazi, Mareetsane and Khayelitsha, etc. They have a right of access to health.


Modulasetilo, mo bofelong ke batla go gwetlha ntlo e e tlotlegang gore a re diriseng dikliniki tsa rona re le baemedi ba Palamente, gore baoki le bona ba re bona re tla kwa tliniking. Re tshwana le mosadi o a tleng apeele balelapa la gagwe dijo. Fa a sena go di apaya a bo a ba tsholela. Fa a fetsa go ba tsholela ena a bo a itira montle a ya go ja kwa lebentleleng la dijo gonne a gopola gore dijo tse a di apeileng di phalwa ke tsa kwa lebentleleng la dijo.

ANC e tshegetsa ka maatla tekanyetsokabo e.[Ba phaphatha diatla.]

Mr K J DIKOBO / T H (Set)/Nb(Eng)/ END OF TAKE


Mr K J DIKOBO: Hon Chairperson, hon Minister and Deputy Minister, and distinguished guests, I listened carefully as you mentioned the pandemics South Africa is facing, I could not, but note that all four are by and large preventable or if already infected, their impact on one's body can be controlled or managed. As we talk about this statistics we have to always remind ourselves that we are talking about human beings here. That is why Azapo rejoices at every announcement of an improvement in our health system.

We welcome the increase in the number of clinics that are licensed or accredited to administer anti retroviral drugs and the increase in the number of nurses who can admininister those. The decision to start ARV treatment for people with a CD4 count of 350 is a welcome one, because people who have a CD4 count of 200 are already very sick, and therefore need more care.

Hon Minister, there are just two issues that we want you to grapple with. You have stated that the Health's budget is 8,7% of the Gross Domestic Product, GDP. That is not bad for a developing country like South Africa. If you say it is R25 billion, how much of this money is spent in the public health system? We are asking this question because we hold a view that private health providers are making huge profits while public health facilities are struggling to make ends meet.

With the best intentions and all the money being pumped into the health system something has to be said and done about the people who work in our health facilities. Without painting health workers with the same brush, we are always disturbed when we hear or read about the bad treatment that our people receive at the hands of some of the health workers. We do not have the time and space to enumerate those incidents. The country needs an assurance that your department shall deal with those errant workers. Azapo supports budget vote 17. I thank you. [Applause.]



Ms E MORE: Hon Chairperson, hon Minister, Deputy Ministers present, members of the House and guests, my speech will focus more on primary health care and the overall budget. About 17 years into democracy South Africans are facing a new challenge for which the highest calibre of leadership vision and commitment is needed. Fortunately, for South Africans we have Dr Motsoaledi, a man with enthusiasm, and who is going to lead this department. Nevertheless, challenges still exist. Universal access to care and equity, and sound information management and technology forms the essential components of primary health care. Quality health statistics promote better monitoring and evaluation of services and empowers good decision making.

The total spending on public health services has increased drastically over the past two years, and we are currently at R113 billion of which R41,9 billion which is 7,6% is allocated for primary or district health.

Also provided in the department's budget is additional R1,4 billion, part of which will be used towards the training of 400 nurses and midwives. And Minister, we only hope that after training 50%, if not more, would be placed at clinics to encourage primary health care, and if possible, ensure that a further of this 50%, if not more, should specialise in primary health care nursing. Primary health care requires a change in socio-economic status of our country, redistribution of rural resources, particularly in rural areas, a focus on health system development and emphasis on basic health services.

Hence the government needs to ensure that it addresses the socio-economic status of the country, especially the poor of the poor, and ensure that there are intersectoral activities between the Department of Health and other departments that need to provide access to quality housing in particular, access to clean water, proper sanitation and also to some extent create employment as soon as yesterday to ensure that better-health-for-all vision is realised.

The ANC-led government's efforts in addressing ground root issues have not responded adequately to the relationship between socio-economic development, health efficiency, and effectiveness. During oversight, most hospitals' chief executive officers still complained of the malfunctioning and ineffective district health system. To date, most primary health care facilities countrywide are still in a very bad state, and this means that most are still badly managed; queues are still long, medicine shortage is still a daily bread in some rural clinics particularly; working conditions are extremely unbearable due to increased demand of primary health care service and therefore increased workloads.

The DA welcomes the notion by the department to finally complete an audit to generate comprehensive information on primary health care infrastructure and services by 2011-12. This is long due. In 1997 the government adopted a White Paper on Batho Pele principles and in 2007 the policy on quality in health care for South Africans, but to date the primary health care services still lack. One wonders what would happen to the office of the health standards compliance after March next year, and only hopes that it does not become worthless and standards compliance not adhered to. All we need is to enforce compliance and adherence to these service principles, polices and standards set or we will end up changing names of strategic interventions every five years until we run out of synonyms for name change. [Applause.]

These will only be achieved if managers act responsibly, and are held accountable for their facilities and the performance management and development system is adhered to in principle, and proper monitoring and evaluation is consistent.

Hon Minister, you mentioned on Service Delivery Review, volume7(3) of 2010 that utilisation of primary health care facilities by the poor has increased, but physical access to these clinics in many rural areas still remains a challenge. The Department of Health needs to fast track the delivery and implementation of telemedicine system across the rural areas as this provides rural communities access to physicians and specialist expertise available in major medical centres and will further support primary health care services.

During its first phase of implementation, funds were available to start Tele-radiography pilot project in Free State and North West provinces, Tele-pathology project in Eastern Cape and Tele-ophthalmology project in KwaZulu Natal, and that was in September 1998, but to date the communities around those provinces still have not felt the real effects of telemedicine. It would be very interesting to analyse as to where we are as a country in terms of health technology.

The extent and nature of changing profile of diseases, particularly the growing threat of noncommunicable diseases, as you already alluded to Minister, continues to increase demand and put severe pressure on primary health care services. This has negative and substantial implications on the poorly managed and under staffed centres, which are unable to absorb this emerging significant burden. The decline in life expectancy, high levels of maternal and infant mortality and the increase in the rate of HIV infections indicate the inability of the current district health system to cope with the emerging needs of the population.

The three health related Millennium Development Goals, MDGs, may, to most extent be realised through strengthening of primary health care. A lot still needs to be done to address funding constraints, procurement irregularities, corruption, investment in critical health care skills shortage and essential equipment. The issue of corruption in health care is derailing progress in infrastructure development, the example of which is the construction of Zola hospital, which was unveiled on 5 June 2007 by the former Gauteng Premier, Mbhazima Shilowa, and to date is still incomplete due to tender malpractices, which unfortunately might in future probably be regarded as classified information, under the proposed Protection of Information Bill. Thank you. [Time expired.] [Applause.]



Ms B T NGCOBO: Chairperson and hon members as well as guests and members from the department. As we support this Budget vote, Minister, we are vigilantly going to monitor, expenditure performance and value for money from the department.

Health is one of the priorities of the government. Progress to date on meeting the Millennium Development Goals, MDGs, is slim, but we hope in our lifetime they will be met.

In the 80s the world health slogan was health for all by year 2000.To react to that, clinics were built. Health care was taken closer to where the people live. Health care was made free for children from birth to six years and for women that are pregnant.

2000 saw the declaration on the MDGs by various countries and these were to be met by 2015.

Family planning was well established, but somehow it fell on the wayside, because women were experiencing deaths due to backstreet abortion. In 1997 the choice of termination of pregnancy Act was promulgated and it was amended in 2004.44000 women had backstreets abortion done and 4-5 were dying annually.

After the Termination of Pregnancy Act, the condition improved. There is thinking that the choice of termination of pregnancy is family planning. It is not. Family planning is family planning and it is intended to deal with unplanned pregnancies.

The Termination of Pregnancy Act is intended to assist those women who would like to terminate their pregnancies within 12 weeks. Anything beyond 12 weeks Minister, is no longer in line with the Act, it is something else. Maybe we need to deal with the something else. I would not say it is murder, but we need to deal with it.

Anything beyond 12 weeks is really outside the Act. Only the Doctor can do a termination of pregnancy on his discretion, because of medical reasons to any patient. The problem these days is, young

young women are becoming pregnant from men older themselves. They decide to terminate their pregnancies long after 12 weeks.

They have inherited the pregnancy as well as HIV.The babies are born prematurely, because they go to whatever help that they get. They are given pills to take by mouth and those pills to be inserted as well, and they are told, once you get into labour, you go to the hospital. They do so and they give birth to small babies. Some of these babies are born and thrown anywhere in the country, in the streets, anywhere. They are collected and taken to the hospital as prematures.So, the neonatal wards are full of these types of babies and at most times, these babies tend to died. That is the problem we have.

Antennal clinic for pregnant women is supposed to commence at 14 weeks, so that the complications can be dealt with, if they are detected early. Where there is anaemia, iron supplements will be given. If HIV is positive, they will be started at a low CD4 count of 350 or below. They will be started straight away on antiretrovirals.Where there is TB,TB treatment will be given. This is a way of trying to help the mother to deliver a healthy baby, and the baby at birth will be given nevirapine.

Deliveries taking place in health facilities will be increased from 88%-95%.Postnatal care for mothers and babies 6 days after delivery will increase to 80%. Breastfeeding is being encouraged, so that babies get the best formula, because the breast milk is the best formula.

Keeping the babies warm, we are now proposing a kangaroo method of warming the baby. Putting the baby between the mother's breasts, so as to get it warm.

Babies death in neonatal wards is a problem and it is being dealt with. I think we need to go back to basics and begin to revamp family planning, so that people plan their pregnancies.

Family planning should be given at schools skills orientation, life orientation, should be given at workplace, at clinics, so that it becomes a norm rather than the termination of pregnancy.

Before I come to a conclusion, Minister . . .


Uyis'khokho mfana kithi . . .


Everybody in this debate is supporting what you have said, and somebody is agreeing with the department. We are quite excited that hon Walters for a change is on our side.

Safe to say that, TB is on the increase, yes TB will be on the increase, because most people with HIV have not revealed their statuses therefore, with a low CD4 count with a high viral load TB takes that opportunity to affect that person. Therefore, we have got a high TB rate because of that.

Hon Kganare, we were aware that you will be talking about the provinces, but we do have our counterparts at NCOP, we have our counterparts in the provinces, provincial staff can be dealt with by dealing with the provincial representatives. We can even go to the MEC or CEO's to deal with such issues. Maybe hon Ganare should have been in NCOP or provincial legislature.

Minister, there is a problem of advertisements. We have free termination of pregnancy all over, available safe abortions, we have advertisement on alcohol, advertisement on money loans, we have a whole range of advertisements. Minister these will be knocking at your door, not before long. What is it that, we as a country and as Parliament must do? It is important that we begin to address this not by you and your department only Minister, but also by us as public representatives.

From here, where do we go? Then I think the march should be on to deal with all this scouches, so that by 2015, if we do not reach the MDGs, we reach them in our lifetime. Thank you [Applause]



The MINISTER OF HEALTH: Hon Chairperson, as many speakers said, by and large, this was a very constructive debate. I think we are all on the same side. We are all in agreement on most of the things, but I need to highlight a few things that have been said here which I regard as very important.

Let me start with the issue raised by hon Dudley from the ACDP. The issue of human resources, HR, is extremely important. Unfortunately, she thought perhaps we are not paying enough attention to it. I want to reassure her that we are definitely paying attention to it, and in accordance with our ten-point programme, we will release our HR strategy in August this year. We know it is long overdue, but by August we will release it. We need to increase the number of health care workers produced in our country. For instance, we cannot keep on producing 1 200 doctors per annum, as we have been doing for the past decade.

We have a two-pronged approach which you will see in that HR strategy. The first one is a temporary measure. Last week, I met with the deans of all the medical schools in our country to discuss this temporary measure. What we are asking them is that they need to find innovative ways of increasing the intake of medical students, even under the current circumstances of restricted space in which they find themselves.

To this end, I can report to the hon Dudley that we have worked very hard with the University of the Witwatersrand. They took 40 extra medical students this year. This they have never done before. It has happened because we worked together, and, of course, for Wits to take the 40 extra medical students, it needed resources. We obliged in the department. We gave them R8 million to do that. [Applause.] We then sold the story to the other deans, so I am eagerly waiting for the deans of the seven remaining medical schools. They asked us to give them eight weeks to respond to this so that we implement in all of them by next year.

The second strategy in this regard is the establishment, in Limpopo, of a ninth medical school, because we have only eight. You are already aware that the President announced this. Furthermore, however, we announced our intention to put up infrastructure in four other tertiary hospitals and their medical schools. It is not only the hospitals. Perhaps we never announced that before.

We subsequently met with the Development Bank of Southern Africa, DBSA, and the Minister of Finance and agreed that it is not only the tertiary hospitals that need to be rebuilt, but even the faculties of medicine. This means that at George Mukare Hospital, it is not only going to be the hospital, but we are also going to look at the faculty. At Chris Hani Baragwanath Hospital, we will do so, too. It is already agreed and finalised at King Edward VIII Hospital: we are going to build a new hospital and a new medical school altogether. [Applause.] At the Nelson R Mandela School of Medicine, we are also looking at a similar issue.

We have already met the vice-chancellors of all these universities to discuss the issue with them. They have put together teams who are looking at this issue, because our aim is that, at the end of this, we must increase the production of medical students in our country, threefold. That is the aim of this exercise.

Coming to nursing, you are aware that we had a very successful National Nursing Summit, which was addressed by the President, in April. All the issues including those pertaining to the training of nurses, compliance, rules, regulations, the occupation specific dispensation, OSD - which did not go very well, as you know - were discussed at that summit, to an extent that we produced a Nursing Compact. I may remind you that we put this compact in most newspapers on International Nurses Day to show what the Nursing Compact consists of.

The task team that organised that Nursing Summit has not been disbanded. After the summit, they sat and worked around the clock to ensure that the issues emanating from the summit are implemented. Only yesterday, they presented that plan to the department, and we are going to be looking at it. So, the issue of human resources is very important to us.

The other issue which was mentioned very passionately by hon Segale-Diswai from my own party and also by hon More from the DA is the issue of primary health care. I want to reassure you that the centre, the core of the health care system is going to be based on this primary health care. [Applause.] I have already told you that we have no option, because I said the present health care system can be defined by four things, and I do not want them. No country can be defined in this way.

In the first place, it is a very unsustainable health care system we are running. It cannot go any further and it will crash in the next decade if we do not do something. I actually have facts and figures to prove this, but maybe today is not the day to do so. The day will come, perhaps, when we debate the National Health Insurance, NHI, because these things must come out. We have this information that must come out. We are running a very unsustainable health care system.

Secondly, we are running a very destructive health care system. Hon Papi Kganare put this. He mentioned two things. He first praised the director-general. Congratulations to you, director-general. Hon Papi Kganare said you are doing very well, and he is right. In the department, we all know that. We hoped that they would also notice it.

He also mentioned a second thing. He said Caesarean section deliveries are becoming a commodity in the private health care sector and he said we must look into it. You are right. It is not only Caesarean sections, but many other things. How does it happen? It is this destructive, extremely costly, hospicentric, curative health care system that I am talking about.

We are dealing with money here, not health care. We are dealing with money. I was not exaggerating when I said some of the things would shame the devil. The whole world knows I have received letters of complaint. For instance, one of them is from a member of the World Health Organisation who stays in Botswana. She happened to have brought her child here, who developed an ischiorectal abscess. Those who are in the health care sector will know what this is. Just for the draining of that abscess, her child was charged R30 000 in a private hospital here.

I can also give the hon Kganare the example of a patient from Swaziland, who presented with a peritoneal abscess. Just for a laparotomy to drain that, he was charged R500 000. [Interjections.] He died while they were demanding an extra R700 000 – a cool R1,2 million just to do this! That cannot be called health. It is very destructive. Even if the day ever arrives when we start doing brain transplants, I do not think it will cost R1,2 million. [Laughter.] I do not think so. But we are already in this space.

Through you, Chairperson, I can tell hon Kganare we have looked into these types of issues. We think something can be done, legally. I have met with the Competition Commission on this issue. I will never rest until it is resolved. I have met the Minister of Economic Development, and I can assure you, very soon, we are going to make a serious announcement on this issue. If it is left as is, we are all going to collapse somewhere. There is no way health care can cost this much.

We kept on being told that we must leave it to market forces. The health of the people cannot be market related. It cannot be. Moreover, it is against section 27(2) of the Constitution of the Republic of South Africa, which hon Papi Kganare was quoting here, which says health is a right. How can this right be bought?

We know of the situation in countries like the United States. The hon member of the FF Plus says I must be careful because Obama is in trouble over this issue. Yes, he is in trouble - because he cannot let it go. We have a graph that shows how much money the United States is spending without any good outcomes - far, far more than many countries in Europe. Their outcomes are poor, however, because they also fell into this trap whereby they are no longer doing health care. In Africa, South Africa has found itself in that situation where it is no longer a health care system but a form of commodity.

So, we are going to look into it. The Minister of Economic Development has agreed. We will make a far-reaching announcement in the next coming weeks to look into this issue, because members of the public will come in.

You know, I have also experienced this - where just to have your blood pressure and temperature taken costs R100. Yes, and I have got invoices to show that somebody would just go and put the cuff around your arm to take your blood pressure, and charge you. As for taking temperatures: they have got new methods these days. During my time, we used to, you know, just put it here. [Interjections.] These days there is an instrument, they just "Shooh!" Yes, it is over in seconds and then it costs R100. How can that be? We are going to look into it.

Let me come to the issue of primary health care. We are going to restructure primary health care into three streams. The first stream will be a district model. This district model is more clinical, because we want it to be a bridge between the curative and primary health care systems. In this model, we will deploy five specialists to each and every one of the 52 districts. Municipalities keep on changing, so I am no longer sure whether we have got 52 districts in South Africa, but when we planned it, it was on the basis of the 52 districts. It will also help us to arrive at the Millennium Development Goals. These teams will consist of a principal gynaecologist, a principal paediatrician, a principal family physician, an advanced midwife and a senior primary health care nurse.

I have already consulted the deans of all the medical schools in our country. I have consulted the professional associations of paediatricians, obstetricians, and family care physicians. I have consulted the Colleges of Medicine in South Africa responsible for specialist training, and I have consulted all the nurses of the country during the recent, successful Nursing Summit.

I am happy to announce that there is overwhelming support for this method from all the people I have mentioned. So, we are absolutely determined that this model will be implemented. Furthermore, we will implement it before the end of this year - not the end of the current financial year, but at the end of the calendar year. We are dead sure. [Applause.]

Once these teams are appointed, they will deal with guidelines and protocols at our antenatal clinics, in the labour wards, postnatal health care, paediatric and child clinics. They will follow up on every case of mortality to make sure that mortality meetings are held for every single incident of death of a woman or a child in any hospital. This will deal with the cause at hospital level, immediately. This is preferable to the present method, where we wait for research and studies to determine how many children died and what the reason is. The specialist teams will deal with that.

Part of the reason that we are doing this is that I once worked in hospitals. I know their protocols. Many simple protocols of how to deal with a woman in labour have just been thrown out of the window. I do not understand why. Some of these things we see surprise us. For instance, for those who are working in hospitals, I know, this is an era of computers, etc. I know. However, I still want somebody to influence me as to the best method of monitoring a woman in labour, other than the partogram. It might look primitive, but it saved women. These days, they have just been thrown out. There are no partograms. People are relying on computers.

I used to have professors who could examine a woman and tell her what the weight of the child is. Yes, there were professors who could do that. These days, they use the computer. So, doctors are losing their clinical skills. They are becoming technicians rather than being clinicians. And we want to change these issues.

These specialist teams in the districts will also deal with the training of interns as well as community doctors and medical officers. I can see the President of the Health Professions Council of South Africa, Prof Mokgokong, sitting somewhere here behind me. I am going to be approaching you, sir, to determine, afresh, what it is that an intern needs to do before we allow them to pass their internship. How many Caesarean sections should they be able to do? How many newborns can they resuscitate? Can they intubate? Can they give anaesthesia?

In our day, some of these procedures were very simple, but all of a sudden, we find it very difficult. I, personally, have visited hospitals where I am surprised to see interns not being able to do things which I thought are basics. One day, I remember having to take off my jacket and help an intern insert an intercostal drain. I do not remember leaving medical school not knowing how to put in an intercostal drain. However, after 10 years of not working in a hospital, I was forced to do it because the intern could just not do it. So, there is something wrong in our training, something that we are not doing very well.

With regard to the method of district clinicians, if we cannot find a principal paediatrician to go into a rural district, we have asked that the universities and the medical school must provide one for at least a year. After that, he can go back to medical school and they can provide another one. We will create the seats and the universities will see how to fill those seats, so that every district has got these senior people. Then our women and children will no longer die as they are doing now.

The second stream of our primary health care to be engineered is the school health system. I agree with you. It is very curious that nurses no longer go to schools in this country. For the past eight weeks, we have been putting together a team to work on this model. I am going to launch it officially with the Minister of Basic Education and the Minister of Social Development. These teams at schools will deal with basic things like eye care for the children.

Some children go to school, they cannot see, and the teachers punish them because they are not even aware that this child cannot see. They are not trained to detect such things. Some children cannot hear, and the teachers keep on shouting at them because they are not even aware that this child has got a hearing problem. Some children have got dental problems, but in this curative health care model, we do not go to school to detect them. No, we sit in the hospital ward waiting for the dental cases to arrive and then we remove the teeth.

In this destructive model - and I need to mention these things - one specialist tried to do it to me. My daughter had a few problems with her teeth and this specialist wanted to do a root canal treatment on my ten-year-old daughter. Root canal treatment means he was going to remove those nerves. This child still has milk teeth! I mean, she is going to outgrow them and get permanent teeth and they will find no nerves there. Of course, I was shocked. I know why the specialist was doing this: he was going to charge me R20 000. [Interjections.] Yes. I took this child to a public hospital and they did a procedure that cost R200.

The question is, What about members of the public who do not know these things? I saved my daughter because I know, and I know it is a criminal thing the specialists want to do. Many people are subjected to that every day. We are told that this is a good health care system and we must not fix it. There is no way we are going to leave this issue! We cannot leave it.

So, the primary health care teams at schools will deal with this. They will deal with immunisation. They will deal with the more complex issues of contraceptive health rights, and teenage pregnancies and abortions, which we know are on the increase. They will also deal with the HIV/Aids problem and the issue of alcohol and drugs in schools.

Of course, the last stream of primary health care we are going to look at very carefully is the primary health care model based in the ward. We need to put 10 well-trained primary health care workers in every ward. In Brazil, they are making use of this method to good effect. They have deployed 30 000 of these people whom they call community health care agents.

I was very highly encouraged when we were in Moscow for the development of the Moscow Declaration. The Minister of Health in India announced that they are deploying 800 000 of these people in the villages of India. They call them health care activists.

In our country, we know that the province closer to this method is KwaZulu-Natal. It is not an accident that they were able to reduce the incidence of mother-to-child transmission in KwaZulu-Natal. It is because they have got these primary health care teams co-ordinated in the Premier's office right at ward level. We want them to move further and implement primary health care as they do in Brazil and India, so that we do not wait for people to get ill in hospital and start charging them the amounts of money that they are being charged. [Time expired.] [Applause.]

Debate concluded.

The Extended Public Committee rose at 16:33.



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