Hansard: NCOP: Motion
House: National Council of Provinces
Date of Meeting: 28 May 2013
Summary
No summary available.
Minutes
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TUESDAY, 28 MAY 2013
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
_______________________
The Council met at 14:08.
The Deputy Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.
NOTICES OF MOTION
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START OF DAY
NOTICES OF MOTION
Mr D A WORTH: Hon Deputy Chairperson, I hereby give notice that on the next sitting day of the Council I shall move on behalf of the DA:
That the Council-
(1)notes that executive Mayor Tjhetane Mofokeng of the financially troubled Dihlabeng Local Municipality in the Free State has paid R109 900 of taxpayers' money for an award from a little-known organisation, as – and I am not joking – the world's best mayor;
(2)also notes that the Dihlabeng local executive mayor was scheduled to travel to Switzerland in July this year in the company of three councillors, at an even greater cost to taxpayers, to receive the dubious award from the little-known European Business Assembly;
(3)further notes that the Free State Premier, Mr Ace Magashule, has intervened and cancelled it, saying it was improper to pay for an award; and
(4)acknowledges that the award is a scam and that the municipality owes R23 million for electricity and water supply to Eskom and Rand Water respectively.
Mr H B GROENEWALD
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Mr D A WORTH
Mr H B GROENEWALD: Hon Deputy Chairperson, I hereby give notice that on the next sitting day of the Council I shall move on behalf of the DA:
That the Council-
(1)notes that the Minister of Transport, Ben Marais, is jumping the gun in gazetting regulations on Gauteng e-tolling before President Jacob Zuma has even signed the Transport Laws and Related Matters Amendment Bill into law;
(2)keeps in mind that Cosatu, the ANC alliance partner, and different church groups, are also against this e-toll of SA National Roads Agency Limited, Sanral;
(3)also notes that this is further evidence of the continued arrogance displayed by the Department of Transport and Sanral on the e-toll project in Gauteng. They are determined to rush ahead with this unpopular project before the matter has even been fully agreed to;
(4)further notes that this is not only an affront to the residents of Gauteng, who will be burdened by this expensive project, but it also undermines the integrity of Parliament and the legislative processes, which have yet to be fully finalised; and
(5)acknowledges that it is high time that both Minister Martins and Sanral understand that they cannot stampede over political or public opinions, that they should stop their arrogant crusade and let the people of Gauteng decide now.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Hon Groenewald, can you explain to the House who is this Marais?
Mr H B GROENEWALD: Hon Deputy Chairperson, it is the Minister of Transport, Mr Ben Martins.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Are you saying that you are correcting the mistake you have made?
Mr H B GROENEWALD: I am correcting the mistake, hon Deputy Chairperson.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Thank you. [Laughter.]
Ms E C VAN LINGEN
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The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela)
Ms E C VAN LINGEN: Hon Deputy Chairperson, I hereby give notice that on the next sitting day of the Council I shall move on behalf of the DA:
That the Council-
(1)notes that the freedom of the City of Cape Town is to be presented to President Obama and First Lady Michelle Obama during their three-day visit to the African continent at the end of the month;
(2)also notes that the DA-led City of Cape Town offers the most comprehensive and generous package of free basic services to indigent residents of any metro in the country;
(3)further notes that in the past financial year, the city spent 57% of its R18 billion budget on direct service delivery to poor residents. That is a fact; and
(4)calls on this House to reject the call made by the ANC for President Obama not to accept the award. The DA is proud of our service-delivery record in the City of Cape Town and we are proud to present the freedom of the city award to President Barack Obama. [Interjections.]
MOTIONS WITHOUT NOTICE
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NOTICES OF MOTION
CORPORAL PUNISHMENT IN SCHOOLS
(Draft Resolution)
Ms D Z RANTHO: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with the utmost concern the persisting reports of corporal punishment in several schools across the country;
(2) further notes that despite the prohibition of corporal punishment by the National Education Policy Act, Act 27 of 1996, and the South African Schools Act, Act 84 of 1996, there are persisting reports of teachers who are costing the Department of Education millions of rand settling cases of people who have successfully sued the department;
(3) also notes that a few days ago, it was reported that a teacher from KwaZulu-Natal cost the Department of Education R4 million after the boy successfully sued the MEC for Education;
(4) further notes that an Eastern Cape teacher was caught on camera using a cane to punish a girl learner;
(5) also notes that a seven-year-old, mentally handicapped boy from Cape Town was whipped with a water pipe by the vice principal of his school;
(6) condemns in the harshest possible terms any subverted, reckless and irresponsible attempts by teachers to undermine the existing legislative framework prohibiting the use of corporal punishment in our schools; and
(7) calls on the Department of Basic Education to embark on an awareness campaign and workshops to alert teachers of the dangers and implications of the use of corporal punishment in our schools.
Motion agreed to in accordance with section 65 of the Constitution.
Mr M P JACOBS
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Ms D Z RANTHO
ASSISTANCE GIVEN TO NEEDY ORPHANS IN THABONG
(Draft Resolution)
Mr M P JACOBS: Deputy Chairperson, I move without notice:
That the Council-
(1) notes the reports of good Samaritans who helped two needy orphans in the township of Thabong in the Free State last week;
(2) further notes that the Thabong police, community police forum, ward 4 councillor and businessmen all came together and made much needed donations of school uniforms and food parcels to 10-year-old Mothusi Kudumane and his seven-year-old sister, Matshokolo Raliditabo;
(3) also notes that the agony of the two small children, who live in terrible conditions, whose mother passed away and who now live with their grandmother, touched the heart of a forum member when she was doing her sector duties of visiting community members;
(4) further notes that she realised the poverty that these kids had to endure;
(5) applauds the great initiative undertaken by the responsible citizens of our country for rescuing the needy from the dire situation they were faced with and brought hope in their lives; and
(6) calls upon others to do the same in their respective areas.
Motion agreed to in accordance with section 65 of the Constitution.
Mr Z MLENZANA
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Mr M P JACOBS
RE-ELECTION OF REV ZIPHO SIWA AS PRESIDING BISHOP OF METHODIST CHURCH OF SOUTHERN AFRICA
(Draft Resolution)
Mr Z MLENZANA: Deputy Chairperson, I move without notice:
That the Council-
(1) congratulates Rev Zipho Siwa for his re-election as the Presiding Bishop of the Methodist Church of Southern Africa;
(2) further notes that Rev Siwa is a scholar, a dynamic preacher and a humble man of God, who has been and continues to be one of the prophetic voices in the SADC region; and
(3) joins him in his call for a Christ-healed Africa; for the healing of nations.
Motion agreed to in accordance with section 65 of the Constitution.
Mr A G MATILA
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Mr Z MLENZANA
ARREST OF CORRUPT POLICE OFFICERS IN RANDFONTEIN
(Draft Resolution)
Mr A G MATILA: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with appreciation the reports of the arrest of three corrupt Gauteng police officers last week;
(2) further notes that the three Randfontein police officers were arrested for corruption after the owner of a local scrap-metal dealership claimed that they took money from him, and they made this demand without any valid reason;
(3) applauds and commends the arrest of the police officers as a clear message to other police officers who think that they operate above the law; and
(4) notes that the long arm of the law will catch every criminal in society, irrespective of who they are and their position in society.
Motion agreed to in accordance with section 65 of the Constitution.
Ms B V MNCUBE
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Mr A G MATILA
BRUTAL KILLING OF FAMILY BY 14-YEAR-OLD BOY
(Draft Resolution)
Ms B V MNCUBE: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with the utmost concern the incident where a 14-year-old boy hacked to death four of his family members;
(2) further notes that reports have surfaced that the boy was on drugs, such as smoking glue;
(3) also notes that he was problematic at school and suspected of several house-breaking incidents around Ekurhuleni; and
(4) takes this opportunity to convey its profound condolences to the family of the deceased and condemns in the strongest possible terms this cruelty and brutality.
Motion agreed to in accordance with section 65 of the Constitution.
Mr M H MOKGOBI
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Ms B V MNCUBE
DECISIVE ACTION BY MPUMALANGA PREMIER AGAINST MUNICIPALITIES RECEIVING DISCLAIMERS AND QUALIFIED AUDITS
(Draft Resolution)
Mr M H MOKGOBI: Deputy Chairperson, I move without notice:
That the Council-
(1) notes the decisive steps taken by the premier of Mpumalanga, David Mabuza, who has given 14 municipal managers and two financial officers a chance to state reasons why they should not be fired after the received disclaimers;
(2) further notes that the report of Auditor-General Terence Nombembe revealed that only two of 21 municipalities in Mpumalanga province received clean audits; and
(3) takes this opportunity to congratulate the premier for his decisive action.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Order! Is there any objection to the motion? In light of the objection, the motion may not be proceeded with. The Motion without Notice will now become a Notice of Motion.
Mr V M MANZINI
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Mr M H MOKGOBI
PSL ACCOLADES BESTOWED ON ITUMELENG KHUNE
(Draft Resolution)
Mr V M MANZINI: Deputy Chairperson, I move without notice:
That the Council-
(1) notes that Itumeleng Khune got all the accolades at the PSL awards on Sunday night, bringing the curtain down on what has been an incredible first full moon as Chiefs skipper;
(2) further notes that Khune became the first goalkeeper since André Arendse in 2002 to win the Footballer of the Year award, which came with R250 000 in prize money;
(3) also notes that Itumeleng scooped the following awards:
(a) Footballer of the Season;
(b) Absa Premier Players' Player of the Season;
(c) Goalkeeper of the Season; and
(d) Nedbank Cup's Player of the Tournament; and
(4) notes that Khune took home a whopping R575 000 in prize money.
Motion agreed to in accordance with section 65 of the Constitution.
Ms M P THEMBA
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Mr V M MANZINI
SEWAGE SPILLAGE HEALTH HAZARD FOR EMALAHLENI RESIDENTS
(Draft Resolution)
Ms M P THEMBA: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with utmost concern the shoddy work that was done on a R49 million sewer reticulation network, which has resulted in constant sewage spillage in parts of the Govan Mbeki Municipality, exposing residents of Emalahleni to health risks and hazards;
(2) further notes that the Govan Mbeki Municipality has promised to stop at nothing to ensure that the contractor is made liable for the shoddy sewage system; and
(3) takes this opportunity to call on the Ministers of Trade and Industry, Police, and Co-operative Governance and Traditional Affairs to investigate this contract and ensure that all those responsible are brought to book.
Motion agreed to in accordance with section 65 of the Constitution.
Mr G G MOKGORO
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Ms M P THEMBA
DEDICATED FLEET OF AMBULANCES FOR PREGNANT WOMEN IN NORTH WEST
(Draft Resolution)
Mr G G MOKGORO: Deputy Chairperson, I move without notice:
That the Council-
(1) notes the reports of exclusive ambulances procured by the North West department of health for pregnant women;
(2) further notes that a fleet of 10 ambulances are still in the process of conversion as they will be fitted with obstetrics equipment to ensure that women are attended to en route to health centres, in order to reduce infant and maternal mortality;
(3) also notes that many women lost their lives and their babies, mainly because they went into labour away from health facilities, and sometimes it would take too long to get help;
(4) takes this opportunity to applaud this great project by the North West department of health, which seeks to guarantee life to pregnant women and unborn babies; and
(5) calls upon all government officials to work together with communities to ensure that the project is a success.
Motion agreed to in accordance with section 65 of the Constitution.
Ms L MABIJA
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Mr G G MOKGORO
CALL FOR BETTER SEX EDUCATION IN MPUMALANGA PROVINCE
(Draft Resolution)
Ms L MABIJA: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with the utmost concern the reports of the high incidence rate of teenage pregnancy in the Mpumalanga province;
(2) further notes that 1 602 pupils fell pregnant last year and that 1 564 were already expecting babies between January and March this year;
(3) acknowledges and supports the efforts of the Mpumalanga province to confront the prevalence of teenage pregnancy in the province by setting aside an amount of R18 million to intensify the drive to educate and discourage teenage pregnancy;
(4) takes this opportunity to call on all parents to play a meaningful role in educating their children against the dangers of unprotected sex; and
(5) notes that President Zuma's administration provides free condoms for both males and females, including sugar-daddies.
Motion agreed to in accordance with section 65 of the Constitution.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Hon Mokgoro, don't intimidate her. [Interjections.]
Mrs R M RASMENI
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Ms L MABIJA)
ABUSE OF OVERTIME SYSTEM IN GAUTENG HEALTH CARE INSTITUTIONS
(Draft Resolution)
Mrs R M RASMENI: Deputy Chairperson, I move without notice:
That the Council-
(1) notes with the utmost concern the alleged abuse of overtime by doctors;
(2) further notes that the Gauteng MEC for Health, Hope Papo, revealed uncovered widespread abuse of the overtime system and evidence that doctors had submitted fraudulent claims;
(3) also notes that these claims are costing the Gauteng department of health millions of rand;
(4) further notes that in one year, the Gauteng department of health paid about R120 million for overtime claims at the Charlotte Maxeke Johannesburg Academic Hospital; and
(5) takes this opportunity to express its support to the initiatives of the Gauteng province to clamp down on doctors who do private work at the expense of their public service duties and ensure that hospitals have proper overtime systems that prevent the abuse of overtime in our hospitals.
Motion agreed to in accordance with section 65 of the Constitution.
Ms E C VAN LINGEN
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Mrs R M RASMENI
CALL FOR FUNDING IN CACADU DISTRICT MUNICIPALITY FOR WATER PROJECTS
(Draft Resolution)
Ms E C VAN LINGEN: Deputy Chairperson, I move without notice:
That the Council-
(1) notes that-
(a) an amount of R800 million has been set aside for water supply projects in the Eastern Cape;
(b) five of the six district municipalities have been awarded funds to develop or upgrade water resources, with Amathole District Municipality being awarded R130 million, Chris Hani District Municipality R280 million, Joe Gqabi District Municipality R60 million, O R Tambo District Municipality R238 million, and Alfred Nzo District Municipality R161 million;
(c) no funding has been set aside for Cacadu District Municipality;
(d) for instance, the Camdeboo Local Municipality requires funding to rehabilitate Nqweba Dam;
(e) the other eight municipalities, which have been listed, all have urgent water supply and infrastructure matters to be addressed; and
(2) calls on the Minister of Water and Environmental Affairs to also avail the required funding for the water projects in Cacadu District Municipality for water supply to the poor rural communities.
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Order! Is there any objection to the motion? In light of the objection, the motion may not be proceeded with. The Motion without Notice will now become a Notice of Motion.
STATEMENT - The MINISTER OF HEALTH
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MOTIONS WITHOUT NOTICE
TURNING THE TIDE AGAINST HIV AND AIDS
(Statement in terms of Rule 251)
The MINISTER OF HEALTH: Hon Deputy Chairperson of the NCOP, my colleague, the Minister of Home Affairs, Mme Naledi Pandor, MEC for Health from the Western Cape province, Mr Theuns Botha, MEC for Health from Free State, Dr Benny Malakoane, chairperson and members of the Select Committee on Social Services, hon Members of the NCOP, invited guests, ladies and gentlemen, last week, when I presented my Budget Vote in the National Assembly, I gave a long account on the HIV and Aids and TB pandemics. I did so as a form of report-back to Parliament on the progress the country has made so far in combating these two diseases.
During the debate, a member of one of the opposition parties cautioned that I stand the risk of being labelled the Minister of HIV and Aids, and the department being renamed the department of HIV and Aids, rather than the Department of Health. It was not the first time that I was subjected to this treatment. I did have a similar experience from a very prominent member of my own party as far back as 2009, at the beginning of this term of our government. This is because whenever I was delivering speeches on health, I mentioned the issue of HIV and Aids at every available opportunity.
I got worried then, when esteemed members of our society did not understand why I was doing so. Clearly they did not understand what the country was going through. I just discovered two weeks ago, in the general assembly, that four years down the line there are esteemed members who still do not understand what the country is going through as far as HIV/Aids and TB are concerned. They do not understand that these two diseases have altered life as we used to understand it in this country.
Hence it is important for me to explain and not take things for granted. It is for this reason that I am extremely grateful that the NCOP has decided to give me the opportunity to do so. I believe that this is what leadership is all about. Once more, I wish to thank the NCOP for affording me this opportunity.
In July 2009, a very prestigious British medical journal, The Lancet, released the results of a far-reaching study that showed that South Africa is going through a quadruple burden of disease. This consists of, firstly, a very high prevalence of HIV and Aids and of TB. These two diseases have entered into a very unholy, synergistic relationship that is detrimental to health in this country. According to this study, while South Africa forms only 0,7% of the world population, it carries 17% of all the people who are HIV positive in the world. In addition, at least 1% of the South African population now has TB, with the highest prevalence being in the correctional service facilities, followed by the mines, especially the gold mines.
The second pandemic is maternal and child mortality, as well as morbidity. While this is regarded as a pandemic in itself, it is actually driven by the high prevalence of HIV and Aids in the country. South Africa started experiencing a very serious challenge in its child and maternal mortality control from the 1990s on, when the effects of HIV/Aids started to bite. Hence 49% of maternal mortality is attributable to HIV and Aids, as is 35% of under-five-year-old or child mortality.
The third pandemic is the exploding prevalence of noncommunicable diseases driven by risk factors related to lifestyle. The fourth is violence, injury and trauma, which have taken the shape of an epidemic themselves. I will leave the other three for now and speak of HIV and Aids, as I was requested.
These four colliding pandemics, as we call them, apart from driving maternal and child mortality, also resulted in general death notification doubling between 1998 and 2008 to 700 000 per annum. This fact was noted by the National Planning Commission. The overall result was that life expectancy in South Africa took a severe knock and declined to worrying levels. Experts were saying that if nothing drastic is done, life expectancy in the country by 2015 would be at the level where it was in 1955. This would have meant that the country had moved backwards by 60 years.
With all these facts at our disposal, it would have been irresponsible for me as Minister of Health not to give HIV and Aids very high priority status. Both HIV/Aids and TB are responsible for most deaths in the country. They are the factors that lowered life expectancy in our country.
It is in this very House, in October 2009, that President Jacob Zuma released mortality figures attributable to HIV and Aids. On 1 December 2009, which was World Aids Day, in an event attended by both President Zuma and Deputy President Kgalema Motlanthe, sharing a platform with the Executive Director of UNAids, Mr Michel Sidibé, President Zuma made what is now called a watershed speech. That speech made South Africa turn the corner as far as the pandemic is concerned.
President Zuma made the following announcements: Firstly, all people who are co-infected with both HIV, Aids and TB must be put on treatment at a CD4 count of 350, instead of at a CD4 count of 200, which was policy then. Secondly, all pregnant women should start with the prevention of mother-to-child transmission at 14 weeks rather than at 28 weeks. Thirdly, all pregnant mothers who are HIV-positive and need treatment should be treated at a CD4 count of 350 rather than at a CD4 count of 200. Fourthly, all children diagnosed HIV-positive must immediately be put on lifelong ARV treatment, regardless of their CD4 count.
To kick-start the implementation of these measures, the President launched a massive HIV counselling and testing campaign on 24 April 2010 at Natalspruit Hospital. The target was to test 15 million South Africans in one year, but we ended up testing 18 million in 18 months. In the very same month of April, we started implementing the new measures, which we believe brought dramatic results that we can now proudly announce today.
Before the implementation of these measures announced by the President - for instance, in February 2010 - the situation was the following: There were only 490 facilities, meaning hospitals and clinics, that were providing ARVs. Today I can announce that there are now 3 540 facilities doing so. The number of nurses trained and certified to provide ARVs in the absence of a doctor was only 250 in the whole country. Today I can proudly announce that the number has now increased to 23 000. This programme is called Nurse Initiated Management of Antiretroviral Therapy, Nimart. The Nimart made it possible for us to increase the number of people who are on ARVs from 923 000 in February 2010 to 1,9 million to date.
The stigma attached to testing and being on treatment reduced remarkably in the country. By the end of last year, researchers, both international and local, started reporting a dramatic increase in life expectancy, a reduction in maternal and child mortality, and an overall reduction in the death rate. We started getting anecdotal evidence that while by 2009 one of the most lucrative business undertakings in the country was establishing a funeral parlour, they are now starting to close down.
It is not adequate to rely on anecdotes, however. We need real proof. Today, I brought a guest, who is in the gallery. I brought her here today to put a face to the statistics that we always present to you. I have Ms Jackie Schoeman, the Director of Cotlands in Turffontein, Johannesburg. Maybe she can stand up and greet you. Jackie, may you please great the House? [Applause.]
Cotlands is an institution for young children. It used to have a special ward for children who had been born HIV-positive, most of whom were orphans. These children were just given palliative treatment, meaning tender loving care until you die. That ward had only 20 beds but they were experiencing at least two deaths per week. She told me that in 2007 they lost 87 babies in that ward. Death was a feature of life at Cotlands.
Today, Ms Jackie Schoeman reports that as a result of this new HIV/Aids programme, that ward has been closed down because over the past three years there has not been a single death due to HIV or Aids. It is no longer necessary to have that ward. [Applause.]
Remember that in 2008, mother-to-child transmission, meaning the number of children who would get HIV/Aids from their mothers, was at 8%. That figure has been reduced dramatically from the level of 8% in 2008 to 3,5% in 2010 and down to 2,7% by 2011. We are expecting that to go down even more. I need to remind the House that a child born HIV-positive is 15 times more likely to die in the first six months of life than one who is born HIV-negative.
This progress in the prevention of mother-to-child transmission therefore saved more than 120 000 children in that period and made it possible for people like Ms Jackie Schoeman to get much needed relief from the trauma they were going through. On Friday last week, when visiting Cotlands, I also visited her and found that the ward that used to have 20 dying children is now used for healthy children who have been abandoned by their mothers and are awaiting adoption. This means Ms Schoeman is continuing with her heroic work. [Applause.]
I would like to see life in South Africa going in that direction. I wish to take this opportunity to thank health workers and people like Ms Jackie Schoeman for their selflessness and for being our heroes and heroines in this fight. Just imagine what could have happened if they were not there; and if we could only rely on doctors, of whom there are always too few on the African continent. For our nurses to get into the Nimart programme, and for 23 of them to start doing the work originally done by doctors - they are indeed our heroes and heroines.
Very recently, we introduced a groundbreaking fixed-dose combination therapy. This made it necessary to train 7 000 health workers for smooth implementation. There is another very important windfall resulting from the fixed-dose combination therapy: In February 2010, it cost the country R313,99 per patient per month to provide ARVs. I can proudly announce today that from April, with the fixed-dose combination therapy, we spend only R89,37 per patient per month. We are now able to treat many more people per month with the same amount of money that we spent in 2009.
Another programme is that of medical male circumcision, which has been proven to reduce the chance of being infected with HIV/Aids by at least 50% to 60%. We have launched a massive medical male circumcision campaign in the country. We want to circumcise at least 4 million males by the 2016. So far, since it was launched two years ago, we have done more than 850 000 circumcisions. The biggest number was done in KwaZulu-Natal because they have the biggest medical male circumcision campaign in the country.
As far as TB is concerned, on 24 March 2011 we started in earnest to introduce new programmes. We unveiled new strategies to combat TB. Firstly, we unveiled the GeneXpert technology. The last time the world unveiled new technology to diagnose TB was 50 years ago. The world then thought we had defeated TB. We now know better. Hence we are immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation's Stop TB Partnerships.
Before the GeneXpert technology, it used to take us a whole week to diagnose TB, but now it takes us only two hours. It used to take us three months to conclude that a person has multidrug resistant TB, but now it takes us only two hours to know that. [Applause.] I am very proud to announce that South Africa was the very first country in this continent to unveil the GeneXpert technology. Since its unveiling on 24 March 2011, we have distributed 242 GeneXpert units around the country. These 242 GeneXpert units constitute 80% of all the facilities we would like to cover.
In five months, we will have achieved 100% coverage of all the district hospitals with the GeneXpert technology. From there we will move to the big community health centres. The biggest of these machines, which can diagnose 48 people at a time within that period of two hours, while others can only do four and 16, are called GeneXpert 48. We have only two in the country. We placed one at Prince Mshiyeni Hospital in the eThekwini Municipality. The second one is in the Cape Metro, at the Green Point National Health Laboratory Service. We did this because eThekwini and Cape Metro are the most challenged cities as far as TB is concerned.
You might be aware that on World TB Day, 24 March 2013, the Deputy President of the Republic unveiled a GeneXpert unit at Pollsmoor Prison, on behalf of all correctional service facilities. This was in response to a Constitutional Court ruling, after an inmate took the government to court. The state was held liable by the Constitutional Court for inmates contracting TB in jail. Yes, it is now well established, as I have mentioned, that the highest prevalence of TB in the country is in correctional service facilities. They too will be supplied with GeneXpert units to screen all inmates upon entry to facilities, as well as twice per annum.
We will also request from the Minister of Correctional Services the names of those who are found by the GeneXpert to have TB, in order to send health workers to their families so that the whole family of such an inmate can be screened. We are doing so because one person with TB can infect 15 others in their lifetime.
The second strategy we adopted was to establish family teams. On our database we have 405 000 families in South Africa that have members who have been diagnosed with TB. The family teams are visiting these families to screen all the members of such a family.
About four weeks ago, the Statistician-General went to the Thabo Mofutsanyane region in Free State to release the yearly figures of the causes of death. He released the 2010 figures 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 awaiting the 2011-12 results to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5%, but in 2012 it improved to 75,9%. The target set by the World Health Organisation is 85%. We are steadily but surely moving in that direction.
However, I have one very serious request. Having turned the corner should not be regarded as a signal that we must be complacent as a country. 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-20-year-olds free of HIV and Aids and we must have decreased the TB contact indices.
At the recent South African National Aids Council, Sanac, plenary, we decided that the Presidency will need to relaunch the HIV counselling and testing campaign in the country. This launch must happen at Gert Sibande District Municipality in Mpumalanga. Gert Sibande District Municipality has officially been declared the district with the highest prevalence of HIV/Aids in the country.
I have a serious complaint: Since this campaign started, there is one extremely powerful place in this country where the HIV counselling and testing campaign was never launched. It is called the Parliament of the Republic of South Africa and, of course, the NCOP. May I please make a humble request that a day be chosen when we will come and publicly launch this campaign here in Parliament? The Chairperson of this House and the Speaker of the National Assembly must take the lead, followed by leaders of all political parties in these hallowed Chambers. Then the provincial legislatures and the district and local councils will follow. If this happened, I would then have the courage to ask churches, schools and all the other centres of civil life to choose their own days for HIV counselling and testing. It is very important for us to keep this campaign alive.
I promise that if you agreed, we would supply a GeneXpert unit and mobile x-ray machines to Parliament and to the NCOP because you too need to be screened for TB, like the rest of society. You need to know your HIV status like the rest of society. We will need to do that so that the dream of the National Planning Commission – of a generation of under-20-years-old free of HIV/Aids by 2030 – can be realised. That dream is very possible if we work together. [Applause.]
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Hon Dr Motsoaledi, I promise to take this forward.
Mr M J R DE VILLIERS
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 218
STATEMENT – MINISTER OF HEALTH
Mr M J R DE VILLIERS: Hon Deputy Chairperson, from 1994 to 2005 South Africa's policy response to the generalised epidemic was most disappointing and a disgrace. This brought us to the 5,6 million people with HIV and Aids in 2011, which could have been much less if we implemented our current approach much earlier. However, that is water under the bridge. I must say that hon Carlisle, then a Member of the Provincial Legislature in the Western Cape, fought extensively for the implementation of antiretrovirals to HIV and Aids patients in the Western Cape, so it was implemented in the Western Cape.
The allocation of R90 million, R100 million and R250 million to the Medical Research Council to strengthen its capabilities, infrastructure and support in respect of diseases such as HIV and Aids, tuberculosis and malaria is highly appreciated. The R800 million for the 2015-16 financial year for the scaling up of antiretroviral treatment to HIV and Aids patients comes at a very good time because I think it must have been very uncomfortable to swallow so many tablets previously.
No one should tell themselves that we need not carry on with awareness raising, safety measures and the promotion of good practices in order not to get infected by this merciless virus.
It is good to read that the number of newly infected children between 0 to 14 years of age fell by 56,2%, from 60 000 to 29 000 in 2011. This is still high because no child deserves to be born with this pandemic.
On Friday, 24 May 2013, in the HIV and Aids Joint Committee, we heard that at our health facilities, patients with HIV and Aids, or even those who are just suspected of having it, are openly handled in a discriminating procedure and not as an ordinary patient. This must be stopped immediately. I also want the Minister to take note of this and we as Members of Parliament must go to our constituencies to follow up on that.
If we bear in mind the money that is thrown into this project, the 12 000 civil society organisations, and others, then we can turn the tide against HIV and Aids. Just carry on with the good work, Minister. [Applause.]
Prince M M M ZULU
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 218
Mr M J R DE VILLIERS
UMntwana M M M ZULU: Phini likaSihlalo, abahlonishwa oNgqongqoshe abakhona, abahlonishwa abangamaLungu ale Ndlu, izindaba ezishiwo umhlonishwa mayelana nesifo seNgculazi kanye nokuphumelela komnyango wakhe zenza ukuthi singakuphikisi ukuthi kukhona ukuzimisela okujulile okwenziwa umnyango wakhe ukuhlangabezana nokwenza izimpilo zabantu zibe ngcono.
Kepha-ke, nginokukhala okuthile ngokulethwa kwezinsiza ezifundazweni kanye nasezifundeni zethu lapho uthola ukuthi abantu bakithi abanakekelwa nhlobo. Isibonelo nje, laphaya emakhaya uthola ukuthi abantu bama olayini abade ukuze bathole ukusizakala ezinhlelweni zikahulumeni kazwelonke ukuze kusizakale abantu bakithi. Mhlonishwa, kuzofanele ukhuphule amasokisi, uzihambele zonke lezi zindawo ubheke ukuthi abantu bakithi bayanakekelwa yini, ubheke ukuthi odokotela bakhona yini ukuze abantu bakwazi ukusizakala kulokhu ozokuthola.
Ngiyakuncoma ukuzimisela kwakho okujulile ekusebenzeleni izwe lakini. Ngiyakuncoma futhi ukuzimisela kwenhloko yomnyango wakho nokuzimisela kwabasebenzi bomnyango wakho, kepha ngicela babheke phela ngoba abantu bobabamkhulu bayafa ngenxa yokungabibikho kodokotela abenele ezibhedlela. Kanjalo nasemtholampilo yethu, uthola ukuthi olayini bade, abantu abakutholi ukusizakala nakuba izinsiza sezikhona, uhulumeni ezilethile.
Sengiphetha, ngibonga igalelo labo bonke abantu baseNingizimu Afrika abasebenza ngokuzimisela ukuze kwenzeke lokhu. Okunye, ngiyabonga ngempumelelo ebonakalayo ekulapheni isifo soFuba ngoba uma umuntu ewathathe kahle amaphilisi akhe siyalapheke.
Mhlonishwa, esinye isifo okufanele nisibheke, yilesi somdlavuza. Umdlavuza isifo esibi okufanele nakuso kubonakale ukuthi yini engenziwa ngochwepheshe ukuze basivimbe ekuqedeni abantu bakithi. Ngiyabonga, Sihlalo. [Ihlombe.]
Mr S H PLAATJIE
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 218
Prince M M M ZULU
Mr S H PLAATJIE: Deputy Chair, Minister, globally more than 34 million people are infected with HIV. In South Africa the prevalence of pregnant women with HIV hovers around 29%. Despite the gloomy picture of these statistics, there is also cheerful news. Minister, you have reported that 20 million South Africans have tested for HIV in the past two years and that HIV transmission from mother to child has dropped to below 3%. New infection rates have fallen by 50% in 25 countries, and 13 of these countries are in sub-Saharan Africa, according to UNAIDS. Half of these reductions in HIV infection are among children. This is indeed good news.
However, this does not mean that we can celebrate. Women and children are still at high risk because of sexual violence and gender inequalities. Gender-based violence increases the risk of HIV for women in South Africa. According to UNAIDS, women who have experienced violence are up to three times more likely to be infected with HIV than those who have not.
Cope agrees with the Minister that early antiretroviral treatment helps an HIV-infected person to stay healthy by suppressing his or her level of the virus. Life expectancy of HIV-positive people on long-term antiretroviral treatment is 80% compared to an HIV-negative person, according to actuary and epidemiologist Dr Johnson of the University of Cape Town.
Minister, research challenges remain a major problem, notably in developing a vaccine, female-controlled methods like microbicides and a cure for Aids. Cope urges the Minister to step up HIV prevention efforts and behavioural change. We no longer hear any "abstain, be faithful and condomise" messages.
We welcome the good news that HIV-positive people will get life insurance in the future. That is long overdue. Minister, you are the hope of the nation. Keep up the good work. [Applause.]
Mrs R N RASMENI
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 219
Mr S H PLAATJIE
Mrs R M RASMENI: Hon Deputy Chairperson, hon Minister Pandor, hon Minister Motsoaledi and hon members, President Jacob Zuma has demonstrated his leadership and assured us of his personal commitment to ensuring that people – especially the poorest of the poor – who are suffering can have access to medicines and information that promote the prevention of HIV. South Africa is a model as far as the treatment of HIV and Aids is concerned. A total of 1,9 million people are on treatment, which is the largest number of people on treatment in the world, not just on this continent.
The Select Committee on Social Services had the task of analysing and reviewing the new National Strategic Plan for HIV and Aids, sexually transmitted infections, STIs and tuberculosis for 2012 to 2016. We take note of several of the plan's accomplishments, which we know will reduce the extent of poor health in this country.
For the first time in the history of South Africa, a comprehensive and multistakeholder plan for health exists and targets society irrespective of race, colour, gender, creed and religious affiliation. The tide is definitely turning in the fight against HIV and Aids. By March 2012, more than 20,2 million people had undergone testing since the HIV counselling and testing campaign started in April 2010.
We have noted that the NSP is a culmination of the National Strategic Plan HIV and the National Strategic Plan TB, and that this current NSP offers a more integrated programme of action for the different stakeholders to address the epidemics. We have found that the new NSP speaks directly to the National Development Plan and its vision for South Africa's health. We note that its long-term vision and objectives align with the proposals of the NDP, particularly with respect to targeting HIV and Aids concurrently with TB.
The select committee agrees with the new NSP that the best method for addressing health concerns related to HIV, STIs and TB is through prevention, treatment, care and support while addressing the social drivers of infection. We applaud the strides made by the Minister and his department in reducing deaths related to Aids.
The ANC acknowledges that there are social and structural factors that make some people vulnerable to HIV, STIs and TB. The rates of infection are highest in informal settlements, rural areas, including farming communities, urban townships and hard-to-reach areas. Hence the department intends to aim most of its strategies in the direction of these communities for the next five years.
Infrastructure development and revitalisation efforts leading to the implementation of the National Health Insurance Scheme will enable this department to extend antiretroviral and TB-related treatment services to needy communities.
The select committee welcomes the good progress made by the department. The fight against HIV and Aids, STIs and TB in South Africa must be intensified to reduce the extent of poor health and to create a healthy nation by 2030, and in particular the clustering of the many Aids tablets into one pill, so that the taking of tablets by those affected is made easy and user-friendly.
The select committee endorses the current NSP as presented by the Minister, because of its responsiveness to the changing patterns of HIV, STIs and TB.
Lastly, I want to tell the Minister and his department to never give up in their quest to see South Africans live longer and healthier lives. Never give up on promoting and preaching against HIV and Aids. We as South Africans are fully behind you. Your vision, energy, vibrancy and agility have made this HIV and Aids programme a success. [Applause.]
Debate concluded.
RULING
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 219
STATEMENT IN TERMS OF RULE 251
SUB JUDICE RULE NOT INFRINGED
(Ruling)
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Hon members, may I be allowed to make a ruling on a point of order raised by hon De Villiers on the sub judice Rule? I would like to make a ruling on a point of order raised on 14 May 2013 by hon De Villiers. The hon member rose on a point of order on the motion put by the hon Dikgale, where the hon member said that according to the Rules, matters before the court are sub judice. I requested the Table to look at the Hansard and to advise accordingly.
Rule 48 of the Council Rules provides that no member, while addressing the Council, may reflect on the merits of any matter on which a judicial decision is pending. The sub judice Rule was created to prevent people from commenting on a case when such comments could prejudice the outcome of the case in some way.
The broad scope of this Rule, which was in force in the pre-democratic era, has been severely curtailed by the Constitution, as was stated in the case of Midi Television v the Director of Public Prosecutions. In emphasising the importance of freedom of expression, the court developed an extremely strict test as to when the sub judice Rule can be invoked.
The court found that it would only be applicable if substantial and real prejudice to the administration of justice would occur as a result of the communication and the prejudice could not be prevented from occurring by any other means.
The motion without notice put by the hon Dikgale was not discussing the merits of the case, but was commenting on the period - 13 years – that it has taken the court to finalise the case. No substantial prejudice to the case could possibly arise through this motion and there is no real risk that prejudice would occur. Members can comment on a matter before the courts, provided that the comment is limited to aspects that are not for determination by the courts. Aspects of a matter that are not for determination by the courts are not sub judice since they are not an issue.
My ruling is that the point of order raised by hon De Villiers cannot be upheld. Thank you.
FIRST ORDER
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 220
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela)
RULING
Appropriation Bill
(Policy debate)
Vote No 4 - Home Affairs and Vote No 16 – Health:
The MINISTER OF HOME AFFAIRS: Chairperson, it is indeed a great pleasure to be back in the National Council of Provinces. Allow me to refer to my hon colleagues, Minister Sisulu and Minister Motsoaledi. Thank you, Minister Sisulu, for joining us this afternoon. Thanks also to the hon MECs, Members of Parliament, members of the NCOP and special delegates to the House.
Last weekend, under the theme "Pan-Africanism and African Renaissance", the African Union and member states marked the 50th anniversary of the founding of the Organisation of African Unity. Many of us in this House will recall the words of Kwame Nkrumah of Ghana in a famous speech he gave at the founding of the OAU in Addis Ababa on 25 May 1963. He called on Africa as follows:
Unite we must. […] Without necessarily sacrificing our sovereignties, big or small, we can here and now forge a political union based on defence, foreign affairs and diplomacy, and a common citizenship, an African currency, an African monetary zone and an African central bank.
Fifty years on, the unification of Africa remains a visionary goal. It has proved immensely difficult to form an effective political union, let alone one bound together by trade and investment. Most of our exports go to markets in the Organisation for Economic Co-operation and Development countries, with only 10% going to other African countries. So, for us as public representatives there is much work to do in the free movement of goods, in increased African trade and the free movement of people.
Twelve years ago the OAU became the African Union and it has played a key role in reshaping what was negatively called "the hopeless continent" into a continent that is now full of hope for the future. One of the areas in which we must build hope is that of recognising that we are one people in Africa, divided by colonialism and apartheid, yet ready to be united as one powerful continent in seeking peace and development.
In the 2011 African Public Relations Association, APRA, report on South Africa, we as a country were found wanting in our policy on and action taken to prevent xenophobia. Our Department of Home Affairs established a counter-xenophobia unit, as is required by the Immigration Act, and a strong communications programme directed at addressing xenophobic sentiments in our country. We continue to do this work with the support of the United Nations High Commissioner for Refugees, funding from the European Union and working with nongovernmental organisations to develop a programme to build unity and peace among diverse communities in our country. It is clear from recent events that we need to strengthen our interventions and move with speed to reach out to all communities in our country.
As I speak today, almost five years to the month after the outbreak of antiforeigner violence that left 62 dead, thousands displaced and damage running into millions of rands, there are clear signs that more needs to be done in order to address violence against African foreign nationals in our country. The violence against vulnerable African foreigners is totally unacceptable and must be rejected by all peace-loving South Africans.
The Department of Home Affairs has a role to play in building tolerance and peaceful communities. There are actions that we can and must take. We need to conduct sustained campaigns for building peaceful and diverse communities, as mandated by law. In addition, we should use our stakeholder forums across the country in a much more dynamic way beyond their primary purpose of promoting citizenship. I believe these forums can play a role in promoting harmony between citizen and foreigner and in shaping a more tolerant climate in our communities.
We need, as the National Development Plan has directed, to adopt a much more progressive migration policy in relation to skilled and unskilled migrants; a policy that will make a substantial contribution to economic growth and job creation; a plan that can build trust, cohesion and peace in all our communities. I am sure all members of the House will agree that the violence we have seen in the past few days is unacceptable and is to be condemned.
We as a department have a number of very significant priorities for our citizenry and for foreign nationals who visit our shores. One of our top priorities is to create a secure and trustworthy National Population Register. Our first step is to register the birth of every citizen on the National Population Register. Our second is to issue 16-year-olds with an identity document and to add their fingerprints to the Home Affairs National Identification System, Hanis. I must say, though, that yesterday I visited the Free State and noted that when registering people who are grant recipients the South African Social Security Agency, Sassa, does take the fingerprints of children. Perhaps it is time that we, as the Department of Home Affairs, also took the fingerprints of children and did not wait until the age of 16. We record any change in a citizen's status - through marriage or death - in our National Population Register.
Our third step is to protect the register against fraud or corruption. We have created a number of opportunities to allow excluded citizens the opportunity to be on our National Population Register. One of the interventions has been the provision of a late registration of birth process. Our one objective is to reach those citizens whose births were unregistered and those who have birth certificates but never applied for an ID at any time in their lives.
Another objective is to inform and mobilise South Africans about the importance of the register and the early registration of births, as well as the fight against corruption over fraudulent birth, death and marriage registration. I remind hon members that if you don't register your child, some stranger who likes your child's name will go and register in that child's name, hence the birth of fraud. That is why it is important that all of us, in our constituency offices and in our homes, encourage everyone to ensure that they are registered and that they register their children.
We have national and international syndicates that work with corrupt officials and seriously compromise our national register by selling and duplicating identities. We have recently suspended nine officials in the Eastern Cape for corrupt practices related to the acquisition of permits and identity documents. This is a thriving business, hence the need for us to recognise the importance of national population registration and the need to secure our identity.
As part of our campaign we have launched more than 250 stakeholder forums covering the majority of district municipalities and metros throughout our country. The forums identify the needs as well as the needy, they support and monitor our department and they hold us accountable on service delivery priorities. The forums are nonpartisan and they focus primarily on ensuring that services reach our people. They work with the support of the three tiers of government and all political parties. We have been absolutely pleased at the enthusiasm with which communities and their representatives have embraced the work of the forums.
Another key aspect of our strategy has been to develop close co-operation between the Department of Home Affairs and relevant government departments, such as the Departments of Education, Health, Social Development and the SA Police Service. We have drawn on the positive example of co-operation during the successful hosting of the 2010 Fifa Soccer World Cup and the recent hosting of Africa Cup of Nations. The support of government departments at all levels has been crucial to us.
I would like to ask the members of the NCOP to work closely with stakeholder forums in their local areas of representation. We draw inspiration from the support of members of this House in assisting our department to rid our country of the legacy of the late registration of births. I wish hon members would support me in my intention to end the late registration of births by the year 2015, because we cannot go on with this process forever.
In the 2012-13 financial year, the Department of Home Affairs registered 602 530 births within 30 days of birth. This was made possible by the steady expansion of our national footprint, which reaches into the most rural and far-flung areas through the use of 389 provincial and district offices and 117 mobile offices. In addition, we have connected 347 health care facilities across the country - 85 hospitals in various provinces form part of this number. We are extremely excited at this footprint, which is expanding and ensuring that we reach millions of our people.
According to the 2013 mid-term population estimates, we had 1 095 669 births in 2012 - the calendar year. That suggests that six out every 10 births were registered in our target period of 30 days. We are making strides; we are beginning to succeed. However, our concern is the four out of 10 that we are not getting to, and that is where we need your help.
In the 2012-13 financial year, the Department of Home Affairs issued 1 039 862 identity documents to first-time applicants. We will continue to work with all of you to mobilise our youth to apply for identity documents. There is no member of this House that can claim not to have an agenda for constituency days because the work of the Department of Home Affairs clearly sets out the campaign programme that every Member of Parliament should be pursuing. Every child should be registered within 30 days of birth; every 16-year-old should apply for an ID and get one. That is what we should be doing in our constituency offices if we were to build a nation with a National Population Register that has integrity.
We remain concerned about the problem of duplicate identity documents. We have publicised in a range of print media and in all the provinces a list of over 49 000 people who are holders of duplicate IDs. Yet few of those listed come forward to us to correct this situation. We cannot continue with this problem of duplicate IDs. It is our intention to invalidate all duplicate IDs by December this year. Those affected should approach us between now and December for assistance, otherwise they will find that they can't access their bank account or they can't access services because we will have invalidated their IDs.
The second important programme is the implementation of our IT Modernisation Project, which is currently under way in the department. Through this we intend to improve service delivery to all our citizens at all levels, both within government and in the private sector. We intend to create a paperless environment within the department and to implement live data capture, an e-visa system and e-permitting for all our permit processes. We will implement a Trusted Traveller Programme, the Enhanced Electronic Movement Control System for migration and the National Identification System using biometric features, as well as introducing the smart ID card.
Between July and September this year, we will begin the phased roll-out of the smart ID card in 27 regional Home Affairs offices, with live capture capacity in the 27 offices. We will achieve this objective with support from our principal partner, the Government Printing Works, which has led the preparatory phase of this project.
The first issue of ID smartcards will be free of charge and thereafter it will cost R140 - the price of the current green ID book. We will replace 6 million ID books a year or 500 000 a month. This means that the smartcard machines will produce 3 000 cards per hour, 24 000 cards in an eight-hour day and 480 000 cards a month. This rate of production could be increased in the future if we added a number of shifts to our production scheme. We could bring production to 960 000 cards per month or almost 12 million cards per annum, in order to wrap-up the replacement of the ID book by the smartcard.
Another area in which we need to act is the effective management of immigration. I intend to pay close attention to key aspects of immigration policy in the next few months. The challenges we face include the management of asylum seekers and refugee policy; attracting international migrants with scarce skills to South Africa; and dealing decisively with the flow of Southern African Development Community migrants with lower-level skills who currently work illegally or are abusing the asylum-seeker process in South Africa.
Our overarching concern is to manage immigration in support of our development priorities while, of course, not compromising our sovereignty or security. We want every citizen, including every official, to be welcoming but at the same time to be vigilant in regard to national security and the corruption that undermines it. Immigration is a growing human activity that can enrich and develop a nation. It can be of value for us in SADC.
However, our citizens must understand that the protection of our sovereignty, our state and our society is paramount and important and that immigration that is not managed effectively can pose serious risks, including those of the kind of social instability that we are seeing today. Realising the benefits of immigration while minimising its risks requires that South Africa puts in place the laws, systems, processes and people that are needed to manage it. Such an approach will ensure that we co-ordinate effectively across departments and within civil society.
We are working on various proposals to do with asylum seekers as well as refugees. I would like to assure the House that it is our intention to improve the management of both refugees and asylum seekers. We intend to work much more closely with the United Nations High Commission for Refugees to assist us in developing more appropriate practices in support and management of asylum seekers and refugees. It is our intention to initiate studies on migration so that we have a more informed, data-based perspective on these matters to support future amendments and policy development.
Third and last, we are considering the introduction of a SADC quota of work permits for economic migrants. We think a more effective means of distinguishing between job seekers and economic migrants as well as asylum seekers is an important step forward for our country and we are intending to find a way of addressing this. At the moment our policy and practice doesn't allow us to identify work seekers and distinguish them from genuine asylum seekers. So, those who want work actually use asylum seeking as a means of getting into South Africa. We will be working with our SADC colleagues and we seek to ensure that any permits for job seekers that we issue will be conditional on bilateral agreements with each SADC country that will participate in this programme.
To achieve these objectives we have a budget set aside by our government to the value of R6,7 billion for this financial year. The bulk goes towards departmental programmes and the remainder goes to our agencies: The Film and Publication Board; the Electoral Commission, which receives a large chunk, given the elections in 2014; and the Government Printing Works, which receives a very modest sum, given the excellent work they do and the excellent income generation that results from their work.
In conclusion, I would like to take this opportunity to extend my gratitude to Deputy Minister Fatima Chohan, who is unfortunately not well and could not be with us today, and to our Director-General, Mr Apleni, and his team of deputies and to thank all of them for their support and the hard they do in the interests of our country, South Africa. [Applause.]
The MINISTER OF HEALTH
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 221
The MINISTER OF HOME AFFAIRS
The MINISTER OF HEALTH: Hon Chairperson, hon Minister of Home Affairs, Mme [Mrs] Naledi Pandor, hon MECs, hon members of the Select Committee on Social Services, hon members of the House, invited guests, ladies and gentlemen, the Department of Health signed a Negotiated Service Delivery Agreement with the President. We committed to four objectives, which we called outputs, during this term of government.
The first one is that we need to increase the life expectancy of our population. The second one is that we need to reduce maternal and child mortality. The third is that we need to reduce the burden of disease from HIV, Aids and TB - I have already given a report on that. The fourth one is that we need to improve the effectiveness and efficiency of the health care system.
I'm sure you are well aware that our flagship programme to change the efficiency and effectiveness of the health care system in this country is the National Health Insurance system. While South Africans have been throwing mud at each other about the NHI, I need to indicate to this House that we must stop wasting our time. NHI has 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 an NHI and are giving well-researched guidance to countries on how to go about implementing their NHI – not to debate whether it is needed or not. The world is far beyond that stage. Recently, the World Bank and Harvard University organised a workshop in Washington for Ministers of Health and Ministers of Finance to encourage Ministers of Finance to support the NHI and to prove to them the economic benefit of doing so.
The NHI is not called that in every country. The World Health Organisation and the United Nations agencies have a generic term for it: It is called "universal health coverage". However, in South Africa, as you know, we still stick to the term "NHI".
The prestigious British medical journal, The Lancet, which I referred to earlier, saying that it released research showing that South Africa was going through a quadruple burden of disease, has also entered the fray. They launched a series late last year in which academics, health activists and researchers are writing articles to guide countries in this concept of Universal Health Coverage. It doesn't matter what you call it, the concept is the same and it simply means that every citizen has the right of access to good-quality and affordable health care. That access should not be determined by the socioeconomic condition of the individual.
Whether you call it the NHI, as we are doing here in South Africa, or the National Health Service, the NHS, as they do in England, or Seguro Popular as they say in Mexico, or Obama Care as the Americans call theirs, they all mean one and the same thing.
In the editorial of The Lancet, Volume 380, 8 September 2012, which I mentioned, they said:
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 and health systems in Mexico, China, India, southeast 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 (UHC), and which will be presented in New York on Sept 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 WHO Director-General 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, and I quote again:
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 world has decided on this issue. Because of that, there is another very important argument in The Lancet that people need to understand. It argues that universal health coverage is poised to be "a third global transition in health".
They also argue that since the beginning of humanity there have only been two transitions in health. The first, which they called the demographic transition, happened in the 18th century and changed the planet in the 20th century through public health improvements, that is, sewerage, sanitation, clean running water, etc. We may be taking these things for granted, but before they were there, there was premature death all over the world.
The second transition, which is called the epidemiological transition, began in the 20th century and eventually reached even the most challenged countries in the 21st century. This is the time when communicable diseases such as smallpox or poliomyelitis were vanquished or controlled on a scale never imagined, opening the way for contemporary action to tackle noncommunicable diseases.
Now The Lancet says the third transition seems to be sweeping the globe, changing the way in which health care is financed and health systems are organised. It says that for a long time getting health care has meant first paying a fee to the provider – a practice that effectively burdens sick and needy people and has meant choosing between going without needed services and facing financial ruin.
In implementing the NHI or universal health coverage, countries are clearly going to pay different prices for different durations of time, depending on internal objective factors and the dynamics in that country. We received a report that in Qatar they are implementing their NHI from July this year. They will finish in December next year. As you know, in South Africa we gave ourselves 14 years to do so.
Unlike Qatar, there are two main prices that we have to pay in South Africa for the successful implementation of the NHI. The first price is that the quality of services in the public health system has to drastically undergo a metamorphosis – the quality simply has to improve. There is no running away from that.
In this regard I am grateful that both Parliament and the NCOP have eventually passed the National Health Amendment Act, which provides for the establishment of the Office of Health Standards Compliance. This office will both set health standards and have an inspectorate. In addition, it will provide for a health ombudsperson, with whom complaints about poor health standards can be lodged. In simple language, our hospitals will be inspected periodically by inspectors to see that they abide by certain basic health standards that we require.
The second cost in the price that we have to pay is that the cost of private health care has to be reduced drastically. Hence we support the hon Minister of Economic Development, Mr Patel, when he announced a month ago in his budget speech that he was going to launch a public market inquiry into the pricing of the private health care system through the amended Competition Act.
For those who don't understand where we come from on this issue, I wish to refer you to the National Development Plan: Vision 2030, which has been accepted by everybody in this country, and I quote:
A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector.
Regarding how we are going to pay the first price that I mentioned earlier - the issue of the quality of health care in the public health system - in the White Paper, which will be released soon, we will outline in full what we are going to do. We are aware that it has been a long time since the Green Paper was released. A great many inputs and developments needed our very careful consideration. We will be ready very soon.
When we release the White Paper on the NHI, it will be with a clear plan on how the NHI will be implemented. Because this plan is elaborate, I am not able to outline it here today. We will make it available in due course. Suffice to say, the plan will include the concept of non-negotiables in health care. This includes the delegation of powers to chief executive officers of hospitals, who are being newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medical supplies directly from suppliers.
I wish to take this opportunity to emphasise again and again that the NHI will be based on a preventive, not a curative health care system. I will repeat on many more occasions to come that primary health care, meaning the prevention of disease and the promotion of health, will be the heartbeat of the NHI in South Africa.
Again, we will drive this health care system according to the dictates of the National Planning Commission, which clearly states that among the important things that we must do is reducing the burden of disease. We must not allow diseases to flourish and then run helter-skelter, trying to cure them in our facilities with limited resources, both human and financial. At present the curative health care system is the hallmark of public health systems on the African continent and it is definitely not working.
I wish to demonstrate with a few examples what we mean by the prevention of diseases and the promotion of health care. I will quote from the Mail & Guardian's newly established Bhekisisa health journalism centre, which reported two weeks ago on what the prevention of disease can do.
Very recently, the Department of Health introduced two very new vaccines: Prevenar, to reduce the risk of children contracting pneumonia, and Rotarix, to prevent diarrhoea in South African children. Remember, diarrhoea was killing 25 South African children under the age of five every day. The SA National Institute of Communicable Diseases was tasked with monitoring and evaluating the inception of the two vaccines. Three centres were chosen: one in Kwazulu-Natal, one in Cape Town and the other in Gauteng.
The findings were as follows. At Ngwelezane Hospital in KwaZulu-Natal, the under-five mortality rate was three times higher than in Soweto. However, Ngwelezane Hospital has now closed the ward that dealt with diarrhoea - the gastrointestinal ward. They recently closed it. In 2006, this ward admitted 1 000 children with diarrhoea. It has now closed down because there is no further need. Earlier I mentioned Ms Jackie Schoeman closing an HIV/Aids ward for children in Cotlands. Ngwelezane Hospital has done the same thing because of this vaccine. On average, these three sites in Gauteng, Cape Town and KwaZulu-Natal have shown a 70% reduction in admissions due to diarrhoeal diseases attributable to the rotavirus.
In view of the success that vaccines can bring about, our next target is cancer of the cervix, which is one of the biggest killers of women. According to experts, 6 000 South African women are afflicted with cancer of the cervix every year. Of these women, 80% are African. Of the 6 000, 3 500 will die annually because 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 more likely to get cancer of the cervix - five times more so than those who are HIV negative. Of course, those who smoke are also twice as likely to get this cancer. Cervical cancer is caused by the human papillomavirus and the bad news is that it is also sexually transmitted. The good news is that a vaccine is now available, although the cost is a problem. At R350 a dose, it is expensive. We have agreed that from next year February, we will make this vaccine available to all girls aged 9 and 10 in quintile 1, 2, 3 and 4 schools. We are not discriminating against quintile 5 schools. We are saying that most parents there will be able to afford it while the state prepares to cover those children too. However, every poor child will be given this vaccine. Next year we hope to vaccinate no less than 420 000 9-year-olds and 10-year-olds. In this manner, we believe we will demonstrate that prevention of disease is always more beneficial. [Applause.]
Mrs R N RASMENI
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 222
The MINISTER OF HEALTH
Mrs R N RASMENI: Deputy Chairperson, hon Ministers, hon MECs, hon members and guests, I greet you again. The ANC is determined to fight fraud and corruption because in pursuing its goal of building a capable developmental state, the efficiency of government is of principal importance. Corruption weakens the state's capacity to provide public goods to the people.
The Department of Home Affairs is especially and critically important in ensuring that citizens have access to the socioeconomic rights enshrined in the Constitution. It is therefore key that not only should those who are eligible to access social grants and other government endowments have access to these but also that those who are not citizens or permanent residents of South Africa should not, through fraudulent means, gain access to enabling documents and, invariably, increase the weight on the fiscus by using such documents to access socioeconomic rights and other elements of the social wage.
We are encouraged by the fact that the department's efforts in the fight against corruption are beginning to bear fruit. In this regard, the integrity of the identity of South Africans is being safeguarded. The whole nation watched when certain fraud and corruption suspects were charged and brought before our courts. Some of these people were even convicted of crime and sentenced to serve appropriate prison terms.
Indeed, it is evident beyond reasonable doubt that the swift movement of the department against corruption has served as a deterrent for many who might have committed the same offences had they believed that they would be able to do so with insignificant or no adverse consequences attending such illicit acts.
It is therefore encouraging to note that, save for a few areas that need attention, the department has complied with legal requirements and continues to discharge its mandate with integrity. In terms of immigration, the mandate of the Department of Home Affairs includes the facilitation of the legal entry and departure of all persons into and out of the Republic through designated ports of entry. The department also has to ensure that foreigners entering the country sojourn and reside in compliance with the terms and conditions of their permits. Further, the department has the obligation to track, trace, investigate and deport foreigners who have become illegal or violated the immigration legislation of the country.
The ANC-led government has the obligation to balance the need for economic, cultural and social development of the country against its security needs and the integrity of our state and society. Security has to include but not be limited to the security of the country, communities and each one of us, including the immigrant communities who are part of South Africa. Social cohesion includes the integration of immigrant communities into South African life.
The above-mentioned challenges call for new measures in response to them. South Africa must take steps to enable us to deal with asylum and asylum seekers who have transited through one or more safe countries. The UN conventions on asylum seekers provide for the "first safe country" rule, which states that an asylum seeker should seek refuge in the first safe country that he or she reaches. In this regard, South Africa should exercise its right to refuse granting refugee status to asylum seekers who have travelled through safe counties.
It is crucial that systems be put in place to effectively and efficiently manage economic immigrants. We all should not forget that there are strong historical flows of labour between certain Southern African Development Community countries and South Africa. Historically, labour from various countries on the continent contributed in building the wealth of this country. The truth of the matter is that nowhere in the world should a country with a stronger economy than its neighbours totally exclude emigrants from neighbouring countries seeking work. Exclusion of low-skilled immigrants is neither possible nor desirable. Lastly, no country that wants to grow its economy should do so in isolation from its region.
We therefore welcome and support the department's intended expenditure to strengthen our immigration system and to ensure a balance between security and development. The objectives of the department, in line with citizens affairs as outlined in the Estimates of National Expenditure, are to ensure that registration at birth is the only entry point to the National Population Register. The department aims to do so by improving on the number of births registered within 30 calendar days of the birth event against the rolling baseline from 618 000 in 2013-14 to 669 000 in 2015-16.
We also note that the department aims to maintain the standard of service delivery for the issuing of enabling documents inter alia by issuing 95% of the projected machine-readable passports for life capture processes within 24 working days in 2013. The law in South Africa requires that a newborn be registered within 30 days, as the Minister mentioned in depth. However, just over 50% of parents still take a year to register their children; sometimes even longer.
The select committee welcomes and will support fully the call by the Minister to encourage women to register their babies within 30 days of birth. But I want to take this opportunity, while both Ministers are present under one roof - the Ministers of Health and of Home Affairs - to request that in ensuring the success of the registration of newborns, both departments should prioritise those women who give birth at home, particularly in rural areas. They should also prioritise clinics that do not provide this service currently and also hospitals that do not register newborns as we speak, such as the hospital we visited in Mpumalanga and other provinces, for instance, the Gert Sibande District.
Another problem is that orphans and other vulnerable children are sometimes not registered, making it difficult for them to claim their citizenship later on. What is of greater concern is that the late registration of birth opens the way for fraud and leads to an insecure and inaccurate national identity database. Another threat to the NPR comes from citizens who are 16 years or older but have not yet applied for an ID. Failure to apply for and collect an ID book at the age of 16 creates opportunities for unscrupulous officials to access these documents and sell them to individuals or organised syndicates who do massive damage to our economy and may even commit acts of terror and sabotage.
The abuse and fraudulent acquisition of a South African identity or citizenship is made worse when citizens who have applied for ID books do not collect them at the offices of the Department of Home Affairs. It is important that the acquisition of permanent residence and citizenship by foreigners in general should be managed in a way that ensures that national security and public safety is not compromised and that the achievement of developmental goals is advanced.
In this regard we welcome the initiative to establish a single national identity system that includes every citizen and foreigner who lives or has lived in South Africa, whatever their status. We are in support of securing such a system through the use of biometrics, including digital photographs, fingerprints and signatures. This system should be designed to prevent any fraudulent change to a person's status and its key component should be a secure register of citizens.
Moving to the Health budget, I have just a few words to share. In 2009 the ANC government put forward a 10-point plan on health. This plan has since been progressively implemented. This has been linked with one of the 12 outcomes that Cabinet has set itself; that of a long and healthy life for all South Africans.
The ANC government has selected four outputs that must be realised to achieve this long and healthy life for all South Africans. The first output is to improve the life expectancy of all South Africans; the second output is to decrease maternal and child mortality; the third output is to deal with the scourge of HIV, Aids and TB; and the fourth output is the negotiated Service Delivery Agreements.
The last output merits special mention because of the extraordinary challenges we have in this area. Whenever South Africans talk about health, they mostly refer to the efficiency and effectiveness of the health care system. Collaboration and solidarity against a shared threat and a common goal is desirable and can produce the desired results. Through combined efforts and collaborative undertakings, the ANC government launched a huge campaign to counsel and test 15 million South Africans for HIV. The ANC government has not only achieved this but exceeded this target and today more than 20 million South Africans know their HIV status.
Through this programme the ANC government has improved the numbers tremendously by placing more than a million South Africans on antiretroviral treatment. In the same period, the ANC government has conducted 320 000 medical male circumcisions. There has been a reduction in the transmission of HIV from mother to child from 8% in 2008 to 3,5%. This is a reduction of over 50%. This success has meant saving 30 000 babies from contracting HIV from their mothers. That means our population is growing.
For the first time in our history, the ANC government has integrated HIV, Aids and TB in the same National Strategic Plan, as I outlined this morning. This new plan outlines a 20-year vision for the country in the fight against the double scourge of HIV/Aids and TB. This plan needs the support of all South Africans to make it a success. The new National Strategic Plan further states that every single South African must test at least once a year. The ANC government believes that if all South Africans did their bit, these goals are easily achievable. We need to make sure that every pregnant woman undergoes routine HIV testing. This will enable the early detection of HIV infection in all mothers-to-be and the consequent protection of their babies.
Assault on women of childbearing age is disproportionately higher on the continent of Africa than in any other part of the world. Hence the African Union came up with a programme, the Campaign for Accelerated Reduction of Maternal and Child Mortality in Africa, or CARMMA.
The output on increasing life expectancy, which is the ANC government's first output, does not only depend on the fight against HIV and Aids and reducing maternal and child mortality. It also depends on bringing noncommunicable diseases under control. These are largely diseases of lifestyle.
Members will recall that in his very first state of the nation address, in 2009, President Zuma said:
We are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.
In response, the ANC government embarked on the process of a health facilities audit. This entails sending teams to all 4 200 public health facilities to audit infrastructure, human resources, cleanliness, the attitude of staff, the safety of staff and patients, infection control, drug stock-outs and the long queues that citizens have to endure when visiting our facilities.
This simply means that our people will no longer share their wards with cockroaches, bring bed linen from their homes, walking in hospital passages with potholes, like the one hospital we saw in Mpumalanga, and other terrible conditions that the patients and health personnel are subjected to. The ANC supports the Budget Vote of the Department of Health and of the Department of Home Affairs. [Applause.]
Mr M J R De VILLIERS
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 223
Ms R N RASMENI
Mr M J R DE VILLIERS: Hon Deputy Chairperson, hon Ministers, members of the NCOP and guests, the responsibilities and accountabilities rightly stated in the vision and mission statement of the Department of Home Affairs include ensuring a safe and secure South Africa, where all of its people are proud and value their identity and citizenship. We as South Africans should treasure this, and it is a must that we teach and educate others in this respect.
The budget of 2012-13 increased from R2 353 million in 2011-12 to R6 567,8 million in 2013-14. An increase in programmes 1, 2 and 3 is experienced. This is an increase of R845,4 million between the two financial years. This amount included the portion allocated to the Electoral Commission. Government printing decreased by 6% and the Citizens Affairs Management subprogramme decreased by 31%, which amounts to R10 million.
The question to ask is whether there aren't any red flags for the department that delivery will be of a low standard and quality. The citizens of South Africa will in most cases be unfairly treated because they will not receive what should be delivered to them. Citizens Affairs declined by 14% in real terms from 2011-12 to 2012-13. In numerical terms, this amounts to R306,3 million.
If we wanted to evaluate it and decide on its quality, we must also check the inside of a vehicle. Catering in the department's activities decreased hugely and congratulations must go to the department for that. Business advisory services, consultants and professional services decreased from 2011-12 to 2012-13, but it has since risen steeply, from R24,721 million in 2012-13 to R33,3617 million in 2013-14 through the medium-term expenditure framework. We must have an explanation for this, because it looks as if there is something sinister to hide. Also, professional and legal costs in 2011-12 were R21,713 million, while in 2013-14 it was R23,082 million.
This department rests heavily on the shoulders of contractors. In 2009-10, this allocation was R60,839 million; in 2010-11 it was R107,735 million; in 2011-12 it was R121,204 million; in 2012-13 it was R121,778 million; and in 2013-14 it was R146,904 million. It is still expected to rise through the MTEF. The question is whether the department relies on contractors to do its work.
In the 2011-12 budget, entertainment was R626 million, in 2012-13 it was R1,774 million and it decreased in 2013-14 to R1,680 million. However, it rises to R2,032 million in 2015-16.
These few questionable economic classification payments must be looked at, evaluated and revised. It is not only the ears of the elephant that matters but the whole structure.
With regard to border control, the facilities and the quality of border entry points are crucial to our safety. The smuggling of drugs and other goods can threaten the economy of South Africa. The strengthening of safety and security measures at Cape Town harbour and the upgrading of other ports of entry is much appreciated.
The R400 million allocated to infrastructure spending over the MTEF for the improvement and construction of residential accommodation and offices at border posts has shifted. This must be rectified with the Department of Treasury this year, not in 2015-16.
I think the department scores very well in the delivery of birth registrations, identity documents, passport services for foreign obligations, work permits and others. I am looking forward to a time when not only fingerprints but also voice prints and eye prints will be a form of identification as standard practice.
The employment equity status of the department must be attended to. This relates to the demographic percentages. Allow me to pause here to give you the following list: Africans total 86%, with the national demography target being 79 - 07% over target. Coloureds total 5,80%, with the national target being 8,9% - 3% under target. Indians total 0,8%, with the national target being 2,5% - underscored by 1,7%. Whites total 7,4%, with the national target being 9,6% - overscored by 2,2%. Disabled people total 0,89%, with a national target of 2% - underscored by 1,2%.
The Gupta saga was unnecessary and created huge embarrassment to us as citizens and to our good reputation in foreign countries. How can so many responsible departments of government that control entry points be paralysed by the Guptas and/or the Indian government? It is not only us as government that owe an explanation and should take actions of accountability ... [Interjections.] ... but the Indian government also owe these to themselves, their citizens, the world and South Africa.
Look at what happened to Professor Karabus in Saudi Arabia. A huge thank you should go to the South African government for the role it played there. The Gupta saga completely violated and destroyed South Africa's security measures, while the safety of our citizens was completely threatened by it. This is a lesson to us as South Africans and as government to obey the rules and to respect the rights of South African citizens as well as foreign citizens.
The 36% vacancy rate is huge, and the department has reported on how they are working on addressing this problem. This will be followed carefully and we will see what progress is being made. I want to thank all the officials in the Department of Home Affairs.
Turning to the Department of Health, in November 2012 Statistics SA indicated that the population had increased by 11,2 million people since Census 1996. In comparison, between 2010 and 2011 an increase of 3,8% in the growth of the population was experienced. That is 1,959 million people per year. We must plan and cater for population growth during this year and every year in the future.
The goals of the department are noble and good. For example, the first goal is to increase life expectancy at birth to 70 years. The second is to decrease the maternal mortality ratio from 310 per 100 000 to 270 per 100 000, or less. The third is to decrease the child mortality ratio from 42 deaths per 1 000 lives to 38 deaths per 1 000 lives.
We must succeed in the stated goals of combating HIV/Aids, tuberculosis and the strengthening of the health system. If we do not, the challenges will overcome us, given our population growth, economic meltdown and the value of our money.
According to the National Injury Mortality Surveillance System's 2005 report, unintentional injury-related deaths accounted for 44% of deaths. On our roads, 43 people per 100 000 die and pedestrian deaths account for 42% of this statistic. We have to sharpen our programmes with regard to safety on our roads.
There were 5,6 million people living with HIV/Aids in 2011, with the highest prevalence being among pregnant women. Our health budget is R30,7 billion in 2013-14, which is a nominal change of 9,4%. We must not get excited over this amount ...
The DEPUTY CHAIRPERSON OF THE NCOP (Ms T C Memela): Hon member, please conclude.
Mr M J R DE VILLIERS: ... because inflation worsens the value of our money, so we must not expect that this department will address every problem experienced in our health sector. [Applause.]
Mr B MALAKOANE
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 224
Mr M J R DE VILLIERS
Mr B MALAKOANE (Free State): Hon Chairperson, hon Minister of Health, Mr Motsoaledi; hon Minister of Home Affairs, Naledi Pandor; hon members of the NCOP; my colleague, the hon MEC of health of the Western Cape; special delegates; ladies and gentlemen, I will start by mentioning what I noted and what was mentioned by one hon member after the other: that the Department of Health is doing a sterling job. That is why no one can say anything untoward and can only sing the praises of the Minister of Health for the leadership he has given and steering the department to deliver on the Negotiated Service Delivery Agreements. What was mostly encouraging and really humbling was the assertion by one hon member who said the Minister was the only hope for this country in combating HIV and Aids and dealing with the scourge of TB.
I will deliberately steer clear of dealing with esoteric allusions that the department is laden with, like statistics and other figures, because they may be difficult for most of us. I will try to be basic and simple in my approach.
The intention of Output 1 is to increase life expectancy and to foster a long and healthy life for South Africans. In this regard, the department made the discovery and there is general acceptance of the fact that the central drivers of morbidity and mortality remain HIV, Aids and TB. While the department is progressively retarding the spread of HIV and Aids infection across the country in many areas, it is concomitantly dealing the same blow to TB and many other gastrointestinal infections in a much more vigorous way.
How was this done or achieved? A thoughtful and deep analysis of the problems was done and a crucial response, forceful in character, was formulated. It features comprehensively developed and well-crafted plans to push back the frontiers of HIV and Aids in general and TB in particular. The conundrum of these two bedfellows could no longer be allowed to perpetuate itself.
This response led to an increase in the number of facilities that provide antiretrovirals, inclusive of the increase in the number of nurses or cadres that were initiating ARVs under the Nurse Initiated Management of Antiretroviral Therapy programme, or Nimart. That same principle was applied in the treatment of TB. This response led to the introduction of a groundbreaking and cost-effective fixed-dose combination drug treatment, which is currently well received and yielding tremendous adherence by patients.
There is improved collaboration with our partners and other government structures in education and advocacy drives, which further encourages HIV/Aids counselling and testing, TB screening and treatment.
With regard to the results, studies showed that there is a progressive decline in maternal and child mortality, as many members have mentioned. That confirms that the department is doing things right and is on track and on the right path towards increasing the life expectancy of South Africans. There is an increase in drug cover, adherence and response to life-saving treatments.
Tuberculosis is known to be as old as mankind and we are contending with its ravages to this day. The department has rolled up its sleeves and has re-engineered its business, enhancing it with better diagnostic technology - the GeneXpert, which the Minister referred to - better screening techniques; and the improved tracing and handling of contacts and family members.
The department's determination and resolve to defeat this enemy is obviously unwavering. The commitment is rock hard and the focus is second to none. The department is making giant leaps in improving the effectiveness of our health systems for better access, planning, decision-making and service delivery. The department is steadfastly addressing the challenges of staff shortages, long queues, the availability of drugs and infection control in its facilities. That is why the target of an 85% cure rate for TB is in the department's sight, but it is obviously aiming beyond that.
The National Health Insurance calls for every citizen to have access to quality and affordable health care and that access should not be determined by a person's socioeconomic status. It is for this reason that the re-engineering of primary health care, which is the precursor to this programme, is robustly under way. This brilliant intervention, which is going to change the way in which health systems are organised and financed, is a boon to the South African public. This is because access to affordable quality care will no longer be determined by the socioeconomic status of any individual, as is the case with private health care. It will be by deliberate coverage for all those who seek relief from discomfort.
Various programmes, like hospital revitalisation programmes, facility improvement programmes and adequate staffing, are bringing about the metamorphosis that is required for the phased-in implementation of the NHI.
One member made mention of the issue now commonly known as remuneration work outside of the Public Service. It is common knowledge that certain shrewd and unscrupulous entrepreneurs, masquerading as honest public sector medical practitioners, have pitted the uninsured general public against the insured private patients for their services, as it is no longer a lucrative business endeavour to treat public patients. Unfortunately, the public patient always emerges as the loser, in terms of time, compassion, empathy and speed of service. Public patients are cruelly punished for their socioeconomic status, which does not make business sense. That is why this system has to be regulated in a very straightforward and uncompromising manner.
This system is being abused without any mercy and certain perpetrators are willing to approach courts to defend any attempts by government to demand the full complement of the hours which government pays a premium for in return for their services. That is why we would support any endeavour to bring the culprits to book and to restore the dignity of the health profession.
In terms of advancement in the prevention and treatment of diarrhoea, we can only commend the department for the introduction of the rotavirus vaccine, which will make a huge difference in saving the lives of those who are vulnerable and are currently exposed to the risk of dying as a result of diarrhoea.
We should further commend the department for making possible the vaccination of girls against infection by the human papillomavirus, which can ultimately and in the long run lead to the development of cancer in girls. This move is intended to be implemented next year.
It is obvious that the department is doing as much as it can to ensure that we achieve our goal of increasing the life expectancy of the South African public. With these words I would like to support the Budget Vote of the Department of Health.
Prince M M M ZULU
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 225
Mr B MALAKOANE (FREE STATE)
Prince M M M ZULU: Deputy Chairperson; the two Ministers, the Minister of Health and the Minister of Home Affairs; ...
IsiZulu:
...abahlonishwa abangamaLungu ale Ndlu, izinhloko zeminyango nalabo ezihamba nabo, uMnyango wezaseKhaya ungumnyango osondele kakhulu ezinhlizweni zethu njengendlu kaMaMonga.
Ngqongqoshe njengoba wazi ukuthi eminyakeni eyishumi nesishiyagalolunye, umzukulu kaMaMonga uke wawuphatha lo mnyango, nakuba kwakunezinkinga eziningi zezinhloko zeminyango ezazithunywe ngaleso sikhathi. Kwakungekho ukusebenzisana okunobuchule, noma udaba lwezombusazwe lwamaqembu lwalusami ngenhla kubantu bakithi.
UMnyango wezaseKhaya usukwazile ukunqoba izinto eziningi ezinjengenkohlakalo - nakuba ingeke iphele ngokushesha - ukuhlela ukubhaliswa kwabantwana abasanda kuzalwa ezibhedlela - njengoba uhulumeni esenohlelo lokuletha amahhovisi angomahambanendlwana ezibhedlela. Lokhu kutholakala kwamahhovisi enu ezibhedlela zethu kuyisu elingcono nelibaluleke kakhulu ukuze ukubhaliswa kwabantwana abasanda kuzalwa kube yimpumelelo.
Okunye okungijabulisa ukuba khona kwamakhadi amasha emali yesibonelelo [smart card], okuwuhlelo okufanele ngabe kade lwasebenza uma bekungeve kungenxa yokungcola kombusazwe ungcoliswa indaba yokubeka phambili ubuqembu kunokubeka phambili izidingo zabantu. Kufanele sikubheke, singamaqembu ezombusazwe akuleli Phalamende kumbe njengabantu abakhethwe ngabantu ukuba babe kulezi ziNdlu zePhalamende, ukuthi ubuqembu sibubeke eceleni, sibheke izidingo zabantu, ukuze kusetshenzwe kahle.
Okunye Ngqongqoshe okusayinselele ukungabibikho kokubambisana okuhle phakathi komnyango wakho noMnyango wezokuThuthukiswa koMphakathi. Kumanje nje kunohlelo lokuvuselela ukuze kuqedwe lo mkhuba omubi wabantu abadla izinkece. UMnyango wezokuThuthukiswa koMphakathi uhamba wodwa, ungekho uMnyango wezaseKhaya ukuba uzobhekisisa ukuthi izitifiketi ziyizo yini na, akuzona izitifiketi ezikokotelwe noma izitifiketi zomgunyathi.
Uma ningalungisa kulolo hlangothi siyokwazi ukuthi sinqobe ngokupheleleyo ukulwisana nobugebengu kuleli lizwe. Egameni leNkatha yeNkululeko siyaleseka iVoti leSabiwomali somnyango wakho ukuze ukwazi ukuhlangabezana nezidingo zawo.
Sengiphetha, kufanele ubheke kule khomishana yokhetho ezimele ukuthi i-CEO yakhona iyaqashwa njalo emva kweminyaka emihlanu. Kepha, kulezi zifundazwe eziyisishiyagalolunye abasebenzi bezifundazwe [provincial officers] basebenza impilo yabo yonke. Kulesi sikhathi senkululeko, akekho umuntu okufanele asebenze impilo yakhe yonke, aze athathe umhlalaphansi. Kufanele njalo emuva kweminyaka eyisihlanu, kubukezwe ukuthi umuntu usasebenza ngendlela eyiyo yini. Uma ngingahlala la kule Ndlu ngize ngiguge ngingagcina sengiyithatha njengendlu yami, ngenze yonke into ewumsangano; ngizenzele into engiyenza kwami.
Mhlonishwa Ngqongqoshe wezeMpilo izinhlelo zakho zonke, njengoba ngike ngasho, zibalulekile kakhulu. Ngiyaphinda ngiyagcizelela ukuthi lezi zinhlelo zomnyango wakho nakuba zibaluleke kakhulu ezweni lakithi kepha ngicela uzibheke zonke izifundazwe eziyisishiyagalolunye kanye nezifunda ukuthi zisebenza ngayo yini indlela okuyiyonayona.
Ngicela ubheke ukuthi abantu bakithi abatholi yini ukuhlukumezeka kulezi zindawo. Abantu bakithi basahamba amabanga amade ukuya emtholampilo ekubeni wena ngala ukhuluma uhlelo oluhle lokuthi isikhungo sezempilo asisondele eduze kwabantu. Kusekhona abantu abahamba amakhilomitha ayi-15 uma beya ezikhungweni zezempilo.
Okunye, kusekhona abantu abagcwalelwa yimifula bangakwazi ukuwela ukuze bayothola usizo lwezempilo. Lezi yizinto okufanele uzibhekisise Ngqongqoshe. Kunezibhedlela zethu ezindala kakhulu zangonyaka we-1928, lapho izindawo imizana yabahlengikazi ziyihlazo uma ubheka iminyaka eyi-19 sakhululeka. Lezi zindawo ungathi kuhlala izingulube uqobo lwazo indlela okungcole ngayo. Nalapho engiphuma khona kwelikaMthaniya kunjalo nje; izindawo ezihlala abahlengikazi zingcolile. Zonke lezi zinto yizinto okufanele zibhekisiswe ngoba isabiwomali sakho kufanele sikwazi ukuzilungisa.
Enye into eyinkinga enkulu ilento yama-ambulensi, lawa aphethwe abantu abazimele. Uthola ukuthi umuntu oshayela i-ambulensi kufanele aqale athole imvume ngaphambi kokuba akwazi ukuyothatha iziguli. Umuntu uze afe afele eduze kwesibhedlela ekubeni sikude ngekhilomitha nje nalapho ehlala khona, kepha ingekho indlela yokuthi angamthatha amhambise esibhedlela.
Lokhu kungenye yezinto okufanele nizibheke emnyangweni wakho. Kufanele nibheke ukuthi abantu bakithi bayakuthola yini ukusizakala. Uma ningayeka le nto yokuthi ama-ambulensi aphathwe abantu abazimele niwabuyisele kuhulumeni ngabe nenze umsebenzi omuhle kakhulu.
Egameni leqembu le Nkatha siyasiseka iSabiwomali somnyango wakho ngaphansi kwesimiso sokuthi nibukeze udaba lokusebenza kwama-ambulensi. Ngiyabonga. [Ihlombe.]
Ms B V MNCUBE
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 226
PRINCE M M M ZULU
Ms B V MNCUBE: Deputy Chairperson, hon Minister Pandor, hon Minister Motsoaledi, hon members of the NCOP and special delegates, at the 53rd National Policy Conference of the ANC, we committed ourselves to the positioning of the Department of Home Affairs to be the backbone of security, service delivery and the developmental state. We said this because we are aware that under the apartheid regime, the main objective of the Department of Home Affairs was to control our people and deny them their citizenship, identity, dignity and freedom of movement, among other injustices.
Today we can say with the utmost pride and humility that we have transformed this department. Today our people have a Department of Home Affairs that plays a decisive role in providing them with pertinent documents to access their basic rights. We have moved with the utmost speed to ensure that this department becomes the backbone of the developmental state that we seek to build. We have ensured that this department remains central to our national efforts to strengthen national security and provide our people with the services to which our Constitution entitles them.
We want to take this opportunity to congratulate Minister Pandor and her predecessors for their tireless effort to make this department the flagship of our national effort to transform South Africa. It is through her decisive and vigilant leadership that today we have a Department of Home Affairs that plays a crucial role in enabling all South Africans to proudly claim their citizenship with the utmost dignity and a great sense of pride.
After the demise of the apartheid regime, we committed ourselves to creating a national identity database that would enable our government to assist us in achieving the goals of the society we envisaged when we took up the fight against apartheid. In our document Ready to Govern, we said we needed to build a comprehensive, accurate and secure population register that would enable our government to have an accurate picture of our national profile.
Indeed, our government has moved with the utmost speed to put all systems in place to ensure that births, deaths and any other changes are recorded. We have moved with the utmost speed to ensure that we register babies immediately after their birth. Our registration of birth drive has ensured that birth registration becomes part of the national consciousness and civic responsibility of all South Africans.
In order to assist citizens to register their children, the Department of Home Affairs has established service points where online registration can take place in 221 hospitals. As the ANC, we have rallied the cadres of our movement to actively assist in making sure that mobile units, which are only a phone call away, are organised for citizens in informal settlements and townships that do not have South African IDs and birth certificates. We want to congratulate the Department of Home Affairs for working tirelessly to narrow the stream of late registrations of birth, which was open to abuse and allowed for the fraudulent acquisition of South African identity and citizenship.
I would like to advise the Minister of Home Affairs to visit Harrison Street in Johannesburg - the fifth floor - where this practice of corruption and buying documents and all those things are still happening.
We are also aware that the department has improved its turnaround time and processes for the issuing of identity documents, passports and birth certificates. Our people continue to express their profound appreciation at the measures that have been put in place to ensure that they are served with dignity and that they are not made to wait for too long for documents that are very important for their access to basic rights and employment.
The Department of Home Affairs plays a central role in regulating and facilitating immigration and to enforce the Immigration Act. As the ANC, we say this because we are aware that immigration impacts strongly on our security and on our economic, social and cultural development. Today, travellers enter and depart from South Africa through a total of 72 designated ports of entry. This includes 10 airports, nine in the maritime borders and 53 land ports.
Today, our nation shares land borders with six countries. We want to commend the department for moving with the utmost speed to strengthen the administration and control of these entry ports. We are also aware that the programmes of the department, in partnership with our law enforcement agents such as the Hawks, continue to bear fruit, especially in waging a concerted war against corruption. The Department of Home Affairs has demonstrated in all aspects to be a department at work to give our people access to services with dignity and national pride.
The Department of Health aims to provide leadership and the co-ordination of health services to promote the health of all the people in South Africa through an accessible, caring and high-quality health system based on the primary health care approach. In his 2013 state of the nation address, the President indicated that health remained one of the five priorities of government, which also included education, fighting crime, creating decent work, as well as rural development and land reform.
During the previous financial years, the Department of Health has made considerable achievements in the implementation of the above-mentioned goals. For example, infant mortality has decreased from 56,5 deaths per 1 000 live birth in 2009 to 42 deaths per 1 000 live births in 2011. These exceed the Health Sector Negotiated Service Delivery Agreement targets of 2014, which are to decrease the under-five mortality rate and the infant mortality rate to 50 and 38 per 1 000 live births respectively by 2014.
In April 2012, the Minister of Health launched the Campaign on the Accelerated Reduction of Maternal and Child Mortality strategy in South Africa to accelerate progress towards improved maternal and child health outcomes and to decrease mortality rates. Significant progress has been made in the prevention of mother-to-child transmission of HIV and Aids, which has decreased from 8,5% nationally in 2008 to 2,67% in 2011, according to the department.
Allow me to take this moment to commend the Gauteng government on the new infrastructure development strategy, which has ensured that our people are given quality health care in modest district hospitals with the same service standards as the private sector. The Natalspruit and Jabulani district hospitals are among the state-of-the-art hospitals in the country that have offices of Social Development and Home Affairs opposite their maternity wards.
These hospitals were handed over to the Department of Health with all kinds of state-of-the-art machines needed to provide our people with world-class, quality healthcare. We are aware that these facilities will need engineers and other technicians to ensure that they maintain their quality. We welcome the initiative taken by the premier of Gauteng in ing with further education and training colleges to produce graduates that would be able to assist these hospitals.
We are happy that the Department of Finance in Gauteng is working in partnership with the Department of Health to ensure that the Department of Health and hospitals spend according to their programmes and budget and have addressed the issue of accruals. We also want to congratulate Gauteng for moving with greater urgency to develop and implement a standardised protocol for conducting patient satisfaction surveys.
The ANC supports these two Budget Votes because they demonstrate the effectiveness of our national transformation agenda and the commitment to change the lives of our people and Africans in general.
Mr J J GUNDA
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 227
Ms B V MNCUBE
Mr J J GUNDA: Hon House Chair, hon Minister Naledi Pandor, hon Minister Motsoaledi, hon members - all protocol observed - the Department of Health and the Department of Home Affairs play a very important role in our country. Let me start by saying that it is not often that we get the opportunity to say something to Ministers who are working. Today, I would like to say, "Well done." These two Ministers are taking their work seriously. We would like to say to them: "Congratulations on a job well done." However, there are still many challenges.
I would like to talk about the Department of Health. Hon Minister, when I listen to your plan and read your Budget Vote and your strategic plan, I can see that this is a plan with a vision. Yes, there is a lot that needs to be done. However, what you have achieved so far must be applauded. Let's look at our health system, especially the National Health Insurance pilot project. I am from the Northern Cape, so I would like to speak about the Northern Cape. One needs to be honest about the NHI project and say that in Pixley ka Seme the NHI has achieved a lot, yes, but the challenges are still there. However, the important thing is - the principle is – that people are getting better and quality service through the NHI pilot project. We can testify to this because we have received many positive responses from people.
However, hon Minister, the shortage of professional and trained nurses and doctors in this country is still a big challenge in the Department of Health. We really need to invest in our young people. We really need to develop and train nurses and doctors, especially from the ranks of children from the rural areas, in order for them to help people at the clinics. In this way these children can get work when they have finished their studies. They can go back to their places of origin and be of good service to our people.
Hon Minister, a challenge that this department is facing is the long queues at hospitals and clinics. It is a sad story that some people sit there for six hours. They get hungry and cannot even buy food. They do not have money to do so because they are poor. The Department of Health really needs to attend to these challenges.
My colleague, the hon Mncube, talked about the state-of-the-art hospitals in Gauteng. Hon Minister, you must come to Upington. You will see the best one in the southern hemisphere. Even when you see state-of-the-art hospitals, I can tell you today that there is not a single hospital in the country that looks like that one. It is the only one - and it is big. We are proud to have a hospital like that. All we need there are nurses and doctors. It will open this year, in September. Regarding the shortage of money, I know Treasury will provide the money to employ personnel so that that hospital can open because there will no longer be accidents involving ambulances between Kimberley and Upington. The reason is that we will have the best hospital in Upington.
The other challenge we are facing is the mental hospital in Kimberley. [Interjections.] I hope the Minister can assist us in the Northern Cape to get that mental hospital finished. A billion rand has been spent on that mental hospital so far, yet it has not been finished. The Upington Hospital has taken three years to build and it is almost finished. There are only a few parts that have not yet been finished. However, by August or September, the hospital will be open. So, challenges remain, but a lot has been achieved.
Hon Minister, let me salute you for your plan and your vision. Let me congratulate you, together with your team. Yes, there are many things that need to be done, like the HIV and Aids and TB patients who still need treatment. However, you are on the right track to see to it that South Africans get quality services; that the poor of this country benefit from the struggle they were part of. In the past, they would not have had these benefits and quality health services. It is important for people to receive services today because some of them, together with their families, paid with their lives to receive these health care services.
In conclusion, let me say to both hon Ministers that I thank you for being honest in your Budget Votes. Thank you for telling the people the truth. Yes, we have achieved a lot but there are still challenges. We will always support you.
Mr T BOTHA [WESTERN CAPE]
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 228
Mr J J GUNDA
Mr J J GUNDA
Mr T BOTHA (Western Cape): Hon Chairperson; Minister of Health, Minister Motsoaledi; Minister Pandor; the MEC for health in the Free State, Mr Malakoane; and members of the NCOP, thank you very much for the opportunity to speak here today and take part in this debate. I would like to start off by congratulating hon Minister Motsoaledi on his Budget Vote. In particular, I want to acknowledge that the quality of health services in the public sector system has to drastically undergo a metamorphosis, according to him.
I want to say that our Minister is very passionate, compassionate, dedicated and ... [Interjections.] Yes, you are right, he knows his job. He also knows about political accountability. I wish there were more of his kind in government. [Interjections.]
While HIV and Aids are such important topics, I want to also mention to hon Minister Motsoaledi that I think that he needs to be congratulated with the new path that South Africa is on with regard to HIV and Aids, contrary to the previous term of government. I want to take this opportunity to say that he has already saved hundreds of thousands of lives. I am saying that against the background of the same government costing us hundreds of thousands of lives in South Africa. Thank you very much for that turnabout in our politics and in the treatment of HIV and TB.
Over the past year – 2012 to 2013 - we have tested 804 000 people in the Western Cape. We are now targeting 938 000 for the coming financial year. When we took over government in the Western Cape, we had 16 000 people on antiretrovirals. Today we have 140 000 on ARVs. We had only 36 facilities that were dedicated as ARV and HIV treatment centres. We now have more than 300 in the province. Currently, we have a mother-to-child transmission rate of below 1%.
Recently, we also introduced the new Rapid Antiretroviral Initiation Programme, RAP, in some of our facilities. With RAP, by providing earlier medication to our patients, we have reduced the treatment period with up to six weeks.
Unfortunately, there are a few things that have not being said about HIV and Aids. In our country, we are a bit reluctant to speak about these issues. Firstly, we have to say that it is unacceptable to have a high number of multiple concurrent sexual partnerships, which is a huge cause of HIV and Aids in our country. Secondly, there is an intergovernmental sex issue that is not addressed in our plans. There are moral standards and issues that we should also address.
Some of the other members - or one, at least - referred to behaviour modification. I really think we need a massive behaviour modification programme in South Africa, specifically relating to health issues, a healthy lifestyle and HIV and Aids. We need to call on our citizens to become more responsible and take greater responsibility for their own health. It needs to be a "whole of society" approach. And in government we need to do this transversally.
Although we are looking forward to the White Paper on National Health Insurance, I want to mention that as yet the Western Cape has not received a response from the national Department of Health on the Green Paper. I am not aware of any institution that submitted a response to the Green Paper and received a response. I really hope that it will happen and that the Minister will at least do so before we move on to the White Paper.
We are taking part in the NHI pilot project in the Eden District. We are very passionate about what we are doing there with this pilot, although we have mentioned that our support for the NHI is not unqualified. However, we are taking part because we believe we can contribute to ultimately achieving the best possible model in South Africa. Our model in the Western Cape is one of universal health care for all our people and we believe it is the issue of insurance that we need to address very seriously. I think it is ultimately the best model to have in National Health Insurance, but our country is still far from that. It is very difficult for developing countries to implement it. It is already difficult for developed countries to implement it successfully. Therefore, in the interim we are looking at the universal health care model.
In the universal health care model, you have proper - very good -management, financial control and responsibility, and political accountability. Those are exactly the three factors that can result in a successful health system or in failure and a bad health system. The Minister has also mentioned and referred to this often and I am comfortable that he is going to address it in this "metamorphosis" that he has mentioned.
The last thing about the NHI is that we are very cautious – in fact, reluctant - to support the central funding system. It would be the single biggest financial fund that this country has ever seen. As it is currently, it will probably require a significant tax increase on the individual tax basis. We are very concerned about the fact that that this will be controlled in the central office of the national Department of Health and not by Treasury. We are also opposing the plans to use provinces only as regional offices for the National Health Insurance. Quite frankly, we believe that that is unconstitutional.
I want to refer to the issue of the roll-out of the human papillomavirus vaccines. We are very excited by the Minister's announcement in this regard and we are awaiting the formal communication from his department to take it forward. However, we are concerned. We have done our calculations and noticed that in the Western Cape it would cost us R248 million. We are very ready for this. We are keen to take part and we think it is absolutely necessary. It would be a major step towards the improvement of health conditions in the province.
In the Western Cape, we have embarked on a wellness programme, aimed at increasing wellness. We believe that we need to create a healthier society by the year 2030. In this regard we are working with other ministries - sport, culture, finance, education, safety and security. We are specifically dealing with social determinants and we will do this project to emphasise early detection as the most important risk factor. We hope to have wellness centres, both mobile and static, running by the end of this year in the Western Cape. The aim is to have centres available so that each and every citizen of this province can undergo annual health check-ups before they become ill. If we eventually achieved that, it would be a first in public health care in the world.
I also want to take this opportunity to thank our health workers. We have only a 4% vacancy rate in our province in terms of staff, and we are very fortunate in that regard. I want to thank them for their dedication and hard work. They are a very special breed of people. I also want to take this opportunity to wish the Minister well in his undertakings for taking health forward. [Applause.]
Mr S H PLAATJIE
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 229
Mr T BOTHA (Western Cape)
Mr S H PLAATJIE: Chair, allow me to open this debate by congratulating the Department of Home Affairs for progress made in ensuring efficiency through digital innovation. Hon Minister, Cope applauds you, your director-general, Ntate Mkuseli Apleni, and the departmental officials in general for following the global line on e-services and paperless governance.
We have learnt, Minister, that the Department of Home Affairs will in the coming months be introducing the long overdue smart identity document cards and a high-security form on which permits issued to asylum-seekers will be printed. The department says this form will actually help improve the management of asylum-seekers and safeguard the system from undue misuse. In the same way, the department assisted a number of displaced residents when 900 shacks burnt down in a fire in Kayamandi in Stellenbosch. The same system could be rolled out in mobile offices in other existing informal settlements, without waiting until after a disaster to help people obtain the document for free and so begin a decent life.
Cope remembers the days of the Witwatersrand Native Labour Association, Wenela, immigrant worker recruitment programme, which was introduced in the olden days. Mine bosses used to have recruitment offices in the neighbouring countries for mine labourers. This was a very efficient system that made sure that before any mine labourer from outside the country was employed in the mines, he needed to be documented in his country of origin. This system eliminated border jumping, illegal border crossings and illegal employment practices through the granting of work permits. This meant that all such workers were documented and their identities traceable, and so were their places of residence.
The Minister visited the Musina border post to Zimbabwe before Easter, but we have not heard of her interest in urgently rectifying the continuous problems of transiting at that border post. The same applies to the Lebombo-to-Mozambique border post. Long queues and poor management of traffic congestion remain a continuous irritation to travellers. The staffing of personnel, their housing and their accommodation are worries. The transportation of officials to and from their work posts and to their families remains a sore point with the workers.
Allow me to quickly jump to the Department of Health. It is interesting that this debate of Home Affairs and Health is a combined debate. Cope has observed the number of efforts made by the enthusiastic Minister Aaron Motsoaledi. We hope such a high level of energy can be supported by other similar efforts to make our country a better, safer and healthier environment for the good of all. Cope would like to see the government focus on immediate needs like the building of more accessible clinics and the provision of health care facilities to rural and farming communities. The improvement of services in hospitals, the extension of compassionate care, the reduction of crime in hospitals, coupled with the increased security of patients, including child theft, should remain the Minister's top priority.
Cope believes this Ministry's short-term achievable goals of five years per time should be pursued.
Ms D Z RANTHO
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 230
Mr S H PLAATJIE
Ms D Z RANTHO: Hon House Chairperson, hon Ministers, hon members, ladies and gentlemen, comrades and friends, at the dawn of democracy in 1994, the ANC implemented the Reconstruction and Development Programme, RDP, a programme designed to mobilise all our people and resources to bury apartheid and build a democratic state. Among the four strategies, which informed the objective of meeting basic needs, you would find the following:
Improving living conditions through better access to basic physical and social services, health care and education, and training for urban and rural communities ...
I thought it is necessary to go back to where we started because this connects very well with the point made by the Minister in his budget speech, when he talked about the National Health Insurance. He said:
Every citizen has the right of access to good quality, affordable health care and that access should not be determined by the socioeconomic condition of the individual.
This is the last Budget Vote of the department in this administration prior to next year's general elections. It comes two years ahead of 2015 - a significant time because South Africa is a signatory to the UN Millennium Development Goals. It then becomes necessary to look at the department's Budget Vote against this background.
The department has focused its programmes and interventions around four key outputs: Increase life expectancy; reduce maternal and child mortality rates; combat the quadruple burden of disease and illness; and improve health system effectiveness. Looking at these outputs, the department is clearly committed to providing access to good-quality health care in this country. The increase in the budget, from R28,1 billion to R30,7 billion, is promising. This takes into account Vision 2030 of our National Development Plan. This department has gone back to basics in emphasising primary health care, which is critical for the wellbeing of the nation. In promoting this, the Department of Health has partnered with other departments and stakeholders in not only fighting disease and illness but also promoting intersectoral collaboration.
Another element to health, which is inherent in the RDP strategy outlined above, is the fact that good health outcomes will be achieved when we recognise that it is an interdepartmental effort. In other words, we can have the best, with modern equipment and medicines and good personnel, but if the majority does not have access to water and sanitation, quality houses with ventilation, improved income and access to clean energy, then the Department of Health will not be able to achieve its objectives. Hon Minister, as the ANC, we are with you as you roll out this programme throughout the country, and we hope that the pilot sites will be a success.
We come from a very low life expectancy, from 56,5 in 2009 and 60 years in 2011. In reducing maternal and child mortality rates, the department is working towards achieving its MDGs by two-thirds under the "age of mortality" ratio - that is MDG 4 - and three-quarters under "maternal mortality" - that is MDG 5. Advocacy for 100% exclusive breast-feeding for at least six months is one way of addressing the challenge of child mortality.
South Africa has been reported as having a high prevalence of HIV and Aids, which has been intensified by co-infection with TB, but now TB is known as the leading cause of death in our country. There are people who qualify for treatment but cannot access TB treatment. Over 2 million people have enrolled for the antiretroviral therapy programme. Pregnant women are expected to improve in their adherence to treatment with the launch of the HIV/Aids fixed-dose combination. The decrease in mother-to-child transmission of HIV is also a positive achievement.
While the Ministry and the department are doing all in their power to improve access to health facilities, I believe that among the issues in the 10-Point Plan to which the department has committed itself should be an effort to improve the manner in which patients receive the various services provided by the department. It is my humble submission that we can do more to make sure that when people visit our treatment centres, they exit such places with their dignity intact and affirmed.
I raise this issue with the aim of encouraging the staff to improve their general attitude. As the NCOP, we have listened to too many complaints from communities in this regard, for example when we did public hearings during our outreach programmes, such as Taking Parliament to the People and Provincial Week. It might be that the staff is not coping with the workload and then they vent their frustration on patients. If that is the case, can we please look into this?
Once more, one of the grounds on which our people continue to judge the effectiveness of the health system is their daily experience with regard to access to medication. We are glad to note that since the last budget was tabled, the real or perceived crisis in the availability of medication - the shortage -has diminished. We now need to focus on reducing the time people are expected to spend in our facilities to get access to their medication.
With regard to the strengthening of its human resource capacity, the department is investing in the recruitment, training and placement of medical professionals to ensure that health care services are provided throughout the country, particularly in rural areas. This will help in the above-mentioned programme.
The National Health Insurance and the review and development of policies geared to address the determinants of health and disease and to improve health system effectiveness are mechanisms that will ensure that our nation has access to quality health care. We have to support this fully. Overall, our country is making progress in improving the health status of the nation. As such, let us support the budget of the Department of Health for 2013-14 financial year, so that it can, and I quote from the White Paper:
... provide leadership and guidance to the National Health System in its efforts to promote and monitor the health of all people in South Africa, and to provide caring and effective services through a primary health care approach.
I would like to make one request to the Minister of Home Affairs. Minister, can you please look into the use of mobile offices by your department? I am saying this because the offices of Home Affairs are not to be found in all areas, especially not in rural areas. The mobile units that are used by the Department of Home Affairs are of great help to our people, but if they are just parked and not used they do not serve the nation.
Again, Minister, the attitude of staff members, especially the young people we employ at the Department of Home Affairs, is not acceptable to our communities. They need to be trained in how to behave and what attitude to have, especially in the way one should address elderly people, as the elderly are the ones who often go to these Home Affairs points to gain access to services. They get a bad attitude from our young people. So, Minister, can you please ensure and strengthen plans and strategies to train these young people?
The MINISTER OF HOME AFFAIRS
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 231
Ms D Z RANTHO
The MINISTER OF HOME AFFAIRS: Chairperson, I would like to thank all the members who participated in the debate for their contributions regarding the Department of Home Affairs. I am very excited to see how familiar members are with the work of Home Affairs. That is the kind of oversight we need to continue to make improvements and to ensure that the progress that has been achieved is sustained over time.
One of the dangers that exist is that when progress is made, Parliament reduces its oversight role. We then become comfortable and retreat rather than advance in terms of achieving the national objectives that all of us are committed to. I therefore assure hon members that we will continue to work hard to achieve the objectives that we have set for the department, but we definitely need your assistance in that regard.
In particular, I am serious about to the request I have made - that hon members should make their constituency work focus on Home Affairs matters. I do not need to remind hon members that it was not part of the natural practice of the majority of our population to approach a Home Affairs office and register children at birth. We now need to make it part of the natural process of building a family or a home that such registration occurs. To do that, we need to be talking to community members, talking to our population, asking those who have had children to show us the birth certificates. In particular, we need to encourage both parents to agree to have their names appear on the now new, unabridged birth certificate that we issue on the spot in the various health centres and centres of registration that we have set up throughout the country.
We are still finding that some parents are reluctant to have both parents' names on the full, unabridged birth certificate. This poses a problem later on, when the children are adults and require services or when they wish to know their family tree or their roots. Then they do not have the names of both parents. If it so happens that one of the parents had not been registered, that child will forever wonder, "Who was my father, actually?" "Who was my mother, actually?" We really need to educate our nation about the importance of the certificates that we have introduced.
I strongly support what the hon Rantho, who spoke a moment ago, said about training. We do need to train our staff members. We do need to ensure that our members are polite and that, in fact, they reflect the service orientation that is part of our mission and vision. It is for this reason that we have established the learning academy in the Department of Home Affairs. I think we are one of the first departments to offer certificated, accredited programmes for training our officials in the department. We have orientation as a basic programme, but then we have dedicated modules that ensure that staff members are competent in the divisions in which they work.
So, we will certainly address the element of just being polite and greeting people. I have complained about this myself. When I visit some of our offices, I walk in and it is clear that the staff still do not know who I am. They do not greet me and then I ask, "But why are you not greeting me? What has the Minister done?" Then they say, "Oh, Minister!" [Laughter.] But it does not have to be a Minister - everybody must be treated with due regard because they have approached us to receive a service.
In conclusion, there is just one or two matters that I should respond to. First of all, I want to respond to hon De Villiers, who referred to our budget. I wish the hon De Villiers was actually the Minister of Finance - he would give us much more money. [Laughter.] However, of course, as the hon member and all members are aware, all the departments have had to take some form of a haircut, and that haircut has an impact on our budget. However, we have ensured that the critical service areas are not affected.
Let me just respond to some of the matters. The civic affairs budget seems to have had a decrease because a number of the expenditure items in this programme was moved to funding through the revenue we collect and we pose in the trading account. As the hon De Villiers would be aware, through payment for passports, IDs and permits in overseas missions, we generate revenue, which is placed in a trading account. We are now going to be paying for printing, courier services, transporting of cash, etc, via that revenue account and not directly from the civic affairs budget. That is why you are seeing that reduction in that budget line item.
With respect to the increase in the cost of consultants and contractors, we have really tried to keep this to as minimal a level as possible. However, as you know, we intend to improve infrastructure at our ports of entry. We need to use architects and other professionals to provide services with respect to the changes that we will be making at the various ports of entry. We have R130 million directed towards this in this financial year and R410 million over the medium-term expenditure framework period.
As I said, we also have the modernisation project, involving implementation in a range of areas, both civic and immigration. Of course, we will be approaching technologists in the information and communication technology sector in order to support us as we implement the Home Affairs modernisation project.
Regarding catering, I really think we do not cater all that much in the department. I must say that I have lost about two-and-a-half kilos since I joined them. [Laughter.] So, I do not see it as an area in which there has been a significant utilisation of funding. What we have done is to have a small adjustment, given the increase in the staff complement and inflationary increases in the cost of goods. However, we are very careful with respect to expenditure in this particular area.
Regarding the hon Plaatjie, he will be pleased to note that we have increased the staff complement at Beitbridge Border Post by appointing 44 more personnel members and 50 more personnel members at Lebombo Border Post. At both of these ports of entry, we have also implemented a process of clearing bus, trucks and taxis away from the actual border post. That is why I spent Easter at Beitbridge Border Post - to oversee the introduction of that process.
We are also attending to the matter of infrastructure, as I indicated a moment ago. We now have Cabinet approval to proceed with conceptualising the creation of a Border Management Agency, under the leadership of the Department of Home Affairs. Once we are ready with the plans, we will come back to the House to inform members of exactly what we intend doing.
So, hon members, let me conclude once more by thanking you all. With your support we will intensify our work,. We will continue to restore the dignity of all our people. We will build a secure system of identification. I hope hon members will be among the first to receive ID smart cards when we introduce them. [Applause.]
The MINISTER OF HEALTH
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
Tuesday, 28 May 2013 Take: 232
THE MINISTER OF HOME AFFAIRS
The MINISTER OF HEALTH: Chairperson, I really welcome the debate, which has been very, very constructive indeed. We will continue to work with hon members to improve the health care situation in the country.
I want to respond to a few concerns that have been raised, especially the issue of the shortage of health care workers, raised by the hon Gunda. I have responded to this many times, not necessarily in this House but generally, across the country, because the issue has been raised on numerous occasions. I want to say that it is true, there is an acute shortage of health workers. However, people make the mistake of believing that it is a uniquely South African problem. This is a global phenomenon. There is a shortage of 4 million health workers around the world. For the world to say "we have good health care systems", we need 4 million people today, around the whole world. That is why this issue is always debated at the World Health Assembly.
The problem we have, however, given this shortage of 4 million, is that the biggest shortage is in sub-Saharan Africa. In fact, the World Health Organisation has declared sub-Saharan Africa a critical area in terms of the shortage of health workers. We are working around the clock to see how we can reduce this deficit.
The first thing we did in the department was to launch the Human Resource Development Strategy. I think the mistake we made as a country, post- and pre-apartheid, was that we never had any clear strategy drawn up or put down in writing regarding what we were going to do in terms of human resources in health. That is why mistakes happened. For instance, with nurses, the first mistake occurred in 1984. In an attempt to improve the standard of nurses, emphasis was placed on training at universities. That resulted in a very big shortage, because remember, in the past, people from poor communities could go to any public hospital and start training there.
Now, we held a nursing summit, which was officially opened by the President, where nurses themselves discussed this issue. We appointed seven different teams to work on the issues of nursing. I am happy to announce that, after two years of discussion and consultation, the strategy has been finalised. We launched it officially in March. We now know what we are going to do. We will once again rely on nursing colleges, as it was before the reliance on universities occurred. We will start training more and more nurses.
The other issue is doctors themselves. This shortage is even worse than that of nurses, as you probably know. We have done three things. Firstly, the country is going to build a ninth medical school. Again, the mistake we made, as a country, is that the last medical school was built 27 years ago. For a whole 27 years, we never built any new medical school in the country. That is where, as a country, we made a mistake.
Compare us with the Cubans. There are 11 million Cubans, but they have 27 medical schools. [Interjections.] There are 51 million of us, but we have only got eight medical schools. You will start seeing the difference. That is why we were able to increase the intake of matriculants to Cuba. Some years ago, there were 60. In 2011, we increased that to 80, but in November last year, as you will remember, we sent 930. So, at the moment, we have 1 300 medical students in Cuba. That is equal to the total number produced by all eight of our medical schools in this country. So, it just shows that we are way behind on this issue, but we are starting to correct it now.
The third thing we have done, even under the present circumstances ... Chairperson, is this clock still running? Am I going to be stopped suddenly? [Laughter.] I am just checking because it looks as if it is stuck. Do I have more time?
The HOUSE CHAIRPERSON: COMMITTEES AND OVERSIGHT (Mr R J Tau): Minister, I will guide you.
The MINISTER OF HEALTH: Thank you! We met with the deans of all eight medical schools. We discussed this issue and we agreed that, even under the present circumstances, they must overstretch themselves and take in more students than they usually do, especially from disadvantaged communities. Wits University is the one that started this first, in 2011. They took 40 more medical students than they usually do. We gave them R8 million for that. The other universities have since followed. As I speak, there are 160 extra medical students from disadvantaged communities this year. Under normal conditions, they would not have been accepted at university, but now they are there, studying. We want to continue with that every year.
Regarding the issue of increasing medical schools, we have advised and are in discussion with the Minister of Higher Education and Training that we must plan for the new university in Mpumalanga to have a medical school eventually. We must also plan for the new university in the Northern Cape to have a medical school eventually. [Applause.]
The Kimberley Mental Hospital issue was raised. Indeed, there are problems there. We have identified them. We have even sent engineers to check on what is happening there. However, our most urgent priority was to bring the project back on course. We are doing so, but I assure the hon member that we are not going to stop there. We need to go back to see who did what wrong. We already know that something went terribly wrong there. Certain people must be brought to book about the Kimberley Mental Hospital. It cannot be left like that. There are people who need to be punished, and we are definitely going to do that. [Interjections.]
The hon MEC in the Western Cape, Theuns Botha, raised the issue of intergenerational sex, which is truly a big problem in our country. In fact, it is a problem not only in South Africa but unfortunately in the whole of sub-Saharan Africa. The Human Sciences Research Council, the Centre for the Aids Programme of Research in South Africa and the Joint United Nations Programme on HIV/Aids have shown that this concept of intergenerational sex is real. It is evidenced by the fact that when you do HIV counselling and testing of young schoolgirls and schoolboys, the prevalence among the girls is sometimes eight times higher than among the boys. The prevalence among young schoolboys is about 2% to 4%, but when you come to the girls, it can go up to 22% in certain areas. We once mentioned these figures and people thought that was the prevalence among schoolgirls across the country. No, I am talking about specific areas where the prevalence is very high. The conclusion by scientists is that this is as a result of intergenerational sex.
We know that in KwaZulu-Natal, the MEC has launched a big programme about this issue. However, we have decided that because we cannot catch these sugar daddies – sometimes we do not even know who they are – the best thing is to protect schoolgirls by reaching out to them, strengthening them and giving them the power to protect themselves. We are going to do this through the school health programme.
If you look at our school health programme, you will see that we have put programmes in place that deal with reproductive health and rights, and we are supplying information. Remember that one of the causes of this problem is that when you and I were young, girls started menstruating at the ages of 16, 17 or 18. Now, menstruation can start at the age of nine. It is no longer at 16, 17 and 18, when people are mature enough. It starts at nine years of age, and it is not God's fault. It is the fault of us human beings. God is still creating the same people, but the diet we are now eating is no longer natural. It is causing young girls to start experiencing menstruation at the age of nine. That is what is causing problems, because many of them are not mature enough to deal with some of these problems. So, we need to stand up and know this and protect them.
That is why we think the school health programme is very important. Some people are objecting to it, believing we will disturb the peace at school when we start talking about issues like sex. It is important to give this information; to teach them so that they can understand, because many of them do not understand.
I have even spoken to the SA Council of Churches. They said they were going to have a meeting with me, because their ministers of religion are interested in this issue. I am very happy that we are making those appointments. We are going to meet them. They want to play a role in society. The General Secretary, Rev Mautji Pataki, came to see me and said they want me to come and address the SACC about this issue so that they can enter the fray.
On the issue of the human papillomavirus vaccine, again, MEC Botha, I do not think it is going to be as expensive as it sounds. We have learnt our lesson with HIV and Aids. In this country we used to pay more than any other country for antiretrovirals, until we were warned or cautioned or advised by no less than the Executive Director of UNAids, Mr Michel Sidibé, when he shared a platform with the President on 1 December 2009. He questioned why we South Africans were paying so much for ARVs when we had the biggest programme. We should have gained from economies of scale. Since that time, we have worked with them. That is why I announced here today that we were spending R313 per patient per month, by February 2010. Today, with the fixed-dose combination ARVs, we are spending only R89 per person per month.
We are planning to do the same thing with these vaccines: sit down and negotiate and make sure that we do not pay the prices that exist in the private sector. The price of this vaccine in the private sector is between R500 and R750 per dose and we know that young girls will need three doses. We are not prepared to pay this price. We are going to sit down and negotiate and get the best price that the country deserves, because we believe we deserve that. It is just unfortunate that the Global Alliance of Vaccines and Immunisation, Gavi, is doing these negotiations on behalf of poor African countries. We are told that we do not qualify for Gavi because in terms of their standards, we are classified as a rich country. Under Gavi prices, the cost is only $4 per dose, and we know that the Pan-American Health Organisation has negotiated prices of $13 per dose for Latin-American countries. We will enter negotiations in our own right and we will make sure that the price is affordable. [Applause.]
Debate concluded.
The Council adjourned at 17:31.
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