Hansard: Debate on Vote 16: Health (OAC)
House: National Assembly
Date of Meeting: 14 May 2013
Summary
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Minutes
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 337
"National Assembly Chamber Main",Unrevised Hansard,20 May 2013,"Take 337 [National Assembly Chamber Main].doc"
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WEDNESDAY, 15 MAY 2013
PROCEEDINGS OF NATIONAL ASSEMBLY
_____________
The House met at 10:03.
House Chairperson, Mr C T Frolick, took the Chair and requested members to observe a moment of silence for prayer or meditation.
The DEPUTY CHIEF WHIP OF THE MAJORITY PARTY
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 337
Start of the Day
APPOINTMENT OF TEMPORARY PRECIDING OFFICERS
(Draft Resolution)
The DEPUTY CHIEF WHIP OF THE MAJORITY PARTY: House Chair, I move:
That the House elects Mr G T Snell and Mrs N J Ngele to preside during the sitting of the House on Thursday, 16 May 2013 when requested to do so by a Presiding Officer.
Agreed to.
The MINISTER OF HEALTH
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 337
The DEPUTY CHIEF WHIP OF THE MAJORITY PARTY
APPROPRIATION BILL
Debate on Vote No 16 – Health
The MINISTER OF HEALTH: Hon House Chair, my colleagues Deputy Ministers and Ministers, chairperson and members of the Portfolio Committee on Health, hon members of the House, invited guests, ladies and gentlemen, it is now documented and generally understood that South Africa faces a quadruple burden of disease while many other countries are faced with only a double burden.
These four are very high prevalence of, firstly, HIV and Aids which has now entered into a synergistic relationship with tuberculosis, TB; secondly, is maternal and child mortality and morbidity; .thirdly, exploding prevalence of noncommunicable diseases mostly driven by risk factors related to llifestyle; and lastly, the issue of injuries and violence.
These four colliding epidemics resulted in death notification doubling to 700 000 per annum between the years 1998 and 2008 as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels. We had to respond to these very urgently and very decisively.
In addition to our Ten Point Programme, the Department of Health signed the negotiated service delivery agreement with the President of the country. We committed to four objectives which we called them outputs during this term of government. These objectives are: firstly, we need to increase life expectancy; secondly, we need to reduce maternal and child mortality; thirdly, we need to reduce the burden of disease from HIV/Aids and TB; and lastly, we need to improve the efficiency and the effectiveness of the health care system.
After going into a deep analysis of these problems it became clear that unless we deal decisively with HIV and Aids and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Therefore, our plans had to have a very strong element of a desire, commitment and passion as far as HIV/Aids and TB are concerned. This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa is by enlarge HIV/Aids and TB.
We responded comprehensively through well designed plans to deal with HIV/Aids and TB and the implementation of these plans were well executed. Among others, we increased the health facilities providing antiretrovirals, ARVs, from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of doctors were increased from only 250 nurses in February 2010 to 23 000 nurses to date. This programme is called Nurse Initiated Management of Antiretroviral Therapy, Nimart.
Hon Chair, there is noise from this side and I can't concentrate. Please, help me.
Nimart made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date – that is actually doubling the number of people on treatment. [Applause.] I wish to take this opportunity to thank all the health workers for this sterling performance, especially the nurses without whom this numbers would have been impossible to achieve given the small number of doctors that the country has.
Very recently, we have introduced the ground-breaking fixed dose combination, FDC, therapy which made it necessary to train 7 000 health workers for smooth implementation. Another very important windfall from these FDCs is that by February 2010 it use to cost us R313,99 per patient per month to provide ARVs, but now with the FDC's it is costing us only R89,37 per patient per month. We are now able to treat many more people per month with the amount of money that we used to treat one person in 2009. [Applause.] The results we achieved from these endeavours are very sweet indeed.
By the end of last year, local and international researchers started reporting a dramatic increase in life expectancy in our country. They also reported a decline in under five-year-olds mortality and maternal mortality. Our biggest challenge however is still the neonatal mortality rate. These researchers include our Medical Research Council's Rapid Mortality Surveillance Report, the Prestigious Medical Journal, the Lancet and the United Nations agencies like the United Nations Programme on HIV and Aids, UNAIDS. All these researchers attributed the decline in mortality and the concomitant increase in life expectancy in South Africa to our comprehensive response to the HIV/Aids epidemic, especially the ARV treatment programme. The fact that we are testing large numbers of our people and large numbers are on treatment has brought much relief to individuals, families and communities.
As far as TB is concerned, we started earnest on 24 March 2011 to introduce new programmes. We have unveiled new strategies to combat TB. Firstly, we unveiled the GeneXpert technology. The last time the world unveiled the new technology to diagnose TB was more than 50 years ago. The world had then thought we had defeated TB. Now we know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation's Stop TB Partnerships.
Before GeneXpert technology it use to take us the whole week to diagnose TB, but now it takes us only two hours. [Applause.] It use to take us three months to conclude that a person has got multidrug resistant TB, but now it takes us only two hours to know. [Applause.]
I'm very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 units around the country. This 242 constitute 80% of all facilities we would like to cover. We had spent R117 million shared by the national Department of Health, the Global Fund and the Centre for Disease Control in the USA to achieve this 80% coverage. We have conducted 1,3 million tests since using this technology in 2011. This 1,3 million tests constitutes more than 50% of the total tests that were conducted throughout the whole world in the same period.
In five months' time, we will achieve 100% coverage of this in all the district hospitals with the GeneXpert technology. From there we will move to the big community health centres. The biggest of these machines can diagnose 48 patients at a time while others can do four or 16 only. The biggest are called GeneXpert 48. We only have two of them in the whole country. We have placed one at the Ethekwini Municipality in Prince Mshiyeni Hospital in KwaZulu-Natal. The second one is in the Cape Metro at the National Health Laboratory Service at Greenpoint. We have done this because both Ethekwini and the Cape Metro are the most very heavily challenged cities as far as TB is concerned.
You are aware that the on World TB Day, 24 March this year, the Deputy President of the Republic unveiled a GeneXpert technology at Pollsmoor Prison on behalf of all Correctional Services facilities. This was in response to a Constitutional Court ruling where an inmate took government to court and the state was held liable for the inmate contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in Correctional Services facilities. They too will be supplied with GeneXpert units to screen all inmates on entry to Correctional Services facilities and to screen them twice a year once they are inside.
We will also request, from the Minister of Correctional Services, the names of all those who are found by the GeneXpert to be having TB in order to send health workers to their families so that the whole family of an inmate could be screened for TB. One person with TB has a potential to infect 15 others in his or her life time.
The second strategy we have adopted was to establish family teams. On our database we have 405 000 families in South Africa where there is a member diagnosed with TB. The family teams are visiting these families to screen all members within such a family. About four weeks ago, the Statistician-General went to Thabo Mofutsanyane Region in the Free State to release Statistics SA's yearly figures on the causes of death. He released the figures for 2010 and announced that TB was found to be the number one killer in the country. This is not surprising given the synergistic relationship between TB and HIV and Aids as I said earlier.
We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5%, but in 2012 it has improved to 75,9%. The target set by the World Health Organisation is 85% cure rate. We are steadily but surely moving in that direction.
However, I have one very serious request to make. Having turned the corner should not be regarded as a signal for South Africans to be complacent. We still have a very long road to travel with HIV/Aids and TB.
The National Development Plan has clearly indicated that by 2030 we must have a generation of under 20s being free from HIV/Aids and we must have a decrease in TB contact indices.
At the recent South African National Aids Council, Sanac, plenary we have decided that the Presidency will need to relaunch for us the HIV Counselling and Testing campaign in the country. This launch must happen at Gert Sibande District Municipality in Mpumalanga. This district is now officially declared as a district with the highest prevalence rate of HIV/Aids in the country. I have a serious complaint; since the campaign had started there is one extremely powerful place in this country where the HIV Counselling and Testing, HCT, campaign was never launched. That place is called the Parliament of the Republic of South Africa.
Hon Chair, please, may I humbly ask that the Speaker must choose a date where we will come and publicly launch this campaign here in Parliament with the Speaker and the Chairperson of the NCOP taking the lead, followed by leaders of all political parties in this hallowed chambers. The provincial legislatures, district councils and local councils will follow suite. I will then have the power to encourage the churches, schools and other centres of civil life to choose their own dates to do so. I promise to supply Parliament with GeneXpert and a mobile X-ray unit on behalf of members. Parliament members also need to be screened for TB and HIV and Aids.
Let me now deal with the intractable problems that the health care system is faced with - which is also in our negotiated service delivery agreement - that is, Output 4: Strengthening health system effectiveness in the country. You are well aware that our flagship programme to change the efficiency and the effectiveness of the health care system in the country is the National Health Insurance, NHI, system.
While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has now gone global. The World Health Organisation, the United Nations, the World Bank and the prestigious institutions of high learning such as the Harvard University have recently entered the fray in support of NHI and in giving well researched guidance to countries on how to go about implementing NHI – not to debate of whether it is needed or not. The world has far gone beyond that stage.
Recently only a month ago, the World Bank and Harvard University organised a workshop for all Ministers of Finance to guide them on how their treasuries should support NHI for the benefit of economic growth around the whole world.
Of course, it is not called NHI in every country. The World Health Organisation and all the UN agencies are calling it through the generic term, the universal health coverage. We, in South Africa, will stick to the term NHI. Late last year, the prestigious British medical journal, The Lancet, has launched a series to allow academics, health activists and researchers to write articles to guide countries about this concept of universal health coverage. It doesn't matter what you call it – the concept is the same and it means every citizen has a right to access to good quality, affordable health care, and that that access should not be determined by the socioeconomic condition of the individual. Whether you call it NHI as we are doing in South Africa; National Health Service, NHS, as they do in England; Seguro Popular as they say in Mexico; or Obama Care as the Americans call it, the concept is the same.
In the editorial of The Lancet: Volume 380 of 8 September 2012 it states that, and I quote:
Certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressibly right. That health care should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding.
The editorial goes further to say:
Building on several previous The Lancet series that have examined health care systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical, political, economic and health arguments in favour of universal health coverage and will be presented in New York on 26 September to coincide with the United Nations General Assembly. The series was facilitated by the Rockefeller Foundation and edited by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation Director-General, Dr Margaret Chan's assertion that, universal health coverage is the most powerful concept that public health has to offer.
The editorial goes on to say:
Universal health coverage, like any other health system, must be accountable for the quality of its outcome and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for share holders.
It is very clear that the whole world, and not only our country, is gearing to rid itself of archaic health care financing systems that caters for the privileged few and punishes the poor, in favour of health care systems that will benefit all citizens of a country.
This assertion led to another article in The Lancet series that I have just mentioned. It argues that universal health coverage is poised to be the third health transition. It argues that they have two transitions since the beginning of humanity. Firstly, it was in the 18th century which the world gained from in the 20th century and was through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths. The second one, which started in the 20th century and reached even the challenged countries in the 21st century, was when the world started tackling communicable diseases through immunisation. Now, they say that a third transition is sweeping the globe and challenging health care financing because for a along time, health care has meant first paying a fee to the provider – a practice that effectively burdens the poor.
In implementing NHI or universal health coverage, countries are clearly going to pay different prices in terms of durations and also in terms of time depending on internal objective factors and dynamics within each country. Hence, a country like Qatar is going to implement NHI starting from July this year and completing it in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same because our internal objectives of factors. Unlike Qatar, there are two main prices that South Africa has to pay for successful implementation of NHI.
The first price is the quality of services in the public health system. It has to drastically undergo a metamorphosis – the quality simply has to improve and there is no running away from that.
The second price is that the cost of private health care has to drastically reduce. We need to firmly regulate the prices in private health care.
As the Department of Health, we strongly welcome last week's announcement by the Minister of Economic Development, the hon Minister Patel, that through the Competition Amended Act, the Competition Commission will launch a public market inquiry into the cost of private health care. We are ready for them and for those who do not understand where this comes from. I wish to refer you to our National Development Plan: Vision 2030, which states that:
A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private health care and supported by better human capacity and systems in the public sector.
On the issue of quality in the public service and as to how we are going to pay this price, we shall outline this in the White Paper to be released soon as I said earler. We are aware that it has taken long time and that it's long overdue, but there were many things that we had to consider before we could release it and we will do so very soon.
It will be released with a plan on how NHI is to be implemented. These are elaborated plans and it will be impossible for me to give them here with the time allocated to me. They will be made available in due course. They will include the whole concept of non-negotiable in health care, the delegation of powers to chief executive officer, CEOs, who are newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.
But I wish to take this opportunity to emphasize over and over again that the NHI will be based on a preventative and not a curative health care system. I will then repeat it in many more occasions to come that primary health care, means prevention of diseases and promotion of health is going to be the heartbeat of NHI in South Africa.
We will drive this healthcare system according to the dictates of the National Planning Commission which clearly states that among the most important things to be done, we need to reduce the burden of disease not to allow them to flourish and run helter-skelter in trying to cure them.
We wish to demonstrate the examples about the rotavirus vaccine and the pneumococcal vaccine. Since its inception four years ago, we have seen miracles in three places. In Ngwelezele Hospital where they used to admit 1 000 children with diarrhoea everyday, they have closed that ward recently because there is no more diarrhoea. [Applause.] In Cape Town and Gauteng generally, diarrhoeal admissions have been reduced by 70% due to attributable to rotavirus.
Seeing the successes that vaccines can bring, our next target is cancer of the cervix of the uterus - one of the biggest killers of women in our country. According to Prof Lynette Deny and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and Chris Hani Baragwanath Hospital respectively, cervical cancer affect 6 000 South African women annually. Eighty percent of them are African women and out of these 6 000 affected between 3 000 and 3 500 die annually as a result of this cancer. More than 50% of the women affected are between the ages of 35 and 55 years of age. Only 20% are older than 65 years of age. HIV positive women are five times more likely to get it than HIV negative women. Women who smoke are two times liable to get it than nonsmokers.
This cancer is caused by another dangerous virus, the human papilloma virus. The good news is that there is now a vaccine against this virus. Unfortunately, it is also sexually transmitted. The very bad news is that the prices are prohibitive; they are between R500 and R750 a dose and you need three doses to be covered. Even in the private sector the uptake is very slow because of these costs.
At the moment, to make these vaccines affordable, the Bill and Melinda Gates Foundation established the Gates Action for Vaccines and Immunisation, Gavi, to help poor countries. Unfortunately, South Africa does not qualify for Gavi as we are regarded to be a rich country - although some times we are told that we are poor. We are also aware that the Pan American Health Organisation has negotiated a price of $13,00 a dose for Latin American countries.
I am extremely happy to announce that in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence to administer the human papilloma virus, HPV, vaccines as part of our School Health Programme by February next year. [Applause.] We will enter negotiations in our own right to also be given a fair deal. We are advised by scientists that the vaccine is fully effective before sexual activity. Therefore, we shall administer this vaccine to the nine-year-old and 10-year-old in Quintiles 1, 2, 3 and 4 schools. This will cover 520 000 girls between the ages of five, nine and 10 years. We will give a booster dose five years later. We are not discriminating against Quintile 5 schools, but we are just saying that parents there can afford. Please, parents must try to buy it on their own until we are able to cover them.
I am calling on all medical aid schemes in the country to pay for these vaccines to help parents with this category of learners because the benefits far outweigh the costs. I was told that it costs about R100 000 per patient in the public sector to treat each one of this 6 000 cervical cancer patients. I'm scared to give you the prices in the private sector.
Very bad news emerged recently from our hospitals about an entity called Remunerated Work Outside the Public Service, RWOPS, whereby doctors fully employed by the state conduct their own private work during working hours. RWOPS is not illegal. It was passed by Cabinet around 1994. The only problem is that it is being abused by some unscrupulous individuals. I must emphasise that the overwhelming number of doctors in the public service are very decent law-abiding hard working citizens who are deeply committed to their patients. It is only a few who are tarnishing the name of the profession. I am appealing to the public that the events that unfolded this past week and early this week in the media should not be misconstrued that most doctors are involved in this practice and start regarding all doctors as criminals. I repeat, the majority of doctors are ethical individuals who understand their calling.
The very few who are involved are not only punishing patients, but they are also destroying the medical training in the country in that. They leave medical students on their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.
I have already warned the private sectors who are benefitting from this bad practice that in the long run they also will lose because we will have poorly trained doctors in the whole country.
I have given this matter to the deans of all the medical schools to deal with and I'm waiting for their recommendations. We will call all stakeholders to discuss this matter because to me is a national problem, but for those who were found guilty because we know their names, we can't avoid criminal charges. We will refer their names to South African Revenue Service, Sars, to check if they are paying tax for the double income that they are earning.
We are also appealing to private sector who are hellbent on attracting this public servants with lots and lots of perverse incentives to please stop this practice because is not only destroying the public sector, but it's also going to destroy them in the long run. Very soon, and I'm not threatening, we will neither have a private health care nor a public health care in South Africa because of this practice.
I wish to take this opportunity to thank the Deputy Minister, the director-general, DG, and all managers in the head office and facilities. Our health workers who are our heroes and heroines despite a few who want to tarnish the good name of their profession. I wish to thank them for the sterling work and performance done sometimes under very trying circumstances. [Time expired.][Applause.]
Mr M B GOQWANA / NN / GC / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 338
"National Assembly Chamber Main",Unrevised Hansard,27 May 2013,"Take 338 [National Assembly Chamber Main].doc"
The MINISTER OF HEALTH
Mr M B GOQWANA: Hon Chair, the Ministers that are here, the Deputy Ministers, hon members, - no, it is not a few minutes, but quite a number of them - I must acknowledge that there are members of the SA Medical Research Council that I have seen, the Health Professions Council of South Africa, HPCSA, the Board of Healthcare Funders, BHF, the National Health Laboratory Services, NHLS, the Council for Medical Schemes and I have also seen the board of SA Medicines Control Council. Let us all congratulate the Department of International Relations and Co-operation for helping the paediatric oncologist to be on the plane today, coming back to South Africa; we welcome that. [Applause.]
We always promise a better life for the people of South Africa. Do we ever look back and ascertain whether we have fulfilled that promise? With regard to health, the ANC-led government has achieved what I regard as the most important indicator in South Africa. For the first time in the history of South Africa, life expectancy is prolonged. The people of South Africa now live longer than they used to before. Consequently, because of the prolonged life expectancy, South African people will be directly contributing to the economy that supports them for longer periods. People see and experience their legacies whilst they are alive.
Allow me to inform the House how the ANC-led government has kept its word to better the lives of South African people.
IsiXhosa
Thina nto zaziyo asothukanga nto. Sitsho sisithi bekufanele, sibona kamhlophe sithi bekumele. Awukho umbutho onokwenza njengoKhongolose. [Kwaqhwatywa.]
English
Honesty is our value; humility is our motto; driven by the people is our mission. The department we are overseeing is very complex. It is both an entry and an exit of humankind to and from life. The Department of Health has power over life and death of the people of this country. The health professionals are tasked with prolonging the period between entry to life and exit to life. For the first time, this has been achieved in South Africa. This indicates to us that the Department of Health is in the right course.
Three years ago, on this platform, we said, the passion showed by the Minister gives us hope. It has been proven that passion without resources can work; resources without passion can be an empty shell. The hopes of the people have been renewed by the successful vaccination of children to reduce pneumonia and the diarrhoeal diseases which were the foremost causes of death in the young ones.
The prices of Antiretroviral, ARV, drugs have tumbled down to help comply with the taking of the ARVs. Pharmaceuticals have introduced a single dose drug that will greatly improve compliance and reduce side effects. Consequently the viral load will drop to zero. What this implies is that the chances of infecting another person will drop to zero when a person is on this therapy. This is also a preventative measure.
Chief executive officers with medical qualifications have been appointed in hospitals. Training has been given to chief executive officers using funds from both public and private sectors. The SA Medical Research Council has produced a few scientists who are South Africans to continue doing research in South Africa. Nothing about us without us!
The public health care sector has been regulated, for the first time. Regulating public health care sector has not happened before. Primary health care has been re-engineered. The school health programme, ward based community involvement, specialists teams in district services have been set up and this brings hope. Maternal deaths have been reduced and progress has been made, especially after the launch of the Campaign for Accelerated Reduction of Maternal Mortality in Africa, CARMMA, held in Durban. The launch of obstetrics ambulances in the provinces was also held in Durban; and the ability to diagnose the most common causes of death in maternal patients. The fact that the department has set up maternal enquiries has made it possible to reduce the maternal death rate.
We commend the Department of Health for actually budgeting for the shortfall of President's Emergency Plan for Aids Relief, PEPFAR, funding that has been reduced. The rate of mother-to-child transmission has dropped. We have seen advances in the health sector such as cloning of skin, performed by Doctor Ridwan Mia and his team. We have heard about the antibodies to HIV virus being discovered by Professor Carrim and his team. All these advances serve to prolong the gap between the entry to and the exit from life.
Does the Department of Health deserve that this House support this Budget Vote? Obviously, yes, we support this Budget Vote because of what I have said. The department has implemented the ANC-led government's policies and I have narrated to the House that when we look back we see that they have done very well.
However, the Department of Health still faces challenges. Statistics SA showed that despite tuberculosis, TB, being a treatable condition, it is still a killer. As a country we are rated low globally because of infectious conditions compared to other countries. Despite the bad association of TB and HIV virus, TB is still the main killer.
I am sure we know that the doctors who are actually saying TB is a killer are correct because it is few conditions where HIV virus is the actual killer. What is worrying about TB is the fact that it still indicates that there is still a big gap between the rich and the poor, particularly because we have got two parallel health structures, which are the public health and the private health sectors and they are failing to converge on a point of rapport.
As for the Western Cape, statistics of TB is very high, yet the statistics of HIV is very low and it tells you something that the gap between rich and poor in the province is very high. [Interjections.] The Department of Health is a divine idea from the mind of God that has been made to manifest. The officials and professionals of the department are accountable to the Minister, Parliament and the Auditor-General.
Besides these structures who should call department officials to account? Is the South African public not supposed to call them to account? They are the taxpayers and it is within their right to demand accountability. People think that issues of health are very complex and hence they shy away from them. It is the responsibility of the department to engage and empower health beneficiaries at all levels that will make people understand health issues.
Are health professionals not entitled to some accountability by the department? Yes they are, but due to the fact that they are speaking in different voices and are not unified, they are making it difficult for the department to respond and account to them. There are many professional voices advocating for health, public health care, private health care, clinical care professionals and health administration. I urge health care professionals to speak with one voice so that they can further advance the struggle for health care.
When persons need health care, irrespective of whether you choose the public or the private, they will be attended to by a nurse, a doctor or the auxiliary health professional, if necessary. At the core of the health services are the health care professionals. Health care professionals should be the ones who drive the universal coverage. As custodians of health care they have the ability to make health services universal.
The private health care should make the department accountable to them too. South Africa needs the private health care sector. When the ANC took over in 1994 the private health care industry was in existence in this country providing services to about R8 million South Africans. We need the private health care, but let us agree that it cannot be business as usual. The high cost of private health care is a disservice to the country. Because of the high cost of private health care, for the great majority of patients on medical aids, benefits get depleted before the patients are cured of their diseases.
The patients, who are discharged from hospitals with diseases such as TB, and who have not completed their treatment or have been cured, go back to their families and communities. In the process, they infect other people as they go back without being cured because of high costs. This is what I allude to by saying high costs of private health are a disservice to the country.
The worst scenario is if a patient who could not complete his or her treatment, due to high costs, that patient, if he suffered from TB will definitely develop what we call Multi-Drug Resistance, MDR, and Extreme Drug Resistant, XDR and this becomes more expensive for the country under these conditions. With situations like these, nobody is safe, even the doctors and nurses looking after the patients. All this is caused by the fact that the private health care industry is not affordable.
When a person falls sick or suffers a cardiovascular accident or a heart attack, it is matter of life and death and there is no time to shop around for a cheaper health care. By the time the sick person gets to another health care provider, the condition has gone worse or the person has died.
I commend the group called Intercare which is in the private health care industry and they are investing in primary health care, rehabilitation and day care hospitals. They keep patients for a shorter period to make sure that they go back and contribute to the economy. In fact it is interesting that the founders of Intercare are health professionals who assisted in actually transforming what we used to call Medical Association of South Africa to South African Medical Association.
South Africa is plagued by a society that is very angry. Whether this anger relates to our past or to the mistrust among the different people inhabiting the country, is yet to be established. The country has a number of undiagnosed psychopaths languishing in prisons. If we look at the profile of a typical psychopath, we will see that these people need mental services, especially after serving their prison sentences. Mental services need to be integrated with primary health care and we need health care workers to specialise in mental health.
Our primary health care plan is very good but the department needs to make sure that the plan filters down to the rural areas. We still have challenges in rural areas, irrespective of the good re-engineering of primary health care. I remember recently there was a programme on SAfm where they were hosting the Deputy Minister and I listened and two doctors phoned from the rural areas, complaining about the services that are not yet in place in the rural areas.
The development of rural health care actually assists in helping the referral system to the big hospital. The public service is facing a serious challenge of quantity as far as health care workers are concerned. This is not exclusive to South Africa but is a worldwide problem.
The pressure of getting many health care workers compromises the quality. The inadequate number of health care workers has a direct impact on the quality of patient management. The downward spiral of quality of patient management is the reason why lawyers are having a free reign in suing the Department of Health.
I am making a serious call to universities, colleges and professional council to assist and be sure of the quality of health care professionals that we train in South Africa. I am reminded of a three months old baby who was in one hospital and this baby when he came to the hospital they wanted to give intravenous treatment and make sure that the baby is rehydrated. They tried to put up a bandage around his head, to look for a vein they could not get it. They put a bandage in the leg, they could not get a vein, they tried the arm to set a drip and they still failed. Three days later, the three months old baby was examined by a doctor, only to find that the limb was black and swollen and it had to be amputated.
The question that you ask is, was this baby not crying when that bandage was left there for all those three days. Obviously this is poor quality of service that needs to be considered. That is why we are calling on the universities, colleges and the professional councils to assist us and make sure that the quality and the attitudes of our health care workers become better.
From the aforementioned, it is evident that the Department of Health has done very well and they deserve this budget that they are calling for. But I think there are certain things that we need to consider. We need to look at the private and public health care because it is these services that actually perpetuate the infectious conditions we have. I also call on the health professionals, all of them, to know that they should be the leaders in the universal coverage. Thank you. [Applause.]
Mrs S P KOPANE / LN/Checked by Nobuntu. / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 339
"National Assembly Chamber Main",Unrevised Hansard,21 May 2013,"Take 339 [National Assembly Chamber Main].doc"
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-339] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Mr M B GOQWANA
Sesotho:
Mof S P KOPANE: Ke a leboha Modulasetulo, Maloko a Palamente a hlomphehang le baahi ba rona kwano Afrika Borwa.
English:
Hon members, we must confront the hard truth about our public health care system if we want to ensure the welfare and the Constitutional rights of all South Africans. By only examining the ailments of our health care sector and successfully diagnosing the problem, we will find the remedies that will heal it.
According to the National Development Plan:
The overall performance of the health system since 1994 has been poor despite the development of good policy and high spending as a proportion of the gross domestic product, GDP.
Sesotho:
Mohlomong re hloka ho ipotsa hore na ebe re fositse ha re le hokae.
English:
One of the many challenges facing our health care system is a lack of qualified doctors, nurses and competent administrative staff, which has led to the unresponsive and cumbersome bureaucracy in the health sector; lack of accountability; and good decision making. This is a tragedy and it is unnecessary. South Africans have the resources and skills base to provide excellent quality health care for all who need it.
Mahatma Gandhi once said: "A nation's greatness is measured by how it treats its weakest members." If it is so, it means the Department of Health must be held responsible for holding us back from the greatness we aspire to.
Where the DA governs, we have achieved nearly 100% of nursing positions filled in this province. This is because we treat our staff well and we manage the department's human resource carefully. This is the difference where the DA governs and where the ANC is governing. [Applause.]
In addition, the life expectancy in the Western Cape is currently 61 years for men and 67 years for women, while the national average is 52 for men and 56 for women. Maternal mortality rate in the Western Cape stands at 98 deaths per 100 000 lives, while the national average is 140 to 160 deaths per 100 000 births. The child mortality rate in the Western Cape is 38,8 deaths per 1 000 births, while the national average stands at 69 deaths per 1 000 births. The Western Cape has an antenatal HIV/Aids prevalence rate of 18,5%, while the national average is 32%. The tuberculosis, TB, cure rate in the Western Cape is 79%, while the national average is only 65%.
During my oversight visit, I realised that most of the institutions still face the challenges of not having enough nurses and doctors, with unnecessary long procedure to fill the vacancies. At Jabulani Gateway Clinic in Soweto, they are operating only at 27% staff capacity. The nursing vacancy at this hospital is the highest with 549 posts that are not filled according to the parliamentary reply.
At Charlotte Maxeke hospital, nearly half of anaesthetists have resigned due to unresolved overtime grievances and the hospital could lose its accreditation. With only a handful of specialists left to train the registrars, many operations will be delayed and many patients will be forced to wait until such time the doctors will be ready to operate them. It is a great pity that the hospital management has mishandled the overtime issue that has led to the resignation of nearly half of anaesthetic department. With the current situation, there are about 10 021 patients who are waiting for operations in Gauteng hospitals alone, according to the reply to the DA question.
According to the member of executive council of the province, MEC, of Health in Gauteng: "The long waiting lists are due to service demands or load that exceeds the capacity of our resources."
My view is that mismanagement is the major factor, and a proper use of resources can bring down the waiting lists. In a short term, private providers should be contracted to bring down the unacceptable waiting times. Patients suffer while waiting for surgery. So, every effort must be taken to reduce this backlog.
Hon Minister, poor management at facilities level is the most cited reason why most doctors are leaving our public sector. Fixing the management by providing hospitals with sufficient resources; implementing stringent targets; and accountability policies will help to address this retention problem. There is a great concern regarding the shortage and maintenance of health technology, medical devices and the infrastructure which are essential for uninterrupted and effective service delivery.
During my oversight visit in Limpopo last year at Lebowakgomo hospital, the x-ray department was completely closed because all the x-ray machines were not working. They were all labelled out of order. This is because the department had failed to pay the service provider just a mere R90 000. Chairperson, on that day there were about four radiographers who were on duty but could not do anything to assist their patients. The only thing they could do was just to look at the patients suffering in front of them.
During my visit to various health care facilities across the provinces, I have discovered that buildings are dilapidated; beds are in short supply; and in many cases, there is still a lack of basic services like water. Last year, I talked about the Brandfort Municipal Clinic. As I am speaking to you today, the situation is still the same. This is totally unacceptable, given the fact that there are millions of rand available to solve these problems.
Jabulani Hospital in Soweto was initially scheduled for completion by May 2008. However, five years later, in 2013, this hospital is not yet completed. Repeated delays have doubled the initial development budget from R334 millions to at least R680 millions. Given the slow spending of: just 58,6% for the revitalisation grant; just 32,2% for the nursing colleges; and just 10% for the National Health Insurance, NHI, it is clear that money is not the problem. The people in charge of our public health care are the problems.
Hon Minister, the success of the NHI is depending on the functioning of the public health care system. Spending on the NHI conditional grant is extremely poor given the fact that R150 million was allocated, and only R14,9 million has been spent by the end of December 2012. Provinces are spending poorly with the worst being Limpopo which spent only 1,2%; the Eastern Cape spent 2,4%; and KwaZulu-Natal spent 3,3%.
Of particular concern has been that the grant is not really being used to pilot the new interventions which needed to be tested for the NHI, but it is rather being used to strengthen the general health care system. A further problem is that there is no credible evaluation strategy which could lead to the favourable outcomes.
Hon Minister, maybe we need to honestly ask ourselves: If NHI is a solution for our public health care system, why are the pilot projects struggling to sustain themselves? We need to make sure that we have the right people into the right positions and they must be held accountable for their performance. According to the ministerial finance task team, no part of the system is held properly accountable for poor health outcomes or poor service delivery.
Hon Chairperson, the DA is concerned about the cost of the private health care that is rising above the inflation rate, and also alarming increase in the fraud that has become a nightmare for almost 100 medical aid schemes by doctors, pharmacists, physiotherapists, radiologists and pathologists. According to the Board of Healthcare Funders of Southern Africa, R22 billion is being claimed by corrupt health professionals annually, resulting in members of the public having to pay extra on their premiums.
In one instance, a doctor billed a medical scheme for 107 appointments in one day, each taking two hours, which would have meant he worked 214 hours in one day. That is totally surprising and unacceptable. About 101 KwaZulu-Natal doctors have claimed more than R22 million from the medical aid schemes for the private work carried out at the time when they were supposed to have been attending the patients in the state hospitals. That is according to the Sunday Tribune. According to a report presented to the KwaZulu-Natal Department of Health, it is indicated that from June 2011 to June 2012 patients in public hospitals were neglected by doctors who were working privately.
The DA urges the Health Professions Council of SA to investigate the report and immediately institute disciplinary hearing proceedings against those who are responsible.
Hon Chairperson, we welcome the announcement made by Minister Patel that the Competition Commission will launch a long-awaited market inquiry into pricing in the private sector. No society can prosper without an affordable, high quality and easily accessible health care. That is why as the DA we build and run world-class hospitals in places where we govern, like Khayelitsha and Mitchell's Plain. We have proper management for patients' medical records right down to the level of clinics. We are also progressively rolling out the system where chronic medication is delivered to a public health care patients' doorstep. That is good governance and service delivery.
The DA has noted all the processes that their democracy has done. Thank you. [Time expired.] [Applause.]
Mr D A KGANARE / KC//A N N (ed)/ A N N(Sotho)/ END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 340
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-340] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Ms S P KOPANE
Mr D A KGANARE: Hon Chairperson, hon Minister and Deputy Minister of Health, hon Ministers and Deputy Ministers, hon members and guests, this debate takes place because our constitution obliges government to ensure that everyone should have access to health care services, including reproductive care. It also guarantees that no one may be refused emergency medical treatment whilst on the other hand guarantees that every child has the right to basic health care services.
These constitutional obligations should be non-negotiable. These obligations should be what the ANC government should deliver, it is not a favour to the people of South Africa. It is what Cope evaluates, the success or failures of the ANC government on behalf of South Africans.
The ANC government promised the people of South Africa that they will deliver care through the implementation of the ten-point plan.
This ten-point plan was supposed to ensure that what the constitution enjoins the government to deliver is delivered.
The ten-point plan promises that government would meet the Millennium Development Goals. It promised through the Negotiated Service Delivery Agreement between the Health Minister and the President that they would deliver an increase of life expectancy whilst decreasing maternal and child mortality. The ten-point plan promised the people of South Africa that quality health care will be delivered via the implementation of the National Health Insurance to ensure that universal health care becomes an achievable dream. This would include the acceleration in the delivery of health infrastructure and efficient management of health technology. All these are based on the re-engineering of the primary health care system.
This is what has been promised. Based on these promises the ANC government has claimed amongst other things that they have achieved the following: a total of 617,147 new patients were put on Antiretroviral treatment in 2011-2; compared to 418,677 in 2010-11;
9,6 million South Africans accepted HIV testing in 2011-12; a cumulative total of 20,2 million people have undergone HIV testing since the launch of the HCT campaign in April 2010; a total of 6,353,000 female condoms were distributed, which exceeds the target of 6 million; the TB cure rate of 73,1% (for 2010) was achieved, against a target of 75%. This is regarded as an improvement compared to the 71,1% cure rate recorded in 2010-11 (for 2009); the TB defaulter rate has decreased from 7% in 2010-11 to 6,8% in 2011-12.
Hon Chairperson, members, ladies and gentlemen, you will be forgiven if you are now convinced that we are dealing with the Minister and department of HIV/Aids and TB, because that's what the achievements sound like. You will not hear how the Minister intends handling the private sector delivery of health care or the ever escalating health care cost. Maybe, you will hear of NHI in the distant future or some investigation which will take place, also in the distant future to deflect attention from addressing these real issues.
The Minister and the ANC speakers whose role is to mainly sing praises are going to tell you hon members that the department got unqualified audit opinions for two consecutive years. Cope congratulates the DG and her staff in this regard. We hope that this trend would be a permanent feature of the department.
What they will not tell you is that out of the nine provincial health departments, six provinces received qualified audit opinions and two received disclaimers. Only one province, the Western Cape, received an unqualified audit opinion. The reasons for this unqualified audit opinion report are inter alia: Employees were appointed without following proper process to verify the claims made in their applications, in contravention of Public Service regulation. Not all senior managements signed a performance agreement as is required by Public Service regulations.
Hon members, this practise to be politically correct is called cadre deployment. By the way, a deployee should be understood to be someone who would under normal circumstances succeed to get a job if proper channels of applying, short-listing and interviews would have taken place. That's why subordinates have no respect for deployees.
Cope is raising these issues because quality health care should not be only heard, our people in clinics and hospitals should experience it. The horror stories in these institutions should be a thing of the past. Health care is not experienced at national level and through health policies but at hospitals and clinics.
There was a young boy called Jean-Pierre Dippenaar who was 25 years of age and had an appointment at the Bongani hospital in Welkom to undergo dialysis treatment. When he arrived at the hospital there was no functional machine. He could not afford to go to a private hospital. The question is, why was this appointment scheduled if the hospital knew that their dialysis machines were not functioning? Why was he not directed to another hospital on time because communication technology is so advanced. Unfortunately, hon member, you can shout as much as you like, for Jean-Pierre is no longer alive because of your inefficiency; because you believe you are only here to shout at all speakers when they tell you of all the failures of government. [Interjections.]
The HOUSE CHAIRPERSON (C T Frolick): Order, order hon members. Continue, hon member.
Mr D A KGANARE: These are the things which Prof Ashraf Coovadia recalled about 1994 when we were inspired and hopeful, and I quote: "We believed we were going to offer better health care for all but we are now far from where we should be and hoping to be. It is a dream gone wrong."
Hon members, Bongani Hospital is not an isolated case. Madwaleni Hospital is about 100 km from Mthatha where the hon Chairperson comes from, was once renowned for excellence. It offered an antiretroviral programme for HIV patients, a caesarean section around the clock and even provided home-based care to chronically ill patients. Now there is only one physician and just two clinical associates to help her serve more than 260 000 people: the hospital theatre is no longer active; no emergency caesarean section can be performed. Patients who need caesarean sections are referred to Nelson Mandela Academic Hospital in Mthatha which is an hour and a half's drive away; the hospital ceased to perform x-rays. The facility has tried to procure a new x-ray machine for the past two years after the original one broke, but the health department has refused every request; patients requiring x-rays are transported to Nelson Mandela Academic Hospital for radiography and use the Mthatha hospital x-ray machine once every Friday; these patients return very late to Madwaleni and they cannot see the doctor and return on Friday afternoons and they are only able to come back and see the doctor on Monday. It is not only in Mthatha.
In Limpopo in the Vhembe region Suzan Modau tried to have her child immunised with DTAP … [Time expired.]
Mrs H S MSWELI /PIETER / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 341
Mr "National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-341] [National Assembly Chamber Main][NAC-Logger][mn].doc"
D A KGANARE
Mrs H S MSWELI: Hon Chair, a long and healthy life for all South Africans is one of the outcomes that the Department of Health aims to fulfil and we all desire to support such an ideal. But over the years, it seems the health situation in our country has seemingly grown worse by the day. Instead of improvements in the state of health care, many communities, especially in rural areas have been neglected and lack the basic services due to every South African. We hear the plans to improve the health system, yet we read about hospitals being closed, machines sitting idle in many clinics and the severe lack of doctors in many hospitals and clinics in areas outside the cities.
The promises given by the department seem to revolve around too much idealism, with plans in place to change the fabric of our health system but at the same time seemingly ignoring the true state of our health system in our society. The extreme lack of leadership within the provincial and municipal health departments have ensured that what the national department promises is taken with a grain of salt by communities.
The plans put in place by the department do not translate into concrete plans on the ground, mainly due to the local health departments not being held accountable for the lack of services to the communities. Those who do try to provide services usually fail because the provincial and national departments do nothing to assist them with equipment or enough staff to service the needs of their communities.
The department desires to accelerate the delivery of health infrastructure during 2013-14, the only problem with this desire is that so many clinics and hospitals are in a state of disrepair, with some wards needing to be demolished because they are not fit for human habitation. In some of these hospitals, ventilation is so poor that the there is...
The HOUSE CHAIRPERSON (Mr C T Frolick): Order, hon members! Hon member, will you just take your seat, please. Hon members, I find it difficult to follow the speaker in front of me. I want to appeal to all members from both sides of the House including the party where the member is from to give the member a fair chance, please. You may continue, hon member.
Mrs H S MSWELI: In some of these hospitals, ventilation is so poor that there is a major probability that people with TB will infect others as there is no fresh air coming into these wards. This defeats the plan to reduce the burden of TB because instead of people getting better, they get worse and infect others at the same time.
In the last financial year, there were hospitals that did not spend the budget that they were allocated, which would have gone a long way in improving the state of health care. This cannot be allowed to continue because it means those put in charge of ensuring the improvement of health care are either too reluctant to do so, preferring to receive their salaries for doing nothing, or they are involved in corruption as they end up misappropriate these funds. This is a state of affairs that seems to happen every year and nothing seems to change.
We constantly read reports of hospital staff, from administration to nurses and doctors who mistreat patients or are indifferent to people's needs. If one asks community members about the staff of their local hospitals or clinics, they will complain about being mistreated or ignored when they need help. It is a constant state of affairs that one can find unqualified people doing work that they are not qualified for – their carelessness constantly puts the lives of patients at risk.
We cannot even begin to deal with issues of HIV and Aids, TB and incidents of maternal and child mortality if the basics of health care are not in place. As much as we need to see action being taken on these issues, the basic structures of health care need to be dealt with as well. We need to be able to support leaders like the MECs, who take their responsibilities seriously, because anything less results in the death of our people. Our rural areas are the worst affected and yet nothing seems to have changed over the years. The department needs to make drastic improvements in providing health care or else our people will never know what is like to receive proper basic health care.
IsiZulu:
Sengigcina Sihlalo, ngifisa ukusho lokhu ukuthi akuqiniswe ezokuphepha ezibhedlela kanye nasemawodini. Lokhu ngikusho ngoba eThekwini kukhona isiguli sesilisa esangena ngefasitela saya esigulini sesifazane sasidlwengula.
English:
That patient died. Nevertheless, the IFP supports the Budget Vote. I thank you.[ Applause.]
Mr S Z NTAPANE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 341
Mrs H S MSWELI
Mr S Z NTAPANE: Hon Chairperson, hon members, I don't serve in this committee but on 17 March 2013 the UDM led a march of the residents of the OR Tambo region in the Eastern Cape to hand over a memorandum to government about their grievances over service delivery in their region.
Chief among their service delivery complaints was the fact that the health services in the OR Tambo region is in a crisis. We therefore deemed it appropriate to take this opportunity to bring their complaints on health issue to the attention of this House and the hon Minister. According to the Health System Trust's, HST, latest annual SA Health Review, SARH, and District Health Barometer - that is the report which highlights three of five trends in the health sector. When measuring the state of health in accordance with the set of indicators the OR Tambo District is ranked at the bottom of the 52 districts. Some of the reasons include but are not limited to the region having the worst rate of deaths among the newborns in the country. Approximately 20,8 newborns per thousand births died in the district when compared with the national average of 10,2. This figure hon Minister, is doubled the national average. Nearly triple the number of children under the age of five died in the district's facilities, compared with the national average of 11,4%. The district also had the third highest deaths of children under 1-year-old.
While this happens, hospitals and clinics across the Eastern Cape province continue to be inadequately resourced and maladministration is allowed to continue. To see this poor state of affairs, hon Minister, we will challenge you to pay a surprise visits to all the hospitals and clinics in the OR Tambo region and the Eastern Cape as a whole.
You will see for yourself that all hospitals and clinics are understaffed, poorly managed and have limited medical supplies. Even the new Nelson Mandela Academic Hospital in Mthatha suffers from the same disease. We bring these matters to you, hon Minister, fully confident that, as one of the top performers in the Cabinet of President Jacob Zuma, they will receive your attention. Finally, we wish to take this opportunity to wish you luck in all your endeavours to turn the Department of Health around. UDM supports the Budget Vote No 16. Thank you.[Applause.].
The DEPUTY MINISTER OF HEALTH / GG / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 342
Mr ational Assembly Chamber Main",Unrevised Hansard,21 May 2013,"Take 342 [National Assembly Chamber Main].doc"
S Z NTAPANE
The DEPUTY MINISTER OF HEALTH: Hon Chair, hon Minister of Health Dr Aaron Motsoaledi, Minister, Deputy Ministers, MECs present here today, portfolio chairperson, hon members, distinguished guests, ladies and gentlemen, globally, 90% of preventable, premature deaths due to noncommunicable diseases occur in low and middle income countries. It is also estimated that high income countries experience 13% of deaths for those under 60 years. These figures are as high as 30% in low and middle income countries like ours in South Africa.
The World Economic Forum also ranks noncommunicable diseases, NCDs, as one of the major threat to economic development. It estimates that when NCDs rise by 10%, the annual economic growth falls by 0,5%. With the double burden of communicable and noncommunicable diseases in our countries, there is a need to develop a more integrated approach in improving the health of our population and their development.
Professor Mayosi, et al in The Lancet medical journal refers to the burden of disease in South Africa as a cocktail of four colliding epidemics. It is like four silent tsunamis that are attacking us.
In asking this august House to support the Department of Health Budget Vote as an enable to tackle these major challenges, we also say to you and our people that we bring good news. The good news is that our children and our young people are living longer, our working population is more productive and alive to nurture their children, and that the elderly are not burying their children and grandchildren at a rate of yesteryears. As we have survived the tsunamis of colonialism and apartheid, we are beginning to halt these epidemics.
I really don't know where the DA gets its figures. According to the Medical Research Council, between the years 2009 and 2011, life expectancy in South Africa increased from 56,5 to 60 years with a 25% decline in infant and under 5% in mortality rates.
Scientists all over the world are applauding our achievements. They say indeed such progress can only be experienced with major social changes like abolition of slavery and other interventions. We should not allow petty party politics to discourage us through criticisms that intend to underplay these gains. These are major and profound gains. Our vision for a long and healthy life for South Africans is in the making. With respect to containing the disease burdens, there is still much to do. There is no room for complacency.
I want to indicate that we have gone ahead to implement the agreements in the declarations of the 2011 UN Summit on Non-Communicable Diseases Noncommunicable Diseases, NCD, Summit that we held in 2011.
Regulations will be enhanced in terms of containing the advertisement of alcohol. The process of legislation to prohibit alcohol advertisement is at an advance stage. The regulations of warning labels on alcohol containers will also be revised. Perry C, in The South African Medical Journal reports that 130 people die daily as a result of alcohol related diseases, costing the public health system in provinces and national level almost R6,7 billion.
We are also busy with regulations to ensure that we reduce salt intake in our diet. Research shows that by halving the amount of salt in our bread it will result in 7 400 fewer deaths due to cardiovascular diseases within a year. Professor Graham Macgregor, the chairman of the World Action on Salt and Health, Wash, describes South Africa as taking a pioneering role in salt reduction programmes. Just to remind you, 60% of intake of salt in South Africa is through industrial supplies. In line with the World Health Organisation's, WHO, recommendations, we call on our people that as we regulate salt intake from industrial products, at home they must also take care that they do not reverse this gains. South Africa's average salt intake is at 40g per day while WHO recommends that it should be 5g per day.
In endorsing the WHO and International Telecommunications Union on e-Health, we have finalised the e-Health Strategy of South Africa. Working with the Medical Research Council, MRC, and the Council for Scientific and Industrial Research, CSIR, we will apply the framework that we have developed as a normative standard against the current 42 health information systems in the public health sector to be compliant.
The National Development Plan, NDP: Vision 2030 indicates that given the escalating costs of services in both public and private sectors and the high proportion of gross domestic products, GDP, that goes to health service funding, it is important to create a culture of evidence-based planning, resource allocation and clinical practice.
To this end, we have introduced the training of Doctor of Philosophy scholars. This year we have started with the 13 Doctor of Philosophy scholars funded as part of our endeavour to at least produce 1000 Doctor of Philosophy students over the next 10 years. [Applause.]
The successes that we have achieved in containing the HIV/Aids epidemic are because we use evidence-based solutions. In terms of the billions of rands saved through a more efficient drug procurement system that the Minister has announced, we would also want to announce that the national central procurement unit has started to assist provinces to ensure that there is a direct delivery to point of care which is health facilities of medicines. We have intervened in this manner to ensure that the medical depots are no longer a reason for facility stock outs on essential medicines.
The ANC government has demonstrated its revoke to ensure that our people live longer. With the commitment that we have made, the committee of expects that we have put in place and working with stakeholders that include and not limited to the ministerial committee on cancer, ministerial committee on mental health care and other committees like in research, we are confident that our vision of a long and a healthy life of South African is in the making. It is happening in our lifetime under the leadership of the ANC government through our collective effort as a nation.
We are aware that in a number of facilities, due to an increase of burden of disease and as well as the historical legacies of under development, we have not achieved the successes that we want to achieve in terms of quality of care. From the head office we have facility improvement teams consisting of officials who visit a number of districts regularly to ensure that we have a bottom-up approach in improving the quality of care. We also want to applaud the House for passing the legislation that will introduce the office of standards to ensure that quality is at the core of our work.
Six important factors that we believe have made us to succeed and that will ensure that we succeed in reducing the battle of disease and improving the quality of our services and effectiveness of our health system, is mainly based on the love we have for our people; decisive leadership that we have demonstrated; the social compacts for social cohesion; evidence-based medicine; and a dedicated health work force; as well as the appreciation that this high battle of disease not only threatens our development agenda, but also mocks the democracy our people fought for.
As we enter the second decade of our democracy the ANC government is not only celebrating with our people the legacy as a liberation movement against political bondage, but also as a liberation movement against ill health, suffering and threats that our democracy and prosperity faces.
The budget that we present today aims to consolidate our efforts, respond to the remaining challenges and to rally our nation respond successfully the NDP goal of increasing the life expectancy from the current 60 to 70 years.
Through strengthening evidence-based approach and stakeholder involvement in our work and not allowing ourselves to be destructed by petty party politics, we are well positioned to succeed.
I would like to ask the House to support the budget that we have presented and indeed to continue celebrating the successes that we have achieved as a way of energising us to deal with the challenges that remain. I thank you. [Applause.]
Ms M J SEGWALE-DISWAI / /Arnold / GC / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 343
THE DEPUTY MINISTER OF HEALTH
"National Assembly Chamber Main",Unrevised Hansard,20 May 2013,"Take 343 [National Assembly Chamber Main].doc"
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-343] [National Assembly Chamber Main][NAC-Logger][mn].doc"
C/W: The DEPUTY MINISTER OF HEALTH
Ms M J SEGALE-DISWAI: Hon Chairperson, hon Minister, hon Deputy Minister, hon Members of Parliament, distinguished guests in the gallery, and ladies gentlemen, the ANC believes that we are on course towards improving the health profile of all South Africans. At the most basic level, health is a fundamental human right.
The Universal Declaration of Human Rights proclaims that everyone has the right to access the service required to live a healthy life, with mothers and children being entitled to special care and assistance. Besides the moral and ethical case for saving women and their children, there are strong social and economic justifications for investing in the maternal health. The link between health, long-term economic growth and poverty reduction is much more powerful than it is generally understood.
Primary health care is at the best of the plans to transform health services in South Africa. An integrated package of essential primary health care service that is available to the entire population will provide solid foundation of a single unified health system. There is no way that the efficiency and effectiveness of the health care system can ever be realised without dealing with the costs of health care and its financing.
There are people who wrongly believe that the concept of health care financing, as envisaged in the National Health Insurance, is a pipe dream concocted by the ANC. While there is still a lot more to be done, to date we are proud of our achievements in the primary health care.
In eradicating institutional racism, our country is a model of democracy and human rights. It is because of these successes that since 1994 we were able to move from the second phase of our transition. The National Development Plan provides us with the vision and roadmap to confront these socioeconomic challenges that are facing our people. To expect that the challenges that confront us as a nation would have been eradicated in only 19 years would be to deny the existence of an extraordinary human disaster that lasted for far too long.
Whenever I stand before this august House to respond to the speech of the Minister of Health, Dr Aaron Motsoaledi, I get enthused at the manner in which he takes his work under the guidance of the ANC. Through him, the ANC government has made the leadership of the health system so simple for all people to understand and have passion. The ANC government makes work for leading the health sector very simple and doable.
Having said that, we need to remind the department that much still needs to be done. Having done what they did, all what remains to be done will be achieved in our lifetime. There are people who still have to walk few kilometres to access health care. There are still facilities that do not operate 24 hours, more especially in the Western Cape. There are those facilities where patients wait for a long period before receiving care.
There are still reports of lack of medication in the facilities; and some showing that our staff members are rude to the patients. These things must continue to keep us awake at night. However, we are hopeful that we will address them because as people know, Rome was not built in a day.
Allow me to reflect on what I have observed about this department since I became a member of this committee in 2009. All of us would remember where this Minister, after being deployed by the ANC, took the department from. When he first opened his mouth in May 2009, many people must have thought that here comes a dreamer. Little did they know that there was a steamroller, and a caterpillar coming, which was going to move health into a position and road of no return. With what this Minister has done, health will never be the same again.
Those who thought that the ANC government was dreaming were made to eat a humble pie as they watched the department moving from one success to another. There are some who may have thought that the first success was a fluke, but when the next plan became a success and the next as well, when they could not count them anymore, they then realised that this is a step in the right direction.
The ANC government went on a path for the transformation of the health sector. In this way, the department has indentified key pillars of the health system which needed attention. Allow me to take a few of those pillars and reflect on how we have watched the department perform under each.
As members would know, when the fish rots, it starts from the head. The department realised that in order to correct the ills of the hospitals, there has to be some work done to improve the performance of its chief executive officers, CEOs. The department did an assessment of CEOs of the hospitals in the public health sector to see if the right people were appointed for the right jobs. The results pointed into a particular direction that confirmed some of the suspicions.
The department did not hesitate to follow the direction that the assessment was showing. They swiftly went on to advertise the posts of CEOs in hospitals; proceeded with the selection process; issued appointment letters; conducted induction of the CEOs; and then sent them to the field to go and do the job. We do accept that this was not an easy road and that there are some areas that need to be finalised. However, we are happy that the first move has been made. This is actually the sizeable step in the right direction that deserves praise.
Seeing that the foundation of health was having serious problems, the department ordered the audit for health facilities. The outcomes of the audit confirmed that there are serious problems that need to be sorted out sooner rather than later. The results will assist the department to be more targeted in its intervention.
Facility improvement teams were established in anticipation of the outcomes of the facility audits. The teams have been allocated to focus on the districts, with special focus on the areas of weaknesses identified during the audits.
Transformation of health system is never complete until an ordinary person has access to health service irrespective of their ability to pay. Both the health facility audits and facility improvement teams were meant to support the implementation of the National Health Insurance. This is the programme that clearly divides South African into pro-rich on the one side and the pro-poor on the other side. I am tempted to put the pro-rich on the right and pro-poor on the left because naturally that is where they both belong.
The pro-rich were critical of the National Health Insurance, NHI, because for them life is normal when the rich are healthy and the poor unhealthy; when the rich have access to services and the poor no access; when the rich are treated in first class setting and the poor in the second class. That is the society they want, whereas the pro-poor on the other side want everything for everybody so that nobody must suffer simply because of the size of their purse.
The NHI is seen by some as a key to unlock the gates that are blocking the access to service. For some of us that come from and still live in rural areas, look up to the NHI for solutions to the problems in the health system. This is the system that is geared towards the poor. Because the government is pro-poor, it will ensure that the poor that have voted the government into power receive good care so that they can live a long and healthy life. [Applause.] Without access to health, long and healthy life will be a pipedream. Therefore, the department wanted to move a dream into reality, concept to implementation, and from theory to practise.
The department went on an uncharted road of re-engineering of primary health care. This process succeeded in three main areas which were made public to the people of South Africa to know: The launch of school health services which was officiated by the number one citizen of this country, President Jacob Zuma, in October 2012; and the establishment of ward based primary health care outreach teams with the pocket on the NHI pilot district. The department has established these teams in an effort to streamline the community-based health intervention.
The department appointed the district clinical specialists in all nine provinces. This programme has some problems, but the committee is excited that this is a move in the right direction. We would like to congratulate the department on its bravery, steadfastness, as well as resoluteness in pursuing the goal of improving the lives of South Africans. We all know that health is a labour sector. In this area, the department works with the deans of medical schools to increase the intake of medical students. This was supported by the increase in a number of students that were sent to Cuba for medical training.
I am of the view that the department did well despite the media report about some of the students were on strike in Cuba. The department also moved swiftly to deal with that situation. The department brought the National Health Act Amendment Bill which was debated by the House. This is a piece of legislature that will surely contribute towards taking the transformation of health to the new level.
It is my wish and hope that the office will be established in line with the Act, and that it will contribute towards improving the conditions in which our people are treated. It will help in improving the quality of health. We know that the office that is to be established will be an added resource outside the department to help improve the situation of our public health.
The ANC government responded in most appropriate ways to the need of accelerated performance towards the attainment of the Millennium Development Goal, by launching campaign on accelerated reduction of health mortality. This launch was once more a sign that the department is more concerned with the unwarranted and preventable causes of death of mothers during and around pregnancy. When the department invited this committee to the launch, there was an overwhelming feeling that indeed there is commitment to attain the plans as outlined in the negotiated service delivery agreement and the MDGs.
This is testimony that the lives of our mothers are valued and taken serious because honestly, it is a shame for a woman to die simply because she has fallen pregnant.
Setswana:
Ntetle ke re go Lefapha la Pholo, nko ya kgomo mogala tshwara thata e se re go utlwa sebodu, wa kgaoga.
English:
This is simply translated in Afrikaans as Hou vas; and in English as hold tight. This is so right in that we do not want you to be complacent because our people still need more services. The mothers need vaccines ... By the way, you are doing very in the immunisation coverage. The old people still need their chronic medication whereas people with disability still need assistive devices. The goals you have scored must spur you to greater height and serve as a motivation to do more. [Time Expired.] The ANC supports the Vote. [Applause.]
Mr A de W ALBERTS / LMM/.../TM / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 344
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-344] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Ms M J SEGWALE-DISWAI
Adv A de W ALBERTS: Hon Chair, the hon Segwale-Diswai ...
Afrikaans:
... moet ook 'n bietjie vashou, want dit is 'n feit dat ons hier in die Opposisie ook vir die arm mense omgee.
English:
She must remember that the poor are now interracial ... [Interjections.] ... and there are many black and white people among the poor. We care about all of them. In fact, sometimes things become so bad within the Department of Health, that some of your people come to the FF Plus to ask us to intervene on their behalf, and to help in state hospitals. [Interjections.] That is how bad things have become. [Interjections.]
One of the 10 critical actions set out by the National Development Plan, NDP, is to; phase in National Health Insurance, NHI, with a focus on upgrading public-health facilities, producing more health professionals and reducing the relative costs of private health care.
Afrikaans:
Die VF Plus is dit eens met die doelwitte om openbare gesondheidsfasiliteite op te gradeer, meer gesondheidslui te skep en die koste van privaat gesondheid af the bring. Die vraag is egter of die Nasionale Gesondheid-Versekering, NGV, die regte instrument is om die doelwitte te bereik. In hierdie verband sal ons graag wil verneem of die Minister al enige terugvoering ontvang het ten aansien van die 10 loodsprojekte.
Dit is van die grootste belang dat goeie navorsing en bona fide data 'n streng toets daarstel of daar 'n kousale verband bestaan tussen die idée van 'n NGV stelsel en die genoemde doelwitte. Daar moet 'n wetenskaplike verband bestaan tussen die voorgestelde stelsel en die beoogde uitkomste, by gebreke waarvan die stelsel nie verder oorweeg behoort te word nie.
English:
Furthermore, the burden to finance the NHI must also be established. Should it finally become apparent that the NHI will merely be financed by the existing base of tax-weary individuals, it must be stopped in its tracks. The current tax base cannot entertain any more taxes, and government will instead have to ask itself how it can eradicate barriers to economic growth, in order for the tax base to expand. However, in the Minister's budget plan, the following chilling words are stated;
Over the long term, more significant funding will be required and it is anticipated that a tax increase will be needed to fund implementation.
Afrikaans:
Dit is net meer belastings! Die feit is dat Suid-Afrika se belasting basis gaan protesteer indien net meer van hulle geëis word. Suid-Afrika is ook nie ontwikkeld genoeg, in ekonomiese terme, om die NGV stelsel te implementeer en te finansier nie. Selfs eerste-wêreld state vind die uitdagend. Die regering moet eerder daarop fokus om die basiese gesondheidsdienste op standaard te kry voordat komplekse stelsels as oplossing gebruik word.
English:
Let's get back to basics and first fix the problems at hand. Too many people still experience state hospitals as a place where one goes to die. The press is filled with horror stories about public medical malpractices and the state of disrepair of hospitals and medical equipment.
Afrikaans:
Hierdie regering is te lief vir groot projekte wat die land kan knak, waarvan die wapenskandaal en die Gauteng se e-tol saga voorbeelde is. Kom ons werk eerder nederig en hard om die bestaande stelsels effektief te maak. Dankie.
Mrs C DUDLEY
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 344
Adv A de W ALBERTS
Mrs C DUDLEY: Chair, one of the health committee's observations, which the ACDP agrees should be prioritised, is that the Medical Research Council's, MRCs, budget is simply not enough, and this has a direct impact on health services. We are told by the MRC that increasing life expectancy, one of the four outputs in the Minister's performance agreement, has been accomplished and life expectancy in South Africa has been dramatically increased. So we say, well done.
However, decreasing maternal and child mortality, another of the four outputs expected of the Minister, has not been accomplished despite the incredible success in preventing mother-to-child transmissions of HIV and Aids through antiretrovirals. The MRC says that the challenge now is the transference of HIV and Aids through breastfeeding.
With this in mind, the ACDP calls on the Minister to give serious thought to expanding the reach of human milk banking. The SA Breastmilk Reserve, SABR, which controls over 90% of breastmilk banking activities in South Africa, targets the highest risk population in public-sector hospitals, and saving lives at birth and in the first two weeks of life. I am told that Minister Motsoaledi has referred to this bank as the golden standard for human milk banking, and that benchmarking teams were sent to learn from them. The problem is that the SABR operates on a shoestring budget and urgently needs funding to support and expand its work, and to ensure maximum safety, with the correct protocols, procedures and testing.
A former director of the United Nations Children's Fund, Unicef, says breastfeeding is a natural safety net against the worst effects of poverty. He believes that a child, who can survive its first month and gets breast milk for the next four months, will erase the health difference between being born into poverty and affluence.
While still on the subject of maternal and child mortality, how is the Minister dealing with the recent situation with regard to the cut in overtime pay, which has led to a loss of anaesthetists, gynaecologists and a plastic surgeon, in one of the largest academic hospitals in Johannesburg? A shortage of specialists will increase waiting times for patients to be diagnosed, and surgeries could come to a standstill. Why is it so important for specialists not to work in the public or private sector after completing 40 hours in a government hospital? If some have abused the system, surely we must deal with them and not punish all the doctors.
Will it affect the hospital's accreditation as an academic hospital if there are too few specialists left to train the registrars and, most importantly, what will the impact be on maternal and child mortality? Finding the balance will not be easy. However, the ACDP will be supporting this budget. Thank you. [Applause.]
Mr I S MFUNDISI
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 344
Mrs C DUDLEY
Mr I S MFUNDISI: Hon Chairperson and hon members, there is no doubt that Minister Motsoaledi is the best thing that could have happened to the Department of Health in this country ... [Applause.] ... in terms of the progressive policies that he brought about. He has succeeded in what his predecessors had gone through. We have had instances where traditional doctors have had to be part of the teams in hospitals. He has had to dispel that, and make sure that scientific medication does not go along with all those other things.
However, we have to plead with the Minister to desist from trying to bring all academic hospitals under his aegis at head office and leave them in the provinces where they are, whilst he will still exercise care, like he does in all other instances.
The problems on the ground include clinics not operating properly, and clinics that are closed on Fridays and that open again on Mondays, as if illness will only switch on when the nurses open the clinics or switched off when they close the clinics, as the case may be. All these are things that we want to believe the Minister, in terms of expounding his policy, would also look into.
We also want to appeal to people, particularly in the ruling party, to help the Minister to desist the propensity of naming health institutions after great people, and thereafter these hospitals do not perform to the standard that those people lived up to. [Interjections.] [Applause.] Those are some of the things that have dragged the names of these illustrious people in the country, through the mud. We should realise that hospitals are meant to be named properly so that everything can go well.
Finally, let us thank the Minister and the department for the efforts that they have made to ensure that, instead of people having to take approximately three tablets for HIV, they now take only one tablet. We want to say, well done, Mr Minister. The UCDP will support the budget. [Applause.]
MS R M MOTSEPE / TH (Eng and Afr) / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 346
Mr I S MFUNDISI
Ms R M MOTSEPE: Chairperson, hon Ministers, Deputy Ministers, Members in the House, distinguished guests in the gallery, I would like to begin by thanking the Deputy President in absentia for chairing the plenary meeting on the South African National Aids Council in Mpumalanga this year. This meeting was able to highlight the continuing progress made to date regarding TB and HIV and Aids in South Africa.
I'd like to focus my debate on the efforts of the ANC government in working towards reducing burden of diseases in the country. In particular, we must first applaud the Minister of Health, Dr Aaron Motsoaledi for upholding the vision of the National Development Plan with respect to TB, HIV and Aids and Malaria as the ANC government and National Development Plan are paying dividends and we see a reduced burden of disease in the country.
Firstly, I think it's important that I explain why TB and Malaria are so high in our country before I lay out the plan devised by the ANC government for addressing the diseases. Healthcare for blacks and Africans, in particular, was deliberately kept substandard by racists and the apartheid regime.
Huge sums of money were pumped into sustaining the middle class lives of some citizens whilst the majority of citizens grew ill from poor health, malnutrition and other poverty-related illnesses including TB and HIV and Aids in poor, rural, township areas and in informal settlements.
As a movement, the ANC's 1955 Freedom Charter called for health care to be availed to all South Africans irrespective of their race, class, and gender. The Freedom Charter also emphasised the need for a preventative health scheme. The ANC knew that such a scheme would ensure that people are healthier for longer, and that ailments are reduced, therefore reducing the overall health costs.
More importantly, prevention would have improved the quality of people's lives and would have reduced their suffering. But, this preventative health care system only manifested when the ANC came into power in 1994 because it cared about the plight of all South Africans.
Setswana
Ke kopa o ntheetse, Rre Waters. Ka nako e e fetileng, pele ga mokgatlho wa rona o busa, batho ba rona kwa metseselegaeng ba ne ba sokola thata, ba bolawa ke bolwetsi jwa Aids, ba sa tlhaloganye gore ke bolwetsi jo bo ntseng jang, segolo thata kwa diporofenseng tsa KwaZulu-Natal le Limpopo. Fa ba ne ba tshwerwe ke bolwetsi jo, e bile ba batla kalafi ya jona, ba ne ba bua ka makgome kgotsa sejeso. Fa e sa le mokgatlho wa rona wa ANC o busa, batho ga e sa tlhole e le batlholagadi; bana ga ba sa tlhole ba fetogile dikhutsana. Jaaka puso ya ANC, ga re sa tlhole re lwantsha tlhaolele, re lwantsha botshelo jo bo siameng.
English:
The ANC and its oversight work were the first to identify that TB was the most prevalent health concern among people living with HIV and Aids and the poorest in our society. The department has responded accordingly by integrating TB, HIV and Aids services because of the high coinfection rate in the country. More importantly, the ANC has revealed that these two diseases, including Malaria, are health challenges directly associated to poverty and structural disadvantage from the previous government.
As such, the ANC government developed the four-year National Strategic Plan for tackling TB, HIV and Aids, and sexually transmitted diseases, in a streamlined way. As one of its objectives, South African National AIDS Council, SANAC, is working towards reducing HIV infections by half as part of the vision of the ANC government to eventually achieve zero new HIV infections in South Africa. Hence, their budget must enable them to meet their targets.
There are a few reasons why the infection rate for HIV and AIDS has stabilised at 10% from 2007 to 2011.One of these reasons is the African Union's Campaign for the Accelerated Reduction of Maternal Mortality in Africa, CARMMA, which was launched by the Minister of Health in KwaZulu Natal.
The Campaign was launched under the banner, "No Woman Should Die While Giving Life" and made South Africa the 37nth country to join it. We are pleased that the campaign is supported by a staunch activist and dedicated leader, the Chairperson of the AU, Dr Nkosazana Dlamini-Zuma.
What will help raise awareness about our goals as the continent are partnerships with local pop stars such as Yvonne Chaka Chaka whose ambassadorial activities lend support to the fight against TB and HIV and Aids in Africa. South Africa's huge mining labour force is drawn from other countries such as Swaziland, Lesotho, Mozambique, and Zimbabwe. We are pleased to see that the agreement between Southern African Development Community, SADC, countries such as South Africa, Mozambique and Swaziland to fight TB had resulted in an 85% decrease in TB related deaths.
A key intervention for further reducing will be to test at least 98% of all TB patients for HIV by 2015-16. The Stop TB campaign estimates that each migrant worker who returns home with TB spreads the disease to an estimated 15 people in their community. Hence, the importance of investing in TB interventions on mines to prevent further spread of the illness to the family.
TB is a major health problem in prisons as well. Prisoners must be treated to prevent the spread of the illness in the country. Hence, we commend the Deputy President for leading World TB day for 2013 in Cape Town at Pollsmoor Prison, where high TB rates in the prisons are not being adequately dealt with by the Western Cape government.
A key intervention will be to test at least 98% of all TB patients for HIV by 2015-16. In addition, if we want to continue making progress in the health of our country, then this must be reflected in the size of the health budget and in the appropriate expenditure of the budget towards TB, HIV and AIDS, and malaria. Malaria has been a scourge on the continent for hundreds of years and it is only with an escalating research agenda and partnerships with our neighbouring countries that the disease has come under control.
It is only under the leadership of ANC President that health indicators related to these diseases have improved. Partnerships have been created with different national and international role players, the body of research is expanding, vaccinations are constantly being developed, and Africa just rises to its challenges. We can see that under the leadership of ANC President in government and in the ANC, we have made significant accomplishments in the domain of TB and Malaria. [Interjections.]
Setswana
Go feleletsa, ke rata go lebogisa motho wa ntlha go dirisa pilisi ya FDC wa kwa Tshwane, kwa Ga-Rankuwa, yo o rileng,: "Tona, re kile ra ya kwa ditseleng, re go lwantsha, mmogo le puso e, lebaka e le fa re akanya fa puso e sa re kgathalele e bile e sa utlwe dilelo tsa rona. Ke itumetse ka letsatsi la gompieno fa ke bona gore ke kgona go nwa pilisi e le nngwe ka letsatsi mme e seng di le dintsi." [Legofi.]
English
ANC supports Vote No 16. Thank you. [Applause.]
Mr R B BHOOLA / EKS/ END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 347
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-347] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Ms R M MOTSEPE
Mr R B BHOOLA: Hon Chairperson, whilst the KwaZulu-Natal health care and medical practitioners are in the news, let us laud KwaZulu-Natal's efforts for taking the lead in dealing with the problems and let's be mindful that other provinces have similar ones.
We must be able to quantify the issues and don't throw the baby out of the tub. It will be totally unethical and inaccurate to paint all the doctors with the same brush. We must commend who do an honest hard day work day of hard work in keeping the public service going.
Similarly, those doctors that abuse the medical aid must be identified and dealt with. However the principle of generalisation is the mother of all disasters; let us not bring good people down.
We must go back to 1994 and identify how many were getting treatment in our public hospital system in comparison with today. The numbers have significantly increased.
Those who assume, no development transpired within the health fraternity are living on stupidity and perhaps we must request our hoardworking doctors to give them a check up.
Health care is life and death issue, people must not stop play to the gallery to score cheap political points but rather place emphasis on promoting the health care environment to ultimately meet the needs and expectations of communities, pertaining to Health Reform Policy and Legislation.
The ARV Roll-out Programme is obviously a massive one, and KwaZulu-Natal is leading in bringing the HIV rate down.
Clinics in rural areas are a massive development. When did you get dental, physiotherapy and gynaecology treatment in rural areas? Did you ever hear about it? Did you ever hear about mobile clinics in the past?
Even if you look at the urban hospitals, whilst there is a lot still to be done, like managing long queues and reducing the waiting time, there are many improvements in treatment and care.
A pensioner today can come out with more than R1 500.00 worth of medication per month which was never available during the apartheid regime.
The Minority Front, MF, is concerned however, about losing our nurses to overseas countries and we must work on the shortage. We are sending 600 students to Cuba to be trained, which is relatively a small and poor country in comparison to the Medical School of KwaZulu-Natal in our top notch reputation.
We can't, in all our medical schools. Why can't we? Yes, the University of Cape Town, UCT, University of KwaZulu-Natal, UKZN and Wits University, why can't we take in more scholars to produce doctors?
Let us all commit to empower doctors to bring health care to all South Africans, black and white. It's simply about building trust relationships and valuing diversity.
This will indeed not only build a healthy, strong and energetic rainbow nation to live for generations to come, but equally, our medical practitioners and nurses will leave an indelible impression for our future generational medical practitioners to advance our health... [Time expired.]... care system to greater success with pride and dignity. The MF will supports the Budget Vote.
Mr K J DIKOBO
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 347
Mr R B BHOOLA
Mr K J DIKOBO: Hon House Chairperson, hon members, distinguished guests, Azapo has been clear and unapologetic on its support for free universal access to health care. We have maintained that health care, like education, should not be a commodity for sale. Access to health should be a basic right and not a privilege reserved for the rich.
Indeed Minister, the use of words and terms can be confusing, that is why Azapo has been reluctant to embrace the concept National Health Insurance, NHI. We have been and we continue to be suspicious about the letter
I-for the word insurance-in our view insurance is something that can be sold, health should not be sold.
Hon Minister, Azapo has no quarrel with the issues that you have raised. In fact, we are generally happy with the performance of your Department. Your Department is in the news mostly for the right reasons. The same cannot be said, of course, about the provincial departments. We have no time and space now to catalogue those, but indeed we have those that we would like to raise with you directly about the provinces.
We welcome the increase in the number of people on HIV/Aids treatment. We congratulate the scientist and researches for introducing a single dose treatment. Our challenge as a country is to break the cycle and work towards an Aids-free generation. It can be done, it has to be done.
Hon Minister, the issue of maternal and infant mortality concerns us. At this time of scientific knowledge and discovery, we should be able to drastically reduce it, if we cannot eliminate it completely.
Minister you possibly have heard about reports of young men who died in circumcision schools- komeng- at the area serviced by Philadelphia Hospital in Dennilton. Our information is that most of them had presented themselves to the hospital before going to the mountain and were declared fit. We have reason to believe that the people who circumcised them were incompetent as all of them developed complications within 2 days of having been circumcised.
Azapo supports the right of communities to practice their cultures but we become worried where this leads to loss of life. Circumcision is only in its first week, we therefore call upon your Department to assist this communities in order to safe lives. Azapo will support Budget Vote-16. We thank you. [Applause.]
Mrs D ROBINSON/sam / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 348
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-348] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Mr K J DIKOBO
Mrs D ROBINSON: Hon House Chair, ministers and members, we have heard much today about the state of health in South Africa, some good and some bad. I do want to acknowledge the role of Dr Motsoaledi in bringing a more enlightened attitude to much that was previously ignored or deliberately misrepresented.
We are grateful that the age of denialism regarding HIV/Aids is now behind us.
Indeed, the DA welcomes the fact that there has been a 40% reduction in the rate of new HIV infections, with HIV antiretroviral, ARV, treatment, being broadened by 75% during the past two years and the number of children newly infected with HIV has been reduced by at least 40%.
The Western Cape increased its ARV treatment provision from 14 370 to 132 279, and brought down the mother-to-child HIV transmission rate to 1.8%, the lowest in the country. This can also be attributed to the fact that ARV treatment was started here in the Western Cape long before it was rolled out in other provinces. The positive outcomes in the Western Cape, Deputy Minister, also contribute to the good reputation of South African health. While the TB rate in the province is still unacceptably high at 768 cases per 100 000 people, it is reported that the province has the highest cure rate in the country, at 82%.
The DA welcomes the improvement in analysis and planning but there are many areas where decisive action still needs to be taken to eradicate problems, Minister, particularly with provincial departments, where there is inefficiency, poor management of staff, inadequate financial controls or proper procurement procedures.
Why is it that the Madwaleni Hospital in the Eastern Cape was allowed to function without X-ray machines for more than 6 years? Why was there only one doctor at this 150-bed hospital for many months? Political rivalry and factionalism cannot be tolerated when the health of the nation is at stake. Heads must roll where malpractices are revealed. Culprits should not be transferred to other districts or be redeployed.
The DA urges Minister Motsoaledi to be decisive, cut to the quick and lance the boil so that healing can take place at all levels.
Let us look at primary health, maternal and infant mortality and mental health. Warning lights flashed when I read that the budget allocated for primary health care had been reduced. Only 0.4% of the Health budget has been allocated to primary healthcare – R109.4 million – less than Programme 4 administration and the only programme to decline in nominal and real terms. Noncommunicable includes monitoring chronic, disability, elderly, mental health and substance abuse.
These budget cuts seem illogical when the Department of Health has indicated that it wishes to focus less on hospice-centric health care but on re-engineering primary health care, in order to be close and accessible to the people. Primary health care is the very foundation for National Health Insurance, but if that is weak and crumbling how can National Health Insurance succeed, apart from the financial problems, of course.
We welcome the establishment of school health programmes as well as the creation of specialist teams in each district, including gynaecologists, paediatricians and anaesthetists, family physicians, midwives, paediatric nurses and primary healthcare nurses. However, I would suggest that an 8th member be added to the team, a psychiatric nurse who is able to pick up developmental, neurological or psychological problems at an early stage.
Mental health is the cornerstone of maternal and child health outcomes as it not only affect the individual but also the children, their families and society in general. Mental health in pregnant women is linked to poor foetal growth and premature delivery. It can also result in their infants being more vulnerable to infections and diseases.
Children of mothers with mental illnesses are also more likely to be abused or perform poorly at school. They could also develop mental illnesses at a later stage.
South Africa has a sad history of abuse, gender and domestic violence. This gives great concern that the budget for maternal and reproductive health care has also been reduced, from R17,6 million to R17.2 million.
South Africa's infant mortality rate is frighteningly high. Currently it is 44 deaths per 1 000 births, whereas the global average is only 39 deaths per 1 000 births. These findings show that there are critical shortcomings in infant care.
In the State of the World's Mothers report of 2013 we read that a baby dies on its first day, almost every hour in South Africa, or that 7 500 babies die per year in the first 24 hours, 21 deaths per day - a shocking and a saddening state of affairs. In the same report it is stated that 3 000 mothers die from childbirth complications. That so many mothers should die when giving life is unacceptable.
In South Africa more than 1 in 3 women living in poverty will experience mental health problems during and after pregnancy. This is often related to violence, abuse and HIV/Aids. Adolescent and young mothers are particularly vulnerable to mental distress and depression.
Poverty, violence and poor education exacerbate these problems so it is suggested by the Perinatal Mental Health Project, PMPH, at the University of Cape Town that a mental health dimension be integrated into the re-engineered plan of primary health care.
Foetal alcohol syndrome is also a major cause of developmental or learning problems amongst children. All these factors could be contributory to the culture of violence, crime and abuse which South Africans experience. These are major social problems which could be related to undiagnosed mental or psychological problems, instead of being regarded as criminality or delinquency.
Autism is a condition which is increasing in frequency – previously children living with autism were regarded as badly behaved, disruptive or stupid but now it is recognised as a neurological condition of people who are often highly intelligent. This condition can be remedied with specialised education and nutrition.
However, we are not equipped to deal with these challenges, so may I ask, Mr Minister, why the total of Programme4 decreased by 17,6% despite the stated aim of delivering, based on primary health care.
How can one explain the 13% nominal and 17,6% real reduction in primary health care services? The decline in funding for primary health care is very worrying – this is exactly where the greatest needs are!
The Democratic Nursing Organisation of South Africa, Denosa, concurs that there is a decline in specialist skills for intensive care, theatre work, midwifery and psychiatric nursing. I wish to pay tribute to many hardworking, caring and dedicated nurses and thank them for their selfless work. I pay tribute also to our doctors, but especially to the endangered species, the psychiatrists, in our hospitals. They, like many of the pathologists... [Hon member your time is expired.] ... who work with inadequate diagnostic equipment and insufficient funding, do sterling service, yet they are unsung heroes and we salute them. [Hon member your time is expired.] More funding needs to be found ...]
Ms B T NGCOBO / Lehahn / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 349
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-349] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Mrs D ROBINSON
Ms B T NGCOBO: Chairperson, hon members and the guest in the gallery, since 1994 the ANC has led the way to provide an integrated holistic approach to major social and economic questions including the provision of infrastructure. One of our major tasks when we took government was to conduct a massive survey of infrastructure needs in the face of the obvious backlogs that we faced.
IsiZulu: 12:17:20
Empeleni kufanele sisho sithi asikaqedi iminyaka engama-25 siphethe uhulumeni, sisaphila leziya zinsuku zikaDokotela Rina Venter kanye noDokotela L A P A Munnik, lapho kwakuthiwa abantu abangebona abamhlophe bazohlala laphaya bese abahlophe bahlala laphaya. Ngakho-ke sisaphila kuleso simo kodwa siyasijika futhi sizosijika.
English:
The National Development Plan, NDP, supported by the New Growth Path and other programmes, invites us to look beyond the constraints of the present to transformation imperatives of the next 20 to 25years. The National Development Plan talks lengthily about health care and infrastructure improvement.
IsiZulu: 12:18:19
Sihlalo kubalulekile ukuthi ngisho ukuthi njengoba kwakhiwa izakhiwo eziningi, empeleni uKhongolose ufike kungekho zakhiwo. Niyakukhumbula lokho. UKhongolose ufike kungekho imitholampilo yabantu kodwa manje wakhe imitholampilo eseduze nalapho kuhlala khona abantu. UKhongolose usuwakhe nezibhedlela waphinde wavuselela nezinye izakhiwo ngendlela esheshayo.
English:
Health facilities infrastructure management focuses on co-ordinating and funding health infrastructure to enable provinces to plan, manage modernize; improve the quality of care in line with the national policy objectives and responsible for conditional grants as well.
I will say it again that infrastructure delivery is a key priority of the ANC-led government hence large amounts have been budgeted for this.
IsiZulu: 12:19:29
Phela izakhiwo lezi ezintsha zibalulekile ukuze izibhedlela zikahulumeni nazo zithandeke njengalezi zongxiwankhulu. Izibhedlela zikahulumeni nanoma zizinhle kanjani ngeke zikhobole abantu, zibakhobolele ukuthi zikhokhela isakhiwo. Uhulumeni uthi yena, usakhile isakhiwo sizosiza umphakathi ngendlela okufanele sisize ngayo.
Siyazi ukuthi izakhiwo lezi zenzelwe ukuthi sikwazi nokuthi le-NHI esikhuluma ngayo ikwazi ukwenzela kahle ngoba abantu bazobe bezithanda zonke izibhedlela futhi bazobe bethola usizo ngayo yonke indlela, ngaso sonke isikhathi ngaphandle kokuthi bakhiphe emaphaketheni abo. Ngakho-ke siyakuncoma lokho ngohulumeni kaKhongolose.
Okulandelayo engizokusho Sihlalo namaLungu ahloniphekileyo...
English:
We are aware that there are four state-of-the-art hospitals and they are completed. These hospitals are modern, well equipped and top of the range. I am surprised that the IFP member says that tuberculosis, TB, seems to be on the rampant in hospitals, when we have these TB hospitals which are well constructed, well ventilated and which allow people to get better even when they have multi-drug-resistant tuberculosis, MDR-TB, because of the way they are constructed.
IsiZulu: 12:21:19
Angazi ukuthi uzakwethu wakwa-IFP uqonde ukuthini.
English:
The Portfolio Committee on Health, for example, visited state-of-the-art TB hospitals which use latest design innovations developed by the Council for Scientific and Industrial Research, CSIR, in South Africa. For instance, the Centre for the AIDS Programme of Research in South Africa, Caprisa, has a wonderful TB hospital which used to be the old TB centre in KwaZulu-Natal. We went to Welkom and as a committee and saw that they have a newly constructed state-of-the-art TB hospital.
The ANC using its geospatial technology is now able to map out where the greatest need for health services is likely to be. It takes into account the difficulty of transport in the area, and a number of other factors, and plans accordingly. The World Health Organisation uses five kilometres as a benchmark for access to health care. Where terrain and other factors impede delivery, mobile clinics are used. These include mobile clinics which visit schools, dealing with dental, and ophthalmic or eye problems. The public health infrastructure comprises of over 4 333 health facilities and is worth more than R300 billion. The ANC has specified that at least 5% of the budgeted amount for infrastructure must be set aside for preventative and routine maintenance.
The successes within health infrastructure delivery are largely due to infrastructure units within the health departments. These units include professional engineers who help to deal with the buildings that are being built. Whilst capacity is scarce, not to mention costly, it is an investment well-made. In addition, the National Treasury's Strategic Projects Support Unit has been helping the national department and provinces with capital and maintenance projects. It provides technical assistance and training in planning, procurement and management.
Some provincial departments have been sluggish in some key capital projects thus causing backlogs. Gauteng spent only 34% of its budgeted expenditure on hospital revitalisation in the past financial year, despite a number of clinics and hospitals needing renovation. At the end of 2012 over 1900 health facilities and 49 nursing colleges were in different stages of construction and refurbishment.
It is important to acknowledge the successes of the ANC in the area of health infrastructure delivery, however a number of challenges remain. The key department used for infrastructure is not doing what it is supposed to do. Contractors come on and off and they charge exorbitant amounts of money. However, that is going to be corrected in the near future.
Nursing colleges are going to be opened in various provinces. To date 70 nursing colleges and schools are being refurbished. These colleges are in the following provinces: Eastern Cape 11, Free State 4, Gauteng 15, KwaZulu-Natal 12, Limpopo 6, Mpumalanga 4, Northern Cape 1, North West 8, and in the Western Cape 11.
IsiZulu: 12:26:04
Kusho ukuthi sizoba nabahlengikazi abanele ngalezi zakhiwo ezizokwakhiwa. [Ihlombe.] Laba bahlengikazi bazokwenza umsebenzi odingwa nguMnyango weZempilo nodingwa ngabantu emphakathini.
English:
Major infrastructure projects are also underway in the tertiary centres. Feasibility studies are at an advance stage in five centres: Polokwane Academic Hospital in Limpopo; Chris Hani Baragwanath Academic Hospital in Gauteng - ...;
IsiZulu:
...empeleni ngisakhuluma nge-Chris Hani Baragwanath Academic Hospital, lesi sibhedlela yisona sodwa esikwazi ukwenza i-dialysis kubo bonke abantu abayidingayo. [Ihlombe.] – bese kuba yi-Dr George Mukhari Hospital e-Gauteng; kube yi-Nelson Mandela Academic Hospital eNtshonalanga Kapa; kube ne-King Edward VIII Hospital KwaZulu-Natali.
English:
The National Human Resource for Health Strategy was launched in 2011. Work has started on the determination of norms and staffing needs for the country for primary and secondary care. This is being done with the support of the Word Health Organization.
As envisaged in the human resources for health strategy, the Leadership and Management Academy was launched in October 2012. The academy's vision is to be a centre of excellence and a beacon of good practice in health leadership and management. The academy's aim is to develop outstanding leadership and management in health in order to improve people's health and their experience of the NHI.
IsiZulu: 12:28:02
Kubalulekile futhi ukuthi ngiphawule ngokuthi izinga lokuqeqeshwa kodokotela liyakhula usuku nosuku. Njengoba sekushiwo ukuthi odokotela bayaqeqeshwa e-Cuba futhi siyazi ukuthi kukhona odokotela abangama-40 abazoqeqeshwa yiNyuvesi yaseWitwatersrand lapho uNgqongqoshe enza amalungiselelo okuthi lokhu kukwazi ukwenzeka. Siyafisa ukuthi namanye amanyuvesi enze into efanayo.
English:
The number of professionals undertaking community services is increasing with 7 162 placements across all provinces from 2012, covering doctors, dentists, pharmacists and other specialists.
The Auditor-General's report on infrastructure delivery in both the health and education sectors listed a number of challenges. These challenges include, amongst others: unsatisfactory planning escalating the cost of projects; lack of capacity at the Department of Public Works njengoba kade ngishilo [as I previously mentioned]; challenges with procurement; challenges in project management; low quality of work resulting in new contractors being appointed to redo work.
Of great concern is the fact that service delivery is delayed when hospitals and clinics are not completed on time. Some provinces tend to start a number or a plethora of infrastructure projects at the same time; and find that they are unable to complete them. In fact all the provinces which came to the portfolio committee reported the same thing. This makes it very difficult, particularly for the patients because some projects commence whilst the facility is still in use and it becomes a great inconvenience. This inconvenience is made worse when long details in construction occur. One of the biggest challenges is the contractors and I do not know how many times this could be repeated.
I must point out at this point that health education is a societal issue; it is not the Department of Health's problem only but it is our problem. No government in the world irrespective of how good it is can be able to go from house to house in order to identify people who need to be taken to the health facility. [Applause.]
The health infrastructure delivery has been identified as a key to achieving fundamental reform of the health system in the country. Undoing a legacy of separate development policies, including the unequal distribution of infrastructure between urban and rural areas, is a tremendous challenge. However, as South Africa prepares for the implementation of the NHI, this is a challenge that must be met.
I would like to conclude by reminding this House that in October 2011 the ANC government appointed a task team on Nurse Education and Training to take forward the recommendations from the April 2011 Nursing Summit. This has resulted in a national strategic plan being completed in February 2013. As a result, an e-health strategy has being launched to harness information communication technologies to help transform the health system. The e-health strategy aims to resolve the problems of the past, clearly articulated in the Negotiated Service Delivery Agreement, NSDA, 2012 to 2014.
IsiZulu: 12:32:35
Ithi ngize kulabozakwethu abaziphumele endleleni bazisholo abakuthandayo. Angazi ukuthi bakuthathaphi konke lokhu abakushoyo kodwa angikusho konke lokho. Kumhlonishwa u-Kganare – awu!, sekahambile? – kodwa-ke ngithanda ukusho ukuthi uKhongolose useduze nabantu, i-Cope ikuphi yona nabantu?
Amalungu: Isenkundleni.
Nks B T NGCOBO: Bese ngiphinda ngokuthi iNtshonalanga Kapa njengoba izincoma kangaka nje, izovala i-GF Jooster Hospital njengoba ibikade izimisele ukuvala izikole. INtshonalanga Kapa isebenza ngokuqathanisa isifundazwe esisodwa nezifundazwe eziyisishagalombili. Manje ngilungisa uzakwethu umhlonishwa uKopane othi impilo yabantu ifika ema-56, hhayi dadewethu, kusho ukuthi wawungekho ngesikhathi i-MRC isitshela ukuthi izinga seliphakeme selingama-60. [Ihlombe.] Ngakho-ke angazi ukuthi lezi zibalo ozanazo uzithathaphi.
INtshonalanga Kapa ngesikhathi kuneziteleka ezweni, yona imane yavala eminye imitholampilo e-De Doorns ngoLwezi 2012. Iwavaleleni imitholampilo lapho abantu bayidinga khona kakhulu? Ngonyaka odlule uMvikeli woMphakathi [Public Protector] uyewathola ukuthi esibhedlela saseGugulethu izinto azihambi kahle njengoba bona besho. Lesi sibhedlela sincolile, izisebenzi zizibhuzele nje. Kodwa-ke...
English:
...I support the Budget debate. Thank you very much. [Applause.]
The MINISTER OF HEALTH / JN / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 350
"National Assembly Chamber Main",Unrevised Hansard,17 May 2013,"Take 351 [National Assembly Chamber Main].doc"
"National Assembly Chamber Main",Unrevised Hansard,15 May 2013,"[Take-351] [National Assembly Chamber Main][NAC-Logger][mn].doc"
Ms B T NGCOBO
The MINISTER OF HEALTH: Chairperson, let me start by correcting one problem, something which might have been misunderstood. When I announced the inception of the human papilloma virus, HPV, vaccine by February 2014 in our schools, I didn't mean that poor children who find themselves in quintile 5 schools will not be covered. Every child who comes from a poor community, regardless of which schools they find themselves in, will be covered by the HPV vaccine. We chose quintiles 1 to 4 schools for very good reason.
It is a pity Ntate Kganare – oh, he is back. Yes, I really need to empower you, comrade. [Interjections.] I think you need to give yourself time to come to my office, and I will give you facts about the issue of the cost of health care. You will also see why the National Planning Commission dealt with this matter you are dealing with. You will also understand what forced the President to come with "Obamacare." Your problem is that you are using your anger and your heart to reason very complex world issues. Please come and we will ensure, comrade, that you will then start using scientific facts.
Hon Ntapane, I wish to thank you very much for your positive contribution to this debate. I can assure you that we are well versed in the issues you have raised about O R Tambo District Municipality. Actually, last week, the Deputy Minister and I specifically asked for a special executive council meeting with the Eastern Cape to go and talk about this issue. The premier obliged and was given four and a half hours to discuss these issues. We dealt with them thoroughly; we have agreed on plans which will start being unveiled very soon.
Hon Kopane, please don't do this to our country. I am really appealing to you. Don't be tempted to do this to our country. Firstly, the figures you have quoted about expenditure in the pilot districts of the National Health Insurance, NHI, are December figures, when a lot of equipment was bought but not paid for, because it was not yet delivered. They differ very much from the March figures when that has happened. A total of R78 million had already been spent by the end of March and R50 million committed for equipment bought for 901 facilities in the 11 pilot districts of NHI. Together, these two figures add to R128 million, so don't quote last year's figures.
That is not the biggest problem or reason that I appeal to you. [Interjections.] I know that happens in politics. I appeal to you about the tragedy that you are bringing to our country, by bargaining it. Firstly, nurses in this country do not belong to any particular province. They belong to South Africa, regardless of which corner of the country they trained in. [Applause.] Doctors in this country belong to the whole country. They are trained in only eight medical schools that other provinces don't even have. It is a tragedy to start comparing various parts of the country, as is being in competition with each other about death and diseases. It is a tragedy. Should Gauteng then stand up and start boasting that it has more doctors than Mpumalanga, for example? We know they have. Chris Hani Baragwanath Hospital alone has 800 doctors. That is more than the total number of doctors in the whole of Mpumalanga. Should it then be celebrated? No, it is wrong. We cannot compare that in a boastful manner. [Interjections.]
Death from the colliding epidemics in the country is well research and well documented in The Lancet by scientists, not by politicians who might have ulterior motives. It is documented by scientists who are driven by the search for the truth. They have outlined – there is a special chapter in The Lancet about why the Western Cape happens to differ from quite a number of parts of the country. It is not something to celebrate. It is absolute inequality. Can South Africa proudly celebrate inequality in the country? [Applause.] It is not me. It is the researchers in The Lancet. When you quoted those figures of mortality, you should have quoted that chapter. They show it precedes our existence. It is historical right from the time that South Africa came into being, and they outline it there scientifically.
I won't stand here in front of this House to celebrate that tuberculosis is the highest in the Western Cape, which it is indeed. When I spoke, I didn't celebrate. I told you we gave you one of only two TB-2G diagnostic test machines – new technology – and there are only two in the whole of Africa. We put one in eThekwini and one here, because of the problems of tuberculosis. I cannot stand up and celebrate that there is a high prevalence of tuberculosis in the Western Cape of the DA. It is a tragedy. I cry because of that. [Interjections.] It is not something to celebrate. [Laughter.]
Should the Northern Cape celebrate the fact that there is more death from HIV/Aids in Gert Sibande District Municipality in Mpumalanga? Should Gert Sibande District Municipality then stand up and celebrate the fact that De Aar in the Northern Cape and Worcester in the Western Cape are centres of foetal alcohol syndrome in the country where babies are dying like that? [Interjections.] You cannot celebrate such a thing.
Should I sit and celebrate the fact that our recent research has just shown us in De Doorns the biggest killer is kwashiorkor and marasmus? I did not celebrate it, because this is South Africa. I cannot celebrate South African kids suffering from kwashiorkor and marasmus, simply because it is in the Western Cape. It is wrong. It is absolutely wrong. I don't think the country should go in that direction. [Interjections.]
We never celebrated the fact that other provinces than KwaZulu-Natal failed to reduce mother-to-child transmission. KwaZulu-Natal did so successfully. I am trying to say that we should leave these party political things when it comes to the lives of our patients. Let us have empathy when our patients are dying. [Applause.] How do you celebrate that there they die early but here we live to old age, all within the borders of South Africa? South Africa is a unitary country. [Interjections.] It must not be ... yes, it must not be cut into Bantustans simply because the DA came into existence. We have gotten rid of Bantustans in this country. We don't want them to come back. Please don't make the Western Cape another Bantustan. [Applause.]
Ntate Dikobo, don't worry about terms. I agree with you. Terms can sometimes be confusing. From me, I agree that we should have called it NHI, but if you are uncomfortable with it, just call it universal health coverage. In Mexico, they call it Seguro Popular, meaning a popular scheme. In England, they call it NHS; in America, they call it "Obamacare". If South Africans agree, we can call it "Dikobocare". If they agree, I won't mind. [Laughter.] So, worry about the concept. The concept is what you have mentioned, Ntate Dikobo, and I support you. The concept is this: every citizen has a right to access to good quality, affordable health care, regardless of their socioeconomic conditions. That is "Dikobocare." So, I agree with you about terms. They must not give you sleepless nights. The concept and the dream is the same, and we are going to implement it as it is.
On the issue of circumcision, Ntate Dikobo, we have a facility in the Department of Health. I even met the kings and all traditional leaders in this country in Mafefe in Limpopo to discuss this, offering assistance through the SA National AIDS Council, Sanac. If any traditional healer wants to start traditional initiations but uses medical male circumcision, we are ready to help them at all times. The problem is that tradition sometimes can be very difficult. You are aware that King Zwelithini in KwaZulu-Natal clearly said that by 2015, there should be 2,5 million males circumcised in that part of the country. He said it must be medical male circumcision. Even in the Eastern Cape, we have just contributed R1,4 million a project, which is about to start, on this issue.
Mrs Robinson, we agree with you. Primary health care is not only going to be the central core of NHI; it is actually going to be the heartbeat. It is the heart. When you remove the heart from a body, the body dies. If you remove primary health care from NHI, there is no NHI. It will die, because primary health care means prevention of diseases and promotion of health. We are going to increase the budget, not decrease it. Thank you, Chairperson. [Applause.]
Debate concluded.
The House adjourned at 12:46.
/Mia / END OF TAKE
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