Hansard: Appropriation Bill: Debate on Vote No 16 – Health
House: National Assembly
Date of Meeting: 15 May 2013
Summary
No summary available.
Minutes
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 337
WEDNESDAY, 15 MAY 2013
PROCEEDINGS OF THE 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.
PRESIDING OFFICERS FOR SITTING ON 16 MAY 2013
(Draft Resolution)
The ACTING 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.
DEBATE ON VOTE 16 – HEALTH: The MINISTER OF HEALTH
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 337
The ACTING 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. Many other countries are faced with only a double burden.
These four are: a very high prevalence HIV and Aids which have now entered into a synergistic relationship with tuberculosis; maternal and child mortality and morbidity; an exploding prevalence of noncommunicable diseases mostly driven by risk factors related to lifestyle; and, lastly, the issue of injuries and violence.
These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per annum, 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 10-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 outputs, during this term of government. These objectives are: one, increasing life expectancy; two, reducing maternal and child mortality; three, reducing the burden of disease from HIV and Aids and TB; and, lastly, improving 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 dealt 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 desire, commitment and passion as far as HIV and 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, by and large, is HIV and Aids and TB.
We responded comprehensively through well-designed plans to deal with HIV and Aids and TB, and the implementation of these plans was well executed. Among other things, we increased the number of 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 was increased from only 250 nurses in February 2010, to 23 000 nurses to date. This programme is called Nimart – the Nurse-Initiated Management of Antiretroviral Therapy.
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 – actually doubling the number of people on treatment. [Applause.] I wish to take this opportunity to thank all health workers for this sterling performance, especially the nurses without whom these numbers would have been impossible to achieve, given the small number of doctors the country has.
Very recently, we introduced the ground-breaking fixed dose combination, or FDC, therapy, which made it necessary to train 7 000 health workers for smooth implementation. Another very important windfall from these FDCs is that in February 2010 it used to cost us R313,99 per patient per month to provide ARVs, but now with FDCs it costs us only R89,37 per patient per month. We are now able to treat a lot 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 have been 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 the mortality of children under five and in 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 United Nations programmes such as the Joint United Nations Programme on HIV/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 and Aids epidemic, especially the ARV treatment programme. The fact that we are testing large numbers of our people and that large numbers are on treatment has brought much relief to individuals, families and communities.
As far as TB is concerned, we started in 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 a new technology to diagnose TB was more than 50 years ago. We thought then that 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 Partnership.
Before GeneXpert technology, it used to take us a whole week to diagnose TB, but now it takes us only two hours. [Applause.] It used to take us three months to conclude that a person had multidrug-resistant TB, now it takes us only two hours. [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. These 242 units constitute 80% of all facilities we would like to cover. We have spent R117 million, shared by the national Department of Health, the Global Fund and the Centres for Disease Control and Prevention in the USA to achieve this 80% coverage. We have conducted 1,3 million tests since using this technology in 2011. These 1,3 million tests constitute 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 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 have only two of them in the whole country. We have placed one in the eThekwini Municipality in the Prince Mshiyeni Memorial 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 heavily challenged cities as far as TB is concerned.
On World TB Day on 24 March this year, the Deputy President of the Republic unveiled GeneXpert technology at Pollsmoor Prison on behalf of all Correctional Service facilities. This was in response to a Constitutional Court ruling in which an inmate took government to court and the state was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in Correctional Service facilities. They too will be supplied with GeneXpert units to screen all inmates on entry to Correctional Service facilities and to screen them twice a year once they are inside.
We will also request the names of those who are who found to have TB by GeneXpert from the Minister of Correctional Services, in order to send health workers to their families so that the whole family of an inmate can be screened for TB. One person with TB has the potential to infect 15 others in his or her lifetime.
The second strategy we have adopted is to establish family teams. On our database we have 405 000 families in South Africa which have a member diagnosed with TB. The family teams are visiting these families to screen all members of the family. About four weeks ago, the Statistician-General went to the Thabo Mofutsanyana 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 only 67,5%, but in 2012 it improved to 75,9%. The target set by the World Health Organisation is an 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 to 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 free from HIV and Aids, and we must have a decrease in the TB contact indices.
At the recent SA National Aids Council, Sanac, plenary we decided that the Presidency will need to relaunch for us the HIV Counselling and Testing campaign in the country. This relaunch must happen at the Gert Sibande district in Mpumalanga. This district has now been officially declared as the district with the highest prevalence rate of HIV and Aids in the country. I have a serious complaint: since the campaign started there is one extremely powerful place in this country where the HIV Counselling and Testing campaign was never launched. That place is called the Parliament of the Republic of South Africa.
Hon Chair, may I humbly ask that the Speaker please choose a date on which 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 these hallowed chambers. The provincial legislatures, district councils and local councils will follow suit. I will then have the power to encourage churches, schools and other centres of civil life to choose their own dates to do so. I promise to supply Parliament with a GeneXpert unit and a mobile X-ray unit on behalf of members in this Parliament. This is because you also need to be screened for TB and HIV and Aids.
Let me now deal with an intractable problem that the health care system is faced with, that is Output No 4 in terms of our negotiated service delivery agreement. Output No 4 is: Efficiency and effectiveness of the health care system 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 prestigious institutions of higher learning, such as 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 – and not to debate whether it is needed or not. The world has gone far 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 in the world.
Of course, it is not called NHI in every country. The World Health Organisation and all UN agencies are using a generic term: universal health coverage. We, in South Africa, will stick to the term NHI. The prestigious British medical journal The Lancet launched a series late last year 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 that every citizen has the right to access 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, 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.
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 insuppressible 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 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 September 26, to coincide with the UN General Assembly. The Series was facilitated by the Rockefeller Foundation and led 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 coverage is the single most powerful concept that public health has to offer".
The editorial goes on to say:
UHC, like any other health system, must be accountable for the quality of its outcomes and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for shareholders.
It is very clear that the whole world, not only our country, is gearing itself to get rid of archaic health care financing systems that cater for the privileged few and punish the poor, in favour of health care systems that will benefit all – and all citizens of a country.
This assertion led to another article in The Lancet Series I have just mentioned. It argues that universal health coverage is poised to be the third health transition. It argues that there have two transitions since the beginning of humanity. The first was the demographic transition that began in the late 18th century and changed the world in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths. The second transition, which began in the 20th century and reached even the most challenged countries in the 21st century, was when the world started tackling communicable diseases through immunisation. Now, they say a third transition is sweeping the globe and challenging health care financing, because for a long time health care has meant first paying a fee to a provider, a practice that effectively burdens the poor.
In implementing NHI or universal health coverage, countries are clearly going to pay different prices for different durations in 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 finishing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same owing to our internal objective factors.
Unlike Qatar, there are two main prices that South Africa has to pay to successfully implement 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 decrease drastically. 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 amended Competition Act, the Competition Commission will launch a public market enquiry into the costs of private health care. We are ready for them, and for those who do not understand where this comes from I wish to refer 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.
As to how we are going to pay the price of quality health care in the Public Service, we shall outline this in the White Paper to be released soon. We are aware that this is 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 elaborate 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-negotiables in health care; the delegation of powers to CEOs, who are being newly appointed and trained; and abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.
I wish to take this opportunity to emphasise over and over again that the NHI will be based on a preventative and not a curative health care system. I will repeat this on many more occasions to come: that primary health care, meaning the prevention of diseases and the promotion of health, is going to be the heartbeat of NHI in South Africa.
We will drive this health care system according to the dictates of the National Planning Commission, which clearly state that among the most important things to be done, is the need to reduce the burden of disease and not allow diseases to flourish and for us to run helter-skelter in trying to cure them.
We wish to demonstrate the example of the Rotavirus vaccine and the pneumococcal vaccine. Since their inception four years ago, we have seen miracles in three places. The Ngwelezana Hospital used to admit 1 000 children with diarrhoea every day, but the ward at the hospital was recently closed because no more children are being admitted with diarrhoea. [Applause.] In Cape Town and Gauteng generally, diarrhoeal admissions have decreased by 70%, which is attributable to the Rotavirus vaccine.
Seeing the success 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 Denny and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at the Groote Schuur Hospital and the Chris Hani Baragwanath Hospital respectively, cervical cancer affects 6 000 South African women annually. Eighty percent of them are African women. Of the 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. Only 20% are older than 65. HIV-positive women are five times more likely to get it than HIV-negative women. Women who smoke are two times more likely to get cervical cancer than nonsmokers.
This cancer is caused by another dangerous virus, the human papillomavirus. The good news is that there is now a vaccine against this virus. Unfortunately, this virus is also sexually transmitted. The very bad news is that the prices are prohibitive: 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 what is called Gavi: the Global Alliance for Vaccines and Immunisation, to help poor countries. Unfortunately, South Africa does not qualify for Gavi as we are regarded as a rich country, even though there are 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 in administering the human papillomavirus vaccine 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 nine and 10-year-olds in Quintiles 1, 2, 3 and 4 schools. This will cover 520 000 girls between the ages of five, nine and 10. We will give a booster dose five years later. We are not discriminating against Quintile 5 schools, but just the parents that can afford the vaccine. Parents must please try to buy the vaccine 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 one of these 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 RWops, or remunerative work outside the Public Service, in terms of which 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, hardworking 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 week in the media should not be misconstrued in that most doctors are involved in this practice and for people to 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 are also destroying medical training in the country. This is because they leave their medical students to 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 sector that is benefiting from this bad practice that in the long run they will also 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 it is a national problem. For those that have been found guilty – because we know their names - we can't avoid criminal charges. We will refer their names to the SA Revenue Service to check if they are paying tax on the double income they are earning.
We are also appealing to the private sector, that is hell-bent on attracting these public servants with lots of lots of perverse incentives, to please stop this practice because it is not only destroying the public sector, but will also destroy them in the long run. Very soon - and I'm not threatening - we will not have private health care or public health care in South Africa owing to this practice.
I wish to take this opportunity to thank the Deputy Minister, the director-general, all managers in the head office and facilities. Our health workers remain our heroes and heroines, despite the few who want to tarnish the good name of their profession. I wish to thank them for their 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
The MINISTER OF HEALTH
Mr M B GOQWANA: Hon Chair, Ministers that are here, Deputy Ministers, hon members, members of the SA Medical Research Council that I have seen, members of the Health Professions Council of SA, members of the Board of Healthcare Funders, members of the National Health Laboratory Service, members of the Council for Medical Schemes and members of the board of the SA Medicines Control Council, I think we must all congratulate the Department of International Relations and Co-operation for helping so that the paediatric oncologist could 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. 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. [Interjections.] 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 the life and death of the people of this country. Health professionals are tasked with prolonging the period between the life entry and the life exit. For the first time, this has been achieved in South Africa. This indicates to us that the Department of Health is on the right course.
Three years ago, on this platform, we said that the passion showed by the Minister gave us hope. It has been proven that passion without resources can work, but 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 diarrhoea, which were the foremost causes of death in the young ones.
The price of antiretroviral drugs has 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.
CEOs with medical qualifications have been appointed in hospitals. Training has been given to CEOs using funds from both the public and private sector. 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 the public health care sector has not happened before. Primary health care has been re-engineered. The School Health Programme, ward-based community involvement, and specialist 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 Carmma, the Campaign for Accelerated Reduction of Maternal Mortality in Africa, held in Durban. This involved the launch of the programme for obstetric ambulances in the provinces, the ability to diagnose the commonest causes of death in maternal patients, and the fact that the department has set up maternal enquiries. All these have made it possible to reduce the maternal death rate.
We commend the Department of Health for actually budgeting for the shortfall in funding for Pepfar, the US President's Emergency Plan for Aids Relief, that has being reduced. The rate of mother-to-child transmission has dropped. We have seen advances in the health sector, such as the first cloned skin graft, performed by Dr Ridwan Mia and his team. We have heard about antibodies to the HIV virus being discovered by Prof Abdool Karim and his team. All these advances serve to prolong the gap between the entry to and exit from this life.
Does the Department of Health deserve this House's support for this Budget Vote? Obviously, yes, we support this Budget Vote owing to 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 being a treatable condition, it is still a killer. As a country, we are rated low globally because of the rate of infectious conditions compared to that of other countries. Despite the bad association of TB and the HI virus, TB is still the main killer.
I am sure we know that doctors who saying that TB is a killer are right because there are few conditions in which the HI virus is the actual killer. What is worrisome about the rate of TB is the fact that this indicates to us that there is still a big gap between the rich and the poor, particularly because we have two parallel health structures, which are the public health care sector and the private health sector, and they are failing to reach a rapport on this matter.
As for the Western Cape, the statistics for TB infection are very high, yet the statistics for HIV are very low. This tells you that the gap between the rich and the 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 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 payers of taxes and it is within their rights 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 in order for people to understand health issues.
Are health professionals not entitled to some accountability by the department? Yes, they are, but owing 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 issues, 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 advance further the struggle for health care.
When persons need health care, irrespective of whether they choose the public or the private sector, they will be attended to by a nurse, a doctor, or an auxiliary health professional if necessary. At the core of health services are the health care professionals. Health care professionals should be the ones who drive universal coverage. As custodians of health care, they have the ability to make health services universal.
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 8 million South Africans. We need 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. Owing to the high cost of private health care, benefits get depleted for a great majority of patients on medical aids before patients are cured of their diseases.
The patient who leaves hospital not having been cured of a disease, such as TB, goes back to his or her family and community and infects more people. This is owing to the high costs. This is what I am alluding to when I say that the high costs of private health care are a disservice to the country.
The worst scenario is that a TB patient, who could not complete his or her treatment owing to high costs, will definitely develop Multidrug-Resistant or Extreme Drug-Resistant TB. His or her treatment becomes more expensive for the country under these conditions. With situations like this, nobody is safe, even the doctors and nurses looking after the patient. All this is caused by the fact that the private health care industry is not affordable.
When a person falls sick, suffers a cardiovascular incident or a heart attack, it is matter of life and death and there is no time to shop around for cheaper health care. By the time the sick person gets to another health care provider, the condition has worsened or the person has died.
I commend a group called Intercare, which is in the private health care industry. 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 the Medical Association of SA to the SA Medical Association.
South Africa is plagued by a society that is very angry. Whether this anger relates to our past or to mistrust among the different people inhabiting the country is yet to be established.
The country has a number of undiagnosed psychopaths languishing in prison. If we could look at the profile of a typical psychopath, we would see that these people need mental services, especially after serving their prison terms. Mental services need to be integrated with primary health care, and we need health care workers to specialise in mental health care.
Our primary health care plan is very good, but the department needs to make sure that the plan filters down to the rural areas. Irrespective of the good re-engineering of primary health care, we still have challenges in rural areas. I remember that listening recently to a programme on SAfm in which the Deputy Minister was hosted. Two doctors phoned from the rural areas, complaining about services that are not very good in the rural areas. The development of rural health care actually assists in helping the referral system to the big hospitals.
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 tendency of wanting to produce larger amounts of 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 in patient management is the reason why lawyers have a free reign in suing the Department of Health.
I am making a serious call on universities, colleges and professional councils to assist and to be sure of the quality of health care professionals that we train in South Africa. I am reminded of the case of a three-month-old baby in hospital: when this baby went to hospital the staff wanted to give intravenous treatment and make sure that the baby was rehydrated. They tried to put a bandage around his head to look for a vein, but couldn't access one. They put a bandage on the leg, but still couldn't get a vein. The staff then tried the arm, but still couldn't find a vein. Three days later, the three-month-old baby was examined by a doctor, only to find that the limb was black and swollen, could not be used any more and had to be amputated.
The question that you ask is: Wasn't this baby crying from the bandage being on for three days? Obviously, this is poor quality service that needs to be considered. That is why we are calling on universities, colleges and 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 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 services, because these services are perpetuating the infectious conditions we have. I also call on all health professionals to know that they should be the leaders in universal coverage. I thank you. [Applause.]
Mrs S P KOPANE / LN/Checked by Nobuntu / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 339
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 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 the 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.
It was Mahatma Gandhi who said: "A nation's greatness is measured by how it treats its weakest members." If that 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 filled nearly 100% of nursing positions in this province. This is because we treat our staff well and we manage the department's human resources carefully. This is the difference between where the DA governs and where the ANC governs. [Applause.]
In addition, 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. The maternal mortality rate in the Western Cape stands at 98 deaths per 100 000 live births, while the national average is 140 to 160 deaths per 100 000 live 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 prevalence rate of 18,5%, while the national average is 30,2%. The 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 challenge of not having enough nurses and doctors, with an unnecessarily long procedure to fill the vacancies. At the 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 the 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 that the doctors are ready to operate on them. It is a great pity that the hospital's management has mishandled the overtime issue that has led to the resignation of nearly half of the anesthesiology department. With the current situation, there are about 10 021 patients awaiting operations in Gauteng hospitals alone, according to a reply to a DA question.
According to the MEC of health in Gauteng, the long waiting lists are due to service demands or loads that exceed the capacity of our resources.
My view is that the mismanagement is the major factor, and a proper use of resources can bring down the waiting lists. In the 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 facility level is the most cited reason why most doctors are leaving our public sector. Fixing the management by providing hospitals with sufficient resources, and implementing stringent targets and accountability policies will help to address this retention problem.
There is 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 to Limpopo last year to the Lebowakgomo Jospital, 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 R90 000. On that day, there were about four radiographers on duty, but they could not do anything to assist their patients. The only thing they could do was just 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.
The Jabulani Hospital in Soweto was initially scheduled for completion by May 2008. However, five years later, in 2013, this hospital hasn't been completed yet. 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, the slow spending of just 32,2% for the nursing colleges, and the slow spending of just 10% for National Health Insurance, NHI, it is clear that money is not the problem. The people in charge of our public health care are the problem.
Hon Minister, the success of the NHI is dependent 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 that only R14,9 million had 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 at 2,4% and KwaZulu-Natal at 3,3%.
Of particular concern has been that the grant is not really being used to pilot the new interventions, which need to test the NHI, but that it is being used to strengthen the general health care system. A further problem is that there is no credible evaluation strategy which could lead to favourable outcomes.
Hon Minister, maybe we need to honestly ask ourselves: If the NHI is the 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 in 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 private health care that is rising above the inflation rate, and also about the 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 private work carried out at a time when they were supposed to have been attending to their patients in state hospitals. This 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.
We welcome the announcement 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, in places like Khayelitsha and Mitchells Plain. We manage properly 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 patient's doorstep – that is good governance and service delivery. The DA has noted all the progress that their democracy has made. 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
Mrs S P KOPANE
The HOUSE SPEAKER (Mr C T Frolick): The next speaker is the hon Kganare. [Interjections.] Order! Order, hon members! Contain yourselves! Continue, hon member.
Mr D A KGANARE: Hon Chairperson, hon Minister and Deputy Minister of Health, hon Ministers and Deputy Ministers here present, hon members and guests, this debate takes place because our Constitution obliges government to ensure that everyone has access to health care services, including to reproductive care. It also guarantees that no one may be refused emergency medical treatment, whilst, at the same time, guaranteeing 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 regards as the success or failure of the ANC government on behalf of South Africans.
The ANC government promised the people of South Africa that they would deliver care through the implementation of a 10-point plan. This 10-point plan was supposed to ensure that what the Constitution enjoins the government to deliver is delivered.
The 10-point plan promises that the government will meet the Millennium Development Goals. They promised, through the Negotiated Service Delivery Agreement between the Health Minister and the President, that they would deliver an increase in life expectancy whilst decreasing maternal and child mortality. The 10-point plan promised the people of South Africa that quality health care would be delivered via the implementation of National Health Insurance to ensure that universal health care became an achievable dream. This would include acceleration in the delivery of health infrastructure and the 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, the HIV counselling and testing campaign, in April 2010; a total of 6,353 000 female condoms have been distributed, which exceeds the target of 6 million; a 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 – and 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 the 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 costs. Maybe you will hear of NHI in the distant future, or some investigation will also take place 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 will 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. [Applause.] The reasons for this unqualified audit opinion ... [Interjections.] That is a fact. I am not the Auditor-General. The reasons for these unqualified audit opinions are, inter alia, that employees were appointed without following proper process to verify the claims made in their applications in contravention of Public Service regulations. Also, not all senior managers signed a performance agreement as required by Public Service regulations.
This practice, to be politically correct, is called cadre deployment. By the way, a deployee should be understood to be someone who would, under normal circumstances, not succeed in getting a job if the proper channels of applying, short-listing and interviews had taken place. That's why subordinates have no respect for deployees.
Cope is raising these issues because quality health care should not only be 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 with policies, but at hospitals and clinics.
A young man, 25, called Jean-Pierre Dippenaar, had an appointment at the Bongani Regional Hospital in Welkom to undergo dialysis treatment. When he arrived at the hospital, there were no functioning machines. 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 given that communication technology is so advanced? [Interjections.] Hon member, you can shout as much as you like, but, unfortunately Jean-Pierre is no longer alive owing to your inefficiency - because you believe you are only here to shout at speakers when they tell you about 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 make Prof Ashraf Coovadia recall the period around 1994 when we were inspired and hopeful. He said, 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." [Interjections.]
The Bongani Regional Hospital is not an isolated case. The Madwaleni Hospital, which is about 100km from Mthatha where the hon Chairperson comes from, was once renowned for excellence. It offered an antiretroviral programme for HIV patients, a round-the-clock caesarean service and even provided home-based care to chronically ill patients. Now there is only one physician and just two clinical associates to help this hospital serve more than 260 000 people. In addition, the hospital theatre is no longer active. No emergency caesarean sections can be performed, and patients who need caesarean sections are referred to the Nelson Mandela Academic Hospital in Mthatha, which is a one-and-a-half hours' drive away. The hospital has ceased to do X-rays. The facility has tried to procure new X-ray machines 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 the Nelson Mandela Academic Hospital for radiography and use the Mthatha hospital's X-ray machines once every Friday. These patients return very late to Madwaleni, and they cannot see the doctors because they come in late on Friday afternoons. They are only able to come back and see the doctors on Monday. This isn't only the case in Mthatha.
In Limpopo, in the Vhembe region, Suzan Modau tried to have her child immunised with the DTaP – diphtheria, tetanus and pertussis - vaccine ...
The HOUSE CHAIRPERSON (Mr C T Frolick): Hon member, your time has expired. [Interjections.] [Applause.]
Mrs H S MSWELI / PIETER/END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 341
Mr 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 want 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 the rural areas, have been neglected and lack basic services due to every South African.
We hear of plans to improve the health care 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 care system in our society. The extreme lack of leadership within the provincial and municipal health departments has 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 owing 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, but the only problem with this desire is that very 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 there is ...
The HOUSE CHAIRPERSON (Mr C T Frolick): Order, hon members! Hon member, would 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 the member is from, to give the member a fair chance to be heard 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 they were allocated, which had it been spent it 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 misappropriating these funds. This is the state of affairs 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. A constant state of affairs one finds is of 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 it is like to receive proper basic health care.
IsiZulu:
Sengigcina Sihlalo, ngifisa ukusho lokhu, 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 on this committee, but on 17 March 2013 the UDM led a march of the residents of the O R 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 are 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 latest annual SA Health Review and District Health Barometer – a report which highlights three of five trends in the health sector – when measuring the state of health in accordance with a set of indicators, the O R 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 death rate among the newborns in the country. Approximately 20,8 newborns per 1 000 births died in the district when compared with the national average of 10,2. This figure, hon Minister, is double 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 per thousand births. The district also had the third highest rate of death of children under a year old.
While this happens, hospitals and clinics across the Eastern Cape 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 visit to all the hospitals and clinics in the O R 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 you, as one of the top performers in the Cabinet of President Jacob Zuma, will give these matters your attention.
Finally, we wish to take this opportunity to wish you luck in all your endeavours to turn the Department of Health around. The UDM supports Budget Vote No 16. Thank you. [Applause.].
The DEPUTY MINISTER OF HEALTH / GG//LIM CHECKED ZLU// END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 342
Mr S Z NTAPANE
The DEPUTY MINISTER OF HEALTH: Hon Chair, hon Minister of Health Dr Aaron Motsoaledi, Ministers, Deputy Ministers, MECs present here today, portfolio committee chairperson, hon members, distinguished guests, ladies and gentlemen, globally 90% of preventable premature deaths owing to noncommunicable diseases occur in low- and middle-income countries. It is estimated that whereas high-income countries experience 13% of deaths for those under 60 years, this figure is as high as 30% in low- and middle-income countries like ours, South Africa.
The World Economic Forum also ranks noncommunicable diseases, NCDs, as one of the major threats 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 country, there is a need to develop a more integrated approach in improving the health of our population and their development.
Prof Mayosi et al. in The Lancet medical journal refer to the burden of disease in South Africa as a cocktail of four colliding epidemics. It is like four silent tsunamis attacking us.
In asking this august House to support the Department of Health's Budget Vote as an enabler to tackle these major challenges, we are also saying to you and the people of South Africa that we are bringing good news. The good news is that our children and young people are living longer, our working population is more productive and alive to nurture their children, and the elderly are not burying their children and grandchildren at a rate like the years before. 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 2009 and 2011 life expectancy in South Africa increased from 56,5 to 60 years, with a 25% decline in infant and under five mortality rates.
Scientists all over the world are applauding our achievements with awe. Such progress indeed, they say, can only be experienced with major social changes like abolishing slavery and other such interventions. We should not allow petty party politics or posturing 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 burden that is still there – because there is no room for complacency - I want to indicate that we have gone ahead to implement the agreements in the declarations of the NCT summit we held in 2011.
Regulations will be enhanced in terms of containing the advertising of alcohol. The process of legislation to prohibit alcohol advertising 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 reported that 130 people died daily as a result of alcohol-related diseases, costing the public health system in provinces and at a 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 halving the amount of salt in our bread will result in 7 400 fewer deaths owing to cardiovascular diseases within a year. Prof 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 us, 60% of intake of salt in South Africa is through industrial supplies. In line with the World Health Organisation's recommendations, we call on our people that as we regulate salt intake from industrial products, we must also take care at home that we do not reverse these gains. South Africa's average salt intake is 40g per day, whereas WHO recommends that it should be 5g per day.
In endorsing the WHO and the International Telecommunications Union on e-Health, we have finalised the e-Health Strategy of South Africa. Working with the Medical Research Council and the Council for Scientific and Industrial Research, we will apply the framework that we have developed as a normative standard against which the current 42 health information systems in the public health sector have to be compliant.
The National Development Plan of 2030 indicates that given the escalating costs of services in both the public and private sectors and the high proportion of GDP that goes towards health care financing, it is important to create a culture of evidence-based planning and resource allocation in clinical practice. To this end, we have introduced the training of PhD scholars, and from this year we have started with the 13 PhD scholars funded as part of our endeavour to at least produce 1 000 PhD students over the next 10 years. [Applause.]
The successes that we have achieved in containing the Aids epidemic are because we use evidence-based solutions. In terms of the billions of rand saved through a more efficient drug procurement system that the Minister announced, we would also like to announce that the national central procurement unit has started to assist provinces to ensure that there is 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 resolve to ensure that our people live longer. With the commitment we have made and the expert committees that we have put in place - as well as working with stakeholders that include and are not limited to the ministerial committee on cancer, the ministerial committee on mental health care and many other committees, for instance, on research - we are confident that our vision of a long and healthy life for South Africans is in the making. This 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, owing to an increase in the burden of disease and the historical legacies of underdevelopment, 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 that 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, we believe, have led to our success. They will ensure that we succeed in reducing the battle of disease and improve the quality of our services and effectiveness of our health system. They are based mainly on the love we have for our people, the decisive leadership we have demonstrated, the social compacts for social cohesion, evidence-based medicine, and a dedicated health workforce, as well as the appreciation that this high burden of disease not only threatens our developmental 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 her legacy as a liberation movement against political bondage, but also her role as a liberation movement against ill health, against suffering and against the threats that our democracy and prosperity face.
The budget that we present today aims to consolidate our efforts, respond to the remaining challenges, and to rally our nation towards successfully realising the NDP goal of increasing life expectancy from the current achievement of 60 to 70 years. Through strengthening the 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
Ms M J SEGALE-DISWAI: Hon Chairperson, hon Minister, hon Deputy Minister, hon Members of Parliament, distinguished guests in the gallery, and ladies and 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 children, there are strong social and economic justifications for investing in 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 heart 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 the solid foundations 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 cost of health care and health care financing.
There are people who wrongly believe that the concept of health care financing, as envisaged in National Health Insurance, is a pipe dream concocted by the ANC.
While there is still a lot more to be done, we are proud of our achievements to date in 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 road map to confront these socioeconomic challenges 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 by the manner in which he takes on his work under the guidance of the ANC. Through him, the ANC government has made leadership of the health system so simple for all people to understand and to have passion for. The ANC government makes work of leading the health sector very simple and do-able.
Having said that, we need to remind the department that much still needs to be done. Having done what they did, all that remains to be done will be achieved in our lifetime. There are still people who have to walk a few kilometres to access health care. There are still facilities that do not operate 24 hours, more especially in the Western Cape. There are facilities at which patients wait for a long period before receiving care.
There are still reports of a lack of medication in facilities, with some reports showing that our staff members are rude to 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 wasn't 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 care to the road of no return. With what this Minister has done, health care will never be the same again.
Those who thought that the ANC government was dreaming were made to eat 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 any more - they realised that these were steps 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 need 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 rots from the head down. The department realised that in order to correct the ills of the hospitals, there had to be some work done to improve the performance of its chief executive officers. 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 in 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 inductions of the CEOs; and then sent them out into the field to do the job. We do accept that this was not an easy road and that there were some areas that needed to be finalised. However, we are happy that the first move has been made. This is actually a sizeable step in the right direction that deserves praise.
Seeing that the foundation of health care was having serious problems, the department ordered an audit of health facilities. The outcomes of the audit confirmed that there were serious problems that needed 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 a special focus on the areas of weaknesses identified during the audits.
The transformation of the health care system is never complete until an ordinary person has access to health services irrespective of their ability to pay. Both the health facility audits and facility improvement teams were meant to support the implementation of 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. I am tempted to put the pro-rich on the right and the pro-poor on the left, because naturally that is where they both belong.
The pro-rich have been critical of National Health Insurance, 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 a first-class setting and the poor in a second-class setting. That is the society they want, whereas the pro-poor on the other side want everything for everybody so that nobody suffers simply because of the size of their purse.
The NHI is seen by some as key to unlocking the gates that are blocking access to services. Some of us that come from and still live in rural areas look to NHI for a solution to the problems of the health care system. This is a system that is geared towards the poor. Because the government is pro-poor, it will ensure that the poor that voted the government into power receive good care so that they can live long and healthy lives. [Applause.] Without access to health care, a long and healthy life becomes a pipe dream, so the department wants to move a dream to reality, move from concepts to implementation, from theory to practice.
The department went on an uncharted road of re-engineering primary health care. This process succeeded in three main areas, which were made public to the people of South Africa: 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 a focus on NHI pilot districts. The department has established these teams in an effort to streamline community-based health intervention.
The department appointed district clinical specialists in all nine provinces. These programmes had 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 and steadfastness, as well as on its resoluteness in pursuing the goal of improving the lives of South Africans.
We all know that health care is a labour-intensive sector. In this area, the department worked with the deans of medical schools to increase the intake of medical students. This was supported by the increase in the number of students that were sent to Cuba for medical training. I am of the view that the department did well, despite media reports about some of the students that were on strike in Cuba. The department also moved swiftly to deal with that situation.
The department brought about the National Health Amendment Bill, which was debated by the House. This is a piece of legislation that will surely contribute towards taking the transformation of health care to a new level. It is my wish and hope that the office that will be established in line with the Act will contribute towards improving the conditions in which our people are treated. It will help in improving the quality of health care. We know that the office that is to be established will be an added resource outside the department to help improve the situation in our public health facilities.
The ANC government responded in the most appropriate way to the need to accelerate performance towards the attainment of the Millennium Development Goals, by launching the Campaign on Accelerated Reduction of Maternal Mortality, Carmma. This launch, once again, was 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 was commitment to attaining the plans as outlined in the negotiated service delivery agreement and the MDGs. This is testimony to the fact that the lives of our mothers are valued and taken seriously, because, honestly, it is a shame for a woman to die simply because she fell 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 health services. The mothers need vaccines, which, by the way, we are doing very well in terms of immunisation coverage. The old people still need their chronic medication, and people with disabilities still need assistive devices. The goals you have scored must spur you to greater heights and serve as a motivation to do more. The ANC supports the Vote. [Time expired.] [Applause.]
Adv A D ALBERTS / LMM/.../TM / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 344
Ms M J SEGWALE-DISWAI
Adv A D 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 that 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 is to: phase in National Health Insurance, with a focus on upgrading public health facilities, on producing more health professionals and on 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:
Further to this, the burden to finance NHI must also be established. Should it finally become apparent that 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 sector 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, Voorsitter.
Mrs C DUDLEY
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 344
Adv A D 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 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 breast-feeding.
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, the SABR, which controls over 90% of breast-milk banking activities in South Africa, targets the highest risk population in public-sector hospitals, 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 get 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 support 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 went 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, as 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 occur when the nurses open the clinics and will not when the nurses close the clinics, as the case may be. All of this 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 with 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 also drag the names of these illustrious people in the country through the mud. We should realise that hospitals are meant to be manned properly so that everything goes 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 of the SA 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 would like to focus my speech on the effort of the ANC government in working towards reducing the burden of these 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 the National Development Plan are paying dividends and we are seeing a reduced burden of these diseases in the country.
But, first, I think it's important that I explain why the incidence of TB and malaria are so high in our country before I lay out the plan devised by the ANC government for addressing these diseases. Health care for blacks and Africans in particular was deliberately kept substandard by the racist and 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 available to all South Africans irrespective of their race, class or gender. The Freedom Charter also emphasised the need for a preventative health scheme. The ANC knew that such a scheme would ensure that people would be healthier for longer, and that the occurrence of ailments would be reduced, therefore reducing 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 itself 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 sotlega thata, ba bolawa ke bolwetsi jwa Aids mme 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 ba sa tlhole ba nna batlholagadi; le bana ga ba sa tlhole ba fetoga dikhutsana. Jaaka puso ya ANC, ga re sa tlhole re lwantsha tlhaolele, re lwantsha botshelo jo bo siameng.
English:
Hence, 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 owing to the high co-infection rate in the country. More importantly, the ANC has revealed that these two diseases, including malaria, are health challenges directly associated with poverty and structural disadvantages from the previous government.
As such, the ANC government developed the four-year National Strategic Plan to tackle TB, HIV and Aids, and sexually transmitted diseases, in a streamlined way. As one of its objectives, the SA 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 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 37th country to join. 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 among Southern African Development Community, SADC, countries such as South Africa, Mozambique and Swaziland to fight TB resulted in an 85% decrease in TB-related deaths.
A key intervention for further reduction 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 the 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 care of our country, then this must be reflected in the size of the health budget and in the appropriate expenditure of the budget on 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 Presidents that health indicators related to these diseases have improved. With the creation of partnerships with different national and international roleplayers, the body of research is expanding, vaccinations are constantly being developed, and Africa rises up to its challenges. We can see that under the leadership of ANC Presidents in government and in the ANC, we have achieved 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, ke a nopola:
Tona, re kile ra ya kwa ditseleng re go lwantsha, mmogo le puso e, lebaka e le fa re ne 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:
The ANC supports Vote No 16. Thank you. [Applause.]
Mr R B BHOOLA / EKS/LIM CHECKED ENGL//LMM//(Setsw) / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 347
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 KZN'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 not throw the baby out with the bath water. It will be totally unethical and inaccurate to paint all doctors with the same brush. We must commend those doctors who do an honest hard day's work in keeping the Public Service going.
Similarly, those doctors that abuse medical aids 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 people 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 in stupidity, and perhaps we must get one of our hardworking doctors to give them a check-up.
Health care is an issue of life and death. People must not play to the gallery to score cheap political points, but rather place emphasis on promoting a health care environment that will 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 KZN 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 that? Did you ever hear about mobile clinics in the past? Even if you look at the urban hospitals, whilst there is a lot that still needs 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 worth of medication per month, which was never available during the apartheid regime. [Applause.]
The 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 a relatively small and poor country in comparison to the medical school of KwaZulu-Natal and its top-notch reputation. We can't take in, at all our medical schools ... Why can't we take in more scholars to produce more doctors at the University of Cape Town, the University of KwaZulu-Natal and Wits University?
Let us all commit to empowering doctors to bring health care to all South Africans, black and white. This is 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 generation of medical practitioners to advance our health care system based on honesty, integrity and dignity. The MF will support the Budget Vote. [Time expired.] [Applause.]
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 care 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 of National Health Insurance. We have been and we continue to be suspicious about the letter I – insurance – because, in our view, insurance is something that can be sold. Health care 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. And, indeed, we have matters regarding provincial departments that we would like to raise with you directly.
We welcome the increase in the number of people on HIV and Aids treatment. We congratulate the scientists and researchers on introducing 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.
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 not eliminate it completely. Minister, you have possibly heard about reports of young men who have died in circumcision schools – komeng - at an area serviced by the Philadelphia Hospital in Dennilton. Our information is that most of them had presented themselves to 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 two days of having been circumcised.
Azapo supports the right of communities to practise their cultures, but we become worried when this leads to loss of life. The circumcision season is only in its first week. We therefore call upon your department to assist these communities in order to save lives. Azapo will support Budget Vote No 16. We thank you. [Applause.]
Mrs D ROBINSON /sam // JN – checked / END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 348
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 about a more enlightened attitude to much that was previously ignored or deliberately misrepresented.
We are grateful that the age of denialism regarding HIV and 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 treatment being broadened by 75% in the past two years, and the number of children newly infected with HIV being 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 care. 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 six 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 health care – 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 and more on re-engineering primary health care, in order to be close and accessible to the people. Primary health care is the very foundation of National Health Insurance, but if that is weak and crumbling, how can NHI 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, anaesthetists, family physicians, midwives, paediatric nurses and primary health care 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 does not affect only the individual but also children, 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, and 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 stands at 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 report of the State of the World's Mothers 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 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 one in three women living in poverty will experience mental health problems during and after pregnancy. This is often related to violence, abuse, and HIV and 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 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 Programme 4 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 SA, 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 ...
The HOUSE CHAIRPERSON (Mr C T Frolick): Hon member, your time has expired.
Mrs D ROBINSON ... who work with inadequate diagnostic equipment and insufficient funding, give a sterling service, yet they are the unsung heroes, and we salute them.
The HOUSE CHAIRPERSON (Mr C T Frolick): Hon member, your time has expired.
Mrs D ROBINSON: More funding needs to be found ... Thank you, Chairperson. [Applause.]
Ms B T NGCOBO / Lehahn/END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 349
Mrs D ROBINSON
Ms B T NGCOBO: Chairperson, hon members and guests in the gallery, since 1994 the ANC has led the way in providing an integrated, holistic approach to major social and economic questions, including the provision of infrastructure. One of our major tasks when we came into government was to conduct a massive survey of infrastructure needs in the face of the obvious backlogs we faced.
IsiZulu:
Empeleni kufanele sisho sithi phela asikaqedi ngisho 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 siyasiguqula futhi sizosiguqula.
English:
The National Development Plan, 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 25 years. The National Development Plan talks at length about health care and infrastructure improvement.
IsiZulu:
Sihlalo kubalulekile ukuthi ngisho ukuthi njengoba kwakhiwe 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 enesivinini esikhulu.
English:
The management of health infrastructure facilities focuses on co-ordinating and funding health infrastructure to enable provinces to plan, manage, modernise and improve the quality of care in line with national policy objectives and responsible for conditional grants as well. I will say again that infrastructure delivery is a key priority of the ANC-led government, hence large amounts have been budgeted for this.
IsiZulu:
Phela izakhiwo lezi ezintsha zibalulekile ukuze izibhedlela zikahulumeni nazo zithandeke njengalezi ezizimele ezingezabadla izambane likapondo. Izibhedlela zikahulumeni noma zingaba zinhle kanjani ngeke zikhobole abantu, zibakhobolele ukuthi izakhiwo zazo ziyabiza. Uhulumeni uma, esesakhile isakhiwo sekuphelile; sesizosiza umphakathi ngendlela okufanele uwusize ngayo.
Siyazi ukuthi izakhiwo lezi zenzelwe ukuthi sikwazi nokuthi lolu Hlelo lwezeMpilo lukaZwelonke, phecelezi i-NHI esikhuluma ngalo lwenzeke 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 that they have been completed. These hospitals are modern, well equipped and top of the range. I am surprised that the IFP member says that TB seems to be rampant in hospitals, when we have these TB hospitals which are well constructed, which are well ventilated and which allow people to get better even when they have multidrug-resistant TB, because of the way these hospitals are constructed.
IsiZulu:
Angazi ukuthi uzakwethu we-IFP uqonde ukuthini.
English:
The Portfolio Committee on Health, for example, visited state-of-the-art TB hospitals, which use the latest design innovations developed by the Council for Scientific and Industrial Research in South Africa. For instance, the Centre for the Aids Programme of Research in SA, Caprisa, has a wonderful TB hospital which used to be the old TB centre in KwaZulu-Natal. We went to Welkom as the committee and saw that they have a wonderful TB hospital. It's brand and has been constructed as a state-of-the-art TB hospital – hon IFP colleague.
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 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 success of health infrastructure delivery is owing to infrastructure units within the Health department. 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 and 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 19 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. The contractors come on and off and charge exorbitant amounts of money. This 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 four; Gauteng 15; KwaZulu-Natal 12; Limpopo six; Mpumalanga four; the Northern Cape one; the North West eight; and the Western Cape 11.
IsiZulu:
Kusho ukuthi sizoba nabahlengikazi abenele ngalezi zakhiwo ezizokwakhiwa. [Ihlombe.] Laba bahlengikazi bazokwenza umsebenzi odingwa nguMnyango wezeMpilo nabantu emphakathini.
English:
Major infrastructure projects are also under way in the tertiary centres. Feasibility studies are at an advance stage in five centres: the Polokwane Academic Hospital in Limpopo, the Chris Hani Baragwanath Academic Hospital in Gauteng ...
IsiZulu:
... empeleni ngisakhuluma nge-Chris Hani Baragwanath Academic Hospital, lesi sibhedlela yisona sodwa esikwazi ukwenza uhlelo lwe-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 Resources 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 health care. This is being done with the support of the Word Health Organisation.
As envisaged in the Human Resources for Health strategy, a leadership and management academy was launched in 2012. Its 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 NHI.
IsiZulu:
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 yase-Witwatersrand 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 there 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 other things: unsatisfactory planning escalating the cost of projects; a 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 the 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 then are not able to complete them. In fact, all the provinces that 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 can be repeated.
I must point out at this point that health education is a societal issue. It is not an issue for the Department of Health only as it is an issue for all of us. No government in the world, irrespective of how good it is, can go from house to house to identify people that need to be taken to a health facility. [Applause.]
Health infrastructure delivery has been identified as a key to achieving fundamental reform of the health system in the country. There is also the issue of undoing the legacy of previous policies. This includes the distribution of infrastructure between urban and rural areas, something which is a tremendous challenge. However, as South Africa prepares for the implementation of 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 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 communications technology to help the health system. The strategy aims to resolve the problems of the past, clearly articulated in the Negotiated Service Delivery Agreement from 2012 to 2014.
IsiZulu:
Ithi ngize kula bozakwethu abaziphumele endleleni bazisholo abakuthandayo. Angazi ukuthi bakuthathaphi konke lokhu abakushoyo kodwa angikusho konke lokho. Kumhlonishwa u-Kganare – awu!, usehambile? Kodwa-ke ngithanda ukusho ukuthi uKhongolose useduze nabantu, i-Cope ikuphi yona nabantu?
AMALUNGU AHLONIPHEKILE: Isenkundleni.
Nks B T NGCOBO: Bese ngiphinda ngithi iNtshonalanga Kapa njengoba izincoma kangaka nje, izovala i-GF Jooster Hospital njengoba ibikade izimisele ukuvala izikole. INtshonalanga Kapa isebenza ngokuqhathanisa isifundazwe esisodwa nezifundazwe eziyisishagalombili. Ake ngilungise uzakwethu umhlonishwa uKopane othi impilo yabantu ifika ema-56, hhayi dadewethu, kusho ukuthi wawungekho ngesikhathi i-MRC nabakwa-Lancet besitshela ukuthi izinga seliphakeme selingama-60. [Ihlombe.] Ngakho-ke angazi ukuthi lezi zibalo oza nazo uzithathaphi. [Ubuwelewele.] INtshonalanga Kapa ngesikhathi kuneziteleka ezweni, yona imane yavala eminye imitholampilo e-De Doorns ngoLwezi 2012. Iyivaleleni imitholampilo ngenkathi abantu beyidinga khona kakhulu? Ngonyaka odlule uMvikeli woMphakathi uye wathola into ebucayi kakhulu. Uthole ukuthi esibhedlela saseGugulethu izinto azihambi kahle njengoba bona besho. Lesi sibhedlela singcolile, izisebenzi ziyaziphuzela nje. Kodwa-ke ...
English:
... I support the budget. Thank you very much. [Applause.]
The MINISTER OF HEALTH/JN//LIM CHECKED ZLU//END OF TAKE
UNREVISED HANSARD
NATIONAL ASSEMBLY
Wednesday, 15 May 2013 Take: 351
Ms B T NGCOBO
The MINISTER OF HEALTH: Hon Chair, let me start by correcting one problem, something which may have been misunderstood. When I announced the inception of the human papillomavirus 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 up 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 the 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 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 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 up 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 specifically about the tragedy that you are bringing to our country, by Balkanising 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 at only eight medical schools, schools which some provinces don't have. It is a tragedy to start comparing various parts of the country as 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. The Chris Hani Baragwanath Hospital alone has 800 doctors. That is more than the total number of doctors in the whole of Mpumalanga. Should Gauteng celebrate that? No, that is wrong. We cannot compare that in a boastful manner. [Interjections.]
Death from the colliding epidemics in the country is well researched and well documented in The Lancet by scientists, not by us 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 that there scientifically.
I won't stand here in front of this House to celebrate the fact that tuberculosis is the highest in the Western Cape, which it is indeed. When I spoke, I didn't celebrate that. I told you we gave you one of only two GeneXpert diagnostic testing machines, and there are only two on 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.
An HON MEMBER: The Eastern Cape is on steroids. [Laughter.] [Applause.]
The MINISTER OF HEALTH: Should the Northern Cape celebrate the fact that there are more deaths from HIV and Aids in the Gert Sibande district in Mpumalanga? Should the Gert Sibande district 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 also are dying? [Interjections.] You cannot celebrate such a thing.
Should I sit and celebrate the fact that our recent research has just shown us that in De Doorns the biggest killer is kwashiorkor and marasmus? I did not celebrate that, because this is South Africa. I cannot celebrate South African kids suffering from kwashiorkor and marasmus, simply because they occur 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 provinces other than KwaZulu-Natal failed to reduce mother-to-child transmission. KwaZulu-Natal reduced the transmission successfully. I am trying to say that we should leave aside 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 up 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 the word "insurance", 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 are the same, and we are going to implement it as such.
On the issue of circumcision, Ntate Dikobo, we have a facility in the Department of Health. I even met with the kings and all traditional leaders in this country in Mafefe in Limpopo to discuss this. The SA National Aids Council can help. 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 our traditions can sometimes 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 by medical circumcision. Even in the Eastern Cape, we have just contributed R1,4 million to a project about this issue, which is about to start.
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 the 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
Audio
No related
Documents
No related documents