Hansard: EPC: Debate on Vote No 16 - Health
House: National Assembly
Date of Meeting: 23 Jul 2014
Summary
No summary available.
Minutes
START OF DAY 10:00
UNREVISED HANSARD
GOOD HOPE CHAMBER
23 JULY 2014
PAGE: 1
WEDNESDAY, 23 JULY 2014
PROCEEDINGS OF THE EXTENDED PUBLIC COMMITTEE - GOOD HOPE CHAMBER
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Members of the Extended Public Committee met in the Good Hope Chamber at 10:02
The TEMPORARY CHAIRPERSON (Ms T C Memela) took the Chair and requested members to observe a moment of silence for prayer and meditation.
START OF DAY
DEBATE ON VOTE 16 – HEALTH
The TEMPORARY CHAIRPERSON (Ms T C Memela): I will now call upon the hon Minister. Oh! The Order Paper, sorry.
The MINISTER OF HEALTH: Hon Chairperson, my colleague, Deputy Minister of Health, Dr Joe Phahla, my colleagues Ministers present, chairperson of the portfolio committee, the hon Dunjwa, members of the Portfolio Committee on Health, hon members of the House, invited guests, ladies and gentlemen, it is a great honour and privilege for me to present the Health Budget Vote for 2014-15 financial year.
This Budget Policy Statement is being delivered under the guidance of imperatives, targets, pledges and obligations, which are both national and international in character. These imperatives have to be considered, targets reached, the obligations and pledges respected by the Department of Health, in particular, but by the country in general.
Firstly, we have the National Development Plan, the NDP which implores on us, amongst others, to increase life expectancy to 70 years by 2015 - excuse me by 2030; to have a generation of under 20's free of HIV and Aids by 2030; reduce maternal and child mortality; significantly reduce the burden of diseases both communicable and noncommunicable; implement the National Health Insurance, the NHI, in phases and complimented by the relative reduction in the cost of private health care, supported by better human resources and systems.
Secondly, at international level, we have the Millennium Development Goals, the MDGs, which, as you know, expires next year in 2015. By and large, within the health fraternity, that is the World Health Organisation, the United Nations Programme on HIV/Aids, UNAIDS, the African Union Health Ministers' Summit, the Brazil, Russia, India, China and South Africa, Brics, Ministers of Health summit, the Commonwealth Health Ministers, the Southern African Development Community, SADC, and many others, there is broad consensus about the Post-2015 World Health Agenda. The consensus is that the Post-2015 World Health Agenda must be characterised by three goals. The first is that the MDGs 4, 5 and 6, need to continue far beyond 2015, meaning the goals on child mortality, maternal mortality and the fight against HIV/Aids, TB and Malaria should not stop in 2015.
The second goal is to deal with the risk factors of noncommunicable diseases by 2015. The third goal is to implement of universal health coverage by every country which as we know is called the in South Africa.
Furthermore, at the International level, we have just witnessed the Partnership Forum housed by the World Health Organisation, and chaired by our very own, Mrs Graça Machel, which held its summit here in our country at the end of June 2014. The communiqué at the end of this partnership forum is that we need to ensure the wellbeing of every woman, child, newborn and teenager.
These are very noble goals and there can never be any argument about them. The question we need to ask is: How? But the answer still has to be provided by us, both individually and collectively.
In order to avoid getting lost in this myriad of goals, targets and pledges, South Africa is always guided by the assessment of our own disease profile. Our own disease profile is characterised by four colliding pandemics, or what we commonly know as the quadruple burden of disease. I've mentioned this many times, but I need to remind this House, lest some might have forgotten in this Budget Speech, that the four pandemics are the following: the first and biggest of them all is HIV/Aids and TB; the second is maternal and child mortality; the third is the noncommunicable diseases; and fourth and last is injury and violence.
When your country is faced with such a huge burden of disease and the NDP implores us to reduce this burden, it means the health care system has to be directed. One cannot reduce a burden of disease through a largely curative health care system such as the one we have in South Africa. A huge disease burden such as ours can only be reduced through a primary health care system. Put simply, it means that a health care system that is directed at the prevention of diseases and the promotion of health. This is what the South African health care system is going to look like. We have no choice in that regard because the NDP guides us towards that direction. Let me start with HIV/Aids and TB.
You will notice that the elimination of HIV/Aids, TB and Malaria is Millennium Development Goal 6. However, you will notice that under the quadruple burden of diseases in South Africa, malaria is not mentioned. This is because we have already exceeded our target for malaria long before 2015. Yes, we have reduced the incidence of Malaria by 89% in our country long before the target date of 2015. We have achieved this through a preventative system called the IRS or Indoor Residual Spray, a system whereby mosquitoes are prevented from landing on the walls of houses and also that they should not be in touch with human beings.
However, our biggest problem remains HIV/Aids and TB. We have made tremendous progress in the fight against these scourges in the last five years. However, a lot still needs to be done.
Hon Chairperson, you and the hon members of this House must have heard about the 20th International Aids Conference that is going on in Melbourne, in Australia. Unfortunately, you have heard about it in a rather tragic manner – the tragic death of citizens of many countries in a plane crash in Eastern Ukraine. Amongst them, the outgoing President of the International Aids Society, Mr Joep Lange, and other luminaries in the fight against HIV/Aids who were on their way to the conference. Yes, it was very tragic and the opening ceremony of this conference on Sunday 20 of July felt the tragedy in the air.
I have just returned back a day before yesterday from this conference. The conference took a far-reaching decision to add to the already existing international goals, which I have already mentioned earlier. The decision is that we need to bring HIV/Aids to an end by 2030.
In South Africa, 2030 is a very important date. It is the target date for the NDP goals. So, this international target agreed to in Melbourne, coincides with this important date on our calendar.
The conference defined what is meant by bringing HIV/Aids to an end by 2030, which means the following three things: firstly, 90% of people should know their status; secondly, 90% of all those that are HIV positive must be on treatment; and thirdly, 90% of those on treatment must be virally suppressed. That means no virus can be detected from their blood. In other words, the strategy is 90% by 2030. Discounting this year, we have 15 years to achieve this target globally. Now, what will it take for South Africa to achieve these targets? Where do we start? Let me start here.
There are 52 million of us. Those who are between 16 and 64 years, which means those who are sexually active are 35 million. This number needs to be prioritised for HIV counselling and testing. Of the 35 million, between 8 and 9 million people are tested annually in the Active Case Detection, the ACD, campaign. Of these, the prevalence rate is 17% for those between 15 and 49 years. With the prevalence rate among pregnant women who use public sector facilities at 29%, we have 6 million people who are HIV positive in this country. Of these, 2,5 million have been initiated on treatment. This figure constitutes 80% of eligible women, 65% of eligible children and 65% of eligible men. The 2,5 million on treatment is 30% or one-third of the total global figure. Of these, about 50% undergo viral load tests, and of these 75% are virally suppressed. I have told you that the Melbourne conference decided that by 2030, 90% of people who are HIV positive must have been virally suppressed.
So, like elsewhere in the world, there are leakages in the HIV/Aids cascade. This needs to be fixed to ensure that those that are prioritised for the Health Care Team, the HCT, are indeed tested.
Our next step is to increase the coverage in the manner proposed by the 90% approach. This means testing almost all of the population annually. In summary, it will mean mass testing in every possible setting, schools, universities, workplaces, churches and communities.
In further chasing those goals, I wish to announce today that as from January next year, we shall move all HIV positive pregnant women to the World Health Organization's option B+ as opposed to the current option B that is operational in the country. Option B+ simply means every pregnant HIV positive woman goes on a lifelong treatment regardless of their CD4 status, whereas option B being that they stay on treatment only while they are breastfeeding, and stop after termination of breastfeeding if their CD4 count is less than 350. Option B+ is lifelong treatment regardless of the CD4 status and it would start that next year. [Applause.]
In addition, it is my pleasure to announce today that as from January 2015, we shall start HIV positive patients on treatment at the CD4 count of less than 500, as against the present CD4 count of less than 350. You will appreciate hon Chairperson that we come from very far in the past 5 years. On 1 December 2009, President Jacob Zuma announced the treatment at CD4 count of less than 350, as against the then CD4 count of less than 200 for special categories of patients.
In September 2011, the then Deputy President Kgalema Motlanthe, expanded this to everybody to make it universal at CD4 count 350. Today, it is a further milestone that we are announcing treatment for all who are at a CD4 count of less than 500. [Applause.]
You will remember that treatment of as many people as possible, has been found by research to also be a form of prevention. So, it is in keeping with our strategy of preventative health care. So, this massive treatment programme will also be accompanied by a wide range of prevention techniques, including massive condom distribution, the HCT, preventing mother to child transmission, the PMTCT, sexually transmitted infections, the STI, management, massive medical male circumcision, for which we are targeting 4 million men by 2016, and the provision of safe blood transfusion, which we have already achieved in our country because today is very rare for anybody to get HIV/AIDS from blood transfusion.
I want to remind you that this did not happen on its own. It is because of the state of the art facility installed about four years ago at the transfusion centre in Roodepoort. Other methods will include information, mass education and communication as well as social mobilisation. We also know that keeping girl children at school at least until matric, protects them from pregnancy and HIV/Aids acquisition. This has also been revealed by research.
For all these noble goals to be achieved, government and civil society, as represented by the SA National AIDS Council, Sanac, must be a well-oiled machinery, which at the moment, I'm afraid, is not really so. I am appealing today to Sanac, to please recharge, for the task ahead in the next 15 years is huge and we cannot afford to be flat-footed at this period in the history of the pandemic – it is the final push.
With regard to the TB front, I have already announced the new measures during my speech on the debate on the President's state of the nation address. We will screen all 150 000 inmates in our correctional services facilities, all the 500 000 miners and the 600 000 strong peri-mining communities in six districts that have a high level of mining activity.
In addition, we are going to embark on a massive decentralisation of multidrug resistant tuberculosis, the MDR-TB, initiation management and treatment. Presently, we have got 100 such decentralised sites, and we are going to infuse them to 2 500. This will happen through a rapid establishment and scale up of nurse-led MDR-TB treatment management teams at municipal ward level.
Let me come to maternal child and women's health. Whether you talk of MDGs, post-2015 MDG health agenda, the National Development Plan, the World Health Assembly or the World's Health Organisation partnership forum, issues of maternal, child and woman's health will always come to the fore. This is because maternal and child mortality is not only a health issue, but also an issue of development of humanity that really kills women in pregnancy and child birth, despite our long held assertion that no woman should die giving life. There are, of course, many causes, most of which are developmental. In South Africa, we already know from the triennial studies of the national confidential committee of Inquiry into maternal mortality that three causes emerge as the most prominent.
These are summarised as the 3Hs. The first one is HIV/Aids which accounts for 49% of maternal mortality and 35% of child mortality; the second one is hypertension in pregnancy; and the last one is haemorrhage, both anti- and postpartum haemorrhage.
You will appreciate why we have consistently and persistently pursued strong HIV programmes for pregnant women like the PMTCT. We are aware that we have scored significant achievements in this regard. Whereas a decade ago we had 70 000 children born HIV positive in South Africa. We now have less than 8 000 annually, due to the massive and successful PMTCT programme. We are going to build up on this success until no child is born HIV positive anymore.
To deal with the other two Hs, the African Union Heads of State have launched Campaign on the Accelerated Reduction of Maternal and Child Mortality, Carma, in Africa. During the past 18 months, 1 468 doctors and 3 625 professional nurses have been trained in what is called Essential Steps in the Management of Obstetric Emergencies, ESMOE, Our data suggests that in the districts when the training has been done, maternal deaths from bleeding after delivery are on the decline. We will continue with this programme until doctors and midwives in all districts in the country are well trained.
Part of the agenda to reduce maternal mortality is family planning. We know from the National Capital Conference on Emergency Medicine, NCCEM's, triennial studies that of the 1 million women, who fall pregnant annually, 8% are girls under the age of 18 years, but they account for a whopping 36% of maternal deaths.
There have been wild claims that the key driver of teenage pregnancy is the child support grant. There is no scientific evidence to back this claim. We have always argued, and the United Nations Fund for Population development, the UNFP, has backed our argument, that one of the main drivers of teenage pregnancy in sub-Saharan Africa is lack of family planning.
This has also led to an exploding number of teenage pregnancies. In dealing with this scourge, on 17 February 2014, we launched a new National Family Planning campaign in Ekurhuleni in Gauteng, under the theme: Dual Protection, meaning consistent use of a condom together with another form of a contraceptive device. On that occasion, we launched a totally new contraceptive device called the Subdermal implant, which is implanted just under the skin of the inner upper arm of the woman.
This was the first time that this long acting contraceptive, that remains active for three years, has been made available in the public health sector in South Africa. Whereas it will cost you up to R1 700, it is provided free in all health facilities, regardless of their socioeconomic status. [Applause.]
For this campaign, we have up to now trained 5 325 nurses across all public health facilities who are now able to insert the implant even in the absence of a doctor. When we started, we agreed that we will order 80 000 units of the implant every quarter, meaning that we would insert 320 000 implants per annum.
We were pleasantly surprised, in only 4 months, we had inserted 362 000 implants, far exceeding what we regarded as the annual target of 320. Already, 600 000 implants have been ordered and we have cause to believe that they will all be inserted by the end of the financial year. Does this not tell us that there has really been a gap in the provision of family planning in this country? We wish to appeal to hon members to help popularise this very convenient method of family planning in their constituencies, their families and even themselves.
I wish to further announce to this House that in March this year we have launched, together with the Department of Higher Education, the Human Papillomavirus, the HPV Vaccine. And I wish to announce to the House that we have reached a target of 345 377 learners. We are planning a second dose in September 2014. The girls who have not been vaccinated will get the vaccine next year. This vaccine costs between R700 and R1000, but we are providing it free of charge in all public schools. [Applause.]
I'm left with 10 seconds, Chairperson. In that 10 seconds I want to announce that on 24 August 2014, we are going to launch the Mom Connect Project, which I have already announced where all the 1 million pregnant women will be connected via cellphones so that we can communicate directly with them. Thank you very much. [Applause.
MS M L DUNJWA
The MINISTER OF HEALTH
Ms M L DUNJWA: Chairperson, hon Minister of Health Dr Motsoaledi and his deputy Dr Phaahla, hon members of the Portfolio Committee on Health, Members of Parliament, the director-general and staff, guests, people of South Africa, friends and fellow comrades, good morning. Today we debate Bugdet Vote No 16 of Health. Firstly, I proudly stand here as a member of the ANC, and I want to say thank you very much to the supporters and the ANC members who again voted for it to lead this countryr. [Applause.] Again, we are standing here, as the ANC, supporting the Budget Vote on Health.
In our 52nd conference in 2007, the ANC identified health as a key priority area, and prioritisation of this area has since remained central to the policy imperatives of the ANC government. Let me elaborate on what we have accomplished thus far.
We have made significant progress in terms of certain aspects of the health system. We have developed sound and progressive public health legislation and policy, established a unified national health system, increased infrastructure at primary care level, removed user fees for maternal and child health services, introduced a system of social support grants, ensured the steady increase of immunisation coverage, and supported the world's largest HIV treatment programme.
However, there is still a long road to health recovery for South Africans. In terms of our progress in fulfilling the Millennium Development Goals, MDGs, on child health, HIV/Aids, tuberculosis and malaria, as well as maternal health, we are still trying our best. Coupled with the quadruple burden of disease, economic and social inequality, barriers to accessing health services, inadequate distribution of health resources, and continued human resource capacity needs, the situation would appear to raise major concern. In response to these challenges and the transformation of the sector a diagnostic process of the key challenges facing the health sector, commissioned by the ANC's national executive committee's subcommittee on health and education in 2008, has developed a health sector road map. You see that we are starting from 2007 because we want the people of South Africa to understand that we, as the ANC, didn't sleep and wake up in terms of the concern of the health sector. The road map led to the development of the 10-point plan intended to guide the government health policy and identifying opportunities for co-ordinating public and private health sector efforts in order to improve access to affordable quality health care in South Africa.
The 10-point plan, which locates the process towards achievement of the MDGs, focuses on the following: providing strategic leadership and creating a social compact for better health outcomes; implementing the National Health Insurance; improving the health service quality; strengthening health care system management, improving human resource development; planning and management; revitalising infrastructure; accelerating the implementation of HIV, sexually transmitted infections and tuberculosis-related strategic plans; intensifiying health promotion programmes and mass mobilisation; reviewing the drug policy; and strengthening research and development.
Again, we believe that chapter 10 of the National Development Plan also alludes to the issues that we, as the portfolio committee, the Department of Health, and the ANC think should be looked into. Again, in the 2014 state of the nation address, President Jacob Zuma also alluded to the improvement of quality care in the public sector, under which health falls.
Primary health care will be re-engineered by increasing the number of ward-based outreach teams, contracting general practitioners and district specialist teams, and expanding school health services. The emphasis is on the delivery of community-based services by reaching out to families more proactively, with more focus on disease prevention, health promotion and community participation. These community outreach activities will be facilitated by a primary health care outreach team consisting of both nurses and community health workers who, in turn, are supported by facility-based and specialist support teams of health care professionals. District specialist teams will be deployed to each of the 52 districts in the country to strengthen clinical governance. The Health and Social Policy will be strengthened, and community health workers will be in the field to reach out to communities.
Emphasis will be placed on quality assurance and improvement through compliance with norms and standards for health care delivery. The newly established Office of Health Standards Compliance will ensure that the quality of health care is improved by inspecting public hospitals for six basic health standards: cleanliness, infection control, attitude of staff, safety and security of staff and patients, waiting times, and drug stock-outs.
How many of us have heard horror stories of filthy wards, patients laying on dirty linen for days, and no proper protection for patients against infectious and contagious diseases, resulting in fatalities? The office will also have an ombudsman which will make it possible for patients to complain about health care institutions.
Government reforms will focus on a competency-based ranking system for public hospitals, chief executive officers and district managers and the development of a governance model for a strengthened district health system. For us to move forward, we must look at health workforce development and improve the management of health care institutions and health districts. Hospitals must function effectively. Competent and skilled hospital managers who are able to ensure accountability and identify weakness by management must be appointed. The training of managers in the leadership and management of government must be prioritised.
A new public entity called the South African Health Products Regulatory Agency will be established to manage the registration, regulation and control of health products. The Medicines and Related Substances Amendmending Bill is before the National Assembly and paves the way for a new regulatory body for medicines. This will lead to a more effective authority than the slow and under-resourced Medicines Control Council. The South African Health Products Regulatory Agency will scrutinise sectors of the market that have, until now, been unregulated, including medical devices and diagnostics. It will also be responsible for foodstuffs, cosmetics and complementary medicines.
Performance management reform initiatives include the organisational review of the national Department of Health, a financial management improvement project and other initiatives, such as those aimed at strengthening the provision of quality health care by health care facilities. The organisational review aims to improve overall organisational effectiveness and capabilities. A thorough diagnostic exercise has highlighted some weaknesses within the national department relating to the ineffectiveness of the current management infrastructure and low morale amongst staff.
IsiXhosa:
Ndicinga ukuba masiyithethe siyikomiti yezempilo ukuba kukho inqaku ebelipapashwe ngomhla we-6 kuJulayi elithetha ngezigulo zengqondo phantsi kweSebe lezeMpilo elikhokelwa nguMphathiswa uMotsoaledi, kwaye liqhuba lithi asikhange senze nto singurhulumente we-ANC. Ndifuna ukuzikhumbuza iintatheli ezibhale eloo nqaku ukuba ngowama-2012, urhulumente we-ANC waya kwintlanganiso yaBaphathi baMazwe [summit] wayivuma into yokuba noko asihambi ngendlela ekhawulezayo.Iintatheli zithatha oko ke zakwenza okwazo.
Andizi kungena kwinqaku, kodwa manditsho ukuba elaa nqaku lithi umntu ogula ngengqondo makathathwe aye kuvalelwa, kanti sithi siyi-ANC isigulo sengqondo sisigulo esifana nazo naziphi na izigulo. Sisigulo esimele ukuba abantu emakhaya bancediswe ngoonompilo [community health workers] Sithi siyikomiti, Mphathiswa, iSebe maliqinisekise ukuba liyancedisa ukuba oonompilo baqeqeshwe ukuze bakwazi ukuncedisana nabantu, bakwazi ukuba xa bengena umzi nomzi bambone umntu oza kuhlaselwa sesi sifo.
Enye into engakhange ivezwe leli nqaku yeyokuba isiphako [stigma] sokuba ukuba unesifo esithile sibangela ukuba uthathwe ngokuba ugula ngengqondo kunye nosapho lwakho. Siyacela ke ukuba iSebe lezeMpilo, phantsi kwesikhokelo sakho, liqinisekise ukuba oonompilo, abongikazi noogqirha bayaqeqeshwa. Xa ndigqibezela, siyacela ukuba
English:
... recruitment of health workers, as outlined in our manifesto. Yes, we agree. We are happy that in your speeches you say that a number nurses will be trained, but there is a challenge in terms of how the nurses are recruited, amongst others.
I know for a fact, in my province, the recruitment of nurses is advertised in newspapers whereas when I was to apply for nursing, I had to apply by saying that I beg to apply, and send it to Livingstone Hospital. I would not have had to go and buy a newspaper. We are raising that because ...
IsiXhosa: [10:37:47]
... abantwana abasemaphandleni nasezifama abakwazi ukuba bangaxhamla. Xa sisuka apha siye ekuqeshweni kwabancedisi ngokubanzi [general assistants] kuba kukho into esingayaziyo singabantu baseMzantsi Afrika yokuba ...
English:
... the make-or-break of any health services in any country is the general assistant. You cannot give a patient medicine on an empty stomach. You can never prepare a patient for theatre when the theatre is dirty and the linen is dirty. You can never!
IsiXhosa: [10:38:17]
Uyabaqeqesha abantu ekuthiwa ngoopota, oomabhalana, kuba umntu xa engena emnyango esibhedlele ungena adibane naba bantu. Ewe, zine iicategories ezibalulekileyo kwezeMpilo, ngumncedisi ngokubanzi, ngumabhalane, yipota kunye nogqirha. Kodwa zininzi izinto ezenza umanyano lwentsebenziswano [package]. Sithi ke kuni, Baphathiswa, xa niyijonga lo mba wezempilo, ningalibali ukuqinisekisa ukuba ezi zinto ziyenzeka. Xa ndisuka apha mandithi ...
English:
... we do have a good story to tell. A good story to tell is ... for your information, what worries me is that in the last Budget Vote, the ANC had been perceived as being an organisation led by people who are illiterate. Thank you. [Time expired.] [Applause.]
The TEMPORARY CHAIRPERSON (Ms T C MEMELA
MS M L DUNJWA
The TEMPORARY CHAIRPERSON (Ms T C MEMELA): The next speaker will be the hon James, but before he takes the podium, may I alert all the members here that there will be a swap between hon Carter and hon Emam. Mr Cater will speak before hon Shaick-Emam.
Mr W G JAMES: Hon Chair, Minister, Deputy Minister, members, guests present, let me start by sharing with you the results of a paper published by Juanita Becker and the paper is titled: The reasons why patients with primary health care problems access a secondary hospital emergency centre. This was published in the South African Medical Journal in 2012.
The researchers wanted to understand why patients went directly to a secondary care hospital in George when they had primary health care problems. It is not a trivial question, as the Minister pointed out. If community-based primary care prevents preventable diseases, the trauma and opportunity costs of hospital care can be avoided and physicians will be able to focus on patients with emergency complaints.
More broadly, if primary health care, the PHC, worked well to prevent disease, our country could spend billions more rands on treating disease and conducting clinical and discovery research, to find new cures in the light of our changing demography and the shifting complex health burden that the Minister described.So, what does the research say about PHC in our country?
The researchers found in George that 88% of the patients who came for emergency care at the George Hospital were self-referred and that 30% had complaints that lasted for more than a month. They established that a mere 4,7% of the self-referred cases were in fact for emergency care.
The reasons why patients came for hospital emergency care were that 27% of the respondents claimed that the prescribed clinical medical was not helping; 23,7% said that the treatment at the hospital is superior, at least they believed it to being superior; and everyone complained that there were no after-hours primary health care services available.
Health Minister Aaron Motsoaledi is therefore entirely correct in his desire to re-engineer the PHC, as described in the various departmental documents. So, what is the plan? The George study researchers made some evidence-based recommendations and said the following.
Firstly, introduce firstly campaigns on the primary health care services that are in fact available and secondly introduce education campaigns to share with the public what the appropriate use of emergency care or hospital services, in fact, is.
Secondly, make clinics available 24/7, which will reduce the number of patients inappropriately ending up in emergency care or alternatively, specially appointed clinical nurse practitioners could provide after-hours PHC services at hospitals.
Finally, channel patients using the existing triage system better to the appropriate level of care, by ramping up the quality of the health information and communication technology and by introducing a standard referral letter.
Equally important to consider is the Tshwane Health Post Model. In a paper published in the African Journal of Primary Health Care and Family Medicine this year, Nomonde Bam and others recommended that primary health care teams with certain qualities be established in the country. The following qualities are important.
Firstly, that a health post manager, which is a professional nurse and between 20 to 30 community health workers be recruited from the communities surrounding the health post. Secondly, that the health post serves between 2 000 to 3 000 households in a defined area within a municipal ward. Thirdly, that the health post is hosted by an existing community-based nongovernmental organisation in the community. Finally, that the teams collect digitized records, using cellular and other modern information technology for the entire community.
I share this sample of work with you because it comes from medical doctors, health professionals and researchers working in the field. These are the people who know how to get the job done. They know how to apply expert knowledge to the task at hand. They know what it is like to spend your life devoted to promoting health.
We have a very large community of medical and nursing professionals with a wealth of experience, insight and commitment. It is government's responsibility to take up the recommendations of their health professionals and I believe that Minister Motsoaledi has begun to do so.
The most recent Annual Performance Plan of the department sets out, as a short-term goal, and I quote: "Improving access to community-based PHC services and the quality of services at health care facilities." This will be achieved by having 1 500 functional ward-based primary health care outreach teams established by 2014-15 and 3 500 by 2018-19.
However, for the like of me, colleagues, I simply cannot find the budget to support success in the PHC. The budget seems entirely inadequate to the task. Not only is the 2013-14 allocation of R102 million small for such a high priority item, but it faces a budgeted decline to R93 million for this year and next year, only to recover at an inflation-level increase to reach R98 million by 2015-16.
The portfolio committee was alarmed by this, and I quote: "PHC services again declines in both nominal and real terms in 2014-15". The report reads: Less than 1% of the entire budget is allocated to this programme, which is less than it received in the previous year, both as a percentage and in real terms.
It is certain, of course, that some funds from other programmes such as the R13 billion HIV and Aids, TB and Maternal and Child Health, which is Programme 3 or the R18,9 billion Hospitals, Tertiary Services and Human Resource Development, the HRD, which is Programme 5 are spent through the PHC system. However, I have no idea how much of that and where.
Similarly, I am also certain that some of the modest R621 million National Health Insurance, the NHI, Health Planning and System Enablement Budget, which is Programme number 3, must be spent on PHC infrastructure and planning to progressively advance universal access, something which the DA wholeheartedly supports. The Western Cape MEC for Health, Mr Theuns Botha, asked me to convey to this House his willingness to host more NHI projects that advance universal access contrary to propaganda about what we support and what we do not. However, again, I have no idea how much and where that is spent. I would therefore like to recommend that Minister Motsoaledi present to the portfolio committee the following.
Firstly, he must have a consolidated budget for all the PHC activities that form part of his re-engineering intention.
Secondly, he must give some ideas of how he would propose to ring-fence primary health care spending at a provincial level and I will get back to that issue in a second.
Thirdly, he must explain the paradox that so little is spent on such a fundamental important issue that is essential to achieving his department's objectives.
My deputy, Dr Heinrich Volmink, and I spent this past Sunday and Monday, speaking to medical doctors, nurses and administrators at the Pelonomi Regional Hospital and a national hospital in Mangaung. We were confronted with the stark reality of the scale of collapse of health services there. Let me give you some examples.
Patients with bone fractures as old as 70 are accommodated within the referral ward on stretchers due to a shortage of bed space, the hospital does not have hot water, nursing staff and patients boil water in coffee urns, patients bring their own blankets and pillows to hospital, due to medical linen shortages, and the hospital regularly runs out of medical consumables.
According to hospital staff, there are three fully equipped operating theatres out of operation, and we saw them, due to a shortage of anaesthetic machines. Some patients in the orthopaedic ward have been waiting for surgery for more than three months. According to the medical staff at the hospital, only four operating theatres are functional and a fifth is out of commission, because it is not equipped with an anaesthetic machine.
This, my friends, is a moral and a constitutional failure that goes beyond the Free State. It is for this reason that we called on Minister Motsoaledi to intervene.
We will spare nothing to compel provincial governments to uphold the constitutional requirements to make health care progressively available so that there is life in the better life for all.
The Free State hospitals are examples of health institutions that suffer from a double whammy. They receive many patients with primary health care problems, because with some notable exceptions, the PHC does not exist in the broad swathes of a large province, geographically speaking, and on the other hand their own hospital facilities are grossly dysfunctional.
It is government's responsibility and duty to support the nation's community of professionals by ensuring that there is adequate infrastructure, a functional work environment, future oriented human resource development, sympathetic, responsive and professionally organised support services and properly calibrated budgets to make it all work.
I believe that Minister Motsoaledi and his Ministry are strengths in the system. They are not weaknesses. They are strengths in the system but the fact is that close to 90% of our health budget consists of transfers and subsidies to provinces and municipalities.
It is here that our weak link in the health care chain lies. It is the failure of municipalities to proactively and regularly test for pathogenic bacterial viral and parasitic infections when it comes to water contamination. Preventing that would have led to the wholly preventable and heart-rending deaths of infants from dysentery in Bloemhof and elsewhere.
It is the failure of most provincial governments to spend their health funds properly, efficiently and strategically.
Judged from the audit outcomes, let me just point out to you the following results from the Auditor-General's reports on viewing provincial departments of education: For Limpopo, it has a disclaimer with findings where they say that the root causes to address are the slow response by political leadership, the lack of consequences for poor performance and transgressions.
The same applies for the Free State, Eastern Cape, Northern Cape, Mpumalanga, KwaZulu-Natal and Gauteng. Only the North West and the Western Cape escaped the negative reports of the Auditor-General. The line that runs through all of that is a lack of consequences for failing to do the job properly.
So, what is to be done? Appoint qualified and capable individuals for the job; support them fully, but have real consequences for failure; hold them accountable; ring-fence provincial budgets; be responsive to problems; and support and value our health care professionals and the community.
I wish I had the time to develop this last point properly. I however I wish to point out that the National Institute for Communicable Disease, which is a surveillance body and its parent, the National Health Laboratory Services, which is a pathology testing body are bankrupt. They have frozen all their posts and they no longer have a critical mass of epidemiologists there.
Let me just say that I want to recommend that the Minister turns surveillance, especially with mass testing at hand, into a fully funded programme of the department. Thank you very much. [Time expired.] [Applause.]
Mr N S MATIASE
Dr W G JAMES
Mr N S MATIASE: Madam Chairperson, we too in the EFF are saddened by the killing of innocent people through the downing of Malaysian Airlines Flight MH17 in the Ukraine. The loss of life of one in such a horrible way is one too many.
The EFF cannot endorse or support this budget presentation by the hon Minister of Health, Aaron Motsoaledi ... [Interjections.] ... as it fails to address any of the causes of the explosion in the prevalence of disease in our country, which is escalating at an alarming rate. If this continues along the projected path, we will not have an economy or a culture worth fighting for in a debate. This budget also does not provide for any solution to reversing the damage inflicted on our people through the uncontrolled proliferation of GMOs; vaccinations; hazardous industrial toxins in foods, medicines and household products; nutrient-deficient foods; and recklessly dangerous agrochemicals.
Surely, the focus of the department should be on the protection of the health of the nation and, by implication, the health of the environment upon which we all depend without exception for our continued existence? The department should be at the forefront of the battle to ensure health and not remain entangled in the commercial perpetuation of disease management. We are managing diseases.
While some lip service is paid to "prevention" and to "health", the department's report suffers from the same ideological problems referred to by Commissar Floyd Shivambu on Monday in his response to the National Treasury Budget Vote: a misdiagnosis of the problems leading to incorrect remedies, and the consequent ravaging of our nation's health and the resultant decrease in health to inappropriate disease management.
Accompanying this problem of incorrect "health" paradigms is the planned corporate theft – as has been revealed in the Free State and other provinces – of medicine and medicinal products. There is also fraud and the plundering of our financial resources through massively inflated prices on drugs and services.
The TEMPORARY CHAIRPERSON (Ms T C Memela): Hon member, you are left with two minutes.
Mr N S MATIASE: Time is of the essence.
Finally, we call on all members of this House to oppose the Medicines and Related Substances Amendment Bill, and it must be brought back because it undermines section 27 of the Constitution. This government, despite overwhelming support and successful elections, has dismally failed to protect the health of the people and continues to be delusional. This government is delusional and it has lost sense of its historical mandate and is no longer in sync with reality. [Interjections.]
Let's remind the ruling party that it must: always bear in mind that the people are not fighting for ideas, for things in anyone's head. They are fighting to win material benefits, to live better and in peace, to see their lives go forward, to guarantee the future of their children. This was said by Amilcar Cabral.
As the EFF, we refuse to endorse this budget and call upon all concerned and affected citizens to reject it as well. [Interjections.]
Setswana:
Ba nang le ditsebe ba utlwile. [Those with ears have heard.]
Dr M G ORIANI-AMBROSINI
Mr N S MATIASE
The TEMPORARY CHAIRPERSON (Ms T C Memela): I now call upon the hon Oriani-Ambrosini. We the people understand that he will speak from where he is. Thanks.
Dr M G ORIANI-AMBROSINI: Thank you for the indulgence, Madam Chairman. I think that this is a committee which we should endeavour – more than another committee – to try to create a national consensus. In order to do so, we must accept being pragmatists, not ideologues. What is at stake is the health of a nation; the pain and suffering of people.
My contribution towards that end is the plea for there to be a hard look at the entire regulatory scheme. I want to be very practical. We have adopted regulations to help people, and many of the laws and the regulations we have adopted have the unintended consequence of throwing out the baby with the bath water. I am under the most advanced treatment in Western medicine, targeted chemotherapy. But, at the same time, I am being treated for my cancer as I would be treated if I were in Beijing or Shanghai, with Chinese medicine.
The new regulations that we have adopted will make the Chinese treatment illegal. Why? Because it cannot be proven in terms of effectiveness and nonharmful nature in terms of a double-blind placebo-based clinical study. And that is a problem. If we need to succeed with the enormous challenges before us, we need to make available everything that works, and we need to determine tests for what works and what does not work which are adequate for the nature of what we are testing.
In this country we may have 1 000 cases of mesothelioma. In China they have 100 000 cases, and their effectiveness is superior to ours in terms of morbidity, quality of life of those who survive and all the applicable tests.
We are part of the Brics group, that is the Brazil, Russia, China and South Africa group, and it is unusual for my colleagues to hear me spend time advocating the benefits of co-operation with China. But China is a great reservoir of ancient knowledge. We are in this strategic position of being able to have privileged exchanges with China, which ought not to be limited only to the trade and industry fields or the cultural field, but should include the medical field. This is because they treat people at a fraction of the cost with medicines that have thousands of years of background behind them, which are equally effective. And why do we test them? We must not make the mistake of having politicians, as we are, determining what doctors are allowed and not allowed to do. We need to return the power to doctors. Let them decide. And that is the nice thing about China: the Chinese government doesn't get into the hospitals. They let the hospitals decide how people should be treated. And we should not determine, in terms of our laws, what doctors can use or cannot use.
I have introduced this Bill, which I hope my colleagues will look at seriously, that will apply only with respect to terminal cases where the discretion is given to doctors to go beyond the parameters of what can be done ordinarily. I think that that discretion should become part of the system. We have enough responsible people to move in that direction, and there is a need not only to treat people but also to ensure the affordability of the system.
In the end, Madam Chairman and hon colleagues, this is, unfortunately, a matter of money. The budgetary cost of extended chemotherapy alone in cases like cancer, or of some of the most expensive pharmaceutical solutions, as opposed to botanical treatments, is one that should encourage us all to look in a different direction. And, I hope, that that consideration is given to my Bill. We have received 1 102 comments that are overwhelmingly favourable. That might be the basis on which a broader consideration of the entire regulatory aspects of the underpinning health system may be given and achieved. Thank you, Madam Chairman. [Applause.]
Ms D CARTER
Dr M G ORIANI-AMBROSINI
Ms D CARTER: Hon Chair, our Constitution is underpinned by the Bill of Rights. Our Constitution requires our state to respect, protect, promote and fulfil the rights of our citizens - the right to human dignity, the right to life and the right to adequate health care. Our Bill of Rights also sets out the rights for children and for the elderly.
The question I pose, hon Minister, is simple: Is our health care service complying with the basic responsibility, as set out in our Constitution? What is the department's budget for cancer research and for testing, at least at stage one or two? Is there a support for entities such as the Cancer Association of South Africa, Cansa or the Sunflower Foundation?
When are we going to decide to establish a bone marrow bank in this country? Currently, we are sitting with the Sunflower Foundation with an increase of 65 000. One out of 100 000 will be a match. It is costly; it is more than R2 500 to do that test.
Hon Minister, we all want HIV to end and thank you that we are now going to make antiretroviral drugs, ARVs, available for those with a CD4 count of 500 and not only 350.
The National Development Plan, the NDP, states that our health care system has been poor despite good policy and high spending. Page 331 states "failure of a health care system".
Towards the end of 2012, my mother was once again admitted to Livingstone Hospital, suffering up to five mild heart attacks a day. Six weeks later, she was transferred to the provincial hospital to undergo a second triple bypass, which we are very grateful for at the age of 78.
At Livingstone Hospital, we found compassionate and too often sleepwalking doctors who have been on duty for up to 36 hours. Each shift started with prayer and a song, lifting the soul, but that is where it stops. Patients' food overnight next to their beds and the food of those who were too weak to eat was returned untouched. Those asking for water were ignored.
I eventually equipped myself with a bottle of water and a drip line, feeding patients water. I can and will never forget for as long as I live how thirsty this one young little girl was. She had meningitis. She could not lift her head, crying out, God, take me.
The minute we put water to that child's lips, that look in her eyes I could never forget. That is what she was crying for; she was thirsty. The stench at times was unbearable. Patients asking for assistance to toilets or a bed pan were ignored, lying in faeces for hours, no soap to wash and no toilet paper. Sometimes the bodies of those not so fortunate would remain in the ward until after visiting hours while nursing staff in their civvies and takkies or even slip-slops would enjoy their lunch.
Livingstone boasts of a state of the art trauma centre, built during the 2010 Fifa World Cup, which is now used by outpatients. There's a shortage of doctors and health care staff where patients have to wait for up to five days at the reception to see a doctor; a shortage of medical equipment, supplies, maintenance and repair of medical equipment; oxygen's lines are regularly faulty; and there's a shortage of surgeons whereby patients wait for months for to have critical life threatening operations.
Just to add, the surgeon that did my mother's triple bypass was his last patient. He went to Canada. The surgery was a success but the problem was for aftercare when we had to try and get her into a state run facility after she got pneumonia and infection. If we did not move her she would have died. [Time expired.] [Applause.]
The DEPUTY MINISTER OF HEALTH
MRS D CARTER
The DEPUTY MINISTER OF HEALTH: Hon House Chairperson; hon Minister of Health, Dr Aaron Motsoaledi, other hon Ministers and Deputy Ministers present, hon chair of the Portfolio Committee on Health, hon Dunjwa, members of the Portfolio committee in the National Assembly, hon members of this House, distinguished guests, ladies and gentlemen, I want to take this opportunity to thank the hon Chair for the opportunity to participate in this 2014-15 Budget Vote for the Department of Health.
Our 2014-19 Strategic Plans and the 2014-15 annual performance plans are firmly anchored in the implementation of the National Development Plan, the NDP. Our vision of a long and healthy life for all South Africans speaks to both the NDP goals and also to Outcome 2 of the government's Medium-Term Strategic Framework. I will speak to the other two NDP goals, which are the significant reduction of the prevalence of noncommunicable diseases and also the reduction of injuries, accidents and violence by 50% from the 2010 levels by 2030.
In addressing these two contributors to what the Minister has already alluded to as the quadruple burden of disease facing our country, we will be able to contribute to raising the life expectancy of South Africans to at least 70 years by 2030, as envisaged by the NDP. The implementation of these programmes will go a long way in realising also the commitments we have made as the ANC in our election manifesto.
We are all familiar, and the Minister has gone quite deep into the fact that as a country we have a challenge of diseases such as HIV/Aids, tuberculosis and high rates of maternal and child morbidity and mortality. We must always be aware of the growing problem of what is now globally known as the new emerging epidemic of noncommunicable diseases.
Currently, in the 30 to 70-year age group, noncommunicable diseases account for 43% of total deaths. Cardiovascular diseases, including hypertension, cancer, diabetes mellitus, chronic respiratory infections, mental disorders and other diseases have been part of our health landscape for many years. Until recently, due to high levels of infectious diseases, have tended to play second fiddle to communicable diseases, especially in low and middle income countries such as South Africa.
However, noncommunicable diseases are emerging as the big health problem of the future globally, and with our own increased urbanisation and industrialisation we are already seeing growing trends of these diseases in our country. These diseases are often called, correctly so, silent killers because many people that have diabetes or hypertension, for example, are not aware of the fact that they are suffering from these ailments.
The NDP is clear in this regard, and I quote:
South Africa's health challenges are more than medical. Behaviour and lifestyle also contribute to ill-health. To become a healthy nation, South Africans need to make informed decisions about what they eat, whether or not they consume alcohol, sexual behaviour, levels of physical activity, among other factors.
It goes on to say:
Promoting health and wellness is critical to preventing and managing lifestyle diseases, particularly the major noncommunicable diseases among the poor, such as heart disease, high blood pressure, cholesterol and diabetes. These diseases are likely to be a major threat over the next 20 to 30 years.
South Africa, together with other member states of the United Nations, have acknowledged, through a General Assembly, a resolution in 2011 that noncommunicable diseases are not merely a health problem, but a major development concern. NCDs are now not a problem of the old and infirm, and of developed countries only, but of our productive populace everywhere in the world. They also crumple budgets of the poorest countries.
In this regard, two weeks ago, representatives from around the world again gathered at the General Assembly in New York to review progress made in implementing the political declaration I have referred to earlier. I am pleased to report that South Africa was acknowledged as a leading country in taking serious steps towards addressing the major risk factors of NCDs, as well as in developing health system innovations that improve health care provision. We are recognised as a leader in areas such as tobacco control, trans fat and salt regulation and also on our proposals to restrict alcohol advertising and sponsorships. Since 1995, we have brought down smoking rates by 30%, including amongst school-going children.
Safeguards are needed to ensure that this trend is strengthened rather than reversed and in line with the Framework Convention on Tobacco Control. Therefore, additional regulations are being planned in this regard. Our salt regulations, which the industry is now beginning to implement ahead of the compulsory targets set for 2016 and 2019, are projected to result in 7 400 fewer deaths due to cardiovascular diseases and 4 300 fewer nonfatal strokes per year if we implement this.
Members, this is very worrying. Alcohol consumption amongst drinkers remains far too high at 27 litres of pure alcohol per annum in people 15 years and over. Consumption of pure alcohol amongst men is even higher at 33 litres per annum. This is significantly higher than the world average of 21 litres. We realised that these figures will not dramatically drop simply by restricting advertising, but it is also well established from several studies that alcohol advertising influences behaviour; brings about positive beliefs about alcohol; and encourages young people to start consuming alcohol sooner at an earlier age and in bigger quantities.
The integrated approach to managing chronic diseases, whether they are communicable or noncommunicable, will go a long way in improving our effectiveness. We believe that the establishment of the National Health Commission will also go a long way in enhancing intersectoral collaboration.
The 10 targets we set for our strategic plan to be reached by 2020 are still some way off, but we believe that we are making progress with the support of organisations such as the Noncommunicable Diseases Alliance, other civil society organisations, and from the industry. We believe we can still reach those goals.
We must reduce premature mortality from the noncommunicable diseases by 25%; tobacco use by 20%; alcohol consumption by 20%; salt intake to less than 5g per day; reduce the percentage of overweight people by 10%; and increase physical activity by 10%. In a few weeks time, the department will sponsor a TV and radio campaign that will inform the public that increased salt intake considerably increases the risk for hypertension and kidney disease. This year we will also be developing and implementing a new strategy to combat obesity as this continues to be a challenge. The number of South Africans who are overweight is still extremely high. A survey done in 2012 found that the prevalence of obesity amongst over 15-year-olds was more than 65% in females and 31% in males.
Listen to this; drinking just one sugar sweetened beverage a day increases the likelihood of being overweight by 27% for adults and 55% for children. One 330ml of carbonated soft drink contains an average of eight teaspoons of sugar, and the same size of sweetened fruit juice constitutes about nine teaspoons. So, every time you guzzle that 330ml of cold drink, know that you might as well take eight teaspoons of sugar -
another matter which is our concern.
The Ministerial Advisory Committee on Cancer has now been functioning. The introduction of the Human papillomavirus, HPV, vaccine, which the Minister touched on as well, is a critical step forward in reducing cervix cancer. The South African cancer control strategy will be launched this year and will be providing additional impetus in the prevention and treatment of cancer.
We are also increasing our intervention in having cataract removed so that we can improve people's eyesight.
I would also like to touch on the areas of violence and accidents. One of the growing public health challenges is the road traffic crash and injuries, which place a heavy burden, not only on the national economy also on household finances, as many families are driven deeply into poverty by the loss of breadwinners and the added burden of caring for a member who is disabled as a result of road accidents.
The total medical costs for violent injuries is estimated at R4,7 billion per annum according to the Centre for the Study of Violence and Reconciliation while the total costs of traffic crushes and injuries are estimated at R110 billion per annum according to the Automobile Association of SA. The injury related costs of alcohol alone are estimated to be twice as much as the excise duties received from alcohol. So, it is not balancing. Road traffic crush injuries can be prevented and we, as government, together with other role players in the civil society, can do a lot in preventing road crushes.
I am pleased to also announce that our Forensic Chemistry Laboratories appointed additional analysts and procured additional equipment resulting in a lot of progress and impact been made in terms of reducing the backlog on conducting tests for alcohol contents in blood. Our budget for the laboratories has also increased from R78 000 000 in the 2013-14 financial year to R122 000 000 in the 2014-15 financial year. We are grateful to our National Treasury for this assistance. This significant increase has also contributed to the decrease in toxicology backlogs and a decrease in the turnaround time of receiving results for toxicology analyses in cases of unnatural deaths.
We are also taking steps to improve our emergency medical services to make sure that we provide timeous and efficient services to our communities. Amongst other interventions, we are promulgating new regulations that govern emergency medical services, which will improve efficiencies by setting high industry standards and also provide minimum norms.
In conjunction with the Health Professions Council of South Africa, we are developing a national policy on National Emergency Care Education and Training in order to improve the skills of emergency care personnel. In order to contribute towards the Millennium Development Goals 4 and 5, a study is being undertaken by the department on the efficacy of mobile obstetric units, in order to provide quicker responses to obstetric emergencies.
With regard to malaria - the Minister touched a bit on that - we have made a lot of progress in terms of reducing the rate of malaria quite drastically from 86% to 78% in malaria-related deaths between 2000 and 2013. This is a huge contribution towards the Millennium Development Goals of reducing malaria by 50% by the year 2010. We have achieved that much earlier through various interventions. Just to mention this, the only challenge that remains is what we call "malaria importation", especially across the Mozambique borders. We are strengthening our partnership with Mozambique on Cross-Border Initiatives where there is a revised programme of co-operation, which is expected to be signed soon between the two countries.
The last matter that I would like to report on quickly is that our programme of co-operation with Cuba, in terms of the Co-operation Agreement in the field of public health, has progressed quite significantly. This was signed in 1995, implemented from 1996 and initially entailed the recruitment of medical practitioners from Cuba. It later progressed to an amended agreement which also encompassed the training of students. This has progressed quite significantly. In 2011 it went from a small number of trainees to an intake of 100 trainees after the amended agreement. I can report that this is progressing very well. As we speak now, there are more than 2 700 students studying in Cuba. This year alone, we have an intake of 607 students. There are currently over 200 Cuban doctors, many of them in the Eastern Cape.
Lastly, there are a number of entities reporting to our department and are functioning quite efficiently.
The hon member mentioned the National Health Laboratory Service amongst others and the National Institute for Communicable Diseases, the NICD. We are aware of the issues and we are attending to them. These entities will continue to serve the country. Thank you very much. [Applause.]
Mr I MOSALA
THE DEPUTY MINISTER OF HEALTH
The TEMPORARY CHAIRPERSON (Ms T C Memela): I now call the hon Mosala. Hon members, it is his maiden speech.
Mr I MOSALA: Hon Chair, hon Minister, hon Deputy Minister, hon members of the Portfolio Committee on Health, ladies and gentlemen, comrades and compatriots, it is an honour and a privilege for me to address this august House on behalf of the ANC on a very important vote, Vote 16.
Prior to 1994, our health system was characterised by fragmentation based on racial segregation and discrimination. Since the advent of democracy in 1994, health provision in South Africa has gone through several radical transformations based on integration at primary health care level, respect for human rights, an emphasis on prevention and health promotion as envisioned by the Freedom Charter and the strategic objectives of the National Democratic Revolution, the NDR, for creating a caring and loving democratic South Africa.
It is pursuant to the ideals of the Freedom Charter that our Constitution, in section 27, entrenches the universal right of access to health care. This section, being part of the Bill of Rights, enjoins our government to respect, protect, promote and fulfil the right of access to health care.
The ANC's Mangaung national conference, the National Development Plan and the ANC election manifesto are reconciliatory and noncontradictory. They have the same vision, commitment and common position in relation to the provisioning of a health system that works for everyone and produces positive health outcomes and is accessible to all. It is apt to remind the House that in terms of the ANC manifesto, from 2009 to date our government continues to prioritise access to health care.
The national health insurance philosophy encapsulates this position by asserting that resources should be received from each according to their abilities, and that health care services be distributed to each according to their needs. This stands to mean that access to health care cannot, at the same time, be a right as well as a commodity.
Hon Chair, spare me a few minutes to remind the hon members about the essence and form of primary health care. Primary health care is the heartbeat of many sustainable health systems globally. It is all about providing essential health care, which is universally accessible to individuals and families in the community. Primary health care is also provided as close as possible to where people live and work.
Primary health care remains at the core of the overhauling of the health system, in particular, the national health insurance in South Africa. The ANC has made progress in the re-engineering of the primary health care system through three streams, namely municipal ward-based primary health care outreach teams, school health programmes, district specialist teams and the contracting of general practitioners to work in pilot programmes. Therefore, you will agree with me when I say that the ANC lives and the ANC leads. [Applause.]
The municipal-based health care is a system designed to have participatory interaction amongst all relevant stakeholders in the specific wards. Currently, the system has community care workers and professional nurses. Furthermore, the department has 1 500 functional ward-based outreach teams, and by 2020, 3 500 teams will be functional. Their main area of focus is to document the demography and epidemiology of households so that it is known who lives in a specific ward and what the health status of each resident who resides in a municipal ward is.
The main strategic objective is to improve the livelihoods of our communities by bringing health care services closer to each street and each household. As we proceed into the future, the system will encourage and stimulate active and robust participation of community leaders, traditional leaders, church leaders, ward committees and traditional health practitioners in ensuring the success of this model.
This system will further benefit our communities that have noncommunicable diseases by minimising their visits to clinics with the sole purpose of reducing long queues at the clinics. The churches, traditional kgotlas [residences] and farmers should be engaged by the department, going forward, to enter into agreements to utilise their venues and sites for the collection of medication.
This strategy will further enable us to enumerate the risk factors and improve the management of noncommunicable diseases, for example, by identifying obesity and assisting in reducing it by 55% in women and 21% in men by 2019 through the establishment of community support groups and counselling which must be intensified at this particular level.
Sesotho:
Modulasetulo, ntumelle ha ke re: E a rora, e a phela, ebile e etelletse pele! [Mahofi.]
English:
The task team, comprised of officials of the Departments of Education and Health, has reviewed the School Health Policy to reflect on the approach to primary health care services at schools. Currently, school health nurses conduct basic screening on Grade R and Grade 1 children in Quintals 1 and 2 poorer schools. The objective is to identify abnormalities and refer them early to the health care facilities, which
screen abnormalities such as hearing defects, visual defects and the immunisation status of our children. At secondary schools, life-skills programmes are rendered, and sexual and reproductive health is intensified to curb teenage pregnancies. Currently, 28% of the Grade 1 and 12% of Grade 8 learners are receiving screening, while 50% of the Grade 1 and 25% of Grade 8 learners will be reached by 2019.
Other interventions by the department in improving the life expectancy of our children are through giving all Grade 4 girls who are nine years and older the human papilloma virus vaccination at schools to protect them from getting cervical cancer. The target is 70%. Indeed, we would all agree that the ANC lives and the ANC leads.
We have a good story to tell about the past 20 years of democracy; that of eradicating anomalies in the then fragmented health system and replacing them with an integrated, nonracial open system. We also, on the other hand, acknowledge that we still have some challenges in some of the health care facilities. Allow me just to mention a few.
We are still confronted by a shortage of human resources, especially health care workers, and this is attributed to the unrevised staffing levels that should cater for new development, for example, the national score standards, primary health care re-engineering and the national health insurance programmes. The lack of full staffing components impedes the impact that could be registered as compared to the progress which has been registered in real terms.
The other issue is infrastructure maintenance which has been varying since prior 1994. This poses a limitation in rendering a full package of primary health care services to our communities.
In closing, allow me to quote Niccolò Machiavelli:
Once problems are recognised ahead of time, they can be easily cured, but if you wait for them to present themselves, the medicine will be too late, for the disease would have become incurable. And what physicians say about disease is applicable here: that at the beginning, a disease is easy to cure but difficult to diagnose; but as time passes, not having been recognised or treated at the outset, it becomes easy to diagnose but difficult to cure.
This is from The Prince.
Indeed, the department, under the leadership of the Minister, should be commended for taking a leap in radically transforming the health conditions of our people without allowing the situation to deteriorate. We must further congratulate them on moving the health care system forward in South Africa. We are witnesses to the fact that our health care system is much better than it was before 1994. [Applause.]
Therefore, this demonstrates that the ANC lives and the ANC leads. On behalf of the organisation that lives and the organisation that leads, we support the budget unreservedly and wholeheartedly. Thank you. Ke a leboga. Baie dankie.[Thank you.] [Applause.]
Ms C N MAJEKE
MR I MOSALA
Ms N C MAJEKE: Hon Chairperson, hon Minister and Deputy Minister, hon members, the UDM commits to protecting and promoting the constitutional right of all South Africans to basic health care and providing proper and immediate responses to the major health risks facing the country.
In re-engineering primary health care the department must prioritise access and quality of this service as this continues to disadvantage poor South Africans. In this regard, we reiterate our position that health care has to be linked to other social cluster portfolios, further recognising the role of social welfare, water and sanitation, basic life skills and the awareness to improve the basic health of the nation.
The current quality of health facilities and their maintenance, especially in hospitals in rural areas, is not of a good standard. Hygiene at many clinics and hospitals in the Eastern Cape needs to be addressed as a matter of urgency.
The UDM believes that job creation can be achieved through infrastructure maintenance and development whilst providing quality health services. Provision and stocking of medicines at many clinics and hospitals still fall short of the basic requirement. Distances travelled by communities to access these facilities remains a challenge.
Staffing for primary health care facilities must be qualified, trained and available at all times to give quality services to all South Africans. In some government hospitals access to a doctor is almost impossible, especially after hours. This is the case in the Eastern Cape at Sulenkama Hospital. Hon Minister, it should not be a privilege for rural people to be serviced by a qualified doctor.
We believe that diseases such as TB, cholera and malaria are preventable and can be treated. However, unless and until we link health with other socioeconomic factors, we will not be able to provide a sustainable service to the nation. Additional hospitals to rural communities need to be prioritised to address the condition that is always found in health facilities. The UDM supports Budget Vote 16. I thank you. [Applause.]
Mr A M SHAIK EMAM
Ms N C MAJEKE
Mr A M SHAIK EMAM: Hon Chairperson, Ministers present, Deputy Ministers present, members of the Portfolio Committee on Health, chairperson and other members of the portfolio committee, hon members, members of the media and invited guests, let me start by advising this House that the NFP supports this Budget Vote. [Applause.]
The approval of this Budget Vote is paramount for the purpose of providing all South Africans with good quality health care, a health care that does not discriminate against any South African citizen, irrespective of the socioeconomic conditions in which they live.
Hon Chairperson, 20 years into democracy, millions of our people continue to be deprived of quality health care. The value of life of a poor, underprivileged citizen is no different from that of a middle class or a rich citizen. Much has been done to provide a quality health care service in South Africa. However, a lot of work still has to be done.
I will be failing in my duty if I do not acknowledge and accept that much progress has been made in 20 years in health care in South Africa. [Applause.] Let us be honest about this, much progress has been made. One cannot expect miracles in 20 years, especially when you have gone from a freedom organisation to a government in waiting. It cannot be possible. So, let us accept that there have been challenges, some have been met and others we will continue to meet.
Whilst the NFP supports this budget which is in the best interest of all citizens of this country, let me express my grave concern that the budget allocation for tuberculosis is grossly inadequate. In addition to this, on the one hand we talk about extending primary health care services in all districts and wards, but on the other hand we decrease the budget by 8,9% which is again totally inadequate. The budget has also been decreased for noncommunicable diseases and I think that the hon Deputy Minister has alluded to and the fact that more attention needs to be paid as far as that is concerned.
Whilst we build more hospitals and clinics, may I urge and advise the Minister and all those responsible not to forget the present hospitals and clinics that are in decline in terms of the quality of service that we provide to the people. There are hospitals and I do not need to go into that, I think we are aware of hospitals that are not providing quality health care services for different reasons and I urge the committee to pay attention to that.
Hon Chairperson, the National Health Insurance and its limited progress is also a matter of concern, especially in ensuring that this pilot phase is another cause for concern in light of this strategic plan to roll out the programme to all districts.
The NFP welcomes the Office of the Health Standards Compliance. However, the district is faced with human resource shortages, especially qualified health care workers. The NFP supports this budget. Thank you very much. [Applause.]
Mr S M JAFTA
Mr A M SHAIK EMAM
Mr S M JAFTA: Hon Chairperson, the AIC emerged to represent the voiceless, poor and marginalised citizens of this country, especially in rural areas. That is why the AIC will focus mainly on the issues directly affecting the lives of communities in this debate.
Hon Chair, the AIC welcomes the budget and supports it as it seems to be a very good plan. [Applause.] However, this party is aware that all the departments always plan and make good budgets each financial year, the Department of Health included, but little is achieved.
The redistribution of funds is not a problem, but how these public funds are utilised becomes a problem. The fact that the department is still planning to improve district governance and strengthening management and leadership of the district health system shows that the department plans and constructs upon a very weak foundation. That is why the image of the Department of Health continues to deteriorate.
Indeed, hon Chair, there is a lack of management and leadership capacity within the public health sector in South Africa. That is characterised by the collapsing infrastructure of public hospitals and clinics. How can this department expect some improvement in these health centres whilst some of them are run without operational managers for years and some by unpaid acting managers?
Many public hospitals and clinics, mostly in rural areas, are ignored. They do not have water at all and nothing is done by the department to save the situation, yet we expect them to render quality health care to the public. It becomes very difficult to get to those public health centres because there are no roads at all.
Mention has been made of the primary health teams deployed to provide care to families and communities. It is really a disgrace to the department and the government for those home-based teams and caregivers who work for some months or even a year without being paid the stipend they are supposed to get at the end of the month.
The TEMPORARY CHAIRPERSON (Ms T C Memela)
MR S M JAFTA
The TEMPORARY CHAIRPERSON (Ms T C Memela): I now call the hon C N Ndaba. This is her maiden speech. [Applause.]
Ms C N NDABA: Thank you, hon Chairperson. Hon Minister and Deputy Minister, hon members, distinguished guests ...
IsiXhosa:
... bahlali baseMzantsi Afrika ndiyanibulisa, molweni.
It is an honour to be afforded this opportunity to be part of the debate on the 2014-15 Budget Vote for Health, a budget which the ANC fully supports. [Applause.] As the ANC, we reaffirm the Freedom Charter as the premise when discussing issues of social transformation. These are not matters of convenience. We want to ensure that we give serious attention to issues of health as part of the ongoing process of looking into the capacity of the state to deliver better services to the citizens of South Africa.
As we start in the new administration, we are humbled by the fact that hon President Jacob Zuma, in his state of the nation address in June 2014, noted that health is one of the priorities of government. On the issues he highlighted: 2,4 million people were initiated on ARVs by 2013, compared to the period 2011-12 when only 600 000 people living with HIV were initiated on the ARV programme. Therefore our duty in this administration is to increase the figure to 4,6 million, thereby increasing the life expectancy of our people.
The department is continuing to contribute to improving the quality of life of people living with HIV and Aids by providing an appropriate package of care, treatment and support services. These services are available at all government health facilities.
According to the 2014 January 8 statement of the ANC, the mother-to-child transmission rate of HIV has decreased by 66% from 24 000 in 2008 to 8 200 by 2011. Asizishayeleni izandla. [Lets applaud for ourselves]. [Applause.]
For example, in Gauteng alone only 2,4% of babies tested at the age of six weeks were HIV-positive, compared to 3,6% in 2011. This is partly owing to a 3% increase in pregnant women receiving long-term antiretroviral treatment, Asizishayeleni izandla [lets applaud for ourselves] and a higher proportion of babies receiving nevirapine within 72 hours of birth. By February 2012, more than 1 750 nurses were trained in nurse-initiated and managed ART, making it possible for professional nurses to put people on treatment.
The SA National Aids Council, Sanac, endorsed the National Health Council policy to initiative treatment for all those who tested positive and have a CD4 count of 350 or less, and that was also a further boost for a treatment programme.
His Excellency President Jacob Zuma mentioned that more than 20 million South Africans have presented themselves for HIV testing since the HIV Counselling and Testing campaign was launched in April 2010. We have seen a positive response from the communities to the call to undergo HIV testing, and this is indicated by the increase in the uptake rate from the targeted 85% by the department to 91% for the period 2011-12.
We hope that many more people who have not tested will heed the call and avail themselves for HIV testing. We want to thank all South Africans who have positively participated in this programme.
Still regarding prevention, government has continued to provide both male and female condoms free at all health facilities. Another initiative is the male circumcision programme, in terms of which just under 350 000 male medical circumcisions were conducted in 2011-12. This reflected high levels of performance for a newly introduced HIV-prevention service.
This is a good initiative by the department and is accessible free in government facilities, with an emphasis on rural nodes. We suggest that the department look at introducing compulsory boy-child circumcision at birth, taking into cognisance the different cultures and beliefs. This may reduce the high death rate at initiation schools, among other measures being taken. We urge the department to continue with community education programmes through various media, school health, etc. We want to thank all citizens who participated and supported government in these initiatives. The ANC supports the budget allocation of R12 billion for the HIV and Aids subprogramme. [Applause.]
With regard to the TB control and management programme, we encourage South African to get tested at least once a year, as outlined in the ANC manifesto for 2014. In addition to the existing TB programme, screening and treatment will be intensified for vulnerable groups. This will include inmates in all Correctional Services facilities, mine workers and people living in mining communities. This is important.
In order to achieve the objectives of the National Development Plan document of initiation of all TB patients on lifelong ARV therapy, irrespective of their CD4 count, the ANC thinks that the budget allocation for TB is still a concern if we want to achieve the 85% recommended by the World Health Organisation - unless those who present with TB symptoms without testing are accommodated in the HIV budget, or government forms partnerships with mining companies to contribute towards miners' wellbeing and provides packages of treatment services for TB and HIV for mining communities. We suggest that the department continually educate and counsel patients, families and communities on preventative measures on TB management.
In 2011 Mpumalanga was doing well in TB control.
When it comes to women's maternal and reproductive health, the budget allocation at less than 1% remains a concern, though the ANC supports the department's view of encouraging breast-feeding in mothers. Breast-feeding is very important for both mother and child for, among other reasons, breast milk has all the nutrients essential for child development; the milk is at the correct temperature at all times; there is less contamination of the milk compared to feeding bottles; breast-feeding promotes bonding between mother and child; breast-feeding is not expensive ...
IsiZulu:
... asikho isidingo sokukhalela ubaba ukuthi akunike imali yobisi. Awukhokhi mali, umane uncelise nje umntwana.
English:
In the olden days, breast-feeding, Minister, was used as a family planning method.
IsiZulu:
Angazi namhlanje ukuthi singakwenza lokho futhi na?
English:
The NDP talks about reducing under-five child mortality rate from 56 to below 30 per 1 000 live births. The ANC has committed to implementing the African Union-inspired campaign on the accelerated reduction in maternal and child mortality. This will place the mother and child at the centre of our health care programmes.
The Western Cape is not doing well in this regard, despite all the infrastructure it has. In addition, the province has lower rates of antenatal care compared to other provinces. Antenatal care is very important to ensure that there is a healthy pregnancy and that the baby is born healthy to give the child the best possible start in life.
So, let us look at the data for Khayelitsha for the last financial year, Khayelitsha being one of the black townships in the Western Cape. The pneumonia rate for children under five years stands at 68,7%, measles at 59,6%, compared to the provincial average of 71,5%. Yet, these are the children that need these services the most.
In fact, an article in the Mail & Guardian of 2011 quoted statistics from the City of Cape Town, in that in 2010 there were 58 deaths of children under five years of age from diarrhoea. These figures are far higher than those of any other part of the city. I quote from this article: "The city's own health data shows clearly that Khayelitsha has by far the highest number of diarrhoea-related infant deaths of any district in Cape Town – its figures are double the city average and more than 10 times worse than those of the affluent southern suburbs."
The TEMPORARY CHAIRPERSON (Ms T C Memela): Hon member, your time has expired.
IsiZulu:
Nks C N NDABA: Anginandaba. [I don't care.]
English:
The TEMPORARY CHAIRPERSON (Ms T C Memela): Thank you very much, hon member, your time has expired.
IsiZulu:
Nks C N NDABA: Thula. Kukhuluma mina. [Can you keep quiet, I'm the one speaking.]
English:
I therefore support the budget.
Mr H C VOLMINK
MS C N NDABA
The TEMPORARY CHAIRPERSON (Ms T C MEMELA): It seems to me the hon Tshishonga is not in the House, and I will therefore call the hon Volmink. It is his maiden speech.
Dr H C VOLMINK: Hon Chairperson, hon Minister and Deputy Minister, hon members, ladies and gentlemen, today I have the honour of addressing this esteemed House for the first time. I was born not too far from here, in an old maternity hospital in District Six. Over the years, I have been given many opportunities for which I am grateful, including the chance to study medicine.
More recently, during my experience as a registrar in community health in Gauteng, I had the privilege of working with those at the frontline of our health system, from community health workers to health care managers, and have been humbled by their dedication to their fellow citizens.
The Minister spoke earlier about the post-2015 agenda after the United Nations Millennium Development Goals, UN MDGs. I would like to pick up on that point because as part of that it has been proposed that we develop sustainable development goals to carry us into the future. Accordingly, I would like to suggest that, in our own country, we consider the idea of a sustainable health system.
Now we must recognise the exemplary work and efforts of our hard-working Minister and our Director-General. Indeed, the health sector Negotiated Service Delivery Agreement, the NSDA, which aims to tackle our country's quadruple burden of disease, includes a focus on strengthening the health system. However, while there has been progress, we still face many challenges. As the hon James said that we are facing challenges often times at the provincial level - so let me turn to Gauteng, where my constituency is based.
In the 2012-13 financial year, the Auditor-General found that the provincial Department of Health had wasteful expenditure of R408 million. Now, in the fourth quarterly report presented just last week in Gauteng, it was shown that the same department, according to the 2013-14 budget, had an underspend of over R1,35 billion. This erratic spending, failure to invest in vital services and squandering of precious public resources is anything but sustainable. We, therefore, call upon the hon Minister to fast-track the capacitation of health care managers, who are entrusted with much of these resources. And points have been made on this, this morning, but I would really like barely just to concretise this.
While we acknowledge the recently established Academy for Leadership and Management in Health Care and the efforts made to train hospital chief executive officers, what we urgently need is a rapid professionalisation of health management, including formal registration and an adapted public service code for all health care managers. This will help to ensure that sufficiently skilled, political independent and publically accountable health care managers can be entrusted with resources – with severe consequences for mismanagement and zero-tolerance for corruption.
The above notwithstanding, we still have many dedicated health care managers. But they are often frustrated by infrastructure that is not sustainable. My hon colleague, the hon Mosala, made this point very audibly a bit earlier on. So, let me continue with this point of infrastructure.
While R16,3 billion has been earmarked for the Health Facility Revitalisation Grant in the Medium-Term Expenditure Framework, the MTEF, period, infrastructure around health facilities also needs to be maintained. Roads to and from hospitals that carry critical supplies have to be prioritised, and we simply cannot have an interruption of water and electricity supply to these facilities.
We, therefore, call upon the hon Minister to develop a co-ordinated infrastructure strategy within the Inter-Ministerial Service Delivery Task Team to drive joined-up governance and planning in this area. When health systems fail, all of us - not just in one province, all of us - are under threat; and they fail when health systems are not sustainable.
As a sobering example of this, the 2013 Global Tuberculosis report highlighted the danger of multidrug-resistant and extensively drug-resistant tuberculosis in our country. Now the department has, commendably, begun to implement a policy on the management of drug-resistant tuberculosis and the Minister did describe this. However, even with this in place, if the health system building blocks are not there, there will be holes in our safety net and a drug-resistant TB epidemic, simmering just beneath the surface could burst through, putting us all under threat.
It is also true, that when health systems fail, those who are at the margins, whose voices are not often heard, are most under threat. We are reminded of the tragic case in 2011, where in the North West province, the four starving children of Kedibone Mmupele, ages nine, seven, six and two, died trying to find their mother who herself was desperately trying to find food for them, just 18 km away.
Now, it can be asked, what does this terrible tragedy have to do with health systems? The answer is simple: A health system that is unresponsive to the relevant social conditions, called the social determinants of health, is one that is frankly unsustainable. While the National Development Plan emphasises these determinants, they are only briefly discussed in the annual performance plan with no clear commitment of resources in the budget.
Furthermore, while there is a proposed national health commission, that body will focus on noncommunicable diseases. I, therefore, ask the hon Minister to establish, as a separate body, a South African commission on social determinants of health. In addition to the World Health Organisation commission, we have precedence for this in Brazil, where a national commission on social determinants of health was established to significant effect. A similar commission could help to transform the landscape of our country's health system. That would be a true revolution.
In conclusion, the DA offers South Africa a compelling health policy aimed at affordable, accessible, high quality health for all. But what is our collective understanding of health? Here we can find guidance from the Alma-Ata Declaration which describes health as, and I quote, "The complete state of physical, mental and social wellbeing, and not merely the absence of disease."
Surely, whatever our political differences are, we can all strive towards that goal, but we can only reach there if we have a health system that is dependable, equitable and, ultimately sustainable. Thank you. [Applause.]
The TEMPORARY CHAIRPERSON (Ms T C MEMELA): Hon Tshishonga, I would like to bring an attention to you that when your term came, you were not in the House. You are therefore losing your chance to speak. There was no excuse. I am looking you right in the eye.
Mr M M TSHISHONGA: I accept the ruling. I was booked twice. I was in the Rural Development and Land Reform and immediately after I finished I rushed here, but I accept your ruling.
The TEMPORARY CHAIRPERSON (T C MEMELA): Okay, you may continue. However, make sure that you do not repeat it because you did the same thing even yesterday while I was chairing.
Mr M M TSHISHONGA
THE TEMPORARY CHAIRPERSON (T C MEMELA)
Mr M M TSHISHONGA: Hon Chair, my apologies to the august House and the Chair. As I have indicated that I was booked twice, I was debating in the Rural Development and Land Reform Budget Vote.
The TEMPORARY CHAIRPERSON (T C MEMELA): Hon Tshoshonga, you are wasting time.
Mr M M TSHISHONGA: Firstly, let me say that we are all concerned about health, but our take as Agang SA on health is that health matters must be viewed holistically. It means that the mental state of the people must be considered. The physical aspect and the spiritual aspect must also be considered. It is my take that whatever is reflected on the physical aspect comes from the mind. If our minds are well treated, then we will have fewer manifestations of diseases which manifest in our bodies. Without waste of time, I think the emphasis is on the holistic approach on health. Let me not go further than that, I think the Minister will take care of the rest. Thank you.
Mr A F MAHLALELA
MR M M TSHISHONGA
Mr A F MAHLALELA: Hon Chairperson, hon Minister, hon Deputy Minister, hon members and distinguished guests, let me begin by relating what the Statistics SA report of 2011 stated. It found that 7,6 per cent of the public health sector users were dissatisfied with the health care services they received, while 85% were being satisfied. Therefore, this means that despite the challenges, users of the public health system are generally satisfied with the service they receive.
Let me come to the issues that were raised by some members. First, let me deal with the issue that the hon James raised - unfortunately the hon James was not part of our committee discussions. Some of the issues that he raised were extensively discussed at a committee level and have reached consensus on how those things, going forward, must be managed.
The issue of the budget on primary health care was thoroughly explained at the committee level. The approach of service delivery on primary health care is at the district level and therefore most of the budget for primary health care is located at the district. You can go and check all of your provincial budgets; the bulk of the budget in provinces is located in the district health programme. That is where primary health care service is being delivered.
If you take your annual performance plan, APP - I am not sure if you have gone through the APP - it has a detailed consolidated budget of all the programmes including the primary health care. So, I don't know why you are now asking the department to give you the same information that you have at your disposal. [Interjections.]
The TEMPORARY CHAIRPERSON (Ms T C MEMELA): Order, members! Order!
Mr A F MAHLALELA: We agreed that the issue of financial management remains a challenge, but when we discussed these matters at a committee level, the department reflected the intervention and the steps that were taken to deal with the challenges of financial management in provinces. They deployed postgraduate teams in all the provinces to be in a position to address these challenges.
There has been a huge movement from where we were years back to where we are. There are still some challenges in provinces where, for example in Limpopo, there have disclaimers, but there have been a substantial improvement in other provinces where they have moved from disclaimers to qualifications and some from qualification to unqualified reports. Therefore, it is not that there is nothing that is being done about it, but there is work going on and we are therefore making sure that there is improvement that is taking place.
The hon Matiase, I am so disappointed by how you approached this debate. I thought you are one of the sober fighters in this Parliament, but you disappointed me dearly today, because, firstly, I am not sure you said in this debate. Secondly, when we dealt with the budget in the committee, you never raised any fundamental opposition to the budget. You agreed to everything. I am not sure whether your boss told you not support anything that the ANC government presents. [Interjection.] It is very unfortunate that you approached the debate in the manner that you did. I hope that at committee level we will engage you further.
We strongly affirm the Declaration of the Alma-Ata which states that:
Health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal whose realisation requires the action of many other social and economic sectors in addition to the health sector.
The Alma-Ata Declaration further states that:
The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.
In order to address the issues raised in that declaration, we introduced and passed the National Health Act, Act 61 of 2003, which gives effect to the right of everyone to have access to health care services as guaranteed by section 27 of the Constitution of South Africa, 1996. The Constitution places express obligations on the state to progressively realise socioeconomic rights, including access to health care, and this access, is for everyone regardless of their status which means no individuals should be unfairly excluded from the provision of health care services.
By introducing the National health Insurance, the NHI, the ANC-led government – a caring government - will fulfil its objectives, which are: to eliminate the current tiered health system; improve access to quality health care services and provide financial risk protection; and provide a mechanism for improving cross subsidisation in the overall health care system so that we can do away with inequality in relation to access to quality health care in order to enable the poor to also receive a better standard of care.
This view is further supported by the World Health Organization, WHO, Commission on Social Determinants of Health on the link between illness and inequality. It indicates that the interconnectedness between the environment, poverty and inequality is both profound and complex. Environmental issues represent major risk factors in the global burden of disease, while poverty and deprivation are major determinants of poor health. Likewise, inequalities contribute to ill health which, in turn, exacerbates poverty and deprivation in a never-ending cyclic pattern.
What this commission arrived at was that health and illness according to them thus follow a social gradient; the lower the socioeconomic position, the worse the health of the individual. This was echoed by the former President Nelson Mandela when he said, and I quote: "... if you are poor you are not likely to live longer." This is the situation in South Africa, which characterises how our people are exposed to these challenges.
We are raising this to illustrate the challenges of quadruple burden of diseases, which include diseases and conditions related to poverty, inequality and underdevelopment, chronic diseases, injuries and violence - which the Deputy Minister spoke about - the issue of HIV/Aids, and TB, - which the Minister extensively dealt with.
The WHO Commission on Social Determinants of Health argues that these are enough evidence for government to take action according to three principles which are, improving the daily living condition of people; reducing health inequality - of which NHI is the solution to - and the ability to monitor population health. This is in line with the strategic trust of government which was properly reflected in the strategic plan 2014-19 of the department, which states that South Africa is at the brink of effecting significant and much needed changes to its health system financing mechanism.
These changes are based on the principles of ensuring the right to health for all, entrenching equity, social solidarity, efficiency and effectiveness in the health system in order to realise universal health coverage. The National Development Plan states that a well-functioning and effective health system is an important bedrock for the attainment of the health outcomes.
In order to realise the long-term health goals for South Africa as well as the priorities as set out in the NDP, the department has outlined eight strategic goals in each five-year strategic plans. These strategic goals are critical in the manner in which health care services will be provided in the next coming five years and which will go a long way in addressing the factors that breed mistrust in the system.
There is a hospital in Mpumalanga - Hon Minister, I am sure you know about it - which is nicknamed "Emva kwakho". When you do a close analysis why this "Emva kwakho" syndrome, you will discover that there are other factors beyond the challenges of the health care services. One of the key challenges is that our people present themselves to health facilities very late, when they are already bedridden. The culture of our people of trying other means first and using health care facilities as the last resort is what resulted in the concept "Emva kwakho".
In this regard, we want to welcome the department's approach in establishing the ward-based outreach teams which will go a long way in encouraging our people to present themselves very early in our health facilities.
We further welcome the step taken by the department to establish and strengthen health committees in each clinic and community health centre. This is a correct step because these formal structures will encourage community participation and should be used to mobilise our people to become active participants on issues affecting their health.
We wish, therefore, to call upon our people to take these opportunities and use them within the context of improving the health care delivery system with special focus on access, efficiency, quality and sustainability. I am raising this because it is a vital part of community involvement in health as they will act as a bridge between the community and health facilities. It will enable our community to engage government and participate in making sure that they monitor the extent to which the department is succeeding in achieving the universal health care coverage in order to improve the health outcomes, particularly focusing on the poor, vulnerable and the disadvantaged groups.
There is a challenge around the provision of health care to people living in farms and in deep rural areas. It is a matter that we need to look carefully into and come up with the best solutions on how we can ensure that the people living in farming communities in deep rural areas have equal access to health facilities, because in most instances services are not being provided in the same manner.
Let me conclude by quoting one of the former ANC Presidents, Chief Albert Luthuli, who once said, and I quote:
We must in our lifetime be able to change the Freedom Charter to read: ... All are enjoying equal rights! There are houses! There is security! There is comfort for all! There is peace and friendship! And, we must be able to say, Afrika isibuyile.
I thank you. [Applause.] [Interjections.]
The TEMPORARY CHAIRPERSON (Ms T C MEMELA): Hon members, order!
The MINISTER OF HEALTH
MR A F MAHLALELA
The MINISTER OF HEALTH: Chairperson, I would like to thank the hon members for their inputs in support of this Vote. I am standing here to commend the House and express my appreciation to those who supported the Vote of R33 955 475 000.
Allow me to deal with a few issues that were mentioned.
We agree with the hon chairperson of the portfolio committee regarding his concern about human resources. In fact, the World Health Organisation, WHO, has named the issue of human resources as one of the six building blocks or pillars of the health care system. We agree with you that human resource allocation has had several problems because, in quite a number of cases, it was done on a hit-and-miss basis. For the first time in the history of South Africa, we now have a Human Resources Development policy. This was launched officially in 2011. We are following it.
Secondly, the WHO has also recognised the anomaly of health workers around the world generally being allocated in terms of populations. Various documents, for example, will state that one doctor is needed for 10 000 people, or maybe one nurse is needed for whatever number of people. But we have realised that that formula does not help the world at all.
So the WHO has come up with a new formula called Work Indicator for Staffing Norms, WISN. It is a clear, applicable mathematical formula and we have been working with it for the past 18 months. I am happy to announce that we have completed all primary health care facilities. Having used this formula, it means we are now in a position to tell every primary health care facility how many nurses, clerks or pharmacists they need, and at what level they are needed. We now have the information on every type of health worker that is needed to run a primary health care facility.
We are currently doing the same with tertiary institutions. It is going to take us some time as tertiary institutions are very complex work places because of the myriad health workers needed there.
We have already spoken to the Minister of Finance and, once we have completed this process, we will present it to Treasury. At that time we will be the position to show what the health care human resources need is for the country.
Every province must vote for them. We are painfully aware, for instance, that there are provinces that just ignored or neglected the hiring of nurses. With WISN it will no longer be possible to do so because the human resource requirement will be put on the table and will show how many nurses are employed and how many are needed.
I am sure you are aware that the Department of Education is better because they are far advanced. I was an MEC for Education for many years, so I know. When I was in Education, we compiled a database over a long period of time – for over 20 years. That allowed us to know each and every school – its size, the number of learners enrolled, the number of teachers it needed, whether it should have a deputy principal, how many deputy principals, etc...
In Health, we never had that. Now, for the first time, WISN is going to give us that opportunity. So I want to assure you that, in terms of this formula, we will be able to tell any hospital in any province whether or not it has enough health workers, and whether it has to budget to fill those posts. We are looking forward to the day on which WISN will be implemented.
The second issue I want to deal with is the issue of cancer. We do have a cancer registry in South Africa. It is relatively new. The registry captures the epidemiology of the disease. There are a number of clinical research studies underway. These might not be widely known. The Medical Research Council is also funding a number of clinical research studies on cancer because we want scientifically proven methods. That is what we are looking for. But we must also realise that research has to be spread equitably among the diseases known as the quadruple burden of disease.
Hon James, we do agree with your observation and the research you mentioned about primary health care. I want to assure the House that the country cannot run away from this issue. This issue of the transformation of primary health care is our historic mission. It is going to happen in two ways. Firstly, primary health care provision will be re-engineered as municipal ward-based primary health care teams. We already have 1 100 teams. We are now busy training 557 teams. Each team consists of six community health care workers led by a nurse. We are going to cover every municipal ward in the country in this way.
The second issue in which it is going to happen is on the issue... [Interjection.]
Yes, I was just checking the time because we have a bell in the NA that guides us. We are at a disadvantage here because we are not really guided, so we keep on looking for guidance!
I just want to brief this House on the second way in which this transformation is going to happen. During the state of the nation address, the President mentioned something called Big Fast Results. Big Fast Results is going to be implemented in the Health environment as we are sufficiently advanced to do so. Maybe people might not have understood what that meant. What does it mean? Big Fast Results is a Malaysian system that argues that every policy in government, anywhere in the world, no matter how good it is, usually exists at 30 000 feet from the people. If it is not brought down from there it will never be implemented. So this system brings initiatives down to the three-foot level. The mindset is, pull it down from there and put it here.
We have agreed that we are going to implement this policy in South Africa. We will start this year on what is called an ideal clinic. What you do is you create what is called a laboratory. Then you put a certain number of people in the laboratory for eight weeks. They never get out of that laboratory during that time. They must work on that system.
Now, for Health we are going to get about 80 people to sit in that laboratory for eight weeks. They come from Health, Public Works, Finance, and from every department that is needed to deal with the work, even the private sector. They are going to be put in there. We are going to give them one job, which is to work on the model of an ideal clinic. They must determine what a clinic should look like in South Africa in terms of its administration, treatments, resources, equipment, etc.... What should it look like? They must work on it from a budget perspective, through the human capital needs, right up to the end and say what the ideal clinic would look like.
We have already defined it. The ideal clinic consists of 10 components and 184 elements that are needed in them. These elements range from the provision of human resources, electricity, water, sanitation, and security, to pharmaceuticals, waste management, and everything else.
So, when these people get out of the laboratory – and it is going to happen this year – they will hand over a plan with a budget detailing everything. Until they come up with that plan, they will never get out of that laboratory. And then we start implementing.
This must be made public. South Africans must know what a clinic should look like. The plan must even include the direction boards to the clinic as well as the board at the gate. In the rural villages where I come from, you won't see a sign pointing to the clinic. Villagers will direct you via a bottle store or a lounge in one corner of the... [Laughter.]
Yes, it's the one that defines where the clinic is!
Under the ideal clinic method, even the board at the road which points to the clinic is specified, and when you arrive at the clinic you will know that it is the clinic because you would have been given a copy of the model of what an ideal clinic must look like. In that way primary health care will start flourishing in our country. Thank you.
Debate concluded.
The Committee rose at 12:33.
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