Hansard: Approppriation Bill: Debate on Vote No 16 – Health
House: National Assembly
Date of Meeting: 23 Apr 2012
Summary
No summary available.
Minutes
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 351
TUESDAY, 24 APRIL 2012
PROCEEDINGS OF EXTENDED PUBLIC COMMITTEE – OLD ASSEMBLY CHAMBER
Members of the Extended Public Committee met in the Old Assembly Chamber at 16:53.
House Chairperson Mr C T Frolick, as Chairperson, took the Chair and requested members to observe a moment of silence for prayers or meditation.
The MINISTER OF HEALTH
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 351
Start of Day
APPROPRIATION BILL
Debate on Vote No 16 – Health:
The MINISTER OF HEALTH: Chairperson, Ministers and Deputy Ministers present here today, my colleague the Deputy Minister of Health Dr Gwen Ramokgopa, MECs from various provinces, hon chairperson of the portfolio committee Dr Monwabisi Goqwana and members of your committee, hon members of the House, the Director-General of Health, Ms Precious Matsoso, Your Excellencies, high commissioners and ambassadors, leaders of the various statutory bodies, health unions and other health-related organisations, our special guest, the Roll-back Malaria and UNICEF Goodwill Ambassador and UN Envoy for Africa, Ms Yvonne Chaka Chaka, distinguished guests, and ladies and gentlemen, it is a great honour and privilege to present to this House the national Department of Health's policy priorities and budgets for the financial year 2012-13 for your consideration.
This period comes at the mid-term of our office. It is very important for me to do some form of review of our health care system. This will shape our understanding of how we can protect and maximise our gains from the remaining half of the term. We started the term by putting forward a 10-point plan, which, by now, you are familiar with. The Department of Health's outcome is "A long and healthy life for all South Africans". It is one of the 12 outcomes of government. This long and healthy life is not going to be achieved through wishes and sloganeering. It is not going to roll in on the wheels of inevitability. There has to be a well-thought out and well-executed plan to achieve this. We have selected four outputs which must be realised to achieve this long and healthy life for all South Africans.
The first output is to improve the life expectancy of all South Africans. We all know that life expectancy in our country has taken a serious knock as a result of the quadruple burden of disease, or the four pandemics, that the country is experiencing. These four pandemics, as you know, are the scourge of HIV/Aids and tuberculosis, the unacceptably high incident of maternal and child mortality, the ever-expanding burden of noncommunicable diseases, NCDs, and the high incidence of violence and injury, including motor vehicle accidents. We need to do everything in our power as a country to defeat the four pandemics. Hence, our second output is decreasing maternal and child mortality. The third output is dealing with the scourge of HIV/Aids and tuberculosis.
Chairperson, to facilitate the understanding of what I am trying to convey to this House, please allow me to deal with these first three outputs, before I even mention the fourth one. I have a special reason to do so, and I will explain it later as I go along.
On the issue of HIV/Aids and tuberculosis, as a country, we started the early decades of HIV/Aids on a wrong footing, but recently, in a typical South African style, we have bounced back. We have shown that collaboration and solidarity against a shared threat and a common goal is desirable and can produce desired results. Through combined efforts and collaborative undertaking, we launched a huge campaign to counsel and test 15 million South Africans for HIV. We have achieved this and even exceeded the target, and today more than 20 million South Africans know their status. Through this programme, we have been able to counsel and place 1,6 million South Africans on antiretroviral, ARV, treatment. We have achieved this by increasing ARV sites from 490 in February 2010 to 3 000 in April 2012. We have increased the number of nurses certified to initiate ARV treatment from 250 in February 2010 to 10 000 in April 2012.
Within the same period, we have conducted 320 000 medical male circumcisions. We have reduced mother-to-child transmission of HIV from 8% in 2008 to 3,5% in 2011 or even to 2,5%, as in the case of the province of KwaZulu-Natal. This is a reduction of 50%. This success allowed us to save 30 000 babies from contracting HIV from their mothers. In order not to be complacent, we have unveiled a new National Strategic Plan on HIV/Aids and tuberculosis for the period 2012-16. This strategic plan was officially launched by President Jacob Zuma on World Aids Day last year. The provincial implementation programme was launched by Deputy President Kgalema Motlanthe on World TB Day on 24 March this year. For the first time in the history of our country, we have integrated HIV/Aids and tuberculosis in the same strategic plan. This new plan outlines a 20-year vision of the country in the fight against the double scourges of HIV/Aids and tuberculosis.
Hon members, we need your support and leadership to make the four strategic objectives in the country's national strategic plan a success. These four strategic objectives are: addressing the social structural drivers of HIV, sexually transmitted diseases, STDs, and tuberculosis care, prevention and support; preventing new HIV, STD and tuberculosis infections; sustaining health and wellness; and, lastly, ensuring protection of human rights and improving access to justice. The new national strategic plan further states that every South African must be tested at least once a year. We believe that if all South Africans can play their role, these goals would be achieved. We need to make sure that every pregnant woman undergoes routine HIV testing. We need to make sure every male is circumcised and, hence, this year, we are targeting 600 000 men.
On the issue of high maternal and child mortality, the high rates of pregnancy-related deaths, the disproportionate number of women exposed to sexual violence, with the worst incidence of all shaming the country just this past week, are a cause for concern. You will have noted that most of our interventions on HIV/Aids are directed at saving pregnant women and children. It is important to note that maternal mortality is not just the death of a woman – it is death of a woman because she dared to fall pregnant. She becomes vulnerable to death, because she is trying to bring new life into this world. We know that even mortality brought by HIV/Aids, as well as malaria, is disproportionally affecting young women of childbearing age more than men. This disproportionate assault on women of childbearing age is happening more on the continent of Africa than in any part of the world.
Hence, the African Union came up with a programme called CARMMA, the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa. In our country, we will launch CARMMA on 4 May at the Osindisweni Hospital in the province of KwaZulu-Natal. Members of the portfolio committee have been invited to this event through their chairperson. We will outline concrete steps to reduce maternal and child mortality during that event. That event shall further elaborate on how we shall roll out the strategy called ESMOE, the Essential Steps in Managing Obstetric Emergencies, and the strategy called EOST, Emergency Obstetric Simulation Training.
The output on increasing life expectancy, which is our first output, does not only depend on our fight against HIV/Aids and reducing maternal and child mortality; it also depends largely on bringing the noncommunicable diseases under control and also decreasing the scourge of violence and injuries on our roads. Until very recently, the issue of noncommunicable disease was less spoken about in the public arena. Many people didn't understand it, though it preceded HIV/Aids by several decades. This is because unlike the NCDs, HIV/Aids arrived abruptly and brutally on this planet, and it came as such a shock to the world that many strong civil society groups were formed to deal with it. This is why there is a measure of success in the battle against HIV/Aids. NCDs, as the name implies, are not transmitted from one person to the other by a germ or a biological agent. They are not only biomedical, but they are by and large diseases of lifestyle.
They are divided into four categories and have four identifiable risk factors. I advise people to remember them as the diseases of 4X4s, because there are four categories with four risk factors. The categories are: high blood pressure and other diseases of the heart and blood vessels; diabetes mellitus and a few other metabolic disorders; chronic respiratory diseases like asthma; and cancers. We would like to add mental health as falling within these categories. The four risks factors, as you know and I will keep on reminding you, are: smoking, harmful use of alcohol, unhealthy eating behaviour or poor diet, something which I can repeat many times; and a continued lack of physical exercise, which can be repeated 10 times.
The President spoke about these problems in the state of the nation address when he advised us not to allow our bodies to bulge uncontrollably, as many of us are unfortunately prone to do. [Laughter.] We are going to announce far-reaching measures to deal with these risk factors. The United Nations General Assembly took a resolution on these issues in September last year. The measures we will announce will leave no holy cows untouched, and that includes alcohol control, which some have attempted to intimidate us not to ever mention, just as they have tried to intimidate us on the issue tobacco and tobacco products.
The fourth output is improving the efficiency and effectiveness of the healthcare system. Chairperson, as I promised earlier, I said I would bring up the issue of the fourth outcome after mentioning the others. It merits special attention on its own because of the extraordinary challenges we are faced with in this area. In fact, in recent days, whenever South Africans talk about health, they are mostly referring to the efficiency and effectiveness of the health care system or the inefficiency and ineffectiveness of the health care system. We have identified five activity areas or rather five programmes. The first is the improvement of infrastructure. The second is issue of human resources, its planning, development and management. The third is quality of health care in our institutions. The fourth is the re-engineering of primary health care. The fifth is the cost of health care. The much talked about National Health Insurance, NHI, falls within this last category programme. Due to a lack of time, today will deal with only two of these problems, which are the issue of quality in our public facilities and the issue of NHI.
The President addressed this issue during the state of the nation address, when he said...
... Fellow South Africans, we are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.
Since that time, we haven't rested on our laurels. We also did not want to work on the basis of anecdotes or common sense in dealing with quality. Hence, we have embarked on a process of health facility audit. This entails sending teams to all of the 4 200 public health facilities to audit infrastructure, human resources, cleanliness, attitude of staff, safety and security of staff, infection control, drug stockout, and the long queues which citizens have to endure when visiting our facilities. Since we are 90% towards completion of the audit, we thought we fully comprehend the nature of the problems. Hence, we have put up four health facility improvement teams to go into these facilities to work with the provincial management to correct all the anomalies and findings identified during the audits. The teams have already started working in Motheo District in the Free State, Sedibeng in Gauteng, Zululand in KwaZulu-Natal and Pixley ka Seme in the Northern Cape. The portfolio committee is busy going through the draft legislation we have presented to them to establish the office of health standard compliance which will deal with these issues of quality as described above, without fear and favour. I would like to repeat it, Chairperson. We would like the office of health standard compliance to deal with issues of health standards without fear or favour.
On the NHI, there is no way the efficiency and effectiveness of the health care system can ever be realised without dealing with the cost of health care and health care financing. There are people who wrongly believe that the concept of health care financing, as envisaged in NHI, is a pipe dream concocted by the ANC government. I wish to advise them that NHI is not just a unique South African concept. The World Health Organisation is actively promoting this concept and describes it as "universal health coverage." Universal health coverage is a system that does not discriminate against any citizen of a country.
Let me quote from a presentation given by Dr Margaret Chan, the Director-General of the World Health Organisation, on 2 April this year, three weeks ago, in Mexico where she was addressing a conference on this issue. Her presentation was entitled "More countries move towards Universal Health Coverage". She said, "This was the tipping point, when the world woke up to the dangers of assuming that market forces by themselves, will solve social problems. They will not." She went further to say:
This world will never become a fair place by itself. Fairness, especially in matters of health, comes only when equity is an explicit policy objective. Universal coverage is a clear pursuit of equity and social justice. Universal coverage is also a powerful equaliser.
She continued by saying that "moving towards Universal coverage is never easy, but every country, at every level of development, and with any level of resources, can take immediate and sustainable steps in that direction".
We have reached a point of no return on this issue of universal coverage through NHI. On 22 March 2012, I announced the names of NHI pilot districts on 10 sites. You remember them in all the districts. As was announced by the Minister of Finance, hon Pravin Gordhan, in Budget 2012, R1 billion has been allocated over the Medium-Term Expenditure Framework, MTEF, for purposes of supporting the pilots.
When we launched the Green Paper in August last year, we also unveiled the timetable of what should happen in the first five years of NHI. On that day, I said there are two preconditions which the country must meet for successful implementation of NHI. The first precondition, I said, is that the quality of health care in the Public Service must improve tremendously and, hence, public health care needs to be overhauled. This overhaul, I said, is non-negotiable. The second precondition, I said, is that the pricing in the private health sector must be regulated. I am repeating that today.
I am going to spent three days in each of the 10 pilot districts to meet various stakeholders to discuss these pilots. Piloting means doing all the things that are needed to meet these preconditions, especially the precondition dealing with the quality in the Public Service. We believe that within a five-year period, we will have covered the rest of the 52 districts of the country and will be able to march forward towards our 14 years of implementation of NHI.
The success of NHI also depends on certain basics in health care being adhered to. We need to understand that the main reason for the existence of any health care delivery system is to take care of the sick and the vulnerable. Health care delivery systems do not exist to create millionaires at the expense of the health of our people. This tendency of putting business before health – yesterday, I called it a "tendercare system" because it is done in the form of tenders – is no longer a health care system but another form of uncontrolled commercialism, which the World Health Organisation has warned us against. The manifestation of this tendency is the disappearance of funds from the most basic tenets of health care, including the nonpayment of pharmaceutical suppliers, resulting in shortages of medicines, vaccines, dry dispensary and other consumables; nonpayment of laboratory services and blood supply services; shortages of equipment and devices for neonatal, perinatal and maternal services; and nonmaintenance of health infrastructure and equipment. I have agreed with the MECs that this must come to an end.
To bring this to an end, we have termed these "non-negotiables". We went to see these non-negotiables being paid for every month, and we shall monitor it on monthly basis. The Budget includes new allocations of R97,6 million for the 2012-13 financial year, R619,4 million for 2013-14 and R1,4 billion for 2014-15. The allocations were divided as follows. An amount of R10 million per annum is provided for the forensic laboratories to purchase equipment and appoint staff to address backlogs. We have recently appointed 70 unemployed graduates with degrees in Chemistry, Biochemistry and Chemical Engineering, to improve the performance and turnaround of the forensic laboratories.
Provision has been made for amounts of R9 million, R10,3 million and R11 million to establish a unit to monitor and support provincial finances and improve audit outcomes. As part of the support to the provinces to improve the audit outcomes, the department has appointed 100 unemployment graduates with BComm degrees to undergo an internship programme. The department is requesting this august House to support the allocation for Vote No 16: Health, amounting to R27,6 billion for the year 2012-13 and growing to R33,9 billion over the MTEF in 2014-15 financial year.
In conclusion, I wish to thank everybody who contributed to the success of this department: my Deputy Minister, Dr Gwen Ramokgopa, with whom we worked tirelessly to make sure that we share the functions, the director-general, Ms Precious Matsoso, and her team, all the structures from the South African National Aids Council, Sanac, which helped us with the national strategic plan, the office of the Deputy President and the Deputy President himself for chairing Sanac and guiding us to fight the scourge of HIV/Aids, the health-related unions, our development partners, and everybody because, as you know, our slogan is that if we work together, we will achieve more. I thank you. [Applause.]
Mr M B GOQWANA /Mia / END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 352
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333352] [Old Assembly Main][90P-4-082A][mn].doc"
THE MINISTER OF HEALTH
MR M B GOQWANA: Chairperson, Minister and other Ministers that are here, hon Deputy Minister and the other Deputy Ministers that are here, the director-general and her team, the MECs that are here - I have noticed that the Board of Healthcare Funders, BHF, is here; there is the Council for Medical Schemes, CMS; there is the Hospital Association of South Africa, Hasa; there are the Health Professions Council of South Africa, HPCSA, and the SA Medical Research Council, MRC - I acknowledge all of you, Members of Parliament, ladies and gentlemen.
I am not going to take a long time, but I just want to start by saying that at this second half of our term in Parliament, my response to this budget speech on health will focus on oversight. We have been voting on funds to the Department of Health, trusting that the deployees are going to transform the department so that it improves life expectancy in a qualitative and quantitative manner.
I always ask myself who sets the agenda in any given situation. In this instance, who sets the health agenda of South Africa? I stand here without fear of contradiction and say that, under the leadership of Dr Aaron Motsoaledi, it is very clear that there is passion and the zeal to come up with solutions to pressing health issues. However, I say with sadness that I have noted that this passion and zeal have not filtered through to some of the provinces ...
An HON MEMBER: Especially in the Eastern Cape!
MR M B GOQWANA: ... and in the provinces is where most of the work is actually done.
We have observed that there is transformation in the health sector, and the agenda is set by the citizens of the country. We have seen drug prices tumbling down to the delight of the citizens. We have seen HIV and Aids patients with CD4 counts of 350 getting antiretrovirals. We have seen TB patients with HIV also getting antiretrovirals. We have seen pregnant females that are HIV-positive getting antiretroviral drugs. As a result of the above, the HIV infection for unborn babies has decreased, especially in the Gauteng and KwaZulu-Natal provinces.
Cure rates for TB have improved, especially in the North West province. Citizens are no longer reluctant to go and test for HIV and I know there are more than 12 or 13 million that have been tested in the past year.
The drive for male medical circumcision in KwaZulu-Natal has improved and this decreases the incidence of sexually-transmitted diseases, including HIV infections. We have seen summits being convened by the Department of Health with all the stakeholders, and we have seen, for the first time, that a human resource plan has been developed by the department. We have seen piloting of the National Health Insurance in these areas.
All of the above have reinforced our confidence in the ability of the department to transform and respond to the needs of the citizens of the country. Hence, we support the requested budget.
However, we have noticed that there are some challenges with regard to some aspects of health provision, and I want to take this opportunity to give a synopsis of observations made during our oversight visits and meetings with the department and some other stakeholders. Our health policies, as good as they are, have got a shortcoming in the sense that they seem to be focusing mostly on the gap between the rich and the poor. They overlook the challenge of the urban-rural divide, which I just want to talk about briefly.
Rural health is a big challenge in our country. To elaborate on this, I will give some statistics that illustrate the challenge at hand, by comparing rural and urban provinces. If you look at life expectancy at birth in Gauteng, you will find that it is 60 years of age. In the Western Cape, life expectancy is 64. However, if you go to provinces like the Eastern Cape, it is 55, and in the North West, it is 58. [Interjections.] I mentioned Gauteng too!
Looking at the prevalence of disability, if you go to Gauteng province, it is 3,3. If you go to the Western Cape, it is 5. If you go to the Eastern Cape, it is 7,9. In the North West, it is 8,5.
If you look at delivery in the facilities, you will find that in Gauteng, it is more than 87%. In the Western Cape, it is about 98%. In the Eastern Cape, it is as low as 75%. In the North West, it is 77%. [Interjections.]
The maternal mortality ratio in Gauteng is 100. If you go to the Eastern Cape, it goes up to 144. In the North West, it is 121.
If you look at infant mortality, in Gauteng province, it is about 20. In the Western Cape, it is 27. If you go to the Eastern Cape, it is 53, and if you go to the North West, it is 32.
This, for me, reflects the relationship again, if you look at maternal and child survival and you compare it with the number of health workers. It is always said that the quantity of health workers in a particular area improves these incidences of maternal and child deaths. We are not looking at the quality of the health workers, but just the number of health workers changes the situation.
The rural provinces have fewer health professionals per population numbers compared to the urban. If you look at the number of doctors per 100 000 people in the communities in Limpopo, which is 90% rural, there are only 17 doctors per 100 000 in the communities. In the Western Cape, you have got about 135 doctors. If you go to the Eastern Cape, you find that there are 31 doctors per 100 000 in the communities. If you go to Gauteng, you find that there are 102 doctors. All of this shows you that there is a problem as far as the rural-urban divide is concerned. Hence, I am talking about rural health.
We have observed that the private health care sector is not assisting in this regard, either. In Limpopo, we have got a population of five million which is 90% rural. They have got only five private hospitals. I am not going to go into detail, but all I want to come to is that there is not much that is done by them as far as primary health care is concerned, either.
However, I must say here there is the Primary Health Care television programme that I always enjoy, by the private health care, which is run by Dr Victor Ramathisele. It always runs on a Saturday. It is a primary health care programme run by the private sector, which I think we need to applaud. [Applause.]
If what we are talking about with regard to the private health care sector – going to these rural provinces - does not make good business sense, I think we could think of public-private partnerships. If, as a country, we are to meet the health Millennium Development Goals or we are to get the universal coverage that we want, we definitely need to look at rural health. In addition, we need to make sure that, specifically, human resources and even our budget must be skewed towards rural health.
The oversight work we do covers the whole health sector, private and public, but the point that I want to bring here is that there always seems to be this paranoia between the private and public health care industries. I think for all of us, the vision is the same. So, we need to make sure that we find a way of ensuring that this divide is done away with, so that we can have good health indicators.
South Africa has other stakeholders in the health sector. I always mention this fact. In South Africa, 70% of our people are still attending traditional healers and I do not think they can be ignored. Whether they are doing the right thing or the wrong thing, for us to be able to meet what we want to meet, we need to make sure that we engage them in one way or another – even making sure that there are proper regulations that are going to deal with that. This is something that we have found in our oversight.
We have observed that most of our hospitals, be they private or public, deal with acute emergencies. We do not have a situation where we have got sub-acute and chronic hospitals, which are cheaper and easier to run. They do not need a lot of staff. We need to look into a way of going that way and if we are talking of a situation where we want to increase the life expectancy of our citizens, then it means at a certain stage we are going to need geriatric care. If geriatric care is going to be needed, we need these sub-acute and chronic hospitals in both the public and private sectors.
The challenges I have highlighted here are not insurmountable. I am confident Dr Motsoaledi leading the Department of Health and his team will come up with appropriate solutions to rural health challenges - and the other challenges that I have talked about - facing South Africa.
I recommend that we pass this health budget, as the department has shown commitment to transforming health services in response to the agenda by the citizens of South Africa. I thank you. [Applause.]
MRS S P KOPANE /Robyn/ END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 353
Mr M B GOQWANA
Sesotho:
Mof S P KOPANE: Modulasetulo ya kgabane le Maloko a Palamente a hlomphehang, ntlafatso ya bophelo bo botle ke e nngwe ya dintho tse ntle tse tla etsang hore re lokise masalla a kgethollo. Kgethollo e ile ya qhelela batho ba rona ba batsho ka thoko ditshebeletsong tsa bophelo bo botle. Ba ile ba iphumana ba tlameha ho tiisetsa le ho mamella mahlonoko a kotelo le ho se natswe. Kahoo mmuso o tlameha ho etsa makgobonthithi wohle hore ho be le tekano le boleng ditshebeletsong tsa bophelo bo botle ho Maafrika Borwa wohle ho sa natswe hore mang ke mang, haholo-holo batho ba bileng mahlatsipa a kgethollo.
English:
Every South African deserves quality health care because, as we all know, a sick nation can never be a successful nation. The provision of accessible, affordable and quality medical care to our people is not only a right but it is also a moral and economic imperative. So, it is the responsibility of this House together with the Minister of Health and the Department of Health to make sure that they provide us with a plan that is going to fix our public health care system and provide every South African with quality health care.
Let us face it, hon members, that the system we have now is failing our people. We are constantly confronted by its failures on a daily basis. When I visited the Marantha Clinic in Brandfort in the Free State last month, I saw nurses and doctors dutifully trying to help the community of Majwemasweu, even though there was no water in the clinic. I was struck and inspired by the commitment and determination of the medical professionals to help their people or community even in the face of immense challenges. However, the nurses told me they could not help everyone because there was no water. The workers there have done their utmost to make the best of their circumstances, but we have not kept up our side of the bargain. As hon members, we should be ashamed of what happened at Marantha. Needless to say, there are other countless clinics and communities across the country that we have left behind and forgotten about just like the Marantha Clinic.
So, let us come to one of the critical questions of our time. What are we going to do to address the situation? I have no doubt that the hon Minister Motsoaledi together with his team from the Department of Health have worked tirelessly to find the solution. I have utmost respect for Minister Motsoaledi. Minister, I respect your commitment and work ethic, and I fully understand that you have approached this problem with the best of intentions. However, with due respect, the hon Minister and the Department of Health have used a wrong approach in dealing with this issue.
Chairperson, let me state it clearly that the National Health Insurance, NHI, is going to be a complete disaster to the very people that hope to benefit from it. I say this because the NHI will be an enormous drain on the fiscus. Nobody knows what the actual cost of NHI will be over a long period.
Hon Minister, I am sure you are going give this House assurance today regarding an accurate costing of NHI. Could you please tell this House how much it is going to cost the taxpayers? What we do know is that it is going to drain resources away from service delivery objectives. The poor will pay for the available few NHI resources and that is a fact.
Secondly, the NHI will create an inefficient and bureaucratic health superstructure. It is highly unlikely that more bureaucracy will solve our problems in heath.
Thirdly, the NHI does not fix the real problem in our system, which is low quality health care provision. Instead, the Green Paper on NHI focuses on accessibility and finance. As we all know, we already have universal accessibility and enough funding to run a good public health care system. The problem is that the quality produced by our system at the moment is not good enough. Nothing in the NHI proposal will solve the quality problem.
Fourthly, the NHI does not adequately address the accountability and management structure. The ministerial task team report on health care funding states that, "no part on health care system is held properly accountable for the poor health outcomes or poor service delivery".
While the Green Paper calls for the establishment of an office of standard of compliance, its members will be appointed by and be answerable to the minister of Health. With such a set-up this office will not be really and truly independent. This will make it vulnerable to political influence not from the current Minister, but from future Ministers who might not have good intentions like you have, hon Minister.
Fifthly, we lack the human resources to implement NHI. We need to triple the 27 000 doctors that we currently have in our country, for NHI to be effective. However, we only train enough doctors each year to keep pace with the number of doctors who retire or emigrate. The state is unable to train the necessary number of doctors or nurses in our country. Hon members, let us be honest about this issue. The numbers do not add up to what we are looking for.
Finally, throwing money at the problem does not always solve it. A good health care system requires a minimum threshold of funding to be effective. However, greater expenditure beyond that threshold does not guarantee better results. Other factors such as accountability, governance and functionality determine the quality of health care.
What does the DA suggest we do about our health care system? I hope this is intention of all of us as Members of Parliament today. We have to focus on fixing accountability, governance and functionality of the system we already have. Attempting to build a complex, highly bureaucratic superstructure on top of a broken system is a recipe for disaster. Instead, we must focus on fixing the system we already have.
We need to create a national framework with national targets, minimum norms and standards for health care providers and effective oversight for both private and public health care sectors. We need to strengthen the provincial health departments for better delivery by giving them more freedom in policy-making and holding them to account for health outcomes and not just for compliance. The Western Cape has shown that this can be a success. Just look at the world-class hospital the Western Cape government has built in Khayelitsha.
We need to capacitate health care providers to take responsibility for their performance. Public hospitals and clinics need increased autonomy and accountability and less micromanagement. We need to create an independent health care oversight body with the powers to investigate complaints of poor health care services and those to account. This should be coupled with a quality rating system applied to all private and public health care providers.
We need to promote public-private partnerships to increase the quality of health care in the public sector by allowing private companies to run public hospitals and by making private resources available to the public sector. We also need to work aggressively to reduce medical skills shortage by promoting the establishment of private medical schools, increasing mentoring and apprenticeships and retaining the number of doctors and nurses in our country.
Spending on these programmes will benefit all South Africans more through improved health care, rather than spending on a bloated NHI system which will never benefit all. The time has come for all of us to start thinking about what is practical and possible given our constraints in human and other resources.
Sesotho:
Re le mokgatlo wa DA re dumela ka hohle-hohle hore bokamoso ba naha ya rona bo itshetlehile hodima diqeto tse nkwang ke rona batho ba etsang molao. Ho hlakile hore re na le matla a ho phahamisa dintle le ditoro tsa Maafrika Borwa le ditakeletso tsa Ntate Mandela tsa Afrika Borwa ya setjhaba se le seng se nang le bokamoso bo le bong. Ke a leboha [Mahofi.]
Mr D A KGANARE / A N N / END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 354
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333354] [Old Assembly Main][90P-4-082A][mn].doc"
Ms S P KOPANE
Mr D A KGANARE: Chairperson, let me acknowledge the presence of everybody that Dr Goqwana had already acknowledged. A budget is a resource which should be utilised by the department to ensure that its plans, strategies and objections are achieved. These intentions can only be assessed and be evaluated by looking at and appreciating the outcomes. When the budget is debated, we hear the intentions, look at the past outcomes and decide whether to support the Budget Vote or not. We also make suggestions concerning the implementation, and allocation to programmes. Hon Minister, there are a lot of visible and encouraging interventions from your side, but unfortunately maintenances of car services is at provincial and municipal level.
Whether we achieve the Millennium Development Goal, MDG, or not, depends on what happens at hospitals, clinics and communities. There are people who continuously argue that, although, South Africa spends significantly on health; its health system provides a low value for money. This statement is premised on the fact that South Africa spend 8,6% of its Gross Domestic Products, GDP, on health services roughly the same as Brazil, England and Italy, all who have better health outcomes, they argued. This argument is disingenuous because these countries have the different history to us and never had to deal with the legacy of apartheid like us.
Hon Chairperson, Cope's assessment of whether the department is dysfunctional or not, depends on whether the patients and staff feel safe and welcomed at our health facilities. We can be safe if the clinics and hospitals are clean, have adequate medication, laboratory service facilities which provide feedbacks to doctors on time, and where there is equipment to provide quality healthcare services. Chairperson, the Auditor-General made some disconcerting findings last year concerning financial management in provinces. That makes only a few of those issues that Cope feels they demand urgent attention. And I quote "provincial departments of health across the country are breaking the rules and regulations when awarding the multimillion tenders; it is the contravention of Construction Industry Development Board Act, No 38 of 2000, CIDB, to appoint a contractor that is either not registered or not registered at the correct grading".
Despite this, health departments from various provinces had awarded tenders to the value of R876,8 million to contractors with no grade or with lower grades. In Soweto, Jabulani hospital began to be built in 2003 and dragged until 2010 at the cost of 537 million, instead of R256 million. These, hon members, happened because some government officials meddled in the awarding of tenders. In most cases hon members, the Supply Chain Management, SCM, process is compromised so that the anointed bigot is awarded the tenders through hook or crook. In this instance hon Minister, I urge you to discuss with your colleagues in the Free State about the Lejweleputswa district SCM.
The suppliers, who approached me in that area, told me that all the staff in the SCM knows who and how corruption is managed. They believe that the senior management, who is aware of what is happening in this district, is either part of the corruption or those involved in the corruption do something which might compromise senior management, hence they intimidates or harass any staff member who raise concern on how corruption is nicely managed, more than the institution. Hon Chairperson, every time corruption is exposed, the ANC government will tell us that heads are going to roll but every time I see very big necks nodding.
Hon members, no one is corrupt by accident, hence I urge you and your colleagues to make an example of the Lejweleputswa district's SCM. Hon members, corruption affects the poorest of the poor more than the affluent. The affluent can buy any service but the poor will not be able to do that. It affects provision of quality health care and it can be directly linked to women and children's mortality rate. Hon Minister, millions of newborn children and mothers continue to die needlessly. Earlier this year, Carolyn Miles, the president and Chief Executive Officer, CEO, of Safe the Children, said that although there has been a reduction in the under five mortality rate, the death of newborns was still a stubborn piece of a problem. She hah also reveals that over 40% of fewer than five deaths occur within the first month of birth. Babies are dying of common diseases such as pneumonia, diarrhoea, preterm complications and asphyxia.
Surely hon Minister, these are not things children should be dying of. If Malawi as poor as she is, can succeed to achieve a 29% decline on newborn deaths, since 2009, and is on track to meet MDG, we can surely learn a thing or two from them. One of the main strategies to bring down maternal death is the provision of contraceptives hon Minister. On the other hand, one of the causes of maternal death is illegal abortions. Whilst on this subject, hon Minister you might enlighten me on whether there are other countries that advertise death to desperate people as we do?
Newspaper and streetlights poles in our country are full of adverts about abortion and at the same time there are these people who advertise the cure for Acquired immune deficiency syndrome, Aids, cancer, they also talk about helping people to win lotto in the same pamphlet; these people continue to operate in our country. I want to check if there is no law which prohibit this type of practise? If not, can we look into formulating the law which will prohibit these activities? Minister, I am not going to talk too much about National Health Insurance, NHI, but the issue here should be clarified because as Cope, we support excess to universal health care, but the politicisation of the concept NHI is really a problem.
The private sector, which projected the NHI as the nationalisation of health, is at the forefront of challenging the NHI as projected. I think it is really up to us to clarify whether it is a financing model or a [Time lapses.] Thank you.
Mrs H S MSWELI
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 354
Mr D A KGANARE
Mrs H S MSWELI: Hon Chairperson, health remains the keystone portfolio in our growing democracy with its issues affecting our entire socio-economic spectrum. It is, therefore, of the outmost importance that the Minister achieves maximum impact with the limited allocation of resources it receives from Treasury. The IFP believes that the following foundational and mandatory areas, where the department should focus its limited resources and adds its greater attention to, are the shortage of hospitals and clinics in rural areas.
There are dire needs for more hospitals and clinics in rural areas and even more pressing need for qualified doctors and nursing staff in our existing care facilities. Whilst this problem had been acknowledged and currently being addressed by the department, the IFP would urge greater attention to this issue as it is of paramount importance that we have able human capital capacity on the ground if we are to deliver adequate and competent health care services to our citizens. It must also be ensured that our rural hospitals and clinics are adequately resourced with the necessary sanitation and consumable supplies in order to avoid unnecessary adverse health issues arising in our care facilities as a result of unhygienic conditions.
We welcome the allocation of R1,2 billion to training institutions, to develop nursing homes, colleges and the establishment of the national institute which will provide leadership training in health to our health care personnel. However, the continued exodus of newly qualified doctors to foreign countries remains the most worrisome trend. What is the department doing to ensure that our health care professionals stay in South Africa? Why do we make it so difficult for our young, newly qualified doctors to obtain medical internships at our hospitals? These are all the questions that must be addressed and workable solutions be found.
On women and children health improvement, infant and child mortality rate, although less than previous years, require our continued and renewed effort at their reduction. In addition, with levels of violence against women and children remaining alarmingly high in South Africa, specifically regarding rape, sexual abuse and domestic violence, we need to ensure that all our medical institutions are adequately capacitated to render the necessary assistance to victims of these abuses both on time and in a professional manner. This is particularly necessary and lacking in our rural areas.
HIV/AIDS needs more reduction. It remains the scourge of both our country...In conclusion, we, the IFP, urge the Minister and the department to leave no stone unturned to pursue excellence in delivery optimal to all of the people our country and to continue to pursue an outcome based approach to service delivery and their solemn obligation and duty. We fully support the budget vote. Thank you. [Applause.]
Mrs N C DUBE / LMM/END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 355
Mrs H S MSWELI
Ms M C DUBE: Hon Chairperson, hon Minister and Members of the Executive present, hon Deputy Minister, hon MECs, members of the department and distinguished guests, it is a great privilege for me to participate in this podium once more, by the way, the ANC supports the Budget.
Now, and even more so in the future, the pursuit of better health status in our society will be determined, to a large extent, by how effectively we are able to prevent and control noncommunicable diseases such as heart, lung, cancer and diabetes and mental disorders.
Last year, in your Budget Vote speech, Minister, you emphasized that these diseases are growing; and that we would be paying greater attention to redressing the main risk factors as well as increasing screening and aiming for better control of chronic conditions. We indeed see you and your department making progress in this regard. The additional actions that are outlined in your plan this year are absolutely in line with the recommendations arising from the Summit of Non-Communicable Diseases that was held in September last year. The General Council of the United Nations also held a meeting on noncommunicable diseases last year.
A healthy lifestyle combines two main approaches; the first is: to facilitate better health through government interventions that assists population health and the second is, getting people themselves to change the unhealthy aspects of their lives, and embark on healthy practices. More work must indeed be done to strengthen both of these levels
Last year, hon Minister, you promised, that you would bring out regulations for the reduction of salt in processed foods - as salt is a major contributor to hypertension and high blood pressure. It affects on average 31% of men and 36% of women in South Africa. We understand that since you made this promise, you have embarked on wider consultation both locally and internationally on reasonable targets and timeframe for achieving them. We are encouraged at the work done thus far, although there is still a long way to go to achieve the goal of reducing noncommunicable diseases, mobility and mortality.
Another risk factor for noncommunicable diseases, but also for communicable diseases like maternal disorder, child health and injuries, is alcohol. Hon Minister, we are encouraged at your commitment to fight this serious issue and we are even more encouraged that you will be bringing legislation on the advertising and marketing of alcohol; this is a great step indeed.
The evidence that is out there on what alcohol does to our society is very clear and all efforts must be employed to fight this disaster. Research shows that alcohol is the third highest global risk factor for disability and it shortens our lifespan.
In South Africa, alcohol accounts for around 130 deaths per day. According to World Health Organization, WHO, we fall into the category of countries that have the highest consumption of alcohol. One study has put us as the tenth highest country for alcohol consumption in the world. In the past year, research has shown that we fall into the second highest category of the WHO countries that have harmful patterns of drinking and heavy episodic drinking with over 30% for both male and female drinkers.
We also note from the survey conducted in 2008 by the MedicalResearch Council, MRC, on Youth Risk Behaviour that 34% of males and 24 % of females in Grade 8-11 are binging drinkers. This is different from the 29% for males and 18% for females figures discovered in 2002.
Hon Minister, if we neglect to take heed of all this information and do not act on it, we surely would be failing in our duties as the custodians and activists of health, but especially as government.
We note with concern that there are those who are opposed to your call of banning alcohol advertising and sponsorships. They argue that such action will not reduce alcohol related harm. Hon Minister, we support you in this endeavour and we beg to differ with them on this matter.
Research indicates that alcohol advertising and sponsorship bring about positive beliefs about drinking, and young people are encouraged to drink alcohol sooner and in greater quantities. These are reasons enough for us to act. We must try to shift away from advertising harmful products, and we look forward to working with you.
Hon Minister and hon members, the success and great achievements we have made on restricting tobacco use in this country are well documented; and we should be proud of that. This quickly reminds me of all those sceptics who lamented and argued so strongly that the banning of tobacco advertising would result in massive job losses and revenue for this country. It is now clear, hon Minister and the House, that these arguments and claims were just futile and are now history.
Hon Members, if I may take a step back to healthy lifestyle and reiterate that we need serious change of attitudes from both government and citizens. Eating healthy food and exercising is a goal that we would like every person in South Africa to take very seriously.
We must do our utmost best through partnerships to try to make healthier food more available and affordable, especially to poor people. We should facilitate greater physical activities for children at school, but I also want to challenge our communities and every person in South Africa to start taking healthy lifestyles more seriously.
We have serious behaviours that we need to change as a society, so that our heath and that of our children can improve. These behaviours include: eating junk food or fast food, lack of exercise, engaging in unsafe sex, excessive and irresponsible use of alcohol and smoking.
We must bring back and instil the culture that our parents had in the past, such as having small vegetable gardens in our homes and at schools; walking to school rather than be driven there; we must distance ourselves from smoking and the use of alcohol. Our grandparents and parents were stronger and healthier because of these practices.
THE DEPUTY MINISTER OF HEALTH / E.S/LIM CHECKED/ END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Takes: 356 & 357
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333356] [Old Assembly Main][90P-4-082A][mn].doc"
THE HOUSE CHAIRPERSON (Mr J D THIBEDI)
THE DEPUTY MINISTER OF HEALTH (Ms G Ramokgopa): Hon Chairperson, Minister of Health, Dr Aaron Motsoaledi, Ministers and Deputy Ministers who are here, colleagues, members of executive councils, MECs, the hon chairperson of the Portfolio Committee on Health, Dr Monwabisi Gogwana ,members of the Committee, hon members of the House, the director-general, DG, various management at national and provincial levels, leaders of various statutory bodies that are here, health unions and other health related organisations , a special acknowledgement in our presence of Mme Yvonne Chaka Chaka, morwedi wa Machaka, distinguished guests, ladies and gentlemen, it is my privilege to address this hon House during this debate on the Health Budget Vote for the financial year 2012-13 within the Medium-Term Framework
This debate is placed as we celebrate the centenary of our liberations movement, the ANC which represents the unstoppable determination of millions of peace loving people of our nation and the world globally to spend on effort in ushering justice and democracy in a better life in our country.
In this month of April we also recall the hanging of Solomon Kalushi Mahlangu, the death of Mita Ngobeni and many other children and young people who paid their ultimate price for the freedom we are enjoying today. For them a long and healthy life was not to be because of the apartheid regime.
Going down this painful but inspirational legacy of the triumph of humanity in our young democracy, I invite you to join me in paying tribute to all progressive health workers who individually and through organisations were part of the liberation struggles in various ways.
Many remained true to their professional ethic and human conscious as they provided essential health services to the oppressed under difficult circumstances. They cared for survivors of the injuries during the mass protests and refuse to trade-off their scientific knowledge for human healing to trade it off with activities of biological murders - what is called biological warfare.
We pay tribute to the then aspirant and practicing health workers who understood that peace, justice, freedom and democracy were also foundational in amongst others reducing the high levels of severe malnutrition our children died of which they, today, are no longer dying of.
In reducing the high levels of trauma and violence as a result of shootings and indeed in winning the battle against the ravaging tuberculosis, TB, which first start in unhealthy conditions in the mining and farming sectors.
We salute amongst others Dr Xuma, Dr Naicker and Dr Dadoo who provided leadership under what is referred to as the Doctors' Pact which unified our people across racial divides and paved the way for the adoption of the Freedom Charter that pronounce on the rights of all South Africans. We pay tribute to Steve Bantu Biko and many aspirant health workers who suffered and died as human rights activists.
We honour Mrs Ruth Bowen who is now 91 years, Mrs Albertina Sisulu and Mrs Rosina Mphahlele who have since passed on, who in a disciplined and tenacious manner nursed our people with distinction and with great care and compassion despite the apartheid system.
We remember Dr Abu-Baker Asvat and Dr Ribeiro and his dear wife who were murdered at their consulting rooms and homes respectively within communities they served and were prepared to do whatever it took to improve their wellbeing. As we build a developmental state today that has as one of its outcome a vision for a long and healthy life for all, we remain inspired by the contributions that these and many others made and to change the underlying socio-political and economic conditions that were a risk to our nation.
We will determinately commit ourselves and invite all within the health system to do so as we recognise that the constitutional protected rights to health and reproductive rights are not as yet accessible to all South Africans especially in rural provinces. I acknowledge that, Dr Gogwana. As we sadly acknowledge that the interventions in the provinces of Limpopo and Gauteng Health Departments through section 100 of the Constitution by Cabinet were indeed necessary to protect the health system for the benefit of mainly the poor in these provinces. We would have no choice for other health care services. We also wish to call on all stakeholders to work with us in the defence of the progress that we have made today.
We should continue to construct a society that is intolerant and ready at all times, especially in the health system to democratically and in a disciplined manner intervene without fear or favour to combat many ills of inexcusable actions and or inactions of inefficiency, incompetence, fraud and corruption that put the names of the heroes and heroines of our liberation struggle to shame in risking the health and wellbeing of our people.
We believe that introducing the office of the standards compliance which has the offices of the ombudsperson, norms and standards and the inspectorate will certainly be valuable in guarding against these ills.
We want to thank the provincial leadership under the members of executive council, MECs, the premiers of these provinces and the heads of the department, HODs, who have worked with us in a very constructive manner to deal with many of these ills. Some were inherited and some indeed happened whilst they were in office. We also would like to call on those that are involved to be subjected to disciplinary majors. You can discipline someone for incompetence as it is provided for. You can discipline someone for fraud and corruption. Actually we must do that to protect the interest of our people and the institutions that many have struggled and died for.
We must also guard against shallow and narrow political opportunism and prejudices that underline racism. For now I'll call it prejudices that turn to dismiss the historical reality that member Kganare referred to. Indeed there are provinces, Gauteng and the Western Cape in particular that benefited from the inequities of the past. Indeed even previously the Cape Province resources were mainly invested in the Western Cape around Cape Town in particular to the detriment of our people throughout the province. [Applause.]
We acknowledge in an interview the statement referring our people who are accessing such services available in their country as refugees. We really ask the DA as a party and its leader to have integrity and formally apologise to the nation and to the people of the Eastern Cape in particular. [Applause.] Yes, I'm aware that you apologised but. . . By the way the interview was not called exactly for that ... [Interjections.]
Let me also acknowledge that it is important and it is for our common goal to have a common vision, work together and redress the imbalances and to remember that South Africans have a right to access services wherever and throughout the country. We were all South Africans before we belong or live in one or the other country or any other city. We shouldn't reinforce the past where people's birth rights were not even acknowledged in the country of their birth.
We indeed agree with hon Kganare that the context of a country is important. In this case, member Kganare in terms of the 8% expenditure that you referred to only 3% of this expenditure is in the public sector to look after the majority of the population whilst around 5% is in the private sector.
Over the next three days here in Cape Town the Department of Health, Department of Science and Technology as well as the Council of Health Research and Development, COHRED, are hosting the Global Forum for Health Research conference under the theme: Beyond aid research and innovation as key drivers for equity and development. This issue of equity and development is not unique to South Africa. It's a worldwide phenomenon that we must work together to deal with.
We have begun to utilise evidence-based research to inform our policies and programmes. Already we are seeing significant progress and amongst others the reduction of mother-to-child transmission of HIV by more than 50% as referred to by the Minister.
We have also invested in convening various summits with experts, health workers and other stake holders in the areas of noncommunicable diseases, mental health, breast feeding and the national health insurance.
Indeed, member Dube, the regulations on salt content control industry are ready for the Minister's consideration and will be signed within the next few months. We encourage that beyond this regulations [Applause.] together we must empower our people to understand that the vegetables that we eat have natural salt that comes from them. Overtime our tongues will get used to those levels of salt. Currently we are used to very high levels of salt and many of us pour raw salt on our food even before we taste. We want South Africans to live long and healthy lives.
The National Health Insurance system is a catalytic program to ensure equity and sustainability of the health system. We are very encouraged that all provinces including the Western Cape have agreed to participate in pilots. We have no doubt that your participation in these pilots will prove that indeed what we have presented to you as a solution for the country is a solution that will work in the Western Cape and any where else through out our country.
Led by Professor Mayosi and the National Health Research Committee, we have began to align scientific research and enovation capacity available in our country and globally towards finding solutions to reduce the burden of deceases and premature deaths as well as to strengthen the quality, efficiency and effectiveness of the health care system.
The work that Dr Bomela in the Ministerial Advisory Committee on Health Technology is doing will be enhanced by the enactment and the establishment of the South African Health Products Regulatory Agency later this year. Already the National Health Council has approved the essential equipment list. This will help us in knowing as to what minimum equipment should be available in every facility throughout the country and to ensure that our healthworkers have these tools of trade and that indeed our patience and our people get high quality services.
We can also liberate technology better in an integrated approach for the benefit of healthworkers and the public. We have already presented a draft of the E-Health Strategy before the National Health Council, that will incorporates Information and Communication Technologies, ICT, for health such as Telemedicine Mobile Health Technologies and others.
We want to thank Professor William Pick, who has just retired for his valuable contributions as the Chairperson of the Council for Medical Schemes which we will leverage in terms of the experience of protecting consumers as we construct this year's National Health Insurance Scheme and piloting it through out the country. The experience of regulating the medical aid schemes in an industry will indeed come very valuable.
We appreciate and we will certainly support and we call on you to support the Ministers effort to visit each of the 10 National Health Insurance pilot sights and districts in order to meet with stake holders and public as well as private sector. My office will also continue to visit other districts to ensure that management remains effective and it improves accordingly and the quality and impact of health services continue to improve significantly.
Indeed, Dr Goqwana, these changes must be visible. Our audits have indicated where the challenges are and as the Minister has said already management teams have been deployed from the national office to ensure that they work with provinces to deal with the gabs that have been found. Already during the visits that we had to the Districts of Namaqua, Amathole and Gariep, respectively we were able to interact with provincial and local government colleagues as well as stakeholders in the area.
Indeed, we must share the excitement of the progress that we see in terms of the public health level that is translated locally. [Applause.] I want to thank everybody and that we support this Budget. Thank you. [Applause.]
Adv A de W ALBERTS /NN/ AZM MNGUNI / END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 357
The DEPUTY MINISTER OF HEALTH
Adv A de W ALBERTS: Minister last year I commended you and your department for taking health care in South Africa in the right direction by way of your vision to improve health quality drastically. Clearly as we sit here today, a lot of work still remains to be done.
The press is filled with horror stories about public medical malpractice and state of disrepair of hospital equipment. The FFP has its own stories to tell as members of the public approach us to intervene when they are fighting an inaccessible and unsympathetic public health care system.
Afrikaans:
Mej Candice Midgley, 'n jong vrou met twee kinders, is met kanker gediagnoseer, maar het maande gesukkel om toegang tot behandeling te kry. Van die verskonings is dat die mediese apparate nie herstel word nie of nie gebruik mag word nie omdat die regering nie uitstaande rekeninge vereffen nie.
'n ONBEKENDE LID: Dit klink na die Oos-Kaap!
Adv A de W ALBERTS: Die pers berig van nog 'n ma wat gesterf het omdat kritiese mediese apparaat nie gewerk het nie weens 'n gebrek aan onderhoud.
English:
A domestic worker's toddler dies as the ambulance took ours to arrive after the event. Minister, I can tell many stories like this and they cut across all racial groups. The bad state of public health care affects all of the poor. Against this background of lack of social injustice, one has to question the viability of introducing such a huge program such as the National Health Insurance. It is just logical that the department should at the very least get the basics of service delivery within the current system right before any other grand schemes can be launched.
Afrikaans:
Dienslewering in die publieke gesondheidsektor is, in die algemeen, steeds uiters swak vanweë 'n gebrek aan behoorlik opgeleide personeel, veral mediese praktisyns. Mense wat aangewese is op die staat vir mediese hulp moet nie uitgelewer wees aan elemente van swak diens wat hul gesondheid verder affekteer en selfs tot hul dood lei nie. Dit reduseer die Handves van Regte vir Pasiente – the Patient Rights Charter – tot net 'n waardelose stuk papier.
Verder, soos ons ook verlede jaar gemaan het wil ons dit weer aan die Minister stel om versigtig te werke te gaan met die nasionale gesondheidsversekering. Suid-Afrika is nie werklik in staat om so 'n enorme program van stapel te stuur nie. Die kernrede is ons klein belastingbasis wat al hoe meer onder druk geplaas word deur die eise van die fiskus. Daarom is dit gerade om eers aandag te skenk aan basiese dienslewering in die publieke gesondheidsektor sodat die armes onmiddelik kwaliteit dienste kan ontvang en die middelklas kan weet dat hul belasting effektief in die openbare belang aangewend word. Enigiets anders is 'n skending van basiese menseregte.
English:
Minister, we therefore implore you to use your budget to tackle the basic issues of service delivery before any grand schemes like the NHI is embarked upon. Thank you. [Applause.]
Mrs C DUDLEY / AZM MNGUNI (Eng)/ nvs (Afr) / END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 358
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333358] [Old Assembly Main][90P-4-082A][mn].doc"
Adv A de W ALBERTS
Mrs C DUDLEY: Chairperson, the ACDP acknowledges the efforts being made to grasp the issues and address the challenges we face in South Africa, in improving access to quality health services for everyone. It is because we have a Health Minister who is prepared to confront even the most difficult challenge with an openness and energy that is contagious, that we have high hopes that progress is possible. We are, however, painfully aware that unless we see significant process, people's lives are going to be increasingly at risk.
This budget will have to meet expectations raised with regard to infrastructure development; hospital revitalisation; training of medical practitioners; women and child health; HIV/Aids; National Health Insurance, NHI, and so much more. The department must make sure that last year's under spending does not happen again, as it can seriously weaken any prospect of process. While the budget for HIV/Aids and TB had increased; the budget for maternal, child and women's health has decreased and at face value this does not look concerning even though it is clear that all programs should impact significantly on maternal child and women's health.
Primary health care services are crucial and a relatively small allocation to this programme does raised questions as to whether plans to achieve a more primary health care approach, as opposed to hospi-centric approach will stay in focus. The ACDP, like the rest of the country, is acutely aware that education and training for the health sector in South Africa has not grown sufficiently to meet our health needs and this must continue to be driven on all the time. While we struggle, in South Africa, with issues of noncompliance and lack of accountability, we faced another side of the coin.
The escalating cost of legal claims, across both state and private sectors, undermines the service delivery and has adverse consequences for patients, the public and those delivering care. Careful thought will have to be given to the issues of noncompliance and accountability, as well as, to the growing problem of litigation, excessive premiums and defensive medicine, potentially crippling the health sector. The protection of the public and the delivery of quality services are complex. The balance must be found between the need for health professionals to be able to do their work free of fear and proper accountability.
With time running out, I will just comment quickly on the National Health Laboratory Service, NHLS, which is vital to our health system. It conducts virtually all diagnostics for the public health system. This includes HIV viral load, CD4 counts, tuberculosis, TB, culture and resistance tests. It is a functioning institution that has been facing bankruptcy and collapse because two Provincial Departments of Health failed to pay a sum of R2 billion. Whilst not facing bankruptcy, the institution has existed on austerity measures in case the financial situation reoccurs. It is unable to employ anyone, except in core and critical positions and it is understaffed due the numbers that resigned, last year during the crisis.
The ACDP calls for the decisive action from the National Department of Health and Treasury to prevent a reoccurrence which could result in a collapse of the NHLS. Thank you [Applause.]
Ms M J SEGALE-DISWAI
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Takes: 358 & 359
Mrs C DUDLEY:
Ms M J SEGALE-DISWAI: Chairperson, hon Minister and Deputy Minister, hon Members of Parliament and distinguished guests. I am very excited that since the Minister took over this portfolio, health as a sector and a discipline, has received positive reception in the mind of South Africans. Minister, you are being celebrated, by fellow South Africans, as the life that has come to shine to many. The leadership of this department has brought hope to many hopeless South Africans. They have done so with a clear mind that there is a need to better the lives of ordinary South Africans who depend on the Public Health Sector for their health and life.
This department, under the leadership of the Minister, Deputy Minister and Director-General, is headed to the direction of improving the health of South Africans. The efforts that they made are up there, for all of us to see, even the opposition. This government, under the 100 years old movement, ANC, can indeed show that you do not find an old man of 100 years, who does not know what to do when there is a problem in his house. This movement of the people is aware of what the people on the ground need because it has been on the side of the people long before it came fashionable to be on the side of the people.
This movement has listened to the rural women of Rankelenyane in North West, when they cried about their children who died from pneumonia; it has listened to the retired mine worker from Driekop in Limpopo, when he complained about asbetosis and that he was not able to afford the treatment in the private hospital; had listened to a young teenage girl from Jozini in the Northern KwaZulu Natal, when she cried out for help, when she was raped by a group of youngsters; and has listened to an old man in Matengteng in Bushbuckridge, in Mpumalanga, when he could not afford to go to nearest clinic to collect chronic medication because he can not walk.
Indeed, it has listened to the old woman in Meweshe, Limpopo, when she said that she was unable to collect her TB treatment because the rain had washed off the bridge. After listening to those cries of those South Africans, under the movement that has this rich history of hearing the cries of the ordinary people, it decided that it will implement the strategy that will ensure that health care is accessible, available and indeed affordable to the poor, rural, remote and farming community. It is after hearing these painful cries and pleas that this government decided that it will look at the best strategy which will address the plight of these South Africans and many others whose cries and pleas come through to the presidential helpline.
The strategy is called National Health Insurance, NHI. This is the strategy that will bring equality and equity for access to health service by all South Africans, irrespective of where they live. This will ensure that a granny, from Manthe in North West, gets the same health care as the person in Klerksdorp; that the school child from Griekwastad in the Northern Cape and a pregnant mother in Matatiele in the Eastern Cape, get the same service as the person living in Port Elizabeth; that a young man from Cape Flats gets the same care and treatment as the person in Chapman's peak. This strategy will ensure that all South Africans get the same quality service because they are all equal citizens of this beautiful motherland of ours. In this regard, I would like to congratulate the leadership of the department for the giant and bold step that it has taken to ensure that the country moves forward, in ensuring that the access of quality care is not a priviledge to the few, but it is the right for all South Africans.
I am convinced, hon Chairperson, that the strategy will be able to address the key problems that health departments have been having. I am excited because this department has identified that which has been the problem for the health sector, some of these has tarnished the image of this glorious profession. Having said those things, hon Chairperson, I would indeed advise the department that they need to ensure that they implement the strategy in health service systematically so that it continues to be sustainable after all these efforts has been made.
Our people are waiting patiently for the day when they can confidently go to the facility and come back, feeling better both mentally and physically. I know that the department has good intentions, but I want to caution that unless these plans are systematically implemented, we are bound to be counted amongst the generation that had good intentions which meant nothing to the ordinary citizens who are interested in service delivery and not talks.
I will say to the Minister beware of the prophets of doom.
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333359] [Old Assembly Main][90P-4-082A][mn].doc"
If we implement a National Health Insurance, NHI, but still fail to reduce maternal mortality, we will have failed our people. If we implement NHI, but continue to have children and infant dying from preventable and curable causes of ill health, we will have done nothing worth celebration. If we continue to have no medication in our facilities, we would have still failed the people we represent.
Hon Chairperson, my learned member there will have to agree with me in as far as NHI is concerned. I'm so delighted if you agree with me. [Laughter.]
The implementation of National Health Insurance should be followed by improvement in the health outcomes because that is what people want to hear. In order for us to achieve these things, we need clarity of mind and thought, to focus on the goals, to have our eyes on the ball - irrespective of negative talk - to spare no time and effort and deliver on the goals we have set for ourselves.
It is also my belief that, unless the department strengthens primary health care and district health system, all the good and wonderful dreams that you have will fail.
I really want to say that if you look at the plan that the hon Kopane talked about, it is a plan which the department has already. It is just that they talk a different language. It has become a common practice with the DA that they come here and dream of telling us that when they take over, these are the plans. Can they please support the plans which are here? How can you really stand here and really shoot downa plan which is going to take South Africa to another level.
An HON MEMBER: Mike, Mike, talk to her!
Ms M J SEGALE-DISWAI:To hon Mike, I think you miss Health, and they did a mistake by removing you. They have put you here today so that you can howl on their behalf. Thank you, Chairperson. [Applause.] [Laughter.]
Mrs D ROBINSON / LM & NB/
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Take: 359
Ms M J SEGALE-DISWAI
Mrs D ROBINSON: Hon Chairperson, members and guests, the DA is heartened, Minister, by the enthusiasm and zeal which you have displayed since your appointment and your hands-on approach. However, if you look at some recent newspaper headlines, we will see that you have inherited a health department that is in deep trouble: "State health care in crisis", the Sunday Times.
In the Weekend Post I read of the hospital of horrors, referring to the dilapidated Elizabeth Donkin Psychiatric Hospital, in Port Elizabeth, where a disturbed patient recently committed suicide ...[Interjections.]... after ward conditions became unbearable because of overcrowding and other factors. There was no proper monitoring by nurses because their station had been removed to accommodate more patients.
Is this the mark of a country which has a patient's rights charter, a Constitution that upholds human rights dignity and the right to a safe, healthy environment? Why do we read of abusive, uncaring nursing staff? Can it be the nursing conditions are so bad that they are demoralised and at the end their tether? [Interjections.]
I believe that that nurse at Cacadu have not been paid, yet, for January, February and March. In some municipalities, cash collections have to be made to buy electricity to keep the fridges in hospital running so that the medication and vaccine for babies doesn't go off. Is this perhaps one of the reasons we have had so many tragic deaths of babies in neonatal units?
The overcrowding and lack of resources at the Charlotte Maxeke Academic Hospital, horrific conditions at the Dr George Mukhari Hospital, the shortage of drugs, disprins and equipments at Chris Hani Baragwanath Hospital and the deaths of 180 babies at the Nelson Mandela Academic Hospital, in Mthatha, all bring shame to our nation. What will the national department do to wake up hospital and management and get competent dedicated professionals into state institutions?
Minister, why was the hospital revitalization programme under spent by R1 billion in 2010-11? How is it possible that there is underspending if so many of our hospitals and clinics are falling apart and their needs are so critical?
In the Herald, I read about the critical staff shortage, which has ended in the country's first acute surgical unit at the Livingston Hospital having to be closed because of the dire staff shortage in Causality. It is regrettable that this unit which was to provide expert treatment and was a signal of progress had to be closed.
The shortage of medical practitioners where on average 30 of health professionals of South Africa registrars training posts are vacant, and 75% of subspecialist positions are vacant, is a matter of grave concern. Is this perhaps because the hospital managers do not have the required skills and financial expertise to run the hospitals properly? Staff appointment must be based on qualifications, fitness for purpose experience, not on favours for comrades but on experience as we see in the Western Cape.
All South Africans, particularly the poor, who suffer most, need to know what programmes your Ministry has in place to get competent and dedicated staff appointed. Minister, why did key activities related to improving training facilities not take place in 2011, for example the accreditation of facilities, external audits of health facilities and the establishment of the Ombuds office?
We have massive problems with health compliance in South Africa. Why is only 2% of the health budget being spent on health regulation and compliance management? The budget of R62 million for the office of standard compliance may not be sufficient. All across the country there are doctors, nurses and health institutions that are not complying with basic minimum standards in health care.
The chaos and lack of quality health care, especially in the Eastern Cape, must be improved. It is a basic right, one which the Western Cape administration here adheres to - and thankyou, Doctor - where the life expectancy is 65 years. [Interjections.]
The NHI, your plan to turn the system around will be stillborn without sufficient doctors, without specialists in every district. We need to be assured that the vast amount of money to be spent on NHI over the 3 years, R900 million, will be well spent.
President Zuma said in his state of the nation address that women's health care programme would be a focus area for the financial year. In the build up to 2015 when we assess our progress in reaching the Millennium Development Goals, MDGs, particularly regarding maternal and infant mortality, the decrease of the budget by almost 40% is a bit sad. Women's health care is not covered adequately in the strategic plan.
Talking about maternal, child and women's health is not enough. We need decisive action to make a difference. We need to utilise our resources correctly to make sure that the most vulnerable people in society get the care they deserve. Primary health care services also have received a relatively small allocation in the budget. This does not gel with the Minister's stated intention to achieve a primary health care approach as opposed to the current hospi-centric approach.
Spending R800 million on the use of consultants is very worrying. We need to know what they will be doing, the projects they will be involved in and whether the department will be getting values for money?
The Auditor-General of South Africa has found significant challenges in infrastructure delivery and provincial departments of health. The current melt down in the national Department of Public Works is harming the poor in all provinces, as they are the people who suffer most when clinics and schools cannot be built due to interminable delays in government red tape.
After 17 years of freedom, the government has failed us. South African deserves better health care. Minister, we trust that you will be able to act as a catalyst and turn the situation around to make the situation better. We look forward to an improvement under your cap. Thank you. [Applause.]
Ms B T NGCOBO / Nb/ END OF TAKE
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Takes: 360 & 361
Mrs D ROBINSON
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333360] [Old Assembly Main][90P-4-082A][mn].doc"
Mrs D ROBINSON:
Ms B T NGCOBO: Chairperson and the hon members, the department has corrected all the issues that were pointed out by the Auditor-General in the Audit Report. It further established an electronic register that is really welcomed by the department. We also welcome the fact that the Minister is going to ensure that the provincial departments are provided with support so that they can do their audits properly.
It is only a non-South African who is not aware of the aggressive work that is being done and has been done on HIV and on TB. Real South Africans are aware that a lot of work has been and is still being done on HIV. Chairperson and the hon members, the major problem with HIV and TB is the issue of defaulters. We are aware that most of our people live in informal settlements and in the mines. When they go home they either never come back or come back in a state of death.
Surely, the current government, and the previous government at that, would have been unable to follow these people to wherever they were because the health of each individual is his responsibility.
We are aware that when these people come back, they are on the verge of death, some have Multi-Drug Resistant Tuberculosis, MDR-TB, and that is a very difficult disease to treat. We know that there are special walls that we can build for these conditions. A lot of difference has been made in the lives of Extensively-Drug Resistant Tuberculosis, XDR-TB, and MDR-TB sufferers. We applaud the North West for the three MDR-TB patients who were completely cured. [Applause.] In South Africa, pregnant women are required to attend clinic programmes even before the period of 20 weeks, at least at 14 weeks, so that any complications with the mother or baby can be detected and treated.
Although our learned friends on my right are against the National Health Insurance, NHI, never mind everything they say, including Mike Waters, they support the NHI. The Minister has reported that the department is going to employ its own engineers, not only nationally but provincially as well. We are aware that the Minister keeps integrating the department and the provinces to move away from fragmentation.
These engineers are going to work with the public and private partnership to deal with the departmental infrastructure projects. There is hope that the infrastructure projects that are in the pipeline will be completed on time. These projects include hospitals such as the Nelson Mandela Academic, Chris Hani Baragwanath, Dr George Mukari, King Edward VIII Hospital and Limpopo Academic. We are hoping that these projects will be completed on time.
The resource envelope that has been given to the department is spread throughout the provinces. Therefore, as the Portfolio Committee of Health, we will monitor whether the provinces are using these conditional grants properly, effectively and to the good of the health of South Africans.
Funding has been given to universities by the department to improve the doctors' pipeline and to ensure that we get more doctors. Regarding funding that has been given to the Department of Education via universities; is the department sure that this funding will do what it is intended for? If it also intended to address the issue of disadvantaged student doctors, will it do so or will the universities do as deemed fit?
We are encouraged by that the budget for the nursing colleges as well as the training of community health workers is already in place. The major challenge that the country is facing, although we are aware that Minister is dealing with it, is to integrate the health system across the board; to improve service and the high cost of care and to improve the lives of all South Africans.
Provinces and departments have to integrate their services, improve communication and accountability, particularly, for the conditional grants that have been given for that purpose.
The NHI tunnel of projects is focused on improving the district's health system as well as for the district to assume greater responsibility towards the health of the nation. The projects will start in ten districts across provinces that will deliver this service.
IsiZulu:
Angisho nje ngesintu ngithi, ngizozibala lezi zifunda ukuze bonke abantu abalapha nabasemakhaya bazi ukuthi yiziphi zona lezi zifunda, nokuthi yini okuzodingeka bayilindele. Ngikhuluma ngalezi ziFunda; i-O R Tambo eseMpumalanga Koloni, iThabo Mofutsanyane eFreyistata, iTshwane eGauteng, uMzinyathi noMgungundlovu KwaZulu Natali - yilapho kuphela lapho kukhethwe izifunda ezimbili, mhlawumbe kwenza nokuthi izinkinga zakhona zingangezifunda zakhona. I-Gert Sibande eMpumalanga, i-Pixley ka Seme eNyakatho Koloni, i-Dr Kenneth Kaunda eNyakatho Ntshonalanga, iVhembe eLimpopo kanye ne-Eden eNtshonalanga Koloni - yize noma laba bengakweseki lokhu kodwa kuzofanele babhekane nesimo ngoba imali yombuso iphumele ukuba ifeze lowo msebenzi, ngaphandle-ke uma bengasitshela ukuthi le mali yombuso bazoyenzani.
"Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333361] [Old Assembly Main][90P-4-082A][mn].doc"
May I go back to the responses of the people who have contributed to this debate. The hon Kopane spoke about the National Health Bill, which looks into the Office of Health Standards Compliance.
An HON MEMBER: And he spoke sense.
Ms B T NGCOBO: Surely, we cannot talk about or discuss that Bill while it is still under discussion by the committee. The committee is still talking about it. [Interjections.]
An HON MEMBER: It is not classified information!
Ms B T NGCOBO: We were listening to briefings only two weeks ago. We are still going to be talking about the Bill. The issue of independence is always a problem in this House. Whatever structure is established, its independence will be doubted because it will be reporting to so and so. [Interjections.] Hon Kopane, how exorbitant and expensive would that private sector medical schools be for the disadvantaged whom we are talking about today? For the elite and the rich that would do very well.
The HOUSE CHAIRPERSON (Mr C T Frolick): Order, hon members! Allow the member to be heard.
Ms B T NGCOBO: The reason is that the elite would be able to afford what should be paid to that medical school. Medical schools, as we see, is expensive, but private sector medical schools ...
An HON MEMBER: You'd better speak to Malema. Maybe he could support you.
Ms B T NGCOBO: [Interjections.] Do that, you do that.
So, we are looking forward to working with the province and the national department and, also to monitor and do oversight in the provinces, as well as in the national department because we would like the quality of health services to South Africans to improve. If I may just ask the people on my right, if it were 17 years back, would you be talking health as you are talking health today or would you be talking "nie-blankes, blankes"? What would you be doing, if we were to roll back the clock 17, 18-19 years? So, government is doing the best that it can do to improve the lives and the quality of life of all South Africans.
Secondly, we have a very committed department as well as Ministry that is working towards improving the quality of life of all South Africans regardless of who you are, wherever you are, how rich or how poor - the quality of life will be improved.
Hon Robinson, public servants are paid through the coffers of the Public Service and Administration, not of Health. They are public servants and they are paid as public servants, not by any department they are serving.
Thirdly, regarding the issue of energy in the Eastern Cape in 2010 - I was working in another committee at that time. We went to the Eastern Cape; the Department of Energy had not used its electricity grant to actually make sure that there is electricity in the rural clinics and schools. At the same time, Water Affairs had not used its budget for clinics and schools. So, that cannot really be in the alleyway of the Department of Health. Chairperson, I thank you. [Applause.]
The MINISTER OF HEALTH
UNREVISED HANSARD
EPC – OLD ASSEMBLY CHAMBER
Tuesday, 24 April 2012 Takes: 361 & 362
Ms B T NGCOBO
The MINISTER OF HEALTH: Hon Chairperson, thank you to those who participated, including those who participated negatively. I started by saying that we have a special guest today, Me Yvonne Chaka Chaka, who is a roll back Malaria and Unicef Goodwill Ambassador and UN Envoy for Africa. We have invited her to celebrate her success. [Applause.] She is the first African women to receive the World Economic Forum's Crystal Award for artists who improve the world through their work. She became involved in the malaria campaign after one of her back up singers, Phumzile Ntuli, died of Malaria in 2004. She is also engaged in the daily battle against HIV/Aids and TB. She's a South African. [Applause.] That is why we need to celebrate her success.
In July 2010 when I accompanied the President to the African Union, AU, she accompanied the AU Social Affairs Commissioner, Adv Gawans, to convince heads of state in Africa to support Campaign on Accelerated Reduction on Maternal and Child Mortality, Carmma, which we are going to launch on 4 May as I have already said. Please applaud her again. [Applause.]
South Africa is one country with nine provinces. I am not sure why people believe, for some reason, I must start competing with the provinces that fall under us. This issue of continuously mentioning what's happening in the Western Cape as if it is not part and parcel of the country must come to an end. I was listening to this story of Khayelitsha District Hospital. You know this is not my nature. I don't want to start these types of things because is not my nature. But you're provoking me to do things which are unlike me.
Khayelitsha District Hospital was planned as far back as 2007 before the DA came into power. If you think it's an issue of competition; its part of the conditional grant from the national government. We give conditional grants and the R700 million is that conditional grant. Let me tell you how conditional grants work. We give a framework from national side and the provinces must comply. Whatever they submit, is on the basis of the framework which we describe. They submit the business plan and we pass it and give the money. That is what we have done. [Interjections.] The Bertha Gxowa Hospital in Gauteng ... Can you shut up, please, and listen. When you spoke I was quiet.
The Bertha Gxowa Hospital in Gauteng was built in the same manner, a State of the Art Hospital, a Green Hospital. I was not there when MEC Mekgwe and the premier opened it, but it was not a competition. It so happened that I came to Khayelitsha because I was available. I told Premier Zille this because my office confirmed very late that I was coming. They wrote that plague in her name. She said "Minister I am sorry. This plaque is written in my name, but I will change it and write it in your name". I said that it was not necessary as I am not in a competition and to leave the plaque in her name. I will just open it. That is the spirit in which we are working here and I don't know what spirit you are bringing to the country for this kind of competing. [Applause.]
We want to rebuild Tygerberg Hospital here in the Western Cape as a state of the art hospital. We have already given R3 million for planning. Should I then start competing? We gave that money and we are going to give no less than R1 billion for the refurbishment of Tygerberg Hospital. [Applause.] I am doing so because this is the Republic of South Africa, it's not the republic of the ANC or the DA. It's the Republic of South Africa for the people of South Africa. The people who go there are South Africans. [Applause.]
We have built Inkhosi Albert Luthuli Hospital in KwaZulu-Natal - a state of the art hospital. We are going to build the Dr George Mukhari Hospital and the Chris Hani Baragwanath Hospital. We have named six hospitals; they are all going to be state of the art spitals – something you have never done before. There is going to be no competition. We are all South Africans. Please, let's avoid that.
Let me correct the issue of underspending. I am the one who brought this issue of underspending to the fore and I even gave you figures. We didn't know. Most of these things that you keep on talking about and criticising, you actually got them from me. [Laughter.] Yes, I told you, [Interjections] that the underspending on infrastructure has been doubling from 2007. It started from R199 million in 2007 until in 2010 it was R813 million, not R1 billion, and I said we would correct it, as Mrs Ngcobo have said, we hired engineers.
I can announced to this House that while the underspending was R813 million in 2010-11, in this financial year that has just ended, we have decreased it to R390 million. I am standing here to tell you that during this financial year we will eliminate it. Next time you will come and cook that again. [Laughter.] We will eliminate it, we decreased it and I was the one who announced that we were going to decrease it. What I promise we will do, we always do in this department. I don't just promise, we promise and do.
Regarding the issue relating to the National Health Insurance, NHI, "Old Assembly Main",Unrevised Hansard,24 Apr 2012,"[Take-333333362] [Old Assembly Main][90P-4-082A][mn].doc"
I am not very sure whether you want to sleep through the revolution; this disaster you are talking about is yours and not ours. [Interjections.] If you are planning a disaster go on why do you want to involve us, [Laughter.] I am not moving with you in that disaster direction, I cannot take the country to disaster. [Laughter.]
This issue of universal health coverage is a world wide phenomenon, you can be left behind, and it is supported and defined by the world organisation. Hon Kganare you talked about politicisation, it is not us who are politicising it this is a world wide phenomenon because which citizen of the world must be left behind when health care is financed. Why is the World Health Organisation leading it? Because in 1978 when the World Health Organisation passed the Declaration of Alma-Ata, they said that the attainment of the highest standard of health is a world wide social goal and its realisation needs action from all sectors, economic and social in addition to the health sector. That is what we are pursuing.
Let me redo this Bangkok Declaration - you can google it – that is where I was quoting the World Health Organisation about Mexico, go to it and read it. Universal Health Coverage sometimes referred to as UC, is a widely shared political aim of most countries and has gathered increasing international attention recently. The International Forum on Sustaining Universal Coverage: Sharing Experience and Supporting Progress, organised by the government of Mexico on 1-2 April 2012 in Mexico City, is the latest international high profile event for universal coverage in Mexico City with a high level of participants from 21 countries and the World Health Organisation, including the Minister of Health of Mexico and the South African Minister of Health as well as the World Health Organisation Director General Dr. Margaret Chan and Assistant Director General Dr. Carrisa Etienne gathered to exchange experience and promote international co-operation on efforts such as progress towards universal health coverage.
The participants heard about various pathways taken and challenges faced by countries on the way. Challenges not obstacles, [laughter.] challenges on the way to universal coverage, they also discussed and identified supportive action that can be taken at international level to recognise the importance of universal coverage for sustainable development equity and population well being – go and check it – that is the Bangkok Declaration which was passed in Thailand during the visit by the Portfolio Committee on Health.
Let me tell you what is going to happen, I am going to give you the copies this, [Interjections.] please shut up and learn to listen and respect for that matter, especially elderly people... [Interjections.]
The HOUSE CHAIRPERSON (Mr C T Frolick): Hon Minister, please take your sit.
Mrs S V KALYAN: Chairperson, I submit that the word, shut up, is unparliamentary [Interjections.] especially from a person who holds a high position as a Minister.
The HOUSE CHAIRPERSON (Mr C T Frolick): I will rule at the end of the debate, hon Minister you may conclude.
The MINISTER OF HEALTH (Dr P A Motsoaledi): It does not matter, I can withdraw it. . . [Laughter.]
Sepedi
Eupša tsebe ga e na sekhurumelo, sesi. [Disego.]
English
I can withdraw it and I am withdrawing. [Laughter.] Let me tell you what is going to happen, this issue is going to the United Nations for it to be universal and international. That is the decision taken at Bangkok and Mexico. Lastly, to the DA, in Sepedi it is said that. . .
Sepedi
... o seila kgaka, senwa moro.
English
It is very funny, you are attacking anything, and they will not be able to interpret it, so forget. [Laughter.] Seila kgaka, senwa moro, nobody will interpret that, [Laughter.] come to my office and I will explain. You are attacking NHI but piloting it, when you do that, in my language o seila kgaka, senwa moro, continue le ila kgaka le e nwa moro and we will continue implementing NHI successfully. Thank you. [Laughter.] [Applause.]
The HOUSE CHAIRPERSON (Mr C T Frolick): In terms of the point of order, the Minister voluntarily withdraw the word shut up, it is indeed unparliamentary.
The Committee rose at 18:59.
GG (NP – Ed)/ & JN /END OF TAKE
END OF TAKE
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